暑热必挟湿。吸气而受。先伤于上。故仲景伤寒。先分六经。河间温热须究
三焦。大凡暑热伤气。湿着阻气。肺主一身周行之气。位高为手太阴经。据述病
样。面赤足冷。上脘痞塞。其为上焦受病显著。缘平素善饮。胃中湿热久伏。辛温
燥裂。不但肺病不合。而胃中湿热。得燥热锢闭。下利稀水。即协热下利。故黄连
苦寒。每进必利甚者。苦寒以胜其辛热。药味尚留于胃底也。然与初受之肺邪
无当。此石膏辛寒。辛先入肺。知母为味清凉。为胃之母气。然不明肺邪。徒曰生
津。焉是至理。昔孙真人未诊先问。最不误事。再据主家说及病起两旬。从无汗
泄。经云。暑当汗出勿止。气分窒塞。日久热侵入血中。咯痰带血。舌红赤不甚渴
饮。上焦不解。漫延中下。此皆急清三焦。是第一章旨。故热病之瘀热留络。而为
遗毒。注腑肠而为洞利。便为束手无策。再论。湿乃重浊之邪。热为熏蒸之气。热
处湿中。蒸淫之气。上迫清窍。耳为失聪。不与少阳耳聋同例。青蒿减柴胡一等。
亦是少阳本药。且大病如大敌。选药如选将。苟非慎重。鲜克有济。议三焦厘清。治从河间法。
飞滑石 生石膏 寒水石 大杏仁 炒黄竹茹 川通草 莹白金汁 金银花露
又 诊脉后。腹胸肌腠。登现瘾疹。气分湿热。原有暗泄之机。早间所谈余邪遗
热。必兼解毒者为此。下午进药后。诊脉较大于早晨。神识亦如前。但舌赤。中心
甚干燥。身体扪之。热甚于早间。此阴分亦被热气蒸伤。瘦人虑其液涸。然痰咯
不清。养阴药无往而非腻滞。议得早进清膈一剂。而三焦热秽之蓄。当用紫雪
丹二三匙。藉其芳香。宣窍逐秽。斯涸热可解。浊痰不粘。继此调理之方。清营分。
滋胃汁。始可瞻顾。其宿垢欲去。犹在旬日之外。古人谓下不嫌迟。非臆说也。
知母 竹叶心 连翘心 炒川贝 犀角 元参 金汁 银花露 紫雪丹
又 经月时邪。脉形小数。小为病退。数为余热。故皮腠麸脱。气血有流行之义。
思食欲餐。胃中有醒豁之机。皆佳兆也。第舌赤而中心黄苔。热蒸既久。胃津与
阴液俱伤。致咽物咽中若阻。溺溲尖管犹痛。咯痰浓浓。宿垢未下。若急遽攻夺。
恐真阴再涸矣。此存阴为主。而清腑兼之。故乳进食物。便是助热。惟清淡之味。
与病不悖。自来热病。最怕食后劳复。举世共闻。非臆说也。
细生地 元参心 知母 炒川贝 麦冬 地骨皮 银花露 竹沥
暑必挟湿。二者皆伤气分。从鼻吸而受。必先犯肺。乃上焦病。治法以辛凉
微苦。气分上焦廓清则愈。惜乎专以陶书六经看病。仍是与风寒先表后里之
药。致邪之在上漫延。结锢四十余日不解。非初受六经。不须再辨其谬。经云。病
自上受者。治其上。援引经义以论治病。非邪僻也。宗河间法。
杏仁 栝蒌皮 半夏 姜汁 白蔻仁 石膏 知母 竹沥
又 脉神颇安。昨午发疹。先有寒战。盖此病起于湿热。当此无汗。肌腠气窒至
肤间。皮脱如麸。犹未能全泄其邪。风疹再发。乃湿因战栗为解。一月以来病魔。
而肌无膏泽。瘦削枯槁。古谓瘦人之病。虑涸其阴。阴液不充。补之以味。然腥膻
浊味。徒助上焦热痰。无益培阴养液。况宿滞未去。肠胃气尚窒钝。必淡薄调理。
上气清爽。痰热不至复聚。从来三时热病。怕反复于病后之覆。当此九仞。幸加
意留神为上。
元参心 细生地 银花 知母 生甘草 川贝 丹皮 橘红 竹沥
病几一月。犹然耳聋。神识不慧。嗽甚痰粘。呼吸喉间有音。此非伤寒暴感。
皆夏秋间暑湿热气内郁。新凉引动内伏之邪。当以轻剂清解三焦。奈何医者。
不晓伏气为病。但以发散消食寒凉清火为事。致胃汁消亡。真阴尽灼。舌边赤。
齿板燥裂。乃邪留营中。有内闭螈 厥逆之变。况右脉小数。左脉涩弱。热固在
里。当此阴伤日下。久之再犯亡阴之戒。从来头面。皆是清窍。既为邪蒙。精华气
血不肯流行。诸窍失司聪明矣。此轻清清解。断断然也。议清上焦气血之壅为
先。不投重剂苦寒。正仿古人肥人之病。虑虚其阳耳。
连翘心 元参 犀角 郁金 橘红 黑栀皮 川贝 鲜菖蒲根 竹沥
又 脉右缓大。左弱。面垢色已减。痰嗽不爽。良由胃中津液。为辛散温燥所伤。
心营肺卫。悉受热焰蒸迫。致神呆喘急耳聋。清阳阻痹。九窍不利。首方宣解气
血继方芳香通窍。无形令其转旋。三焦自有专司。岂与俗医但晓邪滞攻击而
已。今已获效。当与清养胃阴肺气。体素丰浓。阳弱不耐沉寒。然深秋冬交天气
降。则上焦先受。试观霜露下垂。草木皆改异色。人在气交。法乎天地。兼参体质
施治。
枇杷叶 炒黄川贝 橘红 郁金 茯苓 苡仁
三疟之邪在阴。未经向愈。春季洞利不食。想春雨外湿。水谷内聚亦湿。即
湿多成五泄之谓。痍疮仅泄经隧湿邪。而里之湿邪未驱。长夏吸受暑邪。上蒙
清空诸窍。咳嗽耳聋。的系新邪。非得与宿病同日而语。
连翘 飞滑石 嫩竹叶 荷叶边汁 桑叶 杏仁 象贝 黑山栀
奔走气乱。复饮烧酒。酒气辛热。有升无降。肺气 郁。上下不通。舌白消渴。
气结自胸及腹。 自利不爽。周身肤腠皆痛。汗大出不解。无非暑湿热气。始
由肺受。漫布三焦。群医消导苦药。但攻肠胃。在上痞结仍然。议淡渗佐以微辛。
合乎轩岐上病治上之方。
西瓜翠衣 川白通草 大豆黄卷 马兜铃 射干 苡仁
三伏中阴气不生。阳气不潜。其头胀身痛。是暑邪初受。暑湿热必先伤气
分。故舌白。口渴。身痛。早晨清爽。午后烦蒸。状如温疟。沐浴绕动血络。宿病得时
邪而来。仲景云。先治新病。后理宿病。是亦阴气先伤。阳气独发也。
鲜生地 石膏 知母 元参 连翘 竹叶心 荷叶汁
初病伏暑。伤于气分。微热渴饮。邪犯肺也。失治邪张。逆走膻中。遂舌绛缩。
小便忽闭。鼻煤裂血。口疮耳聋。神呆。由气分之邪热。漫延于血分矣。夫肺主卫。
心主营。营卫二气。昼夜行于经络之间。与邪相遇。或凉或热。今则入于络。津液
被劫。必渐昏寐。所谓内闭外脱。
鲜生地 连翘 元参 犀角 石菖薄 金银花
右脉空大。左脉小芤。寒热麻痹。腰痛冷汗。平素积劳内虚。秋暑客邪遂干
脏阴。致神迷心热。烦躁。刮痧似乎略爽。病不肯解。此非经络间病。颇虑热深劫
