湿温1(肠伤寒)
邢某某，男，21岁
初诊
身热8日未退，头晕胸闷，腰际酸楚乏力，大便粘腻不爽，因导而下，临圊腹痛，脘痞，嗳噫不舒小溲色黄不畅。舌白苔腻，脉象沉缓而濡，暑热湿滞互阻不化，湿温已成。先用芳香宣化、苦甘泄热方法。
鲜佩兰10克，鲜藿香10克，大豆卷10克，炒山栀10克，苦杏仁10克，法半夏10克，陈皮6克，姜竹茹6克，白蔻仁2
克(研冲)，二付
二诊
药后身热渐退，头晕胸闷渐减，腰酸已减而未除，腹痛未作，大便如常，时有嗳噫，舌仍白腻，脉来沉濡。汗泄己至胸腹，此湿温邪有渐化之机，病已十日，得此转机，势将热减湿化，仍拟芳化湿郁，兼调气机，饮食当慎。
藿苏梗各6克，佩兰叶10克，淡豆豉10克，炒山栀6克，前胡6克，苦杏仁10克，半夏曲10克，新会皮6克，焦麦芽10克，鸡内金10克，二付
三诊
身热渐退。昨日食荤之后，今晨热势转增，大便二日未近，小溲色黄。舌苔根厚黄腻，脉象两关独滑。此湿温虽有转机，却困食复增重，当防其逆转为要。再以栀子豉汤增损。
淡豆豉10克，炒山栀6克，前胡6克，苦杏仁10克，枇杷叶10克，保和丸15克(布包入煎)，焦麦芽10克，炒莱菔子10克，枳壳10克，白蔻仁2克(研冲)，二付
四诊
药后大便畅通，身热略减，体温仍高，38.5℃，舌苔渐化，根部仍厚，脉象两关滑势已退，自觉胸中满闷大轻小溲渐畅。湿温有渐解之机，积滞化而未楚，仍须清化湿热积滞，少佐清宣，希图21日热退为吉。饮食寒暖，诸宜小心。
淡豆豉10克，炒山栀6克，杏仁10克，前胡6克，厚朴6克，新会皮6克，白蔻仁3克，炒苡米10克，方通草2克，焦三仙各10克，二付
五诊
身热已退净，皮肤微似汗出，津津濡润，已遍及两足，两手脉象沉滑力弱，舌苔已化净，二便如常。湿温重症，三周热退，是为上吉，定要节饮食，慎起居，防其再变。
白蒺藜10克，粉月皮10克，香青蒿5克，大豆卷10克，炒山栀5克，制厚朴6克，川黄连3克，竹茹6克，炙杷叶10克，保和丸15克(布包)，半夏曲10克，鸡内金6克，三付
药后身热未作，食眠二便如常，停药慎食，调养两周而愈
[按]：湿温病湿与热合，如油入面，难解难分。故其病程较长，发热持续难退。治当芳香宣化，宣展气机，分消湿热之邪，使气机畅，三焦通，内外上下宣通，乃得周身汗出而解。且汗出必得周匝于身，从头至足，遍体微汗，是气机宣畅，腠理疏通之征，如此则热必应时而退。按七日为一候，热退必在满候时日，如二候14日、三候21日、四候28日等。此等规律皆从实践中来。此案初诊后已有转机。本当14日退热，因患者不慎口味，致食复热增，遂用仲景治食复法，于宣化方中，合入栀子豉汤为治，并增入消导积滞保和丸、莱菔子、焦麦芽等，食滞一去，则湿热之邪无所依附矣澈凡湿温之病(不独湿温)极当慎饮食、节口味，肥甘助湿，辛辣增热，皆当忌之。否则，虽用药精良，亦不能效也。
湿温2(肠伤寒)
牛某某，男，20岁
初诊
患者于9月15日开始发烧，已五日未退，体温逐渐上升至39℃，脉搏76次／分，白细胞5400／mm3，营养发育中等，意识尚清，表情呆滞，反应迟顿，食欲减退，胸前见大小不等的3～4个玫瑰色红疹，压之退色，咽充血，扁桃体Ⅱ°肿大，余无异常改变。诊断：肠伤寒。于9月22日请中医会诊：
发热，头晕，微汗，腰部酸痛，前胸布红疹5～6粒，其中一粒呈泡疹，白（疒咅）透露于颈下及胸部，数量不多，状如水晶，脉濡缓，舌苔薄腻。湿热郁蒸气分，治以清化湿热，清气透痞法加减。
杏苡仁各10克，淡竹叶4.5克，连翘10克，大豆卷12克，六一散10克(包)，通草3克，云茯苓6克，荷叶一角，芦根12克，佩兰叶6克，西秦艽6克，二付
复诊：药后体温已趋正常，诸症均除，惟白（疒咅）继续外布，精神较好，舌苔前半腻已退，湿化热清，上方获救，当以原方进退。
生苡仁10克，淡竹叶4.5克，光杏仁10克，藿佩兰各10克，滑石10克(包)，通草3克，豆卷12克，荷叶一角，云茯苓10克，神血10克，三付后痊愈出院。
[接]：白（疒咅）多见于湿热证，外发于颈胸皮肤之上，呈白色小颗粒，晶莹剔透，内含水液。是湿热证特有的征候，故见白（疒咅）外发，其必为湿热证。其病机为湿热之邪郁蒸气分。其自痦发出，则邪气有外泄之机。若颗粒饱满，如水晶色，是正气尚足，气液未伤，诚佳兆也；若形瘪色枯，是气液大伤为逆。治当困势利导，用清气化湿方法，常胃薏苡竹叶散加减，本案即是一例。
