春温病表寒里热证
曾××，男，年二十岁，住四川省会理县南街。于1924年2月患春温病三日，脉来浮数，发热微恶寒，头疼体痛。
面垢，唇赤而焦，舌苔白而燥，尖绛，渴喜冷饮，小便短赤。
此系春温病邪热内壅，外有表邪闭束，遂成表寒里热之证，以麻黄杏仁甘草石膏汤主之。
麻黄12克 生石膏30克(碎，布包) 杏仁10克 甘草6克
服一剂后，俄而汗出淋漓，脉静身凉，霍然而愈。
春温病阳明经热证
王××，男，年廿五岁，住四川省会理县北关，于1'324年2月患温病已四日，前医以九味羌活汤加葛根、柴胡、紫苏等与服之，服后汗出未解，发热更甚。延余诊视，病者壮热，恶热而烦渴喜冷饮，头疼，但头汗出，面赤而垢，鼻干而喘，唇赤口燥，苔黄而无滓，小便短赤，大便三日不解。
此系春温病误用辛温发汗，耗伤阴液而成阳明经热之证，以人参白虎汤加寸冬治之。
生石膏30克(碎，布包) 知母20克 沙参15克 寸冬12克
甘草6克粳米10克
连服二盏，竟仰卧而寐，数刻则全身大汗淋漓，热势渐退。次口复诊烦渴已止，脉静身凉，继以生脉散加生地、杭芍，一剂霍然。
沙参16克 寸冬1 3克 五味5克 生地13克 杭芍13克 甘
草6克
春温病少阴热化证
吴××，昆明人，住昆明市绣衣街，有长子年十五岁，于1921年3月患病延余诊视，发热不退已十一日，面红唇赤而焦，舌红苔黄而无津，虚烦不得卧。食物不进，渴喜冷饮，小便短赤，大便不解，脉来沉细而数。查其先前所服之方，始而九味羌活汤，继则服以黄连、栀子、连翘、黄芩、银花、象叶、薄荷等未效。此系春温病误以辛温发散，又复苦燥清热，耗伤真阴，琊热内蕴，转为少阴阴虚热化证。拟黄连阿胶鸡子黄汤治之。
黄连10克 黄芩12克 杭芍24克 阿胶10克(烊化兑入) 鸡
子黄2枚
先煎芩、连、芍药为汤，稍凉，兑入已烊化之阿胶，再搅入生鸡蛋黄二枚和匀而服。
服一剂后即得安静熟寐，烦渴已止，唇舌转润，脉静身凉。继以生脉散加生地、玄参、黄连。
米洋参1 0克 寸冬15克 五味子5克 甘草6克 黑玄参
10克生地12克黄连5克上方连进二剂而愈。
春温病冷水治愈案
李××，女，年五旬，住四川省会理县南乡农村。于1920年2月患春温病已五日，延余诊视之时，见其张目不寐，壮热烦渴而饮冷，舌苔白厚而燥，舌尖绛，唇焦齿干，脉来洪数，恶热头痛，小便短赤。据云已服发表之剂未愈。查前所服之方，系用羌活、独活、苏叶、荆芥、防风、柴胡、葛根之剂。殊服后但见头汗出，身热尤甚，气粗而喘，烦渴引饮。
余诊后断为春温病误用辛温发散，耗劫阴液所致，急须清热养阴生津为治。因患者居处远乡僻壤，药材缺乏，未能如愿配方，但见患者烦渴索饮之状，遂与冰凉之冷水任意饮之。患者饮一碗尽，自言心中爽快，又求再饮，饮至四碗，顿觉清凉不烦，竟然闭目熟睡。俄顷，则见汗出淋漓，湿透内衣。
约半个时辰后再诊，已脉静身凉，津液满口，诸证悉除。
按：春温初起，客邪内传与阳明燥气相合，误投辛散发表，不但邪不得解，反致伤阴劫液，内热燔炽，水源涸竭。
今得冷水相济，补阴救焚，从而阴阳调平，气机通达，则汗出而引邪外散。此为饮冷水救阴液之例，当与人参白虎汤清热生津救焚之意谋同，故能获此良效。
再按：温热病证，内热如焚，真阴欲竭之际，急需清凉之剂以济之。西瓜汁、鲜梨汁，甚至清凉冷饮，皆可以滋添 阴液。但见某些病家或医者，习俗为常，以为几病皆须忌生冷，戒之最严，虽病热者苦索无已，尚不知其相宜而须投之。实热病情，以硝黄石膏为治，其效若灵，滋阴、清热、苦寒之品，在所必用，又何须拘禁于生凉哉。
暑 证(一)
廖××，男，年三十一岁，四川会理县人，住云南省昆明市海潮巷八号。1928年5月16日出外郊游，值酷暑炎热，畏热贪凉，返家时临风脱衣，当晚觉闷热而思饮，全身倦怠违和，次日则有微寒而发热，头昏痛，肢体酸困疼痛。因平素体质较健，向少生病，对此小病不以为然。不日则热势突增，发为壮热烦渴饮冷之证，小便短赤，食思不进，经西法针药施治未效，延余诊视。斯时病已三日，脉来浮弦而数，面赤唇红而焦，舌红苔燥，肌肤皆热，但不见有汗，气息喘促，呻吟不已。良由暑邪伤阴，邪热内壅，复被风寒闭束，腠理不通而成表寒里热之证。法当表里两解，拟仲景麻黄杏仁甘草石膏汤辛凉解表主之。
生麻黄12克 生石膏24克(碎，布包) 杏仁10克 甘草10克
17日一剂，即汗出如洗，热势顿除，脉静身凉，头疼体痛已愈。然表邪虽解，里热未清，仍渴喜冷饮，再剂以人参白虎汤合生脉散培养真阴清解余热。
沙参24克 生石膏15克(碎，布包) 知母12克 寸冬24克
五味子3克 甘草6克 粳米1 0克
服后渴止津生，食量增加，溺尚短赤，照上方去石膏加、滑石40克、生地40克。服后溺清而长，余热已尽，真阴复元，诸证全瘳。
按：昔人谓暑忌麻桂，其实亦不尽然。此证里热被表寒所束，非麻黄何能解表。妙在次方即转用白虎生脉，养阴清热，故而收效甚速。
