2.男。清代医家所谓秋温。包括感冒、胃肠炎、轻型之副伤寒三者。病者从无大病，面垢脉软，苔虽腻而白滑，须防上述之第三者。清水豆卷12克，北柴胡24克，姜半夏9克，江枳实9克，浮萍草6克，黄芩6克，全瓜蒌12克，煨草果4.克，佩兰梗9克，赤苓9克，粉甘草3克，太乙丹1粒(分2次吞)。;二诊:热虽较减，面垢苔腻亦见减退。前方轻其制。清水豆卷12克，北柴胡12克，姜半夏6克，枳实9克，黄芩9克，佩兰梗9克，赤苓9克，全瓜蒌9克，粉甘草3克。
[按]本病例随后叠用清热利湿之剂，约10天而告痊愈。一诊方中用柴胡24克，为当时他医所少见。先生论柴胡功用有三:一祛瘀，二解热，三泻下。这里正用其解热作用。先生又说:"治病用药需胆大心细，当机立断，不可犹豫。"于此可见之。
3.男。秋温侵入血分，面部胸部皮肤锨红如丹，两臂散布红点，咽头红痛。清其热、凉其血。净连翘9克，白薇12克，小蓟9克，紫草茸6克，芦根100厘米(去节)，金银花12克，黄芩6克，丹皮9克，绿豆衣12克，射干6克。二诊:古人以望疹之色，定治疗之法，亦自有其见地。例如疹红者，属热、属血分、属有余之进行性。仍当解热、凉血，平其过胜，为必然矣。杭菊花9克，赤芍9克，金银花15克，川雅连1.克，全瓜蒌12克，嫩白薇12克，紫草茸4.克，射干9克，紫花，地丁9克，赤苓9克。
[按]时在秋季，一因壮热发疹，此症所以辨为秋温;一因先生治此类发疹病，每每遵守叶天士、吴鞠通邪入营血之说，而用清热凉血之法。足见先生临床辨证论治、不阿私一家之说。本病例三诊时，热退神爽，皮肤见脱屑成片，先生仍投前法。认为清热凉血药有消炎解毒的作用，必须维持服用，而不宜立即停用。如其言，病果获痊。
4.女。冬温28天，神志时明时昧，唇焦齿燥，邪未去而阴已伤，阴伤则热愈炽，恐有痉厥之变。北沙参9克，玄参9克，带心麦冬9克，天冬9克，白芍9克，连翘9克，黄芩9克，桑白皮9克，白薇12克，川贝6克，朱灯心1.克，粳米1杯。
二诊:检温不甚高，但脉数不静，其主因在咳。病温已匝月，两颧发赤，邪犹留恋，已见神蒙，不可再见气逆。南北沙参各9克，玄参12克，桑白皮9克，连翘9克，川贝6克，甜葶苈9克，远志4.克，石菖蒲9克，陈胆星6克，牛黄清心丸1粒(化服)。[按]此案患温已28天，阴液亏耗，更兼神蒙，故在养阴生津、清热涤痰外，更用牛黄清心丸。
温热
1.女。高热卒然而起，屡次得汗而热不大挫，此温邪也;大便溏而臭，时欲呕。予葛根芩连汤。葛根12克，川连1.克，淡黄芩6克，晚蚕沙12克(包)，连翘6克，赤苓6克，金银花12克，姜竹茹6克，荠菜花炭12克。另:六一散30克，代茶。
[按]若是风寒，便当得汗而解。此症高热卒起，为《伤寒论》所谓仇汗出已，身灼热n的温热病。因其大便溏而臭，时欲呕，可知热在肠胃，故以葛根芩连汤加减。荠菜花有清热凉血、解毒止痢的作用。早在30年代，先生即经j常采用此类草药，这是他重视民间医疗经验的具体表现。
2.男。热6日，其热不甚壮，而神色有迷蒙状。不更衣6日，时作呕，苔垢腻。此阳明腑实证，当急下存阴。全当归9克，杭白芍9克，全瓜蒌12克，生锦纹6克，制厚朴2.克，生枳实9克，姜半夏9克，莱菔子12克，石菖蒲9克，元明粉12克(分2次冲)。"。[按I《伤寒论》阳明篇记载:"伤寒呕多，虽有阳明证，不可攻之。"成无己注释说:"呕者，热在上焦，未全人腑，故不可下。"先生根据临床经验，认为此呕多与便秘有关，必须用大承气汤急下。由于患者热6日而不甚壮，神色有迷蒙状，为抗病功能低下，所以加用归、芍、蒌仁、莱菔子养营润肠，正所谓"不下则无以去其结热，不润则适以速亡其阴"。
3.男。热高日晡，病势已入阳明阶段。吴鞠通以为温病当论三焦，不可循六经，谬矣。寒水石24克，淡子芩3克，青蒿12克，粉甘草3克，广郁金末3克(分3次吞)，生石膏24克，知母15克，苍术6，克，梗米1酒杯，鲜石菖蒲6克。一[按]伤寒病人阳明，寒从火化，类同温病气分大热之候，其治"法往往无多差异。此用苍术白虎汤复加寒水石、蒿、芩，殆为温而兼湿者设。湿热神昏，可用菖蒲、郁金之香开。六经是伤寒辨证方法，卫气营血、三焦是温病辨证方法。后二者是在前者基础上的发展，既相互联系、相互印证，又相互区别。以"证"为主，则寒、温两家没有不可逾越的鸿沟。此案寥寥数语，适表现先生一生之主张。
4.女。肌热恶寒，旬日不解，清晨忽然战栗。凡战栗得汗则解者，名为战汗;不解者，乃高热之前驱。不更衣6日，先予凉膈散。薄荷6克，山栀9克，黄芩9克，连翘9克，竹叶6克，元明粉9克，制川军9克，甘草3克。[按]外感热病在气分留连日久，突作寒战，汗出即脉静身凉，热随汗出名为"战汗"。盖正邪交争，正气胜则汗出也。此病人已汗出而热不解，说明邪热末去，且不大便者6日，足证无形邪热借燥屎为盘踞。凡邪热不从外解，却又见腹满便秘，治宜表里双解，凉膈散是良方也。
