11.男。病历17日，热势早暮弛张，西医诊为肠伤寒。舌苔虽黄腻，而牙龈出血时作，热入营分，不可墨守芳香化湿之成法。青蒿9克，白薇9克，银花15克，连翘12克，小生地24克，泽兰6克，知母12克，紫花地Tg克，郁金6克，鲜石菖蒲9克，碧玉散12克(包)。二诊:热势大退，牙龈出血不止。鲜生地24克，知母12克，麦冬9克，银花12克，连翘9克，花粉9克，玉竹9克，苦参6克，绿豆衣6克。三诊:脉静身凉，龈血亦大减。大生地15克，知母9克;玉竹9克，冬青子9克，旱莲草9克，制首乌12克，黑大豆15克，仙鹤草12克。
四诊:病势人恢复期，但食欲不振，苔腻，略予和胃消导。佩兰梗6克，苦杏仁9克，炒枳实6克，广郁金4.克，生鸡金9克，谷麦芽各9克，佛手片4.克。五诊:多食多动，其热复升。夫伤寒复病，最为大忌。数日内必须静卧勿动，多饮流质。忍冬藤12克，连翘12克，黑山栀9克，青蒿9克，白薇12克，地龙9克，鸡内金9克，蚕沙12克(包)，谷麦芽各9克。
六诊:微热总不肯退，舌苔略腻，表示肠热未清。忍冬藤12克，连翘12克，淡条芩4.克，苦参6克，地龙9克，青蒿9克，白薇12克，白槿花12克，马齿苋12克，谷麦芽各9克。七诊:热退，脉尚数，但软弱无力，邪去正衰，当补之。生黄芪9克，党参9克，生冬术9克，山药9克，茯苓9克，炙鸡金12克，谷麦芽各9克，甘草3克，仙鹤草12克。
[按]湿温在卫分、气分，以芳香化湿为主。本案病历17日，舌苔黄腻、表示气分之邪未解，龈血不止，则为人营之征。故一至三诊，重在养阴、清热、凉血、解毒。四诊热去血止;苔腻，纳呆，是湿邪未除。湿留则其热不能退尽，故在清理余焰中复人佩兰、佛手、枳实、谷麦芽等芳香行气之品。六诊用苦参、白槿花、马齿苋治肠中湿热。七诊以邪去正衰，继以补气和中以善其后。加仙鹤草既可防止出血，又有强壮之功，可谓周到。
12.男。湿温已逾两候，此病不忌神昏、谵语，最忌大便溏泻、色赤，世俗称作"漏底伤寒"是也。其关键在此。银花炭、荠菜花炭、连翘各15克，带心川贝6克，远志4.克，陈胆星3克，鲜石菖蒲9克，苦参片6克，滑石18克，白槿花12克。
二诊:泄泻得止，最为可喜。若数日之内别无变化则可化险为夷。豆卷12克，鸡苏散9克(包)，连裰12克，带心川贝6克，远志4.克，竹沥半夏9克，赤猪苓各9克，郁金4.克，鲜石菖蒲9克。三诊:高热不退，咳嗽不已。北沙参9克，带心麦冬9克，带心川贝6克，带心连翘15克，远志3克，郁金4.克，杏苡仁各9克，桑白皮9克，卷心竹叶30片，碧玉散12克(包)。
四诊:其热退清如常人，但汗多而冷，腹中绞痛，脉不鼓指，此非正常之退热，乃虚脱之预兆，还须防其肠出血。拟温其里以救脱。炮附块4.克，全当归12克，浮小麦15克，煅龙骨15克(先煎)。另:牡蛎粉60克，外用扑身。高丽参12克，煎汤代茶。
五诊:虽体温骤降，幸脉不增数，腹痛渐定，表示正气尚能挣扎，末酿成两败俱伤之局，然而间不容发矣。炮附块6克，全当归12克，白芍9克，麦冬9克，五味子4.克，远志4.克，竹沥半夏9克，橘皮4.克，炙甘草3克，浮小麦12克。六诊:已离险境，从此向坦途迈进。北沙参9克，山药9克，茯苓9克，白芥子9克，白芍9克，橘皮4.克，扁豆衣9克，炒谷麦芽各9克。
[按]湿温而见神昏、谵语，为邪扰心营，尚不足虑。若泄泻色赤，便为肠出血，并有穿孔危险。其治凉血、止血、清肠止泻，甚属稳善。四诊体温骤降，腹中绞痛，冷汗，脉沉，是阳气不支，虚脱之象，故以参、附回阳，萸肉、五味子、白芍敛阴，俾正气得复;并用牡蛎粉外扑止汗，以治其标。
13.男。此严重之湿温证，2日来大便色红，终日神蒙谵语，湿温证而见此候，生命之危，不绝如缕。川黄柏9克，陈胆星9克，飞滑石15克，白槿花15克，银花炭12克，赤茯苓18克，鲜石菖蒲9克，马齿苋15克，至宝丹1粒(分4次化服)。二诊:药后红色之便不再作，是为大幸，终日谵语不休，神烦不宁，而面容如此黄晦，脉搏如此细数，皆与证情相反，表示正气竭蹶，苦寒香开之药，势难再迸。予全真一气汤作万一之想。炮附块9克，党参9克，生白术9克，鲜生地30克，麦冬9克，远志6克，陈胆星6克，五味子4.克，怀牛膝12克。
三诊:神志仍旧迷蒙，热度与脉搏仍旧高涨，病在危殆中。炮附块6克，鲜生地30克，陈胆星6克，鲜菖蒲6克，党参9克，麦冬9克，郁金4.克，茯神9克。四诊:热虽稽留不退，脉渐次下降，谵语亦减。此证之最严重在谵语之频，脉之细数，此而能稳定，便有转机。上方加远志6克，带心川贝2.克。
五诊:热往下挫，神志亦渐次清晰，伤寒极期有进步，大有转危为安之望。炮附块4.克，制苜乌15克，鲜生地30克，带心川贝2，4克，玉竹12克，麦冬9克，知母9克，远志9克，郁金4.克，鲜石菖蒲9克。
六诊:药后大便得解，热即下挫至常温，舌苔亦化，唯入夜仍有迷蒙状，痰粘难以咯出。如无枝节，可以化险入夷。南北沙参各9克，远志4.克，广玉金4.克，鲜石菖蒲9克，赤苓9克，麦冬9克，桔梗6克，带心川贝2.克，生苡仁15克，车前子12克(包)。
七诊:热已退尽，谵语亦除，大为幸事。党参9克，干地黄18克，茯苓12克，生黄芪9克，五味子4.克，麦冬9克，山药9克，仙鹤草15克，浮小麦15克，糯稻根须15克。
