万氏牛黄清心丸（五分）。
渊按∶阳明痰热未清，遽进谷食，致有下文如是大变。宜仿仲景食服法，佐大黄以微下之。
又 症交十三日，身热不扬，神昏，舌短苔霉。邪入膻中，闭而不达。急急清泄芳开，希冀转机。
犀角 连翘 枳实 竺黄 芦根 菖蒲 黑膏 牛蒡 元参 薄荷根 郁金 鲜斛
紫雪丹五分，另调服。
又 神情呼唤稍清，语仍不出，邪欲达而不达。胸胁红点稍
现，迹稀不显，斑欲透而不透。口臭便秘，时觉矢气，阳明燥实
复聚。舌短心焦边绛，膻中之火方炽。芳开清泄之中，参以生津荡实。
前方加沙参、细生地、磨大黄。
又 口臭喷人，胃火极盛。斑疹虽见，透而未足。目赤神
糊，脉洪口渴。急急化斑为要。古法化斑，以白虎为主。今仍参以犀地清营解毒，再复存阴玉女煎。
犀角 黑膏 麦冬 竺黄 大生地 知母 沙参 洋参 菖蒲 人中黄 芦根 石膏（薄荷打）
渊按∶前方未知下否。若未通，可再下之，所谓急下以存阴
也。有犀地、白虎清营救液，见证有实无虚，不妨放胆。
又 目能识人，舌能退场门，症渐有生机。当大剂存阴，冀其津回乃吉。
大生地 鲜石斛 麦冬 洋参 元参 生甘草 鲜生地 石膏 犀角 沙参 蔗汁
又 黑苔剥落，舌质深红，阴津大伤，燥火未退，左脉细
小，右脉洪大，是其征也。际此阴伤火旺，少阴不足，阳明有
余，惟景岳玉女煎最合。一面存阴，一面泻火，守过三候，其阴当复。
鲜生地 生石膏 元参 洋参 大生地 黑山栀 生甘草 知母 沙参 连翘 芦根
渊按∶右脉洪大，阳明热结夹滞显然。
又 频转屎气，咽喉干燥，燥则语不出声。此阳明火势熏蒸，津不上承。重救其阴，兼通其腑，再商。
大生地 鲜生地 麦冬 生军 海参 北沙参 生甘草 元参 元明粉
渊按∶从前欠下，尚是实热见象，海参嫌腻膈。
又 下后液未回，急当养阴醒胃。
生洋参 茯苓 橘红 麦冬 蔗皮 大生地 石斛 沙参
元参 谷芽
又 耳聋无闻，舌干难掉，阴津大伤。用复脉法。
大生地 麦冬 元参 洋参 阿胶（川连三分，拌炒） 生甘草 鸡子黄
又 迭进滋阴大剂，生津则有余，泻火则不足。今交三候，
齿垢退而复起，神识已清，非阴之不复，乃燥火未清耳。今当法取轻灵。
洋参 枳壳 川贝 橘红 赤苓 枣仁（猪胆汁炒） 川连
雪羹汤煎。
又 诸恙向安。每啜稀粥，必汗沾濡，非虚也，乃津液复而
营气敷布周流也。小溲涩痛，余火未清。惟宜清化。
冬瓜子 鲜石斛 通草 黑栀 生谷芽 甜杏仁 甘草梢
又 病退。日间安静，至夜发热神昏，乃余热留于营分也。
小溲热痛，心火下趋小肠。仿病后遗热例，用百合知母滑石汤合导赤散。
木通 草梢 竹叶 知母 鲜生地 滑石 百合
泉水煎服。
范 阴虚挟湿之体，感受时令风温，初起背微恶寒，头略胀
痛，欲咳不爽，发热不扬，舌白腻，大便溏。峻投消散，暗劫胃
津，以至饥不欲食，嗜卧神糊，呃忒断连，斑疹隐约。症方
八日，势涉危机。阅周先生方，洵尽美善，僭加甘草一味以和
之，具生津补中之力，未始非赞襄之一助也。若云甘能滋湿，甘
能满中，孰不知之！须知苔薄光滑，胸不满而知饥，乃无形湿
热，已有中虚之象，此叶氏所以深戒苦辛消克之剂，幸知者察焉！
牛蒡子 前胡 橘红 竺黄 郁金 刀豆子 桔梗 神曲
菖蒲 连翘 薄荷叶 竹茹 甘草 枇杷叶
渊按∶此痰呃也。中虚挟痰，胃气通降不顺所致。
又 症逾旬日，系温邪挟湿，病在气营之交。苔白腻而边
红，疹点透而不爽，寐则谵语，寤则神清，呃声徐而未除，脉象
软而小数。周先生清营泄卫、理气化浊，恰如其分。
羚羊角 连翘 竺黄 川连 橘红 牛蒡子 半夏 丁香
柿蒂 竹茹 薄荷根 通草 茅根
渊按∶寐昏寤明，痰火阻塞上中焦显然。方较上首好。
又 热处湿中，神蒙嗜卧，呼之则清，语言了了。舌白腻，
脉软数，知非邪陷膻中，乃湿热深漫于上焦，肺气失宣布耳。呃
尚未除，胃浊未化。拟从肺胃立法。
射干 杏仁 郁金 橘红 代赭石 川贝 沙参 桔梗 通草 旋复花 茅根 冬瓜子
渊按∶开肺降胃，更为得旨，所以呃除神清。
又 呃除，苔稍化，欲咳不扬。仍从前法加减。
前方去代赭石，加蛤壳、赤苓。
又 去旋复花、射干、桔梗，加豆卷。
又 便泄数次，粘腻垢污。胃浊以下行为顺，故连日沉迷嗜
卧，昨宵便惺惺少寐，且屡起更衣，愈觉神烦倦乏耳。今便泄未
止，舌苔仍白，身热已和，酒客中虚湿胜。拟和中化浊，仿子和甘露饮。
生洋参 于术 赤苓 泽泻 滑石 鸡距子 广藿 木香 葛花 橘红 通草 竹茹
渊按∶痰从便去，热亦随之，中焦之浊清，上焦之热亦降，
故诸恙若失，转惺惺少寐耳。然苔未化，余湿未清，脾胃转运未复也。不可早补。
又 病已退，湿未楚。前方加减。
前方加参须、于术、神曲、谷芽。
孙 温邪袭肺，肺失清肃，湿挟热而生痰，火载气而逆上。
喘息痰嘶，舌干口腻。昨日之脉据云弦硬，现诊脉象小而涩数，
阴津暗伤，元气渐馁，颇有喘汗厥脱之虑。夫温邪为病，隶乎手
经，肺胃位高，治宜清肃。痰随气涌，化痰以降气为先；气因火
逆，降气以清肃为要。姑拟一方，备候高明酌夺。
鲜石斛 射干 杏仁 象贝 沙参 苏子 桑皮 沉香 芦根 竹油（冲服） 冬瓜子 枇杷叶 姜汁
渊按∶议论明晰，最宜学步。方中沉香易黄芩则善矣。盖热
化肺清，不患不降。凡诸清肺药皆能降气，沉香属木，降肝不降肺耳。
黄 舌干而绛，齿燥唇焦，痰气喘粗，脉象细数。无形邪热
薰蒸于膻中，有形痰浊阻塞于肺胃，而又津枯液燥，正气内亏，
恐有厥脱之变。拟化痰涤热治其标，扶正生津救其本。必得痰喘平，神气清，庶几可图。
羚羊角 旋复花 葶苈 杏仁 川贝 鲜石斛 元参 茅根
竹油 沉香 代赭石 苏子 姜汁 枇杷叶 滚痰丸（三钱，人参汤送下）
又 头汗淋沥，痰喘不止，脉形洪大，面色青晦，舌红干
涸，齿板唇焦。此少阴阴津不足，阳明邪火有余，火载气而上
逆，肺失降而为喘，症势危险，深虑厥脱。勉拟救少阴之津，清
阳明之火，益气以敛其汗，但肺以定其喘，转辗图维，冀其应手乃妙。
大生地（海浮石拌捣） 洋参 牛膝 五味子 石膏 桑皮 川贝
炙甘草 麦冬 人参（一钱，另煎，冲）
