程(四月) 湿温邪扰于阳明,头痛晕眩,身热烦渴,筋骨酸楚,暮夜神昏谵语,大便挟
热溏泄,小便短赤,脉弦滑数,治宜清解。
羚角片 薄荷梗 丹皮 益元散 牛黄清心丸(一颗) 连翘 川郁金 象贝 银花露 牛
蒡鲜斛 竹茹 车前子
长兄(六月) 感受暑风,扰于肺胃,吐泻交作,脘闷烦渴,身热无休,肌肤已现风疹,未
得宣达,神烦不寐,全无汗出,脉弦滑数,胎黄糙。治宜辛凉宣解。
羚角片 嫩薄荷 青蒿子 鲜竹茹 万氏清心丸 连翘 川郁金 纯钩 车前草 牛蒡 鲜斛 象贝 银花露
姑奶奶 暑风秽湿互扰阳明,升降不和,寒热如潮,脘闷络酸,口干溺少,脉弦滑数,胎
黄腻。惟恐汗出不彻,转受白 之弊,治宜清解一法。
连翘 川斛 赤苓 川郁金 银花露 佩兰叶 青蒿子 益元散 纯钩 牛蒡 地骨皮 杏仁 竹茹
伏暑蒸化白 未得宣达,(照前方)或可加∶
羚角片 绿豆衣 车前草 象贝 通草;
头痛甚者中薄荷数分;
无汗加橘红、淡豆豉;
脘闷加川朴、广皮白。
沈老潮(三十二岁大胖子,七月十六日)暑湿热邪扰于阳明,体禀多湿多痰,痰热阻郁
气机,升降不宣,神烦脘闷,骨络烦疼,头眩支倦,红疹已透,未得宣达,脉弦数,右寸关兼浮滑,治宜清解。
局方紫雪丹 连翘 鲜扁斛 真川连 车前草 牛黄清心丸 牛蒡 丹皮 益元散 芦根 羚角片 佩兰
叶纯钩 鲜石菖蒲根(一钱五分,捣汁和冲) 鲜竹沥
按∶痧疹已透,尚未宣达,如无刺平塌者,俗为疹子透勿出,若冒风即隐,属内陷者危,俗为疹子回肚是也。
又按∶痧疹有刺者佳,无刺勿起者,危。
又十七日再诊原方一帖。
又十八十九日去紫雪丹加川郁金。
又二十日红疹已得透解,肺胃痰热未清,肝胃气滞不和,时有潮热,脘闷支倦,神疲嗜
卧,口苦溺赤,脉小弦数,胎黄腻,治宜清肃上中,佐以平肝。
元参 佩兰叶 杏仁 黑栀 车前草 连翘 鲜斛 真川贝 银花露 牛蒡 丹皮 全瓜姜 益元散
又二十二日,阳明遗湿未清,心脾尚有余热,肝胃不和,口干呕酸,头眩支倦,便解下矢
坚黑,小溲短赤而涩且痛,脉弦小数,胎光红,治宜清解为法。
元参 青蒿 生谷芽 宋半夏象贝同拌 车前草一两煎汤代水 连翘 鲜斛 新会
皮佩叶叶 童木通 益元散真西珀三分同灯心研同拌 丹皮 姜汁 焦栀
程某(四月)湿温病邪侵犯阳明经,出现头痛、头晕目眩,身体发热且心烦口渴,筋骨酸痛,夜间神志昏迷并说胡话,大便夹杂热象呈稀溏状,小便短少色赤,脉象弦滑而数,治疗应当采用清热解表的方法。
处方:羚羊角片、薄荷梗、牡丹皮、益元散、牛黄清心丸(一颗)、连翘、川郁金、象贝母、银花露、牛蒡子、鲜石斛、竹茹、车前子。
长兄(六月)感受暑风之邪,邪气扰动肺胃,呕吐与腹泻交替发作,胃脘部闷胀且心烦口渴,身体发热不止,肌肤表面已经显现风疹,但邪气未能宣发透达,心神烦躁无法入睡,完全没有汗出,脉象弦滑而数,舌苔黄且粗糙。治疗应当采用辛凉宣散解表的方法。
处方:羚羊角片、嫩薄荷、青蒿子、鲜竹茹、万氏清心丸、连翘、川郁金、纯钩藤、车前草、牛蒡子、鲜石斛、象贝母、银花露。
姑奶奶 暑风与秽湿相互扰乱阳明经,气机升降失调,寒热往来如潮水般起伏,胃脘部闷胀且经络酸痛,口干且尿量减少,脉象弦滑而数,舌苔黄腻。唯恐汗出不透彻,转而遭受白㾦(白色小水泡)的弊端,治疗应当采用清热解法。
处方:连翘、鲜石斛、赤茯苓、川郁金、银花露、佩兰叶、青蒿子、益元散、纯钩藤、牛蒡子、地骨皮、杏仁、竹茹。
伏暑蒸腾化生白㾦,但未能宣发透达。(参照前方),或者可以加入:
羚羊角片、绿豆衣、车前草、象贝母、通草;
头痛严重者加入薄荷数分;
无汗者加入橘红、淡豆豉;
胃脘闷胀者加入厚朴、广皮白。
沈老潮(三十二岁大胖子,七月十六日)暑湿热邪侵犯阳明经,体质禀赋多湿多痰,痰热阻滞郁遏气机,升降不宣,心神烦躁且胃脘闷胀,骨骼经络烦痛,头晕且肢体倦怠,红疹已经透出,但未能完全宣发透达,脉象弦数,右寸关脉兼见浮滑,治疗应当采用清热解法。
处方:局方紫雪丹、连翘、鲜扁石斛、真黄连、车前草、牛黄清心丸、牛蒡子、牡丹皮、益元散、芦根、羚羊角片、佩兰叶、纯钩藤、鲜石菖蒲根(一钱五分,捣汁兑入冲服)、鲜竹沥。
按语:痧疹已经透出,但尚未完全宣发透达,如果没有刺平塌陷的情况,俗称为疹子透发不出,如果冒风即隐没,属于内陷,情况危急,俗称“疹子回肚”。
又按语:痧疹有刺者为佳,没有刺且不起发的,情况危急。
又十七日再诊,使用原方一帖。
又十八、十九日去掉紫雪丹,加入川郁金。
又二十日红疹已经得到透解,但肺胃痰热未清,肝胃气滞不和,时有潮热,胃脘闷胀且肢体倦怠,精神疲倦嗜卧,口苦尿赤,脉象小弦而数,舌苔黄腻,治疗应当清肃上中二焦,佐以平肝。
处方:玄参、佩兰叶、杏仁、黑栀子、车前草、连翘、鲜石斛、真川贝母、银花露、牛蒡子、牡丹皮、全瓜蒌、益元散。
又二十二日,阳明经遗留的湿气未清,心脾尚有余热,肝胃不和,口干呕吐酸水,头晕且肢体倦怠,大便排出黑色坚硬的粪便,小便短少色赤且涩痛,脉象弦小数,舌面光红,治疗应当以清热解法为主。
处方:玄参、青蒿、生谷芽、宋半夏与象贝母同拌、车前草一两煎汤代水、连翘、鲜石斛、新会皮、佩兰叶、童便木通、益元散真西珀三分同灯心草研细同拌、牡丹皮、姜汁、焦栀子。
Cheng (April) Damp-heat warm pathogen disturbs the Yangming channel, presenting with headache, dizziness, feverish body sensation, irritability and thirst, soreness and pain in bones and sinews, mental confusion and delirium at night, loose stools mixed with heat, short and red urine, wiry-slippery-rapid pulse. Treatment should employ clearing and resolving methods.
