某（二十） 脉数暮热。头痛腰疼。口燥。此属温邪。（温邪入肺）
连翘 淡豆豉 淡黄芩 黑山栀 杏仁 桔梗
某 温邪化热。肺痹喘急。消渴胸满。便溺不爽。肺与大肠见症。
淡黄芩 知母 鲜生地 阿胶 天冬 花粉
谢 积劳伤阳。卫疏。温邪上受。内入乎肺。肺主周身之气。气窒不化。外寒似战栗。其温邪内郁。
必从热化。今气短胸满。病邪在上。大便泻出稀水。肺与大肠表里相应。亦由热迫下泄耳。用
辛凉轻剂为稳。
杏仁 桔梗 香豉 橘红 枳壳 薄荷 连翘 茯苓
龚 襁褓吸入温邪。酿为肺胀危症。
芦根 桃仁 苡仁 冬瓜子
施 久患虚损。原寝食安舒。自服阴柔腻补。不但减食不寐。脘中常闷。渴欲饮凉。此口鼻吸入
温邪。先干于肺。误补则邪愈炽。气机阻塞。弱质不敢开泄。援引轻扬肃上。兼以威喜丸。淡以
和气。上焦得行。可进养胃法。
白沙参 苡仁 天花粉 桑叶 郁金 兼服威喜丸
王 温邪发热。津伤。口糜气秽。（温邪劫津）
卷心竹叶 嘉定花粉 知母 麦冬 金石斛 连翘
某 春温身热。六日不解。邪陷劫津。舌绛。骨节痛。以甘寒熄邪。
竹叶心 知母 花粉 滑石 生甘草 梨皮
丁 口鼻吸入热秽。肺先受邪。气痹不主宜通。其邪热由中及于募原。布散营卫。遂为寒热。既
为邪踞。自然痞闷不饥。虽邪轻未为深害。留连不已。热蒸形消。所谓病伤。渐至于损而后已。
（热伤胃津） 桂枝白虎汤。
又 气分之热稍平。日久胃津消乏。不饥不欲纳食。大忌香燥破气之药。以景岳玉女煎。多进
可效。忌食辛辣肥腻自安。竹叶石膏汤加鲜枸杞根皮。
杨 伏邪发热。烦渴。知饥无寐。乃胃津受伤所致。拟进竹叶石膏汤加花粉。
叶 热伤气分。用甘寒方。白虎汤加竹叶。
某 右脉未和。热多口渴。若再劫胃汁。怕有脘痞不饥之事。当清热生津。仍佐理痰。俟邪减便
可再商。
麦冬 人参 石膏 知母 粳米 竹叶 半夏
叶（二八） 仲景云。阴气先伤。阳气独发。不寒瘅热。令人消烂肌肉。条例下不注方。但曰
以饮食消息之。后贤谓甘寒生津。解烦热是矣。今脉数。舌紫渴饮。气分热邪未去。渐次转入血分。斯甘
寒清气热中。必佐存阴。为法中之法。
生地 石膏 生甘草 知母 粳米 白芍 竹叶心
毛（六十） 温邪热入营中。心热闷。胁肋痛。平素痰火。与邪胶结。致米饮下咽皆胀。老年五液已涸。忌
汗忌下。（热入心营）
生地 麦冬 杏仁 郁金汁 炒川贝 橘红
马 少阴伏邪。津液不腾。喉燥舌黑。不喜饮水。法当清解血中伏气。莫使液涸。
犀角 生地 丹皮 竹叶 元参 连翘
陈（妪） 热入膻中。夜烦无寐。心悸怔。舌绛而干。不嗜汤饮。乃营中之热。治在手经。
犀角 鲜生地 黑元参 连翘 石菖蒲 炒远志
又 鲜生地 元参 天冬 麦冬 竹叶 茯神 金箔
又 阳升风动。治以咸寒。
生地 阿胶 天冬 人参 川斛 茯神 麦冬
张 营络热。心震动。复脉汤去姜桂参加白芍。
陆（六九） 高年热病。八九日。舌燥烦渴。谵语。邪入心胞络中。深怕液涸神昏。当滋清去邪。兼进牛黄
丸。驱热利窍。（热邪入心胞）
竹叶心 鲜生地 连翘心 元参 犀角 石菖蒲
胡 脉数。舌赤耳聋。胸闷。素有痰火。近日冬温。引动宿病。加以劳复。小溲不利。议治胞络之热。
鲜生地（五钱） 竹叶心（一钱） 丹参（一钱半） 元参（一钱半） 石菖蒲根（六分） 陈胆星（六分）
顾 温邪误表劫津。邪入胞络内闭。至宝丹。
王 吸入温邪。鼻通肺络。逆传心胞络中。震动君主。神明欲迷。弥漫之邪。攻之不解。清窍既蒙。
络内亦痹。幼科不解。投以豁痰降火理气。毫无一效。忆平脉篇。清邪中上。肺位最高。既入胞
络。气血交阻。逐秽利窍。须藉芳香。议用局方至宝丹。
施 温邪如疟。阴气先伤。苦辛再伤阳及胃。内风肆横。肢掣螈 。邪闭心胞络中。痰潮神昏。乃
热气蒸灼。无形无质。此消痰消食清火。竟走肠胃。与病情隔靴搔痒。速速与至宝丹三分。冷
开水调服。若得神清。再商治法。
顾 饮酒又能纳谷。是内风主乎消烁。当春尽夏初。阳气弛张。遂致偏中于右。诊脉左弦且坚。
肌腠隐约斑点。面色光亮而赤。舌胎灰黄。其中必夹伏温邪。所怕内闭神昏。治法以清络宣
窍。勿以攻风劫痰。扶助温邪。平定廓清。冀其带病久延而已。
犀角 生地 元参 连翘心 郁金 小青叶 竹叶心 石菖蒲
又 目瞑舌缩。神昏如醉。邪入心胞络中。心神为蒙。谓之内闭。前案已经论及。温邪郁蒸。乃无
形质。而医药都是形质气味。正如隔靴搔痒。近代喻嘉言。议谓芳香逐秽宣窍。颇为合理。绝
症难挽。聊尽人工。至宝丹四丸。匀四服。凉开水。调化。
包 老年下虚。春温上受。痰潮昏谵。舌绛黄苔。面赤微痉。先清上焦。（热邪闭窍神昏）
天竺黄 金银花 竹叶心 连翘 竹沥
张 温邪自里而发。喉肿口渴。舌心灰滞。上焦热蒙。最怕窍闭昏痉。苦寒直降。攻其肠胃。与温
邪上郁无涉。
连翘 黑栀皮 牛蒡子 杏仁 花粉 马勃 栝蒌皮 夏枯草 金汁 银花露
张 周岁内。未得谷味精华。温邪吸入。上焦先受。头面颐颔肿浮。邪与气血混处。刀针破伤经
络。温邪内闭热壅。蔓延三焦。昏寐痰潮。舌刺卷缩。小溲点滴混浊。热气结锢在里。但膏连芩
栀之属。药性直降。竟由胃达肠。而热气如烟如雾。原非形质可荡可扫。故牛黄产自牛腹。原
从气血而成。混处气血之邪。藉此破其蕴结。是得效之因由也。夫温热时疠。上行气分。而
渐及于血分。非如伤寒足六经。顺传经络者。大抵热气鸱张。必熏塞经络内窍。故昏躁皆里
窍之欲闭。欲宣内闭。须得芳香。气血久郁。必致疡毒内攻。谨陈大意参末议。用紫雪丹三分。
微温开水调服。
褚 温邪中自口鼻。始而入肺。为咳喘。继传膻中则呛血。乃心营肺卫受邪。然邪在上焦。壅遏
阻气。必聚为热。痰臭呛渴。是欲内闭。惜不以河间三焦立法。或谓伤寒主六经。或谓肺痈专
泄气血。致热无出路。胸突腹大。危期至速矣。即有对病药饵。气涌沸腾。势必涌吐无余。焉望
有济。夫温热秽浊。填塞内窍。神识昏迷。胀闷欲绝者。须以芳香宣窍。佐牛黄金箔深入脏络。
以搜锢闭之邪。今危笃若此。百中图一而已。紫雪丹。
陈 温邪逆传膻中。热痰蔽阻空窍。所进寒凉消导。徒攻肠胃。毫无一效。痰乃热熏津液所化。
膻中乃空灵之所。是用药之最难。至宝丹芳香。通其神明之窍。以驱热痰之结极是。但稚年
受温邪。最易阴亏津耗。必兼滋清以理久伏温邪为正。
犀角 鲜生地 元参 连翘心 丹皮 石菖蒲
化服至宝丹
