恶寒战栗，头疼身痛，尤其是头痛欲裂，格外厉害，脉浮紧。这是真正伤寒的表证，谁也知道的。客中煎药不便，乃服安基比林，服下后仅仅头觉稍轻，不多时又如前状。一日之中服极大量之安基比林，全身症并未稍减（曾发汗）。余友李静波来视，余已不能起床，伊甚惊慌（俗名夹气伤寒）。余乃立方为羌活、独活、防风、炙麻黄四味，生姜为引。李即为余煎药，服下蒙胧中睡去，至第二日醒后，其症若失，亦未觉出汗。李来视余，甚觉愕然，盖伊前日目视余非仅感冒也，此例极多，凡初得之较重外感，绝非安基比林、阿斯匹林等所能治。历经比较，千真万确、西药并非不灵的，不适用于此种发热，故逊中药一筹耳。）外感发热之症，中医约分十种。即1．表证实邪发热，2．里证实邪发热（也在外皮），3．邪在半表半里发热，4．内外两感发热，5．余邪不尽复出于表发热，6，邪退正虚发热，7．大热似寒，8．大寒似热，9．阴虚发热，10，阳虚发热等。兹将其病状及治法，分述如下：1．表证实邪发热中医论表证发热，是伤寒及温病的第一步（初期）之必有症状，若是伤寒初期的表证，必须发散，才能去病（得汗则解）。可是伤寒之表证，与温病、瘟疫之表证，症候及治法，不能尽同，在伤寒表证初得病的时候，一二日之间，并不难认定。伤寒初起最重要的现象，就是恶寒（就是身上觉着寒冷），头痛、项强、腰痛、腿痛、周身骨节酸痛、舌无苔、脉多浮紧、皮肤或发热或不发热（此时体内温度已升高，但只用手扪，不觉发热耳）。无汗者居多，此证尤其易发于严冬天气，（宜注意严冬二字）、此是极正规的初得的伤寒表证发热（或稍有干呕，此是外寒束缚，感动胃气，并非主要症候。）不可与里证相混，用药但治表证，呕寒自止，若兼顾呕吐，于发汗药中，．加以和胃顺气等药则大错，往往不能发汗，反致贻误。但此呕吐系随恶寒一齐宋，在初得之始，务须切记。若三五日后，恶寒渐少，呕吐日甚，则宜审各兼症（例如头痛、舌苔、大小便、脉象均宜考察），不可一汗再汗，致误病机，此条应特别注意，在初得及严冬等季，庶不至临症茫然，处方无据矣。真正伤寒的第一步，就是如此，治之得法，一汗而愈（所谓太阳表证）。在病者，亦只以受凉或感冒二字为病名，并不重视，殊不知可畏之伤寒，即以此平庸数味之中药而治愈。此时若语以医理上之重大，生命上之危险，鲜有能知者，萤萤之火，扑灭之后，不自知其燎原之危险也。于此有一极大之问题，即中西医关于此点之各是其是，不肯平心静气比较试验，以增长其学问是也。西医译伤寒病为肠窒扶斯，其唯一之科学凭据，即肠窒扶斯病菌之检查，及一定之热型，当然千真万确，毫无疑义。然西医治伤寒，除注射伤寒浆苗，伤寒血清外，其初步用药，多用缓下，次则亦有退热药之应用。然其所下断语，则为待期疗法，及对症疗法。一若既得此症，无论如何治疗，必须待至四星期，始能痊愈者然。若于得病一二日间，用中药发汗而愈者，则必谓绝非此症也。余关于此点，最所究心，自愧无细菌学之技术，不能证明余说。然余实已经过四十余年之实验，关于西医对此症所持理论，发现可疑之点颇多，兹细述之，深愿与当代医坛共讨论也。①此症译名，是否根本错误。查中医《伤寒论》一书，是否兼言温病，已经议论纷纭，莫衷一是，且原书脱落舛错，不易索解，则伤寒一书，是否专治伤寒，已成疑问。西医译名肠窒抉斯，，主要意旨是肠热，，然伤寒初起，只是外伤于寒，纯粹实邪在表，一经发散，豁然而愈，绝不致于肠热，必治不得法，实邪入内，其结果方为肠热；（细参各症自知，所谓热结旁流等症）。当初得表证之时，绝无此症候，惟温病初得，往往即有内热，所以温病之表证，绝与伤寒上列之表证不同。而且中医治温病之表证，亦与伤寒迥异，因伤寒初起，恶寒特甚，温病则或微恶寒，故伤寒之恶寒，必用发汗药，否则只用解肌之品（西医退热药其副作用往往发汗，并非发汗药）。在温病之表匠，第一温病的恶寒，不如伤寒之甚；第二就是头痛的症候，亦比伤寒轻，而且多头晕、头胀，身痛亦比伤寒轻，舌多有滑腻白苔，而皮肤上的热，则较伤寒在恶寒时为重。亦有有汗者，口唇多干，口气重浊，亦与伤寒不同。最多见者，就是两手脉多洪大，尤其右手更显明。这种表证，不限于严冬，越是春末、秋末，更所多见，此症若只用伤寒发散药治之，多不中病（参照后列温病及伤寒各法）。盖伤寒与温病，中医论述，有极端相反之处，即伤寒是寒邪从外入，若不俟其深入，一汗而解。温病是热邪内伏，若不俟其炽盛，一经清凉解肌，亦可痊愈，是二症不同之点。但治之不当，伤寒终极是因肠热而致命，温病终极则不必尽因肠热而致命<温邪逆传卜之更危，司为明证）。然伤寒初起，可以一汗而解，温病初起，可以清解而愈，绝不致演到肠热，变象百出。若然则是西医之待期疗法，理由不能成立，余不知西医译名之肠窒扶斯，究指伤寒之肠热言耶，抑指温病之肠热言耶。西医书肠窒扶斯病名之下，往往注明即古医书之伤寒、温病之类，更不可不加以纠正。盖伤寒系独立病名，温病亦独立病名，绝不可二病并称，混为一谈，概称之曰肠窒扶斯。余曾见有伤寒延长病至数月者（参看后列薛殴宾医验），温病亦有延长数月者（参看后列丁姓医验），非但四星期不足以言待期，而且肠热虽同，而冶法迥异，究竟何者为肠窒扶斯耶？若谓二症皆肠窒扶斯症，试将中医治伤寒之方法以治温病，未有不大错特错，立误人命者。窃愿有志此道者，专心致力，先将此两种病液加以化验，若皆有同一之肠窒扶斯病菌，则是中医已有两种治法，并非绝对待期。若以同一西药治疗此二种不同之病症，所得之结果，必须待期，则不如以中药补西药所不及，医者责任所在，又何乐而不为耶。凡遇此二症，检查确定后，姑且抛开科学，试以中医中药，分别治疗之，所得成绩，加以详慎之统计，与西医理论与治法，互相比较，倘有特别收效之证明，打破待期二字，无妨再以科学的理论，共同探讨中医中药对此二症之收效点究竟何在？余认为此中必含有科学的原理，今日之医理科学，或者仍有许多未臻完善之域，亦未可知也。余治此二症，中西药之应用。并非拘板，从未失败。深知此二症，纯用西药，不易收功，参看后列薛姓等医验自明。所治各症，率皆系经过多医之症候，其人今尚健在，不妨询问也。
2．里证实邪发热实邪在里面，日子浅者，率在肺胄，稍久必至肠内，所以它的主要症候，脉多沉数（快），甚则反而全闭，外面皮肤发热（下午尤甚），内里头多有咳喘，口渴烦躁，胸满，腹痛，呕吐，舌苔黄厚干裂，唇焦，或鼻衄，或厥逆，大便不通（或便脓血），小便短赤（或无），谵语（侵及神经则谵语，此时表证已多不存在，不可听病人自诉，误认仍有表证，用药犹疑，且以上诸症；病人不必皆备，须注意也。）此时治法，率用清热利便之品，尤以早用泻药为值台炳机（泻药最好用大黄，有它症者，（例如咳喘）亦须兼颐，内里一清，表热自退，切记切记。）但热未结实，泻药亦有流弊，故用泻剂宜慎重也。（脉沉实数，乃可泻之）。
