李左 湿温四天，身热有汗不解，胸痞泛恶，口干不多饮，舌苔薄腻而黄，脉濡滑而数。伏邪湿热，漫布三
焦，气机不宣，痰浊交阻，胃失降和。治宜宣气淡渗。
光杏仁（三钱） 清水豆卷（四钱） 鲜竹茹（一钱五分） 江枳实（一钱五分，同炒） 茯苓皮（三钱）
通草（八分） 白蔻仁（一钱） 块滑石（三钱） 佛手露（冲，一两） 生熟苡仁（各三钱） 仙半夏（一钱五分）
酒炒黄芩（一钱五分） 鲜藿香佩兰（各一钱五分）
俞左 湿温五天，身热不解，有汗恶风，遍体骨楚，
胸闷泛恶，不能饮食，舌苔腻布而垢，脉象濡迟。伏温夹湿夹滞，互阻中焦，太阳表邪郁遏，太阴里湿弥漫，清
不升而浊不降，胃乏展和之权，邪势正在鸱张。拟五苓合平胃散加减。
川桂枝（八钱） 赤猪苓（各三钱） 泽泻（一钱五分） 清水豆卷（四钱） 制川朴（一钱） 陈皮（一钱）
半夏（一钱） 制苍术（一钱） 枳实炭（一钱） 六神曲（三钱） 鲜藿梗（一钱五分） 鲜佩兰（一钱五分）
王左 温邪暑湿，夹滞互阻，太阴阳明为病。发热五天，有汗不解，胸痞泛恶，腹痛痢下，日夜四、五十次。
舌尖绛，中浓灰腻而黄，脉象滑数有力。暑为天之气，湿为地之气，暑湿蕴蒸阳明，湿滞郁于肠间，气机窒塞，
胃失降和，湿温兼痢之重症。姑宜泄气分之伏邪，化阳明之垢浊，表里双解，通因通用之意。
炒香豉（三钱） 银花炭（四钱） 六神曲（三钱） 炒竹茹（一钱五分） 黑山栀皮（一钱五分） 扁豆衣
（三钱） 焦楂炭（三钱） 青陈皮（各一钱五分） 酒炒黄芩（一钱五分） 仙半夏（一钱五分） 鲜藿香（一钱
五分） 炒赤芍（一钱五分） 鲜佩兰（一钱五分） 枳实导滞丸（包，三钱）
李左 伏邪湿热，蕴蒸气分，漫布三焦。身热早轻
暮重，已有旬余，白疹布而不多，湿热原有暗泄之机。无如入夜梦呓，如谵语之状，亦是湿热熏蒸清窍所致。
口干溲赤，大便溏薄，热在阳明，湿在太阴，经所谓热搏注泄是也。吴鞠通先生云∶湿温之症，氤氲粘腻，非
易速解，虑其缠绵增剧。拟葛根黄芩黄连汤加味，解肌清温，苦化湿热。
粉葛根（二钱） 朱茯神（三钱） 炒麦芽（三钱） 朱灯心（三扎） 酒炒黄芩（一钱五分） 炒银花
（三钱） 通草（八分） 水炒川连（三分） 连翘壳（一钱五分） 净蝉衣（八分） 鸡苏散（包，三钱）
青荷梗（一枝） 鲜竹叶（三十张）
王右 湿温身热两候，有汗不解，早轻暮重，口干不多饮，红疹白 ，布于胸膺之间。脉数，苔灰黄，伏
邪湿热，蕴蒸气分，漫布三焦。叶香岩先生云∶湿热为粘腻之邪，最难骤化，所以身热久而不退也。宜以宣化。
净蝉衣（八分） 茯苓皮（三钱） 香青蒿（一钱五分） 荷梗（一支） 熟牛蒡（二钱） 通草（八分）
嫩白薇（一钱五分） 黑山栀（一钱五分） 清水豆卷（三钱） 六一散（包，三钱） 酒炒黄芩（一钱五分）
杨左 湿温七天，身热有汗不解，午后入夜尤甚，
口苦而干，渴不多饮，脉濡滑带数，舌苔薄腻，伏邪蕴湿，逗留膜原，少阳阳明为病。前进达原宣化不应，今
拟柴葛解肌加味。
软柴胡（八分） 清水豆卷（四钱） 仙半夏（一钱五分） 六一散（包，三钱） 粉葛根（一钱五分）
赤苓（三钱） 六神曲（三钱） 泽泻（一钱五分） 甘露消毒丹（包，四钱）
二诊 服药两剂，身热较前大减，胸脘不舒，纳减少寐，余邪湿热未楚，胃不和则卧不安也。脉濡滑，苔
薄腻微黄。今拟芳香淡渗，以靖余氛，更当避风节食，不致反复为要。
清水豆卷（四钱） 佩兰叶（一钱五分） 仙半夏（一钱五分） 炒枳壳（一钱） 广藿香（一钱五分）
赤茯苓（三钱） 炒秫米（三钱） 炒麦芽（四钱） 通草（八分） 益元散（包，三钱） 佛手（八分）
甘露消毒丹（包，四钱）
冯左 湿温三候，身热有汗不解，胸痞泛恶，脐腹作胀，两足痿软不能步履，苔腻脉濡。湿邪自下及上，
自外入内，盖香港脚之重症也。若加气喘，则危殆矣，急拟逐湿下行。
清水豆卷（四钱） 陈广皮（一钱） 制苍术（一钱） 制川朴（一钱） 仙半夏（二钱） 枳实炭（一钱）
赤茯苓（三钱） 淡吴
萸（五分） 大腹皮（二钱） 木防己（二钱） 陈木瓜（三钱） 生苡仁（四钱） 生姜（三片）
范童 初患间日疟，寒短热长，继因饮食不节，转成湿温。身热早轻暮重，热盛之时，神识昏糊，谵语妄
言，胸痞闷泛恶，腑行不实，舌苔灰腻满布，脉象滑数，良由伏温夹湿夹滞，蕴蒸生痰，痰浊蒙蔽清窍，清阳之
气失旷，与阳明内热者，不可同日而语也，颇虑传经增变。拟清温化湿，涤痰消滞，去其有形，则无形之邪，自
易解散。
豆豉（三钱） 前胡（一钱五分） 干葛（一钱） 银花（三钱） 连翘（三钱） 赤苓（三钱） 半夏（二钱）
藿香佩兰（各一钱五分） 炒枳实（一钱五分） 荷叶（一角） 竹茹（姜炒，一钱五分） 神曲（三钱） 菖蒲
（八分）
二诊 服前方以来，诸恙渐轻，不过夜有梦语如谵之象。某医认为暑令之恙，暑热熏蒸心包，投芩、连、益
元散、竹叶、茅根等，变为泄泻无度，稀粥食升，犹不知饱，渴喜热饮，身热依然，舌灰淡黄，脉象濡数，此藜藿
之体，中气本虚，寒凉太过，一变而邪陷三阴，太阴清气不升，浊阴凝聚，虚气散逆，中虚求食，有似除中，而尚
未至除中也。阴盛格阳，真寒假热，势已入于险境。姑仿附子理中合小柴胡意，冀其应手则吉。
熟附块（一钱五分） 炒潞党（二钱） 炮姜炭（六分） 炒冬术（二钱） 炙草（四分） 云茯苓（三钱）
煨葛根（一钱五分） 软柴胡（七分） 仙半夏（二钱） 陈皮（一钱） 炒谷芽苡仁（各三钱） 红枣（二枚）
荷叶（一角）
三诊 温运太阴，和解枢机，连服三剂，身热泄泻渐减，胀满亦松，脘中虽饥，已不多食，均属佳境。而神
