红苔白花糙，左脉弦大，右脉濡滑，俱重按少力。久热之下，肝胃阴伤，胃失通降，所有湿邪，不能旋运。恐
虚中生变。拟甘凉育阴，酸苦泄热复入辛燥为之反佐。即请诸高明商进。
霍石斛 生白芍 青盐半夏 大麦冬 云茯苓 水炒竹茹
盐水炒陈皮 蒺藜 左金丸 枇杷叶
二诊 甘寒育阴，酸苦泄热，复入辛燥为之反佐，酸涎上涌已定。左脉弦大稍收，而苔白花糙，退而复
起，竟是糜腐情形。不饥不纳，稍进糜饮，胸脘辄觉难过，而又并非被阻。小溲结滞不爽，临溲之际，往往
中止。大便不行。无非肝胃阴伤，肺津并损，致虚火挟膀胱湿热，熏蒸胃口。既为虚火湿热熏蒸，则不纳
不饥，胸脘不适。小肠与膀胱手足相应，膀胱之湿热，既随虚火上蒸胃口，则小肠火府，自然秘结，大便
因而不行。深入重地，聊明其理，以尽人力。即请诸高明商进。
细生地 甘草梢 细木通 北沙参 川石斛 白茯苓
天花粉 青竹叶 外用姜柏散搽口。
三诊 糜腐稍化，热邪减轻，小溲略爽，脉亦较缓。然仍不饥，稍进糜饮，仍觉气冲。气阴并亏，何能遽复，
浊蒸胃口，何能遽化。惟有循理按法，以觇其后。
细生地 北沙参 川贝母 木通 滑石 茯苓 川石斛 甘草梢 竹茹 竹叶
四诊 小溲色红且浊，湿热之气，稍得下行，而大敌不能摧散，熏蒸之炎，仍不克平。糜腐退者自退，起
者仍起，胸中哽阻，欲噫不爽。足见糜布于舌，而糜之源，实在于胃，源之不清，流安能洁。大肠与胃相连
属，勉再通导府气，而泄胃熟，以降胃浊。即请商之。
导赤加黄连黄芩滑石竹茹茯苓荷花露 外用猪胆汁导法
五诊 大府得通，并有粘腻之物带出，糜腐较昨大化，口渴较数日前大减。然中州郁郁不舒，时有痰
涎随气上冲，饮喜暖热。右脉糊滑。阴液虽虚，而胃中之痰湿郁结不化，遂令清津转难上升，气火无从
下降。病至于此，首尾无从兼顾。非辛不开，非苦不降，拟泻心法。虚家善变。势不暇顾矣。即请商进。
青盐半夏（一钱五分） 白蒺藜（三钱） 川雅连（四分） 鲜竹茹（姜汁炒二钱） 细木通（七分） 橘
红（盐水炒一钱） 车前子（一钱五分） 白茯苓（三钱） 老姜衣（七分）
六诊 病久阴气兼亏，木火夹浊蒸腾，胃糜舌腐。阴液既亏，则不化气，浊不得化，气火内烁，热从内陷。
左脉弦细急促，右脉濡滑，不耐重按。深入重地，勉与崇山先生同议方以尽人力。
洋参（三钱） 细生地（四钱） 金石斛（四钱） 橘红（盐水炒五分） 大麦冬（三钱） 川贝（三钱）
蛤壳（八钱） 竹茹（水炒一钱五分） 真玳瑁（四钱） 濂珠（一钱） 金箔（一大张三味研极细末调服）
某 湿温旬日，有汗不解，胸闷不舒，甚至气逆塞至咽喉，呼吸难于流利，脐旁按之漉漉，今日忽又便
泄小溲不通。脉数糊滑，舌苔薄白，而底质甚腻。此湿郁三焦，恐其转痢。
川朴 白蔻仁 滑石块 通草 橘红 生香附
木香 广郁金 沉香片 竹茹 枳实 鲜佛手
洪（左） 湿温七日，烦热胸闷恶心，汗出至颈而还。脉沉细涩，苔黄罩灰。邪湿郁蒸，湿遏热伏，有内闭神
昏之虞。
制半夏 光杏仁 广郁金 淡黄芩 九节菖蒲 上广皮
白蔻仁 范志曲 炒枳实 炒香豉 玉枢丹（四分研末鲜佛手汤下）
二诊 发出斑痧，而烦热仍然不减，至暮神昏谵语。脉糊不爽，苔霉虽化而底质白 。还是邪湿郁蒸，
欲泄而不能即泄。恐内闭昏痉。
制半夏（二钱） 白桔梗（一钱） 川雅连（三分） 干姜（四分） 九节菖蒲（六分） 光杏仁（三钱）
白蔻仁（四分） 川通草（八分） 枳实（一钱） 上广皮（一钱） 赤猪苓（各二钱） 太乙丹（五分研细先调服）
三诊 汗出颇畅，身热遂解，但脉形不爽。蕴湿未清，还当泄化。
大豆卷 制半夏 赤白苓 泽泻 川朴 木猪苓 生薏仁 鲜佛手
林（幼） 水痘之后，邪虽外达，余热未清。饮食频进，胸中之余热，与谷气交蒸，热绵不退，渐至愈蒸愈重。
湿邪遏伏，津不上布，曾见舌苔干白，而并不渴饮。旬日以来，热势转有起伏，手清时暖，耳聋不聪。脉象
