投姜附，则阴液涸竭而亡。况怀麟七月，恐其胎气受伤，用药最为棘手。而夫子初诊，即认定为热厥，投四
逆散以解之。继又速进养阴清热之剂，使内陷之邪，由脏转腑，由里达表，竟使病者得庆更生，夫子之识见深
矣。治安幸列门墙，弥殷瞻仰，谨录之。受业 朱治安志。
邹女 湿温九天，身热午后尤甚，口干不多饮，头痛且胀，胸闷不能食，腑行溏薄，舌苔薄腻带黄，脉象濡
数，左关带弦，温与湿合，热处湿中，蕴蒸膜原，漫布三焦，温不解则热不退，湿不去则温不清，能得白 ，
而邪始有出路，然湿为粘腻之邪，最难骤化，恐有缠绵之虑。姑拟柴葛解肌，以去其温，芳香淡渗，而利其湿。
软柴胡（八分） 葛根（一钱五分） 清水豆卷（三钱） 赤苓（三钱） 泽泻（五钱） 银花炭（三钱）
连翘（二钱） 鲜藿香（一钱五分） 鲜佩兰（一钱五分） 神曲（二钱） 大腹皮（二钱） 通草（八分）
荷叶（一角） 甘露消毒丹（包，四钱）
二诊 湿温十二天，汗多，身热虽减，而溏泻更甚于前，日夜有十余次之多。细视所泻之粪水，黑多黄少，
并不臭秽，唇焦齿垢，口干欲饮，饮入肠鸣，小溲短少而赤，舌边红，苔干黄，脉象左濡数，右濡迟，趺阳之脉亦
弱。此太阴为湿所困，清气下陷。粪水里黑多黄少，黑属肾色，是少阴胜趺阳负明矣，况泻多既伤脾、亦伤阴。
脾阳不能为胃行其津液，输运于上，伤阴津液亦不上承，唇焦齿垢，职是故也。书云∶自利不渴者属太阴，自
利而渴者属少阴。少阴为水火之脏，为三阴之枢，少阴阴阳两伤，上有浮热，下有虚寒，显然可见。脉证参观，
颇虑正不敌邪，白 不能外达，有内陷之险，欲滋养则碍脾，欲温化则伤阴，顾此失彼，殊属棘手。辗转思维，
惟有扶正祛邪，培补中土，冀正旺则伏邪自达，土浓则
虚火自敛，未识能弋获否。
人参须（一钱） 米炒于术（二钱） 清水豆卷（四钱） 云苓（三钱） 生甘草（三分） 炒淮山药（三钱）
炮姜炭（三分） 炒扁豆衣（三钱） 炒谷芽苡仁（各三钱） 干荷叶（一两） 陈仓米（一两，煎汤代水）
三诊 湿温两候，前方连服三剂，泄泻次数已减。所下粪水，仍黑黄夹杂，小溲短赤，口干欲饮，齿缝渗
血，舌边红，苔干黄，脉象濡数，尺部细弱，白 布于胸膺脐腹之间，籽粒细小不密，伏温蕴湿，有暗泄之机。
然少阴之阴，太阴之阳，因泻而伤，清津无以上供。泻不止，则正气不复，正不复，则邪不能透达，虽逾险岭，
未涉坦途也。仍宜益气崇土为主，固胃涩肠佐之。
吉林参（一钱） 米炒于术（二钱） 生甘草（三分） 云苓（三钱） 炒淮山药（三钱） 炒川贝（二钱）
禹余粮（三钱） 炒谷芽（三钱） 橘白（一钱） 炒薏仁（三钱） 干荷叶（一角）
四诊 湿温十七天，泄泻已减七八，粪色转黄，亦觉臭秽，太阴已有健运之渐，白 布而甚多，色亦显明，
正胜邪达之佳象。口干而腻，不思谷食，睡醒后面红，稍有谵语，超时而清，脉濡数而缓，舌质红苔黄。良由
气阴两伤，神不安舍，余湿酿成痰浊，留恋中焦，胃气呆顿。今拟七分扶正，三分祛邪，虚实兼顾，以善其后也。
人参须（八分）炒于术（一钱五分） 炒川贝（二钱） 云苓神（辰砂拌，各三钱） 远志（一钱）
炒淮药（三钱） 橘白（一钱） 炒谷芽苡仁（各三钱） 清水豆卷（三钱） 佩兰（一钱五分） 清炙枇杷叶
（二钱）
张左 秋温伏暑，蕴蒸阳阴，身热甚壮，有汗不解，口干欲饮，苔黄脉数，两足逆冷。是热在阳明，湿在太
阴，与中寒者不同，症势沉重。姑拟加味苍术白虎汤，清温燥湿，以望转机。
生石膏（五钱） 天花粉（三钱） 黑山栀（一钱五分） 肥知母（一钱五分） 金银花（三钱） 活芦根（去节，
一两） 生甘草（五分） 连翘壳（一钱五分） 制苍术（一钱）
王幼 湿温伏邪，已十六天，汗多潮热，口干欲饮，白 布于胸腹之间，八九日未更衣，脐下按之疼痛，
舌红绛中后腻黄，脉象沉数。叠投清温化湿之剂，诸症不减；良由伏邪蕴湿化热，由气及营，由经入腑，腑中宿垢
不得下达也。吴又可云∶温病下不嫌早。导滞通腑为主，清温凉营佐之，使有形之滞得下，则无形之邪自易
解散。
生川军（二钱） 玄明粉（后入，一钱五分） 枳实（一钱） 生甘草（五分） 冬桑叶（二钱） 粉丹皮（二钱）
青蒿（一钱五分）
嫩白薇（一钱五分） 京赤芍（一钱五分） 青荷梗（一尺） 活水芦根（去节，一尺）
复诊 昨进导滞通腑，清营泄热之剂。腑气已通，潮热渐减，白 布而不多，口干欲饮，舌中腻黄渐化，脉
濡数无力，阴液暗伤，余热留恋气营之间，清津无以上供。今拟生津清化，佐入和胃之品，尚须节食，恐多食
则复，少食则遗之弊。
天花粉（三钱） 霜桑叶（二钱） 粉丹皮（一钱五分） 京赤芍（一钱五分） 朱茯神（三钱） 青蒿梗（一
钱五分） 嫩白薇（一钱五分） 通草（八分） 六一散（包，三钱） 青荷梗（一尺） 生熟谷芽（各三钱）
裘左 湿温八天，壮热有汗不解，口干欲饮，烦躁不寐，热盛之时，谵语妄言，胸痞泛恶，不能纳谷，小溲
浑赤，舌苔黄多白少，脉象弦滑而数。阳明之温甚炽，太阴之湿不化，蕴蒸气分，漫布三焦，有温化热、湿化燥
之势，症非轻浅。姑拟苍术白虎汤加减，以观动静。
生石膏（三钱） 肥知母（一钱五分） 枳实炭（一钱） 通草（八分） 制苍术（八分） 茯苓皮（三钱）
炒竹茹（一钱五分） 飞滑石（三钱） 仙半夏（一钱五分） 活芦根（去节，一尺）
荷梗（一尺）
二诊 今诊脉洪数较缓，壮热之势大减，稍能安寐，口干欲饮，胸闷泛恶，不能纳谷，舌苔腻黄渐化，伏
温渐解，而蕴湿犹留中焦也。既见效机，毋庸更张，参入芳香淡渗之品，使湿热有出路也。
熟石膏（三钱） 仙半夏（一钱五分） 枳实炭（一钱） 泽泻（一钱） 制苍术（八分） 赤茯苓（三钱）
炒竹茹（一钱五分） 通草（八分） 飞滑石（三钱） 鲜藿佩（各一钱五分） 荷梗（一尺）
三诊 热退数日，复转寒热似疟之象，胸闷不思纳谷，且有泛恶，小溲短赤，苔黄口苦，脉象左弦数，右
濡滑。此伏匿之邪，移于少阳，蕴湿留恋中焦，胃失降和。今宜和解枢机，芳香淡渗，使伏匿之邪，从枢机而解，湿
热从小便而出也。
软柴胡（八分） 仙半夏（二钱） 酒黄芩（一钱） 赤苓（三钱） 枳实（一钱） 炒竹茹（一钱五分）
通草（八分） 鲜藿佩（各一钱五分） 泽泻（一钱五分） 荷梗（一尺）
赵童 湿温已延月余，身热早轻暮剧，有时畏冷背寒，热盛之时，谵语郑声，渴喜热饮，小溲短赤，形瘦
骨立，纳谷衰微，舌质红，苔薄黄，脉象虚弦而数，白疹布而不多，色不显明。良由病久正气已虚，太少之邪未
罢，蕴湿留恋膜原，枢机不和，颇虑正不敌邪，致生变
迁。书云∶过经不解，邪在三阳。今拟小柴胡合桂枝白虎汤加减，本虚标实，固本去标为法。
潞党参（一钱五分） 软柴胡（一钱） 生甘草（五分） 仙半夏（二钱） 熟石膏（三钱） 赤茯苓（朱
砂拌，三钱） 炙远志（一钱） 川桂枝（八分） 通草（八分） 泽泻（一钱五分） 焦谷芽（三钱）
佩兰叶（一钱五分）
二诊 进小柴胡合桂枝白虎汤加减，寒热渐退，谵语亦止，白疹布而渐多，脉象濡数，苔薄黄。太少
之邪，已有外达之势，口干不多饮，精神疲倦，谷食衰微，正气已夺，脾胃鼓舞无权。今拟制小其剂，扶
正祛邪，理脾和胃，冀胃气来复，自能入于坦途。
潞党参（一钱五分） 银柴胡（一钱） 生甘草（五分） 云苓（辰砂拌，三钱） 仙半夏（二钱） 粉葛根
（一钱五分） 广橘白（一钱） 佩兰叶（一钱五分） 白薇（一钱五分） 川通草（八分） 生熟谷芽（各三钱）
