天津张姓媪，年过五旬，先得温病，腹疼即又下痢。
病因 因其夫与子相继病，故屡次伤心，蕴有内热，又当端阳节后，天气干热非常，遂得斯证。
证候 腹中搅疼，号呼辗转不能安卧，周身温热，心中亦甚觉热，为其卧不安枕，手足扰动，
脉难细诊，其大致总近热象，其舌色紫而干，舌根微有黄苔，大便两日未行。
诊断 此乃因日日伤心，身体虚损，始则因痛悼而脏腑生热，继则因热久耗阴而更生虚热，继
又因时令之燥热内侵与内蕴之热相并，激动肝火下迫腹中，是以作疼，火热炽盛，是以表
里俱觉发热。此宜清其温热，平其肝火，理其腹疼，更宜防其腹疼成痢也。
处方 先用生杭芍一两、甘草三钱，煎汤一大盅，分两次温服。每次送服卫生防疫宝丹四十粒，约
点半钟服完两次，腹已不疼。又俾用连翘一两、甘草三钱，煎汤一大盅，分作三次温
服。每次送服拙拟离中丹三钱，嘱约两点钟温服一次。
复诊 翌日晚三点钟，复为诊视，闭目昏昏，呼之不应。其家人言，前日将药服完里外之热皆
觉轻减，午前精神颇清爽，午后又渐发潮热，病势一时重于一时。前半点钟呼之犹知答应，
兹则大声呼之亦不应矣。又自黎明时下脓血，至午后已十余次，今则将近两点钟未见下矣。诊
其脉左右皆似大而有力，重按不实，数近六至，知其身体本虚，又因屡次下痢，更兼
外感实热之灼耗，是以精神昏愦，分毫不能支持也。拟放胆投以大剂白虎加人参汤，复即
原方略为加减，俾与病机适宜。
处方 生石膏（三两捣细） 野台参（五钱） 生杭芍（一两） 生怀地黄（一两）
甘草（三钱） 生怀山药（八钱）
共煎汤三盅，分三次徐徐温服下。
此方系以生地黄代原方中知母，生山药代原方中粳米，而又加芍药。以芍药与方中甘
草并用，即《伤寒论》中甘草芍药汤，为仲圣复真阴之妙方。而用于此方之中，又善治后重
腹疼，为治下痢之要药也。
复诊 将药三次服完后，时过夜半，其人豁然省悟，其家人言自诊脉疏方后，又下脓血数次，至
将药服完，即不复下脓血矣。再诊其脉，大见和平，问其心中，仍微觉热，且觉心中
怔忡不安。拟再治以凉润育阴之剂，以清余热，而更加保合气化之品，以治其心中怔忡。
处方 玄参（一两） 生杭芍（六钱） 净萸肉（六钱） 生龙骨（六钱捣碎）
生牡蛎（六钱捣碎） 沙参（四钱） 酸枣仁（四钱炒捣） 甘草（二钱）
共煎汤两盅，分两次温服。每服一次，调入生鸡子黄一枚。
效果 将药连服三剂，余热全消，心中亦不复怔忡矣。遂停服汤药，俾用生怀山药细末一两弱，煮
作茶汤少兑以鲜梨自然汁，当点心服之以善其后。
帮助 温而兼痢之证，愚治之多矣，未有若此证之剧者。盖此证腹疼至辗转号呼不能诊脉，不
但因肝火下迫欲作痢也，实兼有外感毒疠之气以相助为虐。故用芍药以泻肝之热，甘草之
缓肝之急，更用卫生防疫宝丹以驱逐外侵之邪气。迨腹疼已愈，又恐其温热增剧，故又俾用连翘、
甘草煎汤，送服离中丹以清其温热，是以其证翌日头午颇见轻。若即其见轻时而早为之诊脉服药，原
可免后此之昏沉，乃因翌日相延稍晚，竟使病势危至极点，后幸用药得宜，犹能挽回，然亦险矣。谚
有“走马看伤寒”，言其病势更改之速也。至治温病亦何独不然哉。又此证过午所以如此加剧者，亦
以其素本阴虚，又自黎明下痢脓血多次，则虚而益虚，再加以阴亏之虚热，与外感之实热相并，
是以其精神即不能支持。所赖方中药味无多，而举凡虚热实热及下痢所生之热，兼顾无遗，且又煎一
大剂分三次温饮下，使药力前后相继，此古人一煎三服之法。愚遵此法以挽回险证救人多矣。
非然者则剂轻原不能挽回重病，若剂重作一次服病患又将不堪。惟将药多煎少服，
病愈不必尽剂，此以小心行其放胆，洵为挽回险病之要着也。
天津有一位张姓老妇人，年龄超过五十岁，起初患上温病，随后出现腹痛并伴有痢疾。
病因 因为她的丈夫和儿子相继患病去世，所以她多次伤心悲痛，体内蕴积了内热；加之正值端午节后，天气异常干燥炎热，因此得了这个病症。
证候 腹中绞痛，大声呼号，翻来覆去无法安卧，全身发热，心中也觉得很热。由于她躺不安稳，手足躁动，脉象难以仔细诊察，但大致总呈现出热象的特征。她的舌色紫暗且干燥，舌根微微有黄苔，大便两天没有排出。
诊断 这是因为日日伤心导致身体虚损，开始是因为痛悼而导致脏腑生热，接着因为热邪久留耗伤阴液而产生虚热，后来又因为时令的燥热内侵与体内蕴积的热邪相结合，激动肝火向下压迫腹部，所以产生疼痛；火热炽盛，所以感觉表里都发热。这种情况应当清除温热，平抑肝火，调理腹痛，更应当预防腹痛发展成痢疾。
处方 先用生杭芍一两、甘草三钱，煎煮成一大盅汤药，分两次温服。每次送服卫生防疫宝丹四十粒，大约半小时服完两次，腹痛已经停止。又让她用连翘一两、甘草三钱，煎煮成一大盅汤药，分作三次温服。每次送服我拟定的离中丹三钱，嘱咐大约每两小时温服一次。
复诊 第二天晚上三点钟，再次为她诊视，她闭目昏沉，呼唤不回应。她的家人说，前一天将药服完后，内外的热感都觉得减轻，午前精神颇为清爽，午后又逐渐发起潮热，病情一时比一时严重。前半个小时呼唤时还能答应，现在即使大声呼唤也不应声了。又说从黎明时分开始下脓血便，到午后已有十几次，现在将近两点钟还没有再下了。诊察她的脉象左右手都似乎大而有力，重按却感觉不实，脉搏频率接近六至（每分钟约90-100次），知道她身体本来虚弱，又因为屡次下痢，再加上外感实热的灼烧耗损，所以精神昏愦，完全不能支撑。打算大胆投以大剂量的白虎加人参汤，并根据原方稍作加减，使药物与病机相适应。
