四诊 呕吐嘈杂已止，稍能安谷。特块之攻撑虽定，而不能泯然无形，所以于聚形之处，气分总觉窒
滞。脉象濡细而涩，舌光无苔。良由气阴并亏，肝木之气，与平索之饮气互结。大便两旬未行，亦脾土
不能鼓舞运旋耳。衰羸之症，尚未稳当。
人参须 甜杏仁 整砂仁 金石斛 橘白 半夏曲
云茯苓 白蒺藜 白芍 于术 上徭桂（研末饭丸先服）
五诊 呕恶全定，大便亦行，胃纳渐次加增，聚形已泯然无迹，攻撑亦止，音声稍振。虽属转机之象，但
小溲作酸，脉尚细涩，舌苔薄白而 ，时犹嘈杂。良以中气未复，肝虚撼扰，肾阴亦亏，气化不及州都。大
节恰临，还有意外之虞。
人参须 白归身 浓杜仲 川断肉 炒杞子 姜汁炒大熟地
上徭桂 炒山药 淮小麦 黑大豆 萸肉炭 牛膝炭
六诊 诸恙已退，惟尚有嘈杂之意，谷食较寻常所少无几。然匝月以来，仅能转侧不假于人，而仍未
能起坐，偏左头颊作痛。脉濡而滑，左部细弱，舌淡少华频渴。正合内经谷入多而气少之例，其为血液
衰脱，不及告复，确然可见。仿复脉法。
人参须 大麦冬 火麻仁 上徭桂 牛膝炭 炙甘草
炒杞子 淮小麦 制洋参 炒生地 真阿胶 炮姜炭 萸肉炭
某 伏邪晚发，热甚寒微，经水适来适断，冲脉气阻。夫冲脉起于气街，布散于胸中，此响彼应，遂致中
州痞满，痰湿停聚，哕恶呕吐，自觉中脘之间，似有一团凝结，滴水入口，皆聚于此。心火下降，肾水上升，
水火交通，才得成寐。今中州阻痹，则水火相济之道路，阻隔不通，坎离不接，彻夜不能交睫。脉象滑大
而数，沉取濡软，舌淡红，苔白且 。邪湿痰气，交会中宫，而正气渐虚。所虑神昏发呃。气湿之结，前人谓
非辛不能开，非苦不能降，拟泻心为法。
川连（姜汁炒三分） 制半夏（三钱） 赤白苓（各四钱） 鲜佛手（一钱五分） 淡干姜（四分） 陈皮（一钱）
白蔻仁（七分后入） 大腹皮（二钱） 藿香（三钱） 竹茹（姜汁炒一钱） 生姜（三片）
改方加郁金一钱五分，枳实一钱，石菖蒲五分，玉枢丹三分先调服。
某 口鼻吸受暑邪，内藏于骨髓，外舍于分肉之间，至旬前感触秋凉，内伏之邪，由此而发。不寒但热，
热则懊烦胸闷，索饮瓜水，而口渴仍喜暧饮，纤毫无汗，频带哕恶，中脘板痛，齿垢唇焦。而舌红苔白干
毛，脉象糊数不扬。此邪湿滞交蒸，伏邪欲从外达，而气湿相持于内，所以叠经疏解，而未能作汗。暑必
归心，所以懊烦闷乱。将及转候，深恐内闭神昏，发痉发厥。
杏仁 方通草 炒枳实 薄橘红 九节石菖蒲 白蔻仁
制半夏 香豆豉 广郁金 生薏仁 槟榔 藿香 竹茹 桔梗
改方加川连干姜。
荣（左） 三疟已久，复感暑邪，旬日来热势起伏，初起尚觉微寒，今不寒但热，热甚之时，烦懊不堪，思吃
瓜水以救燎原，而所进汤饮，仍喜暖热，胸闷哕恶频频。脉数糊滑，苔白糙腻异常。汗不畅达。此由暑邪
与湿痰相合，三焦之气，尽行窒塞。痰湿相持于内，则里气不能外通于表，所以不能作汗。湿阻中州，则
为哕恶。暑必为烦，所以懊 不堪。湿与暑相蒸，暑与湿交煽，若不从外达，即从内闭，将至神昏发痉发
厥。急化其里，使蕴遏之湿痰开展，暑邪从湿中外透，是为大幸。
制半夏 蔻仁 川朴 香豆豉 九节石菖蒲 佛手
广藿香 桔梗 知母 广郁金 广皮 草果仁 姜汁炒竹二青 磨槟榔（冲）
二诊 烦闷大减，热之起伏亦得稍衰，哕恶较定，神情亦得爽慧。日前屡屡发厥，自昨至今，厥亦未作，
不可不为转机。但脉数犹带糊细，舌苔大化，白色渐次转黄，近根微霉。湿痰之郁遏稍开，而暑湿相蒸，
何能遽化。上中二焦，犹是邪湿交炽。将及两旬，还恐化燥昏厥之类。请正。
光杏仁 白蔻仁 广橘红 生薏仁 制半夏 赤猪苓
苦桔梗 益元散 川通草 鲜佛手 广郁金 淡黄芩 大腹皮
孙（左） 头痛遽见退轻，而每至热蒸，其痛辄甚，咽中牵腻，频作恶心，窒闷尤甚。脉数糊大。良以暑湿内
蒸，火风随之上旋，肺胃之气，不能开降。病起即发白 ，气分素虚。恐湿热交蒸，致内窜昏厥。再从三焦
宣化，参以清泄。
光杏仁 郁金 制半夏 赤猪苓 鲜佛手 通草 橘红 白蔻仁 淡黄芩 竹茹
改方加防己枇杷叶丝瓜叶西瓜翠衣荷叶梗。
沈（幼） 症起十七朝，热甚于里，屡经汗出，而烦懊不宁，夜甚无寐，小溲数而且多，频渴欲饮。曾发飞浆
赤。舌红苔黄，中心略罩微黑。此由吸受暑邪，邪留气分，虽经表散，而暑乃无形之气，与外感风寒不
同，屡表屡汗，而暑热之气仍然未化，以致气分热迫。一饮一勺，为热所迫，则建瓴而下，所以溲数且多。
暑喜归心，所以暑必为烦。大肠与胃相联续，与肺相表里，肺热下移于肠，则大便泄泻。恐暑邪不化，从
暑化热，从热化火，而动风生惊。拟以轻剂清化。候专家商进。
光杏仁（去尖打三钱） 川石斛（三钱） 水炒竹茹（一钱） 橘红（盐水炒一钱） 益元散（三钱） 黑山栀（三
钱） 肥知母（去毛炒二钱） 大连翘壳（三钱） 朱茯神（三钱） 青竹叶（二十片）
二诊 轻清泄化，热势微轻，懊烦较定，大便通行，并不溏泄，极为正色。但舌苔稍化，而中心仍觉黄 。
暑湿蒸腾于胃，湿蕴为热，肺脉通心，所以时作懊烦。前方已经应手，宜再扩充。候专门名家商用。
川雅连（三分） 光杏仁（一钱五分） 广郁金（一钱五分） 制半夏（一钱五分） 橘红（八分） 益元散（三
钱） 生薏仁（三钱） 黑山栀（二钱） 连翘壳（三钱） 竹叶（十二片）
三诊 大热虽退，余蕴未清，至暮神烦口渴，肢倦发热，热愈甚则小溲愈多。良由暑湿热熏蒸，肺当其
