天津康××幼女，年九岁，于孟秋得温病兼大气下陷。
病因 因得罪其母惧谴谪，藏楼下屋中，屋窗四敞，卧床上睡着，被风吹袭遂成温病。
证候 初得病时服药失宜，热邪内陷，神昏不语，后经中西医多位延医二十余日，病益加剧，医者
见病危已至极点，皆辞不治。继延愚为诊视，其两目上窜，几不见黑睛，精神昏愦，毫无知觉，身体
颤动不安，时作嗳声，其肌肤甚热，启其齿见其舌缩而干，苔薄微黄，偶灌以水或米汤犹知下咽，其气
息不匀，间有喘时，其脉数逾六至，左部细而浮，不任重按，右部亦弦细，重诊似有力，大便旬日未行。
诊断 此外感之热久不退，灼耗真阴，以致肝脏虚损，木燥生风
而欲上脱也。当用药清其实热，滋其真阴，而更辅以酸收敛肝之品，庶可救此极危之证。
处方 生石膏（二两轧细） 野台参（三钱） 生怀地黄（一两） 净萸肉（一两）
生怀山药（六钱） 甘草（二钱）
共煎汤两大盅，分三次温饮下，每次调入生鸡子黄一枚。
方解 此方即白虎加人参汤，以生地黄代知母，生山药代粳米，而又加萸肉也。此方若不加
萸肉为愚常用之方，以治寒温证当用白虎加人参汤而体弱阴亏者，今加萸肉借以收敛肝气之将
脱也。至此方不用白虎汤加减，而必用白虎加人参为之加减者，因病至此际，非加人参于
白虎汤中，不能退其深陷之热，复其昏愦之神明也。此理参观药物人参解后所附医案自明。
复诊 将药三次服完，目睛即不上窜，身体安稳不复颤动，嗳声已止，气息已匀，精神较前
明了而仍不能言，大便犹未通下，肌肤犹热，脉数已减，不若从前之浮弦，而右部重诊仍
似有力，遂即原方略为加减，俾再服之。
处方 生石膏（两半轧细） 野台参（三钱） 生怀地黄（一两） 净萸肉（六钱）
天冬（六钱） 甘草（二钱）
共煎汤两盅，分两次温饮下，每次调入生鸡子黄一枚。
三诊 日服药一剂，连服两日，热已全退，精神之明了似将撤消而仍不能言，大便仍未通下，间
有努力欲便之象，遂用灌肠法以通其便。再诊其脉六部皆微弱无力，知其所以不能言
者，胸中大气虚陷，不能上达于舌本也。宜于大剂滋补药中，再加升补气分之品。
处方 生怀山药（一两） 大甘枸杞（一两） 沙参（一两） 天冬（六钱）
寸麦冬（六钱） 生箭 （三钱） 野台参（三钱） 升麻（一钱） 桔梗（一钱）
共煎汤一盅半，分两次温服下。
效果 将药煎服两剂，遂能言语，因即原方去升麻减沙参之半，再加萸肉、生麦芽各三钱，再服数剂以善后。
帮助 医者救危险将脱之证喜用人参，而喻嘉言谓气若上脱，但知重用人参转令人气高不返，必
重用赭石辅之始能奏效，此诚千古不磨之论也。此方中之用人参原非用其救脱，因此证
真阴大亏，惟石膏与人参并用，独能于邪火炽盛之时立复真阴，此白虎加人参汤之实用也。至
于萸肉，其补益气分之力远不如参，而其挽救气分之上脱则远胜于参。诚以肝主疏泄，人之元气甚
虚者，恒因肝之疏泄过甚而上脱，重用萸肉以敛肝使之不复疏泄，则元气之欲上脱者即可不脱，此愚屡
次用之奏效而确知其然者也。
病因 因得罪母亲害怕受罚，躲在楼下房间里，窗户四面敞开，躺在床上睡着时被风吹袭，从而形成了温病。
证候 刚得病时服药不当，导致热邪内陷，神志昏迷不能言语。后经中西医多位医生诊治二十多天，病情更加严重。医生们见病危已到极点，都推辞不治。后来请我诊治，见她双眼上翻，几乎看不见黑眼球，精神昏乱，毫无知觉，身体颤抖不安，不时发出嗳气声。肌肤非常热，张开牙齿看到舌体收缩而干燥，苔薄微黄。偶尔灌喂水或米汤，她还能吞咽下去。气息不均匀，间或有喘息，脉搏跳动超过六次（每呼吸一次脉动六次以上），左脉细而浮，不耐重按；右脉也弦细，重按似乎有力，大便十天未行。
诊断 这是外感的热邪久久不退，灼烧耗损真阴，导致肝脏虚损，肝木燥而生风，想要向上脱逸。应当用药清除实热，滋养真阴，并辅以酸味收敛肝脏的药物，或许可以挽救这个极危重的证候。
处方 生石膏（二两，轧成细粉） 野台参（三钱） 生怀地黄（一两） 净萸肉（一两） 生怀山药（六钱） 甘草（二钱）
共煎煮成两大碗汤药，分三次温服，每次服用时调入一枚生鸡蛋黄。
方解 此方即是白虎加人参汤（Baihu Jia Renshen Tang, White Tiger Decoction with Ginseng），用生地黄代替知母，生山药代替粳米，并且加入了萸肉。如果不加萸肉，这是我常用的方子，用于治疗寒温证中应当使用白虎加人参汤但体质虚弱、阴液亏损的患者。现在加入萸肉，借以收敛即将脱逸的肝气。至于为什么不用白虎汤加减，而必须用白虎加人参汤进行加减，是因为病势到了这个阶段，不在白虎汤中加入人参，就不能退去深陷的热邪，恢复昏乱的神明。这个道理参考药物人参项后所附的医案自然明白。
复诊 将药分三次服完，眼睛不再上翻，身体安稳不再颤抖，嗳气已停止，气息已均匀，精神比之前清醒但仍不能说话，大便仍未通下，肌肤仍然发热，脉搏次数已减少，不像从前那样浮弦，但右脉重按仍似有力，于是就在原方基础上稍作加减，让她继续服用。
处方 生石膏（一两半，轧成细粉） 野台参（三钱） 生怀地黄（一两） 净萸肉（六钱） 天冬（六钱） 甘草（二钱）
共煎煮成两碗汤药，分两次温服，每次服用时调入一枚生鸡蛋黄。
三诊 每天服用一剂药，连续服用两天，热邪已全部消退，精神的清醒程度似乎要消失但仍不能说话，大便仍未通下，间有努力想排便的迹象，于是采用灌肠法来通便。再诊时发现六部脉象皆微弱无力，知道她之所以不能说话，是因为胸中大气虚陷，不能上达于舌根。应当在大量滋补药中，再加入提升补气分的药物。
