遗风漏 风温发热咳嗽，气急不耐，脉弦数，舌浓腻。症势非轻，宜治防变（元月二十九
日。）
姜半夏（三钱） 莱菔子（三钱） 前胡（钱半） 枳壳（钱半） 光杏仁（三钱） 连翘（三钱）
焦山栀（三钱） 花粉（三钱） 霜桑叶（三钱） 象贝（三钱） 广橘红（一钱） （引）竹肉（一丸）
二帖。
介按∶风温先伤肺分，肺气不舒，以致咳嗽气急，脉数舌腻。治法大忌辛温汗散，宜与
辛凉轻剂，肃降肺气，清解表邪。姜半夏虽能消痰止咳，尚宜慎用。
安昌徐 温邪未净，脉尚大，午后肌热，舌白滑，呛咳面浮，大便溏薄。宜养胃、清肺
熄邪。
丹参（三钱） 生米仁（四钱） 银花（钱半） 金沸草（三钱，包煎） 川贝（二钱） 茯苓（
三钱） 丹皮（二钱） 通草（钱半） 省头草（三钱） 桔梗（钱半） 白前（钱半）
清煎。三帖。
介按∶温邪湿热未净，上冲于肺，则咳嗽面浮，阴液未复，而湿热蕴蓄则肌热便溏，必
先清肺热，则咳嗽自止，渗湿扶脾，则便溏自瘥，佐清营热，则肌热亦退。
惟丹参恐是元参之误。
白马山李 温邪上郁，头目不爽，脉数，舌微黄，身热肢楚。宜清解为主（二月二十七日
。）
淡竹叶（钱半） 苦丁茶（钱半） 滑石（四钱） 炒枳壳（钱半） 焦栀子（二钱） 炒远志肉
（八分） 广郁金（三钱） 炒麦芽（三钱） 甘菊（钱半） 石菖蒲（八分） 干地龙（钱半）
清煎。二帖。
介按∶温病发出之途自少阳，热病发出之途由阳明，此病由少阳而上郁清窍，则头目不
爽，
渐次由阳明而化热，故身热肢楚。今以少阳、阳明同治，参用地龙、竹叶，借清胃络之热。
遗风庞 温邪发热，神识乍清乍愦，脉滑数，口燥，咳逆，便闭。宜防变端，候正（四
月十七号三月初二日。）
栝蒌皮（三钱） 石菖蒲（七分） 干地龙（钱半） 焦栀子（三钱） 广郁金（三钱） 连翘（
三钱） 枳壳（钱半） 天花粉（钱半） 银花（钱半） 光杏仁（三钱） 淡竹叶（钱半）
清煎。二帖。
又 大便稍下，热犹不解，脉滑数，咳逆。宜清上焦为主，不致变端无虑（三月初四日
。）
栝蒌皮（三钱） 淡条芩（钱半） 前胡（钱半） 莱菔子（二钱） 焦山栀（三钱） 广郁金（
三钱） 光杏仁（三钱） 象贝（三钱） 枳壳（钱半）
二帖。
介按∶温邪上受，首先犯肺，传于阳明，胃热挟痰而渐逼心胞，致神识乍愦，口燥咳逆
而便
闭。治以清热化痰，芳香宣窍。胃热清降则大便稍下。然肺分之余热不清，故咳逆未止，继
方再清上焦气分，庶无变幻之虑。
渔庄沈（妇） 癸水色尚紫，正夹温邪，咳嗽尤甚，脉浮大，舌红，头疼身热。邪热已极
营络，宜清解消痰（杏月十一日。）
天花粉（三钱） 象贝（三钱） 元参（三钱） 旋复花（三钱，包煎） 连翘（三钱） 甘菊（
钱半
）橘红（一钱） 光杏仁（三钱） 丹参（三钱） 白前（钱半） 银花（钱半） （引）枇杷叶（三片
，去毛）
三帖。
介按∶阴虚内热则癸水色紫，更感温邪，上犯于肺，致咳嗽身热头疼，而脉象浮大，足
气分热炽，已属显然。但两热相并，易入营分，故此方于清肺止咳之中，兼顾营热为治。
安昌顾 温热言谵，脉促数，舌微黄，疹点隐约，咳逆，发热，肢战。症属棘手。宜防
痉厥，候正（四月二十四号甲辰初八日。）
玳瑁（一钱） 紫草（一钱） 银花（三钱） 天花粉（三钱） 连翘（三钱） 蝉衣（一钱） 广
郁金
（三钱，杵） 僵蚕（三钱） 石菖蒲（七分） 象贝（三钱） 老式天竺黄（三钱） （引） 鲜竹叶
一帖。
介按∶病由肺卫而逼入营分，劫液动风，以致言谵肢战。所幸疹现而咳，邪势外达，然
症象
已属热极，故用玳瑁、紫草凉解营分，余味开窍豁痰，清热透邪。洵治温邪逼入营分之良方
