温病战汗诸大家论述甚详，而伤寒战汗，仲景亦曾论及，如《伤寒论》94条：“太阳病未解，脉阴阳俱停，必先振栗，汗出而解”。战汗之形成，在人体感邪之后，邪气尚未深入犹具透表达邪之机，正气与邪气势均力敌、旗鼓相当，即可与邪交争而出现战汗。如患者体内津液尚充，可作汗源之时，即有战后汗出病解之可能。
1975年深秋之某日，余所在地居委干部周老太之丈夫急来邀诊。余知周老太数日来患感冒，头疼、恶寒、无汗、关节酸痛。因而随其丈夫立往彼家。见患者卧于被中战栗不已，床具被震摇而“咯咯”作响。当时余第一次见到此症，疑为战汗而不敢自决。但患者自云无妨，昔年曾发一次，战后得汗即解。余闻此言，心中稍宽，伴随患者，随时以小匙饮以温水，以观察病情变化。大约战至一小时许，患者周身微微汗出，次日热退病解，自此安然无恙。
温病而见热扰血室，感寒而见战汗达邪，此等症临证之际尚不多见，本文所述各一例。以常规之法处治，皆得症解病安。伤寒战汗，仲景未出治法，周老太例则借用温病战汗“益胃”成法，补充水分滋其汗源，竟亦“热达腠开，邪从汗解”而愈。
外感风热误药致变
沈妇，四十九岁，在常州务农。形体甚丰，宿有气管炎。1982年3月某日清晨自乡来沪，旋即赴苏州扫婆婆墓，临晚复归沪上。路途劳顿，自觉疲惫不支。旋见咳嗽、痰多，略带气急。自服枇杷叶膏、半贝丸三日，痰少咳稀，并见气机上逆，呼吸急促。特邀某名医诊治，用麻黄、杏仁、葶苈子、甘草、鹅管石、半夏、陈皮等药，服七帖。咳喘虽挫而诸症峰起：大便泄泻，每日三、四行；心悸慌乱，胸宇烦闷；额汗频出稍动益甚，而余处则无汗；午后自觉蒸热，但体温不升；胃纳锐减，加之浑身疲软，元气以动。于3月29日送某医院检查，诊断为可能“高血压性心脏病。”于当天下午又急请前中医诊治，仍持前议，因有泄泻、额汗见症，于前方中加入白术、茯苓、糯稻根。30日服药一帖，倍觉沉困，胃纳全无，额汗更甚，随揩随渗，卧之于床，扶之亦不能起坐，坐则昏沉不支。至是，患者极度消沉，连夜与夫作生死诀别，翌日(31日)清晨，其夫前来邀诊，作万一之望。
诊见面色暗浊，神情淡漠。询知头颅闷胀，不欲举动。额上汗湿，粒粒如珠，渗出于肤。扪之掌心甚热，而手足躯体肌肤不温，语声低微，气怯懒言，余证俱如前述。切脉则两手细弱涩数，人迎与右寸独见浮数，且明显大于他部。舌干无津，中心厚苔直贯根部，色黄且褐。据此脉症，殊属棘手。余反复推究，参合四诊，意为病属外感风热，因素体丰肥，多痰多湿，又遇劳累气虚，无力鼓邪，遂使外邪与痰浊交结，症情复杂。因前投温燥，反劫津液，津伤热郁变证迭生。为今之计，先当辛凉解表，以驱袭入之外邪；清热豁痰，以开邪出之道路。然津气两伤，亦不可不顾，否则津干不能作汗，气虚无力达邪，徒恃表药，终难克效，谛思惟俞根初《通俗伤寒论》之加减萎蕤汤最为适用，即以此方加味：
葱白三枚淡豆豉9g桔梗3g前胡4．5g白薇9g鲜竹沥30g(冲入)薄荷4．5g(后入)炙草3g冬瓜仁12g红枣5枚玉竹9g
(姜春华老师批语：方佳)
上午服头煎后，即絷絷汗出，遍体津润，至午腹中饥饿，竟食烂面一大碗，约二两许。是日下午即能起坐，患者求愈心切，于当晚又服一剂，一日内两帖俱尽。次日复诊，已觉周身轻快，与日前判若两人，惟额汗虽少未止，精神尚觉短少，此外，别无不适。诊之六脉小而稍数，人迎与右寸浮大之象已平，涩象亦解。舌已不干，然苔仍黄厚，用药仍宗前法，偏重消痰清解：
薄荷3g(后入)豆豉9g桔梗3g前胡4．5g冬瓜仁12g炒山栀6g炒枳壳4．5g姜半夏6g茯苓9g炙草3g焦六曲9g
服药两帖后，除稍觉疲弱外，余证全退，额汗亦止，已能操持家务，并于4月3日乘车返乡。
按：病者事后告知，来沪前三日曾患感冒，发热、头痛，未经治疗热即退。因病中神思恍惚，未予提及，使医者一时难明病源，徒费周折。本例之病因，为宿有痰热，复感外邪，痰邪相结，肺气痹闭，致使邪不外达。肺与大肠相为表里，肺气被遏邪无出路，迫走大肠故见泄泻；热郁于内故心胸烦闷；热蒸于上迫液外泄，则额汗频仍；午后阳盛与邪相争，故午后蒸热，因而见证如斯。余治此病，虽合参四诊反复揣摩，而据其脉象为最多，其间尤以人迎与右寸脉最为可凭。盖右寸属肺，肺主宣发卫气，与外感疾病关系密切。风寒之邪恒自太阳而入；风热犯人每多先伤肺卫。右寸脉浮而有力，是表邪确据，浮而兼数乃感受风温、风热之邪，或寒邪入肺化热之征。至于人迎，明代医家李士材言之甚详。《诊家正眼》曰：“人迎脉在左手关前一分，胆之部也，属风木而为阳，故主在外之病。”“人迎紧盛，伤于风也。”又曰：“左关之前一分，为六腑之源头，为诸阳之土宰，察表者不能外也。”故今见人迎浮数，加上见症如斯，是外感风热无疑。当然，此非凭脉癔断，乃合望闻问三诊而推得之，因而投剂即应，效若桴鼓。
(姜春华老师批语：脉学可凭而不可凭，以证为主，以脉参证，斯可矣。)
(附注：此文写后曾经姜春华老师审阅，先生作批语如上。今先生虽已作古，而先生传道、授业、解惑之功不可没。今乘斯文刊印之机述此以示纪念也。)
秋感温燥凉解宜
《黄帝内经》为中医理论之最高经典，其论病机及四时外邪为病，却遗燥气燥邪一端。金代刘完素于《素问·至真要大论》中“病机十九条”后，增补“诺涩枯涸，干劲皴揭，皆属于燥”一条，俾病机十九条之内容充实、完备。而明·喻嘉言，于《素问·阴阳应象大论》“冬伤于寒，春必温病；春伤于风，夏生飧泄；夏伤于暑，秋必痃疟；秋伤于湿，冬生咳嗽”之文，改“秋伤于湿”为“秋伤于燥”，制清燥救肺汤方，标新立异，独树一帜，开燥气为病证治之先河。隶及清代吴鞠通《温病条辨》专立“秋燥”一门，创制“桑杏汤”、“桑菊饮”诸方，至是则秋令之燥气伤犯肺卫者，治法始备。然秋令燥气之伤人也，有温燥凉燥之别，吴氏所论，乃温燥耳。若云临证之所见，温燥实较凉燥为多，是故吴氏之功，不可没也。
关于温燥之症状，初起头疼身热，干咳无痰，即使咯痰，亦多粘而量少，气逆而喘，咽喉干痛，鼻干唇燥，胸闷胁痛，心烦口渴，舌苔薄白而燥，舌边尖俱红。然患者之病候，常不典型，故每易与风热感冒混淆。《温病条辨》曰：“秋感燥气，右脉数大。”曹炳章评曰：“右脉数大，右寸尤甚，不独秋燥为然，即风温亦如是，此亦识病之要诀，但风温初起，右寸必浮耳”。然先贤虽言之凿凿，而临诊之际，失于明辨者，仍复不少。以致轻感时邪，亦须迁延多日。倘若治不彻底，或失治误治者，每易流入损途。
《理虚元鉴》论“虚症有六因”中“有外感之因”“因外感者，俗语云：伤风不醒结成痨。”“若其人或酒色无度，或心血过伤，或肝火易动，阴血素亏，肺有伏火，一伤于风火，因风动则痨嗽之症作矣。”据此，因外感而成痨嗽者，以温热之邪为多而温热之中，尤以温燥为甚也。盖温燥之气最易伤损肺津，肺为阴脏，喜润而恶燥故也。曹炳章云：“感燥而咳，病势本轻，然迁延误治，必成重症。”是故临证之间，遇感证久治未愈者，务必着意诊察，不可掉以轻心而遗人天殃也。
