邻村许姓学生，年十八岁，于季春得劳热咳嗽证。
病因 秉性刚强，劳心过度；又当新婚之余，或年少失保养，迨至春阳发动，渐成劳热咳嗽证。
证候 日晡潮热，通夜作灼，至黎明得微汗其灼乃退。白昼咳嗽不甚剧，夜则咳嗽不能安枕。
饮食减少，身体羸瘦，略有动作即气息迫促。左右脉皆细弱，重按无根，数逾七至。夫脉一息七至，
即难挽回，况复逾七至乎？犹幸食量犹佳，大便干燥（此等证忌滑泻），知犹可治。拟治以峻补真阴
之剂，而佐以收
敛气化之品。
处方 生怀山药（一两） 大甘枸杞（八钱） 玄参（六钱） 生怀地黄（六钱） 沙参（六钱）
甘草（三钱） 生龙骨（六钱捣碎） 净萸肉（六钱） 生杭芍（三钱） 五味子（三钱捣碎） 牛蒡子（三钱捣碎）
共煎汤一大盅，温服。
方解 五味入汤剂，药局照例不捣。然其皮味酸，核味辛，若囫囵入煎则其味过酸，服之恒有
满闷之弊。故徐灵胎谓宜与干姜之味辛者同服。若捣碎入煎，正可惜其核味之辛以济皮味之酸，无
事伍以干姜而亦不发满闷。是以欲重用五味以治嗽者，当注意令其捣碎，或说给病家自检点。至于甘草
多用至三钱者，诚以此方中不但五味酸，萸肉亦味酸，若用甘草之至甘者与之化合，可增加其补益之力
（如酸能 齿，得甘则不 齿是明征），是以多用至三钱。
复诊 将药连服三剂，灼热似见退，不复出汗，咳嗽亦稍减，而脉仍七至强。因恍悟此脉之数，不
但因阴虚，实亦兼因气虚，犹若力小而强任重者其体发颤也。拟仍峻补其真阴，再辅以补气之品。
处方 生怀山药（一两） 野台参（三钱） 大甘枸杞（六钱） 玄参（六钱） 生怀地黄（六
钱） 甘草（三钱） 净萸肉（五钱） 天花粉（五钱） 五味子（三钱捣碎） 生杭芍（三钱） 射
干（二钱） 生鸡内金（钱半黄色的捣）
共煎一大盅温服。为方中加台参恐服之作闷，是以又加鸡内金以运化之。且凡虚劳之甚者，其
脉络间恒多瘀滞，鸡内金又善化经络之瘀滞也。
三诊 将药连服四剂，灼热咳嗽已愈十之七八，脉已缓至六至，此足征补气有效也。爰即
原方略为加减，多服数剂，病自除根。
处方 生怀山药（一两） 野台参（三钱） 大甘枸杞（六钱） 玄参（五钱） 生怀地
黄（五钱） 甘草（二钱） 天冬（五钱） 净萸肉（五钱） 生杭芍（三钱） 川贝母（三钱）
生远志（二钱） 生鸡内金（钱半黄色的捣）
共煎一大盅温服。
效果 将药连服五剂，灼热咳嗽全愈，脉已复常，遂停服汤剂。
俾日用生怀山药细末煮作茶汤，兑以鲜梨自然汁，当点心服之，以善其后。
邻村许姓学生，十八岁，在暮春时节患上了劳热咳嗽证。
病因 禀性刚强，用脑过度；加之新婚之后，或因年少不知保养，等到春季阳气发动时，逐渐形成了劳热咳嗽证。
证候 每天下午申酉时分（约下午3-7点）出现潮热，整夜身体灼热，直到黎明时分微微出汗，灼热感才消退。白天咳嗽不是很剧烈，晚上则咳嗽严重到无法安睡。饮食减少，身体消瘦，稍微有点活动就气息急促。左右手脉象都细弱无力，重按没有根基，脉搏频率超过七次/息（一呼一吸为一息）。脉搏一息达到七次，就已经难以挽回，何况超过七次呢？幸好食量尚可，大便干燥（这类证候忌讳滑肠腹泻），知道还可以治疗。拟定用峻补真阴的方剂进行治疗，并辅以收敛气化的药物。
处方 生怀山药（一两） 大甘枸杞（八钱） 玄参（六钱） 生怀地黄（六钱） 沙参（六钱） 甘草（三钱） 生龙骨（六钱，捣碎） 净萸肉（六钱） 生杭芍（三钱） 五味子（三钱，捣碎） 牛蒡子（三钱，捣碎）
共煎煮成一大盅汤药，温服。
方解 五味子入汤剂，药房通常照例不捣碎。但是它的皮味酸，核味辛，如果整个放入煎煮，味道会过于酸涩，服用后常常有胸闷胀满的弊端。所以徐灵胎认为应该与干姜这种味辛的药物同服。如果把五味子捣碎后入煎，正好可以利用其核味的辛来济助皮味的酸，不需要配合干姜也不会导致胸闷胀满。因此想要重用五味子来治疗咳嗽时，应当注意让它捣碎，或者嘱咐病人自己检查这一点。至于甘草多用至三钱，确实是因为在这个方子中不仅五味子酸，萸肉也味酸，如果用极甘甜的甘草与之化合，可以增加其补益的力量（就像酸味能刺激牙齿，得到甘味就不会刺激牙齿，这是明显的证据），所以多用至三钱。
复诊 将药连续服用三剂后，灼热感似乎有所减退，不再出汗，咳嗽也有所减轻，但脉搏仍然强劲地保持在七次/息以上。于是恍然大悟，这个脉搏的快速，不仅因为阴虚，实际上也兼有气虚，就像力气小却强行承担重物的人身体会发抖一样。拟定继续峻补真阴，再辅以补气药物。
处方 生怀山药（一两） 野台参（三钱） 大甘枸杞（六钱） 玄参（六钱） 生怀地黄（六钱） 甘草（三钱） 净萸肉（五钱） 天花粉（五钱） 五味子（三钱，捣碎） 生杭芍（三钱） 射干（二钱） 生鸡内金（钱半，黄色的，捣碎）
共煎煮一大盅，温服。因为在方中加入台参恐怕服用后会感到闷滞，所以又加入鸡内金来运化它。而且凡是虚劳严重的患者，其脉络间往往多有瘀滞，鸡内金又善于化解经络中的瘀滞。
三诊 将药连续服用四剂后，灼热和咳嗽已经好了十分之七八，脉搏已经减缓至六次/息，这充分证明补气有效。于是就在原方基础上略微加减，多服用几剂，病自然除根。
