天津叶××，年三十二岁，得肺病咳吐脓血。
病因 其未病之前数月，心中时常发热，由此浸成肺病。
证候 初觉发热时，屡服凉药，热不减退，大便干燥，小便短赤，后则渐生咳嗽，继则痰中
带血，继则痰血相杂，又继则脓血相杂。诊其脉左部弦长，右部洪长，皆重按颇实。
疹断 此乃伏气化热，窜入阳明之腑。医者不知病因，见其心中发热，而多用甘寒滞腻之品，
稽留其热，俾无出路。久之，上熏肺部，至肺中结核因生咳嗽，溃烂遂吐脓血，斯必先清其胃腑之
热，使不复上升熏肺而后肺病可愈。特是，此热为伏气之热所化，原非轻剂所能消除，当先投以
治外感实热之剂。
处方 生石膏（两半捣细） 大潞参（三钱） 生怀山药（六钱） 天花粉（六钱） 金银花（
四钱） 鲜芦根（四钱） 川贝母（三钱） 连翘（二钱） 甘草（二钱） 广三七（二钱轧细）
药共十味，将前九味煎汤一大盅，送服三七末一钱，至煎渣再服时，仍送服余一钱。
方解 此方实仿白虎加人参汤之义而为之变通也。方中以天花粉代知母，以生山药代粳米，仍与
白虎加人参汤无异，故用之以清胃腑积久之实热。而又加金银花、三七以解毒，芦根、
连翘以引之上行，此肺胃双理之剂也。
复诊 将药连服三剂，脓血已不复吐，咳嗽少愈，大便之干燥，小便之短赤亦见愈。惟心中仍
觉发热，脉象仍然有力，拟再投以清肺泻热之剂。
处方 天花粉（八钱） 北沙参（五钱） 玄参（五钱） 鲜芦根（四钱） 川贝母（
三钱） 牛蒡子（三钱捣碎） 五味子（二钱捣细） 射干（三钱） 甘草（二钱轧细）
药共九味，将前八味煎汤一大盅，送服甘草末一钱，至煎渣再服时，仍送服余一钱。方中五味子，
必须捣碎入煎，不然则服之恒多发闷；方中甘草，无论红者黄者，皆可用至轧之不细时，切忌锅炮，
若炮则其性即变，非此方中用甘草之意矣。用此药者，宜自监视轧之，或但罗取其头次所轧之末亦可。
效果 将药连服五剂，诸病皆愈，惟心中犹间有发热之时，脉象较常脉似仍有力。为善后计，
俾用生怀山药轧细，每用七八钱或两许，煮作茶汤，送服离中丹钱许或至钱半（多少宜自酌），
当点心用之。后此方服阅两月，脉始复常，心中亦不复发热矣。离中丹为愚自制之方，即益元
散方以生石膏代滑石也。盖滑石宜于湿热，石膏宜于燥热，北方多热而兼燥者，故将
其方变通之，凡上焦有实热者，用之皆有捷效。
或问 伏气化热，原可成温，即无新受之外感，而忽然咸温病者是也。此证伏气所化之热，何
以不成温病而成肺病？答曰∶伏气之侵人，伏于三焦脂膜之中，有多有少，多者化热重，少
者化热轻，化热重者当时即成温病，化热轻者恒循三焦脂膜而窜入各脏腑。愚临证五十年，细心体
验，知有窜入肝胆病目者，窜入肠中病下痢者，有窜入肾中病虚劳者，窜入肺
中病咳嗽久而成肺病者，有窜入胃中病吐衄而其热上熏亦可成肺病者，如此证是也。是以此证心中
初发热时，医者不知其有伏气化热入胃，而泛以凉药治之，是以不效，而投以白虎加人参汤即随手奏
效。至于不但用白虎汤而必用白虎加人参汤者，诚以此证已阅数月，病久气化虚损，非人参与石膏并
用，不能托深陷之热外出也。
病因：在发病前几个月，他心中经常感觉发热，由此逐渐发展成肺病。
证候：起初觉得发热时，多次服用凉药，但热势不退，大便干燥，小便短少且颜色深红，后来逐渐出现咳嗽，接着痰中带血，再后来痰与血混杂，又接着脓与血混杂。诊察他的脉象，左部弦而长，右部洪大而长，重按时感觉相当坚实。
