者，不可与也；脉沉者，不可与也；不渴者，不可与也，汗不出者，不可与也；常须识此，勿令误也。
此白虎之禁也；按白虎剽悍，邪重非其力不
举，用之得当，原有立竿见影之妙，若用之不当，祸不旋踵。懦者多不敢用，未免坐误事机；孟浪者，
不问其脉证之若何，一概用之，甚至石膏用至斤余之多，应手而效者固多，应手而毙者亦复不少。皆
未真知确见其所以然之故，故手下无准的也。
十、太阴温病，气血两燔者，玉女煎去牛膝加元参主之。
气血两燔，不可专治一边，故选用张景岳气血两治之玉女煎。去牛膝者，牛膝趋下，不合
太明证之用。改熟地为细生地者，亦取其轻而不重，凉而不温之义，且细生地能发血中之表也。加元参者。
取其壮水制火，预防咽痛失血等证也。
玉女煎去牛膝熟地加细生地元参方（辛凉合甘寒法）
生石膏（一两） 知母（四钱） 元参（四钱） 细生地（六钱） 麦冬（六钱）
水八杯，煮取三杯，分二次服，渣再煮一钟服。
十一、太阴温病，血从上溢者，犀角地黄汤合银翘散主之。其中焦病者，以中焦法治之。若
吐粉红血水者，死不治；血从上溢，脉七、八至以上，面反黑者，死不治，可用清络育阴法。
血从上溢，温邪逼迫血液上走清道，循清窍而出，故以银翘散败温毒，以犀角地黄清血分之伏
热，而救水即所以救金也。至粉红水非血非液，实血与液交迫而出，有燎原之势，化源速绝。血从上
溢，而脉至七、八至，面反黑，火极而似水，反兼胜己之化也，亦燎原之势莫制，下焦津液亏极，不能
上济君火，君火反与温热之邪合德，肺金其何以堪，故皆主死。化源绝，乃温病第一死法也。仲子
曰∶敢问死？孔子曰∶未知生，焉知死。瑭以为医者不知死，焉能救生。细按温病死状百端，大纲不
越五条。在上焦有二∶一曰肺之化源绝者死；二曰心神内闭，内闭外脱者死。在中焦亦有二∶一曰阳
明太实，土克水者死；二曰脾郁发黄，黄极则诸窍为闭，秽浊塞窍者死。在下焦则无非热邪深入，消
铄津液，涸尽而死也。
犀角地黄汤方（见下焦篇）
银翘散（方见前）
已用过表药者，去豆豉、芥穗、薄荷。
十二、太阴温病，口渴甚者，悉尼浆沃之；吐白沫粘滞不快者，五汁饮沃之。
此皆甘寒救液法也。
悉尼浆方（甘冷法）
以甜水梨大者一枚薄切，新汲凉水内浸半日，时时频饮。
五汁饮方（甘寒法）
梨汁 荸荠汁 鲜苇根汁 麦冬汁 藕汁（或用蔗浆）
临时斟酌多少，和匀凉服，不甚喜凉者，重汤炖温服。
十三、太阴病得之二、三日，舌微黄，寸脉盛，心烦懊 ，起卧不安，欲呕不得呕，无中焦证，栀子豉汤主之。
温病二、三日，或已汗，或未汗，舌微黄，邪已不全在肺中矣。寸脉盛，心烦懊 ，起卧不安，欲
呕不得，邪在上焦膈中也。在上者因而越之，故涌之以栀子，开之以香豉。
栀子豉汤方（酸苦法）
栀子（捣碎，五枚） 香豆豉（六钱）
水四杯，先煮栀子数沸，后纳香豉，煮取二杯，先温服一杯，得吐止后服。
十四、太阴病得之二、三日，心烦不安；痰涎壅盛，胸中痞塞欲呕者，无中焦证，瓜蒂散主之，虚者加参芦。
此与上条有轻重之分，有有痰无痰之别。重剂不可轻用，病重药轻，又不能了事，故上条止用
栀子豉汤快涌膈中之热，此以痰涎壅盛，必用瓜蒂散急吐之，恐邪入包宫而成痉厥也。瓜蒂，栀子之
苦寒，合赤小豆之甘酸，所谓酸苦涌泄为阴，善吐热痰，亦在上者因而越之方也。
瓜蒂散方（酸苦法）
甜瓜蒂（一钱） 赤小豆（研，二钱） 山栀子（二钱）
水二杯，煮取一杯，先服半杯，得吐止后服，不吐再服。虚者加人参芦一钱五分。
十五、太阴温病，寸脉大，舌绛而干，法当渴，今反不渴者，热在营中也，清营汤去黄连主之。
渴乃温之本病，今反不渴，滋人疑惑；而舌绛且干，两寸脉大，的系温病。盖邪热入营蒸腾，营
气上升，故不渴，不可疑不渴非温病也，故以清营汤清营分之热，去黄连者，不欲其深入也。
清营汤（见暑温门中）
十六、太阴温病，不可发汗，发汗而汗不出
者，必发斑疹，汗出过多者，必神昏谵语。发斑者，化斑汤主之；发疹者，银翘散去豆豉，加细生地、丹
皮、大青叶，倍元参主之。禁升麻、柴胡、当归、防风、羌活、白芷、葛根、三春柳。神昏谵语者，清宫
汤主之，牛黄丸、紫雪丹、局方至宝丹亦主之。
