湿温初起之发热，尤忌辛温发汗，不可用解表药。仲景所言误汗证，大致是指湿温而言。清代医家谓忌麻、桂、姜、辛，因为这些是寒郁表阳(即寒邪伤表)的治法，若误用之，轻则高热不解，重则发生神昏、耳聋、目瞑不言的变证。
治温病邪在气分四不可
温病邪在气分，其治法宜“清”，叶天士云“到气才可清气”，这是主要原则。如热势重者(大热、大汗、大渴、脉洪大)，以白虎汤为主；热势轻者(热不重，渴不甚，汗不多)，用雷氏清暑涤热法。此外，还有几点需要特别注意：
1．不可早用寒滞，如生地、麦冬等，因邪在气分，用药宜取其气，不取其味，早用寒滞则邪遏不能外达。
2．不可过用苦寒，因其药性多下行，服之反使邪气不能向上向外而出，而且苦能化燥，过服苦寒易使温邪化燥伤阴。
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3．不可分利过度，邪在气分，小便短赤，过于分利，则津液尤耗。
4．不可早用清滋药物，用之反而引邪内陷。
温病的愈后调理
温病的愈后调理具有很重要的意义。调理得当，则病体可逐渐恢复健康；调理不当，则病多迁延难愈，甚或导致不良后果。
温病愈后调理的范围较广，大体说来，有两个方面要格外注意，一是饮食起居，一是药物调理。 一、饮食起居 体虚末复，在调理方面尤要注意防止劳复及食复。俗语说得好，“轻病重复劳”，说明任何一种病，只要复劳就比原来的病势险恶，这是由于身体抵抗力下降的关系。根据多年经验认为，温病愈后不宜过早操劳及行房事，以防反复。
温病热退之后，余邪未尽，骤进谷食，脾胃气弱，不及运化，以致食滞内停，余邪复作，是为食复。庞安常说：“凡病瘥后，先进清粥汤，次进糜粥，亦须少与之，切勿过食也；至于酒肉，尤当禁忌。若有不谨，便复发热，名日食复。”
此外，温病愈后还应谨防外感及动气，以防复发。 二、药物调理 温病愈后应根据患者的不同体质、证候，随证治之，～一般以补益气血、生津养液、清泄余热为常用方法。
1．余热未尽者：有两种现象，其一为肺胃之余热未尽，其症身有微热，或口微渴，或稍喜冷性饮食，不饥欲呕，脉较缓，或微数。治宜轻剂以清表里之虚热。用药宜竹叶以清在表之热，石膏以清在里之热，方剂宜参考竹叶石膏汤。其二为心与小肠之余热未尽，症见小便色赤，短涩，多言。治宜导赤散加麦冬、莲子心、灯心草。
2．津液未复者：这是温邪伤阴的具体表现。胃津液不足，口渴舌红而干燥者，治宜益胃生津，方如益胃汤；肠津液不足，大便秘，无所苦者，治宜增液润滑肠，方如增液汤。
3．胃气不降者：其主要症状为“欲呕”或“呕吐”。治宜降胃气止呕吐。用药以半夏、麦冬同用为主，因为半夏虽有降逆止呕的作用，但味辛性燥，不适于温病之呕逆，故以麦冬甘寒滋润之品补其缺陷。
4．气血两虚者：其症或身体赢瘦，或倦怠无力，或言语轻微，或语声颤动，或气不接续，或面色萎黄，或脉象虚弱。治宜补养气血。药宜人参、党参为主，兼表热者与竹叶、茅根等药同用，兼里热者与石膏、麦冬同用。必须注意胃气，避免温补药品，恐有死灰复燃之弊，饮食宜流质，最好为大米或小米稀粥。
邪伏膜原
邪伏膜原，是清代医家俞根初在《通俗伤寒论》中根据温病的一种症状提出来的，实质上是说明伏气温病的一种类型，在发展过程中包括四种现象：
1．外出少阳
主要症状是“寒热如疟”，或口苦或口渴，胁痛，目赤耳聋，尿赤，胸闷欲呕，舌质红，苔黄白垢腻，脉弦数。其“寒热如疟”之症与伤寒少阳病的寒热往来相比，从寒热情况来看是没有差别的，但前者舌质必红，后者舌苔发白。
病理机制：温热之邪和本身素有的湿浊相合阻遏气机，三焦为之不利，故有此与阴争则热、与阳争则寒的寒热如疟的症状。
治法：此证治之得法则由此而解，否则溃入阳明成为阳明经腑之证。治之不可选用寒滞之药，如生地、麦冬等，因此证夹有湿浊，生地、麦冬不但不能去之，恐相得益甚也。宜用蒿芩清胆汤以分上下之势。
2．溃入阳明
这是温病邪伏膜原发展过程中的一种类型，也有外出少阳治不得法形成者，有经证、腑证之别。
(1)阳明经证：身热，恶热，口渴，自汗，舌黄而燥，脉洪大有力。
(2)阳明腑证：除同经证外，兼腹胀痛拒按，大便秘或大便溏而不爽。
治法：寒去热炽，烦渴加重者，用新加白虎汤或合雪梨浆清之润之；吐白沫，粘滞不快者，宜五汁饮；未完全入腑者，凉膈散主之。
3．热逼营阴
主要症状是灼热如焚，口燥，不甚渴，舌绛有苔起刺，神昏谵语，夜寐不安，或出斑疹，或吐血、衄血。‘
治疗还要分清在营、在血，在血宜滋养阴液，在营宜清透血分郁热，使转出气分而解。
4．兼夹新感
主要症状是头疼身痛，寒热无汗，咳嗽口渴，舌质红，舌苔薄白，脉举之有余，寻之或滑或数，或绷急洪大。
凡在热性病初起见到这四种类型的任何一种，便可认为是邪伏膜原，就可认为是伏气温病，在春季者就可以叫作春温，在长夏时节者就可以叫伏暑(伏暑初起可能与寒热不规则的疟疾相混，但此证必兼脘闷口渴，午后热甚，入暮尤剧，天明得汗则热证减轻)。
泄 泻
慢性腹泻 每多夹杂之证
温清补散 量其多少而行
