嘱其每3小时服1次，在其服第2次药不久时，突见身热更剧，体温40．1℃，且见谵语，手足躁扰搐动。其父母大为惊骇，急欲抱其赴病房抢救，正在着急之际，突见患儿大便得下，微汗出，体温亦降至38℃，神志转清，至1小时后，诸证消失。次日，索要饮食，继予一服，愈。
其母云：其病如此之危重，而先生却不急也?答曰：疫邪先传表后传里，表里合邪者，最易战汗而解，此证突然热甚，躁扰，乃欲作战汗之症也，正如吴又可《温疫论》所云：“疫邪先传表，后传里，急得战汗，经气输泄，当即脉静身凉，烦渴顿除。”“三五日阳气渐积，不待饮食劳碌，或有反复者，盖表邪已解，里邪未去，才觉发热，下之即解。”此吾之不急者一也。若急则挪动患儿，必不作战汗也，不战汗则病势反难速解，此所谓不急者二也。其母叹服，曰：余虽曾学中医，然未知其理也，应深究之。
麻疹
1．徒治里热之壅盛，忽视微寒之表郁，郁热不散，岂能得解
杨××，男，4岁。三天前，突然发热流泪，面部及全身出现皮疹，二天前，皮疹又突然消退，继而高热咳喘。医急以抗生素、中药麻杏石甘汤加减治之，不效。乃邀家父治之。云：麻疹喘用麻杏石甘汤实为正治之法，然杨氏患儿脉数中有紧，说明表郁寒邪，寒郁不散，则肺气壅闭作喘，治应于麻杏石甘汤中稍佐辛温。樟脑既温又散，且能透疹，可用之。1剂唇，喘减，热降。3剂后，愈。
2．肺热炽盛，反用清泻心肝之药，脏腑不同，徒用药饵马××，男，2岁。10天前，突患麻疹合并肺炎，急至某儿童医院治疗，住院7天，其效不著。乃邀某医治之。医云：坑生素、大剂中药宣肺定喘，清热解毒不效者，乃药力不足也，犀角为清热解毒之圣药，宜加用之。(注意：犀角现已禁用，可用水牛角代)。处方：犀角粉4．5克，分3次服。连服3日仍不见其效，且见其发热、咳喘更甚。又改邀马老先生治之。马老云：肺热炽盛，不用清肺之品，反用清心肝之药，不可也。喻昌曰：不明脏腑经络，开口动手便错，即此意也。处方：羚羊粉一钱半，分三次服。连服两日，热退，喘止，诸证均失。
病毒性肝炎
1．病为湿热，反用辛甘而温，湿热更甚，延误病期
曹××，女，45岁。十几天来，疲乏无力，身热困重，医始作感冒论治，予感冒清、感冒通，后又作虚证予补益之方，然均不效。某医诊之，云：《伤寒论》言：太阳病，外证未解，脉浮弱者，当以汗解，宜桂枝汤。处方：桂枝10克，白芍10克，炙草10克，生姜4片，大枣7枚(擘)。服药l剂，患者自感烦乱不安，再求该医处方论治。云：“太阳病，初服桂枝汤，反烦不解者，先刺风池、风府，却与桂枝汤则愈。”乃再与桂枝汤1剂，并刺风池、风府。两日后，烦乱更加，并见身黄、尿黄、目黄。乃急转某院求治，诊为亚急性肝坏死。该医询问于予。答曰：湿温之湿重热轻证，其证见头痛恶寒，或恶寒少许，身热不扬，身重疼痛，舌苔白，脉濡缓与太阳中风之头痛，发热，汗出，恶风，脉缓者极为相似，稍有不慎，或将湿温作中风，或将中风作湿温，而两病之治有霄壤之别。若中风作湿温论治，则营卫不调之证更剧，若湿温作中风论治，则湿热壅滞更甚，甚或出现阳盛则毙的现象。某师曾云：猝见身热乏力脉缓之证，辨之甚难，稍有不慎，或以热为寒，或以风作湿，或以虚作实，而误治之，又往往后果不可收拾。此乃经验之谈也。
2．湿郁清阳，当用苦辛，反用呆滞，病故难解郑××，男，45岁。传染性肝炎3年，住院2年，诸证不减。审其诸证，惟见身重乏力，纳差食减，胃脘微痞，偶见胁下隐痛，他无所苦。再审诸医之方药，西药大多为保肝之品，中药或以茵陈辈，或以清热解毒剂，或以疏肝和胃方，然不是不效，就是诸证加重，且日感难于行动矣。察其苔、脉，舌苔薄白，脉见濡缓。因思此恐脾虚之证耳。因拟完带汤加减。处方：白术30克，山药30克，党参10克，白芍10克，车前子10克(布包)，苍术10克，甘草6克，陈皮10克，柴胡3克。服药6剂，其证不减。因忆《伤寒论》云“伤寒五六日，已发汗而复下之，胸胁满微结，小便不利，渴而不呕，但头汗出，往来寒热，心烦者，此为未解也。柴胡桂枝干姜汤主之。”又唐容川曰：“已发汗，则阳气外泄矣。又复下之，则阳气下陷水饮内动，逆于胸胁，故胸胁满微结。小便不利，水结则津不升，故渴。此与五苓散证同一意也。阳遏于内，不能回散，但能上冒，为头汗出。而通身阳气欲出不能，则往来寒热。此与小柴胡汤同一意也。此皆寒水之气，闭其胸膈腠理，而火不得外发，则返于心包，是以心烦。故用柴胡以透达膜腠，用姜、桂以散撤寒水，又用瓜蒌、黄芩以清心郁之火。夫散寒必先助其火，本证心烦，已是火郁于内，初服桂姜，反助其火，故仍见微烦。复与桂姜之性，已得升达，而火外发矣，是以汗出而愈。”询之患者确微有寒热往来，口渴之苦。予柴胡桂枝干姜汤4剂，果然诸证大减，继服4剂，诸证竟失，愈。
3．不审脉证，但予解毒，食滞不化，病反不解苏××，男，29岁。尿黄，目珠微黄，腹满纳呆2年多。医诊传染性肝炎。先以西药治疗1年不效，后以中药清热解毒，燥湿清热等1年亦不效。审其除尿色黄赤，目珠微黄，脘腹微满，纳呆乏力外，并见舌苔白腻，脉弦紧数。综合脉证，思之：弦紧数脉者，肝肖不和，食滞不化脉也。治宜疏肝和胃，消食导滞。处方：川芎10克，苍术15克，香附10克，栀子10克，神曲30克，焦楂30克，茯苓10克，半夏10克，陈皮10克，连翘10克，莱菔子15克，麦芽15克。
服药6剂，尿色转清，食纳增加。经查肝功、尿胆素等均正常。
患者云：何用越鞠保和丸收功如此之速也?答曰：药证合拍也。今食积不化而久不导其滞，故湿热壅郁而为黄疸，今积滞除，湿热化，故得愈也。
流行性乙型脑炎
1．阴盛格阳，反以攻热，阴盛热盛，其病不解
患者，苏××，女，50岁。流行性乙型脑炎，深度昏迷，持续高热不退7天。前医以大剂白虎汤加减、西药、物理降温，其证不减。审之，除深度昏迷，高热40．1℃外，并见舌质红绛，脉数。综合脉证思之：舌质红绛者乃热人营血也，治宜清营凉血；再察其舌苔微黄，知其气分亦热也，当宗叶天士之谓：入营犹可透热转气。乃与清瘟败毒饮加减为法：蜈蚣6条，全蝎6克，生地30克，白芍10克，丹皮10克，丹参10克，元参30克，生石膏60克，知母10克，银花15克，连翘15克。服药3剂，体温降至37．5℃，神志转清。但服至第4剂时，体温又升至40．3℃，神志再度昏迷，再服上方2剂，诸证更甚。再邀予诊。审其除神昏、身热外，并见其腹软而大便失禁，且臭味不明显，指趾厥冷，面虽赤而舌苔薄白，舌质淡嫩。因思仲景《伤寒论》有云：“少阴病，下利清谷，里寒外热，手足厥逆，脉微欲绝，身反不恶寒，其人面色赤，通脉四逆汤主之。”又思尤在泾《伤寒贯珠集》云：“下利消谷，手足厥逆，脉微欲绝者，阴盛于内也，身热不恶寒，面色赤者，格阳于外也。真阳之气，被阴寒所迫，不安其处，而游散于外，故显诸热象，实非热也。”本病之证很似此证，然医家多认为伤寒伤阳，温病伤阴。乙脑者，暑温证也，暑温医家只言其有伤阴之说，而无伤阳之论，岂敢逆天下诸医之说而予大辛大热之剂乎!不得已，勉以生脉散加味一剂试之。其证不减。再思仲景有言随证治之，前人有是证用是药之说，且本证阴盛格阳之象甚著。乃再与诸医相议：成无己《注解伤寒论》云：“下利消谷，手足厥逆，脉微欲绝，为里寒；身热不恶寒，面色赤，为外热，此阴盛于内，格阳于外，不相通也，与通脉四逆汤散寒通阳。”此前用寒药伐阳气助格拒，非其治也，若再予寒凉则恐生命不久也，治宜急予破阴通阳，若稍迟疑恐不治。众医云：可。乃予通脉四逆汤：附子10克，于姜10克，炙甘草10克。服药1剂，神志即清，体温亦降37．2℃，大便亦转正常。后果愈。诸医云：有是证，用是药，真乃卓见，尤应记之。
