寒热二证既明。复有一种寒热错杂证。宜细详之。初起畏寒微热。疲倦。咳嗽。迨至数日。热愈大。夜间尤甚。喉
内渐起白点。日见长大。虽通身大热如火。足趾必冷如冰。或腹痛自利。阴寒犯足太阴牌也。或心胸吵乱作呕者。
混杂之邪。扰于脾胃欲成霍乱也。或鼻出浊涕。且见血丝者。风热熏蒸鼻窍也。或齿牙红肿出血。火毒炽于胃腑也。
此证之迥乎不同也。察其脉两寸浮洪而数。阳邪见阳脉也。两尺沉细无神。阴邪见阴脉也。此脉之显然有别也。脉证既
殊。治疗各异。若专作热证。而用大苦大寒。必至呕吐泻痢。而脾胃败绝。专作寒证而用麻黄炮姜桂附。则上焦之已伤
者再伤。定然吐血衄血。此皆难以救药也。惟疏风清燥以宣于上。调中利湿以和其中。温暖散邪以逐于下。乃克有济。
治宜辛夷散。苏子降气汤。藿香正气散。加减主之。
辛夷散
辛夷（二粒） 桔梗（三钱） 防风（三钱，去芦） 茯苓（三钱）
僵虫（三钱） 前胡（一钱五分） 法夏（二钱，姜汁炒抖） 蝉蜕（九只，去头、翅、足）
白芷（二钱） 川芎（二钱） 黄栗芽（八分，草药店有卖） 薄荷（五分） 陈茶（五钱） 苍耳（四分） 木
通（一钱） 陈皮（一钱） 粉草（一钱） 生姜（一片） 水煎服。
此方辛夷一派。皆驱风开窍以宣发于上。合二陈生姜除痰去湿。以调和脾胃于中。陈茶能清头面之热。木
通能平心肺之火。以降于下。黄栗芽尤解燥热之瘴气。无论喉之已痛未痛。但见脉证相似即投此方。未痛者全
愈。已痛者减半。如头面浮肿去白芷加白附。胸结痰鸣气促。去白芷加旋复花。小便赤涩。加茵陈、瞿麦、扁
蓄。鼻孔出血或吐血。加丝茅根、藕节、侧柏叶炭。
苏子降气汤
当归（二钱） 前胡（二钱） 法夏（二钱，姜汁炒） 茯苓（三钱） 僵虫（三钱） 陈皮（一钱）
水竹茹（一钱） 浓朴（一钱，姜汁炒） 苏子（一钱） 粉草（一钱） 蝉蜕（九只，去头、翅、足） 肉桂
（五分，去皮蒸兑） 生姜（三片） 水煎服。
投前方。脉必见下虚上实。再用此方。连进二三服。取归桂以温养下元。苏子降逆气以化痰。如颈项喉内肿痛
未除。肺气不降。加葶苈子、旋复花、栝蒌、杏仁之类。
藿香正气散
党参（五钱） 苡仁（四钱，炒） 陈米（一小杯，炒） 茯苓（三钱）
扁豆（三钱） 藿梗（二钱） 法夏（二钱，姜汁炒抖） 前胡（二钱） 苏子（一钱） 陈皮（一
钱） 浓朴（一钱，姜汁炒） 腹毛（一钱） 粉草（一钱） 生姜（三片） 水煎服。
投前二方。病势虽退。必饮食减少。腹中胀滞微痛。或余热不退。或大便溏泻。小便赤短。此脾胃困乏。
余邪滞涩。斯时再逐其邪。正气益虚。欲补其正。邪气未净。宜此方以和解。既和之后。审察脉证偏盛之处。以调
其气血。使精气神三者充。自然困倦起病根除矣。
Since the patterns of Cold and Heat have been clarified, there is another type of pattern characterized by a mixture of Cold and Heat, which should be examined in detail. At the onset, there is aversion to cold, slight fever, fatigue, and cough. After several days, the fever becomes more severe, especially at night. White spots gradually appear inside the throat and enlarge daily. Although the whole body is hot as fire, the toes are inevitably cold as ice. Alternatively, abdominal pain and spontaneous diarrhea may occur, indicating that Yin-Cold pathogenic factors invade the Foot-Taiyin Spleen Meridian (足太阴脾经). Or, mental restlessness and vomiting may occur, suggesting that mixed pathogenic factors disturb the Stomach and Spleen, potentially evolving into Cholera (霍乱). Or, turbid nasal discharge with blood streaks may appear, caused by Wind-Heat steaming the nasal orifices. Or, swelling, redness, and bleeding of the gums and teeth may occur, due to blazing Fire-Toxin in the Stomach organ. These manifestations are distinctly different. Upon pulse diagnosis, the Cun positions (寸部) of both wrists are floating, surging, and rapid, representing Yang pathogens presenting with Yang pulses; the Chi positions (尺部) are deep, thin, and lacking spirit, representing Yin pathogens presenting with Yin pulses. This difference in pulses is obvious. Since the pulses and symptoms differ, the treatments must vary. If treated solely as a Heat pattern using bitter-cold herbs, it will inevitably lead to vomiting and dysentery, causing the failure of the Spleen and Stomach. If treated solely as a Cold pattern using Ephedrae Herba (Mahuang, 麻黄), prepared Zingiberis Rhizoma (Paojiang, 炮姜), Cinnamomi Ramulus (Guizhi, 桂枝), and Aconiti Lateralis Radix Praeparata (Fuzi, 附子), the already damaged Upper Jiao (上焦) will be injured again, inevitably leading to hematemesis (吐血) and epistaxis (衄血). These conditions are difficult to save. Only by dispersing Wind and clearing dryness to ventilate the Upper Jiao, regulating the Middle Jiao and promoting dampness to harmonize the center, and warming to scatter pathogens to drive out evil from the Lower Jiao can success be achieved. The treatment should employ Xinyi San (Magnolia Flower Powder), Suzi Jiangqi Tang (Perilla Fruit Decoction for Descending Qi), and Huoxiang Zhengqi San (Agastache Powder for Rectifying the Qi) with modifications.
Xinyi San (Magnolia Flower Powder)
Xinyi (Magnolia Flower, 辛夷) - 2 grains
Jiegeng (Platycodon Root, 桔梗) - 3 qian
Fangfeng (Saposhnikovia Root, 防风) - 3 qian, remove radicle
Fuling (Poria, 茯苓) - 3 qian
Jiangcan (Bombyx Batryticatus, 僵蚕) - 3 qian
Qianhu (Peucedani Radix, 前胡) - 1.5 qian
Banxia (Pinellia Tuber, 法半夏) - 2 qian, stir-fried with ginger juice
Chantui (Cicada Slough, 蝉蜕) - 9 pieces, remove head, wings, and feet
Baizhi (Angelicae Dahuricae Radix, 白芷) - 2 qian
Chuanxiong (Ligusticum Chuanxiong Rhizome, 川芎) - 2 qian
Huangliya (Castanea Chinensis Sprout, 黄栗芽) - 0.8 fen (available in herbal shops)
Bohe (Menthae Haplocalycis Herba, 薄荷) - 0.5 fen
Chencha (Aged Tea, 陈茶) - 5 qian
Cangerzi (Xanthii Fructus, 苍耳子) - 0.4 fen
Mutong (Akebiae Caulis, 木通) - 1 qian
Chenpi (Citri Reticulatae Pericarpium, 陈皮) - 1 qian
Gancao (Glycyrrhizae Radix et Rhizoma, 粉草) - 1 qian
Shengjiang (Zingiberis Rhizoma Recens, 生姜) - 1 slice
Decoct in water and take orally.
The herbs in this formula, such as Xinyi, all disperse Wind and open orifices to ventilate the Upper Jiao. Combined with Erchen Tang (Two-Aged Decoction) and Shengjiang to eliminate phlegm and dampness, they harmonize the Spleen and Stomach in the Middle Jiao. Chencha clears heat from the head and face; Mutong pacifies Heart and Lung Fire, directing it downward. Huangliya particularly resolves dry-heat miasma. Regardless of whether the throat is painful or not, if the pulse and symptoms match, administer this formula. For those without pain, full recovery is expected; for those with pain, reduce the dosage by half. If facial edema occurs, remove Baizhi and add Baifuzi (Typhonii Rhizoma, 白附子). If chest congestion, rattling phlegm, and shortness of breath occur, remove Baizhi and add Xuanfuhua (Inulae Flos, 旋覆花). If urine is red and scanty, add Yichen (Artemisiae Scopariae Herba, 茵陈), Qumai (Dianthi Herba, 瞿麦), and Bianxu (Polygoni Avicularis Herba, 扁蓄). If epistaxis or hematemesis occurs, add Simaogen (Imperatae Rhizoma, 丝茅根), Ou jie (Nelumbinis Node, 藕节), and Cebeiye Tan (Carbonized Platycladi Cacumen, 侧柏叶炭).
