余于治案中，每详言之矣。
孙文垣治万肃庵之子，发热十一日，舌心色若沉香，口渴甚干燥，额上及两胁极热，耳微聋。已下二次，
热不退，小便少，神昏足冷，左脉中按数而有力，右脉软弱，乃少阳阳明并病也。先以柴胡汤清其热，视汗有
无，再相机而处。柴胡五钱，葛根三钱，白芍、石膏各二钱，人参、升麻、天花粉各一钱，粉甘草七分。服后
脉稍缓，热稍退，齿仍干，小水不利，神思尚昏沉，改用柴胡、粉草、花粉、黄芩、人参、白术、茯苓、滑石、
木通、泽泻，小便去二次。下午又觉微热面赤，额上痛且重，（黎按∶此白术壅气之故。）与益元散三钱，大
便行一次，溏而色黄，热仍甚，面仍赤。再诊之，寸关脉将和，两尺洪大。（藜按∶此六一散引热下行之效。）
知其热在下焦，惟利之而已，再与益元散五钱，口渴稍止，齿下盘润，而上盘仍燥，神思昏沉，睡而不醒。
知其热在心包络，投导赤散，二帖而神清。惟小水尚短，以四苓加酒连、木通，二帖而诸症悉退。
吴心逸仆患额疼，口大渴，身大热，汗多胸痞，恶心昏沉。孙与柴苓汤加枳壳、桔梗，热减大半。次日以
六君加黄芩、白芍，调理而愈。此劳倦伤寒，故宜先散后补也。
周鉴泉室病伤寒，发热谵语，口渴咳嗽，胸膈痛，泄泻，呕逆，遍身发斑，六脉洪滑。此少阳阳明合病
也，以升麻葛根汤加滑石、五味进之。服后，汗大出，热退神清。复与柴苓汤加五味、滑石，泻亦止。次日
诊之，左脉和，右脉亦稍收敛，改用白芍为主，陈皮、柴胡、酒芩、五味子、牡蛎、滑石、茯苓、泽泻、白术，
服四帖而安。
陈茂之，劳倦后勉强色欲，精竭而血继至，续感风寒，发热头痛，胸膈饱满。始从太阳而传少阳，胸胁痛，
耳聋，呕逆，口苦，咳嗽，六脉弦数。此少阳症也，以小柴胡加枳壳、桔梗，竹茹而呕逆止。因进粥早，复热
口渴，小水不利，大便一日夜六七次，所行皆清水，日晡热甚，舌上黄苔，昏沉振颤。此食复之候，以猪苓、
泽泻各三钱，赤茯苓一钱，柴胡八分，升麻、木通各五分，连进二帖，小便利而大便实。但热不退，进六神通
解散一帖，热如故。次日诊之，左脉不弦数矣，两寸脉如故，服药无汗，口渴，漱水不欲咽咽。此邪热传阳明
经，不急凉血，必作鼻衄。投黄芩芍药汤合生脉散以止嗽渴，用葛根汤以解肌热。白芍三钱，葛根、升麻、黄
芩各一钱，人参一钱五分，麦冬、滑石各三钱，甘草、五味子各五分，乌梅一枚，进二帖，大便下燥粪十数枚，
始得微汗，安眠，进粥而愈。
庞太夫人病头痛恶寒，胸膈懑且痛，时发寒热，投四物汤加元胡索、丹皮、香附，治五日不瘥。孙诊之，
脉右滑大，左浮弦而数，曰∶头痛恶寒，外感症也；浮弦而数，胸膈懑痛，少阳脉症具在；右脉滑，饮食滞而
为痰也。四物汤皆滞痰闭气之药，内伤可以得消，外感何由得出？投以柴胡汤合平胃散，一服而愈。
一老仆头痛，遍身骨节痛，面色黑，发热口渴，胸膈膨胀，饮食七日不进。复感寒，脉左弦数，右洪大，
以藿香、苍术、防风、葛根、白芷、紫苏、甘草、陈皮、大腹皮、麦芽、枳实投之。服后，胸膈稍宽，热与痛
更甚，改以麻黄、葛根、柴胡各二钱，石膏、滑石各三钱，紫苏、苍术、白芷各一钱，甘草五分，姜三片。服
后，大汗出而热痛皆除。惟口渴，又以白芍、当归、石膏、知母、柴胡、黄芩、麦冬、葛根、陈皮服之而愈。
此三阳合病，先为饮食所伤，故用藿香正气汤加消导以助其内，又以六神通解散加助表之药，以治其标。病虽
重，年虽高，喜其色脉相合，故易愈也。
蔡中林室发热口渴，舌上燥裂，小腹痛，呕吐，药食不入口者七日。右寸脉绝不应指，关沉滑有力，左
手弦数。此阳明少阳合病，邪热壅于上焦也。以软柴胡、石膏各五钱，半夏曲、黄芩、黄连、葛根、竹茹、人
参各二钱，姜三片，五更下黑粪数块，痛热减半。次日仍与前药，右寸脉亦起。改用小柴胡汤加橘红、竹茹、
葛根，服三帖全安。
I have elaborated on these points in my treatment records.
