（附失音）
鲍（右） 咽喉作痛，遇劳即发，颧红目涩。此心胆火郁，恐成喉痹。
连翘壳（三钱） 净蝉衣（一钱） 黑山栀（二钱） 生甘草（三分） 射干（五分） 元参肉（三钱）
桔梗（一钱） 荆芥（一钱） 细生地（四钱） 郁金（一钱五分）
二诊 昨进甘凉，中脘痞阻，而目痛火升咽痛，足厥不温。气火尽从上浮。再反佐以进。
广郁金 磁石 半夏曲（炒） 白蒺藜 光杏仁 炒枳壳
香豆豉 茯苓 滋肾丸（三钱分二次用淡盐汤下）
三诊 咽痛稍减，足厥转温，然中脘仍然不舒。还是气郁火难下降。前法再进一步。
制半夏 炒枳壳 广郁金 橘皮 生熟香附 茯苓 川连（二分干姜四分同炒） 滋肾丸（三钱）
四诊 苦辛开降，中脘稍舒，咽痛略减，颧红稍退。水性常降，宜使之升，火性常升宜使之降，中焦为升
降之总道。再拟苦辛合化，引导火热下行。
制半夏 炒枳实 广郁金 肥知母 黄柏 云茯苓 广皮 竹茹 上徭桂（三分去皮研末饭糊丸桐子大先服）
五诊 胸次稍舒，饭食稍增，然足仍厥逆，咽喉仍痛。还是虚阳上逆。用金匮法。
漂净猪肤（六钱） 白蜜（二钱） 生甘草（三分） 桔梗（一钱） 炒黄粳米粉（二钱）
茯苓（三钱） 滋肾丸（三钱药汁送下）
鲍（右） 经治诸恙稍退。春升木火燃动，不为乳胀，即为咽痛矣。
广郁金 桑叶 白蒺藜 朱茯神 栝蒌皮 钩钩 黑山栀 胡黄连 黑豆衣 吴萸
二诊 节令之后，木火不熄，咽中热痛，头胀牙痛。前法再参育阴。
元参 山栀 丹皮 石决明 灯心 豆豉 郁金 桑叶 滁菊花 青果
三诊 昨兼清泄，咽痛牙疼稍减，然咽次仍有哽塞之象。气郁痰滞，木火欲降无由。再开展气机，气行
痰利火自降也。
香豆豉 黑山栀 竹茹 白茯苓 甜杏仁 灵磁石 栝蒌皮 郁金 炒枳壳 枇杷叶
孙（左） 向有痰嗽，去冬感受风温，以致热与痰合，蒸腾损肺，咽喉作痛，音喑声嘶，内热连绵，痰稠如胶，
而色带青绿。脉象细数。气火尽从上凌，太阴肺津，悉为痰热所耗，金水不能相生，肾藏之水，日形亏乏。
虚劳喉痹，恐非草木可以为功。
元参 花粉 桔梗 川贝母 白莱菔（绞汁半杯温冲） 杏仁 郁金 茯苓 海浮石 青
果（打汁冲五枚） 玉泉散 陈海蛰（漂一两五钱） 大荸荠（打汁冲五枚）
二诊 清化痰热，咽痛音喑，仍然不减。脉象细数，颇有促意。足见痰热虽壅于上，而肾水内亏，虚阳亦
从上逆。再上下分治，以觇造化如何。
大生地炭 生甘草 丹皮 蝉衣 黑元参肉 川贝母 桔梗 山栀
某 不时咽痛，甚则吐血。脉气口带浮。此风热迫损肺络。宜微苦辛凉。
连翘 射干 杏仁 黑山栀 京元参 郁金 茯苓 桑叶 荆芥炭 白茅根
左 春升之令，肝火升腾，咽中痛痒复发，口鼻热冲。恐成喉痹。
黑元参 射干 黑山栀 广郁金 玉泉散 白桔梗 连翘 粉丹皮 炒蒌皮 枇杷叶
王（左） 音喑咽燥作痛，便艰带血。风湿化火，灼烁肺胃。前投凉解，不能应手，拟通地道而开天气，肺与
大肠相表里故也。
黑元参（四钱） 鲜生地（一两） 玉泉散（三钱包） 连翘壳（三钱） 射干（七分） 大麦冬（三钱）
鲜石斛（四钱） 天花粉（二钱） 牛蒡子（三钱） 白桔梗（一钱） 上湘军（三钱煎三钱磨冲） 梨汁（一两冲）
吕（左） 喉症之后，痰滞未清，以至喉间肿胀如核，久而不化。宜化痰开郁。
制半夏（二钱） 水炒竹茹（一钱） 郁金（一钱五分） 茯苓（四钱） 象贝母（二钱） 广橘红（一钱）
杏仁泥（三钱） 炒枳壳（一钱） 桔梗（一钱） 陈海蛰（一两） 大荸荠（四枚二味煎汤代水）
某 石蛾遇劳辄发，发则咽痛，耳后筋胀，鼻窍不利。此喉蛾之后，遗毒未清，不易杜截也。
射干（五分） 黑元参（三钱） 冬桑叶（一钱） 黑山栀（三钱） 广玉金（一钱五分） 桔梗（一钱）
大贝母（三钱） 粉丹皮（二钱） 盐水炒橘红（一钱） 梨肉（一两） 茅根肉（七钱）
龚（右） 头痛内热俱减，然咽中仍然作痛。喉痹情形，极难调治。
北沙参（五钱） 细生地（四钱） 川石斛（四钱） 射干（五分） 粉丹皮（二钱） 川贝母（二钱）
大麦冬（三钱） 竹衣（一分） 天花粉（二钱） 黑元参（三钱） 郁金（一钱五分） 青果（二枚）
二诊 咽痛音喑稍减，而咽中哽阻。肺胃燥痰未化也。
北沙参 川贝母 云茯苓 青果 川石斛 郁金
光杏仁 竹沥 炒蒌皮 黑元参 陈关蛰 地栗
三诊 诸恙皆减，而咽燥甚，则喑亦随之俱甚。气液之耗伤，即此可见。
北沙参 川贝母 元参肉 青蛤散 郁金 川石斛 天花粉 光杏仁 大麦冬 青果 梨片
四诊 咳喑而且吐血。据述病由受寒而起，投补而剧。于无治处求治，姑从此着眼，以希天幸。
炙麻黄（五分） 光杏仁（三钱） 象贝母（一钱五分） 炙桑叶（一钱） 藕节（二枚） 浮蝉衣（一钱五分）
炒当归（一钱五分） 煨石膏（六钱） 云茯苓（三钱） 生甘草（五分）
五诊 辛温寒合方，咳嗽降序。肺伤邪伏，再尽人力以待造化。
炙麻黄（五分） 生甘草（五分） 元参肉（三钱） 射干（五分） 煨石膏（六钱） 炒蒌皮（三钱）
净蝉衣（一钱五分） 竹衣（二分） 北沙参（五钱） 川贝母（二钱） 梨肉（一两五钱）
六诊 久喑久咳，本无发越之理。病从受寒而起，所以辛温之药，叠见应效。药向效边求，从前法进退。
炙麻黄 光杏仁 茯苓 元参 青果 煨石膏 生甘草 花粉 梨肉
七诊 稍感新凉，咳嗽顿剧。太阴伏寒，非温不化也。
炙麻黄（三分） 北细辛（三分） 橘红（一钱） 五味子（六粒老姜二片同打） 川桂枝（三分） 光杏仁
（三钱） 炙黑甘草（三分） 制半夏（一钱五分） 云茯苓（三钱）
八诊 叠进辛温，咳退十六，姑守前法以希天幸。
炙麻黄（四分） 光杏仁（三钱） 炙橘红（一钱） 云茯苓（三钱） 竹衣（一分） 北细辛（三分）
炒苏子（三钱） 生熟甘草（各二分） 桔梗（一钱）
九诊 音声稍爽。再清金润肺，以觇动静。
天花粉 川石斛 桔梗 水炒竹二青 北沙参 黑元参
生甘草 梨肉 光杏仁 云茯苓 竹衣
十诊 心中炙热，致音爽复喑。良以痰热上凌。再清金化痰。
栝蒌皮 桔梗 生甘草 竹沥 生鸡子白（一枚冲） 北沙参 麦冬 云茯苓 郁金
十一诊 经云、人卒然无音者，寒气客于会厌，则厌不能发，发不能下，其开阁不致，故无音。夫卒然者，
非久之之谓也。今喑起仓卒之间，迁延至两年之久，揆诸久病得之为津枯血槁之条，似属相殊。不知
