正肺与大肠司养之际，肺肠相为表里，肺主气而大肠主津，肺受
火淫，燥热移于大肠，大肠当养胎之际，遂移热于胞络。《内
经》云∶人有重身，九月而暗，是胞之络脉绝也。胞脉者，系于
肾而络胞胎。今热上迫肺，故音哑、咳嗽而喉复痛也。按此段经
文，明指胎中阴火，当九月之期有此音哑一症，教人勿亟治之，
惟恐伤其胎气耳。兹方八月，即得音哑咳频，岂非殃及池鱼之谓
欤！今以甘凉生津治其上燥，参入咸寒以降阴中伏火，经所谓热
淫于内，治以咸寒是也。须知治病要察机宜，养阴而火自降，指
久病虚羸而言。火退而阴自充，乃暴病未虚之症。先辈有提其要
曰∶暴病多实，久病多虚。是其义也。然欤否欤，仍候华先生裁正。
北沙参（一两） 川贝（去心，勿研，三钱） 元精石（三钱） 知母（三钱，秋石
煎汤拌浸） 蝉衣（一钱，去翅足） 大豆卷（三钱） 元参（三钱） 天花粉（三钱） 枇
杷露（一杯，冲服） 野苎根（三钱） 赤苓（三钱） 生甘草（四分） 纹银（五分）
改方加羚羊角钱半，鲜生地七钱，黑山栀钱半。
渊按∶伏温由内达外，由里传表，从少阴而出太阴，所以退而
复来，轻而再重，不尽由乎胎热。疹属肺，肺主一身之表。斑属胃，
胃为万物所归，温邪每从两经而达也。胞络者，乃胞门子户之胞，
非心包络。胞络系肾，少阴之脉贯肾，上入喉中，热邪由少阴上干喉中，故音哑。甚则喉痛。
鲍 半月不大便，症交十二日，神昏舌煤，齿垢干枯。阳明
邪火极炽，少阴阴液已亏，肠中宿垢不下，邪热无从出路。不下
恐火盛劫液而痉厥，下之恐亡阴而呃脱。极难着笔，姑备一方。
犀角 鲜生地 生大黄 茯神 当归 菖蒲 大生地 连翘 枳实 麦冬 竺黄 元明粉
渊按∶一面养阴彻热，一面通腑最稳当。硝、黄宜轻用。
又 便解三次，神气渐清，舌煤已化。今拟生津。
鲜石斛（一两） 川贝（二钱） 茯神（三钱） 元参（三钱） 生甘草（五分） 麦
冬（三钱） 竺黄（钱半） 竹茹（一钱） 北沙参（一两） 大生地（一两） 甘蔗皮（一
两）
沈 阴虚之体，感受温邪，反复。今交九日，神识时迷，舌
满碎腐，脉象渐沉。防其昏厥。备方候致和先生晒政。
犀角（四分，磨冲） 连翘（三钱） 丹皮（钱半） 栝蒌仁（三钱） 鲜生地（五钱）
元参（三钱） 竺黄（钱半） 鲜薄荷根（一两）
另∶珠子三分，血珀四分，研细末，芦根汤送下。
又 照前方去蒌仁，加大生地、生洋参、沙参、麦冬。
又 阴津大亏，痰火炽盛，内风暗动，痉厥将至。煎药不肯沾唇，姑以汤方备试。
参须（一钱） 川贝（二钱） 石决明（八钱） 杏仁（三钱） 芦根（一两） 竹油
（三十匙，冲） 麦冬（三钱） 羚羊角（钱半，先煎） 悉尼汁（一杯，冲） 蔗汁（一杯，冲）
又 症势稍转机。仍候济慎先生裁正。
羚羊角 鲜生地 大生地 天冬 麦冬 鲜石斛 北沙参
石决明 西洋参 钩钩 芦根 竹油 茯神 蔗汁 梨汁 淡姜汁 生甘草 元参（二味，济慎先生加）
渊按∶数方养阴则有余，泻火尚不足，致有下文邪热逗留之弊。
又 照前方加元精石，备候济慎先生裁正。
大生地 川贝 鲜石斛 石决明 元参 丹皮 麦冬 生洋参 北沙参 芦根 甘蔗汁
又 腑气不通，阳火不降，阴津不升。元气虽虚，不得不通其腑。
大生地（八钱） 鲜石斛（五分） 北沙参（一两） 元参（三钱） 知母（钱半）
生大黄（三钱） 当归（三钱） 生洋参（三钱） 麦冬（三钱） 芦根（一两）
洪 温邪初起，胸闷头痛，发热有汗。先宜凉解。
牛蒡子 豆豉 黑山栀 连翘 桔梗 橘红 荆芥 杏仁 薄荷 芦根
秦 发汗太过，津液内夺。昨日生津以达邪，汗虽未出而疹
点已化，热虽未退而脉象稍和，是佳兆也。苔煤而不甚燥，神糊
而有时清，犀角、地黄虽可用，然大势无变，方亦无事更张，仍照前方加味。
北沙参（一两） 竺黄（钱半） 鲜石斛（一两） 连翘（三钱） 麦冬（三钱） 茯
神（三钱，朱拌） 生甘草（四分） 元参（三钱）茅根（一两，去心） 灯心（三尺，朱拌） 九节菖蒲（八分）
渊按∶神糊苔煤，鲜石斛可用，北沙参不可用。虽养肺阴，
究嫌补肺助痰，麦冬亦然。此老好用二物，瑕瑜并见。
张 久患便血，阴气先伤于下。今感温邪挟积，肺胃之气阻
窒。上喘下泄，发热口渴，舌绛如朱，额汗不止，遍体无汗，脉小数疾。厥脱险象，勉拟一方备正。
葛根（一钱） 黄芩（钱半） 石膏（三钱，薄荷同研） 赤苓（三钱）黄连（四分）
杏仁（三钱） 牛蒡（元米炒，三钱） 生甘草（四分） 枇杷叶（三片）
上药用水两盏，煎至一盏。另用∶
人参（一钱） 麦冬（钱半） 五味子（五分，炒） 生地（四钱） 阿胶（二钱，蛤粉炒）
用水两盏另煎，煎至半盏，冲和前煎，徐徐服下。
此为复方法。病系温邪，而阴虚欲脱，故立此法。凡暴喘多
实，而壮热舌干，宜从清解。惟久患便血，今更下泄不止，所谓喘而
不休，泄痢不止，水浆不入者不治。故不得不救其阴，希图万一。
渊按∶阴血既耗于下，脾气复伤于中，故一感温邪而上喘下
泄。泄为脾陷，喘为肾逆，两脏不守，厥脱易易。头汗者，阴不
守而阳越也。身无汗者，阴液虚而气不能化也。舌绛如朱，胃阴
亏而心火炽。脉小数疾，阴血虚而邪火伏。两方颇有心思，惟葛
根嫌升发，牛蒡嫌泄肺。盖阴阳两虚，中气不守，气虽陷，不可
升，汗虽无，不可发，急急顾虑中气阴液，犹恐不及。然肯用心如此，敬服之至。
幼 阳明热邪充盛，遍体发出紫斑，鼻血龈碎。急与清解，防内陷。
犀角 石膏 薄荷 茜草 丹皮 鲜生地 连翘 紫草 元参 茅芦根
