之，此诚热肠所迫，不能自已，然亦往往多有能救者。踌躇再四，为疏两方。一方即白虎加人参以山药代粳米
汤，一方用熟地黄二两，生山药、枸杞各一两，真阿胶（不炒）五钱，煎汤后，调入生鸡子黄四枚。二方各煎
汁一大碗，徐徐轮流温服，阅十点钟，尽剂而愈。自言从前服药，皆不知觉，此时则犹如梦醒。视其舌上犹干
黑，然不缩矣。其脉至数仍数，似有余热。又用玄参二两、潞参一两煎汤一大碗，徐徐温服，一日一剂，两日
大便得通。再视其舌，津液满布，黑皮有脱去者矣。
隔数日，其夫年与相等，亦受温病。四五日间，烦热燥渴。遣人于八十里外致冰一担，日夜食之，烦渴如
故。复迎愚延医，其脉洪滑而长，重按有力，舌苔白浓，中心微黄。知其年虽高而火甚实也。遂投以白虎加人
参以山药代粳米汤，将方中石膏改用四两，连进两剂，而热渴俱愈。其家人疑而问曰∶此证从前日食冰若干，
热渴分毫不退，今方中用生石膏数两，连进两剂而热渴俱愈，是石膏之性凉于冰远矣。愚曰∶非也。石膏原不
甚凉，然尽量食冰不愈而重用生石膏即愈者，因石膏生用能使寒温之热有出路也。西人不善治寒温，故遇寒温
实热证最喜用冰，然多有不愈者。至石膏生用，性能发汗，其热可由汗解。即使服后无汗，亦可宣通内蕴之热，
由腠理毛孔息息达出，人自不觉耳。
按∶此证与前证，年岁同，受病之时亦同。而一则辅以熟地、枸杞之类，以滋真阴；一则重加生石膏，以
清大热。此乃随病、脉之虚实，活泼加减，所以投之辄效也。
忆五年前，族家姊，年七旬有三，忽得瘫痪证，迎愚诊视。既至见有医者在座。用药一剂，其方系散风补
气理痰之品，甚为稳善，愚亦未另立方。翌日，脉变洪长，知其已成伤寒证。先时，愚外祖家近族有病者，订
于斯日迎愚，其车适至，愚将行，谓医者曰∶此证乃瘫痪基础预伏于内，今因伤寒而发，乃两病偕来之证。然
瘫痪病缓，伤寒病急。此证阳明实热，已现于脉，非投以白虎加人参汤不可，君须放胆用之，断无差谬。后医
者终畏石膏寒凉，又疑瘫痪证不可轻用凉药。迟延二日，病势垂危，复急迎愚。及至，则已夜半矣。诊其脉，
洪而且数，力能搏指，喘息甚促，舌强直，几不能言。幸喜药坊即在本村，急取白虎加人参汤一剂，方中生石
膏用三两，煎汤两盅，分二次温饮下，病稍愈。又单取生石膏四两，煮汁一大碗，亦徐徐饮下，至正午尽剂而
愈。后瘫痪证调治不愈，他医竟归咎于愚。谓从前用过若干石膏，所以不能调治。吁！年过七旬而瘫痪者，愈
者几人？独不思愚用石膏之时，乃挽回已尽之人命也。且《金匮》治热瘫痫，有风引汤，原石膏与寒水石并用。
彼谤愚者，生平盖未见《金匮》也。
尝治一少年，素羸弱多病。于初夏得温证，表里俱热，延医调治不愈。适愚自他处治病归，经过其处，
因与其父素稔，入视之。其脉数近六至，虽非洪滑鼓指，而确有实热。舌苔微黄，虽不甚干，毫无津液。有煎
就药一剂未服，仍系发表之剂，乃当日延医所疏方，其医则已去矣。愚因谓其父曰∶此病外感实热，已入阳明
之府。其脉象不洪滑者，元气素虚故也。阳明府热之证，断无发表之理。况其脉数液短，兼有真阴虚损之象尤
忌发汗乎。其父似有会悟，求愚另为疏方。本拟用白虎加人参汤，又思用人参，即须多用石膏，其父素小心过
度，又恐其生疑不敢服，遂但为开白虎汤，方中生石膏用二两。嘱其煎汁两茶盅，分二次温饮下，服后若余火
不净，仍宜再服清火之药。言毕，愚即旋里。后
闻其服药后，病亦遂愈。迟十余日，大便又燥结，两腿微肿，将再迎愚延医。而其父友人有自谓知医者，言其
腿肿，系多服生石膏之过。而孰知系服石膏犹少之过哉！病家竟误听其言，改延他医，投以大剂承气汤，服后
其人即不语矣，迁延数日而亡。夫自谓知医者，不过欲炫己之长，而妄指他人之短。岂知其言之一出，即足误
人性命哉！
至产后之证，忌用寒凉。而果系产后温证，心中燥热，舌苔黄浓，脉象洪实，亦宜投以白虎加人参以山药
代粳米汤，而更以玄参代知母则尤妥善。盖愚于产后温证之轻者，其热虽入阳明之府，脉象不甚洪实，恒重用
玄参一两或至二两，辄能应手奏效；若系剧者，必白虎加人参以山药代粳米汤，而更以玄参代知母方能有效。
诚以石膏、玄参，《神农本草经》皆明载其治产乳。故于产后温病之轻者，可单用玄参。至温病之剧者，不妨
石膏、玄参并用也。然用石膏必须佐以人参，因其时当产后，其热虽实，而体则虚也。不用知母者，《神农本
草经》未载其治产乳，不敢师心自用，漫以凉药治产后也。
友人吴××，深通医学，其侄××亦知医，有戚家延之治产后病。临行，吴××嘱之曰∶果系产后温热，阳
明胃府大实，非用《衷中参西录》中白虎加人参以山药代粳米汤，更以玄参代知母不可。及至诊之，果系产后
温证，病脉皆甚实。××遵所嘱，开方取药。而药坊皆不肯与，谓产后断无用生石膏之理，病家因此生疑，××
辞归。病家又延医治数日，病势垂危，复求为延医。携药而往，如法服之，一剂而愈。
附录∶
沧县董××来函∶
赵××，患温病。医者投以桂枝汤，觉热渴气促。又与柴胡
汤，热尤甚，且增喘嗽，频吐痰涎，不得卧者六七日。医者谓病甚重，不能为矣。举家闻之，惶恐无措。伊芳弟
××延为延医。既至，见病患喘促肩息，头汗自出，表里皆热，舌苔深灰，缩不能言。急诊其脉，浮数有力，重
按甚空。因思此证阳明热极，阴分将竭，实为误服桂枝、柴胡之坏证。急投以白虎加人参以山药代粳米汤，更