[按]湿温最严重之合并症为肠出血，故初诊清热开窍之外，用黄柏、马齿苋、白槿花、银花以清肠。二诊谵语不休，神烦不宁，面容黄晦，脉来细数，为病邪末去，正气已伤，治则舍标求本，以救其人。正气不支，扶正则为急务，虽高热、神昏，而不动摇。方以《冯氏锦囊》全真一气汤为主，此方最为先生赏用。五诊以后，体温渐趋正常，是正胜邪去。可见放胆使用温补，实是本案获效之关键。
14.男。病历9日，其热有增无减，神识有恍惚状。虚人患温，用药最难。盖虚当补之，而补有碍邪之弊，不补则正气不支。喻嘉言谓虚人于解表药中加参，其效乃捷。实有至理。鸡苏散(包)、连翘各12克，青蒿9克，白薇、生苡仁各12克，郁金4.克，鲜石菖蒲9克，甘露消毒丹15克(包)，黑大豆60克(煎汤代水)。另:党参24克，煎汤代茶。[按]此气虚病人患温之治法。方意从喻氏人参败毒散悟出，若采用人参则功力更著。因今之党参，非如本草所言"功同人参，惟力稍逊"。而其功用重在补益脾胃。
15.女。此湿温证已逾三候，依旧耳聋、大渴，尤以大便多泄为可虑。三黄汤加苦寒清泄药。苦参片6克，白槿花9克，川连1，2克，黄桕9克，黄芩;4.克，秦皮9克，银花炭12克，天花粉9克，绿豆衣12克，飞滑石6克(分2次冲人药中)，活芦根30克。[按]此为湿温重症。其一，耳聋、大渴、壮热不退;其二，木便多泄，有肠出血之可能。治用三黄汤等泄热解毒，配合苦参清肠燥湿，又用秦皮、银花炭收敛肠壁。可见先生辨证准确，组方精密。
16.女。凡湿温证牙龈易于出血者，如见便溏，需防肠出血。今热势过高，而面色苍然，神气萧索，非病之常规也。鲜生地30克，玄参9克，麦冬9克，银花15克，带心连霰12克，小蓟12克，赤苓12克，冬青子9克，旱莲草9克，郁金4.克，九节菖蒲4.克，至宝丹0.克(分3次服)。二诊:湿温17日，正在紧要关头，出血虽止，依然面黄神痿，两脉糊数。用全真一气汤合紫雪丹，一面育阴扶正，一面慧神祛邪，此变法也。炮附块4.克，潞党参9克，麦冬9克，熟地12克，白术9克，五味子4.克，淮牛膝9克，淡竹叶9克，紫雪丹0.克(分3次服)。
三诊:热渐退，再以养阴温阳并迸。炮附块4，5克，生熟地各12克，生白术9克，炮姜炭3克，白芍12克，麦冬9克，淮牛膝9克，清炙草3克。四诊:心脏已元问题，当侧重清热;病在三期之外，尤当注意营养。银柴胡4.克，青蒿9克，白薇12克，干地黄12克，白芍12克，冬青子9克，淮山药9克，生麦芽9克。五诊:已人恢复阶段，腹胀下利，亦不可忽。秦皮9克，川连2.克，苦参9克，银花炭9克，枳实炭9克，山楂炭15克，白槿花9克，滑石9克，荠菜花炭9克。
[按]此案初诊。末见神昏，即用至宝丹。盖热势过高，神情委顿，心力衰竭之端倪已露。芳香开窍之品，正不必神昏而后始用之。二诊因病势重，两脉糊数，直用参、附、熟地辈，此张景岳、高鼓蜂之法。全真一气汤与紫雪丹并用，粗看寒温颇不一致，其实古人亦有附子与石膏同用者，正为此等证候而设。又其第一诊以止血为主，第二、第三诊以强心为主，第四诊以清热为主，五诊以治利为主。临床时当随证变通，知所侧重。17.男。其热虽略挫，而脉不随之下降，其热势必再升，拟此方以清余焰。淡豆豉9克，黑山栀9克，淡黄芩9克，连翘9克，银花9克，赤苓9克，郁金4.克，莱菔英9克，带叶佩兰9克，甘露消毒丹15克(包)。[按]肠伤寒的热度再度回升，多在体温尚末降至正常时，即王盂英所说:"炉烟已熄，灰中有火。"处方以清热利湿，解除余焰。
18.男。湿温证中之烟煤舌，多见于2周之后，今七八日已如此，非轻恙也。高热灼手，神志有时迷蒙，予清营汤。乌犀角0.克(磨汁对)，带心麦冬9克，带心连翘15克，知母12克，花粉9克，玄参12克，赤苓12克，鲜菖蒲9克，莲心30粒，淡竹叶30片。;(按]黑苔有虚实寒热之分。黑而燥裂为热极，火极似水;黑而.润滑，在杂病多为湿痰困于太阴，在时病则为阳虚至极。此案乃邪毒深人营分，不可误认作阳虚。方用清营汤加减，清营、解毒、生津。
19.男。检温不及彀，大便溏而色黄，舌苔腻布灰黑，七入日来"神气萧然，两脉亦沉细不鼓指，且时时作呕。观此恐非细故。炮附子4.克(先煎)，党参9克，山药9克，云苓12克，生白术9克，炮姜炭4.克，扁豆衣9克，炒米仁15克，伏龙肝24克(先煎)，四神丸9克(分2次吞)。二诊:两脉仍旧不整调，此正气大虚之象，检温有中等之热，幸泄泻已减。予补中益气汤加减。生黄芪9克，太子参9克，生白术9克，银柴胡4.克，绿升麻4.克，全当归9克，远志4.克，陈皮4.克，粉甘草3克，鲜石菖蒲9克。
三诊:据实验室检查，系真性伤寒。但从此病表现看，除三角苔外，另无其他疑似伤寒之处，可谓伤寒变型，两脉仍有歇止。病者虽然口唇干燥，而大便泄泻，精神萎靡，假使误用甘寒，祸不旋踵。银柴胡6克，绿升麻4.克，连翘12克，麦冬9克，太子参9克，云茯苓12克，归身9克，佛手9克，炒米仁15克，鲜石菖蒲9克。四诊:热退，歇止脉解除，病势已入佳境。宜静养，慎饮食。如其热复燃，则功亏一篑矣。沙党参各9克，生黄芪9克，炒冬术9克，茯苓12克，当归9克，炒扁豆衣9克，生熟苡仁各15克，浮小麦12克，粉甘草3克。