暑 证(二)
甘××，男，年二十岁，云南姚安县人，住昆明市武成路。体素健壮，1928年6月12日，值暑热天气，外出旅行，汗多渴饮，因畏热贪凉，遂避暑休息于大树阴凉之下，汗出则腠理疏泄，复被凉风吹袭，感冒而起病。初起即懔懔憎寒，口渴思饮，头身不适，返家后渐次发热，渴饮更甚，头身疼痛，小便短赤。延余诊视，脉来浮弦而数，面赤唇红，舌红而燥，良由酷暑伤阴，邪热内壅，复被表寒闭束，腠理不通而成表寒里热之证，拟仲景麻黄杏仁甘草石膏汤表里两解以治之。
生麻黄10克 生石膏24克(碎，布包) 杏仁10克 甘草10克
13日复诊。服上方一剂后即汗出淋漓，发热退，头体疼痛已愈，继以清热养阴之剂肃清余热，拟方人参白虎汤含生脉散。
沙参20克 生石膏15克(碎，布包) 知母12克寸冬15克生
地12克甘草6克粳米10克
14日复诊。原已脉静身凉，今又身反灼热，渴饮更甚，唇焦舌干而起芒刺，脉来洪数。何以服清热养阴之剂，病反沉重，邪热更甚?是投药失宜，抑或余邪再燃?询及由来，病者三、四日来大便不通，经亲友介绍服通便丸一包，内有巴豆温下等药，服后大便虽泻通数次，但反而热势再张而成是状，始知为错服湿热丸药所致。当即急以人参白虎汤加重分量，并加黄连、麦冬、玄参以清心肺之热而滋水生津，佐绿豆以解巴豆之热毒。
土人参24克 生石膏36克(碎，布包) 知母12克 黑玄参12克
川黄连6克 寸冬21克 小绿豆15克 生甘草6克 白粳米
12克
15日复诊。此方服后，尽然汗出热退，口津回生，舌苔芒刺变软，小便色虽黄赤但已较长，脉沉细而带数象，手心尚热，仍喜冷饮。此乃大病已退，邪热未净，真阴尚虚，再以养阴生津而清余热治之。方用：
黑玄参12克 生地15克 寸冬15克 知母12克 沙参15克
杭芍15克 石膏12克(碎，布包) 小绿豆10克 甘草6克
16日复诊。脉已和缓，手心热退，渴饮止，津液满口，小便清长，神食较增，继以生脉散加口芪、当归、杭芍，两剂而痊。
沙参15克 寸冬12克 五味子3克 当归12克 口芪24克
杭芍12克 甘草6克
甘××暑证痊愈后，随即介绍其同窗学友李某来诊。李亦患暑证，病已六、七日，脉来浮洪，面赤多汗，壮热烦渴而喜冷饮。唇焦舌红苔白而燥，食物不进，小便短涩而赤。
曾服黄连、黄芩、枳壳、栀子、连翘、薄荷、木通、滑石、藿香、香薷等药无效。此系暑邪伤阴、津液枯燥．内热如焚，误服此等苦燥辛散之剂，更增伤津耗液之弊。虽有苦寒之药夹杂其方，犹如杯水无力以救车薪，遂拟人参白虎汤加味治之。
沙参24克 生石膏60克(碎，布包) 知母12克 寸冬24克
生地15克 玄参12克 杭芍12克 甘草6克 粳米12克
次日复诊。一剂后即汗出淋漓，邪热溃退，真阴来复，唇舌较润，烦渴已减少，小便转长，但色仍赤。继以清署解热，养阴生津之法，原方加减主之。
沙参15克 石膏12克(碎，布包) 寸冬12克 五味子3克
知母10克 杭芍12克 尖贝10克 竹叶5克 甘草6克
上方服后，脉静身凉，舌润和，口津生，烦渴止，小便清长，食量渐增，以生脉散加当归、杭芍、生地。连服二剂，邪去正安，食增神健而愈。
赤 痢
彭××，男，年三十五岁，四川人，住云南省昆明市珠市桥。禀赋素强，偶停宿食，兼有湿热，于1929年9月15日 夜起入厕，感受风寒而起病。初起即发热吐泻，头疼体痛，自汗而畏寒，继则下痢赤白，小腹痛甚，里急后重，每便仅一、二匙，日夜无度，小便短赤，噤口不食，脉来浮弦而兼紧象，舌苔白腻，舌尖绛。按病原系湿热挟食积阻遏肠胃，复感风寒外邪，闭束太阳经气运行之机，表寒外束，又有湿热内逼，以致身热下痢，此即所谓“协热痢”。法当表里双治，以桂葛汤解肌表之邪，佐小承气汤加黄连下宿食而清湿热。
葛根12克 桂尖1 0克 杭芍20克 大黄10克(泡水兑入) 油
朴12克枳实10克(捣) 黄连5克 生姜10克 小枣7枚
甘草3克
次日复诊。服上方一剂始尽，即见汗出，汗后热退脉平，表邪已解，痢亦减轻，惟湿热食积尚阻遏胃肠，湿热内逼，痢未全止，每痢仍腹痛后重，遂以“通因通用”之法，拟大承气汤合滨芍顺气汤加减急下宿食兼清湿热。
生杭芍24克 生大黄12克(泡水兑入) 枳实10克(炒、捣)
厚朴10克(炒) 槟榔12克 麦冬12克 广木香5克 芒硝
5克黄连4克
三诊，上方服后，得快利稀粪二、三便，腹痛后重及赤白痢均减去十之七、八，腻苔已退，稍进稀粥。惟小便仍短赤，思食冷物水果。此病状虽减而湿热痢毒未净，仍照原方加减主之。
生杭芍20克 生大黄6克(泡水兑入) 黄连5克 油朴10克
麦冬12克 玄明粉5克 广木香4克
服后又下出溏薄粪便二次，痢遂止，肛门稍坠，食量较增，小便尚赤。余热尚未全清，继拟下方治疗。
沙参13克 寸冬13克 木通10克生杭芍13克酒炙大黄5克
厚朴10克
