患儿盗汗2年。夜间低热，入睡则全身汗出，醒来即止。扪之汗冷而粘。有时汗出过多，内衣裤皆浸湿。望诊：神倦欲眠，形瘦色苍，黑睛带绿，口干喜饮，纳差，大便干燥，舌淡红，苔薄白欠润，脉弦缓。经X光透视，肺部正常。西医认为营养不良，锌元素缺乏，但久治无效。又曾间断服用过当归六黄汤、知柏地黄汤等合潜阳镇摄药物20余剂亦乏效，家长已失去治疗信心。闻道"江尔逊高徒班"开设疑难病专科门诊，特来一试。据患儿症状、舌脉，直断为脾阴亏损，肝旺阳浮之证，拟用滋脾敛肝，潜摄浮阳方法。予张锡纯资生汤加味：生山药30g，玄参15g，白术10g，生鸡内金6g，大力子6g(炒捣)，白芍10g，生龙骨30g，生牡蛎30g，丹皮10g，地骨皮10g。6剂。二诊(9月27日)：服药2剂，夜热盗汗明显减轻，服完6剂遂止。纳转佳，口不干，大便畅，舌淡红苔薄白，脉缓。处方：生山药900g，生鸡内金30g，共轧为极细末，每晨用30g，煮粥，调以白蔗糖令适口，连服1个月。半年后随访，夜热盗汗一直未复发，面容、黑睛转正常。
实习生甲医书上说盗汗多属于阴虚，这是有道理的。因为夜间属阴，夜眠汗出，当然是阴虚。但有的患者白天午睡也汗出不止，也属于阴虚吗?
老师：首先要明确盗汗的概念。不论是在夜晚，还是在白天，只要入睡汗出，醒来汗止，就是盗汗。如《丹溪心法》所说，"盗汗者，谓睡而汗出也。不睡则不能汗出。方其熟睡也，凑凑然出焉，觉则止而不复出，非若自汗而自出也"。这是盗汗的概念。而《证治准绳》将盗汗的病因病机归结为：各种致病因素"伤损阴血，衰惫形气。阴气既虚，不能配阳，于是阳气内蒸，外为盗汗"。不论夜晚还是白天，寐(入睡)则属阴，阴虚则阳旺，"阳加于阴谓之汗"。((素问·阴阳别论))证之临床，外感病盗汗多属邪恋少阳，而内伤杂病盗汗则多属阴虚，属气虚或阳虚或湿热者比较少见。
学员甲盗汗一症，古今医书确实大多责之阴虚内热，阳失潜藏，而以滋阴降火、潜阳镇摄为正治方法。但本例患儿屡用当归六黄汤、知柏地黄汤等滋阴降火，又配合潜阳镇摄药物，为什么乏效呢?
老师：当归六黄汤、知柏地黄汤等，寒凉降火有余，而滋脾敛肝不足。用于成人尚可，用于以"脾弱肝旺"为病理特征的小儿，则不甚契合。若投药二三剂不见起色，犹误认为药力未到而继续用之，用至五六剂，恐难免损脾败胃之虞。观本例患儿，虽然夜热盗汗，但其他一系列症状，并无明显的内热或火旺之征；其舌质淡红，苔薄白欠润，脉弦缓，也非明显的内热或火旺之象，且其服药乏效明矣。
学员乙所谓"脾弱肝旺"，是指小儿杂病的一般病理，并不是盗汗一症的具体病理。但患儿服用滋脾敛肝、潜摄浮阳的资生汤加味后，效果确实佳良，是什么道理?
老师：一般性寓于特殊性之中。盗汗一症，固然是阴亏液耗，阳失潜藏所致，但阴阳失去平衡的根源何在呢?观本例患儿，除了夜热盗汗这一症状之外，尚伴有神倦欲眠，形瘦色苍，黑睛带绿，口千喜饮，纳差，大便干燥等一系列症状。这一系列症状是可以用"脾弱肝旺"四字来概括的。所谓"脾弱"，具体言之，这里是指脾阴不足；脾阴不足，则滋生阴精的功能必然减弱，而身形困顿。所谓"肝旺"，亦具体言之，这里是指肝阴不足，肝中所藏的相火因之偏旺；肝旺，不仅乘脾，而且消耗阴精的机会亦增多。这就是患儿身形困顿与夜热盗汗俱见的根本原因。而身形愈困顿，夜热盗汗愈甚，反之亦热，形成了一种恶性循环。要想切断这种恶性循环，就必须以滋脾敛肝为主。这样图本以治，自然效佳。
老师：资生汤是近代名医张锡纯治疗阴虚劳热的第一方，载于《医学衷中参西录》第一册。我一向认为本方的主要功效是滋补脾阴。方中重用生山药大滋脾阴，辅以白术健运脾气(脾阴虚多伴脾气虚，宜气阴同补)；佐以生鸡内金(鸡之脾胃)，不但取其消食腐积，更取其以脾胃补养脾胃；又用玄参退虚热，大力子润肺滑肠通便。我在原方基础上加白芍敛肝，丹皮、地骨皮助玄参退虚热，龙骨、牡蛎潜摄浮阳。
老师：运用机会很多。我治疗小儿盗汗，几乎必用此方加味，驾轻就熟，屡用不衰。有乡村
医生祝X，言其小儿8岁，盗汗2个月，迭用滋阴潜阳方药不愈，特来索-方。我当即书此方加味，彼视之，流露出不相信的神态。我说"试服2剂无妨"。不久来告曰，"果然服2剂盗汗即止"!如服数剂后盗汗减少而未全止，可加仙鹤草30g；如盗汗兼自汗，可加黄芪15-30g。
老师：有。如清·陈修园治疗盗汗，喜用"莲枣马豆汤"，方中莲米、大枣、马料豆便是滋补脾阴的药物。又如清，林佩琴治疗盗汗，喜用"益阴汤"，即在六味地黄汤滋补肾阴的基础-仁，加麦冬、莲米滋补脾阴，白芍、五味子敛肝，地骨皮退虚热，灯蕊引热下行。这2首处方我都做过一些临床验证，其疗效均不如资生汤加味理想。
实习生乙患儿盗汗已痊愈，还用生山药、生鸡内金做药膳连服1个月，是否有此必要?