处方 生石膏（三两捣细） 野台参（五钱） 生杭芍（一两） 生怀地黄（一两）
甘草（三钱） 生怀山药（八钱）
共煎煮成三盅汤药，分三次徐徐温服。
此方是以生地黄代替原方中的知母，生山药代替原方中的粳米，并且加入了芍药。芍药与方中的甘草并用，就是《伤寒论》中的甘草芍药汤，这是张仲圣恢复真阴的妙方。而用在此方之中，又善于治疗里急后重和腹痛，是治疗痢疾的要药。
复诊 将药分三次服完后，时间已过半夜，病人豁然清醒。她的家人说自从诊脉开方后，又下了几次脓血便，等到药服完，就不再下脓血了。再诊其脉象，变得非常平和。询问她心中，仍然微微觉得热，并且感到心中心悸不安。打算再用凉润育阴的药物，以清除余热，并且更加入保全和气化的药物，以治疗她心中的心悸不安。
处方 玄参（一两） 生杭芍（六钱） 净萸肉（六钱） 生龙骨（六钱捣碎）
生牡蛎（六钱捣碎） 沙参（四钱） 酸枣仁（四钱炒捣） 甘草（二钱）
共煎煮成两盅汤药，分两次温服。每次服药时，调入一枚生鸡蛋黄。
效果 将药连续服用三剂，余热全部消除，心中也不再心悸不安了。于是停服汤药，让她用生怀山药细末一两多一点，煮成茶汤，稍微兑入鲜梨的自然汁，作为点心服用，以善后调理。
帮助 对于温热兼有痢疾的病症，我治疗过很多，没有像这个病例这么严重的。因为这个病例腹痛剧烈到翻来覆去大声呼号以至于无法诊脉，这不仅是因为肝火下迫想要形成痢疾，实在还兼有外感毒疠之气在助长为虐。所以用芍药来泻肝热，用甘草来缓肝之急，更用卫生防疫宝丹来驱逐外侵的邪气。等到腹痛痊愈后，又担心温热加剧，所以又让她用连翘、甘草煎汤，送服离中丹以清除温热，因此第二天上午病情颇见减轻。如果就在病情减轻的时候及早诊脉服药，原本可以避免后来的昏沉，但因为第二天拖延得稍晚，竟然使病情危重到极点，后来幸好用药得当，还能够挽回，但也算是危险了。谚语说“走马看伤寒”，说的是病情变化迅速。至于治疗温病又何尝不是如此呢？另外，这个病例之所以午后加剧，也是因为她素来阴虚，又从黎明时分多次下痢脓血，则虚上加虚，再加上阴亏产生的虚热，与外感的实热相结合，所以精神就不能支持。所赖方中药味不多，而且凡是虚热、实热以及下痢所产生的热，都兼顾到了，没有遗漏，并且又煎一大剂药分三次温饮下去，使药力前后相继，这是古人一煎三服的方法。我遵循这种方法挽回险证救人多矣。如果不是这样，那么药量轻原本不能挽回重病，如果药量大一次服下患者又将不堪忍受。只有将药多煎少服，病愈不必喝完所有药剂，这是以小心谨慎的态度实施大胆的治疗，确实是挽回险病的要害之处。
Tianjin had an elderly surnamed Zhang, over fifty years old, who first contracted a warm disease (Wenbing), followed by abdominal pain and dysentery.
Etiology: Because her husband and son had successively fallen ill and died, she was repeatedly distressed, leading to internal heat accumulation. Additionally, it was after the Dragon Boat Festival, with exceptionally dry and hot weather, thus resulting in this condition.
Symptoms: The abdomen experienced twisting pain, with loud crying and tossing about, unable to lie still. The whole body felt warm, and the heart region also felt very hot. Due to her restlessness, her hands and feet were restless, making fine pulse diagnosis difficult; however, generally, the presentation leaned towards heat signs. Her tongue color was purplish and dry, with a slight yellow coating at the root. Bowel movement had not occurred for two days.