其得此喑病之时，并非久病而得之，实以暴而得之，绵延日久不愈，虽久也，实暴也。但寒久则与暴客
究有不同，以寒久则化热，所以心中有时热辣，而咽中有时作痛。前人谓失之毫厘，谬以千里，不可不
辨而漫为施治也。拟消风散以治其内客之邪。至火邪遏闭，咽干声嘶而痛，古法往往宁肺清咽，即参此意。
台参须（一两） 苦桔梗（一两三钱） 松萝茶（一两五钱） 广皮（一两三钱） 大麦冬（四两） 川羌活（
一两五钱） 生甘草（一两三钱） 防风（一两五钱） 炙款冬（三两） 荆芥穗（一两五钱） 牛蒡子（三两）
川芎（一两五钱） 白僵蚕（二两） 川贝母（三两） 光杏仁（四两） 云茯苓（四两）
共研细末，淡姜汁泛丸，如凤仙子大，不可过大，大则力下行，恐过病所也。临卧服三钱，食后服一钱五分，青
果汤下。
邵（左） 冬令过温，少阴之热，循经而发，喉痛数日，势虽不甚，今交戌亥时，肢节筋脉，忽作牵掣两次，而
无表邪见症。夫少阴，属肾，内藏相火，相火寄于肝胆，胆为少阳而属风，木火动则风生，风煽则火炽。经
云、一阴一阳结，谓之喉痹。即风火相合之意。今肢节掣引少阳之风从内而鼓，诚恐火势因之暴炽，胡可
再投表散，以张其焰。惟有甘凉镇润，为合古人治法。
细生地 大麦冬 白蒺藜 桑叶 生甘草 大白芍 元参肉 黑山栀 钩钩
二诊 投剂后喉痛大定，筋脉牵掣亦未复作，饮食自调。诚以火风从内而发。镇之则风平，润之则火
熄，火与风合，其来也勃然，火与风分，其去也倏然。脉形沉弱，面色青黄。脉经谓营气不足面色青，卫气
不足面色黄。肝为营之源，肾为卫之本，平日肝肾之不足，略见一斑。仍从前法出入。
细生地 豆衣 粉丹皮 元参 甘草 大麦冬 滁菊花 大白芍 钩钩
三诊 喉痛既平数日，忽于戌亥之交，梦在凉月中行，陡然惊寤，肢体又作震战。夫阳气藏于阴中，阴
气敛之，则阳方静谧，戌亥为至阴之际，少阴之敛藏不固，则阳气从阴中勃然而出，经谓肾之变动为
栗者此也。拟大剂育阴，以助蛰藏之令。
大生地 怀牛膝 云茯神 大麦冬 钩钩 豆衣 白蒺藜 东白芍 元参肉
四诊 投剂之后，震战以次渐平，肾之变动为栗，经训确然无疑。夫肾何至于变动哉。良由冬令过温，
少阴不主潜藏，阴中之火从而升动，阴火者，犹雷电之火也，故其发也，作为战栗之状。药既应手，自宜
叠进，以期阴平阳秘。
大生地 东白芍 云茯神 金石斛 怀山药 怀牛膝 大麦冬 钩钩
荣（左） 冬暖阳气不藏，交春阳气更加发泄肾水亏损，不能制伏阳气，以致内火亢盛，上蒸肺胃，喉间
肿痛，喉关之内，已布白点白条，头胀恶寒发热，遍体不舒。津液为火所蒸，变成痰沫，以致痰涎上涌，正
所谓痰即有形之火，火即无形之痰也。白喉风症，为时行险恶之疾。姑清肺胃之热，益肾之水以制火。
生石膏（五钱薄荷头一钱同打绢包） 大生地（五钱） 大元参（三钱） 知母（二钱） 大麦冬（三钱）
栝蒌仁（六钱） 川贝母（二钱） 绿豆衣（三钱） 生甘草（五分） 金银花（二钱） 鲜芦根（去节一两五钱）
二诊 喉间白条已退，肿胀稍定。然仍凛寒发热，汗出则松，大便六日不解，火热结闭，舌红苔黄。李先
生釜底抽薪法，陆先生泄热化痰法，从两方之中，参合并用，未识然否。
鲜生地（七钱） 大连翘（三钱） 黑山栀（三钱） 元参肉（三钱） 苏薄荷（一钱） 大力子（三钱）
川贝母（二钱） 生广军（三钱） 淡黄芩（一钱五分） 元明粉（一钱冲） 竹叶心（二十片） 活水芦根（一两
五钱）
三诊 釜底抽薪，便行两次，蕴热稍得下行，咽喉肿痛大退。然仍作胀多痰，凛寒发热。邪风蕴热未楚。
拟清咽利膈法。
川雅连（四分） 生山栀（一钱五分） 黑元参（三钱） 竹叶（十二片） 白桔梗（一钱） 大力子（三钱打）
连翘壳（三钱） 青防风（一钱） 广郁金（一钱） 荆芥穗（一钱）
四诊 咽赤肿痛大退，脉静身凉。邪势已解，出险履夷。幸至极矣。但腹中气觉呆钝。热化湿动。再清余
炎，兼理湿邪。
大力子（三钱） 白桔梗（八分） 通草（七分） 滑石（三钱） 连翘（三钱） 范志曲（一钱五分）
黑山栀（二钱） 赤苓（三钱） 枳壳（一钱）
改方去连翘，加栝蒌仁五钱，光杏仁三钱，黑山栀一钱。
费毓卿夫人 由瘀化水，水性就下，流入足三阴经，郁而生热，遂致腿股赤肿。肝胆之火，亦因之而起，
火既用事，阴分愈烁，不特分利泄湿，不能却病，即育阴之剂，未见全功。足肿赤痛，口碎咽疼，知是阴虚
之极，阴不藏阳，阳气炽于阴分之中，而浮越于外。随进金匮肾气以导火归原，散越之火，应手而伏，两
足赤痛顿定，肿大如瓜之状，什消五六，可谓冒险逢生。理宜渐渐和平，徐徐图复，岂期散越之火，一扫
而尽，而咽中之痛，稍缓复盛。脉数右寸关较大，而不耐重按。窃思少阴肾脏，是藏精之地，为乙癸之源。
考少阴之脉系舌本，循喉咙，诸经之火既收，何独咽痛不与偕退。良由肾液燥涸之甚，阴气不能下吸，
则虚阳难以潜伏。诚恐糜腐大起，阴阳不相抱负，而致虚脱，兹与屐莓仁兄先生商用仲景猪肤汤，以
救少阴之燥，合阿胶鸡子地黄汤，以救肝肾之阴。转变百出而致于此，得失之数，在此一举，若得应手，
便是转危为安也。
真阿胶 生山药 熟地 鸡子黄 白粳米 麦冬 炒黄川贝 川石斛 猪肤 白蜜
复诊 诸火渐收，而少阴大亏，阴不下吸，虚阳依然上炎，已申明于前案中。夫阴不下吸，为水亏也，猪
肤汤以救肾燥，胶地以滋水源。无如虚阳既从上炎，肺金受烁，肺为水之上源，源头不生，则滋育之品
自为杯水车薪，无从应手。遂以崔氏八味为之反佐，而口糜仍然不退。壮水而水不能壮，导火而火不
【附：失音】
鲍先生（右侧脉象）咽喉疼痛，劳累后即发作，颧骨发红，眼睛干涩。这是心胆之火郁结，恐怕会发展成喉痹（以咽喉肿痛、闭塞为主症的疾病）。
连翘壳三钱，净蝉衣一钱，黑山栀二钱，生甘草三分，射干五分，元参肉三钱，桔梗一钱，荆芥一钱，细生地四钱，郁金一钱五分。
二诊：昨天服用甘凉药物后，中脘部感到痞塞阻滞，而眼睛疼痛、火气上冲、咽喉疼痛，足部厥冷不温。气火全部向上浮越。再次采用反佐法进药。
广郁金，磁石，半夏曲（炒），白蒺藜，光杏仁，炒枳壳，香豆豉，茯苓，滋肾丸三钱（分两次用淡盐汤送服）。
三诊：咽喉疼痛稍减，足部转温，然而中脘仍然不舒服。仍然是气郁导致火难以下降。前面的方法再进一步调整。
制半夏，炒枳壳，广郁金，橘皮，生熟香附，茯苓，川连二分与干姜四分同炒，滋肾丸三钱。