Prescription: Cornu Bubali Slice (Lingjiao Pian), Stem of Mentha Haplocalyx (Bohe Geng), Cortex Moutan (Danpi), Yi Yuan San, Niuhuang Qingxin Wan (one pill), Fructus Forsythiae (Lianqiao), Rhizoma Curcumae Aromatae (Chuan Yujin), Bulbus Fritillariae Thunbergii (Xiangbei), Silver Flower Dew (Yinhua Lu), Fructus Arctii (Niubang), Fresh Dendrobii Caulis (Xian Hu), Caulis Bambusae in Taenia (Zhuru), Semen Plantaginis (Cheqianzi).
Eldest Brother (June) Contracted summer-wind pathogen, disturbing Lung and Stomach, alternating vomiting and diarrhea, epigastric fullness, irritability and thirst, continuous fever, wind rashes already appeared on skin but not yet vented and reached, mental irritability and insomnia, complete absence of sweating, wiry-slippery-rapid pulse, yellow and rough tongue coating. Treatment should employ acrid-cool venting and resolving methods.
Prescription: Cornu Bubali Slice (Lingjiao Pian), Tender Mentha Haplocalyx (Nen Bohe), Herba Artemisiae Annuae (Qinghaozi), Fresh Caulis Bambusae in Taenia (Xian Zhuru), Wanshi Qingxin Wan, Fructus Forsythiae (Lianqiao), Rhizoma Curcumae Aromatae (Chuan Yujin), Uncaria Cum Ramulis Uncis et Hookis (Chun Gou), Herba Plantaginis (Cheqiancao), Fructus Arctii (Niubang), Fresh Dendrobii Caulis (Xian Hu), Bulbus Fritillariae Thunbergii (Xiangbei), Silver Flower Dew (Yinhua Lu).
Grandma (Aunt) Summer-wind and turbid dampness mutually disturb Yangming, ascending and descending functions are disharmonious, chills and fever fluctuate like tides, epigastric fullness and meridian soreness, dry mouth and scanty urination, wiry-slippery-rapid pulse, yellow and greasy tongue coating. Fear that sweat is not thorough, leading to complications of Bai Mo (white miliary rash); treatment should employ clearing and resolving method.
Prescription: Fructus Forsithiae (Lianqiao), Fresh Dendrobii Caulis (Chuan Hu), Poria Cocos with Red Bark (Chi Ling), Rhizoma Curcumae Aromatae (Chuan Yujin), Silver Flower Dew (Yinhua Lu), Herba Menthae Haplocalycis (Peilan Ye), Herba Artemisiae Annuae (Qinghaozi), Yi Yuan San, Uncaria Cum Ramulis Uncis et Hookis (Chun Gou), Fructus Arctii (Niubang), Cortex Lycii (Digupi), Semen Armeniacae Amarum (Xingren), Caulis Bambusae in Taenia (Zhuru).
