冬温2(重感冒)
郑某，男，50岁
初诊
时令当寒反温，咽干心烦，懊依不安，夜寐欠佳，胸中闷闷不乐，连日来过食酒肉辛辣，昨日发烧头晕，体温37 8℃，今诊两脉滑数有力，舌红且干，苔黄根厚浮黑。咽红肿痛，大便干结小溲赤少，自觉灼热，舌疮作痛，唇焦破裂，面红目赤，有时憎寒，口干渴而思冷饮。温邪蕴热在里，热灼津伤，过食辛辣荤腻，胃肠积滞。热妁胸膈，故心烦懊依，积滞不除，则阳明蕴热更甚。凉膈泄热，兼以通腑。
薄荷1.5克(后下)，黄芩10克，炒栀子6克，淡豆豉10克，连翘10克，前胡6克，枳实6克，瓜萎仁25克，元明粉15克(冲)，生大黄粉1.5(后下)，一付
二诊
昨服药2～3小时后，腹痛，大便畅通一次，小溲较多，夜间得小汗而睡眠甚佳，心烦懊慷皆减，体温37℃，身热已退，憎寒亦除，口干渴饮皆轻，舌红苔黄根部略厚，咽红减而肿痛亦止，两脉弦滑仍有力，但数象已无。温邪蕴热，肠胃积滞，药后虽减，但尚未除尽。再以凉胸膈，化积滞，兼以通腑。
炒山栀6克，淡豆豉12克，蝉衣6克，银花18克，竹叶6
克，炒枳壳10克，黄芩10克，瓜萎仁18克，焦三仙各10克，大黄粉1克，元明粉1克(分两次冲)，二付
三诊
药后大便畅通两次，心烦懊饿已除，身热退净，憎寒止而时有口干，舌苔已化，根部略厚不多，咽部红肿皆止，脉象濡滑而有神。胃肠滞热已除，温邪蕴热亦解。仍议疏调胃肠方法。
饮食寒暖，诸当小心，辛辣荤腥仍忌。
炒山栀6克，淡豆豉10克，净蝉衣6克，竹叶茹各6克，炒枳壳6克，大腹皮10克，焦三仙各10克，水红花子10克，大黄1克
四诊
诸证悉除，二便如常，食眠已安，舌脉正常。上方去大黄三付。辛辣腥荤续忌一周。
[按]：冬令反温，感之者即病冬温。该患者恣食酒肉辛辣，肠胃积滞蕴热已久，故病发即传人阳明。治用栀豉轻宣郁热，硝黄微泻胃腑，得大便畅行，郁热顿解，而懊慷悉除矣。凡四诊始终以疏调胃肠为不变之法。治阳明挟滞之温病，此可为镜矣。
春温(重症肌无合并重感冒)
胡某某，女，52岁
初诊患者固重症肌无力住院半年，西药每日注射新斯的明二次，中药出入于八珍汤、十全大补汤之间。4日前突然发烧，体温38.5℃，致病情迅速恶化，每次吃饭前必须加注一次新斯的明，否则不能坚持将饭顺利吃下。因虑其呼吸肌麻痹而致衰竭，已准备向外院借用铁肺备急。由于体温持续上升，病情难以控制，遂请全院老大夫共同会诊。
病人面色萎黄，形体消瘦，精神不振，舌胖苔白糙老且干，两脉虚濡而数，按之细弦且数，自述心烦梦多，小溲色黄，大便两日未行，身热颇壮，体温39.4℃，已从协和医院借来铁肺准备抢救。会诊时，诸医皆日；气血大虚，必须甘温以除大热。赵师问曰；前服参、芪、桂、附诸药皆甘温也，何其不见效?诸医又曰：原方力量太小，应增加剂量。赵师曰：个人看法，虽属虚人，也能生实病，此所说实病，包括新感病、传染病或其它实证。为慎重起见，先请经治医生用冰箱冷水步少与之黯果病人非常喜饮，又多给了一些，病人仍想多喝，将一杯(约300毫升)喝完，病人说：“我还想喝”，遂又给约300毫升。饮毕自觉头身有小汗出，心情愉快，即时安睡。赵师曰：病人素体气血不足，用甘温补中，本属对证。但目前非本虚为主，乃标热为主，暮春患此，当从春温治之。如是虚热，病人何能饮冰水600毫升，且饮后小汗出而入睡?根据其舌胖苔白糙老且干，两脉虚濡而数，按之细弦且数，心烦梦多，溲黄便秘，断定是阳明气分之热，故改用白虎汤。
生石膏25克，生甘草10克，知母10克，粳米60克，煎100毫升，分两次服，一付
二诊
昨服白虎汤后，夜间汗出身热已退，体温37℃，两脉虚濡而滑，按之细弱，弦数之象已无。病人今日精神甚佳，食欲亦增，心烦减而夜寐甚安，大便已通，小溲甚畅，舌胖苔已滑润，改用甘寒生津益气方法，以善其后。
生石膏12克，沙参10克，麦门冬10克，生甘草10克，知母3克，一付
三诊
药后体温36.5℃，精神益佳，食眠均安。脉象濡软，舌胖质淡红苔薄白且润，余热尽退。已无复燃之虞。仍由经治大夫按原治疗方案治疗原发病可也。
[按]：病有标本，宿疾为本，新病为标。宿疾虽虚，新病未必亦虚，反之亦然。故不可一例而视之。虽是虚人，亦可患实证。此患者素服八珍汤、十全大补汤等甘温之剂，此治其重症肌无力，原属对症。然其暮春患感，陡然高烧，脉舌症皆显热象，岂可以虚热对待。虽前贤有甘温除大热之法，然其可治内伤虚热，不能退外感之实热。故虽从医皆日可补，独先生能力排众议，坚请用清。若无定见于胸中，宁不随波逐流以免涉险乎?其用冷水试饮一法，又见诊断之细致入微。如果系实热，则必喜冷饮，若属虚热，则必不喜冷饮。以此法试之，虚实立判。故诊为阳明白虎证，投以白虎汤原方，立见功效。昔薛立斋氏尝以口唇冷热为判定寒热真假之标志，信非虚言矣。
痄腮1(流行性腮腺炎)
孙某某，7岁
初诊
初春患感，身热，微有恶寒，两侧耳下腮肿作痛，舌红苔白根厚，大便略千，小便短黄，口渴心烦，脉象浮滑且数，按之滑数有力。此温邪毒热内蕴，痄腮初起，当以轻宣清解，火郁当发也，宜外用热敷法。忌荤腥油腻，宜静卧休息。
薄荷2克(后下)，杏仁10克，蝉衣6克，僵蚕10克，前胡6克，片姜黄6克，浙贝12克，茅芦根各24克，焦山楂12克，二付
连服两剂，药后得小汗而身热已退，大便已通，腮肿亦退，原方加元参24克，赤芍10克又三付而愈。
[按]：痄腮多见于儿童，颌下肿硬作痛，伴发热恶寒，此为温毒之一种，必素体蕴热，复感温邪，热毒上攻，结于少阳之分，步阳乃枢机所在，枢机不利，则邪结不散澈治之以升降散疏调气机，运转枢机，合杏仁、前胡、薄荷宣肺散邪，浙贝母消肿散结，茅芦根泄热利水遭，焦山楂和胃助消化。药合病机，故能两剂而愈。其外用热敷之法乃先生独到经验，取“温则消而去之”之意，亦《内经》“火郁发之”之一法也。
痄腮2(流行性腮腺走)
黄某某，男，7岁
初诊
发烧2天，体温37.8℃，头痛寒热不重，昨天开始两侧耳下腮腺肿痛，舌红咽痛不肿，两脉浮滑且数，微有咳嗽，夜间睡眠不安，大便略干，小便赤黄。风温郁热上扰，势成痄腮，用宣郁疏风，防其逆传入里，饮食当慎。
薄荷6克(后下)，前胡6克，炒牛蒡6克，片姜黄6克，酒炒黄芩6克，浙贝母6克，僵蚕6克，蝉衣3克，元参10克，马勃3克，芦根20克，二付，并嘱热敷两腮，早晚各30分钟。敷后肿势虽增无妨。
二诊
前药二剂之后，两腮肿势较增而疼痛大减，身热渐退，体温37.3℃，两脉滑数，舌红咽痛皆减，大便已通。风温郁热已透，政以清热解毒方法，仍当静卧休养，饮食当慎。
旋覆花6克，前胡6克，连翘6克，片姜黄6克，僵蚕6
克，元参10克，板兰根10克，马勃3克，焦三仙各6克，二付，仍热敷两腮，早晚各30分钟。
三诊
身热已退净，两脉数象已差，两侧腮腺肿势已退，转为正常。温邪蕴热已解，再以活血通络，清化折热。仍宜静卧休息一周，防引起睾丸炎症。
前胡6克，连翘6克，丹参10克，茜草10克，僵蚕6克，浙贝母10克，马勃3克，板兰根10克，焦三仙各6克，三付。