疲倦怠，渴喜热饮，舌淡黄，脉濡数无力，中虚脾弱，饮水自救。效方出入，毋庸更张。
炒潞党（二钱） 熟附片（一钱） 炮姜炭（五分） 云苓（三钱） 炙草（五分） 大砂仁（八分） 陈皮
（一钱） 炒谷芽苡仁（各三钱） 炒白术（二钱） 荷叶（一角）
又服三剂，加炒淮药（三钱）。
原按∶此症骤见似难着手，然既泻而腹仍膨，则非实胀，已可概见。苔灰淡黄，脉象濡数，俱是假热，所
谓不从脉而从症也。
费左 湿温三候，初病足背湿热结毒起见，腐溃不得脓，疮旁四周肿红 痛，寒热晚甚，梦语如谵。前
医叠投寒凉解毒，外疡虽见轻减，而加呃逆频频，胸痞泛恶，口有酸甜之味，不能饮食，渴不欲饮，口舌糜腐，
小溲短赤，脉象濡滑而数。良由寒凉太过，湿遏热伏，热
处湿中，胃阳被遏，气机窒塞，已成坏症。议进辛以开之，苦以降之，芳香以宣之，淡渗以利之，复方图治，应
手乃幸。
仙半夏（二钱） 淡吴萸（一分） 郁金（五钱） 通草（八分） 清水豆卷（四钱） 枳实炭（一钱）
川雅连（四分） 姜竹茹（五钱） 柿蒂（五枚） 鲜藿香（五钱） 鲜佩兰（五钱） 鲜枇杷叶（去毛、包，三张）
二诊 连服辛开苦降，芳香淡渗之剂，呃逆止，泛恶亦减，胸痞噫气，口舌糜腐依然，口有酸甜之味，身热
起伏无常，小溲短赤，脉象濡数。湿热为粘腻之邪，最难骤化，胶阻于中，则胸痞噫气，熏蒸于上，则口有酸甜，
三焦决渎无权，则小溲短赤，白疹不现，邪无出路。前方既见合度，循序前进，以图后效。
仙半夏（五钱） 左金丸（包，五分） 清水豆卷（四钱） 通草（八分） 枳实炭（一钱） 炒竹茹（二钱）
茯苓皮（三钱） 鲜藿佩（各五钱） 柿蒂（五枚） 枇杷叶（去毛、包，五张） 滋肾通关丸（包煎，五钱）
三诊 呕恶止，胸痞未舒，口舌糜腐亦减，白疹渐现，伏邪湿热，已有暗泄之机。十余日未更衣，小溲短
赤，身热临晚似剧，脉濡数。申酉为阳明旺时，阳阴腑垢不得下达，三焦之余湿，一时未易清澈。再守原法，
加入通幽润肠之品，腑垢得去，则经中之余热，自无形默化也。
仙半夏（四钱） 川连（四分） 青蒿梗（五钱） 白薇（五钱） 清水豆卷（四钱） 全栝蒌（切，四钱）
郁李仁（研，三钱） 大麻仁（研，三钱） 枳实炭（一钱） 炒竹茹（五钱） 鲜佩兰（四钱） 滋肾通关
丸（包煎，五钱）
四诊 腑气已通，诸恙均平。今且调其胃气，宣化余湿，更当节饮食，以杜反复。
南沙参（三钱） 青蒿梗（五钱） 白薇（五钱） 清水豆卷（三钱） 鲜佩兰（五钱） 仙半夏（五钱）
江枳壳（一钱） 竹茹（五钱） 通草（八分） 鲜枇杷叶（四张） 生熟谷芽（各三钱） 滋肾通关丸（包，五钱）
徐右 伏温夹湿，陷入厥阴，神识昏糊，牙关紧闭，四肢逆冷，唇燥而焦，胸闷呕吐，饮食不进，湿热酿成浊
痰，互阻中焦，胃失降和，脉沉细而数，苔灰黄，况素体阴亏，肝火内炽，更兼怀孕，颇虑殒胎，危笃之症也。仿
经旨有故无殒亦无殒也之意，拟四逆散加减，冀陷入之邪，从阳明而解为幸。
银柴胡（一钱） 炙远志肉（一钱） 炙僵蚕（三钱） 仙半夏（五钱） 净蝉衣（七分） 枳实炭（八分）
九节石菖蒲（八分） 炒竹茹（五分） 嫩钩钩（后下，三钱） 清水豆卷（二钱）
广郁金（五钱） 薄荷叶（八分） 淡竹沥（一两） 姜汁（冲服，三、四滴）
二诊 昨进四逆散加减，神识渐清，呕吐亦止。虽属佳兆，无如牙关拘紧，齿垢无津，里热口干，胸闷气
粗，按脉沉细而数，良由阴液已伤，津无上承，陷入之温邪，未能透达，痰热胶阻肺络，肺失输布之权，况怀孕七
月，胎气已伤，虽见小效，尚不足恃也。今拟生津达邪，清神涤痰，未识能得转危就安否。
霍石斛（三钱） 炙远志肉（一钱） 川贝母（二钱） 淡竹油（冲，一两） 清水豆卷（三钱） 鲜石菖蒲
（八分） 栝蒌皮（二钱） 嫩钩钩（后下，三钱） 黑山栀（二钱） 鲜枇杷叶（三张） 鲜竹茹（二钱） 枳
实（七分，同炒）
三诊 神识渐清，呕吐渐止，牙关拘紧亦舒，齿垢无津，咳嗽咯痰不爽，里热头眩，按脉濡滑而数，是阴液
已伤，津少上承，陷入之邪，有暗泄之机，厥阳升腾，痰热胶阻肺络，肺失输布，怀麟七月，今太阴肺经司胎，胎
热乘肺，肺气愈形窒塞，虽逾险岭，未涉坦途。再宜生津达邪，清神涤痰，冀望正胜邪却为吉。
霍山石斛（三钱） 炙远志肉（一钱） 霜桑叶（三钱） 清水
豆卷（三钱） 鲜石菖蒲（八分） 滁菊花（三钱） 黑山栀（二钱） 鲜竹茹（二钱） 光杏仁（三钱）
川贝母（二钱） 栝蒌皮（二钱） 嫩钩钩（后下，三钱） 鲜枇杷叶（三张） 淡竹油（冲，一两）
四诊 神识已清，津液渐回，里热亦减，而呕吐又起，不能饮食，口舌碎痛，腑气不行，脉象左弦数，右濡
滑。此湿火上升，痰浊未楚，肺胃之气，不得下降，能得不生枝节，可望渐入佳境。仍宜生津和胃，苦降痰浊，
怀麟七月，助顺胎气。
川石斛（三钱） 川贝母（二钱） 炙白苏子（五钱） 水炒川连（三分） 全栝蒌（切，四钱） 旋复花
（包，五钱） 仙半夏（五钱） 鲜竹茹（二钱） 生熟谷芽（各三钱） 干芦根（去节，一两） 清炙枇杷叶
（去毛、包，三钱） 柿蒂（十四枚） 广橘白（一钱）
五诊 呕吐已止，口舌碎痛亦减，胸脘不舒，饮食少进，神疲，右颧赤色，脉象软滑无神。怀麟七月，阳明
少阴阴液已伤，痰浊未楚，厥气乘势横逆。再宜益阴柔肝，助顺胎气，而化痰浊。
川石斛（三钱） 抱茯神（三钱） 广橘白（一钱） 生白芍（二钱） 川贝母（二钱） 炒竹茹（二钱）
仙半夏（五钱） 栝蒌皮（二钱） 生熟谷芽（各三钱） 干芦根（去节，二两） 清炙枇杷叶
（去毛、包，三钱） 春砂壳（四分）
六诊 呕吐止，口舌碎痛亦减，惟纳谷不香，颈项胸膺发出白 ，伏邪湿热，已有外泄之佳象。口干不多
