周 十四岁 壬戌八月十六日 伏暑内发，新凉外加。脉右大左弦，身热如烙，无汗，
胶痰
，舌苔满黄，不宜再见泄泻。不渴，腹胀，少腹痛，是谓阴阳并病，两太阳互争，难治之症
。拟先清上焦湿热，盖气化湿亦化也。
杏仁泥（三钱） 银花（二钱） 白通草（一钱） 滑石（三钱） 芦根（二钱） 淡竹叶（一钱）
生苡仁（钱半） 浓朴（二钱） 大贝母（一钱） 连翘（二钱） 梨皮（二钱）
今晚一帖，明早一帖。
十七日 案仍前。
连翘（二钱） 芦根（二钱） 杏仁泥（钱半） 银花（二钱） 薄荷（八分） 浓朴（钱半） 梨
皮
（钱半） 桑叶（一钱） 苦桔梗（钱半） 知母（三钱，炒） 鲜荷叶边（一张） 滑石（三钱） 白
扁豆皮（二钱）
午一帖，晚一帖，明早一帖。
十八日 两与清上焦，热已减其半，手心热于手背，谓之里热，舌苔红黄而浓，为实热
。宜宣之，用苦辛寒法。再按∶暑必夹湿，按腹中之痛胀，故不得不暂用苦燥法。
杏仁泥（三钱） 小枳实（钱半） 黄连（钱半，姜汁炒） 木通（二钱） 浓朴（钱半） 黄芩
炭
（一钱） 广木香（一钱） 栝蒌仁（八分） 广皮炭（一钱） 小茴香炭（钱半） 炒知母（钱半）
槟榔（八分）
十九日 腹之痛胀俱减，舌苔干燥黄黑，唇肉色绛，呛咳痰粘。幼童阴气未坚，当与存
阴退热。
麦冬（六钱，连心） 丹皮（五钱） 元参（五钱） 沙参（三钱） 炒知母（二钱） 犀角（三
钱） 蛤粉（三钱） 杏仁（三钱） 生甘草（一钱） 细生地（四钱） 石膏（四钱）
二十日 津液稍回，宿粪未除，潮热因邪气还表，右脉仍然浮大，未可下，宜保津液，
护火克金之嗽。
焦白芍（四钱） 沙参（三钱） 牡蛎粉（钱半） 麦冬（六钱） 柏子霜（三钱） 杏仁粉（二
钱） 细生地（六钱） 霍石斛（三钱） 石膏（三钱） 元参（六钱） 犀角（一钱）
煮三杯，陆续服。
二十一日 诸症悉解，小有潮热，舌绛苔黑，深入血分之热未尽除也，用育阴法。
焦白芍（四钱） 天冬（钱半） 柏子霜（三钱） 大生地（五钱） 麦冬（六钱） 丹皮（三钱）
沙参（三钱） 炙甘草（二钱） 牡蛎（三钱）
头煎二杯，二煎一杯，分三次服。
二十二日 津液消亡，舌黑干刺，用复脉法。
炒白芍（六钱） 丹皮（四钱） 柏子霜（四钱） 生鳖甲（六钱） 麻仁（三钱） 麦冬（六钱）
生牡蛎（四钱） 阿胶（三钱，冲） 大生地（六钱）
头煎二杯，今日服；二煎一杯，明早服。
二十三日 右脉仍数，余邪陷入肺中，咳甚痰艰，议甘润兼凉肺气。
甜杏仁泥（三两） 桑叶（三钱） 菊花（三钱） 苦桔梗（三钱） 麦冬（一两，连心） 玉竹
（三
钱） 大贝母（三钱） 梨皮（三钱） 细生地（五钱） 沙参（三钱） 甘草（三钱） 丹皮（二钱）
煎四茶杯，分四次服。
二十四日 舌黑苔退，脉仍数，仍咳，腹中微胀。
杏仁粉（三钱） 象贝母（二钱） 郁金（钱半） 茯苓（三钱） 沙参（三钱） 藿梗（二钱）
生扁豆（三钱） 丹皮（三钱） 细生地（五钱） 桔梗（二钱） 麦冬（五钱）
头煎三杯，二煎一杯，分四次服。
二十五日 昨晚得黑粪如许，潮热退，唇舌仍绛。热之所过，其阴必伤，与复脉法复其
阴。
沙参（三钱） 麦冬（一两） 阿胶（二钱，冲） 炙甘草（三钱） 炒白芍（六钱） 生鳖甲（
五钱） 丹皮（三钱） 元参（三钱） 大生地（八钱） 麻仁（三钱） 生牡蛎（五钱）
八碗水，煮成三碗，分三次服。二煎煮一碗，明早服。
二十六日 又得宿粪如许，邪气已退八九，但正阴虚耳，故不欲食，晚间干咳无痰。
大生地（八钱） 阿胶（三钱） 生白芍（五钱） 麻仁（三钱） 炙甘草（三钱） 牡蛎粉（三
钱） 沙参（三钱） 麦冬（六钱） 天冬（二钱）
外用梨汁、藕汁、荸荠汁各一黄酒杯，重汤炖温频服。
二十七日 热伤津液，便燥，微有潮热，干咳舌赤，用甘润法。
元参（六钱） 知母（二钱炒） 阿胶（二钱） 沙参（三钱） 麻仁（三钱） 细生地（五钱）
麦冬（六钱） 郁李仁（二钱） 梨汁（一杯冲） 地栗汁（一酒杯，冲）
二十八日 伏邪内溃，续出白痧如许，脉较前却稍和，第二次舌苔未化，不大便。
连翘（二钱，连心） 麻仁（三钱） 牛蒡子（三钱，炒研） 炒银花（二钱） 阿胶（钱半）
沙参（三钱） 元参（三钱） 生甘草（一钱） 大生地（五钱） 麦冬（六钱）
服此方后，晚间即得大便。
九月初四日 潮热复作，不大便，燥粪复聚，与增液承气汤微和之。
元参（五钱） 细生地（五钱） 麦冬（五钱） 甘草（一钱） 生大黄（二钱）
服此得黑粪如许，而潮热退，脉静。以后一以养阴收功。
陈 二十八岁 左脉洪大数实，右脉阳微，阴阳逆乱，伏暑似疟，最难即愈。议领邪外
出法。
生鳖甲（三两） 青蒿（四钱） 桂枝（三钱） 麦冬（八钱） 焦白芍（三钱） 甘草（钱半）
沙参（三钱） 丹皮（三钱） 知母（三钱，炒）
三帖即愈。
十四日 伏暑寒热已愈，不食不饥不便，胸中痞闷，九窍不和，皆属胃病。
半夏（五钱） 广皮（钱半） 青皮（钱半） 桂枝（钱半） 郁金（二钱） 生苡仁（五钱） 茯
苓（五钱） 党参（三钱）
三帖。
十七日 久病真阳虚则膺痛，余邪化热则口苦，正气不复则肢倦。
西洋参（二钱） 桂枝（三钱） 茯苓（三钱） 半夏（三钱） 黄芩炭（钱半） 焦白芍（三钱）
