左 痰多，自觉身热，而脉不甚数。此痰湿有余，郁遏阳气。
制半夏 炒竹茹 川桂枝 广橘红 云苓 制香附 砂仁末 生熟薏仁 二妙丸（二钱开水先下）
二诊 辛通苦泄，痰气之郁遏者开，则阳气之勃蒸自化。胃气既苏，内热亦退。阴虚生内热，虽属古圣
明训，实与此证异岐。前法再扩充之。
焦苍术（一钱） 泽泻（一钱五分） 广皮（一钱） 姜汁炒黄柏（一钱五分） 制半夏（一钱五分）
桂枝（五分） 云苓（三钱） 炒黄野于术（一钱五分） 炒竹茹（一钱） 炒谷芽（三钱） 生熟米仁（各二钱）
周（左） 每至日晡，辄作漫热，热不退清，汗出稍松，痰多，脉濡滑。气虚痰阻，遂致阴阳开合失其常度。年
近花甲，不宜见此。拟苦辛寒合方，以开阴泄热。
川桂枝（五分） 光杏仁（三钱） 橘红（一钱） 制半夏（一钱五分） 竹茹（一钱五分） 煨石膏（三钱）
茯苓块（三钱） 枳实（七分） 生姜（二片） 红枣（一枚）
二诊 苦辛寒合方而开痰饮，以通阴阳，日晡漫热已退，如鼓应桴，其为开合失度，可以概见。以退为
进拟蠲饮化痰。
制半夏（一钱五分） 茯苓（三钱） 竹茹（一钱） 猪苓（一钱五分） 南星（三分） 上广皮（一钱）
枳实（一钱） 薏仁（四钱） 老姜（二片）
三诊 脉象濡滑。运化迟钝，便溏不实。舌苔中心黑润。痰湿不运，脾阳不克鼓舞。拟温中而蠲饮。
川桂枝（五分） 云茯苓（三钱） 上广皮（一钱） 姜竹茹（一钱） 霞天曲（二钱） 炒于术（二钱）
制半夏（一钱五分） 生熟薏仁（各二钱） 老生姜（三片）
左 久嗽不止，痰稠浓腻，甚则色带青绿，寒热往来。脉软而数。此肝肾素亏，而脾胃之痰热，熏蒸于肺，
阴阳开合之机，悉为痰阻，此所以为寒为热也。将入劳损之门，不易图治。
川桂枝 杏仁泥 制半夏 橘红 炒黄川贝 生石膏 肥知母 海蛤粉 郁金 云苓
二诊 湿痰稍退，而营卫流行，不能和协。再拟和中化痰。
人参须（另煎冲五分） 制半夏 橘红 茯苓 川桂枝 炒枳实 干姜（四分） 郁金 野于术 煨石膏
三诊 开饮化痰和中，阴阳交并，寒热已止，纳增痰爽。足见痰阻营术，与阳虚生外寒，阴虚生内热者
迥异也。再从前法扩充。
人参须（八分） 云苓 制半夏 炒枳实 砂仁 野于术 橘红 川桂枝 石膏（煨）
某 气虚多痰之质，偶食粘腻窒滞之物，气由此不行，湿由此不运，痰由此不化，营卫由此而阻，阴阳
由此而乖，遂至阴阳相争，先寒后热。郁极而通，两次大汗，阴阳稍得协和，热势因之渐缓。然脾肺升降，
仍为痰气所阻，右胁作痛，痰鸣带咳。盛纳在胃，运化在脾，所谓窒滞者阳明也。气之不行，胃气之不行
也。湿之不运，胃湿之不运也。脾为生痰之源，胃为贮痰之器，肺为出痰之窍，痰之不化，是胃中之痰不
化也，阻于斯，滞于斯。寒热交争之下，热虽循减，而胃中之痰湿，已被熏蒸，于是随其阳土之性而欲化
燥，舌苔为之焦黑。舌色如此，而不甚热，不烦闷，不口渴引饮者，独何欤。以痰湿熏蒸，化燥化热，皆由气
机郁遏，津液不行，不若时邪之症，温气化热之后，烁液劫津而成燥也。阳明胃络，上通于心。今胃中为
痰湿弥漫之区，所以神机为之不运，神倦如寐，中脘板硬。脉象左寸微浮，关部溷滑，尺部沉细，右寸细
滞，关弦，尺弱。证由痰湿食停阻，传变化燥，以平素气弱，而致化火不足。化燥不足。惟恐里气一虚，而湿
痰内陷，以致神迷。拟疏化痰湿，参入苦降辛开，即阳土宜清阴土宜温之意。备诸方家采择。
制半夏（二钱） 旋复花（一钱五分包） 光杏仁（三钱） 赤白苓（各二钱） 磨枳实（三分） 白蔻仁（三