饮，舌质红，苔薄腻，脉象濡滑而数。阴伤难复，浊痰未化，津少上承。怀麟七月，胎前以清热养阴为主。再宜
养阴宣肺，和胃化痰。
川石斛（三钱） 抱茯神（三钱） 熟谷芽（四钱） 净蝉衣（八分） 清水豆卷（三钱） 佩兰梗（五钱）
光杏仁（三钱） 陈广皮（一钱） 象贝母（三钱） 清炙枇杷叶（去毛、包，三钱） 炒竹茹（五钱） 干芦根
（去节，一两） 净蝉衣（八分） 吉林参须（八分）
谨按∶此症为阴虚温邪内陷，若遇时医，见神识昏糊而大进犀羚，则邪遏不达而毙。或见四肢逆冷，而任
Li Zuo: Having suffered from damp-warmth (Shi Wen, a disease caused by dampness and heat pathogens) for four days, the patient presents with fever accompanied by sweating that does not alleviate the heat, chest fullness and distension, nausea, dry mouth but little desire to drink, a thin greasy yellow tongue coating, and a soggy slippery rapid pulse. This indicates latent pathogenic damp-heat spreading diffusely through the San Jiao (Triple Burner), with impaired Qi mechanism ventilation, mutual obstruction of phlegm-turbidity, and loss of stomach Qi descending harmony. The treatment should focus on ventilating Qi and using bland leeching methods.
Light Almond (Guang Xing Ren, 3 qian) Clear Water Bean Sprout (Qing Shui Dou Juan, 4 qian) Fresh Bamboo Shavings (Xian Zhu Ru, 1.5 qian) Jiang Zhi Shi (1.5 qian, stir-fried together) Poria Peel (Fu Ling Pi, 3 qian)
Thunberg Fritillary Stem (Tong Cao, 0.8 qian) White Cardamom Seed (Bai Kou Ren, 1 qian) Block Talcum (Kuai Hua Shi, 3 qian) Bergamot Dew (Fo Shou Lu, taken in solution, 1 liang) Raw and Prepared Coix Seed (Sheng Shu Yi Yi Ren, 3 qian each) Immortal Pinellia (Xian Ban Xia, 1.5 qian)
Wine-fried Scutellaria Root (Jiu Chao Huang Qin, 1.5 qian) Fresh Agastache and Fresh Eupatorium (Xian Huo Xiang Pei Lan, 1.5 qian each)
Yu Zuo: Having suffered from damp-warmth for five days, the patient presents with persistent fever, sweating with aversion to wind, generalized bone ache, chest stuffiness and nausea, inability to eat, a thick greasy and dirty tongue coating, and a soggy slow pulse. This is latent warmth complicated by dampness and food stagnation, mutually obstructing the Middle Jiao; exterior pathogenic factors of the Taiyang channel are constrained, while interior dampness of the Taiyin spleen is pervasive. Clear Yang fails to ascend and Turbid Yin fails to descend; the stomach lacks the power to expand and harmonize, and the pathogenic momentum is rampant. It is proposed to modify Wu Ling San (Five-Ling Powder) combined with Ping Wei San (Pingwei Powder).
