例二男性患者，慢性粒细胞自血病。每天傍晚开始发热达40℃，下半夜自汗身凉，大起大落，巳有半年。平时手心微热，两足不温，腰以下特别痠痛，大便数天一次。舌苔厚腻，脉沉细无力。诊断为下焦阴阳并虚，中气不振，用黄芪、生熟地、归身、苁蓉、升麻、白术、泽泻等甘温除热，次日晚上热即平静。
（秦伯未《谦斋医学讲稿》）
例三刘Xx，男，17岁，门诊号：565375。初诊日期：1965年10月21日。患者于了月中旬劳动后，淋浴感寒而致发热（39℃），一56一经西药治疗两周发热仍未退。住院期间，每日下午体温波动于38．℃上下。经西医多种检查未能明确诊断。发热运今已三月余。来诊时每天下午4点至夜间2点发热（38．5℃），烧前先有恶寒，继而身热，无汗，伴有头晕，咽干，胸部觉隐痛，随后汗出热退，饮食尚可，二便一般。舌苔自厚、质红。脉细稍数，略显浮象。辨证；阴虚发热，营卫不和。治法：养阴清热，调和营卫。方药：青蒿10克鳖甲10克秦充6克地骨皮12克玄参12克银花15克天花粉15克鲜生地12克丹皮10克赤白芍各10克僵蚕6克鲜石斛30克灯芯1．5克桂枝3克甘草6克鲜茅根30克银柴胡3克10月25日：服上方4剂后，热势稍减，下午体温38．9℃，胸部时痛，脉滑稍数，上方去桂枝加常山3．5克，银柴胡改为3．5克，继服6剂。11月1日：药后曾有两天体温正常，昨日又达38℃苔白较厚，脉细数。患者日哺发热，属于阳明气机不畅，积热不清，上方加焦槟榔10克，蝉蜕3．5克，继服6剂。11月8日。烧未大作，昨日体温37．st，右侧耳痛，流黄水（素有中耳炎），别无不适，脉沉细稍数，舌苔白，上方再进4剂。皿月12日：近日发烧未作，一般清况良好。巛关幼波临床经验选》）［评按］内伤发热系指脏腑气血虚损或失调所引起的发热。白于阴阳气血偏虚而致者为虚热；因气滞、血瘀、食滞而致者为实热。本组病
例均为高热不退，连同下节“低热”，一57一均属内伤发热范畴。
例一午后发热、脉涩、舌黯，胁痛不移，既无表热见证，又无里热可循，证属血瘀发热。当活血化瘀，方用血府逐瘀汤而立奇功。
例三发热已三月余，因其夜热早凉，咽干、舌红，脉细数，证属阴虚发热，故取青蒿鳖甲汤、清骨散加减，以清阴分伏热，又因时值深秋，且有恶寒发热汗出，故合桂枝汤以调和营卫。全方仍本解肌透邪、清营养阴除热而设，后加常山、焦榔、蝉蜕祛痰导滞，宣达气机，内外调和而愈。
（三）内伤发热
（低热）
例一黄xX，女，39岁。初诊日期：1976年11月6日。今年“五一”节后受凉得病，寒热往来，热度在38oC以上，以后服药热度下降，但始终未退净，半年来每天低热
（37．2℃～37．3℃），鼻干而塞，口干怕冷，到后半夜烦热不得眠，面赤，头及手足出汗而全身无汗，口渴欲饮，咳嗽痰多如自沫，大便秘结，脉迟细，舌色尚正，中心苔黄，舌边起滤泡。辨证：寒邪失于汗解，寒郁化热，邪在气分留恋。外感之病，非骨蒸潮热也。治法．表里双解，仿防风通圣散法。方药：柴胡4．5克黄芩9克知母9克生石膏12克焦山栀9克淡豆豉9克杏仁9克生甘草4．5克鱼腥草30克赤白芍各9克炒枳壳9克制大黄9克姜半夏12克a剂。一58一11月1日
（M诊）：服药后得畅汗，大便亦畅通，已不怕冷，口干亦减，痰巳减少，尚觉鼻干，右颈部有肿胀感。除邪务尽，仍以原法，方药如下：柴胡4．5克葛根9克黄芩9克焦山栀9克淡豆豉9克制大黄9克赤白芍各9克炒枳壳9克姜半夏9克鱼腥草30克杏仁9克夏枯草9克生甘草3克11月14日
（三诊）：外邪已解，低热已不复作。……随访病人此后低热不再发作，逐渐恢复健康，并上班工作。
（金寿山主治，吴杰等整理：高热、低热，《新中医））227，1979）
例＝郭xx，女，40岁。初诊日期：1973年6月17日。患者3年来下午低烧，常达37．7℃～37．8℃，每到夜间两腿发麻，精神萎顿不振，经检查原因未明，久治无效。脉细而稍数，左关稍弦，舌无苔略红。辨证：阴虚肝旺。治法：滋阴调肝。方药：生地黄24克山萸肉12克怀山药12克丹皮12克泽泻9克茯苓9克柴胡9克五味子6克白芍9克紫肉桂6克6月26日复诊：低烧已下降到37C，嘱再服前方10余剂，以巩固疗效。巛岳美中医案集》）
例三龚丶X，男，58岁。初诊日期：1965年3月5日。低烧两年余，手足心热，午后热甚，体温偏高，常自汗—59——出，头晕，周身酸困，咳嗽，二便正常，脉迟，舌淡苔薄白。辨证；气液不足。治法：益气养阴。方药：浮小麦12克炙甘草6克大枣（切）5枚黄芪12克北五味（打）3克天门冬9克地骨皮6克枸杞子6克3月9日
（二诊）：药后低烧巳退，汗出减少，头晕，咳嗽亦减，但晚间手足仍发热，二便正常，脉舌正常，停药观察。3月12日
（三诊）：停药两天又发低烧，宗原方再服5剂。3月20日
