其人肾阳有余，好行淫欲，不避寒冷，尔时虽外伤于寒，而阳气足御，但知身着寒，而不为寒所病。然表寒
虽不得内侵，而虚阳亦不得外散，乃下陷入阴中，故身不知热，而亦不发热，所云阳病者，上行极而下也。冬
时收藏之令，阳不遽发，寒愈久而阳愈匿，阳日盛而阴愈虚。若寒日少而蓄热浅，则阳火应春气而病温；寒
日多而郁热深，则阳火应夏气而病暑。此阴消阳炽，从内而达于外也。《内经》之论脉证治法甚详，学人多
不得其要领，仲景独挈发热而渴不恶寒为提纲，洞悉温病之底蕴，证治散见六经。如伤寒发热，不渴，服汤已。
渴者，是伤寒、温病之关。寒去而热罢，即伤寒欲解证；寒去而热不解，是温病发见矣。如服桂枝汤大汗出后，
大烦渴不解，脉洪大者，即是温势猖獗，用白虎加人参，预保元气于清火之时，是凡病伤寒而成温者之正法也。
如服柴胡汤已，渴者，属阳明也，以法治之。夫柴胡汤有参、甘、姜、枣，皆生津之品，服已反渴，是微寒之
剂不足以解温邪，少阳相火直走阳明也，是当用白虎加人参法。若柴胡加人参法，非其治矣。且温邪有浅深，
治法有轻重。如阳明病脉浮发热，渴欲饮水，小便不利者，猪苓汤主之；瘀热在里，不得越，身体发黄，渴欲
饮水，小便不利者，茵陈蒿汤主之。少阴病，得之二三日，口燥咽干者，大承气汤急下之。厥阴病，下利欲饮
水者，白头翁汤主之。此仲景治温之大略也。夫温与暑，偶感天气而病者轻，因不藏精者其病重，此为自伤。
若再感风土之异气，此三气相合而成温疫也。（柯韵伯）
《内经》冬不藏精，春必病温一语，是指天时，非指人事也。试观天明则日月不明，邪害空窍之句，意
可见矣。夫一日之中，昼明而夜晦者，即藏精也；一岁之中，春生而冬藏者，亦藏精也。使人夜不晦，入冬不
藏，人物能无夭札疵 乎？且冬伤于
寒，至春而病温者少；冬不藏精，至春而病温者多。盖寒乃冬令之正气，人知畏避，故病少；若冬阳开泄，天
暖而雷，乃为淫气，人鲜忌惮，故病多。管窥如此，未识然否？（方星岩）
《经》曰∶冬伤于寒，春必温病。《云笈七签》中改作冬伤于汗。甚妙！盖言冬时过暖以致汗出，则来
年必病温。余细体验之，良然。冬日严寒，来春并无温疫，以其应春而寒，得时令之正故耳。且人伤于寒，岂
能稽留在身，俟周年而后病耶？（刘松峰）
脉候
热病已，得汗而脉尚躁盛，此阴脉之极也，死；其得汗而脉静者，生。热病脉尚躁盛，而不得汗者，此
阳脉之极也，死；脉躁盛，得汗静者，生。（《灵枢》）
温病之脉，行在诸经，不知何经之动也？各随其经所在而取之。（《难经》）
温热怫郁，自内达外，非如伤寒从表而始。不悟此理，乃于温热病而求浮紧之脉，不亦疏乎？○寒病传
经，故脉日变；温热不传经，故脉不变。寒病脉浮洪有力者易治，芤细无力者难治，无脉者不治。温热则不然，
温有一二部无脉者，暑热有三四部无脉者，被火所逼而藏伏耳，于病无妨。（周禹载）
选案
张子春夏月途行受热，延医服药二十余日，水浆不入，大便不通，唇焦舌黑，骨立皮干，目合肢冷，诊
脉模糊。此因邪热熏灼，津血已枯，形肉已脱，亡可立待。贫士既无力服参，若仅以草木根皮滋养气血，何能
速生？索我枯鱼矣。《经》云∶精不足者，补之以味。古人猪肤汤、羊肉汤，可法也。属市猪肉四两，粳米三
合，煮候融化，滤汁一碗，又取梨汁一杯，蜜半杯，与米肉汁相间。一昼夜呷尽，目微开，手足微动，喉间微
作呻吟。次日，其伴求立方。予曰∶此便是方，既效矣，可再行之。即此养其胃气，以生津液；濡其燥火，以
回阴血，勿他求也。如是者三
日，唇舌转润，退去黑壳一层，始开目能言，是夜便下燥屎，脉稍应指。再与六味汤加减，匝月而愈。夫医者
意也，《经》云食肉则复，又云谷肉果菜，食养尽之，医贵变通，不胶于古，亦不离于古，乃可与言仁术。（汪赤崖）
附方
辛凉透表 治温热病邪从皮毛而入，初起发热，头昏，口燥，肢软，脉浮滑，舌淡微苔等证。苏梗、薄
荷、杏仁、桑叶、甘草、桔梗、橘红、黄卷、通草，夹暑湿加滑石、香薷；咽喉不利加牛蒡。○肺主皮毛，邪
从皮毛而入，故用苏、薄、杏、桑之辛以解表。病初起即口燥，此内有积热，故用甘、桔、橘、卷以和里。加
通草者，淡泻通利，使郁热从小便而出，亦轻清分消之法耳。○肺为娇脏，部位最高，受戕最先，宜味淡轻扬，
少佐微辛，正合《经》言肺欲辛之旨。此在上者治其上之法也。若羌、防等药，乃发散太阳风寒表邪，与此何
关？《温热篇》云∶误用辛温表散，是为重虚其表，灼劫津液；若加火熏，为再逆促命期矣。
芳香解秽 治温热病邪从口鼻而入，初起发热头昏，口燥肢软，呕恶胸满，脉浮滑，舌微白苔而兼淡黄
等证，淡豉、苏梗、藿香、薄荷、郁金、橘红、甘草、桔梗、通草，引加鲜姜汁。○兼暑湿加滑石、香薷；咽喉
不利加牛蒡。○大肠与肺为表里，同开窍于鼻；胃与脾为表里，同开窍于口。秽浊传染，口鼻吸受，故用芳香
轻淡以开泄之。○前方用辛凉，此方用芳香，皆汗法也。但此汗由于内清凉而气和畅，则阴汁未伤，元府开而
汗自溢出矣。若辛温强汗，非徒无益，而又害之。○伤寒用姜则煎之，取其能散表寒也；温热则用姜汁，惟取
其去秽恶，不欲其走表也。虽同一用姜，而其法则异。
清里保津 治温热病邪伤卫而将伤营，壮热头眩，口渴心烦，脉滑数，舌苔黄白等证，葛根、薄荷、连
翘、花粉、黄卷、牛蒡、桔梗、橘红、通草，引加淡竹叶、竹茹。○无汗加紫苏、淡
豉；兼暑湿加滑石、绿豆皮；呕恶加芦根、姜汁。○口渴心烦，舌黄脉数，热势入里，肺津胃汁受灼矣。然犹
未至于伤营，故仍从气厘清散之，而加滋润之品，以充其化源。
分泻三焦 治温热病邪漫延三焦气分，时热时退，头眩耳鸣，目 痛连耳后，烦渴胸满，脉弦数，舌苔黄
白而干等证，桑叶、薄荷、橘红、花粉、枳壳、郁金、蒌皮、连翘、茯苓、猪苓，引加淡竹叶。○无汗加苏
梗、香豉；呕恶加半夏、姜汁；兼暑湿加滑石、绿豆皮。○伤寒足少阳胆证也，治宜和解表里；温热手少阳三
焦证也，治宜分消上下。治足少阳，禁吐、汗、下，亦禁利小便者，以胆无出路，惟有和之一法耳。此则三焦
气分阻闭，宜以泻为主，桑、薄、橘、竹、花粉，泻上焦也；枳、郁、蒌、连，泻中焦也；二苓，泻下焦也。
三焦分消，则邪无地容矣。
泄卫透营 治温热邪已伤营，壮热烦渴，筋骨酸痛，寝不能寐，脉洪数，舌绛苔黄而燥等证，连翘、花粉、
知母、黄芩、黑栀、白薇、丹皮、赤芍、郁金、橘皮、银花，引加梨汁、蔗浆。○呕恶加芦根；昏愦加犀角、
菖蒲；口苦耳聋加柴胡，转疟亦加之。○表邪入里，自肺系渐干包络，已伤营矣。身痛者，热逼筋骨，津液受
伤也，慎勿认作表邪而投散剂。是方也，治以清凉，冀其转气透表，俾邪从汗泄，犹可战汗而解。方内用郁、
橘、银花者，以其热熏膻中，浊蒙清窍，乃凉膈中兼芳香开泄法也。
凉膈泻心 治温热邪入心包，热渴，昏谵狂乱，或舌短语涩，口鼻失血，或昏愦而不知渴，脉洪疾促，舌
紫苔黄，或有断纹芒刺等证，黄芩、黄连、生地、丹皮、石膏、知母、元参、黑栀、羚角、木通、金汁，引加
竹叶心。○虚者加人参；口鼻失血，加犀角，重者加大青；内陷络闭，痉厥螈 ，加至宝丹。○热人心包，清窍
闭锢，火旺则水衰，故用苦寒之味，泻阳救阴也。
涤腑解毒 治温热邪入胃腑，热渴，腹满便秘，或发狂斑黄，肢厥，脉洪疾有力，舌焦或有断纹芒刺等证，
黄芩、黄连、黄柏、
石膏、黑栀、木通、大黄、金汁（如无，用人中黄代），痞胀加槟榔；发狂加吞苦参丸；发斑失血加生地、犀
角、桃仁；发黄加茵陈。○胃属土，汗出热甚液干，故便秘；水不制火，故狂乱；热郁于中，而溢于表，故发黄；
热蕴胃腑，透入营中，故发斑。不急下之，则阴水涸矣。病势未急，不可轻投；病势已急，切勿姑息。
以上七方，治邪自外入浅深之法。因证用方，随机应变，非以日数拘次第也。
表里双解 治温热邪自内出，初起寒战发热，头痛昏眩，烦渴痞满，脉实数，舌黄或白如积粉边绛等证，
苏叶、杏仁、薄荷、香豉、连翘、花粉、甘草、橘皮、桔梗、猪苓、通草，呕恶加姜汁；兼暑湿加滑石、绿豆、
香薷；咽喉不利加牛蒡。○邪伏膜原，久化为热，因感而发，外达肌肤，其来也暴。是方苏、薄、杏、豉以解表；
连翘、花粉以清里；甘、桔、橘皮以调中；猪苓、通草以分利。内外蕴伏，自此廓清。若误用辛温，发汗劫津，
益助火邪，贻患匪轻。○或曰∶初起寒战，非感寒邪，何以若是？不知此之恶寒，由火郁于内，热甚生风，冲
突元气，所以凛凛恶寒如疟之战栗，非真寒也。人每因此心疑，先投温散，岂知以风扇火，更助炎威，不能愈
疾，反益疾矣。
清腑润燥 治温热病邪从膜原入胃，壮热头眩，烦渴痞满，喜冷恶热，脉滑数，舌苔黄燥等证，黄芩、
知母、连翘、花粉、黑栀、赤芍、犀角、枳壳、香豉、郁金，引加梨汁、蔗浆。○呕恶加芦根、姜汁；大渴加
石膏；兼暑湿加益元散、绿豆皮；神愦加白薇、银花、菖蒲。○邪由膜原入胃，胃有上下两口，虚而善受，邪入
最易。邪入尚未结实，不宜骤攻，故用清解之法，以照顾津液，冀其战汗透表。热蕴则气郁，少加辛香以开泄之。
泻阳救阴 治温热病邪入腑结实，热渴痞满，便秘狂妄，或斑黄肢厥，脉洪疾有力，舌黑芒刺等证，黄
芩、黄连、黄柏、石
膏、大黄、枳壳、浓朴、黑栀、木通、犀角、金汁（如无，用人中黄代），大便燥结加元明粉；狂乱兼吞苦参
丸；发斑失血加生地、桃仁；内陷昏闭螈 加至宝丹。○热甚液枯，故口渴便秘；热结于中，故神昏脉疾；阳
盛而阴失位，故四肢厥冷。斯时不攻，是犹养虎贻患矣。此方与前涤腑解毒同意，攻之余邪未尽者，延之一日，
又复攻之，则邪荡涤净矣。或有证固当攻，奈元神将惫，欲攻不可者，须重加人参以驾驭之，亦冀挽于万一，
不可坐视待毙也。
以上三方，治邪自内出之法也。自外入者渐，自内出者暴，故治法不同。
和阴清燥 治温热下后，病仍未衰，壮热神昏，烦渴脉急，舌焦等证，生地、元参、洋参、知母、麦冬、
连翘、黄芩、芍药、黑栀、甘草、寒水石，引加桂圆、大枣。○热甚昏乱，鼻煤，加川连、犀角、黄柏。○温
热病久，表里皆热，不分脏腑经络矣。下后正气渐亏，阴水几涸。是方也，生地、元参清心肾之火；黄芩、芍
药清肝胆之火；寒水、知母清脾胃之火；麦冬、连翘清肺肠之火；更加栀子泻三焦之火，使之曲折下行；草、
