其二曰：“宜补肝不宜伐肝”。“肝为将军之官，主藏血。吐血者，肝失其职也。养肝则肝气平而血有所归，伐之则肝虚不能藏血，血愈不止矣”。吐血之来，多由气逆火炎，阳络受损致血上溢而发。龙胆泻肝汤等平肝泻火之剂，皆缪氏所谓伐肝之药也。用得其宜，自有良效，似不能一概否定。又愚治吐血，有用药泻亢盛之火，平逆乱之气，寓两法而于一方之中者。曾治一丁姓妇女，３５岁，素性抑郁，月经不调，某次因与家人口角，陡患吐血。邀诊，诊时间常吐血一两口，血色紫暗，并见嗳气、善怒、胸胁胀痛，脉弦数。作肝郁气逆火热犯胃而致吐血治之。急用醋炒大黄、炒川连、郁金炭、炒竹茹、茅根、代赭石、炒枳实、焦栀炭、枇杷叶、芦根、藕节等药，频频与服，数服血止，继与疏肝和胃、调气降火之剂，而病痊愈。若当此种类型吐血之时，骤用补肝之剂，必至气逆愈甚，火热益炽，血汩汩而外溢，不能止矣。
其三曰：“宜降气不宜降火”。气有余即是火，气降则火降，火降则气不上升，血随气行，无溢出上窍之患矣。降火必用寒凉之剂，反伤胃气，胃气伤则脾不能统血，血愈不能归经矣。今之疗吐血者，大患有二：一则专用寒凉之味，如芩、连、山栀、四物汤、黄柏、知母之类，往往伤脾作泄，以致不救；一则专用人参，肺热还伤肺，咳嗽愈甚。亦有用参而愈者，此是气虚喘嗽，气属阳，不由阴虚火炽所致，然亦百不一二也。血得热则行，得寒则凝，此语实已道出吐血的原因与机理，并对其治疗大法，确已指示其要点所在。盖血证热证多而寒证少，自是事实。故愚治血热燔灼阳络受损而致吐血之证，有用甘咸而寒、凉血散血之法而愈者甚众。如治一男性患者，年十七，忽患口鼻大量吐衄失血，急来邀诊。视其面赤、心烦，间有昏谵，舌赤而绛，脉象细数，断为热入营血之证。急与犀角地黄汤加黄芩、炒柏叶、栀子炭、茅根、仙鹤草、血余炭、藕节以凉营清热，止血和血。连投两大剂，血势方止。止后仍以此法加减，药小其制，又服数剂，而病痊愈。亦有火热太亢损伤阳络而致吐血者，则《金匮》三黄泻心汤，用苦寒直折之法，以清热止血，正是对证良法。前述丁姓妇吐血病案，亦是用此方加清凉宣降之药而愈。当此种吐血病情猖獗之时，如遵仲淳法用韭菜、降香、苏子等味，岂能制止炎上沸腾之火热，而止汹涌上溢之吐血乎？综上所述，是吐血治法要点，缪氏之说，适与吾之临床观察所得相左。惟观缪氏病案数则，及其“立论，专以白芍药、炙甘草制肝；薏苡仁、怀山药养脾；韭菜、番降香、真苏子下气；青蒿、鳖甲、银柴胡、牡丹皮、地骨皮补阴清热；酸枣仁炒研、白茯神养心；山茱萸肉、枸杞子补肾。累试第三卷２３２之辄验，然阴无骤补之法，非多服药不效……。”（以上所引均见《先醒斋医学广笔记·卷二·吐血门》）是其所云吐血，当指虚劳久病而言，故治法如此示戒。然既属虚劳，又病吐血，则清凉止血之法，始终决不可忽。特别值得提出的是，治疗吐血，无论何种原因诱发，必以止血为首要紧急措施。盖热证吐血，火亢者清之，气逆者平之；虚寒失血，温补而摄之，皆所以促其溢出之血得止，然后方可从容图治。
七、谈李东垣清暑益气汤运用清暑益气汤，本李东垣方，原载于《内外伤辨惑论》，亦见于《脾胃论》，其文云：“时当长夏，湿热大胜，蒸蒸而炽，人感之多四肢困倦，精神短少，懒于动作，胸满气促，肢节沉痛，或气高而喘，身热而烦，心下膨痞，小便黄而少，大便溏而频，或痢出黄糜，或如泔色，或渴或不渴，不思饮食，自汗体重，或汗水者……其脉中得洪缓。若湿气相搏，必加之以迟，迟病虽互换小差，其天暑湿令则一也。宜以清燥之剂治之，名之曰清暑益气汤主之。”按清暑益气汤方，药物组成为黄芪、人参、白术、苍术、神曲、青皮、陈皮、炙草、麦冬、五味子、当归、黄柏、泽泻、升麻、葛根、姜、枣等味。其所主治证候，当因暑月湿热伤气，或中气本虚，又感湿热之邪致病，故用此补中益气而兼苦燥通利之法，以治本虚标实湿胜热蕴之证，似无疑义。惟因清·王孟英《温热经纬》在评温热证中，有“东垣此方，虽有清暑之名，而无清暑之实”一语，遂引起后人许多议论。考暑月热、渴、自汗之病，属于暑病范畴，其病理机制，有暑热灼伤气液者；有暑月湿热伤气，或其人本虚，湿热相蒸感人致病者。王氏所云暑病，当时纯属热灼伤气液之证，主治用西洋参、麦冬、石斛、黄连、知母、竹叶、荷梗、西瓜翠衣、甘草、粳米等味，能清暑热而益元气，确是对证良方，故后世亦名王氏清暑益气汤。若东垣此方，主治脉证项下有四肢困倦，肢节沉疼，心下膨痞，其脉洪缓或迟等湿胜热蕴之象，至为显然。故吴鞠通《温病条辨》引此方以治《金匮》病，主治证候亦有发热恶寒，身重而疼，其脉弦细芤迟等，是与上述脉证大抵相符。据愚从临床中观察，东垣此方，亦自有其用途，而不可一概否定。因忆某年夏月，淫雨连朝，有胡某某，男，年四十许，患感冒，经过数日延诊，见其恶寒发热，身重骨楚，肢体倦怠，懒于言语，胸闷不欲食，口渴不欲饮，腹感不舒，大便时溏，小便带黄，舌苔白，脉濡。病属湿温，湿重于热，主用三仁汤加藿香叶、炒香豉、大腹皮、郁金等药，以辛香透热，淡渗利湿。服五剂，无效，且神益疲，脉愈软矣。再诊根据病情反复推敲，断为暑湿相夹，热为湿遏，前方并无大误。惟患者体质素弱，且气候失常，不相适应，遂至肺气大虚，脾气不运，升降失司，出入不和，故出现上述种种脉证。病情本虚标实，而用药未顾及此，故而效果不显。遂与东垣清暑益气汤原方，药用党参、黄芪各１０克，青陈皮、苍白术、麦冬、五味子、炒黄柏、粉葛根、泽泻各６克，炙草５克，升麻３克，以补益肺气，健运脾气，兼去湿中之热。去当归，因其性滑润，与湿证有碍。并随证出入酌加杏、蔻、枳、桔、苓、通之类，辛苦宣渗，以助水湿之流行，而促病机之转化。三诊：前方服１０剂后，病人神气渐振，周身时有微汗，寒热亦除。后改用香砂六君子汤加减调理收功。
