风温4(上呼吸道感染)
龚某某，男，47岁
初诊
形体消瘦，素体阴虚。复感温操之邪，发热口干，头痛咳嗽，干咳无痰，微恶风寒，心烦口渴，尿少且黄，舌红绛且形瘦，两脉细弦小数。阴虚之体，又感温邪，滋阴以养其涟，疏卫兼以退热。
白薇3克，玉竹9克，豆豉6克，前胡3克，薄荷1.5克(后下)，山栀6克，芦根24克，二付
二诊
身热退而恶寒解，头痛减而咳嗽除，咽干口渴，小便色黄，舌绛形瘦，两脉细弦小精，温邪已解，阴分不足，再以甘寒清热，养阴生津。
玉竹9克，山栀6克，前胡3克，鲜芦根24克，鲜石斛15克，桔梗6克
三诊
诸恙皆减，微咳无痰，咽干口褐，脉象弦细小滑，按之略数，舌干质红形瘦。外感温邪已解，阴虚内热未除，再以甘寒养阴，润燥折热方法。
细生地15克，石斛15克，桔梗6克，生草9克，麦冬9克，北沙参24克，川贝6克，鲜茅芦根各24克，三付
四诊
药后诸症皆减，脉仍细小且滑，舌红口干，心烦而欲饮，阴虚已久，肝肾两亏，改用丸药，以善其后。
丸方：细生地60克，肥玉竹60克，川石斛30克，生白芍60克，麦门冬30克，五味子30克，山药45克，丹皮24克，茯苓块60克，元参30克，焦三仙各60克，鸡内金30克，香稻芽60克，砂仁15克，白术30克，炒枳壳30克，木香15克
上药共研细末，炼蜜为丸，如梧桐子大，每日早晚饭后，各服6克，如遇感冒暂停。
[按]：素体阴虚，暮春患感，正合《内经》“冬不藏精，各必病温”例。其形瘦干咳，舌瘦且绛，脉象弦细小数，合为阴亏之征。故首用养阴疏化，终用养阴和胃之丸药。冀以从根本上改善阴虚体质。
风温5(大叶肺炎)
孔某某，男，20岁
初诊
持续发热4日，体温38.7℃～39.5℃，时时恶寒，头痛，咳嗽砗作，咳则胸痛，汗出胸以上为甚，胸闷气促作喘，痰黄稠粘，时有铁锈样痰吐出，大便二日未行。舌红苔黄根厚糙老且干，两脉洪猾且数，心烦口干，渴欲冷饮。经西医检查，确诊为大叶性肺炎。此属风温蕴热壅塞于肺，痰热内阻，升降失和。急以清宣肃化方法，饮食当慎，谨防增重。
苏叶子各6克，杏仁10克，生石膏25克，生甘草6克，莱菔子10克，白芥子3克，甜葶苈3克，芦根25克，黛蛤散12克(包)，二付。
二诊
前药服二剂后，身热退而咳喘皆减，胸痛未作，痰吐略爽，其色亦浅，舌苔黄厚渐化，大便甚畅，两脉弦滑，数势大减。热郁已解，滞热较轻，肺气已畅而升降渐调，再以前方加减，饮食荤腥仍忌。
前胡3克，杏仁10克，黄芩10克，浙贝母12克，苏叶子各3克，莱菔子6克，黛蛤散12克(布包)，冬瓜子30克，茅芦根各30克，二付
三诊
前药又服二剂之后，身热咳喘皆愈，夜寐甚安，咳嗽吐痰甚少，两脉仍属弦滑，二便如常，经透视两肺纹理略粗，肺炎基本吸收，比前大有好转，再以清肃疏化。
前胡3克，杏仁6克，苏子10克，黄芩10克，炙杷叶10克，黛蛤散10克(布包)，芦根25克，焦三仙各10克，二付
又服上方两剂之后，一切均属正常，又休息五天上班工作。
[按] 大叶肺炎一症，往往寒战高热，状类伤寒。切勿以伤寒法治之。盖此为痰热互阻，壅塞于肺，气机不利。故咳即胸痛，吐痰如铁锈色。查之有肺实变征。当结合现代医学检查诊断之。中医治疗当着眼于肃化其痰热，便邪热无痰以结，则易去矣。赵师此案前后凡三诊，悉以肃化祛痰为治，三子养亲，葶苈泻肺，千金苇茎诸名方之义俱见于方中。细研此案，治法自明。
风温6(支气管肺炎)
邢某某，男，7岁
初诊：
发烧咳嗽，面目俱赤，舌苔黄厚，口干渴饮，大便两日未行，夜间咳嗽甚重，小便黄少，两脉弦数有力。前天曾服某医开中药方：麻黄6克，桂枝10克，杏仁10克，炙甘草10克，茯苓10克，生姜3克，大枣两枚，一剂。药后身热加重，体温40℃，咳嗽喘逆，痰中带血，神志有时不清，咽痛且肿，扁桃腺白腐肿大，今查白细胞12000／mm3，尿无异常发现，×线透视：两肺纹理粗糙，符合支气管肺炎现象。此风温蕴热在肺，胃肠食滞蕴蓄，本当清肃化痰兼以导滞，误用辛温发汗方法，以热治热，诸症蜂起，有逆传心包之势，姑以凉膈泄热，兼以通腑，仿凉膈散之义。
薄荷2克(后下)，前胡6克，黄芩10克，生石膏20克，钩藤6克，莱菔子6克，紫雪丹1.5克(分冲)，羚羊角粉0.6克(分冲)，一付
二诊
药后身热渐退，咳喘大减，痰血未吐，神志已清，昨夜安寐一宵，今晨大便一次，色深且粘，恶臭难闻，病势已衰。但舌根苔黄略厚，咽微作痛，温邪滞热减而未净，再以肃降化痰，清解化滞之法，忌食油腻荤腥，甜粘糖果也慎。
前胡3克，杏仁10克，川贝母3克，钩藤10克，黄芩6克，瓜蒌仁15克，莱菔子6克，鲜梨一枚(连皮去核切片)，二付
三诊
身热已退净，体温36.7℃，咳嗽喘逆未作，痰血未吐，今日透视正常，查白细胞6700／mm3，尿正常。两脉细小且滑，舌苔已化净，大小便正常，嘱慎食一周，可上学。
[按]：支气管肺炎小儿多见，以发热喘咳为主证，重者可有惊厥动风之变。此例实属误治。本属风温挟滞，却重用麻黄汤发其表，宜其惊厥在即，危若迭卵矣。治以凉膈泄热，通腑导滞。盖肺与大肠为表里，若肠腑壅实，则肺难肃降，故热壅于肺者，往往以通腑为捷法。此案药后便泄恶臭，是积热下泄之征，故有热退喘平之效。其初诊用紫雪羚羊角粉，意在清心凉肝，防其惊厥，亦未雨绸缪之义也。
风温7(支气管肺炎)
狄某某，女，5岁
初诊
发烧2～3天，体温38.5℃，咳嗽气促作喘，×线透视：支气管肺炎，白血球12000／mm3，两脉滑数，指纹深紫，已至命关，舌红苔白腻根厚，夜间因热惊抽两次，汗出口渴，大便略千。此风温蕴热，因热动风，急用清热凉肝熄风方法。
薄荷1克(后下)，生石膏10克(先煎)，知母6克，连翘6克，芦根30克，钩藤10克，焦三仙各6克，羚羊角粉0.3克(分冲)，一付
二诊
身热渐减，体温38℃，咳喘少轻，脉仍滑数，昨日抽搐未作，口渴夜不安寐，大便仍干小便短赤，温邪蕴热在于气分，再以清热熄风方法。
