天津舒××，年四十五岁，于仲夏得温病兼痧疹。
病因 舒××原精医术，当温疹流行之时，屡次出门为人诊病，受其传染因得斯病。
证候 其前数日皆系自治，屡次服表疹清热之药，疹已遍身出齐而热仍不退，因求愚为延医。其
表里俱觉发热，且又烦躁异常，无片时宁静，而其脉则微弱不起，舌苔薄而微黄，大便
日行一次不干不溏，小便赤涩短少。
诊断 此证当先有伏气化热，因受外感之传染而激发，缘三焦脂膜窜入少阴遏抑肾气，不能
上与心火相济，是以舌苔已黄，小便短赤，阳明腑热已实，而其脉仍然无力也。其烦躁异常
者，亦因水火之气不相交也。此虽温病，实与少阴伤寒之热者无异，故其脉亦与少阴伤寒之
脉同。当治以白虎加人参汤，将原方少为变通，而再加托表疹毒之品辅之。
处方 生石膏（二两捣细） 大潞参（四钱） 天花粉（八钱） 生怀山药（八钱）
鲜茅根（四钱） 甘草（二钱）
共煎汤两盅分两次温服下。
方解 此方即白虎加人参汤以花粉代知母，生山药代粳米，而又加鲜茅根也。花粉与知母，皆
能清热，而花粉于清热之外又善解毒，山药与粳米皆能和胃，而山药于和胃之外又能滋
肾。方中之义，用白虎汤以治外感实热，如此变通则兼能清其虚热解其疹毒，且又助以人参
更可治证实脉虚之热，引以鲜茅根并可治温病下陷之热也。
复诊 将药煎服一剂，热退强半，烦躁亦大轻减，可安睡片时。至翌日过午，发热烦躁又如
旧，脉象仍然无力，因将生石膏改用三两，潞参改用五钱，俾煎汤三盅，分三次温饮下。每
饮一次，调入生鸡子黄一枚。服后其病亦见愈，旋又反复，且其大便一日两次，知此寒凉
之药不可再服。乃此时愚恍然会悟，得治此证之的方矣。
处方 鲜白茅根（六两切碎）
添凉水五盅，在炉上煎一沸，即将药罐离开炉眼，约隔三寸许，迟十分钟再煎一沸，又离开炉眼，
再迟十分钟，视其茅根皆沉水底其汤即成。若茅根不沉水底，可再煎一沸，约可
取清汤三盅，乘热顿饮之以得微汗方佳。
效果 此方如法服两剂，其病脱然愈矣。
帮助 按此证其伏气之化热，固在三焦，而毒菌之传染，实先受于上焦，于斯毒热相并随上焦之
如雾而弥漫于全身之脏腑经络不分界限。茅根凉而能散，又能通达经络脏腑无微不至。
惟性甚平和，非多用不能奏效。是以一剂重用至六两，其凉散之力，能将脏腑经络间之毒热尽数排
出（茅根能微汗利小便，皆其排出之道路），毒热清肃，烦躁自除矣。愚临证五十年，用白虎加人参汤时
不知凡几，约皆随手奏效。今此证两次用之无效，而竟以鲜白茅根收其功，此非愚所素知，乃因
一时会悟后则屡次用之皆效，故特详之以为治温疹者开一法门也。若其脉象洪滑甚
实者，仍须重用石膏清之，或石膏、茅根并用亦可。又按白茅根必须用鲜者，且必如此煎法方效。但
根据之成功多用可至十两，少用亦须至四两，不然此证前两方中皆有茅根四钱未见效验，其宜多用可
知矣。又药局中若无鲜者，可自向洼中剖之，随处皆有。若剖多不能一时皆用，以湿土埋之永久不坏。
病因：舒××原本精通医术，在温疹流行期间，多次出门为人诊病，受到传染因而得了这个病。
证候：他前几天都是自行治疗，屡次服用解表透疹、清热的药物，虽然疹子已经遍布全身出齐，但发热仍然不退，于是请求我为他延请医生诊治。他感觉表里都发热，并且异常烦躁，没有片刻安宁，但他的脉象微弱不起，舌苔薄而微黄，大便每天一次，不干也不稀溏，小便赤涩且短少。
诊断：此证应当是先有伏气化热，因受外感传染而激发。由于三焦脂膜窜入少阴经，遏制抑制了肾气，导致肾气不能上与心火相济（即心肾不交），所以舌苔已黄，小便短赤，阳明腑热已经结实，但脉象仍然无力。其异常烦躁的原因，也是由于水火之气不相交融所致。这虽然是温病，实际上与少阴伤寒的热证没有两样，所以脉象也与少阴伤寒的脉象相同。应当用白虎加人参汤治疗，对原方稍作变通，并再加入托毒透表的药物辅助治疗。
处方：生石膏（二两，捣细） 大潞参（四钱） 天花粉（八钱） 生怀山药（八钱） 鲜茅根（四钱） 甘草（二钱）
共煎成两盅药汤，分两次温服。
方解：此方即是白虎加人参汤，以天花粉代替知母，生山药代替粳米，并且加入了鲜茅根。天花粉与知母都能清热，但天花粉在清热之外又善于解毒；山药与粳米都能和胃，但山药在和胃之外又能滋补肾阴。方中的用意，是用白虎汤来治疗外感实热，如此变通则兼能清除虚热、解除疹毒，而且加入人参更可治疗证实脉虚的热证，引导以鲜茅根还可以治疗温病热邪下陷的情况。
