某 久患三疟未愈，劳力更感风温，而发时证，及今八日。壮热烦躁，汗不能出，疹不能透，热郁蒸痰，神
糊呓语，两胁疼痛，难以转侧，胸闷气粗，动则欲厥。所以然者，邪热与瘀伤混
合，痰浊与气血交阻，莫能分解，以致扰乱神明，渐有昏喘之险。
豆豉（五钱） 苏梗（一钱） 郁金（一钱） 赤茯神（三钱） 连翘（三钱） 丹皮（钱半） 当归
（三钱） 杏仁（三钱） 天竺黄（钱半） 木通（一钱） 猩绛（七分） 菖蒲（五分） 青葱 枇杷叶
渊按∶郁金、杏仁解气郁，当归、葱、猩解血郁，豆豉、苏
梗从里达表，尤宜佐黄芩、鲜地等以解热郁，否则热不解而诸郁亦不开，热蒸痰阻，陷入胞络易易。
宋 湿温过候，斑疹并见，心胸烦懊，神识模糊。脉数混混而不清，舌心苔干而不腻。湿蕴化热，
热渐化燥。气粗短促，目赤耳聋。阴精下亏，风阳上亢。虑其内陷昏痉。拟生津达邪，兼芳香逐秽。
鲜斛 淡豆豉 竹茹 连翘 橘红 赤苓 天竺黄 黑栀 菖蒲 郁金 羚羊 陈胆星 牛黄清心丸（五
分） （加）犀黄（三厘）
又 湿温邪在太阴、阳明，湿胜于热，太阴为多；热胜于湿，阳明为甚。日晡烦躁，阳明旺时也。口虽渴，
苔仍白腻，乃湿蕴
化热，余湿犹滞，气火熏蒸，蒙蔽清窍，故斑疹虽透而神识时糊，脉沉小而数疾，皆邪郁不达之象。倘若热甚风动变
劲，便难措手。
半夏 赤苓 鲜斛 连翘 川连（姜汁炒） 菖蒲 通草 豆豉 郁金 益元散 竹茹 茅根 黑栀
渊按∶宜参凉膈散缓缓通下，不致下文化燥内陷耳。盖湿温
虽不可早下，而热胜挟滞者，不下则热邪挟滞不去。湿邪亦从热化燥化火也。
又 湿温旬日，脉数较大于昨，热势较盛于前，所谓数则烦
心，大为病进，并非阴转为阳、自内达外之象。舌苔白浓，上罩
微灰，面红目赤，阳盛之征；头昏耳聋，阴虚之象；小溲窒塞，
气化不及也。当生津以彻热，利窍以化湿。救阴不在肾而在生胃
津，去湿不可燥而在通小便。盖汗生于津，津充汗出而热解；小肠为心之府，小便通利，心火降而神清。
羚羊角 赤苓 菖蒲 竺黄 泽泻 益元散 知母 鲜斛 通草 竹叶 鲜薄荷根
另∶用珠子（五分） 血珀（五分），为末，调服。
渊按∶名言傥论，勿草草读过。
又 湿热郁蒸，如烟如雾，神识沉迷，脉时躁时静。静则神
倦若寐，躁则起坐如狂，邪内陷矣。虽便不通，而腹鸣不满，肠
胃不实，其粪必溏，未可骤攻下之。大凡温邪时症，验舌为先。
今尖苔白，上罩微霉，邪在营气之交。叶氏云∶邪乍入营，犹可
透热，仍转气分而解，如犀、羚、元、翘等是也。从此立方，参以芳香宣窍。
犀角 羚羊角 鲜斛 竺黄 元参 连翘 益元散 赤苓 竹茹 至宝丹（一粒）
又 前方加鲜地、栝蒌仁、枳实。
又 舌黑而干，湿已化燥；频转屎气，脘腹按痛，邪聚阳明，
肠胃已实，当商通腑。但小便自遗，肾气虚也。正虚邪实，津枯
火炽，惟有泻南补北，勉进黄龙汤法。
鲜地 人参 生军 元参 元明粉 菖蒲 竺黄 连翘 竹叶 甘蔗汁（代水煎药）
渊按∶蔗汁生饮最妙。代水煎药，不但腻膈，且失凉润之性矣。
又 下后舌黑稍退，而脉反洪大，神识仍昏，阳明火旺也。
清阳明燔灼之火，救少阴涸竭之阴，用景岳玉女煎。
鲜地 元参 鲜斛 知母 竺黄 麦冬 石膏 竹叶 芦根 蔗汁（一杯，冲）
又 津回舌润，固属休征；风动头摇，仍为忌款。温邪虽
退，元气大虚，虚风上扰不息，又防眩晕厥脱。今当扶正熄风，参以生津和胃。
生洋参 钩钩 天麻 茯神 制半夏 石决明 秫米 陈皮 麦冬 竹茹 甘蔗皮
渊按∶热滞虽从下而松，肝家阴液早为燥火所伤，故见证如此，迟下之累也。
胡 素有肝胃病，适挟湿温，七日汗解，八日复热。舌灰唇
焦，齿板口渴，欲得热饮。右脉洪大数疾，左亦弦数。脘中仍
痛，经事适来。静思其故，请明析之。夫肝胃乃腹中一脏一府，
木乘土则气郁而痛。若不挟邪，安得寒热？即有寒热，断无大
热，以此为辨也。又询大便坚硬而黑，是肠胃有实热，所谓燥屎
也。考胃气痛门，无燥屎症，惟瘀血痛门有便血，然此症无发狂
妄喜之状，则断乎非蓄血，此又一辨也。渴喜热饮，疑其为寒似
矣。不知湿与热合，热处湿中，湿居热外，必饮热汤而湿乃开，
胸中乃快，与阴寒假热不同，再合脉与唇，其属湿温挟积无疑。
《伤寒大白》云∶唇焦为食积。此言诸书不载，可云高出前古。
豆豉 郁金 延胡 山栀 香附 赤苓 连翘 竹茹 蒌皮
外用葱头十四个，盐一杯，炒热，熨痛处。
按∶病本湿温挟食，交候战汗而解，少顷复热为一忌。汗出
而脉躁疾者，又一忌。适值经来，恐热邪陷入血室，从此滋变，
亦一忌。故用豆豉以解肌，黑栀以清里，一宣一泄，祛表里之客
邪。延胡索通血中气滞、气中血滞，兼治上下诸痛。郁金苦泄以
散肝郁，香附辛散以利诸气，二味合治妇人经脉之逆行，即可杜
热入血室之大患。栝蒌通府，赤苓利湿。加竹茹、连翘，一
以开胃气之郁，一以治上焦之烦。外用葱、盐热熨，即古人摩按之法，相赞成功。
渊按∶此虽有食积，亦不可下，以胸痞脘痛，渴喜热饮，中
焦湿饮郁遏不开，寒热错杂，阳明之气失于顺降。若遽下之，轻
则痞膈，重即结胸矣。同一湿温夹滞，其不同有如此者。
又 服药后大便一次，色黑如栗者数枚，兼带溏粪。脘痛大
减，舌霉、唇焦俱少退，原为美事。惟脉数大者变为虚小无力，
心中觉空，是邪减正虚之象，防神糊痉厥等变。今方九日，延过两候乃吉。
香豉 青蒿 沙参 赤芍 川贝 郁金 黑栀 竹茹 稻叶 金橘饼
渊按∶大便通而痛减，乃葱盐按摩之功也。葱能通气，咸能
顺下，阳明之气得通，胃气自然下降；胃气通降，大便无有不通
者。夫便犹舟也，气犹水也，水流顺畅，舟无停滞之理。若但知
苦寒攻下，不明中气之逆顺，是塞流以行舟耳！
秦 温邪十二日，斑疹遍透，神识仍糊，大便屡行，齿垢未
脱。舌尖红，中心焦，阴津灼也。左脉大，右脉小，元气弱也。
昨投清泄芳开，是从邪面着笔；今诊脉神委顿，当从元气推求。
要知温属阳邪，始终务存津液；胃为阳土，到底宜济甘凉。所虑
液涸动风，易生痉厥之变；胃虚气逆，每致呃忒之虞耳！
羚羊角 沙参 生草 竺黄 菖蒲 鲜石斛 犀角 元参 洋参 泽泻 茯神 芦根 蔗汁
另用濂珠粉三分，上血珀末三分，开水调服。
又 昨用甘寒生津扶正，病势无增无减。然小便得通，亦气
化津回之兆也。症交十三日，是谓过经，乃邪正胜负关头。从此
津液渐回，神气渐清，便是邪退之机；从此而津液不回，神糊益
甚，便是邪进之局。正胜邪则生，邪胜正则重。仍以生津救液，冀其应手。
羚羊 鲜斛 沙参 洋参 麦冬 泽泻 赤苓 元参 蔗汁 芦根 珠黄散
又加知母、川贝。
又 甘寒清润，固足生津，亦能滋湿。向之舌绛干焦者，今
转白腻，口多白沫，是胃浊上泛也。小便由于气化，湿滞中焦，
气机不畅，三焦失于输化，故不饥，不思纳，小便不利也。法宜宣畅三焦。
豆卷 赤苓 猪苓 泽泻 生苡仁 杏仁 通草 竹茹 陈
皮半夏曲 谷芽 血珀（五分，研末，冲服）
渊按∶帆随湘转，妙于转环。脾肾阳气素虚，阳邪一化，阴
湿即来。在脉神委顿时早防之，庶免此日波变。然不料其变之如
是速耳。古方大豆卷治筋挛湿痹，苏地用麻黄汤浸，借以发汗，与此症总不相宜。
又 瘀热蓄于下焦，膀胱气痹不化，少腹硬满，小溲不利。
下既不通，必反上逆，恐生喘呃之变。开上、疏中、渗下，俾得三焦宣畅，决渎流通。
紫菀 杏仁 桔梗 川朴 陈皮 赤苓 猪苓 泽泻 苏梗 血珀 通草
又 照方加参须（五分），煎汤调下血珀（五分）。外用田螺二枚，葱白
一握，桃仁三钱，曲少许，麝香五厘，肉桂五分，合打烂，炖温，敷脐下关元穴。
又 温邪甫退，少腹板硬，膀胱气化无权。昨议疏泄三焦，
小便仍不畅。今少腹硬满过脐，其大如盘，按之不痛，脉沉小，
舌白腻，身无热，口不渴，所谓上热方除中寒复起是也。夫膀胱
与肾相表里，膀胱气化赖肾中阳气蒸腾。肾阳不足，膀胱水气凝