（四诊）：药后偶有低烧，近几天肠胃欠佳，有时半夜腹痛，大便偏稀，饭后微噫气，肠微鸣，脉沉细，舌正无苔，属脾气虚弱。治宜益气缓肝。方药：党参6克炒白术4石克云苓3克炙甘草1．5克陈皮2．4克木瓜3克炒小麦9克五味子（打）3克大枣（切）3枚4月2日
（五诊）：低烧已去，食欲好转，原方继服5剂，诸证悉平。（《蒲辅周医疗经验》）
【按】低热是常见的证候之一，可见干多种病证。UI其难以通过检查而明确诊断，故西医往往冠以“低烧待查”。中医认为部分患者系因外感邪热失于汗解，以致余热缠扰所致。外感发热，若邪在肌表，洽之得法，可以一汗而解。洽法获效之关键在干辨证是否确切，方治是否恰当，若一见发热即用清热解毒之剂，不合病机则造成误治。
例一系外感失一60一汗所致。金氏认为：“对于失汗之热已非一般解表药所能治，必须用柴胡、葛根解肌透表，仍能使之汗解”。本
例证见鼻干而塞，口干便结，说明热象较著。外感寒邪失于汗解，化热入里，治以清热祛邪之法，表里双解，服药后得畅汗，大便已通，表里得解，郁热自退。
例二证属阴虚肝旺，以滋阴调肝为主，妙用肉桂引火归原，久虚低热得以平息。蒲氏认为引起低烧的原因很多，“外感热病治疗失当，将息失宜，或体质素虚，往往导致低烧。”其他又如中气不足、肝脾不和、阴分亏虚，以及气虚、血虚，均可以引起内伤低热。在治法上，他认为苦寒药不宜多用，过用苦寒不仅伤脾败胃，亦易化燥伤阴。内伤低热，脾胃已弱，药量宜轻，宁可再剂，不可重剂。否则易伤中气，反使症情加重。
例三，证属气阴不足。方用甘麦大枣汤加黄芪，亦属甘温除热之法；另加生津增液之品，以益气养阴除热。实属组方严谨，遣药得当。
（四）咳嗽
例一张XX，男，40岁。初诊日期：1955年7月。患伏暑咳嗽，曾自服丸药，得汗不恶寒，唯头部出汗甚少，肢体乏力，连日大便干结，小漫不清，食物不多。宜芳香和化宣达为治。方药：鲜霍香9克黄芩9克六一散（包）9克鲜佩兰9克茯苓9克瓜萎皮18克杏仁泥9克陈皮4．5克鲜荷叶一大张（剪碎）枳壳4．5克伏暑兼挟气郁，服上方头部汗出津津，肢体顿觉轻快，惟胸际阻闷，咳嗽，便秘。再仿原方增味。一61一杏仁泥9克黄芩9克川连2．1克法夏6克川厚朴4．5克黄郁金4．5克川贝9克茯苓9克六一散9克（布包）枳壳4．5克瓜萎皮18克生枇把叶6克（布包）服上苦降辛通方，胸闷立开，咳嗽平复，大便通顺，病已向愈。
（张菊人：《菊人医话）｝）
例二杨X，男，29岁，五月。阴虚火升，火刑金灼，咳而咽燥，两胁震痛，午后有虚潮之热，脉象弦数，舌红而干，久延有失血之虑。清炙桑白皮6克地骨皮9克黛蛤散12克（包）煅赭石12克天花粉6克川郁金4．5克橘红络各4．5克粉丹皮4．5克蜜炙白薇9克川贝9克冬瓜仁12克二诊：潮热已减，咳嗽胸痛见瘥，脉不数。白杏仁9克
（柞）地骨皮9克蜜炙枇把叶12克炙白薇9克清炙桑白皮6克代赭石15克蛤壳12克（杵）炙紫苑6克川贝6克炒橘红4．5克川郁金4．5克泡射干2．4克三诊：火不灼金，金润始复，热退咳减，胁痛巳止，脉弦舌红，再拟清润养肺。南沙参9克麦冬9克甜杏广9克（杵）代赭石12克蛤壳15克（杵）炙紫苑6克川郁金4．5克炒橘红4．5克冬瓜仁12克蜜炙冬花9克川贝6克杜仲12克（《叶熙春医案》）
例三陆XX，男，55岁。一年来舌苔灰黑，口干不欲多饮，咳嗽痰多，有时为一62一黄稠痰，少寐，大便多溏，脉象轻取弦数，重取沉细无力。观以前所服之方，多属清化痰火，疗效平平。此症肺热多痰是标，舌苔多津液，舌质不绛，口干而不欲多饮，脉象重取沉细无力，知非实热，脾肾阳虚，是病之本。其舌苔之灰黑色，应属水极火化，治当温脾肾之阳，稍用清上之品以反佐之。方药：肉桂粉3克
（吞服）制附片3克炮姜3克炒潞党6克炒白木9克炙黄芪12克炙远志4石克炒熟地6克炒山药12克米炒南沙参9克夏枯草3克炒子芩二．5克熟枣仁18克煅龙齿15克法半夏6克炒称米30克
（煎汤代水煎药）服药5剂，灰黑之苔大减，再服十剂，灰黑之苔基本消失，其余诸证亦随之好转，后以温养脾肾，培土生金法善其后。
（邹云翔经验，黄新吾整理：反佐疗法在临床上的运用，《新医药杂志》6：丨，1978）
例四夏xx，女，35岁。初诊日期：1964年4月18日。患咳喘巳一年许，屡洽未效。咳嗽气喘，痰白，时吐清水。经常大便溏泄，进生冷油腻时，则每日须溏泄4～5次。恶寒畏冷，肢末欠温。月经周期正常，但量多色较淡。面部微浮。舌苔白滑，脉象沉小。辨证；脾肾阳虚。治法：温中蠲饮，摄肾纳气。方药：茯苓、菟丝子各9克附子、法夏、苏子各6克陈皮、一63一五味各4石克葫芦巴12克炙甘草3克5月6日：前方连进3剂，咳嗽显著减轻，大便正常。嗣因多食青菜，致咳喘搪泄复发，脉象舌苔如前。仍宜益火生土，从本立法，桂附理中汤加味主之。潞党参、炒自术、附子、葫芦巴各9克干姜、炙甘草、破故纸各6克五味子4．5克肉桂1．2克（另研冲）上药连服4剂，咳嗽泄泻基本消失，继以桂附八味丸收功。至八月中旬追访，据称将近三个月来，咳喘、泄泻均未再发，身体壮实，近来虽进水果、蔬菜、生冷，均安如常人。
