（附烂喉痧）
金（左） 春温疫疠之邪从内而发。发热咽痛，热势甚炽，遍身丹赤，痧点连片不分，咽痛外连颈肿。右脉
滑数左脉弦紧，舌红边尖满布赤点。此由温疫之邪，一发而便化为火，充斥内外蔓延三焦。丹也，痧也，
皆火也。刻当五日，邪势正盛，恐火从内窜，而致神昏发痉。拟咸寒泄热，甘凉保津。
犀尖（五分磨） 鲜生地（七钱） 粉丹皮（二钱） 大青叶（三钱） 金银花（二钱） 霜桑叶（一钱五分）
大力子（二钱） 黑玄参（三钱） 薄荷（五分） 金汁（五钱） 鲜茅芦根肉（各一两）
二诊 咸寒泄热，甘凉保津，丹痧较化，热亦稍轻。然咽中仍然肿痛，左耳下结块作胀，亦属火风所结。
大势稍定，未为稳当。
大连翘 黑山栀 粉丹皮 淡黄芩 白桔梗 人中黄 大玄参 大力子 荆芥 芦根
金（右） 头胀恶风发热，头面四肢已透痧点，咽中微痛。脉数，苔白。风温之邪，袭于肺胃。适值经来，恐热
入血室，不可与寻常并论也。
霜桑叶（一钱） 牛蒡子（三钱） 射干（五分） 象贝母（二钱） 广郁金（一钱五分） 嫩前胡（一钱）
炒杏仁（三钱） 蝉衣（八分） 丹参（二钱） 南楂炭（三钱） 枳壳（一钱炒）
二诊 热势稍减，痧亦畅透，咽痛略轻。经事通行，并无少腹坠满等象。再从肺胃清泄，参以和营。
大力子 嫩前胡 荆芥穗 生甘草 连翘壳 紫丹参 象贝母 白茯苓 白桔梗 青蒿梗
三诊 痧虽畅透而不肯化，经事淋沥未已，舌燥咽中干痛。脉象细数。此由经水适来，血室空虚，血分
暗为热迫。再泄热凉营。
细生地 黑玄参 川石斛 牛蒡子 粉丹皮 青蒿梗 紫丹参 冬瓜子 粉前胡 川贝母 生梨肉 枇杷叶
金 痧点较昨稍透，兼有起浆白疹，咽赤作痛，偏左起腐。肺胃蕴热，未能宣泄。病起三朝，势在正甚。
连翘壳 马勃 荆芥 薄荷叶 桔梗 射干 牛蒡子 蝉衣 广郁金 灯心
二诊 痧点虽布，面心足胫，尚未透发，烦热胸闷咽痛。舌苔黄糙少津。肺胃之邪，不克宣泄，夹滞不化，
恐化火内窜。
净蝉衣 牛蒡子 连翘壳 麻黄（蜜炙三分） 苦桔梗 苏薄荷叶 广玉金 炒枳壳 煨石膏 茅根肉
三诊 咽痛稍轻，肌肤丹赤，投辛温寒宣泄肺胃，热势大减。苔黄大化，而舌边红刺。邪欲化火，再为清泄。
连翘壳 广郁金 滑石块 炒枳壳 煨石膏 黑山栀 淡豆豉 杏仁 牛蒡子 竹叶心
四诊 肌肤丹赤，而痧点未经畅透。肺胃蕴热不能宣泄，邪势化火，劫烁阴津，舌绛干毛。恐邪热内传，
而神昏发痉。
犀尖（三分磨） 丹皮（二钱） 鸡苏散（四钱） 玄参（三钱） 杏仁（三钱） 荆芥（一钱） 鲜生
地（五钱） 牛蒡子（三钱） 连翘（三钱） 广郁金（一钱五分） 茅根肉（八钱） 竹叶（二十片） 灯心（三尺）
五诊 丹痧渐化，而火风未能尽泄，咽痛甚重，大便不行。舌绛无津。拟急下存阴法。
犀尖（三分磨） 丹皮（二钱） 玄参肉（三钱） 防风（一钱） 元明粉（一钱五分） 生广军（三钱）
鲜生地（五钱） 大贝母（二钱） 荆芥（一钱） 黑山栀（三钱） 生甘草（五分） 桔梗（一钱）
六诊 大便畅行，咽痛大减。然仍热甚于里，舌红尖刺无津。痧化太早，邪势化火，劫烁阴津，未为稳当。
玄参肉 细生地 连翘壳 桔梗 银花 郁金 天门冬 山栀 生甘草 竹叶 鲜芦根
七诊 咽痛渐定，热势大减。舌绛刺亦退，然舌心尚觉干毛，还是阴津未复也。
细生地（四钱） 连翘（三钱） 银花（一钱五分） 鲜石斛（五钱） 天花粉（二钱） 大玄参（三钱）
生甘草（五分） 天门冬（三钱） 绿豆衣（三钱） 山栀（三钱） 芦根（一两五钱） 竹叶（三十片）
八诊 脉静身凉，履夷出险，幸甚幸甚。拟清养肺胃，以澈余炎。
大天冬 大玄参 连翘 白银花 茯苓 绿豆衣 川贝母 竹叶心 鲜芦根
金 热势甚重，咽肿作痛，丹痧透露未畅，胸闷神烦。脉形紧数而弦。时疫之邪，郁于肺胃。恐邪化为火，
致生枝节。
荆芥 炒牛蒡子 连翘壳 玄参 薄荷 枳实 郁金 生甘草 范志曲 淡子芩 黑山栀
二诊 痧 畅达，兼发起浆白疹，其风火热毒之重可知。再拟利膈清咽，而导热下行。
连翘壳 川雅连（三分） 防风 淡芩 玄参 丹皮 人中黄（四分） 牛蒡子 防风通圣散（三钱）
某 春温疫疠之邪，由募原而入胃腑，邪化为火，熏蒸于肺，充斥上下，蔓延内外。以致热炽丹痧密布，
上则咽赤肿痛，下则协热下利。脉象紧数，舌红无苔。今则渐增气喘，危象已着。勉拟黄连解毒汤出入。
即请高明商榷行之。
川雅连（五分） 生山栀（二钱） 大青叶（三钱） 犀尖（五分磨） 丹皮（二钱） 川黄柏（三钱炒）
大麦冬（三钱） 淡黄芩（一钱五分） 鲜芦根（去节二两） 竹叶（三十片）
张（左） 外风引动温邪，邪从内发，即化为火。喉风发痧，舌心焦黑，粘痰缠扰咽中，咯吐不尽。脉数弦滑。
时行急病，变端不测。
紫背浮萍（一钱五分） 大元参（四钱） 桔梗（一钱） 马勃（一钱） 光杏仁（三钱） 生石膏（六钱）
生甘草（五分） 连翘（三钱） 射干（七分） 广郁金（一钱五分） 白茅根肉（一两） 竹沥（一两）
二诊 痧疹畅发，咽中粘痰稍利，痛势略轻。舌苔焦黑已化，而里质绛赤，干燥无津。喉关之内，白腐星
布。肺胃之火，灼烁阴津，恐其暴窜。
磨犀尖（五分） 鲜生地（一两洗打） 细生地（五钱） 大麦冬（三钱） 桔梗（一钱） 粉丹皮（二钱）
炒知母（二钱） 煨石膏（四钱） 大玄参（二钱） 金汁（七钱冲） 茅根肉（一两） 鲜芦根（一两）
银花露（一两冲）
（原注） 已后未来看，病亦渐松矣。
严（右） 咽痛红肿，丹痧已透三朝，上至头面，下至足胫，是为透足。邪从痧出，热随邪达，理当病退十七，
乃热势仍然不减。咽痛稍轻，仍然赤肿。脉象滑数，舌红无苔。足见邪势太重，半发丹痧透露于外，半化
火热郁于肺胃。况当经水适行，若肺胃之热，乘血分之虚，袭入营中，便是热入血室。今当出入之际，治
法不可不细论也。经云、火郁发之。则开泄之药，在所必用。又云、热者寒之。则清化之药，在所难缓。而白
喉忌表。殊不知白为金色，火热亢盛之极，金受火刑，所以喉间结成白点，甚者起出白条。凡表药之性，