李老认为，腹泻在急性阶段证候单一者，是很容易治愈的。但若积滞内停，反用补涩以助其滞，寒湿中阻，反用苦寒败胃助湿，湿盛泄泻，反用寒凉以损阳气，表证者，不去解表，反用治里以促表邪内人，肝邪犯土者，不去疏肝抑肝，反用解毒治痢，则非但泄泻不治，反而由急性转为慢性。由于慢性腹泻大多是由误治或延误治疗时机所引起。所以虚实、寒热夹杂证尤多，因此治疗慢性腹泻时尤应注意虚、实、寒、热、表、里与脏、腑、经、络的兼夹情况。李老总结临床以下列五种证型为多见：
1．痰湿阻滞，寒热夹杂证：此证特点是除大便稀溏，一日数次外，并有胃脘痞满，食欲不振，口干或口苦，不能吃冷硬食物或肉食。
若从寒热的多少、虚实的多少比例看，又可分为三大类：
(1)痰湿阻滞，热多寒少证：症见大便稀溏，一日数次，食欲不振，偶见恶心欲吐，甚或呕吐，口苦咽干，胃脘痞满，吃肉食后痞满加重，腹鸣时作，舌苔白或黄白腻，脉滑或滑而稍数。治宜苦辛通降。生姜泻心汤加减：
生姜7．5克半夏7．5克黄连7．5克黄芩7．5克于姜7．5克甘草3克
若胃脘有压痛者，加枳实6克；大便稀较重者，加焦白术9克；吃肉食加重者，加焦山楂9克。
(2)痰湿阻滞，热少寒多证：症见大便稀溏，一日数次，胃脘痞满，食欲不振，时有脐腹冷痛，吃冷性饮食或遇冷时腹痛加重，口干或不干，舌苔薄黄或薄白，脉弦缓或弦而稍紧。治宜苦辛通降。连理汤加减：
黄连9克党参9克 白术9克 干姜9克 炙甘草9克
若手足指趾厥冷者，加附子9克；若时见烧心嘈杂，脉弦细者，治宜黄连汤加减：
黄连10克半夏10克干姜10克 肉桂10克党参10克炙甘草lO克大枣5个
(3)痰湿阻滞，久泻伤阴证：症见大便稀溏，或偶兼粘液便，食欲不振，恶心欲吐或时而少量呕吐，胃脘痞满，五心烦热，口舌生疮，舌质红，无苔，吃辛辣或咸食则口舌痛，手足时出斑疹，皮肤干燥或脱屑，烦躁失眠，脉滑数。治宜除湿化痰，佐以养阴。缩脾饮加减：
陈皮9克木瓜9克 菖蒲9克连翘9克 甘草6克乌梅炭3克砂仁3克
若胃脘痞满较重者，加枳壳9克；胃脘有压痛者，加焦槟榔4．5克。
2．虚实夹杂，积滞不化证：此证特点是大便稀溏有粘液，一日数次，偶有腹痛和里急后重，食欲不振。
若从寒热比例的多少去分，大致有两类：
(1)寒多热少，积滞不化证：症见大便一日数次，里急后重，大便呈稀溏粘液便，吃冷性饮食或遇冷时腹痛加重，舌苔白，脉沉细弦。治宜温中导滞。理中大黄汤加减：
附子4．5克 干姜6克 党参6克 白术6克 大黄3克木香6克乌药6克 山药15克
l周1～2剂，不可多服。
(2)热多寒少，积滞不化证：症见大便一日数次，粘液脓血稀溏便，微有里急后重，五心烦热，舌苔薄白，脉弦滑数。治宜苦辛通降，养阴导滞。驻车丸加减：
黄连9克干姜9克阿胶9克(烊化) 党参9克莱菔子9克木香6克焦槟榔9克
服药时，采用隔日l剂法。
3．肝郁气结，木邪犯土证：此证特点是胁痛，或脐腹一侧疼痛，生气时诸证加重，腹痛则泻，泻后痛减，大便稀溏，脉弦。
根据夹杂证的不同，可分为肝邪犯土，脾虚不运，和肝邪犯土，大肠气滞两类。
(1)肝邪犯土，脾虚不运证：症见胁痛，或脐腹一侧疼痛，痛则欲泻，生气或思想不愉快时加重，或兼有头晕头痛，失眠心烦，舌苔薄白，脉弦细。治宜疏肝健脾。逍遥散加减：
柴胡6克 当归9克 白芍9克 白术9克 干姜1．5克 炙甘草1．5克 防风炭3克陈皮9克
(2)肝邪犯土，大肠气滞证：症见少腹疼痛而坠胀，大便稀溏，一日数次，头晕头痛，失眠心烦，舌苔薄白，脉沉。治宜疏肝理气，健脾导滞。香砂丸加减：
香附9克乌药9克 木香9克 陈皮9克 砂仁6克 焦槟榔4．5克焦白术6克干姜1．5克防风1．5克
4．脾虚失运证：此证的主要特点是食后即泻，大便稀溏，疲乏无力，脉濡缓。
根据寒热的多少和阴阳虚衰的不同，大致分为以下三类：
(1)脾之气阴两虚证：症见食后即泻，大便稀溏，疲乏无力，舌苔薄白，脉濡缓。治宜健脾止泻。参苓白术散加减：
党参9克 白术9克茯苓9克炒扁豆9克砂仁9克陈皮9克炒薏米9克山药15克桔梗1．5克
若夜间口干或劳累后口干者，加葛根9克。
(2)脾虚寒盛证：症见食后即泻或久泻便溏，腹痛，疲乏无力，纳呆食减，舌苔薄白，脉濡缓而弦涩。治宜健脾温中。资生丸加减：
党参9克 白术9克 茯苓6克 扁豆9克 山药15克陈皮9克砂仁9克补骨脂9克吴茱萸6克
若舌苔黄，食后胃脘不适，食欲不振者，加黄连3克，干姜3克，焦三仙各9克。
(3)脾虚痰湿不化证：症见胃脘痞满，食欲不振，口淡乏味，大便稀溏，舌苔白，脉缓。治宜健脾和胃，除湿化痰。香砂六君子汤加减：
木香6克砂仁9克党参9克 白术9克茯苓9克陈皮9克半夏9克炙甘草9克
若胃脘有压痛者，加焦三仙各9克，枳实9克，若年高体衰，消瘦乏力者，改予焦白术4．5克，鸡内金6克。共为细末，1日3次，1次1克。
5．脾肾阳虚证：此证的特点是黎明前腹痛泄泻1～2次。
根据脾肾之间阳虚的多少比例，大致可分为脾虚为主、肾虚为主两类：
(1)脾肾阳虚，脾虚为主证：症见胃脘、脐腹冷痛，五更泄泻，舌苔薄白，脉弦大而紧。治宜温中健脾，补肾止泻。附桂理中合四神丸加减：
附子4．5克 肉桂4．5克党参6克 白术6克干姜6克炙甘草4．5克补骨脂9克 肉豆蔻6克 五味子6克吴茱萸3克山药5克
(2)脾肾阳虚，肾虚为主证：症见黎明前肠鸣腹痛泄泻，偶有腰痛，舌苔薄白，脉弦。治宜补肾止泻。四神丸加减：
补骨脂9克吴茱萸9克煨肉蔻10克五昧子10克山药15克
附案：