生姜（二片） 广皮炭（钱半） 炙甘草（钱半） 大枣（二枚）
某 乙丑八月二十二日 不兼湿气之伏暑误治，津液消亡，以致热不肯退，唇裂舌燥，
四十
余日不解，咳嗽胶痰，谵语口渴。可先服牛黄清心丸，清包络而搜伏邪；汤药与存阴退热法
。
细生地（三钱） 麦冬（五钱） 白芍（三钱炒） 甘草（一钱） 沙参（三钱） 生牡蛎（五钱）
生鳖甲（五钱） 生扁豆（三钱）
二十四日 暑之偏于热者，误以伤寒足经药治之，以致津液消亡。昨用存阴法，兼芳香
开络中闭伏之邪，已见大效。兹因小便赤甚而短，热虽减而未除，议甘苦合化阴气法。
二甲复脉汤，加黄芩（三钱） 如有谵语，其牛黄丸仍服。
二十六日 昨用甘苦合化阴气法，服后大见凉汗，兹热已除，脉减，舌苔尽退，但六脉
重
按全无，舌仍干燥。议热之所过，其阴必伤例，用二甲复脉汤，重加鳖甲、生甘草八帖。
某 乙丑九月十六日 夏伤于湿，冬必咳嗽。况六脉俱弦，木旺克土，脾土受克则泄泻
，胃
土受克则不食欲呕，前曾腹胀，现下胸痞，舌白滑，此寒湿病也。而脉反数，思凉思酸，物
极必反之象，岂浅鲜哉！急宜戒恼怒，小心一切为要。
半夏（三钱） 旋复花（二钱） 杏仁泥（四钱） 白蔻皮（一钱） 生苡仁（五钱） 滑石（三
钱） 郁金（二钱） 茯苓皮（五钱） 通草（一钱）
水五杯，煮两杯，渣再煮一杯，分三次服，二帖。
十八日 脉数甚，思凉，湿中生热之故。
通草（二钱） 郁金（二钱） 滑石（六钱） 茯苓皮（六钱） 白蔻仁（钱半） 藿梗（三钱）
生苡仁（六钱） 半夏（四钱） 杏仁泥（六钱） 小枳实（钱半） 黄芩（二钱）
水八碗，煮三茶碗，渣再煮半碗，分四次服，日三夜一，二帖。
二十日 伏暑必挟火与湿，不能单顾一边。至服药后反觉不快，乃体虚久病，不任开泄
之故。渴思凉者火也，得水则停者湿也。
生石膏（六钱） 半夏（三钱） 杏仁泥（六钱） 炒知母（钱半） 蔻仁（一钱） 黄芩（一钱）
煮三杯，三次服，二帖。
二十二日 去蔻仁加∶
通草（钱半） 石膏（四钱） 滑石（四钱） 知母（五分） 藿梗（三钱）
二十七日 饮居右胁，不得卧，格拒心火，不得下通于肾，故嗌干。
杏仁粉（三钱） 苏子（三钱，去油） 小枳实（三钱） 香附（三钱） 广皮（二钱） 旋复花
（三钱） 半夏（五钱） 茯苓皮（三钱） 藿梗（三钱）
十月初二日 小便不通，于前方内加∶
滑石（三钱） 通草（钱半） 生苡仁（三钱）
前后共九帖。
初六日 小便已通，于前方内去 滑石 通草 苡仁 服三帖。
巴 二十二岁 面目青黄，其为湿热无疑；右脉单弦，其为伏饮无疑；脘痞胸痛，合之
脉弦
，其为肝郁无疑。上年夏日曾得淋症，误服六味酸甘化阴，致令其湿热稳伏久踞，故证现庞
杂无伦，治法以宣通三焦，使邪有出路，安胃能食为要。
生石膏（八钱） 半夏（五钱） 旋复花（三钱） 滑石（一两） 蚕砂（三钱） 香附（三钱）
生苡仁（五钱） 茯苓皮（五钱） 郁金（三钱） 通草（二钱） 杏仁泥（三钱） 萆 （四钱）
初六日 其人本有饮症，又加内暑外凉，在经之邪，似疟而未成，在腑之邪泄泻不止，
恐成
痢疾，急以提邪外出为要。按六脉俱弦之泄泻，古谓之木泄，即以小柴胡汤为主方，况加之
寒热往来乎？六脉俱弦，古谓脉双弦者寒也，指中焦虚寒而言，岂补水之生熟地所可用哉！
现下寒水客气，燥金司天，而又大暑节气，与柴胡二桂枝一法。
柴胡（六钱） 炙甘草（一钱） 桂枝（三钱） 黄芩（二钱） 半夏（六钱） 生姜（三钱） 焦
白芍（二钱） 大枣（二钱） 藿梗（三钱） 广皮（二钱） 青蒿（二钱）
寒热止即止。
初八日 寒暑兼受，成疟则轻，成痢则重。前用柴胡二桂枝一法，现下面色青，热退，
痰多
而稀，舌之赤者亦淡，脉之弦劲者微细，不渴，阳虚可知，与桂枝柴胡各半汤，减黄芩加干
姜。
桂枝（二钱） 半夏（六钱） 柴胡（三钱） 黄芩（一钱，炒） 白芍（钱半，炒） 生甘草（
二钱） 干姜（三钱） 生姜（五钱） 大枣（三钱）
煮三杯，分三次服。
初九日 内暑外寒，相搏成疟，大便溏泄，恐致成痢。口干不渴，经谓自利不渴者属太
阴也
，合之腹痛则更可知矣。仲景谓表急急当救表，里急急当救里。兹表里无偏急象，议两救之
。救表仍用柴胡桂枝各半法，以太、少俱有邪也；救里与理中法。
桂枝（四钱） 黄芩炭（二钱） 生苡仁（五钱） 白芍（二钱，炒） 干姜（三钱） 炙甘草（
钱半）
川椒炭（三钱） 柴胡（四钱） 良姜（二钱） 半夏（六钱） 白蔻仁（钱半） 生姜（五钱） 大
枣（二个）
初十日 昨用两救表里，已见小效，今日仍宗前法而退之，脉中阳气已有生动之机故也
。不可性急，反致偾事。
桂枝（三钱） 黄芩（钱半，炒） 浓朴（二钱） 白芍（二钱，炒） 干姜（二钱） 炙甘草（
钱半
）川椒炭（二钱） 柴胡（三钱） 煨草果（一钱） 半夏（六钱） 生姜（五钱） 大枣（二个）
十一日 内而痰饮蹯踞中焦，外而寒暑扰乱胃阳。连日已夺去成痢疾之路，一以和中蠲
饮为要。盖无形之邪，每借有形质者以为根据附也。
青蒿（三钱） 小枳实（三钱） 黄芩炭（钱半） 杏仁泥（三钱） 茯苓皮（五钱） 柴胡（三
钱）
半夏（一两） 广皮（二钱） 白蔻仁（钱半） 生苡仁（五钱） 桂枝（三钱） 炒白芍（二钱） 生
姜（三片）