。
盛陵龙 湿温杂受，中焦格拒，脉涩滞，舌浓嫩黄，便溺不利。藉小陷胸汤，防变，候
正。（五月三号甲辰十七日。）
杜栝蒌子（钱半） 枳实（一钱） 原滑石（四钱） 炒麦芽（三钱） 姜炒川连（八分） 生楂
肉（三钱） 焦栀子（三钱） 光杏仁（三钱） 仙半夏（钱半） 淡竹叶（钱半） 省头草（三钱）
清煎。二帖。
介按∶内湿素盛，更感温邪，蕴伏中焦，化痰而阻其气化之流行，故以小陷胸汤加味，
藉除中焦之湿热以化痰。
盛陵徐 湿热温邪杂受，寒热交作，脉濡数，大便自利，舌心灰黄。宜防昏蒙之变。候
正。（五月十号甲辰二十四日。）
焦六曲（四钱） 赤苓（四钱） 原滑石（四钱） 银花（钱半） 连翘（三钱） 大豆卷（三钱）
防己（钱半） 石菖蒲（五分） 仙半夏（钱半） 陈皮（钱半） 淡黄芩（钱半）
清煎。二帖。
介按∶湿热凝滞，大便自利，感受温邪，寒热交作，最怕湿阻气机，挟痰而上蒙清窍，
变现神识昏愦。此症既不能表，又不能下，故治法以宣窍而清湿热为首要。
道墟陶 湿温杂受，烦热口燥，身发疹斑，神识乍清乍愦，脉数舌黄。清窍失聪，症属
棘手。宜防厥闭，候正。（五月二十三号乙巳初七日。）
焦栀子（三钱） 贯众（二钱） 银花（二钱） 牛蒡子（钱半） 淡豆豉（三钱） 蝉衣（钱半）
连
先服牛黄清心丸一粒，一帖。
介按∶湿热相蒸，先阻气分，津液被烁，未能上升，是以烦热口燥，日久不解，邪热无
处发
泄，渐走营分，则神昏谵语，上蒙清窍，则耳聋无闻。幸喜肺胃之邪，渐从疹斑而透现。然
症势已在险途，故治以芳香通神，淡渗宣窍，俾秽浊湿邪，由此分消。
盛陵蒋 热入血室，疹斑稍现，舌黄滑，脘闷，大便泻痢，微热。势在重险，宜清解，
防厥。（六月二十一号丙午初七日。）
贯众（二钱） 碧玉散（三钱，荷包） 大豆卷（三钱） 小青草（一钱） 原滑石（四钱） 赤
苓（四钱） 连翘（三钱） 通草（钱半） 银花（三钱） 炒枳壳（钱半） 省头草（钱半 引） 活
水芦根（一两）
二帖。
又 血舍已清，泻痢较差，脉濡数，舌黄，呛咳，微热不清，胸前发斑白 。宜清解为
主。（六月念四号丙午初十日）。
淡竹叶（钱半） 银花（三钱） 省头草（钱半） 桔梗（钱半） 京川贝（二钱） 赤苓（四钱）
广郁金（三钱） 大豆卷（三钱） 碧玉散（四钱，荷包） 小青草（一钱） 通草（钱半）
清煎二帖。
又 泻痢已瘥，身热亦退，脉濡细，脘腹胀闷，咳逆宜治，防变（七月四号丙午二十日
。）
桔梗（钱半） 枳壳（钱半） 新会皮（钱半） 白前（钱半） 川贝（二钱） 赤苓（四钱） 广
郁金（三钱） 蔻壳（钱半） 佩兰（钱半） 通草（钱半） 谷芽（四钱） （引）荷叶（一角）
三帖。
介按∶伏热由阳明而陷入血室，血下则阳热上浮，而神识不清，语言谵妄。张仲景屡有
刺期
门之训，因期门是肝经之募，泻其热而通其经，则汗得遍身而蓄热外泄，下血自止而谵语自
已。此案治法，虽不宗小柴胡汤之例，而悉遵仲景无犯胃气及上二焦之戒，仍以清热利窍，
俾郁热外泄而疹斑透现，确是良法。但肝经之热，恐难速解，故防劫液动风而变痉厥。幸其
郁热渐由大肠而自寻出路，治以清解而斑 更现，泻痢较差，身热亦退，初二两方之着力，
显然可见。惟初方既用碧玉散，则滑石可以去之。第三方若再注重清解，庶免久咳之累。
西庄易 血舍已清，脉数，气口滑，呛咳头晕，身热未退，舌黄尖红，腰疼肢楚。还防
变幻，候正。（五月二十号乙巳初四日。）
栝蒌根（三钱） 冬桑叶（三钱） 象贝（三钱） 干地龙（钱半） 连翘（三钱） 甘菊（钱半）
广