药后诸证悉平，舌脉二便如常，仍需清淡饮食，以防余热复起。
[按]：腮腺暴肿，是郁热不得宣散澈当宣郁疏风透邪外出，不可骤用凉药。尤奇者，用热敷不用冷敷，盖寒则凝，温则通，寒则涩而不流，温则消而去之。此为妙法。唯热敷后势必引起肿势暂时加重，故预先告知病家，不令惊慌无措。虽肿加，而痛减，是欲消散之兆也。观外治之法，亦当知内治之理，不当骤用寒凉药也。
痄腮3(流行性腮腺炎)
张某某，女，40岁
初诊
从3月12日头痛咳嗽，微有寒热，咽徽痛，两侧腮腺作痛。由于工作忙，未能及时到医院治疗，3月15日曾服安宫牛黄丸二丸，并注射消炎针剂。自17日始，面目周身浮肿，胸闷气短孙便短少，头晕周身酸痛，已不能转动，曾化验小便，无异常发现。风温蕴热在肺卫，发为寒热头痛，本当疏和宣化，今反误服安宫牛黄丸寒凉之品，卫气不宣，湿邪遏阻，三焦不通，故面目一身浮肿。热郁于内，不得外解，故两侧腮腺疼痛加重。
胸阳为湿邪所遏，气机为寒凉抑郁，必须用辛宣以开其郁，活络兼祛其湿，防其增重。
苏叶梗各6克，淡豆豉10克，荆穗炭10克，防风6克，杏仁10克，半夏曲10克，草蔻3克，黄芩6克，大腹皮6克，三付
二诊
前药服后，遍体汗出，身热疼痛及周身疼痛皆解，面目四肢浮肿渐消，今晨体温已基本正常，舌苔白腻滑润已化，舌质红势亦浅，两脉已从沉涩带弦转为滑数，且力渐增。病人自述药后肿、满、闷堵及寒热头晕皆愈，然右腮部肿痛，扪之有核如核桃大。此湿郁蕴热，郁阻少阳络脉，改用宣阳和络，转枢少阳方法。并嘱热敷两侧腮腺，每日早午晚各30分钟。
荆穗炭10克，防风6克，柴胡6克，夏枯草10克，旋覆花10克，枇杷叶15克，杏仁10克，前胡6克，渐贝母10克，黄芩10克，焦山楂10克，二付
三诊
病人自述前药一剂后，右腮明显红肿，延及耳前后及面部，其势较重，因医生曾嘱告：“药后肿势大作”，故病人及家属并未着急，仍服第二剂药，每早、午、昨各热敷30分钟。3月24
日仍服前药，继续热敷。3月25日两腮及面部肿势全消，诸症皆去。静卧休息两天，恢复正常，上班工作。
[按]：此为痄腮误治案。痒腮一证本属外感风热邪毒，与体内蕴热相合，郁而不得宣泄，故发为肿胀疼痛。治当宣疏散邪。而前医竟投安宫牛黄寒凉之剂，致冰伏其邪，气机被郁，三焦不畅，则为胸闷短气，一身面目皆肿。此皆过用寒凉，火郁于内所致澈冶用辛散疏化方法，以解其郁而散其邪。药后得汗，邪随汗泄，立时轻松。二诊改用宣阳和络法，并辅以热敷患部，并预告知肿当加甚。其后果如其言。热敷以助通络，内外合治，促其消散。此与现代医学之冷敷法正相反，其理颇深。热敷后可见肿胀愈甚，宣预先告知病家，以免惊慌。然若无此经验，且不明其理者，未必敢用之也。
大头瘟1(颜面丹毒)
张某某，男，56岁
初诊
发烧两日，头面红肿，微有恶寒，继则寒罢而热增。今日开始头面红肿热痛加重，两目不能开张，咽喉红肿且痛，口渴心烦，大便2～3日未行，舌苔黄厚质红，两脉洪滑且数，按之有力。此风温时毒侵袭卫气，内蕴滞热，势将成温毒大头瘟证。用疏风清热解毒方法，使热祛毒解，消其肿痛。
薄荷3克(后下)，牛蒡子6克，苦桔梗8克，片姜黄6克，黄芩12克，酒黄连4.5克，生甘草6克，元参10克，连翘10克，板兰根10克，马勃3克，紫雪散3克(冲)，二付
二诊
服上药后，遍身小汗，恶寒已解，身热渐退，大便一次，头面红肿略消，两目已能张开，咽喉肿势稍减，仍时作痛，心烦，但夜已成寐，两脉洪滑，数势已差，按之力弱。温热蕴毒渐解。
气分之热未清，再以普济消毒饮法加减，忌食荤腥之物。
蝉衣6克，赤芍10克，牛蒡子6克，紫草6克，连翘12克，银花15克，花粉12克，蚤休10克，鲜茅芦根各30克，紫雪散1 8克(分冲)，二付
三诊
温毒蕴热渐解，头面红肿已退，体温正常，夜寐已安，大便溏薄，每日一次，小溲赤步，脉象弦滑而力差，舌苔根部略厚。温热蕴毒已解，胃肠余滞未清，再以清化湿热兼导积滞，饮食当慎。
僵蚕8克，蝉衣6克，片姜黄6克，连翘10克，蚤休10克，水红花子10克，焦三仙各10克，瓜萎仁25克，元明粉1.5克(分冲)二付
前药又二剂之后，诸恙皆安，大便正常，舌苔已化为正常，慎饮食，忌荤腥一周而安。
[按]：大头瘟一证多系风温时毒侵袭而成，且往往挟内热较重，故当疏风清热解毒治之，仿普济消毒饮之意，疏凤则邪从外散，清热则热自内清，毒解热去，何肿之有?惟三诊时见便溏，每日一行，反用元明粉攻之，盖据舌苔根部略厚，则知大肠余滞未清，导滞之后，大便复常，亦通困通用之法也。
**冬温（重感冒）**
郑某，男，50岁。
初诊：
时令本该寒冷却反常温暖，患者咽干心烦，心中烦闷不安，夜间睡眠不佳，胸中郁闷不乐。连日来过食酒肉及辛辣食物，昨日出现发烧、头晕，体温37.8℃。今日诊察见两脉滑数有力，舌质红且干燥，苔黄厚，根部浮黑。咽喉红肿疼痛，大便干结，小便短赤，自觉灼热感，舌部生疮作痛，嘴唇焦裂，面色红，眼睛充血，有时怕冷，口干渴想喝冷饮。此为温邪蕴热在里，热邪灼伤津液；加之过食辛辣荤腻，导致胃肠积滞。热郁于胸膈，所以心烦懊恼；积滞不除，则阳明蕴热更甚。治宜清泄胸膈之热，兼以通导腑气。
处方：薄荷1.5克（后下），黄芩10克，炒栀子6克，淡豆豉10克，连翘10克，前胡6克，枳实6克，瓜蒌仁25克，元明粉15克（冲服），生大黄粉1.5克（后下）。一付。
二诊：
昨日服药2～3小时后，腹痛，大便畅通一次，小便增多，夜间出少量汗，睡眠很好，心烦懊恼症状减轻，体温降至37℃，身热已退，怕冷也消除了，口干渴饮症状减轻，舌红苔黄根部略厚，咽红减轻且肿痛停止，两脉弦滑仍有力，但数象已无。温邪蕴热和肠胃积滞，用药后虽减轻，但尚未除尽。再拟清泄胸膈、化解积滞，兼以通导腑气。
处方：炒山栀6克，淡豆豉12克，蝉衣6克，银花18克，竹叶6克，炒枳壳10克，黄芩10克，瓜蒌仁18克，焦三仙各10克，大黄粉1克，元明粉1克（分两次冲服）。二付。
三诊：
药后大便畅通两次，心烦懊恼已除，身热退净，怕冷止而时有口干，舌苔已化，根部略厚不多，咽部红肿皆止，脉象濡滑而有神。胃肠滞热已除，温邪蕴热亦解。仍建议疏调胃肠的方法。
饮食寒暖，诸当小心，辛辣荤腥仍忌。
处方：炒山栀6克，淡豆豉10克，净蝉衣6克，竹叶茹各6克，炒枳壳6克，大腹皮10克，焦三仙各10克，水红花子10克，大黄1克。
四诊：
诸证悉除，二便如常，食眠已安，舌脉正常。上方去大黄，三付。辛辣腥荤继续忌口一周。
[按语]：冬季应寒反温，感受此气即病冬温。该患者恣意食用酒肉辛辣，肠胃积滞蕴热已久，故发病即传入阳明经。治疗用栀豉汤轻宣郁热，硝石、大黄微泻胃腑，得大便畅行，郁热顿解，而懊恼悉除。凡四诊始终以疏调胃肠为不变之法。治疗阳明挟滞的温病，此可为借鉴。
**春温（重症肌无力合并重感冒）**
胡某某，女，52岁。
初诊：
