（附∶白喉案 瘀后案）
杨左 风温疫疠之邪，引动肝胆之火，蕴袭肺胃两经，发为喉痧。痧布隐隐，身热，咽喉肿红 痛，内关
白腐，舌苔薄黄，脉象郁滑而数。天气通于鼻，地气通于口，口鼻吸受天地不正之气，与肺胃蕴伏之热，熏蒸
上中二焦。咽喉为肺胃之门户，肺胃有热，所以咽喉肿痛，而内关白腐也。邪势正在鸱张之际，虑其增剧。经
云∶风淫于内，治以辛凉，此其候也。
净蝉衣（八分） 苦桔梗（一钱） 金银花（三钱） 京赤芍（二钱） 荆芥穗（八分） 甜苦甘草（各六分） 连
翘壳（三钱） 鲜竹叶（三十张） 淡豆豉（三钱） 轻马勃（一钱） 象贝母（三钱） 白茅根（二扎） 薄荷叶（八
分） 黑山栀（一钱五分） 炙僵蚕（三钱）
二诊 痧虽布，身灼热不退，咽喉肿痛白腐，脉洪数，舌绛。伏温化热，蕴蒸阳明，由气入营，销烁阴
液，厥少之火，乘势上亢。症势沉重，急宜气血双清，而解疫毒。
犀角尖（五分） 甘中黄（八分） 象贝母（三钱） 鲜竹叶（三十张） 鲜生地（四钱） 苦桔梗（一钱）
连翘壳（三钱） 茅芦根（去心节，各一两） 生石膏（打，四钱） 轻马勃（一钱） 黑山栀（一钱五分）
鲜石斛（三钱） 粉丹皮（一钱五分） 陈金汁（一两） 枇杷叶露（冲，四两）
三诊 痧己回，身热不退，项颈漫肿疼痛，咽喉 肿，内关白腐，舌薄黄，脉沉数。温邪伏热，稽留肺胃
两经，血凝毒滞，肝胆火炽，一波未平，一波又起，殊属棘手，宜清肺胃之伏热，解疫疠之蕴毒。
薄荷叶（八分） 甘中黄（八分） 京赤芍（二钱） 鲜竹叶茹（各一钱五分） 京玄参（二钱） 苦桔梗（一钱）
生蒲黄（包，三钱） 黑山栀（一钱五分） 连翘壳（三钱） 炙僵蚕（三钱） 淡豆豉（三钱） 象贝母（三钱）
益母草（三钱） 活芦根（去节，一尺）
李左 疫疠之邪，不外达而内传，心肝之火内炽，化火入营，伤阴劫津。拟犀角地黄合麻杏石甘汤，气血
双清而解疫毒。
犀角尖（五分） 熟石膏（打，五钱） 金银花（三钱） 活芦根（去节，一尺） 鲜生地（四钱）
甘中黄（八分） 连翘壳（三钱） 鲜竹叶（三十张） 净麻黄（四分） 苦桔梗（一钱） 川贝母（三钱）
陈金汁（冲，一两） 光杏仁（三钱） 京赤芍（二钱） 京玄参（二钱）
陈左 温邪疫疠，郁而化火，肺胃被其熏蒸，心肝之火内炽，白喉腐烂 痛，妨于咽饮，壮热烦躁，脉洪
数，舌质红苔黄。经云∶热淫于内，治以咸寒，当进咸寒解毒，清温泄热。
犀角尖（四分） 甘中黄（八分） 连翘壳（三钱） 京玄参（一钱五分） 鲜生地（三钱） 淡豆豉（三钱）
京赤芍（一钱五分） 大贝母（三钱） 天花粉（三钱） 薄荷炭（七分） 金银花（三钱） 生石膏（打，三钱）
鲜竹叶（三十张） 白茅根（去心，两扎）
王右 吸受时气，引动伏邪，蕴袭肺胃两经。肺主皮毛，胃主肌肉，邪留皮毛肌肉之间，则发为红痧。痧
点隐隐，布而不透，形寒发热，胸闷泛恶，邪郁阳明，不得外达也。舌苔薄黄，脉象浮滑而数。邪势正在鸱张，
虑其增剧。宜以辛凉清解。
荆芥穗（一钱） 赤茯苓（三钱） 净蝉衣（八分） 炒竹茹（一钱五分） 淡豆豉（三钱） 江枳壳（一钱）
连翘壳（三钱） 熟牛蒡（二钱） 薄荷叶（八分） 苦桔梗（一钱） 京赤芍（二钱）
项童 痧后肺有伏邪，痰气壅塞，脾有湿热，不能健运，积湿生水，泛滥横溢，无处不到，以致面目虚浮，
腹膨肢肿，咳嗽气逆，苔薄腻，脉濡滑，势成肿胀重症。姑宜肃运分消，顺气化痰。
嫩前胡（一钱五分） 猪苓（三钱） 生熟苡仁（各三钱） 炙桑皮（三钱） 光杏仁（三钱） 大腹皮（二钱）
地枯萝（三钱） 旋复花（包，一钱五分） 清炙枇杷叶（去毛、包，三钱） 象贝母（三钱） 广陈皮（一钱）
枯碧竹（一钱五分） 鲜冬瓜皮（一两，煎汤代水） 连皮苓（四钱） 福泽泻（三钱）
李左 痧后余邪痰热未楚，肺胃两病，身热无汗，咳嗽气逆，口干欲饮，脉数苔黄。此乃无形之伏温，蕴
蒸阳明，有形之痰热，逗留肺络，症势沉重。姑拟清解伏温，而化痰热。
粉葛根（一钱五分） 金银花（三钱） 桑叶皮（各二钱） 活芦根（去节，一尺） 淡豆豉（三钱）
连翘壳（三钱） 光杏仁（三钱） 京赤芍（二钱） 黑山栀（一钱五分） 生甘草（八分） 象贝母（三钱）
