改方去川朴上湘军，加滑石块三钱，白蔻仁入煎两粒，西血珀研先服五分，上沉香三分磨先服。
四诊 以燥治燥，津液果回，其为气湿郁遏，清津无以上供，固无疑义。复下数，次腹胀已松，少腹偏左
之痛已退，偏右按之仍痛。脉细沉数，舌心干毛。幸边道已润。良由郁蒸渐解，气机渐得施化，津液渐得
通行，而余滞积湿，犹未尽达。将及三候，元气支离，未便叠次峻攻，暂为退守待稍能安谷，再商续下可耳。
川雅连（一分） 香豆豉（三钱） 杏仁泥（三钱） 赤猪苓（各三钱） 泽泻（一钱五分） 白蔻仁（入煎三粒）
广郁金（一钱五分） 淡干姜（四分） 枳实（炒成炭一钱） 制香附（二钱） 通草（一钱） 枇杷叶（去毛四片）
方有白 ，以燥治燥，津回而舌心干毛，肺胃之津液已亏，宜于此际酌用甘凉，后案统宜删削。此先生检点
存案自批于后者也。先生于湿温一门，具有心得，以燥化燥生平之效果，历历不爽。独于此案不自满意，记此
数语。先生之虚心如此，详慎如此。从可知症变万端，毫厘千里，断不可坚于自信，而孟浪投方也。（文涵志）
张（右） 病经一候，形寒已罢，热势不解，汗出不及下体，膈间烦闷特甚，呕恶时作，卧寐不安，小溲赤少，
大便不爽。寸关沉按弦数，左更上溢寸外，舌尖赤燥，近根黄腻带浊。此皆湿热之邪，心肝之火，搏结于
胸膈之间，阳明之分，气机被阻，阴液暗耗，其所以渴不喜饮者，挟痰湿故也。势恐肝阳化风，有痉厥昏
蒙之变。议泻胸膈之邪热，清心肝之火。冀得躁平安寐，庶免变端。录方明裁。
羚羊片（先煎七分） 郁金（一钱五分） 囫囵连翘（二钱） 制半夏（一钱五分） 木通（八分） 细川连（姜
汁炒五分） 香豉（三钱） 薄荷（八分） 栝蒌仁（三钱打） 枳实（五分元明粉八分化水磨冲） 丹皮（酒炒一钱
五分） 竹茹（一钱） 芦根（去节八钱）
蒋（左） 神识已清，热亦大减，然频频呃忒，胸脘不舒。舌苔炱黑，脉数糊滑。内闭之热已开，而痰湿滞交
阻不化，虽略转机，尚不足恃也商进。
郁金（磨冲五分） 川雅连（姜汁炒四分） 杏仁泥（三钱） 刀豆子（磨冲五分） 制半夏（一钱五分）
滑石块（四钱） 冬瓜子（四钱打） 炒竹茹（一钱五分） 方通草（一钱） 九节石菖蒲（五分） 新会皮（一
钱） 青芦管（一两） 竹沥达痰丸（三钱开水先送下）
杨（左） 外感风寒，卫阳被郁，先发微寒，阳郁暴伸，遂发壮热，汗出邪泄，阴阳洽和，得以脉静身凉。惟热
气一蒸，里湿悉动，邪虽外达，蕴湿未清，所以胃纳不复，舌苔未化。宜理湿和中。至于头痛昏眩。腹满心
悸，乃平素肝阳之偏亢，由于血虚不能养肝而来。当置缓议。
制半夏（一钱五分） 赤茯苓神（各二钱） 生薏仁（四钱） 大豆卷（三钱） 川朴（一钱） 猪苓（一钱五
分） 白蒺藜（去刺炒三钱） 建泽泻（一钱五分） 广皮（一钱） 佛手（一钱五分）
某 呕吐已止，而气湿不化，烦热仍然不退，耳聋不聪，时带 语。脉糊数不扬。此湿邪弥漫，清窍被阻。
有神昏发痉之虞。拟方即请商正。
光杏仁 郁金 桔梗 赤茯苓 蔻仁 制半夏
香豆豉 橘红 枳壳 晚蚕砂 九节菖蒲
万氏牛黄清心丸（七分灯心汤先送下）
夏（左） 大邪已退，余蕴宿积未清，便不行而频转矢气，病已多日，本不敢浪用重药，叠为推荡。然以姑
息为心，实蹈引虎自卫之弊，不可不察也。
豆卷 广皮 杏仁泥 生薏仁 通草 郁金
苦桔梗 赤猪苓 制半夏 枳实导滞丸（佛手通草汤下）
二诊 流畅三焦，气机宣通，内蕴之浊，得以上越，呕出痰涎甚多。里气既通，表当自达，随后尚有微汗
而热解也。
制半夏 南星 豆卷 泽泻 桔梗 通草 橘红 枳实 广郁
金杏仁 薏仁 淡黄芩
薛金楣 湿痰素盛，复感时邪，邪与湿蒸，发热不解湿邪相持于内，表气不能外通，旬日已来，未经畅
汗，邪势正炽之际，更兼误食面包，胃口为之壅实，湿痰因而弥漫，清津被抑不能上供，以致神识迷糊。
舌干无津，苔黑而舌质淡白。斑点隐约不透，大便不行。脉形滑数。邪湿化燥，弥漫神机，内窜昏厥，指顾
间事也。与子范仁兄大人同议宣通郁遏。以望神机通灵，清津流布，然恐难得也。
枳实（六分磨） 广郁金（二钱） 滑石块（四钱） 天竺黄（三钱） 陈胆星（八分） 川雅连（五分炒）
光杏仁（去尖打三钱） 栝蒌仁（七钱打） 鲜石菖蒲（连根叶洗打三钱） 白萝卜汁（一两冲） 陈关
蛰（洗淡二两） 活水芦根（二两）
二诊 昨进开通蕴遏，流湿润燥舌干转润，迷糊稍清，面色稍淡，郁遏较开。清津得以上供，所以舌燥
转润。表气渐得外通，斑点略为透露。然仍大便不行，迷蒙如睡。脉象糊滑，舌苔灰滞垢腻。胃中之浊邪，
闭郁尚盛，胃脉通心，还恐昏痉。与子范兄同议苦辛泄化，参以劫痰。大敌当前，成败非所知也。即请商裁。
川雅连（姜汁炒五分） 栝蒌仁（五钱） 光杏仁（三钱） 淡黄芩（酒炒一钱五分） 淡干姜（二分）
佩兰叶（三钱） 豆蔻花（四分） 制半夏（三钱） 陈胆星（七分） 莱菔子（四钱炒） 竹茹（一钱五分）
郁金（四分） 菖蒲（二分） 明矾（二分） 明雄精（二分以上四味同研极细末先调服）
三诊 苦辛通降，参以化痰，神识略为清爽，而仍迷蒙如寐。日前神情安静，今则时揭衣被，颇有懊烦
之意。清津既回之后，津液复劫。舌苔焦黑，舌质深红，脉弦滑而数。良由痰湿积蕴遏，渐化为火，火劫阴
津，胃脉通心，深恐热入胞络，症极郑重。勉与子瞻仁兄大人同议急下存阴法。即请商裁。
鲜首乌（洗打六钱） 连翘（三钱） 天花粉（二钱） 光杏仁（去尖打三钱） 广郁金（一钱五分）
元明粉（冲一钱半） 枳实（一钱） 竹茹（一钱水炒） 生广军（一钱五分） 礞石滚痰丸（三钱开水先
化服） 至宝丹（一丸服煎药后隔二点钟用灯心汤化服）
四诊 投剂之后，大便畅行，神情大为清爽，痰亦爽利。而日晡后又复渐见迷蒙，脉形转细。舌干质红
苔黑，以汤润之，则浮糙浊苔满布，齿垢唇焦。斑点虽渐透露，而未畅达。良由邪浊化火，遂令阳明热炽，
劫烁阴津。仍恐热从内窜，而神昏痉厥。勉拟泻南补北，泄热透斑。留候子范仁兄酌夺。
镑犀角（先煎四分） 川贝母（二钱） 阿胶珠（三钱） 镑羚羊角（先煎二钱） 连翘（三钱） 大天冬
（三钱） 鲜石菖蒲（连根叶洗打三钱） 细生地（五钱） 芦根（一两五钱） 竹沥（滴入姜汁少许一两）
濂珠粉（三分灯心汤先调服）
