辽宁赫姓幼子，年五岁，得风温兼喘促证。
病因 季春下旬，在外边HT 戏，出汗受风，遂成温病。医治失宜，七八日间又添喘促。
证候 面红身热，喘息极迫促，痰声漉漉，目似不瞬。脉象浮滑，重按有力。指有紫纹，上透
气关，启口视其舌苔白而润。问其二便，言大便两日未行，小便微黄，然甚通利。
诊断 观此证状况已危至极点，然脉象见滑，虽主有痰亦足征阴
分充足。且视其身体胖壮，知犹可治，宜用《金匮》小青龙加石膏汤，再加杏仁、川贝以利其肺气。
处方 麻黄（一钱） 桂枝尖（一钱） 生杭芍（三钱） 清半夏（二钱）
杏仁（二钱去皮捣碎） 川贝母（二钱捣碎） 五味子（一钱捣碎） 干姜（六分）
细辛（六分） 生石膏（一两捣细）
共煎汤一大盅，分两次温服下。
方解 《金匮》小青龙加石膏汤，原治肺胀咳而上气烦躁而喘，然其石膏之分量，仅为麻桂三分
之二（《金匮》小青龙加石膏汤，其石膏之分量原有差误，曾详论之），而此方中之生石膏则十倍于
麻桂，诚以其面红身热，脉象有力，若不如此重用石膏，则麻、桂、姜、辛之热，即不能用
矣。又《伤寒论》小青龙汤加减之例，喘者去麻黄加杏仁，今加杏仁而不去麻黄者，因重用生
石膏以监制麻黄则麻黄即可不去也。
复诊 将药服尽一剂，喘愈强半，痰犹壅盛，肌肤犹灼热，大便犹未通下，脉象仍有力，
拟再治以清热利痰之品。
处方 生石膏（二两捣细） 栝蒌仁（二两炒捣） 生赭石（一两轧细）
共煎汤两盅，分三次徐徐温饮下。
效果 将药分三次服完，火退痰消，大便通下，病遂全愈。
帮助 此案曾登于《全国名医验案类编》，何廉臣评此案云∶“风温犯肺胀喘促，小儿尤多，
病最危险，儿科专家，往往称为马脾风者此也。此案断定为外寒束内热，仿《金匮》小
青龙加石膏汤，再加贝母开豁清泄，接方用二石蒌仁等清镇滑降而痊。先开后降，步骤井然。
惟五岁小儿能受如此重量，可见北方风气刚强，体质茁实，不比南方人之体质柔弱
也。正惟能受重剂，故能奏速功。”
观何廉臣评语，虽亦推奖此案，而究嫌药量过重，致有南
北分别之设想。不知此案药方之分量若作一次服，以治五岁孺子诚为过重。若分作三次服，则无论南北，凡
身体胖壮之孺子皆可服也。试观近今新出之医书，治产后温病，有一剂用生石膏半斤者矣，曾见于刘蔚楚
君《遇安斋证治丛录》，刘君原广东香山人也。治鼠疫病亦有一剂用生石膏半斤者矣，曾见于李健颐君《鼠
疫新篇》，李君原福建平潭人也。若在北方治此等证，岂药之分量可再加增乎？由此知医者之治病用药，不可
定存南北之见也。且愚亦尝南至汉皋矣，曾在彼处临证处方，未觉有异于北方，惟用发表之剂则南方出汗较
易，其分量自宜从轻。然此乃地气寒暖之关系，非其身体强弱之关系也。既如此，一人之身则冬时发汗与
夏时发汗，其所用药剂之轻重自迥殊也。
尝细验天地之气化，恒数十年而一变。仲景当日原先着《伤寒论》，后着《金匮要略》，《伤寒论》小
青龙汤，原有五种加法，而独无加石膏之例。因当时无当加石膏之病也。至着《金匮》时，则有小青龙加石
膏汤矣，想其时已现有当加石膏之病也。忆愚弱冠时，见医者治外感痰喘证，但投以小青龙汤原方即可治愈。
后数年愚临证遇有外感痰喘证，但投以小青龙汤不效，必加生石膏数钱方效。又迟数年必加生石膏两许，或
至二两方效。由斯知为医者当随气化之转移，而时时与之消息，不可拘定成方而不知变通也。
病因 季春下旬（春季最后一个月下旬），在户外玩耍，出汗后受风，于是形成温病。治疗不当，七八天后又增加了喘促症状。
证候 面色红赤，身体发热，喘息极其急促，喉间痰声漉漉，眼睛似乎不眨动。脉象浮滑，重按有力。手指有紫纹，向上透至气关，张口看其舌苔白而湿润。询问其二便情况，说大便两天未行，小便微黄，但排泄通畅。