5.女。热9日不退，舌中厚腻，边尖红绛，周身有淡紫色血点密布。此温邪人营之候，宜其神烦不宁。治疗当用大剂清营解毒。细生地15克，麦冬9克，玄参9克，银花12克，连翘9克，地骨皮9克，紫花地T12克，绿豆衣9克，白茅根1扎，神犀丹1粒(化服)。[按]邪入营分，便当清营解毒，方用神犀丹清营解毒而透营分之邪。银花、连翘、紫花地丁、茅根解毒泄热;生地、玄参、麦冬养阴。紫花地丁味苦性寒，入心、肝经，能清热解毒，尤擅解疔毒，以往外科多用之。用于温热病者则较少。今亦常用于急性感染性疾患。
6.男。体弱之人，而病极严重之温邪，缠绵时日，正气更伤。今两候终了，转人极期，高热不退、耳聋、谵语，脉微欲绝，此生死之关键系焉。夫正气旺盛则生，衰竭则死。纯用清温开泄，祸不旋踵。昔张景岳治京师一少年，舌焦神愦。以大剂温补回生，其书犹在。炮附块9克，连翘15克，郁金4.克，鲜石菖蒲9克，鲜生地30克，党参12克，麦冬15克，五味子9克，黑大豆30克(煎汤代水)。
[按]温病两候，见高热谵语而投参、附者，极为罕见。此病人体素不足，虽高热而脉微欲绝，乃正气不支，是谓正虚邪炽。正虚是本，热病是标。急用参、附以挽将亡之阳;生地、生脉散以救欲脱之阴。上海老中医祝味菊先生于温热病之舌黑唇焦者，往往用附子。盖其意均在振奋中阳，挽救心力之衰微。
7.男。病热4周之久，最近数日，更见耳聋、谵语，小溲刺痛淋漓，一派温邪燔灼之象。甘寒以滋之、苦寒以清之。小生地12克，知母9克，鲜石斛9克，白薇9克，卷心竹叶9克，苦参片6克，黄柏9克，寒水石18克(打)，泽泻9克，琥珀屑2.克(分2次吞)。[按]病热20余天，阴津受伤，心神受扰，邪末去而正己伤，故用生地、石斛养阴;知、柏、寒水石、白薇、竹叶清热;泽泻、琥珀利尿通淋。用苦参、黄柏者，"小肠火腑，非苦不通"，其意亦在清利湿热而通淋。先生于热病常用苦参，因此药有良好的清热效果，早在《外台》即有记载，而后世则较少应用。
8.男。苔如积粉，不更衣5日，渴喜冷饮。白虎合凉膈散。生石膏30克，粳米1杯，玄明粉12克，黄芩9克，知母12克，甘草2.克，生川军9克，山栀9克，连翘9克，薄荷6克，淡竹叶30片，白蜜30克。二诊:虽然两药皆吐，而得畅便者三，壮热下挫，苔如积粉者，转为松黄潮润。冬桑叶9克，杭菊花9克，连翘9克，江枳实6克，冬瓜子12克，黄芩9克，滑石12克(包)，竹叶30片。三诊:两迸清解之剂，热退脉静，精神较倦，胄纳欠香。予下方善其后。太子参9克，白术9克，陈皮6克，粉甘草3克，茯苓9克，炒谷麦芽各9克。
[按]壮热、渴暮冷饮而不大便者，即《伤寒论》所谓:"阳明腑证"，也是温热家所归纳的"气分证"。先生于此症每喜用白虎汤加凉膈散，或单用凉膈散，屡屡奏效。二诊见便通、热挫，即改用清解之剂。三诊热退神疲，则用加味异功散善后。于此足见先生方随症变，辨证施治何等灵活。
1.女。最近本地流行"七日热"。初起恶寒骨楚，数日后，周身透布散在之红点，亦有神识模糊者，最迟2周可以恢复。今腹痛甚剧，7日仅更衣1次而不畅，治疗之关键在此。生熟锦纹各6克，生枳实9克，五灵脂9克，莱菔子12克，海南片9克，郁李仁15克(打)，小青皮6克，玄明粉12克，糖炒山楂18克，六神曲12克，杭白芍9竞。二诊:温度下挫，尚作惊厥，当然是毒素之剌激。排泄之，无非通利二便。今便通，改予清泄、开窍。嫩白薇9克，嫩紫草9克，荠菜花炭12克，净连翘12克，黄芩炭9克，炒银花12克，广郁金6克，石菖蒲9克，泽泻9克，赤苓9克。
2.男。身热第4日，胸前、两臂散布红点，七日热也。牛子9克，连翘9克，赤苓9克，紫草茸9克，白茅根1扎，浮萍6克，蝉衣3克，西河柳9克，胡荽子9克(包)，草决明9克。二诊:1周后，脉静身凉，诸恙消失而倦怠，默默不欲食。此最为流行习见者。香白芷9克，枳实9克，酒炒桑枝12克，佛手9克，薤白头12克，木瓜9克，仙鹤草12克，稀莶草9克，左金丸2.克(吞)。
3.女。流行之七日热，少有前驱症者。违和五六日，骤有高热，面色潮红，两目充血，则七日热正式开始，而以往是感冒之类也。玄明粉12克，黑山栀9克，黄芩9克，竹叶30片，制锦纹9克，净连翘12克，薄荷叶4.克，粉甘草3克。
4.男。流行症并发脚气，其实脚气蕴伏已久，因猝病之热消耗更甚，故其面容黯淡有如此。上见鼻衄，下见便血，不能纯用辛温，予全真一气汤。炮附子9克，五味子9克，潞党参9克，白术9克，葫芦瓢30克，熟地黄24克，麦冬12克，淮牛膝15克，杜赤豆30@克。
