第三日，恶寒自罢，昼夜发热，日晡益甚，头身之痛较轻，眉棱目眦痛甚，鼻干不得卧，苔白，汗不透，脉洪长而数，溲浑而赤，伏邪外越，阳明经府不和，不致神昏呃逆为吉。 海南槟榔（一钱） 川厚朴（七分） 草果仁（五分） 酒炒黄芩（钱半） 炙甘草（五分） 白知母（钱半） 赤芍（钱半） 葛根（二钱） 生姜（一片）
第四日，得汗虽透，热仍不解，反觉憎寒，耳聋不寐，心烦喜呕，胸满胁痛，苔淡黄，溲浑赤，脉弦数。伏邪交并少阳阳明，小柴达原加减。 柴胡根（一钱） 酒炒黄芩（钱半） 炙甘草（五分） 川厚朴（七分） 海南槟榔（一钱） 草果仁（五分） 赤芍（钱半） 白知母（二钱） 生姜（一片）
第五日，烦呕稍减，夜得少寐，寒热依然，耳聋胸满，溲浑赤，脉弦数。照原方加陈皮一钱。
第六日，小柴达原加减服后，大解一次，色如败酱，浑赤之溲较淡，夜寐稍安，四更后心烦作呕，饮陈米汤少顷即止，平明自汗，身热乍退，唇燥舌干，脉仍弦数，伏邪渐溃，阴液耗伤，虑生歧变。 柴胡根（一钱） 黄芩（钱半） 炙甘草（五分） 赤芍（钱半） 知母（二钱） 陈橘皮（一钱） 当归身（三钱） 逆水芦根（一两） 大荸荠（四枚）
第七日，热退，脉不静，大便如败酱，溲浑如豆汁，夜寐不沉，胸否不食，心烦作呕，舌燥作渴，苔黄不腐，伏邪化热伤阴，最忌神昏，苔刺呃逆。原方加天花粉三钱。
第八日，脉数便未解，溲反浑近赤，颠前心下俱热有汗，肢微冷，苔黄，舌尖赤微有刺，口燥作渴，反欲热饮，神烦少寐。邪伏少阳，倒入阳明，化热伤阴，热极反兼寒化。肢冷，渴欲热饮，大便不解，府气不通，邪无出路，原当承气下结存津，二气素虚，姑从缓治。 大生地（五钱） 当归身（三钱） 柴胡根（一钱） 黄芩（钱半） 知母（二钱） 怀牛膝（三钱） 赤芍（钱半） 枳实（一钱） 逆水芦根（二两）
第九日，服药后大解二次，色黑如漆，中有瘀血，颠前热退，苔刺回润，烦渴减，肢逆和，夜寐安，数脉缓，溲色渐淡，黄苔渐腐，伏邪赖府气宣通渐化，后阴为里之表，邪伏膜原，转入阳明，由大肠传逆变化出焉，其路甚近，与表邪从汗解之意同，故大便解，诸证减，大便闭，诸证加。六淫在表，当从汗解。伏邪在里，当从便解。攻下与发汗何殊，伏气与表邪一体。胃为多血之府，脾为统血之藏，便黑带血，胃热迫血流入大肠，病及至阴，脾伤失统。虑其大便复闭，阳邪复聚，仍以养阴通府。 大生地（四钱） 生甘草（五分） 当归梢（三钱） 怀牛膝（钱半） 赤芍（钱半） 知母（二钱） 黄芩（钱半） 黑山栀（钱半） 桃仁泥（钱半） 杏仁泥（三钱） 栝蒌仁（三钱） 活水芦根（二两）
第十日，本方加大荸荠六个，用长流水煎。 第十一日，两进养阴通府，便解三次，色紫黑有块，纯是停瘀，诸证悉除，宵眠呼吸自若，醒后神志安舒，知饥思食，身凉脉缓，惟溲色犹浑，胸前尚热，余氛未尽，伏邪解于血分，真阴五液俱伤，在内为血，发外为汗，汗即血也。病从血下而瘳，犹表邪随汗而解，后阴为里之表，于兹可见。议补阴益气，以善其后。 大生地（八钱） 人参（一钱） 淮山药（四钱） 炙甘草（五分） 当归身（三钱） 新会皮（一钱） 银柴胡（五分） 炙升麻（三分）
始得病，不恶寒，发热而渴，溲赤不寐，服发表消导等剂，汗不出，热不退，延今四十余日，形容枯削，肢体振掉，苔色灰黑，前后大解共十三次，酱黑之色，逐次渐淡，至于黄，溲亦浑黄不赤，昼夜进数十粒薄粥四五次，夜来倏寐倏醒，力不能转侧，言不足以听，脉微数，按之不鼓，年及中衰，体素羸弱，伏邪虽有欲解之势，元气渺无驱逐之权，邪热纵横，真阴枯涸，势必邪正相寻俱败，危如朝露，急宜峻补，冀其五液三阴一振，正复不能容邪，从中击外，庶几一战于表，得战汗则解。 大生地（八钱） 人参（一钱） 大麦冬（三钱） 辽五味（八分） 当归身（三钱） 白茯神（三钱） 酸枣仁（三钱） 远志肉（一钱） 逆水芦根（二两）
扶阴敛气，辅正驱邪，服后竟得战汗，寒战逾时，厥回身热，汗出如浴，从朝至暮，侵汗不收，鼻息几无，真元几脱，急以前方进服二剂。
前方连服二剂，侵汗旋收，诸证悉退，惟精神慵倦，酣睡若迷。此邪退正复之机，邪正相持日久，邪氛初息，正返于经，休息无为，固当如是，原方再服。是方也，本非发汗，亦非止汗。夫汗之出与汗之收，皆元气为之主宰。气为橐籥，汗为波澜。前服所以汗出者，药力辅正，从藏达府，由经出络，驱邪于表。邪从汗解，而汗不止者，药力不继，正虚不可复收，故以原方仍从某经某络导其散亡之气，还之藏府。若投止汗之剂，则大谬不然，或增减一味亦不可，药性有歧，途迷莫返，故曰失之毫厘，差以千里，欲发汗不知营卫之盛衰，欲止汗不知橐籥之牝牡，是犹荡舟于陆，驾车于海，仆非不能再议一方，故缕述为知者一道。
六脉俱数，浮取不足，沉取有余，十日以来，神昏如醉，间或独语，苔淡黄不润，板齿无津，目赤唇焦，不饥不渴，与汤饮亦受，心下至少腹，按之无痛满，大便如常，溲色红浑，伏邪盘踞太阳，热入膀胱，壬病逆传于丙，丙丁兄妹，由是传心，心火云金，清肃不行，犯经旨死阴之禁，虑难有济。勉拟犀角地黄汤，合导赤散，加黑山栀，取清心保肺，导引邪火屈曲下行之意。 大生地（八钱） 犀角（钱半） 白芍药（三钱） 粉丹皮（三钱） 甘草梢（一钱） 木通（一钱） 黑山栀（二钱） 活水芦根（二两）
经以心之肺，谓之死阴。不过三日而死者，不及金之生数也。服清心保肺三剂，竟过三日，生气复来，清肃令行，热氛自退，知饥欲食，胃气渐醒，神识渐清，溲浑尚赤，导赤保肺，犀角清心以逼丁邪返丙归壬，溲清则愈。 大生地（八钱） 犀角（二钱） 白芍药（三钱） 粉丹皮（三钱） 甘草梢（一钱） 木通（一钱） 黑山栀（二钱） 白茯苓（三钱） 福泽泻（三钱） 黄芩（钱半） 活水芦根（二两）
