盐山范××，年五十余，素有肺痨，发时咳嗽连连，微兼喘促。仲夏末旬，喘发甚剧，咳嗽昼夜不止，且
呕血甚多。延医服药十余日，咳嗽呕血，似更加剧，惫莫能支。适愚自沧回籍，求为延医，其脉象洪而微数，
右部又实而有力，视其舌苔白浓欲黄，问其心中甚热，大便二三日一行，诊毕，断曰∶此温病之热，盘
据阳明之府，逼迫胃气上逆，因并肺气上逆，所以咳喘连连，且屡次呕血也。治病宜清其源，若将温病之热
治愈，则咳喘、呕血不治自愈矣。其家人谓，从前原不觉有外感，即屡次延医服药，亦未尝言有外感，何
以先生独谓系温病乎？答曰∶此病脉象洪实，舌苔之白浓欲黄，及心中之发热，皆为温病之显征。其初不觉有
外感者，因此乃伏气化热而为温病。其受病之原因，在冬令被寒，伏于三焦脂膜之中，因春令阳盛化热而发
动，窜入各脏腑为温病。亦有迟至夏秋而发者，其症不必有新受之外感，亦间有薄受外感不觉，而伏气即因
之发动者，《内经》所谓∶“冬伤于寒，春必病温”者，此也。遂为疏方∶
生地（二两） 生石膏（一两） 知母（八钱） 甘草（一钱）
广犀角（三钱另煎兑服） 三七（二钱细末用水送服）
煎汤两茶盅，分三次温饮下，一剂而诸病皆愈。又改用玄参、贝母、知母、花粉、甘草、白芍诸药，煎
汤服。另用水送服三七末钱许，服两剂后，俾用生山药末煮粥，少加白糖，每次送
服赭石细末钱许，以治其从前之肺痨。若觉热时，则用鲜白茅根
四五两，切碎煮两三沸，当茶饮之。如此调养月余，肺痨亦大见愈。
按∶吐血之症，原忌骤用凉药，恐其离经之血得凉而凝，变为血痹虚劳也。而此症因有温病之壮热，
不得不用凉药以清之，而有三七之善化瘀血者以辅之，所以服之而有益无弊也。
盐山王××，年近六旬，自孟夏患痢，延医服药五十余剂，痢已愈而病转加剧，卧床昏昏有危在旦夕之
虞。此际适愚自沧回籍，求为延医，其脉左右皆洪实，一息五至，表里俱觉发热，胁下连腹，疼痛异常。其
舌苔白浓，中心微黄，大便二三日一行。愚曰∶“此伏气化热而为温病也。当其伏气化热之初，肠为
热迫，酝酿成痢与温俱来。然温为正病，痢为兼病。医者但知治其兼病，而不知治其正病，痢虽愈而温益重。
绵延六十余日，病者何以堪乎？”其家人曰∶“先生之论诚然，特是既为温病，腹胁若是疼痛者何也？将勿
腹中有郁积乎？”答曰∶“从前云大便两三日一行，未必腹有郁积。以脉言之，凡温病之壮热，大抵现
于右脉，因壮热原属阳明胃府之脉，诊于右关也，今左部之脉亦见洪实，肝胆之火必炽盛，而肝木之气，即
乘火之炽盛而施其横恣，此腹胁所以作疼也。”遂为开大剂白虎加人参汤，方用生石膏四两，人参六钱以
滋阴分。为其腹胁疼痛，遵伤寒方例，加生杭芍六钱，更加川楝子六钱，疏通肝胆之郁热下行，以辅芍药之
不逮。令煎汤三茶盅，分三次温饮下。降下粘滞之物若干。持其便盆者，觉热透盆外，其病顿愈，可以进食。
隔二日腹胁又微觉疼，俾用元明粉四钱，净蜜两半，开水调服，又降下粘滞之物若干，病自此全愈。
愚孙，年九岁，于正月下旬感冒风寒，两三日间，表里俱觉
发热。诊其脉象洪实，舌苔白浓。问其大便两日未行，小便色
黄。知其外感之实热，已入阳明之府。为疏方∶
生石膏（二两） 知母（六钱） 连壳（三钱） 薄荷叶（钱半） 甘草（二钱）
晚六点时煎汤两茶盅，分两次服下，翌晨热退强半。因有事他出，临行嘱煎渣与服。阅四日来信言，仍
不愈。按原方又服一剂，亦不见轻。斯时，头面皆肿，愚遂进城往视，见其头面肿甚
剧，脉象之热较前又盛，舌苔中心已黄，大便三日未行。为疏方∶
生石膏（四两） 玄参（一两） 连壳（三钱） 银花（三钱） 甘草（三钱）
煎汤三茶盅，又将西药阿斯匹林三分，融化汤中，分三次温服下。头面周身微汗，热退肿
消，继服清火养阴之剂两剂以善其后。
又邻村李姓少年，亦同时得大头瘟症，医治旬日，病益剧，亦求愚治。其头面连项皆肿，心中烦躁不能
饮食，其脉象虽有热，而重按无力。盖其旧有鸦片嗜好，下元素虚，且大便不实，不敢投以大凉之剂。为疏方∶
玄参（一两） 花粉（五钱） 银花（五钱） 薄荷（钱半） 甘草（钱半）
煎汤一大盅，送服阿斯匹林二分，头面周身皆出汗，病遂脱然全愈。
邻村孙××，年三十许，自初夏得喘症。动则作喘，即安居呼吸亦似迫促，服药五十余剂不愈。医者
以为已成肺痨诿为不治。闻愚回籍求为延医，其脉浮而滑，右寸关尤甚，知其风与痰
互相胶漆滞塞肺窍也。为开麻杏甘石汤∶
麻黄三钱、杏仁三钱、生石膏一两、甘草钱半，煎汤送服苦葶苈子（炒熟）二钱，一剂而喘定，继又服
利痰润肺少加表散之
剂，数服全愈。
邻村刁××，年二十余，自孟冬得喘症。迁延百余日，喘益加剧，屡次延医服药，分毫无效。其脉浮
而无力，数近六至，知其肺为风袭，故作喘。病久阴虚，肝肾不能纳气，故其喘浸剧也。即其脉而论，此时肺
中之风邪犹然存在，欲以散风之药祛之，又恐脉数阴虚益耗其阴分。于是用麻黄三钱，而佐以生山药
二两，临睡时煎服，夜间得微汗，喘愈强半。为脉象虚数，不敢连用发表之剂，俾继用生山药末八钱煮粥，
少调白糖，当点心用，日两次，若服之觉闷，可用粥送服鸡内金末五分，如此服药约半月，喘又见轻。再
