春温过汗变症
城东章某，得春温时病，前医不识，遂谓伤寒，辄用荆、防、羌独等药，一剂得汗，身热退清，次剂
罔灵，复热如火，大渴饮冷，其势如狂。更医治之，谓为火证，竟以三黄解毒为君，不但
热势不平，更变神昏螈 。急来商治于丰，诊其脉，弦滑有力，视其舌，黄燥无津。丰曰∶此春温病也。初
起本宜发汗，解其在表之寒，所以热从汗解，惜乎继服原方，过汗遂化为燥，又如苦寒遏其邪热，以致诸
变丛生，当从邪入心包、肝风内动治之。急以祛热宣窍法，加羚羊、钩藤。服一剂，螈 稍定，神识亦
清，惟津液未回，唇舌尚燥，守旧法，除去至宝、菖蒲，加入沙参、鲜地，连尝三剂，诸恙咸安。
春温甫解几乎误补
三湘刘某之子，忽患春温，热渴不解，计有二十朝来，始延丰诊，脉象洪大鼓指，舌苔灰燥而干，
既以凉解里热法治之。次日黎明，复来邀诊，诣其处，见几上先有药方二纸，一补正回
阳，一保元敛汗。刘曰∶昨宵变证，故延二医酌治，未识那方
中肯？即请示之。丰曰∶先诊其脉再议。刘某伴至寝所，见病者覆被而卧，神气尚清，汗出淋漓，身凉如水，
六脉安静，呼吸调匀。丰曰∶公弗惧，非脱汗也，乃解汗也。曰∶何以知之？曰∶脉静身凉，故知之也。倘今
见汗防脱，投以温补，必阻其既解之邪，变证再加，遂难治矣。乔梓仍信丰言，遂请疏方。思邪方解之秋，最
难用药，补散温凉，概不可施，姑以蒌皮畅其气分，俾其余邪达表； 豆衣以皮行皮，使其尽透肌肤；盖
汗为心之液，过多必损乎心，再以柏子、茯神养其心也；加沙参以保其津，细地以滋其液，米仁甘草，调养
中州；更以浮小麦养心敛汗。连服二剂，肢体回温，汗亦收住。调治半月，起居如昔矣。
或问曰∶先生尝谓凡学时病，必先读仲景之书。曾见《伤寒论》中，漏汗不止，而用附子。今见大汗
身凉，而用沙参细地，能不令人骇然？请详其理。答曰，用附子者，其原必寒，其阳必虚。今用沙、地者，
其原乃温，其阴乃伤。一寒一温，当明辨之。又问∶春温之病，因寒触动，岂无寒乎？曰∶子何迂
也！须知温在内，寒在外。今大汗淋漓，即有在外之寒，亦当透解，故不用附子以固其阳，而截其既解温邪
之路，用沙、地以滋津液，而保其既伤肺肾之阴。若执固阳之法，必使既散之邪复聚，子知是理乎？
风温入肺胃误作阴虚腻补增剧
云岫孙某，平素清 ，吸烟弱质，患咳嗽热渴，计半月矣。前医皆以为阴虚肺损，所服之药，非地、味、
阿胶，即沙参、款、麦，愈治愈剧，始来求治于丰，按其脉，搏大有力，重取滑数，舌绛苔黄，热渴咳嗽，
此明是风温之邪，盘踞肺胃。前方尽是滋腻，益使气机闭塞，致邪不能达解，当畅其肺，清其胃，用辛凉
解表法，加芦根、花粉治之。服二剂，胸次略宽，咳亦畅快，气
分似获稍开，复诊其脉稍缓，但沉分依然，舌苔化燥而灰，身热如火，口渴不寐，此温邪之势未衰，津液被
其所劫也。姑守旧法，减去薄荷，加入石膏、知母。服至第三剂，则肌肤微微汗
润，体热退清，舌上津回，脉转缓怠，继以调补，日渐而安。
风温误补致死
里人范某，患风温时病，药石杂投，久延未愈。请丰诊视，视其形容憔悴，舌苔尖白根黄，脉来左弱右
强，发热缠绵不已，咳嗽勤甚，痰中偶有鲜血，此乃赋禀素亏，风温时气未罄，久化
为火，刑金劫络，理当先治其标，缓治其本，遂以银翘散，去荆芥、桔、豉，加川贝、兜、蝉，此虽治标，
实不碍本，倘见血治血，难免不入虚途。病者信补不服，复请原医，仍用滋阴凉血补肺
之方，另服人参、燕窝。不知温邪得补，益不能解，日累日深，竟成不起。呜呼！医不明标本缓急，
误人性命，固所不免矣。
风温夹湿
南乡梅某，望七之年，素来康健，微热咳嗽，患有数朝，时逢农事方兴，犹是勤耕绿野，加冒春雨，
则发热忽炽，咳嗽频频，口渴不甚引饮，身痛便泻。有谓春温时感，有言漏底伤寒，
所进之方，佥未应手。延丰延医，按其脉，濡数之形，舌苔黄而且腻，前恙未除，尤加胸闷溺赤，此系
风温夹湿之证，上宜清畅其肺，中宜温化其脾，以辛凉解表法，去蒌壳，加葛根、苍术、神
曲、陈皮治之。服二剂，身痛已除，便泻亦止，惟发热咳嗽，口渴喜凉，似乎客湿已解，温热未清，当步原
章，除去苍术、神曲，加入绍贝、蒌根、芦根、甘草。迭进三剂，则咳嗽渐疏，身热退
净。复诊数次，诸恙若失矣。
胃虚温病
海昌张某，于暮春之初，突然壮热而渴，曾延医治，胥未中机。邀丰诊之，脉驶而躁，舌黑而焦，述
服柴葛解肌及银翘散，
毫无应验。推其脉证，温病显然，刻今热势炎炎，津液被劫，神识模糊，似有逆传之局，急用石膏、知母，以
祛其热；麦冬、鲜斛，以保其津；连翘、竹叶，以清其心；甘草、粳米，以调其中。服
之虽有微汗，然其体热未衰，神识略清，舌苔稍润，无如又加呃逆，脉转来盛去衰，斯温邪未清，胃气又虚竭
矣。照前方增入东洋参、刀豆壳，服下似不龃龉，遍体微微有汗，热势渐轻，呃
逆亦疏，脉形稍缓。继以原法，服一煎诸恙遂退，后用金匮麦门冬汤为主，调理匝月而安。
胃实温病
山阴沈某，发热经旬，口渴喜冷，脉来洪大之象，舌苔黄燥而焦。丰曰∶此温病也。由伏气自内而出，
宜用清凉透邪法，去淡豉、竹叶、绿豆衣，加杏仁、蒌壳、花粉、甘草治之。服一剂，未中肯綮，更加谵语
神昏，脉转实大有力，此温邪炽盛，胃有燥屎昭然，改用润下救津法，加杏霜、枳壳治之。午前服下，
至薄暮腹内微疼，先得矢气数下，交子夜始得更衣，有坚燥黑屎十数枚，继下溏粪，色如败酱，臭不可近，
少顷遂熟寐矣，鼾声如昔，肤热渐平，至次日辰牌方醒，醒来腹内觉饥，啜薄粥一碗。复脉转为小软，舌苔
已化，津液亦生。丰曰∶病全愈矣，当进清养胃阴之药。服数剂，精神日复耳。
程曦曰∶斯二症皆是温病，见证似乎相仿，一得人参之力，一得承气之勋，可见学医宜参脉证。一加
呃逆，脉转洪形，便知其为胃气之虚；一加谵语，脉转实大，便知其为胃气之实。
论其常证，相去不远，见其变证，虚实攸分，临证之秋，苟不审其孰虚孰实，焉能迎刃而解耶！
有孕发斑
建德孙某之妻，怀胎五月，忽发温毒之病，延丰诊之，已发斑矣。前医
有用辛温发散，有用补养安胎，不知温毒得辛温愈