Diagnosis: This is due to daily emotional distress causing physical depletion. Initially, grief caused heat in the zang-fu organs; subsequently, prolonged heat consumed yin, generating deficiency heat. Later, seasonal dry-heat invaded internally and combined with the accumulated internal heat, stirring up Liver fire that pressed downward into the abdomen, causing pain. With intense fire-heat, both exterior and interior felt feverish. Treatment should clear the warm-heat, calm the Liver fire, regulate abdominal pain, and prevent the pain from progressing into dysentery.
Prescription: First, use Sheng Hang Shao (Raw Paeoniae Radix Alba) 30g and Gan Cao (Licorice Root) 9g, decocted in one large bowl of water, taken in two doses warm. Each dose is accompanied by forty pills of Weisheng Fangyi Baodan (Health Protection Epidemic Prevention Treasure Pill). After approximately half an hour, completing the two doses, the abdominal pain ceased. Then, have her decoct Lian Qiao (Forsythia Fruit) 30g and Gan Cao (Licorice Root) 9g in one large bowl of water, divided into three warm doses. Each dose is accompanied by 9g of Li Zhong Dan (My Proposed Middle-Fire Clearing Pill), instructed to be taken warm every two hours.
Second Visit: At 3:00 PM the next day, examined again. She kept her eyes closed, drowsy, and unresponsive to calls. Her family stated that after finishing the medicine the previous day, the internal and external heat sensations had lessened, and her spirit was quite clear in the forenoon. However, tidal fever gradually returned in the afternoon, and the condition worsened progressively. Half an hour prior, she could respond to calls, but now even loud calls elicited no response. They also reported that pus and blood discharge began at dawn, occurring more than ten times by afternoon, and had stopped near 2:00 PM. Palpation revealed pulses on both sides appearing large and forceful, but empty upon heavy pressure, with a rate nearing six strokes per breath (approx. 90-100 bpm). Knowing her constitution was originally deficient, further depleted by frequent dysentery, and scorched by exogenous excess heat, her spirit was confused and unable to sustain itself. I decided to boldly administer a large dose of Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng), slightly modifying the original formula to suit the pathogenesis.
