目 录
太阳伤寒表实证
王××，男，四十二岁，某厂干部。
患者于昨夜发热，体温38．9℃，今晨来诊仍发热，头痛，颈项强直，肢体酸楚而痛，流清涕，心泛欲呕、食减而不渴，脉浮紧、舌苔薄白。此系风寒伤及太阳肤表所致。 《内经》云“其在皮者、汗而发之”，照仲景法，当以辛温发散以解表邪，拟麻黄汤加味主之。
麻黄6克 桂枝10克 杏仁10克 法夏6克 防风6克 甘草6克 生姜3片
嘱温服而卧，取汗自愈。殊料病者家属畏忌麻黄一药之温，恐燥热伤津，自行将药中麻黄减除，服一碗，未得汗。
见其躁烦，热势反增，体温升至39．7℃。继服第二碗，则头痛如裂，身痛如被仗，恶寒较昨日更甚，疑为药不对症，邀余急往诊视，脉来浮紧急促，苔白腻，呼痛呻吟，虽言失治，幸喜表寒症型未变，释明其意，即嘱仍用原方，万不能再去麻黄。经照方服药二次后，温覆而卧，稍顷汗出热退，表邪解，遂得脉静身凉而愈。
按：世有畏麻、桂如蛇蝎者，以为其性温而易伤津化燥，不知表寒实证无麻黄之辛散，何以开发腠理，驱邪外 出。无桂枝之温通，何以助阳温经而散寒?不畏邪之伤于人，而畏药性之辛温，实为姑息养奸之弊也。盖用药不在医家之喜恶，而在于审证之明确，有是证用是药，用之得当则 药到病除。用之不当，易变化莫测。阳热偏胜者，辛温固不宜用，营血不足，里虚内伤等证，亦不宜汗。倘确属寒邪束表之症，当用而不用，反以清凉苦寒抑其热，势必助邪伤正，表寒不解，热势更张，斯时宜以麻桂等剂因势利导，驱邪外出，切勿坐失良机而至表邪传里为患，此乃祛邪即所以扶正之法也。
麻黄开玄府，通达腠理。桂枝辛温通阳，助其疏泄。杏仁利肺气，降逆平喘，甘草保中气而生津液。方药化合，专发太阳伤寒肤表之汗，效如桴鼓。然服此方，一、二碗后，覆卧得汗即可，不必尽剂，更勿令其大汗淋漓以致伤津而耗气。俗云“方是死方，法是活法”。欲求其效，宜潜心钻研意旨，无异于（钅卢）锤之非易也。
小儿急惊风(一)
柯某之长子，年一岁半，住云南省昆明市原铁道分局。
1922年阴历九月初六日晨，寐醒抱出，冒风而惊，发热，自汗沉迷，角弓反张，手足抽搐，目上视，指纹赤而浮，唇赤舌淡白，脉来浮缓。由于风寒阻遏太阳经气运行之机，加以小儿营卫未充，脏腑柔嫩，不耐风寒，以致猝然抽搐而成急惊风证。此为太阳肌表之证，以仲景桂枝汤主之，使中于太阳肌腠之邪，得微汗而解。
桂尖10克 杭芍10克 甘草6克 生姜10克 小枣7枚
加入粳米一小撮同煎，嘱服后温覆而卧，使得微汗。
一剂尽，即熟寐，汗出热退，次日霍然。
按：此证利在急治，倘迁延日久，别生变故，难以逆料。案内桂枝全方，力量甚足，故效如桴鼓。
小儿急惊风(二)
(风寒误治救逆)
朱小弟，生甫两月，禀赋单薄。某日因感风寒而病，．身热咳嗽，不思乳食，多啼声。医以清热解表之剂，热不退，发惊惕。又复以追风清热镇惊等法以治之，竞沉迷不乳，体若燔炭，自汗肢冷，咳嗽喘挣不已，痰声漉漉，时作角弓抽掣，奄奄一息。后延余诊之，指纹青黑透关，面唇均含青象，舌白而腻。此为风寒误治引邪入于阴分，阳不胜阴，虚阳浮越于外，法当扶阳驱寒。
附片20克 炮姜6克 京夏6克 北辛2克 生麻茸2克 茯苓10克 甘草3克
频频喂服，一剂尽，汗出，热退其半，已不发惊抽掣，喘咳减，始能吮乳。再剂病退七、八。去麻、辛，又服二剂后，诸证悉除。
小儿慢惊风
张××之次子，生甫一岁，住四川省会理县鹿厂街。
1914年3月，患小儿惊风证，病颇危笃，三日来抽搐不已。
余诊视之，指纹青黑透达三关，脉沉细而弱，舌苔白滑，面唇青黯，闭目沉迷不省，时而手足拘挛抽掣，乳食不进，夜间发热，大便泄泻绿色稀粪。询及病由，其母述及，患儿始因受寒感冒起病，初有发热咳嗽，大便溏泻。某医以清热解表药二剂，服后白昼身热见退，夜晚又复发热，咳、泻未止。继又拟消食清热药二剂，服后病不减，忽而风动抽搐。
该医以为肝经风热，又以平肝驱风镇惊药二剂，病情反见日趋沉重而成是状。时病已十余日，按脉证病情诊察，余思寻之，良由小儿气血未充，脏腑娇嫩，不耐克伐。风寒初起，只须轻宣透表，其病当愈。尔乃误以清热之剂，又复以消食、平肝、驱风等法，元阳受损，正不胜邪，遂致寒痰内壅而成三阴虚寒之慢惊风证。病势已危重，若辞不治，实非我医者应尽之责，力主逐寒荡惊汤挽救之。
上肉桂6克(研末，泡水兑入) 公丁3克 炮姜10克 白胡椒3克(捣) 灶心土130克(烧红淬水，澄清后以水煎药)
上方喂服二次，稍顷，呕吐涎痰一小盏，风状略减，抽搐较轻，两眼已睁，目珠已能转动寻视。再喂药一次，又吐涎痰盏许，风状已定，抽搐不再发作，咳嗽亦平，夜晚已不再发热。患儿之父母见病已恢复，甚为欣慰，但见其子体质赢弱，认为宜培补脾胃，自拟理中地黄汤一剂喂服。殊料服后移时，风动抽搐又起。余往视之，询问缘由，方知患儿大病虽有转机，然寒痰邪阴尚未逐尽，滋补过早，固必增邪，且有碍于阴邪外祛，寒痰内阻，遂致慢风复作。此时，病家始知误施补剂亦有弊端。余仍以逐寒荡惊汤并加附片15克，喂服后又吐涎痰盏许，畅泻酱黑色稀便二次，抽搐平息，且能吮乳，并闻啼声。照原方去胡椒、公丁，加砂仁6克、甘草6克，附片增至30克，煎汤频频喂服。二二剂尽，诸证痊愈。
太阳少阴两感于寒证
(重感冒)
张××，年四十二岁，住云南省昆明市武庙下南联升巷底。肾气素亏，于1929~F 9月2口返家途中，时值阴雨，感冒风寒而病。初起即身热恶寒，头疼体痛，沉迷嗜卧(即少阴病但欲寐之病情也)，兼见渴喜热饮不多，脉沉细而兼紧象。
舌苔白滑，质夹青紫，由于肾气素亏，坎阳内弱，无力卫外固表以抵抗客邪，以致寒风乘虚直入少阴，阻塞真阳运行之机，而成是状。以仲景麻辛附子汤，温经解表辅正除邪治之。
黑附片36克麻黄10克(先煮数沸，去沫)北细辛6克 桂尖13克
3日，服上方一剂即汗，身热已退，唯觉头晕咳嗽、神怯。表邪虽解，肺寒尚未肃清，阳气尚虚，以四逆合二陈加细辛、五味子，扶阳温寒主之。
黑附片50克 干姜26克 甘草10克 广皮1 0克 法夏13克 茯苓13克 北细辛4克 五味子2克
一剂尽，咳嗽立止，食量增加，精神恢复，病遂痊愈。
瘟疫病燥热内结证
谢××之妻，车姓，年十八岁，住四川省会理县南街。
于1920年3月，感瘟疫病邪，发病已二日，起始则见发热而渴，恶热而不寒，头疼体痛，脉浮弦而数，唇赤面垢，舌白如积粉。病虽初起，但邪不在经，若发汗，则既伤表气又易耗损津液，势必热邪愈炽。此乃瘟疫之邪蟠踞募原，有入里化燥伤津之势，宜输转募原之邪，使之达表而解，以达原饮加石膏主之。