诊其脉，不若从前之数，仍投以从前汤药方，又得微汗，喘又稍轻，又服山药粥月余全愈。
沧县王媪，年七旬有一，于仲冬胁下作疼，恶心呕吐，大便燥结。服药月余，更医十余人，病浸加剧。
及愚诊视时，不食者已六七日，大便不行者已二十余日。其脉数五至余，弦而有力，左右皆然。舌苔满布，
起芒刺，色微黄。其心中时觉发热，偶或作渴，仍非燥渴。胁下时时作疼，闻食味则欲呕吐，所以不能进
食。小便赤涩短少。此伤寒之热已至阳明之府，胃与大肠皆实，原是承气汤症。特其脉虽有力，然自弦硬中
见其有力，非自洪滑中见其有力（此阴虚火实之脉），且数近六至，又年过七旬，似不堪承气
之推荡。而愚有变通之法，加药数味于白虎汤中，则呕吐与胁疼皆止，大便亦可通下矣。病家闻之，疑而问
曰∶“先生之论诚善，然从前医者皆未言有外感，且此病初起，亦未有头疼恶寒外征，何以竟成伤寒传府之重
症？”答曰∶此乃伏气为病也。大约此外感，受于秋冬之交，因所受甚轻，所以不觉有外感，亦未能即
病。而其所受之邪，伏于膜原之间，阻塞气化，暗生内热，遂浸养成今日之病。观此舌苔微黄，且有芒刺，
岂非有外感之显征乎？遂为疏方∶
生石膏（两半） 生山药（一两） 知母（五钱） 赭石（五钱）
川楝子（五钱） 生杭芍（四钱） 甘草（二钱）
煎汤两盅，分三次温服下。因其胁疼甚剧，肝木不和，但理以芍药、川楝，仍恐不能奏效，又俾用羚
羊角一钱，另煎汤当茶饮之，以平肝泻热。当日将药服完，次晨复诊，脉象已平，舌上芒刺已无，舌苔变白
色已退强半，胁疼亦大见愈，略思饮食，食稀粥一中碗，亦未呕吐，惟大便仍未通下。疏方再用天冬、玄
参、沙参、赭石各五钱，甘草二钱，西药硫酸镁二钱（冲服），煎服后，大便遂通下，诸病皆愈。为其
年高病久，又俾服滋补之药数剂以善其后。
此症之脉，第一方原当服白虎加人参汤，为其胁下作疼，所以不敢加人参，而权用生山药一两，以代
白虎汤中之粳米，其养阴固气之力，又可以少代人参也。又赭石重坠下行，似不宜与石膏并用，以其能迫石
膏寒凉之力下侵也。而此症因大肠甚实，故并用无妨，且不仅以之通燥结，亦以之镇呕逆也。
沧县李氏妇，年近三旬，月事五月未行，目胀头疼甚剧，诊其脉近五至，左右皆有力，而左脉又弦硬
而长，心中时觉发热，周身亦有热时，知其脑部充血过度，是以目胀头疼也。盖月事不行，由于血室，而血
室为肾之副脏，实借肝气之疏泻以为流通，方书所谓肝行肾之气也。今因月事久瘀，肝气不能由下疏泻而专
于上行，矧因心肝积有内热，气火相并，迫心中上输之血液迅速过甚，脑中遂受充血之病。惟重用牛膝，佐
以凉泻之品，化血室之瘀血以下应月事，此一举两得之法也。遂为疏方∶
怀牛膝（一两） 生杭芍（六钱） 玄参（六钱） 龙胆草（二钱）
丹皮（二钱） 生桃仁（二钱） 红花（二钱）
一剂目胀头疼皆愈强半，心身之热，已轻减。又按其方略为加减，连服数剂，诸病皆愈，月事亦通下。
天津李氏妇，年过四旬，患痢三年不愈，即稍愈旋又反复。其痢或赤或白或赤白参半，且痢而兼泻，其
脉迟而无力。平素所服之药，宜热不宜凉，其病偏于凉可知。俾先用生山药细末，日日煮粥服之，又每日
嚼服蒸熟龙眼肉两许，如此旬日，其泻已愈，痢已见轻。又俾于服山药粥时，送服生硫黄细末三分，日两
次，又兼用木贼一钱，淬水当茶饮之，如此旬日，其痢亦愈。
奉天吕姓童子，年五岁，于季夏初旬，周身发热，至下午三句钟时，忽又发凉，须臾凉已，其热愈烈，此
温而兼疟也。东医治以金鸡纳霜，数日病不少减。盖彼但知治其间歇热，不知治其温热，其温热不愈，间歇
热亦不愈。及愚视之，羸弱已甚，饮水服药，辄呕吐，大便数日未行，脉非洪大，而重按有力。知其阳明
之热已实，其呕吐者，阳明兼少阳也。为兼少阳，所以有疟疾。为拟方∶
生石膏（三两） 生赭石（六钱） 生山药（六钱） 碎竹茹（三钱） 甘草（三钱）
煎汤一盅半，分三次温饮下。将药饮完未吐，一剂大热已退，大便亦通。至翌日复作寒热，然较轻矣。
投以硫酸规泥涅二分强，分三次用白糖水送下，寒热亦愈。
奉天马姓幼女，于午节前得温病，医治旬日病益增剧，周身灼热，精神恍惚，烦躁不安，情势危殆，其
脉确有实热，而至数嫌其过数。盖因久经外感灼热而阴分亏损也。遂用生石膏两半、生山药一两（单用此二味，
取其易服），煮浓汁两茶盅，徐徐与之。连尽两剂，灼热已退，从前两日未大便，至此大便亦通，而仍有烦
躁不安之意。遂用阿斯匹林二分，同白糖钱许，开水冲化服之，周身微汗，透出白痧满身而愈。
或问∶外感之症，在表者当解其表，由表而传里者当清其里。今此症先清其里，后复解其表者何也？答
曰∶子所论者治伤
寒则然也。而温病恒表里毗连，因此表里之界线不清。其症有当日得之者，有表未罢而即传于里者，有传里
多日而表症仍未罢者。究其所以然之故，多因此症内有伏气，又薄受外感，伏气因感而发。一则自内而外，
一则自外而内，以致表里混淆。后世治温者，恒不以六经立论，而以三焦立论，彼亦非尽无见也。是以
愚对于此症有重在解表，而兼用清里之药者，有重在清里而兼用解表之药者，有其症似犹可解表，因脉
