乃告知病家，危险已十有七八，因征得病家之同意，为处一方。以泻心承气增液法加生石膏、葛根、山栀主之。与服一剂，大便连下四次，如酱如胶，恶臭异常，身有微汗。
次日较为好转，谵语不作，撮空亦止，舌上津回，延余复诊。依原方酌减分量，再加连翘三钱，花粉三钱，连服一帖大便再解三次，神识立转清明。后再处调理之方，数服而愈。
当其初处方时，病家问：“何以须如此凉下耶。”余曰：“产妇在十八天以前无病之时，未有不食荤腻补品者，如蹄膀、鸡、鱼、桂圆、大枣等。未病以前，胃肠积垢，仍在其中。既病之后，中医以产后体虚，不敢用凉下之药。西医以泻下之药能引起肠出血，亦不敢用泻下剂。故抗生素虽极对症，而肠胃积垢不去，犹寇盗入主人之室，今注射青霉素，徒以粮资盗寇耳。”病家乃大赞服。
于此可知，每一病症当前，初时不愈，则必有复杂之变症。若徒恃一二种药品，而不能应变处方，以施疗治，乃属劳而无功也。且抗生素之制剂，其作用端在抗菌，一则能妨碍病菌之营养，一则能管制病菌之活动，而使之日暮途穷，渐渐消灭，但并无直接杀菌之能力。然处方目的，对于排泄病菌，并未计及其确定之方，此亦西药疗法之所短也。
泻心汤合承气增液法加石膏、葛根、山栀方生石膏三两粉葛根四钱川黄连一钱五分生黄芩川大黄元明粉生山栀各三钱鲜生地五钱鲜石斛三钱鲜芦根一支湿温肠出血证湿温病延两周日，热度颇高，忽发肠出血证。肛门血出，涓涓不止，体温渐见降低，周身苍白，面无血色，气息微促，手足厥冷，脉沉细而数，扪其胸腹四肢，亦均发凉，而反赤膊赤足，若畏热者，询其欲得冷饮。先与以西瓜汁，次以白虎人参汤加芩、连、地、丹主之。
初未医治，至四五日后，始延闸北附近之医生治之。时医治外感病，通以豆豉、豆卷为首药，其他药味，不问可知。此顾亭林先生所谓“今之医师，其用药也，使人在于不死不活之间，迟延日久，而终至于死也，”可不惧哉。延至两星期，于夜间八时，忽然肛门出血，涓涓不止。再延附近西医，注射止血针药，仍然不止。延至午后十二时，始延余往诊。
其儿媳来时，扣门声甚急，启门视之，则泪流满面，告我以来因，遂与同往。登楼诊视，则仰面而卧，周身苍白，面无血色，气息微促，不言不语，赤膊赤足，只着一短裤，满染鲜血。余问：“体温何时降低。”其妻答曰：“未下血前，终日热高，下午以后尤甚。今一出血，热度即行低降。”于是知其为湿温伤寒之肠出血矣。问：“下血何如此之多。”曰：“已换短裤两条矣，尚有旧布衬于下者，亦均濡湿。”再诊其脉，则沉细而数。两手均觉冰冷，因之再扪其胸腹及四肢，亦同样发凉。而病者则毫不怕冷，不盖被单。时虽当七月初旬，但在晚间小雨之后，至夜深气候颇凉，而病者四肢不收，亦颇若畏热者。病至此时，值得余之慎重考虑矣。
正沉思间，忽触及《伤寒论》中，有一条文云：“身大寒，反不欲近衣者，寒在皮肤，热在骨髓也。”正此症矣。
乃问病者曰，“欲饮冷乎。”病者初无一语，此时忽张目问余曰：“能冷饮乎。”余曰：“莫问能不能，先问要不要。”病者曰：“心中热煞，如何不要。家人不肯与我耳。”余令其妻速购大西瓜来。病者大声曰：“许我食西瓜，死无怨矣。”因为书白虎加人参汤，再加黄芩、黄连、鲜生地、粉丹皮四味。
配方人去，买瓜人来。立将西瓜剖开，以汤匙取汁与之。病者连吃数口，大呼称快，忽自起坐，夺瓜及匙，挖大块西瓜，连瓤啖之。七斤半重之大瓜，立尽其半，乃卧平称快不已。无何药来。令其先煎石膏，次下诸药，后下川连，俟药煎成，再将生地汁冲入，使病者服之。事有至怪者，当食西瓜之后，周身已渐觉转温，但尚末恢复至常温，病者已自觉肛门血少。迨服药后，不一小时，而血渐止矣，体温亦复常。余乃辞去。嘱病者“西瓜少服，其所余之半，再分三次可也。二煎至十时左右再服。”及出门，已至四时。不知东方之既白也。
病者至十时，服二煎后，情形更佳，血不更出。但周身反又发热，仍欲西瓜。至下午四时，延余复诊。余察其热为中度，尚不过高。问“大便解否。”日“未也。”余乃将原方各中药，减量四分之一，再加粉葛根四钱，锦纹军三钱，期其表里两解。再令以西瓜续与之。并嘱“以病者之需要为准，即要食时与食，不要食时，不勉强之。”迨服药之后，先得微汗，约二小时，而表热顿解。至夜间大便解后，里热亦除。据云，“其所下之粪，均为酱黑色。”盖瘀血与粪便俱下也。再服清理余热，佐以调理之剂，数帖而全愈。
