盛陵徐 闺女秋燥发热，脉浮数，咳嗽气急，舌微黄，渴不多饮，症非轻貌。宜防昏变
，候正（九月初四日。）
薄荷（钱半） 桑叶（三钱） 光杏仁（三钱） 象贝（三钱） 连翘（三钱） 蝉衣（钱半） 广
橘红
（一钱） 淡豆豉（三钱） 花粉（三钱） 前胡（钱半） 淡竹叶（三钱） （引）活水芦根（一两）
二帖。
介按∶燥有凉燥、温燥之殊。凉燥治法，宜遵《内经》燥淫所胜，平以苦温之旨。而此
案系
是温燥之症，即《内经》所谓燥化于天，热反胜之之候。须防化热劫液。兹从叶氏上燥治气
。辛凉宣上之意，而清燥救肺，俾上焦之燥热，逐渐清解。
蜀阜张 闺女秋燥发热，脉滑数，呛咳痰阻。症非轻貌，姑宜清燥消痰（九月十五日。）
冬桑叶（三钱） 炒知母（钱半） 白前（钱半） 秦艽（钱半） 象贝（三钱） 光杏仁（三钱）
甘
去毛，三片）
三帖。
介按∶此系温燥化热，烁液成痰而为呛咳。最防内合胃热，引动肝风，骤变痉厥。治以
辛凉清解，滋液豁痰，俾痰热稍蠲，则诸证自痊。
义桥徐 秋感燥化，头晕而疼，咳逆发热，脉右浮滑，左微劲，舌黄尖红。姑宜辛凉清
解（七月初四日。）
薄荷（钱半） 冬桑叶（三钱） 银花（三钱） 淡竹叶（钱半） 连翘（三钱） 甘菊（钱半）
焦栀子（三钱） 象贝（三钱） 桔梗（钱半） 前胡（钱半） 橘红（一钱）
清煎。二帖。
介按∶先哲何廉臣先生曰∶六气之中，惟燥气难明。盖燥有凉燥、温燥、上燥、下燥之
分。
凉燥者，燥之胜气也，治以温润，杏苏散主之。温燥者，燥之复气也，治以清润，清燥救肺
汤主之。上燥治气，吴氏桑杏汤主之。下燥治血。滋燥养营汤主之。今此案系是燥之复气，
故治法悉宗叶氏辛凉清宣之意。
大西庄杨 童年咳嗽，已曾失血，脉细右大，舌微黄，身热火胀，此燥气内逼。宜防成
损（八月十七日）
霜桑叶（二钱） 焦山栀（三钱） 炒知母（钱半） 苦丁茶（钱半） 光杏仁（三钱） 广郁金
（三钱） 川贝（钱
半） 银花（二钱） 池菊（二钱） 橘络（钱半） 白前（钱半）
清煎。三帖。
又 童年血后咳嗽较减，顷脉两手皆弦，舌尖红，头晕。宜清燥以育阴（八月二十二日。）
冬桑叶（三钱） 南沙参（三钱） 天冬（三钱） 白前（钱半） 光杏仁（三钱） 川贝（钱半）
女贞子（三钱） 胖大海（三钱） 生石决明（六钱） 橘络（钱半） 黄草 石斛（三钱）
清煎。
介按∶时令燥气，挟肝经之燥火，互相上蒸，冲肺则咳呛失血，冲脑则头晕目眩。初诊
脉细右大，治在气分，所以咳嗽较减。次则治以清肝肃肺，和胃止血，俾肺气复肃降之权，则
咳晕自止。此后如能再进顾松园之八仙玉液，更为稳妥。又据叶氏《幼科要略》自注云∶秋
燥一证。气分先受，治肺为急。若延绵数十日之久，病必入血分，又非轻浮肺药可治。须审
体质证端，古谓治病当活泼泼地，如盘走珠耳。
【背景信息】
书名：邵兰荪医案 作者：邵兰荪 朝代：清 章节：燥 类别：医论
盛陵徐姓人家的闺女，秋季感受燥邪发热，脉象浮数，咳嗽且气急，舌苔微黄，口渴但饮水不多，病情看起来不轻。应当防止出现神志昏蒙的变证。（九月初四日就诊）
薄荷（一钱半） 桑叶（三钱） 光杏仁（三钱） 象贝母（三钱） 连翘（三钱） 蝉蜕（一钱半） 广橘红（一钱） 淡豆豉（三钱） 天花粉（三钱） 前胡（一钱半） 淡竹叶（三钱） [作为引药] 活水芦根（一两）
共两剂。
按语∶燥邪有凉燥和温燥的区别。凉燥的治疗方法，应当遵循《黄帝内经》中“燥淫所胜，平以苦温”的宗旨。而本案属于温燥病症，即《黄帝内经》所说的“燥化于天，热反胜之”的情况。必须防止燥热化火劫伤津液。此处采用叶天士先生“上燥治气”、辛凉宣透上焦的意旨，运用清燥救肺之法，使上焦的燥热逐渐得到清解。
蜀阜张姓人家的闺女，秋季感受燥邪发热，脉象滑数，呛咳且有痰阻。病情不轻，暂宜采用清燥消痰法（九月十五日就诊）
冬桑叶（三钱） 炒知母（一钱半） 白前（一钱半） 秦艽（一钱半） 象贝母（三钱） 光杏仁（三钱） 甘草（去毛，三片）