湿温3(肠伤寒)
华某某，男，30岁
初诊
身热6～7日，体温39℃，头晕目沉，面色淡白，胸中满闷不舒，周身酸楚乏力，大便略溏，小溲短黄，腰际酸沉，夜寐不安。经某中医治疗，先服银翘解毒丸，后又服汤剂，甘寒清气热，姒生地、元参、知母、沙参等为主。药后大便溏泄，身热加重，周身乏力，舌白滑润，根部厚腻，两脉沉濡，按之无力，近似迟缓孙溲短少，口淡无味。病属素体中阳不足，脾胃运化欠佳，外受暑湿之邪，留连不去，误服甘寒之品，湿邪增重+气机受阻，三焦不利。湿重于热，故面色淡白，唇口不华，脉象亦为寒湿遏阻中阳之象，拟以芳香宣化，疏调气机，以畅胸阳。俟湿化阳复，气机宣畅，则三焦通利，病自渐愈。忌食甜、粘及有渣滓食物。
淡豆豉12克，炒山栀3克，藿香叶10克(后下)，陈香薷1 5克(后下)，焦苍术4 5克，厚朴4.5克，白蔻仁3克，杏仁泥10克，川连2克，半夏10克，陈皮4.5克，鲜煨姜3克，冬瓜皮20克，二付
二诊
药后身热渐退，体温38.5℃，头晕沉重渐解，胸闽渐轻，胸部头额略见小汗，大便仍溏，小溲赤短，腰痛，周身酸楚乏力，苔白滑腻，根部略厚，两脉弦滑力弱，按之濡缓。此为暑热湿邪互阻不化，且过服甘寒，脾阳受遏，三焦不通，气机不畅，再以芳香宣化，通阳祛湿。
淡豆豉12克，炒山栀3克，藿香叶10克(后下)，香白芷6克(后下)，白蔻仁4.5克，杏仁10克，半夏12克，厚朴6克，炒薏米12克，焦苍术4.5克，川连2克，煨姜3克，茯苓皮12克，二付
三诊
叠服芳化通阳祛湿之剂，自觉遍体潮润，已下至两腿，胸中满闷大减，气分亦畅，头部沉重渐解，小溲通畅色深，体温37.8℃，大便今日已渐成形，腰痛，周身酸楚乏力，舌苔白腻略厚，脉象已转濡滑，较前有神。暑湿互阻不化，连服芳香宣解，湿邪渐减，热象亦轻，再以宣化上、中二焦，希图三周热退为吉。
白蒺藜10克，香豆豉12克，嫩前胡3克，香青蒿4 5克，制厚朴4.5克，焦苍术6克，焦薏米10克，制半夏10克，白蔻仁3克，煨姜2克，杏仁泥10克，白米30克炒焦煎汤代水，二付
四诊
身热已退净，体温36.6℃，头部尚觉徽痛，大便通畅，咳嗽痰多，口淡无味，舌苔白腻，两脉和缓有神，湿温三周而解，遍体潮润，唯胃纳欠佳，脘闷仍不思食。再“辛泄余邪，调和阳明。病虽向愈而正气未复，由虚涉怯，意中事也，饮食寒暖，备宜小心。
白蒺藜10克，香青蒿4.5克，粉丹皮4.5克，厚朴花4.5克，川连2克，川贝母10克，杏仁10克，香砂枳术丸15克(布包)，范志曲12克(布包)，香稻芽10克，新会皮3克，白米30克炒焦煎汤代水，三付
三付之后，诸恙皆安，停药后一周而饮食二便皆正常，遂渐康复。
[按]；湿温乃感受湿热之邪，胶固难解，缠绵难愈。因其高热不退，医者往往执寒药以疗之，每致误事。此案前医不知湿温初起当芳香宣化透邪外出，反用寒凉之剂，湿邪遇寒则凝，阻塞气机，三焦不利，邪无从出，其身热更甚，恐将昏蒙矣。故初诊即重用芳香宣化，疏调气机，其方用藿香，不用佩兰，以佩兰性寒不利于湿重故也，炒山栀，川黄连等清热之药用量极轻，其余诸药皆为芳香化湿宣展气机之用。俟三焦畅、气机行则邪可透出矣。药后微汗出从头至颈胸，乃邪透之标志。此后数诊，皆宗此法进退，终至汗出至下肢，乃断其三周退热，果不其然。先生常日；治湿温症必得教汗遍及周身，至双脚趾缝中亦似潮润，斯为邪透尽之征。若误用寒凉滋腻，则湿邪愈盛，邪不得出矣。湿温虽禁发汗，然必得汗出，乃得邪解。
湿温4(肠伤寒)
王某某，男，15岁
初诊
据其家属述病情：患者4月5日开始发烧，头晕，恶心呕吐，胸中满闷不适，曾服银翘解毒丸8丸，其热退， 4月8日经本街某医诊为春温，即服清解方剂，药如银花、连翘、桑叶、菊花、元参、沙参、芦根、石膏，二剂后病势加重，胸闷如痞，夜不能寐，饮食不进，且已卧床不起，小便黄步，大便略稀。又请某医往诊，时4月11日。某医谓：此乃温病日久深重，方用元参，知母，石膏，生地，地骨皮，青蒿等，并加安宫牛黄丸，服二付。4月14日因病势日重，身热不退，神志不清，7、8日未能进食，胸中满闷异常，大便稀，4月15日，医谓病势沉重，原方改安宫牛黄为紫雪丹五分继服二付，病愈危重。
