张 六十八岁 甲子十一月二十五日 舌黄,口渴,头不痛而恶寒,面赤,目赤,脉洪
热甚,形似伤寒,实乃冬温夹痰饮,与伏暑一类。
连翘(六钱) 桔梗(八钱) 杏仁(六钱) 荆芥穗(五钱) 银花(六钱) 甘草(三钱) 半
夏(八钱) 广皮(三钱) 郁金(三钱) 通草(三钱) 藿梗(七钱)
共为粗末,分七包,一时许服一包,芦根汤煎。
二十六日 前方内减 荆芥穗 通草
二十七日 余热未清。
连翘(三钱) 杏仁(三钱) 知母(二钱,炒) 桔梗(三钱) 薄荷(一钱) 小生地(三钱)
黄芩(钱半) 甘草(一钱) 银花(二钱)
水五杯,煮两杯,二次服。二帖。
二十九日 温病渴甚,热甚,面赤甚,脉洪甚。
杏仁(五钱) 生甘草(三钱) 半夏(四钱) 银花(五钱) 石膏(八钱) 连翘(六钱) 郁
金(二钱) 荆芥穗(三钱) 薄荷(三钱) 桔梗(五钱)
三十日 温病最忌食复,况年老气血已衰,再复则难治矣口渴甚,痰多,胁痛,前方加
∶
香附(一钱)
煮三杯,分三次服。二帖。
初一日 大势已退,余热尚存,仍须清淡数日,无使食复。
细生地(五钱) 麦冬(五钱) 连翘(三钱) 银花(三钱) 丹皮(二钱) 甘草(二钱) 元
参(二钱) 黄芩(钱半)
头煎二杯,二煎一杯,分三次服。
初二日 脉洪滑,于前方内加∶
半夏(三钱)
某 三月二十二日 脉不浮而细数,大渴欲饮,大汗,里不足之热病也,用玉女煎法。
生石膏(一两) 甘草(三钱) 桑叶(三钱) 知母(四钱) 麦冬(五钱) 细生地(五钱)
粳米(一撮)
二十三日 温热大渴大汗,脉数,昨用玉女煎法,诸证俱减,平素有消渴病,服昨药后
,大便稀溏,加牡蛎。一面护阴,一面收下。
生石膏(五钱) 炒知母(二钱) 炙甘草(三钱) 大生地(五钱) 麦冬(五钱) 京米(一
撮) 牡蛎(一两)
某 初一日 冬温,脉沉细之极,舌赤,面赤,谵语,大便闭,邪机纯然在血分之里,
与润下法。
元参(六钱) 元明粉(一钱) 细生地(六钱) 麦冬(六钱,连心) 生大黄(五钱) 丹皮
(三钱) 生甘草(二钱)
煮三杯,先服一杯,得便,止后服,汤药之先,先服牛黄清心丸二丸。
初三日 冬温,谵语神昏,皆误表之故,邪在心包,宜急急速开膻中,不然则内闭外脱
矣。
大便闭,面正赤,昨与润下法未通,经谓下不通,非细故也。得药则呕,忌甘也。先与牛黄
清心丸二三丸,以开膻中,继以大承气汤,攻阳明之实。
生大黄(八钱) 元明粉(三钱) 枳实(四钱) 浓朴(二钱) 元参(八钱) 丹皮(五钱)
煮三杯,得便则止,不便再服。
患者张,六十八岁。甲子年十一月二十五日就诊:舌苔黄,口渴,头痛不明显但怕冷,面色红,眼睛红,脉象洪大。
热势很重,症状看似伤寒,实际上是冬温夹杂痰饮,与伏暑属于同一类病证。
处方:连翘(六钱)、桔梗(八钱)、杏仁(六钱)、荆芥穗(五钱)、金银花(六钱)、甘草(三钱)、半夏(八钱)、广陈皮(三钱)、郁金(三钱)、通草(三钱)、藿香梗(七钱)。
将上述药材共捣为粗末,分成七包,每隔约一小时服用一包,用芦根汤煎煮。
二十七日:余热尚未清除。
处方:连翘(三钱)、杏仁(三钱)、知母(二钱,炒制)、桔梗(三钱)、薄荷(一钱)、生地黄(三钱)、黄芩(钱半)、甘草(一钱)、金银花(二钱)。
用水五杯,煮取两杯,分两次服用。共两帖。
二十九日:温病口渴严重,热势重,面色红赤严重,脉象洪大严重。
处方:杏仁(五钱)、生甘草(三钱)、半夏(四钱)、金银花(五钱)、石膏(八钱)、连翘(六钱)、郁金(二钱)、荆芥穗(三钱)、薄荷(三钱)、桔梗(五钱)。
三十日:温病最忌讳因饮食不当导致复发,何况患者年老气血已衰,若再复发则难以治疗。现口渴严重,痰多,胁肋疼痛,在前方中加入:
香附(一钱)。
煮取三杯,分三次服用。共两帖。
十二月初一日:大势已退,余热尚存,仍需清淡饮食数日,避免饮食复发。
处方:细生地(五钱)、麦冬(五钱)、连翘(三钱)、金银花(三钱)、牡丹皮(二钱)、甘草(二钱)、玄参(二钱)、黄芩(钱半)。
头煎取两杯,二煎取一杯,分三次服用。
十二月初二日:脉象洪滑,在前方中加入:
半夏(三钱)。
另一位患者,三月二十二日就诊:脉象不浮而细数,极度口渴想喝水,大汗出,这是里气不足的热病,采用玉女煎法治疗。
处方:生石膏(一两)、甘草(三钱)、桑叶(三钱)、知母(四钱)、麦冬(五钱)、细生地(五钱)、粳米(一撮)。
三月二十三日:温热病导致极度口渴、大汗,脉数,昨日使用玉女煎法后,各种症状都减轻了。该患者平素有消渴病(糖尿病),服用昨日药物后,大便稀溏,加入牡蛎。一方面保护阴液,一方面收敛止泻。
处方:生石膏(五钱)、炒知母(二钱)、炙甘草(三钱)、大生地(五钱)、麦冬(五钱)、京米(一撮)、牡蛎(一两)。
另一位患者,初一日就诊:冬温,脉象沉细至极,舌质红赤,面色红赤,胡言乱语,大便闭塞,邪气完全在血分的深层,给予润下法治疗。
处方:玄参(六钱)、元明粉(一钱)、细生地(六钱)、麦冬(六钱,带心)、生大黄(五钱)、牡丹皮(三钱)、生甘草(二钱)。
煮取三杯,先服用一杯,若大便通畅,则停止后续服用。在服用汤药之前,先服用牛黄清心丸两丸。
初三日:冬温,胡言乱语、神志昏迷,都是误用发汗解表法造成的后果,邪气在心包络,应当紧急快速开通膻中穴区域的气机,否则就会内闭外脱。
大便闭塞,面色正红,昨日给予润下法但未通便,经书说下法不通,不是小问题。服药后呕吐,是因为忌用甘味药。先给牛黄清心丸二三丸,以开通膻中,继以大承气汤,攻逐阳明腑实。