病例：干部王某，年过半百，形体魁梧，肥胖而多病，肝痛、头疼常作不辍。1976年秋，患感冒牙痛，匝月不愈。凡中成药及诸西医感冒药，几已尝遍，似有小效而病终不解，因来余处就诊。视其脉细而带滑；问其症则头痛而不甚，微有恶寒，稍加衣则又觉轰热，不时咳嗽数声，绝无痰浊，苔薄白而燥。此乃感受秋令燥气，并非感冒风寒风热之症，故治感冒之成药宜其不效也。然燥症分温燥、凉燥，今患者所病，乃温燥耳。治法当用凉润清解，拟用桑杏汤化裁。
桑叶9g豆豉4．5g荆芥4．5g南沙参9g炒山栀6g麦冬9g杏仁9g炙草1．5g玉竹9g
与二帖。患者急于求成，是夜连服二煎，睡至半夜醒来，即觉浑身舒适，翌日晨起诸证顿解。余药一帖，则弃置不服矣。
1986年春，余于某医院遇一中年女病人，因高热不退住院，经西医对症处理，高热下降而低热不清；每日午后渐见寒热一、二分；至日晡时升至三、四分；黄昏则五、六分；至人定为七、八分而止。子夜后热渐退，黎明至午前体温正常。每日如此周而复始循环不已。两目自发热后即成视觉障碍，仅可见微光，若视物或人，则仅见两团白影，不能辨为何物，更不能见其细部。邀中医会诊，服药一月余，病无进退。余阅前所服方，前后两诊尽是六味地黄汤加减者。切其脉小而数，可任寻按，舌与苔无明显异常。诊为温病余热不清而作两目岐视，先贤夏应堂先生治验一例，与此极似，因师其法而效其方：
北沙参30g天花粉18g川石斛9g桑叶9g银花9g连翘9g生甘草1．5g白薇9g
服三帖，热即退净，岐视消失，视物可辨其大体。服至十帖，目视复常，患者及乃夫千恩万谢欣然出院。
按：温病岐视一证，临床不甚常见，考诸温病文献，叶、薛、吴、王四大家书中，亦皆缺如。故遇此等证，一时难明病源，前医按《内经》作“精散则岐视”，投以六味地黄汤原亦无可厚非。余诊此症，忆及《近代中医流派经验选集》“夏应堂氏临床经验介绍”一文中，曾载一例，与此类似。虽脉舌症情小有不同，而温邪留恋则一也。至其病机，夏氏论之极精：“是温邪郁而化热，流连于气分，熏蒸于阳明，引动肝火，火性上炎，清窍被蒙，盖肝脉连于目系，胃脉亦系目系故也”。及其治法“而清热保津之法，正堪一施。”“因拟轻清泄热肃肺制肝，俾邪得透达，则蕴热自清，金令下行，则肝火自熄；热清火熄，阴津自保。”正缘夏氏论病细致入微，丝丝入扣，故收药到病除之效。今宗其说而用其方，患者得脱病魔，余则增长见识也。
青年徐某，英年十七。十三岁起颅额左侧一点疼痛，固定不移，痛剧时如刀割锥刺。每日或间日一发，持续数小时方能渐解。发作时间最长者达四小时之久，读书及生活深为所累，其母爱子心切，百计筹措钱款，求医问药二年余，竟无弋获。1991年10月17日至余处诊治。余视其形体瘦瘠，面色无华。按脉弦细，苔薄舌瘪。因年少失怙，家境贫寒，营养久缺而致气血虚衰，但额头之痛为瘀血所作。病属体虚症实，治法按“急则治标，缓则治本”之旨，以除额痛为急。故先疏血府逐瘀汤以行瘀止痛：
大生地12g桃仁9g甘草1g赤芍9g川芎3g白芷6g当归9g红花3g炒枳壳4．5g柴胡4．5g桔梗4．5g怀牛膝9g
服药十四帖，头痛得愈。
继而来诊，惟求切脉观舌，小言病症。其左脉弦细，右关细软而尺稍盛，舌瘪而嫩，边多红点．是阴血不足而兼有相火之象。余疑其夜间遗精。询之果然。以养血安神兼調肝脾为法，随拟一方：
大生地9g茯苓9g炙远志9g丹参9g炙甘草3g炒白术9g炒白芍9g当归4．5g炒黄柏1．5g
又服十四帖，遗精渐止，予一贯煎法以善其后。偶或相火见旺，加入知柏各5g即平，最后诸恙皆安，惟脉弦细不退。于方中参入石斛9g，炙龟板15g以养血柔肝。服十余帖脉渐柔和。
按：王清任《医林改错》之“血府逐瘀汤”，由桃仁12g、红花9g、当归9g、生地黄9g、川芎4．5g、赤芍6g、牛膝9g、桔梗5g，柴胡3g，枳壳6g，甘草3g组成。善于活血祛瘀、行气止痛，为血府血瘀之主方。何谓“血府”?《素问·脉要精微论》曰：“夫脉者，血之府也。”血府之本意乃指脉管，而原书所主治之病症，多为胸中瘀血，阻碍气机之证，而于实际使用中又不受此限，举凡气滞血瘀而病势未甚诸症，均可使用。更不局限于脉管或胸中部位。其中关于辨证，本例以症状为主要依据，患者左额一点疼痛，固定不移、痛如刀割锥刺具有瘀血为患之特点。以血府逐瘀汤治瘀血头痛，已成临床习用之法。《医林改错》中曰：“查患头痛者，无表症，无里症，无气虚、痰饮等症，忽犯忽好，百方不效，用此方一剂而愈。”据上案验证，知非虚语。
温病中的战汗，各位医家的论述非常详尽，而伤寒中的战汗，张仲景也曾论及，如《伤寒论》第94条：“太阳病（太阳经受邪所致的病证）未解，脉阴阳俱停，必先振栗，汗出而解”。战汗的形成，在于人体感受邪气之后，邪气尚未深入，仍有透达体表以排出邪气的时机，正气与邪气势均力敌、旗鼓相当，即可与邪气交争而出现战汗。如果患者体内津液尚且充足，可以作为汗源之时，就有战后汗出而病愈的可能。
1975年深秋的一天，我所在地的居委会干部周老太的丈夫急忙来邀请诊治。我知道周老太这几天患感冒，头疼、恶寒、无汗、关节酸痛。于是跟随其丈夫立即前往她家。见到患者卧在被子里战栗不止，床具被震摇而“咯咯”作响。当时我第一次见到这种症状，怀疑是战汗而不敢自行决断。但患者自己说不要紧，往年曾发作过一次，战后得汗即痊愈。我听到这话，心中稍宽，陪伴在患者身边，随时用小勺喂饮温水，以观察病情变化。大约战栗持续一小时左右，患者周身微微出汗，次日热退病愈，从此安然无恙。
温病出现热扰血室（热邪扰动子宫及肝经），感寒出现战汗以驱邪外出，这类症状在临证时尚不多见，本文各举一例。用常规的方法治疗，都得到症状解除、病情安定的效果。伤寒战汗，张仲景没有给出治法，周老太的例子则借用温病战汗中“益胃”（通过补充胃中津液以助汗源）的成法，补充水分滋其汗源，竟然也“热达腠开（热量到达腠理，毛孔张开），邪从汗解”而痊愈。
外感风热误药致变
沈姓妇女，四十九岁，在常州务农。形体非常丰满，素有气管炎。1982年3月某天清晨从乡下来到上海，随即去苏州扫婆婆墓，傍晚又回到上海。路途劳顿，自觉疲惫不堪。随即出现咳嗽、痰多，略带气急。自行服用枇杷叶膏、半贝丸三天，痰少咳稀，并出现气机上逆，呼吸急促。特邀某名医诊治，用麻黄、杏仁、葶苈子、甘草、鹅管石、半夏、陈皮等药，服七帖。咳喘虽被遏制但诸症蜂拥而起：大便泄泻，每日三、四次；心悸慌乱，胸宇烦闷；额部出汗频繁，稍微活动更甚，而其他部位则无汗；午后自觉蒸热，但体温不升；胃纳锐减，加之浑身疲软，元气受损。于3月29日送某医院检查，诊断为可能“高血压性心脏病。”当天下午又紧急请前中医诊治，仍持前议，因有泄泻、额汗见症，于前方中加入白术、茯苓、糯稻根。30日服药一帖，倍觉沉困，胃纳全无，额汗更甚，随揩随渗，卧之于床，扶之亦不能起坐，坐则昏沉不支。至此，患者极度消沉，连夜与丈夫作生死诀别，翌日(31日)清晨，其夫前来邀诊，作万一之望。
诊见面色暗浊，神情淡漠。询问得知头颅闷胀，不欲举动。额上汗湿，粒粒如珠，渗出于肤。扪之掌心甚热，而手足躯体肌肤不温，语声低微，气怯懒言，余证俱如前述。切脉则两手细弱涩数，人迎穴处与右寸脉独见浮数，且明显大于他部。舌干无津，中心厚苔直贯根部，色黄且褐。据此脉症，殊属棘手。我反复推究，参合四诊（望、闻、问、切），意为病属外感风热，因素体丰肥，多痰多湿，又遇劳累气虚，无力鼓邪，遂使外邪与痰浊交结，症情复杂。因前投温燥，反劫津液，津伤热郁变证迭生。为今之计，先当辛凉解表，以驱袭入之外邪；清热豁痰，以开邪出之道路。然津气两伤，亦不可不顾，否则津干不能作汗，气虚无力达邪，徒恃表药，终难克效，谛思惟俞根初《通俗伤寒论》之加减萎蕤汤最为适用，即以此方加味：