4月17日上午，邀赵师往诊。时体温39℃，高烧不退，神志不清，面危苍白，胸中自痦已渐退，周身干热，大便溏稀，两脉沉濡略数，舌白腻而滑，舌质边尖红绛。此湿温之证，过服滋腻寒凉，乃湿阻不化，遂成冰伏之势，逼热邪入营。非通阳温中并宣化疏解之法不能开闭通窍冷已十二日，用辛温开闭以畅气机，芳香宣解而通神明，病势甚重，诸宜小心，饮食当慎，防其增重。
香豆豉12克，炒山栀3克，前胡3克，藿香叶10克(后下)，菖蒲10克，郁金6克，厚朴3克，半夏10克，杏仁10克，白蔻仁末1克，淡干姜末1克，后二味同研装胶管，分两次随药送下。服二付。
二诊
连服辛开温化宣阳疏调之剂，身热已退，体温37 2℃，遍体小汗，下至两足，面色红润，神志已清，语言清楚，舌苔渐化，胸中自痞基本消失，小溲较畅，大便未通，两脉中取滑濡，冰伏渐解，寒湿得温渐化，气机宣通，仍疏辛宣疏化方法：
香豆豉10克，炒山栀3克，杏仁10克，前胡3克，藿梗10克，厚朴10克，半夏10克，草蔻3克，服三付。
三诊
病情逐渐好转，病人已下地活动，饮食二便如常，舌白滑润，脉濡滑，宜调理中焦，以善其后。
香豆豉10克，旋复花10克，生自术5克，陈皮6克，白扁豆10克，生苡米10克，茯苓10克，焦麦芽10克，三付之后诸恙皆愈，调养半月而安。
原按：湿温宜宣气化湿。最忌滋腻，滋腻之品腻滞气机，且助于湿，反使病胶着难解。湿为阴邪，非温不化。虽湿热为患，治宣分清湿之与热，孰多孰少，当用苦寒也要恰如其分。若误用苦寒，克伐阳气，不仅湿不能去，反致冰伏，气机闭塞，邪无出路，被逼八营，必成昏厥之变。其治法全在开冰伏之郁闭。脾胃位居中焦，为气机升降之枢纽，寒凉入胃，冰伏于中，中焦不通，气机不行。开之必以辛热僳烈之品，如干姜、草蔻。宜“半夏、厚朴辛开苦降，燥湿行滞宣畅中焦，前胡、杏仁宣降肺气，“开上焦，菖蒲、郁金涤痰开窍，又加栀子豉汤，以豆豉宣郁热而展气机，山栀畅三焦而泄火。诸药配合使冰伏解而寒湿化，湿郁开且三焦畅，邪有去路，故入营之热则外透而解。
本证固过用寒凉遏伤阳气，湿热为寒凉冰伏于内，邪无退呼，被逼入营，阴伤不甚，关键在于解冰伏开郁闭宣气机以透热。若营阴被伤，热已透转，仍当兼顾营分。
[按]：此为湿温误治案。患者4月发病，前医据时令以为春温，而选用寒凉滋腻，湿邪得冷而凝，遂成冰伏之势。此时治法，非辛热不足以开闭结，故有草蔻(白蔻)、干姜之用}非芳香不足以畅其气机，醒其神明。药后遗体小汗，面转红润，是冰伏之势已解，而余邪未尽，故续用前法。终以调理脾胃而安。
Damp-Heat Warmth 1 (Typhoid Fever)
Patient Xing, Male, 21 years old
First Visit
Fever has persisted for 8 days without subsiding, accompanied by dizziness, chest tightness and oppression, soreness and weakness in the waist region, sticky and unsmooth bowel movements. Bowel movement was induced, causing abdominal pain during defecation, epigastric fullness and stuffiness, uncomfortable belching, yellow and difficult urination. The tongue coating is white and greasy; the pulse is deep, slow, and soggy. Summerheat-heat and damp-stagnation are mutually obstructing and failing to transform, indicating the formation of Damp-Heat Warmth. Initially, use aromatic diffusing and resolving, along with bitter-sweet clearing heat methods.