湿温病初起时的发热，特别忌讳使用辛温药物发汗，也不可以使用解表药。张仲景所说的误用汗法导致的证候，大致是指湿温病而言。清代医家指出忌讳使用麻黄、桂枝、干姜、细辛，因为这些是治疗寒邪郁闭在体表阳气（即寒邪损伤体表阳气）的方法，如果误用这些药物，轻则高热不退，重则出现神志昏迷、耳聋、闭目不语等变证。
治疗温病邪气在气分阶段的四个禁忌
当温病的邪气位于气分时，治疗方法应当以“清热”为主，叶天士说“到了气分才可以清气”，这是主要原则。如热势较重者（大热、大汗、大渴、脉象洪大），以白虎汤为主方；热势较轻者（热势不重，口渴不明显，出汗不多），使用雷氏清暑涤热法。此外，还有几点需要特别注意：
1．不可过早使用滋腻寒凉的药物，如生地黄、麦冬等，因为邪气在气分，用药宜取其气味中的“气”（轻清宣透之性），而不取其“味”（厚重滋腻之质），过早使用滋腻寒凉药物会导致邪气被遏制而不能向外透达。
2．不可过度使用苦寒药物，因为其药性多向下走，服用后反而使邪气不能向上、向外排出，而且苦味容易化燥，过服苦寒药物容易使温邪化燥并损伤阴液。
3．不可过度使用利尿渗湿药物，邪气在气分时，小便短少且色赤，如果过度利尿，则会进一步耗伤津液。
4．不可过早使用清润滋补的药物，使用反而会引导邪气向内陷入。
温病愈后的调理
温病痊愈后的调理具有重要意义。调理得当，身体可以逐渐恢复健康；调理不当，病情往往迁延难愈，甚至导致不良后果。
温病愈后调理的范围较广，大体说来，有两个方面要格外注意，一是饮食起居，二是药物调理。
一、饮食起居
身体虚弱尚未完全恢复时，在调理方面尤其要注意防止因劳累而复发（劳复）和因饮食不当而复发（食复）。俗话说得好，“轻病重复劳”，说明任何一种病，只要再次劳累，其病情就会比原来的病势更加险恶，这是由于身体抵抗力下降的缘故。根据多年经验认为，温病痊愈后不宜过早操劳及进行房事，以防病情反复。
温病热退之后，余留的邪气未尽，如果突然进食大量谷物食物，脾胃之气虚弱，来不及运化，导致食物停滞在内，余邪再次发作，这称为食复。庞安常说：“凡是病愈之后，先吃清淡的米汤，接着吃稀粥，也要少量给予，千万不要过量食用；至于酒肉，尤其应当禁忌。如果有不谨慎的地方，就会再次发热，名叫食复。”
此外，温病痊愈后还应谨防外感邪气和情绪激动动火，以防复发。
二、药物调理
温病痊愈后应根据患者的不同体质、证候，随证治疗，一般以补益气血、生津养液、清泄余热为常用方法。
1．余热未尽者：有两种现象，其一为肺胃的余热未尽，症状为身体有微热，或口微渴，或稍微喜欢冷性饮食，没有饥饿感且想呕吐，脉象较缓，或微数。治疗宜用轻剂以清解表里之虚热。用药宜用竹叶以清解在表之热，石膏以清解在里之热，方剂宜参考竹叶石膏汤。其二为心与小肠的余热未尽，症状见小便色赤，短涩，多言。治疗宜用导赤散加麦冬、莲子心、灯心草。
2．津液未复者：这是温邪损伤阴液的具体表现。胃津液不足，口渴、舌红而干燥者，治疗宜益胃生津，方剂如益胃汤；肠津液不足，大便秘结，但没有其他痛苦者，治疗宜增液润滑肠道，方剂如增液汤。
3．胃气不降者：其主要症状为“想呕吐”或“呕吐”。治疗宜降胃气止呕吐。用药以半夏、麦冬同用为主，因为半夏虽然有降逆止呕的作用，但味道辛、性质燥，不适合温病引起的呕吐，故用麦冬甘寒滋润之品来弥补其缺陷。
4．气血两虚者：症状或身体消瘦，或倦怠无力，或言语轻微，或语声颤动，或气息不接续，或面色萎黄，或脉象虚弱。治疗宜补养气血。药物宜用人参、党参为主，兼有表热者与竹叶、白茅根等药同用，兼有里热者与石膏、麦冬同用。必须注意保护胃气，避免使用温补药品，恐怕有死灰复燃的弊端，饮食宜流质，最好是大米或小米稀粥。
邪伏膜原
邪伏膜原，是清代医家俞根初在《通俗伤寒论》中根据温病的一种症状提出来的，实质上是说明伏气温病的一种类型，在发展过程中包括四种现象：
1．外出少阳
主要症状是“寒热像疟疾一样”，或口苦或口渴，胁痛，眼睛红、耳聋，尿赤，胸闷想呕吐，舌质红，苔黄白垢腻，脉弦数。其“寒热像疟疾一样”的症状与伤寒少阳病的寒热往来相比，从寒热的情况来看是没有差别的，但前者舌质必红，后者舌苔发白。
病理机制：温热之邪和本身素有的湿浊相合，阻遏气机，三焦为之不利，所以有此与阴争则热、与阳争则寒的寒热像疟疾一样的症状。
治法：此证治疗得法则由此而解，否则溃入阳明成为阳明经腑之证。治疗不可选用滋腻寒凉的药物，如生地黄、麦冬等，因此证夹有湿浊，生地黄、麦冬不但不能去除它，恐怕会相得益彰（加重湿浊）。宜用蒿芩清胆汤以分消上下之势。
2．溃入阳明
这是温病邪伏膜原发展过程中的一种类型，也有因外出少阳治疗不得法形成的，有经证、腑证之别。
(1)阳明经证：身热，怕热，口渴，自汗，舌黄而燥，脉洪大有力。
(2)阳明腑证：除同经证外，兼腹胀痛拒按，大便秘结或大便溏薄但不爽利。
治法：寒去热炽，烦渴加重者，用新加白虎汤或合雪梨浆清解滋润；吐白沫，粘滞不快者，宜五汁饮；未完全入腑者，凉膈散主之。
3．热逼营阴
主要症状是灼热如火烧，口燥，不甚渴，舌绛有苔且起刺，神昏谵语，夜寐不安，或出斑疹，或吐血、衄血。
治疗还要分清在营分、在血分，在血分宜滋养阴液，在营分宜清透血分之郁热，使邪气转出气分而解。
4．兼夹新感
