何姓妇，年三十二岁，受妊五月，于孟秋感受温病。
病因 怀妊畏热，夜眠当窗，未上窗幔，自窗纱透风，感冒成温。
证候 初病时调治失宜，温热传里，阳明府实，延医数人皆言病原当用大凉之药，因怀妊实不
敢轻用，继延愚为诊视，见其面红气粗，舌苔白浓，中心已黄，大便干燥，小便短赤。诊
其脉左右皆洪滑而实，一息五至强。
诊断 据此证状脉象观之，不但阳明胃府之热甚实，即肝胆之热亦甚盛。想其未病之前必曾怒
动肝火，若不急清其热，势将迫血妄行，危险即在目前。治以白虎加人参汤，以白虎汤解
其热，加参以保其胎，遂为疏方俾急服之。
处方 生石膏（三两捣细） 野党参（四钱） 生怀地黄（一两） 生怀山药（一两）
生杭芍（五钱） 甘草（三钱）
共煎汤三盅，分三次温服下。
方解 按此方虽非白虎加人参汤原方，而实以生地黄代知母，以生山药代粳米，而外加
芍药也。盖知母、地黄同能滋阴退热，而知母性滑，地黄则饶有补肾之力，粳米与山药皆有浓汁能
和胃，而粳米汁浓而不粘，山药之汁浓而且粘，大有固肾之力。如此通变原方，自于胎妊
大有益也。外加芍药者，欲借之以清肝胆之热也。
复诊 将药分三次服完，翌日午前大便通下一次，热已退十之七八，脉象已非洪实，仍
然有力，心中仍觉发热，拟再用凉润滋阴之品清之。
处方 玄参（一两） 生怀地黄（一两） 天花粉（五钱） 生杭芍（五钱）
鲜茅根（四钱） 甘草（二钱）
共煎汤两盅，分两次温服下。
效果 将药煎服两剂，病遂霍然全愈。
帮助 凡外感有热之证，皆右部之脉盛于左部之脉，至阳明府实之证，尤必显然于右部见之。
因胃府之脉原候于右关也。今此证为阳明府实，其右部之脉洪滑而实宜矣。而左部之脉亦
现此象，是以知其未病之先肝中先有郁热，继为外感之热所激，则勃然发动而亦现洪滑而实之脉象也。
何姓妇女，年龄三十二岁，怀孕五个月时，在初秋时节感染了温病（由温热邪气引起的急性外感热病）。
病因 因怀孕后怕热，夜晚睡觉时对着窗户，且未挂窗幔，风从窗纱缝隙透入，导致感冒而化为温病。
证候 发病初期治疗不当，温热之邪传入体内，形成阳明腑实证（邪热与肠中糟粕互结的里实热证），请了几位医生诊治，都说病因应当使用大寒凉的药物，但因为患者怀有身孕，实在不敢轻易使用。随后请我诊治，见其面色红赤、呼吸粗重，舌苔白厚，中心部位已变黄，大便干燥，小便短少色赤。诊察其脉象，左右手皆呈洪大、滑利而有力之象，一呼一吸之间脉搏跳动超过五次。
诊断 根据这些症状和脉象来看，不仅阳明胃腑的热邪非常盛实，就连肝胆的热邪也非常旺盛。推测其在生病之前必定曾动怒引发肝火，如果不紧急清除其热邪，势必会导致血液妄行出血，危险就在眼前。治疗方法采用白虎加人参汤（清热生津、益气和胃的方剂），用白虎汤来解除热邪，加入人参以保护胎儿，于是为其开具处方，嘱咐其立即服用。
处方 生石膏（三两，捣碎成细粉） 野党参（四钱） 生怀地黄（一两） 生怀山药（一两） 生杭芍（五钱） 甘草（三钱）
将上述药材共煎煮成三碗药汤，分三次温服。
方解 按照此方分析，虽然这不是白虎加人参汤的原方组成，但实际上是用生地黄代替了知母，用生山药代替了粳米，并且外加了芍药。大概因为知母和生地黄都能滋阴退热，而知母性质滑利，生地黄则富有补肾的功效；粳米与山药都含有浓稠汁液能调和胃气，但粳米的汁液浓稠而不粘滞，山药的汁液浓稠而且粘腻，具有强大的固肾作用。如此灵活变通原方，自然对妊娠大有益处。另外加入芍药，是想借助它来清泄肝胆的热邪。
复诊 将药物分三次服完后，第二天上午大便通畅排下一次，热势已经退了十分之七八，脉象已不再呈现洪大有力之象，但仍然有力，心中仍感觉发热，打算继续使用清凉滋润、滋阴的药物来清除余热。
处方 玄参（一两） 生怀地黄（一两） 天花粉（五钱） 生杭芍（五钱） 鲜茅根（四钱） 甘草（二钱）
将上述药材共煎煮成两碗药汤，分两次温服。
效果 将药物煎服两剂后，疾病便霍然痊愈。
帮助（按语） 凡是外感伴有发热的病症，通常右侧脉象强于左侧脉象，到了阳明腑实证，这种右脉盛于左脉的现象尤为明显。因为胃腑的脉象原本对应于右手关部。如今此证为阳明腑实证，其右部脉象呈现洪大、滑利而有力是适宜的。而左部脉象也出现这种景象，因此知道其在生病之前肝中先有郁积的热邪，继而被外感的邪热所激发，于是勃然发动，也呈现出洪大、滑利而有力的脉象。
A woman surnamed He, aged thirty-two, was five months pregnant when she contracted a warm disease (an acute febrile disease caused by warm pathogenic factors) in early autumn.
