凡能芳香开窍，辛凉透络，强壮心机，兴奋神经等方，皆谓
之开透法，唯一则去实透邪，一则补虚提陷为异耳，此为治温热伏邪，内陷神昏，蒙闭厥脱等危症之要法，急
救非此不可。此等危症，虽由于心肺包络及胃肝内肾冲督等之结邪，而无不关于脑与脑系（脑系，西医曰脑筋，
东医曰神经）。盖以脑为元神之府，心为藏神之脏，心之神明，所得乎脑而虚灵不昧，开智识而省人事，具众
理而应万机。但为邪热所蒸，痰湿所迷，瘀热所蔽，血毒所攻，则心灵有时而昏，甚至昏狂、昏颠、昏蒙、昏
闭、昏痉、昏厥，而全不省人事矣；厥而不返，亦必内闭而外脱矣。何则？人之神在心，而心之灵以气，苟脑
气衰弱，肺气虚脱，则心脏必麻痹而死；故东西医生理学，以心肺脑为人身三大要经，洵精确不磨也。治宜先
其所因，解其所结，补其所虚，提其所陷，以复心主之神明，此开透法之所以出死入生，而为最紧要最珍贵之
良法也。试为胪举其方略∶
一、开窍透络者，叶天士所谓清络热必兼芳香，开里窍以清神识是也。里窍即神所出入之清窍，属心与
脑。因神以心为宅，以囟为门，（六书精蕴说）而其所出入之窍，得以外见者惟目，因心脉上连目系，而目系
上通于脑。故瞳神散大者心神虚散，目不了了者脑被火烁，目眶陷下者脑气虚脱，目瞪直视者脑髓无气，瞳神停
而不轮，舌强不语者，脑与心神气俱脱，故昏厥如尸。王清任医林改错曰∶脑髓中一时无气，不但无灵机，必
死一时。洵足发明厥闭之精义也。络者络脉（即西医所云回血管），有阴络阳络之分∶阳络即胃之大络，阴络即
肺脾心包肝肾冲督之内络也，内络之间，尤多孙络（即西医所云微丝血管），介于脉络之间，为交通经络之细
血管。其在脏腑者，则以心包络与肝冲为最多。以心包主血亦主脉，横通四布；肝主藏血，亦主四合回管，上
通脑而后贯督；冲为血海，导气而上，导血而下，丽于胃而通于胞中者也。观此，则邪热内
陷入络，不仅心包一症，即药之清透络热者，亦各有所主不同；然总以犀羚、西黄、龙脑、蟾酥、玳瑁，西瓜
硝等为最有效用，而麝香尤为开窍透络壮脑提神之主药。故凡治邪热内陷，里络壅闭，堵其神气出入之窍而神
识昏迷者，不问蒙闭痉厥，首推瓜霜紫雪（方省庵方）、犀珀至宝丹（廉臣验方）二方为前锋，安宫牛黄丸（鞠
通条辨方）、新定牛黄清心丸（王孟英方）、局方紫雪（医通更定方）次之，牛黄膏（河间六书方）、厥症返
魂丹（准绳类方）又次之，而以局方妙香丸、局方来复丹为后劲。总之，热陷神昏，必先辨其陷入之淡深，别
其轻重以定方。如热初蒸及心之经，心烦多言，间有糊涂语，其邪虽陷，尚浅而轻，但须丹溪清心汤去硝黄，以
泄卫透营可也。迨陷入心包，妄言妄见，疑鬼疑神，其邪陷渐深而重，先以茶竹灯心汤（细芽茶五分，卷心竹
叶三十片，灯心两小帚）调下万氏牛黄丸一颗至二颗，每多奏效。若服后犹不清醒，反昏厥不语，全不省人事
者，则邪热直陷心脏，极深而重，急用新定牛黄清心丸或安宫牛黄丸，甚或瓜霜紫雪丹调入石氏犀地汤剂中以开
透之，犹可十全一二；或用加减服蛮煎（祝春渠歌方集论方）调入厥症返魂丹四五丸，亦可幸全十中之一；如
或不应，必至内闭外脱而毙；此热陷浅深之次第，用药轻重之方法也。然昏沉虽系热深，却有夹痰浊、夹湿秽、