仁渊曰∶温邪一证，前人每与伤寒混同论治。自喻嘉言始力
辨其非，然犹不能跳出。至叶天士乃别开生面，吴鞠通继之，温
热之治始大昌明。然非前人之误，前人亦为古人所误也。一误于
《内经》∶热病者，伤寒之类也。遂谓伤寒即温病，温病即伤寒，
漫无分别。再误于王叔和集仲景《伤寒论》，以温病搀入伤寒之中，
以为温热乃伤寒之变证，至后人有春变为温，夏变为暑之说，其实
伤寒与温热相去霄壤。然温病亦非一端，有冬温，春温，冬温春发，
风温痧疹，湿温之别。风温痧疹即春温一类，以感春令贼风，
伤其皮毛，内合于肺，引动伏温，故见证咳窒气粗，或发痧疹。
病在肺胃气分，宜辛凉轻泄上焦，不可用重剂及血分药。若冬
温、春温轻者，亦在肺胃，咳窒气促；重者，或发自少阳、少阴。
甚有涉厥阴者，由其阴精先虚，邪热蓄伏于虚处，其机一发，少
阴阴精先已告困，液涸劫津，昏痉颤振接踵而至，起而腰痛胁痛，
有汗不解者，不可轻视。盖腰为肾府，胁乃少阳经络游行之地，
肾水不足，木火炽张故也。吾吴地处温下，湿动最先，冬温夹湿
者少。春温已有夹痰、夹湿，湿温乃湿热相合。清其热尤须开其湿。
清热用苦泄凉润，开湿不得不佐辛通淡渗，而化燥者即不合。盖湿
从热化，见热而不见湿矣。温邪以验舌为先，不可动辄发汗。有汗固
不可再发，即无汗亦宜视其津液何如。若热盛液亏，妄汗最易昏
痉，轻则咳窒气促，重则口鼻出血。辨六经与伤寒同，治法与伤
寒大异。自汉唐及元明，多以伤寒之方治温热，虽经叶天士等大
畅厥旨，然乡曲之士，遵师传而日读《汤头》、《医宗必读》等书，仍以羌、独、柴、前为发表套剂，其祸尚未息也。
此时正值肺与大肠主司滋养的时期，肺与大肠互为表里，肺主管气而大肠主管津液。肺受到火邪的过度侵袭，燥热之邪转移到大肠，大肠正处于孕育胎元的阶段，于是将热邪转移到胞络（子宫及其脉络）。《黄帝内经》说：怀孕的人到了第九个月会失音，这是因为胞宫的络脉气血阻滞不通。胞脉连接肾脏并网络胞胎。现在热邪上迫于肺，所以出现声音嘶哑、咳嗽并且喉咙疼痛的情况。按照这段经文的意思，明确指出了胎儿中的阴火，在第九个月会出现这种失音的症状，教导人们不要急于治疗，唯恐损伤胎气。现在才第八个月，就出现了声音嘶哑和频繁咳嗽，这难道不是“殃及池鱼”（无端受累）的说法吗？现在用甘凉生津的药物来治疗上部的燥热，配合咸寒的药物以降伏阴中的伏火，这就是经书所说的“热邪蕴结于内，用咸寒药物治疗”。必须知道治病要审察病机的适宜性，养阴而火自降，这是针对久病导致身体虚弱消瘦而言的。火退去后阴液自然充盈，这是针对突发疾病且尚未虚弱的症状。前辈曾总结要点说：突发疾病多实证，久病多虚证。就是这个道理。这样理解对吗？仍等候华先生指正。
北沙参（一两） 川贝母（去心，不研磨，三钱） 元精石（三钱） 知母（三钱，用秋石煎汤拌浸） 蝉蜕（一钱，去掉翅膀和足） 大豆卷（三钱） 玄参（三钱） 天花粉（三钱） 枇杷露（一杯，冲服） 野苎麻根（三钱） 赤茯苓（三钱） 生甘草（四分） 纹银（五分）
渊按：伏温由内达外，由里传表，从少阴经传出太阴经，所以病情退去后又复发，轻微后又加重，并不完全是因为胎热。疹属于肺，肺主管一身之表。斑属于胃，胃是万物归聚之所，温邪往往通过这两条经络传达到体表。这里的胞络，是指子宫门户的胞络，而不是心包络。胞络系连肾脏，少阴经脉贯穿肾脏，上行进入喉咙，热邪由少阴经上犯喉咙，所以声音嘶哑。严重时喉咙疼痛。
鲍姓患者半个月不大便，病程已到第十二天，神志昏迷，舌苔黑如煤炭，牙齿垢腻干枯。阳明邪火极度炽盛，少阴阴液已经亏损，肠道中宿存的粪便无法排出，邪热没有出路。如果不通下，恐怕火热旺盛劫夺阴液而导致痉厥；如果强行通下，又恐怕亡失阴液而导致呃逆脱证。病情极难处理，暂且准备一方。
犀角 鲜地黄 生大黄 茯神 当归 石菖蒲 大生地 连翘 枳实 麦冬 竹沥 玄明粉
渊按：一方面滋养阴液透发热邪，一方面通导腑气是最稳妥的方法。硝石、大黄宜轻用。
又诊：大便解了三次，神气逐渐清醒，黑苔已经消退。现在拟定生津之法。
鲜石斛（一两） 川贝母（二钱） 茯神（三钱） 玄参（三钱） 生甘草（五分） 麦冬（三钱） 竹沥（一钱半） 竹茹（一钱） 北沙参（一两） 大生地（一两） 甘蔗皮（一两）
沈姓患者体质阴虚，感受温邪，病情反复。现在病程到第九天，神识时而迷糊，舌面布满碎屑状腐苔，脉象逐渐沉伏。防止其发生昏厥。准备处方等候致和先生审阅。
犀角（四分，磨汁冲服） 连翘（三钱） 牡丹皮（一钱半） 瓜蒌仁（三钱） 鲜地黄（五钱） 玄参（三钱） 竹沥（一钱半） 鲜薄荷根（一两）
又诊：阴津严重亏损，痰火炽盛，内风暗中扰动，痉厥即将发生。煎药不肯入口，暂且以汤剂尝试。
人参须（一钱） 川贝母（二钱） 石决明（八钱） 杏仁（三钱） 芦根（一两） 竹油（三十匙，冲服） 麦冬（三钱） 羚羊角（一钱半，先煎） 雪梨汁（一杯，冲服） 蔗汁（一杯，冲服）
又诊：病情势头稍有转机。仍等候济慎先生裁断指正。
羚羊角 鲜地黄 大生地 天冬 麦冬 鲜石斛 北沙参
石决明 西洋参 钩藤 芦根 竹油 茯神 蔗汁 梨汁 淡姜汁 生甘草 玄参（后两味由济慎先生添加）
渊按：前面的方子滋养阴液有余，泻火不足，导致了下文邪热逗留不去的弊端。
又诊：照前方加入元精石，备候济慎先生裁断指正。
大生地 川贝母 鲜石斛 石决明 玄参 牡丹皮 麦冬 西洋参 北沙参 芦根 甘蔗汁
又诊：腑气不通，阳火不能下降，阴津不能上升。元气虽然虚弱，也不得不通导腑气。
