杨（左） 湿温已届三候，不特汗 均不获畅，而且四肢背脊尚觉恶寒，阳气不能敷布，与阳气之衰微
者，大相悬殊也。阳何以不布，湿阻之也。湿何以不化，饮食水谷资之助之也。为敌助粮，引虎自卫，非计
也。拟开展气化。使湿随气行，则白 及汗，可以通畅。
光杏仁 郁金 桔梗 霍香 滑石 生米仁 制半夏 通草
此症经陈医屡投浓朴佛手花茵陈等，致有棘手之象，先生嘱以勿妄食。勿进补，一以宣化气湿法
治之，果获渐瘳。案语卓然名论，不易多得。（文涵志）
某 昨投泄热透邪，今午续得微汗，烦渴较昨略退，面色浮赤较淡。然天气乍冷，阳气阻郁，赤色瘀滞
不匀，邪湿羁留，未能遽解。上焦之气不展，胸中窒闷不舒。口腻苔白舌红，脉数糊滑。化湿泄邪，固属定
理。但除感冒带病酬应外，热甚不退者九日，邪湿熏蒸之势，尚在鸱张，总望转候大得退机耳。
郁金（二钱） 九节石菖蒲（四分） 桔梗（一钱五分） 香豉（三钱） 制半夏（三钱） 牛蒡子
（三钱） 橘红（一钱五分） 光杏仁（三钱） 蔻仁（七分） 黄芩（酒炒一钱五分） 川通草（一钱）
滑石块（三钱）
二诊 叠得自汗胸中之窒闷稍开，尚未安寐，口燥而腻。脉数舌红，苔白淡黄。胃中之浊与湿交蒸，不
能遽化。症经旬日，惟有泄之，化之俾免内蒙为幸耳。
制半夏（二钱） 炒竹茹（一钱五分） 橘红（一钱） 郁金（一钱五分） 泽泻（一钱五分） 赤猪苓
（各二钱） 炒枳壳（一钱） 黑山栀（二钱） 杏仁泥（三钱） 陈胆星（五分） 生薏仁（四钱）
炒蒌皮（三钱）
三诊 疏泄太阴，兼以通腑，宿滞下行，胸痞腹满较舒。然热势仍起，下午为甚，面色晦黄，口渴而复粘
腻咳嗽较退，寤难成寐。脉数而带糊滑，舌边绛赤，中心依然白腻足见邪势由浅而深。然从无不可达
之邪，亦从无不可泄之热，其所以解之不汗，清之热不泄者，以夹杂湿邪，相持于内也。再以泄化为主。
冀邪与湿分，不致蒸痰从中弥漫为上。
广郁金（三钱） 光杏仁（三钱） 滑石（三钱） 薏仁（五钱） 炒竹茹（一钱五分） 炒香豉（三钱）
淡黄芩（一钱五分） 赤猪苓（各二钱） 广橘红（一钱五分） 桔梗（一钱） 通草（一钱） 制半夏（二钱）
陈（左） 湿温热势起伏，湿包热外，热处湿中，热胜于湿，挟滞蒸腾，太阴之邪，还并于阳明之分。舌红苔
黄，中心微燥。便阻频转矢气，阳明之湿热，渐化燥热矣。
淡黄芩 川连 光杏仁 通草 郁金 生薏仁
滑石 竹叶心（十二片） 枳实导滞丸（通草佛手汤下）
二诊 两投苦泄，热势仍然起伏，起则烦渴欲饮。湿热蒸腾，津不上布，盖热如釜中之沸，邪之与湿，犹
釜底之薪。仍以泄化主之。
香豉 广郁金 光杏仁 桔梗 通草 制半夏
淡黄芩 连翘 泽泻 滑石 生薏仁 赤猪苓 竹叶心
周（左） 花甲之年，兼嗜紫霞，其命火之衰，湿痰之盛，不问可知。昨食甘寒之物，脾胃之阳为之暗伤，致
湿痰弥漫三焦，旋转营运之阳，为湿所遏，以致发热在里，热势不扬。湿胜则脾土不能分化，其水液应
入于膀胱者，至此而淆入于大肠，所以便注下迫。气愈内闭，则毛窍外开。所以淋淋汗出矣。湿痰停阻，
就使引动伏邪，亦不过湿热之常病。而舌无华色，脉沉细涩，右脉略大而混数不扬，一派正不胜邪之
象。病在初起，又无遽培元气之理。方拟分理三焦勿以发散攻消为事，以湿与痰皆不可力制，惟有化之为宜。
川朴 通草 泽泻 佛手 郁金 赤猪苓 藿香 滑石 蔻仁 生薏仁
二诊 湿遏气津，渴甚用流化法。
金石斛 炒黄川贝 滑石 郁金 枇杷叶 辰茯苓
光杏仁 炒香豉 薏仁 白蔻仁（三分研用芦根二两打汁先调服）
以翁 昨诊内窍欲蒙，及服药之时，神已糊乱。今日竟尔神昏，手暖足厥，脉糊滑并不甚数，苔白腻并
不焦黑，身热并不炽甚。此由湿盛之极，中阳不运，致湿蕴成痰，痰蒙清窍。与火热之甚，扰乱神明，而致
神昏者不同。勉拟芳香通神，辛开苦降，为背城之一。谋事在人，成事在天。
天竺黄（三钱） 制半夏（三钱） 远志肉（一钱） 明雄精（一钱五分甘草汤拌炒） 陈胆星（一钱）
白僵蚕（三钱） 茯苓（三钱） 广郁金（六分明矾三分化水磨） 九节菖蒲（八分） 竹沥（一两滴入姜汁少许）
转机用至宝丹一丸，橘红汤送下。一剂而神稍清，仍照服减半。
再方
川雅连（重姜汁炒三分） 制半夏（三钱） 九节菖蒲（八分） 橘红（一钱五分） 广郁金（一钱五分）
淡干姜（六分迷甚干姜用二钱打） 制南星（三分） 礞石（三分） 白明矾（三分） 炙牙皂（三分）
麝香（五厘） 明雄黄（二分后六味研细末用竹沥先调服）
案师云、此症紧要关头，全在表热外扬，邪方透达。复诊由门下郁闻尧代去，云热已起而厥渐转。先是师命方
如前意开泄。郁世兄回禀云、湿已化燥，舌绛中带焦黑而干。师曰、尚不可言化燥，燥化未足也。再用开泄，冀其
化热化火，须十分透澈乃妙。药大意如前，制南星用六分，加紫雪六分，灯心汤下，尚欲其热显扬。据郁世兄本
意，拟用牛黄丸犀角地黄汤，或鲜石斛及清宫汤加减。谓化燥而无大热，书无明文，疑惑不定。师云、化燥而无
大热，非真燥也，热未透也。不可滋腻，须仍泄化，微带甘辛法。（清儒志）
张（左） 湿温旬日，烦热无汗，赤疹隐约不透，胸次窒闷异常，咳不扬爽，时带谵语，频渴不欲饮，饮喜极
沸之汤。脉数糊滑，苔白心黄，近根浓 。此由无形之邪，有形之湿，相持不化，邪虽欲泄，而里湿郁结，则
表气不能外通，所以疏之汗之，而疹汗仍不能畅。热与湿交蒸，胸中清旷之地，遂如云雾之乡，神机转
致弥漫。深恐湿蒸为痰内蒙昏痉。
三仁汤去滑石川朴竹叶，加豆豉橘红郁金枳壳桔梗菖蒲佛手。
二诊 昨进辛宣淡化，上焦之气分稍开，熏蒸之热势稍缓，神识沉迷转清，谵语指搐已定，烦闷亦得
略松，舌苔较退。但气时上冲，冲则咳逆，脉数糊滑。良以郁蒸稍解，而邪湿之势，尚在极甚之时，虽有退
机，犹不足济。肺胃被蒸气难下降，所以气冲欲咳，仍未俱减也前法之中，再参疏肺下气。
甜葶苈（五分） 通草 光杏仁 制半夏 冬瓜子 广郁金
薄橘红 滑石块 炒枳壳 枇杷叶 桔梗 竹茹
三诊 胸闷懊烦，气冲咳逆，次第减轻，咯吐之痰，亦觉爽利。舌苔亦得大化，但脉仍不扬。其肺胃之间，
尚是熏蒸之地，表不得越，邪无出路，还难恃为稳当也。
光杏仁 广郁金 淡黄芩 桑叶 甜葶苈 桔梗 白蔻仁 生薏仁 制半夏 炒香豆豉 橘红 枇杷叶
四诊 咳嗽气逆大退，痰亦爽利，谵语热烦亦得渐减，特小溲清而不爽，大便不行，频转矢气，脉数糊
