胡孟绅患疑。坐卧不安。如畏人捕。自知为痰。饵白金丸吐之。汗出头面。神躁妄闻。孟英
切其脉。弦滑洪数。不为指挠。投石膏竹茹枳实黄连旋复花粉胆星石菖蒲加雪羹竹沥童溲吞
礞
石滚痰丸下其痰火。连得大解。夜分较安。惟不能断酒。为加绿豆银花枳 子吞当归龙荟丸
。旬余脉证渐平。神气亦静。尚多疑惧。改授犀角元参丹皮竹叶竹茹贝母百合莲心猪胆汁炒
枣仁盐水炒黄连吞枕中丹。以清包络肝胆之有余而调神志。又旬日各恙皆蠲。继予十味温胆
法善其后。乃弟季权同时患黑斑。苔秽脉浑气粗面垢。孟英即以凉膈散投之。大解得行。脘
亦不闷。斑皆透绽。脉显滑数而洪。遂予大剂凉润清肃之药。直俟其旬日外大解不泻。药始
缓
授。复又沉卧不醒。孟英曰∶痰热尚炽也。仍投大剂数帖。果频吐胶痰累日而眠食渐安。（
白金丸内白矾苦能化躁。薄荷升阳助热。至郁金亦非热痰主要之药。故汗出头面。神躁妄闻
。生石膏先煎一两六钱。姜竹茹三钱。炒枳实一钱半。酒炒川连一钱。旋复包先三钱。南花
粉四钱。陈胆星炖和服八分。石菖蒲次入二钱。淡海 先煎二两。整荸荠二两。童便煎去头
尾冲一酒杯。药送礞石滚痰丸四钱。嗣去石膏竹茹连枳。加生绿豆二两。济银花一两五钱。
枳子杵四钱。药送当归龙荟丸三钱。嗣改授镑犀角四钱先煎。元参片泡冲去渣八钱。粉丹
皮二钱。鲜竹叶二钱。姜竹茹三钱。川贝杵四钱。百合花三钱。莲子心一钱。胆汁炒枣仁研
三钱。盐水炒川连一钱。药送枕中丹三钱。胡季权凉膈散方。酒炒枯芩三钱。黑栀皮三钱。
炒豆豉三钱。鲜竹叶二钱。生粉草三钱。酒洗生厢黄三钱。元明粉一钱。二味同入煎。大剂
凉润清肃方。鲜芦根二两。生冬瓜子四钱。酒炒枯芩三钱。鲜枇叶刷包三钱。川贝杵五钱。
陈胆星炖和服八分南花粉四钱。姜竹茹三钱。石菖蒲次入二钱。整荸荠打三个。)
屠敬思体气素弱。去冬因子殇于痘。医予舒郁填阴。病以日剧。佥云不治。孟英诊之。两关
甚数。寸上洪滑。嗽逆痰多。卧不着枕。溺赤便难。极其畏冷。是冬温未罢。误补热郁之候
。世间之死于劳损者。何尝尽是虚证。每以补药偾事。授以廓清肺胃之药。周身发疥。各恙
渐安。蕴伏既清。始投滋养善后。不仅病愈。次年春得一子。（酒炒枯芩三钱。酒炒川连一
钱。鲜芦根二两。酒炒枇叶刷包三钱。姜竹茹三钱。丝瓜络三钱。旋复包先三钱。生蛤壳五
钱。生赭石杵五钱。二味同先煎。川贝杵五钱。生冬瓜子四钱。大豆卷次入三钱。)
许芷卿亦精于医。偶患外感。即服清散之药而证不减。或疑其非春温也。邀孟英质之。诊脉
迟涩。二便皆行。筋掣不眠。畏寒能食。喉舌皆赤。予大剂清营药数服而瘥。迨夏两腿患疥
。外科治之。久而不愈。孟英谓其平昔善饮。蕴热深沉。疡科药亟宜概屏。令以雪羹汤送当
归龙荟丸。果得渐瘳。秋间其母患感。迟服温散。转为肢厥便秘。面赤冷汗。脉来一息一歇
。举家惶惶。虑即脱变。孟英视其苔。黄腻不渴。按其胸。闷而不舒。且闻其嗅诸食物。无
不
极臭。断为暑湿内伏。挟痰阻肺。肺主一身之气。气壅不行。法宜升降。是虚脱之反面也。
设
投补药。则内闭而外脱。昧者犹以为投补迟而不及救。孰知真实类虚。不必以老年怀成见。
总须以对证为良药。果一剂而脉至不歇。转为弦滑。再服汗止肢和。便行进粥。数帖而痊。
方用紫菀白前竹茹枳实旋贝杏蒌兜铃枇杷叶也。（二便皆行及能食。皆病不在气之明证。脉
迟涩为病在血。合之筋掣不眠畏寒及喉舌皆赤。皆营热厥逆之象。清营方。济银花一两五钱
。鲜茅根五钱。鲜竹茹三钱。丝瓜络三钱。酒炒桑枝三钱。羚次尖先煎四钱。大生地泡冲
去渣八钱。炒豆豉三钱。大豆卷三钱。酒炒川连一钱。酒炒川黄柏三钱。许芷卿母方。紫菀
茸
一钱半。白前一钱。姜竹茹三钱。炒枳实一钱半。旋复包先一钱半。川贝杵四钱。苦杏泥二
钱。姜蒌皮三钱。马兜铃一钱半。姜枇叶刷包三钱。)
沈辛甫妻体素弱而勤于操作。年逾四秩。汛事过多。兼以便溏。冷汗气逆。参 屡进。病日
以危。孟英诊曰∶心脾之脉尚有根。犹可望也。予龙骨牡蛎龟板鳖甲海螵蛸石英石脂余粮熟
地茯苓为方。一剂转机。渐以向愈。（汛事过多。血虚则肝风暗动。冷汗气逆。为肝阳逆厥
之征。至便溏为热寻出路。参 屡进。则肝风愈炽矣。故用介属重镇。 龙骨杵一两。 牡
蛎杵四两。血龟板杵二两。血鳖甲杵二两。炙海螵蛸四钱。紫石英五钱。赤石脂三钱。禹余
粮三钱。大熟地八钱泡汤去渣。前八味先煎八钟。云苓次入三钱。)
陈舜廷患疟久不愈。其体素亏。医皆束手。孟英视之。舌绛无津。微寒溲赤。原属春温化疟
。体与病皆不是小柴胡之例。过投温散。热炽阴伤。予竹叶石膏汤撤热存津而愈。（生石膏
先
煎一两六钱。酒炒知母四钱。鲜竹叶二钱。淡海 先煎一两。南花粉五钱。济银花一两五钱
。酒炒川连一钱。细木通一钱。石斛先煎一两。炒豆豉三钱。整荸荠二两。)
谢再华室素患肝厥。孟英于癸卯岁授药一剂。六载安然。今夏偶患齿衄。继见臭腐。头痛汛
阻。彻夜无眠。盖秦某作格阳证治。进以肾气汤数服而致剧也。孟英予大剂神犀汤加知柏。
旬日而瘳。（镑犀角先煎八钟四钱。大生地八钱。元参片一两。二味泡煎去渣。酒炒知母四
钱。酒炒川黄柏一钱半。济银花一两五钱。血鳖甲杵四两。血龟板杵二两。生赭石杵二两。
鲜青果杵三个，三味先煎八钟。南花粉五钱。飞青黛一钱。方按神犀汤加减。)
胡韵梅年已逾冠。因夜坐感寒。患头痛恶冷。呕吐肢冷。孟英视之。曰∶舌绛脉数。斑疹之
候。断非受寒。予清透药服之。次日点形圆绽。细询果未出痘。但火势甚炽。一路清凉。自
发起至落痂。毫不杂一味温升攻托之药。而满身密布。形色粗紫。浆浓痂黑。便秘不饥。渴
无一息之停。苟不如是用药。其能免乎。此建中琐言之所以有功于世也。（清透方。大生地
泡冲去渣八钱。酒炒知母三钱。酒炒川黄柏一钱半。酒炒栀皮三钱。石菖蒲次入二钱。酒炒
枇叶刷包三钱。酒炒银花四钱。酒炒丹皮二钱。制半夏一钱。)
朱大镛新婚后神呆目瞪。言语失伦。或疑其体弱神怯。予镇补安神诸药。驯致善饥善怒。骂
詈如狂。孟英诊之。右脉洪滑。予犀角石膏菖蒲胆星竹沥知母吞礞石滚痰丸而愈。其大父患
四
肢冷颤。常服温补。延久不痊。孟英切其脉弦而缓。曰∶非虚也。予通络方。吞指迷茯苓
丸
而瘥。（方义重涤痰热。参以息风。镑犀角先煎四钱。生石膏先煎一两六钱。石菖蒲次入二