而为瘕，须防犯胃冲心呃厥等变。急急温肾通阳泄水，犹恐莫及。
肉桂五苓散，送下金匮肾气丸三钱。
渊按∶须此方解下焦之围，再佐葱、盐按摩更妙。
又 通阳泄水，与病相投，虽未大减已奏小效。腹中觉冷，中阳衰弱显然。
照方加木香、炮姜。
尤 症交十二日，目赤耳聋，舌白烦渴，脉洪大而汗出。当
辛凉以彻气分之热邪，甘凉以救肺胃之津液。
北沙参 麦冬 知母 竺黄 元参 生石膏（薄荷同打） 滑石 竹叶 芦根
又 目张不语而神慧，与汤则咽，身能转侧。舌苔灰白，脉
形洪滑。并非邪闭心包，乃肝阳夹痰火阻塞清明之府。勿再芳香开达，开则邪反内陷矣，慎之！
羚羊角 川贝 郁金 茯苓 胆星 石决明 远志 鲜斛 竹油 姜汁 北沙参
渊按∶清火熄风，豁痰通窍，丝丝入扣。惟沙参可斟酌，以其补肺也。舌苔灰白，痰火征兆。
又 目张不语，多汗脉大。阳盛阴虚，防其厥脱。急救其阴，希图万一。
生洋参 石决明 沙参 茯神 麦冬 川贝母 五味子
又 目已能合，口已能言，但舌蹇而言涩。汗多稍收，脉大
稍敛，似有一线生机。所嫌两臂动强，恐其发痉。拟存阴熄风法。
羚羊角 鲜地 生地 洋参 沙参 石决明 麦冬 钩钩 蔗汁
渊按∶几乎类中。大抵平素肺肾阴气不足，肝阳有余，年过四十者，每有是证。
华 温邪八日，神识模糊，斑色红紫，脘腹拒按，结热旁
流。舌红干燥，目赤唇焦，而又肤冷汗出，脉伏如无。邪热内闭，阴津外泄，颇有内闭外脱之虑。勉进黄龙汤法。
大生地 参须 生军 枳实 连翘 天竺黄 元参 菖蒲 鲜斛
渊按∶肤冷、汗出、脉伏，非虚象，乃闭象也。从斑色红紫上看出。参须可斟酌。
某 久病元气未复，又感湿温，已愈旬日。解表、疏中、通
下之药，皆已服过。现脉仍数，舌白腻。头汗多，身热不解，咳
嗽不扬，小溲不爽。且以分泄三焦，再看转机。
豆卷 杏仁 赤苓 腹皮 川朴 桔梗 蒌皮 苏梗 泽泻 滑石 通草
高 舌白，口渴，咽痛。湿温化热，症方四日。年高正虚，势防战汗。冀其无变为佳。
薄荷 桔梗 射干 滑石 牛蒡子 橘红 杏仁 枳壳 蔻仁 芦根
又 温邪挟积化燥。昨服药后战汗不透，大热虽减，里热仍炽。舌霉边白，脉形不显。高年恐其内陷。
大力子 香豉 鲜斛 连翘 黑栀 薄荷根 滑石 枳实
又 胸脘板痛拒按，此属结胸。舌心燥边白，此挟痰水，挟
气积。症交七日，温邪内伏，将燥未燥，将陷未陷。昨午投生津
达邪一剂，今结胸症已具。势不容缓，再进小陷胸法。
川连 半夏 枳实 蒌仁 香豉 黑栀
渊按∶仲景小陷胸以枳实佐川连，栝蒌佐半夏，苦泄辛润，
开中焦之痞，以化痰水热邪。方名陷胸，与诸泻心汤出入，并非
下剂。今人以蒌、枳为通腑之药，殊属可笑。
顾 温邪得食则复。舌心尖焦黄而干，边苔白腻，心胸痞
闷，此挟积，挟气，挟痰，挟水。大便已十二日不通，其势不得不下。
半夏 茯苓 泽泻 川连 枳实 川朴 蒌仁 大黄 元明
粉
杨 胸闷头痛，寒热往来。邪在少阳，有汗而热不解，是伤
于风也。舌薄白，边色干红。阴亏之体，邪未外达，而津液暗
伤，渐有化燥之象。症交七日，中脘拒按，似欲大便而不得出，
少阳之邪传及阳明，胃家将燥实矣。防其谵语，拟少阳、阳明两解法。
柴胡 淡芩 半夏 枳实 甘草 香豉 黑栀 蒌仁 桔梗 滚痰丸（钱半）
渊按∶从大柴胡、陷胸变化，不用大黄、黄连，以阴亏液
伤，拒按在中脘，不在大腹也。借滚痰丸以微通之，心灵手敏。
又 得汗得便，邪有松机，是以胸闷、心跳、烦躁等症悉
除，而头痛略减也。虽自觉虚馁，未便多进谷食，亦未可就进补剂，但和其胃，化其邪可耳。
香豉 豆卷 半夏 川贝 赤苓 陈皮 郁金 川斛 通草 竹茹
又 用和胃化邪法，一剂颇安，二剂反剧。良以畏虚多进谷
食，留恋其邪，不能宣化，郁于心胸之间，湿蕴生痰，热蒸灼
液，烦躁、恶心、错语。两手寸关脉细滑数，两尺少神，舌边干
红，心苔黄腻，皆将燥未燥，将陷未陷之象。拟导赤泻心各半法，生津化浊，和胃清心。
犀角 川连 鲜斛 枳实 半夏 赤苓 连翘 黑栀 橘红 生甘草 通草 郁金 竹茹 芦根
某患者长期患有三疟疾未愈，因劳累用力又感受风温邪气，导致发作时的症状持续至今已达八天。高热烦躁，汗液无法排出，疹子不能透发，热邪郁蒸生痰，神志模糊并伴有胡言乱语，两侧胁肋部疼痛，身体难以转动，胸闷气息粗重，稍动则欲昏厥。之所以出现这种情况，是因为邪热与瘀血损伤混合在一起，痰浊与气血相互交阻，无法分解，从而扰乱了心神，逐渐有陷入昏迷和喘息的危险。
处方：淡豆豉（五钱）、紫苏梗（一钱）、郁金（一钱）、赤茯神（三钱）、连翘（三钱）、丹皮（钱半）、当归（三钱）、杏仁（三钱）、天竺黄（钱半）、木通（一钱）、猩红绛（七分）、石菖蒲（五分）、青葱、枇杷叶。
王渊按语：郁金、杏仁用于解除气机郁滞，当归、葱、猩红绛用于解除血分郁滞，淡豆豉、紫苏梗从体内达于体表，尤其适宜佐以黄芩、鲜地黄等药物来解除热郁，否则热邪不解而各种郁滞也不能打开，热邪蒸腾痰浊阻滞，极易陷入心包络。
宋姓患者湿温病已过了一候（五天），斑疹同时出现，心胸烦闷懊恼，神识模糊。脉搏数且浑浊不清，舌中心苔干而不腻。湿气蕴结化为热邪，热邪逐渐化为燥邪。呼吸粗短急促，眼睛发红，耳朵聋哑。阴精在下亏损，风阳在上亢盛。担心邪气内陷导致昏迷和惊厥。拟定生津达邪，兼用芳香祛除秽浊的方法。
处方：鲜石斛、淡豆豉、竹茹、连翘、橘红、赤茯苓、天竺黄、黑栀子、石菖蒲、郁金、羚羊角、陈胆星、牛黄清心丸（五分）（加服）犀黄（三厘）。
复诊：湿温邪气在太阴经、阳明经，湿胜于热，以太阴经为主；热胜于湿，以阳明经为甚。下午申时烦躁，这是阳明经旺盛的时候。口虽渴，但舌苔仍白腻，这是湿气蕴结化热，余湿仍然停滞，气火熏蒸，蒙蔽清窍，所以虽然斑疹透出但神识时而模糊，脉象沉小而数疾，都是邪气郁结不得外达的现象。倘若热势严重引动肝风发生变证，就难以处理了。
处方：半夏、赤茯苓、鲜石斛、连翘、川黄连（姜汁炒）、石菖蒲、通草、淡豆豉、郁金、益元散、竹茹、茅根、黑栀子。
王渊按语：宜参考凉膈散缓缓通下，不至于因攻下而导致化燥内陷。因为湿温病虽然不可过早攻下，但如果热胜夹杂积滞，不通下则热邪挟带积滞不去。湿邪也会随着热邪化为燥火。
复诊：湿温病十天，脉搏比昨天更快，热势比以前更盛，所谓“数则烦心，大为病进”，这并不是阴证转为阳证、自内达外的现象。舌苔白厚，上面覆盖微灰色，面色红眼睛红，是阳气盛的征象；头昏耳聋，是阴虚的征象；小便闭塞不通，是气化功能不及。应当生津以清除热邪，利窍以化解湿气。救阴不在于补肾而在于滋生胃津，去湿不可用燥药而在于通利小便。因为汗生于津液，津液充足出汗后热邪自解；小肠是心的腑，小便通利，心火下降而神志清醒。
处方：羚羊角、赤茯苓、石菖蒲、天竺黄、泽泻、益元散、知母、鲜石斛、通草、竹叶、鲜薄荷根。
王渊按语：这是名言妙论，不要草率读过。
复诊：湿热郁蒸，如烟如雾，神识沉迷，脉搏有时躁动有时安静。安静时神疲倦怠像要睡觉，躁动时起坐如狂，这是邪气内陷了。虽然大便不通，但肠鸣腹胀不满，肠胃没有实邪，粪便必定稀溏，不可骤然攻下。大凡温病时症，验舌为先。现在舌尖苔白，上面覆盖微霉色，邪气在营气和气分的交界处。叶天士说：邪气刚入营分，还可以透热转气，仍然通过气分解除，比如犀角、羚羊角、元参、连翘等药物就是这样的道理。据此立方，参以芳香宣窍的药物。
处方：犀角、羚羊角、鲜石斛、天竺黄、元参、连翘、益元散、赤茯苓、竹茹、至宝丹（一粒）。
复诊：前方加入鲜地黄、栝蒌仁、枳实。
复诊：舌苔黑而干燥，湿气已经化为燥邪；频频放屁，脘腹按压疼痛，邪气聚集在阳明经，肠胃已经结实，应当商量通腑泄热。但是小便失禁，说明肾气虚。正气虚弱邪气实，津液枯竭火势炽盛，只有采用泻南补北的方法，勉强试用黄龙汤的法度。