阴。而为痉厥。张司农集诸贤论暑病。谓入肝则麻痹。入肾为消渴。此其明征。议
清阴分之邪。仍以养正补之。
阿胶 小生地 麦冬 人参 小川连 乌梅肉
暑由上受。先入肺络。日期渐多。气分热邪。逆传入营。遂逼心胞络中。神昏
欲躁。舌短缩。手足牵引。乃暑热深陷。谓之发痉。热闭在里。肢体反不发热热邪
内闭则外脱。岂非至意。考古人方法。清络热必兼芳香。开里窍以清神识。若重
药攻邪。直走肠胃。与胞络结闭。无干涉也。
犀角 鲜生地 连翘 鲜菖蒲 银花 化至宝丹四丸
病已十余日。身尚躁热。舌苔粘腻。神呆目定。脉刚而数。烦躁呓语。此暑湿
久伏。与时气之秽邪凝合。酿成胶腻之痰。闭塞清明之府。神情迷昧。胃家浊液
蒸遏不宣。药食甘味。必蛔厥上冒。然内经有湿位之下。燥气乘之。是以从之。湿
转为燥。若无湿痰之潮气上蒸。舌苔早已燥剌矣。今先滋液。以清烈焰之燔。
鲜生地 麦冬 乌梅 蔗浆 银花露 羚羊角 蚌水
又 面垢舌白。渴饮。气短如喘。自利。是秽浊气入口鼻。与水谷之气互相混扰。
湿气阻塞。氤氲内蒸。三焦皆受。胸背肢节。有晦黯斑纹。秽与气血胶固。心络为
邪熏灼。神昏呓语。手经蔓延疫邪。不与伤寒同例。法当芳香辟邪。参以解毒。必
不为湿秽蒙闭。可免痉厥之害。
石菖蒲汁 白蔻仁 犀尖 小青皮 连翘心 金银花 六一散 金汁 至宝丹
又 邪陷复利。伤及厥阴。症见气上撞心。饥不能食。干呕腹痛。全是肝病见端。
肝为至阴之藏。相火内寄。仲圣治法。不用纯刚之剂。以肝为刚藏也。今正交土
旺之时。木火为仇。五日内未为稳当。宜慎之。
人参 淡吴萸 当归 白芍 秦皮 炒乌梅
今年七月。秋暑未除。初病头痛身热。是暑由上窍。伤及清阳。医药当辛凉
取气。同气相求。中上之轻邪自散。无如辛温苦寒清滋之类。杂然并投水谷内
蒸。氤氲不解。见症仍在身半以上。躯壳之间。非关脏腑大病。第能蔬食十日。可
解上焦之郁。
川芎 薄荷 荆芥炭 炒白芷 蔓荆子 菊花蒂 绿茶煎汤代水
中气索虚。贪寒饮冷。遏伏暑湿之火。蕴于膻中。劫津耗液。尽从燥化。肺气
不能下输。肠胃燥满不行。下之。遂逼血下行。血既下夺。亦云竭矣。阴不配阳。汗
不外泄。即为上厥。上厥下竭。肺经独受燥累。急进清燥救肺汤。以回阴液。
枇杷叶 人参 麦冬 桑叶 阿胶 杏仁 生石膏 竹叶
暑热之邪必定挟带湿邪。通过呼吸吸入而受邪，首先损伤上焦。所以张仲景治疗伤寒，先分六经；刘河间治疗温热病，必须究察三焦。大凡暑热伤及气分，湿气阻滞气机运行。肺主一身周行之气，位置最高，属于手太阴肺经。根据所述病情：面色红赤、足部发冷、上脘部痞塞满闷，这是上焦受病的显著表现。因为患者平素喜欢饮酒，胃中湿热久伏，若用辛温燥烈之药，不仅对肺病不合，而且会使胃中湿热被燥热锢闭，导致下利稀水，即协热下利。所以黄连苦寒，每次服用必然导致腹泻加重，这是因为苦寒药胜过了辛热药，但药味仍停留在胃底，与初受于肺的邪气无关。石膏辛寒，辛味先入肺；知母味道清凉，为胃之母气（金生水，肺为胃之母）。如果不明了肺邪，只说生津，不是至理。以前孙思邈未诊先问，最不误事。再据家属说，病起二十天，从无汗出宣泄。《内经》说：暑病应当出汗而不宜止汗。气分窒塞日久，热气侵入血中，咯痰带血，舌红赤但不甚渴饮，上焦不解，蔓延至中下焦。这都是急需清解三焦，是第一要旨。所以热病的瘀热留滞经络，成为遗毒；注入腑肠成为洞泄下利，就束手无策了。
再论，湿是重浊之邪，热是熏蒸之气。热处湿中，蒸淫之气上迫清窍，耳失聪听，这与少阳耳聋不同例。青蒿比柴胡低一等，也是少阳本药。大病如大敌，选药如选将，如果不慎重，很少能成功。议定厘清三焦，治法遵循河间法。飞滑石、生石膏、寒水石、大杏仁、炒黄竹茹、川通草、莹白金汁、金银花露。
又诊：脉后，腹胸肌腠之间，突然显现瘾疹，这是气分湿热有暗泄之机。早间所谈余邪遗热，必兼解毒者为此。下午进药后，脉象较早晨大，神识依然如前，只是舌赤，中心非常干燥，身体摸起来，热势比早间更甚。这是阴分也被热气蒸伤。瘦人担心津液枯竭，然而痰咯不清，养阴药无处不腻滞。议定尽早进服清膈一剂，而三焦热秽之蓄积，当用紫雪丹二三匙，借其芳香，宣通窍道，驱逐秽浊，这样涸热可解，浊痰不粘。继此调理之方，清营分，滋胃汁，才可以顾护。其宿垢欲去，犹在旬日之外。古人谓下法不嫌迟，不是臆说。知母、竹叶心、连翘心、炒川贝、犀角、元参、金汁、银花露、紫雪丹。
又诊：经过一个月时邪，脉形小数，小为病退，数为余热。所以皮腠脱屑，气血有流行之义；思食欲餐，胃中有醒豁之机，都是佳兆。只是舌赤而中心黄苔，热蒸既久，胃津与阴液俱伤，导致咽物咽中若阻，溺溲尖管犹痛，咯痰浓浓，宿垢未下。如果急遽攻夺，恐怕真阴再枯竭。此以存阴为主，而清腑兼之。所以乳进食物，便是助热，只有清淡之味，与病不悖。自来热病，最怕食后劳复，举世共闻，不是臆说。细生地、元参心、知母、炒川贝、麦冬、地骨皮、银花露、竹沥。
暑必挟湿，二者皆伤气分，从鼻吸而受，必先犯肺，乃上焦病。治法以辛凉微苦，气分上焦廓清则愈。可惜医者专以陶华《六书》六经看病，仍是与风寒先表后里之药，致邪之在上漫延，结锢四十余日不解。非初受六经，不须再辨其谬。《内经》云：病自上受者，治其上。援引经义以论治病，并非邪僻。宗河间法。杏仁、栝蒌皮、半夏、姜汁、白蔻仁、石膏、知母、竹沥。
又诊：脉神颇安。昨午发疹，先有寒战。盖此病起于湿热，当此无汗，肌腠气窒至肤间，皮脱如麸，犹未能全泄其邪。风疹再发，乃湿因战栗为解。一月以来病魔，而肌无膏泽，瘦削枯槁。古谓瘦人之病，虑涸其阴。阴液不充，补之以味，然腥膻浊味，徒助上焦热痰，无益培阴养液。况宿滞未去，肠胃气尚窒钝，必淡薄调理，上气清爽，痰热不至复聚。从来三时热病，怕反复于病后之覆。当此九仞，幸加意留神为上。元参心、细生地、银花、知母、生甘草、川贝、丹皮、橘红、竹沥。