右部糊数，左部弦大。当午火升，而热势夜重。舌红温甚，苔白湿甚。咳不扬畅。此由湿热熏蒸，湿多热少，
湿在胃中，阳明少降，致少阳之木火，挟浊上腾，遂令清窍为之蒙阻，若蒙闭内窍，便成棘手重证。然火
升暮热，神烦耳聋，釜中之沸也。如烟如雾蕴酿熏蒸，釜底之薪也。拟流化三焦，以分其清浊，作抽薪之计，
暂观动静。诸高明以为然否。
香豆豉（三钱） 晚蚕砂（三钱） 广郁金（一钱五分） 前胡（一钱） 光杏仁（三钱） 白蒺藜（三钱）
赤白苓（各二钱） 通草（一钱） 白桔梗（八分） 生薏仁（四钱） 鲜竹茹（一钱五分）
二诊 当午火升稍微，沉迷较昨清爽，鼻干转润，迷蒙之气，似为渐开。然蕴酿熏蒸，一时难已，热势仍
然不退。前法略参苦泄，再望转机。
香豆豉 光杏仁 广郁金 橘红 前胡 生薏仁
通草 赤猪苓 白蔻仁（三分） 淡芩 桔梗 晚蚕砂
三诊 流化气机，气通表达，发出白 ，背部为多，背俞属肺，肺气先得宣泄。然阳明之热，太阴之湿，不
克遽化，熏蒸之势，犹然难解，热仍起伏，伏则迷蒙多寐，胸中清旷之区，竟为湿热熏蒸之地，神机自难
转运。舌淡红，苔白腻，右脉糊数。还是邪湿溷处之象。再从流化之中，参入芳香，以破秽浊。即请商裁。
香豆豉 白蔻仁（三分） 蝉衣 鸡苏散 光杏仁 淡子芩
佩兰叶 通草 广郁金 牛蒡子 生薏仁 野蔷薇花（六分） 芦根
四诊 白 随汗透露，色颇津湛，颗粒均匀，饥肤润泽，喻氏谓上焦之湿宜汗，又谓化里可以达表，气
通表达，上焦氤氲之湿，随汗 外泄，熏蒸自衰，热因降序，神情爽慧，浊气渐开，则清窍渐通，耳聋稍聪。
舌苔前半较化，后半尚觉粘腻。大便旬余不行。从宣肺之中，参以润府，冀其湿从下达，彼此分泄，病势自孤耳。
制半夏（一钱五分） 蔻仁（三分） 炒蒌皮（四钱） 光杏仁（三钱） 牛蒡子（三钱） 薄橘红（一钱）
通草（八分） 生薏仁（三钱） 滑石块（三钱） 炒枳实（一钱） 淡子芩（一钱五分） 芦根（一两）
王（左） 症交八日，热重汗不畅达，红疹发而未透，邪难外泄，热蒸湿动，湿阻气机，恶心脘痞，稍进汤饮，
自觉停聚中州，里湿相搏，表气更难开泄，神情懊烦。苔白不渴，脉象糊数。恐邪湿交蒸，而致内蒙昏痉。
拟宣化开泄。
川朴（一钱） 橘皮（一钱） 桑叶（一钱） 牛蒡子（三钱） 制半夏（一钱五分） 杏仁（三钱）
桔梗（一钱） 枳实（一钱） 薄荷（六分） 炒竹茹（一钱五分） 蔻仁（五分） 佛手（一钱）
二诊 宣化开泄，汗出甚畅，热势大减，并能得寐，烦懊因而大定，胸痞转舒，恶心亦止。但脉仍糊数，热
犹未解。舌红苔薄白。气分之邪，依然留恋。再为宣化。
杏仁（三钱） 上广皮（一钱） 茯苓（三钱） 制半夏（一钱五分） 广郁金（一钱五分） 蔻仁（五分）
炒枳实（一钱） 薏仁（三钱） 竹茹（一钱五分） 猪苓（二钱） 通草（一钱）
三诊 热势降序，寐亦稍安，脘痞已舒。然不悲而泣，不恐而惊，痰稠色带灰黑。脉象糊滑而数，苔白质
红。腹中攻撑，便带溏薄。邪从外达，痰被热蒸，蕴而不化，胆胃之气从而失降，以致胆木漂拔。再从宣化
之中参清气化痰。
杏仁（三钱） 橘红（一钱） 郁金（一钱五分） 云苓（三钱） 竹沥半夏（一钱五分） 胆星（五分）
枳实（一钱） 范志曲（二钱） 薏仁（四钱） 通草（一钱） 竹茹（一钱五分）
四诊 脉静身凉，稠痰渐少，思谷知味，胃气渐开，悲泣惊恐亦定。宜和中以清余蕴。
温胆除枳实，甘草加天麻钩钩白蔻仁藿香胆星。
五诊 苔白已化，胃开思纳。惟脉形左大。头重眩晕，肝阳挟痰上逆。再熄肝化痰。
制半夏（一钱五分） 白蒺藜（三钱） 石决明（五钱） 池菊花（一钱） 上广皮（一钱） 煨
天麻（一钱五分） 陈胆星（四分） 白金丸（五分） 钩钩（三钱） 盐水炒竹茹（一钱）
丁（左） 热不外扬，神情烦闷，中脘痞阻，哕恶呕吐，不能容纳，头目晕眩，渴喜沸饮。左脉弦滑，
右部糊滞。此肝阳上逆，挟停饮窒塞气机。恐发痉发呃。