温病忌汗者，病由口鼻而入，邪不在足太阳之
表，故不得伤太阳经也。时医不知而误发之，若其人热甚血燥，不能蒸汗，温邪郁于肌表血分，故必
发斑疹也。若其表疏，一发而汗出不止，汗为心液，误汗亡阳，心阳伤而神明乱，中无所主，故神
昏。心液伤而心血虚，心以阴为体，心阴不能济阳，则心阳独亢，心主言，故谵语不休也。且手经
逆传，世罕知之，手太阴病不解，本有必传手厥阴心包之理，况又伤其气血乎！
化斑汤方
石膏（一两） 知母（四钱） 生甘草（三钱） 元参（三钱） 犀角（二钱） 白粳米（一合）
水八杯，煮取三杯，日三服，渣再煮一钟，夜一服。
〔方论〕此热淫于内，治以咸寒，佐以苦甘法也。前人悉用白虎汤作化斑汤者，以其为阳明证
也。阳明主肌肉，斑家遍体皆赤，自内而外，故以石膏清肺胃之热，知母清金保肺而治阳明独胜之
热，甘草清热解毒和中，粳米清胃热而保胃液，白粳米阳明燥金之岁谷也。本论独加元参、犀角者，
以斑色正赤，木火太过，其变最速，但用白虎燥金之品，清肃上焦，恐不胜任，故加元参启肾经之气，
上交于肺，庶水天一气，上下循环，不致泉源暴绝也，犀角咸寒，禀水木火相生之气，为灵异之兽，具
阳刚之体，主治百毒蛊疰，邪鬼瘴气，取其咸寒，救肾水，以济心火，托斑外出，而又败毒辟瘟也；再
病至发斑，不独在气分矣，故加二味凉血之品。
银翘散去豆豉加细生地丹皮大青叶倍元参方
即于前银翘散内去豆豉，加∶
细生地（四钱） 大青叶（三钱） 丹皮（三钱） 元参（加至一两）
〔方论〕银翘散义见前。加四物，取其清血热；去豆豉，畏其温也。
按∶吴又可有托里举斑汤，不言疹者，混斑疹为一气也。考温病中发疹者，十之七、八。发斑者
十之二、三。盖斑乃纯赤，或大片，为肌肉之病，故主以化斑汤，专治肌肉；疹系红点高起，麻、 、
痧皆一类，系血络中病，故主以芳香透络，辛凉解肌，甘寒清血也。其托里举斑汤方中用归、升、
柴、芷、穿山甲，皆温燥之品，岂不畏其灼津液乎？且前人有痘宜温、疹宜凉之论，实属确见。况温疹
更甚于小儿之风热疹乎！其用升、柴，取其升发之义，不知温病多见于春夏发生之候，天地之气，有
升无降，岂用再以升药升之乎？且经谓“冬藏精者，春不病温”，是温病之人，下焦精气久已不固，
安庸再升其少阳之气，使下竭上厥乎！经谓“无实实，无虚虚，必先岁气，无伐天和”，可不知耶？后
人皆尤而效之，实不读经文之过也。
再按∶时人发温热之表，二、三日汗不出者，即
云斑疹蔽伏，不惟用升、柴、羌、葛，且重以山川柳发之。不知山川柳一岁三花，故得三春之名，俗转
音三春为山川，此柳古称柽木，诗所谓“其柽其椐”者是也。其性大辛大温，生发最速，横枝极
细，善能入络，专发虚寒白疹，若温热气血沸腾之
赤疹，岂非见之如仇乎？夫善治温病者，原可不必出疹，即有邪郁二、三日，或三、五日，既不得汗，有
不得不疹之势，亦可重者化轻，轻者化无，若一派辛温刚燥，气受其灾而移于血，岂非自造斑疹乎？再时医每于
疹已发出，便称放心，不知邪热炽甚之时，正当谨慎，一有疏忽，为害不浅。再疹不忌泻，
若里结须微通之，不可令大泄，致内虚下陷，法在中焦篇。
清宫汤方
元参心（三钱） 莲子心（五分） 竹叶卷心（二钱） 连翘心（二钱） 犀角尖（磨冲，二钱） 连心麦
冬（三钱）
〔加减法〕热痰盛加竹沥、梨汁各五匙；咯痰不清，加栝蒌皮（一钱五分）；热毒盛加金汁、人
中黄；渐欲神昏，加银花（三钱）、荷叶（二钱）、石菖蒲（一钱）。
〔方论〕此咸寒甘苦法，清膻中之方也。谓之清宫者，以膻中为心之宫城也。俱用心者，凡心有
生生不已之意，心能入心，即以清秽浊之品，便补心中生生不已之生气，救性命于微芒也。火能令
人昏，水能令人清，神昏谵语，水不足而火有余，又有秽浊也。且离以坎为体，元参味苦属水，补离中
之虚；犀角灵异味咸，辟秽解毒，所谓灵犀一点通。善通心气，色黑补水，亦能补离中之虚，故以二物
为君。莲心甘苦咸，倒生根，由心走肾，能使心火
下通于肾，又回环上升，能使肾水上潮于心，故以为使。连翘象心，心能退心热。竹叶心锐而中空，