槟榔10克 厚朴10克 草果10克 知母12克 杭芍12克 黄芩10克 甘草6克 生石膏15克(碎，布包)
服一剂后，证情稍减，惟大便已三日燥结不通，于是续前方加大黄12克，嘱即服。因患者之父略知医理，认为该女素体虚弱，恐不能耐受寒下之剂，竟私自将大黄、石膏减去未用。隔日延余再诊，见患者舌苔转黄而燥，胃实胸满，拒按呼痛，烦渴饮冷，小便短赤，大便仍燥结，壮热未解，时发谵语。此系邪已入腑，燥热结滞，非清热泻下不能力挽危绝。当即拟白虎加承气汤合方一剂。其父仍有难色，不敢与服。随后，患者忽鼻衄不止，色鲜红而量较多，稍顷，衄血即凝而成块。病家惶恐，另延中医彭某诊视，断为阳虚亡血之证，且谓如系热证，鼻衄流出之后，必不致凝结成块，主以四逆汤。病家疑虑，踌躇无决，仍不敢与服之。又复求询于余，余据理解释，力说病家：此及邪热亢极灼阴之证，急宜大剂凉下以救真阴，缓则真阴灼尽，危殆难治。又告之，余素谙于用姜附者，尚不敢以温热之剂妄投，当此证情，苦寒泻下尤恐不及，倘若误服温热之剂，犹如火上浇油，危亡立至。因余力主，病家始而信服，遂拟方清热凉下治之。
生石膏60克(碎，布包)生大黄30克(泡水兑入)枳实20克(捣)厚朴20克 芒硝13克 知母20克 生地16克 甘草6克
上方煎汤日夜连进之后，鼻衄方止，神识转清，身热退去六，七。次日照原方再服一剂，服后则二便通畅，脉静身凉，惟仍渴思冷饮，此系余热未净、津液未复所致，以生脉散加味连服三剂，渴饮止，津液满口。其后于此方减去石膏、大黄连服三剂而痊。
沙参30克 麦冬13克 五味子6克 当归16克 生地16克杭芍16克石膏16克大黄6克
瘟疫病阳明燥实证
李××，男，年二十五岁，四川省会理县南乡农民．1921年3月感时疫而病，发热十二日不退，脉来洪数，舌苔黄黑而生芒刺，唇焦齿干，口气蒸手，值午后则热势更张，溅溅汗出，谵语烦躁不能安卧。小便短赤，大便自病后十余日不通，从心下至少腹胀满，呻吟呼痛而拒按，仰卧难以转侧，食物不进，唯烦渴而喜冷饮。此际邪热亢甚，阴津枯涸，燥屎内结，阳明下证悉具。当急下以救阴，缓则危殆。思及亢热已久，燥屎坚结，无阴液以润泽，如行舟之乏水，邪热燥结亦无所由出，宜于急下之剂兼以养阴生津之品以治之，拟加味黄龙汤一剂。
土人参30克 当归26克 生地16克 大黄1 6克(泡水兑入)
芒硝10克(后放) 枳实16克 厚朴16克 生石膏26克(碎，布包)
当晚服后，病者欲便，但十分费力而难于解出，用力挣之，则燥屎一节，缓慢而出，长约尺许坚硬不断，色酱黑。
余亲视之，真坚硬如鞭。次晨诊视，其脉已较和绥，发热已退其半，苔刺变软，口津稍润，腹中胀痛大减，仍渴喜冷饮，嘱照原方再服一剂。第三日诊，大便畅通，色转黄而溏，斯时已脉静身凉，能进米粥。查其舌，见苔已退去其半，津液回生，但仍喜冷饮，此乃邪热始退，阴津尚未完全恢复，拟生脉散加味养阴生津兼清余热。
沙参26克 寸冬16克 五味子3克 甘草6克 生地16克
玄参13克黄连5克
服二剂后，继以六昧地黄汤调理阴分，一、二剂而愈。
生地26克 粉丹10克 枣皮10克 淮药13克 茯苓13克 泽
泻10克
瘟疫病阳明急下证
陈××之父，四川省会理县鹿厂牛上坎农民。年虽六旬，体素康健。1916年4月初，因事赴邻村，值村中时疫流行，遂被传染。返家数日，忽觉胸闷食少，头昏体困，口燥思饮而起病。初起即感懔懔憎寒，继则发热，渴思冷饮，头体疼痛，小便短少，其色如茶，病卧已七、八日，自服发表消导药二剂无效，始延余诊视。脉来洪数，唇焦口燥，舌苔厚腻，边白中黄而生芒刺。但头汗出，余处无汗，壮热烦渴饮冷，时发谵语，小便短涩但又随时点滴遗出。大便已六、七日不通，腹满而不能食。此乃瘟疫误于表散，大伤真阴，疫毒传入阳明之腑，邪热内蒸而呈是状，急宜凉下以救真阴，拟仲景大承气汤加石膏、寸冬，急下救阴，犹釜底抽薪之意，务将胃肠中之邪热疫毒下尽为度。
大黄16克(泡水兑入) 芒硝：3克(后放) 枳实13克(炒，捣)
厚朴13克(炒) 生石膏30克(碎，布包) 寸冬26克
此方煎服三次后，畅下黑酱粪半小桶之多，臭不可当，身热约退七、八，口津渐回，苔刺变软，谵语止，小便已不滴遗，稍见清长，色仍黄，仍渴喜冷饮，当即索取石缸内冰凉冷水一碗与饮之，饮后病者自云心中爽快，再饮一碗，顿觉全身清凉，竟得安卧熟寐片刻。余热未尽，继拟小承气汤加清热养阴生津以治之。
目录
患者王某，男性，42岁，某工厂干部。
患者昨晚出现发热，体温38.9℃，今晨来就诊时仍然发热，伴有头痛、颈项部僵硬不适、肢体酸痛楚痛、流清鼻涕、心中泛恶欲呕、食欲减退且不口渴，脉象浮紧、舌苔薄白。这是风寒之邪损伤了太阳经的肤表所致。《黄帝内经》说：“病邪在皮表的，应当用发汗的方法驱除”，依照张仲景的治法，应当使用辛温发散的药物来解除表邪，拟定麻黄汤加味作为主方。
麻黄6克 桂枝10克 杏仁10克 法半夏6克 防风6克 甘草6克 生姜3片
嘱咐温服后卧床休息，取微汗即可自愈。没想到病人的家属畏惧麻黄这味药的温热之性，担心燥热会损伤津液，自行将药方中的麻黄减去，服用一碗后，未能出汗。
看到病人烦躁不安，热势反而增加，体温升至39.7℃。接着服用第二碗药，则头痛如撕裂般疼痛，身体疼痛如同被杖击一般，怕冷比昨天更严重，怀疑是药不对症，邀请我急忙前往诊视，脉象浮紧急促，舌苔白腻，因疼痛而呼叫呻吟，虽然说是延误治疗，幸好表寒证型没有改变，向其解释清楚原委，随即嘱咐仍用原方，千万不能再去掉麻黄。按照处方服药两次后，覆盖衣被卧床休息，不久后出汗热退，表邪解除，于是脉象平静、身体凉爽而痊愈。
按语：世间有像害怕蛇蝎一样害怕麻黄、桂枝的人，认为它们的性质温热容易伤津化燥，不知道对于表寒实证，如果没有麻黄的辛散作用，如何能开发腠理，驱赶邪气外出？如果没有桂枝的温通作用，如何能助阳温经而散寒？不畏惧邪气伤人，却畏惧药性的辛温，这实在是姑息养奸的弊病。大概用药不在于医家的喜好厌恶，而在于辨证的明确，有这种证候就用这种药，用得恰当则药到病除。用得不得当，病情变化莫测。阳气偏盛者，辛温药固然不宜使用，营血不足、里虚内伤等证候，也不宜发汗。如果确实属于寒邪束表的证候，应当用而不用，反而用清凉苦寒的药抑制其热，势必会助长邪气、损伤正气，表寒不解，热势更加猖獗，这时应当用麻黄汤、桂枝汤等剂型因势利导，驱赶邪气外出，切勿坐失良机导致表邪传入体内造成祸患，这就是祛邪即所以扶正的方法。