炽，得补养弥盛，是以毒势益张，壅滞肌肉而发为斑，其色紫者，胃热盛也，脉数身热，苔黄而焦，此宜解
毒清斑，不宜专用安补。遂以石膏、芦根，透阳明之热；黄芩、鲜地，清受灼之胎；
佐连翘、甘草以解毒，荷叶以升提。服一帖，身热稍清，斑色退淡、惟脉象依然数至，舌苔未见津回，仍守
旧章，重入麦冬，少增参叶。继服二帖，诸恙尽退。后用清补之法，母子俱安。
温毒发疹
古越胡某之郎，年方舞象，忽患热渴咳闭，已半月矣，前医罔效，病势日加沉重。遣人延丰延医，诣
其寓所，先看服过三方，皆是沙参、麦冬、桑皮、地骨，清金止咳等药。审其得病之时，始则发热咳嗽，今
更加之胸闭矣。诊其脉，两寸俱盛，此明系温热之毒，盘踞于上，初失宣气透邪之法，顿使心火内炽，肺
金受刑，盖肺主皮毛，恐温毒外聚肤腠而发为疹，遂令解衣阅之，果见淡红隐隐，乘此将发未透之际，恰好轻
清透剂以治之，宜以辛凉解表法，去蒌壳，加荷叶、绿豆衣、西河柳叶。服下遂鲜红起粒，再服渐淡渐疏，而
热亦减，咳亦平。继以清肃肺金之方，未及一旬，遂全瘥耳。
喉痹急证
城东陈某之室，偶沾温毒而成喉痹，来邀延医，见其颈肿牙闭，不能纳食，惟汤水略为可咽，脉象浮
中不着，沉分极数。丰曰∶此温毒之证，过服寒凉，则温毒被压，益不能化，索前方一阅果然，据愚意理当
先用温宣，解其寒凉药气，俟牙松肿减，而后以凉剂收功。满座皆曰∶然。遂以谷精、紫菀开其喉痹；
薄荷、荆芥宣散风邪；橘红快膈化痰；甘草泻火解毒；桔梗载诸药之性在上，仍能开畅咽喉；细辛治喉痹有
功，且足少阴本药，以少阴之脉，循喉咙也。速令煎尝，另用玉钥匙，即马牙硝钱
半，蓬砂五分，僵蚕三分，大泥冰片一分，擂细吹喉，令涎多出。
自日晡进药，至二更时候，牙关略展，忽作咳嗽连声。次日复邀诊视，告以病情。丰曰∶有生机也。脉形稍
起，苔色纯黄，此温毒透达之象。改以元参、细地、绍贝、牛蒡、参叶、射干、大洞
果、金果榄等药。迭进三剂，颈肿尽消，咽喉畅利，咳嗽亦渐愈矣。
或问曰∶观先生数案，皆用法而不用汤。尝见古人治斑疹颐喉，皆不出吴氏举斑汤、钱氏升葛汤、
活人玄参升麻汤、东垣普济消毒饮等方，方内皆用升麻。窃思斑疹赖其透发，颐喉借其升提，今先生舍而不
用者，是何意也？答曰∶吴淮阴云∶升腾飞越太过之病，不当再用升提，说者谓其引经，亦愚甚矣。
诚哉非谬也！丰深有味乎斯言。即遇当升透之病，莫如荷叶、桔梗为稳。升麻升散力速，他病为宜，
于斑疹颐喉，究难用耳。
伏气晚发
若耶赵某，颇知医理，偶觉头痛发热，时或恶风，自以为感冒风邪，用辛温散剂，热势增重。来迓于丰，
脉象洪滑而数，舌根苔黄，时欲烦躁，口不甚渴。丰曰∶此晚发证也。不当辛散，宜乎清解之方。病者莞然
而笑，即谓∶晚发在乎秋令，春时有此病乎？见其几上有医书数种，内有叶香岩《医效秘传》，
随手翻出使阅，阅之而增愧色，遂请赐方，以辛凉解表法，加芦根、豆卷治之。连服三煎，一如雪污
拔刺，诸恙咸瘳。
城东章姓患者，患春季温热时行疾病。前一位医生未能识别，误认为是伤寒，于是随意使用荆芥、防风、羌活、独活等药物。服用一剂后出汗，身体热度退去且清晰；但第二剂药无效，体温再次升高如火，极度口渴想喝冷水，神志狂乱似疯癫。另一位医生诊治，认为是火证，竟然以三黄解毒汤为主药，不仅热势没有平息，反而出现神志昏迷、肢体抽搐的症状。急忙来找我商议治疗。我诊察其脉象，弦滑而有力；观察其舌苔，黄燥且无津液。我说：“这是春温病。初起本来适宜发汗，以解除在表的寒邪，所以热度随汗而解。可惜继续服用原方，导致发汗过度从而化为燥热；又因苦寒药物遏制了邪热，致使各种变证丛生。应当从邪气进入心包、肝风内动的角度进行治疗。”急忙采用祛热宣窍法，加入羚羊角、钩藤。服用一剂后，抽搐稍定，神识也清醒了，只是津液尚未恢复，嘴唇和舌头依然干燥。坚守旧法，去掉至宝丹、石菖蒲，加入北沙参、鲜地黄，连续服用三剂，所有病症都痊愈了。
春温病刚解几乎被误用补药
三湘刘某的儿子，突然患上春温病，发热口渴不解，病程已有二十多天，才请我诊治。脉象洪大鼓指，舌苔灰燥而干。随即以凉解里热法治之。第二天黎明，他又来邀请我去诊治。到了他家，看见桌上先有两张药方，一张是补正回阳的，一张是保元敛汗的。刘某说：“昨晚病情变化，所以请两位医生斟酌治疗，不知哪一方更切中要害？请您指示。”我说：“先诊察他的脉象再讨论。”刘某陪同我到卧室，看见病人盖着被子躺着，神气尚清，汗出淋漓，身体凉如水，六脉安静，呼吸调匀。我说：“您不要害怕，这不是脱汗，而是解汗。”他问：“怎么知道？”我说：“因为脉静身凉，所以知道。如果现在见汗就担心脱证，投用温补药物，必定阻碍已经解散的邪气，使变证再加，那就难以治疗了。”父子俩仍相信我的话，于是请我开方。我想邪气刚解的时候，最难用药，补散温凉一概不可施用。暂用瓜蒌皮畅达气分，使其余邪透达体表；豆衣以皮行皮，使其尽透肌肤；因为汗为心之液，过多必损伤心脏，再用柏子仁、茯神滋养心脏；加沙参以保护津液，细生地以滋润阴液，薏苡仁、甘草，调养脾胃；再用浮小麦养心敛汗。连续服用两剂，肢体回暖，汗也止住了。调理半个月，起居如常。
有人问：“先生曾说凡学习时病，必须先读仲景的书。曾见《伤寒论》中，漏汗不止，而用附子。现在见大汗身凉，而用沙参、细地，能不令人骇然？请详细说明其中的道理。”回答说：“用附子的情况，其本源必然是寒，阳气必然虚弱。现在用沙参、细地的情况，其本源乃是温热，阴液乃受损伤。一寒一温，应当明辨。又问：‘春温病，因寒触动，难道没有寒吗？’回答说：‘你太迂腐了！须知温邪在内，寒邪在外。现在大汗淋漓，即使有在外的寒邪，也应当透解，所以不用附子以固护阳气，从而截断已经解散的温邪之路，而是用沙参、细地以滋润津液，保护已经受伤的肺肾之阴。如果固执于固阳的方法，必定使已经消散的邪气重新聚集，你明白这个道理吗？’”