处方:生大黄(八钱)、元明粉(三钱)、枳实(四钱)、浓朴(二钱)、玄参(八钱)、牡丹皮(五钱)。
煮取三杯,若大便通畅则停药,若不畅通再服用。
Patient Zhang, 68 years old. On the 25th day of the 11th month in the Jiazi year: Yellow tongue coating (Huang Tai), thirst, no significant headache but aversion to cold (E Han), red face, red eyes, surging pulse (Hong Mai).
The heat is severe; the presentation resembles Cold Damage (Shang Han), but it is actually Winter-Warmth (Dong Wen) complicated by phlegm-fluid retention, belonging to the same category as latent summer-heat (Fu Shu).
Prescription: Lianqiao (Forsythiae Fructus, 6 qian), Jiegeng (Platycodonis Radix, 8 qian), Xingren (Armeniacae Semen Amarum, 6 qian), Jingjie Sui (Schizonepetae Spica, 5 qian), Yinhua (Lonicerae Japonicae Flos, 6 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 3 qian), Banxia (Pinelliae Rhizoma Preparatum, 8 qian), Guangpi (Citri Reticulatae Pericarpium, 3 qian), Yujin (Curcumae Radix, 3 qian), Tongcao (Tetrapanacis Medulla, 3 qian), Huo Geng (Agastachis Herba, 7 qian).
Grind all ingredients into coarse powder, divide into seven packets. Take one packet every hour or so, decocted with Reed Rhizome Decoction (Lugen Tang).
On the 26th: Remove Jingjie Sui and Tongcao from the previous prescription.
On the 27th: Residual heat has not yet cleared.
Prescription: Lianqiao (Forsythiae Fructus, 3 qian), Xingren (Armeniacae Semen Amarum, 3 qian), Zhimu (Anemarrhenae Rhizoma, 2 qian, stir-fried), Jiegeng (Platocodonis Radix, 3 qian), Bohe (Menthae Haplocalycis Herba, 1 qian), Xiao Shengdi (Rehmanniae Radix Preparata, 3 qian), Huangqin (Scutellariae Radix, 1.5 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 1 qian), Yinhua (Lonicerae Japonicae Flos, 2 qian).
Decoct five cups of water to yield two cups, take twice. Two doses.
On the 29th: Warm disease with severe thirst, severe heat, severe redness of the face, and severely surging pulse.
Prescription: Xingren (Armeniacae Semen Amarum, 5 qian), Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma, 3 qian), Banxia (Pinelliae Rhizoma Preparatum, 4 qian), Yinhua (Lonicerae Japonicae Flos, 5 qian), Shigao (Gypsum Fibrosum, 8 qian), Lianqiao (Forsythiae Fructus, 6 qian), Yujin (Curcumae Radix, 2 qian), Jingjie Sui (Schizonepetae Spica, 3 qian), Bohe (Menthae Haplocalycis Herba, 3 qian), Jiegeng (Platocodonis Radix, 5 qian).