十二日 杂受寒暑，再三分析，方成疟疾，寒多热少，脉沉弦，乃邪气深入，与两分阴
阳之中偏于温法。
青蒿（三钱） 半夏（八钱） 槟榔（一钱） 柴胡（三钱） 浓朴（三钱） 良姜（二钱） 黄芩
炭（钱半） 枳实（二钱） 藿梗（三钱） 生姜（五片） 栝蒌皮（二钱） 大枣（二个）
十四日 寒热少减，胸痞甚，去甘加辛，去枣加生姜。
十六日 脉弦细，指尖冷，阳微不及四末之故。兼之腹痛便溏，痰饮咳嗽，更可知矣。
以和胃阳，温中汤，逐痰饮立法。
半夏（六钱） 良姜（二钱） 杏仁（三钱） 川椒炭（三钱） 干姜（二钱） 炒广皮（三钱）
桂枝（三钱） 蔻仁（二钱） 生苡仁（五钱） 生姜（三片）
张 十七日 伏暑酒毒，遇寒凉而发，九日不愈，脉缓而饮，滞下，身热，谵语，湿热
发黄，先清湿热，开心包。
茵陈（五钱） 茯苓皮（五钱） 黄连（二钱） 栀子炭（二钱） 通草（一钱） 黄柏炭（三钱）
滑石（五钱） 生苡仁（三钱） 黄芩（三钱）
十八日 热退，滞下已愈，黄未解。
茵陈（三钱） 黄连（八分） 茯苓皮（五钱） 滑石（五钱） 栀子炭（三钱） 杏仁（三钱）
黄柏炭（三钱） 通草（一钱） 灯草（一钱） 萆 （三钱）
Patient Zhou, 14 years old. On the 16th day of the 8th month in the Renxu year: Latent summerheat (Fushu) erupts internally, compounded by external new coolness (Xinliang). The pulse is large on the right and wiry on the left; body heat feels like a branding iron; no sweating; sticky phlegm expectoration; tongue coating is full and yellow; diarrhea should not occur again. No thirst, abdominal distension, and lower abdominal pain indicate concurrent Yin and Yang diseases (Yinyang Bingbing), with mutual contention between the two Taiyang channels, a difficult-to-treat condition. Plan to first clear damp-heat from the Upper Jiao, as Qi transformation leads to dampness transformation.
Prescription: Almond Paste (Xingren Ni, 3 qian), Honeysuckle Flower (Jinyinhua, 2 qian), White Tongcao (Bai Tongcao, 1 qian), Talcum (Huashi, 3 qian), Reed Rhizome (Lugen, 2 qian), Light Bamboo Leaf (Dan Zhuye, 1 qian), Raw Coix Seed (Sheng Yiyiren, 1.5 qian), Magnolia Bark (Noupu, 2 qian), Large Fritillaria Bulb (Dabeimu, 1 qian), Forsythia Fruit (Lianqiao, 2 qian), Pear Peel (Lipi, 2 qian).
Take one dose tonight, one dose tomorrow morning.
Re-examination on the 17th: Condition remains the same.
Prescription: Forsythia Fruit (Lianqiao, 2 qian), Reed Rhizome (Lugen, 2 qian), Almond Paste (Xingren Ni, 1.5 qian), Honeysuckle Flower (Jinyinhua, 2 qian), Mint (Bohe, 0.8 fen), Magnolia Bark (Noupu, 1.5 qian), Pear Peel (Lipi, 1.5 qian), Mulberry Leaf (Sangye, 1 qian), Bitter Platycodon Root (Ku Jiegeng, 1.5 qian), Anemarrhena Rhizome (Zhimu, 3 qian, stir-fried), Fresh Lotus Leaf Edge (Xian Heyebian, 1 piece), Talcum (Huashi, 3 qian), White Hyacinth Bean Peel (Bai Biandoupi, 2 qian).
