章 七十岁 温热发斑，咽痛。
生石膏（一两） 人中黄（二钱） 苦桔梗（六钱） 知母（四钱） 射干（三钱） 芥穗（二钱）
元
钱）
苇根、白茅根煎汤，煮成四碗，日三服，夜一服。
温斑三日，犹然骨痛，胸痛，咽痛，肢厥，未张之秽热尚多，清窍皆见火疮，目不欲开
，脉
弦数而不洪，口干燥而不渴。邪毒深居血分，虽有药可治，恐高年有限之阴精，不足当此燎
原之势，又恐不能担延十数日之久，刻下趁其尚在上焦，频频进药，速速清阳。再以芳香透
络逐秽，俾邪不入中下焦，可以望愈。
约二时间服紫雪丹二分，宣泄血络之秽毒。
连翘（一钱） 银花（一钱） 犀角（五分） 薄荷（三分） 牛蒡子（一钱，炒研） 丹皮（五
分）
人中黄（三分） 桔梗（一钱） 白茅根（五分） 元参（一钱） 郁金（四分） 藿香梗（五分） 炒
黄芩（三分） 芥穗（三分） 马勃（三分） 苇根（五分） 射干（五分）
周十二时八帖。
照前方加金汁五匙，仍周十二时服八帖。
照前方加犀角三分，黄连三分，炒枯，仍周十二时八帖。
邪有渐化之机，但心火炽盛，阴精枯而被烁，当两济之。
犀角（一两，先煎） 银花（六钱） 生白芍（六钱） 细生地（八钱） 连翘（六钱） 麦冬（
一两
，连心） 黄连（四钱，先煎） 丹皮（一两） 生甘草（四钱） 白茅根（五钱） 鲜荷叶（四钱）
煮成四碗，分四次服。
仍用前药一帖，先煮半帖，约八分二杯，除先服昨日余药一碗外，晚间服此二碗，余药
明早煮成，缓缓服之。
如前日法，邪去八九，收阴中兼清肺胃血分之热而护津液。
生白芍（六钱） 大生地（一两） 沙参（三钱） 炙草（三钱） 柏子霜（三钱） 火麻仁（
三钱） 麦冬（八钱） 白茅根（五钱）
八分三杯，三次服。
里热甚，胸闷骨痛，必须补阴而不宜呆腻。
生白芍（四钱） 沙苑子（二钱） 细生地（五钱） 沙参（三钱） 麦冬（五钱） 柏子霜（三
钱） 冰糖（二钱） 广皮炭（钱半）
王 三十八岁 五月初十日 温热系手太阴病，何得妄用足六经表药九帖之多。即以《
伤寒
论》自开辟以来，亦未有如是之发表者。且柴胡为少阳提线，经谓少阳为枢，最能开转三阳
者。今数数用之，升提太过，不至于上厥下竭不止。汗为心液，屡发不已，既伤心用之阳，
又伤心体之阴，其势必神明内乱，不至于谵语颠狂不止也。今且救药逆，治病亦在其中。温
病大例四损重逆难治。何谓四损？一曰老年真阳已衰，下虚阴竭；一曰婴儿稚阴稚阳未充；
一曰产妇大行血后，血舍空虚，邪易乘虚而入；一曰病久阴阳两伤。何谓重逆？《玉函经》
谓∶一逆尚引日，再逆促命期。今犯逆药至九帖之多，岂止重逆哉！
连翘（三钱） 银花（三钱） 薄荷（八分） 麦冬（八钱） 丹皮（五钱） 桑叶（三钱） 元参
（五钱） 细生地（五钱） 羚羊角（三钱）
辛凉芳香甘寒法，辛凉解肌分发越太过之阳，甘寒定骚扰复丧失之阴，芳香护膻中，定
神明之内乱。
十一日 过服辛温，汗出不止，神明内乱，谵语多笑，心气受伤，邪气乘之，法当治以
芳香。
紫雪丹（五钱） 每服一钱。其汤药仍服前方，日二帖。
十二日 《灵枢》温热论曰∶狂言失志者死。况加以肢厥，冷过肘膝，脉厥六部全无，
皆大
用表药，误伤心阳，致厥阴包络受伤之深如是。现下危急之秋，只有香开内窍，使锢蔽之邪
，一齐涌出方妙。且喜舌苔之板者已化，微有渴意，若得大渴，邪气还表，脉出身热，方是
转机。即于前方内加犀角三钱，如谵语甚，约二时辰，再服紫雪丹一钱。
十三日 肢厥脉厥俱有渐回之象，仍服前方二帖。晚间再服紫雪丹一钱，牛黄丸一粒。
明早有谵语，仍服紫雪丹一钱，不然不必服。
十四日 厥虽回而哕，目白睛，面色犹赤。
连翘（二钱） 元参（五钱） 丹皮（三钱） 银花（二钱） 麦冬（五钱） 犀角（一钱） 细生
地（五钱） 石膏（三钱） 羚羊角（三钱）
今晚一帖，明早一帖。
十五日 即于前方内加∶
柿蒂（六钱） 黄芩（二钱） 郁金（三钱）
日二帖。
十六日 诸症悉减，但舌起新苔，当防其复。
连翘（二钱） 元参（三钱） 丹皮（二钱） 银花（二钱） 麦冬（三钱） 犀角（五分） 黄芩
（二钱） 郁金（二钱） 牛蒡子（二钱） 柿蒂（二钱） 细生地（三钱）
今晚一帖，明早一帖。
谢 五月初三日 酒客脉象模糊，苔如积粉，胸中郁闷，病势十分深重，再舌苔刮白，
大便昼夜十数下，不惟温热，且兼浊湿，岂伤寒六经药可治。
连翘（钱半） 滑石（三钱） 郁金（二钱） 银花（二钱） 藿香（二钱） 生苡仁（三钱） 杏
仁（三钱） 黄连（钱半） 豆豉（二钱） 薄荷（一钱）
今晚一帖，明早一帖。
初四日 温病始终以护津液为主，不比伤寒以通阳气为主。
连翘（三钱） 黄芩（二钱） 桑叶（三钱） 甘草（八分） 麦冬（五钱） 银花（三钱） 薄荷
（一钱） 豆豉（二钱） 黄连（二钱） 滑石（三钱）
今晚一帖，明早一帖。
初五日 旧苔已退，新苔又出，邪之所藏者尚多。脉象之模糊者，较前稍觉光明。
连翘（三钱） 麦冬（四钱） 通草（八分） 银花（三钱） 薄荷（八分） 天花粉（三钱） 桑
叶（
二钱） 滑石（三钱） 黄芩（二钱） 杏仁（三钱） 藿香叶（八分） 黄连（二钱） 鲜芦根（三钱
）
初六日 脉洪，舌滑而中心灰黑，余皆刮白，湿中秽浊，须重用芳香。
连翘（三钱） 荷叶边（二钱） 豆豉（三钱） 银花（二钱） 通草（钱半） 郁金（三钱） 薄
荷（一钱） 滑石（五钱） 藿香（三钱） 黄芩（二钱） 芦根（五钱） 黄连（三钱）
今晚一帖，明早一帖。
初七日 温病已有凉汗，但脉尚数而协热下利不止。议白头翁汤法。
白头翁（五钱） 生白芍（二钱） 秦皮（三钱） 黄芩（三钱） 黄连（三钱）
初八日 热邪虽退，而脉仍未静，尚有余热未清。大泄十余日，大汗一昼夜，津液丧亡