Fresh Peilan (Eupatorium fortunei Herb) 10g, Fresh Huoxiang (Patchouli Herb) 10g, Da Dou Juan (Soybean Sprout) 10g, Chao Shanzhi (Stir-fried Gardenia Fruit) 10g, Ku Xingren (Bitter Apricot Kernel) 10g, Fa Banxia (Prepared Pinellia Tuber) 10g, Chenpi (Tangerine Peel) 6g, Jiang Zhuru (Ginger-processed Bamboo Shavings) 6g, Bai Kou Ren (White Cardamom Seed) 2g (crushed and taken with decoction), 2 doses.
Second Visit
After taking the medicine, body heat gradually receded, dizziness and chest oppression gradually decreased, lower back soreness reduced but not eliminated, abdominal pain did not recur, bowel movements returned to normal, occasional belching occurs, tongue coating remains white and greasy, pulse is deep and soggy. Sweating has reached the chest and abdomen, indicating a gradual transformation of the Damp-Heat pathogen. The disease has lasted ten days; with this turning point, heat will decrease and dampness will resolve. Continue with aromatic resolution of damp stagnation and regulation of Qi mechanism. Diet should be cautious.
Huoxiang Geng (Patchouli Stem) and Suzhu Geng (Perilla Stem) 6g each, Peilan Ye (Eupatorium Leaf) 10g, Dan Dou Chi (Fermented Soybean) 10g, Chao Shanzhi (Stir-fried Gardenia Fruit) 6g, Qianhu (Peucedanum Root) 6g, Ku Xingren (Bitter Apricot Kernel) 10g, Banxia Qu (Pinellia Fermented Curd) 10g, Xin Hui Pi (Xinhui Tangerine Peel) 6g, Jiao Mai Ya (Scorched Malt) 10g, Ji Nei Jin (Chicken Gizzard Lining) 10g, 2 doses.
Third Visit
Body heat gradually receded. After eating meat yesterday, the fever intensified this morning. No bowel movement for two days, urine is yellow. Tongue coating at the root is thick, yellow, and greasy; the pulse at both Guan positions is distinctly slippery. Although there was a turning point in Damp-Heat Warmth, it has worsened due to food recurrence. Prevention of adverse transformation is crucial. Use Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) with modifications.
Dan Dou Chi (Fermented Soybean) 10g, Chao Shanzhi (Stir-fried Gardenia Fruit) 6g, Qianhu (Peucedanum Root) 6g, Ku Xingren (Bitter Apricot Kernel) 10g, Pi Pa Ye (Loquat Leaf) 10g, Bao He Wan (Preserve Harmony Pill) 15g (wrapped in cloth and decocted), Jiao Mai Ya (Scorched Malt) 10g, Chao Lai Fu Zi (Stir-fried Radish Seed) 10g, Zhi Ke (Aurantium Fruit) 10g, Bai Kou Ren (White Cardamom Seed) 2g (crushed and taken with decoction), 2 doses.
Fourth Visit
After medication, bowel movements are smooth, body heat slightly reduced, temperature still high at 38.5°C. Tongue coating is gradually resolving, but the root remains thick. The slippery tendency at both Guan pulses has subsided. Self-perceived chest fullness is greatly relieved, urination is smoother. There is a sign of gradual resolution of Damp-Heat Warmth. Accumulation and stagnation have transformed but are not fully cleared. Continue to clear and transform damp-heat accumulation, with slight addition of clearing and diffusing. Hope for fever resolution by day 21 as an auspicious sign. Be careful with diet and warmth/cold exposure.
Dan Dou Chi (Fermented Soybean) 10g, Chao Shanzhi (Stir-fried Gardenia Fruit) 6g, Xingren (Apricot Kernel) 10g, Qianhu (Peucedanum Root) 6g, Houpo (Magnolia Bark) 6g, Xin Hui Pi (Xinhui Tangerine Peel) 6g, Bai Kou Ren (White Cardamom Seed) 3g, Chao Yi Mi (Stir-fried Coix Seed) 10g, Fang Tong Cao (Stephania Tetrandra Stem) 2g, Jiao San Xian (Scorched Three Immortals: Malt, Hawthorn, Medicated Leaven) 10g each, 2 doses.
Fifth Visit
Body heat has completely subsided. Skin shows slight sweating, moist and refreshing, extending to both feet. Pulse at both hands is deep, slippery, and weak. Tongue coating has completely resolved. Bowel and urinary functions are normal. In severe Damp-Heat Warmth, fever resolution after three weeks is highly auspicious. Strictly regulate diet and daily routine to prevent recurrence.
Bai Ji Li (Tribulus Fruit) 10g, Fen Mu Dan Pi (Powdered Tree Peony Root Bark) 10g, Xiang Qing Hao (Artemisia Annua Herb) 5g, Da Dou Juan (Soybean Sprout) 10g, Chao Shanzhi (Stir-fried Gardenia Fruit) 5g, Zhi Houpo (Processed Magnolia Bark) 6g, Chuan Lian (Coptis Rhizome) 3g, Zhu Ru (Bamboo Shavings) 6g, Zhi Ba Ye (Roasted Loquat Leaf) 10g, Bao He Wan (Preserve Harmony Pill) 15g (wrapped in cloth), Banxia Qu (Pinellia Fermented Curd) 10g, Ji Nei Jin (Chicken Gizzard Lining) 6g, 3 doses.