患者因重症肌无力住院半年，西药每日注射新斯的明二次，中药在八珍汤、十全大补汤之间加减使用。4日前突然发烧，体温38.5℃，致病情迅速恶化，每次吃饭前必须加注一次新斯的明，否则不能顺利吃完饭菜。因担心呼吸肌麻痹导致衰竭，已准备向外院借用铁肺备用急救。由于体温持续上升，病情难以控制，遂请全院老大夫共同会诊。
病人面色萎黄，形体消瘦，精神不振，舌胖苔白糙老且干，两脉虚濡而数，按之细弦且数。自述心烦梦多，小便色黄，大便两日未行，身热颇壮，体温39.4℃，已从协和医院借来铁肺准备抢救。会诊时，众医都说：气血大虚，必须用甘温药以除大热。赵师问曰：之前服用的参、芪、桂、附诸药都是甘温性质的，为何不见效？众医又说：原方力量太小，应增加剂量。赵师说：个人看法，虽然是虚人，也能患实证，这里所说的实证，包括新感病、传染病或其他实证。为慎重起见，先请经治医生用冰箱冷水少许给病人饮用。病人非常喜饮，又多给了一些，病人仍想多喝，将一杯（约300毫升）喝完，病人说：“我还想喝”，遂又给约300毫升。饮毕自觉头身有小汗出，心情愉快，即时安睡。赵师说：病人素体气血不足，用甘温补中，本属对证。但目前并非本虚为主，乃是标热为主，暮春患此病，应当从春温论治。如果是虚热，病人怎能饮用冰水600毫升，且饮后小汗出而入睡？根据其舌胖苔白糙老且干，两脉虚濡而数，按之细弦且数，心烦梦多，溲黄便秘，断定是阳明气分之热，故改用白虎汤。
处方：生石膏25克，生甘草10克，知母10克，粳米60克。煎取100毫升，分两次服，一付。
二诊：
昨日服用白虎汤后，夜间出汗，身热已退，体温37℃，两脉虚濡而滑，按之细弱，弦数之象已无。病人今日精神甚佳，食欲亦增，心烦减而夜寐甚安，大便已通，小便甚畅，舌胖苔已滑润，改用甘寒生津益气方法，以善其后。
处方：生石膏12克，沙参10克，麦门冬10克，生甘草10克，知母3克。一付。
三诊：
药后体温36.5℃，精神益佳，食眠均安。脉象濡软，舌胖质淡红苔薄白且润，余热尽退。已无复燃之虞。仍由经治大夫按原治疗方案治疗原发病可也。
[按语]：病有标本，宿疾为本，新病为标。宿疾虽虚，新病未必亦虚，反之亦然。故不可一例而视之。虽是虚人，亦可患实证。此患者素服八珍汤、十全大补汤等甘温之剂，这是治疗其重症肌无力，原属对症。然其暮春患感，陡然高烧，脉舌症皆显热象，岂可以虚热对待。虽前贤有甘温除大热之法，然其可治内伤虚热，不能退外感之实热。故虽众医皆曰可补，独先生能力排众议，坚请用清法。若无定见于胸中，岂不随波逐流以免涉险乎？其用冷水试饮一法，又见诊断之细致入微。如果系实热，则必喜冷饮，若属虚热，则必不喜冷饮。以此法试之，虚实立判。故诊为阳明白虎证，投以白虎汤原方，立见功效。昔薛立斋氏尝以口唇冷热为判定寒热真假之标志，信非虚言矣。
**痄腮（流行性腮腺炎）1**
孙某某，7岁。
初诊：
初春患感，身热，微有恶寒，两侧耳下腮肿作痛，舌红苔白根厚，大便略干，小便短黄，口渴心烦，脉象浮滑且数，按之滑数有力。此为温邪毒热内蕴，痄腮初起，当以轻宣清解，火郁当发也，宜外用热敷法。忌荤腥油腻，宜静卧休息。
处方：薄荷2克（后下），杏仁10克，蝉衣6克，僵蚕10克，前胡6克，片姜黄6克，浙贝12克，茅芦根各24克，焦山楂12克。二付。
连服两剂，药后得小汗而身热已退，大便已通，腮肿亦退，原方加元参24克，赤芍10克又三付而愈。
[按语]：痄腮多见于儿童，颌下肿硬作痛，伴发热恶寒，此为温毒之一种，必素体蕴热，复感温邪，热毒上攻，结于少阳之分。少阳乃枢机所在，枢机不利，则邪结不散。治之以升降散疏调气机，运转枢机，合杏仁、前胡、薄荷宣肺散邪，浙贝母消肿散结，茅芦根泄热利水，焦山楂和胃助消化。药合病机，故能两剂而愈。其外用热敷之法乃先生独到经验，取“温则消而去之”之意，亦《内经》“火郁发之”之一法也。
**痄腮（流行性腮腺炎）2**
黄某某，男，7岁。
初诊：
发烧2天，体温37.8℃，头痛寒热不重，昨天开始两侧耳下腮腺肿痛，舌红咽痛不肿，两脉浮滑且数，微有咳嗽，夜间睡眠不安，大便略干，小便赤黄。风温郁热上扰，势成痄腮，用宣郁疏风，防其逆传入里，饮食当慎。
处方：薄荷6克（后下），前胡6克，炒牛蒡6克，片姜黄6克，酒炒黄芩6克，浙贝母6克，僵蚕6克，蝉衣3克，元参10克，马勃3克，芦根20克。二付，并嘱热敷两腮，早晚各30分钟。敷后肿势虽增无妨。
二诊：
前药二剂之后，两腮肿势较增而疼痛大减，身热渐退，体温37.3℃，两脉滑数，舌红咽痛皆减，大便已通。风温郁热已透，改以清热解毒方法，仍当静卧休养，饮食当慎。
处方：旋覆花6克，前胡6克，连翘6克，片姜黄6克，僵蚕6克，元参10克，板兰根10克，马勃3克，焦三仙各6克。二付，仍热敷两腮，早晚各30分钟。
三诊：
身热已退净，两脉数象已差，两侧腮腺肿势已退，转为正常。温邪蕴热已解，再以活血通络，清化余热。仍宜静卧休息一周，防引起睾丸炎症。
处方：前胡6克，连翘6克，丹参10克，茜草10克，僵蚕6克，浙贝母10克，马勃3克，板兰根10克，焦三仙各6克。三付。
药后诸证悉平，舌脉二便如常，仍需清淡饮食，以防余热复起。
[按语]：腮腺暴肿，是郁热不得宣散，当宣郁疏风透邪外出，不可骤用凉药。尤奇者，用热敷不用冷敷，盖寒则凝，温则通，寒则涩而不流，温则消而去之。此为妙法。唯热敷后势必引起肿势暂时加重，故预先告知病家，不令惊慌无措。虽肿加，而痛减，是欲消散之兆也。观外治之法，亦当知内治之理，不当骤用寒凉药也。
**痄腮（流行性腮腺炎）3**
张某某，女，40岁。
初诊：
从3月12日头痛咳嗽，微有寒热，咽微痛，两侧腮腺作痛。由于工作忙，未能及时到医院治疗，3月15日曾服安宫牛黄丸二丸，并注射消炎针剂。自17日始，面目周身浮肿，胸闷气短，小便短少，头晕周身酸痛，已不能转动，曾化验小便，无异常发现。风温蕴热在肺卫，发为寒热头痛，本当疏和宣化，今反误服安宫牛黄丸寒凉之品，卫气不宣，湿邪遏阻，三焦不通，故面目一身浮肿。热郁于内，不得外解，故两侧腮腺疼痛加重。
胸阳为湿邪所遏，气机为寒凉抑郁，必须用辛宣以开其郁，活络兼祛其湿，防其增重。
处方：苏叶梗各6克，淡豆豉10克，荆穗炭10克，防风6克，杏仁10克，半夏曲10克，草蔻3克，黄芩6克，大腹皮6克。三付。
二诊：
前药服后，遍体汗出，身热疼痛及周身疼痛皆解，面目四肢浮肿渐消，今晨体温已基本正常，舌苔白腻滑润已化，舌质红势亦浅，两脉已从沉涩带弦转为滑数，且力渐增。病人自述药后肿、满、闷堵及寒热头晕皆愈，然右腮部肿痛，扪之有核如核桃大。此湿郁蕴热，郁阻少阳络脉，改用宣阳和络，转枢少阳方法。并嘱热敷两侧腮腺，每日早午晚各30分钟。
处方：荆穗炭10克，防风6克，柴胡6克，夏枯草10克，旋覆花10克，枇杷叶15克，杏仁10克，前胡6克，浙贝母10克，黄芩10克，焦山楂10克。二付。
三诊：