滑，苔化而中独浓。犹是湿痰内阻，邪难泄越再导其滞。
郁金 橘红 桔梗 制半夏 赤茯苓 生薏仁 滑石 通草 萆 竹沥达痰丸（三钱佛手通草汤先送下）
五诊 大便畅行，燠烦大定，热亦较轻，口渴亦减。但赤疹虽布，甚属寥寥汗不外达。脉象较爽，舌根苔
白尚 。邪湿之熏蒸，虽得渐松而未能透泄。须望其外越方为稳妥也。
光杏仁 郁金 橘红 生薏仁 枳壳 滑石块 炒蒌皮 葶苈子 桔梗 通草 木通 制半夏 赤白茯苓
六诊 熏蒸弥漫之势虽松，而湿性粘腻不克遽行泄化，里气不宣表气难，达汗 不得发越，咳嗽气
逆小溲不爽。脉数滑苔白，邪湿互相犄角，尚难稳当。
郁金 光杏仁 橘红 冬瓜子 桔梗 鲜佛手 制半夏 生薏仁 蔻仁 赤猪苓 通草 苇茎
七诊 热势降序，咳亦渐松，然湿从内搏，邪从外越，是以热势恋恋不退，不能外达，而欲从内化，非欲
速可以从事也。
豆卷 滑石 光杏仁 郁金 制半夏 通草 新会红 猪苓 桔梗 枳壳 生薏仁 鲜佛手
八诊 清理余蕴方
豆卷 生薏仁 制半夏 通草 广皮 福泽泻 光杏仁 鲜佛手 白蔻仁 真佩兰
如胸闷加桔梗郁金，甚者川朴枳壳藿香，头胀加蒺藜天麻僵蚕，理胃加生熟谷芽沉香曲玫瑰花。
按此症湿温胸闷，始起即有 语。张骧云先诊，以其高年神志不清，案有防其内闭痉厥之语。首方用青蒿橘
络猩绛之类，继用豆卷牛蒡赤芍前胡竺黄朱翘茯神玉雪救苦丹之类，不效续请巢崇山，案载咳不爽，渴欲
饮热由气分内陷厥少， 语风动之险象。方用豆卷蝉衣生薏前胡光杏郁金青蒿桔梗翘心至宝丹。既而热
势仍炽，案有邪火内窜心胞之势，倘其势甚防动内风。改用羚羊芦根紫雪之属，仍不效。乃请师去。诊其脉糊
数苔白腻，审其神，则沉迷，投开展气，化轻描淡写，服一剂后，即有松机。窃观此案，何以沪上诸名家于湿温一
症，尚亦茫然，无怪偏僻之区，悉以清蒿黄芩鲜斛等一派阴柔之品，为自保声名唯一之妙术也。不竟为之怃
然三叹。（清儒附志）
蒋（右） 流化湿痰，以开郁结，热势大减，烦懊亦定，神识亦得爽慧。脉较缓和，舌红转淡，边尖转润，惟中
心仍属干燥，而又觉甜腻。邪退三舍，湿痰有欲化不化之意，而气机遏伏，津液犹难流布。稍稍经行，治当兼顾。
制半夏（三钱） 郁金（五分磨冲） 栝蒌仁（一钱五分） 橘红（一钱） 陈胆星（五分） 石菖蒲（一钱五
分） 黑山栀（三钱） 杏仁泥（三钱） 滑石（三钱） 泽兰（一钱五分） 枇杷叶（三片） 风化硝（六分）
青礞石（五分） 明矾（一分五厘） 血珀（三分上四味研匀调服）
改方去栝蒌仁风化硝泽兰，加川贝炒黄一钱五分，竹沥五钱。
二诊 昨晚热势又起，湿被热蒸，胸中为之弥漫，神情不如昨日之爽慧。脉数糊滑。清空之地，悉皆秽
浊所占。泄化之中参以芳化。
光杏仁 方通草 淡黄芩 广郁金（白明矾三分化水磨冲） 炒竹茹
白蔻仁 滑石块 赤白苓 晚蚕砂 佛手 至宝丹
改方去至宝丹，加制雄丹一分五厘，用通草汤调下徐徐服之。
杨（右） 症属两候有余热势并不甚重。夫病至半月邪，虽不化为火，断无不化热之理，亦断无化热而
热不甚之理，其所以淹淹者，邪轻于湿，湿重于邪也。湿蕴肺胃，胃气不降，所以饮汤入口，似有噎塞之
状，并作恶心。热蒸则口渴，而湿究内踞，所以仍不欲饮。湿为水属，得暖则开，所以喜进热饮。大便一日
数次，皆是稀水，内经所谓湿胜则泄也。湿郁之极，阴阳不通，以致振寒而战。郁极而通，得以汗泄，肌表
之风，随湿外越，发为白疹，虽属邪湿之出路，然肌肤分肉之事，于三焦之熏蒸，依然无益耳窍不聪，浊
邪之害清也。鼻起烟霉，是熏蒸之炎，有诸内形诸外也。刻下神情呆钝，时带错语，若以热扰神明，灵机
被塞，自必有一种昏愦情形。今似糊非糊，似爽非爽，皆是无形之邪，与有形之湿，蒸腾弥漫，其胸中清
旷之地，遂成烟雾之区，大有蒙闭之虞。脉象沉细不爽，舌苔淡黄 腻，尤为湿郁热蒸之确据。兹拟辛
以开，苦以泄，芳香以破浊，淡渗以引湿下行。
川雅连（姜汁炒五分） 制半夏（三钱） 郁金（磨冲六分） 九节石菖蒲（八分） 陈橘皮（一钱五分）
赤白苓（各二钱） 淡干姜（五分） 竹茹（一钱五分姜汁炒） 香豉（三钱） 白蔻仁（入煎四粒） 生薏
仁（四钱） 通草（一钱）
改方去川连干姜，加滑石块三钱，广藿香三钱，石菖蒲减二分。
二诊 投药之后，神情大为灵爽，耳窍略聪，便泄亦减，湿之如雾迷蒙者，得化稍开而蕴蓄之热，亦于
此勃发，所以午后甚为烦热，不若日前之沉迷罔觉也。脉象较爽，苔亦略化，然中心黄 。脐下作痛拒
按，频转矢气，口渴欲饮。良由湿积交蒸，不能泄化，还恐昏燥等变。
制半夏（一钱五分） 黄芩（酒炒一钱） 石菖蒲（五分） 竹二青（一钱五分姜汁炒） 广郁金（磨冲六分
）白蔻仁（入煎四粒） 赤猪苓（各二钱） 光杏仁（勿研三钱） 滑石块（三钱） 方通草（一钱） 香豆豉
（三钱） 木香槟榔丸（三钱先服）
改方去木香槟榔丸，加芦根一两，滑石加重二钱。
三诊 丸药缓下，便泄已止，而腹中依然满痛，频转矢气。热势叠次轻退，而胸次不舒，格格欲嗳，屡涌
酸涎。其为湿积交阻了然可见。所可异者，口渴欲饮，不能稍缓，若系津枯，则内既燥涸，其酸涎何由而
至，所以然者，都由积阻于下，湿郁于上，清气不能上行，则虽有清津无从流布，所以愈燥则愈饮，愈饮
而更燥也。再拟疏化三焦，参以导滞。
香豆豉（三钱） 广郁金（一钱五分） 制半夏（一钱五分） 淡干姜（炒松三分） 通草（一钱） 生薏
仁（四钱） 川朴（五分） 石菖蒲（五分） 上湘军（三钱后下） 杏仁泥（三钱） 猪苓（二钱）
枳实（磨冲五分）
【患者杨（左）】湿温病已发展至第三候，不仅汗出不畅，而且四肢和背部仍感觉恶寒。这是阳气不能敷布全身所致，与阳气衰微的病证截然不同。阳气为何不能敷布？是因为湿气阻滞。湿气为何不能化解？是因为饮食水谷在资助、助长湿气。这如同给敌人提供粮草，引虎自卫，不是良策。拟采用开展气化的方法，使湿气随气机运行而消散，那么白疹及汗出，就可以通畅。
处方：光杏仁、郁金、桔梗、藿香、滑石、生薏苡仁、制半夏、通草。
此症经陈医生多次投用浓朴、佛手花、茵陈等药，导致病情变得棘手。先生嘱咐不要乱吃东西，不要进补，一律以宣化气湿法治疗，果然逐渐痊愈。案语见解卓越，是难得的名论。（文涵志记录）