老师：很有必要。因为盗汗虽初愈，但患儿脾阴不足的病根仍然存在，所以必须继续滋养脾阴，充实其生化之源，才能防止复发。生山药虽是寻常服食之晶，但其味甘归脾，能大滋脾阴，且色白入肺，液浓入肾，又能润肺滋肾；少佐生鸡内金消而导之，运化其补益之力，则久服也不会产生满闷之感；加白蔗糖令适口，患儿必喜食。张锡纯治疗阴气虚损的多种疾病，常以此法善后，值得借鉴。而张氏的经验亦有所本--本于《内经》"食养尽之"四字。这确实是一条行之有效的康复之道。
高热7天
四川省乐山市人民医院中医研究室主任余国俊
陈X，男，10岁，1985年8月2日初诊。
患儿7天前因游泳过久，复遭雨淋，致恶寒发热，无汗，全身酸软，咽微痛，测体温39℃。先服银翘散加香薷2剂无效。又肌注柴胡针、穿虎宁，口服扑热息痛、六神丸、穿心莲等，全身出汗，热势渐退，但数小时后高热又起，乃收入急诊观察室。经查血、胸透，未见异常。西医诊为"上呼吸道感染"，以输液(药用氨苄青霉素、维生素等)为主，配服解热镇痛药，仍然热退复热，体温有时高达40．5℃o又加服紫雪丹冀其退高热，亦乏效。前后高热7天，进食甚少，日渐羸弱。经儿科会诊，决定用激素。家长极力阻止，而惶惶然前来邀诊。刻诊：患儿仰卧病床，面容消瘦少华，唇红而燥，汗少，微恶寒，微咳，额热身热，手足冷，精神萎靡不振，时而烦躁不安，大便3日未行，口干思饮，咽微红，舌红，苔薄白微黄欠润，脉紧数。体温39．5℃。此为风寒自表入里化热，三阳合病之证，治宜疏风散寒，清透里热。用柴葛解肌汤加味：柴胡25g，葛根30g，白芷10g，羌活10g，桔梗log，生甘草5g，白芍log，黄芩6g，生石膏50g，连翘10g，钩藤10g，地龙6g。1剂。煎服法：用水500mi，先煎生石膏半小时，纳余药，文火煎10分钟；再纳钩藤，煎3分钟。滤取药液约300ml，每次服60ml，半小时服1次。诊毕，已是下午3时。效果：服药4次后，全身开始微微汗出，高热渐退；至下午4时服完全部药液后，曾大便1次，质软；至11时热已退尽，体温36．8℃。当夜安睡未醒，次晨体温正常。乃改予竹叶石膏汤2剂以善后。从此未再发热，嘱其注意饮食调理，身体逐渐康复。
实习生甲本例患儿感冒高热7天，正值盛夏季节，为什么不考虑暑热为患，而用清暑解表法呢?
老师：暑邪感冒必挟湿，除了暑湿郁遏卫阳而发高热之外，暑湿困顿中焦之症也很明显，如脘腹痞闷，甚至吐泻等。
实习生乙教材上说小儿感冒一般分为风寒、风热、暑邪3种，本例既不属于暑邪感冒，那么是属于风寒还是风热感冒?
老师：高热已7天，已难凿分风寒与风热。客观地说，小儿体禀稚阴稚阳，体质尚未完全定型。所以小儿感冒高热，纯属风寒或风热者比较少见，而以外寒内热或"寒包热"者居多。古人称为"客寒包火"，也是这个意思。此与成人感冒高热是有所差异的。
实习生乙那么我再提两个问题：第一，本例内热症状很明显，但外寒症状并不明显；第二，大便3日未解，为什么不用泻下药?
老师：不明显不等于没有。如微恶寒，汗少，苔薄白微黄，脉带紧象等，都是外寒未解之象。临床上要充分注意外寒，不要一见高热，就忽视了外寒的存在，更不要用体温表来判断寒热。至于大便3日未解，但并无腹胀或腹痛而拒按等腑实症征，怎么能用泻下药呢?
实习生丙小儿感冒高热的病机与成人有所差异，那么治法也应有所差异了?
老师：是的。小儿感冒高热多属"寒包热"，若纯用辛温发敌(麻黄汤、荆防败毒散之类)，则外寒虽去，而内热复炽；纯用辛凉清解(桑菊饮、银翘散之类)，则外寒留恋，内热亦无出路。实践证明，惟主用辛温配辛寒，开通玄府，清透蕴热，辅以枢转升提，引热外出，佐以酸甘化阴，和营泄热，且先安未受邪之地，才能"毕其功于一役"。而柴葛解肌汤就与这种法度十分符合，所以退小儿感冒高热十分迅速而平稳，经得起重复。
学员甲明，陶华创制的柴葛解肌汤，载于{伤寒六书)o其方由柴胡、葛根、白芷、羌活、生石膏、桔梗、黄芩、白芍、甘草、生姜、大枣11味药组成，用以代替葛根汤，治疗太阳阳明经病--恶寒渐轻，身热增盛，头痛肢楚，目痛鼻干，心烦不眠，眼眶胀痛等症。分析该方的药物组成，并不完全符合你刚才所讲的那种法度，你却说完全符合。你的说法有什么根据呢?
老师：古今医书解释柴葛解肌汤，大多注重于单味药物的性味功效，而很少从复方的化合、协同作用角度去理解。我认为本方配伍高明之处，在于以"药对"的形式，巧妙地取法或浓缩五个复方，汲其精华而创制出新的复方。但制方者却含而不露，引而不发。我的分析是：羌活--石膏，辛温配辛寒，师大青龙汤法，发越恋表的风寒，清透内蕴的实热；葛根--白芷，轻清扬散，有升麻葛根汤意，善解阳明肌肉之热；柴胡--黄芩，寓小柴胡汤，旋转少阳枢机，引领邪热外出；桔梗--甘草，即桔梗甘草汤，轻清上浮，盖除胸膈、咽嗌的浮热；白芍--甘草，即芍药甘草汤，酸甘化阴，和营泄肌腠的郁热。综合来看，柴葛解肌汤一方，因其取法或浓缩以上5个复方在内，故能同时兼顾外感邪热的表、里和半表半里三个病理层次，从而发越之、清透之、引领之，直令邪热无所遁形。我临床反复体验，深知使用本方时若剂量、加味恰当，煎服得法，最善退小儿上呼吸道感染引起的高热，且一般不会热退复热。
实习生甲请具体说说本方的剂量、加味和煎服法。
老师：方中羌活、石膏、柴胡、葛根4味药必须用。羌活用3～10g，生石膏重用30g以上，两者比例为1：5～1：10，柴胡不少于25g，葛根不少于30g，其余药物用常规剂量。本方加味：咽痛明显加射干6g白马勃10g挟暑加香薷10g滑石15g；挟食加炒莱菔子10引挟惊加钩藤、地龙各10g，本例虽未挟惊，但高热7天，竟达40．5℃，为防惊厥，故也加用。煎法：生石膏先煎半小时，余药用武火急煎10分钟，只取火煎。服法：小儿苦于服药，如按常规口服3次；每次摄入量不足，间隔时间太长，退热必迟。我初用本方时，也曾走过这种弯路。后来改用少量频服法，小儿容易接受，摄入总量充足，药力也时时相继。据观察多例，一般在服第一次药后约2小时开始微微汗出，高热渐渐消退。服1～2剂，待体温恢复正常后，转用竹叶石膏汤益气生津，续清余热以善后。
学员乙本例感冒高热7天，曾连续使用多种中、西药物，仍然热退复热，山穷水尽，不得已想打激素这张王牌。真是无路可走了吗?这是值得引起反思的!