[按]此患者神气萧索，脉有歇止。作呕，便溏，为脾肾阳虚，故用补法。先生曾说:"若顾虑其苔腻不当补，怀疑其神昏不当温，徘徊于。稳健。之途，则病人死矣。"此病未作一般湿温常规处理，纯用健脾为主，参用清热、利湿、温阳之品。药随证转，正见辨证论治精神。
1.男。壮热7昼夜，夜间较白昼为严重，白昼尚清晰，暮则谵语。凡温邪之发于秋者，热入心包，较其他时令为早。以秋令之燥，温、燥相煽，来势颇重。忍冬花9克，清水豆卷12克，连翘9克，赤苓12克，卷心竹叶4.克，碧玉散9克(包)，黑山栀9克，枳壳9克，全瓜蒌12克。二诊:其效如此之速，殆温而不夹湿者。薄荷3克，粉葛6克，佩兰梗9克，全瓜蒌12克，晚蚕沙6克(包)，枳实3克，忍冬花12克，赤苓9克，莱菔英9克，淡子芩4.克。
[按]燥为秋令主气，初起亦在肺卫，吴鞠通主以桑杏汤。此病壮热7昼夜，且暮有谵语，是燥气化火，侵袭心营，故以锿、翘、栀、芩、竹叶心等以清心肺之热，全瓜蒌、枳壳、莱菔英等以润肠通腑。以其并不夹湿，故一剂知，二剂已。
11. Male. The disease course has lasted for 17 days, with fever presenting as remittent in the morning and evening; Western medicine diagnosed it as Typhoid Fever (Chang Shang Han). Although the tongue coating is yellow and greasy, intermittent bleeding from the gums indicates that the heat has entered the Ying (Nutritive) Level (Ying Fen), so one cannot rigidly adhere to the conventional method of using aromatic herbs to transform dampness. Prescription: Qinghao (Artemisiae Annuae Herba) 9g, Baiwei (Cynanchi Atrati Radix) 9g, Yinhua (Lonicerae Japonicae Flos) 15g, Lianqiao (Forsythiae Fructus) 12g, Xiaoshengdi (Rehmanniae Radix Recens) 24g, Zelan (Lycopus Lucidus Herba) 6g, Zhimu (Anemarrhenae Rhizoma) 12g, Zihuadiding (Viola Yedoensis Herba) [Note: Original text "Tg" likely a typo, interpreted as standard herb], Yujin (Curcumae Longae Rhizoma) 6g, Xian Shichangpu (Acori Tatarinowii Rhizoma Recens) 9g, Biyu San (Jade Green Powder) 12g (wrapped). Second visit: The fever subsided significantly, but gum bleeding continued. Prescription: Xian Shengdi (Rehmanniae Radix Recens) 24g, Zhimu 12g, Maidong (Ophiopogonis Radix) 9g, Yinhua 12g, Lianqiao 9g, Huafen (Trichosanthis Radix) 9g, Yuzhu (Polygonati Odorati Rhizoma) 9g, Kushen (Sophorae Flavescentis Radix) 6g, Ludouyi (Phaseoli Semen Testa) 6g. Third visit: Pulse became calm, body temperature normalized, and gum bleeding decreased substantially. Prescription: Dashengdi (Rehmanniae Radix Preparata) 15g, Zhimu 9g; Yuzhu 9g, Dongqingzi (Ilicis Cornutae Fructus) 9g, Hanliancao (Ecliptae Herba) 9g, Zhi Shouwu (Polygoni Multiflori Radix Preparata) 12g, Heidaudou (Sojae Semen Nigrum) 15g, Xianhecao (Agrimoniae Herba) 12g.
