凉遏(胃肠型感冒)
周某某，女，57岁
初诊
平素脾胃虚弱，内停蕴郁之湿，复感暑热之邪，身热头晕胸脘满闷，口渴。医不察内湿蕴郁而进白虎。服后即觉胸脘满闷异常，少腹因之不舒，舌苔白滑而腻，脉象濡软力弱。素体阳气不足，辛凉重剂戕伤中阳，中焦运化失灵，腹中隐隐作痛，辛馓温以化湿邪，佐芳香兼以缓痛。生冷皆忌。
苏叶6克，藿香梗10克(后下)，大豆卷10克，半夏10克，厚朴6克，白蔻仁3克，煨姜2克，木香5克，茯苓皮10克，二付
二诊
前进芳香疏解、辛微温以化湿之后，中脘满闷渐解，腹中隐痛未作，脉仍濡软，力量略增，再以芳香疏调，治在中焦。
苏藿梗各6克，半夏曲10克，陈皮6克，厚朴花6克，白莲仁3克，鲜煨姜3克，焦麦芽10克，二付而愈。
[按]：凉遏是湿热证中由于治疗不当或饮食失宜而引起的一种变证类型。凡感受湿热之邪而发病者，若患者调摄失宣，或恣食饮冷，或贪凉过度，或误服寒凉之剂，致寒凉阻遏中阳，凝塞气机，湿浊由寒凉而愈盛，脾胃升降之机被阻，全身气机为之滞涩。证见胸脘痞闷加重，憋气堵满，时欲叹息，全身酸楚沉重，大便溏泄，小溲不畅，面色淡黄，舌质略红，舌苔白滑而腻，脉濡缓沉软。治宜辛苦微温法，先开湿郁以畅中阳，宣展气机以利三焦，解其凉遏，湿邪自化，气机宣畅，热随湿皆有出路矣。药如半夏、陈皮、杏仁、白蔻仁、草豆蔻、苍术、木香等。若凉遏偏于上焦者，卫气失宣，阳气不布，周身酸楚，心胸憋闷，时欲叹鼠者，治宜辛以开郁，可用苏叶梗，藿香、白芷、防风等。
必先开湿郁，解凉遏，再议清热，此为定法。此案患者本属内停蕴湿，复感暑热，医误用白虎寒凉重剂，致湿被凉遏，气机滞涩，胸闷异常，治阻辛微温以化湿邪。佐芳香以畅气机，方中无一味凉药，其取“温则消而去之”之意，故投之即效。
寒凝(胃肠型感冒)
鲍某某，男，21岁
初诊
连日炎热，突然患感，身热头晕，心烦口渴，暴吃冰棍六、七支，又过多吃生冷瓜果，移时即觉胸中堵满、憋闷，呼吸粗促，腹中胀小便短少，少腹作痛。遂来应诊。面色青暗，舌白淡腻润精多液，两脉沉涩不畅。此暑热外受，暴进生冷，阳气郁遏，湿为寒凉凝涩，寒凝之证，宜先以辛香微温，宣郁缓痛，温解寒凝。侯寒化、凝开、湿去，再行清化方法。
陈香薷15克(后下)，藿苏梗各10克，白芷6克，煨姜6克，桂枝尖2克，草豆蔻3克，木香6克，白蔻仁2克，半夏10克，二付
二诊
药后遗体小汗出，身热头晕皆减、胸满、憋气堵问之证见轻，呼吸粗促已解，面色略暗小便甚畅。舌仍淡腻，两脉已渐转滑利。前方去陈香薷、桂枝尖、草豆蔻，又服二付而安。
[按]：寒凝亦为湿热误治之一种，原因亦与凉遏同，为贪凉饮冷，或误服寒凉。惟寒凝在程度上较凉遏为重。多由素体中阳不足，湿热之邪多从阴化而归太阴，复加寒冷凝滞中阳，气机为之闭涩，证见胸脘痞满堵闷异常，怫怫作喘，腹中隐痛，大便清稀，小便清白，舌质淡苔白腻水滑，脉沉涩或沉软不起。寒凝湿滞，气机闭阻，非辛温之剂不能驱寒开凝通闭，药宜桂枝尖，草豆蔻、苏叶梗、白蔻仁，生姜等，此等用药，全在于以辛温驱寒解凝，乃救误之法，权宜之计也。中病即止，不可久服。如本案所示，二诊汗出证减，为寒凝已解，即去辛温之品，但用芳香宣化可也。
冰伏(重感冒)
张某某，女，40岁
初诊
近日患感，自觉头晕，身热。恶心，胸闷，全身酸软无力。昨日自服安宫牛黄丸二丸，次日即胸闷异常，呼吸气粗，下肢浮肿，全身无力，四肢逆冷，面色苍白且浮。顷诊两脉沉伏，按之涩而不畅，舌白质淡苔滑润液多，小便不爽，精神萎靡。此暑湿蕴热，过服寒凉，邪被冰伏于中，急以辛温通阳，芳香祛湿，解冰伏散寒邪，开郁通闭。
桂枝10克，干姜6克，香薷6克，半夏10克，厚朴6克，草蔻3克，炒川椒6克，生姜6克，一付，煎服
二诊
药后遍体小汗，身热已退，胸闷大减，呼吸正常，面目四肢浮肿皆退，两脉渐起，脉象濡滑，四肢转温，舌润质略红。此寒去冰解，改用芳香宣化方法：
藿香10克，半夏10克，厚朴6克，草蔻3克，陈皮10克，苍术6克，生姜6克，茯苓10克，冬瓜皮20克
又服三付而愈
[按]：冰伏为湿热证误治最重的一种，其程度较寒凝更甚。并非湿热病一用寒凉即成冰伏，一般湿热证贪凉饮冷，误服寒药，轻者为凉遏，重者成寒凝，最重者变冰伏。故冰伏者虽亦因过用寒凉而来，却多发生于素体阳虚的病人，暴进冷饮，或过服寒凉重剂，致阳气重伤，寒湿大盛，阳气式徽，湿热之邪为寒凉所迫，深伏于内，渐成冰冻之势，气机为之闭塞，阴阳之气不相顺接，阳气不能达于四末。证见面色苍白晦暗，胸脘痞闷堵满概重，憋气似喘，气难接续，四肢厥冷，少腹绞痛，颈面如肿，舌淡润水滑，多液欲滴，脉象沉迟伏或沉涩，重按脉难应指。此冰伏之势已成，邪气深伏难出，急用辛热燥烈之品“温散冰冻，开郁通闭，宜四逆理中方法，药如桂枝，肉桂、干姜、川椒、草蔻、生姜、吴茱萸，淡附片等。药后若面色转为红润，四肢厥冷转温，舌苔水滑已化，脉象沉伏渐起，胸闷憋气减轻，周身微似汗出，即球伏得解，阳气宣通之象，可及时停药，以免温燥过用而转增其热。本案患者因误服安宫牛黄丸而成冰伏，及时应用辛温通阳方法，得遍体小汗，诸证向安，即改用芳香宣化，以清理余邪。
以上湿阻、凉遏、寒凝、冰伏四证多因湿热证误治而成，故所用治法亦为救误之法，乃吾师长期临床经验之精华。观当今之临床湿热证为病甚多，而治疗多不得其法，盖湿热证病多而杂，向无成法可依故也。吾师于湿热证辨治最有心得，既得家传师授，又经临床积累，总结为湿热证辨治十法，分三焦论治，今附之于后，“备临证参考。
附：赵绍琴辨治湿热证十法
(一)芳香宣化法(上焦)
暑热之邪袭于外，湿热秽浊蕴于中。
证见：头晕身热，周身酸沉乏力，胸中气塞，脘闷咳嗽，小便黄赤，舌苔白腻而滑，脉濡滑。
此湿温初起之证，宜芳香宣化方法，鲜佩兰10克(后下)，大豆卷10克，鲜藿香10克(后下)，嫩前胡3克，川郁金6克，白蒺藜10克，姜竹茹10克，制厚朴5克，川黄连3克(研冲)，通草3克
(二)芳香疏解法(上焦)：
暑热外受，表气不畅。