最后余有为读者告者，即湿温伤寒之肠出血，系肠中出血。由肛门涓涓而出，非是大便之时粪中夹血。如此险症，设不用西瓜与此方，宁不危哉。西医谓此症不可用泻下药，恐其引动肠出血。孰知此种肠血，均由不用下药而来。若早下之，则内热内湿有去路，绝无此险矣。前贤谓“医者意也，”今人或谓此语似不合科学逻辑，设余诊病时，若意想不及，或不读《伤寒论》者，虽遇此症，而不敢用大剂凉下药，则病者必名登鬼录矣。
白虎人参汤加芩连地丹方生石膏四两肥知母四钱炙甘草三钱西洋参四钱粳米一两黄芩三钱川连一钱五分鲜生地一两(捣汁冲)粉丹皮四钱(按第二方加葛根四钱、大黄三钱)湿温夹食重证中秋而行夏令，天气酷热，饱食荤腻，夜静露宿受寒。
表里不解，化为湿温。高热自汗，气闷胸痞，心腹满痛，谵语烦躁。舌苔湿润腻黄。选用清凉承气汤攻之，腹满不减。
南通刘辉庭之长子，年22岁，习业于上海西藏南路厚康祥布店。在1939年中秋之夕，店中高级职员，至别家晚宴，嘱学徒三人，将所有酒菜，尽量而食。盖秋令尚酷热异常，恐菜类留至次日，亦将腐坏而不能食也。于是刘等乃恣意饮啖，既醉且饱。刘则露宿于凉台之上，至天将明时，觉身寒而返卧室中。无何，即发热头痛。次日延医诊治，时医以薄荷、豆卷等治之不效。
延已五日，始延余诊。余见其高热自汗，舌苔润黄，胸闷腹满，间以谵语。询知饱食荤腻，大便不解。断为夹食之湿温。且温病下不厌早。况如此大热大实之症乎，乃为之处方。清热用石膏、葛根、银花、连翘，化痰用花粉、瓜蒌、半夏、杏仁，祛湿用薏仁、滑石、佩兰，攻积用大承气汤全味。石膏以二两起始，硝、黄以四钱起始，名日清凉承气汤。连服两帖，只肤有微汗，便下黄水少许而已，而发热胸闷腹满仍如故也。乃将石膏加至三两四两，硝、黄加至五钱六钱，而大便仍为稀黄水，热仍不退，积仍不下也。余乃敬谢不敏，请其另延他医。
刘父乃请西医灌肠，二日连灌二次，亦皆灌出稀黄水而已，而发热胸闷腹满仍如故也。复又延余，余乃胆量骤增，检出《伤寒论》之原文：“腹满不减，减不足言，宜大承气汤”与刘父观之，以坚其信心。将石膏加至六两，硝、黄各用八钱，一贴不效，再贴又不效，大便仍为稀黄水耳，此时余亦感计穷。因惊叹曰：所食即是生铁，亦应攻之使下矣，何积聚如此之坚也。店中女仆忽曰：“其他鱼肉不计，但肥鸡一只，已有大半在其一人之腹中。”二学徒亦证明女仆所言不虚。
余闻此言，忽忆中国医学史中，节录《南齐书》褚澄治李道念食鸡一案，以苏子一升，服之而愈。乃决将原方减味，加苏子霜与服。嗣思若加苏子而果效，则为苏子之功耶，抑仍为硝、黄之功耶，将不得而知之矣。决将硝、黄改为五钱，另加苏子五钱。孰意一服之后，夜间即大下数次。
如胶如漆，粘腻异常，恶臭不堪，最可怪者，夹有酒气。腹满仍不甚减。四日之间，续服四帖。积乃去其六七，嗣乃逐渐减量。又服三帖，宿垢去尽，渐思薄粥。再进调理之剂，而渐痊可。计是症经余诊治，十四日中，服凉下药十三帖。
内石膏用四斤有余，硝、黄各用六两有余。昔人谓：“有是症，即用是药。”又曰：“有病则病受之。”观于此症，当益信而不诬矣。
清凉承气汤方生石膏六两粉葛根六钱净银花净连翘天花粉瓜蒌各五钱制半夏杏仁泥薏苡仁飞滑石佩兰各四钱绵纹军元明粉各八钱上川朴三钱炒枳实五钱’(按：此是第三诊所处之方，分量最重，系次第而加，但仍无效。)清凉承气汤加苏子霜方生石膏四两粉葛根净连翘天花粉全瓜萎飞滑石各四钱锦纹军元明粉各五钱川厚朴三钱炒枳实四钱紫苏子霜五钱(按：此方服四帖后，再减量续服三帖。宿垢始去尽，接服调理之剂而愈。)热病热病夹食重证夏令温热，旬余不解。大热无汗，烦躁不安，谵狂互见，唇焦齿垢，舌苔焦黄带黑，而有芒刺。大渴欲饮，便秘溺赤，身有疹痦，大如绿豆。连进白虎增液承气，并令睡卧湿地，恣食西瓜。狂虽止而谵语仍作，便虽通而积滞不下，询知食鸭肉成疾。以白虎合增液承气汤加苏子主之，终加犀角而清之，其病始愈。
粤人陈某，年23岁，在新闸桥北顺昌押典行中为学徒。
于1940年6月间，患温热病，诸医不效，延已旬余。门人郭文忠为其同乡，介余往诊。余见其大热无汗，烦躁不安，谵语频作，唇焦齿垢，舌苔黄腻带黑，而有芒刺，大渴引饮，无时或休，大便秘结，小便短赤，身发有痦疹，大如绿豆，与寻常之痦疹绝不相同。余乃以白虎汤合增液承气汤投之。石膏用至四两，硝、黄各用四钱，并令恣啖西瓜。然大便虽解黄水，而积滞不下。次日石膏加至五两，硝、黄各加至五钱，仍然如故。
