暑湿协热下痢
夏××，男，卅五岁，干部。1959年。
初诊：因素嗜烟酒，湿热内伏，适当夏秋之交，过食生冷油腻，又感暑邪，发病头痛身疼，恶冷发烧。胸闷不适，欲呕，便泻不畅，一日数行，溺短赤，口燥思饮。曾服发散消导剂，证情不减。继下利赤白，昼夜四、五十行，里急后重，痛楚呻吟。脉浮数，左关弦右关濡。舌红，苔黄燥厚腻。此暑邪内陷，与湿相搏，协热作利。法拟清暑祛湿，理气化滞。处方：
藿香梗6克粉葛根12克炒杭芍9克炒黄芩6克云黄
连4．5克(吴萸水炒) 焦山查9克 炒谷、麦芽各9克 槟
榔9克 广木香3克车前草9克黑木耳9克益元散12克
二诊：服药后，夜得微汗，次日恶寒已罢，发热较退，头身疼痛减轻，胸闷渐舒。下利仍频，红多白少。舌红，苔黄腻少滓。切脉浮濡均减，关仍弦滞。此暑邪得解，湿热积滞未清，续拟下方：
粉葛根12克 藿香梗6克 炒黄连3克 炒黄芩6克 炒大
黄9克 炒杭芍9克 焦楂炭9克 银花炭9克 广木
香3克 炒鸡金6克 黑木耳9克
三诊：服上方后，下利日四、五行，较畅，兼有燥屎数枚。腹痛及里急后重大减。发热退，尚觉口燥思饮。能进稀粥。此湿热将化，积滞已消。脉转细弦，舌红苔薄，续拟下方：
当归尾9克赤白芍各9克 炒黄连3克炒黄芩6克广
木香3克 波蔻6克(冲) 白茯苓12克 红饭豆15克(冲) 车
前仁6克炒鸡金6克 黑木耳9克
四诊：上方连进三剂，下利、腹痛、里急后重等诸症消失。脉细缓，舌淡润，神倦体弱。乃病后气血不足，拟下方调理：
全当归15克 炒杭芍9克 白茯苓12克 金石斛9克 广木
香3克 红饭豆12克(冲) 波蔻6克(冲) 生甘草3克 莲子
肉12克 炒玉米、老米各12克 苏条参12克 炒淮药12克
[按]首重清暑祛湿，理气化滞；继以通导解毒，活血疏调。后病退正虚，用归、芍、条参、淮药、石斛、莲子等品，养益气血及肝脾。
暑热痢(小儿菌痢)
姚× ×，男，五岁。1972年6月。在某医院会诊。
患儿发热月余不退，下痢赤白粘液，日廿余行。口燥，唇焦，腹部胀满，不思饮食。干呕，咳嗽，小便短赤。大便培养，检出痢疾杆菌。午后体温40—41。c。面色发青：神识昏迷，病情急剧，举行中西会诊。
诊脉浮数，左关弦，右关濡滞，舌质红，苔黄少津。触诊腹满而痛，周身肌肤火热。是盛夏伤暑之势，内经云。“因于暑，汗烦则喘咳，静则多言，体若燔炭……”。而暑湿互滞，下注魄门，遂成是证。治则解暑清热，消滞理气。处方：
藿香梗4．5克 粉葛根6克 炒大黄2．4克 炒云连1．5克炒
黄芩4．5克 广木香2．4克炒杭芍6克车前草6克 生甘
草2．4克
二诊：上方服一剂得汗，神识渐清，体温降至38—39。c，下痢减半，腹胀痛均舒，小便短黄，肤热较退，仍咳。脉象弦滞，舌红，苔淡黄。此暑邪得解，胃肠积滞未清，续拟下方：
粉葛根6克 炒云连2．4克 炒黄芩4．5克广木香2．4克 冲
波蔻3克焦山查6克 车前子6克 莱菔子4．5克(炒冲)
苏梗片4．5克 炒赤白芍各4．5克 烧鸡金1枚
三诊：热退神清，体温37—38。C下痢日五、六行，色转黄，小便清长。咳稀，稍能进食。诊脉细弦而滑，舌淡苔薄。续拟下方：
粉葛根4．5克 广木香2．4克 冲波蔻3克 白茯苓9克红
饭豆9克 烧鸡金1枚 云黄连2．4克(吴萸水炒) 炒莱菔
子3克 炒赤白芍各4．5克 广子片4．5克 甘草2．4克
四诊：上方服二剂，下痢全止，大便日一行，化验：痢疾杆菌消失。食眠转佳，余症皆除。脉调、舌润。拟方调理二剂出院。处方：
苏条参9克 漂白术6克 白茯苓9克 炒杭芍6克广木
香2．4克西砂仁3克 生甘草3克 全当归6克 炒玉米、
老米各6克
[按]稚阳之体，暑湿为痢，法拟清解，外疏内畅，药剂轻灵。
风寒夹饮喘咳
孙××，男，三十六岁。1950年7月。
初诊：患者素有喘疾，加感表邪，恶寒发热，咳逆气促，痰吐泡沫。胸满脘闷，时作干呕，不思饮食。头目眩晕，小便不利。脉象浮紧而兼滑数，舌苔白腻而润。此小青龙证也，自宜辛温解表，化饮降逆，祛痰止咳。处方：
麻黄9克 桂枝9克 光杏仁9克 杭芍9克 法夏9克
北细辛3克 五味3克 陈皮6克 炒厚朴9克 干姜9克
甘草3克
二诊：上方服二剂，寒热解，喘咳大减。脉细弦而滑，舌苔白润。痰多头眩，干呕气逆，小便不利。此表解，饮停于中，当以温阳蠲饮，化痰利湿。处方：