枣、参、圆和中扶正。此泻热润燥之通剂也。不论病从外入，与自内出，下后延缠不解者，通用此方治之。
苦泄宣通 治温热邪并中焦，胸膈痞满，懊 干恶，脉沉实数，舌苔黄浊等证，浓朴、枳壳、橘皮、半
夏、蒌仁、连翘、黄芩、郁金、茯苓、甘草，引加芦根、姜汁。○燥热加黄连；烦渴加花粉、知母；腹胀加大
黄、槟榔；噎逆加柿蒂、刀豆子。○浊秽之气，自上而下，漫处三焦。此则并陷中脘，气阻不宣，故痞满懊 。
是方也，合小陷胸、半夏泻心二法，所以开其郁结而泻其热也。○治伤寒，必燥结便秘方可任攻；治温热则不
然。凡中有湿邪，便必不结，故但见痞满腹胀，即当下之，勿拘燥粪。何也？盖下其热，非攻其结也。
清中固脱 治温热邪迫下利，烦躁不安，垢秽无度，甚见脓血，脉沉数，舌苔焦黄等证，黄连、阿胶、黄
芩、黄柏、黑栀、人参、茯苓、白芍、甘草，引加大枣、莲子。○久利脓血，加白头翁、地榆、乌梅，甚者加
余粮、石脂。○病在下焦，热迫大肠，《经》云暴注下迫者是矣。利甚不止，元神欲惫，故用寒以清热，补以保
元，涩以固脱，此救急之法也。
扶胃透汗 治温热病体虚不能战汗，形倦脉濡等证，人参（多寡酌用，另炖冲药服）。元气素弱之人，而
患温热之候，邪欲外出，气从中馁，不能外达，故藉人参大力以助之，则邪气一涌而出矣。前人参苏饮、败毒
散，此表汗剂中用参也；小柴胡汤、人参白虎汤、竹叶石膏汤，是和解剂中用参也；黄龙汤，是下剂中用参也。
人参之功，无往不利，世人不知其妙，疑而不用，或用之不早，诚可惜也。喻嘉言《寓意草》言之甚详，医者
宜究心焉。
养阴扶正 治温热病久正虚，余邪未清，或病愈而神犹昏，神清而热不退，虚烦盗汗，脉数无力，舌浊
未净等证，地黄、阿胶、人参、麦冬、五味、当归、白芍、玉竹、茯神、丹皮、女贞，引加竹心叶、鸡子黄。
【背景信息】
书名：医述 作者：程杏轩 朝代：元 章节：温热(3/4) 类别：医论
【待处理原文】
其人肾阳有余，好行淫欲，不避寒冷，尔时虽外伤于寒，而阳气足御，但知身着寒，而不为寒所病。然表寒虽不得内侵，而虚阳亦不得外散，乃下陷入阴中，故身不知热，而亦不发热，所云阳病者，上行极而下也。冬时收藏之令，阳不遽发，寒愈久而阳愈匿，阳日盛而阴愈虚。若寒日少而蓄热浅，则阳火应春气而病温；寒日多而郁热深，则阳火应夏气而病暑。此阴消阳炽，从内而达于外也。《内经》之论脉证治法甚详，学人多不得其要领，仲景独挈发热而渴不恶寒为提纲，洞悉温病之底蕴，证治散见六经。如伤寒发热，不渴，服汤已。渴者，是伤寒、温病之关。寒去而热罢，即伤寒欲解证；寒去而热不解，是温病发见矣。如服桂枝汤大汗出后，大烦渴不解，脉洪大者，即是温势猖獗，用白虎加人参，预保元气于清火之时，是凡病伤寒而成温者之正法也。如服柴胡汤已，渴者，属阳明也，以法治之。夫柴胡汤有参、甘、姜、枣，皆生津之品，服已反渴，是微寒之剂不足以解温邪，少阳相火直走阳明也，是当用白虎加人参法。若柴胡加人参法，非其治矣。且温邪有浅深，治法有轻重。如阳明病脉浮发热，渴欲饮水，小便不利者，猪苓汤主之；瘀热在里，不得越，身体发黄，渴欲饮水，小便不利者，茵陈蒿汤主之。少阴病，得之二三日，口燥咽干者，大承气汤急下之。厥阴病，下利欲饮水者，白头翁汤主之。此仲景治温之大略也。夫温与暑，偶感天气而病者轻，因不藏精者其病重，此为自伤。若再感风土之异气，此三气相合而成温疫也。（柯韵伯）
《内经》冬不藏精，春必病温一语，是指天时，非指人事也。试观天明则日月不明，邪害空窍之句，意可见矣。夫一日之中，昼明而夜晦者，即藏精也；一岁之中，春生而冬藏者，亦藏精也。使人夜不晦，入冬不藏，人物能无夭札疵乎？且冬伤于寒，至春而病温者少；冬不藏精，至春而病温者多。盖寒乃冬令之正气，人知畏避，故病少；若冬阳开泄，天暖而雷，乃为淫气，人鲜忌惮，故病多。管窥如此，未识然否？（方星岩）
《经》曰∶冬伤于寒，春必温病。《云笈七签》中改作冬伤于汗。甚妙！盖言冬时过暖以致汗出，则来年必病温。余细体验之，良然。冬日严寒，来春并无温疫，以其应春而寒，得时令之正故耳。且人伤于寒，岂能稽留在身，俟周年而后病耶？（刘松峰）
脉候
热病已，得汗而脉尚躁盛，此阴脉之极也，死；其得汗而脉静者，生。热病脉尚躁盛，而不得汗者，此阳脉之极也，死；脉躁盛，得汗静者，生。（《灵枢》）
温病之脉，行在诸经，不知何经之动也？各随其经所在而取之。（《难经》）
温热怫郁，自内达外，非如伤寒从表而始。不悟此理，乃于温热病而求浮紧之脉，不亦疏乎？○寒病传经，故脉日变；温热不传经，故脉不变。寒病脉浮洪有力者易治，芤细无力者难治，无脉者不治。温热则不然，温有一二部无脉者，暑热有三四部无脉者，被火所逼而藏伏耳，于病无妨。（周禹载）
选案
张子春夏月途行受热，延医服药二十余日，水浆不入，大便不通，唇焦舌黑，骨立皮干，目合肢冷，诊脉模糊。此因邪热熏灼，津血已枯，形肉已脱，亡可立待。贫士既无力服参，若仅以草木根皮滋养气血，何能速生？索我枯鱼矣。《经》云∶精不足者，补之以味。古人猪肤汤、羊肉汤，可法也。属市猪肉四两，粳米三合，煮候融化，滤汁一碗，又取梨汁一杯，蜜半杯，与米肉汁相间。一昼夜呷尽，目微开，手足微动，喉间微作呻吟。次日，其伴求立方。予曰∶此便是方，既效矣，可再行之。即此养其胃气，以生津液；濡其燥火，以回阴血，勿他求也。如是者三日，唇舌转润，退去黑壳一层，始开目能言，是夜便下燥屎，脉稍应指。再与六味汤加减，匝月而愈。夫医者意也，《经》云食肉则复，又云谷肉果菜，食养尽之，医贵变通，不胶于古，亦不离于古，乃可与言仁术。（汪赤崖）
附方
辛凉透表 治温热病邪从皮毛而入，初起发热，头昏，口燥，肢软，脉浮滑，舌淡微苔等证。苏梗、薄荷、杏仁、桑叶、甘草、桔梗、橘红、黄卷、通草，夹暑湿加滑石、香薷；咽喉不利加牛蒡。○肺主皮毛，邪从皮毛而入，故用苏、薄、杏、桑之辛以解表。病初起即口燥，此内有积热，故用甘、桔、橘、卷以和里。加通草者，淡泻通利，使郁热从小便而出，亦轻清分消之法耳。○肺为娇脏，部位最高，受戕最先，宜味淡轻扬，少佐微辛，正合《经》言肺欲辛之旨。此在上者治其上之法也。若羌、防等药，乃发散太阳风寒表邪，与此何关？《温热篇》云∶误用辛温表散，是为重虚其表，灼劫津液；若加火熏，为再逆促命期矣。
芳香解秽 治温热病邪从口鼻而入，初起发热头昏，口燥肢软，呕恶胸满，脉浮滑，舌微白苔而兼淡黄等证，淡豉、苏梗、藿香、薄荷、郁金、橘红、甘草、桔梗、通草，引加鲜姜汁。○兼暑湿加滑石、香薷；咽喉不利加牛蒡。○大肠与肺为表里，同开窍于鼻；胃与脾为表里，同开窍于口。秽浊传染，口鼻吸受，故用芳香轻淡以开泄之。○前方用辛凉，此方用芳香，皆汗法也。但此汗由于内清凉而气和畅，则阴汁未伤，元府开而汗自溢出矣。若辛温强汗，非徒无益，而又害之。○伤寒用姜则煎之，取其能散表寒也；温热则用姜汁，惟取其去秽恶，不欲其走表也。虽同一用姜，而其法则异。
清里保津 治温热病邪伤卫而将伤营，壮热头眩，口渴心烦，脉滑数，舌苔黄白等证，葛根、薄荷、连翘、花粉、黄卷、牛蒡、桔梗、橘红、通草，引加淡竹叶、竹茹。○无汗加紫苏、淡豉；兼暑湿加滑石、绿豆皮；呕恶加芦根、姜汁。○口渴心烦，舌黄脉数，热势入里，肺津胃汁受灼矣。然犹未至于伤营，故仍从气厘清散之，而加滋润之品，以充其化源。
分泻三焦 治温热病邪漫延三焦气分，时热时退，头眩耳鸣，目痛连耳后，烦渴胸满，脉弦数，舌苔黄白而干等证，桑叶、薄荷、橘红、花粉、枳壳、郁金、蒌皮、连翘、茯苓、猪苓，引加淡竹叶。○无汗加苏梗、香豉；呕恶加半夏、姜汁；兼暑湿加滑石、绿豆皮。○伤寒足少阳胆证也，治宜和解表里；温热手少阳三焦证也，治宜分消上下。治足少阳，禁吐、汗、下，亦禁利小便者，以胆无出路，惟有和之一法耳。此则三焦气分阻闭，宜以泻为主，桑、薄、橘、竹、花粉，泻上焦也；枳、郁、蒌、连，泻中焦也；二苓，泻下焦也。三焦分消，则邪无地容矣。
泄卫透营 治温热邪已伤营，壮热烦渴，筋骨酸痛，寝不能寐，脉洪数，舌绛苔黄而燥等证，连翘、花粉、知母、黄芩、黑栀、白薇、丹皮、赤芍、郁金、橘皮、银花，引加梨汁、蔗浆。○呕恶加芦根；昏愦加犀角、菖蒲；口苦耳聋加柴胡，转疟亦加之。○表邪入里，自肺系渐干包络，已伤营矣。身痛者，热逼筋骨，津液受伤也，慎勿认作表邪而投散剂。是方也，治以清凉，冀其转气透表，俾邪从汗泄，犹可战汗而解。方内用郁、橘、银花者，以其热熏膻中，浊蒙清窍，乃凉膈中兼芳香开泄法也。
凉膈泻心 治温热邪入心包，热渴，昏谵狂乱，或舌短语涩，口鼻失血，或昏愦而不知渴，脉洪疾促，舌紫苔黄，或有断纹芒刺等证，黄芩、黄连、生地、丹皮、石膏、知母、元参、黑栀、羚角、木通、金汁，引加竹叶心。○虚者加人参；口鼻失血，加犀角，重者加大青；内陷络闭，痉厥螈 ，加至宝丹。○热人心包，清窍闭锢，火旺则水衰，故用苦寒之味，泻阳救阴也。
涤腑解毒 治温热邪入胃腑，热渴，腹满便秘，或发狂斑黄，肢厥，脉洪疾有力，舌焦或有断纹芒刺等证，黄芩、黄连、黄柏、石膏、黑栀、木通、大黄、金汁（如无，用人中黄代），痞胀加槟榔；发狂加吞苦参丸；发斑失血加生地、犀角、桃仁；发黄加茵陈。○胃属土，汗出热甚液干，故便秘；水不制火，故狂乱；热郁于中，而溢于表，故发黄；热蕴胃腑，透入营中，故发斑。不急下之，则阴水涸矣。病势未急，不可轻投；病势已急，切勿姑息。
以上七方，治邪自外入浅深之法。因证用方，随机应变，非以日数拘次第也。
表里双解 治温热邪自内出，初起寒战发热，头痛昏眩，烦渴痞满，脉实数，舌黄或白如积粉边绛等证，苏叶、杏仁、薄荷、香豉、连翘、花粉、甘草、橘皮、桔梗、猪苓、通草，呕恶加姜汁；兼暑湿加滑石、绿豆、香薷；咽喉不利加牛蒡。○邪伏膜原，久化为热，因感而发，外达肌肤，其来也暴。是方苏、薄、杏、豉以解表；连翘、花粉以清里；甘、桔、橘皮以调中；猪苓、通草以分利。内外蕴伏，自此廓清。若误用辛温，发汗劫津，益助火邪，贻患匪轻。○或曰∶初起寒战，非感寒邪，何以若是？不知此之恶寒，由火郁于内，热甚生风，冲突元气，所以凛凛恶寒如疟之战栗，非真寒也。人每因此心疑，先投温散，岂知以风扇火，更助炎威，不能愈疾，反益疾矣。