以玄参代知母。连服两剂，渴愈喘止，脉不浮数，仍然有力，舌伸能言，而痰嗽不甚见轻。继投以从龙汤，去
苏子，加人参四钱，天冬八钱，服七剂全愈。
又∶一赵姓妇，年二十余，产后八九日，忽得温病。因误用热药发汗，致热渴喘促，舌苔干黑，循衣摸床，
呼索凉水，病家不敢与。脉弦数有力，一息七至。急投以白虎加人参以山药代粳米汤，为系产后，更以玄参代
知母。方中生石膏，重用至四两。又加生地、白芍各数钱。煎汤一大碗，分四次温饮下，尽剂而愈。当时有知
医者在座，疑而问曰∶“产后忌用寒凉，何以如此放胆，重用生石膏？且知母、玄参皆系寒凉之品，何以必用
玄参易知母？”答曰∶“此理俱在《衷中参西录》中”，遂于行箧中出书示知，医者细观移时，始喟然叹服。
又∶外祖家表妹，因产后病温，服补药二十余剂，致大热、大渴、大汗，屡索凉水。医者禁勿与饮，急欲
投井。及生视之，舌黑唇焦，目睛直视，谵语发狂。诊其脉，细数有力。问其小便赤涩，大便紫黑粘滞，不甚
通利。盖以产后血虚，又得温病，兼为补药所误，以致外邪无由而出，内热如焚，阴血转瞬告罄。急投以白虎
加人参汤，仍用山药、玄参代粳米、知母。服后，一夜安稳。黎明，旋又反复，热渴又如从前。细思产后血室
空虚，邪热乘虚而入，故大便紫黑，宜调以桃仁承气汤，以下其瘀血，邪热当随之俱下。因小便赤涩，膀胱蓄
热，又加滑石四钱，甘草钱半。乃开药局者系其本族，谓此药断不可服。病家疑甚，复延前
医相质。前医谓，此病余连治三次，投以温补药转剧，昨服白虎加人参汤，既稍见轻，想服承气汤亦无妨也。
病家闻之，始敢煎服。因方中大黄重用六钱，俾煎汤一盅半，分三次温饮下。逾三点钟，降下大便如胶漆者二
次，鲜红色者一次，小便亦清利，脉净身凉而愈。
又∶赵××之子，年十九岁，偶得温病，医者下之太早，大便转不通者十八日，热渴喘满，舌苔干黑，牙龈
出血，目盲谵语，腹胀如鼓，脐突出二寸，屡治不效。忽大便自利，完谷不化，随食随即泻出。诊其脉，尽伏。
身冷厥逆，气息将无。乍临茫然不知所措，细询从前病状及所服之药，始悟为阳极似阴，热深厥亦深也。然须
用药将其滑泻止住，不复热邪旁流，而后能治其热厥。遂急用野台参三钱，大熟地、生山药、滑石各六钱。煎
服后，泻止脉出，洪长滑数，右部尤甚。继拟以大剂白虎加人参汤，生石膏重用至八两。竟身热厥回，一夜
甚安。至明晨，病又如故。试按其腹中，有坚块，重按眉皱似疼，且其腹胀脐突若此，知其内有燥粪甚多。遂
改用大黄一两，芒硝六钱，赭石、蒌仁各八钱，煎汤一大盅，分两次温饮下。下燥粪二十七枚而愈。
奉天铁岭杨××来函∶
本村张氏妇，得温病，继而小产，犹不以为意。越四五日，其病大发。遍请医生，均谓瘟病小产，又兼
邪热太甚，无方可治。其夫造门求为延医。生至其家，见病患目不识人；神气恍惚；渴嗜饮水，大便滑泻；脉
数近八至，且微细无力；舌苔边黄中黑，缩不能伸。为其燥热，又兼滑泻，先投以滋阴清燥汤，一剂泻止，热
稍见愈。继投以大剂白虎加人参以山药代粳米汤，为其产后，以玄参代知母，为其舌缩脉数，阴分大亏，又加
枸杞、生地。煎汤一大碗，调入生鸡子黄三枚，分数次徐徐温饮下。精神清爽，舌能伸出，连服三剂全愈。
（接上文）这确实是出于热心肠的驱使，无法抑制，然而往往多有能够救活的情况。我犹豫再三，为此患者开了两个方子。一方就是白虎加人参以山药代粳米汤，另一方用熟地黄二两，生山药、枸杞各一两，真阿胶（不炒制）五钱，煎成汤后，调入生鸡蛋黄四个。这两个方子各煎出一大碗药汁，慢慢轮流温热服用，经过十个小时，服完全部药液而痊愈。患者自己说以前服药都没有什么感觉，这时候却像从梦中醒来一样清醒。看他的舌头上仍然干燥发黑，但舌头不再收缩了。他的脉搏跳动次数仍然快，似乎还有余热。又用玄参二两、党参一两煎成一大碗汤，慢慢温热服用，每日一剂，两天后大便得以通畅。再看他的舌头，津液布满，黑皮有脱落的现象了。
过了几天，患者的丈夫年龄相仿，也得了温病。在发病四五天的时候，烦躁发热，口干口渴。派人到八十里外运来一担冰，日夜食用，但烦渴症状依旧没有缓解。于是又请我去诊治，他的脉象洪大、滑利且长，重按有力，舌苔白厚，中心微微发黄。我知道他虽然年纪大，但火热邪气非常实盛。于是投以白虎加人参以山药代粳米汤，将方中的石膏改为四两，连续服用两剂，热势和口渴都痊愈了。他的家人怀疑并问道：“这个病症前几天吃了那么多冰，热渴分毫未退，现在方中只用了几两生石膏，连续服用两剂就热渴俱愈，这说明石膏的药性比冰凉得多啊。”我说：“不对。石膏原本并不很凉，但是尽量吃冰不能治愈而重用生石膏就能治愈的原因，是因为生用的石膏能使寒温病（即伤寒与温病）的实热有出路。西方人不善于治疗寒温病，所以遇到寒温病的实热证最喜欢用冰，然而大多不能治愈。至于生用石膏，其性能能发汗，热邪可以通过汗液排出。即使服药后不出汗，也能宣通体内蕴积的热邪，通过腠理毛孔一丝丝地散发出来，人自然感觉不到罢了。”
按语：这个病例与前一个病例，年龄相同，患病时间也相同。但前者辅以熟地、枸杞之类药物，以滋养真阴；后者重加生石膏，以清除大热。这是随着病情、脉象的虚实变化，灵活加减，所以投药立即见效。
