夜间偶发潮热，似有似无，人事不清，尽透大气，恶闻人声，时起时卧，面向里睡，渴不欲饮。医以正气散之治，汗出而烦益甚。从症论之，此受阴暑，暑伤气分，内外两格。而其寸脉见大，关部不及四至，尺部洪而无力。因虑脉与病不合。踌躇良久，碍难处方。遂舍脉从症，嘱其恣食黄瓤瓜，食至不喜吃为度。患者闻之，跃然求食。约食三斤有余，患者叫大便，下水液盈盆，云腹中大为舒畅，上床欲睡。余在病家达四小时，顿见病机若失。当时见其手、面部毫毛竖起，腠理定不宣通，嘱服十物香薷饮，忌油腻，预言秋后必发疟。因其喜凉恶燥，每日深巷纳凉，腠理闭塞，待秋后金燥临旺，疟不免也。至重阳，果打皮寒。
男，年未详
盛暑正午，炎日当空，余路过芦坑，见路旁睡一牛贩，双手捧腹，叫肚痛难受，求水喝，但爬不起来。其面色赤，舌红，认为中暍，即请芦坑街人抬至阴凉处，先用热土置其脐上，余然后对准脐上射尿，至将土射湿为度，防热深入。不到一句钟，该患者已能爬起。后有胡医经过，给太乙救苦丹十粒，两次服下全愈。
女，40岁
深秋患潮热，不进饭食者半月，每日仅食稀米粥、莲子汤等，该妇身体丰满，两颐微红，眉蹙神倦，寸尺均浮数，关部沉而无力，舌微红，中心隐黄，唇色淡红，喉间有酸苦难受。断其伏暑郁冒。眉蹙颐红，当有胃热外见，半月不进饭食，非阳明胃实之可下症，午后潮热，是腠理热，外表不热，乃腠理暑湿内伏，是以不能治表，处方三仁汤：
复诊脉浮稍平，六部一般，舌红，中心隐黄较厚，颐红梢淡，知胃热渐退。该妇云昨晚服药后，打呃三个，腹鸣十余分钟，夜半喉间无酸苦味，仅口微苦。余断其胃热乃暑郁激成，再以三仁汤加味：
煅石膏三钱，香薷二钱，佩兰叶二钱，沙参二钱，益元散三钱，郁金钱半，扁豆二钱，云苓二钱，鲜荷梗二尺同煎。
服二剂，汗出不多，潮热已解，胃口渐趋正常，想吃粥，但吃下作饱。停药五日后，遂大寒大热。因我已下乡，另延黎医以小柴胡治愈。经云：“夏伤于暑，秋必痎疟，”此必然事也。
男，50岁
深秋潮热不退者十余日，面色晦黄，形容焦瘦。据云因受寒而起，当初似疟非疟，无大热，自觉皮肤内蒸蒸，舌边红微黄，能食，二毛骨耸然现象，脉象寸口，浮数无力，两尺数而紧，关部数滑，脉现紊乱，难以体会，思索良久，乃以芳香透络为法，盖认暑入腠理，激；成伏热，欲汗不汗，遂至潮热不解。处方：
佩兰叶二钱，香薷二钱，郁金二钱，青蒿一钱，橘络二钱，丝瓜络三钱，鲜生地二钱益元散三钱，扁豆衣钱半，香豉三十粒，鲜荷梗一尺五寸
服两剂，潮热见减，较前舒服，贪睡。于前方去香薷、青蒿、扁豆、荷梗，加沙参二钱，叩仁二钱，金钗石斛二钱，丝瓜络一尺。
再服二剂，潮热已解，精神好转，换方：
郁金二钱，橘络二钱，丝瓜络三钱，香豉三十粒，当归二钱，赤小豆二钱，寸冬二钱，米炒洋参钱半，五味钱半，淮山二钱，枣皮二钱，四剂病除。
（42）风温
女，年未详
正月中旬，发热自汗，满脸隐红，额时有汗。时北风凛凛，雪花纷飞，其子将门掩上，患者云不要紧，因其似畏风而又不畏风。问病因，云正月初三舂米团，整日当风筛粉，是夜烧热顿起。诊脉浮数，舌边红而中心黄，唇色淡红，微渴，不思食。似此汗出而不退热，无头痛，且不畏风寒，确具春温中之风温见证。开方：
冬桑叶三钱，杭菊三钱，佩兰叶二钱，绿萼梅二钱，芦根三钱，生石膏三钱，白芷钱半，薄荷一钱，香豉三十粒
服两剂，面部不显红色，汗止，口渴，便泄黄水，脉数不浮。知风热将退，于前方加银花三钱，连翘二钱，赤芍钱半，生地二钱，甘蔗汁一杯，去白芷、薄荷、香豉。三剂而愈。
后食老鸭炖海参，当夜泄泻五六次，某医投粟壳、白术、党参、扁豆等，服下腹胀难受。脉见软弱，面色惨暗，舌呈褐色，便带酸臭味，仍溏泻，两足浮肿，余拟方：
川朴钱半，莱菔子二钱，麦芽二钱，法夏曲钱半，神曲二钱，东波叩二钱，扁豆二钱，川连（吴茱萸水炒）二钱
服两剂，泻止。余以为足肿不足为虑，乃病后气虚所致，令服四君子丸，每日开水吞服五十粒，遂全愈。
男，年未详
消瘦不堪，鼻涕眼泪长流，张口透气，语不成句。自汗，舌绛，口渴，溲短，不恶风，唇焦红，食少，夜不成寐，脉浮数不一，此寒凝化热，热极生风，所以鼻塞，痰喘，汗出而不恶风，是风温也。
桑叶三钱，柴胡二钱，瓜蒌仁二钱，苏白钱半，绿萼梅二钱，橘络二钱，象贝二钱，白薇二钱，白前钱半。嘱服二剂。
再诊脉数软，不浮，鼻窍已通，汗少，夜睡较安静。桑叶二钱，南沙参二钱，白果二钱，薏苡仁三钱，芦根三钱，冬瓜仁三钱，白前二钱，白薇二钱，橘络二钱，海浮石二钱，柿霜二钱，蛇胆尖见末一支（随药兑服）令服四剂。
阿胶二钱，泽泻二钱，鸡子黄一个先煎，再入金钗石斛二钱，百合二钱，条芩二钱，五味钱半。服二剂而痊。但闻停药后足肿。
（43）白（疒立口）
男，年未详
烧热不退，医者投九味羌活汤二剂，热愈甚，渴欲饮冷，神昏谵语，家人惶惶不安，某医复诊，解衣查身，出现不水泡，医云是水痘，嘱安天花娘娘，患者拒之。改延余诊。其脉浮数，寸口洪盛，烦扰乱言，两颧见赤，唇舌均绛，时刻叹气。视其身，尽是水晶样泡。余认作白□，拟养阴清热。
佩兰叶二钱，连翘二钱，鲜石斛二钱，鲜生地三钱，栀子皮钱半，玉竹二钱，芦根二钱，生石膏三钱，薏苡仁三钱，丹皮钱半，牛子钱半。
服一剂，患者睡至傍晚犹未醒，至夜间索粥食，身痒甚，水晶泡起如明珠粘身。
再诊脉洪而不大，寸口仍浮数，不似昨日搏指，仍守原方另加：
金银花三钱，连心麦冬二钱，白藓皮二钱，黄芪二钱，绿萼梅二钱，黛黛花二钱
（44）热郁化斑
男，12岁
发烧，热不做声，曾打射火，又用鸡蛋白、雄黄、大■（捣烂）调敷脐上，当夜热退，而突不做声，牙关紧急，不饮不食，双手摄摸身上脉虽应指，按之则无，舌无从辨，只探知湿润，静观其手摸身，不见摸空，似有痒状。乃令解衣，见胸口连串红点，隐约欲现，背部亦然，红点前后分布，齐腰而还，我认是斑，热郁而成者。书方化斑汤。