清腑润燥 治温热病邪从膜原入胃，壮热头眩，烦渴痞满，喜冷恶热，脉滑数，舌苔黄燥等证，黄芩、知母、连翘、花粉、黑栀、赤芍、犀角、枳壳、香豉、郁金，引加梨汁、蔗浆。○呕恶加芦根、姜汁；大渴加石膏；兼暑湿加益元散、绿豆皮；神愦加白薇、银花、菖蒲。○邪由膜原入胃，胃有上下两口，虚而善受，邪入最易。邪入尚未结实，不宜骤攻，故用清解之法，以照顾津液，冀其战汗透表。热蕴则气郁，少加辛香以开泄之。
泻阳救阴 治温热病邪入腑结实，热渴痞满，便秘狂妄，或斑黄肢厥，脉洪疾有力，舌黑芒刺等证，黄芩、黄连、黄柏、石膏、大黄、枳壳、浓朴、黑栀、木通、犀角、金汁（如无，用人中黄代），大便燥结加元明粉；狂乱兼吞苦参丸；发斑失血加生地、桃仁；内陷昏闭螈 加至宝丹。○热甚液枯，故口渴便秘；热结于中，故神昏脉疾；阳盛而阴失位，故四肢厥冷。斯时不攻，是犹养虎贻患矣。此方与前涤腑解毒同意，攻之余邪未尽者，延之一日，又复攻之，则邪荡涤净矣。或有证固当攻，奈元神将惫，欲攻不可者，须重加人参以驾驭之，亦冀挽于万一，不可坐视待毙也。
以上三方，治邪自内出之法也。自外入者渐，自内出者暴，故治法不同。
和阴清燥 治温热下后，病仍未衰，壮热神昏，烦渴脉急，舌焦等证，生地、元参、洋参、知母、麦冬、连翘、黄芩、芍药、黑栀、甘草、寒水石，引加桂圆、大枣。○热甚昏乱，鼻煤，加川连、犀角、黄柏。○温热病久，表里皆热，不分脏腑经络矣。下后正气渐亏，阴水几涸。是方也，生地、元参清心肾之火；黄芩、芍药清肝胆之火；寒水、知母清脾胃之火；麦冬、连翘清肺肠之火；更加栀子泻三焦之火，使之曲折下行；草、枣、参、圆和中扶正。此泻热润燥之通剂也。不论病从外入，与自内出，下后延缠不解者，通用此方治之。
苦泄宣通 治温热邪并中焦，胸膈痞满，懊 干恶，脉沉实数，舌苔黄浊等证，浓朴、枳壳、橘皮、半夏、蒌仁、连翘、黄芩、郁金、茯苓、甘草，引加芦根、姜汁。○燥热加黄连；烦渴加花粉、知母；腹胀加大黄、槟榔；噎逆加柿蒂、刀豆子。○浊秽之气，自上而下，漫处三焦。此则并陷中脘，气阻不宣，故痞满懊 。是方也，合小陷胸、半夏泻心二法，所以开其郁结而泻其热也。○治伤寒，必燥结便秘方可任攻；治温热则不然。凡中有湿邪，便必不结，故但见痞满腹胀，即当下之，勿拘燥粪。何也？盖下其热，非攻其结也。
清腑固脱 治温热邪迫下利，烦躁不安，垢秽无度，甚见脓血，脉沉数，舌苔焦黄等证，黄连、阿胶、黄芩、黄柏、黑栀、人参、茯苓、白芍、甘草，引加大枣、莲子。○久利脓血，加白头翁、地榆、乌梅，甚者加余粮、石脂。○病在下焦，热迫大肠，《经》云暴注下迫者是矣。利甚不止，元神欲惫，故用寒以清热，补以保元，涩以固脱，此救急之法也。
扶胃透汗 治温热病体虚不能战汗，形倦脉濡等证，人参（多寡酌用，另炖冲药服）。元气素弱之人，而患温热之候，邪欲外出，气从中馁，不能外达，故藉人参大力以助之，则邪气一涌而出矣。前人参苏饮、败毒散，此表汗剂中用参也；小柴胡汤、人参白虎汤、竹叶石膏汤，是和解剂中用参也；黄龙汤，是下剂中用参也。人参之功，无往不利，世人不知其妙，疑而不用，或用之不早，诚可惜也。喻嘉言《寓意草》言之甚详，医者宜究心焉。
养阴扶正 治温热病久正虚，余邪未清，或病愈而神犹昏，神清而热不退，虚烦盗汗，脉数无力，舌浊未净等证，地黄、阿胶、人参、麦冬、五味、当归、白芍、玉竹、茯神、丹皮、女贞，引加竹心叶、鸡子黄。
[Background Information]
Book: Yi Shu (Records of Medicine)
Author: Cheng Xingxuan
Dynasty: Yuan
Chapter: Warm-Heat (3/4)
Category: Medical Treatise
[Original Text Translation]
If a person has an excess of Kidney Yang, indulges in sexual desires, and does not avoid cold, although they may suffer external Cold invasion at that time, their sufficient Yang Qi can resist it. They will merely feel cold on the surface but will not be diseased by the Cold. However, since the exterior Cold cannot penetrate inward, the deficient Yang also cannot disperse outward; instead, it sinks downward into the Yin. Therefore, the body feels neither hot nor does it manifest fever. This is what is meant by "Yang diseases, when they reach their peak upward, descend downward." During winter, the natural tendency is storage and conservation; Yang does not suddenly emerge. The longer the Cold persists, the more hidden the Yang becomes; as Yang grows stronger day by day, Yin becomes increasingly deficient. If the days of Cold are few and the accumulated heat is shallow, the Yang Fire responds to the Spring Qi and results in Warm Disease (Wen Bing); if the days of Cold are many and the stagnant heat is deep, the Yang Fire responds to the Summer Qi and results in Summerheat Disease (Shu Bing). This represents Yin declining and Yang blazing, moving from the interior to the exterior. The *Nei Jing* (Inner Canon) discusses pulse signs, symptoms, and treatment methods in great detail, yet many students fail to grasp the essentials. Zhang Zhongjing alone took "fever with thirst and no aversion to cold" as the guiding principle, thoroughly understanding the underlying nature of Warm Diseases. The syndrome treatments are scattered across the Six Channels (Liu Jing). For example, in Cold Damage (Shang Han), there is fever without thirst. After taking decoctions, if thirst appears, this is the turning point between Cold Damage and Warm Disease. If the Cold leaves and the heat ceases, it is a sign that the Cold Damage is resolving; if the Cold leaves but the heat persists, it indicates the manifestation of a Warm Disease. For instance, after taking Guizhi Tang (Cinnamon Twig Decoction) and sweating profusely, if severe restlessness and unrelenting thirst occur with a flooding and large pulse, this indicates rampant Warm pathogenic factors. One should use Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction) to preserve the Primordial Qi while clearing the fire. This is the correct method for those who contract Cold Damage which transforms into Warm Disease. If after taking Chaihu Tang (Bupleurum Decoction) one becomes thirsty, it belongs to the Yangming channel; treat it according to the method. Chaihu Tang contains