能通窍清心，故以为佐。麦冬之所以用心者，本经称其主心腹结气，伤中伤饱，胃脉络绝，试问去心，
焉能散结气，补伤中，通伤饱，续胃脉络绝哉？盖麦冬禀少阴癸水之气，一本横生，根颗联系，有十
二枚者，有十四、五枚者，所以然之故，手足三阳三阴之络，共有十二，加任之尾翳，督之长强，共十
四，又加脾之大络，共十五，此物性合人身自然之妙也，惟圣人能体物象，察物情，用麦冬以通续络
脉。命名与天冬并称门冬者，冬主闭藏，门主开转，谓其有开合之功能也。其妙处全在一心之用，
从古并未有去心之明文，张隐庵谓不知始自何人，相沿已久而不可改，瑭遍考始知自陶弘景始
也，盖陶氏惑于诸心入心，能令人烦之一语，不知麦冬无毒，载在上品，久服身轻，安能令人烦哉！
如参、术、 、草，以及诸仁诸子，莫不有心，亦皆能令人烦而悉去之哉？陶氏之去麦冬心，智者千虑
之失也。此方独取其心，以散心中秽浊之结气，故以之为臣。
安宫牛黄丸方
牛黄（一两） 郁金（一两） 犀角（一两） 黄连（一两） 朱
砂（一两） 梅片（二钱五分） 麝香（二钱五分） 真珠（五钱） 山
栀（一两） 雄黄（一两） 金箔衣 黄芩（一两）
上为极细末，炼老蜜为丸，每丸一钱，金箔为
衣，蜡护。脉虚者人参汤下，脉实者银花、薄荷汤下，每服一丸。兼治飞尸卒厥，五痫中恶，大
人小儿痉厥之因于热者。大人病重体实者，日再服，甚至日三服；小儿服半丸，不知再服半丸。
〔方论〕此芳香化秽浊而利诸窍，咸寒保肾水而安心体，苦寒通火腑而泻心用之方也。牛黄得
日月之精，通心主之神。犀角主治百毒，邪鬼瘴气。真珠得太阴之精，而通神明，合犀角补水救
火。郁金草之香，梅片木之香（按冰片，洋外老杉木浸成，近世以樟脑打成伪之，樟脑发水中之火，
为害甚大，断不可用），雄黄石之香，麝香乃精血之香，合四香以为用，使闭固之邪热温毒深在厥阴之
分者，一齐从内透出，而邪秽自消，神明可复也。黄连泻心火，栀子泻心与三焦之火，黄芩泻胆，肺
之火，使邪火随诸香一齐俱散也。朱砂补心体，泻心用，合金箔坠痰而镇固，再合真珠，犀角为督战
之主帅也。
紫雪丹方（从本事方去黄金）
滑石（一斤） 石膏（一斤） 寒水石（一斤） 磁石（水煮二斤，捣煎去渣入后药） 羚羊角（五两） 木香
（五两） 犀角（五两） 沉香（五两） 丁香（一两） 升麻（一斤） 元参（一斤） 炙甘草（半斤）
以上八味，共捣锉，入前药汁中煎，去渣入后药。
朴硝、硝石各二斤，提净，入前药汁中，微火煎，不住手将柳木搅，候汁欲凝，再加入后二味。
辰砂（研细，三两） 麝香（研细，一两二钱）
入煎药拌匀。合成退火气，冷水调服一、二钱。
〔方论〕诸石利水火而通下窍。磁石、元参补肝肾之阴，而上济君火。犀角、羚羊泻心、胆之火。
甘草和诸药而败毒，且缓肝急。诸药皆降，独用一味升麻，盖欲降先升也。诸香化秽浊，或开上窍，
或开下窍，使神明不致坐困于浊邪而终不克复其明也。丹砂色赤，补心而通心火，内含汞而补心体，为坐镇之用
。诸药用气，硝独用质者，以其水卤结成，性峻而易消，泻火而散结也。
局方至宝丹方
犀角（镑，一两） 朱砂（飞，一两） 琥珀（研，一两） 玳瑁（镑，一两） 牛黄（五钱） 麝香（五钱）
以安息重汤炖化，和诸药为丸一百丸，蜡护。
〔方论〕此方会萃各种灵异，皆能补心体，通心用，除邪秽，解热结，共成拨乱反正之功。大抵安宫牛黄丸最凉，
紫雪次之，至宝又次之，主治略同，而各有所长，临用对证斟酌可也。
十七、邪入心包，舌蹇肢厥，牛黄丸主之，紫雪丹亦主之。
厥者，尽也，阴阳极造其偏，皆能致厥
。伤寒之厥，足厥阴病也。温热之厥，手厥阴病也。舌卷
... (preceding text omitted) ... If the pulse is deep, it cannot be used; if there is no thirst, it cannot be used; if there is no sweating, it cannot be used. One must always keep these in mind and avoid errors.