老师：确实值得反思。临床上似乎有一种倾向，就是治疗小儿感冒高热，绝对忌用辛温药物，而以桑菊饮、银翘散作为枕中鸿秘。更有个别医生，一见高热，不细察病因病机、体质状况，就匆匆以退热药、抗生素打头阵，辅以银花、板蓝根、大青叶、等苦寒药作后援，或滥用含糖量很高的各种"冲剂"。迁延几天，高热不退，病家惶惶不安，医生方寸也乱。于是紫雪丹、至宝丹、安宫牛黄丸等营血分药物也被冒冒失失地推上第一线，也有打出激素王牌的。这种治病"风俗"，教训不少，为害非轻，亟须吸取教训"移风易俗"。
双下肢瘫痪14天
四川省乐山市人民医院中医研究室主任余国俊
张XX，男，36岁，农民，1986年10月24日诊。
患儿盗汗持续2年。夜间出现低热，入睡后全身出汗，醒来即停止。触摸皮肤感觉汗液冷而黏腻。有时出汗过多，内衣裤都被浸湿。望诊可见：精神疲倦想睡觉，形体消瘦面色晦暗，黑眼球颜色偏绿，口干喜欢喝水，食欲差，大便干燥，舌质淡红，苔薄白且不够润泽，脉象弦缓。经X光透视检查，肺部正常。西医诊断为营养不良和锌元素缺乏，但长期治疗无效。此前曾间断服用过当归六黄汤、知柏地黄汤等配合潜阳镇摄药物共20多剂，也缺乏疗效，家长已失去治疗信心。听说“江尔逊高徒班”开设了疑难病专科门诊，特意前来尝试治疗。根据患儿的症状、舌象和脉象，直接判断为脾阴亏损、肝旺阳浮的证候，拟定使用滋脾敛肝、潜摄浮阳的治疗方法。给予张锡纯的资生汤加味：生山药30克，玄参15克，白术10克，生鸡内金6克，大力子6克（炒捣碎），白芍10克，生龙骨30克，生牡蛎30克，丹皮10克，地骨皮10克。共6剂。二诊（9月27日）：服药2剂后，夜间发热和盗汗明显减轻，服完6剂后盗汗停止。食欲好转，口不干，大便通畅，舌淡红苔薄白，脉缓。处方：生山药900克，生鸡内金30克，共同研磨成极细粉末，每天早晨用30克，煮粥，加入适量白糖调味使其可口，连续服用1个月。半年后随访，夜间发热和盗汗一直未复发，面容和黑眼球颜色恢复正常。
实习生甲：医书上说盗汗多属于阴虚，这是有道理的。因为夜间属阴，睡眠时出汗，当然是阴虚。但是有的患者白天午睡时也汗出不止，这也属于阴虚吗？
老师：首先要明确盗汗的概念。不论是在夜晚还是白天，只要入睡后出汗，醒来就停止，就是盗汗。如《丹溪心法》所说：“盗汗者，谓睡而汗出也。不睡则不能汗出。方其熟睡也，凑凑然出焉，觉则止而不复出，非若自汗而自出也。”这就是盗汗的概念。而《证治准绳》将盗汗的病因病机归结为：各种致病因素“伤损阴血，衰惫形气。阴气既虚，不能配阳，于是阳气内蒸，外为盗汗”。不论夜晚还是白天，入睡（寐）则属阴，阴虚则阳旺，“阳加于阴谓之汗”。（《素问·阴阳别论》）结合临床验证，外感病的盗汗多属于邪气留恋少阳，而内伤杂病的盗汗多属于阴虚，属于气虚或阳虚或湿热者比较少见。
学员甲：盗汗这一症状，古今医书确实大多归责于阴虚内热，阳气失于潜藏，而以滋阴降火、潜阳镇摄作为正治方法。但本例患儿多次使用当归六黄汤、知柏地黄汤等滋阴降火，又配合潜阳镇摄药物，为什么缺乏疗效呢？
老师：当归六黄汤、知柏地黄汤等，寒凉降火有余，而滋脾敛肝不足。用于成人还可以，用于以“脾弱肝旺”为病理特征的小儿，则不太契合。如果投药两三天不见起色，还错误地认为药力未到而继续使用，用到五六剂，恐怕难免损伤脾胃的担忧。观察本例患儿，虽然夜间发热盗汗，但其他一系列症状，并没有明显的内热或火旺的迹象；其舌质淡红，苔薄白欠润，脉弦缓，也不是明显的内热或火旺之象，且其服药无效是显而易见的。
学员乙：所谓“脾弱肝旺”，是指小儿杂病的一般病理，并不是盗汗这一症状的具体病理。但患儿服用滋脾敛肝、潜摄浮阳的资生汤加味后，效果确实很好，是什么道理？
老师：一般性寓于特殊性之中。盗汗这一症状，固然是阴亏液耗，阳气失于潜藏所致，但阴阳失去平衡的根源在哪里呢？观察本例患儿，除了夜间发热盗汗这一症状之外，还伴有精神疲倦想睡觉，形体消瘦面色晦暗，黑眼球带绿色，口干喜欢喝水，食欲差，大便干燥等一系列症状。这一系列症状可以用“脾弱肝旺”四个字来概括。所谓“脾弱”，具体而言，这里是指脾阴不足；脾阴不足，则滋生阴精的功能必然减弱，从而导致身形困顿。所谓“肝旺”，亦具体而言，这里是指肝阴不足，肝中所藏的相火因此偏旺；肝旺，不仅乘袭脾土，而且消耗阴精的机会也增多。这就是患儿身形困顿与夜间发热盗汗同时出现的根本原因。而身形越困顿，夜间发热盗汗越严重，反之亦然，形成了一种恶性循环。要想切断这种恶性循环，就必须以滋脾敛肝为主。这样治本，自然疗效佳良。
老师：资生汤是近代名医张锡纯治疗阴虚劳热的第一方，记载于《医学衷中参西录》第一册。我一向认为本方的主要功效是滋补脾阴。方中重用生山药大补脾阴，辅以白术健运脾气（脾阴虚多伴有脾气虚，宜气阴同补）；佐以生鸡内金（鸡的脾胃），不但取其消食化积，更取其以脾胃补养脾胃；又用玄参退虚热，大力子润肺滑肠通便。我在原方基础上加白芍以敛肝，丹皮、地骨皮辅助玄参退虚热，龙骨、牡蛎潜摄浮阳。
老师：运用机会很多。我治疗小儿盗汗，几乎必用此方加味，驾轻就熟，屡用不衰。有一位乡村医生祝某，说他的小孩8岁，盗汗2个月，多次使用滋阴潜阳方药未愈，特意来索要一方。我当即写下此方加味，他看了，流露出不相信的神态。我说“试服2剂无妨”。不久他来告知说，“果然服2剂盗汗即止”！如果服数剂后盗汗减少但未全止，可加仙鹤草30克；如果盗汗兼有自汗，可加黄芪15-30克。
老师：有。如清代陈修园治疗盗汗，喜用“莲枣马豆汤”，方中莲米、大枣、马料豆便是滋补脾阴的药物。又如清代林佩琴治疗盗汗，喜用“益阴汤”，即在六味地黄汤滋补肾阴的基础上，加麦冬、莲米滋补脾阴，白芍、五味子敛肝，地骨皮退虚热，灯蕊引热下行。这2首处方我都做过一些临床验证，其疗效均不如资生汤加味理想。
实习生乙：患儿盗汗已痊愈，还用生山药、生鸡内金做药膳连服1个月，是否有此必要？
老师：很有必要。因为盗汗虽初愈，但患儿脾阴不足的病根仍然存在，所以必须继续滋养脾阴，充实其生化之源，才能防止复发。生山药虽是寻常食物，但其味甘归脾，能大滋脾阴，且色白入肺，液浓入肾，又能润肺滋肾；少佐生鸡内金消导，运化其补益之力，则久服也不会产生满闷之感；加白糖令其适口，患儿必喜食。张锡纯治疗阴气虚损的多种疾病，常以此法善后，值得借鉴。而张氏的经验亦有所本——本于《内经》“食养尽之”四字。这确实是一条行之有效的康复之道。
高热7天
四川省乐山市人民医院中医研究室主任余国俊
陈X，男，10岁，1985年8月2日初诊。