2．腑实不除，但予清热，病在中焦，反治上焦，南辕北辙，怎能得愈
贺××，男，24岁。6天前，突然高热头痛不止。急诊人院。住院3个小时后即神志昏迷不清。急予清热解毒，清气凉营，清心开窍，清瘟败毒饮加减、安宫牛黄丸，西药、物理降温治之，至今一直不效。邀余治之。察其除深度昏迷外，并见其头、身均置冰袋，按其头身均冰冷如尸，脉沉微欲绝，看其古质红，苔黄厚干燥，腹微见膨隆，按其胃脘硬满。询其二便，家属答云：已7日未见矣。思之：此莫不是体厥之证?吴又可《温疫论》云：“温疫得里证，神色不败，言动自如，别无怪证，忽然六脉如丝，沉细不应指，似有如无，或两手俱无，或两手先伏，察其人不应有此脉，有此脉者，皆缘应下失下，内结壅闭，营气逆于内，不能达于四末，此脉厥也。亦有过用黄连、石膏诸苦寒药，强遏其热，致邪愈结，脉愈不通……宜承气汤缓下之，六脉自复。”“阳证阴脉身冷如冰，为体厥……口燥舌干．胎刺如锋，不时太息，咽喉肿痛，心腹胀满，按之痛甚，渴思冰水，日晡益甚，小便赤涩，得涓滴则痛甚，此下证悉具，但通身肌表如冰，指甲青黑，六脉如丝，寻之则有，稍按则无……以脉相参，表里互较，此阳证之最甚者，下证悉具，但嫌下之晚耳。盖因内热之极，气道壅闭，热汲反兼水化，《内经》之亢害证也，乃至脉微欲绝，此脉厥也。阳郁则四肢蹶逆，若素禀肥盛，尤易壅闭，今亢阳已极。以至通身冰冷，此体厥也；六脉如无者，群龙无首之象，证亦危矣，投大承气汤。”此证虽不如吴氏言谈之典型，然从其舌、腹可辨，且仲景《伤寒论》有云：“少阴病，六七日，腹胀，不大便者，急下之，宜大承气汤。”乃与大承气汤。处方：厚朴15克、枳实15克、大黄10克、芒硝10克(冲)。处方刚毕，医云：朱老何不用安宫牛黄丸”答曰：安宫牛黄丸乃治上焦之药，此病明系中焦腑实之证，故不与也?医又云：神志昏迷乃心君之病，安宫牛黄丸乃治心开窍之圣品，何不用之?答曰：神昏有在阳明和心包之分，非仅心包之疾能神昏也，此证病在阳明，不在心包，故不用安宫牛黄治心包，此正如《内经》适其至所意也。又问：清瘟败毒饮加减为方余屡用屡效，何此证反不效也?答曰：此正吴氏所谈之应下失下，但予冰伏之故也。鼻饲1剂，次日果然神清厥回，后果愈。
流行性腮腺炎
1．外感复加，不知疏散，但予解毒，其病难解
岳××，男，6岁。7天前，突然两腮发现肿痛，医予抗生素治之，3天后，不但肿痛之状不减，反见身热达38．8℃。乃邀某医以中药清热解毒之品，板蓝根、元参、银花、连翘，外敷紫金锭治之，4天后，诸证不减。乃邀余前往诊治。医云：所直用诸药均老师所讲治疗腮腺炎方药。然何用之不效也?答曰：病发之始不见发热，三天之后始见发热，此必有新的病因加入也。新的病因为何?在小儿来讲，非外感，即食积察其证不见腹胀满痛之苦，仅见头痛，时有喷嚏之疾，且咏浮数，乃外感之邪所致也。宜上方酌加辛凉解表疏散可也。加蝉蜕、薄荷、荆芥各9克。服药】剂，果然热退证减，后即愈
2．久郁积热，但予解毒，郁其阳气，其热不减员××，男，5岁。5日来，两侧腮腺肿胀疼痛，发热持续不退。医始以抗生素、中药清热解毒，疏风解表之剂治之，不效。邀余诊视。医云：余用老师所介绍之经验，先用清热解毒，后用疏风清热，然其不效者何也?答曰：患者素有便秘，反复发热史，此乃素有积热之证。素有积热者，应佐通腑，此前用诸法所不及也。法宜疏风清热，清腑解毒。处方：蝉衣10克，僵蚕10克，片姜黄10克，板蓝根30克，元参15克，大黄5克，薄荷10克。服药2剂，发热即解，继服2剂，愈。
3．但予解毒，不予散结，久病难除赵××，男，38岁。两侧耳下腮部漫肿疼痛，咀嚼不便一个多月。医诊腮腺炎、、始予西药抗生素与其他对症方法治疗无效，又加用中药普济消毒饮内眼，紫金锭外涂仍无功。且数天来又发现睾丸肿痛：乃改邀余诊治。察其两腮虽肿大隐隐作痛，但色不变，睾丸虽肿大，但阴囊皮色几近正常，舌苔白，脉沉弦小数。因云：此乃火郁较久而痰凝也。治宜拟疏肝解郁，化痰散结。处方：夏枯草30克，赤芍10克，橘叶10克，苏木6克，青皮10克，元参15克，板蓝根15克。服药4剂，腮腺肿痛及睾丸肿痛消退近八成，又服6剂果愈。其母亦系中医，乃云：朱敦授，既然诸医均介绍用普济消毒饮加减，紫金锭外涂有效，何本证反无效而引起并发症?曰：普济消毒饮者，乃清热解毒之良剂，其用于热毒蕴结者往往效如桴鼓，而本证发热不甚，热毒较轻，且脉见沉弦，乃气郁痰结较甚所致，此时若再过用寒凉必使痰凝不化，而病不除。故今以理气散结，微予寒凉清热解毒而愈也。
淋巴细胞脉络丛脑膜炎
嘱其每3小时服用1次药。在患者服用第2次药不久后，突然见到身体发热更加剧烈，体温达到40.1℃，并且出现胡言乱语（谵语），手足躁动不安、抽搐抖动。其父母大为惊恐害怕，急忙想要抱着他去医院病房抢救，正在焦急之际，突然看见患儿排出大便，微微出汗，体温也降至38℃，神志转为清醒，到1小时后，所有症状消失。第二天，索要饮食，再给予一服药，病愈。
他的母亲说：“病情如此危重，而先生却不着急吗？”回答说：“疫邪先传入体表，后传入体内，表里同时受邪的，最容易通过战汗（寒战之后出汗）而痊愈。这个病例突然高热严重、躁动不安，正是将要发生战汗的症状。正如吴又可《温疫论》所说：‘疫邪先传表，后传里，急得战汗，经气输泄，当即脉静身凉，烦渴顿除。’‘三五日阳气渐积，不待饮食劳碌，或有反复者，盖表邪已解，里邪未去，才觉发热，下之即解。’这是我之所以不着急的第一个原因。如果急于移动患儿，必定不会发生战汗，不发生战汗则病情反而难以迅速解除，这是我之所以不着急的第二个原因。”其母感叹佩服，说：“我虽然曾学过中医，但不知道其中的道理，应当深入研究。”
麻疹
1．只治疗里热壅盛，忽视轻微寒邪束表，郁热不散，怎么能解除？
杨××，男，4岁。三天前，突然发热流泪，面部及全身出现皮疹；二天前，皮疹又突然消退，继而出现高热、咳嗽气喘。医生急忙使用抗生素、中药麻杏石甘汤加减治疗，无效。于是邀请家父诊治。说：“治疗麻疹喘证使用麻杏石甘汤确实是正治之法，然而杨氏患儿的脉象数中带紧，说明有表郁寒邪，寒邪郁结不散，导致肺气壅闭而作喘，治疗应当在麻杏石甘汤中稍微佐以辛温药物。樟脑既温热又能发散，且能透发疹毒，可以使用它。”服用1剂后，喘减，热降。3剂后，病愈。
2．肺热炽盛，反而使用清泻心肝的药物，脏腑不同，徒然用药饵
马××，男，2岁。10天前，突发麻疹合并肺炎，急忙到某儿童医院治疗，住院7天，疗效不显著。于是邀请某医生诊治。医生说：“抗生素、大剂量中药宣肺定喘、清热解毒无效的，是药力不足，犀角是清热解毒的圣药，应该加入使用。（注意：犀角现已禁用，可用水牛角代替）。处方：犀角粉4.5克，分3次服用。连续服用3日仍不见效，且见发热、咳喘更严重。又改邀马老先生诊治。马老说：“肺热炽盛，不用清肺的药物，反而使用清心肝的药物，是不可以的。喻昌说：‘不明脏腑经络，开口动手便错’，就是这个意思。”处方：羚羊粉一钱半，分三次服用。连续服用两日，热退，喘止，所有症状均消失。
病毒性肝炎
1．病因为湿热，反而使用辛甘温热的药物，湿热更甚，延误病程