身热汗自出，不欲去衣者，恶寒也。正伤寒汗出恶寒为表虚，伏气则不然，邪伏膜原，外越三阳之表，卫护失司，腠理不密，以溲浑赤为别，非寒伤于表可比。宜顺其性以扬之。不可执有汗用桂枝解肌，仲景有桂枝下咽，阳盛则毙之戒，拟活人败毒散加减。 羌活（一钱） 柴胡根（一钱） 枳壳（一钱） 川芎（一钱） 炙甘草（五分） 桔梗（一钱） 赤茯苓（三钱） 陈皮（一钱） 生姜（一片）
伤寒汗出淋漓，则病不除，伏邪汗出淋漓，则病将解，昨暮服药，汗更大出，发背沾衣，通宵达旦，溱溱不已，遍体凉和，六脉俱静，溲色澄清，惟中胃未醒，宜养胃生阴。 大沙参（三钱） 云茯苓（三钱） 黑脂麻（三钱） 鲜石斛（三钱） 当归身（三钱） 炒谷芽（三钱） 陈橘皮（一钱） 白豆蔻（八分） 六和神曲（钱半） 陈仓米（一两） 荷叶蒂（一个）
诸气膹郁，皆属于肺。诸逆冲上，皆属于火。肺司百脉之气，肾藏五内之精。肾水承制五火，肺金运行诸气。悲则伤肺，恐则精却。思为脾志，实本于心。思则气结，忧则气耗，郁损心阴。真气潜消，邪氛日进，亢则害，五志之阳，与邪浑一，俱从火化，烁阴耗液。所谓热蒸气腾，壮火食气是也。屡寐气屡升，不分左右，似呻吟而近太息，又非短气，寐则阳气下交于阴，血归于肝，气归于肾，清肃不行，蒸热不退，肾水不升，肺气不降，金水交伤，水火不济，肺热奚疑。饮入于胃，输于脾，归于肺，注于膀胱，溲赤是其明验。水出高源，拟用一味苇茎，取其清空之气，甘平之力，以达清虚而益气化，若雨露之溉，荡涤伏热，即是补阴，清金不寒，壮水非补，且兼开胃，不亦宜乎。 活水芦根（四两） 甘澜水煎。
脉浮而数，颠痛身疼无汗，翕翕发热，洒洒振寒，腠理致密，玄府不开，乃三阳表证也。 羌活（一钱） 防风根（一钱） 细辛（三分） 苍术（一钱） 白芷（一钱） 川芎（八分） 黄芩（一钱） 大生地（三钱） 炙甘草（五分） 生姜（一片） 云茯苓（三钱）
服加减冲和汤，得汗遍身悉润，寒热顿除，颠疼亦止，浮数之脉亦缓。惟身痛不休，乃表气未和，宜桂枝汤小和之。 桂枝（八分） 炙甘草（五分） 赤芍（二钱） 生姜（三片） 大枣（二枚）
服桂枝汤，入夜神烦不寐，身反大热，脉反滑数，苔白如积粉，板滞不宣，汗出如浴，恶风不欲去衣，溲赤而浑，间有谵语，此伏邪内动，盘踞膜原，化热伤阴之渐。经以冬伤于寒，春必病温，夏必病热。盖始为寒，而终成热，同气相求，伤寒遇寒则发。前服冲和汤诸证乍退者，新感之寒邪从汗而解，身痛未除者，伏邪乘表虚而外越，与卫气相争，致令营卫失其常度。得桂枝诸证蜂起者，非桂枝之过，乃伏邪化热，直贯阳明，液耗阴伤，而祸乱起于萧墙之内。有神昏如醉，阴枯发痉之虑，故仲景有急下存津之旨。暂以吴氏达原饮，观其进退。 海南槟榔（一钱） 川厚朴（八分） 草果仁（五分） 白知母（钱半） 黄芩（钱半） 炙甘草（五分） 赤芍（二钱） 生姜（一片）
昨服达原饮，舌后之苔转黄，身热不从汗解，溲赤而浑，便溏色绛，竟夜不寐，神烦谵语，心下拒按，脉来滑数，府浊虽行，液耗阴伤可虑，原方加减。 海南槟榔（一钱） 川厚朴（七分） 草果仁（五分） 黄芩（钱半） 炙甘草（五分） 知母（钱半） 赤芍（二钱） 枳实（一钱） 桔梗（一钱） 生姜（一片）
两进达原饮，大解五次俱溏，酱黑之色渐淡，溲转浑黄，胸次渐开，夜得少寐，身热减，自汗收，府浊既行，议下从缓，依方进步。 海南槟榔（一钱） 川厚朴（五分） 草果仁（五分） 白知母（钱半） 黄芩（钱半） 炙甘草（五分） 赤芍（二钱） 鲜生地（八钱） 当归身（三钱）
昨药后，熟寐通宵，寅初忽觉憎寒，须臾寒战如疟，引被自覆，遍身悉冷，四肢厥逆，脉细如丝，神情萧索。卯正遍身灼热，屏去衣被，躁扰不安，欲起者再，倏然大汗淋漓，始自头项，下溉周身，汗之到处，灼热遽除，如汤沃雪。食顷脉静身凉，神清气爽，诸证如失。此非转疟，乃战汗也。得战汗者，以其人本虚，内伏之邪，既从府气宣通而溃，则在经之邪，孤悬难守，不攻自散，仍从表解，外与正争，邪正交争则战，邪退正复则已，正气不支，是以发战，宜安神养营。 大生地（八钱） 白茯神（三钱） 酸枣仁（三钱） 远志肉（一钱） 当归身（三钱） 白芍（二钱） 炙甘草（五分） 陈皮（一钱） 桔梗（一钱）
诸证悉退，溲色犹浑，知饥不欲食，黄苔未尽腐，中胃未醒，余氛未尽，尚宜养胃生阴。 大生地（五钱） 当归身（三钱） 大白芍（钱半） 赤茯苓（三钱） 生甘草（五分） 制半夏（钱半） 陈橘皮（一钱） 炒谷芽（三钱） 六和曲（二钱） 养胃生阴，以安神志。 大生地（五钱） 白茯神（三钱） 当归身（三钱） 白芍药（二钱） 鲜石斛（三钱） 陈橘皮（一钱） 炙甘草（五分） 炒枣仁（三钱） 活水芦根（二两）
养胃生阴，以安神志，已服三剂，知饥欲食，二便如常。惟夜卧不安，虚里穴动，心肾不交，五液真阴未复，六味归脾加减。 大生地（四两） 粉丹皮（两半） 人参（一两） 云茯苓（两半） 淮山药（二两） 福泽泻（两半） 冬白术（两半） 炙甘草（五钱） 当归身（二两） 酸枣仁（二两） 远志肉（一两） 为末，龙眼肉三两，煎水叠丸，早服三钱，晚服二钱。
阴枯邪陷，邪盛正虚，谵语神昏，苔黑起刺，唇焦齿焦，溲赤目赤，汗出至腰而还，潮热日晡益甚，循衣，肢强如痉，大便九日不解，脉数疾无力。补正则邪毒愈甚，攻邪则正气不支，攻之不可，补之不及，两无生理，勉拟一方，冀其百一。 大生地（八钱） 人参（一钱） 当归身（三钱） 大白芍（三钱） 粉丹皮（三钱） 犀角（二钱） 黄芩（二钱） 知母（三钱） 生大黄（五钱，另煎数沸捣汁）