病近一月，犹然耳聋，神识不慧，嗽甚痰粘，呼吸喉间有音。此非伤寒暴感，皆夏秋间暑湿热气内郁，新凉引动内伏之邪。当以轻剂清解三焦。奈何医者不晓伏气为病，但以发散消食寒凉清火为事，致胃汁消亡，真阴尽灼。舌边赤，齿板燥裂，乃邪留营中，有内闭螈疭、厥逆之变。况右脉小数，左脉涩弱，热固在里，当此阴伤日下，久之再犯亡阴之戒。从来头面，皆是清窍，既为邪蒙，精华气血不肯流行，诸窍失司聪明矣。此轻清清解，断断然也。议清上焦气血之壅为先，不投重剂苦寒，正仿古人肥人之病，虑虚其阳耳。连翘心、元参、犀角、郁金、橘红、黑栀皮、川贝、鲜菖蒲根、竹沥。
又诊：脉右缓大，左弱。面垢色已减，痰嗽不爽。良由胃中津液，为辛散温燥所伤。心营肺卫，悉受热焰蒸迫，致神呆喘急耳聋，清阳阻痹，九窍不利。首方宣解气血，继方芳香通窍，无形令其转旋，三焦自有专司，岂与俗医但晓邪滞攻击而已。今已获效，当与清养胃阴肺气。体素丰浓，阳弱不耐沉寒。然深秋冬交天气降，则上焦先受。试观霜露下垂，草木皆改异色，人在气交，法乎天地，兼参体质施治。枇杷叶、炒黄川贝、橘红、郁金、茯苓、苡仁。
三疟之邪在阴，未经向愈。春季洞利不食，想春雨外湿，水谷内聚亦湿，即湿多成五泄之谓。痍疮仅泄经隧湿邪，而里之湿邪未驱。长夏吸受暑邪，上蒙清空诸窍，咳嗽耳聋，的系新邪，非得与宿病同日而语。连翘、飞滑石、嫩竹叶、荷叶边汁、桑叶、杏仁、象贝、黑山栀。
奔走气乱，复饮烧酒。酒气辛热，有升无降，肺气郁，上下不通。舌白消渴，气结自胸及腹，自利不爽，周身肤腠皆痛，汗大出不解。无非暑湿热气，始由肺受，漫布三焦。群医消导苦药，但攻肠胃，在上痞结仍然。议淡渗佐以微辛，合乎轩岐上病治上之方。西瓜翠衣、川白通草、大豆黄卷、马兜铃、射干、苡仁。
三伏中阴气不生，阳气不潜。其头胀身痛，是暑邪初受。暑湿热必先伤气分，故舌白，口渴，身痛，早晨清爽，午后烦蒸，状如温疟。沐浴绕动血络，宿病得时邪而来。仲景云：先治新病，后理宿病。是亦阴气先伤，阳气独发也。鲜生地、石膏、知母、元参、连翘、竹叶心、荷叶汁。
初病伏暑，伤于气分，微热渴饮，邪犯肺也。失治邪张，逆走膻中，遂舌绛缩，小便忽闭，鼻煤裂血，口疮耳聋，神呆。由气分之邪热，漫延于血分矣。夫肺主卫，心主营，营卫二气，昼夜行于经络之间，与邪相遇，或凉或热。今则入于络，津液被劫，必渐昏寐，所谓内闭外脱。鲜生地、连翘、元参、犀角、石菖薄、金银花。
右脉空大，左脉小芤。寒热麻痹，腰痛冷汗。平素积劳内虚，秋暑客邪遂干脏阴，致神迷心热，烦躁。刮痧似乎略爽，病不肯解。此非经络间病，颇虑热深劫阴，而为痉厥。张司农集诸贤论暑病，谓入肝则麻痹，入肾为消渴，此其明征。议清阴分之邪，仍以养正补之。阿胶、小生地、麦冬、人参、小川连、乌梅肉。
暑由上受，先入肺络，日期渐多，气分热邪，逆传入营，遂逼心胞络中，神昏欲躁，舌短缩，手足牵引。乃暑热深陷，谓之发痉。热闭在里，肢体反不发热。热邪内闭则外脱，岂非至意。考古人方法，清络热必兼芳香，开里窍以清神识。若重药攻邪，直走肠胃，与胞络结闭，无干涉也。犀角、鲜生地、连翘、鲜菖蒲、银花、化至宝丹四丸。
病已十余日，身尚躁热，舌苔粘腻，神呆目定，脉刚而数，烦躁呓语。此暑湿久伏，与时气之秽邪凝合，酿成胶腻之痰，闭塞清明之府，神情迷昧。胃家浊液蒸遏不宣，药食甘味，必蛔厥上冒。然内经有湿位之下，燥气乘之，是以从之。湿转为燥。若无湿痰之潮气上蒸，舌苔早已燥剌矣。今先滋液，以清烈焰之燔。鲜生地、麦冬、乌梅、蔗浆、银花露、羚羊角、蚌水。
又诊：面垢舌白，渴饮，气短如喘，自利。是秽浊气入口鼻，与水谷之气互相混扰，湿气阻塞，氤氲内蒸，三焦皆受。胸背肢节，有晦黯斑纹，秽与气血胶固，心络为邪熏灼，神昏呓语，手经蔓延疫邪，不与伤寒同例。法当芳香辟邪，参以解毒，必不为湿秽蒙闭，可免痉厥之害。石菖蒲汁、白蔻仁、犀尖、小青皮、连翘心、金银花、六一散、金汁、至宝丹。
又诊：邪陷复利，伤及厥阴。症见气上撞心，饥不能食，干呕腹痛，全是肝病见端。肝为至阴之藏，相火内寄，仲圣治法，不用纯刚之剂，以肝为刚藏也。今正交土旺之时，木火为仇，五日内未为稳当，宜慎之。人参、淡吴萸、当归、白芍、秦皮、炒乌梅。
今年七月，秋暑未除。初病头痛身热，是暑由上窍，伤及清阳。医药当辛凉取气，同气相求，中上之轻邪自散。无如辛温苦寒清滋之类，杂然并投，水谷内蒸，氤氲不解。见症仍在身半以上，躯壳之间，非关脏腑大病。第能蔬食十日，可解上焦之郁。川芎、薄荷、荆芥炭、炒白芷、蔓荆子、菊花蒂、绿茶煎汤代水。
中气索虚，贪寒饮冷，遏伏暑湿之火，蕴于膻中，劫津耗液，尽从燥化。肺气不能下输，肠胃燥满不行。下之，遂逼血下行。血既下夺，亦云竭矣。阴不配阳，汗不外泄，即为上厥。上厥下竭，肺经独受燥累，急进清燥救肺汤，以回阴液。枇杷叶、人参、麦冬、桑叶、阿胶、杏仁、生石膏、竹叶。
Summerheat pathogenic factors must be accompanied by dampness. They are inhaled through respiration and first damage the upper jiao (Upper Burner). Therefore, Zhang Zhongjing's treatment of Cold Damage (Shanghan) begins with distinguishing the Six Channels (Liu Jing), while Liu Hejian's treatment of Warm Diseases requires investigating the Three Jiaos (Three Burners). Generally speaking, summerheat damages Qi, and dampness