余于治案中，每详言之矣。
孙文垣治万肃庵之子，发热十一日，舌心色若沉香，口渴甚干燥，额上及两胁极热，耳微聋。已下二次，
热不退，小便少，神昏足冷，左脉中按数而有力，右脉软弱，乃少阳阳明并病也。先以柴胡汤清其热，视汗有
无，再相机而处。柴胡五钱，葛根三钱，白芍、石膏各二钱，人参、升麻、天花粉各一钱，粉甘草七分。服后
脉稍缓，热稍退，齿仍干，小水不利，神思尚昏沉，改用柴胡、粉草、花粉、黄芩、人参、白术、茯苓、滑石、
木通、泽泻，小便去二次。下午又觉微热面赤，额上痛且重，（黎按∶此白术壅气之故。）与益元散三钱，大
便行一次，溏而色黄，热仍甚，面仍赤。再诊之，寸关脉将和，两尺洪大。（藜按∶此六一散引热下行之效。）
知其热在下焦，惟利之而已，再与益元散五钱，口渴稍止，齿下盘润，而上盘仍燥，神思昏沉，睡而不醒。
知其热在心包络，投导赤散，二帖而神清。惟小水尚短，以四苓加酒连、木通，二帖而诸症悉退。
吴心逸仆患额疼，口大渴，身大热，汗多胸痞，恶心昏沉。孙与柴苓汤加枳壳、桔梗，热减大半。次日以
六君加黄芩、白芍，调理而愈。此劳倦伤寒，故宜先散后补也。
周鉴泉室病伤寒，发热谵语，口渴咳嗽，胸膈痛，泄泻，呕逆，遍身发斑，六脉洪滑。此少阳阳明合病
也，以升麻葛根汤加滑石、五味进之。服后，汗大出，热退神清。复与柴苓汤加五味、滑石，泻亦止。次日
诊之，左脉和，右脉亦稍收敛，改用白芍为主，陈皮、柴胡、酒芩、五味子、牡蛎、滑石、茯苓、泽泻、白术，
服四帖而安。
陈茂之，劳倦后勉强色欲，精竭而血继至，续感风寒，发热头痛，胸膈饱满。始从太阳而传少阳，胸胁痛，
耳聋，呕逆，口苦，咳嗽，六脉弦数。此少阳症也，以小柴胡加枳壳、桔梗，竹茹而呕逆止。因进粥早，复热
口渴，小水不利，大便一日夜六七次，所行皆清水，日晡热甚，舌上黄苔，昏沉振颤。此食复之候，以猪苓、
泽泻各三钱，赤茯苓一钱，柴胡八分，升麻、木通各五分，连进二帖，小便利而大便实。但热不退，进六神通
解散一帖，热如故。次日诊之，左脉不弦数矣，两寸脉如故，服药无汗，口渴，漱水不欲咽咽。此邪热传阳明
经，不急凉血，必作鼻衄。投黄芩芍药汤合生脉散以止嗽渴，用葛根汤以解肌热。白芍三钱，葛根、升麻、黄
芩各一钱，人参一钱五分，麦冬、滑石各三钱，甘草、五味子各五分，乌梅一枚，进二帖，大便下燥粪十数枚，
始得微汗，安眠，进粥而愈。
庞太夫人病头痛恶寒，胸膈懑且痛，时发寒热，投四物汤加元胡索、丹皮、香附，治五日不瘥。孙诊之，
脉右滑大，左浮弦而数，曰∶头痛恶寒，外感症也；浮弦而数，胸膈懑痛，少阳脉症具在；右脉滑，饮食滞而
为痰也。四物汤皆滞痰闭气之药，内伤可以得消，外感何由得出？投以柴胡汤合平胃散，一服而愈。
一老仆头痛，遍身骨节痛，面色黑，发热口渴，胸膈膨胀，饮食七日不进。复感寒，脉左弦数，右洪大，
以藿香、苍术、防风、葛根、白芷、紫苏、甘草、陈皮、大腹皮、麦芽、枳实投之。服后，胸膈稍宽，热与痛
更甚，改以麻黄、葛根、柴胡各二钱，石膏、滑石各三钱，紫苏、苍术、白芷各一钱，甘草五分，姜三片。服
后，大汗出而热痛皆除。惟口渴，又以白芍、当归、石膏、知母、柴胡、黄芩、麦冬、葛根、陈皮服之而愈。
此三阳合病，先为饮食所伤，故用藿香正气汤加消导以助其内，又以六神通解散加助表之药，以治其标。病虽
重，年虽高，喜其色脉相合，故易愈也。
蔡中林室发热口渴，舌上燥裂，小腹痛，呕吐，药食不入口者七日。右寸脉绝不应指，关沉滑有力，左
手弦数。此阳明少阳合病，邪热壅于上焦也。以软柴胡、石膏各五钱，半夏曲、黄芩、黄连、葛根、竹茹、人
参各二钱，姜三片，五更下黑粪数块，痛热减半。次日仍与前药，右寸脉亦起。改用小柴胡汤加橘红、竹茹、
葛根，服三帖全安。
我在治疗案例中，已经详细阐述过这些观点了。
孙文垣诊治万肃庵的儿子，发热持续十一日，舌中心颜色像沉香色一样，口渴非常严重且干燥，额头及两侧胁肋部极热，耳朵轻微耳聋。已经两次使用泻下法，但热势不退，小便量少，神志昏迷且双脚发冷，左手脉象在中取时数而有力，右手脉象软弱无力，这是少阳病与阳明病并发的证候。先用柴胡汤来清解热邪，观察是否有汗出，再根据情况灵活处理。处方：柴胡五钱，葛根三钱，白芍、石膏各二钱，人参、升麻、天花粉各一钱，粉甘草七分。服药后脉象稍微缓和，热势稍退，但牙齿仍然干燥，小便不通利，神思依然昏沉。于是改用柴胡、粉甘草、天花粉、黄芩、人参、白术、茯苓、滑石、木通、泽泻。服药后小便排出两次。下午又觉得微热且面色发红，额头疼痛且沉重。（黎按：这是白术阻碍气机的缘故。）给予益元散三钱，大便通行一次，粪便稀溏且颜色发黄，但热势仍然很盛，面色依然发红。再次诊察，寸部和关部脉象趋于平和，两尺部脉象洪大。（黎按：这是六一散引导热邪向下排泄的效果。）判断热邪位于下焦，只需通过利小便的方法治疗即可，再次给予益元散五钱，口渴稍微停止，牙齿下部变得湿润，而上部仍然干燥，神思昏沉，睡觉但不醒来。判断热邪在心包络，投用导赤散，服用两帖后神志清醒。只是小便仍然短少，用四苓散加酒黄连、木通，服用两帖后所有症状全部消退。