茯苓15克 桂枝9克 白术12克 甘草3克 法夏9克 陈
皮6克厚朴9克杏仁9克生姜2片 大枣3枚
三诊：上方连服三剂，咳喘已平，心下舒畅，痰少。食增，小便通利。神倦自汗，脉缓舌润。此病退而脾肺不足。
转投六君，以治其源。
苏条参15克 白术12克 茯苓15克 甘草3克 法夏9克
陈皮6克 五味3克 生姜2片 大枣3枚
[按]伤寒论：“夫病痼疾，加以卒病，当先治其丰病，后乃除其痼疾也。”本案先散表寒，次蠲停饮，后健脾肺，程序井然。
喘 咳(热型、寒型)
刘××，男，七十二岁。1968年春季。
初诊：患者咳嗽多年，秋冬尤甚。去冬因天冷冒寒，引起咳嗽，昼夜不休，进而烦躁喘促，夜难平卧。痰吐黄稠，有时咯血。每日午后即恶寒发烧，口燥思饮，食欲减少，大便秘，小便赤，由子女背负来我院门诊。脉象浮紧，舌黄燥少津。此属阴虚肺燥，风寒伏热。治宜散寒解表，清肺化热。拟方麻杏石甘汤加味：
麻绒9克杏仁9克 生石膏12克 甘草3克 苏梗9克
炒黄芩6克 桑叶9克 桔梗6克 炒枳壳9克 鸡金2枚
(炒) 竹茹9克
二诊：服昨方得汗，发热渐退，稍可平卧，仍咳嗽喘促，痰凝带血。大便已通，小便尚黄。能略进稀粥。脉象弦滑而数，舌黄有津。证属表寒已解，肺燥、伏热未净，续用元麦白虎汤加味。处方：
白元参9克 麦门冬9克 炒知母6克 生石膏15克 白茅
根15克 冬桑叶9克 川贝母9克 枇杷叶3片 淡竹
叶9克生甘草3克
三诊：上方连服二帖后，烧热全退，咳嗽减轻，咯血已止，仍有痰凝。喘促渐平，夜可静卧。饮食增加，二便通利。惟神倦头昏，身软无力。脉细滑，舌淡黄有津。症属病退脾弱阴虚肺燥，续用下方调理四、五剂而愈。处方。
肥沙参9克麦门冬9克炒杭芍9克茯苓神15克炙冬
花9克炙远志6克建莲子15克黑小豆15克炙甘草3克
枇杷叶3片
喘 咳(寒型)
黄××，男，七十岁。某厂矿退休工人。1968年。
初诊：患者病已月余，初起畏寒，身困，头眩，咳嗽，痰吐泡沫，继之咳嗽加重，痰凝气滞，动则胸满喘促，心悸气短，夜不能卧，面、足微浮。大便溏，小便清。曾服中药杏苏饮、二陈汤、麻辛附子汤，用过西药四环素、土霉素、氨茶碱，注射青、链霉素针水，均无效。来我院门诊。诊见舌苔白润，脉浮滑而弦。症属表寒外束。痰饮内滞。治则：温肺散寒，止咳定喘。方用小青龙汤加味：
麻黄9克 桂枝9克 法半夏9克 细辛3克 炒杭芍9克
五昧子3克杏仁9克川厚朴6克生甘草3克 生姜3片
大枣3枚
二诊。服前方二剂，咳嗽稍平，白痰仍多，自觉心悸，气短，胸闷，肢冷，恶寒。面足尚浮，夜难入睡，饮食少，二便如前。脉濡滑，苔薄白润。此表寒解后，阳虚脾弱，肺风痰饮未净，拟仿金匮治痰饮法，投苓桂术甘汤加味。处方：
白茯苓18克 桂枝木9克 白术12克 生甘草3克 法半
夏9克 广陈皮6克 生姜2片 大枣3枚
三诊。上方服两剂，咳已稀，痰涎减，思饮食。但神倦思睡，动则喘促，面足仍现轻度浮肿。脉濡缓，两尺沉细，舌自淡。此属痰饮渐消。老年心肾阳虚作喘，用真武汤加味，服十余剂后，症遂平缓。
川附片30克(开水先煨透) 白术12克白茯苓15克广陈皮6克
炒杭芍9克生甘草3克生姜3片 大枣5枚
[姚按]老年咳喘一证(包括现代医学的老年慢性支气管炎)，必须根据辨证的方法按四诊八纲来分型论治，才能达到预期的疗效。上述两例，前者属“热型”， 后者属“寒型”。二位老年病人的脉象、舌苔、证候，在临床上有显著的不同，因而处方用药，也就有很大的差异。两案寒热不同。立法处方，皆出仲景，又须因人因病制宜。
【背景信息】
书名：姚贞白医案 章节：正文(7/20) 类别：医论
暑湿协热下痢
患者夏某某，男性，35岁，干部。1959年就诊。
初诊：因平素嗜好烟酒，导致湿热内伏，适逢夏秋之交，又过食生冷油腻之物，并感受暑邪，发病后出现头痛、身体疼痛、怕冷、发烧。胸闷不适，想呕吐，大便泻下不畅，一天数次，小便短少色赤，口干想喝水。曾服用发散解表和消食导滞的药物，病情未见减轻。随后出现下利赤白脓血，昼夜达四五十次，伴有里急后重（腹痛窘迫，时时欲便，肛门重坠，便出不爽），痛苦呻吟。脉象浮数，左关脉弦，右关脉濡。舌质红，苔黄燥且厚腻。此为暑邪内陷，与湿邪相搏结，协同热邪导致下利。治法拟定为清暑祛湿，理气化滞。处方：
