其腹不拒，至脐下若有物筑筑然振手，解衣视之，状如百钱梗起。其父曰∶此必宿食不下而然。曰∶非也。粪
秽在肠，岂能跳动？此缘误下误消，伤其本元，肝肾之气不藏，亘亘奔突，经所云动气是也。幸属少年，尚可
治，熟地一两五钱，肉苁蓉五钱，甘杞子一两，麦冬、当归各三钱，三剂，下黑燥矢尺余者二，胆油俱去，号
呼顿息，始得睡。再按之，则若百钱者仍在，再与前剂不减，令办参数钱，勉措十金，仅得钱五，煎调前药服
下，则泯然立能进食。惟寒热每日一作，知非本病，必卧室湫隘，天气暴暑，乘虚感疟也，且勿亟治，仍与前
方减半。数日后，饮食大增，乃以常山二钱，火酒炒透，五更煎服，寒热亦瘥。
汤某，年四十余，新秋病感冒，医屡发散，至七八日，无汗，脉弦数且长，身重头眩，尿少而赤，鼻干不
眠，微热而渴。此邪渐入里，肾阴不足，肝脾血燥，表之则不能作汗，下之必成坏症。既非少阳，无容和解。
问欲饮水乎？曰∶甚欲，不敢饮。命与一大碗，犹觉未足。再与一小盏，令且勿药。逾二时许，汗大至，身冷
如冰。亟再诊之，脉虚细而弦，小腹旁跳跃振手。此动气也，缘多服表散，令汗出邪去，而虚症见矣。与生地、
杞子等峻养肝肾，一剂平，三剂全愈。
陈士华兄，武生也，随乡试伊芳迩，日与朋友练习技勇，忽感冒，医治月余不效。脉之弦大而涩，外症不发
热，大便秘，小便少，两额深紫若胭脂，腰痛，口干不欲食。所服药，类皆燥散之品。此少阴不足，劳伤外感，
治之失宜，热邪内陷，法当内托，令其汗出自愈。用熟地、生地、杞子各三钱，蒌仁二钱，黄芩二钱，石斛三
钱，傍晚服下，黄昏胸膈胀闷欲绝，躁扰异常。其家大怼，以为用补必死矣，怒持药瓯掷之门外，环视涕泣。
一更后，忽大汗如雨，衣被沾湿，汗止即索粥，连进两盏，已而酣睡达旦。明晨延诊，脉已圆滑，颊赤亦退，
第困乏无力耳。因问夜来胀闷汗出之故，曰∶病因前药劫其津液，外邪乘虚内结，今以大剂甘润投之，即借其
热结之力，蒸郁勃发，乃一涌而汗出邪散，此所谓内托之法也。令以前方再服四剂，病即起矣。如言而愈。
李韫玉母，年逾四旬，素有胁痛肝火之病，深秋感冒。医与表散，数剂热犹未退。以不大便，投大黄丸、
元明粉下之，遂胁痛大作，晕厥欲脱。更医，治以人参、附子、干姜、肉桂等药，厥止复烦躁，汗时出，不眠，
小便赤涩。医恐虚脱，日投参、术、姜、桂，每汗出，则加五味、黄 、龙骨以敛之。又时时欲利，则加补骨
脂、肉豆蔻以固之。如是四十余日，已服参数两，病益进而食不进。诊之，脉躁数，时大时小，微有寒热，舌
黑而强，鼻煤溢出，额颊唇口如墨，小便惟滴点，两手索刺如柴，第神气不昏，语音犹亮。此由表邪未清，误
下邪陷入里，且伤其真阴，致肝急而厥，又误投辛热固涩，热邪与热药郁结脏腑。今幸元气尚存，犹可活也。
治法仍当汗下，否则邪何由去？或讶曰∶是症仍可再用攻表乎？曰∶不可，第可用不攻表之药下耳。疏方以生
地、杞子各五钱，麦冬二钱，沙参三钱，蒌仁一钱五分，黄芩一钱。或谓前医深恐泄泻，今所用皆一派寒滑，
服之必利下无疑。将弗服，又或曰∶前医治经月余，且辞不治，曷进此以窥进退。服一剂，果利数行。然病患
殊不困，遂日进一剂，四日则利下频数，日夜十余次，所下秽恶不堪，青红黑白，而黄者绝少，腹痛后重。唯
饮食渐进，舌本渐柔，鼻煤渐退，小便渐长，仍前方加熟地五钱，黄连五分。夜乃汗出，其汗亦极臭秽，半月
汗乃止，利渐减，乃加生熟地一两，减黄连，增白芍、甘草，凡五十余剂，病始瘥。计服蒌仁斤许。
姚氏妇，年逾四旬，素有胃痛疾，盖肝火上逆也。夏月患感冒，发热头痛，眩晕不眠，善呕。初服发散未
减，改以二陈、左金治呕，呕未愈而腰连小腹痛不可忍。议为邪入厥阴症，将危殆，欲用四逆回阳之剂。诊之，
脉数而弦，手见红疹，面殊清白，舌两旁及尖皆紫色，中则微黄，口干不甚喜饮。断为肝胆之火炽甚，遇暴寒
折之，不得宣泄，乃上冲胃络作呕，故头偏甚于左。红疹见于四末者，木郁则乘脾也。其初与逍遥自愈，乃用
燥散之剂，更扰其阳，而伤其阴，是以腰腹窘痛。症本厥阴，然非传经，亦非直中也。今标属阳明，宜用竹叶
石膏汤，入杞子一两，饮下呕止，腰腹之痛亦除。惟头痛仍在，改与逍遥汤加川芎、当归。时方霉雨，至夜半
忽霹雳一声，病患觉四肢痛胀异常。此少阳之郁，本诸外淫，因雷复得发越也，已而头痛如失。次日诊之，
脉既和平，与四物去川芎，加女贞、石斛，平调而愈。余表甥尝病疫，因热深厥深，一名医亦与四物汤，幸病
人自知为热症，不之服，用小柴胡、白虎汤合进而愈。
宋复华兄俞氏姊，初夏病感，天癸即来，病随愈，盖热随血去也。越七日，遇端节，食鸡子五枚，酒二杯，
又进饮半瓯，临窗少坐，少顷即头痛发热。次日，前医询知病源，以山楂三钱，谷芽三钱，葛根三钱，其他消
散，大约称是，连进三剂，势将大剧。余至，则前医已在与一邻医议处方。诊之，已昏不知人，面色死青呆白，
目闭口张，气出手撒，呼之不应。脉如沸羹，重按则无，症已败矣。幸未大汗，令人以手按其心下，亦不拒，
知其病初愈，脏腑余热未清，食入肠胃一时不能运化，又感微邪，遂如复症。使勿药，则展转自愈。乃误以大
剂消散，投元虚血弱之人，鼓动其火，反致身热不退，犹以为药力未至，再进三进，至阴阳脱离如是。叩其今
日将用何方，则云∶总是鸡子五枚，硬饭半瓯为患。既消散不应，惟有承气一方下之而已。曰∶承气固是，第
真元已夺，恐宿食未下而遽脱奈何？乃曰∶正为此耳。曰∶余有一方，且弗顾其病，但服之，令病患目开口
