天津胡××，年五十四岁，于仲秋感受温病兼喉疼证。
病因 劳心过度，暗生内热。且日饮牛乳两次作点心，亦能助热，
内热上潮，遂觉咽喉不利，至仲秋感受风温，陡觉咽喉作疼。
证候 表里俱觉发热，咽喉疼痛，妨碍饮食。心中之热时觉上冲，则咽喉之疼即因之益甚。
周身酸懒无力，大便干燥，脉象浮滑而长，右关尤重按有力，舌上白苔满布。
诊断 此证脉象犹浮，舌苔犹白，盖得病甫二日，表证犹未罢也。而右关重按有力，且
时觉有热上冲咽喉者，是内伤外感相并而为病也。宜用重剂清其胃腑之热，而少佐以解表之
品，表解里清，喉之疼痛当自愈矣。
处方 生石膏（四两捣细） 西药阿斯匹林（一瓦）
单将生石膏煎汤一大盅，乘热将阿斯匹林融化其中服之。因阿斯匹林实为酸凉解肌之妙药，与大
量之石膏并用，服后须臾其内伤外感相并之热，自能化汗而解也。
效果 服后约半点钟，其上半身微似有汗，而未能遍身透出，迟一点钟，觉心中之热不复上冲，
咽喉疼痛轻减。时在下午一点钟，至晚间临睡时，仍照原方再服一剂，周身皆得透汗，安睡一夜，
翌晨，诸病若失矣。
邻村高××，年二十五岁，于仲夏得温病。
病因 仲夏上旬，麦秋将至，远出办事，又欲急回收麦，长途趋行于烈日之中。辛苦殊甚，因
得温病。其叔父××与其表叔毛××皆邑中名医，又皆善治温病。二人共治旬日无效，盖
因其劳力过甚，体虚不能托病外出也。
证候 愚诊视时，其两目清白，竟无所见，两手循衣摸床，乱动不休，谵语无伦，分毫不省人事。
其大便从前滑泻，此时虽不滑泻，每月仍溏便一两次，脉象浮而无力，右寸之浮尤甚，两尺按
之即无，一分钟数至一百二十至。舌苔薄黄，中心干而微黑。
诊断 此证两目清白无火，而竟无所见者，肾阴将竭也。其两手乱动不休者，肝风已动也。病
势至此，危险已至极点。幸喜脉浮为病还在太阳，右寸浮尤甚，又为将汗之兆。其所以将
汗而不汗者，人身之有汗，如天地之有雨，天地阴阳和而后雨，人身亦阴阳和而后汗。此证两
尺脉甚弱，阳升而阴不应，是以不能作汗。当用大滋真阴之品，济阴以应其阳必能
自汗，汗出则病愈矣。然非强发其汗也，强发其汗则汗出必脱。调剂阴阳以听其自汗，是以汗出必愈也。
处方 熟怀地黄（二两） 生怀山药（一两） 玄参（一两） 大甘枸杞（一两）
甘草（三钱） 真阿胶（四钱）
药共六味，将前五味煎汤一大碗去渣，入阿胶融化，徐徐分数次温饮下。
效果 时当上午十点钟，将药煎服至下午两点钟将药服完。形状较前安静，再诊其脉颇有起色。俾
再用原方煎汤一大碗，陆续服之，至秉烛时遍身得透汗，其病霍然愈矣。此案曾载于《全国名
医验案类编》，何廉臣对于此案似有疑意，以为诚如案中所述病况，实为不可挽救之证也。故今将
此案又登斯编，以征此案之事实。
帮助 尝实验天地之气化，恒数十年而一变，医者临证用药，即宜随气化而转移，因病者所得之
病已先随气转移也。愚未习医时，见医者治伤寒温病，皆喜用下药，见热已传里其大便稍实者，用
承气汤下之则愈，如此者约二十年。及愚习医学时，其如此治法者则恒多偾事，而愚所阅之医书，又皆系
赵氏《医贯》、《景岳全书》、《冯氏锦囊》诸喜用熟地之书，即外感证亦多喜用之。愚之治
愈此证，实得力于诸书之讲究。而此证之外，又有重用熟地治愈寒温之坏证，诸多验
案（地黄解后载有数案可参观）。此乃用药适与时会，故用之有效也。且自治愈此证之后，毛××、
高××深与愚相契，亦仿用愚方而治愈若干外感之虚证，而一变其从前之用药矣。后至愚年过
四旬，觉天地之气化又变，病者多系气分不足，或气分下陷，外感中亦多兼见此证，即用白虎
汤时多宜加人参方效。其初得外感应发表时，亦恒为加黄 方效。如是者又有年。
乃自一九二一年以来，病多亢阳，宜用大剂凉润之药济阴以
配其阳，其外感实热之证，多宜用大剂白虎汤，更佐以凉润之品。且人脏腑之气化多有升无降，或
脑部充血，或夜眠不寐，此皆气化过升之故，亦即阳亢无制之故。治之者宜镇安其气化，潜藏其
阳分，再重用凉润之药辅之，而病始可治。此诚以天地之气化又有转移，人所生之病即随之转移，而医
者之用药自不得不随之转移也。由此悟自古名医所着之书，多有所偏者非偏也，其所逢之时气化不同
也。愚为滥竽医界者已五十年，故能举生平之所经历而细细陈之也。
天津的胡某某，五十四岁，在仲秋时节感染了温病并伴有咽喉疼痛的症状。
病因：因过度劳心，暗中产生内热。并且每天两次饮用牛奶作为点心，这也会助长热邪。内热上涌，于是感觉咽喉不适，到了仲秋时节感受风温之邪，突然感到咽喉剧烈疼痛。
证候：表里都觉得发热，咽喉疼痛，影响进食。心中热感时常向上冲逆，则咽喉疼痛随之加剧。周身酸软乏力，大便干燥，脉象浮滑而长，右关脉重按有力，舌面上布满白苔。
诊断：此证脉象仍浮，舌苔仍白，大概因为患病仅两天，表证尚未解除。而右关脉重按有力，且时常感觉有热邪上冲咽喉，这是内伤与外感相兼致病。应当使用重剂清泻胃腑之热，并少量佐以解表的药物，待表解里清，咽喉疼痛自然痊愈。
处方：生石膏（四两，捣碎） 西药阿斯匹林（一瓦）
单独将生石膏煎煮成一大盅汤剂，趁热将阿斯匹林融化在其中服用。因为阿斯匹林实为酸凉解肌的妙药，与大量石膏并用，服用后不久，内伤外感相兼的热邪，自能化为汗液而解散。
效果：服药后约半小时，上半身微微似有汗出，但未能遍身透出；过了一小时，感觉心中的热邪不再上冲，咽喉疼痛减轻。当时是下午一点钟，到晚上临睡时，仍照原方再服一剂，周身皆得透汗，安稳睡了一夜，第二天早晨，各种病症消失殆尽。