心计大肠之津液枯矣，正气惫矣。乃先为之注射灭菌葡萄糖1000毫升，然后仍进前药。并将石膏加至六两，硝、黄各加至六钱，而仍然解下稀水而已。再仿黄龙汤法，加党参三钱，并令卧于湿地，仍然无效。不独无效，且增狂妄，竟欲夺窗而走。乃于方中复加紫雪丹四分，石菖蒲三钱，连进两剂。狂虽止而谵语仍作，便时通而滞绝不下。余为计穷，曾嘱郭生致意病家，另延明哲。而病家以余认症的确，用药有胆有识，设再委之于时医，则必死无疑。力请续诊，虽有不测，决无异言。余见其小便赤黑如鸡血，虽将方笺置诸案上，而搁笔不能为一药。因前举诸方诸法，温热病之治法尽矣。
踌躇半日，忽忆刘辉庭之子，方中加苏子霜而愈。乃细询未病之前，曾食何荤腥。据店中同事云，“曾食鸭肉颇多。”余细思鸡、鸭是一类家禽，刘子食鸡肉成疾，治之有效。陈姓食鸭肉成疾，亦必有效也。乃以前方加苏子霜、莱菔子霜各五钱，促令与服。是夜即得积滞大下。其量颇多，如果酱、如鱼冻，成团成块，陆续下行。腹部稍软，舌苔渐退。四日中连进四贴，积滞去其大半，而小便赤污如故，烦渴不减。计先后所服石膏有四五斤之多，硝、黄各有五六两之多，大西瓜约食廿余只，而病仍如此不易清澈，诚出人意料之外。乃将前方分量略减，并加暹犀角六分，连进两帖，滞乃全去，小溲始清，渐思薄粥。接服调理之剂，又周日而安。
白虎合增液承气汤方生石膏六两肥知母四钱炙甘草三钱鲜生地五钱鲜铁皮斛三钱锦纹军元明粉各六钱炒枳实全瓜蒌各四钱炒粳米一两(按：此亦第三诊用量最重之方，服之无效，转增狂妄。
后加紫雪丹四分，石菖蒲三钱，狂妄虽止，而滞绝不下。)白虎合增液承气汤加苏子霜方生石膏四两肥知母四钱炙甘草二钱鲜生地四钱鲜铁皮斛三钱锦纹军元明粉各五钱炒枳实紫苏子霜莱菔子霜各四钱炒粳米一两(按：此方服后，即积滞大下。然仍烦渴溺赤，内热不清。后将此方稍减分量，加暹犀角六分，连服两帖，热始渐清。)热病神昏发厥证女青年初秋病热，初时恶寒发热，而旋不恶寒，但有热候。不慎口腹，更食糍饭。因之热度更高，达40℃以上。
晚间忽然发厥，顿失知觉，少时转醒。医以退热剂投之，并注射青霉素，热不少减。余以一解四清汤与之，一剂热退，再剂热清而康复。
患者彭庚弟，女性，年方18。习护士业於广慈医院，星期日返家休息。时在1955年7月中旬，秋热如虎，初以纳凉冒风，已觉不适。次又糍饭粘食，更觉饱闷。始之以恶寒发热，至午后则热势尤高。后又转为但热不寒，头痛肢疼，心烦内热，晚间更觉烦躁不安。其父恐生变端，雇车拟送广慈医院。及扶庚弟下楼时，忽然发厥，神昏不语，此即西医所谓休克也。其父情急，立以电话通知医院，派救护车来接，无何车来，此时庚弟已醒转，抬之上车。
及至院中，命具急症手续。约一小时后，医师始为之诊察。当告庚弟父曰：“病可无碍。以热高而发休克，此亦常有之事。为之注射青霉素，内服退热之剂，即可渐愈，慎无惧也。”因即如法治之。病家以女习护士，求住院中疗养，院中以病床人满为辞。彭君无奈，只得要求俟续注一针青霉素后再行返家。届时经第二次注射，并予以内服药数包，乃雇车挈之而返。
Then informed the patient's family that the danger was eight or nine out of ten. After obtaining the consent of the patient's family, prescribed a formula. Used Xie Xin Cheng Qi Zeng Ye Fa (Drain the Heart and Bowels, Augment Fluids Method) as the base, adding Sheng Shi Gao (Raw Gypsum Fibrosum), Ge Gen (Puerariae Radix), and Shan Zhi (Gardeniae Fructus) as the main drugs. After taking one dose, defecated four times consecutively; the stool was like paste and glue, with an extremely foul odor, and the body had a slight sweat.