四诊：苦辛开降之法，中脘稍舒，咽喉疼痛略减，颧红稍退。水性常降，宜使之升；火性常升，宜使之降，中焦是升降的总通道。再拟定苦辛合化之法，引导火热下行。
制半夏，炒枳实，广郁金，肥知母，黄柏，云茯苓，广皮，竹茹，上徭桂三分（去皮研末，饭糊丸如梧桐子大，先服用）。
五诊：胸次稍舒，饭食稍增，然而足部仍然厥逆，咽喉仍然疼痛。还是虚阳上逆。使用《金匮要略》的方法。
漂净猪肤六钱，白蜜二钱，生甘草三分，桔梗一钱，炒黄粳米粉二钱，茯苓三钱，滋肾丸三钱（用药汁送下）。
鲍先生（右侧脉象）经过治疗，各种症状稍退。春季阳气升发，木火燃动，如果不表现为乳房胀痛，就会表现为咽喉疼痛。
广郁金，桑叶，白蒺藜，朱茯神，栝蒌皮，钩藤，黑山栀，胡黄连，黑豆衣，吴茱萸。
二诊：节气过后，木火未熄，咽喉热痛，头胀牙痛。前面的方法再参入滋阴之法。
元参，山栀，丹皮，石决明，灯心，豆豉，郁金，桑叶，滁菊花，青果。
三诊：昨天兼用清泄之法，咽痛牙疼稍减，然而咽喉处仍有哽塞之象。气郁痰滞，木火想要下降却没有途径。再开展气机，气行则痰利，火自然下降。
香豆豉，黑山栀，竹茹，白茯苓，甜杏仁，灵磁石，栝蒌皮，郁金，炒枳壳，枇杷叶。
孙先生（左侧脉象）向来有痰嗽，去年冬天感受风温，导致热与痰结合，蒸腾损伤肺脏，咽喉作痛，声音喑哑嘶哑，内热连绵不断，痰稠如胶，颜色带青绿色。脉象细数。气火全部从上凌犯，太阴肺津，全被痰热所耗伤，金水不能相生，肾脏所藏之水，日益亏乏。
这是虚劳喉痹，恐怕不是草木药物可以奏效的。
元参，花粉，桔梗，川贝母，白莱菔（绞汁半杯温服冲入），杏仁，郁金，茯苓，海浮石，青果（打汁冲服五枚），玉泉散，陈海蛰（漂洗一两五钱），大荸荠（打汁冲服五枚）。
二诊：清化痰热后，咽痛音喑，仍然没有减轻。脉象细数，颇有促脉之意。可见痰热虽然壅盛于上，而肾水内部亏虚，虚阳也从上逆。再上下分治，以观察造化如何。
大生地炭，生甘草，丹皮，蝉衣，黑元参肉，川贝母，桔梗，山栀。
某患者不时咽喉疼痛，严重时吐血。脉气口带浮。这是风热迫损肺络。宜用微苦辛凉之法。
连翘，射干，杏仁，黑山栀，京元参，郁金，茯苓，桑叶，荆芥炭，白茅根。
左姓患者：春季升发之时，肝火升腾，咽喉痛痒复发，口鼻热冲。恐怕会形成喉痹。
黑元参，射干，黑山栀，广郁金，玉泉散，白桔梗，连翘，粉丹皮，炒蒌皮，枇杷叶。
王先生（左侧脉象）：声音喑哑，咽喉干燥作痛，大便困难带血。风湿化为火，灼烁肺胃。之前投予凉解药物，不能应手见效，拟通地道（大肠）而开天气（肺），因为肺与大肠相表里。
黑元参四钱，鲜生地一两，玉泉散三钱包煎，连翘壳三钱，射干七分，大麦冬三钱，鲜石斛四钱，天花粉二钱，牛蒡子三钱，白桔梗一钱，上湘军三钱（煎取三钱汁磨冲），梨汁一两（冲服）。
吕先生（左侧脉象）：喉症之后，痰滞未清，以至于喉间肿胀如核，久而不化。宜化痰开郁。
制半夏二钱，水炒竹茹一钱，郁金一钱五分，茯苓四钱，象贝母二钱，广橘红一钱，杏仁泥三钱，炒枳壳一钱，桔梗一钱，陈海蛰一两，大荸荠四枚（两味煎汤代水）。
某患者：石蛾（扁桃体肿大）遇劳辄发，发作时咽喉疼痛，耳后筋脉胀，鼻窍不利。这是喉蛾之后，遗毒未清，不易杜绝截断。
射干五分，黑元参三钱，冬桑叶一钱，黑山栀三钱，广玉金一钱五分，桔梗一钱，大贝母三钱，粉丹皮二钱，盐水炒橘红一钱，梨肉一两，茅根肉七钱。
龚先生（右侧脉象）：头痛内热都减轻了，然而咽喉仍然作痛。喉痹的情况，极难调治。
北沙参五钱，细生地四钱，川石斛四钱，射干五分，粉丹皮二钱，川贝母二钱，大麦冬三钱，竹衣一分，天花粉二钱，黑元参三钱，郁金一钱五分，青果二枚。
二诊：咽痛音喑稍减，而咽喉中哽阻。肺胃燥痰未化也。
北沙参，川贝母，云茯苓，青果，川石斛，郁金，光杏仁，竹沥，炒蒌皮，黑元参，陈关蛰，地栗。
三诊：各种症状都减轻，而咽喉干燥严重，则失音也随之严重。气液的耗伤，由此可见。
北沙参，川贝母，元参肉，青蛤散，郁金，川石斛，天花粉，光杏仁，大麦冬，青果，梨片。
四诊：咳嗽失音而且吐血。据述病由受寒而起，投补药后病情加剧。在无法治疗的地方寻求治疗，姑且从此着眼，以希望天幸。
炙麻黄五分，光杏仁三钱，象贝母一钱五分，炙桑叶一钱，藕节二枚，浮蝉衣一钱五分，炒当归一钱五分，煨石膏六钱，云茯苓三钱，生甘草五分。
五诊：辛温寒合方，咳嗽降序。肺伤邪伏，再尽人力以待造化。
炙麻黄五分，生甘草五分，元参肉三钱，射干五分，煨石膏六钱，炒蒌皮三钱，净蝉衣一钱五分，竹衣二分，北沙参五钱，川贝母二钱，梨肉一两五钱。
六诊：久喑久咳，本无发越之理。病从受寒而起，所以辛温之药，叠见应效。药向效边求，从前法进退。
炙麻黄，光杏仁，茯苓，元参，青果，煨石膏，生甘草，花粉，梨肉。
七诊：稍感新凉，咳嗽顿剧。太阴伏寒，非温不化也。
炙麻黄三分，北细辛三分，橘红一钱，五味子六粒老姜二片同打，川桂枝三分，光杏仁三钱，炙黑甘草三分，制半夏一钱五分，云茯苓三钱。
八诊：叠进辛温，咳退十六，姑守前法以希天幸。
炙麻黄四分，光杏仁三钱，炙橘红一钱，云茯苓三钱，竹衣一分，北细辛三分，炒苏子三钱，生熟甘草各二分，桔梗一钱。
九诊：音声稍爽。再清金润肺，以觇动静。
天花粉，川石斛，桔梗，水炒竹二青，北沙参，黑元参，生甘草，梨肉，光杏仁，云茯苓，竹衣。
十诊：心中炙热，致音爽复喑。良以痰热上凌。再清金化痰。
栝蒌皮，桔梗，生甘草，竹沥，生鸡子白一枚（冲服），北沙参，麦冬，云茯苓，郁金。
十一诊：经云：“人卒然无音者，寒气客于会厌，则厌不能发，发不能下，其开阁不致，故无音。”夫卒然者，非久之之谓也。今喑起仓卒之间，迁延至两年之久，揆诸久病得之为津枯血槁之条，似属相殊。不知其得此喑病之时，并非久病而得之，实以暴而得之，绵延日久不愈，虽久也，实暴也。但寒久则与暴客究有不同，以寒久则化热，所以心中有时热辣，而咽中有时作痛。前人谓失之毫厘，谬以千里，不可不辨而漫为施治也。拟消风散以治其内客之邪。至火邪遏闭，咽干声嘶而痛，古法往往宁肺清咽，即参此意。
台参须一两，苦桔梗一两三钱，松萝茶一两五钱，广皮一两三钱，大麦冬四两，川羌活一两五钱，生甘草一两三钱，防风一两五钱，炙款冬三两，荆芥穗一两五钱，牛蒡子三两，川芎一两五钱，白僵蚕二两，川贝母三两，光杏仁四两，云茯苓四两。