五诊 泻南补北，泄热透斑，斑点渐畅，神识较清，脉亦稍起，舌津稍回，稍稍饮汤，舌质即腻。清津虽回，
而痰浊昏蒙，气不能化，津不上升。与子范仁兄大人共议，乘此津液稍回之际，急急流化气分，以通津
液，仍以化痰宣窍参之。
香豆豉（二钱） 光杏仁（去尖打三钱） 川贝（二钱炒） 活水芦根（去节一两） 滑石块（四钱） 广郁
金（一钱五分） 栝蒌皮（三钱） 陈胆星（一钱五分） 鲜石菖蒲（连根叶洗打三钱） 干枇杷叶（去毛三钱
）天竺黄（三钱） 竹沥（一两用明矾四分磨极细末和入冲服）
六诊 神识较清，而烦热复盛，欲揭衣被不时 语。脉象弦数，舌苔黑质红，仍然少津。斑点未畅，而已
经化淡。邪热内郁，与浊交蒸，化火劫津，所谓火必为烦也。还恐内窜。以透热救阴，仍参化痰留候子范兄商政。
羚羊片（先煎三钱） 黑山栀（三钱） 大天冬（三钱） 细生地（五钱） 元参（三钱） 连翘心（三钱）
天竺黄（三钱） 阿胶珠（三钱） 鲜石菖蒲（连根叶洗打三钱） 滑石块（重加辰砂拌三钱） 青竹叶（
二十片） 活水芦根（去节一两五钱）
七诊 神识渐清，舌黑稍化而邪热尚盛，阴津劫夺不复。舌质尚觉干燥。邪热内扰，神烦不宁。心与小
肠，表里相应，内扰之热，从上下趋，所以神明渐清，而小溲痛甚，囊胯之间，时作奇痒。为今之计，泄热救
阴，所不能缓。前人有上病而下取之法，与子范仁兄同议泻下焦湿热。
细生地（五钱） 大麦冬（去心四钱） 光杏仁（去尖打三钱） 广郁金（一钱五分） 龙胆草（六分）
车前子（三钱） 木通（七分） 黑元参（六钱） 青竹叶（二十片） 益元散（重加辰砂拌绢包四钱） 黑
山栀（三钱）
八诊 用增液兼清下焦湿热，大便未行，小溲作痛，涓滴不爽，气粗颧红，懊烦不宁。脉沉实，舌干苔黑，
中心有断纹。邪热挟积，复聚阳明，劫烁津液，有昏厥之虞。拟调胃承气以抽釜薪。留候子范仁兄商政，并请高明裁夺。
生广军（后入四钱） 生甘草（五分） 大麦冬（去心三钱） 元明粉（冲一钱五分） 滑石块（四钱） 细生
地（四钱） 黑玄参（三钱） 活水芦根（去节一两） 车前子（三钱） 青竹叶（二十片）
九诊 昨用调胃承气合增液法，小便已通。而积热仍聚阳明，不能曲折而下，大便仍然未行，腹满拒
按作痛，频转矢气。舌干苔黑，脉沉，重按有力。大肠与胃相联属，阳明胃脉上通于心，肠胃为积所阻，则
阳土之气，尽化燥火，劫液烁津。热气自胃上冲，则心胸之间，遂成氤氲之地，所以不为烦燥，即为迷蒙。
病中盗食面包，前次畅下，似不应再有余积。殊不知大肠之垢滞虽行，而后进之食，为热熏蒸，自然燥
结于中，不克盘旋而下，所以前人有复下之法也。前法再展一筹。留候子范仁兄裁夺，并请高明商之。
广郁金（二钱） 光杏仁（打三钱） 鲜石斛（洗打一两） 鲜首乌（细切洗打八钱） 枳实（一钱） 桔梗（一
钱） 栝蒌皮（四钱） 鲜生地（洗打一两） 元明粉（三钱冲） 车前子（三钱） 滑石块（四钱） 生广军
（三钱水浸绞汁冲服） 干枇杷叶（去毛绢包三钱） 活水芦根（去节一两五钱）
十诊 下后仍未行，液枯故也备用。
金汁 竹沥 梨汁 青果汁 芦根汁
五味频频服之。（此日回绍兴）
陈（幼） 湿温逗留日久，湿蒸阳明，微寒里热。脉数糊软，苔白。邪湿日恋，原气日伤，将延入损途。
炒杏仁 赤猪苓 泽泻 生薏仁 通草 广郁金
炒青蒿 制半夏 上广皮 豆卷 蔻仁
二诊 宣泄肺气，表气自通，不表而汗，不透而 ，肌表之风，太阴之湿，因之外解。然脉仍带数。余烬尚
恋，虽得转机，犹不足恃也。
制半夏 白蔻仁 赤猪苓 通草 泽泻 光杏仁
生薏仁 炒地骨皮 广皮 蔷薇露（一两温冲）
三诊 小溲黄赤，湿热外泄之兆，所以热势得以渐减。药既应手，再为扩充。
制半夏 通草 薏仁 蔻仁 木猪苓 光杏仁
广皮 泽泻 竹茹 地骨皮 蔷薇露（一两）
鲍（左） 时病之后，湿热未清，熏蒸阳明，晡后微热，有时凛寒，胸中欲咳稍舒。湿郁而荣卫不宣，宜轻宣
肺气，气化则湿亦清也。
杏仁 蔻仁 赤白苓 竹茹 橘皮 鲜佛手
薏仁 通草 猪苓 白残花
二诊 宣化气湿，暮热顿退。而昨晚又觉微热，咳嗽痰不爽。湿热未清，兼感新风。宜为疏化。
前胡 杏仁 橘红 赤猪苓 象贝 炒白薇
蒌皮 生薏仁 豆蔻花（四分）
三诊 胸中渐舒，咳亦降序。然暮热时退时来。阳明湿蒸。再为清化。
制半夏 蔻仁 木猪苓 通草 冬瓜子 生薏仁
杏仁 赤白茯苓 滑石块 野残花
四诊 湿蒸阳明。湿邪旺于阴分，至暮身热宣肺气，淡渗湿，熏蒸既解，暮热已退。拟和中醒脾。谷气既
旺，津气自复。
制半夏（一钱五分） 茯苓（三钱） 通草（八分） 藿香（二钱） 生熟谷芽（各三钱） 生于术（一钱五分
）薏仁（三钱） 猪苓（一钱五分） 白残花（七分） 橘白（一钱）
五诊 培土和中，胃纳稍起。前法再为扩充。
奎党参（二钱） 法半夏（一钱五分） 黑豆衣（三钱） 炒于术（二钱） 茯苓（三钱） 橘白（一钱）
炒白薇（一钱五分） 女贞子（三钱） 生熟谷芽（各二钱） 佩兰叶（一钱五分）
陈（左） 热势不扬，恶心胸闷，汗不畅达。感邪挟湿交蒸，三焦为之阻窒，一候正炽之际也。
香豆豉（三钱） 广郁金（一钱五分） 制半夏（一钱五分） 白蔻仁（七分） 枳实（一钱） 光杏仁（三钱）
干佛手（一钱五分） 广皮（一钱） 桔梗（一钱） 制川朴（一钱） 竹茹（一钱）
凌（左） 类疟数次，少阳之邪，并归阳明，遂致不寒但热，发疹发 ，唇口牵动， 语神乱，风动之后，继以
发厥。今大势虽定，而热恋不解，大便经月不行，酸涎上涌，胸脘不舒，吐出酸水，略觉稍适，渴不多饮。舌
【背景信息】
书名：张聿青医案 作者：张聿青 朝代：清 章节：湿温(2/3) 类别：医论
【待处理原文】
改方去川朴上湘军，加滑石块三钱，白蔻仁入煎两粒，西血珀研先服五分，上沉香三分磨先服。
四诊 以燥治燥，津液果回，其为气湿郁遏，清津无以上供，固无疑义。复下数，次腹胀已松，少腹偏左之痛已退，偏右按之仍痛。脉细沉数，舌心干毛。幸边道已润。良由郁蒸渐解，气机渐得施化，津液渐得通行，而余滞积湿，犹未尽达。将及三候，元气支离，未便叠次峻攻，暂为退守待稍能安谷，再商续下可耳。
川雅连（一分） 香豆豉（三钱） 杏仁泥（三钱） 赤猪苓（各三钱） 泽泻（一钱五分） 白蔻仁（入煎三粒）