制半夏 炒竹茹 广藿香 郁金 川朴 枳实
白蔻仁 煨天麻 生熟香附 玉枢丹（三分研末先调服）
江苏抚军吴 病湿温下虚，缠绵两月有余，仆以病近膏肓，恐药石难于奏效，以未便立方辞。主人坚
恳至再，不得已勉尽绵力，将病脉症因，方治宜忌，变方案之式，为之分列各条，备诸方家及主政采择
之。一、久病湿热，化燥化火，而藏气虚微，脉至少神，症属难治。循例告辞者为此。一、病既沉重，不能
袖手，惟有细究其理，勉为调治。一、口燥舌黄带灰，时喜凉饮，非胃中热甚，安得有此。一、 语错语，
病涉于心。盖阳明胃脉，上通于心，胃热上乘，则心神为之扰乱。一、胃中燥火，原从湿热所化。夫湿热
何以致燥。盖津之与液，清浊攸分，升降异致。浊之清者为津，清之浊者为液，液从上而下降，津从下而
上升，滋养涵濡，悉赖津液敷布。今湿邪抑郁，则津液不布，燥是其标，湿是其本。一、救阴即是润燥，降
火即是清心，无如津不上承，清之养之，仍苦扬汤止沸。一、大腹饱满，按之而软。谓之虚膨，虚者何，脾
虚也。脾有气血，有阴阳，虚膨不运，脾虚其阳，确有可见。一、胃有燥火，而脾虚其阳，勉欲挽回，动辄矛
盾。一、泻胃热而仍顾虑脾阳，前人有连理汤一方，兹仿其意。一、连属苦燥，姜属辛燥，似有抱薪救
火之弊。但火从燥化，燥从湿化，燥为假燥，湿为真湿，正治从治，例得权宜。一、养阴救津，甘凉之品，有
益于胃，即损于脾。再仿前人药露之法，专取其气，以润其津，于脾无损。
川雅连（五分炒） 炮姜（三分） 生熟甘草（各二分） 以上三味煎服。
上濂珠（三分） 西黄（一分） 辰砂（二分飞） 三味研细末，先调服。
西洋参（五钱） 元参（八钱） 细生地（一两） 北沙参（一两五钱） 麦冬（一两） 生甘草（二钱）
白芍（四钱） 上药七味，加荷叶二两，用蒸壶取露，随意温服。
此案变通旧式，罗列条例，精警透辟，得未曾有。药露方尤为奇特。方中丞病甚时，苏沪诸名医遍治罔效，御医
陈某亦束手无策。先生为处此方，旋获效果，盖先生成竹在胸，原非幸获，而犹以未便立方辞，是先生之谦德
也。此案已见医界镜（又名卫生小说），群相称赏。涵当时不获随侍，未知其详。今春编印医案，而先生侄孙绍
曾以此稿抄示，并面述一切。涵读此案，可法可传，洵足突过前贤，而为后学之津梁也。故乐为记之。（文涵志）
[First Visit] The tongue coating is red at the base with white, rough patches on top. The left pulse is wiry and large, the right pulse is soggy and slippery, but both lack force when pressed heavily. Following prolonged fever, the Yin of the Liver and Stomach is damaged, the Stomach loses its descending function, and the dampness in the body cannot be transformed and transported. There is fear of complications arising from deficiency. It is proposed to use sweet-cool herbs to nourish Yin, sour-bitter herbs to drain heat, and add acrid-dry herbs as a counter-agent to prevent rejection. I respectfully ask for the advice of distinguished colleagues.