橘红（一钱） 光杏仁（三钱） 前胡（钱半） 贯众（二钱） 老式天竺黄（钱半） （引）竹肉（一
丸）
二帖。
介按∶温邪由肺而传于胃，表邪虽解而里热尚在熏蒸，是以肌热未退，上熏于肺，则呛
咳头
晕。故治法仍以肃降肺气，蠲除胃热，俾胃热清解，则身热咳嗽可除。因其腰疼肢楚，又佐
地龙善走经络以退热。
遗风徐 冬温汗出发热，脉数右劲，舌心黄浓。咳逆吸短，右胁刺痛，神识乍愦。症势
重险，宜防厥闭，候正（十月十二日。）
干地龙（钱半） 象贝（三钱） 冬桑叶（三钱） 牛蒡子（钱半） 连翘（三钱） 前胡（钱半）
原
郁金（三钱） 橘红（一钱） 光杏仁（三钱） 银花（钱半） 老式天竺黄（二钱） 卷心竹叶（三十
片）
二帖。
又 右胁犹痛，脉滑数，舌黄，吸粗，咳逆痰阻，神色乍愦，还防变幻。
干地龙（钱半） 石菖蒲（八分） 前胡（钱半） 广郁金（三钱） 银花（三钱） 连翘（三钱）
炒
淡黄芩（钱半） 丝瓜络（钱半） 赖橘红（八分） 光杏仁（三钱） 老式天竺黄（二钱） 枇杷叶
（三片，去毛）
三帖。
介按∶冬温犯肺，不得外解，最易逆传心胞，而现神识昏愦。兹以温邪激动肝阳，烁液
成痰
，阻滞气机而致咳逆吸促，右胁刺痛。治以辛凉之剂，整肃肺胃之痰，而解气分之热。然至
次诊，神色犹愦，症势已属棘手矣。
[Background Information]
Book: Shao Lansun's Medical Cases Author: Shao Lansun Dynasty: Qing Chapter: Warm-Heat Category: Medical Discussion
Yifeng Lou [Patient Surname] The patient contracted Wind-Warmth (Feng Wen, a warm-pathogen disease characterized by wind and heat), presenting with fever, cough, and severe shortness of breath that is intolerable. The pulse is wiry and rapid, and the tongue coating is thick and greasy. The condition is not mild; treatment should aim to prevent pathological changes. (January 29th)
Pinellia Tuber (Ban Xia, 3 qian) Radish Seed (Lai Fu Zi, 3 qian) Peucedanum Root (Qian Hu, 1.5 qian) Aurantium Fruit (Zhi Ke, 1.5 qian) Apricot Seed (Xing Ren, 3 qian) Forsythia Fruit (Lian Qiao, 3 qian)
Gardenia Fruit (Shan Zhi, 3 qian) Trichosanthes Root (Hua Fen, 3 qian) Mulberry Leaf (Sang Ye, 3 qian) Fritillaria Bulb (Xiang Bei, 3 qian) Tangerine Peel (Ju Hong, 1 qian) (Guiding herb) Bamboo Concretion (Zhu Rou, 1 pill)
Two doses.
