春温3(重感冒)
庞某某，女，80岁
初诊
素嗜鸦片烟已30余载，经常便秘，大便7～8日一行。自4月28日感受风温邪气，身热咳嗽，咽红肿痛，经中西医治疗十天未见好转。目前身热未退，体温38.3℃，两脉细弦小滑，按之细数，头晕心烦，身热腹满，口干唇焦，咽干微痛，舌苔黄厚干燥，焦黑有裂痕，精神萎靡，一身乏力。老年阴分素亏，久吸鸦片，虚火更甚，津液早亏，病温将及半月，阴液更伤。老年正气不足，热结阴伤，燥屎内结。必须急攻其邪以祛其热，扶其气分防止虚脱，仿新加黄龙汤以攻补兼施。
鲜生地60克，生甘草10克，元参25克，麦门冬15克，赤白芍各25克，当归10克，生大黄末1.2克和元明粉1.5克共研细末冲服，人参25克(另煎兑入)，一付
服药约两小时，侯腹中有动静，或转矢气者，为欲便也。在便前另服：已煎好之人参汤25克，西洋参粉4.5克，调匀分服，再去厕所，以防虚脱。
服汤药后约二小时，腹中痛，意欲大便，即先服人参汤送西洋参4.5克，再去排便，数分钟后，大便畅解甚多，病人微觉气短，又服人参汤少许，即复入睡。
二诊
昨日服新加黄龙汤，大便已通，未出现虚脱症状，这是在气阴两虚之人身上用攻补兼施方法的成功例证。药后患者静睡通宵，今诊两脉细弱无力，身热已退净，体温36.7℃，腹满头晕心烦皆减，舌苔焦黑干裂已除，仍属黄厚近焦，自觉一身疲惫异常。老年病温已久，重伤津液，一时难以恢复，再以甘寒育阴以折虚热，甘微温益气兼扶中阴，饮食寒暖，皆宜小心。
海参片15克(先煎)，沙参30克，元参30克，麦门冬25克，黄精25克，鲜石斛30克，生白芍30克，生熟地各25克，西洋参粉10克(分三次药汁送下)，二付
三诊
连服甘寒育阴兼以益气之后，气阴皆复，患者烧势未作，已能进食少许，舌苔渐化而根部略厚，夜寐较安，且小溲渐多，再以养血育阴兼扶脾胃。
西洋参粉10克(分三次服)，南北沙参30克，生白芍30克，元参30克，麦门冬25克，莲子肉25克，生地黄30克，南百合25克，怀山药30克，炒薏米30克，甜杏仁10克，三付
四诊
服甘寒育阴兼扶脾胃之后，近几天来，精神渐复，饮食渐增，昨日(19日)大便又解一次，初硬而后调，舌苔已化，根部略厚，两脉细弱小措。年已八旬，气阴早亏，又嗜鸦片，阴液消耗过甚，病温半月，正气虚损过度，再以育阴养荣，调理脾胃。
前方继进三付。
五诊
一周来，精神恢复接近正常，已能下地活动，胃纳渐开，夜寐亦安，面色已润泽，舌苔基本正常。嘱其每日进薏苡百合粥，午服山药粥，晚吃桂元肉汤，调养半月而愈。
[按]：老年春月患温，身热不退，迁延日久，阴津大伤矣。舌苔焦黑干裂，燥屎结于腑中，久不能下，热愈结，津愈伤，燥屎一日不去，发热一日不退，终致阴涸而亡，诚可忧也。故仲景有急下存阴之法。然年高体弱病久，难当峻攻，若径用承气法，恐便下之即，便是气脱之时。吴鞠通于此证有新加黄龙汤，仿陶节庵黄龙汤意，攻补兼施，用人参补正，硝黄逐邪，地冬增液。立意颇为周到。赵师运用此法又有所创新，妙在人参另燉浓煎，送服西洋参粉。其服药时间掌握在服汤药后欲排便之时，以二参大补元气，元气足自可运药力攻邪排便，则扶正不虑其恋邪，通便而不虑其气脱。此攻补分投，亦攻补兼施之一法口此法之运用贵在掌握时机，可谓早一刻不可，晚一刻不及。非富有经验而又深虑巧思者不能如此出奇制胜也。此案另当着眼者乃组方之巧，重用增液，微用硝黄，况其年高阴伤，无水舟停，自当增水行舟，不可孟浪峻下也。
暑温1(感冒合并心衰)
钱某某，男，51岁
初诊
两天来身热头晕，阵阵恶寒，右脉洪大而数，左手略小，面赤口渴，头面汗出较多，昨服藿香正气散加减方，藿香10克，苏叶6克，佩兰叶10克，半夏10克，白术6克，厚朴6克，白芷6克，生姜三片，大枣五枚，一付。
服药后汗出更多，夜问四肢发冷，今晨面色苍白，两脉虚大而芤，遍体汗出，口渴欲饮，心慌气短，神志欠清，喘息气急，舌苔白腻。此暑温热蕴，津液大伤，本当益气兼以折热，误服辛散伤棒之品，急于益气生津，达热出表，防其神昏致厥。
生石膏30克(先煎)，知母15克，生甘草10克，梗米30克，生黄芪30克，五味子10克，西洋参粉6克，即刻先服一付
二诊
药后汗出已止，身热渐退，口渴喘息皆止，已能安眠，小溲甚少，两脉已由虚大而芤转为细弱小滑，头面汗出甚少，面仍略红，口干渴亦见缓解。暑温误汗之后，正气大伤，津液过耗，昨服益气生津之品，虽见小效，尚不足恃，再以甘温益气，甘寒生津，兼以祛暑，以观其后。原方减石膏为15克，加党参12克，二付
三诊
前药连投两剂之后，身热已退净而汗出亦止，喘息已平，口仍干渴，面色正常，精神好，两脉细弱且滑，大便通而小溲渐利。暑温误汗之后，气津皆伤，今观舌质偏红，苔白略干，虽汗止气复，然阴津尚未全复，改用甘寒益气，兼祛虚热。饮食当慎，生冷粘甜皆忌。
北沙参25克，太子参10克，生黄芪18克，五味子10克，麦门冬12克，生白芍25克，鲜荷叶半张(撕碎入煎)，二付
上药续服二付，诸症悉平，食眠均佳，舌脉如常。再休息一周而恢复正常工作。
[按]；叶氏云：夏温发自阳明。其为热盛之证明矣。然暑热易伤气津，故当主以白虎加人参汤。此例患者病暑温初用藿香正气发散太过，致汗出不止。汗多气津更伤，遂致致心悸气促，神疲脉芤，乃厥脱在即之象。急用西洋参粉即刻吞服，以固元气，继以白虎汤加黄芪、五味子益气敛津固脱。二诊加党参，三诊易为太子参，可见虽益气一法，亦须随证变药，此间细微功夫，正须吾辈着眼处。此案初诊用西洋参粉6克吞服最为关键之招。告诉我们，危急之证须以抢时机最为紧要。若缓缓坐等汤药煎成，恐已坐失良机矣。
暑温2(流行性乙型脑炎合并剥脱性肠炎)
陈某某，女，58岁
初诊
初起发热恶寒，体温38～39℃，汗出，时有恶心，二天后开始神志不清，烦躁谵语，颈部有抵抗，查脑脊液wBc 23，单核9；入院即给常规抗菌素治疗。第三天开始腹泻，便培养金黄色葡萄球菌。诊为乙脑并发剥脱性肠炎，治疗无效，并产生霉菌，遂邀赵师会诊。
一诊
身热不退，神识昏沉，大便作泄，色黄气臭，小便黄步，舌绛龟裂，苔焦黄唇燥，脉细数。
辨证；此为暑热久蕴入营，蒙蔽心包，且积滞互阻，湿热下迫。气热复炽，营阴已伤。治宜清营养阴，开窍透热。
处方：葛根4 5克，黄芩9克，黄连4.5克，甘草3克，生石膏30克，竹茹6克，菖蒲4 5克，部金6克，鲜石斛15克，紫雪丹3克(分服)，二付
二诊
药后热退泄止，神志转清，溲黄，舌干红，苔已渐化，脉弦滑略数。以扶正养阳，清泄余热而愈。
原按：本证为乙脑重证并发剥脱性肠炎，属中医暑热挟湿。暑热久蕴，营阴已伤。热势深重，蒸湿炼液为痰，蒙蔽心包，且气热炽盛，积滞互阻，湿热下迫。上有内窍堵闭，下有湿热阻滞于肠，气机不畅；又日气热复炽，热邪源源不断由气直涌营中澈以白虎清气热，葛根芩连清利肠热；菖蒲、郁金配紫雪丹清心涤痰开窍，甘草、滑石、竹叶通利三焦，“排除造成营热不能外达的原因，使气机通畅，开营热外达之路。服后热退，泄止神清，为营热外透。舌干红溲黄，为营阴既伤，余热未清，故以养阴清泄余热法而愈。
[按]：此为以透热转气法救治暑温神昏重症。此证神昏与大肠湿热积滞有关，故用葛根黄连汤合菖蒲、郁金、紫雪，坚肠止利与清心开窍并举，又用滑石、竹叶通利水道，则三焦通畅，故收热退神清利止之效。