*Prescription:* Huo Shihu (Dendrobii Caulis), Sheng Baishao (Paeoniae Radix Alba), Qingyan Banxia (Pinelliae Rhizoma preparated with green salt), Da Maidong (Ophiopogonis Radix), Yun Fuling (Poria), Shuichao Zhuru (Bambusae Caulis in Solutio preparated with water), Yanshui Chao Chenpi (Citri Reticulatae Pericarpium preparated with salt water), Jili (Tribuli Fructus), Zuojin Wan (Left Metal Pill), Pipa Ye (Loquat Leaf).
[Second Visit] After employing sweet-cold to nourish Yin, sour-bitter to drain heat, and adding acrid-dry herbs as a counter-agent, the surging acid saliva has subsided. The left wiry-large pulse has slightly receded, yet the tongue coating remains white and rough, disappearing and reappearing, presenting a condition of erosion and putrefaction. There is no appetite and inability to eat; even consuming a small amount of porridge or liquid causes discomfort in the chest and epigastrium, not due to obstruction. Urination is scanty, stagnant, and unsatisfactory, often stopping midway. Bowel movements are absent. This is essentially due to damage to the Yin of the Liver and Stomach, and loss of Lung fluids, causing deficient fire to carry damp-heat from the Bladder to steam the Stomach opening. Since steamed by deficient fire and damp-heat, there is anorexia, lack of hunger, and chest/epigastric discomfort. The Small Intestine and Bladder correspond as interior-exterior pairs; since the damp-heat of the Bladder steams upward to the Stomach via deficient fire, the "Fire Mansion" (Small Intestine) naturally becomes constipated, leading to bowel obstruction. Delving into the core pathology, I briefly clarify the principle to exert human effort. I respectfully ask for the advice of distinguished colleagues.
*Prescription:* Xi Shengdi (Rehmanniae Radix Preparata), Gancao Shao (Glycyrrhizae Radix et Rhizoma tip), Xi Mutong (Akebiae Caulis), Beishashen (Glehniae Radix), Chuan Shihu (Dendrobii Caulis), Bai Fuling (Poria), Tianhuafen (Trichosanthis Radix), Qingzhuye (Bambusae Folium). External: Jiangbai San (Ginger and Phellodendron Powder) applied to the mouth.
[Third Visit] The oral erosion has slightly resolved, heat pathogen has decreased, urination is slightly smoother, and the pulse is slower. However, there is still no appetite; consuming a little porridge causes Qi to rush upward. Both Qi and Yin are deficient, how can they recover suddenly? Turbid steaming at the Stomach opening, how can it dissolve suddenly? We must follow the principles and methods to observe the subsequent development.
*Prescription:* Xi Shengdi, Beishashen, Chuan Beimu (Fritillariae Bulbus), Mutong, Huashi (Talcum), Fuling, Chuan Shihu, Gancao Shao, Zhuru, Zhuye.
[Fourth Visit] Urine is red and turbid; damp-heat Qi has slightly descended, but the main enemy pathogen cannot be dispersed, and the steaming inflammation remains unquenched. Erosion that recedes stays receded, new ones arise; there is a choking sensation in the chest, desire to belch but unable to do so. This shows erosion on the tongue originates from the Stomach; if the source is not clear, how can the flow be pure? The Large Intestine connects with the Stomach. I tentatively guide the Fu organ Qi again to drain Stomach residual heat and descend Stomach turbidity. Please discuss.
*Prescription:* Daochi San (Guide Out Red Powder) added with Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Huashi, Zhuru, Fuling, Hehua Lu (Lotus Flower Dew). External: Pig bile guidance method.
[Fifth Visit] Bowels have moved, bringing out sticky substances; oral erosion has greatly improved compared to yesterday, thirst has significantly reduced compared to days ago. However, the middle jiao feels depressed and uncomfortable, with phlegm-saliva occasionally rushing up with Qi, preferring warm drinks. The right pulse is muddy and slippery. Although Yin fluids are deficient, phlegm-dampness in the Stomach is stagnated and unresolved, making it difficult for clear fluids to ascend and Qi-Fire to descend. At this stage, head and tail cannot be attended to simultaneously. Without acrid, it cannot open; without bitter, it cannot descend. I propose the Xiexin Fa (Drain Heart Method). Deficient patients are prone to changes; the situation allows no time for hesitation. Please discuss.