3。半表半里发热此时脉多弦，或稍数，胸胁满，寒热往来、口苦，耳聋，心烦，喜呕，口干而不欲饮水，舌苔多滑白，或无苔。此由表证将转入里证之阶段，中医率用和解的方法，例如小柴胡汤等，然此种病象，为时甚暂，且不易分晰，学者宜加以注意也。
4．内外两感发热此种热候，温病居多，率皆由于内有蕴热，又值天气变动太骤。例如春末秋深，忽然寒冷，病者早有内热，又受外面寒气束缚。其见症，多有头痛，头或胀或觉沉，微恶寒，身痛，口气多重浊，或咳喘，舌多白苔或微黄或无苔，胸闷呕恶，二便恒觉不利，脉或洪或紧而细，或有汗或无汗，此是内外皆有实邪，治法宜于清热（例如连翘、双花、竹叶、桑叶等）之中，务必加入发散解肌之品（例如防风、薄荷、豆豉、荆芥之类），但不宜用麻黄、桂枝之类耳。（或稍加泻药，此温病与伤寒治法不同之点也。）内热症甚者（例如大渴等，，必重用甘寒（例如菊花、知母、花粉、石膏之类），或苦寒（例如黄芩、栀子、黄连、龙胆草之类）之品。外症重者，可再稍加辛散之品（例如于防风、薄荷之外，加姜少许之类），必得微汗方解（先注重表证），然后再注重清里可也。（或用熟军无妨）。
5．馀邪不尽复出于表发热此即西医所谓回归热之类，中医书又名差后劳复。（俗名重劳）乃于大病治愈之后，忽然又觉不适，遂即皮肤发热，脉多虚浮似数（按之无力），并有倦忌，头痛咳嗽，呕恶烦躁，口干等症（不必皆备）。然病者常现十分衰弱之象，此症西医最确之检查，血液中必有螺旋菌。以余经验上言之，西药中之清凉及退热药（例如稀盐酸及规尼涅），为本病最和乎有效之药品，实有辅助中药之奇能。医者对于此症，须注意其屡发自汗，遂即平复热退，隔数日反复发热（下午尤甚）自汗，（或有盗汗）又复常态。此时，必须注意馀热未尽四字，但为日已久，不可再用汗下、清解、顺气、和胃等法。（如此治法，屡试不效，必误人命，以汗下等法皆不对症也。）若以中药之滋阴等品，补助西医退热之剂，率多奏效。盖此症体虽虚弱，病乃实邪，第一要认明此乃大病后，元气已虚，复感时邪，正气虽虚，邪热亦盛。与中医所谓阴虚发热，阳虚发热，迥乎不同，所以此时若用攻伐之药（例如汗，清、下法。），既所不胜（元气已虚，不胜药力，不但不能退热，且易发生险象。
）若用补药，则胃气壅塞，实邪更易炽盛，必不能适合症象，屡经试验，实不如中西并用（西药如稀盐酸、苦丁枸椽酸、规尼涅等，中药如生地、黄芩、丹皮，寸冬等。）之灵效也。（余非偏信西药，此实经验谈，愿学者深信之）老年人及平素衰弱者，屡感时邪，治法与此略同，医者细心体认可也。兹录最近治验二则于下（本编医案所载之西药、中药互用法，均经多年试验，用之毫无危险，不起化学反对作用，故敢笔之于书，以告学者。但中西药并用，非常危险，凡非本编所载一定之用法，万不可任意滥将中西药品互用，是为至要。）①孟宅幼科四岁，住西城警尔胡同二号，病已六月余。据称初病似疟，屡愈屡发，最近因服中医发汗药，病更重，来诊时，脉微细，头发稀落，下午潮热，喘促，频呼腹痛，夜不安眠而昏迷特甚，小便黄少，大便溏且极臭，好饮水，精神痴呆，有时呕吐吞酸。检查前服药方，率用清解消导表散，经过多医，已成重病。余诊断为阴虚，仍有实邪，乃先与清泻剂，所下大便粘稠恶臭（此孩久食羊乳）病势稍减，继以中药滋阴，重用生地，令其早晚服二次，每日上午十点钟及下午三点钟，服西药优规宁各一包，三日完全退热，中间曾服重曹三次，吞酸亦止，此症中间停药五六日又反复，嗣即仍照原方继续又服中西药二星期，完全治愈。此症以余之经验，纯用中药滋阴，不能退热，纯用优规宁只能退热，亦不能根本补养其已耗之津液完全收功，若以西药补助中药，则收效极速，本症治法最确实。且中西药用法，均安全无危险，佘敢断言也。
②诸夫人二十馀岁，住西城武功卫二号，初病系感时邪，数月后屡治未愈，渐渐午后潮热，咳嗽不思饮食，脉象细数，渐成虚劳。经诊断为阴虚有热。乃令每日早跟规那丸二粒，兼服重曹、稀盐酸、苦丁等西药，约十余日痊愈。此症经过数中医治疗，均未收效，特诘之。
Chills and shivering, headache and body pain, especially the severe headache that feels like splitting, are particularly intense. The pulse is floating and tight. This is a true exterior syndrome of Cold Damage (Shanghan), which everyone knows. Due to the inconvenience of decocting medicine while traveling, I took Antipyrine. After taking it, my head felt slightly relieved, but shortly thereafter, the symptoms returned as before. Throughout one day, I took an extremely large dose of Antipyrine, yet the systemic symptoms did not decrease at all (sweating was attempted). My friend Li Jingbo came to visit; I was unable to get out of bed, and he was very alarmed (colloquially known as "Jiaqi Shanghan" or Cold Damage with Qi stagnation). I then prescribed a formula consisting of Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Fangfeng (Saposhnikoviae Radix), and Zhi Mahuang (Prepared Ephedrae Herba), with Shengjiang (Zingiberis Rhizoma Recens) as a guiding herb. Li prepared the decoction for me. After taking it, I fell asleep in a dazed state. Upon waking the next day, the symptoms had vanished, and I did not feel any sweating. When Li visited again, he was greatly