麻黄开通玄府（汗孔），通达腠理。桂枝辛温通阳，帮助疏泄。杏仁宣利肺气，降逆平喘，甘草保护中气并滋生津液。方药化合，专门发太阳伤寒肤表之汗，效果迅速如敲鼓应声。然而服用此方，一、二碗后，覆盖卧倒得汗即可，不必喝完所有药剂，更不要让大汗淋漓以致伤津耗气。俗话说“方子是死方子，用法是活用法”。想要求得疗效，应当潜心钻研意旨，这并不比锤炼金属容易。
小儿急惊风(一)
柯某的长子，年龄一岁半，住在云南省昆明市原铁道分局。
1922年农历九月初六日早晨，睡醒后被抱出，受风惊吓，发热，自汗且神志昏沉，角弓反张（身体向后弯曲如弓状），手足抽搐，眼睛向上翻，指纹颜色红赤且浮露于表面，嘴唇红赤、舌质淡白，脉象浮缓。由于风寒阻遏了太阳经气运行的机制，加上小儿营卫之气未充实，脏腑柔嫩，不耐受风寒，以至于突然抽搐而成急惊风证。这是太阳肌表的证候，用张仲景的桂枝汤为主方，使侵入太阳肌腠的邪气，通过微汗而解除。
桂尖10克 杭白芍10克 甘草6克 生姜10克 小枣7枚
加入粳米一小撮同煎，嘱咐服用后覆盖衣被卧床休息，使得微微出汗。
一剂药吃完，立即熟睡，出汗热退，第二天完全康复。
按语：此证利于紧急治疗，倘若拖延日久，生出变故，难以预料。案中的桂枝全方，力量很足，所以效果迅速如敲鼓应声。
朱小弟，出生刚两个月，禀赋单薄。某天因为感受风寒而生病，身体发热咳嗽，不想吃奶，啼哭声大。医生用清热解表的药剂，热不退，引发惊惕。又再用追风清热镇惊等方法治疗，竟然神志昏迷不吃奶，身体像烧炭一样热，自汗四肢冰冷，咳嗽喘息不止，痰声漉漉，不时发生角弓反张抽搐，气息奄奄。后来请我诊治，指纹青黑透关，面唇都含有青色，舌苔白而腻。这是风寒误治引邪气进入阴分，阳气不能胜过阴气，虚阳浮越于外，治法应当扶阳驱寒。
附片20克 炮姜6克 法半夏6克 北细辛2克 生麻黄2克 茯苓10克 甘草3克
频频喂服，一剂药吃完，出汗，热退一半，不再发生惊惕抽搐，喘咳减轻，开始能吃奶。再服两剂病退七八成。去掉麻黄、细辛，又服两剂后，各种症状全部消除。
小儿慢惊风
张某的次子，出生刚一岁，住在四川省会理县鹿厂街。
1914年3月，患小儿惊风证，病情非常危重，三天来抽搐不停。
我诊视他，指纹青黑透达三关，脉象沉细而弱，舌苔白滑，面唇青黯，闭目昏沉不省人事，时而手足拘挛抽搐，乳食不进，夜间发热，大便泄泻绿色稀粪。询问病因，其母亲叙述，患儿起初因为受寒感冒起病，初起时有发热咳嗽，大便溏泻。某医生用清热解表药两剂，服用后白天身热见退，夜晚又复发热，咳嗽、腹泻未止。接着又拟消食清热药两剂，服用后病不减，忽然风动抽搐。
该医生认为是肝经风热，又用平肝驱风镇惊药两剂，病情反而日趋沉重而成这样。当时病已十余日，根据脉证病情诊察，我思考寻找原因，良由小儿气血未充实，脏腑娇嫩，不耐受攻伐。风寒初起，只需轻宣透表，病应当痊愈。然而误用清热之剂，又再用消食、平肝、驱风等方法，元阳受损，正气不胜邪气，遂致寒痰内壅而成三阴虚寒的慢惊风证。病势已经危重，如果推辞不治，实在不是我医者应尽的责任，极力主张用逐寒荡惊汤挽救。
上肉桂6克(研末，泡水兑入) 公丁香3克 炮姜10克 白胡椒3克(捣碎) 灶心土130克(烧红淬水，澄清后以水煎药)
上方喂服两次，稍顷，呕吐涎痰一小盏，风状略减，抽搐较轻，两眼已睁，眼珠已能转动寻视。再喂药一次，又吐涎痰一盏左右，风状已定，抽搐不再发作，咳嗽也平息，夜晚已不再发热。患儿的父母见病已恢复，甚为欣慰，但见其子体质羸弱，认为宜培补脾胃，自己拟定理中地黄汤一剂喂服。没想到服用后过了一段时间，风动抽搐又起。我前往诊视，询问缘由，才知道患儿大病虽有转机，然而寒痰邪阴尚未驱逐尽，滋补过早，必然增邪，且有碍于阴邪外祛，寒痰内阻，遂致慢风复发。此时，病家始知误施补剂也有弊端。我仍以逐寒荡惊汤并加附片15克，喂服后又吐涎痰一盏左右，畅泻酱黑色稀便两次，抽搐平息，且能吃奶，并能听到啼哭声。照原方去掉胡椒、公丁香，加砂仁6克、甘草6克，附片增至30克，煎汤频频喂服。两剂药吃完，各种症状痊愈。
张某，年龄42岁，住在云南省昆明市武庙下南联升巷底。肾气素来亏虚，于1929年9月2日返家途中，正值阴雨，感冒风寒而生病。初起即身热恶寒，头疼体痛，沉迷嗜卧（即少阴病但欲寐的病情也），兼见渴喜热饮不多，脉象沉细而兼紧象。
舌苔白滑，舌质夹青紫，由于肾气素来亏虚，坎阳（肾阳）内弱，无力卫外固表以抵抗客邪，以致寒风乘虚直入少阴，阻塞真阳运行的机制，而成是这样。用张仲景的麻黄细辛附子汤，温经解表辅正除邪治之。
黑附片36克 麻黄10克(先煮数沸，去沫) 北细辛6克 桂尖13克
3日，服用上方一剂即出汗，身热已退，只觉头晕咳嗽、神气怯弱。表邪虽解，肺寒尚未肃清，阳气尚虚，用四逆汤合二陈汤加细辛、五味子，扶阳温寒为主治之。
黑附片50克 干姜26克 甘草10克 广陈皮10克 法半夏13克 茯苓13克 北细辛4克 五味子2克
一剂药吃完，咳嗽立即停止，食量增加，精神恢复，病遂痊愈。
瘟疫病燥热内结证
谢某的妻子，车姓，年龄18岁，住在四川省会理县南街。
于1920年3月，感染瘟疫病邪，发病已两天，起始则见发热而渴，恶热而不恶寒，头疼体痛，脉象浮弦而数，嘴唇红赤面色垢浊，舌苔白如积粉。病虽初起，但邪气不在经络，若发汗，则既伤表气又易耗损津液，势必热邪更炽盛。这是瘟疫之邪盘踞募原（半表半里之地），有入里化燥伤津的趋势，宜输转募原之邪，使之达表而解，用达原饮加石膏为主方。
槟榔10克 厚朴10克 草果10克 知母12克 杭白芍12克 黄芩10克 甘草6克 生石膏15克(碎，布包)
服用一剂后，证情稍减，惟大便已三天燥结不通，于是续前方加大黄12克，嘱咐立即服用。因为患者的父亲略知医理，认为该女素体虚弱，恐不能耐受寒下之剂，竟私自将大黄、石膏减去未用。隔日请我再诊，见患者舌苔转黄而燥，胃实胸满，拒按呼痛，烦渴饮冷，小便短赤，大便仍燥结，壮热未解，时常发谵语。这是邪气已进入腑，燥热结滞，非清热泻下不能力挽危绝。当即拟定白虎加承气汤合方一剂。其父仍有难色，不敢给患者服用。随后，患者忽然鼻衄不止，血色鲜红而量较多，稍顷，衄血即凝而成块。病家惶恐，另延请中医彭某诊视，断定为阳虚亡血之证，且谓如果是热证，鼻衄流出之后，必不致凝结成块，主用四逆汤。病家疑虑，犹豫不决，仍不敢服用。又复求询于我，我据理解释，极力说服病家：这是邪热亢极灼伤阴液的证候，急需大剂凉下以救真阴，迟缓则真阴灼尽，危殆难治。又告诉他，我素来擅长用姜、附，尚不敢以温热之剂妄投，当此证情，苦寒泻下尤恐不及，倘若误服温热之剂，犹如火上浇油，危亡立至。因为我极力主张，病家始而信服，遂拟定方剂清热凉下治之。