患儿7天前因游泳时间过长，又遭雨淋，导致恶寒发热，无汗，全身酸软，咽微痛，测体温39℃。先服用银翘散加香薷2剂无效。又肌注柴胡针、穿虎宁，口服扑热息痛、六神丸、穿心莲等，全身出汗，热势渐退，但数小时后高热又起，乃收入急诊观察室。经查血、胸透，未见异常。西医诊断为“上呼吸道感染”，以输液（药用氨苄青霉素、维生素等）为主，配服解热镇痛药，仍然热退复热，体温有时高达40.5℃。又加服紫雪丹希望其退高热，也缺乏疗效。前后高热7天，进食甚少，日渐羸弱。经儿科会诊，决定用激素。家长极力阻止，而惶惶然前来邀请诊治。刻诊：患儿仰卧病床，面容消瘦少华，唇红而燥，汗少，微恶寒，微咳，额头热身热，手足冷，精神萎靡不振，时而烦躁不安，大便3日未行，口干思饮，咽微红，舌红，苔薄白微黄欠润，脉紧数。体温39.5℃。此为风寒自表入里化热，三阳合病之证，治宜疏风散寒，清透里热。用柴葛解肌汤加味：柴胡25克，葛根30克，白芷10克，羌活10克，桔梗10克，生甘草5克，白芍10克，黄芩6克，生石膏50克，连翘10克，钩藤10克，地龙6克。1剂。煎服法：用水500毫升，先煎生石膏半小时，纳余药，文火煎10分钟；再纳钩藤，煎3分钟。滤取药液约300毫升，每次服60毫升，半小时服1次。诊毕，已是下午3时。效果：服药4次后，全身开始微微汗出，高热渐退；至下午4时服完全部药液后，曾大便1次，质软；至11时热已退尽，体温36.8℃。当夜安睡未醒，次晨体温正常。乃改予竹叶石膏汤2剂以善后。从此未再发热，嘱其注意饮食调理，身体逐渐康复。
实习生甲：本例患儿感冒高热7天，正值盛夏季节，为什么不考虑暑热为患，而用清暑解表法呢？
老师：暑邪感冒必挟湿，除了暑湿郁遏卫阳而发高热之外，暑湿困顿中焦之症也很明显，如脘腹痞闷，甚至吐泻等。
实习生乙：教材上说小儿感冒一般分为风寒、风热、暑邪3种，本例既不属于暑邪感冒，那么是属于风寒还是风热感冒？
老师：高热已7天，已难凿分风寒与风热。客观地说，小儿体禀稚阴稚阳，体质尚未完全定型。所以小儿感冒高热，纯属风寒或风热者比较少见，而以外寒内热或“寒包热”者居多。古人称为“客寒包火”，也是这个意思。此与成人感冒高热是有所差异的。
实习生乙：那么我再提两个问题：第一，本例内热症状很明显，但外寒症状并不明显；第二，大便3日未解，为什么不用泻下药？
老师：不明显不等于没有。如微恶寒，汗少，苔薄白微黄，脉带紧象等，都是外寒未解之象。临床上要充分注意外寒，不要一见高热，就忽视了外寒的存在，更不要用体温表来判断寒热。至于大便3日未解，但并无腹胀或腹痛而拒按等腑实症征，怎么能用泻下药呢？
实习生丙：小儿感冒高热的病机与成人有所差异，那么治法也应有所差异了？
老师：是的。小儿感冒高热多属“寒包热”，若纯用辛温发汗（麻黄汤、荆防败毒散之类），则外寒虽去，而内热复炽；纯用辛凉清解（桑菊饮、银翘散之类），则外寒留恋，内热亦无出路。实践证明，惟主用辛温配辛寒，开通玄府，清透蕴热，辅以枢转升提，引热外出，佐以酸甘化阴，和营泄热，且先安未受邪之地，才能“毕其功于一役”。而柴葛解肌汤就与这种法度十分符合，所以退小儿感冒高热十分迅速而平稳，经得起重复。
学员甲：明代，陶华创制的柴葛解肌汤，载于《伤寒六书》。其方由柴胡、葛根、白芷、羌活、生石膏、桔梗、黄芩、白芍、甘草、生姜、大枣11味药组成，用以代替葛根汤，治疗太阳阳明经病——恶寒渐轻，身热增盛，头痛肢楚，目痛鼻干，心烦不眠，眼眶胀痛等症。分析该方的药物组成，并不完全符合你刚才所讲的那种法度，你却说完全符合。你的说法有什么根据呢？
老师：古今医书解释柴葛解肌汤，大多注重于单味药物的性味功效，而很少从复方的化合、协同作用角度去理解。我认为本方配伍高明之处，在于以“药对”的形式，巧妙地取法或浓缩五个复方，汲其精华而创制出新的复方。但制方者却含而不露，引而不发。我的分析是：羌活——石膏，辛温配辛寒，师法大青龙汤，发越恋表的风寒，清透内蕴的实热；葛根——白芷，轻清扬散，有升麻葛根汤意，善解阳明肌肉之热；柴胡——黄芩，寓小柴胡汤，旋转少阳枢机，引领邪热外出；桔梗——甘草，即桔梗甘草汤，轻清上浮，盖除胸膈、咽嗌的浮热；白芍——甘草，即芍药甘草汤，酸甘化阴，和营泄肌腠的郁热。综合来看，柴葛解肌汤一方，因其取法或浓缩以上5个复方在内，故能同时兼顾外感邪热的表、里和半表半里三个病理层次，从而发越之、清透之、引领之，直令邪热无所遁形。我临床反复体验，深知使用本方时若剂量、加味恰当，煎服得法，最善退小儿上呼吸道感染引起的高热，且一般不会热退复热。
实习生甲：请具体说说本方的剂量、加味和煎服法。
老师：方中羌活、石膏、柴胡、葛根4味药必须用。羌活用3～10克，生石膏重用30克以上，两者比例为1：5～1：10，柴胡不少于25克，葛根不少于30克，其余药物用常规剂量。本方加味：咽痛明显加射干6克、马勃10克；挟暑加香薷10克、滑石15克；挟食加炒莱菔子10克；挟惊加钩藤、地龙各10克，本例虽未挟惊，但高热7天，竟达40.5℃，为防惊厥，故也加用。煎法：生石膏先煎半小时，余药用武火急煎10分钟，只取头煎。服法：小儿苦于服药，如按常规口服3次；每次摄入量不足，间隔时间太长，退热必迟。我初用本方时，也曾走过这种弯路。后来改用少量频服法，小儿容易接受，摄入总量充足，药力也时时相继。据观察多例，一般在服第一次药后约2小时开始微微汗出，高热渐渐消退。服1～2剂，待体温恢复正常后，转用竹叶石膏汤益气生津，续清余热以善后。
学员乙：本例感冒高热7天，曾连续使用多种中、西药物，仍然热退复热，山穷水尽，不得已想打激素这张王牌。真是无路可走了吗？这是值得引起反思的！
老师：确实值得反思。临床上似乎有一种倾向，就是治疗小儿感冒高热，绝对忌用辛温药物，而以桑菊饮、银翘散作为枕中鸿秘。更有个别医生，一见高热，不细察病因病机、体质状况，就匆匆以退热药、抗生素打头阵，辅以银花、板蓝根、大青叶等苦寒药作后援，或滥用含糖量很高的各种“冲剂”。迁延几天，高热不退，病家惶惶不安，医生方寸也乱。于是紫雪丹、至宝丹、安宫牛黄丸等营血分药物也被冒冒失失地推上第一线，也有打出激素王牌的。这种治病“风俗”，教训不少，为害非轻，亟须吸取教训“移风易俗”。
双下肢瘫痪14天
四川省乐山市人民医院中医研究室主任余国俊
张XX，男，36岁，农民，1986年10月24日诊。
Case 1: Night Sweats for 2 Years
