侄 夏至后伏气自里而发，热渴心烦，头汗气促，舌灰疹现，厥逆谵语，脉濡数。夫濡为湿，数为热，
里邪蒸湿则为头汗；湿邪郁热则为渴烦；邪壅肺窍则为气促，为红疹；干心包则为谵语，为舌灰；其手足厥
逆，乃热深厥深。误用风药升举助邪，遂致晕厥无寐躁扰，宜清营中伏邪。犀角汁、羚羊角、丹皮、鲜生地、
鲜藕、元参、茯苓、赤芍。日再服，汗透脉和，诸症悉退，调理得平。
族女 热症，脉缓而濡，湿甚于热，头晕目瞑，唇 齿燥，胸腹满痛，湿蒸为热，小溲赤涩。三焦
皆邪势弥漫，况疹现肢厥，急须透解，勿使热酿湿痰，蒙蔽膻中，致成内闭危症。所用枳、朴，堕损胎元，
柴、葛乃伤寒足经药，与三焦无涉，医不中 ，焉望获效。通草、豆豉、羚羊角、蒌霜、麦冬、连翘、牛蒡、
山栀、赤苓、灯心、鲜芦根。二服热势退，手足和，去通草、香豉、羚羊、连翘、蒡、栀，加鲜生地、鲜石斛、
沙参、象贝、黄芩，以防热邪内陷，兼以护胎。数服汗解而愈。
幼孙 晡热头晕，汗渴烦躁，脉洪数。用大剂白虎汤加羚羊角，一啜汗透而愈。
侄 少阴伏邪内发，壮热烦冤，头目如蒙，耳聋，舌尖绛，唇紫口干，手心如烙，脉浮洪溢指外，右
尤甚，交巳午刻症重。初用辛凉以泄卫热，如薄荷露、甘菊、竹叶、杏仁、栀皮、豆豉之属，头目略清，微汗不
彻，脘痞痰沫。用疏利以渗痰湿，如枳壳、大贝、蒌霜、通草、芦根、灯心之属，痰稀溺爽，而臂膊红疹隐现，
胸背全无。再加清透之品，如赤芍、丹皮、连翘、牛蒡、青蒿、麦冬之属，疹虽淡而舌心灰腻，舌尖红晕，
必心胃火燔。用导赤散加石膏，午前服，向晚防其邪入心营。用透营救液法，如犀角尖磨汁、鲜生地、鲜石斛、元
参、花粉、丹皮、沙参之属。舌色未退，转益干燥，脉洪长，防其入腑。急用凉膈散，（芒硝改元明粉、
去甘草、大枣）。得便二次，里结乍通，热势较退，而神迷昏寐，脉数谵语，乃热心包，虑其蒸痰内闭。用
犀角汁下至宝丹及牛黄清心丸，以宣窍驱热，数脉减。再用清镇神明，佐豁痰通络。如血珀、石决明、茯神、
羚羊角、象贝、杏仁、竹茹、夜交藤、通草之属，神识稍清，脉仍浮大，巳午为甚，额颧疹现，喜其邪从外
解。再与清透，用茅根、梨、藕汁服。明早浮脉稍敛，灰舌转润，决其阳极于午，必俟夏至阴生阳退，乃冀
转机，且舌尖晕痕未消，溺后色变混浊。用黄连、人中黄、山栀、赤芍、麦冬之属，加六一散冲服，微汗脉
平，身始凉解。乃用燕窝汤及粥饮调理，渐次
培养胃阴得安。（此症乃热兼疫邪。）
余于丙夏，因诊视时邪染恙，寒热，脉浮大。服栀豉葱白汤，胸背汗，三日后热甚，渴烦少寐，舌苔黄变
黑。服犀角、羚羊角、竹叶、芦根、藕、蔗诸汁，热稍平。逾夕，复壮热谵语神昏，服至宝丹（分半），鲜
菖蒲根汁下，神稍清。又用前各汁，加洋参、鲜生地、象贝、龟板、青蒿、连翘、滑石，清营滋液，专驱痰
热，兼泻三焦，舌黑颇淡，但汗出微凉，汗收仍热，脉数气粗，烦扰竟夕。又服至宝丹（分半），神未定，
直视气促。再服前丹（二分半）昏睡。进洋参汤，汗出热退，但舌心干，用石膏煎清胃，加梨、藕汁，稍津润。
逾日，目赤，舌再灰黑，神再烦扰。改服牛黄清心丸（二分），橘红汤下，得寐。专服洋参、藕、蔗汁、麦
冬、橘红汤，寐熟，热轻。再啜洋参汤，汗出凉解。越五宿，欲大便，以蜜煎导，当夜感寒复热，舌苔如粉，
吐痰欲呕，此为复感。用半夏曲、杏仁、茯苓、紫苏、薄荷、佩兰叶加姜。热未退，口燥脉数，烦扰不寐。
再服牛黄清心丸（五分）、犀角磨汁冲服。逾日大汗如雨，乃凉，然已兼旬外矣。此案芝本日记，附志之，
见热邪之劫烁津液甚炽也。忆是夏坐卧楼窗，吸受暑 ，更加传染，病中苦热，见曦炎出，如膏自焚。口占
七绝，日十余首，有“自笑吴牛喘明月，檐稍怕见石榴红”之句。左氏谓明淫心疾，良不予欺。
Nephew: After the Summer Solstice, latent pathogenic factors erupt from within, presenting with fever, thirst, and irritability. There is sweating on the head, shortness of breath, grayish tongue coating with rash eruption, cold extremities (Jue Ni), and delirium. The pulse is Ru (Soft) and Shu (Rapid). A Ru pulse indicates Dampness; a Shu pulse indicates Heat. Internal pathogens steaming Dampness cause head sweating; Dampness stagnating and transforming into Heat causes thirst and irritability; Pathogen obstructing the Lung orifices causes shortness of breath and red rashes; interference with the Pericardium causes delirium and grayish tongue coating. The cold extremities