皆带升泄，恐升动火热，所以忌用。即非白喉，如喉风喉疳喉蛾之甚者，往往亦有白腐，其为火甚刑金，
则一也。刻下咽痛较前昨稍轻，白点似有若无，喉症之势已得稍缓。而痧点渐化，热势不减，其火热之
渊薮，不在喉间，而蕴于肺胃。显然可见。肺主皮毛，则开泄肺气，是散邪，即散火也。清泄上中，是化热。即
防其入血室也。拟清泄一法。即请商榷行之。
川郁金（一钱五分） 淡黄芩（一钱五分） 大连翘壳（三钱） 黑山栀（三钱） 紫丹参（三钱） 大力子（三
钱） 泽兰叶（二钱） 白桔梗（七分） 薄荷（八分） 白茅根（一两）
二诊 辛凉解表，微苦泄热，参以和营，遍身痧点畅发，邪从痧透，怫郁之热自得稍松，喉间赤肿大退，
热势略得减轻。然脉仍滑数，舌红无苔，不时恶心，还是胃火逆冲，胃气不降。良由邪势太重，泄者虽泄，
留者仍留，总望痧退之后，继之以汗，热势步退，方为正色。再拟清化法。即请商裁。
大连翘（三钱） 紫丹参（二钱） 赤茯苓（三钱） 盐水炒橘皮（六分） 牛蒡子（三钱）
黑山栀（三钱） 苏薄荷（一钱） 水炒竹茹（一钱五分） 淡黄芩（一钱五分） 广郁金（一钱五分） 桑叶（一钱
五分） 白桔梗（七分） 茅根肉（一两）
改方去薄荷桔梗，加芦根一两，竹叶三十片。
三诊 热势降序，咽痛亦轻。然痧点出而不化，寤难成寐，多言而时有错语。脉数细弦，舌红无苔，边尖
皆布红点。此由热甚之时，经水适行，血海空虚，邪热乘虚而入血室，神藏于心，魂藏于肝，而心主血，肝
藏血，今热扰血中，所以神魂不能安贴，灵明渐次为之扰乱，二十二日案中早经提及，正为此也。恐致
神昏痉厥，不得不为预告也。拟养血凉营，以宁神志。即请商榷行之。
大生地（四钱） 磨犀尖（三分） 粉丹皮（二钱） 紫丹参（二钱） 朱茯神（三钱） 川贝母（二钱）
生赤芍（一钱五分） 水炒竹茹（一钱五分） 辰灯心（三尺） 上濂珠（三分） 西血珀（四分）
真玳瑁（三分以上三味研极细末蜜水调服）
顾（童） 风温发痧，痧邪太重，邪热与风，半从外出，半从里陷。痧邪本在肺胃二经，然肺与大肠表里相
应，大肠与胃，又系手足阳明相合，所以陷里之邪，直趋大肠。以致泄痢无度，痧点欲回未回，咳嗽不爽，
遍身作痛。脉数，重按滑大，舌红无苔。上下交困，极为恶劣。勉用薛氏升泄一法。即请明贤商进。
煨葛根（一钱五分） 苦桔梗（一钱） 生甘草（五分） 白茯苓（三钱） 淡枯芩（酒炒一钱五分） 大豆卷（三
钱） 羌活（七分） 炒黄荷叶（三钱）
二诊 昨用升泄之法，陷里之邪，略得升散，脾之清气，稍得升举，泄泻大减，白冻亦退，神情亦略振作。
舌红绛较淡，脉滑大稍平。种属转机之象，守前法扩充，续望应手。即请商裁。
羌活（一钱） 防风根（一钱炒） 广木香（三分） 酒炒淡芩（一钱五分） 枳壳（八分） 苦桔梗（一钱）
大豆卷（二钱） 煨葛根（一钱五分） 生甘草（五分） 白茯苓（三钱） 干荷叶（炒黄三钱）
三诊 下痢稍疏，然昼夜当在二十次之外，所下黑黄居多，肛门烙热，肌表之热，并不甚盛。而脉数竟
在七至以外，舌红起刺。良以陷里之邪，与湿相合，悉化为火，仿金匮协热下痢法。即请商裁。
炒黄柏（二钱） 北秦皮（一钱） 滑石块（三钱） 炒雅连（四分） 生甘草（三分） 白头翁（一钱）
金银花（三钱） 白茯苓（二钱） 金石斛（二钱） 龙井茶（一钱五分）
金（幼） 时疫七日，丹痧回没太早，火热内灼，口疳咽痛，热胜则肿，面目肢体虚浮。脉象弦数。恐变肿胀。
急导火下行。
鲜生地（五钱） 玄参（三钱） 茯苓皮（三钱） 细甘草（五分） 元明粉（一钱） 车前子（一钱五分）
木通（五分） 丝瓜络（二钱） 金银花（二钱） 上湘军（二钱）
二诊 身热已退，口疳稍轻，四肢仍带肿胀。火风阻闭，脾湿因而不运，随风流布。恐肿胀日甚。再理湿祛风。
大腹皮（二钱） 宣木瓜（一钱） 冬瓜皮（四钱炒） 茯苓皮（三钱） 泽泻（一钱五分） 生米仁（四钱）
汉防己（一钱五分） 猪苓（二钱） 青防风（一钱） 左秦艽（一钱五分）
（原注）服后渐愈。
【附：烂喉痧】
金姓患者（左）：春温疫疠之邪从体内发出。发热、咽喉疼痛，热势非常猛烈，全身皮肤发红如丹，痧点连成一片不分界限，咽喉疼痛并向颈部蔓延导致肿胀。右脉滑数，左脉弦紧，舌质红，边缘和尖端满布赤色斑点。这是由于温疫之邪，一经发作便化为火毒，充斥内外并蔓延至三焦。所谓“丹”和“痧”，本质上都是火毒所致。病程已到第五天，邪气势力正盛，担心火毒从内部窜扰，导致神志昏迷或发生抽搐痉挛。拟定咸寒泄热、甘凉保津的治法。
处方：犀角尖（五分磨汁冲服）、鲜生地（七钱）、粉丹皮（二钱）、大青叶（三钱）、金银花（二钱）、霜桑叶（一钱五分）、牛蒡子（二钱）、黑玄参（三钱）、薄荷（五分）、金汁（五钱）、鲜茅根与鲜芦根肉（各一两）。
二诊：采用咸寒泄热、甘凉保津的方法后，丹痧有所消退，热势也稍减轻。然而咽喉仍然肿痛，左侧耳下出现结块且感到胀满，这也属于火风邪气凝结所致。虽然大势稍定，但病情尚未稳固妥当。
处方：大连翘、黑山栀、粉丹皮、淡黄芩、白桔梗、人中黄、大玄参、牛蒡子、荆芥、芦根。
金姓患者（右）：头部胀满、恶风、发热，头面四肢已经透出痧点，咽喉轻微疼痛。脉象数，苔白。这是风温之邪侵袭肺胃所致。恰逢月经来潮，担心热邪进入血室，不能按常规病症论治。
处方：霜桑叶（一钱）、牛蒡子（三钱）、射干（五分）、象贝母（二钱）、广郁金（一钱五分）、嫩前胡（一钱）、炒杏仁（三钱）、蝉蜕（八分）、丹参（二钱）、南楂炭（三钱）、枳壳（一钱炒）。
二诊：热势稍减，痧点透发顺畅，咽痛略微减轻。月经通行正常，没有少腹坠胀满闷等症状。继续从肺胃清泄邪热，配合调和营血的方法。
处方：牛蒡子、嫩前胡、荆芥穗、生甘草、连翘壳、紫丹参、象贝母、白茯苓、白桔梗、青蒿梗。
三诊：痧点虽然透发顺畅但不肯消退，月经淋漓不尽，舌燥、咽喉中干痛。脉象细数。这是因为月经适逢来潮，血室空虚，血分暗中被热邪逼迫。再次采用泄热凉营的方法。
处方：细生地、黑玄参、川石斛、牛蒡子、粉丹皮、青蒿梗、紫丹参、冬瓜子、粉前胡、川贝母、生梨肉、枇杷叶。