大生地（八钱） 鲜石斛（五分） 北沙参（一两） 玄参（三钱） 知母（一钱半）
生大黄（三钱） 当归（三钱） 西洋参（三钱） 麦冬（三钱） 芦根（一两）
牛蒡子 豆豉 黑山栀 连翘 桔梗 橘红 荆芥 杏仁 薄荷 芦根
秦姓患者发汗太过，津液被内部剥夺。昨天用生津法以驱邪，汗虽未出但疹点已化，热虽未退但脉象稍显平和，这是好兆头。舌苔黑但不甚干燥，神志模糊但有时清醒，犀角、地黄虽然可用，但大势没有变化，方子也不必更张，仍照前方加味。
北沙参（一两） 竹沥（一钱半） 鲜石斛（一两） 连翘（三钱） 麦冬（三钱） 茯神（三钱，朱砂拌） 生甘草（四分） 玄参（三钱） 白茅根（一两，去心） 灯心草（三尺，朱砂拌） 九节菖蒲（八分）
渊按：神志模糊、舌苔黑，鲜石斛可以使用，北沙参不可使用。虽然能养肺阴，但终究担心补肺助痰，麦冬也是如此。这位老先生喜欢用这两味药，优缺点并存。
张姓患者长期患便血，阴气先在下方受伤。现在感受温邪夹杂积滞，肺胃之气阻塞窒碍。上面气喘下面泄泻，发热口渴，舌色红绛如朱砂，额头出汗不止，全身无汗，脉象细小数疾。出现厥脱的危险征象，勉强拟定一方以备指正。
葛根（一钱） 黄芩（一钱半） 石膏（三钱，与薄荷同研） 赤茯苓（三钱） 黄连（四分）
杏仁（三钱） 牛蒡子（用元米炒，三钱） 生甘草（四分） 枇杷叶（三片）
以上药物用水两盏，煎至一盏。另外单独煎煮：
人参（一钱） 麦冬（一钱半） 五味子（五分，炒） 生地（四钱） 阿胶（二钱，蛤粉炒）
用水两盏单独煎煮，煎至半盏，与前煎的药液混合，慢慢服用。
这是复方法。病属温邪，但阴虚欲脱，所以设立此法。凡是暴喘多属实证，而壮热舌干，应从清解法治疗。只有长期患便血，现在又下泄不止，所谓喘促不停、泄痢不止、水浆不入的，属于不治之症。所以不得不救其阴液，希图万一的机会。
渊按：阴血已经在下方耗损，脾气又在中间受伤，所以一旦感受温邪就上喘下泄。泄泻是脾陷，气喘是肾逆，两脏功能不守，厥脱很容易发生。头汗出，是因为阴不守而阳气外越。身体无汗，是因为阴液虚而气不能化生津液。舌红绛如朱，是胃阴亏而心火炽盛。脉象细小数疾，是阴血虚而邪火潜伏。两个方子颇有心思，只是葛根嫌其升散，牛蒡子嫌其泄肺。因为阴阳两虚，中气不守，气虽然下陷，不可升提；汗虽然无，不可发汗。急切地顾护中气和阴液，还怕来不及。然而肯如此用心，令人敬佩至极。
幼童患者阳明热邪充盛，遍体发出紫斑，鼻出血牙龈溃烂。急用清解法，防止邪气内陷。
犀角 石膏 薄荷 茜草 牡丹皮 鲜地黄 连翘 紫草 玄参 白茅根与芦根
仁渊曰：温邪这一病症，前人常常将其与伤寒混同论治。自从喻嘉言开始极力辩驳其错误，但仍然未能跳出这个局限。直到叶天士才别开生面，吴鞠通继承发扬，温热病的治疗才开始大大昌明。但这并非前人的错误，前人也是被古人所误导。第一次错误在于《黄帝内经》：“热病者，伤寒之类也。”于是认为伤寒就是温病，温病就是伤寒，漫无分别。第二次错误在于王叔和编纂张仲景的《伤寒论》，将温病掺杂进伤寒之中，认为温热是伤寒的变证，后来有人提出春变为温、夏变为暑的说法，其实伤寒与温热相差悬殊。然而温病也并非只有一种，有冬温、春温、冬温春发、风温痧疹、湿温的区别。风温痧疹即属于春温一类，因感受春季贼风，损伤皮毛，内合于肺，引动伏温，所以见证为咳嗽气粗，或发出痧疹。病在肺胃气分，宜用辛凉轻泄上焦的方法，不可用重剂及血分药。若冬温、春温较轻的，也在肺胃，表现为咳嗽气促；重的，可能发自少阳、少阴。甚至有涉及厥阴的，由其阴精先虚，邪热蓄伏于虚处，其机一发，少阴阴精先已告急，津液枯竭，昏乱、痉厥、震颤接踵而至，起身后腰痛胁痛，有汗不解的，不可轻视。因为腰为肾府，胁部乃少阳经络游行之地，肾水不足，木火炽张的缘故。我们吴地地处温暖湿润之下游，湿气最先发动，夹湿的冬温较少。春温已有夹痰、夹湿，湿温则是湿热相合。清除热邪尤其需要开通湿气。清热用苦泄凉润，开通湿气不得不佐以辛通淡渗，而化燥的方法就不合适了。因为湿从热化，只见热而不见湿了。温邪以观察舌象为先，不可动辄发汗。有汗固然不可再发，即使无汗也应视其津液情况而定。如果热盛液亏，妄用发汗最容易导致昏厥痉厥，轻则咳嗽气促，重则口鼻出血。辨别六经与伤寒相同，治疗方法与伤寒大不相同。自汉唐及元明时期，多以伤寒的方子治疗温热病，虽然经过叶天士等人大力阐发其宗旨，但乡间医生，遵循师传而每天读《汤头歌诀》、《医宗必读》等书，仍然以羌活、独活、柴胡、前胡作为发表套用的方剂，其祸害还没有停止啊。
At this time, the Lung and Large Intestine are in the phase of governing nourishment. The Lung and Large Intestine are exteriorly-interiorly related; the Lung governs Qi, while the Large Intestine governs fluids. When the Lung is invaded by excessive Fire pathogen, dryness-heat transfers to the Large Intestine. During the period when the Large Intestine is nurturing