计左 暑温一候，发热有汗不解，口渴欲饮，胸闷气粗，入夜烦躁，梦语如谵，小溲短赤，舌苔薄黄，脉象
濡数。暑邪湿热，蕴蒸阳明，漫布三焦，经所谓因于暑烦则喘喝，静则多言是也。颇虑暑热逆传厥阴，
至有昏厥之变。
清水豆卷（四钱） 青蒿梗（一钱五分） 天花粉（三钱） 朱茯神（三钱） 通草（八分） 黑山栀
（一钱五分） 带心连翘（三钱） 益元散（包，三钱） 青荷梗（一支） 竹叶心（三钱） 郁金（一钱五分）
万氏牛黄清心丸（一粒）
二诊 暑温九天，汗多发热不解，烦闷谵语，口渴欲饮，舌边红苔黄，脉象濡数，右部洪滑。良由暑湿化
热，蕴蒸阳明之里，阳明者胃也，胃之支脉，贯络心包，胃热上蒸心包，扰乱神明，故神烦而谵语也。恙势正在
鸱张，还虑增剧，今拟竹叶石膏汤加味。
生石膏（五钱） 茯苓（三钱） 郁金（一钱五分） 仙半夏（一钱五分） 通草（八分） 竺黄（二钱）
鲜竹叶心（三钱） 益元散（包，三钱） 鲜石菖蒲（五分） 白茅根（去心，三钱） 荷梗（一支） 万氏牛
黄清心丸（一粒）
三诊 神识渐清，壮热亦减，原方去石膏、牛黄清心丸，加连翘心、花粉、芦根。
方左 长夏酷热，炎威逼人，经商劳碌，赤日中暑。暑热吸受，痰浊内阻，心包被蒙，清阳失旷，以致忽然跌
仆，不省人事，牙关紧闭，肢冷脉伏。暑遏热郁，气机闭塞，脉道为之不利，中暑重症，即热深厥深是也。急拟
清暑开窍，宣气涤痰，以冀挽回。
薄荷叶（八分） 净银花（三钱） 连翘壳（三钱） 碧玉散（包，四钱） 广郁金（一钱五分） 川贝母（三
钱） 天竺黄（二钱） 枳实炭（三钱） 炒竹茹（一钱五分） 鲜石菖蒲（一钱） 西瓜翠衣（三钱）
另苏合香丸（研冲，一粒） 淡竹沥（冲，五钱）
二诊 服清暑开窍、宣气涤痰之剂，神识已清，牙关亦开，伏脉渐起，而转为身热头胀，口干不多饮，胸闷
不能食，舌苔薄黄，暑热有外达之机，暑必夹湿，湿热蕴蒸，有转入阳明之象。今拟清解宣化，以善其后。
炒香豉（三钱） 薄荷（八分） 银花（三钱） 桑叶（三钱） 菊花（三钱） 郁金（一钱） 黑山栀（一钱
五分） 连翘（一钱五分） 枳实（一钱五分） 竹茹叶（各一钱五分） 六一散（包，三钱） 川贝（三钱）
西瓜翠衣（四钱）
谢右 秋凉引动伏暑，夹湿滞内阻，太阳阳明为病，寒热无汗，头胀且痛，胸痞泛恶，苔薄腻，脉濡数，邪
滞互郁，胃气不得下降也。亟宜疏透伏邪，而化湿滞，以冀邪从外达，湿滞内化，不致增剧乃佳。
豆豉（三钱） 前胡（一钱五分） 半夏（三钱） 六曲（三钱） 薄荷（八分） 竹茹（一钱五分）
香薷（五分） 山栀（一钱） 桔梗
（八分） 鲜藿香（一钱五分） 鲜佩兰（一钱五分） 荷叶（一角） 炒枳实（一钱）
钱右 外受风凉，内蕴伏暑，暑必夹湿，湿与滞阻，阳明为病，发热恶寒，胸痞泛恶，头胀且痛，遍体酸
楚，舌苔腻布，脉象濡数，邪势鸱张，非易速解。拟黄连香薷饮加减。
陈香薷（五分） 淡豆豉（三钱） 六神曲（三钱） 姜川连（四分） 炒枳实（一钱五分） 姜竹茹
（一钱五分） 制川朴（八分） 仙半夏（一钱五分） 鲜藿香（一钱五分） 鲜佩兰（一钱五分） 玉枢丹（冲服，
三分）
李童 暑温十天，身热汗出不彻，渴不多饮，胸脘烦闷，口有甜味，苔薄腻黄，脉濡数。暑必夹湿，伏于募
原，既不能从阳明而解，亦不能从下焦而去，势有欲发白 之象。暑湿为粘腻之邪，最为缠绵。
香薷（八分） 青蒿梗（一钱五分） 净蝉衣（八分） 江枳壳（一钱五分） 通草（八分） 川连（三分）
清水豆卷（三钱） 炒牛蒡（二钱） 郁金（一钱五分） 赤苓（三钱） 鲜藿香（一钱五分） 鲜佩兰（一钱五分）
甘露消毒丹（包，三钱）
荣左 伏暑秋温，发热两候，早轻暮重，烦躁不寐，梦语如谵，鼻衄痰红，口干欲饮，大便溏薄色黄，汗泄不
多，舌质红苔黄。此伏暑化热，蕴蒸阳明之里。阳明者胃也，胃络上通心包，胃热上蒙清窍，心神不得安宁，故
烦躁少寐，梦语如谵也。鼻衄虽曰红汗，究属热迫营分，逼血而妄行也。脉象左弦数，右滑数。参脉合证，
阴液暗伤，邪热猖獗，颇虑传入厥阴，致神昏痉厥之险。急宜甘寒生津，清解伏暑，冀营分之热，能得从气分而
解为幸。
天花粉（三钱） 朱茯神（三钱） 粉葛根（一钱五分） 鲜竹茹（二钱） 益元散（包，三钱）
金银花（五钱） 酒炒黄芩（一钱） 冬桑叶（二钱） 连翘壳（三钱） 川雅连（五分） 白茅根（去心，三扎）
二诊 昨投清温生津之剂，身热略减，夜寐稍安，鼻衄亦止，而口干欲饮，胸闷懊 ，难以名状，汗泄不
多，舌质红，苔黄，脉数依然，良由暑温之热，仍在阳明之里，未能达到气分，势欲蒸发白 之象，阴液暗伤，无
作汗之数据，还虑增剧。温邪有汗而再汗之例，仍宜甘寒生津，解肌清温，冀望正胜邪却，始能入于坦途。
天花粉（三钱） 粉葛根（五钱） 粉丹皮（二钱） 鲜石斛（三钱） 清水豆卷（四钱） 鸡苏散（包，三钱）
熟石膏（打，三钱） 冬桑叶（二钱） 连翘壳（三钱） 鲜竹叶（三十张） 活芦根
（去节，一尺） 北秫米（包，三钱）
三诊 连进生津清温，服后热势反增。渴欲引饮，饮后得汗甚畅。白 布于胸腹之间，至天明时热势始
减，胸闷渐舒，脉数稍和，即是正胜邪却之机。既已获效，仍守原法扩充。
天花粉（三钱） 生甘草（六分） 连翘壳（三钱） 鲜石斛（三钱） 嫩白薇（一钱五分） 生石膏（打，
三钱） 仙半夏（一钱五分） 川贝母（二钱） 通草（八分） 鲜竹叶（三十片） 白茅根（去心，两扎）
北秫米（包，三钱）
四诊 身热大减，汗泄溱溱，白 密布腹脐之间，伏暑湿热已得外达。惟咳痰带红，睡醒后口舌干燥，神