Renshen (Ginseng), Gancao (Licorice), Jiang (Ginger), and Zao (Jujube), all of which generate fluids. Becoming thirsty after taking it indicates that this mildly cold agent is insufficient to resolve the Warm pathogen; the Ministerial Fire of Shaoyang moves directly to Yangming. In this case, the method of Baihu Jia Renshen Tang should be used. The method of Chaihu Jia Renshen Tang is not appropriate here. Furthermore, Warm pathogens have depths of invasion, and treatment methods vary in intensity. For example, in Yangming disease, if the pulse is floating, there is fever, thirst with desire to drink water, and difficult urination, Zhuling Tang (Polyporus Decoction) is indicated. If stagnant heat is within, unable to vent, causing yellowing of the body, thirst with desire to drink, and difficult urination, Yinchenshao Tang (Artemisiae Scopariae Decoction) is indicated. In Shaoyin disease, if after two or three days there is dryness of the mouth and throat, Dachengqi Tang (Major Order the Qi Decoction) should be used urgently to purge. In Jueyin disease, if there is diarrhea with desire to drink water, Baitouweng Tang (Pulsatilla Decoction) is indicated. These are the general principles of Zhang Zhongjing in treating Warm Diseases. Regarding Warm and Summerheat diseases, contracting them due to weather conditions alone results in mild illness; however, illness resulting from failing to store Essence (Jing) is severe, constituting self-injury. If one is further exposed to different climatic influences of wind and locale, these three pathogens combine to form Warm Epidemic (Wen Yi). (Ke Yunbo)
The phrase in the *Nei Jing*, "If one fails to store Essence in winter, one will inevitably contract Warm Disease in spring," refers to celestial timing (natural climate), not human affairs. Consider the sentence, "When heaven is bright, the sun and moon lose their clarity, and evil harms the empty orifices"; the meaning can be seen here. Within a day, brightness during the day and darkness at night constitute storing Essence; within a year, growth in Spring and storage in Winter also constitute storing Essence. If people do not observe darkness at night and do not store Essence entering winter, can humans and things avoid premature death or defects? Moreover, fewer people contract Warm Disease in spring after suffering Cold in winter; more people contract Warm Disease in spring after failing to store Essence in winter. This is because Cold is the proper Qi of Winter; people know to fear and avoid it, so illness is rare. If Winter Yang opens and leaks, the weather is warm with thunder, this constitutes excessive Qi; people rarely fear it, so illness is common. Such is my limited insight; I wonder if it is correct? (Fang Xingyan)
The Classic says: "If one suffers Cold in winter, one will surely contract Warm Disease in spring." The *Yunji Qiqian* changes this to "If one suffers Sweat in winter." This is very clever! It implies that if it is too warm in winter causing sweating, one will surely contract Warm Disease the following year. I have experienced this carefully, and it is indeed true. When winter days are severely cold, there is no Warm Epidemic in the coming spring because the cold corresponds to Spring, adhering to the proper seasonal timing. Furthermore, how can Cold remaining in the body linger until a year later to cause disease? (Liu Songfeng)
Pulse Signs
After a Heat disease subsides, if sweat is obtained but the pulse remains rapid and vigorous, this is the extreme of Yin pulses, indicating death; if the pulse becomes calm after sweating, it indicates survival. If the pulse remains rapid and vigorous in a Heat disease and no sweat is obtained, this is the extreme of Yang pulses, indicating death; if the pulse becomes calm after sweating, it indicates survival. (*Ling Shu*)
The pulses of Warm Disease circulate through the various channels; it is unknown which channel is affected. One should locate the pulse according to the affected channel. (*Nan Jing*)