生石膏四钱，犀角二钱，鲜生地二钱丹皮钱半，连翘心钱半，牛子钱半
次日换方，云能索饮，吃米汤即呕出，知其热犹伏上焦，令服局方至宝丹一粒，说明若有变化，必须复诊。两日后，据述冷战后大热，满身脱皮，余认为热毒从战而解，至于脱皮，不饮食，乃胃津不布，可用香豉泡水，一日吃三次，照服全愈。
（45）热郁喉肿
男，32岁
盛暑啖食红瓤瓜，至傍晚冷热交作，胸口逼寒，喉内发烧，口干，不饮，一夜起伏不安。翌晨无寒热，但见喉间红肿。某医以为是假热，非用温散不可，用桔梗、豆根、射干、甘草、附子、肉桂等，服后觉热气更甚，头晕畏风，咽门觉哽阻，恐甚，着人找我。其脉浮大，关部能应指，两尺平平，知病不十分危急。其备述经过，出示前医方，余度其原，属肺热上逆，复用热散，而至于此。权以附子一两（捣细）用口津拌匀，敷足心，取其以热导热下行，暂不服药，可以绿豆煮水代茶，若能吞下绿豆而咽，则大胆咽下，另购青果同萝卜煎水服，最后吞六神丸十粒，日三次。
次日症状减轻，患者要吃药，用
甘草五钱，桔梗三钱，金银花二钱，板蓝根二钱，原寸冬二钱，碧玉散二钱，四剂全愈。
女，年未详
下利脓血四、五个月，脉象虚缓，无腹痛，非实证也。以协热下利治之。
白头翁二钱，秦皮二钱，黄连二钱，黄柏钱半，黄芩二钱，赤石脂炒当归二钱，地榆炭二钱，酒白芍二钱，阿胶珠二钱，马齿苋一两
服三剂，诸症见减，于原方去柏、连，加侧柏炭二钱，香连丸一钱，石连肉三剂而；痊。
女，30岁
性愚笨，下血，就医时不详告病情，而医者亦不详察病象，误侵前阴出血，用阿胶、肉桂之类，令服4剂，再行复诊。服首剂当晚晕倒在地，口吐血水，举家惶恐，急报其养父范某。范着人邀余往诊。脉寸、尺数紧，关部沉伏，满脸鲜红，舌赤边绛，舌本厚滞，唇红，显属内热之象。问病因，据述前在园中扯苋菜草，回家即下血盈盆，已二十多天。问血从何处出？则羞不作答，察其血，乃散形鲜红者，无黑瘀紫块，不似血脱血积，断为肠红。
茅根四两先煎汤，再入黄芩二钱，鲜生地二钱，芦根三钱，绿豆衣二钱，冬瓜仁三钱，瓜蒌仁二钱，火麻仁二钱，薏苡仁三钱，金钗石斛二钱，地榆二钱，青果炭三个服四剂。
地榆二钱，金钗石斛二钱，鲜生地三钱，芦根三钱，佩兰叶二钱，益元散二钱，槐花二钱，当归二钱，莲子心二钱，青果炭三个，白头翁二钱，秦皮钱半，川柏二钱，仍用茅根水煎药。
再服四剂，血止，但叫肛门痛，肚内响，问有血水流出。仍据肺与大肠之表里关系，润肺气以化病源。
川连二钱，阿胶珠二钱，瓜蒌仁二钱，火麻仁二钱，当归二钱，生地二钱，金钗石斛二钱，地榆二钱，伏龙肝一块，茅根水煎药，再服四剂而愈。按肠红症于徐洄溪医案中所见，余悉照徐医次第投药。
（47）下痢
女，50岁
九月，患利不止，呼叫胀痛，一医投以大承气汤，病家惟恐大泻后虚脱，未服。更医用真人养脏汤，服后痛愈甚，顿转赤利。又更医，治以白头翁汤，痛减，但坠胀益甚。乃戚彭某来探病，检视诸医方，责之“都不会看病”，令购鸦胆子二十四粒，桂元肉包完吞下。服后痢止，仍然腹胀，就余治疗。余以为病未透，非导不可，处方：
焦山楂二钱，大白二钱，地榆二钱，川朴二钱，吴茱萸（川连水炒）二钱，广香二钱，白叩二钱，马齿苋一掬，佛手片二钱，苦瓜霜三钱
连服两剂，便已成粪，仍夹血冻。改服香连丸，每日二钱，遂全愈。
男，50岁
由济南归，患溜肚，一日数通，无兼症，精神软弱。前数医迭用分利、健脾、温肾、消导等药皆罔效，乃召余诊。六脉沉细无力，似有代象，舌隐黄无胎，外见眉蹙神疲，稍露呻吟，问其便色，其妻答以溏泻多水，辨色不清，遂疑之，测其必有变幻。拟方：
赤石脂（炒成粉）五钱，川姜。水煎澄清服下。
傍晚服下药，至夜半屙屎打屁，肛门觉有热气，患者告其妻云此药有效。且云两月未打屁，其素自以打屁见舒服。遂照服原方一剂，又打屁，大便暴下，有屎气，患者甚悦之。
复诊脉细，关部能应指，度数亦明，但无力。舌色通红，呻吟较少，如此必防其虚脱，非养胃不可。嘱每日用陈年仓米三合炖水极浓，徐徐咽下，服二日，若小闻饭香，则有胃气矣，然后再进药。倘此时进药，则胃气不容。
三诊时，情况无显著改善，我认为是不服水土，以藿香正气散去苏叶、白芷，加苍术二钱、法夏曲二钱，嘱服三、四帖。越二日，余往视之，云溏泻未好，但胃口改善，能食大碗，问我见解如何？答以此症乃虚脱性下痢不止，所以用桃花汤以养胃气，用藿香正气散者，因你一路风餐露宿，不无寒湿停中，且不服水土。其去苏叶、白芷者，防其疏散，而取苍术燥湿辛温，以发扬胃气，法夏曲燥湿祛寒。
至于脉中兼代象，乃别脉代此脉之义，与大脉不同，宜自为保护，防春、冬季发生寒湿变幻，须素食，恶油腻或酒，可以红饭豆煮粥吃。然不到春初，原病复发，寒热交作，后成单腹胀，善饥而不食，胀闷告卒。
男，50岁
屙红白冻已两月，自知医理，吃药甚多。病情依然，其向我索方，我思其原有大瘾，恐有肠癖之虑，取林文忠公解烟方制丸药。
熟地八钱，枣皮四钱，淮山五钱，云苓五钱，远志四钱，西党四钱，肉苁蓉四钱茯神五钱，当归四钱，粟壳六钱五味子四钱。研末蜜丸，如梧桐子大，每服四十粒，盐水吞下。（先用烟枪内之烟膏泡汁一盅，吞服丸药，或用烟灰掺入丸药更妙）。
但他因已戒烟，如再服烟灰烟膏汁，虑及复染烟瘾，余嘱服药痢止，吃完丸药（一料），即用好高粱酒和红糖化服。能饮则日服一剂，否则减半。同时，可将藕塘污烂莲子，晒干放粥内煮食，忌鱼腥。其依以上诸法，果验，病后转体胖。
男，52岁春天下痢，脉数有力，舌边红而中心黄，唇赤日夜不安。其卧室瓜果满布，尚有凉菜、卤肉、蛋等堆橱内，断其受暑伤食而成痢。
连服两剂，大泻杂色粪便，兼有块状物。患者自知有效，迳自再服一剂，复下瓜片、肉、蛋诸物，从此霍然。但痢愈而觉腹胀，余知其有烟癖，不愿服药，令服六君子丸收功。
