随得随录，故不分门别类。医案贵在发挥明白，故兹录立案，颇有重者。因现症差异
，病
源实同，乃为详辨中的，重见叠出，愈知斯道之圆机。其有浅病，即应手取效，亦不录。
金（一四） 憎寒，发热，怕风，背颈项俱痛，脉浮紧，舌淡黄，此感受天气暴寒也。人
感其气，卫气不行，即伤寒病热之症。麻黄汤既不敢服，只得权宜以应之，与香苏合葱豉法
。
紫苏 香豉 羌活 当归 橘皮 香附 炙草 生姜 大枣 葱头
周（十八） 入暮热甚，心烦不寐，形体骤消，舌白面暗，两脉小数，胸前痞满，此暑邪
已入
血分，血为阴，故暮夜发热。在气分则渴，今在血分，故不渴。黄芩、知母虽能逐热，而心
胸之邪，非黄连不能除，故南阳小陷胸法加减之。
川连（一钱） 栝蒌仁（四钱） 枳实（一钱磨冲） 鲜生地（四钱） 丹皮（一钱五分） 郁金（
一钱五分） 通草（七分）
又两服热退安眠，小便清矣。惟胃口被暑热消烁，未能遽健，改用芳香醒胃，甘寒养津
。
麦冬（二钱） 花粉（二钱） 鲜石斛（四钱） 茯苓（二钱） 橘红（六分） 白蔻仁（五分）
沈（二二） 呕血发热，胸闷自汗，脉虚大而数，此属暑伤肺络。暑伤气分脉虚，今又伤
络，故脉大而数。议与凉血清暑法。
盐水炒香豉（一钱五分） 光杏仁（三钱） 焦山栀（三钱） 广郁金（二钱） 飞滑石（三钱荷
叶包） 醋炒，丹皮（一钱五分） 冬桑叶（一钱五分） 生甘草（四分）
又，脉静身凉血止，见风略觉洒淅，气被暑伤，卫失外护，其畏风宜矣。余历吐血一症
，多有六淫致病者，虽非真阴失守之比，然切宜保养，以冀复元。
北沙参（二钱） 麦冬（二钱） 冬桑叶（二钱） 丹皮（一钱） 茯神（一钱五分） 枣仁（一
钱五分） 南枣肉（二钱） 淮小麦（一钱五分） 山栀（一钱五分）
陆（二三）暑风上冒，头痛脘闷，咳嗽痰多，脉右弦滑，与凉散兼化痰法。
光杏仁（三钱） 苏薄荷（一钱） 射干（一钱） 连翘（一钱五分） 橘红（八分） 栝蒌皮（一
钱五分） 飞滑石（三钱） 生甘草（三分）
两服愈。
王 吸受暑邪，中脘胀闷。
香豉 杏仁 郁金 栝蒌皮 连翘 益元散 丝瓜叶
一服愈。
僧（三三）脘闷，发热，口渴，小便短赤，咳呛见红，两脉虚数。此暑邪内伏，至深秋
发动，始伤气分，久损血分矣。既非阴亏火升，滋补当忌。
光杏仁（三钱） 通草（八分） 橘红（八分盐水炒） 飞滑石（二分） 连翘（一钱五分） 黑山
栀（一钱五分） 栝蒌皮（一钱五分） 甘草（四分）
童便一杯冲。
又两服脉缓身凉血止，唯气大口燥未平，前方清解，今用清养，立方用意，只更一字，
自然有先后之分。
北沙参（三钱） 麦冬（一钱） 花粉 青蒿子（五分） 广皮（五分盐水炒） 鲜石斛（一钱
五分） 荷梗（七寸） 鲜枇杷叶（三钱去毛）
周（十四） 病热旬日，形瘦神呆，心烦不寐，汗泄口燥，便赤气浊，两脉沉细欲绝。此
属伏暑
重症，古称暑伤心，故烦而不寐；暑邪从口鼻吸受，先伤气分，肺为百脉所朝，是为气母。
因受暑热消烁，故脉伏而细。乃庚金逢暑必伏之意，其形脉虽似大虚，切审口燥，思凉饮，
小便短赤，生脉白虎合剂，最对是症。若龙、牡、归、地，滋腻镇摄，暑邪何由得解？
西洋参（三钱） 麦冬（二钱） 通草（七分） 石膏（八分） 知母（一钱五分） 飞滑石（三
钱） 甘草（四分） 竹叶（七片） 白粳米（一撮）
陆（二八） 气急胸闷，发热口渴，小便短赤，中暑之症。
石膏（五钱） 麦冬（二钱） 杏仁（二钱） 通草（七分） 栝蒌皮（一钱五分） 郁金（一钱
五分） 滑石（二钱） 丝瓜叶（一片）
一服病已脱然，彼以效验神速，大有妙处。接服一剂，竟致胸中气逆，痰喘有声。因方
内有
石膏一味，能寒肺气，过服陷秋降之令，气不外泄，则逆于内，故当盛暑，绝无汗出，反见
多痰。