Fourth visit: The condition entered the recovery phase, but appetite was poor and tongue coating was greasy; a mild stomach-harmonizing and digestion-promoting formula was prescribed. Prescription: Peilan Geng (Eupatorii Caulis) 6g, Ku Xingren (Armeniacae Semens Amarum) 9g, Chao Zhishi (Aurantii Fructus Immaturus Preparatus) 6g, Guang Yujin 4g, Sheng Jijin (Galli Gigerii Endothelium Corneum) 9g, Guya and Maiya (Hordei Fructus Germinatus and Zizaniae Fructus Germinatus) each 9g, Foshoupian (Citri Reticulatae Pericarpium Flavum) 4g. Fifth visit: Due to excessive eating and movement, the fever rose again. Relapse of Typhoid Fever is strictly contraindicated. Strict bed rest and liquid diet are required for several days. Prescription: Rendongteng (Lonicerae Japonicae Caulis) 12g, Lianqiao 12g, Heishanzhi (Gardeniae Fructus) 9g, Qinghao 9g, Baiwei 12g, Dilong (Pheretima) 9g, Jineijin (Galli Gigerii Endothelium Corneum) 9g, Can Sha (Bombyx Batryticatus) 12g (wrapped), Guya and Maiya each 9g.
Sixth visit: Slight fever persisted, and tongue coating was slightly greasy, indicating that intestinal heat/dampness had not cleared. Prescription: Rendongteng 12g, Lianqiao 12g, Dan Tianqin (Scutellariae Radix) 4g, Kushen 6g, Dilong 9g, Qinghao 9g, Baiwei 12g, Baijinhua (Hibisci Mutabilis Flos) 12g, Machixian (Portulacae Herba) 12g, Guya and Maiya each 9g. Seventh visit: Fever subsided, pulse was rapid but weak and powerless, indicating pathogen elimination and righteous qi depletion; tonification was indicated. Prescription: Sheng Huangqi (Astragali Radix) 9g, Dangshen (Codonopsis Radix) 9g, Sheng Baizhu (Atractylodis Macrocephalae Rhizoma) 9g, Shanyao (Dioscoreae Rhizoma) 9g, Fuling (Poria) 9g, Zhi Jijin 12g, Guya and Maiya each 9g, Gancao (Glycyrrhizae Radix et Rhizoma) 3g, Xianhecao 12g.
[Commentary] For Damp-Warmth (Shi Wen) at the Wei (Defensive) and Qi (Energy) levels, aromatic herbs to transform dampness are primary. In this case, after 17 days, the yellow-greasy tongue coating indicates unresolved Qi-level pathogens, while persistent gum bleeding signals entry into the Ying level. Thus, visits 1-3 focused on nourishing Yin, clearing heat, cooling blood, and detoxifying. At the fourth visit, heat subsided and bleeding stopped, but greasy coating and anorexia indicated lingering dampness. Since dampness retention prevents complete heat resolution, aromatic Qi-moving herbs like Peilan, Foshou, Zhishi, Guya, and Maiya were added to clear residual heat. At the sixth visit, Kushen, Baijinhua, and Machixian were used to treat intestinal damp-heat. At the seventh visit, due to depleted righteous qi after pathogen elimination, Qi-tonifying and middle-jiao harmonizing herbs were used to conclude treatment. Xianhecao was added to prevent bleeding and provide tonic strength, showing thoroughness.