闭，神气稍回，再为调治如何？二医欣然齐诺，乃用熟地一两五钱，当归五钱，炮姜八分，嘱其急煎服，迟则
不及，第得药下咽则活矣。抵暮来告，病患不知饮药，以匙挑灌数口，喉间 有声，遂全盏与之，少顷果目
开口闭，能转侧，似大有生机。求再往诊。曰∶无庸，但以前方再锉一剂，并前渣浓煎与服可也。明日视之，
神气清明，脉亦圆稳。第称口燥舌干，小便短涩，夜卧不宁，就前方去炮姜，加沙参、麦冬，一服汗出遍身，
能进粥矣。再以前方加减而愈。
孙文垣治族侄元素，春温头疼发热，左脉弦大，右洪大，以小柴胡合白虎汤投之，二帖而愈。乃因食复发
斑，色紫神昏，身重不能转动，合目鼾睡，如醉人形状，面赤发热，舌苔外黄内黑，有芒刺，脉六部俱浮洪，
以三黄石膏汤加枳实、鳖甲进之。稍得微汗，大便如有臭粪，次日开目能言，用小柴胡汤加山栀、枳实、鳖
甲、白芍，调理而愈。又治侄君孝，三月患头项痛，腰脊强，身如被杖，脐腹亦痛，口渴不寐，六脉浮数。医
以为阴虚，为之滋阴降火，三投而三剧，反加呕恶。又与疏通，热不退，下午烦乱。方和宇视之，以为外感，
拟进人参败毒散。前医力争，谓阴虚不可再汗，仍用四物加柴胡、葛根、薄荷、黄芩、知母，而热如焚，神且
昏冒矣。孙诊之，六脉浮弦鼓指，曰∶此春温也。方脉良是，因复加内伤，故病剧。滋阴药壅塞，且引邪入阴
分，宜乎热加而躁闷也。法当清解兼消，以二陈汤加羌活、防风、麦芽、山楂，服之得微汗，热减其半。惟下
午作潮热，大便未行，腰脐痛不止，改用小柴胡汤加葛根、白芍、青皮、黄连、山楂。热少退，大便行，腰脐
痛减，但不知饥，再以柴胡、甘草、青皮、枳实、麦芽、知母、黄芩、白芍投之，诸症悉平。惟体倦乏力，加
人参、扁豆、薏苡，去柴胡、青皮，调养而愈。
程好吾，季春患两太阳痛，胸胁稍痛，口渴便泻，左脉浮弦而数，中按有力，右关滑大，此春温也。予柴
胡、前胡、葛根、粉草、青皮、黄芩、知母、桔梗、半夏曲、石膏。夜半后，得微汗。因起大便感风，续又发
热，口渴烦躁，用石膏三钱，知母、柴胡各二钱，葛根、黄芩各一钱，粉草、桔梗各五分，竹叶二十片，两
进而汗出热解，诸症悉平。四肢尚倦，口微干，语言乏力，以生脉汤加薏苡、石斛、甘草、白芍、黄芩，调养
如愈。
仆贵，春温头痛身热，面赤舌心焦燥。用石膏、柴胡、葛根、甘草、黄芩、知母、天花粉、白芍服之，舌
不焦黑矣。进粥太早，半夜复热，中脘硬痛，与大柴胡汤一帖，汗出津津，大便行二次。腹痛不止，乃以小承
气汤调下元明粉一钱，又行二次，热不退而痛全减。旋作鼻衄，改用石膏、丹皮、生地、甘草、山栀、升麻、
黄芩、赤芍，一帖而热散衄止。
孙元素妇，春温后，经水适至，余热不退，口渴，胸胁痛，耳聋，脉左弦数，右滑大而数。用小柴胡加石
膏、知母、桔梗、枳壳、栝蒌、半夏曲服之，热渴如故。改用柴胡二钱，人参、甘草、天花粉、黄芩各七分，
白芍、红花、当归、丹皮、知母各八分，调理而瘳。
徐君育，素禀阴虚多火，且多脾约便血证。十月间，便患冬温，发热咽痛，医用麻黄、杏仁、半夏、枳、
橘之类，遂喘逆倚息不得卧，声飒如哑，头面赤热，手足逆冷。张脉之，左手关寸虚大微数，此热伤手太阴气
分也。与葳蕤、甘草等药不应。为制猪肤汤一瓯，令隔汤炖热，不时挑服，三日声清，终剂而痛如失。
郑墨林内，素有便红，怀妊七月，正肺经养胎时而患冬温咳嗽，咽痛如刺，下血如崩，脉较平时觉小弱而
数。此热伤手太阴血分也，与黄连阿胶汤二剂。血止后去黄连，加葳蕤、桔梗、人中黄，四剂而安。
万氏牛黄清心丸∶西牛黄二分五厘，镜面朱砂一钱五分，生黄连五钱，黄芩三钱，山栀三钱，郁金二钱。
上为末，蒸饼糊丸如黍大，每服七八丸。王晋三曰∶喻嘉言治中风门云，热阻关窍，汤剂中调入牛黄清心丸。
但古有数方，其义各别，若治温邪内陷包络神昏者，惟万氏之方为妙。盖温热入于心包络，邪在表矣，草木之
香，仅能达表，不能透里，必藉牛黄幽香物性，乃能内透包络，与神明相合。然犹配合之品，佐使咸宜。万氏
用芩、连、山栀以泻心火，郁金以通心气，辰砂以镇心神，合之牛黄，相使之妙。是丸调入犀角、羚羊角、金
汁、甘草，或人中黄、连、薄荷等汤剂中，定建奇功。
尤在泾曰∶温邪之发，阴必先伤。设有当行解散者，必兼滋阴之品于其中。昔人于葱豉汤内加童便，于栀
豉汤内加地黄、麦冬，亦此意也。
黄锦芳治林国柱患风温，汗出倦怠，鼻鼾语难，嗜卧不休，微恶寒而不甚。或欲用清暑益气汤。黄曰∶此
热扰肾之症，幸胃气尚存，可用滋阴之药以救之。若误用清暑益气，则热得参、 而益盛，火得升、柴而益炽，
直视失溲与螈 等症，必相继而出矣。用熟地三钱，山药二钱，丹皮一钱，龟板一钱，防风一钱，阿胶一钱，
桂枝二钱，一剂而神清，四剂而诸症悉除。
这位病人的腹部按压不抗拒，但到了脐下部位，感觉有物体在跳动震动手背。解开衣服查看，皮肤表面隆起，形状像一百枚铜钱叠在一起。他的父亲说：“这一定是因为宿食停滞不下才这样的。”我说：“不对。粪便污秽在肠道里，怎么可能跳动？这是因为误用攻下和消导药物，损伤了人体的根本元气，导致肝肾之气不能潜藏，横亘奔突，这就是《伤寒论》所说的‘动气’。幸好病人是年轻人，还可以治疗。处方：熟地黄一两五钱，肉苁蓉五钱，甘枸杞子一两，麦冬、当归各三钱。服用三剂后，排出黑燥大便一尺多长的两次，胆经的郁热随之而去，病人的号呼声顿时停止，开始能够入睡。再次按压腹部，那种像百钱梗起的状况仍然存在，再给予前面的药方也没有减少。于是让家属准备人参数钱，勉强凑足十两银子，只买到五钱人参。煎煮后调服前面的药方，症状立刻消失，马上就能进食了。只是每天发作一次寒热，我知道这不是本病的表现，一定是卧室狭窄潮湿，天气酷热，乘虚感染了疟邪。暂时不要急于治疗，仍将前方减半服用。几天后，饮食大增，于是用常山二钱，用火酒炒透，在五更天煎服，寒热症状也随之痊愈。