暑温3(流行性乙型脑炎)
吴某某，男，15岁
初诊
发热4～5天，两天来加重，体温39.7℃，头晕恶心，呕吐颈强，神昏谵语，大便已两日未通，舌绛苔黄厚，小便短少，两脉沉滑濡数。此暑温湿热逆传心包，姑以芳香化湿，凉营开窍泄热方法：
佩兰12克(后下)，藿香9克(后下)，生石膏25克，连翘9克，竹叶茹各10克，菖蒲6克，郁金10克，黄连6克，银花15克，半夏12克，六一散12克(布包)，紫雪丹6克(分两次服)，服二付。
即刻煎服一付，随即送某医院检查，并做腰穿，诊断为乙型脑炎，当晚又服第二剂汤药，
二诊
今晨大便畅泄两次，且色深气臭甚多，身热已退，神志转清，体温正常，想吃东西，舌微黄质红，脉濡滑。停药观察，数日后出院。
三诊
身热已退，体温正常，无恶心呕吐，舌苔已化，浮而略黄，脉濡滑且弱，再以养阴清热兼助消化方法。
北沙参24克，麦门冬10克，连翘10克，元参10克，焦三仙各10克，鸡内金10克，茅芦根各24克，服三付药后已愈。
原接：本案为暑温湿热逆传心包。因湿热阻滞，气机不畅，郁热日深，热蒸湿浊，遂成痰热，外阻气机，内闭心包，且大便两日未通，腑气不畅，心包之热外达之路不通，欲使营热外透，急当宣畅气机，故以紫雪丹清心开窍，且通腑泻热，又以芳香之品化湿开郁，宣畅气机，辛凉清气而透热外达。使内窍开而腑气通，湿化而气机畅，气得展布，心包之热随便下泄外透而去，故神清热退知饥，再以养阴清热调理而安。
[按]：此亦透热转气案。用药奥妙已见于原按语中。用芳香宣化、清心开窍后，得大便畅行，瘀热得下，即神清热退。说明三焦通畅，气机调畅在温病治疗中多么重要。另，治疗急重温病，不可拘于一日一剂二煎之法，服药宜促其问，如日三夜二，或4小时一服，务使药力接续，方克有济。
暑湿(胃肠型感冒)
王某某，女，41岁
初诊
身热四五日，头晕且沉，微有憎寒，胸闷泛呕，呕吐恶心，舌白苔腻根厚，两脉濡滑而数，大便溏薄，小便短赤，暑热挟湿互阻不化，拟以芳香疏化方法，防其湿热增重，饮食寒暖诸宜小心。
鲜佩兰10克(后下)，鲜藿香10克(后下)，大豆卷10克，前胡3克，半夏10克，厚朴5克，竹茹10克，陈皮6克，马尾连10克，芦根30克，六一散10克(布包)，鲜荷叶一角，白蔻仁末1克(冲)，二付
二诊
药后身热憎寒皆解，呕吐止而胸闷亦轻，胃纳渐开，小溲如常，暑湿难解而苔腻根厚，大便未行，再妨前方增损之。
原方加鸡内金10克，焦麦芽10克。又二付，而告痊愈。
[按]：暑月湿热俱重，感之者多病暑湿，胸脘痞闷，泛恶欲呕，是其症也。暑热挟湿，互阻不化，须忌寒凉，治当芳香疏化，分消其邪，故用鲜藿佩、大豆卷、前胡芳化于上焦，陈、夏、朴、蔻辛开于中焦，芦根、六一散导湿于下焦，马尾连、鲜荷叶、竹茹清暑热，兵分数路，各奏其功，故可收桴鼓之效。
湿阻(胃肠型感冒
张某某，男，65岁
初诊
雨后天晴，暑热湿动，起居不慎，感邪致病。今觉身热头晕，胸脘满闷，周身酸楚乏力，微有恶心，胃不思纳。大便尚可，小溲不畅，舌白苔腻，脉象濡软略滑。病属暑热外迫，湿阻中、上焦，气机不畅，法当芳香宣化，辛开苦泄。
鲜佩兰10克(后下)，鲜藿香10克(后下)，大豆卷10克，制厚朴6克，陈皮6克，川连3克，六一散10克(布包)，一付
二诊
药后遍体小汗，身热渐退，头晕已减，身酸楚亦轻。但中脘仍闷，略有恶心，舌白苔腻，脉象濡滑，再以前方增损之。
原方加草蔻1克，杏仁10克，连服三付而愈。
[按]：湿热证一般分为湿阻、凉遏、寒凝、冰伏四个阶段治疗。这是赵师家传的独到经验验，湿阻为初起阶段，湿邪偏盛，阻滞于中上二焦，尚未化热，或虽热而不盛。在上焦肺先受邪，湿阻于肺则肺气不利，清阳不升，则头晕头沉重如裹；肺合皮毛，营卫不和，则周身沉困酸楚；肺失宣降则咳嗽、胸闷，甚或作喘滞之当芳香宣化，以展气机，气化则湿亦化，此治湿阻于肺之要诀也，药如前胡、杏仁、浙贝母、芦根之属。若湿阻滞中焦，则升降之机枢失司，此必素体太阴内伤，脾虚湿盛之人，客邪外至，与内湿相合，困阻脾胃，则成中焦湿阻之证，多见胸脘痞闷不舒，呕恶纳呆，大便溏而不爽，伴见一身倦怠乏力，四肢沉重，无力以动等证。湿阻中焦当以运脾气为主，脾主升清降浊，职司运化，故药宜灵动，忌守中，用辛开苦降法，辛开气机，以化湿邪，苦以燥湿泄热，则湿热分消而去。药如半夏、陈皮、厚朴、苦仁、大腹皮、黄芩、黄连等，并须注意芩连等苦寒之药用量宜轻，以防过用伤阳。凡湿阻之证，无问邪在中焦上焦，其脉象多呈濡软缓滑之象，舌苔白腻润滑，是湿盛之征也。有此舌脉，即为湿阻之征象，皆当先治其湿，不可过用寒凉，侯湿化再泄其热可也。此案即典型的湿阻之证，邪在中上二焦，故用药以芳香宣化与辛开苦降同投，气机畅行，湿邪自化而证愈矣。
【背景信息】
书名：赵绍琴临证验案精选上 章节：正文(3/33) 类别：综合
春温（春季发生的温热病，相当于重感冒）
庞某某，女，80岁
初诊
平时嗜好吸食鸦片已有三十多年，经常便秘，大便7～8日一行。自4月28日感受风温邪气，出现身热咳嗽、咽红肿痛，经中西医治疗十天未见好转。目前身热未退，体温38.3℃，两脉细弦小滑，按之细数，头晕心烦，身热腹满，口干唇焦，咽干微痛，舌苔黄厚干燥，焦黑有裂痕，精神萎靡，一身乏力。老年人阴分素来亏虚，长期吸食鸦片，虚火更甚，津液早已亏损，患温病将近半月，阴液更加受伤。老年人正气不足，热结阴伤，燥屎内结。必须急攻其邪以祛除热邪，扶助气分以防止虚脱，仿照新加黄龙汤法以攻补兼施。
鲜生地60克，生甘草10克，元参25克，麦门冬15克，赤白芍各25克，当归10克，生大黄末1.2克和元明粉1.5克共研细末冲服，人参25克(另煎兑入)，一付
服药约两小时，如果腹中有动静，或转矢气者，为欲便也。在便前另服：已煎好之人参汤25克，西洋参粉4.5克，调匀分服，再去厕所，以防虚脱。
服汤药后约二小时，腹中痛，意欲大便，即先服人参汤送西洋参4.5克，再去排便，数分钟后，大便畅解甚多，病人微觉气短，又服人参汤少许，即复入睡。
二诊
昨日服新加黄龙汤，大便已通，未出现虚脱症状，这是在气阴两虚之人身上用攻补兼施方法的成功例证。药后患者静睡通宵，今诊两脉细弱无力，身热已退净，体温36.7℃，腹满头晕心烦皆减，舌苔焦黑干裂已除，仍属黄厚近焦，自觉一身疲惫异常。老年病温已久，重伤津液，一时难以恢复，再以甘寒育阴以折虚热，甘微温益气兼扶中阴，饮食寒暖，皆宜小心。
海参片15克(先煎)，沙参30克，元参30克，麦门冬25克，黄精25克，鲜石斛30克，生白芍30克，生熟地各25克，西洋参粉10克(分三次药汁送下)，二付
三诊
连服甘寒育阴兼以益气之后，气阴皆复，患者烧势未作，已能进食少许，舌苔渐化而根部略厚，夜寐较安，且小溲渐多，再以养血育阴兼扶脾胃。
西洋参粉10克(分三次服)，南北沙参30克，生白芍30克，元参30克，麦门冬25克，莲子肉25克，生地黄30克，南百合25克，怀山药30克，炒薏米30克，甜杏仁10克，三付
四诊