葱白三枚淡豆豉9g桔梗3g前胡4．5g白薇9g鲜竹沥30g(冲入)薄荷4．5g(后入)炙草3g冬瓜仁12g红枣5枚玉竹9g
(姜春华老师批语：方佳)
上午服头煎后，即絷絷汗出，遍体津润，至午腹中饥饿，竟食烂面一大碗，约二两许。是日下午即能起坐，患者求愈心切，于当晚又服一剂，一日内两帖俱尽。次日复诊，已觉周身轻快，与日前判若两人，惟额汗虽少未止，精神尚觉短少，此外，别无不适。诊之六脉小而稍数，人迎与右寸浮大之象已平，涩象亦解。舌已不干，然苔仍黄厚，用药仍宗前法，偏重消痰清解：
薄荷3g(后入)豆豉9g桔梗3g前胡4．5g冬瓜仁12g炒山栀6g炒枳壳4．5g姜半夏6g茯苓9g炙草3g焦六曲9g
服药两帖后，除稍觉疲弱外，余证全退，额汗亦止，已能操持家务，并于4月3日乘车返乡。
按：病者事后告知，来沪前三日曾患感冒，发热、头痛，未经治疗热即退。因病中神思恍惚，未予提及，使医者一时难明病源，徒费周折。本例之病因，为宿有痰热，复感外邪，痰邪相结，肺气痹闭，致使邪不外达。肺与大肠相为表里，肺气被遏邪无出路，迫走大肠故见泄泻；热郁于内故心胸烦闷；热蒸于上迫液外泄，则额汗频仍；午后阳盛与邪相争，故午后蒸热，因而见证如斯。余治此病，虽合参四诊反复揣摩，而据其脉象为最多，其间尤以人迎与右寸脉最为可凭。盖右寸属肺，肺主宣发卫气，与外感疾病关系密切。风寒之邪恒自太阳而入；风热犯人每多先伤肺卫。右寸脉浮而有力，是表邪确据，浮而兼数乃感受风温、风热之邪，或寒邪入肺化热之征。至于人迎，明代医家李士材言之甚详。《诊家正眼》曰：“人迎脉在左手关前一分，胆之部也，属风木而为阳，故主在外之病。”“人迎紧盛，伤于风也。”又曰：“左关之前一分，为六腑之源头，为诸阳之土宰，察表者不能外也。”故今见人迎浮数，加上见症如斯，是外感风热无疑。当然，此非凭脉癔断，乃合望闻问三诊而推得之，因而投剂即应，效若桴鼓。
(姜春华老师批语：脉学可凭而不可凭，以证为主，以脉参证，斯可矣。)
(附注：此文写后曾经姜春华老师审阅，先生作批语如上。今先生虽已作古，而先生传道、授业、解惑之功不可没。今乘斯文刊印之机述此以示纪念也。)
秋感温燥凉解宜
《黄帝内经》为中医理论之最高经典，其论病机及四时外邪为病，却遗燥气燥邪一端。金代刘完素于《素问·至真要大论》中“病机十九条”后，增补“诺涩枯涸，干劲皴揭，皆属于燥”一条，俾病机十九条之内容充实、完备。而明·喻嘉言，于《素问·阴阳应象大论》“冬伤于寒，春必温病；春伤于风，夏生飧泄；夏伤于暑，秋必痃疟；秋伤于湿，冬生咳嗽”之文，改“秋伤于湿”为“秋伤于燥”，制清燥救肺汤方，标新立异，独树一帜，开燥气为病证治之先河。隶及清代吴鞠通《温病条辨》专立“秋燥”一门，创制“桑杏汤”、“桑菊饮”诸方，至是则秋令之燥气伤犯肺卫者，治法始备。然秋令燥气之伤人也，有温燥凉燥之别，吴氏所论，乃温燥耳。若云临证之所见，温燥实较凉燥为多，是故吴氏之功，不可没也。
关于温燥之症状，初起头疼身热，干咳无痰，即使咯痰，亦多粘而量少，气逆而喘，咽喉干痛，鼻干唇燥，胸闷胁痛，心烦口渴，舌苔薄白而燥，舌边尖俱红。然患者之病候，常不典型，故每易与风热感冒混淆。《温病条辨》曰：“秋感燥气，右脉数大。”曹炳章评曰：“右脉数大，右寸尤甚，不独秋燥为然，即风温亦如是，此亦识病之要诀，但风温初起，右寸必浮耳”。然先贤虽言之凿凿，而临诊之际，失于明辨者，仍复不少。以致轻感时邪，亦须迁延多日。倘若治不彻底，或失治误治者，每易流入损途。
《理虚元鉴》论“虚症有六因”中“有外感之因”“因外感者，俗语云：伤风不醒结成痨。”“若其人或酒色无度，或心血过伤，或肝火易动，阴血素亏，肺有伏火，一伤于风火，因风动则痨嗽之症作矣。”据此，因外感而成痨嗽者，以温热之邪为多而温热之中，尤以温燥为甚也。盖温燥之气最易伤损肺津，肺为阴脏，喜润而恶燥故也。曹炳章云：“感燥而咳，病势本轻，然迁延误治，必成重症。”是故临证之间，遇感证久治未愈者，务必着意诊察，不可掉以轻心而遗人天殃也。
病例：干部王某，年过半百，形体魁梧，肥胖而多病，肝痛、头疼常作不辍。1976年秋，患感冒牙痛，匝月不愈。凡中成药及诸西医感冒药，几已尝遍，似有小效而病终不解，因来余处就诊。视其脉细而带滑；问其症则头痛而不甚，微有恶寒，稍加衣则又觉轰热，不时咳嗽数声，绝无痰浊，苔薄白而燥。此乃感受秋令燥气，并非感冒风寒风热之症，故治感冒之成药宜其不效也。然燥症分温燥、凉燥，今患者所病，乃温燥耳。治法当用凉润清解，拟用桑杏汤化裁。
桑叶9g豆豉4．5g荆芥4．5g南沙参9g炒山栀6g麦冬9g杏仁9g炙草1．5g玉竹9g
与二帖。患者急于求成，是夜连服二煎，睡至半夜醒来，即觉浑身舒适，翌日晨起诸证顿解。余药一帖，则弃置不服矣。
1986年春，余于某医院遇一中年女病人，因高热不退住院，经西医对症处理，高热下降而低热不清；每日午后渐见寒热一、二分；至日晡时升至三、四分；黄昏则五、六分；至人定为七、八分而止。子夜后热渐退，黎明至午前体温正常。每日如此周而复始循环不已。两目自发热后即成视觉障碍，仅可见微光，若视物或人，则仅见两团白影，不能辨为何物，更不能见其细部。邀中医会诊，服药一月余，病无进退。余阅前所服方，前后两诊尽是六味地黄汤加减者。切其脉小而数，可任寻按，舌与苔无明显异常。诊为温病余热不清而作两目岐视（视一物为二），先贤夏应堂先生治验一例，与此极似，因师其法而效其方：
北沙参30g天花粉18g川石斛9g桑叶9g银花9g连翘9g生甘草1．5g白薇9g
服三帖，热即退净，岐视消失，视物可辨其大体。服至十帖，目视复常，患者及乃夫千恩万谢欣然出院。
按：温病岐视一证，临床不甚常见，考诸温病文献，叶、薛、吴、王四大家书中，亦皆缺如。故遇此等证，一时难明病源，前医按《内经》作“精散则岐视”，投以六味地黄汤原亦无可厚非。余诊此症，忆及《近代中医流派经验选集》“夏应堂氏临床经验介绍”一文中，曾载一例，与此类似。虽脉舌症情小有不同，而温邪留恋则一也。至其病机，夏氏论之极精：“是温邪郁而化热，流连于气分，熏蒸于阳明，引动肝火，火性上炎，清窍被蒙，盖肝脉连于目系，胃脉亦系目系故也”。及其治法“而清热保津之法，正堪一施。”“因拟轻清泄热肃肺制肝，俾邪得透达，则蕴热自清，金令下行，则肝火自熄；热清火熄，阴津自保。”正缘夏氏论病细致入微，丝丝入扣，故收药到病除之效。今宗其说而用其方，患者得脱病魔，余则增长见识也。