金姓患者：痧点比昨天稍微透发一些，兼有起浆的白色疹子，咽喉发红作痛，左侧开始溃烂腐坏。肺胃蕴积热邪，未能宣泄。病起三天，势头正处于旺盛阶段。
处方：连翘壳、马勃、荆芥、薄荷叶、桔梗、射干、牛蒡子、蝉蜕、广郁金、灯心草。
二诊：痧点虽然分布，但面部中心、足部和小腿部位尚未透发，烦热、胸闷、咽痛。舌苔黄糙且缺少津液。肺胃的邪气，无法宣泄，夹杂食滞不化，担心化为火毒内窜。
处方：净蝉蜕、牛蒡子、连翘壳、麻黄（蜜炙三分）、苦桔梗、苏薄荷叶、广玉金、炒枳壳、煨石膏、茅根肉。
三诊：咽痛稍微减轻，肌肤发红如丹，投用辛温与寒凉药物宣泄肺胃，热势大幅减退。舌苔黄色大部分消退，但舌边出现红色刺状突起。邪气欲化为火，再次进行清泄。
处方：连翘壳、广郁金、滑石块、炒枳壳、煨石膏、黑山栀、淡豆豉、杏仁、牛蒡子、竹叶心。
四诊：肌肤发红如丹，但痧点未曾畅透。肺胃蕴积热邪不能宣泄，邪气势力化为火毒，劫灼阴津，舌质绛红干燥且有毛刺。担心邪热内传，导致神志昏迷或发生抽搐痉挛。
处方：犀角尖（三分磨汁冲服）、丹皮（二钱）、鸡苏散（四钱）、玄参（三钱）、杏仁（三钱）、荆芥（一钱）、鲜生地（五钱）、牛蒡子（三钱）、连翘（三钱）、广郁金（一钱五分）、茅根肉（八钱）、竹叶（二十片）、灯心草（三尺）。
五诊：丹痧逐渐消退，但火风邪气未能完全泄除，咽痛非常严重，大便不通。舌质绛红无津液。拟定急下存阴的治疗方法。
处方：犀角尖（三分磨汁冲服）、丹皮（二钱）、玄参肉（三钱）、防风（一钱）、元明粉（一钱五分）、生大黄（三钱）、鲜生地（五钱）、大贝母（二钱）、荆芥（一钱）、黑山栀（三钱）、生甘草（五分）、桔梗（一钱）。
六诊：大便通畅排出，咽痛大幅减轻。然而体内热势依然严重，舌红、舌尖有刺且无津液。痧毒化解过早，邪气势力化为火毒，劫灼阴津，治疗尚不稳妥。
处方：玄参肉、细生地、连翘壳、桔梗、银花、郁金、天门冬、山栀、生甘草、竹叶、鲜芦根。
七诊：咽痛逐渐稳定，热势大幅减退。舌上红刺也已消退，但舌中心仍感觉干燥粗糙，这是因为阴津尚未恢复。
处方：细生地（四钱）、连翘（三钱）、银花（一钱五分）、鲜石斛（五钱）、天花粉（二钱）、大玄参（三钱）、生甘草（五分）、天门冬（三钱）、绿豆衣（三钱）、山栀（三钱）、芦根（一两五钱）、竹叶（三十片）。
八诊：脉象平静，身体凉爽，平安度过险境，庆幸之至。拟定清养肺胃的方法，以清除残余炎症。
处方：大天冬、大玄参、连翘、白银花、茯苓、绿豆衣、川贝母、竹叶心、鲜芦根。
金姓患者：热势非常严重，咽喉肿胀作痛，丹痧透发不畅，胸闷、神志烦躁。脉象紧数而弦。时行疫疠之邪，郁结于肺胃。担心邪气化为火毒，导致生出变故。
处方：荆芥、炒牛蒡子、连翘壳、玄参、薄荷、枳实、郁金、生甘草、范志曲、淡子芩、黑山栀。
二诊：痧毒畅达，兼发起浆的白色疹子，其风火热毒之重可知。再次拟定利膈清咽，引导热邪下行的方法。
处方：连翘壳、川雅连（三分）、防风、淡芩、玄参、丹皮、人中黄（四分）、牛蒡子、防风通圣散（三钱）。
某患者：春温疫疠之邪，由募原进入胃腑，邪气化为火毒，熏蒸于肺，充斥上下，蔓延内外。导致热势炽盛、丹痧密布，上则咽喉发红肿痛，下则伴有热性腹泻。脉象紧数，舌红无苔。如今逐渐增加气喘症状，危重迹象已现。勉强拟定黄连解毒汤加减。
即请高明之士商讨施行。
处方：川雅连（五分）、生山栀（二钱）、大青叶（三钱）、犀角尖（五分磨汁冲服）、丹皮（二钱）、川黄柏（三钱炒）、大麦冬（三钱）、淡黄芩（一钱五分）、鲜芦根（去节二两）、竹叶（三十片）。
张姓患者（左）：外感风邪引动温邪，邪气从体内发出，随即化为火毒。喉风发痧，舌中心焦黑，粘痰缠绕干扰咽喉，咯吐不尽。脉象数、弦、滑。这是时行急病，变化端绪不可预测。
处方：紫背浮萍（一钱五分）、大元参（四钱）、桔梗（一钱）、马勃（一钱）、光杏仁（三钱）、生石膏（六钱）、生甘草（五分）、连翘（三钱）、射干（七分）、广郁金（一钱五分）、白茅根肉（一两）、竹沥（一两）。
二诊：痧疹畅发，咽喉中粘痰稍微通畅，痛势略微减轻。舌苔焦黑已经消退，但舌里质地绛赤，干燥无津液。喉关之内，白色腐坏物星罗棋布。肺胃之火，灼烁阴津，担心其暴烈窜扰。
处方：磨犀角尖（五分）、鲜生地（一两洗打）、细生地（五钱）、大麦冬（三钱）、桔梗（一钱）、粉丹皮（二钱）、炒知母（二钱）、煨石膏（四钱）、大玄参（二钱）、金汁（七钱冲服）、茅根肉（一两）、鲜芦根（一两）、银花露（一两冲服）。
（原注）：此后未来复诊，病情也逐渐松缓了。
严姓患者（右）：咽喉疼痛红肿，丹痧已经透发三天，上至头面，下至足胫，这叫透足。邪气随痧而出，热势随邪气到达，按理应当病退十分之七，然而热势仍然不减。咽痛稍微减轻，但仍然赤肿。脉象滑数，舌红无苔。足见邪气势力太重，一半丹痧透露于外，一半化为火热郁结于肺胃。况且正值月经运行期间，如果肺胃之热，乘血分之虚，袭入营分，就是热入血室。现在处于发病的关键之际，治法不可不仔细讨论。经云：“火郁发之。”那么开泄的药物，在所必用。又云：“热者寒之。”那么清化的药物，在所难缓。而且白喉忌用解表药。殊不知“白”为金色，火热亢盛到了极点，金受火刑，所以喉间结成白点，严重的长出白条。凡是解表药的药性，都带有升提发散的作用，担心升动火热，所以忌讳使用。即使不是白喉，如喉风、喉疳、喉蛾等严重的病症，往往也有白腐现象，它们都是火甚刑金，道理是一样的。当下咽痛较前几天稍微减轻，白点似有若无，喉症之势已经得到稍许缓解。而痧点逐渐消退，热势不减，这火热之源，不在喉间，而蕴积于肺胃。显然可见。肺主皮毛，所以开泄肺气，即是散邪，也就是散火。清泄上中焦，即是化热，也就是防止其进入血室。拟定清泄一法。即请商讨施行。
处方：川郁金（一钱五分）、淡黄芩（一钱五分）、大连翘壳（三钱）、黑山栀（三钱）、紫丹参（三钱）、牛蒡子（三钱）、泽兰叶（二钱）、白桔梗（七分）、薄荷（八分）、白茅根（一两）。
