桑丹汤、四汁紫金锭（西瓜汁、芦根汁、生萝卜汁各五瓢，甘蔗汁一杯，紫金锭五分磨汁冲。徐洄溪验方）之
类，方虽神效，然须防热去寒起。每见服后，神识虽清而虚烦自利，手足仍冷，口燥渴饮者，即转机而用既济
汤（吉林参五分，原麦冬钱半，生甘草五分，仙露夏一钱，淡附片五分，鲜竹叶念片，荷叶包生粳米三钱。宋
玉硕易简方），其应如神。须知阳极似阴，其人根气必虚也。甚则有用当归四逆汤（仲景方）调入犀珀至宝丹
（廉臣验方）。或用五枝绛复汤（川桂枝五分，西河柳嫩枝三钱，紫苏旁枝钱半，嫩桑枝二尺，桃树嫩枝一尺，
真新绛钱半，旋复花三钱，青葱管五寸，沈云臣验方）调入局方来复丹，皆能通阴回阳，而令神清厥回者。然
一经肢温阳回，即当易辙，不可过剂，以耗其精液，此为根气下虚者而设。若根气不虚，但因火郁络中而四逆
者，治宜仲景四逆散（川柴胡八分，小枳实钱半，赤芍钱半，生甘草五分）加双钩藤、天仙藤、络石藤各
三钱，嫩桑枝二尺，桔梗一钱，发越肝络之伏风，使转出气分而解。又如肢冷甲青唇黑便秘者，当参厥应下之
一法，治宜仲景大柴胡合绛复汤，通泄肝络之伏邪，转出肠络而解，亦为正宗治法。惟肝络血郁，延累包络，
手足厥阴同病，神昏肢冷，血厥如尸者，宜用通窍活血汤（赤芍、川芎各一钱，桃仁三钱，藏红花五分，青葱
管五寸，鲜姜汁二滴，红枣二枚，当门子五厘。王勋臣医林改错方）调入珠黄散一服（珠粉、西黄、辰砂各二分，
川贝末六分，周澹然温证指归方），服后每见有咯出紫血及粘涎而神清厥回者。清宣脑络，瓜霜紫雪丹、济生
羚犀汤（羚角一钱，
犀角八分，生石膏四钱，生甘草六分，旋复花三钱，紫菀、前胡各钱半，细辛三分。严用和济生方）二方最灵，
其次，犀羚镇痉汤亦有殊功。此皆清络宣气之精要者也。余详开透法中夹血结一节。
十、苦寒复甘寒法者，陈修园谓之苦甘化阴法，吴鞠通谓之甘苦合化阴气法。因伏火烁津耗液，或其人
素禀液虚，虽治当苦寒清火，亦必参以甘寒生津，此为清气血两燔之正法。轻则如白虎加生地黄汤（王孟英方）、
清燥养荣汤（吴又可方）、加减白虎汤（廉臣验方）之类，重则如千金生地黄煎、准绳三黄石膏汤、白虎合黄
连解毒汤（准绳类方）之类。若汗出或疹 出后热仍不解者，胃津亡也，当以甘寒为主，略参苦泄以坚阴。如
白虎加人参汤（仲景方）、人参化 汤（准绳类方）、加味芦根饮子（廉臣验方）之类，皆可酌用，新定五汁
饮（鲜生地汁、鲜金钗汁各三瓢，鲜芦根汁、雅梨汁、甘蔗汁各二瓢，重汤炖温服。廉臣验方）尤为灵效，此
为甘寒参苦寒法。总之苦寒复甘寒者，注重在清降实火，甘寒参苦寒者，注重在清滋虚热，先后虚实之间，临
症制方，不可不细辨也。
十一、苦寒复酸寒法者，苦以清胃，酸以泄肝也。如黄芩汤（仲景方）之芩、芍并用，犀角黄连汤（外
台方）之连、梅并用，清中安蛔汤（汪琥伤寒论注方）之连、柏、乌梅并用，清毒活血汤（聂久吾方）之芩、
连、木通与赤芍、山楂并用，连梅安胃汤（川连六分，川楝子一钱，生白芍钱半，乌梅肉三分，归须八分，赖
橘红五分，炒川椒一分。叶天士验方）之黄连、川楝与乌梅、白芍并用，皆内经所谓酸苦泄热也。若胃阴已亏
者，宜用吴氏连梅汤（小川连一钱，乌梅肉一钱，连心麦冬三钱，细生地三钱，阿胶二钱。鞠通验方）酸苦复
甘寒法。若胃阳已虚者，宜用王氏安胃汤（米炒潞党参钱半，淡干
姜八分，小川连五分，乌梅肉五分，炒枳实八分，炒川椒二分。晋三新制验方）酸苦复辛甘法。他如张氏猪脏
丸（景岳全书方）、加味脏连丸（廉臣验方），一则槐米与醋同煮，一则槐连与醋同煮，则为苦以坚肠、酸以
泄肝法，脏连六味丸则为酸苦泄热、酸甘化阴法，人参乌梅汤（西洋参钱半，乌梅肉三分，木瓜八分，炙甘草
五分，淮山药三钱，带心石莲子一钱。吴氏温病条辨方）则为酸甘化阴、微苦泄热法。总之同一酸苦泄热，而
立法各有不同，功用各擅其长，临时对症选用可也。
十二、苦寒复咸寒法者，取其咸苦达下也。其法有四∶
一清利内肾溺毒，如陈氏夺命饮、犀羚二鲜汤（皆疫痧草方）效力最大；小便饮子（童子小便、鲜生地汁、
生藕汁各一杯，生川柏浸汁两瓢。庞安常伤寒总病论方）、红白散（辰砂一钱，人中白、元明粉各五分，开水
泡去渣服。龚居中寿世仙丹方）、导赤散冲四汁饮（细木通钱半，生甘梢八分，淡竹叶二钱，开水一碗，煎成
冲入∶鲜生地汁、生藕汁、鲜茅根汁、童便各一杯。廉臣验方）、童便四草汤四方亦屡奏捷效。
一清镇冲气上逆，资液救焚汤（医门法律方）、平阳清里汤（梁氏舌鉴辨正方）、加减犀羚二鲜汤（廉臣
验方）三方最有效力；黄连阿胶汤（仲景方）冲入童便一杯，三甲白薇汤（生鳖甲、生打左牡蛎、生龟甲心各
六钱，东白薇五钱，西洋参钱半，归须一钱，生甘梢八分，金银器各一具煎汤代水。廉臣验方）二方亦极灵验。
一清通外肾败精，首推千金栀豉加石膏鼠矢汤、陶氏逍遥汤（陶节庵伤寒全生集方）二方，其次导赤散合
加味虎杖散、猪苓汤合 鼠矢散（皆廉臣验方）皆可酌用。若子宫蓄有败精，每与血浊互结，其症小腹胀痛，
牵引腰腹，攻刺难忍，二便不通，不能坐卧，立哭呻吟，宜急治之，缓则自下胀上，十死不救，急
用鼠麝通精丸（雄鼠粉、王不留行各一两，炒黑丑、五灵脂、炒穿甲、桃仁各五钱，杜牛膝汁粉三钱，麝香三