处方：鲜地黄、人参、生大黄、元参、玄明粉、石菖蒲、天竺黄、连翘、竹叶、甘蔗汁（代替水煎药）。
王渊按语：蔗汁生饮最好。代替水煎药，不仅腻膈，而且失去了凉润的性质。
复诊：攻下后舌黑稍微减退，但脉搏反而洪大，神识仍然昏沉，这是阳明火旺。清泄阳明燔灼之火，挽救少阴涸竭之阴，使用张景岳的玉女煎。
处方：鲜地黄、元参、鲜石斛、知母、天竺黄、麦冬、石膏、竹叶、芦根、蔗汁（一杯，冲服）。
复诊：津液回复舌面湿润，固然是好转的迹象；但风动头摇，仍然是禁忌。温邪虽然退去，元气大虚，虚风上扰不止，又要防止眩晕厥脱。现在应当扶正熄风，参以生津和胃。
处方：西洋参、钩藤、天麻、茯神、制半夏、石决明、秫米、陈皮、麦冬、竹茹、甘蔗皮。
王渊按语：热滞虽然从下面松动，但肝家阴液早已被燥火所伤，所以见证如此，这是迟于攻下的拖累。
胡姓患者素有肝胃病，恰好夹杂湿温，七天时汗出而解，八天又发热。舌苔灰暗嘴唇焦裂，牙龈口渴，想要喝热饮。右脉洪大数疾，左脉也弦数。脘中仍然疼痛，月经刚好来潮。静思其缘故，请明析之。肝和胃是腹中的一脏一腑，木乘土则气郁而痛。如果不夹杂邪气，怎么会寒热？即使有寒热，断然不会有大热，以此作为辨别。又询问大便坚硬而黑，这是肠胃有实热，所谓的燥屎。考察胃气痛门，没有燥屎症，只有瘀血痛门有便血，然而此症没有发狂妄喜的状态，则断然不是蓄血，这是又一辨别点。渴喜热饮，怀疑其为寒似乎有理。不知道湿与热合，热处湿中，湿居热外，必须喝热汤而湿气才开，胸中才快，这与阴寒假热不同，再结合脉象与唇色，属于湿温夹杂积滞无疑。
《伤寒大白》说：唇焦为食积。这话其他书不载，可以说高出前古。
处方：淡豆豉、郁金、延胡索、山栀、香附、赤茯苓、连翘、竹茹、栝楼皮。
外用：葱头十四个，盐一杯，炒热，熨烫痛处。
按语：病本是湿温夹杂食积，交节战汗而解，稍后又发热是一忌。汗出而脉搏躁疾者，又是另一忌。恰逢经期来潮，恐热邪陷入血室，从此滋生变化，也是一忌。所以用淡豆豉以解肌表，黑栀子以清里热，一宣一泄，祛除表里的客邪。延胡索通血中气滞、气中血滞，兼治上下诸痛。郁金苦泄以散肝郁，香附辛散以利诸气，两味合治妇人经脉之逆行，即可杜绝热入血室的大患。栝楼通腑，赤茯苓利湿。加竹茹、连翘，一味开胃气之郁，一味治上焦之烦。外用葱、盐热熨，即古人摩按之法，相辅相成成功。
王渊按语：此症虽有食积，也不可攻下，因为胸痞脘痛，渴喜热饮，中焦湿饮郁遏不开，寒热错杂，阳明之气失于顺降。如果立刻攻下，轻则痞膈，重即结胸。同样是湿温夹滞，其不同之处有如此之多。
复诊：服药后大便一次，颜色黑如栗子的几枚，兼带稀粪。脘痛大减，舌霉、唇焦都稍微减退，原为美事。只是脉搏数大变为虚小无力，心中觉得空，这是邪气减少正气虚弱的征象，防备神识模糊惊厥等变证。现在方子用了九天，拖延过两个节气才好。
处方：香豉、青蒿、沙参、赤芍、川贝母、郁金、黑栀子、竹茹、稻叶、金橘饼。
王渊按语：大便通而痛减，是葱盐按摩的功效。葱能通气，咸能顺下，阳明之气得通，胃气自然下降；胃气通降，大便没有不通的。大便犹如船，气犹如水，水流顺畅，船没有停滞的道理。如果只知道苦寒攻下，不明白中气的逆顺，这是堵塞水流来行船啊！
秦姓患者温邪十二天，斑疹遍透，神识仍然模糊，大便多次通行，齿垢未脱。舌尖红，中心焦，是阴津被灼烧。左脉大，右脉小，是元气弱。昨天投用清泄芳开，是从邪气方面着笔；今天诊察脉神委顿，应当从元气推求。要知道温属阳邪，始终务必保存津液；胃为阳土，到底宜济甘凉。所担心的是液涸动风，易生惊厥之变；胃虚气逆，每致呃逆之虞。
处方：羚羊角、沙参、生甘草、天竺黄、石菖蒲、鲜石斛、犀角、元参、西洋参、泽泻、茯神、芦根、蔗汁。
另用濂珠粉三分，上血珀末三分，开水调服。
复诊：昨天用甘寒生津扶正，病势无增无减。然而小便得通，也是气化津回的征兆。病症进入十三天，这叫过经，是邪正胜负关头。从此津液渐回，神气渐清，便是邪退之机；从此津液不回，神糊更甚，便是邪进之局。正胜邪则生，邪胜正则重。仍以生津救液，希望应手见效。
处方：羚羊角、鲜石斛、沙参、西洋参、麦冬、泽泻、赤茯苓、元参、蔗汁、芦根、珠黄散。
复诊：又加知母、川贝母。
复诊：甘寒清润，固然足以生津，也能滋湿。之前的舌绛干焦，现在转为白腻，口多白沫，这是胃浊上泛。小便由于气化，湿滞中焦，气机不畅，三焦失于输化，所以不饥，不思纳食，小便不利。法宜宣畅三焦。
处方：大豆卷、赤茯苓、猪苓、泽泻、生薏苡仁、杏仁、通草、竹茹、陈皮半夏曲、谷芽、血珀（五分，研末，冲服）。
王渊按语：帆随湘转，妙于转环。脾肾阳气素虚，阳邪一变，阴湿即来。在脉神委顿时早防之，以免这一天的波变。然而没料到变化如此之速。古方大豆卷治筋挛湿痹，苏地用麻黄汤浸，借以发汗，与此症总不相宜。
复诊：瘀热蓄于下焦，膀胱气痹不化，少腹硬满，小便不利。下面不通，必然反向上逆，恐怕产生喘息呃逆的变证。开上、疏中、渗下，使得三焦宣畅，决渎流通。
处方：紫菀、杏仁、桔梗、厚朴、陈皮、赤茯苓、猪苓、泽泻、紫苏梗、血珀、通草。
复诊：照方加人参须（五分），煎汤调下血珀（五分）。外用田螺二枚，葱白一握，桃仁三钱，曲少许，麝香五厘，肉桂五分，合打烂，炖温，敷脐下关元穴。
复诊：温邪刚退，少腹板硬，膀胱气化无权。昨天议定疏泄三焦，小便仍不畅。现在少腹硬满超过肚脐，大如盘子，按压不痛，脉沉小，舌白腻，身无热，口不渴，所谓上热方除中寒复起。膀胱与肾相表里，膀胱气化赖肾中阳气蒸腾。肾阳不足，膀胱水气凝而为瘕，须防犯胃冲心呃厥等变证。急急温肾通阳泄水，还恐怕来不及。
王渊按语：须此方解下焦之围，再佐葱、盐按摩更妙。
复诊：通阳泄水，与病相投，虽未大减已奏小效。腹中觉冷，中阳衰弱显然。
照方加木香、炮姜。
尤姓患者病症进入十二天，目赤耳聋，舌白烦渴，脉洪大而汗出。当用辛凉以彻气分之热邪，甘凉以救肺胃之津液。
处方：北沙参、麦冬、知母、天竺黄、元参、生石膏（薄荷同打）、滑石、竹叶、芦根。
复诊：眼睛睁开不语但神识聪慧，给汤则咽，身体能转侧。舌苔灰白，脉形洪滑。并非邪闭心包，乃肝阳夹痰火阻塞清明之府。不要再芳香开达，开则邪反内陷，慎之！
处方：羚羊角、川贝母、郁金、茯苓、胆星、石决明、远志、鲜石斛、竹油、姜汁、北沙参。
王渊按语：清火熄风，豁痰通窍，丝丝入扣。惟独沙参可斟酌，因为它补肺。舌苔灰白，是痰火征兆。
复诊：眼睛睁开不语，多汗脉大。阳盛阴虚，防备厥脱。急救其阴，希图万一。
复诊：眼睛已能闭合，口已能言，但舌蹇而言涩。汗多稍收，脉大稍敛，似有一线生机。所嫌两臂动强，恐怕发生惊厥。拟存阴熄风法。
处方：羚羊角、鲜地黄、生地黄、西洋参、沙参、石决明、麦冬、钩藤、蔗汁。
王渊按语：几乎类似中风。大抵平素肺肾阴气不足，肝阳有余，年过四十者，常有此证。
华姓患者温邪八天，神识模糊，斑色红紫，脘腹拒按，结热旁流。舌红干燥，目赤唇焦，而又肤冷汗出，脉伏如无。邪热内闭，阴津外泄，颇有内闭外脱之虑。勉进黄龙汤法。
处方：大生地、参须、生大黄、枳实、连翘、天竺黄、元参、石菖蒲、鲜石斛。
王渊按语：肤冷、汗出、脉伏，不是虚象，是闭象。从斑色红紫上看出。参须可斟酌。
某患者久病元气未复，又感湿温，已愈十天。解表、疏中、通下的药，都已服过。现脉仍数，舌白腻。头汗多，身热不解，咳嗽不扬，小便不爽。暂且分泄三焦，再看转机。
处方：大豆卷、杏仁、赤茯苓、大腹皮、厚朴、桔梗、栝楼皮、紫苏梗、泽泻、滑石、通草。
高姓患者舌白，口渴，咽痛。湿温化热，病症才四天。年高正虚，势防战汗。希望无变为佳。
处方：薄荷、桔梗、射干、滑石、牛蒡子、橘红、杏仁、枳壳、蔻仁、芦根。
复诊：温邪挟积化燥。昨天服药后战汗不透，大热虽减，里热仍炽。舌霉边白，脉形不显。高年恐其内陷。