服甘寒育阴兼扶脾胃之后，近几天来，精神渐复，饮食渐增，昨日(19日)大便又解一次，初硬而后调，舌苔已化，根部略厚，两脉细弱小措。年已八旬，气阴早亏，又嗜鸦片，阴液消耗过甚，病温半月，正气虚损过度，再以育阴养荣，调理脾胃。
前方继进三付。
五诊
一周来，精神恢复接近正常，已能下地活动，胃纳渐开，夜寐亦安，面色已润泽，舌苔基本正常。嘱其每日进薏苡百合粥，午服山药粥，晚吃桂元肉汤，调养半月而愈。
[按]：老年春月患温，身热不退，迁延日久，阴津大伤矣。舌苔焦黑干裂，燥屎结于腑中，久不能下，热愈结，津愈伤，燥屎一日不去，发热一日不退，终致阴涸而亡，诚可忧也。故仲景有急下存阴之法。然年高体弱病久，难当峻攻，若径用承气法，恐便下之即，便是气脱之时。吴鞠通于此证有新加黄龙汤，仿陶节庵黄龙汤意，攻补兼施，用人参补正，硝黄逐邪，地冬增液。立意颇为周到。赵师运用此法又有所创新，妙在人参另燉浓煎，送服西洋参粉。其服药时间掌握在服汤药后欲排便之时，以二参大补元气，元气足自可运药力攻邪排便，则扶正不虑其恋邪，通便而不虑其气脱。此攻补分投，亦攻补兼施之一法口此法之运用贵在掌握时机，可谓早一刻不可，晚一刻不及。非富有经验而又深虑巧思者不能如此出奇制胜也。此案另当着眼者乃组方之巧，重用增液，微用硝黄，况其年高阴伤，无水舟停，自当增水行舟，不可孟浪峻下也。
暑温1(感冒合并心衰)
钱某某，男，51岁
初诊
两天来身热头晕，阵阵恶寒，右脉洪大而数，左手略小，面赤口渴，头面汗出较多，昨服藿香正气散加减方，藿香10克，苏叶6克，佩兰叶10克，半夏10克，白术6克，厚朴6克，白芷6克，生姜三片，大枣五枚，一付。
服药后汗出更多，夜问四肢发冷，今晨面色苍白，两脉虚大而芤，遍体汗出，口渴欲饮，心慌气短，神志欠清，喘息气急，舌苔白腻。此暑温热蕴，津液大伤，本当益气兼以折热，误服辛散伤棒之品，急于益气生津，达热出表，防其神昏致厥。
生石膏30克(先煎)，知母15克，生甘草10克，梗米30克，生黄芪30克，五味子10克，西洋参粉6克，即刻先服一付
二诊
药后汗出已止，身热渐退，口渴喘息皆止，已能安眠，小溲甚少，两脉已由虚大而芤转为细弱小滑，头面汗出甚少，面仍略红，口干渴亦见缓解。暑温误汗之后，正气大伤，津液过耗，昨服益气生津之品，虽见小效，尚不足恃，再以甘温益气，甘寒生津，兼以祛暑，以观其后。原方减石膏为15克，加党参12克，二付
三诊
前药连投两剂之后，身热已退净而汗出亦止，喘息已平，口仍干渴，面色正常，精神好，两脉细弱且滑，大便通而小溲渐利。暑温误汗之后，气津皆伤，今观舌质偏红，苔白略干，虽汗止气复，然阴津尚未全复，改用甘寒益气，兼祛虚热。饮食当慎，生冷粘甜皆忌。
北沙参25克，太子参10克，生黄芪18克，五味子10克，麦门冬12克，生白芍25克，鲜荷叶半张(撕碎入煎)，二付
上药续服二付，诸症悉平，食眠均佳，舌脉如常。再休息一周而恢复正常工作。
[按]；叶氏云：夏温发自阳明。其为热盛之证明矣。然暑热易伤气津，故当主以白虎加人参汤。此例患者病暑温初用藿香正气发散太过，致汗出不止。汗多气津更伤，遂致致心悸气促，神疲脉芤，乃厥脱在即之象。急用西洋参粉即刻吞服，以固元气，继以白虎汤加黄芪、五味子益气敛津固脱。二诊加党参，三诊易为太子参，可见虽益气一法，亦须随证变药，此间细微功夫，正须吾辈着眼处。此案初诊用西洋参粉6克吞服最为关键之招。告诉我们，危急之证须以抢时机最为紧要。若缓缓坐等汤药煎成，恐已坐失良机矣。
暑温2(流行性乙型脑炎合并剥脱性肠炎)
陈某某，女，58岁
初诊
初起发热恶寒，体温38～39℃，汗出，时有恶心，二天后开始神志不清，烦躁谵语，颈部有抵抗，查脑脊液wBc 23，单核9；入院即给常规抗菌素治疗。第三天开始腹泻，便培养金黄色葡萄球菌。诊为乙脑并发剥脱性肠炎，治疗无效，并产生霉菌，遂邀赵师会诊。
一诊
身热不退，神识昏沉，大便作泄，色黄气臭，小便黄步，舌绛龟裂，苔焦黄唇燥，脉细数。
辨证；此为暑热久蕴入营，蒙蔽心包，且积滞互阻，湿热下迫。气热复炽，营阴已伤。治宜清营养阴，开窍透热。
处方：葛根4 5克，黄芩9克，黄连4.5克，甘草3克，生石膏30克，竹茹6克，菖蒲4 5克，部金6克，鲜石斛15克，紫雪丹3克(分服)，二付
二诊
药后热退泄止，神志转清，溲黄，舌干红，苔已渐化，脉弦滑略数。以扶正养阳，清泄余热而愈。
原按：本证为乙脑重证并发剥脱性肠炎，属中医暑热挟湿。暑热久蕴，营阴已伤。热势深重，蒸湿炼液为痰，蒙蔽心包，且气热炽盛，积滞互阻，湿热下迫。上有内窍堵闭，下有湿热阻滞于肠，气机不畅；又日气热复炽，热邪源源不断由气直涌营中澈以白虎清气热，葛根芩连清利肠热；菖蒲、郁金配紫雪丹清心涤痰开窍，甘草、滑石、竹叶通利三焦，“排除造成营热不能外达的原因，使气机通畅，开营热外达之路。服后热退，泄止神清，为营热外透。舌干红溲黄，为营阴既伤，余热未清，故以养阴清泄余热法而愈。
[按]：此为以透热转气法救治暑温神昏重症。此证神昏与大肠湿热积滞有关，故用葛根黄连汤合菖蒲、郁金、紫雪，坚肠止利与清心开窍并举，又用滑石、竹叶通利水道，则三焦通畅，故收热退神清利止之效。
暑温3(流行性乙型脑炎)
吴某某，男，15岁
初诊
发热4～5天，两天来加重，体温39.7℃，头晕恶心，呕吐颈强，神昏谵语，大便已两日未通，舌绛苔黄厚，小便短少，两脉沉滑濡数。此暑温湿热逆传心包，姑以芳香化湿，凉营开窍泄热方法：
佩兰12克(后下)，藿香9克(后下)，生石膏25克，连翘9克，竹叶茹各10克，菖蒲6克，郁金10克，黄连6克，银花15克，半夏12克，六一散12克(布包)，紫雪丹6克(分两次服)，服二付。
即刻煎服一付，随即送某医院检查，并做腰穿，诊断为乙型脑炎，当晚又服第二剂汤药，
二诊
今晨大便畅泄两次，且色深气臭甚多，身热已退，神志转清，体温正常，想吃东西，舌微黄质红，脉濡滑。停药观察，数日后出院。
三诊
身热已退，体温正常，无恶心呕吐，舌苔已化，浮而略黄，脉濡滑且弱，再以养阴清热兼助消化方法。
北沙参24克，麦门冬10克，连翘10克，元参10克，焦三仙各10克，鸡内金10克，茅芦根各24克，服三付药后已愈。
原接：本案为暑温湿热逆传心包。因湿热阻滞，气机不畅，郁热日深，热蒸湿浊，遂成痰热，外阻气机，内闭心包，且大便两日未通，腑气不畅，心包之热外达之路不通，欲使营热外透，急当宣畅气机，故以紫雪丹清心开窍，且通腑泻热，又以芳香之品化湿开郁，宣畅气机，辛凉清气而透热外达。使内窍开而腑气通，湿化而气机畅，气得展布，心包之热随便下泄外透而去，故神清热退知饥，再以养阴清热调理而安。
[按]：此亦透热转气案。用药奥妙已见于原按语中。用芳香宣化、清心开窍后，得大便畅行，瘀热得下，即神清热退。说明三焦通畅，气机调畅在温病治疗中多么重要。另，治疗急重温病，不可拘于一日一剂二煎之法，服药宜促其问，如日三夜二，或4小时一服，务使药力接续，方克有济。
暑湿(胃肠型感冒)
王某某，女，41岁
初诊
身热四五日，头晕且沉，微有憎寒，胸闷泛呕，呕吐恶心，舌白苔腻根厚，两脉濡滑而数，大便溏薄，小便短赤，暑热挟湿互阻不化，拟以芳香疏化方法，防其湿热增重，饮食寒暖诸宜小心。