astonished, as his observation of my condition the previous day indicated it was more than just a common cold. Such cases are numerous. Severe exterior conditions at their onset cannot be treated by Western medicines such as Antipyrine or Aspirin. Through repeated comparison, it is absolutely certain: Western medicines are not ineffective, but they are not suitable for this type of fever, thus falling short of Chinese herbal medicine.) Regarding fevers caused by external pathogens, Traditional Chinese Medicine (TCM) generally categorizes them into ten types. Namely: 1. Exterior excess heat, 2. Interior excess heat (also manifesting on the skin surface), 3. Heat at the half-exterior half-interior level, 4. Simultaneous exterior and interior infection, 5. Residual pathogen re-emerging to the exterior, 6. Heat due to deficiency after pathogen retreat, 7. Extreme heat resembling cold, 8. Extreme cold resembling heat, 9. Yin-deficiency fever, 10. Yang-deficiency fever, etc. Below, I will describe the symptoms and treatment methods for each:
1. Exterior Excess Heat In TCM, fever associated with an exterior syndrome is a mandatory symptom in the first step (initial stage) of both Cold Damage (Shanghan) and Warm Diseases (Wenbing). If it is an exterior syndrome in the initial stage of Cold Damage, dispersal (releasing the exterior through sweating) is required to eliminate the disease (resolution occurs with sweating). However, the exterior syndrome of Cold Damage differs in symptoms and treatment from that of Warm Diseases and Epidemic Febrile Diseases. In the early stages of an exterior Cold Damage syndrome (within one or two days of onset), it is not difficult to identify. The most important phenomenon at the onset of Cold Damage is aversion to cold (feeling cold on the body), headache, stiffness of the neck, lower back pain, leg pain, generalized joint soreness, absence of tongue coating, and a mostly floating and tight pulse. The skin may or may not feel hot (although internal temperature has risen, palpation does not reveal heat). Most cases present without sweating. This condition is particularly prone to occur in severe winter weather (note the emphasis on "severe winter"). This is a standard initial exterior syndrome fever of Cold Damage (with possible slight dry retching, caused by external cold constraining and disturbing stomach Qi, which is not a primary symptom). It must not be confused with interior syndromes. Treatment should focus solely on the exterior syndrome; if done correctly, the vomiting and cold sensations will cease. If one attempts to address the vomiting simultaneously by adding stomach-harmonizing and Qi-regulating herbs to the diaphoretic formula, it is a major error. This often prevents sweating and delays recovery. Note that this