疲肢倦，小溲频数不爽，溺时管痛，脉象濡数不静，舌质淡红，此阴液已伤，木火易升，肺金化源受伤，不能下及
州都，阳明之蕴热，尚留恋为患也。仍拟竹叶石膏汤加减，生津液以滋化源，清阳明而息余焰。
西洋参（一钱五分） 朱茯神（三钱） 川通草（八分） 活芦根（去节，一尺） 生石膏（打，三钱）
川贝母（二钱） 粉丹皮（二钱） 北秫米（包，三钱） 鲜竹叶（三十张） 生甘草（六分） 天花粉（三钱）
冬桑叶（二钱） 滋肾通关丸（包煎，一钱五分）
五诊 身热已退，白 密布甚多，口舌干燥亦减，伏暑之热有整肃之渐，而小溲尚未爽利，咳痰色黄，脉
象濡数无力，舌淡红，肺胃余热留恋，气化不及州都也。仍拟甘寒生津，养胃清肺，以善其后。
西洋参（一钱五分） 朱茯神（三钱） 冬桑叶（二钱） 冬瓜子（三钱） 活芦根（去节，一尺）
生甘草（八分） 川贝母（三钱） 粉丹皮（一钱五分） 北秫米（包，三钱） 金石斛（二钱） 栝蒌皮（三钱）
嫩白薇（一钱五分） 通天草（八分） 滋肾通关丸（包煎，一钱五分）
何女 秋温伏暑，延今三候，初起吐血衄血，继则身灼热无汗，热盛于夜，谵语妄言，口渴欲饮，七八日未
更衣，舌焦糙无津，唇色紫暗，脉象弦滑而数，红白疹虽现即隐，咳呛痰内带红，良由伏温由营及气，由里及表，
表未得汗，仍传于里，里热炽盛，少阴之阴液被劫，津无上承，阳明经热未得外解，腑中燥屎不得下行，腑热熏
蒸心包，神明无以自主，手指震动，肝风欲起，痉厥之变，即在目前矣。急拟生津解肌，下则存阴，表里两治，
以望转机。
鲜生地（六钱） 天花粉（三钱） 熟石膏（打，三钱） 川贝母（三钱） 茅芦根（去心节，各一两）
京玄参（三钱）
薄荷叶（八分） 生甘草（五分） 枳实炭（一钱） 鲜石斛（四钱） 粉葛根（一钱） 全栝蒌（切，四钱）
玄明粉（一钱五分，同捣） 鲜竹茹（二钱） 清宁丸（包，三钱）
二诊 投生津解肌，下则存阴之剂，已服两帖，微微得汗，腑垢已得下行，所下之垢，色紫黑甚畅，灼热略
衰，谵语亦减，而咳呛咯痰不出，痰内带红，耳聋失聪，口干欲饮，舌糙黑已减，脉尚弦数，唇焦而裂，此少阴阴
液已伤，阳明伏暑化热，灼津液而为痰，痰阻肺络，清肃之令不行，木火升腾，扰犯清窍，虽有转机之兆，尚未敢
轻许无妨。今拟人参白虎汤合清营增液汤加减，清营凉气，肃肺化痰，能得精胜邪却，即可望出险入夷。
西洋参（一钱五分） 鲜生地（五钱） 肥知母（二钱） 连翘壳（三钱） 鲜竹叶（三十张） 生石膏（打，
四钱） 京玄参（三钱） 川贝母（三钱） 粉丹皮（二钱） 生甘草（八分） 鲜石斛（三钱） 朱茯神（三钱）
枳实炭（八分） 活芦根（去节，一尺）
三诊 人参白虎汤、清营增液汤又服二剂，灼热已减其半，神识亦清，舌焦黑已退，转为红绛，脉左弦数，
右濡滑而数，睡则惊悸，耳聋口渴，咳呛咯痰不爽，痰中夹血，津液有来复之渐，暑热有退避之势。余焰烁液为
痰，胶阻肺络，木火升腾，扰犯清空，合脉论证，已有出险入夷之佳象。再议生津泄热，清肺化痰。
西洋参（一钱五分） 肥知母（一钱五分） 冬桑叶（二钱） 朱茯神（三钱） 活芦根（去节，一尺）
生甘草（六分） 青蒿梗（一钱五分） 生石膏（打，三钱） 天花粉（三钱） 粉丹皮（二钱） 川贝母（三钱）
生石决（八钱） 嫩白薇（一钱五分） 鲜藕（切片入煎，四两）
四诊 身灼热已去七八，惟咳呛咯痰不爽，口渴不多饮，痰中之血，两日不见，耳鸣失聪，脉左弦小而数，
右濡滑而数，舌绛红，肾阴胃液难复，木火易于上升，余波未尽，肺金清肃之令不行，况值燥令，燥从火化，火
未有不克金也。再宜甘凉濡润，生津泄热，清肺化痰。
西洋参（一钱五分） 生甘草（八分） 水炙桑叶皮（各一钱五分） 生石决（八钱） 朱茯神（三钱）
天花粉（三钱） 肥知母（一钱五分） 粉丹皮（一钱五分） 嫩白薇（一钱五分） 北秫米（包，三钱）
冬瓜子（三钱） 活芦根（去节，一尺） 枇杷叶露（后入，四两）
茅童 温邪夹湿，发热十三天，汗泄不畅，口干欲饮，舌质红，罩薄腻，左脉弦数，右脉濡数。前医早进白
虎汤，致邪陷太阴，清气不升，大便溏薄，日夜十余次，小溲短赤，心烦少寐，热势加剧，病情非轻。拟解肌疏
邪，而理中土，仲圣谓里重于表者，先治其里，仿此意化
裁。
粉葛根（二钱） 炮姜炭（四分） 炒潞党（三钱） 生白术（二钱） 生甘草（五分） 赤苓（三钱）
金银花（三钱） 山楂炭（三钱） 炒车前子（包，三钱） 戊己丸（包，二钱） 鲜荷叶（一角）
二诊 昨进理中汤加减，大便溏泄渐止，而发热依然，口干欲饮，舌转红绛，脉象弦数，汗泄不通。此气分
之温未罢，营分之热内炽，湿化为燥，燥亦伤阴，津乏上承，今拟清营透气，兼顾中土。
天花粉（三钱） 炒银花（三钱） 赤苓（三钱） 冬桑叶（三钱） 煨葛根（一钱五分） 生白术（二钱）
粉丹皮（一钱五分） 扁豆衣（三钱） 生甘草（五分） 白薇（一钱五分） 鲜荷叶（一角） 白茅根（五钱）
三诊 昨进清营透气，兼顾中土之剂，身热渐减，又见鼻红，虽曰红汗，究属热遏营分，逼血上行。舌红
绛，脉弦数不静，阴分已伤，肝火内炽，湿从燥化，阳明之温，尚未清彻也。既有效机，再进一筹出入。
鲜生地（三钱） 炒银花（三钱） 赤苓（三钱） 桑叶（三钱） 天花粉（二钱） 生白术（二钱）
粉丹皮（一钱五分） 川贝（二钱） 生甘草（五分） 白薇（一钱五分） 炒扁豆衣（三钱） 北秫米（包，三钱）
鲜荷叶（一角） 茅根（去心，五钱）
陈左 湿温已延月余，潮热时轻时剧，渴喜热饮。白 亦布，谵语郑声，小溲浑赤，脉象虚滑而数，舌质红
润，唇燥，此乃气阴已伤，伏邪湿热留恋阳明，上蒙清窍，神明无以自主也，脉证参合，已入危险一途。亟宜