杏仁 薄荷 防风 桔梗 橘红 苏子
朱（三三） 从前吸受暑邪，热炽发渴，恣啖西瓜；热渴稍解，而腹胀足重，不思纳食，
脉细，舌白，呼吸窒滞，气分受病无疑，调治失宜，必成鼓胀。
杏仁 橘红 通草 郁金 连翘 苏梗 茯苓皮 淡竹叶
又三服，病减大半，惟气短未平，原方加北沙参、枇杷叶。
王（四十） 暑邪内伏，风寒外侵，头疼恶寒，身热冷汗，口臭便赤，大腹胀满；已历四
旬，纳食无几，形瘦神呆，岂是小恙？用河间桂苓甘露饮加减。
石膏（四钱） 滑石（一钱五分） 桂枝（五分） 小川连（六分） 茯苓（一钱五分） 橘皮（
一钱） 浓朴（一钱）通草（七分） 甘草（三分）
两服前患顿除，胃阴受伤，元气虚耗，当用滋养。
党参 麦冬 黄 橘皮 茯苓 扁豆 甘草
午后微热自汗，小便复赤，脉浮大而数，此为假实，法当大补，十全大补去川芎，十数
剂而愈。
高妪（六五） 身热浃旬，神昏遗溺，气短耳聋，舌胎灰滞，此暑邪内陷之症。前方香豉
、杏
仁、石膏、知母，非不清暑宣气，其如不及何？非局方至宝丹不能直达病所，驱邪外泄；更
用清芳淡补之剂调其中，症虽危险，或可有效。先用灯心汤调进至宝丹两丸，续进∶
栝蒌皮（一钱五分） 橘红（六分） 通草（六分） 北沙参（三钱） 麦冬（三钱，六味因气短重
用） 西瓜翠衣（六分） 鲜荷梗（七寸） 淡竹叶（三十片）
两服热减，神清，已能起坐如圊。惟舌赤而思冷冻饮料，暑毒尚未消尽，与凉解血热法。
犀角（五分） 连翘心（一钱） 白金汁（一小匙） 通草（七分） 郁金（一钱） 滑石（二钱）
一服能下黑粪数枚，内陷之邪始解，继用生脉散调理痊愈。
戈（五六） 发热胸闷，神魂撩乱，脉弦数，舌白，六七日内，形消色滞，小便不利而赤
。此
暑邪结于中焦，须加味陷胸汤治之。病者自忖平素胃寒，不信服此。越二日，昏冒发厥，谵
语不停，急又延予。予曰∶但服我方自安，无容多议，若再延挨，大事去矣。追悔莫及，
伊芳子急归煎服后，泄气难闻，连解小便，去病甚速，方录于下。
川连 枳实 栝蒌皮 橘皮 通草 滑石 甘草梢 淡竹叶
汤（四三） 暑邪内迫，血痢缠绵，宜清热导滞。
苦参 黄芩 白芍 楂肉 浓朴 橘皮 葛根 银花 蛀大枣
病历四旬，三帖而愈。
徐（二五） 身热气短咳嗽，察形脉，知劳倦伏暑，投生脉白虎汤，加杏仁、射干、滑石
、青
蒿，去五味子，三服而痊。近年人参大贵，难以概用，勉以北沙参代之。盖此症暑多而虚少
，故效；若虚多而暑少，非人参不可。
Recorded as they occurred, thus not categorized by department. Medical cases are valued for their clear exposition; therefore, the cases recorded here, particularly those of significant severity, have been documented. Since current symptoms may vary while the root cause remains the same, detailed differentiation is performed to grasp the essence. Recurring phenomena further reveal that the art of medicine lies in flexible and adaptive wisdom. Minor illnesses that respond immediately upon treatment are not recorded.