These are the contraindications for Baihu Tang (Cinnamon Twig Decoction). Note: Baihu Tang is potent and fierce; when pathogenic factors are heavy, only its great strength can dispel them. When used appropriately, it has the effect of raising a rod and seeing its shadow immediately; however, if used inappropriately, disaster follows swiftly. Timid practitioners often dare not use it, thereby missing opportunities; rash practitioners, regardless of the pulse and symptoms, use it indiscriminately, even using up more than one *jin* (approx. 500g) of Shigao (Gypsum Fibrosum). Although many cases respond effectively, many also die as a result. This is because they do not truly understand the reasons behind it, thus lacking precision in their application.
10. In Taiyin Warm Disease, where both Qi and Blood are blazing with heat (Qi and Blood Liang Fan), Yunnv Jian (Jade Woman Decoction) modified by removing Niuxi (Achyranthis Bidentatae Radix) and adding Yuanshen (Scrophulariae Radix) is the primary formula.
When both Qi and Blood are blazing, treatment cannot focus on just one aspect; therefore, Zhang Jingyue’s Yunnv Jian, which treats both Qi and Blood, is selected. Niuxi is removed because its downward-draining nature is unsuitable for Taiyin patterns. Shudi (Rehmanniae Radix Preparata) is replaced with Xishengdi (Rehmanniae Radix) to utilize its light and non-heavy properties, and cool rather than warm nature; furthermore, Xishengdi can vent heat from the surface within the Blood level. Yuanshen is added to nourish Water to control Fire (nourishing Kidney Water to restrain Heart Fire), preventing symptoms such as sore throat and bleeding.
Yunnv Jian Modified (Removing Niuxi, Shudi, Adding Xishengdi and Yuanshen) [Method: Acrid-Cool combined with Sweet-Cold]
Shigao (Gypsum Fibrosum) (1 liang)
Zhimu (Anemarrhenae Rhizoma) (4 qian)
Yuanshen (Scrophulariae Radix) (4 qian)
Xishengdi (Rehmanniae Radix) (6 qian)
Maidong (Ophiopogonis Radix) (6 qian)
Boil 8 cups of water until reduced to 3 cups; divide into two doses. Boil the dregs again for one cup.
11. In Taiyin Warm Disease, with bleeding from the upper orifices, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) combined with Yinqiao San (Honeysuckle and Forsythia Powder) is indicated. If the pathology is in the Middle Jiao, treat according to Middle Jiao methods. If pink, bloody fluid is vomited, it is a fatal condition unmanageable by treatment; if bleeding occurs from the upper orifices, the pulse reaches seven or eight beats per breath, and the face turns black, it is also fatal and unmanageable; at this stage, Qingluo Yuyin Fa (Clear Collaterals and Nourish Yin Method) may be applied.
Bleeding from the upper orifices occurs because Warm Pathogens force blood upward through the clear pathways, exiting via the clear orifices. Therefore, Yinqiao San is used to defeat Warm Toxins, and Xijiao Dihuang Tang clears latent heat in the Blood level. Saving Kidney Water is equivalent to saving Lung Metal. The pink bloody fluid is neither pure blood nor body fluids, but a mixture forced out under intense pressure, resembling a prairie fire that rapidly destroys the source of transformation. Bleeding from the upper orifices with a pulse of seven or eight beats per breath and a blackened face indicates extreme Fire resembling Water (a reverse phase in Five Elements theory). This unstoppable "prairie fire" signifies extreme depletion of Lower Jiao fluids, unable to ascend to assist the Ministerial Fire. The Ministerial Fire combines with Warm Pathogens, making it unbearable for Lung Metal; thus, death is predicted. Destruction of the Source of Transformation is the primary fatal mechanism in Warm Diseases. Zhongzi asked, "May I ask about death?" Confucius replied, "If you do not know life, how can you know death?" I believe that if a physician does not understand death, they cannot save life. Careful analysis shows hundreds of death signs in Warm Diseases, summarized in five main categories. In the Upper Jiao, there are two: first, death due to destruction of the Lung's Source of Transformation; second, death due to internal closure of the Heart Spirit with external collapse. In the Middle Jiao, there are two: first, death due to excessive Yangming excess leading to Earth overcoming Water; second, death due to severe Spleen stagnation causing jaundice, where extreme yellowing closes all orifices with turbid pathogens blocking them. In the Lower Jiao, death results solely from Deep Penetration of Heat consuming and exhausting fluids.