生石膏60克(碎，布包) 生大黄30克(泡水兑入) 枳实20克(捣碎) 厚朴20克 芒硝13克 知母20克 生地16克 甘草6克
上方煎汤日夜连进之后，鼻衄才止，神识转清，身热退去六七成。次日照原方再服一剂，服用后则二便通畅，脉静身凉，惟仍渴思冷饮，这是余热未净、津液未复所致，用生脉散加味连服三剂，渴饮止，津液满口。其后于此方减去石膏、大黄连服三剂而痊愈。
沙参30克 麦冬13克 五味子6克 当归16克 生地16克 杭白芍16克 石膏16克 大黄6克
李某，男性，年龄25岁，四川省会理县南乡农民。1921年3月感染时疫而生病，发热十二天不退，脉象洪数，舌苔黄黑而生芒刺，嘴唇焦裂牙齿干燥，口气蒸手，值午后则热势更张，濈濈汗出（连续不断出汗），谵语烦躁不能安卧。小便短赤，大便自病后十余日不通，从心下至少腹胀满，呻吟呼痛而拒按，仰卧难以转侧，食物不进，唯烦渴而喜冷饮。此时邪热亢盛，阴津枯涸，燥屎内结，阳明下证悉具。应当急下以救阴，迟缓则危殆。考虑到亢热已久，燥屎坚结，无阴液以润泽，如同行船缺乏水，邪热燥结也无从排出，宜于急下之剂兼以养阴生津之品以治之，拟定加味黄龙汤一剂。
土人参30克 当归26克 生地16克 大黄16克(泡水兑入)
芒硝10克(后放) 枳实16克 厚朴16克 生石膏26克(碎，布包)
当晚服用后，病人想排便，但十分费力而难于解出，用力挣之，则燥屎一节，缓慢而出，长约尺许坚硬不断，色酱黑。
我亲自查看，真坚硬如鞭。次日早晨诊视，其脉已较和缓，发热已退其半，苔刺变软，口津稍润，腹中胀痛大减，仍渴喜冷饮，嘱咐照原方再服一剂。第三日诊，大便畅通，色转黄而溏，此时已脉静身凉，能进米粥。查其舌，见苔已退去其半，津液回生，但仍喜冷饮，这是邪热始退，阴津尚未完全恢复，拟定生脉散加味养阴生津兼清余热。
沙参26克 寸冬16克 五味子3克 甘草6克 生地16克
玄参13克 黄连5克
服用两剂后，继以六味地黄汤调理阴分，一两剂而痊愈。
生地26克 粉丹皮10克 枣皮10克 淮山药13克 茯苓13克 泽泻10克
陈某之父，四川省会理县鹿厂牛上坎农民。年龄虽六十岁，体质素来康健。1916年4月初，因事赴邻村，正值村中时疫流行，遂被传染。返家数日，忽觉胸闷食少，头昏体困，口燥思饮而起病。初起即感凛凛憎寒，继则发热，渴思冷饮，头体疼痛，小便短少，其色如茶，病卧已七八日，自服发表消导药两剂无效，始延我诊视。脉象洪数，嘴唇焦裂口燥，舌苔厚腻，边白中黄而生芒刺。但头汗出，余处无汗，壮热烦渴饮冷，时常发谵语，小便短涩但又随时点滴遗出。大便已六七天不通，腹满而不能食。这是瘟疫误于表散，大伤真阴，疫毒传入阳明之腑，邪热内蒸而呈是这样，急需凉下以救真阴，拟定张仲景的大承气汤加石膏、寸冬，急下救阴，犹如釜底抽薪之意，务将胃肠中之邪热疫毒下尽为度。
大黄16克(泡水兑入) 芒硝3克(后放) 枳实13克(炒，捣碎)
厚朴13克(炒) 生石膏30克(碎，布包) 寸冬26克
此方煎服三次后，畅下黑酱粪半小桶之多，臭不可当，身热约退七八成，口津渐回，苔刺变软，谵语止，小便已不滴遗，稍见清长，色仍黄，仍渴喜冷饮，当即索取石缸内冰凉冷水一碗与饮之，饮用后病人自云心中爽快，再饮一碗，顿觉全身清凉，竟得安卧熟寐片刻。余热未尽，继拟小承气汤加清热养阴生津以治之。
Table of Contents
Exterior Excess Syndrome of Cold Damage to the Taiyang Channel
Patient Wang, male, 42 years old, a cadre at a certain factory.
The patient developed fever last night with a body temperature of 38.9°C. Upon consultation this morning, he still had fever, accompanied by headache, stiffness and discomfort in the neck and nape, soreness and pain in the limbs, runny clear nasal discharge, nausea with desire to vomit, decreased appetite without thirst, floating-tight pulse, and thin white tongue coating. This is caused by wind-cold pathogenic factors damaging the exterior surface of the Taiyang channel. As stated in the *Huangdi Neijing* (Yellow Emperor's Inner Canon): "When the pathogen is in the skin, use sweating methods to expel it." Following Zhang Zhongjing's method, acrid-warm dispersing agents should be used to resolve the exterior pathogen. The modified Mahuang Tang (Ephedra Decoction) was prescribed as the main formula.
Mahuang (Ephedrae Herba) 6g, Guizhi (Cinnamomi Ramulus) 10g, Xingren (Armeniacae Semen Amarum) 10g, Fa Banxia (Pinelliae Rhizoma Preparatum) 6g, Fangfeng (Saposhnikoviae Radix) 6g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Shengjiang (Zingiberis Rhizoma Recens) 3 slices.
