张（二四） 初冬病热旬日，舌黄口渴，胸满背痛自汗。此内有伏暑，外感新寒，用双解
法。
石膏（五钱消暑止汗） 苏叶（一钱） 羌活（一钱，疏肌逐邪） 黄芩（一钱，退热） 花粉
（一
钱，止渴） 橘红（一钱，宽胸） 栝蒌（二钱，清热消烦） 浓朴（一钱三分，除满） 甘草（三
分和中）
又两服，诸症皆退，尚有余热。
川斛 地骨皮 青蒿 知母 丹皮 橘皮 甘草
曹（十七） 左脉弦细，右弦大而数，日夜发热，头痛不休，频喜饮啜，而不消水。正属
劳倦内伤，壮火食气，用景岳四阴煎。若因头痛作外感，脉弦数喜饮作寒热，或用小柴胡和
解，
危矣哉！
生地（四钱） 麦冬（二钱） 党参（一钱五分） 于术（一钱五分） 归身（一钱五分） 广皮
（一钱） 丹皮（一钱） 青蒿（一钱） 炙草（四分）
又前方四服热解，略有头痛，入暮微发寒热，自汗盗汗。虚象毕露，当补营卫，补
中益气去升、麻，加生地三钱，浮小麦钱半，四帖痊愈。
庄（三四） 发热十日，神昏谵语，唇焦口臭，烦躁呻吟，脉反沉细。此热邪已入血分，
症非轻浅，拟桃仁承气下之。
大黄（三钱） 芒硝（一钱） 桃仁（一钱五分） 黄芩（一钱五分） 知母（一钱五分） 滑石
（二钱） 甘草（四分）石膏（一两）
服下旋即如圊，数回解下燥粪两块，浊秽甚多，热退神清，舌苔退淡。古称阳症见阴脉
者死
，未尽然也。盖邪气结于阳明，血无不燥。营行脉中，卫行脉外，营卫热结不交，其脉多现
沉细阴脉，此段与古人翻案。学人审之，余热未尽，只消清养胃阴。
鲜生地 鲜石斛 知母 麦冬 花粉 甘草
费（三十） 畏寒身热，脉虚肢软，舌苔白滑，属脾虚不能护表，补中益气去升、麻，加
桂枝四帖愈。
陆（三六） 身热吐蛔，咳痰面清淡，脉浮洪而数。此脾虚发热，非时疫也。（因多时疫
。）误
投攻下，几乎不免，数日来全不纳谷，胸前胀满，岂是小恙？急宜扶助脾胃，观其转旋。
党参 生于术 黄 归身 熟地 麦冬 茯苓 橘皮 炙草 煨姜
五服热退神复，稍能应对，咳痰未能尽除。当属补力未到，前方去地、冬，加苡仁、半
夏、苏子，十服而愈。
柏（四一） 发热恶食，口苦便赤，脉细盗汗，劳伤血分。
生地 归身 白芍 丹皮 麦冬 青蒿 地骨皮
四服愈。
沈（五十） 发热不休，日轻夜重，神昏谵语，两脉细数。若为温疟，全无少阳现症，面
色清
淡，不似邪滞之容。倘辨不确，作热邪治，投小白汤。（即小柴胡合白虎汤，能治温疟。）
何异鸩毒哉！此为血虚发热，其谵语乃肝燥所致，但服此方，即明予言不谬矣。八珍汤去川
芎，加黄 、枸杞、五味子、龙眼肉，一剂知二剂已。
周（二六） 发热如伤寒，全不纳食，右脉不起，左三部浮大而软，观其形痿气微，必属
劳倦伤脾；既带外感，终是轻枝薄叶，治病专贵求本，仿李东垣法，庶可挽回。
党参 黄 蒸冬术 归身 生地 麦冬 橘皮 青蒿 柴胡 炙草 姜 枣
又脉起而调，神爽能纳，惟入暮微发寒热，咳嗽。此营卫虚损，久病宜用温补。
熟地 黄 党参 蒸冬术 归身 枸杞 柴胡 桂枝 炙草
杨（二三） 外感祛，头痛畏风除，其热未解，胸闷不纳，形弱气乏，病邪半入于里。
柴胡 防风 升麻 黄芩 半夏 橘皮 北沙参 甘草 姜皮
两服痊愈。
查氏（四十） 前投消导开郁，胸前胀痛愈，畏风除；惟身热，纳食欲呕。此肝
火上逆，胃气不降所致。
半夏 橘红 郁金 丹皮 麦冬 白芍 茯苓 山栀 黄芩
两服痊愈。
陆（十七） 两脉浮大，不时发热盗汗，证属劳倦，虽当伏天亢炎，终宜补益；稍带暑邪
，岂可轻投！故辨证最贵明确。
党参 黄 归身 蒸冬术 生地黄 橘皮 炒谷芽 炙草
四服痊愈。
安儿（十三）暮秋患发热、畏风、嗳腐，脉弦数，投以消导解肌清热，两服无效∶其夜半
稍缓
，余无休时，全不思纳。改投柴、葛、石膏、黄芩、知母，两和表里，得汗旋退旋复，出入
数剂，加至石膏两余，终不去病。因诊脉紧而甚数，且七八日不大便，解肌清里不愈，必须
下之，用大承气汤，解下燥粪一块，继浊秽甚多，身热即减。至明朝起，寒战似疟，傍午热
尤甚。予思汗下之后，其病不除，由营卫二气不和，宜清淡之品；况且咳呛，即以竹叶五十
片，薄荷一钱五分，甘草三分，白粳米百粒，煎服两帖。热轻寒重，脉带虚形，色惨淡，舌
苔少而不渴，小便不热，见火无赤大之象，乃当其未寒前，一时许服。
半夏 党参 广皮 归身 黄 柴胡 升麻 防风 葛根 炙草 大枣 生姜
此方意在补脾胃，消痰涎，彻其卫阳，使不内陷。其日寒来甚微，热只二时许，口和思
纳，又下日，以黄 当归建中汤，加半夏、橘皮，服后不知病之去向矣。
沈（三二） 发热吐蛔，口燥而渴，舌心红亮，脉右弱左弦，全不纳食。此外受风寒，内
伤暑热，不是轻证，用双解法。
柴胡 葛根 知母 黄芩 白芍 花粉 楂肉 橘皮 甘草
一服热退渴止，脉和能纳。惟合眼汗即大泄，此胃家有虚热，津液不得下输，宜和营法