第七日，三投汗剂，继进麻黄，汗竟不出，潮热颠疼，肢尖反冷，脉数，苔淡黄不润，溲浑赤，神昏。此非表证，乃伏邪内壅，阳郁不伸，气液不能敷布于外，必得里气宣通，云蒸雨化，伏邪还表，方能作汗，譬如缚足之鸟，乃欲飞腾，其得可乎。 柴胡根（一钱） 黄芩（钱半） 炙甘草（五分） 栝蒌仁（三钱） 大贝母（二钱） 赤芍（二钱） 当归身（三钱） 陈橘皮（一钱） 活水芦根（二两）
On the third day, aversion to cold ceased spontaneously. There was fever throughout the day and night, worsening in the late afternoon (Shen hour). Pain in the head and body lightened, but pain in the brow ridge and corners of the eyes became severe. The nose was dry, making sleep impossible. The tongue coating was white, sweating was incomplete, the pulse was surging, long, and rapid. Urine was turbid and red. This indicates latent pathogenic factors emerging outward, with disharmony between the Yangming meridian and fu organs. As long as there is no coma or hiccups, it is auspicious. Areca Nut from Hainan (1 qian), Magnolia Bark from Sichuan (0.7 qian), Fruit Seed of Tsaoko (0.5 qian), Scutellaria Root stir-fried with wine (1.5 qian), Licorice Root roasted with honey (0.5 qian), Anemarrhena Rhizome (1.5 qian), Red Peony Root (1.5 qian), Kudzu Root (2 qian), Fresh Ginger (1 slice).
On the fourth day, although sweating was thorough, the heat did not resolve; instead, there was a feeling of aversion to cold. There was deafness, insomnia, mental restlessness, a tendency to vomit, chest fullness, and hypochondriac pain. The tongue coating was pale yellow, urine was turbid and red, and the pulse was wiry and rapid. Latent pathogens were intermingling in the Shaoyang and Yangming meridians. Xiao Chai Hu Da Yuan Decoction was modified. Bupleurum Root (1 qian), Scutellaria Root stir-fried with wine (1.5 qian), Licorice Root roasted with honey (0.5 qian), Magnolia Bark from Sichuan (0.7 qian), Areca Nut from Hainan (1 qian), Fruit Seed of Tsaoko (0.5 qian), Red Peony Root (1.5 qian), Anemarrhena Rhizome (2 qian), Fresh Ginger (1 slice).
On the fifth day, irritability and vomiting slightly decreased, and there was slight sleep at night. However, alternating chills and fever persisted, along with deafness and chest fullness. Urine remained turbid and red, and the pulse was wiry and rapid. Chenpi (Tangerine Peel) 1 qian was added to the original formula.