扶正宣邪，苦化湿热，以望转机。
党参（三钱） 朱茯神（三钱） 川雅连（三分） 川贝母（三钱） 银柴胡（一钱） 炙远志肉（五分）
细木通（五分） 天竺黄（二钱） 白薇（一钱五分） 紫贝齿（三钱） 仙半夏（一钱五分） 北秫米（包，三钱）
益元散（包，三钱）
[Patient Ji] Summer-heat warm disease has persisted for one week. There is fever with sweating, but the heat does not resolve; there is thirst with desire to drink, chest tightness and coarse breathing. At night, there is restlessness and dream-talk resembling delirium. Urine is short and red. The tongue coating is thin and yellow, and the pulse is soggy and rapid. This is summer-heat pathogen combined with damp-heat, accumulating and steaming in the Yangming channel, spreading diffusely through the Triple Burner. As stated in the classics: "Affected by summer-heat, when agitated, there is panting and drinking; when quiet, there is much talking." I am quite concerned that the summer-heat heat may transmit reversely to the Jueyin channel, leading to the complication of coma and syncope.
Qingshui Doujuan (Taro Bean Sprouts) 4 qian; Qinghao Geng (Artemisia Annua Stem) 1.5 qian; Tianhuafen (Trichosanthes Root) 3 qian; Zhu Fushen (Poria with Agarwood) 3 qian; Tongcao (Akebia Stem) 0.8 qian; Heishanzhi (Gardenia Fruit) 1.5 qian; Daixin Liaoqiao (Forsythia Fruit with Heart) 3 qian; Yiyuan San (Houttuynia Powder) wrapped, 3 qian; Qinghe Geng (Lotus Stem) 1 piece; Zhuye Xin (Bamboo Leaf Heart) 3 qian; Yujin (Curcuma Tuber) 1.5 qian.
Additionally, Wan's Niuhuang Qingxin Wan (Calculus Bovis Clear Heart Pill) 1 pill.
Second visit: Summer-heat warm disease for nine days. Profuse sweating and unresolved fever, irritability, oppression, and delirious speech. Thirst with desire to drink. The sides of the tongue are red with a yellow coating. The pulse is soggy and rapid, with the right side being surging and slippery. This is primarily due to summer-dampness transforming into heat, accumulating and steaming in the interior of Yangming. Yangming refers to the Stomach. The collateral vessels of the Stomach penetrate and connect to the Pericardium. Heat from the Stomach steams upward to disturb the Pericardium, disturbing the Spirit, hence the mental agitation and delirious speech. The condition is currently rampant, and I fear it may worsen. I now propose modified Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction).