吴心逸的仆人患额头疼痛，口大渴，身体大热，汗多且胸脘痞闷，恶心且神志昏沉。孙文垣给予柴苓汤加枳壳、桔梗，热势减轻大半。次日用六君子汤加黄芩、白芍，调理后痊愈。这是因劳倦导致的伤寒，所以适宜先发散表邪后补益正气。
周鉴泉的妻子患伤寒，发热且谵语，口渴咳嗽，胸膈疼痛，泄泻，呕逆，全身发出斑疹，六脉洪大滑数。这是少阳病与阳明病合病，用升麻葛根汤加滑石、五味子服用。服药后，大汗出，热退神清。随后再用柴苓汤加五味子、滑石，泄泻也停止了。次日诊察，左脉平和，右脉也稍微收敛，改用白芍为主药，配合陈皮、柴胡、酒黄芩、五味子、牡蛎、滑石、茯苓、泽泻、白术，服用四帖后病情安定。
陈茂之，在劳倦之后勉强进行房事，精血枯竭，随后感受风寒，发热头痛，胸膈胀满。病邪起初从太阳经传入少阳经，出现胸胁疼痛，耳聋，呕逆，口苦，咳嗽，六脉弦数。这是少阳病的证候，用小柴胡汤加枳壳、桔梗、竹茹，呕逆停止。因为过早进食粥类，再次发热口渴，小便不利，大便一天一夜六七次，排出的都是清水，傍晚时分热势甚重，舌上有黄苔，神志昏沉且身体震颤。这是食复（因饮食不当导致疾病复发）的征候，用猪苓、泽泻各三钱，赤茯苓一钱，柴胡八分，升麻、木通各五分，连续服用两帖，小便通利且大便成形。但热势仍不退，服用六神通解散一帖，热势如故。次日诊察，左脉不再弦数，两寸脉象依旧，服药后无汗，口渴，想含水漱口但不想咽下。这是邪热传入阳明经，如果不及时凉血，必然会导致鼻衄（鼻出血）。投用黄芩芍药汤合生脉散以止咳止渴，用葛根汤以解肌表之热。处方：白芍三钱，葛根、升麻、黄芩各一钱，人参一钱五分，麦冬、滑石各三钱，甘草、五味子各五分，乌梅一枚。服用两帖后，大便排出燥结粪便十数枚，才开始微微出汗，安稳入睡，喝粥后痊愈。
庞太夫人患病，头痛恶寒，胸膈满闷且疼痛，时而发冷发热，投用四物汤加延胡索、牡丹皮、香附，治疗五日未愈。孙文垣诊察，脉象右侧滑大，左侧浮弦而数，说：头痛恶寒，是外感证候；脉浮弦而数，胸膈满闷疼痛，少阳病的脉症具备；右侧脉滑，是饮食停滞而生痰。四物汤都是阻滞痰湿、闭塞气机的药物，对于内伤可以消除，但对于外感如何能发散出来？于是投用柴胡汤合平胃散，服用一帖即愈。
一位老仆人头痛，全身骨节疼痛，面色黑，发热口渴，胸膈膨胀，七天不能进食。又感受寒邪，脉象左弦数，右洪大，用藿香、苍术、防风、葛根、白芷、紫苏、甘草、陈皮、大腹皮、麦芽、枳实投药。服药后，胸膈稍微宽舒，但热势和疼痛更加严重，改为用麻黄、葛根、柴胡各二钱，石膏、滑石各三钱，紫苏、苍术、白芷各一钱，甘草五分，生姜三片。服药后，大汗出而热痛皆除。只是仍有口渴，又用白芍、当归、石膏、知母、柴胡、黄芩、麦冬、葛根、陈皮服用后痊愈。这是三阳合病，先前被饮食所伤，所以用藿香正气汤加消导药物以助其内部运化，又用六神通解散加助表药物，以治其标。病虽重，年龄虽高，庆幸其神色与脉象相符，所以容易痊愈。
蔡中林的妻子发热口渴，舌上干燥裂开，小腹痛，呕吐，药食无法入口达七日。右寸脉绝不应指，关脉沉滑有力，左手脉弦数。这是阳明病与少阳病合病，邪热壅塞于上焦。用软柴胡、石膏各五钱，半夏曲、黄芩、黄连、葛根、竹茹、人参各二钱，生姜三片。五更时分排出黑色粪便数块，疼痛和热势减半。次日仍用前药，右寸脉也起。改用小柴胡汤加橘红、竹茹、葛根，服用三帖后完全安康。
I have elaborated on these points in my treatment records.
Sun Wen Yuan treated the son of Wan Su An, who had been feverish for eleven days. The center of his tongue was dark like sandalwood, with severe thirst and dryness; his forehead and both hypochondriac regions were extremely hot, and he suffered from slight deafness. He had undergone purgation twice, yet the fever did not subside. His urine output was scant, he was comatose with cold feet, the pulse at the middle position of the left hand was rapid and forceful, while the right pulse was weak and soft. This is a concurrent syndrome of Shaoyang (Lesser Yang) and Yangming (Yang Brightness). Initially, Chaihu Tang (Bupleurum Decoction) was used to clear the heat, observing whether sweating occurred, and then