共三剂。
按语∶此属温燥化热，灼伤津液成痰，从而引起呛咳。最需防止病邪内合胃热，引动肝风，突然发生痉厥（抽搐昏迷）。治疗采用辛凉清解、滋液豁痰的方法，使痰热稍减，则各种症状自然痊愈。
义桥徐姓人家，秋季感受燥邪化热，头晕且痛，咳逆发热，右脉浮滑，左脉微劲，舌苔黄舌尖红。暂宜采用辛凉清解法（七月初四日就诊）
薄荷（一钱半） 冬桑叶（三钱） 金银花（三钱） 淡竹叶（一钱半） 连翘（三钱） 甘菊花（一钱半） 焦栀子（三钱） 象贝母（三钱） 桔梗（一钱半） 前胡（一钱半） 橘红（一钱）
清水煎服。两剂。
按语∶先哲何廉臣先生说∶在六气（风、寒、暑、湿、燥、火）之中，只有燥气难以阐明。因为燥有凉燥、温燥、上燥、下燥之分。
凉燥，是燥的胜气（主气），治疗用温润之法，以杏苏散为主方。温燥，是燥的复气（客气），治疗用清润之法，以清燥救肺汤为主方。上燥治气，以吴鞠通氏的桑杏汤为主方。下燥治血，以滋燥养营汤为主方。如今这个案例属于燥的复气，所以治疗方法完全遵循叶天士先生辛凉清宣的意旨。
大西庄杨姓人家，儿童时期咳嗽，曾经有过咯血，脉象细弱且右脉大，舌苔微黄，身体发热腹部胀满，这是燥气内逼所致。应当防止发展成虚损病（八月十七日就诊）
霜桑叶（二钱） 焦山栀（三钱） 炒知母（一钱半） 苦丁茶（一钱半） 光杏仁（三钱） 广郁金（三钱） 川贝母（一钱半） 金银花（二钱） 池菊（二钱） 橘络（一钱半） 白前（一钱半）
清水煎服。三剂。
复诊∶儿童咯血后咳嗽有所减轻，近来两手脉象皆弦，舌尖红，头晕。宜采用清燥以滋养阴液的方法（八月二十二日就诊）
冬桑叶（三钱） 南沙参（三钱） 天冬（三钱） 白前（一钱半） 光杏仁（三钱） 川贝母（一钱半） 女贞子（三钱） 胖大海（三钱） 生石决明（六钱） 橘络（一钱半） 黄草石斛（三钱）
清水煎服。
按语∶时令燥气，挟带肝经的燥火，互相向上蒸腾，冲犯肺部则引起咳呛失血，冲犯脑部则引起头晕目眩。初诊时脉细右大，治疗重点在气分，所以咳嗽有所减轻。第二次治疗则采用清肝肃肺、和胃止血的方法，使肺气恢复肃降的功能，则咳嗽和头晕自然停止。此后如果能再进服顾松园先生的八仙玉液丸，更为稳妥。另外根据叶天士《幼科要略》自注所说∶秋燥这一病症，气分先受邪，治疗肺脏为急务。如果拖延数十日之久，病邪必然进入血分，这就不是轻浮的肺经药物可以治疗的了。必须审察体质和证候端绪，古人说治病应当灵活多变，就像珠子在盘中滚动一样。
[Background Information]
Book: *Shao Lansun's Medical Cases* Author: Shao Lansun Dynasty: Qing Chapter: Dryness Category: Medical Discussion
**Case 1: Xu Family, Shengling**
The young daughter of the Xu family in Shengling suffered from fever due to autumn dryness. Her pulse was floating and rapid (Fú Shuò), accompanied by coughing with shortness of breath. Her tongue coating was slightly yellow, and she felt thirsty but did not desire to drink much. The condition appeared serious, and there was a risk of developing coma or altered consciousness. (Visited on the 4th day of the 9th lunar month.)