Commentary by Jie: Wind-Warmth first injures the Lung sector, causing Lung Qi stagnation, leading to cough and shortness of breath, with a rapid pulse and greasy tongue coating. The treatment method strictly forbids acrid-warm diaphoretic dispersal; instead, it is appropriate to use a light acrid-cool formula to descend Lung Qi and clear/resolve exterior pathogens. Although Pinellia Tuber can eliminate phlegm and stop cough, it should still be used with caution.
Anchang Xu [Patient Surname] Warm pathogens remain uncleared; the pulse is still large. There is afternoon skin fever, white slippery tongue coating, harsh cough with facial edema, and loose stools. Treatment should nourish the Stomach, clear the Lungs, and extinguish pathogens.
Salvia Root (Dan Shen, 3 qian) Coix Seed (Yi Yi Ren, 4 qian) Honeysuckle Flower (Jin Yin Hua, 1.5 qian) Antennaria Herb (Jin Fei Cao, 3 qian, wrapped for decoction) Fritillaria Bulb (Chuan Bei, 2 qian) Poria (Fu Ling, 3 qian) Moutan Bark (Dan Pi, 2 qian) Tongcao Stem (Tong Cao, 1.5 qian)
Acorus Herb (Sheng Tou Cao, 3 qian) Platycodon Root (Jie Geng, 1.5 qian) Cynanchum Root (Bai Qian, 1.5 qian)
Decoct in clear water. Three doses.
Commentary by Jie: Warm pathogens and damp-heat are not yet cleared. Rising to the Lungs causes cough and facial edema. Since Yin fluids have not recovered, and damp-heat accumulates, there is skin fever and loose stools. One must first clear Lung heat so that cough stops naturally; leaching out dampness and supporting the Spleen will cure loose stools naturally; assisting with clearing Ying-level heat will make skin fever recede.
It is suspected that Dan Shen (Salvia Root) is a miswriting of Yuan Shen (Scrophularia Root).
Baimashan Li [Patient Surname] Warm pathogens are constrained upward, causing unclear head and eyes, rapid pulse, slightly yellow tongue, body fever, and limb soreness. Treatment should primarily focus on clearing and resolving. (February 27th)
Bamboo Leaf (Zhu Ye, 1.5 qian) Tea Leaf (Ku Ding Cha, 1.5 qian) Talcum (Hua Shi, 4 qian) Fried Aurantium Fruit (Chao Zhi Ke, 1.5 qian) Fried Gardenia Fruit (Jiao Zhi Zi, 2 qian) Fried Polygala Root (Chao Yuan Zhi, 0.8 fen) Curcuma Tuber (Yu Jin, 3 qian) Fried Barley Sprout (Chao Mai Ya, 3 qian) Chrysanthemum Flower (Gan Ju, 1.5 qian) Acorus Rhizome (Shi Chang Pu, 0.8 fen) Earthworm (Di Long, 1.5 qian)
Decoct in clear water. Two doses.
Commentary by Jie: The pathway for Warm Disease emergence starts from the Shaoyang channel, while the pathway for Heat Disease emergence is via the Yangming channel. This disease arises from Shaoyang constraining upward the clear orifices, causing unclear head and eyes, and gradually transforms into heat via Yangming, hence body fever and limb soreness. Now treating both Shaoyang and Yangming simultaneously, incorporating Earthworm and Bamboo Leaf to borrow their ability to clear Stomach collateral heat.
Yifeng Pang [Patient Surname] Warm pathogens cause fever; consciousness fluctuates between clarity and confusion; pulse is slippery and rapid; dry mouth; cough and counterflow qi; constipation. Prevent pathological changes and observe healthy Qi. (April 17th / Lunar March 2nd)
Trichosanthes Peel (Gua Lou Pi, 3 qian) Acorus Rhizome (Shi Chang Pu, 0.7 fen) Earthworm (Di Long, 1.5 qian) Fried Gardenia Fruit (Jiao Zhi Zi, 3 qian) Curcuma Tuber (Yu Jin, 3 qian) Forsythia Fruit (Lian Qiao, 3 qian) Aurantium Fruit (Zhi Ke, 1.5 qian) Trichosanthes Root (Tian Hua Fen, 1.5 qian) Honeysuckle Flower (Jin Yin Hua, 1.5 qian) Apricot Seed (Xing Ren, 3 qian) Bamboo Leaf (Zhu Ye, 1.5 qian)
Decoct in clear water. Two doses.