are due to "Heat deep, Jue deep" (the deeper the heat, the deeper the cold extremities). Misusing Wind-dispelling herbs to raise and assist the pathogen leads to syncope, insomnia, and restlessness. One should clear the latent pathogen in the Ying (Nutritive) level. Prescription: Rhinoceros Horn Juice (Shuijiao Zhi), Antelope Horn (Lingyang Jiao), Moutan Cortex (Danpi), Fresh Rehmannia Root (Xian Shengdi), Fresh Lotus Root (Xian Ou), Scrophularia Root (Yuanshen), Poria (Fuling), Red Peony Root (Chishao). Take twice daily. Once sweat penetrates and the pulse harmonizes, all symptoms recede, and recovery follows regulation.
Female Relative: Suffering from a Heat syndrome, the pulse is Huan (Slow) and Ru (Soft), indicating Dampness exceeds Heat. Symptoms include dizziness, blurred vision, dry lips and teeth, chest and abdominal fullness and pain. Dampness steaming transforms into Heat, causing dark and scanty urination. Pathogens pervade the San Jiao (Triple Burner). Given the rash eruption and cold extremities, urgent resolution through venting is required to prevent Heat from generating Damp-Phlegm that clouds the Dan Zhong (Pericardium), leading to critical internal closure. Using Zhi Shi (Immature Bitter Orange) and Hou Po (Magnolia Bark) damages the fetal origin; Chai Hu (Bupleurum) and Ge Gen (Kudzu Root) treat Taiyang and Yangming meridians of the Foot, irrelevant to the San Jiao. If the physician's treatment is inaccurate, how can efficacy be expected? Prescription: Tong Cao (Tetrapanax Pith), Fermented Soybean (Douchi), Antelope Horn (Lingyang Jiao), Trichosanthes Fruit Rind (Lou Shuang), Ophiopogon Tuber (Maidong), Forsythia Fruit (Lianqiao), Arctii Fructus (Niubangzi), Gardenia Fruit (Shanzhizi), Red Poria (Chiling), Centipeda Herb (Dengxin). After two doses, heat subsides, and hands/feet warm. Remove Tong Cao, Douchi, Lingyang Jiao, Lianqiao, Niubangzi, Shanzhizi; add Fresh Rehmannia Root (Xian Shengdi), Fresh Ophiopogon Tuber (Xian Shihu), Glehnia Root (Shashen), Fritillaria Bulb (Xiangbei), Scutellaria Root (Huangqin) to prevent Heat sinking inward and to protect the fetus. After several doses, resolution via sweating occurs, and the patient recovers.
