某(七月) 体禀阴虚,感受酷暑热邪蕴留阳明,加以风食扰动,始起头疼恶寒,烦渴
呕恶,继则身热脘闷,热甚神昏,肌腠曾现红疹白 ,渐次透达,病经一月之久,肺津与胃
液已被热邪消烁,前治一派蛮法,遂致阴分日耗一日,所谓夺汗则无血也,今诊脉象弦滑虚
数,按之均少神韵,唇焦口燥,以脉参证再延恐有喘脱之虞,姑拟扶正化邪,冀其转机附方请高明酌正。
台参须玫瑰花(三朵同炖冲) 天花粉 石决明 真川贝 珠黄散 大连心麦冬 鲜金斛
朱茯神 竹沥菖蒲汁一茶匙同冲 鲜生地 丹皮 连翘 益元散真西珀(三分研同冲)。
迭因前治进滋腻收涩之品,拟用花露以涤肠胃。
银花露 青蒿露 佛手露 玫瑰露 鲜谷子露 杷叶露
按、此即甘露饮法。
叶左(七月十三日,灯下) 二年前曾经
咯血,火升咳嗽由来日久,阴虚阳浮不喻可知。入夏以来感受暑湿热邪,自阳明扰动肝
阳,潮热来时于火妄动遗精走泄,小便短赤,口渴津烦。前医竟作温热论治,甚至服二角二
鲜紫雪至宝之类,津液从此暴脱,唇灰燥裂舌起白屑,大便泄痢不止,内热而饮不解渴,脉
细如丝,将有喘脱之虞。勉拟壮水之主以制阳光法,然鞭长莫及矣。附方请高明酌夺。
台参须玫瑰(三朵同炖冲) 女贞子 鳖甲童便炙 炒秫米 车前草 麦冬米炒 东白芍
青蒿童便炙 鲜莲子 霍石斛 左牡蛎 生熟谷芽(各四钱) 半贝丸
又(十四日次诊) 大便已结,内热亦减,精神渐旺,而腰膂痛楚,脘窒少纳,眩晕体疲,
此阴虚也,脉尚濡小而数,两关近弦,舌边微红,中后白屑已退而微黄,治从前法略为损益,附方请政。
台参须 左牡蛎 地骨皮 生谷芽 车前草 金扃斛 淡鳖甲 朱茯神 生米仁 东白芍 陈青
蒿真川贝 鲜莲子
【七月】患者体质本属阴虚,又感受酷暑热邪蕴结于阳明经,加之风邪与食积扰动,起初出现头痛、恶寒、心烦口渴、呕吐恶心等症状;随后发展为身体发热、胃脘部闷胀感,热势极盛时出现神志昏迷,皮肤腠理间曾出现红疹和白痦(一种由湿热郁蒸引起的细小水疱),逐渐透出。病程已持续一个月,肺津与胃液已被热邪消烁殆尽。之前的治疗使用了一派蛮横攻伐的方法,导致阴分日益耗损,正如古语所说“夺汗则无血”(过度发汗会导致阴血枯竭)。如今诊察脉象弦滑而虚数,按之缺乏神韵,嘴唇焦枯、口舌干燥。结合脉象与症状判断,若再拖延恐怕会有气喘欲脱的危险。暂且拟定扶正祛邪之法,希望病情能出现转机。附上方剂,请高明医家斟酌校正。
处方:台参须配玫瑰花(三朵同炖后冲服)、天花粉、石决明、真川贝、珠黄散、大连心麦冬、鲜金斛(鲜石斛)、朱茯神、竹沥菖蒲汁一茶匙同冲服、鲜生地、丹皮、连翘、益元散、真西珀(三分研末同冲服)。
此前因误用滋腻收涩的药物,现拟用花露类饮品以涤荡肠胃。
银花露、青蒿露、佛手露、玫瑰露、鲜谷子露、枇杷叶露。
按语:此法即甘露饮的变通应用。
【七月十三日,灯下】患者两年前曾有咯血病史,火气上炎、咳嗽由来已久,阴虚阳浮的道理不言而喻。入夏以来感受暑湿热邪,自阳明经扰动肝阳,潮热发作时相火妄动导致遗精滑泄,小便短赤,口渴烦躁。前医竟当作温热病论治,甚至服用二角二分量的紫雪丹、至宝丹等药物,导致津液从此暴脱,嘴唇灰暗干燥开裂,舌面起白屑,大便泄痢不止,体内有热但饮水不能解渴,脉象细如丝线,将有气喘欲脱的危险。勉强拟定“壮水之主以制阳光”(滋阴以抑制亢盛的阳热)之法,然而恐难奏效。附上方剂,请高明医家斟酌决定。
处方:台参须配玫瑰(三朵同炖后冲服)、女贞子、鳖甲(童便炙)、炒秫米、车前草、麦冬(米炒)、东白芍、青蒿(童便炙)、鲜莲子、霍石斛、左牡蛎、生熟谷芽(各四钱)、半贝丸。
【十四日次诊】大便已成形,内热亦减轻,精神逐渐恢复,但腰背部疼痛,胃脘痞闷、食欲稍减,眩晕、身体疲乏,这是阴虚的表现。脉象仍濡小而数,两关部近弦,舌边微红,中后部的白屑已退去转为微黄。治疗沿用前法略作增减。附上方剂,请指正。
处方:台参须、左牡蛎、地骨皮、生谷芽、车前草、金扃斛(鲜石斛的一种)、淡鳖甲、朱茯神、生米仁(薏苡仁)、东白芍、陈青蒿、真川贝、鲜莲子。
[July] The patient’s constitution is inherently Yin-deficient. Having contracted the pathogenic factor of intense summer-heat, which accumulated in the Yangming channel, and further aggravated by wind and food stagnation, the initial symptoms included headache, aversion to cold, vexation with thirst, vomiting, and nausea. Subsequently, the condition progressed to fever and epigastric stuffiness; as the heat intensified, it led to coma. Red rashes and white miliary blisters (a type of small vesicle caused by damp-heat accumulation) appeared on the skin and interstices, gradually emerging. The disease had persisted for a month, during which the Lung fluids and Stomach fluids were consumed by the heat pathogen. Previous treatments employed aggressive and unrefined methods, causing daily depletion of the Yin aspect, consistent with the saying "excessive sweating leads to blood loss." Current pulse diagnosis reveals a wiry, slippery, deficient, and rapid quality, lacking vitality upon palpation. The lips are scorched and dry, and the mouth is parched. Correlating the pulse with the symptoms, further delay may risk asthma and collapse. Tentatively prescribing a method to support the healthy Qi and transform pathogens, hoping for a turning point. Attached is the prescription for review by distinguished physicians.