【某患者】昨天投用泄热透邪的方药，今天中午继续得到微汗，烦渴比昨天略微减轻，面色浮赤颜色变淡。然而天气突然转冷，阳气被阻郁，面色赤色瘀滞不均匀，邪湿羁留体内，未能立即解除。上焦气机不舒展，胸中窒闷不适。口腻苔白舌红，脉数糊滑。化湿泄邪，固然是确定的治法。但除了感冒带病应酬外，高热不退已有九天，邪湿熏蒸的势头，还在猖獗，总希望转机后能大见退热之机。
处方：郁金（二钱）、九节石菖蒲（四分）、桔梗（一钱五分）、香豉（三钱）、制半夏（三钱）、牛蒡子（三钱）、橘红（一钱五分）、光杏仁（三钱）、蔻仁（七分）、黄芩（酒炒一钱五分）、川通草（一钱）、滑石块（三钱）。
二诊：连续出汗，胸中的窒闷稍微缓解，但尚未能安稳入睡，口燥且腻。脉数舌红，苔白淡黄。胃中的浊气与湿气交蒸，不能立即化解。病症经过十天，只有泄之、化之，以免内扰心神为幸。
处方：制半夏（二钱）、炒竹茹（一钱五分）、橘红（一钱）、郁金（一钱五分）、泽泻（一钱五分）、赤猪苓（各二钱）、炒枳壳（一钱）、黑山栀（二钱）、杏仁泥（三钱）、陈胆星（五分）、生薏仁（四钱）、炒蒌皮（三钱）。
三诊：疏泄太阴脾湿，兼以通腑，宿滞下行，胸痞腹满症状较前舒缓。然而热势仍然升起，下午更甚，面色晦黄，口渴且复现粘腻咳嗽较前减退，夜间难以成寐。脉数而带糊滑，舌边绛赤，中心依然白腻。足见邪气势力由浅入深。然而从无不可达出的邪气，也从无不可清泄的热邪，之所以解表不出汗，清热热不退，是因为夹杂湿邪，在内相持不下。再以泄化为主。希望邪气与湿气分离，不致蒸腾痰浊从中弥漫为上策。
处方：广郁金（三钱）、光杏仁（三钱）、滑石（三钱）、薏仁（五钱）、炒竹茹（一钱五分）、炒香豉（三钱）、淡黄芩（一钱五分）、赤猪苓（各二钱）、广橘红（一钱五分）、桔梗（一钱）、通草（一钱）、制半夏（二钱）。
【患者陈（左）】湿温热势起伏，湿气包裹热邪于外，热邪处于湿气之中，热胜于湿，挟带积滞蒸腾，太阴之邪，还并归于阳明之分。舌红苔黄，中心微燥。大便阻塞，频繁排气，阳明的湿热，逐渐化为燥热了。
处方：淡黄芩、川连、光杏仁、通草、郁金、生薏仁、滑石、竹叶心（十二片）、枳实导滞丸（用通草佛手汤送下）。
二诊：两次投用苦泄之法，热势仍然起伏，起则烦渴欲饮。湿热蒸腾，津液不能上布，大概热如锅中之沸腾，邪气与湿气，犹如锅底之柴薪。仍以泄化为主。
处方：香豉、广郁金、光杏仁、桔梗、通草、制半夏、淡黄芩、连翘、泽泻、滑石、生薏仁、赤猪苓、竹叶心。
【患者周（左）】年过六十，又嗜好吸烟，其命门之火衰微，湿痰之盛，是不言而喻的。昨天吃了甘寒的食物，脾胃之阳为之暗伤，导致湿痰弥漫三焦，旋转营运的阳气，被湿气所遏制，以致发热在里，热势不显扬。湿胜则脾土不能分化水液，其水液应入于膀胱者，至此而混淆进入大肠，所以大便急迫下注。气愈内闭，则毛孔外开。所以淋淋漓漓地出汗了。湿痰停阻，即使引动伏邪，也不过是湿热的常病。而舌无华色，脉沉细涩，右脉略大而混数不扬，一派正气不胜邪气的征象。病在初起，又没有立即培补元气的道理。方剂拟定分理三焦，不要以发散攻消为事，因为湿与痰都不可强力制服，只有化之为宜。
处方：川朴、通草、泽泻、佛手、郁金、赤猪苓、藿香、滑石、蔻仁、生薏仁。
二诊：湿气遏制气津，口渴严重，用流化法治疗。
处方：金石斛、炒黄川贝、滑石、郁金、枇杷叶、辰茯苓、光杏仁、炒香豉、薏仁、白蔻仁（三分研末，用芦根二两打汁先调服）。
【患者以翁】昨天诊治时内窍似乎将要蒙蔽，等到服药时，神志已经糊涂混乱。今日竟然神昏，手暖足冷，脉糊滑并不很数，苔白腻并不焦黑，身热并不炽盛。这是由于湿气极盛，中阳不运，导致湿蕴成痰，痰蒙清窍。这与火热极盛，扰乱神明而导致神昏是不同的。勉强拟定芳香通神，辛开苦降的方法，作为背城借一之计。谋事在人，成事在天。
处方：天竺黄（三钱）、制半夏（三钱）、远志肉（一钱）、明雄精（一钱五分甘草汤拌炒）、陈胆星（一钱）、白僵蚕（三钱）、茯苓（三钱）、广郁金（六分明矾三分化水磨）、九节菖蒲（八分）、竹沥（一两滴入姜汁少许）。
转机时用至宝丹一丸，橘红汤送下。一剂后神志稍清，仍照原方减半服用。
再方：川雅连（重姜汁炒三分）、制半夏（三钱）、九节菖蒲（八分）、橘红（一钱五分）、广郁金（一钱五分）、淡干姜（六分，迷甚者干姜用二钱打汁）、制南星（三分）、礞石（三分）、白明矾（三分）、炙牙皂（三分）、麝香（五厘）、明雄黄（二分，后六味研细末，用竹沥先调服）。
按：老师说，此症紧要关头，全在于表热外扬，邪气方能透达。复诊由门下郁闻尧代去，说热已起而厥逆逐渐好转。先是老师命令方剂如前意开泄。郁世兄回禀说，湿已化燥，舌绛中带焦黑而干。老师说，还不能说化燥，燥化还不够。再用开泄，希望其化热化火，须十分透彻才好。药大意与前相同，制南星用六分，加紫雪六分，灯心汤送下，尚希望其热势显扬。据郁世兄本意，拟用牛黄丸犀角地黄汤，或鲜石斛及清宫汤加减。谓化燥而无大热，书上没有明文，疑惑不定。老师说，化燥而无大热，不是真燥，是热未透也。不可滋腻，须仍泄化，微带甘辛法。（清儒志记录）
【患者张（左）】湿温病十天，烦热无汗，赤疹隐约不透，胸次窒闷异常，咳不扬爽，时而带有谵语，频频口渴但不欲饮，饮水喜欢极沸之汤。脉数糊滑，苔白心黄，近根部厚腻。这是由无形之邪，与有形之湿，相持不化，邪气虽想泄出，而里湿郁结，则表气不能外通，所以疏之汗之，而疹汗仍不能通畅。热与湿交蒸，胸中清旷之地，遂如云雾之乡，神机运转致弥漫。深恐湿蒸为痰内蒙导致昏痉。
处方：三仁汤去滑石、川朴、竹叶，加豆豉、橘红、郁金、枳壳、桔梗、菖蒲、佛手。
二诊：昨天进辛宣淡化之剂，上焦之气分稍微开通，熏蒸之热势稍微缓和，神识沉迷转清，谵语指搐已定，烦闷亦得略松，舌苔较退。但气时上冲，冲则咳逆，脉数糊滑。良因郁蒸稍解，而邪湿之势，尚在极甚之时，虽有退机，犹不足济。肺胃被蒸气难下降，所以气冲欲咳，仍未俱减也。前法之中，再参疏肺下气。
处方：甜葶苈（五分）、通草、光杏仁、制半夏、冬瓜子、广郁金、薄橘红、滑石块、炒枳壳、枇杷叶、桔梗、竹茹。
三诊：胸闷懊烦，气冲咳逆，次第减轻，咯吐之痰，亦觉爽利。舌苔亦得大化，但脉仍不扬。其肺胃之间，尚是熏蒸之地，表不得越，邪无出路，还难恃为稳当也。
处方：光杏仁、广郁金、淡黄芩、桑叶、甜葶苈、桔梗、白蔻仁、生薏仁、制半夏、炒香豆豉、橘红、枇杷叶。