钱。陈胆星炖和服八分。姜竹沥两大酒杯冲。酒炒知母四钱。药送礞石滚痰丸四钱。朱大镛
祖脉弦而缓。系为温补窒气。并非阳虚。玩吞指迷茯苓丸便见。通络方。制半夏三钱。浮橘
络
一钱五分。鲜薤白打三钱。石菖蒲二钱。姜竹茹三钱。丝瓜络三钱。姜汁拌茅根四钱。姜汁
炒桑枝三钱。陈胆星炖和服八分。药送指迷茯苓丸三钱。)
许安卿患咽痛。疡科连予升散之药。延及龈肿。牙关不开。舌不出齿。自汗脉涩。绝谷濒危
。孟英往勘。即洗去满颈敷药。以菊叶捣涂。吹以锡数散。煎犀羚射干马勃栀贝山豆根等药
灌之。数日而痊。（病情为肝风逆上。窒遏气机。镑犀角四钱。羚次尖四钱。二味同先煎八
钟。姜射干三钱。马勃一钱半。姜栀皮三钱。川贝杵四钱。姜炒山豆根一钱。)
庄芝阶媳患搐搦。闲日而作。孟英诊脉弦数。泛泛欲呕。口苦不饥。凛寒头痛。汛事愆期。
溲热如火。乃足厥阴暑疟也。投以大剂犀羚元参栀菊木通知楝花粉银花之药。数日而愈。（
泛泛欲呕四句。皆肝风炽逆现证。镑犀角四钱。羚次尖四钱。二味同先煎八钟。元参片泡煎
去渣一两。姜栀皮三钱。杭白菊三钱。细木通一钱。酒炒知母四钱。楝核杵先三钱。南花粉
四钱。济银花一两五钱。)
仲夏淫雨匝月。泛滥为灾。季夏酷暑如焚。人多热病。沈小园病。医但知湿甚。不知化热。
投以平胃散数帖。壮热昏狂。证极危殆。孟英视之。脉滑实而数。大渴溲赤。稀水旁流。予
石膏大黄数下之而愈。孟英因论曰∶考古惟叶天士甘露消毒丹神犀丹二方为湿温暑疫最妥之
药。一治气分。一治营分。规模已具。即有兼证。尚可通融。司天在泉不必拘泥。今岁奇荒
。明年恐有奇疫。但甘露二字。人必疑为大寒之药。消毒二字。世人或误作外证之方。因易
其名曰普济解疫丹。根据方合送。救活极多。（壮热昏狂方。生石膏先煎一两六钱。酒洗生厢
黄四钱。鲜芦根二两。生冬瓜子八钱。南花粉五钱。炒枳实二钱。整荸荠二两。冬桑叶四钱
。杭白菊三钱。姜竹茹三钱。姜竹沥两大酒杯冲。酒炒知母三钱。鲜枇叶刷包三钱。石菖蒲
次入二钱。)
附普济解疫丹
（壅正癸丑叶天士先生定)
飞滑石（十五两) 绵茵陈（十一两) 淡黄芩（十两) 石菖蒲（六两) 川贝母（五两) 木通（
五两) 藿香 射干 连翘 蒲荷 白豆蔻（各四两) 上药晒燥。生研细末。（见火则药尽热
。)每服三钱。开水调服日二次。或以神曲糊丸如弹子大。开水化服亦可。孟英自注云。此
治
湿温时疫之主方也。每岁仲夏温湿蒸腾。更加烈日之暑。烁石流金。人在气交之中。口鼻吸
受其气。留而不去。乃成温热暑疫之病。则为发热倦怠。胸闷腹胀。肢酸咽肿。斑疹身黄。
颐肿口渴。溺赤便秘。吐泻疟痢。淋浊疮疡等证。但看病患舌苔淡白。或浓腻。或干黄者。
是暑湿热疫之邪尚在气分。悉以此丹治之立效。而薄滋味。远酒色。尤为辟疫之主要。医家
临证准此化裁。失之者鲜。（上参喻嘉言张石顽叶天士沉尧封诸家。)
附神犀丹
犀角尖（磨汁) 石菖蒲 黄芩（各六两) 直生地（冷水洗净，浸透，捣绞汁) 银花（各一斤
，如有鲜者，捣汁用尤良) 金汁 连翘（各十两) 板蓝根（九两，无则以飞净青黛代之)
香豉（八两) 元参（七两) 花粉 紫草（各四两) 各药生晒（切忌火炒。)研细。以犀角地
黄汁金汁（即数十年陈粪清。)和捣为丸。（切勿加蜜。如难丸，可将香豉，煮烂。)每重三钱
。凉开水化服。小儿用半丸。如无金汁。可加人中黄四两研入。孟英自注云∶温热暑疫诸病
。邪不即解。耗液伤营。逆传内陷。痉厥昏狂。谵语发斑等证。但看病患舌色干光。或紫绛
。或圆硬。或苔黑。皆以此丹救之。若初病即觉神情昏躁而舌赤口干者。是温暑径入营分。
酷热之时。阴虚之体。及新产妇人患此最多。急须用此。多可挽回。切勿拘泥日数。误投别
药以偾事也。兼治痘 毒重。夹带紫斑危证。暨痘 后余毒内炽。口糜咽腐。目赤神烦诸证
。（上本叶氏参治验。)
姚禄皆遇水复受酷热患感。顾某诊为湿邪。予桂枝葛根药三帖。病乃剧。赵某知其误治。连
用清解。因见蓝斑。不肯接诊。孟英视之。脉细数而体瘦。平昔阴亏。热邪借风药而披猖。
营液得温燥而干涸。斑色渐退。而昏狂遗溺。大渴不已。仍予前方。调紫雪数剂。热退神清
而言出无伦。犹如梦呓。或虑共成癫。孟英曰∶痰留包络也。予犀角菖蒲元参鳖甲花粉竹茹
黄连生地木通甘草为方。调以真珠牛黄。始得渐安。改授存阴调理而愈。（姚禄皆前方。生
石膏先煎一两二钱。鲜芦根二两。整荸荠二两。淡海 先煎二两。石斛先煎一两。酒炒知母
三钱。酒炒川连一钱。石菖蒲次入二钱。痰留包络方。镑犀角先煎四钱。石
菖蒲次入二钱。元参片泡冲去渣一两。血鳖甲杵先煨六钟二两。南花粉四钱。姜竹茹三钱。
酒炒川连一钱。大生地泡冲去渣八钱。细木通一钱。生粉草三钱。元参鳖甲生地甘草。针治
温散误药。)
陈蕴泉陡患昏谵。乞诊孟英。脉甚滑数。苔色腻黄。乃平素多痰。兼吸暑热。予清解药一剂
。化而为疟。脉亦较平。或谓体弱不宜凉药。须用人参。孟英坚持不可。盖暑脉颇类乎虚。
而痰阻于肺。呼吸不调。又与气虚短促者相似。平昔虽虚。有病必先去病。况热能伤气。清
暑热即所以顾元虚也。遂连投白虎加减而愈。（白虎加减方。生石膏先煎八钱。姜炒知
母三钱。南花粉四钱。姜竹茹三钱。姜牛子研丝瓜络各三钱。炒枳实一钱半。石
菖蒲次入二钱。西滑石包先四钱。)
高若舟庶母患脱肛。孟英脉之。弦而滑。溲涩苔黄。虽属高年。非虚证也。清其湿热而痊。
（酒炒西茵陈一钱半。酒炒枯芩一钱半。酒炒川连八分。石菖蒲次入二钱。冬瓜皮四钱。晚
蚕砂五钱。生冬瓜子四钱。西滑石先五钱。细木通一钱。川贝杵五钱。)
孟英治乍浦人滞下证。昼夜百余行。不饥不渴。而欲呕腹痛。上及于心胸。脉颇平和。是寒
【背景信息】
书名：《王氏医案绎注》 作者：任锡庚 朝代：清 章节：卷八(1/2) 类别：医论
