蒋某夏月病患发热，口渴，头疼，身痛。医云伤暑，初用香薷饮不应，因其热盛，更加
青蒿
连翘。服之益剧，诊脉沉细，望色，舌白面青，身虽热而反近衣，口虽渴而喜热饮，谓曰∶
此阴暑证也，非姜附莫治。其家人曰∶病者日来热盛，连服凉剂，尚未见效，且天时酷暑，
姜附恐未可用。予曰∶夏月伏阴在内，人多畏热贪凉，受寒最易。若云夏月不可服热药，则
冬月不可服凉药矣。何仲景治冬月伤寒，每用石膏芩连耶。舍时从证，自古有之，乃投附子
理中汤，一服热退，再服病却。
汪木工年二旬余，夏间患感证，初起寒热呕泻，自汗头痛，他医与疏表和中药，呕泻虽
止，发热不退，汗多口渴，形倦懒言，望色青白不泽，舌苔黑黄而润，诊脉虚细。经云∶脉
虚身热，得之伤暑。因拟清暑益气汤加减。服药一剂，夜热更甚，谵狂不安，次早复诊，其
脉更细，凝为阳证阴脉。及视舌苔与昨大异，色紫肉
碎，凝有血痕，渴嗜冷冻饮料。予思此必内有热邪，蕴伏未透，当舍脉从证，改用白虎汤，加生
地、丹皮、山栀、黄芩、竹茹、灯心。下午人来请云∶服头煎药后周身汗出，谵狂虽定，神
呆肢冷，不识何故。予往扪其手足，果冰冷异常，按脉至骨不见，阖目不省人事，知为热厥
。命再进药，旁议以为体脉如此，怕系阴证，前药恐未合宜。予曰∶此非阴证，乃阳极似阴
耳。若误投热剂，则殆，否则今晚勿药，明日再看何如。众然之。次日神呆略回，体脉如故
，视其舌苔，又与昨异，形短而浓，满舌俱起紫泡，大如葡萄，并有青黄黑绿杂色，腻胎罩
于其上，予甚惊异，辞以不治。其母哀恳拯救。予悯之，揣摩再四，令取紫雪蜜调涂舌，于
前方内加入犀角、黄连、元参以清热，金汁、人中黄、银花、绿豆以解毒，另用雪水煎药。
翌日再诊，厥回脉出，观其舌泡消退，苔仅干紫耳。再剂热净神清，舌色如常。是役也，予
虽能审其阳证似阴于后，然未能察其实证类虚于前。自咎学力未到，但生平历治伤寒瘟疫诸
候，曾未见此舌苔之异，且诊视五日，变幻如出五人，前贤诸书亦鲜言及，真匪夷所思也。
谚云∶读尽王叔和，不如临证多。洵非妄语。
蒋某在夏季患病，出现发热、口渴、头痛、全身疼痛的症状。医生认为是伤暑，起初使用香薷饮无效，因为患者热势旺盛，又加入了青蒿和连翘。服药后病情反而加重，诊察发现脉象沉细，观察面色舌苔，舌苔白而面色青，身体虽然发热却反而想要靠近衣物取暖，口虽然渴却喜欢喝热水。我对他说：“这是阴暑证，非用附子、干姜等温热药物不能治疗。”他的家人说：“病人这几天热势很盛，连续服用凉药，还没有见效，况且现在天气酷暑，恐怕不能用附子、干姜这类热药。”我说：“夏季体内潜伏着阴寒之气，人们大多害怕炎热而贪凉，最容易受寒。如果说夏季不可以服用热药，那么冬季也不可以服用凉药了吗？为什么张仲景治疗冬季的伤寒，经常使用石膏、黄芩、黄连呢？舍弃时令而从证候出发，自古就有这样的先例。”于是投用附子理中汤，服一次后热退，再服后病愈。
汪姓木工二十多岁，夏天患感受外邪之证，初起时恶寒发热、呕吐腹泻、自汗、头痛，其他医生给予疏风解表调和的药物，呕吐腹泻虽然停止，但发热不退，出汗多且口渴，形体疲倦懒言，观察面色青白无光泽，舌苔黑黄而湿润，诊脉虚细。《内经》说：“脉虚身热，是伤暑所致。”因此拟定清暑益气汤加减。服药一剂后，夜间热势更重，胡言乱语、狂躁不安。第二天早上复诊，脉象更细，判断为阳证见阴脉。再看舌苔与前一天大不相同，颜色紫暗，舌肉破碎，凝结有血痕，口渴喜好冷冻饮料。我思考这必定是内有热邪，蕴伏未能透发，应当舍脉从证，改用白虎汤，加入生地黄、牡丹皮、山栀、黄芩、竹茹、灯心草。下午有人来请，说服用头煎药后周身出汗，谵妄狂躁虽然安定，但神情呆滞、四肢冰冷，不知道是什么缘故。我去触摸他的手足，果然冰冷异常，按脉至骨都摸不到，闭眼不省人事，知道这是热厥。命令继续进药，旁边的人议论认为体质脉象如此，怕是阴证，前面的药恐怕不合适。我说：“这不是阴证，乃是阳极似阴罢了。如果误投热剂，就会危险；否则今晚不要用药，明天再看如何？”众人认为对。第二天神情呆滞稍微恢复，体质脉象如故，看他的舌苔，又与前一天不同，形状短而厚腻，满舌都升起紫色水泡，大如葡萄，并有青、黄、黑、绿杂色，腻苔覆盖在上面，我非常惊异，推辞说无法治疗。他的母亲哀求拯救。我怜悯他，反复揣摩，让人取紫雪散用蜂蜜调匀涂抹舌头，在前面方剂中加入犀角、黄连、玄参以清热，金汁、人中黄、金银花、绿豆以解毒，另外用雪水煎药。第二天再诊，四肢厥逆回温，脉象复出，观察舌泡消退，舌苔仅干燥紫暗而已。再服两剂后热退神清，舌色恢复正常。这次诊疗，我虽然能在后来审察出阳证似阴，然而未能在前阶段察觉实证类虚。自责学识能力未到，但我生平诊治过伤寒瘟疫等各种病症，从未见过如此奇特的舌苔，而且诊视五天，变化如同出自五人，前贤的书籍中也很少提及，真是匪夷所思啊。谚语说：“读尽王叔和的书，不如临证经验丰富。”确实不是假话。