诊断 观察此证状况已危至极点，然而脉象见滑，虽然主有痰，也足以证明阴分充足。且看其身体胖壮，知道还可以治疗，适宜用《金匮》小青龙加石膏汤，再加杏仁、川贝以利于肺气。
处方 麻黄（一钱） 桂枝尖（一钱） 生杭芍（三钱） 清半夏（二钱）
杏仁（二钱去皮捣碎） 川贝母（二钱捣碎） 五味子（一钱捣碎） 干姜（六分）
细辛（六分） 生石膏（一两捣细）
共煎汤一大盅，分两次温服下。
方解 《金匮》小青龙加石膏汤，原本治疗肺胀咳而上气烦躁而喘，但是其中石膏的分量，仅为麻黄、桂枝的三分之二（《金匮》小青龙加石膏汤中，石膏的原有的分量有误，曾详细论述过），而这个方子中的生石膏则是麻黄、桂枝十倍之多，确实是因为患者面红身热，脉象有力，如果不如此重用石膏，那么麻黄、桂枝、干姜、细辛的热性，就不能使用了。另外《伤寒论》中小青龙汤加减的例子，喘者去掉麻黄加杏仁，现在加杏仁而不去掉麻黄，是因为重用生石膏来监制麻黄，所以麻黄就可以不去掉了。
复诊 将药服完一剂，喘促减轻大半，痰仍然壅盛，肌肤仍然灼热，大便仍然未通下，脉象仍然有力，打算再用清热利痰的药物继续治疗。
处方 生石膏（二两捣细） 栝蒌仁（二两炒捣） 生赭石（一两轧细）
共煎汤两盅，分三次徐徐温饮下。
效果 将药分三次服完，火退痰消，大便通下，病遂全愈。
帮助 此案曾刊登于《全国名医验案类编》，何廉臣评论此案说：“风温犯肺胀喘促，小儿尤其多见，病最危险，儿科专家，往往称为马脾风的即是此病。此案断定为外寒束内热，仿照《金匮》小青龙加石膏汤，再加贝母开豁清泄，接方用二石蒌仁等清镇滑降而痊愈。先开后降，步骤井然。只是五岁小儿能承受如此重量，可见北方风气刚强，体质茁实，不比南方人的体质柔弱啊。正因为能受重剂，所以能奏速功。”
观看何廉臣评语，虽然也推奖此案，但终究嫌药量过重，导致有南北分别的设想。不知道此案药方的分量若作一次服，以治五岁幼儿确实为过重。若分作三次服，则无论南北，凡是身体胖壮的幼儿都可以服用啊。试观近来新出的医书，治疗产后温病，有一剂用生石膏半斤的了，曾见于刘蔚楚君《遇安斋证治丛录》，刘君原广东香山人也。治疗鼠疫病也有一剂用生石膏半斤的了，曾见于李健颐君《鼠疫新篇》，李君原福建平潭人也。若在北方治疗这些病症，难道药的分量可以再加增吗？由此可知医者治病用药，不可定存南北之见。况且我也曾南至汉皋，曾在那里临证处方，未觉得有异于北方，只是用发表之剂则南方出汗较易，其分量自然宜从轻。但这乃是地气寒暖的关系，不是身体强弱的关系啊。既然这样，一个人的身体则冬天发汗与夏天发汗，其所用药剂的轻重自然迥然不同啊。
曾经仔细验证天地之气化，恒常几十年而一变。仲景当日原先着《伤寒论》，后着《金匮要略》，《伤寒论》小青龙汤，原有五种加法，而独无加石膏的例子。因为当时没有应当加石膏的病。到着《金匮》时，则有小青龙加石膏汤了，想其时已现有应当加石膏的病啊。回忆我弱冠时，见医者治外感痰喘证，只投以小青龙汤原方即可治愈。后数年我临证遇到有外感痰喘证，只投以小青龙汤不效，必加生石膏数钱才效。又迟数年必加生石膏一两许，或至二两才效。由此知作为医者当随气化之转移，而时时与之消息，不可拘定成方而不知变通啊。
The young son of a family surnamed He in Liaoning, aged five, suffered from Wind-Warmth complicated by panting and shortness of breath.