藿香梗6克，粉葛根12克，炒杭芍9克，炒黄芩6克，云黄连4.5克（用吴茱萸水炒制），焦山楂9克，炒谷芽和麦芽各9克，槟榔9克，广木香3克，车前草9克，黑木耳9克，益元散12克。
二诊：服药后，夜间微微出汗，次日恶寒已止，发热较前减退，头身疼痛减轻，胸闷逐渐舒缓。下利仍然频繁，脓血中红色多于白色。舌质红，苔黄腻且津液较少。切脉浮濡之象均减轻，但关脉仍显弦滞。此为暑邪已解，但湿热积滞未清，继续拟定下方：
粉葛根12克，藿香梗6克，炒黄连3克，炒黄芩6克，炒大黄9克，炒杭芍9克，焦山楂炭9克，银花炭9克，广木香3克，炒鸡内金6克，黑木耳9克。
三诊：服用上方后，下利每日四至五次，较为通畅，兼有少量干硬粪便排出。腹痛及里急后重感大幅减轻。发热退去，但仍觉口干想喝水。能进食稀粥。此为湿热将化，积滞已消。脉象转为细弦，舌红苔薄，继续拟定下方：
当归尾9克，赤芍和白芍各9克，炒黄连3克，炒黄芩6克，广木香3克，白豆蔻6克（冲服），白茯苓12克，红饭豆15克（冲服），车前仁6克，炒鸡内金6克，黑木耳9克。
四诊：上方连续服用三剂，下利、腹痛、里急后重等症状全部消失。脉象细缓，舌淡润，精神疲倦，体质虚弱。这是病后气血不足，拟定下方进行调理：
全当归15克，炒杭芍9克，白茯苓12克，金石斛9克，广木香3克，红饭豆12克（冲服），白豆蔻6克（冲服），生甘草3克，莲子肉12克，炒玉米和老米各12克，苏条参12克，炒淮山药12克。
[按语]首诊重在清暑祛湿，理气化滞；继以通导解毒，活血疏调。后因病退正虚，使用当归、白芍、党参、淮山药、石斛、莲子等药物，滋养补益气血及肝脾。
暑热痢（小儿菌痢）
患者姚某某，男性，5岁。1972年6月在某医院会诊。
患儿发热一个多月不退，下痢赤白粘液，每天二十多次。口干，嘴唇焦裂，腹部胀满，不思饮食。干呕，咳嗽，小便短少色赤。大便培养检出痢疾杆菌。午后体温高达40—41℃。面色发青，神识昏迷，病情急剧，举行中西医会诊。
诊脉浮数，左关脉弦，右关脉濡滞，舌质红，苔黄少津。触诊腹部胀满而痛，周身肌肤火热。这是盛夏伤暑的态势，《内经》说：“因于暑，汗烦则喘咳，静则多言，体若燔炭……”。而暑湿互结停滞，下注于肛门，遂成此证。治疗原则为解暑清热，消滞理气。处方：
藿香梗4.5克，粉葛根6克，炒大黄2.4克，炒云连1.5克，炒黄芩4.5克，广木香2.4克，炒杭芍6克，车前草6克，生甘草2.4克。
二诊：上方服用一剂后得汗，神识逐渐清醒，体温降至38—39℃，下利减半，腹胀痛均缓解，小便短黄，皮肤发热较退，仍有咳嗽。脉象弦滞，舌红，苔淡黄。此为暑邪已解，胃肠积滞未清，继续拟定下方：
粉葛根6克，炒云连2.4克，炒黄芩4.5克，广木香2.4克，冲服白豆蔻3克，焦山楂6克，车前子6克，莱菔子4.5克（炒后冲服），苏梗片4.5克，炒赤芍和白芍各4.5克，烧鸡内金1枚。
三诊：热退神清，体温37—38℃，下利每日五至六次，颜色转黄，小便清长。咳嗽减少，稍能进食。诊脉细弦而滑，舌淡苔薄。继续拟定下方：
粉葛根4.5克，广木香2.4克，冲服白豆蔻3克，白茯苓9克，红饭豆9克，烧鸡内金1枚，云黄连2.4克（用吴茱萸水炒制），炒莱菔子3克，炒赤芍和白芍各4.5克，广陈皮片4.5克，甘草2.4克。
四诊：上方服用两剂，下利完全停止，大便每日一行，化验显示痢疾杆菌消失。饮食睡眠转佳，其余症状皆除。脉象调和，舌面润泽。拟定方剂调理两剂后出院。处方：
苏条参9克，漂白术6克，白茯苓9克，炒杭芍6克，广木香2.4克，西砂仁3克，生甘草3克，全当归6克，炒玉米和老米各6克。
[按语]小儿稚阳之体，患暑湿痢，治法拟定为清解，外疏内畅，药剂轻灵。
风寒夹饮喘咳
患者孙某某，男性，36岁。1950年7月就诊。
初诊：患者素有喘疾，加之感受表邪，出现恶寒发热，咳嗽气逆气促，痰吐泡沫。胸满脘闷，时常干呕，不思饮食。头目眩晕，小便不利。脉象浮紧而兼滑数，舌苔白腻而润。此为小青龙汤证，自宜辛温解表，化饮降逆，祛痰止咳。处方：
麻黄9克，桂枝9克，光杏仁9克，杭芍9克，法半夏9克，北细辛3克，五味子3克，陈皮6克，炒厚朴9克，干姜9克，甘草3克。
二诊：上方服用两剂，寒热解除，喘咳大减。脉象细弦而滑，舌苔白润。痰多头晕，干呕气逆，小便不利。此为表证已解，饮邪停于中焦，当以温阳蠲饮，化痰利湿。处方：