Xijiao Dihuang Tang (See Lower Jiao Chapter)
Yinqiao San (Formula seen previously)
If exterior-releasing herbs have already been used, remove Douchi (Fermented Soybean) and Jiesui (Schizonepetae Spica) and Bohe (Menthae Haplocalycis Herba).
12. In Taiyin Warm Disease, with severe thirst, Xueli Jiang (Pear Syrup) is used to moisten. With sticky, obstructive white foam being vomited, Wuzhi Yin (Five Juices Drink) is used to moisten.
These both belong to the Sweet-Cold Fluid-Nourishing Method.
Xueli Jiang Formula (Sweet-Cold Method)
Take one large sweet pear, slice thinly, soak in fresh cold water for half a day, and drink frequently.
Wuzhi Yin Formula (Sweet-Cold Method)
Lizhi (Pear Juice)
Biqi Zhi (Dioscorea Hypoglauca Juice)
Xian Weigen Zhi (Fresh Phragmitis Rhizome Juice)
Maidong Zhi (Ophiopogon Juice)
Ou Zhi (Lotus Root Juice) (or Sugarcane Juice)
Mix in appropriate proportions, cool, and take. For those who dislike cold, warm by double-boiling.
13. In Taiyin Warm Disease, after two or three days, with slightly yellow tongue coating, surging Cun (Inch) pulse, mental restlessness and vexation, inability to lie still, desire to vomit without success, and no Middle Jiao symptoms, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated.
After two or three days of Warm Disease, whether sweated or not, a slightly yellow tongue indicates the pathogen is no longer entirely in the Lung. A surging Cun pulse, mental restlessness, vexation, inability to lie still, and desire to vomit indicate the pathogen is in the Upper Jiao diaphragm area. For pathogens in the upper, induce vomiting to expel them; thus, Zhizi (Gardeniae Fructus) is used to induce vomiting, and Xiangchi (Perillae Folium Fermentatum) to open stagnation.
Zhizi Chi Tang Formula (Sour-Bitter Method)
Zhizi (Gardeniae Fructus) (crushed, 5 fruits)
Xiangdouchi (Fermented Soybean) (6 qian)
Boil 4 cups of water. First boil Zhizi for a few boils, then add Xiangdouchi. Boil until reduced to 2 cups. Take one cup warm initially; stop remaining dose if vomiting occurs.
14. In Taiyin Warm Disease, after two or three days, with mental restlessness, abundant phlegm-saliva, chest oppression and fullness with desire to vomit, and no Middle Jiao symptoms, Gouti San (Melon Peduncle Powder) is indicated. For deficiency patterns, add Renshen Lu (Ginseng Stalk).
This differs from the previous case in severity and presence of phlegm. Heavy formulas should not be used lightly; if the disease is heavy and medicine too light, it fails to resolve the issue. Thus, the previous case used Zhizi Chi Tang to quickly purge heat from the diaphragm. This case, with abundant phlegm-saliva, requires Gouti San to urgently induce vomiting, fearing the pathogen will enter the Pericardium causing spasms and convulsions. The bitter-cold of Gouti combined with the sweet-acid of Chixiaodou (Vigna Angularis Semen) exemplifies "sour-bitter inducing drainage as Yin," effectively vomiting hot phlegm. It is also a formula for expelling pathogens in the upper via vomiting.
Gouti San Formula (Sour-Bitter Method)
Tian Gouti (Melonis Pedunculus) (1 qian)
Chixiaodou (Vigna Angularis Semen) (ground, 2 qian)
Shanzhizi (Gardeniae Fructus) (2 qian)
Boil 2 cups of water until reduced to 1 cup. Take half cup initially; stop if vomiting occurs. If no vomiting, take again. Add 1.5 qian of Renshen Lu for deficiency.
15. In Taiyin Warm Disease, with a surging Cun pulse, crimson and dry tongue, thirst is expected. If there is currently no thirst, the heat is in the Ying (Nutrient) level. Qingying Tang (Clear Nutrient Decoction) modified by removing Huanglian (Coptidis Rhizoma) is indicated.
Thirst is a fundamental symptom of Warm Disease; lack of thirst causes confusion. However, a crimson dry tongue and surging Cun pulses confirm Warm Disease. Heat entering the Ying level steams and rises Ying Qi, causing absence of thirst. Do not doubt that lack of thirst excludes Warm Disease. Qingying Tang clears heat in the Ying level. Huanglian is removed to prevent the medicine from penetrating too deeply.