vomiting accompanies the aversion to cold and appears at the very beginning; this must be remembered. If, after three to five days, aversion to cold decreases but vomiting worsens, one must carefully examine accompanying symptoms (such as headache, tongue coating, urination/defecation, and pulse characteristics). One must not induce sweating repeatedly, as this may miss the pathological mechanism. This point requires special attention, especially during the initial stage and in winter seasons, to avoid confusion and unfounded prescriptions when treating patients. This is the first step of true Cold Damage. With proper treatment, one episode of sweating leads to cure (known as the Taiyang exterior syndrome). Patients often simply label this as "catching a chill" or "common cold" and do not take it seriously. Little do they know that the formidable Cold Damage can be cured by these ordinary few Chinese herbs. At this stage, few realize the significant medical principles and life-threatening dangers involved; extinguishing a small flame leaves one unaware of the danger of a prairie fire. A major issue here is that both Chinese and Western medicine adhere to their own views without calmly comparing and testing to expand knowledge. Western medicine translates Cold Damage as Typhoid Fever (Changzhisifu), relying solely on the scientific evidence of detecting Typhoid bacteria and specific fever patterns, which is undoubtedly accurate. However, in treating Cold Damage, besides injecting typhoid vaccine or serum, initial treatment often involves mild purgatives or antipyretics. Their conclusion relies on "waiting therapy" (expectant management) and symptomatic treatment, implying that regardless of treatment, four weeks must pass for recovery. If a patient recovers via sweating using Chinese herbs within one or two days of onset, Western medicine would assert it was never this disease. I have closely studied this point. Lacking bacteriological techniques, I cannot prove my theory scientifically. However, based on over forty years of clinical experience, I find many doubts regarding Western theories on this condition, which I detail below, hoping for discussion with contemporary medical circles. ① Is the translation name fundamentally wrong? Regarding whether the TCM classic *Treatise on Cold Damage* (*Shanghan Lun*) also discusses Warm Diseases, opinions are divided and inconsistent. Given the text's omissions and errors, making it hard to interpret, it is questionable whether the book exclusively treats Cold Damage. The Western term "Intestinal Typhus/Fever" primarily implies intestinal heat. However, at the onset of Cold Damage, it is purely external cold injury with excess pathogen at the exterior. Once dispersed, it resolves immediately without progressing to