炎，遂令津液不能约束。拟泻火生津法。
川雅连（二分） 天花粉（一钱五分） 藕汁（一酒杯） 活水芦根（八钱）
李（右） 每至下午，辄凛寒而热，热势不扬于外，而甚于里，胸闷中脘痞阻，恶心呕吐，渴不多饮，少腹作
痛。脉数沉郁不扬。咳嗽痰多。苔黄质腻。暑邪夹湿，郁阻气分，肺胃之气，不克下行，开合因而失度。症起
旬日，病邪方盛，恐再转剧。姑开泄气机，以通三焦而致开合。即请商裁。
制半夏（一钱五分） 炒枳实（一钱） 上广皮（一钱） 白蔻仁（五分） 竹茹（一钱） 粉前胡（一钱）
淡干姜（二分） 广郁金（一钱五分） 川连（三分） 杏仁（三钱） 鲜佛手（一钱）
二诊 中脘痞阻已舒，恶心亦减，凛热退轻，咳亦稍松，故气逆因而大定。然下午仍有微寒，痰多胶腻。
脉象稍扬，而带糊滑，舌红苔白不匀。上焦微通，而湿蕴成痰，弥漫肺胃。再参清化。
香青蒿（一钱五分） 杏仁（三钱） 杜苏子（三钱） 冬瓜子（三钱） 云茯苓（三钱） 竹沥半夏（一钱五分）
栝蒌皮（一钱五分） 旋复花（一钱五分） 竹茹（一钱五分） 枇杷叶（去毛三片）
三诊 似疟已止，中州亦舒，咳嗽亦减。然仍痰多粘腻，痰气秽浊。舌苔前半稍化，后半尚觉白腻。少阳
阳明之邪，早经泄化，而湿热熏蒸于肺胃之间，浊酿成痰，肺胃少降。拟降肺化痰。
甜葶苈 制半夏 冬瓜子 炒竹茹 生薏仁 炒苏子 栝蒌仁 橘红 茯苓 枇杷叶
荣（右） 木郁已久，兹兼暑湿内伏，风邪外束，脾胃受困，骤然吐泻。伏暑风邪，乘此而发，不能外泄，郁于
肺胃之间，以致咽赤作痛，肌痒发痧，烦热不解。热迫下注，大便频泄。胃热上冲，咽中牵腻，干恶连绵。又
当天癸临期，经行不爽。脉细弦数，舌红无苔。热郁阴伤，势多变局。拟清咽滋肺汤进退。
大连翘（三钱） 川雅连（五分） 大元参（三钱） 炒牛蒡（三钱） 泽兰叶（二钱） 酒炒淡黄芩（一钱五分）
青防风（一钱） 泡射干（六分） 细木通（六分） 滑石块（三钱） 枳实（八分） 桔梗（一钱）
紫丹参（二钱） 薄荷（一钱后入）
二诊 利膈清咽，热态稍安，而咽中赤碎痛甚，环口发出热泡，两腮碎痛，烦渴欲饮。经色紫黑。左脉弦
紧，舌红边尖绛刺。邪热化火，熏灼肺胃，阴津暗伤。恐热入血室，而致昏喘。
磨犀尖（六分冲） 鲜生地（一两洗打） 大元参（三钱） 柴胡（五分） 丹皮（二钱） 细生地（四钱）
大天冬（三钱） 连翘壳（三钱） 肥知母（二钱） 人中黄（五分） 泽兰叶（二钱） 青竹叶（三十片）
三诊 凉营泄热和阴，咽赤碎痛稍减，渐能得寐痰，稍爽利。舌绛赤转淡，中心似苔非苔，颇觉粘腻。火
得水而渐衰，湿得水而仍浊，浊火蒸腾，仍是熏蒸肺胃之局。拟泄热化浊。
羚羊片（三钱先煎一炷香） 白茯苓（四钱） 黑山栀（三钱） 碧玉散（三钱包） 连翘壳（三钱） 净蝉衣（六
分） 柴胡（五分） 枳实（七分） 水炒竹茹（二钱） 青竹叶（三十片） 竹沥（一两冲） 鲜橄榄（去核五枚打
汁冲）
四诊 咽痛略定，气逆较平，痰稍爽利，烦热亦轻，而肌肤仍然作痒，口渴喜凉饮，咽中白腐不退。左脉
细弦而数，右脉细数微弱，舌白质红，舌尖满布红点。火热劫烁肺胃，阴津大伤。咽通于胃，喉通于肺，肺
为辛金，在色为白，金因火旺，其腐为白，金之色也。还恐火刑金烁，而致肺喘。再清肺胃之热，而救肺胃之阴。
北沙参（五钱） 大麦冬（三钱） 生石膏（六钱） 真川贝（三钱） 冬桑叶（一钱） 鲜生地（洗打八钱）
鲜铁斛（洗打七钱） 元参肉（三钱） 天花粉（三钱） 甘中黄（五分） 粉丹皮（二钱） 生赤芍（一
钱五分） 冬瓜子（三钱打） 金汁（一两冲） 青芦管（一两五钱）
五诊 另定方服。
龙胆草（二钱） 杭白芍（二钱） 大元参（八钱） 生甘草（二钱） 生山栀（二钱） 大生地（一两）
川黄柏（一钱五分） 全栝蒌（三钱） 生石膏（三钱） 马兜铃（二钱） 板蓝根（三钱）
六诊 咽痛白腐布满，项侧耳后肿胀作痛，热势不衰，肝胆之火，势若燎原。大苦泄热，大寒胜热，咽痛
略减，白腐略退。然热势仍炽，经紫色不净，脐下按之板滞。脉象弦数，舌红起刺。肝胆之火风，交炽于上，
欲行未行之血，凝滞于下，营郁则热，亦属定理。再从清泄之中，兼和营滞。以备商酌。
大生地（七钱） 龙胆草（一钱五分） 黑山栀（三钱） 桑叶（二钱） 生甘草（七分） 板蓝根（三钱）
生赤芍（二钱） 丹皮（二钱） 酒炒延胡索（一钱五分） 单桃仁（三钱去皮尖打） （另）上濂珠（二分）
上西黄（四厘） 西血珀（四分三味研末蜜水调服）
七诊 清泄肝胆，兼化营滞，热势减轻，咽痛碎腐大退，略能安谷。人之一身，营卫阴阳而已矣，周流贯
通，无一息之停。卫者阳也，所以卫闭者则生寒。营者阴也，所以营郁则生热。盖营郁则阳气屈曲，自然
生热。热重复轻，其势起伏，以营郁而阳不得宣，屈曲而热，郁极而通，热即转轻。迨周流至营郁之处，阳
气复阻，屈曲复热，此热势起伏之情形也。昨进药后，少腹微微攻动，旋即大便，坚而且黑，甚觉安舒，未
始非滞血之所化。然少腹尚觉板滞，项侧耳后，肿硬渐甚，外疡大有起发之势。其肿硬之处，营血亦必
停阻，肝胆之火亢甚，夫人而知之矣。而营气不宣，阳气屈曲，积薪助火，安得而不燎原乎。再从和阴泄热，兼化营滞。
羚羊片（三钱先煎） 粉丹皮（二钱） 人中黄（五分） 大生地（六钱） 元参（三钱） 霜桑叶（二钱）
龙胆草（一钱五分） 泽兰叶（二钱） 大贝母（三钱） 丹参（三钱） 生赤芍（一钱五分） 十大功劳叶（二钱）
