21.男。伏温亦是流行性感冒。苔腻、欲呕是肠胃型感冒，故难速效;寒热有起伏，可予达原饮。厚朴3克(研细末)，煨草果6克，白芍9克，酒炒黄芩6克，槟榔9克，知母9克，粉甘草3克，姜半夏9克。[按]此案苔腻，欲呕，寒热起伏，一派湿热蕴结之象，故予达原饮加减，以疏解宣通，燥湿清热。
22.男。暑令感冒，恶寒无汗者，不忌麻桂;今有汗，且不甚恶寒，则清代医家之法尚矣。大豆卷15克，带叶佩兰9克，冬桑叶9克，甘菊花9克，陈皮5克，炒枳壳9克，赤苓16克，牛蒡子9克，佛手片5克。[按]此夏令感冒，方用桑、菊、牛子辛以散风;枳实、佩兰、橘皮、佛手芳香化浊;豆卷、赤苓淡渗利湿。是取清代医家轻清宣化之法。
23，马男。余热总不能尽，面色萎黄。凡正气不足者，无论其热由于内伤、外感，皆难速效。东垣于暑令之热多用补药，正此故也。今师其法。潞党参9克，麦冬9克，五味子5克，生黄芪9克，香青蒿9克，净连翘16克，荷梗30厘米，绿豆衣6克。[按]经曰：虚身热，得之伤暑。"东垣于是有清暑益气汤之制。此案以余热不尽，气阴两亏，故师东垣法，用参、芪以扶正气，麦、味之养阴液，复入青蒿、连翘、荷梗、绿豆衣清解暑热。
24.男。苔有湿象，头眩，神倦，此暑邪也。香薷9克，扁豆9克，厚朴花3克，枳壳9克，赤茯苓9克，木瓜9克，佩兰梗6克，鲜藿香9克，晚蚕沙9克(包)，佛手6克，五磨饮9克(分2次吞服)。[按]舌多夹湿，叶天士谓，"夏热气闭无汗，渴饮停水"是也。方取香蓠饮加利湿理气之品，芳香化湿，气行则水行。香薷一味，叶天士谓"辛温发汗，能泄宿水"。诚为夏月感冒之妙品。
25.女。从童年迄今，每逢夏令有疰夏。下午有微热，纳呆，苔腻，予芳香化浊法。佩兰叶12克，生苍术6克，橘皮6克，扁豆衣12克，厚朴3克，车前子12克，炒苡仁18克，藿香梗12克，佛手片5克。二诊:下午体温正常，食量亦增，唯疲乏而已。生苍术6克，木瓜6克，陈皮6克，川朴3克，米仁15克，佛手5克，谷麦芽各12克，砂仁3克。
[按]疰夏或称夏季热，多为暑邪夹湿，但有偏暑、偏湿的不同。湿偏盛者，其热不扬，治以芳香化浊、淡渗利湿为主;击偏盛者，每多壮热，人参白虎汤之类。此案为湿偏盛者，投芳香之品后热退，继以平胃散加减燥湿为功。"疲乏"仍为湿困，非气虚。故不用参、芪。
26.女。其舌尖红，流行性感冒之的证。古籍以时令定病名，有称为冬温者。得汗不解，法当凉散。薄荷5克(后下)，豆豉9克，桔梗5克，浮萍草5克，前胡6克，杏仁泥16克，桑叶皮各9克，菊花9克，粉草3克，全瓜蒌9克，枇杷叶3片(去毛，包)。[按]风寒表证，宜乎辛温发散;温热表证，则应凉散为法。此病舌尖红，得汗不解，为温热外感所致，治用辛凉轻剂桑菊饮加减，轻宣凉散，颇为中肯。
27.男。喉蛾双发，掀红肿痛，恶寒已罢，当清其热。紫花地丁16克，板蓝根9克，大青叶9克，山豆根9克，连翘9克，黄芩9克，桑白皮9克，绿豆衣16克，知母9克，甘草3克。[按]喉蛾红肿，即急性扁桃体炎，多为感言之并发症。其有表症者，仍当表散;如发热不退，则当用清法。此症"恶寒己罢"，为风寒已解;喉蛾撇红肿痛"，系邪热为患。方用苦寒之品清热解毒，颇为对证。
28.女。寒热3日，脉数不静，舌红苔腻，颇类时症初起，不可忽视;兼见咳呛不爽，7日不更衣，则咽喉咽饮作痛，良有以也。豆卷12克，鸡苏散12克(包)，川郁金3克，杏仁泥9克，活芦根30厘米，葛根9克，黑山栀9克，枳实9克，紫菀9克，全瓜蒌12克。
[按]肺气通于喉，肺与大肠相表里，咽喉肿痛而兼大便秘者，通大便则咽喉肿痛可迅速消退。此案既用豆卷、鸡苏散、葛根、山栀解表清热，又用杏仁、紫菀、瓜蒌祛痰止咳，更用枳实、郁金配瓜蒌宣中通便，表里兼治，照顾周到。
29.弟。咳呛可引起失音与咽痛;其苔白，微恶寒，疏散风寒即是。冬桑叶5克，薄荷叶3克(后下)，粉前胡5克，光杏仁9克，玉桔梗5克，浙贝母9克，牛蒡子9克，胖大海3只，玉蝴蝶3克，生甘草3克，嫩射干3克。[按]此症由肺受风寒，咳呛所引起，苔白，微恶寒，病仍在表，故以疏散风寒，宣通肺气为治。
30.女。感冒发热三四日，咳引胸膺痛，咯痰不爽，临风毛耸。荆芥9克，白前9克，桔梗3克，紫菀9克，陈皮6克，百部6克，甘草3克，苏子12克。二诊:服止嗽散后，咳减轻，咳引胸膺痛已除，咯痰仍不爽，怕风。桔梗3克，苏子12克，陈皮6克，大力子9克，薄荷叶5克(后下)，象贝母9克，粉草3克，车前子9克(包)。[按)方用《医学心悟》止嗽散，此方不寒不热，温润和平，既无攻击过当之虞。大有启门驱敌之功，是以客邪易散，肺气安宁。