[Background Information]
Book: Medical Experience Records · Medical Cases Chapter: Main Text (7/14) Category: Medical Discussion
Occasional tidal fever (fever occurring at regular intervals like the tide) at night, seemingly present and absent, with unclear consciousness, manifesting throughout the whole body, aversion to hearing human voices, alternating between sitting up and lying down, sleeping facing inward, thirst without desire to drink. The physician treated it with Zhengqi San (a formula for dispelling dampness, releasing the exterior, and harmonizing healthy qi), sweating ensued but irritability worsened. Based on symptoms, this is Yin Summerheat (summerheat contracted due to excessive cooling or cold exposure in summer), where summerheat damages the Qi level, causing obstruction between the interior and exterior. The Cun pulse (radial artery near the wrist crease) appears large, the Guan pulse (middle part of radial artery) is less than four beats per respiration, and the Chi pulse (part of radial artery near the elbow) is flooding but forceless. Concerned that the pulse does not match the disease, I hesitated for a long time, finding it difficult to prescribe. Thus, discarding the pulse diagnosis and treating based on symptoms, I advised the patient to eat yellow-fleshed melon freely until they no longer wished to eat. Upon hearing this, the patient happily requested food. After eating over three jin (approx. 1.5 kg), the patient had a bowel movement, expelling a basin full of watery stool, reporting significant abdominal relief and a desire to sleep. I stayed at the patient's home for four hours, and suddenly the pathological mechanism seemed to vanish. At that time, I observed hair standing erect on his hands and face, indicating that the Couli (skin pores and interstices) were definitely obstructed. I prescribed Shiwu Xiangru Yin (a formula for resolving the exterior and transforming dampness), advised avoiding greasy food, and predicted malaria would inevitably occur after autumn. Because he preferred coolness and disliked dryness, spending days cooling off in deep alleys caused his Couli to close. When the Metal Qi (autumn dryness) becomes strong later in autumn, malaria is unavoidable. Indeed, by the Double Ninth Festival, he suffered from chills and high fever alternating.