夹胃实、夹血结、夹毒攻、夹冲逆之分，而无不关系于神经。其分布于心肺胃三经者，即第十对迷走神经，主
心肺胃之知觉运动，凡结邪在此神经，其人知觉即昏迷，即肝肾冲督，亦有交感神经反射之作用。由是推之，
肺主气，气闭而神昏迷者，由于痰浊迷漫神经也，故曰痰迷，亦曰痰厥。治宜先用卧龙丹（西黄、金箔各四分，
梅冰、荆芥、闹羊花各二钱，麝香、辰砂各五分，猪牙皂角钱半，细辛一钱，灯心灰二钱五分，共研细末）搐
鼻取嚏，以通肺窍；次用导痰开关散（过玉书
治疔汇要方）开水调服一钱，以吐稠痰；若痰虽吐而神犹不醒，急用犀角三汁饮（犀角汁五匙，生萝卜汁半碗，
梨汁三瓢，雪水三煎沸，和入三汁即服）调入炼雄丹（明雄黄一分，牙硝六分，研细同入铜勺内，微火熔化拨匀，
俟如水时，急滤清者于碗内，俟其将凝，即印成锭）三厘或五厘，徐徐冷灌，一日三服，每见有吐出清痰粘涎
数碗而神识全清；终以枇杷叶饮子（外台方）调入岩制川贝（顾松园方）一二方，去余痰以整肃肺气，或用二
陈汤善其后；此治痰厥重症之方法也。若势轻者，加味导痰汤（感症宝筏方）亦效。其夹湿秽而神昏迷者，由于
湿热郁蒸过极，迷蒙神经也，故曰湿蒙。治以芳香辟秽，辛淡开闭，藿朴夏苓汤去蔻朴，加细辛三分，白芥子八
分，芦根一两，滑石五钱，煎汤代水，乘热即饮，蒙闭即开，屡验不爽；甚则调入太乙紫金丹一丸，投无不效。
若热势稍重者，宜以清凉透热，芳烈宣窍，清芳透邪汤（鲜石菖蒲叶钱半，泽兰叶二钱、薄荷叶八分，青蒿脑钱
半，鲜茅根四十支，水芦根一两，解毒万病丹一锭，即紫金锭加雄黄、琥珀各五钱。徐洄溪验方）亦屡投辄验，
樊师每用藿朴二陈汤亦屡验，或去本方中紫金片，磨冲苏合香丸一颗，尤效。若夹胃实而神昏迷者，多属胃热蒸
脑，脑筋起炎，神即昏蒙，头摇目瞪矣；延及脊脑筋亦发炎，则手足发痉，甚则角弓反张矣。盖胃为五脏六腑之
海，其清气上注于目，其悍气上冲于头，循咽喉，上走空窍，循眼系，入络脑，脑为元神之府，所以胃热蒸脑，
无不发现神经诸病也，此为温热病最多之候，方法已详载攻里篇，兹不赘。其夹血结而神昏迷者，蓄血迷乱神
经也，蓄血在上焦者属心包络，症必脉细肢厥，胸痹痛厥，故曰血结胸。法宜横开旁达，加味桂枝红花汤（叶氏
温病论方）、四逆散合白薇汤（廉臣验方）二方最效，甚则调入厥症返魂丹五粒，屡验，蓄血在中焦者属脾络，
症必脘痛串胁，脉涩肢厥，胀
痛在左胁者居多，故名脾胀。和血逐邪汤（鳖血柴胡、荆芥穗、制香附、嫩苏梗、秦艽各钱半，川朴、枳壳各
一钱，抚芎八分，益母草、泽兰各三钱，绛通一钱，生姜皮二分。沈月光验方）甚效，五枝松针汤（紫苏旁枝
钱半，川桂枝五分，樟树嫩枝、桃树嫩枝各五寸，酒炒嫩桑枝二尺，青松针八钱煎汤代水。廉臣验方）亦验，
重则加鳖甲煎丸（张仲景方）四五钱，或加宽膨散（叶氏验方）一钱，奏功最捷，蓄血在下焦者属肝络冲脉，
症必左脉弦涩，手足厥冷，大便溏黑，小便自利，神昏如狂。治宜宣气解结，透络通瘀，叶氏加减小柴胡汤
（天士论温二十则方）、舒氏增损小柴胡汤（驰远伤寒集注方）、四逆散合白薇汤。三方酌用。延久必变肝胀
血蛊，治宜开郁通络，如新加绛复汤（徐氏医学举要方）、开郁通络饮（薛瘦吟医赘方）、开郁正元散（金
鉴妇科心法方）、当归活血汤（医通方）、代抵当丸（寒温条辨方）、无极丸（本草纲目方）、回生至宝丹（华