广郁金（一钱五分） 淡干姜（四分） 枳实（炒成炭一钱） 制香附（二钱） 通草（一钱） 枇杷叶（去毛四片）
方有白 ，以燥治燥，津回而舌心干毛，肺胃之津液已亏，宜于此际酌用甘凉，后案统宜删削。此先生检点存案自批于后者也。先生于湿温一门，具有心得，以燥化燥生平之效果，历历不爽。独于此案不自满意，记此数语。先生之虚心如此，详慎如此。从可知症变万端，毫厘千里，断不可坚于自信，而孟浪投方也。（文涵志）
张（右） 病经一候，形寒已罢，热势不解，汗出不及下体，膈间烦闷特甚，呕恶时作，卧寐不安，小溲赤少，大便不爽。寸关沉按弦数，左更上溢寸外，舌尖赤燥，近根黄腻带浊。此皆湿热之邪，心肝之火，搏结于胸膈之间，阳明之分，气机被阻，阴液暗耗，其所以渴不喜饮者，挟痰湿故也。势恐肝阳化风，有痉厥昏蒙之变。议泻胸膈之邪热，清心肝之火。冀得躁平安寐，庶免变端。录方明裁。
羚羊片（先煎七分） 郁金（一钱五分） 囫囵连翘（二钱） 制半夏（一钱五分） 木通（八分） 细川连（姜汁炒五分） 香豉（三钱） 薄荷（八分） 栝蒌仁（三钱打） 枳实（五分元明粉八分化水磨冲） 丹皮（酒炒一钱五分） 竹茹（一钱） 芦根（去节八钱）
蒋（左） 神识已清，热亦大减，然频频呃忒，胸脘不舒。舌苔炱黑，脉数糊滑。内闭之热已开，而痰湿滞交阻不化，虽略转机，尚不足恃也商进。
郁金（磨冲五分） 川雅连（姜汁炒四分） 杏仁泥（三钱） 刀豆子（磨冲五分） 制半夏（一钱五分）
滑石块（四钱） 冬瓜子（四钱打） 炒竹茹（一钱五分） 方通草（一钱） 九节石菖蒲（五分） 新会皮（一钱） 青芦管（一两） 竹沥达痰丸（三钱开水先送下）
杨（左） 外感风寒，卫阳被郁，先发微寒，阳郁暴伸，遂发壮热，汗出邪泄，阴阳洽和，得以脉静身凉。惟热气一蒸，里湿悉动，邪虽外达，蕴湿未清，所以胃纳不复，舌苔未化。宜理湿和中。至于头痛昏眩。腹满心悸，乃平素肝阳之偏亢，由于血虚不能养肝而来。当置缓议。
制半夏（一钱五分） 赤茯苓神（各二钱） 生薏仁（四钱） 大豆卷（三钱） 川朴（一钱） 猪苓（一钱五分） 白蒺藜（去刺炒三钱） 建泽泻（一钱五分） 广皮（一钱） 佛手（一钱五分）
某 呕吐已止，而气湿不化，烦热仍然不退，耳聋不聪，时带谵语。脉糊数不扬。此湿邪弥漫，清窍被阻。有神昏发痉之虞。拟方即请商正。
光杏仁 郁金 桔梗 赤茯苓 蔻仁 制半夏
香豆豉 橘红 枳壳 晚蚕砂 九节菖蒲
万氏牛黄清心丸（七分灯心汤先送下）
夏（左） 大邪已退，余蕴宿积未清，便不行而频转矢气，病已多日，本不敢浪用重药，叠为推荡。然以姑息为心，实蹈引虎自卫之弊，不可不察也。
豆卷 广皮 杏仁泥 生薏仁 通草 郁金
苦桔梗 赤猪苓 制半夏 枳实导滞丸（佛手通草汤下）
二诊 流畅三焦，气机宣通，内蕴之浊，得以上越，呕出痰涎甚多。里气既通，表当自达，随后尚有微汗而热解也。
制半夏 南星 豆卷 泽泻 桔梗 通草 橘红 枳实 广郁金 杏仁 薏仁 淡黄芩
薛金楣 湿痰素盛，复感时邪，邪与湿蒸，发热不解湿邪相持于内，表气不能外通，旬日已来，未经畅汗，邪势正炽之际，更兼误食面包，胃口为之壅实，湿痰因而弥漫，清津被抑不能上供，以致神识迷糊。舌干无津，苔黑而舌质淡白。斑点隐约不透，大便不行。脉形滑数。邪湿化燥，弥漫神机，内窜昏厥，指顾间事也。与子范仁兄大人同议宣通郁遏。以望神机通灵，清津流布，然恐难得也。
枳实（六分磨） 广郁金（二钱） 滑石块（四钱） 天竺黄（三钱） 陈胆星（八分） 川雅连（五分炒）
光杏仁（去尖打三钱） 栝蒌仁（七钱打） 鲜石菖蒲（连根叶洗打三钱） 白萝卜汁（一两冲） 陈关蛰（洗淡二两） 活水芦根（二两）
二诊 昨进开通蕴遏，流湿润燥舌干转润，迷糊稍清，面色稍淡，郁遏较开。清津得以上供，所以舌燥转润。表气渐得外通，斑点略为透露。然仍大便不行，迷蒙如睡。脉象糊滑，舌苔灰滞垢腻。胃中之浊邪，闭郁尚盛，胃脉通心，还恐昏痉。与子范兄同议苦辛泄化，参以劫痰。大敌当前，成败非所知也。即请商裁。
川雅连（姜汁炒五分） 栝蒌仁（五钱） 光杏仁（三钱） 淡黄芩（酒炒一钱五分） 淡干姜（二分）
佩兰叶（三钱） 豆蔻花（四分） 制半夏（三钱） 陈胆星（七分） 莱菔子（四钱炒） 竹茹（一钱五分）
郁金（四分） 菖蒲（二分） 明矾（二分） 明雄精（二分以上四味同研极细末先调服）
三诊 苦辛通降，参以化痰，神识略为清爽，而仍迷蒙如寐。日前神情安静，今则时揭衣被，颇有懊烦之意。清津既回之后，津液复劫。舌苔焦黑，舌质深红，脉弦滑而数。良由痰湿积蕴遏，渐化为火，火劫阴津，胃脉通心，深恐热入胞络，症极郑重。勉与子瞻仁兄大人同议急下存阴法。即请商裁。
鲜首乌（洗打六钱） 连翘（三钱） 天花粉（二钱） 光杏仁（去尖打三钱） 广郁金（一钱五分）
元明粉（冲一钱半） 枳实（一钱） 竹茹（一钱水炒） 生广军（一钱五分） 礞石滚痰丸（三钱开水先化服） 至宝丹（一丸服煎药后隔二点钟用灯心汤化服）
四诊 投剂之后，大便畅行，神情大为清爽，痰亦爽利。而日晡后又复渐见迷蒙，脉形转细。舌干质红苔黑，以汤润之，则浮糙浊苔满布，齿垢唇焦。斑点虽渐透露，而未畅达。良由邪浊化火，遂令阳明热炽，劫烁阴津。仍恐热从内窜，而神昏痉厥。勉拟泻南补北，泄热透斑。留候子范仁兄酌夺。
镑犀角（先煎四分） 川贝母（二钱） 阿胶珠（三钱） 镑羚羊角（先煎二钱） 连翘（三钱） 大天冬（三钱） 鲜石菖蒲（连根叶洗打三钱） 细生地（五钱） 芦根（一两五钱） 竹沥（滴入姜汁少许一两） 濂珠粉（三分灯心汤先调服）
五诊 泻南补北，泄热透斑，斑点渐畅，神识较清，脉亦稍起，舌津稍回，稍稍饮汤，舌质即腻。清津虽回，而痰浊昏蒙，气不能化，津不上升。与子范仁兄大人共议，乘此津液稍回之际，急急流化气分，以通津液，仍以化痰宣窍参之。
香豆豉（二钱） 光杏仁（去尖打三钱） 川贝（二钱炒） 活水芦根（去节一两） 滑石块（四钱） 广郁金（一钱五分） 栝蒌皮（三钱） 陈胆星（一钱五分） 鲜石菖蒲（连根叶洗打三钱） 干枇杷叶（去毛三钱） 天竺黄（三钱） 竹沥（一两用明矾四分磨极细末和入冲服）
