刘××，二十五岁，于季春得温病。
病因 自正二月间，心中恒觉发热，懒于饮食，喜坐房阴乘凉，薄受外感，遂成温病。
证候 初得病时，延近处医者延医，阅七八日病势益剧，精神昏愦，闭目蜷卧，似睡非睡，懒
于言语，咽喉微疼，口唇干裂，舌干而缩，薄有黄苔欲黑，频频饮水不少濡润，饮食懒进，
一日之间，惟强饮米汤瓯许，自言心中热而且干，周身酸软无力，抚其肌肤不甚发热，体温37. 8℃
其脉六部皆微弱而沉，左部又兼细，至数如常，大便四日未行，小便短少赤涩。
诊断 此伏气触发于外，感而成温，因肾脏虚损而窜入少阴也。《内经》谓∶“冬伤于寒，春必病
温”，此言冬时所受之寒甚轻，不能实时成为伤寒，恒伏于三焦脂膜之中，阻塞气化之升降，暗生内热，至春
阳萌动之时，其所生之热恒激发于春阳而成温。然此等温病未必入少阴也。《内经》又谓∶“冬不藏精，
春必病温”，此言冬不藏精之人，因阴虚多生内热，至春令阳回其内热必益加增，略为外感激发，即可
成温病。而此等温病亦未必入少阴也。惟其人冬伤于寒又兼冬不藏精，其所伤之寒伏于三焦，随春阳而化热，
恒因其素不藏精乘虚而窜入少阴，此等证若未至春令即化热窜入少阴，则为少阴伤寒，即伤寒少阴证二三日
以上，宜用黄连阿胶汤者也。若已至春令始化热窜入少阴，当可名为少阴温病，即温病中内有实热，脉转微细
者也。诚以脉生于心，必肾阴上潮与心阳相济，而后其跳动始有力。盖此证因温邪窜入少阴，俾心肾
不能相济，是以内虽蕴有实热，而脉转微细，其咽喉疼者，因少阴之脉上通咽喉，其热邪循经上逆也。其唇
裂舌干而缩者，肾中真阴为邪热遏抑不能上潮，而心中之亢阳益妄动上升以铄耗其津液也。至于心中发热且发
干，以及大便燥结小便赤涩，亦无非阴亏阳亢之所致。为其肾阴心阳不能相济为功，是以精神昏愦，闭目蜷
卧，烦人言语，此乃热邪深陷气化隔阂之候，在温病中最为险证。正不可因其脉象无火，身
不甚热，而视为易治之证也。愚向拟有坎离互根汤可为治此病的方，今将其方略为加减俾与病候相宜。
处方 生石膏（三两轧细） 野台参（四钱） 生怀地黄（一两） 生怀山药（八钱）
玄参（五钱） 辽沙参（五钱） 甘草（三钱） 鲜茅根（五钱）
药共八味，先将前七味煎十余沸，再入鲜茅根煎七八沸其汤即成。取清汤三盅，分三次温服下，每
服一次调入生鸡子黄一枚。此方若无鲜茅根，可用干茅根两半，水煮数沸，取其汤代水煎药。
方解 温病之实热，非生石膏莫解，辅以人参并能解邪实正虚之热，再辅以地黄、山药诸滋阴
之品，更能解肾亏阴虚之热。且人参与滋阴之品同用，又能助肾阴上潮以解上焦之燥热。用鸡子黄者，
化学家谓鸡子黄中含有副肾髓质之分泌素，为滋补肾脏最要之品也。用茅根者，其凉而能散，用之作引，
能使深入下陷之邪热上出外散以消解无余也。
复诊 将药三次服完，周身之热度增高，脉象较前有力，似近洪滑，诸病皆见轻减，精神已振。
惟心中仍觉有余热，大便犹未通下，宜再以大剂凉润之药清之，而少佐以补气之品。
处方 生石膏（一两轧细） 大潞参（三钱） 生怀地黄（一两） 玄参（八钱）
辽沙参（八钱） 大甘枸杞（六钱） 甘草（二钱） 鲜茅根（四钱）
药共八味，先将前七味煎十余沸，再入茅根煎七八沸其汤即成。取清汤两大盅，分两次温服下，每服一
次调入生鸡子黄一枚。
效果 将药连服两剂，大便通下，病遂全愈。
帮助 此证之脉象沉细，是肾气不能上潮于心，而心肾不交也。
迨服药之后，脉近洪滑，是肾气已能上潮于心而心肾相交也。为其心肾相交，是以诸病
皆见轻减，非若寻常温病其脉洪大为增剧也。
刘××，二十五岁，在晚春时节患上温病。
病因 从正、二月间开始，心中经常感觉发热，食欲不振，喜欢坐在阴凉处乘凉，因轻微感受外邪，于是形成了温病。