The pediatric patient suffered from night sweats (night sweats, sweating during sleep) for 2 years. There was low-grade fever at night; whole-body sweating occurred upon falling asleep and ceased upon waking. The sweat felt cold and sticky to the touch. Sometimes the sweating was excessive, soaking inner clothes and pants. Inspection revealed: mental fatigue with a desire to sleep, emaciated body with a sallow complexion, greenish tint in the black part of the eyes (pupil/iris), dry mouth with a preference for drinking, poor appetite, dry stool, pale red tongue with thin white coating that lacked moisture, and a wiry-slow pulse. X-ray fluoroscopy showed normal lungs. Western medicine diagnosed malnutrition and zinc deficiency, but long-term treatment was ineffective. Previously, Danggui Liu Huang Tang (Cinnamon Twig and Six-Herb Decoction) and Zhibai Dihuang Tang (Anemarrhena and Rehmannia Decoction) were taken intermittently along with drugs for subduing yang and securing essence (subduing floating yang and anchoring spirit) for over 20 doses, also without effect. The parents had lost confidence in treatment. Hearing that the "Jiang Erxun Advanced Class" opened a specialized outpatient clinic for difficult cases, they specifically came to try it. Based on the pediatric patient's symptoms, tongue, and pulse, it was directly diagnosed as a syndrome of Spleen Yin deficiency with Liver hyperactivity and floating Yang. The treatment method proposed was to nourish the Spleen Yin, restrain the Liver, and subdue floating Yang. Zhang Xichun's Zisheng Tang (Nourishing Life Decoction) was prescribed with modifications: Raw Dioscorea Rhizome (Shanyao) 30g, Scrophularia Root (Xuanshen) 15g, Atractylodes Macrocephala Rhizome (Baizhu) 10g, Raw Chicken Gizzard Lining (Jineijin) 6g, Arctium Fruit (Niu Bangzi) 6g (stir-fried and crushed), White Peony Root (Baishao) 10g, Raw Dragon Bone (Longgu) 30g, Raw Oyster Shell (Muli) 30g, Moutan Cortex (Danpi) 10g, Groundcherry Root Bark (Digupi) 10g. Total 6 doses. Second visit (September 27): After taking 2 doses, night fever and night sweats significantly reduced; after finishing 6 doses, they stopped. Appetite improved, mouth no longer dry, bowel movements smooth, tongue pale red with thin white coating, pulse slow. Prescription: Raw Dioscorea Rhizome 900g, Raw Chicken Gizzard Lining 30g, ground together into an extremely fine powder. Use 30g every morning, cook into porridge, adjust taste with white cane sugar, take continuously for 1 month. Follow-up half a year later: Night fever and night sweats did not recur, facial appearance and eye color returned to normal.
Intern Jia: Medical books state that night sweats mostly belong to Yin deficiency, which is reasonable. Because night belongs to Yin, sweating during sleep is naturally Yin deficiency. But some patients also sweat incessantly during daytime naps; does this also belong to Yin deficiency?