Sheng Shigao (Raw Gypsum) 5 qian; Fuling (Poria) 3 qian; Yujin (Curcuma Tuber) 1.5 qian; Xian Banxia (Pinellia Tuber) 1.5 qian; Tongcao (Akebia Stem) 0.8 qian; Zhuhu (Nepal Star Apple Seed) 2 qian; Xian Zhuye Xin (Fresh Bamboo Leaf Heart) 3 qian; Yiyuan San (Houttuynia Powder) wrapped, 3 qian; Xian Shichangpu (Acorus Rhizome) 0.5 qian; Baimaogen (Imperata Rhizome) peeled, 3 qian; Hegeng (Lotus Stem) 1 piece.
Additionally, Wan's Niuhuang Qingxin Wan (Calculus Bovis Clear Heart Pill) 1 pill.
Third visit: Consciousness is gradually clearing, and high fever has subsided. Remove Shigao (Gypsum) and Niuhuang Qingxin Wan (Calculus Bovis Clear Heart Pill) from the original prescription; add Liaoqiao Xin (Forsythia Fruit Heart), Tianhuafen (Trichosanthes Root), and Lugeng (Reed Rhizome).
[Patient Fang] In late summer, the heat is酷烈 (severe), oppressive. Due to commercial labor, he suffered heatstroke under the scorching sun. Inhalation of summer-heat leads to internal obstruction by turbid phlegm. The Pericardium is covered/muddled, causing the Clear Yang to lose its expansion. Consequently, he suddenly fell, lost consciousness, had clenched jaws, cold limbs, and a hidden pulse. Summer-heat suppresses and heat stagnates, blocking Qi mechanism and impeding the pulse vessels. This is a severe case of heatstroke, known as "deep heat leads to deep cold extremities" (Re Shen Jue Shen). Urgently propose clearing summer-heat and opening orifices, promoting Qi circulation and eliminating phlegm, hoping to reverse the situation.
Bohe Ye (Mint Leaf) 0.8 qian; Jing Yinjin (Honeysuckle Flower) 3 qian; Liaoqiao Qiao (Forsythia Husk) 3 qian; Biyu San (Azurite Powder) wrapped, 4 qian; Guang Yujin (Curcuma Tuber) 1.5 qian; Chuan Beimu (Fritillaria Bulb) 3 qian; Tianzhuhuang (Nepal Star Apple Seed) 2 qian; Zhishi Tan (Immature Bitter Orange Charcoal) 3 qian; Chao Zhuru (Bamboo Shavings) 1.5 qian; Xian Shichangpu (Acorus Rhizome) 1 qian; Xigua Cuiyi (Watermelon Rind) 3 qian.
Separately, Suhe Xiang Wan (Styrax Pill) ground and taken with water, 1 pill; Dan Zhuli (Light Bamboo Sap) taken with water, 5 qian.
Second visit: After taking the summer-heat clearing and orifice-opening, Qi-promoting and phlegm-eliminating agents, consciousness has cleared, jaws have opened, and the hidden pulse has risen. However, there is now body heat and head distension, dry mouth with little desire to drink, chest oppression and inability to eat. The tongue coating is thin and yellow. This indicates that summer-heat has a tendency to reach the exterior. Summer-heat must be accompanied by dampness; damp-heat accumulates and steams, showing signs of transitioning to Yangming. Now propose clearing, resolving, promoting, and transforming methods to conclude the treatment.
Chao Xiangchi (Stir-fried Fermented Soybean) 3 qian; Bohe (Mint) 0.8 qian; Yinhua (Honeysuckle) 3 qian; Sangye (Mulberry Leaf) 3 qian; Juhua (Chrysanthemum) 3 qian; Yujin (Curcuma Tuber) 1 qian; Heishanzhi (Gardenia Fruit) 1.5 qian; Liaoqiao (Forsythia) 1.5 qian; Zhishi (Immature Bitter Orange) 1.5 qian; Zhuru Ye (Bamboo Shavings and Leaves) each 1.5 qian; Liuyi San (Six-to-One Powder) wrapped, 3 qian; Chuanbei (Fritillaria) 3 qian; Xigua Cuiyi (Watermelon Rind) 4 qian.
[Patient Xie] Autumn coolness triggers latent summer-heat, combined with internal damp-stagnation, affecting the Taiyang and Yangming channels. There are alternating chills and fever without sweating, head distension and pain, chest fullness and nausea. The tongue coating is thin and greasy, and the pulse is soggy and rapid. Pathogenic factors and stagnation mutually constrain, preventing Stomach Qi from descending. It is urgent to disperse and penetrate the latent pathogen and transform damp-stagnation, hoping for the pathogen to reach the exterior and damp-stagnation to transform internally, preventing worsening.
Douchi (Fermented Soybean) 3 qian; Qianhu (Peucedanum Root) 1.5 qian; Banxia (Pinellia Tuber) 3 qian; Liuqu (Medicated Leaven) 3 qian; Bohe (Mint) 0.8 qian; Zhuru (Bamboo Shavings) 1.5 qian; Xiangru (Elsholtzia Herb) 0.5 qian; Shanzhi (Gardenia Fruit) 1 qian; Jiegeng (Platycodon Root) 0.8 qian; Xian Huoxiang (Patchouli Herb) 1.5 qian; Xian Peilan (Aglaonema Herb) 1.5 qian; Heye (Lotus Leaf) 1 corner; Chao Zhishi (Immature Bitter Orange) 1 qian.
[Patient Qian] External exposure to wind-cold, internal accumulation of latent summer-heat. Summer-heat is invariably accompanied by dampness. Dampness and stagnation obstruct, affecting the Yangming channel. There is fever and aversion to cold, chest fullness and nausea, head distension and pain, generalized body soreness. The tongue coating is greasy, and the pulse is soggy and rapid. The pathogenic momentum is rampant and difficult to resolve quickly. Propose modified Huanglian Xiangru Yin (Coptis and Elsholtzia Decoction).