Sun Wen Yuan treated the son of Wan Su An, who had been feverish for eleven days. The center of his tongue was dark like sandalwood, with severe thirst and dryness; his forehead and both hypochondriac regions were extremely hot, and he suffered from slight deafness. He had undergone purgation twice, yet the fever did not subside. His urine output was scant, he was comatose with cold feet, the pulse at the middle position of the left hand was rapid and forceful, while the right pulse was weak and soft. This is a concurrent syndrome of Shaoyang (Lesser Yang) and Yangming (Yang Brightness). Initially, Chaihu Tang (Bupleurum Decoction) was used to clear the heat, observing whether sweating occurred, and then adjusting the treatment accordingly. The prescription consisted of: Chai Hu (Bupleuri Radix) 5 qian, Ge Gen (Puerariae Lobatae Radix) 3 qian, Bai Shao (Paeoniae Radix Alba) and Shi Gao (Gypsum Fibrosum) each 2 qian, Ren Shen (Ginseng Radix), Sheng Ma (Cimicifugae Rhizoma), and Tian Hua Fen (Trichosanthis Radix) each 1 qian, and Fen Gan Cao (Glycyrrhizae Radix et Rhizoma Preparatum) 7 fen. After administration, the pulse slowed slightly, and the fever subsided somewhat, but the teeth remained dry, urination was difficult, and mental clarity was still impaired. Therefore, the formula was changed to include Chai Hu, Fen Gan Cao, Tian Hua Fen, Huang Qin (Scutellariae Radix), Ren Shen, Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Hua Shi (Talcum), Mu Tong (Akebiae Caulis), and Ze Xie (Alismatis Rhizoma). Urine was passed twice after taking this. In the afternoon, he felt slight fever and facial flushing, with pain and heaviness in the forehead. (Note by Li: This is due to the qi-stagnating nature of Bai Zhu.) Yi Yuan San (Quintessential Powder) 3 qian was administered, resulting in one bowel movement; the stool was loose and yellow, but the fever remained intense and the face red. Upon re-examination, the Cun (Inch) and Guan (Bar) positions of the pulse were harmonizing, while both Chi (Cubit) positions were surging and large. (Note by Li: This demonstrates the effect of Liu Yi San (Six-to-One Powder) in guiding heat downward.) It was determined that the heat resided in the Lower Jiao (Lower Burner), so treatment focused on promoting diuresis. Another 5 qian of Yi Yuan San was given. Thirst subsided slightly, the lower part of the teeth became moist, but the upper part remained dry; he was comatose, sleeping but unrousable. The heat was identified as affecting the Xin Bao Luo (Pericardium Collateral), so Dao Chi San (Guide Out Redness Powder) was administered. After two doses, mental clarity returned. However, urine volume remained low, so Si Ling San (Four-Mushroom Powder) combined with Jiu Lian (Wine-processed Coptidis Rhizoma) and Mu Tong was given. After two doses, all symptoms resolved.