诊断：这是伏气（潜伏体内的邪气）化热，窜入阳明胃腑。医生不了解病因，见他心中发热，就多用甘寒滋腻的药物，导致热邪滞留，没有出路。久而久之，热气上熏肺部，致使肺中形成结核（此处指病理性的结节或病变），因而产生咳嗽，溃烂后便吐出脓血。这种情况必须先清除胃腑的热邪，使其不再上升熏灼肺部，然后肺病才能痊愈。只是这热邪是由伏气所化生，原本不是轻剂所能消除的，应当先投用治疗外感实热的方剂。
处方：生石膏（半两，捣细） 大潞参（三钱） 生怀山药（六钱） 天花粉（六钱） 金银花（四钱） 鲜芦根（四钱） 川贝母（三钱） 连翘（二钱） 甘草（二钱） 广三七（二钱，轧成细末）
药共十味，将前九味煎汤一大盅，送服三七末一钱；等到煎煮药渣再次服用时，仍送服剩余的一钱三七末。
方解：此方实际上是仿照白虎加人参汤的意义而进行的变通。方中以天花粉代替知母，以生山药代替粳米，整体功效与白虎加人参汤无异，所以用它来清除胃腑积久的实热。另外加入金银花、三七以解毒，芦根、连翘以引导药力上行，这是调理肺胃的双管齐下的方剂。
复诊：连续服药三剂后，脓血已不再吐出，咳嗽稍有好转，大便干燥和小便短赤的症状也见减轻。只是心中仍然感觉发热，脉象依然有力，打算再投用清肺泻热的方剂。
处方：天花粉（八钱） 北沙参（五钱） 玄参（五钱） 鲜芦根（四钱） 川贝母（三钱） 牛蒡子（三钱，捣碎） 五味子（二钱，捣细） 射干（三钱） 甘草（二钱，轧成细末）
药共九味，将前八味煎汤一大盅，送服甘草末一钱；等到煎煮药渣再次服用时，仍送服剩余的甘草末。方中的五味子，必须捣碎后入煎，否则服用后常常会导致胸闷；方中的甘草，无论是红皮还是黄皮的，都可以用到轧得不那么细的程度，切忌锅炒炮制，如果经过炮制，其药性就会改变，就不符合本方使用甘草的本意了。使用此药的人，宜自行监督轧制，或者只选取第一次轧制的细末也可以。
效果：连续服药五剂后，各种病症都痊愈了，只是心中偶尔还有发热的时候，脉象比正常脉似乎仍然有力。为了善后调理，建议用生怀山药轧成细末，每次用七八钱或一两左右，煮成茶汤，送服离中丹一钱到一钱半（用量宜自行斟酌），当作点心服用。此后服用此方两个月，脉象才恢复正常，心中也不再发热了。离中丹是我自己制作的方子，即在益元散方中用生石膏代替滑石。因为滑石适宜于湿热，石膏适宜于燥热，北方多热兼燥的情况，所以将此方变通，凡是上焦有实热者，使用它都有迅速疗效。
或问：伏气化热，原本可以形成温病，即使没有新受的外感，突然发生全身性温热病的就是这种情况。这个病例中伏气所化的热，为什么不成温病而成肺病？答曰：伏气侵入人体，潜伏在三焦脂膜之中，有多有少，多的化热重，少的化热轻。化热重的当时就形成温病，化热轻的往往顺着三焦脂膜窜入各个脏腑。我临证五十年，细心体验，知道有窜入肝胆导致眼病的，窜入肠道导致下痢的，窜入肾脏导致虚劳的，窜入肺部导致咳嗽日久成为肺病的，窜入胃部导致吐血衄血而其热上熏也可成为肺病的，像这个病例就是这样。因此，这个病例在最初心中发热时，医生不知道有伏气化热入胃，而泛泛地用凉药治疗，所以无效，而投用白虎加人参汤即随手奏效。至于不但用白虎汤而必用白虎加人参汤的原因，确实是因为这个病例已经过了几个月，病久导致气化虚损，非有人参与石膏并用，不能托举深陷的热邪外出。
Ye XX from Tianjin, aged thirty-two, suffered from a lung disease characterized by coughing up pus and blood.