生姜（一片） 红枣（三枚）
李左 脉来濡数，濡为湿，数为热，湿与热合，蕴蒸气分，漫布三焦，是以身热三候，朝轻暮重，白疹满
布胸膺之间，形瘦神疲，乃湿热郁久不化，耗气伤阴所致，症势非轻。急宜存阴清宣。
金石斛（三钱） 嫩白薇（一钱五分） 六一散（包，三钱） 象贝母（三钱） 南北沙参（各一钱五分）
茯苓皮（三钱） 净蝉
衣（八分） 鲜竹叶（三十张） 香青蒿（一钱五分） 通草（八分） 连翘壳（一钱五分） 荷梗（一支）
沈左 湿温四候，身热早轻暮重，有汗不解，白 已布，色不显明，口干欲饮，唇燥齿垢，形瘦神疲，舌
质红，苔微黄，脉濡数无力。此乃气阴已伤，余邪湿热，留恋气营之间，入夜梦语如谵，有神不守舍之象，且
有咳嗽，肺胃亦虚，虚多邪少，还虑生波。今拟清养肺胃之阴，宣化三焦之湿。
南沙参（三钱） 朱茯神（三钱） 川贝（二钱） 通草（八分） 川石斛（三钱） 冬桑叶（三钱）
栝蒌皮（二钱） 冬瓜子（三钱） 嫩白薇（一钱五分） 粉丹皮（一钱五分） 广橘白（一钱） 生苡仁（三钱）
清炙枇杷叶（去毛、包，二钱）
复诊 诸恙见轻，原方加北秫米（包）三钱。
郑左 湿温十六天，身灼热，有汗不退，口渴欲饮，烦躁少寐，梦语如谵，目红溲赤，舌红糙无津，脉象弦
数，红疹布于胸膺之间。此温已化热，湿已化燥，燥火入营，伤阴劫津，有吸尽西江之势，化源告竭、风动痉
厥之变，恐在目前。亟拟大剂生津凉营，以清炎炎之威，冀其津生邪却，出险入夷为幸。
鲜生地（六钱） 天花粉（三钱） 川贝母（二钱） 生甘草（八分） 粉丹皮（二钱） 冬桑叶（三钱）
银花（八钱） 白薇（一钱五分）
羚羊片（八分） 朱茯神（三钱） 带心连翘（三钱） 茅芦根（各一两） 鲜石斛（四钱） 鲜竹叶（三十片）
二诊 湿温十八天，甘寒清解，已服二剂，舌红糙略润，津液有来复之渐。身灼热、口渴引饮均减，
夜寐略安，佳境也。红疹布而渐多，目白红丝，小溲短赤，脉数不静，少阴之阴已伤，水不济火，营分之
热尚炽，木火升腾。前方既见效机，毋庸改弦易辙也。
原方加∶西洋参（一钱五分）、鲜藕（四两，切片入煎）。
三诊 湿温三候，温化热，湿化燥，叠进生津凉解，身灼热大减，寐安，梦语亦止。红疹满布，营分
之热，已得外达，脉数不静，舌转光红，小便黄，七、八日未更衣，阴液难以骤复，木火尚炽，余焰未
净。仍拟生津泄热，佐通腑气，虽缓下，亦寓存阴之意。
西洋参（一钱五分） 冬桑叶（二钱） 天花粉（三钱） 白薇（一钱五分） 鲜生地（四钱） 粉丹皮
（二钱） 川贝母（三钱） 生甘草（六分） 鲜石斛（四钱） 朱茯神（三钱） 郁李仁（研，三钱）
麻仁（研，四钱） 活芦根（去节，一尺）
四诊 湿温二十二天，身灼热已退，寐安神清，红疹布而渐化，腑气亦通，舌质红，苔微白，脉象濡
软而数，精神疲倦，小溲淡黄，谷食无味，邪退正虚，脾胃鼓舞无权。今拟养正和胃，寒凉慎用，虑过
犹不及也。
西洋参（米炒，五钱） 朱茯神（三钱） 川石斛（三钱） 生甘草（五分） 通草（八分） 栝蒌皮（二钱）
广橘白（一钱） 川贝母（二钱） 北秫米（包，三钱）
巫左 湿温症已延月，寒热时轻时剧，口干不喜饮，腑行溏薄。初由伏邪湿热，蕴于募原，少阳枢机
不和，太阴为湿所困，清气不升。阅前方参、附、龙、牡、姜、桂、二陈等剂，温涩太过，致伏邪无路可出，
愈郁愈深，如胶似漆。邪遏化热，湿遏化燥，伤阴劫津，化源告竭，气逆而促，神糊谵语，所由来也。舌
苔黑糙而垢，有似少阴热结旁流、急下存阴之条，无如脉象左弦细促数，右部虚散，腹无燥实坚满之形，
安有可下之理？阴液枯槁，正气亦匮，厥脱之变，即在目前矣。勉拟增液生津，以救其焚，亦不过尽人力
以冀天眷！
西洋参（三钱） 朱茯神（三钱） 天竺黄（一钱五分） 嫩钩钩（后入，三钱） 大麦冬（二钱）
紫贝齿（三钱） 银柴胡（八分） 枳实炭（八分） 霍石斛（三钱） 川贝母（二钱） 清炙草（四分）
炒竹茹（一钱五分）
费右 湿温三候，灼热不退，舌绛起刺，脉洪数。温邪化火，由气入营，热邪内炽，扰犯包宫，伤
津劫液，化源欲竭。以致唇焦齿垢，谵语妄言，内陷重症，危笃之至。拟养阴救液，清火开窍，未识能有
挽回否。
犀角尖（三分） 粉丹皮（一钱五分） 带心麦冬（三钱） 鲜石菖蒲（五分） 鲜生地（三钱）
京赤芍（一钱五分） 上川连（三分） 鲜竹叶心（三钱） 带心连翘（三钱） 京玄参（三钱） 天竺黄
（二钱） 活芦根（去节，一两） 牛黄清心丸（一粒，另研细末化服）
（前文案例回顾）若使用干姜、附子等温热药物，会导致阴液枯竭而死亡。况且患者怀麟怀孕七月，担心胎气受损，用药最为棘手。但丁甘仁先生初诊时，即认定为热厥证，投用四逆散来疏解郁热。随后又迅速进服养阴清热的方剂，使内陷的邪气，由脏转至腑，由里达表，竟然使病人得以死里逃生，先生的见识确实深远。学生朱治安有幸拜入门下，心中充满敬仰之情，谨将此案记录于此。受业弟子 朱治安 记述。
邹姓女子：患湿温病九天，身体发热，午后尤为严重，口干但不想多饮水，头痛且伴有胀感，胸闷不能进食，大便稀溏，舌苔薄腻带黄色，脉象濡数，左关脉带弦象。这是温邪与湿邪相合，热蕴于湿中，熏蒸于膜原，弥漫分布于三焦。温邪不解则热不退，湿邪不去则温不清，只有等到白㾦（一种晶莹的小水疱，为湿热外透之象）发出，邪气才有出路。然而湿邪性质粘腻，最难迅速化解，恐怕会有缠绵难愈的忧虑。暂拟柴葛解肌汤加减，以去除温邪，配合芳香淡渗之法以利湿邪。
处方：软柴胡八分，葛根一钱五分，清水豆卷三钱，赤茯苓三钱，泽泻五钱，银花炭三钱，连翘二钱，鲜藿香一钱五分，鲜佩兰一钱五分，神曲二钱，大腹皮二钱，通草八分，荷叶一角，甘露消毒丹四钱（包煎）。
二诊：湿温病十二天，汗出较多，身体发热虽然减退，但腹泻比之前更严重，日夜多达十余次。仔细观察所排泄的粪水，黑色多黄色少，并不臭秽，嘴唇焦裂，牙齿有垢，口干想喝水，但喝水后肠鸣作响，小便短少且颜色红赤，舌边红，苔干黄，脉象左手濡数，右手濡迟，趺阳脉也微弱。这是太阴脾土被湿邪困阻，清气下陷所致。粪水中黑多黄少，黑色属肾色，说明少阴肾气盛而趺阳胃气负是明显的了。况且腹泻过多既损伤脾气，也损伤阴液。脾阳不能为胃输送津液上行，阴津也不能上承滋润口唇，导致唇焦齿垢，就是这个原因。医书说：“自利不渴的属于太阴，自利而口渴的属于少阴。”少阴是水火之脏，是三阴经的枢纽，现在少阴阴阳两伤，上有浮热，下有虚寒，从脉证来看很明显。综合脉证分析，很担心正气不敌邪气，白㾦不能外达，有邪气内陷的危险。想要滋养阴液则会碍滞脾胃，想要温化湿邪又会损伤阴液，顾此失彼，非常棘手。反复思考，只有扶助正气、祛除邪气，培补中焦脾胃，希望正气旺盛则潜伏的邪气自然透出，土气厚实则虚火自然收敛，不知能否成功。
处方：人参须一钱，米炒白术二钱，清水豆卷四钱，云茯苓三钱，生甘草三分，炒淮山药三钱，炮姜炭三分，炒扁豆衣三钱，炒谷芽和薏苡仁各三钱，干荷叶一两，陈仓米一两（煎汤代水）。
三诊：湿温病十四天（两候），前方连续服用三剂，泄泻次数已经减少。所下的粪水，仍然是黑黄夹杂，小便短赤，口干想喝水，齿缝渗血，舌边红，苔干黄，脉象濡数，尺部细弱，白㾦分布在胸膺和脐腹之间，籽粒细小且不密集，伏温蕴湿，有暗泄的趋势。然而少阴之阴、太阴之阳，因腹泻而受伤，清津无法上供。如果腹泻不止，正气就无法恢复；正气不恢复，邪气就不能透达。虽然度过了险境，但未进入平坦大道。仍应以益气健脾为主，固胃涩肠为辅。
