前年三月间，朱锡基家一女婢病发热，请诊洽。予轻剂透发，次日热更甚，未见疹点。续与透发，三日病加剧，群指谓猩红热，当急送传染病医院受治。锡基之房东尤恐惧，怂恿最力。锡基不能决，请予毅然用方。予允之。细察病者痧已发而不畅，咽喉肿痛，有白腐意，喘声大作，呼吸困难不堪，咯痰不出，身热胸闷，目不能张视，烦躁不得眠，此实烂喉痧之危候，当与：净麻黄钱半生石膏五钱光杏仁四钱生草一钱略加芦根竹茹蝉衣蚤休等，透发清热化痰之品。服后，即得安睡，痧齐发而明，喉痛渐除。续与调理，三日全愈。事后婢女叩谢曰，前我病剧之时，服药（指本方）之后，凉爽万分，不知如何快适云。
【按】夫麻疹以透净为吉，内伏为凶，尽人所知也。而透之之法却有辨别。
盖痧毒内伏，须随汗液乃能外出。而汗液寄汗腺之内，须随身热乃能外泌。故痧前之身热乃应有之现象。惟此种身热亦有一定之标准，过低固不可，过高亦不佳。
事实上过高者少，过低者多。故用药宜偏于温，万不可滥用凉剂以遏之。及痧毒正发之时，小儿身热往往过度，与未发前成反比。不知身热过重又妨痧毒之外透。
此时热迫肺部则喘急，热蒸汗腺则汗出，热灼心君则神昏，热熏痰浊则干咳，此为麻杏甘石之的证，重剂投之，百发百中，又岂平淡之药所能及哉？疹病之兼喉病者，中医谓之烂喉痧，西医称之曰猩红热。丁甘仁先生擅治此病，其治法大意，略曰喉痧当以痧为本，以喉为标，但求痧透，则喉自愈，可谓要言不繁。而本汤之治喉痧所以得特效者，即此故也。
本汤条文曰：发汗后（又曰下后）不可更行桂枝汤，汗出而喘，无大热者，可与麻黄杏仁甘草石膏汤云云。而或者欲易之为无汗而喘，大热者。不知麻黄汤证，由或未发热进为发热，其证势为由郁而发。麻杏甘石汤证，由身大热转为身无大热，其证势为由表入里。惟其逐渐由表入里，由寒化热，故无汗渐转为汗出。独其喘则必不除。然后知热喘二字实为本汤之主证。得此一隅，庶几三反。而经文何必涂改之耶！
麻黄杏仁甘草石膏汤证其四（附列门人治验）
王左乳蛾双发，红肿疼痛，妨于咽饮，身热，微微恶风，二便尚自可，脉微数，舌微绛，宜辛凉甘润法。
薄荷一钱后下杏仁三钱连翘二钱象贝三钱桑叶二钱生草钱半赤芍二钱蝉衣一钱僵蚕三钱炙桔梗一钱马勃八分牛蒡二钱活芦根一尺去节另用玉钥匙吹喉中
【按】当九十月燥气当令之时，喉病常多，其轻者但觉喉中梗梗然仿于咽饮，其略重者则咽喉两关发为乳蛾，红肿如桃。西医称此为扁挑腺肿，但须照上列方随意加减，可以一剂知，二剂已。蛾退之后，悉如常态。至若乳蛾渐由红种而化白腐，或生白点，可加玄参一味以治之，其效如神。若更由白腐而化脓，乃可用刺法，使脓出亦愈。然使早用辛凉甘润，必不至如此地步，此辛凉甘润法之所以可贵也。
有一派喉科医生治喉，喜用苦寒之药，如板蓝根、川连、地丁、人中黄之属。服后，虽可暂折邪气，每致郁而不宣，牵延时日，甚或转变重症，至堪危虑。凡患乳蛾因服苦寒药不解，续进辛凉甘润药者，则见效必较缓，甚或初剂二剂竟毫不见效，余试之屡矣。又有一派医生治喉，喜用重腻育阴之药，如生地、麦冬、石斛、沙参之属，竟重用至八钱一两者。以此治乳娥，亦不能速愈。友人谢君维岐籍隶吴县，患喉痛小恙，名医与以育阴重剂，多费而少效。余卒用辛凉轻剂，一服见功，二服全愈，此辛凉甘润法之所以可贵也。辛凉甘润乃仲圣大法，温热家不过伸言之耳。
叶氏《幼科医案》曰：春月暴暖忽冷，先受温邪，继为冷束，咳嗽痰喘最多。……夫轻为咳，重为喘，喘急则鼻掀胸挺。此实麻杏甘石汤之的证，使及时投以麻杏甘石汤重剂，则药到病除，何致有逆传心包之危？依佐景临床所得，本汤证以小儿患者居多，且多发在冬春之间，与夫白虎加桂枝汤证之多发于夏日及大人者，悉相反，与叶氏所言颇合，是叶氏乃明知麻杏甘石汤者也。吴氏鞠通亦知之，故虽在《条辨》上焦中焦二篇隐而不言，及在下焦篇第四十八条，即不复藏匿。曰：喘，咳，息促，吐稀涎，脉洪数，右大于左，喉哑，是为热饮，麻杏甘石汤主之。然则温热诸家果能识宜施用辛凉甘润法之麻杏甘石汤证，并即以为基础，更从而变化之，扩充之，欲自成为广义之温病学说，实无疑义。
惜乎不肯道破根源耳。故余敢作公平之论，曰：温热家立说并非不可，时方轻方并非全不可用，但当明其与伤寒经方间之师承贯通处，然后师经方之法，不妨用时方之药，且用之必更神验，此为亲历之事实，所可忠告于同仁者也。
葛根黄连黄芩汤证其一（附列门人治验）
李孩疹发未畅，下利而臭，日行二十余次，舌质绛，而苔白腐，唇干，目赤，脉数，寐不安，宜葛根芩连汤加味。
粉葛根六钱细川连一钱淮山药五钱生甘草三钱淡黄芩二钱天花粉六钱升麻钱半
【按】李孩服后，其利渐稀，痧透有增无减，逐渐调理而安。湘人师兄亦在红卍字会医院屡遇小孩发麻疹时下利，必治以本汤，良佳。又有溏泄发于疹后者，亦可以推治。
麻疹之利属于热者，常十居七八，属于寒者，十不过二三，故宜于葛根芩连汤者十常七八，宜于理中汤或桂枝人参汤者十不过二三。一或不慎，误投汤药，祸乃立至，可不畏哉！今人每以葛根芩连汤证之利为协热利，实则葛根芩连汤证之利虽属热性，仲圣并未称之为协热利，至桂枝人参汤证之寒性利，反称之为协热而利。盖协热者，犹言挟表热也，此不可不知。
太阳病，当解表，若不予解表，而用治阳明法以下之，则变证。但或从寒化，或从热化，每无定局。正气盛者多从热化，正气衰者则从寒化。仲圣云：太阳病，外证未除，而数下之，遂协热而利，利下不止，心下痞鞕，表里不解者，桂枝人参汤主之。此从寒化之例也。又曰：太阳病，桂枝证，医反下之，利遂不止，脉促者，表未解也，喘而汗出者，葛根黄连黄芩汤主之。此从热化之例也。
本条有余意，有省文，若欲知其洋，而不嫌辞赘者，可在也字下，加宜葛根汤，若利不止诸字样，则经旨明矣。意谓桂枝汤证因下伤津，利不止亦伤津，而脉促近于浮，为表未解，故宜葛根汤，以解其表，而养其津。若表解之后，内热甚炽，肺受热灼而喘，汗受热蒸而出者，当用葛根芩连汤以直折之。