陈粳米煎汤代水。
渊按∶脉形洪大，合之头汗面青，上实下虚大着。从补下纳
气之中，想出清热救津之法，故能应手。人参、石膏、粳米，救肺清热，亦所以救肾也。
又 汗稍收，喘稍平，脉大稍软。但气仍急促，心中烦躁，
舌红干涸，齿垢唇焦。津液犹未回，虚阳犹未息，上逆之气犹未
降，虽逾险岭，未涉坦途。今少腹似有透 之象，是亦邪之出路。仍拟救少阴，清阳明，再望转机。
大生地（蛤粉炒） 洋参 沙参 元参 麦冬 鲜生地 牛膝 通草 豆卷 五味子 竹叶 枇杷叶
陈粳米煎汤代水。
渊按∶前方应手，此即头头是道。通草、豆卷，淡渗泄表。
恐其耗津。不必虑邪之不去，津气回而邪自不容矣。
又 阴津稍回，气火未平。仍宜步步小心，勿致变端为幸。
大生地 洋参 沙参 元参 泽泻 麦冬 天竺黄 鲜石斛 石决明 茯神 芦根
张 温邪两候不解，脉形洪大中空；神昏蒙而如醉，舌淡红
而无苔。与汤亦不却，不与亦不讨；呓语如呢喃，叮咛重复道。
昨日用芳开，神情略觉好。然凭症而论之，乃津枯而液燥。是必
甘寒润燥生津液，俾得气化津回方保吉。聊立方法以备参，候高明以商夺。
大生地 鲜石斛 沙参 茯苓 麦冬 羚羊角 鲜生地 竺黄 甘蔗汁 芦根尖
渊按∶案语清华，方法简洁，非学识兼到者不能。
许 温邪内蕴，痰浊上泛。壮热无汗，神识模糊，气逆痰多，舌腻尖红，大便不通。势防厥脱。
羚羊角 葶苈 杏仁 川贝 竺黄 黑山栀 蒌仁 枳实 豆豉 菖蒲
滚痰丸三钱。此方效。
渊按∶实热夹痰，滚痰丸甚合，煎方亦好。
吴 温邪五日，舌苔干黄，壮热无汗，胸腹板满硬痛，手不
可近。此属结胸。烦躁气喘，口吐涎沫。防其喘厥。
黑山栀 豆豉 蒌仁 川连 杏仁 生大黄 葶苈 柴胡 枳实 淡芩 元明粉 皂荚子
凡结胸症，烦躁气促者死。此方是大柴胡汤、大小陷胸、栀豉合剂。
渊按∶烦躁无汗而有气喘者，柴胡不可用。用柴胡仍蹈前人治
伤寒之故辙也。幸有硝、黄、连、杏主持其间，否则坏矣。
又 下后结胸之硬满已消，而烦躁昏狂略无定刻，舌苔干
燥，渴欲凉饮，壮热无汗。邪气犹在气分。以苦辛寒清里达表，冀
其战汗无变为妙。幸其壮热无汗，可冀战汗。若汗出而仍壮热，
则内陷矣。此方三黄石膏汤、鸡苏散与栀豉合剂。
又 战而得汗，脉静身凉，邪已解矣。舌黄未去，胃中余浊未清，尚宜和化。
川贝 赤苓 豆豉（炒） 连翘 黑山栀 通草 滑石 枳壳（炒） 竹茹
凡战汗后脉静身凉，用方大法，不外乎此。
严 病后元气未复，温邪乘虚窃发。初起即便壮热神糊，舌
干，肩膊胁肋疼痛。今方二日，邪未宣达，已见津涸之象，其为
重候可知。当此论治，是宜达邪以解其表。然叶氏云∶初起舌即
干，神略糊者，宜急养正，微加透邪之药。若昏愦而后救里，有措手不及之虞矣。
北沙参（一两） 牛蒡（三钱） 杏仁（三钱） 焦曲（三钱） 黑山栀（钱半） 豆
豉（三钱） 连翘（三钱） 竺黄（一钱） 枳壳（一钱） 茅根（一两） 鲜薄荷根（五钱）
渊按∶深得叶氏心传。
孙 营阴素亏之体，感受温邪，病起肢麻寒热，旋即便泄神
糊。今交七日，脉数而洪，舌燥齿干，必荡气促。阳明之火方
炽，少阴之阴已涸。又腹硬痛，大便三日不通。积聚于中不下，
气火尽浮于上。似宜通降为先。然阴津大涸，不得不先养其津。姑拟一方备商。
鲜生地（一两四钱） 北沙参（二两） 磨苏梗（五分，冲） 杏仁（三钱） 天
竺黄（钱半） 茯神（三钱） 麦冬（五钱） 川贝（三钱） 悉尼汁（一杯，冲） 枇杷叶（三片）
渊按∶先养正救津，斯为老眼无花。
又 津回舌润，汗出甚多，热势亦退。惟心烦不寐，大便不通。仍以前方加减。
前方去苏梗，加细生地一两，天冬三钱，麻仁三钱。
蔡 温邪发斑透疹，总在肺胃两经。邪热郁蒸，从里达外。
血分热炽则发斑，气分热炽则发疹。邪从外入，由气传营。热自
内出，由营达气。此症胸前先发斑点，身未觉热。数日之后，始
发寒热，续布痧疹。似乎营分先有伏热，而后温邪凑集，肺胃受
病，始见咳嗽寒热等症。然斑已将化，疹已透齐，即有余邪，清
之解之可已；乃反胸痞烦闷，气升恶心，喉痛难咽，其故何欤？
良以怀孕八月，适当太阴、阳明养胎之候，邪热甚于肺胃，胎气
失荫而上逆，繇是胸高气逆，烦躁不得卧，岂非病虽由热，而实
乃胎气上冲所致也。为今之计，清解肺胃温邪，以化斑疹热毒，
是为正治。然燎原之下，液灼津伤，亦必养其津液。胎气上升，
为变最速，尤要先平胎气。肺主一身之主，又必降其肺气。肺气降而得卧，胎安不上冲，庶无喘厥之虞矣。
鲜生地（一两） 淡豆豉（三钱，同鲜地研） 川贝母（三钱） 磨苏梗（五分，冲）
磨犀角（五分，冲） 磨郁金（五分，冲） 纹银（一两，先煎） 元参（二钱） 白薇
（三钱） 竹茹（一钱） 野苎根（五钱） 枇杷叶（三片，去毛）
又 温邪上受，自气传营；而化火上炎，由胃及肺。喉属肺
经，咽属胃经。凡咽喉之症，属实火者多，因肺胃之阳盛。肾脉
循喉，肝脉绕咽，系虚火者，始关肝肾之阴亏。是其大略也。此
症乃斑痧之后，喉痛色赤，全由邪火炽张。图治之方，犀角地
黄，不出甘寒清解。昨吐红痰，无非气火熏蒸。今观脉色，已觉
神清爽朗。喜逢知己，共斟酌而揣摩，幸谢主人，转忧疑为欣
慰。立夏恰今朝，病能减而即是退；怀麟当此疾，胎不动即是
安。大便才通，亦是转机之兆。小心调理，冀无欲速之讥。略泐数行，伏希晒政。
犀角 羚羊角 川贝 鲜石斛 元参 知母 鲜生地 麦冬 枇杷叶
金银花露、绿豆皮煎汤，与燕窝汤相和频饮。
又 夫温邪燔亢之余，余热固未能净；肺胃燎原之下，阴津
必受其戕。养阴不在血而在津与汗，叶氏之名言；安胎须顺气，
阴火忌上冲，妇科之要论。此症儿及两候，温痧既退，安得邪火
复炽？喉肿既消，何以燥痛复盛？所以然者，胎当七八月之间，
王渊按：阳明经的痰热尚未清除，就急于进食谷物食物，导致出现下文所述的大变证。应当效仿张仲景的“食服法”，配合大黄以轻微通下。
又诊：病程进入第十三日，身体发热但不明显张扬，神志昏迷，舌体短缩、舌苔霉腐。邪气侵入膻中穴所在区域，闭塞而不能通达。必须紧急使用清热泄火、芳香开窍的方法，希望能借此转机。