Warm-Heat stagnation arises from the interior and reaches the exterior, unlike Cold Damage which begins at the exterior. Failing to understand this principle, seeking a floating-tight pulse in Warm-Heat diseases is certainly negligent. ○ Cold diseases transmit through channels, so the pulse changes daily; Warm-Heat diseases do not transmit through channels, so the pulse remains unchanged. In Cold diseases, a floating, flooding, and forceful pulse is easy to treat; a hollow, fine, and weak pulse is difficult to treat; absence of pulse is untreatable. Warm-Heat is different. In Warm diseases, absence of pulse in one or two positions, or in Summerheat diseases, absence of pulse in three or four positions, is due to being forced inward by Fire and lying dormant; this does not hinder the disease. (Zhou Yucai)
Selected Case
Mr. Zhang was heated while traveling in spring and summer. He consulted a physician and took medicine for over twenty days. He could not take food or water, his bowels were blocked, his lips were scorched, his tongue black, his bones stood out, his skin was dry, his eyes were closed, his limbs were cold, and his pulse was indistinct. This was due to pathogenic Heat scorching, exhausting Body Fluids and Blood, wasting flesh and form; death could be expected immediately. As a poor scholar, he had no power to take Ginseng. If only herbal roots and barks were used to nourish Qi and Blood, how could life be quickly restored? You would be asking me for dried fish. The Classic says: "For deficiency of Essence, tonify with flavor." The ancient Pig Skin Decoction and Mutton Decoction can be emulated. I instructed him to buy four taels of pork belly and three he of glutinous rice. Boil until melted, filter to obtain one bowl of juice. Then take one cup of pear juice and half a cup of honey, alternating with the rice and meat juice. Drink it all within a day and night. His eyes opened slightly, hands and feet moved slightly, and he groaned softly in his throat. The next day, his companion asked for a prescription. I said: "This itself is the prescription. Since it is effective, continue it." This nourishes Stomach Qi to generate fluids; moistens Dryness-Fire to restore Yin Blood; do not seek anything else. After three days like this, his lips and tongue became moist, a layer of black crust peeled off, he opened his eyes and could speak. That night, dry feces were passed, and the pulse responded slightly to pressure. Again, modify Liuwei Tang (Six-Ingredient Decoction) and administer it. Within a month, he recovered. The healer uses intent. The Classic says: "Eating meat causes relapse," and also: "Grains, meats, fruits, and vegetables complete the dietary nourishment." Healing values flexibility; not sticking rigidly to antiquity, nor departing from it, allows one to discuss the benevolent art. (Wang Chiya)
Attached Formulas
Xinliang TouBiao (Acrid-Cool Surface-Releasing Method)
Treats Warm-Heat pathogenic factors entering from skin and hair, initial fever, dizziness, dry mouth, soft limbs, floating-slippery pulse, pale tongue with slight coating. Su Geng (Perilla Stem), Bo He (Mint), Xing Ren (Apricot Seed), Sang Ye (Mulberry Leaf), Gan Cao (Licorice), Jie Geng (Platycodon Root), Ju Hong (Tangerine Peel), Huang Juan (Yellow Bean Sprout), Tong Cao (Tetrapanax Pith). Add Hua Shi (Talcum), Xiang Ru (Elsholtzia) for Summer-Dampness; add Niu Bang Zi (Arctium Fruit) for throat obstruction. ○ The Lung governs skin and hair; since the pathogen enters from the skin and hair, use the acrid properties of Perilla, Mint, Apricot Seed, and Mulberry Leaf to release the exterior. Dry mouth at onset indicates internal accumulated heat; use sweet and acrid ingredients like Licorice, Platycodon, Tangerine Peel, and Yellow Bean Sprout to harmonize the interior. Adding Tetrapanax Pith provides mild purgation and promotion of urination, allowing stagnant heat to exit via urine, a method of light clearing and dispersing. ○ The Lung is a delicate organ, located highest, and injured first; it suits mild flavors and light aromatics, with a little acrid assistance, conforming to the Classic's statement that "the Lung desires acridity." This is the method of treating upper-level disorders. Drugs like Qiang Huo and Fang Feng disperse Taiyang Wind-Cold exterior pathogens; what relevance do they have here? The *Wen Re Pian* states: "Misusing acrid-warm surface-releasing drugs heavily depletes the exterior and burns Body Fluids; adding moxibustion or fire fumigation constitutes a second reversal, hastening death."