余前谓桂枝汤证化热，则为白虎汤证，麻黄汤证化热，则为麻杏甘石汤证，今当续为之说，曰葛根汤证化热则为葛根芩连汤证。征之于临床，考之于经文，历历不爽。
曹颖甫曰：表未解者，必不汗出，盖利不止而脉促为表未解。表未解者，宜葛根汤。利不止而喘汗，为表病入里，则宜葛根芩连汤。脉促为脉紧变文，前于伤寒发微中已略申其旨。固知葛根芩连汤惟已经化热者宜之耳。惟其化热者宜之，而舌苔白腐，唇干目赤，乃无乎不宜，不惟热利为然也。
葛根黄连黄芩汤证其二（附列门人治验）
孙宝宝住厅西路初诊满舌生疮，环唇纹裂，不能吮饮，饮则痛哭，身热，溲少，脉洪而数，常烦躁不安，大便自可，拟葛根芩连汤加味。
粉葛根四钱淡黄芩钱半小川连六分生甘草三钱灯心三扎活芦根一尺
【按】孙君维翰，友人也。其小公子未二龄，甚活泼可爱，体肥硕，肖其父。每患微恙，余必愈之。顾以事繁，常无暇面诊，有时仅凭孙君之陈述而疏方焉。一日，孙君又言其孩身热，咳嗽，口渴，不安云云，当遥拟辛凉轻剂与之。服之二日，不差反剧。谓口舌生疮矣。当请面诊，允之。细察之下，乃知本为葛根汤证，今乃化热进而为葛根芩连汤证矣。葛根汤证何以化热变剧？盖辛凉轻剂不胜重任故也。孙孩服此之后，将一剂而愈乎？曰：不然。次日，其病不增不减，仅维原状而已。
二诊口疮，投葛根芩连汤，不见大效，宜进一步，合承气法。
粉葛根四钱细川连八分生川军二钱生甘草三钱淡黄芩钱半枳实钱半玄明粉钱半分冲
【按】又次日，孙君来告，此方之效乃无出其右，服后一小时许，能饮水而不作痛状，夜寐甚安。越宿醒来，舌疮大退，肯吮乳。嘱减量再服，遂愈。乃知大黄内服，却胜冰硼外搽，因此散我固曾用于二三日前也。
葛根汤证化热，为葛根芩连汤证，葛根芩连汤证化热，则为承气汤证。我因失治缓治于先，故补治急治于后，不待其大便闭结，而乘其即将闭结，预用硝黄以图之，此急治补治之说也。然设使我能及时重用葛根芩连，又何需乎硝黄？我能及时重用葛根汤，又何需乎芩连？溯本穷源，为医者不当若是乎？昔我治一妇人，舌尖下发一白点，渐内蚀，饮食则□，不能触咸味，尤不可碰热菜。我曰：此属热，宜师白虎汤，服石膏。妇服之数日，腐点不动，而胃纳反差。闻人言，服黄连可效，竟一剂而愈。我乃恍然若闻道，知葛根芩连汤与白虎汤本属并肩，各有主治，不容混淆，设使互易为治，必两不奏功。
曹颖甫曰：葛根芩连汤既为化热而设，服之不效，肠胃燥实即为热病之结果，故佐景谓合承气法为进一步也。
葛根黄连黄芩汤证其三
徐左美亚十厂六月十二日小便已，阴疼，此本大肠燥气，熏灼膀胧，《伤寒论》所谓宜大承气汤之证也。而治之不当，服某种丸药，以致大便日滞，小便转数，阴疼如故，足腿痠，上及背脊俱痠。而胃纳不减者，阳明燥气用事也。阙上略痛，阳明余热为病也。右脉滑大，仍宜大承气汤。惟虚者不可重虚，姑宜葛根芩连汤加绿豆，以清下陷之热，而兼消丸药之毒。
葛根一两五钱淡芩三钱川连一钱绿豆一两生草一钱
【按】吾师所谓小便已阴疼，立大承气汤者，义详《伤寒发微》。本汤之加绿豆，与葛根场之加粳米，有异曲同工之妙。
本证当用大承气汤，以其虚，故退一步用葛根芩连汤。前案，以其实，故进一步合承气法。能进者病以速愈，能退者疾乃无危。夫进退之法，兵家之事也，今吾于医术亦云，且凡百证治皆然，第于本案发之。
曹颖甫曰：予用此方不过因热利而设，初未尝有退一步想，然亦何尝非退一步想也。小便已阴疼，原属当下之证，设非先经妄下，何至不用硝黄。比与佐景加硝黄于本方中者适得其反，固知治病用药，当观其通，墨守成方，直土木偶人耳。
大承气汤证其一
方左病延二候，阙上痛，渴饮，大便八日不行，脉实，虽今见心痛彻背，要以大承气汤主治。
生川军四钱后入小枳实四钱中川朴一钱芒硝二钱后入全瓜蒌五钱拙巢注：下后胸隔顿宽，惟余邪未尽，头尚晕，乃去硝黄，再剂投之，即愈。
【按】大论曰：问曰：阳明病外证云何？答曰：身热，汗自出，不恶寒，反恶热也。此概统白虎承气而言之。若求大承气汤之全部证状，当为：一，大便不行，腹痛拒按，此以胃中有燥矢故也。二，阙上痛。《内经》以阙上属喉间病，此概以气色言之，若阳明燥气上冲及脑，则阙上必痛，其不甚者则但胀耳。
三，右髀有筋牵掣，右膝外旁痛，此为吾师所独验而得之者。四，脉洪大而实，然亦有迟者。五，日晡潮热。他若舌苔黄燥厚腻，大渴引冷，当在应有之例。然此不过言其常耳，若下列诸案所引，则其变也，知常知变，乃可与言大道。
吾师善用诸承气汤，历年治阳明实证，十九全愈。吾师之用药也，麻桂膏黄，柴芩姜附，悉随其证而定之，绝不似世之名家，偏凉偏热，以执一为能事者。余敢曰：凡仲圣所称某某汤主之云者，此皆一剂知，二剂已之方也，倘能药量适合，则一帖愈病，原属平淡无奇之事，安足怪者？而《伤寒论》中之阳明病占全书篇幅四之一，于承气汤尤反复推论，其详备明确远出三阴诸方之上，然则硝黄之用，复有何疑者？阅者能明此旨，是为知吾师者，是为知仲圣者。
大承气汤证其二
若华忽病头痛，干呕，服吴茱萸汤，痛益甚，眠则稍轻，坐则满头剧痛，咳嗽引腹中痛，按之，则益不可忍，身无热，脉微弱，但恶见火光，口中燥，不类阳明腑实证状。盖病不专系肠中，而所重在脑，此张隐庵所谓阳明悍热之气上循入脑之证也。按即西医所谓脑膜炎之类。及其身无热，脉微弱之时，而急下之，所谓釜底抽薪也。若身有大热，脉大而实，然后论治，晚矣。
生川军三饯芒硝三钱枳实四钱厚朴一钱
【按】若华女士服本方后约三小时，即下，所下非燥矢，盖水浊也，而恙乃悉除，不须再诊。是时，余按日从师受课，故知之稔。
头满头剧痛，病所在脑也。一下而愈，病源在肠也。合而言之，所谓上病下取，治求其本也。盖肠中既燥，胃居其上，声气互通，乃亦化热。胃有神经上通于脑，辗转相传。脑神经受热熏灼，故发为满头剧痛。抑又肠胃燥实者，周身血液亦必随之化热，其敷陈血管壁间之诸神经，自受同一之影响。而脑部为全身神经之总汇，枢机重要，所系更巨，故非特满头剧痛，甚则神昏谵语，发狂喜妄。
