治同前证。外表已解，其人或不滑泻，或兼喘息，或兼咳嗽，频吐痰涎，确有外感实热，而脉象甚虚数者。
若前证，服滋阴宣解汤后，犹有余热者，亦可继服此汤。
其方即滋阴宣解汤，去连翘、蝉蜕。
一妇人，受妊五月，偶得伤寒。三四日间，胎忽滑下。上焦燥渴，喘而且呻，痰涎壅盛，频频咳吐。延医
服药，病未去，而转添滑泻，昼夜十余次。医者辞不治，且谓危在旦夕。其家人惶恐，迎愚诊视。其脉似洪滑，
重诊指下豁然，两尺尤甚。本拟治以滋阴清燥汤，为小产才四五日，不敢遽用寒凉。遂先用生山药二两、酸石
榴一个，连皮捣烂，同煎汁一大碗，分三次温饮下。滑泻见愈，他病如故。再诊其脉，洪滑之力较实，因思此
证虽虚，确有外感实热，若不先解其实热，他病何以得愈？时届晚三点钟，
病患自言，每日此时潮热，又言精神困倦已极，昼夜苦不得睡。遂于斯日，复投以滋阴清燥汤。方中生山药重
用两半，煎汁一大碗，徐徐温饮下，一次只饮药一口，诚以产后，脉象又虚，不欲寒凉侵下焦也。斯夜遂得安
睡，渴与滑泻皆愈，喘与咳亦愈其半。又将山药、滑石各减五钱，加龙骨、牡蛎各八钱，一剂而愈。
一室女，伤寒过两旬矣，而瘦弱支离，精神昏愦，过午发热，咳而且喘，医者辞不治。诊其脉，数至七至，
微弱欲无。因思此证，若系久病至此，不可为矣。然究系暴虚之证，生机之根柢当无损。勉强投以滋阴清燥汤，
将滑石减半，又加玄参、熟地黄各一两，野台参五钱，煎汤一大碗，徐徐温饮下。饮完煎滓重饮，俾药力昼夜
相继。两日之间，连服三剂，滑石渐减至二钱，其病竟愈。
按∶此证始终不去滑石者，恐当伤寒之余，仍有余邪未净。又恐补药留邪，故用滑石引之下行，使有出路
也。又凡煎药若大剂，必需多煎汤数杯，徐徐服之。救险证宜如此，而救险证之阴分亏损者，尤宜如此也。
汲××之母，年近七旬。身体羸弱，谷食不能消化，惟饮牛乳，或间饮米汤少许，已二年卧床，不能起坐矣。
于戊午季秋，受温病。时愚初至奉天，自锦州邀愚诊视。脉甚细数，按之微觉有力。发热咳嗽，吐痰稠粘，精
神昏愦，气息奄奄。投以滋阴清燥汤，减滑石之半，加玄参五钱，一剂病愈强半。又煎渣取清汤一茶盅，调入
生鸡子黄一枚，服之全愈。
奉天一孺子年四岁，得温病，邪犹在表，医者不知为之清解，遽投以苦寒之剂，服后滑泻，四五日不止。
上焦燥热，闭目而喘，精神昏愦。延为延医，病虽危险，其脉尚有根柢，知可挽回。俾用滋阴清燥汤原方，煎
汁一大茶杯，为其幼小，俾徐徐温饮下，尽剂而愈。然下久亡阴，余有虚热，继用生山药、玄参各
一两以清之，两剂热尽除。大抵医者遇此等证，清其燥热，则滑泻愈甚，补其滑泻，其燥热亦必愈甚。惟此方，
用山药以止滑泻，而山药实能滋阴退热，滑石以清燥热，而滑石实能利水止泻，二药之功用，相得益彰。又佐
以芍药之滋阴血、利小便，甘草之燮阴阳、和中宫，亦为清热止泻之要品。汇集成方，所以效验异常。愚用此
方，救人多矣，即势至垂危，投之亦能奏效。
奉天刘××，年二十五六，于季冬得伤寒，经医者误治，大便滑泻无度，而上焦烦热，精神昏愦，时作谵语，
脉象洪数，重按无力。遂重用生山药两半、滑石一两、生杭芍六钱、甘草三钱，一剂泻止。上焦烦热不退，仍
作谵语，爰用玄参、沙参诸凉润之药清之，仍复滑泻，再投以前方一剂泻又止，而上焦之烦热益甚，精神亦益
昏愦，毫无知觉。此时其家人毕至，皆以为不可复治。诊其脉虽不实，仍有根柢，至数虽数，不过六至，知犹
可治，遂慨切谓其家人曰∶“果信服余药，此病尚可为也”，其家人似领悟。为疏方，用大剂白虎加人参汤，