鲜佩兰10克(后下)，鲜藿香10克(后下)，大豆卷10克，前胡3克，半夏10克，厚朴5克，竹茹10克，陈皮6克，马尾连10克，芦根30克，六一散10克(布包)，鲜荷叶一角，白蔻仁末1克(冲)，二付
二诊
药后身热憎寒皆解，呕吐止而胸闷亦轻，胃纳渐开，小溲如常，暑湿难解而苔腻根厚，大便未行，再妨前方增损之。
原方加鸡内金10克，焦麦芽10克。又二付，而告痊愈。
[按]：暑月湿热俱重，感之者多病暑湿，胸脘痞闷，泛恶欲呕，是其症也。暑热挟湿，互阻不化，须忌寒凉，治当芳香疏化，分消其邪，故用鲜藿佩、大豆卷、前胡芳化于上焦，陈、夏、朴、蔻辛开于中焦，芦根、六一散导湿于下焦，马尾连、鲜荷叶、竹茹清暑热，兵分数路，各奏其功，故可收桴鼓之效。
湿阻(胃肠型感冒
张某某，男，65岁
初诊
雨后天晴，暑热湿动，起居不慎，感邪致病。今觉身热头晕，胸脘满闷，周身酸楚乏力，微有恶心，胃不思纳。大便尚可，小溲不畅，舌白苔腻，脉象濡软略滑。病属暑热外迫，湿阻中、上焦，气机不畅，法当芳香宣化，辛开苦泄。
鲜佩兰10克(后下)，鲜藿香10克(后下)，大豆卷10克，制厚朴6克，陈皮6克，川连3克，六一散10克(布包)，一付
二诊
药后遍体小汗，身热渐退，头晕已减，身酸楚亦轻。但中脘仍闷，略有恶心，舌白苔腻，脉象濡滑，再以前方增损之。
原方加草蔻1克，杏仁10克，连服三付而愈。
[按]：湿热证一般分为湿阻、凉遏、寒凝、冰伏四个阶段治疗。这是赵师家传的独到经验验，湿阻为初起阶段，湿邪偏盛，阻滞于中上二焦，尚未化热，或虽热而不盛。在上焦肺先受邪，湿阻于肺则肺气不利，清阳不升，则头晕头沉重如裹；肺合皮毛，营卫不和，则周身沉困酸楚；肺失宣降则咳嗽、胸闷，甚或作喘滞之当芳香宣化，以展气机，气化则湿亦化，此治湿阻于肺之要诀也，药如前胡、杏仁、浙贝母、芦根之属。若湿阻滞中焦，则升降之机枢失司，此必素体太阴内伤，脾虚湿盛之人，客邪外至，与内湿相合，困阻脾胃，则成中焦湿阻之证，多见胸脘痞闷不舒，呕恶纳呆，大便溏而不爽，伴见一身倦怠乏力，四肢沉重，无力以动等证。湿阻中焦当以运脾气为主，脾主升清降浊，职司运化，故药宜灵动，忌守中，用辛开苦降法，辛开气机，以化湿邪，苦以燥湿泄热，则湿热分消而去。药如半夏、陈皮、厚朴、苦仁、大腹皮、黄芩、黄连等，并须注意芩连等苦寒之药用量宜轻，以防过用伤阳。凡湿阻之证，无问邪在中焦上焦，其脉象多呈濡软缓滑之象，舌苔白腻润滑，是湿盛之征也。有此舌脉，即为湿阻之征象，皆当先治其湿，不可过用寒凉，侯湿化再泄其热可也。此案即典型的湿阻之证，邪在中上二焦，故用药以芳香宣化与辛开苦降同投，气机畅行，湿邪自化而证愈矣。
Background Information:
Book: Selected Clinical Cases of Zhao Shaoqin (Volume 1)
Chapter: Main Text (3/33)
Category: Comprehensive
Spring Warmth (Warm disease occurring in spring, equivalent to severe cold)
Patient Pang, Female, 80 years old
First Visit
Habitually addicted to opium smoking for over 30 years, frequently suffering from constipation with bowel movements every 7-8 days. Since contracting wind-warmth pathogenic factor on April 28, experiencing fever, cough, red and swollen painful throat. After ten days of treatment by both Chinese and Western medicine, no improvement was seen. Currently, fever persists with a body temperature of 38.3°C. Both pulses are fine, wiry, small, and slippery, feeling rapid upon pressure. Symptoms include dizziness, irritability, abdominal fullness with fever, dry mouth and scorched lips, dry throat with slight pain. Tongue coating is yellow, thick, dry, scorched black with cracks. Mental state is listless, whole body feels weak. Elderly patients inherently lack Yin essence; long-term opium use exacerbates deficient fire, leading to early depletion of body fluids. Having suffered from warmth disease for nearly half a month, Yin fluids are further injured. Elderly individuals have insufficient healthy Qi; heat accumulation injures Yin, causing dry stool accumulation internally. It is necessary to urgently attack the pathogen to eliminate heat, support Qi level to prevent collapse, imitating the method of Xinjia Huanglong Decoction to combine attacking and tonifying.
Fresh Rehmanniae Radix (Sheng Dihuang) 60g, Raw Licorice Root (Sheng Gancao) 10g, Scrophulariae Radix (Yuanshen) 25g, Ophiopogonis Tuber (Maidong) 15g, Red and White Paeoniae Radix (Chibaishao) 25g each, Angelicae Sinensis Radix (Danggui) 10g, Raw Rhubarb Powder (Sheng Dahuang) 1.2g and Mirabilite Powder (Yuanmingfen) 1.5g ground together and taken with water, Ginseng (Renshen) 25g (decocted separately and mixed in), one dose.