分冲） 广橘红（一钱） 淡干姜（四分） 川雅连（三分） 生香附（一钱五分）
二诊 疏降胃府，苦辛开通，脉数稍退，舌焦黑顿化十七。郁蒸之热，已退三舍。大便虽未通行，而中脘
略软频转矢气，亦属府气欲通之象，不可不为起色。但热仍未退，右胁仍痛，痰鸣欲咳，还是痰湿交蒸，
不可遽化，所谓伤食类伤寒者，即此是也。再拟疏化一法，而步步顾其中阳，以防内陷神昏之变。备方家采择。
制半夏（二钱） 橘红（一钱） 生香附（一钱五分） 淡干姜（四分） 磨枳实（三分） 雅连（二分）
光杏仁（三钱） 旋复花（二钱） 炒苏子（三钱） 竹茹（八分） 白蔻仁（三分冲） 豆卷（三钱）
右 阴分久亏不复，阴虚生内热，经训昭垂，固无疑义。特内热无已时，兹则间数日或旬日即热，显与
寻常之内热迥殊。所以然者。良由喉证之后，余热袭入营分，营中有热，至数日而其热郁勃，故发热，热
则气泄郁解，故复能退。拟于养营之中，参以清营。
镑犀尖（二分先煎） 炙生地（四钱） 炒归身（一钱） 十大功劳叶（一钱） 西赤芍（一钱五分）
炒山药（三钱） 软白薇（二钱） 粉丹皮（一钱五分）
二诊 凉营泄热，大便饮食如常。守前法以觇动静。
生地炭（四钱） 磨犀尖（二分冲） 香青蒿（二钱） 十大功劳叶（一钱五分） 粉丹皮（二钱）
炒白芍（一钱五分） 当归（二钱酒炒） 炒白薇（二钱）
三诊 每至身热，辄口碎。阳明营分之热无疑。
炙生地（四钱） 犀角尖（二分磨冲） 粉丹皮（一钱五分） 玉泉散（一钱五分包） 川石斛（三钱） 白茅根
（五钱去心）
四诊 此次热轻且短，惟口糜作痛。再清胃热。
生甘草（三分） 煨石膏（二钱） 黑山栀（一钱五分） 粉丹皮（一钱五分） 广藿梗（二钱） 川石斛（三钱）
制半夏（一钱五分） 青防风（八分）
五诊 叠进凉营泄热，热退未楚，然两目尚涩，还是余热之象也。
粉丹皮（一钱五分） 青防风（一钱） 广藿香（三钱） 黑山栀（一钱五分） 煨石膏（四钱研） 生甘草（三
分） 炒菊花（一钱）
六诊 脉象和缓。但小溲有时仍痛，还是余热未尽。再清泄以澈之。
镑犀尖（三分） 熟石膏（三钱） 细木通（四分） 车前子（一钱五分） 甘草梢（三分） 竹叶心（十二片）
Left Pulse Case: Excessive phlegm, subjective sensation of body heat, but the pulse is not very rapid. This indicates excess phlegm-dampness obstructing and suppressing Yang Qi (Yang Energy).
Prescription: Zhi Banxia (Prepared Pinellia Rhizome), Chao Zhuru (Stir-fried Bamboo Shavings), Chuan Guizhi (Cinnamon Twig), Guang Juhong (Broad-leaved Kelp Peel), Yunling (Poria), Zhi Xiangfu (Prepared Cyperus Rhizome), Sharen Mo (Amomum Seed Powder), Sheng Shu Yiren (Raw and Prepared Coix Seed), Ermiao Wan (Two Marvels Pill) (2 qian, decocted first in boiling water).
