曾治患者郭××，男，54岁。咽喉疼痛，时轻时重5年多。某院诊为慢性咽炎。先用西药治疗2年多无效，后又配合中药咽喉丸、六神丸含化2个多月仍无效。不得已，又改请中医治疗，前后易医十几人，服药1000余剂仍无功。细询其证，除咽喉疼痛外，并见痰多，咽喉、胸部憋胀，烧心泛酸，舌苔薄白而微腻，脉弦细缓。再察其所服诸方，或认为是梅核气而予半夏厚朴汤加减，或诊为咽喉发热与清热解毒利咽之剂加减，或认为属阴虚火旺而予养阴清热之剂加减，或认为系热痰阻塞而与清热化痰之剂加减，种种不一，然终未见效。综合脉证后，反复思考，开始略悟其机理。《伤寒论·少阴篇》云：“少阴病，咽中痛，半夏散及汤主之。”并列服药方法，云：“右三味，等分，各别捣筛已，合治之，白饮和，服方寸匕，日三服：若不能散服者，以水一升，煎七沸，内散两方寸匕，鬯煮三沸，下火令小冷，少少咽之。”尤在泾云：“少阴咽痛，甘不能缓者，必以辛散之，寒不能除者，必以温发之，盖少阴寒邪，郁聚咽嗌之间，既不得出，复不得入，设以寒治，则聚益甚，投以辛温，则郁反通，《内经》‘微者逆之，甚者从之’之意也。半夏散及汤，甘辛相合，而辛胜于甘，其气又温，不特能解客寒之气，亦能劫散咽喉拂郁之热也。”此证久用寒凉小效，舌苔又见白腻，脉弦细而缓。证脉合参，不正是少阴咽痛，寒邪闭郁之痰乎?乃拟半夏散为汤小剂服之。处方：半夏30克，桂枝30克，甘草30克。共为细末，分30包，一日3次，一次l包，水煎，频频含咽之。1剂后，泛酸、烧心即解，咽痛稍减，继服2剂，诸证消失而愈。
郑××，女，40岁。三年前，突然发现咽喉疼痛。某院诊为咽炎。先与青霉素、喉片、六神丸等治疗2个月无效，继改用中药清热解毒之剂治之。数月后，不但无效，反而日渐感到痰多，咽喉憋胀，乃易医治之。医云：梅核气，予四七汤加减治之，不效。其后，又易医十几人，然终未见效。邀余治之，始以柴胡枳桔汤微效，继服20剂则无效。余审思再三．不得其解。偶读章虚谷《伤寒本旨》，云：“少阴之脉，其直者上循咽喉，外邪人里，阳不得伸，郁而化火，上灼咽痛，仍用辛温开达，使邪外解，则内火散，此推本而治也。若见咽痛而投寒凉，则反闭其邪，必致更重。”始而大悟：此证正是少阴咽痛过用寒凉郁闭之证也，何不用半夏散及汤法治之。再思我20多年讲授《伤寒论》“少阴病，咽中痛，半夏散及汤主之”时一节的讲授方法，大多宗《伤寒论释义》内容解释之错误，所谓“当有恶寒痰多等证”尤失原文含义，故以半夏散为汤含咽之。服用1剂，痛减几半，继服1剂痛消而愈。
半夏散及汤治疗咽喉疼痛者，古人列述医案者有之，近人报道之个案亦有之，然多不被人重视，致使寒邪外束久久不愈者甚多。
喉喑
急性喉炎的声音嘶哑以风热犯肺者为多，故以蝉蜕、桔梗、甘草、麦冬以取效；然亦有风寒闭郁者，故亦有取麻杏石甘汤取效者；然痰热阻塞，声音难出者，亦时有发现，临床时尤应注意。例如：贾××，女，24岁。2个月前感冒时突然发生声音嘶哑，其后感冒已治愈，但声音嘶哑不见改善。某院诊．为喉炎。耳鼻喉科治疗1个月仍然不见改善。审其证见声音嘶哑，咽喉不利，痰多而粘，甚难咳出，舌苔白，脉弦滑，尤以右寸为甚。云：脉证相参，当为痰热阻滞，阴液不能上潮，所谓重金不鸣之证也。为拟清化热痰、佐以养阴。清气化痰丸加减：南星9克，半夏9克，橘红9克，杏仁9克，浙贝母9克，瓜蒌9克，沙参15克，麦冬15克。药进2剂即愈，再进2剂他汪亦消。
声音嘶哑有虚有实，声带麻痹的声音嘶哑亦不例外，正如张景岳所说：“喑哑之病，当知虚实。实者，其病在标，因窍闭而喑也；虚者，其病在本，因内夺而喑也。窍闭者，有风寒之闭，外感证也；有火邪之闭，热乘肺也；有气逆之闭，肝滞强也。”又说：“至若痰涎之闭，虽日有虚有实，然非治节不行，何致痰邪若此，此其虚者多实者少，当察邪正分缓急而治之可也。”
翟××，女，43岁。声音嘶哑发紧10个多月。某院诊为声带麻痹。西药、针灸、理疗等久治不效，转请中医治疗。审其舌苔薄白，脉沉而滑。诊为气滞痰郁，肺气不利证。为拟理气化痰、清热养阴。四逆散加味：柴胡6克，枳壳9克，白芍9克，桔梗9克，蝉衣9克，连翘9克，麦冬9克，元参9克，甘草6克，瓜蒌15克，薄荷6克，黄芩6克。药进4剂嘶哑即减，20剂后诸证消失。
李××，女，42岁。声音嘶哑2年多。经北京、太原等数个医院确诊为声带麻痹，中、西药物、理疗、针灸等久治不效。细审其证，除声音嘶哑外，并见喉部发紧，咽喉干燥，舌苔薄白，脉虚。综合其脉证，乃阴虚痰热之证也。乃拟养阴化痰。麦门冬汤加减：麦冬12克，沙参12克，半夏6克，紫菀6觅，枇杷叶9克，生薏米仁15克，元参12克。药进8剂，“因喉发紧好转，声音亦有时能顺利发出，继进8剂诸证减去七八，乃连续又服16剂，后果愈。
鼽嚏
《素问。金匮真言论》曰：“西方白色，人通于肺，开窍于鼻，藏精于肺。”《灵枢·脉度篇》曰：“肺气通于鼻，肺和则鼻能知臭香矣。”张景岳说：“鼻为肺窍”，故鼻病恒多从肺论治，至若病久不愈，多因气虚内火不得泄越，故多从补气泄火论治。李用粹说：“又有气虚人，每遇严寒，感寒鼻酸，此气虚易于招寒，内火不得泄越，相搏作酸。”曾治患者郭××。女，成。两年来在改变环境(如由冷到热或由热到冷的环境时)或遇异味(如化学品、香脂、花粉)时，即不断的打喷嚏，流清水样鼻涕。某院五官科诊为过敏性鼻炎。前医予中药辛夷散、苍耳子散加减及西药等久治不效。审其证，除以上症状外，并见口苦口干，舌苔薄白，舌质红，脉虚而少滑。综其脉证，诊为肺气不足，内火蕴结。为拟益气聪明汤补气泻火。处方：蔓荆子9克，升麻9克，葛根15克，黄芪15克，党参10克，黄柏9克，白芍9克，炙甘草6克。2剂后喷嚏骤然由一日10～20次减为l～2次，继服14剂而愈。