After medication, no fever recurrence, appetite, sleep, and excretions are normal. Stop medication and observe dietary restrictions. Recovered after two weeks of recuperation.
[Commentary]: Damp-Heat Warmth involves the combination of dampness and heat, like oil mixed into flour, making them difficult to separate. Thus, the course is long, and fever persists. Treatment requires aromatic diffusing and resolving to spread the Qi mechanism, dividing and eliminating damp-heat pathogens. When the Qi mechanism flows freely and the Triple Burner is open, allowing internal and external circulation, sweat from the whole body indicates resolution. Sweating must cover the entire body, from head to foot, with slight perspiration throughout, signaling free Qi flow and unobstructed pores; thus, heat will subside timely. According to the seven-day cycle, fever resolution should occur within complete cycles, such as 14 days (two cycles), 21 days (three cycles), or 28 days (four cycles). These patterns derive from practice. This case showed a turning point after the first visit. Fever should have resolved in 14 days, but careless diet caused food recurrence and increased heat. Therefore, Zhang Zhongjing’s method for food recurrence was used, combining Zhi Zi Chi Tang with the diffusing formula, adding Bao He Wan, Lai Fu Zi, and Jiao Mai Ya to guide out stagnation. Once food stagnation is removed, damp-heat pathogens lose their attachment. For all Damp-Heat diseases (not just Damp-Heat Warmth), diet and taste must be strictly regulated. Rich, sweet foods promote dampness; spicy foods increase heat; these must be avoided. Otherwise, even excellent medication will fail.
Damp-Heat Warmth 2 (Typhoid Fever)
Patient Niu, Male, 20 years old
First Visit
The patient began fever on September 15, persisting for five days. Temperature gradually rose to 39°C, pulse 76 beats/min, WBC 5400/mm³. Nutrition and development are average. Consciousness is clear, expression is dull, reaction is slow, appetite is decreased. On the chest, 3-4 rose-colored macules of varying sizes appear, blanching upon pressure. Pharynx is congested, tonsils are Grade II enlarged, no other abnormalities. Diagnosis: Typhoid Fever. TCM consultation requested on September 22:
Fever, dizziness, slight sweating, soreness and pain in the waist, 5-6 red macules on the anterior chest, one appearing as a vesicle. Bai Bei (white miliary rash) appears below the neck and on the chest, few in number, resembling crystal, pulse is soggy and slow, tongue coating is thin and greasy. Damp-heat stagnates and steams the Qi Level. Treatment: Clear and transform damp-heat, clear Qi and penetrate Bai Bei with modifications.
Xing Yi Ren (Apricot and Coix Seeds) 10g each, Dan Zhu Ye (Lophatherum Herb) 4.5g, Lian Qiao (Forsythia Fruit) 10g, Da Dou Juan (Soybean Sprout) 12g, Liu Yi San (Six-to-One Powder) 10g (wrapped), Tong Cao (Tetrapanax Pith) 3g, Yun Fu Ling (Poria Cocos) 6g, He Ye (Lotus Leaf) one corner, Lu Gen (Reed Rhizome) 12g, Peilan Ye (Eupatorium Leaf) 6g, Xi Qin Jiao (Qin Jiao) 6g, 2 doses.
Follow-up: After medication, temperature normalized, all symptoms excepted, Bai Bei continues to erupt externally. Spirit is better. Tongue coating at the front half has resolved. Dampness transforms, heat clears. The previous prescription was effective; continue with original formula adjustments.
Sheng Yi Ren (Raw Coix Seed) 10g, Dan Zhu Ye (Lophatherum Herb) 4.5g, Guang Xing Ren (Bitter Apricot Kernel) 10g, Huo Peilan (Patchouli and Eupatorium) 10g each, Hua Shi (Talcum) 10g (wrapped), Tong Cao (Tetrapanax Pith) 3g, Dou Juan (Soybean Sprout) 12g, He Ye (Lotus Leaf) one corner, Yun Fu Ling (Poria Cocos) 10g, Shen Qu (Medicated Leaven) 10g, 3 doses. Recovered and discharged.
[Commentary]: Bai Bei (white miliary rash) is common in damp-heat syndromes, erupting on the skin of the neck and chest as small, translucent white granules containing fluid. It is a specific sign of damp-heat syndrome. Its appearance confirms damp-heat pathology. The pathogenesis is damp-heat stagnating and steaming the Qi Level. Eruption indicates the pathogen has an outlet for release. If granules are plump and crystal-clear, it signifies sufficient healthy Qi and undamaged Qi/fluids, a good omen. If shriveled and dry, it indicates severe damage to Qi and fluids, an adverse sign. Treatment should follow the trend, using methods to clear Qi and transform dampness, often modifying Yi Yi Zhu Ye San (Coix and Lophatherum Decoction). This case is an example.
