第一方，连翘三钱竹叶二钱银花三钱芥穗钱半香豆豉钱半绿豆皮四钱姜引。服此方后．并未见效，虽得微汗，而恶寒仍然，第二日，脉洪数，余症同前，乃照前方加菊花、天花粉、栀子与服。服后约三点钟，全吐，第三日病势更加，已三日未大便，头痛如蒙、精神昏迷、舌苔厚渐黄、口渴、呕逆、腿足痛肿更加、脉数、仍恶寒。病势颇重，乃议于辛凉解表诸药之中，加入滋阴苦降之品。四月十日第三方。连翘四钱竹叶二钱花粉三钱银花三钱芥穗二钱鲜生地三钱桔梗一钱熟军一钱寸冬二钱薄荷钱半藿香三钱黄芩二钱鲜苇根三钱引煎服，不必取汗。服前方得大便一次，诸症均大减，恶寒已去（并未取汗），最见奇效者，为病者之头痛如蒙及精神昏迷之症状皆退，左腿尚肿痛。余症均轻减，病势遂有顺利希望，然尚不能起床。
十一日照前方去熟军，加滑石二钱，栀子二钱，服后，不如第三方之效。十二日加泽泻一钱，亦不如第三方之效。十三日．乃仍以第三方与服，立见大效，遂照原方连服三剂，腿肿亦消，治疗约十余日，诸症完全告愈。
此症虽为单纯之春温，然治不得法，必致逆传，颇有研究之兴味，故录之。第一即在初病之时，本非重症，患者因余不受诊费，不肯再延复诊：是以勉强告愈。以后遂未服药，迨至二十余日之后，余热酝酿又发，则其内热已久，虽云事隔月馀（着眼在此），实已不得渭之新病。盖蕴热月馀，其体内血液。早巳不清，是以腿及足骨节皆肿甚，然证以恶寒，则又不可忽略其表邪。第一次方，服之未效，余颇疑不宜用解表之药，然余实确知此症，逆传紧要关键，多由于当解肌而不解肌必致外闭，轻则肢厥，重则通身皆凉。当降不降，或误降，亦必致内闭，轻则谵语发狂，重则痉厥窍闭。然只与解叽，只与降下，流弊亦大。解肌之中仍宜佐以清凉芳香宣扬之品，以宣肺气，苦降之中更宜佐以养阴滋润之品，以护阴液。而后在里之蕴热，不致因解肌而化燥，在表之实邪，不致因苦降而内陷，此本病第三方表里双解之所以大有奇效，稍有加减便不妥贴也。余当第一、二两方用解表药不效，第三方诊断时颇犹疑，余思此症恶寒显然，何以解表而病势不减，是必由于—月前之伏热胶滞既久，其内热之实邪已十倍于外感之表证。此时法取苦降，稍稍照顾表邪，自必内热一退．而表邪亦解。况内热之极亦有恶寒，医者须知此病理，不可固执凡有恶寒皆表证也。又此君习惯，服熟大黄一钱，必便通，故只用一钱，微通其便。此症有效主要之药，即大黄、黄芩、生地，麦冬，而大黄、黄芩尤为重要之品，其馀虽系辅佐之药，亦均有妙用。盖既佐以芥穗、连翘、薄荷等辛凉解叽之品，微解其表，以防在外之邪，因其恶寒太甚因用大黄等苫降而内陷，又佐以银花、竹叶清轻芳香去秽之品，以防固苦降太甚，反与弥漫上焦气分之邪，以入心包络之引诱，佐以生地、寸冬等清热滋阴之品，以防因用苦降与解肌，反致潜伏血分之邪，得以化燥，而逞其胶滞顽固之实热，此立方之精义也。幸而立着大效，——如所期，故敢坦白报告，以告学者，此症此际，可轻可重，-一药关系，极其微妙，愿学者于此等分际，思过半矣。第三方稍为更动，立即效验大减，学者应特别注意，此症无沦若何恶寒，绝对禁用麻黄、桂枝、柴胡，即羌活、独活等，亦绝对禁用。倘犯此禁，一剂神昏．渐即逆传，古书谓温症忌汗，应作如是解。杀人如反掌也，戒之戒之。
丁君五十三岁，住阜城门内东廓下四号，人力车夫，于二十六年十二月三日来诊。舁入诊室，喘促支离，已至危险。据其弟云，病已月余，初病系由南苑拉车至城内，大汗又饮凉水，遂病倒。经数医诊治，未愈，现在医者皆辞不治。余见病者目呆口开，喘促昏沉，唇裂若有血痕，面目枯槁黧黑，问其所苦，不能自答，诊脉，右寸关细数已极，两尺脉及左手脉均停，而肌肤枯燥，犹干热不退。幸有此耳，若现厥逆必死。据其弟称，以前病状，发烧、身痛、大渴，现在大便尽泻血水，小便极少，亦如血水，发烧仍然，夜内盗汗、不寐、心神恍惚、口渴，询以前医治疗情形及服何药？已不能记忆，此本症已往之经过也。
佘认此症为温症第三期，肠出血之甚者中医所谓劳倦内伤，复感温病，指初得病而言热邪深入卜焦，中医所谓少阴、厥阴症，即西医所谓脑症状及肠出血也。阳亢阴竭，病虽月馀，阴血虽亏而实邪仍在。着眼在此四字学者注意但病已垂危，用药颇觉棘手，补泻两难不忍不救，爰为处方如下：先与甘汞锭三个。每个含量0.2克嘱其先服—个，隔三点钟，再服一个，视其大便所下何样如仍泻血水，隔三点钟，再服一个。约自午前八点，于午后五点服完。如服第二个，所泻之物，已非血水，则停止第三个，不必再服．并嘱多饮白水。甘汞药量极小，因病者衰弱已极故也。又与中药方一个，嘱其夜内十二点钟煎妥服一次．第二日早晨再服一次，中药不可与甘汞同时眼用，必须隔开八、九点钟方好。第二日午前十二点钟．再来诊治；第一方，鲜生地四钱杭白芍三钱天花粉三钱菊花二钱寸冬二钱元参三饯竹茹二钱鲜茅根二钱引煎服，又配与竹叶露、鲜生地露、银花露一瓶，嘱其随时兑水饮之．渴则饮此，不拘次数。