（俞长荣：益火生士法则的认识与实践，《中医杂志》11：28，1964）
例五张xx，男，44岁。病案号：C139556。1978年3月因咳嗽、咯痰、胸痛，进行性呼吸困难入院。患者于1977年3月突然发高热伴咳嗽、咯痰，经胸透诊为“肺部感染”。用多种抗菌素治疗2个月，发热消退，但咳嗽、咯痰未见明显好转。咯痰略呈白色泡沫状，每日十余口，胸胁经常痛，胸闷、气短，气喘，食纳减少，体重减轻。入院后经检查，包括痰病理检查（有大量粉染蛋白样物，PAS染色强阳性）与开胸活检，证实为肺泡蛋白沉着症。5月6日开始采用肝素、糜蛋白酶溶于生理盐水超声雾化吸入，服活血化瘀中药6剂，未见明显好转。现症：咳嗽，痰白粘不易咯出，两胁隐痛，胸中满闷，气短不足以息，上楼或活动稍多则气短、乏力纳差，颜面晦暗不华，唇甲青紫，二便正常，脉沉细弦滑，舌体胖，有齿痕，舌下静脉怒张。辨证：本为胸中大气下陷，标为瘀血阻络，痰浊不化。治法；升陷汤加味。一64一方药：生黄芪25克知母10克柴胡10克升麻3克桔梗10克当归10克川穹10克丹参15克旋复花（布包）10克海浮石（布包）10克葶苈子10克生意仁25克每日1剂，水煎服。服中药期间仍继续应用超声雾化吸入。服上方6剂，证情明显好转，饮食增加，气短减轻，痰量同前，乃于方中加杏仁12克，续服30剂后，饮食由每日9两增加至1石斤，行路上楼亦不觉气短，并从7月14日开始慢跑锻炼，证情平稳。1978年7月27日带方出院。方药：生黄芪25克党参15克知母10克桔梗10克柴胡10克升麻3克旋复花（布包）10克黛蛤散（布包）15克冬瓜子30克紫苑10克杏仁10克白前10克随诊一年，病情稳定，无明显变化。经中医中药治疗后，不但症状有改善，肺功能检查也有明显好转
（肺功能检查：第一秒时间肺活量由治前89．5％，恢复到100％；氧分压由69．4毫米汞拄，升至80．2毫米汞柱；肺内分流由12．4％降至7．32％；生理死腔由44．2％降至26．77％）。
Case 2: A male patient suffering from chronic myeloid leukemia (Chronic Myelogenous Leukemia). He began to have fever every evening, reaching up to 40°C, with spontaneous sweating (Zi Han) and cooling of the body in the early hours of the morning; the temperature fluctuated drastically for half a year. Usually, his palms were slightly hot, while both feet were cold. He experienced severe soreness and pain below the waist, and bowel movements occurred only once every few days. The tongue coating was thick and greasy, and the pulse was deep, fine, and powerless. The diagnosis was deficiency of both Yin and Yang in the Lower Jiao (Lower Burner), with weak Middle Qi (Middle Energy). Treatment employed sweet-warm methods to eliminate fever using herbs such as Huangqi (Radix Astragali), Sheng Dihuang (Radix Rehmanniae Preparata), Shu Dihuang (Radix Rehmanniae Preparata), Guishen (Radix Angelicae Sinensis), Rongrong (Cibotii Rhizoma), Shengma (Cimicifugae Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), and Zexie (Alismatis Rhizoma). By the next evening, the fever subsided.