Damp-Heat Warmth 3 (Typhoid Fever)
Patient Hua, Male, 30 years old
First Visit
Fever for 6-7 days, temperature 39°C, dizziness and heavy eyes, pale complexion, chest fullness and oppression, body soreness and weakness, loose stools, short yellow urine, sore and heavy waist, restless sleep. Treated by another TCM practitioner: initially took Yin Qiao Jie Du Wan (Honeysuckle and Forsythia Detoxification Pills), then herbal decoctions focusing on sweet-cold clearing Qi heat, mainly Sheng Di Huang (Rehmannia Root), Yuan Shen (Scrophularia Root), Zhi Mu (Anemarrhena Rhizome), Sha Shen (Glehnia Root). After medication, loose diarrhea occurred, fever worsened, body weakness increased. Tongue is white, slippery, root thick and greasy. Pulses are deep, soggy, weak upon pressure, approximating slow. Urine is short, mouth tastes bland. The disease belongs to inherent deficiency of Middle Jiao Yang and poor Spleen-Stomach transportation. External summerheat-dampness lingers. Mistaken use of sweet-cold substances increased dampness, obstructed Qi mechanism, and hindered the Triple Burner. Dampness outweighs heat, hence pale face, lackluster lips/mouth, and pulse reflecting cold-damp suppressing Middle Yang. Plan: Aromatic diffusing and resolving, regulating Qi mechanism to unblock Chest Yang. Wait for dampness to transform and Yang to recover; once Qi flows freely, Triple Burner opens, and disease heals. Avoid sweet, sticky, and fibrous foods.
Dan Dou Chi (Fermented Soybean) 12g, Chao Shanzhi (Stir-fried Gardenia Fruit) 3g, Huo Xiang Ye (Patchouli Leaf) 10g (added later), Chen Xiang Ru (Old Mosla Herb) 15g (added later), Jiao Cang Zhu (Scorched Atractylodes Rhizome) 4.5g, Houpo (Magnolia Bark) 4.5g, Bai Kou Ren (White Cardamom Seed) 3g, Xing Ren Ni (Apricot Kernel Paste) 10g, Chuan Lian (Coptis Rhizome) 2g, Ban Xia (Pinellia Tuber) 10g, Chen Pi (Tangerine Peel) 4.5g, Xian Wei Jiang (Fresh Roasted Ginger) 3g, Dong Gua Pi (Winter Melon Peel) 20g, 2 doses.
Second Visit
Fever gradually receded, temperature 38.5°C. Heavy dizziness resolved, chest oppression lightened. Slight sweating on chest, head, and forehead. Stools still loose, urine red and short, lower back pain, body soreness/weakness. Tongue coating white, slippery, greasy, root slightly thick. Pulses stringy-slippery, weak, soggy-slow upon pressure. Summerheat-heat and dampness mutually obstruct. Overuse of sweet-cold suppressed Spleen Yang, blocking Triple Burner and Qi mechanism. Continue aromatic diffusing and resolving, unblocking Yang and dispelling dampness.
Dan Dou Chi (Fermented Soybean) 12g, Chao Shanzhi (Stir-fried Gardenia Fruit) 3g, Huo Xiang Ye (Patchouli Leaf) 10g (added later), Xiang Bai Zhi (Angelica Dahurica) 6g (added later), Bai Kou Ren (White Cardamom Seed) 4.5g, Xing Ren (Apricot Kernel) 10g, Ban Xia (Pinellia Tuber) 12g, Houpo (Magnolia Bark) 6g, Chao Yi Mi (Stir-fried Coix Seed) 12g, Jiao Cang Zhu (Scorched Atractylodes Rhizome) 4.5g, Chuan Lian (Coptis Rhizome) 2g, Wei Jiang (Roasted Ginger) 3g, Fu Ling Pi (Poria Cortex) 12g, 2 doses.
Third Visit
Repeated doses of aromatic diffusing, unblocking Yang, and dispelling dampness. Patient feels moist throughout body, down to legs. Chest fullness greatly reduced, Qi mechanism free. Head heaviness resolving. Urination smooth, dark color. Temperature 37.8°C. Stools forming. Lower back pain, body soreness/weakness remain. Tongue coating white, greasy, slightly thick. Pulse turned soggy-slippery, more spirited than before. Summerheat-damp obstruction persists. Continuous aromatic diffusing reduces dampness and heat signs. Continue diffusing Upper and Middle Jiao. Hope for fever resolution in three weeks as auspicious.
Bai Ji Li (Tribulus Fruit) 10g, Xiang Dou Chi (Fragrant Fermented Soybean) 12g, Nen Qian Hu (Young Peucedanum Root) 3g, Xiang Qing Hao (Artemisia Annua Herb) 4.5g, Zhi Houpo (Processed Magnolia Bark) 4.5g, Jiao Cang Zhu (Scorched Atractylodes Rhizome) 6g, Jiao Yi Mi (Scorched Coix Seed) 10g, Zhi Ban Xia (Processed Pinellia Tuber) 10g, Bai Kou Ren (White Cardamom Seed) 3g, Wei Jiang (Roasted Ginger) 2g, Xing Ren Ni (Apricot Kernel Paste) 10g, Bai Mi (Rice) 30g (scorched and decocted for water substitute), 2 doses.