Jin (14 years old) Chills, fever, aversion to wind, pain in the back, neck, and nape. The pulse is floating and tight, and the tongue coating is pale yellow. This is caused by exposure to sudden cold weather. When humans contract this pathogenic Qi, the Wei Qi (Defensive Qi) fails to circulate properly, resulting in the feverish symptoms of Cold Damage disease. Since it is unsafe to administer Mahuang Tang (Ephedra Decoction), a temporary measure is adopted: Xiangsu San combined with Congchi Tang (Perilla and Fermented Soybean Decoction).
Perillae Folium (Zisu), Fermented Soybean (Xiangchi), Notopterygii Rhizoma et Radix (Qianghuo), Angelicae Sinensis Radix (Danggui), Citri Reticulatae Pericarpium (Jupi), Cyperi Rhizoma (Xiangfu), Prepared Licorice Root (Zhigancao), Fresh Ginger Shavings (Shengjiang), Jujube (Dazao), Scallion Head (Congtou)
Zhou (18 years old) Fever intensifies at dusk, mental restlessness, insomnia, rapid emaciation, white tongue coating, dark complexion, fine and rapid pulses in both wrists, chest oppression and fullness. This indicates that Summerheat Pathogen has entered the Blood Level. Blood belongs to Yin, hence fever occurs at night. If the pathogen were in the Qi Level, thirst would be present; since it is in the Blood Level, there is no thirst. Although Huangqin (Scutellaria Root) and Zhimu (Anemarrhena Rhizome) can clear heat, they cannot eliminate the pathogen in the heart and chest; only Huanglian (Coptis Rhizome) can do so. Therefore, Zhang Zhongjing's Xiaoxianxiong Tang (Minor Intractable Chest Mass Formula) is modified.
Coptidis Rhizoma (Chuanlian, 1 qian), Trichosanthis Semen (Gualouren, 4 qian), Immature Bitter Orange (Zhishi, 1 qian, ground and taken with water), Fresh Rehmanniae Radix (Xianshengdi, 4 qian), Moutan Cortex (Danpi, 1.5 qian), Curcumae Aromatae Rhizoma (Yujin, 1.5 qian), Tetsuqua Herb (Tongcao, 0.7 qian).
After two doses, the fever subsided, sleep was restored, and urination became clear. However, the stomach function was impaired by summerheat consumption and did not recover immediately. Aromatic herbs to awaken the spleen/stomach and sweet-cold herbs to nourish fluids were used.
Ophiopogonis Radix (Maidong, 2 qian), Trichosanthis Radix (Huafen, 2 qian), Fresh Dendrobii Caulis (Xianshihu, 4 qian), Poria (Fuling, 2 qian), Exocarpium Citri Reticulatae Viride (Juhong, 0.6 fen), Amomi Fructus Rotundus (Baokourén, 0.5 fen).
Shen (22 years old) Hematemesis with fever, chest oppression, spontaneous sweating. The pulse is deficient, large, and rapid. This belongs to Summerheat damaging the Lung Collaterals. Summerheat damaging the Qi Level presents with a deficient pulse; now that the collaterals are also damaged, the pulse becomes large and rapid. It is proposed to use a method to cool the blood and clear summerheat.
Fermented Soybean fried in salt water (Xiangchi, 1.5 qian), Almond Seed (Xingren, 3 qian), Gardenia Fruit charred (Zhishanzi, 3 qian), Curcuma Aromatica Rhizome (Yujin, 2 qian), Precipitated Talcum (Huashi, 3 qian, wrapped in lotus leaf), Moutan Cortex vinegar-fried (Danpi, 1.5 qian), Mulberry Leaf (Sangye, 1.5 qian), Raw Licorice Root (Shenggancao, 0.4 qian).