处方 生怀山药（一两） 大甘枸杞（一两） 沙参（一两） 天冬（六钱） 寸麦冬（六钱） 生箭芪（三钱） 野台参（三钱） 升麻（一钱） 桔梗（一钱）
共煎煮成一碗半汤药，分两次温服。
效果 将药煎服两剂后，就能说话了，因此就在原方中去掉升麻，减少沙参的一半，再加萸肉、生麦芽各三钱，再服用几剂以巩固疗效。
帮助 医生救治危险即将脱逸的证候喜欢用人参，但喻嘉言认为如果气向上脱逸，只知道重用转令人参反而会导致气高不返，必须重用赭石辅助才能奏效，这确实是千古不变的真理。此方中使用人参原本不是为了救脱，因为这个证候真阴大亏，只有石膏与人参并用，独能在邪火炽盛之时立即恢复真阴，这是白虎加人参汤的实际应用。至于萸肉，其补益气分的力量远不如人参，但其挽救气分向上脱逸的效果则远胜于人参。确实因为肝主疏泄，人的元气非常虚弱时，常常因为肝的疏泄过度而导致向上脱逸，重用萸肉来收敛肝脏使其不再疏泄，那么元气想要向上脱逸的情况就可以不发生，这是我屡次使用奏效并确切知道其中的道理。
The nine-year-old daughter of Kang XX from Tianjin contracted a warm disease (Wenbing, febrile disease) complicated by sinking of the Great Qi (Daqi, primordial qi residing in the chest) during early autumn.
Etiology She offended her mother and, fearing punishment, hid in a room downstairs. With windows wide open on all sides, she fell asleep on the bed and was exposed to wind, which led to the development of the warm disease.
Symptoms Initially, inappropriate medication caused the pathogenic heat to sink inward, resulting in coma and mutism. After more than twenty days of treatment by multiple Chinese and Western physicians, the condition worsened. Seeing the critical state, doctors declined further treatment. I was then consulted. Her eyes were deviated upward, barely revealing the pupils; her spirit was confused with no perception; her body trembled restlessly; she occasionally emitted belching sounds. Her skin was very hot. Upon opening her mouth, her tongue was retracted and dry, with a thin, slightly yellow coating. When water or rice soup was occasionally administered, she could still swallow. Her respiration was irregular, with intermittent panting. Her pulse beat more than six times per breath (rapid). The left pulse was fine and floating, unresponsive to heavy pressure; the right pulse was wiry and fine, but seemed forceful upon deep palpation. She had not had a bowel movement for ten days.
Diagnosis This is a case where external pathogenic heat has persisted for a long time, burning and consuming the True Yin (Zhenyin, essential yin fluid), leading to liver deficiency. The dryness of Wood (Liver) generates Wind, threatening upward collapse (Shangtuo). Treatment should clear excess heat, nourish True Yin, and be supplemented with sour herbs that astringe the Liver, hopefully saving this critically dangerous condition.