第二日来诊，据云服甘汞锭至第三个后，约午后八点钟时，大便泻下粘滞，如黑豆油状之物甚多，小便由深赤色变黄色，仍短．口渴身热稍减，仍自汗，喘促．据病者自称诸症觉减轻．诊脉如前仍细微，精神略清醒。乃以急救阴液论治，与下方：第二方，干地黄四钱生白芍三钱元参三钱麦冬三钱花粉二钱沙参三钱生牡蛎二钱黄芩二钱丹皮三钱鲜竹叶二钱鲜茅根三钱引，煎妥分二次眼，仍配与鲜竹叶露、鲜生地露、鲜银花露一瓶，嘱其照前法饮用。十二月十日来诊，已能起立．前方共服五剂，诸症大碱，热亦渐退，自觉腿痛极甚，此系得病之先，长途拉车劳伤，至此始显，每日能进稀粥．小便渐多，舌苔黄，但稍见润泽，精神已清醒．诊脉左右手均见，但仍沉细微数，仍以滋阴养血立议。与下方：第三方，干地黄叫钱大沙参三钱生牛膝三钱生白芍五钱当归身二钱玉竹二钱天花粉二饯白茅根二钱引，煎妥分二次服，此药共服六剂。
二十二日宋诊，已能步履，诸症巳痊愈，腿微痛，脉渐和平，一息六至，但有时一止，此心脏仍未健康之现象，饮食亦加。但有虚汗，稍活动则喘汗，且有发热之倾向，乃以滋阴大意制膏剂，嘱令常服，约一月馀，完全恢复健康矣。
第四方，膏利干地黄二两知母一两丹皮一两生鳖甲—两生牡蛎二两青蒿五钱寸冬—两白芍—两加蜜炼膏。每服一小茶匙，一日三次：开水化服。此膏一料，约服—月。
此一例在温热病中，为较重之症．其前半治疗经过，无从查考。然此病者家甚贫，想其得病之初，未必及时延医诊治，迫至病势加重，延医治疗，亦恐不能按时服药，以致汗下、清凉，均失病机。温热郁久，津液大耗，而在内之实邪，仍未尽去，是以余接治之初，一经缓下，病势力减。但此症现象，若仅拘泥于脉象，万无再下之理，然实邪仍在，肠之穿孔，已有可疑，若只与以滋阴之品，势必助其胶滞，无济于事。若只与缓下，则实邪虽减，真阴愈亏，不但虚热可虑，且恐因此消耗，骤然发生心脏停止之险。以其咏太危险故余不敢用大黄，以此药刺激肠胃，且泻后又有收缩性也。亦不敢用蓖麻子油，以病者汤水已难下，此药殊不适口，且以余之经验，屡见有虚热已极，服此药骤然心脏停止者，此例亦不少。考药物学，此药极和平，此盖因其滑泻太甚，对于心脏衰弱者，大有不良影响欤！余惟恐略知西药梗概者，妄用西药，发生危险，故不厌详细说明。此种脉象，若用阿斯比林等退热，祸不旋踵，此又不可不注意者也。此种分际，以用中药麻仁、蒌仁等为缓下润肠剂，比较稳妥，然蒌仁过用，亦能重泻，麻仁效较缓，故加减复脉汤中采用之，然不如用甘汞之效确实而速，故以此缓缓消息之。而又以大剂滋阴中药，以救济之，是以得获痊愈。此人幸是贫苦，若在宽裕之家，初感温邪，及时延医诊治，遇有谨守古法之医者，必以劳后感温四字为铁板注脚，必用人参。一剂之后．周身毛孔皆闭，杀人之祸，即基于此，虽有智者，无以善其后矣。用中药必讲中医之医理，用西药必讲西医之医理，不可渭中药之泻药，即西药之泻药。此症中医滋阴之说，精妙绝伦：其药亦确实有效，当此干钧——发之际，实不能不推中医药为独步。设使此症用甘汞得效后，再以西药继续治疗，余不知以用何法为有特效，强心剂耶？退热剂耶？清凉剂耶？强壮剂耶？余于四十年前恒用之，至今日余敢断言，均不及中药之滋阴和平有效也。余希望中西两医，互济为用。各保其独立之特长，而渐进于世界完善之医学．以造福于人类，当有谅余言者。此症完全施诊施药，病愈后赠余茶叶一盒、酒两瓶，古道犹存。于此证之，愿我医者常存此心也。
何春元，六十二岁。德州纪庄卢文肃公家农户。民国元年八月，余适至卢府，患者与余素相识。是日余正进早餐，忽闻侍者告余曰，何浪堂将死矣，盖患者乳名浪堂，人皆习惯呼之。余闻之极惊讶，乃驰往其家诊视：至则患者六脉俱闭。目瞑舌缩。两手撮空，喘息急促，已易篑矣。无法诊察．无从施水，仅问其家族，据云患者初病之时，头痛．身痛，乡间医药不便，仅用红糖姜水发汗，以后即发烧、呕吐、大渴、耳聋，嗣即渐浙谵语，发狂、头痛、呕吐更甚。延医诊治，泻下数次，药方已无，不知所用何药，以意度之，盖泻药也。以后即狂躁更甚，不省人事，药入即吐，自得病至此，已二十馀日，医者均辞不治．此本病已往之经过也。