鲜竹茹（二钱） 天花粉（三钱） 薄荷叶（八分）
[Appendix: Diphtheria Case, Post-Scarlet Fever Case]
Patient Yang (Left): The pathogenic factors of wind-warmth and epidemic pestilence stirred up the fire of the Liver and Gallbladder, accumulating and invading the Lung and Stomach meridians, manifesting as throat scarlet fever (an acute infectious disease characterized by sore throat and skin eruption). The scarlet spots are faintly visible, accompanied by fever, redness, swelling, and pain in the throat, with white putrid membranes on the inner Guan area. The tongue coating is thin and yellow, and the pulse is stagnant, slippery, and rapid. Heaven's Qi connects to the nose, and Earth's Qi connects to the mouth; inhaling impure Qi from heaven and earth through the mouth and nose interacts with the latent heat in the Lung and Stomach, steaming and affecting the Upper and Middle Jiao. The throat is the gateway of the Lung and Stomach; heat in these organs causes sore throat, swelling, and white putrid membranes on the inner Guan. The pathogenic force is currently rampant, raising concern for exacerbation. As stated in the Classics: "When wind invades internally, treat it with acrid-cool substances." This case fits this pattern.
Prescription: Cicada Slough (8 fen), Bitter Platycodon Root (1 qian), Honeysuckle Flower (3 qian), Red Peony Root from Jing (2 qian), Schizonepeta Spike (8 fen), Sweet and Bitter Licorice Root (6 fen each), Forsythia Fruit (3 qian), Fresh Bamboo Leaves (30 sheets), Fermented Soybean (3 qian), Light Mop Head Lichen (1 qian), Fritillaria Thunbergii Bulb (3 qian), White Imperata Rhizome (2 bundles), Mint Leaf (8 fen), Gardenia Fruit (1.5 qian), Processed Silkworm (3 qian).
