寒热二证既明。复有一种寒热错杂证。宜细详之。初起畏寒微热。疲倦。咳嗽。迨至数日。热愈大。夜间尤甚。喉
内渐起白点。日见长大。虽通身大热如火。足趾必冷如冰。或腹痛自利。阴寒犯足太阴牌也。或心胸吵乱作呕者。
混杂之邪。扰于脾胃欲成霍乱也。或鼻出浊涕。且见血丝者。风热熏蒸鼻窍也。或齿牙红肿出血。火毒炽于胃腑也。
此证之迥乎不同也。察其脉两寸浮洪而数。阳邪见阳脉也。两尺沉细无神。阴邪见阴脉也。此脉之显然有别也。脉证既
殊。治疗各异。若专作热证。而用大苦大寒。必至呕吐泻痢。而脾胃败绝。专作寒证而用麻黄炮姜桂附。则上焦之已伤
者再伤。定然吐血衄血。此皆难以救药也。惟疏风清燥以宣于上。调中利湿以和其中。温暖散邪以逐于下。乃克有济。
治宜辛夷散。苏子降气汤。藿香正气散。加减主之。
辛夷散
辛夷（二粒） 桔梗（三钱） 防风（三钱，去芦） 茯苓（三钱）
僵虫（三钱） 前胡（一钱五分） 法夏（二钱，姜汁炒抖） 蝉蜕（九只，去头、翅、足）
白芷（二钱） 川芎（二钱） 黄栗芽（八分，草药店有卖） 薄荷（五分） 陈茶（五钱） 苍耳（四分） 木
通（一钱） 陈皮（一钱） 粉草（一钱） 生姜（一片） 水煎服。
此方辛夷一派。皆驱风开窍以宣发于上。合二陈生姜除痰去湿。以调和脾胃于中。陈茶能清头面之热。木
通能平心肺之火。以降于下。黄栗芽尤解燥热之瘴气。无论喉之已痛未痛。但见脉证相似即投此方。未痛者全
愈。已痛者减半。如头面浮肿去白芷加白附。胸结痰鸣气促。去白芷加旋复花。小便赤涩。加茵陈、瞿麦、扁
蓄。鼻孔出血或吐血。加丝茅根、藕节、侧柏叶炭。
苏子降气汤
当归（二钱） 前胡（二钱） 法夏（二钱，姜汁炒） 茯苓（三钱） 僵虫（三钱） 陈皮（一钱）
水竹茹（一钱） 浓朴（一钱，姜汁炒） 苏子（一钱） 粉草（一钱） 蝉蜕（九只，去头、翅、足） 肉桂
（五分，去皮蒸兑） 生姜（三片） 水煎服。
投前方。脉必见下虚上实。再用此方。连进二三服。取归桂以温养下元。苏子降逆气以化痰。如颈项喉内肿痛
未除。肺气不降。加葶苈子、旋复花、栝蒌、杏仁之类。
藿香正气散
党参（五钱） 苡仁（四钱，炒） 陈米（一小杯，炒） 茯苓（三钱）
扁豆（三钱） 藿梗（二钱） 法夏（二钱，姜汁炒抖） 前胡（二钱） 苏子（一钱） 陈皮（一
钱） 浓朴（一钱，姜汁炒） 腹毛（一钱） 粉草（一钱） 生姜（三片） 水煎服。
投前二方。病势虽退。必饮食减少。腹中胀滞微痛。或余热不退。或大便溏泻。小便赤短。此脾胃困乏。
余邪滞涩。斯时再逐其邪。正气益虚。欲补其正。邪气未净。宜此方以和解。既和之后。审察脉证偏盛之处。以调
其气血。使精气神三者充。自然困倦起病根除矣。
寒证与热证既然已经阐明，又有一种寒热错杂的证候，应当仔细详察。发病初期出现怕冷、轻微发热、疲倦、咳嗽等症状。等到几天后，发热更加严重，夜间尤为厉害，咽喉内部逐渐出现白点，并且日渐扩大。虽然全身高热如火，但脚趾必定冰冷如冰。或者出现腹痛、自发性腹泻，这是阴寒之邪侵犯足太阴脾经所致。或者心胸烦乱、恶心呕吐，这是混杂的邪气扰乱脾胃，即将形成霍乱。或者鼻孔流出浊涕，且带有血丝，这是风热熏蒸鼻窍所致。或者牙齿牙龈红肿出血，这是火毒炽盛于胃腑所致。这些症状表现截然不同。诊察其脉象，两手寸部脉浮洪而数，是阳邪见到阳脉的表现；两手尺部脉沉细而无神，是阴邪见到阴脉的表现。这种脉象差异非常明显。脉象与症状既然不同，治疗方法也各异。如果单纯当作热证，使用大苦大寒的药物，必然导致呕吐、泻痢，从而使脾胃败绝。如果单纯当作寒证，使用麻黄、炮姜、肉桂、附子等药，则会使上焦已经受损的部位再次受伤，必然导致吐血、衄血（鼻出血）。这些都是难以救治的情况。只有疏风清燥以宣通上部，调理中焦利湿以调和中部，温暖散邪以驱逐下部邪气，才能取得疗效。治疗适宜用辛夷散、苏子降气汤、藿香正气散加减来主治。
辛夷散
辛夷（二粒） 桔梗（三钱） 防风（三钱，去芦头） 茯苓（三钱）
僵蚕（三钱） 前胡（一钱五分） 法半夏（二钱，姜汁炒制抖干） 蝉蜕（九只，去头、翅、足）
白芷（二钱） 川芎（二钱） 黄栗芽（八分，草药店有售） 薄荷（五分） 陈茶（五钱） 苍耳子（四分） 木通（一钱） 陈皮（一钱） 甘草（一钱） 生姜（一片） 水煎服。
此方中的辛夷等药物，都是驱风开窍以宣发于上部。配合二陈汤和生姜去除痰湿，以调和脾胃于中部。陈茶能清除头面部的热邪，木通能平抑心肺之火，使其下行。黄栗芽尤其能解除燥热之瘴气。无论咽喉是否已经疼痛，只要见到脉证相似即可投用此方。未疼痛者可以痊愈，已疼痛者剂量减半。如果出现头面部浮肿，去掉白芷，加入白附子。如果胸部结滞、痰鸣、气促，去掉白芷，加入旋覆花。如果小便赤涩，加入茵陈、瞿麦、扁蓄。如果鼻孔出血或吐血，加入丝茅根、藕节、侧柏叶炭。
苏子降气汤
当归（二钱） 前胡（二钱） 法半夏（二钱，姜汁炒） 茯苓（三钱） 僵蚕（三钱） 陈皮（一钱）
水竹茹（一钱） 厚朴（一钱，姜汁炒） 紫苏子（一钱） 甘草（一钱） 蝉蜕（九只，去头、翅、足） 肉桂（五分，去皮蒸后兑入） 生姜（三片） 水煎服。
服用前方后，脉象必然表现为下虚上实，再用此方。连续服用二三剂，利用当归、肉桂温养下元，紫苏子降逆气以化痰。如果颈部和咽喉肿痛未除，肺气不降，可加入葶苈子、旋覆花、瓜蒌、杏仁之类。
藿香正气散
党参（五钱） 薏苡仁（四钱，炒） 陈米（一小杯，炒） 茯苓（三钱）
扁豆（三钱） 藿香梗（二钱） 法半夏（二钱，姜汁炒制抖干） 前胡（二钱） 紫苏子（一钱） 陈皮（一钱） 厚朴（一钱，姜汁炒） 腹皮（一钱，即大腹皮） 甘草（一钱） 生姜（三片） 水煎服。
