天津侯姓幼男,年八岁,得热病兼脑膜炎。
病因 蒙学暑假乍放,幼童贪玩,群在烈日中HT 戏,出汗受风,遂得斯证。
证候 闭目昏昏,呼之不应,周身灼热无汗,其脉洪滑而长,两寸尤盛。其母言病已三日,
昨日犹省人事,惟言心中发热,至夜间即昏无知觉。然以水灌之犹知下咽,问其大便三日未行。
诊断 此温热之病,阳明腑热已实,其热循经上升兼发生脑膜炎也。脑藏神明主知觉,神经因
热受伤,是以知觉全无,宜投以大剂白虎汤以清胃腑之热,而复佐以轻清之品,以引药之
凉力上行,则脑中之热与胃腑之热全清,神识自明了矣。
处方 生石膏(三两捣细) 知母(八钱) 连翘(三钱) 茵陈(钱半)
甘草(三钱) 粳米(五钱)
煎至米熟其汤即成。取清汁三茶杯,徐徐分三次温服,病愈无须尽剂。
效果 服至两次已明了能言,自言心中犹发热,将药服完,其热遂尽消,霍然全愈。
天津钱姓幼男,年四岁,于孟秋得温热兼泄泻,病久不愈。
病因 季夏感受暑温,服药失宜,热留阳明之腑,久则灼耗胃
阴,嗜凉且多嗜饮水,延至孟秋,上热未清,而下焦又添泄泻。
证候 形状瘦弱已极,周身灼热,饮食少许则恶心欲呕吐。小便不利,大便一昼夜十余次,多系稀水,
卧不能动,哭泣无声,脉数十至且无力(四岁时,当以七至为正脉),指纹现淡红色,已透气关。
诊断 此因外感之热久留耗阴,气化伤损,是以上焦发热懒食,
下焦小便不利而大便泄泻也。宜治以滋阴、清热、利小便兼固大便之剂。
处方 生怀山药(一两五钱) 滑石(一两) 生杭芍(六钱) 甘草(三钱)
煎汤一大盅,分数次徐徐温服下。
方解 此方即拙拟滋阴清燥汤也。原方生山药是一两,今用两半者,因此幼童瘦弱已极,气化
太虚也。方中之义,山药与滑石同用,一利小便,一固大便,一滋阴以退虚热,一泻火以
除实热。芍药与甘草同用,甘苦化合,味近人参,能补益气化之虚损。而芍药又善滋肝肾以利小
便,甘草又善调脾胃以固大便,是以汇集而为一方也。
效果 将药连服两剂,热退泻止,小便亦利,可进饮食,惟身体羸瘦不能遽复。俾用生怀
山药细末七八钱许,煮作粥,调以白糖,作点心服之。且每次送西药百布圣一瓦,如此将养月余始胖壮。
病因:蒙学暑假刚刚放假,幼童贪玩,一群孩子在烈日下嬉戏,出汗后受风,于是得了这个病证。
证候:闭着眼睛昏昏沉沉,叫他不答应,全身灼热且无汗,脉象洪大、滑利而长,两寸脉尤其旺盛。他的母亲说病已经三天了,昨天还稍微清醒能人事,只是说心里发热,到了夜间就昏迷没有知觉。然而用水灌下去他还知道吞咽,问他大便三天没有排解。
诊断:这是温热性质的疾病,阳明腑的热邪已经结实,热邪顺着经络上升并引发了脑膜炎。脑脏主宰神明和知觉,神经因为受热而受伤,所以知觉完全丧失,应当投以大剂量的白虎汤来清泻胃腑的热邪,同时辅助以轻扬清透的药物,以引导药力的凉性上行,那么脑中的热与胃腑的热就能全部清除,神识自然就会清明了。
处方:生石膏(三两,捣碎成细粉) 知母(八钱) 连翘(三钱) 茵陈(一钱半)
甘草(三钱) 粳米(五钱)
煎煮至米粒熟透,药汤即成。取澄清的药汁三茶杯,慢慢分三次温服,病愈后不需要喝完剩下的药。
效果:服用两次后已经神志清楚能说话,自己说心里仍然发热,将药服完后,热邪随即全部消退,霍然痊愈。
天津钱姓家的幼童,四岁,在初秋时节得了温热病并伴有泄泻,病情迁延不愈。
病因:盛夏时节感受暑温之邪,服药不当,热邪留滞在阳明之腑,时间久了会灼伤耗损胃阴,因此嗜食凉物且大量饮水,拖延到初秋,上焦的热邪尚未清除,下焦又增添了泄泻的症状。
证候:形体瘦弱到了极点,全身灼热,饮食稍多就会恶心想要呕吐。小便不通畅,大便一昼夜十多次,多为稀水样便,卧床不能动弹,哭泣时没有声音,脉搏跳动极快且无力(四岁儿童,正常的脉象应该是七至),指纹呈现淡红色,已经透达气关。
诊断:这是因为外感的热邪久留体内耗伤阴液,气化功能受损,所以上焦发热、不想进食,下焦小便不利且大便泄泻。应当用滋阴、清热、利小便兼固涩大便的方剂来治疗。
处方:生怀山药(一两五钱) 滑石(一两) 生杭芍(六钱) 甘草(三钱)
煎一大盅汤药,分几次慢慢温服。
方解:这个方子就是我拟定的滋阴清燥汤。原方中生山药是一两,现在用一两半,因为这个幼童瘦弱到了极点,气化功能太虚弱了。方中的意义在于,山药与滑石同用,一个利小便,一个固大便;一个滋阴以退虚热,一个泻火以除实热。芍药与甘草同用,甘苦化合,味道接近人参,能够补益气化功能的虚损。而且芍药善于滋补肝肾以利小便,甘草善于调理脾胃以固大便,所以汇集这些药物组成一方。
效果:连续服用两剂药后,热退泻止,小便也通畅了,可以进食,只是身体羸瘦不能立刻恢复。建议用生怀山药细末七八钱左右,煮成粥,调入白糖,作为点心服用。并且每次送服西药百布圣一瓦,这样调养了一个多月才长得胖壮起来。
The young boy of the Hou family in Tianjin, aged eight, suffered from a febrile disease complicated by meningitis.