胡孟绅患有疑病（疑病症，指患者怀疑自己患重病而焦虑不安）。坐卧不宁，好像害怕被人抓捕。他自己知道是痰湿为患，服用白金丸催吐。结果汗出仅见于头面部，神志烦躁，胡言乱语。孟英诊察他的脉象，弦滑洪数，脉搏有力而不受指力影响。给予生石膏、竹茹、枳实、黄连、旋覆花、天花粉、胆南星、石菖蒲，加雪羹汤（由海蜇和荸荠组成）、竹沥、童便，并吞服礞石滚痰丸以泻下痰火。连得大便通畅，夜间稍安。只是不能断酒，因此加入绿豆、金银花、枳椇子，吞服当归龙荟丸。十余日后，脉证逐渐平稳，神气也安静下来。但仍多疑恐惧，改为授予犀角、玄参、牡丹皮、竹叶、竹茹、贝母、百合、莲子心、猪胆汁炒酸枣仁、盐水炒黄连，吞服枕中丹。用以清泄心包络与肝胆的有余之热，并调理神志。又过十日，各种症状都消除了。继予十味温胆法善后。他的弟弟季权同时患有黑斑，舌苔秽浊，脉象浑乱，气息粗重，面色垢腻。孟英立即给予凉膈散投治。大便得以通行，脘腹也不再闷胀，黑斑全部透发绽开，脉象显现滑数而洪大。于是给予大剂量的凉润清肃药物，直到十多天后大便不再腹泻，药量才逐渐减缓。后来他又沉睡不醒。孟英说：“痰热仍然炽盛。”仍投大剂量药物数帖，果然频繁吐出胶结之痰，多日后睡眠和饮食逐渐安稳。（白金丸内白矾味苦能化躁，薄荷升阳助热，至于郁金也不是治疗热痰的主要药物，所以导致汗出头面，神志烦躁妄闻。生石膏先煎一两六钱，姜竹茹三钱，炒枳实一钱半，酒炒川黄连一钱，旋覆花包煎先煮三钱，南花粉四钱，陈胆南星炖和服八分，石菖蒲后入二钱，淡海蜇先煎二两，整荸荠二两，童便煎去头尾冲服一杯酒，药送礞石滚痰丸四钱。随后去掉石膏、竹茹、黄连、枳实，加生绿豆二两，济银花一两五钱，枳椇子杵碎四钱，药送当归龙荟丸三钱。随后改授镑犀角四钱先煎，玄参片泡冲去渣八钱，粉牡丹皮二钱，鲜竹叶二钱，姜竹茹三钱，川贝母杵碎四钱，百合花三钱，莲子心一钱，胆汁炒酸枣仁研末三钱，盐水炒川黄连一钱，药送枕中丹三钱。胡季权凉膈散方：酒炒枯黄芩三钱，黑栀子皮三钱，炒豆豉三钱，鲜竹叶二钱，生甘草三钱，酒洗生大黄三钱，元明粉一钱，后两味同入煎煮。大剂凉润清肃方：鲜芦根二两，生冬瓜子四钱，酒炒枯黄芩三钱，鲜枇杷叶刷毛包煎三钱，川贝母杵碎五钱，陈胆南星炖和服八分，南花粉四钱，姜竹茹三钱，石菖蒲后入二钱，整荸荠打碎三个。）
屠敬思体质素来虚弱。去年冬天因为儿子死于痘疹，医生给予舒肝解郁、填补阴精的药物，病情日益加重。众人都说无法医治。孟英诊察他，两关脉甚数，寸口脉洪滑，咳嗽气逆，痰多，睡觉不能着枕，小便赤涩，大便困难，极其怕冷。这是冬温病未罢，误用补药导致热邪郁结的候象。世间死于劳损的人，何尝不是尽是虚证？往往因为补药而坏事。授予廓清肺胃的药物，周身发出疥疮样皮疹，各症逐渐安宁。蕴伏之邪既清，才开始投予滋养药物善后。不仅病愈，次年春天还生了一个儿子。（酒炒枯黄芩三钱，酒炒川黄连一钱，鲜芦根二两，酒炒枇杷叶刷毛包煎三钱，姜竹茹三钱，丝瓜络三钱，旋覆花包煎先煮三钱，生蛤壳五钱，生赭石杵碎五钱，后两味同先煎，川贝母杵碎五钱，生冬瓜子四钱，大豆卷后入三钱。）
许芷卿也精通医学。偶然患外感，即服用清散药物而症状不减。有人怀疑不是春温病。邀请孟英来质询。诊脉迟涩，大小便皆通，筋脉抽搐，失眠，怕冷但能进食，咽喉和舌头皆红赤。给予大剂量清营药物数服而痊愈。到了夏天，双腿患疥疮。外科医生治疗，久而不愈。孟英认为他平素善于饮酒，蕴热深沉，疡科药物亟宜一概摒弃。令以雪羹汤送服当归龙荟丸，果然逐渐好转。秋天，他的母亲患感冒，迟服温散药物，转为四肢厥冷，便秘，面赤冷汗，脉来一息一歇（间歇脉）。全家惶恐，担心即刻发生脱变。孟英看她的舌苔，黄腻但不口渴，按她的胸部，闷胀而不舒畅，而且闻到她嗅各种食物，无不极臭。判断为暑湿内伏，挟痰阻肺。肺主一身之气，气机壅滞不行，法宜升降。这是虚脱的反面。如果投予补药，则内闭而外脱。愚昧的人还以为投补药迟了而不及救。谁知道真实情况类似虚证，不必因为老年人就怀有成见。总须以对证为良药。果然一剂后脉至不再间歇，转为弦滑，再服药后汗止肢和，大便进粥，数帖而痊愈。方用紫菀、白前、竹茹、枳实、旋覆花、贝母、杏仁、瓜蒌、马兜铃、枇杷叶。（大小便皆通及能进食，都是病不在气的明证。脉迟涩说明病在血，结合筋脉抽搐、失眠、怕冷及咽喉舌头皆红赤，都是营热厥逆的象。清营方：济银花一两五钱，鲜茅根五钱，鲜竹茹三钱，丝瓜络三钱，酒炒桑枝三钱，羚羊角次尖先煎四钱，大生地泡冲去渣八钱，炒豆豉三钱，大豆卷三钱，酒炒川黄连一钱，酒炒川黄柏三钱。许芷卿母亲方：紫菀茸一钱半，白前一钱，姜竹茹三钱，炒枳实一钱半，旋覆花包煎先煮一钱半，川贝母杵碎四钱，苦杏仁泥二钱，姜瓜蒌皮三钱，马兜铃一钱半，姜枇杷叶刷毛包煎三钱。）
沈辛甫的妻子体质素弱但勤于劳作。年过四十，月经过多，兼有大便溏薄，冷汗，气逆，人参、黄芪屡进，病情日益危险。孟英诊察说：“心脾之脉尚有根，还可以期望。”给予龙骨、牡蛎、龟板、鳖甲、海螵蛸、石英、石脂、余粮、熟地、茯苓为方。一剂后出现转机，逐渐向愈。（月经过多，血虚则肝风暗动，冷汗气逆，是肝阳逆厥的征象。至于便溏是热寻找出路，人参、黄芪屡进，则肝风愈炽。故用介属重镇。龙骨杵碎一两，牡蛎杵碎四两，血龟板杵碎二两，血鳖甲杵碎二两，炙海螵蛸四钱，紫石英五钱，赤石脂三钱，禹余粮三钱，大熟地八钱泡汤去渣，前八味先煎八钟，云苓后入三钱。）
陈舜廷患疟疾久不愈。其体质素亏，医生都束手无策。孟英视之，舌绛无津液，微寒，小便赤。原属春温化为疟疾。体质与病情都不是小柴胡汤的适应证。过投温散药物，导致热炽阴伤。给予竹叶石膏汤撤热存津而痊愈。（生石膏先煎一两六钱，酒炒知母四钱，鲜竹叶二钱，淡海蜇先煎一两，南花粉五钱，济银花一两五钱，酒炒川黄连一钱，细木通一钱，石斛先煎一两，炒豆豉三钱，整荸荠二两。）
谢再华的妻室素患肝厥。孟英于癸卯年给药一剂，六年安然无恙。今年夏天偶然患齿衄（牙龈出血），继而出现口臭腐坏，头痛，月经阻滞，彻夜无眠。原来是秦某作格阳证治疗，进服肾气汤数服而导致病情加剧。孟英给予大剂量神犀汤加知母、黄柏。旬日而愈。（镑犀角先煎八钟四钱，大生地八钱，玄参片一两，后两味泡煎去渣，酒炒知母四钱，酒炒川黄柏一钱半，济银花一两五钱，血鳖甲杵碎四两，血龟板杵碎二两，生赭石杵碎二两，鲜青果杵碎三个，后三味先煎八钟，南花粉五钱，飞青黛一钱。方按神犀汤加减。）