处方：牛蒡子、香豉、鲜石斛、连翘、黑栀子、薄荷根、滑石、枳实。
复诊：胸脘板痛拒按，这属于结胸。舌心燥边白，这挟痰水，挟气积。病症进入七天，温邪内伏，将燥未燥，将陷未陷。昨天中午投生津达邪一剂，现在结胸症已具。势不容缓，再进小陷胸法。
王渊按语：仲景小陷胸汤以枳实佐川连，栝楼佐半夏，苦泄辛润，开中焦之痞，以化痰水热邪。方名陷胸，与诸泻心汤出入，并非下剂。今人以栝楼、枳实为通腑之药，殊属可笑。
顾姓患者温邪得食则复发。舌心尖焦黄而干，边苔白腻，心胸痞闷，这挟积，挟气，挟痰，挟水。大便已十二日不通，其势不得不下。
处方：半夏、茯苓、泽泻、川黄连、枳实、厚朴、栝楼仁、大黄、玄明粉。
杨姓患者胸闷头痛，寒热往来。邪在少阳，有汗而热不解，是伤于风。舌薄白，边色干红。阴亏之体，邪未外达，而津液暗伤，渐有化燥之象。病症进入七天，中脘拒按，似欲大便而不得出，少阳之邪传及阳明，胃家将燥实矣。防其谵语，拟少阳、阳明两解法。
处方：柴胡、淡黄芩、半夏、枳实、甘草、香豉、黑栀子、栝楼仁、桔梗、滚痰丸（钱半）。
王渊按语：从大柴胡汤、陷胸汤变化，不用大黄、黄连，因为阴亏液伤，拒按在中脘，不在大腹。借滚痰丸以微通之，心灵手敏。
复诊：得汗得便，邪有松机，是以胸闷、心跳、烦躁等症悉除，而头痛略减。虽然自觉虚馁，未便多进谷食，也未可就进补剂，但和其胃，化其邪即可。
处方：香豉、豆卷、半夏、川贝母、赤茯苓、陈皮、郁金、川石斛、通草、竹茹。
复诊：用和胃化邪法，一剂颇安，二剂反剧。良以畏虚多进谷食，留恋其邪，不能宣化，郁于心胸之间，湿蕴生痰，热蒸灼液，烦躁、恶心、错语。两手寸关脉细滑数，两尺少神，舌边干红，心苔黄腻，皆将燥未燥，将陷未陷之象。拟导赤散泻心汤各半法，生津化浊，和胃清心。
A certain patient had suffered from intermittent malaria for a long time without recovery. Due to overexertion, they contracted wind-warmth pathogen, leading to the recurrence of symptoms which have persisted for eight days. There is high fever and restlessness, inability to sweat, failure of macules to erupt, heat stagnation steaming phlegm, confusion of spirit with muttering in sleep, pain in both hypochondria making turning difficult, chest oppression with coarse breathing, and a sensation of fainting upon movement. The reason for this is that the evil heat mixes with blood stasis injury, while turbid phlegm obstructs qi and blood, unable to separate, thus disturbing the mind-spirit, gradually posing a danger of coma and panting.
Prescription: Fermented Soybean (Douchi, 5 qian), Perilla Stem (Sugeng, 1 qian), Turmeric Tuber (Yujin, 1 qian), Red Poria Spirit (Chifushen, 3 qian), Forsythia Fruit (Lianqiao, 3 qian), Moutan Bark (Danpi, 1.5 qian), Angelica Root (Danggui, 3 qian), Apricot Seed (Xingren, 3 qian), Himalayan Gentian Rhizome (Tianzhuhuang, 1.5 qian), Akebia Caulis (Mutong, 1 qian), Scarlet Safflower (Xingjiang, 0.7 fen), Fresh Green Onion (Qingcong), Loquat Leaf (Pipaye).
Commentary by Wang Yuan: Yujin and Xingren resolve qi stagnation; Danggui, Cong, and Xingjiang resolve blood stagnation; Douchi and Sugeng guide from interior to exterior. It is especially suitable to add Scutellaria Root (Huangqin) and fresh Rehmannia Root (Sheng Dihuang) to resolve heat stagnation. Otherwise, if heat does not resolve, all stagnations will not open, and heat steaming phlegm obstruction will easily sink into the pericardium collaterals.
Patient Song has passed one period (five days) of damp-warmth disease, with macules and rashes appearing simultaneously. There is chest and heart vexation and regret, and blurred consciousness. The pulse is rapid and muddy/unclear; the coating on the center of the tongue is dry but not greasy. Dampness accumulates and transforms into heat; heat gradually transforms into dryness. Breathing is coarse and short, eyes are red, and ears are deaf. Yin essence is deficient below, while wind-yang is hyperactive above. There is concern about internal sinking leading to coma and convulsions. The method proposed is to generate fluids and expel pathogens, combined with aromatic herbs to dispel turbidity.