余认此症为温病第三期极危之候，中医所谓。温邪逆传心包络，窍闭昏痉之内闭外聣是也。脑膜炎并发症乃本中医学说，与以芳香逐秽开窍之品，以冀化其久滞膻中之热邪，又以病者距城二十馀里恐购药需时，先以随带之紫雪丹一钱，用鲜竹叶以院内适有丛竹水化灌眼：又用平安散纳入鼻内取嚏（并未得喷嚏），并令速将殓衣除去，乡俗濒死，必服棉衣，此时室内既热，病者表亦发热，故令去之。约三时余，病者目渐转动，嗣服中药一剂，用小茶匙灌—昼夜方完。如下第一方，鲜薄荷三钱石菖蒲四钱金银花二两黄芩二钱连翘一两川连二钱吴萸炒郁金三钱佩兰三钱犀角二钱橘红—钱鲜竹叶一两煎妥后化入牛黄清心丸二粒。用井白凉水乡中无冰将药隔杯镇凉，以小茶匙频频灌入病者口中，并将病床上头略垫高，令病者仰卧，上半身令稍高．时时抚摩病者颈喉部，使药水容易下咽。至第二日下午，渐渐能自咽药，而口眼亦能自动，夜间能语。呼渴，屡次饮水，一夜极多，余药亦—次饮下。第三日晨，精神渐清，又延余诊，处方如下：第二方，佩兰三钱犀角一钱石菖蒲五钱川连一钱吴萸炒连翘四钱丹皮三钱菊花三钱金银花三钱黄芩二钱枳壳一钱鲜竹叶三钱橘红二钱陈皮—钱郁金一钱化服至宝丹五分作二次分服此药服后大效，已能进饮食，啜藕粉一碗。诊左右手均有脉，且右手现洪大脉，病者自觉诸症全去，唯身体酸软，仍不能动，头晕，耳聋，以余急于回城，嘱令照原方服三剂，以后病者又自主张，每日服牛黄清心丸一粒，又服五日痊愈。
按：此病以前治疗经过，颇不能详，以意度之，不外汗下二法，均已用之。其病因汗下均不得法，迟延至二十馀日，是以无形无质之热气（即温邪）逆传入心包络，弥漫于空洞高巅之膻中。既无形质，又不在肺胃血脉，徒以苦寒攻夺，车温发表，均属无的放矢，与病毫不相干，故余宗芳香逐秽开窍之说，大剂救援，幸能挽回。余所治内闭之症多矣，未有如此症之重笃者，故特识之，此症药费值太昂，贫农之家，不易措办，幸余表叔卢平甫先生担任之，使此重症，得庆更生，殊令人感佩。此人乳名何浪堂，余小时即与之识，病愈后极健壮，每进城恒以枣果饷余，后至八十馀而卒。至今余表兄弟等，相见扳谈均犹以此症为资料也。
张夫人住济南西乡辛庄，年六十九岁，患暑温症。伊家系洋行职员，信仰西医，历来患病，亦均经西医治愈。病者初患寒热、下利、呕吐，住城内某医院，治疗凡十馀日，病势沉重，无法治疗。该医院断为必死之症，通知伊家病重，迫不得已，舁回家中，延余及王芝事先生第五镇炮五标一营军医长合诊。伊家本不信中医，此于无可奈何时，始延中医诊治，竞获痊愈，可见天下事不可执一定之见也。病状脉案，详列于后，此为温病已经逆传极重之内闭症，故历三十馀年，余犹保存此医案也。
First Prescription: Lianqiao (Forsythiae Fructus) 3 qian, Zhuye (Bambusae Folium) 2 qian, Yinhua (Lonicerae Japonicae Flos) 3 qian, Jiesui (Schizonepetae Spica) 1.5 qian, Xiangdouchi (Sojae Semen Praeparatum) 1.5 qian, Ludoupi (Phaseoli Radiati Pericarpium) 4 qian, with Shengjiang (Zingiberis Rhizoma Recens) as a guide. After taking this prescription, there was no effect; although slight sweating occurred, aversion to cold persisted. On the second day, the pulse was surging and rapid, and other symptoms remained the same. Therefore, Ju Hua (Chrysanthemi Flos), Tianhuafen (Trichosanthis Radix), and Zhizi (Gardeniae Fructus) were added to the previous prescription. About three hours after taking it, the patient vomited completely. On the third day, the condition worsened; there had been no bowel movement for three days, headache felt like being covered by something, mental