31.女。曾患风疹块者，如有感冒，用辛温之发散药，恒能引起疹之复发。本来西药中之水杨酸制剂，特异质亦能发疹;中药荆芥、西河柳亦然。前胡6克，秦艽9克，刺蒺藜9克，桔梗5克，当归6克，桂枝3克(后人)，苏子9克(包)，神曲9克，晚蚕沙9克(包)，白芍9克，粉草3克，谷麦芽各9克。(按]荆芥、西河柳等辛温发散药，能引起风疹复发，确系经验之谈。本案系"曾患风疹块"之感冒，故避免使用此类药物。
1.殷男，体温39.9℃,脉数（142次/分），此春温症之重者也。病甫6日，精神殊觉困顿，舌光红起刺。两日之中，冀其速解，不解则缠绵时日矣。鲜生地24克，知母、玄参、黄芩、连翘、青蒿各9克，天花粉、车前子(包)各12克，郁金3克，鲜石菖蒲6克。二诊:其热一如昨日，夜间两颧发赤，舌红起刺，咳不甚剧而痰多，神志迷蒙，邪陷心包。心包者，实指中枢神经也。南沙参9克，鲜生地2.克，带心麦冬9克，带心连翘12克，桑白皮12克，陈胆星3克，远志6克，白茅根30克，紫雪丹1.克(每4小时服0.克)。
[按]本案系春温重症，里热伤津，故病甫6日，精神困顿，舌光起刺。首方重用甘寒养阴，配以苦寒直清里热。二诊以邪陷心包，故加紫雪，以清热解毒，开窍镇痉。
2.男。体温39.℃，谵语见于病起之第3日，在肠伤寒殊为少见。呼吸紧张，时有痰凝于喉间，咯吐不爽，此温邪首先犯肺之候。桑白皮9克，地骨皮9克，连翘12克，知母9克，否苡仁各9克，葶苈子9克，地龙9克，远志肉4.克，瓜蒌仁9克(玄明粉9克同捣)，生甘草2.克。二诊:气略平，入夜两颧发赤。如见神蒙，便是逆传心包之候。生麻黄2.克，生石膏30克，光杏仁9克，粉甘草3克，淡黄芩9克，地龙9克，桑白皮9克，远志肉4.克，陈胆星2.克，石菖蒲9克。
[按]热邪迫肺，灼液为痰，肺气阻痹而咳喘，乃为风温必有之症。首诊用桑皮、地骨皮，连翘、知母、地龙以泻肺经之热;葶苈、否、苡、瓜蒌以消痰利肺;远志祛痰宁神;玄明粉与瓜蒌同捣，既可清化热痰，又兼通里荡邪。二诊用麻杏石甘加黄芩、桑皮、地龙开闭泄热;陈胆星、菖蒲、远志以祛痰宁心。痰热廓清，则可免逆传心包之险。
3.男。身热自汗出而不能解者，是为风温。病5日，从末得便。凡温邪皆下不嫌早。粉葛根9克，淡黄芩9克，地枯萝12克，春柴胡9克，连翘9克，望江南30克，黑山栀9克，菊花9克，赤苓9克，郁李仁12克。
[按]病人服本方3剂后，即热退身凉。其后曾因纳谷欠香，神倦，复诊两次。先生以异功散加味给予调理善后。由此足见n温邪下不嫌早"，确是经验之谈。方中郁李仁、望江南均是通便药，而望江南通便作用缓和而可靠，且无腹痛和继发便秘等副作用，因此用于热性病很是安全o但此药必须浓煎，否则效果较差。
4.左。1941年2月4日初诊。排便有白色粘液，胃之右侧作痛，病灶在肠之象，日昨因高热而咯吐红色之痰，予凉膈散。玄明粉(冲)、黑山栀各9克，黄芩12克，青蒿子、桑白皮各9克，生锦纹4.5克(后下)，净连翘12克，薄荷6克(后下)，杭白芍9克，淡竹叶30片。二诊:所咯之血，稀散不凝，自觉右胁痛，人夜有迷蒙状，此热高也。玄参9克，天花粉9克，连翘9克，白薇12克，麦冬9克，丹皮10克，知母9克，银花12克，黄芩9克，青蒿子9克，芦根30克。
三诊:肺炎，因高热而吐红色之沫，右胁痛，喉间痰声漉漉，此温邪苜先犯肺，人夜迷蒙，有逆传之象。北沙参6克，桑白皮9克，麦门冬9克，生石膏15克(先煎)，芦根30克，桔梗6克，知、贝母各9克，卷心竹叶30片，京玄参9克，地骨皮9克，淡黄芩9克，葶苈子9克，杭白芍9克，苏合香丸1粒(化服)。
[按)此例壮热陡作，伴有胸痛痰鸣，咯吐血沫，而外无恶寒之情，内乏阴津之供，其热郁肺而不得泄，势必下迫，以大肠与肺相表里,故"排便有白粘液"，《内经》所谓"肺移热于大肠"也。
凡疾病之始，其外证尚未毕具，每贻辨证以困窘。此例初诊称其"病灶在肠"，迨三诊方确断其为"温邪首先犯肺"，先生不讳言其误，坦然修正诊断，且案中绝无一辞以文饰，其实事求是精神，堪作后学之楷模。
