三诊：烧热轻减，白痦续出，饮水减少，纳增，二便通畅，鼻仍微衄。咳嗽浙宣，痰凝，耳听失聪。脉弦滑而数，舌转润，苔黄渐退。此伏邪由里达表，营分积热由气分外透，再拟滋阴清热，宣肺化痰之方：
黑玄参9克 大寸冬9克 白茅根13克 冬桑叶9克 川贝
母6克(冲) 广连翘6克 金银花6克 生甘草3克 竹茹
6克 鸡内金2枝(烧)
四诊：上方连服二剂，烧热甫退，鼻衄止，咳嗽已宣，略出多量浓痰。全身白痦渐退，二便正常。纳佳，脉细弦而滑，舌润苔薄。此伏邪将尽，肺燥余热不清，续用下方：
细生地9克 黑玄参3克 大寸冬9克 吴白芷9克 川贝
母4．5克(冲) 白茯苓12克 金银花6克广连翘6克冬
桑叶9克生甘草3克生苡仁12克鸡内金2枚《烧)
五诊：烧热退净，咳减，痰少。白痦脱屑，积之盈捧，听聪已复。脉象转现和缓，舌红润有津。再用滋养调理之方。
细生地9克 淮山药9克 白茯苓12克 炒杭芍9克 红饭
豆12克(冲) 绿小豆9克(冲) 炒苡仁12克 广桔络6克
净杷叶3片 冬桑叶9克丝瓜络6克生甘草3克
[按]症由腹胀便秘，壮热后又息满唇焦，面垢齿燥，神昏谵语，是病势趋由卫气渐传入营，似当清营透热，惟阳明腑积不通，三焦气化壅闭，故涤荡腑实为当务之急，遂用寒凉通导佐以清心化热，宣达肺气，兼顾其表。药后大便通畅，鼻衄，并且周身发出白痦，因而三焦气化得到枢转，病邪由营转气外透，实属佳兆。后再拟健脾化痰，清络育阴之品，调理善后。
内 科
虚痨烧
周××，男，十三岁，学生，住昆明市财神巷。1930年4月。
初诊：患者病经七、八月，初期畏寒发热，曾按疟疾治疗未减。继见烧热连绵，咳嗽、声嘶、痰血、鼻衄、胸胁牵痛，自汗、盗汗、日燥思饮等症，又杂进寒热补泻之方多剂，病情加剧，奄奄一息，家属焦急，延余诊治。
时见患者卧床不起，精神萎糜，形容憔悴，面赤唇干，咳嗽、痰中带血，声音嘶哑，日晡及夜间潮烧、盗汗，食少思饮。大便旬日始一行，小便短赤。脉象乍按弦数，有时反现濡滑且芤。舌干红，如镜面。
此缘病邪久羁少阳，烧热日久，气津两伤，灼及真阴，肺燥胆热，脾弱肝旺，病属虚痨。治当首重枢转，清热润燥，兼固气阴，扶正除邪。拟方；
胆炒柴胡6克醋炒法夏9克酒炒黄芩4-5克 醋炙别甲
12克 醋炒青蒿6克 鲜白茅根30克 大寸冬9克 地骨皮
9克 炒杭芍6克 生甘草3克 白人参6克(另煨兑服) 另
用粳米60克 煎汤代水煨药。每服兑入梨、藕汁各一匙
二诊：上方服两剂，面赤、潮烧略退，咳嗽、痰血、鼻衄较减，但咳时胸胁牵痛，自汗盗汗未止，便秘、溺黄。口燥未除，思饮，食少。脉弦数而滑，芤象渐减。舌仍干红、如镜面。病势非轻，治则仍守原意。处方：
白人参6克(另煨兑服) 胆炒柴胡6克 炒杭芍6克 酒炒
知母6克广桔络6克醋炒法夏9克 酒炒黄芩4．5克 醋
炙别甲12克 醋炒青蒿4．5克 地骨皮9克 鲜自茅根30克
小红枣5枚生甘草3克
三诊：上方服三剂，面赤及脯、夜烧热较退，咳减，痰血、鼻衄已止，自汗盗汗渐收，思饮亦减，声嘶渐宣。食少，形容仍憔悴，大便尚秘，溺仍黄。脉弦滑微数、芤象已无。
舌上渐布津液，微有薄苔。此证得枢机，气津渐回，但病久阴虚，内热难尽，况脾胃失调，肠燥不润。亟宜益气养阴，清热润燥。处方：
白人参6克(另煨兑服) 空沙参9克 大寸冬9克 干地黄
9克 醋炙别甲9克 银柴胡6克 炒知母4．5克 地骨皮
9克生甘草3克五仁丸一丸、生蜂蜜一匙调服
四诊：上方服三剂，烧热退，便秘亦通，溺黄转淡，自汗盗汗收敛。咳少，声嘶渐复，口中和，思饮食，面色转现苍白，仍消瘦。脉滑缓无力，舌红、苔薄白有津。此属病退，气血两虚，心脾不足，宜再滋养调理。处方：
苏条参6克 空沙参6克 大寸冬9克 全当归12克 炒淮
药9克 炒杭芍6克 广桔络6克地骨皮9克云茯神12克
甜杏仁6克 炙甘草3克 建莲子9克(去心) 炒黑小豆
9克
五诊：上方服三剂后，诸症悉去。饮食日渐增加，精神较振，仅肌肤瘦弱，颜面苍白。病至此，已由险境转入坦途。
赓续下方，调补滋养，病遂全瘥。处方：
苏条参6克 空沙参6克 全当归12g 炒杭芍6克 云茯
神12克 建莲子9克(去心) 炙杷叶3片 炙甘草3克 小
红枣9枚 炒黑小豆9克 东阿胶15克(烊化兑服)
[按]首从少阳枢转和解，抓住病机变化的主要矛盾。方中用胆炒的柴胡，醋炒的半夏、别甲，酒炒的黄芩、知母等品，是别出心裁；以苦辛宣泄，舒运肝胆，佐酸甘化阴，释开合之机，拓除羁伏已久之病邗。后连连扶正，滋润津液气血，遂起沉疴。
阴虚潮烧
郭××，女，二十五岁，昆明市人。1938年秋。
初诊：初病寒热，自服解表剂，恶寒止而热不退，日晡尤甚。复进小柴胡、栀豉、自虎等方，病势有增无减。诊见面黄肌瘦，形容枯槁，食少，喉干口燥，微咳夜烦，午后潮烧。便秘，溺短赤。继询患者，素月经不调，量少色黑。脉象细弦而数，舌质红，苔黄燥少津。症属血虚肺燥，乃木火刑金，阴津受损所致。宜养阴润肺清热以治。处方：