曹××，女，45岁。十几天来，疲乏无力，身体发热困重。医生起初当作感冒论治，给予感冒清、感冒通，后来又当作虚证给予补益方剂，然而均无效。某医生诊察后说：“《伤寒论》言：太阳病，外证未解，脉浮弱者的，应当以发汗法解除，宜用桂枝汤。”处方：桂枝10克，白芍10克，炙甘草10克，生姜4片，大枣7枚（掰开）。服药1剂，患者自感烦乱不安，再次求该医生处方论治。医生说：“太阳病，初服桂枝汤，反烦不解的，先针刺风池、风府穴，再给予桂枝汤则愈。”于是再给予桂枝汤1剂，并针刺风池、风府。两天后，烦乱更加严重，并出现身黄、尿黄、目黄。于是急忙转院求治，诊断为亚急性肝坏死。该医生向我询问。回答说：“这是湿温病的湿重热轻证，其症状见头痛恶寒，或恶寒少许，身热不扬，身重疼痛，舌苔白，脉濡缓，与太阳中风证的头痛、发热、汗出、恶风、脉缓极为相似，稍有不慎，或将湿温误作中风，或将中风误作湿温，而两种病的治疗有天壤之别。若将中风当作湿温论治，则营卫不调的症状会更严重；若将湿温当作中风论治，则湿热壅滞会更严重，甚至出现阳盛则死的现象。某老师曾说：猝然见到身热乏力脉缓的症状，辨别很难，稍有不慎，或以热为寒，或以风作湿，或以虚作实，从而误治，往往后果不可收拾。这是经验之谈啊。”
2．湿邪郁遏清阳，当用苦辛法，反而使用呆滞药物，病情难解
郑××，男，45岁。传染性肝炎3年，住院2年，各种症状不减。审察其各种症状，只见身体沉重乏力，食欲差食量减少，胃脘部微痞闷，偶尔见胁下隐痛，没有其他痛苦。再审察之前医生的方药，西药大多为保肝之品，中药或以茵陈辈，或以清热解毒剂，或以疏肝和胃方，然而不是无效，就是诸证加重，且日益感到行动困难。观察其舌苔、脉象，舌苔薄白，脉象濡缓。因而思考这可能是脾虚之证。因此拟定完带汤加减。处方：白术30克，山药30克，党参10克，白芍10克，车前子10克（布包），苍术10克，甘草6克，陈皮10克，柴胡3克。服药6剂，症状不减。因而想起《伤寒论》云：“伤寒五六日，已发汗而复下之，胸胁满微结，小便不利，渴而不呕，但头汗出，往来寒热，心烦者，此为未解也。柴胡桂枝干姜汤主之。”又唐容川说：“已发汗，则阳气外泄矣。又复下之，则阳气下陷水饮内动，逆于胸胁，故胸胁满微结。小便不利，水结则津不升，故渴。此与五苓散证同一意也。阳遏于内，不能回散，但能上冒，为头汗出。而通身阳气欲出不能，则往来寒热。此与小柴胡汤同一意也。此皆寒水之气，闭其胸膈腠理，而火不得外发，则返于心包，是以心烦。故用柴胡以透达膜腠，用姜、桂以散撤寒水，又用瓜蒌、黄芩以清心郁之火。夫散寒必先助其火，本证心烦，已是火郁于内，初服桂姜，反助其火，故仍见微烦。复与桂姜之性，已得升达，而火外发矣，是以汗出而愈。”询问患者确实微有寒热往来、口渴之苦。给予柴胡桂枝干姜汤4剂，果然诸证大减，继服4剂，诸证竟失，病愈。
3．不审察脉证，只给予解毒，食滞不化，病情反而不解
苏××，男，29岁。尿黄，眼珠微黄，腹胀纳呆2年多。医生诊断为传染性肝炎。先以西药治疗1年无效，后以中药清热解毒、燥湿清热等治疗1年亦无效。审察其除尿色黄赤、眼珠微黄、脘腹微满、纳呆乏力外，并见舌苔白腻，脉弦紧数。综合脉证，思考：弦紧数脉，是肝脾不和、食滞不化的脉象。治疗宜疏肝和胃，消食导滞。处方：川芎10克，苍术15克，香附10克，栀子10克，神曲30克，焦山楂30克，茯苓10克，半夏10克，陈皮10克，连翘10克，莱菔子15克，麦芽15克。
服药6剂，尿色转清，食欲增加。经查肝功、尿胆素等均正常。
患者说：“为什么用越鞠保和丸收功如此之快？”回答说：“药证合拍啊。现在食积不化而久不疏导其滞，所以湿热壅郁而为黄疸，现在积滞除，湿热化，所以得以痊愈。”
流行性乙型脑炎
1．阴盛格阳，反而以攻热法治疗，阴盛热盛，病情不解
患者，苏××，女，50岁。流行性乙型脑炎，深度昏迷，持续高热不退7天。前医以大剂白虎汤加减、西药、物理降温，其证不减。审察之，除深度昏迷、高热40.1℃外，并见舌质红绛，脉数。综合脉证思考：舌质红绛乃是热入营血，治疗宜清营凉血；再察其舌苔微黄，知其气分亦热，应当遵循叶天士所说的：入营犹可透热转气。于是以清瘟败毒饮加减为法：蜈蚣6条，全蝎6克，生地30克，白芍10克，丹皮10克，丹参10克，元参30克，生石膏60克，知母10克，银花15克，连翘15克。服药3剂，体温降至37.5℃，神志转清。但服至第4剂时，体温又升至40.3℃，神志再度昏迷，再服上方2剂，诸证更甚。再邀我诊治。审察其除神昏、身热外，并见其腹软而大便失禁，且臭味不明显，指趾厥冷，面虽赤而舌苔薄白，舌质淡嫩。因而思考仲景《伤寒论》有云：“少阴病，下利清谷，里寒外热，手足厥逆，脉微欲绝，身反不恶寒，其人面色赤，通脉四逆汤主之。”又思考尤在泾《伤寒贯珠集》云：“下利消谷，手足厥逆，脉微欲绝者，阴盛于内也，身热不恶寒，面色赤者，格阳于外也。真阳之气，被阴寒所迫，不安其处，而游散于外，故显诸热象，实非热也。”本病的症状很类似此证，然而医家多认为伤寒伤阳，温病伤阴。乙脑属于暑温证，暑温医家只言其有伤阴之说，而无伤阳之论，岂敢违背天下诸医之说而给予大辛大热的药剂呢！不得已，勉强以生脉散加味一剂试之。其证不减。再思考仲景有言随证治之，前人有是证用是药之说，且本证阴盛格阳之象甚著。于是再与诸医商议：成无己《注解伤寒论》云：“下利消谷，手足厥逆，脉微欲绝，为里寒；身热不恶寒，面色赤，为外热，此阴盛于内，格阳于外，不相通也，与通脉四逆汤散寒通阳。”此前用寒药伐阳气助格拒，不是正确的治疗，若再予寒凉则恐怕生命不久也，治疗宜急予破阴通阳，若稍迟疑恐不治。众医生说：“可以。”于是给予通脉四逆汤：附子10克，干姜10克，炙甘草10克。服药1剂，神志即清，体温亦降37.2℃，大便亦转正常。后果痊愈。诸医生说：“有是证，用是药”，真是卓见，尤其应当记住。
2．腑实不除，只予清热，病在中焦，反治上焦，南辕北辙，怎能得愈
贺××，男，24岁。6天前，突然高热头痛不止。急诊入院。住院3个小时后即神志昏迷不清。急予清热解毒、清气凉营、清心开窍、清瘟败毒饮加减、安宫牛黄丸、西药、物理降温治疗，至今一直无效。邀我诊治。察其除深度昏迷外，并见其头、身均置冰袋，按其头身均冰冷如尸，脉沉微欲绝，看其舌质红，苔黄厚干燥，腹微见膨隆，按其胃脘硬满。询问其二便，家属答说：已7日未见矣。思考：这莫非是体厥之证？吴又可《温疫论》云：“温疫得里证，神色不败，言动自如，别无怪证，忽然六脉如丝，沉细不应指，似有如无，或两手俱无，或两手先伏，察其人不应有此脉，有此脉者，皆缘应下失下，内结壅闭，营气逆于内，不能达于四末，此脉厥也。亦有过用黄连、石膏诸苦寒药，强遏其热，致邪愈结，脉愈不通……宜承气汤缓下之，六脉自复。”“阳证阴脉身冷如冰，为体厥……口燥舌干，胎刺如锋，不时太息，咽喉肿痛，心腹胀满，按之痛甚，渴思冰水，日晡益甚，小便赤涩，得涓滴则痛甚，此下证悉具，但通身肌表如冰，指甲青黑，六脉如丝，寻之则有，稍按则无……以脉相参，表里互较，此阳证之最甚者，下证悉具，但嫌下之晚耳。盖因内热之极，气道壅闭，热汲反兼水化，《内经》之亢害证也，乃至脉微欲绝，此脉厥也。阳郁则四肢蹶逆，若素禀肥盛，尤易壅闭，今亢阳已极。以至通身冰冷，此体厥也；六脉如无者，群龙无首之象，证亦危矣，投大承气汤。”此证虽不如吴氏言谈之典型，然而从其舌、腹可辨，且仲景《伤寒论》有云：“少阴病，六七日，腹胀，不大便者，急下之，宜大承气汤。”于是给予大承气汤。处方：厚朴15克、枳实15克、大黄10克、芒硝10克（冲）。处方刚毕，医生说：“朱老为何不用安宫牛黄丸？”回答说：“安宫牛黄丸乃治上焦之药，此病明系中焦腑实之证，故不与也。”医生又说：“神志昏迷乃心君之病，安宫牛黄丸乃治心开窍之圣品，何不用之？”回答说：“神昏有在阳明和心包之分，非仅心包之疾能神昏也，此证病在阳明，不在心包，故不用安宫牛黄治心包，此正如《内经》适其至所意也。”又问：“清瘟败毒饮加减为方余屡用屡效，何此证反不效也？”回答说：“此正吴氏所谈之应下失下，但予冰伏之故也。”鼻饲1剂，次日果然神清厥回，后果痊愈。