二诊：辛凉解表，微苦泄热，配合调和营血，遍身痧点畅发，邪气随痧透发，怫郁的热邪自然稍得松解，喉间赤肿大幅减退，热势略微减轻。然而脉仍滑数，舌红无苔，不时恶心，还是胃火逆冲，胃气不降。良由邪气势力太重，泄者虽泄，留者仍留，总希望痧退之后，继之以汗法，热势逐步减退，才是正治之法。再拟定清化法。即请斟酌裁定。
处方：大连翘（三钱）、紫丹参（二钱）、赤茯苓（三钱）、盐水炒橘皮（六分）、牛蒡子（三钱）、黑山栀（三钱）、苏薄荷（一钱）、水炒竹茹（一钱五分）、淡黄芩（一钱五分）、广郁金（一钱五分）、桑叶（一钱五分）、白桔梗（七分）、茅根肉（一两）。
改方去掉薄荷、桔梗，加芦根一两，竹叶三十片。
三诊：热势下降，咽痛也减轻。然而痧点出而不消，夜间难以入睡，多言且时有错语。脉象数、细、弦，舌红无苔，边缘和尖端皆布红点。这是因为热势严重时，月经适逢来潮，血海空虚，邪热乘虚而入血室，神藏于心，魂藏于肝，而心主血，肝藏血，如今热扰血中，所以神魂不能安贴，灵明逐渐为之扰乱，二十二日的医案中早已提及，正是为此。担心导致神昏痉厥，不得不预先告知。拟定养血凉营，以宁神志的方法。即请商讨施行。
处方：大生地（四钱）、磨犀角尖（三分）、粉丹皮（二钱）、紫丹参（二钱）、朱茯神（三钱）、川贝母（二钱）、生赤芍（一钱五分）、水炒竹茹（一钱五分）、辰灯心（三尺）、上濂珠（三分）、西血珀（四分）、真玳瑁（三分，以上三味研极细末，蜜水调服）。
顾姓（儿童）：风温发痧，痧邪太重，邪热与风邪，一半从外出，一半从里陷。痧邪本在肺胃二经，然而肺与大肠表里相应，大肠与胃，又是手足阳明相合，所以陷入体内的邪气，直趋大肠。导致泄痢无度，痧点欲回未回，咳嗽不爽，遍身作痛。脉数，重按滑大，舌红无苔。上下交困，极为恶劣。勉强用薛氏升泄一法。即请明贤商讨进用。
处方：煨葛根（一钱五分）、苦桔梗（一钱）、生甘草（五分）、白茯苓（三钱）、淡枯芩（酒炒一钱五分）、大豆卷（三钱）、羌活（七分）、炒黄荷叶（三钱）。
二诊：昨日用升泄之法，陷入体内的邪气，略得升散，脾之清气，稍得升举，泄泻大幅减少，白冻（粘液便）也退了，神情也略微振作。舌红绛较淡，脉滑大稍平。种属转机之象，守前法扩充，续望应手有效。即请商讨裁定。
处方：羌活（一钱）、防风根（一钱炒）、广木香（三分）、酒炒淡芩（一钱五分）、枳壳（八分）、苦桔梗（一钱）、大豆卷（二钱）、煨葛根（一钱五分）、生甘草（五分）、白茯苓（三钱）、干荷叶（炒黄三钱）。
三诊：下痢稍微稀疏，然而昼夜当在二十次之外，所下多为黑黄色，肛门烙热，肌表之热，并不很盛。而脉数竟在七至以外，舌红起刺。良以陷入体内的邪气，与湿相合，全部化为火毒，仿照《金匮要略》协热下痢法。即请商讨裁定。
处方：炒黄柏（二钱）、北秦皮（一钱）、滑石块（三钱）、炒雅连（四分）、生甘草（三分）、白头翁（一钱）、金银花（三钱）、白茯苓（二钱）、金石斛（二钱）、龙井茶（一钱五分）。
金姓（幼儿）：时疫七天，丹痧回没太早，火热内灼，口疮咽痛，热胜则肿，面目肢体虚浮。脉象弦数。担心变为肿胀病。急导火下行。
处方：鲜生地（五钱）、玄参（三钱）、茯苓皮（三钱）、细甘草（五分）、元明粉（一钱）、车前子（一钱五分）、木通（五分）、丝瓜络（二钱）、金银花（二钱）、上湘军（二钱）。
二诊：身热已退，口疮稍微减轻，四肢仍带肿胀。火风阻闭，脾湿因而不运，随风流布。担心肿胀日益加重。再理湿祛风。
处方：大腹皮（二钱）、宣木瓜（一钱）、冬瓜皮（四钱炒）、茯苓皮（三钱）、泽泻（一钱五分）、生米仁（四钱）、汉防己（一钱五分）、猪苓（二钱）、青防风（一钱）、左秦艽（一钱五分）。
（原注）：服药后逐渐痊愈。
[Appendix: Lanhou Sha (Rotting Throat Rash)]
Patient Jin (Left): The pathogenic factors of Spring-Warmth and epidemic pestilence erupt from within. Symptoms include fever, sore throat, with intense heat, generalized erythema resembling cinnabar, confluent rash spots without clear boundaries, and sore throat extending to the neck causing swelling. The right pulse is slippery and rapid; the left pulse is wiry and tight. The tongue is red with crimson dots covering the edges and tip. This is caused by epidemic pathogens that, upon eruption, transform into fire toxin, filling the interior and exterior and spreading through the Triple Burner. Both "Dan" (erythema) and "Sha" (rash) are essentially manifestations of fire. It has been five days since onset, and the pathogenic force is at its peak. There is fear that the fire toxin may窜 (cuan, rush/crawl) internally, leading to coma or convulsions. The proposed treatment is Salty-Cold to drain heat and Sweet-Cool to preserve fluids.