intestinal heat. Intestinal heat only results if treatment is improper, allowing the excess pathogen to enter the interior (see symptoms like "heat binding with peripheral flow"). At the initial exterior stage, intestinal heat symptoms are absent. In contrast, Warm Diseases often present with internal heat from the start, so their exterior syndrome differs significantly from the Cold Damage exterior syndrome described above. Moreover, TCM treatment for Warm Disease exterior syndromes differs from Cold Damage. Cold Damage onset features severe aversion to cold, requiring diaphoretic herbs. Otherwise, only muscle-relieving agents are used (Western antipyretics often cause sweating as a side effect, but are not true diaphoretics). For Warm Disease exterior syndromes: First, aversion to cold is less severe than in Cold Damage. Second, headaches are milder, often accompanied by dizziness and distension, and body pain is lighter. Tongue coating is often slippery and white, while skin heat is heavier than in Cold Damage during aversion to cold. Some cases have sweating, dry lips, and heavy breath odor, differing from Cold Damage. The most common pulse is surging and large, especially on the right hand. This exterior syndrome is not limited to winter but is more common in late spring and late autumn. Treating this solely with Cold Damage dispersal formulas is often ineffective (refer to subsequent Warm Disease and Cold Damage methods). TCM discussions on Cold Damage and Warm Diseases are extremely opposite: Cold Damage is cold pathogen entering from outside, resolved by one sweat before it penetrates deeply. Warm Disease is heat pathogen lying dormant inside, resolved by cooling and muscle-relieving measures before it flares up. These are key differences. Improper treatment can lead to fatal intestinal heat in Cold Damage, whereas Warm Disease fatality is not necessarily due to intestinal heat (reverse transmission of Warm pathogen is even more critical, as proof). However, Cold Damage can be cured by sweating initially, and Warm Disease by clearing and resolving initially, never progressing to intestinal heat with myriad changes. If so, the rationale for Western "waiting therapy" is invalid. I do not know if the Western term "Typhoid Fever" refers to the intestinal heat of Cold Damage or Warm Disease. Western texts often note under "Typhoid Fever" that it corresponds to ancient "Cold Damage" or "Warm Disease," which needs correction. Cold Damage and Warm Disease are independent entities and must not be conflated under "Typhoid Fever." I have seen Cold Damage prolonging for months (see Dr. Xue Oubin's case) and Warm Disease lasting months (see Mr. Ding's case). Four weeks is insufficient to define waiting periods. Although intestinal heat may be similar, treatments