证候 刚得病时，请了附近的医生诊治，过了七八天病情反而加重，精神昏沉迷糊，闭着眼睛蜷缩着躺卧，似睡非睡，懒得说话，咽喉轻微疼痛，口唇干裂，舌头干燥且萎缩，舌苔薄黄欲黑，频繁喝水却仍不能得到滋润，不想进食，一天之中只勉强喝下一小碗米汤，自述心中既热又干，全身酸痛无力，触摸皮肤并不觉得特别发热，体温37.8℃，六部脉象皆微弱而沉，左脉兼见细象，至数（脉搏频率）正常，大便四天未行，小便短少且赤涩不畅。
诊断 这是伏气被外邪触发，感而成温，因肾脏虚损而窜入少阴经。《内经》说：“冬伤于寒，春必病温”，这是说冬天所受之寒邪很轻，当时不能立即成为伤寒，常潜伏在三焦脂膜之中，阻碍气化的升降，暗中产生内热，到了春天阳气萌动之时，所生之热常激发于春阳而成为温病。然而这类温病未必会入少阴经。《内经》又说：“冬不藏精，春必病温”，这是说冬天不藏精的人，因阴虚多生内热，到了春季阳气回复，其内热必然更加增加，稍微受到外感激发，即可形成温病。而这类温病也未必会入少阴经。只有那些冬天既伤于寒又兼冬天不藏精的人，所伤之寒潜伏在三焦，随着春阳而化热，常因其平时不藏精而乘虚窜入少阴经。这类证候如果未到春季就化热窜入少阴经，则为少阴伤寒，即伤寒少阴证二三日以上，适宜用黄连阿胶汤的证候。如果已到春季才化热窜入少阴经，应当可以称为少阴温病，即温病中内有实热，脉象转为微细的证候。诚然，脉生于心，必须肾阴上潮与心阳相济，然后脉搏跳动才有力量。大概此证因温邪窜入少阴，使得心肾不能相济，因此体内虽蕴有实热，而脉象转为微细。其咽喉疼痛，是因为少阴经脉上通咽喉，热邪循经上逆所致。其嘴唇开裂、舌头干燥萎缩，是因为肾中真阴被邪热遏制不能上潮，而心中的亢阳更加妄动上升以灼耗津液所致。至于心中发热且发干，以及大便燥结、小便赤涩，也无非是阴亏阳亢所致。因为肾阴与心阳不能相济发挥作用，所以精神昏沉迷糊，闭目蜷卧，烦扰不愿言语，这是热邪深陷、气化隔阂的征候，在温病中属于最危险的证候。绝不能因为其脉象看似无火，身体不甚发热，而视为容易治疗的证候。我先前拟定了坎离互根汤作为治疗此病的方剂，现在将其方略稍作加减，以便与病候相适应。
处方 生石膏（三两，轧细） 野台参（四钱） 生怀地黄（一两） 生怀山药（八钱）
玄参（五钱） 辽沙参（五钱） 甘草（三钱） 鲜茅根（五钱）
药共八味，先将前七味煎煮十余沸，再放入鲜茅根煎七八沸，汤即成。取清汤三盅，分三次温服，每次服用时调入一枚生鸡蛋黄。此方若无鲜茅根，可用干茅根一两半，水煮数沸，取其汤代替水来煎药。
方解 温病的实热，非生石膏不能解除，辅以人参并能解除邪实正虚之热，再辅以地黄、山药等滋阴之品，更能解除肾亏阴虚之热。而且人参与滋阴之品同用，又能助肾阴上潮以解除上焦的燥热。使用鸡蛋黄，化学家认为鸡蛋黄中含有副肾髓质之分泌素，是滋补肾脏最重要的物品。使用茅根，其性凉而能散，用作引经药，能使深入下陷的邪热向上向外散发从而彻底消解。
复诊 将药分三次服完，周身热度增高，脉象较前有力，似乎接近洪滑，诸病皆见减轻，精神已振作。只是心中仍觉有余热，大便仍未通下，适宜再用大剂量的凉润药物清解，并少量佐以补气之品。
处方 生石膏（一两，轧细） 大潞参（三钱） 生怀地黄（一两） 玄参（八钱）
辽沙参（八钱） 大甘枸杞（六钱） 甘草（二钱） 鲜茅根（四钱）
药共八味，先将前七味煎煮十余沸，再放入茅根煎七八沸，汤即成。取清汤两大盅，分两次温服，每次服用时调入一枚生鸡蛋黄。
效果 将药连续服用两剂，大便通下，病遂全愈。
帮助 此证的脉象沉细，是肾气不能上潮于心，导致心肾不交。等到服药之后，脉象接近洪滑，是肾气已能上潮于心，导致心肾相交。正因为心肾相交，所以诸病皆见减轻，不像寻常温病那样脉象洪大为病情加重。
Liu XX, aged twenty-five, contracted a warm disease (Wenbing) in late spring.