服上方后饮食复常，神形健如，痢止溺清、腹痛若失而瘥。
按：余遇下痢之证，身热头体痛有表证者，当即以桂葛汤先解表邪。若无表邪，则当头以凉下为急，如此疗法，无不效如桴鼓。苟不解除表邪，则身热不退，易转危笃。故《内经》云： “利证身热不休者死。”不行攻下，邪热痢毒亦不能除。若属久痢虚寒者，又当以温固之法治之。
小儿时疫痢(小儿志贺氏杆菌性痢疾)
张小妹，女，一岁，于1961年8月19日园发热一日，腹泻十多次，粪便带红白粘液，经昆明市红十字会医院诊断为“菌痢”收住儿科病房治疗。
据入院病历所载，患儿发育较差，营养中等，未出牙，前囟未闭合，颈部淋巴可触及。咽喉、心、肺及腹部未见异常，体温摄氏39℃(肛表)。8月20日血象，红细胞340万／立方毫米，血色素66％，白细胞总数5300／立方毫米，中性68％，淋巴27％，单核3％。8月22日大便培养报告检出志贺氏痢 疾杆菌。8月23日起用氯霉素治疗。8月24日加用多粘菌素，并内服清热解毒止痢中药。但腹泻不止，体温仍在39．5℃左右(肛表)。8月28日血象，红细胞315万／立方毫米，血色素60％，白细胞总数1 3，600／立方毫米，中性68％，淋巴30％，单核2％。病孩住院十日，经用多种抗菌药物及中药治疗，仍未见好转，于8月29日邀余会诊。
当日下午诊视，见患儿卧床，正在输液，面赤身热，体温40．5℃(肛表)，衰弱无神，唇口干燥，眼瞠凹陷。但见其母频频喂饮，时闻啼声，气息低弱，不思乳食，自汗出，稍动则易惊怖。询及今日大便已泻十余次，每次便量不多，红白粘液混杂，小便短少。指纹色赤而浮，舌苔粉白。此系内伤饮食，复感表邪，表证不解，邪气又陷入阳明，遂成太阳阳明合病下痢之证。如过早施用清热止痢及苦寒泻下之剂，易伤里气，若表邪深陷，则痢无止期。此证已属二阳合病，当以解表兼以升提陷入阳明经邪之法治之。建议暂停前面所用中西药物，拟桂葛汤一剂。
桂枝10克葛根10克杭芍6克生姜2小片 小枣3枚甘
草3克
当晚喂服二次，至夜有微汗出，身热稍退，体温39℃(肛表)。次晨又煎服第三次，日内照方服完二剂。每次喂药后片刻，均有热汗徐徐外出。于30日晚体温已降至37．8℃(肛表)，大便终日未见泻利。
**Spring-Warmth Disease: Exterior-Cold and Interior-Heat Syndrome**
Zeng XX, male, 20 years old, residing at South Street, Huili County, Sichuan Province. He contracted Spring-Warmth Disease (an exogenous febrile disease caused by warm pathogens in spring) three days prior to February 1924. His pulse was floating and rapid (Fu Shu), with fever accompanied by slight aversion to cold (E Han), headache, and body pain.
His face appeared dirty, lips were red and dry/cracked, tongue coating was white and dry with a crimson tip, he felt thirsty and preferred cold drinks, and urination was scanty with dark yellow urine.
This is a case of Spring-Warmth Disease where pathogenic heat is obstructed internally, while external pathogenic factors bind the exterior, resulting in an Exterior-Cold and Interior-Heat syndrome. It is treated primarily with Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction).
Mahuang (Ephedrae Herba) 12g, Sheng Shigao (Gypsum Fibrosum) 30g (crushed, wrapped in cloth), Xingren (Armeniacae Semen Amarum) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g.