Prescription: Fresh Dendrobium Stem (Xian Hu), Fermented Soybean (Danshidou), Bamboo Shavings (Zhuru), Forsythia Fruit (Lianqiao), Tangerine Peel (Juhong), Red Poria (Chiling), Himalayan Gentian Rhizome (Tianzhuhuang), Black Gardenia Fruit (Heizhi), Calamus Rhizome (Changpu), Turmeric Tuber (Yujin), Antelope Horn (Lingyang), Aged Pinellia Rhizome (Chen Dansheng), Niuhuang Qingxin Wan (5 fen) [plus] Musk and Bezoar Pill (Xihuang, 3 li).
Second Visit: The damp-warmth pathogen is in the Taiyin and Yangming meridians. When dampness exceeds heat, Taiyin is predominant; when heat exceeds dampness, Yangming is severe. Restlessness at Shen hour (3-5 PM) corresponds to the peak of Yangming meridian Qi. Although thirsty, the tongue coating remains white and greasy, indicating dampness accumulating and transforming into heat, with residual dampness still stagnant. Qi-fire steaming and clouding the clear orifices causes the macules/rashes to erupt yet consciousness remains intermittently blurred. The pulse is deep, small, and rapid, all signs of pathogen stagnation failing to reach the exterior. If heat becomes severe and stirs wind causing complications, it will be difficult to manage.
Prescription: Pinellia Rhizome (Banxia), Red Poria (Chiling), Fresh Dendrobium Stem (Xianhu), Forsythia Fruit (Lianqiao), Coptis Rhizome (Chuanlian, stir-fried with ginger juice), Calamus Rhizome (Changpu), Tongcao, Fermented Soybean (Douchi), Turmeric Tuber (Yujin), Yi Yuan San, Bamboo Shavings (Zhuru), Reed Rhizome (Maogen), Black Gardenia Fruit (Heizhi).
Commentary by Wang Yuan: It is advisable to refer to Liangge San for slow purgation to avoid transformation into dryness and internal sinking due to premature purging. Although damp-warmth should not be purged early, if heat dominates with accumulation, failure to purge means heat and accumulation remain. Dampness also transforms into dryness and fire along with heat.
Third Visit: Ten days of damp-warmth; the pulse is faster than yesterday, and heat is more intense than before. "Rapid indicates vexation of the heart; large indicates disease progression." This is not a sign of yin transforming to yang or moving from interior to exterior. The tongue coating is thick white with a slight gray cover; face is red and eyes are red, signs of yang excess; dizziness and deafness are signs of yin deficiency; urinary blockage indicates failure of qi transformation. The method should be to generate fluids to clear heat and unblock orifices to transform dampness. Nourishing yin lies not in tonifying kidney but in generating stomach fluids; removing dampness relies not on drying herbs but on promoting urination. Sweat originates from fluids; when fluids are sufficient, sweating occurs and heat resolves. The Small Intestine is the fu organ of the Heart; when urination is smooth, heart fire descends and spirit clears.
Prescription: Antelope Horn (Lingyangjiao), Red Poria (Chiling), Calamus Rhizome (Changpu), Himalayan Gentian Rhizome (Zhuhuang), Alisma Rhizome (Zexie), Yi Yuan San, Anemarrhena Rhizome (Zhimu), Fresh Dendrobium Stem (Xianhu), Tongcao, Bamboo Leaf (Zhuye), Fresh Mint Root (Xian Bohegen).
Separate Prescription: Pearl Powder (Zhenzhu, 5 fen), Blood Amber (Xuepo, 5 fen), ground and taken with water.