The next day, the condition improved somewhat; delirium ceased, and picking at empty air stopped; saliva returned to the tongue. Invited Yu Wu Yan for a follow-up consultation. Followed the original formula but reduced the dosages appropriately, added Lian Qiao (Forsythiae Fructus) 3 qian and Hua Fen (Trichosanthis Radix) 3 qian. Continued taking one dose; defecated three more times, and mental clarity returned immediately. Afterwards, prescribed a conditioning formula; after several doses, recovered completely.
When initially prescribing, the patient's family asked: "Why must such cooling and purging methods be used?" I said: "Before falling ill eighteen days ago, when the parturient woman was healthy, she undoubtedly consumed rich, greasy tonics such as pork trotters, chicken, fish, longan, and jujubes. Before illness, accumulated filth in the stomach and intestines remained inside. After becoming ill, Traditional Chinese Medicine (TCM) dares not use cooling purgatives due to postpartum deficiency; Western medicine dares not use purgatives because they may cause intestinal hemorrhage. Therefore, although antibiotics are highly symptomatic, if the accumulated filth in the gastrointestinal tract is not removed, it is like bandits entering the master's house. Injecting penicillin now merely provides provisions for the bandits." The family greatly agreed.
From this, we can see that for every symptom complex, if not cured initially, there will inevitably be complex changes. Relying solely on one or two types of medicines without adapting prescriptions to changes results in futile efforts. Moreover, the action of antibiotic preparations lies in antibacterial effects: on one hand, hindering bacterial nutrition; on the other hand, controlling bacterial activity until they are exhausted and gradually eliminated, but they lack direct bactericidal capability. However, the purpose of prescription does not consider a definitive method for excreting bacteria, which is also a shortcoming of Western medical therapy.
Xie Xin Tang combined with Cheng Qi Zeng Ye Fa plus Shi Gao, Ge Gen, Shan Zhi Formula: Sheng Shi Gao (Raw Gypsum Fibrosum) 3 liang, Fen Ge Gen (Puerariae Radix) 4 qian, Chuan Huang Lian (Coptidis Rhizoma) 1.5 qian, Sheng Huang Qin (Scutellariae Radix) [dosage missing], Da Huang (Rhei Radix et Rhizoma) [dosage missing], Yuan Ming Fen (Natrii Sulfas) [dosage missing], Sheng Shan Zhi (Gardeniae Fructus) each 3 qian, Xian Sheng Di (Rehmanniae Radix Fresh) 5 qian, Xian Shi Hu (Dendrobii Caulis Fresh) 3 qian, Xian Lu Gen (Phragmitis Rhizoma Fresh) 1 piece.
Damp-Warmth Disease with Intestinal Hemorrhage Syndrome: Damp-warmth disease persisted for two weeks with high fever, suddenly developing intestinal hemorrhage. Blood flowed continuously from the anus; body temperature gradually decreased; the whole body was pale, face lacked color, breath was weak and rapid; hands and feet were cold; pulse was deep, fine, and rapid. Palpating chest, abdomen, and limbs revealed coldness, yet the patient exposed bare arms and legs, appearing to fear heat; inquiry revealed desire for cold drinks. First gave watermelon juice, then used Bai Hu Ren Shen Tang (White Tiger and Ginseng Decoction) plus Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Sheng Di (Rehmanniae Radix), and Dan Pi (Moutan Cortex) as the main formula.
Xu Changlin, a fellow townsman living in Shanghai, aged 53, suffered from damp-warmth typhoid in 1943.
Initially untreated, only after four or five days did he seek treatment from a doctor near Zhabei. At that time, doctors treating external contraction diseases typically used Dou Chi (Sojae Semen Praeparatum) and Dou Juan (Sojae Sprout) as primary drugs; other ingredients were predictable. This is what Gu Tinglin said: "Current physicians, in their medication, keep people between life and death, delaying for a long time until death ensues," how can one not fear this? Delayed for two weeks, at 8 PM suddenly developed anal bleeding, flowing continuously. Consulted nearby Western doctors again, injected hemostatic injections, still uncontrolled. Until 12 PM noon, invited me to diagnose.