云岫孙某，平素清高，吸烟体质弱，患咳嗽热渴，病程半月了。前医都认为是阴虚肺损，所服用的药物，不是地黄、五味子、阿胶，就是沙参、款冬花、麦冬，越治越重，才来求治于我。按摸其脉，搏动大而有力，重取滑数，舌质绛红苔黄，热渴咳嗽，这明显是风温之邪盘踞肺胃。前方尽是滋腻药物，更加使气机闭塞，导致邪气不能透达解散。应当通畅肺气，清泄胃热，用辛凉解表法，加芦根、天花粉治疗。服用两剂，胸次略微宽舒，咳嗽也畅快，气分似乎获得稍许开通。复诊时脉稍缓，但沉分依然有力，舌苔化燥而灰，身体热如火，口渴不寐，这是温邪之势未衰，津液被其所劫夺。暂守旧法，减去薄荷，加入石膏、知母。服用到第三剂，肌肤微微汗润，体热退去且清晰，舌上津液回复，脉转缓怠，继以调补，日渐安宁。
风温病误用补药致死
同乡范某，患风温时行疾病，药物杂乱投用，久延未愈。请我诊治，看其形容憔悴，舌苔尖白根黄，脉来左弱右强，发热缠绵不已，咳嗽频繁严重，痰中偶有鲜血。这是禀赋素亏，风温时气未尽，日久化为火邪，刑克肺金、劫伤络脉，理当先治其标，缓治其本。遂以银翘散，去掉荆芥、桔梗、豆豉，加川贝母、兜铃、蝉蜕。这虽然是治标，实际上不妨碍治本。如果见血就治血，难免陷入虚损误区。病人相信补法不服我的药，又请原医生，仍用滋阴凉血补肺之方，另服人参、燕窝。不知道温邪得补益更不能解散，日积月累加深，竟成不治之症。唉！医生不明白标本缓急，误人性命，确实是不可避免的。
风温夹湿
南乡梅某，七十多岁，素来康健，微热咳嗽，患病几天。恰逢农事兴起，还在绿野勤耕，加上冒雨，则发热忽然炽盛，咳嗽频频，口渴不甚想喝水，身痛便泻。有人说春温时感，有人说漏底伤寒，所进的方子，都没有见效。请我诊治，按其脉，濡数之形，舌苔黄而且腻，前恙未除，尤其增加胸闷溺赤，这是风温夹湿之证。上宜清畅其肺，中宜温化其脾，以辛凉解表法，去掉瓜蒌壳，加葛根、苍术、神曲、陈皮治疗。服用两剂，身痛已除，便泻也止，惟发热咳嗽，口渴喜凉，似乎客湿已解，温热未清，应当沿袭原方，除去苍术、神曲，加入浙贝母、瓜蒌根、芦根、甘草。连续进服三剂，则咳嗽渐疏，身热退净。复诊数次，诸恙若失矣。
胃虚温病
海昌张某，在暮春之初，突然壮热而渴，曾请医生医治，都没有切中机理。邀我诊治，脉驶而躁，舌黑而焦，述说服用柴葛解肌及银翘散，毫无应验。推究其脉证，温病显然。此刻热势炎炎，津液被劫，神识模糊，似有逆传之局。急用石膏、知母，以祛其热；麦冬、鲜石斛，以保其津；连翘、竹叶，以清其心；甘草、粳米，以调其中。服用之后虽有微汗，然而其体热未衰，神识略清，舌苔稍润，无奈又加呃逆，脉转来盛去衰，这是温邪未清，胃气又虚竭了。照前方增入东洋参、刀豆壳，服用下似乎不抵触，遍体微微有汗，热势渐轻，呃逆也疏，脉形稍缓。继以原法，服一煎诸恙遂退，后用金匮麦门冬汤为主，调理一个月而安。
胃实温病
山阴沈某，发热经旬，口渴喜冷，脉来洪大之象，舌苔黄燥而焦。我说：“这是温病。由伏气自内而出，宜用清凉透邪法，去掉淡豆豉、竹叶、绿豆衣，加杏仁、瓜蒌壳、天花粉、甘草治疗。服用一剂，未中肯綮，更加谵语神昏，脉转实大有力，这是温邪炽盛，胃有燥屎昭然。改用润下救津法，加杏霜、枳壳治疗。午前服下，至薄暮腹内微疼，先得矢气数下，交子夜始得更衣，有坚燥黑屎十数枚，继下溏粪，色如败酱，臭不可近，少顷遂熟寐矣，鼾声如昔，肤热渐平，至次日辰牌方醒，醒来腹内觉饥，啜薄粥一碗。复脉转为小软，舌苔已化，津液亦生。我说：“病全愈矣，当进清养胃阴之药。服用数剂，精神日复耳。”
程曦说：“这两个病症都是温病，见证似乎相仿，一个得人參之力，一个得承气之勋，可见学医宜参脉证。一加呃逆，脉转洪形，便知其为胃气之虚；一加谵语，脉转实大，便知其为胃气之实。论其常证，相去不远，见其变证，虚实攸分，临证之秋，苟不审其孰虚孰实，焉能迎刃而解耶！”
有孕发斑
建德孙某之妻，怀胎五月，忽发温毒之病，请我诊治，已发斑了。前医有用辛温发散，有用补养安胎，不知道温毒得辛温愈炽，得补养弥盛，是以毒势益张，壅滞肌肉而发为斑，其色紫者，胃热盛也，脉数身热，苔黄而焦，此宜解毒清斑，不宜专用安补。遂以石膏、芦根，透阳明之热；黄芩、鲜地黄，清受灼之胎；佐连翘、甘草以解毒，荷叶以升提。服用一帖，身热稍清，斑色退淡、惟脉象依然数至，舌苔未见津回，仍守旧章，重入麦冬，少增参叶。继服二帖，诸恙尽退。后用清补之法，母子俱安。
温毒发疹
古越胡某之子，年方舞象（少年），忽患热渴咳闭，已半月矣，前医罔效，病势日加沉重。遣人请我诊治，到其寓所，先看服过三方，皆是沙参、麦冬、桑皮、地骨皮，清金止咳等药。审其得病之时，始则发热咳嗽，今更加之胸闭矣。诊其脉，两寸俱盛，此明系温热之毒，盘踞于上，初失宣气透邪之法，顿使心火内炽，肺金受刑，盖肺主皮毛，恐温毒外聚肤腠而发为疹，遂令解衣阅之，果见淡红隐隐，乘此将发未透之际，恰好轻清透剂以治之，宜以辛凉解表法，去掉瓜蒌壳，加荷叶、绿豆衣、西河柳叶。服用后遂鲜红起粒，再服渐淡渐疏，而热亦减，咳亦平。继以清肃肺金之方，未及一旬，遂全瘥耳。
喉痹急证
城东陈某之妻，偶沾温毒而成喉痹，来邀请医，见其颈肿牙闭，不能纳食，惟汤水略为可咽，脉象浮中不着，沉分极数。我说：“这是温毒之证，过服寒凉，则温毒被压，益不能化，索前方一阅果然，据愚意理当先用温宣，解其寒凉药气，俟牙松肿减，而后以凉剂收功。满座皆曰：‘对。’遂以谷精草、紫菀开其喉痹；薄荷、荆芥宣散风邪；橘红快膈化痰；甘草泻火解毒；桔梗载诸药之性在上，仍能开畅咽喉；细辛治喉痹有功，且足少阴本药，以少阴之脉，循喉咙也。速令煎尝，另用玉钥匙，即马牙硝钱半，蓬砂五分，僵蚕三分，大泥冰片一分，擂细吹喉，令涎多出。
自日晡进药，至二更时候，牙关略展，忽作咳嗽连声。次日复邀诊视，告以病情。我说：“有生机也。脉形稍起，苔色纯黄，此温毒透达之象。改以元参、细地、绍贝、牛蒡、参叶、射干、大洞果、金果榄等药。迭进三剂，颈肿尽消，咽喉畅利，咳嗽亦渐愈矣。”