处方：吉林参一钱，米炒白术二钱，生甘草三分，云茯苓三钱，炒淮山药三钱，炒川贝母二钱，禹余粮三钱，炒谷芽三钱，橘白一钱，炒薏仁三钱，干荷叶一角。
四诊：湿温病十七天，泄泻已减少七八成，粪便颜色转黄，也感到有些臭秽，太阴脾土已有健运的迹象，白㾦分布很多，颜色也显明，这是正气战胜邪气外达的好现象。口干且感觉粘腻，不想吃东西，睡醒后面部发红，稍有胡言乱语，过一会儿就清醒，脉象濡数而缓，舌质红苔黄。这是由于气阴两伤，心神不安，残余湿气酿成痰浊，留恋在中焦，导致胃气呆滞。现在拟定七分扶正，三分祛邪，虚实兼顾，以善后调理。
处方：人参须八分，炒白术一钱五分，炒川贝母二钱，云苓神辰砂拌各三钱，远志一钱，炒淮药三钱，橘白一钱，炒谷芽和薏苡仁各三钱，清水豆卷三钱，佩兰一钱五分，清炙枇杷叶二钱。
张姓左侧：秋温伏暑，蕴蒸于阳明经，身体发热非常剧烈，有汗但不能退热，口干想喝水，苔黄脉数，两脚逆冷。这是热在阳明，湿在太阴，与中寒证不同，病情沉重。暂拟加味苍术白虎汤，清热燥湿，希望能出现转机。
处方：生石膏五钱，天花粉三钱，黑山栀一钱五分，肥知母一钱五分，金银花三钱，活芦根去节一两，生甘草五分，连翘壳一钱五分，制苍术一钱。
王姓幼童：湿温伏邪，已十六天，汗多潮热，口干想喝水，白㾦布于胸腹之间，八九日未排便，脐下按压疼痛，舌红绛中后部腻黄，脉象沉数。多次投用清热化湿的药剂，各种症状没有减轻；这是因为伏邪蕴湿化热，由气分波及营分，由经络传入腑中，腑中宿便不得下行所致。吴又可说：“温病攻下不嫌早。”以导滞通腑为主，清热凉营为辅，使有形的积滞得以下行，则无形的邪气自然容易解散。
处方：生大黄二钱，玄明粉后下一钱五分，枳实一钱，生甘草五分，冬桑叶二钱，粉丹皮二钱，青蒿一钱五分，嫩白薇一钱五分，京赤芍一钱五分，青荷梗一尺，活水芦根去节一尺。
复诊：昨天服用导滞通腑、清营泄热的药剂。腑气已通，潮热逐渐减退，白㾦分布不多，口干想喝水，舌中腻黄渐化，脉象濡数无力，阴液暗中受伤，余热留恋在气营之间，清津无法上供。现在拟定生津清化，佐入和胃的药物，还需要节制饮食，恐怕多吃会复发，少吃会遗留病邪的弊端。
处方：天花粉三钱，霜桑叶二钱，粉丹皮一钱五分，京赤芍一钱五分，朱茯神三钱，青蒿梗一钱五分，嫩白薇一钱五分，通草八分，六一散包煎三钱，青荷梗一尺，生熟谷芽各三钱。
裘姓左侧：湿温病八天，壮热有汗不能退热，口干想喝水，烦躁失眠，热盛之时，胡言乱语，胸闷泛恶，不能进食，小便浑浊红赤，舌苔黄多白少，脉象弦滑而数。阳明之温邪甚炽，太阴之湿邪不化，蕴蒸气分，弥漫三焦，有温邪化热、湿邪化燥的趋势，病情非轻浅。暂拟苍术白虎汤加减，以观察病情变化。
处方：生石膏三钱，肥知母一钱五分，枳实炭一钱，通草八分，制苍术八分，茯苓皮三钱，炒竹茹一钱五分，飞滑石三钱，仙半夏一钱五分，活芦根去节一尺，荷梗一尺。
二诊：今天诊察脉象洪数较前缓和，壮热之势大减，稍能安睡，口干想喝水，胸闷泛恶，不能进食，舌苔腻黄渐化，伏温渐解，但蕴湿仍留滞中焦。既然见到疗效，无需更改方药，加入芳香淡渗的药物，使湿热有出路。
处方：熟石膏三钱，仙半夏一钱五分，枳实炭一钱，泽泻一钱，制苍术八分，赤茯苓三钱，炒竹茹一钱五分，通草八分，飞滑石三钱，鲜藿香和鲜佩兰各一钱五分，荷梗一尺。
三诊：热退数日后，又转为寒热似疟的症状，胸闷不想进食，且有泛恶，小便短赤，苔黄口苦，脉象左手弦数，右手濡滑。这是潜伏的邪气，转移到了少阳经，蕴湿留恋中焦，胃失和降。现在宜和解枢机，芳香淡渗，使潜伏的邪气从枢机而解，湿热从小便而出。
处方：软柴胡八分，仙半夏二钱，酒黄芩一钱，赤茯苓三钱，枳实一钱，炒竹茹一钱五分，通草八分，鲜藿香和鲜佩兰各一钱五分，泽泻一钱五分，荷梗一尺。
赵姓儿童：湿温病已延续一个多月，身体发热早晨轻晚上重，有时怕冷背寒，热盛之时，胡言乱语声音低微，渴喜热饮，小便短赤，形体消瘦骨立，进食极少，舌质红，苔薄黄，脉象虚弦而数，白疹分布不多，颜色不显明。这是因为病久正气已虚，太少二经之邪未罢，蕴湿留恋膜原，枢机不和，很担心正气不敌邪气，导致病情变化。医书说：“过经不解，邪在三阳。”现在拟定小柴胡汤合桂枝白虎汤加减，针对本虚标实，以固本去标为法则。
处方：潞党参一钱五分，软柴胡一钱，生甘草五分，仙半夏二钱，熟石膏三钱，赤茯苓朱砂拌三钱，炙远志一钱，川桂枝八分，通草八分，泽泻一钱五分，焦谷芽三钱，佩兰叶一钱五分。
二诊：服用小柴胡合桂枝白虎汤加减后，寒热逐渐消退，胡言乱语也停止，白疹分布渐多，脉象濡数，苔薄黄。太少之邪，已有外达的趋势，口干但不想多饮，精神疲倦，食欲衰微，正气已夺，脾胃鼓舞无权。现在拟定缩小剂量，扶正祛邪，理脾和胃，希望胃气来复，自然能步入坦途。
处方：潞党参一钱五分，银柴胡一钱，生甘草五分，云茯苓辰砂拌三钱，仙半夏二钱，粉葛根一钱五分，广橘白一钱，佩兰叶一钱五分，白薇一钱五分，川通草八分，生熟谷芽各三钱，生姜一片，红枣三枚。
李姓左侧：脉象濡数，濡主湿，数主热，湿与热相合，蕴蒸气分，弥漫三焦，所以身体发热三个候期（约六天），早晨轻晚上重，白疹满布胸膺之间，形体消瘦神疲，这是湿热郁久不化，耗气伤阴所致，病情非轻。急宜存阴清宣。
处方：金石斛三钱，嫩白薇一钱五分，六一散包煎三钱，象贝母三钱，南北沙参各一钱五分，茯苓皮三钱，净蝉蜕八分，鲜竹叶三十张，香青蒿一钱五分，通草八分，连翘壳一钱五分，荷梗一支。
沈姓左侧：湿温病二十天（四候），身体发热早晨轻晚上重，有汗不能退热，白㾦已布，颜色不显明，口干想喝水，嘴唇干燥牙齿有垢，形体消瘦神疲，舌质红，苔微黄，脉象濡数无力。这是气阴已伤，残余邪气湿热，留恋在气营之间，入夜梦话如谵语，有神不守舍的现象，且有咳嗽，肺胃亦虚，虚多邪少，还担心产生变证。现在拟定清养肺胃之阴，宣化三焦之湿。
处方：南沙参三钱，朱茯神三钱，川贝母二钱，通草八分，川石斛三钱，冬桑叶三钱，栝蒌皮二钱，冬瓜子三钱，嫩白薇一钱五分，粉丹皮一钱五分，广橘白一钱，生苡仁三钱，清炙枇杷叶去毛包煎二钱。
复诊：各种症状见轻，原方加北秫米包煎三钱。
郑姓左侧：湿温病十六天，身体灼热，有汗不退，口渴想喝水，烦躁少寐，梦话如谵语，眼睛红小便赤，舌红糙无津，脉象弦数，红疹布于胸膺之间。这是温邪已化热，湿邪已化燥，燥火入营，伤阴劫津，有吸尽西江之水之势，化源告竭，风动痉厥的变证，恐怕就在眼前。亟需拟定大剂生津凉营，以清除炎炎之威，希望其津生邪却，出险入夷为幸。
处方：鲜生地六钱，天花粉三钱，川贝母二钱，生甘草八分，粉丹皮二钱，冬桑叶三钱，银花八钱，白薇一钱五分，羚羊片八分，朱茯神三钱，带心连翘三钱，茅芦根各一两，鲜石斛四钱，鲜竹叶三十片。
二诊：湿温病十八天，甘寒清解之剂，已服用两剂，舌红糙略润，津液有来复的迹象。身体灼热、口渴引饮均减轻，夜间睡眠略安，是好现象。红疹分布渐多，眼白有红丝，小便短赤，脉数不静，少阴之阴已伤，水不济火，营分之热尚炽，木火升腾。前方既然见效，无需改换方药。
原方加：西洋参一钱五分，鲜藕四两（切片入煎）。