数烦躁，遂变通其方，先清其里而后解其表者。如此则服药不至瞑眩，而其病亦易愈也。下列所治之案，盖
准此义。试观解表于清里之后，而白痧又可表出，是知临症者，原可变通因心，不必拘于一端也。
病者 刘××，年二十五岁，寄居天津。
病名 脏腑瘀血。
病候 其先偶患大便下血甚剧，西医于静脉管中注射以流动麦角膏其血立止。而血止之后已月余矣，仍
不能起床，但觉周身酸软无力。饮食不能恢撤消量，仅如从前之半。大小便亦照常，而惟觉便时不顺利。
其脉搏至数如常，芤而无力，重按甚涩，左右两部皆然。
诊断 此因下血之时，血不归经，行血之道路紊乱，遽用药止之，则离经之血，瘀于脏腑经络之间。
盖麦角止血之力甚大，愚尝嚼服其小者一枚，陡觉下部会阴穴处有抽掣之力，其最能收闭血管可知。此症因其
血管收闭之后，其瘀血留滞于脏腑之间，阻塞气化之流行。致瘀不去而新不生，是以周身酸软无力，饮食
减少，不能起床也。此症若不急治，其周身气化阻塞日久，必生灼热。灼热久之，必生咳嗽，或成肺病，或
成痨瘵，即难为调治矣。今幸为日未久，灼热咳嗽未作，则调治固易易也。
疗法 当以化其瘀血为目标。将瘀血化尽，身中气化还其流
通之常，其饮食必然增加，身体自能撤消矣。
处方 （旱三七细末三钱） 为一日之量，分两次服，空心时开水送下。
效果 服药数次后，自大便下瘀血若干，其色紫黑。后每大便时，必有瘀血若干，至第五日下血渐少，
第七日便时不见瘀血矣。遂停服药，后未旬日，身体即健康如初矣。
病者 王××，年四十九岁。
病名 温病兼泄泻。
病因 丙寅仲春来津。其人素吸鸦片，立志蠲除，因致身弱。于仲夏晚间，乘凉稍过，遂得温病，且兼泄泻。
Fan XX from Yanshan County, in his fifties, had a chronic history of pulmonary tuberculosis (Feilao). During exacerbations, he experienced continuous coughing with slight dyspnea. In late summer, the dyspnea became severe, accompanied by incessant day-and-night coughing and massive hematemesis. After consulting physicians and taking medicine for over ten days, the cough and hematemesis seemed to worsen, leaving him exhausted and unable to bear it. Coincidentally, I returned to my hometown from Cangzhou and was requested to treat him. His pulse was surging yet faint and slightly rapid; the right side was solid and forceful. His tongue coating was thick white turning yellow. He reported intense heat in the chest and bowel movements every two to three days. Upon diagnosis, I concluded: "This is heat from a warm disease (Wenbing) entrenched in the Yangming Fu organs (stomach and large intestine), forcing stomach Qi to rebel upwards, thereby dragging lung Qi upward as well. Hence the continuous coughing, wheezing, and recurrent hematemesis. Treatment should clear the source. If the heat of the warm disease is cured, the coughing, wheezing, and hematemesis will resolve spontaneously without direct treatment." His family said, "Previously, we did not feel any external contraction (Waigan). Even when consulting doctors repeatedly, no one mentioned external contraction. Why do