回忆五年前，族里的姐姐，七十三岁，忽然得了瘫痪证，请我去诊视。到了之后，见有医生在场。用药一剂，方子是散风、补气、理痰的药物，非常稳妥善良，我也没有另外开方。第二天，脉象变为洪长，知道已经变成了伤寒证。在此之前，我外祖父家近亲中有病人，约好这天请我去，车正好到了，我准备出发时，对医生说：“这个病症是瘫痪的基础潜伏在内，现在因为伤寒而发作，这是两种病同时到来的证候。然而瘫痪病势缓，伤寒病势急。此证阳明实热，已经在脉象上显现，非投以白虎加人参汤不可，您必须放手使用，绝对不会有差错。”后来的医生终究畏惧石膏的寒凉，又怀疑瘫痪证不可以轻易使用凉药。拖延了两天，病势垂危，又急忙请我去。等到我到时，已经是半夜了。诊察他的脉象，洪大而且数急，力量足以搏击手指，喘息非常急促，舌头僵硬挺直，几乎不能说话。幸好药坊就在本村，急忙取白虎加人参汤一剂，方中生石膏用三两，煎成两盅汤，分两次温热饮下，病稍有好转。又单取生石膏四两，煮成一大碗汁，也慢慢饮下，到正午服完全部药液而痊愈。后来瘫痪证调理不好，其他医生竟然归咎于我。说从前用了多少石膏，所以不能调理。唉！年过七十而患瘫痪的人，治愈的有几人？他们独不思量我使用石膏的时候，正是挽回已经耗尽的人命啊。况且《金匮要略》治疗热瘫痫，有风引汤，原方就是石膏与寒水石并用。那些诽谤我的人，生平大概没见过《金匮要略》吧。
曾经治疗过一个少年，向来瘦弱多病。在初夏得了温证，表里俱热，延医调理没有痊愈。恰好我从别处治病回来，经过那里，因为与他父亲一向熟悉，进去查看。他的脉数接近六至，虽然不是洪滑鼓指，但确有实热。舌苔微黄，虽然不是很干，但毫无津液。有一剂煎好的药没喝，仍然是发表（解表）的药物，那是当天延医所开的方子，那位医生已经离开了。我对他父亲说：“这个病是外感实热，已经入阳明之腑。其脉象不洪滑的原因，是元气素来虚弱所致。阳明腑热之证，断无使用发表法的道理。何况其脉数、津液短少，兼有真阴虚损的迹象，尤其忌讳发汗呢。”他父亲似乎有所领悟，求我另外开方。本打算用白虎加人参汤，又想到用人参，就必须多用石膏，他父亲向来小心过度，又恐怕他起疑不敢服用，于是只开了白虎汤，方中生石膏用二两。嘱咐他煎出两茶盅汁，分两次温热饮下，服后如果余火不净，仍宜再服用清火的药。说完，我就回家了。后来听说他服药后，病也就痊愈了。过了十多天，大便又燥结，两条腿微肿，将要再次请我去诊治。而他父亲的朋友中有自称懂医的人，说他的腿肿，是多服生石膏造成的过错。而谁知道这是服石膏太少的过错呢！病家竟然误听他的话，改请其他医生，投以大剂量的承气汤，服后这个人就不说话了，拖延数日后死亡。那个自称懂医的人，不过是想炫耀自己的长处，而胡乱指责别人的短处。哪里知道他的话一出口，就足以致人性命啊！
至于产后之证，忌讳使用寒凉。但如果果真是产后温证，心中燥热，舌苔黄厚，脉象洪实，也适宜投以白虎加人参以山药代粳米汤，而更以玄参代替知母则更加妥善。因为我对于产后温证的轻症，其热虽入阳明之腑，脉象不甚洪实，常常重用玄参一两或至二两，往往能应手奏效；如果是重症，必用白虎加人参以山药代粳米汤，而更以玄参代替知母才能有效。确实因为石膏、玄参，《神农本草经》都明确记载它们治疗产乳（产后病）。所以对于产后温病的轻症，可单用玄参。至于温病的重症，不妨石膏、玄参并用。然而使用石膏必须佐以人参，因为此时正值产后，其热虽然实盛，但体质则是虚弱的。不用知母的原因，《神农本草经》未记载它治疗产乳，我不敢主观自用，随意用凉药治疗产后病。
友人吴××，深通医学，他的侄子××也懂医，有亲戚家请他去治产后病。临行前，吴××嘱咐他说：“果真是产后温热，阳明胃腑大实，非用《衷中参西录》中的白虎加人参以山药代粳米汤，更以玄参代替知母不可。”等到诊察后，果真是产后温证，病脉都很实盛。××遵照嘱咐，开方取药。但药坊都不肯给药，说产后断然没有用生石膏的道理，病家因此产生怀疑，××辞别回家。病家又请医生治疗几天，病势垂危，又请求让他去诊治。带着药前往，按照方法服用，一剂就痊愈了。
附录：
沧县董××来函：
赵××，患温病。医生投以桂枝汤，觉得热渴气促。又给予柴胡汤，热势更甚，且增加喘嗽，频繁吐痰涎，不能躺卧达六七天。医生认为病很重，不能治了。全家听闻，惶恐无措。他的弟弟××请我去诊治。到了之后，见病患喘促肩息（呼吸时肩膀耸动），头汗自出，表里皆热，舌苔深灰，缩回不能言。急诊其脉，浮数有力，重按甚空。心想这个证候阳明热极，阴分将竭，实在是误服桂枝、柴胡导致的坏证。急忙投以白虎加人参以山药代粳米汤，更以玄参代替知母。连续服用两剂，口渴愈止，喘止，脉不浮数，仍然有力，舌头伸出能言，但痰嗽不太见轻。继投以从龙汤，去掉苏子，加人参四钱，天冬八钱，服用七剂全愈。
又：一位赵姓妇女，二十多岁，产后八九日，忽然得温病。因误用热药发汗，导致热渴喘促，舌苔干黑，循衣摸床（神志不清，手抓衣物），呼索凉水，病家不敢给。脉弦数有力，一息七至。急忙投以白虎加人参以山药代粳米汤，因为是产后，更以玄参代替知母。方中生石膏，重用至四两。又加生地、白芍各数钱。煎汤一大碗，分四次温热饮下，服完全部药液而痊愈。当时有懂医的人在座，怀疑并问道：“产后忌用寒凉，为何如此大胆，重用生石膏？且知母、玄参都是寒凉之品，为何必用玄参易知母？”回答说：“这个道理都在《衷中参西录》中”，于是在行囊中拿出书给医生看，医生仔细观看片刻，才叹息佩服。