分，研匀令细，生韭汁泛丸，如麻子大，每服一钱。廉臣验方）一钱或钱半，煎牵牛楝实汤（炒黑丑三钱，盐
水炒川楝子钱半，炒穿甲一钱，小茴香三分。李濒湖验方）送下，往往一服而减，三服而平。
一清滋任脉阴精，丹溪大补阴丸最妙，滋肾益阴煎（炙龟板、大熟地各四钱，川柏八分，知母二钱，生甘
梢八分，春砂仁六分。金鉴妇科心法方）亦灵。他如滋肾六味汤（知母钱半，川柏六分，熟地三钱，山萸肉八
分，丹皮、泽泻、赤苓各钱半，淮药四钱，炙龟板三钱，蒙自桂二分，童便一杯冲）、救阴滋任汤（大黑豆三
钱，熟地二钱，麦冬、冬桑叶、丹皮、山药、南沙参各钱半，猪脊髓一条，青盐二分。皆廉臣验方）亦多奏效。
以上一十二节，皆述清凉法之条目，至于热之浅者在营卫，以石膏、黄芩为主，柴葛为辅；热之深者在胸
膈，以花粉、知母、蒌仁、栀子、豆豉为主；热在肠胃者，当用下法，不用清法，或下法兼清亦可；热入心包
者，黄连、犀角、羚羊角为主；热直入心脏，则难救矣，用牛黄犹可十中救一，须用至钱许，少则无济，非若
小儿惊风诸方，每用分许，即可有效，如戴北山原书云云者。此但言其大要耳。今将当清凉诸症，详列于下∶
热在营卫之候∶身热汗自出，不恶寒反恶热，身重，头面项红肿，周身红肿，眼白黄，目珠胀，鼻孔干，
唇燥，烦躁；轻发疹 ，重发丹斑；舌苔白而底绛，或两边白苔而中红；或身热反减，恶热反甚，咳嗽有痰，
上气喘急，口渴或呕，四畔舌色紫绛中见粉白苔。
热在胸膈，气分抑郁之候∶咽干喉痛，胸胁满痛，甚或胸前红肿按之热甚，小便色黄；舌苔浓白而糙，或
黄腻而燥，或见朱点，或有裂纹，或黄白相兼，或灰白。
热陷心包及心，血分灼烁之候∶谵语发狂，或沉昏嗜睡，或烦扰不寐，四肢厥逆，指甲青紫，大便溏黑
极臭，小便赤涩或痛，舌绛无苔，或舌上略有粘苔（余详开透法诸症中）。
邪热攻脑，或溺毒上脑之候∶晕厥不语，两手发痉，状如惊痫，时 ，头独摇，甚或遗尿直视，筋惕肉
，循衣摸床撮空，舌苔起腐，间有黑点，或起黑晕黑瓣。
热在胃肠之候∶便血，便脓血，谵语多言，腹满痛，唇裂，齿燥，舌苔黄燥（余详攻里法诸症中）。
热陷肝肾之候∶日轻夜重，朝凉暮热，面少华色，口干消渴，气上冲心，心中痛热，饥不欲食，食则吐蛔，
四肢厥逆，烦躁不寐，小便涩痛，甚或癃闭，腰 足冷，大便或秘或溏，甚或泻水，舌绛无苔，干粘带涩，或
紫中兼有黑点。
热陷冲任之候∶朝凉暮热，冲任脉动，少腹里急，阴中拘挛，甚或舌卷囊缩，小便涩痛，男则遗精腰痛，女
则带下如注；舌色焦紫起刺如杨梅，或舌紫无苔而有点，或舌红无苔而胶干，或舌红中有白糜点。
桑丹汤、四汁紫金锭（由西瓜汁、芦根汁、生萝卜汁各五瓢，甘蔗汁一杯组成，另取五分紫金锭磨成汁冲服。此为徐洄溪的经验方）之类的方剂，虽然疗效神奇，但必须防止热邪退去后寒邪兴起。我常常见到患者服药后，虽然神志清醒了，却出现虚烦、自发性腹泻，手脚仍然冰冷，口干口渴想喝水的症状。这时应立即转换治疗方案，使用既济汤（吉林参五分，原麦冬一钱半，生甘草五分，仙露夏一钱，淡附片五分，鲜竹叶二十片，荷叶包裹生粳米三钱。此为宋玉硕的简易方），其效果灵验如神。必须知道，这是阳极似阴的表现，患者的根本元气必然虚弱。严重时甚至需要使用当归四逆汤（张仲景方），调入犀珀至宝丹（何廉臣经验方）。或者使用五枝绛复汤（川桂枝五分，西河柳嫩枝三钱，紫苏旁枝一钱半，嫩桑枝二尺，桃树嫩枝一尺，真新绛一钱半，旋复花三钱，青葱管五寸。沈云臣经验方），调入局方来复丹，这些方法都能通达阴气、回阳救逆，使神志清醒、四肢回暖。然而，一旦肢体温暖、阳气回复，就应当改变治法，不可过度用药，以免耗伤精液，这是针对根本元气下虚的患者所设立的治法。如果根本元气不虚，只是因为火郁结在络脉中而导致四肢厥逆的，治疗适宜用张仲景的四逆散（川柴胡八分，小枳实一钱半，赤芍一钱半，生甘草五分），加入双钩藤、天仙藤、络石藤各三钱，嫩桑枝二尺，桔梗一钱，以发散肝络中潜伏的风邪，使其转出气分而解。又比如出现手脚冰冷、指甲青紫、嘴唇发黑、便秘等症状时，应当参考“厥应下之”的一种治法，治疗适宜用张仲景的大柴胡汤合绛复汤，通泄肝络中潜伏的病邪，使其转出肠络而解，这也是正宗的治法。如果是肝络血瘀，延及心包络，导致手足厥阴经同病，神志昏迷、手脚冰冷、因血厥而像死人一样的情况，适宜使用通窍活血汤（赤芍、川芎各一钱，桃仁三钱，藏红花五分，青葱管五寸，鲜姜汁两滴，红枣二枚，麝香五厘。王清任《医林改错》方），调入珠黄散服用一次（珍珠粉、西黄、辰砂各二分，川贝母末六分，周澹然《温证指归》方），服药后常可见患者咯出紫黑色血液及粘稠涎液，随后神志清醒、四肢回暖。清宣脑络，瓜霜紫雪丹、济生羚犀汤（羚羊角一钱，犀角八分，生石膏四钱，生甘草六分，旋复花三钱，紫菀、前胡各一钱半，细辛三分。严用和《济生方》方）这两个方子最为灵验，其次，犀羚镇痉汤也有特殊功效。这些都是清络宣气的精要之法。详细内容见“开透法”中夹有血结的一节。