After taking one dose, profuse sweating occurred shortly thereafter; the pulse became calm, the body cooled down, and he recovered abruptly.
**Spring-Warmth Disease: Yangming Meridian Heat Syndrome**
Wang XX, male, 25 years old, residing at North Gate, Huili County, Sichuan Province. In February 1924, he had suffered from Warm Disease for four days. The previous physician prescribed Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) added with Gegen (Puerariae Radix), Chaihu (Bupleuri Radix), Zisu (Perillae Folium), etc. After taking it, sweating occurred but the illness did not resolve; fever intensified. I was invited to examine him. The patient exhibited high fever (Zhuang Re), aversion to heat, irritability, thirst preferring cold drinks, headache, sweating only on the head, facial redness with dirtiness, dry nose with panting, red and dry lips/mouth, yellow tongue coating without dregs, scanty dark yellow urine, and no bowel movement for three days.
This resulted from the erroneous use of acrid-warm diaphoretic agents for Spring-Warmth Disease, which consumed Yin fluids, leading to Yangming Meridian Heat Syndrome. It is treated with Renshen Baihu Tang (Ginseng, White Tiger Decoction) added with Mudanpi/Maidong (here Maidong/Ophiopogonis Radix).
Sheng Shigao (Gypsum Fibrosum) 30g (crushed, wrapped in cloth), Zhimu (Anemarrhenae Rhizoma) 20g, Shashen (Glehniae Radix) 15g, Cundong (Ophiopogonis Radix) 12g.
Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Jingmi (Oryzae Fructus Glutinosus) 10g.
After continuously drinking two bowls, he fell into supine sleep; after a short while, profuse whole-body sweating occurred, and the fever gradually subsided. On the next day's follow-up, irritability and thirst had ceased, the pulse was calm, and the body was cool. Subsequently, Shengmai San (Generate the Pulse Powder) was added with Shengdi (Rehmanniae Radix) and Hangshao (Paeoniae Radix Alba), resolving the condition in one dose.
Shashen (Glehniae Radix) 16g, Cundong (Ophiopogonis Radix) 13g, Wuwei Zi (Schisandrae Fructus) 5g, Shengdi (Rehmanniae Radix) 13g, Hangshao (Paeoniae Radix Alba) 13g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g.
**Spring-Warmth Disease: Shaoyin Heat Transformation Syndrome**
Wu XX, from Kunming, residing on Xiuyi Street, Kunming City. His eldest son, aged 15, fell ill in March 1921. I was consulted as he had had unremitting fever for eleven days. His face was red, lips red and dry/cracked, tongue red with yellow coating lacking moisture, experiencing empty irritability and inability to sleep. He refused food, was thirsty preferring cold drinks, had scanty dark yellow urine, constipation, and a deep, fine, and rapid pulse. Reviewing his previous prescriptions, he first took Jiuwei Qianghuo Tang, followed by Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructus), Lianqiao (Forsythiae Fructus), Huangqin (Scutellariae Radix), Yinhua (Lonicerae Flos), Sangye (Mori Folium), Bohe (Menthae Haplocalycis Herba), etc., without effect. This was due to the erroneous use of acrid-warm dispersants for Spring-Warmth Disease, compounded by bitter-dry heat-clearing agents, which damaged True Yin. Pathogenic heat accumulated internally, transforming into Shaoyin Yin-Deficiency Heat Transformation Syndrome. I prescribed Huanglian Ejiao Jizihuang Tang (Coptis, Donkey-Hide Gelatin, and Egg Yolk Decoction).
Huanglian (Coptidis Rhizoma) 10g, Huangqin (Scutellariae Radix) 12g, Hangshao (Paeoniae Radix Alba) 24g, Ejiao (Colla Corii Asini) 10g (melted and mixed in), Ji Zihuang (Ovi Ovis Collyrium/Chicken Egg Yolk) 2 pieces.
First decoct Huangqin, Huanglian, and Shaoyao into a soup, let it cool slightly, then mix in the melted Ejiao, and finally stir in two raw chicken egg yolks evenly before consumption.
After one dose, he slept peacefully, irritability and thirst ceased, lips and tongue became moist, pulse calmed, and body cooled. Subsequently, Shengmai San (Generate the Pulse Powder) was added with Shengdi (Rehmanniae Radix), Xuanshen (Scrophulariae Radix), and Huanglian (Coptidis Rhizoma).
Xiyangshen (Panacis Quinquefolii Radix/Western Ginseng) 10g, Cundong (Ophiopogonis Radix) 15g, Wuweizi (Schisandrae Fructus) 5g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Hei Xuanshen (Scrophulariae Radix) 10g, Shengdi (Rehmanniae Radix) 12g, Huanglian (Coptidis Rhizoma) 5g. The above formula was taken for two consecutive doses, resulting in recovery.
**Spring-Warmth Disease Cured by Cold Water Case**
Li XX, female, 50 years old, residing in a rural area of South Township, Huili County, Sichuan Province. In February 1920, she had suffered from Spring-Warmth Disease for five days. Upon my examination, she was keeping her eyes open unable to sleep, suffering from high fever, irritability, and thirst preferring cold drinks. Tongue coating was thick white and dry, tip crimson, lips cracked, teeth dry. Pulse was surging and rapid, with aversion to heat, headache, and scanty dark yellow urine. She reported that previous diaphoretic agents had failed. The previous prescription contained Qianghuo (Notopterygii Radix), Duhuo (Angelicae Pubescentis Radix), Zisu Ye (Perillae Folium), Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Chaihu (Bupleuri Radix), Gegen (Puerariae Radix). Surprisingly, after taking it, only head sweating occurred, body heat intensified, breathing became coarse with panting, and irritability/thirst worsened requiring water intake.