主要症状是头疼身痛，寒热无汗，咳嗽口渴，舌质红，舌苔薄白，脉举之有余，寻之或滑或数，或绷急洪大。
凡在热性病初起见到这四种类型的任何一种，便可认为是邪伏膜原，就可认为是伏气温病，在春季者就可以叫作春温，在长夏时节者就可以叫伏暑（伏暑初起可能与寒热不规则的疟疾相混，但此证必兼脘闷口渴，午后热甚，入暮尤剧，天明得汗则热证减轻）。
泄泻
慢性腹泻 每多夹杂之证
温清补散 量其多少而行
李老认为，腹泻在急性阶段证候单一者，是很容易治愈的。但若积滞内停，反用补涩药以助其滞，寒湿中阻，反用苦寒药败胃助湿，湿盛泄泻，反用寒凉药以损阳气，表证者，不去解表，反用治里药以促表邪内入，肝邪犯土者，不去疏肝抑肝，反用解毒治痢药，则非但泄泻不治，反而由急性转为慢性。由于慢性腹泻大多是由误治或延误治疗时机所引起。所以虚实、寒热夹杂证尤多，因此治疗慢性腹泻时尤应注意虚、实、寒、热、表、里与脏、腑、经、络的兼夹情况。李老总结临床以下列五种证型为多见：
1．痰湿阻滞，寒热夹杂证：此证特点是除大便稀溏，一日数次外，并有胃脘痞满，食欲不振，口干或口苦，不能吃冷硬食物或肉食。
若从寒热的多少、虚实的多少比例看，又可分为三大类：
(1)痰湿阻滞，热多寒少证：症见大便稀溏，一日数次，食欲不振，偶见恶心欲吐，甚或呕吐，口苦咽干，胃脘痞满，吃肉食后痞满加重，腹鸣时作，舌苔白或黄白腻，脉滑或滑而稍数。治宜苦辛通降。生姜泻心汤加减：
生姜7.5克 半夏7.5克 黄连7.5克 黄芩7.5克 干姜7.5克 甘草3克
若胃脘有压痛者，加枳实6克；大便稀较重者，加焦白术9克；吃肉食加重者，加焦山楂9克。
(2)痰湿阻滞，热少寒多证：症见大便稀溏，一日数次，胃脘痞满，食欲不振，时有脐腹冷痛，吃冷性饮食或遇冷时腹痛加重，口干或不干，舌苔薄黄或薄白，脉弦缓或弦而稍紧。治宜苦辛通降。连理汤加减：
黄连9克 党参9克 白术9克 干姜9克 炙甘草9克
若手足指趾厥冷者，加附子9克；若时见烧心嘈杂，脉弦细者，治宜黄连汤加减：
黄连10克 半夏10克 干姜10克 肉桂10克 党参10克 炙甘草10克 大枣5个
(3)痰湿阻滞，久泻伤阴证：症见大便稀溏，或偶兼粘液便，食欲不振，恶心欲吐或时而少量呕吐，胃脘痞满，五心烦热，口舌生疮，舌质红，无苔，吃辛辣或咸食则口舌痛，手足时出斑疹，皮肤干燥或脱屑，烦躁失眠，脉滑数。治宜除湿化痰，佐以养阴。缩脾饮加减：
陈皮9克 木瓜9克 菖蒲9克 连翘9克 甘草6克 乌梅炭3克 砂仁3克
若胃脘痞满较重者，加枳壳9克；胃脘有压痛者，加焦槟榔4.5克。
2．虚实夹杂，积滞不化证：此证特点是大便稀溏有粘液，一日数次，偶有腹痛和里急后重，食欲不振。
若从寒热比例的多少去分，大致有两类：
(1)寒多热少，积滞不化证：症见大便一日数次，里急后重，大便呈稀溏粘液便，吃冷性饮食或遇冷时腹痛加重，舌苔白，脉沉细弦。治宜温中导滞。理中大黄汤加减：
附子4.5克 干姜6克 党参6克 白术6克 大黄3克 木香6克 乌药6克 山药15克
1周1～2剂，不可多服。
(2)热多寒少，积滞不化证：症见大便一日数次，粘液脓血稀溏便，微有里急后重，五心烦热，舌苔薄白，脉弦滑数。治宜苦辛通降，养阴导滞。驻车丸加减：
黄连9克 干姜9克 阿胶9克（烊化） 党参9克 莱菔子9克 木香6克 焦槟榔9克
服药时，采用隔日1剂法。
3．肝郁气结，木邪犯土证：此证特点是胁痛，或脐腹一侧疼痛，生气时诸证加重，腹痛则泻，泻后痛减，大便稀溏，脉弦。
根据夹杂证的不同，可分为肝邪犯土，脾虚不运，和肝邪犯土，大肠气滞两类。
(1)肝邪犯土，脾虚不运证：症见胁痛，或脐腹一侧疼痛，痛则欲泻，生气或思想不愉快时加重，或兼有头晕头痛，失眠心烦，舌苔薄白，脉弦细。治宜疏肝健脾。逍遥散加减：
柴胡6克 当归9克 白芍9克 白术9克 干姜1.5克 炙甘草1.5克 防风炭3克 陈皮9克
(2)肝邪犯土，大肠气滞证：症见少腹疼痛而坠胀，大便稀溏，一日数次，头晕头痛，失眠心烦，舌苔薄白，脉沉。治宜疏肝理气，健脾导滞。香砂丸加减：
香附9克 乌药9克 木香9克 陈皮9克 砂仁6克 焦槟榔4.5克 焦白术6克 干姜1.5克 防风1.5克
4．脾虚失运证：此证的主要特点是食后即泻，大便稀溏，疲乏无力，脉濡缓。
根据寒热的多少和阴阳虚衰的不同，大致分为以下三类：
(1)脾之气阴两虚证：症见食后即泻，大便稀溏，疲乏无力，舌苔薄白，脉濡缓。治宜健脾止泻。参苓白术散加减：
党参9克 白术9克 茯苓9克 炒扁豆9克 砂仁9克 陈皮9克 炒薏米9克 山药15克 桔梗1.5克
若夜间口干或劳累后口干者，加葛根9克。
(2)脾虚寒盛证：症见食后即泻或久泻便溏，腹痛，疲乏无力，纳呆食减，舌苔薄白，脉濡缓而弦涩。治宜健脾温中。资生丸加减：
党参9克 白术9克 茯苓6克 扁豆9克 山药15克 陈皮9克 砂仁9克 补骨脂9克 吴茱萸6克
若舌苔黄，食后胃脘不适，食欲不振者，加黄连3克，干姜3克，焦三仙各9克。
(3)脾虚痰湿不化证：症见胃脘痞满，食欲不振，口淡乏味，大便稀溏，舌苔白，脉缓。治宜健脾和胃，除湿化痰。香砂六君子汤加减：
木香6克 砂仁9克 党参9克 白术9克 茯苓9克 陈皮9克 半夏9克 炙甘草9克