流行性腮腺炎
1．外感复加，不知疏散，只予解毒，病情难解
岳××，男，6岁。7天前，突然两腮发现肿痛，医生给予抗生素治疗，3天后，不但肿痛之状不减，反见身热达38.8℃。于是邀请某医生用中药清热解毒之品，板蓝根、元参、银花、连翘，外敷紫金锭治疗，4天后，诸证不减。于是邀请我前往诊治。医生说：“所用诸药均是老师所讲治疗腮腺炎方药。然而为何用之不效？”回答说：“病发之初不见发热，三天之后始见发热，这必有新的病因加入也。新的病因为何？在小儿来讲，非外感，即食积。察其证不见腹胀满痛之苦，仅见头痛，时有喷嚏之疾，且脉浮数，乃外感之邪所致也。宜上方酌加辛凉解表疏散可也。加蝉蜕、薄荷、荆芥各9克。”服药1剂，果然热退证减，后即痊愈。
2．久郁积热，只予解毒，郁其阳气，其热不减
员××，男，5岁。5日来，两侧腮腺肿胀疼痛，发热持续不退。医生起初以抗生素、中药清热解毒、疏风解表之剂治疗，无效。邀我诊视。医生说：“我用老师所介绍之经验，先用清热解毒，后用疏风清热，然而其不效者何也？”回答说：“患者素有便秘，反复发热史，此乃素有积热之证。素有积热者，应佐通腑，此前用诸法所不及也。法宜疏风清热，清腑解毒。”处方：蝉衣10克，僵蚕10克，片姜黄10克，板蓝根30克，元参15克，大黄5克，薄荷10克。服药2剂，发热即解，继服2剂，痊愈。
3．只予解毒，不予散结，久病难除
赵××，男，38岁。两侧耳下腮部漫肿疼痛，咀嚼不便一个多月。医生诊断腮腺炎，开始给予西药抗生素与其他对症方法治疗无效，又加用中药普济消毒饮内服，紫金锭外涂仍无功。且数天来又发现睾丸肿痛：于是改邀我诊治。察其两腮虽肿大隐隐作痛，但色不变，睾丸虽肿大，但阴囊皮色几近正常，舌苔白，脉沉弦小数。因而说：“此乃火郁较久而痰凝也。治疗宜拟疏肝解郁，化痰散结。”处方：夏枯草30克，赤芍10克，橘叶10克，苏木6克，青皮10克，元参15克，板蓝根15克。服药4剂，腮腺肿痛及睾丸肿痛消退近八成，又服6剂果愈。其母亦系中医，于是说：“朱敦授，既然诸医均介绍用普济消毒饮加减，紫金锭外涂有效，为何本证反无效而引起并发症？”回答说：“普济消毒饮者，乃清热解毒之良剂，其用于热毒蕴结者往往效如桴鼓，而本证发热不甚，热毒较轻，且脉见沉弦，乃气郁痰结较甚所致，此时若再过用寒凉必使痰凝不化，而病不除。故今以理气散结，微予寒凉清热解毒而愈也。”
Instructed to take the medicine once every 3 hours. Shortly after the patient took the second dose, it was suddenly observed that the body heat became more severe, with a body temperature of 40.1°C, accompanied by delirium (delirious speech) and restlessness with convulsions of the hands and feet. The parents were greatly terrified and anxious to carry him to the hospital ward for emergency rescue. Just as they were in a panic, it was suddenly seen that the child passed stool, sweated slightly, and the body temperature dropped to 38°C. The mental state cleared, and within one hour, all symptoms disappeared. The next day, he asked for food. Another dose was administered, and he recovered.
His mother said: "The illness was so critical, yet you did not seem anxious?" I replied: "The epidemic pathogen first transmits to the exterior, then to the interior. When both exterior and interior are affected simultaneously, it is most likely to resolve through *zhan han* (shivering followed by sweating). This case's sudden severe fever and restlessness indicate that it is about to undergo *zhan han*. As Wu Keyi stated in *Wen Yi Lun* (Treatise on Epidemic Febrile Diseases): 'The epidemic pathogen first transmits to the exterior, then to the interior. If *zhan han* occurs urgently, the meridional qi is vented, the pulse becomes calm, the body cools down, and the vexation and thirst are instantly relieved.' 'On the third to fifth day, yang qi gradually accumulates. Without needing dietary excess or physical exertion, there may be recurrences. This is because the exterior pathogen has been resolved, but the interior pathogen remains; feeling feverish again indicates that purgation will resolve it.' This is my first reason for not being anxious. If we had moved the child hastily, *zhan han* would certainly not have occurred. Without *zhan han*, the disease course would have been harder to resolve quickly. This is my second reason for not being anxious." His mother sighed in admiration and said: "Although I studied Traditional Chinese Medicine before, I did not understand the principle. I should study it deeply."