12. Male. Damp-Warmth has exceeded two weeks (14 days). This disease does not fear coma or delirium; it fears loose stools with red color, commonly known as "Le Di Shang Han" (Leaking Bottom Typhoid). The key lies here. Prescription: Yinhua Tan (Charred Lonicerae Japonicae Flos), Qicaihua Tan (Charred Cardamineae Herba), Lianqiao each 15g, Daixin Chuanbei (Fritillariae Thunbergii Bulbus with stamen) 6g, Yuanzhi (Polygalae Radix) 4g, Chen Danning (Arisomatis Rhizoma Preparatum) 3g, Xian Shichangpu 9g, Kushen Pian (Sophorae Flavescentis Radix Slice) 6g, Huashi (Talcum) 18g, Baijinhua 12g.
Second visit: Diarrhea stopped, which is highly desirable. If no other changes occur within a few days, danger can be turned into safety. Prescription: Doujuan (Sojae Semen Preparatum) 12g, Jisu San (Chicken Su Powder) 9g (wrapped), Lianqiao 12g, Daixin Chuanbei 6g, Yuanzhi 4g, Zhuli Banxia (Pinelliae Rhizoma Prepared with Bamboo Juice) 9g, Chi Fuling (Poria with Red Host) and Zhu Ling (Polyporus) each 9g, Yujin 4g, Xian Shichangpu 9g. Third visit: High fever persists, cough continues. Prescription: Beishashen (Glehniae Radix) 9g, Daixin Maidong 9g, Daixin Chuanbei 6g, Daixin Lianqiao 15g, Yuanzhi 3g, Yujin 4g, Xingyi Ren (Armeniacae Semen Amarum and Coicis Semen) each 9g, Sangbaipi (Mori Cortex) 9g, Juanxin Zhuye (Bambusae Folium) 30 leaves, Biyu San 12g (wrapped).
Fourth visit: Temperature returned to normal clarity, but sweating was profuse and cold, abdominal cramping pain occurred, and pulse did not beat against the finger. This is not normal fever reduction but a precursor to collapse; intestinal hemorrhage must be guarded against. Internal warming to rescue collapse is planned. Prescription: Pao Fu Kuai (Aconiti Lateralis Radix Preparata) 4g, Quan Danggui (Angelicae Sinensis Radix) 12g, Fu Xiaomai (Tritici Fructus) 15g, Duan Longgu (Fossilia Ossis Mastodi Preparata) 15g (decocted first). Additionally: Muli Fen (Concha Ostreae Powder) 60g, applied externally to the body. Gaolishen (Panax Ginseng) 12g, decocted to replace tea.
Fifth visit: Although body temperature dropped sharply, fortunately the pulse did not become rapid, and abdominal pain gradually settled, indicating that righteous qi could still struggle, avoiding a mutually destructive outcome, though the situation was critical. Prescription: Pao Fu Kuai 6g, Quan Danggui 12g, Baishao (Paeoniae Radix Alba) 9g, Maidong 9g, Wuweizi (Schisandrae Fructus) 4g, Yuanzhi 4g, Zhuli Banxia 9g, Jupi (Citri Reticulatae Pericarpium) 4g, Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma) 3g, Fu Xiaomai 12g. Sixth visit: Danger has passed, moving towards smooth recovery. Prescription: Beishashen 9g, Shanyao 9g, Fuling 9g, Baijiezi (Sinapis Semen) 9g, Baishao 9g, Jupi 4g, Biandouyi (Lablab Album Testa) 9g, Chao Guya and Maiya each 9g.
[Commentary] In Damp-Warmth, coma and delirium indicate pathogen disturbing the Heart Ying level, which is not yet worrying. However, bloody diarrhea indicates intestinal hemorrhage with risk of perforation. Treatment with blood-cooling, hemostatic, intestinal-clearing, and anti-diarrheal methods is very sound. At the fourth visit, sharp temperature drop, abdominal cramping, cold sweat, and deep pulse indicated Yang qi failure and collapse signs; thus, Renshen and Fuzi were used to restore Yang, while Shanruzhu (Corni Fructus), Wuweizi, and Baishao were used to astringe Yin, allowing righteous qi to recover; Muli powder was applied externally to stop sweating, treating the branch symptom.
13. Male. This is a severe Damp-Warmth syndrome. For 2 days, stool has been red, and there has been continuous mental confusion and delirium. Such symptoms in Damp-Warmth indicate life-threatening danger. Prescription: Chuan Huangbai (Phellodendri Chinensis Cortex) 9g, Chen Danning 9g, Fei Huashi (Talcum) 15g, Baijinhua 15g, Yinhua Tan 12g, Chi Fuling 18g, Xian Shichangpu 9g, Machixian 15g, Zhibao Dan (Treasure Pill) 1 pill (divided into 4 doses, dissolved and taken). Second visit: After medication, red stool ceased, which is fortunate. However, continuous delirium, mental agitation, sallow complexion, and fine-rapid pulse contradict the excess pattern, indicating exhaustion of righteous qi. Bitter-cold and aromatic-opening medicines are difficult to administer further. Quan Zhen Yi Qi Tang (Complete True One Qi Decoction) is given as a last resort. Prescription: Pao Fu Kuai 9g, Dangshen 9g, Sheng Baizhu 9g, Xian Shengdi 30g, Maidong 9g, Yuanzhi 6g, Chen Danning 6g, Wuweizi 4g, Huainiuxi (Achyranthis Bidentatae Radix) 12g.