阳明属胃，与脾相表里，脾土虚衰，阳明之经亦失所养，正如张景岳所说：“然其经络所至专属阳明，自山根以上则连太阳督脉以通于脑，故数经之病皆能及之。”所以鼽嚏之剂非肺虚者亦有之。例如：刘××，男，成。在改变环境(特别是由冷到热环境)时，即感全身不适，连续喷嚏20多个还不停止，汗多，但汗出后发作更加严重。某院五官科诊为过敏性鼻炎。前医予西药及中药辛夷散、益气聪明汤等不效。细询其证，除以上诸证外，尚见胃脘隐隐作痛，纳呆食减，脐腹悸动，舌苔薄白，脉缓少弦。综合脉证，诊为脾虚外邪所客。拟桂枝加芍药汤：桂枝10克，白芍20克，生姜10克，炙甘草10克，大枣12个。服药4剂，喷嚏次数明显减少，继按原方服药20剂愈。
脑脊液鼻漏，《上海中医杂志》曾报道予补肾法治愈一例余初采用此法试治一例未效，诊其脉濡缓，予益气聪明汤而愈者。例如：患者胡××，男，27岁。感冒以后两年多来，右侧鼻孔不断流出清水样鼻涕，昼夜不止。某院诊为脑脊液鼻漏鼻漏液：蛋白质90毫克％，葡萄糖50毫克％，氯化钠750毫克％。审其证，除不断用手帕揩擦鼻涕外，并见头晕腰冷，疲乏嗜睡，表情呆滞，视力下降(只能看清3米内的物体)，舌苔白，脉濡缓。综其脉证，诊为肺气不足，内热蕴结：为拟益气聪明汤：蔓荆子10克，升麻10克，葛根15克，党参12克，黄芪20克，黄柏10克，白芍10克，甘草9克。服药4剂，鼻涕少减，腰冷减轻，继服7剂，腰冷消失，头晕、嗜眠、视力下降明显改善，舌苔薄白，脉浮弦，加枸杞子9克、五味子10克以补肾气，继服40剂诸证消失而愈。
第二章病
第一节内科
流行性感冒
1．偏执温病，忽视伤寒，以寒作温，延误病期
余友赵××，男，38岁。
高烧7日，医作流感论治，先以输液、抗生素投入4日，继又配以中药清热解毒，辛凉解表法以治，然均无效。商治于余。察体温持续在39~C～39．5cc之间波动，头痛身痛，恶寒发热俱见，且烦躁不安，脉浮紧数。云：仲景《伤寒论》有言：“太阳中风，脉浮紧，发热恶寒，身疼痛，不汗出而烦躁者，大青龙汤主之。”此证与大青龙证甚相合拍也，然你之体温高达39％～39．5℃，恐辛温之品以热助热，甚或热极生风，不宜也，姑暂拟辛凉重剂先治发烧，而后再以辛温解之可也。赵友与其家属均认为议论甚有理。予大剂白虎汤一剂不效，又易清瘟败毒饮一剂仍不效：友云：此非外感风寒之邪，闭郁于表，邪实于表，热郁于里之证乎?予云：证脉均系大青龙汤证，不妨试用之。处方：麻黄18克，桂枝6克，炙甘草6克，杏仁10克，生姜10克，大枣10个(擘)，生石膏15克。
药进1剂，全身微微汗出，热退，证解。云：偏执温病多而伤寒少，偏执清热即可降温之论，误也，误也。
2．表里三焦俱病，但予清热，失于疏通，久久不解
李××，男，50岁。
4天前，突然高热不退。医诊流行性感冒。始予青霉素不效，继又予卡那霉素，氨苄青霉素、病毒唑仍不效。因其合并出现二联律、束支传导阻滞、ST段下降，证见心悸气短，咽喉疼痛，而加用激素、中药清热解毒剂2天，然其体温仍不见下降。改邀余前往诊视。察其体温39．5℃，头晕头痛，咽喉干痛，脘腹胀满，大便不爽，脘腹按之微有压痛，舌苔黄白，脉浮弦滑。综合脉证，思之：脉浮者表证也，表证应予解表；脘腹胀满，按之微痛，脉滑者，里证也，里证当予攻下。又思上见头痛咽喉疼痛，中见脘腹胀满，下见便秘溲赤，乃三焦俱病也。三焦俱病，不去调治三焦，而但予清热冰伏，岂能得解?清·杨栗山《寒温条辨》云：“表里三焦大热，其证不可名状者，此方(按：即升降散)主之。”“如头痛眩晕，胸膈胀闷，心腹疼痛，呕哕吐食者；如内烧作渴，上吐下泻，身不发热者；如憎寒壮热，一身骨节酸痛，饮水无度者；如四肢厥冷，身凉如冰，而气喷如火，烦躁不宁者；如身热如火，烦渴引饮，头面猝肿，其大如斗者；如咽喉肿痛，痰涎壅盛，滴水不能下咽者；如遍身红肿，发块如瘤者；如斑疹杂出，有似丹毒风疮者；如胸高胁起胀痛，呕如血汁者；如血从口鼻出，或¨出，或牙缝出，毛孔出者；如血从大便出，甚如烂瓜肉屋漏水昔：如小便涩淋，如血滴点作，疼不可忍者；如小便不通，火便火泻无度，腹痛肠鸣如雷者；如便清泻白，足重难移者，肉晌筋惕者；如舌卷囊缩，或舌出寸许，绞扰不住，音声不出耆；如谵语狂乱不省人事，如醉如痴者；如头痛如破，腰痛如斫，满面红肿，目不能开者；如热盛神昏，形如醉人哭笑无常，目不能开者；如手舞足蹈，见神见鬼，似疯癫狂祟者；如误4良发汗之药变为亡阳之证，而发狂叫跳，或昏不识人者；外让小同，受邪则一，凡未曾服过他药者，无论十日、半月、一月，但服此散，无不辄效也。”乃予升降散加减为剂予之。处力：蝉衣10克，僵蚕10克，片姜黄10克，大黄4克，元参10克，薄荷10克。
服药1剂后，体温恢复正常，发热消失，心悸气短亦明显减轻，24小时动态心电图显示仍偶见束支传导阻滞，而二联律及sT段下降消失。审其脉弦滑，偶见胸满咽干。此乃太阴少阳俱病拟用柴胡枳桔汤加减为剂。前后服药6剂，诸证消失。
3．表寒里热，微兼里实，但予清热解毒，其何能愈?