。
生地 归身 白芍 黄 麦冬 北沙参 枣仁 茯神 炙草 浮小麦
如此双感重症，两服痊愈，可见药贵对症。虽临危之疾，大气未绝，亦可应手取效也。
仲景云∶一剂知二剂已。信不我斯？所以感症投剂，至三帖后不见效验，错路无疑。
Zhang (24 years old): In early winter, he suffered from fever for more than ten days. His tongue coating was yellow, he felt thirsty, had chest fullness, back pain, and spontaneous sweating. This indicated latent summerheat inside and new cold outside. The treatment method used was simultaneous release of exterior and interior.
Shigao (Gypsum Fibrosum) (5 qian, clears summerheat and stops sweating) Suye (Perilla Folium) (1 qian) Qianghuo (Notopterygii Rhizoma et Radix) (1 qian, disperses the muscle layer and expels pathogens) Huangqin (Scutellariae Radix) (1 qian, reduces heat) Huafen (Trichosanthis Radix) (1 qian, stops thirst) Juhong (Citri Reticulatae Pericarpium Rubrum) (1 qian, expands the chest) Gualou (Trichosanthis Fructus) (2 qian, clears heat and relieves irritability) Nongpo (Magnoliae Officinalis Cortex) (1.3 qian, removes fullness) Gancao (Glycyrrhizae Radix et Rhizoma) (0.3 qian, harmonizes the middle)
After taking two more doses, all symptoms subsided, but residual heat remained.
Chuanhu (Dendrobii Caulis) Digupi (Lycii Cortex) Qinghao (Artemisiae Annuae Herba) Zhimu (Anemarrhenae Rhizoma) Danpi (Moutan Cortex) Jupi (Citri Reticulatae Pericarpium) Gancao (Glycyrrhizae Radix et Rhizoma)
Cao (17 years old): The left pulse was wiry and fine; the right pulse was wiry, large, and rapid. He had fever day and night, unremitting headache, frequently desired to drink, but could not digest water. This precisely belonged to internal injury due to fatigue and overwork, where vigorous fire consumes qi. The prescription Jingyue Siyin Jian (Jingyue Four-Yin Decoction) was used. If the headache were treated as an external contraction, or if the wiry-rapid pulse and desire to drink were treated as alternating chills and fever, or if Xiaochaihu Tang (Minor Bupleurum Decoction) were used to harmonize, it would be perilous!