On the sixth day, after taking the modified Xiao Chai Hu Da Yuan Decoction, one bowel movement occurred. The stool color resembled spoiled sauce, and the turbid red urine became lighter. Nighttime sleep was slightly more peaceful. After the fourth watch (4-6 AM), mental restlessness and vomiting returned, stopping shortly after drinking a little aged rice soup. Spontaneous sweating occurred at dawn, and body heat temporarily subsided. Lips were dry, the tongue was dry, and the pulse remained wiry and rapid. Latent pathogens were gradually dissipating, consuming yin fluids. Concern arose regarding potential complications. Bupleurum Root (1 qian), Scutellaria Root (1.5 qian), Licorice Root roasted with honey (0.5 qian), Red Peony Root (1.5 qian), Anemarrhena Rhizome (2 qian), Aged Tangerine Peel (1 qian), Angelica Sinensis Body (3 qian), Reed Rhizome from reverse-flowing water (1 liang), Large Water Chestnut (4 pieces).
On the seventh day, heat subsided, but the pulse remained restless. Stool was like spoiled sauce, urine was turbid like bean dregs. Nighttime sleep was shallow. Chest oppression led to anorexia. Mental restlessness and vomiting occurred. The tongue was dry with thirst. Tongue coating was yellow but not greasy/foul. This indicates latent pathogens transforming into heat and injuring yin. Coma, prickly tongue coating, and hiccups are most feared. Tianhuafen (Trichosanthes Root) 3 qian was added to the original formula.
On the eighth day, the pulse was rapid, and bowel movements had not yet resolved. Urine became turbid and nearly red. Heat and sweating were present on the vertex and epigastrium. Limbs were slightly cold. Tongue coating was yellow, with a red tip and slight prickle. Mouth was dry with thirst, yet there was a desire for hot drinks. Mental restlessness and poor sleep persisted. Pathogens lay dormant in Shaoyang, transferring to Yangming, transforming into heat and injuring yin. Extreme heat manifested with cold signs. Cold limbs, thirst for hot drinks, constipation, and blocked fu qi indicated pathogens had no exit. Originally, Chengqi Decoction should have been used to purge accumulation and preserve fluids, but given the patient's constitutional deficiency, slow treatment was adopted. Rehmannia Root (5 qian), Angelica Sinensis Body (3 qian), Bupleurum Root (1 qian), Scutellaria Root (1.5 qian), Anemarrhena Rhizome (2 qian), Achyranthes Root (3 qian), Red Peony Root (1.5 qian), Immature Bitter Orange (1 qian), Reed Rhizome from reverse-flowing water (2 liang).