Second Visit: Using acrid-unblocking and bitter-draining methods, the obstruction of Phlegm-Qi is resolved, thus the vigorous steaming of Yang Qi naturally transforms. Once Stomach Qi revives, internal heat also recedes. Although "Yin deficiency generates internal heat" is a clear teaching from ancient sages, it actually differs significantly from this syndrome. The previous method is further expanded.
Prescription: Jiao Cangzhu (Charred Atractylodes Rhizome) (1 qian), Zexie (Alisma Rhizome) (1.5 qian), Guangpi (Tangerine Peel) (1 qian), Jiangzhi Chao Huangbai (Ginger-juice stir-fried Phellodendron Bark) (1.5 qian), Zhi Banxia (Prepared Pinellia Rhizome) (1.5 qian), Guizhi (Cinnamon Twig) (0.5 qian), Yunling (Poria) (3 qian), Chao Huang Yeyuzhu (Stir-fried Yellow Wild Atractylodes Macrocephala Rhizome) (1.5 qian), Chao Zhuru (Stir-fried Bamboo Shavings) (1 qian), Chao Guya (Stir-fried Rice Sprout) (3 qian), Sheng Shu Miren (Raw and Prepared Coix Seed) (2 qian each).
Zhou (Left Pulse): Every day towards dusk, diffuse heat arises; the heat does not dissipate clearly, sweating brings slight relief, there is excessive phlegm, and the pulse is soggy and slippery. Qi deficiency with Phlegm obstruction leads to the loss of normal rhythm in Yin-Yang opening and closing. Being near sixty years old, such a condition is inappropriate. A combined formula of bitter, acrid, and cold properties is proposed to open Yin and drain Heat.
Prescription: Chuan Guizhi (Cinnamon Twig) (0.5 qian), Guang Xingren (Apricot Kernel) (3 qian), Juhong (Tangerine Peel) (1 qian), Zhi Banxia (Prepared Pinellia Rhizome) (1.5 qian), Zhuru (Bamboo Shavings) (1.5 qian), Wei Shigao (Calcined Gypsum) (3 qian), Fuling Kuai (Poria Blocks) (3 qian), Zhishi (Immature Bitter Orange) (0.7 qian), Shengjiang (Fresh Ginger) (2 slices), Hongzao (Jujube) (1 piece).
Second Visit: Using the bitter-acrid-cold combined formula to open Phlegm-fluid and unblock Yin-Yang, the dusk diffuse heat has already receded, responding quickly like a drum hit by a mallet, confirming the disorder of opening and closing. Advancing by retreating, the strategy is to eliminate fluid and resolve phlegm.
Prescription: Zhi Banxia (Prepared Pinellia Rhizome) (1.5 qian), Fuling (Poria) (3 qian), Zhuru (Bamboo Shavings) (1 qian), Zhuling (Polyporus) (1.5 qian), Nanxing (Arisaema Rhizome) (0.3 qian), Shang Guangpi (Premium Tangerine Peel) (1 qian), Zhishi (Immature Bitter Orange) (1 qian), Yiren (Coix Seed) (4 qian), Laojiang (Old Ginger) (2 slices).
Third Visit: The pulse is soggy and slippery. Transportation and transformation are sluggish, stools are loose and unformed. The tongue coating in the center is black and moist. Phlegm-dampness fails to transform, and Spleen Yang cannot be inspired. The approach is to warm the middle and eliminate fluid.
Prescription: Chuan Guizhi (Cinnamon Twig) (0.5 qian), Yun Fuling (Poria) (3 qian), Shang Guangpi (Premium Tangerine Peel) (1 qian), Jiang Zhuru (Ginger-processed Bamboo Shavings) (1 qian), Xiatian Qu (Fungal Medicinal Paste) (2 qian), Chao Yuzhu (Stir-fried Atractylodes Macrocephala Rhizome) (2 qian), Zhi Banxia (Prepared Pinellia Rhizome) (1.5 qian), Sheng Shu Yiren (Raw and Prepared Coix Seed) (2 qian each), Lao Shengjiang (Old Fresh Ginger) (3 slices).