复诊：将药煎服一剂后，热度退去大半，烦躁也大大减轻，可以安稳睡一会儿。到了第二天午后，发热烦躁又像以前一样，脉象仍然无力，于是将生石膏改为三两，潞参改为五钱，使煎成三盅药汤，分三次温饮。每次饮用时，调入一枚生鸡蛋黄。服药后病情虽有好转，随即又反复，并且大便一天两次，知道这种寒凉的药物不可再服用。此时我恍然大悟，得到了治疗此证的对症良方。
处方：鲜白茅根（六两，切碎）
添加凉水五盅，在炉上煎至沸腾，立即将药罐离开炉火，约隔三寸许的距离，延迟十分钟后再煎至沸腾，又离开炉火，再延迟十分钟，看到茅根都沉在水底，药汤就熬成了。如果茅根不沉水底，可以再煎至沸腾，大约可取得清汤三盅，趁热一次性喝下，以得出微汗为佳。
效果：此方按照方法服用两剂，病便彻底痊愈了。
按语：此证中伏气化热，固然在三焦，但毒菌的传染，实在先受于上焦，随着毒热相结合，跟随上焦如雾露般弥漫于全身脏腑经络，不分界限。茅根性凉而能发散，又能通达经络脏腑，无微不至。只是性质非常平和，不多用不能奏效。因此一剂重用至六两，其凉散之力，能将脏腑经络间的毒热全部排出（茅根能通过微汗和小便作为排出的途径），毒热清肃，烦躁自然消除。我临证五十年，使用白虎加人参汤不知多少次，大约都随手奏效。如今此证两次使用无效，竟然靠鲜白茅根取得了成功，这不是我平时所熟知的，而是因为一时领悟后屡次使用皆有效，所以特别详细记载，为治疗温疹者开辟一个法门。如果脉象洪滑甚实者，仍须重用石膏清之，或者石膏、茅根并用也可以。另外按：白茅根必须用新鲜的，并且必须如此煎法才有效。根据之前的成功经验，多用可达十两，少用也必须达到四两，否则此证前两方中都有茅根四钱却未见效验，可知宜多用了。另外药局中如果没有新鲜的，可以自己向洼地挖掘获取，随处都有。如果挖掘多了不能一时都用完，用湿土埋藏可永久不坏。
Tianjin resident Shu XX, aged forty-five, contracted warm disease (Wen Bing) accompanied by scarlet rash (Sha Zhen) in mid-summer.
Etiology: Mr. Shu was originally proficient in medical arts. During the epidemic of warm diseases and rashes, he went out multiple times to diagnose and treat others, contracting the infection and thus falling ill with this condition.
Symptoms: For the preceding few days, he treated himself, repeatedly taking herbs for releasing the exterior, venting rashes, and clearing heat. Although the rash had fully erupted over his entire body, the fever persisted, prompting him to request my consultation. He felt heat in both the interior and exterior, accompanied by extreme restlessness and irritability, with no moment of tranquility. His pulse was weak and faint, his tongue coating thin and slightly yellow, bowel movements occurred once daily without being dry or loose, and urination was dark, scanty, and difficult.