differ vastly. Which one is truly "Typhoid Fever"? If both are considered Typhoid Fever, applying Cold Damage treatment to Warm Disease would be a grave error leading to death. I urge those dedicated to this field to specialize and test these two diseases' fluids. If both contain the same Typhoid bacteria, TCM already has two distinct treatments, refuting absolute waiting. If treating these two different conditions with the same Western medicine yields results requiring waiting, it is better to use Chinese herbs to supplement Western medicine's limitations. What joy could there be in not fulfilling a doctor's responsibility? Upon confirming these two conditions, setting aside science temporarily, try treating them separately with TCM. Statistically analyze the results and compare them with Western theory and treatment. If there is proof of special efficacy breaking the "waiting" concept, we can further discuss the scientific basis of TCM's efficacy for these two conditions using scientific theory. I believe scientific principles exist here. Today's medical science may still have imperfections. My application of Chinese and Western medicines for these two conditions has never failed. Purely using Western medicine rarely achieves success (see Dr. Xue's cases). All treated cases were referred by multiple doctors; the patients are alive today, so inquiries can be made.
2. Interior Excess Heat When the excess pathogen is inside, if the duration is short, it usually affects the lungs and stomach; if longer, it reaches the intestines. Main symptoms include a mostly sinking and rapid (fast) pulse, or even completely obstructed. The skin feels hot externally (especially in the afternoon). Internally, there is often coughing and wheezing, thirst, irritability, chest fullness, abdominal pain, vomiting, yellow thick dry cracked tongue coating, scorched lips, epistaxis, or cold extremities. Stool may be unpassable (or contain pus and blood), urine scanty and red (or absent), and delirium (if nerves are involved, causing delirium; at this stage, exterior symptoms largely no longer exist. Do not rely on patient complaints mistakenly believing exterior symptoms persist, leading to hesitant medication. Also, patients do not necessarily exhibit all the above symptoms; pay attention.). Treatment generally uses heat-clearing and bowel-unblocking agents. Using purgatives early is crucial to seize the opportunity (Purgatives like Dahuang [Rhei Radix et Rhizoma] are best; for other symptoms like coughing/wheezing, they must also be addressed. Once the interior is cleared, exterior heat naturally recedes. Remember this!). However, if heat has not solidified, purgatives have drawbacks, so caution is needed with purgative agents (Only use if pulse is sinking, solid, and rapid).