薄荷1克(后下)，生石膏10克，僵蚕4.5克，连翘10克，芦根30克，钩藤10克，羚羊角粉0.3克(分冲)，二付
三诊
身热渐退，体温37.5℃，咳喘大减，抽搐未作，昨夜安寐甚佳，两脉弦滑，数象大减，指纹已淡，回至风关，舌红苔略厚，再以原方进退。
前胡1.5克，蝉衣3克，片姜黄3克，钩藤10克，芦根30克，焦麦芽6克，牛黄抱龙丸一丸(分两次药选下)，二付
四诊
身热退而咳喘亦止，体温36 5℃，抽搐未作，夜寐甚安，指纹、脉象皆如常，舌苔已化，二便如常，再以清热化滞方法。禁荤腥，吃素食，注意寒暖。
前胡1.5克，芦根15克，焦麦芽10克，鸡内金10克，二付后诸恙皆安，调理一周如常。
[按]：此为风温气分热盛动风之候，故用清热凉肝息风方法。生石膏、知母取法于白虎汤，清阳明之热；钩藤、羚羊角寓羚角钩藤意，息厥阴之风；焦三仙消食滞于内；薄荷、连翘、芦根分消风热邪气于外。观此治法可知透热转气之运用矣。
春温1(上呼吸道感染)
邵某某，女，57岁
初诊
暮春感温，形体削瘦，面色黑浊，素质阴亏，滓液不足，近感温热之邪，身热不重，微有恶寒，干咳无痰，头部微痛，心烦口干，咽部疼痛，舌干瘦而鲜红，脉来弦细小数。此阴虚感温，津亏液少，当用滋阴清宣方法。
肥玉竹10克，嫩白薇6克，炒栀皮6克，淡豆豉10克，苦桔梗6克，前胡6克，沙参10克，杏仁6克，茅芦根各10克，三付
二诊
药后，寒热已解，仍干咳无痰，再以原方去豆豉、桔梗、加麦冬10克，天冬10克，又三付而逐渐痊愈。
[按]：辨治外感证亦须注意患者的素体状况，此例患者素体阴伤，津液早亏，再感温邪，虽身热不重而阴必更伤，故舌干瘦鲜红，脉弦细小数，细主脏阴之亏，数乃郁热之象，故用滋阴生津，清宣郁热方法，仿加减葳蕤汤治之而愈。然但取加减藏蕤汤养阴之意，不用葱白发表之药，加入养阴轻宣之品，药合病机，乃能取效如此。
春温2(重感冒)
宋某某，女，65岁
初诊
初春发病，身热20余日，体温38.5℃上下，形体消瘦，面色暗黑，舌干纬而有裂痕，苔垢厚焦黄，唇焦起皮，胃纳少思，脘腹胀满拒按，口干欲凉饮，咽红干痛，两脉沉细小滑，按之仍有力。素患肺结核十余年，经常夜间有汗，有时低烧。近来感受温邪，屡投辛温解表，重亡津液，阴分过亏，津液大伤，蕴热腑实，便秘不通。阴愈亏而热愈炽，肠愈燥而阴愈耗，必须顾津液以润其燥，通腑实求其热除。本虚标实之证，急以增液承气汤治之。
元参45克，生地黄30克，麦门冬25克，白芍30克，川石斛25克，芒硝1.5克(冲)，大黄粉1.2克(冲)，一付
二诊
药后昨夜大便畅通一次，初干如羊屎，后则少缓，肛门破裂，微带血渍。今日体温37.5℃，舌干绛而有裂痕，胃纳渐开，脘腹胀满已减。咽仍红，干痛已见缓和。两脉沉细小滑，力量稍逊。素体阴分不足，血虚热盛，患温病又复伤阴，大便秘结。此液枯肠燥，无水舟停，故先用增水行舟润肠通便法，今便已通热已减，再以甘寒润燥，以补药之体，作泄药之用，切不可再用硝黄。
北沙参30克，生地黄25克，白芍25克，清阿胶15克(分两次烊化)，黑木耳12克，炙鳖甲15克(先煎)，麦门冬15克，二付
三诊
身热已退净，体温37℃，舌苔已化，质绛干裂，胃纳如常，大便又行一次，便下正常，腹不胀满，咽干痛已无，脉见细弦小滑，再以甘寒育阴，从本治疗。
生地黄25克，北沙参25克，生白芍25克，生苡米15克，生白扁豆25克，清阿胶12克(分两次烊化)，天麦冬各10克，鸡内金10克，五付
药后诸恙皆安，身热退净。饮食睡眠皆好，嘱平时忌用辛辣厚睐，食以清淡为佳。
[按]：素患结核，知其为阴虚之体；初春即患温症，正合冬不藏精，春必病温之倒，温邪又必伤阴，是二伤也，病后误用辛温，屡屡发表，过汗更必伤阴，是三伤也。阴津伤而燥热内结肠腑，而成无水舟停之证。故首用增水行舟方法，得便通症减，即变为甘寒濡润，所谓以补药之体作泻药之用，唯恐久病年高之体，难当硝黄之峻。其小心谨慎有如此者。终以甘寒育阴收功。可见治温病当以存阴为第一要义，此案可资证明。
风温4（上呼吸道感染）
龚某某，男，47岁
初诊
形体消瘦，素体阴虚。又感受温热之邪，出现发热、口干、头痛、咳嗽，干咳无痰，轻微恶风寒，心烦口渴，尿少且黄，舌质红绛且形体瘦小，两脉细弦而小数。患者为阴虚体质，又感温邪，治宜滋阴以养其液，疏解卫分兼以退热。
白薇3克，玉竹9克，豆豉6克，前胡3克，薄荷1.5克（后下），山栀6克，芦根24克，二付
二诊
身热退去而恶寒解除，头痛减轻而咳嗽消除，咽干口渴，小便色黄，舌质绛红形体瘦小，两脉细弦小数，温热之邪已解，阴分不足，再用甘寒清热，养阴生津之法。
玉竹9克，山栀6克，前胡3克，鲜芦根24克，鲜石斛15克，桔梗6克
三诊
诸症皆减，微咳无痰，咽干口燥，脉象弦细小滑，按之略数，舌干质红形瘦。外感温邪已解，阴虚内热未除，再用甘寒养阴，润燥折热的方法。
细生地15克，石斛15克，桔梗6克，生草9克，麦冬9克，北沙参24克，川贝6克，鲜茅芦根各24克，三付
四诊
服药后诸症皆减，脉仍细小且滑，舌红口干，心烦而欲饮，阴虚已久，肝肾两亏，改用丸药，以善其后。
丸方：细生地60克，肥玉竹60克，川石斛30克，生白芍60克，麦门冬30克，五味子30克，山药45克，丹皮24克，茯苓块60克，元参30克，焦三仙各60克，鸡内金30克，香稻芽60克，砂仁15克，白术30克，炒枳壳30克，木香15克
上药共研细末，炼蜜为丸，如梧桐子大，每日早晚饭后，各服6克，如遇感冒暂停。
[按]：素体阴虚，暮春患感，正合《内经》“冬不藏精，春必病温”之例。其形瘦干咳，舌瘦且绛，脉象弦细小数，合为阴亏之征。故首用养阴疏化，终用养阴和胃之丸药。冀以从根本上改善阴虚体质。
风温5（大叶肺炎）
孔某某，男，20岁
初诊