Sichuan Cinnamon Twig (Chuan Gui Zhi, 8 qian) Red Polyporus (Chi Zhu Ling, 3 qian each) Alisma Rhizome (Ze Xie, 1.5 qian) Clear Water Bean Sprout (Qing Shui Dou Juan, 4 qian) Processed Magnolia Bark (Zhi Chuan Po, 1 qian) Tangerine Peel (Chen Pi, 1 qian)
Pinellia Tuber (Ban Xia, 1 qian) Processed Atractylodes Rhizome (Zhi Cang Zhu, 1 qian) Charred Immature Bitter Orange (Zhi Shi Tan, 1 qian) Six-God Qu (Liu Shen Qu, 3 qian) Fresh Agastache Stem (Xian Huo Geng, 1.5 qian) Fresh Eupatorium (Xian Pei Lan, 1.5 qian)
Wang Zuo: Affected by warm pathogenic factors and summer-heat dampness, complicated by stagnation mutually obstructing, involving the Taiyin Spleen and Yangming Stomach. Fever for five days, sweating without relief, chest fullness and nausea, abdominal pain with dysentery-like diarrhea occurring 40-50 times daily. The tongue tip is crimson, the center has a thick gray-greasy yellow coating, and the pulse is slippery, rapid, and forceful. Summer-heat is the Qi of Heaven, dampness is the Qi of Earth; summer-heat and dampness accumulate and steam in the Yangming, while damp-stagnation郁s in the intestines. The Qi mechanism is blocked, and the stomach loses harmony. This is a severe case of damp-warmth complicated by dysentery. Tentatively, it is suitable to vent latent pathogenic factors in the Qi level, resolve turbid filth in the Yangming, simultaneously release the exterior and interior, employing the principle of "treating obstruction with unblocking agents" (Tong Yin Tong Yong).
Fragrant Fermented Soybean Paste (Chao Xiang Chi, 3 qian) Silver Flower Char (Yin Hua Tan, 4 qian) Six-God Qu (Liu Shen Qu, 3 qian) Stir-fried Bamboo Shavings (Chao Zhu Ru, 1.5 qian) Black Gardenia Skin (Hei Shan Zhi Pi, 1.5 qian) Dolichos Lablab Skin (Bian Dou Yi, 3 qian)
Charred Hawthorn Fruit (Jiao Zha Tan, 3 qian) Green and Tangerine Peel (Qing Chen Pi, 1.5 qian each) Wine-fried Scutellaria Root (Jiu Chao Huang Qin, 1.5 qian) Immortal Pinellia (Xian Ban Xia, 1.5 qian) Fresh Agastache (Xian Huo Xiang, 1.5 qian)
Stir-fried Red Peony Root (Chao Chi Shao, 1.5 qian) Fresh Eupatorium (Xian Pei Lan, 1.5 qian) Immature Bitter Orange Detoxifying Pill (Zhi Shi Dao Zhi Wan, wrapped, 3 qian)
Li Zuo: Latent pathogenic damp-heat accumulates in the Qi level, spreading diffusely through the San Jiao. Body heat is lighter in the morning and heavier in the evening, persisting for over ten days. White rash appears but is sparse, indicating an original opportunity for damp-heat to secretly excrete. Unfortunately, at night, there is somniloquy resembling delirium, also caused by damp-heat steaming and clouding the clear orifices. Dry mouth, red urine, loose stools; heat is in the Yangming, dampness is in the Taiyin, as stated in the classics: "Heat clashing leads to diarrhea." Mr. Wu Jutong said: Damp-warmth diseases are misty and sticky, not easily resolved quickly; one must fear lingering and worsening. It is proposed to add ingredients to Ge Gen Huang Qin Huang Lian Tang (Kudzu, Scutellaria, and Coptis Decoction) to release the muscle layer and clear warmth, using bitter methods to transform damp-heat.
Powdered Kudzu Root (Fen Ge Gen, 2 qian) Cinnabar-coated Poria Spirit (Zhu Fu Shen, 3 qian) Stir-fried Malt (Chao Mai Ya, 3 qian) Cinnabar-coated Centipede Grass (Zhu Deng Xin, 3 bundles) Wine-fried Scutellaria Root (Jiu Chao Huang Qin, 1.5 qian) Stir-fried Silver Flower (Chao Yin Hua, 3 qian)
Thunberg Fritillary Stem (Tong Cao, 0.8 qian) Water-fried Coptis Rhizome (Shui Chao Chuan Lian, 0.3 qian) Forsythia Husk (Lian Qiao Ke, 1.5 qian) Clean Cicada Slough (Jing Chan Yi, 0.8 qian) Ji Su San (Chicken Mint Powder, wrapped, 3 qian)
Green Lotus Stem (Qing He Geng, 1 branch) Fresh Bamboo Leaves (Xian Zhu Ye, 30 sheets)
Wang You: Suffering from damp-warmth fever for two weeks (two hou), sweating without relief, lighter in the morning and heavier in the evening, dry mouth with little desire to drink, red rashes and white rash distributed between the chest and epigastrium. Pulse is rapid, coating is gray-yellow. Latent pathogenic damp-heat accumulates in the Qi level, spreading diffusely through the San Jiao. Mr. Ye Xianyan said: Damp-heat is a sticky pathogen, hardest to resolve suddenly, hence the prolonged fever. It is appropriate to use ventilation and transformation methods.
Clean Cicada Slough (Jing Chan Yi, 0.8 qian) Poria Peel (Fu Ling Pi, 3 qian) Fragrant Artemisia Annua (Xiang Qing Hao, 1.5 qian) Lotus Stem (He Geng, 1 branch) Prepared Burdock Fruit (Shu Niu Bang, 2 qian) Thunberg Fritillary Stem (Tong Cao, 0.8 qian)
Tender Anemone Root (Nen Bai Wei, 1.5 qian) Black Gardenia (Hei Shan Zhi, 1.5 qian) Clear Water Bean Sprout (Qing Shui Dou Juan, 3 qian) Liu Yi San (Six-to-One Powder, wrapped, 3 qian) Wine-fried Scutellaria Root (Jiu Chao Huang Qin, 1.5 qian)
Yang Zuo: Suffering from damp-warmth for seven days, body heat with sweating but no relief, worse in the afternoon and night, bitter and dry mouth, thirst with little desire to drink, soggy slippery slightly rapid pulse, thin greasy tongue coating. Latent pathogenic factors harbor dampness, lingering in the Mo Yuan (Membrane Source), involving Shaoyang and Yangming. Previous treatment with Da Yuan Yin (Origin-Reaching Powder) for ventilation failed. Now, Chai Ge Jie Ji Tang (Bupleurum and Kudzu Muscle-Releasing Decoction) with modifications is proposed.