Etiology: Several months prior to the onset of illness, he frequently experienced a sensation of heat in the heart region, which gradually developed into the lung disease.
Symptoms: Initially, when he felt feverish, he repeatedly took cooling medicines, but the fever did not subside. His stool was dry, and his urine was scanty and dark red. Later, he gradually developed a cough, followed by blood-streaked sputum, then mixed sputum and blood, and subsequently mixed pus and blood. Palpation of his pulse revealed that the left side was wiry and long, and the right side was surging and long, both feeling quite firm upon heavy pressure.
Diagnosis: This is due to latent pathogenic qi (latent pathogens) transforming into heat and invading the Yangming stomach fu-organ. The physicians, unaware of the etiology, seeing only the heat in the heart region, used many sweet-cold and cloying/stagnating herbs, causing the heat to remain trapped without an outlet. Over time, the heat steamed upward to the lungs, causing nodules/pathological lesions in the lungs, leading to cough, and eventually ulceration resulting in the expectoration of pus and blood. In such cases, one must first clear the heat accumulated in the stomach fu-organ, preventing it from rising to scorch the lungs, before the lung disease can be cured. However, this heat is generated by latent qi and cannot be eliminated by mild prescriptions; therefore, one should initially administer a formula for treating excess heat from external contraction.
Prescription: Sheng Shi Gao (Raw Gypsum Fibrosum, 1.5 liang, crushed fine); Da Lu Shen (Codonopsis Radix, 3 qian); Sheng Huai Shan Yao (Fresh Dioscoreae Oppositifoliae Rhizoma, 6 qian); Tian Hua Fen (Trichosanthis Radix, 6 qian); Jin Yin Hua (Lonicerae Japonicae Flos, 4 qian); Xian Lu Gen (Imperatae Rhizoma, fresh, 4 qian); Chuan Bei Mu (Fritillariae Cirrhosae Bulbus, 3 qian); Lian Qiao (Forsythiae Fructus, 2 qian); Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 qian); Guang San Qi (Notoginseng Radix et Rhizoma, 2 qian, ground to powder).
The prescription consists of ten ingredients. Decoct the first nine ingredients in a large cup of water. Take the decoction with one qian of San Qi powder. When taking the second decoction of the dregs, take it with the remaining one qian of San Qi powder.
Formula Analysis: This formula is actually a modification based on the principle of Bai Hu Jia Ren Shen Tang (White Tiger plus Ginseng Decoction). By substituting Tian Hua Fen for Zhi Mu and Sheng Shan Yao for Jing Mi, its efficacy remains similar to Bai Hu Jia Ren Shen Tang; thus, it is used to clear the long-standing excess heat in the stomach fu-organ. Additionally, Jin Yin Hua and San Qi are added to resolve toxicity, while Lu Gen and Lian Qiao guide the medicinal action upward. This is a dual-regulating formula for both the lung and stomach.
Second Visit: After taking three doses continuously, the expectoration of pus and blood ceased, the cough improved slightly, and the dryness of stool and scantiness of urine also showed improvement. However, the sensation of heat in the heart region persisted, and the pulse remained forceful. It is proposed to administer another formula to clear the lungs and drain heat.