共研细末，淡姜汁泛丸，如凤仙子大，不可过大，大则力下行，恐过病所也。临卧服三钱，食后服一钱五分，青果汤下。
邵先生（左侧脉象）：冬令过温，少阴之热，循经而发，喉痛数日，势虽不甚，今交戌亥时，肢节筋脉，忽作牵掣两次，而无表邪见症。夫少阴，属肾，内藏相火，相火寄于肝胆，胆为少阳而属风，木火动则风生，风煽则火炽。经云：“一阴一阳结，谓之喉痹。”即风火相合之意。今肢节掣引少阳之风从内而鼓，诚恐火势因之暴炽，胡可再投表散，以张其焰。惟有甘凉镇润，为合古人治法。
细生地，大麦冬，白蒺藜，桑叶，生甘草，大白芍，元参肉，黑山栀，钩钩。
二诊：投剂后喉痛大定，筋脉牵掣亦未复作，饮食自调。诚以火风从内而发。镇之则风平，润之则火熄，火与风合，其来也勃然，火与风分，其去也倏然。脉形沉弱，面色青黄。脉经谓营气不足面色青，卫气不足面色黄。肝为营之源，肾为卫之本，平日肝肾之不足，略见一斑。仍从前法出入。
细生地，豆衣，粉丹皮，元参，甘草，大麦冬，滁菊花，大白芍，钩钩。
三诊：喉痛既平数日，忽于戌亥之交，梦在凉月中行，陡然惊寤，肢体又作震战。夫阳气藏于阴中，阴气敛之，则阳方静谧，戌亥为至阴之际，少阴之敛藏不固，则阳气从阴中勃然而出，经谓肾之变动为栗者此也。拟大剂育阴，以助蛰藏之令。
大生地，怀牛膝，云茯神，大麦冬，钩钩，豆衣，白蒺藜，东白芍，元参肉。
四诊：投剂之后，震战以次渐平，肾之变动为栗，经训确然无疑。夫肾何至于变动哉。良由冬令过温，少阴不主潜藏，阴中之火从而升动，阴火者，犹雷电之火也，故其发也，作为战栗之状。药既应手，自宜叠进，以期阴平阳秘。
大生地，东白芍，云茯神，金石斛，怀山药，怀牛膝，大麦冬，钩钩。
荣先生（左侧脉象）：冬暖阳气不藏，交春阳气更加发泄肾水亏损，不能制伏阳气，以致内火亢盛，上蒸肺胃，喉间肿痛，喉关之内，已布白点白条，头胀恶寒发热，遍体不舒。津液为火所蒸，变成痰沫，以致痰涎上涌，正所谓痰即有形之火，火即无形之痰也。白喉风症，为时行险恶之疾。姑清肺胃之热，益肾之水以制火。
生石膏五钱（薄荷头一钱同打绢包），大生地五钱，大元参三钱，知母二钱，大麦冬三钱，栝蒌仁六钱，川贝母二钱，绿豆衣三钱，生甘草五分，金银花二钱，鲜芦根去节一两五钱。
二诊：喉间白条已退，肿胀稍定。然仍凛寒发热，汗出则松，大便六日不解，火热结闭，舌红苔黄。李先生釜底抽薪法，陆先生泄热化痰法，从两方之中，参合并用，未识然否。
鲜生地七钱，大连翘三钱，黑山栀三钱，元参肉三钱，苏薄荷一钱，大力子三钱，川贝母二钱，生广军三钱，淡黄芩一钱五分，元明粉一钱（冲服），竹叶心二十片，活水芦根一两五钱。
三诊：釜底抽薪，便行两次，蕴热稍得下行，咽喉肿痛大退。然仍作胀多痰，凛寒发热。邪风蕴热未楚。拟清咽利膈法。
川雅连四分，生山栀一钱五分，黑元参三钱，竹叶十二片，白桔梗一钱，大力子三钱（打），连翘壳三钱，青防风一钱，广郁金一钱，荆芥穗一钱。
四诊：咽赤肿痛大退，脉静身凉。邪势已解，出险履夷。幸至极矣。但腹中气觉呆钝。热化湿动。再清余炎，兼理湿邪。
大力子三钱，白桔梗八分，通草七分，滑石三钱，连翘三钱，范志曲一钱五分，黑山栀二钱，赤苓三钱，枳壳一钱。
改方去连翘，加栝蒌仁五钱，光杏仁三钱，黑山栀一钱。
费毓卿夫人：由瘀化水，水性就下，流入足三阴经，郁而生热，遂致腿股赤肿。肝胆之火，亦因之而起，火既用事，阴分愈烁，不特分利泄湿，不能却病，即育阴之剂，未见全功。足肿赤痛，口碎咽疼，知是阴虚之极，阴不藏阳，阳气炽于阴分之中，而浮越于外。随进金匮肾气以导火归原，散越之火，应手而伏，两足赤痛顿定，肿大如瓜之状，什消五六，可谓冒险逢生。理宜渐渐和平，徐徐图复，岂期散越之火，一扫而尽，而咽中之痛，稍缓复盛。脉数右寸关较大，而不耐重按。窃思少阴肾脏，是藏精之地，为乙癸之源。考少阴之脉系舌本，循喉咙，诸经之火既收，何独咽痛不与偕退。良由肾液燥涸之甚，阴气不能下吸，则虚阳难以潜伏。诚恐糜腐大起，阴阳不相抱负，而致虚脱，兹与屐莓仁兄先生商用仲景猪肤汤，以救少阴之燥，合阿胶鸡子地黄汤，以救肝肾之阴。转变百出而致于此，得失之数，在此一举，若得应手，便是转危为安也。
真阿胶，生山药，熟地，鸡子黄，白粳米，麦冬，炒黄川贝，川石斛，猪肤，白蜜。
复诊：诸火渐收，而少阴大亏，阴不下吸，虚阳依然上炎，已申明于前案中。夫阴不下吸，为水亏也，猪肤汤以救肾燥，胶地以滋水源。无如虚阳既从上炎，肺金受烁，肺为水之上源，源头不生，则滋育之品自为杯水车薪，无从应手。遂以崔氏八味为之反佐，而口糜仍然不退。壮水而水不能壮，导火而火不
[Appendix: Loss of Voice]
Mr. Bao (Right pulse): Throat pain, recurring upon exertion, with red malar flush and dry eyes. This is stagnation of fire in the Heart and Gallbladder, which may develop into Hou Bi (Throat Obstruction, a disease characterized by swelling and obstruction of the throat).
Qiaokiao Ke (Forsythiae Fructum) 3 qian, Jing Chanyi (Cicadae Periostracum) 1 qian, Hei Shanzhi (Gardeniae Fructus) 2 qian, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 3 fen, Shegan (Belamcandae Rhizoma) 5 fen, Yuanshen Rou (Scrophulariae Radix) 3 qian, Jiegeng (Platycodonis Radix) 1 qian, Jingjie (Schizonepetae Herba) 1 qian, Xi Shengdi (Rehmanniae Radix) 4 qian, Yujin (Curcumae Radix) 1.5 qian.