前年三月，朱锡基家中一名女仆发热生病，请我诊治。我用轻剂帮助透发邪气，第二天热势更重，仍未见疹点。继续给予透发治疗，第三天病情加重，众人指认为猩红热，应当紧急送往传染病医院接受治疗。朱锡基的房东尤其恐惧，极力怂恿送医。朱锡基无法决定，请求我果断用药。我答应了。仔细察看病者，痧毒已经发出但不通畅，咽喉肿痛，有白腐的迹象，喘鸣声大作，呼吸困难不堪，咯痰不出，身体发热胸闷，眼睛不能睁开视物，烦躁不得睡眠，这实际上是烂喉痧（一种以咽喉溃烂、肌肤发疹为特征的急性传染病）的危重证候，应当给予：净麻黄一钱半、生石膏五钱、光杏仁四钱、生甘草一钱，略加芦根、竹茹、蝉衣、蚤休等具有透发、清热、化痰作用的药物。服药后，患者立即安睡，痧毒全部发出且色泽明亮，喉痛逐渐消除。随后给予调理，三天完全痊愈。事后婢女叩头谢恩说，之前我病重的时候，服用这个药之后，感觉凉爽万分，不知如何那样舒适。
【按语】麻疹以透发干净为吉兆，邪气内伏为凶险，这是人人都知道的道理。但是透发的方法却有辨别之处。
因为痧毒内伏，必须随着汗液才能外出。而汗液寄存在汗腺之内，必须随着身体发热才能外泌。所以在出痧之前的身体发热是应有的现象。只是这种身热也有一定标准，过低固然不行，过高也不好。
事实上过高的情况少，过低的情况多。所以用药宜偏向温性，万不可滥用凉剂来遏制它。等到痧毒正发之时，小儿的身热往往过度，与未发前成反比。不知道身热过重又会妨碍痧毒的外透。
此时热迫肺部则喘急，热蒸汗腺则汗出，热灼心君则神昏，热熏痰浊则干咳，这是麻杏甘石汤（麻黄杏仁甘草石膏汤）的确切适应证，重用此方，百发百中，难道平淡的药物所能达到的吗？疹病兼有喉病的，中医称之为烂喉痧，西医称之为猩红热。丁甘仁先生擅长治疗此病，其治法大意，大致说喉痧应当以痧为本，以喉为标，只要痧毒透发出来，喉部自然痊愈，可谓要言不繁。而这个汤剂治疗喉痧之所以获得特效，就是这个原因。
本汤条文说：发汗后（又说下后）不可再用桂枝汤，汗出而喘，没有大热的，可以给予麻黄杏仁甘草石膏汤等等。而有人想要将其改为无汗而喘，大热的。不知道麻黄汤证，是由未发热发展为发热，其病势是由郁结而发散。麻杏甘石汤证，是由身大热转为身无大热，其病势是由表入里。正因为逐渐由表入里，由寒化热，所以无汗逐渐转为汗出。唯独喘症一定不除。然后知道“热喘”二字确实是本汤的主要证候。得到这一角，就可以举一反三了。那经文何必涂改呢！
麻黄杏仁甘草石膏汤证第四例（附列门人治验）
王姓患者双侧乳蛾（扁桃体）发作，红肿疼痛，妨碍吞咽饮水，身体发热，微微恶风，大小便尚可，脉微数，舌微绛，适宜辛凉甘润法。
薄荷一钱（后下）、杏仁三钱、连翘二钱、象贝母三钱、桑叶二钱、生甘草一钱半、赤芍二钱、蝉衣一钱、僵蚕三钱、炙桔梗一钱、马勃八分、牛蒡子二钱、活芦根一尺（去节另用）、玉钥匙吹喉中。
【按语】在九十月燥气当令的时候，喉病常多，轻的只觉得喉中梗梗然妨碍吞咽饮水，稍重的则咽喉两关发为乳蛾，红肿如桃。西医称此为扁桃体肿，但只要照上列方剂随意加减，可以一剂见效，二剂痊愈。乳蛾消退后，完全恢复正常。至于乳蛾逐渐由红变而化为白腐，或生白点，可加玄参一味来治疗，其效如神。如果更进一步由白腐化为脓，才可用刺法，使脓排出也能痊愈。然而如果早用辛凉甘润，必定不至于到这个地步，这就是辛凉甘润法之所以珍贵的原因。
有一派喉科医生治疗喉病，喜欢用苦寒的药物，如板蓝根、川黄连、地丁草、人中黄之类。服用后，虽然可以暂时折服邪气，往往导致郁结而不能宣散，拖延时日，甚至转变为重症，令人担忧。凡是患乳蛾因服用苦寒药不解，接着进服辛凉甘润药的，那么见效必然较慢，甚至初服一二剂竟毫无效果，我尝试过很多次了。又有一派医生治疗喉病，喜欢用重腻滋阴的药物，如生地、麦冬、石斛、沙参之类，竟然重用至八钱一两。以此治疗乳蛾，也不能速愈。我的朋友谢维岐先生籍贯吴县，患喉痛小病，名医给予滋阴重剂，多花钱而少效果。我最终用辛凉轻剂，一服见效，二服全愈，这就是辛凉甘润法之所以珍贵的原因。辛凉甘润乃是张仲景的大法，温热学派不过是加以阐发罢了。
叶氏《幼科医案》说：春月突然变暖忽冷，先受温邪，继为冷束，咳嗽痰喘最多。……轻的为咳，重的为喘，喘急则鼻翼扇动胸挺起。这确实是麻杏甘石汤的确切适应证，如果及时投以麻杏甘石汤重剂，则药到病除，何至于有逆传心包的危候？依佐景临床所得，本汤证以小儿患者居多，且多发在冬春之间，与夫白虎加桂枝汤证之多发于夏日及大人的，完全相反，与叶氏所言颇合，可见叶氏是明知麻杏甘石汤的。吴鞠通也知道这一点，所以虽然在《温病条辨》上焦中焦二篇隐而不谈，及在下焦篇第四十八条，就不再隐藏。说：喘，咳，呼吸急促，吐稀涎，脉洪数，右大于左，喉哑，这是热饮，麻杏甘石汤主之。既然这样，温热诸家果真能识别适宜施用辛凉甘润法的麻杏甘石汤证，并以此为基础上，进而变化它，扩充它，想要自成为广义的温病学说，实无疑义。
可惜不肯道破根源罢了。所以我敢作公平之论，说：温热家立说并非不可，时方轻方并非全不可用，但应当明确其与伤寒经方之间的师承贯通处，然后师法经方之法，不妨用时方之药，而且使用必更神验，这是亲历的事实，所可忠告于同仁的。
葛根黄连黄芩汤证第一例（附列门人治验）
李孩疹发未畅，下利且臭，日行二十余次，舌质绛，而苔白腐，唇干，目赤，脉数，寐不安，适宜葛根芩连汤加味。
粉葛根六钱、细川黄连一钱、淮山药五钱、生甘草三钱、淡黄芩二钱、天花粉六钱、升麻一钱半。
【按语】李孩服用后，其痢疾逐渐稀薄，痧毒透发有增无减，逐渐调理而安。湖南师兄也在红卍字会医院屡遇小孩发麻疹时下利，必治以本汤，疗效良好。又有溏泄发于疹后的，也可以推演治疗。
麻疹之利属于热性的，常占十之七八，属于寒性的，十不过二三，所以宜于葛根芩连汤的十常七八，宜于理中汤或桂枝人参汤的十不过二三。一旦不慎，误投汤药，祸患立刻到来，能不畏惧吗！今人每以葛根芩连汤证之利为协热利，实则葛根芩连汤证之利虽属热性，仲圣并未称之为协热利，至桂枝人参汤证之寒性利，反而称之为协热而利。盖协热者，犹言挟表热也，这一点不可不知道。