obstructs the movement of Qi. The Lung governs the circulation of Qi throughout the body, is located high, and belongs to the Hand-Taiyin Lung Meridian. Based on the described symptoms—red face, cold feet, and epigastric fullness/stuffiness—it is evident that the disease originated in the Upper Jiao. This is because the patient habitually drinks alcohol, causing damp-heat to lie latent in the Stomach for a long time. Using acrid-warm and drying/cracking herbs not only fails to address the Lung pathology but also causes the damp-heat in the Stomach to be sealed off by the dry heat, leading to diarrhea with watery stools, known as "Xie Re Xia Li" (Diarrhea accompanying heat). Thus, Huanglian (Coptis Rhizome), being bitter and cold, inevitably worsens the diarrhea upon each administration; this is because the bitter-cold nature overcomes the acrid-warm heat, yet the medicinal flavor remains at the bottom of the Stomach, having no effect on the initial pathogen affecting the Lung. Shigao (Gypsum Fibrosum) is acrid and cold; the acrid flavor enters the Lung first. Zhimu (Anemarrhenae Rhizoma) has a cooling taste and represents the mother Qi of the Stomach (Metal generates Water, Lung is the mother of Kidney/Stomach contextually implies generating fluids). However, without understanding the Lung pathogen, merely claiming to generate fluids is not the ultimate principle. In the past, Sun Simiao asked questions before diagnosing, which was least likely to cause errors. Furthermore, according to the family, the illness began twenty days ago with no sweating or release. The Classic states: "In summerheat, one should sweat and not stop it." Due to obstruction in the Qi level for a long time, heat penetrates into the Blood level, resulting in hemoptysis (coughing up blood-stained sputum), red tongue, and little thirst. If the Upper Jiao is not resolved, it spreads to the Middle and Lower Jiaos. These are all indications for urgently clearing the Three Jiaos, which is the primary objective. Therefore, if stasis-heat from heat diseases remains in the collaterals, becoming residual toxins; or if it pours into the Fu organs and intestines causing severe diarrhea, then one would be helpless.