Prescription: Rhinoceros Horn Tip (Xi Jiao) [5 fen, ground and mixed], Fresh Rehmannia Root (Sheng Di Huang) [7 qian], Moutan Bark (Mu Dan Pi) [2 qian], Isatis Leaf (Da Qing Ye) [3 qian], Honeysuckle Flower (Jin Yin Hua) [2 qian], Mulberry Leaf (Sang Ye) [1.5 qian], Arctium Fruit (Niu Bang Zi) [2 qian], Scrophularia Root (Xuan Shen) [3 qian], Mint (Bo He) [5 fen], Human Excrement Juice (Jin Zhi) [5 qian], Fresh Imperata Rhizome and Fresh Phragmites Rhizome (Mao Gen Rou & Lu Gen Rou) [each 1 liang].
Second visit: After using Salty-Cold to drain heat and Sweet-Cool to preserve fluids, the erythema and rash have somewhat resolved, and the heat has slightly decreased. However, the throat remains swollen and painful, and there is a lump with distension below the left ear, which also belongs to the knotting of Fire-Wind pathogens. Although the major trend has stabilized, the condition is not yet secure.
Prescription: Large Forsythia Fruit (Da Lian Qiao), Gardenia Fruit (Hei Shan Zhi), Moutan Bark (Fen Dan Pi), Scutellaria Root (Dan Huang Qin), Platycodon Root (Bai Jie Geng), Human Excrement Powder (Ren Zhong Huang), Scrophularia Root (Da Xuan Shen), Arctium Fruit (Da Li Zi), Schizonepeta (Jing Jie), Phragmites Rhizome (Lu Gen).
Patient Jin (Right): Head distension, aversion to wind, and fever. Rash spots have already emerged on the head, face, and limbs, with slight sore throat. The pulse is rapid, and the coating is white. This is Wind-Warmth pathogen attacking the Lung and Stomach. Coinciding with menstruation, there is concern about Heat entering the Blood Chamber (Xue Shi), so it cannot be treated as a common case.
Prescription: Mulberry Leaf (Shuang Sang Ye) [1 qian], Arctium Fruit (Niu Bang Zi) [3 qian], Belamcanda Rhizome (She Gan) [5 fen], Fritillaria Bulb (Xiang Bei Mu) [2 qian], Curcuma Tuber (Guang Yu Jin) [1.5 qian], Peucedanum Root (Nen Qian Hu) [1 qian], Fried Apricot Seed (Chao Xing Ren) [3 qian], Cicada Slough (Chan Yi) [8 fen], Salvia Root (Dan Shen) [2 qian], Charred Hawthorn Fruit (Nan Zha Tan) [3 qian], Aurantium Fruit (Zhi Ke) [1 qian, fried].
Second visit: Heat has slightly decreased, and the rash is smoothly emerging, with slight relief in sore throat. Menstruation flows normally, without lower abdominal heaviness or fullness. Continue to clear and drain from the Lung and Stomac, combined with harmonizing the Ying (Nutritive) level.
Prescription: Arctium Fruit (Da Li Zi), Peucedanum Root (Nen Qian Hu), Schizonepeta Spike (Jing Jie Sui), Licorice Root (Sheng Gan Cao), Forsythia Husk (Lian Qiao Ke), Red Sage Root (Zi Dan Shen), Fritillaria Bulb (Xiang Bei Mu), Poria (Bai Fu Ling), Platycodon Root (Bai Jie Geng), Artemisia Annua Stem (Qing Hao Geng).
Third visit: Although the rash is smoothly emerging, it refuses to resolve. Menstruation is dripping continuously. The tongue is dry, and the throat is dry and painful. The pulse is fine and rapid. This is because menstruation arrived just then, leaving the Blood Chamber empty, and the Blood Level is secretly pressured by Heat. Reapply methods to drain heat and cool the Ying level.
Prescription: Fine Rehmannia Root (Xi Sheng Di), Scrophularia Root (Hei Xuan Shen), Dendrobium Stem (Chuan Shi Hu), Arctium Fruit (Niu Bang Zi), Moutan Bark (Fen Dan Pi), Artemisia Annua Stem (Qing Hao Geng), Red Sage Root (Zi Dan Shen), Winter Melon Seed (Dong Gua Zi), Fritillaria Root (Fen Qian Hu), Fritillaria Bulb (Chuan Bei Mu), Raw Pear Flesh (Sheng Li Rou), Loquat Leaf (Pi Pa Ye).
Patient Jin: Rash spots are slightly more emergent than yesterday, accompanied by white vesicles forming pus. The throat is red and painful, with ulceration starting on the left side. Heat accumulated in the Lung and Stomac fails to vent. The disease began three days ago, and the momentum is currently strong.
Prescription: Forsythia Husk (Lian Qiao Ke), Malva Nut (Ma Bo), Schizonepeta (Jing Jie), Mint Leaf (Bo He Ye), Platycodon Root (Jie Geng), Belamcanda Rhizome (She Gan), Arctium Fruit (Niu Bang Zi), Cicada Slough (Chan Yi), Curcuma Tuber (Guang Yu Jin), Juncus Effusus (Deng Xin).
Second visit: Although rash spots are distributed, they have not yet emerged on the center of the face, feet, and calves. There is irritability, chest oppression, and sore throat. The tongue coating is yellow, rough, and lacks fluids. The pathogens in the Lung and Stomac cannot be vented, and food stagnation fails to transform. There is fear of transformation into fire toxin rushing internally.
Prescription: Clean Cicada Slough (Jing Chan Yi), Arctium Fruit (Niu Bang Zi), Forsythia Husk (Lian Qiao Ke), Ephedra Stem (Ma Huang, honey-fried 3 fen), Bitter Platycodon Root (Ku Jie Geng), Perilla Mint Leaf (Su Bo He Ye), Curcuma Tuber (Guang Yu Jin), Fried Aurantium Fruit (Chao Zhi Ke), Calcined Gypsum (Wei Shi Gao), Imperata Rhizome (Mao Gen Rou).
Third visit: Sore throat has slightly lightened, and skin is erythematous. After administering Acrid-Warm and Cold herbs to vent the Lung and Stomac, heat has significantly decreased. The yellow coating has largely resolved, but red prickles appear on the tongue edges. The pathogen desires to transform into fire; reapply clearing and draining.