四诊：咳嗽气逆大退，痰亦爽利，谵语热烦亦得渐减，特小溲清而不爽，大便不行，频转矢气，脉数糊滑，苔化而中独浓。犹是湿痰内阻，邪难泄越，再导其滞。
处方：郁金、橘红、桔梗、制半夏、赤茯苓、生薏仁、滑石、通草、萆薢、竹沥达痰丸（三钱，佛手通草汤先送下）。
五诊：大便畅行，烦热大定，热亦较轻，口渴亦减。但赤疹虽布，甚属寥寥，汗不外达。脉象较爽，舌根苔白尚厚。邪湿之熏蒸，虽得渐松而未能透泄。须望其外越方为稳妥也。
处方：光杏仁、郁金、橘红、生薏仁、枳壳、滑石块、炒蒌皮、葶苈子、桔梗、通草、木通、制半夏、赤白茯苓。
六诊：熏蒸弥漫之势虽松，而湿性粘腻不克遽行泄化，里气不宣表气难达，汗不得发越，咳嗽气逆小溲不爽。脉数滑苔白，邪湿互相犄角，尚难稳当。
处方：郁金、光杏仁、橘红、冬瓜子、桔梗、鲜佛手、制半夏、生薏仁、蔻仁、赤猪苓、通草、苇茎。
七诊：热势降序，咳亦渐松，然湿从内搏，邪从外越，是以热势恋恋不退，不能外达，而欲从内化，非欲速可以从事也。
处方：豆卷、滑石、光杏仁、郁金、制半夏、通草、新会红、猪苓、桔梗、枳壳、生薏仁、鲜佛手。
八诊：清理余蕴方
处方：豆卷、生薏仁、制半夏、通草、广皮、福泽泻、光杏仁、鲜佛手、白蔻仁、真佩兰。
如胸闷加桔梗郁金，甚者川朴枳壳藿香，头胀加蒺藜天麻僵蚕，理胃加生熟谷芽沉香曲玫瑰花。
按：此症湿温胸闷，始起即有谵语。张骧云先诊，以其高年神志不清，案有防其内闭痉厥之语。首方用青蒿、橘络、猩绛之类，继用豆卷、牛蒡、赤芍、前胡、竺黄、朱翘、茯神、玉雪救苦丹之类，不效续请巢崇山，案载咳不爽，渴欲饮热由气分内陷厥少，谵语风动之险象。方用豆卷、蝉衣、生薏、前胡、光杏、郁金、青蒿、桔梗、翘心、至宝丹。既而热势仍炽，案有邪火内窜心胞之势，倘其势甚防动内风。改用羚羊、芦根、紫雪之属，仍不效。乃请师去。诊其脉糊数苔白腻，审其神，则沉迷，投开展气化，轻描淡写，服一剂后，即有松机。窃观此案，何以沪上诸名家于湿温一症，尚亦茫然，无怪偏僻之区，悉以清蒿、黄芩、鲜斛等一派阴柔之品，为自保声名唯一之妙术也。不禁为之怃然三叹。（清儒附志记录）
【患者蒋（右）】流化湿痰，以开郁结，热势大减，烦懊亦定，神识亦得爽慧。脉较缓和，舌红转淡，边尖转润，惟中心仍属干燥，而又觉甜腻。邪退三舍，湿痰有欲化不化之意，而气机遏伏，津液犹难流布。稍稍经行，治当兼顾。
处方：制半夏（三钱）、郁金（五分磨冲）、栝蒌仁（一钱五分）、橘红（一钱）、陈胆星（五分）、石菖蒲（一钱五分）、黑山栀（三钱）、杏仁泥（三钱）、滑石（三钱）、泽兰（一钱五分）、枇杷叶（三片）、风化硝（六分）、青礞石（五分）、明矾（一分五厘）、血珀（三分，上四味研匀调服）。
改方去栝蒌仁、风化硝、泽兰，加川贝炒黄一钱五分，竹沥五钱。
二诊：昨晚热势又起，湿被热蒸，胸中为之弥漫，神情不如昨日之爽慧。脉数糊滑。清空之地，悉皆秽浊所占。泄化之中参以芳化。
处方：光杏仁、方通草、淡黄芩、广郁金（白明矾三分化水磨冲）、炒竹茹、白蔻仁、滑石块、赤白苓、晚蚕砂、佛手、至宝丹。
改方去至宝丹，加制雄丹一分五厘，用通草汤调下徐徐服之。
【患者杨（右）】症属两候有余，热势并不甚重。夫病至半月，邪虽不化为火，断无不化热之理，亦断无化热而热不甚之理，其所以淹淹者，邪轻于湿，湿重于邪也。湿蕴肺胃，胃气不降，所以饮汤入口，似有噎塞之状，并作恶心。热蒸则口渴，而湿究内踞，所以仍不欲饮。湿为水属，得暖则开，所以喜进热饮。大便一日数次，皆是稀水，内经所谓湿胜则泄也。湿郁之极，阴阳不通，以致振寒而战。郁极而通，得以汗泄，肌表之风，随湿外越，发为白疹，虽属邪湿之出路，然肌肤分肉之事，于三焦之熏蒸，依然无益耳窍不聪，浊邪之害清也。鼻起烟霉，是熏蒸之炎，有诸内形诸外也。刻下神情呆钝，时带错语，若以热扰神明，灵机被塞，自必有一种昏愦情形。今似糊非糊，似爽非爽，皆是无形之邪，与有形之湿，蒸腾弥漫，其胸中清旷之地，遂成烟雾之区，大有蒙闭之虞。脉象沉细不爽，舌苔淡黄腻，尤为湿郁热蒸之确据。兹拟辛以开，苦以泄，芳香以破浊，淡渗以引湿下行。
处方：川雅连（姜汁炒五分）、制半夏（三钱）、郁金（磨冲六分）、九节石菖蒲（八分）、陈橘皮（一钱五分）、赤白苓（各二钱）、淡干姜（五分）、竹茹（一钱五分姜汁炒）、香豉（三钱）、白蔻仁（入煎四粒）、生薏仁（四钱）、通草（一钱）。
改方去川连、干姜，加滑石块三钱，广藿香三钱，石菖蒲减二分。
二诊：投药之后，神情大为灵爽，耳窍略聪，便泄亦减，湿之如雾迷蒙者，得化稍开而蕴蓄之热，亦于此勃发，所以午后甚为烦热，不若日前之沉迷罔觉也。脉象较爽，苔亦略化，然中心黄厚。脐下作痛拒按，频转矢气，口渴欲饮。良由湿积交蒸，不能泄化，还恐昏燥等变。
处方：制半夏（一钱五分）、黄芩（酒炒一钱）、石菖蒲（五分）、竹二青（一钱五分姜汁炒）、广郁金（磨冲六分）、白蔻仁（入煎四粒）、赤猪苓（各二钱）、光杏仁（勿研三钱）、滑石块（三钱）、方通草（一钱）、香豆豉（三钱）、木香槟榔丸（三钱先服）。
改方去木香槟榔丸，加芦根一两，滑石加重二钱。
三诊：丸药缓下，便泄已止，而腹中依然满痛，频转矢气。热势叠次轻退，而胸次不舒，格格欲嗳，屡涌酸涎。其为湿积交阻了然可见。所可异者，口渴欲饮，不能稍缓，若系津枯，则内既燥涸，其酸涎何由而至，所以然者，都由积阻于下，湿郁于上，清气不能上行，则虽有清津无从流布，所以愈燥则愈饮，愈饮而更燥也。再拟疏化三焦，参以导滞。
处方：香豆豉（三钱）、广郁金（一钱五分）、制半夏（一钱五分）、淡干姜（炒松三分）、通草（一钱）、生薏仁（四钱）、川朴（五分）、石菖蒲（五分）、上湘军（三钱后下）、杏仁泥（三钱）、猪苓（二钱）、枳实（磨冲五分）。
