第二期约在五、六日之后，所谓中焦症也。身热更甚、因第一期即身热，神昏谵语、呕千呕哕、或厥逆舌蹇若短面赤目朦、或头面肿、舌苔厚腻而黄、或干裂、或有黑芒刺、咽痛、口渴欲冷饮、腮肿、或关节肿、各症不必皆具但有一二者多。耳聋、此症温病最多，第二期多实邪、第三期则虚邪，不可相混也。鼻衄、腹痛、腹硬满，大便闭，或下利小便短赤、或有沉锭白粉样或小便闭、咏多沉数有力、亦有沉弦而紧小者或洪大而数、身痛、有腿足肿者或咳喘、心烦、或发黄，或发斑疹、凡或字即不一定之词，不可认为各症—-并皆发也，发疹即西医所称发疹窒扶斯。甚则厥逆更甚、通体皆凉、神昏气喘、痞闷烦躁，斑疹并发症，应列于温病内，则治法自无错误。西医既合伤寒温病为一症，统名曰肠窒扶斯，故有发疹窒扶斯之名。余既认定伤寒与温病，确系两病，故将斑疹列入此类也。陷于危笃矣。此期以不大便，或大小便有异状，腹坚硬而痛为断。
第三期约在八、九日或十余日之后，所谓逆传膻中，此时脉多不实，可为明征。故只宜开宣，不宜攻下，若脉见实，则邪在肠，所谓邪入下焦实证，当泻下矣。此期之初，强半由于积热太甚，治疗失当，延误日久而成，其现象率成逆症，约分三项：1.应下不下，温病一见肠热征兆，例如腹痛、小便短赤、或白而浊如米泔水样、大便干燥、或大便少而不爽、或泻极臭之稀屎、或肠鸣、或展转矢气、俗称之屁再证以潮热、口干、或臭舌苔黄．脉实数等症。不必皆具总宜视其病情，此四字最宜细恩，此时必有其他兼症（例如头痛），医者必细察之而后加泻药，于其他药中与之，或缓下或峻下，均宜斟酌尽善，以赴病机也。
及早用泻药下之，温症最忌滥用泻药，认定宜下方用之，不可轻试。凡逆传内闭，多由于此。慎之慎之。失此不下，肠内腐败物（菌）已被吸收，全身血液受其影响。肠热愈甚，渐渐发现第三期之危症。例如下利脓血、四肢厥逆、其则全体皆凉烦躁神昏、痉厥舌短、目合、寻衣摸床状其危也或呕逆不止、滴水皆吐或脉症相反、例如症虽大热，而脉反细小，甚则脉闭。或干热不息、稽留脉现结代、心脏有停止之虞或喘促自汗、或战汗不出，参看前论战汗皆危症也。以上诸症虽危．多属有余实证，应注意。
2．误下，此时期病者体力，因不胜药力屡屡攻伐肠胃，长期消耗，精神气血均已馅于衰弱，毫无滋养及恢复健康之能力。本病毒害，此时早已转变，绝无毒热暴烈之实质的作用，所余者，不过只有残颓不振之余气，与夫稀薄低温之弱血，实邪已退，虚象完成，故此时患者之脉，多现细微或虚数，面色苍白、不腹痛、便溏或下利清谷、或稀水甚或一日数次泄泻、完谷下化小便清白、神衰此与上节不同欲眠，不思饮食、口气寒凉、四肢寒凉、此与上节厥逆不同心中怔忡、此是烦躁之反面或暮热晨凉、自汗盗汗、时时欲脱、或皮肤甲错而干热、此二字宜特别注意、此虚热也。或口燥咽干、津液短也头重头晕、皆虚象或冷汗出、眠时目不能尽合、咳嗽痰喘、有因而诱起帅结核者神气淹淹、衰弱已极。以上诸症，皆属不足，但阳虚阴虚（参看专条），须分清楚，不可慨以虚字含混治之。
3．误治，此由于病势前进中，或误信偏方，或误于医药，当解肌取微汗而不解肌，或病重药轻，或不当下而妄下，或苦降太早，或偏信某医、延误病机（参看医验，以致表里气血，均为邪扰。医者见其头痛、寒热，呕逆、谵语、狂躁、厥逆等症，纷纭杂陈，再误用发散升散之药，例如柴胡或温邪尚在气分过用苦降及消导之药，或过用泻药误下，攻伐无过致令温邪羁滞日久津液劫烁，邪热胶滞膻中，此二字应注意渐渐酿成内闭、外脱之险象。所谓内闭者，温热之邪，日久不解，弥漫胸际，无形无质，清窍蒙蔽，故脉不实，应注意神昏烦躁、痪疚不寐、甚则发狂痉厥、目吊胸挺、角弓反张、舌短脉闭，此种症象，危险已极。此症因温邪由气分入血分，胶滞绵延，不在肠胃是以发散泻下均非所宜。温病死于此阶段者极多，应格外注意也。