Re-examination: Pulse quiet, body cool, bleeding stopped. Slight chills when exposed to wind indicate that Qi was damaged by summerheat and Wei Qi lost its external protection, making aversion to wind expected. In my experience, hematemesis is often caused by the Six Exogenous Pathogens. Although not as severe as True Yin failure, careful nursing is essential to hope for recovery.
Glehniae Radix (Beishashen, 2 qian), Ophiopogonis Radix (Maidong, 2 qian), Mulberry Leaf (Sangye, 2 qian), Moutan Cortex (Danpi, 1 qian), Poria with Hostwood (Fushen, 1.5 qian), Ziziphus Seed (Suanzaoren, 1.5 qian), Date Flesh (Nanzao, 2 qian), Triticum Aestivum (Huaimai, 1.5 qian), Gardenia Fruit (Zhizi, 1.5 qian).
Lu (23 years old) Summerwind attacking upwards, headache, epigastric oppression, cough with profuse sputum. Right pulse is wiry and slippery. Use cooling dispersal combined with phlegm-resolving methods.
Almond Seed (Xingren, 3 qian), Mentha Haplocalyx (Bohe, 1 qian), Belamcanda Rhizome (Shegan, 1 qian), Forsythia Fruit (Lianqiao, 1.5 qian), Exocarpium Citri Reticulatae Viride (Juhong, 0.8 fen), Trichosanthis Pericarpium (Gualoupi, 1.5 qian), Precipitated Talcum (Huashi, 3 qian), Raw Licorice Root (Shenggancao, 0.3 fen).
Cured after two doses.
Wang Contracted summerheat, causing epigastric distension and oppression.
Fermented Soybean, Almond Seed, Curcuma Aromatica Rhizoma, Trichosanthis Pericarpium, Forsythia Fruit, Yi Yuan San (Benefit Element Powder), Loofah Leaf.
Cured after one dose.
Monk (33 years old) Epigastric oppression, fever, thirst, scanty dark urine, coughing with blood traces, deficient and rapid pulses. This is latent summerheat activating in late autumn, first damaging the Qi Level, and over time damaging the Blood Level. Since it is not Yin deficiency with fire rising, tonification is contraindicated.
Almond Seed (Xingren, 3 qian), Tetsuqua Herb (Tongcao, 0.8 fen), Citri Reticulatae Pericarpium fried in salt water (Juhong, 0.8 fen), Precipitated Talcum (Huashi, 0.2 fen), Forsythia Fruit (Lianqiao, 1.5 qian), Blackened Gardenia Fruit (Heizhizi, 1.5 qian), Trichosanthis Pericarpium (Gualoupi, 1.5 qian), Licorice Root (Gancao, 0.4 qian).
Mixed with one cup of Child's Urine (Tongbian).
After two more doses, the pulse slowed, body cooled, and bleeding stopped. Only excessive breathing and dry mouth remained. The previous formula cleared and resolved; now using clearing and nourishing. The prescription intention changes with just one word, naturally distinguishing sequence.
Glehniae Radix (Beishashen, 3 qian), Ophiopogonis Radix (Maidong, 1 qian), Trichosanthis Radix (Huafen), Artemisia Annua Seed (Qinghaozi, 0.5 fen), Citri Reticulatae Pericarpium fried in salt water (Guapi, 0.5 fen), Fresh Dendrobii Caulis (Xianshihu, 1.5 qian), Lotus Stem Peduncle (Hegeng, 7 cun), Fresh Loquat Leaf (Xianpiluye, 3 qian, de-hairy).
Zhou (14 years old) Febrile illness for ten days, emaciated with dull spirit, mental restlessness, insomnia, sweating, dry mouth, red urine, turbid breath, deep and fine pulses nearly imperceptible. This is a severe case of Latent Summerheat, traditionally called "Summerheat hurting the Heart," causing irritability and insomnia. Summerheat enters via nose and mouth, first damaging the Qi Level. The Lung is the meeting place of all vessels and the mother of Qi. Due to summerheat consumption, the pulse is hidden and fine. This reflects the principle that Metal (Geng Jin) hides when encountering summerheat. Although the form and pulse suggest severe deficiency, considering the dry mouth, desire for cold drinks, and scanty red urine, Shengmai San combined with Baihu Tang (White Tiger Decoction) is most appropriate. Using heavy sedatives like Longgu (Dragon Bone), Muli (Oyster Shell), Danggui (Angelica Sinensis), and Dihuang (Rehmannia) would prevent the summerheat from resolving.