茯苓15克，桂枝9克，白术12克，甘草3克，法半夏9克，陈皮6克，厚朴9克，杏仁9克，生姜2片，大枣3枚。
三诊：上方连续服用三剂，咳喘已平，心下舒畅，痰少。食欲增加，小便通利。精神疲倦，自汗，脉缓舌润。此为病退而脾肺不足。
转投六君子汤，以治其本源。
苏条参15克，白术12克，茯苓15克，甘草3克，法半夏9克，陈皮6克，五味子3克，生姜2片，大枣3枚。
[按语]《伤寒论》云：“夫病痼疾，加以卒病，当先治其卒病，后乃除其痼疾也。”本案先散表寒，次蠲除停饮，后健脾肺，程序井然有序。
喘咳（热型、寒型）
患者刘某某，男性，72岁。1968年春季就诊。
初诊：患者咳嗽多年，秋冬季节尤为严重。去年冬天因天冷受寒，引起咳嗽，昼夜不休，进而烦躁喘促，夜间难以平卧。痰吐黄稠，有时咯血。每日午后即恶寒发烧，口干想喝水，食欲减少，大便秘结，小便色赤，由子女背负来我院门诊。脉象浮紧，舌黄燥少津。此属阴虚肺燥，风寒伏热。治宜散寒解表，清肺化热。拟方麻杏石甘汤加味：
麻绒9克，杏仁9克，生石膏12克，甘草3克，苏梗9克，炒黄芩6克，桑叶9克，桔梗6克，炒枳壳9克，鸡内金2枚（炒），竹茹9克。
二诊：服用昨日方剂后得汗，发热渐退，稍可平卧，仍咳嗽喘促，痰凝带血。大便已通，小便尚黄。能略进稀粥。脉象弦滑而数，舌黄有津。证属表寒已解，肺燥、伏热未净，续用元麦白虎汤加味。处方：
白元参9克，麦门冬9克，炒知母6克，生石膏15克，白茅根15克，冬桑叶9克，川贝母9克，枇杷叶3片，淡竹叶9克，生甘草3克。
三诊：上方连续服用两帖后，烧热全退，咳嗽减轻，咯血已止，仍有痰凝。喘促渐平，夜间可静卧。饮食增加，二便通利。惟精神疲倦头昏，身软无力。脉细滑，舌淡黄有津。症属病退脾弱阴虚肺燥，续用下方调理四、五剂而愈。处方：
肥沙参9克，麦门冬9克，炒杭芍9克，茯苓神15克，炙款冬花9克，炙远志6克，建莲子15克，黑小豆15克，炙甘草3克，枇杷叶3片。
喘咳（寒型）
患者黄某某，男性，70岁。某厂矿退休工人。1968年就诊。
初诊：患者病已月余，初起畏寒，身困，头眩，咳嗽，痰吐泡沫，继之咳嗽加重，痰凝气滞，动则胸满喘促，心悸气短，夜间不能卧，面、足微浮。大便溏薄，小便清长。曾服中药杏苏饮、二陈汤、麻辛附子汤，用过西药四环素、土霉素、氨茶碱，注射青霉素、链霉素针剂，均无效。来我院门诊。诊见舌苔白润，脉浮滑而弦。症属表寒外束，痰饮内滞。治则：温肺散寒，止咳定喘。方用小青龙汤加味：
麻黄9克，桂枝9克，法半夏9克，细辛3克，炒杭芍9克，五味子3克，杏仁9克，川厚朴6克，生甘草3克，生姜3片，大枣3枚。
二诊：服用前方两剂，咳嗽稍平，白痰仍多，自觉心悸，气短，胸闷，肢冷，恶寒。面足尚浮，夜难入睡，饮食少，二便如前。脉濡滑，苔薄白润。此为表寒解后，阳虚脾弱，肺风痰饮未净，拟仿《金匮要略》治痰饮法，投苓桂术甘汤加味。处方：
白茯苓18克，桂枝木9克，白术12克，生甘草3克，法半夏9克，广陈皮6克，生姜2片，大枣3枚。
三诊：上方服用两剂，咳已稀少，痰涎减少，思饮食。但神倦思睡，动则喘促，面足仍现轻度浮肿。脉濡缓，两尺沉细，舌自淡。此属痰饮渐消。老年心肾阳虚作喘，用真武汤加味，服十余剂后，症遂平缓。
川附片30克（开水先煨透），白术12克，白茯苓15克，广陈皮6克，炒杭芍9克，生甘草3克，生姜3片，大枣5枚。
[姚按]老年咳喘一证（包括现代医学的老年慢性支气管炎），必须根据辨证的方法按四诊八纲来分型论治，才能达到预期的疗效。上述两例，前者属“热型”，后者属“寒型”。二位老年病人的脉象、舌苔、证候，在临床上有显著的不同，因而处方用药，也就有很大的差异。两案寒热不同，立法处方，皆出自张仲景，又须因人因病制宜。
Background Information
Book: Yao Zhenbai's Medical Cases Chapter: Main Text (7/20) Category: Medical Discourse
Dysentery with Summerheat-Dampness and Accompanying Heat
Patient Xia XX, Male, 35 years old, Cadre. Year 1959.