白元参9克 炒知母6克 大寸冬9克 炒杭芍9克 金石
斛9克 白茯神15克 粉丹皮6克 地骨皮9克 细生地12克
银柴胡6克 白薇4．5克竹茹6克 甘草3克
二诊：上方服三剂，口舌较润，潮烧略退，咳嗽痰凝，烦躁自汗。仍宗原意拟方：
细生地12克粉丹皮6克炒杭芍9克茯神木isg白元
参9克大寸冬9克炒知母6克 生甘草3克 枣皮6克
白薇6克川贝母9克净枇杷叶3片
三诊：上方连进五剂，潮烧已退，咳减，痰凝渐涤，神色转佳，二便正常。脉平舌润。此阴复热化，症趋坦途。续用养血育阴，以资巩固。处方：
细生地12克全当归12克炒杭芍9克 川芎片6克粉丹
皮6克枣皮6克空沙参9克 大寸冬9克 甘草3克
黑豆15克 莲子15克(去心) 净枇杷叶3片
上方服十余剂后，病全愈。月经量亦增加，色转红。乃嘱每月经期前后，照上方配服，增益气血。
[按]以阴血素虚之体受邪，其热非发汗清凉所能解除。
内经云：“阴虚生内热”，热自阴来，须当养阴，阴不回则热亦不去。养阴与清热二法，虽互相关，但各具不同之性质。本案先用养阴以清热，后用滋血以固阴。
虚痨咳烧
金××，女，五十三岁，家住昆明市。1943年。
初诊：患咳，烧数年不瘥，时作时止。余视其形瘦肌消，唇干，颧红，声嘶不扬。询悉孀居多年，操劳过甚，素常极易伤风感冒。病发时胸闷气促，痰凝不爽，且痰中有血丝夹带，潮烧自汗，口中干燥。自述生平不喜辛燥、温补之药，而清热之品已服多剂，罔然无效。所幸者食欲善佳，夜能安卧。
脉象乍取弦滑而数，重候则虚，舌质红，苔白燥少津。
此因过劳，精气有伤，外邪入侵，肺先受病，兼因肝郁化热，木火刑金，久则血弱阴亏娇脏失润，至成虚痨之疾。金匮云：“脉大为劳。脉极虚亦为劳。”此之谓也。亟宜清燥救肺，养肝调理。处方：
炙麻黄根6克 苏梗片9克 光杏仁9克 广桔络6克 京
半夏9克 炒杭芍9克 茯苓神15克 生甘草3克 藕干
4．5克竹茹6克冬瓜子9克(冲) 白茅根12克 净杷叶
2片
二诊：上方三剂，咳嗽略减，气促稍平。余症仍然，便秘溺黄。续用原方化裁。处方：
白元参9克 大寸冬9克 炒杭芍9克 茯苓神15克 瓜蒌
壳9克光杏仁9克冲苏子9克 生甘草3克 竹茹6克
白茅根1 2克 藕干4．5克 浮小麦15克 薏苡仁12克 净杷
叶2片
三诊：上方连进五剂，潮烧、自汗已减，痰中血丝减少。
咳时偶感胁痛，尚觉口干。便秘渐润，溺色转淡。脉细弦而滑，舌红，苔薄较润。仍守原意，酌加滋润之品。处方：
甜桔梗6克川贝母9克 白茅根15克生杭芍9克炙紫
苑9克炙冬花9克瓜萎壳9克大寸冬9克生甘草3克
冬桑叶9克银柴胡9克新鲜梨、藕汁每服调兑各一匙。
四诊：上方续进五剂，潮烧已退，痰血已止，口燥渐除。
时咳嗽，头昏神倦。此燥邪得清，气阴渐调润。再拟下方：
空沙参9克麦门冬9克冲苏子6克光杏仁9克川贝母
9克 炙冬花9克 炒杭芍9克 京半夏9克 广桔络6克
生甘草3克 冬桑叶9克 茯苓神15克 白茅根15克 生苡
仁12克净杷叶2片
五诊：上方服用十剂，诸症消失，脉象转为缓弱，舌苔红润。病势向愈，赓续滋益脾肺，调血养肝。处方：
空沙参9克 自元参9克淮山药12克茯苓神15克京半
夏9克 广桔络6克 炒杭芍9克黑小豆15克净杷叶2片
莲子15克 炙冬花6克 炙甘草3克 二冬羔、雪梨羔，
每服各调兑一小匙为引。
[按]虚痨既成，而肺燥气郁，痰热之势嚣张，攻补皆误。以清燥救肺法出入变化，缓症缓治，看之平淡，行之实难。
三诊：发热减轻，白痦（一种细小的白色疱疹）继续出现，饮水量减少，食欲增加，大小便通畅，但鼻子仍有轻微出血。咳嗽逐渐缓解，痰液粘稠，听力下降。脉象弦滑而数，舌面转润，黄苔逐渐消退。这是伏邪由里出表，营分积热通过气分外透，再拟定滋阴清热、宣肺化痰的方剂：
黑玄参9克 大寸冬9克 白茅根13克 冬桑叶9克 川贝母6克(冲服) 广连翘6克 金银花6克 生甘草3克 竹茹6克 鸡内金2枝(烧焦)
四诊：上方连续服用两剂后，发热刚退，鼻衄停止，咳嗽已缓解，排出较多浓痰。全身白痦逐渐消退，大小便正常。食欲好，脉象细弦而滑，舌润苔薄。这是伏邪将尽，肺燥余热未清，继续使用下方：
细生地9克 黑玄参3克 大寸冬9克 吴白芷9克 川贝母4.5克(冲服) 白茯苓12克 金银花6克 广连翘6克 冬桑叶9克 生甘草3克 生苡仁12克 鸡内金2枚(烧焦)
五诊：发热完全退去，咳嗽减轻，痰少。白痦脱屑，堆积满捧，听力已恢复。脉象转为和缓，舌红润有津液。再用滋养调理的方剂。
细生地9克 淮山药9克 白茯苓12克 炒杭芍9克 红饭豆12克(冲服) 绿小豆9克(冲服) 炒苡仁12克 广桔络6克 净杷叶3片 冬桑叶9克 丝瓜络6克 生甘草3克
[按]症状起因于腹胀便秘，壮热之后又出现胸闷唇焦，面色污垢牙齿干燥，神志昏迷胡言乱语，这是病势由卫气渐传入营分，似乎应当清营透热，惟独阳明腑实积滞不通，三焦气化壅闭，所以涤荡腑实是当务之急，于是用寒凉通导药佐以清心化热，宣达肺气，兼顾其表。服药后大便通畅，鼻衄，并且周身发出白痦，因而三焦气化得到枢转，病邪由营转气外透，实属佳兆。后再拟定健脾化痰、清络育阴的药物，调理善后。