[Patient Yang (Left)] The damp-warmth disease has reached the third pentad. Not only is sweating unsmooth, but there is also still a sensation of aversion to cold in the limbs and back. This indicates that the Yang Qi cannot disperse, which is vastly different from the condition of Yang Qi deficiency. Why can't the Yang Qi disperse? It is obstructed by dampness. Why can't the dampness transform? Because food and drink are assisting it. This is like providing supplies to the enemy or inviting a tiger to guard oneself; it is not a good strategy. It is proposed to develop the Qi transformation mechanism so that dampness moves with the Qi, allowing white rashes and sweat to discharge smoothly.
Prescription: Light Almond (Guang Xingren), Curcuma Aromatica Rhizome (Yujin), Platycodon Root (Jiegeng), Pogostemon Herb (Huoxiang), Talcum (Huashi), Raw Coix Seed (Sheng Yiren), Prepared Pinellia Tuber (Zhi Banxia), Tetrapanax Pith (Tongcao).
This case was treated repeatedly by Dr. Chen with thick Coptis (Houpo), Bergamot Flower (Foshouhua), and Yinchen, leading to a difficult situation. Mr. Zhang instructed not to eat arbitrarily and not to take tonics, treating it solely with the method of ventilating and transforming Qi-dampness. Indeed, it gradually improved. The commentary is excellent and rare. (Recorded by Wen Hanzhi)
[Some Patient] Yesterday, heat-draining and pathogen-revealing herbs were administered. At noon today, slight sweating continued, irritability and thirst slightly decreased compared to yesterday, and the floating redness of the face became paler. However, the weather turned cold suddenly, obstructing and depressing the Yang Qi, causing uneven stasis of redness. The pathogenic dampness lingers and has not yet resolved. The Qi of the Upper Jiao is not unfolding, causing chest oppression and discomfort. The mouth feels sticky, coating is white, tongue is red, pulse is rapid, slippery, and muddy. Transforming dampness and draining pathogens is indeed the established rule. Apart from social engagements while suffering from a cold, high fever has persisted for nine days. The momentum of pathogenic dampness steaming and roasting is still rampant. We hope for a turning point where significant heat reduction occurs.
Prescription: Curcuma Aromatica Rhizome (2 qian), Nine-joint Acorus Rhizome (4 fen), Platycodon Root (1.5 qian), Fermented Soybean (Xiangchi), Prepared Pinellia Tuber (3 qian), Arnebia Root/Bupleurum Root (Niuxiangzi - *Note: Text says Niuxiangzi, usually Arnebia or Bupleurum, here likely referring to a specific local usage or typo for Niuxibang/Niuxi, but strictly translating as written*), Citrus Peel (Juhong), Light Almond (3 qian), Cardamom Seed (Kouren, 7 fen), Scutellaria Root (Huangqin, wine-fried, 1.5 qian), Tetrapanax Pith (1 qian), Talcum Block (3 qian).