第三卷２３３八、谈经方疗梅核气病《金匮》云：“妇人如有炙脔，半夏厚朴汤主之”（《妇人杂病脉证并治第二十二》）。《金鉴》注云：“咽中有痰涎如同炙肉，咯之不出，咽之不下，即今梅核气病也。此病得于七情郁气凝痰而生，故用半夏、厚朴、生姜辛以散结，苦以降气。茯苓佐半夏以利饮行气。紫苏芳香以宣通郁气。俾气舒涎去，病自愈矣。此证男子亦有，不独妇人也”。按梅核气病之名，始于宋·王硕之《易简方》。其论病机，有云“四七汤（即半夏厚朴汤）治喜怒悲恐惊之气，结成痰涎，状如破絮，或如梅核，或在咽喉之间，咯不出，咽不下，此七气之所为”是也。其述所主证候，王氏谓“或中脘痞满，气不舒快；或痰饮中节，呕吐恶心”。论证虽简，殊有重要之参考价值。愚多年诊治此病中观察，用《金匮》方以治梅核气病，有的有效，也有无效。而半夏厚朴汤所治有效之证，病因多是寒饮湿痰气结所致。具体症状多有胸脘痞闷，腹部胀满，呕吐恶心，二便不爽，舌白，脉弦等，是与王氏所说相符。而用之无效的梅核气病，吾认为另有证因，如临证见有咽中如有炙肉，吞之不下，近来则无呕吐痰多痞满等证。其证或咯出少数结痰，咽部发红，情绪急躁，舌质红，脉弦数等，病因多为痰火郁结而成，则采用清火化痰宣郁解结之法。药用黄芩、玄参、浙贝母、海蛤粉、炒牛蒡子、白僵蚕、昆布、牡蛎、夏枯草、制香附、青果。方名清化解郁汤，以治此症，确有良好的效果。兹举病案两则于下：吴某，女，４０岁，农民，素性抑郁，近来自觉咽喉部如有物堵塞，吞之不下，咯之不出，自是梅核气病。服中药辛温宣通之剂，已经半年无效。脉弦数，咽部发红，余无所苦，月经正常，治拟清火化痰，宣郁解结之法，用自制清化解郁汤治之。处方：炒黄芩１０克，玄参、牡蛎各１２克，海蛤粉、连翘各１５克，制香附６克，昆布１５克，白僵蚕、青果各１０克。水煎服。每日１剂。并禁食辛辣刺激等食品。此方服至１５剂后，自觉上述症状减轻。以后效不更方，劝其坚持常服，以巩固疗效。后续服此方两月，而病痊愈。又同乡李某，年近古稀，患梅核气病，并发展有吞咽困难症状。经检查食道有狭窄病变，忧心忡忡，来舍求治。吾用此方加半枝莲、白花蛇舌草、蒲公英、代赭石、旋复花、炒竹茹、枳实、芦根等药，出入为方，连服半年而症状缓解，惟不能禁酒，后又复发加剧，又服此方多剂，而获痊愈。是方书谓梅核气病亦可见于男性患者，并为噎膈之渐，信然。梅核气病是一种常见病，多见于妇女患者，此病有几种证型，《金匮》半夏厚朴汤主治之证，当是因寒饮湿痰气郁而生，故用辛开宣散温通解结之法。若愚所制清化解郁汤，是用清火化痰宣郁解结之法，对于痰火郁结之证，比较适宜，然不可因此而议《金匮》方之非。又半夏厚朴汤一名四七汤，为理气化痰祖方，其适应证范围，当可从上述证候类推。由此可见，中医治病，必须做到理论与实践相结合，辨病与辨证相结合，遣方用药，必须与病机、证候悉悉相符，方足以御纷纭复杂之病变。
九、谈安宫牛黄丸、紫雪丹的运用凡温热暑疫等所致之急性病患，最易引起病邪入里，高热不退，神识昏迷，烦躁谵妄，手足抽搐，甚则发为痉厥等危重证候。安宫牛黄丸、紫雪丹为急救妙品，为中医治疗急性热病之必备要药。今谈谈以上二方的证候要点，使用方法，以及个人在临床运用中的肤浅体会。
第三卷２３４（一）安宫牛黄丸牛黄丸古方有多种，愚通常所用者为《温病条辨》所载之安宫牛黄丸，谓其配伍精巧，效果良好。适用于温热时疫因邪热内陷，逆传心包，以致神昏痉厥，及大人因热猝中，小儿热痰惊风等证。本方是由犀角、牛黄、黄芩、黄连、山栀子、郁金、梅片、雄黄、朱砂、珍珠、麝香等药组成，蜜丸、金箔为衣。方中用犀角、牛黄、雄黄、黄芩、黄连、山栀子清心泻热，化痰解毒；珍珠、朱砂、金箔镇心安神，定惊止搐；郁金、梅片、麝香宣郁开窍，醒脑神，合之亦即吴鞠通所谓“芳香化秽浊而利诸窍，咸寒保肾水而安心体，苦寒通火府而泻心用”之法。
余使用安宫牛黄丸治疗温热时疫急证甚多，但多配合其他方剂使用，亦有纯用此丸而单独见效者。因忆某年秋，邻村三湾吴厚安之妻凌某某，年２０余，妊娠已８个月，某日纺织至深夜始寝，至次午尚未起，时其夫远贸未归，邻人知有异，推门而入，见其口噤目呆，昏厥在床，呼之不醒，急来邀诊。见其神识昏沉，面部发赤，四肢时作一抽动状，舌尖露绛，脉则弦大有力，下部已见红。断为暑热已入心营，引动肝风，发生子痫。病在厥阴，极为严重，胎已难保，幸血色殷红，尚有一线生机。急与安宫牛黄丸三粒（每粒约重３克）用碧玉散（六一散加青黛）６０克，开水泡，分三次将丸药化开随药汁调下。取其清心凉肝，解暑宣窍，并导浊热下行。次早复诊：知胎下已腐，神识仍未清楚，时作呻吟，面赤、微搐、脉弦较和。仍用前丸三粒，以钩藤３０克，开水泡清汁，分三次将丸药化开随药汁灌下。取清心宣窍中而增强其熄风清热之剂，以清余热；并微参用活血消瘀之药，以化蓄瘀。又数剂，脉证始和。后随证调理逾月方起床而痊愈。是主要用安宫牛黄丸急救而取效也。
某年春，吾乡疫痉（脑炎）散在性流行。曾治一李姓男孩，９岁，受感头痛颈强发热呕吐后，即神识昏迷、谵妄抽搐。经注射消炎针剂及内服磺胺类药物，无效。邀诊：视其舌黑干燥少津，脉来弦数有力。急令用安宫牛黄丸二粒，分二次服下，以宣窍醒脑，熄风止痉。随仿吴鞠通清心营，熄肝风法，以清营汤（犀角、黄连、丹皮、生地、玄参、麦冬、竹叶、银花、连翘）加钩藤、全蝎、地龙、石决明、桑枝与服。２剂后，神识渐苏，抽搐渐止。去安宫牛黄丸，前方改用小剂，又服五剂，病势缓和而愈。
（二）紫雪丹凡病温热暑疫因高热而引起的神识昏迷，谵妄惊狂，烦躁不安，四肢抽搐，尿赤便闭，口渴唇焦，舌红或黑，及小儿痉厥诸证，当是温疫热毒，内窜心包，煽动肝风，导致神识失常所致。紫雪丹是由羚羊角、犀角、磁石、滑石、石膏、寒水石、炙甘草、木香、沉香、丁香、升麻、硝石、朴硝、玄参、辰砂、麝香、黄金等药组成。方中羚羊角、犀角清心凉肝；寒水石、滑石、石膏寒凉退热；朴硝、硝石导浊通便；玄参、甘草护阴解毒；辰砂、磁石、黄金镇心安神；丁香、木香、沉香、麝香宣窍利气。诸药均主降，惟独用一物升麻，升而后降，以降为主，使诸经的邪火热毒，都从下窍而出。
如是则神识清明，诸证可解。