证见：形寒头晕，周身酸楚，身热肌肤干涩，中皖满闷，恶心呕吐，腹中不舒。舌苔白腻，脉濡滑，按之濡软略数。
芳香疏解，退热定呕。
佩兰叶12克(后下)，广藿香10克(后下)，陈香薷5克(后下)，大豆卷10克+制厚朴6克，自蔻仁5克，煨鲜姜3克，杏仁6克，太乙玉枢丹1克研细分冲。
(三)芳香化浊法(上、中焦)：
暑热湿滞、互阻中焦。
证见；身热泛恶，呕吐痰水，心烦急躁，两目有神，口干不欲饮水。胸腹中阵痛，大便欲解不得。舌白苔腻，脉象糯数，按之弦滑且数。
以芳香化浊法定呕降逆折热。
佩兰叶10克(后下)，藿香6克(后下)，制厚朴6克，半夏曲12克，川连3克，佛手10克，大腹皮10克，煨姜3克，保和丸12克(布包)，赤芍12克，焦麦芽10克
上落水沉香末1克、白蔻仁末1克二味共研装胶囊分两次汤药迭下。沉香末以降其气逆，蔻仁末以化开湿郁。治若不当，即可转痢。
(四)轻扬宣解法(上、中焦)：
暑温蕴热，互阻肺胃。
证见：身热头晕，咳嗽痰多，胸脘痞闷。舌红苔白腻，脉弦滑略数，右脉濡滑且数。
热在肺胃，法宣宣解；湿浊中阻，又当轻扬。
香豆豉12克，炒山栀6克，嫩前胡3克，象贝母10克，杏仁泥10克，枇杷叶12克(布包)，保和丸15克(布包)。鲜芦根30克
(五)宣肃疏化法(上、中焦)：
暑湿热郁，蕴阻肺胃
证见：咳嗽痰多，胸中满闷，大便不通，小溲赤黄，舌苔黄垢而厚，脉象孺滑，右关尺滑且有力。
宜宣肃上焦，疏化畅中法。
前胡3克，象贝母12克，杏仁泥10克，香豆豉12克(布包)，山栀3克，炙杷叶12(布包)，黄芩10克，保和丸15克(布包)，焦麦芽10克，枳壳3克
(六)轻宣清化法(上、中焦)：
暑热偏多，湿邪略少。
证见：身热咳嗽，汗出口干，意欲凉饮+胸脘少闷。舌红苔黄，脉滑数略濡，右部有力。
宜清解暑热，轻宣他浊
薄荷细枝2克(后下)，佩兰叶10克(后下)，连翘12克，炙杷叶12克(布包)，白蒺黎12克+前胡3克，杏仁10克，川贝母5克(研冲)，鲜西瓜翠衣30克，鲜荷叶一角，益元散12克(布包)，竹叶6克，黄芩6克
(七)辛开苦降法(中焦)：
湿热病，热郁中州，湿阻不化。
证见：头晕且胀，胸闷而周身酸楚，漾漾泛恶，大便不畅，小便赤黄，苔白滑腻，脉濡滑而沉取有力。
宜辛开其部以利三焦，苦降其热以燥湿浊，少佐淡渗分消。
白蒺藜10克，佩兰叶12克(后下)，白芷3克(后下)，半夏10克，黄芩10克，黄连3克(研冲)，炒苡米12克，白蔻仁12克，赤苓12克，滑石12克
(八)宣化通腑法(中、下焦)：
暑挟湿滞，互阻不化。
证见：恶心口区吐，愎胀矢气，大便不通，小溲艰涩。舌苔白腻，根部垢厚，脉濡滑关、尺有力。
宜宣化降逆，展气通腑，一方两法，兼顾胃肠。
鲜佩兰1 2克(后下)，鲜藿香6克(后下)，香豆豉12克，山栀5克，新会皮5克，佛手片10克，槟榔10克，杏仁10克，前胡6克，通草3克，煨姜2克。
酒军O.5克，太乙玉枢丹1克二味共研，装胶囊，分两次用佛手片10克，媲姜3克，煎汤送下，先药服。(此定呕法)
(九)泄化余邪、轻通胃肠法(中、下焦)：
湿温后期，身热已遢，症状大轻，余热未除，湿热积滞退而不净。
证见：大便不通，腑气不畅，腹中不舒，舌苔腻根黄厚，脉象濡滑，右侧关、尺滑且有力。
直泄化余邪而通胃肠
白蒺藜10克，粉丹皮6克，香青蒿1克，枳实3克，鲜杷叶12克，保和丸15克(布包)，全瓜蒌30克，知母6克，炒苡米12克，山楂炭12克，杏仁10克，茵陈12克，白蔻仁末0.6克、生熟大黄末各1克，上三味共研细末装胶囊，分两次汤药送下。
(十)泄化余邪、甘润和中(中、下焦)：
湿温初愈，邪退不净，中阳未复，阴分亦虚，运化欠佳。
证见：胃纳不馨，周身乏力。舌胖而淡，脉濡精缓弱，按之弱而无力。
宜泄化余邪，甘润和中方法，以善其后。病势向愈，饮食寒暖切当留意。
川石斛12克，丹皮6克，香青蒿0.5克，甜杏仁10克，范志曲12克，鸡内金10克，冬瓜子20克，茯苓皮15克，生熟谷麦芽各12克，香砂枳术丸15克(布包)
周某某，女性，57岁。
初诊：
患者平素脾胃虚弱，体内停滞蕴结郁滞的湿邪，又外感暑热之邪，出现身体发热、头晕、胸部和胃脘部满闷不适、口渴等症状。医生未察觉其内有湿邪蕴结郁滞，而使用了白虎汤（清热生津的重剂）。服药后即刻感到胸脘部满闷异常，小腹部因此也不舒适，舌苔白滑且腻，脉象濡软无力。患者素体阳气不足，辛凉重剂损伤了中焦阳气，导致中焦运化功能失灵，腹中隐隐作痛。治疗宜用辛微温之法以化除湿邪，佐以芳香药物兼以缓解疼痛。忌食生冷食物。
处方：苏叶6克，藿香梗10克（后下），大豆卷10克，半夏10克，厚朴6克，白蔻仁3克，煨姜2克，木香5克，茯苓皮10克。共两剂。
二诊：
经过前方芳香疏解、辛微温以化湿的治疗后，中脘部的满闷症状逐渐解除，腹中隐痛未再发作，脉象仍显濡软，但力量略有增加。继续采用芳香疏调的方法，治疗重点在中焦。
处方：苏梗、藿香梗各6克，半夏曲10克，陈皮6克，厚朴花6克，白莲仁3克，鲜煨姜3克，焦麦芽10克。服用两剂后痊愈。
[按语]：凉遏是湿热证中由于治疗不当或饮食失宜而引起的一种变证类型。凡是感受湿热之邪而发病者，如果患者调摄失当，或恣意食用冷饮，或贪凉过度，或误服寒凉药物，导致寒凉阻遏中焦阳气，凝塞气机，湿浊因寒凉而更加盛实，脾胃升降的功能被阻滞，全身气机随之滞涩。症状表现为胸脘痞闷加重，憋气堵满，时常想要叹息，全身酸楚沉重，大便溏泄，小便不畅，面色淡黄，舌质略红，舌苔白滑而腻，脉象濡缓沉软。治疗宜用辛苦微温法，先开通湿郁以畅达中阳，宣展气机以利三焦，解除凉遏，湿邪自然化解，气机宣畅，热随湿气皆有出路。药物如半夏、陈皮、杏仁、白蔻仁、草豆蔻、苍术、木香等。若凉遏偏于上焦者，卫气失于宣发，阳气不能布散，周身酸楚，心胸憋闷，时常想要叹息者，治疗宜用辛味药以开郁，可用苏叶梗、藿香、白芷、防风等。