三诊：湿温病二十一天（三候），温化热，湿化燥，连续进服生津凉解之剂，身体灼热大减，睡眠安稳，梦语也停止。红疹满布，营分之热，已得外达，脉数不静，舌转光红，小便黄，七、八日未排便，阴液难以骤然恢复，木火尚炽，余焰未净。仍拟定生津泄热，佐以通腑气，虽然是缓下，也蕴含存阴的意思。
处方：西洋参一钱五分，冬桑叶二钱，天花粉三钱，白薇一钱五分，鲜生地四钱，粉丹皮二钱，川贝母三钱，生甘草六分，鲜石斛四钱，朱茯神三钱，郁李仁研三钱，麻仁研四钱，活芦根去节一尺。
四诊：湿温病二十二天，身体灼热已退，睡眠安稳神志清醒，红疹分布渐化，腑气亦通，舌质红，苔微白，脉象濡软而数，精神疲倦，小便淡黄，食物无味，邪退正虚，脾胃鼓舞无权。现在拟定养正和胃，慎用寒凉，担心过犹不及。
处方：西洋参米炒五钱，朱茯神三钱，川石斛三钱，生甘草五分，通草八分，栝蒌皮二钱，广橘白一钱，川贝母二钱，北秫米包煎三钱。
巫姓左侧：湿温症已延续一个月，寒热时轻时重，口干不喜欢喝水，大便稀溏。起初由伏邪湿热，蕴于募原，少阳枢机不和，太阴被湿所困，清气不升。看前面的方子参、附、龙、牡、姜、桂、二陈等药剂，温涩太过，导致伏邪无路可出，越郁越深，如胶似漆。邪遏化热，湿遏化燥，伤阴劫津，化源告竭，气逆而促，神糊谵语，由此而来。舌苔黑糙而垢，有点像少阴热结旁流、急下存阴的条文，无奈脉象左手弦细促数，右手虚散，腹部没有燥实坚满的形状，哪里有可下的道理？阴液枯槁，正气亦匮，厥脱的变证，就在眼前了。勉强拟定增液生津，以救其焚，也不过是尽力而为以期望上天眷顾！
处方：西洋参三钱，朱茯神三钱，天竺黄一钱五分，嫩钩藤后入三钱，大麦冬二钱，紫贝齿三钱，银柴胡八分，枳实炭八分，霍石斛三钱，川贝母二钱，清炙甘草四分，炒竹茹一钱五分。
费姓右侧：湿温病二十一天（三候），灼热不退，舌绛起刺，脉洪数。温邪化火，由气入营，热邪内炽，扰犯心包，伤津劫液，化源欲竭。以致嘴唇焦裂牙齿有垢，胡言乱语，内陷重症，危笃之至。拟定养阴救液，清火开窍，不知能否挽回。
处方：犀角尖三分，粉丹皮一钱五分，带心麦冬三钱，鲜石菖蒲五分，鲜生地三钱，京赤芍一钱五分，上川连三分，鲜竹叶心三钱，带心连翘三钱，京玄参三钱，天竺黄二钱，活芦根去节一两，牛黄清心丸一粒（另研细末化服）。
(Review of previous case) If warming herbs such as Rhizoma Zingiberis Preparatum (Shengjiang, dried ginger) and Radix Aconiti Lateralis Preparata (Fuzi, prepared lateral root of Aconitum carmichaelii) are used, it will lead to the exhaustion of Yin fluids and death. Moreover, since patient Huailin is seven months pregnant, there is a fear of damaging the fetal Qi, making medication particularly difficult. However, at the initial diagnosis, Dr. Ding Ganren identified it as Heat Jue (Heat Reversal Syndrome), prescribing Si Ni San (Four Counterflow Powder) to resolve the constraint. Subsequently, he rapidly administered formulas to nourish Yin and clear heat, causing the internalized pathogen to shift from the Zang organs to the Fu organs, and from the interior to the exterior, miraculously saving the patient's life. The doctor's insight was indeed profound. Student Zhu Anzhi, honored to be in his discipleship, feels deep admiration and records this case. Disciple Zhu Anzhi records.
Ms. Zou: Suffering from Damp-Warmth (Shi Wen) for nine days, body heat is more severe in the afternoon, dry mouth with little desire to drink, headache with distending sensation, chest fullness with inability to eat, loose stools, thin greasy yellow coating on the tongue, soggy and rapid pulse, left Guan position shows a string-like quality. This indicates Warmth combined with Dampness, where Heat is trapped within Dampness, steaming the Membrane Source (Mo Yuan) and spreading throughout the Triple Burner (San Jiao). If Warmth is not resolved, Heat does not subside; if Dampness is not removed, Warmth is not cleared. Only when Bai Fen (white papular rash, indicating damp-heat emerging) appears will the pathogen have an exit. However, Dampness is sticky and tenacious, hardest to transform quickly, raising concern for a lingering course. Tentatively prescribe Chai Ge Jie Ji Tang (Bupleurum and Pueraria Decoction to Resolve the Muscle Layer) to remove Warmth, combined with aromatic and light-leaching methods to promote Dampness drainage.