已多
，不可强责小便。再胃之上脘痛，有责之阳衰者，有责之痰饮者，有责之液伤者。兹当热邪
大伤津液之后，脉尚未静，犹然自觉痰粘，断不得作阳衰论。且阳衰胸痹之痛，不必咽津
而后痛也。与甘苦合化阴气法，既可以保胃汁，又可以蓄水之上源，得天水循环，水天一气
，自然畅流。
麦冬（六钱） 炙草（三钱） 大生地（五钱） 火麻仁（三钱） 生牡蛎（五钱） 黄连（一
钱） 炒黄芩（一钱） 沙参（三钱） 象贝母（二钱）
煮三碗，三次服。渣煮一碗，明早服。
初九日 即于前方内加∶
丹皮（三钱） 赤芍（三钱）
初十日 肺脉独大，仍渴思凉。
连翘（三钱） 知母（二钱） 银花（三钱） 桑叶（三钱） 黄芩（二钱） 杏仁（三钱） 生甘
草（一钱） 石膏（三钱）
今晚一帖，明早一帖。
十一日 左关独大，仍喜凉物，余热未清，小便赤，用苦甘法。
黄连（一钱） 知母（二钱） 黄芩（二钱） 生草（一钱） 丹皮（五钱） 细生地（二钱） 桑
叶（三钱） 赤芍（二钱） 木通（二钱） 麦冬（二钱）
今晚一帖，明早一帖。
长氏 二十二岁 温热发疹，系木火有余之证，焉有可用足三阳经之羌防柴葛，诛伐无
过之理，举世不知，其如人命何？议辛凉达表，非直攻表也∶芳香透络。非香燥也。
初四日
连翘（六钱） 银花（八钱） 薄荷（三钱） 桔梗（五钱） 元参（六钱） 生草（二钱） 牛蒡
子（五钱） 黄芩（三钱） 桑叶（三钱）
为粗末，分六包，一时许服一包，芦根汤煎。
初五日 温毒脉象模糊，舌黄喉痹，胸闷渴甚。议时时轻扬，勿令邪聚方妙。
连翘（八钱） 银花（一两） 薄荷（三钱） 元参（一两） 射干（三钱） 人中黄（三钱） 黄
连（
三钱） 牛蒡子（一两） 黄芩（三钱） 桔梗（一两） 生石膏（一两） 郁金（三钱） 杏仁（五钱
）马勃（三钱）
共为粗末，分十二包，约一时服一包，芦根汤煎。
初六日 舌苔老黄，舌肉甚绛，脉沉壮热，夜间谵语，烦躁面赤，口干唇燥，喜凉饮。
议急下以存津液法，用大承气减枳朴辛药，加增液润法。
生大黄（八钱） 元明粉（四钱） 浓朴（三钱） 枳实（三钱） 元参（三钱） 麦冬（五钱）
细生地（五钱）
煮三杯，先服一杯，得快便止后服，不便或不快，进第二杯，约三时不便，进第三杯。
初七日 其势已杀，其焰未平，下后护阴为主，用甘苦化阴。
细生地（八钱） 黄芩（二钱） 元参（三钱） 生草（一钱） 丹皮（五钱） 麦冬（六钱） 黄
连（钱半）
煮三杯，分三次服。渣煮一杯，明早服。
初八日 脉浮邪气还表，下行极而上也。即于前方内加∶
连翘（三钱） 银花（三钱） 去黄连
初九日 脉仍数，余焰未息，口仍微渴，少用玉女煎法，两解气血伏热。
细生地 生甘草 麦冬 连翘 元参 银花 生石膏 知母
各等分，服法如前。
初十日 脉沉微数，自觉心中躁，腹中不爽，舌上老黄苔，二日不大便，议小承气汤微
和之。
生大黄（三钱） 浓朴（三钱） 枳实（二钱）
水五杯，煮二杯，先服一杯，得利止后服，不快再服。
赵 七十岁 五月十二日 温病之例，四损重逆为难治。今年老久病之后，已居四损之
二。况初起见厥，病入已深。再温病不畏其大渴，引饮思凉，最畏其不渴。盖渴乃气分之病，不
渴则归血分。此皆年老藩篱已撤，邪气直入下焦之故。勉议清血分之热，加以领邪外出法。
丹皮（二钱） 细生地（二钱） 连翘（二钱） 郁金（二钱） 桔梗（一钱） 羚羊角（钱半）
甘草（五分） 桑叶（一钱） 银花（一钱） 麦冬（一钱） 茶菊花（一钱） 薄荷（八分）
日三帖，渣不再煎。
十三日 今日厥轻，但老年下虚，邪居血分，不肯外出，可畏，用辛凉合芳香法。
连翘（三钱） 牛蒡子（三钱） 藿香（钱半） 元参（三钱） 豆豉（三钱） 薄荷（八分） 银
花
十四日 六脉沉数而实，四日不大便，汗不得除，舌苔微黄，老年下虚，不可轻下。然
热病之热退，每在里气既通以后。议增液汤，作增水行舟之计。
元参（二两） 细生地（一两） 栀子炭（六钱） 丹皮（六钱） 麦冬（一两） 牛蒡子（八钱）
水八碗，煮三碗，三次服，均于今晚服尽，明早再将渣煮一碗服。
十五日 仍未大便，酌加去积聚之润药，即于前方内加∶
元参（一两） 细生地（一两）
十六日 脉已滑，渴稍加，汗甚多，邪有欲出之势，但仍未大便，犹不能外增液法，少
入玉女煎可也。既可润肠，又可保护老年有限津液，不比壮年可放心攻劫也。
元参（三两） 知母（三钱） 细生地（二两） 麦冬（一两） 生甘草（二钱） 生石膏（一两）
银花（六钱） 连翘（五钱）
十七日 渴更甚，加以保肺为急，即于前方内加∶
黄芩（三钱） 生石膏（一两） 知母（二钱）
十八日 大便已见，舌苔未净，脉尚带数，不甚渴，仍清血分为主，复领邪法。
麦冬（三钱） 生甘草（二钱） 细生地（一两） 元参（五钱） 丹皮（六钱） 银花（三钱）
连翘（三钱） 黄芩（二钱）
煮三碗，三次服。
苗 十七岁 初一日 温热本木火有余之病。无奈世人不识四时，乃以治冬日之羌防柴
葛治之
城为要。
麦冬（一两，连心） 生石膏（六钱） 元参心（六钱） 犀角（五分） 莲子心（一两） 竹叶
心（三钱） 细生地（五钱） 黄连（二钱） 连翘（五钱，连心） 丹皮（五钱） 勾藤勾（三钱）
再按∶痉厥神昏，故以清宫为主。血分太热脉极数，故以地黄汤犀角为佐。邪气在血分
虽多
一辙，其势不得不用复方也，煮成三碗，分三次服。明日渣再煮半碗服。
初二日 诸证俱减而未尽除，脉之至数亦减。但老年下虚，咳声不满喉咙，可畏之至。
议搜邪之中，寓补阴和阳之用。
麦冬（二两，连心） 丹皮（八钱） 黄芩（三钱） 黄连（二钱） 连翘（三钱） 生石膏（一
两） 细生地（一两） 大生地（一两） 犀角（五钱）
