天津陈姓童子，年十五岁，于仲秋得温病，兼衄血便血。
病因 初因周身发热出有斑点，有似麻疹。医用凉药清之，斑点即回，连服凉药数剂，周身
热已退，而心中时觉烦躁。逾旬日因薄受外感，其热陡然反复。
证候 表里壮热，衄血两次，小便时或带血。呕吐不受饮食，服药亦多吐出。心中自觉为热
所灼，怔忡莫支。其脉摇摇而动，数逾五至，左右皆有力，而重按不实。舌苔白而欲黄，
大便三日未行。本拟投以白虎加人参汤，恐其服后作呕。
处方 生石膏（三两细末） 生怀山药（二两）
共煎汤一大碗，俾徐徐温饮下。为防其呕吐，一次只饮一大口，限定四小时将药服完。
方解 凡呕吐之证，饮汤则吐，服粥恒可不吐。生山药二两煎取浓汁与粥无异，且无药味，服
后其粘滞之力自能留恋于胃中。且其温补之性，又能固摄下焦以止便血，培养心气以治
怔忡也。而以治此温而兼虚之证，与石膏相伍为方，以石膏清其温，以山药补其虚，虽非白
虎加人参汤，而亦不啻白虎加人参汤矣。
复诊 翌日复诊，热退十之七八，心中亦不怔忡，少进饮食亦不呕吐，衄血便血皆愈。脉象力减，至数仍数。
处方 玄参（二两） 潞参（五钱） 连翘（五钱）
效果 仍煎汤一大碗，徐徐温饮下，尽剂而愈，大便亦即通下。
方解 盖其大热已退而脉仍数者，以其有阴虚之热也。玄参、潞参并用，原善退阴虚作热，而犹
恐其伏有疹毒，故又加连翘以托之外出也。
帮助 此证若能服药不吐，投以大剂白虎加人参汤，大热退后其脉即可不数。乃因其服药呕吐，
遂变通其方，重用生山药二两与生石膏同煎服。因山药能健脾滋肾，其补益之力虽不如
人参，实有近于人参处也。至大热退后，脉象犹数，遂重用玄参二两以代石膏，取其能滋真阴兼能
清外感余热，而又伍以潞参、连翘各五钱。潞参即古之人参。此由白虎加人参之
义化裁而出，故虚热易退，而连翘又能助玄参凉润之力外透肌肤，则余热亦易清也。
天津陈姓男孩，十五岁，在仲秋时节患上温病，同时伴有鼻出血和便血。
病因：起初因为全身发热并出现斑点，看起来像麻疹。医生使用凉性药物进行清热治疗，斑点随即消退。连续服用几剂凉药后，全身的热虽然退了，但心中时常感到烦躁。过了十几天，因为轻微感受外邪，体内的热势突然反复。
证候：表里壮热（体表和体内都高热），鼻出血两次，小便有时带血。呕吐严重，无法进食饮水，服药也大多吐出。自觉心中被热邪灼烧，心悸惊慌难以忍受。脉搏跳动不稳且快速，每息超过五次，左右手脉象都有力，但重按感觉不实。舌苔白而即将变黄，大便三天未行。原本打算投用白虎加人参汤（由知母、石膏、甘草、粳米、人参组成的方剂，主治气分热盛兼气阴两伤），但担心患者服药后会呕吐。
共同煎煮成一大碗汤，让患者慢慢温热饮用。为了防止呕吐，每次只喝一大口，限定四小时内将药服完。
方解：凡是呕吐的病症，喝汤药就会吐出来，喝粥通常就不会吐。生山药二两煎取浓汁，与粥没有区别，而且没有药味，服用后其粘滞的特性自然能留滞在胃中。并且它的温补性质，又能固摄下焦以停止便血，培养心气以治疗心悸。用来治疗这种温病兼有虚损的证候，与石膏配合组成方剂，用石膏清除温病之热，用山药补益虚损，虽然不是白虎加人参汤，但也等同于白虎加人参汤了。
复诊：第二天复诊，热度退了十分之七八，心中也不再心悸，稍微吃点东西也不呕吐，鼻出血和便血都好了。脉象力量减弱，但至数仍然快。
效果：还是煎煮成一大碗汤，慢慢温热饮用，全部服完后痊愈，大便也随之通畅排出。
方解：大概是因为大热已退但脉象仍然快，是因为有阴虚产生的内热。玄参和潞参并用，原本善于退除阴虚引起的发热，但仍然担心体内潜伏有疹毒，所以又加入连翘来透发外出。
帮助：这个证候如果能服药不吐，投以大剂量白虎加人参汤，在大热退去后脉象就可以不再快。但是因为患者服药呕吐，于是变通原方，重用生山药二两与生石膏同煎服用。因为山药能健脾滋肾，其补益的力量虽然不如人参，实际上也有接近人参的地方。到大热退去后，脉象仍然快，于是重用玄参二两来代替石膏，取它既能滋养真阴又能清除外感余热，并且又配合潞参、连翘各五钱。潞参就是古时候的人参。这是从白虎加人参汤的意义化裁而出，所以虚热容易退去，而连翘又能帮助玄参凉润之力向外透达肌肤，那么余热也容易清除。
A fifteen-year-old boy surnamed Chen from Tianjin contracted a warm disease (Wen Bing, febrile diseases caused by warm pathogens) in mid-autumn, accompanied by epistaxis (nosebleed) and hematochezia (blood in stool).