Furthermore, dampness is a heavy and turbid pathogen, while heat is a steaming and vaporizing qi. Heat situated within dampness creates steaming vapors that oppress the clear orifices from above, causing deafness. This differs from Shaoyang deafness. Qinghao (Artemisiae Annuae Herba) is one degree inferior to Chaihu (Bupleuri Radix) but is also a fundamental herb for Shaoyang. A major illness is like a great enemy; selecting herbs is like selecting generals. Without caution, success is rare. It is proposed to clarify the Three Jiaos, following Liu Hejian's method. Fei Huashi (Talcum), Sheng Shigao (Raw Gypsum Fibrosum), Hanshui Shi (Calcitum), Da Xingren (Semen Armeniacae Amarum), Chao Huang Zhu Ru (Fried Bamboo Shavings), Chuan Tongcao (Tetrapanacis Medulla), Ying Bai Jin Zhi (Clear White Human Excrement Juice), Yinjin Hua Lu (Honeysuckle Flower Dew).
Second visit: After pulse diagnosis, urticaria suddenly appeared on the abdomen, chest, muscles, and skin pores. This indicates that damp-heat in the Qi level has an opportunity for hidden discharge. The residual pathogens and lingering heat discussed in the morning must involve detoxification for this reason. After taking medicine in the afternoon, the pulse was larger than in the morning, and mental clarity remained unchanged, except for the red tongue, especially dry in the center. Palpating the body revealed higher heat than in the morning. This indicates the Yin level is also damaged by steaming heat. For thin individuals, one worries about fluid depletion. However, since phlegm is difficult to expectorate, yin-nourishing herbs tend to be cloying and stagnating. It is proposed to administer a dose of Qing Ge Tang (Clear Diaphragm Decoction) early on. For the accumulation of heat and turbidity in the Three Jiaos, Zi Xue Dan (Purple Snow Pill) 2-3 spoons should be used. Relying on its aromatic properties to open orifices and expel turbidity will resolve the depleted heat and prevent turbid phlegm from sticking. Subsequent conditioning formulas should clear the Ying (Nutritive) level and nourish Stomach fluids to ensure recovery. The expulsion of accumulated fecal matter may take ten days. Ancients said purgation is not too late; this is not speculation. Zhimu (Anemarrhenae Rhizoma), Zhuye Xin (Bamboo Leaf Heart), Lianqiao Xin (Forsythiae Fruit Heart), Chao Chuan Bei Mu (Fried Fritillariae Bulbus), Xijiao (Rhinocerotis Cornu - *Note: Substitute with Buffalo Horn in modern practice*), Yuanshen (Scrophulariae Radix), Jin Zhi (Human Excrement Juice), Yinhua Lu (Honeysuckle Dew), Zi Xue Dan (Purple Snow Pill).