（治法）温病治法，与伤寒治法迥异。而在第一期之治法，更与伤寒绝对不同，理论亦异若以伤寒第一期所谓太阳表证发汗之药，例如麻黄、桂枝、羌活、细辛等类，施之于温病之表证，不但无效，必致病势加剧。盖温病第一期初得虽亦多有多有二字应注意，盖此症不必尽有此病象也。恶寒、头痛、身痛等，类似伤寒之表证，然其内热先伏，此种表证，不过外为气候诱因，气候变动异常，所谓风、寒、暑、湿、燥、火之类六气之说，只作如是解，不可太粘滞，人当过劳之时，尤易感染时邪，亦为诱因之一，此义与冬不藏精，春必病温之说，亦隐隐相通，医者读书，须心领意会，不可拘泥文字。以致发动内蕴之热。其表证，直可谓之副症，以温症先有内热，则宜以内热为本病。万不可视同伤寒之表证病理。寒伤于外，治不得法，体温不能放散调节，因而郁为内热。（参看伤寒条）故温病唯一治法，初得之时，人手即须注重内热二字。此第一期之内热，指肺热言，指气分言，稍久至第二期、三期，则指心包络（膻中）及血分、胃与肠言之。中医分辨颇精详，可以参考，但不可信其太玄虚者。然初得之时，若兼有表证，例如恶寒身痛只治内热绝难收效。若稍有类似之表证，不论何季总宜于清轻芳香解热药中，例如连翘，金银花，桑叶、菊花、竹叶、夏枯草、佩蓝叶、鲜茅根之类。加入清凉发散药品。例如葛根，芥穗、防风、薄荷、白芷、藿香之类。使其外来之邪，即诱闽，例如偶感风寒、秽气。先自解散，取微汗内蕴之热，此时但肺热，肠胃尚未大热，应注意，同时亦渐因清扬宣透而随之渐渐蒸发以去，此时内热，可作热气二字解，自知秽浊气感之理。自然表里双清，约二、三剂即愈绝不致演成第三期之肠热及内闭之重症。中医芳香去秽之说，最为可倍，中医谓肺之呼吸，感受秽浊及各种不正之气，因而病温。是以上焦气分先病，（参阅肺循环条）论极精当，但此秽浊二字，亦不可太拘泥。例如南中深山，桂花落后，郁霉蒸发，气味芬芳，香闻十里，闽粤山中，尤多此气，土人渭之佳花瘴。凡感受此气，立时头疼发热，其症与温病无异，所谓山岚瘴气，即指此类。故余以为此症所称秽浊之气，不可作臭气解，凡不正之气（六气）皆包括也。故芳香轻散清凉药品，均极有效。西药中之芳香调味药绝无效，不可误解芳香二字。盖此种药品，不仅利用药之芳香，且必兼有轻扬、——煮即沸清凉两功用者，方为妙用，若只知芳香二字，则误人矣。又中医书内有用桂枝汤治初起恶寒之温症者，此药决不可用，兹特表而出之，以免贻害病人也。此从历试而知，绝非臆断。古书中对第一期温病有用人参之说，所谓劳倦内伤复感温邪亦断不可以，其当归、阿胶、海参等药，亦不可用。盖时邪泛指风、寒，暑、湿而言虽系因劳倦感受，例如苦役远行、劳力工作或长途旅行，饥渴过甚之类。医者若见其脉现虚象，即于治温病方中加入人参…—味，全身毛孔必致立时关闭，可使温邪逆传，内闭危症致人死命。虽有良医，恐亦无法倪救英。服人参未久，如见险象，可令病人恣食白萝卜汤，约一昼夜可解，此治药误，非治病也。余曾亲见因长途跋涉，感受温邪，误服人参，而致不救者，不知凡几，固不在第一、第二期也。余戚某十八岁，由城内赴其外家，骑自行车，于烈日下约行四十里，因而得病，大汗大渴大热。其舅某，因知医者，团与白虎加人参汤，——剂汗止而神昏谵语，身热更甚。某医又谓系表证，与以发汗药，病更危。又延某西医，渭当下而呕吐不能服药，乃以灌肠法通其大便，凡十日而死。余亲见其—误再误：不能救也。然推其致命原因。实由于—剂人参，遂今外感之时邪，无法解其束缚，内蕴之实热，无法宣透疏通，遂致酿成种种逆症，不可救药矣，古方之不可尽信如此，学医者须知也。今举例证明，可见人参为绝对禁用品矣。
第二期之治法，本症所称第二期，系指病情演变，当然顺序之现象而言。并非—-定经过二期方至三朗（例如肺痨病）之谓，例如本病第一期误治，日期稍久（约六、七日）即可变为痉厥逆症，此症即中医所谓足厥阴症（邪入下焦）应入第三期，即应照第三期治法治之。盖本症之分三期说明者，系按病之轻重言，与巾医分三焦之说，绝无关系。例如危笃之肺炎，温病中常有之并发症，岂可只云中焦，肠出血及穿孔亦为温病恒有之危症，岂可只云中焦，至中医所谓少阴、厥阳等下焦症，则又强半牵及于肋之症状，更不叮以肝脏云云，属之—卜焦。故余对此症，只以轻重而分其阶段，不以三焦论症，反致眩惑。其中参以西医生理病理，而又采取中医对本病之精当论断及方法，合而为一，似较适合实际，而又不失中医对此症之特长。只以节省文字之故，对每-一症状及治法，不能一一详细说明中西医之所以然，及以经验所得，比较中西医之短长，俾读者根本了解奉病之真缔，是则殊为遗憾者也。