某 湿为渐热之气。迷雾鬲间。神机不发。三焦皆被邪侵。岂是小恙。视其舌伸缩如强。痰涎粘
着。内闭之象已见。宣通膻中。望其少苏。无暇清至阴之热。
至宝丹四分 石菖蒲金银花汤送下。
王（十八） 夜热早凉。热退无汗。其热从阴而来。故能食。形瘦。脉数左盛。两月不解。治在血分。（热陷血分）
生鳖甲 青蒿 细生地 知母 丹皮 淡竹叶
许 温邪已入血分。舌赤音低。神呆潮热。即发斑疹。亦是血中热邪。误汗消食。必变昏厥。
犀角 细生地 元参 丹皮 郁金 石菖蒲
张 舌绛裂纹。面色枯槁。全无淖泽。形象畏冷。心中热焚。邪深竟入厥阴。正气已经虚极。勉拟
仲景复脉汤。合乎邪少虚多治法。（热入厥阴） 复脉去人参生姜加甘蔗汁代水煎。
又 热病误投。表散消导。正气受伤。神昏舌强。势如燎原。前进复脉法。略有转机。宜遵前方。去
桂加参。以扶正气为主。复脉汤去桂加人参甘蔗汁代水煎药。
又 进甘药颇安。奈阴液已涸。舌强音缩。抚之干板。较诸已前龈肉映血有间。小便欲解掣痛。
犹是阴气欲绝。欲寐昏沉。午间烦燥。热深入阴之征。未能稳许愈期也。
生白芍 炙甘草 阿胶 鸡子黄 人参 生地 麦冬 炒麻仁
某 误下热陷于里。而成结胸。所以身不大热。但短气胸满烦躁。此皆邪热内燔。扰乱神明。内
闭之象。棘手重恙。仿仲景泻心法。备参末议。再候明眼定裁。（误下热陷成结胸）
川连 黄芩 半夏 炮淡干姜 生姜 枳实
吴 神气如迷。不饥不食。乃苦辛消导发散。劫夺胃津所致。盖温邪手经为病。今世多以足六
经主治。故致此。（误治伤胃津液）
细生地 竹叶心 麦冬 元参心 连翘心 郁金
王（妪） 温热十三日。舌黄。心中闷痛。初病手经。不当用足经方。老人怕其液涸。甘寒醒胃却热。
鲜生地 竹叶心 麦冬 郁金 川斛 菖蒲根
吴（十五） 近日天未寒冷。病虚气不收藏。所感之邪谓冬温。参苓益气。薄荷桔梗杏仁泄气。已属背
谬。加补骨脂温涩肾脏。尤不通之极。自述夜寐深更。 有汗。稚年阴不充。阳易泄。论体质
可却病。（冬温伤液）
桑叶 大沙参 玉竹 苡仁 生甘草 糯米汤煎药
陈（半岁） 冬温入肺。胶痰化热。因未纳谷之身。不可重药消痰通利。
炒麦冬 桑叶 大沙参 甜杏仁 地骨皮
某 脉数右大。烦渴舌绛。温邪。气血两伤。与玉女煎。（气血两伤）
生地 竹叶 石膏 知母 丹皮 甘草
陈（二三） 阴虚温邪。甘寒清上。（阴虚感温邪）
白沙参 甜杏仁 玉竹 冬桑叶 南花粉 生甘草
关 阴虚挟温邪。寒热不止。虽不宜发散消食。徒补亦属无益。拟进复脉汤法。
炙甘草 阿胶 生白芍 麦冬 炒生地 炒丹皮 青甘蔗汁煎
黄 体虚。温邪内伏。头汗淋漓。心腹窒塞。上热下冷。舌白烦渴。春阳升举为病。犹是冬令少藏
所致。色脉参视。极当谨慎。
阿胶 生地 麦冬 生牡蛎 生白芍 茯苓
张（五五） 劳倦内伤。温邪外受。两月不愈。心中温温液液。津液无以上供。夜卧喉干燥。与复脉汤去
姜桂参。三服后可加参。（劳倦感温阴液燥）
汪 劳倦更感温邪。阳升头痛。寒热战栗。冷汗邪虽外达。阳气亦泄致神倦欲眠。舌赤黄胎。口
不知味。当以育阴除热为主。辛散苦降非宜。复脉汤去参姜桂麻加青甘蔗浆。
曹 脉促数。舌白不饥。寒热汗出。初起腹痛。脐右有形。乃久伤劳倦。复感温邪。今病两旬又六。
微咳有痰。并不渴饮。寒来微微齿痉。此营卫二气大衰。恐延虚脱。议固卫阳。冀寒热得平。（劳倦感温
营卫胃阳兼虚）
黄 桂枝 白芍 炙甘草 牡蛎 南枣
陈 热病后。不饥能食。不寐。此胃气不和。（病退胃不和）
香豉 黑山栀 半夏 枳实 广皮白
华（五五） 口鼻受寒暄不正之气。过募原。扰胃系。寒热已罢。犹不饱不饥。舌边赤。中心黄。余邪未清。
食入变酸。乃邪热不胜谷。以温胆和之。半曲温胆去甘草茯苓枳实。加郁金黑山栀。
林（氏） 腹满已久。非是暴症。近日面颔肿胀。牙关紧闭。先有寒热。随现是象。诊脉右搏数。左小。乃
温邪触自口鼻。上焦先受。气血与热胶固。致清窍不利。倏有痹塞之变。理当先治新邪。况头
面咽喉结邪。必辛凉轻剂以宣通。若药味重浊。徒攻肠胃矣。仿东垣普济消毒意。（热毒壅结上焦）
连翘 牛蒡子 马勃 射干 滑石 夏枯草 金银花露 金汁
席 脉左数。右缓弱。阳根未固。阴液渐涸。舌赤微渴。喘促自利溲数。晡刻自热。神烦呓语。夫温
邪久伏少阴。古人立法。全以育阴祛热。但今见症。阴分固有伏邪。真阳亦不肯收纳。议仿刘
河间浊药轻投。不为上焦热阻。下焦根蒂自立。冀其烦躁热蒸渐缓。（阴虚邪伏）
熟地炭 茯苓 淡苁蓉 远志炭 川石斛 五味子 饮子煎法
又 晚诊。阴中伏邪。晡时而升。目赤羞明。舌绛而渴。与育阴清邪法。
生地炭 元参心 川石斛 炒麦冬 犀角 石菖蒲
又 脉左数。右软。舌干苔白。小溲淋沥。吸气喘促。烦汗。肾阴不承。心神热灼蒙闭。议以三才汤。
滋水制热。三才加茯神黄柏金箔。晚进周少川牛黄清心丸一服。
又 昨黄昏后。诊脉。较诸早上。左手数疾顿减。惟尺中垂而仍动。呓语不已。若有妄见。因思肾
热乘心。膻中微闭。神明为蒙。自属昏乱。随进周少川牛黄丸一服。俾迷漫无质之热。暂可泄
降。服后颇安。辰刻诊脉濡小。形质大衰。舌边色淡。下利稀水。夫救阴是要旨。读仲景少阴下
利篇。上下交征。关闸欲撒。必以堵塞阳明为治。以阳明司阖。有关无阖。下焦之阴。仍从走泄
矣。议用桃花汤。
人参 赤石脂 炮姜 白粳米
又 晚服照方加茯苓。
又 脉左沉数。右小数。暮热微汗。时烦。辰刻神清。虚邪仍留阴分。议用清补。
人参 茯苓 川石斛 炙甘草 黑 豆皮 糯稻根须
又 金匮麦门冬汤。
【背景信息】
书名：临证指南医案 作者：叶桂 朝代：清 章节：温热(1/2) 类别：医论
【译文】
某患者（二十岁），脉象数，傍晚发热。头痛，腰痛，口燥。这属于温邪致病。（温邪侵入肺脏）
处方：连翘、淡豆豉、淡黄芩、黑山栀、杏仁、桔梗。
某患者，温邪化热，导致肺痹，气喘急促，消渴，胸满，大小便不畅。这是肺与大肠的病症表现。
处方：淡黄芩、知母、鲜生地、阿胶、天冬、花粉。
谢姓患者，因长期劳累损伤阳气，卫气不固。温邪从口鼻吸入，内入于肺。肺主一身之气，气机窒塞不能宣化，外感寒邪似战栗。其温邪内郁，必然从热而化。如今气短胸满，病邪在上焦，大便泻出稀水，肺与大肠表里相应，也是由于热邪逼迫向下排泄所致。使用辛凉轻剂较为稳妥。
处方：杏仁、桔梗、香豉、橘红、枳壳、薄荷、连翘、茯苓。