犀角 连翘 枳实 天竺黄 芦根 石菖蒲 黑膏 牛蒡子 玄参 薄荷根 郁金 鲜石斛
紫雪丹五分，单独调服。
又诊：神情呼唤时稍微清醒，但言语仍不能发出，邪气想要外达却未能透出。胸胁部红点稍现，痕迹稀疏不明显，斑疹欲透发而未透发。口臭便秘，时常感觉排气，阳明燥实之邪再次聚集。舌体短缩、心火焦灼、舌边绛红，膻中之火正炽盛。在芳香开窍、清热泄火的方药中，参入生津润燥、荡涤实邪的药物。
前方加入沙参、细生地、磨碎的大黄。
又诊：口臭喷人，胃火极盛。斑疹虽然出现，但透发不足。眼睛发红、神志模糊，脉象洪大、口渴。必须紧急采用化斑的方法。古法治疗化斑，以白虎汤为主。现在仍然参用犀角地黄汤清营解毒，再复用存阴的玉女煎。
犀角 黑膏 麦冬 天竺黄 大生地 知母 沙参 西洋参 石菖蒲 人中黄 芦根 石膏（用薄荷打汁）
王渊按：前面的方剂不知是否已经通便。如果未通，可以再使用下法，这就是所谓的“急下以存阴”。有犀角地黄汤、白虎汤清热救液，见证表现为实证而无虚象，不妨大胆用药。
又诊：眼睛能识别他人，舌头能伸出齿列之外，病情逐渐有了生机。应当使用大剂量药物保存阴津，希望津液回复才算吉利。
大生地 鲜石斛 麦冬 西洋参 玄参 生甘草 鲜生地 石膏 犀角 沙参 蔗汁
又诊：黑苔剥落，舌质深红，阴津大伤，燥火未退，左脉细小，右脉洪大，这是其征象。此时阴伤火旺，少阴不足，阳明有余，只有张景岳的玉女煎最符合病机。一方面保存阴津，一方面泻火，坚持过三个候（约五天），阴津应当恢复。
鲜生地 生石膏 玄参 西洋参 大生地 黑山栀 生甘草 知母 沙参 连翘 芦根
又诊：频繁转放屁，咽喉干燥，因干燥而说不出话。这是阳明火势熏蒸，津液不能上承。重在拯救阴津，兼通腑气，再作商议。
大生地 鲜生地 麦冬 生军（大黄） 海参 北沙参 生甘草 玄参 元明粉
又诊：攻下后津液未回，急需养阴醒胃。
生洋参 茯苓 橘红 麦冬 蔗皮 大生地 石斛 沙参
玄参 谷芽
大生地 麦冬 玄参 西洋参 阿胶（用黄连三分拌炒） 生甘草 鸡子黄
又诊：连续进服滋阴大剂，生津则有余，泻火则不足。如今过了三候，齿垢退了又起，神识已清，并非阴津不复，而是燥火未清罢了。现在应当效法轻灵之法。
西洋参 枳壳 川贝 橘红 赤苓 枣仁（猪胆汁炒） 川连
用雪羹汤煎服。
又诊：各种病症趋向安宁。每次喝稀粥，必定汗出沾湿衣服，这不是虚证，而是津液回复、营气敷布周流的表现。小便涩痛，余火未清。只宜清热化浊。
又诊：病势减退。白天安静，到了夜间发热神昏，这是余热留在于营分。小便热痛，心火下趋小肠。仿照病后遗热的例子，使用百合知母滑石汤合导赤散。
范姓患者：阴虚挟湿体质，感受时令风温，初起背部微恶寒，头部略胀痛，想咳嗽却咳不爽，发热不张扬，舌苔白腻，大便溏薄。峻烈地投用消散药物，暗中劫耗胃津，以至于饥饿却不欲食，嗜睡神志模糊，呃逆接连不断，斑疹隐约可见。病症刚满八日，形势涉及危机。查阅周先生的处方，确实尽善尽美，我僭越地加一味甘草来调和它，具有生津补中的力量，未尝不是襄助之一。如果说甘味能滋湿、甘味能满中，谁不知道呢！须知苔薄光滑，胸部不胀满且知道饥饿，这是无形湿热，已有中焦虚弱的迹象，这就是叶天士所以深深告诫避免使用苦辛消克药剂的原因，希望知情者明察！
牛蒡子 前胡 橘红 天竺黄 郁金 刀豆子 桔梗 神曲
石菖蒲 连翘 薄荷叶 竹茹 甘草 枇杷叶
王渊按：这是痰阻导致的呃逆。中焦虚弱挟痰，胃气通降不顺所致。
又诊：病症超过十天，属于温邪挟湿，病位在气分和营分的交界处。舌苔白腻而边缘红，疹点透发而不爽利，睡觉时说胡话，醒来时神志清醒，呃声缓慢但未消除，脉象软而小数。周先生清营泄卫、理气化浊，恰如其分。
羚羊角 连翘 天竺黄 川连 橘红 牛蒡子 半夏 丁香
柿蒂 竹茹 薄荷根 通草 茅根
王渊按：睡时昏沉醒时明白，痰火阻塞上中焦非常明显。方子比上一首好。
又诊：热处湿中，神志蒙蔽嗜睡，呼叫则清醒，语言清楚。舌苔白腻，脉软数，知道不是邪气陷入膻中，而是湿热深漫于上焦，肺气失去宣发肃降功能。呃逆尚未消除，胃浊未化。打算从肺胃立法。
射干 杏仁 郁金 橘红 代赭石 川贝 沙参 桔梗 通草 旋复花 茅根 冬瓜子
王渊按：开宣肺气、降逆和胃，更为得要领，所以呃逆除、神志清。
又诊：呃逆停止，苔稍化，想咳嗽却咳出不畅。仍从前的方法加减。
又诊：腹泻数次，粘腻垢污。胃浊以下行为顺，所以连日来沉迷嗜睡，昨宵大便后稍微清醒少寐，且屡次起身更衣，更加觉得神烦倦乏。如今便泄未止，舌苔仍白，身热已缓和，酒客中虚湿胜。拟和中化浊，仿子和甘露饮。
生洋参 于术 赤苓 泽泻 滑石 鸡距子 广藿 木香 葛花 橘红 通草 竹茹
王渊按：痰从便去，热亦随之，中焦之浊清，上焦之热亦降，所以诸恙若失，转惺惺少寐耳。然苔未化，余湿未清，脾胃转运未复也。不可早补。
又诊：病已退，湿未楚。前方加减。
孙姓患者：温邪袭肺，肺失清肃，湿挟热而生痰，火载气而逆上。
喘息痰嘶，舌干口腻。昨日之脉据云弦硬，现诊脉象小而涩数，阴津暗伤，元气渐馁，颇有喘汗厥脱之虑。夫温邪为病，隶乎手经，肺胃位高，治宜清肃。痰随气涌，化痰以降气为先；气因火逆，降气以清肃为要。姑拟一方，备候高明酌夺。
鲜石斛 射干 杏仁 象贝 沙参 苏子 桑皮 沉香 芦根 竹油（冲服） 冬瓜子 枇杷叶 姜汁
王渊按：议论明晰，最宜学步。方中沉香易黄芩则善矣。盖热化肺清，不患不降。凡诸清肺药皆能降气，沉香属木，降肝不降肺耳。
黄姓患者：舌干而绛，齿燥唇焦，痰气喘粗，脉象细数。无形邪热薰蒸于膻中，有形痰浊阻塞于肺胃，而又津枯液燥，正气内亏，恐有厥脱之变。拟化痰涤热治其标，扶正生津救其本。必得痰喘平，神气清，庶几可图。
羚羊角 旋复花 葶苈 杏仁 川贝 鲜石斛 元参 茅根
竹油 沉香 代赭石 苏子 姜汁 滚痰丸（三钱，人参汤送下）