八诊 辛凉重剂，原为清热解毒，救液熄风而设，何以喉间更痛者。曰、红炉泼水，烈焰飞腾也。何以少
腹痞硬者。大气欲泄而不泄，肠间之气，反为痹阻也。经云、其始则异，其终则同。斯之谓欤。今诸款见松，
喉腐亦定，痛势且缓，独是遗毒胀痛，更甚于前。脉小数弦，口干作渴，唇吻燥痛。分明郁伏之邪火，由脏
出腑，由腑出经，痛虽不堪，而症则由此转顺矣。所嫌者本质阴虚，又当邪火燔灼之余，气伤液耗，热犹
未已，而遗毒之痛，亦起心火，则火化风而劫液，实为可虑。急急存阴清热，导腑解毒，安内攘外之法，未识当否。
羚羊片（三钱先煎） 桑叶（二钱） 银花（三钱） 元参（三钱） 连翘（二钱） 丹皮（二钱）
人中黄（五分） 赤芍（一钱五分） 石膏（八钱） 川贝母（二钱） 枯芩（一钱五分） 铁皮斛（五钱）
知母（二钱） 猴枣（二分） 金汁（一两冲） 芦根（一两）
王（右） 伏暑感新凉而发，凛寒而热有起伏，胸闷恶心欲呕，适及经来，少腹不舒。脉细数而滞，舌苔白
腻。此伏邪夹湿，郁阻气机，深恐内闭昏痉。
Fourth Visit: Vomiting and epigastric discomfort (Zaocao) have ceased, and the patient can now consume food slightly. Although the distending pain from the abdominal mass has subsided, it has not completely disappeared into formlessness; thus, at the site of aggregation, the Qi mechanism feels obstructed. The pulse is soggy, fine, and choppy; the tongue is glossy without coating. This is undoubtedly due to simultaneous deficiency of Qi and Yin, where the Qi of Liver Wood aggregates with the chronic Phlegm-Fluids. Bowel movement has not occurred for twenty days, also because Spleen Earth fails to inspire and rotate transportation. The condition of emaciation and debility is not yet stable.
Ren Shen Xu (Ginseng Rootlet), Tian Xing Ren (Sweet Almond), Zheng Sha Ren (Amomum Fruit), Jin Shi Hu (Dendrobium Stem), Ju Bai (Tangerine White Peel), Ban Xia Qu (Pinellia Fermented Paste).
Yun Fu Ling (Poria), Bai Ji Li (Tribulus Fruit), Bai Shao (White Peony Root), Yu Zhu (Atractylodes Macrocephala Rhizome), Shang Yao Gui (Cinnamon Twig, powdered and taken as rice pills first).
Fifth Visit: Nausea and vomiting are completely resolved, bowel movements have resumed, appetite gradually increases, the aggregated mass has vanished without a trace, and distending pain has stopped; voice is slightly stronger. Although this indicates a turning point for recovery, urine has a sour odor, the pulse remains fine and choppy, the tongue coating is thin white and dry, and epigastric discomfort persists. This is because Middle Qi has not recovered, Liver deficiency causes disturbance, Kidney Yin is also deficient, and Qi transformation fails to reach the Bladder (Zhou Du). With the major solar term approaching, there is still concern about unexpected complications.