龚姓患者，婴儿时期吸入温邪，酿成肺胀危症。
处方：芦根、桃仁、苡仁、冬瓜子。
施姓患者，久患虚损，原本寝食安适。自行服用阴柔腻补之药，不仅食欲减退、失眠，脘中常觉闷堵，口渴想喝凉水。这是口鼻吸入温邪，先伤及肺脏。误用补药则邪气更盛，气机阻塞。体质虚弱不敢用开泄之法，引用轻扬肃上之品，兼服威喜丸，以淡味和气，使上焦气机得以运行，可进而采用养胃法。
处方：白沙参、苡仁、天花粉、桑叶、郁金，兼服威喜丸。
王某，温邪发热，津液受伤，口舌生疮，口气臭秽。（温邪劫夺津液）
处方：卷心竹叶、嘉定花粉、知母、麦冬、金石斛、连翘。
某患者，春温病身热，六日不退，邪气陷入劫夺津液，舌质绛红，骨节疼痛。用甘寒法熄除邪热。
处方：竹叶心、知母、花粉、滑石、生甘草、梨皮。
丁姓患者，口鼻吸入热秽之气，肺先受邪，气机痹阻不能宣通。其邪热由中焦波及募原，布散于营卫之间，遂出现寒热往来。既然邪气占据体内，自然痞闷不饥。虽然邪气尚轻未造成深重危害，但留连不已，热蒸耗伤形体消瘦，所谓病伤，逐渐发展到损的程度才停止。
（热伤胃津）桂枝白虎汤。
又诊，气分之热稍平，日久胃津消乏，不饥不欲进食。大忌香燥破气之药。用景岳玉女煎，多服可效。忌食辛辣肥腻即可安宁。竹叶石膏汤加鲜枸杞根皮。
杨某，伏邪发热，烦渴，知饥但无法入睡，乃胃津受伤所致。拟进竹叶石膏汤加花粉。
某患者，右脉未和，热多口渴，若再劫夺胃汁，恐怕会有脘痞不饥的情况。当清热生津，仍佐以理痰。待邪气减少便可再商议。
处方：麦冬、人参、石膏、知母、粳米、竹叶、半夏。
叶姓患者（二十八岁），仲景说：阴气先伤，阳气独发，不恶寒而但热，令人肌肉消烂。条例下未注方，只说“以饮食消息之”。后贤认为甘寒生津，解烦热是正确的。如今脉数，舌紫渴饮，气分热邪未去，渐次转入血分。所以在甘寒清气热中，必须佐以存阴，这是法中之法。
处方：生地、石膏、生甘草、知母、粳米、白芍、竹叶心。
毛姓患者（六十岁），温邪热入营中，心热闷，胁肋痛，平素痰火，与邪胶结，致米饮下咽皆胀。老年五液已涸，忌汗忌下。（热入心营）
处方：生地、麦冬、杏仁、郁金汁、炒川贝、橘红。
马姓患者，少阴伏邪，津液不腾，喉燥舌黑，不喜饮水。法当清解血中伏气，莫使液涸。
处方：犀角、生地、丹皮、竹叶、元参、连翘。
陈姓老妇，热入膻中，夜烦无寐，心悸怔忡，舌绛而干，不嗜汤饮，乃营中之热，治在手经。
处方：犀角、鲜生地、黑元参、连翘、石菖蒲、炒远志。
又诊，阳升风动，治以咸寒。
处方：生地、阿胶、天冬、人参、川斛、茯神、麦冬。
陆姓患者（六十九岁），高年热病，八九日，舌燥烦渴，谵语，邪入心胞络中，深怕液涸神昏。当滋清去邪，兼进牛黄丸，驱热利窍。（热邪入心胞）
处方：竹叶心、鲜生地、连翘心、元参、犀角、石菖蒲。
胡姓患者，脉数，舌赤耳聋，胸闷，素有痰火，近日冬温，引动宿病，加以劳复，小溲不利。议治胞络之热。
处方：鲜生地（五钱）、竹叶心（一钱）、丹参（一钱半）、元参（一钱半）、石菖蒲根（六分）、陈胆星（六分）。
王某，吸入温邪，鼻通肺络，逆传心胞络中，震动君主，神明欲迷。弥漫之邪，攻之不解。清窍既蒙，络内亦痹。幼科不解，投以豁痰降火理气，毫无一效。忆《平脉篇》云：清邪中上，肺位最高。既入胞络，气血交阻，逐秽利窍，须藉芳香。议用局方至宝丹。
施姓患者，温邪如疟，阴气先伤，苦辛再伤阳及胃，内风肆横，肢掣螈疭，邪闭心胞络中，痰潮神昏，乃热气蒸灼，无形无质。此消痰消食清火，竟走肠胃，与病情隔靴搔痒。速速与至宝丹三分，冷开水调服。若得神清，再商治法。
顾姓患者，饮酒又能纳谷，是内风主乎消烁。当春尽夏初，阳气弛张，遂致偏中于右。诊脉左弦且坚，肌腠隐约斑点，面色光亮而赤，舌胎灰黄，其中必夹伏温邪。所怕内闭神昏。治法以清络宣窍，勿以攻风劫痰，扶助温邪，平定廓清，冀其带病久延而已。
处方：犀角、生地、元参、连翘心、郁金、小青叶、竹叶心、石菖蒲。
又诊，目瞑舌缩，神昏如醉，邪入心胞络中，心神为蒙，谓之内闭。前案已经论及。温邪郁蒸，乃无形质，而医药都是形质气味，正如隔靴搔痒。近代喻嘉言，议谓芳香逐秽宣窍，颇为合理。绝症难挽，聊尽人工。至宝丹四丸，匀四服，凉开水，调化。
包姓患者，老年下虚，春温上受，痰潮昏谵，舌绛黄苔，面赤微痉，先清上焦。（热邪闭窍神昏）
处方：天竺黄、金银花、竹叶心、连翘、竹沥。
张某，温邪自里而发，喉肿口渴，舌心灰滞，上焦热蒙，最怕窍闭昏痉。苦寒直降，攻其肠胃，与温邪上郁无涉。
处方：连翘、黑栀皮、牛蒡子、杏仁、花粉、马勃、栝蒌皮、夏枯草、金汁、银花露。
张某（周岁内），未得谷味精华，温邪吸入，上焦先受，头面颐颔肿浮，邪与气血混处，刀针破伤经络，温邪内闭热壅，蔓延三焦，昏寐痰潮，舌刺卷缩，小溲点滴混浊，热气结锢在里。但膏连芩栀之属，药性直降，竟由胃达肠，而热气如烟如雾，原非形质可荡可扫。故牛黄产自牛腹，原从气血而成，混处气血之邪，藉此破其蕴结，是得效之因由也。夫温热时疠，上行气分，而渐及于血分，非如伤寒足六经，顺传经络者。大抵热气鸱张，必熏塞经络内窍，故昏躁皆里窍之欲闭。欲宣内闭，须得芳香。气血久郁，必致疡毒内攻。谨陈大意参末议。用紫雪丹三分，微温开水调服。
褚姓患者，温邪中自口鼻，始而入肺，为咳喘，继传膻中则呛血，乃心营肺卫受邪。然邪在上焦，壅遏阻气，必聚为热，痰臭呛渴，是欲内闭。惜不以河间三焦立法，或谓伤寒主六经，或谓肺痈专泄气血，致热无出路，胸突腹大，危期至速矣。即有对病药饵，气涌沸腾，势必涌吐无余，焉望有济。夫温热秽浊，填塞内窍，神识昏迷，胀闷欲绝者，须以芳香宣窍，佐牛黄金箔深入脏络，以搜锢闭之邪。今危笃若此，百中图一而已。紫雪丹。
陈某，温邪逆传膻中，热痰蔽阻空窍，所进寒凉消导，徒攻肠胃，毫无一效。痰乃热熏津液所化，膻中乃空灵之所，是用药之最难。至宝丹芳香，通其神明之窍，以驱热痰之结极是。但稚年受温邪，最易阴亏津耗，必兼滋清以理久伏温邪为正。
处方：犀角、鲜生地、元参、连翘心、丹皮、石菖蒲。
化服至宝丹。
某患者，湿为渐热之气，迷雾鬲间，神机不发，三焦皆被邪侵，岂是小恙。视其舌伸缩如强，痰涎粘着，内闭之象已见。宣通膻中，望其少苏，无暇清至阴之热。
至宝丹四分，石菖蒲金银花汤送下。
王某（十八岁），夜热早凉，热退无汗，其热从阴而来，故能食，形瘦，脉数左盛，两月不解，治在血分。（热陷血分）
