邑城东刘氏女，年十五岁，于季春患温病久不愈。
病因 因天气渐热，犹勤纺织，劳力之余出外乘凉，有汗被风遂成温病。
证候 初得周身发热，原宜辛凉解肌，医者竟用热药发之，汗未出而热益甚，心中亦热而且渴。此
时若用大剂白虎加人参汤清之，病亦可愈，而又小心不敢用。惟些些投以凉润小剂，迁延二十余日，
外感之热似渐退。然午前稍轻而午后则仍然灼热，且多日不能饮食，形体异常清瘦。左脉弦细无根，右
部关脉稍实，一息六至。舌苔薄而微黄，毫无津液。大便四五日一行，颇干燥。
诊断 此因病久耗阴，阴虚生热，又兼外感之热留滞于阳明之府未尽消也。当以清外感之热为主，
而以滋补真阴之药辅之。
处方 生石膏（一两捣细） 野党参（三钱） 生怀地黄（一两） 生怀山药（一两）
生杭芍（四钱） 滑石（三钱） 甘草（三钱）
共煎汤一大盅，分两次温服下。
复诊 将药煎服两剂后，外感之热已退，右关脉已平和，惟过午
犹微发热，此其阴分犹虚也。当再滋补其阴分。
处方 玄参（一两） 生怀山药（一两） 甘枸杞（五钱大者） 生杭芍（五钱）
滑石（二钱） 熟地黄（一两） 生鸡内金（一钱黄色的捣） 甘草（二钱）
共煎一大盅，分两次温服。
效果 日服药一剂，连服三日，灼热全愈。
帮助 按此方于大队滋阴药中犹少加滑石者，恐外感之热邪未尽，引之自小便出也。愚凡治
外感之热兼有虚热者，恒生山药与滑石并用，泻热补虚一举两得。至上有外感燥热而下焦复滑
泻者，用之以清热止泻（宜各用一两），尤屡次奏效。二药相伍，原有化合之妙用，若再加
芍药、甘草，即拙拟之滋阴清燥汤，可参观也。
【背景信息】
书名：《医学衷中参西录》 作者：张锡纯 朝代：清 章节：35．温病兼虚热 类别：医论
【原文翻译】
本县城东刘家的女儿，年龄十五岁，在晚春时节患上温病（由温热病邪引起的急性外感热病），病程长久未能痊愈。
病因 因为天气逐渐转热，她仍然辛勤纺织，在劳累之余外出乘凉，出汗后受风侵袭，从而形成了温病。
证候 刚发病时全身发热，原本适宜用辛凉性质的药物解除肌表之邪，但医生竟然使用热性药物来发汗，导致汗液未出而热势更加严重，心中也感到烦热且口渴。此时如果服用大剂量的白虎加人参汤（清热生津的方剂）进行清解，疾病本可痊愈，但医生因谨慎小心而不敢使用。只是少量投予凉润的小剂量药物，拖延了二十多天，外感的热邪似乎逐渐消退。然而上午病情稍轻，午后则依然灼热，并且多日无法进食，身体异常消瘦。左侧脉象弦细且无根底，右侧关部脉象稍显实象，一呼一吸之间脉搏跳动六次（数脉）。舌苔薄而微黄，完全没有津液。大便四五天排一次，相当干燥。
诊断 这是因为患病日久耗伤了阴液，阴虚产生内热，又兼有外感的热邪留滞于阳明腑（指胃肠系统）尚未完全消除。治疗应当以清除外感热邪为主，辅以滋补真阴的药物。
处方 生石膏（一两，捣碎成细粉） 野党参（三钱） 生怀地黄（一两） 生怀山药（一两）
生杭芍（四钱） 滑石（三钱） 甘草（三钱）
共同煎煮成一大盅汤药，分两次温服。
复诊 将药物煎服两剂后，外感的热邪已经退去，右关脉象已经平和，只是过了中午仍有轻微发热，这是阴分仍然虚弱所致。应当继续滋补其阴分。
处方 玄参（一两） 生怀山药（一两） 甘枸杞（五钱，选大的） 生杭芍（五钱）
滑石（二钱） 熟地黄（一两） 生鸡内金（一钱，黄色的，捣碎） 甘草（二钱）
共同煎煮一大盅，分两次温服。
效果 每天服用一剂药，连续服用三天，灼热症状完全痊愈。
按语 按照这个方子，在大队滋阴药中稍微加入滑石的原因，是担心外感的热邪没有完全清除，借此引导热邪从小便排出。我凡是治疗外感热邪兼有虚热的情况，总是习惯将山药与滑石并用，达到泻热补虚一举两得的效果。至于上面有外感燥热、下面又有滑泄腹泻的情况，使用这两味药可以清热止泻（各用一两），尤其屡次取得疗效。这两味药配合使用，原有化合的奇妙作用，如果再增加芍药和甘草，就是我拙拟定的滋阴清燥汤，可以参考。
[Background Information]
Book Title: *Yixue Zhongzhong Canxi Lu* (Records of Medical Practice Integrating Chinese and Western Medicine)
Author: Zhang Xichun
Dynasty: Qing Dynasty
Chapter: 35. Warm Disease Complicated with Deficiency-Heat
Category: Medical Discourse
[Translation]
The daughter of the Liu family in the east of the county, aged fifteen, suffered from a warm disease (an acute febrile disease caused by warm pathogenic factors) in late spring, which persisted for a long time without recovery.