氏妇科验方）、桃仁承气合逍遥散加味（王馥原验方）之类，临时对症选用可也。若夹毒攻而神昏迷者，血毒
攻心也，名曰血闭，其症有三∶一为温毒烁血，血毒攻心，法宜峻下，已详前攻里篇；一为产后结瘀，血毒攻心，
回生至宝丹最灵，黑神丸（洄溪验方）最稳而效；一为溺毒入血，血毒攻心，甚或血毒上脑，其症极危，急宜通
窍开闭，利溺逐毒，导赤泻心汤（陶节庵伤寒六书方）调入犀珀至宝丹，或导赤散合加味虎杖散（廉臣验方）调
入局方来复丹二三钱，尚可幸全一二。此皆治实症之开透法也。若夹冲逆而神昏痉厥者，症属阴虚火亢，法宜镇
摄，不在此例。
二、强心提神法，为温热病已经汗下清透后，内伤气血精神，而其人由倦而渐昏，由昏而渐沉，乃大虚将
脱之危症，急宜强壮心机，兴奋神经，不得不于开透法中筹一特开生面之峻补提陷法，庶几九死者尚可一生，
此与普通调补法迥殊。其法有四∶
一为强壮心脑，如参归鹿茸汤（聂久吾方）冲入葡萄酒（东西医用以壮脑提神近已盛行）一瓢，人参养荣汤
（和剂局方）冲入鹿茸酒一瓢，补中益气汤加鹿茸血片三分（程祖植医学新报方）之类，能治脑气衰弱心神虚散
者，惟此三方最力大而效速，为急救大虚昏沉之峻剂。
二为急救阴阳，如陶氏回阳急救汤（黑附块、安边桂、川姜各五分，别直参、湖广术、辰茯神各一钱，姜
半夏、炒橘白各七分，炙甘草五分，五味子三分，麝香三厘冲）最妙。凡治温热病凉泻太过，克伐元阳而阳虚
神散者多效，此为节庵老名医得意之方，妙在参附桂与麝香同用，世俗皆知麝香为散气通窍之药，而不知其实为
壮脑补神之要药，阅过丁氏实验化学新本草及曹氏麝香辨者皆深悉之，惜吾医界多茫茫耳。次如冯氏全真一气
汤（别直参二钱，提麦冬五钱，北五味三分，大熟地五七钱至一两，江西术三钱，淡附片一钱，酒蒸怀牛膝二
钱）亦佳，凡治湿热症劫伤太甚，阴损及阳而神沉不语者颇验，此为楚瞻锦囊中得意之方，功在于一派滋养阴
液之中，得参附气化，俾上能散津于肺，下能输精于肾，且附子得牛膝引火下行，不为食气之壮火，而为生气之
少火，大有云腾致雨之妙，故救阴最速。陶冯二方虽同为急救阴阳之良剂，而一则注重阳气，一则注重阴气，
临症用方时务宜注意。
三为复脉振神，如复脉汤冲入参桂养荣酒一瓢奏功最速，其次千金生脉散煎汤冲鹿茸酒一瓢亦灵。二方之
效，效在酒能提神，刺激血液之循环，以强壮心机而复经脉之营运，庶几脉无息止而神亦因之清醒矣。
四为开闭固脱，其症有二∶一内闭而外脱，内闭者络闭，外脱者气脱。叶天士云∶平时心虚有痰，外热一
陷，里络就闭，人即昏厥发痉。若不急开其闭，或开闭不得其法，必致
心气与肺气不相顺接，而其人肤冷汗出，躁扰不卧，脉细而急疾，便为气脱之症矣。此时急救之法，急宜开其
内闭，固其外脱，如叶氏加减复脉汤去苡仁、枇杷叶，加绵 皮钱半，北五味念粒，调入牛黄清心丸；甚则陶
氏回阳急救汤，调入叶氏神犀丹，尚可幸全十中之一二。一外闭而内脱，外闭者，邪束阳郁之谓也；内脱者，
阳盛阴涸之谓也。多由温热病兼风兼寒之候，不先祛风散寒以解表，早用苦寒直降，致表不解而邪陷入内。此
时仍以轻扬发表者解其外而外不闭，如邵氏热郁汤、五叶芦根汤之类，以撤热存阴者救其内而内不脱，如竹叶