Shengdi (Rehmanniae Radix) (4 qian) Maidong (Ophiopogonis Radix) (2 qian) Dangshen (Codonopsis Radix) (1.5 qian) Yuzhu (Atractylodis Macrocephalae Rhizoma) (1.5 qian) Guishen (Angelicae Sinensis Radix) (1.5 qian) Guangpi (Citri Reticulatae Pericarpium) (1 qian) Danpi (Moutan Cortex) (1 qian) Qinghao (Artemisiae Annuae Herba) (1 qian) Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) (0.4 qian)
After taking four more doses of the previous formula, the heat resolved, with slight headache remaining. In the evening, there were mild chills and fever, spontaneous sweating, and nocturnal sweating. The deficiency signs were fully revealed. It was necessary to tonify Ying (Nutrient) and Wei (Defensive) Qi. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used, removing Shengma (Cimicifugae Rhizoma) and Ma Huang (Ephedrae Herba), adding Shengdi (Rehmanniae Radix) 3 qian and Fuxiaomai (Tritici Fructus Hordei Germinatus) 0.5 qian. After four doses, he recovered.
Zhuang (34 years old): Fever for ten days, coma, delirious speech, cracked lips, foul breath, restlessness, groaning. The pulse was surprisingly deep and fine. This indicated that the pathogenic heat had entered the Blood level. The condition was not light. Taoren Chengqi Tang (Peach Kernel and Cathartic Decoction) was proposed for purgation.
Dahuang (Rhei Radix et Rhizoma) (3 qian) Mangxiao (Natrii Sulfas) (1 qian) Taoren (Persicae Semen) (1.5 qian) Huangqin (Scutellariae Radix) (1.5 qian) Zhimu (Anemarrhenae Rhizoma) (1.5 qian) Huashi (Talcum) (2 qian) Gancao (Glycyrrhizae Radix et Rhizoma) (0.4 qian) Shigao (Gypsum Fibrosum) (1 liang)
After taking the medicine, he immediately went to the toilet. Several times, dry feces in two pieces were passed, along with much turbid filth. The heat subsided, consciousness cleared, and the tongue coating faded. Ancients said that Yang conditions presenting Yin pulses indicate death, but this is not entirely true. Generally, when pathogenic qi knots in the Yangming channel, the blood becomes dry. Ying (Nutrient) Qi circulates within the vessels, while Wei (Defensive) Qi circulates outside. When Ying and Wei are bound by heat and do not interact, the pulse often appears deep and fine (Yin pulse). This section overturns ancient views. Students should examine this carefully. For residual heat, simply clear and nourish Stomach Yin.
Xianshengdi (Fresh Rehmanniae Radix) Xianshihu (Fresh Dendrobii Caulis) Zhimu (Anemarrhenae Rhizoma) Maidong (Ophiopogonis Radix) Huafen (Trichosanthis Radix) Gancao (Glycyrrhizae Radix et Rhizoma)
Fei (30 years old): Chills with body heat, deficient pulse, soft limbs, white and slippery tongue coating. This belonged to Spleen deficiency failing to protect the exterior. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used, removing Shengma (Cimicifugae Rhizoma) and Ma Huang (Ephedrae Herba), adding Guizhi (Cinnamomi Ramulus). After four doses, he recovered.
Lu (36 years old): Body heat, vomiting roundworms, pale complexion with phlegm cough, floating, large, and rapid pulse. This was Spleen deficiency generating heat, not a seasonal epidemic. (Since there were many epidemics at the time.) Misusing purgatives almost led to disaster. For several days, he could not eat at all, with chest fullness. Was this a minor ailment? Urgently, support the Spleen and Stomach and observe the transformation.
Dangshen (Codonopsis Radix) Yuzhu (Atractylodis Macrocephalae Rhizoma) Huangqi (Astragali Radix) Guishen (Angelicae Sinensis Radix) Shudi (Prepared Rehmanniae Radix) Maidong (Ophiopogonis Radix) Fuling (Poria) Jupi (Citri Reticulatae Pericarpium) Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) Weijiang (Prepared Zingiberis Rhizoma)
After five doses, heat subsided, spirit returned, and he could respond slightly, but phlegm cough was not fully resolved. This indicated the tonifying power had not yet reached its target. The previous formula removed Shudi (Prepared Rehmanniae Radix) and Maidong (Ophiopogonis Radix), added Yiren (Coicis Semen), Banxia (Pinelliae Rhizoma), and Suzi (Perillae Fructus). After ten doses, he recovered.
Bo (41 years old): Fever, aversion to food, bitter taste, red urine, fine pulse, nocturnal sweating. Injury to the Blood level due to fatigue.
Shengdi (Rehmanniae Radix) Guishen (Angelicae Sinensis Radix) Baishao (Paeoniae Radix Alba) Danpi (Moutan Cortex) Maidong (Ophiopogonis Radix) Qinghao (Artemisiae Annuae Herba) Digupi (Lycii Cortex)
After four doses, he recovered.