十、苦寒复甘寒法，陈修园称之为苦甘化阴法，吴鞠通称之为甘苦合化阴气法。因为伏火灼烧津液耗损体液，或者患者素来禀赋津液不足，虽然治疗应当用苦寒药清火，但也必须配合甘寒药生津，这是清气分和血分同时受热的正法。轻症如白虎加生地黄汤（王孟英方）、清燥养荣汤（吴又可方）、加减白虎汤（何廉臣经验方）之类；重症如千金生地黄煎、准绳三黄石膏汤、白虎合黄连解毒汤（《准绳类方》）之类。如果出汗或皮疹发出后热势仍不解，说明胃津亡失，当以甘寒药为主，略微配合苦泄药以坚固阴液。如白虎加人参汤（张仲景方）、人参化汤（《准绳类方》）、加味芦根饮子（何廉臣经验方）之类，都可以酌情使用，新定五汁饮（鲜生地汁、鲜金钗石斛汁各五瓢，鲜芦根汁、雅梨汁、甘蔗汁各二瓢，隔水炖温服。何廉臣经验方）尤为灵验有效，这属于甘寒配合苦寒的治法。总之，苦寒复甘寒法，注重在于清降实火；甘寒参苦寒法，注重在于清滋虚热，在先后虚实之间，临症制方，不可不仔细辨别。
十一、苦寒复酸寒法，苦味可以清胃，酸味可以泄肝。如黄芩汤（张仲景方）中黄芩、白芍并用，犀角黄连汤（《外台秘要》方）中黄连、乌梅并用，清中安蛔汤（汪琥《伤寒论注》方）中黄连、黄柏、乌梅并用，清毒活血汤（聂久吾方）中黄芩、黄连、木通与赤芍、山楂并用，连梅安胃汤（川黄连六分，川楝子一钱，生白芍一钱半，乌梅肉三分，当归须八分，赖橘红五分，炒川椒一分。叶天士经验方）中黄连、川楝与乌梅、白芍并用，都是《内经》所说的酸苦泄热。如果胃阴已经亏损，适宜用吴氏连梅汤（小川黄连一钱，乌梅肉一钱，连心麦冬三钱，细生地三钱，阿胶二钱。吴鞠通经验方），即酸苦配合甘寒法。如果胃阳已经虚弱，适宜用王氏安胃汤（米炒潞党参一钱半，淡干姜八分，小川黄连五分，乌梅肉五分，炒枳实八分，炒川椒二分。唐宗海新制经验方），即酸苦配合辛甘法。其他如张氏猪脏丸（《景岳全书》方）、加味脏连丸（何廉臣经验方），前者是槐米与醋同煮，后者是槐连与醋同煮，则属于苦以坚肠、酸以泄肝法；脏连六味丸则属于酸苦泄热、酸甘化阴法；人参乌梅汤（西洋参一钱半，乌梅肉三分，木瓜八分，炙甘草五分，淮山药三钱，带心石莲子一钱。吴鞠通《温病条辨》方）则属于酸甘化阴、微苦泄热法。总之，同样是酸苦泄热，但立法各有不同，功用各擅其长，临时对症选用即可。
十二、苦寒复咸寒法，取其咸味和苦味能下达的作用。此法有四方面：
一是清利内肾溺毒，如陈氏夺命饮、犀羚二鲜汤（均出自《疫痧草》方）效力最大；小便饮子（童子小便、鲜生地汁、生藕汁各一杯，生川柏浸汁两瓢。庞安常《伤寒总病论》方）、红白散（辰砂一钱，人中白、元明粉各五分，开水泡去渣服。龚居中《寿世仙丹》方）、导赤散冲四汁饮（细木通一钱半，生甘梢八分，淡竹叶二钱，开水一碗，煎成后冲入：鲜生地汁、生藕汁、鲜茅根汁、童便各一杯。何廉臣经验方）、童便四草汤四方也屡奏捷效。
二是清镇冲气上逆，资液救焚汤（喻嘉言《医门法律》方）、平阳清里汤（梁氏《舌鉴辨正》方）、加减犀羚二鲜汤（何廉臣经验方）三方最有效力；黄连阿胶汤（张仲景方）冲入童便一杯，三甲白薇汤（生鳖甲、生打左牡蛎、生龟甲心各六钱，东白薇五钱，西洋参一钱半，当归须一钱，生甘梢八分，金银器各一具煎汤代水。何廉臣经验方）二方也极灵验。
三是清通外肾败精，首推千金栀豉加石膏鼠矢汤、陶氏逍遥汤（陶华《伤寒全生集》方）二方，其次导赤散合加味虎杖散、猪苓汤合鼠矢散（均为何廉臣经验方）皆可酌情使用。如果子宫蓄积有败精，常与血浊互结，症状表现为小腹胀痛，牵引腰腹，攻刺难忍，大小便不通，不能坐卧，站立哭泣呻吟，应当紧急治疗，拖延则病势自下向上发展，十死无救，急用鼠麝通精丸（雄鼠粉、王不留行各一两，炒黑牵牛子、五灵脂、炒穿山甲、桃仁各五钱，杜牛膝汁粉三钱，麝香三分，研匀令细，用生韭汁泛丸，如麻子大，每服一钱。何廉臣经验方）一钱或一钱半，煎牵牛楝实汤（炒黑牵牛子三钱，盐水炒川楝子一钱半，炒穿山甲一钱，小茴香三分。李时珍经验方）送下，往往一服症状减轻，三服病情平复。
四是清滋任脉阴精，丹溪大补阴丸最妙，滋肾益阴煎（炙龟板、大熟地各四钱，川黄柏八分，知母二钱，生甘梢八分，春砂仁六分。《金鉴妇科心法》方）也灵验。其他如滋肾六味汤（知母一钱半，川黄柏六分，熟地三钱，山萸肉八分，丹皮、泽泻、赤茯苓各一钱半，淮药四钱，炙龟板三钱，蒙自桂二分，童便一杯冲）、救阴滋任汤（大黑豆三钱，熟地二钱，麦冬、冬桑叶、丹皮、山药、南沙参各一钱半，猪脊髓一条，青盐二分。均为何廉臣经验方）也多奏效。
以上十二节，都阐述了清凉法的条目。至于热邪浅表的在营卫，以石膏、黄芩为主，柴胡、葛根为辅；热邪深的在胸膈，以花粉、知母、瓜蒌仁、栀子、豆豉为主；热在肠胃者，应当用下法，不用清法，或者下法兼清也可以；热入心包者，以黄连、犀角、羚羊角为主；热直入心脏，则难以救治，使用牛黄尚可十中救一，必须用到一钱左右，量少则无济于事，不像小儿惊风诸方，每用分许即可有效，如戴北山原书所说的那样。这里只说其大要。现将应当使用清凉法的各种症状，详细列于下面：
热在营卫的症状：身体发热，汗自出，不恶寒反而恶热，身体沉重，头面项部红肿，周身红肿，眼白发黄，眼球胀痛，鼻孔干燥，嘴唇干燥，烦躁；轻则发疹，重则发丹斑；舌苔白而底质绛红，或两边白苔而中间红；或者身热反而减轻，恶热反而加重，咳嗽有痰，上气喘急，口渴或呕吐，舌头四周色紫绛中间见粉白苔。