Etiology Due to heat intolerance during pregnancy, she slept facing the window at night without drawing the curtain. Wind penetrated through the window screen, leading to an exogenous contraction that transformed into a warm disease.
Symptoms Inappropriate treatment at the onset allowed the warm pathogen to transmit inward, resulting in Yangming Fu-organ excess syndrome (a interior excess-heat syndrome characterized by the interaction of evil heat and accumulated feces in the intestines). Several physicians were consulted, all stating that the etiology required the use of strongly cooling medications. However, due to her pregnancy, they dared not use them lightly. I was then invited to examine her. She presented with a red face and coarse breathing, a thick white tongue coating with yellowing in the center, dry stool, and scanty dark urine. Her pulse was surging, slippery, and forceful on both left and right sides, beating more than five times per breath cycle.
Diagnosis Based on these symptoms and pulse characteristics, it is evident that not only is the heat in the Yangming Stomach organ extremely excessive, but the heat in the Liver and Gallbladder is also very vigorous. It is presumed that she must have experienced anger-induced Liver fire prior to falling ill. If the heat is not cleared urgently, there is a risk of reckless bleeding, posing immediate danger. The treatment employed Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng), using Baihu Tang to resolve the heat and adding Ren Shen (Ginseng) to protect the fetus. A prescription was issued for immediate administration.
Prescription Sheng Shi Gao (Raw Gypsum Fibrosum, 3 liang, finely ground) Ye Dang Shen (Wild Codonopsis Radix, 4 qian) Sheng Huai Di Huang (Fresh Rehmanniae Radix, 1 liang) Sheng Huai Shan Yao (Fresh Dioscoreae Oppositiflorae Rhizoma, 1 liang) Sheng Hang Shao (Fresh Paeoniae Radix Alba, 5 qian) Gan Cao (Licorice Root, 3 qian)
Decoct together to yield three bowls of liquid, divided into three doses taken warm.
Formula Analysis Although this formula is not the original composition of Baihu Jia Renshen Tang, it effectively substitutes Zhi Mu (Anemarrhenae Rhizoma) with Sheng Di Huang (Rehmanniae Radix Praeparata) and Jing Mi (Oryza Sativa) with Shan Yao (Dioscoreae Rhizoma), while additionally adding Shao Yao (Paeoniae Radix). This is because both Zhi Mu and Sheng Di Huang can nourish Yin and reduce fever; however, Zhi Mu has a lubricating nature, whereas Sheng Di Huang possesses strong Kidney-nourishing properties. Both Jing Mi and Shan Yao contain viscous juices that harmonize the Stomach; Jing Mi’s juice is thick but non-sticky, while Shan Yao’s juice is thick and sticky, offering significant Kidney-fortifying power. Such flexible modification of the original formula is highly beneficial for pregnancy. The addition of Shao Yao aims to clear heat from the Liver and Gallbladder.
Second Visit After completing the three doses of the previous prescription, the patient had a bowel movement the following morning before noon. The fever had subsided by seventy to eighty percent. The pulse was no longer surging and forceful but remained strong. She still felt internal heat. It was decided to continue using cooling, moistening, and Yin-nourishing agents to clear the residual heat.
Prescription Xuan Shen (Scrophulariae Radix, 1 liang) Sheng Huai Di Huang (Fresh Rehmanniae Radix, 1 liang) Tian Hua Fen (Trichosanthis Radix, 5 qian) Sheng Hang Shao (Fresh Paeoniae Radix Alba, 5 qian) Xian Mao Gen (Imperatae Rhizoma, 4 qian) Gan Cao (Licorice Root, 2 qian)
Decoct together to yield two bowls of liquid, divided into two doses taken warm.
Outcome After taking two doses, the illness was completely resolved.
Commentary In cases of exogenous heat, the right-side pulse is typically stronger than the left. In Yangming Fu-organ excess syndrome, this distinction is particularly pronounced on the right side, as the Stomach pulse is primarily reflected at the Right Guan position. Therefore, a surging, slippery, and forceful pulse on the right side is appropriate for this case. The fact that the left-side pulse also exhibits this image indicates that there was pre-existing stagnant heat in the Liver prior to the illness, which was then激ated by the exogenous heat, causing it to flare up and manifest as a surging, slippery, and forceful pulse.