六诊 神识较清，而烦热复盛，欲揭衣被不时谵语。脉象弦数，舌苔黑质红，仍然少津。斑点未畅，而已经化淡。邪热内郁，与浊交蒸，化火劫津，所谓火必为烦也。还恐内窜。以透热救阴，仍参化痰留候子范兄商政。
羚羊片（先煎三钱） 黑山栀（三钱） 大天冬（三钱） 细生地（五钱） 元参（三钱） 连翘心（三钱） 天竺黄（三钱） 阿胶珠（三钱） 鲜石菖蒲（连根叶洗打三钱） 滑石块（重加辰砂拌三钱） 青竹叶（二十片） 活水芦根（去节一两五钱）
七诊 神识渐清，舌黑稍化而邪热尚盛，阴津劫夺不复。舌质尚觉干燥。邪热内扰，神烦不宁。心与小肠，表里相应，内扰之热，从上下趋，所以神明渐清，而小溲痛甚，囊胯之间，时作奇痒。为今之计，泄热救阴，所不能缓。前人有上病而下取之法，与子范仁兄同议泻下焦湿热。
细生地（五钱） 大麦冬（去心四钱） 光杏仁（去尖打三钱） 广郁金（一钱五分） 龙胆草（六分） 车前子（三钱） 木通（七分） 黑元参（六钱） 青竹叶（二十片） 益元散（重加辰砂拌绢包四钱） 黑山栀（三钱）
八诊 用增液兼清下焦湿热，大便未行，小溲作痛，涓滴不爽，气粗颧红，懊烦不宁。脉沉实，舌干苔黑，中心有断纹。邪热挟积，复聚阳明，劫烁津液，有昏厥之虞。拟调胃承气以抽釜薪。留候子范仁兄商政，并请高明裁夺。
生广军（后入四钱） 生甘草（五分） 大麦冬（去心三钱） 元明粉（冲一钱五分） 滑石块（四钱） 细生地（四钱） 黑玄参（三钱） 活水芦根（去节一两） 车前子（三钱） 青竹叶（二十片）
九诊 昨用调胃承气合增液法，小便已通。而积热仍聚阳明，不能曲折而下，大便仍然未行，腹满拒按作痛，频转矢气。舌干苔黑，脉沉，重按有力。大肠与胃相联属，阳明胃脉上通于心，肠胃为积所阻，则阳土之气，尽化燥火，劫液烁津。热气自胃上冲，则心胸之间，遂成氤氲之地，所以不为烦燥，即为迷蒙。病中盗食面包，前次畅下，似不应再有余积。殊不知大肠之垢滞虽行，而后进之食，为热熏蒸，自然燥结于中，不克盘旋而下，所以前人有复下之法也。前法再展一筹。留候子范仁兄裁夺，并请高明商之。
广郁金（二钱） 光杏仁（打三钱） 鲜石斛（洗打一两） 鲜首乌（细切洗打八钱） 枳实（一钱） 桔梗（一钱） 栝蒌皮（四钱） 鲜生地（洗打一两） 元明粉（三钱冲） 车前子（三钱） 滑石块（四钱） 生广军（三钱水浸绞汁冲服） 干枇杷叶（去毛绢包三钱） 活水芦根（去节一两五钱）
十诊 下后仍未行，液枯故也备用。
金汁 竹沥 梨汁 青果汁 芦根汁 五味频频服之。（此日回绍兴）
陈（幼） 湿温逗留日久，湿蒸阳明，微寒里热。脉数糊软，苔白。邪湿日恋，原气日伤，将延入损途。
炒杏仁 赤猪苓 泽泻 生薏仁 通草 广郁金 炒青蒿 制半夏 上广皮 豆卷 蔻仁
二诊 宣泄肺气，表气自通，不表而汗，不透而疹，肌表之风，太阴之湿，因之外解。然脉仍带数。余烬尚恋，虽得转机，犹不足恃也。
制半夏 白蔻仁 赤猪苓 通草 泽泻 光杏仁 生薏仁 炒地骨皮 广皮 蔷薇露（一两温冲）
三诊 小溲黄赤，湿热外泄之兆，所以热势得以渐减。药既应手，再为扩充。
制半夏 通草 薏仁 蔻仁 木猪苓 光杏仁 广皮 泽泻 竹茹 地骨皮 蔷薇露（一两）
鲍（左） 时病之后，湿热未清，熏蒸阳明，晡后微热，有时凛寒，胸中欲咳稍舒。湿郁而荣卫不宣，宜轻宣肺气，气化则湿亦清也。
杏仁 蔻仁 赤白苓 竹茹 橘皮 鲜佛手 薏仁 通草 猪苓 白残花
二诊 宣化气湿，暮热顿退。而昨晚又觉微热，咳嗽痰不爽。湿热未清，兼感新风。宜为疏化。
前胡 杏仁 橘红 赤猪苓 象贝 炒白薇 蒌皮 生薏仁 豆蔻花（四分）
三诊 胸中渐舒，咳亦降序。然暮热时退时来。阳明湿蒸。再为清化。
制半夏 蔻仁 木猪苓 通草 冬瓜子 生薏仁 杏仁 赤白茯苓 滑石块 野残花
四诊 湿蒸阳明。湿邪旺于阴分，至暮身热宣肺气，淡渗湿，熏蒸既解，暮热已退。拟和中醒脾。谷气既旺，津气自复。
制半夏（一钱五分） 茯苓（三钱） 通草（八分） 藿香（二钱） 生熟谷芽（各三钱） 生于术（一钱五分） 薏仁（三钱） 猪苓（一钱五分） 白残花（七分） 橘白（一钱）
五诊 培土和中，胃纳稍起。前法再为扩充。
奎党参（二钱） 法半夏（一钱五分） 黑豆衣（三钱） 炒于术（二钱） 茯苓（三钱） 橘白（一钱） 炒白薇（一钱五分） 女贞子（三钱） 生熟谷芽（各二钱） 佩兰叶（一钱五分）
陈（左） 热势不扬，恶心胸闷，汗不畅达。感邪挟湿交蒸，三焦为之阻窒，一候正炽之际也。
香豆豉（三钱） 广郁金（一钱五分） 制半夏（一钱五分） 白蔻仁（七分） 枳实（一钱） 光杏仁（三钱） 干佛手（一钱五分） 广皮（一钱） 桔梗（一钱） 制川朴（一钱） 竹茹（一钱）
凌（左） 类疟数次，少阳之邪，并归阳明，遂致不寒但热，发疹发痧，唇口牵动，谵语神乱，风动之后，继以发厥。今大势虽定，而热恋不解，大便经月不行，酸涎上涌，胸脘不舒，吐出酸水，略觉稍适，渴不多饮。舌
[Background Information]
Book: Zhang Yuqing's Medical Cases; Author: Zhang Yuqing; Dynasty: Qing; Chapter: Damp-Heat Warmth (2/3); Category: Medical Discussion
[Original Text Translation]
Modified prescription: Remove Chuanpu (Cortex Magnoliae Officinalis) and Shangxiangjun (Radix Rhe Palmatae). Add Sanqian of Huashishi (Talcum), two grains of Baokouren (Fructus Amomi Rotundus) for decoction, five fen of Xixuepo (Succinum) ground to powder taken first, and three fen of Shangchenxiang (Lignum Aquilariae Resinatum) ground to liquid taken first.