有人问：“观先生数案，皆用法而不用汤。尝见古人治斑疹颐喉，皆不出吴氏举斑汤、钱氏升葛汤、活人玄参升麻汤、东垣普济消毒饮等方，方内皆用升麻。窃思斑疹赖其透发，颐喉借其升提，今先生舍而不用者，是何意也？”回答说：“吴鞠通云：‘升腾飞越太过之病，不当再用升提。’说者谓其引经，亦愚甚矣。诚哉非谬也！丰深有味乎斯言。即遇当升透之病，莫如荷叶、桔梗为稳。升麻升散力速，他病为宜，于斑疹颐喉，究难用耳。”
若耶赵某，颇知医理，偶觉头痛发热，时或恶风，自以为感冒风邪，用辛温散剂，热势增重。来请我诊治，脉象洪滑而数，舌根苔黄，时欲烦躁，口不甚渴。我说：“这是晚发证也。不当辛散，宜乎清解之方。病者莞然而笑，即谓：‘晚发在乎秋令，春时有此病乎？’见其几上有医书数种，内有叶香岩《医效秘传》，随手翻出使阅，阅之而增愧色，遂请赐方，以辛凉解表法，加芦根、豆卷治疗。连服三煎，一如雪污拔刺，诸恙咸瘳。”
**Variations of Spring-Warmth Disease Caused by Excessive Sweating**
Mr. Zhang from the east of the city contracted a spring-warmth seasonal disease. The previous physician failed to recognize it and mistakenly diagnosed it as *Shanghan* (Cold Damage). He arbitrarily prescribed herbs such as *Jingjie* (Schizonepetae Spica), *Fangfeng* (Saposhnikoviae Radix), *Qianghuo* (Notopterygii Rhizoma et Radix), and *Duhuo* (Angelicae Pubescentis Radix). After one dose, sweating occurred, and body heat subsided clearly. However, the second dose was ineffective; the fever returned fiercely like fire, accompanied by extreme thirst for cold drinks and a manic state resembling madness. Another physician treated him, diagnosing it as a Fire syndrome, and used *Sanhuang Jiedu Tang* (Three-Yellow Detoxification Decoction) as the principal formula. Not only did the heat not subside, but the patient also developed unconsciousness and convulsions (*Yongzhi*). He urgently sought my consultation. I palpated his pulse, which was wiry, slippery, and forceful; I observed his tongue coating, which was yellow, dry, and lacked fluids. I said: "This is Spring-Warmth disease. At the onset, it was appropriate to induce sweating to release the exterior cold, so the heat resolved with sweat. Unfortunately, continuing the original prescription led to excessive sweating, transforming into dryness-heat. Furthermore, bitter-cold herbs suppressed the pathogenic heat, causing various variations to arise. Treatment should address the pathogen entering the Pericardium and internal stirring of Liver Wind." I urgently employed the method of dispelling heat and opening orifices, adding *Lingyangjiao* (Saigae Tataricae Cornu) and *Gouteng* (Uncariae Ramulus cum Uncis). After one dose, the convulsions slightly stabilized, and consciousness cleared, although fluids had not yet recovered, and lips and tongue remained dry. Adhering to the old method, I removed *Zhibao Dan* (Treasure of Life Pill) and *Changpu* (Acori Tatarinowii Rhizoma), and added *Shashen* (Glehniae Radix) and *Xiadihuang* (Rehmanniae Radix Recens). After three doses, all ailments were resolved.