Bohe (Menthae Haplocalycis Herba, 1.5 qian) Sangye (Mori Folium, 3 qian) Guang Xingren (Armeniacae Semen Amarum, 3 qian) Xiangbei (Fritillariae Thunbergii Bulbus, 3 qian) Lianqiao (Forsythiae Fructus, 3 qian) Chanyi (Cicadae Periostracum, 1.5 qian) Guang Juhong (Citri Reticulatae Pericarpium Rubrum, 1 qian) Dan Douchi (Sojae Semen Preparatum, 3 qian) Huafen (Trichosanthis Radix, 3 qian) Qianhu (Peucedani Radix, 1.5 qian) Dan Zhuyez (Phyllostachidis Folium, 3 qian) [as guiding herb] Huoshui Lugeng (Phragmitis Rhizoma, 1 liang)
Two doses.
Commentary: Dryness pathogen differs into cool dryness (Liang Zao) and warm dryness (Wen Zao). For cool dryness, treatment should follow the principle in *Huangdi Neijing* (Yellow Emperor's Inner Canon): "When dryness overflows, soothe it with bitter-warm methods." This case, however, is warm dryness, corresponding to the *Neijing* description: "Dryness transforms under heaven, and heat counteracts it excessively." One must guard against transformation into heat that consumes fluids. Here, we adopt Ye Tianshi’s principle of "treating qi for upper dryness" and using acrid-cool methods to diffuse the upper jiao, employing Qingzao Jiufei Tang (Clearing Dryness and Saving the Lung Decoction) to gradually clear and resolve the dryness-heat in the upper jiao.
**Case 2: Zhang Family, Shufu**
The young daughter of the Zhang family in Shufu suffered from fever due to autumn dryness. Her pulse was slippery and rapid (Hua Shuo), with harsh coughing and phlegm obstruction. The condition was not mild; temporarily, clearing dryness and resolving phlegm is appropriate. (Visited on the 15th day of the 9th lunar month.)
Dongsangye (Mulberry Leaf, 3 qian) Chao Zhimu (Anemarrhenae Rhizoma stir-fried, 1.5 qian) Baiqian (Cynanchi Stauntonii Rhizoma, 1.5 qian) Qinjiao (Gentianae Macrophyllae Radix, 1.5 qian) Xiangbei (Fritillariae Thunbergii Bulbus, 3 qian) Guang Xingren (Armeniacae Semen Amarum, 3 qian) Gancao (Licorice Root, de-haired, 3 slices)
Three doses.
Commentary: This is warm dryness transforming into heat, scorching fluids to form phlegm, resulting in harsh coughing. One must most fear internal combination with stomach heat, stirring up liver wind, leading to sudden convulsions and syncope. Treatment employs acrid-cool clearing and resolving, nourishing fluids and expelling phlegm. Once phlegm-heat is slightly reduced, all symptoms will naturally heal.
**Case 3: Xu Family, Yiqiao**
Suffered from autumn dryness transformation, with dizziness and headache, reverse coughing, and fever. The right pulse was floating and slippery, the left pulse slightly tense. Tongue coating yellow with a red tip. Temporarily employ acrid-cool clearing and resolving. (Visited on the 4th day of the 7th lunar month.)
Bohe (Menthae Haplocalycis Herba, 1.5 qian) Dongsangye (Mulberry Leaf, 3 qian) Yinhua (Lonicerae Japonicae Flos, 3 qian) Dan Zhuyez (Phyllostachidis Folium, 1.5 qian) Lianqiao (Forsythiae Fructus, 3 qian) Ganju (Chrysanthemi Flos, 1.5 qian) Jiao Zhizi (Gardeniae Fructus charred, 3 qian) Xiangbei (Fritillariae Thunbergii Bulbus, 3 qian) Jiegeng (Platycodonis Radix, 1.5 qian) Qianhu (Peucedani Radix, 1.5 qian) Juhong (Citri Reticulatae Pericarpium Rubrum, 1 qian)
Decoct in clear water. Two doses.
