奉天郑××，年五十二岁，于季春得温病，兼冲气自下上冲。
病因 其人素有痰饮，偶有拂意之事，肝火内动，其冲气即挟痰饮上涌，连连呕吐痰水。季春之
时，因受感冒成温病。温热内传，触动冲气又复上冲。
证候 表里俱壮热，嗜饮凉水，痰涎上泛，屡屡咳吐，呃逆哕气，连连不除，两胁作胀。舌
苔白浓，而中心微黄。大便三日未行。其脉左部弦硬而长，右部洪滑而长，皆重按有力。
此温病之热，已入阳明之府，又兼肝火挟冲气上冲也。是以其左脉弦硬为肝火炽盛，其弦硬而
长即为冲脉上冲之现象也；其右脉洪滑，为温热已入阳明胃腑，其洪滑而长，亦冲
气上冲之现象也。因冲脉虽居于上，而与阳明厥阴皆有连带之关系也。欲治此证，当重用白虎汤以
清阳明之热，而以泻肝降冲理痰之品辅之。
处方 生石膏（三两捣细） 生赭石（一两轧细） 生龙骨（八钱捣碎） 生牡蛎（八钱捣碎）
白知母（八钱） 生杭芍（六钱） 清半夏（三钱） 浓朴（钱半）
甘草（二钱） 粳米（四钱）
共煎汤三盅，分三次温饮下。
效果 将药分三次服完，热退气平，痰涎亦减十之七八，脉象亦
近平和。其大便犹未通下，遂即原方将石膏、龙骨、牡蛎各减半，再煎服一剂，大便通下，病全愈。
帮助 方书用石膏未有与赭石并用者，即愚生平用石膏亦未尝与赭石并用，恐其寒凉之性与赭石
之重坠者并用，而直趋下焦也。然遇有当用之病则病当之，非人当之。有如此证，不重用石膏则阳
明之大热不除，不重用赭石则上逆之冲气莫制，此所以并用之而无妨碍也。设若此证，但阳明热实而无
冲气上逆，服此药后其大盒饭即通下，或更至于滑泻。而阳明胃腑之热转难尽消，为其兼有冲气
上逆，故必俟服之第二剂大便始能通下，此正所谓病当之，非人当之之明征也。龙骨、牡蛎之性，
皆善镇肝敛冲，以之治痰原非所长，而陈修园谓龙骨、牡蛎同用，能引逆上之火泛滥之水下归其
宅，为治痰之神品。其所谓痰，皆逆上之火泛滥之水所成，即此证之冲气上冲痰饮上泛者是也。是
以方中龙骨、牡蛎各重用八钱，辅翼赭石以成降逆消痰之功，而非可泛以之治痰也。至于二药必生用
者，非但取其生则性凉能清热也，《伤寒论》太阳篇用龙骨、牡蛎者三方，皆表证未罢，后世解者
谓，龙骨、牡蛎，敛正气而不敛邪气，是以仲师于表证未罢者亦用之。然三方中之龙骨、牡蛎下
皆未注有 字，其生用可知，虽其性敛正气不敛邪气，若 之则其性过涩，亦必于
外感有碍也。且 之则其气轻浮不能沉重下达以镇肝敛冲，更可知矣。
奉天郑××，五十二岁，在晚春时节患上温病，同时伴有冲气从下向上冲逆的症状。
病因：此人平素体内就有痰饮，偶尔遇到不顺心的事，导致肝火在内躁动，冲气便挟带痰饮向上涌出，连续呕吐痰水。晚春时节，因感受外邪而发展为温病。温热之邪向内传变，触动冲气再次上冲。
证候：表里都呈现高热，喜欢喝凉水，痰涎向上泛溢，频繁咳嗽并吐出痰液，呃逆和嗳气连连不断，两胁感到胀满。舌苔白厚，但中心部位微微发黄。大便三天未排。脉象左侧弦硬且长，右侧洪大滑利且长，重按时都有力。
这是温病的热邪已经传入阳明腑，同时又兼有肝火挟带冲气上冲。因此，左脉弦硬代表肝火炽盛，其弦硬且长的形态就是冲脉之气上冲的表现；右脉洪滑，代表温热之邪已入阳明胃腑，其洪滑且长的形态，也是冲气上冲的表现。因为冲脉虽然位置偏上，但与阳明经和厥阴经都有连带关系。想要治疗此证，应当重用白虎汤来清泄阳明之热，并用泻肝、降冲、理痰的药物辅助治疗。
处方：生石膏（三两，捣细） 生赭石（一两，轧细） 生龙骨（八钱，捣碎） 生牡蛎（八钱，捣碎） 白知母（八钱） 生杭芍（六钱） 清半夏（三钱） 浓朴（一钱半） 甘草（二钱） 粳米（四钱）
共同煎煮成三碗药汤，分三次温服。
疗效：将药物分三次服完后，热退气平，痰涎也减少了十分之七八，脉象也接近平和。此时大便仍未通下，于是就在原方基础上将石膏、龙骨、牡蛎各减半量，再煎服一剂，大便通畅，疾病痊愈。