Left Pulse Case: Chronic cough persists, phlegm is thick, dense, and greasy, sometimes greenish-blue in color, with alternating chills and fever. The pulse is soft and rapid. This indicates inherent deficiency of Liver and Kidney, while Phlegm-Heat from Spleen and Stomach steams upward to the Lung. The mechanism of Yin-Yang opening and closing is completely blocked by phlegm, which explains the alternation of cold and heat. It is approaching the stage of consumptive disease and is difficult to treat.
Prescription: Chuan Guizhi (Cinnamon Twig), Xingren Ni (Apricot Kernel Paste), Zhi Banxia (Prepared Pinellia Rhizome), Juhong (Tangerine Peel), Chao Huang Chuanbei (Stir-fried Yellow Fritillaria Bulb), Sheng Shigao (Raw Gypsum), Fei Zhimu (Thick Anemarrhena Rhizome), Haige Fen (Clam Shell Powder), Yujin (Curcuma Longa Rhizome), Yunling (Poria).
Second Visit: Damp-phlegm has slightly receded, but Ying (Nutritive) and Wei (Defensive) circulation lacks harmony. The approach is again to harmonize the middle and resolve phlegm.
Prescription: Renshen Xu (Ginseng Rootlets) (decocted separately, 0.5 qian added to other decoction), Zhi Banxia (Prepared Pinellia Rhizome), Juhong (Tangerine Peel), Fuling (Poria), Chuan Guizhi (Cinnamon Twig), Chao Zhishi (Stir-fried Immature Bitter Orange), Ganjiang (Dried Ginger) (0.4 qian), Yujin (Curcuma Longa Rhizome), Yeyuzhu (Wild Atractylodes Macrocephala Rhizome), Wei Shigao (Calcined Gypsum).
Third Visit: By opening fluid, resolving phlegm, and harmonizing the middle, Yin and Yang intersect, chills and fever have ceased, appetite has increased, and phlegm is easily expectorated. This demonstrates that phlegm blocking Ying and Wei is distinctly different from external cold generated by Yang deficiency and internal heat generated by Yin deficiency. The previous method is further expanded.
Prescription: Renshen Xu (Ginseng Rootlets) (0.8 qian), Yunling (Poria), Zhi Banxia (Prepared Pinellia Rhizome), Chao Zhishi (Stir-fried Immature Bitter Orange), Sharen (Amomum Fruit), Yeyuzhu (Wild Atractylodes Macrocephala Rhizome), Juhong (Tangerine Peel), Chuan Guizhi (Cinnamon Twig), Shigao (Gypsum) (calcined).
Certain Patient: A constitution of Qi deficiency with excessive phlegm. Accidentally consuming sticky, cloying, and stagnating food causes Qi to fail to move, Dampness to fail to transform, and Phlegm to fail to dissolve. Ying and Wei become obstructed, Yin and Yang become discordant, leading to contention between Yin and Yang, starting with chills followed by fever. After extreme stagnation, breakthrough occurs with two episodes of profuse sweating, allowing Yin and Yang to achieve slight harmony, and the fever gradually subsides. However, the ascending and descending of Spleen and Lung remain obstructed by Phlegm-Qi, causing right hypochondriac pain, phlegm rales, and cough. Reception lies in the Stomach, transformation lies in the Spleen; the so-called stagnation is in the Yangming Stomach. The failure of Qi movement is the failure of Stomach Qi. The failure of Dampness transformation is the failure of Stomach Dampness transformation. The Spleen is the source of phlegm production, the Stomach is the vessel storing phlegm, the Lung is the aperture for phlegm exit. The failure of phlegm transformation is due to the failure of transforming phlegm in the Stomach, obstructing and stagnating here. Under the contention of cold and heat, although heat decreases, the phlegm-dampness in the Stomach has been steamed, thus tending to dry out according to its Yang-Earth nature, turning the tongue coating scorched black. Why is the tongue colored thus, yet without significant heat, restlessness, or thirst prompting drinking? Because