例如温病神经系统之特有现象，西医书因为神识朦胧，强度重听，病势渐进，患者对外界之反应愈钝，且发谵妄，或则狂躁不安，（敏捷性神经热）或则静卧无欲。（迟钝性神经热）然中医则分别此二种之神经病状，为一虚一实。故其说曰神倦换疚，（西医谓之腱跳动，亦为本症之一，神倦欲眠，邪羁少阴，但欲寐，郑声等皆属温病中之虚症，治宜急救津液，以防目闭痉厥。（由少阴延及厥阴）又曰谵语、发狂、脉不实，属心包络，不痪疯，但神昏，下利．澹语咏实，（属肠胃实）皆属温病中之实证，治宜分别开窍及攻下，以逐实邪。而虚证之中，又分阴虚，阳虚，实证之中，又分肺与心包及胃肠，并气分、血分，不能含混论治。（寻衣摸床等现象属绝症）此中西医对本病之脑症状（甚则并发脑暎炎）立论之大概也。考西说对于本症之脑症状，列为必有现象，而治法则殊，缺乏特效药品，故一遇是症，并发脑膜炎，则已无用武之馀地矣。况不分虚实，只以神经热目之，究竟对于迟钝性与敏捷性之神经热，有无对症良药，至今仍未之闻。此时若听其病势进行，必致愈演愈进，不陷于危笃而不止，此非西医医理之不精，实由于药物缺乏，不能以对此症有效之良药，佐医者之治疗；不能不有此缺点。是以此症之神经症状，西医讲解虽极精当，治疗上则尚无相当药品，可断言也。此段文字，专研中西医对温症中之神经症状及治法，简单说明，已觉太冗。是以本编论症，不能一一比较中西医之对某病之所以然，亦著者之遗憾也。可视热之深浅，酌定用药之标准。盖此时温邪，已半入胃肠，所谓中焦不可专用轻清之品，例如第一期药在正规之第二期温症，若肠热症热结旁流，或大便闭，小便短赤，腹痛，潮热，谵语，舌苔黄厚，脉沉实而数。尚未十分显露，但见大热口渴，此时头或痛或晕，或身痛，或肢肿，不可认为表证，咯与缓下或清血热，有特效。痰涎壅盛，呕恶，神昏烦躁，或自汗等症，只宜酌与芳香辛开或苦寒、甘寒之药参看医验均有奇效。此时立方，大宜注重轻清芳香之品，例如连翘、双花、石菖蒲、郁金、橘红、桑叶、绿豆皮等，希望热从外减，内毒亦轻，若呕逆过甚，黄连、黄芩，亦必用之，但不可尽用苦寒下降之药耳！均可酌量用之。此时期亦间有患关节肿、头面肿者，可于上列药品中，加入泻下药。例如大黄、瓜蒌等。表热太高时，亦可酌用西药阿斯比林及撒曹等退热剂，无不大效。但此时期中，固不赖于西药．若遇中药退热太缓时，可以用之。
第三期之治法，约分三种：①①②③三项下，应与症候条下对照，兹不重叙，以省文字。此应斟酌其内热此时外感亦系内热所致，不可误为表证。程度，与以芳香、辛开、苦降之品，以为本期之主药，然此时病已渐危，于主药中，又必视其现症及咏象，咏现虚象亦不可加入补药加入各种辅佐之药。例如咳嗽痰喘，加杏仁、橘红、有谓此药不宜用者，不必信也。贝母、白茅根；必重用之下利脓血太甚，加芒硝、川军、慎用黄芩、黄柏、白头翁以及枳实、木香槟榔丸等，均可酌加；小便短赤，加通草；肠胃积滞太甚而体弱者，加木香梹榔丸，较大黄、芒硝为和平，宜注意；呕逆太甚，加黄连、竹茹、黄芩、蔻仁；大渴口干唇裂，加天花粉、生地、麦冬；皮热甚，加丹皮、绿豆皮；烦躁神昏发狂，加犀角、紫雪丹、牛黄清心丸，均为对症有效之品。此时亦有头痛，只宜用菊花、薄荷清上焦之药，不可发汗。惟战汗将作参看前论战汗不可乱与服药。
The second stage occurs approximately five to six days after onset, known as the Middle Jiao syndrome (Middle Burner Syndrome). The body heat becomes more severe (since fever was already present in the first stage), accompanied by coma and delirium, dry heaving or hiccups, or cold extremities, stiff or shortened tongue, red face, and blurred vision; or swelling of the head and face, thick