按语：医书中使用石膏从未见过与赭石并用的，即使我生平使用石膏，也未曾与赭石并用，担心石膏的寒凉之性与赭石的沉重坠降之性合用，会直趋下焦。然而，遇到该用的病症时，是病证承受药力，而不是人体承受药力。像这样的证候，不重用石膏则阳明的大热不能清除，不重用赭石则上逆的冲气无法遏制，这就是两者并用而没有妨碍的原因。假如这个证候，只有阳明热实而没有冲气上逆，服用此药后大便就会立即通下，甚至可能导致滑泻。而阳明胃腑的热邪反而难以完全消除。正因为兼有冲气上逆，所以必须等到服用第二剂药后大便才能通下，这正是“病当之，非人当之”的明显证据。龙骨、牡蛎的药性，都善于镇肝潜阳、收敛冲气，用来治疗痰饮原本不是它们的专长，但陈修园说龙骨、牡蛎同用，能引导逆上的火焰和泛滥的泪水回归本宅，是治疗痰饮的神妙药物。它们所说的痰，都是由逆上的火焰和泛滥的泪水形成的，就像此证中冲气上冲、痰饮上泛的情况一样。因此在方中重用龙骨、牡蛎各八钱，辅助赭石完成降逆消痰的功效，而不是泛指用它来治疗所有痰证。至于这两味药必须生用的原因，不仅是因为生用时性质凉能清热，《伤寒论》太阳篇中使用龙骨、牡蛎的三个方子，都是表证尚未解除，后世解释者认为，龙骨、牡蛎能收敛正气而不收敛邪气，所以张仲景在表证未解时也使用它们。然而这三个方子中的龙骨、牡蛎下面都没有注明“煅”字，可知是生用。虽然它们的性质是收敛正气而不收敛邪气，但如果经过煅制，其性质就会过于涩滞，也必定对外感病有害。而且煅制后，其气轻浮，不能沉重下达以镇肝敛冲，这更是显而易见的。
Fengtian patient Zheng XX, aged fifty-two, contracted Warm Disease (Wen Bing) in late spring, accompanied by Chong Qi (Rebellious Qi of the Chong Vessel) rushing upward from below.
Etiology: The patient had phlegm-fluid retention (Tan Yin) in his body normally. Occasionally, due to frustrating events, Liver Fire (Gan Huo) stirred internally, causing the Chong Qi to carry phlegm-fluids upward, resulting in continuous vomiting of phlegm and water. In late spring, he caught a cold which developed into Warm Disease. The internal transmission of warm-heat pathogens triggered the Chong Qi to rush upward again.
Symptoms: Both exterior and interior exhibited high fever; there was a craving for drinking cold water; phlegm-saliva floated upward with frequent coughing and expectoration; hiccups and belching were continuous and unrelieved; distension occurred in both hypochondriac regions. The tongue coating was thick white, slightly yellow in the center. Bowel movement had not occurred for three days. The pulse on the left side was wiry, hard, and long; the pulse on the right side was surging, slippery, and long, both forceful upon heavy pressure.