太阳病，应当解表，如果不给解表，而用治阳明法以下之，则变证。但或从寒化，或从热化，每无定局。正气盛者多从热化，正气衰者则从寒化。仲圣说：太阳病，外证未除，而数下之，遂协热而利，利下不止，心下痞硬，表里不解者，桂枝人参汤主之。这是从寒化的例子。又说：太阳病，桂枝证，医反下之，利遂不止，脉促者，表未解也，喘而汗出者，葛根黄连黄芩汤主之。这是从热化的例子。
本条有余意，有省文，若想知其详，而不嫌辞赘者，可在“也”字下，加“宜葛根汤，若利不止”诸字样，则经旨明矣。意谓桂枝汤证因下伤津，利不止亦伤津，而脉促近于浮，为表未解，故宜葛根汤，以解其表，而养其津。若表解之后，内热甚炽，肺受热灼而喘，汗受热蒸而出者，当用葛根芩连汤以直折之。
我之前说桂枝汤证化热，则为白虎汤证，麻黄汤证化热，则为麻杏甘石汤证，现在应当续为之说，说葛根汤证化热则为葛根芩连汤证。征之于临床，考之于经文，历历不爽。
曹颖甫说：表未解者，必不汗出，盖利不止而脉促为表未解。表未解者，宜葛根汤。利不止而喘汗，为表病入里，则宜葛根芩连汤。脉促为脉紧变文，前于《伤寒发微》中已略申其旨。固知葛根芩连汤惟已经化热者宜之耳。惟其化热者宜之，而舌苔白腐，唇干目赤，乃无乎不宜，不惟热利为然也。
葛根黄连黄芩汤证第二例（附列门人治验）
孙宝宝住厅西路初诊满舌生疮，环唇纹裂，不能吮饮，饮则痛哭，身体发热，小便少，脉洪而数，常烦躁不安，大便正常，拟葛根芩连汤加味。
粉葛根四钱、淡黄芩一钱半、小川黄连六分、生甘草三钱、灯心三扎、活芦根一尺。
【按语】孙君维翰，是我的朋友。他的小公子未满两岁，很活泼可爱，体肥硕，像他父亲。每次患微恙，我必治愈他。但因为事繁，常无暇面诊，有时仅凭孙君的陈述而开方。一日，孙君又说其孩子身热，咳嗽，口渴，不安等等，当时遥拟辛凉轻剂给他。服用两天，不差反剧。说口舌生疮了。当时请面诊，答应了。仔细察看之下，才知道本是葛根汤证，如今乃化热进而为葛根芩连汤证了。葛根汤证何以化热变剧？盖辛凉轻剂不胜重任的缘故。孙孩服用此方之后，将一剂而愈乎？说：不然。次日，其病不增不减，仅维持原状而已。
二诊口疮，投葛根芩连汤，不见大效，宜进一步，合承气法。
粉葛根四钱、细川黄连八分、生川军二钱、生甘草三钱、淡黄芩一钱半、枳实一钱半、玄明粉一钱（分冲）。
【按语】又次日，孙君来告，此方之效乃无出其右，服用后一小时许，能饮水而不作痛状，夜寐甚安。越宿醒来，舌疮大退，肯吮乳。嘱减量再服，遂愈。才知道大黄内服，却胜冰硼外搽，因此散我也曾用于二三日前也。
葛根汤证化热，为葛根芩连汤证，葛根芩连汤证化热，则为承气汤证。我因失治缓治于先，故补治急治于后，不待其大便闭结，而乘其即将闭结，预用硝黄以图之，此急治补治之说也。然而设使我能及时重用葛根芩连，又何需乎硝黄？我能及时重用葛根汤，又何需乎芩连？溯本穷源，为医者不当若是乎？昔我治一妇人，舌尖下发一白点，渐内蚀，饮食则□，不能触咸味，尤不可碰热菜。我说：此属热，宜师白虎汤，服石膏。妇服之数日，腐点不动，而胃纳反差。闻人言，服黄连可效，竟一剂而愈。我乃恍然若闻道，知葛根芩连汤与白虎汤本属并肩，各有主治，不容混淆，设使互易为治，必两不奏功。
曹颖甫说：葛根芩连汤既为化热而设，服之不效，肠胃燥实即为热病之结果，故佐景谓合承气法为进一步也。
葛根黄连黄芩汤证第三例
徐左美亚十厂六月十二日小便已，阴疼，这本来是大肠燥气，熏灼膀胱，《伤寒论》所谓宜大承气汤的证候。而治之不当，服某种丸药，以致大便日滞，小便转数，阴疼如故，足腿酸，上及背脊俱酸。而胃纳不减者，阳明燥气用事也。阙上略痛，阳明余热为病也。右脉滑大，仍宜大承气汤。惟虚者不可重虚，姑宜葛根芩连汤加绿豆，以清下陷之热，而兼消丸药之毒。
葛根一两五钱、淡芩三钱、川连一钱、绿豆一两、生甘草一钱。
【按语】吾师所谓小便已阴疼，立大承气汤者，义详《伤寒发微》。本汤之加绿豆，与葛根汤之加粳米，有异曲同工之妙。
本证当用大承气汤，以其虚，故退一步用葛根芩连汤。前案，以其实，故进一步合承气法。能进者病以速愈，能退者疾乃无危。夫进退之法，兵家之事也，今吾于医术亦云，且凡百证治皆然，第于本案发之。
曹颖甫说：予用此方不过因热利而设，初未尝有退一步想，然亦何尝非退一步想也。小便已阴疼，原属当下之证，设非先经妄下，何至不用硝黄。比与佐景加硝黄于本方中者适得其反，固知治病用药，当观其通，墨守成方，直土木偶人耳。
大承气汤证第一例
方左病延二候，阙上痛，渴饮，大便八日不行，脉实，虽今见心痛彻背，要以大承气汤主治。
生川军四钱（后入）、小枳实四钱、中川朴一钱、芒硝二钱（后入）、全瓜蒌五钱。拙巢注：下后胸隔顿宽，惟余邪未尽，头尚晕，乃去硝黄，再剂投之，即愈。
【按语】大论曰：问曰：阳明病外证云何？答曰：身热，汗自出，不恶寒，反恶热也。此概统白虎承气而言之。若求大承气汤之全部证状，当为：一，大便不行，腹痛拒按，此以胃中有燥矢故也。二，阙上痛。《内经》以阙上属喉间病，此概以气色言之，若阳明燥气上冲及脑，则阙上必痛，其不甚者则但胀耳。
三，右髀有筋牵掣，右膝外旁痛，此为吾师所独验而得之者。四，脉洪大而实，然亦有迟者。五，日晡潮热。他若舌苔黄燥厚腻，大渴引冷，当在应有之例。然此不过言其常耳，若下列诸案所引，则其变也，知常知变，乃可与言大道。
吾师善用诸承气汤，历年治阳明实证，十九全愈。吾师之用药也，麻桂膏黄，柴芩姜附，悉随其证而定之，绝不似世之名家，偏凉偏热，以执一为能事者。余敢曰：凡仲圣所称某某汤主之云者，此皆一剂知，二剂已之方也，倘能药量适合，则一帖愈病，原属平淡无奇之事，安足怪者？而《伤寒论》中之阳明病占全书篇幅四之一，于承气汤尤反复推论，其详备明确远出三阴诸方之上，然则硝黄之用，复有何疑者？阅者能明此旨，是为知吾师者，是为知仲圣者。