青年徐某，英年十七。十三岁起颅额左侧一点疼痛，固定不移，痛剧时如刀割锥刺。每日或间日一发，持续数小时方能渐解。发作时间最长者达四小时之久，读书及生活深为所累，其母爱子心切，百计筹措钱款，求医问药二年余，竟无弋获。1991年10月17日至余处诊治。余视其形体瘦瘠，面色无华。按脉弦细，苔薄舌瘪。因年少失怙，家境贫寒，营养久缺而致气血虚衰，但额头之痛为瘀血所作。病属体虚症实，治法按“急则治标，缓则治本”之旨，以除额痛为急。故先疏血府逐瘀汤以行瘀止痛：
大生地12g桃仁9g甘草1g赤芍9g川芎3g白芷6g当归9g红花3g炒枳壳4．5g柴胡4．5g桔梗4．5g怀牛膝9g
服药十四帖，头痛得愈。
继而来诊，惟求切脉观舌，小言病症。其左脉弦细，右关细软而尺稍盛，舌瘪而嫩，边多红点．是阴血不足而兼有相火之象。余疑其夜间遗精。询之果然。以养血安神兼調肝脾为法，随拟一方：
大生地9g茯苓9g炙远志9g丹参9g炙甘草3g炒白术9g炒白芍9g当归4．5g炒黄柏1．5g
又服十四帖，遗精渐止，予一贯煎法以善其后。偶或相火见旺，加入知柏各5g即平，最后诸恙皆安，惟脉弦细不退。于方中参入石斛9g，炙龟板15g以养血柔肝。服十余帖脉渐柔和。
按：王清任《医林改错》之“血府逐瘀汤”，由桃仁12g、红花9g、当归9g、生地黄9g、川芎4．5g、赤芍6g、牛膝9g、桔梗5g，柴胡3g，枳壳6g，甘草3g组成。善于活血祛瘀、行气止痛，为血府血瘀之主方。何谓“血府”?《素问·脉要精微论》曰：“夫脉者，血之府也。”血府之本意乃指脉管，而原书所主治之病症，多为胸中瘀血，阻碍气机之证，而于实际使用中又不受此限，举凡气滞血瘀而病势未甚诸症，均可使用。更不局限于脉管或胸中部位。其中关于辨证，本例以症状为主要依据，患者左额一点疼痛，固定不移、痛如刀割锥刺具有瘀血为患之特点。以血府逐瘀汤治瘀血头痛，已成临床习用之法。《医林改错》中曰：“查患头痛者，无表症，无里症，无气虚、痰饮等症，忽犯忽好，百方不效，用此方一剂而愈。”据上案验证，知非虚语。
The discussion on "Zhan Han" (shivering followed by sweating) in warm diseases is very detailed among various experts, while Zhang Zhongjing also mentioned "Zhan Han" in cold damage. For instance, Article 94 of *Shanghan Lun* states: "In Taiyang disease that has not yet resolved, if the pulses at Yin and Yang positions both cease, there will first be shivering and chills, followed by sweating and resolution." The formation of "Zhan Han" occurs after the human body contracts pathogenic factors; when the pathogens have not yet penetrated deeply and there is still an opportunity to expel them through the exterior, the healthy Qi and pathogenic factors are evenly matched. They contend with each other, resulting in "Zhan Han". If the patient's body fluids are still sufficient to serve as a source for sweat, there is a possibility of disease resolution after sweating follows the shivering.
One day in late autumn of 1975, the husband of Elder Zhou, a cadre of the neighborhood committee where I resided, urgently invited me to consult. Knowing that Elder Zhou had suffered from a common cold for several days, presenting with headache, aversion to cold, absence of sweating, and soreness and pain in the joints, I immediately went with her husband to her home. I saw the patient lying in bed, shivering incessantly, shaking the bedstead so much that it made a "clacking" sound. At that time, this was my first encounter with such a symptom. Suspecting it was "Zhan Han", I dared not make a decision myself. However, the patient said it was no big deal, recalling that she had experienced it once before in previous years, and recovered after sweating followed the shivering. Hearing this, I felt somewhat relieved. I accompanied the patient, feeding her warm water with a small spoon at intervals to observe changes in her condition. After about an hour of shivering, the patient sweated slightly all over her body. The next day, her fever subsided, and she recovered, remaining safe and sound thereafter.