Qingying Tang (See Summerheat Warmth Section)
16. Taiyin Warm Disease prohibits sweating. If sweating is attempted and no sweat emerges, macules (Ban) and papules (Zhen) will definitely appear. If sweating is excessive, mental confusion and delirious speech will definitely occur. For macules, Huaban Tang (Macule-Resolving Decoction) is indicated. For papules, Yinqiao San modified by removing Douchi, adding Xishengdi, Danpi (Moutan Cortex), Daqingye (Isatidis Folium), and doubling Yuanshen is indicated. Prohibit Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Danggui (Angelicae Sinensis Radix), Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Baizhi (Angelicae Dahuricae Radix), Gegen (Puerariae Lobatae Radix), and Sanchunliu (Tamarici Cacumen). For mental confusion and delirious speech, Qinggong Tang (Palace-Clearing Decoction) is indicated; Angong Niuhuang Wan (Calculus Bovis Pill for Rescuing from Congestion), Zixue Dan (Purple Snow Elixir), and Jufang Zhibao Dan (Imperial Prescription Precious Treasure Elixir) are also indicated.
Warm Disease forbids sweating because the pathogen enters via the mouth and nose, not residing in the exterior of the Foot-Taiyang channel; thus, damaging the Taiyang channel is contraindicated. Contemporary physicians, unaware, err by inducing sweat. If the patient has severe heat and dry blood, unable to vaporize sweat, Warm Pathogens stagnate in the muscle and blood levels, inevitably causing macules and papules. If the exterior is loose, inducing sweat leads to continuous sweating. Sweat is the fluid of the Heart; erroneous sweating depletes Yang, injuring Heart Yang and confusing the Spirit, leading to mental confusion. Injury to Heart fluid causes Heart Blood deficiency. Since the Heart relies on Yin as its substance, insufficient Heart Yin allows Heart Yang to hyperactive. As the Heart governs speech, delirious speech persists. Moreover, counter-transmission of Hand meridians is rarely understood. Untreated Hand-Taiyin Lung disease naturally transmits to Hand-Jueyin Pericardium; compounded by injury to Qi and Blood, the damage is severe.
Huaban Tang Formula
Shigao (Gypsum Fibrosum) (1 liang)
Zhimu (Anemarrhenae Rhizoma) (4 qian)
Sheng Gancao (Glycyrrhizae Radix et Rhizoma) (3 qian)
Yuanshen (Scrophulariae Radix) (3 qian)
Xijiao (Rhinoceri Cornu) (2 qian)
Baijingmi (Oryza Sativa) (1 he)
Boil 8 cups of water until reduced to 3 cups; take three times daily. Boil dregs again for one cup, take at night.
[Formula Commentary] This uses Salty-Cold to treat internal Heat, assisted by Bitter-Sweet. Predecessors used Baihu Tang as Huaban Tang because it addresses Yangming patterns. Yangming governs muscles; macules cover the body red, emerging from inside out. Shigao clears Lung-Stomach heat; Zhimu clears Metal, protects Lung, and treats exclusive Yangming heat; Gancao clears heat, resolves toxicity, and harmonizes middle; Jingmi clears Stomach heat and preserves Stomach fluids. Baijingmi is the grain of Yangming Dry Metal. This treatise adds Yuanshen and Xijiao because bright red macules indicate excessive Wood-Fire with rapid changes. Using only Baihu Tang's Dry Metal herbs to clear the Upper Jiao may be insufficient. Yuanshen启 Kidney Qi to ascend to Lung, ensuring Water and Heaven circulate, preventing sudden exhaustion of the source. Xijiao is Salty-Cold, embodying Water-Wood-Fire generation, an spiritual beast with Yang structure, treating toxins and miasmas. Its Salty-Cold nature saves Kidney Water to balance Heart Fire, pushes macules outward, and defeats toxins. Furthermore, macules indicate involvement beyond the Qi level, hence adding Blood-cooling herbs.
Yinqiao San Modified (Removing Douchi, Adding Xishengdi, Danpi, Daqingye, Doubling Yuanshen)
From previous Yinqiao San, remove Douchi, add:
Xishengdi (Rehmanniae Radix) (4 qian)
Daqingye (Isatidis Folium) (3 qian)
Danpi (Moutan Cortex) (3 qian)
Yuanshen (Scrophulariae Radix) (increase to 1 liang)
[Formula Commentary] See Yinqiao San explanation above. These four herbs clear Blood heat; Douchi is removed due to its warmth.
