天津徐姓媪，年五十九岁，于中秋上旬得温病，带有伏气化热。
病因 从前原居他处，因迁居劳碌，天气燥热，有汗受风，遂得斯病。
证候 晨起，觉周身微发热兼酸懒不舒，过午，陡觉表里大热，且其热浸增。及晚四点钟往
视时，见其卧床闭目，精神昏昏。呻吟不止。诊其脉左部沉弦，右部洪实，数近六至。问
其未病之前，曾有拂意之事乎？其家人曰∶诚然，其禀性褊急，恒多忧思，且又易动肝火。欲见其
舌苔，大声呼数次，始知启口，视其舌上似无苔而有肿胀之意，问其大便，言素恒干燥。
诊断 其左脉沉弦者，知其肝气郁滞不能条达，是以呻吟不止，此欲借呻吟以舒其气也。其右脉
洪实者，知此证必有伏气化热，窜入阳明，不然则外感之温病，半日之间何至若斯之
剧也。此当用白虎汤以清阳明之热，而以调气舒肝之药佐之。
处方 生石膏（二两捣细） 知母（八钱） 生莱菔子（三钱捣碎） 青连翘（三钱）
甘草（二钱） 粳米（四钱）
共煎汤两盅，分两次温服。
方解 莱菔子为善化郁气之药。其性善升亦善降，炒用之则降多于升，生用之则升多于降。
凡肝气之郁者宜升，是以方中用生者。至于连翘，原具有透表之力，而用于此方之中，不但
取其能透表也，其性又善舒肝，凡肝气之郁而不舒者，连翘皆能舒之也。是则连翘一味，既可佐
白虎以清温热，更可辅莱菔以开肝气之郁滞。
复诊 将药两次服完，周身得汗，热退十之七八，精神骤然清爽。左脉仍有弦象而不沉，右脉
已无洪象而仍似有力，至数之数亦减。问其心中仍有觉热之时，且腹中知饥而懒于进
食，此则再宜用凉润滋阴之品清其余热。
处方 玄参（一两） 沙参（五钱） 生杭芍（四钱） 生麦芽（三钱）
鲜茅根（四钱） 滑石（三钱） 甘草（二钱）
共煎汤一大盅，温服。方中用滑石者，欲其余热自小便泻出也。
效果 将药连服两剂，大便通下，其热全消，能进饮食，脉象亦和平矣。而至数仍有数象，俾
再用玄参两半，潞参三钱，煎服数剂以善其后。
The elderly woman surnamed Xu in Tianjin, aged fifty-nine, contracted a warm disease (Wen Bing) ten days before the Mid-Autumn Festival, complicated by latent pathogenic heat transforming into fire.
Etiology Previously residing elsewhere, she fell ill due to the exertion of moving house, combined with dry and hot weather, wind invasion after sweating.
Symptoms Upon waking in the morning, she felt slight fever throughout the body accompanied by soreness, fatigue, and discomfort. After noon, she suddenly experienced intense heat both on the exterior and interior, which progressively increased. When visited at four o'clock in the evening, she was found lying in bed with eyes closed, appearing lethargic and drowsy, groaning incessantly. Her pulse was examined: the left position was deep and wiry (Chen Xian), the right position was surging and solid (Hong Shi), with a frequency approaching six beats per respiration (approx. 100+ bpm). Inquiry revealed that prior to illness, she had experienced distressing events. Her family confirmed this, noting her irritable and narrow-minded temperament, tendency towards worry and overthinking, and susceptibility to Liver Fire. Attempts to inspect her tongue coating required several loud calls before she opened her mouth; inspection revealed an apparent lack of coating but signs of swelling. Regarding bowel movements, she reported chronic constipation/dry stools.
Diagnosis The deep and wiry pulse on the left indicates stagnation of Liver Qi failing to flow freely, causing the incessant groaning as a mechanism to relieve Qi stagnation. The surging and solid pulse on the right indicates that latent pathogenic heat has transformed and invaded the Yangming channel; otherwise, an external warm disease would not have progressed to such severity within half a day. Treatment should employ Baihu Tang (White Tiger Decoction) to clear Yangming heat, assisted by herbs that regulate Qi and soothe the Liver.
Prescription Sheng Shigao (Raw Gypsum Fibrosum, 2 liang, crushed to fine powder), Zhi Mu (Anemarrhenae Rhizoma, 8 qian), Sheng Laifuzi (Raw Raphani Semen, 3 qian, crushed), Qing Lianqiao (Forsythiae Fructum, 3 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 2 qian), Jingmi (Oryza Sativa, 4 qian).
Decoct together to yield two bowls of liquid, taken warm in two divided doses.
Formula Analysis Laifuzi is effective in resolving Qi stagnation. Its nature facilitates both ascending and descending actions; when stir-fried, descending action predominates, while raw usage favors ascending action. Since Liver Qi stagnation benefits from ascending dispersal, raw Laifuzi is used here. Lianqiao possesses the power to vent pathogens from the exterior. In this formula, it is selected not only for its exterior-venting property but also because its nature soothes the Liver, effectively relieving any Liver Qi stagnation. Thus, Lianqiao serves a dual purpose: assisting Baihu Tang in clearing warm-heat pathogens and aiding Laifuzi in opening Liver Qi stagnation.
Second Visit After completing the two doses, the patient sweated profusely, reducing fever by 70-80%, and her mental state became suddenly clear. The left pulse remained wiry but was no longer deep; the right pulse lost its surging quality but retained strength; the pulse rate decreased. She reported occasional sensations of internal heat and hunger without appetite. This condition warrants the use of cooling, moistening, and Yin-nourishing herbs to clear residual heat.
Prescription Xuanshen (Scrophulariae Radix, 1 liang), Shashen (Glehniae Radix, 5 qian), Sheng Hangshao (Raw Paeoniae Radix Alba, 4 qian), Sheng Maiya (Hordei Fructus Germinatus, 3 qian), Xian Maogen (Imperatae Rhizoma, 4 qian), Huashi (Talcum, 3 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 2 qian).
Decoct together to yield one large bowl, taken warm. Huashi is included to facilitate the excretion of residual heat via urination.
Outcome After two consecutive doses, bowel movements were unblocked, heat completely subsided, appetite returned, and the pulse became harmonious. However, the pulse rate remained rapid. To consolidate recovery, Xuanshen (1.5 liang) and Lushen (Codonopsis Radix, 3 qian) were prescribed for several more doses.