Third visit: Mental state remains confused, heat and pulse remain high; the condition is critical. Prescription: Pao Fu Kuai 6g, Xian Shengdi 30g, Chen Danning 6g, Xian Changpu (Acori Tatarinowii Rhizoma Recens) 6g, Dangshen 9g, Maidong 9g, Yujin 4g, Fushen (Poria with Pine Root) 9g. Fourth visit: Heat persists, but pulse gradually decreases, and delirium reduces. The most serious aspect of this case is frequent delirium and fine-rapid pulse; stability here offers a turning point. Add Yuanzhi 6g and Daixin Chuanbei 2g to the above prescription.
Fifth visit: Heat is suppressed downward, mental clarity gradually returns; progress is seen in the critical stage of Typhoid Fever, with great hope of turning danger into safety. Prescription: Pao Fu Kuai 4g, Zhi Shouwu (Polygoni Multiflori Radix Preparata) 15g, Xian Shengdi 30g, Daixin Chuanbei 2.4g, Yuzhu 12g, Maidong 9g, Zhimu 9g, Yuanzhi 9g, Yujin 4g, Xian Shichangpu 9g.
Sixth visit: After medication, bowel movement occurred, heat dropped to normal, tongue coating transformed. Only slight confusion at night and sticky phlegm difficult to expectorate remain. Without complications, danger can be resolved. Prescription: Nan Shashen (Glehniae Radix) and Beishashen each 9g, Yuanzhi 4g, Guang Yujin 4g, Xian Shichangpu 9g, Chi Fuling 9g, Maidong 9g, Jiegeng (Platycodonis Radix) 6g, Daixin Chuanbei 2g, Sheng Yiren (Coicis Semen) 15g, Cheqianzi (Plantaginis Semen) 12g (wrapped).
Seventh visit: Heat completely subsided, delirium eliminated, which is very fortunate. Prescription: Dangshen 9g, Gan Dihuang (Rehmanniae Radix Preparata) 18g, Fuling 12g, Sheng Huangqi 9g, Wuweizi 4g, Maidong 9g, Shanyao 9g, Xianhecao 15g, Fu Xiaomai 15g, Nuodaogenxu (Oryzae Sativa Radix Stamen) 15g.
[Commentary] The most severe complication of Damp-Warmth is intestinal hemorrhage. Therefore, besides clearing heat and opening orifices in the first visit, Huangbai, Machixian, Baijinhua, and Yinhua were used to clear the intestines. At the second visit, continuous delirium, agitation, sallow face, and fine-rapid pulse indicated that pathogens remained while righteous qi was damaged. The treatment principle shifted to addressing the root to save life. When righteous qi fails, tonification becomes urgent, regardless of high fever or coma. The formula is based on Quan Zhen Yi Qi Tang from *Feng Shi Jin Nang*, which the author favors. After the fifth visit, temperature normalized, indicating righteous qi overcoming pathogens. Bold use of warm tonification was indeed the key to success in this case.
14. Male. Disease course 9 days, heat increasing without decrease, mental state fluctuating. Treating Warm diseases in deficient patients is difficult. Deficiency requires tonification, but tonification may hinder pathogen expulsion; lack of tonification leads to righteous qi failure. Yu Jiayan stated that adding Renshen to exterior-releasing formulas for deficient patients yields swift results. This is profound truth. Prescription: Jisu San (wrapped), Lianqiao each 12g, Qinghao 9g, Baiwei, Sheng Yiren each 12g, Yujin 4g, Xian Shichangpu 9g, Ganlu Xiaodu Dan (Sweet Dew Detoxication Pill) 15g (wrapped), Heidaudou 60g (decocted to replace water). Additionally: Dangshen 24g, decocted to replace tea. [Commentary] This is the treatment method for Warm diseases in Qi-deficient patients. The formula intent derives from Yu's Renshen Baidu San (Renshen Detoxication Decoction); using Renshen would enhance efficacy. Modern Dangshen is not exactly as described in materia medica ("equal to Renshen but slightly weaker"); its function focuses on tonifying Spleen and Stomach.
15. Female. This Damp-Warmth syndrome has exceeded three weeks (21 days), with persistent deafness and extreme thirst, and notably frequent loose stools, which is concerning. Sanhuang Tang (Three Yellow Decoction) plus bitter-cold draining herbs. Prescription: Kushen Pian 6g, Baijinhua 9g, Chuan Lian (Coptidis Rhizoma) 1.2g, Huangbo (Phellodendri Cortex) 9g, Huangqin (Scutellariae Radix) 4g, Qinpi (Fraxini Cortex) 9g, Yinhua Tan 12g, Tianhuafen (Trichosanthis Radix) 9g, Ludouyi 12g, Fei Huashi 6g (taken in 2 doses mixed with medicine), Huo Lugen (Phragmitis Rhizoma Recens) 30g. [Commentary] This is a severe Damp-Warmth case. First, deafness, extreme thirst, and persistent high fever; second, frequent loose stools suggest possible intestinal hemorrhage. Treatment uses Sanhuang Tang to drain heat and detoxify, Kushen to clear intestinal dampness, and Qinpi and Yinhua Tan to astringe the intestinal wall. This shows accurate differentiation and precise formulation.