邻村的高某某，二十五岁，在仲夏时节得了温病。
病因：仲夏月上旬，麦收将至，远出办事，又急于回家收割麦子，在烈日下长途奔波。辛苦程度极大，因此得了温病。他的叔父某某与其表叔毛某某都是县中的名医，也都擅长治疗温病。两人共同治疗十天无效，大概是因为他劳力过甚，体质虚弱，无法托举病邪外出所致。
证候：我诊视时，见他两眼清白，竟然看不见东西，两手循着衣物摸索床铺，乱动不休，胡言乱语，完全不省人事。他以前大便滑泻，此时虽然不滑泻了，但每月仍有稀便一两次，脉象浮而无力，右寸脉浮尤为明显，两尺脉重按即无，一分钟跳动一百二十次。舌苔薄黄，中心干燥且微黑。
诊断：此证两眼清白无火气，却看不见东西，这是肾阴即将枯竭的表现。两手乱动不休，这是肝风已动的表现。病势发展到这种地步，危险已达到极点。幸好脉浮说明病邪仍在太阳经，右寸脉浮尤为明显，又是将要出汗的征兆。之所以将要出汗却不出汗，是因为人身之汗，如同天地之雨，天地阴阳调和而后下雨，人身也是阴阳调和而后出汗。此证两尺脉很弱，阳气上升而阴气不能应和，所以不能作汗。应当使用大滋真阴的药物，济助阴气以应和阳气，必然能自汗，汗出则病愈了。但这并非强行发汗，强行发汗则汗出必致虚脱。调剂阴阳以听任其自汗，所以汗出必然痊愈。
处方：熟怀地黄（二两） 生怀山药（一两） 玄参（一两） 大甘枸杞（一两） 甘草（三钱） 真阿胶（四钱）
药共六味，将前五味煎煮成一大碗汤剂，去渣，加入阿胶使其融化，慢慢分几次温服。
效果：时间是上午十点钟，煎药服药直到下午两点钟将药服完。病情较之前安静，再诊脉象颇有起色。让继续用原方煎汤一大碗，陆续服用，等到点蜡烛时（傍晚），遍身得到透汗，病霍然痊愈。此案曾记载于《全国名医验案类编》，何廉臣对此案似乎有疑意，认为诚如案中所述病况，实在是不可挽救的证候。所以现在将此案又刊登在这本编书中，以验证此案的真实性。
帮助（按语）：我曾实验天地的气化规律，往往几十年发生一次变化，医生临证用药，就应当随着气化而变化，因为患者所患的疾病已经先随着气化转移了。我未学医时，见医生治疗伤寒温病，都喜欢用下药，见到热邪已传入里，大便稍结实者，用承气汤攻下则痊愈，这样的做法大约持续了二十年。等我学习医学时，像这样治法的人往往多把事情办坏，而我阅读的医书，又都是赵氏《医贯》、《景岳全书》、《冯氏锦囊》等喜欢用熟地黄的书籍，即使是外感证也多喜欢用这些药。我治愈此证，实在得力于对这些书籍的研究。除了此证之外，又有重用熟地黄治愈寒温坏证的许多验案（地黄解后载有数案可供参考）。这是因为用药恰好顺应了当时的气候特点，所以使用有效。而且自从我治愈此证之后，毛某某、高某某与我深相契合，也仿照我的方子治愈了若干外感虚证，从而改变了他们从前用药的习惯。后来到我年过四十，觉得天地的气化又发生了变化，患者多属于气分不足，或气分下陷，外感中也多兼见此证，即用白虎汤时多宜加人参才有效。初得外感应发表时，也恒常加黄芪才有效。像这样的情况又持续了几年。
然而自一九二一年以来，病多表现为亢阳，宜用大剂量的凉润药物济助阴气以配合同阳气，其外感实热之证，多宜用大剂量白虎汤，更佐以凉润之品。而且人脏腑的气化多有升无降，或脑部充血，或夜间失眠，这都是气化过升的缘故，也就是阳亢无法制约的缘故。治疗者应当镇安其气化，潜藏其阳分，再重用凉润之药辅助，病才可治。这确实是天地的气化又有转移，人所生的疾病也随之转移，而医生的用药自然不得不随之转移。由此领悟到自古名医所著的书籍，多有偏颇之处，并非真的偏颇，而是他们所遇到的时代气化不同罢了。我滥竽于医界已有五十年，所以能列举生平所经历的事情细细陈述出来。
Hu XX from Tianjin, aged fifty-four, contracted a warm disease (Wen Bing) accompanied by sore throat in the middle of autumn.
Etiology: Excessive mental labor secretly generated internal heat. Additionally, drinking cow's milk twice daily as a snack also aids heat generation. Internal heat surged upward, causing a sensation of discomfort in the throat. Upon contracting wind-warmth (Feng Wen) in mid-autumn, severe throat pain suddenly occurred.
Symptoms: Both exterior and interior felt feverish; throat pain hindered eating. Heat in the heart region frequently surged upward, exacerbating the throat pain. The body felt sore, lazy, and weak; stool was dry. The pulse was floating, slippery, and long, with the right Guan position particularly forceful upon heavy pressure. The tongue was covered with a white coating.