It is not uncommon to see "Heat disturbing the Blood Chamber" in warm diseases or "Zhan Han expelling pathogens" in cold damage, though these presentations are relatively rare in clinical practice. This article presents one case of each. Treating them with conventional methods resulted in the relief of symptoms and stability of the condition. Although Zhang Zhongjing did not provide a specific treatment for "Zhan Han" in cold damage, the case of Elder Zhou borrowed the established method of "benefiting the Stomach" from warm disease "Zhan Han"—supplementing fluids to nourish the sweat source. Consequently, the patient recovered as the heat reached the interstices, opening the pores, allowing the pathogens to exit via sweat.
**Complications from Mismedication for Exterior Wind-Heat**
Mrs. Shen, 49 years old, engaged in farming in Changzhou. She had a robust physique and a history of bronchitis. On a certain morning in March 1982, she came to Shanghai from the countryside and then went to Suzhou to sweep her mother-in-law's tomb, returning to Shanghai in the evening. Exhausted by the journey, she felt weak and unsupported. Soon after, she developed coughing, excessive phlegm, and slight shortness of breath. She self-medicated with Loquat Leaf Paste and Banbei Pill for three days. While the phlegm decreased and coughing became sparse, she experienced rebellious Qi movement and rapid breathing. A famous doctor was specially invited for consultation. He prescribed Ephedrae Herba (Mahuang), Armeniacae Semen Amarum (Xingren), Lepidii Fructus (Tinglizi), Glycyrrhizae Radix et Rhizoma (Gancao), Astragali Heterophylli Radix (Eguanshi), Pinelliae Rhizoma Preparatum (Banxia), and Citri Reticulatae Pericarpium (Chenpi). After taking seven doses, although the cough and wheezing were suppressed, numerous other symptoms emerged: diarrhea, three to four times daily; palpitations and panic, chest oppression and irritability; frequent sweating on the forehead, worsening with slight movement, while no sweat appeared elsewhere; a sensation of steaming heat in the afternoon, but without an actual rise in body temperature; sharp decrease in appetite, coupled with general weakness and depletion of Yuan Qi. On March 29, she was sent to a hospital for examination and diagnosed with possible "Hypertensive Heart Disease." That same afternoon, the previous TCM practitioner was urgently consulted again. Adhering to the previous prescription, White Atractylodes Rhizome (Baizhu), Poria (Fuling), and Imperatae Rhizoma Glutinosum Root (Nuodaogen) were added due to the presence of diarrhea and forehead sweating. On the 30th, after taking one dose, she felt extremely heavy and lethargic, lost all appetite, and the forehead sweating intensified, dripping continuously despite wiping. She lay in bed, unable to sit up even with assistance; sitting caused dizziness and collapse. At this point, the patient was extremely depressed, making life-and-death farewells with her husband overnight. Early the next morning (the 31st), her husband came to invite me, holding onto a slim hope.