Chen Xiangru (Elsholtzia Herb) 0.5 qian; Dan Douchi (Light Fermented Soybean) 3 qian; Liushenqu (Six-God Medicated Leaven) 3 qian; Jiang Chuanlian (Coptis Rhizome fried with ginger) 0.4 qian; Chao Zhishi (Immature Bitter Orange) 1.5 qian; Jiang Zhuru (Bamboo Shavings fried with ginger) 1.5 qian; Zhi Chuanpo (Magnolia Bark processed) 0.8 qian; Xian Banxia (Pinellia Tuber) 1.5 qian; Xian Huoxiang (Patchouli Herb) 1.5 qian; Xian Peilan (Aglaonema Herb) 1.5 qian; Yushudan (Jade Seal Red Pill) taken with water, 0.3 qian.
[Child Li] Summer-heat warm disease for ten days. Body heat with incomplete sweating, thirst with little desire to drink, chest and epigastric oppression, sweet taste in the mouth. Tongue coating is thin, greasy, and yellow; pulse is soggy and rapid. Summer-heat is invariably accompanied by dampness, lying latent in the Moyuan (Diaphragmatic Origin). It cannot resolve via Yangming nor exit via the Lower Jiao. There is a tendency to develop Bai Fei (white miliary rash). Summer-dampness is a sticky and viscous pathogen, most lingering and persistent.
Xiangru (Elsholtzia Herb) 0.8 qian; Qinghao Geng (Artemisia Annua Stem) 1.5 qian; Jing Chan Yi (Cicada Slough) 0.8 qian; Jiang Zhike (Immature Bitter Orange) 1.5 qian; Tongcao (Akebia Stem) 0.8 qian; Chuanlian (Coptis Rhizome) 0.3 qian; Qingshui Doujuan (Taro Bean Sprouts) 3 qian; Chao Niuxi (Armed Magnolia Flower) 2 qian; Yujin (Curcuma Tuber) 1.5 qian; Chiling (Red Poria) 3 qian; Xian Huoxiang (Patchouli Herb) 1.5 qian; Xian Peilan (Aglaonema Herb) 1.5 qian.
Additionally, Ganlu Xiaodu Dan (Sweet Dew Detoxication Powder) wrapped, 3 qian.
[Patient Rong] Latent summer-heat and autumn-warmth. Fever for two weeks, lighter in the morning and heavier at night. Restlessness and insomnia, dream-talk resembling delirium, epistaxis and blood-streaked sputum, dry mouth with desire to drink, loose yellow stools, scant sweating. Tongue body is red with a yellow coating. This is latent summer-heat transforming into heat, accumulating and steaming in the interior of Yangming. Yangming refers to the Stomach. The Stomach collaterals connect upward to the Pericardium. Stomach heat steams upward to cover the clear orifices, preventing the Heart Spirit from finding peace, hence restlessness, sleeplessness, and delirious dream-talk. Although epistaxis is called "red sweat," it ultimately belongs to heat forcing the Ying (Nutrient) level, compelling blood to flow recklessly. The pulse is wiry and rapid on the left, and slippery and rapid on the right. Combining pulse and symptoms, Yin fluids are secretly damaged, and pathogenic heat is rampant. I fear transmission to the Jueyin channel, leading to the danger of coma and convulsions. Urgently propose sweet-cold generating fluids and clearing latent summer-heat, hoping that Ying-level heat can be resolved via the Qi level.
Tianhuafen (Trichosanthes Root) 3 qian; Zhu Fushen (Poria with Agarwood) 3 qian; Fen Gegen (Kudzu Root) 1.5 qian; Xian Zhuru (Fresh Bamboo Shavings) 2 qian; Yiyuan San (Houttuynia Powder) wrapped, 3 qian; Jinyinhua (Honeysuckle Flower) 5 qian; Jiuchao Huangqin (Scutellaria Root wine-fried) 1 qian; Dong Sangye (Winter Mulberry Leaf) 2 qian; Liaoqiao Qiao (Forsythia Husk) 3 qian; Chuan Yalian (Coptis Rhizome) 0.5 qian; Baimaogen (Imperata Rhizome) peeled, 3 bundles.
Second visit: Yesterday, administering clearing-warmth and generating-fluid agents slightly reduced body heat, allowed slightly better sleep at night, and stopped epistaxis. However, there is still dry mouth with desire to drink, chest oppression and anguish indescribable, scant sweating. Tongue body is red, coating yellow, and pulse remains rapid. This is because the heat of summer-warmth is still in the interior of Yangming and has not reached the Qi level. There is a tendency to evaporate Bai Fei (white miliary rash). Yin fluids are secretly damaged, lacking sufficient data (fluids) to produce sweat. I still fear worsening. There is a precedent in warm diseases of "sweating again after sweating." Still appropriate to use sweet-cold generating fluids, releasing the muscle layer and clearing warmth, hoping for righteous Qi to overcome pathogenic factors, thus entering a smooth path.
Tianhuafen (Trichosanthes Root) 3 qian; Fen Gegen (Kudzu Root) 5 qian; Fen Danpi (Moutan Cortex) 2 qian; Xian Shihu (Dendrobium Stem) 3 qian; Qingshui Doujuan (Taro Bean Sprouts) 4 qian; Jisu San (Elsholtzia Powder) wrapped, 3 qian; Shu Shigao (Calcined Gypsum) crushed, 3 qian; Dong Sangye (Winter Mulberry Leaf) 2 qian; Liaoqiao Qiao (Forsythia Husk) 3 qian; Xian Zhuye (Fresh Bamboo Leaf) 30 leaves; Huo Lugeng (Living Reed Rhizome) unjointed, 1 chi; Beishumi (Broomcorn Millet) wrapped, 3 qian.