Etiology: Initially, he suffered from generalized fever with spots appearing on the body, resembling measles. The physician treated him with cooling herbs to clear heat, after which the spots receded. After taking several doses of cooling medicine, the systemic fever subsided, but he felt frequent irritability in the chest. Over ten days later, due to a slight external contraction, the fever suddenly relapsed.
Symptoms: Severe heat in both exterior and interior, two episodes of epistaxis, and urine occasionally containing blood. He suffered from severe vomiting, unable to retain food or drink, and most ingested medicines were vomited out. He felt as if his chest was being scorched by heat, accompanied by palpitations (Zhen Tong, anxiety and palpitation) that were unbearable. His pulse was unstable and rapid, exceeding five beats per respiration, forceful on both left and right sides when lightly pressed, but empty upon heavy pressure. The tongue coating was white turning yellow, and there had been no bowel movement for three days. It was originally intended to administer Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng), but fear of inducing vomiting prevented this.
Prescription: Sheng Shi Gao (Raw Gypsum Fibrosum, 3 liang, finely powdered); Sheng Huai Shan Yao (Fresh Dioscorea Opposita Rhizoma, 2 liang).
Decoct together in a large bowl of water. Allow the patient to drink it slowly while warm. To prevent vomiting, administer only one large mouthful at a time, ensuring the entire dose is consumed within four hours.
Formula Analysis: In cases of vomiting, decoctions often induce vomiting, whereas congee usually does not. Decocting 2 liang of fresh Shan Yao yields a thick liquid similar to congee, without any medicinal taste. Its sticky nature naturally adheres to the stomach after ingestion. Furthermore, its warming and tonifying properties can secure the lower jiao (Lower Burner) to stop hematochezia and nourish heart qi to treat palpitations. Used to treat this condition of warm disease complicated by deficiency, combined with Shi Gao, where Shi Gao clears the warm heat and Shan Yao tonifies the deficiency, this formula is functionally equivalent to Baihu Jia Renshen Tang.
Follow-up Visit: On the second day, the fever had subsided by seventy to eighty percent, palpitations ceased, slight intake of food did not cause vomiting, and both epistaxis and hematochezia had resolved. The pulse strength decreased, but the rate remained rapid.
Prescription: Xuan Shen (Scrophulariae Radix, 2 liang); Lu Shen (Codonopsis Pilosula, 5 qian); Lian Qiao (Forsythiae Fructus, 5 qian).
Outcome: Decocted in a large bowl of water, taken slowly while warm. Upon completion of the dose, the patient recovered, and bowel movements resumed normally.
Formula Analysis: The reason the fever had largely subsided but the pulse remained rapid was due to heat arising from yin deficiency. The combination of Xuan Shen and Lu Shen is effective in clearing heat from yin deficiency. However, fearing latent pathogenic factors related to the previous rash/toxins, Lian Qiao was added to vent them outward.
Commentary: If this patient could have retained medication, administering a large dose of Baihu Jia Renshen Tang would have normalized the pulse rate after the high fever subsided. Due to vomiting induced by medication, the formula was modified by heavily using 2 liang of fresh Shan Yao decocted with Raw Shi Gao. Shan Yao strengthens the spleen and nourishes the kidney; although its tonifying power is not as strong as Ren Shen (Ginseng), it shares similar properties. After the high fever subsided, the pulse remained rapid, so 2 liang of Xuan Shen was used to replace Shi Gao, leveraging its ability to nourish true yin and clear residual exogenous heat. It was combined with 5 qian each of Lu Shen and Lian Qiao. Lu Shen is the ancient form of Ren Shen. This prescription is derived from the principles of Baihu Jia Renshen Tang; thus, the deficient heat is easily cleared, and Lian Qiao assists Xuan Shen’s cooling and moistening properties to vent outward through the skin, facilitating the clearance of residual heat.