此例初起，虽按西医辨病，定位不确，然其施治则仍遵中医传统，是以末致与证情相扦格。首方用黄芩、栀子、连翘、薄荷、竹叶、桑白皮等味，清泄上焦郁热;又以降泄之大黄、玄明粉，因势利导，借阳明为出路，方药颇有力量。奈其时邪热鸱张，未能奏功。二诊因邪热炽盛与阴津亏耗之症状愈益突出，故立方从育阴清热着手。
三诊之方，则系通过确诊。针对其证情之热壮阴耗、痰热阻肺、闭窍迫肠，而兼采自虎、增液、泻白以及葶苈大枣泻肺汤诸方之长，并加清心开窍之品而成。方用石膏、知母、贝母、桔梗以清热宣肺化痰;取泻白散中之地骨皮、桑白皮，益以黄芩，上泻肺热而疗胸痛痰红，下清大肠而除白色粘液;用卷心竹叶、苏合香丸以清心开窍;仿增液汤之用玄参、麦冬，并伍以沙参、白芍、芦根，以救其亏耗之阴津;其用葶苈子者。以葶苈"走肺经气分，兼走大肠，从上下降"(节引自《温病条辨.儿难》)，仍冀肺中伏热痰浊，借大肠为出路。立意周密，选药精当。
5.男。平卧则喘，痰有铁锈色，左肋痛，此王者皆肺炎之证候。初起曾有战栗，壮热而神蒙者，属大叶性肺炎。生麻黄4.克，桔梗6克，生石膏l2克(研末另吞)，黄芩6克，葶苈子6克，杏仁泥12克，杭白芍9克，桑白皮9克，粉草4.克，活芦根30克(去节)。
二诊:痰中仍有铁锈色，肺循环郁血故也。两脉细数不整，平卧则气逆，此二者皆循环系病。病虽因咳而起，治咳尚是次要。麻黄所以为此症主要药，即因其能亢迸血压，消失郁血故也。生麻黄4.克，升麻4.克，车前子12克(包)，五味子4.克，桔梗9克，海蛤壳24克(先煎)，葶苈子9克，杏仁15克，杭白芍12克，桑皮9克，紫菀9克，粉甘草4.克。
[按]大叶性肺炎辨证多属痰热壅肺。方用麻杏石甘汤加味，一。则用其宣肺达邪，一则以其清热化痰。方中生石膏研末吞服，在于清热之功较煎服为优。近世张锡纯先生常用此法。以治温热病壮热之证。
1.男。病甫3日，身热不退，腹痛便溏，日七八行，色红如血，苔腻脉数。暑湿之邪，深伏其内，非小恙也。白头翁9克，川雅连2.克，黄柏9克，黄芩9克，银花炭15克，连翘9克，郁金6克，马齿苋12克，荠菜花12克，滑石9克，鲜荷梗30厘米。
二诊:药后便血大见瘥可，今晨大便色黑而溏，前方再进。白头翁9克，秦皮9克，川雅连1.克，黄柏9克，白槿花15克，马齿苋15克，败酱草12克，滑石9克，苦参片6克，陈红茶9克。三诊:凡时症初起，便溏如血，继以色黑如胶者，预后大都不良。进白头翁汤，大便次数减。然头昏目眩，神情疲惫，深虑正气不支，发生虚脱。银花15克，连翅12克，小蓟炭12克，马齿苋12克，贯众炭12克，赤苓12克，碧玉散12克(包)，车前子9克(包)，荷梗30厘米。
四诊:重用苦寒清肠之剂，便之如酱者己止，而又见咯血。其血虽因咳而来，但其人之血液易于渗溢，已无可讳。肺与大肠相为表里，必须大剂清肠润肺，双管齐下，以免顾此失彼。玄参6克，寸冬9克，桑白皮9克，知母9克，生侧柏叶18克，茜草炭12克，金银花15克，冬瓜子9克，杏仁泥15克，甘草3克，白茅根1扎。五诊:便血咯血，俱不再作。数日来之变化，固然出乎意外;而今奏效之速，亦非始料所及。热虽下任，而脉犹虚数，还虑虚中生波。北沙参9克，干地黄12克。白芍9克，麦冬9克，玉竹9克，冬青子9克，旱莲草9克，料豆衣12克。
21. Male. Fuguan Wenbing (Warm disease with latent pathogen) is also a manifestation of influenza. Greasy tongue coating and nausea indicate gastro-intestinal type influenza, thus difficult to achieve rapid effect; alternating chills and fever with fluctuations can be treated with Da Yuan Yin (Origin-Reaching Decoction). Houpo 3g (ground into fine powder), Wei Caoguo 6g, Baishao 9g, Jiuchao Huangqin 6g, Binglang 9g, Zhimu 9g, Fen Gancao 3g, Jiang Banxia 9g. [Commentary] This case shows greasy tongue coating, nausea, and fluctuating chills and fever, presenting a picture of damp-heat accumulation. Therefore, Da Yuan Yin was modified to soothe, resolve, unblock, dry dampness, and clear heat.