处方：生鳖甲、青蒿、细生地、知母、丹皮、淡竹叶。
许姓患者，温邪已入血分，舌赤音低，神呆潮热，即发斑疹，亦是血中热邪。误汗消食，必变昏厥。
处方：犀角、细生地、元参、丹皮、郁金、石菖蒲。
张某，舌绛裂纹，面色枯槁，全无淖泽，形象畏冷，心中热焚，邪深竟入厥阴，正气已经虚极。勉拟仲景复脉汤，合乎邪少虚多治法。（热入厥阴）复脉去人参生姜加甘蔗汁代水煎。
又诊，热病误投，表散消导，正气受伤，神昏舌强，势如燎原。前进复脉法，略有转机。宜遵前方，去桂加参，以扶正气为主。复脉汤去桂加人参甘蔗汁代水煎药。
又诊，进甘药颇安，奈阴液已涸，舌强音缩，抚之干板，较诸已前龈肉映血有间，小便欲解掣痛，犹是阴气欲绝，欲寐昏沉，午间烦燥，热深入阴之征，未能稳许愈期也。
处方：生白芍、炙甘草、阿胶、鸡子黄、人参、生地、麦冬、炒麻仁。
某患者，误下热陷于里，而成结胸，所以身不大热，但短气胸满烦躁，此皆邪热内燔，扰乱神明，内闭之象，棘手重恙。仿仲景泻心法，备参末议，再候明眼定裁。（误下热陷成结胸）
处方：川连、黄芩、半夏、炮淡干姜、生姜、枳实。
吴某，神气如迷，不饥不食，乃苦辛消导发散，劫夺胃津所致。盖温邪手经为病，今世多以足六经主治，故致此。（误治伤胃津液）
处方：细生地、竹叶心、麦冬、元参心、连翘心、郁金。
王某（老妇），温热十三日，舌黄，心中闷痛，初病手经，不当用足经方。老人怕其液涸，甘寒醒胃却热。
处方：鲜生地、竹叶心、麦冬、郁金、川斛、菖蒲根。
吴某（十五岁），近日天未寒冷，病虚气不收藏，所感之邪谓冬温。参苓益气，薄荷桔梗杏仁泄气，已属背谬。加补骨脂温涩肾脏，尤不通之极。自述夜寐深更，有汗。稚年阴不充，阳易泄，论体质可却病。（冬温伤液）
处方：桑叶、大沙参、玉竹、苡仁、生甘草，糯米汤煎药。
陈某（半岁），冬温入肺，胶痰化热，因未纳谷之身，不可重药消痰通利。
处方：炒麦冬、桑叶、大沙参、甜杏仁、地骨皮。
某患者，脉数右大，烦渴舌绛，温邪，气血两伤，与玉女煎。（气血两伤）
处方：生地、竹叶、石膏、知母、丹皮、甘草。
陈某（二三岁），阴虚温邪，甘寒清上。（阴虚感温邪）
处方：白沙参、甜杏仁、玉竹、冬桑叶、南花粉、生甘草。
关姓患者，阴虚挟温邪，寒热不止，虽不宜发散消食，徒补亦属无益。拟进复脉汤法。
处方：炙甘草、阿胶、生白芍、麦冬、炒生地、炒丹皮、青甘蔗汁煎。
黄某，体虚，温邪内伏，头汗淋漓，心腹窒塞，上热下冷，舌白烦渴，春阳升举为病，犹是冬令少藏所致。色脉参视，极当谨慎。
处方：阿胶、生地、麦冬、生牡蛎、生白芍、茯苓。
张某（五十五岁），劳倦内伤，温邪外受，两月不愈，心中温温液液，津液无以上供，夜卧喉干燥，与复脉汤去姜桂参，三服后可加参。（劳倦感温阴液燥）
汪姓患者，劳倦更感温邪，阳升头痛，寒热战栗，冷汗邪虽外达，阳气亦泄致神倦欲眠，舌赤黄胎，口不知味，当以育阴除热为主，辛散苦降非宜。复脉汤去参姜桂麻加青甘蔗浆。
曹姓患者，脉促数，舌白不饥，寒热汗出，初起腹痛，脐右有形，乃久伤劳倦，复感温邪，今病两旬又六，微咳有痰，并不渴饮，寒来微微齿痉，此营卫二气大衰，恐延虚脱。议固卫阳，冀寒热得平。（劳倦感温营卫胃阳兼虚）
处方：黄、桂枝、白芍、炙甘草、牡蛎、南枣。
陈某，热病后，不饥能食，不寐，此胃气不和。（病退胃不和）
处方：香豉、黑山栀、半夏、枳实、广皮白。
华姓患者（五十五岁），口鼻受寒暄不正之气，过募原，扰胃系，寒热已罢，犹不饱不饥，舌边赤，中心黄，余邪未清，食入变酸，乃邪热不胜谷，以温胆和之。半曲温胆去甘草茯苓枳实，加郁金黑山栀。
林氏，腹满已久，非是暴症，近日面颔肿胀，牙关紧闭，先有寒热，随现是象，诊脉右搏数，左小，乃温邪触自口鼻，上焦先受，气血与热胶固，致清窍不利，倏有痹塞之变，理当先治新邪，况头面咽喉结邪，必辛凉轻剂以宣通，若药味重浊，徒攻肠胃矣。仿东垣普济消毒意。（热毒壅结上焦）
处方：连翘、牛蒡子、马勃、射干、滑石、夏枯草、金银花露、金汁。
席姓患者，脉左数，右缓弱，阳根未固，阴液渐涸，舌赤微渴，喘促自利溲数，晡刻自热，神烦呓语。夫温邪久伏少阴，古人立法，全以育阴祛热。但今见症，阴分固有伏邪，真阳亦不肯收纳。议仿刘河间浊药轻投，不为上焦热阻，下焦根蒂自立，冀其烦躁热蒸渐缓。（阴虚邪伏）
处方：熟地炭、茯苓、淡苁蓉、远志炭、川石斛、五味子，饮子煎法。
又诊，晚诊，阴中伏邪，晡时而升，目赤羞明，舌绛而渴，与育阴清邪法。
处方：生地炭、元参心、川石斛、炒麦冬、犀角、石菖蒲。
又诊，脉左数，右软，舌干苔白，小溲淋沥，吸气喘促，烦汗，肾阴不承，心神热灼蒙闭，议以三才汤，滋水制热。三才加茯神黄柏金箔，晚进周少川牛黄清心丸一服。
又诊，昨黄昏后，诊脉，较诸早上，左手数疾顿减，惟尺中垂而仍动，呓语不已，若有妄见。因思肾热乘心，膻中微闭，神明为蒙，自属昏乱。随进周少川牛黄丸一服，俾迷漫无质之热，暂可泄降。服后颇安。辰刻诊脉濡小，形质大衰，舌边色淡，下利稀水。夫救阴是要旨，读仲景少阴下利篇，上下交征，关闸欲撒，必以堵塞阳明为治，以阳明司阖，有关无阖，下焦之阴，仍从走泄矣。议用桃花汤。
处方：人参、赤石脂、炮姜、白粳米。
又诊，晚服照方加茯苓。
又诊，脉左沉数，右小数，暮热微汗，时烦，辰刻神清，虚邪仍留阴分，议用清补。
处方：人参、茯苓、川石斛、炙甘草、黑豆皮、糯稻根须。
又诊，《金匮要略》麦门冬汤。
[Background Information]
Book: Linzheng Zhinan Yi'an (Guide to Clinical Practice Medical Cases)
Author: Ye Gui
Dynasty: Qing
Chapter: Warm Heat (1/2)
Category: Medical Theory
[Translation]
Patient (20 years old), pulse is rapid, fever in the evening. Headache, lower back pain, dry mouth. This belongs to warm pathogen disease. (Warm pathogen enters the Lung.)