Ren Shen Xu (Ginseng Rootlet), Bai Gui Shen (Angelica Sinensis Root), Nong Du Zhong (Eucommia Bark), Chuan Duan Rou (Dipsacus Root), Chao Qi Zi (Fried Lycium Fruit), Jiang Zhi Chao Da Shu Di (Rehmannia Root fried with Ginger Juice).
Shang Yao Gui (Cinnamon Twig), Chao Shan Yao (Fried Dioscorea Rhizome), Huai Xiao Mai (Lilyturf Seed), Hei Da Dou (Black Soybean), Yu Rou Tan (Cornus Fruit Charcoal), Niu Xi Tan (Achyranthes Root Charcoal).
Sixth Visit: Various ailments have receded, only slight epigastric discomfort remains, and food intake is barely less than usual. However, for nearly a month, the patient could only turn in bed without assistance but still could not sit up or stand, with pain on the left side of the head and cheek. The pulse is soggy and slippery, the left portion is fine and weak, the tongue is pale and lusterless, with frequent thirst. This perfectly matches the principle in *Neijing*: "Much food intake but little Qi." It is evident that Blood depletion has failed to recover. I imitate the Fumai Method (Restore Pulse Method).
Ren Shen Xu (Ginseng Rootlet), Da Mai Dong (Ophiopogon Tuber), Huo Ma Ren (Hemp Seed), Shang Yao Gui (Cinnamon Twig), Niu Xi Tan (Achyranthes Root Charcoal), Zhi Gan Cao (Honey-fried Licorice Root).
Chao Qi Zi (Fried Lycium Fruit), Huai Xiao Mai (Lilyturf Seed), Zhi Yang Shen (Prepared American Ginseng), Chao Sheng Di (Fried Rehmannia Root), Zhen E Jiao (Donkey-hide Gelatin), Pao Jiang Tan (Roasted Ginger Charcoal), Yu Rou Tan (Cornus Fruit Charcoal).
Patient [Name Omitted]: Late onset of latent pathogen, severe heat with mild chills, menstruation just started and stopped, Chong Mai (Penetrating Vessel) Qi obstruction. The Chong Mai originates from Qichuan and spreads in the chest; resonance here affects there, leading to Middle Jiao fullness and stagnation, accumulation of Phlegm-Dampness, hiccups, nausea, and vomiting. The patient feels a lump congealed in the Zhongwan area; even a drop of water entering gathers there. Heart Fire descends, Kidney Water ascends; only when Water and Fire interact can sleep be achieved. Now, Middle Jiao blockage obstructs the path of mutual nourishment between Water and Fire, Kan and Li do not connect, resulting in sleeplessness all night. The pulse is slippery, large, and rapid, soft upon deep pressure; the tongue is pale red with a white, dry coating. Pathogenic Dampness and Phlegm-Qi intersect in the Middle Palace, while Righteous Qi gradually declines. The concern is coma and hiccups. Regarding the knotting of Qi and Dampness, predecessors stated: "Only Acridity can open, only Bitterness can descend." I propose using Xiexin Tang (Drain the Epigastrium Decoction) as the method.
Chuan Lian (Safflower Coptis, stir-fried with Ginger Juice, 3 fen), Zhi Ban Xia (Prepared Pinellia, 3 qian), Chi Bai Ling (Red and White Poria, 4 qian each), Xian Fo Shou (Fresh Bergamot, 1.5 qian), Dan Gan Jiang (Mild Dried Ginger, 4 fen), Chen Pi (Tangerine Peel, 1 qian).
Bai Kou Ren (White Cardamom Seed, 7 fen added later), Da Fu Pi (Areca Peel, 2 qian), Huo Xiang (Patchouli, 3 qian), Zhu Ru (Bamboo Shavings, stir-fried with Ginger Juice, 1 qian), Sheng Jiang (Fresh Ginger, 3 slices).
Modified prescription adds Yu Jin (Turmeric Tuber, 1.5 qian), Zhi Shi (Immature Bitter Orange, 1 qian), Shi Chang Pu (Acorus Rhizome, 5 fen), Yu Shu Dan (Jade Pill, 3 fen, mixed and taken first).
Patient [Name Omitted]: Summerheat pathogen inhaled through mouth and nose, stored internally in bone marrow, externally lodged between muscle layers. Ten days ago, exposed to autumn coolness, causing the latent pathogen to erupt. No chills, only heat; heat causes vexation, restlessness, and chest tightness. Craves watermelon juice, yet thirst prefers warm drinks. No sweat at all, frequent hiccups and nausea, board-like pain in Zhongwan, dental plaque, scorched lips. Tongue red with dry, hairy white coating; pulse is muddy, rapid, and suppressed. This is stagnation and steaming of Pathogenic Dampness; the latent pathogen desires to exit via exterior, but Qi and Dampness contend internally, so repeated resolving treatments failed to induce sweating. Summerheat must return to the Heart, causing vexation and mental confusion. Approaching seasonal change, deep fear of internal closure leading to coma, convulsions, or syncope.
Xing Ren (Almond), Fang Tong Cao (Stephania Tetrandra Stem), Chao Zhi Shi (Fried Immature Bitter Orange), Bo Ju Hong (Thin Tangerine Red Peel), Jiu Jie Shi Chang Pu (Nine-joint Acorus Rhizome), Bai Kou Ren (White Cardamom Seed).
Zhi Ban Xia (Prepared Pinellia), Xiang Dou Chi (Fragrant Fermented Soybean), Guang Yu Jin (Curcuma Tuber), Sheng Yi Ren (Raw Coix Seed), Bing Lang (Betel Nut), Huo Xiang (Patchouli), Zhu Ru (Bamboo Shavings), Jie Geng (Platycodon Root).
Modified prescription adds Chuan Lian (Coptis) and Gan Jiang (Dried Ginger).