22. Male. Summer-heat influenza with aversion to cold and anhidrosis does not contraindicate Ma Huang Tang or Gui Zhi Tang; however, now there is sweating and mild aversion to cold, so the methods of Qing dynasty physicians are preferable. Dadoujuan 15g, Peilan with leaves 9g, Dong Sangye 9g, Gan Juhua 9g, Chenpi 5g, Chao Zhiqiao 9g, Chi Ling 16g, Niubangzi 9g, Foshoupian 5g. [Commentary] This is summer influenza. The formula uses Sangye, Juhua, and Niubangzi to disperse wind-heat acridly; Zhiqiao, Peilan, Chenpi, and Foshou to transform turbidity with aromatic herbs; Doujuan and Chi Ling to leach out dampness lightly. This adopts the Qing dynasty method of light, clear, and transforming therapy.
23. Ma's boy. Residual heat cannot be completely cleared, complexion is sallow. For those with insufficient righteous qi, regardless of whether the heat stems from internal injury or external contraction, rapid recovery is difficult. Li Dongyuan often used tonifying medicines for heat during summer, precisely for this reason. Now following his method. Ludangshen 9g, Maidong 9g, Wuweizi 5g, Sheng Huangqi 9g, Xiang Qinghao 9g, Jing Lianqiao 16g, Hegeng 30cm, Lvdouyi 6g. [Commentary] The Classic says: "Heat in deficient bodies often results from summer-heat injury." Li Dongyuan thus formulated Qingshu Yiqi Tang. This case involves lingering residual heat and deficiency of both qi and yin, so it follows Li Dongyuan's method, using Renshen and Huangqi to support righteous qi, Maidong and Wuweizi to nourish yin fluids, and adding Qinghao, Lianqiao, Hegeng, and Lv douyi to clear and resolve summer-heat.