又：外祖父家的表妹，因产后病温，服补药二十余剂，导致大热、大渴、大汗，屡次索要凉水。医生禁止不给饮用，她急欲投井。等我去看时，舌黑唇焦，目睛直视，谵语发狂。诊其脉，细数有力。问其小便赤涩，大便紫黑粘滞，不太通利。这是因为产后血虚，又得温病，兼为补药所误，以致外邪无由而出，内热如焚，阴血转瞬告罄。急忙投以白虎加人参汤，仍用山药、玄参代粳米、知母。服后，一夜安稳。黎明，旋即又反复，热渴又如从前。仔细思考产后血室空虚，邪热乘虚而入，故大便紫黑，宜调以桃仁承气汤，以下其瘀血，邪热当随之俱下。因为小便赤涩，膀胱蓄热，又加滑石四钱，甘草半钱。乃开药局的是其本族，说此药断不可服。病家非常怀疑，又请前医来质询。前医说，这个病我连治三次，投以温补药反而加重，昨天服白虎加人参汤，既然稍见轻，想服承气汤也无妨吧。病家听闻，才敢煎服。因为方中大黄重用六钱，使煎汤一盅半，分三次温热饮下。超过三个小时，降下大便如胶漆者二次，鲜红色者一次，小便亦清利，脉净身凉而愈。
又：赵××的儿子，十九岁，偶得温病，医生下之太早，大便转不通者十八日，热渴喘满，舌苔干黑，牙龈出血，目盲谵语，腹胀如鼓，脐突出二寸，屡治不效。忽然大便自利，完谷不化，随食随即泻出。诊其脉，尽伏。身冷厥逆，气息将无。乍临茫然不知所措，细询从前病状及所服之药，始悟为阳极似阴，热深厥亦深也。然而须用药将其滑泻止住，不复热邪旁流，而后能治其热厥。于是急忙用野台参三钱，大熟地、生山药、滑石各六钱。煎服后，泻止脉出，洪长滑数，右部尤甚。继拟以大剂白虎加人参汤，生石膏重用至八两。竟身热厥回，一夜甚安。至明晨，病又如故。试按其腹中，有坚块，重按眉皱似疼，且其腹胀脐突若此，知其内有燥粪甚多。遂改用大黄一两，芒硝六钱，赭石、蒌仁各八钱，煎汤一大盅，分两次温热饮下。下燥粪二十七枚而愈。
奉天铁岭杨××来函：
本村张氏妇，得温病，继而小产，犹不以为意。越四五日，其病大发。遍请医生，均谓瘟病小产，又兼邪热太甚，无方可治。其夫造门求为延医。我至其家，见病患目不识人；神气恍惚；渴嗜饮水，大便滑泻；脉数近八至，且微细无力；舌苔边黄中黑，缩不能伸。为其燥热，又兼滑泻，先投以滋阴清燥汤，一剂泻止，热稍见愈。继投以大剂白虎加人参以山药代粳米汤，为其产后，以玄参代知母，为其舌缩脉数，阴分大亏，又加枸杞、生地。煎汤一大碗，调入生鸡子黄三枚，分数次徐徐温饮下。精神清爽，舌能伸出，连服三剂全愈。
(Continuing from the previous text) This is indeed driven by a warm-heartedness that cannot be restrained, yet often there are many cases that can be saved. After much hesitation, I prescribed two formulas for him. One formula was *Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang* (White Tiger Decoction with Ginseng, substituting Chinese Yam for Rice), and the other used *Shudihuang* (Rehmanniae Radix Praeparata) 2 liang, *Sheng Shanyao* (Raw Dioscoreae Rhizoma) and *Gouqi* (Lycii Fructus) each 1 liang, *Zhen Ejiao* (True Donkey-hide Gelatin, not stir-fried) 5 qian. After decocting into a soup, four raw chicken egg yolks were stirred in. Each of these two formulas yielded one large bowl of decoction, which was taken slowly and alternately while warm. Over ten hours, after finishing all the medicine, he recovered. He said that previously when taking medicine, he felt nothing, but at this time it was as if waking from a dream. Looking at his tongue, it was still dry and black, but no longer contracted. His pulse rate remained rapid, suggesting residual heat. I then used *Xuanshen* (Scrophulariae Radix) 2 liang and *Lushen* (Codonopsis Radix) 1 liang, decocted into one large bowl of soup, taken slowly and warm, one dose per day. After two days, his bowels moved freely. Re-examining his tongue, fluids covered it completely, and the black coating had begun to peel off.