更以生山药一两代粳米，大生地一两代知母，煎汤一大碗，嘱其药须热饮，一次止饮一口，限以六句钟内服完，
尽剂而愈。
津市钱姓小儿四岁，灼热滑泻，重用滋阴清燥汤治愈。
附录∶
奉天铁岭杨××来函∶
治李姓妇人膨胀证。先经他医用苍术、槟榔、浓朴、枳实、香附、紫蔻之类辛燥开破，初服觉轻，七八剂
后病转增剧，烦渴泄泻。又更他医，投以紫朴琥珀丸，烦渴益甚，一日夜泄泻十五六次，再诊时，医者辞不治。
又延医数人，皆诿为不治。后乃一息奄奄，舁至床上两次，待时而已。其姻家有知生者强生往视。其脉如水上
浮麻，不分至数，按之即无，惟两尺犹似有根，言语不
真，仿佛可辨，自言心中大渴，少饮水即疼不可忍，盖不食者已三日矣。先投以滋阴清燥汤，为脉象虚甚，且
气息有将脱之意，又加野台参、净萸肉，一剂，诸病皆愈，可以进食。遂俾用一味薯蓣粥，送服生鸡内金细末
及西药百布圣，取其既可作药，又可作饭也。又即前方加减，日服一剂，旬日全愈。
治疗与前文所述证候相同。表邪已经解除，患者可能没有滑泻症状，或者兼有喘息，或者兼有咳嗽，频繁呕吐痰涎，确实存在外感实热，但脉象非常虚数。
如果前一种证候，服用滋阴宣解汤后，仍有残余热邪的，也可以继续服用此方。
有一位妇女，怀孕五个月时，偶然得了伤寒。在三四天之间，胎儿突然流产。上焦干燥口渴，气喘且呻吟，痰涎壅盛，频繁咳吐。请医生服药，病未去除，反而增添了滑泻，昼夜达十余次。医生推辞不治疗，并且说病情危在旦夕。其家人惶恐不安，请来我诊治。脉象看似洪滑，重按指下豁然空虚，两尺部尤为明显。本打算用滋阴清燥汤治疗，但因为小产才四五日，不敢贸然使用寒凉药物。于是先用生山药二两、酸石榴一个，连皮捣烂，同煎取汁一大碗，分三次温服。滑泻逐渐好转，其他病症依旧。再次诊脉，洪滑之力较之前实在了一些，因此想到此证虽然体虚，但确实存在外感实热，如果不先解除其实热，其他病症怎么能痊愈呢？当时是下午三点钟，病人自己说，每天这个时候出现潮热，又说精神极度困倦，昼夜痛苦无法入睡。于是在当天，再次投以滋阴清燥汤。方中生山药重用一两半，煎汁一大碗，徐徐温服，每次只喝一口药，实在是因为产后，脉象又虚，不想让寒凉之药损伤下焦。这一夜便得以安睡，口渴与滑泻都好了，气喘与咳嗽也好了大半。又将山药、滑石各减少五钱，加龙骨、牡蛎各八钱，一剂药而痊愈。
有一位未婚女子，患伤寒已过二十多天，身体瘦弱支离破碎，精神昏愦，午后发热，咳嗽且气喘，医生推辞不治疗。诊其脉，每息七至，微弱得几乎摸不到。因此想到此证，如果是久病导致如此程度，那就不可治了。然而究其本质，这是暴虚之证，生机的根本应当没有受损。勉强投以滋阴清燥汤，将滑石减半，又加玄参、熟地黄各一两，野台参五钱，煎汤一大碗，徐徐温服。喝完药渣再煎取汁饮用，使药力昼夜相继。两天之内，连续服用三剂，滑石逐渐减至二钱，病竟痊愈。
按语：此证始终不除去滑石的原因，是恐怕在伤寒之后，仍有残余邪气未净。又恐怕补药留滞邪气，所以用滑石引导邪气下行，使其有出路。另外，凡是煎药若是大剂量，必须多煎出几杯汤汁，徐徐服用。救治险证应该如此，而救治险证中阴分亏损的患者，尤其应该如此。
汲××的母亲，年龄近七十岁。身体羸弱，谷物食物不能消化，只喝牛奶，或偶尔喝少许米汤，已经卧床两年，不能起坐。在戊午年深秋，感染温病。当时我刚到奉天，从锦州被邀请去诊治。脉象非常细数，按上去微觉有力。发热咳嗽，吐痰稠粘，精神昏愦，气息奄奄。投以滋阴清燥汤，减去一半的滑石，加玄参五钱，一剂病势减轻大半。又煎药渣取清汤一茶盅，调入生鸡蛋黄一枚，服用后完全痊愈。