Young Grandson: Evening fever, dizziness, sweating, thirst, and irritability. Pulse is Hong (Surging) and Shu (Rapid). Use a large dose of Baihu Tang (White Tiger Decoction) plus Antelope Horn (Lingyang Jiao). After one dose, sweat penetrates, and the patient recovers.
Nephew: Shaoyin latent pathogen erupts internally, causing high fever, oppression, sensation of heaviness in the head and eyes, deafness, crimson tongue tip, purple lips, dry mouth, and burning palms. The pulse is Fu (Floating) and Hong (Surging), overflowing beyond the fingers, more pronounced on the right. Symptoms worsen during Si and Wu hours (9 AM - 1 PM). Initially, use Acrid-Cool herbs to vent Wei (Defensive) Heat, such as Mint Dew, Chrysanthemum, Bamboo Leaf, Apricot Seed, Gardenia Peel, and Fermented Soybean. Head and eyes clear slightly, slight sweat fails to penetrate fully, resulting in epigastric stuffiness and phlegm foam. Use dispersing and draining herbs to渗 (percolate) Phlegm-Dampness, such as Aurantium Peel (Zhi Qiao), Large Fritillaria (Da Bei), Trichosanthes Rind (Lou Shuang), Tetrapanax Pith (Tong Cao), Reed Rhizome (Lugen), and Centipeda Herb (Dengxin). Phlegm becomes thin, urination smooth, but faint red rashes appear on arms, absent on chest/back. Add clearing and venting agents like Red Peony Root (Chishao), Moutan Cortex (Danpi), Forsythia (Lianqiao), Arctii Fructus (Niubangzi), Artemisia Annua (Qinghao), and Ophiopogon (Maidong). Although rashes are pale, the center of the tongue is gray and greasy, and the tip has a red halo, indicating blazing Heart-Stomach Fire. Use Daochi San (Guide Out the Red Powder) plus Gypsum (Shigao), taken in the morning, to prevent pathogen entering the Ying level by evening. Use venting and nourishing Yin method: Rhinoceros Horn Tip Juice, Fresh Rehmannia, Fresh Ophiopogon, Scrophularia, Polygonatum Rhizome (Huafen), Moutan Cortex, Glehnia Root. Tongue color does not recede, becoming drier; pulse is Hong and Chang (Long), fearing entry into the Fu organs. Urgently use Liangge San (Cool the Diaphragm Powder) (replace Mangxiao with Yuanming Fen, remove Licorice and Jujube). Two bowel movements occur, internal binding temporarily clears, heat slightly subsides, but consciousness is confused with somnolence, rapid pulse, and delirium, indicating Heat invading the Pericardium, fearing Phlegm-Heat internal closure. Use Rhinoceros Horn Juice to administer Zhibao Dan (Precious Treasure Pill) and Niuhuang Qingxin Wan (Calvescent Cow-bezoar Clear Heart Pill) to open orifices and drive out Heat; rapid pulse decreases. Then use clearing and calming Spirit, assisting with resolving Phlegm and unblocking collaterals: Blood Amber (Xuepo), Halite (Shijueming), Poria Spirit (Fushen), Antelope Horn, Fritillaria, Apricot Seed, Bamboo Shavings (Zhuru), Night-crossing Vine (Yejaoteng), Tetrapanax Pith. Consciousness slightly clears, pulse remains Fu and Da (Large), worse at Si/Wu hours, rash appears on forehead and cheeks; fortunate that pathogen resolves externally. Again use clearing and venting: Imperata Rhizome juice, Pear juice, Lotus Root juice. Next morning, Fu pulse contracts slightly, gray tongue moistens. Determine that Yang peaks at Wu hour; must wait for Summer Solstice when Yin generates and Yang retreats to hope for turnaround. However, tongue tip halo persists, urine turns turbid after voiding. Use Coptis Rhizome (Huanglian), Human Excrement Charcoal (Renzhonghuang), Gardenia Fruit, Red Peony Root, Ophiopogon, plus Liuyi San (Six-to-One Powder) taken with water. Slight sweat, pulse平和 (peaceful), body cools. Then use Bird's Nest Soup and porridge to regulate, gradually cultivating Stomach Yin for peace. (This case involves Heat combined with Epidemic Pathogen.)