内科
虚劳烧
周××，男，十三岁，学生，住昆明市财神巷。1930年4月。
初诊：患者患病经过七、八个月，初期畏寒发热，曾按疟疾治疗未减。继见发热连绵，咳嗽、声嘶、痰中带血、鼻衄、胸胁牵痛，自汗、盗汗、口干思饮等症状，又杂进寒热补泻之方多剂，病情加剧，奄奄一息，家属焦急，延请余诊治。
时见患者卧床不起，精神萎靡，形容憔悴，面赤唇干，咳嗽、痰中带血，声音嘶哑，日晡及夜间潮热、盗汗，食少思饮。大便旬日始一行，小便短赤。脉象乍按弦数，有时反现濡滑且芤。舌干红，如镜面。
这是因为病邪久羁留于少阳，发热日久，气津两伤，灼伤真阴，肺燥胆热，脾弱肝旺，病属虚劳。治当首重枢转，清热润燥，兼固气阴，扶正除邪。拟方：
胆炒柴胡6克 醋炒法夏9克 酒炒黄芩4-5克 醋炙别甲12克 醋炒青蒿6克 鲜白茅根30克 大寸冬9克 地骨皮9克 炒杭芍6克 生甘草3克 白人参6克(另煨兑服) 另用粳米60克 煎汤代水煨药。每服兑入梨、藕汁各一匙
二诊：上方服两剂，面赤、潮热略退，咳嗽、痰血、鼻衄较减，但咳时胸胁牵痛，自汗盗汗未止，便秘、溺黄。口燥未除，思饮，食少。脉弦数而滑，芤象渐减。舌仍干红、如镜面。病势非轻，治则仍守原意。处方：
白人参6克(另煨兑服) 胆炒柴胡6克 炒杭芍6克 酒炒知母6克 广桔络6克 醋炒法夏9克 酒炒黄芩4.5克 醋炙别甲12克 醋炒青蒿4.5克 地骨皮9克 鲜白茅根30克 小红枣5枚 生甘草3克
三诊：上方服三剂，面赤及午后、夜间发热较退，咳减，痰血、鼻衄已止，自汗盗汗渐收，思饮亦减，声嘶渐宣。食少，形容仍憔悴，大便尚秘，溺仍黄。脉弦滑微数、芤象已无。舌上渐布津液，微有薄苔。此证得枢机，气津渐回，但病久阴虚，内热难尽，况脾胃失调，肠燥不润。亟宜益气养阴，清热润燥。处方：
白人参6克(另煨兑服) 空沙参9克 大寸冬9克 干地黄9克 醋炙别甲9克 银柴胡6克 炒知母4.5克 地骨皮9克 生甘草3克 五仁丸一丸、生蜂蜜一匙调服
四诊：上方服三剂，发热退，便秘亦通，溺黄转淡，自汗盗汗收敛。咳少，声嘶渐复，口中和，思饮食，面色转现苍白，仍消瘦。脉滑缓无力，舌红、苔薄白有津。此属病退，气血两虚，心脾不足，宜再滋养调理。处方：
苏条参6克 空沙参6克 大寸冬9克 全当归12克 炒淮药9克 炒杭芍6克 广桔络6克 地骨皮9克 云茯神12克 甜杏仁6克 炙甘草3克 建莲子9克(去心) 炒黑小豆9克
五诊：上方服三剂后，诸症悉去。饮食日渐增加，精神较振，仅肌肤瘦弱，颜面苍白。病至此，已由险境转入坦途。
赓续下方，调补滋养，病遂全瘥。处方：
苏条参6克 空沙参6克 全当归12g 炒杭芍6克 云茯神12克 建莲子9克(去心) 炙杷叶3片 炙甘草3克 小红枣9枚 炒黑小豆9克 东阿胶15克(烊化兑服)
[按]首先从少阳枢转和解入手，抓住病机变化的主要矛盾。方中用胆炒的柴胡，醋炒的半夏、别甲，酒炒的黄芩、知母等品，是别出心裁；以苦辛宣泄，舒运肝胆，佐酸甘化阴，释开合之机，拓除羁伏已久之病邪。后连连扶正，滋润津液气血，遂起沉疴。
阴虚潮热
郭××，女，二十五岁，昆明市人。1938年秋。
初诊：初病寒热，自服解表剂，恶寒止而热不退，日晡尤甚。复进小柴胡、栀豉、白虎等方，病势有增无减。诊见面黄肌瘦，形容枯槁，食少，喉干口燥，微咳夜烦，午后潮热。便秘，溺短赤。继询患者，素月经不调，量少色黑。脉象细弦而数，舌质红，苔黄燥少津。症属血虚肺燥，乃木火刑金，阴津受损所致。宜养阴润肺清热以治。处方：
白元参9克 炒知母6克 大寸冬9克 炒杭芍9克 金石斛9克 白茯神15克 粉丹皮6克 地骨皮9克 细生地12克 银柴胡6克 白薇4.5克 竹茹6克 甘草3克
二诊：上方服三剂，口舌较润，潮热略退，咳嗽痰凝，烦躁自汗。仍宗原意拟方：
细生地12克 粉丹皮6克 炒杭芍9克 茯神木15克 白元参9克 大寸冬9克 炒知母6克 生甘草3克 枣皮6克 白薇6克 川贝母9克 净枇杷叶3片
三诊：上方连进五剂，潮热已退，咳减，痰凝渐涤，神色转佳，二便正常。脉平舌润。此阴复热化，症趋坦途。续用养血育阴，以资巩固。处方：
细生地12克 全当归12克 炒杭芍9克 川芎片6克 粉丹皮6克 枣皮6克 空沙参9克 大寸冬9克 甘草3克 黑豆15克 莲子15克(去心) 净枇杷叶3片
上方服十余剂后，病全愈。月经量亦增加，色转红。乃嘱每月经期前后，照上方配服，增益气血。
[按]以阴血素虚之体受邪，其热非发汗清凉所能解除。
内经云：“阴虚生内热”，热自阴来，须当养阴，阴不回则热亦不去。养阴与清热二法，虽互相关，但各具不同之性质。本案先用养阴以清热，后用滋血以固阴。
虚劳咳热
金××，女，五十三岁，家住昆明市。1943年。