必须先开通湿郁，解除凉遏，然后再议清热，这是固定的法则。此案患者本属体内停滞蕴湿，又复感暑热，医生误用白虎汤这一寒凉重剂，导致湿邪被凉遏，气机滞涩，胸闷异常，故治疗阻断使用辛微温以化湿邪，佐以芳香以畅达气机，方中无一味凉药，取其“温则消而去之”的意思，所以投药即效。
鲍某某，男性，21岁。
初诊：
连日炎热，突然患病，身体发热、头晕，心烦口渴，暴饮冰棍六七支，又过量吃生冷瓜果，过了一会儿即觉得胸中堵满、憋闷，呼吸粗促，腹部胀满、小便短少，小腹部作痛。于是前来就诊。面色青暗，舌白淡腻润精多液，两脉沉涩不畅。此为暑热外受，暴进生冷，阳气郁遏，湿为寒凉凝涩，属于寒凝之证，宜先用辛香微温之法，宣通郁滞、缓解疼痛，温散解除寒凝。待寒化、凝开、湿去之后，再进行清化方法。
处方：陈香薷15克（后下），藿香梗、苏梗各10克，白芷6克，煨姜6克，桂枝尖2克，草豆蔻3克，木香6克，白蔻仁2克，半夏10克。共两剂。
二诊：
服药后身体微微出汗，身体发热、头晕皆减轻，胸满、憋气堵闷的症状见轻，呼吸粗促已解除，面色略暗，小便非常通畅。舌仍淡腻，两脉已渐转滑利。前方去掉陈香薷、桂枝尖、草豆蔻，又服用两剂而安。
[按语]：寒凝也是湿热误治的一种，原因与凉遏相同，多为贪凉饮冷，或误服寒凉药物。只是寒凝在程度上较凉遏为重。多由素体中阳不足，湿热之邪多从阴化而归太阴，再加上寒冷凝滞中阳，气机为之闭涩，症状表现为胸脘痞满堵闷异常，怫怫作喘（气喘貌），腹中隐痛，大便清稀，小便清白，舌质淡苔白腻水滑，脉沉涩或沉软不起。寒凝湿滞，气机闭阻，非辛温之剂不能驱寒开凝通闭，药物宜用桂枝尖、草豆蔻、苏叶梗、白蔻仁、生姜等，这些用药，全在于以辛温驱寒解凝，乃是救误之法，权宜之计也。中病即止，不可久服。如本案所示，二诊汗出证减，为寒凝已解，即去掉辛温之品，仅用芳香宣化即可。
张某某，女性，40岁。
初诊：
近日患病，自觉头晕，身体发热，恶心，胸闷，全身酸软无力。昨日自行服用安宫牛黄丸两丸，次日即胸闷异常，呼吸气粗，下肢浮肿，全身无力，四肢逆冷，面色苍白且浮。诊察时两脉沉伏，按之涩而不畅，舌白质淡苔滑润液多，小便不爽，精神萎靡。此为暑湿蕴热，过服寒凉，邪气被冰伏于中，急需用辛温通阳，芳香祛湿，解冰伏散寒邪，开郁通闭。
处方：桂枝10克，干姜6克，香薷6克，半夏10克，厚朴6克，草蔻3克，炒川椒6克，生姜6克。一剂，煎服。
二诊：
服药后遍体微微出汗，身体热已退，胸闷大减，呼吸正常，面目四肢浮肿皆退，两脉渐起，脉象濡滑，四肢转温，舌润质略红。此为寒去冰解，改用芳香宣化方法：
处方：藿香10克，半夏10克，厚朴6克，草蔻3克，陈皮10克，苍术6克，生姜6克，茯苓10克，冬瓜皮20克。
又服用三剂而愈。
[按语]：冰伏是湿热证误治最重的一种，其程度较寒凝更甚。并非湿热病一用寒凉即成冰伏，一般湿热证贪凉饮冷，误服寒药，轻者为凉遏，重者成寒凝，最重者变冰伏。故冰伏者虽亦因过用寒凉而来，却多发生于素体阳虚的病人，暴进冷饮，或过服寒凉重剂，致阳气重伤，寒湿大盛，阳气式微，湿热之邪为寒凉所迫，深伏于内，渐成冰冻之势，气机为之闭塞，阴阳之气不相顺接，阳气不能达于四末。症状见面色苍白晦暗，胸脘痞闷堵满加重，憋气似喘，气难接续，四肢厥冷，少腹绞痛，颈面如肿，舌淡润水滑，多液欲滴，脉象沉迟伏或沉涩，重按脉难应指。此冰伏之势已成，邪气深伏难出，急用辛热燥烈之品“温散冰冻，开郁通闭”，宜用四逆理中方法，药物如桂枝、肉桂、干姜、川椒、草蔻、生姜、吴茱萸、淡附片等。药后若面色转为红润，四肢厥冷转温，舌苔水滑已化，脉象沉伏渐起，胸闷憋气减轻，周身微似汗出，即冰伏得解，阳气宣通之象，可及时停药，以免温燥过用而转增其热。本案患者因误服安宫牛黄丸而成冰伏，及时应用辛温通阳方法，得遍体小汗，诸证向安，即改用芳香宣化，以清理余邪。
以上湿阻、凉遏、寒凝、冰伏四证多因湿热证误治而成，故所用治法亦为救误之法，乃吾师长期临床经验之精华。观当今之临床湿热证为病甚多，而治疗多不得其法，盖湿热证病多而杂，向无成法可依故也。吾师于湿热证辨治最有心得，既得家传师授，又经临床积累，总结为湿热证辨治十法，分三焦论治，今附之于后，“备临证参考。
(一) 芳香宣化法（上焦）
暑热之邪袭于外，湿热秽浊蕴于中。
症状表现：头晕身热，周身酸沉乏力，胸中气塞，脘闷咳嗽，小便黄赤，舌苔白腻而滑，脉濡滑。
此为湿温初起之证，宜用芳香宣化方法：鲜佩兰10克（后下），大豆卷10克，鲜藿香10克（后下），嫩前胡3克，川郁金6克，白蒺藜10克，姜竹茹10克，制厚朴5克，川黄连3克（研冲），通草3克。
(二) 芳香疏解法（上焦）：
暑热外受，表气不畅。
症状表现：形寒头晕，周身酸楚，身热肌肤干涩，中皖满闷，恶心呕吐，腹中不舒。舌苔白腻，脉濡滑，按之濡软略数。
治法：芳香疏解，退热定呕。
处方：佩兰叶12克（后下），广藿香10克（后下），陈香薷5克（后下），大豆卷10克，制厚朴6克，白蔻仁5克，煨鲜姜3克，杏仁6克，太乙玉枢丹1克研细分冲。
(三) 芳香化浊法（上、中焦）：
暑热湿滞、互阻中焦。
症状表现：身热泛恶，呕吐痰水，心烦急躁，两目有神，口干不欲饮水。胸腹中阵痛，大便欲解不得。舌白苔腻，脉象糯数，按之弦滑且数。
治法：以芳香化浊法定呕降逆折热。
处方：佩兰叶10克（后下），藿香6克（后下），制厚朴6克，半夏曲12克，川连3克，佛手10克，大腹皮10克，煨姜3克，保和丸12克（布包），赤芍12克，焦麦芽10克。
另取落水沉香末1克、白蔻仁末1克二味共研装胶囊分两次汤药迭下。沉香末以降其气逆，蔻仁末以化开湿郁。治若不当，即可转痢。
(四) 轻扬宣解法（上、中焦）：
暑温蕴热，互阻肺胃。
症状表现：身热头晕，咳嗽痰多，胸脘痞闷。舌红苔白腻，脉弦滑略数，右脉濡滑且数。
治法：热在肺胃，法宜宣解；湿浊中阻，又当轻扬。
处方：香豆豉12克，炒山栀6克，嫩前胡3克，象贝母10克，杏仁泥10克，枇杷叶12克（布包），保和丸15克（布包）。鲜芦根30克。
(五) 宣肃疏化法（上、中焦）：
暑湿热郁，蕴阻肺胃。