Upon diagnosis, her complexion was dark and turbid, and her expression was indifferent. Inquiry revealed a dull distension in the head and a desire to remain inactive. Her forehead was wet with sweat, droplets like pearls seeping from the skin. Palpation showed hot palms, while the skin of the limbs and trunk was not warm. Her voice was low, her Qi timid, and she was reluctant to speak. Other symptoms were as previously described. Pulse palpation revealed thin, weak, choppy, and rapid pulses in both hands. The Renying point pulse and the Right Cun position pulse alone showed floating and rapid qualities, significantly larger than other positions. The tongue was dry without fluid, with a thick coating in the center extending straight to the root, yellow and brown. Based on these pulse and symptom findings, the case was particularly tricky. After repeated deliberation and integrating the Four Diagnostic Methods, I determined that the disease belonged to exterior Wind-Heat contraction. Due to her naturally robust and obese constitution, she had abundant Phlegm and Dampness. Coupled with fatigue-induced Qi deficiency, she lacked the strength to expel pathogens, causing external pathogens to knot with Phlegm-Turbidity, complicating the condition. The previous use of warm-drying herbs had instead consumed body fluids; fluid injury and Heat stagnation led to successive transformational syndromes. The current strategy should first employ Acrid-Cool methods to release the exterior and drive out invading pathogens; clear Heat and resolve Phlegm to open the pathway for pathogen exit. However, the dual injury of Fluids and Qi cannot be ignored. Otherwise, dried fluids cannot produce sweat, and deficient Qi lacks the power to reach and expel pathogens. Relying solely on exterior-releasing drugs would ultimately fail. Upon careful consideration, Yu Genchu’s *Jian Wang Wei Rui Tang* (Modified Anemarrhenia Decoction) from *Tongsu Shanghan Lun* seemed most suitable. I used this formula with modifications:
Scallion White (Congbai) 3 pieces, Fermented Soybean (Douchi) 9g, Platycodon Root (Jiegeng) 3g, Peucedanum Root (Qianhu) 4.5g, Anemarrhenae Rhizoma (Baiwei) 9g, Fresh Bamboo Sap (Xian Zhuli) 30g (mixed in), Mint (Bohe) 4.5g (added later), Honey-fried Licorice (Zhigancao) 3g, Winter Melon Seed (Dongguaren) 12g, Red Dates (Hongzao) 5 pieces, Polygonati Odorati Rhizoma (Yuzhu) 9g.
(Teacher Jiang Chunhua’s comment: Excellent formula.)
After taking the first decoction in the morning, she began to sweat profusely, with moisture covering her entire body. By noon, she felt hungry and ate a large bowl of soft noodles, weighing about two taels (approx. 100g). In the afternoon, she was able to sit up. Eager for recovery, she took another dose that night, consuming two doses within one day. During the follow-up visit the next day, she felt light and agile all over, looking completely different from before. Only the forehead sweating had decreased but not stopped, and she still felt a lack of spirit. Otherwise, there were no discomforts. Pulse diagnosis showed small and slightly rapid pulses in all six positions. The floating and large qualities of the Renying and Right Cun pulses had normalized, and the choppy quality had resolved. The tongue was no longer dry, but the coating remained yellow and thick. Medication continued with the previous method, focusing more on resolving Phlegm and clearing Heat:
Mint (Bohe) 3g (added later), Fermented Soybean (Douchi) 9g, Platycodon Root (Jiegeng) 3g, Peucedanum Root (Qianhu) 4.5g, Winter Melon Seed (Dongguaren) 12g, Stir-fried Gardenia (Chaoshanzhi) 6g, Stir-fried Bitter Orange (Chao Zhiqiao) 4.5g, Ginger-processed Pinellia (Jiang Banxia) 6g, Poria (Fuling) 9g, Honey-fried Licorice (Zhigancao) 3g, Scorched Six-Medicine Leaven (Jiao Liuqu) 9g.
After taking two doses, except for slight fatigue, all other symptoms receded, and forehead sweating stopped. She could manage household chores and returned home by bus on April 3rd.
Note: The patient later informed me that three days before coming to Shanghai, she had suffered from a cold with fever and headache, which subsided without treatment. Due to mental confusion during the illness, she did not mention it, making it difficult for doctors to identify the source of the disease temporarily, leading to unnecessary detours. The etiology of this case was pre-existing Phlegm-Heat combined with newly contracted external pathogens. The knotting of Phlegm and pathogens obstructed Lung Qi, preventing the expulsion of pathogens. Since the Lung and Large Intestine are interior-exterior related, when Lung Qi was obstructed and pathogens had no outlet, they forced their way into the Large Intestine, causing diarrhea; Heat stagnating internally caused chest and heart irritability; Heat steaming upwards forced fluids outward, causing frequent forehead sweating; Yang was abundant in the afternoon, contending with pathogens, hence the steaming heat in the afternoon, explaining these manifestations. In treating this disease, although I integrated the Four Diagnostic Methods and pondered repeatedly, I relied most on the pulse image, especially the Renying and Right Cun pulses. The Right Cun corresponds to the Lung, which governs the dissemination of Defensive Qi and is closely related to exterior diseases. Cold-Wind pathogens usually enter via the Taiyang channel; Wind-Heat pathogens often first injure the Lung-Wei. A Right Cun pulse that is floating and forceful is definite evidence of exterior pathogens; floating and rapid indicates contracting Wind-Warmth or Wind-Heat pathogens, or Cold pathogens transforming into Heat in the Lung. As for the Renying pulse, Ming Dynasty physician Li Shicai discussed it in detail. *Zhenjia Zhengyan* states: "The Renying pulse is located one fen anterior to the Guan position on the left hand, belonging to the Gallbladder department, associated with Wind-Wood and Yang, thus governing external diseases." "A tight and full Renying pulse indicates injury by Wind." It also says: "One fen anterior to the left Guan is the source of the Six Fu organs, the ruler of all Yang channels; those examining the exterior cannot exclude it." Therefore, seeing a floating and rapid Renying pulse, along with these symptoms, confirms exterior Wind-Heat infection beyond doubt. Of course, this is not a hasty judgment based solely on the pulse, but deduced by combining Inspection, Auscultation-Olfaction, and Inquiry. Hence, the prescription acted immediately, effective as fast as a drumstick striking a drum.
(Teacher Jiang Chunhua’s comment: Pulse theory can be relied upon but also not entirely; prioritize symptoms and use the pulse to corroborate symptoms, which is acceptable.)
(Note: This article was reviewed by Teacher Jiang Chunhua after writing, who provided the above comments. Although he has passed away, his merit in transmitting the Way, teaching, and resolving doubts cannot be forgotten. Taking this opportunity of publication, I recount this to commemorate him.)