Measles
1. Treating only the interior heat congestion while ignoring the slight exterior cold constraint; if the constrained heat does not dissipate, how can it resolve?
Yang XX, male, 4 years old. Three days ago, he suddenly developed fever, tearing, and rashes on the face and whole body. Two days ago, the rashes suddenly disappeared, followed by high fever, cough, and wheezing. The doctor urgently treated him with antibiotics and modified *Ma Xing Shi Gan Tang* (Ephedra, Apricot Seed, Gypsum, and Licorice Decoction), but it was ineffective. My father was invited to treat him. He said: "Using *Ma Xing Shi Gan Tang* for measles-induced wheezing is indeed the correct treatment method. However, the child's pulse is rapid with a tightness, indicating exterior-constrained cold pathogen. If the cold constrains and does not dissipate, lung qi becomes congested and closed, causing wheezing. The treatment should add slightly acrid-warm herbs to *Ma Xing Shi Gan Tang*. Camphor is both warming and dispersing, and can also promote the eruption of rashes; it can be used." After one dose, the wheezing decreased, and the fever dropped. After three doses, he recovered.
2. Lung heat blazing fiercely, yet using herbs to clear and drain the Heart and Liver; since the zang-fu organs differ, merely using medication is futile.
Ma XX, male, 2 years old. Ten days ago, he suddenly contracted measles complicated with pneumonia and was urgently admitted to a children's hospital. After seven days of hospitalization, the efficacy was not significant. A certain doctor was invited. The doctor said: "Antibiotics, large doses of Chinese herbs to diffuse the lungs and relieve wheezing, and clear heat and detoxify—these failed because the medicinal power was insufficient. Rhinoceros horn is the sacred herb for clearing heat and detoxifying; it should be added. (Note: Rhinoceros horn is now banned; water buffalo horn can be used as a substitute.) Prescription: Rhinoceros horn powder 4.5 grams, taken in three divided doses. After taking it continuously for three days, there was still no effect, and the fever and wheezing worsened. Mr. Ma was invited again. Mr. Ma said: 'Lung heat is blazing fiercely, yet instead of using herbs to clear the lungs, herbs to clear the Heart and Liver are used. This is incorrect.' Yu Chang said: 'If one does not understand the zang-fu and collaterals, opening one's mouth and moving one's hands leads to errors,' which is exactly this meaning. Prescription: Antelope horn powder 1 qian and half, taken in three divided doses. After taking it for two days, the fever subsided, the wheezing stopped, and all symptoms disappeared."