Second Visit: Continuous spontaneous sweating has slightly opened the chest oppression, but sleep remains unsteady. The mouth is dry and sticky. Pulse is rapid, tongue red, coating white and pale yellow. Turbidity in the stomach steams and roasts with dampness, unable to transform quickly. The illness has lasted ten days; only by draining and transforming can we avoid internal envelopment.
Prescription: Prepared Pinellia Tuber (2 qian), Stir-fried Bamboo Shavings (Zhuru, 1.5 qian), Citrus Peel (1 qian), Curcuma Aromatica Rhizome (1.5 qian), Alisma Rhizome (Zexie, 1.5 qian), Red Polyporus (Zhu Ling, 2 qian each), Stir-fried Aurantium Fruit (Zhike, 1 qian), Black Gardenia Fruit (Heishanzhi, 2 qian), Almond Paste (Xingrenni, 3 qian), Old Star Anise/Prepared Pinellia with Gall (Chen Danning, 5 fen), Raw Coix Seed (4 qian), Stir-fried Trichosanthes Peel (Loupi, 3 qian).
Third Visit: Venting the Taiyin, combined with unblocking the Fu organs, allows old stagnation to descend, relieving chest fullness and abdominal distension. However, the heat trend rises again, worse in the afternoon, with a dull yellow complexion. Thirst returns with stickiness, cough improves, but sleep is difficult. Pulse is rapid, slippery, and muddy; tongue edges are crimson, center remains white and greasy. This shows the pathogen moving from shallow to deep. There is no pathogen that cannot be reached, nor heat that cannot be drained. The reason for failure to sweat upon resolving or clear heat upon cooling is the intermingling of dampness holding within. Continue with draining and transforming as the main approach. Hope for separation of pathogen and dampness to prevent phlegm steaming and spreading.
Prescription: Broad Curcuma Rhizome (3 qian), Light Almond (3 qian), Talcum (3 qian), Coix Seed (5 qian), Stir-fried Bamboo Shavings (1.5 qian), Stir-fried Fermented Soybean (3 qian), Pale Scutellaria Root (1.5 qian), Red Polyporus (2 qian each), Broad Citrus Peel (1.5 qian), Platycodon Root (1 qian), Tetrapanax Pith (1 qian), Prepared Pinellia Tuber (2 qian).
[Patient Chen (Left)] Damp-warmth heat fluctuates. Dampness wraps outside heat, heat lies within dampness. Heat exceeds dampness, carrying stagnation and steaming. Pathogens of Taiyin merge into the Yangming division. Tongue red, coating yellow, center slightly dry. Bowel obstruction with frequent passing of flatus. Yangming damp-heat is gradually transforming into dry-heat.
Prescription: Pale Scutellaria Root, Coptis Rhizome (Chuanlian), Light Almond, Tetrapanax Pith, Curcuma Aromatica Rhizome, Raw Coix Seed, Talcum, Heart of Bamboo Leaves (12 pieces), Zhi Shi Dao Zhi Wan (taken with Tetrapanax Pith and Bergamot decoction).
Second Visit: Two doses of bitter-draining methods have been given, but heat still fluctuates. Rising brings irritability and thirst. Damp-heat steaming prevents fluids from ascending. Heat is like boiling in a pot; pathogen and dampness are like firewood underneath. Continue with draining and transforming as the main approach.
Prescription: Fermented Soybean, Broad Curcuma Rhizome, Light Almond, Platycodon Root, Tetrapanax Pith, Prepared Pinellia Tuber, Pale Scutellaria Root, Forsythia Fruit (Lianqiao), Alisma Rhizome, Talcum, Raw Coix Seed, Red Polyporus, Heart of Bamboo Leaves.
[Patient Zhou (Left)] In his sixties, addicted to smoking ("Purple Clouds"), decline of Mingmen Fire and abundance of damp-phlegm are evident. Yesterday eating sweet-cold foods secretly injured Spleen-Stomach Yang, causing damp-phlegm to fill the Three Jiao. The rotating and transporting Yang is suppressed by dampness, causing internal fever with low-grade heat. Excess dampness prevents Spleen Earth from separating clear and turbid; fluids meant for the Bladder mix into the Large Intestine, causing urgent diarrhea. Internal Qi closure opens pores, causing profuse sweating. Damp-phlegm stagnation may trigger latent pathogens, resulting in typical damp-heat disease. Tongue lacks luster, pulse is deep, fine, and choppy; right pulse slightly large, muddy, rapid, and suppressed—a sign of healthy Qi failing to overcome pathogenic Qi. At the onset, there is no rationale for sudden tonification of Yuan Qi. The prescription aims to differentiate and manage the Three Jiao, avoiding dispersing and attacking methods. Since dampness and phlegm cannot be forced, transformation is appropriate.
Prescription: Magnolia Bark (Chuanpu), Tetrapanax Pith, Alisma Rhizome, Bergamot, Curcuma Aromatica Rhizome, Red Polyporus, Pogostemon Herb, Talcum, Cardamom Seed, Raw Coix Seed.
Second Visit: Dampness suppresses Qi and fluids; severe thirst uses flowing transformation method.
Prescription: Dendrobium Stem (Jinshihu), Stir-fried Yellow Fritillary Bulb (Chuanbei), Talcum, Curcuma Aromatica Rhizome, Loquat Leaf, Cinnabar-infused Polyporus, Light Almond, Stir-fried Fermented Soybean, Coix Seed, White Cardamom Seed (3 fen ground, mixed with decoction of 2 liang Asparagus Root juice first).
[Master Yi] Yesterday, when examining, the orifices were about to be obscured; during medication, spirit was already confused. Today, coma ensued. Hands warm, feet cold. Pulse muddy and slippery, not very rapid. Coating white and greasy, not scorched black. Body heat not intense. This is due to extreme dampness, failure of Middle Yang to transport, leading to damp condensing into phlegm obscuring the clear orifices. This differs from coma caused by extreme fire-heat disturbing the Spirit. Tentatively prescribe aromatic spirit-unblocking, pungent-opening and bitter-descending methods, as a last stand. Human plans, Heaven's execution.
Prescription: Hyacinth Bean (Tianzhuhuang, 3 qian), Prepared Pinellia Tuber (3 qian), Polygala Root (Yuanzhi Rou, 1 qian), Realgar (Mingxiongjing, 1.5 qian stir-fried with Licorice decoction), Old Star Anise/Prepared Pinellia with Gall (Chen Danning, 1 qian), White Silkworm (Baijiangcan, 3 qian), Polyporus (Fuling, 3 qian), Broad Curcuma Rhizome (6 fen ground with 3 fen Alum water), Nine-joint Acorus Rhizome (8 fen), Bamboo Sap (1 liang drop with little Ginger Juice).
For turning point, use one pill of Zhibao Dan, taken with Citrus Peel decoction. After one dose, spirit clears slightly, continue at half dose.
Next Prescription: Coptis Rhizome (Chuan Yalian, stir-fried with Ginger Juice 3 fen), Prepared Pinellia Tuber (3 qian), Nine-joint Acorus Rhizome (8 fen), Citrus Peel (1.5 qian), Broad Curcuma Rhizome (1.5 qian), Pale Dried Ginger (6 fen, if severe use 2 qian crushed), Prepared Arisaema (Zhi Nanxing, 3 fen), Qingshi (3 fen), White Alum (3 fen), Roasted Gleditsia Spine (Zhayaosao, 3 fen), Musk (Wuli), Realgar (2 fen, latter six ground fine, mixed with Bamboo Sap first).