One dose at noon, one dose at evening, one dose tomorrow morning.
Re-examination on the 18th: After two applications of clearing the Upper Jiao, heat has reduced by half. Heat in the palms greater than the dorsum indicates Interior Heat (Lire); red-yellow thick tongue coating indicates Excess Heat (Shire). Should disperse using the Bitter-Acrid-Cold method (Kuxin Han Fa). Further analysis: Summerheat must be accompanied by dampness; based on abdominal pain and distension, it is necessary to temporarily use the Bitter-Dry method (Kuzao Fa).
Prescription: Almond Paste (Xingren Ni, 3 qian), Small Immature Bitter Orange (Xiao Zhishi, 1.5 qian), Coptis Rhizome (Huanglian, 1.5 qian, fried with ginger juice), Akebia Stem (Mutong, 2 qian), Magnolia Bark (Noupu, 1.5 qian), Scutellaria Root Charcoal (Huangqin Tan, 1 qian), Aucklandia Root (Guangmuxiang, 1 qian), Trichosanthes Seed (Gualou Ren, 0.8 fen), Tangerine Peel Charcoal (Guangpi Tan, 1 qian), Small Fennel Fruit Charcoal (Xiao Huixiang Tan, 1.5 qian), Stir-fried Anemarrhena Rhizome (Chao Zhimu, 1.5 qian), Areca Seed (Binglang, 0.8 fen).
Re-examination on the 19th: Abdominal pain and distension have decreased, but tongue coating is dry, yellow-black; lip flesh is crimson; choking cough with sticky phlegm. Children's Yin Qi is not yet firm; should nourish Yin and reduce heat.
Prescription: Ophiopogon Tuber (Maidong, 6 qian, with heart), Moutan Cortex (Danpi, 5 qian), Scrophularia Root (Yuanshen, 5 qian), Glehnia Root (Shashen, 3 qian), Stir-fried Anemarrhena Rhizome (Chao Zhimu, 2 qian), Rhinoceros Horn (Xijiao, 3 qian), Gypsum Powder (Gafen, 3 qian), Almond (Xingren, 3 qian), Raw Licorice Root (Sheng Gancao, 1 qian), Fine Rehmannia Root (Xi Shengdi, 4 qian), Gypsum (Shigao, 4 qian).
Re-examination on the 20th: Fluids slightly recovered, but retained stool remains; tidal fever is due to pathogenic factors returning to the exterior; right pulse remains floating and large; purgation is contraindicated; should protect fluids and treat cough caused by Fire insulting Metal (lungs).
Prescription: Scorched White Peony Root (Jiao Baishao, 4 qian), Glehnia Root (Shashen, 3 qian), Oyster Shell Powder (Muli Fen, 1.5 qian), Ophiopogon Tuber (Maidong, 6 qian), Biota Seed Frost (Baizi Shuang, 3 qian), Almond Powder (Xingfen, 2 qian), Fine Rehmannia Root (Xi Shengdi, 6 qian), Dendrobium Stem (Huoshihu, 3 qian), Gypsum (Shigao, 3 qian), Scrophularia Root (Yuanshen, 6 qian), Rhinoceros Horn (Xijiao, 1 qian).
Decoct to three cups, take successively.
Re-examination on the 21st: All symptoms resolved, slight tidal fever remains; tongue is crimson with black coating, indicating residual heat deep in the Blood level not fully cleared; use Nourishing Yin method.
Prescription: Scorched White Peony Root (Jiao Baishao, 4 qian), Asparagus Tuber (Tiantong, 1.5 qian), Biota Seed Frost (Baizi Shuang, 3 qian), Large Rehmannia Root (Da Shengdi, 5 qian), Ophiopogon Tuber (Maidong, 6 qian), Moutan Cortex (Danpi, 3 qian), Glehnia Root (Shashen, 3 qian), Honey-fried Licorice Root (Zhi Gancao, 2 qian), Oyster Shell (Muli, 3 qian).
First decoction yields two cups, second yields one cup; divide into three doses.
Re-examination on the 22nd: Fluids depleted, tongue black and dry with prickles; use Pulse-Recovering Method (Fumai Fa).
Prescription: Stir-fried White Peony Root (Chao Baishao, 6 qian), Moutan Cortex (Danpi, 4 qian), Biota Seed Frost (Baizi Shuang, 4 qian), Raw Turtle Shell (Sheng Biejia, 6 qian), Hemp Seed (Maren, 3 qian), Ophiopogon Tuber (Maidong, 6 qian), Raw Oyster Shell (Sheng Muli, 4 qian), Donkey-hide Gelatin (Ejiao, 3 qian, melted in), Large Rehmannia Root (Da Shengdi, 6 qian).
First decoction yields two cups, take today; second yields one cup, take tomorrow morning.
Re-examination on the 23rd: Right pulse remains rapid; residual pathogens have sunk into the Lungs; severe cough with difficult sputum; propose Sweet-Moistening combined with Cooling Lung Qi method.
Prescription: Sweet Almond Paste (Tian Xingren Ni, 3 liang), Mulberry Leaf (Sangye, 3 qian), Chrysanthemum Flower (Juhua, 3 qian), Bitter Platycodon Root (Ku Jiegeng, 3 qian), Ophiopogon Tuber (Maidong, 1 liang, with heart), Polygonatum Rhizome (Yuzhu, 3 qian), Large Fritillaria Bulb (Dabeimu, 3 qian), Pear Peel (Lipi, 3 qian), Fine Rehmannia Root (Xi Shengdi, 5 qian), Glehnia Root (Shashen, 3 qian), Licorice Root (Gancao, 3 qian), Moutan Cortex (Danpi, 2 qian).