若胃脘有压痛者，加焦三仙各9克，枳实9克，若年高体衰，消瘦乏力者，改予焦白术4.5克，鸡内金6克。共为细末，1日3次，1次1克。
5．脾肾阳虚证：此证的特点是黎明前腹痛泄泻1～2次。
根据脾肾之间阳虚的多少比例，大致可分为脾虚为主、肾虚为主两类：
(1)脾肾阳虚，脾虚为主证：症见胃脘、脐腹冷痛，五更泄泻，舌苔薄白，脉弦大而紧。治宜温中健脾，补肾止泻。附桂理中合四神丸加减：
附子4.5克 肉桂4.5克 党参6克 白术6克 干姜6克 炙甘草4.5克 补骨脂9克 肉豆蔻6克 五味子6克 吴茱萸3克 山药5克
(2)脾肾阳虚，肾虚为主证：症见黎明前肠鸣腹痛泄泻，偶有腰痛，舌苔薄白，脉弦。治宜补肾止泻。四神丸加减：
补骨脂9克 吴茱萸9克 煨肉蔻10克 五味子10克 山药15克
附案：
The fever at the initial stage of damp-heat warm disease (Shi Wen Chu Qi Zhi Fa Re) particularly contraindicates the use of acrid-warm diaphoretic herbs to induce sweating, and exterior-releasing formulas should not be used. The syndrome caused by erroneous sweating mentioned by Zhang Zhongjing generally refers to damp-heat warm disease. Qing dynasty physicians pointed out that Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Ganjiang (Zingiberis Rhizoma), and Xixin (Asari Radix et Rhizoma) are contraindicated because these are treatments for cold pathogen stagnating the body surface yang (Han Yu Biao Yang, i.e., cold pathogen injuring the body surface yang). If misused, mild cases result in persistent high fever, while severe cases lead to complications such as coma, deafness, and mutism with eyes closed.
Four Taboos for Treating Warm Disease Pathogen in the Qi Level
When the warm disease pathogen is at the Qi level, the treatment method should prioritize "clearing heat." Ye Tianshi stated, "Only when reaching the Qi level can one clear the Qi," which is the main principle. For heavy heat conditions (high fever, profuse sweating, intense thirst, surging pulse), Baihu Tang (White Tiger Decoction) is the primary formula; for mild heat conditions (mild fever, slight thirst, little sweating), Leishi Qingshu Di Re Method (Leishijia's Heat-Clearing and Summer-Heat-Purging Method) is used. Additionally, several points require special attention:
1. Do not use cloying and cold-natured herbs too early, such as Shengdi Huang (Rehmanniae Radix) and Maidong (Ophiopogonis Radix). Since the pathogen is in the Qi level, medication should utilize the "Qi" (light and penetrating nature) rather than the "Flavor" (heavy and cloying quality). Using cloying cold herbs too early will constrain the pathogen, preventing it from being expelled outward.