American Ginseng (Xiyangshen, 3 qian), Ophiopogonis Radix (Maidong, 2 qian), Tetsuqua Herb (Tongcao, 0.7 fen), Gypsum Fibrosum (Shigao, 0.8 fen), Anemarrhena Rhizome (Zhimu, 1.5 qian), Precipitated Talcum (Huashi, 3 qian), Licorice Root (Gancao, 0.4 qian), Bamboo Leaf (Zhuye, 7 slices), White Rice (Bajingmi, a pinch).
Lu (28 years old) Shortness of breath, chest oppression, fever, thirst, scanty red urine. Symptoms of Heatstroke.
Gypsum Fibrosum (Shigao, 5 qian), Ophiopogonis Radix (Maidong, 2 qian), Almond Seed (Xingren, 2 qian), Tetsuqua Herb (Tongcao, 0.7 fen), Trichosanthis Pericarpium (Gualoupi, 1.5 qian), Curcuma Aromatica Rhizoma (Yujin, 1.5 qian), Talcum (Huashi, 2 qian), Loofah Leaf (Siguye, 1 slice).
One dose resulted in complete relief. The patient considered the rapid effect miraculous. However, taking another dose led to rebellious Qi in the chest and wheezing with phlegm. This is because Shigao (Gypsum) cools the Lung Qi; excessive intake forces the descending energy of Autumn inward, preventing outward release, leading to internal rebellion. Thus, in peak summer without sweating, excessive phlegm appears.
Almond Seed, Mint, Saposhnikovia Root (Fangfeng), Platycodon Root (Jiegeng), Exocarpium Citri Reticulatae Viride (Juhong), Perilla Fruit (Suzi).
Zhu (33 years old) Previously contracted summerheat, intense heat and thirst, indulged in eating watermelon. Heat and thirst slightly relieved, but abdominal distension and heavy legs appeared, loss of appetite, fine pulse, white tongue, stifled respiration. Clearly a Qi Level pathology. Improper treatment will lead to Drum Distension (Ascites).
Almond Seed, Exocarpium Citri Reticulatae Viride (Juhong), Tetsuqua Herb (Tongcao), Curcuma Aromatica Rhizoma (Yujin), Forsythia Fruit (Lianqiao), Perilla Stem (Sugeng), Poria Peel (Fulingpi), Light Bamboo Leaf (Danzhuye).
After three doses, illness reduced by half. Only shortness of breath remained. Added Glehniae Radix (Beishashen) and Loquat Leaf (Piluye) to the original formula.
Wang (40 years old) Latent summerheat internally, Wind-Cold externally invading. Headache, aversion to cold, body heat with cold sweat, bad breath, red stool, severe abdominal distension. Duration: 40 days. Poor appetite, emaciated with dull spirit. Is this a minor ailment? Use He Jian's Guiling Ganlu Yin (Cassia, Polyporus, and Sweet Dew Decoction) modified.
Gypsum Fibrosum (Shigao, 4 qian), Talcum (Huashi, 1.5 qian), Cinnamon Twig (Guizhi, 0.5 fen), Small Coptis Rhizoma (Xiaochuanlian, 0.6 fen), Poria (Fuling, 1.5 qian), Citri Reticulatae Pericarpium (Jupi, 1 qian), Magnolia Bark (N Houpo, 1 qian), Tetsuqua Herb (Tongcao, 0.7 fen), Licorice Root (Gancao, 0.3 fen).
Two doses cured previous ailments. Stomach Yin injured, Yuan Qi depleted. Tonification is needed.
Codonopsis Radix (Dangshen), Ophiopogonis Radix (Maidong), Astragali Radix (Huangqi), Citri Reticulatae Pericarpium (Jupi), Poria (Fuling), Lablab Seed (Bidou), Licorice Root (Gancao).
Afternoon slight fever and spontaneous sweating, urine turned red again, pulse floating, large, and rapid. This is false excess. The method requires major tonification. Shiquan Dabu Tang (Perfect Great Tonifying Decoction) minus Chuanxiong Rhizoma (Chuanxiong), taken for over ten doses, resulted in cure.