持续发热4日，体温38.7℃～39.5℃，时时恶寒，头痛，咳嗽阵作，咳则胸痛，汗出胸以上为甚，胸闷气促作喘，痰黄稠粘，时有铁锈样痰吐出，大便二日未行。舌红苔黄根厚糙老且干，两脉洪滑且数，心烦口干，渴欲冷饮。经西医检查，确诊为大叶性肺炎。此属风温蕴热壅塞于肺，痰热内阻，升降失和。急以清宣肃化方法，饮食当慎，谨防增重。
苏叶子各6克，杏仁10克，生石膏25克，生甘草6克，莱菔子10克，白芥子3克，甜葶苈3克，芦根25克，黛蛤散12克（包），二付。
二诊
前药服二剂后，身热退而咳喘皆减，胸痛未作，痰吐略爽，其色亦浅，舌苔黄厚渐化，大便甚畅，两脉弦滑，数势大减。热郁已解，滞热较轻，肺气已畅而升降渐调，再以前方加减，饮食荤腥仍忌。
前胡3克，杏仁10克，黄芩10克，浙贝母12克，苏叶子各3克，莱菔子6克，黛蛤散12克（布包），冬瓜子30克，茅芦根各30克，二付
三诊
前药又服二剂之后，身热咳喘皆愈，夜寐甚安，咳嗽吐痰甚少，两脉仍属弦滑，二便如常，经透视两肺纹理略粗，肺炎基本吸收，比前大有好转，再以清肃疏化。
前胡3克，杏仁6克，苏子10克，黄芩10克，炙杷叶10克，黛蛤散10克（布包），芦根25克，焦三仙各10克，二付
又服上方两剂之后，一切均属正常，又休息五天上班工作。
[按] 大叶肺炎一症，往往寒战高热，状类伤寒。切勿以伤寒法治之。盖此为痰热互阻，壅塞于肺，气机不利。故咳即胸痛，吐痰如铁锈色。查之有肺实变征。当结合现代医学检查诊断之。中医治疗当着眼于肃化其痰热，使邪热无痰以结，则易去矣。赵师此案前后凡三诊，悉以肃化祛痰为治，三子养亲，葶苈泻肺，千金苇茎诸名方之义俱见于方中。细研此案，治法自明。
风温6（支气管肺炎）
邢某某，男，7岁
初诊：
发烧咳嗽，面目俱赤，舌苔黄厚，口干渴饮，大便两日未行，夜间咳嗽甚重，小便黄少，两脉弦数有力。前天曾服某医开中药方：麻黄6克，桂枝10克，杏仁10克，炙甘草10克，茯苓10克，生姜3克，大枣两枚，一剂。药后身热加重，体温40℃，咳嗽喘逆，痰中带血，神志有时不清，咽痛且肿，扁桃腺白腐肿大，今查白细胞12000／mm3，尿无异常发现，×线透视：两肺纹理粗糙，符合支气管肺炎现象。此风温蕴热在肺，胃肠食滞蕴蓄，本当清肃化痰兼以导滞，误用辛温发汗方法，以热治热，诸症蜂起，有逆传心包之势，姑以凉膈泄热，兼以通腑，仿凉膈散之义。
薄荷2克（后下），前胡6克，黄芩10克，生石膏20克，钩藤6克，莱菔子6克，紫雪丹1.5克（分冲），羚羊角粉0.6克（分冲），一付
二诊
药后身热渐退，咳喘大减，痰血未吐，神志已清，昨夜安寐一宵，今晨大便一次，色深且粘，恶臭难闻，病势已衰。但舌根苔黄略厚，咽微作痛，温邪滞热减而未净，再以肃降化痰，清解化滞之法，忌食油腻荤腥，甜粘糖果也慎。
前胡3克，杏仁10克，川贝母3克，钩藤10克，黄芩6克，瓜蒌仁15克，莱菔子6克，鲜梨一枚（连皮去核切片），二付
三诊
身热已退净，体温36.7℃，咳嗽喘逆未作，痰血未吐，今日透视正常，查白细胞6700／mm3，尿正常。两脉细小且滑，舌苔已化净，大小便正常，嘱慎食一周，可上学。
[按]：支气管肺炎小儿多见，以发热喘咳为主证，重者可有惊厥动风之变。此例实属误治。本属风温挟滞，却重用麻黄汤发其表，宜其惊厥在即，危若迭卵矣。治以凉膈泄热，通腑导滞。盖肺与大肠为表里，若肠腑壅实，则肺难肃降，故热壅于肺者，往往以通腑为捷法。此案药后便泄恶臭，是积热下泄之征，故有热退喘平之效。其初诊用紫雪羚羊角粉，意在清心凉肝，防其惊厥，亦未雨绸缪之义也。
风温7（支气管肺炎）
狄某某，女，5岁
初诊
发烧2～3天，体温38.5℃，咳嗽气促作喘，×线透视：支气管肺炎，白血球12000／mm3，两脉滑数，指纹深紫，已至命关，舌红苔白腻根厚，夜间因热惊抽两次，汗出口渴，大便略干。此风温蕴热，因热动风，急用清热凉肝熄风方法。
薄荷1克（后下），生石膏10克（先煎），知母6克，连翘6克，芦根30克，钩藤10克，焦三仙各6克，羚羊角粉0.3克（分冲），一付
二诊
身热渐减，体温38℃，咳喘少轻，脉仍滑数，昨日抽搐未作，口渴夜不安寐，大便仍干小便短赤，温邪蕴热在于气分，再以清热熄风方法。
薄荷1克（后下），生石膏10克，僵蚕4.5克，连翘10克，芦根30克，钩藤10克，羚羊角粉0.3克（分冲），二付
三诊
身热渐退，体温37.5℃，咳喘大减，抽搐未作，昨夜安寐甚佳，两脉弦滑，数象大减，指纹已淡，回至风关，舌红苔略厚，再以原方进退。
前胡1.5克，蝉衣3克，片姜黄3克，钩藤10克，芦根30克，焦麦芽6克，牛黄抱龙丸一丸（分两次药送下），二付
四诊
身热退而咳喘亦止，体温36.5℃，抽搐未作，夜寐甚安，指纹、脉象皆如常，舌苔已化，二便如常，再以清热化滞方法。禁荤腥，吃素食，注意寒暖。
前胡1.5克，芦根15克，焦麦芽10克，鸡内金10克，二付后诸恙皆安，调理一周如常。
[按]：此为风温气分热盛动风之候，故用清热凉肝息风方法。生石膏、知母取法于白虎汤，清阳明之热；钩藤、羚羊角寓羚角钩藤意，息厥阴之风；焦三仙消食滞于内；薄荷、连翘、芦根分消风热邪气于外。观此治法可知透热转气之运用矣。
春温1（上呼吸道感染）
邵某某，女，57岁
初诊
暮春感温，形体削瘦，面色黑浊，素质阴亏，津液不足，近感温热之邪，身热不重，微有恶寒，干咳无痰，头部微痛，心烦口干，咽部疼痛，舌干瘦而鲜红，脉来弦细小数。此阴虚感温，津亏液少，当用滋阴清宣方法。
肥玉竹10克，嫩白薇6克，炒栀皮6克，淡豆豉10克，苦桔梗6克，前胡6克，沙参10克，杏仁6克，茅芦根各10克，三付
二诊
药后，寒热已解，仍干咳无痰，再以原方去豆豉、桔梗、加麦冬10克，天冬10克，又三付而逐渐痊愈。
[按]：辨治外感证亦须注意患者的素体状况，此例患者素体阴伤，津液早亏，再感温邪，虽身热不重而阴必更伤，故舌干瘦鲜红，脉弦细小数，细主脏阴之亏，数乃郁热之象，故用滋阴生津，清宣郁热方法，仿加减葳蕤汤治之而愈。然但取加减葳蕤汤养阴之意，不用葱白发表之药，加入养阴轻宣之品，药合病机，乃能取效如此。