24. Male. Tongue coating indicates dampness, dizziness, mental fatigue; this is pathogenic summer-heat. Xiangru 9g, BianDou 9g, Houpuhua 3g, Zhiqiao 9g, Chi Fuling 9g, Mugua 9g, Peilanggeng 6g, Xin Huoxiang 9g, Wancansha 9g (wrapped), Foshou 6g, Wu Mo Yin 9g (taken in two doses). [Commentary] Tongue coating often includes dampness. Ye Tianshi stated, "In summer, heat closes the pores causing anhidrosis; thirst leads to water retention." This is what he meant. The formula takes Xiangru Yin plus damp-resolving and qi-regulating herbs, using aromatics to transform dampness; when qi moves, water moves. Xiangru alone, according to Ye Tianshi, "acrid-warm inducing sweat can drain old water." It is indeed a superb herb for summer influenza.
25. Female. From childhood until now, she suffers from Zhu Xia (summer lethargy syndrome) every summer. Slight afternoon fever, poor appetite, greasy tongue coating. Treatment with aromatic transformation of turbidity method. Peilanye 12g, Sheng Cangzhu 6g, Jupi 6g, Biandouyi 12g, Houpo 3g, Cheqianzi 12g, Chao Yiren 18g, Huoxianggeng 12g, Foshoupian 5g. Second visit: Afternoon temperature normal, appetite increased, only fatigue remains. Sheng Cangzhu 6g, Mugua 6g, Chenpi 6g, Chuan Pu 3g, Miren 15g, Foshou 5g, Guya and Maiya 12g each, Sharen 3g.
[Commentary] Zhu Xia, or summer heat, is mostly summer-heat combined with dampness, but differs in being predominantly summer-heat or predominantly dampness. When dampness predominates, heat is not prominent; treatment focuses on aromatic transformation of turbidity and light leaching of dampness. When summer-heat predominates, high fever often occurs, treated with formulas like Renshen Baihu Tang. This case is predominantly dampness; after aromatic herbs, heat subsided, followed by Pingwei San modifications to dry dampness. "Fatigue" is due to dampness encumbering, not qi deficiency. Hence, no Renshen or Huangqi.
26. Female. Red tongue tip is a typical sign of influenza. Ancient texts named diseases by season, some calling it Dongwen (Winter Warmth). Sweating fails to resolve the condition; the method should be cooling dispersion. Bohe 5g (added later), Douchi 9g, Jiegeng 5g, Fupingcao 5g, Qianhu 6g, Xingrenni 16g, Sangyepi 9g each, Juhua 9g, Fen Cao 3g, Quangualou 9g, Pipaye 3 slices (de-haired, wrapped). [Commentary] Wind-cold exterior syndrome requires acrid-warm dispersion; warm-heat exterior syndrome requires cooling dispersion. This case has red tongue tip and unresolved condition after sweating, caused by warm-heat external contraction. Treatment uses the light acrid-cool agent Sang Ju Yin modified, lightly dispersing coolness, which is quite appropriate.
27. Male. Bilateral Hou'e (tonsillitis) with swelling, redness, and pain; aversion to cold has ceased, heat should be cleared. Zihuadiding 16g, Banlangen 9g, Daqingye 9g, Shandougen 9g, Lianqiao 9g, Huangqin 9g, Sangbaipi 9g, Lv douyi 16g, Zhimu 9g, Gancao 3g. [Commentary] Swollen and red Hou'e refers to acute tonsillitis, often a complication of influenza. If exterior symptoms exist, release the exterior; if fever persists, use clearing methods. Here, "aversion to cold has ceased" means wind-cold is resolved; "swollen, red, painful Hou'e" indicates pathogenic heat. The formula uses bitter-cold herbs to clear heat and detoxify, fitting the syndrome well.
28. Female. Alternating chills and fever for 3 days, rapid pulse restless, red tongue with greasy coating, resembling early stage epidemic disease, must not be ignored; accompanied by coughing and difficulty expectorating, constipation for 7 days, throat pain upon swallowing, all have reasons. Dadoujuan 12g, Jisu San 12g (wrapped), Chuan Yujin 3g, Xingrenni 9g, Huo Lugeng 30cm, Gegen 9g, Hei Shanzhi 9g, Zhishi 9g, Ziwan 9g, Quangualou 12g.
[Commentary] Lung qi connects to the throat, and Lung and Large Intestine are interior-exterior partners. Throat swelling/pain with constipation: purging bowels rapidly reduces throat symptoms. This case uses Dadoujuan, Jisu San, Gegend, Shanzhi to release exterior and clear heat; Xingren, Ziwan, Gualou to resolve phlegm and stop cough; Zhishi, Yujin paired with Gualou to promote middle jiao circulation and bowel movement, treating both exterior and interior comprehensively.