病人自述前药一剂后，右腮明显红肿，延及耳前后及面部，其势较重，因医生曾嘱告：“药后肿势大作”，故病人及家属并未着急，仍服第二剂药，每早、午、晚各热敷30分钟。3月24日仍服前药，继续热敷。3月25日两腮及面部肿势全消，诸症皆去。静卧休息两天，恢复正常，上班工作。
[按语]：此为痄腮误治案。痄腮一证本属外感风热邪毒，与体内蕴热相合，郁而不得宣泄，故发为肿胀疼痛。治当宣疏散邪。而前医竟投安宫牛黄寒凉之剂，致冰伏其邪，气机被郁，三焦不畅，则为胸闷短气，一身面目皆肿。此皆过用寒凉，火郁于内所致。治用辛散疏化方法，以解其郁而散其邪。药后得汗，邪随汗泄，立时轻松。二诊改用宣阳和络法，并辅以热敷患部，并预告知肿当加甚。其后果如其言。热敷以助通络，内外合治，促其消散。此与现代医学之冷敷法正相反，其理颇深。热敷后可见肿胀愈甚，应预先告知病家，以免惊慌。然若无此经验，且不明其理者，未必敢用之也。
**大头瘟（颜面丹毒）1**
张某某，男，56岁。
初诊：
发烧两日，头面红肿，微有恶寒，继则寒罢而热增。今日开始头面红肿热痛加重，两目不能开张，咽喉红肿且痛，口渴心烦，大便2～3日未行，舌苔黄厚质红，两脉洪滑且数，按之有力。此风温时毒侵袭卫气，内蕴滞热，势将成温毒大头瘟证。用疏风清热解毒方法，使热祛毒解，消其肿痛。
处方：薄荷3克（后下），牛蒡子6克，苦桔梗8克，片姜黄6克，黄芩12克，酒黄连4.5克，生甘草6克，元参10克，连翘10克，板兰根10克，马勃3克，紫雪散3克（冲服）。二付。
二诊：
服上药后，遍身小汗，恶寒已解，身热渐退，大便一次，头面红肿略消，两目已能张开，咽喉肿势稍减，仍时作痛，心烦，但夜已成寐，两脉洪滑，数势已差，按之力弱。温热蕴毒渐解。
气分之热未清，再以普济消毒饮法加减，忌食荤腥之物。
处方：蝉衣6克，赤芍10克，牛蒡子6克，紫草6克，连翘12克，银花15克，花粉12克，蚤休10克，鲜茅芦根各30克，紫雪散1.8克（分冲）。二付。
三诊：
温毒蕴热渐解，头面红肿已退，体温正常，夜寐已安，大便溏薄，每日一次，小便赤，脉象弦滑而力差，舌苔根部略厚。温热蕴毒已解，胃肠余滞未清，再以清化湿热兼导积滞，饮食当慎。
处方：僵蚕8克，蝉衣6克，片姜黄6克，连翘10克，蚤休10克，水红花子10克，焦三仙各10克，瓜蒌仁25克，元明粉1.5克（分冲）。二付。
前药又二剂之后，诸恙皆安，大便正常，舌苔已化为正常，慎饮食，忌荤腥一周而安。
[按语]：大头瘟一证多系风温时毒侵袭而成，且往往挟内热较重，故当疏风清热解毒治之，仿普济消毒饮之意，疏风则邪从外散，清热则热自内清，毒解热去，何肿之有？惟三诊时见便溏，每日一行，反用元明粉攻之，盖据舌苔根部略厚，则知大肠余滞未清，导滞之后，大便复常，亦通因通用之法也。
**Winter-Warmth (Severe Common Cold)**
Zheng, Male, 50 years old.
First Visit:
The season should be cold but is unusually warm. The patient has a dry throat, irritability, inner restlessness and anxiety, poor night sleep, and a feeling of depression in the chest. Over the past few days, he has consumed excessive amounts of alcohol, meat, and spicy foods. Yesterday, he developed fever and dizziness with a body temperature of 37.8°C. Pulse examination today reveals slippery and rapid pulses with strength on both sides. The tongue is red and dry, with a yellow, thick coating that is floating and black at the root. The pharynx is red, swollen, and painful. Stool is dry and constipated; urine is scanty and dark red, with a sensation of burning. There are oral ulcers causing pain, cracked and parched lips, facial flushing, and injected conjunctiva. Occasionally, there is aversion to cold. There is dry mouth and thirst with a desire for cold drinks. This indicates Warm-Evil heat accumulating internally, scorching and injuring body fluids. Additionally, excessive consumption of spicy and greasy foods has led to accumulation and stagnation in the stomach and intestines. Heat constrained in the chest and diaphragm causes irritability and inner restlessness. If the stagnation is not removed, the accumulated heat in Yangming will become even more severe. Treatment should focus on clearing and draining heat from the chest and diaphragm, combined with unblocking the fu-organs.
Prescription: Bohe (Menthae Haplocalyx) 1.5g (added later), Huangqin (Scutellariae Radix) 10g, Chao Zhizi (Gardeniae Fructus, stir-fried) 6g, Dan Douchi (Sojae Semen Praeparatum) 10g, Lianqiao (Forsythiae Fructum) 10g, Qianhu (Peucedani Radix) 6g, Zhishi (Aurantii Fructus Immaturus) 6g, Gualou Ren (Trichosanthis Semen) 25g, Yuanmingfen (Natrii Sulfas) 15g (dissolved), Sheng Dahuang Fen (Rhei Radix et Rhizoma powder, added later) 1.5g. One dose.
