天津姚姓媪，年六旬有二，于孟秋得温病兼下痢。
病因 孟秋天气犹热，且自觉心中有火，多食瓜果，又喜当风乘凉，遂致病温兼下痢。
证候 周身灼热，心中热且渴，连连呻吟不止，一日夜下痢十二三次，赤白参半，后重腹疼，
饮食懒进，恶心欲呕，其脉左部弦而兼硬，右部似有力而重按不实，数近六至。延医治疗近旬日，病益加剧。
诊断 其左脉弦而兼硬者，肝血虚而胆火盛也。其右脉似有力而重按不实者，因其下痢久而气化
已伤，外感之热又侵入阳明之腑也。其数六至者，缘外感之热灼耗已久，而其真阴大有
亏损也。证脉合参，此乃邪实正虚之候。拟用拙定通变白虎加人参汤，及通变白头翁汤二方相并治之。
处方 生石膏（二两捣细） 野台参（四钱） 生怀山药（一两） 生杭芍（一两）
白头翁（四钱） 金银花（四钱） 秦皮（二钱） 生地榆（二钱）
甘草（二钱） 广三七（二钱轧细） 鸦胆子（成实者五十粒去皮）
共药十一味，先用白糖水送服三七、鸦胆子各一半，再将余药煎汤两盅，分两次温服下。至煎渣
再服时，亦先服所余之三七、鸦胆子。
复诊 将药煎服日进一剂，服两日表里之热皆退，痢变为泻，仍稍带痢，泻时仍觉腹疼后重
而较前轻减，其脉象已近平和，此宜以大剂温补止其泄泻，再少辅以治痢之品。
处方 生怀山药（一两） 炒怀山药（一两） 龙眼肉（一两） 大云苓片（三钱）
生杭芍（三钱） 金银花（三钱） 甘草（二钱）
共煎汤一大盅，温服。
效果 将药煎服两剂，痢已净尽而泻未全愈，遂即原方去金银
花、芍药，加白术三钱，服两剂其泻亦愈。
A sixty-two-year-old woman surnamed Yao in Tianjin contracted warm disease (Wen Bing, a category of febrile diseases caused by warm pathogens) accompanied by dysentery in early autumn.
Etiology: The weather was still hot in early autumn. She felt internal heat and consumed many fruits and melons. Additionally, she enjoyed cooling off while exposed to drafts. Consequently, she developed warm disease complicated by dysentery.
Clinical Manifestations: Her whole body felt burning hot; her chest felt hot with thirst. She groaned incessantly. She had dysenteric stools twelve to thirteen times a day and night, consisting of half pus and half blood. She experienced tenesmus (a feeling of incomplete defecation with straining) and abdominal pain. She had poor appetite, nausea, and a desire to vomit. Her left pulse was wiry (Xian) and hard; her right pulse seemed forceful but was empty upon heavy pressure. The pulse rate was nearly six beats per respiration period. After consulting physicians for nearly ten days, the condition worsened.
Diagnosis: The wiry and hard quality of the left pulse indicates Liver Blood deficiency and Gallbladder Fire excess. The right pulse, which seems forceful but is empty upon heavy pressure, suggests that prolonged dysentery has damaged Qi transformation, and external pathogenic heat has invaded the Yangming Fu organs. The rapid pulse rate (six beats per respiration) is due to prolonged consumption by external heat, resulting in significant depletion of True Yin (Zhen Yin). Integrating symptoms and pulse findings, this is a pattern of Excess Pathogen and Deficient Healthy Qi. I proposed treating it with a combination of my formulated Modified Baihu Jia Renshen Tang (Modified White Tiger Decoction plus Ginseng) and Modified Baitouweng Tang (Modified Pulsatilla Decoction).
Prescription: Sheng Shi Gao (Raw Gypsum Fibrosum, 2 liang, crushed); Ye Tai Shen (Wild Taishan Ginseng Root, 4 qian); Sheng Huai Shan Yao (Fresh Chinese Yam Rhizome, 1 liang); Sheng Hang Shao (Raw Paeonia Lactiflora Root, 1 liang); Baitouweng (Pulsatilla Chinensis Root, 4 qian); Jinyinhua (Lonicera Japonica Flower, 4 qian); Qinpi (Fraxinus Bark, 2 qian); Sheng Di Yu (Sanguisorba Officinalis Root, 2 qian); Gancao (Licorice Root, 2 qian); Guang Sanqi (Notoginseng Root, 2 qian, finely ground); Yadanzi (Brucea javanica Seed, 50 mature seeds, peeled).
Total eleven ingredients. First, take half of the Sanqi and Yadanzi, administered via white sugar water. Then, decoct the remaining herbs into two bowls of liquid, taken warm in two divided doses. When decocting the dregs for the second administration, also take the remaining Sanqi and Yadanzi first.
Follow-up Visit: One dose was taken daily. After two days, both exterior and interior heat subsided. Dysentery transformed into diarrhea, though still slightly bloody. During defecation, abdominal pain and tenesmus persisted but were milder than before. The pulse had returned to near normal. At this stage, it is appropriate to use a large dose of warming and tonifying agents to stop diarrhea, supplemented with a small amount of agents treating dysentery.
Prescription: Sheng Huai Shan Yao (Fresh Chinese Yam Rhizome, 1 liang); Chao Huai Shan Yao (Stir-fried Chinese Yam Rhizome, 1 liang); Longyan Rou (Longan Aril, 1 liang); Da Yun Ling Pian (Poria Cocos Sclerotium slices, 3 qian); Sheng Hang Shao (Raw Paeonia Lactiflora Root, 3 qian); Jinyinhua (Lonicera Japonica Flower, 3 qian); Gancao (Licorice Root, 2 qian).
Decoct together into one large bowl, take warm.
Outcome: After taking two doses, dysentery cleared completely, but diarrhea did not fully resolve. Therefore, Jinyinhua and Shaoyao were removed from the original prescription, and Baizhu (Atractylodes Macrocephala Rhizome, 3 qian) was added. After two more doses, the diarrhea also resolved.