First Visit: Due to a long-term habit of smoking and drinking alcohol, damp-heat was latent within. Coinciding with the transition between summer and autumn, he consumed excessive raw, cold, and greasy foods, and contracted summerheat pathogen. The onset presented with headache, body ache, aversion to cold, and fever. He experienced chest tightness and discomfort, nausea, unsatisfactory diarrhea occurring several times a day, short and dark urine, dry mouth with desire to drink. He had taken diaphoretic and digestive-promoting agents, but the condition did not improve. Subsequently, he developed dysentery with red and white pus and blood, occurring forty to fifty times day and night, accompanied by tenesmus (urgency and straining with little passage), severe pain, and groaning. The pulse was floating and rapid; the left Guan position was wiry, and the right Guan position was soft. The tongue was red with a thick, greasy, yellow, and dry coating. This indicates summerheat pathogen sinking inward, struggling with dampness, and combining with heat to cause dysentery. The treatment principle is to clear summerheat, dispel dampness, regulate qi, and resolve stagnation. Prescription:
Huoxiang Geng (Patchouli Stem) 6g, Fengegen (Kudzu Root) 12g, Chao Hangshao (Stir-fried White Peony Root) 9g, Chao Huangqin (Stir-fried Scutellaria Root) 6g, Yunhuanglian (Cloud Coptis Rhizome) 4.5g (stir-fried with Evodia water), Jiaoshanzha (Charred Hawthorn Fruit) 9g, Chao Guya and Chao Maiya (Stir-fried Millet Sprout and Barley Sprout) each 9g, Binglang (Areca Seed) 9g, Guangmuxiang (Aucklandia Root) 3g, Cheqiancao (Plantago Herb) 9g, Heimuer (Black Wood Ear) 9g, Yiyuan San (Benefit Prime Powder) 12g.
Second Visit: After taking the medicine, slight sweating occurred at night. The next day, aversion to cold ceased, fever subsided somewhat, headache and body ache lessened, and chest tightness gradually relieved. Dysentery remained frequent, with more red than white discharge. The tongue was red with a thinning yellow-greasy coating indicating reduced fluids. The floating and soft pulse qualities decreased, but the Guan position remained wiry and stagnant. This indicates summerheat has been resolved, but damp-heat and accumulated stagnation remain uncleaned. Continue with the following prescription:
Fengegen (Kudzu Root) 12g, Huoxiang Geng (Patchouli Stem) 6g, Chao Huanglian (Stir-fried Coptis Rhizome) 3g, Chao Huangqin (Stir-fried Scutellaria Root) 6g, Chao Dahuang (Stir-fried Rheum Palmatum Root) 9g, Chao Hangshao (Stir-fried White Peony Root) 9g, Jiaozhaca Tan (Charred Charred Hawthorn) 9g, Yinjia Tan (Charred Lonicera Flower) 9g, Guangmuxiang (Aucklandia Root) 3g, Chao Jinji (Stir-fried Chicken Gizzard Lining) 6g, Heimuer (Black Wood Ear) 9g.
Third Visit: After taking the above prescription, dysentery occurred four to five times daily, more smoothly, with a few hard stools passed. Abdominal pain and tenesmus significantly reduced. Fever subsided, though dry mouth and desire to drink persisted. He could consume congee. This indicates damp-heat is transforming and stagnation is clearing. The pulse turned fine and wiry; the tongue was red with a thin coating. Continue with the following prescription:
Dangguiwei (Tail of Angelica Sinensis Root) 9g, Chi Shao and Bai Shao (Red and White Peony Roots) each 9g, Chao Huanglian (Stir-fried Coptis Rhizome) 3g, Chao Huangqin (Stir-fried Scutellaria Root) 6g, Guangmuxiang (Aucklandia Root) 3g, Bo Kou (Cardamom Seed) 6g (taken with liquid), Baifuling (White Poria) 12g, Hongfandou (Red Rice Bean) 15g (taken with liquid), Cheqianren (Plantago Seed) 6g, Chao Jinji (Stir-fried Chicken Gizzard Lining) 6g, Heimuer (Black Wood Ear) 9g.
Fourth Visit: After three doses of the above prescription, dysentery, abdominal pain, and tenesmus disappeared completely. The pulse was fine and slow; the tongue was pale and moist. Spirit was fatigued, and the physique was weak. This is deficiency of qi and blood after illness. Prescribe for regulation:
Quandanggui (Whole Angelica Sinensis Root) 15g, Chao Hangshao (Stir-fried White Peony Root) 9g, Baifuling (White Poria) 12g, Jinshihu (Dendrobium Stem) 9g, Guangmuxiang (Aucklandia Root) 3g, Hongfandou (Red Rice Bean) 12g (taken with liquid), Bo Kou (Cardamom Seed) 6g (taken with liquid), Sheng Gancao (Raw Licorice Root) 3g, Lianzirou (Lotus Seed Meat) 12g, Chao Yumi and Laomi (Stir-fried Corn and Old Rice) each 12g, Sutiaoshen (Codonopsis Root) 12g, Chao Huaiyao (Stir-fried Chinese Yam Rhizome) 12g.