申××，女，3岁。
两天前，突然发热。医始以输液、抗生素、柴胡注射液等治疗，不但发热不退，反见体温由38℃升至39．5℃，又配用中药清热解毒之剂一付，诸证亦不好转。审其身热如炭，体温39．7cc，无汗，便干，两日未行，舌苔黄白，脉浮数。乃云：此表寒闭郁，里实热盛相兼为病也，宜外疏表邪，内泻里热可也。处方：蝉蜕9克，僵蚕9克，苏叶3克，片姜黄9克，大黄3克。
处方刚毕，某医云：既见便干，何不加大黄至9克?答曰：此证脉浮而数，浮脉者，表证也。表证多者应予解表为主，不可以泻下治里为主，以防表邪人里不解耳。服药1剂，果然热退，继服1剂，愈。
4．表里俱病，身热搐搦，急用攻邪，其病得愈
朱××，男，2岁。
三天前，突然发热思睡。其母系西医儿科医生，乃先用抗生素、病毒唑类药治疗。两日后，发热不但不退，反见体温由38．7cI=上升至39．5℃，乃急请某医以清热解毒药2剂，昼夜兼进，配合用之，仍不效。审其腹部微满，大便数日不行，舌苔黄白，脉浮滑数。云：此表里合邪，表里俱实也。宜外疏风邪，内泻里热。处方：蝉蜕10克，僵蚕10克，片姜黄10克，大黄3克，苏叶3克，连翘10克。
曾诊治患者郭××，男性，54岁。咽喉疼痛，时轻时重已五年多。某医院诊断为慢性咽炎。先用西药治疗两年多无效，后又配合服用中药咽喉丸、六神丸含化两个多月仍无效。不得已，又改请中医治疗，前后更换医生十几位，服药一千多剂仍然没有效果。详细询问病情，除咽喉疼痛外，还见痰多，咽喉、胸部憋闷胀满，烧心泛酸，舌苔薄白而微腻，脉象弦细缓。再查看他所服用的各方，有的认为是梅核气（一种以咽中如有物阻，咯之不出，咽之不下为特征的病证）而给予半夏厚朴汤加减，有的诊断为咽喉发热而用清热解毒利咽的方剂加减，有的认为属阴虚火旺而用养阴清热的方剂加减，有的认为系热痰阻塞而与清热化痰的方剂加减，种种说法不一，然而最终都没有见效。综合脉象和症状后，反复思考，开始略微领悟其机理。《伤寒论·少阴篇》说：“少阴病，咽中痛，用半夏散及汤主治。”并列出了服药方法，说：“以上三味药，等分，分别捣碎过筛后，混合在一起，用白米汤调和，每次服用一方寸匕，每日三次；如果不能散服，用水一升，煎煮七沸，加入散剂两方寸匕，再煮沸三沸，离火稍冷，少量多次吞咽。”尤在泾说：“少阴咽痛，甘味不能缓解的，必须用辛味发散；寒邪不能消除的，必须用温法发越。这是因为少阴寒邪，郁结聚积在咽喉之间，既不得出，又不得入，如果用寒凉药治疗，则郁结更甚，投以辛温药，则郁结反而通畅，这正是《内经》‘微者逆之，甚者从之’的意思。半夏散及汤，甘辛相合，而辛胜于甘，其药性又温，不仅能解除客寒之气，也能劫散咽喉拂郁之热。”此证久用寒凉药小效，舌苔又见白腻，脉弦细而缓。证脉合参，不正是少阴咽痛，寒邪闭郁之痰吗？于是拟定半夏散改为汤剂小剂量服用。处方：半夏30克，桂枝30克，甘草30克。共研为细末，分30包，一日3次，一次1包，水煎，频频含咽。1剂后，泛酸、烧心即解，咽痛稍减，继服2剂，诸证消失而痊愈。
郑××，女性，40岁。三年前，突然感到咽喉疼痛。某医院诊断为咽炎。先给予青霉素、喉片、六神丸等治疗2个月无效，继改用中药清热解毒的方剂治疗。数月后，不但无效，反而日渐感到痰多，咽喉憋胀，于是换医治疗。医生说：梅核气，给予四七汤加减治疗，无效。其后，又换医生十几位，然而始终未见效。邀请我治疗，起初用柴胡枳桔汤微效，继服20剂则无效。我审思再三，不得其解。偶然读到章虚谷《伤寒本旨》，说：“少阴经脉，其直行者上循咽喉，外邪入里，阳气不得伸展，郁而化火，上灼咽喉致痛，仍用辛温开达之法，使邪气外解，则内火消散，这是推求本源而治的方法。如果见咽痛就投用寒凉药，则反而闭塞邪气，必然导致病情加重。”始而大悟：此证正是少阴咽痛过用寒凉导致郁闭的证候啊，为何不用半夏散及汤法治之。再想我20多年讲授《伤寒论》“少阴病，咽中痛，半夏散及汤主之”这一节时的讲授方法，大多宗《伤寒论释义》的内容解释之错误，所谓“当有恶寒痰多等证”尤其失原文含义，故以半夏散改为汤剂含咽之。服用1剂，痛减几乎一半，继服1剂痛消而痊愈。
半夏散及汤治疗咽喉疼痛者，古人列述医案者有之，近人报道之个案亦有之，然而多不被人重视，致使寒邪外束久久不愈者甚多。
喉喑（声音嘶哑）
急性喉炎的声音嘶哑以风热犯肺者为多，故以蝉蜕、桔梗、甘草、麦冬取效；然而也有风寒闭郁者，故也有取麻杏石甘汤取效者；然而痰热阻塞，声音难出者，也时有发现，临床时尤应注意。例如：贾××，女性，24岁。2个月前感冒时突然发生声音嘶哑，其后感冒已治愈，但声音嘶哑不见改善。某医院诊断为喉炎。耳鼻喉科治疗1个月仍然不见改善。审查其证见声音嘶哑，咽喉不利，痰多而粘，甚难咳出，舌苔白，脉弦滑，尤以右寸脉为甚。云：脉证相参，当为痰热阻滞，阴液不能上潮，所谓重金不鸣（比喻肺气被痰热所困，声音不出）的证候也。于是拟定清化热痰、佐以养阴之法。清气化痰丸加减：南星9克，半夏9克，橘红9克，杏仁9克，浙贝母9克，瓜蒌9克，沙参15克，麦冬15克。药进2剂即愈，再进2剂其他症状也消除。
声音嘶哑有虚有实，声带麻痹的声音嘶哑亦不例外，正如张景岳所说：“喑哑之病，当知虚实。实者，其病在标，因窍闭而喑也；虚者，其病在本，因内夺而喑也。窍闭者，有风寒之闭，外感证也；有火邪之闭，热乘肺也；有气逆之闭，肝滞强也。”又说：“至若痰涎之闭，虽曰有虚有实，然非治节不行，何致痰邪若此，此其虚者多实者少，当察邪正分缓急而治之可也。”
翟××，女性，43岁。声音嘶哑发紧10个多月。某医院诊断为声带麻痹。西药、针灸、理疗等久治不效，转请中医治疗。审查其舌苔薄白，脉沉而滑。诊为气滞痰郁，肺气不利证。于是拟定理气化痰、清热养阴之法。四逆散加味：柴胡6克，枳壳9克，白芍9克，桔梗9克，蝉衣9克，连翘9克，麦冬9克，元参9克，甘草6克，瓜蒌15克，薄荷6克，黄芩6克。药进4剂嘶哑即减，20剂后诸证消失。
李××，女性，42岁。声音嘶哑2年多。经北京、太原等数个医院确诊为声带麻痹，中、西药物、理疗、针灸等久治不效。仔细审查其证，除声音嘶哑外，还见喉部发紧，咽喉干燥，舌苔薄白，脉虚。综合其脉证，乃阴虚痰热之证也。于是拟定养阴化痰之法。麦门冬汤加减：麦冬12克，沙参12克，半夏6克，紫菀6克，枇杷叶9克，生薏米仁15克，元参12克。药进8剂，“因喉发紧好转，声音亦有时能顺利发出，继进8剂诸证减去七八，乃连续又服16剂，后果痊愈。
鼽嚏（鼻塞、打喷嚏）
《素问·金匮真言论》说：“西方白色，人通于肺，开窍于鼻，藏精于肺。”《灵枢·脉度篇》说：“肺气通于鼻，肺和则鼻能知臭香矣。”张景岳说：“鼻为肺窍”，所以鼻病恒多从肺论治，至于病久不愈，多因气虚内火不得泄越，故多从补气泄火论治。李用粹说：“又有气虚人，每遇严寒，感寒鼻酸，此气虚易于招寒，内火不得泄越，相搏作酸。”曾诊治患者郭××，女性，成年。两年来在改变环境（如由冷到热或由热到冷的环境时）或遇异味（如化学品、香脂、花粉）时，即不断的打喷嚏，流清水样鼻涕。某医院五官科诊断为过敏性鼻炎。前医予中药辛夷散、苍耳子散加减及西药等久治不效。审查其证，除以上症状外，还见口苦口干，舌苔薄白，舌质红，脉虚而少滑。综合其脉证，诊为肺气不足，内火蕴结。于是拟定益气聪明汤补气泻火。处方：蔓荆子9克，升麻9克，葛根15克，黄芪15克，党参10克，黄柏9克，白芍9克，炙甘草6克。2剂后喷嚏骤然由一日10～20次减为1～2次，继服14剂而痊愈。