Diagnosis: This condition likely originated from latent pathogenic qi transforming into heat, which was triggered by external infectious transmission. The three-jiao fatty membranes allowed the pathogen to penetrate into the Shaoyin channel, suppressing Kidney Qi, preventing it from ascending to harmonize with Heart Fire. Consequently, the tongue coating turned yellow, and urine became scanty and dark. The Yangming fu-organ heat was substantial, yet the pulse remained powerless. The extreme restlessness was due to the failure of Water and Fire energies to interact. Although this is a warm disease, it is essentially identical to the heat syndrome of Shaoyin Cold Damage (Shanghan), hence the pulse resembles that of Shaoyin Cold Damage. Treatment should employ Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng), with slight modifications to the original formula, supplemented by herbs that support the exterior to expel rash toxins.
Prescription: Raw Gypsum (Lianghua Shi, 2 liang, crushed fine); Dalu Ren Shen (Codonopsis Radix, 4 qian); Tian Hua Fen (Trichosanthis Radix, 8 qian); Sheng Huai Shan Yao (Dioscoreae Rhizoma, 8 qian); Fresh Mao Gen (Imperatae Rhizoma, 4 qian); Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 qian).
Decoct together to yield two bowls of decoction, taken warm in two divided doses.
Formula Analysis: This formula is based on Baihu Jia Renshen Tang, substituting Tian Hua Fen for Zhi Mu (Anemarrhenae Rhizoma), Sheng Shan Yao for Jing Mi (Oryzae Fructus Germinatus), and adding fresh Mao Gen. Both Tian Hua Fen and Zhi Mu clear heat, but Tian Hua Fen additionally resolves toxicity. Both Shan Yao and Jing Mi harmonize the Stomach, but Shan Yao additionally nourishes the Kidney. The intent of using Baihu Tang is to treat exterior excess heat; these modifications allow it to simultaneously clear deficiency heat and resolve rash toxins. Furthermore, adding Ren Shen treats heat characterized by excess symptoms but a deficient pulse, while guiding with fresh Mao Gen addresses heat sinking downward in warm diseases.
Follow-up Visit: After one dose of the prescribed medicine, the fever subsided by more than half, and restlessness significantly decreased, allowing for brief periods of peaceful sleep. However, after noon the next day, fever and restlessness returned to their previous state, and the pulse remained weak. Therefore, the dosage of Raw Gypsum was increased to 3 liang, and Dalu Ren Shen to 5 qian, yielding three bowls of decoction to be taken warm in three divided doses. Each dose was mixed with one raw chicken egg yolk. Although the condition improved initially, it relapsed, and bowel movements increased to twice daily. Recognizing that such cold-natured herbs could no longer be administered, I suddenly realized the correct approach for treating this case.
Prescription: Fresh Bai Mao Gen (Imperatae Rhizoma, 6 liang, chopped).
Add five bowls of cool water. Boil briefly on the stove, then immediately remove the pot from the direct flame, placing it about three inches away. Wait ten minutes, then boil again briefly, and remove from the flame again. Wait another ten minutes. When the Imperata rhizome sinks to the bottom, the decoction is ready. If it does not sink, boil briefly once more. Approximately three bowls of clear decoction can be obtained. Drink it all at once while hot; achieving a slight sweat is ideal.
Outcome: Following this method, two doses resulted in complete recovery.
Commentary: In this case, the latent qi transforming into heat resides primarily in the three jiao, but the bacterial infection first affects the upper jiao. As the toxic heat combines, it spreads like mist throughout the entire body's zang-fu organs and meridians without distinction. Imperata root is cool and dispersing, capable of unblocking meridians and zang-fu organs thoroughly. Its nature is very mild; therefore, high doses are required for efficacy. Thus, a single dose uses six liang. Its cooling and dispersing power exhausts the toxic heat within the zang-fu and meridians (with slight sweating and diuresis serving as the pathways for expulsion). Once the toxic heat is cleared, restlessness naturally ceases. In my fifty years of clinical practice, I have used Baihu Jia Renshen Tang countless times, almost always with immediate effect. In this instance, two attempts failed, yet fresh Imperata root succeeded. This was not something I previously knew, but rather a sudden insight that proved effective upon repeated use. I record this in detail to open a new avenue for treating warm diseases with rashes. If the pulse is surging, slippery, and solid, heavy doses of Gypsum should still be used for clearing, or a combination of Gypsum and Imperata may be employed. Additionally, fresh Bai Mao Gen must be used, and the specific decoction method is essential for efficacy. Based on prior success, high doses may reach ten liang, and low doses must still be four liang; otherwise, the previous prescriptions containing only four qian of Imperata were ineffective, indicating the necessity of higher doses. If fresh roots are unavailable in pharmacies, they can be dug from depressions where water collects, as they grow everywhere. If dug in excess and not used immediately, bury them in moist soil to preserve them indefinitely.