adjusting the treatment accordingly. The prescription consisted of: Chai Hu (Bupleuri Radix) 5 qian, Ge Gen (Puerariae Lobatae Radix) 3 qian, Bai Shao (Paeoniae Radix Alba) and Shi Gao (Gypsum Fibrosum) each 2 qian, Ren Shen (Ginseng Radix), Sheng Ma (Cimicifugae Rhizoma), and Tian Hua Fen (Trichosanthis Radix) each 1 qian, and Fen Gan Cao (Glycyrrhizae Radix et Rhizoma Preparatum) 7 fen. After administration, the pulse slowed slightly, and the fever subsided somewhat, but the teeth remained dry, urination was difficult, and mental clarity was still impaired. Therefore, the formula was changed to include Chai Hu, Fen Gan Cao, Tian Hua Fen, Huang Qin (Scutellariae Radix), Ren Shen, Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Hua Shi (Talcum), Mu Tong (Akebiae Caulis), and Ze Xie (Alismatis Rhizoma). Urine was passed twice after taking this. In the afternoon, he felt slight fever and facial flushing, with pain and heaviness in the forehead. (Note by Li: This is due to the qi-stagnating nature of Bai Zhu.) Yi Yuan San (Quintessential Powder) 3 qian was administered, resulting in one bowel movement; the stool was loose and yellow, but the fever remained intense and the face red. Upon re-examination, the Cun (Inch) and Guan (Bar) positions of the pulse were harmonizing, while both Chi (Cubit) positions were surging and large. (Note by Li: This demonstrates the effect of Liu Yi San (Six-to-One Powder) in guiding heat downward.) It was determined that the heat resided in the Lower Jiao (Lower Burner), so treatment focused on promoting diuresis. Another 5 qian of Yi Yuan San was given. Thirst subsided slightly, the lower part of the teeth became moist, but the upper part remained dry; he was comatose, sleeping but unrousable. The heat was identified as affecting the Xin Bao Luo (Pericardium Collateral), so Dao Chi San (Guide Out Redness Powder) was administered. After two doses, mental clarity returned. However, urine volume remained low, so Si Ling San (Four-Mushroom Powder) combined with Jiu Lian (Wine-processed Coptidis Rhizoma) and Mu Tong was given. After two doses, all symptoms resolved.