Suzi Jiangqi Tang (Perilla Fruit Decoction for Descending Qi)
Danggui (Angelicae Sinensis Radix, 当归) - 2 qian
Qianhu (Peucedani Radix, 前胡) - 2 qian
Banxia (Pinellia Tuber, 法半夏) - 2 qian, stir-fried with ginger juice
Fuling (Poria, 茯苓) - 3 qian
Jiangcan (Bombyx Batryticatus, 僵蚕) - 3 qian
Chenpi (Citri Reticulatae Pericarpium, 陈皮) - 1 qian
Zhuru (Bambusae Medulla, 水竹茹) - 1 qian
Houpo (Magnoliae Officinalis Cortex, 浓朴) - 1 qian, stir-fried with ginger juice
Suzi (Perillae Fructus, 苏子) - 1 qian
Gancao (Glycyrrhizae Radix et Rhizoma, 粉草) - 1 qian
Chantui (Cicada Slough, 蝉蜕) - 9 pieces, remove head, wings, and feet
Rougui (Cinnamomi Cortex, 肉桂) - 0.5 fen, peel, steam, and add later
Shengjiang (Zingiberis Rhizoma Recens, 生姜) - 3 slices
Decoct in water and take orally.
After administering the previous formula, the pulse will likely show deficiency below and excess above. Use this formula next. Take 2-3 doses continuously. Danggui and Rougui warm and nourish the Lower Yuan (下元); Suzi descends rebellious Qi to transform phlegm. If neck and throat swelling and pain persist, and Lung Qi does not descend, add Tinglizi (Descurainiae Semen seu Lepidii Semen, 葶苈子), Xuanfuhua (Inulae Flos, 旋覆花), Gualou (Trichosanthis Fructus, 栝蒌), and Xingren (Prunus Armeniacae Semen, 杏仁).
Huoxiang Zhengqi San (Agastache Powder for Rectifying the Qi)
Dangshen (Codonopsis Radix, 党参) - 5 qian
Yiyiren (Coicis Semen, 苡仁) - 4 qian, stir-fried
Chenmi (Aged Rice, 陈米) - 1 small cup, stir-fried
Fuling (Poria, 茯苓) - 3 qian
Baidou (Phaseoli Semen, 扁豆) - 3 qian
Huogeng (Agastaches Rhizoma et Rhizoma, 藿梗) - 2 qian
Banxia (Pinellia Tuber, 法半夏) - 2 qian, stir-fried with ginger juice
Qianhu (Peucedani Radix, 前胡) - 2 qian
Suzi (Perillae Fructus, 苏子) - 1 qian
Chenpi (Citri Reticulatae Pericarpium, 陈皮) - 1 qian
Houpo (Magnoliae Officinalis Cortex, 浓朴) - 1 qian, stir-fried with ginger juice
Fupi (Arecae Pericarpium, 腹毛/大腹皮) - 1 qian
Gancao (Glycyrrhizae Radix et Rhizoma, 粉草) - 1 qian
Shengjiang (Zingiberis Rhizoma Recens, 生姜) - 3 slices
Decoct in water and take orally.
After administering the first two formulas, although the disease trend recedes, appetite will inevitably decrease, accompanied by abdominal distension, mild pain, lingering residual heat, loose stools, or scanty red urine. This indicates Spleen and Stomach exhaustion with residual pathogens stagnating. At this stage, forcibly expelling pathogens will further weaken healthy Qi; tonifying healthy Qi while pathogens remain unclean is inappropriate. It is suitable to use this formula for harmonization. After harmonization, examine the pulse and symptoms to identify where excess lies, then regulate Qi and Blood. When Essence, Qi, and Spirit are充盈 (full/plentiful), fatigue will naturally subside, and the root of the disease will be eradicated.