Prescription Raw Gypsum (Shigao, *Gypsum Fibrosum*) 2 liang, ground finely; Wild Taishan Ginseng (Yetaishen, *Panax ginseng* var. *alternum*) 3 qian; Raw Huai Rehmannia Root (Shengdihuang, *Rehmanniae Radix Recens*) 1 liang; Cleaned Cornus Fruit (Jinyurou, *Corni Fructus*) 1 liang; Raw Huai Yam (Shengshanyao, *Dioscoreae Rhizoma*) 6 qian; Licorice Root (Gancao, *Glycyrrhizae Radix et Rhizoma*) 2 qian.
Decoct together to make two large bowls of decoction, taken in three doses at warm temperature. Each dose should be mixed with one raw chicken egg yolk.
Formula Analysis This formula is essentially Baihu Jia Renshen Tang (White Tiger Decoction with Ginseng), substituting Raw Rehmannia for Anemarrhena (*Zhimu*), Raw Yam for Coix Seed/Rice (*Jingmi*), and adding Cornus Fruit. Without Cornus, this is my commonly used formula for treating cold-warm diseases requiring Baihu Jia Renshen Tang in patients with weak constitution and yin deficiency. Here, Cornus is added to astringe the Liver Qi that is about to collapse. Regarding why Baihu Tang modifications are not used, but rather Baihu Jia Renshen Tang modifications are necessary: at this stage of illness, without adding Ginseng to Baihu Tang, it is impossible to retreat the deeply sunk heat and restore the confused consciousness. This principle becomes clear when referring to the medical cases attached to the explanation of Ginseng (*Renshen*).
Second Visit After completing three doses, her eyes no longer deviated upward, her body stabilized and ceased trembling, belching stopped, and respiration became regular. Her spirit was clearer than before, though she still could not speak. Bowel movement remained unpassed, skin remained hot, and pulse rate decreased, no longer as floating and wiry as before, but the right pulse still seemed forceful upon deep palpation. Therefore, slight modifications were made to the original prescription for continued use.
Prescription Raw Gypsum 1.5 liang, ground finely; Wild Taishan Ginseng 3 qian; Raw Huai Rehmannia Root 1 liang; Cleaned Cornus Fruit 6 qian; Asparagus Tuber (Tiantong, *Asparagi Radix*) 6 qian; Licorice Root 2 qian.
Decoct together to make two bowls of decoction, taken in two doses at warm temperature. Each dose should be mixed with one raw chicken egg yolk.
Third Visit One dose was taken daily for two consecutive days. Heat completely subsided. Although mental clarity seemed to be fading and she still could not speak, bowel movement remained unpassed, with occasional signs of straining to defecate. Enema was used to promote bowel movement. On re-examination, all six pulse positions were weak and powerless. It was understood that her inability to speak was due to the sinking of the Great Qi in the chest, preventing it from reaching the root of the tongue. Large-dose tonifying medicines should be used, supplemented with herbs that raise and tonify Qi in the Qi aspect.
Prescription Raw Huai Yam 1 liang; Large Sweet Goji Berry (Dagouqi, *Lycii Fructus*) 1 liang; Glehnia Root (Shashen, *Glehniae Radix*) 1 liang; Asparagus Tuber 6 qian; Ophiopogon Tuber (Cundongdong, *Ophiopogonis Radix*) 6 qian; Raw Arrow Astragalus (Shengjianqi, *Astragali Radix*) 3 qian; Wild Taishan Ginseng 3 qian; Cimicifuga Rhizome (Shengma, *Cimicifugae Rhizoma*) 1 qian; Platycodon Root (Jiegeng, *Platycodi Radix*) 1 qian.
Decoct together to make one and a half bowls of decoction, taken in two doses at warm temperature.
Outcome After taking two doses, she regained the ability to speak. Therefore, Shengma was removed from the original formula, Shashen was halved, and both Cornus Fruit and Raw Barley Sprout (Shengmaiya, *Hordei Fructus Germinatus*) were added at 3 qian each. Several more doses were taken to consolidate recovery.
Commentary Physicians often prefer using Ginseng to rescue conditions of impending collapse. However, Yu Jiayan stated that if Qi is collapsing upward, relying solely on heavy doses of Ginseng may cause Qi to rise uncontrollably; heavy doses of Hematite (*Heshi*, *Hematitum*) must be added to assist for efficacy. This is indeed an immortal truth. In this formula, Ginseng was not used primarily to rescue collapse. Because this condition involves severe depletion of True Yin, only the combination of Gypsum and Ginseng can immediately restore True Yin amidst blazing pathogenic fire. This demonstrates the practical application of Baihu Jia Renshen Tang. As for Cornus Fruit, its power to tonify Qi in the Qi aspect is far inferior to Ginseng, but its ability to rescue upward collapse of Qi far surpasses Ginseng. Indeed, the Liver governs dispersion and excretion. When Yuan Qi (Primal Qi) is extremely deficient, excessive hepatic dispersion often leads to upward collapse. Heavy doses of Cornus astringe the Liver, preventing excessive dispersion, thereby preventing the collapse of Yuan Qi. I have frequently achieved success with this method and am certain of its mechanism.