Rong (Left Pulse): Chronic Malaria for a long time, re-infected by Summerheat. For ten days, fever fluctuates; initially slight chills, now no chills only heat. During severe heat, unbearable vexation, craving watermelon juice to quench the raging fire, yet preferred warm drinks. Chest tightness, frequent hiccups and nausea. Pulse rapid, muddy, slippery; coating white, rough, and greasy. Sweat does not flow freely. This is due to Summerheat combining with Phlegm-Dampness, blocking all Qi mechanisms of the Three Jiaos. Phlegm-Dampness contending internally prevents Interior Qi from connecting to the Exterior, hence no sweat. Dampness blocking Middle Jiao causes hiccups and nausea. Summerheat inevitably causes vexation, hence unbearable restlessness. Damp steaming with Summerheat, Summerheat fanning with Dampness; if not released via exterior, it will close internally, leading to coma, convulsions, or syncope. Urgently resolve the interior, unblock the entangled Phlegm-Dampness, allowing Summerheat to penetrate outward through Dampness—this would be great fortune.
Zhi Ban Xia (Prepared Pinellia), Kou Ren (Cardamom Seed), Chuan Po (Magnolia Bark), Xiang Dou Chi (Fragrant Fermented Soybean), Jiu Jie Shi Chang Pu (Nine-joint Acorus Rhizome), Fo Shou (Bergamot).
Guang Huo Xiang (Patchouli), Jie Geng (Platycodon Root), Zhi Mu (Anemarrhena Rhizome), Guang Yu Jin (Curcuma Tuber), Guang Pi (Tangerine Peel), Cao Guo Ren (Tsao-ko Fruit), Jiang Zhi Chao Zhu Er Qing (Bamboo Shavings stir-fried with Ginger Juice), Mo Bing Lang (Crushed Betel Nut, taken with liquid).
Second Visit: Vexation greatly reduced, fever fluctuations slightly declined, hiccups and nausea stabilized, spirit refreshed. Frequent syncope previously; since yesterday until now, no syncope occurred, which is a turning point. However, pulse is still rapid, muddy, and fine; tongue coating largely transformed, white turning yellow, slightly moldy near root. Phlegm-Dampness entrapment slightly opened, but Summerheat-Damp steaming cannot be quickly resolved. Upper and Middle Jiaos still see intense pathogenic Dampness. Approaching two weeks, fear of drying out leading to coma or syncope. Please advise.
Guang Xing Ren (Almond), Bai Kou Ren (White Cardamom Seed), Guang Ju Hong (Tangerine Red Peel), Sheng Yi Ren (Raw Coix Seed), Zhi Ban Xia (Prepared Pinellia), Chi Zhu Ling (Red and Pig Poria).
Ku Jie Geng (Bitter Platycodon Root), Yi Yuan San (Benefit Origin Powder), Chuan Tong Cao (Stephania Tetrandra Stem), Xian Fo Shou (Fresh Bergamot), Guang Yu Jin (Curcuma Tuber), Dan Huang Qin (Light Scutellaria Root), Da Fu Pi (Areca Peel).
Sun (Left Pulse): Headache suddenly lightened, but worsens during heat steaming. Throat feels sticky and pulling, frequent nausea, severe oppression. Pulse rapid, muddy, large. Due to internal steaming of Summerheat-Dampness, Fire and Wind ascend accordingly; Lung and Stomach Qi fail to open and descend. White miliaria appeared at onset; Qi constitution was originally deficient. Fear of damp-heat steaming causing internal penetration leading to coma or syncope. Again promote diffusion and transformation via Three Jiaos, combined with clearing and draining.
Guang Xing Ren (Almond), Yu Jin (Curcuma Tuber), Zhi Ban Xia (Prepared Pinellia), Chi Zhu Ling (Red and Pig Poria), Xian Fo Shou (Fresh Bergamot), Tong Cao (Tetrandra Stem), Ju Hong (Tangerine Red Peel), Bai Kou Ren (White Cardamom Seed), Dan Huang Qin (Light Scutellaria Root), Zhu Ru (Bamboo Shavings).
Modified prescription adds Fang Ji (Stephania Root), Pi Pa Ye (Loquat Leaf), Si Gua Ye (Luffa Leaf), Xi Gua Cui Yi (Watermelon Rind), He Ye Geng (Lotus Leaf Stem).
Shen (Child): Illness began seventeen days ago, severe heat in interior. Repeated sweating, yet vexation and restlessness persist, worse at night, insomnia. Urination frequent and abundant, frequent thirst desiring drink. Previously developed flying pustule rash. Tongue red with yellow coating, center slightly covered with black. This is inhaling Summerheat pathogen, pathogen remaining in Qi level. Although surface-dispersed, Summerheat is formless Qi, different from exogenous Wind-Cold. Repeated surface treatment and sweating failed to transform Summerheat-Qi, leading to Qi-level heat forcing. Any drink, however small, is forced downward like a waterfall, hence frequent and abundant urination. Summerheat loves returning to Heart, hence Summerheat inevitably causes vexation. Large Intestine connects to Stomach and is exterior-interior to Lung; Lung heat transfers downward to Intestine, causing diarrhea. Fear Summerheat pathogen fails to transform, transforms from Summerheat to Heat, from Heat to Fire, stirring Wind and generating惊 (fright/convulsions). Propose light agents for clearing and transforming. Wait for specialist consultation.
Guang Xing Ren (Almond, remove tips, crush 3 qian), Chuan Shi Hu (Dendrobium Stem, 3 qian), Shui Chao Zhu Ru (Bamboo Shavings water-stir-fried, 1 qian), Ju Hong (Tangerine Red Peel, salt-water stir-fried, 1 qian), Yi Yuan San (Benefit Origin Powder, 3 qian), Hei Shan Zhi (Gardenia Fruit, 3 qian), Fei Zhi Mu (Anemarrhena Rhizome, remove hairs, stir-fried, 2 qian), Da Lian Qiao Ke (Forsythia Husk, 3 qian), Zhu Fu Shen (Poria with Hostwood, 3 qian), Qing Zhu Ye (Green Bamboo Leaf, 20 pieces).