阳明属胃，与脾相表里，脾土虚衰，阳明之经亦失所养，正如张景岳所说：“然其经络所至专属阳明，自山根以上则连太阳督脉以通于脑，故数经之病皆能及之。”所以鼽嚏之剂非肺虚者亦有之。例如：刘××，男性，成年。在改变环境（特别是由冷到热环境）时，即感全身不适，连续喷嚏20多个还不停止，汗多，但汗出后发作更加严重。某医院五官科诊断为过敏性鼻炎。前医予西药及中药辛夷散、益气聪明汤等不效。详细询问其证，除以上诸证外，尚见胃脘隐隐作痛，纳呆食减，脐腹悸动，舌苔薄白，脉缓少弦。综合脉证，诊为脾虚外邪所客。拟桂枝加芍药汤：桂枝10克，白芍20克，生姜10克，炙甘草10克，大枣12个。服药4剂，喷嚏次数明显减少，继按原方服药20剂痊愈。
脑脊液鼻漏，《上海中医杂志》曾报道予补肾法治愈一例。余初采用此法试治一例未效，诊其脉濡缓，予益气聪明汤而愈者。例如：患者胡××，男性，27岁。感冒以后两年多来，右侧鼻孔不断流出清水样鼻涕，昼夜不止。某医院诊断为脑脊液鼻漏。鼻漏液：蛋白质90毫克％，葡萄糖50毫克％，氯化钠750毫克％。审查其证，除不断用手帕揩擦鼻涕外，还见头晕腰冷，疲乏嗜睡，表情呆滞，视力下降（只能看清3米内的物体），舌苔白，脉濡缓。综合其脉证，诊为肺气不足，内热蕴结：于是拟定益气聪明汤：蔓荆子10克，升麻10克，葛根15克，党参12克，黄芪20克，黄柏10克，白芍10克，甘草9克。服药4剂，鼻涕少减，腰冷减轻，继服7剂，腰冷消失，头晕、嗜眠、视力下降明显改善，舌苔薄白，脉浮弦，加枸杞子9克、五味子10克以补肾气，继服40剂诸证消失而痊愈。
第二章 病
第一节 内科
流行性感冒
1．偏执温病，忽视伤寒，以寒作温，延误病期
我的好友赵××，男性，38岁。
高烧7日，医生作流感论治，先以输液、抗生素投入4日，继又配以中药清热解毒，辛凉解表法以治，然而均无效。商量治疗于我。观察体温持续在39℃～39.5℃之间波动，头痛身痛，恶寒发热俱见，且烦躁不安，脉浮紧数。我说：仲景《伤寒论》有言：“太阳中风，脉浮紧，发热恶寒，身疼痛，不汗出而烦躁者，大青龙汤主之。”此证与大青龙证甚相合拍也，然而你的体温高达39℃～39.5℃，恐怕辛温之品以热助热，甚或热极生风，不宜也，姑暂拟辛凉重剂先治发烧，而后再以辛温解之可也。赵友与其家属均认为议论甚有理。给予大剂白虎汤一剂不效，又易清瘟败毒饮一剂仍不效：友人云：此非外感风寒之邪，闭郁于表，邪实于表，热郁于里之证乎？我说：证脉均系大青龙汤证，不妨试用之。处方：麻黄18克，桂枝6克，炙甘草6克，杏仁10克，生姜10克，大枣10个（擘），生石膏15克。
药进1剂，全身微微汗出，热退，证解。我说：偏执温病多而伤寒少，偏执清热即可降温之论，误也，误也。
2．表里三焦俱病，但予清热，失于疏通，久久不解
李××，男性，50岁。
4天前，突然高热不退。医生诊断流行性感冒。始予青霉素不效，继又予卡那霉素，氨苄青霉素、病毒唑仍不效。因其合并出现二联律、束支传导阻滞、ST段下降，证见心悸气短，咽喉疼痛，而加用激素、中药清热解毒剂2天，然而其体温仍不见下降。改邀我前往诊视。观察其体温39.5℃，头晕头痛，咽喉干痛，脘腹胀满，大便不爽，脘腹按之微有压痛，舌苔黄白，脉浮弦滑。综合脉证，思之：脉浮者表证也，表证应予解表；脘腹胀满，按之微痛，脉滑者，里证也，里证当予攻下。又思上见头痛咽喉疼痛，中见脘腹胀满，下见便秘溲赤，乃三焦俱病也。三焦俱病，不去调治三焦，而但予清热冰伏，岂能得解？清·杨栗山《寒温条辨》说：“表里三焦大热，其证不可名状者，此方（按：即升降散）主之。”“如头痛眩晕，胸膈胀闷，心腹疼痛，呕哕吐食者；如内烧作渴，上吐下泻，身不发热者；如憎寒壮热，一身骨节酸痛，饮水无度者；如四肢厥冷，身凉如冰，而气喷如火，烦躁不宁者；如身热如火，烦渴引饮，头面猝肿，其大如斗者；如咽喉肿痛，痰涎壅盛，滴水不能下咽者；如遍身红肿，发块如瘤者；如斑疹杂出，有似丹毒风疮者；如胸高胁起胀痛，呕如血汁者；如血从口鼻出，或耳出，或牙缝出，毛孔出者；如血从大便出，甚如烂瓜肉屋漏水者；如小便涩淋，如血滴点作，疼不可忍者；如小便不通，火便火泻无度，腹痛肠鸣如雷者；如便清泻白，足重难移者，肉瞤筋惕者；如舌卷囊缩，或舌出寸许，绞扰不住，音声不出者；如谵语狂乱不省人事，如醉如痴者；如头痛如破，腰痛如斫，满面红肿，目不能开者；如热盛神昏，形如醉人哭笑无常，目不能开者；如手舞足蹈，见神见鬼，似疯癫狂祟者；如误服发汗之药变为亡阳之证，而发狂叫跳，或昏不识人者；外感小同，受邪则一，凡未曾服过他药者，无论十日、半月、一月，但服此散，无不辄效也。”于是予升降散加减为剂予之。处方：蝉衣10克，僵蚕10克，片姜黄10克，大黄4克，元参10克，薄荷10克。
服药1剂后，体温恢复正常，发热消失，心悸气短亦明显减轻，24小时动态心电图显示仍偶见束支传导阻滞，而二联律及ST段下降消失。审查其脉弦滑，偶见胸满咽干。此乃太阴少阳俱病拟用柴胡枳桔汤加减为剂。前后服药6剂，诸证消失。
3．表寒里热，微兼里实，但予清热解毒，其何能愈？
申××，女性，3岁。
两天前，突然发热。医生始以输液、抗生素、柴胡注射液等治疗，不但发热不退，反见体温由38℃升至39.5℃，又配用中药清热解毒之剂一付，诸证亦不好转。审查其身热如炭，体温39.7℃，无汗，便干，两日未行，舌苔黄白，脉浮数。于是说：此表寒闭郁，里实热盛相兼为病也，宜外疏表邪，内泻里热可也。处方：蝉蜕9克，僵蚕9克，苏叶3克，片姜黄9克，大黄3克。
处方刚毕，某医生说：既见便干，何不加大黄至9克？回答说：此证脉浮而数，浮脉者，表证也。表证多者应予解表为主，不可以泻下治里为主，以防表邪入里不解耳。服药1剂，果然热退，继服1剂，痊愈。
4．表里俱病，身热搐搦，急用攻邪，其病得愈
朱××，男性，2岁。
三天前，突然发热思睡。其母系西医儿科医生，乃先用抗生素、病毒唑类药治疗。两日后，发热不但不退，反见体温由38.7℃上升至39.5℃，乃急请某医以清热解毒药2剂，昼夜兼进，配合用之，仍不效。审查其腹部微满，大便数日不行，舌苔黄白，脉浮滑数。我说：此表里合邪，表里俱实也。宜外疏风邪，内泻里热。处方：蝉蜕10克，僵蚕10克，片姜黄10克，大黄3克，苏叶3克，连翘10克。
A patient, Guo XX, male, 54 years old, was treated. He suffered from sore throat with fluctuating severity for over five years. A certain hospital diagnosed chronic pharyngitis. Western medicine treatment for over two years was ineffective. Subsequently, he took Chinese patent medicines Houyan Wan (Throat Pill) and Liushen Wan (Six-God Pill) by sucking them in the mouth for over two months, still without effect. Forced to seek Traditional Chinese Medicine (TCM) treatment, he changed doctors more than ten times and took over a thousand doses of decoctions, yet achieved no success. Upon detailed inquiry into his symptoms, besides