初诊：患咳，发热数年不瘥，时作时止。余视其形瘦肌消，唇干，颧红，声嘶不扬。询悉孀居多年，操劳过甚，素常极易伤风感冒。病发时胸闷气促，痰凝不爽，且痰中有血丝夹带，潮热自汗，口中干燥。自述生平不喜辛燥、温补之药，而清热之品已服多剂，罔然无效。所幸者食欲善佳，夜能安卧。
脉象乍取弦滑而数，重候则虚，舌质红，苔白燥少津。
此因过劳，精气有伤，外邪入侵，肺先受病，兼因肝郁化热，木火刑金，久则血弱阴亏娇脏失润，至成虚劳之疾。金匮云：“脉大为劳。脉极虚亦为劳。”此之谓也。亟宜清燥救肺，养肝调理。处方：
炙麻黄根6克 苏梗片9克 光杏仁9克 广桔络6克 京半夏9克 炒杭芍9克 茯苓神15克 生甘草3克 藕干4.5克 竹茹6克 冬瓜子9克(冲服) 白茅根12克 净杷叶2片
二诊：上方三剂，咳嗽略减，气促稍平。余症仍然，便秘溺黄。续用原方化裁。处方：
白元参9克 大寸冬9克 炒杭芍9克 茯苓神15克 瓜蒌壳9克 光杏仁9克 冲苏子9克 生甘草3克 竹茹6克 白茅根12克 藕干4.5克 浮小麦15克 薏苡仁12克 净杷叶2片
三诊：上方连进五剂，潮热、自汗已减，痰中血丝减少。咳时偶感胁痛，尚觉口干。便秘渐润，溺色转淡。脉细弦而滑，舌红，苔薄较润。仍守原意，酌加滋润之品。处方：
甜桔梗6克 川贝母9克 白茅根15克 生杭芍9克 炙紫菀9克 炙冬花9克 瓜蒌壳9克 大寸冬9克 生甘草3克 冬桑叶9克 银柴胡9克 新鲜梨、藕汁每服调兑各一匙。
四诊：上方续进五剂，潮热已退，痰血已止，口燥渐除。时咳嗽，头昏神倦。此燥邪得清，气阴渐调润。再拟下方：
空沙参9克 麦门冬9克 冲苏子6克 光杏仁9克 川贝母9克 炙冬花9克 炒杭芍9克 京半夏9克 广桔络6克 生甘草3克 冬桑叶9克 茯苓神15克 白茅根15克 生苡仁12克 净杷叶2片
五诊：上方服用十剂，诸症消失，脉象转为缓弱，舌苔红润。病势向愈，赓续滋益脾肺，调血养肝。处方：
空沙参9克 白元参9克 淮山药12克 茯苓神15克 京半夏9克 广桔络6克 炒杭芍9克 黑小豆15克 净杷叶2片 莲子15克 炙冬花6克 炙甘草3克 二冬羔、雪梨羔，每服各调兑一小匙为引。
Third visit: Fever subsided, milia (a type of small, crystalline vesicular rash) continued to appear, water intake decreased, appetite increased, bowel and bladder movements were smooth, but slight epistaxis persisted. Cough gradually alleviated, sputum was sticky, and hearing loss occurred. The pulse was wiry, slippery, and rapid; the tongue surface became moist, and yellow coating gradually receded. This indicates that latent pathogenic factors are moving from the interior to the exterior, with accumulated heat in the Ying (Nutritive) level penetrating outward through the Qi (Defensive) level. A prescription for nourishing Yin, clearing heat, diffusing Lung Qi, and resolving phlegm is proposed:
Black Scrophulariae Radix (Xuan Shen) 9g, Large Ophiopogonis Tuber (Mai Dong) 9g, White Imperata Rhizome (Bai Mao Gen) 13g, Mulberry Leaf (Sang Ye) 9g, Fritillariae Bulbus (Chuan Bei Mu) 6g (taken with decoction), Forsythiae Fructus (Lian Qiao) 6g, Lonicerae Japonicae Flos (Jin Yin Hua) 6g, Raw Glycyrrhizae Radix et Rhizoma (Sheng Gan Cao) 3g, Bamboo Shavings (Zhu Ru) 6g, Chicken Gizzard Lining (Ji Nei Jin) 2 branches (charred).