*Prescription:* Qingyan Banxia (1.5 qian), Baijili (3 qian), Chuan Yalian (Coptidis Rhizoma) (0.4 qian), Xian Zhuru (Fresh Bamboo Shavings stir-fried with ginger juice) (2 qian), Xi Mutong (0.7 qian), Juhong (Citri Reticulatae Pericarpium preparated with salt water) (1 qian), Cheqianzi (Plantaginis Semen) (1.5 qian), Bai Fuling (3 qian), Laojiangyi (Old Ginger Skin) (0.7 qian).
[Sixth Visit] The disease has lasted long, damaging Yin Qi; Wood-Fire carries turbidity to steam, causing gastric erosion and tongue putrefaction. With Yin fluid deficiency, Qi cannot be transformed; with turbidity unresolved, Qi-Fire scorches internally, and heat sinks inward. The left pulse is wiry, thin, rapid, and urgent; the right pulse is soggy and slippery, intolerant of heavy pressure. Delving deep, I tentatively consult Mr. Chongshan to discuss the prescription to exert human effort.
*Prescription:* Yangshen (American Ginseng) (3 qian), Xi Shengdi (4 qian), Jin Shihu (Dendrobii Caulis) (4 qian), Juhong (preparated with salt water) (0.5 qian), Da Maidong (3 qian), Chuan Bei (Fritillariae Bulbus) (3 qian), Qiaoqiao (Clam Shell) (8 qian), Zhuru (water-stir-fried) (1.5 qian), Zhen Daimao (Hawksbill Turtle Scute) (4 qian), Lianzhu (Pearl) (1 qian), Jinbo (Gold Foil) (one large sheet, last three powdered finely and taken mixed).
[Case of Mou] Wet-warmth for ten days, sweating does not resolve the disease, chest tightness and discomfort, even Qi rebellion blocking the throat, breathing difficult and unsmooth, gurgling sound upon pressing beside the navel. Today suddenly diarrhea occurs with urinary retention. Pulse is rapid, muddy, and slippery; tongue coating is thin white, but the tongue substance is very greasy. This is dampness stagnating in the Triple Burner, fearing transformation into dysentery.
*Prescription:* Chuan Pu (Magnoliae Officinalis Cortex), Baokouren (Amomi Fructus Rotundus), Huashi Shi (Talcum), Tongcao (Tetrapanacis Medulla), Juhong, Sheng Xiangfu (Cyperi Rhizoma), Muxiang (Aucklandiae Radix), Guang Yujin (Curcumae Radix), Chenxiang Pian (Aquilariae Lignum Resinatum), Zhuru, Zhishi (Immature Bitter Orange), Xian Foshou (Citri Sarcodactylis Fructus).
[Case of Hong (Left)] Wet-warmth for seven days, irritability, heat, chest tightness, nausea, sweating only reaches the neck and stops. Pulse is deep, thin, and choppy; tongue coating yellow covering gray. Evil dampness stagnates and steams, dampness suppresses heat lying hidden, with risk of internal closure and coma.
*Prescription:* Zhi Banxia (Pinelliae Rhizoma preparated), Guang Xingren (Armeniacae Semen Amarum), Guang Yujin, Dan Huangqin (Scutellariae Radix), Jiejie Changpu (Acori Tatarinowii Rhizoma), Shang Guangpi (Citri Reticulatae Pericarpium), Baokouren, Fan Zhi Qu (Medicated Leaven), Chao Zhishi (Immature Bitter Orange stir-fried), Chao Xiangchi (Sojae Semen Praeparatum stir-fried), Yushu Dan (Jade Seal Pill) (0.4 qian powdered, taken with fresh Foshou decoction).
[Second Visit] Macules and rashes appear, but irritability and heat remain unchanged; by evening, coma and delirium occur. Pulse is muddy and unsatisfactory; mold-like coating has dissolved but the base is white. Still evil dampness stagnating and steaming, wanting to vent but unable to immediately release. Fear of internal closure, coma, and convulsions.
*Prescription:* Zhi Banxia (2 qian), Bai Jiegeng (Platycodonis Radix) (1 qian), Chuan Yalian (0.3 qian), Ganjiang (Dried Ginger) (0.4 qian), Jiejie Changpu (0.6 fen), Guang Xingren (3 qian), Baokouren (0.4 qian), Chuan Tongcao (0.8 fen), Zhishi (1 qian), Shang Guangpi (1 qian), Chi Zhu Ling (Red Poria and Polyporus) (2 qian each), Taiyi Dan (Great One Pill) (0.5 fen powdered, taken first mixed).
[Third Visit] Sweating is quite smooth, body heat resolves, but the pulse form is still unsatisfactory. Accumulated dampness is not cleared, should still be drained and transformed.