初三日 脉证虽减，犹在险途。
大生地（一两） 黄连（二钱） 犀角（五钱） 黄芩（三钱） 细生地（一两） 麦冬（二两）
丹皮（六钱） 连翘（三钱） 焦白芍（五钱） 熟石膏（五钱）
初四日 神识略清，脉洪数有力，周身尽赤若斑，大便大频，用玉女煎加苦以坚阴。今
[Patient Zhang, 70 years old] Warm-heat pathogen causes macules on the skin and sore throat.
Prescription: Raw Gypsum (Shi Gao, 1 liang), Zhong Ren Huang (2 qian), Bitter Platycodon Root (Jie Geng, 6 qian), Anemarrhena Rhizome (Zhi Mu, 4 qian), Belamcanda Rhizome (She Gan, 3 qian), Schizonepeta Spike (Jie Sui, 2 qian).
Decoction method: Decoct Reed Rhizome (Wei Gen) and Imperata Rhizome (Bai Mao Gen) to make a soup, then decoct the above herbs in this soup to yield four bowls of liquid. Take three times during the day and once at night.
After three days of warm-macule disease, there is still bone pain, chest pain, sore throat, cold limbs, much latent turbid heat not yet vented, fire sores visible in the orifices (eyes, ears, nose, mouth), unwillingness to open eyes, pulse is wiry and rapid but not surging, mouth is dry but not thirsty. The evil toxin resides deeply in the blood level. Although treatable with medicine, it is feared that the limited Yin essence of this elderly patient cannot withstand the raging momentum of the pathogen; furthermore, it is feared the condition cannot last for more than ten days. Currently, taking advantage of the pathogen still being in the Upper Jiao, administer medicine frequently to quickly clear Yang-level heat. Then use aromatic substances to penetrate collaterals and expel turbidity, preventing the pathogen from entering the Middle and Lower Jiao, thus offering hope for recovery.
Approximately two hours later, take Zi Xue Dan (Purple Snow Pill) 2 fen to vent turbid toxins in the blood collaterals.
Prescription: Forsythia Fruit (Lian Qiao, 1 qian), Honeysuckle Flower (Yin Hua, 1 qian), Rhinoceros Horn (Xi Jiao, 5 fen), Mint Leaf (Bo He, 3 fen), Arisaema Bulb (Niu Bang Zi, 1 qian, stir-fried and crushed), Moutan Bark (Dan Pi, 5 fen), Zhong Ren Huang (3 fen), Platycodon Root (Jie Geng, 1 qian), Imperata Rhizome (Bai Mao Gen, 5 fen), Scrophularia Root (Yuan Shen, 1 qian), Curcuma Tuber (Yu Jin, 4 fen), Pogostemon Stem (Huo Xiang Geng, 5 fen), Stir-fried Scutellaria Root (Huang Qin, 3 fen), Schizonepeta Spike (Jie Sui, 3 fen), Pilewort Flower (Ma Bo, 3 fen), Reed Rhizome (Wei Gen, 5 fen), Belamcanda Rhizome (She Gan, 5 fen).