Commentary by Wang Yuan: These are profound words; do not read them carelessly.
Fourth Visit: Damp-heat stagnates steaming like smoke and fog; spirit is immersed. Pulse fluctuates between agitation and calm. Calmness brings mental fatigue resembling sleep; agitation brings restlessness akin to madness, indicating pathogen internal sinking. Although stool is blocked, there is borborygmus without fullness, and intestines/stomach lack excess, so stool must be loose. Sudden purgation is contraindicated. In warm diseases, examining the tongue is paramount. Currently, the tip has white coating with slight moldiness, indicating pathogen at the junction of Ying and Qi levels. Ye Tianshi said: "When pathogen just enters Ying, heat can still be vented, returning to Qi level for resolution," using herbs like Rhinoceros Horn (Xi Jiao), Antelope Horn (Lingyang), Scrophularia Root (Yuanshen), and Forsythia (Lianqiao). Based on this, formulate with aromatic orifice-opening herbs.
Prescription: Rhinoceros Horn (Xijiao), Antelope Horn (Lingyangjiao), Fresh Dendrobium Stem (Xianhu), Himalayan Gentian Rhizome (Zhuhuang), Scrophularia Root (Yuanshen), Forsythia Fruit (Lianqiao), Yi Yuan San, Red Poria (Chiling), Bamboo Shavings (Zhuru), Zhibao Dan (1 pill).
Fifth Visit: Add Fresh Rehmannia Root (Xiandi), Trichosanthes Seed (Gualou Ren), and Immature Bitter Orange (Zhishi) to the previous formula.
Sixth Visit: Tongue is black and dry, indicating dampness has transformed into dryness. Frequent passage of flatus, tenderness upon pressing epigastrium and abdomen, pathogen gathered in Yangming, intestines/stomach are solid. Discuss purging the fu organs. However, involuntary urination indicates Kidney Qi deficiency. Righteousness is weak, pathogen is strong; fluids are depleted, fire is blazing. Only the method of draining South (Heart/Fire) and tonifying North (Kidney/Water) applies. Tentatively advance the method of Huanglong Tang.
Prescription: Fresh Rehmannia Root (Xiandi), Ginseng (Renshen), Raw Rhubarb (Shengjun), Scrophularia Root (Yuanshen), Mirabilite (Yuanmingfen), Calamus Rhizome (Changpu), Himalayan Gentian Rhizome (Zhuhuang), Forsythia Fruit (Lianqiao), Bamboo Leaf (Zhuye), Sugarcane Juice (Shanzhizhi, replace water for decoction).
Commentary by Wang Yuan: Drinking sugarcane juice raw is best. Using it for decoction makes it cloying and loses its cooling/moistening properties.
Seventh Visit: After purging, black tongue coating recedes slightly, but pulse becomes surging and large; spirit remains confused, indicating Yangming fire blazing. Clear Yangming scorching fire, save Shaoyin depleted yin. Use Jingyue's Yunnv Jian.
Prescription: Fresh Rehmannia Root (Xiandi), Scrophularia Root (Yuanshen), Fresh Dendrobium Stem (Xianhu), Anemarrhena Rhizome (Zhimu), Himalayan Gentian Rhizome (Zhuhuang), Ophiopogon Tuber (Maidong), Gypsum (Shigao), Bamboo Leaf (Zhuye), Reed Rhizome (Lugen), Sugarcane Juice (Shanzhizhi, 1 cup, mixed in).
Eighth Visit: Fluids return, tongue becomes moist, a good sign; but wind stirring head shaking remains a contraindication. Warm pathogen has retreated, but primal Qi is greatly deficient. Deficient wind disturbs upward incessantly; fear of vertigo and collapse. Now tonify righteousness and extinguish wind, combined with generating fluids and harmonizing stomach.
Prescription: American Ginseng (Sheng Yangshen), Uncaria Ramulus cum Uncis (Gougou), Gastrodia Tuber (Tianma), Poria (Fushen), Processed Pinellia Rhizome (Zhi Banxia), Mother of Pearl Shell (Shijueming), Sorghum Grain (Shumi), Tangerine Peel (Chenpi), Ophiopogon Tuber (Maidong), Bamboo Shavings (Zhuru), Sugarcane Peel (Shanzhupi).
Commentary by Wang Yuan: Heat stagnation loosened via downward purging, but Liver yin fluids were damaged by dry fire earlier, hence these manifestations; this is the consequence of delayed purging.
Patient Hu has chronic Liver/Stomach disease, complicated by damp-warmth. Sweating resolved it on day seven, but fever returned on day eight. Tongue coating gray, lips cracked, gums thirsty, desiring hot drinks. Right pulse surging, large, rapid; left pulse wiry, rapid. Epigastric pain persists; menstruation just started. Analyze the cause: Liver and Stomach are one zang and one fu in the abdomen. Wood invading Earth causes qi stagnation and pain. Without pathogen, how could there be alternating chills and fever? Even if present, surely not high fever; use this to differentiate. Asked about stool: hard and black, indicating intestinal/stomach excess heat, i.e., dry feces. In Stomach Qi Pain category, no dry feces symptom; only in Blood Stasis Pain category is there bloody stool. But this case lacks mania/wild joy, ruling out blood accumulation. Thirst for hot drinks suggests cold, seemingly plausible. However, damp and heat combine; heat resides in damp, damp surrounds heat. Must drink hot soup to open dampness, bringing relief in chest, different from yin-cold false heat. Combined with pulse and lips, it is undoubtedly damp-warmth with accumulation.
"Shanghan Dabai" states: Cracked lips indicate food accumulation. This is not recorded in other books, surpassing ancient texts.
Prescription: Fermented Soybean (Douchi), Turmeric Tuber (Yujin), Corydalis Rhizome (Yanhuzhu), Gardenia Fruit (Shanzhi), Cyperus Rhizome (Xiangfu), Red Poria (Chiling), Forsythia Fruit (Lianqiao), Bamboo Shavings (Zhuru), Trichosanthes Peel (Loupi).
External Application: 14 Green Onion Heads, 1 cup Salt, stir-fry hot, apply to painful area.
Commentary: The disease was damp-warmth with food accumulation, resolving with battle-sweat at the transition period, then recurring fever is one taboo. Sweating with rapid/agitated pulse is another taboo. Menstruation occurring risks pathogen sinking into Blood Chamber, another taboo. Thus, Douchi releases muscle layer, Heizhi clears interior; one dispersing, one draining, removing exterior-interior pathogens. Yanhusuo moves qi/blood stasis, treating various pains. Yujin bitter-draining dissipates Liver stagnation; Xiangfu pungent-dispersing benefits all qi; together treat female meridian retrograde flow, preventing pathogen entering Blood Chamber. Gualou unblocks fu organs, Chiling drains dampness. Zhuru/Lianqiao open stomach qi stagnation and treat upper jiao vexation. External onion/salt hot compress mimics ancient massage methods, assisting success.
Commentary by Wang Yuan: Although there is food accumulation, purging is contraindicated because chest fullness/epigastric pain, thirst for hot drinks indicate middle jiao damp-fluid stagnation not opening, cold-heat complex, Yangming Qi failing to descend. Immediate purging leads to pi-ge or jie-xiong. Same damp-warmth with stagnation, differences are as such.
Ninth Visit: One bowel movement after medication, black like chestnuts several pieces, mixed with loose stool. Epigastric pain greatly reduced, tongue mold/lip cracks receded, originally good. But pulse changed from rapid-large to deficient-small-weak, feeling empty in heart, indicating pathogen decreasing, righteousness deficient. Fear of blurred spirit/convulsions. Day nine of treatment; delay two periods for auspiciousness.
Prescription: Fermented Soybean (Xiangshi), Artemisia Annua (Qinghao), Glehnia Root (Shashen), Red Peony Root (Chishao), Fritillaria Bulb (Chuanbei), Turmeric Tuber (Yujin), Black Gardenia (Heizhi), Bamboo Shavings (Zhuru), Rice Leaf (Daoye), Kumquat Candy (Jinji Bing).