In the summer of Bing year, I contracted illness while diagnosing seasonal pathogens, experiencing chills and fever, with a Fu Da (Floating and Large) pulse. Took Zhichi Congbai Tang (Gardenia, Fermented Soybean, and Scallion Decoction); sweat appeared on chest/back. Three days later, heat intensified, with thirst, irritability, and poor sleep; tongue coating turned yellow then black. Took juices of Rhinoceros Horn, Antelope Horn, Bamboo Leaf, Reed Rhizome, Lotus Root, Sugarcane; heat slightly stabilized. Overnight, returned to high fever, delirium, and coma. Took Zhibao Dan (half portion) down with fresh Calamus Root juice; spirit slightly cleared. Used previous juices plus American Ginseng, Fresh Rehmannia, Fritillaria, Turtle Shell, Artemisia Annua, Forsythia, Talc, to clear Ying and nourish fluids, specifically driving Phlegm-Heat, and draining San Jiao. Black tongue lightened significantly, but only slight coolness after sweat; upon cessation, heat returned. Pulse rapid, breathing coarse, restless all night. Took Zhibao Dan again (half portion); spirit unsettled, staring straight, shortness of breath. Took previous pill (2.5 fen); fell into coma. Advanced American Ginseng Decoction; sweat occurred, heat retreated, but tongue center dry. Used Gypsum decoction to clear Stomach, added Pear and Lotus Root juice; slightly moistened. Next day, eyes red, tongue gray-black again, spirit restless. Changed to Niuhuang Qingxin Wan (2 fen) down with Tangerina Peel Decoction; slept. Specifically took American Ginseng, Lotus Root, Sugarcane juice, Ophiopogon, Tangerina Peel Decoction; deep sleep, heat lighter. Drank American Ginseng Decoction again; sweat, cool relief. Five nights later, desired defecation; used Honey Suppository. That night, caught cold, fever returned; tongue coating like powder, expectorated phlegm, nausea—this was re-infection. Used Pinellia Curd, Apricot Seed, Poria, Perilla, Mint, Eupatorium Leaf with Ginger. Heat unresolved, mouth dry, pulse rapid, restless insomnia. Took Niuhuang Qingxin Wan (5 fen), Rhinoceros Horn juice mixed in. Next day, profuse sweat like rain, then cool, but it had been over ten days. This case is recorded in Zhiben's diary, attached here, showing how fiercely Heat pathogens devour Body Fluids. Recalling sitting by the window that summer, inhaling Summer Heat, compounded by infection. In sickness, suffering intense heat, seeing sunlight felt like grease self-combusting. Improvised seven-character quatrains, over ten daily, including "Laughing at myself, the Water Buffalo pants at the bright moon, afraid to see the pomegranate red at the eaves." Zuo Qiuming said "Excessive brightness causes Heart disease," indeed he did not deceive me.