Second Visit: Although the rash has erupted, the burning fever persists. Sore throat, swelling, and white putrid membranes remain. The pulse is surging and rapid, and the tongue is crimson. Latent warmth transforms into heat, steaming in the Yangming channel, moving from the Qi level to the Ying (Nutrient) level, consuming Yin fluids. Fire from the Jueyin and Shaoyin channels rises aggressively due to the momentum. The condition is severe; urgent treatment requires clearing both Qi and Ying levels to resolve the epidemic toxin.
Prescription: Rhinoceros Horn Tip (5 fen), Gan Zhong Huang (8 fen), Fritillaria Thunbergii Bulb (3 qian), Fresh Bamboo Leaves (30 sheets), Fresh Rehmannia Root (4 qian), Bitter Platycodon Root (1 qian), Forsythia Fruit (3 qian), Imperata and Arundo Rhizomes (heart and nodes removed, 1 liang each), Raw Gypsum (crushed, 4 qian), Light Mop Head Lichen (1 qian), Gardenia Fruit (1.5 qian), Fresh Dendrobium Stem (3 qian), Moutan Cortex (1.5 qian), Chen Jin Zhi (1 liang), Loquat Leaf Dew (taken with liquid, 4 liang).
Third Visit: The rash has receded, but fever persists. There is diffuse swelling and pain in the neck and jaw area, throat swelling, and persistent white putrid membranes on the inner Guan. The tongue coating is thin and yellow, and the pulse is deep and rapid. Warm pathogens and latent heat linger in the Lung and Stomach meridians. Blood stasis and toxic stagnation occur, with blazing fire in the Liver and Gallbladder. One wave subsides only for another to rise, making the case particularly tricky. Treatment should clear latent heat in the Lung and Stomach and resolve the accumulated toxicity of epidemic pestilence.
Prescription: Mint Leaf (8 fen), Gan Zhong Huang (8 fen), Red Peony Root from Jing (2 qian), Fresh Bamboo Leaf and Sheath (1.5 fen each), Scrophularia Root from Jing (2 qian), Bitter Platycodon Root (1 qian), Raw Cuscuta Seed/Pollen (wrapped, 3 qian), Gardenia Fruit (1.5 qian), Forsythia Fruit (3 qian), Processed Silkworm (3 qian), Fermented Soybean (3 qian), Fritillaria Thunbergii Bulb (3 qian), Motherwort Herb (3 qian), Live Arundo Root (nodes removed, 1 chi).
Patient Li (Left): The epidemic pestilence pathogen fails to reach the exterior and instead transmits inward. Fire in the Heart and Liver blazes internally, transforming into fire that enters the Ying level, damaging Yin and depleting fluids. Prescribe Xi Jiao Di Huang Tang combined with Ma Xing Shi Gan Tang to clear Qi and Ying levels and resolve the epidemic toxin.
Prescription: Rhinoceros Horn Tip (5 fen), Calcined Gypsum (crushed, 5 qian), Honeysuckle Flower (3 qian), Live Arundo Root (nodes removed, 1 chi), Fresh Rehmannia Root (4 qian), Gan Zhong Huang (8 fen), Forsythia Fruit (3 qian), Fresh Bamboo Leaves (30 sheets), Clean Ephedra Herb (4 fen), Bitter Platycodon Root (1 qian), Sichuan Fritillaria Bulb (3 qian), Chen Jin Zhi (taken with liquid, 1 liang), Apricot Seed (3 qian), Red Peony Root from Jing (2 qian), Scrophularia Root from Jing (2 qian).
Patient Chen (Left): Warm pathogens and epidemic pestilence stagnate and transform into fire, steaming the Lung and Stomach. Fire in the Heart and Liver blazes internally, causing diphtheria with rotting and painful ulcers, obstructing swallowing and drinking. Symptoms include high fever, restlessness, surging and rapid pulse, red tongue body with yellow coating. The Classics state: "When heat invades internally, treat it with salty-cold substances." Administer salty-cold detoxifying agents to clear warmth and drain heat.