sore throat, there was excessive phlegm, distending fullness in the throat and chest, heartburn with acid regurgitation, a thin white and slightly greasy tongue coating, and a string-taut, fine, and slow pulse. Reviewing the prescriptions he had taken, some considered it as Plum-pit Qi (a condition characterized by the sensation of a foreign body in the throat), prescribing modified Banxia Houpo Tang (Pinellia and Magnolia Bark Decoction); others diagnosed throat heat and prescribed modified formulas for clearing heat and detoxifying to benefit the throat; some attributed it to Yin deficiency with hyperactive fire, prescribing modified formulas for nourishing Yin and clearing heat; others believed it was obstruction by Phlegm-Heat, prescribing modified formulas for clearing heat and resolving phlegm. The opinions varied, but none were effective. After synthesizing the pulse and symptoms and reflecting repeatedly, I began to comprehend the mechanism. The *Shanghan Lun* (Treatise on Cold Damage), Shaoyin Chapter, states: "In Shaoyin disease, if there is pain in the throat, Banxia San Ji Tang (Pinellia Powder and Decoction) governs." It also lists the method of administration: "The above three ingredients, in equal parts, are separately pounded and sifted, then mixed. They are taken with rice water, one fangcun bi (a square-inch measure) at a time, three times a day. If powder form cannot be taken, boil one sheng (approx. 200ml) of water, add two fangcun bi of the powder after seven boils, boil for three more boils, remove from fire, let cool slightly, and swallow slowly in small amounts." You Zaijing said: "For Shaoyin sore throat, if sweet flavors cannot relieve it, pungent dispersants must be used; if cold nature cannot eliminate it, warm methods must be employed. This is because Shaoyin cold pathogen is constrained and gathered between the throat and epiglottis, unable to exit or enter. If treated with cold herbs, the constraint worsens; if administered pungent-warm herbs, the constraint opens. This embodies the principle of *Neijing*: 'For minor conditions, oppose them; for severe conditions, follow them.' Banxia San Ji Tang combines sweet and pungent, with pungency prevailing, and its nature is warm. It not only resolves exogenous cold but also forcibly dissipates the constrained heat in the throat." In this case, prolonged use of cold-natured herbs yielded little effect, the tongue coating remained white and greasy, and the pulse was string-taut, fine, and slow. Correlating syndrome and pulse, is this not Shaoyin sore throat due to cold pathogen constriction and phlegm? Thus, I prescribed Banxia San modified as a decoction in a small dose. Prescription: Banxia (Pinelliae Rhizoma) 30g, Guizhi (Cinnamomi Ramulus) 30g, Gancao (Glycyrrhizae Radix et Rhizoma) 30g. Pulverized into fine powder, divided into 30 packets, taken three times daily, one packet each time, decocted in water, and swallowed slowly while holding in the mouth. After one dose, acid regurgitation and heartburn resolved, and sore throat decreased slightly. After continuing for two more doses, all symptoms disappeared, and he recovered.