Viral Hepatitis
1. The pathology is damp-heat, yet acrid-sweet-warm herbs are used; damp-heat becomes worse, delaying the disease course.
Cao XX, female, 45 years old. For over ten days, she suffered from fatigue and weakness, with a sensation of heat and heaviness in the body. The doctor initially treated her for a common cold, prescribing *Gan Mao Qing* and *Gan Mao Tong*. Later, treating her as a deficiency syndrome, tonifying formulas were given, but none were effective. A certain doctor diagnosed her, saying: "*Shang Han Lun* (Treatise on Cold Damage) states: In Taiyang disease, if the exterior syndrome is unresolved and the pulse is floating and weak, it should be resolved by sweating, preferably with Gui Zhi Tang." Prescription: Gui Zhi (Cinnamon Twig) 10 g, Bai Shao (White Peony Root) 10 g, Zhi Gan Cao (Honey-fried Licorice Root) 10 g, Sheng Jiang (Fresh Ginger) 4 slices, Da Zao (Jujube) 7 pieces (split). After one dose, the patient felt internally troubled and uneasy, and sought the same doctor again. The doctor said: "'In Taiyang disease, if after the first dose of Gui Zhi Tang, vexation persists without resolution, first needle Feng Chi and Feng Fu points, then administer Gui Zhi Tang to cure.'" Thus, another dose of Gui Zhi Tang was given, along with needling at Feng Chi and Feng Fu. Two days later, the internal turmoil worsened, and jaundice of the body, urine, and eyes appeared. She was urgently transferred to another hospital and diagnosed with subacute hepatic necrosis. The doctor asked me for an opinion. I replied: "This is a damp-heat syndrome where dampness is heavy and heat is light. Symptoms include headache and aversion to cold, or slight aversion to cold, unmanifested body heat, heaviness and pain in the body, white tongue coating, and a soggy-slow pulse. These are extremely similar to Taiyang Wind Strike syndrome's headache, fever, sweating, aversion to wind, and slow pulse. With slight carelessness, damp-heat might be mistaken for Wind Strike, or Wind Strike for damp-heat. The treatments for these two diseases are worlds apart. If Wind Strike is treated as damp-heat, the disharmony of Ying and Wei will worsen; if damp-heat is treated as Wind Strike, the stagnation of damp-heat will become more severe, potentially leading to death due to excessive Yang. A teacher once said: 'Suddenly encountering symptoms of body heat, fatigue, and a slow pulse makes differentiation very difficult. Slight carelessness may lead to mistaking heat for cold, wind for dampness, or deficiency for excess, resulting in misdiagnosis and often disastrous consequences.' This is a statement based on experience."
2. Dampness obstructs the clear Yang; bitter-acrid methods should be used, yet stagnant drugs were used, making the disease hard to resolve.
Zheng XX, male, 45 years old. Infectious hepatitis for 3 years, hospitalized for 2 years, with no reduction in symptoms. Examining the symptoms, only heaviness and fatigue in the body, poor appetite, slight epigastric fullness, and occasional dull pain under the ribs were seen, with no other discomfort. Reviewing previous prescriptions, Western medicines were mostly liver-protective agents. Chinese herbs included Yin Chen group, heat-clearing and detoxifying agents, or liver-soothing and stomach-harmonizing formulas. However, either they were ineffective or symptoms worsened, and daily movement became increasingly difficult. Observing the tongue coating and pulse: thin white coating, soggy-slow pulse. I thought this might be a Spleen deficiency syndrome. Therefore, I prescribed modified *Wan Dai Tang* (Complete Leukorrhea Decoction). Prescription: Bai Zhu (Atractylodes Macrocephala Rhizome) 30 g, Shan Yao (Dioscorea Rhizome) 30 g, Dang Shen (Codonopsis Root) 10 g, Bai Shao (White Peony Root) 10 g, Che Qian Zi (Plantago Seed) 10 g (wrapped in cloth), Cang Zhu (Atractylodes Rhizome) 10 g, Gan Cao (Licorice Root) 6 g, Chen Pi (Citrus Reticulata Peel) 10 g, Chai Hu (Bupleurum Root) 3 g. After six doses, symptoms did not improve. I recalled *Shang Han Lun* stating: "Cold damage after five or six days, having been sweated and then purged, presents with chest and hypochondriac fullness with slight knotting, difficulty urinating, thirst without vomiting, only sweating on the head, alternating chills and fever, and irritability. This indicates unresolved condition. It should be treated with Chai Hu Gui Zhi Gan Jiang Tang." Tang Rongchuan also said: "Having been sweated, Yang Qi leaks outward. Having then been purged, Yang Qi sinks, and fluid retention moves internally, reversing into the chest and hypochondrium, causing chest and hypochondriac fullness with slight knotting. Difficulty urinating means fluid retention prevents Jin-Ye ascent, causing thirst. This shares the same principle as Wu Ling San. Yang is constrained internally and cannot return/disperse, only rising upward, causing head sweating. Whole-body Yang Qi desires to exit but cannot, causing alternating chills and fever. This shares the same principle as Xiao Chai Hu Tang. All these involve cold-water qi closing the chest, diaphragm, and pores, preventing fire from exiting outward, thus returning to the Pericardium, causing irritability. Therefore, Chai Hu is used to penetrate the membranes, Ginger and Cinnamon are used to scatter cold-water, and Gua Lou and Huang Qin are used to clear heart-depressed fire. To scatter cold, one must first assist fire. Since this case has irritability, fire is already depressed internally. Initially taking Gui and Jiang may further assist fire, hence slight vexation remains. Re-administering the nature of Gui and Jiang allows ascending and penetrating, and fire exits outward, hence sweating and recovery." Asking the patient confirmed slight alternating chills/fever and thirst. I gave Chai Hu Gui Zhi Gan Jiang Tang for four doses. Indeed, symptoms greatly reduced. Continuing for four more doses, all symptoms vanished, and he recovered.
3. Not examining pulse and symptoms, only giving detoxification; food stagnation is not transformed, so the disease does not resolve.