Decoct to four tea cups, divide into four doses.
Re-examination on the 24th: Black tongue coating recedes, pulse remains rapid, cough persists, slight abdominal distension.
Prescription: Almond Powder (Xingfen, 3 qian), Elephant Fritillaria Bulb (Xiang Beimu, 2 qian), Curcuma Tuber (Yujin, 1.5 qian), Poria (Fuling, 3 qian), Glehnia Root (Shashen, 3 qian), Agastache Stem (Huogeng, 2 qian), Raw Hyacinth Bean (Sheng Biandou, 3 qian), Moutan Cortex (Danpi, 3 qian), Fine Rehmannia Root (Xi Shengdi, 5 qian), Platycodon Root (Jiegeng, 2 qian), Ophiopogon Tuber (Maidong, 5 qian).
First decoction yields three cups, second yields one cup; divide into four doses.
Re-examination on the 25th: Passed black stool last night, tidal fever subsided, lips and tongue remain crimson. Where heat has passed, Yin must be injured; use Pulse-Recovering Method to restore Yin.
Prescription: Glehnia Root (Shashen, 3 qian), Ophiopogon Tuber (Maidong, 1 liang), Donkey-hide Gelatin (Ejiao, 2 qian, melted in), Honey-fried Licorice Root (Zhi Gancao, 3 qian), Stir-fried White Peony Root (Chao Baishao, 6 qian), Raw Turtle Shell (Sheng Biejia, 5 qian), Moutan Cortex (Danpi, 3 qian), Scrophularia Root (Yuanshen, 3 qian), Large Rehmannia Root (Da Shengdi, 8 qian), Hemp Seed (Maren, 3 qian), Raw Oyster Shell (Sheng Muli, 5 qian).
Decoct eight bowls of water to three bowls, divide into three doses. Second decoction yields one bowl, take tomorrow morning.
Re-examination on the 26th: Passed retained stool again, pathogens retreated by 80-90%, only Zheng Qi (Upright Qi) Yin deficiency remains, hence anorexia; evening dry cough without phlegm.
Prescription: Large Rehmannia Root (Da Shengdi, 8 qian), Donkey-hide Gelatin (Ejiao, 3 qian), Raw White Peony Root (Sheng Baishao, 5 qian), Hemp Seed (Maren, 3 qian), Honey-fried Licorice Root (Zhi Gancao, 3 qian), Oyster Shell Powder (Muli Fen, 3 qian), Glehnia Root (Shashen, 3 qian), Ophiopogon Tuber (Maidong, 6 qian), Asparagus Tuber (Tiantong, 2 qian).
Externally: Pear juice, Lotus root juice, and Water Chestnut juice, each one yellow wine cup, warm in double boiler, take frequently.
Re-examination on the 27th: Heat injured fluids, dry stool, slight tidal fever, dry cough, red tongue; use Sweet-Moistening method.
Prescription: Scrophularia Root (Yuanshen, 6 qian), Anemarrhena Rhizome (Zhimu, 2 qian, stir-fried), Donkey-hide Gelatin (Ejiao, 2 qian), Glehnia Root (Shashen, 3 qian), Hemp Seed (Maren, 3 qian), Fine Rehmannia Root (Xi Shengdi, 5 qian), Ophiopogon Tuber (Maidong, 6 qian), Chinese Privet Seed (Yuliren, 2 qian), Pear Juice (Lizhi, 1 cup, mixed in), Water Chestnut Juice (Dili Zhi, 1 wine cup, mixed in).
Re-examination on the 28th: Latent pathogens溃散 internally, continuous eruption of white sand-like rash, pulse slightly harmonious compared to before, second observation shows tongue coating not transformed, constipation.
Prescription: Forsythia Fruit (Lianqiao, 2 qian, with heart), Hemp Seed (Maren, 3 qian), Arctium Seed (Niubangzi, 3 qian, stir-fried and crushed), Stir-fried Honeysuckle Flower (Chao Jinyinhua, 2 qian), Donkey-hide Gelatin (Ejiao, 1.5 qian), Glehnia Root (Shashen, 3 qian), Scrophularia Root (Yuanshen, 3 qian), Raw Licorice Root (Sheng Gancao, 1 qian), Large Rehmannia Root (Da Shengdi, 5 qian), Ophiopogon Tuber (Maidong, 6 qian).
After taking this prescription, bowel movement occurred that evening.
September 4th: Tidal fever recurred, constipation, dry stool re-accumulated; administer Zengye Chengqi Tang (Increase Fluids and Purge Accumulation Decoction) to mildly harmonize.
Prescription: Scrophularia Root (Yuanshen, 5 qian), Fine Rehmannia Root (Xi Shengdi, 5 qian), Ophiopogon Tuber (Maidong, 5 qian), Licorice Root (Gancao, 1 qian), Raw Rhubarb (Sheng Dahuang, 2 qian).
After taking, passed black stool, tidal fever subsided, pulse quiet. Thereafter, focus solely on nourishing Yin to conclude treatment.
Patient Chen, 28 years old. Left pulse is flooding, large, rapid, and excess; right pulse Yang is weak; Yin and Yang are chaotic; latent summerheat resembles malaria, hardest to cure immediately. Propose guiding pathogens outward.
Prescription: Raw Turtle Shell (Sheng Biejia, 3 liang), Qinghao Herb (Qinghao, 4 qian), Cinnamon Twig (Guizhi, 3 qian), Ophiopogon Tuber (Maidong, 8 qian), Scorched White Peony Root (Jiao Baishao, 3 qian), Licorice Root (Gancao, 1.5 qian), Glehnia Root (Shashen, 3 qian), Moutan Cortex (Danpi, 3 qian), Anemarrhena Rhizome (Zhimu, 3 qian, stir-fried).
Three doses result in cure.