汤某，四十多岁，初秋患感冒，医生多次使用发汗解表法，到了七八天，仍然无汗，脉象弦数且长，身体沉重头晕，尿少且颜色红赤，鼻干失眠，微热且口渴。这是邪气逐渐入里，肾阴不足，肝脾血分干燥，如果再用发汗法则不能出汗，如果用攻下法必定造成坏证。既然不是少阳病，就不需要和解。问他是否想喝水？他说：“非常想喝，但不敢喝。”命令给他一大碗水，他还觉得不够。再给一小盏，让他暂时不要服药。过了两个多小时，大汗淋漓，身体冷得像冰一样。急忙再次诊察，脉象虚细而弦，小腹旁边跳动震手。这就是动气，是因为多次服用发散药物，导致汗出邪去，但虚证显露出来。给予生地黄、枸杞子等峻补肝肾的药物，一剂后平复，三剂后完全痊愈。
陈士华的哥哥，是武秀才，跟随乡试队伍到附近地方，每天和朋友练习武艺，忽然感冒，医生治疗一个多月无效。诊脉弦大而涩，外表症候没有发热，大便秘结，小便量少，两额深紫如胭脂，腰痛，口干不想吃东西。所服用的药物，大多是燥散之品。这是少阴不足，劳伤兼外感，治疗失当，热邪内陷，治法应当采用内托法，让其自然出汗而自愈。用熟地黄、生地黄、枸杞子各三钱，瓜蒌仁二钱，黄芩二钱，石斛三钱，傍晚服用。黄昏时胸膈胀闷欲绝，烦躁异常。家属非常怨恨，认为用补药必死无疑，愤怒地拿着药碗扔到门外，环顾四周哭泣。一更天后，忽然大汗如雨，衣被湿透，汗止后立即索要粥喝，连续喝了两大碗，随后酣睡到天亮。第二天早晨请医生诊治，脉象已变得圆滑，脸颊的红赤也退了，只是感到困乏无力罢了。于是询问昨晚胀闷出汗的原因，我说：“病因在于前药劫夺了津液，外邪乘虚内结，现在用大剂量的甘润药物投喂，便借其热结之力，蒸腾郁勃而发，于是涌出大汗，邪气随汗而散，这就是所谓的内托法。”令继续服用前方四剂，病就好了。照此办理而痊愈。
李韫玉的母亲，四十多岁，平时就有胁痛肝火旺盛的病，深秋感冒。医生给予发散药物，几剂后热仍未退。因为不大便，投用大黄丸、元明粉攻下，于是胁痛大作，晕厥欲脱。换医生治疗，用人参、附子、干姜、肉桂等药，厥逆止住后又出现烦躁，时时出汗，失眠，小便赤涩。医生担心虚脱，每天投入人参、白术、干姜、肉桂，每次出汗，就加五味子、黄芪、龙骨以收敛。又时时想排便，就加补骨脂、肉豆蔻以固涩。这样四十多天，已经服用人参数两，病情反而加重而吃不下饭。诊察发现，脉象躁数，时而大时而小，微有寒热，舌黑而僵硬，鼻孔溢出煤烟状分泌物，额头脸颊嘴唇像墨一样黑，小便只有点滴，两手索刺如柴，只是神气没有昏迷，语音还响亮。这是由于表邪未清，误用攻下导致邪气陷入里部，并且伤了真阴，导致肝急而厥逆，又误投辛热固涩药物，热邪与热药郁结在脏腑。现在幸亏元气尚存，还可以救治。治法仍应当汗下，否则邪气从哪里去除？有人惊讶地说：“这个病症还可以再用攻表的方法吗？”我说：“不可以，只是可以用不攻表的药物来攻下而已。”开方用地黄、枸杞子各五钱，麦冬二钱，沙参三钱，瓜蒌仁一钱五分，黄芩一钱。有人说前医深深害怕泄泻，现在所用都是一派寒滑药物，服用后必然利下无疑。病人家属不肯服，又有人说：“前医治疗了一个多月，而且推辞不治，何不进此药以试探进退。”服用一剂，果然利下数次。然而病人并不感到困倦，于是每天进一剂，四天则利下频繁，日夜十余次，所下的秽恶不堪，青红黑白都有，而黄色的极少，腹痛后重。唯独饮食逐渐增加，舌根逐渐变软，鼻孔煤烟状物逐渐消退，小便逐渐增多，仍在前方加熟地黄五钱，黄连五分。夜间出汗，汗味也极臭秽，半个月汗才停止，利下逐渐减少，于是加生熟地黄一两，减黄连，增白芍、甘草，共五十多剂，病才好。共计服用了约一斤瓜蒌仁。
姚氏的妻子，四十多岁，平时就有胃痛疾，这是肝火上逆所致。夏季患感冒，发热头痛，眩晕失眠，容易呕吐。起初服用发散药未减轻，改用二陈汤、左金丸治疗呕吐，呕吐未愈而腰连小腹痛不可忍。议论认为是邪气进入厥阴症，将要危殆，想用四逆回阳之剂。诊察发现，脉数而弦，手部出现红疹，面色特别清白，舌两旁及舌尖皆紫色，中间微黄，口干不甚喜欢喝水。断定为肝胆之火炽盛，遇到暴寒遏制，不得宣泄，于是上冲胃络作呕，所以头偏重于左侧疼痛。红疹见于四肢末端，是木郁则乘脾的表现。起初如果给予逍遥散可以自愈，却用了燥散之剂，更加扰乱阳气，伤害阴液，所以腰腹窘迫疼痛。症本属厥阴，但不是传经，也不是直中。现在标症属阳明，宜用竹叶石膏汤，加入枸杞子一两，饮下后呕吐停止，腰腹之痛也消除。只是头痛仍在，改予逍遥汤加川芎、当归。当时正值霉雨季节，半夜忽然一声霹雳，病患觉得四肢痛胀异常。这是少阳之郁，本于外淫，因雷声而复得发越，随后头痛消失。第二天诊察，脉象平和，给予四物汤去川芎，加女贞子、石斛，平调而痊愈。我的表甥曾患瘟疫，因热深厥深，一位医生也给予四物汤，幸好病人自知为热症，不服用，用小柴胡汤、白虎汤合用而痊愈。