Fourth Consultation: Treating dryness with drying agents has indeed restored the body fluids. It is undoubtedly that the Qi and dampness were constrained and obstructed, preventing the clear fluids from ascending to nourish the upper parts. After several more bowel movements, the abdominal distension has loosened, and the pain on the left side of the lower abdomen has receded, but pressing on the right side still causes pain. The pulse is fine, deep, and rapid; the center of the tongue is dry and hairy. Fortunately, the sides have become moist. This is largely because the constrained steaming has gradually resolved, the Qi mechanism has gradually begun to function, and the body fluids have gradually started to circulate. However, the remaining stagnant accumulated dampness has not yet been fully cleared. Approaching three weeks (a "hou" is a traditional time unit, roughly 5 days), the primordial Qi is fragmented. It is inappropriate to repeatedly use harsh purgatives. For now, we will temporarily retreat and defend, waiting until he can tolerate food slightly better, then we can discuss continuing with purgation.
Prescription: Yalianlian (Coptidis Rhizoma) one fen; Xiangdouchi (Fermented Soybean) three qian; Xingrenni (Paste of Armeniacae Semen Amarum) three qian; Chizhuling (Polyporus) three qian each; Zexie (Alismatis Rhizoma) one qian five fen; Baokouren (Fructus Amomi Rotundus) three grains for decoction; Guangyujin (Curcumae Radix) one qian five fen; Danjiangjiang (Dried Ginger) four fen; Zhishi (Immature Bitter Orange, stir-fried to charcoal) one qian; Zhixiangfu (Cyperi Rhizoma, processed) two qian; Tongcao (Tetrapanacis Medulla) one qian; Pipaye (Eriobotryae Folium, de-husked) four slices.
Note by the author: "Treating dryness with drying agents, although fluids returned, the center of the tongue remained dry and hairy, indicating that the lung and stomach fluids are already deficient. At this juncture, sweet-cool herbs should be酌情ly used. Subsequent cases should generally be deleted." This is a self-critique added by Mr. Zhang when reviewing his archived cases. Mr. Zhang has profound insights into damp-heat warmth, and his lifetime effect of using drying methods to resolve dampness has been consistent and accurate. He was dissatisfied only with this case, recording these few words. Such is Mr. Zhang's humility and meticulousness. From this, we can see that symptoms change in myriad ways, where a slight deviation leads to great errors. One must never be overly confident and prescribe recklessly. (Recorded by Wen Hanzhi)
Zhang (Right): The disease has lasted one week (hou). The aversion to cold has ceased, but the fever persists. Sweating does not reach the lower body. There is extreme stifling oppression in the diaphragm, occasional nausea and vomiting, restless sleep, dark and scanty urine, and unsatisfactory bowel movements. The cun and guan positions feel string-taut and rapid upon deep pressure; the left position overflows beyond the cun point. The tip of the tongue is red and dry, while the root area has a yellow, greasy, and turbid coating. All these indicate that pathogenic damp-heat and the fire of the heart and liver are knotting together between the chest and diaphragm, and in the Yangming region. The Qi mechanism is obstructed, and Yin fluids are secretly consumed. The reason for thirst without desire to drink is due to accompanying phlegm-dampness. There is a risk of Liver Yang transforming into wind, leading to convulsions, syncope, and confusion. We propose draining the pathogenic heat from the chest and diaphragm, and clearing the fire of the heart and liver. We hope to achieve calmness and peaceful sleep, thereby avoiding further complications. Recording the prescription for your judgment.
Prescription: Lingyangpian (Cornu Bubali) seven fen, decocted first; Yujin (Curcumae Radix) one qian five fen; Hulianqiao (Forsythiae Fructus, whole) two qian; Banxia (Pinelliae Rhizoma, processed) one qian five fen; Mutong (Akebiae Caulis) eight fen; Xilianlian (Coptidis Rhizoma, stir-fried with ginger juice) five fen; Xiangchi (Fermented Soybean) three qian; Bohe (Menthae Haplocalycis Herba) eight fen; Gualouren (Trichosanthis Semen) three qian, crushed; Zhishi (Immature Bitter Orange) five fen, Yuanmingfen (Natrii Sulfas) eight fen dissolved in water and mixed; Mudanpi (Moutan Cortex, wine-fried) one qian five fen; Zhuru (Bambusae Caulis in Taeniam) one qian; Lugeng (Phragmitis Rhizoma, de-jointed) eight qian.
Jiang (Left): Mental clarity has returned, and the fever has greatly decreased. However, there is frequent hiccups and discomfort in the chest and epigastrium. The tongue coating is soot-black, and the pulse is rapid, slippery, and muddy. The internal closed heat has opened, but phlegm-dampness stagnation remains obstructed and untransformed. Although there is a slight turning point, it is not yet reliable. Discussing further advancement.
Prescription: Yujin (Curcumae Radix) five fen, ground and mixed; Yalianlian (Coptidis Rhizoma, ginger juice-fried) four fen; Xingrenni (Paste of Armeniacae Semen Amarum) three qian; Daoudouzi (Canarium Lablami Fructus) five fen, ground and mixed; Banxia (Pinelliae Rhizoma, processed) one qian five fen; Huashishi (Talcum) four qian; Dongguazi (Benincasae Semen) four qian, crushed; Chaozhuru (Stir-fried Bambusae Caulis in Taeniam) one qian five fen; Fangtongcao (Tetrapanacis Medulla) one qian; Jiujieshipu (Acori Tatarinowii Rhizoma) five fen; Xinhuiqi (Citri Reticulatae Pericarpium) one qian; Qingluguan (Phragmitis Rhizoma) one liang; Zhulida Tan Wan (Bambusae Calamus Phlegm-Resolving Pill) three qian, taken first with boiling water.
Yang (Left): Externally contracted wind-cold, Wei-Yang was constrained. Initially, slight chills occurred. Then, constrained Yang suddenly extended, causing high fever. Sweating allowed the pathogen to exit, Yin and Yang harmonized, resulting in a quiet pulse and cool body. However, once the hot qi steamed, internal dampness moved completely. Although the pathogen reached the exterior, the accumulated dampness was not cleared, hence appetite has not recovered and the tongue coating has not transformed. It is appropriate to regulate dampness and harmonize the middle. As for headache, dizziness, abdominal fullness, and palpitations, these stem from chronic hyperactivity of Liver Yang due to Blood deficiency failing to nourish the Liver. These should be deferred for later discussion.
Prescription: Banxia (Pinelliae Rhizoma, processed) one qian five fen; Chifulingshen (Poria with Hostwood) two qian each; Shengyiren (Coicis Semen) four qian; Dadoujuan (Sojae Semen Praeparatum) three qian; Chuanpu (Cortex Magnoliae Officinalis) one qian; Zhuling (Polyporus) one qian five fen; Baijili (Tribuli Fructus, de-spined and stir-fried) three qian; Jianzexie (Alismatis Rhizoma) one qian five fen; Guangpi (Citri Reticulatae Pericarpium) one qian; Foshou (Citri Sarcodactylis Fructus) one qian five fen.
Anonymous: Vomiting has stopped, but Qi and dampness are not transforming. Irritable heat persists. Deafness and poor hearing occur, accompanied by occasional delirious speech. The pulse is muddy, rapid, and weak. This indicates pervasive pathogenic dampness obstructing the clear orifices. There is a risk of coma and convulsions. Drafting a prescription for your review.
Prescription: Guangxingren (Armeniacae Semen Amarum); Yujin (Curcumae Radix); Jiegeng (Platycodonis Radix); Chifuling (Poria); Kouren (Fructus Amomi); Banxia (Pinelliae Rhizoma, processed); Xiangdouchi (Fermented Soybean); Juhong (Citri Reticulatae Pericarpium Rubrum); Zhike (Immature Bitter Orange); Wancansha (Bombyx Batryticatus); Jiujiechangpu (Acori Tatarinowii Rhizoma); Wanshi Niuhuang Qingxin Wan (Wan's Calculus Bovis Heart-Clearing Pill) seven fen, taken first with Dengxin Tang (Junci Medulla Decoction).
Xia (Left): The major pathogen has retreated, but residual accumulation remains uncleared. Bowel movements do not occur, but frequent flatus is passed. The illness has lasted many days. Originally, I dared not rashly use heavy medicines for repeated purging. However, acting out of indulgence actually falls into the trap of 'inviting the tiger to guard the house,' which must be observed.