Prescription: Forsythia Husk (Lian Qiao Ke), Curcuma Tuber (Guang Yu Jin), Talcum (Hua Shi Kuai), Fried Aurantium Fruit (Chao Zhi Ke), Calcined Gypsum (Wei Shi Gao), Gardenia Fruit (Hei Shan Zhi), Fermented Soybean (Dan Dou Chi), Apricot Seed (Xing Ren), Arctium Fruit (Niu Bang Zi), Heart of Bamboo Leaf (Zhu Ye Xin).
Fourth visit: Skin is erythematous, but rash spots have not emerged smoothly. Heat accumulated in the Lung and Stomac cannot be vented. Pathogenic momentum transforms into fire, devouring Yin fluids. The tongue is crimson, dry, and hairy. Fear of internal transmission of pathogenic heat leading to coma or convulsions.
Prescription: Rhinoceros Horn Tip (Xi Jiao) [3 fen, ground], Moutan Bark (Dan Pi) [2 qian], Elsholtzia Powder (Ji Su San) [4 qian], Scrophularia Root (Xuan Shen) [3 qian], Apricot Seed (Xing Ren) [3 qian], Schizonepeta (Jing Jie) [1 qian], Fresh Rehmannia Root (Xian Sheng Di) [5 qian], Arctium Fruit (Niu Bang Zi) [3 qian], Forsythia (Lian Qiao) [3 qian], Curcuma Tuber (Guang Yu Jin) [1.5 qian], Imperata Rhizome (Mao Gen Rou) [8 qian], Bamboo Leaf (Zhu Ye) [20 pieces], Juncus Effusus (Deng Xin) [3 chi].
Fifth visit: Erythema and rash are gradually resolving, but Fire-Wind has not been fully drained. Sore throat is severe, and defecation is obstructed. The tongue is crimson and fluidless. Propose the method of urgent purgation to preserve Yin.
Prescription: Rhinoceros Horn Tip (Xi Jiao) [3 fen, ground], Moutan Bark (Dan Pi) [2 qian], Scrophularia Root (Xuan Shen Rou) [3 qian], Saposhnikovia Root (Fang Feng) [1 qian], Mirabilite (Yuan Ming Fen) [1.5 qian], Raw Rheum Root (Sheng Guang Jun) [3 qian], Fresh Rehmannia Root (Xian Sheng Di) [5 qian], Large Fritillaria Bulb (Da Bei Mu) [2 qian], Schizonepeta (Jing Jie) [1 qian], Gardenia Fruit (Hei Shan Zhi) [3 qian], Licorice Root (Sheng Gan Cao) [5 fen], Platycodon Root (Jie Geng) [1 qian].
Sixth visit: Defecation is smooth, and sore throat has greatly reduced. However, internal heat remains severe. The tongue is red with prickles on the tip and lacks fluids. The rash resolved too early; pathogenic momentum transformed into fire, devouring Yin fluids. The treatment is not yet secure.
Prescription: Scrophularia Root (Xuan Shen Rou), Fine Rehmannia Root (Xi Sheng Di), Forsythia Husk (Lian Qiao Ke), Platycodon Root (Jie Geng), Honeysuckle (Yin Hua), Curcuma Tuber (Yu Jin), Asparagus Tuber (Tian Dong), Gardenia (Shan Zhi), Licorice Root (Sheng Gan Cao), Bamboo Leaf (Zhu Ye), Fresh Phragmites Rhizome (Xian Lu Gen).
Seventh visit: Sore throat is gradually stabilizing, and heat has significantly decreased. Crimson prickles on the tongue have receded, but the center of the tongue still feels dry and rough. This indicates that Yin fluids have not yet recovered.
Prescription: Fine Rehmannia Root (Xi Sheng Di) [4 qian], Forsythia (Lian Qiao) [3 qian], Honeysuckle (Yin Hua) [1.5 qian], Fresh Dendrobium (Xian Shi Hu) [5 qian], Trichosanthes Root (Tian Hua Fen) [2 qian], Large Scrophularia Root (Da Xuan Shen) [3 qian], Licorice Root (Sheng Gan Cao) [5 fen], Asparagus Tuber (Tian Dong) [3 qian], Mung Bean Coat (Lv Dou Yi) [3 qian], Gardenia (Shan Zhi) [3 qian], Phragmites Rhizome (Lu Gen) [1.5 liang], Bamboo Leaf (Zhu Ye) [30 pieces].
Eighth visit: Pulse is calm, body is cool. Having safely navigated danger, this is fortunate. Propose clearing and nourishing the Lung and Stomac to dissipate residual inflammation.
Prescription: Large Asparagus Tuber (Da Tian Dong), Large Scrophularia Root (Da Xuan Shen), Forsythia (Lian Qiao), Silver Honeysuckle (Bai Yin Hua), Poria (Fu Ling), Mung Bean Coat (Lv Dou Yi), Fritillaria Bulb (Chuan Bei Mu), Heart of Bamboo Leaf (Zhu Ye Xin), Fresh Phragmites Rhizome (Xian Lu Gen).
Patient Jin: Heat is very severe, with swollen and painful throat. Erythema and rash are not smoothly revealed. Chest oppression and mental restlessness. The pulse is tight, rapid, and wiry. Epidemic pathogens are stagnant in the Lung and Stomac. Fear that pathogens will transform into fire, causing complications.
Prescription: Schizonepeta (Jing Jie), Fried Arctium Fruit (Chao Niu Bang Zi), Forsythia Husk (Lian Qiao Ke), Scrophularia Root (Xuan Shen), Mint (Bo He), Aurantium Fruit (Zhi Shi), Curcuma Tuber (Yu Jin), Licorice Root (Sheng Gan Cao), Vanilli Curd (Fan Zhi Qu), Light Scutellaria Root (Dan Zi Qin), Gardenia Fruit (Hei Shan Zhi).
Second visit: Rash is smoothly discharged, accompanied by the emergence of white vesicles. The severity of Wind-Fire-Toxin is evident. Again propose opening the diaphragm, clearing the throat, and guiding heat downward.
Prescription: Forsythia Husk (Lian Qiao Ke), Coptis Rhizome (Chuan Ya Lian) [3 fen], Saposhnikovia Root (Fang Feng), Light Scutellaria Root (Dan Qin), Scrophularia Root (Xuan Shen), Moutan Bark (Dan Pi), Human Excrement Powder (Ren Zhong Huang) [4 fen], Arctium Fruit (Niu Bang Zi), Fangfeng Tongsheng San [3 qian].
Patient Mou: The pathogenic factors of Spring-Warmth and epidemic pestilence enter the stomach via the Mu Yuan (Source). Pathogens transform into fire, steaming the Lung, filling the upper and lower, and spreading inside and outside. This results in intense heat, dense erythema and rash, upper symptoms of red and swollen painful throat, and lower symptoms of heat-induced diarrhea. The pulse is tight and rapid; the tongue is red without coating. Now, panting is gradually increasing, indicating critical signs. Tentatively propose modifications of Huanglian Jiedu Tang.
Please request high-level experts to discuss and implement.