Second Visit:
Two to three hours after taking the medicine yesterday, abdominal pain occurred, followed by one smooth bowel movement. Urine output increased. A slight sweat occurred at night, leading to good sleep. Irritability and inner restlessness decreased. Body temperature dropped to 37°C. Systemic heat subsided, and aversion to cold disappeared. Dry mouth and thirst lessened. The tongue remains red with a slightly thick yellow coating at the root. Pharyngeal redness reduced, and swelling/pain stopped. Pulses are wiry and slippery but still strong; however, the rapid quality is gone. Although the Warm-Evil heat and gastrointestinal stagnation have decreased with medication, they are not yet completely resolved. Continue to clear the chest and diaphragm, resolve stagnation, and unblock the fu-organs.
Prescription: Chao Shanzhi (Gardeniae Fructus, stir-fried) 6g, Dan Douchi (Sojae Semen Praeparatum) 12g, Chenyi (Bombyx Batryticatus) 6g, Yinhua (Lonicerae Japonicae Flos) 18g, Zhuye (Phyllostachidis Folium) 6g, Chao Zhiqiao (Aurantii Fructus, stir-fried) 10g, Huangqin (Scutellariae Radix) 10g, Gualou Ren (Trichosanthis Semen) 18g, Jiao Sanxian (Stir-fried Hawthorn, Medicated Leaven, and Malt) 10g each, Dahuang Fen (Rhei Radix et Rhizoma powder) 1g, Yuanmingfen (Natrii Sulfas) 1g (taken in two divided doses). Two doses.
Third Visit:
After medication, there were two smooth bowel movements. Irritability and inner restlessness have ceased. Systemic heat is completely gone. Aversion to cold has stopped, though occasional dry mouth persists. Tongue coating has transformed, with only slight thickness at the root. Pharyngeal redness and swelling have resolved. Pulse is soggy and slippery with spirit. Gastrointestinal stagnant heat is cleared, and Warm-Evil accumulated heat is resolved. Continue with methods to regulate the stomach and intestines.
Dietary precautions regarding cold/warmth are essential. Avoid spicy and greasy foods.
Prescription: Chao Shanzhi (Gardeniae Fructus, stir-fried) 6g, Dan Douchi (Sojae Semen Praeparatum) 10g, Jing Chenyi (Bombyx Batryticatus) 6g, Zhuyeqiu (Phyllostachidis Folium) 6g each, Chao Zhiqiao (Aurantii Fructus, stir-fried) 6g, Dafupi (Arecae Pericarpium) 10g, Jiao Sanxian (Stir-fried Hawthorn, Medicated Leaven, and Malt) 10g each, Shuihonghua Zi (Polygoni Orientalis Fructus) 10g, Dahuang (Rhei Radix et Rhizoma) 1g.
Fourth Visit:
All symptoms have disappeared. Bowel and bladder functions are normal. Eating and sleeping are stable. Tongue and pulse are normal. Remove Dahuang from the previous prescription. Three doses. Continue to avoid spicy and greasy foods for one week.