2. Do not overuse bitter-cold herbs, as their properties tend to direct downward. Taking them may prevent the pathogen from moving upward and outward. Moreover, bitterness can transform into dryness; excessive use of bitter-cold herbs easily causes warm pathogens to transform into dryness and injure Yin fluids.
3. Do not overuse diuretic and damp-draining methods. When the pathogen is in the Qi level, urine is scanty and dark. Excessive diuresis will further consume body fluids.
4. Do not use clearing and moistening tonics too early, as doing so may instead guide the pathogen inward.
Post-Recovery Regulation of Warm Disease
Post-recovery regulation of warm disease is of great significance. Proper regulation allows the body to gradually recover health; improper regulation often leads to prolonged illness or even adverse consequences.
The scope of post-recovery regulation is broad. Generally, two aspects require extra attention: diet and daily life, and medicinal regulation.
I. Diet and Daily Life
When the body is weak and has not fully recovered, particular care must be taken to prevent relapse due to labor (Lao Fu) and relapse due to diet (Shi Fu). As the saying goes, "A mild illness repeated through labor," indicating that for any disease, relapse due to overexertion is more perilous than the original condition, due to decreased physical resistance. Based on years of experience, it is believed that after recovering from warm disease, one should avoid premature exertion and sexual activity to prevent recurrence.
After the fever subsides, residual pathogens remain. Sudden intake of grain foods, combined with weak Spleen-Stomach Qi, cannot be transformed and transported effectively, leading to food stagnation internally and the resurgence of residual pathogens, known as Shi Fu (Dietary Relapse). Pang Anchang said: "After a disease resolves, first consume clear rice soup, then millet gruel, but give only small amounts; do not overeat. Wine and meat are especially taboo. Any lack of caution will cause fever to return, named Shi Fu."
Furthermore, after recovering from warm disease, one should guard against external contraction and emotional agitation to prevent recurrence.
II. Medicinal Regulation
Post-recovery treatment should be based on the patient's different constitutions and syndromes. Generally, replenishing Qi and Blood, generating fluids, and clearing residual heat are common methods.
1. Residual Heat Not Exhausted: There are two manifestations. First, residual heat in the Lung and Stomach remains, presenting with slight fever, slight thirst, preference for cold drinks, lack of appetite with nausea, slow or slightly rapid pulse. Treatment requires light agents to clear deficiency heat in the interior and exterior. Use Zhuye (Bambusae Folium) to clear exterior heat and Shigao (Gypsum Fibrosum) to clear interior heat; refer to Zhuyegushao Tang (Bamboo Leaf and Pork Rib Decoction). Second, residual heat in the Heart and Small Intestine remains, presenting with red, scanty, and painful urination, and excessive talking. Treatment uses Daochi San (Guide Out the Red Powder) plus Maidong, Lianzixin (Nelumbinis Plumula), and Dengxincao (Junci Medulla).
2. Fluids Not Restored: This is a specific manifestation of warm pathogens injuring Yin. For insufficient Stomach fluids presenting with thirst, red tongue, and dryness, treat by benefiting the Stomach and generating fluids, using formulas like Yiwei Tang (Benefit the Stomach Decoction). For insufficient Intestine fluids presenting with constipation without other distress, treat by increasing fluids and lubricating the intestines, using formulas like Zengye Tang (Increase Fluids Decoction).
3. Stomach Qi Not Descending: Main symptoms are "urge to vomit" or "vomiting." Treatment aims to descend Stomach Qi and stop vomiting. Use Banxia (Pinelliae Rhizoma) and Maidong together. Although Banxia has descending and anti-emetic effects, its acrid and drying nature is unsuitable for warm disease vomiting; thus, Maidong's sweet, cold, and moistening nature compensates for this defect.
4. Qi and Blood Deficiency: Symptoms include emaciation, fatigue, weak speech, trembling voice, shortness of breath, sallow complexion, or weak pulse. Treatment involves nourishing Qi and Blood. Use Renshen (Ginseng Radix) and Dangshen (Codonopsis Radix) as main herbs. For concurrent exterior heat, combine with Zhuye and Baigemao Gen (Imperatae Rhizoma); for interior heat, combine with Shigao and Maidong. Care must be taken to protect Stomach Qi and avoid warm-tonic medicines to prevent the risk of dead ashes reigniting. Diet should be liquid, preferably rice or millet porridge.
Pathogen Hidden in the Membrane Source
The concept of "Pathogen Hidden in the Membrane Source" was proposed by Qing dynasty physician Yu Genchu in *Tongsu Shanghan Lun* (Popularized Treatise on Cold Damage) based on a symptom of warm disease. It essentially describes a type of latent warm disease, involving four developmental phenomena:
1. Emerging to Shaoyang
Main symptoms include "chills and fever resembling malaria," bitter taste or thirst, hypochondriac pain, red eyes, deafness, dark urine, chest fullness with urge to vomit, red tongue body, greasy yellow-white coating, and wiry-rapid pulse. Compared to the alternating chills and fever of Shaoyang syndrome in Cold Damage, the chills and fever patterns are similar, but the former features a red tongue body, while the latter has a white coating.
Pathological Mechanism: Warm-heat pathogens combine with inherent damp-turbidity, obstructing Qi mechanism and causing dysfunction of the Triple Burner. Thus, fighting Yin causes heat, and fighting Yang causes chills, resulting in malaria-like chills and fever.
Treatment: If treated correctly, the syndrome resolves; otherwise, it penetrates into Yangming, becoming Yangming Channel or Organ syndrome. Do not use cloying cold herbs like Shengdi Huang or Maidong, as they cannot remove damp-turbidity and may exacerbate it. Use Haoqin Qingdan Tang (Artemisiae Scopariae and Scutellariae Gallbladder-Clearing Decoction) to separate and drain upper and lower levels.