[按]七日热，又名登革热。它是一种由黑斑蚊所传染的急性病毒性传染病。发病突然。高热，全身疼痛，特别是以头、腰部疼痛剧烈为主要症状;第四、第五日，乃出现红疹，多数还伴有呕吐、便秘，重则谵语、神昏。小儿可发生搐搦。结膜、咽头充血，也较常见。又可并见鼻衄、胃肠道和子宫出血。它的全过程约7天，故有"七日热"的名称。中医辨证，属于温疫、温毒，也有作为丹痧一类病症来看待的。治法一般以清热、凉血、解毒为主。先生辨此证，也不例外。一般初起恶寒、骨节痛剧者，用辛温之剂;苔腻者，用芳香化湿浊的方法;便秘者，佐以下剂;也有用养阴以保其津液者。对异型或并发症以及有出血素质者，其治疗也有所不同。今此症已罕见，录之以备一格。
5.男。热度高张，不得汗，亦不得便，胸中烦闷殊甚，予柴葛达原饮。柴胡9克，黄芩9克，肥知母9克，葛根9克，煨草果2，4克，杭白芍9克，海南片6克，川朴4.克，太乙丹1粒。二诊:去冬曾病疟，用外治法而愈。此番高热，有匍行疹，脾脏不肿大，不更衣5日，先下之。郁李仁12克，海南片9克，净连翘12克，生枳实9克，草决明9克，广玉金4.克，黄芩9克，全瓜蒌12克，六一散12克(包)。[按]先生对热性病初起，凡是便秘者总是先行通便，往往获显效。本病例三诊时，其热已退，可知先生善于应用温病"下不嫌4%之法。
6.男。初起曾经战栗，随后其热并不高张，温温然4日，以头部剧痛为苦，便虽通，不爽利。春柴胡4.克，淡黄芩9克，制黑丑6克，法半夏9克，熟锦纹6克，生枳实9克，杭白芍9克，橘皮6克，粉甘草3克。二诊:加味大柴胡汤服后，得汗与便，而热稍挫，其苔垢腻，腻是湿。凡时症夹湿，则难速效，何况时在湿令。清水豆卷12克，淡黄芩9克，黑山栀9克，鸡苏散9克(包)，净连翘9克，赤茯苓9克，郁金4.克川朴花4.克生熟苡仁各12克佩兰6克莱菔英9克。另:甘露消毒丹18克，煎汤代茶。
三诊:清化湿热后，苔之垢腻者渐化，佳象也。昨夜神志有迷蒙状。再拟清化湿热，佐以芳香开窍。制半夏9克，白蔻仁2.克，佩兰梗9克，川朴花3克，黄芩3克，生苡仁9克，连翘9克，广郁金4.克，滑石12克，石菖蒲9克，赤苓9克。四诊:神志清晰，苔腻转薄，但热未清;溲尚短。予下方以清理余蕴。清水豆卷9克，制半夏4.克，梗通3克，陈皮4.克，杏仁9克，佩兰6克，生苡仁9克，佛手4.克，泽泻6克。
2. Male. The "Autumn-Warmth" (Qiū Wēn) mentioned by Qing Dynasty physicians includes three conditions: common cold, gastroenteritis, and mild typhoid fever. The patient has no history of major illness, presents with a sallow complexion and a soft pulse. Although the tongue coating is greasy, it is white and slippery; one must guard against the third condition mentioned above (mild typhoid fever). Prescription: *Qingshui Doujuan* (Vigna angularis var. nipponensis) 12g, *Beichaihu* (Bupleuri Radix) 24g, *Jiang Banxia* (Pinelliae Rhizoma Preparatum cum Zingibere et Alumine) 9g, *Jiang Zhishi* (Aurantii Fructus Immaturus Preparatum) 9g, *Fupingcao* (Urticae Herba) 6g, *Huangqin* (Scutellariae Radix) 6g, *Quangualou* (Trichosanthis Fructus) 12g, *Wei Caoguo* (Tsaoko Fructus Praeparatus) 4g, *Peilan Geng* (Eupatorii Caulis) 9g, *Chiling* (Poria Cocos cum Ligno Quercus) 9g, *Fen Gancao* (Glycyrrhizae Radix et Rhizoma Preparatum) 3g. Additionally, take one pill of *Taiyi Dan* (Taiyi Pill), divided into two doses for swallowing.