Prescription: Doujuan (Sojae Semen Praeparatum); Guangpi (Citri Reticulatae Pericarpium); Xingrenni (Paste of Armeniacae Semen Amarum); Shengyiren (Coicis Semen); Tongcao (Tetrapanacis Medulla); Yujin (Curcumae Radix); Ku Jiegeng (Platycodonis Radix); Chizhuling (Polyporus); Banxia (Pinelliae Rhizoma, processed); Zhishi Daozhi Wan (Immature Bitter Orange Stagnation-Expelling Pill), taken with Foshou Tongcao Tang (Citri Sarcodactylis Fructus and Tetrapanacis Medulla Decoction).
Second Consultation: The Triple Burner is flowing smoothly, and the Qi mechanism is unblocked. Internal turbidity rises upward, resulting in much expectoration of phlegm-saliva. Since the interior Qi is unblocked, the exterior should naturally release. Subsequently, slight sweating will occur, and the heat will resolve.
Prescription: Banxia (Pinelliae Rhizoma, processed); Nanxing (Arisaematis Rhizoma); Doujuan (Sojae Semen Praeparatum); Zexie (Alismatis Rhizoma); Jiegeng (Platycodonis Radix); Tongcao (Tetrapanacis Medulla); Juhong (Citri Reticulatae Pericarpium Rubrum); Zhishi (Immature Bitter Orange); Guangyujin (Curcumae Radix); Xingren (Armeniacae Semen Amarum); Yiren (Coicis Semen); Dan Huangqin (Scutellariae Radix, pale)
Xue Jinmei: Damp-phlegm was abundant originally, compounded by seasonal pathogens. Pathogen and dampness steamed together, causing persistent fever. Dampness held firm internally, preventing exterior Qi from circulating outward. For ten days, there was no profuse sweating. At the peak of pathogenic intensity, mistaken consumption of bread caused gastric congestion. Consequently, damp-phlegm became pervasive, suppressing clear fluids from ascending, leading to mental confusion. The tongue is dry without fluids, black-coated, but the tongue body is pale white. Spots are faint and not fully revealed. Bowel movements do not occur. The pulse is slippery and rapid. Pathogenic dampness transforms into dryness, pervading the spirit mechanism, potentially rushing inward to cause syncope and coma at any moment. Discussed with Brother Zi Fan to unblock constraints, hoping for the spirit mechanism to become agile and clear fluids to circulate, though this may be difficult to achieve.
Prescription: Zhishi (Immature Bitter Orange) six fen, ground; Guangyujin (Curcumae Radix) two qian; Huashishi (Talcum) four qian; Tianzhu Huang (Calculus Bolus) three qian; Chendanxing (Arisaematis Cum Bile) eight fen; Yalianlian (Coptidis Rhizoma) five fen, stir-fried; Guangxingren (Armeniacae Semen Amarum) three qian, de-husked and crushed; Gualouren (Trichosanthis Semen) seven qian, crushed; Xianshipu (Acori Tatarinowii Rhizoma with roots and leaves, washed and crushed) three qian; Bailuojuice (White Radish Juice) one liang, mixed; Chenguanzhe (Chen Guan Zhe - likely a specific preparation or typo for a mollusk/shell, context suggests resolving phlegm/damp) two liang, washed and desalted; Huoshui Lugeng (Fresh Phragmitis Rhizoma) two liang.
Second Consultation: Yesterday, we advanced opening and unblocking constraints. Flowing moisture and drying the tongue turned the dry tongue moist. Confusion cleared slightly, complexion lightened, and constraints opened somewhat. Clear fluids could ascend, hence the tongue driedness turned to moisture. Exterior Qi gradually circulated outward, spots slightly revealed. However, bowel movements still do not occur, and confusion persists like sleep. The pulse is muddy and slippery; the tongue coating is gray, stagnant, and greasy. Turbid pathogens in the stomach remain strongly closed and constrained. Since the Stomach meridian connects to the Heart, we still fear coma and convulsions. Discussed with Brother Zi Fan to use bitter-pungent drainage and transformation, supplemented by phlegm-resolving. Facing a great enemy, success or failure is unknown. Requesting your judgment.
Prescription: Yalianlian (Coptidis Rhizoma, ginger juice-fried) five fen; Gualouren (Trichosanthis Semen) five qian; Guangxingren (Armeniacae Semen Amarum) three qian; Dan Huangqin (Scutellariae Radix, wine-fried) one qian five fen; Dan Jiangjiang (Dried Ginger) two fen; Peilan Ye (Eupatorii Herba) three qian; Doukou Hua (Cardamomi Flos) four fen; Banxia (Pinelliae Rhizoma, processed) three qian; Chendanxing (Arisaematis Cum Bile) seven fen; Laifuzi (Raphani Semen, stir-fried) four qian; Zhuru (Bambusae Caulis in Taeniam) one qian five fen; Yujin (Curcumae Radix) four fen; Changpu (Acori Tatarinowii Rhizoma) two fen; Mingfan (Alumen) two fen; Mingxiongjing (Realgar) two fen or more, the above four ingredients ground into extremely fine powder, taken first mixed with water.
Third Consultation: Bitter-pungent descending and transforming, supplemented by phlegm-resolving, mental clarity improved slightly, but confusion persists like sleep. Previously, the demeanor was quiet; now, the patient frequently pulls off clothes and blankets, showing signs of restlessness and vexation. After clear fluids returned, fluids were again depleted. The tongue coating is scorched black, the tongue body deep red, and the pulse string-taut, slippery, and rapid. This is due to accumulated phlegm-dampness transforming into fire, which depletes Yin fluids. Since the Stomach meridian connects to the Heart, we deeply fear heat entering the pericardium. The condition is very serious. Reluctantly discussed with Brother Zi Zhan the method of urgent purging to preserve Yin. Requesting judgment.
Prescription: Xian Shouwu (Polygoni Multiflori Caulis, washed and crushed) six qian; Lianqiao (Forsythiae Fructus) three qian; Tianhuafen (Trichosanthis Radix) two qian; Guangxingren (Armeniacae Semen Amarum) three qian, de-husked and crushed; Guangyujin (Curcumae Radix) one qian five fen; Yuanmingfen (Natrii Sulfas) one qian half, mixed; Zhishi (Immature Bitter Orange) one qian; Zhuru (Bambusae Caulis in Taeniam, water-fried) one qian; Sheng Guangjun (Radix Rhe Palmatae, raw) one qian five fen; Mengshi Gun Tan Wan (Magnitae Lapis Preparatus Phlegm-Rolling Pill) three qian, dissolved first in boiling water; Zhibao Dan (Precious Treasure Pill) one pill, taken two hours after decoction, dissolved in Dengxin Tang (Junci Medulla Decoction).
Fourth Consultation: After taking the medicine, bowel movements flowed freely, demeanor became much clearer, and phlegm was easier to expectorate. However, after dusk, confusion gradually reappeared, and the pulse turned fine. The tongue is dry, red-bodied, black-coated. Moistening with soup reveals floating, rough, turbid coating covering the surface, with dental calculus and scorched lips. Although spots are gradually revealing, they are not fully expressed. This is due to pathogenic turbidity transforming into fire, causing intense Yangming heat, which depletes Yin fluids. We still fear heat rushing inward, causing coma and convulsions. Reluctantly proposing 'Draining South and Tonifying North' (clearing heat and nourishing Yin), draining heat and revealing spots. Waiting for Brother Zi Fan's decision.
Prescription: Bang Xi Jiao (Rhino Horn, sliced) four fen, decocted first; Chuan Beimu (Fritillariae Cirrhosae Bulbus) two qian; Ejiao Zhu (Asini Corii Colla, pearlized) three qian; Bang Ling Yang Jiao (Cornu Bubali, sliced) two qian, decocted first; Lianqiao (Forsythiae Fructus) three qian; Da Tian Dong (Asparagi Radix) three qian; Xianshipu (Acori Tatarinowii Rhizoma with roots and leaves, washed and crushed) three qian; Xi Sheng Di (Rehmanniae Radix Preparata) five qian; Lugeng (Phragmitis Rhizoma) one liang five qian; Zhuli (Bambusae Sucus) one liang, add a little ginger juice; Lianzhu Fen (Bambusae Concretio Silicea) three fen, taken first mixed with Dengxin Tang (Junci Medulla Decoction).