大承气汤证第二例
若华忽病头痛，干呕，服吴茱萸汤，痛益甚，眠则稍轻，坐则满头剧痛，咳嗽引腹中痛，按之，则益不可忍，身无热，脉微弱，但恶见火光，口中燥，不类阳明腑实证状。盖病不专系肠中，而所重在脑，此张隐庵所谓阳明悍热之气上循入脑之证也。按即西医所谓脑膜炎之类。及其身无热，脉微弱之时，而急下之，所谓釜底抽薪也。若身有大热，脉大而实，然后论治，晚矣。
生川军三钱、芒硝三钱、枳实四钱、厚朴一钱。
【按语】若华女士服用本方后约三小时，即下，所下非燥矢，盖水浊也，而恙乃悉除，不须再诊。是时，余按日从师受课，故知之稔。
头满头剧痛，病所在脑也。一下而愈，病源在肠也。合而言之，所谓上病下取，治求其本也。盖肠中既燥，胃居其上，声气互通，乃亦化热。胃有神经上通于脑，辗转相传。脑神经受热熏灼，故发为满头剧痛。抑又肠胃燥实者，周身血液亦必随之化热，其敷陈血管壁间之诸神经，自受同一之影响。而脑部为全身神经之总汇，枢机重要，所系更巨，故非特满头剧痛，甚则神昏谵语，发狂喜妄。
In the third month of the previous year, a female servant in Zhu Xiji's household fell ill with fever and was consulted. I prescribed a mild formula to vent the pathogen. The next day, the fever intensified, yet no rash appeared. I continued with venting treatment. By the third day, the condition worsened. The crowd identified it as scarlet fever (Hongre) and urged immediate transfer to an infectious disease hospital for treatment. Zhu Xiji's landlord was particularly terrified and strongly advocated for this course of action. Unable to decide, Zhu Xiji requested that I prescribe medication decisively. I agreed. Upon careful examination, I found that the sha toxin (Sha Du) had erupted but was not smooth; there was swelling and pain in the throat with signs of white putrefaction; wheezing was loud, and breathing was severely difficult; phlegm could not be expectorated; the body was hot with chest tightness; the eyes could not be opened or used for vision; and there was irritability and insomnia. This was actually a critical presentation of Lanhou Sha (a severe acute infectious disease characterized by throat ulceration and skin eruption). I prescribed: Jing Mahuang (Cinnamomum Cassia Twig? No, Ephedrae Herba Purified) 1.5 qian, Sheng Shigao (Gypsum Fibrosum) 5 qian, Guang Xingren (Armeniacae Semen Amarum) 4 qian, Sheng Cao (Glycyrrhizae Radix et Rhizoma) 1 qian, plus some Lugen (Phragmitis Rhizoma), Zhuru (Bambusae Caulis in Taeniam), Chanyi (Bombyx Batryticatus), and Xiuxiu (Paris Polyphyllae Rhizoma) to promote venting, clear heat, and resolve phlegm. After taking the medicine, the patient slept peacefully immediately. The rash erupted fully and brightly, and the sore throat gradually subsided. Subsequent conditioning led to complete recovery within three days. Afterwards, the maid knelt and thanked me, saying that when her illness was at its worst, after taking this medicine, she felt extremely cool and comfortable beyond words.