and greasy yellow tongue coating, or dry and cracked tongue with black prickles, sore throat, thirst for cold drinks, swollen parotid glands, or joint swelling. These symptoms do not necessarily all appear, but having one or two is common. Deafness is most frequent in warm diseases. The pathogenic factors in the second stage are mostly excess (Shi) patterns, whereas those in the third stage are mostly deficiency (Xu) patterns; they must not be confused. Epistaxis, abdominal pain, abdominal hardness and fullness, constipation, or diarrhea with scanty dark-red urine, or discharge resembling white powder sediment, or urinary retention. The pulse is mostly deep, rapid, and forceful, but may also be deep, wiry, tight, and small, or surging, large, and rapid. Body pain, leg and foot edema, cough and asthma, irritability, jaundice, or maculopapular rash. The word "or" indicates possibility, not certainty; one should not assume all symptoms occur simultaneously. Maculopapular rash corresponds to what Western medicine calls Typhoid Fever with rash. In severe cases, cold extremities worsen, the whole body becomes cold, coma and asthma, chest oppression, and irritability occur. Complications of maculopapular rashes should be categorized within warm diseases, ensuring correct treatment methods. Western medicine combines Shanghan (Cold Damage) and warm diseases into one condition, collectively named Enteric Fever (Typhoid), hence the term Typhoid with Rash. Since I firmly believe Shanghan and warm diseases are distinct entities, I classify maculopapular rashes here. This leads to a critical state. This stage is judged by constipation, abnormalities in bowel movements or urination, and hard, painful abdomen.