**Autumn Contraction of Warm-Dryness: Cool Resolution is Appropriate**
*Huangdi Neijing* is the highest classic of TCM theory. Its discussion on pathogenesis and seasonal external pathogens omits Dryness-Qi and Dryness-Pathogens. Jin Dynasty’s Liu Wansu, after the "Nineteen Pathogenesis Formulas" in *Suwen: Zhi Zhen Yao Da Lun*, supplemented with "Rigidity, dryness, withering, and wrinkling all belong to Dryness," enriching and completing the content of the Nineteen Pathogenesis Formulas. Later, Ming Dynasty’s Yu Jiayan, in *Suwen: Yin-Ying Xiang Da Lun*, changed "Autumn injury by Dampness" to "Autumn injury by Dryness" in the text "Winter injury by Cold leads to Warm Disease in Spring; Spring injury by Wind leads to incomplete digestion in Summer; Summer injury by Summer-Heat leads to Malaria in Autumn; Autumn injury by Dampness leads to Cough in Winter." He formulated Qingzao Jiufei Tang (Clear Dryness Rescue Lung Decoction), innovating uniquely and pioneering the treatment of Dryness-Qi diseases. By the Qing Dynasty, Wu Jutong’s *Wenbing Tiaobian* specifically established a chapter on "Autumn Dryness," creating formulas like Sangxing Tang (Mulberry Leaf and Apricot Kernel Decoction) and Sangju Yin (Mulberry Leaf and Chrysanthemum Drink). Thus, treatments for Dryness-Qi injuring Lung-Wei in Autumn became complete. However, Dryness-Qi in Autumn injuring humans has distinctions between Warm-Dryness and Cool-Dryness. Wu’s discussion focused only on Warm-Dryness. Clinically, Warm-Dryness is actually more common than Cool-Dryness, so Wu’s contribution cannot be overlooked.
Regarding symptoms of Warm-Dryness: initially headache and body heat, dry cough without phlegm; even if phlegm is expectorated, it is mostly sticky and scanty; rebellious Qi and wheezing; dry and painful throat; dry nose and lips; chest oppression and hypochondriac pain; irritability and thirst; thin white and dry tongue coating; red edges and tip of the tongue. However, patient symptoms are often atypical, easily confused with Wind-Heat common cold. *Wenbing Tiaobian* states: "Autumn contraction of Dryness-Qi, Right pulse is rapid and large." Cao Bingzhang commented: "Right pulse rapid and large, especially at Right Cun, is not unique to Autumn Dryness; Wind-Warmth is also like this. This is a key to recognizing the disease, but in early Wind-Warmth, the Right Cun must be floating." Although ancient sages spoke definitively, many still failed to distinguish clearly in clinical practice, causing mild seasonal pathogen contractions to linger for days. If treatment is incomplete, or missed/mistreated, it often leads to consumption diseases.
*Lixu Yuanjian* discusses "Six Causes of Deficiency Syndromes," including "External Contraction Cause": "Those injured by external pathogens... if the person indulges in alcohol and sex, excessively injures Heart-Blood, Liver-Fire moves easily, Yin-Blood is inherently deficient, and there is latent Fire in the Lung, once injured by Wind-Fire, the wind stirs, and Tuberculosis Cough syndrome arises." Accordingly, tuberculosis cough caused by external contraction is mostly due to Warm-Heat pathogens, among which Warm-Dryness is the most severe. Warm-Dryness-Qi easily injures Lung-Jin (Fluids). The Lung is a Yin organ, preferring moisture and disliking dryness. Cao Bingzhang said: "Contraction of Dryness causing cough, the disease progression is originally mild, but if delayed and mistreated, it must become severe." Therefore, in clinical practice, encountering infectious syndromes that do not heal after long-term treatment requires careful observation; one must not be careless to avoid bringing disaster upon others.
Case: Cadre Wang, over fifty years old, robust and obese, prone to illness, suffering from liver pain and headaches frequently. In Autumn 1976, he contracted a cold with toothache, lasting a month without healing. Having tried almost all Chinese patent medicines and Western cold remedies, with slight effect but no cure, he came to me for consultation. His pulse was thin and slippery; symptoms included mild headache, slight aversion to cold, feeling hot when adding clothes, occasional coughing without any turbid phlegm, thin white and dry tongue coating. This was a contraction of Autumn Dryness-Qi, not a Wind-Cold or Wind-Heat cold, hence the ineffectiveness of cold medicines. Dryness syndromes are divided into Warm-Dryness and Cool-Dryness; this patient suffered from Warm-Dryness. The treatment method should use Cool-Moistening and Clearing-Resolution. I planned to modify Sangxing Tang:
Mulberry Leaf (Sangye) 9g, Fermented Soybean (Douchi) 4.5g, Schizonepeta Spike (Jingjie) 4.5g, Glehnia Root (Nanshashen) 9g, Stir-fried Gardenia (Chaoshanzhi) 6g, Ophiopogon Tuber (Maidong) 9g, Apricot Kernel (Xingren) 9g, Honey-fried Licorice (Zhigancao) 1.5g, Polygonati Odorati Rhizoma (Yuzhu) 9g.
Given two doses. The patient was eager for quick results, taking both decoctions of the second dose that night. Waking up at midnight, he felt comfortable all over. The next morning, all symptoms resolved instantly. He discarded the remaining dose without taking it.
**Warm Disease Diplopia**
In Spring 1986, I encountered a middle-aged female patient in a certain hospital hospitalized for persistent high fever. After symptomatic Western medical treatment, the high fever dropped but low-grade fever persisted; gradually appearing 1-2 degrees of chills/fever in the afternoon; rising to 3-4 degrees by late afternoon; 5-6 degrees at dusk; stopping at 7-8 degrees at nightfall. After midnight, the fever gradually subsided, and temperature was normal from dawn to noon. This cycle repeated daily. Since the onset of fever, she suffered visual impairment, seeing only faint light. When looking at objects or people, she saw only two white shadows, unable to distinguish what they were, let alone details. TCM consultation was invited. After taking medicine for over a month, the disease showed no progress or regression. Reviewing previous prescriptions, both consultations used modified Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). Pulse was small and rapid, tender to pressure. Tongue and coating showed no obvious abnormalities. Diagnosed as residual Heat from Warm Disease causing diplopia (seeing one object as two). Recalling a successful case treated by the ancient expert Mr. Xia Yingtang, which was very similar, I adopted his method and formula:
Glehnia Root (Beishashen) 30g, Trichosanthes Root (Tianhuafen) 18g, Dendrobium Stem (Chuanshihu) 9g, Mulberry Leaf (Sangye) 9g, Lonicera Flower (Yinhua) 9g, Forsythia Fruit (Lianqiao) 9g, Raw Licorice (Sheng Gancao) 1.5g, Anemarrhenae Rhizoma (Baiwei) 9g.