Second Visit: Light clear draining and transforming, heat slightly lighter, vexation stabilized, bowel movement passed, not loose, very normal color. But tongue coating slightly transformed, center still feels yellow-dry. Summerheat-Damp steaming in Stomach, Damp accumulating as Heat; Lung pulse connects to Heart, hence occasional vexation. Previous formula responded well, should expand further. Wait for specialist consultation.
Chuan Ya Lian (Coptis, 3 fen), Guang Xing Ren (Almond, 1.5 qian), Guang Yu Jin (Curcuma Tuber, 1.5 qian), Zhi Ban Xia (Prepared Pinellia, 1.5 qian), Ju Hong (Tangerine Red Peel, 8 fen), Yi Yuan San (Benefit Origin Powder, 3 qian), Sheng Yi Ren (Raw Coix Seed, 3 qian), Hei Shan Zhi (Gardenia Fruit, 2 qian), Lian Qiao Ke (Forsythia Husk, 3 qian), Zhu Ye (Bamboo Leaf, 12 pieces).
Third Visit: Major heat retreated, residual heat not cleared. Evening mental vexation and thirst, limb fatigue and fever; more heat means more urination. Due to Summerheat-Damp-Heat steaming, Lung bears the inflammation, causing fluids to lose constraint. Propose Draining Fire and Generating Fluids method.
Chuan Ya Lian (Coptis, 2 fen), Tian Hua Fen (Trichosanthes Root, 1.5 qian), Ou Zhi (Lotus Root Juice, one wine cup), Huo Shui Lu Gen (Living Reed Rhizome, 8 qian).
Li (Right Pulse): Every afternoon, chills followed by heat, heat not manifesting strongly externally but severe internally. Chest tightness, Zhongwan fullness and obstruction, nausea and vomiting, thirst but little drinking desire, lower abdomen pain. Pulse rapid, deep, suppressed. Cough with much phlegm. Coating yellow, substance greasy. Summerheat pathogen with Dampness, stagnant in Qi level; Lung and Stomach Qi cannot descend, opening/closing functions lost. Illness began ten days ago, pathogen vigorous, fear worsening. Tentatively open and drain Qi mechanism to unblock Three Jiaos and restore opening/closing. Please consult.
Zhi Ban Xia (Prepared Pinellia, 1.5 qian), Chao Zhi Shi (Fried Immature Bitter Orange, 1 qian), Shang Guang Pi (Tangerine Peel, 1 qian), Bai Kou Ren (White Cardamom Seed, 5 fen), Zhu Ru (Bamboo Shavings, 1 qian), Fen Qian Hu (Peucedanum Root, 1 qian).
Dan Gan Jiang (Mild Dried Ginger, 2 fen), Guang Yu Jin (Curcuma Tuber, 1.5 qian), Chuan Lian (Coptis, 3 fen), Xing Ren (Almond, 3 qian), Xian Fo Shou (Fresh Bergamot, 1 qian).
Second Visit: Zhongwan obstruction relieved, nausea reduced, chill-heat lighter, cough looser, thus rebellious Qi largely settled. However, slight chills remain in afternoon, phlegm is copious and sticky. Pulse slightly lifted, muddy and slippery; tongue red, coating white uneven. Upper Jiao slightly open, but Damp accumulates into Phlegm, filling Lung and Stomach. Again combine with clearing and transforming.
Xiang Qing Hao (Artemisia Annua, 1.5 qian), Xing Ren (Almond, 3 qian), Du Su Zi (Perilla Seed, 3 qian), Dong Gua Zi (Winter Melon Seed, 3 qian), Yun Fu Ling (Poria, 3 qian), Zhu Li Ban Xia (Pinellia with Bamboo Juice, 1.5 qian).
Gua Lou Pi (Trichosanthes Peel, 1.5 qian), Xuan Fu Hua (Inula Flower, 1.5 qian), Zhu Ru (Bamboo Shavings, 1.5 qian), Pi Pa Ye (Loquat Leaf, remove hairs, 3 pieces).
Third Visit: Malaria-like symptoms stopped, Middle Jiao comfortable, cough reduced. Yet phlegm remains copious, sticky, turbid. Tongue coating front slightly transformed, back still white-greasy. Shaoyang and Yangming pathogens already drained, but damp-heat steams between Lung and Stomach, turbidity brews into Phlegm, Lung and Stomach lack descending function. Propose Descending Lung and Transforming Phlegm.
Tian Ting Li (Descurainia Seed), Zhi Ban Xia (Prepared Pinellia), Dong Gua Zi (Winter Melon Seed), Chao Zhu Ru (Fried Bamboo Shavings), Sheng Yi Ren (Raw Coix Seed), Chao Su Zi (Fried Perilla Seed), Gua Lou Ren (Trichosanthes Seed), Ju Hong (Tangerine Red Peel), Fu Ling (Poria), Pi Pa Ye (Loquat Leaf).
Rong (Right Pulse): Liver Qi stagnation for a long time, now accompanied by internal latent Summerheat-Dampness, external Wind binding, Spleen and Stomach constrained, sudden vomiting and diarrhea. Latent Summerheat-Wind pathogen erupts due to this, unable to vent externally, stagnates between Lung and Stomach, causing red painful throat, skin itching with sand-rash, unresolved vexation-heat. Heat forces downward, frequent diarrhea. Stomach Heat rushes upward, throat sticky, continuous dry retching. Also, menstrual period approaching, flow irregular. Pulse fine, wiry, rapid; tongue red without coating. Heat stagnation injuring Yin, situation prone to change. Propose Qing Yan Zi Fei Tang (Clear Throat Nourish Lung Decoction) variations.