14th Re-examination: Latent summerheat chills and fevers cured, but no appetite, no hunger, no bowel movement, chest oppression, nine orifices disharmonious, all belong to Stomach disease.
Prescription: Pinellia Tuber (Banxia, 5 qian), Broad-leaved Mandarin Peel (Guangpi, 1.5 qian), Green Tangerine Peel (Qingpi, 1.5 qian), Cinnamon Twig (Guizhi, 1.5 qian), Curcuma Tuber (Yujin, 2 qian), Raw Coix Seed (Sheng Yiyiren, 5 qian), Poria (Fuling, 5 qian), Codonopsis Root (Dangshen, 3 qian).
Three doses.
17th Re-examination: Long-term illness causes True Yang deficiency leading to chest pain; residual pathogens transform into heat causing bitter taste; failure of Zheng Qi to recover causes limb fatigue.
Prescription: American Ginseng (Xiyangshen, 2 qian), Cinnamon Twig (Guizhi, 3 qian), Poria (Fuling, 3 qian), Pinellia Tuber (Banxia, 3 qian), Scutellaria Root Charcoal (Huangqin Tan, 1.5 qian), Scorched White Peony Root (Jiao Baishao, 3 qian), Ginger (Shengjiang, 2 slices), Tangerine Peel Charcoal (Guangpi Tan, 1.5 qian), Honey-fried Licorice Root (Zhi Gancao, 1.5 qian), Jujube (Dazao, 2 pieces).
Certain Patient, August 22nd in Yichou year: Latent summerheat without dampness was mis-treated, causing fluid depletion, resulting in persistent heat, cracked lips, dry tongue, unresolved for over 40 days, cough with sticky phlegm, delirium, thirst. First administer Niuhuang Qingxin Wan (Calculus Bovis Clearing Heart Pill) to clear Pericardium and search out latent pathogens; decoctions use Preserve Yin and Reduce Heat method.
Prescription: Fine Rehmannia Root (Xi Shengdi, 3 qian), Ophiopogon Tuber (Maidong, 5 qian), White Peony Root (Baishao, 3 qian, stir-fried), Licorice Root (Gancao, 1 qian), Glehnia Root (Shashen, 3 qian), Raw Oyster Shell (Sheng Muli, 5 qian), Raw Turtle Shell (Sheng Biejia, 5 qian), Raw Hyacinth Bean (Sheng Biandou, 3 qian).
24th Re-examination: Summerheat biased towards heat was mis-treated with Shaoyang foot meridian drugs for Cold Damage, causing fluid depletion. Yesterday used Preserve Yin method, combined with aromatic opening to unblock closed latent pathogens in collaterals, showing great effect. Now due to very red and short urine, heat reduced but not eliminated, propose Sweet-Bitter Combined Transforming Yin Qi method.
Erjia Fumai Tang (Two-Shelled Pulse-Recovering Decoction), add Scutellaria Root (Huangqin, 3 qian). If delirium occurs, continue Niuhuang Wan.
26th Re-examination: Yesterday used Sweet-Bitter Combined Transforming Yin Qi method, resulted in profuse cool sweat after taking; now heat eliminated, pulse slowed, tongue coating completely receded, but six pulses vanish upon heavy pressure, tongue still dry. Propose following principle "Where heat passes, Yin is injured," use Erjia Fumai Tang, heavily increase Turtle Shell and Raw Licorice Root, total 8 doses.
Certain Patient, September 16th in Yichou year: Summer injury by dampness leads to winter cough. Moreover, six pulses are wiry, Wood excess insults Earth; Spleen Earth insulted causes diarrhea, Stomach Earth insulted causes anorexia and vomiting; previously abdominal distension, now chest oppression, white slippery tongue coating, this is Cold-Damp disease. But pulse is surprisingly rapid, desiring cool and sour, indicating reversal at extremes, how shallow is this! Urgently avoid anger, be cautious in all matters.
Prescription: Pinellia Tuber (Banxia, 3 qian), Inula Flower (Xuanfuhua, 2 qian), Almond Paste (Xingren Ni, 4 qian), White Cardamom Peel (Baikou Pi, 1 qian), Raw Coix Seed (Sheng Yiyiren, 5 qian), Talcum (Huashi, 3 qian), Curcuma Tuber (Yujin, 2 qian), Poria Skin (Fulingpi, 5 qian), Akebia Stem (Tongcao, 1 qian).
Five cups water, boil to two cups, dregs boil to one cup, divide into three doses, two doses total.
18th Re-examination: Pulse very rapid, desiring cool, due to heat generating within dampness.
Prescription: Akebia Stem (Tongcao, 2 qian), Curcuma Tuber (Yujin, 2 qian), Talcum (Huashi, 6 qian), Poria Skin (Fulingpi, 6 qian), White Cardamom Seed (Baikou Ren, 1.5 qian), Agastache Stem (Huogeng, 3 qian), Raw Coix Seed (Sheng Yiyiren, 6 qian), Pinellia Tuber (Banxia, 4 qian), Almond Paste (Xingren Ni, 6 qian), Small Immature Bitter Orange (Xiao Zhishi, 1.5 qian), Scutellaria Root (Huangqin, 2 qian).
Eight bowls water, boil to three tea bowls, dregs boil to half bowl, divide into four doses, three times day one time night, two doses total.
20th Re-examination: Latent summerheat must carry Fire and Dampness, cannot attend to only one side. Feeling uncomfortable after medication is due to weak constitution and long-term illness unable to tolerate dispersing methods. Thirst for cool is Fire; water retention is Dampness.
Prescription: Raw Gypsum (Sheng Shigao, 6 qian), Pinellia Tuber (Banxia, 3 qian), Almond Paste (Xingren Ni, 6 qian), Stir-fried Anemarrhena Rhizome (Chao Zhimu, 1.5 qian), Cardamom Seed (Kouren, 1 qian), Scutellaria Root (Huangqin, 1 qian).