The servant of Wu Xin Yi suffered from frontal headache, extreme thirst, high fever, profuse sweating, chest fullness, nausea, and lethargy. Sun prescribed Chai Ling Tang (Bupleurum and Poria Decoction) with Zhi Ke (Aurantii Fructus) and Jie Geng (Platycodonis Radix). The fever decreased by more than half. The next day, Liu Jun Zi Tang (Six Gentlemen Decoction) with Huang Qin and Bai Shao was used for regulation, leading to recovery. This was a Taiyang (Greater Yang) syndrome caused by fatigue and overexertion, thus requiring initial dispersal followed by tonification.
Zhou Jian Quan's wife suffered from Taiyang syndrome with fever, delirium, thirst, cough, chest and diaphragm pain, diarrhea, vomiting, generalized macules, and a surging, slippery pulse in all six positions. This is a combined syndrome of Shaoyang and Yangming. Sheng Ma Ge Gen Tang (Ephedra and Kudzu Root Decoction) with Hua Shi and Wu Wei Zi (Schisandrae Chinensis Fructus) was administered. After taking it, profuse sweating occurred, the fever subsided, and mental clarity returned. Subsequently, Chai Ling Tang with Wu Wei Zi and Hua Shi was given, stopping the diarrhea. On the next day, the left pulse was harmonious, and the right pulse had converged slightly. The prescription shifted to focus on Bai Shao, combined with Chen Pi (Citri Reticulatae Pericarpium), Chai Hu, Jiu Huang Qin (Wine-processed Scutellariae Radix), Wu Wei Zi, Mu Li (Ostreae Concha), Hua Shi, Fu Ling, Ze Xie, and Bai Zhu. After four doses, the patient stabilized.
Chen Mao Zhi, after fatigue, engaged in excessive sexual activity, leading to depletion of essence and blood, followed by exposure to wind-cold. Symptoms included fever, headache, and chest/diaphragm fullness. The pathogen initially transmitted from Taiyang to Shaoyang, presenting with chest and hypochondriac pain, deafness, vomiting, bitter taste, cough, and a wiry, rapid pulse in all six positions. This is a Shaoyang syndrome. Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Zhi Ke, Jie Geng, and Zhu Ru (Bambusae Caulis in Taenia) was used, stopping the vomiting. Because porridge was consumed too early, fever and thirst recurred, along with difficulty urinating. Bowel movements occurred six to seven times in a day and night, consisting entirely of clear water. Fever intensified in the late afternoon, with a yellow coating on the tongue, lethargy, and tremors. This indicates recurrence due to improper diet (Shi Fu). Zhu Ling (Polypori Umbilicati Sclerotium) and Ze Xie each 3 qian, Chi Fu Ling (Red Poria) 1 qian, Chai Hu 8 fen, Sheng Ma and Mu Tong each 5 fen were administered continuously for two doses. Urination improved, and stools formed. However, fever persisted. One dose of Liu Shen Tong San Jie San (Six-Way Unblocking Decoction) was given, but the fever remained unchanged. On the next day, the left pulse was no longer wiry and rapid, but both Cun pulses remained the same. There was no sweat after medication, thirst was present, and the patient wanted to rinse the mouth with water but did not wish to swallow. This indicates pathogenic heat transmitting to the Yangming channel. If blood-cooling is not performed urgently, epistaxis (Bi Ni) will occur. Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction) combined with Sheng Mai San (Generate the Pulse Powder) was used to stop cough and thirst, and Ge Gen Tang (Kudzu Root Decoction) was used to release the muscle layer. The prescription included: Bai Shao 3 qian, Ge Gen, Sheng Ma, and Huang Qin each 1 qian, Ren Shen 1.5 qian, Mai Dong (Ophiopogonis Radix) and Hua Shi each 3 qian, Gan Cao (Glycyrrhizae Radix et Rhizoma) and Wu Wei Zi each 5 fen, and W Mei (Mume Fructus) one piece. After two doses, several hard fecal pellets were passed, slight sweating occurred, sound sleep was achieved, and recovery followed after consuming porridge.