Commentary by Wang Yuan: Bowel movement and pain reduction is merit of onion/salt massage. Onion moves qi, salty flavor directs downward, Yangming Qi opens, Stomach Qi descends naturally; if Stomach Qi descends, stool cannot fail to pass. Stool is boat, Qi is water; smooth flow prevents boat stagnation. Knowing only bitter-cold purging without understanding middle qi reversal/blockage is blocking flow to move boat!
Patient Qin: Warm pathogen twelve days, macules/rashes fully erupted, spirit still blurred, stool passed multiple times, dental crust not shed. Tongue tip red, center scorched, yin fluids burned. Left pulse large, right pulse small, primal Qi weak. Yesterday used clearing/draining/aromatic-opening, focusing on pathogen; today pulse/spirit depressed, deduce from primal Qi. Warmth is yang pathogen, always preserve fluids; Stomach is yang earth, always benefit with sweet-cool. Fear fluid depletion stirring wind causing convulsions; Stomach deficiency qi rebellion causing hiccups.
Prescription: Antelope Horn (Lingyangjiao), Glehnia Root (Shashen), Raw Licorice Root (Shengcao), Himalayan Gentian Rhizome (Zhuhuang), Calamus Rhizome (Changpu), Fresh Dendrobium Stem (Xian Shihu), Rhinoceros Horn (Xijiao), Scrophularia Root (Yuanshen), American Ginseng (Yangshen), Alisma Rhizome (Zexie), Poria (Fushen), Reed Rhizome (Lugen), Sugarcane Juice (Shanzhizhi).
Separate: Lianzhu Powder (3 fen), Blood Amber Powder (3 fen), mix with boiling water.
Second Visit: Sweet-cool generated fluids/tonified righteousness, disease status unchanged. Urination通畅 indicates qi transformation/fluid return. Day thirteen, past the meridian cycle, critical juncture of pathogen/righteousness victory. From here, if fluids return/spirit clears, pathogen retreats; if not, spirit blurs more, pathogen advances. Righteousness wins = life; Pathogen wins = severe. Continue generating fluids/saving yin.
Prescription: Antelope Horn (Lingyang), Fresh Dendrobium (Xianhu), Glehnia Root (Shashen), American Ginseng (Yangshen), Ophiopogon Tuber (Maidong), Alisma Rhizome (Zexie), Red Poria (Chiling), Scrophularia Root (Yuanshen), Sugarcane Juice (Shanzhizhi), Reed Rhizome (Lugen), Zhu Huang San.
Third Visit: Added Anemarrhena Rhizome (Zhimu), Fritillaria Bulb (Chuanbei).
Fourth Visit: Sweet-cool clears/moistens, generates fluids but also nourishes dampness. Previous crimson/dry/scorched tongue now turns white/greasy, mouth full of white foam, stomach turbidity rising. Urination depends on qi transformation; damp stagnates middle jiao, qi mechanism unsmooth, three jiao fails to transport/distribute, hence anorexia, no desire to eat, dysuria. Method: Ventilate/unblock three jiao.
Prescription: Soybean Sprouts (Doujuan), Red Poria (Chiling), Polyporus (Zhuling), Alisma Rhizome (Zexie), Coix Seed (Sheng Yiren), Apricot Seed (Xingren), Tongcao, Bamboo Shavings (Zhuru), Tangerine Peel & Pinellia Fermented Paste (Chenpi Banxiaqu), Barley Sprout (Guya), Blood Amber (Xuepo, 5 fen, ground, mixed).
Commentary by Wang Yuan: Like sails following the river, skillful in rotation. Spleen/Kidney yang deficient originally; once yang pathogen changes, yin-damp arrives. Prevent early when pulse/spirit depressed to avoid this wave change. Unexpectedly fast change. Ancient Soybean Sprouts treat spasm/damp-bi; Soaked Perilla in Ma Huang Tang for sweating, unsuitable here.
Fifth Visit: Blood-heat accumulates in lower jiao, Bladder qi obstruction fails to transform, lower abdomen hard/full, dysuria. Downward blockage reverses upward, fear of panting/hiccups. Open upper, unblock middle, seep lower, ensuring three jiao ventilation, Duque flow.
Prescription: Astera Root (Ziwan), Apricot Seed (Xingren), Platycodon Root (Jiegeng), Magnolia Bark (Chuanpu), Tangerine Peel (Chenpi), Red Poria (Chiling), Polyporus (Zhuling), Alisma Rhizome (Zexie), Perilla Stem (Sugeng), Blood Amber (Xuepo), Tongcao.
Sixth Visit: Add Ginseng Tendril (Renshenxu, 5 fen), decoct to mix Blood Amber (5 fen). External: 2 Snails, Handful of White Onion, 3 qian Peach Kernels, Little Curd, 5 li Musk, 5 fen Cinnamon Bark, mash, warm, apply to Guan Yuan acupoint below navel.
Seventh Visit: Warm pathogen just retreated, lower abdomen board-hard, Bladder qi transformation powerless. Yesterday discussed unblocking three jiao, urine still unsmooth. Now lower abdomen hard/full exceeding navel, plate-sized, non-tender, pulse deep-small, tongue white-greasy, body no heat, mouth no thirst. Upper heat just removed, middle cold rises again. Bladder/Kidney exterior-interior, Bladder qi transformation relies on Kidney yang steaming. Kidney yang insufficient, bladder water condenses into mass, fear stomach invasion/heart rush hiccups/collapse. Urgently warm Kidney, unblock yang, drain water, lest too late.
Prescription: Rougui Wu Ling San, swallow Jin Kui Shen Qi Wan (3 qian).
Commentary by Wang Yuan: This formula solves lower jiao siege; adding onion/salt massage is better.
Eighth Visit: Unblocking yang/drain water matches disease, slight effect though not major reduction. Abdomen feels cold, middle yang weakness evident.
Add Amomum Fruit (Muxiang), Roasted Ginger (Paojiang).
Patient You: Day twelve, red eyes/deaf ears, white tongue/vexed thirst, surging pulse/sweating. Use pungent-cool to clear qi-level heat, sweet-cool to save Lung/Stomach fluids.
Prescription: Northern Glehnia Root (Beishashen), Ophiopogon Tuber (Maidong), Anemarrhena Rhizome (Zhimu), Himalayan Gentian Rhizome (Zhuhuang), Scrophularia Root (Yuanshen), Raw Gypsum (Sheng Shigao, crushed with Mint), Talcum (Huashi), Bamboo Leaf (Zhuye), Reed Rhizome (Lugen).
Second Visit: Eyes open but silent, yet spirit clear; swallows medicine, body turns. Tongue coating gray-white, pulse surging-slippery. Not pathogen closing Pericardium, but Liver yang with phlegm-fire blocking clear orifices. Do not use aromatic opening again, or pathogen sinks internally. Caution!
Prescription: Antelope Horn (Lingyangjiao), Fritillaria Bulb (Chuanbei), Turmeric Tuber (Yujin), Poria (Fuling), Betel Nut Star (Danning), Mother of Pearl Shell (Shijueming), Polygala Root (Yuanzhi), Fresh Dendrobium (Xianhu), Bamboo Oil (Zhuyou), Ginger Juice (Jiangzhi), Northern Glehnia Root (Beishashen).
Commentary by Wang Yuan: Clear fire/extinguish wind, resolve phlegm/open orifices, precise. Shashen needs consideration as it tonifies Lung. Gray-white coating indicates phlegm-fire.
Third Visit: Eyes open silent, profuse sweating, large pulse. Yang excess/yin deficiency, fear collapse. Urgently save yin, hope for miracle.
Prescription: American Ginseng (Sheng Yangshen), Mother of Pearl Shell (Shijueming), Glehnia Root (Shashen), Poria Spirit (Fushen), Ophiopogon Tuber (Maidong), Fritillaria Bulb (Chuanbeimu), Schisandra Berry (Wuweizi).