On the ninth day, after medication, two bowel movements occurred. Stool was black like lacquer, containing blood stasis. Heat on the vertex subsided. Prickles on the tongue receded. Irritability and thirst decreased. Limbs warmed. Nighttime sleep was peaceful. Rapid pulse slowed. Urine color faded. Yellow coating began to rot/dissolve. Latent pathogens gradually transformed relying on the unblocking of fu qi. The lower orifice (anus) is the exterior of the interior. Pathogens lying in the Membrane Source transferred to Yangming, exiting via the Large Intestine. This path is close, similar to the concept of resolving exterior pathogens via sweat. Thus, when bowels open, symptoms decrease; when bowels close, symptoms increase. Six Evils on the exterior should be resolved via sweat. Latent pathogens in the interior should be resolved via stool. What is the difference between purgation and diaphoresis? Latent Qi and exterior pathogens are of one nature. The Stomach is a fu organ abundant in blood; the Spleen is the zang organ governing blood. Black bloody stool indicates stomach heat forcing blood into the Large Intestine, affecting the Yin organs, damaging the Spleen's control. Fear of recurrent constipation and re-aggregation of yang pathogens led to a strategy of nourishing yin and unblocking the fu. Rehmannia Root (4 qian), Raw Licorice Root (0.5 qian), Angelica Sinensis Tip (3 qian), Achyranthes Root (1.5 qian), Red Peony Root (1.5 qian), Anemarrhena Rhizome (2 qian), Scutellaria Root (1.5 qian), Gardenia Fruit charred (1.5 qian), Peach Kernel paste (1.5 qian), Apricot Kernel paste (3 qian), Trichosanthes Seed (3 qian), Living Water Reed Rhizome (2 liang).
On the tenth day, six additional Water Chestnuts were added to the formula, decocted with flowing water. On the eleventh day, after two doses of yin-nourishing and fu-unblocking herbs, three bowel movements occurred. Stool was purple-black with clots, entirely stagnant blood. All symptoms disappeared. Nighttime breathing was normal. Upon waking, spirit was calm and comfortable. Hunger and desire for food returned. Body temperature normalized, pulse slowed. Only urine remained turbid, with residual heat in the chest. Residual pathogens lingered. Latent pathogens were resolved in the blood level. True yin and the five fluids were injured. Internally manifesting as blood, externally as sweat, sweat is blood. Disease healed via blood descent, just as exterior pathogens resolve via sweat. The lower orifice is the exterior of the interior, as seen here. Strategy: Nourish yin and boost qi for recovery. Rehmannia Root (8 qian), Ginseng (1 qian), Chinese Yam (4 qian), Licorice Root roasted with honey (0.5 qian), Angelica Sinensis Body (3 qian), Xinhui Tangerine Peel (1 qian), Silver Bupleurum (0.5 qian), Prepared Cimicifuga Rhizome (0.3 qian).
At onset, there was no aversion to cold, only fever and thirst, red urine, and insomnia. Diaphoretic and digestive-promoting agents were taken, but no sweat came, and heat persisted. Forty days passed. Emaciation, limb tremors, gray-black tongue coating. Thirteen bowel movements total,酱黑色 fading to yellow. Urine turbid yellow, not red. Consumed small amounts of thin porridge 4-5 times daily. Sleep was intermittent. Weakness prevented turning over. Speech was inaudible. Pulse was faint and rapid, weak upon pressure. Middle-aged decline, constitutionally weak. Although latent pathogens showed signs of resolution, yuan qi was too weak to expel them. Pathogenic heat raged, true yin dried up. Both evil and righteous qi would perish. Danger was imminent like morning dew. Urgent vigorous tonification was needed to revive the five fluids and three yins. Once righteous qi recovered, it could not tolerate evil, striking from within to expel it outward, hoping for a battle-sweat resolution. Rehmannia Root (8 qian), Ginseng (1 qian), Ophiopogon Tuber (3 qian), Schisandra Berry (0.8 qian), Angelica Sinensis Body (3 qian), Poria with Hostwood (3 qian), Sour Jujube Seed (3 qian), Polygala Root (1 qian), Reed Rhizome from reverse-flowing water (2 liang).
Nourishing yin, consolidating qi, assisting righteous qi to drive out evil. Battle-sweat ensued. Shivering lasted over an hour. Cold extremities warmed, body heated. Sweat poured like a bath from morning to evening, unremitting. Breath nearly stopped, yuan qi nearly collapsed. Two doses of the previous formula were urgently administered.