Zheng XX, female, 40 years old. Three years ago, she suddenly experienced sore throat. A hospital diagnosed pharyngitis. She was first treated with Penicillin, throat lozenges, and Liushen Wan for two months without effect. Then switched to TCM formulas for clearing heat and detoxifying. After several months, not only was there no improvement, but she increasingly felt excessive phlegm and throat distension, prompting her to change doctors. The doctor diagnosed Plum-pit Qi and prescribed modified Siqui Tang (Four-Seven Decoction), which was ineffective. Later, she changed doctors more than ten times, yet never saw results. Inviting me to treat her, I initially used Chaihu Zhijie Tang (Bupleurum and Citrus Aurantium Decoction) with slight effect, but after 20 doses, it became ineffective. I pondered deeply but could not find the solution. Accidentally reading Zhang Xugu's *Shanghan Benshi* (Original Meaning of Treatise on Cold Damage), I read: "The Shaoyin meridian, its straight branch ascends along the throat. When external pathogens enter the interior, Yang Qi cannot extend, becomes constrained and transforms into fire, scorching the throat causing pain. One should still use pungent-warm opening and unblocking methods to release the pathogen externally, thereby dispersing internal fire. This is treating the root. If one sees sore throat and administers cold-cooling herbs, it will instead close the pathogen, inevitably worsening the condition." I suddenly realized: This case is precisely Shaoyin sore throat caused by excessive use of cold herbs leading to constriction. Why not use the method of Banxia San Ji Tang? Reflecting on my 20+ years of teaching the section "Shaoyin disease, pain in the throat, governed by Banxia San Ji Tang" from *Shanghan Lun*, most explanations followed the erroneous content of *Shanghan Lun Shiyi* (Explanation of Treatise on Cold Damage), particularly the claim that "there should be aversion to cold and excessive phlegm," which deviated from the original meaning. Therefore, I prescribed Banxia San modified as a decoction to be held in the mouth. After one dose, pain reduced by nearly half; after another dose, pain vanished, and he recovered.
Although ancient texts record cases of Banxia San Ji Tang treating sore throat, and recent reports exist, they are often overlooked, resulting in many cases of persistent sore throat due to exogenous cold constraint remaining uncured.
Hoarseness (Houyin)
Acute laryngitis with hoarseness is mostly due to Wind-Heat invading the Lung, so remedies using Chan Tui (Cicada Slough), Jiegeng (Platycodon Root), Gancao (Licorice Root), and Maidong (Ophiopogon Tuber) are effective. However, there are cases of Wind-Cold constraint, where Mahuang Xinggan Shigan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) yields results. Also, cases of Hoarseness due to Phlegm-Heat obstruction occur occasionally and deserve clinical attention. For example: Jia XX, female, 24 years old. Two months ago, during a cold, she suddenly developed hoarseness. Although the cold was cured, the hoarseness did not improve. A hospital diagnosed laryngitis. Otolaryngology treatment for one month showed no improvement. Examining the syndrome: hoarseness, throat discomfort, excessive sticky phlegm difficult to expectorate, white tongue coating, string-taut and slippery pulse, especially prominent at the right Cun position. Pulse and syndrome correlation suggests Phlegm-Heat obstruction preventing Yin fluids from ascending, known as "Heavy Metal Cannot Ring" (metaphor for lung qi trapped by phlegm-heat). I prescribed clearing and transforming Phlegm-Heat, assisted by nourishing Yin. Modified Qingqi Huatan Wan (Clear Qi and Transform Phlegm Pill): Nanxing (Arisaematis Rhizoma Preparatum) 9g, Banxia (Pinelliae Rhizoma) 9g, Juhong (Citri Reticulatae Pericarpium Rubrum) 9g, Xingren (Armeniacae Semen Amarum) 9g, Zhe Beimu (Fritillariae Thunbergii Bulbus) 9g, Gualou (Trichosanthis Fructus) 9g, Shashen (Glehniae Radix) 15g, Maidong (Ophiopogonis Tuber) 15g. After two doses, she recovered; after two more doses, other symptoms disappeared.
Hoarseness can be Deficiency or Excess. Hoarseness due to vocal cord paralysis is no exception. As Zhang Jingyue stated: "In diseases of aphonia/hoarseness, one must know Deficiency and Excess. Excess lies in the branch, due to orifice closure causing aphonia; Deficiency lies in the root, due to internal depletion causing aphonia. Orifice closure includes Wind-Cold closure (exogenous syndrome), Fire-Evil closure (Heat affecting Lung), and Qi Reversal closure (Liver stagnation)." He further said: "Regarding closure by Phlegm-Saliva, although it can be Deficiency or Excess, if the regulation of Qi does not fail, how could Phlegm-Evil become so severe? Here, Deficiency is common, Excess is rare. One should observe the pathogen and healthy Qi, prioritize urgency, and treat accordingly."
Zhai XX, female, 43 years old. Hoarseness with tightness for over 10 months. Diagnosed with vocal cord paralysis at a hospital. Long-term treatment with Western medicine, acupuncture, and physiotherapy was ineffective. Transferred to TCM. Tongue coating thin white, pulse deep and slippery. Diagnosed as Qi Stagnation and Phlegm Constraint, Lung Qi Unsmoothness. Prescribed regulating Qi, transforming Phlegm, clearing Heat, and nourishing Yin. Modified Sini San (Frigid Extremities Powder): Chaihu (Bupleuri Radix) 6g, Zhike (Aurantii Fructus Immaturus) 9g, Baishao (Paeoniae Radix Alba) 9g, Jiegeng (Platycodonis Radix) 9g, Chan Yi (Cicadae Periostracum) 9g, Lianqiao (Forsythiae Fructus) 9g, Maidong (Ophiopogonis Tuber) 9g, Yuanshen (Scrophulariae Radix) 9g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Gualou (Trichosanthis Fructus) 15g, Bohe (Menthae Haplocalycis Herba) 6g, Huangqin (Scutellariae Radix) 6g. After four doses, hoarseness decreased; after 20 doses, all symptoms disappeared.
Li XX, female, 42 years old. Hoarseness for over 2 years. Confirmed as vocal cord paralysis by multiple hospitals in Beijing and Taiyuan. Long-term treatment with Chinese/Western medicine, physiotherapy, and acupuncture was ineffective. Detailed examination revealed, besides hoarseness, throat tightness, dry throat, thin white tongue coating, and deficient pulse. Synthesizing pulse and syndrome, it was Yin Deficiency with Phlegm-Heat. Prescribed nourishing Yin and transforming Phlegm. Modified Maimendong Tang (Ophiopogon Decoction): Maidong (Ophiopogonis Tuber) 12g, Shashen (Glehniae Radix) 12g, Banxia (Pinelliae Rhizoma) 6g, Ziwan (Asteri Radix) 6g, Pipaye (Eriobotryae Folium) 9g, Yiyiren (Coicis Semen) 15g, Yuanshen (Scrophulariae Radix) 12g. After eight doses, throat tightness improved, voice could sometimes be produced smoothly. After another eight doses, 70-80% of symptoms subsided. Finally, taking 16 more consecutive doses led to complete recovery.