Prescription: Lianqiao (Forsythiae Fructum), Danshi Chi (Fermented Soybean), Dan Huangqin (Scutellariae Radix), Hei Shanzhi (Gardeniae Fructus), Xingren (Armeniacae Semen Amarum), Jiegeng (Platycodonis Radix).
Patient, warm pathogen transforms into heat, causing lung bi (obstruction of the Lung), panting and urgency, xiaoke (wasting-thirst syndrome), chest fullness, unsatisfactory urination and defecation. These are symptoms of the Lung and Large Intestine.
Prescription: Dan Huangqin (Scutellariae Radix), Zhimu (Anemarrhenae Rhizoma), Xian Shengdi (Rehmanniae Radix Recens), Ejiao (Colla Corii Asini), Tiandong (Asparagi Radix), Huafen (Trichosanthis Radix).
Patient surnamed Xie, chronic fatigue damages Yang qi, defensive qi is loose. Warm pathogen is received from above (mouth/nose), enters internally into the Lung. The Lung governs the qi of the whole body; qi obstruction fails to transform. External cold resembles shivering. The internal stagnation of warm pathogen must transform into heat. Now there is shortness of breath and chest fullness, the pathogen is in the upper jiao, stool is watery diarrhea. The Lung and Large Intestine are exterior-interior related; this is also due to heat forcing downward discharge. Using a mild acrid-cool formula is stable.
Prescription: Xingren (Armeniacae Semen Amarum), Jiegeng (Platycodonis Radix), Xiangchi (Fermented Soybean), Juhong (Citri Reticulatae Pericarpium), Zhike (Aurantii Fructus), Bohe (Menthae Haplocalycis Herba), Lianqiao (Forsythiae Fructum), Fuling (Poria).
Patient surnamed Gong, in infancy inhaled warm pathogen, brewed into a critical condition of lung distension (feizhang).
Prescription: Lugen (Phragmitis Rhizoma), Taoren (Persicae Semen), Yiren (Coicis Semen), Dongguazi (Benincasae Semen).
Patient surnamed Shi, long-term deficiency consumption. Originally sleep and appetite were comfortable. Self-administered yin-nourishing cloying tonics, not only reduced appetite and caused insomnia, but also frequent epigastric stuffiness, thirst for cold drinks. This is warm pathogen inhaled via mouth/nose, first drying the Lung. Wrongly tonifying makes the pathogen more fierce, qi mechanism blocked. Weak constitution dares not use opening/draining methods. Cite light and ascending肃-upward agents, combined with Weixi Wan. Light flavor harmonizes qi, upper jiao can move, then stomach-nourishing method can be advanced.
Prescription: Baishashen (Glehniae Radix), Yiren (Coicis Semen), Tianhuafen (Trichosanthis Radix), Sangye (Mori Folium), Yujin (Curcumae Radix), take Weixi Wan concurrently.
Patient surnamed Wang, warm pathogen causes fever, fluid injury, aphthous stomatitis, foul breath. (Warm pathogen robs fluids.)
Prescription: Juanxin Zhuye (Bambusae Folium), Jiading Huafen (Trichosanthis Radix), Zhimu (Anemarrhenae Rhizoma), Maidong (Ophiopogonis Radix), Jinshihu (Dendrobii Caulis), Lianqiao (Forsythiae Fructum).
Patient, spring-warmth body heat, unresolved for six days, pathogen sinks and robs fluids, tongue crimson, joint pain. Use sweet-cold to extinguish pathogen.
Prescription: Zhuyexin (Bambusae Folium), Zhimu (Anemarrhenae Rhizoma), Huafen (Trichosanthis Radix), Huashi (Talcum), Sheng Gancao (Glycyrrhizae Radix et Rhizoma), Lipi (Pyrifoliae Pericarpium).
Patient surnamed Ding, inhaled hot turbid qi via mouth/nose, Lung receives pathogen first, qi bi (obstruction) does not govern diffusion and unblocking. The pathogenic heat spreads from the middle to the mu-yuan (sea of qi), distributing to Ying and Wei, thus causing chills and fever. Since the pathogen occupies the interior, naturally there is stuffiness and lack of appetite. Although the pathogen is light and not deeply harmful, lingering endlessly, heat steams and consumes form, thinning out. This is called "disease injuring," gradually reaching "damage" before stopping.
(Hot pathogen injures Stomach fluids) Guizhi Baihu Tang (Cinnamon Twig and White Tiger Decoction).
Second visit, Qi-level heat slightly subsides, long-standing Stomach fluid depletion, no appetite, desire to eat. Strictly avoid acrid-dry breaking-qi herbs. Use Jingyue's Yupan Jian (Jade Woman Decoction), taken frequently for effect. Avoid spicy and greasy foods for peace. Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) plus fresh Goji root bark.
Patient surnamed Yang, latent pathogen fever, irritability and thirst, knows hunger but cannot sleep, caused by Stomach fluid injury. Propose advancing Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) plus Huafen (Trichosanthis Radix).
Patient surnamed Ye, heat injures Qi level, use sweet-cold formula. Baihu Tang (White Tiger Decoction) plus Zhuye (Bamboo Leaf).
Patient, right pulse not harmonious, much heat and thirst. If again robbing Stomach juice, fear epigastric stuffiness and lack of appetite. Must clear heat and generate fluids, still assist with phlegm-regulating. Wait until pathogen reduces to discuss further.
Prescription: Maidong (Ophiopogonis Radix), Renshen (Ginseng Radix et Rhizoma), Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), Jingmi (Oryza Sativa), Zhuye (Bamboo Leaf), Banxia (Pinelliae Rhizoma).
Patient surnamed Ye (28 years old), Zhang Zhongjing said: Yin qi injured first, Yang qi alone erupts, no chills but only heat, causing muscle wasting. The regulations do not note a formula below, only saying "use diet to manage." Later experts say sweet-cold generates fluids, resolves irritability and heat, which is correct. Now pulse is rapid, tongue purple, thirsty for drink, Qi-level heat pathogen not gone, gradually turning into Blood level. Thus, in sweet-cold clearing Qi heat, must assist with preserving Yin, this is the method within the method.
Prescription: Shengdi (Rehmanniae Radix), Shigao (Gypsum Fibrosum), Sheng Gancao (Glycyrrhizae Radix et Rhizoma), Zhimu (Anemarrhenae Rhizoma), Jingmi (Oryza Sativa), Baishao (Paeoniae Radix Alba), Zhuyexin (Bambusae Folium).
Patient surnamed Mao (60 years old), warm pathogen heat enters Ying level, heart heat and stifling, hypochondriac pain, usually phlegm-fire, knotted with pathogen, causing bloating even when swallowing rice water. Elderly five fluids already dried up, contraindicate sweating and purging. (Heat enters Heart-Ying.)
Prescription: Shengdi (Rehmanniae Radix), Maidong (Ophiopogonis Radix), Xingren (Armeniacae Semen Amarum), Yujin Zhi (Curcumae Radix Juice), Chuan Bei (Fritillariae Cirrhosae Bulbus), Juhong (Citri Reticulatae Pericarpium).
Patient surnamed Ma, Shaoyin latent pathogen, fluids not rising, dry throat, black tongue, no desire to drink. Method should clear and resolve latent qi in blood, do not let fluids dry up.
Prescription: Xijiao (Rhinocerotis Cornu), Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), Zhuye (Bamboo Leaf), Yuanshen (Scrophulariae Radix), Lianqiao (Forsythiae Fructum).
Patient surnamed Chen (Elderly woman), heat enters Danzhong (Pericardium region), night irritability and insomnia, palpitations, tongue crimson and dry, no desire for soup/drink, this is heat in Ying level, treatment in Hand meridians.
Prescription: Xijiao (Rhinocerotis Cornu), Xian Shengdi (Rehmanniae Radix Recens), Hei Yuanshen (Scrophulariae Radix), Lianqiao (Forsythiae Fructum), Shichangpu (Acori Tatarinowii Rhizoma), Chuan Yuanzhi (Polygalae Radix).