Male, age unknown
In the height of summer at noon, under the scorching sun, I passed through Lukeng and saw a cattle dealer sleeping by the road, holding his abdomen with both hands, crying out in severe abdominal pain, asking for water, but unable to get up. His complexion was red, tongue red; I diagnosed it as Heatstroke (Zhong Ye). I immediately asked people from Lukeng street to carry him to a shady place. First, I placed hot earth on his umbilicus, then urinated onto the hot earth until it was wet, to prevent heat from penetrating deeper. Within less than an hour, the patient could crawl up. Later, a doctor surnamed Hu passed by, gave him Taiyi Jiuku Dan (Great Sage Saving Souls Pill), ten pills, which cured him after two doses.
Female, 40 years old
Suffering from tidal fever in late autumn, she had not eaten solid food for half a month, consuming only thin rice porridge and lotus seed soup. The woman was well-built, with slightly red cheeks, furrowed brows, and listless spirit. Both Cun and Chi pulses were floating and rapid, while the Guan pulse was deep and forceless. The tongue was slightly red with hidden yellow in the center, lips pale red, and a sour-bitter discomfort in the throat. Diagnosed as latent summerheat causing oppression and dizziness. Furrowed brows and red cheeks indicate stomach heat manifesting externally. Half a month without eating is not a syndrome of Yangming Stomach Excess (accumulation of excess heat in the stomach and intestines) suitable for purgation. Tidal fever in the afternoon indicates heat in the Couli, with no external heat, suggesting latent summer-dampness within the Couli; thus, exterior-releasing treatment is inappropriate. Prescribed Sanren Tang (Three Seeds Decoction):
Bai Kou Ren (Cardamomi Fructus Rotundus), Yi Yi Ren (Coicis Semen) each 3 qian, Dong Gua Ren (Benincasae Semen) 4 qian, decocted in water and taken orally.
Follow-up visit: The floating pulse became flatter, the six positions were generally normal, tongue red with thicker hidden yellow in the center, cheek redness faded slightly, indicating stomach heat gradually receding. The woman reported that after taking the medicine last night, she belched three times, had borborygmus for over ten minutes, and by midnight the sour-bitter taste in her throat disappeared, leaving only slight bitterness in the mouth. I judged her stomach heat was caused by summerheat stagnation irritating the system, and prescribed Sanren Tang with modifications:
Duan Shi Gao (Calcined Gypsum) 3 qian, Xiang Ru (Moslae Herba) 2 qian, Pei Lan Ye (Eupatorii Folium) 2 qian, Sha Shen (Glehniae Radix) 2 qian, Yiyuan San (Hirudinis et Glycyrrhizae Powder) 3 qian, Yu Jin (Curcumae Radix) 1.5 qian, Bian Dou (Dolichoris Semen) 2 qian, Yun Ling (Poria) 2 qian, Xian He Geng (Nelumbinis Petiolus) 2 chi, decocted together.
After two doses, sweating was minimal, tidal fever resolved, appetite returned to normal, desiring porridge but feeling full quickly. Five days after stopping medication, sudden severe chills and high fever occurred. As I had gone to the countryside, another physician named Li cured her with Xiaochaihu Tang (Minor Bupleurum Decoction). The Classic states: "Summer injury by summerheat leads to Jie Malaria in autumn," which is inevitable.
Male, 50 years old
Tidal fever persisted for over ten days in late autumn, complexion dull yellow, emaciated. Claimed to have started from cold exposure. Initially resembled malaria but wasn't, with no high fever, yet felt internal steaming heat from the skin. Tongue edges red with slight yellow, able to eat, hair erect. Pulse at Cun Kou was floating, rapid, and forceless; both Chi pulses were rapid and tight; Guan pulse was rapid and slippery. The pulse was chaotic and difficult to grasp. After much thought, I adopted the method of aromatic meridians penetration, recognizing that summerheat entered the Couli, irritating latent heat, wanting to sweat but unable to do so, leading to unresolved tidal fever. Prescribed:
Pei Lan Ye 2 qian, Xiang Ru 2 qian, Yu Jin 2 qian, Qing Hao (Artemisiae Annuae Herba) 1 qian, Ju Luo (Citri Reticulatae Pericarpium Retinervum) 2 qian, Si Gua Luo (Luffae Fructus Retinervum) 3 qian, Xian Sheng Di (Rehmanniae Radix Recens) 2 qian, Yiyuan San 3 qian, Bian Dou Yi (Dolichoris Semen Testa) 1.5 qian, Xiang Chi (Fermented Soybean) 30 grains, Xian He Geng 1.5 chi.
