邑城东刘氏女，年十五岁，于季春患温病久不愈。
病因 因天气渐热，犹勤纺织，劳力之余出外乘凉，有汗被风遂成温病。
证候 初得周身发热，原宜辛凉解肌，医者竟用热药发之，汗未出而热益甚，心中亦热而且渴。此
时若用大剂白虎加人参汤清之，病亦可愈，而又小心不敢用。惟些些投以凉润小剂，迁延二十余日，
外感之热似渐退。然午前稍轻而午后则仍然灼热，且多日不能饮食，形体异常清瘦。左脉弦细无根，右
部关脉稍实，一息六至。舌苔薄而微黄，毫无津液。大便四五日一行，颇干燥。
诊断 此因病久耗阴，阴虚生热，又兼外感之热留滞于阳明之府未尽消也。当以清外感之热为主，
而以滋补真阴之药辅之。
处方 生石膏（一两捣细） 野党参（三钱） 生怀地黄（一两） 生怀山药（一两）
生杭芍（四钱） 滑石（三钱） 甘草（三钱）
共煎汤一大盅，分两次温服下。
复诊 将药煎服两剂后，外感之热已退，右关脉已平和，惟过午
犹微发热，此其阴分犹虚也。当再滋补其阴分。
处方 玄参（一两） 生怀山药（一两） 甘枸杞（五钱大者） 生杭芍（五钱）
滑石（二钱） 熟地黄（一两） 生鸡内金（一钱黄色的捣） 甘草（二钱）
共煎一大盅，分两次温服。
效果 日服药一剂，连服三日，灼热全愈。
帮助 按此方于大队滋阴药中犹少加滑石者，恐外感之热邪未尽，引之自小便出也。愚凡治
外感之热兼有虚热者，恒生山药与滑石并用，泻热补虚一举两得。至上有外感燥热而下焦复滑
泻者，用之以清热止泻（宜各用一两），尤屡次奏效。二药相伍，原有化合之妙用，若再加
芍药、甘草，即拙拟之滋阴清燥汤，可参观也。
[Background Information]
Book Title: *Yixue Zhongzhong Canxi Lu* (Records of Medical Practice Integrating Chinese and Western Medicine)
Author: Zhang Xichun
Dynasty: Qing Dynasty
Chapter: 35. Warm Disease Complicated with Deficiency-Heat
Category: Medical Discourse
[Translation]
The daughter of the Liu family in the east of the county, aged fifteen, suffered from a warm disease (an acute febrile disease caused by warm pathogenic factors) in late spring, which persisted for a long time without recovery.
Etiology Due to the gradually warming weather, she continued to work diligently at weaving. After exertion, she went outside to enjoy the cool breeze; sweating and subsequently exposed to wind led to the formation of a warm disease.
Symptoms Initially, when the disease first appeared, there was generalized fever. It should have been treated with acrid-cool herbs to release the muscle layer, but the physician mistakenly used hot-natured herbs to induce sweating. Consequently, no sweat was produced, yet the heat intensified significantly, accompanied by vexing heat in the heart and thirst. At this stage, if a large dose of Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction, a formula for clearing heat and generating fluids) had been administered, the disease could have been cured. However, due to excessive caution, the physician dared not use it. Instead, only small doses of cooling and moistening herbs were given intermittently. The condition dragged on for over twenty days, and although the external heat seemed to subside slightly, the patient felt slightly better in the morning but experienced intense burning heat in the afternoon. She had been unable to eat for many days, and her body became abnormally emaciated. The left pulse was wiry and thin without root, while the right Guan position (corresponding to the Spleen/Stomach) was slightly excess, with six beats per breath (rapid pulse). The tongue coating was thin and slightly yellow, completely lacking moisture. Bowel movements occurred only once every four or five days and were quite dry.
Diagnosis This condition resulted from prolonged illness consuming Yin fluids, leading to deficiency-heat, compounded by residual external heat lingering in the Yangming Fu organs (referring to the Stomach and Intestines) that had not yet fully dissipated. Treatment should focus primarily on clearing the external heat, supplemented by herbs that tonify true Yin.
Prescription Raw Gypsum (Shi Gao, 1 liang, finely crushed) Wild Codonopsis (Ye Dang Shen, 3 qian) Raw Huai Rehmannia Root (Sheng Huai Di Huang, 1 liang) Raw Huai Chinese Yam (Sheng Huai Shan Yao, 1 liang) Raw Hang Peony Root (Sheng Hang Shao, 4 qian) Talcum (Hua Shi, 3 qian) Licorice Root (Gan Cao, 3 qian)
Decoct together in a large bowl of water, and take half warm in the morning and half in the evening.
Second Visit After taking two doses of the prescription, the external heat had subsided, and the right Guan pulse had normalized. However, slight fever persisted after noon, indicating that the Yin aspect remained deficient. Further tonification of Yin is required.
Prescription Scrophularia Root (Xuan Shen, 1 liang) Raw Huai Chinese Yam (Sheng Huai Shan Yao, 1 liang) Goji Berry (Gan Gou Qi, 5 qian, selecting large ones) Raw Hang Peony Root (Sheng Hang Shao, 5 qian) Talcum (Hua Shi, 2 qian) Prepared Rehmannia Root (Shu Di Huang, 1 liang) Raw Chicken Gizzard Lining (Sheng Ji Nei Jin, 1 qian, yellow variety, crushed) Licorice Root (Gan Cao, 2 qian)
Decoct together in a large bowl of water, and take half warm in the morning and half in the evening.
Outcome Taking one dose daily for three consecutive days, the burning heat was completely resolved.
Commentary In this prescription, the addition of Talcum (Hua Shi) among a large group of Yin-nourishing herbs is intended to prevent any remaining external heat pathogens from lingering, guiding them out through urination. Whenever I treat external heat complicated by deficiency-heat, I habitually combine Chinese Yam (Shan Yao) and Talcum (Hua Shi), achieving both heat-clearing and deficiency-tonifying effects simultaneously. In cases where there is external dry-heat above and loose diarrhea below, using these two herbs can clear heat and stop diarrhea (each used in 1 liang dosage), yielding repeated success. The combination of these two herbs possesses subtle synergistic properties; if Peony Root (Shao Yao) and Licorice Root (Gan Cao) are added, it constitutes my formulated Ziyin Qingzao Tang (Nourish Yin and Clear Dryness Decoction), which may be consulted for reference.