Second visit: The fever has decreased somewhat, and the sallow complexion and greasy tongue coating have also improved. Reduce the dosage of the previous prescription. Prescription: *Qingshui Doujuan* 12g, *Beichaihu* 12g, *Jiang Banxia* 6g, *Zhishi* 9g, *Huangqin* 9g, *Peilan Geng* 9g, *Chiling* 9g, *Quangualou* 9g, *Fen Gancao* 3g.
[Commentary] This case was subsequently treated continuously with heat-clearing and dampness-draining formulas, resulting in recovery after approximately 10 days. The use of 24g of Chaihu (*Bupleuri Radix*) in the first prescription was uncommon among other physicians at that time. Mr. Zhang discussed three functions of Chaihu: one is to dispel stasis, two is to relieve fever, and three is to purge downward. Here, its fever-relieving function was utilized. Mr. Zhang also stated, "Treating diseases requires boldness and meticulousness, decisiveness, and hesitation is inadmissible." This is evident here.
3. Male. Autumn-Warmth pathogen has invaded the Blood level (Xue Fen). The skin on the face and chest is red like cinnabar, with scattered red spots on both arms, and the pharynx is red and painful. Treatment principle: Clear the Heat and cool the Blood. Prescription: *Jing Lianqiao* (Forsythiae Fructum) 9g, *Baiwei* (Cynanchi Atrati Radix) 12g, *Xiaoji* (Cirsii Japonici Herba) 9g, *Zicao Rong* (Arnebiae Radix et Rhizoma) 6g, *Lugen* (Imperatae Rhizoma) 100cm (remove nodes), *Jinyinhua* (Lonicerae Japonicae Flos) 12g, *Huangqin* 6g, *Danpi* (Moutan Cortex) 9g, *Lvdouyi* (Phaseoli Radiati Pericarpium) 12g, *Shegan* (Belamcandae Rhizoma) 6g.
Second visit: Ancient physicians determined treatment methods by observing the color of the rash, which has its own merit. For example, red rashes indicate Heat, involvement of the Blood level, and a progressive excess syndrome. It is necessary to continue resolving Heat and cooling the Blood to pacify the excessive pathogenic factor. Prescription: *Hang Juhua* (Dendranthema Flos) 9g, *Chishao* (Paeoniae Radix Rubra) 9g, *Jinyinhua* 15g, *Chuan Yalian* (Coptidis Rhizoma) 1g, *Quangualou* 12g, *Nen Baiwei* 12g, *Zicao Rong* 4g, *Shegan* 9g, *Zihuadi Ding* (Violaris Herba) 9g, *Chiling* 9g.
[Commentary] At this time, it was autumn. On one hand, due to high fever and rash, this syndrome was differentiated as Autumn-Warmth. On the other hand, when treating such rashing diseases, Mr. Zhang often adhered to Ye Tianshi and Wu Jutong's theory that "pathogens enter Ying and Blood levels," employing heat-clearing and blood-cooling methods. This demonstrates that Mr. Zhang practiced syndrome differentiation and treatment clinically without favoring any single school of thought. In the third visit, the fever subsided, consciousness cleared, and peeling skin appeared in patches. Mr. Zhang continued the previous method, believing that heat-clearing and blood-cooling herbs possess anti-inflammatory and detoxifying effects and must be maintained rather than stopped immediately. As predicted, the disease was cured.
Warm-Heat Disease Chapter
1. Female. High fever arose suddenly. Despite repeated sweating, the fever did not significantly subside; this indicates Warm-Evil (Wen Xie). Stools are loose and foul-smelling, with frequent nausea. Prescribe *Gegen Qinlian Tang* (Kudzu and Scutellaria Decoction). Prescription: *Gegen* (Puerariae Lobatae Radix) 12g, *Chuanlian* (Coptidis Rhizoma) 1g, *Dan Huangqin* 6g, *Wancansha* (Bombyx Batryticatus) 12g (wrapped), *Lianqiao* 6g, *Chiling* 6g, *Jinyinhua* 12g, *Jiang Zhuru* (Bambusae Caulis Preparatus) 6g, *Qicaihua Tan* (Cardamine Flower Charcoal) 12g. Additionally: *Liuyi San* (Six-to-One Powder) 30g, to be taken as tea.
[Commentary] If it were Wind-Cold, sweating should resolve the condition. This sudden onset of high fever corresponds to the Warm-Heat disease described in the *Shanghan Lun* (Treatise on Cold Damage) as "after sweating, the body burns hot." Because the stools are loose and foul with nausea, the Heat is located in the Intestines and Stomach; thus, *Gegen Qinlian Tang* is modified. *Qicaihua* clears Heat, cools Blood, detoxifies, and stops dysentery. As early as the 1930s, Mr. Zhang frequently used such herbal medicines, reflecting his emphasis on folk medical experience.