I diagnosed this as Spring-Warmth Disease caused by the erroneous use of acrid-warm dispersants, which depleted Yin fluids. Immediate treatment required clearing heat, nourishing Yin, and generating fluids. Since the patient lived in a remote village lacking medicinal herbs, I could not prescribe as desired. Seeing her desperate thirst and request for water, I gave her ice-cold water to drink freely. After finishing one bowl, she said she felt refreshed inside and requested more. After four bowls, she suddenly felt cool and free of irritability, closing her eyes for a sound sleep. Soon after, profuse sweating occurred, soaking her inner clothes.
Half an hour later upon re-examination, her pulse was calm, body cool, mouth full of saliva, and all symptoms resolved.
Commentary: At the onset of Spring-Warmth Disease, external pathogens transmit inward and combine with Yangming dryness. Erroneous use of acrid-dispersing diaphoretics not only fails to resolve pathogens but also damages Yin and depletes fluids, causing interior heat to blaze and water sources to dry up.
Now, aided by cold water, Yin is replenished and fire saved, thereby balancing Yin and Yang and unblocking Qi mechanism, leading to sweating that expels pathogens outward. This is an example of using cold water to save Yin fluids, sharing the same intent as Renshen Baihu Tang (Ginseng, White Tiger Decoction) in clearing heat, generating fluids, and saving from burning. Hence, good results are achieved.
Further Commentary: In warm-heat diseases, when interior heat burns like fire and True Yin is about to exhaust, cooling agents are urgently needed. Watermelon juice, fresh pear juice, or even cold drinks can nourish and add to Yin fluids. However, some patients or physicians, bound by custom, believe all illnesses must avoid raw/cold items, strictly forbidding them. Even if heat patients suffer greatly and beg for relief, they do not realize its appropriateness. For excess-heat conditions, treating with Xiaoshi (Natrii Sulfas), Dahuang (Rhei Radix et Rhizoma), and Shigao (Gypsum Fibrosum) is effective. Nourishing Yin, clearing heat, and bitter-cold substances are essential; why restrict oneself from raw/cooling items?
**Summerheat Syndrome (I)**
Liao XX, male, 31 years old, from Huili County, Sichuan, residing at No. 8 Haichao Alley, Kunming City, Yunnan Province. On May 16, 1928, during an outing, he encountered intense summer heat. Averse to heat and coveting coolness, he removed his clothes while exposed to wind upon returning home. That night, he felt muggy and thirsty. The next day, he experienced slight chills and fever, dizziness, headache, and soreness/pain in limbs. Being generally healthy and rarely sick, he disregarded this minor illness. Soon, fever surged, developing into high fever, irritability, and thirst preferring cold drinks, with scanty dark yellow urine and loss of appetite. Western medicine injections and drugs failed. I was consulted. By then, the illness had lasted three days. Pulse was floating, wiry, and rapid. Face red, lips red and dry/cracked, tongue red with dry coating, skin hot, no sweating, panting breath, and continuous groaning. This was due to Summerheat damaging Yin, pathogenic heat accumulating internally, combined with closure by Wind-Cold, blocking pores, resulting in Exterior-Cold and Interior-Heat syndrome. The method should be resolving both exterior and interior. I prescribed Zhang Zhongjing’s Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) to acrid-coolly release the exterior.
Sheng Mahuang (Ephedrae Herba) 12g, Sheng Shigao (Gypsum Fibrosum) 24g (crushed, wrapped in cloth), Xingren (Armeniacae Semen Amarum) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 10g.
On the 17th, one dose resulted in sweating like washing, fever instantly removed, pulse calm, body cool, headache and body pain resolved. Although exterior pathogens were resolved, interior heat remained clear; he still craved cold drinks. A second dose used Renshen Baihu Tang (Ginseng, White Tiger Decoction) combined with Shengmai San (Generate the Pulse Powder) to cultivate True Yin and clear residual heat.
Shashen (Glehniae Radix) 24g, Sheng Shigao (Gypsum Fibrosum) 15g (crushed, wrapped in cloth), Zhimu (Anemarrhenae Rhizoma) 12g, Cundong (Ophiopogonis Radix) 24g.
Wuweizi (Schisandrae Fructus) 3g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Jingmi (Oryzae Fructus Glutinosus) 10g.
After taking it, thirst stopped, fluids generated, appetite increased, but urine remained scanty and dark yellow. Following the above formula, remove Shigao, add Huashi (Talcum) 40g and Shengdi (Rehmanniae Radix) 40g. After taking it, urine became clear and long, residual heat exhausted, True Yin restored, and all symptoms cured.
Commentary: Ancients said Summerheat contraindicates Mahuang and Guizhi, but this is not entirely true. In this case, interior heat is bound by exterior cold; without Mahuang, how can the exterior be resolved? The brilliance lies in switching to Baihu and Shengmai in the next stage to nourish Yin and clear heat, thus achieving rapid effect.