症状表现：咳嗽痰多，胸中满闷，大便不通，小溲赤黄，舌苔黄垢而厚，脉象濡滑，右关尺滑且有力。
治法：宜宣肃上焦，疏化畅中法。
处方：前胡3克，象贝母12克，杏仁泥10克，香豆豉12克（布包），山栀3克，炙杷叶12（布包），黄芩10克，保和丸15克（布包），焦麦芽10克，枳壳3克。
(六) 轻宣清化法（上、中焦）：
暑热偏多，湿邪略少。
症状表现：身热咳嗽，汗出口干，意欲凉饮，胸脘少闷。舌红苔黄，脉滑数略濡，右部有力。
治法：宜清解暑热，轻宣他浊。
处方：薄荷细枝2克（后下），佩兰叶10克（后下），连翘12克，炙杷叶12克（布包），白蒺黎12克，前胡3克，杏仁10克，川贝母5克（研冲），鲜西瓜翠衣30克，鲜荷叶一角，益元散12克（布包），竹叶6克，黄芩6克。
(七) 辛开苦降法（中焦）：
湿热病，热郁中州，湿阻不化。
症状表现：头晕且胀，胸闷而周身酸楚，漾漾泛恶，大便不畅，小便赤黄，苔白滑腻，脉濡滑而沉取有力。
治法：宜辛开其部以利三焦，苦降其热以燥湿浊，少佐淡渗分消。
处方：白蒺藜10克，佩兰叶12克（后下），白芷3克（后下），半夏10克，黄芩10克，黄连3克（研冲），炒苡米12克，白蔻仁12克，赤苓12克，滑石12克。
(八) 宣化通腑法（中、下焦）：
暑挟湿滞，互阻不化。
症状表现：恶心呕逆，腹胀矢气，大便不通，小溲艰涩。舌苔白腻，根部垢厚，脉濡滑关、尺有力。
治法：宜宣化降逆，展气通腑，一方两法，兼顾胃肠。
处方：鲜佩兰12克（后下），鲜藿香6克（后下），香豆豉12克，山栀5克，新会皮5克，佛手片10克，槟榔10克，杏仁10克，前胡6克，通草3克，煨姜2克。
另取酒军0.5克，太乙玉枢丹1克二味共研，装胶囊，分两次用佛手片10克，煨姜3克，煎汤送下，先药服。（此定呕法）
(九) 泄化余邪、轻通胃肠法（中、下焦）：
湿温后期，身热已退，症状大轻，余热未除，湿热积滞退而不净。
症状表现：大便不通，腑气不畅，腹中不舒，舌苔腻根黄厚，脉象濡滑，右侧关、尺滑且有力。
治法：直泄化余邪而通胃肠。
处方：白蒺藜10克，粉丹皮6克，香青蒿1克，枳实3克，鲜杷叶12克，保和丸15克（布包），全瓜蒌30克，知母6克，炒苡米12克，山楂炭12克，杏仁10克，茵陈12克，白蔻仁末0.6克、生熟大黄末各1克，上三味共研细末装胶囊，分两次汤药送下。
(十) 泄化余邪、甘润和中（中、下焦）：
湿温初愈，邪退不净，中阳未复，阴分亦虚，运化欠佳。
症状表现：胃纳不馨，周身乏力。舌胖而淡，脉濡精缓弱，按之弱而无力。
治法：宜泄化余邪，甘润和中方法，以善其后。病势向愈，饮食寒暖切当留意。
处方：川石斛12克，丹皮6克，香青蒿0.5克，甜杏仁10克，范志曲12克，鸡内金10克，冬瓜子20克，茯苓皮15克，生熟谷麦芽各12克，香砂枳术丸15克（布包）。
Cold Suppression (Gastrointestinal Type Cold)
Zhou XX, Female, 57 years old.
First Visit:
The patient has always had weak spleen and stomach, with dampness stagnating and accumulating internally, and recently contracted summer-heat pathogenic factor externally. Symptoms included fever, dizziness, fullness and oppression in the chest and epigastrium, and thirst. The physician failed to recognize the internal dampness accumulation and prescribed Baihu Tang (White Tiger Decoction, a heavy agent for clearing heat and generating fluids). Immediately after taking the medicine, the patient felt extreme fullness and oppression in the chest and epigastrium, and discomfort in the lower abdomen. The tongue coating was white, slippery, and greasy; the pulse was soggy, soft, and weak. The patient's constitution lacked yang qi. The heavy cold-natured and acrid-cool agents damaged the middle jiao yang qi, causing failure of middle jiao transportation and transformation, resulting in dull abdominal pain. Treatment should employ acrid-slightly-warm methods to resolve dampness, assisted by aromatic herbs to relieve pain. Raw and cold foods are contraindicated.
Prescription: Perilla Leaf (Suye) 6g, Aromatic Mint Stem (Huoxiang Geng) 10g (added later), Soybean Sprout (Dadoujuan) 10g, Pinellia Tuber (Banxia) 10g, Magnolia Bark (Houpo) 6g, White Cardamom Seed (Baikouren) 3g, Baked Ginger (Weijiang) 2g, Costus Root (Muxiang) 5g, Poria Skin (Fuling Pi) 10g. Two doses.