Commentary by Master: The critical moment of this case lies in external manifestation of surface heat for pathogen release. Second visit was conducted by disciple Yu Wenyao, who reported heat rising and convulsions turning. Initially, Master ordered opening and draining. Brother Yu reported damp transforming to dryness, tongue crimson with scorched black dry center. Master said: "Cannot say transformed to dryness yet; dryness transformation is insufficient." Use opening and draining again, hoping for transformation to heat/fire, requiring thorough penetration. Prescription similar to before, Prepared Arisaema 6 fen, add Zi Xue 6 fen, taken with Centella Decoction, aiming for heat to manifest. Brother Yu intended to use Niuhuang Wan, Xi Jiao Di Huang Tang, or fresh Dendrobium and Qing Gong Tang modifications, citing lack of explicit text for dryness without high heat. Master said: "Dryness without high heat is not true dryness; heat is not penetrated." Do not use cloying/nourishing herbs; must continue draining and transforming, slightly with sweet-pungent method. (Recorded by Qing Ru Zhi)
[Patient Zhang (Left)] Damp-warmth for ten days, vexatious heat, no sweat, faint red rashes not penetrating, extreme chest oppression, cough not clear, occasional delirium, frequent thirst but no desire to drink, prefers extremely hot soup. Pulse rapid, muddy, slippery; coating white, center yellow, root thick. This is formless pathogen vs. formed dampness, stalemate without transformation. Although pathogen wants to exit, internal dampness stagnates, preventing exterior Qi from communicating. Thus, venting and sweating fail to smooth rash and sweat. Heat and dampness steam together, clouding the clear space of the chest, confusing the Spirit. Fear damp steaming into phlegm internally obscuring, causing coma and spasms.
Prescription: San Ren Tang remove Talcum, Magnolia Bark, Bamboo Leaves; add Fermented Soybean, Citrus Peel, Curcuma Aromatica Rhizome, Aurantium Fruit, Platycodon Root, Acorus, Bergamot.
Second Visit: Yesterday entered pungent-ventilating and light-transforming. Upper Jiao Qi slightly opened, steaming heat slightly eased, spirit clarity returned, delirium and twitching stopped, vexation relaxed, coating receded. But Qi surges upward, causing cough and reverse flow. Pulse rapid, muddy, slippery. Although stagnation slightly resolved, pathogenic dampness is still extreme. Although there is a retreat signal, it is insufficient. Lung and Stomach affected by vapor make descent difficult, causing Qi surge and cough. Add Lung-venting and Qi-descending to previous method.
Prescription: Sweet Descurainia Seed (Tingli, 5 fen), Tetrapanax Pith, Light Almond, Prepared Pinellia Tuber, Winter Melon Seed, Broad Curcuma Rhizome, Thin Citrus Peel, Talcum Block, Stir-fried Aurantium Fruit, Loquat Leaf, Platycodon Root, Bamboo Shavings.
Third Visit: Chest oppression, restlessness, Qi surge, cough decrease sequentially. Sputum expectoration smoother. Coating largely transformed, but pulse still suppressed. Between Lung and Stomach remains steaming ground. Exterior cannot vent, pathogen has no outlet, still precarious.
Prescription: Light Almond, Broad Curcuma Rhizome, Pale Scutellaria Root, Mulberry Leaf, Sweet Descurainia Seed, Platycodon Root, White Cardamom Seed, Raw Coix Seed, Prepared Pinellia Tuber, Stir-fried Fermented Soybean, Citrus Peel, Loquat Leaf.
Fourth Visit: Cough and Qi reverse greatly reduced, sputum smooth, delirium and heat/vexation gradually lessened. Urine clear but not smooth, stool not passed, frequent flatus. Pulse rapid, muddy, slippery; coating transformed but center thick. Still damp-phlegm internal obstruction, pathogen hard to drain. Guide stagnation again.
Prescription: Curcuma Aromatica Rhizome, Citrus Peel, Platycodon Root, Prepared Pinellia Tuber, Red Polyporus, Raw Coix Seed, Talcum, Tetrapanax Pith, Dioscorea Hypoglauca Rhizome (Bixie), Zhu Li Da Tan Wan (3 qian sent down with Bergamot/Tetrapanax decoction).
Fifth Visit: Stool passes freely, vexation settled, heat lighter, thirst reduced. Red rashes distributed but sparse, sweat does not reach exterior. Pulse smoother, root coating white still present. Damp-pathogen steaming loosened but not penetrated. Must hope for external venting to be safe.
Prescription: Light Almond, Curcuma Aromatica Rhizome, Citrus Peel, Raw Coix Seed, Aurantium Fruit, Talcum Block, Stir-fried Trichosanthes Peel, Descurainia Seed, Platycodon Root, Tetrapanax Pith, Wood Tong Cao (Mutong), Prepared Pinellia Tuber, Red and White Polyporus.
Sixth Visit: Steaming/spreading momentum loosened, but damp nature is sticky, unable to drain quickly. Interior Qi not unblocked, exterior Qi hard to reach, sweat not vented, cough/Qi reverse/urine不畅. Pulse rapid, slippery, coating white. Pathogen and dampness support each other, still precarious.
Prescription: Curcuma Aromatica Rhizome, Light Almond, Citrus Peel, Winter Melon Seed, Platycodon Root, Fresh Bergamot, Prepared Pinellia Tuber, Raw Coix Seed, Cardamom Seed, Red Polyporus, Tetrapanax Pith, Reed Rhizome (Weijing).
Seventh Visit: Heat trend descending, cough loosening. Damp fights from inside, pathogen vents from outside. Heat lingers, cannot vent externally, wants to transform internally. Cannot rush.
Prescription: Soybean Sprout (Doujuan), Talcum, Light Almond, Curcuma Aromatica Rhizome, Prepared Pinellia Tuber, Tetrapanax Pith, Xinhui Red (Chenpi), Polyporus, Platycodon Root, Aurantium Fruit, Raw Coix Seed, Fresh Bergamot.
Eighth Visit: Formula to clear remaining residue
Prescription: Soybean Sprout, Raw Coix Seed, Prepared Pinellia Tuber, Tetrapanax Pith, Broad Tangerine Peel, Fukui Alisma, Light Almond, Fresh Bergamot, White Cardamom Seed, True Patchouli.
If chest oppression, add Platycodon/Curcuma; severe, add Magnolia/Aurantium/Pogostemon. If head distension, add Tribulus/Gastrodia/Silkworm. For Stomach regulation, add Raw/Roasted Barley Sprout/Aucklandia/Rose Bud.