春温2（重感冒）
宋某某，女，65岁
初诊
初春发病，身热20余日，体温38.5℃上下，形体消瘦，面色暗黑，舌干绛而有裂痕，苔垢厚焦黄，唇焦起皮，胃纳少思，脘腹胀满拒按，口干欲凉饮，咽红干痛，两脉沉细小滑，按之仍有力。素患肺结核十余年，经常夜间有汗，有时低烧。近来感受温邪，屡投辛温解表，重亡津液，阴分过亏，津液大伤，蕴热腑实，便秘不通。阴愈亏而热愈炽，肠愈燥而阴愈耗，必须顾津液以润其燥，通腑实求其热除。本虚标实之证，急以增液承气汤治之。
元参45克，生地黄30克，麦门冬25克，白芍30克，川石斛25克，芒硝1.5克（冲），大黄粉1.2克（冲），一付
二诊
药后昨夜大便畅通一次，初干如羊屎，后则少缓，肛门破裂，微带血渍。今日体温37.5℃，舌干绛而有裂痕，胃纳渐开，脘腹胀满已减。咽仍红，干痛已见缓和。两脉沉细小滑，力量稍逊。素体阴分不足，血虚热盛，患温病又复伤阴，大便秘结。此液枯肠燥，无水舟停，故先用增水行舟润肠通便法，今便已通热已减，再以甘寒润燥，以补药之体，作泄药之用，切不可再用硝黄。
北沙参30克，生地黄25克，白芍25克，清阿胶15克（分两次烊化），黑木耳12克，炙鳖甲15克（先煎），麦门冬15克，二付
三诊
身热已退净，体温37℃，舌苔已化，质绛干裂，胃纳如常，大便又行一次，便下正常，腹不胀满，咽干痛已无，脉见细弦小滑，再以甘寒育阴，从本治疗。
生地黄25克，北沙参25克，生白芍25克，生苡米15克，生白扁豆25克，清阿胶12克（分两次烊化），天麦冬各10克，鸡内金10克，五付
药后诸恙皆安，身热退净。饮食睡眠皆好，嘱平时忌用辛辣厚味，食以清淡为佳。
[按]：素患结核，知其为阴虚之体；初春即患温症，正合冬不藏精，春必病温之例，温邪又必伤阴，是二伤也，病后误用辛温，屡屡发表，过汗更必伤阴，是三伤也。阴津伤而燥热内结肠腑，而成无水舟停之证。故首用增水行舟方法，得便通症减，即变为甘寒濡润，所谓以补药之体作泻药之用，唯恐久病年高之体，难当硝黄之峻。其小心谨慎有如此者。终以甘寒育阴收功。可见治温病当以存阴为第一要义，此案可资证明。
Wind-Warmth 4 (Upper Respiratory Tract Infection)
Gong XX, Male, 47 years old
First Visit
The patient is emaciated and has a constitution of Yin deficiency. He contracted warm pathogenic factors, presenting with fever, dry mouth, headache, cough, dry cough without sputum, slight aversion to wind and cold, irritability, thirst, scanty and yellow urine, red and crimson tongue that is thin in shape, and fine, wiry, and slightly rapid pulses in both positions. Given the Yin-deficient constitution combined with warm pathogen invasion, the treatment should nourish Yin to moisten fluids, release the Wei level, and reduce fever.
Baiwei (Cortex Corydalis), 3g; Yuzhu (Rhizoma Polygonati Odorati), 9g; Douchi (Ferus Sojae Preparatus), 6g; Qianhu (Radix Peucedani), 3g; Bohe (Herba Menthae), 1.5g (added later); Shanzhi (Fructus Gardeniae), 6g; Lugeng (Rhizoma Phragmitis), 24g; 2 doses.
Second Visit
Body heat subsided and aversion to cold resolved; headache decreased and cough disappeared. There is dry throat and thirst, yellow urine, crimson tongue with thin shape, and fine, wiry, small, and rapid pulses. The warm pathogen has been resolved, but there is insufficiency in the Yin aspect. Use sweet-cold herbs to clear heat, nourish Yin, and generate fluids.
Yuzhu (Rhizoma Polygonati Odorati), 9g; Shanzhi (Fructus Gardeniae), 6g; Qianhu (Radix Peucedani), 3g; Fresh Lugeng (Rhizoma Phragmitis), 24g; Fresh Shihu (Caulis Dendrobii), 15g; Jiegeng (Radix Platycodonis), 6g.
Third Visit