Take eight doses over twelve hours (Zhou Shi Er Shi).
Add five spoons of Jin Zhi (Human Excrement Juice) to the previous prescription, still taken over twelve hours for eight doses.
Add 3 fen of Xi Jiao and 3 fen of Huang Lian (stir-fried until charred) to the previous prescription, still taken over twelve hours for eight doses.
The pathogen shows signs of gradual resolution, but Heart Fire is blazing, and Yin essence is withered and scorched. Both should be nourished simultaneously.
Prescription: Rhinoceros Horn (Xi Jiao, 1 liang, decocted first), Honeysuckle Flower (Yin Hua, 6 qian), Raw White Peony Root (Sheng Bai Shao, 6 qian), Fine Rehmannia Root (Xi Sheng Di, 8 qian), Forsythia Fruit (Lian Qiao, 6 qian), Ophiopogon Tuber (Mai Dong, 1 liang, with heart), Coptis Rhizome (Huang Lian, 4 qian, decocted first), Moutan Bark (Dan Pi, 1 liang), Raw Licorice Root (Sheng Gan Cao, 4 qian), Imperata Rhizome (Bai Mao Gen, 5 qian), Fresh Lotus Leaf (Xian He Ye, 4 qian).
Decoct into four bowls, divide into four servings.
Still use one dose of the previous medicine, decoct half a dose first, yielding approximately two-eighths of a cup. Besides the one bowl of leftover medicine from yesterday taken earlier, take these two bowls in the evening. The remaining medicine will be decocted tomorrow morning and taken slowly.
Following the method of previous days, as the pathogen is cleared by eighty to ninety percent, focus on collecting Yin while clearing Heat in the Lung, Stomach, and Blood levels to protect Fluids.
Prescription: Raw White Peony Root (Sheng Bai Shao, 6 qian), Large Rehmannia Root (Da Sheng Di, 1 liang), Glehnia Root (Sha Shen, 3 qian), Honey-fried Licorice Root (Zhi Cao, 3 qian), Biota Seed (Bai Zi Shuang), Hemp Seed (Huo Ma Ren, 3 qian), Ophiopogon Tuber (Mai Dong, 8 qian), Imperata Rhizome (Bai Mao Gen, 5 qian).
Decoct to yield two-eighths of a cup, divide into three servings.
Interior Heat is severe, with chest tightness and bone pain. Must tonify Yin without using cloying or stagnant substances.
Prescription: Raw White Peony Root (Sheng Bai Shao, 4 qian), Astragalus Complanatus Seed (Sha Yuan Zi, 2 qian), Fine Rehmannia Root (Xi Sheng Di, 5 qian), Glehnia Root (Sha Shen, 3 qian), Ophiopogon Tuber (Mai Dong, 5 qian), Biota Seed (Bai Zi Shuang, 3 qian), Rock Sugar (Bing Tang, 2 qian), Charred Tangerine Peel (Guang Pi Tan, 1.5 qian).
[Patient Wang, 38 years old, May 10th] Warm-heat disease belongs to the Hand-Taiyin Lung meridian. Why were nine doses of foot Six Meridian exterior-releasing medicines used recklessly? Even since the compilation of *Shanghan Lun*, there has never been such excessive exterior-releasing treatment. Moreover, Chai Hu is the guiding herb for Shaoyang; the Classics state Shaoyang is the pivot, best able to regulate the Three Yang meridians. Using it repeatedly causes excessive ascending and lifting, leading to upper collapse and lower exhaustion. Sweat is the fluid of the Heart. Repeated sweating damages both the Yang function and the Yin substance of the Heart. The inevitable result is internal chaos of the Spirit (Shen Ming), leading to delirious speech and madness. Now, we must correct the medicinal error; treating the disease is included within this correction. In warm diseases, "Four Damages" (Si Sun) and "Severe Reversal" (Zhong Ni) are difficult to treat. What are the Four Damages? 1. Elderly people with depleted True Yang, lower deficiency and Yin exhaustion; 2. Infants with unfulfilled tender Yin and Yang; 3. Postpartum women after heavy blood loss, where the Blood residence is empty, allowing pathogens to enter easily; 4. Chronic illness causing Yin and Yang dual injury. What is Severe Reversal? *Yuhan Jing* states: "One reversal may prolong life, a second reversal hastens death." Committing reversal errors with nine doses of medicine is far worse than just severe reversal!
Prescription: Forsythia Fruit (Lian Qiao, 3 qian), Honeysuckle Flower (Yin Hua, 3 qian), Mint Leaf (Bo He, 8 fen), Ophiopogon Tuber (Mai Dong, 8 qian), Moutan Bark (Dan Pi, 5 qian), Mulberry Leaf (Sang Ye, 3 qian), Scrophularia Root (Yuan Shen, 5 qian), Fine Rehmannia Root (Xi Sheng Di, 5 qian), Antelope Horn (Ling Yang Jiao, 3 qian).
Method: Acrid-Cool, Aromatic, Sweet-Cold. Acrid-cool releases muscle layer and disperses excessive Yang; Sweet-cold stabilizes the disturbed and lost Yin; Aromatic protects the Pericardium (Tan Zhong) and calms internal chaos of the Spirit.