Teacher: First, one must clarify the concept of night sweats. Whether at night or during the day, as long as sweating occurs upon falling asleep and ceases upon waking, it is night sweats. As stated in *Danxi Xinfa*: "Night sweats refer to sweating while sleeping. Without sleep, there is no sweating. While in deep sleep, it comes out quietly; upon awakening, it stops and does not reappear, unlike spontaneous sweating which flows out on its own." This is the concept of night sweats. *Zhengzhi Zhunsheng* attributes the etiology and pathogenesis of night sweats to: various pathogenic factors "damaging Yin blood, exhausting form and Qi. Since Yin Qi is deficient, it cannot match Yang, thus Yang Qi steams internally and manifests externally as night sweats." Whether at night or during the day, sleep (entering sleep) belongs to Yin; Yin deficiency leads to Yang hyperactivity, and "when Yang acts upon Yin, it becomes sweat" (*Suwen: Lun Yu Yin Yang Bie Lun*). Clinical verification shows that night sweats in exogenous diseases mostly belong to pathogens lingering in the Shaoyang channel, while night sweats in endogenous miscellaneous diseases mostly belong to Yin deficiency; those belonging to Qi deficiency, Yang deficiency, or Damp-Heat are relatively rare.
Student Jia: Indeed, ancient and modern medical books mostly attribute night sweats to internal heat due to Yin deficiency and Yang failing to be anchored, making nourishing Yin and descending fire, along with subduing Yang and securing essence, the standard treatment. But why did this pediatric patient fail to respond to multiple uses of Danggui Liu Huang Tang and Zhibai Dihuang Tang for nourishing Yin and descending fire, combined with drugs for subduing Yang and securing essence?
Teacher: Danggui Liu Huang Tang and Zhibai Dihuang Tang have excess cold and bitter properties to descend fire but lack sufficient ability to nourish Spleen Yin and restrain the Liver. They may be acceptable for adults, but are not well-suited for children whose pathological characteristic is "Spleen weakness and Liver hyperactivity." If no improvement is seen after two or three doses, mistakenly believing the medicinal power has not yet taken effect and continuing use, by five or six doses, there is a risk of damaging the Spleen and Stomach. Observing this pediatric patient, although there was night fever and night sweats, the other series of symptoms showed no obvious signs of internal heat or fire hyperactivity; the pale red tongue, thin white moist-deficient coating, and wiry-slow pulse were also not obvious signs of internal heat or fire hyperactivity, making the ineffectiveness of the medication evident.
Student Yi: The so-called "Spleen weakness and Liver hyperactivity" refers to the general pathology of miscellaneous diseases in children, not the specific pathology of night sweats. But after the patient took Zisheng Tang modified to nourish Spleen Yin, restrain the Liver, and subdue floating Yang, the effect was indeed excellent. What is the reason?
Teacher: Generality resides within specificity. Night sweats, undoubtedly, are caused by Yin fluid depletion and Yang failing to be anchored, but where lies the root cause of the imbalance between Yin and Yang? Observing this pediatric patient, besides night fever and night sweats, there were also a series of symptoms: mental fatigue with a desire to sleep, emaciated body with sallow complexion, greenish tint in the eyes, dry mouth with preference for drinking, poor appetite, and dry stool. This series of symptoms can be summarized by the four characters "Spleen weakness and Liver hyperactivity." The so-called "Spleen weakness," specifically, refers here to Spleen Yin insufficiency; Spleen Yin insufficiency inevitably weakens the function of generating Yin essence, leading to physical exhaustion. The so-called "Liver hyperactivity," specifically, refers here to Liver Yin insufficiency, causing the Ministerial Fire stored in the Liver to become hyperactive; Liver hyperactivity not only insults the Spleen but also increases opportunities to consume Yin essence. This is the fundamental reason for the simultaneous occurrence of physical exhaustion and night fever with night sweats in the patient. The more exhausted the body, the worse the night fever and night sweats, and vice versa, forming a vicious cycle. To break this vicious cycle, one must focus mainly on nourishing Spleen Yin and restraining the Liver. Treating the root in this way naturally yields good results.
Student Bing: There are many prescriptions conforming to the method of nourishing Spleen Yin and restraining the Liver; why choose Zisheng Tang exclusively?
Teacher: Zisheng Tang is the primary formula used by the modern famous doctor Zhang Xichun for treating Yin deficiency with labor fever, recorded in Volume 1 of *Yixue Zhongzhong Canxi Lu*. I have always believed that the main efficacy of this formula is to nourish Spleen Yin. In the formula, Raw Dioscorea Rhizome is heavily used to greatly nourish Spleen Yin, assisted by Atractylodes Macrocephala Rhizome to strengthen and transport Spleen Qi (Spleen Yin deficiency often accompanies Spleen Qi deficiency, so Qi and Yin should be tonified simultaneously); assisted by Raw Chicken Gizzard Lining (the stomach of the chicken), not only for its ability to digest food and resolve accumulation, but also to use the stomach to nourish the stomach; further using Scrophularia Root to clear deficiency heat, and Arctium Fruit to moisten the Lungs and lubricate the intestines to relieve constipation. On the basis of the original formula, I added White Peony Root to restrain the Liver, Moutan Cortex and Groundcherry Root Bark to assist Scrophularia Root in clearing deficiency heat, and Dragon Bone and Oyster Shell to subdue floating Yang.
Student Ding: Is the application of Zisheng Tang modified for treating pediatric night sweats frequent?
Teacher: The opportunity for application is high. In my treatment of pediatric night sweats, I almost invariably use this modified formula, handling it with ease and achieving consistent success. A rural doctor named Zhu told me his 8-year-old child had night sweats for 2 months, unresponsive to repeated use of formulas for nourishing Yin and subduing Yang, and specifically came to request a prescription. I immediately wrote down this modified formula. He looked at it with skepticism. I said, "Try taking 2 doses, it won't hurt." Soon he reported back, "Indeed, after taking 2 doses, the night sweats stopped!" If after several doses the night sweats decrease but do not completely stop, add Agrimony Herba (Xianhecao) 30g; if night sweats are accompanied by spontaneous sweating, add Astragalus Root (Huangqi) 15-30g.
Student Yi: Did ancient doctors also consider Spleen Yin when treating night sweats?
Teacher: Yes. For example, Chen Xiuyuan of the Qing Dynasty liked to use "Lian Zao Ma Dou Tang" for treating night sweats; Lotus Seed (Lianmi), Jujube (Dazao), and Horse Bean (Maliaodou) in the formula are drugs that nourish Spleen Yin. Similarly, Lin Peiqin of the Qing Dynasty liked to use "Yiyin Tang" for treating night sweats, which adds Ophiopogon Tuber (Maidong) and Lotus Seed to nourish Spleen Yin on the basis of Liuwei Dihuang Tang nourishing Kidney Yin, White Peony Root and Schisandra Berry (Wuweizi) to restrain the Liver, Groundcherry Root Bark to clear deficiency heat, and Rheedea Spike (Dengxinjie) to guide heat downward. I have conducted some clinical verification on these two prescriptions, and their efficacy was not as ideal as Zisheng Tang modified.
Intern Yi: The pediatric patient's night sweats have healed; is it necessary to continue taking Raw Dioscorea Rhizome and Raw Chicken Gizzard Lining as medicated diet for 1 month?