Fangxiang Jie Hui (Aromatic Resolving of Filth Method)
Treats Warm-Heat pathogenic factors entering from mouth and nose, initial fever, dizziness, dry mouth, soft limbs, vomiting, chest fullness, floating-slippery pulse, slight white coating with pale yellow tint. Dan Chi (Fermented Soybean), Su Geng (Perilla Stem), Huo Xiang (Patchouli), Bo He (Mint), Yu Jin (Curcuma Rhizome), Ju Hong (Tangerine Peel), Gan Cao (Licorice), Jie Geng (Platycodon Root), Tong Cao (Tetrapanax Pith), guided by fresh Ginger Juice. ○ Add Hua Shi and Xiang Ru for Summer-Dampness; add Niu Bang Zi for throat obstruction. ○ Large Intestine and Lung are exterior-interior pairs, both opening at the nose; Stomach and Spleen are exterior-interior pairs, both opening at the mouth. Filthy turbidity transmits via inhalation through mouth and nose; thus, use aromatic and light flavors to open and vent. ○ The previous formula uses Acrid-Cool; this formula uses Aromatic; both are Sweating Methods. However, this sweat arises from internal cooling and harmonious Qi flow, so Yin fluids are not damaged, Yuan Orifices open, and sweat overflows naturally. Forcing sweat with Acrid-Warm drugs is not only useless but harmful. ○ In Cold Damage, Ginger is decocted to disperse exterior Cold; in Warm-Heat, Ginger Juice is used solely to remove filth, not to move to the exterior. Although both use Ginger, the methods differ.
Qing Li Bao Jin (Clearing Interior Protecting Fluids Method)
Treats Warm-Heat pathogenic factors injuring Wei (Defensive) level and about to injure Ying (Nutritive) level, high fever, dizziness, thirst, irritability, slippery-rapid pulse, yellow-white coating. Ge Gen (Kudzu Root), Bo He (Mint), Lian Qiao (Forsythia), Hua Fen (Trichosanthes Root), Huang Juan (Yellow Bean Sprout), Niu Bang Zi (Arctium Fruit), Jie Geng (Platycodon Root), Ju Hong (Tangerine Peel), Tong Cao (Tetrapanax Pith), guided by Dan Zhu Ye (Bamboo Leaf) and Zhu Ru (Bamboo Shavings). ○ Add Zi Su (Perilla Leaf) and Dan Chi for no sweat; add Hua Shi and Lu Dou Pi (Mung Bean Skin) for Summer-Dampness; add Lu Gen (Reed Rhizome) and Ginger Juice for vomiting. ○ Thirst, irritability, yellow tongue, rapid pulse indicate Heat entering the interior, scorching Lung fluids and Stomach juices. However, it has not yet reached the Ying level, so still clear and disperse from the Qi level, adding moistening agents to replenish the source of transformation.
Fen Xie San Jiao (Dividing and Purging the Triple Burner Method)
Treats Warm-Heat pathogenic factors spreading through the Qi level of the Triple Burner, intermittent fever, dizziness, tinnitus, eye pain extending behind ears, irritability, thirst, chest fullness, wiry-rapid pulse, yellow-white dry coating. Sang Ye (Mulberry Leaf), Bo He (Mint), Ju Hong (Tangerine Peel), Hua Fen (Trichosanthes Root), Zhi Ke (Bitter Orange), Yu Jin (Curcuma Rhizome), Lou Pi (Melon Rind), Lian Qiao (Forsythia), Fu Ling (Poria), Zhu Ling (Polyporus), guided by Dan Zhu Ye (Bamboo Leaf). ○ Add Su Geng and Xiang Chi for no sweat; add Ban Xia (Pinellia) and Ginger Juice for vomiting; add Hua Shi and Lu Dou Pi for Summer-Dampness. ○ Cold Damage involves Foot-Shaoyang Gallbladder syndrome, treated by harmonizing exterior and interior; Warm-Heat involves Hand-Shaoyang Triple Burner syndrome, treated by dividing and eliminating upper and lower. Treating Foot-Shaoyang prohibits vomiting, sweating, purging, and promoting urination, as the Gallbladder has no exit, relying only on harmonization. Here, Triple Burner Qi level blockage requires purging as primary. Mulberry Leaf, Mint, Tangerine Peel, Bamboo, Trichosanthes purge Upper Burner; Bitter Orange, Curcuma, Melon Rind, Forsythia purge Middle Burner; Poria and Polyporus purge Lower Burner. Dividing and eliminating the Triple Burner leaves no place for the pathogen.