宋复华的哥哥俞氏的姐姐，初夏患病，月经即来，病随之痊愈，这是因为热随血去。过了七天，遇到端午节，吃了五个鸡蛋，两杯酒，又喝了半瓯饮料，临窗稍坐，一会儿就头痛发热。第二天，前医询问得知病因，用山楂三钱，谷芽三钱，葛根三钱，其他消导发散药，大致正确，连续服用三剂，病情将大剧。我到达时，前医已在与一位邻医商议处方。诊察发现，已经昏不知人，面色死青呆白，目闭口张，气出手撒，呼唤不应。脉象如沸羹，重按则无，症已败坏。幸好没有大汗，让人用手按其心下，也不抗拒，知道她病初愈，脏腑余热未清，食物进入肠胃一时不能运化，又感受微邪，于是像复发症。如果不吃药，则会辗转自愈。却误用大剂量消散药，投给元气虚弱血弱的人，鼓动其火，反而导致身热不退，还以为药力未到，再进三剂，导致阴阳脱离如此严重。问他们今天打算用什么方，则说：“总是那五个鸡蛋，半瓯硬饭造成的祸患。既然消散不应，惟有承气一方攻下而已。”我说：“承气汤固然对，但真元已夺，恐怕宿食未下而遽然脱亡怎么办？”回答说：“正是为此担忧。”我说：“我有一个方子，暂且不顾及其病，只管服用它，让病患目开口闭，神气稍回，再行调治如何？”两位医生欣然齐声答应，于是用熟地黄一两五钱，当归五钱，炮姜八分，嘱咐他们急煎服用，迟则来不及，只要药一下咽就能活。傍晚来人告知，病患不知道喝药，用勺子挑灌了几口，喉间有声，于是全盏给她，过了一会儿果然目开口闭，能转侧，似大有生机。请求再去诊察。我说：“不用，只需以前方再锉一剂，连同之前的药渣浓煎给她服用即可。”第二天看，神气清明，脉象也圆稳。只是称口燥舌干，小便短涩，夜卧不宁，就在前方去掉炮姜，加沙参、麦冬，一服后汗出遍身，能进粥了。再以前方加减而痊愈。
孙文垣治疗族侄元素，春温头疼发热，左脉弦大，右洪大，用小柴胡汤合白虎汤投喂，两帖而愈。后来因为饮食复发斑，色紫神昏，身重不能转动，合目鼾睡，像醉人形状，面赤发热，舌苔外黄内黑，有芒刺，脉六部俱浮洪，用三黄石膏汤加枳实、鳖甲进服。稍微得到微汗，大便如有臭粪，第二天开目能言，用小柴胡汤加山栀、枳实、鳖甲、白芍，调理而愈。又治疗侄儿君孝，三月患头项痛，腰脊强，身如被杖，脐腹亦痛，口渴不寐，六脉浮数。医生认为是阴虚，为之滋阴降火，三次投药而三次加剧，反加呕恶。又给予疏通，热不退，下午烦乱。方和宇视之，认为是外感，拟进人参败毒散。前医力争，谓阴虚不可再汗，仍用四物汤加柴胡、葛根、薄荷、黄芩、知母，而热如焚，神且昏冒矣。孙文垣诊之，六脉浮弦鼓指，说：“这是春温。”方脉确实正确，但因为复加内伤，所以病剧。滋阴药壅塞，且引邪入阴分，理应热加而躁闷也。治法应当清解兼消，用二陈汤加羌活、防风、麦芽、山楂，服用后得微汗，热减其半。只是下午作潮热，大便未行，腰脐痛不止，改用小柴胡汤加葛根、白芍、青皮、黄连、山楂。热稍退，大便行，腰脐痛减，但不知饥，再以柴胡、甘草、青皮、枳实、麦芽、知母、黄芩、白芍投喂，诸症悉平。只是体倦乏力，加人参、扁豆、薏苡，去柴胡、青皮，调养而愈。
程好吾，季春患两太阳穴痛，胸胁稍痛，口渴便泻，左脉浮弦而数，中按有力，右关滑大，这是春温。给予柴胡、前胡、葛根、粉草、青皮、黄芩、知母、桔梗、半夏曲、石膏。半夜后，得微汗。因为起床大便感风，续又发热，口渴烦躁，用石膏三钱，知母、柴胡各二钱，葛根、黄芩各一钱，粉草、桔梗各五分，竹叶二十片，两进而汗出热解，诸症悉平。四肢尚倦，口微干，语言乏力，用生脉汤加薏苡、石斛、甘草、白芍、黄芩，调养如愈。
仆人贵，春温头痛身热，面赤舌心焦燥。用石膏、柴胡、葛根、甘草、黄芩、知母、天花粉、白芍服用，舌不焦黑了。进粥太早，半夜复热，中脘硬痛，与大柴胡汤一帖，汗出津津，大便行二次。腹痛不止，乃以小承气汤调下元明粉一钱，又行二次，热不退而痛全减。旋作鼻衄，改用石膏、丹皮、生地、甘草、山栀、升麻、黄芩、赤芍，一帖而热散衄止。
孙元素的妻子，春温后，月经适至，余热不退，口渴，胸胁痛，耳聋，脉左弦数，右滑大而数。用小柴胡汤加石膏、知母、桔梗、枳壳、栝蒌、半夏曲服用，热渴如故。改用柴胡二钱，人参、甘草、天花粉、黄芩各七分，白芍、红花、当归、丹皮、知母各八分，调理而瘳。
徐君育，素禀阴虚多火，且多脾约便血证。十月间，便患冬温，发热咽痛，医生用麻黄、杏仁、半夏、枳、橘之类，遂喘逆倚息不得卧，声飒如哑，头面赤热，手足逆冷。张脉之，左手关寸虚大微数，这是热伤手太阴气分也。给予葳蕤、甘草等药不应。为他制猪肤汤一瓯，令隔汤炖热，不时挑服，三日声清，终剂而痛如失。
郑墨林的妻子，平时就有便红（便血），怀孕七月，正当肺经养胎时而患冬温咳嗽，咽痛如刺，下血如崩，脉较平时觉小弱而数。这是热伤手太阴血分也，给予黄连阿胶汤二剂。血止后去黄连，加葳蕤、桔梗、人中黄，四剂而安。
万氏牛黄清心丸：西牛黄二分五厘，镜面朱砂一钱五分，生黄连五钱，黄芩三钱，山栀三钱，郁金二钱。上为末，蒸饼糊丸如黍大，每服七八丸。王晋三说：喻嘉言治中风门云，热阻关窍，汤剂中调入牛黄清心丸。但古有数方，其义各别，若治温邪内陷包络神昏者，惟万氏之方为妙。盖温热入于心包络，邪在表矣，草木之香，仅能达表，不能透里，必藉牛黄幽香物性，乃能内透包络，与神明相合。然犹配合之品，佐使咸宜。万氏用芩、连、山栀以泻心火，郁金以通心气，辰砂以镇心神，合之牛黄，相使之妙。是丸调入犀角、羚羊角、金汁、甘草，或人中黄、连、薄荷等汤剂中，定建奇功。
尤在泾说：温邪之发，阴必先伤。设有当行解散者，必兼滋阴之品于其中。昔人于葱豉汤内加童便，于栀豉汤内加地黄、麦冬，亦此意也。