奉天有一个四岁的孩子，得了温病，邪气还在体表，医生不知道为他清热解表，急忙投以苦寒的药物，服用后滑泻，四五天不止。上焦燥热，闭目气喘，精神昏愦。请我去诊治，病虽危险，但脉象尚有根基，知道可以挽回。让他用滋阴清燥汤原方，煎汁一大茶杯，因为孩子幼小，让他徐徐温服，服完一剂而痊愈。然而腹泻久了亡失阴液，余留有虚热，继用生山药、玄参各一两来清除，两剂药热邪尽除。大抵医生遇到此类证候，清其燥热，则滑泻会更严重；补其滑泻，其燥热也必然更严重。只有此方，用山药来止滑泻，而山药确实能滋阴退热；用滑石来清燥热，而滑石确实能利水止泻，这两味药的功用，相得益彰。又佐以芍药的滋阴血、利小便，甘草的协调阴阳、调和脾胃，也是清热止泻的重要药物。汇集成方，所以疗效异常。我用此方，救人多矣，即使病情垂危，投以此方也能奏效。
奉天刘××，年龄二十五六岁，在隆冬时节得了伤寒，经过医生误治，大便滑泻无度，而上焦烦热，精神昏愦，时常说胡话，脉象洪数，重按无力。于是重用生山药一两半、滑石一两、生杭芍六钱、甘草三钱，一剂药泻止。上焦烦热不退，仍说胡话，于是用玄参、沙参等凉润药物清热，仍然滑泻，再次投以前方一剂，泻又止，而上焦的烦热更加严重，精神也更加昏愦，毫无知觉。此时其家人全部到了，都认为不可再治。诊其脉虽然不实，仍有根基，至数虽然快，不过六至，知道还可以治，于是恳切地对他的家人说：“果真信服我的药，这病还可以治”，其家人似乎领悟。于是开方，用大剂量的白虎加人参汤，更以生山药一两代替粳米，大生地一两代替知母，煎汤一大碗，嘱咐药必须热饮，一次只喝一口，限定在六小时内服完，服完一剂而痊愈。
附录：
奉天铁岭杨××来信：
治疗李姓妇人的膨胀证。先前经其他医生用苍术、槟榔、浓朴、枳实、香附、紫蔻之类辛燥开破的药物，初服觉得轻快，七八剂后病情转剧，烦渴泄泻。又换其他医生，投以紫朴琥珀丸，烦渴更加严重，一昼夜泄泻十五六次，再次诊脉时，医生推辞不治疗。又请了几位医生，都推脱为不治之症。后来只剩一口气奄奄一息，抬到床上两次，等待死亡而已。其姻亲中有认识我的人的，强行让我前往诊治。其脉象如水上浮麻，不分至数，按之即无，惟两尺部犹似有根，言语不真，仿佛可辨，自说心中大渴，少饮水即疼不可忍，大概三天没吃东西了。先投以滋阴清燥汤，因为脉象极虚，且气息有将脱之意，又加野台参、净萸肉，一剂，诸病皆愈，可以进食。于是让其用一味薯蓣粥，送服生鸡内金细末及西药百布圣，取其既可作药，又可作饭也。又即前方加减，日服一剂，旬日全愈。
Treats the same syndrome as mentioned previously. The exterior pathogen has been resolved; the patient may not have loose stools, or may have accompanying panting, or accompanying cough, with frequent expectoration of phlegm and saliva. There is indeed an exterior-contracted excess heat, yet the pulse is very deficient and rapid.