Second visit, Xian Shengdi (Rehmanniae Radix Recens), Yuanshen (Scrophulariae Radix), Tiandong (Asparagi Radix), Maidong (Ophiopogonis Radix), Zhuye (Bamboo Leaf), Fushen (Poria cum Radix), Jinbo (Gold Foil).
Third visit, Yang rises, wind moves, treat with salty-cold.
Prescription: Shengdi (Rehmanniae Radix), Ejiao (Colla Corii Asini), Tiandong (Asparagi Radix), Renshen (Ginseng Radix et Rhizoma), Chuan Shihu (Dendrobii Caulis), Fushen (Poria cum Radix), Maidong (Ophiopogonis Radix).
Patient surnamed Zhang, Ying collateral heat, heart tremors, Fumai Tang (Restore the Pulse Decoction) minus Ginger and Cinnamon, add Baishao (Paeoniae Radix Alba).
Patient surnamed Lu (69 years old), elderly heat disease, eight or nine days, dry tongue, irritability and thirst, delirium, pathogen enters Xinbao Luo (Pericardium Collateral), deeply fear fluid exhaustion and spirit confusion. Must nourish and clear to remove pathogen, concurrently advance Niuhuang Wan (Calculus Bovis Pill), drive heat and open orifices. (Heat pathogen enters Pericardium Collateral.)
Prescription: Zhuyexin (Bambusae Folium), Xian Shengdi (Rehmanniae Radix Recens), Lianqiao Xin (Forsythiae Fructum Stamen), Yuanshen (Scrophulariae Radix), Xijiao (Rhinocerotis Cornu), Shichangpu (Acori Tatarinowii Rhizoma).
Patient surnamed Hu, pulse rapid, tongue red, deafness, chest stuffiness, usually has phlegm-fire, recently winter-warmth, triggers old illness, plus relapse from overwork, scanty urination. Discuss treating heat in Pericardium Collateral.
Prescription: Xian Shengdi (5 qian), Zhuyexin (1 qian), Danshen (Salviae Miltiorrhizae Radix et Rhizoma, 1.5 qian), Yuanshen (1.5 qian), Shichangpu Gen (Acori Tatarinowii Rhizoma Root, 6 fen), Chen Danning (Arisomatis Rhizoma Preparatum, 6 fen).
Patient surnamed Gu, warm pathogen wrongly treated with sweating/purging robbed fluids, pathogen enters Pericardium Collateral and closes internally, Zhibao Dan (Treasure of Life Pellet).
Patient surnamed Wang, inhaled warm pathogen, nose connects to Lung collaterals, retrograde transmission to Pericardium Collateral, shakes the Monarch (Heart), spirit mind about to confuse. Diffuse pathogen, attacking does not resolve. Clear orifices covered, collaterals inside also obstructed. Pediatricians do not understand, administer phlegm-resolving, fire-reducing, qi-regulating, without any effect. Recall Pingmai Pian: Clear pathogen attacks upper, Lung position is highest. Once entering Pericardium Collateral, Qi and Blood intersect and block, expel turbidity and open orifices, must rely on aromatic. Discuss using Ju Fang Zhibao Dan (Official Formula Treasure of Life Pellet).
Patient surnamed Shi, warm pathogen like malaria, Yin qi injured first, bitter-acrid again damages Yang and Stomach, internal wind rampant, limb convulsions, pathogen closes Pericardium Collateral, phlegm tide and spirit confusion, this is heat steaming and burning, formless and substance-less. This resolving phlegm, digesting food, clearing fire, goes straight to intestines/stomach, scratching an itch outside the boot relative to the condition. Quickly give Zhibao Dan (Treasure of Life Pellet) 3 fen, mix with cold boiled water. If spirit clears, discuss treatment again.
Patient surnamed Gu, drinking alcohol yet able to eat, internal wind dominates consumption. When late spring and early summer, Yang qi relaxes and expands, thus affecting the right side. Pulse left wiry and firm, skin faint spots, face bright and red, tongue coating gray-yellow, must contain latent warm pathogen. Fear internal closure and spirit confusion. Treatment method: clear collaterals and open orifices, do not attack wind and rob phlegm, assisting warm pathogen, calm and clear, hope for prolonged survival with disease.
Prescription: Xijiao (Rhinocerotis Cornu), Shengdi (Rehmanniae Radix), Yuanshen (Scrophulariae Radix), Lianqiao Xin (Forsythiae Fructum Stamen), Yujin (Curcumae Radix), Xiao Qingye (Small Bamboo Leaf), Zhuyexin (Bamboo Leaf), Shichangpu (Acori Tatarinowii Rhizoma).
Second visit, eyes closed, tongue retracted, spirit confused like drunk, pathogen enters Pericardium Collateral, Heart spirit covered, called internal closure. Previous case already discussed. Warm pathogen stagnant steaming, is formless, while medicine all has form and smell/taste, just like scratching an itch outside the boot. Modern Yu Jiayan proposed aromatic expelling turbidity and opening orifices, quite reasonable. Terminal illness hard to save, merely doing human effort. Zhibao Dan (Treasure of Life Pellet) 4 pills, divided into 4 doses, cool boiled water, dissolve.
Patient surnamed Bao, elderly lower deficiency, spring-warmth received from above, phlegm tide, confusion and delirium, tongue crimson yellow coating, face red slight spasm, first clear upper jiao. (Heat pathogen closes orifices, spirit confusion.)
Prescription: Tianzhuhuang (Calami Tuber), Jinyinhua (Lonicerae Japonicae Flos), Zhuyexin (Bamboo Leaf), Lianqiao (Forsythiae Fructum), Zhuli (Bambusa Textilis Caulis Sap).
Patient surnamed Zhang, warm pathogen erupts from inside, swollen throat, thirst, gray-stagnant tongue center, upper jiao heat covers, most fear orifice closure, confusion, spasm. Bitter-cold direct descent, attack intestines/stomach, unrelated to warm pathogen upper stagnation.
Prescription: Lianqiao (Forsythiae Fructum), Hei Zhipi (Gardeniae Fructus Pericarpium), Niubangzi (Arctii Fructus), Xingren (Armeniacae Semen Amarum), Huafen (Trichosanthis Radix), Mabo (Macrostemonis Flos), Gualou Pi (Trichosanthis Pericarpium), Xiakucao (Prunellae Spica), Jin Zhi (Human Feces Distillate), Yinhua Lu (Honeysuckle Flower Dew).
Patient surnamed Zhang (Under one year old), did not obtain grain essence, inhaled warm pathogen, upper jiao receives first, head/face/jaw swollen, pathogen mixed with Qi and Blood, knife/needle breaks collaterals, warm pathogen internal closure heat congestion, spreads to three jiao, confusion/sleep/phlegm tide, tongue prickles/retracts, urine drops turbid, heat knots internally. But Gao, Lian, Qin, Zhi type drugs, nature directly descends, actually reaches stomach/intestines, while heat is like smoke/mist, originally not form/substance that can be swept away. Thus Niuhuang (Calculus Bovis) produced in cow belly, originally formed from Qi and Blood, mixed in Qi/Blood pathogen, relies on this to break accumulation, this is reason for efficacy. Warm-heat epidemic pathogens ascend Qi level, gradually reach Blood level, not like Cold Damage foot six meridians, smooth transmission through collaterals. Generally heat raging, must smoke-seal internal orifices of collaterals, thus confusion/restlessness all desire closure of internal orifices. To open internal closure, must get aromatic. Qi/Blood long stagnation, must cause ulcer-toxin internal attack. Respectfully state main idea for reference. Use Zixue Dan (Purple Snow Pellet) 3 fen, mix with slightly warm boiled water.
Patient surnamed Chu, warm pathogen enters via mouth/nose, starts entering Lung, causes cough/wheeze, subsequently transmits to Danzhong then hemoptysis, this is Heart Ying and Lung Wei receiving pathogen. However pathogen in upper jiao, congests and blocks qi, must gather into heat, foul phlegm/choking/thirst, is desiring internal closure. Pity not using He Jian's Three Jiao legislation, some say Cold Damage governs six meridians, some say Lung Abscess specifically drains Qi/Blood, causing heat no exit, chest protrudes abdomen large, danger period very fast. Even if correct medicine, Qi surges boiling, inevitably vomits everything, how expect help. Warm-heat turbid filth fills internal orifices, spirit consciousness confused, bloating suffocation desiring death, must use aromatic to open orifices, assist Niuhuang (Calculus Bovis) and Jinbo (Gold Foil) deep into organ collaterals, to search trapped-closed pathogen. Now critical like this, one in hundred chance. Zixue Dan (Purple Snow Pellet).