Old Woman Gao (65 years old) Body heat for ten days, coma, urinary incontinence, shortness of breath, deafness, gray and stagnant tongue coating. This is Summerheat sinking inward. Previous formulas with Xiangchi, Xingren, Shigao, and Zhimu were not ineffective in clearing summerheat and diffusing Qi, but they were insufficient. Only Juzhong Baobao Dan (Precious Pill of the Center) can reach the disease site directly and expel pathogens. Follow with light aromatic and mild tonifying agents to regulate the middle. Though dangerous, effectiveness is possible. First, administer two pills of Baobao Dan mixed in Juncus Decoction (Dengxin Tang). Then continue with:
Trichosanthis Pericarpium (Gualoupi, 1.5 qian), Exocarpium Citri Reticulatae Viride (Juhong, 0.6 fen), Tetsuqua Herb (Tongcao, 0.6 fen), Glehniae Radix (Beishashen, 3 qian), Ophiopogonis Radix (Maidong, 3 qian, increased due to shortness of breath), Watermelon Rind (Xiguacuiyi, 0.6 fen), Fresh Lotus Stem Peduncle (Xian Hegeng, 7 cun), Light Bamboo Leaf (Danzhuye, 30 slices).
Two doses reduced fever, cleared spirit, allowed sitting up and going to toilet. Tongue red, craving cold drinks, indicating summerheat toxin not fully cleared. Use cooling to resolve blood heat.
Rhinoceros Horn (Xijiao, 0.5 fen) - *Note: Substitute with Buffalo Horn in modern practice*, Forsythia Heart (Lianqiaoxin, 1 qian), Platinum Juice (Baijinzhi, 1 small spoon), Tetsuqua Herb (Tongcao, 0.7 fen), Curcuma Aromatica Rhizoma (Yujin, 1 qian), Talcum (Huashi, 2 qian).
One dose passed several black stools, indicating resolution of inward-sinking pathogens. Subsequently treated with Shengmai San (Generate the Pulse Powder) for recovery.
Ge (56 years old) Fever, chest oppression, chaotic spirit, wiry and rapid pulse, white tongue. Within six to seven days, emaciation and dull complexion, difficult and red urination. Summerheat knotting in the Middle Jiao. Requires Jiawei Xiaoxianxiong Tang (Modified Minor Intractable Chest Mass Formula). Patient believed he had chronic Stomach Cold and refused this prescription. Two days later, coma, syncope, and continuous delirium. Urgently summoned me. I said: Take my prescription and you will be safe; do not debate. Further delay will be disastrous. Regret came too late. His son hurried home, decocted and administered. Foul gas expelled, frequent urination, disease removed quickly. Prescription recorded below:
Coptidis Rhizoma (Chuanlian), Immature Bitter Orange (Zhishi), Trichosanthis Pericarpium (Gualoupi), Citri Reticulatae Pericarpium (Jupi), Tetsuqua Herb (Tongcao), Talcum (Huashi), Licorice Root Tip (Gancaoshao), Light Bamboo Leaf (Danzhuye).
Tang (43 years old) Summerheat forcing inward, persistent bloody dysentery. Clear heat and guide out stagnation.
Sophora Flavescens Root (Kushen), Scutellaria Root (Huangqin), White Peony Root (Baishao), Hawthorn Meat (Zharou), Magnolia Bark (N Houpo), Citri Reticulatae Pericarpium (Jupi), Kudzu Root (Gegen), Honeysuckle Flower (Yinhua), Worm-eaten Jujube (Zhu Dazao).
Illness lasted forty days, cured in three doses.
Xu (25 years old) Body heat, shortness of breath, cough. Observing form and pulse, determined it was fatigue with latent summerheat. Administered Shengmai Baihu Tang (Generate Pulse White Tiger Decoction), added Almond Seed, Belamcanda Rhizome, Talcum, Artemisia Annua Seed, removed Schisandra Berry (Wuweizi). Cured in three doses. Recently, Ginseng is very expensive and cannot be used universally; reluctantly replaced with Glehniae Radix (Beishashen). This case had more summerheat than deficiency, hence the efficacy. If deficiency were predominant, Ginseng would be indispensable.