Boil to three cups, three doses, two doses total.
22nd Re-examination: Remove Cardamom Seed, add:
Akebia Stem (Tongcao, 1.5 qian), Gypsum (Shigao, 4 qian), Talcum (Huashi, 4 qian), Anemarrhena Rhizome (Zhimu, 0.5 fen), Agastache Stem (Huogeng, 3 qian).
27th Re-examination: Fluid accumulation in right hypochondrium, inability to lie flat, blocking Heart Fire from descending to Kidney, causing throat dryness.
Prescription: Almond Powder (Xingfen, 3 qian), Perilla Seed (Suzi, 3 qian, oil removed), Small Immature Bitter Orange (Xiao Zhishi, 3 qian), Cyperus Rhizome (Xiangfu, 3 qian), Broad-leaved Mandarin Peel (Guangpi, 2 qian), Inula Flower (Xuanfuhua, 3 qian), Pinellia Tuber (Banxia, 5 qian), Poria Skin (Fulingpi, 3 qian), Agastache Stem (Huogeng, 3 qian).
October 2nd: Urinary obstruction, add to previous formula:
Talcum (Huashi, 3 qian), Akebia Stem (Tongcao, 1.5 qian), Raw Coix Seed (Sheng Yiyiren, 3 qian).
Total nine doses so far.
6th Re-examination: Urination resumed, remove Talcum, Akebia Stem, Coix Seed from previous formula, take three doses.
Patient Ba, 22 years old. Face and eyes blue-yellow, undoubtedly Damp-Heat; right pulse alone wiry, undoubtedly latent Phlegm-Fluid; epigastric oppression and chest pain, combined with wiry pulse, undoubtedly Liver Depression. Last summer suffered from strangury, mis-administered Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) acid-sweet transforming Yin, causing Damp-Heat to settle firmly and occupy for a long time, hence complex and chaotic symptoms. Treatment focuses on ventriculating the Three Jiao, providing an exit for pathogens, and calming Stomach to restore appetite.
Prescription: Raw Gypsum (Sheng Shigao, 8 qian), Pinellia Tuber (Banxia, 5 qian), Inula Flower (Xuanfuhua, 3 qian), Talcum (Huashi, 1 liang), Silkworm Frass (Cansha, 3 qian), Cyperus Rhizome (Xiangfu, 3 qian), Raw Coix Seed (Sheng Yiyiren, 5 qian), Poria Skin (Fulingpi, 5 qian), Curcuma Tuber (Yujin, 3 qian), Akebia Stem (Tongcao, 2 qian), Almond Paste (Xingren Ni, 3 qian), Dioscorea Hypoglottis (Bixie, 4 qian).
6th Re-examination: Patient originally had Phlegm-Fluid disease, added internal summerheat and external coolness; pathogens in meridians resemble malaria but not formed; pathogens in fu organs cause incessant diarrhea, fear becoming dysentery, urgently extract pathogens outward. Six wiry pulses in diarrhea is anciently called Wood Diarrhea (Mu Xie), primarily use Xiaochaihu Tang (Minor Bupleurum Decoction), especially with alternating chills and fever? Six wiry pulses, anciently called double-wiry pulse indicates Cold, referring to Middle Jiao deficiency cold, how can nourishing water herbs like Raw/Cooked Rehmannia be used! Current Cold Water hostile Qi, Dry Metal ruling heaven, yet Great Heat solar term, use Chaihu 2, Guizhi 1 method.
Prescription: Bupleurum Root (Chaihu, 6 qian), Honey-fried Licorice Root (Zhi Gancao, 1 qian), Cinnamon Twig (Guizhi, 3 qian), Scutellaria Root (Huangqin, 2 qian), Pinellia Tuber (Banxia, 6 qian), Ginger (Shengjiang, 3 qian), Scorched White Peony Root (Jiao Baishao, 2 qian), Jujube (Dazao, 2 qian), Agastache Stem (Huogeng, 3 qian), Broad-leaved Mandarin Peel (Guangpi, 2 qian), Qinghao Herb (Qinghao, 2 qian).
Stop when chills and fever cease.
8th Re-examination: Cold and summerheat both received, forming malaria is mild, forming dysentery is severe. Previously used Chaihu 2 Guizhi 1 method, now face is blue, heat subsided, phlegm abundant and thin, tongue redness faded, pulse wiry-forceful became fine, no thirst, Yang deficiency known, give Guizhi Chaihu Half-Decoction (Guizhi Chaihu Ge Ban Tang), reduce Scutellaria add Dried Ginger.
Prescription: Cinnamon Twig (Guizhi, 2 qian), Pinellia Tuber (Banxia, 6 qian), Bupleurum Root (Chaihu, 3 qian), Scutellaria Root (Huangqin, 1 qian, stir-fried), White Peony Root (Baishao, 1.5 qian, stir-fried), Raw Licorice Root (Sheng Gancao, 2 qian), Dried Ginger (Ganjiang, 3 qian), Ginger (Shengjiang, 5 qian), Jujube (Dazao, 3 qian).
Boil to three cups, divide into three doses.
9th Re-examination: Internal summerheat and external cold contend forming malaria, loose stool, fear becoming dysentery. Mouth dry but no thirst, Classics say self-diarrhea without thirst belongs to Taiyin, combined with abdominal pain confirms this. Zhang Zhongjing says if exterior urgent save exterior, if interior urgent save interior. Here no exterior/interior urgency, propose saving both. Save exterior using Chaihu Guizhi Half-Decoction, as both Taiyang and Shaoyang have pathogens; save interior using Lizhong Fa (Regulate Middle Method).