All symptoms reduced; slight cough without sputum, dry throat and mouth. Pulse is wiry, fine, small, and slippery, slightly rapid upon pressure. Tongue is dry, red in substance, and thin in shape. The external warm pathogen is resolved, but internal heat due to Yin deficiency remains. Continue with sweet-cold methods to nourish Yin, moisten dryness, and reduce heat.
Xi Shengdi (Radix Rehmanniae Preparata), 15g; Shihu (Caulis Dendrobii), 15g; Jiegeng (Radix Platycodonis), 6g; Shengcao (Radix Glycyrrhizae), 9g; Maidong (Tuber Ophiopogonis), 9g; Beishashen (Radix Glehniae), 24g; Chuanbei (Bulbus Fritillariae Cirrhosae), 6g; Fresh Maolugeng (Rhizoma Imperatae et Phragmitis), each 24g; 3 doses.
Fourth Visit
After medication, all symptoms reduced. Pulses remain fine, small, and slippery. Tongue is red, mouth is dry, irritability with desire to drink. Long-standing Yin deficiency involves Liver and Kidney depletion. Switch to pills for consolidation.
Pill Formula: Xi Shengdi (Radix Rehmanniae Preparata), 60g; Fei Yuzhu (Rhizoma Polygonati Odorati), 60g; Chuan Shihu (Caulis Dendrobii), 30g; Sheng Baishao (Radix Paeoniae Alba), 60g; Maimendong (Tuber Ophiopogonis), 30g; Wuweizi (Fructus Schisandrae), 30g; Shanyao (Rhizoma Dioscoreae), 45g; Danpi (Cortex Moutan), 24g; Fuling (Sclerotium Poriae), 60g; Yuan Shen (Radix Scrophulariae), 30g; Jiao Sanxian (Ferus Fructus Crataegi, Semen Ziziphus Spinosae, Fructus Massonae), each 60g; Jineijin (Endothelium Corneum Gigeriae Galli), 30g; Xiang Daoya (Fructus Oryzae Germinatus cum Aromate), 60g; Sharen (Fructus Amomi Rotundus), 15g; Baizhu (Rhizoma Atractylodis Macrocephalae), 30g; Chao Zhike (Pericarpium Citri Reticulatae Viride), 30g; Muxiang (Radix Aucklandiae), 15g.
Grind all herbs into fine powder, mix with refined honey to make pills the size of paulownia seeds. Take 6g after breakfast and dinner daily. Suspend use if a cold occurs.
[Commentary]: The patient had a baseline Yin deficiency and contracted illness in late spring, consistent with the *Neijing* principle: "If essence is not stored in winter, warmth diseases will occur in spring." Emaciation, dry cough, thin and crimson tongue, and wiry, fine, small, rapid pulses are signs of Yin depletion. Thus, initial treatment focused on nourishing Yin and resolving pathogens, concluding with pills to nourish Yin and harmonize the Stomach, aiming to fundamentally improve the Yin-deficient constitution.