Etiology: The summer vacation for the private school had just begun. The children, fond of play, frolicked under the scorching sun. Sweating and then exposed to wind, they contracted this syndrome.
Symptoms: His eyes were closed, he was lethargic and unresponsive to calls. His body was burning hot with no sweat. His pulse was surging (Hong), slippery (Hua), and long, with the cun positions on both sides being particularly vigorous. His mother stated that the illness had lasted three days; yesterday he was still somewhat conscious, complaining only of heat in the heart region. By nightfall, however, he fell into a coma without perception. Nevertheless, when water was poured into his mouth, he knew how to swallow. He had not passed stool for three days.
Diagnosis: This is a warm-heat disease. The heat in the Yangming Fu-organs has become solidified. The heat ascends along the meridians, complicating into meningitis. The brain houses the Shen (Spirit) and governs perception. The nerves have been injured by heat, resulting in a complete loss of perception. It is appropriate to administer a large dose of Baihu Tang (White Tiger Decoction) to clear the heat of the Stomach Fu-organ, while assisting it with light and clearing agents to guide the cooling power of the medicine upward. Thus, the heat in the brain and the heat in the Stomach Fu-organ will be completely cleared, and the Shen will naturally become lucid.
Prescription: Sheng Shigao (Raw Gypsum Fibrosum, 3 liang, crushed to fine powder); Zhi Mu (Anemarrhenae Rhizoma, 8 qian); Lian Qiao (Forsythiae Fructum, 3 qian); Yin Chen (Artemisiae Scopariae Herba, 1.5 qian); Gancao (Glycyrrhizae Radix et Rhizoma, 3 qian); Jingmi (Oryza Sativa, 5 qian).
Decoct until the rice grains are cooked; the decoction is then ready. Take three tea cups of the clear liquid, and slowly divide it into three doses for warm administration. There is no need to finish the remaining medicine once the patient recovers.
Outcome: After two doses, the patient became lucid and able to speak. He reported that there was still heat in the heart region. After finishing the prescription, the heat completely subsided, and he recovered abruptly and fully.
The young boy of the Qian family in Tianjin, aged four, contracted a warm-heat disease accompanied by diarrhea in early autumn, which persisted without resolution.
Etiology: In midsummer, he was affected by summer-warmth pathogens. Improper medication allowed the heat to remain in the Yangming Fu-organs. Over time, it scorched and consumed Stomach Yin, leading to a craving for cool substances and excessive drinking of water. By early autumn, the upper-jiao heat had not yet cleared, and diarrhea had developed in the lower-jiao.
Symptoms: His physique was extremely emaciated. His body was burning hot. Consuming even a small amount of food caused nausea and vomiting. Urination was difficult. He had more than ten bowel movements per day and night, mostly consisting of watery stools. He lay immobile, crying without sound. His pulse beat dozens of times per unit and was forceless (for a four-year-old, seven beats per unit is normal). The fingerprint appeared pale red and had penetrated to the Qi Guan (Gate of Qi).
Diagnosis: This condition arises because external pathogenic heat remained for a long time, consuming Yin and damaging Qi transformation. Consequently, there is fever and anorexia in the upper-jiao, and difficulty urinating with diarrhea in the lower-jiao. Treatment should employ a formula that nourishes Yin, clears heat, promotes urination, and simultaneously consolidates the bowels.
Prescription: Sheng Huai Shanyao (Raw Dioscoreae Hypoglaucae Rhizoma, 1.5 liang); Huashi (Talcum, 1 liang); Sheng Hangshao (Raw Paeoniae Radix Alba, 6 qian); Gancao (Glycyrrhizae Radix et Rhizoma, 3 qian).
Decoct in one large cup of water, and take in divided doses, slowly administered warm.
Formula Analysis: This formula is my original formulation, Ziyin Qingzao Tang (Yin-Nourishing and Dryness-Clearing Decoction). In the original formula, Shanyao is used in the amount of one liang; here, one and a half liang is used because this young child is extremely emaciated, indicating severe deficiency of Qi transformation. The rationale within the formula is as follows: Shanyao combined with Huashi—one promotes urination, the other consolidates the bowels; one nourishes Yin to retreat deficient heat, the other drains fire to eliminate excess heat. Shaoyao combined with Gancao—their sweet and bitter flavors combine, resembling Ren Shen (Ginseng Radix et Rhizoma), capable of tonifying the deficiency of Qi transformation. Furthermore, Shaoyao is excellent at nourishing the Liver and Kidneys to facilitate urination, while Gancao is excellent at regulating the Spleen and Stomach to consolidate the bowels. Thus, these herbs are gathered to form this single prescription.
Outcome: After taking two consecutive doses, the fever subsided, diarrhea stopped, and urination became smooth. He could tolerate food intake. However, his body remained emaciated and could not recover immediately. It was advised to use fine powder of raw Huai Shanyao (about 7–8 qian), boiled into a porridge, seasoned with white sugar, and taken as a snack. Additionally, each time, one wafer of the Western medicine "Bubusheng" (likely referring to a digestive aid or specific proprietary preparation mentioned by Zhang Xichun) was administered with the porridge. Through such nursing care over more than a month, he eventually gained weight and strength.