His daughter-in-law arrived knocking urgently; opening the door, tears streamed down her face, explaining the situation, so I went with her. Ascending the stairs to examine, the patient lay supine, whole body pale, face lacking color, breath weak and rapid, silent, bare-chested and bare-footed, wearing only shorts stained with blood. I asked: "When did the body temperature drop?" His wife replied: "Before bleeding, fever was high all day, especially severe in the afternoon. Now that bleeding started, temperature dropped immediately." Thus knowing this was intestinal hemorrhage of damp-warmth typhoid. Asked: "Why so much bleeding?" Answered: "Already changed two pairs of shorts; old cloth liners underneath were also soaked." Re-palpated pulse: deep, fine, and rapid. Both hands felt cold; therefore palpated chest, abdomen, and limbs, equally cold. But the patient feared no cold, did not cover with blankets. Although it was early July, after evening light rain, the night climate was quite cool, yet the patient's limbs hung limp, resembling heat intolerance. At this stage of illness, careful consideration was warranted.
While pondering, suddenly recalled a passage from Shang Han Lun (Treatise on Cold Damage): "Body feels very cold, yet desires not to wrap in clothes; cold is in the skin, heat is in the bone marrow." Exactly this syndrome.
Asked the patient: "Do you want to drink something cold?" Patient initially silent, then suddenly opened eyes and asked: "Can I drink cold things?" I said: "Don't ask if you can, ask if you want to." Patient said: "Heart burns with heat, how could I not want to? Family refuses to give it to me." Ordered his wife to quickly buy a large watermelon. Patient shouted loudly: "If allowed to eat watermelon, I die without regret." Then wrote Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction), adding Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Xian Sheng Di (Rehmanniae Radix Fresh), and Fen Dan Pi (Moutan Cortex) four herbs.
Prescription sent, melon buyer arrived. Immediately cut open the watermelon, took juice with a spoon and gave it to him. Patient ate several mouthfuls, shouting with pleasure, suddenly sat up, snatched melon and spoon, dug large chunks of watermelon, eating flesh and rind together. A seven-and-a-half-jin large melon, half finished immediately, then lay flat expressing great satisfaction. Soon medicine arrived. Instructed to decoct Shi Gao (Gypsum Fibrosum) first, then add other herbs, finally add Chuan Lian (Coptidis Rhizoma); once decocted, mix in Sheng Di juice, let patient take it. Strange thing occurred: after eating watermelon, body gradually felt warm, though not yet normal temperature, patient already felt anal bleeding decrease. After taking medicine, within less than an hour, bleeding gradually stopped, temperature returned to normal. Then I left. Instructed patient: "Eat less watermelon; divide the remaining half into three portions. Take second decoction around 10 o'clock." Upon exiting, it was already 4 PM. Unaware that dawn had broken.
Patient at 10 o'clock, after taking second decoction, condition better, bleeding ceased. But body heated up again, still desired watermelon. At 4 PM afternoon, invited me for follow-up. Observed moderate fever, not excessively high. Asked: "Have you passed stool?" Answered: "No." Reduced dosage of each herb in original formula by one-quarter, added Fen Ge Gen (Puerariae Radix) 4 qian and Jin Wen Jun (Rhei Radix et Rhizoma) 3 qian, hoping to resolve both exterior and interior. Instructed to continue giving watermelon. Also instructed: "Base actions on patient's needs; give when wanted, do not force when not wanted." After taking medicine, first obtained slight sweat; after about two hours, exterior heat instantly resolved. At night, after passing stool, interior heat also cleared. Reported: "Stool passed was酱黑色 (paste-black)." This was stasis blood mixed with feces. Took another round of clearing residual heat and conditioning agents; after several doses, fully recovered.
Finally, I have something to tell readers: intestinal hemorrhage in damp-warmth typhoid is bleeding from the intestine, flowing continuously from the anus, not blood mixed in stool during defecation. Such a critical condition, if watermelon and this formula were not used, would surely be perilous. Western medicine claims this condition cannot use purgatives, fearing induction of intestinal hemorrhage. Who knew this intestinal blood resulted from *not* using purgatives? If purgatives were used early, internal heat and dampness would have an outlet, avoiding this danger entirely. Ancients said "Physician relies on intuition"; some today say this phrase seems illogical scientifically. If I had failed to intuit this, or not read Shang Han Lun, even encountering this case, daring not use large doses of cooling purgatives, the patient would surely have died.
Bai Hu Ren Shen Tang plus Qin, Lian, Di, Dan Formula: Sheng Shi Gao (Gypsum Fibrosum) 4 liang, Fei Zhi Mu (Anemarrhenae Rhizoma) 4 qian, Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata) 3 qian, Xi Yang Shen (Panacis Quinquefolii Radix) 4 qian, Jing Mi (Oryzae Fructus Glutinosa) 1 liang, Huang Qin (Scutellariae Radix) 3 qian, Chuan Lian (Coptidis Rhizoma) 1.5 qian, Xian Sheng Di (Rehmanniae Radix Fresh) 1 liang (crushed juice mixed in), Fen Dan Pi (Moutan Cortex) 4 qian. (Note: Second formula adds Ge Gen 4 qian, Da Huang 3 qian).