处方 生怀山药（一两） 野台参（三钱） 大甘枸杞（六钱） 玄参（五钱） 生怀地黄（五钱） 甘草（二钱） 天冬（五钱） 净萸肉（五钱） 生杭芍（三钱） 川贝母（三钱） 生远志（二钱） 生鸡内金（钱半，黄色的，捣碎）
共煎煮一大盅，温服。
效果 将药连续服用五剂后，灼热和咳嗽完全痊愈，脉搏恢复正常，于是停止服用汤剂。让患者日常用生怀山药细末煮成茶汤，兑入鲜梨的自然汁，作为点心服用，以善后调理。
A student surnamed Xu from a neighboring village, aged eighteen, contracted the syndrome of *Lao Re Ke Sou* (Tubercular Fever with Cough) in late spring.
Etiology His disposition was strong-willed, and he overworked his mind; furthermore, following his recent marriage, or due to lack of preservation in his youth, when the spring yang energy began to stir, it gradually developed into the syndrome of tubercular fever with cough.
Symptoms He experienced tidal fever every afternoon (Shen and You hours), feeling burning heat throughout the night, which subsided only after slight sweating at dawn. The cough was not severe during the day, but at night it was so intense that he could not sleep peacefully. His appetite decreased, his body became emaciated, and any slight movement caused shortness of breath. Both radial pulses were fine and weak, lacking root upon heavy pressure, and rapid, exceeding seven beats per respiration cycle. A pulse rate of seven beats per respiration is already difficult to reverse, let alone exceeding seven. Fortunately, his food intake remained good, and his stool was dry (such syndromes contraindicate loose stools), indicating that treatment was still possible. I prescribed a potent formula to strongly tonify True Yin, assisted by herbs that consolidate and regulate Qi transformation.
Prescription Sheng Huai Shan Yao (Raw Dioscorea Opposita Rhizome, 1 liang), Da Gan Gou Qi Zi (Large Sweet Lycium Fruit, 8 qian), Xuan Shen (Scrophularia Root, 6 qian), Sheng Huai Di Huang (Raw Rehmannia Root, 6 qian), Sha Shen (Glehnia Root, 6 qian), Gan Cao (Licorice Root, 3 qian), Sheng Long Gu (Raw Fossilized Bones, 6 qian, crushed), Jing Yu Rou (Cleaned Cornus Fruit, 6 qian), Sheng Hang Shao (Raw Paeonia Lactiflora Root, 3 qian), Wu Wei Zi (Schisandra Fruit, 3 qian, crushed), Niu Bang Zi (Arctium Seed, 3 qian, crushed).