Fifth Consultation: Draining South and tonifying North, clearing heat and revealing spots. Spots are gradually expressing, mental clarity is better, pulse is slightly rising, tongue fluids are returning. Drinking a little soup makes the tongue body greasy. Although clear fluids return, turbid phlegm causes confusion, Qi cannot transform, and fluids do not ascend. Discussed with Brother Zi Fan to seize this moment when fluids slightly return, urgently flow and transform Qi in the Qi level to unblock fluids, still supplementing with phlegm-resolving and orifice-opening.
Prescription: Xiangdouchi (Fermented Soybean) two qian; Guangxingren (Armeniacae Semen Amarum) three qian, de-husked and crushed; Chuan Bei (Fritillariae Cirrhosae Bulbus, stir-fried) two qian; Huoshui Lugeng (Fresh Phragmitis Rhizoma, de-jointed) one liang; Huashishi (Talcum) four qian; Guangyujin (Curcumae Radix) one qian five fen; Gualou Pi (Trichosanthis Pericarpium) three qian; Chendanxing (Arisaematis Cum Bile) one qian five fen; Xianshipu (Acori Tatarinowii Rhizoma with roots and leaves, washed and crushed) three qian; Gan Pipaye (Eriobotryae Folium, de-husked) three qian; Tianzhu Huang (Calculus Bolus) three qian; Zhuli (Bambusae Sucus) one liang, mix with two fen of Mingfan (Alumen) ground to fine powder.
Sixth Consultation: Mental clarity is better, but irritability and heat flare up again. The patient wants to pull off clothes and blankets, occasionally speaking deliriously. The pulse is string-taut and rapid; the tongue coating is black, body red, still lacking fluids. Spots are not fully expressed but have faded. Pathogenic heat is internally constrained, steaming with turbidity, transforming into fire and depleting fluids. As said, fire causes vexation. We still fear internal rushing. Using heat-releasing and Yin-nourishing methods, still supplementing with phlegm-resolving. Waiting for Brother Zi Fan's review.
Prescription: Lingyang Pian (Cornu Bubali) three qian, decocted first; Hei Shanzhi (Gardeniae Fructus, charred) three qian; Da Tian Dong (Asparagi Radix) three qian; Xi Sheng Di (Rehmanniae Radix Preparata) five qian; Yuan Shen (Scrophulariae Radix) three qian; Lianqiao Xin (Forsythiae Fructus Heart) three qian; Tianzhu Huang (Calculus Bolus) three qian; Ejiao Zhu (Asini Corii Colla, pearlized) three qian; Xianshipu (Acori Tatarinowii Rhizoma with roots and leaves, washed and crushed) three qian; Huashishi (Talcum) three qian, heavily mixed with Zhensha (Cinnabar); Qing Zhuye (Bambusae Folium) twenty leaves; Huoshui Lugeng (Fresh Phragmitis Rhizoma, de-jointed) one liang five qian.
Seventh Consultation: Mental clarity gradually returns. Black tongue coating slightly transforms, but pathogenic heat is still strong, and Yin fluids are depleted and not recovering. The tongue body feels dry. Pathogenic heat disturbs internally, causing mental restlessness. Heart and Small Intestine are interior-exterior corresponding. Internally disturbing heat tends downward, so spirit clears gradually, but urination is very painful, and there is intermittent strange itching in the scrotum and groin. For now, clearing heat and saving Yin cannot be delayed. Precedents mention treating upper disorders by draining below. Discussed with Brother Zi Fan to drain damp-heat from the Lower Burner.
Prescription: Xi Sheng Di (Rehmanniae Radix Preparata) five qian; Da Mai Dong (Ophiopogonis Radix, de-heart) four qian; Guangxingren (Armeniacae Semen Amarum) three qian, de-husked and crushed; Guangyujin (Curcumae Radix) one qian five fen; Longdan Cao (Gentianae Radix) six fen; Cheqian Zi (Plantaginis Semen) three qian; Mutong (Akebiae Caulis) seven fen; Hei Yuan Shen (Scrophulariae Radix, charred) six qian; Qing Zhuye (Bambusae Folium) twenty leaves; Yi Yuan San (Yi Yuan Powder) four qian, heavily mixed with Zhensha (Cinnabar), wrapped in silk; Hei Shanzhi (Gardeniae Fructus, charred) three qian.
Eighth Consultation: Using fluid-increasing methods combined with clearing Lower Burner damp-heat. Bowel movements have not occurred, urination is painful, dripping with difficulty. Breathing is coarse, malar flush is red, restlessness and vexation persist. The pulse is deep and solid; the tongue is dry, black-coated, with a central crack. Pathogenic heat combines with accumulation, gathering again in Yangming, depleting fluids, with risk of syncope. Proposing Tiaowei Chengqi Tang (Harmonizing the Stomach and Forming Qi Decoction) to remove the fuel from under the pot. Waiting for Brother Zi Fan's review and asking for expert judgment.
Prescription: Sheng Guangjun (Radix Rhe Palmatae, raw, added last) four qian; Sheng Gancao (Glycyrrhizae Radix et Rhizoma) five fen; Da Mai Dong (Ophiopogonis Radix, de-heart) three qian; Yuanmingfen (Natrii Sulfas) one qian five fen, mixed; Huashishi (Talcum) four qian; Xi Sheng Di (Rehmanniae Radix Preparata) four qian; Hei Xuan Shen (Scrophulariae Radix, charred) three qian; Huoshui Lugeng (Fresh Phragmitis Rhizoma, de-jointed) one liang; Cheqian Zi (Plantaginis Semen) three qian; Qing Zhuye (Bambusae Folium) twenty leaves.
Ninth Consultation: Yesterday, using Tiaowei Chengqi combined with fluid-increasing methods, urination has通畅 (smoothed). But accumulated heat still gathers in Yangming, unable to descend through curves, so bowel movements still do not occur. Abdominal fullness, tenderness, and pain upon pressing, frequent flatus. Tongue dry, black-coated, pulse deep, forceful upon heavy pressure. Large Intestine and Stomach are connected. Yangming Stomach meridian connects upward to the Heart. When intestines and stomach are blocked by accumulation, Yang Earth Qi transforms entirely into dry fire, depleting fluids. Hot Qi rushes upward from the Stomach, creating a misty environment in the chest and heart, leading to either vexation or confusion. During the illness, secret eating of bread. Previous thorough purging seemed to leave no residual accumulation. Little did we know, although large intestine debris passed, newly ingested food, steamed by heat, naturally dries and knots in the middle, unable to descend smoothly. Hence, ancients had the method of repeated purging. Advancing the previous method slightly. Waiting for Brother Zi Fan's judgment and asking for expert discussion.
Prescription: Guangyujin (Curcumae Radix) two qian; Guangxingren (Armeniacae Semen Amarum) three qian, crushed; Xian Shihu (Dendrobii Caulis, washed and crushed) one liang; Xian Shouwu (Polygoni Multiflori Caulis, finely cut, washed, and crushed) eight qian; Zhishi (Immature Bitter Orange) one qian; Jiegeng (Platycodonis Radix) one qian; Gualou Pi (Trichosanthis Pericarpium) four qian; Xian Sheng Di (Rehmanniae Radix, washed and crushed) one liang; Yuanmingfen (Natrii Sulfas) three qian, mixed; Cheqian Zi (Plantaginis Semen) three qian; Huashishi (Talcum) four qian; Sheng Guangjun (Radix Rhe Palmatae, raw) three qian, soaked in water, juice squeezed and mixed; Gan Pipaye (Eriobotryae Folium, de-husked, wrapped in silk) three qian; Huoshui Lugeng (Fresh Phragmitis Rhizoma, de-jointed) one liang five qian.
Tenth Consultation: After purging, still no movement. Due to fluid exhaustion, prepared as backup.
Prescription: Jin Zhi (Gold Juice); Zhuli (Bambusae Sucus); Li Zhi (Pyrus Sinensis Fructus Juice); Qing Guo Zhi (Green Fruit Juice); Lugeng Zhi (Phragmitis Rhizoma Juice). Take these five flavors frequently. (Returned to Shaoxing on this day.)