Shen (50 years old): Unremitting fever, lighter during the day and heavier at night, coma, delirious speech, both pulses fine and rapid. If this were Wen Nue (Warm Malaria), there would be no Shaoyang symptoms. The complexion was pale, unlike the appearance of pathogenic stagnation. If misdiagnosed and treated as pathogenic heat, using Xiao Bai Tang (which is Xiaochaihu Tang combined with Baihu Tang, capable of treating Warm Malaria) would be like administering poison! This was heat due to Blood deficiency. The delirium was caused by Liver dryness. Taking this formula would prove my words correct. Bazhen Tang (Eight-Treasure Decoction) was used, removing Chuanxiong (Ligustici Chuanxiong Rhizoma), adding Huangqi (Astragali Radix), Gouqi (Lycii Fructus), Wuweizi (Schisandrae Fructus), and Longyanrou (Longan Arillus). One dose showed improvement, two doses cured.
Zhou (26 years old): Fever resembling Taiyang disease, complete loss of appetite, right pulse non-elevated, left three positions floating, large, and soft. Observing his emaciated form and weak qi, this must belong to Spleen injury due to fatigue and overwork. Although accompanied by external contraction, it is ultimately superficial. Treating disease values seeking the root. Following Li Dongyuan's method, recovery might be achieved.
Dangshen (Codonopsis Radix) Huangqi (Astragali Radix) Zheng Dongzhu (Steamed Atractylodis Rhizoma) Guishen (Angelicae Sinensis Radix) Shengdi (Rehmanniae Radix) Maidong (Ophiopogonis Radix) Jupi (Citri Reticulatae Pericarpium) Qinghao (Artemisiae Annuae Herba) Chaihu (Bupleuri Radix) Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) Jiang (Zingiberis Rhizoma) Zao (Jujubae Fructus)
Subsequently, the pulse rose and regulated, spirit refreshed, able to eat. Only in the evening were there mild chills and fever, and cough. This was deficiency and damage of Ying (Nutrient) and Wei (Defensive) Qi. For chronic illness, warm tonification is suitable.
Shudihuang (Prepared Rehmanniae Radix) Dangshen (Codonopsis Radix) Zheng Dongzhu (Steamed Atractylodis Rhizoma) Guishen (Angelicae Sinensis Radix) Gouqi (Lycii Fructus) Chaihu (Bupleuri Radix) Guizhi (Cinnamomi Ramulus) Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma)
Yang (23 years old): External contraction expelled, headache and aversion to wind resolved, but heat unresolved, chest fullness, inability to eat, weak form, lack of qi. Pathogenic evil half-entered the interior.
Chaihu (Bupleuri Radix) Fangfeng (Saposhnikoviae Radix) Shengma (Cimicifugae Rhizoma) Huangqin (Scutellariae Radix) Banxia (Pinelliae Rhizoma) Jupi (Citri Reticulatae Pericarpium) Beishashen (Glehniae Radix) Gancao (Glycyrrhizae Radix et Rhizoma) Jiangpi (Zingiberis Pericarpium)
After two doses, he recovered.
Mrs. Zha (40 years old): Previously administered digestion-promoting and depression-resolving herbs; chest fullness and pain resolved, aversion to wind eliminated; only body heat remained, with desire to eat but nausea. This was caused by Liver Fire rebelling upward and Stomach Qi failing to descend.
Banxia (Pinelliae Rhizoma) Juhong (Citri Reticulatae Pericarpium Rubrum) Yujin (Curcumae Radix) Danpi (Moutan Cortex) Maidong (Ophiopogonis Radix) Baishao (Paeoniae Radix Alba) Fuling (Poria) Shanzhi (Gardeniae Fructus) Huangqin (Scutellariae Radix)
After two doses, he recovered.
Lu (17 years old): Both pulses floating and large, intermittent fever and nocturnal sweating. The condition belonged to fatigue and overwork. Although it was the height of summer heat, tonification was still appropriate. With slight Summerheat pathogen, how could one lightly administer clearing herbs! Therefore, differentiation is most valuable when clear.
Dangshen (Codonopsis Radix) Huangqi (Astragali Radix) Guishen (Angelicae Sinensis Radix) Zheng Dongzhu (Steamed Atractylodis Rhizoma) Shengdihuang (Raw Rehmanniae Radix) Jupi (Citri Reticulatae Pericarpium) Chao Guya (Stir-fried Hordei Fructus Germinatus) Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma)
After four doses, he recovered.