热在胸膈，气分抑郁的症状：咽干喉痛，胸胁满痛，甚至胸前红肿按之热甚，小便色黄；舌苔浓白而粗糙，或黄腻而干燥，或见朱砂点，或有裂纹，或黄白相间，或灰白。
热陷心包及心脏，血分灼烁的症状：谵语发狂，或昏沉嗜睡，或烦扰不寐，四肢厥逆，指甲青紫，大便溏黑极臭，小便赤涩或痛，舌绛无苔，或舌上略有粘苔（详见开透法诸症中）。
邪热攻脑，或溺毒上脑的症状：晕厥不语，两手发痉，状如惊痫，时而抽搐，头部独自摇动，甚至遗尿直视，筋惕肉瞤，循衣摸床撮空，舌苔起腐，间有黑点，或起黑晕黑瓣。
热在胃肠的症状：便血，便脓血，谵语多言，腹满痛，唇裂，齿燥，舌苔黄燥（详见攻里法诸症中）。
热陷肝肾的症状：日轻夜重，朝凉暮热，面色少华，口干消渴，气上冲心，心中痛热，饥不欲食，食则吐蛔，四肢厥逆，烦躁不寐，小便涩痛，甚至癃闭，腰足冷，大便或秘或溏，甚至泻水，舌绛无苔，干粘带涩，或紫中兼有黑点。
热陷冲任的症状：朝凉暮热，冲任脉动，少腹里急，阴中拘挛，甚至舌卷囊缩，小便涩痛，男性则遗精腰痛，女性则带下如注；舌色焦紫起刺如杨梅，或舌紫无苔而有点，或舌红无苔而胶干，或舌红中有白糜点。
Sangdan Decoction (Mulberry and Cinnabar Decoction) and Sizhi Zijin Ding (Four-Juice Purple Gold Pill, composed of watermelon juice, reed rhizome juice, raw radish juice each 5 ladles, sugarcane juice 1 cup, with 0.5 fen of Zijin Ding ground into juice for mixing. This is an empirical formula by Xu Huixi) are examples. Although these formulas are miraculously effective, one must guard against the rise of cold pathogen after the heat pathogen recedes. I often see that after taking the medicine, although the patient's consciousness becomes clear, they experience deficiency-related irritability and spontaneous diarrhea, while their hands and feet remain cold, and they suffer from dry mouth and thirst craving drink. At this point, the treatment should shift to Jiji Tang (Jilin Ginseng 0.5 fen, Oryzae Semen Preparatum [Yuan Maidong] 1.5 qian, Raw Licorice Root 0.5 fen, Xian Lu Xia 1 qian, Dan Fu Pian 0.5 fen, Fresh Bamboo Leaf 20 slices, Sheng Jing Mi wrapped in Lotus Leaf 3 qian. This is a simple formula by Song Yushuo), which acts as if by magic. It must be understood that this is "extreme yang resembling yin," indicating that the patient's root qi is necessarily deficient. In severe cases, Danggui Sini Tang (Zhang Zhongjing's formula) may be used with Xipi Zhibao Dan (He Lianchen's empirical formula) mixed in. Or Wuzhi Jiangfu Tang (Chuan Guizhi 0.5 fen, Xi Heliu tender branches 3 qian, Zisu pangzhi 1.5 qian, Nen Sangzhi 2 chi, Taoshu nenzhi 1 chi, Zhen Xinjiang 1.5 qian, Xuanfuhua 3 qian, Qingcong Guan 5 cun. Shen Yunchen's empirical formula) may be used with Jufang Laifudan mixed in. All these methods can unblock