Prescription: Sheng Shi Gao (Raw Gypsum Fibrosum) 90g (crushed), Ye Tai Shen (Wild Taishan Ginseng) 15g, Sheng Hang Shao (Raw Paeoniae Radix Alba) 30g, Sheng Huai Di Huang (Raw Rehmanniae Radix) 30g, Gan Cao (Licorice Root) 9g, Sheng Huai Shan Yao (Raw Dioscoreae Rhizoma) 24g.
Decoct together to yield three bowls of liquid, take warm slowly in three doses.
This formula replaces Zhi Mu (Anemarrhenae Rhizoma) in the original formula with Sheng Di Huang (Rehmanniae Radix Praeparata), and replaces Jing Mi (Oryza Sativa) with Shan Yao (Dioscoreae Rhizoma), while adding Shao Yao (Paeoniae Radix). The combination of Shao Yao and Gan Cao constitutes Gancao Shaoyao Tang (Licorice and Peony Decoction) from Shanghan Lun, a miraculous formula by Zhang Zhongjing to restore true yin. Used within this formula, it effectively treats tenesmus and abdominal pain, serving as a key herb for treating dysentery.
Second Visit (Follow-up): After taking the medicine in three doses, past midnight, the patient suddenly regained consciousness. Her family said that after the pulse diagnosis and prescription, she passed pus and blood several more times, but once the medicine was finished, the discharge ceased. Re-palpation showed the pulse becoming very harmonious. Upon inquiry, she still felt slight heat in the heart region and palpitations/unease. I planned to treat with cooling, moistening, and yin-nourishing agents to clear residual heat, and add herbs to preserve qi transformation to treat the palpitations.
Prescription: Xuan Shen (Scrophulariae Radix) 30g, Sheng Hang Shao (Raw Paeoniae Radix Alba) 18g, Jing Yu Rou (Cleaned Corni Fructus) 18g, Sheng Long Gu (Raw Fossilia Ossis Mastodi) 18g (crushed), Sheng Mu Li (Raw Ostreae Concha) 18g (crushed), Sha Shen (Glehniae Radix) 12g, Suan Zao Ren (Ziziphi Spinosae Semen) 12g (stir-fried and crushed), Gan Cao (Licorice Root) 6g.
Decoct together to yield two bowls of liquid, take warm in two doses. Mix in one raw chicken egg yolk with each dose.
Outcome: After taking the medicine continuously for three doses, all residual heat disappeared, and the palpitations ceased. The decoction was then stopped. Instead, she was advised to consume nearly 30g of finely powdered Sheng Huai Shan Yao (Raw Dioscoreae Rhizoma) boiled as tea, mixed with fresh pear juice, taken as a snack for convalescence.
Commentary: I have treated many cases of warm diseases complicated by dysentery, none as severe as this one. The abdominal pain here was so severe that she tossed and cried, preventing pulse diagnosis. This was not only due to Liver fire pressing downward threatening dysentery, but also because exogenous toxic pestilential qi was assisting in exacerbating the condition. Therefore, Shao Yao was used to drain Liver heat, Gan Cao to relieve Liver urgency, and Weisheng Fangyi Baodan to expel the invading pathogen. Once the abdominal pain resolved, fearing the worsening of warm-heat, Lian Qiao and Gan Cao decoction was given with Li Zhong Dan to clear warm-heat, which led to significant improvement by the next morning. If pulse diagnosis and medication had been administered promptly during this period of improvement, subsequent lethargy could have been avoided. However, due to delay, the condition became critically dangerous. Fortunately, appropriate medication managed to reverse it, though it was perilous. The proverb "watch Shanghan like a galloping horse" refers to the rapid changes in disease progression. Does this not apply equally to treating warm diseases? Furthermore, the aggravation in the afternoon was due to her inherent yin deficiency, compounded by multiple episodes of pus and blood dysentery since dawn, increasing deficiency. Combined with deficiency heat from yin loss and excess heat from exogenous factors, her spirit could not sustain itself. Fortunately, the formula contained few ingredients, comprehensively addressing deficiency heat, excess heat, and heat generated by dysentery without omission. By decocting a large batch and dividing it into three warm doses, the medicinal power remained continuous, following the ancient method of one decoction taken in three doses. I have saved many critical cases using this method. Otherwise, a light dose would fail to save a serious illness, while a heavy dose taken at once would overwhelm the patient. Only by decocting a large amount and taking small doses frequently—without needing to finish the entire course if cured—can one balance caution with boldness, which is indeed crucial for reversing critical conditions.