胡韵梅年已成年。因夜间坐着感受寒冷，患头痛恶冷，呕吐，四肢冷。孟英视之，说：“舌绛脉数，是斑疹的候象。断非受寒。”给予清透药物服用。次日点状圆形绽开，细问果然未出痘。但火势甚炽。一路清凉，自发起至落痂，毫不杂一味温升攻托的药物。而满身密布，形色粗紫，浆浓痂黑，便秘不饥，口渴无一息之停。如果不这样用药，怎么能避免呢。这就是建中琐言之所以有功于世的原因。（清透方：大生地泡冲去渣八钱，酒炒知母三钱，酒炒川黄柏一钱半，酒炒栀皮三钱，石菖蒲后入二钱，酒炒枇杷叶刷毛包煎三钱，酒炒银花四钱，酒炒丹皮二钱，制半夏一钱。）
朱大镛新婚后神呆目瞪，言语失伦。有人怀疑他体弱神怯，给予镇补安神诸药。逐渐导致善饥善怒，骂詈如狂。孟英诊察，右脉洪滑，给予犀角、石膏、菖蒲、胆南星、竹沥、知母，吞服礞石滚痰丸而愈。他的祖父患四肢冷颤，常服温补，拖延日久不痊。孟英切其脉弦而缓，说：“不是虚证。”给予通络方，吞服指迷茯苓丸而痊愈。（方义重在涤除痰热，参以息风。镑犀角先煎四钱，生石膏先煎一两六钱，石菖蒲后入二钱，陈胆南星炖和服八分，姜竹沥两大酒杯冲服，酒炒知母四钱，药送礞石滚痰丸四钱。朱大镛祖父脉弦而缓，是因为温补窒塞气机，并非阳虚。玩味吞服指迷茯苓丸便可见。通络方：制半夏三钱，浮橘络一钱五分，鲜薤白打碎三钱，石菖蒲二钱，姜竹茹三钱，丝瓜络三钱，姜汁拌茅根四钱，姜汁炒桑枝三钱，陈胆南星炖和服八分，药送指迷茯苓丸三钱。）
许安卿患咽痛。疡科医生连续给予升散药物，延及牙龈肿，牙关不开，舌不出齿，自汗，脉涩，绝食濒危。孟英前往勘察，即洗去满颈敷药，以菊叶捣涂，吹以锡类散，煎犀角、羚羊角、射干、马勃、栀子、贝母、山豆根等药灌之。数日而痊愈。（病情为肝风逆上，窒遏气机。镑犀角四钱，羚羊角次尖四钱，后两味同先煎八钟，姜射干三钱，马勃一钱半，姜栀皮三钱，川贝母杵碎四钱，姜炒山豆根一钱。）
庄芝阶的儿媳患搐搦（抽搐），闲时发作。孟英诊脉弦数，泛泛欲呕，口苦不饥，凛寒头痛，月经愆期，小便热如火。乃是足厥阴暑疟。投以大剂量犀角、羚羊角、玄参、栀子、菊花、木通、知母、楝核、花粉、银花的药物。数日而愈。（泛泛欲呕四句，皆是肝风炽逆现证。镑犀角四钱，羚羊角次尖四钱，后两味同先煎八钟，玄参片泡煎去渣一两，姜栀皮三钱，杭白菊三钱，细木通一钱，酒炒知母四钱，楝核杵碎先煮三钱，南花粉四钱，济银花一两五钱。）
仲夏淫雨匝月，泛滥为灾。季夏酷暑如焚，人多热病。沈小园患病，医生只知道湿气重，不知道化热。投以平胃散数帖，壮热昏狂，证极危殆。孟英视之，脉滑实而数，大渴，小便赤，稀水旁流（协热下利）。给予石膏、大黄数次泻下而痊愈。孟英因而论述道：“考古只有叶天士的甘露消毒丹、神犀丹二方为湿温暑疫最妥的药物。一方治气分，一方治营分，规模已具，即使有兼证，尚可通融。司天在泉不必拘泥。今年奇荒，明年恐有奇疫。但‘甘露’二字，人必疑为大寒之药；‘消毒’二字，世人或误作外证之方。因此易其名曰普济解疫丹。根据方合送，救活极多。”（壮热昏狂方：生石膏先煎一两六钱，酒洗生大黄四钱，鲜芦根二两，生冬瓜子八钱，南花粉五钱，炒枳实二钱，整荸荠二两，冬桑叶四钱，杭白菊三钱，姜竹茹三钱，姜竹沥两大酒杯冲服，酒炒知母三钱，鲜枇杷叶刷毛包煎三钱，石菖蒲后入二钱。）
附普济解疫丹
（壅正癸丑叶天士先生定）
飞滑石（十五两）绵茵陈（十一两）淡黄芩（十两）石菖蒲（六两）川贝母（五两）木通（五两）藿香、射干、连翘、薄荷、白豆蔻（各四两）上药晒燥，生研细末。（见火则药尽热。）每服三钱，开水调服日二次，或以神曲糊丸如弹子大，开水化服亦可。孟英自注云：此治湿温时疫之主方也。每岁仲夏温湿蒸腾，更加烈日之暑，烁石流金，人在气交之中，口鼻吸受其气，留而不去，乃成温热暑疫之病。则为发热倦怠，胸闷腹胀，肢酸咽肿，斑疹身黄，颐肿口渴，溺赤便秘，吐泻疟痢，淋浊疮疡等证。但看病患舌苔淡白，或浓腻，或干黄者，是暑湿热疫之邪尚在气分，悉以此丹治之立效。而薄滋味，远酒色，尤为辟疫之主要。医家临证准此化裁，失之者鲜。（上参喻嘉言、张石顽、叶天士、沉尧封诸家。）
附神犀丹
犀角尖（磨汁）石菖蒲、黄芩（各六两）直生地（冷水洗净，浸透，捣绞汁）银花（各一斤，如有鲜者，捣汁用尤良）金汁、连翘（各十两）板蓝根（九两，无则以飞净青黛代之）香豉（八两）元参（七两）花粉、紫草（各四两）各药生晒（切忌火炒。）研细，以犀角地黄汁、金汁（即数十年陈粪清。）和捣为丸。（切勿加蜜。如难丸，可将香豉，煮烂。）每重三钱，凉开水化服。小儿用半丸。如无金汁，可加人中黄四两研入。孟英自注云：温热暑疫诸病，邪不即解，耗液伤营，逆传内陷，痉厥昏狂，谵语发斑等证。但看病患舌色干光，或紫绛，或圆硬，或苔黑，皆以此丹救之。若初病即觉神情昏躁而舌赤口干者，是温暑径入营分。酷热之时，阴虚之体，及新产妇人患此最多。急须用此，多可挽回。切勿拘泥日数，误投别药以偾事也。兼治痘毒重，夹带紫斑危证，暨痘后余毒内炽，口糜咽腐，目赤神烦诸证。（上本叶氏参治验。）
姚禄皆遇水复受酷热患感。顾某诊为湿邪，给予桂枝、葛根药三帖，病乃加剧。赵某知其误治，连用清解。因见蓝斑，不肯接诊。孟英视之，脉细数而体瘦，平昔阴亏，热邪借风药而披猖，营液得温燥而干涸。斑色渐退，而昏狂遗尿，大渴不已。仍予前方，调紫雪数剂，热退神清而言出无伦，犹如梦呓。有人虑其共成癫狂。孟英说：“痰留包络也。”给予犀角、菖蒲、玄参、鳖甲、花粉、竹茹、黄连、生地、木通、甘草为方。调以真珠、牛黄，始得渐安。改授存阴调理而痊愈。（姚禄皆前方：生石膏先煎一两二钱，鲜芦根二两，整荸荠二两，淡海蜇先煎二两，石斛先煎一两，酒炒知母三钱，酒炒川黄连一钱，石菖蒲后入二钱。痰留包络方：镑犀角先煎四钱，石菖蒲后入二钱，玄参片泡冲去渣一两，血鳖甲杵碎先煨六钟二两，南花粉四钱，姜竹茹三钱，酒炒川黄连一钱，大生地泡冲去渣八钱，细木通一钱，生粉草三钱。元参、鳖甲、生地、甘草，针治温散误药。）
陈蕴泉陡患昏谵。乞诊孟英。脉甚滑数，苔色腻黄，乃平素多痰，兼吸暑热。给予清解药一剂，化而为疟，脉亦较平。有人说体弱不宜凉药，须用人参。孟英坚持不可。盖暑脉颇类乎虚，而痰阻于肺，呼吸不调，又与气虚短促者相似。平昔虽虚，有病必先去病，况热能伤气，清暑热即所以顾元虚也。遂连投白虎汤加减而痊愈。（白虎加减方：生石膏先煎八钱，姜炒知母三钱，南花粉四钱，姜竹茹三钱，姜牛子研、丝瓜络各三钱，炒枳实一钱半，石菖蒲后入二钱，西滑石包煎先煮四钱。）