Approximately two hours after taking the medicine, if there is movement in the abdomen or passing of gas, it indicates impending defecation. Before defecation, take separately: 25g of already decocted Ginseng soup and 4.5g of American Ginseng powder (Xiyangshen), mix well and take in divided doses, then go to the toilet to prevent collapse.
About two hours after taking the herbal decoction, abdominal pain occurs, indicating desire for defecation. First take Ginseng soup to deliver 4.5g of American Ginseng powder, then proceed to defecate. After several minutes, large amount of smooth defecation occurs. The patient feels slightly short of breath, takes a little more Ginseng soup, and falls back asleep.
Second Visit
Yesterday, after taking Xinjia Huanglong Decoction, bowel movement was unblocked without signs of collapse. This is a successful example of using combined attacking and tonifying methods in patients with Qi and Yin deficiency. After medication, the patient slept quietly through the night. Current pulse is fine, weak, and powerless. Fever has completely subsided, body temperature 36.7°C. Abdominal fullness, dizziness, and irritability have decreased. Scorched black cracked tongue coating has disappeared, remaining yellow and thick near scorched. Patient feels extreme fatigue. Elderly patients with prolonged warmth disease severely injure body fluids, which are difficult to recover quickly. Use sweet-cold methods to nourish Yin and reduce deficient heat, sweet-slightly-warm methods to tonify Qi and support middle Yin. Diet and temperature regulation require caution.
Sea Cucumber Slices (Haishenpian) 15g (decoct first), Glehniae Radix (Shashen) 30g, Scrophulariae Radix (Yuanshen) 30g, Ophiopogonis Tuber (Maidong) 25g, Polygonati Rhizoma (Huangjing) 25g, Fresh Dendrobii Caulis (Shihu) 30g, Raw White Peony Root (Baishao) 30g, Raw and Prepared Rehmanniae Radix (Shu Di) 25g each, American Ginseng Powder (Xiyangshen) 10g (taken in three doses with herbal juice), two doses.
Third Visit
After continuously taking sweet-cold Yin-nourishing and Qi-tonifying herbs, both Qi and Yin are restored. Fever does not recur, able to eat a little, tongue coating gradually transforms but root remains slightly thick, sleep at night is relatively peaceful, urine volume gradually increases. Further use blood-nourishing and Yin-nourishing methods while supporting Spleen and Stomach.
American Ginseng Powder (Xiyangshen) 10g (taken in three doses), Northern and Southern Glehniae Radices (Nanbeishashen) 30g, Raw White Peony Root (Baishao) 30g, Scrophulariae Radix (Yuanshen) 30g, Ophiopogonis Tuber (Maidong) 25g, Lotus Seeds (Lianziren) 25g, Fresh Rehmanniae Radix (Shengdihuang) 30g, Southern Lily Bulb (Nai Baihe) 25g, Huai Yam (Huai Shanyao) 30g, Stir-fried Coix Seed (Chao Yimi) 30g, Sweet Almond (Tian Xingren) 10g, three doses.