If, in the aforementioned syndrome, after taking Ziyin Xuanjie Tang (Nourishing Yin and Dispersing Resolution Decoction), residual heat remains, this decoction may also be continued.
This formula is Ziyin Xuanjie Tang (Nourishing Yin and Dispersing Resolution Decoction), with Lianqiao (Forsythiae Fructus) and Chantui (Cicadae Periostracum) removed.
A woman, five months pregnant, accidentally contracted Shanghan (Cold Damage). Within three to four days, the fetus suddenly miscarried. She suffered from upper jiao dryness and thirst, panting and groaning, with excessive phlegm and saliva, frequently coughing and vomiting. After consulting a physician and taking medicine, the illness did not resolve, but was complicated by loose stools, occurring more than ten times a day and night. The physician declined treatment, stating that death was imminent. Her family, in panic, invited me to examine her. The pulse appeared surging and slippery, but upon heavy pressure, it felt hollow under the fingers, especially at the two Chi positions. I originally intended to treat her with Ziyin Qingzao Tang (Nourishing Yin and Clearing Dryness Decoction), but since the miscarriage had only occurred four or five days prior, I dared not abruptly use cold-natured herbs. Instead, I first used raw Shanyao (Dioscoreae Rhizoma) 2 liang and one sour pomegranate (Suan Shiliu), crushed together with the peel, decocted in water to obtain one large bowl of liquid, which was divided into three doses and taken warm. The loose stools gradually improved, but other symptoms remained unchanged. Upon re-examination, the surging and slippery force of the pulse became more substantial. I reasoned that although this case involved deficiency, there was indeed an exterior-contracted excess heat. If this excess heat were not resolved first, how could other symptoms heal? It was then 3:00 PM. The patient stated that she experienced tidal fever at this time every day, and said she was extremely exhausted spiritually, suffering from insomnia day and night. Therefore, on that day, I administered Ziyin Qingzao Tang (Nourishing Yin and Clearing Dryness Decoction) again. In the formula, raw Shanyao (Dioscoreae Rhizoma) was heavily dosed at 1.5 liang, decocted in water to obtain one large bowl, taken slowly and warm. Only one sip was taken at a time, primarily because postpartum pulses are often deficient, and I wished to avoid allowing cold-natured herbs to damage the lower jiao. That night, she slept peacefully. Thirst and loose stools healed; panting and coughing improved by half. Then, Shanyao (Dioscoreae Rhizoma) and Huashi (Talcum) were each reduced by 5 qian, and Longgu (Fossilia Ossis Mastodi) and Muli (Concha Ostreae) were each added at 8 qian. One dose resulted in complete recovery.