**Spring-Warmth Disease Almost Mismanaged with Tonics Upon Resolution**
The son of Mr. Liu from Sanxiang suddenly contracted Spring-Warmth disease. Fever and thirst persisted without relief for over twenty days before I was consulted. The pulse was surging and large, striking the fingers; the tongue coating was gray, dry, and parched. I immediately treated it using the method of cooling and resolving interior heat. At dawn the next day, he invited me again. Arriving at his home, I saw two prescriptions on the table: one for tonifying righteousness and restoring Yang, and another for preserving Yuan Qi and consolidating sweat. Mr. Liu said: "Due to symptom changes last night, I invited two physicians to deliberate. I do not know which prescription hits the mark. Please instruct me." I said: "Let us palpate the pulse first." Accompanying me to the bedroom, Mr. Liu showed me the patient lying covered with blankets. His spirit was clear, sweating profusely, body cool as water, six pulses quiet, and breathing regular. I said: "Do not fear, this is not collapse sweating, but resolution sweating." He asked: "How do you know?" I replied: "Because the pulse is quiet and the body is cool. If we see sweat and fear collapse, administering warm tonics will obstruct the already resolved pathogen, causing further variations, making it difficult to treat." Trusting my words, they asked for a prescription. I considered that when pathogens are just resolving, medication is difficult; tonics, dispersants, warmers, and coolers should generally be avoided. I temporarily used *Loupi* (Benincasae Exocarpium) to promote Qi movement in the Qi level, allowing residual pathogens to reach the exterior; *Douyi* (Sojae Semen Preparatum) acts via skin to reach skin, helping pathogens fully penetrate the skin surface; since sweat is the fluid of the Heart, excessive loss damages the Heart, so I added *Baiziren* (Ziziphi Spinosae Semen) and *Fushen* (Poria Cum Radix Pinelliae) to nourish the Heart; *Shashen* (Glehniae Radix) to protect fluids; *Xidi* (Rehmanniae Radix Preparata) to moisten Yin; *Yiyiren* (Coicis Semen) and *Gancao* (Glycyrrhizae Radix et Rhizoma) to regulate the Middle Jiao; and *Fuxiaomai* (Tritici Caput) to nourish the Heart and consolidate sweat. After two doses, limbs warmed, and sweating stopped. After half a month of regulation, daily life returned to normal.