Third visit: After a month of seasonal pathogens, the pulse is small and rapid. Small indicates disease retreat; rapid indicates residual heat. Therefore, peeling skin suggests the free flow of Qi and Blood; appetite returning suggests the Stomach is awakening. These are good omens. However, the red tongue with yellow coating in the center indicates that prolonged heat steaming has damaged both Stomach fluids and Yin fluids, causing difficulty swallowing and pain in the urethral tip. Phlegm is thick, and accumulated waste has not passed. If attacked hastily, true Yin may be further depleted. The main strategy here is preserving Yin, supplemented by clearing the Fu organs. Therefore, consuming milk/food aids heat; only bland flavors harmonize with the disease. Since ancient times, heat diseases fear relapse due to dietary indiscretion after illness, a universally known fact, not speculation. Xi Shengdi (Rehmanniae Radix Preparata), Yuanshen Xin (Scrophulariae Radix Heart), Zhimu (Anemarrhenae Rhizoma), Chao Chuan Bei Mu (Fried Fritillariae Bulbus), Maidong (Ophiopogonis Tuber), Digupi (Lycii Cortex), Yinhua Lu (Honeysuckle Dew), Zhuli (Bamboo Juice).
Summerheat must carry dampness; both injure the Qi level. They enter via the nose and first attack the Lung, constituting a disease of the Upper Jiao. Treatment methods use acrid-cool and slightly bitter herbs; once the Qi level of the Upper Jiao is cleared, the disease resolves. Regrettably, physicians specialized in Tao Hua's Six Classics viewed the disease through the Six Channels, using herbs for exterior-release followed by interior-clearing typical of Wind-Cold. This caused the pathogen located in the upper part to spread and remain bound for over forty days. Since it was not initially a Six Channel disease, there is no need to debate its fallacy. The Classic says: "Diseases entering from above should be treated from above." Citing classic principles to discuss treatment is not heretical. Following Liu Hejian's method: Xingren (Semen Armeniacae Amarum), Gualou Pi (Trichosanthis Pericarpium), Banxia (Pinelliae Rhizoma), Jiang Zhi (Ginger Juice), Baiko Ren (Amomi Fructus Rotundus), Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), Zhuli (Bamboo Juice).
Fourth visit: Pulse spirit is quite calm. Rash appeared yesterday noon, preceded by chills. Since this illness originated from damp-heat, and there was no sweat, Qi obstruction in muscle and skin pores prevented complete expulsion of the pathogen despite skin peeling like bran. The recurrence of wind-rash indicates dampness resolving through shivering. For a month, the disease has ravaged the body, leaving muscles without lubrication, emaciated and withered. Ancients said for thin patients, worry about Yin depletion. If Yin fluids are insufficient, tonify with flavor, but fishy/fatty/turbid flavors only aid Upper Jiao heat-phlegm and do not benefit Yin nourishment. Moreover, since accumulated stagnation remains and intestinal Qi is still obstructed/dull, bland conditioning is necessary to keep Upper Qi fresh so heat-phlegm does not re-aggregate. Seasonal heat diseases fear post-illness relapse. At this critical stage ("nine ren"), careful attention is urged. Yuanshen Xin (Scrophulariae Radix Heart), Xi Shengdi (Rehmanniae Radix Preparata), Yinhua (Honeysuckle), Zhimu (Anemarrhenae Rhizoma), Sheng Gancao (Raw Licorice Root), Chuan Bei (Fritillariae Bulbus), Danpi (Moutan Cortex), Juhong (Citri Reticulatae Pericarpium Rubrum), Zhuli (Bamboo Juice).
Illness nearly a month, still deaf, mental confusion, severe cough with sticky phlegm, audible breathing sounds in throat. This is not acute Cold Damage, but rather summer-damp-heat internal depression during Summer/Autumn, triggered by new coolness activating latent pathogens. Light agents should clear and resolve the Three Jiaos. Alas, physicians do not understand latent Qi disease, focusing only on dispersing, digesting, cooling, and fire-clearing. This consumes Stomach juices and burns true Yin. Red tongue edges, dry/cracked gums indicate pathogen remaining in Ying (Nutritive) level, risking internal closure, convulsions, and reversal cold. Right pulse small/rapid, left pulse choppy/weak. Heat is firmly internal. With daily Yin injury, prolonged neglect risks Yin collapse. Head and face are clear orifices; when obscured by pathogen, essence/Qi/Blood do not circulate freely, losing sensory function. Light clearing and resolving is decisive. Propose clearing congestion of Qi and Blood in Upper Jiao first, avoiding heavy bitter-cold herbs, imitating ancients' caution against damaging Yang in obese patients. Lianqiao Xin (Forsythiae Fruit Heart), Yuanshen (Scrophulariae Radix), Xijiao (Rhinocerotis Cornu), Yujin (Curcumae Radix), Juhong (Citri Reticulatae Pericarpium Rubrum), Hei Zhipi (Gardeniae Cortex), Chuan Bei (Fritillariae Bulbus), Xian Changpu Gen (Fresh Acori Tatarinowii Rhizoma), Zhuli (Bamboo Juice).