Fourth Visit
After taking sweet-cold Yin-nourishing and Spleen-Stomach supporting herbs, mental state gradually recovers, appetite increases. Yesterday (19th), had another bowel movement, initially hard then soft. Tongue coating has transformed, root slightly thick. Pulses are fine, small, and weak. At eighty years old, Qi and Yin were already deficient, compounded by opium addiction causing excessive consumption of Yin fluids. Having suffered from warmth disease for half a month, healthy Qi is excessively damaged. Continue with Yin-nourishing and Nutrient-supporting methods, regulating Spleen and Stomach.
Continue previous prescription for three doses.
Fifth Visit
Over the past week, mental state has recovered close to normal, able to get out of bed and move, stomach appetite gradually opens, sleep at night is peaceful, complexion is lustrous, tongue coating is basically normal. Instructed to consume Coix and Lily porridge daily, Yam porridge at noon, Longan meat soup at night. Recovered after half a month of recuperation.
[Commentary]: Elderly patients contracting warmth in spring with persistent fever over a long period suffer severe injury to Yin fluids. Scorched black cracked tongue coating indicates dry stool accumulated in the fu organs, unable to pass for a long time. Heat accumulates more, fluids injure more. As long as dry stool remains, fever persists, ultimately leading to Yin exhaustion and death, truly worrying. Thus, Zhang Zhongjing proposed the method of urgent purging to preserve Yin. However, elderly patients with weak constitutions and prolonged illness cannot withstand harsh purging. Directly using Chengqi methods risks Qi collapse immediately after defecation. Wu Jutong proposed Xinjia Huanglong Decoction for this condition, imitating Tao Jian'an's Huanglong Decoction idea, combining attacking and tonifying. Using Ginseng to tonify healthy Qi, Mirabilite and Rhubarb to expel pathogens, Rehmannia and Ophiopogon to increase fluids. The concept is quite thorough. Master Zhao innovated this method by stewing Ginseng separately for concentrated decoction to deliver American Ginseng powder. The timing of administration is crucial, taken when the patient desires defecation after taking the herbal decoction. These two Ginsengs greatly tonify Yuan Qi. With sufficient Yuan Qi, it can drive the medicinal power to attack pathogens and promote defecation. Thus, supporting healthy Qi does not worry about retaining pathogens, and promoting defecation does not worry about Qi collapse. This separate administration of attacking and tonifying is also a method of combined attacking and tonifying. The key to applying this method lies in mastering the timing; not a moment too early, not a moment too late. Only those rich in experience and deep in thoughtful strategy can achieve such unexpected victory. Another focus of this case is the cleverness of the prescription: heavily using fluid-increasing agents, lightly using Mirabilite and Rhubarb. Given the elderly patient's Yin injury and "waterless boat stopping," one should naturally "increase water to move the boat" and avoid rash harsh purging.
Summer Warmth 1 (Cold complicated by heart failure)
Patient Qian, Male, 51 years old
First Visit
For two days, fever, dizziness, intermittent aversion to cold. Right pulse is surging and rapid, left hand slightly smaller. Red face, thirst, excessive sweating on head and face. Yesterday took modified Huoxiang Zhengqi San: Agastaches Herba (Huoxiang) 10g, Perilla Leaf (Ziye) 6g, Eupatorium Leaf (Peilan Ye) 10g, Pinellia Tuber (Banxia) 10g, Atractylodis Rhizoma (Baizhu) 6g, Magnolia Bark (Houpo) 6g, Angelica Dahurica Radix (Baizhi) 6g, Ginger slices 3, Jujube fruits 5 pieces, one dose.
After taking the medicine, sweating increased more. At night, limbs became cold. This morning, complexion pale, pulses empty, large, and hollow (Kou). Sweating all over the body, thirst with desire to drink, palpitations, shortness of breath, unclear consciousness, panting and急促 breathing, white greasy tongue coating. This is Summer Warmth with heat accumulation, severely injuring body fluids. Originally should have tonified Qi and reduced heat. Mistakenly taking acrid-dispersing damaging substances, urgently tonifying Qi and generating fluids, driving heat out of the exterior, preventing coma and syncope.
Raw Gypsum (Sheng Shigao) 30g (decoct first), Anemarrhenae Rhizoma (Zhimu) 15g, Raw Licorice Root (Sheng Gancao) 10g, Rice (Gengmi) 30g, Astragali Radix (Huangqi) 30g, Schisandrae Fructus (Wuweizi) 10g, American Ginseng Powder (Xiyangshen) 6g, take one dose immediately.
Second Visit
After medication, sweating stopped, fever gradually subsided, thirst and panting ceased, able to sleep peacefully. Urine volume is very small. Pulses have changed from empty, large, and hollow to fine, small, and slippery. Sweating on head and face is minimal, face still slightly red, dry mouth and thirst alleviated. After mistaken sweating in Summer Warmth, healthy Qi is severely injured, fluids excessively consumed. Yesterday's intake of Qi-tonifying and fluid-generating herbs showed minor effect, but not enough to rely on. Further use sweet-warm methods to tonify Qi, sweet-cold methods to generate fluids, combined with dispelling summerheat, to observe subsequent developments. Reduce Raw Gypsum in original formula to 15g, add Codonopsis Radix (Dangshen) 12g, two doses.
Third Visit
After administering previous medicine for two doses, fever completely subsided and sweating stopped. Panting has leveled off, mouth still dry and thirsty, complexion normal, spirit good. Pulses are fine, weak, and slippery. Bowel movement unblocked, urine gradually flows freely. After mistaken sweating in Summer Warmth, both Qi and fluids are injured. Observing tongue body slightly red, coating white and slightly dry. Although sweating stopped and Qi recovered, Yin fluids are not fully restored. Change to sweet-cold Qi-tonifying and clearing deficient heat. Diet should be cautious, avoiding raw, cold, sticky, and sweet foods.
Northern Glehniae Radix (Beishashen) 25g, Pseudostellariae Radix (Taizishen) 10g, Astragali Radix (Huangqi) 18g, Schisandrae Fructus (Wuweizi) 10g, Ophiopogonis Tuber (Maidong) 12g, Raw White Peony Root (Baishao) 25g, Fresh Lotus Leaf (He ye) half sheet (torn and decocted), two doses.
Continuing to take the above medicine for two doses, all symptoms resolved, eating and sleeping excellent, tongue and pulse normal. Rest for another week to return to normal work.
[Commentary]: Ye Tianshi said: Summer warmth originates from Yangming. This proves it is a manifestation of intense heat. However, summerheat easily injures Qi and fluids, so Baihu Jia Renshen Tang should be the main treatment. This patient initially used Huoxiang Zhengqi San for Summer Warmth, dispersing too much, causing continuous sweating. Excessive sweating further injures Qi and fluids, leading to palpitations, shortness of breath, fatigue, and hollow pulse, indicating imminent collapse. Urgently take American Ginseng powder immediately to consolidate Yuan Qi, followed by Baihu Tang plus Astragalus and Schisandra to tonify Qi, retain fluids, and secure against collapse. Second visit added Codonopsis, third visit changed to Pseudostellaria. This shows that even in Qi-tonifying methods, herbs must change according to symptoms. This subtle skill requires our attention. The most critical move in this case was taking 6g of American Ginseng powder orally at the first visit. It tells us that in critical conditions, seizing the opportunity is paramount. If waiting slowly for the herbal decoction to brew, we may miss the golden opportunity.