[11th Day] Overuse of Acrid-Warm medicines caused incessant sweating, internal chaos of the Spirit, delirious speech and laughter. Heart Qi is injured, and pathogens exploit this weakness. Treatment should employ Aromatic methods.
Prescription: Zi Xue Dan (Purple Snow Pill, 5 qian), take 1 qian per dose. Continue the previous herbal decoction, two doses per day.
[12th Day] *Ling Shu: Wen Re Lun* states: "Delirious speech and loss of memory indicate death." Especially with cold limbs, cold past elbows and knees, and absent pulses in all six positions. This deep injury to the Jueyin Pericardium resulted from massive use of exterior-releasing medicines mistakenly damaging Heart Yang. In this critical moment, only aromatic opening of inner orifices can force the trapped pathogens out. Fortunately, the stiff tongue coating has transformed, and there is slight thirst. If great thirst develops, indicating pathogen returning to the exterior, with pulse emergence and fever, this would be a turning point. Add 3 qian of Xi Jiao to the previous prescription. If delirium is severe, take 1 qian of Zi Xue Dan after approximately two shichen (hours).
[13th Day] Cold limbs and pulse absence show signs of gradual return. Continue two doses of the previous prescription. Take 1 qian of Zi Xue Dan and one pill of Niu Huang Wan (Calculus Bovis Pill) in the evening.
If delirium occurs the next morning, take 1 qian of Zi Xue Dan; otherwise, do not take it.
[14th Day] Although cold limbs have resolved, hiccups appear, sclera changes color, and complexion remains red.
Prescription: Forsythia Fruit (Lian Qiao, 2 qian), Scrophularia Root (Yuan Shen, 5 qian), Moutan Bark (Dan Pi, 3 qian), Honeysuckle Flower (Yin Hua, 2 qian), Ophiopogon Tuber (Mai Dong, 5 qian), Rhinoceros Horn (Xi Jiao, 1 qian), Fine Rehmannia Root (Xi Sheng Di, 5 qian), Gypsum (Shi Gao, 3 qian), Antelope Horn (Ling Yang Jiao, 3 qian).
One dose tonight, one dose tomorrow morning.
[15th Day] Add to the previous prescription:
Persimmon Calyx (Shi Di, 6 qian), Scutellaria Root (Huang Qin, 2 qian), Curcuma Tuber (Yu Jin, 3 qian).
Two doses per day.
[16th Day] All symptoms decreased, but new tongue coating appeared. Prevent recurrence.
Prescription: Forsythia Fruit (Lian Qiao, 2 qian), Scrophularia Root (Yuan Shen, 3 qian), Moutan Bark (Dan Pi, 2 qian), Honeysuckle Flower (Yin Hua, 2 qian), Ophiopogon Tuber (Mai Dong, 3 qian), Rhinoceros Horn (Xi Jiao, 5 fen), Scutellaria Root (Huang Qin, 2 qian), Curcuma Tuber (Yu Jin, 2 qian), Arisaema Bulb (Niu Bang Zi, 2 qian), Persimmon Calyx (Shi Di, 2 qian), Fine Rehmannia Root (Xi Sheng Di, 3 qian).
One dose tonight, one dose tomorrow morning.
[Patient Xie, May 3rd] A wine drinker presents with vague pulse, tongue coating like accumulated powder, chest oppression, and severe disease progression. Scraping the tongue reveals white underneath. Bowel movements occur ten-plus times day and night. This is not only warm-heat but also mixed with turbid dampness. How can Shaohang Six Meridian medicines treat this?
Prescription: Forsythia Fruit (Lian Qiao, 1.5 qian), Talcum (Hua Shi, 3 qian), Curcuma Tuber (Yu Jin, 2 qian), Honeysuckle Flower (Yin Hua, 2 qian), Pogostemon Herb (Huo Xiang, 2 qian), Raw Coix Seed (Sheng Yi Ren, 3 qian), Apricot Seed (Xing Ren, 3 qian), Coptis Rhizome (Huang Lian, 1.5 qian), Fermented Soybean (Dou Chi, 2 qian), Mint Leaf (Bo He, 1 qian).
One dose tonight, one dose tomorrow morning.
[4th Day] Warm-heat disease always prioritizes protecting Fluids, unlike Shaohang which prioritizes unblocking Yang Qi.
Prescription: Forsythia Fruit (Lian Qiao, 3 qian), Scutellaria Root (Huang Qin, 2 qian), Mulberry Leaf (Sang Ye, 3 qian), Licorice Root (Gan Cao, 8 fen), Ophiopogon Tuber (Mai Dong, 5 qian), Honeysuckle Flower (Yin Hua, 3 qian), Mint Leaf (Bo He, 1 qian), Fermented Soybean (Dou Chi, 2 qian), Coptis Rhizome (Huang Lian, 2 qian), Talcum (Hua Shi, 3 qian).
One dose tonight, one dose tomorrow morning.
[5th Day] Old coating has receded, new coating appears; much pathogen remains hidden. The vague pulse feels slightly clearer than before.
Prescription: Forsythia Fruit (Lian Qiao, 3 qian), Ophiopogon Tuber (Mai Dong, 4 qian), Akebia Caulis (Tong Cao, 8 fen), Honeysuckle Flower (Yin Hua, 3 qian), Mint Leaf (Bo He, 8 fen), Trichosanthes Root (Tian Hua Fen, 3 qian), Mulberry Leaf (Sang Ye, 2 qian), Talcum (Hua Shi, 3 qian), Scutellaria Root (Huang Qin, 2 qian), Apricot Seed (Xing Ren, 3 qian), Pogostemon Leaf (Huo Xiang Ye, 8 fen), Coptis Rhizome (Huang Lian, 2 qian), Fresh Reed Rhizome (Xian Lu Gen, 3 qian).