服用前两个方剂后，病势虽然减退，但必然出现饮食减少、腹部胀滞微痛，或者余热不退，或者大便溏泻、小便短赤。这是脾胃困乏，余邪滞留涩阻。此时如果再强行驱逐邪气，正气会更加虚弱；想要补益正气，邪气又尚未清除干净。适宜用此方来和解。在和解之后，审察脉证偏盛之处，以调和其气血，使精、气、神三者充盈，自然困倦消除，病根也就除去了。
Since the patterns of Cold and Heat have been clarified, there is another type of pattern characterized by a mixture of Cold and Heat, which should be examined in detail. At the onset, there is aversion to cold, slight fever, fatigue, and cough. After several days, the fever becomes more severe, especially at night. White spots gradually appear inside the throat and enlarge daily. Although the whole body is hot as fire, the toes are inevitably cold as ice. Alternatively, abdominal pain and spontaneous diarrhea may occur, indicating that Yin-Cold pathogenic factors invade the Foot-Taiyin Spleen Meridian (足太阴脾经). Or, mental restlessness and vomiting may occur, suggesting that mixed pathogenic factors disturb the Stomach and Spleen, potentially evolving into Cholera (霍乱). Or, turbid nasal discharge with blood streaks may appear, caused by Wind-Heat steaming the nasal orifices. Or, swelling, redness, and bleeding of the gums and teeth may occur, due to blazing Fire-Toxin in the Stomach organ. These manifestations are distinctly different. Upon pulse diagnosis, the Cun positions (寸部) of both wrists are floating, surging, and rapid, representing Yang pathogens presenting with Yang pulses; the Chi positions (尺部) are deep, thin, and lacking spirit, representing Yin pathogens presenting with Yin pulses. This difference in pulses is obvious. Since the pulses and symptoms differ, the treatments must vary. If treated solely as a Heat pattern using bitter-cold herbs, it will inevitably lead to vomiting and dysentery, causing the failure of the Spleen and Stomach. If treated solely as a Cold pattern using Ephedrae Herba (Mahuang, 麻黄), prepared Zingiberis Rhizoma (Paojiang, 炮姜), Cinnamomi Ramulus (Guizhi, 桂枝), and Aconiti Lateralis Radix Praeparata (Fuzi, 附子), the already damaged Upper Jiao (上焦) will be injured again, inevitably leading to hematemesis (吐血) and epistaxis (衄血). These conditions are difficult to save. Only by dispersing Wind and clearing dryness to ventilate the Upper Jiao, regulating the Middle Jiao and promoting dampness to harmonize the center, and warming to scatter pathogens to drive out evil from the Lower Jiao can success be achieved. The treatment should employ Xinyi San (Magnolia Flower Powder), Suzi Jiangqi Tang (Perilla Fruit Decoction for Descending Qi), and Huoxiang Zhengqi San (Agastache Powder for Rectifying the Qi) with modifications.