黄锦芳治疗林国柱患风温，汗出倦怠，鼻鼾语难，嗜卧不休，微恶寒而不甚。有人想用清暑益气汤。黄锦芳说：这是热扰肾之症，幸胃气尚存，可用滋阴之药以救之。若误用清暑益气，则热得参、 而益盛，火得升、柴而益炽，直视失溲与螈 等症，必相继而出矣。用熟地三钱，山药二钱，丹皮一钱，龟板一钱，防风一钱，阿胶一钱，桂枝二钱，一剂而神清，四剂而诸症悉除。
The abdomen was not resistant to pressure, but below the navel, there was a sensation of an object pulsating and vibrating against the hand. Upon unbuttoning the clothes for inspection, the skin surface protruded, resembling a stack of one hundred copper coins. His father said, "This must be due to retained food stagnation that cannot descend." I replied, "Incorrect. Fecal waste in the intestines cannot possibly pulse. This is caused by the erroneous use of purgatives and digestive aids, which damaged the body's fundamental Yuan Qi (Primordial Energy), causing the Qi of the Liver and Kidney to fail in its storing function, surging horizontally and violently. This is what the *Shanghan Lun* (Treatise on Cold Damage) refers to as 'Moving Qi' (Dongqi). Fortunately, the patient is young and can still be treated. Prescription: Shu Di Huang (Prepared Rehmannia Root) 1 liang 5 qian, Rou Cong Rong (Cistanche Stem) 5 qian, Gan Qi Zi (Goji Berry) 1 liang, Mai Dong (Ophiopogon Tuber) and Dang Gui (Angelica Sinensis Root) each 3 qian. After three doses, two stools of black, dry feces, over a chi long, were passed, and the stagnant heat of the Gallbladder channel was eliminated. The patient's wailing ceased immediately, and sleep became possible. Palpating the abdomen again, the protrusion resembling stacked coins remained, and the previous prescription yielded no reduction. Therefore, the family was instructed to procure several qian of Ren Shen (Ginseng Root); they managed to gather only five qian from ten taels of silver. Decocted and mixed with the previous medicine, the symptoms vanished instantly, and eating resumed. However, chills and fever occurred once daily. I knew this was not part of the primary disease but rather malaria contracted due to deficiency, exacerbated by a cramped, damp bedroom and extreme summer heat. There was no need for urgent treatment; the previous prescription was halved. Several days later, appetite increased significantly. Then, Chang Shan (Dichroa Root) 2 qian, stir-fried thoroughly with rice wine, was decocted and taken at the fifth watch (early morning), resolving the chills and fever.