Xie Wei Tou Ying (Releasing Exterior Penetrating Ying Method)
Treats Warm-Heat pathogen having injured Ying level, high fever, irritability, thirst, soreness and pain of sinews and bones, insomnia, flooding-rapid pulse, crimson tongue with yellow dry coating. Lian Qiao (Forsythia), Hua Fen (Trichosanthes Root), Zhi Mu (Anemarrhena Rhizome), Huang Qin (Scutellaria Root), Hei Zhi (Black Gardenia), Bai Wei (Cynanchum Root), Dan Pi (Moutan Bark), Chi Shao (Red Peony Root), Yu Jin (Curcuma Rhizome), Ju Pi (Tangerine Peel), Yin Hua (Honeysuckle Flower), guided by Pear Juice and Sugarcane Syrup. ○ Add Lu Gen for vomiting; add Xi Jiao (Rhinoceros Horn - substitute with Buffalo Horn) and Shi Chang Pu (Acorus Rhizome) for confusion; add Chai Hu (Bupleurum Root) for bitter taste and deafness, also for malaria conversion. ○ Exterior pathogen enters interior, gradually affecting the Pericardium from the Lung system, injuring Ying. Body pain indicates Heat forcing into sinews and bones, damaging fluids; do not mistake this for exterior pathogen and use dispersing agents. This formula treats with cooling, hoping for Qi transformation to penetrate exterior, allowing pathogen to exit via sweat, potentially resolving via Battle Sweat. Using Curcuma, Tangerine Peel, and Honeysuckle in the formula addresses Heat steaming the Chest Center, turbidity obscuring clear orifices, combining Cooling Chest with Aromatic Venting method.
Liang Ge Xie Xin (Cooling Chest Purging Heart Method)
Treats Warm-Heat pathogen entering Pericardium, fever and thirst, confusion, delirium, mania, or short speech and stiffness, bleeding from mouth and nose, or confusion without thirst, flooding-rapid-prompt pulse, purple tongue with yellow coating, or cracked texture and prickles. Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), Sheng Di (Rehmannia Root), Dan Pi (Moutan Bark), Shi Gao (Gypsum), Zhi Mu (Anemarrhena Rhizome), Yuan Shen (Scrophularia Root), Hei Zhi (Black Gardenia), Ling Jiao (Antelope Horn), Mu Tong (Akebia Stem), Jin Zhi (Gold Juice), guided by Zhu Ye Xin (Bamboo Leaf Heart). ○ Add Renshen (Ginseng) for deficiency; add Xi Jiao (Buffalo Horn) for bleeding, Da Qing (Isatis Leaf) for severe cases; add Zhi Bao Dan (Treasure Pearl Pill) for internal collapse, meridian closure, spasms, and convulsions. ○ Heat entering Pericardium closes clear orifices; Fire flourishing leads to Water decline; thus, use bitter-cold flavors to purge Yang and save Yin.
Di Fu Jie Du (Purging Fu Organs Detoxifying Method)
Treats Warm-Heat pathogen entering Stomach Fu, fever and thirst, abdominal fullness, constipation, or mania, macules, jaundice, cold limbs, flooding-rapid-forceful pulse, scorched tongue with cracks or prickles. Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), Huang Bo (Phellodendron Bark), Shi Gao (Gypsum), Hei Zhi (Black Gardenia), Mu Tong (Akebia Stem), Da Huang (Rhubarb Root), Jin Zhi (Gold Juice - substitute Ren Zhong Huang if unavailable), add Bing Lang (Areca Seed) for bloating; swallow Ku Shen Wan (Sophora Pill) for mania; add Sheng Di, Xi Jiao, Tao Ren (Peach Kernel) for macules and bleeding; add Yin Chen (Artemisia Scoparia) for jaundice. ○ Stomach belongs to Earth; sweating leads to intense Heat and dry fluids, causing constipation; Water failing to control Fire causes mania; Heat stagnating internally overflowing to exterior causes jaundice; Heat accumulating in Stomach Fu penetrating Ying causes macules. Urgent purging is needed, or Yin Water will dry up. Do not lightly administer if condition is not urgent; do not hesitate if condition is urgent.
The above seven formulas treat the depth of pathogen entering from exterior. Use formulas according to syndrome, adapting flexibly, not restricted by days.
Biao Li Shuang Jie (Simultaneous Release of Exterior and Interior Method)
Treats Warm-Heat pathogen emerging from interior, initial chills and fever, headache, dizziness, irritability, thirst, fullness, solid-rapid pulse, yellow or white coating like accumulated powder with crimson edges. Su Ye (Perilla Leaf), Xing Ren (Apricot Seed), Bo He (Mint), Xiang Chi (Fermented Soybean), Lian Qiao (Forsythia), Hua Fen (Trichosanthes Root), Gan Cao (Licorice), Ju Pi (Tangerine Peel), Jie Geng (Platycodon Root), Zhu Ling (Polyporus), Tong Cao (Tetrapanax Pith), add Ginger Juice for vomiting; add Hua Shi, Lu Dou, Xiang Ru for Summer-Dampness; add Niu Bang Zi for throat obstruction. ○ Pathogen lies dormant in Mo Yuan (Membrane Source), transforming into heat over time, triggered by exposure, reaching skin violently. This formula uses Perilla, Mint, Apricot Seed, Fermented Soybean to release exterior; Forsythia and Trichosanthes to clear interior; Licorice, Platycodon, Tangerine Peel to regulate middle; Polyporus and Tetrapanax to divide and promote urination. Internal and external accumulation is cleared from here. Misusing Acrid-Warm drugs to sweat depletes fluids, aiding Fire pathogen, causing serious harm. ○ Some ask: Initial chills, not caused by Cold pathogen, why such reaction? Know that this aversion to cold is due to Fire stagnating internally, intense Heat generating Wind, conflicting with Primordial Qi, causing shivering like malaria; it is not true Cold. People often doubt this, first administering Warm-Dispersing drugs; knowing not that Wind fans Fire, further assisting Blaze, failing to cure disease,反而 worsening it.
Qing Fu Run Zao (Clearing Fu Moistening Dryness Method)
Treats Warm-Heat pathogen entering Stomach from Mo Yuan, high fever, dizziness, irritability, thirst, fullness, preference for cold, aversion to heat, slippery-rapid pulse, yellow dry coating. Huang Qin (Scutellaria Root), Zhi Mu (Anemarrhena Rhizome), Lian Qiao (Forsythia), Hua Fen (Trichosanthes Root), Hei Zhi (Black Gardenia), Chi Shao (Red Peony Root), Xi Jiao (Buffalo Horn), Zhi Ke (Bitter Orange), Xiang Chi (Fermented Soybean), Yu Jin (Curcuma Rhizome), guided by Pear Juice and Sugarcane Syrup. ○ Add Lu Gen and Ginger Juice for vomiting; add Shi Gao for extreme thirst; add Yi Yuan San and Lu Dou Pi for Summer-Dampness; add Bai Wei, Yin Hua, Shi Chang Pu for mental confusion. ○ Pathogen enters Stomach from Mo Yuan; Stomach has upper and lower openings, empty and receptive, making entry easy. Pathogen has not yet formed solid accumulation, so sudden purging is unsuitable; use Clearing-Resolving method to protect fluids, hoping for Battle Sweat to penetrate exterior. Heat accumulation causes Qi stagnation; add little Acrid-Aromatic to vent.