Damp-Warmth Complicated with Food Retention Severe Syndrome: Mid-Autumn season behaving like Summer, weather intensely hot, overeating rich/greasy foods, sleeping outdoors at night catching cold.
Exterior and interior unresolved, transforming into Damp-Warmth. High fever with spontaneous sweating, chest oppression and fullness, abdominal distension and pain, delirium and irritability. Tongue coating moist, greasy, yellow. Selected Qing Liang Cheng Qi Tang (Cooling and Purging Decoction) to attack; abdominal fullness did not decrease.
Inquired learned of excessive consumption of mixed meats; used Qing Liang Cheng Qi Tang plus Su Zi Shuang (Perillae Fructus Frost) to purge; recovered.
Liu Huiting's eldest son from Nantong, aged 22, apprenticed at Hou Kang Xiang Cloth Shop on Tibet South Road, Shanghai. On the eve of Mid-Autumn Festival 1939, senior staff dined elsewhere, instructing three apprentices to consume all food and drink. Likely fearing autumn heat would spoil leftovers. Thus Liu and others ate and drank freely, getting drunk and stuffed. Liu slept outdoors on a balcony; feeling cold near dawn, returned to bedroom. Soon developed fever and headache. Next day sought medical treatment; contemporary doctors treated with Bo He (Menthae Haplocalycis Herba), Dou Juan (Sojae Sprout) etc., ineffective.
Delayed five days before seeking my diagnosis. Saw high fever with spontaneous sweating, moist yellow tongue coating, chest stuffiness and abdominal fullness, intermittent delirium. Inquired learned of gluttony on rich foods, constipation. Diagnosed as Damp-Warmth complicated with food retention. Furthermore, in Warm Diseases, purging is not too early. Especially for such intense heat and excess syndromes. Prescribed: Clear heat with Shi Gao (Gypsum Fibrosum), Ge Gen (Puerariae Radix), Yin Hua (Lonicerae Japonicae Flos), Lian Qiao (Forsythiae Fructus); transform phlegm with Hua Fen (Trichosanthis Radix), Gua Lou (Trichosanthis Fructus), Ban Xia (Pinelliae Rhizoma), Xing Ren (Armeniacae Semen Amarum); dispel dampness with Yi Ren (Coicis Semen), Hua Shi (Talcum), Pei Lan (Eupatorii Herba); purge accumulation with Da Cheng Qi Tang (Major Order the Qi Decoction) full formula. Start Shi Gao at 2 liang, Xiao (Natrii Sulfas) and Huang (Rhei Radix et Rhizoma) start at 4 qian, named Qing Liang Cheng Qi Tang. Took two doses consecutively; only slight sweat on skin, passed small amount of yellow liquid stool; fever, chest stuffiness, and abdominal fullness remained unchanged. Increased Shi Gao to 3 liang, then 4 liang; Xiao and Huang to 5 qian, then 6 qian; stool remained thin yellow liquid, fever did not recede, accumulation did not pass. Respectfully declined further responsibility, advised seeking other doctors.
Liu's father consulted Western doctors for enemas; two consecutive enemas over two days yielded only thin yellow liquid; fever, chest stuffiness, and abdominal fullness remained unchanged. Returned to me; courage surged. Retrieved text from Shang Han Lun: "Abdominal fullness does not decrease, nor is reduction worth mentioning; suitable for Da Cheng Qi Tang" showed to Liu's father to strengthen confidence. Increased Shi Gao to 6 liang, Xiao and Huang each 8 qian. One dose ineffective, second dose ineffective; stool remained thin yellow liquid. At this point, felt out of options. Exclaimed: "Even if ingested raw iron should be purged, why is accumulation so stubborn?" Female servant suddenly said: "Ignoring other meat/fish, a whole fat chicken was mostly eaten by him alone." Two apprentices confirmed servant's statement.
Hearing this, suddenly recalled Medical History excerpting Chu Cheng treating Li Daonian's chicken ingestion case from Nan Qi Shu, cured with 1 sheng of Su Zi (Perillae Fructus). Decided to reduce original formula ingredients, add Su Zi Shuang (Perillae Fructus Frost). Later thought: if effective after adding Su Zi, is it Su Zi's merit or still Xiao/Huang's? Uncertain. Decided to change Xiao/Huang to 5 qian, add Su Zi 5 qian. Unexpectedly, after one dose, massive purging occurred several times at night.
Like glue and lacquer, abnormally sticky, unbearable foul odor; strangest of all, carried alcohol smell. Abdominal fullness still not significantly reduced. Over four days, continued taking four doses. Accumulation cleared 60-70%; subsequently reduced dosage gradually. Took three more doses, old filth completely gone, began craving thin porridge. Advanced conditioning agents, gradually recovered. Calculating this case treated over fourteen days, took thirteen doses of cooling purgatives.
Used over 4 jin of Shi Gao, over 6 liang each of Xiao and Huang. Ancients said: "With this syndrome, use this medicine." And: "When there is disease, the disease receives the medicine." Observing this case, belief in these statements is reinforced.