Instructed to take warm and lie down to induce slight sweating for self-healing. Unexpectedly, the patient's family members feared the warming nature of Mahuang, worrying that dryness-heat would damage body fluids, and arbitrarily removed Mahuang from the prescription. After taking one bowl, no sweating occurred.
Observing restlessness, the heat intensified, with body temperature rising to 39.7°C. After taking the second bowl, severe splitting headache and body pain as if beaten by sticks occurred, with worsening aversion to cold compared to yesterday. Suspecting the prescription was incorrect, they invited me to examine urgently. The pulse was floating, urgent, and rapid; the tongue coating was white and greasy; he cried out in pain. Although treatment was delayed, fortunately, the exterior cold syndrome pattern remained unchanged. I explained the rationale and instructed to continue with the original prescription, absolutely not removing Mahuang again. After taking the medicine twice according to the prescription, covered with blankets and lying down, sweating occurred shortly thereafter, followed by subsidence of fever. The exterior pathogen was resolved, leading to a calm pulse, cool body, and recovery.
Commentary: There are people in the world who fear Mahuang and Guizhi like snakes and scorpions, believing their warming nature easily damages fluids and causes dryness. They do not realize that for exterior excess cold syndromes, without the acrid dispersal of Mahuang, how can the couli (pores) be opened to drive pathogens out? Without the warming unblocking action of Guizhi, how can Yang energy be assisted to warm the channels and dispel cold? Fearing the warming nature of herbs rather than the harm of pathogens is indeed a fault of indulging evil. Medication depends not on the physician's preferences but on accurate differentiation. With the correct syndrome, use the correct herb; when used appropriately, the disease is cured. Inappropriate use leads to unpredictable changes. For those with excess Yang-heat, acrid-warm herbs are unsuitable; for deficiency of Ying-Blood or interior deficiency with internal injury, sweating is also unsuitable. If it is indeed a syndrome of cold binding the exterior, failing to use appropriate treatment and instead using cooling bitter-cold herbs to suppress heat will likely aid the pathogen and damage healthy Qi, leaving the exterior cold unresolved and heat more rampant. At this time, formulas like Mahuang Tang or Guizhi Tang should be used to guide the pathogen out顺势利导. Do not miss the opportunity for the exterior pathogen to transmit inward, causing disaster. This is the method of eliminating pathogens to support healthy Qi.