confusion, thick tongue coating gradually turning yellow, thirst, vomiting and regurgitation, worsening pain and swelling of the legs and feet, rapid pulse, and persistent aversion to cold. The condition was quite severe, so it was decided to add Yin-nourishing and bitter-descending herbs among the acrid-cool exterior-releasing medicines.
On April 10th, the third prescription was prescribed: Lianqiao 4 qian, Zhuye 2 qian, Huafen (Trichosanthis Radix) 3 qian, Yinhua 3 qian, Jiesui 2 qian, Xianshengdi (Rehmanniae Radix Recens) 3 qian, Jiegeng (Platycodonis Radix) 1 qian, Shujun (Rhei Radix et Rhizoma processed) 1 qian, Cundong (Ophiopogonis Radix) 2 qian, Bohe (Menthae Haplocalycis Herba) 1.5 qian, Huoxiang (Agastaches Herba) 3 qian, Huangqin (Scutellariae Radix) 2 qian, Xianweigen (Phragmitis Rhizoma Recens) 3 qian. Decoct and take without aiming for sweating. After taking the previous prescription, one bowel movement occurred, and all symptoms decreased significantly; aversion to cold disappeared (without deliberate sweating). The most remarkable efficacy was the resolution of the headache feeling covered and mental confusion; however, the left leg still had pain and swelling. Other symptoms were lighter, and the condition showed hope of smooth recovery, but the patient could not yet get out of bed.
On the 11th, following the previous prescription, Shujun was removed, and Huashi (Talcum) 2 qian and Zhizi 2 qian were added. After taking it, the effect was inferior to that of the third prescription. On the 12th, Zexie (Alismatis Rhizoma) 1 qian was added, which was also inferior to the third prescription. On the 13th, the third prescription was administered again, yielding immediate significant efficacy. It was continued for three doses according to the original formula, and leg swelling subsided. Treatment lasted about ten days, and all symptoms completely resolved.