The third stage occurs approximately eight to nine days or ten-plus days later, referred to as "reverse transmission to the Pericardium (Shanzhong)." The pulse is mostly deficient, which serves as clear evidence. Therefore, only opening and diffusing methods are suitable; purgation is contraindicated. If the pulse is excess, the pathogen is in the intestines, constituting an excess pattern of the Lower Jiao, requiring purgation. The beginning of this stage is often due to excessive accumulated heat resulting from improper treatment and delay. The manifestations usually form adverse syndromes, roughly divided into three categories: 1. Failure to purge when indicated. Upon seeing signs of intestinal heat in warm diseases, such as abdominal pain, scanty dark-red urine, or turbid white urine like rice water, dry stool, infrequent and unsatisfactory defecation, extremely foul-smelling loose stools, borborygmus, or passing gas, combined with tidal fever, dry mouth, halitosis, yellow tongue coating, and excess-rapid pulse. Not all symptoms need be present; one must always assess the specific condition ("assessing the condition" requires careful thought). There will likely be accompanying symptoms (e.g., headache). The physician must observe carefully before adding purgatives to other medications, deciding between mild or strong purgation to suit the disease mechanism.
Early use of purgatives is crucial. Warm diseases strictly forbid the abuse of purgatives; they should only be used when clearly indicated, never lightly tested. Reverse transmission and internal closure often result from this caution. Be extremely careful. Missing this window allows intestinal putrefactive substances (bacteria) to be absorbed, affecting the entire blood system. Intestinal heat increases, gradually revealing critical third-stage symptoms. Examples include dysentery with pus and blood, cold extremities progressing to whole-body coldness, irritability, coma, spasms, short tongue, closed eyes, and picking at bedclothes—a very dangerous state. Or unceasing vomiting where even water is rejected. Or pulse-symptom mismatch, e.g., extreme heat but fine or hidden pulse. Or persistent dry heat with knotted/intermittent pulse, risking cardiac arrest. Or panting, spontaneous sweating, or failure of shivering sweat (see previous discussion on shivering sweat as a critical sign). Although these critical signs often belong to excess patterns, attention is required.
2. Improper purgation. By this stage, the patient's physical strength has been depleted by repeated attacks on the stomach and intestines, leading to exhaustion of spirit, Qi, and blood, leaving no capacity for nourishment or recovery. The viral harm has transformed; there is no longer violent toxic-heat excess. Only residual weak Qi and thin, cold blood remain. Excess pathogens have retreated, and deficiency patterns are complete. Thus, the pulse is often fine or deficient-rapid, complexion pale, no abdominal pain, loose stools or watery diarrhea with undigested food, clear urine, mental fatigue, desire to sleep, anorexia, cold breath, cold limbs (distinct from the cold extremities in section 1), palpitations (the opposite of irritability), evening fever/morning coolness, spontaneous or night sweats, sensation of impending collapse, rough/dry skin with dry heat (note: this is deficiency heat), dry mouth/throat (fluid deficiency), heavy head/dizziness (all deficiency signs), cold sweat, inability to fully close eyes during sleep, cough with phlegm/asthma, potentially inducing tuberculosis, extreme weakness. All these indicate deficiency. However, Yin deficiency and Yang deficiency (see specific articles) must be distinguished; do not treat vaguely under the label of "deficiency."