Second visit: After taking sweet and cool herbs yesterday, there was a sensation of fullness and obstruction in the epigastrium, while eye pain, rising fire, throat pain, and cold feet persisted. Qi and fire are all floating upwards. Re-administer using the method of counter-assistance (adding a small amount of hot/cold herb to prevent rejection).
Guang Yujin (Curcumae Radix), Cishi (Magnetitum), Banxia Qu (Pinelliae Fermentatum), Bai Jili (Tribuli Fructus), Guang Xingren (Armeniacae Semen), Chao Zhiqiao (Aurantii Fructus Immaturus), Xiang Douchi (Sojae Semen Praeparatum), Fuling (Poria), Zishen Wan (Kidney-Nourishing Pill) 3 qian (taken in two doses with light salt water).
Third visit: Throat pain has slightly decreased, feet have warmed, but the epigastrium remains uncomfortable. It is still qi stagnation preventing fire from descending. The previous method should be advanced further.
Zhi Banxia (Pinelliae Rhizoma), Chao Zhiqiao (Aurantii Fructus Immaturus), Guang Yujin (Curcumae Radix), Ju Pi (Citri Reticulatae Pericarpium), Sheng Shu Xiangfu (Cyperi Rhizoma), Fuling (Poria), Chuan Lian (Coptidis Rhizoma) 2 fen stir-fried with Ganjiang (Zingiberis Rhizoma) 4 fen, Zishen Wan (Kidney-Nourishing Pill) 3 qian.
Fourth visit: With bitter and acrid methods to open and descend, the epigastrium is slightly relieved, throat pain slightly reduced, and malar flush faded. Water nature tends to descend, so it should be guided to ascend; Fire nature tends to ascend, so it should be guided to descend. The Middle Jiao is the general pathway for ascending and descending. Again, prescribe bitter-acrid combination to guide fire downwards.
Zhi Banxia (Pinelliae Rhizoma), Chao Zhishi (Aurantii Fructus Immaturus), Guang Yujin (Curcumae Radix), Fei Zhimu (Anemarrhenae Rhizoma), Huangbai (Phellodendri Cortex), Yun Fuling (Poria), Guang Pi (Citri Reticulatae Pericarpium), Zhuru (Bambusae Caulis in Taenia), Shang Yao Gui (Cinnamomi Ramulus) 3 fen (peeled, powdered, pillified with rice paste into wu-tong seed size, take first).
Fifth visit: Chest feels slightly relieved, appetite slightly increased, yet feet remain cold and throat painful. This is deficiency Yang floating upward. Use the method from *Jinkui Yaolue*.
Piao Jing Zhufu (Porcinis Cutis) 6 qian, Bai Mi (Mel) 2 qian, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 3 fen, Jiegeng (Platycodonis Radix) 1 qian, Chao Huang Jingmi Fen (Oryzae Semen) 2 qian, Fuling (Poria) 3 qian, Zishen Wan (Kidney-Nourishing Pill) 3 qian (taken with decoction juice).
Mr. Bao (Right pulse): Various symptoms have slightly receded after treatment. In spring, when Yang rises and Wood-Fire ignites, if not manifesting as breast distension, it will manifest as throat pain.
Guang Yujin (Curcumae Radix), Sangye (Mori Folium), Bai Jili (Tribuli Fructus), Zhu Fushen (Poria cum Risus), Gualou Pi (Trichosanthis Pericarpium), Gougou (Uncariae Ramulus cum Uncis), Hei Shanzhi (Gardeniae Fructus), Huhuanglian (Coptidis Rhizoma var.), Heidouyi (Sojae Semen Nigrum Testa), Wuyu (Evodiae Fructus).
Second visit: After solar terms, Wood-Fire has not extinguished; throat is hot and painful, head distended, teeth ache. Modify the previous method by incorporating Yin-nourishing herbs.
Yuanshen (Scrophulariae Radix), Shanzhi (Gardeniae Fructus), Danpi (Moutan Cortex), Shijueming (Concha Arcae), Dengxin (Junci Medulla), Douchi (Sojae Semen Praeparatum), Yujin (Curcumae Radix), Sangye (Mori Folium), Chu Juhua (Chrysanthemi Indici Flos), Qingguo (Canarii Fructus).
Third visit: Yesterday, combined with clearing and draining, throat and tooth pain slightly decreased, but there is still a sensation of blockage in the throat. Qi stagnation and phlegm retention prevent Wood-Fire from descending. Further promote Qi mechanism; when Qi moves, Phlegm clears, and Fire descends naturally.
Xiang Douchi (Sojae Semen Praeparatum), Hei Shanzhi (Gardeniae Fructus), Zhuru (Bambusae Caulis in Taenia), Bai Fuling (Poria), Tian Xingren (Armeniacae Semen), Ling Cishi (Magnetitum), Gualou Pi (Trichosanthis Pericarpium), Yujin (Curcumae Radix), Chao Zhiqiao (Aurantii Fructus Immaturus), Pipaye (Eriobotryae Folium).
Mr. Sun (Left pulse): Previously had phlegm-cough. Last winter, contracted Wind-Warmth, causing Heat to combine with Phlegm, steaming and damaging the Lung. Throat hurts, voice is hoarse and raspy, internal heat persists, phlegm is thick like glue, greenish-blue in color. Pulse is fine and rapid. Qi and Fire all overwhelm from above; Taiyin Lung fluids are exhausted by Phlegm-Heat. Metal and Water do not generate each other; Kidney Water is daily depleted.
This is Deficiency Consumption with Throat Obstruction; likely grass and wood herbs cannot achieve success.
Yuanshen (Scrophulariae Radix), Huafen (Trichosanthis Radix), Jiegeng (Platycodonis Radix), Chuan Beimu (Fritillariae Cirrhosae Bulbus), Bailai Fu (Raphani Fructus) (juice half cup, taken warm), Xingren (Armeniacae Semen), Yujin (Curcumae Radix), Fuling (Poria), Haifushi (Lithotrichum), Qingguo (Canarii Fructus) (juiced, 5 fruits taken), Yuquan San (Spring Juice Powder), Chen Haizhe (Stichopus Japonicus) (washed 1.5 liang), Da Biqi (Dioscoreae Hypoglaucae Tuber) (juiced, 5 fruits taken).
Second visit: After clearing and transforming Phlegm-Heat, throat pain and hoarseness remain unchanged. Pulse is fine and rapid, showing signs of Cu Mai (Hasty Pulse). This shows that although Phlegm-Heat is congested above, Kidney Water is deficient internally, and Deficient Yang also rebels upward. Treat upper and lower separately to observe the outcome.
Da Shengdi Tan (Rehmanniae Radix Carbonized), Sheng Gancao (Glycyrrhizae Radix et Rhizoma), Danpi (Moutan Cortex), Chanyi (Cicadae Periostracum), Hei Yuanshen Rou (Scrophulariae Radix), Chuan Beimu (Fritillariae Cirrhosae Bulbus), Jiegeng (Platycodonis Radix), Shanzhi (Gardeniae Fructus).
Certain patient: Intermittent throat pain, severe cases involve hemoptysis. Pulse at Kou position is floating. This is Wind-Heat forcing damage to Lung collaterals. Use slightly bitter, acrid, and cool methods.
Lianqiao (Forsythiae Fructum), Shegan (Belamcandae Rhizoma), Xingren (Armeniacae Semen), Hei Shanzhi (Gardeniae Fructus), Jing Yuanshen (Scrophulariae Radix), Yujin (Curcumae Radix), Fuling (Poria), Sangye (Mori Folium), Jingjie Tan (Schizonepetae Herba Carbonized), Bai Maogen (Imperatae Rhizoma).
Zuo patient: During Spring ascent, Liver Fire surges, throat pain and itching recur, heat rushes to mouth and nose. Fear of developing Hou Bi (Throat Obstruction).
Hei Yuanshen (Scrophulariae Radix), Shegan (Belamcandae Rhizoma), Hei Shanzhi (Gardeniae Fructus), Guang Yujin (Curcumae Radix), Yuquan San (Spring Juice Powder), Bai Jiegeng (Platycodonis Radix), Lianqiao (Forsythiae Fructum), Fen Danpi (Moutan Cortex), Chao Loupi (Trichosanthis Pericarpium), Pipaye (Eriobotryae Folium).