又诊：头汗淋沥，痰喘不止，脉形洪大，面色青晦，舌红干涸，齿板唇焦。此少阴阴津不足，阳明邪火有余，火载气而上逆，肺失降而为喘，症势危险，深虑厥脱。勉拟救少阴之津，清阳明之火，益气以敛其汗，但肺以定其喘，转辗图维，冀其应手乃妙。
大生地（海浮石拌捣） 洋参 牛膝 五味子 石膏 桑皮 川贝
炙甘草 麦冬 人参（一钱，另煎，冲）
陈粳米煎汤代水。
王渊按：脉形洪大，合之头汗面青，上实下虚大着。从补下纳气之中，想出清热救津之法，故能应手。人参、石膏、粳米，救肺清热，亦所以救肾也。
又诊：汗稍收，喘稍平，脉大稍软。但气仍急促，心中烦躁，舌红干涸，齿垢唇焦。津液犹未回，虚阳犹未息，上逆之气犹未降，虽逾险岭，未涉坦途。今少腹似有透 之象，是亦邪之出路。仍拟救少阴，清阳明，再望转机。
大生地（蛤粉炒） 洋参 沙参 元参 麦冬 鲜生地 牛膝 通草 豆卷 五味子 竹叶 枇杷叶
陈粳米煎汤代水。
王渊按：前方应手，此即头头是道。通草、豆卷，淡渗泄表。恐其耗津。不必虑邪之不去，津气回而邪自不容矣。
又诊：阴津稍回，气火未平。仍宜步步小心，勿致变端为幸。
大生地 洋参 沙参 元参 泽泻 麦冬 天竺黄 鲜石斛 石决明 茯神 芦根
张姓患者：温邪两候不解，脉形洪大中空；神昏蒙而如醉，舌淡红而无苔。与汤亦不却，不与亦不讨；呓语如呢喃，叮咛重复道。
昨日用芳开，神情略觉好。然凭症而论之，乃津枯而液燥。是必甘寒润燥生津液，俾得气化津回方保吉。聊立方法以备参，候高明以商夺。
大生地 鲜石斛 沙参 茯苓 麦冬 羚羊角 鲜生地 竺黄 甘蔗汁 芦根尖
王渊按：案语清华，方法简洁，非学识兼到者不能。
许姓患者：温邪内蕴，痰浊上泛。壮热无汗，神识模糊，气逆痰多，舌腻尖红，大便不通。势防厥脱。
羚羊角 葶苈 杏仁 川贝 竺黄 黑山栀 蒌仁 枳实 豆豉 菖蒲
滚痰丸三钱。此方效。
王渊按：实热夹痰，滚痰丸甚合，煎方亦好。
吴姓患者：温邪五日，舌苔干黄，壮热无汗，胸腹板满硬痛，手不可近。此属结胸。烦躁气喘，口吐涎沫。防其喘厥。
黑山栀 豆豉 蒌仁 川连 杏仁 生大黄 葶苈 柴胡 枳实 淡芩 元明粉 皂荚子
凡结胸症，烦躁气促者死。此方是大柴胡汤、大小陷胸、栀豉合剂。
王渊按：烦躁无汗而有气喘者，柴胡不可用。用柴胡仍蹈前人治伤寒之故辙也。幸有硝、黄、连、杏主持其间，否则坏矣。
又诊：下后结胸之硬满已消，而烦躁昏狂略无定刻，舌苔干燥，渴欲凉饮，壮热无汗。邪气犹在气分。以苦辛寒清里达表，冀其战汗无变为妙。幸其壮热无汗，可冀战汗。若汗出而仍壮热，则内陷矣。此方三黄石膏汤、鸡苏散与栀豉合剂。
又诊：战而得汗，脉静身凉，邪已解矣。舌黄未去，胃中余浊未清，尚宜和化。
川贝 赤苓 豆豉（炒） 连翘 黑山栀 通草 滑石 枳壳（炒） 竹茹
凡战汗后脉静身凉，用方大法，不外乎此。
严姓患者：病后元气未复，温邪乘虚窃发。初起即便壮热神糊，舌干，肩膊胁肋疼痛。今方二日，邪未宣达，已见津涸之象，其为重候可知。当此论治，是宜达邪以解其表。然叶氏云∶初起舌即干，神略糊者，宜急养正，微加透邪之药。若昏愦而后救里，有措手不及之虞矣。
北沙参（一两） 牛蒡（三钱） 杏仁（三钱） 焦曲（三钱） 黑山栀（钱半） 豆豉（三钱） 连翘（三钱） 竺黄（一钱） 枳壳（一钱） 茅根（一两） 鲜薄荷根（五钱）
王渊按：深得叶氏心传。
孙姓患者：营阴素亏之体，感受温邪，病起肢麻寒热，旋即便泄神糊。今交七日，脉数而洪，舌燥齿干，必荡气促。阳明之火方炽，少阴之阴已涸。又腹硬痛，大便三日不通。积聚于中不下，气火尽浮于上。似宜通降为先。然阴津大涸，不得不先养其津。姑拟一方备商。
鲜生地（一两四钱） 北沙参（二两） 磨苏梗（五分，冲） 杏仁（三钱） 天竺黄（钱半） 茯神（三钱） 麦冬（五钱） 川贝（三钱） 悉尼汁（一杯，冲） 枇杷叶（三片）
王渊按：先养正救津，斯为老眼无花。
又诊：津回舌润，汗出甚多，热势亦退。惟心烦不寐，大便不通。仍以前方加减。
蔡姓患者：温邪发斑透疹，总在肺胃两经。邪热郁蒸，从里达外。血分热炽则发斑，气分热炽则发疹。邪从外入，由气传营。热自内出，由营达气。此症胸前先发斑点，身未觉热。数日之后，始发寒热，续布痧疹。似乎营分先有伏热，而后温邪凑集，肺胃受病，始见咳嗽寒热等症。然斑已将化，疹已透齐，即有余邪，清之解之可已；乃反胸痞烦闷，气升恶心，喉痛难咽，其故何欤？良以怀孕八月，适当太阴、阳明养胎之候，邪热甚于肺胃，胎气失荫而上逆，繇是胸高气逆，烦躁不得卧，岂非病虽由热，而实乃胎气上冲所致也。为今之计，清解肺胃温邪，以化斑疹热毒，是为正治。然燎原之下，液灼津伤，亦必养其津液。胎气上升，为变最速，尤要先平胎气。肺主一身之主，又必降其肺气。肺气降而得卧，胎安不上冲，庶无喘厥之虞矣。
鲜生地（一两） 淡豆豉（三钱，同鲜地研） 川贝母（三钱） 磨苏梗（五分，冲）
磨犀角（五分，冲） 磨郁金（五分，冲） 纹银（一两，先煎） 元参（二钱） 白薇（三钱） 竹茹（一钱） 野苎根（五钱） 枇杷叶（三片，去毛）
又诊：温邪上受，自气传营；而化火上炎，由胃及肺。喉属肺经，咽属胃经。凡咽喉之症，属实火者多，因肺胃之阳盛。肾脉循喉，肝脉绕咽，系虚火者，始关肝肾之阴亏。是其大略也。此症乃斑痧之后，喉痛色赤，全由邪火炽张。图治之方，犀角地黄，不出甘寒清解。昨吐红痰，无非气火熏蒸。今观脉色，已觉神清爽朗。喜逢知己，共斟酌而揣摩，幸谢主人，转忧疑为欣慰。立夏恰今朝，病能减而即是退；怀麟当此疾，胎不动即是安。大便才通，亦是转机之兆。小心调理，冀无欲速之讥。略泐数行，伏希晒政。
犀角 羚羊角 川贝 鲜石斛 元参 知母 鲜生地 麦冬 枇杷叶
金银花露、绿豆皮煎汤，与燕窝汤相和频饮。
又诊：夫温邪燔亢之余，余热固未能净；肺胃燎原之下，阴津必受其戕。养阴不在血而在津与汗，叶氏之名言；安胎须顺气，阴火忌上冲，妇科之要论。此症儿及两候，温痧既退，安得邪火复炽？喉肿既消，何以燥痛复盛？所以然者，胎当七八月之间，
Wanshi Niuhuang Qingxin Wan (5 fen).