*Prescription:* Dadoujuan (Sojae Semen Album preparated), Zhi Banxia, Chi Bai Ling (Red and White Poria), Zexie (Alismatis Rhizoma), Chuan Pu, Mu Zhu Ling (Polyporus with wood), Sheng Yiren (Coicis Semen), Xian Foshou.
[Case of Lin (Child)] After chickenpox, evil has reached the exterior, but residual heat is not cleared. Frequent eating causes residual heat in the chest to steam with grain Qi, heat lingering without retreat, gradually becoming heavier. Dampness suppresses and hides, fluids do not distribute upward; previously saw dry white tongue coating but no thirst. Over ten days, heat fluctuates, hands sometimes cold sometimes warm, deafness and poor hearing. Pulse: right muddy and rapid, left wiry and large. When noon Fire rises, heat worsens at night. Tongue red and hot, coating white and damp. Cough is not loud and smooth. This is due to damp-heat steaming, more damp than heat, damp in the Stomach, Yangming failing to descend, causing Shaoyang Wood-Fire to carry turbidity upward, blocking the clear orifices. If internal orifices are blocked, it becomes a difficult severe case. However, fire rising, evening heat, mental irritability, and deafness are like boiling in a pot. Smoke and fog brewing and steaming are like the firewood under the pot. I propose flowing and transforming the Triple Burner to separate clear and turbid, acting as removing firewood from under the pot, observing temporarily. Do you agree?
*Prescription:* Xiang Douchi (Perillae Fructus preparated) (3 qian), Wancansha (Bombyx Batryticatus) (3 qian), Guang Yujin (1.5 qian), Qianhu (Peucedani Radix) (1 qian), Guang Xingren (3 qian), Baijili (3 qian), Chi Bai Ling (2 qian each), Tongcao (1 qian), Bai Jiegeng (0.8 fen), Sheng Yiren (4 qian), Xian Zhuru (1.5 qian).
[Second Visit] Noon Fire rising slightly slowed, confusion clearer than yesterday, dry nose turned moist, misty qi seems gradually opening. However, brewing and steaming cannot stop instantly, heat still does not retreat. Previous method slightly adds bitter-draining, hoping for a turn.
*Prescription:* Xiang Douchi, Guang Xingren, Guang Yujin, Juhong, Qianhu, Sheng Yiren, Tongcao, Chi Zhu Ling, Baokouren (0.3 fen), Dan Qin (Scutellariae Radix), Jiegeng, Wancansha.
[Third Visit] Flowing and transforming Qi mechanism, Qi connects to express to the exterior, white miliary rash appears, mostly on the back. Back Shu points belong to the Lung, Lung Qi gets ventilated first. However, Yangming heat and Taiyin dampness cannot resolve quickly, steaming trend is still hard to solve, heat still fluctuates; hidden leads to confusion and excessive sleep. The clear spacious area in the chest becomes a place of damp-heat steaming, Shen mechanism is hard to transport. Tongue pale red, coating white and greasy, right pulse muddy and rapid. Still the image of evil dampness mixing. From flowing and transforming, add aromatic herbs to break foul turbidity. Please discuss.
*Prescription:* Xiang Douchi, Baokouren (0.3 fen), Chan Yi (Cicadae Periostracum), Jisu San (Chicken Su Powder), Guang Xingren, Dan Ziqin (Scutellariae Radix), Peilan Ye (Eupatorii Herba), Tongcao, Guang Yujin, Niubangzi (Arctii Fructus), Sheng Yiren, Ye Qiangwei Hua (Wild Rose Flower) (0.6 fen), Lugeng (Phragmitis Rhizoma).
[Fourth Visit] White miliary rash reveals with sweat, color is moist and bright, particles uniform, skin moist. Yu Shi said dampness in the Upper Jiao should be sweated, also said transforming interior can reach the exterior. Qi connects to express to the exterior, upper jiao misty dampness escapes with sweat, steaming naturally declines, heat descends in order, spirit is clear and wise, turbid qi gradually opens, clear orifices gradually connect, deafness slightly improves. Tongue coating front half dissolves, back half still feels sticky. Bowel movement absent for over ten days. From lung-ventilating, add moistening the fu organs, hoping dampness descends from below, separating and draining each other, disease momentum will become isolated.
*Prescription:* Zhi Banxia (1.5 qian), Kou Ren (Amomi Fructus) (0.3 fen), Chao Lou Pi (Trichosanthis Pericarpium stir-fried) (4 qian), Guang Xingren (3 qian), Niubangzi (3 qian), Bo Juhong (Thin Citri Reticulatae Pericarpium) (1 qian), Tongcao (0.8 fen), Sheng Yiren (3 qian), Huashi Shi (3 qian), Chao Zhishi (1 qian), Dan Ziqin (1.5 qian), Lugeng (1 liang).