After two doses, tidal fever decreased, feeling more comfortable, sleepy. Removed Xiang Ru, Qing Hao, Bian Dou, He Geng from the previous formula; added Sha Shen 2 qian, Bai Kou Ren 2 qian, Jin Chai Shi Hu (Dendrobii Noduli) 2 qian, Si Gua Luo 1 chi.
After another two doses, tidal fever resolved, spirit improved. Changed prescription:
Yu Jin 2 qian, Ju Luo 2 qian, Si Gua Luo 3 qian, Xiang Chi 30 grains, Dang Gui (Angelicae Sinensis Radix) 2 qian, Chi Xiao Dou (Adzuki Bean) 2 qian, Cun Dong (Ophiopogonis Radix) 2 qian, Mi Chao Yang Shen (Panax Ginseng Radix et Rhizoma stir-fried with rice) 1.5 qian, Wu Wei Zi (Schisandrae Fructus) 1.5 qian, Huai Shan (Dioscoreae Rhizoma) 2 qian, Zao Pi (Zizyphi Fructus) 2 qian. Four doses cured the illness.
(42) Wind-Warmth
Female, age unknown
Mid-January, fever with spontaneous sweating, faint redness all over the face, occasional sweating on the forehead. North wind was biting, snowflakes flying. Her son closed the door; the patient said it didn't matter, as she seemed afraid of wind but also not afraid of it. Asking about the cause, she said on the third day of the first lunar month, she pounded rice balls and sifted flour all day against the wind. That night, fever spiked suddenly. Pulse floating and rapid, tongue edges red with yellow center, lips pale red, slight thirst, no appetite. Such sweating without reducing fever, no headache, and aversion neither to wind nor cold, indeed presents the Wind-Warmth manifestation within Spring-Warmth. Prescribed:
Dong Sang Ye (Mori Folium) 3 qian, Hang Ju (Chrysanthemi Flos) 3 qian, Pei Lan Ye 2 qian, Lv E Mei (Prunus mume flos) 2 qian, Lu Gen (Phragmitis Rhizoma) 3 qian, Sheng Shi Gao (Gypsum Fibrosum) 3 qian, Bai Zhi (Angelicae Dahuricae Radix) 1.5 qian, Bo He (Menthae Haplocalycis Herba) 1 qian, Xiang Chi 30 grains.
After two doses, facial redness disappeared, sweating stopped, thirst appeared, diarrhea of yellow water, pulse rapid but no longer floating. Knowing wind-heat was retreating, added Yin Hua (Lonicerae Japonicae Flos) 3 qian, Lian Qiao (Forsythiae Fructus) 2 qian, Chi Shao (Paeoniae Radix Rubra) 1.5 qian, Sheng Di (Rehmanniae Radix) 2 qian, Gan Zhe Zhi (Saccharum Jelly) one cup to the previous formula; removed Bai Zhi, Bo He, Xiang Chi. Cured in three doses.
Later ate old duck stewed with sea cucumber. That night, diarrhea five or six times. A certain doctor administered Su Ke (Cortex Cornus Fructus), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Dang Shen (Codonopsis Radix), Bian Dou, etc. After taking them, abdominal distension and discomfort occurred. Pulse weak, complexion dark, tongue brown, stool acidic and smelly, still loose stool, bilateral foot edema. I formulated:
Chuan Po (Magnoliae Officinalis Cortex) 1.5 qian, Lai Fu Zi (Raphani Semen) 2 qian, Mai Ya (Hordei Fructus Germinatus) 2 qian, Fa Xia Qu (Pinelliae Preparata et Saccharum) 1.5 qian, Shen Qu (Massa Medicata Fermentata) 2 qian, Dong Bo Kou (Citri Reticulatae Pericarpium) 2 qian, Bian Dou 2 qian, Chuan Lian (Coptidis Rhizoma stir-fried with Evodiae Fructus water) 2 qian.
After two doses, diarrhea stopped. I considered foot edema negligible, caused by post-illness Qi deficiency, and ordered Sijunzi Wan (Four Gentlemen Pills), taken orally with boiled water, fifty pills daily, resulting in complete recovery.
Male, age unknown
Extremely emaciated, continuous runny nose and tears, breathing through open mouth, speech unintelligible. Spontaneous sweating, crimson tongue, thirst, short urine, no aversion to wind, cracked red lips, poor appetite, insomnia at night, pulse floating and rapid irregularly. This is cold congealing transforming into heat, extreme heat generating wind, causing nasal congestion, phlegm-wheezing, sweating without aversion to wind; this is Wind-Warmth.
Sang Ye 3 qian, Chai Hu (Bupleuri Radix) 2 qian, Gua Lou Ren (Trichosanthis Semen) 1.5 qian, Su Bai (Perillae Folium?) 1.5 qian, Lv E Mei 2 qian, Ju Luo 2 qian, Xiang Bei (Sinomenii Caulis? likely Zhe Bei Mu) 2 qian, Bai Wei (Cynanchi Atrati Radix) 2 qian, Bai Qian (Cynanchi Stauntonii Rhizoma et Radix) 1.5 qian. Instructed to take two doses.