The servant of Wu Xin Yi suffered from frontal headache, extreme thirst, high fever, profuse sweating, chest fullness, nausea, and lethargy. Sun prescribed Chai Ling Tang (Bupleurum and Poria Decoction) with Zhi Ke (Aurantii Fructus) and Jie Geng (Platycodonis Radix). The fever decreased by more than half. The next day, Liu Jun Zi Tang (Six Gentlemen Decoction) with Huang Qin and Bai Shao was used for regulation, leading to recovery. This was a Taiyang (Greater Yang) syndrome caused by fatigue and overexertion, thus requiring initial dispersal followed by tonification.
Zhou Jian Quan's wife suffered from Taiyang syndrome with fever, delirium, thirst, cough, chest and diaphragm pain, diarrhea, vomiting, generalized macules, and a surging, slippery pulse in all six positions. This is a combined syndrome of Shaoyang and Yangming. Sheng Ma Ge Gen Tang (Ephedra and Kudzu Root Decoction) with Hua Shi and Wu Wei Zi (Schisandrae Chinensis Fructus) was administered. After taking it, profuse sweating occurred, the fever subsided, and mental clarity returned. Subsequently, Chai Ling Tang with Wu Wei Zi and Hua Shi was given, stopping the diarrhea. On the next day, the left pulse was harmonious, and the right pulse had converged slightly. The prescription shifted to focus on Bai Shao, combined with Chen Pi (Citri Reticulatae Pericarpium), Chai Hu, Jiu Huang Qin (Wine-processed Scutellariae Radix), Wu Wei Zi, Mu Li (Ostreae Concha), Hua Shi, Fu Ling, Ze Xie, and Bai Zhu. After four doses, the patient stabilized.
Chen Mao Zhi, after fatigue, engaged in excessive sexual activity, leading to depletion of essence and blood, followed by exposure to wind-cold. Symptoms included fever, headache, and chest/diaphragm fullness. The pathogen initially transmitted from Taiyang to Shaoyang, presenting with chest and hypochondriac pain, deafness, vomiting, bitter taste, cough, and a wiry, rapid pulse in all six positions. This is a Shaoyang syndrome. Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Zhi Ke, Jie Geng, and Zhu Ru (Bambusae Caulis in Taenia) was used, stopping the vomiting. Because porridge was consumed too early, fever and thirst recurred, along with difficulty urinating. Bowel movements occurred six to seven times in a day and night, consisting entirely of clear water. Fever intensified in the late afternoon, with a yellow coating on the tongue, lethargy, and tremors. This indicates recurrence due to improper diet (Shi Fu). Zhu Ling (Polypori Umbilicati Sclerotium) and Ze Xie each 3 qian, Chi Fu Ling (Red Poria) 1 qian, Chai Hu 8 fen, Sheng Ma and Mu Tong each 5 fen were administered continuously for two doses. Urination improved, and stools formed. However, fever persisted. One dose of Liu Shen Tong San Jie San (Six-Way Unblocking Decoction) was given, but the fever remained unchanged. On the next day, the left pulse was no longer wiry and rapid, but both Cun pulses remained the same. There was no sweat after medication, thirst was present, and the patient wanted to rinse the mouth with water but did not wish to swallow. This indicates pathogenic heat transmitting to the Yangming channel. If blood-cooling is not performed urgently, epistaxis (Bi Ni) will occur. Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction) combined with Sheng Mai San (Generate the Pulse Powder) was used to stop cough and thirst, and Ge Gen Tang (Kudzu Root Decoction) was used to release the muscle layer. The prescription included: Bai Shao 3 qian, Ge Gen, Sheng Ma, and Huang Qin each 1 qian, Ren Shen 1.5 qian, Mai Dong (Ophiopogonis Radix) and Hua Shi each 3 qian, Gan Cao (Glycyrrhizae Radix et Rhizoma) and Wu Wei Zi each 5 fen, and W Mei (Mume Fructus) one piece. After two doses, several hard fecal pellets were passed, slight sweating occurred, sound sleep was achieved, and recovery followed after consuming porridge.