Mahuang opens the xuanku (spiritual gates/pores) and unblocks the couli. Guizhi is acrid and warm, unblocking Yang and aiding dispersion. Xingren benefits Lung Qi, directs rebellious Qi downward, and calms wheezing. Gancao protects Middle Qi and generates fluids. The combination of herbs specifically induces sweating from the Taiyang exterior cold syndrome, with efficacy as immediate as striking a drum. However, after taking one or two bowls, covering and lying down to induce sweating is sufficient; there is no need to finish the entire dose, nor should profuse sweating occur, which would damage fluids and deplete Qi. As the saying goes, "Formulas are fixed, but methods are flexible." To achieve efficacy, one must study the principles deeply, which is no easy task.
Pediatric Acute Convulsive Disease (I)
Eldest son of Mr. Ke, aged one and a half years, residing at the former Railway Branch Bureau in Kunming City, Yunnan Province.
On the morning of the sixth day of the ninth lunar month in 1922, after waking from sleep and being carried outside, the child was exposed to wind and frightened. Symptoms included fever, spontaneous sweating, lethargy, opisthotonos (arching of the back), convulsions of hands and feet, upward deviation of eyes, red and superficial finger vein, red lips, pale tongue body, and floating-slow pulse. This was due to wind-cold obstructing the circulation of Qi in the Taiyang channel, combined with the child's insufficient Ying-Blood and Wei-Qi, tender Zang-Fu organs, and intolerance to wind-cold, resulting in sudden convulsions constituting acute pediatric convulsive disease. This is a Taiyang muscle-surface syndrome. Zhang Zhongjing's Guizhi Tang (Cinnamon Twig Decoction) was used as the main formula to resolve the pathogen invading the Taiyang muscle-couli through slight sweating.
Guizhi (Cinnamomi Ramulus) 10g, Hang Shaoyao (Paeoniae Radix Alba) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Shengjiang (Zingiberis Rhizoma Recens) 10g, Xiaozao (Jujubae Fructus) 7 pieces.
Added a pinch of Jingmi (Oryzae Fructus Glutinosus) for decoction. Instructed to cover and lie down after ingestion to induce slight sweating.
After one dose, the child fell into deep sleep, sweated, fever subsided, and recovered completely the next day.
Commentary: This syndrome requires urgent treatment. If delayed, complications may arise unpredictably. The full Guizhi Tang formula in this case has sufficient potency, hence its immediate efficacy.
Pediatric Acute Convulsive Disease (II)
(Mishandled Wind-Cold Rescue)
Zhu Xiaodi, born only two months ago, with weak constitution. One day, illness began due to wind-cold exposure. Symptoms included fever, cough, refusal to nurse, and loud crying. The doctor used clearing-heat and resolving-exterior agents, but fever persisted, leading to fright. Subsequent treatments with wind-chasing, heat-clearing, and calming-fright methods resulted in lethargy, refusal to nurse, body hot as burning charcoal, spontaneous sweating, cold limbs, incessant coughing and panting, rattling phlegm sounds, intermittent opisthotonos and convulsions, and critical breathing. Later, I examined him. The finger vein was blue-black penetrating the three joints; face and lips showed bluish hue; tongue coating was white and greasy. This was wind-cold mishandled, drawing pathogen into the Yin aspect, where Yang could not overcome Yin, causing deficient Yang to float outward. The treatment method should be to support Yang and dispel cold.
Fupian (Aconiti Lateralis Radix Praeparata) 20g, Paojiang (Zingiberis Rhizoma Preparatum) 6g, Jingxia (Pinelliae Rhizoma) 6g, Beixin (Asari Radix et Rhizoma) 2g, Sheng Mahuang (Ephedrae Herba) 2g, Fuling (Poria) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 3g.
Fed frequently. After one dose, sweating occurred, fever reduced by half, fright and convulsions ceased, coughing and panting decreased, and nursing resumed. After another two doses, symptoms improved by 70-80%. Mahuang and Xin were removed, and two more doses were taken until all symptoms disappeared.
Pediatric Chronic Convulsive Disease
Second son of Mr. Zhang, aged one year, residing in Luchang Street, Huili County, Sichuan Province.
In March 1914, he suffered from pediatric convulsive disease, which was very critical, with continuous convulsions for three days.
Upon examination, the finger vein was blue-black penetrating the three joints; pulse was deep, fine, and weak; tongue coating was white and slippery; face and lips were dark bluish; eyes closed, lethargic, and unconscious; occasional limb spasms and convulsions; refusal of milk and food; night fever; green watery diarrhea. Inquiry revealed the mother stated the illness started with cold exposure and respiratory infection, initially presenting with fever, cough, and loose stools. A doctor prescribed two doses of clearing-heat and resolving-exterior medicines. Daytime fever subsided slightly, but night fever returned, and cough/diarrhea persisted. Then, two doses of digestion-promoting and heat-clearing medicines were given, but the condition did not improve, suddenly developing wind-movement and convulsions.
The doctor attributed this to Liver channel wind-heat and prescribed two doses of liver-calming, wind-dispelling, and fright-calming medicines, causing the condition to worsen further. By then, the illness had lasted over ten days. Based on pulse and symptoms, I reasoned that children have unfulfilled Qi and Blood and tender Zang-Fu, intolerant to harsh purgatives. Early wind-cold should be treated with mild exterior-releasing methods for cure. However, mistaken use of heat-clearing agents, followed by digestion-promoting, liver-calming, and wind-dispelling methods, damaged Yuan-Yang (Primordial Yang). Healthy Qi could not overcome the pathogen, leading to internal accumulation of cold-phlegm and constituting the chronic convulsive disease of Three-Yin deficiency-cold. The condition was critical. Refusing treatment would violate my duty as a physician. I strongly advocated using Zhuhan Dangjing Tang (Cold-Expelling and Fright-Shaking Decoction) to save the patient.