[Commentary] It is well known that for measles (Mazhen), smooth eruption is auspicious, while internal retention is ominous. However, the method of eruption requires differentiation.
Because the sha toxin is internally retained, it must exit along with sweat. Sweat resides within the sweat glands and must be secreted externally driven by body heat. Therefore, fever prior to the appearance of sha is a normal phenomenon. Yet, this fever has a certain standard; too low is inadmissible, and too high is also undesirable.
In practice, cases of excessive fever are rare, while those of insufficient fever are common. Thus, medication should lean towards warmth; one must never recklessly use cooling agents to suppress it. When the sha toxin is erupting, children's body heat often becomes excessive, inversely proportional to pre-eruption levels. Not realizing that excessive heat hinders the external eruption of the sha toxin.
At this time, heat forcing into the lungs causes wheezing and urgency; heat steaming the sweat glands causes sweating; heat scorching the Heart Mind (Xin Jun) causes unconsciousness; and heat steaming turbid phlegm causes dry cough. These are precise indications for Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction). Administering it in heavy doses yields hundred percent success; how can mild medications achieve this? When a rash disease involves the throat, TCM calls it Lanhou Sha, while Western medicine calls it Scarlet Fever. Mr. Ding Ganren excelled in treating this disease. His general treatment principle stated that for Hou Sha, one should treat the sha as the root and the throat as the branch; once the sha is vented, the throat heals itself. This is concise and accurate. The reason this decoction achieves special effects in treating Hou Sha is precisely due to this principle.
The text of this decoction states: "After sweating (or purging), Guizhi Tang should not be used again. If there is sweating, wheezing, and no significant heat, Mahuang Xingren Gancao Shigao Tang may be given." Some wish to change this to "no sweating, wheezing, and significant heat." They do not realize that Mahuang Tang syndrome progresses from no fever to fever, with the pathological trend moving from stagnation to eruption. Mahuang Xingren Gancao Shigao Tang syndrome progresses from significant body heat to no significant body heat, with the trend moving from exterior to interior. Because it gradually moves from exterior to interior, and from cold to heat, lack of sweating gradually turns into sweating. Only the wheezing remains unresolved. Thus, we understand that "heat-induced wheezing" is indeed the main syndrome of this decoction. Grasping this aspect allows one to infer others. Why tamper with the classic text?
**Mahuang Xingren Gancao Shigao Tang Syndrome Case 4 (Student's Clinical Experience)**
Patient Wang suffered from bilateral tonsillitis (Rumei), with redness, swelling, and pain, hindering swallowing and drinking. There was body heat, slight aversion to wind, bowel and bladder functions were acceptable, pulse was slightly rapid, and the tongue was slightly crimson. The appropriate method is Acrid-Cool and Sweet-Moistening.
Bohe (Menthae Haplocalycis Herba) 1 qian (added later), Xingren (Armeniacae Semen Amarum) 3 qian, Lianqiao (Forsythiae Fructus) 2 qian, Xiangbei (Fritillariae Thunbergii Bulbus) 3 qian, Sangye (Mori Folium) 2 qian, Shengcao (Glycyrrhizae Radix et Rhizoma) 1.5 qian, Chishao (Paeoniae Radix Rubra) 2 qian, Chanyi (Bombyx Batryticatus) 1 qian, Jiangcan (Bombyx Batryticatus) 3 qian, Zhi Jiegeng (Platycodonis Radix) 1 qian, Mabo (Belamcandae Rhizoma) 0.8 fen, Niubangzi (Arctii Fructus) 2 qian, Huo Lugeng (Phragmitis Rhizoma) 1 chi (nodes removed, prepared separately), and Yuyaochi powder blown into the throat.
[Commentary] During the months of September and October, when dryness qi dominates, throat diseases are frequent. Mild cases feel only a lump in the throat hindering swallowing. Slightly more severe cases develop tonsillitis (Rumei) at both sides of the throat, red and swollen like peaches. Western medicine calls this tonsillar swelling. With appropriate modifications to the above formula, improvement is seen in one dose, and cure in two. After the tonsils recede, everything returns to normal. If the tonsils gradually turn from red to white putrefaction or develop white spots, adding Xuanshen (Scrophulariae Radix) is effective. If they further suppurate, puncture therapy to drain pus is required. However, early use of Acrid-Cool and Sweet-Moistening methods would prevent such progression, highlighting the value of this approach.
One school of throat specialists prefers bitter-cold herbs like Banlangen (Isatidis Radix), Chuanlian (Coptidis Rhizoma), Diding (Violaris Herba), and Renzhonghuang (Hominis Excrementum Depuratum). While these may temporarily subdue pathogens, they often cause stagnation and failure to disperse, prolonging the illness or leading to severe complications. In my experience, if Rumei does not resolve with bitter-cold herbs, subsequent use of Acrid-Cool and Sweet-Moistening methods yields slow results, sometimes even no effect in the first few doses. Another school prefers heavy, cloying yin-nourishing herbs like Shengdi (Rehmanniae Radix), Maidong (Ophiopogonis Radix), Shihu (Dendrobii Caulis), and Shashen (Glehniae Radix), sometimes using large doses of 8 qian to 1 liang. This also fails to quickly cure Rumei. My friend Mr. Xie Weiqi from Wu County suffered from minor throat pain. Famous doctors prescribed heavy yin-nourishing formulas with little effect. I ultimately used a light Acrid-Cool formula, which worked in one dose and cured him in two. This demonstrates the value of Acrid-Cool and Sweet-Moistening. This is Zhang Zhongjing's great method, merely elaborated by the Warm Disease school.
Ye Tianshi's *Pediatric Medical Cases* states: "In spring, sudden warmth followed by cold leads to initial warm pathogen invasion constrained by cold, resulting in frequent cough and phlegm-wheezing... Mild cases are cough, severe cases are wheezing; severe wheezing involves nasal flaring and chest protrusion. This is a precise indication for Mahuang Xingren Gancao Shigao Tang. Timely administration of heavy doses prevents the danger of reverse transmission to the Pericardium." Based on my clinical experience, this syndrome occurs mostly in children during winter and spring, opposite to Baihu Jia Guizhi Tang syndrome which affects adults in summer. This aligns with Ye Tianshi, proving he understood Mahuang Xingren Gancao Shigao Tang. Wu Jutong also knew this, though he hid it in the Upper and Middle Jiao chapters of *Wenbing Tiaobian*, revealing it in Chapter 48 of the Lower Jiao chapter: "Wheezing, cough, shortness of breath, spitting thin saliva, surging and rapid pulse, right greater than left, hoarse voice indicates Heat-Fluid Retention, treated with Mahuang Xingren Gancao Shigao Tang." Thus, Warm Disease theorists who recognize this syndrome can build upon it to expand their theories.