[Case of Wang (Left)] Disease combined for eight days, heavy heat, sweat not smooth, red macules erupted but not fully transparent, evil hard to exit exterior, heat steams damp moving, damp blocks Qi mechanism, nausea and epigastric fullness, after taking soup/drink, feels stagnant in Middle Jiao, interior damp fights, exterior Qi hard to open, spirit annoyed. Coating white, no thirst, pulse muddy and rapid. Fear evil damp steaming together, leading to internal enclosure, coma, and convulsions.
Propose Ventilating, Transforming, Opening, and Draining.
Chuan Pu (1 qian), Ju Pi (Citri Reticulatae Pericarpium) (1 qian), Sang Ye (Mori Folium) (1 qian), Niubangzi (3 qian), Zhi Banxia (1.5 qian), Xingren (Armeniacae Semen Amarum) (3 qian), Jiegeng (1 qian), Zhishi (1 qian), Bohe (Menthae Haplocalycis Herba) (0.6 fen), Chao Zhuru (1.5 qian), Kou Ren (0.5 fen), Foshou (1 qian).
[Second Visit] Ventilating and transforming, opening and draining, sweating very smooth, heat greatly reduced, able to sleep, annoyance greatly settled, chest fullness relieved, nausea stopped. But pulse still muddy and rapid, heat not resolved. Tongue red, coating thin white. Qi level evil still lingers. Again ventilate and transform.
Xingren (3 qian), Shang Guangpi (1 qian), Fuling (3 qian), Zhi Banxia (1.5 qian), Guang Yujin (1.5 qian), Kou Ren (0.5 fen), Chao Zhishi (1 qian), Yiren (Coicis Semen) (3 qian), Zhuru (1.5 qian), Zhuling (Polyporus) (2 qian), Tongcao (1 qian).
[Third Visit] Heat descends in order, sleep slightly peaceful, epigastric fullness relieved. However, crying without sadness, startling without fear, thick phlegm gray-black. Pulse muddy, slippery, and rapid, coating white, substance red. Abdomen distending/painful, stool loose. Evil reaches exterior, phlegm steamed by heat, accumulates without resolving, Gallbladder and Stomach Qi lose descent, causing Gallbladder Wood to float. From ventilating and transforming, add clearing heat and transforming phlegm.
Xingren (3 qian), Juhong (1 qian), Yujin (Curcumae Radix) (1.5 qian), Yun Ling (Poria) (3 qian), Zhuli Banxia (Pinelliae Rhizoma preparated with bamboo sap) (1.5 qian), Dansheng (Arisaematis Cum Bile) (0.5 fen), Zhishi (1 qian), Fan Zhi Qu (2 qian), Yiren (4 qian), Tongcao (1 qian), Zhuru (1.5 qian).
[Fourth Visit] Pulse quiet, body cool, thick phlegm gradually less, desiring food and knowing taste, Stomach Qi gradually opening, crying and startling settled. Should harmonize middle to clear remaining accumulation.
Wendan Tang remove Zhishi, Gancao add Tianma (Gastrodiae Rhizoma), Gougou (Uncariae Ramulus cum Uncis), Baokouren, Huoxiang (Agastaches Herba), Dansheng.
[Fifth Visit] White coating dissolved, Stomach opens, desiring intake. Only pulse form left large. Heavy head, vertigo, Liver Yang carrying phlegm rebels upward. Again extinguish Liver and transform phlegm.
Zhi Banxia (1.5 qian), Baijili (3 qian), Shijueming (Haliotidis Concha) (5 qian), Chiju Hua (Chrysanthemi Flos) (1 qian), Shang Guangpi (1 qian), Wei Tianma (Gastrodiae Rhizoma baked) (1.5 qian), Chen Dansheng (Arisaematis Cum Bile aged) (0.4 fen), Baijin Wan (White Gold Pill) (0.5 fen), Gougou (Uncariae Ramulus cum Uncis) (3 qian), Yanshui Chao Zhuru (Bambusae Caulis in Solutio preparated with salt water) (1 qian).
[Case of Ding (Left)] Heat does not spread outward, spirit irritable and depressed, epigastric blockage, hiccups, nausea, vomiting, unable to retain, dizziness of head and eyes, thirst preferring boiling water. Left pulse wiry and slippery, right muddy and stagnant. This is Liver Yang rebelling upward, carrying retained fluid blocking Qi mechanism. Fear convulsions and hiccups.