16. Female. In Damp-Warmth cases prone to gum bleeding, if loose stools appear, intestinal hemorrhage must be feared. Current heat is too high, yet complexion is pale and spirit is listless, which is atypical. Prescription: Xian Shengdi 30g, Xuanshen (Scrophulariae Radix) 9g, Maidong 9g, Yinhua 15g, Daixin Lianqiao 12g, Xiaoji (Cirsii Herba) 12g, Chi Fuling 12g, Dongqingzi 9g, Hanliancao 9g, Yujin 4g, Jiuie Changpu (Acori Tatarinowii Rhizoma) 4g, Zhibao Dan 0.3g (divided into 3 doses). Second visit: Day 17 of Damp-Warmth, at a critical juncture. Bleeding stopped, but face is sallow, spirit is weak, and pulses are muddy and rapid. Quan Zhen Yi Qi Tang combined with Zi Xue Dan (Purple Snow Pill) is used to nourish Yin, support righteous qi, awaken spirit, and expel pathogens—a modified approach. Prescription: Pao Fu Kuai 4g, Lu Dangshen 9g, Maidong 9g, Shudi (Rehmanniae Radix Preparata) 12g, Baizhu 9g, Wuweizi 4g, Huainiuxi 9g, Dan Zhuye (Bambusae Folium) 9g, Zi Xue Dan 0.3g (divided into 3 doses).
Third visit: Heat gradually subsides; nourishing Yin and warming Yang proceed together. Prescription: Pao Fu Kuai 4.5g, Sheng Shudi (Raw and Prepared Rehmanniae Radix) each 12g, Sheng Baizhu 9g, Pao Jiang Tan (Zingiberis Rhizoma Preparatus Charred) 3g, Baishao 12g, Maidong 9g, Huainiuxi 9g, Qing Zhi Gancao (Clear Honey-fried Glycyrrhizae Radix) 3g. Fourth visit: Heart issues resolved; focus shifts to clearing heat. Beyond the third stage, nutrition is crucial. Prescription: Yinchaihu (Cistanches Herba? Note: Likely Yin Chai Hu - Stellariae Radix) 4g, Qinghao 9g, Baiwei 12g, Gan Dihuang 12g, Baishao 12g, Dongqingzi 9g, Huaishanyao 9g, Sheng Maiya (Hordei Fructus Germinatus) 9g. Fifth visit: Entered recovery phase; abdominal distension and diarrhea should not be ignored. Prescription: Qinpi 9g, Chuan Lian 2g, Kushen 9g, Yinhua Tan 9g, Zhishi Tan (Aurantii Fructus Immaturus Charred) 9g, Shanzha Tan (Crataegi Fructus Charred) 15g, Baijinhua 9g, Huashi 9g, Qicaihua Tan 9g.
[Commentary] In the first visit, although coma was absent, Zhibao Dan was used immediately. High heat and listlessness showed early signs of heart failure. Aromatic orifice-opening herbs need not wait for coma. At the second visit, due to severity and muddy-rapid pulse, Renshen, Fuzi, and Shudi were used directly, following Zhang Jingyue and Gao Bufeng's methods. Combining Quan Zhen Yi Qi Tang and Zi Xue Dan seems contradictory in cold/heat nature, but ancients also used Fuzi with Shigao (Gypsum) for such conditions. Visit 1 focused on stopping bleeding; Visits 2-3 on strengthening the heart; Visit 4 on clearing heat; Visit 5 on treating diarrhea. Clinical practice requires flexibility and prioritization based on symptoms.
17. Male. Heat slightly suppressed, but pulse did not drop accordingly; heat will likely rise again. This formula is intended to clear residual heat. Prescription: Danshouchi (Sojae Semen Preparatum) 9g, Heishanzhi 9g, Dan Huangqin 9g, Lianqiao 9g, Yinhua 9g, Chi Fuling 9g, Yujin 4g, Laifuying (Radish Herb) 9g, Daiye Peilan (Eupatorium with Leaves) 9g, Ganlu Xiaodu Dan 15g (wrapped). [Commentary] Recurrence of fever in Typhoid Fever often happens before temperature fully normalizes, as Wang Mengying said: "The stove smoke has extinguished, but fire remains in the ashes." The prescription clears heat and promotes diuresis to resolve residual heat.
18. Male. Coal-black tongue in Damp-Warmth usually appears after 2 weeks; appearing at 7-8 days indicates a serious condition. High fever burning to touch, occasional mental confusion; Qingying Tang (Clear the Nutritive Level Decoction) is prescribed. Prescription: Wuxijiao (Rhino Horn) 0.3g (ground juice mixed), Daixin Maidong 9g, Daixin Lianqiao 15g, Zhimu 12g, Huafen 9g, Xuanshen 12g, Chi Fuling 12g, Xian Changpu 9g, Lianxin (Nelumbinis Plumula) 30 grains, Dan Zhuye 30 leaves. [Commentary] Black tongue coating varies by deficiency/excess and cold/heat. Dry and cracked black indicates extreme heat (fire mimicking water); moist and slippery black in chronic diseases indicates damp-phlegm trapping Taiyin, while in acute febrile diseases it indicates extreme Yang deficiency. This case involves deep pathogenic toxins entering the Ying level, not Yang deficiency. Qingying Tang modifications are used to clear Ying level, detoxify, and generate fluids.