Diagnosis: The pulse remains floating, and the tongue coating remains white, indicating that since the illness began only two days ago, the exterior syndrome has not yet resolved. However, the right Guan pulse is forceful upon heavy pressure, and there is a frequent sensation of heat surging to the throat, indicating a combination of internal injury and external contraction. It is appropriate to use a heavy dose to clear heat from the stomach fu organ, supplemented slightly with exterior-resolving agents. Once the exterior is resolved and the interior cleared, the throat pain should heal spontaneously.
Prescription: Sheng Shi Gao (Raw Gypsum Fibrosum, four liang, crushed); Aspirin (one grain).
Decoct the Raw Gypsum alone in a large bowl of water. While hot, dissolve the Aspirin into the decoction and administer. Since Aspirin is an excellent acid-cool agent for resolving the muscle layer, when used in large quantities with Gypsum, the combined heat of internal injury and external contraction will transform into sweat and resolve shortly after ingestion.
Outcome: Approximately half an hour after ingestion, slight sweating appeared on the upper body but did not pervade the whole body. After another hour, the sensation of heat surging from the heart ceased, and throat pain diminished. At 1:00 PM, a second dose of the original prescription was taken before bed at night. The entire body sweated profusely, allowing for a peaceful night's sleep. By the next morning, all symptoms had vanished.
Gao XX from the neighboring village, aged twenty-five, contracted a warm disease in mid-summer.
Etiology: In early mid-summer, approaching wheat harvest, he traveled far for business and rushed home to harvest wheat, walking long distances under the scorching sun. The physical exertion was extreme, leading to the contraction of a warm disease. His uncle XX and cousin Mao XX were both renowned physicians in the county, skilled in treating warm diseases. They treated him jointly for ten days without effect, likely because his excessive labor caused constitutional deficiency, preventing the pathogen from being expelled outward.