高若舟庶母患脱肛。孟英脉之，弦而滑，溲涩苔黄，虽属高年，非虚证也。清其湿热而痊愈。（酒炒西茵陈一钱半，酒炒枯黄芩一钱半，酒炒川黄连八分，石菖蒲后入二钱，冬瓜皮四钱，晚蚕砂五钱，生冬瓜子四钱，西滑石先煎五钱，细木通一钱，川贝母杵碎五钱。）
[Background Information]
Book: *Wang's Medical Cases Annotated and Interpreted* (Wangshi Yi'an Yizhu)
Author: Ren Xigeng
Dynasty: Qing
Chapter: Volume 8 (1/2)
Category: Medical Discussion
Hu Mengshen suffered from hypochondriac anxiety (a condition characterized by excessive worry about one's health). He was restless in sitting and lying, as if fearing arrest. Knowing himself to be afflicted by phlegm-dampness, he took Baijin Wan (Platinum Pill) to induce vomiting. This resulted in sweating only on the head and face, with a烦躁 (restless/agitated) spirit and delirious speech. Mengying palpated his pulse, finding it wiry, slippery, flooding, and rapid, strong and unyielding to pressure. He prescribed Shigao (Gypsum Fibrosum), Zhuru (Bambusae Caulis in Taeniam), Zhishi (Aurantii Fructus Immaturus), Huanglian (Coptidis Rhizoma), Xuanfuhua (Inulae Flos), Huafen (Trichosanthis Radix), Danning (Arisarum Rhizoma Preparatum), Shichangpu (Acori Tatarinowii Rhizoma), added Xue Geng Decoction (composed of Aurelia Aurita and Dioscoreae Bulbiferae), Zhuli (Bambusae Sap), and Tongxiao (Infans Urine), and administered Mengshi Gun Tan Wan (Magnitae Lapis Preparatus Phlegm-Rolling Pill) orally to purge phlegm-fire. After several large bowel movements, he found some relief at night. However, he could not abstain from alcohol, so Lüdou (Phaseoli Semen), Yinhua (Lonicerae Japonicae Flos), and Zhizi (Aurantii Fructus) were added, along with Danggui Longhui Wan (Angelica Sinensis and Gardenia Pill) taken orally. Over ten days, the pulse and symptoms gradually stabilized, and his spirit quieted. Yet, he remained suspicious and fearful. The prescription was changed to Xijiao (Rhinocerotis Cornu - now substituted with Buffalo Horn), Xuanshen (Scrophulariae Radix), Mudanpi (Moutan Cortex), Zhuye (Phyllostachys Folium), Zhuru, Beimu (Fritillariae Bulbus), Baihe (Lilii Bulbus), Lianxin (Nelumbinis Plumula), Zhu Danzhi (Porcine Bile), Zaoren (Ziziphi Spinosomi Semen stir-fried with porcine bile), and Huanglian (Coptidis Rhizoma stir-fried with salt water), with Zhenzhong Dan (Pillow Center Pill) taken orally. This aimed to clear excess heat from the Pericardium and Liver/Gallbladder and regulate the spirit. Ten days later, all ailments were eliminated. Subsequently, Shiwei Wendan Fa (Ten-Ingredient Warm Gallbladder Method) was given for convalescence.