Prescription: Tian Hua Fen (Trichosanthis Radix, 8 qian); Bei Sha Shen (Glehniae Radix, 5 qian); Xuan Shen (Scrophulariae Radix, 5 qian); Xian Lu Gen (Imperatae Rhizoma, fresh, 4 qian); Chuan Bei Mu (Fritillariae Cirrhosae Bulbus, 3 qian); Niu Bang Zi (Arctii Fructus, 3 qian, crushed); Wu Wei Zi (Schisandrae Chinensis Fructus, 2 qian, crushed); She Gan (Belamcandae Rhizoma, 3 qian); Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 qian, ground to powder).
The prescription consists of nine ingredients. Decoct the first eight ingredients in a large cup of water. Take the decoction with one qian of Gan Cao powder. When taking the second decoction of the dregs, take it with the remaining Gan Cao powder. The Wu Wei Zi in the formula must be crushed before decoction; otherwise, it often causes chest tightness after ingestion. The Gan Cao in the formula, whether red-skinned or yellow-skinned, can be used even if not ground extremely fine. It is strictly forbidden to stir-fry (pao) it in a pan; if processed by frying, its properties change, which contradicts the intention of using Gan Cao in this formula. Users should supervise the grinding process themselves, or simply select the finest powder obtained from the first grinding.
Outcome: After taking five doses continuously, all symptoms resolved. However, there were still occasional episodes of heat in the heart region, and the pulse seemed slightly more forceful than normal. For follow-up care, it is recommended to grind Sheng Huai Shan Yao (Fresh Dioscoreae Oppositifoliae Rhizoma) into fine powder, use seven or eight qian or approximately one liang each time, boil it as a tea, and take it with one qian to one and a half qian of Li Zhong Dan (dosage should be adjusted according to individual needs), consuming it as a snack. After taking this regimen for two months, the pulse returned to normal, and the sensation of heat in the heart region disappeared. Li Zhong Dan is a formula self-developed by me, which is Yi Yuan San (Benefit Prime Powder) modified by replacing Hua Shi (Talcum) with Sheng Shi Gao (Raw Gypsum Fibrosum). Since Hua Shi is suitable for damp-heat and Shi Gao is suitable for dry-heat, and the north tends to have heat combined with dryness, I modified the formula accordingly. It yields rapid results for any case of excess heat in the upper jiao.
Question: Latent qi transforming into heat can originally form warm diseases (Wen Bing). Even without new external contractions, sudden systemic febrile diseases occur. Why does the heat transformed from latent qi in this case result in lung disease rather than a warm disease?
Answer: Latent qi invades the body and hides within the membranes of the triple burner (San Jiao). There is variation in quantity: abundant latent qi transforms into heavy heat, while scant latent qi transforms into light heat. Heavy heat manifests immediately as a warm disease. Light heat often follows the membranes of the triple burner and invades various zang-fu organs. In my fifty years of clinical practice, through careful observation, I have known cases where it invaded the liver and gallbladder causing eye diseases, invaded the intestines causing dysentery, invaded the kidneys causing consumptive diseases (Xu Lao), invaded the lungs causing chronic cough developing into lung disease, and invaded the stomach causing hematemesis and epistaxis, with heat steaming upward also resulting in lung disease, as seen in this case. Therefore, when the patient first experienced heat in the heart region, the physicians did not realize that latent qi had transformed into heat and entered the stomach. They generally treated it with cooling medicines, which was ineffective. Administering Bai Hu Jia Ren Shen Tang (White Tiger plus Ginseng Decoction) yielded immediate results. As for why Bai Hu Jia Ren Shen Tang was used instead of just Bai Hu Tang, it is indeed because the illness had lasted for several months, leading to deficiency and damage of qi transformation due to prolonged disease. Only the combination of Ren Shen (Ginseng Radix) and Shi Gao (Gypsum Fibrosum) can support and expel the deeply seated heat.