[Commentary] The first visit focused on clearing summerheat, dispelling dampness, regulating qi, and resolving stagnation; subsequently, guiding out toxicity, activating blood, and regulating. Later, as the pathogen receded and righteousness weakened, herbs such as Danggui, Shaoyao, Tiaoshen, Huaiyao, Shihu, and Lianzi were used to nourish and tonify qi, blood, Liver, and Spleen.
Summerheat Dysentery (Pediatric Bacillary Dysentery)
Patient Yao XX, Male, 5 years old. June 1972. Consultation at a certain hospital.
The child had suffered from fever for over a month without resolution, presenting with dysentery of red and white mucus, occurring twenty-plus times daily. Dry mouth, cracked lips, abdominal distension, and anorexia. Dry retching, cough, and short dark urine. Stool culture identified dysentery bacilli. Post-prandial temperature reached 40–41°C. Complexion was cyanotic, consciousness was comatose, and the condition deteriorated rapidly, prompting a joint Chinese-Western medical consultation.
Pulse was floating and rapid; left Guan was wiry, right Guan was soft and stagnant. Tongue substance was red, coating yellow with scant fluids. Palpation revealed abdominal fullness and pain, with hot skin throughout the body. This reflects the pattern of summerheat injury in midsummer. As stated in the *Neijing*: "Due to summerheat, sweating causes irritability, panting, and cough; quietness leads to excessive talking; the body feels like burning charcoal..." Summerheat and dampness intermingled and stagnated, descending to the anus, thus forming this syndrome. The treatment principle is to resolve summerheat, clear heat, reduce stagnation, and regulate qi. Prescription:
Huoxiang Geng (Patchouli Stem) 4.5g, Fengegen (Kudzu Root) 6g, Chao Dahuang (Stir-fried Rheum Palmatum Root) 2.4g, Chao Yunlian (Stir-fried Cloud Coptis) 1.5g, Chao Huangqin (Stir-fried Scutellaria Root) 4.5g, Guangmuxiang (Aucklandia Root) 2.4g, Chao Hangshao (Stir-fried White Peony Root) 6g, Cheqiancao (Plantago Herb) 6g, Sheng Gancao (Raw Licorice Root) 2.4g.
Second Visit: After one dose of the above prescription, sweating occurred, consciousness gradually cleared, temperature dropped to 38–39°C, dysentery halved, abdominal distension and pain relieved, urine short and yellow, skin heat subsided, though cough persisted. Pulse was wiry and stagnant; tongue red with light yellow coating. This indicates summerheat resolved, but gastrointestinal stagnation remains uncleaned. Continue with the following prescription:
Fengegen (Kudzu Root) 6g, Chao Yunlian (Stir-fried Cloud Coptis) 2.4g, Chao Huangqin (Stir-fried Scutellaria Root) 4.5g, Guangmuxiang (Aucklandia Root) 2.4g, Bo Kou (Cardamom Seed) 3g (mixed in), Jiaoshanzha (Charred Hawthorn Fruit) 6g, Cheqianzi (Plantago Seed) 6g, Laifuzi (Radish Seed) 4.5g (stir-fried and mixed in), Sugeng Pian (Perilla Stem Slice) 4.5g, Chao Chi Bai Shao (Stir-fried Red and White Peony Roots) each 4.5g, Shao Jinji (Roasted Chicken Gizzard Lining) 1 piece.
Third Visit: Heat subsided, consciousness clear, temperature 37–38°C. Dysentery five to six times daily, color turned yellow, urine clear and abundant. Cough rare, able to eat slightly. Pulse fine, wiry, and slippery; tongue pale with thin coating. Continue with the following prescription:
Fengegen (Kudzu Root) 4.5g, Guangmuxiang (Aucklandia Root) 2.4g, Bo Kou (Cardamom Seed) 3g (mixed in), Baifuling (White Poria) 9g, Hongfandou (Red Rice Bean) 9g, Shao Jinji (Roasted Chicken Gizzard Lining) 1 piece, Yunhuanglian (Cloud Coptis Rhizome) 2.4g (stir-fried with Evodia water), Chao Laifuzi (Stir-fried Radish Seed) 3g, Chao Chi Bai Shao (Stir-fried Red and White Peony Roots) each 4.5g, Guangpi Pian (Citrus Peel Slice) 4.5g, Gancao (Licorice Root) 2.4g.
Fourth Visit: After two doses of the above prescription, dysentery stopped completely, bowel movement once daily. Lab test: dysentery bacilli disappeared. Eating and sleeping improved, other symptoms eliminated. Pulse harmonious, tongue moist. Prescribed two doses for regulation before discharge. Prescription:
Sutiaoshen (Codonopsis Root) 9g, Paibai Zhu (Bleached Atractylodes Rhizome) 6g, Baifuling (White Poria) 9g, Chao Hangshao (Stir-fried White Peony Root) 6g, Guangmuxiang (Aucklandia Root) 2.4g, Xisha Ren (Amomum Fruit) 3g, Sheng Gancao (Raw Licorice Root) 3g, Quandanggui (Whole Angelica Sinensis Root) 6g, Chao Yumi and Laomi (Stir-fried Corn and Old Rice) each 6g.
[Commentary] In children with tender yang constitution, summerheat-dampness causing dysentery requires a treatment principle of clearing and resolving, exterior dispersing and interior unblocking, using light and delicate herbal preparations.
Cough and Asthma with Wind-Cold and Fluid Retention
Patient Sun XX, Male, 36 years old. July 1950.