Xie Yang Jiu Yin (Purging Yang Saving Yin Method)
Treats Warm-Heat pathogen entering Fu forming solid accumulation, fever, thirst, fullness, constipation, mania, or macules, jaundice, cold limbs, flooding-rapid-forceful pulse, black tongue with prickles. Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), Huang Bo (Phellodendron Bark), Shi Gao (Gypsum), Da Huang (Rhubarb Root), Zhi Ke (Bitter Orange), Hou Po (Magnolia Bark), Hei Zhi (Black Gardenia), Mu Tong (Akebia Stem), Xi Jiao (Buffalo Horn), Jin Zhi (Gold Juice - substitute Ren Zhong Huang if unavailable), add Yuan Ming Fen (Mirabilite) for dry stool; swallow Ku Shen Wan for mania; add Sheng Di, Tao Ren for macules and bleeding; add Zhi Bao Dan for internal collapse, confusion, and convulsions. ○ Intense Heat exhausts fluids, causing thirst and constipation; Heat knotting in middle causes confusion and rapid pulse; Yang flourishing and Yin losing position causes cold limbs. At this time, not purging is like nurturing a tiger and inviting disaster. This formula agrees with the previous Purging Fu Detoxifying method. For residual pathogen after purging, delay one day, then purge again, so pathogen is thoroughly cleansed. If syndrome requires purging but Primordial Spirit is exhausted, making purging impossible, must heavily add Renshen (Ginseng) to manage it, hoping to save in one in ten thousand cases; do not sit idle waiting for death.
The above three formulas treat pathogen emerging from interior. Entering from exterior is gradual; emerging from interior is violent; thus treatment methods differ.
He Yin Qing Zao (Harmonizing Yin Clearing Dryness Method)
Treats post-purgation Warm-Heat where disease has not subsided, high fever, confusion, irritability, thirst, urgent pulse, scorched tongue. Sheng Di (Rehmannia Root), Yuan Shen (Scrophularia Root), Yang Shen (American Ginseng), Zhi Mu (Anemarrhena Rhizome), Mai Dong (Ophiopogon Tuber), Lian Qiao (Forsythia), Huang Qin (Scutellaria Root), Shao Yao (Peony Root), Hei Zhi (Black Gardenia), Gan Cao (Licorice), Han Shui Shi (Halloysitum Rubrum), guided by Gui Yuan (Longan Aril) and Da Zao (Jujube). ○ Add Chuan Lian (Szechwan Chinaberry), Xi Jiao, Huang Bo for intense Heat, confusion, and blackened nose. ○ Long-standing Warm-Heat, interior and exterior both hot, distinguishing organs and meridians is lost. After purgation, Righteous Qi declines, Yin Water nearly dries. This formula: Rehmannia and Scrophularia clear Heart-Kidney Fire; Scutellaria and Peony clear Liver-Gallbladder Fire; Halloysite and Anemarrhena clear Spleen-Stomach Fire; Ophiopogon and Forsythia clear Lung-Intestine Fire; additionally Gardenia purges Triple Burner Fire, guiding it downward curvingly; Licorice, Jujube, Ginseng, Longan harmonize middle and support Righteous Qi. This is a universal formula for purging Heat and moistening Dryness. Regardless of pathogen entering from exterior or emerging from interior, if lingering unresolved after purgation, universally use this formula.
Ku Xie Xuan Tong (Bitter Draining Promoting Circulation Method)
Treats Warm-Heat pathogen converging in Middle Jiao, chest and diaphragm fullness, oppression, dry nausea, sinking-solid-rapid pulse, yellow turbid coating. Hou Po (Magnolia Bark), Zhi Ke (Bitter Orange), Ju Pi (Tangerine Peel), Ban Xia (Pinellia Tuber), Lou Ren (Melon Seed), Lian Qiao (Forsythia), Huang Qin (Scutellaria Root), Yu Jin (Curcuma Rhizome), Fu Ling (Poria), Gan Cao (Licorice), guided by Lu Gen (Reed Rhizome) and Ginger Juice. ○ Add Huang Lian for Dry-Heat; add Hua Fen and Zhi Mu for irritability-thirst; add Da Huang and Bing Lang for abdominal distension; add Shi Di (Persimmine Calyx) and Dao Dou Zi (Lablab Seed) for hiccups. ○ Turbid filth Qi flows from top to bottom, filling Triple Burner. Here it sinks into Zhong Wan, Qi obstructed not circulating, causing fullness and oppression. This formula combines Xiao Xian Xiong Tang (Minor Trap the Chest Decoction) and Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction) methods to open stagnation and purge Heat. ○ Treating Cold Damage requires dry accumulation and constipation before purging; treating Warm-Heat is different. Where Dampness exists internally, stools will not accumulate; thus, seeing fullness and distension, one should purge, not restricting to dry feces. Why? Because purging Heat, not attacking accumulation.
Qing Fu Gu Tuo (Clearing Fu Securing Collapse Method)
Treats Warm-Heat pathogen forcing diarrhea, restlessness, foul discharge unlimited, even pus and blood, sinking-rapid pulse, scorched yellow coating. Huang Lian (Coptis Rhizome), E Jiao (Donkey-hide Gelatin), Huang Qin (Scutellaria Root), Huang Bo (Phellodendron Bark), Hei Zhi (Black Gardenia), Renshen (Ginseng), Fu Ling (Poria), Bai Shao (White Peony Root), Gan Cao (Licorice), guided by Da Zao (Jujube) and Lian Zi (Lotus Seed). ○ Add Baitouweng, Di Yu (Sanguisorba Root), Wu Mei (Chinese Plum) for chronic pus-blood diarrhea; add Yu Liang Shi and Shi Zhi (Kaolin) for severe cases. ○ Disease in Lower Jiao, Heat forcing Large Intestine; Classic says "violent flowing downward urgency." Profuse unceasing diarrhea, Primordial Spirit exhausted; thus use Cold to clear Heat, Tonify to preserve Primordial, Astringe to secure collapse. This is emergency method.
Fu Wei Tou Han (Supporting Stomach Penetrating Sweat Method)
Treats Warm-Heat disease with body deficiency unable to produce Battle Sweat, fatigue, soggy pulse. Renshen (Ginseng) (dose adjusted, separately decocted and mixed with medicine). For persons with inherently weak Primordial Qi suffering Warm-Heat, pathogen desires to exit, but Qi falters internally, unable to reach exterior; thus rely on Renshen's strong power to assist, so pathogen surges out. Previous Renshen Su Yin (Ginseng Perilla Drink), Bai Du San (Decocting Toxin Powder), use Ginseng in Exterior-Sweating agents; Xiao Chai Hu Tang, Renshen Baihu Tang, Zhuye Shigao Tang, use Ginseng in Harmonizing agents; Huanglong Tang, use Ginseng in Purging agents. The merit of Ginseng is successful everywhere; people do not know its wonder, doubt and do not use, or use too late, truly pitiable. Yu Jiayan's *Yuyi Cao* explains this in detail; healers should study it.
Yang Yin Fu Zheng (Nourishing Yin Supporting Righteous Method)
Treats long-standing Warm-Heat with Righteous deficiency, residual pathogen not cleared, or disease resolved but spirit still confused, spirit clear but heat not receding, deficiency irritability, night sweats, rapid-weak pulse, turbid tongue not clean. Di Huang (Rehmannia Root), E Jiao (Donkey-hide Gelatin), Renshen (Ginseng), Mai Dong (Ophiopogon Tuber), Wu Wei Zi (Schisandra Berry), Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root), Yu Zhu (Polygonatum Odoratum), Fu Shen (Poria with Hostwood), Dan Pi (Moutan Bark), Nu Zhen Zi (Ligustrum Fruit), guided by Zhu Xin Ye (Bamboo Leaf Heart) and Ji Zi Huang (Egg Yolk).