Wind-Warmth 5 (Lobar Pneumonia)
Kong XX, Male, 20 years old
First Visit
Continuous fever for 4 days, temperature 38.7°C–39.5°C, intermittent aversion to cold, headache, paroxysmal cough, chest pain upon coughing, sweating more pronounced above the chest, chest tightness, shortness of breath, wheezing, thick yellow sticky sputum, occasional rust-colored sputum, no bowel movement for two days. Tongue is red with yellow coating, thick and rough at the root, dry. Pulses are surging, slippery, and rapid. Irritability, dry mouth, desire for cold drinks. Western medical examination confirmed lobar pneumonia. This belongs to Wind-Warmth with accumulated heat obstructing the Lung, phlegm-heat blocking internally, and disorder of ascending and descending functions. Urgently apply clearing, dispersing, and transforming methods. Diet must be cautious to prevent worsening.
Suye (Folium Perillae), each 6g; Xingren (Semen Pruni Armeniacae), 10g; Sheng Shigao (Gypsum Fibrosum), 25g; Sheng Gancao (Radix Glycyrrhizae), 6g; Laifuzi (Semen Raphani), 10g; Baijiezi (Semen Sinapis Albae), 3g; Tiantili (Fructus Descurainiae), 3g; Lugeng (Rhizoma Phragmitis), 25g; Daihe San (Powder of Haematitum and Concha Meretricis), 12g (wrapped); 2 doses.
Second Visit
After two doses, body heat subsided, cough and wheezing reduced, chest pain ceased, sputum expectoration easier and lighter in color, yellow thick coating gradually dissolving, bowel movement smooth, pulses wiry and slippery, rapidness greatly reduced. Heat stagnation resolved, residual heat mild, Lung Qi unblocked, ascending/descending functions adjusting. Modify previous formula, continue avoiding meat and greasy food.
Qianhu (Radix Peucedani), 3g; Xingren (Semen Pruni Armeniacae), 10g; Huangqin (Radix Scutellariae), 10g; Zhebeimu (Bulbus Fritillariae Thunbergii), 12g; Suye (Folium Perillae), each 3g; Laifuzi (Semen Raphani), 6g; Daihe San (Powder of Haematitum and Concha Meretricis), 12g (wrapped); Dongguazi (Semen Benincasae), 30g; Maolugeng (Rhizoma Imperatae et Phragmitis), each 30g; 2 doses.
Third Visit
After another two doses, fever, cough, and wheezing cured, sleep peaceful, cough and sputum minimal, pulses still wiry and slippery, bowel and bladder normal. Fluoroscopy shows slightly coarse lung markings, pneumonia basically absorbed, significant improvement. Continue clearing and transforming.
Qianhu (Radix Peucedani), 3g; Xingren (Semen Pruni Armeniacae), 6g; Suzi (Fructus Lepidii seu Descurainiae), 10g; Huangqin (Radix Scutellariae), 10g; Zhi Paye (Folium Eriobotryae Praeparatum), 10g; Daihe San (Powder of Haematitum and Concha Meretricis), 10g (wrapped); Lugeng (Rhizoma Phragmitis), 25g; Jiao Sanxian (Ferus Fructus Crataegi, Semen Ziziphus Spinosae, Fructus Massonae), each 10g; 2 doses.
After two more doses, everything normalized, rested for five days before returning to work.
[Commentary]: Lobar pneumonia often presents with chills and high fever, resembling Cold Damage. Do not treat it as Cold Damage. It is caused by phlegm-heat obstruction in the Lung, leading to Qi mechanism dysfunction. Hence, cough causes chest pain, and sputum is rust-colored. Physical exam shows lung consolidation signs. Diagnosis should combine modern medical examinations. TCM treatment focuses on clearing and transforming phlegm-heat, so that pathogenic heat has no phlegm to bind with, making it easy to eliminate. Master Zhao’s case involved three visits, all focusing on clearing and transforming phlegm. Principles from Sanzi Yangqin Tang, Tingli Daizao Xiefei Tang, and Qianjin Weijing Tang are reflected in the formulas. Careful study clarifies the treatment method.
Wind-Warmth 6 (Bronchopneumonia)
Xing XX, Male, 7 years old
First Visit:
Fever and cough, red face and eyes, thick yellow tongue coating, dry mouth with desire to drink, no bowel movement for two days, severe night cough, scanty yellow urine, wiry, rapid, and forceful pulses. Two days ago, took a prescription: Mahuang (Herba Ephedrae), 6g; Guizhi (Ramulus Cinnamomi), 10g; Xingren (Semen Pruni Armeniacae), 10g; Zhigancao (Radix Glycyrrhizae Preparata), 10g; Fuling (Sclerotium Poriae), 10g; Shengjiang (Rhizoma Zingiberis Recens), 3g; Dazao (Fructus Jujubae), 2 pieces; 1 dose. After medication, fever worsened, temperature 40°C, cough and wheezing, blood in sputum, occasional confusion, sore and swollen throat, tonsillar white exudate and swelling. WBC count 12,000/mm³, urine normal. X-ray fluoroscopy: coarse lung markings, consistent with bronchopneumonia. This is Wind-Warmth with heat accumulating in the Lung, food stagnation in Stomach and Intestines. Should have used clearing, transforming, and guiding stagnation out. Mistakenly used acrid-warm diaphoresis, treating heat with heat, causing multiple symptoms to arise, with potential reverse transmission to the Pericardium. Temporarily use Liangge San to drain heat and unblock the Bowels.
Bohe (Herba Menthae), 2g (added later); Qianhu (Radix Peucedani), 6g; Huangqin (Radix Scutellariae), 10g; Sheng Shigao (Gypsum Fibrosum), 20g; Gouteng (Ramulus Uncariae cum Uncis), 6g; Laifuzi (Semen Raphani), 6g; Zixue Dan (Purple Snow Pill), 1.5g (mixed separately); Lingyangjiao Fen (Hornis Rhinocerotis Pulvis), 0.6g (mixed separately); 1 dose.