(Qin Bowei, *Qianzhai Medical Lectures*)
Case 3: Liu XX, Male, 17 years old, Outpatient No.: 565375. First visit date: October 21, 1965. After laboring in mid-month, the patient took a shower and caught cold, resulting in fever (39°C). Despite two weeks of Western medicine treatment, the fever persisted. During hospitalization, his body temperature fluctuated around 38°C every afternoon. Various Western medical examinations failed to clarify the diagnosis. The fever had lasted for more than three months. Upon consultation, he had fever (38.5°C) daily from 4 PM to 2 AM. Before the fever rose, he felt aversion to cold (E Han), followed by body heat, anhidrosis (Wu Han), dizziness, dry throat, and dull pain in the chest. Subsequently, sweating occurred, and the fever subsided. His diet was acceptable, and urination and defecation were normal. The tongue coating was naturally thick, and the tongue body was red. The pulse was fine and slightly rapid, showing a slight floating tendency. Pattern differentiation: Fever due to Yin deficiency, disharmony of Ying and Wei (Nutritive and Defensive levels). Therapeutic method: Nourish Yin and clear heat, harmonize Ying and Wei. Prescription: Qinghao (Artemisiae Annuae Herba) 10g, Biejia (Testudinis Carapax et Plastrum) 10g, Qinjiao (Gentianae Macrophyllae Radix) 6g, Digupi (Lycii Cortex) 12g, Xuanshen (Scrophulariae Radix) 12g, Yinhua (Lonicerae Japonicae Flos) 15g, Tianhuafen (Trichosanthis Radix) 15g, Xian Shengdi (Fresh Radix Rehmanniae) 12g, Danpi (Moutan Cortex) 10g, Chishao (Radix Paeoniae Rubra) and Baishao (Radix Paeoniae Alba) 10g each, Jiangcan (Bombyx Batryticatus) 6g, Xian Shihu (Dendrobii Caulis) 30g, Dengxin (Junci Medulla) 1.5g, Guizhi (Cinnamomi Ramulus) 3g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Xian Maogen (Imperatae Rhizoma) 30g, Yinchaihu (Cistanches Herba) 3g. October 25: After taking 4 doses of the above prescription, the fever intensity decreased slightly, with afternoon temperature at 38.9°C and occasional chest pain. The pulse was slippery and slightly rapid. Guizhi was removed from the prescription, Changshan (Dichroae Radix) 3.5g was added, and Yinchaihu was adjusted to 3.5g. Continue for 6 doses. November 1: For two days after medication, the temperature was normal, but yesterday it reached 38°C. The tongue coating was white and relatively thick, and the pulse was fine and rapid. The patient's fever in the late afternoon (Ribu) indicates stagnation of Qi mechanism in the Yangming channel and unresolved accumulated heat. Jiaobinglang (Arecae Semen Preparatum) 10g and Chantui (Cicadae Periostracum) 3.5g were added to the prescription. Continue for 6 doses. November 8: The fever did not become severe; yesterday's temperature was 37.5°C. There was right ear pain with yellow discharge (history of otitis media), with no other discomfort. The pulse was deep, fine, and slightly rapid; the tongue coating was white. Take the previous prescription for another 4 doses. November 12: Recently, there has been no fever, and general condition is good. (*Selected Clinical Experience of Guan Youbo*) [Commentary]: Internal injury fever refers to fever caused by deficiency or dysfunction of Zang-Fu organs, Qi, and Blood. Deficiency of Yin, Yang, Qi, or Blood leads to deficient heat; Qi stagnation, blood stasis, or food retention leads to excess heat. All cases in this group involve persistent high fever, along with "low-grade fever" in the next section, all belonging to the category of internal injury fever.
Case 1: Fever in the afternoon, choppy pulse, dark tongue, fixed hypochondriac pain, without exterior heat signs or interior heat patterns, belongs to fever due to blood stasis. The treatment should be to invigorate blood and resolve stasis. Using Xuefu Zhuyu Tang achieved remarkable results.
Case 2: The pattern belongs to deficiency of both Yin and Yang, with weak Middle Qi. Treatment with sweet-warm methods to eliminate fever was effective immediately.
Case 3: The fever had lasted for over three months. Due to night fever and early morning coolness, dry throat, red tongue, and fine-rapid pulse, the pattern belongs to fever due to Yin deficiency. Therefore, Qinghao Biejia Tang and Qinggu San were modified to clear latent heat in the Yin level. Additionally, since it was late autumn and accompanied by aversion to cold, fever, and sweating, Guizhi Tang was combined to harmonize Ying and Wei. The entire formula is based on releasing the muscle layer and expelling pathogens, nourishing Ying, nourishing Yin, and eliminating heat. Later, Changshan, Jiaobinglang, and Chantui were added to resolve phlegm, guide out stagnation, and promote the free flow of Qi mechanism, achieving harmony between interior and exterior.