Wang Yuan's comment: Phlegm-heat in the Yangming channel has not yet cleared, and food was consumed hastily, leading to the severe changes described below. One should imitate Zhang Zhongjing's "food administration method," assisting with Rhubarb (Da Huang) to induce mild purgation.
Second visit: The disease has entered the thirteenth day. Body heat is present but not manifesting strongly; there is mental confusion, a short tongue, and moldy coating. Pathogenic factors have entered the area of the Pericardium (Shanzhong), causing blockage without unblocking. Urgently apply clearing, draining, and aromatic opening methods to hope for a turning point.
Rhinoceros Horn (Xijiao), Forsythia (Lianqiao), Immature Bitter Orange (Zhishi), Calamansi Seed (Tianzhuhuang), Reed Rhizome (Lugen), Acorus (Shichangpu), Black Paste (Heigao), Burdock Fruit (Niubangzi), Scrophularia (Yuanshen), Mint Root (Bohetegen), Curcuma (Yujin), Fresh Dendrobium (Xianhu).
Zixue Dan (5 fen), taken separately mixed with water.
Second visit: Mental state responds slightly to calls, but speech remains absent; pathogenic factors desire to reach the exterior but fail. Red spots on the chest and hypochondrium appear slightly, sparse and indistinct; macules desire to emerge but do not fully emerge. Bad breath, constipation, frequent passage of flatus; Yangming dryness and excess re-aggregate. Tongue is short, heart fire is scorching, tongue edges are crimson; fire at the Pericardium is blazing. Amidst aromatic opening and clearing/draining methods, incorporate drugs that generate fluids and purge excess.
Add Glehnia (Shashen), Fine Rehmannia (Xi Shengdi), and ground Rhubarb (Dahuang) to the previous formula.
Third visit: Foul breath is pungent; stomach fire is extremely strong. Macules and rashes have appeared but are insufficiently erupted. Eyes are red, spirit is blurred, pulse is surging, mouth is thirsty. Urgently employing macule resolution is essential. Ancient methods for resolving macules prioritize Baihu Tang. Now, still incorporate Xijiao Dihuang Tang to clear the nutritive level and detoxify, then resume Yunnv Jian to preserve yin.
Rhinoceros Horn (Xijiao), Black Paste (Heigao), Ophiopogon (Maidong), Calamansi Seed (Tianzhuhuang), Large Rehmannia (Da Shengdi), Anemarrhena (Zhimu), Glehnia (Shashen), American Ginseng (Yangshen), Acorus (Shichangpu), Human Waste Charcoal (Renzhonghuang), Reed Rhizome (Lugen), Gypsum (Gao Shi - pounded with mint).
Wang Yuan's comment: It is unknown if the previous formula resulted in bowel movement. If not unblocked, it can be purged again; this is what is meant by "urgent purgation to preserve yin." With Xijiao Dihuang Tang and Baihu Tang to clear heat and save fluids, and the presentation showing excess without deficiency, one may boldly administer treatment.
Fourth visit: Eyes can recognize people, tongue can extend beyond teeth; the condition shows signs of vitality. Large doses to preserve yin should be used, hoping for fluid recovery as auspicious.
Large Rehmannia (Da Shengdi), Fresh Dendrobium (Xian Shihu), Ophiopogon (Maidong), American Ginseng (Yangshen), Scrophularia (Yuanshen), Raw Licorice (Sheng Gancao), Fresh Rehmannia (Xian Shengdi), Gypsum (Shigao), Rhinoceros Horn (Xijiao), Glehnia (Shashen), Sugarcane Juice (Zheshi).
Fifth visit: Black coating is peeling, tongue substance is deep red; yin fluids are severely damaged, dryness-fire remains. Left pulse is fine and small, right pulse is surging and large; this is the sign. At this juncture of yin damage and fire prosperity, Shaoyin insufficiency and Yangming excess exist. Only Jingyue's Yunnv Jian fits best. On one hand preserve yin, on the other drain fire. Maintain this for three periods (approx. 5 days), and yin should recover.
Fresh Rehmannia (Xian Shengdi), Raw Gypsum (Sheng Shigao), Scrophularia (Yuanshen), American Ginseng (Yangshen), Large Rehmannia (Da Shengdi), Black Gardenia (Hei Shanzhi), Raw Licorice (Sheng Gancao), Anemarrhena (Zhimu), Glehnia (Shashen), Forsythia (Lianqiao), Reed Rhizome (Lugen).
Wang Yuan's comment: Right pulse surging and large indicates Yangming heat accumulation with stagnation is obvious.
Sixth visit: Frequent passage of flatus, throat dryness; due to dryness, voice cannot be produced. This is Yangming fire steaming, fluids failing to ascend. Focus heavily on saving yin, simultaneously unblocking the fu organs, and discuss further.
Large Rehmannia (Da Shengdi), Fresh Rehmannia (Xian Shengdi), Ophiopogon (Maidong), Raw Rhubarb (Sheng Jun), Sea Cucumber (Haishen), Northern Glehnia (Beishashen), Raw Licorice (Sheng Gancao), Scrophularia (Yuanshen), Mirabilite (Yuanmingfen).
Wang Yuan's comment: Previously lacking purgation, this still presents as excess-heat. Sea cucumber is too cloying and obstructs the diaphragm.
Seventh visit: After purgation, fluids have not returned; urgently nourish yin and awaken the stomach.
Raw American Ginseng (Sheng Yangshen), Poria (Fuling), Tangerine Peel (Juhong), Ophiopogon (Maidong), Sugarcane Peel (Zhepi), Large Rehmannia (Da Shengdi), Dendrobium (Shihu), Glehnia (Shashen).
Scrophularia (Yuanshen), Rice Sprout (Guya).
Eighth visit: Deafness, inability to hear; tongue is dry and difficult to move; yin fluids are severely damaged. Use Fumai method.
Large Rehmannia (Da Shengdi), Ophiopogon (Maidong), Scrophularia (Yuanshen), American Ginseng (Yangshen), Donkey-hide Gelatin (Ejiao - stir-fried with 3 fen Coptis/Chuanlian), Raw Licorice (Sheng Gancao), Egg Yolk (Jizihuang).
Ninth visit: Repeatedly administering large yin-nourishing doses, generating fluids is sufficient, but draining fire is insufficient. Now past three periods, dental plaque receded then reappeared, consciousness is clear; this is not failure of yin recovery, but residual dryness-fire. Now adopt a light and agile approach.
American Ginseng (Yangshen), Immature Bitter Orange (Zhike), Fritillaria (Chuanbei), Tangerine Peel (Juhong), Red Poria (Chiling), Ziziphus Seed (Zaoren - stir-fried with pig bile), Coptis (Chuanlian).
Decoct with Xuegang Soup.