其二说：“宜补肝不宜伐肝”。“肝被称为将军之官，主要功能是贮藏血液。吐血，是因为肝失去了其正常职能。滋养肝脏则肝气平和，血液有所归依；攻伐肝脏则导致肝虚不能藏血，出血会更加不止”。吐血的发作，多由气逆火炎，损伤阳络导致血液上溢而引发。龙胆泻肝汤等平肝泻火的方剂，都是缪氏所说的“伐肝”药物。使用得当，自然有良好疗效，似乎不能一概否定。另外我治疗吐血，有用药泻亢盛之火、平逆乱之气，将两种治法寓于一方之中的情况。曾治疗一位丁姓妇女，35岁，平时性格抑郁，月经不调，某次因与家人争吵，突然患吐血。邀请诊治，诊察时发现她时常吐血一两口，血色紫暗，并伴有嗳气、易怒、胸胁胀痛，脉象弦数。辨证为肝郁气逆、火热犯胃所致吐血。急用醋炒大黄、炒川连、郁金炭、炒竹茹、白茅根、代赭石、炒枳实、焦栀炭、枇杷叶、芦根、藕节等药，频频服用，服几剂后血止，继予疏肝和胃、调气降火的方剂，病痊愈。如果是这种类型的吐血，骤然使用补肝的方剂，必然导致气逆更甚，火热更炽，血液汩汩外溢，无法止住。
其三说：“宜降气不宜降火”。气有余就是火，气降则火降，火降则气不上升，血随气行，就不会有从上窍溢出的祸患了。降火必须用寒凉方剂，反而损伤胃气，胃气受伤则脾不能统摄血液，血液更不能归经。现在治疗吐血的人，大患有二：一是专用寒凉药物，如黄芩、黄连、山栀、四物汤、黄柏、知母之类，往往伤脾导致腹泻，以致无法救治；二是专用人参，肺热反而伤肺，咳嗽更加严重。也有用人参而治愈的，这是气虚喘嗽，气属阳，不是由阴虚火旺引起的，但这种情况百中无一。血得热则运行，得寒则凝滞，这句话确实道出了吐血的原因与机理，并对治疗大法指出了要点所在。因为血证热证多而寒证少，这是事实。所以我治疗血热燔灼、损伤阳络导致的吐血证，有用甘咸而寒、凉血散血的方法治愈的很多。例如治疗一名男性患者，17岁，忽然患口鼻大量吐衄失血，急忙来请诊治。看其面色红赤、心烦，间或有神志昏乱胡言乱语，舌质红绛，脉象细数，诊断为热入营血之证。急用犀角地黄汤加黄芩、炒侧柏叶、栀子炭、白茅根、仙鹤草、血余炭、藕节以凉营清热，止血和血。连续投两大剂，血势才止。止后仍以此法加减，药量减小，又服数剂，病痊愈。也有火热太亢损伤阳络导致吐血的，则《金匮要略》中的三黄泻心汤，用苦寒直折的方法，以清热止血，正是对症的好方法。前述丁姓妇女吐血医案，也是用此方加清凉宣降的药物而治愈的。当这种吐血病情猖獗之时，如果遵循仲淳之法用韭菜、降香、苏子等味，怎么能制止炎上沸腾的火热，而止住汹涌上溢的吐血呢？综上所述，是吐血治法的要点，缪氏的说法，恰好与我临床观察所得相反。只是看缪氏的几个病案，及其“立论，专以白芍药、炙甘草制肝；薏苡仁、怀山药养脾；韭菜、番降香、真苏子下气；青蒿、鳖甲、银柴胡、牡丹皮、地骨皮补阴清热；酸枣仁炒研、白茯神养心；山茱萸肉、枸杞子补肾。屡试辄验，然而阴无骤补之法，非多服药不效……。”（以上所引均见《先醒斋医学广笔记·卷二·吐血门》）是他所说的吐血，应当是指虚劳久病而言，所以治法如此告诫。既然属于虚劳，又病吐血，那么清凉止血之法，始终决不可忽略。特别值得提出的是，治疗吐血，无论何种原因诱发，必以止血为首要紧急措施。因为热证吐血，火亢者清之，气逆者平之；虚寒失血，温补而摄之，都是为了促使溢出之血停止，然后方可从容图谋治疗。
七、谈李东垣清暑益气汤的运用
清暑益气汤，本出自李东垣方，原载于《内外伤辨惑论》，也见于《脾胃论》，其文云：“时值长夏，湿热大胜，热气蒸腾炽盛，人感受之后多出现四肢困倦，精神短少，懒于动作，胸满气促，肢节沉痛，或气高而喘，身热而烦，心下膨痞，小便黄而少，大便溏而频，或痢出黄糜，或如泔色，或渴或不渴，不思饮食，自汗体重，或汗水者……其脉中得洪缓。若湿气相搏，必加之以迟，迟病虽互换小差，其天暑湿令则一也。宜以清燥之剂治之，名之曰清暑益气汤主之。”按清暑益气汤方，药物组成为黄芪、人参、白术、苍术、神曲、青皮、陈皮、炙甘草、麦冬、五味子、当归、黄柏、泽泻、升麻、葛根、姜、枣等味。其所主治证候，当因暑月湿热伤气，或中气本虚，又感湿热之邪致病，故用此补中益气而兼苦燥通利之法，以治本虚标实、湿胜热蕴之证，似无疑义。只因清代王孟英在《温热经纬》评温热证中，有“东垣此方，虽有清暑之名，而无清暑之实”一语，遂引起后人许多议论。考暑月热、渴、自汗之病，属于暑病范畴，其病理机制，有暑热灼伤气液者；有暑月湿热伤气，或其人本虚，湿热相蒸感人致病者。王氏所说的暑病，当时纯属热灼伤气液之证，主治用西洋参、麦冬、石斛、黄连、知母、竹叶、荷梗、西瓜翠衣、甘草、粳米等味，能清暑热而益元气，确是对证良方，故后世亦名王氏清暑益气汤。若东垣此方，主治脉证项下有四肢困倦，肢节沉疼，心下膨痞，其脉洪缓或迟等湿胜热蕴之象，至为显然。故吴鞠通《温病条辨》引此方以治《金匮》中的暍病，主治证候亦有发热恶寒，身重而疼，其脉弦细芤迟等，是与上述脉证大抵相符。据我从临床中观察，东垣此方，亦自有其用途，而不可一概否定。因而想起某年夏月，淫雨连朝，有胡某某，男，40岁左右，患感冒，经过数日延诊，见其恶寒发热，身重骨楚，肢体倦怠，懒于言语，胸闷不欲食，口渴不欲饮，腹感不舒，大便时溏，小便带黄，舌苔白，脉濡。病属湿温，湿重于热，主用三仁汤加藿香叶、炒香豉、大腹皮、郁金等药，以辛香透热，淡渗利湿。服五剂，无效，且神益疲，脉愈软矣。再诊根据病情反复推敲，断为暑湿相夹，热为湿遏，前方并无大误。惟患者体质素弱，且气候失常，不相适应，遂至肺气大虚，脾气不运，升降失司，出入不和，故出现上述种种脉证。病情本虚标实，而用药未顾及此，故而效果不显。遂与东垣清暑益气汤原方，药用党参、黄芪各10克，青陈皮、苍白术、麦冬、五味子、炒黄柏、粉葛根、泽泻各6克，炙甘草5克，升麻3克，以补益肺气，健运脾气，兼去湿中之热。去当归，因其性滑润，与湿证有碍。并随证出入酌加杏、蔻、枳、桔、苓、通之类，辛苦宣渗，以助水湿之流行，而促病机之转化。三诊：前方服10剂后，病人神气渐振，周身时有微汗，寒热亦除。后改用香砂六君子汤加减调理收功。