Mr. Wang (Left pulse): Hoarseness, dry painful throat, difficult defecation with blood. Wind-Damp transforms into Fire, scorching Lung and Stomach. Previous cooling and resolving prescriptions were ineffective. Prescribe unblocking the Lower Dao (Large Intestine) to open the Upper Heaven (Lung), as Lung and Large Intestine are exterior-interior related.
Hei Yuanshen (Scrophulariae Radix) 4 qian, Xian Shengdi (Rehmanniae Radix) 1 liang, Yuquan San (Spring Juice Powder) 3 qian (wrapped in cloth), Lianqiao Ke (Forsythiae Fructum) 3 qian, Shegan (Belamcandae Rhizoma) 7 fen, Da Maidong (Ophiopogonis Tuber) 3 qian, Xian Shihu (Dendrobii Caulis) 4 qian, Tianhuafen (Trichosanthis Radix) 2 qian, Niubangzi (Arctii Fructus) 3 qian, Bai Jiegeng (Platycodonis Radix) 1 qian, Shang Xiangjun (Radix Gentianae Macrophyllae) 3 qian (decocted to 3 qian, ground and mixed), Lizhi (Pyrus Sinkiangensis Juice) 1 liang (mixed).
Mr. Lv (Left pulse): After throat illness, Phlegm stagnation is not cleared, leading to throat swelling like a nut, persisting for a long time without resolving. Resolve Phlegm and open depression.
Zhi Banxia (Pinelliae Rhizoma) 2 qian, Shui Chao Zhuru (Bambusae Caulis in Taenia) 1 qian, Yujin (Curcumae Radix) 1.5 qian, Fuling (Poria) 4 qian, Xiang Beimu (Fritillariae Thunbergii Bulbus) 2 qian, Guang Juhong (Citri Reticulatae Pericarpium Rubrum) 1 qian, Xingren Ni (Armeniacae Semen Paste) 3 qian, Chao Zhiqiao (Aurantii Fructus Immaturus) 1 qian, Jiegeng (Platycodonis Radix) 1 qian, Chen Haizhe (Stichopus Japonicus) 1 liang, Da Biqi (Dioscoreae Hypoglaucae Tuber) 4 pieces (decoct these two to replace water).
Certain patient: Shi E (Stone Moth/tonsillar hypertrophy) recurs upon exertion, causing throat pain, distension of tendons behind ears, and nasal obstruction. This is residual toxin after throat moth, not easy to eradicate.
Shegan (Belamcandae Rhizoma) 5 fen, Hei Yuanshen (Scrophulariae Radix) 3 qian, Dong Sangye (Mori Folium) 1 qian, Hei Shanzhi (Gardeniae Fructus) 3 qian, Guang Yujin (Curcumae Radix) 1.5 qian, Jiegeng (Platycodonis Radix) 1 qian, Da Beimu (Fritillariae Thunbergii Bulbus) 3 qian, Fen Danpi (Moutan Cortex) 2 qian, Yan Shui Chao Juhong (Citri Reticulatae Pericarpium Rubrum salt-fried) 1 qian, Li Rou (Pyrus Sinkiangensis Flesh) 1 liang, Maogen Rou (Imperatae Rhizoma Flesh) 7 qian.
Mr. Gong (Right pulse): Headache and internal heat have both decreased, but throat still hurts. The condition of Hou Bi (Throat Obstruction) is extremely difficult to treat.
Beishashen (Glehniae Radix) 5 qian, Xi Shengdi (Rehmanniae Radix) 4 qian, Chuan Shihu (Dendrobii Caulis) 4 qian, Shegan (Belamcandae Rhizoma) 5 fen, Fen Danpi (Moutan Cortex) 2 qian, Chuan Beimu (Fritillariae Cirrhosae Bulbus) 2 qian, Da Maidong (Ophiopogonis Tuber) 3 qian, Zhuyi (Bambusae Membrana) 1 fen, Tianhuafen (Trichosanthis Radix) 2 qian, Hei Yuanshen (Scrophulariae Radix) 3 qian, Yujin (Curcumae Radix) 1.5 qian, Qingguo (Canarii Fructus) 2 pieces.
Second visit: Throat pain and hoarseness slightly decreased, but blockage in throat persists. Dry Phlegm in Lung and Stomach has not transformed.
Beishashen (Glehniae Radix), Chuan Beimu (Fritillariae Cirrhosae Bulbus), Yun Fuling (Poria), Qingguo (Canarii Fructus), Chuan Shihu (Dendrobii Caulis), Yujin (Curcumae Radix), Guang Xingren (Armeniacae Semen), Zhuli (Bambusae Sucus), Chao Loupi (Trichosanthis Pericarpium), Hei Yuanshen (Scrophulariae Radix), Chen Guanzhe (Stichopus Japonicus), Dilì (Dioscoreae Hypoglaucae Tuber).
Third visit: All symptoms decreased, but throat dryness is severe, and hoarseness follows suit. Depletion of Qi and Fluids is evident here.
Beishashen (Glehniae Radix), Chuan Beimu (Fritillariae Cirrhosae Bulbus), Yuanshen Rou (Scrophulariae Radix), Qingge San (Green Clam Powder), Yujin (Curcumae Radix), Chuan Shihu (Dendrobii Caulis), Tianhuafen (Trichosanthis Radix), Guang Xingren (Armeniacae Semen), Da Maidong (Ophiopogonis Tuber), Qingguo (Canarii Fructus), Lipian (Pyrus Sinkiangensis Slices).
Fourth visit: Cough, hoarseness, and hemoptysis. According to history, the illness started from Cold, and tonics aggravated it. Seek treatment where no treatment seems possible, focusing on this aspect, hoping for divine luck.
Zhi Mahuang (Ephedrae Herba Prepared) 5 fen, Guang Xingren (Armeniacae Semen) 3 qian, Xiang Beimu (Fritillariae Thunbergii Bulbus) 1.5 qian, Zhi Sangye (Mori Folium Prepared) 1 qian, Oujie (Nelumbinis Node) 2 pieces, Fu Chanyi (Cicadae Periostracum Floating) 1.5 qian, Chao Danggui (Angelicae Sinensis Radix) 1.5 qian, Wei Shigao (Gypsum Fibrosum Calcined) 6 qian, Yun Fuling (Poria) 3 qian, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 5 fen.
Fifth visit: Acrid-warm and cold combined formula, cough order descends. Lung injured, pathogen latent; exert human effort to await destiny.
Zhi Mahuang (Ephedrae Herba Prepared) 5 fen, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 5 fen, Yuanshen Rou (Scrophulariae Radix) 3 qian, Shegan (Belamcandae Rhizoma) 5 fen, Wei Shigao (Gypsum Fibrosum Calcined) 6 qian, Chao Loupi (Trichosanthis Pericarpium) 3 qian, Jing Chanyi (Cicadae Periostracum) 1.5 qian, Zhuyi (Bambusae Membrana) 2 fen, Beishashen (Glehniae Radix) 5 qian, Chuan Beimu (Fritillariae Cirrhosae Bulbus) 2 qian, Li Rou (Pyrus Sinkiangensis Flesh) 1.5 liang.
Sixth visit: Chronic hoarseness and cough have no principle of dispersal. Illness started from Cold, so acrid-warm herbs repeatedly showed efficacy. Seek efficacy from the prescription, adjusting the previous method.
Zhi Mahuang (Ephedrae Herba Prepared), Guang Xingren (Armeniacae Semen), Fuling (Poria), Yuanshen (Scrophulariae Radix), Qingguo (Canarii Fructus), Wei Shigao (Gypsum Fibrosum Calcined), Sheng Gancao (Glycyrrhizae Radix et Rhizoma), Huafen (Trichosanthis Radix), Li Rou (Pyrus Sinkiangensis Flesh).
Seventh visit: Slight exposure to new coolness caused sudden worsening of cough. Latent Cold in Taiyin requires warmth to transform.