the fetus, it subsequently transfers heat to the Bao Luo (uterine collaterals). The *Neijing* states: "When a person is pregnant, they lose their voice at the ninth month; this is because the collaterals of the uterus are obstructed." The Bao Mai (uterine vessels) connect to the Kidney and network the Bao Tai (uterus and fetus). Now, heat forces upward upon the Lung, causing hoarseness, coughing, and throat pain. According to this passage from the classic texts, it clearly points out that Yin fire within the fetus causes hoarseness during the ninth month, instructing practitioners not to treat it urgently, for fear of damaging fetal Qi. It is currently only the eighth month, yet hoarseness and frequent coughing have already occurred; is this not what is meant by "collateral damage" (innocent parties suffering)? Currently, sweet-cool fluids-generating herbs are used to treat upper dryness, combined with salty-cold herbs to descend latent fire within Yin. This corresponds to the classic saying: "For heat disorder internal, treat with salty-cold." One must understand that treating disease requires observing the appropriateness of the mechanism. Nourishing Yin so that fire descends applies to chronic illness resulting in deficiency and emaciation. Once fire recedes, Yin naturally replenishes, which applies to acute illness without deficiency. Predecessors summarized the essence: "Acute diseases are mostly excess; chronic diseases are mostly deficiency." This is the principle. Is this correct? Still awaiting Mr. Hua's correction.
Bei Sha Shen (Glehniae Radix, 1 liang), Chuan Bei Mu (Fritillariae Bulbus, heart removed, not ground, 3 qian), Yuan Jing Shi (Natrii Sulfas crystallized, 3 qian), Zhi Mu (Anemarrhenae Rhizoma, 3 qian, soaked in decoction of Qiu Shi), Chan Yi (Cicadae Periostracum, wings and feet removed, 1 qian), Da Dou Juan (Sojae Semen Praeparatum, 3 qian), Xuan Shen (Scrophulariae Radix, 3 qian), Tian Hua Fen (Trichosanthis Radix, 3 qian), Pi Pa Lu (Loquat Leaf Lotion, 1 cup, taken with decoction), Ye Zhu Gen (Artemisiae Scopariae Radix, 3 qian), Chi Ling Shen (Poria Cocos with Red Sandalwood, 3 qian), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma Recens, 4 fen), Wen Yin (Silver Ribbon, 5 fen).