Etiology From the months of Zheng and Er (lunar calendar), he constantly felt heat in the heart region, had a poor appetite, and preferred sitting in cool, shaded places. Due to slight exposure to external pathogens, a warm disease ensued.
Symptoms When the illness first began, local physicians were consulted. After seven or eight days, the condition worsened. His spirit was confused and lethargic; he lay curled up with eyes closed, appearing half-asleep, and was reluctant to speak. His throat was slightly painful, lips dry and cracked, tongue dry and atrophic, with a thin yellow coating turning black. He drank frequently but remained unmoistened. He lacked desire for food, managing only to force down about one bowl of rice soup per day. He reported that his heart region felt hot and dry, and his whole body felt sore and weak. Palpation of the skin did not reveal significant heat; body temperature was 37.8°C. The pulse in all six positions was weak, deep, and fine on the left side, with a normal rate. Bowel movements had not occurred for four days, and urination was scanty, red, and difficult.
Diagnosis This is a latent pathogen triggered by external factors, transforming into a warm disease due to kidney deficiency and invading the Shaoyin channel. The *Neijing* states: "Injury by cold in winter leads to warm diseases in spring." This refers to mild cold injury in winter that does not immediately manifest as Cold Damage (Shanghan) but lies latent within the Sanjiao (Triple Burner) membranes, obstructing the ascending and descending of Qi transformation, secretly generating internal heat. When Yang energy sprouts in spring, this generated heat is often stimulated by spring Yang to become a warm disease. However, such warm diseases do not necessarily invade the Shaoyin. The *Neijing* also states: "Failure to store essence in winter leads to warm diseases in spring." This refers to individuals who fail to store essence in winter, leading to Yin deficiency and excessive internal heat. When Yang returns in spring, their internal heat increases further; slight external stimulation can then trigger a warm disease. Such warm diseases also do not necessarily invade the Shaoyin. Only when an individual suffers from both winter cold injury and failure to store essence does the latent cold in the Sanjiao transform into heat with spring Yang, and due to inherent essence deficiency, it invades the Shaoyin vacuously. If such conditions transform into heat and invade Shaoyin before spring, they constitute Shaoyin Cold Damage, specifically the Shanghan Shaoyin syndrome after two to three days, suitable for treatment with Huanglian Ejiao Tang. If they transform into heat and invade Shaoyin only upon reaching spring, they may be named Shaoyin Warm Disease, characterized by internal excess heat and a pulse becoming faint and fine. Indeed, the pulse originates from the Heart; it requires Kidney Yin to ascend and harmonize with Heart Yang for the pulse to beat with strength. In this case, because warm pathogens invaded the Shaoyin, preventing the mutual assistance between Heart and Kidney, although there is internal excess heat, the pulse becomes faint and fine. The throat pain occurs because the Shaoyin meridian connects to the throat, and heat pathogens follow the meridian upward. The cracked lips and dry, atrophic tongue result from True Yin in the Kidneys being suppressed by heat pathogens, unable to ascend, while hyperactive Yang in the Heart rises recklessly, burning and consuming body fluids. The heat and dryness in the heart region, along with dry stool and red, difficult urination, are all caused by Yin deficiency and Yang hyperactivity. Because Kidney Yin and Heart Yang cannot function together, spirit becomes confused, eyes close, and the body curls up, with reluctance to speak. This indicates heat pathogens deeply entrenched and obstruction of Qi transformation, representing a critical condition in warm diseases. One must not consider it easily treatable merely because the pulse appears devoid of fire signs and the body is not significantly hot. I previously formulated Kanli Hugen Tang (Kanli Mutual Root Decoction) to treat this condition. Now, I have slightly modified it to suit the symptoms.