Fourth Visit
Fever completely resolved, temperature 36.6°C. Mild headache remains. Bowels smooth. Cough with profuse sputum, bland taste. Tongue coating white, greasy. Pulses harmonious and spirited. Damp-Heat Warmth resolved in three weeks. Body moist. Poor appetite, epigastric oppression, no desire to eat. Reiterate "Pungent release of residual pathogens, harmonize Yangming." Disease healing but Healthy Qi not restored; deficiency leading to timidity is expected. Careful with diet and warmth/cold.
Bai Ji Li (Tribulus Fruit) 10g, Xiang Qing Hao (Artemisia Annua Herb) 4.5g, Fen Dan Pi (Powdered Tree Peony Root Bark) 4.5g, Hou Po Hua (Magnolia Flower) 4.5g, Chuan Lian (Coptis Rhizome) 2g, Chuan Bei Mu (Fritillaria Bulb) 10g, Xing Ren (Apricot Kernel) 10g, Xiang Sha Zhi Zhu Wan (Fragrant Amomum and Atractylodes Pill) 15g (wrapped), Fan Zhi Qu (Fan Medicated Leaven) 12g (wrapped), Xiang Dao Ya (Fragrant Rice Sprout) 10g, Xin Hui Pi (Xinhui Tangerine Peel) 3g, Bai Mi (Rice) 30g (scorched and decocted for water substitute), 3 doses.
After three doses, all ailments settled. One week after stopping medication, diet and excretions normalized. Gradual recovery.
[Commentary]: Damp-Heat Warmth involves sticky, hard-to-resolve damp-heat pathogens, lingering and difficult to cure. Due to persistent high fever, doctors often use cold medicines, leading to errors. In this case, the previous doctor did not know that early Damp-Heat Warmth requires aromatic diffusing to expel pathogens outward. Instead, cold agents were used. Dampness congeals when meeting cold, blocking Qi mechanism and Triple Burner, leaving pathogens无处 to exit, worsening fever, risking coma. First visit heavily used aromatic diffusing to regulate Qi. Huo Xiang was used instead of Peilan because Peilan is cold and unsuitable for heavy dampness. Heat-clearing drugs like Chao Shanzhi and Chuan Lian were used in very small doses; others were for aromatic damp-transforming and Qi spreading. Once Triple Burner is free and Qi moves, pathogens can emerge. Slight sweating from head to neck/chest after medication marks pathogen emergence. Subsequent visits followed this method, eventually reaching sweating down to lower limbs, predicting fever resolution in three weeks, which proved true. Mr. Zhao often said: Treating Damp-Heat Warmth requires sweating covering the whole body, even moistening between toes, marking complete pathogen expulsion. Mistaken use of cold/damp-nourishing agents increases dampness and blocks pathogen exit. Although Damp-Heat Warmth prohibits inducing sweat, sweat must occur for pathogen resolution.
Damp-Heat Warmth 4 (Typhoid Fever)
Patient Wang, Male, 15 years old
First Visit
Family history: Fever started April 5, with dizziness, nausea, vomiting, chest fullness/oppression. Took 8 pills of Yin Qiao Jie Du Wan, fever subsided. April 8, local doctor diagnosed Spring-Warmth, prescribed clearing/resolving formulas: Yin Hua (Honeysuckle), Lian Qiao (Forsythia), Sang Ye (Mulberry Leaf), Ju Hua (Chrysanthemum), Yuan Shen (Scrophularia Root), Sha Shen (Glehnia Root), Lu Gen (Reed Rhizome), Shi Gao (Gypsum). After two doses, condition worsened: chest oppression like痞 (glomus), insomnia, inability to eat, bedridden. Urine yellow, stools slightly loose. Another doctor consulted on April 11. Doctor stated: Warm disease prolonged and severe. Formula: Yuan Shen, Zhi Mu, Shi Gao, Sheng Di, Di Gu Pi, Qing Hao, plus An Gong Niu Huang Wan (Calculus Bovis and Realgar Pill). Two doses. April 14: Condition worsened daily, fever persisted, consciousness unclear, unable to eat for 7-8 days, extreme chest fullness, loose stools. April 15: Doctor stated critical condition, changed An Gong Niu Huang Wan to Zi Xue Dan (Purple Snow Pellet) 0.5 fen, continued two doses. Condition critically dangerous.
April 17 morning, invited Master Zhao. Temperature 39°C, persistent high fever, unconscious, face dangerously pale. Chest Bai Bei (rash) gradually receded. Body dry-hot, stools loose. Pulses deep, soggy, slightly rapid. Tongue white, greasy, slippery; tongue body edges/tips crimson. This is Damp-Heat Warmth. Overuse of cloying/cold substances caused damp obstruction and failure to transform, leading to "Ice-Fixed" state, forcing heat pathogens into Ying (Nutritive) Level. Only unblocking Yang, warming Middle, and diffusing/resolving can open closure and unblock orifices. Ill for twelve days. Use pungent-warm to open closure, free Qi mechanism, aromatic diffusing to clarify spirit. Condition severe, caution required, diet strict.