Second visit: Pulse rapid and soft, no longer floating, nasal passages clear, less sweating, quieter sleep at night. Sang Ye 2 qian, Nan Sha Shen (Glehniae Radix) 2 qian, Bai Guo (Ginkgonis Semen) 2 qian, Yi Yi Ren 3 qian, Lu Gen 3 qian, Dong Gua Ren 3 qian, Bai Qian 2 qian, Bai Wei 2 qian, Ju Luo 2 qian, Hai Fu Shi (Pumex) 2 qian, Shi Shuang (Diospyros Frost) 2 qian, She Dan Jian (Snake Gallbladder Tip) one piece (mixed with medicine powder). Take four doses.
Third visit: Phlegm-wheezing greatly reduced, but restless sleep at night.
E Jiao (Asini Corii Colla) 2 qian, Ze Xie (Alismatis Rhizoma) 2 qian, Ji Zi Huang (Galli Ovum Vitellus) one egg yolk, decocted first; then add Jin Chai Shi Hu 2 qian, Bai He (Lilii Bulbus) 2 qian, Tiao Qin (Scutellariae Radix) 2 qian, Wu Wei Zi 1.5 qian. Two doses cured. But heard of foot swelling after stopping medication.
(43) Bai Fei (White Papules)
Male, age unknown
Persistent fever. Physicians gave Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) for two doses, heat worsened, thirst for cold drinks, delirium, family anxious. Another doctor examined the body after undressing, found non-blistering papules, diagnosed as chickenpox, advised worshipping the Heavenly Flower Goddess. Patient refused. Consulted me. Pulse floating and rapid, Cun Kou flooding, irritable and confused speech, red malar area, crimson lips and tongue, frequent sighing. Body covered in crystal-like papules. Diagnosed as Bai Fei, planned nourishing Yin and clearing heat.
Pei Lan Ye 2 qian, Lian Qiao 2 qian, Xian Shi Hu (Dendrobii Nodulus) 2 qian, Xian Sheng Di 3 qian, Zhi Zi Pi (Gardeniae Pericarpium) 1.5 qian, Yu Zhu (Polygonati Odorati Rhizoma) 2 qian, Lu Gen 2 qian, Sheng Shi Gao 3 qian, Yi Yi Ren 3 qian, Dan Pi (Moutan Cortex) 1.5 qian, Niu Zi (Arctii Fructus) 1.5 qian.
One dose taken, patient slept until evening still unconscious, woke at night asking for porridge, severe itching, crystal papules rose like pearls sticking to the body.
Second visit: Pulse flooding but not large, Cun Kou still floating and rapid, not as bounding as yesterday. Maintained original formula plus:
Jin Yin Hua (Lonicerae Japonicae Flos) 3 qian, Lian Xin Mai Dong (Ophiopogonis Radix cum Medulla) 2 qian, Bai Xian Pi (Dictamni Cortex) 2 qian, Huang Qi (Astragali Radix) 2 qian, Lv E Mei 2 qian, Dai Dai Hua (Osmanthus Fragrans Flos) 2 qian.
Two doses taken, white papules gone, only listless spirit and somnolence. Cured by self-administering American ginseng soaked in water.
(44) Heat Stagnation Transforming into Macules
Male, 12 years old
Fever, silent due to heat, previously subjected to fire-shooting therapy (likely cauterization or similar), and application of egg white, Realgar, and crushed [herb] to the umbilicus. Heat subsided that night, but suddenly became mute, trismus, no drinking or eating, hands patting body. Pulse responsive to touch but vanishes upon pressure, tongue unidentifiable, only moist. Watching him pat his body, not grasping at empty air, seemed itchy. Ordered undressing, saw continuous red spots on chest, faintly appearing, similarly on back, distributed front and back, reaching waist. Identified as macules formed by heat stagnation. Prescribed Huaban Tang (Macule-Resolving Decoction).
Sheng Shi Gao 4 qian, Xi Jiao (Rhinocerotis Cornu) 2 qian, Xian Sheng Di 2 qian, Dan Pi 1.5 qian, Lian Qiao Xin (Forsythiae Fructus Medulla) 1.5 qian, Niu Zi 1.5 qian.
After taking, knew itching, condition stable. Instructed to use Zixue Dan (Purple Snow Pill) mixed with boiled water.
Next day changed prescription, said could ask for drink, vomited rice soup, knowing heat still lodged in Upper Jiao. Instructed to take Yifang Zhibao Dan (Official Formula Treasure of Life Pill) one pill, explained must follow up if changes occur. Two days later, reported severe chills followed by high fever, peeling skin all over. Believed heat toxin resolved through shaking. Peeling and lack of appetite due to failure of Stomach fluids to distribute. Could use Xiang Chi soaked in water, three times daily, continued until cured.
(45) Heat Stagnation Throat Swelling
Male, 32 years old
Consumed red-fleshed melon in midsummer. By evening, alternating chills and fever, chest feeling oppressive cold, throat burning, dry mouth, no desire to drink, restless all night. Next morning no chills or fever, but throat red and swollen. A doctor thought it was false heat, insisted on warm dispersal, used Jie Geng (Platycodonis Radix), Dou Gen (Stemonae Radix), She Gan (Belamcandae Rhizoma), Gan Cao (Glycyrrhizae Radix), Fu Zi (Aconiti Lateralis Radix Praeparata), Rou Gui (Cinnamomi Cortex), etc. After taking, heat sensation intensified, dizziness, aversion to wind, choking sensation in throat, great fear, sent for me. Pulse floating and large, Guan pulse responsive, both Chi pulses flat. Knew illness not critical. Listened to history, showed previous prescription. Judged origin as Lung heat reversing upward, repeated warm dispersal led to this. Temporarily applied Fu Zi (one liang, finely ground) mixed with saliva to sole of foot, using heat to guide heat downward. No oral medicine temporarily. Can boil mung beans for tea. If able to swallow mung bean, swallow boldly. Also buy Qing Guo (Canarium album fruit) boiled with radish to drink. Finally swallow Liushen Wan (Six Gods Pill) ten pills, three times daily.