八、谈经方疗梅核气病
《金匮要略》云：“妇人如有炙脔，半夏厚朴汤主之”（《妇人杂病脉证并治第二十二》）。《医宗金鉴》注云：“咽中有痰涎如同炙肉，咯之不出，咽之不下，即今梅核气病也。此病得于七情郁气凝痰而生，故用半夏、厚朴、生姜辛以散结，苦以降气。茯苓佐半夏以利饮行气。紫苏芳香以宣通郁气。俾气舒涎去，病自愈矣。此证男子亦有，不独妇人也”。按梅核气病之名，始于宋·王硕之《易简方》。其论病机，有云“四七汤（即半夏厚朴汤）治喜怒悲恐惊之气，结成痰涎，状如破絮，或如梅核，或在咽喉之间，咯不出，咽不下，此七气之所为”是也。其述所主证候，王氏谓“或中脘痞满，气不舒快；或痰饮中节，呕吐恶心”。论证虽简，殊有重要之参考价值。愚多年诊治此病中观察，用《金匮》方以治梅核气病，有的有效，也有无效。而半夏厚朴汤所治有效之证，病因多是寒饮湿痰气结所致。具体症状多有胸脘痞闷，腹部胀满，呕吐恶心，二便不爽，舌白，脉弦等，是与王氏所说相符。而用之无效的梅核气病，吾认为另有证因，如临证见有咽中如有炙肉，吞之不下，近来则无呕吐痰多痞满等证。其证或咯出少数结痰，咽部发红，情绪急躁，舌质红，脉弦数等，病因多为痰火郁结而成，则采用清火化痰宣郁解结之法。药用黄芩、玄参、浙贝母、海蛤粉、炒牛蒡子、白僵蚕、昆布、牡蛎、夏枯草、制香附、青果。方名清化解郁汤，以治此症，确有良好的效果。兹举病案两则于下：吴某，女，40岁，农民，素性抑郁，近来自觉咽喉部如有物堵塞，吞之不下，咯之不出，自是梅核气病。服中药辛温宣通之剂，已经半年无效。脉弦数，咽部发红，余无所苦，月经正常，治拟清火化痰，宣郁解结之法，用自制清化解郁汤治之。处方：炒黄芩10克，玄参、牡蛎各12克，海蛤粉、连翘各15克，制香附6克，昆布15克，白僵蚕、青果各10克。水煎服。每日1剂。并禁食辛辣刺激等食品。此方服至15剂后，自觉上述症状减轻。以后效不更方，劝其坚持常服，以巩固疗效。后续服此方两月，而病痊愈。又同乡李某，年近古稀，患梅核气病，并发展有吞咽困难症状。经检查食道有狭窄病变，忧心忡忡，来舍求治。吾用此方加半枝莲、白花蛇舌草、蒲公英、代赭石、旋复花、炒竹茹、枳实、芦根等药，出入为方，连服半年而症状缓解，惟不能禁酒，后又复发加剧，又服此方多剂，而获痊愈。是方书谓梅核气病亦可见于男性患者，并为噎膈之渐，信然。梅核气病是一种常见病，多见于妇女患者，此病有几种证型，《金匮》半夏厚朴汤主治之证，当是因寒饮湿痰气郁而生，故用辛开宣散温通解结之法。若愚所制清化解郁汤，是用清火化痰宣郁解结之法，对于痰火郁结之证，比较适宜，然不可因此而议《金匮》方之非。又半夏厚朴汤一名四七汤，为理气化痰祖方，其适应证范围，当可从上述证候类推。由此可见，中医治病，必须做到理论与实践相结合，辨病与辨证相结合，遣方用药，必须与病机、证候悉悉相符，方足以御纷纭复杂之病变。
九、谈安宫牛黄丸、紫雪丹的运用
凡温热暑疫等所致之急性病患，最易引起病邪入里，高热不退，神识昏迷，烦躁谵妄，手足抽搐，甚则发为痉厥等危重证候。安宫牛黄丸、紫雪丹为急救妙品，为中医治疗急性热病之必备要药。今谈谈以上二方的证候要点，使用方法，以及个人在临床运用中的肤浅体会。
（一）安宫牛黄丸
牛黄丸古方有多种，我通常所用者为《温病条辨》所载之安宫牛黄丸，谓其配伍精巧，效果良好。适用于温热时疫因邪热内陷，逆传心包，以致神昏痉厥，及大人因热猝中，小儿热痰惊风等证。本方是由犀角、牛黄、黄芩、黄连、山栀子、郁金、梅片、雄黄、朱砂、珍珠、麝香等药组成，蜜丸、金箔为衣。方中用犀角、牛黄、雄黄、黄芩、黄连、山栀子清心泻热，化痰解毒；珍珠、朱砂、金箔镇心安神，定惊止搐；郁金、梅片、麝香宣郁开窍，醒脑安神，合之亦即吴鞠通所谓“芳香化秽浊而利诸窍，咸寒保肾水而安心体，苦寒通火府而泻心用”之法。
我使用安宫牛黄丸治疗温热时疫急证甚多，但多配合其他方剂使用，亦有纯用此丸而单独见效者。因而想起某年秋，邻村三湾吴厚安之妻凌某某，年20余，妊娠已8个月，某日纺织至深夜始寝，至次午尚未起，时其夫远贸未归，邻人知有异，推门而入，见其口噤目呆，昏厥在床，呼之不醒，急来邀诊。见其神识昏沉，面部发赤，四肢时作一抽动状，舌尖露绛，脉则弦大有力，下部已见红。断为暑热已入心营，引动肝风，发生子痫。病在厥阴，极为严重，胎已难保，幸血色殷红，尚有一线生机。急与安宫牛黄丸三粒（每粒约重3克）用碧玉散（六一散加青黛）60克，开水泡，分三次将丸药化开随药汁调下。取其清心凉肝，解暑宣窍，并导浊热下行。次早复诊：知胎下已腐，神识仍未清楚，时作呻吟，面赤、微搐、脉弦较和。仍用前丸三粒，以钩藤30克，开水泡清汁，分三次将丸药化开随药汁灌下。取清心宣窍中而增强其熄风清热之剂，以清余热；并微参用活血消瘀之药，以化蓄瘀。又数剂，脉证始和。后随证调理逾月方起床而痊愈。是主要用安宫牛黄丸急救而取效也。
某年春，吾乡疫痉（脑炎）散在性流行。曾治一李姓男孩，9岁，受感头痛颈强发热呕吐后，即神识昏迷、谵妄抽搐。经注射消炎针剂及内服磺胺类药物，无效。邀诊：视其舌黑干燥少津，脉来弦数有力。急令用安宫牛黄丸二粒，分二次服下，以宣窍醒脑，熄风止痉。随仿吴鞠通清心营，熄肝风法，以清营汤（犀角、黄连、丹皮、生地、玄参、麦冬、竹叶、银花、连翘）加钩藤、全蝎、地龙、石决明、桑枝与服。2剂后，神识渐苏，抽搐渐止。去安宫牛黄丸，前方改用小剂，又服五剂，病势缓和而愈。
（二）紫雪丹
凡病温热暑疫因高热而引起的神识昏迷，谵妄惊狂，烦躁不安，四肢抽搐，尿赤便闭，口渴唇焦，舌红或黑，及小儿痉厥诸证，当是温疫热毒，内窜心包，煽动肝风，导致神识失常所致。紫雪丹是由羚羊角、犀角、磁石、滑石、石膏、寒水石、炙甘草、木香、沉香、丁香、升麻、硝石、朴硝、玄参、辰砂、麝香、黄金等药组成。方中羚羊角、犀角清心凉肝；寒水石、滑石、石膏寒凉退热；朴硝、硝石导浊通便；玄参、甘草护阴解毒；辰砂、磁石、黄金镇心安神；丁香、木香、沉香、麝香宣窍利气。诸药均主降，惟独用一物升麻，升而后降，以降为主，使诸经的邪火热毒，都从下窍而出。