Soft Bupleurum Root (Ruan Chai Hu, 0.8 qian) Clear Water Bean Sprout (Qing Shui Dou Juan, 4 qian) Immortal Pinellia (Xian Ban Xia, 1.5 qian) Liu Yi San (Six-to-One Powder, wrapped, 3 qian) Powdered Kudzu Root (Fen Ge Gen, 1.5 qian)
Red Poria (Chi Ling, 3 qian) Six-God Qu (Liu Shen Qu, 3 qian) Alisma Rhizome (Ze Xie, 1.5 qian) Gan Lu Xiao Du Dan (Sweet Dew Detoxication Powder, wrapped, 4 qian)
Second Visit: After taking two doses, body heat decreased significantly compared to before. Chest and epigastric discomfort remain, appetite is reduced, and sleep is poor. Residual damp-heat pathogens are not cleared; "when the stomach is not harmonious, sleep is uneasy." Pulse is soggy slippery, coating thin greasy slightly yellow. Now, aromatic and bland leeching methods are proposed to pacify residual pathogens. Avoiding wind and regulating diet is crucial to prevent recurrence.
Clear Water Bean Sprout (Qing Shui Dou Juan, 4 qian) Pei Lan Leaf (Pei Lan Ye, 1.5 qian) Immortal Pinellia (Xian Ban Xia, 1.5 qian) Stir-fried Aurantium (Chao Zhi Ke, 1 qian) Guang Agastache (Guang Huo Xiang, 1.5 qian)
Red Poria (Chi Fu Ling, 3 qian) Stir-fried Sorghum Grain (Chao Shu Mi, 3 qian) Stir-fried Malt (Chao Mai Ya, 4 qian) Thunberg Fritillary Stem (Tong Cao, 0.8 qian) Yi Yuan San (Benefit Origin Powder, wrapped, 3 qian) Bergamot (Fo Shou, 0.8 qian)
Gan Lu Xiao Du Dan (Sweet Dew Detoxication Powder, wrapped, 4 qian)
Feng Zuo: Suffering from damp-warmth for three weeks (three hou), body heat with sweating but no relief, chest fullness and nausea, umbilical and abdominal distension, flaccidity and weakness of both legs unable to walk, greasy coating, soggy pulse. Damp pathogenic factors move from lower to upper, from exterior to interior; this is likely a severe case of Hong Kong Foot (Jiao Qi, Beriberi). If panting adds, it will be critical. Urgently, downward-draining dampness is proposed.
Clear Water Bean Sprout (Qing Shui Dou Juan, 4 qian) Aged Tangerine Peel (Chen Guang Pi, 1 qian) Processed Atractylodes Rhizome (Zhi Cang Zhu, 1 qian) Processed Magnolia Bark (Zhi Chuan Po, 1 qian) Immortal Pinellia (Xian Ban Xia, 2 qian) Charred Immature Bitter Orange (Zhi Shi Tan, 1 qian)
Red Poria (Chi Fu Ling, 3 qian) Light Evodia Fruit (Dan Wu Yu, 0.5 qian) Areca Peel (Da Fu Pi, 2 qian) Stephania Tetrandra (Mu Fang Ji, 2 qian) Aged Quince (Chen Mu Gua, 3 qian) Raw Coix Seed (Sheng Yi Yi Ren, 4 qian) Ginger (Sheng Jiang, 3 slices)
Fan Tong: Initially suffered from intermittent malaria, short chills and long fever. Subsequently, due to irregular diet, transformed into damp-warmth. Body heat lighter in morning, heavier in evening. During high fever, consciousness is confused, with delirious speech. Chest fullness, stifling sensation, nausea, loose stools. Tongue coating is gray-greasy and widespread, pulse is slippery and rapid. This is due to latent warmth complicated by dampness and stagnation, accumulating and steaming to generate phlegm. Phlegm-turbidity clouds the clear orifices, and Clear Yang Qi loses its openness. This cannot be compared to internal heat in the Yangming. There is great concern about transmission and changes. It is proposed to clear warmth, transform dampness, wash away phlegm, and eliminate stagnation. Removing有形 (material) pathogens allows无形 (immaterial) pathogens to disperse easily.
Fermented Soybean (Dou Chi, 3 qian) Peucedanum Root (Qian Hu, 1.5 qian) Dried Kudzu Root (Gan Ge, 1 qian) Silver Flower (Yin Hua, 3 qian) Forsythia (Lian Qiao, 3 qian) Red Poria (Chi Ling, 3 qian) Pinellia Tuber (Ban Xia, 2 qian)
Agastache and Eupatorium (Huo Xiang Pei Lan, 1.5 qian each) Stir-fried Immature Bitter Orange (Chao Zhi Shi, 1.5 qian) Lotus Leaf (He Ye, 1 corner) Bamboo Shavings (Zhu Ru, fried with ginger, 1.5 qian) Divine Qu (Shen Qu, 3 qian) Acorus Rhizome (Chang Pu, 0.8 qian)
Second Visit: Since taking the previous prescription, various ailments have gradually lightened, except for nocturnal somniloquy resembling delirium. A certain physician considered it a summer-heat ailment, attributing it to summer-heat steaming the Pericardium, and administered Scutellaria, Coptis, Yi Yuan San, Bamboo Leaves, and Imperata Rhizome. This resulted in profuse diarrhea, eating porridge without satiety, craving hot drinks, persistent fever, gray-pale yellow tongue coating, and soggy rapid pulse. This is a person of humble constitution with originally deficient Middle Qi. Excessive cold-cooling herbs caused the pathogen to sink into the Three Yin channels. Taiyin Clear Yang fails to ascend, Turbid Yin condenses, deficient Qi scatters and rebels. Deficient Middle seeks food, resembling Chu Zhong (Exhaustion of Stomach Qi), though not yet reaching that state. Yin excess repelling Yang, true cold false heat, the situation has entered a dangerous realm. Tentatively imitating Fu Zi Li Zhong Tang (Aconite and Gastrodia Regulate the Middle Decoction) combined with Xiao Chai Hu Tang (Minor Bupleurum Decoction), hoping for a prompt response brings auspiciousness.