It is a pity they do not reveal the root source. I offer a fair opinion: Warm Disease theories are not invalid, and contemporary light formulas are not useless. However, one must understand the lineage connection between them and Shanghan Jing formulas. Mastering Jingfang methods allows the use of Shifang herbs with greater efficacy, as proven by my experience.
**Gegen Qinlian Huangqin Tang Syndrome Case 1 (Student's Clinical Experience)**
Child Li had incomplete rash eruption, foul diarrhea occurring over twenty times daily, crimson tongue with white putrid coating, dry lips, red eyes, rapid pulse, and restless sleep. Gegen Qinlian Tang with modifications is indicated.
Fen Gegen (Puerariae Lobatae Radix) 6 qian, Xi Chuanlian (Coptidis Rhizoma) 1 qian, Huaishanyao (Dioscoreae Rhizoma) 5 qian, Shengcao (Glycyrrhizae Radix et Rhizoma) 3 qian, Dan Huangqin (Scutellariae Radix) 2 qian, Tianhuafen (Trichosanthis Radix) 6 qian, Shengma (Cimicifugae Rhizoma) 1.5 qian.
[Commentary] After taking this, Child Li's diarrhea became looser, and the rash erupted more fully. Gradual conditioning led to recovery. A Hunan senior colleague also frequently encountered children with measles complicated by diarrhea at the Red Cross Hospital, always treating them with this formula with good results. Diarrhea occurring after rash eruption can also be treated similarly.
Measles-related diarrhea is heat-type in 70-80% of cases and cold-type in 20-30%. Thus, Gegen Qinlian Tang is suitable for 70-80%, while Lizhong Tang or Guizhi Renshen Tang for 20-30%. Mistakes here lead to immediate disaster. Modern practitioners often call Gegen Qinlian Tang diarrhea "Xi Re Li" (Collateral Heat Diarrhea). Actually, Zhongjing did not call this Xi Re Li; he called the cold-type diarrhea of Guizhi Renshen Tang "Xi Re Er Li". "Xi Re" means accompanying exterior heat. This is crucial to know.
Taiyang disease requires exterior resolution. If purgatives are used instead, complications arise, either transforming into cold or heat. Strong righteous qi tends toward heat transformation; weak righteous qi tends toward cold. Zhongjing said: "Taiyang disease, exterior symptoms unremoved, frequent purging leads to Xi Re Li, unceasing diarrhea, epigastric fullness/hardness, exterior and interior unresolved, Guizhi Renshen Tang governs." This is cold transformation. He also said: "Taiyang disease, Guizhi pattern, doctor wrongly purges, diarrhea continues, pulsation is cu (surging/rapid), exterior unresolved, wheezing and sweating, Gegen Qinlian Huangqin Tang governs." This is heat transformation.
This clause implies omitted text. To clarify without redundancy, add "If diarrhea persists, use Gegen Tang" after the word "ye". Meaning: Guizhi Tang syndrome damaged fluids by purging; persistent diarrhea further damages fluids. Pulse cu near floating indicates unresolved exterior. Thus, Gegen Tang resolves exterior and nourishes fluids. If exterior resolves but internal heat is intense, lung scorched by heat causing wheezing, and sweat steamed by heat, Gegen Qinlian Tang directly reduces heat.
Previously, I stated Guizhi Tang transforming into heat becomes Baihu Tang, and Mahuang Tang transforming into heat becomes Mahuang Xingren Gancao Shigao Tang. Now I add: Gegen Tang transforming into heat becomes Gegen Qinlian Huangqin Tang. Clinical and textual evidence supports this.
Cao Yingfu said: Unresolved exterior means no sweating. Persistent diarrhea with cu pulse indicates unresolved exterior; Gegen Tang is indicated. Persistent diarrhea with wheezing and sweating indicates interiorization; Gegen Qinlian Tang is indicated. Cu pulse is a variation of Jin (tight) pulse. Gegen Qinlian Tang is suitable only for heat-transformed cases. With white putrid coating, dry lips, and red eyes, it is universally suitable, not just for heat diarrhea.
**Gegen Qinlian Huangqin Tang Syndrome Case 2 (Student's Clinical Experience)**
Baby Sun, living on Tingxi Road, presented with mouth ulcers covering the tongue, cracked lips around the mouth, inability to suckle, crying upon drinking, body heat, scanty urine, surging and rapid pulse, constant irritability, and normal stool. Gegen Qinlian Tang with modifications is planned.
Fen Gegen (Puerariae Lobatae Radix) 4 qian, Dan Huangqin (Scutellariae Radix) 1.5 qian, Xiao Chuanlian (Coptidis Rhizoma) 0.6 qian, Shengcao (Glycyrrhizae Radix et Rhizoma) 3 qian, Dengxin (Junci Medulla) 3 bundles, Huo Lugeng (Phragmitis Rhizoma) 1 chi.
[Commentary] Mr. Sun Weihuan is a friend. His young son, under two years old, was lively and chubby, resembling his father. I usually cured his minor illnesses. Due to busy schedule, I often prescribed remotely based on Mr. Sun's description. One day, he reported fever, cough, thirst, and restlessness. I remotely prescribed a light Acrid-Cool formula. After two days, the condition worsened, developing mouth ulcers. Upon face-to-face consultation, I realized this was originally a Gegen Tang syndrome that transformed into heat, becoming Gegen Qinlian Tang syndrome. Why did it transform? The light Acrid-Cool formula was insufficient for the severity. Would one dose have cured him? No. The next day, the condition remained static.
Second visit: Mouth ulcers persisted. Gegen Qinlian Tang showed little effect. Step further, combine with Chengqi method.
Fen Gegen (Puerariae Lobatae Radix) 4 qian, Xi Chuanlian (Coptidis Rhizoma) 0.8 fen, Sheng Chuanjun (Rhei Radix et Rhizoma) 2 qian, Shengcao (Glycyrrhizae Radix et Rhizoma) 3 qian, Dan Huangqin (Scutellariae Radix) 1.5 qian, Zhishi (Aurantii Fructus Immaturus) 1.5 qian, Xuanmingfen (Natrii Sulfas) 1 qian (mixed in).
[Commentary] The next day, Mr. Sun reported this formula was unsurpassed. Within an hour, he could drink without pain and slept peacefully. Waking up, tongue ulcers receded significantly, and he suckled milk. Reduced dose cured him. Oral Dahuang proved superior to topical Bingpeng San.