Summer Warmth 2 (Japanese Encephalitis complicated by exfoliative enteritis)
Patient Chen, Female, 58 years old
First Visit
Initially fever and aversion to cold, body temperature 38-39°C, sweating, occasional nausea. Two days later, began unconsciousness, restlessness, delirium, neck resistance. Cerebrospinal fluid WBC 23, monocytes 9. Admitted and given routine antibiotics. Third day started diarrhea, stool culture positive for Staphylococcus aureus. Diagnosed as Japanese Encephalitis complicated by exfoliative enteritis. Treatment ineffective, fungal infection developed. Invited Master Zhao for consultation.
First Visit
Fever persists, consciousness dull, diarrhea with yellow foul-smelling stool, yellow urine, tongue crimson with turtle-shell cracks, scorched yellow coating, dry lips, fine rapid pulse.
Syndrome Differentiation: This is Summerheat lingering for a long time entering Ying level, clouding the Pericardium, with stagnation obstructing, damp-heat forcing downward. Qi heat flares up again, Ying Yin is injured. Treatment should clear Ying level, nourish Yin, open orifices, and vent heat.
Prescription: Puerariae Radix (Gegen) 4.5g, Scutellariae Radix (Huangqin) 9g, Coptidis Rhizoma (Huanglian) 4.5g, Licorice Root (Gancao) 3g, Raw Gypsum (Shigao) 30g, Bamboo Shavings (Zhuru) 6g, Acori Tatarinowii Rhizoma (Shichangpu) 4.5g, Curcumae Radix (Yujin) 6g, Fresh Dendrobii Caulis (Shihu) 15g, Zixue Dan 3g (taken in divided doses), two doses.
Second Visit
After medication, fever subsided, diarrhea stopped, consciousness cleared, yellow urine, dry red tongue, coating gradually transforming, wiry slippery slightly rapid pulse. Used supporting healthy Qi, nourishing Yang, clearing residual heat to cure.
Original Commentary: This syndrome is severe Japanese Encephalitis complicated by exfoliative enteritis, belonging to Summerheat-dampness in TCM. Summerheat lingers for a long time, Ying Yin is injured. Heat intensity is deep, steaming dampness into phlegm, clouding Pericardium. Qi heat is fierce, stagnation obstructs, damp-heat forces downward. Upper orifices blocked, lower damp-heat obstructs intestines, Qi mechanism unsmooth. Again, Qi heat flares, heat pathogen continuously surges from Qi directly into Ying. Use Baihu to clear Qi heat, Gegen Qinlian Tang to clear intestinal heat. Shichangpu and Yujin combined with Zixue Dan clear Heart, wash away phlegm, open orifices. Gancao, Talcum (Huashi), Bambusa Leaves (Zhuye) unblock Sanjiao. "Eliminate causes preventing Ying heat from reaching exterior, make Qi mechanism smooth, open path for Ying heat to reach exterior." After taking, fever subsides, diarrhea stops, consciousness clears, indicating Ying heat vents outward. Dry red tongue, yellow urine indicate Ying Yin injured, residual heat not cleared. Thus cured by nourishing Yin and clearing residual heat.
[Commentary]: This uses the method of venting heat to transform Qi to treat severe Summer Warmth with coma. This coma is related to Large Intestine damp-heat stagnation. Thus use Gegen Huanglian Tang combined with Shichangpu, Yujin, Zixue Dan. Firm intestine stop diarrhea and clear Heart open orifices simultaneously. Also use Talcum and Bambusa Leaves to unblock water passages, making Sanjiao smooth. Thus achieving fever subsiding, consciousness clearing, diarrhea stopping.
Summer Warmth 3 (Japanese Encephalitis)
Patient Wu, Male, 15 years old
First Visit
Fever for 4-5 days, worsening for two days, body temperature 39.7°C. Dizziness, nausea, vomiting, neck stiffness, coma, delirium. No bowel movement for two days. Tongue crimson, yellow thick coating. Urine short and scant. Pulses sunken, slippery, moist, rapid. This is Summer Warmth damp-heat counter-transmitting to Pericardium. Tentatively use aromatic damp-transforming, cooling Ying level, opening orifices, and draining heat method:
Eupatorium Herb (Peilan) 12g (added later), Agastaches Herba (Huoxiang) 9g (added later), Raw Gypsum (Shigao) 25g, Forsythiae Fructum (Lianqiao) 9g, Bamboo Leaves (Zhuye) and Bamboo Shavings (Zhuru) 10g each, Acori Tatarinowii Rhizoma (Shichangpu) 6g, Curcumae Radix (Yujin) 10g, Coptidis Rhizoma (Huanglian) 6g, Lonicerae Japonicae Flos (Jinyinhua) 15g, Pinellia Tuber (Banxia) 12g, Liuyi San 12g (wrapped in cloth), Zixue Dan 6g (taken in two doses), take two doses.
Decoct and take one dose immediately, then sent to hospital for examination and lumbar puncture. Diagnosed as Japanese Encephalitis. Took second dose of herbal medicine that night.
Second Visit
This morning, two smooth bowel movements, dark color, foul smell, large amount. Fever subsided, consciousness cleared, temperature normal, wants to eat. Tongue slightly yellow, red body, moist slippery pulse. Stop medication and observe. Discharged after several days.
Third Visit
Fever subsided, temperature normal, no nausea or vomiting. Tongue coating transformed, floating and slightly yellow. Pulse moist, slippery, and weak. Further use Yin-nourishing, heat-clearing, and digestion-assisting method.
Northern Glehniae Radix (Beishashen) 24g, Ophiopogonis Tuber (Maidong) 10g, Forsythiae Fructum (Lianqiao) 10g, Scrophulariae Radix (Yuanshen) 10g, Charred Three Immortals (Jiao Sanxian) 10g each, Chicken Gizzard Lining (Jineijin) 10g, Phragmitis Rhizome (Má Gēn) and Reishi Root (Lú Gēn) 24g each. Cured after taking three doses.
Original Commentary: This case is Summer Warmth damp-heat counter-transmitting to Pericardium. Due to damp-heat obstruction, Qi mechanism unsmooth, stagnant heat deepens daily. Heat steams damp turbidity, forming phlegm-heat. Exterior obstructs Qi mechanism, interior closes Pericardium. Bowel movement unblocked for two days, Fu Qi unsmooth, path for Pericardium heat to reach exterior blocked. To make Ying heat vent outward, urgently need to promote Qi mechanism. Thus use Zixue Dan to clear Heart and open orifices, and unblock Fu to drain heat. Also use aromatic substances to transform dampness and open depression, promote Qi mechanism, acrid-cool clear Qi and vent heat outward. Make internal orifices open and Fu Qi smooth, dampness transform and Qi mechanism smooth, Qi spreads, Pericardium heat drains down with stool and vents outward. Thus consciousness clears, fever subsides, hunger known. Further regulate with Yin-nourishing and heat-clearing to settle.