Prepared Aconite Chunk (Shu Fu Kuai, 1.5 qian) Stir-fried Codonopsis (Chao Lu Dang, 2 qian) Roasted Ginger Char (Pao Jiang Tan, 0.6 qian) Stir-fried Winter Atractylodes (Chao Dong Zhu, 2 qian) Honey-fried Licorice (Zhi Cao, 0.4 qian) Cloud Poria (Yun Fu Ling, 3 qian)
Baked Kudzu Root (Wei Ge Gen, 1.5 qian) Soft Bupleurum (Ruan Chai Hu, 0.7 qian) Immortal Pinellia (Xian Ban Xia, 2 qian) Tangerine Peel (Chen Pi, 1 qian) Stir-fried Rice Sprout and Coix Seed (Chao Gu Ya Yi Ren, 3 qian each) Red Dates (Hong Zao, 2 pieces)
Lotus Leaf (He Ye, 1 corner)
Third Visit: Warming and transporting Taiyin, harmonizing the pivot. After three doses, fever and diarrhea gradually decreased, distension relaxed. Although hungry in the epigastrium, appetite is low, all indicating a favorable condition. However, spirit is fatigued and lethargic, thirst prefers hot drinks, tongue is pale yellow, pulse is soggy, rapid, and powerless. This is Middle deficiency and Spleen weakness, drinking water to save itself. The effective formula is modified, no need to change structure.
Stir-fried Codonopsis (Chao Lu Dang, 2 qian) Prepared Aconite Slice (Shu Fu Pian, 1 qian) Roasted Ginger Char (Pao Jiang Tan, 0.5 qian) Cloud Poria (Yun Ling, 3 qian) Honey-fried Licorice (Zhi Cao, 0.5 qian) Large Amomum Fruit (Da Sha Ren, 0.8 qian) Tangerine Peel (Chen Pi, 1 qian)
Stir-fried Rice Sprout and Coix Seed (Chao Gu Ya Yi Ren, 3 qian each) Stir-fried Atractylodes Macrocephala (Chao Bai Zhu, 2 qian) Lotus Leaf (He Ye, 1 corner)
Take three more doses, adding Stir-fried Chinese Yam (Chao Huai Yao, 3 qian).
Original Note: This case seems difficult to address at first glance, but since diarrhea occurs while the abdomen remains distended, it is clearly not excess distension. Gray-pale yellow coating and soggy rapid pulse are all false heat, as stated: "Do not follow the pulse but follow the symptoms."
Fei Zuo: Suffering from damp-warmth for three weeks (three hou). Initially, damp-heat toxin formed on the dorsum of the foot, rotting and ulcerating without pus, with surrounding redness, swelling, and pain. Chills and fever worsened in the evening, with somniloquy resembling delirium. Previous physicians repeatedly used cold-cooling detoxification herbs. Although the external sorelightened, frequent hiccups added, along with chest fullness, nausea, sweet-and-sour taste in the mouth, inability to eat, thirst without desire to drink, oral and lingual erosion, short red urine, and soggy slippery rapid pulse. This is due to excessive cold-cooling herbs causing dampness to constrain and heat to hide, heat residing within dampness, Stomach Yang constrained, Qi mechanism blocked, becoming a ruined case. It is discussed to enter pungent herbs to open, bitter herbs to descend, aromatic herbs to ventilate, and bland leeching herbs to promote urination. Compound formulas are planned for treatment; a prompt response is hoped for.
Immortal Pinellia (Xian Ban Xia, 2 qian) Light Evodia Fruit (Dan Wu Yu, 0.1 qian) Curcuma Root (Yu Jin, 5 qian) Thunberg Fritillary Stem (Tong Cao, 0.8 qian) Clear Water Bean Sprout (Qing Shui Dou Juan, 4 qian) Charred Immature Bitter Orange (Zhi Shi Tan, 1 qian)
Ya Coptis Rhizome (Chuan Ya Lian, 0.4 qian) Ginger Bamboo Shavings (Jiang Zhu Ru, 5 qian) Persimmon Calyx (Shi Di, 5 pieces) Fresh Agastache (Xian Huo Xiang, 5 qian) Fresh Eupatorium (Xian Pei Lan, 5 qian) Fresh Loquat Leaf (Xian Pi Pa Ye, de-haired, wrapped, 3 sheets)
Second Visit: After continuously taking pungent-opening, bitter-descending, aromatic, and bland-leeching agents, hiccups stopped, nausea reduced. However, chest fullness and belching persist, oral/lingual erosion remains, sweet-and-sour taste in mouth, fluctuating fever, short red urine, soggy rapid pulse. Damp-heat is a sticky pathogen, hardest to resolve suddenly. Stuck in the Middle, it causes chest fullness and belching; steaming upwards, it causes sweet-and-sour taste; San Jiao regulation fails, causing short red urine; white rash does not appear, so pathogens have no exit. Since the previous formula was appropriate, proceed sequentially to seek subsequent effects.
Immortal Pinellia (Xian Ban Xia, 5 qian) Zuo Jin Wan (Left Metal Pill, wrapped, 0.5 qian) Clear Water Bean Sprout (Qing Shui Dou Juan, 4 qian) Thunberg Fritillary Stem (Tong Cao, 0.8 qian) Charred Immature Bitter Orange (Zhi Shi Tan, 1 qian) Stir-fried Bamboo Shavings (Chao Zhu Ru, 2 qian)
Poria Peel (Fu Ling Pi, 3 qian) Fresh Agastache and Eupatorium (Xian Huo Pei, 5 qian each) Persimmon Calyx (Shi Di, 5 pieces) Loquat Leaf (Pi Pa Ye, de-haired, wrapped, 5 sheets) Zi Shen Tong Guan Wan (Kidney-Nourishing Passage-Regulating Pill, wrapped/decocted, 5 qian)
Third Visit: Vomiting and nausea stopped, chest fullness not relieved, oral/lingual erosion reduced, white rash gradually appeared. Latent pathogenic damp-heat has an opportunity for secret excretion. No bowel movement for over ten days, short red urine, fever seems worse in the evening, pulse soggy rapid. Shen and You hours belong to Yangming prosperity time. Yangming fu organ filth cannot descend, residual dampness in San Jiao is hard to clear instantly. Continue original method, adding herbs to unblock the dark and moisten intestines. Once fu filth is removed, residual heat in meridians will naturally transform invisibly.