Lady Pang suffered from headache, aversion to cold, chest and diaphragm oppression and pain, and alternating chills and fever. She was treated with Si Wu Tang (Four Substances Decoction) plus Yan Hu Suo (Corydalis Rhizoma), Dan Pi (Moutan Cortex), and Xiang Fu (Cyperi Rhizoma) for five days without improvement. Sun examined her pulse: the right side was slippery and large, the left side was floating, wiry, and rapid. He stated: Headache and aversion to cold are external contraction symptoms; floating, wiry, and rapid pulse with chest oppression and pain indicate complete Shaoyang pulse and symptom presentation; the slippery right pulse indicates food stagnation generating phlegm. Si Wu Tang consists of herbs that stagnate phlegm and close qi; while suitable for internal injury, they cannot expel external pathogens. Therefore, Chai Hu Tang combined with Ping Wei San (Peaceful Stomach Powder) was administered, resulting in cure after one dose.
An old servant suffered from headache, generalized joint pain, dark complexion, fever, thirst, chest distension, and inability to eat for seven days. He contracted cold again. The left pulse was wiry and rapid, the right pulse was surging and large. He was given Huo Xiang (Agastaches Herba), Cang Zhu (Atractylodis Rhizoma), Fang Feng (Saposhnikoviae Radix), Ge Gen, Bai Zhi (Angelicae Dahuricae Radix), Zi Su (Perillae Folium), Gan Cao, Chen Pi, Da Fu Pi (Arecae Pericarpium), Mai Ya (Hordei Fructus Germinatus), and Zhi Shi (Aurantii Fructus Immaturus). After administration, the chest felt slightly relieved, but fever and pain worsened. The prescription was changed to Ma Huang (Ephedrae Herba), Ge Gen, and Chai Hu each 2 qian, Shi Gao and Hua Shi each 3 qian, Zi Su, Cang Zhu, and Bai Zhi each 1 qian, Gan Cao 5 fen, and three slices of Jiang (Zingiberis Rhizoma Recens). After taking it, profuse sweating occurred, and fever and pain disappeared. Only thirst remained. He was then treated with Bai Shao, Dang Gui (Angelicae Sinensis Radix), Shi Gao, Zhi Mu (Anemarrhenae Rhizoma), Chai Hu, Huang Qin, Mai Dong, Ge Gen, and Chen Pi, leading to recovery. This was a combined syndrome of the Three Yang channels, initially injured by diet. Thus, Huo Xiang Zheng Qi Tang (Agastache Regulating Qi Decoction) with digestive aids was used to assist the interior, and Liu Shen Tong San Jie San with exterior-releasing herbs was used to treat the exterior manifestation. Although the disease was severe and the patient elderly, the harmony between complexion and pulse ensured an easy recovery.
Cai Zhong Lin's wife suffered from fever, thirst, dry and cracked tongue, lower abdominal pain, and vomiting, unable to take medicine or food for seven days. The right Cun pulse was absent, the Guan pulse was deep, slippery, and forceful, and the left hand pulse was wiry and rapid. This is a combined syndrome of Yangming and Shaoyang, with pathogenic heat congested in the Upper Jiao (Upper Burner). Soft Chai Hu and Shi Gao each 5 qian, Ban Xia Qu (Pinelliae Fermentatum), Huang Qin, Huang Lian (Coptidis Rhizoma), Ge Gen, Zhu Ru, and Ren Shen each 2 qian, with three slices of Jiang were administered. At dawn, several pieces of black stool were passed, and pain and fever reduced by half. The next day, the same prescription was continued, and the right Cun pulse recovered. The formula was changed to Xiao Chai Hu Tang with Ju Hong (Citri Reticulatae Pericarpium Rubrum), Zhu Ru, and Ge Gen. After three doses, full health was restored.