[6th Day] Pulse is surging, tongue is slippery with gray-black center, other parts white when scraped. Dampness mixed with turbid foulness requires heavy use of aromatic substances.
Prescription: Forsythia Fruit (Lian Qiao, 3 qian), Lotus Leaf Edge (He Ye Bian, 2 qian), Fermented Soybean (Dou Chi, 3 qian), Honeysuckle Flower (Yin Hua, 2 qian), Akebia Caulis (Tong Cao, 1.5 qian), Curcuma Tuber (Yu Jin, 3 qian), Mint Leaf (Bo He, 1 qian), Talcum (Hua Shi, 5 qian), Pogostemon Herb (Huo Xiang, 3 qian), Scutellaria Root (Huang Qin, 2 qian), Reed Rhizome (Lu Gen, 5 qian), Coptis Rhizome (Huang Lian, 3 qian).
One dose tonight, one dose tomorrow morning.
[7th Day] Warm-heat disease now presents with cool sweat, but pulse is still rapid with heat-associated diarrhea. Propose Ba Tou Weng Tang method.
Prescription: Pulsatilla Root (Bai Tou Weng, 5 qian), Raw White Peony Root (Sheng Bai Shao, 2 qian), Birch Bark (Qin Pi, 3 qian), Scutellaria Root (Huang Qin, 3 qian), Coptis Rhizome (Huang Lian, 3 qian).
[8th Day] Heat pathogen has retreated, but pulse is not yet calm, residual heat remains. After more than ten days of severe diarrhea and one day/night of profuse sweating, Fluids are largely lost. Do not forcefully promote urination. Furthermore, pain in the upper stomach (epigastrium) is attributed by some to Yang deficiency, others to Phlegm-Fluid, others to Fluid injury. Given the recent massive damage to Fluids by Heat, and the unsettled pulse with sensation of sticky phlegm, it cannot be diagnosed as Yang deficiency. Yang deficiency chest bi pain does not require swallowing saliva to trigger pain. Use Sweet-Bitter method to transform Yin Qi. This preserves Gastric Juice and acts as the source of Water storage, creating a cycle of Heaven and Earth water, ensuring natural flow.
Prescription: Ophiopogon Tuber (Mai Dong, 6 qian), Honey-fried Licorice Root (Zhi Cao, 3 qian), Large Rehmannia Root (Da Sheng Di, 5 qian), Hemp Seed (Huo Ma Ren, 3 qian), Raw Oyster Shell (Sheng Mu Li, 5 qian), Coptis Rhizome (Huang Lian, 1 qian), Stir-fried Scutellaria Root (Chao Huang Qin, 1 qian), Glehnia Root (Sha Shen, 3 qian), Fritillaria Thunbergii Bulb (Xiang Bei Mu, 2 qian).
Decoct into three bowls, take three times. Decoct residue into one bowl, take tomorrow morning.
[9th Day] Add to previous prescription:
Moutan Bark (Dan Pi, 3 qian), Red Peony Root (Chi Shao, 3 qian).
[10th Day] Lung pulse is uniquely large, still thirsty for cool drinks.
Prescription: Forsythia Fruit (Lian Qiao, 3 qian), Anemarrhena Rhizome (Zhi Mu, 2 qian), Honeysuckle Flower (Yin Hua, 3 qian), Mulberry Leaf (Sang Ye, 3 qian), Scutellaria Root (Huang Qin, 2 qian), Apricot Seed (Xing Ren, 3 qian), Raw Licorice Root (Sheng Gan Cao, 1 qian), Gypsum (Shi Gao, 3 qian).
One dose tonight, one dose tomorrow morning.
[11th Day] Left Guan pulse is uniquely large, still prefers cool items, residual heat not cleared, urine is red. Use Bitter-Sweet method.
Prescription: Coptis Rhizome (Huang Lian, 1 qian), Anemarrhena Rhizome (Zhi Mu, 2 qian), Scutellaria Root (Huang Qin, 2 qian), Raw Licorice Root (Sheng Cao, 1 qian), Moutan Bark (Dan Pi, 5 qian), Fine Rehmannia Root (Xi Sheng Di, 2 qian), Mulberry Leaf (Sang Ye, 3 qian), Red Peony Root (Chi Shao, 2 qian), Wood Betony Caulis (Mu Tong, 2 qian), Ophiopogon Tuber (Mai Dong, 2 qian).
One dose tonight, one dose tomorrow morning.
[Patient Chang, 22 years old] Warm-heat disease with rash indicates excess Wood-Fire. How could one use Yang Huo, Fang Feng, Chai Hu, Ge Gen of the Foot Three Yang meridians? This punishes the innocent. The world does not understand this, what about human lives? Propose Acrid-Cool to reach the exterior, not direct attack; Aromatic to penetrate collaterals, not aromatic-dryness.
[4th Day]
Prescription: Forsythia Fruit (Lian Qiao, 6 qian), Honeysuckle Flower (Yin Hua, 8 qian), Mint Leaf (Bo He, 3 qian), Platycodon Root (Jie Geng, 5 qian), Scrophularia Root (Yuan Shen, 6 qian), Raw Licorice Root (Sheng Cao, 2 qian), Arisaema Bulb (Niu Bang Zi, 5 qian), Scutellaria Root (Huang Qin, 3 qian), Mulberry Leaf (Sang Ye, 3 qian).
Grind to coarse powder, divide into six packs. Take one pack every hour, decoct with Reed Rhizome soup.
[5th Day] Warm-toxin presents with vague pulse, yellow tongue, throat obstruction, chest tightness, severe thirst. Propose frequent light dispersal to prevent pathogen aggregation.