Second Visit:
After previous treatment with aromatic dispersing and resolving, and acrid-slightly-warm methods to resolve dampness, the fullness and oppression in the epigastrium gradually resolved, and the dull abdominal pain did not recur. The pulse remained soggy but slightly stronger. Continue with aromatic regulating methods, focusing on the middle jiao.
Prescription: Perilla Stem and Aromatic Mint Stem 6g each, Fermented Pinellia (Banxia Qu) 10g, Tangerine Peel (Chenpi) 6g, Magnolia Flower (Houpuhua) 6g, White Lotus Seed (Bailianren) 3g, Fresh Baked Ginger 3g, Scorched Malt (Jiaomaiya) 10g. Cured after two doses.
[Commentary]: "Liang'e" (Cold Suppression) is a type of complication in damp-heat syndromes caused by improper treatment or dietary indiscretion. For those contracting damp-heat pathogens, if regulation is neglected, or if one indulges in cold drinks/foods, seeks excessive cooling, or mistakenly takes cold-natured medicines, the coldness suppresses the middle jiao yang qi, obstructs qi mechanism, and causes damp turbidity to become more abundant due to the cold. The ascending and descending functions of spleen and stomach are blocked, and the body's qi mechanism becomes stagnant. Symptoms include worsening chest and epigastric stuffiness, feeling of suffocation and fullness, frequent sighing, whole-body soreness and heaviness, loose stools, difficult urination, pale yellow complexion, slightly red tongue body, white slippery and greasy tongue coating, and soggy, slow, deep, and soft pulse. Treatment should use acrid-pungent, bitter, and slightly warm methods to first open damp obstruction to unblock middle yang, promote qi mechanism to benefit the three jiaos, resolve the cold suppression, allowing dampness to transform naturally. Once qi mechanism is smooth, heat will have an exit along with dampness. Herbs such as Pinellia, Tangerine Peel, Apricot Kernel, White Cardamom, Rhizoma Alpiniae Katsumadai, Atractylodes Macrocephala, and Costus Root can be used. If cold suppression is biased towards the upper jiao, with defensive qi failing to disperse and yang qi unable to distribute, causing whole-body soreness, chest oppression, and frequent sighing, treatment should use acrid herbs to open depression, such as Perilla Stem, Aromatic Mint, Angelica Dahurica, and Saposhnikovia Root.