Although this case was a simple Spring-Warmth disease, improper treatment would inevitably lead to counter-transmission, making it worthy of study; thus, it is recorded. First, at the onset, it was not a severe illness. The patient, because I did not charge a consultation fee, refused further follow-up visits, leading to a forced recovery. Subsequently, no medicine was taken. More than twenty days later, residual heat brewed and re-emerged. Since internal heat had existed for a long time, although more than a month had passed (the key point here), it could not be considered a new disease. Roughly a month of accumulated heat meant the blood in the body was already impure, causing severe swelling in the legs and ankle joints. However, combined with aversion to cold, the exterior pathogen cannot be ignored. The first prescription was ineffective, leading me to doubt the use of exterior-releasing drugs. However, I firmly knew that the critical point of counter-transmission in this case often stemmed from failing to release the muscle layer when necessary, leading to exterior closure. Mild cases result in limb coldness; severe cases result in whole-body coldness. Failure to descend when necessary, or erroneous descending, leads to interior closure. Mild cases result in delirium and mania; severe cases result in spasms, syncope, and orifice closure. However, using only muscle-releasing or only descending methods has great drawbacks. Among muscle-releasing methods, cool, aromatic, and disseminating herbs should be assisted to ventilate Lung Qi; among bitter-descending methods, Yin-nourishing and moistening herbs should be assisted to protect Yin fluids. Thus, interior accumulated heat will not transform into dryness due to muscle-releasing, and exterior excess pathogens will not sink inward due to bitter-descending. This is why the third prescription's simultaneous release of exterior and interior yielded miraculous effects; any slight modification would be inappropriate. When using exterior-releasing drugs in the first and second prescriptions failed, I was hesitant during the diagnosis of the third prescription. I thought that since aversion to cold was obvious, why did exterior-releasing fail to reduce the condition? It must be due to latent heat stagnating for a long time a month ago, where the interior excess heat was ten times greater than the exterior cold syndrome. At this time, the method should take bitter-descending, slightly attending to the exterior pathogen. Naturally, once interior heat recedes, the exterior pathogen will also resolve. Moreover, extreme interior heat can also cause aversion to cold; physicians must understand this pathology and not rigidly believe that all aversion to cold is an exterior syndrome. Additionally, this patient habitually takes 1 qian of processed Rhubarb (Shu Dahuang) to achieve bowel movement, so only 1 qian was used to slightly unblock the bowels. The main effective drugs for this case are Dahuang (Rhei Radix et Rhizoma), Huangqin, Shengdi (Rehmanniae Radix), and Maidong (Ophiopogonis Radix), with Dahuang and Huangqin being particularly important. Although the others are auxiliary, they all have subtle uses. By assisting with acrid-cool muscle-releasing herbs like Jiesui, Lianqiao, and Bohe to slightly release the exterior, preventing external pathogens from sinking inward due to excessive aversion to cold and bitter-descending; by assisting with light, aromatic, and purifying herbs like Yinhua and Zhuye to prevent excessive bitter-descending from becoming a lure for turbid pathogens in the Upper Jiao Qi level entering the Pericardium; by assisting with heat-clearing and Yin-nourishing herbs like Shengdi and Cundong to prevent latent Blood-level pathogens from transforming into dryness and exhibiting stubborn excess heat due to bitter-descending and muscle-releasing—this is the essence of the prescription formulation. Fortunately, immediate great efficacy was achieved as expected, so I dare to report this frankly to inform scholars. In this stage of the disease, it can be mild or severe; the relationship between one herb is extremely subtle. I hope scholars ponder over these distinctions. Slight changes to the third prescription immediately reduced efficacy significantly; scholars should pay special attention. Regardless of how severe the aversion to cold is, Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), and Chaihu (Bupleuri Radix) are absolutely contraindicated, as are Qianghuo (Notopterygii Rhizoma et Radix) and Duhuo (Angelicae Pubescentis Radix). Violating this prohibition leads to mental confusion after one dose and gradual counter-transmission. Ancient texts state that Warm diseases forbid sweating; this should be understood as such. Killing is as easy as flipping a hand; beware, beware.
Mr. Ding, 53 years old, lived at No. 4 East Wall Down, Fuchengmen Inner Gate, and was a rickshaw puller. He consulted on December 3rd of the 26th year. He was carried into the consulting room, panting disjointedly, reaching a dangerous state. According to his brother, he had been ill for over a month. Initially, while pulling a cart from Nanyuan to the city, he sweated profusely and then drank cold water, causing him to collapse. Several doctors treated him without success, and current physicians refused treatment. I saw the patient with staring eyes, open mouth, panting and lethargy, cracked lips resembling blood marks, withered and dark complexion. Asked about his suffering, he could not answer. Pulse diagnosis revealed the Right Cun and Guan positions were extremely fine and rapid; both Chi positions and the Left hand pulses were absent. Skin was dry and rough, yet dry heat persisted. Fortunately, hearing remained; if convulsions appeared, death would be certain. His brother stated previous symptoms included fever, body pain, and extreme thirst. Currently, stools consisted entirely of bloody water, urine was very scant and also like bloody water, fever persisted, night sweats occurred, insomnia, mental vagueness, and thirst. Previous medical history and medications could not be remembered. This was the past course of the disease.