A few days later, his husband, of similar age, also contracted a Warm Disease. During the fourth or fifth day, he suffered from irritability, fever, dryness, and thirst. Someone was sent eighty *li* away to fetch one担 (dan) of ice, which he ate day and night, yet the irritability and thirst remained unchanged. He invited me again to treat him. His pulse was洪滑而长 (Hong, Hua, and Chang - surging, slippery, and long), forceful upon heavy pressure; the tongue coating was thick white with a slight yellow center. I knew that although he was advanced in years, his fire pathogen was extremely excess. Thus, I administered *Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang*, changing the dosage of *Shigao* (Gypsum Fibrosum) in the formula to 4 liang. After taking two doses consecutively, both the fever and thirst resolved. His family members questioned doubtfully: "This condition, having consumed so much ice over the past days, saw no relief in fever and thirst. Now, using only several liang of raw *Shigao* in the formula, and taking two doses resulted in recovery. Does this not mean *Shigao* is far cooler than ice?" I replied: "Incorrect. *Shigao* is not inherently very cool. The reason why consuming ice failed to cure, but heavy use of raw *Shigao* succeeded, is because raw *Shigao* provides an outlet for the excess heat of Hanwen diseases (Cold-Warm diseases). Western physicians are not adept at treating Hanwen diseases; thus, when encountering excess heat syndromes of Hanwen, they prefer using ice, yet often fail to cure. However, raw *Shigao* has the property of inducing sweating, allowing heat to be resolved through sweat. Even if no sweat occurs after ingestion, it can disseminate internal accumulated heat, releasing it gradually through the collaterals and pores, which people naturally do not perceive."