After two doses, sweating stopped, symptoms retreated. Spirit was lethargic, sleeping deeply. This is the phase where evil retreats and righteous qi recovers. Long-standing struggle between evil and righteous qi, initial calming of evil atmosphere, return of righteous qi to meridians requires rest. Original formula continued. This formula neither induces nor stops sweat. Sweat release and retention are governed by yuan qi. Qi is the bellows; sweat is the waves. Previous sweating resulted from medicinal power assisting righteous qi, moving from zang to fu, from meridians to collaterals, driving evil to the exterior. Evil exited via sweat, but sweat continued due to lack of sustained medicinal force and deficient righteous qi unable to consolidate. Thus, the original formula guides scattered qi back from specific meridians/collaterals to zang-fu organs. Using anti-sudorifics would be a major error. Even adding/removing one herb changes the nature, leading astray. "Miss by a hair, miss by a mile." To induce sweat without knowing Ying-Wei status, or to stop sweat without understanding the bellows' mechanism, is like sailing on land or driving a cart at sea. I do not refuse to propose another formula, but detail this for the knowledgeable.
Six pulses were rapid. Superficial grip insufficient, deep grip sufficient. For ten days, coma-like drunkenness, occasional solitary muttering. Pale yellow, non-moist tongue coating. Teeth plate-like, no saliva. Red eyes, scorched lips. No hunger/thirst, but accepted liquids. Epigastrium to lower abdomen: no pain/fullness on pressure. Bowels normal. Urine red/turbid. Latent pathogens entrenched in Taiyang, heat entering Bladder. Ren water pathology transmitted reversely to Bing fire. Bing/Ding are siblings, transmitting to Heart. Heart fire attacks Lung metal, clearing/descending function fails, violating the taboo of "dead yin" in classics. Rescue difficult. Tentatively formulated Xijiao Dihuang Tang combined with Daochi San, plus charred Gardenia, to clear heart, protect lung, and guide evil fire downward. Rehmannia Root (8 qian), Rhinoceros Horn (1.5 qian), White Peony Root (3 qian), Moutan Cortex (3 qian), Licorice Root tip (1 qian), Akebia Stem (1 qian), Charred Gardenia (2 qian), Living Water Reed Rhizome (2 liang).
Classics state: Heart disease transmitting to Lung is called "dead yin." Death within three days occurs because it falls short of Metal's generative number. After three doses of Clear Heart Protect Lung, survival past three days was achieved. Vital qi returned, clearing/descending function operated, heat retreated. Hunger/appetite returned, stomach qi awakened, consciousness cleared. Urine still turbid/red. Continued Daochi Protect Lung, Xijiao Clear Heart to force Ding evil back to Bing/Ren. Cure when urine clears. Rehmannia Root (8 qian), Rhinoceros Horn (2 qian), White Peony Root (3 qian), Moutan Cortex (3 qian), Licorice Root tip (1 qian), Akebia Stem (1 qian), Charred Gardenia (2 qian), Poria (3 qian), Alisma Rhizome (3 qian), Scutellaria Root (1.5 qian), Living Water Reed Rhizome (2 liang).
Body heat with spontaneous sweating, unwillingness to remove clothes, indicates aversion to cold. Typical Shanghan with sweat/aversion to cold is exterior deficiency. Latent Qi is different. Pathogens lie in Membrane Source, emerging to Taiyang exterior. Wei qi protection fails, pores loose. Differentiated by turbid red urine, unlike cold injury to exterior. Should follow its nature to disperse. Do not rigidly use Guizhi Tang for sweating/exterior release. Zhongjing warned: "Guizhi swallowed, yang excess leads to death." Proposed Huoren Baidu San modified. Notopterygium Rhizome (1 qian), Bupleurum Root (1 qian), Immature Bitter Orange peel (1 qian), Lovage Rhizome (1 qian), Licorice Root roasted with honey (0.5 qian), Platycodon Root (1 qian), Red Poria (3 qian), Tangerine Peel (1 qian), Fresh Ginger (1 slice).
Shanghan with profuse sweating leaves disease unresolved. Latent Qi with profuse sweating indicates disease resolution. Last night's medication caused greater sweating, soaking clothes overnight. Whole body cooled, six pulses quiet, urine clear. Only middle jiao stomach qi unawakened. Strategy: Nourish stomach, generate yin. Glehnia Root (3 qian), Poria (3 qian), Black Sesame (3 qian), Fresh Dendrobium (3 qian), Angelica Sinensis Body (3 qian), Fried Rice Sprout (3 qian), Aged Tangerine Peel (1 qian), White Cardamom (0.8 fen), Liuhe Shenqu (1.5 qian), Aged Barn-rice (1 liang), Lotus Leaf Peduncle (1 piece).