Patient surnamed Chen, warm pathogen retrograde transmits to Danzhong, heat-phlegm blocks empty orifices, entered cold-clearing digestion, vainly attacks intestines/stomach, no effect at all. Phlegm is heat steaming fluids transformed, Danzhong is empty-spirit place, is hardest medication. Zhibao Dan (Treasure of Life Pellet) aromatic, opens spirit-mind orifices, to drive heat-phlegm knot is extremely correct. But young age receives warm pathogen, most easily Yin deficiency fluid consumption, must combine nourish-clear to manage long-latent warm pathogen as correct.
Prescription: Xijiao (Rhinocerotis Cornu), Xian Shengdi (Rehmanniae Radix Recens), Yuanshen (Scrophulariae Radix), Lianqiao Xin (Forsythiae Fructum Stamen), Danpi (Moutan Cortex), Shichangpu (Acori Tatarinowii Rhizoma).
Dissolve and take Zhibao Dan (Treasure of Life Pellet).
Patient, dampness is gradual heat qi, foggy mist between diaphragm, spirit mechanism not issuing, three jiao all invaded by pathogen, how is it minor illness. View tongue extension/retraction like stiff, phlegm saliva sticky, internal closure signs seen. Unblock Danzhong, hope for slight recovery, no time to clear extreme Yin heat.
Zhibao Dan (Treasure of Life Pellet) 4 fen, delivered with Shichangpu Jinyinhua Tang (Acorus and Honeysuckle Decoction).
Patient surnamed Wang (18 years old), night fever morning cool, fever retreats no sweat, heat comes from Yin, thus can eat, thin form, pulse rapid left strong, two months unresolved, treat in Blood level. (Heat sinks into Blood level.)
Prescription: Sheng Biejia (Testudinis Carapax et Plastrum), Qinghao (Artemisiae Annuae Herba), Xi Shengdi (Rehmanniae Radix), Zhimu (Anemarrhenae Rhizoma), Danpi (Moutan Cortex), Dan Zhuye (Light Bamboo Leaf).
Patient surnamed Xu, warm pathogen already entered Blood level, tongue red voice low, spirit dull tidal fever, immediately erupts macules/rashes, also is heat pathogen in blood. Wrong sweating/digestion, must change to confusion/collapse.
Prescription: Xijiao (Rhinocerotis Cornu), Xi Shengdi (Rehmanniae Radix), Yuanshen (Scrophulariae Radix), Danpi (Moutan Cortex), Yujin (Curcumae Radix), Shichangpu (Acori Tatarinowii Rhizoma).
Patient surnamed Zhang, tongue crimson cracks, face withered, no luster, image fears cold, heart burns with heat, pathogen deep enters Jueyin, Zheng qi already extremely deficient. Reluctantly propose Zhang Zhongjing's Fumai Tang (Restore the Pulse Decoction), conforms to less-pathogen more-deficiency treatment method. (Heat enters Jueyin.) Fumai minus Renshen/Ginger add Sugarcane juice replace water decoction.
Second visit, heat disease wrongly administered, surface-dispersing/digestion, Zheng qi injured, spirit confusion tongue stiff, situation like prairie fire. Advance Fumai method, slight turn. Should follow previous formula, remove Cinnamon add Ginseng, to support Zheng qi as main. Fumai Tang remove Cinnamon add Renshen Sugarcane juice replace water decoction.
Third visit, advance sweet medicine quite peaceful, alas Yin fluids already dried, tongue stiff voice retracted, touch dry board, compared to previous gum flesh reflecting blood has difference, urination desires release pulling pain, still Yin qi desiring extinction, drowsy confusion, noon irritability, heat deeply enters Yin sign, cannot firmly promise cure date.
Prescription: Sheng Baishao (Paeoniae Radix Alba), Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma), Ejiao (Colla Corii Asini), Jizihuang (Galli Oleum), Renshen (Ginseng Radix et Rhizoma), Shengdi (Rehmanniae Radix), Maidong (Ophiopogonis Radix), Chao Mahong (Semen Cannabis Preparatum).
Patient, wrongly purged heat sinks into interior, becomes Jie Xiong (knotted chest), so body not much heat, but shortness of breath chest fullness irritability, this all pathogenic heat internal burning, disturbing spirit mind, internal closure sign, tricky heavy illness. Imitate Zhang Zhongjing's Xie Xin Fa (Drain the Epigastrium Method), prepare for reference, wait for expert decision. (Wrongly purged heat sinks becomes knotted chest.)
Prescription: Chuan Lian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Banxia (Pinelliae Rhizoma), Pao Dan Jiang (Prepared Light Ginger), Shengjiang (Fresh Ginger), Zhishi (Aurantii Fructus).
Patient surnamed Wu, spirit energy like confused, no hunger no food, is bitter-acrid digestion dispersing, robbing Stomach fluids caused. Because warm pathogen Hand meridian disease, modern world mostly uses Foot six meridians to govern, thus causing this. (Wrong treatment injures Stomach fluids.)
Prescription: Xi Shengdi (Rehmanniae Radix), Zhuyexin (Bamboo Leaf), Maidong (Ophiopogonis Radix), Yuanshen Xin (Scrophulariae Radix Stamen), Lianqiao Xin (Forsythiae Fructum Stamen), Yujin (Curcumae Radix).
Patient surnamed Wang (Elderly woman), warm-heat thirteen days, tongue yellow, heart stifling pain, initially Hand meridian disease, should not use Foot meridian formula. Elderly fear fluid exhaustion, sweet-cold awakens Stomach and removes heat.
Prescription: Xian Shengdi (Rehmanniae Radix Recens), Zhuyexin (Bamboo Leaf), Maidong (Ophiopogonis Radix), Yujin (Curcumae Radix), Chuan Shihu (Dendrobii Caulis), Changpu Gen (Acori Tatarinowii Rhizoma Root).
Patient surnamed Wu (15 years old), recently sky not cold, disease deficiency Qi not storing/gathering, contracted pathogen called Winter-Warmth. Renshen/Lingqi Tonify Qi, Bohe/Jiegeng/Xingren Drain Qi, already contrary to error. Add Buguzhi warm-astring Kidney, especially不通 (unconnected) extreme. Self reports deep night sleep, sweating. Young age Yin not full, Yang easily leaks, discuss constitution can repel disease. (Winter-Warmth injures fluids.)
Prescription: Sangye (Mori Folium), Da Shashen (Glehniae Radix), Yuzhu (Polygonati Odorati Rhizoma), Yiren (Coicis Semen), Sheng Gancao (Glycyrrhizae Radix et Rhizoma), decoct with Nuomi Tang (Glutinous Rice Decoction).
Patient surnamed Chen (Half year old), Winter-Warmth enters Lung, glue-phlegm transforms heat, because not-grain-ingested body, cannot heavy medicine resolve-phlegm unblock-drain.
Prescription: Chao Maidong (Prepared Ophiopogonis Radix), Sangye (Mori Folium), Da Shashen (Glehniae Radix), Tian Xingren (Sweet Armeniacae Semen), Digupi (Lycii Cortex).
Patient, pulse rapid right large, irritability/thirst tongue crimson, warm pathogen, Qi and Blood both injured, give Yupan Jian (Jade Woman Decoction). (Qi and Blood both injured.)
Prescription: Shengdi (Rehmanniae Radix), Zhuye (Bamboo Leaf), Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), Danpi (Moutan Cortex), Gancao (Glycyrrhizae Radix et Rhizoma).
Patient surnamed Chen (2-3 years old), Yin deficiency warm pathogen, sweet-cold clear upper. (Yin deficiency feels warm pathogen.)
Prescription: Baishashen (Glehniae Radix), Tian Xingren (Sweet Armeniacae Semen), Yuzhu (Polygonati Odorati Rhizoma), Dong Sangye (Winter Mulberry Leaf), Nan Huafen (Southern Trichosanthis Radix), Sheng Gancao (Glycyrrhizae Radix et Rhizoma).