Note: This case and the previous case involved patients of the same age and contracting illness at the same time. Yet, the former was supplemented with *Shudi* (Rehmanniae Radix) and *Gouqi* to nourish True Yin, while the latter heavily added raw *Shigao* to clear major heat. This demonstrates flexible modification based on the deficiency or excess of the disease and pulse, which is why the treatment was effective immediately.
Recalling five years ago, a clan sister, aged seventy-three, suddenly developed paralysis. I was invited to diagnose her. Upon arrival, I found another physician present. He had prescribed one dose consisting of herbs for dispersing wind, tonifying Qi, and resolving phlegm, which seemed very prudent. I did not prescribe another formula. The next day, her pulse became Hong and Chang (surging and long), indicating it had transformed into a Shanghan (Cold Damage) syndrome. Prior to this, a close relative of my maternal grandfather had scheduled an appointment for me on this day. As my carriage arrived and I was about to leave, I told the attending physician: "This condition involves latent paralysis pathology internally, now triggered by Shanghan. It is a simultaneous presentation of two diseases. However, paralysis progresses slowly, whereas Shanghan progresses rapidly. This case shows Yangming excess heat manifested in the pulse. It absolutely requires *Baihu Jia Renshen Tang* (White Tiger Decoction with Ginseng). You must dare to use it; there will be no error." The subsequent physician, fearing the cold nature of *Shigao*, and doubting whether cooling herbs could be lightly used for paralysis, delayed for two days. The condition became critical, and she was urgently summoned again. By the time I arrived, it was midnight. Her pulse was Hong and Shu (rapid), forceful enough to beat against the fingers; she panted severely, her tongue was stiff and straight, and she could hardly speak. Fortunately, the pharmacy was in the same village. I urgently obtained one dose of *Baihu Jia Renshen Tang*, using 3 liang of raw *Shigao*. Decocted into two zhong (bowls), it was taken warm in two portions. The condition improved slightly. Then, I took 4 liang of raw *Shigao* alone, boiled into one large bowl of juice, and drank it slowly. By noon, after finishing the dose, she recovered. Later, the paralysis was not fully cured by other treatments, and other physicians blamed me, claiming that the use of *Shigao* previously hindered recovery. Alas! Among those over seventy suffering from paralysis, how many recover? Did they not consider that when I used *Shigao*, I was rescuing a life that was already exhausted? Moreover, *Jinkui Yaolue* (Essential Prescriptions from the Golden Cabinet) treats heat-induced paralysis and epilepsy with *Fengyin Tang* (Wind-Driving Decoction), which originally combines *Shigao* with *Hanshuishi* (Halloysitum Rubrum). Those who slandered me had likely never seen *Jinkui Yaolue* in their lives.
I once treated a young man who was constitutionally weak and frequently ill. In early summer, he contracted a Warm Syndrome, with heat in both exterior and interior. Medical treatment failed to resolve it. Coincidentally, I returned from treating others elsewhere and passed by his home. Knowing his father well, I entered to examine him. His pulse was Shu (rapid) approaching six beats per breath. Although not Hong Hua Gu Zhi (surging, slippery, and drum-like), there was definite excess heat. The tongue coating was slightly yellow; although not very dry, it lacked fluids. There was a prepared dose of medicine unswallowed, still consisting of exterior-releasing agents, prescribed by the doctor who had just left. I told his father: "This disease is external excess heat that has entered the Yangming Fu organ. The reason the pulse is not Hong Hua is due to chronic deficiency of Yuan Qi (Primal Qi). For Yangming Fu heat syndromes, exterior-releasing methods are absolutely contraindicated. Furthermore, given the rapid pulse and short fluids, along with signs of True Yin deficiency, sweating is especially taboo." His father seemed to understand and requested a new prescription. I intended to use *Baihu Jia Renshen Tang*, but considering that using *Renshen* (Ginseng Radix) would require more *Shigao*, and his father was overly cautious and might suspect or refuse it, I only prescribed *Baihu Tang* (White Tiger Decoction), using 2 liang of raw *Shigao*. I instructed him to decoct into two tea bowls, taken warm in two portions. If residual fire remained, clearing heat medicines should be taken again. After speaking, I returned home. Later, I heard that after taking the medicine, his illness resolved. More than ten days later, his bowels became dry and constipated again, and his legs swelled slightly. He was about to invite me again. However, a friend of his father, claiming medical knowledge, stated that the leg swelling was caused by excessive consumption of raw *Shigao*. Who would have known it was actually due to insufficient *Shigao*? The patient's family mistakenly listened to him, changed doctors, and administered a large dose of *Chengqi Tang* (Purgative Decoction). After ingestion, the patient fell silent and died after several days. That self-proclaimed knowledgeable person merely wanted to show off his strengths and falsely criticize others' weaknesses. He did not realize that his words were sufficient to cause death.