On the 30th: Warm diseases most strictly forbid recurrence due to dietary indiscretion. Moreover, given the patient's advanced age and depleted Qi and Blood, recurrence would be difficult to treat. Present symptoms: severe thirst, profuse phlegm, hypochondriac pain. Add to the previous prescription:
Xiangfu (Cyperi Rhizoma, 1 qian).
Decoct to yield three cups, take in three divided doses. Two doses.
On the 1st day of the next month: The major pathogenic factors have subsided, but residual heat remains. Maintain a light diet for several days to prevent recurrence due to diet.
Prescription: Xi Shengdi (Prepared Rehmanniae Radix, 5 qian), Maidong (Ophiopogonis Tuber, 5 qian), Lianqiao (Forsythiae Fructus, 3 qian), Yinhua (Lonicerae Japonicae Flos, 3 qian), Danpi (Moutan Cortex, 2 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 2 qian), Yuanshen (Scrophulariae Radix, 2 qian), Huangqin (Scutellariae Radix, 1.5 qian).
First decoction yields two cups, second decoction yields one cup, take in three divided doses.
On the 2nd day of the next month: Pulse is surging and slippery. Add to the previous prescription:
Banxia (Pinelliae Rhizoma Preparatum, 3 qian).
Another patient, on March 22nd: Pulse is not floating but fine and rapid, extreme thirst with desire to drink, profuse sweating. This is a heat disease due to insufficiency of interior Qi. Treat using the method of Yü Nü Jian (Jade Woman Decoction).
Prescription: Sheng Shigao (Raw Gypsum Fibrosum, 1 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 3 qian), Sangye (Mori Folium, 3 qian), Zhimu (Anemarrhenae Rhizoma, 4 qian), Maidong (Ophiopogonis Tuber, 5 qian), Xi Shengdi (Prepared Rehmanniae Radix, 5 qian), Jingmi (Oryza Sativa, a pinch).
On March 23rd: Warm-heat disease causing extreme thirst and profuse sweating, rapid pulse. Yesterday, Yü Nü Jian was used, and all symptoms decreased. The patient has a chronic history of Xiao Ke (Wasting-Thirst Disease). After taking yesterday's medicine, loose stools occurred. Add Muli (Ostrea Concha). One aspect protects Yin, another aspect astringes and stops diarrhea.
Prescription: Sheng Shigao (Raw Gypsum Fibrosum, 5 qian), Chao Zhimu (Stir-fried Anemarrhenae Rhizoma, 2 qian), Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma, 3 qian), Da Shengdi (Large Prepared Rehmanniae Radix, 5 qian), Maidong (Ophiopogonis Tuber, 5 qian), Jingmi (Oryza Sativa, a pinch), Muli (Ostrea Concha, 1 liang).
Another patient, on the 1st day: Winter-warmth, pulse is extremely deep and fine, red tongue body, red face, delirium, constipation. The pathogen is entirely in the interior of the Blood level. Apply the moistening purgative method.
Prescription: Yuanshen (Scrophulariae Radix, 6 qian), Yuanmingfen (Natrii Sulfas, 1 qian), Xi Shengdi (Prepared Rehmanniae Radix, 6 qian), Maidong (Ophiopogonis Tuber, 6 qian, with heart), Sheng Dahuang (Raw Rhei Radix et Rhizoma, 5 qian), Danpi (Moutan Cortex, 3 qian), Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma, 2 qian).
Decoct to yield three cups. Take one cup first; if stool passes, stop subsequent administration. Before taking the decoction, first take two pills of Niuhuang Qingxin Wan (Calculus Bovis Clear Heart Pill).
On the 3rd day: Winter-warmth, delirium and coma are due to previous erroneous use of diaphoresis (sweating methods). The pathogen is in the Pericardium (Xin Bao). Urgently open the Shanzhong (Chest Center) area. Otherwise, internal closure and external collapse will occur.
Constipation, bright red face. Yesterday, the moistening purgative method was given but did not unblock the bowels. The Classics state that failure to purge via the lower pathway is no minor matter. Vomiting after taking medicine indicates an intolerance to sweet flavors. First administer two or three pills of Niuhuang Qingxin Wan to open the Shanzhong, followed by Da Chengqi Tang (Major Order the Qi Decoction) to attack the excess in the Yangming.
Prescription: Sheng Dahuang (Raw Rhei Radix et Rhizoma, 8 qian), Yuanmingfen (Natrii Sulfas, 3 qian), Zhishi (Aurantii Fructus Immaturus, 4 qian), Nongpo (Magnoliae Officinalis Cortex, 2 qian), Yuanshen (Scrophulariae Radix, 8 qian), Danpi (Moutan Cortex, 5 qian).
Decoct to yield three cups. Stop if stool passes; if not, take again.