Modified prescription adds Ling Yang Jiao (Capricornis Cornu, 1.5 qian), Xian Sheng Di Huang (Rehmanniae Radix Recens, 7 qian), Hei Shan Zhi (Gardeniae Fructus carbonized, 1.5 qian).
Yuanyuan notes: Latent warm pathogens emerge from interior to exterior, transmitting from deep layers to superficial layers, exiting from the Shaoyin channel to the Taiyin channel. Therefore, the condition retreats and returns, becoming light then heavy again, not entirely due to fetal heat. Rashes belong to the Lung, which governs the exterior of the whole body. Macules belong to the Stomach, which is the gathering place of all things; warm pathogens often reach the exterior through these two channels. Here, "Bao Luo" refers to the collaterals of the uterine gate, not the Pericardium Luo. The Bao Luo connects to the Kidney; the Shaoyin channel penetrates the Kidney and enters the throat. Heat pathogens ascend from Shaoyin to harass the throat, causing hoarseness. In severe cases, throat pain occurs.
Patient Bao has not had a bowel movement for half a month, now on the twelfth day of illness. Consciousness is clouded, tongue coating is black like coal, teeth are coated with dry垢. Yangming evil fire is extremely blazing, Shaoyin Yin fluids are already depleted, old feces in the intestines cannot pass, leaving no exit for evil heat. If not purged, there is fear that intense fire will rob fluids leading to spasms and syncope; if purged, there is fear of losing Yin leading to hiccups and collapse. It is extremely difficult to prescribe. I tentatively prepare one formula.
Xi Jiao (Rhinocerotis Cornu), Xian Sheng Di Huang (Rehmanniae Radix Recens), Sheng Da Huang (Rhei Radix et Rhizoma), Fu Shen (Poria Cocos with Hostwood), Dang Gui (Angelicae Sinensis Radix), Chang Pu (Acori Tatarinowii Rhizoma), Da Sheng Di (Rehmanniae Radix Preparata), Lian Qiao (Forsythiae Fructus), Zhi Shi (Aurantii Fructus Immaturus), Mai Dong (Ophiopogonis Radix), Zhu Li (Bambusae Succus in Crustula), Yuan Ming Fen (Natrii Sulfas).
Yuanyuan notes: On one hand, nourish Yin and vent heat; on the other, unblock the fu organs. This is the safest approach. Xiao (Mang Xiao/Natrii Sulfas) and Huang (Da Huang/Rhei Radix et Rhizoma) should be used lightly.