**Summerheat Syndrome (II)**
Gan XX, male, 20 years old, from Yao’an County, Yunnan, residing on Wucheng Road, Kunming City. Generally robust constitution. On June 12, 1928, during summer heat weather, he traveled outdoors, sweating heavily and drinking much. Averse to heat and coveting coolness, he rested under a large tree’s shade. With sweat coming out, pores opened, and he was exposed to cool wind, catching a cold. Initially, he felt severe chills, thirst desiring drink, head/body discomfort. Returning home, fever gradually developed, thirst intensified, head/body hurt, and urine became scanty/dark yellow. I examined him: pulse floating, wiry, rapid; face red, lips red, tongue red and dry. This was due to intense summer heat damaging Yin, pathogenic heat accumulating internally, combined with exterior cold binding, blocking pores, resulting in Exterior-Cold and Interior-Heat syndrome. I prescribed Zhang Zhongjing’s Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) to resolve both exterior and interior.
Sheng Mahuang (Ephedrae Herba) 10g, Sheng Shigao (Gypsum Fibrosum) 24g (crushed, wrapped in cloth), Xingren (Armeniacae Semen Amarum) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 10g.
Follow-up on the 13th. After one dose of the above, profuse sweating occurred, fever subsided, head/body pain resolved. Subsequently, heat-clearing and Yin-nourishing agents were used to clear residual heat. Formula: Renshen Baihu Tang (Ginseng, White Tiger Decoction) containing Shengmai San (Generate the Pulse Powder).
Shashen (Glehniae Radix) 20g, Sheng Shigao (Gypsum Fibrosum) 15g (crushed, wrapped in cloth), Zhimu (Anemarrhenae Rhizoma) 12g, Cundong (Ophiopogonis Radix) 15g, Shengdi (Rehmanniae Radix) 12g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Jingmi (Oryzae Fructus Glutinosus) 10g.
Follow-up on the 14th. Previously, pulse was calm and body cool; now body felt scorching again, thirst intensified, lips cracked, tongue dry with prickles, pulse surging and rapid. Why did heat-clearing/Yin-nourishing agents make the illness heavier and heat worse? Was medication inappropriate, or did residual pathogens reignite? Inquiry revealed that for three to four days, he had no bowel movement. Introduced by friends, he took a packet of Tongbian Wan (Constipation Pill) containing Badou (Crotonis Fructus) and other warming purgatives. Although stool passed several times, fever flared up again. It was known to be caused by mistakenly taking damp-heat pills. Immediately, I used Renshen Baihu Tang (Ginseng, White Tiger Decoction) with increased dosage, adding Huanglian (Coptidis Rhizoma), Maidong (Ophiopogonis Radix), and Xuanshen (Scrophulariae Radix) to clear Heart/Lung heat and nourish water/generate fluids, assisted by Lv Dou (Phaseoli Radiatus Semen) to resolve Badou’s heat toxicity.
Tu Renshen (Codonopsis Radix/Turmeric Ginseng equivalent) 24g, Sheng Shigao (Gypsum Fibrosum) 36g (crushed, wrapped in cloth), Zhimu (Anemarrhenae Rhizoma) 12g, Hei Xuanshen (Scrophulariae Radix) 12g.
Chuan Huanglian (Coptidis Rhizoma) 6g, Cundong (Ophiopogonis Radix) 21g, Xiao Lv Dou (Phaseoli Radiatus Semen) 15g, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Bai Jingmi (Oryzae Fructus Glutinosus) 12g.
Follow-up on the 15th. After taking this formula, sweating occurred, heat retreated, oral fluids returned, tongue prickles softened, urine although yellow/red became longer, pulse deep/fine with rapid quality, palms still hot, still craving cold drinks. This indicated major illness receded, residual heat not cleared, True Yin still deficient. Treat with nourishing Yin, generating fluids, and clearing residual heat. Formula:
Hei Xuanshen (Scrophulariae Radix) 12g, Shengdi (Rehmanniae Radix) 15g, Cundong (Ophiopogonis Radix) 15g, Zhimu (Anemarrhenae Rhizoma) 12g, Shashen (Glehniae Radix) 15g.
Hangshao (Paeoniae Radix Alba) 15g, Shigao (Gypsum Fibrosum) 12g (crushed, wrapped in cloth), Xiao Lv Dou (Phaseoli Radiatus Semen) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g.
Follow-up on the 16th. Pulse harmonious, palm heat gone, thirst stopped, mouth full of fluids, urine clear/long, spirit/appetite increased. Subsequently, Shengmai San (Generate the Pulse Powder) added with Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), and Hangshao (Paeoniae Radix Alba), cured in two doses.
Shashen (Glehniae Radix) 15g, Cundong (Ophiopogonis Radix) 12g, Wuweizi (Schisandrae Fructus) 3g, Danggui (Angelicae Sinensis Radix) 12g, Huangqi (Astragali Radix) 24g.
Hangshao (Paeoniae Radix Alba) 12g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g.
After Gan XX recovered from Summerheat, he introduced his classmate Li Mou. Li also suffered from Summerheat, ill for six-seven days. Pulse floating/surging, face red, excessive sweating, high fever, irritability, thirst preferring cold drinks. Lips cracked, tongue red, white/dry coating, refusal of food, scanty/burning dark yellow urine.