Next day symptoms alleviated, patient wanted medicine, used:
Gan Cao 5 qian, Jie Geng 3 qian, Jin Yin Hua 2 qian, Ban Lan Gen (Isatidis Radix) 2 qian, Yuan Cun Dong 2 qian, Bi Yu San (Jade Green Powder) 2 qian. Four doses cured.
(46) Dysentery with Pus and Blood, Intestinal Redness
Female, age unknown
Dysentery with pus and blood for four to five months, pulse deficient and slow, no abdominal pain, not excess syndrome. Treated as dysentery with accompanying heat.
Bai Tou Weng (Pulsatillae Radix) 2 qian, Qin Pi (Fraxini Cortex) 2 qian, Huang Lian (Coptidis Rhizoma) 2 qian, Huang Bai (Phellodendri Cortex) 1.5 qian, Huang Qin (Scutellariae Radix) 2 qian, Chi Shi Zhi stir-fried with Dang Gui 2 qian, Di Yu Tan (Sanguisorbae Carbonized Radix) 2 qian, Jiu Bai Shao (Paeoniae Radix Alba wine-processed) 2 qian, E Jiao Zhu (Asini Corii Colla prepared beads) 2 qian, Ma Chi Xian (Portulacae Herba) one liang.
Three doses taken, symptoms reduced. Removed Huang Bai and Huang Lian from original formula, added Ce Bai Tan (Biota Tops Carbonized) 2 qian, Xiang Lian Wan (Amomum and Coptis Pill) 1 qian. Three doses of Shi Lian Rou cured.
Female, 30 years old
Intelligent deficit, bleeding, did not disclose condition accurately when seeking medical help, and physician did not examine thoroughly, mistakenly treating anterior genital bleeding, used E Jiao, Rou Gui, etc., instructed to take 4 doses, then follow up. After first dose, fainted on ground that night, vomiting blood and water, family panicked, urgently notified adoptive father Fan. Fan invited me. Pulse Cun and Chi rapid and tight, Guan deep and hidden, face bright red, tongue red with crimson edges, tongue root thick and stagnant, lips red, clearly internal heat. Asked cause, stated plucking amaranth grass in garden earlier, returned home and had a basin full of blood, already over twenty days. Asked where blood comes from? Ashamed not to answer. Examined blood, scattered fresh red, no black stasis purple clots, unlike blood loss or accumulation, diagnosed as Intestinal Redness (hematochezia).
Mao Gen (Imperatae Rhizoma) four liang decocted first, then add Huang Qin 2 qian, Xian Sheng Di 2 qian, Lu Gen 3 qian, Lv Dou Yi (Vigna Radiata Testa) 2 qian, Dong Gua Ren 3 qian, Gua Lou Ren 2 qian, Huo Ma Ren (Cannabis Semen) 2 qian, Yi Yi Ren 3 qian, Jin Chai Shi Hu 2 qian, Di Yu 2 qian, Qing Guo Tan (Canarium carbonized) three. Take four doses.
Bleeding drastically reduced, pulse rapid and normalized. Family confirmed it was indeed hematochezia. Changed prescription:
Di Yu 2 qian, Jin Chai Shi Hu 2 qian, Xian Sheng Di 3 qian, Lu Gen 3 qian, Pei Lan Ye 2 qian, Yiyuan San 2 qian, Huai Hua (Sophorae Flos) 2 qian, Dang Gui 2 qian, Lian Zi Xin (Nelumbinis Plumula) 2 qian, Qing Guo Tan three, Bai Tou Weng 2 qian, Qin Pi 1.5 qian, Chuan Bai (Phellodendri Cortex) 2 qian. Still decoct with Mao Gen water.
Another four doses, bleeding stopped, but complained of anal pain, abdominal rumbling, asked if blood water flowing out. Still according to the exterior-interior relationship between Lung and Large Intestine, moisten Lung Qi to transform disease source.
Chuan Lian 2 qian, E Jiao Zhu 2 qian, Gua Lou Ren 2 qian, Huo Ma Ren 2 qian, Dang Gui 2 qian, Sheng Di 2 qian, Jin Chai Shi Hu 2 qian, Di Yu 2 qian, Fu Long Gan (Dragon's House Earth) one piece. Decoct with Mao Gen water. Another four doses cured. Regarding Intestinal Redness cases seen in Xu Huixi's medical records, I followed Dr. Xu's sequence completely.
(47) Dysentery
Female, 50 years old
September, dysentery unceasing, calling out with pain and distension. One doctor gave Da Chengqi Tang (Major Order the Qi Decoction), family feared collapse after severe diarrhea, did not take. Another doctor used Zhenren Yangzang Tang (True Man Nourish Viscera Decoction), after taking pain worsened, suddenly turned to bloody dysentery. Yet another doctor treated with Bai Tou Weng Tang, pain reduced but heaviness and bearing-down sensation increased. Relative Peng visited, inspected prescriptions, blamed "none know how to treat," ordered buying 24 Yadanzi (Brucea javanica seeds), wrapped in Longan flesh to swallow. After taking, dysentery stopped, but abdominal distension remained, sought my treatment. I believed disease not fully cleared, needed guiding out. Prescribed:
Jiao Shan Zha (Crataegi Fructus stir-fried) 2 qian, Da Bai (Zhi Shi? likely Zhi Shi) 2 qian, Di Yu 2 qian, Chuan Po 2 qian, Wu Zhu Yu (Evodiae Fructus stir-fried with Chuan Lian water) 2 qian, Guang Xiang (Litseaee Fructus) 2 qian, Bai Kou 2 qian, Ma Chi Xian one handful, Fo Shou Pian (Citri Sarcodactylis Fructus slices) 2 qian, Ku Gua Shuang (Momordicae Fructus Frost) 3 qian.