Prescription: Coptis Rhizome (Chuan Ya Lian) [5 fen], Gardenia Fruit (Sheng Shan Zhi) [2 qian], Isatis Leaf (Da Qing Ye) [3 qian], Rhinoceros Horn Tip (Xi Jiao) [5 fen, ground], Moutan Bark (Dan Pi) [2 qian], Phellodendron Bark (Chuan Huang Bai) [3 qian, fried], Large Ophiopogon Tuber (Da Mai Dong) [3 qian], Light Scutellaria Root (Dan Huang Qin) [1.5 qian], Fresh Phragmites Rhizome (Xian Lu Gen, nodes removed) [2 liang], Bamboo Leaf (Zhu Ye) [30 pieces].
Patient Zhang (Left): External Wind stirs up Warm pathogens, which erupt from within and immediately transform into fire. Throat Wind and Rash emerge. The center of the tongue is scorched black. Sticky phlegm entangles the throat, unable to be completely expectorated. The pulse is rapid, wiry, and slippery. This is an epidemic acute disease with unpredictable changes.
Prescription: Purple Back Floating Duckweed (Zi Bei Fu Ping) [1.5 qian], Large Scrophularia Root (Da Yuan Shen) [4 qian], Platycodon Root (Jie Geng) [1 qian], Malva Nut (Ma Bo) [1 qian], Almond (Guang Xing Ren) [3 qian], Raw Gypsum (Sheng Shi Gao) [6 qian], Licorice Root (Sheng Gan Cao) [5 fen], Forsythia (Lian Qiao) [3 qian], Belamcanda Rhizome (She Gan) [7 fen], Curcuma Tuber (Guang Yu Jin) [1.5 qian], White Imperata Rhizome (Bai Mao Gen Rou) [1 liang], Bamboo Sap (Zhu Li) [1 liang].
Second visit: Rash and macules are smoothly emitted. Sticky phlegm in the throat is slightly relieved, and pain is slightly lighter. The scorched black tongue coating has resolved, but the tongue body is crimson, dry, and fluidless. Inside the throat gate, white ulcerations are scattered. Fire of the Lung and Stomac burns Yin fluids, fearing violent窜 (rushing).
Prescription: Ground Rhinoceros Horn Tip (Mo Xi Jiao) [5 fen], Fresh Rehmannia Root (Xian Sheng Di) [1 liang, washed and pounded], Fine Rehmannia Root (Xi Sheng Di) [5 qian], Large Ophiopogon Tuber (Da Mai Dong) [3 qian], Platycodon Root (Jie Geng) [1 qian], Moutan Bark (Fen Dan Pi) [2 qian], Fried Anemarrhena Rhizome (Chao Zhi Mu) [2 qian], Calcined Gypsum (Wei Shi Gao) [4 qian], Large Scrophularia Root (Da Xuan Shen) [2 qian], Human Excrement Juice (Jin Zhi) [7 qian, mixed], Imperata Rhizome (Mao Gen Rou) [1 liang], Fresh Phragmites Rhizome (Xian Lu Gen) [1 liang], Honeysuckle Dew (Yin Hua Lu) [1 liang, mixed].
(Original Note): Did not return for follow-up; the illness gradually eased.
Patient Yan (Right): Sore throat with redness and swelling. Erythema and rash have been emerging for three days, reaching from the head and face down to the calves; this is called "fully emerged." Pathogens exit via the rash, and heat reaches with the pathogens. Logically, the illness should have receded by seventy percent, yet heat remains unrelieved. Sore throat is slightly lighter, but still red and swollen. The pulse is slippery and rapid; the tongue is red without coating. This shows the pathogenic force is too heavy. Half of the erythema and rash are revealed externally, while half transforms into Fire-Heat stagnant in the Lung and Stomac. Moreover, menstruation is currently flowing. If Lung-Stomach Heat takes advantage of the deficiency in the Blood Level to invade the Ying Level, it becomes Heat entering the Blood Chamber. Now is a critical juncture; treatment methods must be discussed carefully. The Classic states: "For Fire Stagnation, Vent it." Therefore, dispersing and opening herbs are essential. It also states: "For Heat, Cool it." Therefore, clearing and transforming herbs cannot be delayed. White Diphtheria (Bai Hou) contraindicates surface-releasing herbs. One might not know that "White" corresponds to Metal. When Fire-Heat is extremely hyperactive, Metal suffers from Fire punishment, resulting in white spots forming in the throat, or even white strips in severe cases. All surface-releasing herbs have ascending and dispersing properties, fearing they will stir up Fire-Heat, hence they are contraindicated. Even if not White Diphtheria, severe cases of Throat Wind, Throat Ulcer, or Throat Tonsil often present with white ulcerations. They all share the mechanism of excessive Fire punishing Metal. Currently, sore throat is slightly lighter than before. White spots are faintly visible. The throat condition has slightly eased. Rash spots are gradually resolving, but heat does not decrease. The source of this Fire-Heat is clearly not in the throat, but accumulated in the Lung and Stomac. The Lung governs skin and hair; thus, venting Lung Qi is dispersing pathogens, which is also dispersing Fire. Clearing and draining the Upper and Middle Jiao is transforming Heat, which also prevents invasion into the Blood Chamber. Propose a method of clearing and draining. Please discuss and implement.
Prescription: Curcuma Tuber (Chuan Yu Jin) [1.5 qian], Light Scutellaria Root (Dan Huang Qin) [1.5 qian], Large Forsythia Husk (Da Lian Qiao Ke) [3 qian], Gardenia Fruit (Hei Shan Zhi) [3 qian], Red Sage Root (Zi Dan Shen) [3 qian], Arctium Fruit (Da Li Zi) [3 qian], Landsberg Leuzea Leaf (Ze Lan Ye) [2 qian], White Platycodon Root (Bai Jie Geng) [7 fen], Mint (Bo He) [8 fen], White Imperata Root (Bai Mao Gen) [1 liang].
Second visit: Acrid-Cool surface release, slightly bitter heat drainage, combined with Ying harmonization. Rash spots on the whole body emerged smoothly. Pathogens exited via the rash, and stagnant heat naturally relaxed slightly. Redness and swelling in the throat greatly subsided, and heat slightly decreased. However, the pulse remains slippery and rapid, the tongue is red without coating, and nausea occurs occasionally. This is due to Stomach Fire rebelling upward and Stomach Qi failing to descend. Because the pathogenic force is too heavy, although some was drained, the remainder remains. We hope that after the rash recedes, sweating therapy will follow, allowing heat to stepwise decline, which would be the correct approach. Again propose a clearing and transforming method. Please deliberate.
Prescription: Large Forsythia (Da Lian Qiao) [3 qian], Red Sage Root (Zi Dan Shen) [2 qian], Red Poria (Chi Fu Ling), Tangerine Peel fried in salt water (Yan Shui Chao Ju Pi) [6 fen], Arctium Fruit (Niu Bang Zi) [3 qian], Gardenia Fruit (Hei Shan Zhi) [3 qian], Perilla Mint (Su Bo He) [1 qian], Bamboo Sheath fried in water (Shui Chao Zhu Ru) [1.5 qian], Light Scutellaria Root (Dan Huang Qin) [1.5 qian], Curcuma Tuber (Guang Yu Jin) [1.5 qian], Mulberry Leaf (Sang Ye) [1.5 qian], White Platycodon Root (Bai Jie Geng) [7 fen], Imperata Rhizome (Mao Gen Rou) [1 liang].