Fourth visit: After taking two doses of the above prescription, fever just subsided, epistaxis stopped, cough had resolved, and a large amount of thick sputum was expectorated. Whole-body milia gradually receded, bowel and bladder movements were normal. Appetite was good, pulse was fine, wiry, and slippery, tongue was moist with thin coating. This indicates that latent pathogens are nearly exhausted, but Lung dryness and residual heat remain unclear. Continue with the following prescription:
Rehmanniae Radix Preparata (Shu Di Huang) 9g, Black Scrophulariae Radix (Xuan Shen) 3g, Large Ophiopogonis Tuber (Mai Dong) 9g, Angelicae Dahuricae Radix (Bai Zhi) 9g, Fritillariae Bulbus (Chuan Bei Mu) 4.5g (taken with decoction), Poria (Fu Ling) 12g, Lonicerae Japonicae Flos (Jin Yin Hua) 6g, Forsythiae Fructus (Lian Qiao) 6g, Mulberry Leaf (Sang Ye) 9g, Raw Glycyrrhizae Radix et Rhizoma (Sheng Gan Cao) 3g, Coix Seed (Yi Yi Ren) 12g, Chicken Gizzard Lining (Ji Nei Jin) 2 pieces (charred).
Fifth visit: Fever completely subsided, cough reduced, sputum scant. Milia desquamated, accumulating in handfuls, hearing restored. Pulse became harmonious and moderate, tongue red and moist with fluids. Use another prescription for nourishment and regulation:
Rehmanniae Radix Preparata (Shu Di Huang) 9g, Dioscoreae Rhizoma (Huai Shan Yao) 9g, Poria (Fu Ling) 12g, Paeoniae Radix Alba (Bai Shao) stir-fried 9g, Red Rice Bean (Hong Fan Dou) 12g (taken with decoction), Green Mung Bean (Lv Xiao Dou) 9g (taken with decoction), Coix Seed (Yi Yi Ren) stir-fried 12g, Citri Reticulatae Pericarpium Viride (Ju Luo) 6g, Purified Loquat Leaf (Pi Ye) 3 slices, Mulberry Leaf (Sang Ye) 9g, Luffae Fructus Retinervia (Si Gua Luo) 6g, Raw Glycyrrhizae Radix et Rhizoma (Sheng Gan Cao) 3g.
[Commentary] Symptoms originated from abdominal distension and constipation, followed by high fever, chest fullness, dry lips, dirty face, dry teeth, delirium, and unconsciousness. This indicates the disease trend moving from Wei (Defensive) and Qi levels gradually into Ying (Nutritive) level. It seems appropriate to clear Ying level and vent heat. However, since Yangming Fu organ accumulation is unblocked and San Jiao (Triple Burner) Qi transformation is obstructed, purging Fu excess becomes the urgent priority. Thus, cold-natured purgatives were used assisted by heart-clearing and heat-resolving herbs, diffusing Lung Qi, while attending to the exterior. After medication, bowel movements became smooth, epistaxis occurred, and whole-body milia erupted. Consequently, San Jiao Qi transformation was pivoted, and pathogens moved from Ying to Qi level to vent outward, which is indeed a favorable sign. Subsequently, prescriptions for strengthening Spleen, resolving phlegm, clearing collaterals, and nourishing Yin were used for recovery and aftercare.
Internal Medicine
Consumptive Fever
Zhou XX, Male, 13 years old, Student, residing at Caishen Lane, Kunming City. April 1930.
First visit: The patient had been ill for seven or eight months. Initially, there was aversion to cold and fever, treated as malaria without improvement. Subsequently, continuous fever, cough, hoarseness, blood-streaked sputum, epistaxis, chest and hypochondriac pulling pain, spontaneous sweating, night sweats, dry mouth with desire for drink appeared. Multiple prescriptions of cold, hot, tonifying, and purgative herbs were taken indiscriminately, aggravating the condition until the patient was on the verge of death. Family anxious, sought my treatment.
The patient was seen bedridden, spirit listless, appearance haggard, face red, lips dry, cough with blood-streaked sputum, hoarse voice, tidal fever at sunset and at night, night sweats, poor appetite with desire for drink. Bowel movement once every ten days, urine short and red. Pulse felt wiry and rapid initially, sometimes appearing soggy, slippery, and knotted (Kou). Tongue dry and red, like a mirror surface.
This is due to pathogenic factors lingering in Shaoyang (Lesser Yang) for a long time, prolonged fever injuring both Qi and fluids, scorching True Yin, causing Lung dryness and Gallbladder heat, weak Spleen and hyperactive Liver. The disease belongs to Consumption (Xu Lao). Treatment should first focus on pivoting mechanism, clearing heat, moistening dryness, simultaneously consolidating Qi and Yin, supporting healthy Qi to eliminate pathogens. Prescription:
Gallbladder-fried Bupleuri Radix (Chai Hu) 6g, Vinegar-processed Pinelliae Rhizoma (Fa Ban Xia) 9g, Wine-fried Scutellariae Radix (Huang Qin) 4-5g, Vinegar-processed Testudinis Carapax et Plastrum (Bie Jia) 12g, Vinegar-processed Artemisiae Annuae Herba (Qing Hao) 6g, Fresh Imperata Rhizome (Bai Mao Gen) 30g, Large Ophiopogonis Tuber (Mai Dong) 9g, Cortex Lycii (Di Gu Pi) 9g, Paeoniae Radix Alba (Bai Shao) stir-fried 6g, Raw Glycyrrhizae Radix et Rhizoma (Sheng Gan Cao) 3g, White Ginseng Radix et Rhizoma (Ren Shen) 6g (simmered separately and mixed in). Additionally, use 60g Coix Seed (Jing Mi) decocted as water to simmer medicine. Each dose mixed with one spoonful of pear juice and lotus root juice.