phlegm-dampness steaming, drying out, and generating heat all result from Qi mechanism stagnation and failure of Jin-Ye (Body Fluids) to circulate, unlike seasonal pathogenic factors where warming transformation turns into heat, scorching fluids and seizing Jin-Ye to form dryness. The Yangming Stomach collaterals connect upward to the Heart. Now the Stomach is a region of pervasive phlegm-dampness, so Shen-Ji (Spirit Mechanism) fails to operate, causing mental fatigue resembling sleep, and hardness in the Zhongwan area. The pulse shows Left Cun slightly floating, Guan muddy-slippery, Chi deep-thin; Right Cun thin-stagnant, Guan wiry, Chi weak. The syndrome arises from phlegm-dampness and food retention causing transmission and transformation into dryness; due to habitual Qi weakness, there is insufficient transformation into fire and insufficient transformation into dryness. The fear is that once Interior Qi becomes deficient, damp-phlegm sinks inward, leading to spirit confusion. The proposal is to disperse and resolve phlegm-dampness, incorporating bitter-descending and acrid-opening, reflecting the principle that Yang Earth should be cleared and Yin Earth should be warmed. Reserved for experts' selection.
Prescription: Zhi Banxia (Prepared Pinellia Rhizome) (2 qian), Xuanfuhua (Inula Flower) (1.5 qian, wrapped), Guang Xingren (Apricot Kernel) (3 qian), Chi Bai Ling (Red and White Poria) (2 qian each), Mo Zhishi (Ground Immature Bitter Orange) (0.3 qian), Baokou Ren (White Cardamom Seed) (0.3 qian, added late), Guang Juhong (Broad-leaved Kelp Peel) (1 qian), Dan Ganjiang (Light Dried Ginger) (0.4 qian), Chuan Yalian (Sichuan Coptis Rhizome) (0.3 qian), Sheng Xiangfu (Raw Cyperus Rhizome) (1.5 qian).
Second Visit: Dispersing and descending Stomach Fu, bitter-acrid unblocking, the rapid pulse has slightly retreated, the scorched-black tongue coating has transformed significantly. The steaming heat has receded considerably. Although stool has not passed, the Zhongwan area is slightly soft with frequent flatus, indicating the Fu organ Qi desires to unblock, which is a positive sign. However, heat remains, right hypochondriac pain persists, phlegm rales and urge to cough continue, still due to phlegm-dampness steaming together, which cannot be quickly resolved. This is what is meant by food injury resembling Taiyang disease. Again proposing a dispersing and resolving method, while carefully protecting Middle Yang at every step to prevent sinking inward and spirit confusion. Reserved for experts' selection.
Prescription: Zhi Banxia (Prepared Pinellia Rhizome) (2 qian), Juhong (Tangerine Peel) (1 qian), Sheng Xiangfu (Raw Cyperus Rhizome) (1.5 qian), Dan Ganjiang (Light Dried Ginger) (0.4 qian), Mo Zhishi (Ground Immature Bitter Orange) (0.3 qian), Yalian (Coptis Rhizome) (0.2 qian), Guang Xingren (Apricot Kernel) (3 qian), Xuanfuhua (Inula Flower) (2 qian), Chao Suzi (Stir-fried Perilla Seed) (3 qian), Zhuru (Bamboo Shavings) (0.8 qian), Baokou Ren (White Cardamom Seed) (0.3 qian, added late), Doujuan (Soja Seed Sprout) (3 qian).
Right Pulse Case: Yin aspect has been deficient for a long time and not recovered; Yin deficiency generating internal heat, as stated in classics, is beyond doubt. Specifically, internal heat has no end; now fever occurs every few days or ten days, clearly distinct from ordinary internal heat. The reason is that after throat disease, residual heat invaded the Ying (Nutritive) level. Heat in Ying accumulates over several days, becoming vigorous, thus causing fever. When heat rises, Qi leaks and stagnation resolves, thus fever can retreat again. The approach is to nourish Ying while incorporating clearing of Ying.