All qi stagnation and depression belong to the Lung. All rebellious upward rushing belongs to Fire. Lung governs qi of all vessels. Kidney stores essence of five viscera. Kidney water controls five fires. Lung metal moves all qi. Grief injures Lung. Fear causes essence retreat. Thought is Spleen emotion, rooted in Heart. Thought causes qi knotting. Worry consumes qi. Depression damages Heart yin. True qi dissolves secretly, evil atmosphere advances. Excess brings harm. Five emotions' yang merges with evil, transforming to fire, scorching yin/fluids. "Heat vaporizes, strong fire eats qi." Frequent sleep with rising qi, moaning/sighing, not shortness of breath. During sleep, yang enters yin, blood returns to Liver, qi returns to Kidney. Clearing/descending fails, steaming heat persists. Kidney water does not rise, Lung qi does not descend. Metal/Water mutually injure, Water/Fire fail to interact. Lung heat is certain. Drink enters Stomach, transports to Spleen, returns to Lung, pours into Bladder. Red urine confirms this. Water originates high source. Propose single Herb: Eupatorium Rhizome (Reed Shoot), utilizing its clear/empty qi, sweet/neutral power to reach clarity/vacuity, benefit qi transformation, like rain/dew washing away latent heat, which is nourishing yin. Clearing metal is not cold, strengthening water is not tonifying, yet opens stomach. Is this not suitable? Living Water Reed Rhizome (4 liang), Decocted with Ganlan Water.
Pulse floating and rapid. Vertex pain, body ache, no sweat. Flickering fever, shivering chills. Pores dense, xuangu (pores) closed. This is Taiyang/Yangming/Yueyin exterior syndrome. Notopterygium Rhizome (1 qian), Saposhnikovia Root (1 qian), Asarum (0.3 qian), Atractylodes Rhizome (1 qian), Angelica Dahurica Root (1 qian), Lovage Rhizome (0.8 qian), Scutellaria Root (1 qian), Rehmannia Root (3 qian), Licorice Root roasted with honey (0.5 qian), Fresh Ginger (1 slice), Poria (3 qian).
After taking Modified Chonghe Tang, whole-body moist sweat, chills/heat removed, headache stopped, floating/rapid pulse slowed. Persistent body pain indicates exterior qi not harmonized. Guizhi Tang should be used to gently harmonize. Cinnamon Twig (0.8 fen), Licorice Root roasted with honey (0.5 fen), Red Peony Root (2 qian), Fresh Ginger (3 slices), Jujube (2 pieces).
After Guizhi Tang, nighttime mental restlessness/insomnia, body heat increased, pulse slippery/rapid, tongue coating white like accumulated powder, stiff/non-diffusing, sweat pouring, aversion to wind/unwilling to remove clothes, red/turbid urine, occasional delirium. This indicates internal movement of latent pathogens, entrenched in Membrane Source, beginning to transform heat/injure yin. Classics: Winter cold injury leads to Spring Warmth, Summer Heat. Initially cold, finally heat. Like attracts like. Shanghan manifests with cold. Previous Chonghe Tang symptoms briefly retreated because new cold evil exited via sweat. Unresolved body pain: latent pathogens exploited exterior deficiency, emerged, fought Wei qi, disrupting Ying-Wei balance. Symptoms flaring after Guizhi are not Guizhi's fault, but latent pathogens transforming heat, penetrating Yangming, consuming fluids/yin, causing chaos internally. Fear of coma/spasms from yin exhaustion. Hence Zhongjing's principle of urgent purgation to preserve fluids. Temporarily use Wu's Dayuan Yin to observe progress. Areca Nut (1 qian), Magnolia Bark (0.8 qian), Tsaoko Seed (0.5 qian), Anemarrhena Rhizome (1.5 qian), Scutellaria Root (1.5 qian), Licorice Root roasted with honey (0.5 qian), Red Peony Root (2 qian), Fresh Ginger (1 slice).
Yesterday's Dayuan Yin turned posterior tongue coating yellow. Heat not resolved by sweat. Red/turbid urine. Loose stool crimson. Insomnia all night. Mental restlessness/delirium. Epigastric tenderness/rejection. Slippery/rapid pulse. Fu turbidity moved, but fluid/yin injury concerning. Modified original formula. Areca Nut (1 qian), Magnolia Bark (0.7 qian), Tsaoko Seed (0.5 qian), Scutellaria Root (1.5 qian), Licorice Root roasted with honey (0.5 qian), Anemarrhena Rhizome (1.5 qian), Red Peony Root (2 qian), Immature Bitter Orange (1 qian), Platycodon Root (1 qian), Fresh Ginger (1 slice).
Two doses of Dayuan Yin. Five loose stools. Sauce-black color fading. Urine turbid yellow. Chest opening. Slight nighttime sleep. Heat reduced, spontaneous sweating stopped. Fu turbidity moved. Purging strategy delayed, proceeding per formula. Areca Nut (1 qian), Magnolia Bark (0.5 qian), Tsaoko Seed (0.5 qian), Anemarrhena Rhizome (1.5 qian), Scutellaria Root (1.5 qian), Licorice Root roasted with honey (0.5 qian), Red Peony Root (2 qian), Fresh Rehmannia (8 qian), Angelica Sinensis Body (3 qian).