3. Mismanagement. During disease progression, trusting folk remedies or medical errors can lead to issues. If muscle-releasing methods with mild sweating were not used, or if the medication was too light for the severity, or purgatives were used inappropriately, or bitter-cold downward-draining herbs were used too early, or reliance on a specific doctor delayed treatment (see medical cases), causing exterior-interior and Qi-blood to be disturbed by pathogens. Physicians seeing headaches, chills/fever, vomiting, delirium, mania, and cold extremities might mistakenly use dispersing and ascending drugs like Chai Hu (Bupleuri Radix), or overuse bitter-cold downward-draining and digestive aids while the warm pathogen is still in the Qi level, or overuse purgatives. This excessive attack causes the warm pathogen to linger, consuming fluids, and allowing pathogenic heat to stagnate in the Shanzhong (Pericardium). Note these two characters. This gradually酿sces dangerous signs of internal closure and external collapse. Internal closure refers to warm-heat pathogens lingering unresolved, filling the chest, obscuring the clear orifices without form or substance, resulting in a non-excess pulse. Note signs like coma, irritability, spasms, insomnia, madness, convulsions, upward-gazing eyes, rigid torso, opisthotonos, short tongue, and hidden pulse—extremely dangerous. Since the warm pathogen moves from Qi to Blood levels and stagnates rather than residing in the intestines, dispersing and purging are inappropriate. Many die at this stage; extra caution is needed.
(Treatment Methods) The treatment of warm diseases differs significantly from Shanghan. The first-stage treatment is absolutely different from Shanghan, both theoretically and practically. Using Shanghan first-stage exterior-releasing drugs like Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Qianghuo (Notopterygii Rhizoma), or Xixin (Asari Radix) for warm disease exterior patterns is ineffective and exacerbates the condition. Note the phrase "often has": not all symptoms are present. Chills, headache, and body pain resemble Shanghan exterior patterns, but internal heat is latent. These exterior signs are merely triggered by climate changes (Wind, Cold, Summerheat, Dampness, Dryness, Fire—the Six Qi). Do not be too rigid. Overwork makes one susceptible to seasonal pathogens, another trigger. This aligns with the saying "if essence is not stored in winter, warmth diseases strike in spring." Physicians must understand the meaning, not just the text, to avoid stirring up internal heat. The exterior pattern is secondary; internal heat is the primary disease. Do not view it through the pathology of Shanghan exterior patterns. External cold mishandled leads to trapped internal heat (see Shanghan articles). Thus, the sole method for warm diseases at onset is focusing on internal heat. First-stage internal heat refers to Lung heat and Qi level. Later stages refer to the Pericardium (Shanzhong), Blood level, Stomach, and Intestines. TCM differentiation is precise; reference it but avoid overly mystical interpretations. If exterior signs like chills and body pain coexist, treating only internal heat is ineffective. If slight exterior-like signs exist, regardless of season, add cooling-diffusing agents like Gegen (Puerariae Lobatae Radix), Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Bohe (Menthae Haplocalycis Herba), Baizhi (Angelicae Dahuricae Radix), or Huoxiang (Agastaches Rhizoma) to light-aromatic heat-clearing herbs like Lianqiao (Forsythiae Fructus), Jinyinhua (Lonicerae Japonicae Flos), Sangye (Mori Folium), Juhua (Chrysanthemi Flos), Zhuye (Bambusae Folium), Xiakucao (Prunellae Spica), Peilan Ye (Petasitis Folium), or Xian Maogen (Imperatae Rhizoma). This disperses external triggers (e.g., wind-cold, foul air) via mild sweating. Internal heat (initially Lung heat, intestines not yet hot) evaporates with clearing and diffusing action. Internal heat here means "hot qi," explaining the logic of foul air infection. Naturally, interior and exterior are cleared simultaneously. Two to three doses usually cure it, preventing progression to third-stage intestinal heat and internal closure. TCM's theory of aromatic herbs removing foulness is highly