An unmarried girl had suffered from Shanghan (Cold Damage) for over twenty days. She was emaciated and frail, with confused spirit, fever after noon, cough, and panting. Physicians declined treatment. Her pulse was rapid, reaching seven beats per respiration, weak and nearly imperceptible. I considered that if this condition resulted from chronic illness, it would be incurable. However, upon investigation, it was a case of acute deficiency, and the root of vital energy should remain intact. I reluctantly prescribed Ziyin Qingzao Tang (Nourishing Yin and Clearing Dryness Decoction), reducing Huashi (Talcum) by half, and adding Xuanshen (Scrophulariae Radix) and Shudihuang (Rehmanniae Radix Preparata) at 1 liang each, and Yetaishen (Codonopsis Radix) at 5 qian. Decocted in water to make one large bowl, it was taken slowly and warm. The dregs were decocted again for subsequent drinking, ensuring continuous medicinal effect day and night. Within two days, three doses were taken consecutively. Huashi (Talcum) was gradually reduced to 2 qian, and the illness was completely cured.
Note: The reason Huashi (Talcum) was never removed throughout this case is the fear that residual pathogens might remain after Shanghan (Cold Damage). Additionally, to prevent tonifying herbs from retaining pathogens, Huashi (Talcum) was used to guide them downward, providing an exit route. Furthermore, when decocting large doses of medicine, it is necessary to produce several cups of liquid and administer it slowly. This approach is suitable for treating critical conditions, especially those involving yin deficiency in critical cases.
The mother of Ji XX, nearly seventy years old, was emaciated and unable to digest grain food, consuming only cow's milk or occasionally a small amount of rice soup. She had been bedridden for two years, unable to sit up. In late autumn of the Wuwu year, she contracted Wenbing (Warm Disease). At that time, I had just arrived in Fengtian and was invited from Jinzhou to examine her. Her pulse was very fine and rapid, feeling slightly strong upon pressure. She had fever, cough, thick sticky sputum, confused spirit, and faint breath. I prescribed Ziyin Qingzao Tang (Nourishing Yin and Clearing Dryness Decoction), reducing Huashi (Talcum) by half and adding Xuanshen (Scrophulariae Radix) at 5 qian. One dose reduced the illness severity by more than half. I then decocted the dregs to extract one teacup of clear liquid, mixed with one raw chicken egg yolk (Sheng Jizi Huang). Administration led to full recovery.
A four-year-old child in Fengtian contracted Wenbing (Warm Disease). The pathogen was still in the exterior. The physician failed to clear and resolve the pathogen, instead hastily administering bitter-cold agents. After ingestion, loose stools persisted for four to five days without stopping. Upper jiao dryness-heat caused closed-eye panting and confused spirit. Upon my consultation, although the condition was dangerous, the pulse still had a root, indicating recoverability. I instructed the use of the original Ziyin Qingzao Tang (Nourishing Yin and Clearing Dryness Decoction), decocted into one large teacup of liquid. Due to the child's young age, it was administered slowly and warm. Completion of one dose resulted in recovery. However, prolonged diarrhea had depleted yin, leaving residual deficiency heat. Subsequently, raw Shanyao (Dioscoreae Rhizoma) and Xuanshen (Scrophulariae Radix) at 1 liang each were used to clear the heat. Two doses eliminated all heat. Generally, when physicians encounter such syndromes, clearing dryness-heat exacerbates loose stools, while treating loose stools exacerbates dryness-heat. Only this formula uses Shanyao (Dioscoreae Rhizoma) to stop loose stools, while Shanyao (Dioscoreae Rhizoma) truly nourishes yin and reduces fever; it uses Huashi (Talcum) to clear dryness-heat, while Huashi (Talcum) truly promotes urination and stops diarrhea. The functions of these two herbs complement each other. Additionally, Shaoyao (Paeoniae Radix Alba) nourishes blood and promotes urination, and Gancao (Glycyrrhizae Radix et Rhizoma) harmonizes yin and yang and regulates the middle jiao; both are important herbs for clearing heat and stopping diarrhea. Assembled into this formula, its efficacy is extraordinary. I have used this formula to save many people; even in critical conditions, it can achieve results.