Second visit: Bowel movements have occurred three times, spirit gradually clears, black coating has transformed. Now planning to generate fluids.
Xian Shi Hu (Dendrobii Caulis Recens, 1 liang), Chuan Bei Mu (Fritillariae Bulbus, 2 qian), Fu Shen (Poria Cocos with Hostwood, 3 qian), Xuan Shen (Scrophulariae Radix, 3 qian), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma Recens, 5 fen), Mai Dong (Ophiopogonis Radix, 3 qian), Zhu Li (Bambusae Succus in Crustula, 1.5 qian), Zhu Ru (Bambusae Caulis in Crustula, 1 qian), Bei Sha Shen (Glehniae Radix, 1 liang), Da Sheng Di (Rehmanniae Radix Preparata, 1 liang), Gan Zhe Pi (Sacchari Tabulae Cortex, 1 liang).
Patient Shen has a Yin-deficient constitution and contracted warm pathogens, with recurrent symptoms. Now on the ninth day, consciousness is intermittently confused, tongue surface is covered with fragmented rot-like coating, pulse is gradually sinking. Prevent syncope. Prepare formula awaiting Mr. Zhihe's review.
Xi Jiao (Rhinocerotis Cornu, 4 fen, ground and mixed), Lian Qiao (Forsythiae Fructus, 3 qian), Dan Pi (Moutan Cortex, 1.5 qian), Gua Lou Ren (Trichosanthis Semen, 3 qian), Xian Sheng Di (Rehmanniae Radix Recens, 5 qian), Xuan Shen (Scrophulariae Radix, 3 qian), Zhu Li (Bambusae Succus in Crustula, 1.5 qian), Xian Bo He Gen (Menthae Haplocalycis Radix, 1 liang).
Separately: Zhu Zi (Concha Margaritifera, 3 fen), Xue Po (Electri Succinum, 4 fen), finely ground, taken with Lu Gen Tang (Phragmitis Rhizoma Decoction).
Second visit: Follow previous formula, remove Gua Lou Ren, add Da Sheng Di (Rehmanniae Radix Preparata), Sheng Yang Shen (Panacis Quinquefolii Radix), Bei Sha Shen (Glehniae Radix), Mai Dong (Ophiopogonis Radix).
Third visit: Yin fluids severely depleted, phlegm-fire blazing, internal wind stirring secretly, spasms and syncope imminent. Refuses to take decoction. Tentatively try soup formula.
Ren Shen Xu (Ginseng Radicula, 1 qian), Chuan Bei Mu (Fritillariae Bulbus, 2 qian), Shi Jue Ming (Haliotidis Concha, 8 qian), Xing Ren (Armeniacae Semen Amarum, 3 qian), Lu Gen (Phragmitis Rhizoma, 1 liang), Zhu You (Bambusae Succus, 30 spoons, mixed), Mai Dong (Ophiopogonis Radix, 3 qian), Ling Yang Jiao (Capricornis Cornu, 1.5 qian, decocted first), Xi Ni Zhi (Pyrifoliae Juice, 1 cup, mixed), Zhe Zhi (Sacchari Tabulae Juice, 1 cup, mixed).
Fourth visit: Condition shows slight improvement. Still awaiting Mr. Jishen's judgment.
Ling Yang Jiao (Capricornis Cornu), Xian Sheng Di (Rehmanniae Radix Recens), Da Sheng Di (Rehmanniae Radix Preparata), Tian Dong (Asparagi Radix), Mai Dong (Ophiopogonis Radix), Xian Shi Hu (Dendrobii Caulis Recens), Bei Sha Shen (Glehniae Radix).
Shi Jue Ming (Haliotidis Concha), Xi Yang Shen (Panacis Quinquefolii Radix), Gou Gou (Uncariae Ramulus cum Uncis), Lu Gen (Phragmitis Rhizoma), Zhu You (Bambusae Succus), Fu Shen (Poria Cocos with Hostwood), Zhe Zhi (Sacchari Tabulae Juice), Li Zhi (Piriformis Fructus Juice), Dan Jiang Zhi (Zingiberis Rhizoma Recens Juice), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma Recens), Xuan Shen (Scrophulariae Radix, last two added by Mr. Jishen).
Yuanyuan notes: Previous formulas were sufficient in nourishing Yin but insufficient in clearing fire, leading to the subsequent drawback of lingering evil heat.
Fifth visit: Follow previous formula, add Yuan Jing Shi (Natrii Sulfas crystallized), awaiting Mr. Jishen's judgment.
Da Sheng Di (Rehmanniae Radix Preparata), Chuan Bei Mu (Fritillariae Bulbus), Xian Shi Hu (Dendrobii Caulis Recens), Shi Jue Ming (Haliotidis Concha), Xuan Shen (Scrophulariae Radix), Dan Pi (Moutan Cortex), Mai Dong (Ophiopogonis Radix), Sheng Yang Shen (Panacis Quinquefolii Radix), Bei Sha Shen (Glehniae Radix), Lu Gen (Phragmitis Rhizoma), Gan Zhe Zhi (Sacchari Tabulae Juice).
Sixth visit: Fu organ qi blocked, Yang fire not descending, Yin fluids not ascending. Although Yuan Qi is deficient, it is necessary to unblock the fu organs.