One must first open damp obstruction and resolve cold suppression before discussing clearing heat; this is a fixed principle. In this case, the patient originally had internal dampness accumulation and contracted summer-heat. The physician mistakenly used the heavy cold agent Baihu Tang, causing dampness to be suppressed by cold and qi mechanism to stagnate, leading to extreme chest fullness. Therefore, treatment interrupted the use of cold agents and employed acrid-slightly-warm methods to resolve dampness, assisted by aromatics to smooth qi mechanism. The prescription contained no cold herbs, following the meaning of "warmth eliminates and removes," hence immediate efficacy.
Cold Coagulation (Gastrointestinal Type Cold)
Bao XX, Male, 21 years old.
First Visit:
Due to consecutive hot days, the patient suddenly fell ill with fever, dizziness, irritability, and thirst. He consumed six or seven ice pops and ate excessive raw and cold fruits and vegetables. Shortly after, he felt chest blockage and oppression, coarse breathing, abdominal distension, scanty urine, and lower abdominal pain. Upon examination, his complexion was dark and bluish; the tongue was white, pale, greasy, moist with excess fluid; both pulses were deep, choppy, and unsmooth. This indicates external summer-heat contraction combined with sudden intake of raw/cold foods, leading to depressed yang qi, where dampness is coagulated and stiffened by cold. This is a syndrome of Cold Coagulation. Treatment should initially use acrid-aromatic and slightly warm methods to vent depression, relieve pain, and warm-dispel cold coagulation. After cold resolves, coagulation opens, and dampness leaves, then proceed with clearing and transforming methods.
Prescription: Old Eupatorium Herb (Chen Xiangru) 15g (added later), Aromatic Mint Stem and Perilla Stem 10g each, Angelica Dahurica 6g, Baked Ginger 6g, Cinnamon Twig Tip (Guizhi Jian) 2g, Rhizoma Alpiniae Katsumadai 3g, Costus Root 6g, White Cardamom Seed 2g, Pinellia Tuber 10g. Two doses.
Second Visit:
After medication, slight sweating occurred throughout the body; fever and dizziness decreased significantly. Chest fullness, suffocation, and oppression improved; coarse breathing resolved. Complexion was slightly dark, but urination was very smooth. Tongue remained pale and greasy; pulses gradually became slippery and smooth. Remove Old Eupatorium Herb, Cinnamon Twig Tip, and Rhizoma Alpiniae Katsumadai from the previous prescription; take two more doses to stabilize.
[Commentary]: Cold Coagulation is also a result of mismanagement of damp-heat syndromes, with causes similar to Cold Suppression, often due to seeking coolness, drinking cold liquids, or mistakenly taking cold medicines. However, Cold Coagulation is more severe than Cold Suppression. It often occurs in patients with inherent deficiency of middle yang, where damp-heat pathogens tend to transform into yin and belong to the Taiyin stage. Added cold coagulates and stagnates middle yang, closing off the qi mechanism. Symptoms include extreme chest and epigastric stuffiness and oppression, panting, dull abdominal pain, watery loose stools, clear urine, pale tongue body with white greasy and watery slippery coating, and deep choppy or deep soft pulse that fails to rise. With cold coagulation and damp stagnation blocking the qi mechanism, only acrid-warm agents can dispel cold, open coagulation, and unblock obstruction. Suitable herbs include Cinnamon Twig Tip, Rhizoma Alpiniae Katsumadai, Perilla Stem, White Cardamom Seed, and Ginger. These medications aim to dispel cold and resolve coagulation with acrid-warm properties, serving as emergency rescue measures and temporary expedients. Stop when the disease is cured; do not use long-term. As shown in this case, at the second visit, sweating and symptom reduction indicated resolution of cold coagulation; thus, acrid-warm items were removed, and only aromatic ventilating and transforming methods were used.
Ice Immobilization (Severe Cold)
Zhang XX, Female, 40 years old.
First Visit:
Recently fell ill with dizziness, fever, nausea, chest oppression, and whole-body soreness and weakness. Yesterday, she self-administered two pills of Angong Niuhuang Wan (Calculus Bovis Rescue Pill). The next day, she experienced extreme chest oppression, coarse breathing, lower limb edema, whole-body weakness, cold limbs, and pale, puffy complexion. Examination revealed deep and hidden pulses, choppy and unsmooth upon pressure; white tongue, pale body, slippery coating with excess fluid; difficult urination; and listless spirit. This indicates summer-dampness with accumulated heat, exacerbated by excessive intake of cold medicines, causing pathogens to be immobilized by ice-like cold in the center. Urgently apply acrid-warm methods to unblock yang, aromatic methods to dispel dampness, resolve ice immobilization, dispel cold pathogens, open depression, and unblock obstruction.
Prescription: Cinnamon Twig 10g, Dried Ginger 6g, Eupatorium Herb 6g, Pinellia Tuber 10g, Magnolia Bark 6g, Rhizoma Alpiniae Katsumadai 3g, Stir-fried Sichuan Pepper 6g, Fresh Ginger 6g. One dose, decocted and taken orally.
Second Visit:
After medication, slight sweating occurred throughout the body; fever subsided, chest oppression greatly reduced, breathing normalized, edema in face, eyes, and limbs resolved, pulses gradually rose and became soggy-slippery, limbs turned warm, tongue became moist with slightly red body. This indicates cold gone and ice melted. Switch to aromatic ventilating and transforming method:
Prescription: Aromatic Mint 10g, Pinellia Tuber 10g, Magnolia Bark 6g, Rhizoma Alpiniae Katsumadai 3g, Tangerine Peel 10g, Atractylodes Macrocephala 6g, Fresh Ginger 6g, Poria 10g, Winter Melon Peel 20g.
Cured after three more doses.