Zhi Banxia, Chao Zhuru, Guang Huoxiang (Agastaches Herba), Yujin, Chuan Pu, Zhishi, Baokouren, Wei Tianma, Sheng Shu Xiangfu (Cyperi Rhizoma raw and prepared), Yushu Dan (0.3 fen powdered, taken first mixed).
[Case of Wu, Governor-General of Jiangsu] Suffering from wet-warmth with lower deficiency, lingering for over two months. I declined to prescribe, citing the illness approaching the vital organs and fearing medicine would be ineffective. The owner insisted repeatedly, so I reluctantly exerted my limited strength. I listed the pathology, pulse, symptoms, cause, treatment principles, contraindications, and modified prescription format in separate items for experts and administrators to choose from.
1. Long-standing damp-heat transforms into dryness and fire, while viscera Qi is weak and minute, pulse lacks spirit, syndrome is difficult to treat. Declining based on routine is for this reason.
2. Since the illness is severe, I cannot stand idle; I must study the principle carefully and tentatively treat.
3. Dry mouth, yellow tongue coating with gray, occasionally preferring cold drinks. Unless Stomach heat is severe, how could this happen?
4. Delirious speech and wrong words involve the Heart. The Yangming Stomach meridian connects upward to the Heart; Stomach heat attacking upward disturbs the Heart Spirit.
5. Stomach dry-fire originally transforms from damp-heat. How does damp-heat cause dryness? Fluids and liquids are divided by clear/turbid, ascending/descending differ. Clear from turbid is Jin (thin fluid), turbid from clear is Ye (thick fluid). Ye descends from above, Jin ascends from below, nourishing and moistening relies on distribution of Jin and Ye. Now dampness depresses, Jin and Ye do not distribute; dryness is the branch, dampness is the root.
6. Saving Yin is moistening dryness, lowering fire is clearing the Heart. Alas, if Jin does not ascend, clearing and nourishing is still like boiling water to stop boiling (futile).
7. Abdomen full and soft on pressure. Called false distension. What is deficiency? Spleen deficiency. Spleen has Qi/Blood, Yin/Yang. False distension without transport, Spleen Yang deficiency is visible.
8. Stomach has dry-fire, Spleen Yang is deficient. Trying to salvage creates contradiction.
9. To drain Stomach heat while worrying about Spleen Yang, predecessors had Lianli Tang. Here I imitate its intent.
10. Lianlian is bitter-dry, Jiang is acrid-dry, seeming like adding firewood to save a fire. But fire transforms from dryness, dryness transforms from dampness. Dryness is fake dryness, dampness is true dampness. Correct and contrary treatments allow flexibility.
11. Nourishing Yin and saving Jin, sweet-cool herbs benefit the Stomach but harm the Spleen. Again imitating predecessor's herb dew method, taking only the Qi to moisten Jin, harmless to the Spleen.
*Prescription 1:* Chuan Yalian (Stir-fried Coptidis Rhizoma) (0.5 fen), Paojiang (Prepared Ginger) (0.3 fen), Sheng Shu Gancao (Raw and Prepared Licorice Root) (0.2 fen each). Decoct these three.
*Prescription 2:* Shang Lianzhu (Pearl) (0.3 fen), Xi Huang (Bezoar) (0.1 fen), Chensha (Cinnabaris prepared) (0.2 fen). Powder these three finely, take mixed first.
*Prescription 3:* Xiyangshen (American Ginseng) (5 qian), Yuan Shen (Scrophulariae Radix) (8 qian), Xi Shengdi (Rehmanniae Radix Preparata) (1 liang), Beishashen (Glehniae Radix) (1.5 liang), Maidong (Ophiopogonis Radix) (1 liang), Sheng Gancao (Raw Licorice Root) (2 qian), Baishao (Paeoniae Radix Alba) (4 qian). Add 2 liang Lotus Leaf to the above seven herbs, use a steamer to extract dew, take warm as desired.
This case modifies the old style, listing items, precise and penetrating, unprecedented. The Herb Dew Prescription is particularly unique. When Fang Zhongcheng was critically ill, famous doctors in Suzhou and Shanghai treated him without effect, Imperial Physician Chen was also at a loss. Mr. Zhang prescribed this formula and achieved results quickly. This shows Mr. Zhang had a clear plan in mind, not accidental success, yet he declined to prescribe initially, showing his humility. This case appeared in *Yi Jie Jing* (also known as *Wei Sheng Xiao Shuo*), praised by all. Han was not present then to know details. This spring, compiling medical cases, Mr. Zhang's nephew Shao Zeng showed me this manuscript and narrated everything. Reading this case, it is worthy of emulation and transmission, truly surpassing former sages and serving as a bridge for learners. Therefore, I gladly record it. (Recorded by Wen Han)