Child An (13 years old): In late autumn, suffered from fever, aversion to wind, belching with rotten smell. Pulse was wiry and rapid. Administered digestion-promoting, muscle-releasing, and heat-clearing herbs. Two doses were ineffective. At midnight, it eased slightly, otherwise without rest, completely losing appetite. Changed to Chaihu (Bupleuri Radix), Ge Gen (Puerariae Lobatae Radix), Shigao (Gypsum Fibrosum), Huangqin (Scutellariae Radix), Zhimu (Anemarrhenae Rhizoma) to harmonize interior and exterior. Sweating occurred, heat receded then returned. Over several doses, Shigao (Gypsum Fibrosum) increased to over 1 liang, but the disease persisted. Because the pulse was tight and very rapid, and there had been no bowel movement for seven or eight days, releasing the muscle and clearing the interior failed. Purging was necessary. Da Chengqi Tang (Major Order the Qi Decoction) was used. One piece of dry feces was passed, followed by much turbid filth. Body heat immediately decreased. Starting from dawn next day, chills resembling malaria occurred, with heat peaking around noon. I thought that after sweating and purging, the disease remained because Ying (Nutrient) and Wei (Defensive) Qi were disharmonious. Light and clear substances were suitable. Moreover, with coughing, Ye Zhu (Bambusae Folium) 50 leaves, Bohe (Menthae Haplocalycis Herba) 1.5 qian, Gancao (Glycyrrhizae Radix et Rhizoma) 0.3 qian, and Baijingmi (Oryzae Sativa Granum Album) 100 grains were decocted and taken for two doses. Heat was light, chills heavy. Pulse showed deficiency. Complexion was dull. Tongue coating was scant, no thirst. Urine was not hot. No redness or swelling upon pressing. Taken about an hour before chills.
Banxia (Pinelliae Rhizoma) Dangshen (Codonopsis Radix) Guangpi (Citri Reticulatae Pericarpium) Guishen (Angelicae Sinensis Radix) Huangqi (Astragali Radix) Chaihu (Bupleuri Radix) Shengma (Cimicifugae Rhizoma) Fangfeng (Saposhnikoviae Radix) Gegen (Puerariae Lobatae Radix) Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) Dazao (Jujubae Fructus) Shengjiang (Zingiberis Rhizoma Recens)
This formula intended to tonify Spleen and Stomach, eliminate phlegm, penetrate Wei (Defensive) Yang, preventing it from sinking inward. That day, chills were minimal, heat lasted only about two hours. Mouth was comfortable, desire to eat returned. The next day, Huangqi Danggui Jianzhong Tang (Astragalus and Angelica Decoction to Establish the Middle) was used, adding Banxia (Pinelliae Rhizoma) and Jupi (Citri Reticulatae Pericarpium). After taking it, the whereabouts of the disease were unknown.
Shen (32 years old): Fever, vomiting roundworms, dry mouth and thirst, red and bright center of tongue. Right pulse weak, left pulse wiry. Complete loss of appetite. This was external contraction of Wind-Cold and internal injury of Summerheat-Heat. Not a light condition. Used simultaneous release of exterior and interior.
Chaihu (Bupleuri Radix) Gegen (Puerariae Lobatae Radix) Zhimu (Anemarrhenae Rhizoma) Huangqin (Scutellariae Radix) Baishao (Paeoniae Radix Alba) Huafen (Trichosanthis Radix) Zarou (Crataegi Fructus) Jupi (Citri Reticulatae Pericarpium) Gancao (Glycyrrhizae Radix et Rhizoma)
After one dose, heat subsided, thirst stopped, pulse harmonized, able to eat. Only upon closing eyes did sweat pour out. This indicated deficient heat in the Stomach, with fluids unable to descend. Harmonizing Ying (Nutrient) method was suitable.
Shengdi (Rehmanniae Radix) Guishen (Angelicae Sinensis Radix) Baishao (Paeoniae Radix Alba) Huangqi (Astragali Radix) Maidong (Ophiopogonis Radix) Beishashen (Glehniae Radix) Zaoren (Ziziphi Spinosae Semen) Fushen (Poria cum Radice) Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) Fuxiaomai (Tritici Fructus Hordei Germinatus)
Such severe double-pathogen condition cured in two doses. This shows that medicines must suit the syndrome. Even critical illnesses, if the vital Qi is not exhausted, can be effective promptly.
Zhongjing said: One dose shows improvement, two doses cure. Is this not true for me? Therefore, for contracted diseases, if no effect is seen after three doses, the path is undoubtedly wrong.