[Commentary]: Ice Immobilization is the most severe form of mismanagement in damp-heat syndromes, more severe than Cold Coagulation. Not every use of cold medicine in damp-heat disease leads to Ice Immobilization. Generally, in damp-heat syndromes, seeking coolness, drinking cold liquids, or mistakenly taking cold medicines results in mild cases becoming Cold Suppression, severe cases becoming Cold Coagulation, and most severe cases turning into Ice Immobilization. Thus, although Ice Immobilization arises from excessive use of cold medicines, it mostly occurs in patients with inherent yang deficiency. Sudden intake of cold drinks or heavy cold agents severely injures yang qi, causing abundant cold-dampness and declining yang qi. Damp-heat pathogens are forced deep inside by cold, gradually forming an ice-like state, closing off the qi mechanism. Yin and yang qi fail to connect smoothly, and yang qi cannot reach the four extremities. Symptoms include pale and dull complexion, severe chest and epigastric stuffiness and oppression, suffocation resembling asthma, difficulty continuing breath, cold limbs, colicky lower abdominal pain, swollen neck and face, pale and moist slippery tongue with dripping fluid, and deep, slow, hidden, or choppy pulse difficult to feel even with heavy pressure. With ice immobilization established and pathogens deeply hidden, urgently use acrid-hot and drying-pungent substances to "warmly disperse ice, open depression, and unblock obstruction." Use Sini Lizhong methods (Decoctions for Reversing Collapse and Regulating Middle), such as Cinnamon Twig, Cinnamon Bark, Dried Ginger, Sichuan Pepper, Rhizoma Alpiniae Katsumadai, Ginger, Evodia Fruit, and Prepared Aconite Lateralis Radix. If complexion turns ruddy, limbs warm up, tongue moisture transforms, pulses rise from deep-hidden, chest oppression eases, and slight sweating occurs throughout the body, ice immobilization is resolved, indicating unblocking of yang qi. Stop medication promptly to avoid excessive warming and drying increasing heat. In this case, the patient developed ice immobilization due to mistaken use of Angong Niuhuang Wan. Timely application of acrid-warm methods to unblock yang resulted in slight sweating and stabilization of symptoms, followed by switching to aromatic ventilating and transforming methods to clear residual pathogens.
The above four syndromes—Damp Obstruction, Cold Suppression, Cold Coagulation, and Ice Immobilization—are mostly caused by mismanagement of damp-heat syndromes. Therefore, the treatments used are also emergency rescue methods, representing the essence of my teacher's long-term clinical experience. Observing current clinical practice, there are many damp-heat diseases, yet treatments often miss the mark. This is because damp-heat diseases are numerous and complex, lacking established standard methods. My teacher has profound insights into the differentiation and treatment of damp-heat syndromes, combining family heritage and teacher instruction with clinical accumulation, summarizing ten methods for differentiating and treating damp-heat syndromes, discussed according to the three jiaos. Attached below for clinical reference.
Appendix: Ten Methods for Differentiating and Treating Damp-Heat Syndromes by Zhao Shaoqin
(I) Aromatic Ventilating and Transforming Method (Upper Jiao)
Summer-heat pathogen attacks externally; damp-heat and turbid filth accumulate internally.
Symptoms: Dizziness and fever, whole-body soreness/heaviness and fatigue, chest qi blockage, epigastric oppression and cough, yellow-red urine, white greasy and slippery tongue coating, soggy-slippery pulse.
This is the initial stage of Damp-Warmth. Use aromatic ventilating and transforming method: Fresh Eupatorium Herb 10g (added later), Soybean Sprout 10g, Fresh Aromatic Mint 10g (added later), Tender Peucedanum Root 3g, Curcuma Aromatica Rhizome 6g, Tribulus Fruit 10g, Ginger-processed Bamboo Shavings 10g, Processed Magnolia Bark 5g, Coptis Rhizome 3g (powdered and mixed in), Talcum 3g.
(II) Aromatic Dispersing and Resolving Method (Upper Jiao):
Summer-heat contracted externally, exterior qi flow unsmooth.
Symptoms: Chills and dizziness, whole-body soreness, fever with dry skin, epigastric fullness, nausea and vomiting, abdominal discomfort. White greasy tongue coating, soggy-slippery pulse, soggy-soft and slightly rapid upon pressure.
Method: Aromatic dispersing and resolving, reduce fever and stop vomiting.
Prescription: Patchouli Leaf 12g (added later), Guang Aromatic Mint 10g (added later), Old Eupatorium Herb 5g (added later), Soybean Sprout 10g, Processed Magnolia Bark 6g, White Cardamom Seed 5g, Baked Fresh Ginger 3g, Apricot Kernel 6g, Taiyi Yushu Dan 1g (powdered and mixed in).
(III) Aromatic Resolving Turbidity Method (Upper and Middle Jiao):
Summer-heat and damp-stagnation mutually obstructing the middle jiao.
Symptoms: Fever and nausea, vomiting phlegm-water, irritability, bright eyes, dry mouth without desire to drink. Paroxysmal pain in chest/abdomen, urge to defecate but unable. White greasy tongue coating, soggy-rapid pulse, string-taut-slippery and rapid upon pressure.
Method: Use aromatic resolving turbidity to stop vomiting, direct rebellious qi downward, and curb heat.
Prescription: Patchouli Leaf 10g (added later), Aromatic Mint 6g (added later), Processed Magnolia Bark 6g, Fermented Pinellia 12g, Coptis Rhizome 3g, Bergamot Fruit 10g, Areca Peel 10g, Baked Ginger 3g, Baohe Wan 12g (wrapped), Red Peony Root 12g, Scorched Malt 10g.
Separately, grind Luoshui Chenxiang Powder 1g and White Cardamom Seed Powder 1g together, fill capsules, and take twice with decoction. Chenxiang powder directs rebellious qi downward; Cardamom powder resolves damp depression. Improper treatment may lead to dysentery.
(IV) Light and Yang Ventilating and Resolving Method (Upper and Middle Jiao):
Summer-warmth with accumulated heat mutually obstructing Lung and Stomach.
Symptoms: Fever and dizziness, cough with profuse sputum, chest and epigastric stuffiness. Red tongue with white greasy coating, string-taut-slippery and slightly rapid pulse, right side soggy-slippery and rapid.
Method: Heat in Lung/Stomach requires ventilating and resolving; damp-turbidity obstructing middle requires light and floating approaches.