Regarding postpartum conditions, cold-natured herbs are contraindicated. However, if it is truly a postpartum Warm Syndrome with dry heat in the heart, thick yellow tongue coating, and Hong Shi (surging and solid) pulse, it is appropriate to administer *Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang*, substituting *Xuanshen* (Scrophulariae Radix) for *Zhimu* (Anemarrhenae Rhizoma) for even better results. In mild postpartum Warm Syndromes where heat enters the Yangming Fu but the pulse is not significantly Hong Shi, I often heavily use 1 to 2 liang of *Xuanshen*, which usually yields immediate effect. For severe cases, *Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang* with *Xuanshen* replacing *Zhimu* is necessary for efficacy. This is because both *Shigao* and *Xuanshen* are explicitly recorded in *Shennong Bencao Jing* (Divine Farmer's Materia Medica) to treat postpartum conditions. Thus, for mild postpartum Warm Diseases, *Xuanshen* alone can be used. For severe cases, *Shigao* and *Xuanshen* can be combined. However, *Shigao* must be accompanied by *Renshen*, because during the postpartum period, although the heat is excess, the body is deficient. *Zhimu* is not used because *Shennong Bencao Jing* does not record its efficacy for postpartum conditions; I dare not act subjectively and casually use cold herbs for postpartum treatment.
My friend Wu XX, deeply versed in medicine, had a nephew XX who also knew medicine. A relative hired XX to treat a postpartum illness. Before leaving, Wu XX instructed him: "If it is indeed postpartum warmth with significant excess in the Yangming Stomach Fu, non-use of *Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang* from *Zhongzhong Canxi Lu* (Records of Integrating Traditional Chinese and Western Medicine), with *Xuanshen* replacing *Zhimu*, is unacceptable." Upon diagnosis, it was indeed a postpartum Warm Syndrome with very solid disease pulses. XX followed the instructions and prescribed the medicine. However, pharmacies refused to dispense it, stating that raw *Shigao* is absolutely contraindicated postpartum. The patient's family became suspicious, and XX returned. The family consulted other doctors for several days until the condition became critical, then sought XX again. I went with the medicine, administered it according to method, and one dose resulted in recovery.
Appendix:
Letter from Dong XX of Cangxian County:
Zhao XX suffered from a Warm Disease. The physician prescribed *Guizhi Tang* (Cinnamon Twig Decoction), resulting in increased heat, thirst, and shortness of breath. Then *Chaihu Tang* (Bupleurum Decoction) was given, making the heat worse, adding wheezing and coughing, frequent expectoration of phlegm-saliva, and inability to lie down for six or seven days. The physician claimed the disease was too severe to treat. The whole family was terrified and helpless. His brother XX invited me to treat him. Upon arrival, the patient was panting with shoulder breathing, sweating on the head, with heat in both exterior and interior. The tongue coating was deep gray, contracted, and unable to speak. Emergency pulse examination revealed Floating, Rapid, and Forceful, but empty upon heavy pressure. I reasoned that this case involved extreme Yangming heat and impending exhaustion of Yin, truly a damaged syndrome caused by mistaken use of *Guizhi* and *Chaihu*. I urgently prescribed *Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang*, substituting *Xuanshen* for *Zhimu*. After two consecutive doses, thirst ceased, wheezing stopped, the pulse was no longer floating and rapid but remained forceful, the tongue extended and speech resumed, though phlegm-cough did not improve much. Subsequently, *Conglong Tang* (Following Dragon Decoction) was prescribed, removing *Suzi* (Perillae Fructus), adding 4 qian of *Renshen* and 8 qian of *Tiantong* (Asparagi Radix). After seven doses, full recovery occurred.
Also: A surnamed Zhao woman, in her twenties, eight or nine days postpartum, suddenly contracted a Warm Disease. Due to mistaken use of hot herbs to induce sweating, she developed heat, thirst, wheezing, and shortness of breath. The tongue coating was dry and black; she exhibited 'seeking clothes and bed-rubbing' (signs of delirium), calling for cold water, which the family dared not give. The pulse was Xuan Shu (wiry and rapid) and forceful, seven beats per breath. I urgently prescribed *Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang*. Since it was postpartum, *Xuanshen* replaced *Zhimu*. Raw *Shigao* was heavily used at 4 liang. Additionally, *Shengdi* (Rehmanniae Radix) and *Baishao* (Paeoniae Radix Alba) were added, several qian each. Decocted into one large bowl, taken warm in four portions, recovery occurred after finishing the dose. At that time, a knowledgeable physician was present, questioning doubtfully: "Postpartum contraindicates cold herbs. Why such boldness in heavily using raw *Shigao*? And since both *Zhimu* and *Xuanshen* are cold, why must *Xuanshen* replace *Zhimu*?" I answered: "The principles are all in *Zhongzhong Canxi Lu*." I took the book from my travel bag to show the physician. After careful observation for a while, he sighed in admiration.