Second Visit: Bowels have moved slightly, but heat remains unresolved; pulse is slippery and rapid; cough and counterflow qi. Treatment should primarily clear the Upper Jiao, avoiding pathological changes without worry. (Lunar March 4th)
Trichosanthes Peel (Gua Lou Pi, 3 qian) Scutellaria Root (Tiao Qin, 1.5 qian) Peucedanum Root (Qian Hu, 1.5 qian) Radish Seed (Lai Fu Zi, 2 qian) Fried Gardenia Fruit (Jiao Shan Zhi, 3 qian) Curcuma Tuber (Yu Jin, 3 qian) Apricot Seed (Xing Ren, 3 qian) Fritillaria Bulb (Xiang Bei, 3 qian) Aurantium Fruit (Zhi Ke, 1.5 qian)
Two doses.
Commentary by Jie: Warm pathogens enter from above, first attacking the Lungs, then transmitting to Yangming. Stomach heat combined with phlegm gradually presses against the Pericardium, causing fluctuating consciousness, dry mouth, cough, and constipation. Treatment uses clearing heat and transforming phlegm, aromatic opening of orifices. When Stomach heat descends, bowels move slightly. However, residual heat in the Lung sector remains uncleaned, so cough persists. Subsequent formulas continue to clear Upper Jiao Qi level heat to avoid further changes.
Yuzhuang Shen [Female Patient] Menstrual blood color is still purplish, coinciding with contraction of warm pathogens; cough is particularly severe; pulse is floating and large; red tongue; headache and body fever. Pathogenic heat has reached extreme levels in the Ying collaterals; treatment should clear heat and resolve phlegm. (Lunar April 11th)
Trichosanthes Root (Tian Hua Fen, 3 qian) Fritillaria Bulb (Xiang Bei, 3 qian) Scrophularia Root (Xuan Shen, 3 qian) Inula Flower (Xuan Fu Hua, 3 qian, wrapped) Forsythia Fruit (Lian Qiao, 3 qian) Chrysanthemum Flower (Gan Ju, 1.5 qian) Tangerine Peel (Ju Hong, 1 qian) Apricot Seed (Xing Ren, 3 qian) Salvia Root (Dan Shen, 3 qian) Cynanchum Root (Bai Qian, 1.5 qian) Honeysuckle Flower (Jin Yin Hua, 1.5 qian) (Guiding herb) Loquat Leaf (Pi Pa Ye, 3 slices, de-hairy)
Three doses.
Commentary by Jie: Yin deficiency with internal heat results in purplish menstrual blood. Contracting warm pathogens additionally attacks the Lungs, causing severe cough, body fever, and headache, with a floating-large pulse, indicating blazing Qi-level heat. However, with two types of heat combining, it easily enters the Ying level. Thus, this formula balances clearing Lung heat/stopping cough with addressing Ying heat.
Anchang Gu [Patient Surname] Warm-heat disease presents with delirious speech; pulse is hurried and rapid; slightly yellow tongue; faint rash points; cough and counterflow qi; fever; limb tremors. The condition is tricky. Prevent convulsions and syncope; observe healthy Qi. (April 24th / Jiachen Year, Lunar March 8th)
Acanthoscyllium Shell (Dai Mao, 1 qian) Arnebia Root (Zi Cao, 1 qian) Honeysuckle Flower (Jin Yin Hua, 3 qian) Trichosanthes Root (Tian Hua Fen, 3 qian) Forsythia Fruit (Lian Qiao, 3 qian) Cicada Slough (Chan Yi, 1 qian) Curcuma Tuber (Yu Jin, 3 qian, crushed) Silkworm (Jiang Can, 3 qian) Acorus Rhizome (Shi Chang Pu, 0.7 fen) Fritillaria Bulb (Xiang Bei, 3 qian) Traditional Hyacinth Bean (Tian Zhu Huang, 3 qian) (Guiding herb) Fresh Bamboo Leaf
One dose.
Commentary by Jie: The disease progressed from Lung-Wei to pressing into the Ying level, consuming fluids and stirring wind, leading to delirium and limb tremors. Fortunately, the appearance of rash and cough indicates pathogenic factors moving outward. However, the symptoms indicate extreme heat, so Dai Mao and Zi Cao are used to cool and resolve Ying level heat, while other herbs open orifices, resolve phlegm, clear heat, and vent pathogens. This is indeed an excellent formula for warm pathogens pressing into the Ying level.