First Visit: The patient had a chronic history of asthma, compounded by contracting exterior pathogens. Symptoms included aversion to cold, fever, cough with rebellious qi and shortness of breath, expectoration of foamy sputum. Chest fullness and epigastric oppression, occasional dry retching, anorexia. Dizziness and vertigo, difficult urination. Pulse was floating, tight, and slippery-rapid; tongue coating was white, greasy, and moist. This is a Xiao Qing Long Tang (Minor Blue Dragon Decoction) pattern. It is appropriate to use acrid-warm methods to release the exterior, transform fluid retention, direct rebellious qi downward, and dispel phlegm to stop cough. Prescription:
Mahuang (Ephedra Herb) 9g, Guizhi (Cinnamon Twig) 9g, Guang Xingren (Apricot Kernel) 9g, Hangshao (White Peony Root) 9g, Fa Banxia (Prepared Pinellia Tuber) 9g, Bei Xixin (Asarum Root) 3g, Wuweizi (Schisandra Berry) 3g, Chenpi (Tangerine Peel) 6g, Chao Houpo (Stir-fried Magnolia Bark) 9g, Ganjiang (Dried Ginger) 9g, Gancao (Licorice Root) 3g.
Second Visit: After two doses of the above prescription, cold and fever resolved, cough and asthma greatly reduced. Pulse fine, wiry, and slippery; tongue coating white and moist. Profuse sputum, dizziness, dry retching, rebellious qi, difficult urination. This indicates the exterior is resolved, but fluid retention remains in the middle jiao. Treatment should warm yang, eliminate fluid retention, transform phlegm, and promote dampness drainage. Prescription:
Fuling (Poria) 15g, Guizhi (Cinnamon Twig) 9g, Baizhu (Atractylodes Macrocephala Rhizome) 12g, Gancao (Licorice Root) 3g, Fa Banxia (Prepared Pinellia Tuber) 9g, Chenpi (Tangerine Peel) 6g, Houpo (Magnolia Bark) 9g, Xingren (Apricot Kernel) 9g, Shengjiang (Fresh Ginger) 2 slices, Dazao (Jujube Fruit) 3 pieces.
Third Visit: After three consecutive doses of the above prescription, cough and asthma flattened, epigastric region felt comfortable, sputum reduced. Appetite increased, urination became smooth. Fatigue and spontaneous sweating, pulse slow, tongue moist. This indicates pathogen receding while Spleen and Lung are deficient.
Switch to Liu Jun Zi Tang (Six Gentlemen Decoction) to treat the root cause.
Sutiaoshen (Codonopsis Root) 15g, Baizhu (Atractylodes Macrocephala Rhizome) 12g, Fuling (Poria) 15g, Gancao (Licorice Root) 3g, Fa Banxia (Prepared Pinellia Tuber) 9g, Chenpi (Tangerine Peel) 6g, Wuweizi (Schisandra Berry) 3g, Shengjiang (Fresh Ginger) 2 slices, Dazao (Jujube Fruit) 3 pieces.
[Commentary] The *Shanghan Lun* states: "When a chronic disease is complicated by an acute disease, one should first treat the acute disease, then remove the chronic disease." In this case, exterior cold was dispersed first, then retained fluids were eliminated, followed by strengthening Spleen and Lung, proceeding in an orderly manner.
Cough and Asthma (Heat Type, Cold Type)
Patient Liu XX, Male, 72 years old. Spring 1968.
First Visit: The patient had suffered from cough for many years, worsening in autumn and winter. Last winter, due to cold weather and exposure to cold, cough began, continuing day and night, progressing to irritability, panting, and inability to lie flat at night. Expectoration of yellow, thick sputum, sometimes hemoptysis. Daily afternoon chills and fever, dry mouth with desire to drink, decreased appetite, constipation, dark urine. Brought to our outpatient clinic by his children. Pulse floating and tight; tongue yellow, dry with scant fluids. This belongs to yin deficiency with lung dryness, with wind-cold and latent heat. Treatment should disperse cold, release exterior, clear lung, and transform heat. Prescribe Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) modified:
Maurong (Processed Ephedra) 9g, Xingren (Apricot Kernel) 9g, Sheng Shigao (Raw Gypsum) 12g, Gancao (Licorice Root) 3g, Sugeng (Perilla Stem) 9g, Chao Huangqin (Stir-fried Scutellaria Root) 6g, Sangye (Mulberry Leaf) 9g, Jiegeng (Platycodon Root) 6g, Chao Zhike (Stir-fried Bitter Orange Fruit) 9g, Jinji (Chicken Gizzard Lining) 2 pieces (stir-fried), Zhuru (Bamboo Shavings) 9g.
Second Visit: After taking yesterday's prescription, sweating occurred, fever gradually subsided, able to lie down slightly, still coughing and panting, sputum sticky with blood. Bowels open, urine still yellow. Able to take some congee. Pulse wiry, slippery, and rapid; tongue yellow with fluids. Syndrome indicates exterior cold resolved, but lung dryness and latent heat remain. Continue with Yuanmai Baihu Tang (Yuan Paramelissa and White Tiger Decoction) modified. Prescription:
Bai Yuanshen (Rehmannia Root) 9g, Maidong (Ophiopogon Tuber) 9g, Chao Zhimu (Stir-fried Anemarrhena Rhizome) 6g, Sheng Shigao (Raw Gypsum) 15g, Bai Maogen (Imperata Rhizome) 15g, Dong Sangye (Winter Mulberry Leaf) 9g, Chuan Beimu (Fritillaria Cirrhosa Bulb) 9g, Pipaye (Loquat Leaf) 3 leaves, Danzhuye (Lophatherum Herb) 9g, Sheng Gancao (Raw Licorice Root) 3g.