Fifth visit: Pulse right slow/large, left weak. Facial dirtiness reduced, phlegm-cough unsmooth. Likely due to Stomach fluids damaged by acrid-dispersing/warm-drying herbs. Heart Ying and Lung Wei are all steamed by heat flames, causing mental dullness, panting, deafness, obstruction of Clear Yang, and dysfunction of nine orifices. First formula: disperse/resolve Qi and Blood. Second formula: aromatic orifice-opening. Let the formless transform and rotate; Three Jiaos have their specific functions, unlike vulgar doctors who only know attacking stagnation. Now effective, proceed to clear/nourish Stomach Yin and Lung Qi. Constitution is robust, Yang weak, intolerant of deep cold. However, in late Autumn/Winter transition, Heaven's Qi descends, affecting Upper Jiao first. Observe frost/dew falling, plants changing color; humans in Qi intersection follow Heaven and Earth, combining constitution with treatment. Pipa Ye (Loquat Leaf), Chao Huang Chuan Bei (Fried Yellow Fritillariae Bulbus), Juhong (Citri Reticulatae Pericarpium Rubrum), Yujin (Curcumae Radix), Fuling (Poria), Yiren (Coicis Semen).
San Nüe (Tri-periodic Malaria) pathogen is in Yin, not yet healed. Spring severe diarrhea/anorexia suggests spring rain external dampness and internal water/grain dampness aggregation, i.e., "dampness becomes five types of diarrhea". Skin lesions only drained collateral dampness, not internal dampness. Long Summer inhaled summerheat, obscuring clear orifices, causing cough/deafness. This is clearly a new pathogen, not comparable to chronic disease. Lianqiao (Forsythiae Fructum), Fei Huashi (Talcum), Nen Zhuye (Young Bamboo Leaf), Hetu Bian Zhi (Lotus Leaf Margin Juice), Sangye (Mori Folium), Xingren (Semen Armeniacae Amarum), Xiang Bei (Fritillariae Thunbergii Bulbus), Hei Shanzhi (Gardeniae Fructum).
Running around disrupts Qi, compounded by drinking liquor. Liquor qi is acrid-hot, ascending without descending, causing Lung Qi depression, upper-lower blockage. White tongue, thirst, Qi knot from chest to abdomen, foul-smelling loose stools, body ache, profuse sweating without relief. All stem from summer-damp-heat starting in Lung, spreading through Three Jiaos. Doctors used digestive/bitter drugs attacking only intestines/stomach, leaving upper blockage unresolved. Propose light leaching aided by slight acridity, conforming to Xuanti's "treat upper disease from above" formula. Xigua Cuiyi (Watermelon Rind), Chuan Bai Tongcao (Tetrapanacis Medulla), Dadou Huangjuan (Sojae Semen Praeparatum), Madouling (Aristolochiae Radix), Shegan (Belamcandae Rhizoma), Yiren (Coicis Semen).
During Sanfu (Dog Days), Yin Qi does not generate, Yang Qi does not hide. Head distension/body pain indicates initial summerheat reception. Summerheat-damp-heat first injures Qi level, hence white tongue, thirst, body pain, refreshing mornings, stifling afternoons, resembling warm malaria. Bathing agitates blood collaterals; chronic disease meets seasonal pathogen. Zhongjing said: "Treat new disease first, then manage chronic disease." This is also Yin Qi injured first, Yang Qi flaring alone. Xian Shengdi (Fresh Rehmanniae Radix), Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), Yuanshen (Scrophulariae Radix), Lianqiao (Forsythiae Fructum), Zhuye Xin (Bamboo Leaf Heart), Hetu Zhi (Lotus Juice).
Initial latent summerheat injures Qi level, mild fever/thirst, pathogen attacks Lung. Mismanagement allows pathogen to expand, reverse to Danzhong (Conception Vessel area), causing crimson/shrunken tongue, sudden urinary retention, blackened nose/cracked bleeding, mouth ulcers/deafness, mental dullness. Qi-level heat spreads to Blood level. Lung governs Wei (Defensive), Heart governs Ying (Nutritive). Ying-Wei Qi circulates meridians day/night, meeting pathogen, alternating cool/hot. Now entering collaterals, fluids robbed, leading to gradual coma/sleepiness, termed "internal closure, external collapse". Xian Shengdi (Fresh Rehmanniae Radix), Lianqiao (Forsythiae Fructum), Yuanshen (Scrophulariae Radix), Xijiao (Rhinocerotis Cornu), Shichangpu Bo (Acori Tatarinowii Rhizoma Peel), Yinhua (Honeysuckle).
Right pulse empty/large, left pulse small/hollow. Alternating chills/fever, numbness/palsy, lower back pain, cold sweat. Chronic internal deficiency from labor, autumn summerheat guest pathogen invades Zang Yin, causing mental confusion, heart heat, irritability. Scraping provides slight relief, but disease persists. Not a meridian disease, but worry about deep heat robbing Yin leading to spasms/reversal. Zhang Sinong collected theories on summerheat: entering Liver causes numbness/palsy, entering Kidney causes thirst, clear evidence. Propose clearing Yin-level pathogen, supplementing with righteousness/nourishment. Ejiao (Asini Corii Colla), Xiao Shengdi (Small Fresh Rehmanniae Radix), Maidong (Ophiopogonis Tuber), Renshen (Ginseng Radix), Xiao Chuanlian (Small Coptidis Rhizoma), Wumei Rou (Mume Fructus Seed Flesh).