Liu XX from Fengtian, aged twenty-five or twenty-six, contracted Shanghan (Cold Damage) in late winter. Mismanagement by previous physicians led to uncontrolled loose stools, upper jiao irritability and heat, confused spirit, occasional delirium, a surging and rapid pulse that was powerless upon deep pressure. I heavily prescribed raw Shanyao (Dioscoreae Rhizoma) 1.5 liang, Huashi (Talcum) 1 liang, raw Hangu Shao Yao (Paeoniae Radix Alba) 6 qian, and Gancao (Glycyrrhizae Radix et Rhizoma) 3 qian. One dose stopped the diarrhea. Upper jiao irritability and heat persisted, along with delirium. Thus, cool-moistening herbs like Xuanshen (Scrophulariae Radix) and Shashen (Glehniae Radix) were used to clear heat, but loose stools recurred. Re-administering the previous formula stopped the diarrhea again, but upper jiao irritability and heat worsened, spirit became more confused, and consciousness was lost. At this point, his family gathered, believing the case was incurable. Although the pulse was not excess, it still had a root; although rapid, it was only six beats per respiration. Knowing it was still treatable, I earnestly told his family, "If you faithfully take my medicine, this illness can still be treated." They seemed to understand. I prescribed a large dose of Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng), substituting raw Shanyao (Dioscoreae Rhizoma) 1 liang for Jingmi (Oryzae Semen Germineatum), and raw Dihuang (Rehmanniae Radix) 1 liang for Zhimu (Anemarrhenae Rhizoma). Decocted in water to make one large bowl, I instructed that the medicine must be drunk hot, one sip at a time, completed within six hours. Completion of the dose resulted in recovery.
A four-year-old boy from Qianshi, Jintan, presented with burning heat and loose stools. He was cured using a heavy dose of Ziyin Qingzao Tang (Nourishing Yin and Clearing Dryness Decoction).
Appendix:
Letter from Yang XX of Tieling, Fengtian:
Treating distension syndrome in a woman surnamed Li. Previously, another physician used acrid-drying dispersing and breaking agents such as Cangzhu (Atractylodis Rhizoma), Binglang (Arecae Semen), Houpo (Magnoliae Officinalis Cortex), Zhishi (Aurantii Fructus Immaturus), Xiangfu (Cyperi Rhizoma), and Zike (Myristicae Semen). Initially, relief was felt, but after seven or eight doses, the condition worsened significantly, accompanied by irritability, thirst, and diarrhea. Another physician administered Zipu Hupo Wan (Purple Magnolia and Amber Pill), causing severe irritability and thirst, with fifteen to sixteen episodes of diarrhea per day and night. Upon re-examination, the physician declined treatment. Several other physicians were consulted, all declaring it incurable. Eventually, she lay dying, moved to bed twice, awaiting death. A relative who knew me strongly urged me to visit. Her pulse resembled floating hemp seeds on water, indistinguishable in rate, disappearing upon pressure, except at the two Chi positions where a root seemed present. Speech was incoherent but barely discernible. She claimed extreme internal thirst, stating that drinking even a little water caused unbearable pain. She had not eaten for three days. I first prescribed Ziyin Qingzao Tang (Nourishing Yin and Clearing Dryness Decoction). Given the extremely deficient pulse and signs of qi collapse, I added Yetaishen (Codonopsis Radix) and Jing Yurou (Corni Fructus). One dose cured all illnesses, allowing her to eat. I then advised a diet of single-herb Shanyao (Dioscoreae Rhizoma) porridge, taken with finely ground raw Jineijin (Galli Gigerii Endothelium Corneum) and the Western medicine Pepzin (Bismuth Subgallate), as it served as both medicine and food. Adjustments to the previous formula were taken once daily. Full recovery was achieved within ten days.