Someone asked: "You often say that to study seasonal diseases, one must first read Zhongjing's works. In *Shanghan Lun*, continuous leakage of sweat is treated with *Fuzi* (Aconiti Lateralis Radix Praeparata). Now, seeing massive sweating with a cool body, you use *Shashen* and *Xidi*. Is this not startling? Please explain the rationale." I answered: "When using *Fuzi*, the root cause must be Cold, and Yang must be deficient. When using *Shashen* and *Xidi*, the root cause is Warmth, and Yin is injured. One is Cold, one is Warmth; this must be clearly distinguished." They asked: "Spring-Warmth is triggered by Cold; is there no Cold involved?" I replied: "You are too rigid! Understand that Warmth is internal, while Cold is external. With massive sweating, even if external Cold exists, it should be released through permeation. Therefore, I do not use *Fuzi* to secure Yang and block the path of the resolved Warmth pathogen, but use *Shashen* and *Xidi* to moisten fluids and protect the injured Lung and Kidney Yin. Clinging to methods of securing Yang would cause dispersed pathogens to re-aggregate. Do you understand this principle?"
**Wind-Warmth Entering Lung and Stomach Misdiagnosed as Yin Deficiency, Aggravated by Greasy Tonics**
Sun Mou from Yunxiu was naturally pure and refined, smoked, and had a weak constitution. He suffered from cough, fever, and thirst for half a month. Previous physicians all believed it was Yin deficiency and Lung damage. The medicines taken were either *Dihuang* (Rehmanniae Radix), *Wuweizi* (Schisandrae Fructus), *Ejiao* (Asini Corii Colla), or *Shashen* (Glehniae Radix), *Kuandonghua* (Farfarae Flos), and *Maidong* (Ophiopogonis Radix). The more he was treated, the worse it became, until he sought my help. Palpating his pulse, it was large and forceful; deep pressure revealed slippery and rapid qualities. The tongue body was crimson with a yellow coating. Fever, thirst, and cough indicated that Wind-Warmth pathogens were entrenched in the Lung and Stomach. The previous prescriptions were full of cloying and greasy substances, further blocking Qi mechanism and preventing pathogen resolution. We needed to unblock Lung Qi and clear Stomach heat using the method of acrid-cool exterior release, adding *Lugen* (Phragmitis Rhizoma) and *Huafen* (Trichosanthis Radix). After two doses, chest tightness slightly eased, cough became smoother, and Qi level seemed slightly opened. On re-examination, the pulse was slightly slower, but deep pressure remained strong. Tongue coating turned dry and gray. Body heat was fierce, thirst prevented sleep. This indicated the Warmth pathogen's momentum had not waned, and fluids were being robbed. I adhered to the old method, removing *Bohe* (Menthae Haplocalycis Herba), and adding *Shigao* (Gypsum Fibrosum) and *Zhimu* (Anemarrhenae Rhizoma). By the third dose, skin was slightly moist with sweat, body heat subsided clearly, tongue fluids returned, and pulse became slow and relaxed. Subsequent regulation led to gradual peace.
**Wind-Warmth Mismanaged with Tonics Leading to Death**
Fan Mou, a townsman, suffered from Wind-Warmth seasonal disease. Medicines were administered indiscriminately, prolonging the illness without cure. I examined him: emaciated appearance, tongue coating white at tip and yellow at root, left pulse weak and right pulse strong, lingering fever, frequent severe cough, occasional blood in sputum. This indicated innate deficiency, unresolved Wind-Warmth qi, transformation into fire over time, damaging Metal (Lung) and collaterals. Principle dictates treating the branch (symptoms) first and root (constitution) later. I prescribed *Yinqiao San* (Honeysuckle and Forsythia Powder), removing *Jingjie* (Schizonepetae Spica), *Jiegeng* (Platycodonis Radix), and *Chidouchi* (Sojae Semen Preparatum), adding *Chuanbei* (Fritillariae Cirrhosae Bulbus), *Dudoulong* (Stemonae Radix), and *Chanstui* (Cicadae Periostracum). Although treating the branch, it does not hinder the root. Treating blood directly upon seeing blood would lead to deficiency patterns. The patient trusted tonics, refused my medicine, and consulted the original doctor, who prescribed nourishing Yin, cooling blood, and tonifying Lung formulas, along with *Renshen* (Ginseng Radix) and *Yanwo* (Swallow's Nest). Unaware that tonics exacerbate Warmth pathogens, the condition worsened daily until death. Alas! Physicians ignorant of branch/root and urgency inevitably cause fatal errors.