His brother, Ji Quan, simultaneously suffered from black spots. His tongue coating was turbid, pulse chaotic, breath coarse, and complexion dirty. Mengying immediately prescribed Liangge San (Cool the Chest Powder). After bowel movements occurred and abdominal fullness subsided, the spots fully erupted. The pulse became slippery, rapid, and flooding. Large doses of cooling, moistening, clearing, and purifying herbs were then administered until, after more than ten days without diarrhea, the dosage was gradually reduced. Later, he fell into a deep sleep and did not wake. Mengying stated, "Phlegm-heat is still blazing." He continued with large doses for several prescriptions. Indeed, he frequently vomited thick phlegm, and over several days, sleep and appetite gradually improved. (Note on Baijin Wan: Mingfan (Alumen) is bitter and can resolve agitation; Bohe (Menthae Haplocalycis Herba) raises yang and aids heat; Jinyu (Curcumae Radix) is not the primary herb for hot phlegm; hence sweating on the head and delirium occurred. Dosages: Shigao 1 liang 6 qian pre-decocted; Jiang Zhuru 3 qian; Chao Zhishi 1.5 qian; Jiu Chao Chuanlian 1 qian; Xuanfu wrapped and pre-decocted 3 qian; Nan Huafen 4 qian; Chen Danning decocted and mixed for administration 0.8 qian; Shichangpu added later 2 qian; Dan Hai Zhe pre-decocted 2 liang; Zheng Biqi 2 liang; Tongxiao decocted, head and tail removed, mixed with 1 cup of wine; Mengshi Gun Tan Wan 4 qian sent down with medicine. Later, Shigao, Zhuru, Lian, Zhishi removed; Sheng Lüdou 2 liang, Ji Yinhua 1.5 liang, Zhizi crushed 4 qian added; Danggui Longhui Wan 3 qian sent down. Then switched to Bang Xijiao 4 qian pre-decocted; Xuanshen slices soaked, decocted, dregs removed 8 qian; Fen Mudanpi 2 qian; Xian Zhuye 2 qian; Jiang Zhuru 3 qian; Chuan Bei crushed 4 qian; Baihehua 3 qian; Lianzin 1 qian; Zhuren studied 3 qian; Shuiyan Chuanlian 1 qian; Zhenzhong Dan 3 qian sent down. Hu Ji Quan's Liangge San formula: Jiu Chao Ku Qin 3 qian; Hei Zhipi 3 qian; Chao Douchi 3 qian; Xian Zhuye 2 qian; Sheng Gancao 3 qian; Jiu Xi Sheng Huang 3 qian; Yuanmingfen 1 qian; last two decocted together. Large dose cooling/moistening/clearing/purifying formula: Xian Lugen 2 liang; Sheng Dongguazi 4 qian; Jiu Chao Ku Qin 3 qian; Xian Piyeshua wrapped 3 qian; Chuan Bei crushed 5 qian; Chen Danning decocted and mixed 0.8 qian; Nan Huafen 4 qian; Jiang Zhuru 3 qian; Shichangpu added later 2 qian; Zheng Biqi crushed 3.)
Tu Jingsi had a constitution that was inherently weak. Last winter, after his son died of smallpox, doctors prescribed herbs to soothe depression and tonify yin, causing the illness to worsen daily. Everyone said it was incurable. Mengying diagnosed him: pulses at both Guan positions were very rapid; Cun position was flooding and slippery; cough with rebellious qi and profuse phlegm; inability to lie flat; red urine and difficult stool; extreme aversion to cold. This indicated Winter-Warmth had not resolved, and mistaken tonification led to heat stagnation. It is rare for those who die from consumptive diseases to have purely deficiency patterns; often, tonics cause harm. He prescribed herbs to clear the Lung and Stomach. Prickly heat appeared on the body, and symptoms gradually eased. Once latent pathogens were cleared, nourishing herbs were given for recovery. Not only did he recover, but he also had a son the following spring. (Jiu Chao Ku Qin 3 qian; Jiu Chao Chuanlian 1 qian; Xian Lugen 2 liang; Jiu Chao Piyeshua wrapped 3 qian; Jiang Zhuru 3 qian; Sigualuo 3 qian; Xuanfu wrapped and pre-decocted 3 qian; Sheng Geqiao 5 qian; Sheng Zheshi crushed 5 qian; latter two pre-decocted together; Chuan Bei crushed 5 qian; Sheng Dongguazi 4 qian; Dadoujuan added later 3 qian.)
Xu Zhiqing was also skilled in medicine. He contracted an external pathogen and took clearing/dispersing herbs, but symptoms persisted. Some doubted it was Spring-Warmth and invited Mengying to consult. Pulse was slow and choppy; urination and defecation were normal; muscle twitching and insomnia; aversion to cold but able to eat; throat and tongue red. Large doses of Ying-clearing herbs cured him. In summer, he developed prickly heat on both legs. Surgical treatment failed for a long time. Mengying noted his history of heavy drinking and deep-seated heat, advising against surgical herbs. He prescribed Xue Geng Tang to send down Danggui Longhui Wan, leading to gradual improvement. In autumn, his mother contracted a cold. Delayed warm dispersal led to limb coldness, constipation, red face, cold sweat, and intermittent pulse (one beat pause). The family panicked, fearing collapse. Mengying observed yellow, greasy tongue coating without thirst; pressed chest finding fullness and discomfort; noted foul odor from food sniffing. Diagnosis: Summer-heat and Dampness latent inside, combined with Phlegm obstructing the Lung. Lung governs Qi of the whole body; Qi stagnation requires ascending/descending regulation. This is the opposite of collapse. Tonics would cause internal closure and external collapse. Ignorant people might blame late tonification. Truth resembles deficiency; do not hold prejudices against the elderly. Symptom-matching is key. One dose stopped pulse pauses, turning wiry/slippery; second dose stopped sweating and harmonized limbs; bowel movement resumed with congee; cured in several doses. Formula: Ziwan, Baiqian, Zhuru, Zhishi, Xuanbei, Xinglou, Doulou, Pipaye. (Normal bowel/urine/eating proves disease not in Qi. Slow/choppy pulse indicates Blood involvement. Twitching/insomnia/cold/red throat/tongue indicate Ying-heat and reversal cold. Ying-clearing formula: Ji Yinhua 1.5 liang; Xian Maogen 5 qian; Xian Zhuru 3 qian; Sigualuo 3 qian; Jiu Chao Sangzhi 3 qian; Lingjiao Cijian pre-decocted 4 qian; Da Shengdi soaked, decocted, dregs removed 8 qian; Chao Douchi 3 qian; Dadoujuan 3 qian; Jiu Chao Chuanlian 1 qian; Jiu Chao Chuanhuangbai 3 qian. Xu Zhiqing's Mother's Formula: Ziwanrong 1.5 qian; Baiqian 1 qian; Jiang Zhuru 3 qian; Chao Zhishi 1.5 qian; Xuanfu wrapped and pre-decocted 1.5 qian; Chuan Bei crushed 4 qian; Ku Xingni 2 qian; Jiang Loupi 3 qian; Madoulou 1.5 qian; Jiang Piyeshua wrapped 3 qian.)