He had taken Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Zhike (Aurantii Fructus), Zhizi (Gardeniae Fructus), Lianqiao (Forsythiae Fructus), Bohe (Menthae Haplocalycis Herba), Mutong (Akebiae Caulis), Huashi (Talcum), Huoxiang (Agastaches Herba), Xiangru (Elsholtziae Herba) without effect. This was Summerheat damaging Yin, dryness of fluids, interior heat burning. Erroneous use of bitter-dry/acrid-dispersing agents further damaged fluids/jin ye. Although bitter-cold herbs were mixed, it was like a cup of water trying to extinguish a cartload of burning wood. Thus, I prescribed Renshen Baihu Tang (Ginseng, White Tiger Decoction) modified.
Shashen (Glehniae Radix) 24g, Sheng Shigao (Gypsum Fibrosum) 60g (crushed, wrapped in cloth), Zhimu (Anemarrhenae Rhizoma) 12g, Cundong (Ophiopogonis Radix) 24g.
Shengdi (Rehmanniae Radix) 15g, Xuanshen (Scrophulariae Radix) 12g, Hangshao (Paeoniae Radix Alba) 12g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Jingmi (Oryzae Fructus Glutinosus) 12g.
Next day follow-up. After one dose, profuse sweating occurred, pathogenic heat retreated, True Yin recovered, lips/tongue moister, irritability/thirst reduced, urine longer but still red. Continue with clearing Summerheat, resolving heat, nourishing Yin, generating fluids. Modify original formula.
Shashen (Glehniae Radix) 15g, Shigao (Gypsum Fibrosum) 12g (crushed, wrapped in cloth), Cundong (Ophiopogonis Radix) 12g, Wuweizi (Schisandrae Fructus) 3g.
Zhimu (Anemarrhenae Rhizoma) 10g, Hangshao (Paeoniae Radix Alba) 12g, Jian Bei (Fritillariae Thunbergii Bulbus) 10g, Zhuye (Phyllostachys Folium/Bamboo Leaf) 5g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g.
After taking the above, pulse calm, body cool, tongue moist/harmonious, oral fluids generated, irritability/thirst stopped, urine clear/long, appetite gradually increased. Use Shengmai San (Generate the Pulse Powder) added with Danggui (Angelicae Sinensis Radix), Hangshao (Paeoniae Radix Alba), Shengdi (Rehmanniae Radix). Taken for two consecutive doses, pathogens expelled, Zheng (Righteous Qi) safe, appetite/spirit strengthened, and cured.
**Red Dysentery**
Peng XX, male, 35 years old, from Sichuan, residing at Zhushi Bridge, Kunming City, Yunnan Province. Naturally strong constitution. Occasionally retained undigested food, combined with damp-heat. On the night of September 15, 1929, he went to the toilet and caught Wind-Cold. Initially, fever, vomiting, diarrhea, headache, body pain, spontaneous sweating, and aversion to cold. Then progressed to dysentery with red and white discharge, severe lower abdominal pain, tenesmus (li ji hou zhong), passing only one or two spoons per defecation, day and night without limit, scanty dark yellow urine, inability to eat (Jin Kou Bu Shi), pulse floating/wiry/tight, tongue coating white/greasy, tip crimson. According to pathology, damp-heat with food stagnation obstructed intestines/stomach, compounded by external Wind-Cold binding Taiyang meridian Qi mechanism. Exterior cold bound outside, damp-heat pressed inside, causing fever and dysentery, known as "Xie Re Li" (Dysentery accompanying heat). Method: Treat both exterior and interior. Use Guige Tang (Cinnamon and Pueraria Decoction) to resolve muscle/exterior pathogens, assisted by Xiao Chengqi Tang (Minor Order the Qi Decoction) added with Huanglian (Coptidis Rhizoma) to purge retained food and clear damp-heat.
Gegen (Puerariae Radix) 12g, Guijian (Cinnamomi Ramulus/Cinnamon Twig Tip) 10g, Hangshao (Paeoniae Radix Alba) 20g, Dahuang (Rhei Radix et Rhizoma) 10g (soaked and mixed in), You Puhuo (Magnoliae Officinalis Cortex) 12g, Zhishi (Aurantii Fructus Immaturus) 10g (crushed), Huanglian (Coptidis Rhizoma) 5g, Shengjiang (Zingiberis Rhizoma Recens) 10g, Xiao Zao (Jujubae Fructus) 7 pieces.
Gancao (Glycyrrhizae Radix et Rhizoma) 3g.
Next day follow-up. After finishing one dose of the above, sweating occurred. After sweating, fever subsided, pulse normalized, exterior pathogens resolved, dysentery lightened. However, damp-heat and food stagnation still obstructed GI tract, damp-heat pressed inside, dysentery not fully stopped, abdominal pain and tenesmus persisted with each episode. Thus, using the method of "Tong Yin Tong Yong" (Treating obstruction with draining methods), I prescribed Da Chengqi Tang (Major Order the Qi Decoction) combined with Binshao Shunqi Tang (Areca Peel and Peony Regulating Qi Decoction) modified to urgently purge retained food and clear damp-heat.
Sheng Hangshao (Paeoniae Radix Alba) 24g, Sheng Dahuang (Rhei Radix et Rhizoma) 12g (soaked and mixed in), Zhishi (Aurantii Fructus Immaturus) 10g (stir-fried, crushed), Houpo (Magnoliae Officinalis Cortex) 10g (stir-fried), Binglang (Arecae Semen) 12g, Maidong (Ophiopogonis Radix) 12g, Guang Muxiang (Vladimiriae Radix) 5g, Mangxiao (Natrii Sulfas Exsiccatus) 5g, Huanglian (Coptidis Rhizoma) 4g.