Shengling Long [Patient Surname] Mixed contraction of Damp-Warmth, rejection in the Middle Jiao; pulse is choppy and stagnant; tongue coating is thick, tender, and yellow; difficult urination and defecation. Borrow Xiao Xian Xiong Tang to prevent changes and observe healthy Qi. (May 3rd / Jiachen Year, Lunar May 17th)
Trichosanthes Fruit (Gua Lou Zi, 1.5 qian) Immature Bitter Orange (Zhi Shi, 1 qian) Raw Talcum (Hua Shi, 4 qian) Fried Barley Sprout (Chao Mai Ya, 3 qian) Ginger-fried Coptis Rhizome (Chuan Lian, 0.8 fen) Raw Hawthorn Flesh (Shan Zha, 3 qian) Fried Gardenia Fruit (Jiao Zhi Zi, 3 qian) Apricot Seed (Xing Ren, 3 qian) Pinellia Tuber (Xian Ban Xia, 1.5 qian) Bamboo Leaf (Zhu Ye, 1.5 qian) Acorus Herb (Sheng Tou Cao, 3 qian)
Decoct in clear water. Two doses.
Commentary by Jie: Internal dampness is abundant, compounded by warm pathogens, lying dormant in the Middle Jiao. Phlegm formation obstructs the circulation of Qi transformation. Therefore, modified Xiao Xian Xiong Tang is used to eliminate Middle Jiao damp-heat and transform phlegm.
Shengling Xu [Patient Surname] Mixed contraction of Damp-Heat and Warm pathogens; alternating chills and fever; pulse is soggy and rapid; spontaneous loose stools; gray-yellow tongue center. Prevent mental clouding changes. Observe healthy Qi. (May 10th / Jiachen Year, Lunar May 24th)
Fried Medicated Leaven (Liu Qu, 4 qian) Red Poria (Chi Fu Ling, 4 qian) Raw Talcum (Hua Shi, 4 qian) Honeysuckle Flower (Jin Yin Hua, 1.5 qian) Forsythia Fruit (Lian Qiao, 3 qian) Soybean Hull (Da Dou Juan, 3 qian) Stephania Root (Fang Ji, 1.5 qian) Acorus Rhizome (Shi Chang Pu, 0.5 fen) Pinellia Tuber (Xian Ban Xia, 1.5 qian) Tangerine Peel (Chen Pi, 1.5 qian) Light Scutellaria Root (Dan Huang Qin, 1.5 qian)
Decoct in clear water. Two doses.
Commentary by Jie: Damp-heat stagnation with spontaneous loose stools, contracting warm pathogens, causing alternating chills and fever. The greatest fear is dampness obstructing Qi mechanism, carrying phlegm to cloud the clear orifices, manifesting as mental confusion. This condition cannot be treated with sweating (exterior) nor purging (interior); thus, the treatment priority is opening orifices and clearing damp-heat.
Daoxu Tao [Patient Surname] Mixed contraction of Damp-Warmth; vexing heat and dry mouth; body rash and macules; fluctuating consciousness; rapid pulse and yellow tongue. Clear orifices lose acuity; condition is tricky. Prevent syncope and closure. Observe healthy Qi. (May 23rd / Yisi Year, Lunar May 7th)
Fried Gardenia Fruit (Jiao Zhi Zi, 3 qian) Cyathula Root (Guan Zhong, 2 qian) Honeysuckle Flower (Jin Yin Hua, 2 qian) Barbarceae Seed (Niu Bang Zi, 1.5 qian) Fermented Soybean (Dan Dou Chi, 3 qian) Cicada Slough (Chan Yi, 1.5 qian) Forsythia Fruit (Lian Qiao)
First take one pill of Niu Huang Qing Xin Wan, followed by one dose of the herbal decoction.
Commentary by Jie: Dampness and heat steam each other, first blocking the Qi level. Fluids are scorched and fail to rise, causing vexing heat and dry mouth. Unresolved over time, pathogenic heat has no outlet, gradually entering the Ying level, causing coma and delirium, and clouding clear orifices, causing deafness. Fortunately, Lung-Stomach pathogens gradually emerge through rash and macules. However, the condition is critical. Treatment uses aromatic spirit-penetrating and light-leaching orifice-opening methods to disperse turbid damp pathogens.