Summerheat enters from above, first into Lung collaterals. Days pass, Qi-level heat reversely transmits to Ying, forcing into Pericardium collaterals, causing coma/restlessness, short tongue, limb traction. Deep summerheat invasion is called Fa Jing (Spasm). Heat closed internally, limbs反而 not hot. Heat closed internally leads to external collapse, profound truth. Ancient methods: clearing collateral heat must combine aromatics to open inner orifices and clear consciousness. Heavy drugs attacking pathogen go straight to intestines/stomach, irrelevant to Pericardium closure. Xijiao (Rhinocerotis Cornu), Xian Shengdi (Fresh Rehmanniae Radix), Lianqiao (Forsythiae Fructum), Xian Changpu (Fresh Acori Tatarinowii Rhizoma), Yinhua (Honeysuckle), Hua Zhibao Dan (Transformed Ultimate Treasure Pill) 4 pills.
Illness over ten days, body still restless/heat, sticky tongue coating, mental dullness/fixed eyes, rigid/rapid pulse, irritability/confabulation. Long-latent summer-damp combined with seasonal turbid pathogen, brewing sticky phlegm, blocking clear mansion, confusing spirit. Stomach turbid fluids steamed/oppressed, cannot vent. Sweet meds/herbs cause ascariasis reversal/vomiting. Classic says: below damp position, dry qi attacks, thus follow it. Damp turns to dry. Without damp-phlegm moisture steaming up, tongue coating would already be dry/cracked. Now first nourish fluids to clear raging fire. Xian Shengdi (Fresh Rehmanniae Radix), Maidong (Ophiopogonis Tuber), Wumei (Mume Fructus), Zhe Jiang (Sugarcane Juice), Yinhua Lu (Honeysuckle Dew), Lingyang Jiao (Saiga Antelope Horn), Bang Shui (Clam Water).
Sixth visit: Dirty face, white tongue, thirst, short breath like panting, spontaneous diarrhea. Turbid qi entered nose/mouth, mixed with food/grain qi, dampness blocked, steaming internally, Three Jiaos affected. Dark spots on chest/back/limbs, turbidity stuck with Qi/Blood, Heart collaterals scorched by pathogen, coma/confabulation. Hand meridians spread epidemic pathogen, different from Cold Damage. Method: aromatic repulsion of pathogen, assisted by detoxification, preventing damp-turbid obscuration, avoiding spasms/reversal. Shichangpu Zhi (Acori Tatarinowii Rhizoma Juice), Baiko Ren (Amomi Fructus Rotundus), Xijian (Rhinocerotis Cornu Tip), Xiao Qingpi (Small Citri Reticulatae Pericarpium Viride), Lianqiao Xin (Forsythiae Fruit Heart), Yinhua (Honeysuckle), Liuyi San (Six-to-One Powder), Jin Zhi (Human Excrement Juice), Zhibao Dan (Ultimate Treasure Pill).
Seventh visit: Pathogen sank, diarrhea returned, injuring Jueyin. Symptoms: Qi rushing to heart, hunger but no appetite, dry heaving/abdominal pain, all signs of Liver disease. Liver is storage of extreme Yin, housing Minister Fire. Zhang Zhongjing's method avoids purely rigid/hot agents because Liver is a rigid organ. Now intersecting Earth prosperous time, Wood/Fire are enemies. Five days not stable, caution advised. Renshen (Ginseng Radix), Dan Wuyu (Light Evodiae Fructus), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Qinpi (Fraxini Cortex), Chao Wumei (Fried Mume Fructus).
This July, autumn summerheat not removed. Initial headache/body heat, summerheat from upper orifices injuring Clear Yang. Medicine should use acrid-cool to capture Qi, same qi seeks same, middle-upper light pathogens disperse naturally. Instead, acrid-warm, bitter-cold, clearing/nourishing mixed together, food/grain internal steaming, turbidity unresolved. Symptoms still above waist, between shell, not major Zang-Fu disease. Ten days of vegetable diet can resolve Upper Jiao depression. Chuanxiong (Ligustici Chuanxiong Rhizoma), Bohe (Menthae Haplocalycis Herba), Jingjie Tan (Schizonepetae Spica Carbonized), Chao Baizhi (White Peucedani Radix), Manjingzi (Vernoniae Semen), Juhua Di (Chrysanthemi Flos Calyx), Green Tea decocted as water.
Middle Qi exhausted, craving cold drinks/drinks, suppressing summer-damp fire, accumulating in Danzhong, robbing fluids/consuming liquids, all transforming to dryness. Lung Qi cannot descend, intestines/stomach dry/full/blockage. Purging forces blood downward. Once blood is lost, it is exhausted. Yin cannot match Yang, sweat does not escape, becoming Upper Reversal. Upper reversal, lower exhaustion, Lung meridian alone suffers dryness. Urgently administer Qingzao Jiufei Tang (Clear Dryness Rescue Lung Decoction) to restore Yin fluids. Pipa Ye (Loquat Leaf), Renshen (Ginseng Radix), Maidong (Ophiopogonis Tuber), Sangye (Mori Folium), Ejiao (Asini Corii Colla), Xingren (Semen Armeniacae Amarum), Sheng Shigao (Raw Gypsum Fibrosum), Zhuye (Bamboo Leaf).