Jiang suffered from fever, thirst, headache, and body pain during the summer. The physician diagnosed it as heatstroke (Shangshu). Initially, Xiangru Yin (Elsholtzia Decoction) was used but proved ineffective. Due to the intense heat, Qinghao (Artemisiae Annuae Herba) and Lianqiao (Forsythiae Fructus) were added. After taking the medicine, the condition worsened. Pulse diagnosis revealed a deep and fine pulse. Observation showed a white tongue coating and bluish complexion. Although the body was hot, the patient preferred to wrap up in clothes; although thirsty, he preferred hot drinks. I said, "This is Yin Heatstroke (Yin Shu), which can only be treated with Aconite (Fuzi) and Ginger (Ganjiang)." His family members said, "The patient has had high fever for days. Continuous use of cooling medicines has been ineffective. Moreover, given the scorching weather, it seems inappropriate to use hot medicines like Aconite and Ginger." I replied, "In summer, yin cold lurks inside the body. People often fear heat and crave coolness, making them susceptible to cold pathogens. If one argues that hot medicines cannot be taken in summer, then cold medicines should not be taken in winter either. Why did Zhang Zhongjing frequently use Gypsum (Shigao), Scutellaria (Huangqin), and Coptis (Huanglian) when treating Winter Cold Damage (Shanghan)? Discarding the season to follow the syndrome is a practice established since ancient times." Therefore, Fuzi Lizhong Tang (Aconite Pill to Regulate the Middle) was administered. After one dose, the fever subsided; after another dose, the illness resolved.