valuable. TCM states lung respiration absorbs foul/unwholesome qi, causing warm diseases, starting in the Upper Jiao Qi level (see pulmonary circulation). This is accurate, but "foulness" should not be interpreted too literally. For example, decaying osmanthus in southern mountains emits fragrant mold vapors ("good flower miasma") in Fujian/Guangdong mountains. Exposure causes immediate headache and fever, identical to warm diseases (mountain miasma). Thus, "foul/unwholesome qi" includes all abnormal Six Qi, not just bad odors. Aromatic, light, diffusing, and cooling herbs are effective. Western aromatic flavorings are useless; do not misunderstand "aromatic." These herbs must possess light-diffusing and cooling properties (boiling off easily). Relying solely on aroma misleads people. Guizhi Tang should never be used for initial chills in warm diseases, as proven by experience, not speculation. Ginseng (Renshen), Danggui (Angelicae Sinensis Radix), Ejiao (Colla Corii Asini), and Haishen (Holothuria) are also contraindicated for first-stage warm diseases, even if caused by fatigue-induced susceptibility (e.g., long travel, hunger/thirst). If a deficiency pulse appears, adding Renshen closes pores instantly, causing reverse transmission and fatal internal closure. Even good doctors cannot save them. If danger signs appear after taking Renshen, drink abundant white radish soup for a day to resolve the drug error, not the disease. I have witnessed many deaths from this mistake, not limited to the first or second stages. My nephew, aged 18, cycled 40 li in the sun, developed profuse sweating, thirst, and high fever. His uncle, a doctor, gave Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng). One dose stopped sweating but caused coma, delirium, and worse fever. Another doctor treated it as an exterior pattern with diaphoretics, worsening the condition. A Western doctor suggested purgation, but vomiting prevented oral intake, so enemas were used. He died after ten days. I witnessed double mismanagement; he could not be saved. The fatal cause was the single dose of Renshen, trapping the external seasonal pathogen and blocking internal excess heat, leading to irreversible adverse syndromes. Ancient formulas cannot be blindly trusted; students must know this. This example proves Renshen is absolutely contraindicated.
The second-stage treatment refers to the natural sequence of disease evolution, not a fixed timeline like consumption (TB). If the first stage is mistreated for 6-7 days, it may become a spasm/cold-extremity adverse syndrome, classified as Foot-Jueyin syndrome (pathogen entering Lower Jiao), entering the third stage and requiring third-stage treatment. The three-stage division here is based on severity, unrelated to the TCM Sanjiao (Triple Burner) theory. Critical pneumonia, a common complication, is not just Middle Jiao. Intestinal bleeding/perforation, also critical, is not just Middle Jiao. Shaoyin and Jueyin Lower Jiao symptoms often involve the Liver, not Upper Jiao. Thus, I divide stages by severity, avoiding Sanjiao confusion to prevent bewilderment. Integrating Western physiology/pathology with TCM diagnoses/methods seems practical, preserving TCM strengths. To save space, I cannot detail every symptom/treatment rationale or compare中西医 pros/cons thoroughly, which is regrettable. For instance, Western medicine describes nervous system phenomena in warm diseases: clouded consciousness, severe deafness, progressive dullness, delirium, restlessness (agitated neural fever), or quiet lethargy (sluggish neural fever). TCM distinguishes these as deficiency vs. excess. "Spirit fatigue and twitching" (tendon clonus in Western terms) with desire to sleep indicates pathogen lodging in Shaoyin (but desire to sleep, Zhengsheng)—deficiency patterns in warm diseases. Treatment should urgently preserve fluids to prevent eye closure and spasms (progressing from Shaoyin to Jueyin). "Delirium, madness, non-excess pulse" belongs to Pericardium; no spasms, but coma, diarrhea, delirium with excess pulse (intestinal excess)—excess patterns. Treatment requires opening orifices or purging to expel excess. Deficiency patterns split into Yin/Yang; excess patterns split into Lung/Pericardium/GI, Qi/Blood levels. Do