Chen (Young): Damp-heat warmth has lingered for a long time. Dampness steams Yangming, with slight chills and internal heat. Pulse is rapid, muddy, and soft; coating is white. Pathogenic dampness lingers daily, damaging original Qi daily, likely progressing to consumptive disease.
Prescription: Chao Xingren (Stir-fried Armeniacae Semen Amarum); Chizhuling (Polyporus); Zexie (Alismatis Rhizoma); Sheng Yiren (Coicis Semen); Tongcao (Tetrapanacis Medulla); Guang Yujin (Curcumae Radix); Chao Qing Hao (Stir-fried Artemisiae Annuae Herba); Ban Xia (Pinelliae Rhizoma, processed); Shang Guang Pi (Citri Reticulatae Pericarpium); Dou Juan (Sojae Semen Praeparatum); Kou Ren (Fructus Amomi).
Second Consultation: Ventilating Lung Qi, exterior Qi naturally unblocks. Without explicit exterior-releasing, sweat occurs; without explicit spot-revealing, spots appear. Wind on muscle-skin and Taiyin dampness resolve externally. However, pulse still carries rapidness. Embers still linger. Although there is a turning point, it is not yet reliable.
Prescription: Ban Xia (Pinelliae Rhizoma, processed); Bai Kou Ren (Fructus Amomi Rotundus); Chi Zhu Ling (Polyporus); Tong Cao (Tetrapanacis Medulla); Ze Xie (Alismatis Rhizoma); Guang Xing Ren (Armeniacae Semen Amarum); Sheng Yi Ren (Coicis Semen); Chao Di Gu Pi (Stir-fried Lycii Cortex); Guang Pi (Citri Reticulatae Pericarpium); Qiang Wei Lu (Rose Dew) one liang, warmed and mixed.
Third Consultation: Urine is yellow and red, a sign of damp-heat exiting externally, hence fever gradually decreases. Medicine is effective, expanding further.
Prescription: Ban Xia (Pinelliae Rhizoma, processed); Tong Cao (Tetrapanacis Medulla); Yi Ren (Coicis Semen); Kou Ren (Fructus Amomi); Mu Zhu Ling (Polyporus); Guang Xing Ren (Armeniacae Semen Amarum); Guang Pi (Citri Reticulatae Pericarpium); Ze Xie (Alismatis Rhizoma); Zhu Ru (Bambusae Caulis in Taeniam); Di Gu Pi (Lycii Cortex); Qiang Wei Lu (Rose Dew) one liang.
Bao (Left): After seasonal disease, damp-heat is not cleared. Steaming Yangming, slight fever after dusk, sometimes chills. Chest feels relieved slightly by coughing. Dampness constrains Ying and Wei, not circulating. Should lightly ventilate Lung Qi. When Qi transforms, dampness also clears.
Prescription: Xing Ren (Armeniacae Semen Amarum); Kou Ren (Fructus Amomi); Chi Bai Ling (Poria, red and white); Zhu Ru (Bambusae Caulis in Taeniam); Ju Pi (Citri Reticulatae Pericarpium); Xian Fo Shou (Citri Sarcodactylis Fructus); Yi Ren (Coicis Semen); Tong Cao (Tetrapanacis Medulla); Zhu Ling (Polyporus); Bai Can Hua (Bombyx Batryticatus Flower? Likely refers to a specific flower or herb, context suggests resolving damp/phlegm).
Second Consultation: Ventilating and transforming Qi-damp, evening fever instantly recedes. But last night felt slight fever again, cough with unsatisfactory phlegm. Damp-heat not cleared, additionally contracted new wind. Should disperse and transform.
Prescription: Qian Hu (Peucedani Radix); Xing Ren (Armeniacae Semen Amarum); Ju Hong (Citri Reticulatae Pericarpium Rubrum); Chi Zhu Ling (Polyporus); Xiang Bei (Fritillariae Thunbergii Bulbus); Chao Bai Wei (Stir-fried Viticis Radix); Lou Pi (Trichosanthis Pericarpium); Sheng Yi Ren (Coicis Semen); Dou Kou Hua (Cardamomi Flos) four fen.
Third Consultation: Chest gradually comfortable, cough descending in order. But evening fever comes and goes. Yangming damp-steaming. Clear and transform again.
Prescription: Ban Xia (Pinelliae Rhizoma, processed); Kou Ren (Fructus Amomi); Mu Zhu Ling (Polyporus); Tong Cao (Tetrapanacis Medulla); Dong Gua Zi (Benincasae Semen); Sheng Yi Ren (Coicis Semen); Xing Ren (Armeniacae Semen Amarum); Chi Bai Fu Ling (Poria, red and white); Hua Shi Shi (Talcum); Ye Can Hua (Wild Bombyx Batryticatus Flower?).
Fourth Consultation: Damp-steaming Yangming. Damp pathogen prospers in Yin aspect, body heat at dusk. Ventilating Lung Qi, light渗 (percolating) dampness. Once steaming resolves, evening fever recedes. Propose harmonizing middle and awakening spleen. Once grain Qi is strong, fluids and Qi recover naturally.
Prescription: Ban Xia (Pinelliae Rhizoma, processed) one qian five fen; Fu Ling (Poria) three qian; Tong Cao (Tetrapanacis Medulla) eight fen; Huo Xiang (Agastaches Herba) two qian; Sheng Shu Gu Ya (Raw and Stir-fried Hordei Fructus Germinatus) three qian each; Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma) one qian five fen; Yi Ren (Coicis Semen) three qian; Zhu Ling (Polyporus) one qian five fen; Bai Can Hua (Bombyx Batryticatus Flower?) seven fen; Ju Bai (Citri Reticulatae Pericarpium Album) one qian.
Fifth Consultation: Cultivating earth and harmonizing middle, stomach appetite slightly rises. Expand previous method.
Prescription: Kui Dang Shen (Codonopsis Radix, Kweichow variety) two qian; Fa Ban Xia (Pinelliae Rhizoma, processed) one qian five fen; Hei Dou Yi (Sojae Semen Nigrum Testa) three qian; Chao Bai Zhu (Stir-fried Atractylodis Macrocephalae Rhizoma) two qian; Fu Ling (Poria) three qian; Ju Bai (Citri Reticulatae Pericarpium Album) one qian; Chao Bai Wei (Stir-fried Viticis Radix) one qian five fen; Nu Zhen Zi (Ligustri Lucidi Fructus) three qian; Sheng Shu Gu Ya (Raw and Stir-fried Hordei Fructus Germinatus) two qian each; Pei Lan Ye (Eupatorii Herba) one qian five fen.
Chen (Left): Fever intensity is not prominent, nausea, chest tightness, sweating not smooth. Contracted pathogen combines with dampness, steaming together, blocking Triple Burner. At the peak of one week.
Prescription: Xiang Dou Chi (Fermented Soybean) three qian; Guang Yu Jin (Curcumae Radix) one qian five fen; Zhi Ban Xia (Pinelliae Rhizoma, processed) one qian five fen; Bai Kou Ren (Fructus Amomi Rotundus) seven fen; Zhi Shi (Immature Bitter Orange) one qian; Guang Xing Ren (Armeniacae Semen Amarum) three qian; Gan Fo Shou (Citri Sarcodactylis Fructus, dried) one qian five fen; Guang Pi (Citri Reticulatae Pericarpium) one qian; Jie Geng (Platycodonis Radix) one qian; Zhi Chuan Pu (Cortex Magnoliae Officinalis, processed) one qian; Zhu Ru (Bambusae Caulis in Taeniam) one qian.
Ling (Left): Malaria-like episodes several times. Shaoyang pathogen merges into Yangming, resulting in no chills but only heat. Erupting spots and sha (rash), lip and mouth twitching, delirious speech and mental chaos. After wind movement, followed by syncope. Now major trend is stable, but heat lingers unresolved. Bowel movements have not occurred for a month. Sour saliva surges upward, chest and epigastrium uncomfortable. Vomiting sour water brings slight relief. Thirst but little desire to drink. Tongue...