I identified this case as the third stage of Warm Disease, severe intestinal bleeding. TCM calls this "Labor-fatigue internal injury, compounded by Warm disease," referring to the initial onset where Heat pathogens deeply entered the Lower Jiao. TCM terms this Shaoyin and Jueyin syndromes, corresponding to Western medicine's cerebral symptoms and intestinal bleeding. Yang hyperactivity and Yin exhaustion. Although ill for a month, although Yin-blood is deficient, excess pathogens remain. Focus on these four characters, scholars note. But the disease is critical, making medication tricky; tonification and purgation are difficult. Unwilling to not save, I prescribed as follows: First, give three Calomel tablets, each containing 0.2 grams. Instruct to take one first, wait three hours, then take another. Observe the stool; if bloody water persists, wait three hours and take the third. Approximately from 8 AM to 5 PM, finish taking them. If after the second tablet, the discharged matter is no longer bloody water, stop the third tablet and do not take it further. Also instruct to drink plenty of plain water. The dose of Calomel is very small because the patient is extremely weak. Another Chinese herbal prescription was given, instructed to decoct and take once at midnight, and again the next morning. Chinese medicine must not be taken simultaneously with Calomel; leave an interval of 8-9 hours. Come back for consultation at noon on the second day. First Prescription: Xianshengdi 4 qian, Hang Baishao (Paeoniae Radix Alba) 3 qian, Tianhuafen 3 qian, Ju Hua 2 qian, Cundong 2 qian, Xuanshen (Scrophulariae Radix) 3 qian, Zhuru (Bambusae Caulis in Taeniam) 2 qian, Xianmaogen (Imperatae Rhizoma Recens) 2 qian. Decoct and take. Also prepared Zhuye Lu (Bamboo Leaf Dew), Xianshengdi Lu, and Yinhua Lu, one bottle each. Instruct to mix with water and drink as needed for thirst, without limit.
Consulted on the second day. According to reports, after taking the third Calomel tablet, around 8 PM, the stool became sticky, discharging much substance resembling black bean oil. Urine changed from deep red to yellow, still scant. Thirst and body heat slightly reduced, spontaneous sweating persisted, panting continued. The patient claimed symptoms felt relieved. Pulse remained fine and subtle as before, spirit slightly clearer. Therefore, treating for urgent rescue of Yin fluids, the following prescription was given: Second Prescription: Ganyedi (Rehmanniae Radix Preparata) 4 qian, Sheng Baishao 3 qian, Xuanshen 3 qian, Maidong 3 qian, Huafen 2 qian, Shashen (Glehniae Radix) 3 qian, Sheng Muli (Concha Ostreae) 2 qian, Huangqin 2 qian, Danpi (Moutan Cortex) 3 qian, Xian Zhuye 2 qian, Xian Maogen 3 qian. Decoct well and divide into two doses. Also prepared Xian Zhuye Lu, Xianshengdi Lu, and Xian Yinhua Lu, one bottle each. Instruct to drink as before. Consulted on December 10th. Able to stand up. Took five doses of the previous prescription. All symptoms greatly reduced, heat gradually receded. Self-reported severe leg pain, which manifested now due to long-distance cart-pulling labor injury prior to illness. Could eat thin porridge daily. Urine increased. Tongue coating yellow but slightly moist. Spirit clear. Pulse visible in both hands, but still deep, fine, subtle, and rapid. Still proposing Yin-nourishing and Blood-tonifying strategy. Third Prescription: Ganyedi 4 qian, Da Shashen 3 qian, Sheng Niuxi (Achyranthis Bidentatae Radix) 3 qian, Sheng Baishao 5 qian, Danggui Shen (Angelicae Sinensis Radix root part) 2 qian, Yuzhu (Polygonati Odorati Rhizoma) 2 qian, Tianhuafen 2 qian, Baimaogen (Imperatae Rhizoma) 2 qian. Decoct well and divide into two doses. Took six doses of this medicine.
Review on the 22nd. Able to walk. All symptoms cured, slight leg pain. Pulse gradually harmonious, six beats per breath, but occasionally skipping. This indicates the heart is not yet healthy. Appetite increased. But there is deficiency sweating; slight activity causes panting and sweating, with a tendency for fever. Therefore, preparing a paste based on Yin-nourishing principles, instructing regular intake. After about a month, completely recovered health.
Fourth Prescription: Paste. Ganyedi 2 liang, Zhimu (Anemarrhenae Rhizoma) 1 liang, Danpi 1 liang, Sheng Biejia (Carapax Trionycis) 1 liang, Sheng Muli 2 liang, Qinghao (Artemisiae Annuae Herba) 5 qian, Cundong 1 liang, Baishao 1 liang. Add honey and refine into paste. Take one small tea spoon each time, three times a day, dissolved in boiling water. One batch of this paste lasts about one month.