Second visit: After two doses of the above prescription, facial redness and tidal fever slightly subsided, cough, blood-streaked sputum, and epistaxis reduced, but chest and hypochondriac pulling pain during coughing persisted, spontaneous and night sweats did not stop, constipation and yellow urine remained. Dry mouth and desire for drink persisted, poor appetite. Pulse wiry, rapid, and slippery, knotted sensation gradually decreasing. Tongue still dry and red, like a mirror surface. Disease severity is not light, treatment principle remains original intent. Prescription:
White Ginseng Radix et Rhizoma (Ren Shen) 6g (simmered separately and mixed in), Gallbladder-fried Bupleuri Radix (Chai Hu) 6g, Paeoniae Radix Alba (Bai Shao) stir-fried 6g, Wine-fried Anemarrhenae Rhizoma (Zhi Mu) 6g, Citri Reticulatae Pericarpium Viride (Ju Luo) 6g, Vinegar-processed Pinelliae Rhizoma (Fa Ban Xia) 9g, Wine-fried Scutellariae Radix (Huang Qin) 4.5g, Vinegar-processed Testudinis Carapax et Plastrum (Bie Jia) 12g, Vinegar-processed Artemisiae Annuae Herba (Qing Hao) 4.5g, Cortex Lycii (Di Gu Pi) 9g, Fresh Imperata Rhizome (Bai Mao Gen) 30g, Small Red Dates (Xiao Hong Zao) 5 pieces, Raw Glycyrrhizae Radix et Rhizoma (Sheng Gan Cao) 3g.
Third visit: After three doses of the above prescription, facial redness and afternoon/evening fever relatively subsided, cough reduced, blood-streaked sputum and epistaxis stopped, spontaneous and night sweats gradually ceased, desire for drink decreased, hoarseness gradually improved. Poor appetite, appearance still haggard, bowel still constipated, urine still yellow. Pulse wiry, slippery, slightly rapid, knotted sensation gone. Tongue gradually covered with fluids, slight thin coating. This case has accessed the pivot mechanism, Qi and fluids gradually returning, but due to prolonged illness and Yin deficiency, internal heat is hard to exhaust. Moreover, Spleen and Stomach dysfunction leads to intestinal dryness. Urgently need to tonify Qi, nourish Yin, clear heat, and moisten dryness. Prescription:
White Ginseng Radix et Rhizoma (Ren Shen) 6g (simmered separately and mixed in), Empty Adenophorae Radix (Kong Sha Shen) 9g, Large Ophiopogonis Tuber (Mai Dong) 9g, Dry Rehmanniae Radix (Sheng Di Huang) 9g, Vinegar-processed Testudinis Carapax et Plastrum (Bie Jia) 9g, Silver Bupleuri Radix (Yin Chai Hu) 6g, Stir-fried Anemarrhenae Rhizoma (Zhi Mu) 4.5g, Cortex Lycii (Di Gu Pi) 9g, Raw Glycyrrhizae Radix et Rhizoma (Sheng Gan Cao) 3g. One pill of Five Seeds Pill (Wu Ren Wan) and one spoonful of raw honey mixed for administration.
Fourth visit: After three doses of the above prescription, fever subsided, constipation also resolved, yellow urine turned pale, spontaneous and night sweats converged. Cough lessened, hoarseness gradually recovered, mouth neutral, desire for food returned, complexion turned pale, still emaciated. Pulse slippery, slow, and forceless, tongue red with thin white coating and fluids. This indicates disease retreat, deficiency of both Qi and Blood, insufficiency of Heart and Spleen. Further nourishment and regulation are suitable. Prescription:
Suzhou Codonopsis Radix (Su Tiao Shen) 6g, Empty Adenophorae Radix (Kong Sha Shen) 6g, Large Ophiopogonis Tuber (Mai Dong) 9g, Complete Angelicae Sinensis Radix (Dang Gui) 12g, Stir-fried Chinese Yam (Huai Shan Yao) 9g, Paeoniae Radix Alba (Bai Shao) stir-fried 6g, Citri Reticulatae Pericarpium Viride (Ju Luo) 6g, Cortex Lycii (Di Gu Pi) 9g, Cloud Poria (Fu Shen) 12g, Sweet Almond (Xing Ren) 6g, Honey-fried Glycyrrhizae Radix et Rhizoma (Zhi Gan Cao) 3g, Jian Lotus Seed (Lian Zi) 9g (heart removed), Stir-fried Black Soybean (Hei Xiao Dou) 9g.
Fifth visit: After three doses of the above prescription, all symptoms disappeared. Food intake increased day by day, spirit more vigorous, only skin and muscles weak, face pale. At this stage, disease has moved from danger to safety.
Continue with the following prescription for regulation, tonification, and nourishment, disease will fully recover. Prescription:
Suzhou Codonopsis Radix (Su Tiao Shen) 6g, Empty Adenophorae Radix (Kong Sha Shen) 6g, Complete Angelicae Sinensis Radix (Dang Gui) 12g, Paeoniae Radix Alba (Bai Shao) stir-fried 6g, Cloud Poria (Fu Shen) 12g, Jian Lotus Seed (Lian Zi) 9g (heart removed), Honey-fried Loquat Leaf (Pi Ye) 3 slices, Honey-fried Glycyrrhizae Radix et Rhizoma (Zhi Gan Cao) 3g, Small Red Dates (Xiao Hong Zao) 9 pieces, Stir-fried Black Soybean (Hei Xiao Dou) 9g, Dong E Jiao (Donkey-hide Gelatin) 15g (melted and mixed in).
[Commentary] First, pivot and harmonize from Shaoyang, grasping the main contradiction in the change of pathogenesis. Using gallbladder-fried Bupleuri Radix, vinegar-processed Pinelliae Rhizoma and Testudinis Carapax et Plastrum, wine-fried Scutellariae Radix and Anemarrhenae Rhizoma in the formula is ingenious; using bitter and pungent to vent and diffuse, soothing and moving Liver and Gallbladder, assisted by sour and sweet to generate Yin, releasing the mechanism of opening and closing, removing long-standing pathogenic factors. Subsequently, continuously supporting healthy Qi, moistening fluids, Qi, and Blood, thereby curing chronic illness.