2. Male. Fever for 6 days. The fever is not severe, but the spirit appears confused. No bowel movement for 6 days, occasional vomiting, greasy tongue coating. This is Yangming Fu-Organ Excess Syndrome (Yangming Fu Shi Zheng); urgent purgation is required to preserve Yin. Prescription: *Quandonggui* (Angelicae Sinensis Radix) 9g, *Hang Baishao* (Paeoniae Radix Alba) 9g, *Quangualou* 12g, *Sheng Jinwen* (Rhei Radix et Rhizoma Cruda) 6g, *Zhi Houpo* (Magnoliae Officinalis Cortex Preparata) 2g, *Sheng Zhishi* 9g, *Jiang Banxia* 9g, *Laifuzi* (Radish Seed) 12g, *Shichangpu* (Acori Tatarinowii Rhizoma) 9g, *Yuanmingfen* (Mirabilite) 12g (divided into two doses, dissolved and taken).
[Commentary] The *Shanghan Lun* Yangming chapter states: "In cold damage, if there is much vomiting, even if there are Yangming signs, do not attack with purgatives." Cheng Wuji commented: "Vomiting indicates Heat in the Upper Jiao, not yet fully entered the Fu organs, so purgation is contraindicated." Based on clinical experience, Mr. Zhang believed this vomiting was related to constipation and required urgent purgation with *Da Chengqi Tang*. Since the patient had been feverish for 6 days without severe heat and showed confusion, indicating low resistance, he added *Dangui*, *Baishao*, *Gualouren*, and *Laifuzi* to nourish the nutritive level and moisten the intestines, as stated: "Without purging, the accumulated Heat cannot be removed; without moistening, Yin will perish quickly."
3. Male. High fever worsens at dusk (Ribbit hour). The disease has entered the Yangming stage. Wu Jutong argued that Warm diseases should be discussed via the Triple Burner (San Jiao) system, not the Six Meridians, which is erroneous. Prescription: *Han Shuishi* (Halloysitum Rubrum) 24g, *Dan Zixin* (Scutellariae Radix) 3g, *Qinghao* (Artemisiae Annuae Herba) 12g, *Fen Gancao* 3g, *Guang Yujin Mo* (Curcumae Radix Powder) 3g (divided into three doses), *Sheng Shigao* (Gypsum Fibrosum) 24g, *Zhimu* (Anemarrhenae Rhizoma) 15g, *Cangzhu* (Atractylodis Rhizoma) 6g, *Jingmi* (Oryzae Semen) 1 wine cup, *Xian Shichangpu* 6g.
[Commentary] When Taiyang Cold Damage transforms into Yangming, Cold turns to Fire, resembling the intense Heat of the Qi level in Warm diseases; treatment methods are often similar. Here, *Cangzhu Baihu Tang* is combined with *Han Shuishi*, *Qinghao*, and *Huangqin*, likely designed for Warm disease complicated by Dampness. For Damp-Heat causing coma, aromatic orifices-opening herbs like *Shichangpu* and *Yujin* can be used. The Six Meridians are the diagnostic method for Cold Damage, while Wei-Qi-Ying-Blood and San Jiao are methods for Warm diseases. The latter two developed from the former, being interconnected yet distinct. Focusing on "Syndrome," there is no insurmountable gap between Cold Damage and Warm Disease schools. These few words reflect Mr. Zhang's lifelong philosophy.
4. Female. Muscle fever and aversion to cold persisting for ten days. Suddenly shivering in the early morning. Shivering followed by sweating leading to resolution is called "Battle Sweat" (Zhan Han); if unresolved, it is a precursor to high fever. No bowel movement for 6 days. First prescribe *Liangge San* (Cooling the Chest Powder). Prescription: *Bohe* (Menthae Haplocalycis Herba) 6g, *Shanzhi* (Gardeniae Fructus) 9g, *Huangqin* 9g, *Lianqiao* 9g, *Zhuye* (Phyllostachys Viridis Folium) 6g, *Yuanmingfen* 9g, *Zhi Chuanjun* (Rhei Radix et Rhizoma Preparata) 9g, *Gancao* 3g.
[Commentary] When external febrile diseases linger in the Qi level for a long time and suddenly present with chills, followed by sweating, quiet pulse, and cool body, where Heat exits with sweat, it is named "Battle Sweat." This occurs when Righteous Qi struggles against Pathogenic factors; if Righteous Qi prevails, sweat occurs. This patient sweated but fever persisted, indicating Pathogenic Heat remains. With six days of constipation, it proves formless Pathogenic Heat is entrenched by dry stool. When Pathogenic Heat does not resolve from the exterior and abdominal fullness/constipation appear, simultaneous release of exterior and interior is indicated; *Liangge San* is an excellent formula.
5. Female. Fever persists for 9 days. Tongue center has thick greasy coating; edges and tip are crimson. The whole body is covered with dense pale purple blood spots. This is a sign of Warm-Evil entering the Ying (Nutritive) level; mental restlessness is expected. Treatment requires large doses of formulas to clear the Ying level and detoxify. Prescription: *Xi Shengdi* (Rehmanniae Radix Preparata) 15g, *Maidong* (Ophiopogonis Radix) 9g, *Xuanshen* (Scrophulariae Radix) 9g, *Yinhua* (Lonicerae Japonicae Flos) 12g, *Lianqiao* 9g, *Digupi* (Lycii Cortex) 9g, *Zihuadi Ding* 12g, *Lvdouyi* 9g, *Baimaogen* (Imperatae Rhizoma) 1 bunch, *Shenxi Dan* (Shenxi Pill) 1 pill (dissolved and taken).