Qing Liang Cheng Qi Tang Formula: Sheng Shi Gao (Gypsum Fibrosum) 6 liang, Fen Ge Gen (Puerariae Radix) 6 qian, Jing Yin Hua (Lonicerae Japonicae Flos), Jing Lian Qiao (Forsythiae Fructus), Tian Hua Fen (Trichosanthis Radix), Gua Lou (Trichosanthis Fructus) each 5 qian, Zhi Ban Xia (Pinelliae Rhizoma Preparata), Xing Ren Ni (Armeniacae Semen Amarum Paste), Yi Yi Ren (Coicis Semen), Fei Hua Shi (Talcum), Pei Lan (Eupatorii Herba) each 4 qian, Mian Wen Jun (Rhei Radix et Rhizoma), Yuan Ming Fen (Natrii Sulfas) each 8 qian, Shang Chuan Pu (Magnoliae Officinalis Cortex) 3 qian, Chao Zhi Shi (Aurantii Fructus Immaturus Preparata) 5 qian. (Note: This is the third clinic's prescription, heaviest dosage, increased stepwise, yet still ineffective.)
Qing Liang Cheng Qi Tang plus Su Zi Shuang Formula: Sheng Shi Gao (Gypsum Fibrosum) 4 liang, Fen Ge Gen (Puerariae Radix), Jing Lian Qiao (Forsythiae Fructus), Tian Hua Fen (Trichosanthis Radix), Quan Gua Lou (Trichosanthis Fructus), Fei Hua Shi (Talcum) each 4 qian, Jin Wen Jun (Rhei Radix et Rhizoma), Yuan Ming Fen (Natrii Sulfas) each 5 qian, Chuan Hou Po (Magnoliae Officinalis Cortex) 3 qian, Chao Zhi Shi (Aurantii Fructus Immaturus Preparata) 4 qian, Zi Su Zi Shuang (Perillae Fructus Frost) 5 qian. (Note: After taking four doses of this formula, reduced dosage and continued for three more doses. Old filth completely cleared, followed by conditioning agents to recover.)
Heat Disease Complicated with Food Retention Severe Syndrome: Summer warmth, unresolved for over ten days. Great heat without sweat, irritability and restlessness, alternating delirium and mania, dry lips and dental plaque, tongue coating scorched yellow with black, thorny papillae. Great thirst desiring drink, constipation and dark urine, skin eruptions/rash, size of mung beans. Continuously administered Bai Hu Zeng Ye Cheng Qi (White Tiger Augment Fluids Purge Decoction), instructed to sleep on wet ground, eat watermelon freely. Mania stopped but delirium persisted; stool passed but accumulation remained. Inquired learned illness caused by eating duck meat. Used Bai Hu combined with Zeng Ye Cheng Qi Tang plus Su Zi as main treatment; finally added Xi Jiao (Rhinocerotis Cornu) to clear heat; illness finally cured.
Chen from Guangdong, aged 23, apprentice at Shunchang Pawnshop north of Xinzhao Bridge.
In June 1940, suffered from Warm Disease; various doctors ineffective, delayed over ten days. Student Guo Wenzhong, fellow townsman, introduced me to diagnose. Saw great heat without sweat, irritability and restlessness, frequent delirium, dry lips and dental plaque, tongue coating yellow-greasy with black, thorny papillae, great thirst drinking constantly, no respite, severe constipation, scanty dark urine, skin eruptions/rash size of mung beans, absolutely different from ordinary rashes. Used Bai Hu Tang (White Tiger Decoction) combined with Zeng Ye Cheng Qi Tang (Augment Fluids Purge Decoction). Shi Gao (Gypsum Fibrosum) up to 4 liang, Xiao (Natrii Sulfas) and Huang (Rhei Radix et Rhizoma) each 4 qian, instructed to eat watermelon freely. Although stool passed yellow liquid, accumulation did not pass. Next day increased Shi Gao to 5 liang, Xiao and Huang to 5 qian each; still unchanged.
Thought: Large intestine fluids exhausted, righteous qi exhausted. First injected 1000 ml sterile glucose, then continued previous medicine. Increased Shi Gao to 6 liang, Xiao and Huang to 6 qian each; still passed only thin water. Again imitated Huang Long Tang (Yellow Dragon Decoction) method, added Dang Shen (Codonopsis Radix) 3 qian, instructed to lie on wet ground; still ineffective. Not only ineffective, but increased mania, attempting to break window to escape. Added Zi Xue Dan (Purple Snow Pill) 4 fen, Shi Chang Pu (Acori Tatarinowii Rhizoma) 3 qian to formula; took two consecutive doses. Mania stopped but delirium persisted; stool sometimes passed but obstruction absolute. Out of options, instructed Guo to inform family to seek wise doctors. Family insisted I diagnose accurately, prescribed with courage and insight; entrusting to contemporary doctors would surely mean death. Urgently requested continued treatment, accepting any risk without complaint. Saw urine red-black like chicken blood; placed prescription on desk, put down pen unable to prescribe. Because aforementioned formulas and methods exhausted treatments for Warm Disease.