Su XX, male, 29 years old. Yellow urine, slightly yellow sclera, abdominal fullness, and poor appetite for over 2 years. Diagnosed with infectious hepatitis. Treated with Western medicine for 1 year without effect. Then treated with Chinese herbs for heat-clearing, detoxifying, drying dampness, and clearing heat for 1 year, also without effect. Examining him, besides yellow-red urine, slightly yellow sclera, mild epigastric/abdominal fullness, poor appetite, and fatigue, he had a white-greasy tongue coating and a string-tight-rapid pulse. Synthesizing pulse and symptoms: String-tight-rapid pulse indicates Liver-Spleen disharmony and food stagnation. Treatment should soothe the Liver, harmonize the Stomach, and promote digestion to remove stagnation. Prescription: Chuan Xiong (Sichuan Lovage Rhizome) 10 g, Cang Zhu (Atractylodes Rhizome) 15 g, Xiang Fu (Cyperus Rhizome) 10 g, Zhi Zi (Gardenia Fruit) 10 g, Shen Qu (Medicated Leaven) 30 g, Jiao Zha (Charred Hawthorn) 30 g, Fu Ling (Poria) 10 g, Ban Xia (Pinellia Tuber) 10 g, Chen Pi (Citrus Reticulata Peel) 10 g, Lian Qiao (Forsythia Fruit) 10 g, Lai Fu Zi (Radish Seed) 15 g, Mai Ya (Barley Sprout) 15 g.
After six doses, urine color cleared, and appetite increased. Liver function and urobilinogen tests were normal.
The patient said: "Why did Yue Ju Bao He Wan achieve such rapid results?" I answered: "Because the medicine matched the syndrome. Currently, food accumulation is not transforming, and long-term failure to guide out stagnation causes damp-heat to congest and depress, leading to jaundice. Now that stagnation is removed and damp-heat transformed, recovery is achieved."
Japanese Encephalitis B
1. Yin excess repelling Yang, yet heat-attacking methods were used; Yin excess and heat persist, disease does not resolve.
Patient, Su XX, female, 50 years old. Japanese Encephalitis B, deep coma, persistent high fever for 7 days. Previous doctors used large doses of modified Bai Hu Tang (White Tiger Decoction), Western medicine, and physical cooling, but symptoms did not improve. Examining: besides deep coma and high fever of 40.1°C, the tongue body was red-purple, and the pulse was rapid. Synthesizing pulse and symptoms: Red-purple tongue body indicates heat entering the Ying (Nutrient) and Blood levels; treatment should clear Ying and cool Blood. Observing the tongue coating was slightly yellow, indicating Qi level heat as well. Following Ye Tianshi's principle: "When heat enters Ying, it can still be vented to transform Qi." Thus, I used modified Qing Wen Bai Du Yin (Clear Plague and Resolve Toxin Decoction): Centipede 6 pieces, Quan Xie (Scorpion) 6 g, Sheng Di (Rehmannia Root) 30 g, Bai Shao (White Peony Root) 10 g, Dan Pi (Moutan Bark) 10 g, Dan Shen (Salvia Root) 10 g, Yuan Shen (Scrophularia Root) 30 g, Sheng Shi Gao (Gypsum Fibrosum) 60 g, Zhi Mu (Anemarrhena Rhizome) 10 g, Yin Hua (Honeysuckle Flower) 15 g, Lian Qiao (Forsythia Fruit) 15 g. After three doses, body temperature dropped to 37.5°C, and mental state cleared. But upon taking the fourth dose, temperature rose again to 40.3°C, and consciousness returned to coma. Taking two more doses of the same prescription worsened all symptoms. I was invited again. Examining: besides coma and body heat, abdomen was soft with fecal incontinence, odorless, fingers and toes were cold, face was red but tongue coating was thin-white, and tongue body was pale-tender. I recalled *Shang Han Lun*: "Shaoyin disease, diarrhea with undigested food, interior cold with exterior heat, cold extremities, pulse faint and almost imperceptible, body contrary to aversion to cold, person's face is red. Tong Mai Si Ni Tang (Pulse-Unblocking Four Reversals Decoction) governs this." I also recalled You Zaijing's *Shang Han Guan Zhu Ji*: "Diarrhea with undigested food, cold extremities, faint-almost-impalpable pulse indicates Yin excess internally. Body heat without aversion to cold, red face indicates Yang repelled externally. True Yang Qi, forced by Yin-cold, is unsettled and wanders externally, showing heat signs, but it is actually not heat." This disease closely resembles this syndrome. However, many physicians believe Shang Han damages Yang, while Wen Bing damages Yin. Encephalitis belongs to Shu Wen (Summer-Heat Warmth). Physicians only mention Shu Wen damages Yin, not Yang. How could I dare to contradict all physicians and prescribe strongly acrid-hot herbs? Reluctantly, I tried Sheng Mai San (Generate Pulse Powder) with modifications for one dose. Symptoms did not improve. Recalling Zhang Zhongjing's words to treat according to symptoms, and the ancients' saying "with this syndrome, use this medicine," and seeing strong signs of Yin excess repelling Yang in this case, I discussed with other doctors. Cheng Wuji's *Zhu Jie Shang Han Lun* states: "Diarrhea with undigested food, cold extremities, faint-almost-impalpable pulse is interior cold; body heat without aversion to cold, red face is exterior heat. This is Yin excess internally, repelling Yang externally, lack of communication. Give Tong Mai Si Ni Tang to scatter cold and unblock Yang." Previously using cold herbs attacked Yang Qi and assisted repulsion, which was incorrect. Using cold again risks life. Urgent treatment requires breaking Yin and unblocking Yang. Hesitation may lead to untreatability. Doctors agreed. Tong Mai Si Ni Tang was prescribed: Fu Zi (Aconite Lateralis Radix Preparata) 10 g, Gan Jiang (Dried Ginger) 10 g, Zhi Gan Cao (Honey-fried Licorice Root) 10 g. After one dose, consciousness cleared, temperature dropped to 37.2°C, and bowel movements normalized. He eventually recovered. Doctors said: "With this syndrome, use this medicine" is truly insightful and should be remembered.
2. Fu organ excess not removed, only heat-clearing given; disease is in Middle Jiao, yet Upper Jiao is treated; going south by driving the chariot north, how can it heal?