This case is relatively severe among Warm-Thermal diseases. The first half of the treatment process cannot be traced. However, the patient's family was very poor. It is likely that at the onset, timely medical attention was not sought. Forced to seek treatment only when the condition worsened, and even then, fearing inability to take medicine on time,致使 sweating, purgation, and cooling methods missed the pathological timing. Warm-themes stagnated for a long time, consuming large amounts of Jin-Ye (Body Fluids), while interior excess pathogens remained. Thus, upon my initial treatment, gentle purgation immediately reduced the condition. However, regarding this symptom presentation, if strictly adhering to the pulse, there is absolutely no reason for further purgation. Yet, excess pathogens remain, and intestinal perforation is suspicious. If only Yin-nourishing herbs are given, it will inevitably assist stagnation, achieving nothing. If only gentle purgation is used, although excess pathogens decrease, True Yin becomes more deficient. Not only is deficiency heat concerning, but consumption may suddenly cause cardiac arrest danger. Because the risk is too high, I dared not use Dahuang, as this drug stimulates the gastrointestinal tract and has a contracting effect after purgation. I also dared not use Castor Oil, as the patient could hardly swallow liquids, this drug is unpleasant, and based on my experience, I have frequently seen cases of extreme deficiency heat where taking this drug caused sudden cardiac arrest; this example is not rare. Examining pharmacology, this drug is very mild. Perhaps because its slippery purgation is too severe, it has a great adverse effect on those with heart weakness! I fear that those with a general knowledge of Western medicine might recklessly use Western drugs, causing danger, so I explain in detail without tiring. For this type of pulse, using Aspirin etc. to reduce fever brings disaster swiftly; this must be noted. At this juncture, using Chinese herbs like Mahuren (Cannabis Fructus) and Louren (Benincasae Semen) as gentle purgative and intestinal-moistening agents is relatively safe. However, excessive Louren can cause heavy purgation, and Mahuren's effect is slower, so it is adopted in Jiawei Fumai Tang (Modified Decoction for Reviving the Pulse), but it is not as effective and fast as Calomel. Therefore, I used it cautiously. Furthermore, large doses of Yin-nourishing Chinese herbs were used to rescue, thereby achieving recovery. Fortunately, this person was poor. If he were from a wealthy family, seeking timely medical attention upon initial Warm-pathogen infection, encountering a physician strictly adhering to ancient methods, they would definitely treat "Warm disease after labor" with Ginseng (Renshen). After one dose, all pores would close, causing death. Even with wisdom, there would be no way to remedy it afterwards. Using Chinese medicine requires understanding TCM theory; using Western medicine requires understanding Western medical theory. One cannot say that Chinese purgatives are simply Western purgatives. The TCM theory of Yin-nourishing for this case is exquisitely wonderful; the drugs are indeed effective. At this critical moment, we must acknowledge Chinese medicine as unparalleled. Suppose after Calomel proved effective, Western medicine continued treatment. I do not know what method would be specifically effective: Cardiotonics? Antipyretics? Cooling agents? Tonics? I used them constantly forty years ago. Today, I dare assert that none are as effective and mild as Chinese Yin-nourishing medicine. I hope Chinese and Western medicine complement each other. Each preserves its independent strengths, gradually advancing towards perfect world medicine to benefit humanity. There will be those who understand my words. This case involved complete consultation and medication. After recovery, the patient gifted me a box of tea and two bottles of wine. Ancient customs still exist. Reflecting on this case, I wish my fellow physicians always keep this mindset.
He Chunyuan, 62 years old. A farmer in the household of Lord Lu Wensu in Jizhuang, Dezhou. In August of the first year of the Republic of China, I happened to arrive at the Lu residence. The patient was an old acquaintance of mine. That day, I was having breakfast when a servant suddenly told me, "He Langtang is dying." The patient's nickname was Langtang, and people were accustomed to calling him so. I was extremely surprised and rushed to his home for consultation. Upon arrival, the patient's six pulses were closed. Eyes closed, tongue retracted. Hands clutching at empty air, panting rapidly. Death seemed imminent. Unable to examine, unable to administer water. Only asked the family. According to them, at the beginning of the illness, there was headache and body pain. Medical care in the countryside was inconvenient, so only Red Sugar and Ginger Water was used to induce sweating. Afterwards, fever, vomiting, extreme thirst, and deafness occurred. Subsequently, gradual delirium, mania, worsening headache and vomiting. Doctors were consulted, purged several times. Prescriptions were lost, unknown what drugs were used. Guessing by intention, probably purgatives. Afterwards, mania worsened, loss of consciousness, vomiting upon taking medicine. From onset to now, more than twenty days have passed. Physicians all refused treatment. This was the past course of the disease.