[Commentary]: This is also a case of venting heat to transform Qi. The subtlety of medication is seen in the original commentary. After using aromatic transformation and clearing Heart opening orifices, smooth bowel movement achieved, stasis-heat drained down, consciousness clears and fever subsides. This shows how important smooth Sanjiao and regulated Qi mechanism are in treating warm diseases. Additionally, in treating acute and severe warm diseases, do not stick to one dose twice a day. Medication should be frequent, e.g., three times day and two times night, or every 4 hours, ensuring medicinal power connects continuously to be effective.
Summer-Dampness (Gastrointestinal Cold)
Patient Wang, Female, 41 years old
First Visit
Fever for four to five days, dizziness and heaviness, slight aversion to cold, chest tightness and retching, vomiting and nausea. Tongue white coating greasy, root thick. Pulses moist, slippery, and rapid. Loose stools, short red urine. Summerheat-dampness mutually obstructing and not transforming. Plan to use aromatic dispersing-transforming method to prevent damp-heat worsening. Diet and temperature regulation require caution.
Fresh Eupatorium Herb (Peilan) 10g (added later), Fresh Agastaches Herba (Huoxiang) 10g (added later), Soybean Sprout (Dadoujuan) 10g, Peucedani Radix (Qianhu) 3g, Pinellia Tuber (Banxia) 10g, Magnolia Bark (Houpo) 5g, Bamboo Shavings (Zhuru) 10g, Citrus Reticulata Peel (Chenpi) 6g, Malian Lian 10g, Phragmitis Rhizome (Lugen) 30g, Liuyi San 10g (wrapped in cloth), Fresh Lotus Leaf corner, White Cardamom Seed Powder (Baokouren) 1g (mixed in), two doses.
Second Visit
After medication, fever and aversion to cold resolved, vomiting stopped, chest tightness lightened. Stomach appetite gradually opens, urine normal. Summer-dampness difficult to resolve, greasy root thick coating, no bowel movement. Further modify previous prescription.
Add Chicken Gizzard Lining (Jineijin) 10g, Charred Barley Malt (Jiao Maiya) 10g to original formula. Take two more doses, then recovered.
[Commentary]: In summer months, dampness and heat are heavy. Those infected often suffer Summer-Dampness. Chest and epigastric stuffiness, retching and desire to vomit are its symptoms. Summerheat-dampness mutually obstructing and not transforming requires avoiding cold-cooling. Treatment should use aromatic dispersing-transforming to distribute and eliminate pathogens. Thus use fresh Huoxiang and Peilan, Dou Dou Juan, Qianhu to aromatic-transform upper Jiao. Chenpi, Banxia, Houpo, Baokou to acrid-open middle Jiao. Lugen, Liuyi San to guide dampness to lower Jiao. Malian Lian, fresh Lotus Leaf, Zhuru to clear summerheat. Dividing troops into different routes, each achieving its function, thus receiving drum-beat effect.
Dampness Obstruction (Gastrointestinal Cold)
Patient Zhang, Male, 65 years old
First Visit
Rain stops, sky clears, summerheat and dampness move. Careless living habits, contracted pathogen causing disease. Now feels fever, dizziness, chest and epigastric fullness, whole body soreness and weakness, slight nausea, stomach not desiring food. Bowel movement acceptable, urination unsmooth. Tongue white greasy coating, pulse moist, soft, slightly slippery. Disease belongs to summerheat externally pressing, dampness obstructing Middle and Upper Jiao, Qi mechanism unsmooth. Method should be aromatic diffusion-transforming, acrid-opening bitter-draining.
Fresh Eupatorium Herb (Peilan) 10g (added later), Fresh Agastaches Herba (Huoxiang) 10g (added later), Soybean Sprout (Dadoujuan) 10g, Processed Magnolia Bark (Zhi Houpo) 6g, Citrus Reticulata Peel (Chenpi) 6g, Sichuan Coptis (Chuanlian) 3g, Liuyi San 10g (wrapped in cloth), one dose.
Second Visit
After medication, slight sweat all over body, fever gradually subsided, dizziness reduced, body soreness lightened. But epigastric region still stuffy, slight nausea. Tongue white greasy coating, pulse moist slippery. Further modify previous prescription.
Add Grass Cardamom (Caokou) 1g, Apricot Seed (Xingren) 10g to original formula. Take three consecutive doses and cured.
[Commentary]: Damp-heat syndromes are generally treated in four stages: Dampness Obstruction, Cool Restriction, Cold Coagulation, Ice Trapping. This is Master Zhao's family unique experience. Dampness Obstruction is the initial stage, dampness pathogen predominant, obstructing Middle and Upper Jiao, not yet transforming into heat, or heat not intense. In Upper Jiao, Lung receives pathogen first. Dampness obstructing Lung makes Lung Qi unsmooth, Clear Yang not ascending, causing dizziness and heavy head like wrapped. Lung combines with skin and hair, Ying and Wei unharmonious, causing whole body heaviness and soreness. Lung loses diffusing and descending, causing cough, chest tightness, even asthma. Should use aromatic diffusion-transforming to expand Qi mechanism. When Qi transforms, dampness also transforms. This is the key to treating dampness obstructing Lung. Herbs like Peucedani Radix, Apricot Seed, Fritillaria Thunbergii Bulb, Phragmitis Rhizome. If dampness obstructs Middle Jiao, ascending-descending pivot fails. This must be inherent Ta Yin internal injury, Spleen deficiency with dampness abundance. External pathogen arrives, combines with internal dampness, traps and obstructs Spleen and Stomach, forming Middle Jiao Dampness Obstruction. Commonly sees chest and epigastric stuffiness, vomiting, poor appetite, loose unsatisfactory stools, accompanied by whole body fatigue, heavy limbs, inability to move. Treating Middle Jiao Dampness Obstruction should focus on moving Spleen Qi. Spleen governs ascending clear and descending turbid, responsible for transportation and transformation. Thus herbs should be agile, avoid staying central. Use acrid-opening bitter-draining method. Acrid opens Qi mechanism to transform dampness, bitter dries dampness and drains heat, thus damp-heat distributed and eliminated. Herbs like Pinellia, Citrus Peel, Magnolia Bark, Bitter Almond, Areca Seed, Scutellaria, Coptis. Note that bitter-cold herbs like Scutellaria and Coptis should be used lightly to prevent excessive use injuring Yang. For any Dampness Obstruction, whether pathogen in Middle or Upper Jiao, pulse usually appears moist, soft, slow, slippery. Tongue coating white greasy and lubricated, sign of dampness abundance. With this tongue and pulse, it is sign of Dampness Obstruction. All should first treat dampness, not overuse cold-cooling. Wait until dampness transforms then drain heat. This case is typical Dampness Obstruction. Pathogen in Middle and Upper Jiao. Thus use aromatic diffusion-transforming and acrid-opening bitter-draining together. Qi mechanism smooth, dampness self-transforms and syndrome cures.