Da Sheng Di (Rehmanniae Radix Preparata, 8 qian), Xian Shi Hu (Dendrobii Caulis Recens, 5 fen), Bei Sha Shen (Glehniae Radix, 1 liang), Xuan Shen (Scrophulariae Radix, 3 qian), Zhi Mu (Anemarrhenae Rhizoma, 1.5 qian).
Sheng Da Huang (Rhei Radix et Rhizoma, 3 qian), Dang Gui (Angelicae Sinensis Radix, 3 qian), Sheng Yang Shen (Panacis Quinquefolii Radix, 3 qian), Mai Dong (Ophiopogonis Radix, 3 qian), Lu Gen (Phragmitis Rhizoma, 1 liang).
Patient Hong: Warm pathogens just started, chest fullness, headache, fever with sweating. First, use cool resolution method.
Niu Bang Zi (Armeniaceae Semen, 3 qian), Dou Chi (Sojae Semen Preparatum, 3 qian), Hei Shan Zhi (Gardeniae Fructus carbonized, 3 qian), Lian Qiao (Forsythiae Fructus, 3 qian), Jie Geng (Platycodonis Radix, 3 qian), Ju Hong (Citri Reticulatae Pericarpium Rubrum, 3 qian), Jing Jie (Schizonepetae Spica, 3 qian), Xing Ren (Armeniacae Semen Amarum, 3 qian), Bo He (Menthae Haplocalycis Herba, 3 qian), Lu Gen (Phragmitis Rhizoma, 1 liang).
Patient Qin: Sweating was excessive, fluids stolen internally. Yesterday, generated fluids to expel pathogens. Although sweat did not appear, rash spots transformed. Although heat did not subside, pulse became slightly harmonious. This is a good omen. Tongue coating is black but not very dry, consciousness is blurred but occasionally clear. Xi Jiao (Rhinocerotis Cornu) and Di Huang (Rehmanniae Radix) can be used, but the general trend has not changed, so no need to change the formula. Still follow previous formula with additions.
Bei Sha Shen (Glehniae Radix, 1 liang), Zhu Li (Bambusae Succus in Crustula, 1.5 qian), Xian Shi Hu (Dendrobii Caulis Recens, 1 liang), Lian Qiao (Forsythiae Fructus, 3 qian), Mai Dong (Ophiopogonis Radix, 3 qian), Fu Shen (Poria Cocos with Hostwood, 3 qian, mixed with Cinnabar), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma Recens, 4 fen), Xuan Shen (Scrophulariae Radix, 3 qian), Mao Gen (Imperatae Rhizoma, 1 liang, heart removed), Deng Xin (Junci Medulla, 3 chi, mixed with Cinnabar), Jiu Jie Chang Pu (Acori Tatarinowii Rhizoma, 8 fen).
Yuanyuan notes: For blurred consciousness and black tongue coating, Xian Shi Hu (Dendrobii Caulis Recens) can be used, but Bei Sha Shen (Glehniae Radix) should not be used. Although it nourishes Lung Yin, it is feared to tonify Lung and assist phlegm production; Mai Dong (Ophiopogonis Radix) is similar. This old physician likes using these two herbs; both flaws and merits are present.
Patient Zhang: Long-term hematochezia, Yin qi injured first from below. Now contracted warm pathogens with accumulation, Lung and Stomach Qi obstructed. Upper asthma, lower diarrhea, fever, thirst, tongue crimson like vermilion, forehead sweating incessantly, whole body no sweat, pulse fine, rapid, and hurried. Signs of syncope and collapse are dangerous. Tentatively propose a formula for correction.
Ge Gen (Puerariae Lobatae Radix, 1 qian), Huang Qin (Scutellariae Radix, 1.5 qian), Shi Gao (Gypsum Fibrosum, 3 qian, ground with Bo He), Chi Ling Shen (Poria Cocos with Red Sandalwood, 3 qian), Huang Lian (Coptidis Rhizoma, 4 fen).
Xing Ren (Armeniacae Semen Amarum, 3 qian), Niu Bang Zi (Armeniaceae Semen, stir-fried with Yuan Mi, 3 qian), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma Recens, 4 fen), Pi Pa Ye (Eriobotryae Folium, 3 slices).
Decoct above herbs with 2 cups of water until 1 cup remains. Separately decoct:
Ren Shen (Panacis Ginseng Radix, 1 qian), Mai Dong (Ophiopogonis Radix, 1.5 qian), Wu Wei Zi (Schisandrae Fructus, stir-fried, 5 fen), Sheng Di (Rehmanniae Radix, 4 qian), E Jiao (Colla Corii Asini, stir-fried with Ge Fen, 2 qian).
Decoct separately with 2 cups of water until half cup remains. Mix with previous decoction, take slowly.
This is a compound method. The disease is warm pathogens, but Yin deficiency leads to collapse, hence this method. Generally, sudden asthma is excess, and high fever with dry tongue should be treated with clearing and resolving. Only when there is long-term hematochezia and current uncontrollable diarrhea, described as "asthma without rest, dysentery without stop, unable to take food or drink," is it considered untreatable. Thus, it is necessary to save Yin, hoping for a miracle.