you alone attribute this to a warm disease?" I replied, "The surging and solid pulse, the thick white tongue coating turning yellow, and the internal heat are all obvious signs of a warm disease. The initial lack of perceived external contraction is because this is a warm disease formed by latent pathogenic factors (Fuqi) transforming into heat. The cause lies in cold contracted in winter, which lay dormant in the Sanjiao fatty membranes. Due to the abundance of Yang energy in spring, it transformed into heat and activated, invading various Zang-Fu organs to become a warm disease. Some cases manifest later in summer or autumn, where symptoms may not involve new external contraction, or only slight unnoticed external contraction triggers the activation of latent factors. This corresponds to what the *Neijing* states: 'If harmed by cold in winter, one will suffer from warmth in spring.'" Thus, I prescribed:
Sheng Di Huang (Rehmanniae Radix Preparata, 2 liang), Sheng Shi Gao (Gypsum Fibrosum, 1 liang), Zhi Mu (Anemarrhenae Rhizoma, 8 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, 1 qian).
Guang Xi Jiao (Rhinocerotis Cornu, 3 qian, decocted separately and mixed in), San Qi (Notoginseng Radix et Rhizoma, 2 qian, fine powder taken with water).
Decocted in two teacups of water, taken warm in three doses. One dose resulted in the resolution of all symptoms. Subsequently, I switched to Xuan Shen (Scrophulariae Radix), Bei Mu (Fritillariae Bulbus), Zhi Mu, Hua Fen (Trichosanthis Radix), Gan Cao, and Bai Shao (Paeoniae Radix Alba), decocted and taken. Additionally, San Qi powder (approx. 1 qian) was taken with water after two doses. Then, raw Shan Yao (Dioscoreae Rhizoma) powder porridge with a little white sugar was prescribed, with each dose accompanied by Chi Shi (Haematitum, approx. 1 qian fine powder) to treat his prior pulmonary tuberculosis. When feeling hot, fresh Bai Mao Gen (Imperatae Rhizoma, 4-5 liang) was chopped, boiled briefly, and drunk as tea. After such conditioning for over a month, the pulmonary tuberculosis improved significantly.