Tenth visit: Various ailments tend toward peace. Every time thin rice gruel is drunk, sweat soaks the clothes; this is not deficiency, but fluid recovery and distribution of Ying Qi throughout the body. Urination is涩 painful, residual fire is not cleared. Only clearing and transforming is suitable.
Winter Melon Seed (Dongguazi), Fresh Dendrobium (Xian Shihu), Tetrapanax (Tongcao), Black Gardenia (Hei Zhi), Raw Rice Sprout (Sheng Guya), Sweet Almond (Tian Xingren), Licorice Tip (Gancao Shao).
Eleventh visit: Disease recedes. Quiet during the day, fever and mental confusion at night; this is residual heat remaining in the Ying level. Urination is hot and painful, Heart fire descends to the Small Intestine. Imitating the example of residual heat after illness, use Baihe Zhimu Huashi Tang combined with Daochi San.
Akebia (Mutong), Licorice Tip (Cao Shao), Bamboo Leaf (Zhuye), Anemarrhena (Zhimu), Fresh Rehmannia (Xian Shengdi), Talc (Huashi), Lily Bulb (Baihe).
Decoct with spring water.
Case of Fan: Constitution of Yin deficiency with dampness, contracted seasonal wind-warmth. Initially slight aversion to cold on the back, slight head distension and pain, desire to cough but unsatisfactory, heat not manifesting strongly, white greasy tongue coating, loose stool. Harshly administering dispersing drugs secretly depleted Stomach fluids, resulting in hunger but no desire to eat, lethargy with blurred spirit, continuous hiccups, faint macules and rashes. Disease just eight days, situation critical. Reviewed Mr. Zhou's prescription, truly excellent; I presumptuously added one dose of Licorice to harmonize it, possessing power to generate fluids and tonify middle; this is certainly an aid. If one says sweet flavor generates dampness or fills the middle, who does not know this! But note: thin smooth coating, no chest fullness but knowing hunger, indicates formless damp-heat with signs of Middle Jiao deficiency. This is why Ye Tianshi deeply warns against bitter-cold acrid-dispersing drugs; those who understand should observe!
Burdock Fruit (Niubangzi), Peucedanum (Qianhu), Tangerine Peel (Juhong), Calamansi Seed (Tianzhuhuang), Curcuma (Yujin), Cardamine Seed (Dao Dou Zi), Platycodon (Jiegeng), Medicated Leaven (Shenqu).
Acorus (Shichangpu), Forsythia (Lianqiao), Mint Leaf (Bohoye), Bamboo Rind (Zhuru), Licorice (Gancao), Loquat Leaf (Pipaye).
Wang Yuan's comment: This is phlegm-induced hiccup. Caused by Middle Jiao deficiency with phlegm, Stomach Qi failing to descend smoothly.
Twelfth visit: Disease exceeds ten days, warm pathogen with dampness, pathology at the junction of Qi and Ying levels. White greasy tongue coating with red edges, rashes erupted but not smooth, delirium during sleep, clarity upon waking, slow hiccups persisting, pulse soft and slightly rapid. Mr. Zhou's clearing Ying, venting Wei, regulating Qi, transforming turbidity is appropriate.
Antelope Horn (Lingyangjiao), Forsythia (Lianqiao), Calamansi Seed (Tianzhuhuang), Coptis (Chuanlian), Tangerine Peel (Juhong), Burdock Fruit (Niubangzi), Pinellia (Banxia), Clove (Dingxiang), Persimmon Calyx (Shidi), Bamboo Rind (Zhuru), Mint Root (Bohetegen), Tetrapanax (Tongcao), Imperata Root (Maogen).
Wang Yuan's comment: Sleep confusion, waking clarity, phlegm-fire blocking Upper and Middle Jiao is obvious. Formula is better than the previous one.
Thirteenth visit: Heat within dampness, spirit muddled and lethargic, clears when called, speech coherent. White greasy tongue coating, soft rapid pulse; known not to be pathogen sinking into Pericardium, but damp-heat deeply permeating Upper Jiao, Lung Qi failing to disperse and descend. Hiccups not yet removed, Stomach turbidity not transformed. Plan to legislate from Lung and Stomach.
Belamcanda (Shegan), Apricot Seed (Xingren), Curcuma (Yujin), Tangerine Peel (Juhong), Magnetite (Daizheshi), Fritillaria (Chuanbei), Glehnia (Shashen), Platycodon (Jiegeng), Tetrapanax (Tongcao), Inula Flower (Xuanfuhua), Imperata Root (Maogen), Winter Melon Seed (Dongguazi).
Wang Yuan's comment: Opening Lung and descending Stomach is more apt, thus hiccups cease and spirit clears.
Fourteenth visit: Hiccups ceased, coating slightly transformed, desire to cough but not forceful. Still modify previous method.
Remove Magnetite (Daizheshi) from previous formula, add Clam Shell (Geqiao), Red Poria (Chiling).
Fifteenth visit: Remove Inula Flower (Xuanfuhua), Belamcanda (Shegan), Platycodon (Jiegeng), add Soybean Sprout (Doujuan).
Sixteenth visit: Diarrhea several times, sticky and filthy. Stomach turbidity descending is favorable, hence lethargy over recent days; last night after stool, slightly awake and less sleep, frequently rising to defecate, feeling more mentally vexed and fatigued. Diarrhea continues, tongue coating still white, body heat harmonized; wine drinker with Middle Jiao deficiency and damp excess. Plan to harmonize Middle and transform turbidity, imitating Hezi's Ganlu Yin.
Raw American Ginseng (Sheng Yangshen), Atractylodes (Yuzhu), Red Poria (Chiling), Alisma (Zexie), Talc (Huashi), Lycium Fruit (Jiju Zi), Guang Huo Xiang, Costus Root (Muxiang), Kudzu Flower (Ge Hua), Tangerine Peel (Juhong), Tetrapanax (Tongcao), Bamboo Rind (Zhuru).
Wang Yuan's comment: Phlegm exits via stool, heat follows; Middle Jiao turbidity clears, Upper Jiao heat descends, thus ailments seem lost, turning to wakefulness and less sleep. However, coating not transformed, residual dampness not cleared, Spleen-Stomach transport not restored. Do not tonify early.
Seventeenth visit: Disease retreated, dampness not cleared. Modify previous formula.
Add Ginseng Tendril (Renshen Xu), Atractylodes (Yuzhu), Medicated Leaven (Shenqu), Rice Sprout (Guya) to previous formula.
Case of Sun: Warm pathogen attacks Lung, Lung loses clear descent; damp carries heat to generate phlegm, fire carries Qi to reverse upward.
Wheezing and hoarse phlegm, dry tongue and greasy mouth. Yesterday's pulse reportedly wiry and hard, current pulse small, choppy and rapid; yin fluids secretly damaged, Yuan Qi gradually weakened, concern for wheezing, sweating, syncope, and collapse. Warm pathogen disease belongs to Hand meridians; Lung and Stomach are high positions, treatment should favor clearing and descending. Phlegm surges with Qi, resolving phlegm prioritizes descending Qi; Qi reverses due to fire, descending Qi prioritizes clearing and descending. Tentatively prescribe one formula for expert consideration.
Fresh Dendrobium (Xian Shihu), Belamcanda (Shegan), Apricot Seed (Xingren), Elephant Fritillaria (Xiangbei), Glehnia (Shashen), Perilla Fruit (Suzi), Mulberry Bark (Sangpi), Agarwood (Chenxiang), Reed Rhizome (Lugen), Bamboo Oil (Zhuyou - taken with liquid), Winter Melon Seed (Dongguazi), Loquat Leaf (Pipaye), Ginger Juice (Jiangzhi).
Wang Yuan's comment: Discussion is clear, worthy of study. Replacing Agarwood (Chenxiang) with Scutellaria (Huangqin) in the formula would be better. Since heat transforms and Lung clears, no worry about lack of descent. All Lung-clearing drugs can descend Qi; Agarwood belongs to Wood, descends Liver but not Lung.