yin, restore yang, clear the spirit, and reverse cold extremities. However, once the limbs become warm and yang returns, the treatment strategy must change immediately; overmedication must be avoided to prevent depletion of essence and fluids. This approach is designed for patients with deficient root qi at the lower jiao. If the root qi is not deficient, but the four extremities are cold due to fire stagnation in the collaterals, the appropriate treatment is Zhang Zhongjing's Sini San (Chuan Chaihu 0.8 fen, Xiao Zhishi 1.5 qian, Chi Shao 1.5 qian, Sheng Gancao 0.5 fen), added with Gouteng 3 qian, Tianxianteng 3 qian, Luoshiteng 3 qian, Nen Sangzhi 2 chi, and Jiegeng 1 qian, to disperse latent wind in the liver collaterals, allowing it to transform and resolve via the qi level. Furthermore, if symptoms include cold extremities, cyanotic nails, black lips, and constipation, one should refer to the method of "purging in jue syndrome." The appropriate treatment is Zhang Zhongjing's Dahuang Huanglian Xixin Tang combined with Jiangfu Tang to unblock and purge latent pathogens in the liver collaterals, allowing them to exit via the intestinal collaterals. This is also an orthodox treatment method. In cases where liver collateral blood stasis extends to the pericardium collaterals, causing simultaneous disease of the hand and foot jueyin meridians, characterized by coma, cold extremities, and blood jue resembling death, Tongqiao Huoxue Tang (Chi Shao 1 qian, Chuan Xiong 1 qian, Taoren 3 qian, Zanghonghua 0.5 fen, Qingcong Guan 5 cun, Xian Jiangzhi 2 drops, Hongzao 2 pieces, Shexiang 0.05 li. Wang Qingren's *Yilin Gaicuo* formula) should be used with Zhuhuang San taken once (Zhufen 0.02 fen, Xihuang 0.02 fen, Chen Sha 0.02 fen, Chuan Bei Mo 0.06 fen. Zhou Danshan's *Wen Zheng Zhi Gui* formula). After administration, patients often expectorate purple blood and viscous saliva, followed by clarity of spirit and warming of extremities. For clearing and venting brain collaterals, Guashuang Zixue Dan and Jisheng Lingxi Tang (Lingjiaojiao 1 qian, Xijiaojiao 0.8 fen, Sheng Shigao 4 qian, Sheng Gancao 0.6 