Rougui (Cinnamomi Cortex) 6g (powdered, mixed with water), Gongding (Syzygii Flos) 3g, Paojiang (Zingiberis Rhizoma Preparatum) 10g, Baihujiao (Piperis Longi Fructus) 3g (crushed), Zaoxintu (Caulis Argillae Ustus) 130g (heated red, quenched with water, clarified, and used to decoct herbs).
After two feedings, a small cup of salivary phlegm was vomited, wind signs slightly reduced, convulsions lighter, eyes opened, and eyeballs could move and track. After another feeding, another cup of salivary phlegm was vomited, wind signs stabilized, convulsions stopped, cough ceased, and night fever ended. The parents were relieved but noticed the child's emaciated constitution and believed spleen-stomach tonification was needed. They self-prescribed Lizhong Dihuang Tang (Regulate Middle and Rehmannia Decoction) for one dose. Unexpectedly, after some time, wind-movement and convulsions recurred. Upon examination, I learned that although the major illness had turned, cold-phlegm and evil Yin were not fully expelled. Premature tonification increased pathogenic factors and hindered the expulsion of Yin evil and internal cold-phlegm, causing recurrence of slow wind. The family then realized the dangers of inappropriate tonification. I continued with Zhuhan Dangjing Tang plus Fupian (Aconiti Lateralis Radix Praeparata) 15g. After feeding, another cup of salivary phlegm was vomited, followed by two passages of dark brown watery stool. Convulsions ceased, nursing resumed, and crying was heard. The original formula was modified by removing Baihujiao and Gongding, adding Renshen (Codonopsis Radix) 6g and Gancao (Glycyrrhizae Radix et Rhizoma) 6g, increasing Fupian to 30g, decocted and fed frequently. After two doses, all symptoms resolved.
Taiyang and Shaoin Simultaneous Cold Damage Syndrome
(Severe Common Cold)
Mr. Zhang, aged 42, residing at Nanlian Sheng Alley, Wumiao Xia, Kunming City, Yunnan Province. He had always deficient Kidney Qi. On September 2, 1929, during his return home in rainy weather, he contracted wind-cold. Initial symptoms included fever, aversion to cold, headache, body pain, lethargy and desire to sleep (similar to Shaoyin disease's "desire to sleep"), slight thirst preferring hot drinks, deep-fine-tight pulse.
Tongue coating was white and slippery; tongue body had bluish-purple tints. Due to inherent Kidney Qi deficiency and weak Kan-Yang (Kidney Yang), unable to defend the exterior against external pathogens, cold wind entered the Shaoyin directly through the deficiency, blocking the circulation of True Yang, resulting in this state. Zhang Zhongjing's Maxing Fuzi Tang (Ephedra, Asarum, and Prepared Aconite Decoction) was used to warm the channels, resolve the exterior, support healthy Qi, and eliminate pathogens.
Hei Fupian (Prepared Black Aconite Root) 36g, Mahuang (Ephedrae Herba) 10g (boiled first to remove foam), Beixin (Asari Radix et Rhizoma) 6g, Guizhi (Cinnamomi Ramulus) 13g.
On the 3rd day, after one dose, sweating occurred, and fever subsided. Only dizziness, cough, and mental timidity remained. Although the exterior pathogen was resolved, Lung cold was not cleared, and Yang Qi was still deficient. Sini Tang (Four Reversal Decoction) combined with Erchen Tang (Two Aged Things Decoction) plus Beixin and Wuweizi (Schisandrae Fructus) was used to support Yang and warm cold.
Hei Fupian 50g, Ganjiang (Zingiberis Rhizoma) 26g, Gancao 10g, Guangpi (Citri Reticulatae Pericarpium) 10g, Faxia (Pinelliae Rhizoma Preparatum) 13g, Fuling 13g, Beixin 4g, Wuweizi 2g.
After one dose, cough stopped immediately, appetite increased, spirit recovered, and the illness was cured.
Plague Disease Syndrome of Dry-Heat Internal Binding
Wife of Mr. Xie, surnamed Che, aged 18, residing in South Street, Huili County, Sichuan Province.
In March 1920, she contracted plague pathogenic factors. Two days into the illness, initial symptoms included fever with thirst, aversion to heat without aversion to cold, headache, body pain, floating-string-numerous pulse, red lips, dirty complexion, and white tongue coating like accumulated powder. Although early stage, the pathogen was not in the meridians. Sweating would damage exterior Qi and consume fluids, likely intensifying heat. This was plague pathogen lodging in the Mu Yuan (semi-interior/semi-exterior region), trending inward to transform into dryness and damage fluids. The strategy was to transport the Mu Yuan pathogen to the exterior for resolution, using Da Yuan Yin (Reach the Origin Drink) plus Shigao (Gypsum Fibrosum) as the main formula.
Bolang (Arecae Semen) 10g, Houpo (Magnoliae Officinalis Cortex) 10g, Caoguo (Tsaoko Fructus) 10g, Zhimu (Anemarrhenae Rhizoma) 12g, Hangshaoyao (Paeoniae Radix Alba) 12g, Huangqin (Scutellariae Radix) 10g, Gancao 6g, Sheng Shigao (Gypsum Fibrosum) 15g (crushed, cloth-wrapped).
After one dose, symptoms slightly decreased, but constipation for three days persisted. Therefore, Dahuang (Rhei Radix et Rhizoma) 12g was added to the previous formula, instructed to take immediately. The patient's father, knowing some medicine, believed the girl was constitutionally weak and feared intolerance to cold-purgative agents. He privately removed Dahuang and Shigao. Two days later, upon re-examination, the tongue coating turned yellow and dry, epigastric fullness and chest distension with tenderness and pain on pressure, irritability, thirst for cold drinks, short dark urine, persistent constipation, high fever unresolved, and occasional delirium. This indicated the pathogen had entered the Fu organs, with dry-heat binding. Only clearing-heat and purging could save the critical situation. Immediately, Baihu Jia Chengqi Tang (White Tiger Plus Chengqi Decoction) was prescribed. The father hesitated and refused administration. Suddenly, the patient suffered continuous epistaxis, bright red and heavy. Shortly after, the blood clotted. The family panicked and sought another TCM practitioner, Peng, who diagnosed Yang deficiency with blood loss, arguing that heat-induced epistaxis would not clot, and prescribed Sini Tang. The family doubted and hesitated, refusing to take it. They consulted me again. I explained firmly: This is a syndrome of extreme pathogenic heat scorching Yin. Urgent large-dose cooling purgation is needed to save True Yin; delay will lead to exhaustion of True Yin and critical danger. I also stated that even I, skilled in using Jiang (Zingiberis Rhizoma) and Fu (Aconiti Radix), dare not recklessly use warming agents here. With this syndrome, bitter-cold purgation might even be insufficient; mistakenly using warming agents would be like pouring oil on fire, leading to immediate death. Persuaded by my insistence, the family agreed, and a cooling purgative formula was prescribed.