[Commentary]: Winter warmth occurs when winter weather is abnormally warm. This patient’s indulgence in alcohol, meat, and spicy foods caused long-standing accumulation and heat in the stomach and intestines, so the disease entered the Yangming stage immediately upon onset. Treatment used Zhichi Tang (Gardenia and Fermented Soybean Decoction) to lightly ventilate constrained heat, and Xiaoshi (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma) to mildly purge the stomach fu. With smooth bowel movements, constrained heat was instantly resolved, and inner restlessness eliminated. Throughout all four visits, regulating the stomach and intestines remained the constant method. This case serves as a reference for treating Warm diseases complicated by Yangming stagnation.
**Spring-Warmth (Myasthenia Gravis Complicated by Severe Common Cold)**
Hu, Female, 52 years old.
First Visit:
The patient had been hospitalized for six months for Myasthenia Gravis, receiving Neostigmine injections twice daily and herbal medicines alternating between Bazhen Tang (Eight-Tonics Decoction) and Shiquan Dabu Tang (Ten Substances Great Tonifying Decoction). Four days ago, sudden fever with a temperature of 38.5°C caused rapid deterioration. She now requires a Neostigmine injection before every meal to eat properly. Due to fear of respiratory muscle paralysis leading to failure, an iron lung was borrowed from another hospital for emergency use. With rising temperatures and uncontrollable condition, senior physicians were consulted collectively.
The patient appeared sallow and emaciated, with low spirits. The tongue was enlarged with a white, rough, old, and dry coating. Pulses were deficient, soggy, and rapid, becoming fine, wiry, and rapid upon pressure. She reported irritability, frequent dreams, yellow urine, and no bowel movement for two days. Systemic heat was significant, with a temperature of 39.4°C. An iron lung had been borrowed from Peking Union Medical College Hospital for rescue. During consultation, other doctors stated: "Qi and Blood are severely deficient; sweet-warm herbs must be used to eliminate great heat." Master Zhao asked: "Previous prescriptions containing Ginseng, Astragalus, Cinnamon Twig, and Aconite Root were all sweet-warm. Why did they fail?" The doctors replied: "The original dosage was too small; it should be increased." Master Zhao said: "In my opinion, although the patient is constitutionally deficient, she can also suffer from excess conditions, including new external contractions, infectious diseases, or other excess syndromes. For caution, let the attending physician give her some cold water from a refrigerator." The patient drank eagerly and requested more. After finishing one cup (approx. 300ml), she said, "I want more," so another 300ml was given. After drinking, she felt a slight sweat on her head and body, felt happy, and fell asleep immediately. Master Zhao said: "The patient's constitutional Qi and Blood deficiency makes sweet-warm tonification theoretically correct. However, currently, the root deficiency is not primary; rather, the branch-heat is dominant. Contracted in late spring, this should be treated as Spring-Warmth. If it were deficiency-heat, how could she drink 600ml of ice water and fall asleep after sweating slightly? Based on the enlarged tongue with white, rough, old, dry coating, deficient-soggy-rapid pulses becoming fine-wiry-rapid, irritability, frequent dreams, yellow urine, and constipation, I diagnose Heat in the Qi Level of Yangming. Therefore, I change to Baihu Tang (White Tiger Decoction)."
Prescription: Sheng Shigao (Gypsum Fibrosum) 25g, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 10g, Zhimu (Anemarrhenae Rhizoma) 10g, Jingmi (Oryzae Fructus) 60g. Decoct to obtain 100ml, taken in two divided doses. One dose.
Second Visit:
After taking Baihu Tang yesterday, night sweats occurred, and systemic heat subsided. Temperature is 37°C. Pulses are deficient, soggy, and slippery, becoming fine and weak upon pressure; the wiry-rapid quality is gone. The patient has excellent energy and appetite. Irritability has decreased, and night sleep is very peaceful. Bowels have moved, and urination is smooth. The tongue is enlarged, and the coating has become moist and slippery. Switch to sweet-cold methods to generate fluids and benefit Qi to conclude treatment.
Prescription: Sheng Shigao (Gypsum Fibrosum) 12g, Shashen (Glehniae Radix) 10g, Maidong (Ophiopogonis Tuber) 10g, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 10g, Zhimu (Anemarrhenae Rhizoma) 3g. One dose.
Third Visit:
Temperature is 36.5°C. Energy is better. Eating and sleeping are peaceful. Pulse is soggy and soft. Tongue is enlarged, pale-red in substance, with thin white and moist coating. Residual heat is completely gone. No risk of recurrence. The attending physician may continue the original treatment plan for the primary disease.
[Commentary]: Diseases have root and branch aspects. Chronic illness is the root; new illness is the branch. Although the chronic illness involves deficiency, the new illness is not necessarily deficient, and vice versa. Thus, they cannot be treated uniformly. Even a deficient person can suffer from excess conditions. This patient regularly took sweet-warm formulas like Bazhen Tang and Shiquan Dabu Tang for Myasthenia Gravis, which was appropriate for that condition. However, contracting an external pathogen in late spring with sudden high fever presents pulse, tongue, and symptom signs of heat. It cannot be treated as deficiency-heat. Although ancients advocated using sweet-warm herbs to treat great heat, this applies to internal injury deficiency-heat, not external contraction excess-heat. While other doctors insisted on tonification, Master Zhao alone resisted the consensus and firmly advocated clearing heat. Without firm conviction, one might just follow the crowd to avoid risk. His method of testing with cold water showed meticulous diagnosis. Excess-heat patients prefer cold drinks; deficiency-heat patients do not. This test distinguishes excess from deficiency immediately. Diagnosing Yangming Baihu syndrome, he prescribed Baihu Tang, achieving immediate results. Xue Lizhai once used lip temperature to judge true/false cold/heat, which is indeed not empty words.
**Mumps (Epidemic Parotitis) 1**
Sun, Male, 7 years old.
First Visit:
Contracted an external pathogen in early spring. Fever, slight aversion to cold, swelling and pain in the parotid glands on both sides of the ears. Tongue red with white coating, thick at the root. Stool slightly dry. Urine short and yellow. Thirst, irritability. Pulse floating, slippery, and rapid, becoming slippery and strong upon pressure. This is Warm-Evil toxic heat accumulating internally, with early-stage mumps. Treatment should use light ventilation and clearing resolution. Fire constrained must be vented. External hot compress therapy is suitable. Avoid greasy and fishy foods; rest in bed.
Prescription: Bohe (Menthae Haplocalyx) 2g (added later), Xingren (Armeniacae Semen Amarum) 10g, Chenyi (Bombyx Batryticatus) 6g, Jiangcan (Bombyx Batryticatus) 10g, Qianhu (Peucedani Radix) 6g, Pian Jianghuang (Curcumae Radix slice) 6g, Zhebei (Fritillariae Thunbergii Bulbus) 12g, Maolugen (Imperatae Rhizoma and Phragmitis Rhizoma) 24g each, Jiao ShanZha (Crataegi Fructus, stir-fried) 12g. Two doses.