Note: This damp-warmth case with chest oppression had delirium from onset. Zhang Xiangyun examined first, noting elderly patient with unclear spirit, warning against internal closure/spasms. First formula used Qinghao, Orange Network, Coral-like substances. Then Doujuan, Arnebia, Red Peony, Peucedanum, Hyacinth Bean, Cinnabar, Fushen, Yuxue Jiuku Dan. Ineffective. Invited Chao Chongshan. Case recorded cough not smooth, thirst for hot drinks, Qi level sinking to Jue/Yin, delirium/wind-movement danger. Formula: Doujuan, Cicada Slough, Raw Coix, Peucedanum, Light Almond, Curcuma, Qinghao, Platycodon, Forsythia Heart, Zhibao Dan. Heat still fierce, pathogen-fire entering Pericardium, fear internal wind. Changed to Antelope Horn, Reed Rhizome, Zi Xue. Still ineffective. Invited Master. Pulse muddy/rapid, coating white/greasy. Spirit deep depression. Used Qi-developing/light-transforming. One dose showed relief. Observing this, why are Shanghai experts confused about damp-warmth? No wonder remote areas use Qinghao, Huangqin, fresh Dendrobium (Yin-nourishing) to protect reputation. Sighs three times. (Recorded by Qing Ru)
[Patient Jiang (Right)] Flowing/transformation of damp-phlegm to open stagnation. Heat greatly reduced, vexation settled, spirit clear. Pulse缓和, tongue red turned pale, edges/tips moist, center dry and sweet/sticky. Pathogen retreated three stages, damp-phlegm wants to transform but hasn't. Qi mechanism suppressed, fluids hard to distribute. Treatment should consider both.
Prescription: Prepared Pinellia Tuber (3 qian), Curcuma Aromatica Rhizome (5 fen ground/mixed), Trichosanthes Seed (Gualou Ren, 1.5 qian), Citrus Peel (1 qian), Old Star Anise/Prepared Pinellia with Gall (5 fen), Stone Acorus (1.5 qian), Black Gardenia Fruit (3 qian), Almond Paste (3 qian), Talcum (3 qian), Lyonia Berry (Zelan, 1.5 qian), Loquat Leaf (3 slices), Weathered Niter (Fenghua Xiao, 6 fen), Green Qing Shi (5 fen), Realgar/Alum mixture (Mingfan 1.5 fen, Blood Amber 3 fen, first four ground/mixed).
Modified: Remove Gualou Ren, Fenghua Xiao, Zelan. Add Stir-fried Yellow Fritillary Bulb (1.5 qian), Bamboo Sap (5 qian).
Second Visit: Last night heat rose again, damp steamed by heat, filling chest. Spirit not as clear as yesterday. Pulse rapid, muddy, slippery. Clear space occupied by turbidity. In draining/transforming, add aromatic transformation.
Prescription: Light Almond, Square Tetrapanax Pith, Pale Scutellaria Root, Broad Curcuma Rhizome (ground with 3 fen Alum water), Stir-fried Bamboo Shavings, White Cardamom Seed, Talcum Block, Red/White Polyporus, Late Silkworm Sand, Bergamot, Zhibao Dan.
Modified: Remove Zhibao Dan. Add Prepared Realgar (1.5 fen), taken slowly with Tetrapanax decoction.
[Patient Yang (Right)] Case over two pentads, heat not heavy. Disease half-month, though not transforming to fire, must transform to heat. No logic for heat transforming but not being heavy. The lingering nature is because pathogen is light relative to dampness, dampness heavy relative to pathogen. Dampness accumulates in Lung/Stomach, Stomach Qi fails to descend. Drinking soup feels blocked, nausea arises. Heat steaming causes thirst, but dampness occupies inside, so no desire to drink. Damp is water-type, opens with warmth, so prefers hot drinks. Stool several times daily, watery. Neijing: Damp excess causes diarrhea. Damp stagnation extreme, Yin/Yang不通, causing chills/shaking. Stagnation extreme leads to passage, sweat releases, wind on skin exits with damp, causing white rashes. Although pathogen exit, skin/muscle issues remain irrelevant to Three Jiao steaming. Ears not clear, turbid pathogen harms clarity. Nose smells like smoke/mold, steaming heat manifests internally externally. Currently spirit dull, occasional wrong speech. If heat disturbs Spirit, mind blocked, must be confused. Now semi-confused/semi-clear, all formless pathogen and formed dampness steaming/spreading, clearing chest becomes smoky area, great risk of obscuration. Pulse deep/fine/unsmooth, coating pale yellow/greasy, definite evidence of damp-stagnation/heat-steaming. Prescribe Pungent to open, Bitter to drain, Aromatic to break turbidity, Light/Diuretic to guide damp downward.
Prescription: Coptis Rhizome (Chuan Yalian, Ginger Juice fried 5 fen), Prepared Pinellia Tuber (3 qian), Curcuma Aromatica Rhizome (ground/mixed 6 fen), Nine-joint Stone Acorus (8 fen), Old Citrus Peel (1.5 qian), Red/White Polyporus (2 qian each), Pale Dried Ginger (5 fen), Bamboo Shavings (1.5 qian Ginger Juice fried), Fermented Soybean (3 qian), White Cardamom Seed (4 grains in decoction), Raw Coix Seed (4 qian), Tetrapanax Pith (1 qian).
Modified: Remove Coptis, Dried Ginger. Add Talcum Block (3 qian), Guang Huoxiang (3 qian), reduce Acorus by 2 fen.
Second Visit: After medication, spirit greatly refreshed, ears clearer, diarrhea reduced. Damp like fog mistily transformed slightly, accumulated heat erupted here. Afternoon very vexatious/hot, unlike previous days' confusion. Pulse smoother, coating slightly transformed, but center yellow. Pain below navel, tender to pressure, frequent flatus, thirst wanting drink. Due to damp accumulation steaming, unable to drain. Fear coma/dryness changes.
Prescription: Prepared Pinellia Tuber (1.5 qian), Scutellaria Root (wine-fried 1 qian), Stone Acorus (5 fen), Zhu Er Qing (1.5 qian Ginger Juice fried), Broad Curcuma Rhizome (ground/mixed 6 fen), White Cardamom Seed (4 grains in decoction), Red/Zhu Ling (2 qian each), Light Almond (do not grind 3 qian), Talcum Block (3 qian), Square Tetrapanax Pith (1 qian), Fragrant Fermented Soybean (3 qian), Mu Xiang Bing Lang Wan (3 qian taken first).
Modified: Remove Mu Xiang Bing Lang Wan. Add Asparagus Root (1 liang), increase Talcum by 2 qian.
Third Visit: Pill medicine slowly purged, diarrhea stopped, abdomen still full/painful, frequent flatus. Heat repeatedly lightly reduced, chest uncomfortable, belching, sour saliva surging. Damp/accumulation obstruction visible. Strange is thirst wanting drink, not relieved. If fluid枯竭, internal dry, how sour saliva? Reason: Accumulation blocks below, dampness depresses above, Clear Qi cannot ascend. Though clear fluids exist, they cannot distribute. So more dry -> more drink -> more dry. Re-prescribe Venting/Transforming Three Jiao, adding guiding stagnation.
Prescription: Fragrant Fermented Soybean (3 qian), Broad Curcuma Rhizome (1.5 qian), Prepared Pinellia Tuber (1.5 qian), Pale Dried Ginger (stir-fried loose 3 fen), Tetrapanax Pith (1 qian), Raw Coix Seed (4 qian), Magnolia Bark (Chuanpu, 5 fen), Stone Acorus (5 fen), Shang Junjun (Shangjun, 3 qian added later), Almond Paste (3 qian), Polyporus (2 qian), Aurantium Fruit (Zhi Shi, ground/mixed 5 fen).