Prescription: Fermented Soybean 12g, Stir-fried Gardenia 6g, Tender Peucedanum Root 3g, Fritillaria Thunbergii Bulb 10g, Apricot Kernel Paste 10g, Loquat Leaf 12g (wrapped), Baohe Wan 15g (wrapped). Fresh Reed Rhizome 30g.
(V) Ventilating, Sedating, Dispersing, and Transforming Method (Upper and Middle Jiao):
Summer-heat-dampness depression, accumulating and obstructing Lung and Stomach.
Symptoms: Cough with profuse sputum, chest fullness, constipation, dark-yellow urine, yellow dirty and thick tongue coating, soggy-slippery pulse, right Guan and Chi positions slippery and forceful.
Method: Ventilate and sedate Upper Jiao, disperse and transform to smooth Middle Jiao.
Prescription: Peucedanum Root 3g, Fritillaria Thunbergii Bulb 12g, Apricot Kernel Paste 10g, Fermented Soybean 12g (wrapped), Gardenia 3g, Roasted Loquat Leaf 12 (wrapped), Scutellaria Root 10g, Baohe Wan 15g (wrapped), Scorched Malt 10g, Aurantium Fructus 3g.
(VI) Light Ventilating and Clearing Transforming Method (Upper and Middle Jiao):
More summer-heat, slightly less dampness.
Symptoms: Fever and cough, sweating with dry mouth, desire for cool drinks, slight chest/epigastric oppression. Red tongue with yellow coating, slippery-rapid and slightly soggy pulse, right side forceful.
Method: Clear and resolve summer-heat, lightly ventilate turbidity.
Prescription: Thin Mint Branch 2g (added later), Patchouli Leaf 10g (added later), Forsythia Fruit 12g, Roasted Loquat Leaf 12g (wrapped), Tribulus Fruit 12g, Peucedanum Root 3g, Apricot Kernel 10g, Fritillaria Cirrhosa Bulb 5g (powdered and mixed in), Fresh Watermelon Rind 30g, Fresh Lotus Leaf corner, Yi Yuan San 12g (wrapped), Bamboo Leaf 6g, Scutellaria Root 6g.
(VII) Acrid Opening and Bitter Descending Method (Middle Jiao):
Damp-heat disease, heat depression in Middle Earth, dampness obstruction failing to transform.
Symptoms: Dizziness and distension, chest oppression with whole-body soreness, nausea, difficult defecation, dark-yellow urine, white slippery greasy coating, soggy-slippery pulse, forceful upon deep pressure.
Method: Acridly open to benefit three jiaos, bitterly descend to dry damp-turbidity, slightly assist with bland leaching to separate and eliminate.
Prescription: Tribulus Fruit 10g, Patchouli Leaf 12g (added later), Angelica Dahurica 3g (added later), Pinellia Tuber 10g, Scutellaria Root 10g, Coptis Rhizome 3g (powdered and mixed in), Stir-fried Coix Seed 12g, White Cardamom Seed 12g, Red Poria 12g, Talcum 12g.
(VIII) Ventilating Transforming and Purging Bowels Method (Middle and Lower Jiao):
Summer-heat with damp-stagnation mutually obstructing and failing to transform.
Symptoms: Nausea and vomiting, abdominal distension with flatus, constipation, difficult urination. White greasy tongue coating, dirty and thick root, soggy-slippery pulse, forceful at Guan and Chi positions.
Method: Ventilating transforming and directing rebellious qi downward, expanding qi and purging bowels. One prescription, two methods, attending to both stomach and intestines.
Prescription: Fresh Patchouli 12g (added later), Fresh Aromatic Mint 6g (added later), Fermented Soybean 12g, Gardenia 5g, Xin Hui Peel 5g, Bergamot Slice 10g, Areca Nut 10g, Apricot Kernel 10g, Peucedanum Root 6g, Talcum 3g, Baked Ginger 2g.
Separately, grind Wine-processed Rhubarb 0.5g and Taiyi Yushu Dan 1g together, fill capsules, take twice with decoction of Bergamot Slice 10g and Baked Ginger 3g, administer medicine first. (This is the method to stop vomiting)
(IX) Draining and Transforming Residual Pathogens, Lightly Unblocking Stomach and Intestines Method (Middle and Lower Jiao):
Late stage of Damp-Warmth, fever has receded, symptoms largely lightened, residual heat remains, damp-heat accumulation has retreated but is not clean.
Symptoms: Constipation, bowel qi unsmooth, abdominal discomfort, greasy tongue coating with yellow-thick root, soggy-slippery pulse, right Guan and Chi positions slippery and forceful.
Method: Directly drain and transform residual pathogens and unblock stomach/intestines.
Prescription: Tribulus Fruit 10g, Moutan Cortex 6g, Sweet Wormwood Sprout 1g, Zhi Shi 3g, Fresh Loquat Leaf 12g, Baohe Wan 15g (wrapped), Whole Trichosanthes Fruit 30g, Anemarrhena Rhizome 6g, Stir-fried Coix Seed 12g, Charred Hawthorn Fruit 12g, Apricot Kernel 10g, Yinchen 12g, White Cardamom Seed Powder 0.6g, Raw and Prepared Rhubarb Powder 1g each. Grind these three powders finely, fill capsules, take twice with decoction.
(X) Draining and Transforming Residual Pathogens, Sweet-Moistening and Harmonizing Middle Method (Middle and Lower Jiao):
Early recovery from Damp-Warmth, pathogens retreated but not clean, middle yang not restored, yin aspect also deficient, transportation poor.
Symptoms: Poor appetite, whole-body fatigue. Fat and pale tongue, soggy-slow-weak pulse, weak and powerless upon pressure.
Method: Drain and transform residual pathogens, sweet-moisten and harmonize middle to conclude treatment. Pay attention to diet and temperature as condition improves.
Prescription: Dendrobium 12g, Moutan Cortex 6g, Sweet Wormwood Sprout 0.5g, Sweet Apricot Kernel 10g, Fan Zhi Qu 12g, Chicken Gizzard Lining 10g, Winter Melon Seed 20g, Poria Skin 15g, Raw and Prepared Grain/Malt 12g each, Xiangsha Zhizhu Wan 15g (wrapped).