Note: Hematemesis generally contraindicates the sudden use of cooling medicines, fearing that blood leaving its vessels might congeal due to cold, leading to Blood Bi or deficiency consumptive diseases. However, this case required cooling medicines due to the high fever of the warm disease. The inclusion of San Qi, which excels at resolving blood stasis, ensured benefit without harm.
Wang XX from Yanshan County, nearly sixty years old, suffered from dysentery starting in early summer. After taking over fifty doses of medicine, the dysentery resolved but the condition worsened. He lay bedridden, drowsy, facing imminent danger. At this time, I returned from Cangzhou and was requested to treat him. His left and right pulses were both surging and solid, beating five times per breath. He felt heat throughout the body surface and interior. Pain in the hypochondrium extending to the abdomen was extreme. His tongue coating was thick white with a slight yellow center, and bowel movements occurred every two to three days. I said, "This is a warm disease caused by latent factors transforming into heat. Initially, when latent factors transformed into heat, the intestines were pressured by heat, fermenting into dysentery accompanying the warm disease. Here, the warm disease is the primary illness, and dysentery is the secondary. Physicians knew only to treat the secondary illness and ignored the primary one. Although the dysentery healed, the warm disease intensified. How could the patient endure this for over sixty days?" His family asked, "Your theory is correct. But if it is a warm disease, why is there abdominal and hypochondriac pain? Is there stagnation in the abdomen?" I replied, "Previous reports of bowel movements every two to three days do not necessarily indicate abdominal stagnation. Regarding the pulse, high fever in warm diseases usually manifests in the right pulse, as high fever belongs to the Yangming Stomach Fu pulse, diagnosed at the Right Guan position. Now, the Left pulse is also surging and solid, indicating blazing fire in the Liver and Gallbladder. The Wood Qi of the Liver, taking advantage of the blazing fire, acts recklessly, causing the abdominal and hypochondriac pain." Thus, I prescribed a large dose of Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng): Sheng Shi Gao (4 liang) and Ren Shen (Panax Ginseng, 6 qian) to nourish Yin. For the abdominal and hypochondriac pain, following Shanghan formulas, I added Sheng Hang Shao (Paeoniae Radix Alba, 6 qian) and Chuan Lian Zi (Toosendan Fructus, 6 qian) to unblock and descend stagnant heat in the Liver and Gallbladder, assisting the effect of Shaoyao. Decocted in three teacups, taken warm in three doses. Several amounts of sticky substances were discharged. The person holding the chamber pot felt heat penetrating through it. The illness instantly resolved, and he could eat. Two days later, mild abdominal and hypochondriac pain recurred. He was given Yuan Ming Fen (Mirabilite, 4 qian) and Jing Mi (Pure Honey, half liang) mixed in boiling water. More sticky substances were discharged, and the illness completely resolved.
My grandson, nine years old, caught wind-cold in late January. Within two to three days, he felt heat on both the surface and interior. His pulse was surging and solid, and his tongue coating was thick white. He had not had a bowel movement for two days, and his urine was yellow. I determined that the excess heat from the external contraction had entered the Yangming Fu. I prescribed:
Sheng Shi Gao (2 liang), Zhi Mu (6 qian), Lian Qiao (Forsythiae Fructus, 3 qian), Bo He Ye (Menthae Haplocalycis Folium, 1.5 qian), Gan Cao (2 qian).
Decocted in two teacups at 6 PM, taken in two doses. By next morning, the fever subsided by more than half. Due to other matters, I left, instructing him to take the dregs. Four days later, a letter stated he was still not recovered. Taking another dose of the original formula yielded no improvement. At this time, his head and face were swollen. I went to the city to examine him. His head and face swelling was severe, the heat in his pulse was stronger than before, the center of his tongue coating had turned yellow, and he had not had a bowel movement for three days. I prescribed:
Sheng Shi Gao (4 liang), Xuan Shen (1 liang), Lian Qiao (3 qian), Yin Hua (Lonicerae Japonicae Flos, 3 qian), Gan Cao (3 qian).