Zhi Mahuang (Ephedrae Herba Prepared) 3 fen, Bei Xixin (Asari Radix et Rhizoma) 3 fen, Juhong (Citri Reticulatae Pericarpium Rubrum) 1 qian, Wuweizi (Schisandrae Fructus) 6 grains with Laojiang (Zingiberis Rhizoma Recens) 2 slices pounded together, Chuan Guizhi (Cinnamomi Ramulus) 3 fen, Guang Xingren (Armeniacae Semen) 3 qian, Zhi Hei Gancao (Glycyrrhizae Radix et Rhizoma Charred) 3 fen, Zhi Banxia (Pinelliae Rhizoma) 1.5 qian, Yun Fuling (Poria) 3 qian.
Eighth visit: Repeated administration of acrid-warm herbs reduced cough by sixteen parts; temporarily maintain the previous method hoping for divine luck.
Zhi Mahuang (Ephedrae Herba Prepared) 4 fen, Guang Xingren (Armeniacae Semen) 3 qian, Zhi Juhong (Citri Reticulatae Pericarpium Rubrum Prepared) 1 qian, Yun Fuling (Poria) 3 qian, Zhuyi (Bambusae Membrana) 1 fen, Bei Xixin (Asari Radix et Rhizoma) 3 fen, Chao Suzi (Perillae Fructus) 3 qian, Sheng Shu Gancao (Glycyrrhizae Radix et Rhizoma) 2 fen each, Jiegeng (Platycodonis Radix) 1 qian.
Ninth visit: Voice slightly clear. Clear Metal and moisten Lung again to observe movement and stillness.
Tianhuafen (Trichosanthis Radix), Chuan Shihu (Dendrobii Caulis), Jiegeng (Platycodonis Radix), Shui Chao Zhu Er Qing (Bambusae Caulis in Taenia and Bambusae Membrana), Beishashen (Glehniae Radix), Hei Yuanshen (Scrophulariae Radix), Sheng Gancao (Glycyrrhizae Radix et Rhizoma), Li Rou (Pyrus Sinkiangensis Flesh), Guang Xingren (Armeniacae Semen), Yun Fuling (Poria), Zhuyi (Bambusae Membrana).
Tenth visit: Burning heat in heart caused voice to become clear then hoarse again. Due to Phlegm-Heat overwhelming upwards. Clear Metal and transform Phlegm again.
Gualou Pi (Trichosanthis Pericarpium), Jiegeng (Platycodonis Radix), Sheng Gancao (Glycyrrhizae Radix et Rhizoma), Zhuli (Bambusae Sucus), Sheng Jizi Bai (Album Ovi Galli) 1 piece (mixed), Beishashen (Glehniae Radix), Maidong (Ophiopogonis Tuber), Yun Fuling (Poria), Yujin (Curcumae Radix).
Eleventh visit: The Classic says: "When a person suddenly loses voice, Cold Qi lodges in the Huiyan (Epiglottis), causing it unable to open or close properly, hence no voice." Sudden loss is not chronic. Now hoarseness started suddenly and persisted for two years. Judging by chronic illness principles of fluid depletion and blood drying, it seems different. However, when this hoarseness occurred, it was not due to chronic illness but acute onset. Prolonged non-healing makes it long, but essentially it is acute. But long-standing Cold differs from acute invasion because long Cold transforms into Heat, hence occasional burning heat in heart and throat pain. As predecessors said, miss by a hair, miss by a mile; one must distinguish before treating blindly. Prescribe Xiaofeng San to treat internal pathogens. For Fire Pathogen obstruction causing dry throat, hoarseness, and pain, ancient methods often calm Lung and clear throat, referencing this intent.
Taishenxu (Ginseng Radix et Rhizoma Stamen) 1 liang, Ku Jiegeng (Platycodonis Radix) 1.3 liang, Songluocha (Usnea) 1.5 liang, Guangpi (Citri Reticulatae Pericarpium) 1.3 liang, Da Maidong (Ophiopogonis Tuber) 4 liang, Chuan Qianghuo (Notopterygii Rhizoma et Radix) 1.5 liang, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 1.3 liang, Fangfeng (Saposhnikoviae Radix) 1.5 liang, Zhi Kuidong (Farfarae Flos) 3 liang, Jingjisui (Schizonepetae Spica) 1.5 liang, Niubangzi (Arctii Fructus) 3 liang, Chuanxiong (Ligustici Chuanxiong Rhizoma) 1.5 liang, Bai Jiangcan (Bombyx Batryticatus) 2 liang, Chuan Beimu (Fritillariae Cirrhosae Bulbus) 3 liang, Guang Xingren (Armeniacae Semen) 4 liang, Yun Fuling (Poria) 4 liang.
Grind into fine powder, pillify with light Ginger Juice, size of Phoenix Seed (large bean), not too large, otherwise force goes downward, fearing passing the disease site. Take 3 qian before bed, 1.5 qian after meals, washed down with Qingguo Decoction.
Mr. Shao (Left pulse): Winter was too warm, Shaoyin Heat followed meridians to erupt, throat pain for several days, severity not high. Now during Xu-Hai hours (9-11 PM), limb joints and tendons suddenly spasmed twice, without exterior pathogen symptoms. Shaoyin belongs to Kidney, containing Ministerial Fire. Ministerial Fire resides in Liver and Gallbladder. Gallbladder is Shaoyang belonging to Wind. Wood-Fire movement generates Wind; Wind fanning intensifies Fire. Classic says: "One Yin and One Yang knotting is called Hou Bi." Meaning Wind and Fire combining. Now limb spasms draw Shaoyang Wind from within to drum up, fearing Fire will violently blaze. How can we again use exterior-dispersing methods to fuel the flame? Only Sweet-Cool, sedating, and moistening methods align with ancient treatment.
Xi Shengdi (Rehmanniae Radix), Da Maidong (Ophiopogonis Tuber), Bai Jili (Tribuli Fructus), Sangye (Mori Folium), Sheng Gancao (Glycyrrhizae Radix et Rhizoma), Da Baishao (Paeoniae Radix Alba), Yuanshen Rou (Scrophulariae Radix), Hei Shanzhi (Gardeniae Fructus), Gougou (Uncariae Ramulus cum Uncis).
Second visit: After administration, throat pain greatly stabilized, tendon spasms did not recur, diet self-regulated. Indeed, Fire and Wind erupted from within. Sedating calms Wind, moistening extinguishes Fire. When Fire and Wind combine, they come vigorously; when separated, they depart swiftly. Pulse is deep and weak, complexion green-yellow. Pulse Classic states: Deficient Ying Qi causes green complexion; Deficient Wei Qi causes yellow complexion. Liver is source of Ying, Kidney is root of Wei. Daily insufficiency of Liver and Kidney is slightly visible. Still adjust from previous method.
Xi Shengdi (Rehmanniae Radix), Douyi (Sojae Semen Nigrum Testa), Fen Danpi (Moutan Cortex), Yuanshen (Scrophulariae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Da Maidong (Ophiopogonis Tuber), Chu Juhua (Chrysanthemi Indici Flos), Da Baishao (Paeoniae Radix Alba), Gougou (Uncariae Ramulus cum Uncis).
Third visit: Throat pain flat for several days, suddenly at Xu-Hai transition, dreamed of walking in cool moon, startled awake, body trembled. Yang Qi hides in Yin; Yin Qi gathers it, then Yang is tranquil. Xu-Hai is extreme Yin time. If Shaoyin gathering/storage is insecure, Yang Qi bursts out from Yin. Classic says: Kidney's change is trembling/chills. Prescribe large dose to nourish Yin, assisting hibernation command.
Da Shengdi (Rehmanniae Radix), Huainiu Xi (Achyranthis Bidentatae Radix), Yun Fushen (Poria cum Risus), Da Maidong (Ophiopogonis Tuber), Gougou (Uncariae Ramulus cum Uncis), Douyi (Sojae Semen Nigrum Testa), Bai Jili (Tribuli Fructus), Dong Baishao (Paeoniae Radix Alba), Yuanshen Rou (Scrophulariae Radix).
Fourth visit: After administration, tremors gradually flattened. Kidney's change is trembling, classic teaching is certain. Why would Kidney change? Indeed, winter was too warm, Shaoyin did not govern hidden storage, Fire within Yin rose and moved. Yin Fire is like lightning fire, hence its eruption manifests as shivering. Since medicine worked, continue administering to achieve Yin-Yang balance.