After yesterday's medicine, deep sleep all night. Early Tiger hour (3-5 AM): sudden aversion to cold. Soon shivering like malaria, pulling covers, whole body cold, extremities cold, thread-like pulse, desolate spirit. Rabbit hour (5-7 AM): whole body burning hot, discarded clothes/quilt, restless, wanting to rise repeatedly. Suddenly profuse sweating starting from head/neck, irrigating whole body. Wherever sweat reached, burning heat vanished instantly like snow melting in hot water. Shortly after, pulse quiet, body cool, spirit clear, symptoms gone. Not malaria conversion, but battle-sweat. Battle-sweat occurs in constitutionally deficient persons. Internal latent pathogens, having溃 (broken) via fu qi unblocking, become isolated in meridians, hard to hold, dispersing without attack, resolving via exterior. Fighting righteous qi externally causes shivering. Evil retreats, righteous recovers, shivering stops. Righteous qi failing causes shivering. Strategy: Calm spirit, nourish Ying. Rehmannia Root (8 qian), Poria with Hostwood (3 qian), Sour Jujube Seed (3 qian), Polygala Root (1 qian), Angelica Sinensis Body (3 qian), White Peony Root (2 qian), Licorice Root roasted with honey (0.5 qian), Tangerine Peel (1 qian), Platycodon Root (1 qian).
All symptoms retreated, urine still turbid. Hunger without appetite. Yellow coating not fully rotted. Middle jiao stomach qi unawakened. Residual atmosphere lingering. Still need to nourish stomach/generate yin. Rehmannia Root (5 qian), Angelica Sinensis Body (3 qian), Large White Peony (1.5 qian), Red Poria (3 qian), Raw Licorice (0.5 qian), Processed Pinellia (1.5 qian), Aged Tangerine Peel (1 qian), Fried Rice Sprout (3 qian), Liuhe Qu (2 qian). Nourish stomach/generate yin to calm spirit. Rehmannia Root (5 qian), Poria with Hostwood (3 qian), Angelica Sinensis Body (3 qian), White Peony Root (2 qian), Fresh Dendrobium (3 qian), Aged Tangerine Peel (1 qian), Licorice Root roasted with honey (0.5 qian), Fried Sour Jujube Seed (3 qian), Living Water Reed Rhizome (2 liang).
Nourish stomach/generate yin to calm spirit. Three doses taken. Hunger/appetite returned. Bowels/urine normal. Nighttime restlessness. Xu Li point pulsating. Heart/Kidney non-interaction. Five fluids/true yin not restored. Liuwei Dihuang + Guipi Tang modified. Rehmannia Root (4 liang), Moutan Cortex (1.5 liang), Ginseng (1 liang), Poria (1.5 liang), Chinese Yam (2 liang), Alisma (1.5 liang), Atractylodes Macrocephala (1.5 liang), Licorice Root roasted with honey (5 qian), Angelica Sinensis Body (2 liang), Sour Jujube Seed (2 liang), Polygala Root (1 liang). Powdered, mixed with Longan Aril (3 liang), decocted water to form pills. Take 3 qian morning, 2 qian evening.
Yin exhausted, evil trapped. Evil excess, righteous deficiency. Delirium/coma. Black prickly tongue coating. Scorched lips/teeth. Red urine/eyes. Sweating stopping at waist. tidal fever worsening in late afternoon. Grasping clothes. Rigidity like spasms. Constipation nine days. Rapid/weak pulse. Tonifying righteous qi intensifies evil toxin. Attacking evil exhausts righteous qi. Neither attack nor tonify works. No life. Tentative formula, hoping for 1% chance. Rehmannia Root (8 qian), Ginseng (1 qian), Angelica Sinensis Body (3 qian), Large White Peony (3 qian), Moutan Cortex (3 qian), Rhinoceros Horn (2 qian), Scutellaria Root (2 qian), Anemarrhena Rhizome (3 qian), Raw Rhubarb (5 qian, separately decocted, boiled few times, juice extracted).
Seventh day. Three doses of diaphoretics, followed by Ephedra. No sweat. Tidal fever/headache. Cold extremity tips. Rapid pulse. Pale yellow non-moist coating. Turbid red urine. Coma. Not exterior syndrome. Latent pathogens internally obstructed. Yang qi depressed, unable to extend. Qi/fluids cannot distribute outward. Must obtain interior qi unblocking, cloud-steaming/rain-transforming, latent pathogens returning to exterior, then sweat can occur. Like a bird with bound feet trying to fly—is it possible? Bupleurum Root (1 qian), Scutellaria Root (1.5 qian), Licorice Root roasted with honey (0.5 qian), Trichosanthes Seed (3 qian), Fritillaria Bulb (2 qian), Red Peony Root (2 qian), Angelica Sinensis Body (3 qian), Aged Tangerine Peel (1 qian), Living Water Reed Rhizome (2 liang).