Third visit: Continuously administering fluid-generating and warmth-clearing agents. After ingestion, heat intensity反而 (instead) increased. Thirst with desire to drink large amounts. After drinking, sweating was very profuse. Bai Fei (white miliary rash) spread between the chest and abdomen. By dawn, heat intensity began to subside, chest oppression gradually relieved, and pulse rate became slightly harmonious. This is the sign of righteous Qi overcoming pathogenic factors. Since efficacy has been achieved, still adhere to the original method and expand upon it.
Tianhuafen (Trichosanthes Root) 3 qian; Sheng Gancao (Raw Licorice Root) 0.6 qian; Liaoqiao Qiao (Forsythia Husk) 3 qian; Xian Shihu (Dendrobium Stem) 3 qian; Nen Baiwei (Smilax Glabra Rhizome) 1.5 qian; Sheng Shigao (Raw Gypsum) crushed, 3 qian; Xian Banxia (Pinellia Tuber) 1.5 qian; Chuan Beimu (Fritillaria Bulb) 2 qian; Tongcao (Akebia Stem) 0.8 qian; Xian Zhuye (Fresh Bamboo Leaf) 30 leaves; Baimaogen (Imperata Rhizome) peeled, 2 bundles; Beishumi (Broomcorn Millet) wrapped, 3 qian.
Fourth visit: Body heat greatly reduced, sweating profuse. Bai Fei (white miliary rash) densely distributed between the abdomen and navel. Latent summer-heat and damp-heat have reached the exterior. Only cough with blood-streaked sputum, dry mouth and tongue upon waking, mental fatigue and limb weakness, frequent and unsatisfactory urination with burning pain during urination. Pulse is soggy and rapid, restless. Tongue body is pale red. This indicates Yin fluids are damaged, Liver Fire easily ascends, Lung Metal source of transformation is injured, unable to descend to the Zhou Du (Bladder). Residual heat in Yangming lingers as a nuisance. Still propose modified Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) to generate fluids and nourish the source, clear Yangming and extinguish remaining flames.
Xiyangshen (American Ginseng) 1.5 qian; Zhu Fushen (Poria with Agarwood) 3 qian; Chuan Tongcao (Akebia Stem) 0.8 qian; Huo Lugeng (Living Reed Rhizome) unjointed, 1 chi; Sheng Shigao (Raw Gypsum) crushed, 3 qian; Chuan Beimu (Fritillaria Bulb) 2 qian; Fen Danpi (Moutan Cortex) 2 qian; Beishumi (Broomcorn Millet) wrapped, 3 qian; Xian Zhuye (Fresh Bamboo Leaf) 30 leaves; Sheng Gancao (Raw Licorice Root) 0.6 qian; Tianhuafen (Trichosanthes Root) 3 qian; Dong Sangye (Winter Mulberry Leaf) 2 qian; Zishen Tongguan Wan (Kidney-Nourishing Passage-Regulating Pill) wrapped and decocted, 1.5 qian.
Fifth visit: Body heat has receded, Bai Fei (white miliary rash) is densely distributed and abundant. Dry mouth and tongue have also decreased. The heat of latent summer-heat shows signs of orderly resolution. However, urination is not yet smooth. Cough produces yellow sputum. Pulse is soggy, rapid, and weak. Tongue is pale red. Residual heat in Lung and Stomach lingers; Qi transformation fails to reach the Zhou Du (Bladder). Still propose sweet-cold generating fluids, nourishing Stomach and clearing Lung to conclude the treatment.
Xiyangshen (American Ginseng) 1.5 qian; Zhu Fushen (Poria with Agarwood) 3 qian; Dong Sangye (Winter Mulberry Leaf) 2 qian; Dongguazi (Winter Melon Seed) 3 qian; Huo Lugeng (Living Reed Rhizome) unjointed, 1 chi; Sheng Gancao (Raw Licorice Root) 0.8 qian; Chuan Beimu (Fritillaria Bulb) 3 qian; Fen Danpi (Moutan Cortex) 1.5 qian; Beishumi (Broomcorn Millet) wrapped, 3 qian; Jin Shihu (Dendrobium Stem) 2 qian; Gualou Pi (Trichosanthes Peel) 3 qian; Nen Baiwei (Smilax Glabra Rhizome) 1.5 qian; Tongtian Cao (Centella Asiatica Herb) 0.8 qian; Zishen Tongguan Wan (Kidney-Nourishing Passage-Regulating Pill) wrapped and decocted, 1.5 qian.
[Patient He, Female] Autumn-warmth and latent summer-heat have persisted for three weeks. Initially hematemesis and epistaxis, followed by burning body heat without sweating, heat worse at night, delirious speech, thirst with desire to drink. No bowel movement for seven to eight days. Tongue is scorched, rough, and devoid of fluids. Lips are purple and dark. Pulse is wiry, slippery, and rapid. Red and white rashes appeared but vanished quickly. Coughing with blood-streaked sputum. This is primarily due to latent warmth moving from Ying (Nutrient) to Qi levels, from interior to exterior. The exterior did not achieve sweating, so the pathogen still transmitted to the interior. Interior heat is blazing. The Yin fluids of Shaoyin are plundered; fluids fail to ascend. Heat in the Yangming Meridian is not resolved externally; dry feces in the Fu organs cannot descend downward. Fu-heat steams and insults the Pericardium; the Spirit has no autonomy. Finger tremors indicate Liver Wind is about to rise. The complication of convulsions and syncope is imminent. Urgently propose generating fluids and releasing the muscle layer. Purging preserves Yin. Treat both exterior and interior, hoping for a turning point.