Prescription: Ruan Chai Hu (Bupleuri Radix) 8 fen, Ge Gen (Puerariae Radix) 1.5 qian, Qing Shui Dou Juan (Sojae Semen Praeparatum) 3 qian, Chi Ling (Poria cum Rosa) 3 qian, Ze Xie (Alismatis Rhizoma) 5 qian, Yin Hua Tan (Lonicerae Flos Carbonized) 3 qian, Lian Qiao (Forsythiae Fructus) 2 qian, Xian Huo Xiang (Agastaches Herba Fresh) 1.5 qian, Xian Pei Lan (Eupatorii Herba Fresh) 1.5 qian, Shen Qu (Massa Medicata Fermentata) 2 qian, Da Fu Pi (Arecae Pericarpium) 2 qian, Tong Cao (Tetrapanacis Medulla) 8 fen, He Ye (Nelumbinis Folium) 1 jiao, Gan Lu Xiao Du Dan (Sweet Dew Detoxication Pill) 4 qian (wrapped).
Second visit: Damp-Warmth for twelve days, profuse sweating, body heat reduced but diarrhea worse than before, occurring more than ten times day and night. Careful observation of the stool water shows black predominating over yellow, without foul odor, cracked lips, dental plaque, dry mouth with desire to drink, but drinking causes borborygmus, scanty dark urine, red tongue edges, dry yellow coating, soggy-rapid pulse on the left, soggy-slow pulse on the right, and weak Duyang pulse. This indicates Taiyin Spleen constrained by Dampness, with Clear Qi sinking. Black predominating in stool suggests Kidney color (Water element) is strong while Duyang Stomach Qi is weak, which is evident. Moreover, excessive diarrhea damages both Spleen Qi and Yin fluids. Spleen Yang cannot transport fluids upward for the Stomach, and Yin fluids cannot ascend to moisten the lips, causing cracked lips and dental plaque. The classics state: "Spontaneous diarrhea without thirst belongs to Taiyin; spontaneous diarrhea with thirst belongs to Shaoyin." Shaoyin is the organ of Water and Fire, the pivot of the Three Yin channels. Now Shaoyin Yin and Yang are both damaged, with floating Heat above and deficient Cold below, clearly visible. Considering pulse and symptoms, there is concern that Zheng Qi (Upright Qi) cannot overcome the pathogen, Bai Fen may fail to emerge, risking internalization of the pathogen. Nourishing Yin would hinder the Spleen, while warming to transform Dampness would damage Yin, creating a dilemma. After careful thought, the only approach is to support Zheng Qi and expel pathogens, fortify the Middle Earth (Spleen/Stomach), hoping that robust Zheng Qi will naturally expel latent pathogens, and thickened Earth Qi will contain deficient Fire. Whether this will succeed remains to be seen.
Prescription: Ren Shen Xu (Ginseng Radicula) 1 qian, Mi Chao Yu Zhu (Atractylodis Macrocephalae Rhizoma stir-fried with rice) 2 qian, Qing Shui Dou Juan 4 qian, Yun Ling (Poria) 3 qian, Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma) 3 fen, Chao Huai Shan Yao (Dioscoreae Rhizoma stir-fried) 3 qian, Pao Jiang Tan (Zingiberis Rhizoma Carbonized) 3 fen, Chao Bian Dou Yi (Phaseoli Contusii Semen Exocarpium stir-fried) 3 qian, Chao Gu Ya (Sacchari Stulis Germinatus) and Yi Yi Ren (Coicis Semen) each 3 qian, Gan He Ye (dried Nelumbinis Folium) 1 liang, Chen Cang Mi (aged Coicis Semen decocted as water) 1 liang.