Decocted in three teacups. Aspirin (3 fen) was dissolved in the decoction and taken warm in three doses. Mild sweating over the head, face, and body followed, the fever subsided, and swelling disappeared. Two doses of clearing heat and nourishing Yin agents were taken subsequently to conclude the treatment.
A youth surnamed Li from the neighboring village simultaneously contracted Da Tou Wen (Big Head Plague, likely epidemic parotitis or similar acute infectious disease). After ten days of medical treatment, the condition worsened, and he sought my care. His head, face, and neck were swollen. He was irritable inside, unable to eat. His pulse showed heat but was weak upon deep pressure. Given his long-term opium addiction, his lower Yuan was inherently deficient, and his stools were loose. I dared not prescribe strong cooling agents. I prescribed:
Xuan Shen (1 liang), Hua Fen (5 qian), Yin Hua (5 qian), Bo He (1.5 qian), Gan Cao (1.5 qian).
Decocted in one large cup. Aspirin (2 fen) was taken with the decoction. Sweating over the head, face, and body ensued, and the illness completely resolved.
Sun XX from the neighboring village, around thirty years old, developed asthma starting in early summer. Movement triggered asthma; even at rest, breathing seemed hurried. Over fifty doses of medicine failed to help. Physicians attributed it to pulmonary tuberculosis and deemed it incurable. Hearing of my return, they sought my treatment. His pulse was floating and slippery, especially at the Right Cun and Guan positions. I identified phlegm and wind binding together, obstructing the lung orifices. I prescribed Ma Xing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction):
Ma Huang (Ephedrae Herba, 3 qian), Xing Ren (Armeniacae Semen Amarum, 3 qian), Sheng Shi Gao (1 liang), Gan Cao (1.5 qian).
Taken with decoction, accompanied by Ku Ting Li Zi (Thladianthae Fructus, roasted, 2 qian). One dose settled the asthma. Subsequent doses of phlegm-resolving, lung-moistening agents with slight exterior-releasing properties led to complete recovery.
Diao XX from the neighboring village, in his twenties, developed asthma in early winter. It persisted for over a hundred days, worsening despite multiple treatments. His pulse was floating and weak, rapid (nearly six beats per breath). I determined the lungs were attacked by wind, causing asthma. Chronic illness led to Yin deficiency, and the Liver and Kidney failed to grasp Qi, intensifying the asthma. Although wind pathogens remained in the lungs, dispersing wind might further deplete Yin due to the rapid pulse and deficiency. Thus, I used Ma Huang (3 qian) assisted by Sheng Shan Yao (Dioscoreae Rhizoma, 2 liang), taken before sleep. Mild night sweats occurred, and asthma improved by more than half. Due to the deficient and rapid pulse, I avoided consecutive exterior-releasing doses. Instead, he took Sheng Shan Yao powder (8 qian) porridge with white sugar twice daily as a snack. If bloated, Ji Nei Jin (Galli Gigerii Endothelium Corneum, 0.5 fen) powder was taken with the porridge. After about half a month, asthma lightened. Re-examination showed a less rapid pulse. The previous decoction was resumed, inducing mild sweat and further alleviating asthma. Continued Shan Yao porridge for over a month resulted in full recovery.
Old Woman Wang from Cangzhou County, seventy-one years old, suffered hypochondriac pain, nausea, vomiting, and dry constipation in mid-winter. After a month of medication and seeing over ten physicians, the condition worsened. At my examination, she had not eaten for six or seven days and had no bowel movement for over twenty days. Her pulse beat over five times per breath, wiry and forceful on both sides. Tongue coating was widespread, prickly, and slightly yellow. She felt intermittent internal heat and occasional thirst, though not parched. Hypochondriac pain was frequent. Smells of food induced vomiting, preventing intake. Urine was red, scanty, and difficult. This indicated Shaoyin heat reaching the Yangming Fu, with excess in the Stomach and Large Intestine, originally an Cheng Qi Tang syndrome. However, although her pulse was forceful, it was forceful from wiriness and hardness, not surging and slippery (indicating Yin deficiency with fire excess). With a rapid pulse and age over seventy, she seemed unfit for the purgative force of Cheng Qi Tang. I employed a modified approach, adding ingredients to Bai Hu Tang (White Tiger Decoction). This stopped vomiting and hypochondriac pain and allowed bowel movement. The family questioned, "Your theory is sound, but previous doctors noted no external contraction, nor initial headache or aversion to cold. How did it become a severe Shaoyin transmission to Fu?" I replied, "This is illness caused by latent factors. The external contraction likely occurred in late autumn/early winter. Being mild, it was unnoticed and did not cause immediate illness. The pathogen lay dormant in the Mo Yuan (Membrane Source), blocking Qi transformation and generating internal heat, gradually forming this illness. The slightly yellow tongue coating with prickles indicates external contraction." I prescribed:
Sheng Shi Gao (1.5 liang), Sheng Shan Yao (1 liang), Zhi Mu (5 qian), Zhe Shi (Haematitum, 5 qian).