**Wind-Warmth Complicated with Dampness**
Mei Mou from southern township, aged seventy, was usually healthy. Suffering slight fever and cough for a few days, he worked hard in fields during farming season, exposed to spring rain. Fever suddenly intensified, cough frequent, thirst not desiring much drinking, body pain, and diarrhea. Some diagnosed Spring-Warmth seasonal infection, others Leakage-type Cold Damage. Prescriptions were ineffective. I examined him: pulse was soggy and rapid, tongue coating yellow and greasy. Symptoms unchanged, plus chest oppression and red urine. This is Wind-Warmth complicated with Dampness. Upper burner needs clearing and unblocking Lung; middle burner needs warming and transforming Spleen Dampness. Using acrid-cool exterior release method, removing *Louqiao* (Benincasae Exocarpium), adding *Gegen* (Puerariae Lobatae Radix), *Cangzhu* (Atractylodis Rhizoma), *Shenqu* (Massa Medicata), and *Chenpi* (Citri Reticulatae Pericarpium). After two doses, body pain ceased, diarrhea stopped. Fever, cough, and thirst for cool drinks remained, suggesting external dampness resolved but warmth unclarified. Following the original chapter, removing *Cangzhu* and *Shenqu*, adding *Shaobei* (Fritillariae Thunbergii Bulbus), *Lougen* (Trichosanthis Radix), *Lugen* (Phragmitis Rhizoma), and *Gancao* (Glycyrrhizae Radix et Rhizoma). After three doses, cough gradually thinned, fever completely subsided. Several re-examinations confirmed recovery.
**Stomach Deficiency in Warmth Disease**
Zhang Mou from Haichang, early late spring, suddenly had high fever and thirst. Previous treatments missed the mark. I consulted: pulse was swift and restless, tongue black and scorched. He reported taking *Chaige Jiexin Tang* (Bupleurum and Kudzu Decoction to Relieve Muscle Layer) and *Yinqiao San* (Honeysuckle and Forsythia Powder) with no effect. Analyzing pulse and symptoms, Warmth disease is evident. Heat is blazing, fluids robbed, consciousness blurred, suggesting reverse transmission. Urgently using *Shigao* (Gypsum Fibrosum) and *Zhimu* (Anemarrhenae Rhizoma) to dispel heat; *Maidong* (Ophiopogonis Radix) and *Xianhu* (Dendrobii Caulis) to preserve fluids; *Lianqiao* (Forsythiae Fructus) and *Zhuye* (Phyllostachidis Folium) to clear Heart; *Gancao* (Glycyrrhizae Radix et Rhizoma) and *Jingmi* (Oryzae Semen) to regulate middle. After administration, slight sweat occurred, but body heat did not subside, consciousness slightly cleared, tongue slightly moist. However, hiccups appeared, pulse became strong at arrival and weak at departure. Warmth pathogen uncleaned, Stomach Qi exhausted. Adding *Dongyangshen* (Korean Ginseng) and *Daodouqiao* (Canavaliae Semen Testa) to the previous formula. Administration was smooth, slight sweat over body, heat lightened, hiccups thinned, pulse slowed. Continuing original method, one decoction resolved symptoms. Later, *Jinkui Maidong Tang* (Golden Cabinet Ophiopogon Decoction) was main treatment, regulating for a month until safe.
**Stomach Excess in Warmth Disease**
Shen Mou from Shanyin, fever for ten days, thirst preferring cold, pulse surging and large, tongue coating yellow, dry, and scorched. I said: "This is Warmth disease. Hidden qi emerges from within. Use cooling and penetrating method. Remove *Danchi* (Sojae Semen Preparatum), *Zhuye* (Phyllostachidis Folium), *Lvdouyi* (Sojae Semen Preparatum), add *Xingren* (Armeniacae Semen Amarum), *Louqiao* (Benincasae Exocarpium), *Huafen* (Trichosanthis Radix), and *Gancao* (Glycyrrhizae Radix et Rhizoma). After one dose, no effect, worsening to delirium and unconsciousness. Pulse became solid, large, and forceful. Warmth pathogen raging, dry feces in Stomach evident. Switch to moistening purgative to save fluids, adding *Xingshuang* (Armeniacae Semen Amarum powder) and *Zhiqiao* (Aurantii Fructus). Taken in morning, slight abdominal pain by dusk, flatus passed several times. Changed clothes after midnight, passing dozens of hard, dry, black stools, followed by loose stool like spoiled sauce, foul odor. Shortly after, fell into deep sleep, snoring as usual, skin heat gradually flattened. Woke at Chen hour next day, felt hungry, drank thin porridge. Pulse became small and soft, tongue coating transformed, fluids generated. I said: "Disease cured. Administer herbs to clear and nourish Stomach Yin. After several doses, spirit improved daily."
Cheng Xi said: "Both cases are Warmth disease, symptoms seem similar. One benefited from *Renshen* (Ginseng Radix), the other from *Chengqi* (Major Order the Qi Decoction). Thus, studying medicine requires analyzing pulse and symptoms. Hiccups with surging pulse indicate Stomach Qi deficiency; delirium with solid-large pulse indicates Stomach Qi excess. Constant symptoms are close, but variable symptoms distinguish deficiency and excess. In clinical practice, without judging deficiency vs. excess, how can one solve problems effortlessly?"
**Pregnancy with Macules**
Wife of Sun Mou from Jiande, five months pregnant, suddenly contracted Warmth-Toxin disease. I consulted, macules had erupted. Previous doctors used acrid-warm dispersants or tonic pregnancy protection. Unaware that Warmth-Toxin intensifies with acrid-warm herbs and flourishes with tonics, toxin spread, stagnating in muscles to form macules. Purple color indicates Stomach heat excess. Pulse rapid, body hot, tongue yellow and scorched. Should detoxify and clear macules, not solely focus on pregnancy protection. Used *Shigao* (Gypsum Fibrosum) and *Lugen* (Phragmitis Rhizoma) to vent Yangming heat; *Huangqin* (Scutellariae Radix) and *Xiandi* (Rehmanniae Radix Recens) to clear scalded fetus; assisted by *Lianqiao* (Forsythiae Fructus) and *Gancao* (Glycyrrhizae Radix et Rhizoma) to detoxify; *Heye* (Nelumbinis Folium) to lift. After one dose, body heat slightly cleared, macule color faded. Pulse still rapid, tongue fluids not returned. Adhered to old chapter, heavily added *Maidong* (Ophiopogonis Radix), slightly increased *Shanye* (Ginseng Leaf). After two doses, all ailments retreated. Later, clear-tonic method ensured safety for both mother and child.