Third visit: Damp-Warmth for fourteen days (two periods), taking the previous formula for three doses has reduced diarrhea frequency. Stool still mixed black and yellow, scanty dark urine, dry mouth with desire to drink, bleeding from gum margins, red tongue edges, dry yellow coating, soggy-rapid pulse, fine-weak Chi position. Bai Fen distributed between chest/epigastrium and umbilical abdomen, small grains not dense, latent Warmth and accumulated Dampness show signs of dark discharge. However, Shaoyin Yin and Taiyin Yang are injured by diarrhea, preventing Clear Jin Ye (fluids) from ascending. If diarrhea continues, Zheng Qi cannot recover; if Zheng Qi does not recover, pathogens cannot penetrate outward. Although danger has passed, safety is not yet reached. Continue primarily with Qi-tonifying and Earth-fortifying methods, assisted by Stomach-consolidating and intestine-astringing herbs.
Prescription: Ji Lin Shen (Jilin Ginseng Root) 1 qian, Mi Chao Yu Zhu 2 qian, Sheng Gan Cao 3 fen, Yun Ling 3 qian, Chao Huai Shan Yao 3 qian, Chuan Bei Mu (Fritillariae Cirrhosae Bulbus stir-fried) 2 qian, Yu Yu Liang (Hematitum) 3 qian, Chao Gu Ya 3 qian, Ju Bai (Citri Reticulatae Pericarpium Album) 1 qian, Chao Yi Ren 3 qian, Gan He Ye 1 jiao.
Fourth visit: Damp-Warmth for seventeen days, diarrhea reduced by 70-80%, stool color turned yellow and slightly odorous, Taiyin Spleen showing signs of healthy transportation. Bai Fen abundant and distinct, a good sign of Zheng Qi overcoming and expelling pathogens. Dry mouth with sticky sensation, anorexia, facial redness upon waking, slight delirium resolving after a while, soggy-rapid-slow pulse, red tongue with yellow coating. This results from dual injury of Qi and Yin, unsettled Shen (Spirit), residual Dampness transforming into Phlegm-Turbidity lingering in the Middle Jiao, causing Stomach Qi stagnation. Now propose 70% supporting Zheng Qi and 30% expelling pathogens, addressing both deficiency and excess for convalescence.
Prescription: Ren Shen Xu 8 fen, Chao Yu Zhu 1.5 qian, Chuan Bei Mu 2 qian, Yun Ling Shen (Poria with Polyporus, mixed with Cinnabar) 3 qian each, Yuan Zhi (Polygalae Radix) 1 qian, Chao Huai Yao 3 qian, Ju Bai 1 qian, Chao Gu Ya and Yi Ren each 3 qian, Qing Shui Dou Juan 3 qian, Pei Lan 1.5 qian, Qing Zhi Pi Pa Ye (Loquat Leaf honey-fried) 2 qian.
Mr. Zhang (Left side): Autumn Warmth with latent Summerheat, steaming in the Yangming channel, intense body heat, sweating without relief, dry mouth with desire to drink, yellow coating, rapid pulse, cold feet. This is Heat in Yangming and Dampness in Taiyin, different from Cold Damage, indicating serious condition. Tentatively prescribe Modified Cang Zhu Bai Hu Tang (Atractylodes and White Tiger Decoction) to clear Warmth and dry Dampness, hoping for a turning point.
Prescription: Sheng Shi Gao (Gypsum Fibrosum) 5 qian, Tian Hua Fen (Trichosanthis Radix) 3 qian, Hei Shan Zhi (Gardeniae Fructus carbonized) 1.5 qian, Fei Zhi Mu (Anemarrhenae Rhizoma) 1.5 qian, Jin Yin Hua (Lonicerae Japonicae Flos) 3 qian, Huo Lu Gen (Phragmitis Rhizoma fresh) 1 liang (remove joints), Sheng Gan Cao 5 fen, Lian Qiao Ke (Forsythiae Fructus shell) 1.5 qian, Zhi Cang Zhu (Atractylodis Rhizoma processed) 1 qian.
Young Wang: Latent Damp-Warmth pathogen, sixteen days duration, sweats with tidal fever, dry mouth with desire to drink, Bai Fen on chest/abdomen, no bowel movement for 8-9 days, pain on pressure below navel, crimson tongue with greasy yellow coating posteriorly, deep-rapid pulse. Multiple administrations of clearing-warmth-transforming-dampness formulas failed to reduce symptoms; this is due to latent pathogen accumulating Dampness transforming into Heat, moving from Qi level to Ying level, from meridians to Fu organs, with old fecal matter in the Fu organs unable to descend. Wu Youke stated: "In Warm diseases, purgation should not be considered too early." Primary strategy: guide stagnation and unblock Fu organs, assisted by clearing-warmth and cooling-Ying methods. Once有形 (material) stagnation is evacuated,无形 (immaterial) pathogens will easily dissipate.
Prescription: Sheng Chuan Jun (Rhei Radix et Rhizoma raw) 2 qian, Xuan Ming Fen (Natrii Sulfas) added later 1.5 qian, Zhi Shi (Immaturus Citri Grandis Fructus) 1 qian, Sheng Gan Cao 5 fen, Dong Sang Ye (Mori Folium) 2 qian, Fen Dan Pi (Moutan Cortex) 2 qian, Qing Hao (Artemisiae Annuae Herba) 1.5 qian, Nen Bai Wei (Cynanchi Atrati Radix tender) 1.5 qian, Jing Chi Shao (Paeoniae Radix Rubra) 1.5 qian, Qing He Geng (Nelumbinis Petiolus) 1 chi, Huo Shui Lu Gen (Phragmitis Rhizoma fresh water) 1 chi (remove joints).
Follow-up visit: Yesterday administered purgative and cooling-Ying-clearing-heat formula. Fu Qi (Fu organ Qi) has circulated, tidal fever gradually reduced, Bai Fen not abundant, dry mouth with desire to drink, middle tongue greasy yellow coating dissolving, soggy-rapid-weak pulse, hidden injury to Yin fluids, residual heat lingering between Qi and Ying levels, Clear Jin Ye unable to ascend. Now propose generating Jin Ye and clearing transformation, assisting with Stomach-harmonizing herbs. Dietary restriction is necessary; fear that overeating causes relapse, while undereating leaves pathogens behind.
Prescription: Tian Hua Fen 3 qian, Shuang Sang Ye (Mulberry Leaf frosted) 2 qian, Fen Dan Pi 1.5 qian, Jing Chi Shao 1.5 qian, Zhu Fu Shen (Poria with Polyporus and Cinnabar) 3 qian, Qing Hao Geng (Artemisiae Annuae Herba stem) 1.5 qian, Nen Bai Wei 1.5 qian, Tong Cao 8 fen, Liu Yi San (Six-to-One Powder wrapped) 3 qian, Qing He Geng 1 chi, Sheng Shu Gu Ya (Germinated Sorghum raw and cooked) each 3 qian.
Mr. Qiu (Left side): Damp-Warmth eight days, high fever with sweating without relief, dry mouth with desire to drink, irritability and insomnia, delirious speech during high fever, chest痞 (fullness/stuffiness) with nausea, inability to eat, turbid dark urine, yellow coating predominating over white, wiry-slippery-rapid pulse. Yangming Warmth is fierce, Taiyin Dampness fails to transform, accumulating in Qi level, spreading through Triple Burner, showing trend of Warmth transforming to Heat and Dampness transforming to Dryness. Condition is not mild. Tentatively prescribe Cang Zhu Bai Hu Tang modified to observe dynamics.
Prescription: Sheng Shi Gao 3 qian, Fei Zhi Mu 1.5 qian, Zhi Shi Tan (Immaturus Citri Grandis Fructus carbonized) 1 qian, Tong Cao 8 fen, Zhi Cang Zhu 8 fen, Fu Ling Pi (Poria Cocostis Peridium) 3 qian, Chao Zhu Ru (Bambusae Caulis in Taenia stir-fried) 1.5 qian, Fei Hua Shi (Talcum) 3 qian, Xian Ban Xia (Pinelliae Rhizoma fresh) 1.5 qian, Huo Lu Gen 1 chi (remove joints), He Geng (Nelumbinis Petiolus) 1 chi.