Immortal Pinellia (Xian Ban Xia, 4 qian) Coptis Rhizome (Chuan Lian, 0.4 qian) Green Artemisia Stem (Qing Hao Geng, 5 qian) Anemone Root (Bai Wei, 5 qian) Clear Water Bean Sprout (Qing Shui Dou Juan, 4 qian) Whole Trichosanthes Fruit (Quan Gua Lou, cut, 4 qian)
Prunus Seeds (Yu Li Ren, ground, 3 qian) Hemp Seeds (Da Ma Ren, ground, 3 qian) Charred Immature Bitter Orange (Zhi Shi Tan, 1 qian) Stir-fried Bamboo Shavings (Chao Zhu Ru, 5 qian) Fresh Eupatorium (Xian Pei Lan, 4 qian) Zi Shen Tong Guan Wan (Kidney-Nourishing Passage-Regulating Pill, wrapped/decocted, 5 qian)
Fourth Visit: Fu Qi has circulated, all ailments are stable. Now regulate Stomach Qi, ventilate and transform residual dampness. Regulate diet to prevent recurrence.
Southern Sandalwood Root (Nan Sha Shen, 3 qian) Green Artemisia Stem (Qing Hao Geng, 5 qian) Anemone Root (Bai Wei, 5 qian) Clear Water Bean Sprout (Qing Shui Dou Juan, 3 qian) Fresh Eupatorium (Xian Pei Lan, 5 qian) Immortal Pinellia (Xian Ban Xia, 5 qian)
Jiang Aurantium (Jiang Zhi Ke, 1 qian) Bamboo Shavings (Zhu Ru, 5 qian) Thunberg Fritillary Stem (Tong Cao, 0.8 qian) Fresh Loquat Leaf (Xian Pi Pa Ye, 4 sheets) Raw and Prepared Rice Sprouts (Sheng Shu Gu Ya, 3 qian each) Zi Shen Tong Guan Wan (Kidney-Nourishing Passage-Regulating Pill, wrapped, 5 qian)
Xu You: Latent warmth complicated by dampness, sinking into Jueyin. Consciousness confused, jaw locked, cold limbs, dry and cracked lips, chest stuffiness and vomiting, inability to eat. Damp-heat brewed turbid phlegm, mutually obstructing Middle Jiao, stomach lost harmony. Pulse deep, fine, and rapid, coating gray-yellow. Moreover, constitutionally Yin deficient with internal blazing Liver Fire, plus pregnancy, greatly fearing miscarriage. This is a critical case. Imitating the classic principle "If there is pathology, there is no harm [to the fetus]," Si Ni San (Four Counterflow Powder) with modifications is proposed, hoping the sunk pathogen resolves via Yangming.
Silver Bupleurum Root (Yin Chai Hu, 1 qian) Honey-fried Polygala Root (Zhi Yuan Zhi Rou, 1 qian) Honey-fried Silkworm (Zhi Jiang Can, 3 qian) Immortal Pinellia (Xian Ban Xia, 5 qian) Clean Cicada Slough (Jing Chan Yi, 0.7 qian) Charred Immature Bitter Orange (Zhi Shi Tan, 0.8 qian)
Nine-Joint Stone Acorus (Jiu Jie Shi Chang Pu, 0.8 qian) Stir-fried Bamboo Shavings (Chao Zhu Ru, 0.5 qian) Tender Uncaria Hook (Nen Gou Gou, added later, 3 qian) Clear Water Bean Sprout (Qing Shui Dou Juan, 2 qian)
Broad Curcuma (Guang Yu Jin, 5 qian) Mint Leaf (Bo He Ye, 0.8 qian) Light Bamboo Sap (Dan Zhu Li, 1 liang) Ginger Juice (Jiang Zhi, taken in solution, 3-4 drops)
Second Visit: Yesterday, Si Ni San modification was taken. Consciousness gradually cleared, vomiting stopped. Although a good sign, jaw stiffness persists, dental crust lacks moisture, internal heat and dry mouth, chest stuffiness and coarse breathing. Pulse deep, fine, rapid. This is due to injured Yin fluids, lack of upward bearing of fluids, sunk warm pathogen unable to penetrate, phlegm-heat stuck in Lung collaterals, Lung losing distribution function. Moreover, pregnant for seven months, fetal Qi injured. Although small effect seen, not sufficient to rely on. Now, generating fluids and expelling pathogens, clearing spirit and washing phlegm is proposed. Whether turning danger to safety remains to be seen.
Huohua Dendrobium (Huo Shi Hu, 3 qian) Honey-fried Polygala Root (Zhi Yuan Zhi Rou, 1 qian) Sichuan Fritillary Bulb (Chuan Bei Mu, 2 qian) Light Bamboo Oil (Dan Zhu You, taken in solution, 1 liang) Clear Water Bean Sprout (Qing Shui Dou Juan, 3 qian) Fresh Stone Acorus (Xian Shi Chang Pu, 0.8 qian)
Trichosanthes Peel (Gua Lou Pi, 2 qian) Tender Uncaria Hook (Nen Gou Gou, added later, 3 qian) Black Gardenia (Hei Shan Zhi, 2 qian) Fresh Loquat Leaf (Xian Pi Pa Ye, 3 sheets) Fresh Bamboo Shavings (Xian Zhu Ru, 2 qian) Immature Bitter Orange (Zhi Shi, 0.7 qian, stir-fried together)
Third Visit: Consciousness gradually cleared, vomiting stopped, jaw stiffness relaxed. Dental crust lacks moisture, cough with unsatisfactory sputum, internal heat and dizziness. Pulse soggy, slippery, rapid. This is injured Yin fluids, scarce fluids failing to ascend, sunk pathogen having opportunity for secret excretion. Jue Yang rising, phlegm-heat stuck in Lung collaterals, Lung losing distribution. Pregnant seven months, now Taiyin Lung channel governs the fetus. Fetal heat attacks Lung, Lung Qi becomes more blocked. Although crossing dangerous ridges, not yet on smooth roads. Again, generating fluids, expelling pathogens, clearing spirit, washing phlegm is proposed, hoping righteous Qi wins and pathogens retreat.