Hesitated half a day, suddenly recalled Liu Huiting's son cured by adding Su Zi Shuang. Carefully inquired what meat/fish eaten before illness. Colleagues reported: "Ate considerable duck meat." Thought carefully: chicken and duck are similar poultry; Liu's son sick from chicken, treatment effective. Chen sick from duck, must also be effective. Used previous formula plus Su Zi Shuang (Perillae Fructus Frost) and Lai Fu Zi Shuang (Radish Seed Frost) each 5 qian, urged administration. That night, massive purging of accumulation occurred. Volume large, like jam or fish jelly, clumped and chunked, descending successively. Abdomen slightly softer, tongue coating gradually retreated. Four days, took four consecutive doses; accumulation cleared more than half; urine remained red/dirty,烦渴 (irritability/thirst) unchanged. Calculated total Shi Gao taken 4-5 jin, Xiao/Huang 5-6 liang each, ate over 20 large watermelons; yet illness so difficult to clear, truly unexpected. Slightly reduced previous formula dosage, added Xi Xi Jiao (Siam Rhinoceros Horn) 6 fen; took two consecutive doses; obstruction completely cleared, urine cleared, began craving thin porridge. Followed with conditioning agents; peaceful after another week.
Bai Hu combined with Zeng Ye Cheng Qi Tang Formula: Sheng Shi Gao (Gypsum Fibrosum) 6 liang, Fei Zhi Mu (Anemarrhenae Rhizoma) 4 qian, Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata) 3 qian, Xian Sheng Di (Rehmanniae Radix Fresh) 5 qian, Xian Tie Pi Hu (Dendrobii Caulis Fresh) 3 qian, Jin Wen Jun (Rhei Radix et Rhizoma), Yuan Ming Fen (Natrii Sulfas) each 6 qian, Chao Zhi Shi (Aurantii Fructus Immaturus Preparata), Quan Gua Lou (Trichosanthis Fructus) each 4 qian, Chao Jing Mi (Oryzae Fructus Glutinosa Preparata) 1 liang. (Note: Also the heaviest dosage formula of third consultation, ineffective, led to increased mania. Later added Zi Xue Dan 4 fen, Shi Chang Pu 3 qian; mania stopped, but obstruction absolute.)
Bai Hu combined with Zeng Ye Cheng Qi Tang plus Su Zi Shuang Formula: Sheng Shi Gao (Gypsum Fibrosum) 4 liang, Fei Zhi Mu (Anemarrhenae Rhizoma) 4 qian, Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata) 2 qian, Xian Sheng Di (Rehmanniae Radix Fresh) 4 qian, Xian Tie Pi Hu (Dendrobii Caulis Fresh) 3 qian, Jin Wen Jun (Rhei Radix et Rhizoma), Yuan Ming Fen (Natrii Sulfas) each 5 qian, Chao Zhi Shi (Aurantii Fructus Immaturus Preparata), Zi Su Zi Shuang (Perillae Fructus Frost), Lai Fu Zi Shuang (Radish Seed Frost) each 4 qian, Chao Jing Mi (Oryzae Fructus Glutinosa Preparata) 1 liang. (Note: After taking this formula, massive purging of accumulation occurred. Yet still irritability/thirst and dark urine, interior heat unclear. Later slightly reduced formula dosage, added Xi Xi Jiao 6 fen; took two consecutive doses, heat gradually cleared.)
Heat Disease with Divine Confusion and Collapse Syndrome: Young female, early autumn heat disease. Initially aversion to cold and fever, soon no longer aversive to cold, only heat signs. Neglected diet, ate glutinous rice cakes. Consequently temperature higher, exceeding 40°C.
Suddenly collapsed at night, lost consciousness, regained awareness after a while. Doctors administered antipyretics and injected penicillin; fever little reduced. Used Yi Jie Si Qing Tang (One Resolve Four Clear Decoction); one dose fever subsided, two doses heat cleared, recovered.
Patient Peng Gengdi, female, aged 18. Studied nursing at Guangci Hospital, returned home to rest on Sunday. Mid-July 1955, autumn heat fierce. Initially cooled off, caught wind, felt uncomfortable. Next, glutinous rice cake sticky food, felt fuller/stuffy. Started with aversion to cold and fever; by afternoon heat intensified. Later transformed to heat only, no cold; headache and limb pain, inner irritability and heat, worse restlessness at night. Father feared complications, hired car to send to Guangci Hospital. While helping Gengdi downstairs, suddenly collapsed, unconscious and speechless; this is Western medicine's shock. Father anxious, immediately called hospital, dispatched ambulance. Car arrived shortly; Gengdi awake, lifted into car.
Arrived at hospital, emergency procedures initiated. About one hour later, physician examined. Told Gengdi's father: "Condition harmless. Shock due to high fever, common occurrence. Inject penicillin, take oral antipyretics, will gradually recover, do not fear." Followed treatment. Family requested hospitalization due to nursing background; hospital cited full beds. Peng reluctantly requested one more penicillin injection before returning home. Received second injection and several packets of oral medicine, hired car to return.