Fourth Visit: Eyes close, mouth speaks, but tongue stiff/slurred speech. Sweating reduced, pulse large/converged, slight vitality. Arms stiff/trembling, fear convulsions. Preserve yin/extinguish wind method.
Prescription: Antelope Horn (Lingyangjiao), Fresh Rehmannia (Xiandi), Raw Rehmannia (Shengdi), American Ginseng (Yangshen), Glehnia Root (Shashen), Mother of Pearl Shell (Shijueming), Ophiopogon Tuber (Maidong), Uncaria (Gougou), Sugarcane Juice (Shanzhizhi).
Commentary by Wang Yuan: Almost stroke. Generally, chronic Lung/Kidney yin deficiency, Liver yang excess, age over forty often has this syndrome.
Patient Hua: Warm pathogen eight days, spirit blurred, macules red-purple, epigastrium/abdomen tender/refusing pressure, bound heat with leakage. Tongue red/dry, red eyes/cracked lips, yet cold skin/sweating, pulse hidden/almost absent. Pathogen heat internally closed, yin fluids externally leaking, fear internal closure/external collapse. Tentatively advance Huanglong Tang method.
Prescription: Large Rehmannia Root (Da Shengdi), Ginseng Tendril (Renshenxu), Raw Rhubarb (Shengjun), Immature Bitter Orange (Zhishi), Forsythia Fruit (Lianqiao), Himalayan Gentian Rhizome (Tianzhuhuang), Scrophularia Root (Yuanshen), Calamus Rhizome (Changpu), Fresh Dendrobium (Xianhu).
Commentary by Wang Yuan: Cold skin/sweating/hidden pulse is not deficiency, but closure. Seen from red-purple macules. Renshenxu needs consideration.
Certain Patient: Chronic illness primal Qi not recovered, contracted damp-warmth, recovered ten days. Exterior-releasing, middle-unblocking, down-purging medicines all taken. Pulse still rapid, tongue white-greasy. Head sweat profuse, body heat unresolved, cough suppressed, dysuria. Temporarily separate/draining three jiao, observe turn.
Prescription: Soybean Sprouts (Doujuan), Apricot Seed (Xingren), Red Poria (Chiling), Greater Celandine Fruit (Fupi), Magnolia Bark (Chuanpu), Platycodon Root (Jiegeng), Trichosanthes Peel (Loupi), Perilla Stem (Sugeng), Alisma Rhizome (Zexie), Talcum (Huashi), Tongcao.
Patient Gao: White tongue, thirsty, sore throat. Damp-warmth transforming heat, disease four days. Elderly righteous deficiency, fear battle-sweat. Hope no complication.
Prescription: Mint (Bohe), Platycodon Root (Jiegeng), Belamcanda Rhizome (Shegan), Talcum (Huashi), Arisaema Tuber (Niubangzi), Tangerine Peel (Juhong), Apricot Seed (Xingren), Immature Bitter Orange (Zhike), Cardamom Seed (Kouren), Reed Rhizome (Lugen).
Second Visit: Warm pathogen with accumulation transforms dryness. Battle-sweat incomplete after medicine, high heat reduced but interior heat blazing. Tongue mold/white edges, pulse indistinct. Elderly fear internal sinking.
Prescription: Arisaema Tuber (Dali Zi - likely typo for Niubangzi/Arisaema context implies external release, usually Niubangzi/Burdock), Fermented Soybean (Xiangshi), Fresh Dendrobium (Xianhu), Forsythia Fruit (Lianqiao), Black Gardenia (Heizhi), Mint Root (Bohegen), Talcum (Huashi), Immature Bitter Orange (Zhishi).
Third Visit: Chest/epigastrium board-hard/tender, belongs to Jie-Xiong. Tongue center dry/edges white, carries phlegm-water/qi-accumulation. Disease seven days, warm pathogen latent, about to dry/fall. Yesterday noon gave fluid-generating/pathogen-reaching agent, now Jie-Xiong symptoms complete. Urgent, advance Xiao Xianxiong method.
Prescription: Coptis Rhizome (Chuanlian), Pinellia Rhizome (Banxia), Immature Bitter Orange (Zhishi), Trichosanthes Seed (Guaren), Fermented Soybean (Xiangshi), Black Gardenia (Heizhi).
Commentary by Wang Yuan: Zhang Zhongjing's Xiao Xianxiong uses Zhishi with Chuanlian, Gualou with Banxia, bitter-draining/pungent-moistening, opens middle jiao pi, resolves phlegm-water-heat. Named Xianxiong, varies from Xiexin formulas, not a purgative. Moderns view Gualou/Zhishi as fu-purging, ridiculous.
Patient Gu: Warm pathogen recurs with food. Tongue center-tip scorched-yellow/dry, edge coating white-greasy, chest/heart full/oppressed, carries accumulation/qi/phlegm/water. Stool blocked twelve days, force requires purging.
Prescription: Pinellia Rhizome (Banxia), Poria (Fuling), Alisma Rhizome (Zexie), Coptis Rhizome (Chuanlian), Immature Bitter Orange (Zhishi), Magnolia Bark (Chuanpu), Trichosanthes Seed (Guoren), Rhubarb (Dahuang), Mirabilite (Yuanmingfen).
Patient Yang: Chest oppression/headache, alternating chills/fever. Pathogen in Shaoyang, sweating but heat unresolved, injured by Wind. Tongue thin-white, edges dry-red. Yin deficient constitution, pathogen not exteriorized, fluids secretly damaged, gradually transforming dryness. Disease seven days, epigastrium tender, wants stool but cannot, Shaoyang pathogen transmits to Yangming, Stomach about to dry-solid. Fear delirium, propose Shaoyang/Yangming dual resolution.
Prescription: Bupleurum Root (Chaihu), Light Scutellaria Root (Danqin), Pinellia Rhizome (Banxia), Immature Bitter Orange (Zhishi), Licorice Root (Gancao), Fermented Soybean (Xiangshi), Black Gardenia (Heizhi), Trichosanthes Seed (Guoren), Platycodon Root (Jiegeng), Guntan Wan (1.5 qian).
Commentary by Wang Yuan: Varies from Da Chaihu/Xianxiong, no Rhubarb/Coptis due to yin deficiency/fluid damage. Tender point in epigastrium, not lower abdomen. Uses Guntan Wan for mild unblocking, agile mind/hands.
Second Visit: Sweating/stool achieved, pathogen loosens, chest oppression/palpitations/vexation removed, headache slightly reduced. Feels deficient, cannot eat much, cannot tonify directly, only harmonize stomach/transform pathogen.
Prescription: Fermented Soybean (Xiangshi), Bean Sprouts (Doujuan), Pinellia Rhizome (Banxia), Fritillaria Bulb (Chuanbei), Red Poria (Chiling), Tangerine Peel (Chenpi), Turmeric Tuber (Yujin), Chuan Dendrobium (Chuanhu), Tongcao, Bamboo Shavings (Zhuru).
Third Visit: Harmonize stomach/transform pathogen method, one dose peaceful, two doses worse. Fear of deficiency led to excessive eating, pathogen lingers, cannot ventilate/distribute, stagnates in chest/heart. Damp accumulates phlegm, heat steams burns fluids, vexation/nausea/confused speech. Cun/Guan pulses fine-slippery-rapid, Chi pulses lacking spirit, tongue edges dry-red, heart coating yellow-greasy, all about-to-dry/about-to-sink signs. Propose Dao Chi/Xie Xin half-method, generate fluids/transform turbidity, harmonize stomach/clear heart.
Prescription: Rhinoceros Horn (Xijiao), Coptis Rhizome (Chuanlian), Fresh Dendrobium (Xianhu), Immature Bitter Orange (Zhishi), Pinellia Rhizome (Banxia), Red Poria (Chiling), Forsythia Fruit (Lianqiao), Black Gardenia (Heizhi), Tangerine Peel (Juhong), Raw Licorice (Sheng Gancao), Tongcao, Turmeric Tuber (Yujin), Bamboo Shavings (Zhuru), Reed Rhizome (Lugen).