3. Half-Exterior Half-Interior Heat At this stage, the pulse is mostly wiry or slightly rapid. Symptoms include chest and hypochondriac fullness, alternating chills and fever, bitter taste in the mouth, deafness, mental restlessness, tendency to vomit, dry mouth without desire to drink, and a mostly slippery white or absent tongue coating. This is the stage where an exterior syndrome transitions to an interior syndrome. TCM generally uses harmonizing methods, such as Xiaochaihu Tang (Minor Bupleurum Decoction). However, this pathology is brief and difficult to distinguish clearly; students should pay attention.
4. Simultaneous Exterior and Interior Infection This type of heat is mostly due to Warm Diseases, resulting from internal latent heat combined with sudden weather changes. For example, in late spring or deep autumn, sudden cold strikes a patient who already has internal heat, binding it with external cold. Symptoms include headache (distending or heavy), slight aversion to cold, body pain, heavy breath odor, possibly coughing/wheezing, white or slightly yellow or absent tongue coating, chest oppression, nausea/vomiting, difficulty in urination/defecation, pulse may be surging, tight and thin, with or without sweating. This indicates excess pathogens both inside and outside. Treatment should involve clearing heat (e.g., Lianqiao [Forsythiae Fructum], Jinyinhua [Lonicerae Japonicae Flos], Zhuye [Bambusae Folium], Sangye [Mori Folium]) while definitely adding dispersing and muscle-relieving herbs (e.g., Fangfeng [Saposhnikoviae Radix], Bohe [Menthae Haplocalycis Herba], Chidou [Sojae Semen Praeparatum], Jingjie [Schizonepetae Spica]). However, Mahuang [Ephedrae Herba] and Guizhi [Cinnamomi Ramulus] should not be used. (A slight addition of purgatives is a difference between Warm Disease and Cold Damage treatment.) For severe internal heat symptoms (e.g., extreme thirst), heavily use sweet-cold herbs (e.g., Juhua [Chrysanthemi Flos], Zhimu [Anemarrhenae Rhizoma], Huafen [Trichosanthis Radix], Shigao [Gypsum Fibrosum]) or bitter-cold herbs (e.g., Huangqin [Scutellariae Radix], Zhizi [Gardeniae Fructum], Huanglian [Coptidis Rhizoma], Longdancao [Gentianae Radix]). For severe external symptoms, add slightly more acrid-dispersing herbs (e.g., add a little ginger to Fangfeng and Bohe). Mild sweating is required for resolution (focus on exterior first), then focus on clearing the interior. (Using cooked Dahuang [Prepared Rhei Radix et Rhizoma] is acceptable).