Prescription: Bang Xi Jian (Slashed Rhinoceros Horn Tip) (0.2 qian, decocted first), Zhi Shengdi (Honey-fried Rehmannia Root) (4 qian), Chao Guishen (Stir-fried Angelica Sinensis Root) (1 qian), Shida Gonglao Ye (Ten Great Merits Leaf) (1 qian), Xi Chishao (West Red Peony Root) (1.5 qian), Chao Shanyao (Stir-fried Dioscorea Rhizome) (3 qian), Ruan Baiwei (Soft Saposhnikovia Root) (2 qian), Fen Danpi (Powdered Moutan Cortex) (1.5 qian).
Second Visit: Cooling Ying and draining heat, bowel movements and diet are normal. Adhering to the previous method to observe dynamics.
Prescription: Shengdi Tan (Rehmannia Root Charcoal) (4 qian), Mo Xi Jian (Ground Rhinoceros Horn Tip) (0.2 qian, added late), Xiang Qinghao (Fragrant Artemisia Annua Herb) (2 qian), Shida Gonglao Ye (Ten Great Merits Leaf) (1.5 qian), Fen Danpi (Powdered Moutan Cortex) (2 qian), Chao Baishao (Stir-fried White Peony Root) (1.5 qian), Danggui (Angelica Sinensis Root) (2 qian, wine-fried), Chao Baiwei (Stir-fried Saposhnikovia Root) (2 qian).
Third Visit: Whenever body heat arises, mouth ulcers occur. Undoubtedly, heat in Yangming Ying level.
Prescription: Zhi Shengdi (Honey-fried Rehmannia Root) (4 qian), Xijiao Jian (Rhinoceros Horn Tip) (0.2 qian, ground and added late), Fen Danpi (Powdered Moutan Cortex) (1.5 qian), Yuquan San (Jade Spring Powder) (1.5 qian, wrapped), Chuan Shihu (Dendrobium Stem) (3 qian), Baimaogen (Imperata Rhizome) (5 qian, heart removed).
Fourth Visit: This time heat is mild and short, only mouth thrush causes pain. Again clearing Stomach heat.
Prescription: Sheng Gancao (Raw Licorice Root) (0.3 qian), Wei Shigao (Calcined Gypsum) (2 qian), Hei Shanzhi (Black Gardenia Fruit) (1.5 qian), Fen Danpi (Powdered Moutan Cortex) (1.5 qian), Guang Huogeng (Broad-leaved Patchouli Stem) (2 qian), Chuan Shihu (Dendrobium Stem) (3 qian), Zhi Banxia (Prepared Pinellia Rhizome) (1.5 qian), Qing Fangfeng (Green Saposhnikovia Root) (0.8 qian).
Fifth Visit: Repeatedly administering cooling Ying and draining heat, heat has retreated but not fully cleared; eyes are still gritty, indicating residual heat.
Prescription: Fen Danpi (Powdered Moutan Cortex) (1.5 qian), Qing Fangfeng (Green Saposhnikovia Root) (1 qian), Guang Huoxiang (Broad-leaved Patchouli Herb) (3 qian), Hei Shanzhi (Black Gardenia Fruit) (1.5 qian), Wei Shigao (Calcined Gypsum) (4 qian, ground), Sheng Gancao (Raw Licorice Root) (0.3 qian), Chao Juhua (Stir-fried Chrysanthemum Flower) (1 qian).
Sixth Visit: Pulse is harmonious and slow. However, urination occasionally still hurts, indicating residual heat is not exhausted. Again clearing and draining to thoroughly remove it.
Prescription: Bang Xi Jian (Slashed Rhinoceros Horn Tip) (0.3 qian), Shu Shigao (Cooked Gypsum) (3 qian), Xi Mutong (Fine Akebia Caulis) (0.4 qian), Cheqianzi (Plantago Seed) (1.5 qian), Gancao Shao (Licorice Root Tip) (0.3 qian), Zhuye Xin (Bamboo Leaf Heart) (12 pieces).