Prescription: Rhinoceros Horn Tip (4 fen), Gan Zhong Huang (8 fen), Forsythia Fruit (3 qian), Scrophularia Root from Jing (1.5 qian), Fresh Rehmannia Root (3 qian), Fermented Soybean (3 qian), Red Peony Root from Jing (1.5 qian), Large Fritillaria Bulb (3 qian), Trichosanthes Root (3 qian), Charred Mint Leaf (7 fen), Honeysuckle Flower (3 qian), Raw Gypsum (crushed, 3 qian), Fresh Bamboo Leaves (30 sheets), White Imperata Rhizome (heart removed, 2 bundles).
Patient Wang (Right): Inhalation of seasonal Qi stirs up latent pathogens, accumulating and invading the Lung and Stomach meridians. The Lung governs skin and hair, and the Stomach governs muscles. Pathogens remaining between the skin/hair and muscles manifest as red scarlet fever. The red spots are faintly visible but not fully erupted. Chills and fever, chest fullness, and nausea occur because pathogens are stagnated in the Yangming channel and cannot reach the exterior. Tongue coating is thin and yellow; pulse is floating, slippery, and rapid. The pathogenic force is rampant, raising concern for exacerbation. Use acrid-cool clearing and resolving methods.
Prescription: Schizonepeta Spike (1 qian), Red Poria (3 qian), Cicada Slough (8 fen), Stir-fried Bamboo Shavings (1.5 qian), Fermented Soybean (3 qian), Amomum Fruit from Jiang (1 qian), Forsythia Fruit (3 qian), Prepared Burr Medicinal Fruit (2 qian), Mint Leaf (8 fen), Bitter Platycodon Root (1 qian), Red Peony Root from Jing (2 qian).
Child Xiang: After scarlet fever, latent pathogens remain in the Lung, causing phlegm and Qi obstruction. Damp-heat exists in the Spleen, impairing transportation. Accumulated dampness generates water, overflowing everywhere, leading to puffy face and eyes, abdominal distension, limb edema, cough, and rebellious Qi. Tongue coating is thin and greasy; pulse is soggy and slippery. The condition threatens severe edema. Temporarily use lung-salvaging and spleen-moving methods to separate and eliminate dampness, regulating Qi and resolving phlegm.
Prescription: Young Peucedanum Root (1.5 qian), Polyporus (3 qian), Raw and Processed Coix Seed (3 qian each), Processed Mulberry Root Bark (3 qian), Apricot Seed (3 qian), Areca Peel (2 qian), Radish Root (3 qian), Inula Flower (wrapped, 1.5 qian), Clear Processed Loquat Leaf (de-haired, wrapped, 3 qian), Fritillaria Thunbergii Bulb (3 qian), Broad Tangerine Peel (1 qian), Dried Bamboo Tube (1.5 qian), Fresh Winter Melon Peel (1 liang, decocted as water substitute), Poria with Skin (4 qian), Alisma Rhizome (3 qian).
Patient Li (Left): Residual pathogens, phlegm, and heat remain unclarified after scarlet fever. Both Lung and Stomach are diseased. Symptoms include fever without sweat, cough with rebellious Qi, dry mouth with desire to drink, rapid pulse, and yellow coating. This involves formless latent warmth steaming in Yangming, and有形 (formable) phlegm-heat lingering in the Lung collaterals. The condition is severe. Temporarily prescribe clearing and resolving latent warmth while resolving phlegm-heat.
Prescription: Kudzu Root (1.5 qian), Honeysuckle Flower (3 qian), Mulberry Leaf and Twig (2 qian each), Live Arundo Root (nodes removed, 1 chi), Fermented Soybean (3 qian), Forsythia Fruit (3 qian), Apricot Seed (3 qian), Red Peony Root from Jing (2 qian), Gardenia Fruit (1.5 qian), Raw Licorice Root (8 fen), Fritillaria Thunbergii Bulb (3 qian), Fresh Bamboo Shavings (2 qian), Trichosanthes Root (3 qian), Mint Leaf (8 fen).