Prescription Sheng Shigao (Raw Gypsum Fibrosum, 3 liang, finely crushed) Yetaishen (Wild Taishen Root, 4 qian) Sheng Huai Dihuang (Fresh Rehmanniae Radix, 1 liang) Sheng Huai Shanyao (Fresh Dioscoreae Rhizoma, 8 qian) Xuanshen (Scrophulariae Radix, 5 qian) Liaoshashen (Glehniae Radix, 5 qian) Gancao (Licorice Root, 3 qian) Xian Maogen (Fresh Imperatae Rhizoma, 5 qian)
The eight herbs are processed as follows: Decoct the first seven herbs for more than ten boils, then add fresh Maogen and decoct for seven or eight boils. Strain to obtain three portions of clear decoction. Take orally in three divided doses, warm. For each dose, mix in one raw chicken egg yolk. If fresh Maogen is unavailable, use 1.5 liang of dried Maogen, boil in water for several times, and use the resulting water to decoct the other herbs.
Formula Analysis Excess heat in warm diseases is best resolved by Raw Gypsum Fibrosum. Assisted by Ginseng Radix et Rhizoma, it resolves heat due to both pathogenic excess and righteous deficiency. Further assisted by Rehmanniae Radix and Dioscoreae Rhizoma (Yin-nourishing herbs), it resolves heat due to Kidney deficiency and Yin deficiency. Moreover, combining Ginseng Radix et Rhizoma with Yin-nourishing herbs assists Kidney Yin in ascending to resolve upper Jiao dryness-heat. Chicken Egg Yolk is used because chemists note it contains adrenal medulla secretions, making it a crucial tonic for the Kidneys. Imperatae Rhizoma is used for its cooling and dispersing properties; acting as a guiding herb, it enables deeply sunk heat pathogens to rise and disperse externally, eliminating them completely.
Second Visit After completing three doses, body temperature increased, the pulse became stronger and approached a surging and slippery quality, all symptoms alleviated, and spirit revived. However, residual heat remained in the heart region, and bowels were still unopened. It is appropriate to use a large dose of cooling and moistening herbs to clear the heat, supplemented with a small amount of Qi-tonifying herbs.
Prescription Sheng Shigao (Raw Gypsum Fibrosum, 1 liang, finely crushed) Dalushen (Large Luduan Ginseng Radix et Rhizoma, 3 qian) Sheng Huai Dihuang (Fresh Rehmanniae Radix, 1 liang) Xuanshen (Scrophulariae Radix, 8 qian) Liaoshashen (Glehniae Radix, 8 qian) Dagouqi (Large Lycii Fructus, 6 qian) Gancao (Licorice Root, 2 qian) Xian Maogen (Fresh Imperatae Rhizoma, 4 qian)
The eight herbs are processed as follows: Decoct the first seven herbs for more than ten boils, then add Maogen and decoct for seven or eight boils. Strain to obtain two large portions of clear decoction. Take orally in two divided doses, warm. For each dose, mix in one raw chicken egg yolk.
Outcome After taking two consecutive doses, bowel movements occurred, and the patient recovered completely.
Explanation The sinking and fine pulse in this case indicates that Kidney Qi fails to ascend to the Heart, resulting in non-interaction between Heart and Kidney. After medication, the pulse approaching surging and slippery indicates that Kidney Qi has ascended to the Heart, achieving interaction between Heart and Kidney. Due to this Heart-Kidney interaction, all symptoms alleviated, unlike ordinary warm diseases where a surging and large pulse indicates worsening condition.