Chuan Lian Zi (5 qian), Sheng Hang Shao (4 qian), Gan Cao (2 qian).
Decocted in two cups, taken warm in three doses. Due to severe hypochondriac pain and Liver disharmony, using only Shaoyao and Chuan Lian Zi might be insufficient. She was also instructed to drink Ling Yang Jiao (Capris Cornu, 1 qian) decoction to calm the Liver and drain heat. After finishing the medicine that day, re-examination the next morning showed a normalized pulse, disappearance of tongue prickles, reduction of tongue coating, significant relief of hypochondriac pain, and appetite returning (eating a bowl of thin porridge without vomiting). Bowel movement remained blocked. I prescribed Tian Dong (Asparagi Radix), Xuan Shen, Sha Shen (Glehniae Radix), Zhe Shi (each 5 qian), and Gan Cao (2 qian), along with Magnesium Sulfate (2 qian, dissolved). After ingestion, bowel movement occurred, and all illnesses resolved. Given her advanced age and chronic illness, several doses of tonifying medicine were given to conclude treatment.
Note: The first prescription should have been Bai Hu Jia Ren Shen Tang. Due to hypochondriac pain, Ren Shen was omitted, and Sheng Shan Yao (1 liang) was used instead of Jing Mi (rice) in Bai Hu Tang. Its Yin-nourishing and Qi-firming power substitutes for Ren Shen to some extent. Zhe Shi, being heavy and descending, seems incompatible with Shi Gao as it might drive the cooling nature downward. However, since the Large Intestine was very excess, their combination was safe. It not only cleared dryness but also anchored rebellious Qi.
Li's wife from Cangzhou County, nearly thirty, had amenorrhea for five months, severe eye distension, and headache. Her pulse was near five beats per breath, forceful on both sides, with the Left pulse wiry, hard, and long. She felt intermittent internal heat and body heat. I diagnosed cerebral hyperemia causing the eye and head symptoms. Amenorrhea relates to the Blood Chamber (Uterus), an assistant organ of the Kidney, relying on Liver Qi for circulation ("Liver moves Kidney Qi"). Due to long-standing menstrual stasis, Liver Qi could not descend and flow upward. Combined with internal heat in Heart and Liver, Qi and Fire merged, forcing blood upward rapidly, causing cerebral congestion. Heavy use of Niu Xi (Achyranthis Bidentatae Radix) with cooling and draining agents resolves uterine stasis to restore menstruation, achieving two goals with one action. I prescribed:
Huai Niu Xi (1 liang), Sheng Hang Shao (6 qian), Xuan Shen (6 qian), Long Dan Cao (Gentianae Radix, 2 qian).
Dan Pi (Moutan Cortex, 2 qian), Sheng Tao Ren (Persicae Semen, 2 qian), Hong Hua (Carthami Flos, 2 qian).
One dose relieved more than half of the eye distension and headache, and reduced body heat. Adjustments were made based on follow-up palpation. Several doses led to full recovery and resumption of menstruation.
Li's wife from Tianjin, over forty, suffered from dysentery for three years, recurring frequently. Stools varied between red, white, or mixed, accompanied by diarrhea. Her pulse was slow and weak. Her usual medications favored warming over cooling, indicating a cold-biased pathology. She was instructed to eat porridge made from fine Sheng Shan Yao powder daily. Also, steamed Long Yan Rou (Longan Arillus, approx. 2 qian) was chewed daily. After ten days, diarrhea ceased, and dysentery lightened. While eating Shan Yao porridge, she took Sheng Liu Huang (Sulfur, 3 fen) fine powder twice daily, and drank Mu Zei (Equiseti Herba, 1 qian) infused water. After ten days, dysentery also resolved.
Boy surnamed Lv from Fengtian, five years old, had whole-body fever in early late summer. At 3 PM, he suddenly felt cold, followed by intense heat once the cold passed. This was Warm Disease combined with Malaria. Western doctors used Quinine (Jin Ji Na Shuang) for several days with no improvement. They treated only the intermittent fever, ignoring the warm-heat component. Without resolving the warm-heat, the intermittent fever would not cease. Upon examination, he was severely emaciated, vomiting water and medicine, with no bowel movement for days. Pulse was not surging but forceful upon deep pressure. I determined Yangming heat was excess, and vomiting indicated concurrent Shaoyang involvement (hence malaria-like symptoms). I prescribed:
Sheng Shi Gao (3 liang), Sheng Zhe Shi (6 qian), Sheng Shan Yao (6 qian), Sui Zhu Ru (Bambusae Caulis in Taenia, 3 qian), Gan Cao (3 qian).