Taken continuously for two doses, stool formed feces, still mixed with blood and mucus. Changed to Xiang Lian Wan, 2 qian daily, cured.
Male, 50 years old
Returned from Jinan, suffered from loose stools, several times a day, no accompanying symptoms, weak spirit. Previous doctors repeatedly used diuretics, spleen-tonifying, kidney-warming, digestion-promoting drugs all ineffective. Summoned me. Six pulses deep, fine, forceless, resembling Dai pulse (intermittent). Tongue hidden yellow, no coating, externally furrowed brows, listless, slight groaning. Asked stool color, wife answered watery loose stool, unclear color, suspected changes. Formulated:
Chi Shi Zhi (Kaolin) (stir-fried to powder) 5 qian, Chuan Jiang (Zingiberis Rhizoma) decocted in water, clarified and taken.
Evening dose taken, by midnight defecated and passed gas, anus felt hot heat. Patient told wife medicine effective. Said hadn't passed gas in two months, usually felt comfortable passing gas. Continued original formula one dose, passed gas again, violent diarrhea with stool odor, patient very pleased.
Follow-up: Pulse fine, Guan responsive, rate clear but forceless. Tongue bright red, less groaning. Must prevent collapse, must nourish stomach. Instructed to use aged warehouse rice three he measured, stew water extremely thick, swallow slowly. Take two days, if smell of rice appreciated, then Stomach Qi returns, then advance medicine. If medicine advanced now, Stomach Qi cannot tolerate.
Third visit: Condition no significant improvement. I believed it was maladaptation to local environment. Used Huoxiang Zhengqi San (Agastache Rectify Qi Powder) removing Su Ye and Bai Zhi, added Cang Zhu 2 qian, Fa Xia Qu 2 qian, instructed to take three or four doses. Two days later, I visited, said loose stool not cured, but appetite improved, can eat large bowl. Asked for opinion. Answered this case is collapse-type dysentery unceasing, so used Taohua Tang (Peach Kernel Decoction) to nourish Stomach Qi. Used Huoxiang Zhengqi San because you traveled exposed to wind and dew, surely cold-dampness stagnated in middle, and maladaptation. Removing Su Ye and Bai Zhi to prevent dispersal, taking Cang Zhu for drying dampness and pungent-warmth to promote Stomach Qi, Fa Xia Qu for drying dampness and dispelling cold.
Regarding Dai pulse in pulse, it means other pulses replacing this pulse, different from large pulse. Should protect oneself, prevent cold-damp changes in spring/winter. Must eat vegetarian, dislike greasy food or alcohol. Can cook red rice beans into porridge. However, before early spring, original disease relapsed, alternating chills and fever, later developed single abdominal distension, hunger but no desire to eat, distension and oppression ended abruptly.
Male, 50 years old
Passed red and white mucus for two months, knew medical principles, took many medicines. Condition unchanged, requested prescription from me. Thought he had heavy addiction (smoking), feared intestinal parasites/dysentery. Took Lin Wenzhong Gong's Smoking-Cessation Formula to make pills.
Shu Di (Rehmanniae Radix Preparata) 8 qian, Zao Pi 4 qian, Huai Shan 5 qian, Yun Ling 5 qian, Yuan Zhi (Polygalae Radix) 4 qian, Xi Dang (Codonopsis Radix) 4 qian, Rou Cong Rong (Cynomorphi Herba) 4 qian, Fu Shen (Poria with Hostwood) 5 qian, Dang Gui 4 qian, Su Ke (Cornus Fructus Cortex) 6 qian, Wu Wei Zi 4 qian. Grind to powder, honey pills, size of paulownia seeds. Take forty pills each time, swallow with salt water. (First soak tobacco paste juice from pipe in one cup, swallow pills with it, or mix tobacco ash into pills is better).
But since he quit smoking, if taking tobacco ash/paste juice again, fearing relapse, I instructed: after medicine stops dysentery, finish one batch of pills, then dissolve in good sorghum liquor and brown sugar. If can drink, take one dose daily, otherwise half. Meanwhile, can take rotten lotus seeds from pond, dry and cook in porridge. Avoid fishy smells. Followed these methods, indeed effective, gained weight after illness.
Male, 52 years old
Spring dysentery, pulse rapid and forceful, tongue edges red center yellow, lips red, restless day and night. Bedroom filled with fruits, cabinet piled with cold dishes, braised meat, eggs. Diagnosed as summerheat and food retention causing dysentery.
Da Huang (Rhei Radix et Rhizoma) 3 qian, Zhi Shi (Aurantii Fructus Immaturus) 3 qian, Chuan Po 2 qian, Po Xiao (Natri Sulfas) 2 qian.
Taken continuously for two doses, massive diarrhea of mixed colored feces, including lumps. Patient knew it was effective, took another dose alone, passed melon slices, meat, eggs, thereafter recovered. But after dysentery cured, felt abdominal distension. Knew he had smoking habit, unwilling to take medicine, ordered Liujunzi Wan (Six Gentlemen Pills) to conclude treatment.
(48) Cold, Dampness, Heat Syndromes