Third visit. After taking the above, rapid loose stools passed two or three times. Abdominal pain, tenesmus, and red/white dysentery reduced by 70-80%. Greasy coating retreated, able to take thin porridge. Urine still scanty/dark yellow, craving cold foods/fruits. Although symptoms reduced, damp-heat dysentery toxin not cleared. Continue with original formula modified.
Sheng Hangshao (Paeoniae Radix Alba) 20g, Sheng Dahuang (Rhei Radix et Rhizoma) 6g (soaked and mixed in), Huanglian (Coptidis Rhizoma) 5g, You Puhuo (Magnoliae Officinalis Cortex) 10g.
Maidong (Ophiopogonis Radix) 12g, Xuanming Fen (Natrii Sulfas Exsiccatus) 5g, Guang Muxiang (Vladimiriae Radix) 4g.
After taking, two more loose stools passed, dysentery stopped, anus slightly heavy, appetite increased, urine still red. Residual heat not fully cleared. Prescribe below for treatment.
Shashen (Glehniae Radix) 13g, Cundong (Ophiopogonis Radix) 13g, Mutong (Akebiae Caulis) 10g, Sheng Hangshao (Paeoniae Radix Alba) 13g, Jiu Zhi Dahuang (Rhei Radix et Rhizoma Wine-processed) 5g.
Houpo (Magnoliae Officinalis Cortex) 10g.
After taking, diet normalized, spirit/form healthy, dysentery stopped, urine clear, abdominal pain gone, cured.
Commentary: When encountering dysentery with fever, headache/body pain indicating exterior syndrome, I immediately use Guige Tang (Cinnamon and Pueraria Decoction) to resolve exterior pathogens first. If no exterior pathogens, urgent cooling purgation is primary. Such therapy is invariably effective as quickly as a drumstick striking. If exterior pathogens are not resolved, fever persists, easily turning critical. Thus, *Neijing* states: "Dysentery with unceasing fever indicates death." Without purgation, pathogenic heat and dysentery toxins cannot be removed. If it belongs to chronic dysentery deficiency-cold, treat with warming and consolidating methods.
**Pediatric Epidemic Dysentery (Pediatric Shigella Dysentery)**
Zhang Xiaomei, female, 1 year old. On August 19, 1961, fever for one day, diarrhea over ten times, stool with red/white mucus. Diagnosed as "Bacterial Dysentery" by Kunming Red Cross Hospital and admitted to pediatric ward.
According to admission records: Poor development, average nutrition, no teeth erupted, anterior fontanelle not closed, cervical lymph nodes palpable. Throat, heart, lungs, abdomen normal. Temperature 39°C (rectal). Aug 20 blood count: RBC 3.4 million/mm³, Hemoglobin 66%, WBC 5,300/mm³, Neutrophils 68%, Lymphocytes 27%, Monocytes 3%. Aug 22 stool culture positive for Shigella dysenteriae. Chloramphenicol started Aug 23. Polymyxin added Aug 24, along with internal Chinese medicine for clearing heat/toxin and stopping dysentery. Diarrhea continued, temperature remained around 39.5°C (rectal). Aug 28 blood count: RBC 3.15 million/mm³, Hemoglobin 60%, WBC 13,600/mm³, Neutrophils 68%, Lymphocytes 30%, Monocytes 2%. After ten days of hospitalization with various antibiotics and Chinese medicine, no improvement. Consulted on Aug 29.
Examination that afternoon: Patient lying in bed, receiving IV fluids, face red, body hot, temperature 40.5°C (rectal), weak/no spirit, dry lips/mouth, sunken eyes. Mother frequently feeding/drinking, occasional crying, weak breath, refusing milk/food, spontaneous sweating, easily frightened with slight movement. Inquiry: Stool passed over ten times today, small amount each time, mixed red/white mucus, scanty urine. Finger vein red and floating, tongue coating pink-white. This is internal injury from diet, compounded by external pathogens. Exterior syndrome unresolved, pathogens sinking into Yangming, forming Taiyang-Yangming Combined Disease Dysentery. Premature use of heat-clearing/dysentery-stopping and bitter-cold purgatives easily damages interior Qi. If exterior pathogens sink deeply, dysentery will not stop. This case belongs to Two Yangs Combined Disease. Treat by releasing exterior and lifting pathogens sunk into Yangming meridian. Suggested suspending previous Western/Chinese medicines, prescribing Guige Tang (Cinnamon and Pueraria Decoction) one dose.
Guizhi (Cinnamomi Ramulus) 10g, Gegen (Puerariae Radix) 10g, Hangshao (Paeoniae Radix Alba) 6g, Shengjiang (Zingiberis Rhizoma Recens) 2 small slices, Xiao Zao (Jujubae Fructus) 3 pieces, Gancao (Glycyrrhizae Radix et Rhizoma) 3g.
Fed twice that night. By night, slight sweating occurred, body heat slightly subsided, temperature 39°C (rectal). Next morning, boiled third dose, finished two doses within the day. Shortly after each dose, warm sweat slowly emerged. By evening of the 30th, temperature dropped to 37.8°C (rectal), no diarrhea observed all day.