Etiology In the late stage of the last month of spring (late spring), he played outdoors, sweated, and was exposed to wind, thereby developing Warmth Disease (Wen Bing). Due to inappropriate treatment, after seven or eight days, panting and shortness of breath were added.
Symptoms The face was red, the body was hot, breathing was extremely rapid and forced, with rattling phlegm sounds in the throat, and the eyes seemed unblinking. The pulse was floating and slippery, and forceful upon heavy pressure. There was a purple pattern on the fingers extending up to the Qi Gate (Qiguan). Upon opening the mouth, the tongue coating was white and moist. Inquiry into his bowel and bladder movements revealed that he had not passed stool for two days, urine was slightly yellow but flowed freely.
Diagnosis Observing this condition, it appeared critical to the extreme; however, the slippery pulse, although indicating phlegm, also sufficiently attests to sufficient Yin fluid. Furthermore, seeing his robust and plump physique, it is known that it is still treatable. It is appropriate to use Xiao Qing Long Jia Shi Gao Tang (Minor Green Dragon Decoction plus Gypsum) from *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet), adding Xing Ren (Apricot Seed) and Chuan Bei Mu (Fritillaria Bulb) to benefit Lung Qi.
Prescription Ma Huang (Ephedrae Herba, 1 qian)
Gui Zhi Jian (Cinnamomi Ramulus, 1 qian)
Sheng Hang Shao (Paeoniae Radix Alba, 3 qian)
Qing Ban Xia (Pinelliae Rhizoma Preparatum, 2 qian)
Xing Ren (Armeniacae Semen Amarum, 2 qian, peeled and crushed)
Chuan Bei Mu (Fritillariae Cirrhosae Bulbus, 2 qian, crushed)
Wu Wei Zi (Schisandrae Fructus, 1 qian, crushed)
Gan Jiang (Zingiberis Rhizoma, 6 fen)
Xi Xin (Asari Radix et Rhizoma, 6 fen)
Sheng Shi Gao (Gypsum Fibrosum, 1 liang, crushed fine)
Decoct together in one large cup of water, divide into two doses, and take warm.
Formula Analysis Xiao Qing Long Jia Shi Gao Tang (Minor Green Dragon Decoction plus Gypsum) from *Jin Gui* originally treats Lung Distension (Fei Zhang) with cough, upward rushing of Qi, irritability, and panting. However, in that original formula, the dosage of Shi Gao (Gypsum) was only two-thirds of that of Ma Huang (Ephedrae Herba) and Gui Zhi (Cinnamomi Ramulus) (Note: The original dosage of Gypsum in *Jin Gui*'s Xiao Qing Long Jia Shi Gao Tang contained an error, which has been discussed in detail elsewhere). In this prescription, the amount of Sheng Shi Gao (Raw Gypsum) is ten times that of Ma Huang and Gui Zhi. This is indeed because the patient presented with a red face, body heat, and a forceful pulse; without such a heavy use of Gypsum, the warming properties of Ma Huang, Gui Zhi, Gan Jiang, and Xi Xin could not be effectively utilized. Additionally, according to the modification examples of Xiao Qing Long Tang (Minor Green Dragon Decoction) in *Shang Han Lun* (Treatise on Cold Damage), when there is panting, Ma Huang is removed and Xing Ren is added. Here, Xing Ren is added but Ma Huang is not removed because the heavy use of Sheng Shi Gao controls and restrains Ma Huang, allowing Ma Huang to remain.