(III) Internal Injury Fever
(Low-grade Fever)
Case 1: Huang XX, Female, 39 years old. First visit date: November 6, 1976. After catching cold following the May Day holiday this year, she experienced alternating chills and fever, with temperatures above 38°C. Although medication lowered the fever, it never completely subsided. For the past six months, she has had daily low-grade fever (37.2°C–37.3°C), dry and stuffy nose, dry mouth, aversion to cold, irritability and insomnia in the late night, flushed face, sweating on the head and extremities but no sweating on the rest of the body, thirst with desire to drink, cough with profuse white frothy sputum, constipation, slow and fine pulse, normal tongue color, yellow coating in the center, and follicles on the tongue edges. Pattern differentiation: Failure of cold pathogen to be resolved through sweating, leading to cold stagnation transforming into heat, with pathogen lingering in the Qi level. This is an external contraction disease, not bone-steaming tidal fever. Therapeutic method: Simultaneously resolve exterior and interior, modeled after Fangfeng Tongsheng San. Prescription: Chaihu (Bupleuri Radix) 4.5g, Huangqin (Scutellariae Radix) 9g, Zhimu (Anemarrhenae Rhizoma) 9g, Sheng Shigao (Gypsum Fibrosum) 12g, Jiao Shanzhi (Gardeniae Fructus Preparatus) 9g, Dandouchi (Sojae Semens Praeparatum) 9g, Xingren (Armeniacae Semen Amarum) 9g, Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma) 4.5g, Yuxingcao (Houttuyniae Herba) 30g, Chishao and Baishao 9g each, Chao Zhiqiao (Aurantii Fructus Preparatus) 9g, Zhi Dahuang (Rhei Radix et Rhizoma Preparated) 9g, Jiang Banxia (Pinelliae Tuber Preparated with Ginger) 12g, 3 doses. November 1 (Follow-up): After taking the medicine, profuse sweating occurred, and bowel movements became smooth. She no longer feared cold, and dry mouth decreased. Phlegm reduced, but nasal dryness remained, and there was swelling sensation in the right neck. To thoroughly eliminate pathogens, continue with the original method. Prescription: Chaihu 4.5g, Gegen (Puerariae Lobatae Radix) 9g, Huangqin 9g, Jiao Shanzhi 9g, Dandouchi 9g, Zhi Dahuang 9g, Chishao and Baishao 9g each, Chao Zhiqiao 9g, Jiang Banxia 9g, Yuxingcao 30g, Xingren 9g, Xiakucao (Prunellae Spica) 9g, Sheng Gancao 3g. November 14 (Third Visit): External pathogens have been resolved, and low-grade fever has ceased. ... Follow-up showed that the patient's low-grade fever did not recur, and she gradually recovered health and returned to work.
(Master Jin Shoushan, organized by Wu Jie et al.: High Fever, Low-grade Fever, *New Chinese Medicine* 227, 1979)
Case 2: Guo XX, Female, 40 years old. First visit date: June 17, 1973. For the past three years, the patient has had afternoon low-grade fever, often reaching 37.7°C–37.8°C. Every night, her legs feel numb, and she feels mentally depressed and listless. Examinations failed to find the cause, and long-term treatment was ineffective. The pulse was fine and slightly rapid, the left Guan position slightly wiry, and the tongue had no coating and was slightly red. Pattern differentiation: Liver hyperactivity due to Yin deficiency. Therapeutic method: Nourish Yin and regulate the Liver. Prescription: Sheng Dihuang (Radix Rehmanniae Preparata) 24g, Shanyurou (Corni Fructus) 12g, Huai Shanyao (Dioscoreae Rhizoma) 12g, Danpi (Moutan Cortex) 12g, Zexie (Alismatis Rhizoma) 9g, Fuling (Poria) 9g, Chaihu (Bupleuri Radix) 9g, Wuweizi (Schisandrae Chinensis Fructus) 6g, Baishao (Radix Paeoniae Alba) 9g, Zi Rougui (Cinnamomi Cortex) 6g. June 26 Follow-up: Low-grade fever dropped to 37°C. Instructed to take the previous prescription for another 10+ doses to consolidate efficacy. (*Collected Cases of Yue Meizhong*)
Case 3: Gong XX, Male, 58 years old. First visit date: March 5, 1965. Low-grade fever for over two years, heat in palms and soles, worse in the afternoon, elevated body temperature, frequent spontaneous sweating, dizziness, body soreness and fatigue, cough, normal urination and defecation, slow pulse, pale tongue with thin white coating. Pattern differentiation: Deficiency of Qi and fluids. Therapeutic method: Tonify Qi and nourish Yin. Prescription: Fuxiaomai (Tritici Levis Fructus) 12g, Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma) 6g, Dazao (Jujubae Fructus, sliced) 5 pieces, Huangqi (Radix Astragali) 12g, Bei Wuwei (Schisandrae Chinensis Fructus, crushed) 3g, Tianmendong (Asparagi Radix) 9g, Digupi (Lycii Cortex) 6g, Gouqizi (Lycii Fructus) 6g. March 9 (Second Visit): After medication, low-grade fever subsided, sweating decreased, dizziness and cough also reduced, but hands and feet still felt hot at night. Urination and defecation were normal, pulse and tongue were normal. Stop medication and observe. March 12 (Third Visit): Low-grade fever recurred two days after stopping medication. Repeat the original prescription for 5 doses. March 20 (Fourth Visit): Occasional low-grade fever after medication. Recent gastrointestinal discomfort, occasional abdominal pain in the middle of the night, loose stools, slight belching after meals, mild intestinal borborygmus. Pulse is deep and fine, tongue is normal without coating. Belongs to Spleen Qi deficiency. Therapeutic method: Tonify Qi and soothe the Liver. Prescription: Dangshen (Codonopsis Radix) 6g, Chao Baizhu (Atractylodis Macrocephalae Rhizoma Preparated) 4.5g, Yunling (Poria) 3g, Zhi Gancao 1.5g, Chenpi (Citri Reticulatae Pericarpium) 2.4g, Mugua (Chaenomelis Fructus) 3g, Chao Xiaomai (Tritici Fructus Preparated) 9g, Wuweizi (Schisandrae Chinensis Fructus, crushed) 3g, Dazao (Jujubae Fructus, sliced) 3 pieces. April 2 (Fifth Visit): Low-grade fever has gone, appetite improved. Continue the original prescription for 5 doses. All symptoms resolved. (*Medical Experience of Pu Fuzhou*)
[Commentary] Low-grade fever is one of the common syndromes, visible in various diseases. Since it is difficult to diagnose clearly through examinations, Western medicine often labels it as "fever of unknown origin." Traditional Chinese Medicine believes that some patients suffer from residual heat lingering due to failure of external pathogenic heat to be resolved through sweating. For external fever, if the pathogen is in the muscle layer, proper treatment can resolve it with a single sweat. The key to therapeutic efficacy lies in whether the pattern differentiation is accurate and the prescription appropriate. If one uses heat-clearing and detoxifying agents upon seeing any fever without matching the pathology, it causes mis-treatment.