Lady Pang suffered from headache, aversion to cold, chest and diaphragm oppression and pain, and alternating chills and fever. She was treated with Si Wu Tang (Four Substances Decoction) plus Yan Hu Suo (Corydalis Rhizoma), Dan Pi (Moutan Cortex), and Xiang Fu (Cyperi Rhizoma) for five days without improvement. Sun examined her pulse: the right side was slippery and large, the left side was floating, wiry, and rapid. He stated: Headache and aversion to cold are external contraction symptoms; floating, wiry, and rapid pulse with chest oppression and pain indicate complete Shaoyang pulse and symptom presentation; the slippery right pulse indicates food stagnation generating phlegm. Si Wu Tang consists of herbs that stagnate phlegm and close qi; while suitable for internal injury, they cannot expel external pathogens. Therefore, Chai Hu Tang combined with Ping Wei San (Peaceful Stomach Powder) was administered, resulting in cure after one dose.
An old servant suffered from headache, generalized joint pain, dark complexion, fever, thirst, chest distension, and inability to eat for seven days. He contracted cold again. The left pulse was wiry and rapid, the right pulse was surging and large. He was given Huo Xiang (Agastaches Herba), Cang Zhu (Atractylodis Rhizoma), Fang Feng (Saposhnikoviae Radix), Ge Gen, Bai Zhi (Angelicae Dahuricae Radix), Zi Su (Perillae Folium), Gan Cao, Chen Pi, Da Fu Pi (Arecae Pericarpium), Mai Ya (Hordei Fructus Germinatus), and Zhi Shi (Aurantii Fructus Immaturus). After administration, the chest felt slightly relieved, but fever and pain worsened. The prescription was changed to Ma Huang (Ephedrae Herba), Ge Gen, and Chai Hu each 2 qian, Shi Gao and Hua Shi each 3 qian, Zi Su, Cang Zhu, and Bai Zhi each 1 qian, Gan Cao 5 fen, and three slices of Jiang (Zingiberis Rhizoma Recens). After taking it, profuse sweating occurred, and fever and pain disappeared. Only thirst remained. He was then treated with Bai Shao, Dang Gui (Angelicae Sinensis Radix), Shi Gao, Zhi Mu (Anemarrhenae Rhizoma), Chai Hu, Huang Qin, Mai Dong, Ge Gen, and Chen Pi, leading to recovery. This was a combined syndrome of the Three Yang channels, initially injured by diet. Thus, Huo Xiang Zheng Qi Tang (Agastache Regulating Qi Decoction) with digestive aids was used to assist the interior, and Liu Shen Tong San Jie San with exterior-releasing herbs was used to treat the exterior manifestation. Although the disease was severe and the patient elderly, the harmony between complexion and pulse ensured an easy recovery.
Cai Zhong Lin's wife suffered from fever, thirst, dry and cracked tongue, lower abdominal pain, and vomiting, unable to take medicine or food for seven days. The right Cun pulse was absent, the Guan pulse was deep, slippery, and forceful, and the left hand pulse was wiry and rapid. This is a combined syndrome of Yangming and Shaoyang, with pathogenic heat congested in the Upper Jiao (Upper Burner). Soft Chai Hu and Shi Gao each 5 qian, Ban Xia Qu (Pinelliae Fermentatum), Huang Qin, Huang Lian (Coptidis Rhizoma), Ge Gen, Zhu Ru, and Ren Shen each 2 qian, with three slices of Jiang were administered. At dawn, several pieces of black stool were passed, and pain and fever reduced by half. The next day, the same prescription was continued, and the right Cun pulse recovered. The formula was changed to Xiao Chai Hu Tang with Ju Hong (Citri Reticulatae Pericarpium Rubrum), Zhu Ru, and Ge Gen. After three doses, full health was restored.