Second visit: Pulse now洪数 (surging-rapid) but slower than before, high fever significantly reduced, able to sleep slightly, dry mouth with desire to drink, chest fullness with nausea, anorexia, greasy yellow coating dissolving, latent Warmth gradually resolving, but accumulated Dampness remains in Middle Jiao. Since efficacy is seen, no need to change prescription; add aromatic and light-leaching herbs to provide an exit for Damp-Heat.
Prescription: Shu Shi Gao (Gypsum Fibrosum cooked) 3 qian, Xian Ban Xia 1.5 qian, Zhi Shi Tan 1 qian, Ze Xie 1 qian, Zhi Cang Zhu 8 fen, Chi Fu Ling (Poria cum Rosa) 3 qian, Chao Zhu Ru 1.5 qian, Tong Cao 8 fen, Fei Hua Shi 3 qian, Xian Huo Pei (Fresh Huo Xiang and Pei Lan) each 1.5 qian, He Geng 1 chi.
Third visit: Fever subsided for several days, then returned with chills and fever resembling malaria, chest fullness, anorexia, nausea, scanty dark urine, yellow coating, bitter taste, wiry-rapid pulse on left, soggy-slippery on right. This latent pathogen has shifted to Shaoyang, Dampness lingers in Middle Jiao, Stomach loses descending harmony. Now appropriate to harmonize the pivot, use aromatic and light-leaching methods, allowing latent pathogen to resolve via the pivot, and Damp-Heat to exit via urination.
Prescription: Ruan Chai Hu 8 fen, Xian Ban Xia 2 qian, Jiu Huang Qin (Scutellariae Radix wine-processed) 1 qian, Chi Ling 3 qian, Zhi Shi 1 qian, Chao Zhu Ru 1.5 qian, Tong Cao 8 fen, Xian Huo Pei each 1.5 qian, Ze Xie 1.5 qian, He Geng 1 chi.
Child Zhao: Damp-Warmth prolonged for over a month, body heat lighter in morning, severe in evening, sometimes aversion to cold/back chill, delirious low-voice speech during high fever, craving hot drinks, scanty dark urine, emaciated, poor appetite, red tongue, thin yellow coating, deficient-wiry-rapid pulse, Bai Zhen (rash) sparse and indistinct. Due to prolonged illness, Zheng Qi is deficient, pathogens in Taiyang-Shaoyang and Shaoyin-Taiyang not resolved, Dampness lingers in Mo Yuan, pivot disharmony. Fear Zheng Qi cannot overcome pathogen, leading to changes. Classics say: "After passing the meridian cycle without resolution, pathogen remains in Three Yang." Now prescribe Xiao Chai Hu Tang combined with Gui Zhi Bai Hu Tang modified, addressing root deficiency and branch excess, solidifying root and eliminating branch.
Prescription: Lu Dang Shen (Codonopsis Radix) 1.5 qian, Ruan Chai Hu 1 qian, Sheng Gan Cao 5 fen, Xian Ban Xia 2 qian, Shu Shi Gao 3 qian, Chi Fu Ling (mixed with Cinnabar) 3 qian, Zhi Yuan Zhi 1 qian, Chuan Gui Zhi (Cinnamomi Ramulus) 8 fen, Tong Cao 8 fen, Ze Xie 1.5 qian, Jiao Gu Ya (Charred Germinated Sorghum) 3 qian, Pei Lan Ye (Eupatorii Herba leaf) 1.5 qian.
Second visit: After taking modified Xiao Chai Hu plus Gui Zhi Bai Hu Tang, chills/fever receding, delirium stopped, Bai Zhen increasing, soggy-rapid pulse, thin yellow coating. Pathogens in Taiyang-Shaoyang and Shaoyin-Taiyang showing signs of external emergence. Dry mouth with little desire to drink, mental fatigue, poor appetite, Zheng Qi depleted, Spleen/Stomach lacking motivating power. Now reduce dosage, support Zheng Qi and expel pathogens, regulate Spleen and harmonize Stomach, hoping for Stomach Qi recovery to ensure smooth progress.
Prescription: Lu Dang Shen 1.5 qian, Yin Chai Hu (Stellariae Radix) 1 qian, Sheng Gan Cao 5 fen, Yun Ling (mixed with Cinnabar) 3 qian, Xian Ban Xia 2 qian, Fen Ge Gen (Puerariae Radix powder) 1.5 qian, Guang Ju Bai (Citri Reticulatae Pericarpium Album) 1 qian, Pei Lan Ye 1.5 qian, Bai Wei 1.5 qian, Chuan Tong Cao 8 fen, Sheng Shu Gu Ya each 3 qian, Sheng Jiang (Zingiberis Rhizoma Fresh) 1 slice, Hong Zao (Jujubae Fructus) 3 pieces.
Ms. Li (Left side): Pulse soggy-rapid; soggy indicates Dampness, rapid indicates Heat. Dampness and Heat combine, steaming in Qi level, spreading through Triple Burner. Hence body heat for three periods (approx. 6 days), lighter in morning, heavier in evening, Bai Zhen covering chest/epigastrium, emaciation and fatigue, caused by long-standing Damp-Heat郁 (stagnation) failing to transform, consuming Qi and injuring Yin. Condition is serious. Urgently preserve Yin and clear/disperse.
Prescription: Jin Shi Hu (Dendrobii Caulis mineral-treated) 3 qian, Nen Bai Wei 1.5 qian, Liu Yi San wrapped 3 qian, Xiang Bei Mu (Fritillariae Thunbergii Bulbus) 3 qian, Nan Bei Sha Shen (Glehniae Radix and Adenophorae Radix) each 1.5 qian, Fu Ling Pi 3 qian, Jing Chan Yi (Cicadae Periostracum) 8 fen, Xian Zhu Ye (Bambusae Folium fresh) 30 sheets, Xiang Qing Hao (Artemisiae Argyi Herba fragrant) 1.5 qian, Tong Cao 8 fen, Lian Qiao Ke 1.5 qian, He Geng 1 stalk.
Ms. Shen (Left side): Damp-Warmth twenty days (four periods), body heat lighter in morning, heavier in evening, sweating without relief, Bai Fen emerged but indistinct, dry mouth with desire to drink, dry lips, dental plaque, emaciation, fatigue, red tongue, slight yellow coating, soggy-rapid-weak pulse. Qi and Yin already injured, residual Damp-Heat pathogens lingering between Qi and Ying levels, dream-talk like delirium at night, Shen not residing in its house, cough present, Lung and Stomach also deficient, deficiency exceeds excess, worry about complications. Now propose clearing-nourishing Lung and Stomach Yin, dispersing-transforming Triple Burner Dampness.
Prescription: Nan Sha Shen 3 qian, Zhu Fu Shen 3 qian, Chuan Bei Mu 2 qian, Tong Cao 8 fen, Chuan Shi Hu (Dendrobii Caulis) 3 qian, Dong Sang Ye 3 qian, Gua Lou Pi (Benincasae Exocarpium) 2 qian, Dong Gua Zi (Benincasae Semen) 3 qian, Nen Bai Wei 1.5 qian, Fen Dan Pi 1.5 qian, Guang Ju Bai 1 qian, Sheng Yi Ren (Coicis Semen raw) 3 qian, Qing Zhi Pi Pa Ye (Loquat Leaf honey-fried, remove hairs, wrap) 2 qian.
Follow-up visit: Symptoms improved, original formula plus Bei Shu Mi (Setariae Milicae Semen) wrapped 3 qian.