fen, Xuanfuhua 3 qian, Ziwan 1.5 qian, Qianhu 1.5 qian, Xixin 0.03 fen. Yan Yonghe's *Jisheng Fang* formula) are most effective; secondarily, Xiling Zhenjing Tang also has special merits. These are all essential methods for clearing collaterals and venting qi. Details are provided in the section on "Kaitou Fa" involving blood accumulation.
Ten, the method of combining bitter-cold with sweet-cold, referred to by Chen Xiuyuan as "bitter-sweet transforming into yin" and by Wu Jutong as "sweet-bitter jointly transforming yin qi." This is because latent fire scorches fluids and consumes body liquids, or because the patient constitutionally lacks fluids. Although treatment requires bitter-cold herbs to clear fire, sweet-cold herbs must be included to generate fluids. This is the orthodox method for simultaneous burning of qi and blood levels. Mild cases use Baibu Jia Shengdi Huang Tang (Wang Mengying's formula), Qingzao Yangrong Tang (Wu Youke's formula), or Jiabai Baibu Tang (He Lianchen's empirical formula). Severe cases use Qianjin Shengdi Huang Jian, Zhunsan Sanhuang Shigao Tang, or Baihu He Huanglian Jiedu Tang (*Zhunsan Lei Fang*). If fever persists after sweating or rash eruption, stomach fluids are depleted; treatment should focus on sweet-cold herbs, slightly incorporating bitter-draining herbs to consolidate yin. Examples include Baihu Jia Renshen Tang (Zhang Zhongjing's formula), Renshen Hua Tang (*Zhunsan Lei Fang*), and Jiawei Lugeng Yinzi (He Lianchen's empirical formula). The newly formulated Wuzhi Yin (Fresh Shengdihuang juice 5 ladles, Fresh Jinchai Shi juice 5 ladles, Fresh Lugeng juice 2 ladles, Ya Li juice 2 ladles, Sugarcane juice 2 ladles, warmed by double boiling. He Lianchen's empirical formula) is particularly effective. This represents the method of sweet-cold combined with bitter-cold. In summary, bitter-cold combined with sweet-cold focuses on clearing and descending excess fire, while sweet-cold incorporated with bitter-cold focuses on clearing and nourishing deficiency heat. One must carefully distinguish between prior/subsequent and excess/deficiency when prescribing.