Wang, a carpenter in his early twenties, contracted an exogenous pathogenic condition in summer. Initially, he experienced aversion to cold alternating with fever, vomiting, diarrhea, spontaneous sweating, and headache. Other physicians prescribed formulas to disperse wind and harmonize the exterior. Although vomiting and diarrhea ceased, the fever persisted. He had profuse sweating, thirst, fatigue, and reluctance to speak. His complexion was bluish-white and lusterless. The tongue coating was blackish-yellow and moist. The pulse was deficient and fine. The Classic states: "Deficient pulse with body heat indicates injury by summerheat." Thus, Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction) was prescribed with modifications. After one dose, the night fever intensified, accompanied by delirium and restlessness. On the next morning's re-examination, the pulse became even finer, indicating a Yang syndrome presenting with Yin pulse characteristics. The tongue coating differed significantly from the previous day: it was purplish, the tongue flesh was fragmented, and blood traces were coagulated. He was thirsty and craved frozen beverages. I reasoned that there must be internal heat pathogens lurking and failing to penetrate. One should discard the pulse signs and follow the symptoms, switching to Baihu Tang (White Tiger Decoction) supplemented with Shengdi Huang (Rehmanniae Radix), Mudan Pi (Moutan Cortex), Zhizi (Gardeniae Fructus), Huangqin (Scutellariae Radix), Zhuru (Bambusae Caulis in Taenia), and Dengxincao (Junci Medulla). In the afternoon, someone came requesting my presence, stating that after taking the first decoction, the whole body sweated. Although delirium stabilized, the spirit was dull, and limbs were cold. Upon examination, his hands and feet were abnormally ice-cold. The pulse could not be felt even at the bone level. Eyes closed, he was unconscious. This was identified as Heat Jue (Heat Reversal). I ordered the medication to continue. Bystanders argued that given the constitution and pulse, it might be a Yin syndrome, suggesting the previous prescription was unsuitable. I said, "This is not a Yin syndrome, but extreme Yang mimicking Yin. If hot medicines are mistakenly administered, danger ensues; otherwise, let us withhold medication tonight and reassess tomorrow." They agreed. The next day, mental dullness slightly improved, but the physical state and pulse remained unchanged. The tongue coating had changed again: it was short and thick, covered with purple blisters as large as grapes, mixed with green, yellow, black, and colors, overlaid with a greasy coating. I was greatly astonished and declined treatment. His mother pleaded for help. Pitying him, I deliberated extensively, instructed applying Zixue San (Purple Snow Powder) mixed with honey to the tongue, and modified the formula by adding Xijiao (Rhinocerotis Cornu - *Note: Substitute with Buffalo Horn in modern practice*), Huanglian (Coptidis Rhizoma), Xuanshen (Scrophulariae Radix) to clear heat; Jinzhi (Gold Juice), Renzhonghuang (Human Waste Precipitate), Yinhua (Lonicerae Japonicae Flos), and Ludou (Phaseoli Semen) to detoxify. Additionally, snow water was used to decoct the herbs. On the second day's re-examination, the reversal reversed, and the pulse returned. The tongue blisters subsided, leaving only dry, purplish coating. After two more doses, the fever cleared, consciousness returned, and the tongue color normalized. In this case, although I correctly identified the Yang syndrome mimicking Yin later, I failed to detect the excess syndrome resembling deficiency earlier. I blame my insufficient scholarly attainment. Throughout my career treating Shanghan and Plague conditions, I have never seen such anomalous tongue coatings. Over five days of consultation, the changes seemed to come from five different patients. Such phenomena are rarely mentioned in ancient texts, truly beyond imagination. As the proverb says, "Reading all of Wang Shuhe's works is inferior to gaining clinical experience." Indeed, this is no empty talk.