Yuanyuan notes: Yin blood consumed below, Spleen Qi injured in middle, so once warm pathogens contract, upper asthma and lower diarrhea occur. Diarrhea is Spleen sinking, asthma is Kidney rebellion. Two organs failing to maintain function makes syncope and collapse easy. Forehead sweating indicates Yin not holding and Yang floating outward. Body no sweat indicates Yin fluid deficiency and Qi unable to transform. Tongue crimson like vermilion indicates Stomach Yin deficiency and Heart Fire blazing. Pulse fine, rapid, and hurried indicates Yin blood deficiency and evil fire lurking. Both formulas show ingenuity, but Ge Gen (Puerariae Lobatae Radix) is too ascending, and Niu Bang Zi (Armeniaceae Semen) is too draining to Lung. Since both Yin and Yang are deficient, Middle Qi does not hold. Although Qi sinks, it should not be lifted; although no sweat, it should not be induced. Urgently protect Middle Qi and Yin fluids, fearing it may still be too late. However, such dedication is deeply respected.
Child patient: Yangming heat pathogens abundant, purple macules appeared all over body, epistaxis and gum erosion. Urgently use clearing and resolving, prevent internal collapse.
Xi Jiao (Rhinocerotis Cornu), Shi Gao (Gypsum Fibrosum), Bo He (Menthae Haplocalycis Herba), Qian Cao (Rubiae Radix et Rhizoma), Dan Pi (Moutan Cortex), Xian Sheng Di (Rehmanniae Radix Recens), Lian Qiao (Forsythiae Fructus), Zi Cao (Arnebiae Radix seu Lithospermi Radix), Xuan Shen (Scrophulariae Radix), Mao Gen (Imperatae Rhizoma) and Lu Gen (Phragmitis Rhizoma).
Yuanyuan says: Regarding warm pathogens, predecessors often treated them identically to Cold Damage (Shanghan). Since Yu Jiayan, efforts were made to refute this, yet still failed to break free. Until Ye Tianshi opened a new path, and Wu Jutong continued it, the treatment of warm-heat diseases began to flourish greatly. However, this was not the fault of predecessors; they were misled by ancients. The first error lies in the *Neijing*: "Heat diseases are a category of Cold Damage." Thus, it was believed that Cold Damage is warm disease, and warm disease is Cold Damage, without distinction. The second error lies in Wang Shuhe compiling Zhang Zhongjing's *Treatise on Cold Damage*, inserting warm diseases into Cold Damage, considering warm-heat as a transformation of Cold Damage. Later people proposed spring transforms to warm, summer transforms to hot, but actually Cold Damage and warm-heat are worlds apart. However, warm diseases are not monolithic; there are Winter-Warm, Spring-Warm, Winter-Warm emerging in Spring, Wind-Warm with rashes, and Damp-Warm distinctions. Wind-Warm and rashes belong to Spring-Warm, caused by contracting spring thieving winds, damaging skin and hair, combining internally with Lung, stirring latent warm pathogens, thus presenting with cough, airway obstruction, coarse breathing, or rashes. Disease is in Lung and Stomach Qi level, suitable for pungent-cool light dispersal of Upper Jiao, not heavy agents or Blood-level herbs. If Winter-Warm or Spring-Warm are mild, also in Lung and Stomach, with cough and shortness of breath; severe cases may originate from Shaoyang or Shaoyin. Some even involve Jueyin, due to prior Yin essence deficiency, with evil heat accumulating in deficiency areas. Once triggered, Shaoyin Yin essence is immediately exhausted, fluids dried up, followed by coma, spasms, and tremors. Rising with lower back and hypochondriac pain, sweating without relief, should not be underestimated. Waist is the residence of Kidney, hypochondrium is where Shaoyang meridions travel. Insufficient Kidney Water leads to blazing Wood-Fire. Our Wu region is located in warm, low-lying areas, where dampness moves earliest. Winter-Warm with dampness is rare. Spring-Warm often has phlegm and dampness; Damp-Warm is dampness and heat combined. Clearing heat especially requires opening dampness. Clearing heat uses bitter-draining and cool-moistening; opening dampness must assist with pungent-unblocking and bland-leaching, whereas drying methods are unsuitable. Because dampness transforms with heat, only heat is seen, not dampness. With warm pathogens, inspecting the tongue is paramount; do not induce sweating arbitrarily. If sweating exists, certainly do not induce again; even if no sweating, observe fluid status. If heat is intense and fluids deficient, reckless sweating easily causes coma and spasms, mildly cough and shortness of breath, severely epistaxis and gingival bleeding. Differentiating Six Channels is same as Cold Damage, but treatment methods are vastly different. From Han-Tang to Yuan-Ming, Cold Damage formulas were mostly used for warm-heat diseases. Although Ye Tianshi and others vigorously elucidated its principles, country doctors, following traditions and reading *Tangtou Gejue* and *Yizong Bidu* daily, still use Qiang Huo, Du Huo, Chai Hu, Qian Hu as standard exterior-releasing formulas. The disaster has not ceased.