Xinyi San (Magnolia Flower Powder)
Xinyi (Magnolia Flower, 辛夷) - 2 grains
Jiegeng (Platycodon Root, 桔梗) - 3 qian
Fangfeng (Saposhnikovia Root, 防风) - 3 qian, remove radicle
Fuling (Poria, 茯苓) - 3 qian
Jiangcan (Bombyx Batryticatus, 僵蚕) - 3 qian
Qianhu (Peucedani Radix, 前胡) - 1.5 qian
Banxia (Pinellia Tuber, 法半夏) - 2 qian, stir-fried with ginger juice
Chantui (Cicada Slough, 蝉蜕) - 9 pieces, remove head, wings, and feet
Baizhi (Angelicae Dahuricae Radix, 白芷) - 2 qian
Chuanxiong (Ligusticum Chuanxiong Rhizome, 川芎) - 2 qian
Huangliya (Castanea Chinensis Sprout, 黄栗芽) - 0.8 fen (available in herbal shops)
Bohe (Menthae Haplocalycis Herba, 薄荷) - 0.5 fen
Chencha (Aged Tea, 陈茶) - 5 qian
Cangerzi (Xanthii Fructus, 苍耳子) - 0.4 fen
Mutong (Akebiae Caulis, 木通) - 1 qian
Chenpi (Citri Reticulatae Pericarpium, 陈皮) - 1 qian
Gancao (Glycyrrhizae Radix et Rhizoma, 粉草) - 1 qian
Shengjiang (Zingiberis Rhizoma Recens, 生姜) - 1 slice
Decoct in water and take orally.
The herbs in this formula, such as Xinyi, all disperse Wind and open orifices to ventilate the Upper Jiao. Combined with Erchen Tang (Two-Aged Decoction) and Shengjiang to eliminate phlegm and dampness, they harmonize the Spleen and Stomach in the Middle Jiao. Chencha clears heat from the head and face; Mutong pacifies Heart and Lung Fire, directing it downward. Huangliya particularly resolves dry-heat miasma. Regardless of whether the throat is painful or not, if the pulse and symptoms match, administer this formula. For those without pain, full recovery is expected; for those with pain, reduce the dosage by half. If facial edema occurs, remove Baizhi and add Baifuzi (Typhonii Rhizoma, 白附子). If chest congestion, rattling phlegm, and shortness of breath occur, remove Baizhi and add Xuanfuhua (Inulae Flos, 旋覆花). If urine is red and scanty, add Yichen (Artemisiae Scopariae Herba, 茵陈), Qumai (Dianthi Herba, 瞿麦), and Bianxu (Polygoni Avicularis Herba, 扁蓄). If epistaxis or hematemesis occurs, add Simaogen (Imperatae Rhizoma, 丝茅根), Ou jie (Nelumbinis Node, 藕节), and Cebeiye Tan (Carbonized Platycladi Cacumen, 侧柏叶炭).