Also: My maternal grandfather's cousin, due to postpartum Warm Disease, took tonic herbs for over twenty doses, leading to severe heat, thirst, and profuse sweating. She repeatedly demanded cold water. Physicians forbade giving it; she desperately wanted to jump into a well. When I examined her, her tongue was black, lips scorched, eyes fixed, delirious and manic. Pulse was Xi Shu (fine and rapid) but forceful. Urination was red and difficult; stool was purple-black, sticky, and poorly discharged. This was due to postpartum blood deficiency compounded by Warm Disease and mistaken tonic use, causing external pathogens no exit and internal heat burning, depleting Yin-blood instantly. I urgently prescribed *Baihu Jia Renshen Tang*, using *Shanyao* (Dioscoreae Rhizoma) and *Xuanshen* to replace *Jingmi* (Oryzae Semen) and *Zhimu*. After ingestion, she slept peacefully for one night. At dawn, symptoms recurred with heat and thirst as before. Carefully considering that postpartum blood chamber emptiness allows evil heat to enter vacuity, causing purple-black stool, I decided to regulate with *Taoren Chengqi Tang* (Peach Kernel Purgative Decoction) to purge blood stasis, expecting evil heat to descend with it. Due to red/difficult urination and bladder heat accumulation, I added 4 qian of *Huashi* (Kaolin) and half a qian of *Gancao* (Glycyrrhizae Radix). The local pharmacy, belonging to her clan, declared the medicine undrinkable. The family was highly suspicious and consulted the previous physician. The previous physician stated: "I treated this three times; warming tonics worsened it. Yesterday, *Baihu Jia Renshen Tang* brought slight relief; taking *Chengqi Tang* should be fine." The family then dared to decoct and take it. With 6 qian of *Dahuang* (Rhei Radix et Rhizoma) heavily used, decocted into 1.5 zhong, taken warm in three portions. After three hours, two stools like glue/paint and one fresh red stool were passed. Urination cleared, pulse normalized, body cooled, and she recovered.
Also: Son of Zhao XX, nineteen years old, accidentally contracted a Warm Disease. The physician purged too early, leading to eighteen days of bowel obstruction. Symptoms included heat, thirst, wheezing, fullness, dry black tongue coating, gum bleeding, blindness, delirium, abdominal distension like a drum, and umbilical protrusion two cun. Multiple treatments failed. Suddenly, spontaneous loose stools occurred, containing undigested food, excreted immediately after eating. Pulse was completely hidden (Fu). Body cold, extremities inverted, breath nearly gone. Initially bewildered, after detailed inquiry into past symptoms and medications, I realized it was Extreme Yang resembling Yin, where deep heat causes deep inversion (Jue). However, the loose diarrhea had to be stopped first to prevent heat pathogen from flowing sideways, before treating the heat-Jue. I urgently used 3 qian of *Yetaishen* (Wild Panax Notoginseng/Ginseng), 6 qian each of *Dashudi* (Prepared Rehmanniae Radix), *Sheng Shanyao*, and *Huashi*. After decoction and ingestion, diarrhea stopped, pulse emerged—Hong, Chang, Hua, Shu (surging, long, slippery, rapid), especially in the Right position. Subsequently, I planned a large dose of *Baihu Jia Renshen Tang*, using 8 liang of raw *Shigao*. Body heat returned, inversion reversed, peaceful sleep for one night. Next morning, symptoms recurred. Palpating the abdomen, hard masses were felt; heavy pressure caused frowning/pain. Given the abdominal distension and umbilical protrusion, I knew there was much dry feces inside. I switched to 1 liang of *Dahuang*, 6 qian of *Mangxiao* (Natrii Sulfas), 8 qian each of *Zhesshi* (Haematitum) and *Louren* (Trichosanthis Semen). Decocted into one large zhong, taken warm in two portions. Twenty-seven pieces of dry feces were passed, and she recovered.
Letter from Yang XX of Tieling, Fengtian Province:
Mrs. Zhang in our village contracted a Warm Disease, followed by miscarriage, which she ignored. Four or five days later, the disease flared up widely. Doctors were consulted everywhere, all stating that Warm Disease with miscarriage, plus excessive evil heat, had no curable formula. Her husband came to my door requesting treatment. Upon arrival, I saw the patient could not recognize people; spirit was confused; thirsty and desiring water; loose diarrhea; pulse rapid approaching eight beats per breath, fine and weak; tongue coating yellow at edges, black in center, contracted and unable to extend. Due to dryness-heat combined with loose diarrhea, I first prescribed *Ziyin Qingzao Tang* (Nourish Yin Clear Dryness Decoction). After one dose, diarrhea stopped, heat slightly improved. Subsequently, I prescribed a large dose of *Baihu Jia Renshen Yi Shanyao Dai Jingmi Tang*. Because it was postpartum, *Xuanshen* replaced *Zhimu*. Because of tongue contraction and rapid pulse indicating severe Yin deficiency, I added *Gouqi* and *Shengdi*. Decocted into one large bowl, three raw chicken egg yolks were stirred in. Taken warm in multiple portions slowly. Spirit refreshed, tongue extended. After three consecutive doses, full recovery occurred.