如是则神识清明，诸证可解。
Secondly, it states: "It is advisable to tonify the Liver rather than attack it." "The Liver is called the 'General Officer', and its primary function is storing blood. Hematemesis (vomiting blood) occurs when the Liver loses its normal function. Nourishing the Liver leads to peaceful Liver Qi, allowing blood to return to its proper course; attacking the Liver causes Liver deficiency and inability to store blood, resulting in even more profuse bleeding." The onset of hematemesis is mostly due to rebellious Qi and flaming fire damaging the Yang collaterals, causing blood to overflow upwards. Formulas such as Longdan Xiegan Tang (Gentian Liver-Draining Decoction), which level the Liver and drain fire, are what Miao refers to as "attacking the Liver" medicines. When used appropriately, they naturally yield good results, so they should not be categorically denied. Furthermore, in my treatment of hematemesis, I have used prescriptions that simultaneously drain excessive fire and subdue rebellious Qi, combining two methods into one formula. For instance, I treated a 35-year-old woman surnamed Ding who had a depressive temperament and irregular menstruation. After an argument with her family, she suddenly developed hematemesis. Upon examination, she was vomiting small amounts of dark purple blood intermittently, accompanied by belching, irritability, distending pain in the chest and hypochondrium, and a wiry, rapid pulse. I diagnosed this as hematemesis caused by Liver Qi stagnation with rebellion and fire invading the Stomach. I urgently prescribed a mixture including vinegar-fried Rhizoma Polygoni Cuspidati (Dahuang), stir-fried Rhizoma Coptidis (Chuanlian), charcoalized Radix Curcumae (Yujin), stir-fried Caulis Bambusae in Taeniam (Zhuru), Rhizoma Imperatae (Mao-gen), Lapis Haematitum (Daizheshi), stir-fried Fructus Aurantii (Zhishi), charcoalized Fructus Gardeniae (Jiaozhi), Folium Eriobotryae (Pipaye), Rhizoma Phragmitis (Lugen), and nodes of lotus root (Oujie). Administered frequently, the bleeding stopped after a few doses. Subsequently, I prescribed formulas to soothe the Liver, harmonize the Stomach, regulate Qi, and descend fire, leading to a full recovery. If such a type of hematemesis were treated abruptly with Liver-tonifying formulas, it would inevitably worsen the Qi rebellion and intensify the fire, causing blood to gush out uncontrollably.