Rhinitis and Sneezing (Qiuti)
*Suwen: Jingui Zhenyan Lun* states: "The West corresponds to White, connects to the Lung, opens into the Nose, and stores Essence in the Lung." *Ling Shu: Maidu Pian* states: "Lung Qi communicates with the Nose; when Lung is harmonious, the nose can distinguish odors." Zhang Jingyue said: "The Nose is the orifice of the Lung." Thus, nasal diseases are often treated from the Lung perspective. For chronic cases, it is often due to Qi Deficiency with internal fire unable to vent, so treatment focuses on tonifying Qi and draining fire. Li Yongcui said: "In people with Qi Deficiency, upon encountering severe cold, feeling nasal sourness indicates that Qi Deficiency easily attracts Cold, and internal fire cannot vent, clashing to cause sourness." I once treated patient Guo XX, female, adult. For two years, changing environments (e.g., cold to hot or hot to cold) or encountering odors (chemicals, perfumes, pollen) triggered continuous sneezing and clear watery rhinorrhea. An ENT department diagnosed allergic rhinitis. Previous treatments with Xin Yi San (Magnolia Flower Powder), Cang Er Zi San (Xanthium Fruit Powder) modifications, and Western medicine were ineffective long-term. Examining the syndrome: besides above symptoms, bitter taste, dry mouth, thin white tongue coating, red tongue body, deficient and slightly slippery pulse. Synthesizing pulse and syndrome, diagnosed as Lung Qi Insufficiency with Internal Fire Accumulation. Prescribed Yiqi Congming Tang (Benefit Qi and Brighten Eyes Decoction) to tonify Qi and drain fire. Prescription: Manjingzi (Vernoniae Fructus) 9g, Shengma (Cimicifugae Rhizoma) 9g, Gegen (Puerariae Lobatae Radix) 15g, Huangqi (Astragali Radix) 15g, Dangshen (Codonopsis Radix) 10g, Huangbai (Phellodendri Cortex) 9g, Baishao (Paeoniae Radix Alba) 9g, Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) 6g. After two doses, sneezing dropped sharply from 10-20 times/day to 1-2 times/day. After 14 more doses, she recovered.
Yangming belongs to the Stomach, paired internally-externally with the Spleen. If Spleen Earth is deficient, Yangming meridians also lose nourishment. As Zhang Jingyue said: "Where its meridians reach, they belong exclusively to Yangming. From the mountain root upwards, they connect to Taiyang and Du Meridians to communicate with the brain, so diseases of these meridians can affect it." Thus, remedies for rhinitis/sneezing are not limited to Lung Deficiency. For example: Liu XX, male, adult. Changing environments (especially cold to hot) caused general discomfort, continuous sneezing (over 20 times), profuse sweating, with attacks worsening after sweating. Diagnosed with allergic rhinitis. Previous treatments with Western medicine, Xin Yi San, and Yiqi Congming Tang were ineffective. Detailed inquiry revealed, besides above, dull stomach ache, poor appetite, abdominal palpitations, thin white tongue coating, slow and slightly string-taut pulse. Synthesizing pulse and syndrome, diagnosed as Spleen Deficiency with External Pathogen Invasion. Prescribed Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony Root): Guizhi (Cinnamomi Ramulus) 10g, Baishao (Paeoniae Radix Alba) 20g, Shengjiang (Zingiberis Rhizoma Recens) 10g, Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) 10g, Dazao (Jujubae Fructus) 12 pieces. After four doses, sneezing frequency decreased significantly. Continuing the original prescription for 20 doses led to recovery.
Cerebrospinal Fluid Rhinorrhea: *Shanghai Journal of Traditional Chinese Medicine* reported a case cured by Kidney Tonification. I initially tried this method on one case without success. Upon examining a damp-slow pulse, I prescribed Yiqi Congming Tang, which cured him. For example: Patient Hu XX, male, 27 years old. For over two years since a cold, clear watery fluid continuously flowed from the right nostril, day and night. Diagnosed with CSF rhinorrhea. Analysis of nasal fluid: Protein 90mg%, Glucose 50mg%, Sodium Chloride 750mg%. Examining syndrome: besides constant wiping of nose, dizziness, cold lower back, fatigue, hypersomnia, dull expression, decreased vision (only seeing within 3 meters), white tongue coating, damp-slow pulse. Synthesizing pulse and syndrome, diagnosed as Lung Qi Insufficiency with Internal Heat Accumulation. Prescribed Yiqi Congming Tang: Manjingzi (Vernoniae Fructus) 10g, Shengma (Cimicifugae Rhizoma) 10g, Gegen (Puerariae Lobatae Radix) 15g, Dangshen (Codonopsis Radix) 12g, Huangqi (Astragali Radix) 20g, Huangbai (Phellodendri Cortex) 10g, Baishao (Paeoniae Radix Alba) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 9g. After four doses, nasal discharge decreased slightly, lower back coldness alleviated. After seven more doses, lower back coldness disappeared, dizziness, hypersomnia, and vision improved significantly. Tongue coating became thin white, pulse floating-string-taut. Added Gouqizi (Lycii Fructus) 9g and Wuweizi (Schisandrae Chinensis Fructus) 10g to tonify Kidney Qi. After 40 more doses, all symptoms disappeared, and he recovered.
Chapter 2 Diseases
Section 1 Internal Medicine
Influenza
1. Bias towards Warm Diseases, neglecting Cold Damage, mistaking Cold for Warm, delaying treatment period.
My friend Zhao XX, male, 38 years old.
High fever for 7 days. Doctors treated as influenza. First, IV fluids and antibiotics for 4 days, then added TCM for clearing heat/detoxifying and releasing exterior with cool-natured methods, all ineffective. Consulted me. Temperature fluctuated between 39°C and 39.5°C. Headache, body ache, aversion to cold and fever both present, restlessness, floating-tight-rapid pulse. I said: Zhang Zhongjing's *Shanghan Lun* states: "In Taiyang Wind Strike, if pulse is floating-tight, fever and aversion to cold, body pain, no sweat, and restlessness, Da Qinglong Tang (Major Green Dragon Decoction) governs." This case fits Da Qinglong Syndrome well. However, your temperature is high (39-39.5°C), fearing pungent-warm herbs might aid heat with heat, or extreme heat generates wind, it is unsuitable. Temporarily prescribe heavy cool-natured agent to reduce fever first, then resolve with pungent-warm later. Zhao and family agreed it was reasonable. Prescribed large dose of Baihu Tang (White Tiger Decoction) for one dose, ineffective. Changed to Qingwen Baidu Yin (Clear Plague and Rescue Poison Decoction) for one dose, still ineffective. Friend said: Is this not exogenous Wind-Cold pathogen constrained at exterior, pathogen excess at exterior, heat constrained at interior? I said: Pulse and syndrome are both Da Qinglong Tang indications, why not try it? Prescription: Mahuang (Ephedrae Herba) 18g, Guizhi (Cinnamomi Ramulus) 6g, Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) 6g, Xingren (Armeniacae Semen Amarum) 10g, Shengjiang (Zingiberis Rhizoma Recens) 10g, Dazao (Jujubae Fructus) 10 pieces (split), Sheng Shigao (Gypsum Fibrosum) 15g.