Shengling Jiang [Patient Surname] Heat entering the Blood Chamber; rash and macules slightly appearing; yellow slippery tongue; epigastric fullness; dysentery; slight fever. Situation is critical and dangerous; clear and resolve, prevent syncope. (June 21st / Bingwu Year, Lunar June 7th)
Cyathula Root (Guan Zhong, 2 qian) Bi Yu San (3 qian, bagged) Soybean Hull (Da Dou Juan, 3 qian) Small Green Herb (Xiao Qing Cao, 1 qian) Raw Talcum (Hua Shi, 4 qian) Red Poria (Chi Fu Ling, 4 qian) Forsythia Fruit (Lian Qiao, 3 qian) Tongcao Stem (Tong Cao, 1.5 qian) Honeysuckle Flower (Jin Yin Hua, 3 qian) Fried Aurantium Fruit (Chao Zhi Ke, 1.5 qian) Acorus Herb (Sheng Tou Cao, 1.5 qian, guiding) Living Reed Rhizome (Lu Gen, 1 liang)
Two doses.
Second Visit: Blood chamber is cleared, dysentery improved; pulse is soggy and rapid; yellow tongue; harsh cough; lingering slight fever; white spots on chest. Primary treatment should be clearing and resolving. (June 24th / Bingwu Year, Lunar June 10th)
Bamboo Leaf (Zhu Ye, 1.5 qian) Honeysuckle Flower (Jin Yin Hua, 3 qian) Acorus Herb (Sheng Tou Cao, 1.5 qian) Platycodon Root (Jie Geng, 1.5 qian) Sichuan Fritillaria (Chuan Bei, 2 qian) Red Poria (Chi Fu Ling, 4 qian) Curcuma Tuber (Yu Jin, 3 qian) Soybean Hull (Da Dou Juan, 3 qian) Bi Yu San (4 qian, bagged) Small Green Herb (Xiao Qing Cao, 1 qian) Tongcao Stem (Tong Cao, 1.5 qian)
Decoct in clear water. Two doses.
Third Visit: Dysentery cured, body heat subsided; pulse is soggy and fine; epigastric and abdominal distension; cough and counterflow qi need treatment; prevent changes. (July 4th / Bingwu Year, Lunar July 20th)
Platycodon Root (Jie Geng, 1.5 qian) Aurantium Fruit (Zhi Ke, 1.5 qian) Xinhui Tangerine Peel (Xin Hui Pi, 1.5 qian) Cynanchum Root (Bai Qian, 1.5 qian) Fritillaria Bulb (Chuan Bei, 2 qian) Red Poria (Chi Fu Ling, 4 qian) Curcuma Tuber (Yu Jin, 3 qian) Cardamom Shell (Ke Qiao, 1.5 qian) Eupatorium Leaf (Pei Lan, 1.5 qian) Tongcao Stem (Tong Cao, 1.5 qian) Grain Sprout (Gu Ya, 4 qian) (Guiding herb) Lotus Leaf (He Ye, 1 corner)
Three doses.
Commentary by Jie: Dormant heat sinks from Yangming into the Blood Chamber. As blood flows downward, Yang heat floats upward, causing unclear consciousness and delirious speech. Zhang Zhongjing frequently instructed needle-pointing at Qimen (Liver Front-Mu point). Since Qimen is the Front-Mu point of the Liver channel, draining its heat and unblocking the channel allows sweat to cover the body, releasing stored heat externally, stopping bleeding, and ending delirium. This case's treatment does not follow the Xia Chai Hu Tang example but strictly adheres to Zhongjing's warning against damaging Stomach Qi and the Upper Two Jiaos. It still focuses on clearing heat and benefiting orifices, allowing trapped heat to vent and rash to emerge, which is indeed a good method. However, Liver channel heat may not resolve quickly, so preventing fluid consumption and wind-stirring leading to convulsions is necessary. Fortunately, trapped heat gradually finds an exit via the Large Intestine. Treatment with clearing/resolving leads to more rash, improved dysentery, and subsided fever, showing the efficacy of the first two formulas. Since Bi Yu San was used in the first formula, Talcum could be removed. If the third formula emphasizes clearing/resolving more, it would avoid lingering cough.