He XX, male, 24 years old. Six days ago, sudden high fever and incessant headache. Emergency admission. After 3 hours in hospital, consciousness became unclear. Urgently treated with heat-clearing, detoxifying, Qi-level clearing, Ying-level cooling, Heart-opening, modified Qing Wen Bai Du Yin, An Gong Niu Huang Wan, Western medicine, and physical cooling, but ineffective until now. Invited me to treat. Examining: besides deep coma, ice packs were placed on head and body; palpating head and body felt cold as a corpse; pulse was deep, faint, almost imperceptible; tongue body was red, coating thick-yellow-dry; abdomen slightly distended; epigastrium was hard and full. Asking about urination and defecation, family answered: none for 7 days. Thinking: Could this be Ti Jue (Body Reversal)? Wu Keyi's *Wen Yi Lun* states: "Warm epidemic obtaining Fu syndrome, spirit/color not failing, speech/movement normal, no other strange signs, suddenly six pulses like silk, deep-thin not responding to finger, seeming present-absent, or absent in both hands, or hidden first. Observing the person should not have this pulse; those who do, are due to indicated purgation missed, internal knotting/congestion, Ying Qi reversing internally, unable to reach four extremities. This is Mai Jue (Pulse Reversal). Also, overusing bitter-cold herbs like Huang Lian and Shi Gao, forcibly suppressing heat, causing pathogen to knot more, pulse to block more... Should use Cheng Qi Tang to gently purge, six pulses will recover." "Yang syndrome with Yin pulse, body cold as ice, is Ti Jue... Mouth dry, tongue parched, papillae sharp, frequent sighing, throat swelling/pain, heart/abdominal fullness, painful on pressure, craving ice water, worsening at dusk, red-scanty urine, pain upon slightest drop. All purgation indications present, but whole body skin like ice, nails cyanotic-black, six pulses like silk, palpable when seeking, vanishing with slight pressure... Comparing pulse, contrasting interior/exterior, this is the most severe Yang syndrome, all purgation indications present, only regretting late purgation. Due to extreme internal heat, airway congestion, heat sucking transforms into water, *Nei Jing*'s Excess-Damage syndrome, even to faint-almost-impalpable pulse, this is Mai Jue. Yang constrained causes four limbs reversal. If constitutionally robust, especially prone to congestion. Now hyper-Yang is extreme. Causing whole body cold, this is Ti Jue; six pulses absent is image of dragons without leader, syndrome critical. Administer Da Cheng Qi Tang." Although this case is not typical as Wu described, it can be distinguished by tongue and abdomen. *Shang Han Lun* states: "Shaoyin disease, six or seven days, abdominal fullness, no bowel movement, urgent purgation, Da Cheng Qi Tang governs." Thus, Da Cheng Qi Tang was given. Prescription: Hou Po (Magnolia Bark) 15 g, Zhi Shi (Immature Bitter Orange) 15 g, Da Huang (Rhubarb Root and Rhizome) 10 g, Mang Xiao (Mirabilite) 10 g (dissolved). Prescription finished, doctor said: "Why doesn't Dr. Zhu use An Gong Niu Huang Wan?" I answered: "An Gong Niu Huang Wan treats Upper Jiao. This disease clearly is Middle Jiao Fu excess, so I do not give it." Doctor said: "Coma is a Heart Sovereign disease. An Gong Niu Huang Wan is the sacred product for opening Heart orifices. Why not use it?" I answered: "Coma can be in Yangming or Pericardium. Not only Pericardium disease causes coma. This disease is in Yangming, not Pericardium, so I do not use An Gong Niu Huang Wan to treat Pericardium. This aligns with *Nei Jing*'s principle of reaching the target." Asked: "I use modified Qing Wen Bai Du Yin frequently with success. Why ineffective here?" I answered: "This is exactly what Wu discussed: indicated purgation missed, only using ice-cold suppression." Nasogastric administration of one dose. Next day, consciousness cleared, reversals returned. He eventually recovered.
Mumps
1. Exterior contraction added, not knowing to disperse, only giving detoxification; disease hard to resolve.
Yue XX, male, 6 years old. Seven days ago, sudden swelling and pain in both cheeks. Treated with antibiotics. After 3 days, swelling/pain did not decrease, but body heat reached 38.8°C. Invited a doctor to use Chinese herbs for heat-clearing/detoxifying: Lan Gen (Isatis Root), Xuan Shen (Scrophularia Root), Yin Hua (Honeysuckle Flower), Lian Qiao (Forsythia Fruit), external application of Zi Jin Ding. After 4 days, symptoms did not decrease. Invited me. Doctor said: "All herbs used are those taught by the teacher for mumps. Why ineffective?" I answered: "At onset, no fever. Fever appeared after three days. There must be a new pathogen added. What is the new pathogen? In children, it is either exterior contraction or food stagnation. Examining symptoms, no abdominal fullness/pain discomfort, only headache, occasional sneezing, and floating-rapid pulse. This is caused by exterior contraction pathogen. Acrid-cool exterior-dispersing herbs should be added to the above prescription. Add Chan Tui (Cicada Slough), Bo He (Mint), Jing Jie (Schizonepeta) 9 g each." After one dose, fever subsided, symptoms reduced, and he recovered.
2. Long-standing constrained accumulated heat, only giving detoxification; constraining Yang Qi, heat does not decrease.
Yuan XX, male, 5 years old. For 5 days, bilateral parotid swelling/pain, persistent fever. Initially treated with antibiotics, Chinese herbs for heat-clearing/detoxifying, wind-dispersing/exterior-resolving. Ineffective. Invited me. Doctor said: "I used the teacher's experience: first heat-clearing/detoxifying, then wind-dispersing/heat-clearing. Why ineffective?" I answered: "Patient has history of constipation and recurrent fever. This is a syndrome of pre-existing accumulated heat. Pre-existing accumulated heat should be assisted with bowel-unblocking. Previous methods could not address this. Method should be wind-dispersing/heat-clearing, clearing Fu organs/detoxifying." Prescription: Chan Yi (Cicada Slough) 10 g, Jiang Can (Bombyx Batryticatus) 10 g, Pian Jiang Huang (Turmeric) 10 g, Lan Gen (Isatis Root) 30 g, Xuan Shen (Scrophularia Root) 15 g, Da Huang (Rhubarb Root and Rhizome) 5 g, Bo He (Mint) 10 g. After two doses, fever resolved. Continuing two more doses, he recovered.
3. Only giving detoxification, not resolving nodules; chronic disease hard to eliminate.
Zhao XX, male, 38 years old. Diffuse swelling/pain in bilateral submandibular/parotid regions, difficulty chewing for over a month. Diagnosed with mumps. Initially treated with Western antibiotics and symptomatic methods, ineffective. Added Pu Ji Xiao Du Yin (Universal Benefit Decoction to Eliminate Toxins) orally, Zi Jin Ding externally, still useless. Additionally, testicular swelling/pain discovered over several days. Invited me. Examining: cheeks swollen with dull pain, color unchanged; testes swollen, scrotal skin color nearly normal; tongue coating white, pulse deep-string-small-rapid. Said: "This is Fire constrained for a long time with Phlegm condensation. Treatment should soothe Liver, resolve constraint, transform Phlegm, dissipate nodules." Prescription: Xia Ku Cao (Prunella Spike) 30 g, Chi Shao (Red Peony Root) 10 g, Ju Ye (Citrus Leaf) 10 g, Su Mu (Sappan Wood) 6 g, Qing Pi (Aurantii Fructus Imperforati Pericarpium) 10 g, Xuan Shen (Scrophularia Root) 15 g, Lan Gen (Isatis Root) 15 g. After four doses, parotid and testicular swelling/pain reduced by nearly 80%. After six more doses, he recovered. His mother, also a TCM practitioner, said: "Zhu Dunshou, since all doctors recommend modified Pu Ji Xiao Du Yin and external Zi Jin Ding are effective, why was this case ineffective and caused complications?" I answered: "Pu Ji Xiao Du Yin is a good agent for heat-clearing/detoxifying, often effective like striking a drum for heat-toxin congestion. But this case has slight fever, mild heat-toxin, and deep-string pulse, indicating severe Qi constraint and Phlegm knotting. At this time, overusing cold herbs will surely prevent Phlegm transformation, and disease will not be eliminated. Thus, now using Qi-regulating/nodule-dissipating methods, with slight cold-heat-clearing/detoxifying, resulted in recovery."
Lymphocytic Choriomeningitis