Da Shengdi (Rehmanniae Radix), Dong Baishao (Paeoniae Radix Alba), Yun Fushen (Poria cum Risus), Jin Shihu (Dendrobii Caulis), Huaishanyao (Dioscoreae Satvae Rhizoma), Huainiu Xi (Achyranthis Bidentatae Radix), Da Maidong (Ophiopogonis Tuber), Gougou (Uncariae Ramulus cum Uncis).
Mr. Rong (Left pulse): Winter warmth prevented Yang storage. Entering Spring, Yang excretion increased. Kidney Water deficient, unable to control Yang, leading to hyperactive internal Fire steaming Lung and Stomach. Throat swollen and painful, white spots/streaks inside throat gate. Head distended, aversion to cold, fever, whole body discomfort. Fluids steamed by Fire became Phlegm foam, causing Phlegm-Saliva surging. Truly, Phlegm is有形 (有形) Fire; Fire is无形 (Formless) Phlegm. Baihou Fengzheng (White Throat Wind Syndrome) is a seasonal dangerous disease. Temporarily clear Lung-Stomach Heat, benefit Kidney Water to control Fire.
Sheng Shigao (Gypsum Fibrosum) 5 qian (with Bohe Tou Menthae Haplocalycis 1 qian, pounded, wrapped in silk), Da Shengdi (Rehmanniae Radix) 5 qian, Da Yuanshen (Scrophulariae Radix) 3 qian, Zhimu (Anemarrhenae Rhizoma) 2 qian, Da Maidong (Ophiopogonis Tuber) 3 qian, Gualou Ren (Trichosanthis Semen) 6 qian, Chuan Beimu (Fritillariae Cirrhosae Bulbus) 2 qian, Lüdouyi (Sojae Semen Nigrum Testa) 3 qian, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 5 fen, Jinyinhua (Lonicerae Japonicae Flos) 2 qian, Xian Lugeng (Phragmitis Rhizoma) de-jointed 1.5 liang.
Second visit: White streaks in throat retreated, swelling slightly settled. Yet still chills and fever, loose after sweating, constipation for six days, Fire-Heat binding closed, tongue red coating yellow. Mr. Li's "Pulling Firewood from Under the Cauldron" method, Mr. Lu's "Draining Heat Transforming Phlegm" method, combine both prescriptions, wonder if correct.
Xian Shengdi (Rehmanniae Radix) 7 qian, Da Lianqiao (Forsythiae Fructum) 3 qian, Hei Shanzhi (Gardeniae Fructus) 3 qian, Yuanshen Rou (Scrophulariae Radix) 3 qian, Su Bohe (Menthae Haplocalycis Folium) 1 qian, Dalizi (Arctii Fructus) 3 qian, Chuan Beimu (Fritillariae Cirrhosae Bulbus) 2 qian, Sheng Guangjun (Rhei Radix et Rhizoma) 3 qian, Dan Huangqin (Scutellariae Radix) 1.5 qian, Yuanmingfen (Natrii Sulfas) 1 qian (mixed), Zhuxie Xin (Bambusae Folium) 20 leaves, Huoshui Lugeng (Phragmitis Rhizoma) 1.5 liang.
Third visit: Pulling Firewood from Under the Cauldron, bowel movement twice, accumulated Heat slightly descended, throat swelling and pain greatly retreated. Yet still bloating and much Phlegm, chills and fever. Evil Wind and accumulated Heat not cleared. Prescribe Qingyan Lige Fa (Clear Throat Benefit Diaphragm Method).
Chuan Yalian (Coptidis Rhizoma) 4 fen, Sheng Shanzhi (Gardeniae Fructus) 1.5 qian, Hei Yuanshen (Scrophulariae Radix) 3 qian, Zhuye (Bambusae Folium) 12 pieces, Bai Jiegeng (Platycodonis Radix) 1 qian, Dalizi (Arctii Fructus) 3 qian (pounded), Lianqiao Ke (Forsythiae Fructum) 3 qian, Qing Fangfeng (Saposhnikoviae Radix) 1 qian, Guang Yujin (Curcumae Radix) 1 qian, Jingjisui (Schizonepetae Spica) 1 qian.
Fourth visit: Throat redness, swelling, and pain greatly retreated, pulse quiet, body cool. Pathogen trend resolved, escaped danger, walked safely. Extremely fortunate. But abdominal Qi feels dull. Heat transformed, Damp moved. Clear remaining inflammation, manage Damp Pathogen simultaneously.
Dalizi (Arctii Fructus) 3 qian, Bai Jiegeng (Platycodonis Radix) 8 fen, Tongcao (Tetrapanacis Medulla) 7 fen, Huashi (Talcum) 3 qian, Lianqiao (Forsythiae Fructum) 3 qian, Fanzhi Qu (Massae Medicatae Fermentatae) 1.5 qian, Hei Shanzhi (Gardeniae Fructus) 2 qian, Chi Ling (Poria Rubra) 3 qian, Zhiqiao (Aurantii Fructus Immaturus) 1 qian.
Modify prescription: Remove Lianqiao, add Gualou Ren 5 qian, Guang Xingren 3 qian, Hei Shanzhi 1 qian.
Mrs. Fei Yuqing: From Blood Stasis transformed to Water. Water nature flows downward, entering Foot Three Yin Meridians, stagnating generating Heat, leading to red and swollen thighs and legs. Liver-Gallbladder Fire also arose due to this. Since Fire is active, Yin division scorched more. Not only separating benefits and draining Damp fails to cure disease, even Yin-nourishing agents show incomplete success. Leg swelling red and painful, mouth ulcers, throat pain. Know it is extreme Yin Deficiency, Yin not storing Yang, Yang blazing in Yin division and floating outward. Immediately administered Jinkui Shenqi to guide Fire back to origin. Scattered Fire subdued upon contact, leg redness/pain instantly settled, swelling like melon reduced by 50-60%. Considered surviving adventure. Should gradually harmonize, slowly seek recovery. Unexpectedly, scattered Fire swept away completely, yet throat pain, slightly relieved, surged again. Pulse rapid, Right Cun/Guan larger, unable to bear heavy pressure. Secretly thinking: Shaoyin Kidney is place storing Essence, source of Yi-Gui (Liver-Kidney). Examining Shaoyin meridian ties to tongue root, follows throat. Since Fire of all meridians collected, why does throat pain not retreat together? Indeed due to extreme dryness of Kidney Fluid, Yin Qi cannot descend absorb, thus Deficient Yang hard to hide. Fear extensive ulceration, Yin-Yang not embracing, leading to collapse. Here consult Brother Jimei to use Zhang Zhongjing's Zhufu Tang to save Shaoyin Dryness, combined with Ejiao Jizi Dihuang Tang to save Liver-Kidney Yin. Transformations myriad leading here, gain/loss count in this move. If effective, turns crisis to safety.
Zhen Ejiao (Colla Corii Asini), Sheng Shanyao (Dioscoreae Satvae Rhizoma), Shudi (Rehmanniae Radix Preparata), Jizi Huang (Ovi Gallii Yolk), Bai Jingmi (Oryzae Semen), Maidong (Ophiopogonis Tuber), Chao Huang Chuanbei (Fritillariae Cirrhosae Bulbus Prepared Yellow), Chuan Shihu (Dendrobii Caulis), Zhufu (Porcinis Cutis), Bai Mi (Mel).
Follow-up Visit: Various Fires gradually收了 (collected/retracted), but Shaoyin greatly deficient. Yin does not descend absorb, Deficient Yang still flares upward, stated in previous case. Yin not descending absorbing is Water Deficiency. Zhufu Tang saves Kidney Dryness, Ejiao/Dihuang nourishes Water Source. Alas, since Deficient Yang flares upward, Lung Metal scorched. Lung is Upper Source of Water. If source doesn't generate, nourishing products are but a bucket of water on a cart of fire, unable to work. Thus used Cui Shi Ba Wei (Eight-Ingredient Pill of Cui) as counter-assistance, yet mouth ulcers still不退 (do not retreat). Strengthening Water but Water cannot strengthen, Guiding Fire but Fire does not...