Tidal Fever due to Yin Deficiency
Guo XX, Female, 25 years old, Resident of Kunming City. Autumn 1938.
First visit: Initially suffering from alternating chills and fever, self-administered exterior-releasing agents. Aversion to cold stopped but fever did not subside, worse at sunset. Re-administered Xiao Chai Hu Tang, Gardeniae and Sojae Semen Praeparatum Decoction, and Bai Hu Tang, disease trend increased without decrease. Examination showed sallow face, emaciated body, haggard appearance, poor appetite, dry throat and mouth, slight cough with nighttime irritability, tidal fever in afternoon. Constipation, short red urine. Further inquiry revealed irregular menstruation, scanty flow, dark color. Pulse fine, wiry, and rapid, tongue body red, coating yellow, dry, and lacking fluids. Symptoms belong to Blood deficiency and Lung dryness, caused by Wood Fire punishing Metal, damaging Yin and fluids. Should nourish Yin, moisten Lung, and clear heat for treatment. Prescription:
White Scrophulariae Radix (Xuan Shen) 9g, Stir-fried Anemarrhenae Rhizoma (Zhi Mu) 6g, Large Ophiopogonis Tuber (Mai Dong) 9g, Paeoniae Radix Alba (Bai Shao) stir-fried 9g, Dendrobii Caulis (Shi Hu) 9g, White Poria (Fu Shen) 15g, Moutan Cortex (Mu Dan Pi) 6g, Cortex Lycii (Di Gu Pi) 9g, Fine Rehmanniae Radix (Sheng Di Huang) 12g, Silver Bupleuri Radix (Yin Chai Hu) 6g, Coptidis Rhizoma? No, Cynanchi Stauntonii Radix (Bai Wei) 4.5g, Bamboo Shavings (Zhu Ru) 6g, Glycyrrhizae Radix et Rhizoma (Gan Cao) 3g.
Second visit: After three doses of the above prescription, mouth and tongue moister, tidal fever slightly subsided, cough with sticky sputum, irritability, and spontaneous sweating. Still adhering to original intent, prescribe:
Fine Rehmanniae Radix (Sheng Di Huang) 12g, Moutan Cortex (Mu Dan Pi) 6g, Paeoniae Radix Alba (Bai Shao) stir-fried 9g, Poria Wood (Fu Shen Mu) 15g, White Scrophulariae Radix (Xuan Shen) 9g, Large Ophiopogonis Tuber (Mai Dong) 9g, Stir-fried Anemarrhenae Rhizoma (Zhi Mu) 6g, Raw Glycyrrhizae Radix et Rhizoma (Sheng Gan Cao) 3g, Cornus Officinalis Fruit (Shan Zhu Yu) 6g, Cynanchi Stauntonii Radix (Bai Wei) 6g, Fritillariae Bulbus (Chuan Bei Mu) 9g, Purified Loquat Leaf (Pi Ye) 3 slices.
Third visit: After five consecutive doses of the above prescription, tidal fever subsided, cough reduced, sticky sputum gradually cleared, spirit and color improved, bowel and bladder movements normal. Pulse calm, tongue moist. This indicates Yin restored, heat transformed, symptoms trending towards safety. Continue with Blood-nourishing and Yin-moistening for consolidation. Prescription:
Fine Rehmanniae Radix (Sheng Di Huang) 12g, Complete Angelicae Sinensis Radix (Dang Gui) 12g, Paeoniae Radix Alba (Bai Shao) stir-fried 9g, Ligusticum Chuanxiong Rhizome (Chuan Xiong Pian) 6g, Moutan Cortex (Mu Dan Pi) 6g, Cornus Officinalis Fruit (Shan Zhu Yu) 6g, Empty Adenophorae Radix (Kong Sha Shen) 9g, Large Ophiopogonis Tuber (Mai Dong) 9g, Glycyrrhizae Radix et Rhizoma (Gan Cao) 3g, Black Soybean (Hei Dou) 15g, Lotus Seed (Lian Zi) 15g (heart removed), Purified Loquat Leaf (Pi Ye) 3 slices.
After taking over ten doses of the above prescription, disease completely healed. Menstrual volume also increased, color turned red. Advised to take according to the above prescription before and after each menstrual period to augment Qi and Blood.
[Commentary] For a constitution originally deficient in Yin and Blood receiving pathogenic factors, the heat cannot be resolved by sweating or cooling alone.
Nei Jing states: "Yin deficiency generates internal heat." Heat comes from Yin, must nourish Yin; if Yin does not return, heat will not go. Nourishing Yin and clearing heat are two methods, although interrelated, each has different natures. In this case, first used nourishing Yin to clear heat, later used nourishing Blood to consolidate Yin.
Consumptive Cough with Fever
Jin XX, Female, 53 years old, Resident of Kunming City. 1943.
First visit: Suffering from cough and fever for several years without cure, intermittent. I observed her thin body, wasted muscles, dry lips, malar flush, hoarse voice not resonant. Inquiry revealed widowhood for many years, excessive labor, prone to wind-cold common colds. During attacks, chest stuffiness, shortness of breath, sticky sputum difficult to expectorate, blood streaks in sputum, tidal fever with spontaneous sweating, dry mouth. Self-reported dislike for pungent-dry and warming-tonifying medicines, and multiple doses of heat-clearing products taken without effect. Fortunately, appetite good, able to sleep peacefully at night.
Pulse felt wiry, slippery, and rapid superficially, deficient deeply. Tongue body red, coating white, dry, lacking fluids.