Mr. Tang, over forty years old, contracted a cold in early autumn. Physicians repeatedly used diaphoretic methods. By the seventh or eighth day, there was still no sweat, the pulse was wiry, rapid, and long, the body felt heavy with dizziness, urine was scant and red, the nose was dry with insomnia, slight fever, and thirst. This indicated the pathogen gradually entering the interior, with insufficiency of Kidney Yin and dryness of the Liver and Spleen blood. Using diaphoretics would fail to produce sweat, while using purgatives would lead to complicated syndromes. Since it was not a Shaoyang syndrome, harmonization was unnecessary. When asked if he desired water, he replied, "I desire it greatly but dare not drink." He was ordered to drink a large bowl, yet still felt insufficient. Another small cup was given, and he was told to withhold medication. After about two hours, profuse sweating occurred, and the body became cold as ice. A hurried re-examination revealed a deficient, fine, and wiry pulse, with jumping vibrations beside the lower abdomen. This is Moving Qi, resulting from excessive use of dispersing agents, where sweat expelled the pathogen but exposed the deficiency. Strong tonification of the Liver and Kidney with Sheng Di Huang (Rehmannia Root) and Qi Zi (Goji Berry) was prescribed. The condition stabilized after one dose and fully recovered after three.
Brother Chen Shihua, a military scholar, accompanied his examination party nearby, practicing martial arts daily with friends. He suddenly contracted a cold, and medical treatment for over a month proved ineffective. The pulse was wiry, large, and choppy. Externally, there was no fever, but constipation, scanty urine, deep purple cheeks like rouge, lower back pain, dry mouth, and loss of appetite. The medications taken were mostly drying and dispersing in nature. This indicated insufficiency of Shaoyin, combined with fatigue-induced external contraction. Improper treatment allowed heat pathogens to sink inward. The method should have been internal support (Neituo) to induce spontaneous sweating for recovery. Prescription: Shu Di Huang, Sheng Di Huang, and Qi Zi each 3 qian, Gua Lou Ren (Trichosanthes Seed) 2 qian, Huang Qin (Scutellaria Root) 2 qian, Shi Hu (Dendrobium Stem) 3 qian, taken in the evening. At dusk, severe chest and diaphragm distension and abnormal irritability ensued. The family was furious, believing that tonics would cause death, throwing the medicine bowl outside and weeping. After the first double-hour period (Yi Geng), sudden profuse sweating soaked the clothes and bedding. Immediately after sweating stopped, he demanded porridge, consuming two bowls, followed by sound sleep until dawn. The next morning, the pulse had become round and slippery, facial redness subsided, leaving only fatigue. Explaining the night's events, I stated: "The prior medicines depleted fluids, allowing external pathogens to bind internally. The large dose of sweet and moistening herbs utilized the power of the heat binding to vaporize and erupt, expelling pathogens via sweat—this is the Internal Support method." Four more doses of the same formula led to recovery.
Mother of Li Yunyu, over forty, habitually suffered from hypochondriac pain due to Liver Fire. In late autumn, she caught a cold. Dispersing herbs failed to reduce the heat. Due to constipation, Da Huang Wan (Rhubarb Pill) and Yuan Ming Fen (Mirabilite) were administered to purge, causing severe hypochondriac pain and syncope. A subsequent physician used Ren Shen (Ginseng), Fu Zi (Aconite), Gan Jiang (Dried Ginger), and Rou Gui (Cinnamon Bark). Syncope ceased, but irritability, sweating, and insomnia persisted, along with dark, difficult urination. Fearing collapse, the physician daily added Ren Shen, Bai Zhu (Atractylodes), Gan Jiang, and Rou Gui. With each sweat episode, Wu Wei Zi (Schisandra), Huang Qi (Astragalus), and Long Gu (Fossilized Bone) were added to astringe. Frequent urges to defecate prompted the addition of Bu Gu Zhi (Psoralea) and Rou Dou Kou (Nutmeg). For over forty days, several taels of Ginseng were consumed, yet the condition worsened while appetite vanished. The pulse was restless and rapid, fluctuating between large and small, with slight chills and fever. The tongue was black and stiff, coal-like discharge issued from the nostrils, forehead, cheeks, lips, and mouth were ink-black, urine was drop-by-drop, and hands were thin and prickly, though spirit remained clear and voice loud. This resulted from unresolved exterior pathogens, erroneous purging driving pathogens inward, damaging True Yin, leading to Liver tension and syncope, compounded by erroneous use of acrid-warm astringents, trapping heat within the organs. Fortunately, Yuan Qi remained, offering hope. Treatment required both diaphoresis and purgation; otherwise, how could pathogens exit? Some questioned if attacking the exterior was still viable. I replied, "No, but non-exterior-attacking purgatives can be used." Prescription: Sheng Di Huang and Qi Zi each 5 qian, Mai Dong 2 qian, Sha Shen (Glehnia Root) 3 qian, Gua Lou Ren 1.5 qian, Huang Qin 1 qian. Critics warned that the cold-slippery nature would cause diarrhea. Reluctantly tried, it indeed caused several bowel movements. However, the patient did not feel weak. One dose daily for four days resulted in frequent, foul-smelling stools (green, red, black, white, rarely yellow) with abdominal pain and tenesmus. Appetite improved, tongue softened, nasal discharge decreased, and urine volume increased. Shu Di Huang 5 qian and Huang Lian (Coptis Rhizome) 0.5 qian were added. Sweating occurred at night, extremely foul-smelling, lasting half a month. Bowel movements decreased. Sheng and Shu Di Huang were increased to 1 liang, Huang Lian reduced, Bai Shao (White Peony Root) and Gan Cao (Licorice Root) added. Over fifty doses were needed for recovery. Approximately one jin of Gua Lou Ren was consumed.