I identify this case as the extremely critical third stage of Warm Disease, what TCM calls "Warm pathogen counter-transmitting to the Pericardium Collateral, Orifice closure, coma, spasms, Interior Closure and Exterior Collapse." Meningitis complications stem from this TCM theory. Given aromatic, turbidity-dispelling, and orifice-opening substances, hoping to transform the heat pathogen stagnating in the膻中 (Shanzhong/Sea of Qi) for a long time. Also, since the patient was more than twenty li from the city, fearing drug procurement would take time, first gave 1 qian of Suixue Dan (Purple Snow Pill) carried with me, dissolved in fresh Bamboo Leaf water (from bamboo groves in the courtyard) and灌ed into the eyes. Also used Ping'an San (Peace Powder) inserted into the nose to induce sneezing (did not sneeze), and ordered the removal of burial clothes immediately. Rural custom dictates wearing cotton clothes when near death. At this time, the room was hot, and the patient's exterior was also hot, so ordered their removal. After about three hours, the patient's eyes began to move. Subsequently took one dose of Chinese medicine,灌ed with a small tea spoon, completing it over a day and night. As follows, First Prescription: Xian Bohe (Menthae Haplocalycis Herba Recens) 3 qian, Shichangpu (Acori Tatarinowii Rhizoma) 4 qian, Jinyinhua (Lonicerae Japonicae Flos) 2 liang, Huangqin 2 qian, Lianqiao 1 liang, Chuanlian (Coptidis Rhizoma) 2 qian, Wu Yu Chao Yujin (Curcumae Radix stir-fried with Evodiae Fructus) 3 qian, Peilan (Polypodii Herba) 3 qian, Xijiao (Rhinocerotis Cornu) 2 qian, Juhong (Citri Reticulatae Pericarpium Rubrum) 1 qian, Xian Zhuye 1 liang. After decocting, dissolve two pills of Niuhuang Qingxin Wan (Calculus Bovis Clear Heart Pill). Use well water, cool in a cup since ice was unavailable in the village. Frequently灌 into the patient's mouth with a small tea spoon. Slightly elevate the head of the bed, let the patient lie supine, upper body slightly raised. Frequently massage the neck and throat to facilitate swallowing. By the afternoon of the second day, gradually able to swallow medicine independently, eyes and mouth moved automatically, spoke at night, called for thirst, drank water repeatedly, drank a lot overnight, finished remaining medicine at once. Morning of the third day, spirit gradually cleared. Consulted again, prescribed as follows: Second Prescription: Peilan 3 qian, Xijiao 1 qian, Shichangpu 5 qian, Chuanlian 1 qian, Wu Yu Chao Lianqiao 4 qian, Danpi 3 qian, Ju Hua 3 qian, Jinyinhua 3 qian, Huangqin 2 qian, Zhike (Aurantii Fructus Immaturus) 1 qian, Xian Zhuye 3 qian, Juhong 2 qian, Chenpi (Citri Reticulatae Pericarpium) 1 qian, Yujin 1 qian. Dissolve Zhibao Dan (Treasure Pill) 5 fen, divide into two doses. After taking this medicine, great efficacy was achieved. Able to eat, drank a bowl of lotus root powder. Pulses palpable in both Left and Right hands, Right hand showed Surging Large pulse. Patient felt all symptoms gone, only body soreness and weakness, still unable to move, dizziness, deafness. Since I was eager to return to the city, instructed to take three doses of the original prescription. Afterwards, the patient took one pill of Niuhuang Qingxin Wan daily on his own initiative, and recovered after five more days.
Commentary: The previous treatment course of this disease is unclear. Guessing by intention, it did not exceed sweating and purgation methods, both of which were used. The cause was that sweating and purgation were not performed correctly, delaying for more than twenty days. Thus, formless and intangible heat qi (i.e., Warm pathogen) counter-transmitted to the Pericardium Collateral, diffusing in the hollow, high Shanzhong. Since it has neither form nor substance, and is not in the Lung, Stomach, or Blood vessels, merely using bitter-cold attacking and draining, or warm-releasing exterior methods, are shooting arrows without a target, irrelevant to the disease. Therefore, I followed the theory of aromatic turbidity-dispelling and orifice-opening, using large doses for rescue. Fortunately, it was successful. I have treated many Interior Closure cases, none as severe as this, so I specially record it. The cost of medicine for this case was too high, difficult for a poor farming family to arrange. Fortunately, my maternal uncle Mr. Lu Pingfu assumed the cost, allowing this severe case to survive, which is truly admirable. This person's nickname was He Langtang. I knew him since childhood. After recovery, he was very robust, often bringing dates and fruits to me when entering the city. He lived to over eighty years old. To this day, my cousins and I still discuss this case when we meet.
Mrs. Zhang lived in Xin Zhuang, West Township, Jinan, aged 69, suffering from Summer-Warm disease. Her family were clerks in a foreign firm, believing in Western medicine. Historically, all illnesses were cured by Western medicine. Initially, the patient suffered chills and fever, diarrhea, and vomiting, staying in a certain hospital in the city. Treatment lasted over ten days, condition became heavy, untreatable. The hospital diagnosed it as a fatal case, notified the family of the severity. Forced, she was carried home. I and Mr. Wang Zhishi, Military Surgeon of the First Battalion, Fifth Standard, Fifth Division of the Fifth Army, were invited for joint consultation. Her family originally did not believe in Chinese medicine. Only in desperation did they invite Chinese medicine treatment, and surprisingly recovered. This shows that worldly matters cannot be viewed with fixed opinions. Symptoms and pulse records are listed below. This is a severe Internal Closure case where Warm disease has already counter-transmitted severely. Thus, after thirty-plus years, I still preserve this medical case.