Follow-up Visit After completing one dose of the medicine, the panting decreased by more than half, but phlegm remained abundant, the skin was still burning hot, stool had not yet been passed, and the pulse remained forceful. It was planned to continue treatment with herbs that clear heat and promote the draining of phlegm.
Prescription Sheng Shi Gao (Gypsum Fibrosum, 2 liang, crushed fine)
Gua Lou Ren (Trichosanthis Semen, 2 liang, stir-fried and crushed)
Sheng Zhe Shi (Ochra, 1 liang, ground fine)
Decoct together in two cups of water, divide into three doses, and drink slowly while warm.
Outcome After taking the medicine in three divided doses, the heat subsided, phlegm dissipated, stool was passed, and the disease was completely cured.
Commentary This case was published in *Quan Guo Ming Yi Yan An Lei Bian* (Compilation of Verified Cases by Famous Physicians Nationwide). He Lianchen commented on this case: "Wind-Warmth attacking the Lung causing distension and panting is particularly common in children, and the disease is most dangerous. Pediatric experts often refer to this as 'Ma Pi Feng' (Horse Spleen Wind). This case was diagnosed as external cold binding internal heat. Mimicking Xiao Qing Long Jia Shi Gao Tang from *Jin Gui*, plus Bei Mu (Fritillariae Bulbus) to open and clear, followed by a subsequent prescription using Er Shi Gua Lou Ren (Ochra and Trichosanthis Seeds) to clear, settle, and descend, resulting in recovery. The steps of first opening then descending were orderly. However, it is surprising that a five-year-old child could tolerate such heavy dosages. This shows that the climate in the North is vigorous and constitutions are robust, unlike the delicate constitutions of people in the South. Precisely because they can tolerate heavy agents, rapid results are achieved."
Regarding He Lianchen's commentary, although he praised this case, he ultimately felt the dosages were too heavy, leading to speculation about regional differences. He did not realize that if the dosages in this prescription were taken at once, treating a five-year-old would indeed be excessive. If divided into three doses, regardless of North or South, any robust child could take them. Consider recent medical books: there are cases of treating Postpartum Warmth Disease using half a jin (approx. 500g) of Sheng Shi Gao in one dose, recorded in Liu Weichu's *Yu An Zhai Zheng Zhi Cong Lu*; Liu was originally from Xiangshan, Guangdong. There are also cases of treating Plague (Shu Yi) using half a jin of Sheng Shi Gao in one dose, recorded in Li Jianyi's *Shu Yi Xin Pian*; Li was originally from Pingtan, Fujian. If treating such conditions in the North, could the dosages be increased further? From this, we know that physicians should not hold fixed views regarding North-South differences when prescribing. Moreover, I have traveled south to Hangan (Hubei region) and practiced medicine there, finding no difference from the North, except that when using exterior-releasing agents, sweating occurs more easily in the South, so dosages should naturally be lighter. However, this is due to the relationship of local climatic warmth and cold, not the strength of the constitution. Thus, for the same individual, releasing sweat in winter versus summer requires significantly different dosages.
Having carefully observed the transformation of Heaven and Earth's Qi, it changes every few decades. When Zhang Zhongjing first wrote *Shang Han Lun* (Treatise on Cold Damage), and later *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet), Xiao Qing Long Tang (Minor Green Dragon Decoction) in *Shang Han Lun* originally had five modifications, but none included adding Shi Gao (Gypsum). This was because there were no diseases at that time requiring the addition of Gypsum. By the time *Jin Gui* was written, Xiao Qing Long Jia Shi Gao Tang existed, suggesting that diseases requiring Gypsum had already appeared. I recall when I was in my twenties, I saw physicians curing exterior-contracted phlegm-panting cases simply by administering the original Xiao Qing Long Tang. A few years later, when I encountered similar cases, Xiao Qing Long Tang alone was ineffective; I had to add several qian of Sheng Shi Gao for efficacy. Several years after that, I had to add around one liang, or even two liang, of Sheng Shi Gao for efficacy. From this, we know that physicians must adapt to the shifting transformations of Qi and adjust accordingly, rather than rigidly adhering to established formulas without flexibility.