Decocted in one and a half cups, taken warm in three doses. No vomiting occurred after finishing the dose. High fever subsided, and bowel movement occurred after one dose. On the second day, chills and fever recurred but were milder. Stronger than 2 fen of Quinine Sulfate was taken in three doses with white sugar water, resolving the chills and fever.
Young girl surnamed Ma from Fengtian, contracted Warm Disease before the Dragon Boat Festival. After ten days of treatment, the condition worsened. Whole-body burning heat, mental confusion, irritability, and critical condition. Pulse showed definite excess heat but was excessively rapid. Likely due to Yin deficiency from prolonged external heat. I used Sheng Shi Gao (1.5 liang) and Sheng Shan Yao (1 liang), decocted into a concentrated liquid (two teacups), administered slowly. After two doses, burning heat subsided. Having not had a bowel movement for two days, it now occurred. Irrability persisted. Aspirin (2 fen) mixed with white sugar (approx. 1 qian) in boiling water was taken. Mild sweating ensued, white rashes appeared all over the body, and she recovered.
Question: For external contractions, surface conditions require releasing the exterior, while interior transmission requires clearing the interior. Why does this case clear the interior first and then release the exterior?
Answer: Your statement applies to treating Cold Damage (Shanghan). Warm diseases often have connected interior and exterior, blurring boundaries. Symptoms may appear on the same day, transmit to the interior before the exterior resolves, or persist in the exterior after transmitting to the interior for days. The reason is often latent factors within, triggered by slight external contraction. One aspect moves from interior to exterior, the other from exterior to interior, confusing the two. Later practitioners of Warm Diseases often discuss via the Triple Burner rather than the Six Channels, which has merit. Therefore, for such cases, I sometimes prioritize exterior release with interior clearing, sometimes prioritize interior clearing with exterior release, and sometimes, if exterior release seems possible but pulse is rapid and irritable, I modify the formula to clear the interior first, then release the exterior. This prevents severe adverse reactions (Mingxuan) and facilitates recovery. The following cases illustrate this principle. Observing that exterior release after interior clearing allows white rashes to emerge shows that clinicians can adapt flexibly, not rigidly adhering to one method.
Patient: Liu XX, 25 years old, residing in Tianjin.
Disease Name: Visceral Blood Stasis.
Symptoms: Previously suffered severe hematochezia. Western doctors injected Ergotamine into veins, stopping bleeding immediately. Over a month later, he remained bedridden, feeling general soreness and weakness. Appetite was half of normal. Bowel and bladder functions were normal, except for difficulty during defecation.
Pulse: Normal rate, Kou (Hollow) and weak, rough upon deep pressure, identical on both sides.
Diagnosis: During bleeding, blood left its vessels, disrupting flow paths. Sudden hemostatic drugs caused blood leaving its vessels to stagnate in viscera and collaterals. Ergot stops bleeding strongly; chewing a small piece caused twitching at the Huiyin acupoint, proving its ability to constrict vessels. Post-constriction, blood stasis remained in viscera, blocking Qi transformation. Stasis prevented new blood generation, causing weakness, poor appetite, and inability to rise. Untreated, prolonged Qi blockage would generate heat, leading to cough, lung disease, or consumption, becoming hard to treat. Fortunately, it is recent, without heat or cough, making treatment easy.
Therapy: Target is resolving blood stasis. Once stasis is cleared, Qi transformation restores, appetite increases, and strength returns.
Prescription: Han San Qi (Notoginseng Radix et Rhizoma) fine powder, 3 qian per day, divided into two doses, taken with warm water on an empty stomach.
Effect: After several doses, purple-black blood stasis was passed in stool. Each subsequent bowel movement produced some stasis. By day five, bleeding decreased. By day seven, no stasis was seen. Medication stopped. Within ten days, health fully restored.
Patient: Wang XX, 49 years old.
Disease Name: Warm Disease with Diarrhea.
Cause: Arrived in Tianjin in mid-spring of Bingyin year. Habitual opium smoker, determined to quit, leading to physical weakness. In mid-summer evening, stayed out too long in cool air, contracting Warm Disease with concomitant diarrhea.