5. Residual Pathogen Re-emerging to the Exterior This corresponds to Relapsing Fever in Western medicine, known in TCM as post-illness recurrence due to overexertion (colloquially "Chonglao"). After recovering from a major illness, discomfort suddenly returns, followed by skin fever. Pulse is mostly deficient, floating, and seemingly rapid (weak upon pressure), accompanied by fatigue, headache, cough, vomiting, irritability, and dry mouth (not all symptoms need be present). The patient often appears very weak. The most accurate Western check for this condition is the presence of spirochetes in the blood. Based on my experience, Western cooling and antipyretic drugs (e.g., dilute hydrochloric acid and Quinine/Guiniene) are the most appropriate and effective medicines for this disease, possessing miraculous abilities to assist Chinese herbs. Doctors must note that this condition frequently presents with spontaneous sweating, followed by temporary relief and fever reduction, then recurring fever (especially in the afternoon) with spontaneous sweating (or night sweats), returning to normal. At this time, one must note "residual heat not fully exhausted." Since it has been long, methods like sweating, purging, clearing, Qi-regulating, and stomach-harmonizing should not be used again. (Such treatments have repeatedly failed and can be fatal, as sweating/purging are inappropriate.) Using Chinese yin-nourishing herbs to supplement Western antipyretics often yields good results. Although the body is weak, the disease is due to excess pathogen. First, recognize this is post-major illness where Yuan Qi (Original Qi) is deficient, compounded by seasonal pathogens. Although Zheng Qi (Upright Qi) is weak, pathogenic heat is strong. This is distinctly different from TCM's Yin-deficiency fever or Yang-deficiency fever. Therefore, using attacking drugs (sweating, clearing, purging) at this stage is unsuitable (Yuan Qi is too weak to withstand the drug force; not only will fever not subside, but dangerous signs may arise). Using tonics causes stomach Qi stagnation, making excess pathogen more vigorous, failing to match the syndrome. Repeated trials show that combining Chinese and Western medicine is more effective (Western: dilute hydrochloric acid, Kuding Lemon Acid, Quinine; Chinese: Shengdi [Rehmanniae Radix], Huangqin [Scutellariae Radix], Danpi [Moutan Cortex], Maidong [Ophiopogonis Radix]). (I am not biased towards Western medicine; this is empirical experience, urging students to believe it.) Elderly and chronically weak individuals suffering recurrent seasonal pathogens have similar treatment methods; doctors should observe carefully. Below are two recent cases (The combination methods of Western and Chinese medicines recorded in this volume have been tested for years with no danger or chemical opposition, so I dare to publish them for students. However, combining Chinese and Western medicines is very dangerous. Unless following the specific methods in this volume, arbitrarily mixing drugs is strictly prohibited, which is paramount.) ① Meng family's young child, four years old, living at No. 2 Erhutong, Xicheng. Ill for over six months. Initially resembled malaria, recurring despite treatment. Recently worsened after taking TCM diaphoretics. At consultation, pulse was minute and fine, hair sparse, tidal fever in the afternoon, panting, frequent crying from abdominal pain, severe insomnia and coma, scanty yellow urine, loose and extremely foul-smelling stool, craving water, mental dullness, occasional vomiting and acid regurgitation. Previous prescriptions used clearing, resolving, digesting, and dispersing herbs, treated by many doctors, becoming severe. I diagnosed Yin deficiency with residual excess pathogen. First gave a clearing-purgative agent. Stool passed was sticky and foul (child had long consumed goat milk). Condition slightly improved. Then used TCM to nourish Yin, heavily using Shengdi [Rehmanniae Radix], taken twice morning and evening. At 10 AM and 3 PM daily, took one packet each of Western medicine Youguining (Quinine) and another unspecified Western med. Fever completely subsided in three days. Took baking soda three times in between, stopping acid regurgitation. Condition relapsed after stopping meds for 5-6 days. Continued original prescription with Chinese and Western medicines for two more weeks, achieving complete cure. Based on my experience, pure TCM Yin nourishment cannot reduce fever; pure Youguining reduces fever but cannot fundamentally replenish depleted fluids for complete recovery. Supplementing TCM with Western medicine yields rapid results, making this the most accurate treatment. Both methods are safe. I dare to assert this.
② Mrs. Zhu, over twenty years old, living at No. 2 Wugongwei, Xicheng. Initial illness was seasonal pathogen infection. After months of unsuccessful treatment, developed gradual afternoon tidal fever, cough, loss of appetite, fine and rapid pulse, gradually becoming consumptive. Diagnosed as Yin deficiency with heat. Ordered two pills of Guina Wan every morning, combined with Western medicines including baking soda, dilute hydrochloric acid, and Kuding. Recovered in about ten days. This case showed no effect after several TCM treatments, prompting inquiry.