Gegen Tang transforming into heat becomes Gegen Qinlian Tang; Gegen Qinlian Tang transforming into heat becomes Chengqi Tang. I delayed treatment initially, so I urgently supplemented later. I used Xiaosha (Mirabilite) and Dahuang before constipation set in, anticipating it. This is urgent supplementation. Had I used heavy Gegen Qinlian Tang earlier, Xiaosha/Dahuang would not have been needed. Had I used heavy Gegen Tang earlier, Qinlian/Huangqin would not have been needed. Tracing back, physicians should not act thus. I once treated a woman with a white spot on the tip of her tongue that eroded inward, painful with food/salt/heat. I diagnosed heat and prescribed Baihu Tang (Shigao). Days passed, no change, appetite worsened. Hearing Chuanlian helped, she took it and cured in one dose. I realized Gegen Qinlian Tang and Baihu Tang are parallel, each with specific indications; swapping them fails.
Cao Yingfu said: Gegen Qinlian Tang is for heat transformation. If ineffective, intestinal dryness/excess is the result. Hence, combining with Chengqi is the next step.
**Gegen Qinlian Huangqin Tang Syndrome Case 3**
Ms. Xu, Meiya Factory, June 12th: Pain in the yin after urination. Originally caused by Large Intestine dryness qi scorching the Bladder, indicating Da Chengqi Tang per *Shanghan Lun*. Improper treatment with certain pills caused daily stool stagnation, frequent urination, persistent yin pain, sore legs/back. Stomach appetite remained unaffected due to Yangming dryness qi dominance. Slight pain above the glabella indicates residual Yangming heat. Right pulse slippery and large still suggests Da Chengqi Tang. However, since the patient is deficient, avoid re-deficiency. Temporarily use Gegen Qinlian Tang plus Lv Dou (Mung Bean) to clear sinking heat and detoxify the pills.
Gegen (Puerariae Lobatae Radix) 1.5 liang, Dan Qin (Scutellariae Radix) 3 qian, Chuanlian (Coptidis Rhizoma) 1 qian, Lv Dou (Phaseoli Radiatus Semen) 1 liang, Shengcao (Glycyrrhizae Radix et Rhizoma) 1 qian.
[Commentary] My master's prescription of Da Chengqi Tang for post-urination yin pain is detailed in *Shanghan Fawei*. Adding Lv Dou to this formula is akin to adding Jingmi (Oryza Sativa) to Gegen Tang, achieving similar goals through different means.
This case required Da Chengqi Tang, but due to deficiency, we stepped back to Gegen Qinlian Tang. In the previous case, due to excess, we stepped forward to combine with Chengqi. Advancing cures quickly; retreating prevents danger. This进退 (advance/retreat) method is military strategy applied to medicine.
Cao Yingfu said: I used this formula for heat diarrhea, not intending to retreat. But isn't it a retreat? Post-urination yin pain requires purging. If not for prior wrongful purging, why avoid Xiaosha/Dahuang? Combining them with Zuojing's formula contradicts this. Treating requires flexibility; sticking rigidly to formulas makes one a wooden idol.
**Da Chengqi Tang Syndrome Case 1**
Patient Fang, illness lasted two weeks. Pain above the glabella, thirst/drinking, no bowel movement for eight days, solid pulse. Although presenting with heart pain radiating to the back, Da Chengqi Tang is primary.
Sheng Chuanjun (Rhei Radix et Rhizoma) 4 qian (added later), Xiao Zhishi (Aurantii Fructus Immaturus) 4 qian, Zhong Chuanpu (Magnoliae Officinalis Cortex) 1 qian, Mangxiao (Natrii Sulfas) 2 qian (added later), Quan Gualou (Trichosanthis Fructus) 5 qian.
*Zhuochao Note*: After purging, chest/diaphragm widened instantly. Residual pathogen remained, head still dizzy. Removed Xiaosha/Dahuang, administered another dose, cured.
[Commentary] The Great Treatise asks: What are Yangming exterior symptoms? Answer: Body heat, spontaneous sweating, aversion to neither cold but aversion to heat. This generally covers Baihu and Chengqi. For full Da Chengqi Tang symptoms: 1. No bowel movement, abdominal pain refusing pressure, due to dry feces in stomach/intestines. 2. Pain above glabella. *Neijing* associates glabella with throat; here it refers to complexion/qi color. If Yangming dryness qi rushes to brain, glabella hurts; otherwise, just distension. 3. Tendon pulling in right thigh, pain outside right knee (unique verification by my master). 4. Surging, large, solid pulse (sometimes slow). 5. Tidal fever at dusk. Other expected signs: yellow, dry, thick coating, extreme thirst for cold drinks. These are norms; variations exist in following cases. Knowing norm and variation allows discussion of the Great Way.
My master excels in Chengqi formulas, curing 90% of Yangming excess cases. His use of Mahuang/Guizhi/Shigao/Dahuang/Chaihu/Qinjin/Jiang/Fuzi follows the syndrome, unlike famous doctors who stick to one bias. I dare say: Any formula Zhongjing designated "governs" works in one dose for improvement, two for cure. With correct dosage, curing in one dose is ordinary. Yangming disease occupies one-quarter of *Shanghan Lun*, with repeated discussion of Chengqi, far exceeding Three Yin formulas. Why doubt Xiaosha/Dahuang? Understanding this honors my master and Zhongjing.
**Da Chengqi Tang Syndrome Case 2**
Ruohua suddenly developed headache, dry vomiting. Took Wuzhuyu Tang, pain worsened. Sleep brought slight relief; sitting caused severe whole-head pain; cough pulled abdominal pain; pressing made it unbearable. No body heat, weak pulse, only afraid of firelight, dry mouth. Does not resemble Yangming Fu-excess. The disease focuses on the brain, not just intestines. This is Zhang Yinan's "Yangming fierce heat qi ascending to brain" syndrome, akin to Western meningitis. At the time of no heat and weak pulse, urgent purging is "drawing firewood from under the pot." If waiting for high heat and strong pulse, it is too late.
Sheng Chuanjun (Rhei Radix et Rhizoma) 3 qian, Mangxiao (Natrii Sulfas) 3 qian, Zhishi (Aurantii Fructus Immaturus) 4 qian, Houpo (Magnoliae Officinalis Cortex) 1 qian.
[Commentary] Ms. Ruohua defecated about three hours after taking this formula. The discharge was not dry feces but turbid water, and the illness vanished completely. I was studying with my master daily then, so I knew well.
Severe whole-head pain indicates brain involvement. Cure after one purge indicates intestinal origin. Combined, this is "treating upper disease by lowering," seeking the root. Since intestines are dry, the stomach above transforms into heat via communication. Stomach nerves connect to the brain, transmitting heat. Brain nerves scorched cause severe headache. Furthermore, intestinal dryness/excess heats blood, affecting all vascular nerves. As the brain is the nerve hub, consequences are severe: not just headache, but confusion, delirium, mania.