Shen Xinfu's wife was inherently weak but diligent. Over forty, she had excessive menstruation, loose stools, cold sweat, and rebellious qi. Ginseng and Astragalus aggravated the condition. Mengying diagnosed: Heart/Spleen pulses still rooted, hope remains. Prescribed Longgu, Muli, Guiban, Biejia, Haipiaoxiao, Shiy ing, Shizhi, Yuliang, Shudi, Fuling. One dose brought turnaround, gradual recovery. (Excessive menses cause Blood deficiency and hidden Liver Wind. Cold sweat/rebellious qi indicate Liver Yang reversal. Loose stools indicate Heat seeking exit. Tonics exacerbate Liver Wind. Use heavy/shell minerals to anchor. Longgu 1 liang; Muli 4 liang; Xue Guiban 2 liang; Xue Biejia 2 liang; Zhi Haipiaoxiao 4 qian; Zi Shiy ing 5 qian; Chi Shizhi 3 qian; Yu Yuliang 3 qian; Da Shudi 8 qian soaked/decocted/dregs removed; first eight pre-decocted 8 zhong; Yunling added later 3 qian.)
Chen Shunting had chronic malaria. Constitution weak, doctors helpless. Tongue crimson without fluids, slight chills, red urine. Originally Spring-Warmth transforming into Malaria. Not a Xiao Chaihu Tang case. Overuse of warm dispersal caused Heat blazing and Yin injury. Yeju Shigao Tang cleared Heat and preserved Yin, curing him. (Shigao 1 liang 6 qian pre-decocted; Jiu Chao Zhimu 4 qian; Xian Zhuye 2 qian; Dan Haizhe 1 liang pre-decocted; Nan Huafen 5 qian; Ji Yinhua 1.5 liang; Jiu Chao Chuanlian 1 qian; Xi Mutong 1 qian; Shihu 1 liang pre-decocted; Chao Douchi 3 qian; Zheng Biqi 2 liang.)
Xie Zaihua's wife suffered from Liver Jue (reversal). Mengying gave one prescription in Gui Mao year, safe for six years. This summer, sudden gingival bleeding, foul odor, headache, menstrual obstruction, insomnia. Previously treated by Dr. Qin as False Heat (Ge Yang) with Shenqi Tang, worsening condition. Mengying prescribed large dose Shenxi Tang plus Zhimu and Huangbai. Cured in ten days. (Bang Xijiao 4 qian pre-decocted 8 zhong; Da Shengdi 8 qian; Xuanshen 1 liang; latter two soaked/decocted/dregs removed; Jiu Chao Zhimu 4 qian; Jiu Chao Chuanhuangbai 1.5 qian; Ji Yinhua 1.5 liang; Xue Biejia 4 liang crushed; Xue Guiban 2 liang crushed; Sheng Zheshi 2 liang crushed; Xian Qingguo 3 crushed; latter three pre-decocted 8 zhong; Nan Huafen 5 qian; Fei Qingdai 1 qian. Formula based on Shenxi Tang modifications.)
Hu Yunmei, adult, caught cold while sitting at night. Headache, aversion to cold, vomiting, cold limbs. Mengying observed: Crimson tongue, rapid pulse, sign of macules/rash. Not cold exposure. Prescribed clearing/venting herbs. Next day, round macules erupted. Confirmed no smallpox. Fire heat was intense. Used cooling herbs exclusively from onset to scabbing, no warming/ascending/expelling drugs. Dense, dark purple rash, thick pus, black scabs, constipation, no hunger, constant thirst. Without this treatment, outcome would be poor. Hence the value of Jianzhong Suoyan. (Clearing/Venting Formula: Da Shengdi 8 qian soaked/decocted/dregs removed; Jiu Chao Zhimu 3 qian; Jiu Chao Chuanhuangbai 1.5 qian; Jiu Chao Zhipi 3 qian; Shichangpu added later 2 qian; Jiu Chao Piyeshua wrapped 3 qian; Jiu Chao Yinhua 4 qian; Jiu Chao Danpi 2 qian; Zhi Banxia 1 qian.)
Zhu Dayang, post-marriage, stared blankly, lost speech coherence. Suspected weak spirit, treated with calming/tonifying herbs. Resulted in excessive hunger/anger,狂 (madness). Right pulse flooding/slippery. Prescribed Xijiao, Shigao, Changpu, Danning, Zhuli, Zhimu, Mengshi Gun Tan Wan. Cured. His grandfather had cold/trembling limbs, treated with warm tonics chronically. Pulse wiry/slow. Mengying: Not deficiency. Prescribed Tongluo Fang, Zhimi Fuling Wan. Cured. (Formula meaning: Clear phlegm-heat, extinguish wind. Bang Xijiao 4 qian pre-decocted; Shigao 1 liang 6 qian pre-decocted; Shichangpu 2 qian added later; Chen Danning 0.8 qian decocted/mixed; Jiang Zhuli 2 large cups mixed; Jiu Chao Zhimu 4 qian; Mengshi Gun Tan Wan 4 qian sent down. Grandfather's wiry/slow pulse due to warm tonics blocking Qi, not Yang deficiency. Zhimi Fuling Wan indicates this. Tongluo Formula: Zhi Banxia 3 qian; Fu Juluo 1.5 qian; Xian Xiebai 3 qian crushed; Shichangpu 2 qian; Jiang Zhuru 3 qian; Sigualuo 3 qian; Jiangzhi Mai gen 4 qian; Jiangzhi Sangzhi 3 qian; Chen Danning 0.8 qian decocted/mixed; Zhimi Fuling Wan 3 qian sent down.)
Xu Anqing had sore throat. Surgeons used ascending/dispersing herbs, leading to gum swelling, trismus, tongue protrusion, spontaneous sweating, choppy pulse, starvation, critical state. Mengying washed off neck compresses, applied crushed Chrysanthemum leaves, blew Xi Lei San, decocted Xijiao, Lingjiao, Shegan, Mabo, Zhizi, Beimu, Shandougen. Cured in days. (Pathology: Liver Wind rebelling upward, blocking Qi mechanism. Bang Xijiao 4 qian; Lingjiao Cijian 4 qian; latter two pre-decocted 8 zhong; Jiang Shegan 3 qian; Mabo 1.5 qian; Jiang Zhipi 3 qian; Chuan Bei 4 qian crushed; Jiang Chao Shandougen 1 qian.)
Zhuang Zhijie's daughter-in-law had spasms, intermittent. Pulse wiry/rapid, nausea, bitter taste, no hunger, chills/headache, delayed menses, hot urine like fire. Foot Jueyin Summer-heat Malaria. Large dose Xijiao, Lingjiao, Xuanshen, Zhizi, Juhua, Mutong, Zhimu, Lianhe, Huafen, Yinhua. Cured in days. (Nausea etc. indicate blazing Liver Wind. Bang Xijiao 4 qian; Lingjiao Cijian 4 qian; latter two pre-decocted 8 zhong; Xuanshen 1 liang soaked/decocted/dregs removed; Jiang Zhipi 3 qian; Hang Baiju 3 qian; Xi Mutong 1 qian; Jiu Chao Zhimu 4 qian; Lianhe crushed pre-decocted 3 qian; Nan Huafen 4 qian; Ji Yinhua 1.5 liang.)