Note: Wu Youke's Tuoli Juban Tang mentions macules but not papules, conflating them. In Warm Disease, papules appear in 70-80% of cases, macules in 20-30%. Macules are purely red or large patches, affecting muscles, treated by Huaban Tang focusing on muscles. Papules are raised red spots, similar to measles and sand-rash, affecting blood collaterals, treated by aromatic collateral-penetrating, acrid-cool muscle-relieving, and sweet-cold Blood-clearing methods. Tuoli Juban Tang uses Danggui, Shengma, Chaihu, Baizhi, and Shanjiajia (Manis Squama), all warm-drying herbs, risking fluid consumption. Precedents state measles should be warmed, rashes cooled, which is accurate. Warm rashes are worse than pediatric wind-heat rashes. Using Shengma and Chaihu for ascending properties ignores that Warm Disease often occurs in Spring/Summer when Heaven's Qi ascends without descending; further ascending is inappropriate. Classics state "Those who store Essence in Winter do not get Warm in Spring"; Warm Disease patients already have insecure Lower Jiao Essence. Why raise Shaoyang Qi, causing lower exhaustion and upper collapse? Classics warn "Do not tonify Excess or drain Deficiency; respect seasonal Qi and preserve Harmony." Ignoring this is a failure to study classics.
Furthermore, contemporary physicians treating Warm-Heat exterior patterns, if no sweat after 2-3 days, claim hidden macules/papules, using Shengma, Chaihu, Qianghuo, Gegen, and heavily Sanchunliu (Tamarix). Sanchunliu blooms thrice yearly, named for Spring. Ancient name Chengmu ("Its Cheng and Ju"). It is Acrid-Warm, fast-growing, fine branches penetrate collaterals, treating deficient-cold white rashes. For Warm-Heat boiling red rashes, it acts like an enemy. Good Warm Disease treatment avoids rashes; if pathogens stagnate 2-5 days without sweat, forcing rashes may reduce severity. Using Acrid-Warm-Dry herbs damages Qi, transferring disaster to Blood, creating iatrogenic macules. Physicians relax once rashes appear, ignoring intense heat requiring caution. Negligence causes harm. Rashes do not forbid purgation; if interior binding exists, mild purgation is needed, avoiding severe diarrhea causing interior collapse (see Middle Jiao Chapter).
Qinggong Tang Formula
Yuanshenxin (Scrophulariae Radix Heart) (3 qian)
Lianzixin (Nelumbinis Plumula) (5 fen)
Zhuyejuanxin (Lophatheri Folium Rolled Heart) (2 qian)
Liaoqiaoxin (Lonicerae Japonicae Flos Heart) (2 qian)
Xijiaojian (Rhinoceri Cornu Tip) (ground, 2 qian)
Lianxin Maidong (Ophiopogonis Radix with Heart) (3 qian)
[Modifications] For severe heat-phlegm, add Zhuli (Bamboo Sap) and Lizhi (Pear Juice) 5 spoons each. For unclear expectoration, add Gualoupi (Trichosanthis Pericarpium) 1.5 qian. For severe heat-toxin, add Jinzhi (Golden Juice) and Renzhonghuang (Human Midden Yellow). For impending confusion, add Jinyinhua (Lonicerae Japonicae Flos) 3 qian, Heye (Nelumbinis Folium) 2 qian, Shichangpu (Acori Tatarinowii Rhizoma) 1 qian.
[Formula Commentary] This is Salty-Cold Sweet-Bitter method, clearing the Pericardium (Tan Zhong). Called "Palace Clearing" because Tan Zhong is the Palace City of the Heart. Using "Hearts" leverages the Heart's generative power; clearing turbidity replenishes generative Qi, saving life. Fire causes confusion; Water brings clarity. Confusion/delirium indicates Water insufficiency and Fire excess with turbidity. Li Trigram uses Kan as substance. Yuanshen is Bitter-Water, supplementing Li's void. Xijiao is Salty-Spiritual, detoxifying, connecting Heart Qi. Black color supplements Water, aiding Li's void; thus, they are Sovereign herbs. Lianxin is Bitter-Salty, growing upside down from Heart to Kidney, descending Heart Fire to Kidney and ascending Kidney Water to Heart; thus, it is Envoy. Liaoqiao resembles Heart, clearing Heart heat. Zhuyexin is sharp and hollow, opening orifices and clearing Heart; thus, Assistant. Maidong uses heart because Classic states it treats Heart-chest knot-Qi. Removing heart prevents resolving knots. Maidong embodies Shaoyin Gui Water; roots connect 12-15 nodes matching meridian connections. Sage observes this harmony. Named Mendong (Door Winter) implies opening/closing function. Using heart disperses Heart turbidity knot; thus, Minister herb. Historically, Tao Hongjing wrongly removed Maidong heart fearing irritation, despite Shanghan Lun listing it as top-grade safe herb. Ginseng, Atractylodes, Licorice, seeds all have hearts but don't cause irritation. Tao's removal was a mistake. This formula uniquely uses heart to disperse Heart turbidity knot.