Case of Huang: Dry crimson tongue, dry teeth and scorched lips, phlegm wheezing and coarse breathing, fine rapid pulse. Formless pathogenic heat steams the Pericardium,有形 phlegm-turbidity blocks Lung and Stomach, fluids dried, Zheng Qi internally deficient, fear of syncope and collapse. Plan to resolve phlegm and purge heat to treat symptoms, support Zheng and generate fluids to treat root. Must achieve calm phlegm-wheezing and clear spirit before proceeding.
Antelope Horn (Lingyangjiao), Inula Flower (Xuanfuhua), Lepidium Seed (Tingli), Apricot Seed (Xingren), Fritillaria (Chuanbei), Fresh Dendrobium (Xian Shihu), Scrophularia (Yuanshen), Imperata Root (Maogen).
Bamboo Oil (Zhuyou), Agarwood (Chenxiang), Magnetite (Daizheshi), Perilla Fruit (Suzi), Ginger Juice (Jiangzhi), Guntan Wan (3 qian, delivered with Ginseng decoction).
Second visit: Head sweating profusely, phlegm-wheezing unceasing, pulse surging and large, complexion dark and dull, red dry tongue, dry gums and scorched lips. Shaoyin yin fluid insufficiency, Yangming pathogenic fire excess; fire carries Qi upward reversal, Lung fails to descend causing wheezing; condition dangerous, deep concern for syncope/collapse. Tentatively plan to save Shaoyin fluids, clear Yangming fire, tonify Qi to consolidate sweat, calm Lung to stop wheezing; maneuvering carefully, hoping for effective response.
Large Rehmannia (Da Shengdi - pounded with Halloysite/Hai Fusshi), American Ginseng (Yangshen), Achyranthes (Niuxi), Schisandra (Wuweizi), Gypsum (Shigao), Mulberry Bark (Sangpi), Fritillaria (Chuanbei).
Roasted Licorice (Zhi Gancao), Ophiopogon (Maidong), Ginseng (1 qian, decocted separately, taken with liquid).
Decoct aged Rice (Chen Jingmi) as water substitute.
Wang Yuan's comment: Surging pulse combined with head sweat and blue-green face indicates significant Upper Excess and Lower Deficiency. From supplementing lower and grasping Qi, conceived clearing heat and saving fluids method, thus effective. Ginseng, Gypsum, Rice save Lung and clear heat, which is also saving Kidney.
Third visit: Sweat slightly stopped, wheezing slightly calmed, large pulse slightly softened. But Qi still urgent, mental restlessness, red dry tongue, dental plaque and scorched lips. Fluids not yet returned, deficient Yang not yet rested, ascending Qi not yet descended; though passed dangerous ridge, not yet on flat road. Lower abdomen seems to have signs of eruption, which is also an exit for pathogen. Still plan to save Shaoyin, clear Yangming, hope for turning point.
Large Rehmannia (Da Shengdi - stir-fried with Aragonite/Shufen), American Ginseng (Yangshen), Glehnia (Shashen), Scrophularia (Yuanshen), Ophiopogon (Maidong), Fresh Rehmannia (Xian Shengdi), Achyranthes (Niuxi), Tetrapanax (Tongcao), Soybean Sprout (Doujuan), Schisandra (Wuweizi), Bamboo Leaf (Zhuye), Loquat Leaf (Pipaye).
Decoct aged Rice (Chen Jingmi) as water substitute.
Wang Yuan's comment: Previous formula effective, this is logical step-by-step. Tetrapanax and Soybean Sprout are bland and渗 to vent exterior. Fear they consume fluids. Do not worry about pathogen not leaving; once fluids and Qi return, pathogen will not endure.
Fourth visit: Yin fluids slightly returned, Qi and fire not yet peaceful. Still proceed cautiously, hoping to avoid complications.
Large Rehmannia (Da Shengdi), American Ginseng (Yangshen), Glehnia (Shashen), Scrophularia (Yuanshen), Alisma (Zexie), Ophiopogon (Maidong), Calamansi Seed (Tianzhuhuang), Fresh Dendrobium (Xian Shihu), Abalone Shell (Shijueming), Poria Spirit (Fushen), Reed Rhizome (Lugen).
Case of Zhang: Warm pathogen unresolved for two periods (10 days), pulse surging, large and hollow; mental confusion like drunkenness, pale red tongue without coating. Taking decoction does not reject it, not taking does not seek it; muttering like whispering, repeating instructions.
Yesterday used aromatic opening, spirit slightly improved. But judging by symptoms, it is fluid depletion and dryness. Must use sweet-cold to moisten dryness and generate fluids, allowing Qi transformation and fluid recovery to ensure safety. Briefly establish method for reference, awaiting expert discussion.
Large Rehmannia (Da Shengdi), Fresh Dendrobium (Xian Shihu), Glehnia (Shashen), Poria (Fuling), Ophiopogon (Maidong), Antelope Horn (Lingyangjiao), Fresh Rehmannia (Xian Shengdi), Calamansi Seed (Tianzhuhuang), Sugarcane Juice (Zheshi), Reed Tip (Lugenjian).
Wang Yuan's comment: Case language is elegant, method concise, only achievable by those with both learning and experience.
Case of Xu: Warm pathogen internally stored, phlegm-turbidity floats upward. High fever without sweat, blurred consciousness, rebellious Qi with much phlegm, greasy tongue tip red, constipation. Prevent syncope/collapse.
Antelope Horn (Lingyangjiao), Lepidium Seed (Tingli), Apricot Seed (Xingren), Fritillaria (Chuanbei), Calamansi Seed (Tianzhuhuang), Black Gardenia (Hei Shanzhi), Trichosanthes Seed (Louren), Immature Bitter Orange (Zhishi), Fermented Soybean (Douchi), Acorus (Shichangpu).
Guntan Wan 3 qian. This formula is effective.
Wang Yuan's comment: Excess-heat with phlegm, Guntan Wan is very suitable, decoction formula is also good.
Case of Wu: Warm pathogen five days, dry yellow tongue coating, high fever without sweat, chest and abdomen board-like fullness, hardness and pain, intolerable to touch. This belongs to Jie Xiong (Chest Binding). Restlessness, wheezing, spitting saliva. Prevent wheezing-syncope.
Black Gardenia (Hei Shanzhi), Fermented Soybean (Douchi), Trichosanthes Seed (Louren), Coptis (Chuanlian), Apricot Seed (Xingren), Raw Rhubarb (Sheng Dahuang), Lepidium Seed (Tingli), Bupleurum (Chaihu), Immature Bitter Orange (Zhishi), Light Scutellaria (Dan Qin), Mirabilite (Yuanmingfen), Soap Pod (Zaojiao Zi).
For all Jie Xiong cases, restlessness and shortness of breath indicate death. This formula is a combination of Da Chaihu Tang, Da/Xiao Xie Xiong Tang, and Zhi Chi Tang.
Wang Yuan's comment: For restlessness, no sweat, and wheezing, Bupleurum (Chaihu) should not be used. Using Bupleurum repeats the old track of treating Cold Damage. Fortunately, Niter, Rhubarb, Coptis, and Apricot Seed manage the center; otherwise, it would be ruined.
Second visit: After purgation, hardness/fullness of Jie Xiong dissipated, but restlessness and mania vary不定ly, dry tongue coating, thirst for cold drinks, high fever without sweat. Pathogen still in Qi level. Use bitter-acrid-cold to clear interior and reach exterior, hoping for battle-sweat without complication. Fortunately high fever without sweat allows hope for battle-sweat. If sweat occurs and high fever persists, pathogen sinks inward. This formula is Sanhuang Shigao Tang, Jisu San combined with Zhi Chi Tang.
Third visit: Battle-sweat achieved, pulse quiet, body cool, pathogen resolved. Yellow tongue coating remains, residual Stomach turbidity not cleared, still suitable for harmonizing and transforming.