Sheng Shigao 60g (crushed, cloth-wrapped), Sheng Dahuang 30g (soaked, mixed in), Zhishi (Aurantii Fructus Immaturus) 20g (crushed), Houpo 20g, Mangxiao (Natrii Sulfas) 13g, Zhimu 20g, Shengdi (Rehmanniae Radix) 16g, Gancao 6g.
After continuous day-and-night intake, epistaxis stopped, consciousness cleared, and fever reduced by 60-70%. The next day, another dose of the original formula was taken, resulting in free urination and defecation, calm pulse, cool body, but still craving cold drinks due to residual heat and unrecovered fluids. Shengmai San (Generate Pulse Powder) plus modifications was taken for three doses, stopping thirst and restoring oral moisture. Subsequently, Shigao and Dahuang were removed, and three more doses were taken for complete recovery.
Shashen (Glehniae Radix) 30g, Maidong (Ophiopogonis Radix) 13g, Wuweizi 6g, Danggui (Angelicae Sinensis Radix) 16g, Shengdi 16g, Hangshaoyao 16g, Shigao 16g, Dahuang 6g.
Plague Disease Yangming Dry-Heat Excess Syndrome
Mr. Li, male, aged 25, farmer in Southern Township, Huili County, Sichuan Province. Contracted seasonal epidemic in March 1921. Fever persisted for twelve days without relief. Pulse was surging-numerous; tongue coating was yellow-black with prickles; lips were cracked, teeth dry, breath hot to touch; fever intensified in the afternoon with continuous sweating; delirium, irritability, inability to lie still. Urine was short and dark. No bowel movement for over ten days since onset. Abdominal distension and fullness from epigastrium to lower abdomen, groaning in pain, tenderness on pressure, difficulty turning while supine, refusal of food, only irritability and thirst for cold drinks. At this point, pathogenic heat was extreme, Yin fluids exhausted, dry feces bound internally, and all Yangming purgation indications were present. Urgent purgation was needed to save Yin; delay meant critical danger. Considering prolonged high heat and hard dry feces without Yin fluid lubrication, like a boat lacking water, pathogenic heat and dryness had no outlet. Urgent purgation combined with Yin-nourishing and fluid-generating agents was required. Modified Huanglong Tang (Yellow Dragon Decoction) was prescribed.
Turenshen (Codonopsis Radix / Panax Ginseng substitute) 30g, Danggui 26g, Shengdi 16g, Dahuang 16g (soaked, mixed in).
Mangxiao 10g (added later), Zhishi 16g, Houpo 16g, Sheng Shigao 26g (crushed, cloth-wrapped).
That night, after ingestion, the patient desired defecation but struggled significantly. Straining produced a segment of dry feces slowly, about one chi long, hard and unbroken, sauce-black in color.
I personally examined it; truly hard as a whip. Next morning, pulse was more harmonious, fever reduced by half, tongue prickles softened, oral moisture slightly returned, abdominal distension and pain greatly reduced, still craving cold drinks. Instructed to take another dose of the original formula. On the third day, bowel movements were smooth, stool turned yellow and soft. Pulse was calm, body cool, able to eat rice porridge. Tongue coating had receded by half, fluids regenerated, but still preferred cold drinks, indicating initial heat subsidence and incomplete Yin fluid recovery. Shengmai San plus modifications was prescribed to nourish Yin, generate fluids, and clear residual heat.
Shashen 26g, Cundong (Ophiopogonis Radix) 16g, Wuweizi 3g, Gancao 6g, Shengdi 16g.
Xuanshen (Scrophulariae Radix) 13g, Huanglian (Coptidis Rhizoma) 5g.
After two doses, Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) was used to regulate the Yin aspect, recovering after one or two doses.
Shengdi 26g, Fudanpi (Moutan Cortex) 10g, Zaopi (Corni Fructus) 10g, Huaiyao (Dioscoreae Rhizoma) 13g, Fuling 13g, Zexie (Alismatis Rhizoma) 10g.
Plague Disease Yangming Urgent Purgation Syndrome
Father of Mr. Chen, farmer in Niushangkhan, Luchang, Huili County, Sichuan Province. Although sixty years old, constitution was generally robust. In early April 1916, visiting a neighboring village during an epidemic outbreak, he became infected. Returning home, after a few days, he suddenly felt chest oppression, poor appetite, dizziness, body fatigue, dry mouth desiring drink, initiating illness. Initially felt chilling aversion to cold, followed by fever, thirst for cold drinks, head and body pain, scanty tea-colored urine. Bedridden for seven to eight days, self-administered two doses of exterior-releasing and digestion-promoting medicines with no effect, then sought my consultation. Pulse was surging-numerous; lips cracked, mouth dry; tongue coating thick and greasy, white edges, yellow center with prickles. Sweating only on the head, no sweat elsewhere; high fever, irritability, thirst for cold drinks, occasional delirium; scanty difficult urination with involuntary dribbling. No bowel movement for six to seven days; abdominal fullness preventing eating. This was plague mishandled by exterior-releasing methods, severely damaging True Yin. Epidemic toxin transmitted to the Yangming Fu organs, with internal steaming of pathogenic heat. Urgent cooling purgation was needed to save True Yin. Zhang Zhongjing's Dachengqi Tang (Major Order the Qi Decoction) plus Shigao and Cundong was prescribed for urgent purgation to save Yin, akin to removing firewood from under the pot, aiming to purge all pathogenic heat and epidemic toxin from the stomach and intestines.
Dahuang 16g (soaked, mixed in), Mangxiao 3g (added later), Zhishi 13g (stir-fried, crushed).
Houpo 13g (stir-fried), Sheng Shigao 30g (crushed, cloth-wrapped), Cundong 26g.
After three decoctions and administrations, profuse passage of black sauce-like stool amounting to half a small bucket, extremely foul-smelling. Fever reduced by 70-80%, oral moisture gradually returned, tongue prickles softened, delirium ceased, urination no longer dribbled, becoming slightly clear and long, though still yellow, still craving cold drinks. Immediately provided a bowl of ice-cold water from a stone jar. After drinking, the patient reported feeling refreshed internally. After a second bowl, whole-body coolness ensued, allowing peaceful sleep. Residual heat remaining, Xiao Chengqi Tang (Minor Order the Qi Decoction) plus clearing-heat, nourishing-Yin, and generating-fluid agents was prescribed subsequently.