After one dose, slight whole-body sweating, fever subsided, symptoms resolved. I said: Bias towards many Warm Disease cases and few Cold Damage cases, bias towards theory that clearing heat reduces fever, is error, error.
2. Exterior, Interior, and Triple Burner all diseased, only clearing heat given, lacking unblocking, prolonged non-resolution.
Li XX, male, 50 years old.
Sudden high fever for 4 days. Doctor diagnosed influenza. Initially Penicillin ineffective, then Kanamycin, Ampicillin, Ribavirin still ineffective. Due to combined bigeminy, bundle branch block, ST segment depression, symptoms of palpitations, shortness of breath, sore throat, hormones and TCM clearing heat/detoxifying agents added for 2 days, yet temperature still did not drop. Invited me to examine. Temperature 39.5°C, dizziness, headache, dry painful throat, abdominal distension, uncomfortable bowel movements, slight tenderness on abdominal palpation, yellow-white tongue coating, floating-string-taut-slippery pulse. Synthesizing pulse and syndrome, thinking: Floating pulse indicates Exterior Syndrome, should release exterior; Abdominal distension, slight tendence, slippery pulse indicate Interior Syndrome, should purge interior. Thinking further: Upper has headache and sore throat, middle has abdominal distension, lower has constipation and dark urine, thus Triple Burner is all diseased. With Triple Burner diseased, failing to regulate Triple Burner, but only clearing heat and freezing it, how can it resolve? Qing Dynasty Yang Lishan's *Hanwen Tiaobian* (Differentiation of Cold and Warm Diseases) states: "When Exterior, Interior, and Triple Burner have great heat, and symptoms are indescribable, this formula (i.e., Shengjiang San) governs." "...Such as headache and vertigo, chest/diaphragm distension, heart/abdominal pain, vomiting/regurgitation; such as internal burning thirst, upper vomiting/lower diarrhea, body not feverish; such as aversion to cold with high fever, whole body joint soreness, drinking without limit; such as cold limbs, body cool as ice, but breath hot as fire, restlessness; such as body hot as fire, vexed thirst seeking drink, sudden swelling of head/face size of a bucket; such as sore/swollen throat, abundant phlegm-saliva, unable to swallow even a drop of water; such as whole body red/swollen, lumps like tumors; such as macules/rashes mixed, resembling erysipelas/wind sores; such as chest high/costal distension/pain, vomiting blood-like juice; such as bleeding from mouth/nose, or ears, or teeth gaps, or pores; such as bleeding from stool, like rotten melon/meat or leaking house roof; such as dysuria, blood drops dripping, unbearable pain; such as urinary retention, frequent loose stools, abdominal pain/bowel sounds like thunder; such as clear/white diarrhea, heavy legs hard to move, muscle twitching/tendon tremor; such as curled tongue/retracted scrotum, or tongue protruding inch, twisting/uncontrollable, voice absent; such as delirium/madness unconscious, drunk/confused; such as headache like breaking, low back pain like chopping, face fully red/swollen, eyes unable to open; such as heat excess spirit confusion, shape like drunk person crying/laughing irregularly, eyes unable to open; such as dancing hands/kicking feet, seeing spirits/gods, like mad possession; such as mistaken use of diaphoretic drugs turning into Yang Collapse syndrome, raging/jumping, or unconscious not recognizing people; External contraction is similar, pathogen reception is one. For those who haven't taken other drugs, regardless of 10 days, half month, or one month, simply taking this powder, all respond immediately." Thus, I prescribed modified Shengjiang San (Ascending and Descending Powder). Prescription: Chan Yi (Cicadae Periostracum) 10g, Jiangcan (Bombyx Batryticatus) 10g, Pian Jianghuang (Curcumae Radix) 10g, Dahuang (Rhei Radix et Rhizoma) 4g, Yuanshen (Scrophulariae Radix) 10g, Bohe (Menthae Haplocalycis Herba) 10g.
After one dose, temperature normalized, fever disappeared, palpitations/shortness of breath significantly reduced. 24-hour dynamic ECG still showed occasional bundle branch block, but bigeminy and ST depression disappeared. Examining pulse string-taut-slippery, occasional chest fullness/dry throat. This is Taiyang-Shaoyang dual disease. Prescribed modified Chaihu Zhijie Tang. Total 6 doses, all symptoms disappeared.
3. Exterior Cold Interior Heat, slightly combined with Interior Excess, only clearing heat/detoxifying given, how can it cure?
Shen XX, female, 3 years old.
Sudden fever for 2 days. Doctors initially treated with IV fluids, antibiotics, Chaihu Injection. Not only fever persisted, temperature rose from 38°C to 39.5°C. Added one dose of TCM clearing heat/detoxifying, symptoms did not improve. Examined body hot as charcoal, temperature 39.7°C, no sweat, dry stool, no bowel movement for two days, yellow-white tongue coating, floating-rapid pulse. I said: This is Exterior Cold constraint combined with Interior Excess Heat. Should disperse exterior pathogen externally, purge interior heat internally. Prescription: Chan Tui (Cicadae Periostracum) 9g, Jiangcan (Bombyx Batryticatus) 9g, Suye (Perillae Folium) 3g, Pian Jianghuang (Curcumae Radix) 9g, Dahuang (Rhei Radix et Rhizoma) 3g.
Prescription just finished, another doctor said: Since dry stool is seen, why not increase Dahuang to 9g? Answer: This case pulse is floating and rapid. Floating pulse indicates Exterior Syndrome. Cases with much exterior syndrome should prioritize releasing exterior, cannot prioritize purging interior, to prevent exterior pathogen entering interior unresolved. After one dose, indeed fever subsided. After one more dose, recovered.
4. Exterior and Interior both diseased, body heat with convulsions, urgently using attacking pathogen method, disease gets cured.
Zhu XX, male, 2 years old.
Sudden fever and sleepiness for 3 days. Mother is a Western pediatrician, initially treated with antibiotics, Ribavirin. Two days later, fever not only didn't subside, temperature rose from 38.7°C to 39.5°C. Urgently asked another doctor to give 2 doses of clearing heat/detoxifying drugs, day and night, combined, still ineffective. Examined abdomen slightly full, no bowel movement for several days, yellow-white tongue coating, floating-slippery-rapid pulse. I said: This is Exterior-Interior combined pathogen, Exterior-Interior both Excess. Should disperse Wind pathogen externally, purge interior heat internally. Prescription: Chan Tui (Cicadae Periostracum) 10g, Jiangcan (Bombyx Batryticatus) 10g, Pian Jianghuang (Curcumae Radix) 10g, Dahuang (Rhei Radix et Rhizoma) 3g, Suye (Perillae Folium) 3g, Lianqiao (Forsythiae Fructus) 10g.