Da Lian Qiao (Forsythia Fruit, 3 qian), Chuan Ya Lian (Coptis, 5 fen), Da Yuan Shen (Scrophularia Root, 3 qian), Chao Niu Bang (Burdock Fruit, 3 qian), Ze Lan Ye (Lycopus Leaf, 2 qian), Jiu Chao Dan Huang Qin (Scutellaria Root wine-stir-fried, 1.5 qian).
Qing Fang Feng (Saposhnikovia Root, 1 qian), Pao She Gan (Belamcanda Rhizome, 6 fen), Xi Mu Tong (Akebia Stem, 6 fen), Hua Shi Shi (Talc Block, 3 qian), Zhi Shi (Immature Bitter Orange, 8 fen), Jie Geng (Platycodon Root, 1 qian).
Zi Dan Shen (Salvia Root, 2 qian), Bo He (Mint, 1 qian added later).
Second Visit: Clearing diaphragm and throat, heat slightly calm, but throat red, fragmented, severe pain, hot blisters around mouth, bilateral cheek pain, vexation-thirst desiring drink. Menstrual blood purple-black. Left pulse wiry-tight, tongue red with crimson thorns at edges and tip. Pathogenic Heat transforms into Fire, scorching Lung and Stomach, Yin fluids secretly injured. Fear Heat entering Blood Chamber leading to coma and panting.
Mo Xi Jian (Rhino Horn, ground, 6 fen taken with liquid), Xian Sheng Di (Fresh Rehmannia Root, washed and crushed 1 liang), Da Yuan Shen (Scrophularia Root, 3 qian), Chai Hu (Bupleurum Root, 5 fen), Dan Pi (Moutan Bark, 2 qian), Xi Sheng Di (Fine Fresh Rehmannia Root, 4 qian).
Da Tian Dong (Asparagus Tuber, 3 qian), Lian Qiao Ke (Forsythia Husk, 3 qian), Fei Zhi Mu (Anemarrhena Rhizome, 2 qian), Ren Zhong Huang (Human Waste Yellow, 5 fen), Ze Lan Ye (Lycopus Leaf, 2 qian), Qing Zhu Ye (Green Bamboo Leaf, 30 pieces).
Third Visit: Cooling Ying, draining Heat, harmonizing Yin; throat red-fragmented pain slightly reduced, sleep gradually possible, phlegm slightly clearer. Tongue crimson-red turns pale, center looks like coating but isn't, quite sticky. Fire diminishes with Water, Damp remains turbid with Water; Turbid-Fire steaming continues to affect Lung and Stomach. Propose Draining Heat and Transforming Turbidity.
Ling Yang Pian (Antelope Horn Slice, 3 qian decocted first for incense time), Bai Fu Ling (White Poria, 4 qian), Hei Shan Zhi (Gardenia Fruit, 3 qian), Bi Yu San (Jade Green Powder, wrapped 3 qian), Lian Qiao Ke (Forsythia Husk, 3 qian), Jing Chan Yi (Cicada Slough, 6 fen), Chai Hu (Bupleurum Root, 5 fen), Zhi Shi (Immature Bitter Orange, 7 fen), Shui Chao Zhu Ru (Bamboo Shavings water-stir-fried, 2 qian), Qing Zhu Ye (Green Bamboo Leaf, 30 pieces), Zhu Li (Bamboo Juice, 1 liang taken with liquid), Xian Gan Lan (Fresh Olive, pitted 5 pieces crushed juice taken with liquid).
Fourth Visit: Throat pain slightly settled, rebellious Qi calmer, phlegm clearer, vexation-heat lighter, yet skin still itches, thirst prefers cold drinks, white decay in throat persists. Left pulse fine-wiry-rapid, right pulse fine-rapid-weak, tongue white substance red, tip covered with red dots. Fire-Heat roasts Lung and Stomach, Yin fluids severely injured. Throat connects to Stomach, Larynx connects to Lung; Lung is Metal, color white. When Metal is overwhelmed by Fire, its decay is white, the color of Metal. Fear Fire punishing Metal leading to Lung panting. Again clear Lung-Stomach Heat and save Lung-Stomach Yin.
Bei Sha Shen (Glehnia Root, 5 qian), Da Mai Dong (Ophiopogon Tuber, 3 qian), Sheng Shi Gao (Gypsum Fibrosum, 6 qian), Zhen Chuan Bei (Fritillaria Cirrhosa Bulb, 3 qian), Dong Sang Ye (Mulberry Leaf, 1 qian), Xian Sheng Di (Fresh Rehmannia Root, washed and crushed 8 qian).
Xian Tie Hu (Dendrobium Stem, washed and crushed 7 qian), Yuan Shen Rou (Scrophularia Flesh, 3 qian), Tian Hua Fen (Trichosanthes Root, 3 qian), Gan Zhong Huang (Licorice Center Yellow, 5 fen), Fen Dan Pi (Moutan Bark, 2 qian), Sheng Chi Shao (Fresh Red Peony Root, 1.5 qian), Dong Gua Zi (Winter Melon Seed, 3 qian crushed), Jin Zhi (Gold Juice, 1 liang taken with liquid), Qing Lu Guan (Green Reed Tube, 1.5 liang).
Fifth Visit: Separate prescription taken.
Long Dan Cao (Gentian Root, 2 qian), Hang Bai Shao (White Peony Root, 2 qian), Da Yuan Shen (Scrophularia Root, 8 qian), Sheng Gan Cao (Raw Licorice Root, 2 qian), Sheng Shan Zhi (Raw Gardenia Fruit, 2 qian), Da Sheng Di (Large Fresh Rehmannia Root, 1 liang).
Chuan Huang Bo (Phellodendron Bark, 1.5 qian), Quan Gua Lou (Whole Trichosanthes Fruit, 3 qian), Sheng Shi Gao (Gypsum Fibrosum, 3 qian), Ma Dou Ling (Aristolochia Vine, 2 qian), Ban Lan Gen (Isatis Root, 3 qian).