Prescription: Forsythia Fruit (Lian Qiao, 8 qian), Honeysuckle Flower (Yin Hua, 1 liang), Mint Leaf (Bo He, 3 qian), Scrophularia Root (Yuan Shen, 1 liang), Belamcanda Rhizome (She Gan, 3 qian), Zhong Ren Huang (3 qian), Coptis Rhizome (Huang Lian, 3 qian), Arisaema Bulb (Niu Bang Zi, 1 liang), Scutellaria Root (Huang Qin, 3 qian), Platycodon Root (Jie Geng, 1 liang), Raw Gypsum (Sheng Shi Gao, 1 liang), Curcuma Tuber (Yu Jin, 3 qian), Apricot Seed (Xing Ren, 5 qian), Pilewort Flower (Ma Bo, 3 qian).
Grind to coarse powder, divide into twelve packs. Take one pack every hour, decoct with Reed Rhizome soup.
[6th Day] Tongue coating is old yellow, tongue flesh is very crimson, pulse is deep with high fever, nighttime delirium, irritability, red face, dry mouth/lips, prefers cool drinks.
Propose urgent purgation to preserve Fluids. Use Da Cheng Qi Tang minus Zhi Shi and Hou Po (acrid substances), add Zeng Ye (Increase Fluids) moistening method.
Prescription: Raw Rhubarb (Sheng Da Huang, 8 qian), Mirabilite (Yuan Ming Fen, 4 qian), Magnolia Bark (Nong Po, 3 qian), Immature Bitter Orange (Zhi Shi, 3 qian), Scrophularia Root (Yuan Shen, 3 qian), Ophiopogon Tuber (Mai Dong, 5 qian), Fine Rehmannia Root (Xi Sheng Di, 5 qian).
Decoct into three cups. Take one cup first; stop if loose stool occurs. If no stool or discomfort, take second cup. If no stool after three hours, take third cup.
[7th Day] Momentum has subsided, but flames remain. Post-purgation focuses on protecting Yin using Sweet-Bitter Yin transformation.
Prescription: Fine Rehmannia Root (Xi Sheng Di, 8 qian), Scutellaria Root (Huang Qin, 2 qian), Scrophularia Root (Yuan Shen, 3 qian), Raw Licorice Root (Sheng Cao, 1 qian), Moutan Bark (Dan Pi, 5 qian), Ophiopogon Tuber (Mai Dong, 6 qian), Coptis Rhizome (Huang Lian, 1.5 qian).
Decoct into three cups, take three times. Decoct residue into one cup, take tomorrow morning.
[8th Day] Floating pulse indicates pathogen returning to exterior. "Descending to extreme, it ascends." Add to previous prescription:
Forsythia Fruit (Lian Qiao, 3 qian), Honeysuckle Flower (Yin Hua, 3 qian). Remove Huang Lian.
[9th Day] Pulse remains rapid, residual heat lingers, slight thirst persists. Use small amount of Yu Nu Jian method to resolve latent Heat in Qi and Blood levels.
Prescription: Fine Rehmannia Root, Raw Licorice Root, Ophiopogon Tuber, Forsythia Fruit, Scrophularia Root, Honeysuckle Flower, Raw Gypsum, Anemarrhena Rhizome.
Equal parts, take as before.
[10th Day] Pulse is deep, faint, and rapid. Patient feels internal restlessness, abdominal discomfort, old yellow tongue coating, no bowel movement for two days. Propose Xiao Cheng Qi Tang to gently harmonize.
Prescription: Raw Rhubarb (Sheng Da Huang, 3 qian), Magnolia Bark (Nong Po, 3 qian), Immature Bitter Orange (Zhi Shi, 2 qian).
Five cups of water, decoct to two cups. Take one cup first; stop if stool passes. If uncomfortable, take again.
[Patient Zhao, 70 years old, May 12th] In warm diseases, "Four Damages" and "Severe Reversal" are difficult to treat. Being elderly and chronically ill, he already suffers from two of the Four Damages. Initial cold limbs indicate deep pathogen entry. Warm diseases fear lack of thirst more than great thirst. Thirst indicates Qi-level disease; lack of thirst indicates Blood-level involvement. This is due to elderly patients having weakened defenses, allowing pathogens to enter directly into the Lower Jiao. Tentatively propose clearing Blood-level Heat and guiding pathogen outward.
Prescription: Moutan Bark (Dan Pi, 2 qian), Fine Rehmannia Root (Xi Sheng Di, 2 qian), Forsythia Fruit (Lian Qiao, 2 qian), Curcuma Tuber (Yu Jin, 2 qian), Platycodon Root (Jie Geng, 1 qian), Antelope Horn (Ling Yang Jiao, 1.5 qian), Licorice Root (Gan Cao, 5 fen), Mulberry Leaf (Sang Ye, 1 qian), Honeysuckle Flower (Yin Hua, 1 qian), Ophiopogon Tuber (Mai Dong, 1 qian), Tea Chrysanthemum (Cha Ju Hua, 1 qian), Mint Leaf (Bo He, 8 fen).
Three doses per day, residue not decocted again.
[13th Day] Cold limbs are milder today. However, elderly lower deficiency with pathogen in Blood level refusing to exit is concerning. Use Acrid-Cool combined with Aromatic method.
Prescription: Forsythia Fruit (Lian Qiao, 3 qian), Arisaema Bulb (Niu Bang Zi, 3 qian), Pogostemon Herb (Huo Xiang, 1.5 qian), Scrophularia Root (Yuan Shen, 3 qian), Fermented Soybean (Dou Chi, 3 qian), Mint Leaf (Bo He, 8 fen), Honeysuckle Flower (Yin Hua - dosage omitted in original text).
[14th Day] Six pulses are deep, rapid, and solid. No bowel movement for four days. Sweating did not resolve the issue. Tongue coating is slightly yellow. Elderly lower deficiency precludes mild purgation lightly. However, heat clearance in heat diseases often follows the unblocking of interior Qi. Propose Zeng Ye Tang, employing the strategy of "increasing water to float the boat."