19. Male. Temperature measurement incomplete/abnormal, loose yellow stool, gray-black greasy tongue coating. For 7 days, "spirit is listless, pulse is deep, fine, and powerless, with frequent vomiting. This suggests a serious issue." Prescription: Pao Fuzi (Aconiti Radix Preparata) 4g (decocted first), Dangshen 9g, Shanyao 9g, Yunling (Poria) 12g, Sheng Baizhu 9g, Pao Jiang Tan 4g, Biandouyi 9g, Chao Miren (Coicis Semen Preparated) 15g, Fulonggan (Dragon's Liver Soil) 24g (decocted first), Sishen Wan (Four Spirits Pill) 9g (swallowed in 2 doses). Second visit: Pulse remains irregular, indicating severe righteous qi deficiency. Moderate fever detected, fortunately diarrhea reduced. Modified Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Prescription: Sheng Huangqi 9g, Taizishen (Pseudostellariae Radix) 9g, Sheng Baizhu 9g, Yinchaihu 4g, Lv Shengma (Cimicifugae Rhizoma) 4g, Quan Danggui 9g, Yuanzhi 4g, Chenpi (Citri Reticulatae Pericarpium) 4g, Fen Gancao (Powdered Glycyrrhizae Radix) 3g, Xian Shichangpu 9g.
Third visit: Laboratory tests confirmed true Typhoid Fever. However, clinically, aside from triangular tongue coating, there are no other typical Typhoid symptoms; this is a variant Typhoid. Pulse still shows intermissions. Although lips are dry, diarrhea occurs, and spirit is depressed; mistakenly using sweet-cold herbs would bring disaster swiftly. Prescription: Yinchaihu 6g, Lv Shengma 4g, Lianqiao 12g, Maidong 9g, Taizishen 9g, Yun Fuling 12g, Guishen (Angelicae Sinensis Radix) 9g, Foshou 9g, Chao Miren 15g, Xian Shichangpu 9g. Fourth visit: Heat subsided, intermitting pulse resolved, condition improving. Rest and careful diet are advised. If heat reignites, all efforts will be in vain. Prescription: Sha Dangshen (Codonopsis Radix) 9g, Sheng Huangqi 9g, Chao Dongzhu (Atractylodis Rhizoma Preparated) 9g, Fuling 12g, Danggui 9g, Chao Biandouyi 9g, Sheng Sheng Yiren (Raw and Prepared Coicis Semen) each 15g, Fu Xiaomai 12g, Fen Gancao 3g.
[Commentary] This patient had listless spirit and intermitting pulse. Vomiting and loose stools indicated Spleen-Kidney Yang deficiency, hence the use of tonification. The author once said: "If one hesitates to tonify due to greasy coating, or doubts warming due to coma,徘徊 (wavering) on the path of 'stability' will kill the patient." This case did not follow standard Damp-Warmth protocols but focused purely on Spleen tonification, supplemented with heat-clearing, damp-draining, and Yang-warming herbs. Medications changed with the syndrome, demonstrating the spirit of syndrome differentiation and treatment.
Autumn Warmth, Winter Warmth
1. Male. High fever for 7 days and nights, worse at night than day; clear during the day, delirious at dusk. Warm pathogens arising in Autumn enter the Pericardium earlier than in other seasons. Due to Autumn dryness, Warmth and Dryness fan each other, leading to a severe onset. Prescription: Rendonghua (Lonicerae Japonicae Flos) 9g, Qingshui Doujuan (Water-soaked Sojae Semen Preparatum) 12g, Lianqiao 9g, Chi Fuling 12g, Juanxin Zhuye (Bambusae Folium) 4g, Biyu San 9g (wrapped), Heishanzhi 9g, Zhike (Aurantii Fructus) 9g, Quangualou (Benincasae Fructus) 12g. Second visit: Effect was so rapid, likely Warmth without Dampness. Prescription: Bohe (Menthae Haplocalycis Herba) 3g, Fen Ge (Puerariae Lobatae Radix) 6g, Peilan Geng 9g, Quangualou 12g, Wancansha (Bombyx Batryticatus) 6g (wrapped), Zhishi 3g, Rendonghua 12g, Chi Fuling 9g, Laifuying 9g, Dan Ziqin (Scutellariae Radix) 4g.
[Commentary] Dryness is the dominant Qi of Autumn. Initially affecting Lung and Wei levels, Wu Jutong primarily used Sangxing Tang (Mulberry Leaf and Apricot Kernel Decoction). This case had high fever for 7 days and evening delirium, indicating Dryness transforming into Fire and invading Heart Ying. Thus, Yin, Qiao, Zhi, Qin, and Zhuye Xin were used to clear Lung and Heart heat, while Quangualou, Zhike, and Laifuying moistened intestines and unblocked bowels. Since there was no Dampness, improvement was seen after one dose, and cure after two.