29. Younger brother. Coughing can cause aphonia and sore throat; white tongue coating, slight aversion to cold, dispersing wind-cold is sufficient. Dong Sangye 5g, Boheye 3g (added later), Fen Qianhu 5g, Guang Xingren 9g, Yu Jiegeng 5g, Zhe Beimu 9g, Niubangzi 9g, Pangdahai 3 pieces, Yuhudie 3g, Sheng Gancao 3g, Nen Shegan 3g. [Commentary] This syndrome is caused by lung affected by wind-cold leading to coughing. White coating and slight aversion to cold indicate the pathogen is still at the exterior level; thus, dispersing wind-cold and unblocking lung qi is the treatment.
30. Female. Influenza fever for 3-4 days, cough pulling chest pain, difficult expectoration, piloerection in wind. Jingjie 9g, Baiqian 9g, Jiegeng 3g, Ziwan 9g, Chenpi 6g, Baibu 6g, Gancao 3g, Suzi 12g. Second visit: After taking Zhisou San, cough reduced, chest pain from coughing gone, expectoration still difficult, aversion to wind. Jiegeng 3g, Suzi 12g, Chenpi 6g, Dalizi 9g, Boheye 5g (added later), Xiang Beimu 9g, Fen Cao 3g, Cheqianzi 9g (wrapped). [Commentary] The formula uses Zhisou San from *Yixue Xinwu*. This formula is neither cold nor hot, gentle and peaceful, avoiding excessive aggression, effectively expelling pathogens and calming lung qi.
31. Female. Those who have suffered from urticaria (wind rash blocks) often experience recurrence of rashes if treated with acrid-warm dispersing drugs for influenza. Similarly, salicylate preparations in Western medicine can cause rashes in sensitive individuals; Chinese herbs Jingjie and Xi Heliu do the same. Qianhu 6g, Qinjiao 9g, Cijili 9g, Jiegeng 5g, Danggui 6g, Guizhi 3g (added later), Suzi 9g (wrapped), Shenqu 9g, Wancansha 9g (wrapped), Baishao 9g, Fen Cao 3g, Guya and Maiya 9g each. [Commentary] Acrid-warm dispersing herbs like Jingjie and Xi Heliu can indeed trigger urticaria recurrence, based on experience. This case involves influenza in a patient with history of urticaria, hence such drugs were avoided.
Wind-Warmth and Spring-Warmth
1. Yin male, temperature 39.9°C, rapid pulse (142 bpm), this is a severe case of Chunwen (Spring Warmth). Disease duration only 6 days, spirit extremely fatigued, tongue bare red with prickles. Within two days, hoping for rapid resolution; otherwise, it will linger. Xian Shengdi 24g, Zhimu, Xuanshen, Huangqin, Lianqiao, Qinghao each 9g, Tianhuafen, Cheqianzi (wrapped) each 12g, Yujin 3g, Xian Shichangpu 6g. Second visit: Heat persists as yesterday, malar flush at night, red tongue with prickles, cough not severe but profuse phlegm, confused consciousness, pathogen trapped in Pericardium. Pericardium here refers to the central nervous system. Nanshashen 9g, Xian Shengdi 2g, Daixin Maidong 9g, Daixin Lianqiao 12g, Sangbaipi 12g, Chen Danning 3g, Yuanzhi 6g, Baimaogen 30g, Zixue Dan 1g (0.1g every 4 hours).
[Commentary] This is a severe Chunwen case, interior heat damaging fluids, hence fatigue and prickle-covered tongue after 6 days. First prescription heavily uses sweet-cold to nourish yin, paired with bitter-cold to directly clear interior heat. Second visit adds Zixue Dan due to pathogen trapping Pericardium, to clear heat, detoxify, open orifices, and calm spasms.
2. Male. Temperature 39.°C, delirium appeared on day 3, rare in typhoid fever. Tense breathing, phlegm congealing in throat, difficult expectoration, indicating warm pathogen first attacking Lung. Sangbaipi 9g, Digupi 9g, Lianqiao 12g, Zhimu 9g, Yiyiren each 9g, Tinglizi 9g, Dilong 9g, Yuanzhi Rou 4g, Gualou Ren 9g (t pounded with Xuanshifen 9g), Sheng Gancao 2g. Second visit: Breathing slightly calmer, malar flush at night. If confusion appears, it indicates reverse transmission to Pericardium. Sheng Mahuang 2g, Sheng Shigao 30g, Guang Xingren 9g, Fen Gancao 3g, Dan Huangqin 9g, Dilong 9g, Sangbaipi 9g, Yuanzhi Rou 4g, Chen Danning 2g, Shichangpu 9g.