Third Visit: After two doses of the above prescription, fever completely subsided, cough reduced, hemoptysis stopped, though sputum remains sticky. Panting gradually eased, able to sleep quietly at night. Diet increased, bowels and bladder smooth. Only fatigue, dizziness, and weakness remain. Pulse fine and slippery, tongue pale yellow with fluids. Syndrome indicates post-illness spleen weakness, yin deficiency, and lung dryness. Continue with the following prescription for regulation over four to five doses to achieve cure. Prescription:
Fei Shashen (Glehnia Root) 9g, Maidong (Ophiopogon Tuber) 9g, Chao Hangshao (Stir-fried White Peony Root) 9g, Fushen (Poria with Hostwood) 15g, Zhi Donghua (Honey-fried Kolkwitzia Flower) 9g, Zhi Yuanzhi (Honey-fried Polygala Root) 6g, Jian Lianzi (Lotus Seed) 15g, Heixiaodou (Black Soybean) 15g, Zhi Gancao (Honey-fried Licorice Root) 3g, Pipaye (Loquat Leaf) 3 leaves.
Cough and Asthma (Cold Type)
Patient Huang XX, Male, 70 years old. Retired worker from a certain factory. 1968.
First Visit: The patient had been ill for over a month. Initially, aversion to cold, body heaviness, dizziness, cough, expectoration of foamy sputum. Subsequently, cough worsened, sputum stagnated with qi obstruction, chest fullness and panting upon exertion, palpitations and shortness of breath, inability to sleep at night, mild edema of face and feet. Loose stools, clear urine. Previously took Chinese medicines Xing Su Yin, Er Chen Tang, Ma Xin Fu Zi Tang, and Western medicines Tetracycline, Oxytetracycline, Aminophylline, and injections of Penicillin and Streptomycin, all ineffective. Came to our outpatient clinic. Tongue coating white and moist, pulse floating, slippery, and wiry. Syndrome indicates exterior cold binding externally, phlegm-fluid retention internally. Treatment principle: Warm lung, disperse cold, stop cough, calm asthma. Formula: Xiao Qing Long Tang (Minor Blue Dragon Decoction) modified:
Mahuang (Ephedra Herb) 9g, Guizhi (Cinnamon Twig) 9g, Fa Banxia (Prepared Pinellia Tuber) 9g, Xixin (Asarum Root) 3g, Chao Hangshao (Stir-fried White Peony Root) 9g, Wuweizi (Schisandra Berry) 3g, Xingren (Apricot Kernel) 9g, Chuan Houpo (Magnolia Bark) 6g, Sheng Gancao (Raw Licorice Root) 3g, Shengjiang (Fresh Ginger) 3 slices, Dazao (Jujube Fruit) 3 pieces.
Second Visit: After two doses of the previous prescription, cough slightly eased, white sputum still profuse, subjective palpitations, shortness of breath, chest tightness, cold limbs, aversion to cold. Face and feet still edematous, difficulty sleeping at night, poor diet, bowels and bladder unchanged. Pulse soft and slippery, coating thin white and moist. This indicates after resolving exterior cold, yang deficiency and spleen weakness exist, with lingering lung wind-phlegm-fluid retention. Following the method for treating phlegm-fluid retention in *Jingui Yaolue*, prescribe Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) modified. Prescription:
Baifuling (White Poria) 18g, Guizhimu (Cinnamon Twig Heart) 9g, Baizhu (Atractylodes Macrocephala Rhizome) 12g, Sheng Gancao (Raw Licorice Root) 3g, Fa Banxia (Prepared Pinellia Tuber) 9g, Guang Chenpi (Broad-leaved Tangerine Peel) 6g, Shengjiang (Fresh Ginger) 2 slices, Dazao (Jujube Fruit) 3 pieces.
Third Visit: After two doses of the above prescription, cough became sparse, sputum reduced, appetite returned. However, fatigue and sleepiness, panting upon exertion, mild edema of face and feet persist. Pulse soft and slow, both Chi positions deep and fine, tongue naturally pale. This indicates phlegm-fluid retention gradually dissipating. For elderly heart-kidney yang deficiency causing asthma, prescribe Zhen Wu Tang (True Warrior Decoction) modified. After taking over ten doses, symptoms stabilized.
Chuan Fupian (Prepared Aconite Lateral Root) 30g (simmered thoroughly in boiling water first), Baizhu (Atractylodes Macrocephala Rhizome) 12g, Baifuling (White Poria) 15g, Guang Chenpi (Broad-leaved Tangerine Peel) 6g, Chao Hangshao (Stir-fried White Peony Root) 9g, Sheng Gancao (Raw Licorice Root) 3g, Shengjiang (Fresh Ginger) 3 slices, Dazao (Jujube Fruit) 5 pieces.
[Yao's Commentary] The syndrome of cough and asthma in the elderly (including modern medical senile chronic bronchitis) must be differentiated and treated according to the four diagnostic methods and eight principles to achieve expected efficacy. The above two cases, the former belongs to the "Heat Type," the latter to the "Cold Type." The pulse, tongue coating, and syndromes of these two elderly patients differ significantly in clinical practice, leading to substantial differences in prescription and medication. Although the two cases differ in cold and heat, their legislative principles and prescriptions derive from Zhang Zhongjing, yet must be adapted to the individual and the specific disease.