Fritillaria (Chuanbei), Red Poria (Chiling), Fermented Soybean (Douchi - stir-fried), Forsythia (Lianqiao), Black Gardenia (Hei Shanzhi), Tetrapanax (Tongcao), Talc (Huashi), Immature Bitter Orange (Zhike - stir-fried), Bamboo Rind (Zhuru).
General principle for formulas after battle-sweat with quiet pulse and cool body is not outside this.
Case of Yan: Post-illness Yuan Qi not recovered, warm pathogen takes advantage of deficiency to emerge. Initially high fever and blurred spirit, dry tongue, shoulder/arm/hypochondriac pain. Just two days, pathogen not dispersed/reached, already signs of fluid depletion; clearly a serious condition. Treatment here should reach pathogen to release exterior. But Ye Tianshi said: If tongue is dry initially and spirit slightly blurred, urgently nourish Zheng, slightly add pathogen-reaching drugs. If coma occurs then rescue interior, there is risk of being caught off guard.
Northern Glehnia (Beishashen - 1 liang), Burdock (Niubang - 3 qian), Apricot Seed (Xingren - 3 qian), Scorched Medicated Leaven (Jiao Qu - 3 qian), Black Gardenia (Hei Shanzhi - 1.5 qian), Fermented Soybean (Douchi - 3 qian), Forsythia (Lianqiao - 3 qian), Calamansi Seed (Tianzhuhuang - 1 qian), Immature Bitter Orange (Zhike - 1 qian), Imperata Root (Maogen - 1 liang), Fresh Mint Root (Xian Bohetegen - 5 qian).
Wang Yuan's comment: Deeply inherits Ye Tianshi's core transmission.
Case of Sun: Constitution with chronic Ying Yin deficiency, contracted warm pathogen, disease begins with limb numbness and chills/fever, quickly followed by diarrhea, blurred spirit. Now seven days, pulse rapid and surging, dry tongue and teeth, must have rapid breathing. Yangming fire just blazing, Shaoyin yin already depleted. Also abdominal hardness/pain, constipation for three days. Accumulation inside not descending, Qi and fire float entirely upward. Seems suitable to prioritize descending/unblocking. But yin fluids severely depleted, must first nourish fluids. Tentatively prescribe one formula for discussion.
Fresh Rehmannia (Xian Shengdi - 1.4 liang), Northern Glehnia (Beishashen - 2 liang), Ground Perilla Stem (Mo Sugen - 5 fen, taken with liquid), Apricot Seed (Xingren - 3 qian), Calamansi Seed (Tianzhuhuang - 1.5 qian), Poria Spirit (Fushen - 3 qian), Ophiopogon (Maidong - 5 qian), Fritillaria (Chuanbei - 3 qian), Sydney Juice (Xini Zhi - 1 cup, taken with liquid), Loquat Leaf (Pipaye - 3 slices).
Wang Yuan's comment: First nourish Zheng and save fluids, this is experienced wisdom without illusion.
Second visit: Fluids returned, tongue moist, sweating profuse, heat trend retreated. Only mental restlessness and insomnia, constipation. Still modify previous formula.
Remove Perilla Stem (Sugen) from previous formula, add Fine Rehmannia (Xi Shengdi - 1 liang), Asparagus Root (Tiandong - 3 qian), Hemp Seed (Maren - 3 qian).
Case of Cai: Warm pathogen causes macules and rashes, always involving Lung and Stomach meridians. Pathogenic heat stagnates and steams, reaching exterior from interior. Blood level heat blazing causes macules, Qi level heat blazing causes rashes. Pathogen enters from exterior, transmits from Qi to Ying. Heat exits from interior, reaches from Ying to Qi. This case: macules first appear on chest, body feels no heat. After several days, chills and fever start, then rashes spread. Seems Ying level had latent heat initially, then warm pathogen gathered, Lung and Stomach affected, starting with cough, chills, fever etc. However, macules about to resolve, rashes fully erupted; even if residual pathogen exists, clearing and resolving should suffice; instead chest stuffiness, restlessness, Qi rising, nausea, sore throat difficult to swallow, why? Indeed pregnant eight months, coinciding with Taiyin/Yangming nourishing fetus period, pathogenic heat severe in Lung/Stomach, fetal Qi loses shade and reverses upward, thus chest Qi rises, restlessness unable to lie down; isn't it that although disease originates from heat, actually it is fetal Qi rushing upward causing it? Current plan: clear/resolve Lung/Stomach warm pathogen to transform macule/rash heat toxin, this is correct treatment. But under prairie fire, fluids burned and damaged, must also nourish fluids. Fetal Qi rising causes fastest changes, especially must first calm fetal Qi. Lung governs the whole body, must also descend Lung Qi. Lung Qi descends and lying becomes possible, fetus calms and does not rush upward, thus avoiding fear of wheezing/syncope.
Fresh Rehmannia (Xian Shengdi - 1 liang), Light Fermented Soybean (Dan Douchi - 3 qian, pounded together with fresh Rehmannia), Fritillaria Mother Bulb (Chuanbeimu - 3 qian), Ground Perilla Stem (Mo Sugen - 5 fen, taken with liquid), Ground Rhinoceros Horn (Mo Xijiao - 5 fen, taken with liquid), Ground Curcuma (Mo Yujin - 5 fen, taken with liquid), Patterned Silver (Wenyin - 1 liang, decocted first), Scrophularia (Yuanshen - 2 qian), Anemarrhena (Baiwei - 3 qian), Bamboo Rind (Zhuru - 1 qian), Wild Ramie Root (Ye Zhu Gen - 5 qian), Loquat Leaf (Pipaye - 3 slices, remove hairs).
Second visit: Warm pathogen received from above, transmits from Qi to Ying; transformed fire ascends, from Stomach to Lung. Throat belongs to Lung meridian, pharynx belongs to Stomach meridian. Generally throat diseases are mostly excess fire, due to Lung/Stomach Yang prosperity. Kidney meridian circulates throat, Liver meridian winds pharynx; deficiency fire relates to Kidney/Liver Yin deficiency. This is the general outline. This case: after macules/rashes, throat pain red, entirely due to pathogenic fire blazing. Treatment plan, Xijiao Dihuang, does not go beyond sweet-cold clearing/resolving. Yesterday vomited red phlegm, nothing but Qi/fire steaming. Now observing pulse/color, spirit feels refreshed and clear. Happy to meet confidant, jointly deliberate and ponder, thankfully thank owner, turning worry/doubt to relief. Start of Summer is today, disease reducing means retreating; carrying child during this illness, fetus not moving means safe. Bowel movement just通畅, also sign of turning point. Carefully regulate, hope to avoid criticism of impatience. Briefly write a few lines, humbly request review.
Rhinoceros Horn (Xijiao), Antelope Horn (Lingyangjiao), Fritillaria (Chuanbei), Fresh Dendrobium (Xian Shihu), Scrophularia (Yuanshen), Anemarrhena (Zhimu), Fresh Rehmannia (Xian Shengdi), Ophiopogon (Maidong), Loquat Leaf (Pipaye).
Honeysuckle Dew (Jinyinhua Lu), Mung Bean Skin (Lv Dou Pi) decocted soup, mixed with Bird's Nest Soup (Yanwo Tang) to drink frequently.
Third visit: After warm pathogen burns fiercely, residual heat surely not clean; under Lung/Stomach prairie fire, yin fluids must suffer damage. Nourishing yin lies not in blood but in fluids and sweat, Ye Tianshi's famous saying; calming fetus requires smoothing Qi, deficient fire fears ascending, gynecology's key theory. This case: fetus reaches two periods, warm-rash retreated, how can pathogenic fire blaze again? Throat swelling subsided, why does dry pain prevail again? The reason is, fetus at seven-eight months,