2. Penetrating into Yangming
This is a type in the development of pathogen hidden in the membrane source, also potentially formed by incorrect treatment of Shaoyang emergence. It distinguishes between Channel and Organ syndromes.
(1) Yangming Channel Syndrome: Fever, aversion to heat, thirst, spontaneous sweating, yellow and dry tongue coating, surging and forceful pulse.
(2) Yangming Organ Syndrome: In addition to Channel symptoms, includes abdominal distension and pain with refusal to press, constipation, or loose stools that are difficult to pass.
Treatment: If cold dissipates and heat flares up with aggravated irritability and thirst, use Xinjia Baihu Tang (Newly Modified White Tiger Decoction) or combine with Xueli Jiang (Pear Juice) to clear and moisten. For white frothy expectoration that is sticky and uncomfortable, use Wuzhi Yin (Five Juices Drink). If not fully entering the Organ, use Liangge San (Cooling the Diaphragm Powder).
3. Heat Pressing on Ying-Yin
Main symptoms include burning heat like fire, dry mouth, slight thirst, crimson tongue with prickles, delirium, restless sleep, macules/rashes, hematemesis, or epistaxis.
Treatment must distinguish between Ying level and Blood level. For Blood level, nourish Yin fluids; for Ying level, clear and vent stagnant heat in the Blood level, allowing the pathogen to exit to the Qi level for resolution.
4. Concurrent New Contraction
Main symptoms include headache and body ache, chills and fever without sweating, cough, thirst, red tongue body, thin white coating, floating pulse with excess upon lifting, slippery or rapid upon pressing, or tense-surging-large pulse.
If any of these four types appear at the onset of an acute febrile disease, it can be considered pathogen hidden in the membrane source, i.e., latent warm disease. In spring, it is called Chunwen (Spring Warmth); in late summer, it is called Fushu (Latent Summerheat). (Fushu onset may be confused with irregular malaria, but this syndrome always includes epigastric stuffiness and thirst, worse heat in the afternoon, most severe at night, and reduced heat after morning sweating.)
Diarrhea
Chronic diarrhea often involves mixed syndromes.
Warm, Clear, Tonify, Disperse: Administer according to proportions.
Old Li believes that diarrhea in the acute stage with a single syndrome is easy to cure. However, if food stagnation is present, using astringents worsens stagnation; if cold-damp obstructs the middle, using bitter-cold herbs damages the Stomach and aids dampness; if dampness causes diarrhea, using cold herbs damages Yang Qi; if exterior syndrome exists, failing to release the exterior and treating the interior promotes interior invasion of exterior pathogens; if Liver pathogen invades Earth, failing to soothe the Liver and using detoxifying dysentery herbs fails to cure diarrhea and turns acute into chronic. Chronic diarrhea is mostly caused by misdiagnosis/mistreatment or delayed timing. Thus, mixed deficiency-excess and cold-heat syndromes are common. Treating chronic diarrhea requires attention to mixed deficiency-excess, cold-heat, interior-exterior, and Zang-Fu/Channel/Collateral involvement. Old Li summarizes five common clinical syndromes:
1. Phlegm-Damp Obstruction with Mixed Cold-Heat: Characterized by loose stools multiple times daily, epigastric fullness, poor appetite, dry or bitter mouth, intolerance to cold/hard foods or meat.
Based on cold-heat and deficiency-excess ratios, divided into three categories:
(1) Phlegm-Damp Obstruction, More Heat than Cold: Loose stools, poor appetite, occasional nausea/vomiting, bitter/dry mouth, epigastric fullness worsening after meat, borborygmus, white or yellow-greasy coating, slippery or slightly rapid pulse. Treat with bitter-acrid descending. Modify Shengjiang Xiexin Tang (Ginger Heart-Draining Decoction):
Shengjiang 7.5g, Banxia 7.5g, Huanglian 7.5g, Huangqin 7.5g, Ganjiang 7.5g, Gancao 3g.
Add Zhishi 6g for epigastric tenderness; Jiaobaizhu 9g for severe loose stools; Jiaoshanzha 9g if worsening after meat.
(2) Phlegm-Damp Obstruction, Less Heat than Cold: Loose stools, epigastric fullness, poor appetite, occasional umbilical/abdominal cold pain worsening with cold food/exposure, dry or non-dry mouth, thin yellow or white coating, wiry-slow or wiry-tight pulse. Treat with bitter-acrid descending. Modify Lianli Tang (Coptis and Poria Decoction):
Huanglian 9g, Dangshen 9g, Baizhu 9g, Ganjiang 9g, Zhigancao 9g.
Add Fuzi 9g for cold extremities; if heartburn and wiry-thin pulse occur, modify Huanglian Tang (Coptis Decoction):
Huanglian 10g, Banxia 10g, Ganjiang 10g, Rougui 10g, Dangshen 10g, Zhigancao 10g, Dazao 5 pieces.
(3) Phlegm-Damp Obstruction, Long-term Diarrhea Injuring Yin: Loose stools or occasional mucous stool, poor appetite, nausea/vomiting, epigastric fullness, five-palm heat, oral ulcers, red tongue without coating, mouth/tongue pain after spicy/salty food, rashes on hands/feet, dry/scaly skin, irritability/insomnia, slippery-rapid pulse. Treat with damp-draining and phlegm-resolving, assisted by Yin-nourishing. Modify Suopi Yin (Spleen-Constricting Drink):
Chenpi 9g, Mugua 9g, Changpu 9g, Lianqiao 9g, Gancao 6g, Wumeitan 3g, Sharen 3g.
Add Zhike 9g for severe epigastric fullness; Jiaobinglang 4.5g for epigastric tenderness.
2. Mixed Deficiency-Excess with Undigested Stagnation: Loose mucous stools multiple times daily, occasional abdominal pain and tenesmus, poor appetite.