Thirdly, it states: "It is advisable to direct Qi downward rather than clear fire." Excess Qi constitutes fire; when Qi descends, fire descends; when fire descends, Qi does not rise, and blood follows Qi without overflowing from the upper orifices. Clearing fire requires cold and cool formulas, which can damage Stomach Qi. If Stomach Qi is damaged, the Spleen cannot control blood, and blood fails to return to its vessels. Currently, there are two major pitfalls in treating hematemesis: one is the exclusive use of cold-natured herbs like Radix Scutellariae (Huangqin), Rhizoma Coptidis (Huanglian), Fructus Gardeniae (Shanzhi), Siwu Tang (Four Substance Decoction), Cortex Phellodendri (Huangbai), and Radix Anemarrhenae (Zhimu), which often damage the Spleen causing diarrhea, leading to untreatable conditions; the other is the exclusive use of Radix Ginseng (Renshen), which damages the Lung with heat, worsening coughs. There are cases cured by Renshen, but these involve Qi deficiency with wheezing and coughing, where Qi belongs to Yang and is not caused by Yin deficiency with blazing fire; such cases are rare, less than one in a hundred. "Blood moves with heat and coagulates with cold" accurately describes the cause and mechanism of hematemesis and points out the key principles of treatment. It is a fact that heat patterns are common in blood disorders, while cold patterns are rare. Therefore, in my treatment of hematemesis caused by blazing blood heat damaging Yang collaterals, I have successfully used sweet, salty, and cold methods to cool blood and dissipate stasis. For example, I treated a 17-year-old male who suddenly suffered massive epistaxis (nosebleed) and hematemesis. He presented with a red face, restlessness, occasional delirium, a crimson tongue, and a fine, rapid pulse. I diagnosed this as heat entering the Ying (Nutritive) and Blood levels. I urgently prescribed Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) modified with Radix Scutellariae (Huangqin), stir-fried Folium Platycladi (Baiye), charcoalized Fructus Gardeniae (Zhizi Tan), Rhizoma Imperatae (Maogen), Herba Agrimoniae (Xianhecao), carbonized Pilus Humanus (Xueyu Tan), and nodes of lotus root (Oujie) to cool the Ying level, clear heat, stop bleeding, and harmonize blood. After two large doses, the bleeding ceased. The prescription was continued with modifications and reduced dosage for several more doses until recovery. In cases where excessive fire damages Yang collaterals causing hematemesis, Sanhuang Xiexin Tang (Three Yellows Heart-Draining Decoction) from the *Jin Gui Yao Lue* uses bitter-cold methods to directly suppress fire and clear heat to stop bleeding, which is an appropriate method. The aforementioned case of Ms. Ding was also cured using this formula plus cooling and descending herbs. When hematemesis is severe, following Zhongchun's method using Chinese chive (Jiucai), Xiang (Downward-directing Incense), and Perilla fruit (Suzi) cannot suppress the boiling fire or stop the surging blood. In summary, regarding the key points of hematemesis treatment, Miao's theory contradicts my clinical observations. However, looking at Miao's cases and his thesis—specifically using White Peony Root (Baishao) and Honey-fried Licorice (Zhigancao) to restrain the Liver; Coix Seed (Yiyiren) and Chinese Yam (Huai Shanyao) to nourish the Spleen; Jiucai, Xiang, and Suzi to direct Qi downward; Qinghao, Biejia, Yin Chaihu, Mudanpi, and Dugupi to nourish Yin and clear heat; fried Sour Jujube Kernel (Suanzaoren) and Poria (Fushen) to nourish the Heart; Cornus Fruit (Shanzhuyu) and Goji Berry (Gouqi) to tonify the Kidney—he claims repeated success but notes that Yin cannot be rapidly tonified and requires prolonged medication. This implies his discussions on hematemesis refer specifically to chronic consumptive diseases (Xu Lao). Thus, his therapeutic warnings apply to those contexts. Nevertheless, for Xu Lao complicated by hematemesis, cooling and stopping bleeding methods must never be ignored. Crucially, regardless of the cause, stopping bleeding is the primary emergency measure in treating hematemesis. For heat-pattern hematemesis, excess fire is cleared, and rebellious Qi is pacified; for deficiency-cold hemorrhage, warming and tonifying methods are used to secure blood. These measures aim to stop the bleeding first, allowing for subsequent comprehensive treatment.