[Commentary] When pathogens enter the Ying level, one must clear the Ying level and detoxify. *Shenxi Dan* clears the Ying level, detoxifies, and vents pathogens from the Ying level. *Yinhua*, *Lianqiao*, *Zihuadi Ding*, and *Baimaogen* clear Heat and detoxify; *Shengdi*, *Xuanshen*, and *Maidong* nourish Yin. *Zihuadi Ding* is bitter and cold, enters the Heart and Liver meridians, clears Heat and detoxifies, especially effective for carbuncles; traditionally used more in surgery. Less common in Warm diseases, now often used for acute infectious diseases.
6. Male. A person with weak constitution contracts a severe Warm-Evil. Lingering for many days, Righteous Qi is further damaged. Now, after two periods (approx. 10 days), the disease enters the critical stage: persistent high fever, deafness, delirium, and a faint pulse nearly imperceptible. Life and death depend on this. Abundant Righteous Qi leads to survival; exhaustion leads to death. Purely using clearing and venting methods for Warm diseases would bring disaster swiftly. In the past, Zhang Jingyue treated a youth in the capital with scorched tongue and confusion, reviving him with large doses of warming tonics; the record remains. Prescription: *Pao Fu Kuai* (Aconiti Lateralis Radix Preparata) 9g, *Lianqiao* 15g, *Yujin* 4g, *Xian Shichangpu* 9g, *Xian Shengdi* (Rehmanniae Radix Recens) 30g, *Dangshen* (Codonopsis Radix) 12g, *Maidong* 15g, *Wuweizi* (Schisandrae Chinensis Fructus) 9g, *Heida Dou* (Sojae Semen Nigrum) 30g (decocted to replace water).
[Commentary] Using Ginseng (*Renshen*) and Aconite (*Fuzi*) for high fever and delirium in Warm diseases after two periods is extremely rare. This patient had inherent deficiency; despite high fever, the faint pulse indicates Righteous Qi failure, termed "Righteous Deficiency and Pathogenic Exuberance." Deficiency is the root; Heat disease is the branch. Urgently use Ginseng and Aconite to salvage impending Yang collapse; *Shengdi* and *Shengmai San* to rescue impending Yin collapse. Shanghai senior physician Zhu Weiju often used Aconite for Warm diseases presenting with black tongue and scorched lips, aiming to invigorate Middle Yang and save failing heart power.
7. Male. Fever for 4 weeks. Recently, deafness and delirium appeared, with stinging pain and dribbling urine, showing signs of blazing Warm-Evil. Use Sweet-Cold to nourish and Bitter-Cold to clear. Prescription: *Xiao Shengdi* 12g, *Zhimu* 9g, *Xian Shihu* (Dendrobii Caulis) 9g, *Baiwei* 9g, *Juanxin Zhuye* (Phyllostachys Viridis Folium) 9g, *Kushen Pian* (Sophorae Flavescentis Radix) 6g, *Huangbai* (Phellodendri Chinensis Cortex) 9g, *Han Shuishi* 18g (crushed), *Zexie* (Alismatis Rhizoma) 9g, *Hupo Xie* (Electri Succinum) 2g (divided into two doses).
[Commentary] After 20+ days of fever, Yin fluids are injured, disturbing the Heart Spirit. Pathogen remains, Righteous Qi is damaged. Thus, *Shengdi* and *Shihu* nourish Yin; *Zhimu*, *Huangbai*, *Han Shuishi*, *Baiwei*, and *Zhuye* clear Heat; *Zexie* and *Hupo* promote urination and unblock strangury. *Kushen* and *Huangbai* are used because "The Small Intestine, the Fire Fu Organ, requires Bitterness to unblock," aiming to clear Damp-Heat and unblock strangury. Mr. Zhang commonly used *Kushen* for febrile diseases due to its good heat-clearing effect, recorded in *Waitai Miyao*, though less used later.
8. Male. Tongue coating like piled powder, no bowel movement for 5 days, thirst preferring cold drinks. Combine *Baihu Tang* (White Tiger Decoction) with *Liangge San*. Prescription: *Sheng Shigao* 30g, *Jingmi* 1 cup, *Xuanmingfen* 12g, *Huangqin* 9g, *Zhimu* 12g, *Gancao* 2g, *Sheng Chuanjun* 9g, *Shanzhi* 9g, *Lianqiao* 9g, *Bohe* 6g, *Dan Zhuye* 30 leaves, *Baimi* (White Honey) 30g.
Second visit: Although both medicines were vomited, three smooth bowel movements occurred. High fever dropped. Tongue coating changed from piled powder to loose, yellow, and moist. Prescription: *Dongsangye* (Mori Folium) 9g, *Hang Juhua* 9g, *Lianqiao* 9g, *Jiang Zhishi* 6g, *Dongguazi* (Benincasae Semen) 12g, *Huangqin* 9g, *Huashi* (Kaolinitum) 12g (wrapped), *Zhuye* 30 leaves.