Suzi Jiangqi Tang (Perilla Fruit Decoction for Descending Qi)
Danggui (Angelicae Sinensis Radix, 当归) - 2 qian
Qianhu (Peucedani Radix, 前胡) - 2 qian
Banxia (Pinellia Tuber, 法半夏) - 2 qian, stir-fried with ginger juice
Fuling (Poria, 茯苓) - 3 qian
Jiangcan (Bombyx Batryticatus, 僵蚕) - 3 qian
Chenpi (Citri Reticulatae Pericarpium, 陈皮) - 1 qian
Zhuru (Bambusae Medulla, 水竹茹) - 1 qian
Houpo (Magnoliae Officinalis Cortex, 浓朴) - 1 qian, stir-fried with ginger juice
Suzi (Perillae Fructus, 苏子) - 1 qian
Gancao (Glycyrrhizae Radix et Rhizoma, 粉草) - 1 qian
Chantui (Cicada Slough, 蝉蜕) - 9 pieces, remove head, wings, and feet
Rougui (Cinnamomi Cortex, 肉桂) - 0.5 fen, peel, steam, and add later
Shengjiang (Zingiberis Rhizoma Recens, 生姜) - 3 slices
Decoct in water and take orally.
After administering the previous formula, the pulse will likely show deficiency below and excess above. Use this formula next. Take 2-3 doses continuously. Danggui and Rougui warm and nourish the Lower Yuan (下元); Suzi descends rebellious Qi to transform phlegm. If neck and throat swelling and pain persist, and Lung Qi does not descend, add Tinglizi (Descurainiae Semen seu Lepidii Semen, 葶苈子), Xuanfuhua (Inulae Flos, 旋覆花), Gualou (Trichosanthis Fructus, 栝蒌), and Xingren (Prunus Armeniacae Semen, 杏仁).
Huoxiang Zhengqi San (Agastache Powder for Rectifying the Qi)
Dangshen (Codonopsis Radix, 党参) - 5 qian
Yiyiren (Coicis Semen, 苡仁) - 4 qian, stir-fried
Chenmi (Aged Rice, 陈米) - 1 small cup, stir-fried
Fuling (Poria, 茯苓) - 3 qian
Baidou (Phaseoli Semen, 扁豆) - 3 qian
Huogeng (Agastaches Rhizoma et Rhizoma, 藿梗) - 2 qian
Banxia (Pinellia Tuber, 法半夏) - 2 qian, stir-fried with ginger juice
Qianhu (Peucedani Radix, 前胡) - 2 qian
Suzi (Perillae Fructus, 苏子) - 1 qian
Chenpi (Citri Reticulatae Pericarpium, 陈皮) - 1 qian
Houpo (Magnoliae Officinalis Cortex, 浓朴) - 1 qian, stir-fried with ginger juice
Fupi (Arecae Pericarpium, 腹毛/大腹皮) - 1 qian
Gancao (Glycyrrhizae Radix et Rhizoma, 粉草) - 1 qian
Shengjiang (Zingiberis Rhizoma Recens, 生姜) - 3 slices
Decoct in water and take orally.
After administering the first two formulas, although the disease trend recedes, appetite will inevitably decrease, accompanied by abdominal distension, mild pain, lingering residual heat, loose stools, or scanty red urine. This indicates Spleen and Stomach exhaustion with residual pathogens stagnating. At this stage, forcibly expelling pathogens will further weaken healthy Qi; tonifying healthy Qi while pathogens remain unclean is inappropriate. It is suitable to use this formula for harmonization. After harmonization, examine the pulse and symptoms to identify where excess lies, then regulate Qi and Blood. When Essence, Qi, and Spirit are充盈 (full/plentiful), fatigue will naturally subside, and the root of the disease will be eradicated.