Teacher: It is very necessary. Although the night sweats have just healed, the root cause of Spleen Yin insufficiency still exists, so it is necessary to continue nourishing Spleen Yin and enriching its source of generation to prevent recurrence. Raw Dioscorea Rhizome, although a common food, has a sweet flavor entering the Spleen and can greatly nourish Spleen Yin; its white color enters the Lungs, and its thick fluid enters the Kidneys, thus also moistening the Lungs and nourishing the Kidneys; adding a little Raw Chicken Gizzard Lining aids digestion and guides the movement of its tonifying power, so long-term use will not cause fullness or stuffiness; adding white cane sugar makes it palatable, and the child will surely enjoy eating it. Zhang Xichun often used this method for follow-up care in treating various diseases of Yin Qi deficiency, which is worth learning from. And Zhang's experience also has its basis—in the four characters "complete dietary therapy" from *Neijing*. This is indeed an effective path to recovery.
Case 2: High Fever for 7 Days
Yu Guojun, Director of the Traditional Chinese Medicine Research Office, Leshan People's Hospital, Sichuan Province
Chen X, Male, 10 years old, First consultation on August 2, 1985.
Seven days ago, the pediatric patient swam for too long and was caught in the rain, resulting in aversion to cold and fever, absence of sweating, whole-body soreness and weakness, slight throat pain, and a measured temperature of 39°C. Initially, Yinqiao San (Honeysuckle and Forsythia Powder) plus Elsholtzia Herb (Xiangru) for 2 doses was taken without effect. Then Chaihu Injection and Chuanning Injection were administered intramuscularly, and Paracetamol, Liushen Wan, and Andrographis Herba (Chuanxinlian) were taken orally. Whole-body sweating occurred, and the fever gradually subsided, but high fever returned hours later, leading to admission to the emergency observation room. Blood tests and chest fluoroscopy showed no abnormalities. Western medicine diagnosed "Upper Respiratory Tract Infection," primarily treating with infusion (Ampicillin, Vitamins, etc.) and antipyretics/analgesics. However, the fever returned after subsiding, sometimes reaching up to 40.5°C. Zixue Dan (Purple Snow Pill) was added hoping to reduce the high fever, also without effect. High fever persisted for 7 days, with very little food intake, becoming increasingly emaciated. After pediatric consultation, hormones were decided upon. The parents strongly objected and anxiously sought TCM consultation. Current examination: The patient lay supine on the bed, face emaciated and lacking luster, lips red and dry, scant sweating, slight aversion to cold, slight cough, hot forehead and body, cold hands and feet, listless spirit, occasional restlessness, no bowel movement for 3 days, dry mouth with desire to drink, slightly red pharynx, red tongue, thin white coating slightly yellow and lacking moisture, tight-rapid pulse. Temperature 39.5°C. This is a syndrome of Wind-Cold transforming into Heat from the exterior to the interior, involving the Taiyang, Yangming, and Shaoyang channels (Three Yang Combined Disease). The treatment should be to disperse Wind and scatter Cold, and clear and diffuse interior Heat. Chai Ge Jie Ji Tang (Bupleurum and Pueraria Decoction to Release the Muscles) was prescribed with modifications: Bupleurum Root (Chaihu) 25g, Kudzu Root (Gegen) 30g, Angelica Dahurica Root (Baizhi) 10g, Notopterygium Rhizome (Qianghuo) 10g, Platycodon Root (Jiegeng) 10g, Raw Licorice Root (Gancao) 5g, White Peony Root (Baishao) 10g, Scutellaria Root (Huangqin) 6g, Raw Gypsum (Shigao) 50g, Forsythia Fruit (Lianqiao) 10g, Uncaria Ramulus cum Uncis (Gouteng) 10g, Earthworm (Dilong) 6g. 1 dose. Decoction and administration method: Use 500ml water, decoct Raw Gypsum first for half an hour, then add remaining herbs, simmer gently for 10 minutes; then add Uncaria Ramulus, decoct for 3 minutes. Filter to obtain approximately 300ml of liquid medicine, take 60ml each time, every half hour. The consultation ended at 3 PM. Effect: After taking the medicine 4 times, the whole body began to sweat slightly, and high fever gradually subsided; after finishing all the liquid medicine by 4 PM, there was one bowel movement, soft consistency; by 11 PM, the fever had completely subsided, temperature 36.8°C. Slept peacefully through the night, normal temperature the next morning. Changed to Zhuye Shigao Tang (Leaf and Gypsum Decoction) for 2 doses for follow-up care. No further fever since then, advised attention to dietary regulation, and the body gradually recovered.
Intern Jia: This pediatric patient had a cold with high fever for 7 days, right in the midsummer season. Why not consider Summer-Heat pathogen and use the method of clearing Summer-Heat and releasing the exterior?
Teacher: Summer-Heat pathogen colds must be complicated with Dampness. Besides high fever caused by Summer-Dampness stifling and constraining Defensive Yang, symptoms of Summer-Dampness stagnating in the Middle Jiao are also very obvious, such as epigastric and abdominal fullness/stuffiness, even vomiting and diarrhea, etc.
Intern Yi: Textbooks state that pediatric colds are generally divided into Wind-Cold, Wind-Heat, and Summer-Heat types. Since this case does not belong to Summer-Heat cold, does it belong to Wind-Cold or Wind-Heat cold?
Teacher: With high fever for 7 days, it is difficult to rigidly distinguish between Wind-Cold and Wind-Heat. Objectively speaking, children possess immature Yin and Yang, and their constitution has not been fully established. Therefore, pediatric colds with high fever that are purely Wind-Cold or Wind-Heat are relatively rare, while those with Exterior Cold and Interior Heat or "Cold wrapping Heat" are predominant. Ancients called this "Guest Cold wrapping Fire," which means the same thing. This differs from adult colds with high fever.
Intern Yi: Then let me ask two more questions: First, the interior Heat symptoms in this case are very obvious, but the Exterior Cold symptoms are not obvious; second, the bowels have not moved for 3 days, why not use purgative drugs?
Teacher: Not obvious does not mean absent. Such as slight aversion to cold, scant sweating, thin white coating slightly yellow, pulse with a tight quality, etc., are all signs that Exterior Cold has not resolved. Clinically, one must pay full attention to Exterior Cold; do not ignore the existence of Exterior Cold just because of high fever, and certainly do not judge Cold and Heat solely by a thermometer. As for the bowels not moving for 3 days, but without abdominal distension or pain with refusal to press (signs of Fu-organ excess), how can purgative drugs be used?
Intern Bing: The pathogenesis of high fever in pediatric colds differs from adults, so should the treatment methods also differ?