Xiang Dou Chi (Fragrant Fermented Soybean) 12g, Chao Shanzhi (Stir-fried Gardenia Fruit) 3g, Qian Hu (Peucedanum Root) 3g, Huo Xiang Ye (Patchouli Leaf) 10g (added later), Chang Pu (Acorus Rhizome) 10g, Yu Jin (Curcuma Tuber) 6g, Hou Po (Magnolia Bark) 3g, Ban Xia (Pinellia Tuber) 10g, Xing Ren (Apricot Kernel) 10g, Bai Kou Ren Mo (White Cardamom Powder) 1g, Dan Gan Jiang Mo (Dried Ginger Powder) 1g. Last two powders mixed, loaded into gelatin capsules, taken twice with decoction. 2 doses.
Second Visit
Continuous intake of pungent-opening, warm-transforming, Yang-unblocking, Qi-regulating agents. Fever resolved, temperature 37.2°C. Whole body slight sweating, down to feet. Face ruddy, consciousness clear, speech coherent. Tongue coating resolving. Chest glomus basically disappeared. Urination smoother. Bowels not yet open. Pulses middle-pressure slippery-soggy. Ice-fixation gradually resolving. Cold-damp warming and transforming. Qi mechanism free. Continue pungent-diffusing and resolving method.
Xiang Dou Chi (Fragrant Fermented Soybean) 10g, Chao Shanzhi (Stir-fried Gardenia Fruit) 3g, Xing Ren (Apricot Kernel) 10g, Qian Hu (Peucedanum Root) 3g, Huo Geng (Patchouli Stem) 10g, Hou Po (Magnolia Bark) 10g, Ban Xia (Pinellia Tuber) 10g, Cao Kou (Black Cardamom) 3g, 3 doses.
Third Visit
Condition gradually improved. Patient walking, diet/excretions normal. Tongue white, slippery. Pulse soggy-slippery. Regulate Middle Jiao to conclude treatment.
Xiang Dou Chi (Fragrant Fermented Soybean) 10g, Xuan Fu Hua (Inula Flower) 10g, Sheng Bai Zhu (Raw Atractylodes Macrocephala Rhizome) 5g, Chen Pi (Tangerine Peel) 6g, Bai Bian Dou (White Hyacinth Bean) 10g, Sheng Yi Mi (Raw Coix Seed) 10g, Fu Ling (Poria Cocos) 10g, Jiao Mai Ya (Scorched Malt) 10g. After three doses, all ailments cured. Recuperated for half a month.
Original Commentary: Damp-Heat Warmth requires diffusing Qi and transforming dampness. Most contraindicated are cloying substances, which stagnate Qi and aid dampness, making disease sticky and hard to resolve. Dampness is Yin pathogen, requiring warmth to transform. Although damp-heat exists, treatment must distinguish damp vs. heat ratio. Bitter-cold use must be precise. Mistaken bitter-cold damages Yang, preventing damp removal, causing ice-fixation, Qi closure, no pathogen exit, forcing pathogens into Ying level, leading to coma. Treatment focuses on opening ice-fixation closure. Spleen/Stomach are Middle Jiao pivot. Cold entering stomach causes ice-fixation in Middle, blocking Qi. Opening requires pungent-hot/acrid agents like Gan Jiang (Dried Ginger), Cao Kou (Black Cardamom). Ban Xia and Houpo use pungent-opening/bitter-descending to dry dampness, move stagnation, free Middle Jiao. Qian Hu and Xing Ren diffuse/descend Lung Qi, opening Upper Jiao. Chang Pu and Yu Jin clear phlegm, open orifices. Added Zhi Zi Chi Tang: Dou Chi diffuses constrained heat and spreads Qi; Shanzhi frees Triple Burner and drains fire. Combination resolves ice-fixation, transforms cold-damp, opens damp-constraint, frees Triple Burner, gives pathogens exit, so Ying-level heat emerges and resolves.
This case involved overuse of cold damaging Yang. Damp-heat frozen internally by cold, no exit, forced into Ying. Yin damage not severe; key is resolving ice-fixation, opening constraint, diffusing Qi to vent heat. If Ying Yin damaged and heat emerged, consider Ying level.
[Commentary]: This is a mistreated Damp-Heat Warmth case. Patient fell ill in April. Previous doctor diagnosed Spring-Warmth based on season, using cold/cloying agents. Dampness congealed with cold, forming ice-fixation. At this stage, only pungent-hot can open closure, hence Cao Kou (White Cardamom) and Gan Jiang. Only aromatic can free Qi and awaken spirit. After medication, slight sweating, ruddy face indicate ice-fixation resolved, residual pathogens remain. Continue previous method. Finally, regulate Spleen/Stomach for safety.