Mr. Zheng (Left side): Damp-Warmth sixteen days, burning heat, sweating without reduction, thirst with desire to drink, irritability, scanty sleep, dream-talk like delirium, red eyes, dark urine, rough red tongue without moisture, wiry-rapid pulse, red rash on chest/epigastrium. Warmth has transformed to Heat, Dampness to Dryness, Dry-Fire entering Ying, injuring Yin and seizing Jin Ye, threatening to drain the West River (metaphor for severe fluid depletion), source of transformation exhausted, risk of wind-movement, spasms, and Jue. Likely imminent. Urgently prescribe large dose to generate Jin Ye and cool Ying, to clear blazing威 (might), hoping for Jin Ye generation and pathogen retreat, exiting danger to safety.
Prescription: Xian Sheng Di (Rehmanniae Radix Fresh) 6 qian, Tian Hua Fen 3 qian, Chuan Bei Mu 2 qian, Sheng Gan Cao 8 fen, Fen Dan Pi 2 qian, Dong Sang Ye 3 qian, Yin Hua (Lonicerae Flos) 8 qian, Bai Wei 1.5 qian, Ling Yang Pian (Capricornus Cornu sliced) 8 fen, Zhu Fu Shen 3 qian, Dai Xin Lian Qiao (Forsythiae Fructus with heart) 3 qian, Mao Lu Gen (Phragmitis Rhizoma) and Lu Gen each 1 liang, Xian Shi Hu (Dendrobii Caulis Fresh) 4 qian, Xian Zhu Ye (Bambusae Folium Fresh) 30 slices.
Second visit: Damp-Warmth eighteen days, sweet-cold clearing-resolving formula taken for two doses, tongue rough-red slightly moist, Jin Ye showing signs of recovery. Burning heat and thirst reduced, night sleep slightly better, favorable outcome. Red rash increasing, scleral red veins, scanty dark urine, restless rapid pulse, Shaoyin Yin injured, Water failing to control Fire, Ying-level Heat still fierce, Wood-Fire rising. Previous formula effective, no need to change direction.
Add to original formula: Xi Yang Shen (Panacis Quinquefolii Radix) 1.5 qian, Xian Ou (Nelumbinis Rhizoma Fresh) 4 liang (sliced for decoction).
Third visit: Damp-Warmth twenty-one days (three periods), Warmth transformed to Heat, Dampness to Dryness, continuous administration of Jin Ye-generating and cooling-resolving formulas, burning heat greatly reduced, sleep peaceful, dream-talk stopped. Red rash widespread, Ying-level Heat externally emerged, restless rapid pulse, tongue turned glossy-red, yellow urine, no bowel movement for 7-8 days, Yin fluids hard to restore suddenly, Wood-Fire still fierce, residual flames not clean. Still propose generating Jin Ye and draining Heat, assisting with unblocking Fu Qi. Although gentle purgation, it contains the intent of preserving Yin.
Prescription: Xi Yang Shen 1.5 qian, Dong Sang Ye 2 qian, Tian Hua Fen 3 qian, Bai Wei 1.5 qian, Xian Sheng Di 4 qian, Fen Dan Pi 2 qian, Chuan Bei Mu 3 qian, Sheng Gan Cao 6 fen, Xian Shi Hu 4 qian, Zhu Fu Shen 3 qian, Yu Li Ren (Pruni Semen studied) 3 qian, Ma Ren (Cannabis Semen studied) 4 qian, Huo Lu Gen 1 chi (remove joints).
Fourth visit: Damp-Warmth twenty-two days, burning heat retreated, sleep peaceful mind clear, red rash fading, Fu Qi circulated, red tongue, slight white coating, soggy-soft-rapid pulse, mental fatigue, pale yellow urine, food tasteless, pathogen retreated Zheng Qi deficient, Spleen/Stomach lacking motivating power. Now propose nourishing Zheng Qi and harmonizing Stomach, use cold herbs cautiously, fearing excess leads to insufficiency.
Prescription: Xi Yang Shen stir-fried with rice 5 qian, Zhu Fu Shen 3 qian, Chuan Shi Hu 3 qian, Sheng Gan Cao 5 fen, Tong Cao 8 fen, Gua Lou Pi 2 qian, Guang Ju Bai 1 qian, Chuan Bei Mu 2 qian, Bei Shu Mi wrapped 3 qian.
Mr. Wu (Left side): Damp-Warmth prolonged for a month, chills/fever fluctuating, dry mouth without desire to drink, loose stools. Initially latent Warmth-Dampness accumulated in Mo Yuan, Shaoyang pivot disharmony, Taiyin constrained by Dampness, Clear Qi not ascending. Previous prescriptions with Shen, Fu, Long, Mu, Jiang, Gui, Er Chen etc., were too warming and astringent, leaving no exit for latent pathogen, deeper stagnation like glue/paint. Pathogen constraint transforms to Heat, Dampness constraint transforms to Dryness, injuring Yin and seizing Jin Ye, source exhausted, Qi reversing and急促 (rapid/shallow), Shen confused delirious, thus arising. Tongue coating black-rough-greasy resembles Shaoyin Heat-binding with leakage requiring urgent purgation to save Yin, but pulse left wiry-fine-rapid-palpitation, right deficient-scattered, abdomen lacks dry-solid-fullness shape, how can purgation be justified? Yin fluids withered, Zheng Qi depleted, Jue-Tuo (collapse) change imminent. Tentatively prescribe Zeng Ye Sheng Jin (Increase Fluids Generate Jin Ye) to save from burning, merely doing human effort hoping for heavenly blessing!
Prescription: Xi Yang Shen 3 qian, Zhu Fu Shen 3 qian, Tian Zhu Huang (Calami Tintinnabuli Spatium) 1.5 qian, Nen Gou Gou (Uncariae Ramulus Cum Uncis tender) added later 3 qian, Da Mai Dong (Ophiopogonis Radix large) 2 qian, Zi Bei Chi (Conchae Margaritiferae Costatae) 3 qian, Yin Chai Hu 8 fen, Zhi Shi Tan 8 fen, Huo Shi Hu (Dendrobii Caulis Huo variety) 3 qian, Chuan Bei Mu 2 qian, Qing Zhi Cao (Glycyrrhizae Radix et Rhizoma honey-fried) 4 fen, Chao Zhu Ru 1.5 qian.
Ms. Fei (Right side): Damp-Warmth twenty-one days (three periods), burning heat unreduced, crimson tongue with prickles, surging-rapid pulse. Warmth pathogen transforms to Fire, moves from Qi to Ying, Heat internally fierce, disturbing Bao Gong (Pericardium), injuring Jin and seizing Ye, source of transformation about to exhaust. Resulting in cracked lips, dental plaque, delirious speech, severe internalization, critical condition. Propose nourishing Yin saving fluids, clearing Fire opening orifices, unknown if salvageable.
Prescription: Xi Jiao Jian (Rhinocerotis Cornu tip - note: substitute with Water Buffalo Horn in modern practice) 3 fen, Fen Dan Pi 1.5 qian, Dai Xin Mai Dong (Ophiopogonis Radix with heart) 3 qian, Xian Shi Chang Pu (Acori Tatarinowii Rhizoma fresh) 5 fen, Xian Sheng Di 3 qian, Jing Chi Shao 1.5 qian, Shang Chuan Lian (Coptidis Rhizoma upper grade) 3 fen, Xian Zhu Ye Xin (Bambusae Folium heart fresh) 3 qian, Dai Xin Lian Qiao 3 qian, Jing Xuan Shen (Scrophulariae Radix) 3 qian, Tian Zhu Huang 2 qian, Huo Lu Gen 1 liang (remove joints), Niu Huang Qing Xin Wan (Calci Hircus Calculus Clear Heart Pill) 1 pill (separately ground fine, dissolved and taken).