Case 1 resulted from failure to sweat after external contraction. Master Jin believed: "For heat caused by failure to sweat, general exterior-resolving medicines are insufficient; one must use Chaihu and Gegen to release the muscle layer and penetrate the exterior, still enabling resolution through sweating." This case presented with dry/stuffy nose and dry mouth/constipation, indicating significant heat signs. External cold pathogen failed to be resolved by sweating, transformed into heat and entered the interior. Treatment used heat-clearing and pathogen-expelling methods, simultaneously resolving exterior and interior. After taking the medicine, profuse sweating occurred, bowels moved, exterior and interior were resolved, and stagnant heat retreated spontaneously.
Case 2 belongs to Liver hyperactivity due to Yin deficiency, primarily treated by nourishing Yin and regulating the Liver. Ingeniously using Rougui (Cinnamon Bark) to guide fire back to its source allowed long-standing low-grade fever to subside. Master Pu believed there are many causes for low-grade fever: "Improper treatment of external febrile diseases, improper nursing, or inherent constitutional weakness often lead to low-grade fever." Others include insufficient Middle Qi, Disharmony of Liver and Spleen, deficiency of Yin level, as well as Qi deficiency and Blood deficiency, which can all cause internal injury low-grade fever. Regarding therapeutic methods, he believed bitter-cold medicines should not be used excessively. Overuse of bitter-cold not only damages Spleen and Stomach but also easily dries and injures Yin. For internal injury low-grade fever, the Spleen and Stomach are already weak; dosage should be light. It is better to repeat doses than to use heavy doses. Otherwise, it easily damages Middle Qi and aggravates the condition.
Case 3 belongs to Qi and Yin deficiency. The prescription used Ganmai Dazao Tang plus Huangqi, also employing the sweet-warm method to eliminate heat; additionally, ingredients to generate fluids and increase liquids were added to tonify Qi, nourish Yin, and eliminate heat. The prescription formulation was rigorous, and herb selection appropriate.
(IV) Cough
Case 1: Zhang XX, Male, 40 years old. First visit date: July 1955. Suffered from latent summerheat cough. Took pills himself, sweated without aversion to cold, but only slight sweating on the head. Limbs felt weak. Bowels were dry for consecutive days, urination unclear, poor appetite. Treatment should focus on aromatic transformation and promoting free flow. Prescription: Xian Huoxiang (Pogostemonis Herba Fresh) 9g, Huangqin (Scutellariae Radix) 9g, Liuyisan (Six-to-One Powder, wrapped) 9g, Xian Peilan (Agastaches Herba Fresh) 9g, Fuling (Poria) 9g, Gualoupi (Trichosanthis Pericarpium) 18g, Xingrenni (Paste of Armeniacae Semen Amarum) 9g, Chenpi (Citri Reticulatae Pericarpium) 4.5g, Xian Heye (Nelumbinis Folium Fresh, torn) one large sheet, Zhiqiao (Aurantii Fructus) 4.5g. Latent summerheat complicated by Qi stagnation. After taking the above prescription, sweating occurred on the head, limbs felt instantly lighter, but chest felt obstructed and stuffy, with cough and constipation. Again imitate the original formula with added flavors. Xingrenni 9g, Huangqin 9g, Chuanlian (Coptidis Rhizoma) 2.1g, Faxia (Pinelliae Tuber Prepared with Alum) 6g, Chuan Houpo (Magnoliae Officinalis Cortex) 4.5g, Huang Yujin (Curcumae Radix) 4.5g, Chuanbei (Fritillariae Cirrhosae Bulbus) 9g, Fuling 9g, Liuyisan 9g (wrapped in cloth), Zhiqiao 4.5g, Gualoupi 18g, Sheng Pipaye (Loquat Leaf Fresh, wrapped in cloth) 6g. Taking this bitter-descending and acrid-unblocking formula, chest obstruction opened immediately, cough subsided, bowels moved smoothly, and the illness was healing.