Modified prescription: Remove Mint and Platycodon, add Phragmites Rhizome (1 liang) and Bamboo Leaf (30 pieces).
Third visit: Heat has declined, and sore throat is lighter. However, rash spots emerge but do not resolve. Difficulty sleeping at night, excessive talking with occasional confused speech. The pulse is rapid, fine, and wiry. The tongue is red without coating, with red dots on the edges and tip. This is because during severe heat, menstruation occurred just then, emptying the Sea of Blood. Pathogenic Heat entered the Blood Chamber taking advantage of the deficiency. Spirit resides in the Heart, Soul resides in the Liver. The Heart governs Blood, and the Liver stores Blood. Now Heat disturbs the Blood, so the Spirit and Soul cannot settle, and mental clarity is gradually disturbed. This was mentioned in the case record of the 22nd day, precisely for this reason. Fear of coma and convulsions, so advance warning is necessary. Propose nourishing Blood and cooling the Ying level to calm the Spirit. Please discuss and implement.
Prescription: Large Rehmannia Root (Da Sheng Di) [4 qian], Ground Rhinoceros Horn Tip (Mo Xi Jiao) [3 fen], Moutan Bark (Fen Dan Pi) [2 qian], Red Sage Root (Zi Dan Shen) [2 qian], Poria with Cordyceps (Zhu Fu Shen) [3 qian], Fritillaria Bulb (Chuan Bei Mu) [2 qian], Raw Red Peony Root (Sheng Chi Shao) [1.5 qian], Bamboo Sheath fried in water (Shui Chao Zhu Ru) [1.5 qian], Cinnabar Juncus Effusus (Chen Deng Xin) [3 chi], Pearl Powder (Shang Lian Zhu) [3 fen], Amber (Xi Xue Po) [4 fen], True Tortoise Shell (Zhen Dai Mao) [3 fen, above three ingredients ground to fine powder, taken with honey water].
Patient Gu (Child): Wind-Warmth causes Rash. The Rash pathogen is too heavy. Pathogenic Heat and Wind, half exit externally, half sink internally. The Rash pathogen originally resides in the Lung and Stomac meridians. However, the Lung and Large Intestine are exterior-interior related, and the Large Intestine and Stomac are combined as Hand and Foot Yangming. Thus, pathogens sinking internally go directly to the Large Intestine. This leads to unlimited dysentery, rash spots wanting to retreat but not retreating, unsatisfactory cough, and generalized body pain. The pulse is rapid; deep pressure reveals slippery and large qualities. The tongue is red without coating. Upper and lower systems are distressed, extremely adverse. Tentatively use Xue's method of ascending and venting. Please request wise experts to discuss and administer.
Prescription: Calcined Kudzu Root (Wei Ge Gen) [1.5 qian], Bitter Platycodon Root (Ku Jie Geng) [1 qian], Licorice Root (Sheng Gan Cao) [5 fen], White Poria (Bai Fu Ling), Light Scorched Scutellaria Root (Dan Ku Qin, wine-fried) [1.5 qian], Soybean Sprout (Da Dou Juan) [3 qian], Notopterygium Rhizome (Qiang Huo) [7 fen], Fried Yellow Lotus Leaf (Chao Huang He Ye) [3 qian].
Second visit: Yesterday, using the ascending and venting method, the sinking pathogens were slightly dispersed. Spleen Clear Qi was slightly lifted. Diarrhea greatly decreased, and white mucus discharge retreated. Mental state slightly revived. The crimson-red tongue is paler; the slippery-large pulse is calmer. These are signs of turning point. Adhere to the previous method and expand. Continue hoping for effective response. Please deliberate.
Prescription: Notopterygium Rhizome (Qiang Huo) [1 qian], Saposhnikovia Root (Fang Feng Gen) [1 qian, fried], Aromatic Magnolia Bark (Guang Mu Xiang) [3 fen], Wine-fried Light Scutellaria Root (Jiu Chao Dan Qin) [1.5 qian], Aurantium Fruit (Zhi Ke) [8 fen], Bitter Platycodon Root (Ku Jie Geng) [1 qian], Soybean Sprout (Da Dou Juan) [2 qian], Calcined Kudzu Root (Wei Ge Gen) [1.5 qian], Licorice Root (Sheng Gan Cao) [5 fen], White Poria (Bai Fu Ling) [3 qian], Dry Lotus Leaf (Fried Yellow) [3 qian].
Third visit: Dysentery is slightly less frequent, but still exceeds twenty times a day. Discharge is mostly black and yellow. Anus feels burning hot. Surface heat is not very strong. However, the pulse rate exceeds seven beats per breath. The tongue is red with prickles. This is because sinking pathogens combine with Dampness and all transform into Fire. Following the Jin Gui Yao Lue method for Heat-associated Dysentery. Please deliberate.
Prescription: Fried Phellodendron Bark (Chao Huang Bai) [2 qian], Northern Fraxinus Bark (Bei Qin Pi) [1 qian], Talcum (Hua Shi Kuai) [3 qian], Fried Coptis Rhizome (Chao Ya Lian) [4 fen], Licorice Root (Sheng Gan Cao) [3 fen], Pulsatilla Root (Bai Tou Weng) [1 qian], Honeysuckle Flower (Jin Yin Hua) [3 qian], White Poria (Bai Fu Ling) [2 qian], Dendrobium Stem (Jin Shi Hu) [2 qian], Longjing Tea (Long Jing Cha) [1.5 qian].
Patient Jin (Young Child): Epidemic disease for seven days. Erythema and rash retreated too early. Fire-Heat burns internally. Mouth ulcers and sore throat. Excessive heat causes swelling. Face, eyes, and limbs are puffy. The pulse is wiry and rapid. Fear of developing edema. Urgently guide Fire downward.
Prescription: Fresh Rehmannia Root (Xian Sheng Di) [5 qian], Scrophularia Root (Xuan Shen) [3 qian], Poria Peel (Fu Ling Pi) [3 qian], Fine Licorice Root (Xi Gan Cao) [5 fen], Mirabilite (Yuan Ming Fen) [1 qian], Plantago Seed (Che Qian Zi) [1.5 qian], Akebia Stem (Mu Tong) [5 fen], Luffa Network (Si Gua Luo) [2 qian], Honeysuckle Flower (Jin Yin Hua) [2 qian], Shang Xiang Jun (Shang Jun Yu/Rheum) [2 qian].
Second visit: Body heat has receded. Mouth ulcers are slightly lighter. Limbs still have swelling. Fire-Wind obstruction causes Spleen Dampness to fail to transport, spreading with the Wind. Fear of worsening edema. Again regulate Dampness and dispel Wind.
Prescription: Areca Petiole (Da Fu Pi) [2 qian], Chaenomelis Fruit (Xuan Mu Gua) [1 qian], Winter Melon Peel (Dong Gua Pi, fried) [4 qian], Poria Peel (Fu Ling Pi) [3 qian], Alisma Rhizome (Ze Xie) [1.5 qian], Coix Seed (Sheng Yi Ren) [4 qian], Stephania Root (Han Fang Ji) [1.5 qian], Polyporus (Zhu Ling) [2 qian], Green Saposhnikovia (Qing Fang Feng) [1 qian], Gentiana Root (Zuo Qin Jiao) [1.5 qian].
(Original Note): Gradually recovered after taking the medicine.