Prescription: Cinnamon Twig (Guizhi, 4 qian), Scutellaria Root Charcoal (Huangqin Tan, 2 qian), Raw Coix Seed (Sheng Yiyiren, 5 qian), White Peony Root (Baishao, 2 qian, stir-fried), Dried Ginger (Ganjiang, 3 qian), Honey-fried Licorice Root (Zhi Gancao, 1.5 qian), Sichuan Pepper Charcoal (Chuanjiao Tan, 3 qian), Bupleurum Root (Chaihu, 4 qian), Galangal Root (Liangjiang, 2 qian), Pinellia Tuber (Banxia, 6 qian), White Cardamom Seed (Baikou Ren, 1.5 qian), Ginger (Shengjiang, 5 qian), Jujube (Dazao, 2 pieces).
10th Re-examination: Yesterday used saving both exterior and interior, small effect seen, today follow previous method but reduce dosage, because Yang Qi in pulse has signs of movement. Do not be impatient, lest causing failure.
Prescription: Cinnamon Twig (Guizhi, 3 qian), Scutellaria Root (Huangqin, 1.5 qian, stir-fried), Magnolia Bark (Noupu, 2 qian), White Peony Root (Baishao, 2 qian, stir-fried), Dried Ginger (Ganjiang, 2 qian), Honey-fried Licorice Root (Zhi Gancao, 1.5 qian), Sichuan Pepper Charcoal (Chuanjiao Tan, 2 qian), Bupleurum Root (Chaihu, 3 qian), Roasted Areca Nut (Wei Caoguo, 1 qian), Pinellia Tuber (Banxia, 6 qian), Ginger (Shengjiang, 5 qian), Jujube (Dazao, 2 pieces).
11th Re-examination: Internally Phlegm-Fluid occupies Middle Jiao, externally Cold/Summerheat disturbs Stomach Yang. Days have blocked path to dysentery, focus entirely on harmonizing Middle and eliminating Phlegm-Fluid. Formless pathogens often rely on formless matter for attachment.
Prescription: Qinghao Herb (Qinghao, 3 qian), Small Immature Bitter Orange (Xiao Zhishi, 3 qian), Scutellaria Root Charcoal (Huangqin Tan, 1.5 qian), Almond Paste (Xingren Ni, 3 qian), Poria Skin (Fulingpi, 5 qian), Bupleurum Root (Chaihu, 3 qian), Pinellia Tuber (Banxia, 1 liang), Broad-leaved Mandarin Peel (Guangpi, 2 qian), White Cardamom Seed (Baikou Ren, 1.5 qian), Raw Coix Seed (Sheng Yiyiren, 5 qian), Cinnamon Twig (Guizhi, 3 qian), Stir-fried White Peony Root (Chao Baishao, 2 qian), Ginger (Shengjiang, 3 slices).
12th Re-examination: Mixed reception of Cold/Summerheat, analyzed repeatedly, finally forms malaria, more cold less heat, pulse deep-wiry, pathogens deeply entered, use warming method biased within dividing Yin/Yang.
Prescription: Qinghao Herb (Qinghao, 3 qian), Pinellia Tuber (Banxia, 8 qian), Areca Seed (Binglang, 1 qian), Bupleurum Root (Chaihu, 3 qian), Magnolia Bark (Noupu, 3 qian), Galangal Root (Liangjiang, 2 qian), Scutellaria Root Charcoal (Huangqin Tan, 1.5 qian), Immature Bitter Orange (Zhishi, 2 qian), Agastache Stem (Huogeng, 3 qian), Ginger (Shengjiang, 5 slices), Trichosanthes Peel (Gualou Pi, 2 qian), Jujube (Dazao, 2 pieces).
14th Re-examination: Chills/fever reduced, chest oppression severe, remove sweet add acrid, remove Jujube add Ginger.
16th Re-examination: Pulse wiry-fine, fingertips cold, Yang weak failing to reach extremities. Combined with abdominal pain, loose stool, Phlegm-Fluid cough, further confirmed.
Use Harmonize Stomach Yang, Warm Middle Decoction (Wenzhong Tang), eliminate Phlegm-Fluid legislation.
Prescription: Pinellia Tuber (Banxia, 6 qian), Galangal Root (Liangjiang, 2 qian), Almond (Xingren, 3 qian), Sichuan Pepper Charcoal (Chuanjiao Tan, 3 qian), Dried Ginger (Ganjiang, 2 qian), Stir-fried Broad-leaved Mandarin Peel (Chao Guangpi, 3 qian), Cinnamon Twig (Guizhi, 3 qian), Cardamom Seed (Kouren, 2 qian), Raw Coix Seed (Sheng Yiyiren, 5 qian), Ginger (Shengjiang, 3 slices).
Patient Zhang, 17th Re-examination: Latent summerheat and alcohol toxin, erupted upon cold exposure, unresolved for 9 days, pulse slow with Phlegm-Fluid, dysentery, body heat, delirium, Damp-Heat jaundice, first clear Damp-Heat, open Pericardium.
Prescription: Capillary Barberry Root (Yinchen, 5 qian), Poria Skin (Fulingpi, 5 qian), Coptis Rhizome (Huanglian, 2 qian), Gardenia Charcoal (Zhizi Tan, 2 qian), Akebia Stem (Tongcao, 1 qian), Phellodendron Bark Charcoal (Huangbai Tan, 3 qian), Talcum (Huashi, 5 qian), Raw Coix Seed (Sheng Yiyiren, 3 qian), Scutellaria Root (Huangqin, 3 qian).
18th Re-examination: Heat subsided, dysentery cured, jaundice not resolved.
Prescription: Capillary Barberry Root (Yinchen, 3 qian), Coptis Rhizome (Huanglian, 0.8 fen), Poria Skin (Fulingpi, 5 qian), Talcum (Huashi, 5 qian), Gardenia Charcoal (Zhizi Tan, 3 qian), Almond (Xingren, 3 qian), Phellodendron Bark Charcoal (Huangbai Tan, 3 qian), Akebia Stem (Tongcao, 1 qian), Juncus Spike (Dengcao, 1 qian), Dioscorea Hypoglottis (Bixie, 3 qian).