[Commentary] Heat forcing Lung, scorching fluids into phlegm, obstructing Lung qi causing cough/wheeze, is essential to Fengwen. First visit uses Sangpi, Digupi, Lianqiao, Zhimu, Dilong to drain Lung heat; Tinglizi, Yiyi, Gualou to eliminate phlegm and benefit Lung; Yuanzhi to resolve phlegm and calm spirit; Xuanshifen pounded with Gualou clears hot-phlegm and purges interior. Second visit uses Mahuang Xing Shi Gan Tang plus Huangqin, Sangpi, Dilong to open closure and drain heat; Chen Danning, Changpu, Yuanzhi to resolve phlegm and calm heart. Clearing phlegm-heat avoids risk of reverse transmission to Pericardium.
3. Male. Fever with spontaneous sweating that does not resolve is Fengwen. Disease 5 days, no bowel movement. With warm pathogens, purging is never too early. Fen Gegen 9g, Dan Huangqin 9g, Di Kulo 12g, Chun Chaihu 9g, Lianqiao 9g, Wangjiangnan 30g, Hei Shanzhi 9g, Juhua 9g, Chi Ling 9g, Yuliren 12g.
[Commentary] Patient took 3 doses, then fever subsided and body cooled. Later visited twice for poor appetite and fatigue, treated with Yigong San modified for recovery. This confirms "purging warm pathogens is never too early" is sound experience. Yuliren and Wangjiangnan are laxatives; Wangjiangnan acts gently and reliably without abdominal pain or secondary constipation, safe for febrile diseases. Must be decocted strongly for best effect.
4. Left surname. First visit Feb 4, 1941. Stool with white mucus, right epigastric pain, lesion in intestine. Yesterday, high fever caused hemoptysis of red sputum, prescribed Liang Ge San. Xuanshifen (dissolved), Hei Shanzhi each 9g, Huangqin 12g, Qinghaozi, Sangbaipi each 9g, Sheng Jinwen 4.5g (added later), Jing Lianqiao 12g, Bohe 6g (added later), Hang Baishao 9g, Dan Zhuye 30 leaves. Second visit: Expectorated blood is thin and non-clotting, self-reported right hypochondriac pain, nocturnal confusion, indicating high heat. Xuanshen 9g, Tianhuafen 9g, Lianqiao 9g, Baiwei 12g, Maidong 9g, Danpi 10g, Zhimu 9g, Yinhua 12g, Huangqin 9g, Qinghaozi 9g, Lugeng 30g.
Third visit: Pneumonia, red frothy sputum from high fever, right hypochondriac pain, rattling phlegm in throat, warm pathogen first attacking Lung, nocturnal confusion indicating reverse transmission. Beishashen 6g, Sangbaipi 9g, Menmendong 9g, Sheng Shigao 15g (decocted first), Lugeng 30g, Jiegeng 6g, Zhimu, Beimu each 9g, Juanxin Zhuye 30 leaves, Jing Xuanshen 9g, Digupi 9g, Dan Huangqin 9g, Tinglizi 9g, Hang Baishao 9g, Suhexiang Wan 1 pill (dissolved).
[Commentary] This case features sudden high fever, chest pain, wheezing, hemoptysis, no exterior aversion to cold, lack of interior yin fluid. Heat stagnates in Lung, unable to vent, inevitably pressing downward. Since Lung and Large Intestine are interior-exterior pairs, "white mucus in stool" reflects the Classic's "Lung transferring heat to Large Intestine."
Early disease stages often present incomplete exterior signs, complicating differentiation. Initially diagnosed as "intestinal lesion," corrected to "warm pathogen first attacking Lung" by third visit. The physician openly admitted error, revised diagnosis frankly, without embellishment, setting an example of seeking truth from facts.
Although initial Western medical localization was inaccurate, treatment followed traditional Chinese medicine principles, avoiding contradiction with syndrome. First prescription used Huangqin, Zhizi, Lianqiao, Bohe, Zhuye, Sangbaipi to clear upper jiao stagnant heat; used Da Huang and Xuanshifen to guide heat downward via Yangming pathway, powerful formula. However, rampant pathogenic heat prevented efficacy. Second visit focused on nourishing yin and clearing heat due to prominent heat excess and yin depletion.