not treat vaguely. (Picking at bedclothes is a terminal sign.) This summarizes Western and TCM views on cerebral symptoms (even meningoencephalitis complications). Western medicine lists cerebral symptoms as mandatory but lacks specific treatments; once meningitis complicates, options are exhausted. Without distinguishing deficiency/excess, viewing it merely as "neural fever," there is no known specific remedy for sluggish/agitated types. Allowing progression leads to critical states. This is not due to poor Western theory but lack of effective drugs. Thus, while Western explanation of neurological symptoms is precise, treatment lacks adequate drugs. This paragraph on neurological symptoms is already lengthy; comparing中西医 rationales for every disease is regrettably omitted. Assess heat depth to determine medication standards. At this stage, the warm pathogen is half in the GI tract (Middle Jiao); do not use only light-clearing herbs like those for the first stage. In standard second-stage warm diseases, if intestinal heat presents with "heat binding with side-flow" (liquid stool around impaction), constipation, scanty dark urine, abdominal pain, tidal fever, delirium, thick yellow coating, and deep-excess-rapid pulse, but these are not fully manifest—only showing high fever and thirst, with possible headache/dizziness, body pain, or limb swelling—do not treat as exterior pattern. Mild purgation or blood-cooling herbs have special effects. For copious phlegm, nausea/vomiting, coma/irritability, or spontaneous sweating, use appropriate aromatic-acrid-opening or bitter-cold/sweet-cold herbs (see medical cases for miraculous effects). Prescriptions should emphasize light-aromatic herbs like Lianqiao, Shuanghua (Jinyinhua), Shichangpu (Acori Tatarinowii Rhizoma), Yujin (Curcumae Radix), Juhong (Citri Reticulatae Pericarpium), Sangye, and Lv Dou Pi (Phaseoli Semen Testa) to reduce external heat and internal toxins. If vomiting is severe, Huanglian (Coptidis Rhizoma) and Huangqin (Scutellariae Radix) are necessary, but do not rely entirely on bitter-cold downward-draining herbs. Use as appropriate. Joint or head/face swelling may occur; add purgatives like Dahuang (Rhei Radix et Rhizoma) or Gualou (Trichosanthis Fructus) to the above. If exterior heat is too high, aspirin or acetaminophen (Sa Cao) can be used effectively, though reliance on Western drugs is not preferred; use only if Chinese herb cooling is too slow.
Third-stage treatment is roughly divided into three types: Items 1, 2, and 3 below correspond to the symptom section; repetition is omitted to save space. Assess the degree of internal heat (external sensations here are also caused by internal heat; do not mistake for exterior patterns). Use aromatic, acrid-opening, and bitter-cold descending agents as main drugs. Since the disease is critical, auxiliary herbs must be added based on current symptoms and pulse. Even if the pulse shows deficiency, do not add tonics. For cough/phlegm/asthma, add Xingren (Armeniacae Semen Amarum), Juhong; ignore claims that these are contraindicated. Bei Mu (Fritillariae Bulbus), Baimaogen (Imperatae Rhizoma) should be heavily used. For severe dysentery with pus/blood, add Mangxiao (Natrii Sulfas), Chuanjun (Dahuang); use Huangqin, Huangbai, Baitouweng, Zhishi (Aurantii Fructus Immaturus), and Muxiang Binglang Wan cautiously. Add Tongcao (Tetrapanacis Medulla) for scanty dark urine. For severe GI stagnation in weak patients, add Muxiang Binglang Wan (milder than Dahuang/Mangxiao). For severe vomiting, add Huanglian, Zhuru (Bambusae Caulis in Taenia), Huangqin, Kouren (Amomi Fructus Rotundus). For extreme thirst, dry mouth, cracked lips, add Tianhuafen (Trichosanthis Radix), Shengdi (Rehmanniae Radix), Maidong (Ophiopogonis Radix). For intense skin heat, add Danpi (Moutan Cortex), Lv Dou Pi. For irritability, coma, madness, add Xijiao (Rhino Ceratoss), Zixue Dan (Purple Snow Pill), Niuhuang Qingxin Wan (Calculus Bovis Heart-Clearing Pill)—all effective symptomatic treatments. Headache at this stage should be treated with Ju Hua (Chrysanthemi Flos) and Bohe to clear Upper Jiao; do not induce sweating. When shivering sweat is about to occur (see previous discussion), do not administer medication indiscriminately.