Third visit: After two treatments with clearing and resolving agents, fever subsided, pulse quieted, spirit is fatigued, appetite is poor. Prescribe the following for convalescence. Prescription: *Taizishen* (Codonopsis Radix Preparata) 9g, *Baizhu* (Atractylodis Macrocephalae Rhizoma) 9g, *Chenpi* (Citri Reticulatae Pericarpium) 6g, *Fen Gancao* 3g, *Fuling* (Poria Cocos) 9g, *Chao Guyamai* (Hordei Fructus Germinatus and Maydis Semen) 9g each.
[Commentary] High fever, thirst for cold drinks, and constipation correspond to "Yangming Fu-Organ Syndrome" in *Shanghan Lun* and "Qi Level Syndrome" in Warm Disease theory. Mr. Zhang often preferred *Baihu Tang* plus *Liangge San*, or *Liangge San* alone, with frequent success. In the second visit, seeing smooth bowels and reduced fever, he switched to clearing agents. In the third visit, seeing fever subsided and fatigue, he used modified *Yigong San* for recovery. This shows Mr. Zhang's flexibility in changing formulas according to symptoms and practicing syndrome-based treatment.
Warm Epidemic Disease Chapter
1. Female. Local epidemic of "Seven-Day Fever" recently. Initial aversion to cold and bone ache. After several days, scattered red spots appeared all over the body; some had blurred consciousness. Recovery takes up to 2 weeks at latest. Now severe abdominal pain. Only one bowel movement in 7 days, incomplete. Treatment key lies here. Prescription: *Sheng Shu Jinwen* (Rhei Radix et Rhizoma) 6g each, *Sheng Zhishi* 9g, *Wulingzhi* (Trogopterori Faeces) 9g, *Laifuzi* 12g, *Hainanpian* (Arecae Semen) 9g, *Yuliren* (Pruni Semen) 15g (crushed), *Xiao Qingpi* (Citri Reticulatae Pericarpium Viride) 6g, *Xuanmingfen* 12g, *Tang Chao Shanzha* (Crataegi Fructus Preparatus) 18g, *Liushenqu* (Medicated Leaven) 12g, *Hang Baishao* 9g.
Second visit: Temperature dropped, still having convulsions, obviously due to toxin stimulation. Elimination involves promoting urination and defecation. Bowels now open, switch to clearing, draining, and opening orifices. Prescription: *Nen Baiwei* 9g, *Nen Zicao* 9g, *Qicaihua Tan* 12g, *Jing Lianqiao* 12g, *Huangqin Tan* 9g, *Chao Yinhua* 12g, *Guang Yujin* 6g, *Shichangpu* 9g, *Zexie* 9g, *Chiling* 9g.
2. Male. Body heat on day 4. Red spots scattered on chest and arms. Seven-Day Fever. Prescription: *Niuzi* (Armeniacae Semen Amarum) 9g, *Lianqiao* 9g, *Chiling* 9g, *Zicao Rong* 9g, *Baimaogen* 1 bunch, *Fuping* 6g, *Chanyi* (Bombyx Batryticatus) 3g, *Xi Heliu* (Salicis Capreae Ramulus) 9g, *Husui Zi* (Coriandri Sativi Fructus) 9g (wrapped), *Caojieming* (Cassiae Semen) 9g.
Second visit: One week later, pulse quiet, body cool, all symptoms disappeared but fatigue remains, silent and anorexic. This is the most common presentation. Prescription: *Xiang Baizhi* (Angelicae Dahuricae Radix) 9g, *Zhishi* 9g, *Jiu Chao Sangzhi* (Mori Ramulus Preparatus) 12g, *Foshou* (Citrus Sarcodactylis Fructus) 9g, *Xie Beitou* (Allii Macrostemonis Bulbus) 12g, *Mugua* (Chaenomelis Fructus) 9g, *Xianhecao* (Agrimoniae Herba) 12g, *Xixiancao* (Siegesbeckiae Herba) 9g, *Zuojin Wan* (Zuojin Pill) 2g (swallowed).
3. Female. Epidemic Seven-Day Fever rarely has prodromal symptoms. After 5-6 days of malaise, sudden high fever, flushed face, congested eyes marks the official start of Seven-Day Fever, whereas previously it resembled a cold. Prescription: *Xuanmingfen* 12g, *Hei Shanzhi* (Gardeniae Fructus Carbonized) 9g, *Huangqin* 9g, *Zhuye* 30 leaves, *Zhi Jinwen* 9g, *Jing Lianqiao* 12g, *Bohe Ye* (Menthae Haplocalycis Folium) 4g, *Fen Gancao* 3g.
4. Male. Epidemic complicated by Beriberi. Actually, Beriberi had been latent for a long time, exacerbated by the consumption from sudden high fever, hence the dull complexion. Epistaxis above, hematochezia below. Cannot use purely Acrid-Warm formulas. Prescribe *Quanzhen Yiqi Tang* (Complete True Vital Qi Decoction). Prescription: *Pao Fuzi* (Aconiti Lateralis Radix Preparata) 9g, *Wuweizi* 9g, *Luchangshen* (Codonopsis Radix) 9g, *Baizhu* 9g, *Hulu Piao* (Tricosanthes Fruit Peduncle) 30g, *Shu Dihuang* (Rehmanniae Radix Preparata) 24g, *Maidong* 12g, *Huainiuxi* (Achyranthis Bidentatae Radix) 15g, *Du Chidou* (Adzuki Bean) 30g.