Symptoms: Upon my examination, his eyes were clear but blind; his hands wandered over clothes and bedposts, moving restlessly; he spoke deliriously and was completely unconscious. Previously, he suffered from loose stools; although this had stopped, he still passed loose stools once or twice monthly. The pulse was floating and powerless, with the right Cun position particularly prominent; the two Chi positions disappeared upon pressure. The pulse rate was one hundred twenty beats per minute. The tongue coating was thin and yellow, dry in the center, and slightly black.
Diagnosis: The clarity of the eyes without fire signs, coupled with blindness, indicates that Kidney Yin is nearly exhausted. The restless hand movements indicate that Liver Wind has stirred. The condition has reached a critical point of danger. Fortunately, the floating pulse indicates the pathogen remains in the Taiyang channel; the prominence of the right Cun pulse suggests impending sweating. The reason for impending but absent sweating is that bodily sweat is like heavenly rain; just as heaven and earth produce rain only when Yin and Yang harmonize, the body produces sweat only when Yin and Yang harmonize. Here, the Chi pulses are very weak; Yang rises but Yin does not respond, hence no sweat. One should use substantial Yin-nourishing herbs to assist Yin in responding to Yang, which will naturally induce sweating, leading to recovery. This is not forced sweating; forced sweating would lead to collapse. By regulating Yin and Yang to allow spontaneous sweating, recovery is ensured.
Prescription: Shu Huai Di Huang (Prepared Rehmanniae Radix, two liang); Sheng Huai Shan Yao (Fresh Dioscoreae Rhizoma, one liang); Xuan Shen (Scrophulariae Radix, one liang); Da Gan Gou Qi Zi (Large Sweet Lycii Fructus, one liang); Gan Cao (Licorice Root, three qian); Zhen E Jiao (True Donkey-hide Gelatin, four qian).
These six herbs: Decoct the first five in a large bowl of water, strain, dissolve the E Jiao, and drink slowly in divided doses while warm.
Outcome: Medication preparation started at 10:00 AM and finished by 2:00 PM. The patient became quieter than before, and the pulse showed improvement. He continued taking the original prescription in a large bowl, administered gradually. By candlelight (evening), he sweated profusely throughout the body, and the illness was cured abruptly. This case was recorded in *Compilation of Verified Cases by Famous Doctors Nationwide*. He Lianchen expressed doubt about this case, believing that given the described condition, it was truly incurable. Therefore, this case is reprinted here to verify its factual basis.
Commentary: I have observed that the qi transformation of heaven and earth changes every few decades. Physicians should adjust their medication according to these transformations, as patients' diseases shift with the climate. Before I studied medicine, I saw physicians treating cold damage and warm diseases often using purgatives. When heat transmitted to the interior and stool became slightly firm, they used Cheng Qi Tang (Order the Qi Decoction) to purge, resulting in cure. This practice lasted about twenty years. When I began studying medicine, such methods often failed, and the medical texts I read, such as Zhao's *Yi Guan*, Zhang Jingyue's *Complete Works*, and Feng's *Jin Nang*, favored the use of Prepared Rehmannia (Shu Di Huang), even for exterior syndromes. My cure of this case benefited greatly from studying these texts. Besides this case, there are many verified cases of curing complicated cold/warm diseases with heavy doses of Shu Di Huang (see several cases following the explanation of Rehmannia). This efficacy arose because the medication coincided with the prevailing climate. After curing this case, Mao XX and Gao XX, who agreed with me, imitated my formula to cure several exterior deficiency cases, changing their previous prescribing habits. Later, when I passed forty, I felt the climate changed again; patients mostly suffered from Qi deficiency or sinking Qi, often accompanying exterior syndromes. When using Bai Hu Tang (White Tiger Decoction), adding Ren Shen (Ginseng Root) was often necessary for efficacy. For initial exterior syndromes requiring release, adding Huang Qi (Astragalus Root) was often effective. This pattern persisted for several years.
Since 1921, however, diseases have predominantly manifested as Hyperactive Yang. It is appropriate to use large doses of cooling and moistening herbs to nourish Yin and balance Yang. Exterior excess-heat syndromes often require large doses of Bai Hu Tang, supplemented with cooling and moistening agents. Furthermore, the qi transformation of viscera and bowels often ascends without descending, leading to cerebral congestion or insomnia. These result from excessive qi ascent and uncontrolled Hyperactive Yang. Treatment should stabilize qi transformation and submerge the Yang aspect, assisted by heavy doses of cooling and moistening herbs, for the disease to be treatable. This confirms that as heavenly qi transforms, human diseases follow, necessitating adjustments in medical treatment. Thus, I realize that ancient famous physicians' books appear biased not due to error, but because the climate of their times differed. Having practiced medicine for fifty years, I can detail my experiences.