After taking three doses, the fever cleared completely, and diplopia disappeared, allowing her to discern the general shape of objects. After ten doses, vision returned to normal. The patient and her husband thanked me profusely and were discharged happily.
Note: Diplopia in Warm Disease is not very common clinically. Examining Warm Disease literature, the works of Ye, Xue, Wu, and Wang, the four great masters, also lack records. Thus, encountering such cases makes it difficult to identify the source of the disease initially. Previous physicians, following *Neijing*’s "scattered Essence causes diplopia," prescribed Liuwei Dihuang Tang, which was not unreasonable. Diagnosing this case, I recalled an article in *Selected Clinical Experiences of Modern TCM Schools* introducing Mr. Xia Yingtang’s clinical experience, which contained a similar case. Although pulse, tongue, and symptoms differed slightly, the lingering Warm Pathogen was the same. Regarding pathogenesis, Mr. Xia’s discussion was extremely precise: "This Warm Pathogen stagnates and transforms into Heat, lingering in the Qi Level, steaming the Yangming, stirring Liver-Fire. Fire nature rises upward, clouding the clear orifices. Since the Liver meridian connects to the eye system, and the Stomach meridian also connects to the eye system..." Regarding treatment: "The method of clearing Heat and preserving Fluids is precisely applicable." "Therefore, I proposed lightly clearing Heat, purifying the Lung, and controlling the Liver, allowing pathogens to penetrate and exit, so accumulated Heat clears naturally; Metal function descends, so Liver-Fire extinguishes itself; Heat clears, Fire extinguishes, Yin Fluids preserve themselves." Precisely because Mr. Xia’s discussion of the disease was meticulous and coherent, he achieved the effect of medicine curing the disease. Today, following his theory and using his formula, the patient escaped the demon of illness, and I gained knowledge.
**Blood Stasis Headache Accompanied by Yin Deficiency and Nocturnal Emission**
Young Xu, 17 years old. Since age 13, he suffered from pain at a fixed point on the left side of his forehead, unchanging. When severe, it felt like knife-cutting or awn-stabbing. Occurring daily or every other day, lasting several hours to gradually resolve. The longest episode lasted four hours. Studying and life were deeply affected. His mother, anxious for her son, devised ways to raise money, seeking medical help and medicine for over two years, with no success. On October 17, 1991, he came to me for treatment. I observed his emaciated physique and lusterless complexion. Pulse was wiry and thin; coating thin, tongue flaccid. Due to losing his father young, poor family background, and long-term nutritional deficiency leading to Qi and Blood deficiency, but the forehead pain was caused by Blood Stasis. The disease belonged to constitutional deficiency with pathological excess. Following the principle of "treat the branch in acute stages, treat the root in chronic stages," eliminating forehead pain was urgent. Thus, I first prescribed Xuefu Zhuyu Tang (Blood Mansion Removing Stasis Decoction) to move Blood and relieve pain:
Large-sheng Di Huang (Da Shengdi) 12g, Peach Kernel (Taoren) 9g, Licorice (Gancao) 1g, Red Peony Root (Chishao) 9g, Ligusticum Rhizome (Chuanxiong) 3g, Angelica Dahurica Root (Baizhi) 6g, Angelica Sinensis Root (Danggui) 9g, Safflower (Honghua) 3g, Stir-fried Bitter Orange (Chao Zhiqiao) 4.5g, Bupleurum Root (Chaihu) 4.5g, Platycodon Root (Jiegeng) 4.5g, Achyranthes Root (Huainiuxi) 9g.
After taking fourteen doses, the headache was cured.
Subsequent visits involved only pulse-taking and tongue-observing, with minor discussion of symptoms. Left pulse was wiry and thin; Right Guan position was thin and soft, Chi position slightly full. Tongue was flaccid and tender, with many red spots on the edges. This indicated Yin-Blood insufficiency accompanied by Minister Fire manifestation. I suspected nocturnal emission. Inquiry confirmed it. Using the method of nourishing Blood, calming Spirit, and regulating Liver and Spleen, I prescribed:
Large-sheng Di Huang (Da Shengdi) 9g, Poria (Fuling) 9g, Polygalae Radix (Zhianyuanzhi) 9g, Salvia Root (Danshen) 9g, Honey-fried Licorice (Zhigancao) 3g, Stir-fried Atractylodes Macrocephala Rhizome (Chaobaizhu) 9g, Stir-fried White Peony Root (Chaibaishao) 9g, Angelica Sinensis Root (Danggui) 4.5g, Stir-fried Phellodendron Bark (Chaohuangbo) 1.5g.
After taking another fourteen doses, nocturnal emissions gradually stopped. I used Yiguan Jian method to conclude the treatment. Occasionally, if Minister Fire became prominent, adding 5g each of Anemarrhenae Rhizoma (Zhimu) and Phellodendron Bark (Huangbai) would calm it. Finally, all ailments were resolved, except the wiry and thin pulse remained. I added Dendrobium Stem (Shihu) 9g and Honey-fried Turtle Shell (Zhiguiban) 15g to nourish Blood and soften the Liver. After taking over ten doses, the pulse gradually became gentle.
Note: Wang Qingren’s *Yilin Gaicuo* “Xuefu Zhuyu Tang” consists of Peach Kernel 12g, Safflower 9g, Angelica Sinensis Root 9g, Raw Rehmannia Root 9g, Ligusticum Rhizome 4.5g, Red Peony Root 6g, Achyranthes Root 9g, Platycodon Root 5g, Bupleurum Root 3g, Bitter Orange 6g, Licorice 3g. It excels at invigorating Blood, dispelling stasis, moving Qi, and relieving pain, serving as the main formula for Blood Mansion Blood Stasis. What is "Blood Mansion"? *Suwen: Maiyao Jingwei Lun* states: "Pulse is the mansion of Blood." The original meaning of Blood Mansion refers to blood vessels. The conditions treated in the original book were mostly Chest Blood Stasis obstructing Qi mechanism. However, in practical use, it is not limited to this. Any condition of Qi stagnation and Blood stasis with mild severity can be used. It is not limited to blood vessels or the chest area. Regarding differentiation, this case relied mainly on symptoms. The patient’s pain at one point on the left forehead, fixed and unchanging, stabbing like a knife or awn, has characteristics of Blood Stasis pathology. Using Xuefu Zhuyu Tang to treat Blood Stasis headache has become a commonly used clinical method. *Yilin Gaicuo* states: "Examining patients with headache, without exterior symptoms, without interior symptoms, without Qi deficiency, Phlegm-Fluid etc., suddenly occurring and improving, ineffective after hundred prescriptions, use this formula one dose and it cures." Verified by the above case, we know this is not empty talk.