Wife of Yao, over forty, habitually suffered from stomach pain due to ascending Liver Fire. In summer, she contracted a cold with fever, headache, dizziness, insomnia, and vomiting. Initial dispersing herbs failed. Er Chen Tang (Two-Cured Decoction) and Zuo Jin Wan (Left Metal Pill) were switched to for vomiting, but vomiting persisted, worsening into unbearable lower back and abdominal pain. It was discussed as a Jueyin syndrome, critical, considering Si Ni Tang (Frigid Extremities Decoction) for returning Yang. Pulse was rapid and wiry, red rashes appeared on hands, face was pale, sides and tip of tongue purple, center slightly yellow, dry mouth with little desire to drink. Diagnosed as intense Liver-Gallbladder fire suppressed by sudden cold, unable to vent, rushing up to stomach collaterals causing vomiting, hence left-sided head pain predominance. Rashes on extremities indicated Wood stagnation attacking Earth. Initially, Xiao Yao San (Free and Easy Wanderer Powder) would have cured her; instead, drying/dispersing herbs disturbed Yang and damaged Yin, causing pain. Though Jueyin in origin, it was neither transmitted nor direct invasion. Now presenting as Yangming, Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) with 1 liang of Qi Zi was used. Vomiting stopped, pain resolved. Headache remained, so Xiao Yao Tang with Chuan Xiong (Sichuan Lovage Rhizome) and Dang Gui was given. During rainy season, a thunderclap at midnight caused unusual limb pain/swelling. This was Shaoyang depression, originally external, released by the thunder. Headache vanished. Next day, pulse was peaceful. Si Wu Tang (Four Substance Decoction) minus Chuan Xiong, plus Nu Zhen Zi (Privet Fruit) and Shi Hu, harmonized and cured. My cousin once had epidemic disease with deep heat and cold extremities. A doctor prescribed Si Wu Tang, but the patient, knowing it was heat, refused, taking Xiao Chai Hu Tang (Minor Bupleurum Decoction) and Bai Hu Tang (White Tiger Decoction) together, recovering well.
Sister-in-law of Song Fuhua, Yu clan, fell ill in early summer, menstruation started, illness resolved as heat exited with blood. Seven days later, during Dragon Boat Festival, she ate five eggs, drank two cups of wine and half a gourd of beverage, sat by the window, then developed headache and fever. The previous doctor identified the cause, prescribing Shan Zha (Hawthorn) 3 qian, Gu Ya (Sprouted Millet) 3 qian, Ge Gen (Kudzu Root) 3 qian, and other digestive/dispersing herbs. Three doses made the condition critical. Upon my arrival, the previous doctor was consulting a neighbor. The patient was unconscious, deathly pale/green, eyes closed, mouth open, limbs flaccid, pulse like boiling soup, vanishing under pressure. Condition seemed terminal. Fortunately, no profuse sweat. Pressing the epigastrium showed no resistance. Knowing she had just recovered, residual heat remained, food couldn't digest, and mild pathogens invaded, mimicking relapse. Without meds, she might recover naturally. Instead, large doses of dispersing herbs were given to a deficient person, stirring fire, preventing fever resolution. Believing dosage was insufficient, three more doses were given, leading to Yin-Yang separation. Asked about the next prescription, they blamed the eggs/rice. Since dispersing failed, Cheng Qi Tang (Order the Qi Decoction) was proposed for purgation. I said, "Cheng Qi is correct, but with lost Yuan Qi, fear premature collapse before food expulsion." They agreed this was the worry. I offered a formula to restore spirit before treating the disease: Shu Di Huang 1 liang 5 qian, Dang Gui 5 qian, Pao Jiang (Roasted Ginger) 0.8 fen. Urged immediate decoction. Evening report: Patient couldn't swallow, spoon-fed a few mouthfuls, gurgling sounds in throat, then whole cup given. Soon, eyes opened/closed, ability to turn, signs of life returned. Requested further visit. I declined, advising another dose of the same formula with dregs. Next day, spirit clear, pulse steady. Complaints of dry mouth/tongue, scanty urine, restless sleep. Pao Jiang removed, Sha Shen and Mai Dong added. One dose produced full-body sweat, able to eat porridge. Continued adjustments led to recovery.
Sun Wen Yuan treated nephew Yuan Su with Spring Warmth headache/fever. Left pulse wiry-large, right pulse large-hong. Xiao Chai Hu Tang combined with Bai Hu Tang cured in two doses. Recurrence of spots (rash) due to diet, purple color, coma, heavy body, snoring sleep, drunk-like appearance, red face, fever, yellow outer/black inner tongue coating with prickles, floating-large pulse in all six positions. San Huang Shi Gao Tang (Three Yellows and Gypsum Decoction) with Zhi Shi (Immature Bitter Orange) and Bie Jia (Turtle Shell) was given. Slight sweat, foul stool, next day awake/speaking. Xiao Chai Hu Tang with Shan Zhi (Gardenia), Zhi Shi, Bie Jia, Bai Shao restored health. Also treated nephew Jun Xiao with March onset of head/neck pain, stiff back, body feeling beaten, umbilical/abdominal pain, thirst, insomnia, floating-rapid pulse in six positions. Previous doctors diagnosed Yin deficiency, used Yin-nourishing/fire-reducing herbs, worsening condition with vomiting. Another attempted dredging, fever persisted, afternoon irritability. Fang Heyu suspected external contraction, suggested Ren Shen Bai Du San. Previous doctors argued against sweating for Yin deficiency, using Si Wu Tang plus Chai Hu, Ge Gen, Bo He (Mint), Huang Qin, Zhi Mu. Heat burned, spirit confused. Sun diagnosed Spring Warmth with internal injury complicating it. Yin tonics blocked flow, drawing pathogens into Yin. Method: Clear and resolve while eliminating stagnation. Er Chen Tang plus Qiang Huo (Notopterygium), Fang Feng (Siler), Mai Ya (Barley Sprout), Shan Zha. Slight sweat, fever halved. Afternoon tidal fever, constipation, waist/navel pain continued. Switched to Xiao Chai Hu Tang plus Ge Gen, Bai Shao, Qing Pi (Aged Tangerine Peel), Huang Lian, Shan Zha. Fever reduced, stool passed, pain lessened, but no hunger. Chai Hu, Gan Cao, Qing Pi, Zhi Shi, Mai Ya, Zhi Mu, Huang Qin, Bai Shao flattened symptoms. Fatigue remained, added Ren Shen, Bian Dou (Hyacinth Bean), Yi Yi Ren (Coix Seed), removed Chai Hu, Qing Pi, nourished to recovery.
Cheng Haowu, late spring, bilateral Taiyang headache, slight chest/hypochondriac pain, thirst, diarrhea. Left pulse floating-wiry-rapid, strong mid-pressure; Right Guan pulse slippery-large. Diagnosed Spring Warmth. Given Chai Hu, Qian Hu (Peucedanum), Ge Gen, Fen Cao (Licorice), Qing Pi, Huang Qin, Zhi Mu, Jie Geng (Platycodon), Ban Xia Qu (Pinellia Fermented), Shi Gao (Gypsum). Late night, slight sweat. Got up, defecated, caught wind, fever returned, thirst, irritability. Shi Gao 3 qian, Zhi Mu and Chai Hu 2 qian each, Ge Gen and Huang Qin 1 qian each, Fen Cao and Jie Geng 0.5 fen each, Zhu Ye (Bamboo Leaf) 20 leaves. Two doses brought sweat, heat resolution, symptom relief. Limb fatigue, slight dry mouth, weak speech. Sheng Mai San (Generate the Pulse Powder) plus Yi Yi Ren, Shi Hu, Gan Cao, Bai Shao, Huang Qin restored health.
Servant Gui, Spring Warmth headache/fever, red face, scorched tongue center. Shi Gao, Chai Hu, Ge Gen, Gan Cao, Huang Qin, Zhi Mu, Tian Hua Fen (Trichosanthes Root), Bai Shao cured tongue scorching. Porridge eaten too early, fever returned at midnight, hard/painful epigastrium. Da Chai Hu Tang (Greater Bupleurum Decoction) one dose, profuse sweat, two bowel movements. Abdominal pain persisted. Xiao Cheng Qi Tang (Minor Order the Qi Decoction) mixed with 1 qian Yuan Ming Fen, two more movements. Fever remained, pain vanished. Epistaxis occurred. Switched to Shi Gao, Dan Pi (Moutan Cortex), Sheng Di, Gan Cao, Shan Zhi, Sheng Ma (Cimicifuga), Huang Qin, Chi Shao (Red Peony). One dose cleared heat, stopped bleeding.
Wife of Sun Yuan Su, post-Spring Warmth, menstruation arrived, residual heat persisted, thirst, chest/hypochondriac pain, deafness. Left pulse wiry-rapid, right slippery-large-rapid. Xiao Chai Hu Tang plus Shi Gao, Zhi Mu, Jie Geng, Zhi Ke (Bitter Orange), Gua Lou, Ban Xia Qu failed to resolve heat/thirst. Changed to Chai Hu 2 qian, Ren Shen, Gan Cao, Tian Hua Fen, Huang Qin 0.7 fen each, Bai Shao, Hong Hua (Safflower), Dang Gui, Dan Pi, Zhi Mu 0.8 fen each. Harmonized and healed.
Mr. Xu Jun Yu, constitutionally Yin deficient with fire, prone to spleen constraint and bloody stool. October, Winter Warmth, fever, sore throat. Doctor used Ma Huang (Ephedra), Xing Ren (Apricot Seed), Ban Xia, Zhi Ju (Citrus). Result: panting, inability to lie flat, hoarse voice, red/hot head/face, cold extremities. Pulse: Left Guan/Cun deficient-large-micro-rapid. Heat injured Hand Taiyin Qi. Yu Zhu (Polygonatum) and Gan Cao failed. Prepared Zhu Fu Tang (Pig Skin Decoction), warmed in water bath, taken intermittently. Voice cleared in three days, pain gone after finishing.
Wife of Zheng Mo Lin, habitually bloody stool, pregnant seven months, Lung meridian nurturing fetus time, Winter Warmth cough, stabbing sore throat, heavy vaginal bleeding, pulse smaller/weaker-rapid than usual. Heat injured Hand Taiyin Blood. Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction) two doses. After bleeding stopped, Huang Lian removed, Yu Zhu, Jie Geng, Ren Zhong Huang (Human Waste Ash) added. Four doses brought peace.
Wan Shi Niu Huang Qing Xin Wan (Dr. Wan’s Calming Heart Pill with Calculus Bovis): Xi Niu Huang (Calculus Bovis) 2.5 li, Jing Mian Zhu Sha (Refined Cinnabar) 1.5 qian, Sheng Huang Lian 5 qian, Huang Qin 3 qian, Shan Zhi 3 qian, Yu Jin (Curcuma Radix) 2 qian. Powdered, pill-sized with steamed bread paste. Dose: 7-8 pills. Wang Jin San noted: Yu Jiayan in Stroke chapter mentioned mixing Niu Huang Qing Xin Wan into decoctions for heat blocking orifices. Ancient formulas differ. For Warm pathogens sinking into Pericardium causing coma, Wan Shi’s formula is superior. Heat entering Pericardium is superficial; herbal aromas only reach surface, not interior. Calculus Bovis’s subtle fragrance penetrates Pericardium, merging with Spirit. Wan Shi uses Huang Qin, Huang Lian, Shan Zhi to drain Heart Fire, Yu Jin to open Heart Qi, Zhu Sha to calm Spirit, synergizing with Niu Huang. Mixing this pill with Xi Jiao (Rhinoceros Horn - now substituted), Ling Yang Jiao (Antelope Horn), Jin Zhi (Gold Juice), Gan Cao, or Ren Zhong Huang, Lian, Bo He decoctions yields miraculous results.
You Zai Jing stated: Warm pathogen emission always injures Yin first. If dispersing is needed, Yin-nourishing herbs must be included. Ancients added Tong Bian (Child Urine) to Cong Chi Tang, and Di Huang/Mai Dong to Zhi Chi Tang, reflecting this intent.
Huang Jinfang treated Lin Guozhu with Wind-Warmth, sweating, fatigue, snoring, difficulty speaking, lethargy, slight aversion to cold. Someone suggested Qing Shu Yi Qi Tang. Huang said: "This is heat disturbing the Kidney. Stomach Qi remains, so Yin-nourishing herbs can save him. Misusing Qing Shu Yi Qi would let heat thrive with Ren Shen/Shan Yao, and fire blaze with Sheng Ma/Chai Hu, leading to staring, incontinence, and convulsions." Used Shu Di 3 qian, Shan Yao 2 qian, Dan Pi 1 qian, Gui Ban (Turtle Plastron) 1 qian, Fang Feng 1 qian, E Jiao (Donkey-Hide Gelatin) 1 qian, Gui Zhi (Cinnamon Twig) 2 qian. One dose cleared spirit, four doses resolved all symptoms.