Decoct together in one large cup of water, take warm.
Formula Analysis When Wu Wei Zi is included in decoctions, pharmacies usually do not crush it according to standard practice. However, its skin is sour, and its seed is pungent. If taken whole, the flavor becomes excessively sour, often causing chest fullness and oppression after ingestion. Therefore, Xu Lingtai stated it should be taken with Gan Jiang (Dried Ginger), which is pungent. If crushed before decoction, the pungency of the seed naturally balances the sourness of the skin, eliminating the need for Gan Jiang and preventing chest fullness. Thus, when heavily utilizing Wu Wei Zi to treat cough, one must ensure it is crushed, or instruct the patient to check this. As for using Gan Cao up to 3 qian, it is indeed because in this formula, both Wu Wei Zi and Yu Rou are sour. Combining them with the extremely sweet Gan Cao enhances their tonic power (just as sour flavors irritate teeth, sweetness neutralizes this irritation, which is clear evidence); hence, it is used in larger quantities up to 3 qian.
Second Visit After taking three doses, the burning heat seemed to subside slightly, sweating ceased, and the cough reduced somewhat, yet the pulse remained strongly at seven beats per respiration. I suddenly realized that this rapidity was not solely due to Yin deficiency, but also involved Qi deficiency, similar to how a person with little strength trembling under a heavy load. I decided to continue strongly tonifying True Yin, supplemented by Qi-tonifying herbs.
Prescription Sheng Huai Shan Yao (Raw Dioscorea Opposita Rhizome, 1 liang), Ye Tai Shen (Wild Codonopsis Root, 3 qian), Da Gan Gou Qi Zi (Large Sweet Lycium Fruit, 6 qian), Xuan Shen (Scrophularia Root, 6 qian), Sheng Huai Di Huang (Raw Rehmannia Root, 6 qian), Gan Cao (Licorice Root, 3 qian), Jing Yu Rou (Cleaned Cornus Fruit, 5 qian), Tian Hua Fen (Trichosanthes Root, 5 qian), Wu Wei Zi (Schisandra Fruit, 3 qian, crushed), Sheng Hang Shao (Raw Paeonia Lactiflora Root, 3 qian), She Gan (Belamcanda Rhizome, 2 qian), Sheng Ji Nei Jin (Raw Chicken Gizzard Lining, 1.5 qian, yellow variety, crushed).
Decoct in one large cup, take warm. Tai Shen was added to the formula, but to prevent potential stagnation/fullness, Ji Nei Jin was added to promote digestion and transformation. Moreover, in cases of severe consumptive disease, there are often stasis in the collaterals; Ji Nei Jin is particularly effective at resolving collateral stasis.
Third Visit After taking four doses, the fever and cough had improved by seventy to eighty percent, and the pulse slowed to six beats per respiration, confirming the efficacy of Qi tonification. Therefore, I made minor adjustments to the original prescription and advised taking several more doses to eradicate the root cause.
Prescription Sheng Huai Shan Yao (Raw Dioscorea Opposita Rhizome, 1 liang), Ye Tai Shen (Wild Codonopsis Root, 3 qian), Da Gan Gou Qi Zi (Large Sweet Lycium Fruit, 6 qian), Xuan Shen (Scrophularia Root, 5 qian), Sheng Huai Di Huang (Raw Rehmannia Root, 5 qian), Gan Cao (Licorice Root, 2 qian), Tian Dong (Asparagus Root, 5 qian), Jing Yu Rou (Cleaned Cornus Fruit, 5 qian), Sheng Hang Shao (Raw Paeonia Lactiflora Root, 3 qian), Chuan Bei Mu (Fritillaria Bulb, 3 qian), Sheng Yuan Zhi (Raw Polygala Root, 2 qian), Sheng Ji Nei Jin (Raw Chicken Gizzard Lining, 1.5 qian, yellow variety, crushed).
Decoct in one large cup, take warm.
Outcome After taking five doses, the fever and cough completely resolved, and the pulse returned to normal. Decoction therapy was discontinued. Instead, he was instructed to consume a tea made from finely powdered Raw Dioscorea Opposita Rhizome boiled daily, mixed with fresh pear juice, taken as a snack for convalescence.