Sixth Visit: Throat pain and white decay widespread, swelling and pain behind neck and ears, heat persists. Liver-Gallbladder Fire rages like a prairie fire. Great Bitterness drains Heat, Great Cold overcomes Heat; throat pain slightly reduced, white decay slightly receded. Yet heat still fierce, menstrual blood purple and unclean, lower abdomen board-like stiffness upon pressure. Pulse wiry-rapid, tongue red with thorns. Liver-Gallbladder Fire-Wind intensely burning above, blood wanting to flow but not flowing, stagnating below; Ying stagnation generates Heat, which is a established principle. Again from clearing-draining, simultaneously harmonize Ying stagnation. For consultation.
Da Sheng Di (Large Fresh Rehmannia Root, 7 qian), Long Dan Cao (Gentian Root, 1.5 qian), Hei Shan Zhi (Gardenia Fruit, 3 qian), Sang Ye (Mulberry Leaf, 2 qian), Sheng Gan Cao (Raw Licorice Root, 7 fen), Ban Lan Gen (Isatis Root, 3 qian).
Sheng Chi Shao (Fresh Red Peony Root, 2 qian), Dan Pi (Moutan Bark, 2 qian), Jiu Chao Yan Hu Suo (Corydalis Rhizome wine-stir-fried, 1.5 qian), Dan Tao Ren (Single Peach Kernel, 3 qian remove tips and skins, crush). (Separately) Shang Lian Zhu (Pearl, 2 fen), Shang Xi Huang (Bezoar, 4 li), Xi Xue Po (Succinite, 4.3 fen). These three ground to powder, mixed with honey water and taken.
Seventh Visit: Clearing-draining Liver-Gallbladder, simultaneously transforming Ying stagnation; heat reduced, throat pain and fragmentation greatly receded, able to eat slightly. The human body consists only of Ying, Wei, Yin, and Yang, circulating continuously without pause. Wei is Yang, so Wei closure generates chills. Ying is Yin, so Ying stagnation generates heat. Ying stagnation causes Yang Qi to twist, naturally generating heat. Heat heavy then light, fluctuating because Ying stagnation prevents Yang from venting; twisting generates heat, extreme stagnation leads to opening, heat then lightens. When circulation reaches Ying stagnation site, Yang Qi blocks again, twists and heats again; this is the pattern of heat fluctuation. After taking medicine yesterday, lower abdomen slightly moved, immediately had bowel movement, hard and black, feeling very comfortable; this may be transformation of stagnant blood. Yet lower abdomen still board-like stiff, neck and ear swelling hardening increasingly, external abscess showing signs of eruption. At swollen-hard sites, Ying-Blood must also stop; Liver-Gallbladder Fire is extremely high, everyone knows this. And Ying Qi not venting, Yang Qi twisting, adding fuel to fire, how can it not rage? Again harmonize Yin and drain Heat, simultaneously transform Ying stagnation.
Ling Yang Pian (Antelope Horn Slice, 3 qian decocted first), Fen Dan Pi (Moutan Bark, 2 qian), Ren Zhong Huang (Human Waste Yellow, 5 fen), Da Sheng Di (Large Fresh Rehmannia Root, 6 qian), Yuan Shen (Scrophularia Root, 3 qian), Shuang Sang Ye (Frost Mulberry Leaf, 2 qian).
Long Dan Cao (Gentian Root, 1.5 qian), Ze Lan Ye (Lycopus Leaf, 2 qian), Da Bei Mu (Fritillaria Thunbergii Bulb, 3 qian), Dan Shen (Salvia Root, 3 qian), Sheng Chi Shao (Fresh Red Peony Root, 1.5 qian), Shi Da Gong Lao Ye (Mahonia Leaf, 2 qian).
Eighth Visit: Heavy Acrid-Cool agents were originally set to clear Heat and detoxify, save fluids and extinguish Wind. Why is throat pain worse? Answer: Splashing water on a red furnace, flames fly up. Why is lower abdomen full and hard? Vital Qi wants to vent but cannot, Qi in intestines becomes blocked instead. Classics say: "Initially different, finally same." Is this what it means? Now various symptoms relaxed, throat decay settled, pain eased, only residual toxin distension-pain worse than before. Pulse small-rapid-wiry, mouth dry thirst, lip-corner dry-pain. Clearly stagnant latent pathogenic Fire moves from Zang to Fu, from Fu to Meridian. Pain unbearable, yet condition turns favorable. Disliked is original Yin deficiency, plus after pathogenic Fire scorching, Qi injured, fluids consumed, heat not yet ended, and residual toxin pain also arises from Heart Fire, Fire transforms Wind and robs fluids, truly concerning. Urgently preserve Yin and clear Heat, guide Fu to detoxify, secure interior and repel exterior method, wonder if appropriate.
Ling Yang Pian (Antelope Horn Slice, 3 qian decocted first), Sang Ye (Mulberry Leaf, 2 qian), Yin Hua (Honeysuckle Flower, 3 qian), Yuan Shen (Scrophularia Root, 3 qian), Lian Qiao (Forsythia Fruit, 2 qian), Dan Pi (Moutan Bark, 2 qian).
Ren Zhong Huang (Human Waste Yellow, 5 fen), Chi Shao (Red Peony Root, 1.5 qian), Shi Gao (Gypsum Fibrosum, 8 qian), Chuan Bei Mu (Fritillaria Cirrhosa Bulb, 2 qian), Ku Qin (Scutellaria Root, 1.5 qian), Tie Pi Hu (Dendrobium Stem, 5 qian).
Zhi Mu (Anemarrhena Rhizome, 2 qian), Hou Zao (Monkey Gallstone, 2 fen), Jin Zhi (Gold Juice, 1 liang taken with liquid), Lu Gen (Reed Rhizome, 1 liang).
Wang (Right Pulse): Latent Summerheat erupted after new coolness exposure, chills with fluctuating heat, chest tightness, nausea, desire to vomit. Menstruation just arrived, lower abdomen uncomfortable. Pulse fine-rapid-stagnant, tongue coating white-greasy. This is latent pathogen with Dampness, stagnating Qi mechanism, deep fear of internal closure leading to coma and convulsions.