(Zhang Jurén: *Jurén's Medical Conversations*)
Case 2: Yang X, Male, 29 years old, May. Yin deficiency with Fire rising, Fire insulting Metal and scorching, cough with dry throat, throbbing pain in both hypochondria, afternoon tidal fever, wiry-rapid pulse, red and dry tongue, prolonged course risks hemorrhage. Qing Zhi Sangbaipi (Mulberry Root Bark Prepared with Honey) 6g, Digupi (Lycii Cortex) 9g, Daihe San (Blue-green Clay and Cockle Shell Powder, wrapped) 12g, Duan Zhesi (Hematitum Calcined) 12g, Tianhuafen (Trichosanthis Radix) 6g, Chuan Yujin (Curcumae Radix) 4.5g, Juhongluo (Citri Reticulatae Pericarpium and Retinervum) 4.5g each, Fen Danpi (Moutan Cortex) 4.5g, Mi Zhi Baiwei (Clehornea Root Prepared with Honey) 9g, Chuanbei (Fritillariae Cirrhosae Bulbus) 9g, Dongguaren (Benincasae Semen) 12g. Second Visit: Tidal fever reduced, cough and chest pain improved, pulse no longer rapid. Baixingren (Apricot Kernel) 9g (crushed), Digupi 9g, Mi Zhi Pipaye (Loquat Leaf Prepared with Honey) 12g, Zhi Baiwei 9g, Qing Zhi Sangbaipi 6g, Daizheshi (Hematitum) 15g, Geke (Meretrix Shell, pounded) 12g, Zhi Ziwan (Asternatis Radix Prepared with Honey) 6g, Chuanbei 6g, Chao Juhong (Citri Reticulatae Pericarpium Preparated) 4.5g, Chuan Yujin 4.5g, Pao Shegan (Belamcandae Rhizoma Soaked) 2.4g. Third Visit: Fire no longer scorches Metal, Metal moistens and recovers, heat retreats, cough reduces, hypochondriac pain stops. Pulse wiry, tongue red. Re-prescribe clearing, moistening, and nourishing Lung. NanShashen (Glehniae Radix) 9g, Maidong (Ophiopogonis Tuber) 9g, Tian Xingren (Sweet Apricot Kernel, pounded) 9g, Daizheshi 12g, Geke 15g (pounded), Zhi Ziwan 6g, Chuan Yujin 4.5g, Chao Juhong 4.5g, Dongguaren 12g, Mi Zhi Donghua (Adenophorae Radix Prepared with Honey) 9g, Chuanbei 6g, Duzhong (Eucommiae Cortex) 12g. (*Medical Cases of Ye Xichun*)
Case 3: Lu XX, Male, 55 years old. For a year, tongue coating gray-black, dry mouth without desire to drink much, cough with profuse sputum, sometimes yellow and thick, insomnia, mostly loose stools, pulse wiry-rapid on light pressure, deep-fine-powerless on heavy pressure. Observing previously taken prescriptions, they mostly belonged to clearing phlegm and resolving fire, with mediocre efficacy. This case's lung heat with profuse phlegm is the branch manifestation. The tongue coating has abundant moisture, tongue body is not crimson, dry mouth without desire to drink, pulse deep-fine-powerless on heavy pressure, indicating not excess heat, but Spleen-Kidney Yang deficiency, which is the root of the disease. The gray-black tongue coating should belong to extreme water transforming into fire. Treatment should warm Spleen-Kidney Yang, slightly using upper-clearing items as counter-assistance. Prescription: Rougui Fen (Cinnamon Bark Powder) 3g (swallow), Zhi Fupian (Aconiti Lateralis Radix Preparata) 3g, Pao Jiang (Zingiberis Rhizoma Preparated) 3g, Chao Ludangshen (Codonopsis Radix Preparated) 6g, Chao Baizhu (Atractylodis Macrocephalae Rhizoma Preparated) 9g, Zhi Huangqi (Radix Astragali Prepared with Honey) 12g, Zhi Yuanzhi (Polygalae Radix Prepared with Honey) 4.5g, Chao Shudi (Rehmanniae Radix Preparata Preparated) 6g, Chao Shanyao (Dioscoreae Rhizoma Preparated) 12g, Mi Chao Nanshashen (Glehniae Radix Preparated with Rice) 9g, Xiakucao (Prunellae Spica) 3g, Chao Zihuangqin (Scutellariae Radix Preparated) 2.5g, Shu Zaoren (Ziziphi Spinosae Semen Preparated) 18g, Duan Longchi (Longgu Calcined) 15g, Fa Banxia (Pinelliae Tuber Prepared with Alum) 6g, Chao Jingmi (Oryza Sativa Grain Preparated) 30g (decoct soup to decoct herbs). After 5 doses, gray-black coating significantly reduced. After another 10 doses, gray-black coating basically disappeared, and other symptoms improved accordingly. Afterwards, warming and nourishing Spleen-Kidney, cultivating Earth to generate Metal method was used to conclude treatment.
(Experience of Zou Yunxiang, organized by Huang Xinwu: Application of Counter-Assistance Therapy in Clinical Practice, *New Medical Journal* 6:1, 1978)
Case 4: Xia XX, Female, 35 years old. First visit date: April 18, 1964. Suffered from cough and asthma for about a year, repeatedly treated without effect. Cough and asthma, white sputum, occasionally spitting clear water. Frequent loose stools; when eating raw, cold, or greasy food, must have 4-5 loose stools daily. Aversion to cold and fear of cold, extremities not warm. Menstrual cycle normal, but volume heavy and color pale. Face slightly puffy. Tongue coating white and slippery, pulse deep and small. Pattern differentiation: Spleen-Kidney Yang deficiency. Therapeutic method: Warm Middle and dispel fluid retention, grasp Kidney and receive Qi. Prescription: Fuling (Poria) and Tusizi (Cuscutae Semen) 9g each, Fuzi (Aconiti Lateralis Radix Preparata), Faxia (Pinelliae Tuber Prepared with Alum), Suzi (Perillae Fructus) 6g each, Chenpi (Citri Reticulatae Pericarpium), Wuwei (Schisandrae Chinensis Fructus) 4.5g each, Huluba (Trigonellae Semen) 12g, Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma) 3g. May 6: Previous prescription taken continuously for 3 doses, cough significantly reduced, bowels normal. Subsequently, due to excessive consumption of green vegetables, cough, asthma, and diarrhea recurred, pulse and tongue coating as before. Still suitable to benefit Fire to generate Earth, legislating from the root. Gui Fu Lizhong Tang with modifications is the main prescription. Ludangshen (Codonopsis Radix), Chao Baizhu (Atractylodis Macrocephalae Rhizoma Preparated), Fuzi (Aconiti Lateralis Radix Preparata), Huluba (Trigonellae Semen) 9g each, Ganjiang (Zingiberis Rhizoma) 6g, Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma), Po Gu Zhi (Psoraleae Fructus) 6g each, Wuweizi (Schisandrae Chinensis Fructus) 4.5g, Rougui (Cinnamomi Cortex) 1.2g (separately ground and mixed). These medicines taken continuously for 4 doses, cough and diarrhea basically disappeared. Subsequently concluded with Gui Fu Ba Wei Wan. Mid-August follow-up claimed that for nearly three months, cough, asthma, and diarrhea did not recur again. Body strong. Recently, even consuming fruits, vegetables, and raw/cold foods, remained stable as usual.