Latent summer-heat steams and transforms into Bai Mo, but fails to be vented and reached. (Refer to previous formula), or may add:
Cornu Bubali Slice (Lingjiao Pian), Seed Coat of Phaseoli Volubilis (Lv Dou Yi), Herba Plantaginis (Cheqiancao), Bulbus Fritillariae Thunbergii (Xiangbei), Herba Tectonae (Tongcao);
For severe headache, add Mentha Haplocalyx (Bohe) a few fen;
For absence of sweat, add Pericarpium Citri Reticulatae (Juhong), Semen Sojae Preparatum (Dandouchi);
For epigastric fullness, add Rhizoma Magnoliae Officinalis (Chuan Pu), Albedo Citri Reticulatae (Guang Pi Bai).
Shen Laochao (32 years old, obese male, July 16) Summer-heat-damp-heat pathogen disturbs Yangming, constitution is prone to dampness and phlegm, phlegm-heat obstructs and stagnates Qi mechanism, ascending and descending not unobstructed, mental irritability and epigastric fullness, bone and meridian irritability and pain, dizziness and limb fatigue, red rashes have emerged but not fully vented and reached, wiry-rapid pulse, right Cun and Guan positions additionally floating-slippery, treatment should employ clearing and resolving methods.
Prescription: Jufang Zixue Dan, Fructus Forsythiae (Lianqiao), Fresh Biflora Dendrobii Caulis (Xian Bian Hu), Real Coptidis Rhizome (Zhen Chuanlian), Herba Plantaginis (Cheqiancao), Niuhuang Qingxin Wan, Fructus Arctii (Niubang), Cortex Moutan (Danpi), Yi Yuan San, Radix Asparagi (Lugen), Cornu Bubali Slice (Lingjiao Pian), Herba Menthae Haplocalycis (Peilan Ye), Uncaria Cum Ramulis Uncis et Hookis (Chun Gou), Fresh Rhizoma Acori Tatarinowii (Xian Shichangpu Gen, 1 qian 5 fen, crushed for juice and mixed), Fresh Caulis Bambusae in Taenia Juice (Xian Zhuli).
Note: Sha zhen (scarlet-like rashes) have emerged but not fully vented and reached. If there is no flat depression, commonly called "rashes failing to emerge"; if they disappear upon exposure to wind, it belongs to internal collapse, which is critical, commonly called "rashes retreating to the abdomen".
Another Note: Sha zhen with papules/spines are auspicious; those without spines and not rising are critical.
On the 17th day, second consultation, one dose of original prescription.
On the 18th and 19th days, remove Zixue Dan, add Rhizoma Curcumae Aromatae (Chuan Yujin).
On the 20th day, red rashes have been vented and resolved, but Lung-Stomach phlegm-heat is not cleared, Liver-Stomach Qi stagnation and disharmony persist, periodic tidal fever occurs, epigastric fullness and limb fatigue, mental fatigue and desire to sleep, bitter taste in mouth and red urine, small wiry-rapid pulse, yellow greasy tongue coating. Treatment should clear and purify Upper and Middle Jiao, assisted by calming Liver.
Prescription: Radix Scrophulariae (Yuanshen), Herba Menthae Haplocalycis (Peilan Ye), Semen Armeniacae Amarum (Xingren), Black Gardenia Fruit (Hei Zhi), Herba Plantaginis (Cheqiancao), Fructus Forsythiae (Lianqiao), Fresh Dendrobii Caulis (Xian Hu), Real Fritillariae Bulbus (Zhen Chuanbei), Silver Flower Dew (Yinhua Lu), Fructus Arctii (Niubang), Cortex Moutan (Danpi), Whole Trichosanthes Fruit (Quanguagua), Yi Yuan San.
On the 22nd day, residual dampness in Yangming is not cleared, Heart-Spleen still has lingering heat, Liver-Stomach disharmony, dry mouth and sour vomiting, dizziness and limb fatigue, stool passes black hard feces, urine is short, red,涩 (astringent/stagnant) and painful, wiry-small-rapid pulse, smooth red tongue surface. Treatment should employ clearing and resolving as the method.
Prescription: Radix Scrophulariae (Yuanshen), Herba Artemisiae Annuae (Qinghao), Germinated Grain Sprout (Sheng Guya), Song Banxia mixed with Xiangbei, Herba Plantaginis (Cheqiancao, 1 liang decocted water substitute), Fructus Forsythiae (Lianqiao), Fresh Dendrobii Caulis (Xian Hu), Xin Hui Peel (Xinhuipi), Peilan Ye, Tong Mutong, Yi Yuan San mixed with 3 fen Zhen Xi Po ground together with Dengxin Cao, Cortex Moutan (Danpi), Ginger Juice (Jiangzhi), Scorched Gardenia Fruit (Jiao Zhi).