Prescription: Taishen Xu (Ginseng Rootlets) with Rose Flowers (three flowers stewed together and taken with the decoction), Trichosanthis Radix (Tianhuafen), Halitum (Shijueming), Zhen Chuanbei (True Fritillaria Bulb), Zhuhuang San (Pearl and Realgar Powder), Dalianxin Maidong (Lonicera Caulis with Heart), Xian Jinhu (Fresh Dendrobium), Zhufushen (Poria with Cinnabar), Zhuli Changpu Zhi (Acorus Rhizome Juice mixed with Bamboo Sap, one teaspoon taken with the decoction), Sheng Dihuang (Fresh Rehmannia Root), Mudanpi (Tree Peony Bark), Lianqiao (Forsythia Fruit), Yi Yuan San (Benefiting Origin Powder), Zhen Xi Po (True Amber, three fen ground and taken with the decoction).
Since previous treatments involved cloying and astringent substances, floral distillates are now prescribed to cleanse the intestines and stomach.
Jinyin Lu (Honeysuckle Distillate), Qinghao Lu (Artemisia Annua Distillate), Foshou Lu (Citrus Medica Distillate), Meigui Lu (Rose Distillate), Xian Gu Zi Lu (Fresh Millet Distillate), Paye Lu (Loquat Leaf Distillate).
Commentary: This approach is based on the method of Ganlu Yin (Sweet Dew Decoction).
[July 13th, by lamplight] Two years ago, the patient experienced hemoptysis. Fire rising and chronic cough have existed for a long time; the mechanism of Yin deficiency with floating Yang is self-evident. Since entering summer, the patient contracted summer-heat-dampness pathogenic factors, which disturbed Liver Yang from the Yangming channel. During tidal fevers, ministerial fire moved recklessly, leading to nocturnal emission and seminal leakage. Symptoms include scanty dark urine, thirst, and fluid distress. Previous physicians treated this as a warm disease, even administering Zijue Dan (Purple Snow Pill) and Zhibao Dan (Treasure of Life Pill) in doses of two jiao and two fen. Consequently, body fluids suffered sudden depletion. The lips are gray, dry, and cracked; the tongue surface has white patches; diarrhea and dysentery persist uncontrollably. There is internal heat but drinking does not quench thirst. The pulse is fine as a silk thread, indicating a risk of asthma and collapse. Reluctantly prescribing the method of "strengthening the master of water to control sunlight" (nourishing Yin to suppress hyperactive Yang), though efficacy may be limited due to the severity. Attached is the prescription for review by distinguished physicians.
Prescription: Taishen Xu (Ginseng Rootlets) with Rose (three flowers stewed together and taken with the decoction), Nvzhenzi (Ligustrum Lucidum Fruit), Biejia (Turtle Shell, processed with child's urine), Chao Shumi (Stir-fried Sorghum), Cheqiancao (Plantago Herb), Maidong (Ophiopogon Tuber, stir-fried with rice), Dong Baishao (White Peony Root from East), Qinghao (Artemisia Annua, processed with child's urine), Xian Lianzi (Fresh Lotus Seed), Huo Shihu (Dendrobium), Zuomuli (Left Oyster Shell), Sheng Shu Guya (Raw and Cooked Barley Sprouts, four qian each), Banbei Wan (Banxia and Beimu Pill).
[14th Day, Second Visit] Stool has formed, internal heat has decreased, and spirit is gradually recovering. However, there is pain in the lower back and loins, epigastric obstruction, poor appetite, dizziness, and fatigue. These indicate Yin deficiency. The pulse remains soggy, small, and rapid; the Guan positions on both sides are near-wiry. The tongue edges are slightly red; the white patches on the middle and posterior parts have receded, turning slightly yellow. Treatment follows the previous method with slight modifications. Attached is the prescription for correction.
Prescription: Taishen Xu (Ginseng Rootlets), Zuomuli (Left Oyster Shell), Digupi (Cortex Lycii), Sheng Guya (Barley Sprout), Cheqiancao (Plantago Herb), Jinjiong Hu (Dendrobium), Dan Biejia (Light Turtle Shell), Zhufushen (Poria with Cinnabar), Sheng Yiren (Coix Seed), Dong Baishao (White Peony Root), Chen Qinghao (Old Artemisia Annua), Zhen Chuanbei (True Fritillaria Bulb), Xian Lianzi (Fresh Lotus Seed).