Second Visit
After medication, fever gradually subsided, cough and wheezing significantly reduced, no hemoptysis, consciousness clear, slept well last night, one bowel movement this morning, dark and sticky stool with foul odor, disease trend declining. Root of tongue has slightly thick yellow coating, slight throat pain. Warm pathogen and residual heat reduced but not cleared. Continue descending Lung Qi, transforming phlegm, clearing heat, and resolving stagnation. Avoid greasy/meaty foods and sweet/sticky candies.
Qianhu (Radix Peucedani), 3g; Xingren (Semen Pruni Armeniacae), 10g; Chuanbeimu (Bulbus Fritillariae Cirrhosae), 3g; Gouteng (Ramulus Uncariae cum Uncis), 10g; Huangqin (Radix Scutellariae), 6g; Gualou Ren (Semen Benincasae), 15g; Laifuzi (Semen Raphani), 6g; Fresh Pear (one piece, sliced with skin, pith removed); 2 doses.
Third Visit
Fever completely gone, temperature 36.7°C, no cough or wheezing, no hemoptysis. X-ray normal, WBC 6,700/mm³, urine normal. Pulses fine, small, and slippery. Tongue coating cleared. Bowel and bladder normal. Advised careful diet for one week, can attend school.
[Commentary]: Bronchopneumonia is common in children, mainly presenting with fever, wheezing, and cough. Severe cases may involve convulsions and stirring wind. This case was a misdiagnosis/mistreatment. It was Wind-Warmth with stagnation, but heavy use of Mahuang Tang to release the exterior led to imminent convulsions, critical danger. Treatment used Liangge San to drain heat and unblock Bowels. Lung and Large Intestine are exterior-interior related; if intestinal fu-organs are full, Lung cannot descend properly. Thus, for heat obstructing the Lung, unblocking the Bowels is often the quickest method. The foul stool after medication indicates downward discharge of accumulated heat, leading to fever reduction and calm breathing. Initial use of Zixue Dan and Lingyangjiao Fen aimed to clear Heart and cool Liver to prevent convulsions, showing foresight.
Wind-Warmth 7 (Bronchopneumonia)
Di XX, Female, 5 years old
First Visit
Fever for 2-3 days, temperature 38.5°C, cough, shortness of breath, wheezing. X-ray: Bronchopneumonia, WBC 12,000/mm³. Pulses slippery and rapid. Finger vein deep purple, reaching Mingguan (Life Gate). Tongue red with white greasy coating, thick at root. Two nocturnal febrile convulsions. Sweating, thirst, slightly dry stool. This is Wind-Warmth with heat accumulation, stirring wind due to heat. Urgently use clearing heat, cooling Liver, and extinguishing wind.
Bohe (Herba Menthae), 1g (added later); Sheng Shigao (Gypsum Fibrosum), 10g (decocted first); Zhimu (Rhizoma Anemarrhenae), 6g; Lianqiao (Fructus Forsythiae), 6g; Lugeng (Rhizoma Phragmitis), 30g; Gouteng (Ramulus Uncariae cum Uncis), 10g; Jiao Sanxian (Ferus Fructus Crataegi, Semen Ziziphus Spinosae, Fructus Massonae), each 6g; Lingyangjiao Fen (Hornis Rhinocerotis Pulvis), 0.3g (mixed separately); 1 dose.
Second Visit
Fever gradually decreasing, temperature 38°C, cough/wheezing slightly lighter, pulses still slippery and rapid. No convulsions yesterday. Thirst, restless sleep at night, dry stool, scanty red urine. Warm pathogen heat in Qi level. Continue clearing heat and extinguishing wind.
Bohe (Herba Menthae), 1g (added later); Sheng Shigao (Gypsum Fibrosum), 10g; Jiangcan (Bombyx Batryticatus), 4.5g; Lianqiao (Fructus Forsythiae), 10g; Lugeng (Rhizoma Phragmitis), 30g; Gouteng (Ramulus Uncariae cum Uncis), 10g; Lingyangjiao Fen (Hornis Rhinocerotis Pulvis), 0.3g (mixed separately); 2 doses.
Third Visit
Fever gradually receding, temperature 37.5°C, cough/wheezing greatly reduced, no convulsions, good sleep last night. Pulses wiry and slippery, rapidness greatly reduced. Finger vein faded, returned to Fengguan (Wind Gate). Tongue red with slightly thick coating. Adjust previous formula.
Qianhu (Radix Peucedani), 1.5g; Chan Yi (Periostracum Cicadae), 3g; Pian Jianghuang (Rhizoma Curcumae Longae), 3g; Gouteng (Ramulus Uncariae cum Uncis), 10g; Lugeng (Rhizoma Phragmitis), 30g; Jiao Maiya (Fructus Hordei Germinatus), 6g; Niuhuang Baolong Wan (Calculus Bovis Bao Long Pill), 1 pill (split into two doses mixed with medicine); 2 doses.
Fourth Visit
Fever gone, cough/wheezing stopped, temperature 36.5°C, no convulsions, good sleep. Finger vein and pulses normal. Tongue coating cleared. Bowel/bladder normal. Continue clearing heat and resolving stagnation. Avoid meat/grease, eat vegetarian, keep warm/cool balanced.
Qianhu (Radix Peucedani), 1.5g; Lugeng (Rhizoma Phragmitis), 15g; Jiao Maiya (Fructus Hordei Germinatus), 10g; Jineijin (Endothelium Corneum Gigeriae Galli), 10g; 2 doses. After which all symptoms settled, regulated for one week to normal.
[Commentary]: This is Wind-Warmth with excessive heat in Qi level stirring wind. Used clearing heat, cooling Liver, extinguishing wind. Shigao and Zhimu follow Baihu Tang to clear Yangming heat; Gouteng and Lingyangjiao imply Lingjiao Gouteng Tang to extinguish Jueyin wind; Jiao Sanxian resolves internal food stagnation; Bohe, Lianqiao, Lugeng disperse external wind-heat. This illustrates the application of "transmitting heat outwards."