Teacher: Yes. Pediatric colds with high fever mostly belong to "Cold wrapping Heat." If purely using Acrid-Warm diaphoretics (like Mahuang Tang or Jingfang Baidu San), although Exterior Cold is removed, Interior Heat flares up again; if purely using Acrid-Cool clearing and resolving agents (like Sangju Yin or Yinqiao San), Exterior Cold lingers, and Interior Heat has no outlet. Practical experience proves that only by primarily using Acrid-Warm combined with Acrid-Cold, opening the Xuefu (pores), clearing and diffusing accumulated Heat, assisting with pivoting and lifting to guide Heat outward, assisting with Sour-Sweet transforming Yin, harmonizing Ying and draining Heat, and first calming areas not yet affected by pathogens, can "the task be accomplished in one stroke." Chai Ge Jie Ji Tang conforms very well to this method, so it reduces high fever in pediatric colds very rapidly and steadily, standing up to repetition.
Student Jia: Ming Dynasty, Tao Hua created Chai Ge Jie Ji Tang, recorded in *Shanghan Liushu*. Its formula consists of 11 herbs: Bupleurum Root, Kudzu Root, Angelica Dahurica Root, Notopterygium Rhizome, Raw Gypsum, Platycodon Root, Scutellaria Root, White Peony Root, Licorice Root, Ginger, and Jujube. It is used to replace Gegen Tang to treat Taiyang-Yangming channel disease—symptoms like gradually lightening aversion to cold, increasing body heat, headache and limb discomfort, eye pain and nasal dryness, vexation and insomnia, orbital swelling and pain, etc. Analyzing the composition of this formula, it does not completely conform to the method you just described, yet you say it completely conforms. What is the basis for your statement?
Teacher: Ancient and modern medical books explaining Chai Ge Jie Ji Tang mostly focus on the nature, flavor, and efficacy of individual herbs, and rarely understand it from the perspective of compound combination and synergistic effects. I believe the brilliance of this formula's compatibility lies in cleverly adopting or concentrating five compound formulas in the form of "herb pairs," extracting their essence to create a new compound formula. But the formula creator kept it hidden and unrevealed. My analysis is: Qianghuo–Shigao, Acrid-Warm combined with Acrid-Cold, following the method of Da Qing Long Tang, releasing Wind-Cold lingering on the exterior and clearing/diffusing interior Excess Heat; Gegen–Baizhi, light and clear ascending and dispersing, having the intent of Shengma Gegen Tang, excellently resolving Yangming muscle heat; Chaihu–Huangqin, containing Xiao Chai Hu Tang, rotating the Shaoyang pivot, guiding pathogenic Heat outward; Jiegeng–Gancao, i.e., Jiegeng Gancao Tang, light and clear ascending, covering/removing floating Heat in the chest/diaphragm and pharynx; Baishao–Gancao, i.e., Shaoyao Gancao Tang, Sour-Sweet transforming Yin, harmonizing Ying and draining stagnant Heat in muscles and pores. Comprehensive view: Chai Ge Jie Ji Tang, because it adopts or concentrates the above 5 compound formulas within it, can simultaneously address the exterior, interior, and half-exterior/half-interior pathological levels of exogenous pathogenic Heat, thereby releasing it, clearing/diffusing it, and guiding it, leaving the pathogenic Heat nowhere to hide. Through repeated clinical experience, I deeply know that when using this formula, if dosage and modifications are appropriate, and decoction/administration methods are correct, it is best at reducing high fever caused by upper respiratory tract infections in children, and generally does not result in fever returning after subsiding.
Intern Jia: Please specifically discuss the dosage, modifications, and decoction/administration method of this formula.
Teacher: Qianghuo, Shigao, Chaihu, and Gegen, these 4 herbs in the formula must be used. Qianghuo use 3–10g, Raw Gypsum heavily use 30g or more, the ratio between the two is 1:5 to 1:10, Chaihu not less than 25g, Gegen not less than 30g, remaining herbs use conventional dosages. Modifications to this formula: Add Shegan (Belamcanda Rhizome) 6g and Bobo (Parasitic Mushroom Spore) 10g for obvious throat pain; add Xiangru (Elsholtzia Herb) 10g and Huashi (Talcum) 15g if complicated with Summer-Heat; add Chao Laifuzi (Stir-fried Radish Seed) 10g if complicated with Food Retention; add Gouteng (Uncaria Ramulus) and Dilong (Earthworm) 10g each if complicated with Fright. Although this case was not complicated with Fright, due to high fever for 7 days reaching 40.5°C, to prevent convulsions, they were also added. Decoction method: Raw Gypsum decocted first for half an hour, remaining herbs decocted urgently with strong fire for 10 minutes, only taking the first decoction. Administration method: Children suffer from taking medicine; if taken orally 3 times conventionally; each intake is insufficient, interval time is too long, fever reduction will definitely be slow. When I first used this formula, I also walked this detour. Later changed to small-dose frequent-administration method, which children accept easily, total intake is sufficient, and medicinal power is continuous. According to observation of multiple cases, generally about 2 hours after taking the first dose, slight sweating begins, and high fever gradually subsides. Take 1–2 doses, after temperature returns to normal, switch to Zhuye Shigao Tang to benefit Qi and generate fluids, continuing to clear residual Heat for follow-up care.
Student Yi: This case of cold with high fever for 7 days, continuously used multiple Chinese and Western medicines, still fever returned after subsiding, at the end of the road, reluctantly wanting to play the hormone trump card. Is there really no way out? This is worth reflecting upon!
Teacher: Indeed worth reflecting. There seems to be a tendency in clinical practice: absolutely avoiding Acrid-Warm drugs for treating pediatric colds with high fever, and regarding Sangju Yin and Yinqiao San as secret treasures. Even more, some doctors, seeing high fever, without carefully examining etiology/pathogenesis and constitution, hastily start with antipyretics and antibiotics, supported by bitter-cold drugs like Jin Yin Hua (Honeysuckle Flower), Banlangen (Isatis Root), Da Qing Ye (Isatis Leaf), etc., or abuse various granules with very high sugar content. After dragging on for a few days, high fever does not subside, families are anxious, doctors lose composure. Thus, Ying-Blood level drugs like Zixue Dan, Zhibao Dan, Angong Niuhuang Wan are rashly pushed to the frontline, and some even play the hormone trump card. This "custom" of treating disease has many lessons, causes significant harm, and urgently needs to learn lessons and "change customs."
Case 3: Paralysis of Both Lower Limbs for 14 Days
Yu Guojun, Director of the Traditional Chinese Medicine Research Office, Leshan People's Hospital, Sichuan Province
Zhang XX, Male, 36 years old, Farmer, Consultation on October 24, 1986.