Xian Shengdi (Fresh Rehmannia Root) 6 qian; Tianhuafen (Trichosanthes Root) 3 qian; Shu Shigao (Calcined Gypsum) crushed, 3 qian; Chuan Beimu (Fritillaria Bulb) 3 qian; Mao Lugen (Imperata and Reed Rhizomes) peeled and jointless, each 1 liang; Jing Xuanshen (Scrophularia Root) 3 qian; Bohe Ye (Mint Leaf) 0.8 qian; Sheng Gancao (Raw Licorice Root) 0.5 qian; Zhishi Tan (Immature Bitter Orange Charcoal) 1 qian; Xian Shihu (Dendrobium Stem) 4 qian; Fen Gegen (Kudzu Root) 1 qian; Quan Gualou (Whole Trichosanthes Fruit) sliced, 4 qian; Xuanmingfen (Mirabilite) 1.5 qian, pounded together; Xian Zhuru (Fresh Bamboo Shavings) 2 qian; Qingning Wan (Clear Peace Pill) wrapped, 3 qian.
Second visit: After administering fluid-generating, muscle-releasing, and purging-to-preserve-Yin agents, and taking two doses, slight sweating occurred. Fu filth descended downward. The discharged filth was dark purple-black and smooth. Burning heat slightly declined, and delirium decreased. However, coughing and expectoration are unsuccessful, with blood in sputum. Deafness and loss of hearing. Dry mouth with desire to drink. Tongue roughness and blackness have decreased, but pulse remains wiry and rapid. Lips are scorched and cracked. This indicates Shaoyin Yin fluids are damaged. Yangming latent summer-heat transforms into fire, scorching fluids into phlegm. Phlegm obstructs Lung collaterals; the command of clear descent does not function. Liver Fire ascends, insulting the clear orifices. Although there are signs of turning, I dare not lightly say it is safe. Now propose Ren Shen Bai Hu Tang (Ginseng, White Tiger Decoction) combined with Qingying Zengye Tang (Clear Nutrient and Increase Fluids Decoction) modified. Clear Nutrient and cool Qi, purge Lung and eliminate phlegm. If essence overcomes pathogenic factors, we can hope to emerge from danger into safety.
Xiyangshen (American Ginseng) 1.5 qian; Xian Shengdi (Fresh Rehmannia Root) 5 qian; Fei Zhimu (Anemarrhena Rhizome) 2 qian; Liaoqiao Qiao (Forsythia Husk) 3 qian; Xian Zhuye (Fresh Bamboo Leaf) 30 leaves; Sheng Shigao (Raw Gypsum) crushed, 4 qian; Jing Xuanshen (Scrophularia Root) 3 qian; Chuan Beimu (Fritillaria Bulb) 3 qian; Fen Danpi (Moutan Cortex) 2 qian; Sheng Gancao (Raw Licorice Root) 0.8 qian; Xian Shihu (Dendrobium Stem) 3 qian; Zhu Fushen (Poria with Agarwood) 3 qian; Zhishi Tan (Immature Bitter Orange Charcoal) 0.8 qian; Huo Lugeng (Living Reed Rhizome) unjointed, 1 chi.
Third visit: After taking Ren Shen Bai Hu Tang (Ginseng, White Tiger Decoction) and Qingying Zengye Tang (Clear Nutrient and Increase Fluids Decoction) for another two doses, burning heat has reduced by half. Consciousness is clear. Tongue scorched black has receded, turning crimson-red. Pulse is wiry and rapid on the left, soggy, slippery, and rapid on the right. Startles and palpitations during sleep. Deafness and thirst. Coughing and expectoration are unsatisfactory, with blood mixed in sputum. Fluids show signs of recovery. Summer-heat shows signs of retreating. Remaining flames scorch fluids into phlegm, sticking and obstructing Lung collaterals. Liver Fire ascends, insulting the clear void. Combining pulse and syndrome, there is a good omen of emerging from danger into safety. Again discuss generating fluids and draining heat, clearing Lung and eliminating phlegm.
Xiyangshen (American Ginseng) 1.5 qian; Fei Zhimu (Anemarrhena Rhizome) 1.5 qian; Dong Sangye (Winter Mulberry Leaf) 2 qian; Zhu Fushen (Poria with Agarwood) 3 qian; Huo Lugeng (Living Reed Rhizome) unjointed, 1 chi; Sheng Gancao (Raw Licorice Root) 0.6 qian; Qinghao Geng (Artemisia Annua Stem) 1.5 qian; Sheng Shigao (Raw Gypsum) crushed, 3 qian; Tianhuafen (Trichosanthes Root) 3 qian; Fen Danpi (Moutan Cortex) 2 qian; Chuan Beimu (Fritillaria Bulb) 3 qian; Sheng Shijue (Concha Arcae) 8 qian; Nen Baiwei (Smilax Glabra Rhizome) 1.5 qian; Xian Ou (Fresh Lotus Rhizome) sliced for decoction, 4 liang.
Fourth visit: Body burning heat has gone 70-80%. Only coughing and expectoration are unsatisfactory. Thirst with little desire to drink. Blood in sputum has not appeared for two days. Tinnitus and deafness. Pulse is wiry, small, and rapid on the left; soggy, slippery, and rapid on the right. Tongue is crimson-red. Kidney Yin and Stomach fluids are difficult to restore. Liver Fire easily ascends. Residual waves are not exhausted. The command of Lung Metal clear descent does not function. Moreover, it is the dry season; dryness transforms from fire. Fire inevitably conquers Metal. Again suitable for sweet-cool moistening, generating fluids and draining heat, clearing Lung and eliminating phlegm.
Xiyangshen (American Ginseng) 1.5 qian; Sheng Gancao (Raw Licorice Root) 0.8 qian; Shuizhi Sangye Pi (Mulberry Leaf and Bark water-fried) each 1.5 qian; Sheng Shijue (Concha Arcae) 8 qian; Zhu Fushen (Poria with Agarwood) 3 qian; Tianhuafen (Trichosanthes Root) 3 qian; Fei Zhimu (Anemarrhena Rhizome) 1.5 qian; Fen Danpi (Moutan Cortex) 1.5 qian; Nen Baiwei (Smilax Glabra Rhizome) 1.5 qian; Beishumi (Broomcorn Millet) wrapped, 3 qian; Dongguazi (Winter Melon Seed) 3 qian; Huo Lugeng (Living Reed Rhizome) unjointed, 1 chi; Pipaye Lu (Loquat Leaf Dew) added later, 4 liang.