After two doses, slight sweat occurred, fever subsided, bowels moved, and parotid swelling receded. Add Yuanshen (Scrophulariae Radix) 24g and Chishao (Paeoniae Radix Rubra) 10g to the original prescription. Three more doses resulted in recovery.
[Commentary]: Mumps is common in children, presenting with hard, painful swelling under the jaw, accompanied by fever and aversion to cold. It is a type of Warm-Toxin. It requires underlying internal heat plus new Warm-Evil contraction. Toxic heat attacks upward, knotting in the Shaoyang region. Shaoyang is the pivot; if the pivot is dysfunctional, pathogens remain knotted. Treatment uses Shengjiang San (Ascending-Descending Powder) to regulate Qi mechanism and turn the pivot, combined with Xingren, Qianhu, and Bohe to ventilate Lung and scatter pathogens, Zhebei to reduce swelling and dissipate nodules, Malugen to drain heat and promote urination, and Jiao ShanZha to harmonize stomach and aid digestion. The herbs match the pathology, hence recovery in two doses. The external hot compress is Master Zhao’s unique experience, based on the principle "warmth dissolves and removes," also a method from *Neijing* ("Ventilate constrained fire").
**Mumps (Epidemic Parotitis) 2**
Huang, Male, 7 years old.
First Visit:
Fever for 2 days, temperature 37.8°C. Headache, mild chills and fever. Starting yesterday, swelling and pain in parotid glands on both sides. Tongue red, pharynx painful but not swollen. Pulses floating, slippery, and rapid. Mild cough. Restless sleep at night. Stool slightly dry. Urine red and yellow. Wind-Warm constrained heat disturbing upwards, likely developing into mumps. Use ventilation of constraint and dispersal of wind to prevent reversal transmission inward. Diet should be cautious.
Prescription: Bohe (Menthae Haplocalyx) 6g (added later), Qianhu (Peucedani Radix) 6g, Chao Niuxiang (Arctii Fructus, stir-fried) 6g, Pian Jianghuang (Curcumae Radix slice) 6g, Jiuhuangqin (Scutellariae Radix, wine-fried) 6g, Zhebei (Fritillariae Thunbergii Bulbus) 6g, Jiangcan (Bombyx Batryticatus) 6g, Chenyi (Bombyx Batryticatus) 3g, Yuanshen (Scrophulariae Radix) 10g, Mabo (Polyporus) 3g, Lugeng (Phragmitis Rhizoma) 20g. Two doses. Also instruct hot compress on both cheeks, 30 minutes morning and evening. Increased swelling after application is acceptable.
Second Visit:
After two doses, cheek swelling increased but pain significantly decreased. Systemic heat gradually subsided, temperature 37.3°C. Pulses slippery and rapid. Tongue red, pharyngeal pain reduced. Bowels moved. Wind-Warm constrained heat has been vented. Change to clearing heat and detoxifying method. Continue resting and cautious diet.
Prescription: Xuanfuhua (Inulae Flos) 6g, Qianhu (Peucedani Radix) 6g, Lianqiao (Forsythiae Fructum) 6g, Pian Jianghuang (Curcumae Radix slice) 6g, Jiangcan (Bombyx Batryticatus) 6g, Yuanshen (Scrophulariae Radix) 10g, Banlangen (Isatidis Radix) 10g, Mabo (Polyporus) 3g, Jiao Sanxian (Stir-fried Hawthorn, Medicated Leaven, and Malt) 6g each. Two doses. Continue hot compress on both cheeks, 30 minutes morning and evening.
Third Visit:
Systemic heat completely gone. Rapid pulse quality has diminished. Parotid swelling on both sides has receded to normal. Warm-Evil accumulated heat is resolved. Further use blood-invigorating and collateral-unblocking methods, clearing residual heat. Rest in bed for one week to prevent orchitis.
Prescription: Qianhu (Peucedani Radix) 6g, Lianqiao (Forsythiae Fructum) 6g, Danshen (Salviae Miltiorrhizae Radix) 10g, Qiancao (Rubiae Cordifoliae Radix et Rhizoma) 10g, Jiangcan (Bombyx Batryticatus) 6g, Zhebei (Fritillariae Thunbergii Bulbus) 10g, Mabo (Polyporus) 3g, Banlangen (Isatidis Radix) 10g, Jiao Sanxian (Stir-fried Hawthorn, Medicated Leaven, and Malt) 6g each. Three doses.
After medication, all symptoms normalized. Tongue, pulse, and excretions are normal. Maintain bland diet to prevent resurgence of residual heat.
[Commentary]: Sudden parotid swelling is due to constrained heat unable to disperse. Ventilation of constraint and dispersal of wind are needed to guide pathogens out. Do not abruptly use cold herbs. Uniquely, hot compress is used instead of cold. Cold causes coagulation; warmth promotes flow. Cold causes stagnation; warmth dissolves and removes. This is a brilliant method. Hot compress inevitably causes temporary increase in swelling, so warn the family beforehand to avoid panic. Although swelling increases, pain decreases, indicating impending resolution. Understanding external therapy requires understanding internal principles; do not abruptly use cold herbs.
**Mumps (Epidemic Parotitis) 3**
Zhang, Female, 40 years old.
First Visit:
From March 12: headache, cough, mild chills and fever, slight sore throat, pain in parotid glands on both sides. Due to busy work, delayed medical treatment. On March 15, took two pills of Angong Niuhuang Wan and received anti-inflammatory injections. From the 17th: generalized edema of face and body, chest tightness, shortness of breath, scanty urine, dizziness, generalized body ache, inability to move. Urine test showed no abnormalities. Wind-Warm accumulated heat in Lung and Wei levels caused chills, fever, and headache. Should have been treated with harmonizing and ventilating. Instead, cold-natured Angong Niuhuang Wan was mistakenly taken. Wei-Qi failed to ventilate, dampness obstructed, Sanjiao blocked, causing facial and bodily edema. Heat constrained internally, unable to escape externally, worsened parotid pain.
Chest-Yang is obstructed by dampness; Qi mechanism is depressed by cold herbs. Must use pungent ventilation to open constraint, invigorate collaterals, and dispel dampness to prevent worsening.
Prescription: Suzhugeng (Perillae Caulis and Petiole) 6g each, Dan Douchi (Sojae Semen Praeparatum) 10g, Jingsuisui Tan (Leonuri Herba carbonized) 10g, Fangfeng (Saposhnikoviae Radix) 6g, Xingren (Armeniacae Semen Amarum) 10g, Banxiaqu (Pinelliae Tuber prepared with bran) 10g, Cao Kou (Amomi Fructus Rotundus) 3g, Huangqin (Scutellariae Radix) 6g, Dafupi (Arecae Pericarpium) 6g. Three doses.