Etiology Due to the gradually warming weather, she continued to work diligently at weaving. After exertion, she went outside to enjoy the cool breeze; sweating and subsequently exposed to wind led to the formation of a warm disease.
Symptoms Initially, when the disease first appeared, there was generalized fever. It should have been treated with acrid-cool herbs to release the muscle layer, but the physician mistakenly used hot-natured herbs to induce sweating. Consequently, no sweat was produced, yet the heat intensified significantly, accompanied by vexing heat in the heart and thirst. At this stage, if a large dose of Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction, a formula for clearing heat and generating fluids) had been administered, the disease could have been cured. However, due to excessive caution, the physician dared not use it. Instead, only small doses of cooling and moistening herbs were given intermittently. The condition dragged on for over twenty days, and although the external heat seemed to subside slightly, the patient felt slightly better in the morning but experienced intense burning heat in the afternoon. She had been unable to eat for many days, and her body became abnormally emaciated. The left pulse was wiry and thin without root, while the right Guan position (corresponding to the Spleen/Stomach) was slightly excess, with six beats per breath (rapid pulse). The tongue coating was thin and slightly yellow, completely lacking moisture. Bowel movements occurred only once every four or five days and were quite dry.
Diagnosis This condition resulted from prolonged illness consuming Yin fluids, leading to deficiency-heat, compounded by residual external heat lingering in the Yangming Fu organs (referring to the Stomach and Intestines) that had not yet fully dissipated. Treatment should focus primarily on clearing the external heat, supplemented by herbs that tonify true Yin.
Prescription Raw Gypsum (Shi Gao, 1 liang, finely crushed) Wild Codonopsis (Ye Dang Shen, 3 qian) Raw Huai Rehmannia Root (Sheng Huai Di Huang, 1 liang) Raw Huai Chinese Yam (Sheng Huai Shan Yao, 1 liang) Raw Hang Peony Root (Sheng Hang Shao, 4 qian) Talcum (Hua Shi, 3 qian) Licorice Root (Gan Cao, 3 qian)
Decoct together in a large bowl of water, and take half warm in the morning and half in the evening.
Second Visit After taking two doses of the prescription, the external heat had subsided, and the right Guan pulse had normalized. However, slight fever persisted after noon, indicating that the Yin aspect remained deficient. Further tonification of Yin is required.
Prescription Scrophularia Root (Xuan Shen, 1 liang) Raw Huai Chinese Yam (Sheng Huai Shan Yao, 1 liang) Goji Berry (Gan Gou Qi, 5 qian, selecting large ones) Raw Hang Peony Root (Sheng Hang Shao, 5 qian) Talcum (Hua Shi, 2 qian) Prepared Rehmannia Root (Shu Di Huang, 1 liang) Raw Chicken Gizzard Lining (Sheng Ji Nei Jin, 1 qian, yellow variety, crushed) Licorice Root (Gan Cao, 2 qian)
Decoct together in a large bowl of water, and take half warm in the morning and half in the evening.
Outcome Taking one dose daily for three consecutive days, the burning heat was completely resolved.
Commentary In this prescription, the addition of Talcum (Hua Shi) among a large group of Yin-nourishing herbs is intended to prevent any remaining external heat pathogens from lingering, guiding them out through urination. Whenever I treat external heat complicated by deficiency-heat, I habitually combine Chinese Yam (Shan Yao) and Talcum (Hua Shi), achieving both heat-clearing and deficiency-tonifying effects simultaneously. In cases where there is external dry-heat above and loose diarrhea below, using these two herbs can clear heat and stop diarrhea (each used in 1 liang dosage), yielding repeated success. The combination of these two herbs possesses subtle synergistic properties; if Peony Root (Shao Yao) and Licorice Root (Gan Cao) are added, it constitutes my formulated Ziyin Qingzao Tang (Nourish Yin and Clear Dryness Decoction), which may be consulted for reference.