Spring-Warmth 1 (Upper Respiratory Tract Infection)
Shao XX, Female, 57 years old
First Visit
Contracted warmth in late spring, emaciated, dark and turbid complexion, baseline Yin deficiency, insufficient fluids. Recently contracted warm pathogen, mild fever, slight aversion to cold, dry cough without sputum, slight headache, irritability, dry mouth, sore throat. Tongue dry, thin, fresh red. Pulses wiry, fine, small, rapid. This is Yin deficiency with warmth contraction, fluid depletion. Use nourishing Yin and clearing/dispersing method.
Fei Yuzhu (Rhizoma Polygonati Odorati), 10g; Nen Baiwei (Cortex Corydalis), 6g; Chao Zhipi (Cortex Gardeniae Preparata), 6g; Dan Douchi (Ferus Sojae Preparatus), 10g; Ku Jiegeng (Radix Platycodonis), 6g; Qianhu (Radix Peucedani), 6g; Shashen (Radix Glehniae), 10g; Xingren (Semen Pruni Armeniacae), 6g; Maolugeng (Rhizoma Imperatae et Phragmitis), each 10g; 3 doses.
Second Visit
After medication, chills/fever resolved, still dry cough without sputum. Remove Douchi and Jiegeng from original formula, add Maidong (Tuber Ophiopogonis), 10g; Tiandong (Tuber Asparagi), 10g. Another 3 doses led to gradual recovery.
[Commentary]: Treating exterior syndromes requires attention to baseline constitution. This patient had baseline Yin injury and early fluid depletion. Contracting warm pathogen further injured Yin despite mild fever. Dry thin red tongue and wiry fine small rapid pulses indicate organ Yin deficiency and stagnant heat. Used nourishing Yin, generating fluids, clearing stagnant heat, following Jiawei Weirui Tang. However, only adopted its Yin-nourishing intent, omitting Congbai (Scallion Stem) for releasing exterior, adding light dispersing Yin-nourishing herbs. Herbs matched pathology, achieving effect.
Spring-Warmth 2 (Severe Cold)
Song XX, Female, 65 years old
First Visit
Illness onset in early spring, fever for over 20 days, temperature around 38.5°C. Emaciated, dark complexion. Tongue dry, crimson, cracked. Coating thick, dirty, scorched yellow. Lips dry, peeling. Poor appetite, abdominal distension/pain refusing pressure. Dry mouth desiring cold drinks. Red, dry, painful throat. Pulses sinking, fine, small, slippery, still forceful upon pressure. History of pulmonary tuberculosis for 10+ years, night sweats, occasional low-grade fever. Recent warm pathogen contraction, repeated use of acrid-warm exterior-releasing herbs caused severe fluid loss, extreme Yin deficiency, major fluid injury, accumulated heat and Fu-organ excess, constipation. Yin depletion leads to intensified heat; intestinal dryness consumes Yin further. Must protect fluids to moisten dryness, unblock Fu-excess to remove heat. This is root deficiency with branch excess. Urgently use Zengye Chengqi Tang.
Yuanshen (Radix Scrophulariae), 45g; Sheng Dihuang (Radix Rehmanniae), 30g; Maimendong (Tuber Ophiopogonis), 25g; Baishao (Radix Paeoniae Alba), 30g; Chuan Shihu (Caulis Dendrobii), 25g; Mangxiao (Natrii Sulfas), 1.5g (mixed); Dahuang Fen (Radix et Rhizoma Rhei Pulvis), 1.2g (mixed); 1 dose.
Second Visit
After medication, smooth bowel movement last night. Initially dry like sheep dung, then softer. Anal fissure, slight blood. Temperature 37.5°C today. Tongue dry, crimson, cracked. Appetite improving, abdominal distension reduced. Throat still red, pain easing. Pulses sinking, fine, small, slippery, slightly weaker. Baseline Yin insufficiency, blood deficiency with heat excess. Warm disease further injured Yin, causing constipation. Fluid exhaustion and intestinal dryness, "boat stopping without water." Initially used "increasing water to move boat" method for moistening intestines and unblocking bowels. Now stool passed, heat reduced. Use sweet-cold to moisten dryness, using tonifying herbs as purgatives. Do not use Mangxiao or Dahuang again.
Beishashen (Radix Glehniae), 30g; Sheng Dihuang (Radix Rehmanniae), 25g; Baishao (Radix Paeoniae Alba), 25g; Qing Ejiao (Colla Corii Asini), 15g (melted in two parts); Heimuer (Auricula Auricularia), 12g; Zhi Biejia (Carapax et Plastrum Testudinis), 15g (decocted first); Maimendong (Tuber Ophiopogonis), 15g; 2 doses.
Third Visit
Fever completely gone, temperature 37°C. Tongue coating cleared, substance crimson and dry/cracked. Appetite normal. One more normal bowel movement, abdomen not distended, throat dry/pain gone. Pulses fine, wiry, small, slippery. Continue sweet-cold to nurture Yin, treating the root.
Sheng Dihuang (Radix Rehmanniae), 25g; Beishashen (Radix Glehniae), 25g; Sheng Baishao (Radix Paeoniae Alba), 25g; Sheng Yimi (Semen Coicis), 15g; Sheng Baibian Dou (Semen Phaseoli Radiati), 25g; Qing Ejiao (Colla Corii Asini), 12g (melted in two parts); Tianmaidong (Tuber Asparagi et Ophiopogonis), each 10g; Jineijin (Endothelium Corneum Gigeriae Galli), 10g; 5 doses.
After medication, all symptoms settled, fever gone. Good diet and sleep. Advised avoiding spicy and rich flavors, eating light diet.
[Commentary]: Baseline tuberculosis indicates Yin deficiency constitution. Early spring warmth illness fits "winter essence not stored, spring warmth disease." Warm pathogen injures Yin (second injury). Post-illness mistaken use of acrid-warm herbs, frequent sweating, further injures Yin (third injury). Yin/fluid injury leads to dry-heat accumulating in Fu-organs, "boat stopping without water." Initially used "increasing water to move boat," stool passed, symptoms reduced. Then switched to sweet-cold moistening, "using tonics as purgatives," fearing harsh Mangxiao/Dahuang would damage long-term ill, elderly constitution. Such caution is evident. Ultimately concluded with sweet-cold Yin nurturing. This proves preserving Yin is paramount in treating Warm Diseases.