This indicates that the heat of the Warm Disease has entered the Yangming Fu organs, combined with Liver Fire carrying the Chong Qi upward. Thus, the wiry and hard left pulse signifies excessive Liver Fire; its wiry, hard, and long nature is the manifestation of the Chong Vessel's Qi rushing upward. The surging and slippery right pulse indicates that warm-heat has entered the Yangming Stomach Fu organ; its surging, slippery, and long nature is also a manifestation of the Chong Qi rushing upward. This is because although the Chong Vessel is located superiorly, it has connections with both the Yangming and Jueyin meridians. To treat this syndrome, one should heavily use Baihu Tang (White Tiger Decoction) to clear Yangming heat, assisted by herbs that purge Liver fire, descend rebellious Qi, and resolve phlegm.
Prescription: Sheng Shi Gao (Raw Gypsum Fibrosum, 3 liang, crushed fine), Sheng Zhe Shi (Raw Haematitum, 1 liang, ground fine), Sheng Long Gu (Raw Os Draconis, 8 qian, crushed), Sheng Mu Li (Raw Concha Ostreae, 8 qian, crushed), Bai Zhi Mu (Rhizoma Anemarrhenae, 8 qian), Sheng Hang Shao (Radix Paeoniae Alba, 6 qian), Qing Ban Xia (Rhizoma Pinelliae Preparatum, 3 qian), Nong Po (Cortex Magnoliae Officinalis, 1.5 qian), Gan Cao (Radix Glycyrrhizae, 2 qian), Jing Mi (Semen Oryzae Sativae, 4 qian).
Decoct together to make three bowls of decoction, taken warm in three doses.
Outcome: After completing the three doses, the fever subsided, Qi calmed, and phlegm-saliva reduced by seventy to eighty percent. The pulse became nearly harmonious. Since bowel movement still had not occurred, the original prescription was used again with Shi Gao, Long Gu, and Mu Li each halved in dosage. One additional dose was decocted and taken, resulting in bowel movement and complete recovery.
Commentary: Medical texts rarely combine Shi Gao (Gypsum Fibrosum) with Zhe Shi (Haematitum). Even in my own practice, I have never combined them, fearing that the cold-cooling property of Shi Gao combined with the heavy-descending property of Zhe Shi would drive the medicine directly to the lower Jiao. However, when a disease requires such treatment, the disease bears the effect of the medicine, not the person. In cases like this, without heavily using Shi Gao, the severe heat of Yangming cannot be eliminated; without heavily using Zhe Shi, the rebellious upward-rushing Chong Qi cannot be controlled. This is why their combination causes no harm. If this case involved only Yangming heat-excess without rebellious Chong Qi, taking this medicine would cause immediate bowel movement or even diarrhea, making it difficult to fully eliminate the heat in the Yangming Stomach. Precisely because of the accompanying rebellious Chong Qi, bowel movement only occurred after the second dose. This is clear evidence that "the disease bears the effect, not the person." The properties of Long Gu (Os Draconis) and Mu Li (Concha Ostreae) are good at calming the Liver and restraining the Chong Qi. They are not primarily suited for treating phlegm, but Chen Xiuyuan stated that using Long Gu and Mu Li together can guide rebellious fire and overflowing fluids back to their origin, making them divine herbs for treating phlegm. The phlegm they refer to is formed by rebellious fire and overflowing fluids, exactly as seen in this case of Chong Qi rushing up and phlegm-fluids floating up. Therefore, Long Gu and Mu Li are heavily used (8 qian each) in the formula to assist Zhe Shi in descending rebellion and resolving phlegm, rather than being generally used for all types of phlegm. As for why these two herbs must be used raw: not only is it because their raw state is cool and clears heat, but also because in the three formulas in the Taiyang chapter of Shanghan Lun (Treatise on Cold Damage) using Long Gu and Mu Li, the exterior syndrome was not yet resolved. Later commentators explained that Long Gu and Mu Li consolidate righteous Qi without consolidating pathogenic factors. Thus, Zhang Zhongjing used them even when the exterior syndrome was unresolved. However, in those three formulas, no character indicating calcination ("Duan") was noted under Long Gu and Mu Li, implying they were used raw. Although their nature consolidates righteous Qi without trapping pathogens, if calcined, their nature becomes overly astringent, which would certainly hinder the treatment of external contractions. Moreover, calcination makes their qi light and floating, preventing them from sinking heavily to calm the Liver and restrain the Chong Qi, which is self-evident.