Second Visit:
After medication, full-body sweat occurred. Systemic heat, pain, and body ache resolved. Facial and limb edema gradually subsided. Morning temperature basically normal. White, greasy, slippery tongue coating has transformed. Redness of tongue substance has faded. Pulses changed from deep, choppy, and wiry to slippery and rapid, with increasing strength. Patient reports swelling, fullness, chest tightness, chills, fever, and dizziness have resolved. However, right cheek swelling and pain persist, palpable as a walnut-sized nodule. This is damp-constraint with accumulated heat, blocking Shaoyang collaterals. Change to ventilating Yang and harmonizing collaterals, turning the Shaoyang pivot. Instruct hot compress on both parotids, 30 minutes morning, noon, and evening.
Prescription: Jingsuisui Tan (Leonuri Herba carbonized) 10g, Fangfeng (Saposhnikoviae Radix) 6g, Chaihu (Bupleuri Radix) 6g, Xiakucao (Prunellae Spica) 10g, Xuanfuhua (Inulae Flos) 10g, Pipaye (Eriobotryae Folium) 15g, Xingren (Armeniacae Semen Amarum) 10g, Qianhu (Peucedani Radix) 6g, Zhebei (Fritillariae Thunbergii Bulbus) 10g, Huangqin (Scutellariae Radix) 10g, Jiao ShanZha (Crataegi Fructus, stir-fried) 10g. Two doses.
Third Visit:
Patient reports that after one dose of previous prescription, right cheek became significantly red and swollen, extending to around ears and face, with severe intensity. Because the doctor had warned "swelling will intensify after medication," the patient and family were not anxious. Took second dose. Applied hot compress 30 minutes morning, noon, and evening. Continued previous prescription and hot compress on March 24. By March 25, swelling of both cheeks and face completely disappeared. All symptoms gone. Rested quietly for two days, recovered, and returned to work.
[Commentary]: This is a case of misdiagnosis/treatment of mumps. Mumps is caused by external Wind-Heat toxin combining with internal accumulated heat, constrained and unable to vent, causing swelling and pain. Treatment should be dispersing and venting. Previous doctors mistakenly used cold Angong Niuhuang Wan, freezing the pathogen, depressing Qi mechanism, blocking Sanjiao, causing chest tightness, shortness of breath, and generalized edema. This resulted from overuse of cold herbs, trapping fire internally. Treatment used pungent dispersing and resolving methods to relieve constraint and scatter pathogens. Sweating after medication allowed pathogens to exit with sweat, bringing instant relief. Second visit switched to ventilating Yang and harmonizing collaterals, supplemented by hot compress, with prior warning of increased swelling. Outcome matched prediction. Hot compress aids collateral flow; internal and external treatment together promotes resolution. This contrasts with modern cold compress therapy, with profound rationale. Warn families about potential swelling increase after hot compress to avoid panic. Without this experience and understanding, such treatment would rarely be attempted.
**Big Head Plague (Facial Erysipelas) 1**
Zhang, Male, 56 years old.
First Visit:
Fever for two days. Swelling and redness of head and face, slight aversion to cold. Then chills ceased, and heat increased. Today, swelling, redness, heat, and pain of head and face worsened. Eyes unable to open. Pharynx red, swollen, and painful. Thirst, irritability. No bowel movement for 2-3 days. Tongue coating yellow and thick, substance red. Pulses surging, slippery, and rapid, strong upon pressure. Wind-Warm seasonal toxin attacked Wei and Qi levels, with internal stagnant heat. Likely developing into Warm-Toxin Big Head Plague syndrome. Use dispersing wind, clearing heat, and detoxifying methods to remove heat, resolve toxin, and reduce swelling/pain.
Prescription: Bohe (Menthae Haplocalyx) 3g (added later), Niuzi (Arctii Fructus) 6g, Kujiegeng (Platycodonis Radix) 8g, Pian Jianghuang (Curcumae Radix slice) 6g, Huangqin (Scutellariae Radix) 12g, Jiu Huanglian (Coptidis Rhizoma, wine-fried) 4.5g, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Yuanshen (Scrophulariae Radix) 10g, Lianqiao (Forsythiae Fructum) 10g, Banlangen (Isatidis Radix) 10g, Mabo (Polyporus) 3g, Zixue San (Purple Snow Powder) 3g (dissolved). Two doses.
Second Visit:
After taking medicine, slight full-body sweat occurred. Aversion to cold resolved. Systemic heat gradually subsided. One bowel movement. Head and face swelling/redness slightly reduced. Eyes can open. Pharyngeal swelling slightly reduced, still occasionally painful. Irritability persists, but able to sleep at night. Pulses surging and slippery, rapid quality diminished, weak upon pressure. Warm-heat accumulated toxin gradually resolving.
Heat in Qi level not yet cleared. Modify Puji Xiaodu Yin (Universal Benefit Decoction to Eliminate Toxin) method. Avoid greasy and fishy foods.
Prescription: Chenyi (Bombyx Batryticatus) 6g, Chishao (Paeoniae Radix Rubra) 10g, Niuzi (Arctii Fructus) 6g, Zicao (Arnebiae Radix seu Rhizoma) 6g, Lianqiao (Forsythiae Fructum) 12g, Yinhua (Lonicerae Japonicae Flos) 15g, Huafen (Trichosanthis Radix) 12g, Zhouzhu (Paris Polyphylla) 10g, Xian Maolugen (Imperatae Rhizoma and Phragmitis Rhizoma, fresh) 30g each, Zixue San (Purple Snow Powder) 1.8g (divided doses). Two doses.
Third Visit:
Warm-toxin accumulated heat gradually resolving. Head and face swelling/redness receded. Temperature normal. Night sleep peaceful. Stool loose, once daily. Urine red. Pulse wiry, slippery, but weak. Tongue coating slightly thick at root. Warm-heat accumulated toxin resolved, but residual stagnation in stomach/intestines not cleared. Clear-damp heat and guide out stagnation. Diet cautious.
Prescription: Jiangcan (Bombyx Batryticatus) 8g, Chenyi (Bombyx Batryticatus) 6g, Pian Jianghuang (Curcumae Radix slice) 6g, Lianqiao (Forsythiae Fructum) 10g, Zhouzhu (Paris Polyphylla) 10g, Shuihonghua Zi (Polygoni Orientalis Fructus) 10g, Jiao Sanxian (Stir-fried Hawthorn, Medicated Leaven, and Malt) 10g each, Gualou Ren (Trichosanthis Semen) 25g, Yuanmingfen (Natrii Sulfas) 1.5g (divided doses). Two doses.
After two more doses, all ailments settled. Bowels normal. Tongue coating normalized. Careful diet, avoid greasy/fishy foods for one week, then stable.
[Commentary]: Big Head Plague is mostly caused by Wind-Warm seasonal toxin invasion, often accompanied by heavy internal heat. Treatment should disperse wind, clear heat, and detoxify, imitating Puji Xiaodu Yin. Dispersing wind scatters pathogens externally; clearing heat purifies heat internally. With toxin resolved and heat gone, what swelling remains? In the third visit, loose stool occurred once daily, yet Yuanmingfan (Natrii Sulfas) was used to attack. Based on the slightly thick coating at the root, residual large intestine stagnation was known. After guiding out stagnation, bowels returned to normal. This is the method of "treating obstruction with unblocking" (Tong Yin Tong Yong).