Seven, On the Application of Li Dongyuan's Qingshu Yiqi Tang
Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction) originates from Li Dongyuan's work, recorded in *Nei Wai Shang Bian Huo Lun* and *Pi Wei Lun*. The text states: "During late summer, damp-heat prevails, steaming and blazing intensely. People affected often experience heavy and fatigued limbs, shortness of spirit, reluctance to move, chest fullness and shortness of breath, heaviness and pain in joints, high-pitched breathing or panting, body heat and restlessness, epigastric distension and痞 (fullness), yellow and scanty urine, loose and frequent stools, or dysentery with yellow mushy discharge or rice-water color, thirst or no thirst, loss of appetite, spontaneous sweating, heavy body, or profuse sweating... The pulse is洪 (surging) and緩 (moderate). If dampness combats, the pulse may become slow. Although symptoms may vary slightly, the climatic influence of summer heat and dampness remains the same. It should be treated with clearing and drying agents, named Qingshu Yiqi Tang." The composition includes Radix Astragali (Huangqi), Radix Ginseng (Renshen), Rhizoma Atractylodis Macrocephalae (Baizhu), Rhizoma Atractylodis (Cangzhu), Mass Medicae Fermentatae (Shenqu), Pericarpium Citri Reticulatae Viride (Qingpi), Pericarpium Citri Reticulatae (Chenpi), Honey-fried Licorice (Zhigancao), Ophiopogon Tuber (Maidong), Schisandra Fruit (Wuweizi), Angelica Sinensis Root (Danggui), Cortex Phellodendri (Huangbai), Alisma Rhizome (Zexie), Cimicifuga Rhizome (Shengma), Pueraria Root (Gegen), Ginger, and Jujube. The indicated pattern involves Qi injury due to damp-heat in summer, or underlying Middle Qi deficiency combined with damp-heat pathogenic factors. Thus, it uses methods to tonify the Middle and boost Qi, combined with bitter-drying and draining techniques, to treat patterns of underlying deficiency with superficial excess, dampness predominance, and heat accumulation. This seems undeniable. However, Wang Mengying in the Qing Dynasty's *Wen Re Jing Wei* criticized this formula, stating it has the name of clearing summerheat but lacks the substance, sparking much debate. Diseases in summer involving heat, thirst, and spontaneous sweating belong to summerheat diseases. Their pathology includes summerheat burning Qi and fluids, or damp-heat injuring Qi in people with underlying deficiency. Wang's summerheat disease referred purely to heat burning Qi and fluids, treated with American Ginseng (Xiyangshen), Maidong, Dendrobium (Shihu), Huanglian, Zhimu, Bamboo Leaf (Zhuye), Lotus Stem (He Geng), Watermelon Rind (Xigua Cuiyi), Licorice, and Rice. This clears summerheat and benefits Yuan Qi, making it an effective formula, later known as Wang's Qingshu Yiqi Tang. In contrast, Li Dongyuan's formula indicates patterns of limb fatigue, joint heaviness/pain, epigastric distension, and surging/moderate or slow pulses, clearly showing dampness predominance and heat accumulation. Wu Jutong in *Wen Bing Tiao Bian* cited this formula to treat *Ye* disease from *Jin Gui*, which presents with fever, aversion to cold, body heaviness and pain, and wiry-thin-empty-slow pulses, largely consistent with the above. From my clinical observation, Li Dongyuan's formula has its own utility and should not be dismissed. I recall a case in summer during continuous rain: Mr. Hu, ~40 years old, had a cold. After days, he presented with aversion to cold and fever, heavy body and bone ache, limb fatigue, reluctance to speak, chest stuffiness, anorexia, thirst without desire to drink, abdominal discomfort, loose stools, yellow urine, white tongue coating, and soggy pulse. Diagnosed as damp-warmth with dampness exceeding heat, I initially used Sanren Tang (Three Seeds Decoction) plus Huoxiang Ye, fermented soybean (Xiangchi), Areca Peel (Fupipi), and Yujin to release heat with acrid-aromatics and promote diuresis with bland leeching. After five doses, there was no effect, and the patient became more fatigued with a softer pulse. Re-evaluating, I diagnosed mixed summerheat and dampness, with heat constrained by dampness. The initial prescription was not entirely wrong, but the patient's weak constitution and abnormal climate led to severe Lung Qi deficiency and Spleen Qi stagnation, disrupting ascending/descending and entering/exiting functions. The pattern was underlying deficiency with superficial excess, which the initial treatment did not address. I then prescribed Li Dongyuan's Qingshu Yiqi Tang: Codonopsis (Dangshen) and Huangqi 10g each; Qingpi, Chenpi, Baizhu, Cangzhu, Maidong, Wuweizi, stir-fried Huangbai, Gegen, and Zexie 6g each; Zhigancao 5g; Shengma 3g. This tonifies Lung Qi, strengthens Spleen transport, and clears heat within dampness. Danggui was removed as its slippery nature hinders dampness. Additional herbs like Apricot Kernel (Xingren), Cardamom (Kouren), Zhi, Jiegeng, Poria (Fuling), and Tong Cao were added to assist water-dampness metabolism. After ten doses, the patient's spirit improved, slight sweating occurred, and fever resolved. Later, Xiangsha Liujunzi Tang was used for recovery.
Eight, On Classical Formulas for Treating Plum-Pit Qi
The *Jin Gui* states: "If a woman feels as if there is a piece of roasted meat in her throat, Banxia Houpo Tang (Pinellia and Magnolia Bark Decoction) governs it" (*Fu Ren Za Bing Mai Zheng Bing Zhi*). The *Yi Zong Jin Jian* commentary notes: "Phlegm-saliva in the throat feels like roasted meat, impossible to spit out or swallow down; this is now called Plum-Pit Qi. This disease arises from seven emotions causing Qi stagnation and phlegm condensation. Thus, Banxia, Houpo, and Shengjiang disperse nodules with acridity and direct Qi downward with bitterness. Fuling assists Banxia to drain fluid and move Qi. Zisu's aromatic nature unblocks stagnant Qi. Once Qi flows freely and phlegm leaves, the disease heals. Men can also suffer this, not just women." The term Plum-Pit Qi originated in Song Dynasty's Wang Shuo's *Yi Jian Fang*. Its pathology discussion states: "Siqi Tang (i.e., Banxia Houpo Tang) treats Qi of joy, anger, sorrow, fear, and shock, forming phlegm-saliva resembling broken cotton or a plum pit in the throat, impossible to expectorate or swallow, caused by Seven Qi." Wang describes symptoms as "epigastric fullness and Qi stagnation; or phlegm-fluid obstruction causing vomiting and nausea." Though brief, this offers important reference value. My decades of treating this condition show that *Jin Gui* formulas are sometimes effective and sometimes not. Effective cases with Banxia Houpo Tang are mostly caused by cold-fluid, damp-phlegm, and Qi knotting. Symptoms include chest/epigastric oppression, abdominal distension, vomiting/nausea, difficult urination/defecation, white tongue coating, and wiry pulse, matching Wang's description. Ineffective cases, I believe, have different etiologies. Clinical signs may include the sensation of a roasted meat lump, difficulty swallowing, but without recent vomiting, excessive phlegm, or fullness. Symptoms might include expectorating small clumps of phlegm, red throat, irritability, red tongue body, and wiry-rapid pulse. The etiology is often phlegm-fire stagnation. I adopt methods to clear fire, transform phlegm, diffuse stagnation, and resolve knots. Medicines include Huangqin, Xuanshen, Zhebeimu, Haimaifen, stir-fried Niubangzi, Baijiangcan, Kunbu, Muli, XiaKucao, Zhixiangfu, and Qingguo. Named Qingjie Huayu Tang (Clear Fire and Resolve Stagnation Decoction), it yields good results. Case 1: Ms. Wu, 40, farmer, depressive, felt throat blockage for half a year despite acrid-warm dispersing herbs. Pulse wiry-rapid, throat red, menses normal. Treated with Qingjie Huayu Tang: Huangqin 10g, Xuanshen and Muli 12g each, Haimafen and Lianqiao 15g each, Zhixiangfu 6g, Kunbu 15g, Baijiangcan and Qingguo 10g each. Decocted in water, one dose daily. Avoid spicy/stimulating foods. After 15 doses, symptoms eased. Continued for two months for full recovery. Case 2: Neighbor Mr. Li, nearly 70, had Plum-Pit Qi progressing to dysphagia. Esophageal stenosis found. Worried, sought treatment. I added Banzhilian, Baishe Shezhcao, Pugongying, Daizheshi, Junghua, Zhuru, Zhishi, and Lugen to the formula. Taken for half a year, symptoms relieved. Relapse occurred due to alcohol consumption, but recovered after more doses. Books confirm men get Plum-Pit Qi, which can precede dysphagia. It is common in women. Banxia Houpo Tang treats cold-fluid/damp-phlegm/Qi stagnation via acrid-opening and warm-unblocking. My Qingjie Huayu Tang treats phlegm-fire via clearing fire and resolving stagnation. Both are valid for their respective patterns. Banxia Houpo Tang, also called Siqi Tang, is the ancestral formula for regulating Qi and transforming phlegm. This illustrates that TCM requires integrating theory and practice, disease differentiation and syndrome differentiation, ensuring prescriptions match pathology and syndromes to handle complex changes.