[Commentary] Seven-Day Fever, also known as Dengue Fever, is an acute viral infectious disease transmitted by *Aedes albopictus* mosquitoes. Sudden onset. High fever, general body pain, especially severe headache and lower back pain; on the 4th-5th day, rash appears, often accompanied by vomiting and constipation; severely, delirium and coma occur. Children may have convulsions. Conjunctival and pharyngeal congestion are common. Epistaxis, gastrointestinal, and uterine bleeding may also occur. The entire course lasts about 7 days, hence the name "Seven-Day Fever." TCM differentiation classifies it as Warm Epidemic or Warm Toxin, sometimes viewed similarly to Dan Sha (Scarlet Fever). Treatment generally focuses on clearing Heat, cooling Blood, and detoxifying. Mr. Zhang's differentiation follows this. Generally, initial aversion to cold and severe joint pain are treated with Acrid-Warm formulas; greasy coating with aromatic damp-resolving methods; constipation with purgatives; or Yin-nourishing to preserve fluids. Treatment differs for atypical cases, complications, or those with bleeding tendencies. This disease is now rare; recorded here for reference.
5. Male. High fever intensity, no sweating, no bowel movement, extreme chest irritability. Prescribe *Chai Ge Da Yuan Yin* (Bupleurum and Kudzu Reaching the Origin Decoction). Prescription: *Chaihu* 9g, *Huangqin* 9g, *Fei Zhimu* 9g, *Gegen* 9g, *Wei Caoguo* 2.4g, *Hang Baishao* 9g, *Hainanpian* 6g, *Chuan Pu* (Magnoliae Officinalis Cortex) 4g, *Taiyi Dan* 1 pill.
Second visit: Last winter, suffered from Malaria, cured by external therapy. This episode of high fever, with creeping rash, non-enlarged spleen, no bowel movement for 5 days. First, purge. Prescription: *Yuliren* 12g, *Hainanpian* 9g, *Jing Lianqiao* 12g, *Sheng Zhishi* 9g, *Caojieming* 9g, *Guang Yujin* 4g, *Huangqin* 9g, *Quangualou* 12g, *Liuyi San* 12g (wrapped).
[Commentary] For early-stage febrile diseases, Mr. Zhang always prioritizes promoting bowel movements in cases of constipation, often achieving significant effects. In the third visit of this case, the fever had subsided, showing Mr. Zhang's skill in applying the Warm Disease principle "purging is never too early."
6. Male. Initially experienced shivering, then fever was not high-intensity, lingering warmth for 4 days, suffering from severe headache. Bowels open but not smooth. Prescription: *Chun Chaihu* (Bupleuri Radix Spring Harvest) 4g, *Dan Huangqin* 9g, *Zhi Heiqiu* (Morning Glory Seed Preparata) 6g, *Fa Banxia* (Pinelliae Rhizoma Preparatum) 9g, *Shu Jinwen* 6g, *Sheng Zhishi* 9g, *Hang Baishao* 9g, *Jupi* (Citri Reticulatae Pericarpium) 6g, *Fen Gancao* 3g.
Second visit: After taking modified *Da Chaihu Tang*, sweating and bowel movement occurred, fever slightly subsided. Tongue coating is greasy; greasiness indicates Dampness. When seasonal diseases involve Dampness, quick results are difficult, especially during humid seasons. Prescription: *Qingshui Doujuan* 12g, *Dan Huangqin* 9g, *Hei Shanzhi* 9g, *Jisu San* (Polyporus Powder with Mentha) 9g (wrapped), *Jing Lianqiao* 9g, *Chiling* 9g, *Yujin* 4g, *Chuan Pu Hua* (Magnoliae Officinalis Flos) 4g, *Sheng Shu Yiren* (Coicis Semen) 12g each, *Peilan* 6g, *Laifuying* (Radish Leaf) 9g. Additionally: *Ganlu Xiaodu Dan* (Sweet Dew Detoxification Pill) 18g, decocted to replace tea.
Third visit: After clearing and transforming Damp-Heat, the greasy tongue coating gradually resolved, a good sign. Last night, consciousness was blurred. Further plan: Clear and transform Damp-Heat, assist with aromatic orifice-opening. Prescription: *Zhi Banxia* 9g, *Baokou Ren* (Amomi Fructus Rotundus) 2g, *Peilan Geng* 9g, *Chuan Pu Hua* 3g, *Huangqin* 3g, *Sheng Yiren* 9g, *Lianqiao* 9g, *Guang Yujin* 4g, *Huashi* 12g, *Shichangpu* 9g, *Chiling* 9g.
Fourth visit: Consciousness clear, tongue coating thin, but Heat not fully cleared; urine still scant. Prescribe the following to clear residual pathogens. Prescription: *Qingshui Doujuan* 9g, *Zhi Banxia* 4g, *Gengtong* (Platycodonis Radix) 3g, *Chenpi* 4g, *Xingren* (Armeniaceae Semen Amarum) 9g, *Peilan* 6g, *Sheng Yiren* 9g, *Foshou* 4g, *Zexie* 6g.