Third prescription, confirmed by diagnosis, addressed high heat, yin consumption, phlegm-heat blocking Lung, orifice closure, and intestinal pressure. Combined strengths of Baihu Tang, Zengye Tang, Xiebai San, and Tingli Dazao Xiefei Tang, plus orifice-opening agents. Used Shigao, Zhimu, Beimu, Jiegeng to clear heat, diffuse Lung, resolve phlegm; Digupi, Sangbaipi from Xiebai San plus Huangqin to clear Lung heat (treating chest pain/red sputum) and Large Intestine heat (removing white mucus); Juanxin Zhuye, Suhexiang Wan to clear heart and open orifices; Xuanshen, Maidong from Zengye Tang plus Shashen, Baishao, Lugeng to rescue depleted yin; Tinglizi used because it "travels Lung qi branch and Large Intestine, descending from above" (*Wenbing Tiaobian*), hoping lung latent heat/phlegm exits via Large Intestine. Thoughtful design, precise herb selection.
5. Male. Dyspnea when lying flat, rust-colored sputum, left rib pain, all signs of pneumonia. Initial chills, high fever, and confusion indicate lobar pneumonia. Sheng Mahuang 4g, Jiegeng 6g, Sheng Shigao 12g (powder, taken separately), Huangqin 6g, Tinglizi 6g, Xingrenni 12g, Hang Baishao 9g, Sangbaipi 9g, Fen Cao 4g, Huo Lugeng 30cm (nodes removed).
Second visit: Sputum still rust-colored, due to pulmonary circulatory congestion. Fine, rapid, irregular pulses, dyspnea when supine, both indicating circulatory issues. Though caused by cough, treating cough is secondary. Mahuang is key here because it raises blood pressure and resolves congestion. Sheng Mahuang 4g, Sheng Shengma 4g, Cheqianzi 12g (wrapped), Wuweizi 4g, Jiegeng 9g, Haigekiao 24g (decocted first), Tinglizi 9g, Xingren 15g, Hang Baishao 12g, Sangpi 9g, Ziwan 9g, Fen Gancao 4g.
[Commentary] Lobar pneumonia syndrome differentiation often belongs to phlegm-heat congesting Lung. Formula uses Mahuang Xing Shi Gan Tang modified: one aspect diffuses Lung to expel pathogen, another clears heat and resolves phlegm. Sheng Shigao powdered and swallowed offers superior heat-clearing effect compared to decoction. Modern Zhang Xichun frequently used this method for high fever in warm diseases.
Summer-Dampness and Damp-Warmth
1. Male. Disease only 3 days, persistent fever, abdominal pain, loose stools 7-8 times daily, red like blood, greasy coating, rapid pulse. Summer-dampness pathogen deeply hidden inside, not a minor ailment. Baitouweng 9g, Chuan Yalian 2g, Huangbo 9g, Huangqin 9g, Yinhua Tan 15g, Lianqiao 9g, Yujin 6g, Machixian 12g, Qicaihua 12g, Huashi 9g, Xin Hegeng 30cm.
Second visit: Hematochezia greatly improved after medication, black loose stool this morning, continue previous formula. Baitouweng 9g, Qinpi 9g, Chuan Yalian 1g, Huangbo 9g, Bai Jinhua 15g, Machixian 15g, Baijiangcao 12g, Huashi 9g, Kushen Pian 6g, Chen Hongcha 9g. Third visit: Early epidemic stage, bloody loose stools turning black like glue usually has poor prognosis. Administered Baitouweng Tang, stool frequency reduced. However, dizziness, fatigue, worry about righteous qi collapse and syncope. Yinhua 15g, Lianchi 12g, Xiaoji Tan 12g, Machixian 12g, Guanzhong Tan 12g, Chi Ling 12g, Biyu San 12g (wrapped), Cheqianzi 9g (wrapped), Hegeng 30cm.
Fourth visit: Heavy bitter-cold intestinal clearing stopped jam-like stools, but hemoptysis appeared. Blood comes from cough, but patient's blood easily extravasates, undeniable fact. Lung and Large Intestine are interior-exterior; must use large dose to clear intestines and moisten lungs simultaneously to avoid neglecting either. Xuanshen 6g, Cundong 9g, Sangbaipi 9g, Zhimu 9g, Sheng Cebeiye 18g, Qiancao Tan 12g, Jinyinhua 15g, Dongguazi 9g, Xingrenni 15g, Gancao 3g, Baimaogen 1 bundle. Fifth visit: Hematochezia and hemoptysis ceased. Changes over days were unexpected; speed of effect was unforeseen. Although heat moved downward, pulse remains deficient and rapid, worry about complications from deficiency. Beishashen 9g, Ganyedi 12g, Baishao 9g, Maidong 9g, Yuzhu 9g, Dongqingzi 9g, Hanliancao 9g, Liaodouyi 12g.