This is due to overwork injuring Essence and Qi, external pathogens invading, Lung affected first, combined with Liver depression transforming into heat, Wood Fire punishing Metal. Long-term results in Blood weakness and Yin deficiency, delicate organ losing moisture, leading to Consumptive disease. Jin Gui states: "Large pulse indicates Labor. Extremely deficient pulse also indicates Labor." This is what is meant. Urgently need to clear dryness and save Lung, nourish Liver and regulate. Prescription:
Charred Ephedrae Radix et Rhizoma Root (Ma Huang Gen) 6g, Perilla Stem Slice (Su Geng Pian) 9g, Light Apricot Seed (Xing Ren) 9g, Citri Reticulatae Pericarpium Viride (Ju Luo) 6g, Beijing Pinelliae Rhizoma (Ban Xia) 9g, Paeoniae Radix Alba (Bai Shao) stir-fried 9g, Poria Spirit (Fu Ling Shen) 15g, Raw Glycyrrhizae Radix et Rhizoma (Sheng Gan Cao) 3g, Dried Lotus Root (Ou Gan) 4.5g, Bamboo Shavings (Zhu Ru) 6g, Benincasa Cerase Fructus Seed (Dong Gua Zi) 9g (taken with decoction), White Imperata Rhizome (Bai Mao Gen) 12g, Purified Loquat Leaf (Pi Ye) 2 slices.
Second visit: After three doses of the above prescription, cough slightly reduced, shortness of breath slightly leveled. Other symptoms persist, constipation and yellow urine. Continue modifying original prescription. Prescription:
White Scrophulariae Radix (Xuan Shen) 9g, Large Ophiopogonis Tuber (Mai Dong) 9g, Paeoniae Radix Alba (Bai Shao) stir-fried 9g, Poria Spirit (Fu Ling Shen) 15g, Trichosanthis Pericarpium (Gua Lou Ke) 9g, Light Apricot Seed (Xing Ren) 9g, Mixed Perilla Seed (Su Zi) 9g, Raw Glycyrrhizae Radix et Rhizoma (Sheng Gan Cao) 3g, Bamboo Shavings (Zhu Ru) 6g, White Imperata Rhizome (Bai Mao Gen) 12g, Dried Lotus Root (Ou Gan) 4.5g, Floating Wheat (Fu Xiao Mai) 15g, Coix Seed (Yi Yi Ren) 12g, Purified Loquat Leaf (Pi Ye) 2 slices.
Third visit: After five consecutive doses of the above prescription, tidal fever and spontaneous sweating reduced, blood streaks in sputum decreased. Occasional rib pain during coughing, still feeling dry mouth. Constipation gradually moistened, urine color turned pale. Pulse fine, wiry, and slippery, tongue red, coating thin and moister. Still adhering to original intent,酌情 add moistening products. Prescription:
Sweet Platycodon Root (Jie Geng) 6g, Fritillariae Bulbus (Chuan Bei Mu) 9g, White Imperata Rhizome (Bai Mao Gen) 15g, Raw Paeoniae Radix Alba (Sheng Bai Shao) 9g, Charred Aster Root (Zi Wan) 9g, Charred Adenophorae Flower Bud (Dong Hua) 9g, Trichosanthis Pericarpium (Gua Lou Ke) 9g, Large Ophiopogonis Tuber (Mai Dong) 9g, Raw Glycyrrhizae Radix et Rhizoma (Sheng Gan Cao) 3g, Mulberry Leaf (Sang Ye) 9g, Silver Bupleuri Radix (Yin Chai Hu) 9g. Fresh pear and lotus root juice, one spoonful each mixed per dose.
Fourth visit: After continuing five doses of the above prescription, tidal fever subsided, blood-streaked sputum stopped, dry mouth gradually eliminated. Occasional cough, dizziness, mental fatigue. This indicates dryness pathogen cleared, Qi and Yin gradually regulated and moistened. Again propose the following prescription:
Empty Adenophorae Radix (Kong Sha Shen) 9g, Ophiopogonis Tuber (Mai Men Dong) 9g, Mixed Perilla Seed (Su Zi) 6g, Light Apricot Seed (Xing Ren) 9g, Fritillariae Bulbus (Chuan Bei Mu) 9g, Charred Adenophorae Flower Bud (Dong Hua) 9g, Paeoniae Radix Alba (Bai Shao) stir-fried 9g, Beijing Pinelliae Rhizoma (Ban Xia) 9g, Citri Reticulatae Pericarpium Viride (Ju Luo) 6g, Raw Glycyrrhizae Radix et Rhizoma (Sheng Gan Cao) 3g, Mulberry Leaf (Sang Ye) 9g, Poria Spirit (Fu Ling Shen) 15g, White Imperata Rhizome (Bai Mao Gen) 15g, Raw Coix Seed (Sheng Yi Yi Ren) 12g, Purified Loquat Leaf (Pi Ye) 2 slices.
Fifth visit: After taking ten doses of the above prescription, all symptoms disappeared, pulse turned slow and weak, tongue coating red and moist. Disease trend healing, continue to nourish and benefit Spleen and Lung, regulate Blood and nourish Liver. Prescription:
Empty Adenophorae Radix (Kong Sha Shen) 9g, White Scrophulariae Radix (Xuan Shen) 9g, Chinese Yam (Huai Shan Yao) 12g, Poria Spirit (Fu Ling Shen) 15g, Beijing Pinelliae Rhizoma (Ban Xia) 9g, Citri Reticulatae Pericarpium Viride (Ju Luo) 6g, Paeoniae Radix Alba (Bai Shao) stir-fried 9g, Black Soybean (Hei Xiao Dou) 15g, Purified Loquat Leaf (Pi Ye) 2 slices, Lotus Seed (Lian Zi) 15g, Charred Adenophorae Flower Bud (Dong Hua) 6g, Honey-fried Glycyrrhizae Radix et Rhizoma (Zhi Gan Cao) 3g. Er Dong Gao (Two Winter Pastes) and Snow Pear Gao, mix one small spoonful of each per dose as guide.
[Commentary] Once Consumptive disease is formed, with Lung dryness and Qi stagnation, and rampant Phlegm-Heat, both attacking and tonifying are errors. Using variations of Qing Zao Jiu Fei method, treating mild symptoms slowly, appearing plain, but actually difficult to execute.