**Warmth-Toxin with Rash**
Son of Hu Mou from Guyue, young man, suddenly suffered fever, thirst, and closed cough for half a month. Previous doctors ineffective, condition worsened. Sent for me. Reviewed three previous prescriptions: all contained *Shashen* (Glehniae Radix), *Maidong* (Ophiopogonis Radix), *Sangbai* (Mori Cortex), and *Digupi* (Lygodii Radix), clearing Metal and stopping cough. Examining onset: started with fever and cough, now chest oppression added. Pulse: both Cun positions vigorous. Clearly Warmth-Toxin entrenched above. Initial failure to ventilate Qi and penetrate pathogen caused Heart fire to blaze internally, punishing Lung Metal. Lung governs skin and hair, fearing Warmth-Toxin gathering externally to form rash. Ordered undressing to check: indeed, faint red rashes visible. Taking advantage of impending eruption, suitable for light-clearing penetrating agents. Used acrid-cool exterior release method, removing *Louqiao* (Benincasae Exocarpium), adding *Heye* (Nelumbinis Folium), *Lvdouyi* (Sojae Semen Preparatum), and *Xihe Liuye* (Salicis Matsudanae Folium). After administration, bright red papules appeared. Further doses faded and thinned, heat reduced, cough calmed. Subsequently, formula to clear and肃ify Lung Metal. Within ten days, complete recovery.
**Urgent Case of Throat Bi**
Wife of Chen Mou from east city, contracted Warmth-Toxin resulting in Throat Bi. Neck swollen, teeth clenched, unable to eat, only liquids swallowable. Pulse floating and middle not apparent, deep position extremely rapid. I said: "This is Warmth-Toxin. Overuse of cold-cool herbs suppresses Warmth-Toxin, preventing transformation. Reviewing previous prescription confirms this. My opinion: initially use warm-acrid to resolve cold-cool herb effects. Wait for teeth relaxation and swelling reduction, then finish with cool formula." All agreed. Used *Gujingcao* (Gymnosporiae Spore), *Ziwan* (Asternis Radix) to open Throat Bi; *Bohe* (Menthae Haplocalycis Herba) and *Jingjie* (Schizonepetae Spica) to disperse wind; *Juhong* (Citri Reticulatae Pericarpium) to move diaphragm and transform phlegm; *Gancao* (Glycyrrhizae Radix et Rhizoma) to drain fire and detoxify; *Jiegeng* (Platycodonis Radix) to carry properties upward, opening throat; *Xixin* (Asari Radix et Rhizoma) effective for Throat Bi, belonging to Foot-Shaoyin channel, which traverses throat. Fast preparation. Also used *Yu Yaoshi* (Jade Key): *Mayaxiao* (Natrii Nitratis Crystal), *Pengsha* (Borax), *Jiangcan* (Bombyx Batryticatus), *Bingpian* (Borneolum Syntheticum) ground fine and blown into throat to induce salivation.
From You hour medicine entered, until Er hour, jaw slightly opened, sudden continuous coughing. Next day consulted, informed of condition. I said: "Vitality exists. Pulse shape rising, tongue purely yellow, indicating Warmth-Toxin penetration. Changed to *Xuanshen* (Scrophulariae Radix), *Xidi* (Rehmanniae Radix Preparata), *Shaobei* (Fritillariae Thunbergii Bulbus), *Niubangzi* (Arctii Fructus), *Shanye* (Ginseng Leaf), *Shegan* (Belamcandae Rhizoma), *Dadongguo* (Actinidia Polystachya Fruit), *Jinguolan* (Tetrastigma Caulis). After three doses, neck swelling gone, throat smooth, cough improving."
Someone asked: "Observing your cases, you use methods rather than specific soups. Ancients treating macules/rash/throat used Wu's Ju Ban Tang, Qian's Sheng Ge Tang, Huoren Xuanshen Shengma Tang, Dongyuan Puji Xiaodu Yin, all containing *Shengma* (Cimicifugae Rhizoma). Thinking macules rely on penetration, throat relies on lifting, why do you abandon them? What is the meaning?" I answered: "Wu Jutong said: 'Diseases of soaring and flying excessively should not use lifting.' Those saying it guides meridians are foolish. Indeed, not false! I deeply appreciate this. Even for diseases requiring lifting/penetration, *Heye* (Nelumbinis Folium) and *Jiegeng* (Platycodonis Radix) are safer. *Shengma* lifts and disperses rapidly, suitable for other diseases, but difficult to use for macules/rash/throat."
**Late Eruption of Hidden Qi**
Zhao Mou from Ruoye, knew medical principles well. Suddenly felt headache and fever, occasionally aversion to wind. Believed himself to have caught wind-cold, used acrid-warm dispersants, heat intensified. Consulted me. Pulse surging, slippery, and rapid, tongue root yellow coating, occasional irritability, mouth not very thirsty. I said: "This is Late Eruption syndrome. Acrid dispersal inappropriate, should use clearing-resolving formula." Patient smiled, said: "Late eruption occurs in autumn, does this happen in spring?" Saw medical books on desk, including Ye Tianshi's *Yixiao Mishuan*. Read it, blushing with shame, requested prescription. Used acrid-cool exterior release method, adding *Lugen* (Phragmitis Rhizoma) and *Doujuan* (Sojae Semen Germinatum). After three decoctions, like snow cleaning dirt and pulling thorns, all ailments healed.