Xizhuang Yi [Patient Surname] Blood chamber is cleared; pulse is rapid; Qi Kou pulse is slippery; harsh cough and dizziness; body heat not subsided; yellow tongue with red tip; lower back pain and limb soreness. Still guard against changes; observe healthy Qi. (May 20th / Yisi Year, Lunar May 4th)
Trichosanthes Root (Gua Lou Gen, 3 qian) Winter Mulberry Leaf (Dong Sang Ye, 3 qian) Fritillaria Bulb (Xiang Bei, 3 qian) Earthworm (Di Long, 1.5 qian) Forsythia Fruit (Lian Qiao, 3 qian) Chrysanthemum Flower (Gan Ju, 1.5 qian) Broad Tangerine Peel (Guang Ju Hong, 1 qian) Apricot Seed (Xing Ren, 3 qian) Peucedanum Root (Qian Hu, 1.5 qian) Cyathula Root (Guan Zhong, 2 qian) Traditional Hyacinth Bean (Tian Zhu Huang, 1.5 qian) (Guiding herb) Bamboo Concretion (Zhu Rou, 1 pill)
Two doses.
Commentary by Jie: Warm pathogens transmit from Lungs to Stomach. Although exterior pathogens are resolved, interior heat continues steaming, so skin heat remains. Rising to the Lungs causes harsh cough and dizziness. Thus, treatment still focuses on descending Lung Qi and eliminating Stomach heat. Once Stomach heat is cleared, body heat and cough will cease. Due to lower back pain and limb soreness, Earthworm is added for its ability to traverse collaterals to reduce heat.
Yifeng Xu [Patient Surname] Winter-Warmth with sweating and fever; rapid pulse, right side forceful; thick yellow tongue center. Cough with shortness of breath, stabbing pain in right hypochondrium, fluctuating consciousness. Condition is critical and dangerous; prevent syncope and closure. Observe healthy Qi. (October 12th)
Earthworm (Di Long, 1.5 qian) Fritillaria Bulb (Xiang Bei, 3 qian) Winter Mulberry Leaf (Dong Sang Ye, 3 qian) Barbarceae Seed (Niu Bang Zi, 1.5 qian) Forsythia Fruit (Lian Qiao, 3 qian) Peucedanum Root (Qian Hu, 1.5 qian) Original Curcuma Tuber (Yu Jin, 3 qian) Tangerine Peel (Ju Hong, 1 qian) Apricot Seed (Xing Ren, 3 qian) Honeysuckle Flower (Jin Yin Hua, 1.5 qian) Traditional Hyacinth Bean (Tian Zhu Huang, 2 qian) Heart Bamboo Leaf (Juan Xin Zhu Ye, 30 leaves)
Two doses.
Second Visit: Right hypochondrium still painful; pulse slippery and rapid; yellow tongue; coarse breathing; cough with phlegm obstruction; fluctuating consciousness; still guard against changes.
Earthworm (Di Long, 1.5 qian) Acorus Rhizome (Shi Chang Pu, 0.8 fen) Peucedanum Root (Qian Hu, 1.5 qian) Curcuma Tuber (Yu Jin, 3 qian) Honeysuckle Flower (Jin Yin Hua, 3 qian) Forsythia Fruit (Lian Qiao, 3 qian) Fried Light Scutellaria Root (Chao Dan Huang Qin, 1.5 qian) Luffa Fiber (Si Gua Luo, 1.5 qian) Lai Tangerine Peel (Lai Ju Hong, 0.8 fen) Apricot Seed (Xing Ren, 3 qian) Traditional Hyacinth Bean (Tian Zhu Huang, 2 qian) Loquat Leaf (Pi Pa Ye, 3 slices, de-hairy)
Three doses.
Commentary by Jie: Winter-Warmth attacking the Lungs, unable to resolve externally, easily transmits inversely to the Pericardium, presenting with confused consciousness. Here, warm pathogens agitate Liver Yang, scorching fluids into phlegm, blocking Qi mechanism, causing cough, shortness of breath, and right hypochondriac stabbing pain. Treatment uses acrid-cool agents to regulate Lung-Stomach phlegm and resolve Qi-level heat. However, by the second visit, consciousness remains confused, and the condition is already tricky.