Patient surnamed Guan, Yin deficiency carries warm pathogen, chills/fever continuous, although should not disperse/digest, vain tonify also belongs to useless. Propose advance Fumai Tang (Restore the Pulse Decoction) method.
Prescription: Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma), Ejiao (Colla Corii Asini), Sheng Baishao (Paeoniae Radix Alba), Maidong (Ophiopogonis Radix), Chao Shengdi (Prepared Rehmanniae Radix), Chao Danpi (Prepared Moutan Cortex), Qing Zhugan Zhi (Green Sugarcane Juice) decoct.
Patient surnamed Huang, body deficient, warm pathogen internal latent, head sweat dripping, heart/abdomen stuffed, upper heat lower cold, white tongue irritability/thirst, Spring Yang rising causes disease, still Winter season lacking storage caused. Color/pulse consult view, extremely cautious.
Prescription: Ejiao (Colla Corii Asini), Shengdi (Rehmanniae Radix), Maidong (Ophiopogonis Radix), Sheng Muli (Ostreae Concha), Sheng Baishao (Paeoniae Radix Alba), Fuling (Poria).
Patient surnamed Zhang (55 years old), fatigue internal injury, warm pathogen external receive, two months not healed, heart warm/liquid feeling, fluids unable to supply above, night sleep throat dry, give Fumai Tang remove Ginger/Cinnamon/Renshen, after three doses can add Renshen. (Fatigue feels warm Yin fluids dry.)
Patient surnamed Wang, fatigue further feels warm pathogen, Yang rising headache, chills/fever shivering, cold sweat pathogen although externally reaches, Yang qi also leaks causing spirit tired desiring sleep, tongue red yellow coating, mouth unknown taste, should use nourish-Yin remove-heat as main, acrid-disperse bitter-descent not suitable. Fumai Tang remove Renshen/Ginger/Cinnamon/Hemp add Green Sugarcane Juice.
Patient surnamed Cao, pulse hurried rapid, white tongue no hunger, chills/fever sweating, initially abdominal pain, right navel has shape, is long-injured fatigue, further feels warm pathogen, now disease twenty days plus six, slight cough has phlegm, not thirsty for drink, chills come slight jaw spasm, this Ying/Wei two Qi greatly decline, fear prolong deficiency collapse. Discuss solidify Defensive Yang, hope chills/fever get flat. (Fatigue feels warm Ying/Wei Stomach Yang concurrent deficiency.)
Prescription: Huang (Yellow - likely missing herb name or typo in source, context suggests Huangqi or similar, kept as Huang per text constraint or implied Huangqi/Astragali Radix based on context of solidifying Yang, but strictly text says "Huang"), Guizhi (Cinnamomi Ramulus), Baishao (Paeoniae Radix Alba), Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma), Muli (Ostreae Concha), Nanzao (Jujubae Fructus).
Patient surnamed Chen, after heat disease, no hunger can eat, no sleep, this Stomach Qi not harmonious. (Disease retreats Stomach not harmonious.)
Prescription: Xiangchi (Fermented Soybean), Hei Shanzhi (Gardeniae Fructus), Banxia (Pinelliae Rhizoma), Zhishi (Aurantii Fructus), Guang Pi Bai (Tangerine Peel White).
Patient surnamed Hua (55 years old), mouth/nose receive cold/warm incorrect qi, pass mu-yuan, disturb Stomach system, chills/fever already ceased, still not full not hungry, tongue edge red, center yellow, residual pathogen not cleared, food enters turns sour, is pathogenic heat cannot overcome grain, use Wendan (Warm Gallbladder) to harmonize. Banxia Wendan remove Gancao/Fuling/Zhishi, add Yujin/Hei Shanzhi.
Patient surnamed Lin, abdominal fullness long time, not acute disease, recently face/jaw swelling, jaw locked, initially chills/fever, then appears this sign, diagnose pulse right pounding rapid, left small, is warm pathogen touches via mouth/nose, upper jiao receives first, Qi/Blood and heat knotted solid, causing clear orifices not beneficial, suddenly has bi-obstruction change, should first treat new pathogen, moreover head/face/throat knotted pathogen, must acrid-cool mild agent to diffuse-unblock, if drug flavor heavy/turbid, vainly attacks intestines/stomach. Imitate Dong Yuan's Puji Xiaodu (Universal Relief Detoxification) intent. (Heat toxin congests upper jiao.)
Prescription: Lianqiao (Forsythiae Fructum), Niubangzi (Arctii Fructus), Mabo (Macrostemonis Flos), Shegan (Belamcandae Rhizoma), Huashi (Talcum), Xiakucao (Prunellae Spica), Jinyinhua Lu (Honeysuckle Flower Dew), Jin Zhi (Human Feces Distillate).
Patient surnamed Xi, pulse left rapid, right slow weak, Yang root not solid, Yin fluids gradually dried, tongue red slight thirst, panting spontaneous diarrhea urination frequent, dusk self-heat, spirit irritability sleep-talking. Because warm pathogen long-lays Shaoyin, ancient people legislation, entirely nourish-Yin remove-heat. But now seen signs, Yin level inherently latent pathogen, True Yang also refuses to receive. Discuss imitate Liu Hejian turbid drug light throw, not for upper jiao heat block, lower jiao root stands self, hope irritability heat steaming gradually slows. (Yin deficiency pathogen lays.)
Prescription: Shudi Tan (Prepared Rehmanniae Radix Charcoal), Fuling (Poria), Dan Congrong (Cynomorii Herba), Yuanzhi Tan (Polygalae Radix Charcoal), Chuan Shihu (Dendrobii Caulis), Wuweizi (Schisandrae Fructus), decoct method.
Second visit, evening diagnosis, Yin internal latent pathogen, dusk time rises, eye red ashamed of light, tongue crimson thirsty, give nourish-Yin clear-pathogen method.
Prescription: Shengdi Tan (Rehmanniae Radix Charcoal), Yuanshen Xin (Scrophulariae Radix Stamen), Chuan Shihu (Dendrobii Caulis), Chao Maidong (Prepared Ophiopogonis Radix), Xijiao (Rhinocerotis Cornu), Shichangpu (Acori Tatarinowii Rhizoma).
Third visit, pulse left rapid, right soft, tongue dry white coating, urination dribbling, inhale panting, irritability sweat, Kidney Yin not supporting, Heart spirit heat burning covered, discuss Sancai Tang (Three Talents Decoction), nourish-water control-heat. Sancai add Fushen/Huangbo/Jinbo, evening advance Zhou Shaochuan Niuhuang Qingxin Wan (Calculus Bovis Heart-Clearing Pill) one dose.
Fourth visit, yesterday dusk, diagnose pulse, compared to morning, left hand rapid疾 sudden reduce, only Chi position droops and still moves, sleep-talk endless, if hallucinations. Because think Kidney heat attacks Heart, Danzhong slight closure, spirit mind covered, naturally belongs to confusion. Follow advance Zhou Shaochuan Niuhuang Wan one dose, let diffuse substance-less heat, temporarily can drain-descend. After taking quite peaceful. Morning pulse soft-small, form-substance greatly declines, tongue edge color pale, down diarrhea watery. Saving Yin is key point, read Zhang Zhongjing Shaoyin Down Diarrhea chapter, upper/lower compete, gate valve desiring open, must block Yangming to treat, because Yangming governs closing, has opening no closing, lower jiao Yin, still from leaking. Discuss use Taohua Tang (Peach Kernel Decoction).
Prescription: Renshen (Ginseng Radix et Rhizoma), Chishizhi (Halloysit Rubrum), Pao Jiang (Prepared Ginger), Bai Jingmi (White Glutinous Rice).
Fifth visit, evening take according to formula add Fuling.
Sixth visit, pulse left sink rapid, right small rapid, dusk heat slight sweat, sometimes irritability, morning spirit clear, deficient pathogen still stays Yin level, discuss use clear-tonify.
Prescription: Renshen (Ginseng Radix et Rhizoma), Fuling (Poria), Chuan Shihu (Dendrobii Caulis), Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma), Heidoupi (Black Soybean Skin), Nuodaogenxu (Echinochloae Fructus Root Hair).
Seventh visit, Jingui Maimendong Tang (Mai Men Dong Decoction from Golden Cabinet).