Huoshan Dendrobium (Huo Shan Shi Hu, 3 qian) Honey-fried Polygala Root (Zhi Yuan Zhi Rou, 1 qian) Frost Mulberry Leaf (Shuang Sang Ye, 3 qian) Clear Water Bean Sprout (Qing Shui Dou Juan, 3 qian) Fresh Stone Acorus (Xian Shi Chang Pu, 0.8 qian) Chuzhou Chrysanthemum (Chu Ju Hua, 3 qian) Black Gardenia (Hei Shan Zhi, 2 qian) Fresh Bamboo Shavings (Xian Zhu Ru, 2 qian) Light Almond (Guang Xing Ren, 3 qian)
Sichuan Fritillary Bulb (Chuan Bei Mu, 2 qian) Trichosanthes Peel (Gua Lou Pi, 2 qian) Tender Uncaria Hook (Nen Gou Gou, added later, 3 qian) Fresh Loquat Leaf (Xian Pi Pa Ye, 3 sheets) Light Bamboo Oil (Dan Zhu You, taken in solution, 1 liang)
Fourth Visit: Consciousness cleared, fluids returning, internal heat reduced. But vomiting restarted, inability to eat, fragmented pain in mouth and tongue, Fu Qi not moving. Pulse left wiry-rapid, right soggy-slippery. This is damp-fire rising, phlegm-turbidity not cleared, Lung and Stomach Qi unable to descend. If complications do not arise, gradual improvement is expected. Still, generating fluids and harmonizing Stomach, bitter-descending phlegm-turbidity is proposed. Pregnant seven months, assisting smooth fetal Qi.
Sichuan Dendrobium (Chuan Shi Hu, 3 qian) Sichuan Fritillary Bulb (Chuan Bei Mu, 2 qian) Honey-fried White Perilla Seed (Zhi Bai Su Zi, 5 qian) Water-fried Coptis Rhizome (Shui Chao Chuan Lian, 0.3 qian) Whole Trichosanthes Fruit (Quan Gua Lou, cut, 4 qian) Inula Flower (Xuan Fu Hua, wrapped, 5 qian)
Immortal Pinellia (Xian Ban Xia, 5 qian) Fresh Bamboo Shavings (Xian Zhu Ru, 2 qian) Raw and Prepared Rice Sprouts (Sheng Shu Gu Ya, 3 qian each) Dry Reed Rhizome (Gan Lu Gen, de-jointed, 1 liang) Clear Honey-fried Loquat Leaf (Qing Zhi Pi Pa Ye, de-haired, wrapped, 3 sheets) Persimmon Calyx (Shi Di, 14 pieces) Broad Tangerine White (Guang Ju Bai, 1 qian)
Fifth Visit: Vomiting stopped, mouth/tongue pain reduced, chest/epigastric discomfort, low appetite, fatigue, red right cheekbone, pulse soft-slippy lacking spirit. Pregnant seven months, Yangming and Shaoyin Yin fluids injured, phlegm-turbidity not cleared, Jue Qi invading horizontally. Again, nourishing Yin and softening Liver, assisting smooth fetal Qi, and transforming phlegm-turbidity is proposed.
Sichuan Dendrobium (Chuan Shi Hu, 3 qian) Embracing Poria Spirit (Bao Fu Shen, 3 qian) Broad Tangerine White (Guang Ju Bai, 1 qian) Raw White Peony Root (Sheng Bai Shao, 2 qian) Sichuan Fritillary Bulb (Chuan Bei Mu, 2 qian) Stir-fried Bamboo Shavings (Chao Zhu Ru, 2 qian)
Immortal Pinellia (Xian Ban Xia, 5 qian) Trichosanthes Peel (Gua Lou Pi, 2 qian) Raw and Prepared Rice Sprouts (Sheng Shu Gu Ya, 3 qian each) Dry Reed Rhizome (Gan Lu Gen, de-jointed, 2 liang) Clear Honey-fried Loquat Leaf (Qing Zhi Pi Pa Ye, de-haired, wrapped, 3 sheets) Spring Sand Shell (Chun Sha Ke, 0.4 qian)
Sixth Visit: Vomiting stopped, mouth/tongue pain reduced, only appetite is poor. White rash appeared on neck, chest, and epigastrium. Latent pathogenic damp-heat has a good sign of external excretion. Dry mouth, little desire to drink, red tongue body, thin greasy coating, soggy slippery rapid pulse. Yin injury hard to restore, turbid phlegm not transformed, scarce fluids failing to ascend. Pregnant seven months, pre-delivery focuses on clearing heat and nourishing Yin. Again, nourishing Yin and ventilating Lung, harmonizing Stomach and transforming phlegm is proposed.
Sichuan Dendrobium (Chuan Shi Hu, 3 qian) Embracing Poria Spirit (Bao Fu Shen, 3 qian) Prepared Rice Sprout (Shu Gu Ya, 4 qian) Clean Cicada Slough (Jing Chan Yi, 0.8 qian) Clear Water Bean Sprout (Qing Shui Dou Juan, 3 qian) Pei Lan Stem (Pei Lan Geng, 5 qian)
Light Almond (Guang Xing Ren, 3 qian) Aged Tangerine Peel (Chen Guang Pi, 1 qian) Elephant Fritillary Bulb (Xiang Bei Mu, 3 qian) Clear Honey-fried Loquat Leaf (Qing Zhi Pi Pa Ye, de-haired, wrapped, 3 sheets) Stir-fried Bamboo Shavings (Chao Zhu Ru, 5 qian) Dry Reed Rhizome (Gan Lu Gen, de-jointed, 1 liang)
Clean Cicada Slough (Jing Chan Yi, 0.8 qian) Jilin Ginseng Radicle (Ji Lin Shen Xu, 0.8 qian)
Carefully Noted: This case is Yin-deficient warm pathogen sinking inward. If encountered by contemporary physicians who see confused consciousness and heavily administer Rhinoceros Horn and Antelope Horn, the pathogen will be constrained and not expelled, leading to death. Or if seeing cold limbs, and disregarding...