[Child Mao] Warm pathogen combined with dampness. Fever for thirteen days. Sweating is unsmooth. Dry mouth with desire to drink. Tongue body is red, covered with thin greasy coating. Left pulse is wiry and rapid; right pulse is soggy and rapid. The previous doctor administered Bai Hu Tang (White Tiger Decoction) too early, causing the pathogen to sink into Taiyin. Clear Qi does not ascend. Stools are loose, more than ten times a day. Urine is short and red. Mental restlessness and little sleep. Heat intensity increases. The condition is serious. Propose releasing the muscle layer and dispersing the pathogen, while regulating the Middle Earth (Spleen/Stomach). Master Zhongjing said: "When interior syndrome is heavier than exterior, treat the interior first." Following this idea, I modify the formula.
Fen Gegen (Kudzu Root) 2 qian; Pao Jiangtan (Roasted Ginger Charcoal) 0.4 qian; Chao Lushen (Codonopsis Root stir-fried) 3 qian; Sheng Baizhu (Atractylodes Macrocephala Rhizome raw) 2 qian; Sheng Gancao (Raw Licorice Root) 0.5 qian; Chiling (Red Poria) 3 qian; Jinyinhua (Honeysuckle Flower) 3 qian; Shanzha Tan (Crataegus Fruit Charcoal) 3 qian; Chao Cheqianzi (Plantago Seed stir-fried) wrapped, 3 qian; Wuji Wan (Five-Justice Pill) wrapped, 2 qian; Xian Heye (Fresh Lotus Leaf) 1 corner.
Second visit: Yesterday, administering modified Lizhong Tang (Regulate the Middle Decoction), loose stools gradually stopped. However, fever persists. Dry mouth with desire to drink. Tongue turns crimson-red. Pulse is wiry and rapid. Sweating is blocked. This indicates Qi-level warmth has not ceased, while Ying-level heat burns internally. Dampness transforms into dryness; dryness also damages Yin. Fluids lack capacity to ascend. Now propose clearing Ying and venting Qi, attending to the Middle Earth simultaneously.
Tianhuafen (Trichosanthes Root) 3 qian; Chao Yinhua (Honeysuckle stir-fried) 3 qian; Chiling (Red Poria) 3 qian; Dong Sangye (Winter Mulberry Leaf) 3 qian; Wei Gegen (Kudzu Root baked) 1.5 qian; Sheng Baizhu (Atractylodes Macrocephala Rhizome raw) 2 qian; Fen Danpi (Moutan Cortex) 1.5 qian; Biandou Yi (Lablab Skin) 3 qian; Sheng Gancao (Raw Licorice Root) 0.5 qian; Baiwei (Smilax Glabra Rhizome) 1.5 qian; Xian Heye (Fresh Lotus Leaf) 1 corner; Baimaogen (Imperata Rhizome) 5 qian.
Third visit: Yesterday, administering Ying-clearing, Qi-venting, and Middle-Earth-regulating agents, body heat gradually decreased. Epistaxis reappeared. Although called "red sweat," it ultimately belongs to heat suppressing the Ying level, forcing blood upward. Tongue is crimson-red. Pulse is wiry and rapid, restless. Yin division is damaged. Liver Fire burns internally. Dampness transforms from dryness. Yangming warmth is not yet thoroughly cleared. Since there is an effective trend, advance one step with modifications.
Xian Shengdi (Fresh Rehmannia Root) 3 qian; Chao Yinhua (Honeysuckle stir-fried) 3 qian; Chiling (Red Poria) 3 qian; Sangye (Mulberry Leaf) 3 qian; Tianhuafen (Trichosanthes Root) 2 qian; Sheng Baizhu (Atractylodes Macrocephala Rhizome raw) 2 qian; Fen Danpi (Moutan Cortex) 1.5 qian; Chuanbei (Fritillaria) 2 qian; Sheng Gancao (Raw Licorice Root) 0.5 qian; Baiwei (Smilax Glabra Rhizome) 1.5 qian; Chao Biandou Yi (Lablab Skin stir-fried) 3 qian; Beishumi (Broomcorn Millet) wrapped, 3 qian; Xian Heye (Fresh Lotus Leaf) 1 corner; Maogen (Imperata Rhizome) peeled, 5 qian.
[Patient Chen] Damp-warmth has persisted for over a month. Tidal fever fluctuates in severity. Thirst prefers hot drinks. Bai Fei (white miliary rash) has also appeared. Delirious speech and muttering. Urine is turbid and red. Pulse is deficient, slippery, and rapid. Tongue body is red and moist. Lips are dry. This indicates Qi and Yin are damaged. Latent pathogenic damp-heat lingers in Yangming, covering the clear orifices above, preventing the Spirit from having autonomy. Combining pulse and syndrome, it has entered a dangerous path. Urgently support righteousness and disperse pathogen, bitter-transform damp-heat, hoping for a turning point.
Dangshen (Codonopsis Root) 3 qian; Zhu Fushen (Poria with Agarwood) 3 qian; Chuan Yalian (Coptis Rhizome) 0.3 qian; Chuan Beimu (Fritillaria Bulb) 3 qian; Yin Chaihu (Sterculia Lychnophora Root) 1 qian; Zhi Yuanzhi Rou (Polygala Root bark honey-fried) 0.5 qian; Xi Mutong (Akebia Stem) 0.5 qian; Tianzhuhuang (Nepal Star Apple Seed) 2 qian; Baiwei (Smilax Glabra Rhizome) 1.5 qian; Zi Beichi (Concha Arginae) 3 qian; Xian Banxia (Pinellia Tuber) 1.5 qian; Beishumi (Broomcorn Millet) wrapped, 3 qian; Yiyuan San (Houttuynia Powder) wrapped, 3 qian.