Eleven, the method of combining bitter-cold with sour-cold: bitter clears the stomach, sour drains the liver. Examples include Huangqin Tang (Zhang Zhongjing's formula) using Huangqin and Shaoyao together; Xijiao Huanglian Tang (*Waitai Mi Yao* formula) using Huanglian and Wumei together; Qingzhong Anqi Tang (Wang Hu's commentary on *Shanghan Lun*) using Huanglian, Huangbai, and Wumei together; Qingdu Huoxue Tang (Nie Jiuwu's formula) using Huangqin, Huanglian, Mutong, Chi Shao, and Shanzha together; and Lianmei Anwei Tang (Chuan Lianlian 0.06 fen, Chuan Lianzi 1 qian, Sheng Baishao 1.5 qian, Wumei Rou 0.03 fen, Guixu 0.08 fen, Lai Juhong 0.05 fen, Chao Chuanjiao 0.01 fen. Ye Tianshi's empirical formula) using Huanglian, Chuanlian, Wumei, and Baishao together. All these exemplify the *Neijing* principle of "sour-bitter draining heat." If stomach yin is already deficient, Wu's Lianmei Tang (Xiao Chuanlian 1 qian, Wumei Rou 1 qian, Lianxin Maidong 3 qian, Xi Shengdi 3 qian, Ejiao 2 qian. Wu Jutong's empirical formula) should be used, applying the sour-bitter combined with sweet-cold method. If stomach yang is already deficient, Wang's Anwei Tang (Mi Chao Ludangshen 1.5 qian, Dan Ganjiang 0.08 fen, Xiao Chuanlian 0.05 fen, Wumei Rou 0.05 fen, Chao Zhishi 0.08 fen, Chao Chuanjiao 0.02 fen. Tang Zongsan's new empirical formula) should be used, applying the sour-bitter combined with pungent-sweet method. Others include Zhang's Zhuzang Wan (*Jingyue Quanshu* formula) and Jiawei Zanglian Wan (He Lianchen's empirical formula); the former boils Huaimi with vinegar, the latter boils Hualian with vinegar, representing the method of bitter consolidating intestines and sour draining liver. Zanglian Liuwei Wan represents sour-bitter draining heat and sour-sweet transforming yin. Renshen Wumei Tang (Xiyangshen 1.5 qian, Wumei Rou 0.03 fen, Mugua 0.08 fen, Zhi Gancao 0.05 fen, Huaishanyao 3 qian, Daixin Shilianzi 1 qian. Wu Jutong's *Wenbing Tiaobian* formula) represents sour-sweet transforming yin and slight bitter draining heat. In short, although all employ sour-bitter draining heat, the principles differ, and each excels in different functions; select according to symptoms.
Twelve, the method of combining bitter-cold with salty-cold, utilizing the descending action of salty and bitter flavors. There are four aspects:
First, clearing and draining internal kidney urine toxins: Chen's Dueming Yin and Xiling Erxian Tang (both from *Yisha Cao*) have the greatest efficacy; Xiaobian Yinzi (Tongzi Xiaobian, fresh Shengdihuang juice, fresh Oujiu juice each 1 cup, Sheng Chuanbai infused juice 2 ladles. Pang Anchang's *Shanghan Zongbing Lun* formula), Hongbai San (Chensha 1 qian, Renzhongbai, Yuanmingfen each 0.05 fen, soaked in boiling water, strained and taken. Gong Juzhong's *Shoushi Xiandan* formula), Daochi San mixed with Sizhi Yin (Ximutong 1.5 qian, Sheng Ganshao 0.08 fen, Dan Zhuye 2 qian, decocted in 1 bowl of boiling water, then mixed with: fresh Shengdihuang juice, fresh Oujiu juice, fresh Maogen juice, Tongzi Xiaobian each 1 cup. He Lianchen's empirical formula), and Tongbian Sicao Tang all frequently yield excellent results.
Second, calming rebellious chong qi and nourishing fluids to save from burning: Ziyejiaofen Tang (*Yimen Falü* formula), Pingyang Qingli Tang (Liang's *Shejian Bianzheng* formula), and Jiabai Xiling Erxian Tang (He Lianchen's empirical formula) are most effective; Huanglian Ejiao Tang (Zhang Zhongjing's formula) mixed with 1 cup of Tongzi Xiaobian, and Sanjia Baiwei Tang (Sheng Biejia, Sheng Da Zuomuli, Sheng Guixinxin each 6 qian, Dong Baiwei 5 qian, Xiyangshen 1.5 qian, Guixu 1 qian, Sheng Ganshao 0.08 fen, decocted with silver and gold vessels as water. He Lianchen's empirical formula) are also extremely effective.
Third, clearing and unblocking external kidney seminal impurities: Qianjin Zhichi Jia Shigao Shushi Tang and Tao's Xiaoyao Tang (Tao Jian'an's *Shanghan Quansheng Ji* formula) are recommended first; secondly, Daochi San combined with Jiawei Huzhang San, or Zhuling Tang combined with Shushi San (all He Lianchen's empirical formulas) can be used. If seminal impurities accumulate in the uterus, often binding with turbid blood, symptoms include lower abdominal distension and pain radiating to waist and abdomen, unbearable stabbing pain, obstruction of urination and defecation, inability to sit or lie down, crying and groaning. Urgent treatment is required; delay leads to upward progression of pathology, resulting in ten deaths without cure. Urgently administer Shushe Tongjing Wan (Xiongshufen, Wangbuliuxing each 1 liang, Chao Heiqian Niu, Wulingzhi, Chao Chuannanjia, Taoren each 5 qian, Dunniumi powder 3 qian, Shexiang 0.03 fen, finely ground, pills made with fresh Leizhi juice, size of hemp seeds, dose 1 qian. He Lianchen's empirical formula) 1 qian or 1.5 qian, delivered with Qian Niu Lianshi Tang (Chao Heiqian Niu 3 qian, Yanshui Chao Chuan Lianzi 1.5 qian, Chao Chuannanjia 1 qian, Xiaohui Xiang 0.03 fen. Li Shizhen's empirical formula). Often, one dose reduces symptoms, three doses resolve them.
Fourth, nourishing ren mai yin essence: Danxi's Dabu Yin Wan is best; Zishen Yiyin Jian (Zhi Guiban, Da Shudi each 4 qian, Chuanbai 0.08 fen, Zhimu 2 qian, Sheng Ganshao 0.08 fen, Chuna Ren 0.06 fen. *Jinjian Fuke Xinfa* formula) is also effective. Others include Zishen Liuwei Tang (Zhimu 1.5 qian, Chuanbai 0.06 fen, Shudi 3 qian, Shanyurou 0.08 fen, Danpi, Zexie, Chifuling each 1.5 qian, Huaishanyao 4 qian, Zhi Guiban 3 qian, Mengzigu 0.02 fen, Tongzi Xiaobian 1 cup mixed), and Jiuyin Ziren Tang (Daheidou 3 qian, Shudi 2 qian, Maidong, Dong Sangye, Danpi, Shanyao, Nanshashen each 1.5 qian, Zhu Suizhui 1 strip, Qingyan 0.02 fen. All He Lianchen's empirical formulas) also show frequent efficacy.
The above twelve sections describe the items of the Cooling Method. Regarding heat: superficial heat in Ying and Wei uses Shigao and Huangqin as main herbs, with Chaihu and Gegen as auxiliaries; deep heat in Chest and Diaphragm uses Fenhua, Zhimu, Louren, Zhizi, and Douchi as main herbs; heat in Stomach and Intestines requires purgative methods rather than cooling, or purgatives combined with cooling; heat entering Pericardium uses Huanglian, Xijiao, and Lingyangjiao as main herbs; if heat enters the Heart directly, it is difficult to save; Niuhuang can save one in ten, requiring a dose of about 1 qian; less is ineffective, unlike pediatric convulsion formulas where small doses suffice, as stated by Dai Beishan. This only covers the general principles. The following details symptoms requiring cooling methods:
Heat in Ying and Wei: Fever with spontaneous sweating, aversion to cold replaced by aversion to heat, heaviness of body, redness and swelling of head, face, and neck, generalized redness and swelling, yellow whites of eyes, distending pain of eyeballs, dry nostrils, dry lips, irritability; mild cases present with rashes, severe cases with erysipelas-like spots; tongue coating white with crimson base, or white coating on sides with red center; or fever decreases while aversion to heat increases, cough with phlegm, wheezing, thirst or vomiting, purple-crimson tongue edges with pink-white coating in center.
Heat in Chest and Diaphragm, Qi level depression: Dry throat and sore throat, fullness and pain in chest and hypochondrium, even redness and swelling in anterior chest with intense heat on pressure, yellow urine; thick white and rough tongue coating, or yellow-greasy and dry, or vermilion points, or cracks, or yellow-white mixed, or grey-white.
Heat sinking into Pericardium and Heart, Blood level scorching: Delirium and mania, or lethargy and drowsiness, or irritability and insomnia, cold extremities, cyanotic-purple nails, loose black foul-smelling stool, red scanty or painful urination, crimson tongue without coating, or tongue with slight sticky coating (see Kaitou Fa symptoms).
Pathogenic heat attacking Brain, or Urine toxin ascending to Brain: Syncope and muteness, spasms of hands, resembling epilepsy, occasional tremors, independent shaking of head, even enuresis and fixed gaze, muscle twitching, grasping at empty air, picking at bedclothes, putrid tongue coating with occasional black spots, or black halos and petals.
Heat in Stomach and Intestines: Bloody stool, pus and blood in stool, delirious speech, abdominal fullness and pain, cracked lips, dry teeth, yellow-dry tongue coating (see Gongli Fa symptoms).
Heat sinking into Liver and Kidney: Milder during day, heavier at night, cool in morning, hot in evening, lackluster complexion, dry mouth and excessive thirst, qi rushing to heart, painful heat in heart, hunger without desire to eat, vomiting roundworms upon eating, cold extremities, irritability and insomnia, scanty painful urination, even urinary retention, cold waist and feet, constipation or loose stools, even watery diarrhea, crimson tongue without coating, dry-sticky and rough, or purple with black spots.
Heat sinking into Chong and Ren: Cool in morning, hot in evening, pulsation of Chong and Ren pulses, urgency in lower abdomen, spasm in genitals, even curled tongue and contracted testicles, scanty painful urination, males with spermatorrhea and backache, females with profuse leukorrhea; tongue color scorched purple with prickles like bayberry, or purple without coating with spots, or red without coating and gelatinously dry, or red with white fungal spots.