Prescription: Scrophularia Root (Yuan Shen, 2 liang), Fine Rehmannia Root (Xi Sheng Di, 1 liang), Gardenia Charcoal (Zhi Zi Tan, 6 qian), Moutan Bark (Dan Pi, 6 qian), Ophiopogon Tuber (Mai Dong, 1 liang), Arisaema Bulb (Niu Bang Zi, 8 qian).
Eight bowls of water, decoct to three bowls. Take three times, finishing all tonight. Tomorrow morning decoct residue into one bowl and take.
[15th Day] Still no bowel movement. Appropriately add moistening herbs to remove accumulation. Add to previous prescription:
Scrophularia Root (Yuan Shen, 1 liang), Fine Rehmannia Root (Xi Sheng Di, 1 liang).
[16th Day] Pulse is slippery, thirst slightly increased, profuse sweating, pathogen shows tendency to exit. Still no bowel movement. Cannot rely solely on Zeng Ye method; small addition of Yu Nu Jian is acceptable. It moistens intestines and protects limited Fluids of the elderly, unlike young adults who can tolerate aggressive purgation.
Prescription: Scrophularia Root (Yuan Shen, 3 liang), Anemarrhena Rhizome (Zhi Mu, 3 qian), Fine Rehmannia Root (Xi Sheng Di, 2 liang), Ophiopogon Tuber (Mai Dong, 1 liang), Raw Licorice Root (Sheng Gan Cao, 2 qian), Raw Gypsum (Sheng Shi Gao, 1 liang), Honeysuckle Flower (Yin Hua, 6 qian), Forsythia Fruit (Lian Qiao, 5 qian).
[17th Day] Thirst is more severe. Protecting Lung is urgent. Add to previous prescription:
Scutellaria Root (Huang Qin, 3 qian), Raw Gypsum (Sheng Shi Gao, 1 liang), Anemarrhena Rhizome (Zhi Mu, 2 qian).
[18th Day] Bowel movement observed, tongue coating not clean, pulse still slightly rapid, not very thirsty. Continue focusing on clearing Blood level Heat and guiding pathogen outward.
Prescription: Ophiopogon Tuber (Mai Dong, 3 qian), Raw Licorice Root (Sheng Gan Cao, 2 qian), Fine Rehmannia Root (Xi Sheng Di, 1 liang), Scrophularia Root (Yuan Shen, 5 qian), Moutan Bark (Dan Pi, 6 qian), Honeysuckle Flower (Yin Hua, 3 qian), Forsythia Fruit (Lian Qiao, 3 qian), Scutellaria Root (Huang Qin, 2 qian).
Decoct into three bowls, take three times.
[Patient Miao, 17 years old, 1st Day] Warm-heat is inherently a Wood-Fire excess disease. Unfortunately, people ignore the seasons and use winter treatments (Yang Huo, Fang Feng, Chai Hu, Ge Gen), which is narrow-minded.
Prescription: Ophiopogon Tuber (Mai Dong, 1 liang, with heart), Raw Gypsum (Sheng Shi Gao, 6 qian), Scrophularia Heart (Yuan Shen Xin, 6 qian), Rhinoceros Horn (Xi Jiao, 5 fen), Lotus Plumule (Lian Zi Xin, 1 liang), Bamboo Leaf (Zhu Ye Xin, 3 qian), Fine Rehmannia Root (Xi Sheng Di, 5 qian), Coptis Rhizome (Huang Lian, 2 qian), Forsythia Fruit (Lian Qiao, 5 qian, with heart), Moutan Bark (Dan Pi, 5 qian), Uncaria Ramulus (Gou Teng Gou, 3 qian).
Note: Spasm, convulsion, and coma require Qing Gong (Clear Pericardium) as main treatment. Extreme Blood Heat with rapid pulse requires Di Huang Tang and Xi Jiao as assistants. Pathogen in Blood level often requires compound formulas. Decoct into three bowls, take three times. Decoct residue into half bowl tomorrow.
[2nd Day] Symptoms reduced but not eliminated, pulse rate decreased. However, elderly lower deficiency with cough sound not filling the throat is extremely concerning.
Propose searching for pathogen while incorporating Yin tonification and Yang harmonization.
Prescription: Ophiopogon Tuber (Mai Dong, 2 liang, with heart), Moutan Bark (Dan Pi, 8 qian), Scutellaria Root (Huang Qin, 3 qian), Coptis Rhizome (Huang Lian, 2 qian), Forsythia Fruit (Lian Qiao, 3 qian), Raw Gypsum (Sheng Shi Gao, 1 liang), Fine Rehmannia Root (Xi Sheng Di, 1 liang), Large Rehmannia Root (Da Sheng Di, 1 liang), Rhinoceros Horn (Xi Jiao, 5 qian).
[3rd Day] Pulse and symptoms reduced, but still in dangerous territory.
Prescription: Large Rehmannia Root (Da Sheng Di, 1 liang), Coptis Rhizome (Huang Lian, 2 qian), Rhinoceros Horn (Xi Jiao, 5 qian), Scutellaria Root (Huang Qin, 3 qian), Fine Rehmannia Root (Xi Sheng Di, 1 liang), Ophiopogon Tuber (Mai Dong, 2 liang), Moutan Bark (Dan Pi, 6 qian), Forsythia Fruit (Lian Qiao, 3 qian), Stir-fried White Peony Root (Jiao Bai Shao, 5 qian), Calcined Gypsum (Shu Shi Gao, 5 qian).
[4th Day] Consciousness slightly clears, pulse is surging, rapid, and forceful. Whole body red like macules. Frequent bowel movements. Use Yu Nu Jian plus Bitter to firm Yin. Now...