Mid-Summer rain, late-Summer heat. Many heat cases. Shen Xiaoyuan treated for dampness with Pingwei San, worsened to high fever/delirium. Pulse slippery/real/rapid, great thirst, red urine, watery diarrhea. Shigao and Dahuang purged successfully. Mengying commented: Ye Tianshi's Ganlu Xiaodu Dan and Shenxi Dan are best for Damp-Warmth/Summer-heat Epidemics. One treats Qi level, one Ying level. Adaptable. Tianwen Diquan theories need not be rigid. Given current famine, epidemic likely next year. 'Ganlu' sounds too cold; 'Xiaodu' sounds external. Renamed Puji Jieyi Dan. Saved many lives. (High Fever/Delirium Formula: Shigao 1 liang 6 qian pre-decocted; Jiu Xi Sheng Huang 4 qian; Xian Lugen 2 liang; Sheng Dongguazi 8 qian; Nan Huafen 5 qian; Chao Zhishi 2 qian; Zheng Biqi 2 liang; Dong Sangye 4 qian; Hang Baiju 3 qian; Jiang Zhuru 3 qian; Jiang Zhuli 2 large cups mixed; Jiu Chao Zhimu 3 qian; Xian Piyeshua wrapped 3 qian; Shichangpu added later 2 qian.)
Appendix: Puji Jieyi Dan
(Fixed by Mr. Ye Tianshi in Gui Chou Year)
Fei Huashi (15 liang), Mian Yichen (11 liang), Dan Huangqin (10 liang), Shichangpu (6 liang), Chuan Beimu (5 liang), Mutong (5 liang), Huoxiang, Shegan, Lianqiao, Bohe, Baudoukou (each 4 liang). Dry and grind fine. Do not roast. Take 3 qian with boiled water twice daily, or pill with Shenqu. Mengying Note: Main formula for Damp-Warmth/Epidemic. Mid-summer heat/damp steaming, sun scorches. People breathe this air, it stays, causing Warmth/Summer-heat Epidemic. Symptoms: fever, fatigue, chest fullness, bloating, limb ache, sore throat/swelling, macules, jaundice, swollen jaw, thirst, red urine/constipation, vomiting/diarrhea/malaria/dysentery, stranguria, sores. If tongue coating is pale white, thick greasy, or dry yellow, pathogen is at Qi level. This powder works instantly. Light diet, avoid alcohol/sex is crucial for prevention. Physicians should adapt accordingly. (References Yu Jiayan, Zhang Shiweng, Ye Tianshi, Chen Yaofeng.)
Appendix: Shenxi Dan
Xijiao Jian (ground juice), Shichangpu, Huangqin (each 6 liang), Zhishengdi (washed, soaked, crushed/juiced), Yinhua (1 jin, fresh preferred/juiced), Jinzhi, Lianqiao (each 10 liang), Banlangen (9 liang, substitute Qingdai), Xiangchi (8 liang), Xuanshen (7 liang), Huafen, Zicao (each 4 liang). Sun-dry, do not roast. Grind fine. Mix with Xijiao/Shengdi juice and Jinzhi (aged urine) to make pills. No honey. If hard, boil Xiangchi. 3 qian per dose, cool boiled water. Children half dose. If no Jinzhi, add Renzhonghuang 4 liang. Mengying Note: For Warmth/Summer-heat Epidemics where pathogen lingers, consumes fluids/Ying, reverses inward causing spasms/coma/delirium/macules. If tongue dry/shiny, purple-crimson, hard, or black coating, use this. If early stage has coma/restlessness/red tongue/dry mouth, pathogen entered Ying directly. Common in heat, Yin-deficiency, postpartum. Use urgently to save life. Do not delay. Also treats severe smallpox toxins with purple macules, or residual heat after smallpox causing mouth ulcers/throat rot/red eyes/fretfulness. (Based on Ye's verified cases.)
Yao Lu jie contracted cold after water exposure and heat. Dr. Gu diagnosed Dampness, gave Guizhi/Gegen, worsened. Dr. Zhao saw blue macules, refused treatment. Mengying: Fine/rapid pulse, thin body, inherent Yin deficiency. Heat exacerbated by wind herbs, Ying fluid dried by warm/dry herbs. Macules faded, but coma/delirium/enuresis/great thirst persisted. Continued previous formula, adjusted with Zixue. Heat subsided, spirit cleared, but speech incoherent/dream-like. Fear of madness. Mengying: "Phlegm in Pericardium." Prescribed Xijiao, Changpu, Xuanshen, Biejia, Huafen, Zhuru, Huanglian, Shengdi, Mutong, Gancao, adjusted with Zhenzhu/Niuhuang. Gradually stable. Switched to Yin-preserving regulation. Cured. (Previous Formula: Shigao 1.2 liang pre-decocted; Xian Lugen 2 liang; Zheng Biqi 2 liang; Dan Haizhe 2 liang pre-decocted; Shihu 1 liang pre-decocted; Jiu Chao Zhimu 3 qian; Jiu Chao Chuanlian 1 qian; Shichangpu 2 qian added later. Phlegm in Pericardium Formula: Bang Xijiao 4 qian pre-decocted; Shichangpu 2 qian added later; Xuanshen 1 liang soaked/decocted/dregs removed; Xue Biejia 2 liang pre-roasted/pre-decocted 6 zhong; Nan Huafen 4 qian; Jiang Zhuru 3 qian; Jiu Chao Chuanlian 1 qian; Da Shengdi 8 qian soaked/decocted/dregs removed; Xi Mutong 1 qian; Sheng Gancao 3 qian. Xuanshen/Biejia/Shengdi/Gancao treat errors from warm/dispersing meds.)
Chen Yunquan suddenly had coma/delirium. Pulse slippery/rapid, greasy yellow coating. Chronic phlegm + Summer-heat inhalation. One dose clearing/ventilating herbs transformed it into Malaria, pulse calmer. Others suggested Ginseng for weakness. Mengying refused. Summer-heat pulse resembles deficiency; Phlegm in Lung causes breathing issues resembling Qi deficiency. Although constitutionally weak, must treat disease first. Heat damages Qi; clearing Summer-heat protects primordial deficiency. Baihu Tang modified cured him. (Baihu Modified: Shigao 8 qian pre-decocted; Jiang Chao Zhimu 3 qian; Nan Huafen 4 qian; Jiang Zhuru 3 qian; Jiang Niuzi crushed/Sigualuo each 3 qian; Chao Zhishi 1.5 qian; Shichangpu 2 qian added later; Xi Huashi wrapped/pre-decocted 4 qian.)
Gao Ruozhou's concubine had rectal prolapse. Pulse wiry/slippery, difficult urination, yellow coating. Elderly but not deficiency. Cleared Damp-Heat, cured. (Jiu Chao Xi Yichen 1.5 qian; Jiu Chao Ku Qin 1.5 qian; Jiu Chao Chuanlian 0.8 qian; Shichangpu 2 qian added later; Donggua pi 4 qian; Wancan sha 5 qian; Sheng Dongguazi 4 qian; Xi Huashi 5 qian pre-decocted; Xi Mutong 1 qian; Chuan Bei 5 qian crushed.)
Mengying treated a man from Zhapu with dysentery (Zhixia), >100 times/day, no hunger/thirst, nausea/abdominal pain extending to chest, pulse relatively peaceful. This is Cold...