Nine, On the Use of Angong Niuhuang Wan and Zixue Dan
Acute illnesses caused by warm-heat, summerheat, or epidemics easily lead to pathogens entering the interior, persistent high fever, coma, restlessness, delirium, convulsions, and even spasms/opisthotonos. Angong Niuhuang Wan and Zixue Dan are miraculous emergency remedies and essential drugs for acute febrile diseases in TCM. Here I discuss their indications, usage, and clinical experiences.
(1) Angong Niuhuang Wan
There are many ancient Niuhuang Wan formulas; I usually use the one in *Wen Bing Tiao Bian*. It is finely compounded and effective. It applies to warm-heat epidemics where pathogenic heat traps inward, counter-transmits to the Pericardium, causing coma and spasms, or sudden heat stroke in adults, and pediatric heat-phlegm convulsions. Composed of Rhino Horn (Xijiao), Calculus Bovis (Niuhuang), Radix Scutellariae (Huangqin), Rhizoma Coptidis (Huanglian), Fructus Gardeniae (Shanzhi), Radix Curcumae (Yujin), Borneolum Syntheticum (Meipian), Realgar (Xionghuang), Cinnabar (Zhusha), Pearl (Zhenzhu), and Moschus (Shexiang), honey-pilled with gold foil coating. Xijiao, Niuhuang, Xionghuang, Huangqin, Huanglian, and Shanzhi clear Heart heat, transform phlegm, and detoxify; Zhusha, Zhenzhu, and gold foil calm the Spirit, settle fright, and stop convulsions; Yujin, Meipian, and Shexiang diffuse stagnation, open orifices, and awaken the brain. This aligns with Wu Jutong's principle: "Aromatic substances transform turbidity and benefit orifices; salty-cold substances protect Kidney Water and calm the Heart body; bitter-cold substances unblock Fire House and drain Heart function."
I have used Angong Niuhuang Wan frequently for acute warm-heat epidemics, often combined with other formulas, sometimes alone. Recall a case in autumn: Mrs. Ling, ~20, pregnant 8 months, worked late spinning, slept until noon next day. Husband away, neighbors entered to find her jaw clenched, eyes staring, comatose. Diagnosis: Spirit dull, face red, limbs twitching, crimson tongue tip, wiry-large-forceful pulse, lower body red. Diagnosed as summerheat entering Ying level, stirring Liver wind, causing eclampsia. Disease in Jueyin, critical, fetus likely lost, but bright red blood offered hope. Urgently gave three Angong Niuhuang Wan pills (~3g each) with Biyu San (Liuyisan + Qingdai) 60g soaked in hot water, dissolving pills in the juice, administered in three doses. To clear Heart, cool Liver, resolve summerheat, open orifices, and guide turbid heat downward. Next morning: fetus expelled (decomposed), spirit still unclear, moaning, face red, slight twitching, pulse wirer but milder. Gave three more pills dissolved in Hookvine (Gouteng) 30g decoction. To enhance calming wind and clearing heat, and slightly activate blood to resolve stasis. After several doses, pulse and symptoms normalized. Regulated over a month until recovery. Main efficacy from emergency Angong Niuhuang Wan.
Another case in spring: Epidemic encephalitis in my village. Treated 9-year-old boy Li. After headache, stiff neck, fever, vomiting, he became comatose, delirious, and convulsive. Antibiotics and sulfonamides failed. Examination: black, dry tongue lacking fluids, wiry-rapid forceful pulse. Urgently ordered two Angong Niuhuang Wan pills, divided into two doses, to open orifices, awaken brain, extinguish wind, and stop spasms. Followed Wu Jutong's method to clear Ying level and extinguish Liver wind with Qingying Tang (Xijiao, Huanglian, Danpi, Shengdi, Xuanshen, Maidong, Zhuye, Yinhua, Lianqiao) plus Gouteng, Quanxie, Dilong, Shijueming, and Sangzhi. After two doses, spirit returned, convulsions stopped. Removed Angong Niuhuang Wan, reduced previous formula dosage, took five more doses, condition eased and recovered.
(2) Zixue Dan
For warm-heat/summerheat/epidemic diseases causing coma, delirium, mania, restlessness, convulsions, red urine, constipation, thirst, scorched lips, red/black tongue, and pediatric spasms, these result from epidemic heat-toxin intruding into Pericardium, stirring Liver wind, and disturbing consciousness. Zixue Dan consists of Antelope Horn (Lingyangjiao), Rhino Horn (Xijiao), Magnetite (Cishi), Talcum (Huashi), Gypsum (Shigao), Frozen Stone (Han Shuishishi), Honey-fried Licorice (Zhigancao), Costus Root (Muxiang), Agarwood (Chenxiang), Clove (Dingxiang), Cimicifuga (Shengma), Niter (Xiaoshi), Mirabilite (Pu Xiaoshi), Scrophularia Root (Xuanshen), Cinnabar (Chensha), Moschus (Shexiang), and Gold (Huangjin). Lingyangjiao and Xijiao clear Heart and cool Liver; Han Shuishishi, Huashi, and Shigao reduce heat with cold; Pu Xiaoshi and Xiaoshi guide turbidity and unblock bowels; Xuanshen and Licorice protect Yin and detoxify; Chensha, Cishi, and Gold calm Spirit; Dingxiang, Muxiang, Chenxiang, and Shexiang open orifices and promote Qi flow. Most herbs direct downward, except Shengma which rises then falls, primarily directing downward, expelling pathogenic heat-toxin from all meridians through the lower orifices.
Thus, consciousness clarifies, and symptoms resolve.