Commentary: The late scholar He Lianchen stated: Among the Six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire), only Dryness is difficult to clarify. Because dryness divides into cool dryness, warm dryness, upper dryness, and lower dryness. Cool dryness is the dominant qi of dryness; treat with moistening-warmth, primarily using Xingsu San (Apricot and Perilla Powder). Warm dryness is the returning qi of dryness; treat with clearing-moisture, primarily using Qingzao Jiufei Tang (Clearing Dryness and Saving the Lung Decoction). Upper dryness treats qi, primarily using Wu’s Sangxing Tang (Mulberry Leaf and Apricot Kernel Decoction). Lower dryness treats blood, primarily using Zizao Yangying Tang (Nourishing Dryness and Nourishing Blood Decoction). This case belongs to the returning qi of dryness; thus, the treatment method fully follows Ye Tianshi’s intent of acrid-cool clearing and diffusing.
**Case 4: Yang Family, Daxizhuang**
In childhood, suffered from coughing and had previously experienced hemoptysis. Pulse was fine with the right side being large. Tongue coating slightly yellow. Body hot and abdomen distended. This is dryness forcing inward. Guard against development into consumptive disease. (Visited on the 17th day of the 8th lunar month.)
Shuang Sangye (Frost Mulberry Leaf, 2 qian) Jiao Shanzhi (Gardeniae Fructus charred, 3 qian) Chao Zhimu (Anemarrhenae Rhizoma stir-fried, 1.5 qian) Kudingcha (Ilicis Latifoliae Folium, 1.5 qian) Guang Xingren (Armeniacae Semen Amarum, 3 qian) Guang Yujin (Curcumae Radix, 3 qian) Chuanbei (Fritillariae Cirrhosae Bulbus, 1.5 qian) Yinhua (Lonicerae Japonicae Flos, 2 qian) Chiju (Chrysanthemi Indici Flos, 2 qian) Juluo (Citri Reticulatae Pericarpium Fibra, 1.5 qian) Baiqian (Cynanchi Stauntonii Rhizoma, 1.5 qian)
Decoct in clear water. Three doses.
Follow-up: After hemoptysis, coughing decreased. Recently, both hands’ pulses are wiry (Xian), tongue tip is red, and there is dizziness. Employ clearing dryness to nourish yin. (Visited on the 22nd day of the 8th lunar month.)
Dongsangye (Mulberry Leaf, 3 qian) Nanshashen (Glehniae Radix, 3 qian) Tiandong (Asparagi Radix, 3 qian) Baiqian (Cynanchi Stauntonii Rhizoma, 1.5 qian) Guang Xingren (Armeniacae Semen Amarum, 3 qian) Chuanbei (Fritillariae Cirrhosae Bulbus, 1.5 qian) Nüzhenzi (Ligustri Lucidi Fructus, 3 qian) Pangdahai (Sterculiae Lychnophorae Semen, 3 qian) Sheng Shijueming (Conchae Arcae, raw, 6 qian) Juluo (Citri Reticulatae Pericarpium Fibra, 1.5 qian) Huangcao Shihu (Dendrobii Caulis, 3 qian)
Decoct in clear water.
Commentary: Seasonal dryness qi, carrying liver meridian dryness-fire, steams upward mutually. Rushing to the lungs causes coughing and hemoptysis; rushing to the brain causes dizziness and vertigo. In the first visit, the pulse was fine with the right side large; treatment focused on the qi level, so coughing decreased. The second treatment employed clearing liver and purifying lungs, harmonizing stomach and stopping bleeding, restoring the lung’s descending function, thereby stopping cough and dizziness. If one can subsequently take Gu Songyuan’s Baxian Yuye Wan (Eight Immortals Jade Elixir Pill), it would be more secure. Furthermore, according to Ye Tianshi’s self-note in *Youke Yaolüe* (Essentials of Pediatrics): Autumn dryness affects the qi level first; treating the lung is urgent. If it lingers for dozens of days, the disease enters the blood level, which cannot be treated with light-floating lung herbs. One must examine constitution and symptom patterns. As ancients said, treating disease requires flexibility, like a pearl rolling in a plate.