Angong Niuhuang Wan Formula
Niuhuang (Calculus Bovis) (1 liang)
Yujin (Curcumae Radix) (1 liang)
Xijiao (Rhinoceri Cornu) (1 liang)
Huanglian (Coptidis Rhizoma) (1 liang)
Zhusha (Cinnabaris) (1 liang)
Meipian (Borneolum Syntheticum) (2.5 qian)
Shexiang (Moschus) (2.5 qian)
Zhenzhu (Margarita) (5 qian)
Shanzhi (Gardeniae Fructus) (1 liang)
Xionghuang (Realgar) (1 liang)
Jinbo Yi (Gold Leaf Coating)
Huangqin (Scutellariae Radix) (1 liang)
Grind to fine powder, mix with aged honey into pills, 1 qian each, coat with gold leaf, wax seal. For deficient pulse, take with Ginseng decoction; for excess pulse, with Honeysuckle-Mint decoction. One pill per dose. Treats sudden fainting, epilepsy, toxic heat spasms in adults and children. Adults with severe/excess conditions: twice daily, up to three times. Children: half pill, repeat if necessary.
[Formula Commentary] Fragrant herbs transform turbidity and open orifices; Salty-Cold protects Kidney Water and calms Heart substance; Bitter-Cold drains Fire腑 and reduces Heart function. Niuhuang captures Sun/Moon essence, connects to Heart Spirit. Xijiao treats toxins/miasmas. Zhenzhu captures Yin essence, connects to Spirit, combines with Xijiao to supplement Water/save Fire. Yujin (Herb fragrance), Meipian (Wood fragrance - note: synthetic borneol from camphor is harmful, avoid), Xionghuang (Stone fragrance), Shexiang (Essence/Blood fragrance). Four fragrances together drive out deep Jueyin Heat-Toxins, eliminating turbidity, restoring Spirit. Huanglian drains Heart Fire; Zhizi drains Heart/Sanjiao Fire; Huangqin drains Gallbladder/Lung Fire. Zhusha supplements Heart substance, drains Heart function, settles phlegm with Gold Leaf, directs battle with Pearl/Xijiao.
Zixue Dan Formula (From Benshi Fang, removing Gold)
Huashi (Talcum) (1 jin)
Shigao (Gypsum Fibrosum) (1 jin)
Han Shuishishi (Aragonitum) (1 jin)
Cishi (Magnetitum) (water-boiled 2 jin, pounded, decocted, strained)
Lingyangjiao (Saigae Tataricae Cornu) (5 liang)
Muxiang (Aucklandiae Radix) (5 liang)
Xijiao (Rhinoceri Cornu) (5 liang)
Chenxiang (Aquilariae Lignum Resinatum) (5 liang)
Dingxiang (Caryophylli Flos) (1 liang)
Shengma (Cimicifugae Rhizoma) (1 jin)
Yuanshen (Scrophulariae Radix) (1 jin)
Zhi Gancao (Glycyrrhizae Radix et Rhizoma Prepared) (0.5 jin)
First eight herbs chopped, decocted in Cishi liquid, strained. Add purified Poxiao (Natrii Sulfas) and Xiaosho (Nitrums) 2 jin each. Simmer slowly, stirring with willow wood until thickening. Add Chen Sha (Cinnabaris ground, 3 liang) and Shexiang (Moschus ground, 1.2 liang). Mix well. Cool before taking 1-2 qian with cold water.
[Formula Commentary] Stones facilitate Water/Fire and open lower orifices. Cishi/Yuanshen supplement Liver/Kidney Yin, assisting Minister Fire. Xijiao/Lingyangjiao drain Heart/Gallbladder Fire. Gancao harmonizes, detoxifies, soothes Liver urgency. All herbs descend except Shengma, used to descend by first ascending. Fragrances transform turbidity, opening upper/lower orifices to prevent Spirit entrapment. Zhusha (Red) supplements Heart/Fire, contains Mercury supplementing Heart substance, acting as anchor. Salts use substance (crystallized, harsh, dissolving) to drain Fire/scatter knots.
Jufang Zhibao Dan Formula
Xijiao (Rhinoceri Cornu sliced, 1 liang)
Zhusha (Flown Cinnabar, 1 liang)
Hupo (Amberum ground, 1 liang)
Daimai (Megalosauri Os preparatum, 1 liang)
Niuhuang (Calculus Bovis, 5 qian)
Shexiang (Moschus, 5 qian)
Dissolve Anxi Xiang (Styrax) in hot water, mix with herbs into 100 pills, wax seal.
[Formula Commentary] Combines spiritual substances to supplement Heart substance, open Heart function, remove turbidity, resolve heat knots, restoring order. Angong Niuhuang Wan is coolest, Zixue Dan next, Zhibao Dan third. Indications similar, strengths differ; choose based on syndrome.
17. Pathogen entering Pericardium, with stiff tongue and cold limbs, Niuhuang Wan is indicated; Zixue Dan is also indicated.
Jue means extremity/extremes. Extreme deviation of Yin and Yang causes Jue. Cold Damage Jue involves Foot-Jueyin. Warm Heat Jue involves Hand-Jueyin. Tongue curling...