Divided into two categories by cold-heat ratio:
(1) More Cold than Heat, Undigested Stagnation: Loose stools multiple times daily, tenesmus, mucous loose stools, pain worsening with cold, white coating, deep-thin-wiry pulse. Treat with warming middle and guiding stagnation. Modify Lizhong Dahuang Tang (Major Yellow Modified Lizhong Decoction):
Fuzi 4.5g, Ganjiang 6g, Dangshen 6g, Baizhu 6g, Dahuang 3g, Muxiang 6g, Wuyao 6g, Shanyao 15g.
1-2 doses per week; do not overdose.
(2) More Heat than Cold, Undigested Stagnation: Loose mucopurulent bloody stools multiple times daily, mild tenesmus, five-palm heat, thin white coating, wiry-slippery-rapid pulse. Treat with bitter-acrid descending, Yin-nourishing, and stagnation-guiding. Modify Zhuche Wan (Parking Pill):
Huanglian 9g, Ganjiang 9g, Ejiao 9g (melted), Dangshen 9g, Laifuzi 9g, Muxiang 6g, Jiaobinglang 9g.
Administer every other day.
3. Liver Qi Stagnation with Wood Invading Earth: Hypochondriac pain or unilateral umbilical/abdominal pain, worsening with anger, pain relieved by defecation, loose stools, wiry pulse.
Divided into Liver invading Earth with Spleen deficiency and Liver invading Earth with Large Intestine Qi stagnation:
(1) Liver Invading Earth, Spleen Deficiency with Failure to Transport: Hypochondriac/unilateral pain, urge to defecate with pain, worsening with anger/unpleasant thoughts, dizziness/headache, insomnia/irritability, thin white coating, wiry-thin pulse. Treat with soothing Liver and strengthening Spleen. Modify Xiaoyao San (Free Wanderer Powder):
Chaihu 6g, Danggui 9g, Baishao 9g, Baizhu 9g, Ganjiang 1.5g, Zhigancao 1.5g, Fangfengtan 3g, Chenpi 9g.
(2) Liver Invading Earth, Large Intestine Qi Stagnation: Lower abdominal pain with bearing-down sensation, loose stools multiple times daily, dizziness/headache, insomnia/irritability, thin white coating, deep pulse. Treat with soothing Liver, regulating Qi, strengthening Spleen, and guiding stagnation. Modify Xiangsha Wan (Costus and Amomum Pill):
Xiangfu 9g, Wuyao 9g, Muxiang 9g, Chenpi 9g, Sharen 6g, Jiaobinglang 4.5g, Jiaobaizhu 6g, Ganjiang 1.5g, Fangfeng 1.5g.
4. Spleen Deficiency with Failure to Transport: Main characteristic is immediate diarrhea after eating, loose stools, fatigue, soggy-slow pulse.
Divided into three categories by cold-heat and Yin-Yang deficiency:
(1) Spleen Qi and Yin Dual Deficiency: Immediate diarrhea after eating, loose stools, fatigue, thin white coating, soggy-slow pulse. Treat with strengthening Spleen and stopping diarrhea. Modify Shenling Baizhu San (Poria and Atractylodes Macrocephala Powder):
Dangshen 9g, Baizhu 9g, Fuling 9g, Chao Bian Dou 9g, Sharen 9g, Chenpi 9g, Chao Yimi 9g, Shanyao 15g, Jiegeng 1.5g.
Add Gegen 9g for night/labor-induced dry mouth.
(2) Spleen Deficiency with Abundant Cold: Immediate or long-term loose diarrhea, abdominal pain, fatigue, poor appetite, thin white coating, soggy-slow-wiry-choppy pulse. Treat with strengthening Spleen and warming middle. Modify Zisheng Wan (Nourishing Life Pill):
Dangshen 9g, Baizhu 9g, Fuling 6g, Bian Dou 9g, Shanyao 15g, Chenpi 9g, Sharen 9g, Buguzhi 9g, Wuzhuyu 6g.
Add Huanglian 3g, Ganjiang 3g, Jiao Sanxian 9g each if yellow coating, postprandial discomfort, or poor appetite.
(3) Spleen Deficiency with Untransformed Phlegm-Damp: Epigastric fullness, poor appetite, bland taste, loose stools, white coating, slow pulse. Treat with strengthening Spleen, harmonizing Stomach, draining damp, and resolving phlegm. Modify Xiangsha Liujunzi Tang (Costus, Amomum, and Six-Gentlemen Decoction):
Muxiang 6g, Sharen 9g, Dangshen 9g, Baizhu 9g, Fuling 9g, Chenpi 9g, Banxia 9g, Zhigancao 9g.
Add Jiao Sanxian 9g each and Zhishi 9g for epigastric tenderness; for elderly/frail patients, change to Jiaobaizhu 4.5g and Jineijin 6g. Make fine powder, take 1g three times daily.
5. Spleen-Kidney Yang Deficiency: Characteristic is abdominal pain and diarrhea 1-2 times before dawn.
Divided into Spleen-deficiency predominant and Kidney-deficiency predominant:
(1) Spleen-Kidney Yang Deficiency, Spleen Predominant: Cold pain in epigastrium/umbilicus/abdomen, dawn diarrhea, thin white coating, large-tight-wiry pulse. Treat with warming middle, strengthening Spleen, tonifying Kidney, and stopping diarrhea. Combine Fugui Lizhong with Sishen Wan:
Fuzi 4.5g, Rougui 4.5g, Dangshen 6g, Baizhu 6g, Ganjiang 6g, Zhigancao 4.5g, Buguzhi 9g, Roudoukou 6g, Wuweizi 6g, Wuzhuyu 3g, Shanyao 5g.
(2) Spleen-Kidney Yang Deficiency, Kidney Predominant: Bowel sounds, abdominal pain, and diarrhea before dawn, occasional lower back pain, thin white coating, wiry pulse. Treat with tonifying Kidney and stopping diarrhea. Modify Sishen Wan:
Buguzhi 9g, Wuzhuyu 9g, Weiroukou 10g, Wuweizi 10g, Shanyao 15g.
Appendix Cases: