滕昙恭，豫章南昌人也。年五岁，母患热病，思食寒瓜，土俗所不产。昙恭历访不得，俄遇一桑门问其
故，昙恭具以告。桑门曰∶我有两瓜，分一相遗，还以与母，举室惊异。寻访桑门，莫知所在。（《南史》。）
唐武宗有心热病，百医不效。青城山邢道人，以紫花梨绞汁而进，疾遂愈。后复求之，苦无此梨，常山忽
有一株，因缄实以进，帝多食之，烦躁顿解。（《医说续编》。）
张子和治常仲明之妻，每遇冬寒，两手热痛。曰∶四肢者，诸阳之本也。当夏时散越而不痛，及乎秋冬收
敛则痛。（要言不烦。）以三花神 丸大下之，热遂去。
李东垣治节使赵君，年几七旬，病身体热麻，股膝无力，饮食有汗，妄喜笑，善饥，痰涎不利，舌强难言，
声嗄不鸣。诊得左寸脉洪大而有力，是邪热客于经络之中也。盖手之三阳从手表上行于头，阴伏于阴，阳并于
阳，势甚炽焉。故邪热妄行，流散于周身，而为热麻。胃热虫动，虫动则廉泉开，故涎下。热伤元气，而为股
膝无力。饮食入胃， 悍之气，不寻常度，故多汗。心火盛，则妄喜笑。脾胃热，则消谷善饥。肺金衰，则声
不鸣。仲景云∶微数之脉，慎不可灸，焦骨伤筋，血难复也。君奉养以膏梁之味，无故而加以火 之毒，热伤
经络而为此病明矣。《内经》云∶热湿所胜，治以苦寒，佐以甘泻之，以酸收之。当以黄柏、知母之苦寒为君，
以泻火邪，壮筋坚骨。黄 、生甘草之甘寒泻热实表，（据此， 、草可云甘寒。）五味子味酸止汗，补肺气
之不足，以为臣。炙甘草、当归之甘辛，和血润燥。升麻、柴胡之苦平，少阳阳明二经，自地升天，以苦发
之者也，以为佐。 咀同煎，清汁服之。更缪刺四肢，以泻诸阳之本，使十二经相接而泻火邪。不旬日良愈。
遂名其方曰清神补气汤。（《试效方》。）
张子和曰∶余向日从军于江汇上，一舟子病，余诊之，乃五实也。余自幼读医经，尝记此五实之症，竟未
之遇也。既见其人，窃私料之，此不可以常法治，乃作大剂下之，殊不动摇。计竭智穷，无如之何。忽忆桃花
萼丸，顿下七八十丸，连泻二百余行，与前药相兼而下。其人昏困，数日方已。盖大疾已去，自然卧憩。不如
此，则病无由衰也。徐以调和胃气之药， 粥日加，自尔平复也。（五实者，脉盛、皮热、腹胀、前后不通，瞀闷也。）
蒋仲芳治萧氏妇，年二十余，素虚弱，患热病将一月。一夕忽厥，竹沥生姜灯心汤灌之，下咽少顷微动，
细察之，腹痛甚。问其大便，云二十日不食，亦不行矣。以大黄一两，芒硝五钱，桃仁、当归各三钱与之。众
骇曰∶素有弱症，且病久，何能堪此？曰∶更有法在。强与之，遂去黑物半桶。即用人参五钱，煎汤补之。盖
原素弱，急下后不得不进补也。调理月余而愈，今连生三子。此诸医因其虚而不治其实之误也。
枢密副使耶律斜轸妻，有沉 。易数医，不能治。耶律敌鲁视之，曰∶心有蓄热，非药石所能及，当以意
疗。因其 ，HT 之使狂，用泄其毒则可治。于是令大击 鼓于前。翌日果狂，叫呼怒骂，力亟而止，遂愈。
（《辽史》。又见《储记》。）
上洋刘公远，至洞庭山治病。病者已气绝，刘曰∶无恐，当即活也。但某今夜必欲观剧，又所演必剧武者。
从之，遂令以毡缛裹病患置场上，已而 鼓喧 ，则病者欠伸复苏矣。（张氏卮言∶观其治法与前案颇同，
则为病亦必仿佛。）
万密斋治胡应龙，五月患热病，治半月未愈。脉弦数，鼻衄三四日一作，左胁痛不能侧卧。先以炒山栀一
个，妇人发同烧存性，吹入鼻中而衄止。再以当归龙苍丸方作汤，一剂而胁痛即止。再诊其脉，弦而浮数，曰∶
当以汗解。盖卫气不共营气谐和者也，当用桂枝汤以治其阳。今乃营气不共卫气谐和，则当用黄连解毒汤，合
白虎以治其阴，使营卫和则得汗而愈也。乃以二汤合煎饮之。先告之曰∶当战汗，勿惊也。连进二剂，果汗而愈也。
胡龙嘉六月病热，身壮热，自汗出，大渴，喜裸体。诊其脉弦大而虚，万为制一方∶小柴胡，人参白虎汤
内摘知母、甘草，栀子豉汤内摘淡豆豉，共五味，淡竹叶煎，名三合汤。一剂而愈。
缪仲淳治辛衡阳铨部热病，病在阳明，头痛壮热，渴甚且呕，鼻干燥，不能眠。诊其脉，洪大而实。仲淳
故问医师，曰∶阳明症也。曰∶然。问投何药？曰∶葛根汤。仲淳曰∶非也。曰∶葛根汤非阳明经药乎？曰∶
阳明之药，表剂有二，一为葛根，一为白虎。不呕吐而解表，用葛根汤。今吐甚，是阳明之气逆升也，葛根升
散，故用之不宜，宜白虎汤加麦冬、竹叶，名竹叶石膏汤。石膏辛能解肌，镇坠下胃家痰热。肌解热散，则不
呕而烦躁壮热皆解矣。遂用大剂与之，且戒其仲君曰∶虏荆非六十万人不可，李信二十万则奔还矣。又嘱曰∶
此时投药，五鼓瘥。天明投药，朝餐瘥。已而果然。或谓呕甚不用半夏，何也？仲淳曰∶半夏有三禁，渴家、
汗家、血家是也。病患渴甚而呕，是阳明邪热炽盛，劫其津液，故渴。邪火上升，故呕。半夏辛苦，温而燥，
且有毒。定非所宜。又疑其不用甘草，曰∶呕家忌甘，仲景法也。
龚子才治一妇人，夏间病热，初用平调气血，兼清热和解之剂，二三服不应。热愈甚，舌上焦黑，膈间有
火，漱水不咽，诊之两手皆虚微，而右手微甚，六七日内，谵语撮空，循衣摸床，恶症俱见。后用四物汤加黄
、人参、白术、陈皮、麦冬、知母、熟附子，服之一二时，汗出热退。次日复热，再服仍退。又次日复发，
知其虚剧也，遂连服十剂皆加附子而安。（藜按∶热病内，亦间有此种症，不可不知。）
喻嘉言治王玉原，昔年感症，治之不善，一身津液尽为邪热所铄，究竟十年余热未尽去，右耳之窍常闭。
今夏复病感，缠绵五十多日，面足浮肿，卧寐不宁，耳间气往外触。盖新热与旧热相合，野狼狈为患，是以难于
去体。医者不察其情，治之茫不中 。延至秋深，金寒水冷，病方自退。然浅者可因时而自退，深者未由遽
退也。喻曰∶面足浮肿者，肺金之气为热所壅，失其清肃下行之权也。（面肿可云，足肿则不确，终是阴虚
血不配气耳。）卧寝不宁者，胃中之津液干枯，不能荣其魂魄也。（话殊牵强，亦由阴虚肝火浮入胞络也。）
耳间火气撞出者，久闭之窍，气来不觉，今病体虚羸，中无阻隔，气逆上冲，始知之也。（总不外阴虚二字。）
外病虽愈，而饮食药饵之内调者，尚居其半。特挈二事大意，为凡病感者明善后之法焉。盖人当感后，身中之
元气已虚，身中之邪热未退，于此而补虚，则热不可除。于此而清热，则虚不能任。即一半补虚，一半清热，
终属模糊，不得要领。然舍补虚清热外，更无别法，当细察之。补虚有二法，一补脾，一补胃。如疟痢后，饮
食不能运化，宜补其脾。如伤寒后，胃中津液久耗，新者未生，宜补其胃。二者有霄壤之殊也。清热有二法，
初病时之热为实热，宜用苦寒药清之；大病后之热为虚热，宜用甘寒药清之。（此说极透彻。）二者亦霄壤之殊
也。人身天真之气，全在胃口。津液不足即是虚，生津液即是补虚。（雄按∶千古名言，故以生津之药，合
甘寒泻热之药，而治感后之虚热，如麦冬、生地、丹皮、人参、梨汁、竹沥之属，皆为合法。仲景每用天水散
以清虚热，正取滑石、甘草一甘一寒之义也。雄按∶肺主一身之气，而皮毛者，肺之合也。感症后，气复而
血虚，足肿者固有之，而余热不清，肺气雍滞者则尤多也。又胃热未清，则津液不复。经云∶胃不和则卧
不安也。又耳闭宜清肺，与耳鸣宜滋阴者有间。）天水散以清虚热，正取滑石、甘草一甘一寒之义也。设误
投参、 、苓、术补脾之药为补，宁不并邪热而补之乎？至于饮食之补，但取其气，不取其味，如五谷之气以
养之，五菜之气以充之，每食之间，便觉津液汗透，将身中蕴蓄之邪热，以渐运出于毛孔，何其快哉。人皆不
知此理，急于用肥甘之味以补之。目下虽精采健旺可喜，不思油腻阻滞经络，邪热不能外出，久之充养完
固，愈无出期矣。前哲有鉴于此，宁食淡茹蔬，使体暂虚而热易出，乃为贵耳。
前医药中以浮肿属脾，用苓、术为治，致余热纠缠不已。总由补虚清热之旨未明，故详及之。
按∶《寓意草》中，多有发前人所未发处。至于支离牵强处，亦复不少。如此案，谓感冒后以甘寒清
热，最得肯綮。然以补脾补胃立论，便尔模糊。雄按∶脾胃分别论治，诚开万古之群蒙也。叶天士深得力
于此，而为灵胎、润安所折服者。但当云，气虚者补气，血虚者补血。凡疟痢后，饮食不运多气虚，宜
气分药，如参、 、苓之类；凡感症后，津液不充多血虚，宜地、冬、梨、竹之属。以感症多余热未
清也。何等明快，然犹未免于偏。又魏氏痢后疟后之论，亦颇精确。常见痢以下多而亡阴，疟以汗多而耗
液，饮食难运，多由相火盛，真气衰，非大剂二冬二地投之，多见缠绵不已也。至其论面足浮肿，卧寐不
宁，尤属隔靴搔痒。
陆养愚治凌比部藻泉，暑月荣归，烦劳过度，夜间头痛如破，内热如火，不寐汗多，小水短赤，舌上黄苔，
右胁胀痛。有谓头痛身热宜散者，有谓烦劳之后宜补者。诊之，见其身热喘急，语言间气乏不足以息，脉浮数，
按之不甚有力，曰∶此热伤元气也。乃以河间桂苓甘露饮加人参一钱，服之片时，汗止热减，喘定能言。再与
一剂，昏倦思睡。次早脉浮桉已平，沉按弦而有力。此浮热已除，内热未尽，故胁腹尚微痛也，与当归龙苍丸
一钱五分，空腹服之。至下午进粥，超时便通而色黑，痛即减。后以参麦散调理而安。
陆肖愚治史洞庭室，四月间，患头痛发热，脉洪数见于气口，用清解药二剂，大约柴、葛、栀、芩之类。
一医谓头痛身热，乃太阳症，而遽用柴、葛，不引邪入阳明少阳乎。汗未得而遽用栀、芩寒凉之品，表邪何由
而解，不将传里乎。（以正伤寒论，未尝不是。）用大青龙汤二剂，病家止服一剂，夜间遍身如 ，口渴咽干
，已有谵语矣。明日又以为非伤寒，乃痛风也，（观前说，其人亦颇阅书，而临症则卤莽不堪，殆福薄而气浮
欤，抑识浅而意易移欤。）用羌活、独活、首乌、牛膝等，二剂，乃登高而歌，弃衣而走，骂詈不避亲疏。再
求诊，乃令数妇人絷之，谓洞庭曰∶此阳症也，扰之益剧，当以言宽谕之。果如言而止。因先用糖水法灌之，
势便缓。随以白虎加元明粉、芩、连、蒌仁、犀角，数剂而骂詈止。时或妄言，知大便久不去也，以润字丸三
钱投之，夜出燥矢约二十枚。然谵语犹未全止，仍进前汤，又以丸药二钱投之，出燥矢数枚，溏便少许。又三日方思粥
饮，以清气养荣汤调理之。
吕东庄治吴华崖馆童，夏月随役湖上，感热症，下痢脓血，身如燔炭。（因是热症，否则下痢身热，
为不治矣。）曰∶此阳明病也，不当作痢治，视其舌必黑而燥，夜必谵语。果如所言。诊之则脉已散乱，忽
有忽无，状类 游，不可治也。吴强之，不得已，用熟地一两，生地、麦冬、当归、白芍、甘草、枸杞佐之。
戒曰∶汗至乃活。夜来热不减，谵语益狂悖，但血痢不下耳。服药后，见微汗，少顷即止。诊之，脉已接续
分明，洪数鼓指，曰∶今生矣。仍前方，去生地，加枣仁、山药、丹皮、山萸，（加减无当甚。）连服六帖。
其家以昏热甚，每日求更方。令姑忍，定以活人还汝。再诊，脉始敛而圆，乃曰∶今当为汝去之。用四顺清
凉饮，加熟地一两，大黄五钱，下黑矢数十枚，诸症顿愈。越二日薄暮，忽复狂谵发热，喘急口渴，此欲回
阳作汗也，与白术一两，黄 一两，干姜三钱，甘草一钱，归、芍各三钱。尽剂，汗如注，酣卧至晓，病霍然而愈。
按∶先补而下，再补而汗，治法固善。然此症在初时数剂，能与天水泻心并行，定不致如许决张。
杨乘六族弟患热症，六七日不解，口渴便秘，发狂逾墙上屋，赤身驰骤，谵妄骂詈，不避亲疏，覆盖尽去，
不欲近衣，如是者五日矣。时杨以岁试自苕上归，尚未抵岸。病患曰∶救人星至矣。问是谁？曰∶云峰大兄回
来也。顷之，杨果至，家人咸以为奇。视之良久，见其面若无神，两目瞪视，其言动甚壮劲有力。意以胃中热
甚，上乘于心，心为热冒，故神昏而狂妄耳。不然，何口渴便秘，白虎凉膈等症悉具耶？及诊其脉，豁大无伦，
重按则空。验其舌，黄上加黑，而滋润不燥。乃知其症由阴盛于内，逼阳于外。虽壮劲有力，乃外假热而内真
寒也。其阳气大亏，神不守舍，元神飞越，故先遇人于未至之前。遂以养荣汤加附子、倍枣仁、五味、白芍，
浓煎与之。一剂狂妄悉除，神疲力倦，熟睡周时方寤，渴止食进而便通矣。继用补中益气加白芍、五味而痊。
滕昙恭是豫章南昌人。他五岁时，母亲患热病，想吃寒瓜，但当地风俗不产这种瓜。昙恭四处寻找未果，不久遇到一位僧人询问原因，昙恭详细告知了情况。僧人说：“我有两个瓜，分一个给你。”昙恭拿回去给母亲，全家都感到惊异。后来寻找那位僧人，却不知其去向。（出自《南史》。）
唐武宗患有心脏热病，众多医生治疗无效。青城山的邢道人，用紫花梨榨汁让他服用，疾病随即痊愈。后来再次求医，苦于没有这种梨，常山忽然长出一株，于是密封果实进献，皇帝多吃后，烦躁顿然缓解。（出自《医说续编》。）
张子和治疗常仲明的妻子，每逢冬季寒冷，双手发热疼痛。他说：“四肢是诸阳经的根本。在夏季阳气发散时不痛，到了秋冬季节阳气收敛时就疼痛。”（出自《要言不烦》。）用三花神丸猛烈攻下，热邪随之去除。
李东垣治疗节度使赵君，年近七十，患病身体发热麻木，大腿膝盖无力，饮食时出汗，无故喜欢笑，容易饥饿，痰涎不利，舌体僵硬难以言语，声音嘶哑不能发声。诊得左寸脉洪大有力，这是邪热客居在经络之中。手之三阳经从手部上行至头部，阴气潜伏于内，阳气合并于外，火势非常炽盛。所以邪热妄行，流散于全身，导致发热麻木。胃中有热导致虫动，虫动则廉泉穴开，所以唾液流出。热邪损伤元气，导致大腿膝盖无力。食物进入胃中，卫气不循常道，所以多汗。心火旺盛，所以无故喜笑。脾胃有热，所以消谷善饥。肺金衰弱，所以声音不响。张仲景说：“脉象微数，千万不可灸治，否则会焦骨伤筋，血液难以恢复。”赵君平素供养丰厚，以肥甘厚味为主，无故又加上火毒，热邪损伤经络而患此病，是很明显的。《内经》说：“热湿偏胜，用苦寒药治疗，佐以甘味泻下药，用酸味药收敛。”应当以黄柏、知母的苦寒之性为君药，以泻火邪，强壮筋骨。黄芪、生甘草的甘寒之性以泻热实表（据此，芪、草可称为甘寒），五味子味酸止汗，补肺气之不足，作为臣药。炙甘草、当归的甘辛之性，调和血液润燥。升麻、柴胡的苦平之性，针对少阳阳明二经，自地升天，用苦味发散，作为佐药。切碎同煎，取清汁服用。再配合缪刺法针刺四肢，以泻诸阳经之本，使十二经脉相接而泻火邪。不到十天便痊愈。于是将此方命名为清神补气汤。（出自《试效方》。）
张子和说：“我从前随军在江汇上游，一名船夫生病，我诊治他，发现是五实证。我自幼读医经，曾记得这五种实证的症状，竟从未遇到过。见到此人后，私下推测，此病不能用常规法治，于是用大剂量攻下药，病人却毫无动摇。我想尽了办法，无计可施。忽然想起桃花萼丸，立刻让病人服下七八十丸，连续腹泻二百多次，与前药一起排出。病人昏沉困倦，几天后才停止。因为大病已去，自然需要卧睡休息。如果不这样，病就不会衰退。后用调和胃气的药物，逐渐增加米粥，从此平复。（所谓五实，是指脉象盛大、皮肤发热、腹部胀满、大小便不通、神志昏蒙闷乱。）”
蒋仲芳治疗萧氏妇人，二十多岁，平时虚弱，患热病将近一个月。一天晚上突然厥逆，灌入竹沥生姜灯心汤，咽下片刻后微微动弹，仔细检查，发现腹痛剧烈。问其大便，回答说二十天没吃东西，也没有排便。给予大黄一两，芒硝五钱，桃仁、当归各三钱。众人惊骇说：“平时体质虚弱，且病久，怎么能承受这种猛药？”我说：“还有办法。”强行喂下，结果排出黑色粪便半桶。随即用人参五钱煎汤补益。因为原本体质虚弱，急下之后不得不进补。调理一个多月痊愈，如今连生三个孩子。这是其他医生因其虚证而不治其实证的错误。
枢密副使耶律斜轸的妻子，患有严重的忧郁症。换了好几位医生，都不能治愈。耶律敌鲁诊治后说：“心中蓄积热邪，不是药物所能达到的，应当用心意来治疗。”因为她的忧郁，通过刺激使她发狂，用发泄的方法可以解毒治疗。于是让人在前面大声击鼓。第二天果然发狂，叫喊怒骂，力气用尽才停止，于是痊愈。（出自《辽史》，又见于《储记》。）
上洋刘公远到洞庭山治病。病人已经气绝，刘公远说：“不要怕，马上就能救活。”但他要求当晚必须看戏剧，而且演的必须是激烈的武戏。听从了他的要求，于是让人用毡毯包裹病人放在场上，随后锣鼓喧天，病人便欠身伸腿复苏了。（张氏卮言：看他的治法与前案颇为相同，那么病情也必然相似。）
万密斋治疗胡应龙，五月患热病，治疗半个月未愈。脉象弦数，鼻衄每隔三四天发作一次，左胁痛不能侧卧。先用炒山栀一个，与妇女头发同烧存性，吹入鼻中，鼻衄即止。再用当归龙胆丸方改为汤剂，一剂后胁痛即止。再诊脉象，弦而浮数，说：“应当用发汗法解表。”这是因为卫气不与营气和谐。应当用桂枝汤治疗其阳。现在是营气不与卫气和谐，则应当用黄连解毒汤，合白虎汤治疗其阴，使营卫调和则能出汗而愈。于是将两方合煎饮用。事先告诉他说：“将会出现战汗，不要惊慌。”连续服用两剂，果然出汗而愈。
胡龙嘉六月患热病，身体高热，自汗出，极度口渴，喜欢裸体。诊其脉象弦大而虚，万密斋制定一方：从小柴胡汤、人参白虎汤中摘取知母、甘草，从栀子豉汤中摘取淡豆豉，共五味药，用淡竹叶煎煮，名为三合汤。一剂即愈。
缪仲淳治疗辛衡阳铨部的热病，病在阳明经，头痛高热，极度口渴且呕吐，鼻干燥，不能入睡。诊其脉象，洪大而实。缪仲淳故意问医生，医生说：“这是阳明证。”缪仲淳说：“对。”问投用什么药？医生说：“葛根汤。”缪仲淳说：“不对。”医生说：“葛根汤不是阳明经的药吗？”缪仲淳说：“阳明经的解表药有两种，一是葛根，一是白虎汤。不呕吐而解表，用葛根汤。现在呕吐严重，这是阳明之气上逆，葛根具有升散作用，所以不宜使用，应当用白虎汤加麦冬、竹叶，名为竹叶石膏汤。石膏辛凉能解肌，镇坠下行清除胃家痰热。肌表解散热邪消散，则不呕吐、烦躁、高热都解除了。”于是用大剂量给他服用，并且告诫他的弟弟说：“攻打虏荆非六十万人不可，李信带二十万就会败退回来。”又嘱咐说：“此时服药，五更时分病愈。天明服药，吃早饭时病愈。”后来果然如此。有人问呕吐严重不用半夏，为什么？缪仲淳说：“半夏有三禁，渴者、汗者、血虚者是也。病人极度口渴而呕吐，是阳明邪热炽盛，劫夺津液，所以口渴。邪火上炎，所以呕吐。半夏辛苦温燥，且有毒，肯定不适合。又怀疑他不用甘草，说：“呕吐者忌甘，这是张仲景的法度。”
龚子才治疗一名妇人，夏天患热病，初用平调气血、兼清热和解的药剂，服二三剂无效。热势更甚，舌上焦黑，膈间有火，漱水不咽，诊两手脉皆虚微，而右手脉尤为微弱，六七日内，出现谵语、撮空、循衣摸床等恶症全部显现。后用四物汤加黄芪、人参、白术、陈皮、麦冬、知母、熟附子，服用一二小时后，出汗热退。次日复发热，再服仍退。又次日复发，知道她虚损严重，于是连续服用十剂都加附子而安定。（藜按：热病内部，也有这种症状，不可不知道。）
喻嘉言治疗王玉原，往年感受外邪，治疗不当，一身津液全被邪热灼干，究竟十年余热未尽去，右耳窍常闭塞。今年夏天又感外邪，缠绵五十多天，面足浮肿，卧寐不宁，耳间有气往外冲撞。这是新热与旧热相合，狼狈为患，所以难于去除。医生不察病情，治疗茫然不中肯綮。延至深秋，金寒水冷，病才自行消退。然而浅的病可因时而自退，深的病不能迅速消退。喻嘉言说：“面足浮肿，是肺金之气被热邪壅滞，失去了清肃下行的权能。（面肿可以说，足肿则不准确，终究是阴虚血不配气。）卧寝不宁，是胃中津液干枯，不能滋养魂魄。（这话很牵强，也是由阴虚肝火浮入胞络所致。）耳间火气撞出，是因为久闭之窍，气来时不觉，现在病体虚羸，中间无阻隔，气逆上冲，才知道。（总离不开阴虚二字。）”外病虽愈，但饮食药饵的内调，还占一半。特提出两点大意，为凡感邪者阐明善后之法。大概人在感邪后，体内元气已虚，体内邪热未退，于此补虚，则热不可除；于此清热，则虚不能任受。即使一半补虚，一半清热，终究模糊，不得要领。然而舍去补虚清热外，更没有别法，应当细细观察。补虚有二法，一补脾，一补胃。如疟痢后，饮食不能运化，宜补脾。如伤寒后，胃中津液久耗，新津未生，宜补胃。二者有天壤之别。清热有二法，初病时的热为实热，宜用苦寒药清之；大病后的热为虚热，宜用甘寒药清之。（此说极透彻。）二者也有天壤之别。人身天真之气，全在胃口。津液不足即是虚，生津液即是补虚。（雄按：千古名言，所以用生津药，合甘寒泻热药，治疗感后之虚热，如麦冬、生地、丹皮、人参、梨汁、竹沥之类，都是合法。张仲景每用天水散以清虚热，正是取滑石、甘草一甘一寒之义。雄按：肺主一身之气，皮毛是肺之合。感邪后，气复而血虚，足肿者固有之，而余热不清，肺气雍滞者则更多。又胃热未清，则津液不复。经云：胃不和则卧不安。又耳闭宜清肺，与耳鸣宜滋阴者不同。）天水散以清虚热，正是取滑石、甘草一甘一寒之义。如果误投参、芪、苓、术补脾药为补，岂不是连同邪热一起补了吗？至于饮食之补，只取其气，不取其味，如五谷之气以养之，五菜之气以充之，每食之间，便觉津液汗透，将身中蕴蓄之邪热，渐渐运出于毛孔，何其痛快！人们都不知道这个道理，急于用肥甘厚味来补。眼下虽然精神健旺可喜，但不思油腻阻滞经络，邪热不能外出，久之充养完固，更无出路了。前哲鉴于此，宁可食淡茹蔬，使身体暂虚而热易出，这才是宝贵的。
以前医生认为浮肿属脾，用茯苓、白术治疗，导致余热纠缠不已。总归是补虚清热的主旨不明，所以详细说明。
按：《寓意草》中，多有发前人所未发之处。至于支离牵强处，也不少。如此案，谓感冒后用甘寒清热，最得要领。但以补脾补胃立论，便显模糊。雄按：脾胃分别论治，诚然开启万古之蒙昧。叶天士深得力于此，而为灵胎、润安所折服。但应当说，气虚者补气，血虚者补血。凡疟痢后，饮食不运多气虚，宜气分药，如参、芪、苓之类；凡感邪后，津液不充多血虚，宜地、冬、梨、竹之类。因为感邪多余热未清。何等明快，然而犹未免于偏颇。又魏氏关于痢后疟后的论述，也很精确。常见痢疾以下利多而亡阴，疟疾以汗多而耗液，饮食难运，多由相火盛，真气衰，非大剂二冬二地投之，多见缠绵不已。至于论面足浮肿，卧寐不宁，尤属隔靴搔痒。
陆养愚治疗凌比部藻泉，暑月荣归，烦劳过度，夜间头痛如破，内热如火，不寐汗多，小便短赤，舌上黄苔，右胁胀痛。有人说头痛身热宜散，有人说烦劳之后宜补。诊视，见其身热喘急，语言间气乏不足以息，脉浮数，按之不甚有力，说：“这是热伤元气。”于是用河间桂苓甘露饮加人参一钱，服用片刻，汗止热减，喘定能言。再给一剂，昏倦思睡。次早脉浮按已平，沉按弦而有力。这是浮热已除，内热未尽，所以胁腹尚微痛，给予当归龙胆丸一钱五分，空腹服用。至下午进粥，超时便通而色黑，痛即减。后用参麦散调理而安。
陆肖愚治疗史洞庭之妻，四月间，患头痛发热，脉洪数见于气口，用清解药二剂，大约是柴胡、葛根、栀子、黄芩之类。有一医生说头痛身热，是太阳证，而遽用柴胡、葛根，不把邪引入阳明少阳吗？汗未得而遽用栀子、黄芩寒凉之品，表邪如何而解，不将传里吗？（以正统伤寒论来看，未尝不是。）用大青龙汤二剂，病家只服一剂，夜间遍身如蚁走，口渴咽干，已有谵语。第二天又认为不是伤寒，是痛风，（观前说，其人亦颇读书，而临症则卤莽不堪，大概是福薄而气浮呢，还是见识浅而意志易移呢？）用羌活、独活、首乌、牛膝等，二剂，于是登高而歌，弃衣而走，骂詈不避亲疏。再求诊，令数名妇人绑住他，对洞庭说：“这是阳证，扰动会更剧烈，应当用言语宽慰开导他。”果然如言而止。于是先用糖水法灌之，势头稍缓。随即用白虎汤加元明粉、黄芩、黄连、瓜蒌仁、犀角，数剂后骂詈止。时而妄言，知道大便久不去，用润字丸三钱投之，夜出燥屎约二十枚。然而谵语犹未全止，仍进前汤，又以丸药二钱投之，出燥屎数枚，溏便少许。又三日才思粥饮，用清气养荣汤调理之。
吕东庄治疗吴华崖馆童，夏月随役湖上，感热症，下痢脓血，身如燔炭。（因为是热症，否则下痢身热，为不治之症。）说：“这是阳明病，不应当作痢疾治，看其舌必黑而燥，夜间必谵语。”果如所言。诊之则脉已散乱，忽有忽无，状类雀啄，不可治。吴强令他治，不得已，用熟地一两，生地、麦冬、当归、白芍、甘草、枸杞佐之。告诫说：“汗至乃活。”夜里热不减，谵语更狂悖，只是血痢不下。服药后，见微汗，少顷即止。诊之，脉已接续分明，洪数鼓指，说：“今生得救了。”仍前方，去生地，加枣仁、山药、丹皮、山萸肉，（加减不当。）连服六帖。其家因昏热甚，每日求更方。令其姑且忍耐，定能还你活人。再诊，脉始敛而圆，乃说：“现在当为你去病。”用四顺清凉饮，加熟地一两，大黄五钱，下黑矢数十枚，诸症顿愈。越二日薄暮，忽复狂谵发热，喘急口渴，这是欲回阳作汗，给予白术一两，黄芪一两，干姜三钱，甘草一钱，当归、白芍各三钱。尽剂，汗如注，酣卧至晓，病霍然而愈。
按：先补而下，再补而汗，治法固然好。然而此症在初时数剂，能与天水泻心并行，定不至于如此险峻。
杨乘六族弟患热症，六七日不解，口渴便秘，发狂逾墙上屋，赤身驰骤，谵妄骂詈，不避亲疏，覆盖尽去，不欲近衣，如是五日了。当时杨乘六以岁试自苕上归，尚未抵岸。病患说：“救人星至矣。”问是谁？说：“云峰大兄回来了。”不久，杨乘六果然至，家人咸以为奇。视之良久，见其面若无神，两目瞪视，其言动甚壮劲有力。意以胃中热甚，上乘于心，心为热冒，故神昏而狂妄耳。不然，何口渴便秘，白虎凉膈等症悉具耶？及诊其脉，豁大无伦，重按则空。验其舌，黄上加黑，而滋润不燥。乃知其症由阴盛于内，逼阳于外。虽壮劲有力，乃外假热而内真寒也。其阳气大亏，神不守舍，元神飞越，故先遇人于未至之前。遂以养荣汤加附子、倍枣仁、五味子、白芍，浓煎与之。一剂狂妄悉除，神疲力倦，熟睡周时方寤，渴止食进而便通矣。继用补中益气加白芍、五味子而痊。
Teng Dangong was a native of Nanchang, Yuzhang. At the age of five, his mother suffered from a febrile disease and craved cold melons (Han Gua), which were not produced in the local customs. Dangong searched everywhere but could not find any. Soon he encountered a Buddhist monk (Sangmen) and asked him about it. Dangong explained the situation in detail. The monk said, "I have two melons; I will give you one." Dangong took it back to his mother, and the whole family was astonished. Later, they searched for the monk but could not find where he had gone. (From *History of the Southern Dynasties*.)
Emperor Wuzong of Tang suffered from a heart-heat disease, to which many physicians failed to respond. Xing Daoren from Qingcheng Mountain administered juice extracted from purple pear (Zi Hua Li), after which the illness was cured. Later, when seeking treatment again, there was a苦 shortage of this specific pear. Suddenly, a single tree appeared in Changshan, so the fruit was sealed and presented to the Emperor. After consuming much of it, his irritability was instantly relieved. (From *Continued Compilation of Medical Sayings*.)
Zihehe treated the wife of Chang Zhongming, who experienced heat and pain in both hands whenever winter cold arrived. He stated, "The four limbs are the root of all Yang meridians. In summer, when Yang Qi disperses, there is no pain; but in autumn and winter, when Yang Qi converges, pain occurs." (From *Essential Words Without Triviality*.) He used Sanhua Shenwan (Three-Flower Divine Pill) to vigorously purge, after which the heat was eliminated.
Li Dongyuan treated Zhao Jun, a Jiedushi (Military Commissioner), who was nearly seventy years old. His symptoms included body heat and numbness, weakness in the thighs and knees, sweating during meals, unprovoked laughter, excessive hunger, difficulty with phlegm and saliva, a stiff tongue making speech difficult, hoarseness, and inability to speak clearly. The pulse at the left Cun position was surging (Hong) and large, yet forceful, indicating that pathogenic heat had lodged within the meridians. The three Yang meridities of the hand ascend from the hand to the head; Yin remains latent internally while Yang merges externally, creating an intense fire. Thus, pathogenic heat wanders and scatters throughout the body, causing heat and numbness. Stomach heat causes worms to move; their movement opens the Lianquan acupoint, leading to salivation. Heat damages Yuan Qi, causing weakness in the thighs and knees. When food enters the stomach, Wei Qi does not follow its normal course, causing excessive sweating. Excessive Heart Fire leads to unprovoked laughter. Spleen-Stomach heat leads to rapid digestion and hunger. Decline of Lung Metal leads to voicelessness. Zhang Zhongjing said, "With a subtle and rapid pulse, moxibustion must be strictly avoided, as it can scorch bones and injure sinews, making blood recovery difficult." Zhao Jun's lifestyle involved rich and greasy foods, and he was inadvertently subjected to fire toxins. It was clear that heat damaging the meridians caused this illness. *Neijing* states: "When heat and dampness prevail, treat with bitter-cold herbs, assist with sweet-purgative herbs, and use sour herbs to astringe." Therefore, Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma), being bitter-cold, should be the Sovereign herb to purge fire evil and strengthen sinews and bones. Huangqi (Astragali Radix) and Sheng Gancao (Raw Glycyrrhizae Radix), being sweet-cold, should assist in purging heat and consolidating the exterior. Wuweizi (Schisandrae Fructus), being sour, stops sweating and supplements insufficient Lung Qi, serving as the Minister herb. Zhi Gancao (Honey-fried Glycyrrhizae Radix) and Danggui (Angelicae Sinensis Radix), being sweet and acrid, harmonize blood and moisten dryness. Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix), being bitter and neutral, target the Shaoyang and Yangming meridians, ascending from earth to heaven, using bitterness to disperse, serving as the Assistant herb. These were chopped and decocted together; the clear liquid was taken orally. Additionally, Miao Ci (miraculous puncture) was applied to the four limbs to drain the roots of all Yang meridians, allowing the twelve meridians to connect and drain fire evil. Within ten days, he recovered completely. This formula was named Qingshen Bqi Tang (Clear Spirit and Replenish Qi Decoction). (From *Shi Xiao Fang*.)
Zihehe said, "In the past, while campaigning upstream on the Jiang River, I treated a boatman. My diagnosis revealed a Five Excess syndrome (Wu Shi). Since childhood, I had studied medical classics and remembered these five excess symptoms, but had never encountered them. Upon seeing the patient, I privately speculated that this could not be treated by standard methods. I prescribed a large dose of purgatives, but the patient showed no reaction. Exhausted in wisdom and resources, I knew not what to do. Suddenly remembering Taohua E Wan (Peach Blossom Calyx Pill), I immediately administered 70-80 pills. He defecated over 200 times, expelling both the previous medicine and new matter. The patient fell into a coma and lethargy, lasting several days before stopping. Because the major illness had departed, natural rest was required. Otherwise, the illness would not subside. Subsequently, I used medicines to harmonize Stomach Qi, gradually increasing rice gruel, until he recovered. (The Five Excesses refer to: surging pulse, hot skin, abdominal distension, obstruction of urination and defecation, and mental confusion/oppression.)"
Jiang Zhongfang treated Lady Xiao, who was in her twenties and constitutionally weak. She had suffered from a febrile disease for nearly a month. One night, she suddenly collapsed (Jue). Bamboo sap (Zhuli), ginger juice, and Jiaoxin (Centelli Herba) decoction were forced down her throat. A short while after swallowing, she moved slightly. Upon close examination, severe abdominal pain was found. Asking about her bowel movements, she replied that she had not eaten or passed stool for twenty days. She was given Dahuang (Rhei Radix et Rhizoma) 1 liang, Mangxiao (Natrii Sulfas) 5 qian, Taoren (Persicae Semen) 3 qian, and Danggui (Angelicae Sinensis Radix) 3 qian. The crowd was horrified, saying, "She is constitutionally weak and has been ill for a long time; how can she tolerate this?" I said, "There is another method." Forcing her to take it, she expelled half a bucket of black matter. Immediately afterwards, Renshen (Ginseng Radix) 5 qian was decocted in water to tonify. Because she was originally weak, tonification was necessary after vigorous purging. After more than a month of regulation, she recovered and has since borne three children. This illustrates the error of other physicians who, seeing deficiency, failed to treat the excess.
The wife of Yelü Xiezhen, Vice Director of Military Affairs, suffered from severe melancholy (Chen Yu). Several physicians failed to cure her. Yelü Dilu diagnosed her, stating, "Heat is accumulated in the Heart; drugs cannot reach it. It must be treated with intention." Because of her melancholy, stimulating her to induce madness could vent the toxicity and cure her. He ordered loud drumming in front of her. The next day, she indeed became mad, shouting and cursing, until her strength was exhausted, after which she recovered. (From *History of Liao*, also seen in *Chu Ji*.)
Liu Gongyuan from Shangyang went to Dongting Mountain to treat patients. One patient appeared to have lost their breath (Qi Jue). Liu said, "Do not fear, I will revive him immediately." However, he insisted on watching a drama that night, specifically a martial play. Complying, he had the patient wrapped in felt mats and placed on the stage. Soon, drums and gongs clamored loudly, and the patient stretched and yawned, reviving. (Zhangshi Zhiyan notes: His treatment method is similar to the previous case, so the condition must also be similar.)
Wan Mizhai treated Hu Yinglong, who contracted a febrile disease in May and had not recovered after half a month of treatment. The pulse was wiry (Xian) and rapid (Shu), with nasal bleeding (Bi Nu) occurring every three to four days, and left hypochondriac pain preventing side-lying. First, one fried Zhizi (Gardeniae Fructus) was burned with women's hair to preserve its nature, then blown into the nose to stop the bleeding. Next, Danggui Longdan Wan (Angelica and Gentian Pill) formula was made into a decoction; one dose stopped the hypochondriac pain. Re-examining the pulse, it was wiry, floating, and rapid. He said, "It should be resolved through sweating." This is because Wei Qi does not harmonize with Ying Qi. Guizhi Tang (Cinnamon Twig Decoction) should be used to treat the Yang aspect. Now, since Ying Qi does not harmonize with Wei Qi, Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity) combined with Baihu Tang (White Tiger Decoction) should be used to treat the Yin aspect. Harmonizing Ying and Wei allows sweating and recovery. The two decoctions were mixed and drunk. He warned beforehand, "You will experience chills and sweating; do not be alarmed." After two doses, he indeed sweated and recovered.
Hu Longjia contracted a febrile disease in June with high fever, spontaneous sweating, extreme thirst, and a desire to strip naked. The pulse was wiry, large, and empty. Wan formulated a prescription: extracting Zhimu (Anemarrhenae Rhizoma) and Gancao (Glycyrrhizae Radix) from Xiaochaihu Tang (Minor Bupleurum Decoction) and Renshen Baihu Tang, and Dan Douchi (Fermented Soybean) from Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction), totaling five ingredients, decocted with Dan Zhuye (Lophatheri Folium), named Sanhe Tang (Three-Harmony Decoction). One dose resulted in recovery.
Miao Zhongchun treated Xin Hanyang, a Quansbu official, with a febrile disease located in the Yangming channel. Symptoms included headache, high fever, extreme thirst, vomiting, dry nose, and insomnia. The pulse was surging, large, and solid. Miao deliberately asked the attending physician, "Is this a Yangming syndrome?" The physician agreed. Asked what medicine was given, the physician replied, "Ge Gen Tang (Kudzu Decoction)." Miao said, "Incorrect." The physician asked, "Is Ge Gen Tang not a Yangming channel medicine?" Miao replied, "There are two exterior-resolving medicines for Yangming: one is Ge Gen (Puerariae Radix), the other is Baihu Tang. If there is no vomiting, Ge Gen Tang is used for exterior resolution. Now, vomiting is severe, indicating reversal of Yangming Qi. Ge Gen has ascending and dispersing properties, so it is unsuitable. Baihu Tang plus Maidong (Ophiopogonis Radix) and Zhuye (Lophatheri Folium), named Zhuye Shigao Tang (Lophatherum and Gypsum Decoction), should be used. Shigao (Gypsum Fibrosum) is acrid and cool, resolving the muscle layer and suppressing/phlegm-heat in the Stomach. Once the muscle layer resolves and heat dissipates, vomiting, irritability, and high fever will cease." He prescribed a large dose and warned the brother, "Attacking Lu Jing requires 600,000 troops; Li Xin with 200,000 will flee." He added, "If medicine is given now, recovery by fifth watch. If given at dawn, recovery by breakfast." This proved true. Someone asked why Banxia (Pinelliae Rhizoma) was not used for severe vomiting. Miao replied, "Banxia has three prohibitions: those with thirst, those with sweating, and those with blood deficiency. The patient is extremely thirsty and vomiting due to blazing Yangming pathogenic heat devouring fluids. Rising evil fire causes vomiting. Banxia is bitter, acrid, warm, and drying, and toxic; it is definitely unsuitable." Doubts arose regarding the omission of Gancao. Miao said, "Vomiters avoid sweet flavors; this is Zhang Zhongjing's rule."
Gong Zicai treated a woman who contracted a febrile disease in summer. Initially treated with formulas to balance Qi and Blood and clear heat/harmonize, but after 2-3 doses, there was no response. Heat increased, tongue coating turned scorched black, fire sensation in the diaphragm, rinsing water without swallowing. Both wrists had deficient and faint pulses, with the right wrist particularly weak. Within 6-7 days, delirium, grasping at empty air, and feeling along clothes/bed occurred, showing all malignant signs. Later, Siwu Tang (Four Substances Decoction) was used with additions: Huangqi (Astragali Radix), Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Maidong (Ophiopogonis Radix), Zhimu (Anemarrhenae Rhizoma), and Shu Fuzi (Prepared Aconiti Lateralis Radix). After 1-2 hours, sweating occurred and heat subsided. Fever returned the next day, subsiding again after another dose. On the third day, it recurred. Knowing the deficiency was severe, ten consecutive doses with Fuzi were administered, stabilizing the condition. (Li An notes: Febrile diseases sometimes present with such symptoms; this must be known.)
Yu Jiayan treated Wang Yuyuan, who had contracted an external pathogen years prior. Improper treatment caused all body fluids to be scorched by pathogenic heat. Residual heat remained for ten years, causing constant closure of the right ear canal. That summer, he contracted another external pathogen, lingering for over fifty days. Facial and foot edema, restless sleep, and a sensation of air pushing out from the ears occurred. New heat combined with old heat, creating mutual harm, making it difficult to eliminate. Physicians failed to understand the condition, treating blindly. By late autumn, when Metal was cold and Water was cold, the illness retreated naturally. Superficial cases retreat with time; deep ones do not retreat quickly. Yu said, "Facial and foot edema indicates Lung Metal Qi obstructed by heat, losing its clearing, descending, and purifying function. (Facial swelling is accurate; foot swelling is less so; ultimately, it is Yin deficiency with Blood failing to nourish Qi.) Restless sleep indicates dryness of Stomach fluids, failing to nourish Hun and Po. (This explanation is forced; it is due to Yin deficiency with Liver Fire floating into the pericardium collateral.) Fire qi rushing from the ear results from the long-closed orifice; previously unnoticed, now with body debility and no internal obstruction, rebellious Qi rushes upward, becoming noticeable. (Ultimately, it comes down to Yin deficiency.)" Although external symptoms healed, internal regulation via diet and medicine accounts for half the recovery. Two main points are highlighted to clarify post-infection care. After infection, Yuan Qi is deficient, and residual heat remains. Tonifying deficiency here removes heat poorly; clearing heat here burdens deficiency. Even splitting tonification and clearing is vague and misses the essence. However, apart from tonifying deficiency and clearing heat, no other method exists; careful observation is needed. There are two methods of tonifying deficiency: tonifying Spleen and tonifying Stomach. After malaria/dysentery, if digestion fails, tonify Spleen. After typhoid/fever, if Stomach fluids are depleted and new fluids not generated, tonify Stomach. These differ vastly. There are two methods of clearing heat: early-stage heat is excess heat, cleared with bitter-cold herbs; post-major illness heat is deficiency heat, cleared with sweet-cold herbs. (This explanation is profound.) They also differ vastly. The innate Qi of the human body resides in the Stomach mouth. Lack of fluids is deficiency; generating fluids is tonifying deficiency. (Xiong An notes: Eternal truth. Thus, fluid-generating herbs combined with sweet-cold heat-clearing herbs treat post-infection deficiency heat, e.g., Maidong, Shengdi, Mudanpi, Renshen, Pear Juice, Zhu Li. Zhang Zhongjing often uses Tianshui San to clear deficiency heat, taking advantage of the sweet-cool combination of Huashi and Gancao. Xiong An notes: Lung governs Qi of the body; skin/hair are its exterior. Post-infection, Qi recovers but Blood is deficient; foot edema occurs, but unresolved residual heat with Lung Qi stagnation is even more common. Also, if Stomach heat is unresolved, fluids do not return. Classic says: Disharmony of Stomach leads to restless sleep. Ear blockage requires clearing Lung; this differs from tinnitus requiring Yin nourishment.) Tianshui San clears deficiency heat via the sweet-cool principle of Huashi and Gancao. Mistakenly tonifying with Renshen, Huangqi, Fuling, Baizhu would tonify the pathogenic heat along with deficiency. Dietary tonification should focus on Qi, not flavor. Grains and vegetables provide Qi to nourish. During meals, fluid secretion and sweating occur, gradually transporting stored heat out through pores. How refreshing! People ignore this,急于 using rich/greasy foods to tonify. While spirits may seem robust initially, grease blocks meridians, trapping heat. Over time, consolidation makes escape impossible. Ancients, aware of this, preferred bland diets to allow temporary deficiency for easy heat release. This is precious.
Previous doctors attributed edema to Spleen, using Fuling and Baizhu, causing lingering residual heat. This stems from unclear principles of tonifying deficiency and clearing heat.
Note: *Yuyi Cao* contains many insights not previously expressed. However, it also has fragmented and forced explanations. In this case, using sweet-cold herbs to clear heat post-cold is most appropriate. However, distinguishing Spleen/Stomach tonification is vague. Xiong An notes: Treating Spleen and Stomach separately truly enlightens ages. Ye Tianshi benefited greatly from this, impressing Lingtai and Run'an. But it should be stated: Qi deficiency requires Qi tonification; Blood deficiency requires Blood tonification. Post-malaria/dysentery, poor digestion indicates Qi deficiency, suitable for Qi-class herbs like Renshen, Huangqi, Fuling. Post-infection, lack of fluids indicates Blood deficiency, suitable for Shengdi, Maidong, Pear, Bamboo. This is because residual heat remains post-infection. How clear, yet still somewhat biased. Wei's discussions on post-dysentery/malaria are precise. Dysentery leads to Yin loss via diarrhea; malaria leads to fluid consumption via sweating. Poor digestion often stems from ministerial fire excess and true Qi decline. Without large doses of Dong'Er Di (Dongguan, Maidong, Shengdi, Dihuang),缠绵 persists. Discussions on facial/foot edema and restless sleep are superficial.
Lu Yangyu treated Ling Biaobu Zhaoquan, who returned home in summer after excessive fatigue. Nighttime headache felt like breaking, internal heat like fire, insomnia, heavy sweating, short dark urine, yellow tongue coating, right hypochondriac distension/pain. Some suggested dispersing for headache/fever; others suggested tonifying after fatigue. Diagnosis: body heat, panting, shortness of breath, floating-rapid pulse, weak upon pressure. "Heat has damaged Yuan Qi." He used Hejian Guiling Ganlu Yin plus Renshen 1 qian. After a moment, sweating stopped, heat reduced, breathing stabilized, speech resumed. Another dose caused drowsiness. Next morning, floating pulse normalized, deep pulse wiry and forceful. Floating heat removed, internal heat remaining, causing slight hypochondriac/abdominal pain. Danggui Longdan Wan 1.5 qian was given fasting. By afternoon, after eating porridge, bowels moved with black stool, pain decreased. Regulated with Shenmai San.
Lu Xiaoyu treated Lady Shidongting. In April, she had headache and fever. Pulse surging-rapid at Qi Kou. Two doses of clearing/resolving herbs (Chaihu, Ge Gen, Zhizi, Huangqin) were used. One physician argued that headache/fever is Taiyang syndrome; using Chaihu/Ge Gen prematurely draws pathogen into Yangming/Shaoyang. Using cold Zhizi/Huangqin before sweating prevents exterior resolution and drives pathogen inward. (According to orthodox Shanghan Lun, this is correct.) Two doses of Da Qinglong Tang were prescribed. Family gave only one dose. Nighttime: body felt like ants crawling, thirst, dry throat, delirium. Next day, diagnosed as gout, not Shanghan. (The person reads books but treats rashly; perhaps thin fortune and floating Qi, or shallow knowledge and fickle will?) Used Qianghuo, Duhuo, Shouwu, Niuxi for two doses. Result: singing on heights, running naked, cursing without discrimination. Re-diagnosis: female attendants restrained him. Told Shidongting, "This is Yang syndrome; agitation worsens it. Comfort him verbally." He stopped. Sugar water was administered to ease tension. Then Baihu Tang plus Yuanming Fen, Huangqin, Huanglian, Gualou Ren, Xijiao for several doses, stopping cursing. Occasional delirium indicated constipation. Runzi Wan 3 qian was given; 20 dry stools passed at night. Delirium persisted. Previous decoction continued, plus 2 qian pill; more dry stools and some loose stool passed. Three days later, desired porridge. Regulated with Qingqi Yangying Tang.
Lv Dongzhuang treated a servant of Wu Huaya, who contracted heat syndrome while working on a lake in summer, with dysentery of pus/blood and body burning like charcoal. (Since it is heat syndrome, otherwise dysentery with fever is incurable.) "This is Yangming disease, not dysentery. Tongue will be black and dry; delirium at night." This occurred. Pulse was chaotic, intermittent, like sparrow pecking, untreatable. Wu insisted. Reluctantly, Shudi 1 liang, Shengdi, Maidong, Danggui, Baishao, Gancao, Gouqi were used. Warned, "Recovery depends on sweating." Night: heat unchanged, delirium worse, but bloody dysentery stopped. After medicine, slight sweat appeared briefly. Pulse connected clearly, surging-rapid and pounding. "He will live." Same formula, remove Shengdi, add Zaoren, Shanyao, Mudanpi, Shanzhuyu. (Modifications were inappropriate.) Six doses. Family requested change due to severe confusion/heat. Lv told them to wait, promising life. Re-pulse: gathered and round. "Now I will remove the disease." Sishun Qingliang Yin plus Shudi 1 liang, Dahuang 5 qian administered. Dozens of black stools passed, symptoms resolved. Two days later, dusk: sudden madness, fever, panting, thirst. This was returning Yang to produce sweat. Baizhu 1 liang, Huangqi 1 liang, Ganjiang 3 qian, Gancao 1 qian, Danggui, Baishao 3 qian each. Full dose: profuse sweating, slept soundly till dawn, recovered suddenly.
Note: Tonify then purge, then tonify then sweat. Treatment is good. However, in early stages, combining with Tianshui Xiexin might have prevented such danger.
Yang Chengliu's clan brother suffered heat syndrome for 6-7 days without relief. Thirst, constipation, madness climbing walls/roofs, running naked, delirious cursing, discarding covers, refusing clothing, for five days. Yang returned from trial in Zhaoshang. Patient said, "The saving star has arrived." Asked who, replied, "Brother Yunfeng is back." Yang arrived, family amazed. Observation: face lacked spirit, eyes staring fixedly, speech/movement strong/powerful. Thought: Stomach heat overwhelming Heart, confusing spirit. Otherwise, why thirst, constipation, White Tiger/Liangge symptoms? Pulse: vast and boundless, empty upon deep pressure. Tongue: yellow with black, moist not dry. Diagnosis: Yin excess internally forcing Yang outward. Strength is false heat, true cold internally. Yang Qi severely deficient, Spirit not housed, Primordial Spirit fleeing, hence anticipating arrival. Yangrong Tang plus Fuzi, doubled Zaoren, Wuweizi, Baishao, decocted thickly. One dose: madness ceased, exhaustion, slept fully, thirst stopped, appetite returned, bowels moved. Continued with Buzhong Yiqi Tang plus Baishao, Wuweizi for recovery.