(Yu Changrong: Understanding and Practice of the Rule of Benefiting Fire to Generate Earth, *Chinese Journal of Traditional Medical Science and Technology* 11:28, 1964)
Case 5: Zhang XX, Male, 44 years old. Case No.: C139556. Admitted in March 1978 due to cough, expectoration, chest pain, and progressive dyspnea. In March 1977, suddenly developed high fever with cough and expectoration, diagnosed as "pulmonary infection" via chest fluoroscopy. Treated with multiple antibiotics for 2 months, fever subsided, but cough and expectoration did not improve significantly. Expectoration slightly white and foamy, over ten times daily, frequent chest and hypochondriac pain, chest fullness, shortness of breath, asthma, reduced appetite, weight loss. After admission, examinations including sputum pathology (large amount of pink-stained protein-like material, PAS staining strongly positive) and open lung biopsy confirmed Pulmonary Alveolar Proteinosis. Starting May 6, Heparin and Chymotrypsin dissolved in physiological saline were inhaled via ultrasonic nebulization. Took 6 doses of blood-invigorating and stasis-resolving Chinese herbal medicine, no obvious improvement. Current symptoms: Cough, white sticky sputum difficult to expectorate, dull pain in both hypochondria, chest fullness, shortness of breath insufficient to breathe, shortness of breath and fatigue with poor appetite upon climbing stairs or slight activity, dull complexion, cyanotic lips and nails, normal urination and defecation, pulse deep-fine-wiry-slippery, tongue fat with teeth marks, distended sublingual veins. Pattern differentiation: Root is sinking of Great Qi in the Chest, branch is blood stasis blocking collaterals and turbid phlegm not transforming. Therapeutic method: Shengxian Tang with modifications. Prescription: Sheng Huangqi (Radix Astragali) 25g, Zhimu (Anemarrhenae Rhizoma) 10g, Chaihu (Bupleuri Radix) 10g, Shengma (Cimicifugae Rhizoma) 3g, Jiegeng (Platycodonis Radix) 10g, Danggui (Angelicae Sinensis Radix) 10g, Chuanxiong (Ligusticum Chuanxiong Rhizoma) 10g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 15g, Xuanjinhua (Inulae Flos, wrapped in cloth) 10g, Haifushi (Pumex) 10g (wrapped in cloth), Tinglizi (Descurainiae Semen seu Lepidii Semen) 10g, Yiyiren (Coicis Semen) 25g. One dose daily, decocted in water and taken orally. Ultrasonic nebulization continued during Chinese medicine treatment. After 6 doses of the above prescription, condition significantly improved, diet increased, shortness of breath reduced, sputum volume same as before. Then added Xingren (Armeniacae Semen Amarum) 12g to the prescription, continued for 30 doses. Diet increased from 9 liang per day to 1 jin. Walking and climbing stairs no longer caused shortness of breath. Started jogging exercise from July 14, condition stabilized. Discharged with prescription on July 27, 1978. Prescription: Sheng Huangqi (Radix Astragali) 25g, Dangshen (Codonopsis Radix) 15g, Zhimu (Anemarrhenae Rhizoma) 10g, Jiegeng (Platycodonis Radix) 10g, Chaihu (Bupleuri Radix) 10g, Shengma (Cimicifugae Rhizoma) 3g, Xuanjinhua (Inulae Flos, wrapped in cloth) 10g, Daihe San (Blue-green Clay and Cockle Shell Powder, wrapped in cloth) 15g, Dongguazi (Benincasae Semen) 30g, Ziwan (Asternatis Radix) 10g, Xingren (Armeniacae Semen Amarum) 10g, Baiqian (Cynanchi Stauntonii Rhizoma et Radix) 10g. Follow-up for one year, condition stable, no obvious changes. After Chinese medicine treatment, not only symptoms improved, but pulmonary function tests also showed significant improvement (Pulmonary function test: Forced expiratory volume in one second recovered from 89.5% before treatment to 100%; Partial pressure of oxygen increased from 69.4 mmHg to 80.2 mmHg; Intrapulmonary shunt decreased from 12.4% to 7.32%; Physiological dead space decreased from 44.2% to 26.77%).
(Master Zhu Zhanyu, organized by Dong Zhenhua et al.: Integrated Chinese and Western Medicine Treatment of Pulmonary Alveolar Proteinosis)