石膏汤、加减竹叶石膏汤之类，皆可酌用以奏功。一方并治，如外台三黄石膏汤、杨氏增损三黄石膏汤之类。
若胸腹胀满，痛而拒按，大便不通者，急宜下之，法详攻里篇。此皆补虚提陷之法也。与开透法虽迥异，而用
意则同。惟治外闭内脱，则不在此例。谨述宜于开透及提陷诸症如下∶
邪热初蒸心经之候∶心神不安，睡多梦语，醒时自清，甚则心神渐烦而多言，然所言皆日用常行之事，无
糊涂语，夜间或有一二谵语，然犹清白语居多，舌红苔粘，小便黄赤，里热重而表热反轻，胸闷不舒。
邪陷心包，热深厥深之候∶神昏谵语，言多妄见妄闻，甚至疑鬼疑神，人所未见未闻，然对而呼之犹省人
语，舌色绛而尚有粘腻似苔非苔，望之若干，手扪之尚有津液，两目大小 赤，唇红耳聋，心中热痛，拒按而
软，四肢厥冷，指甲青紫，大便溏黑极臭，或下鲜血，小便黄赤涩痛。
邪热深入心脏之候∶神昏不语，不省人事，如痴如醉，形若尸厥，面有笑容，目瞪直视，舌硬或卷短，舌苔
红中有黑点黑中有红点，身冷肢厥，胸中独热按之灼手，神气虽醒似睡，时作鼾睡声，齿龈结瓣，紫如干漆。
按∶此等见证，虽脏气将绝之候，若囊不缩，面不青，息不高，喉颡不直，鼻不扇，耳不焦，不鱼目，
不鸦口，尚有一线生机，大剂急救，频频灌服，药能下咽至胃者，犹可幸全十中之一。如目珠不轮，瞳神散大，
舌色淡灰无神，遗溺自汗者，必死不治。
热陷痰迷之候∶终日神昏嗜睡，似寐非寐，或烦躁狂言，或错语呻吟，或独语如见鬼，或喉中有水鸡声，
不语如尸厥，口吐粘涎，胸虽满痛，按之则软，鼻扇气急，舌绛而润，扪之粘腻，或舌虽欲伸退场门而抵齿难骤
伸者，甚或闷乱搐搦，状如惊痫。
热陷湿蒙之候∶胸膈痞满，心烦懊 ，两眼欲闭，神昏谵语，舌苔白滑甚或黄腻，小便短涩黄热，大便溏
而不爽，面色油腻，口气秽浊，耳聋干呕。
热陷血厥之候∶神昏如醉，呼之即觉，与之言亦知人事，若任其自睡而心放，即神昏谵语，甚或昏厥不语，
身重胸痛，四肢厥逆，粪虽硬而大便反易，色紫黑，小便自利，舌色紫暗而润。
邪热结瘀，血毒攻心之候∶神昏如狂，或如惊痫，喜笑怒骂，见人欲啮，舌紫而暗，口噤难开，或手足发
痉。
凡是具有芳香开窍、辛凉透络、强壮心机、兴奋神经等作用的方剂，都称为开透法。其区别在于：一种是通过祛除实邪来透达病邪，另一种是通过补益虚损来提升下陷之气。这是治疗温热伏邪内陷导致神志昏迷、蒙闭厥脱等危重病症的关键方法，紧急救治非此不可。这类危重病症，虽然是由于心肺包络以及胃、肝、内肾、冲脉、督脉等处的邪气结聚所致，但无不与脑及脑系（脑系，西医称为脑筋，东医称为神经）有关。因为脑是元神所在的府邸，心是藏神的脏器，心的神明功能依赖于脑而保持虚灵不昧，开启智慧并省察人事，具备各种理则以应对万物。但如果被邪热熏蒸、痰湿迷惑、瘀热遮蔽、血毒攻击，那么心灵就会有时昏乱，甚至出现昏狂、昏颠、昏蒙、昏闭、昏痉、昏厥，完全不能省察人事；如果厥逆而不能回复，也必然是内部闭塞而外部脱失。为什么呢？人的神志在心，而心的灵动依靠气，如果脑气衰弱，肺气虚脱，那么心脏必定麻痹而死；所以东西方医生理学认为，心、肺、脑是人身的三大重要经络，确实精确无误。治疗应当先针对病因，解除结聚，补益虚损，提升下陷，以恢复心主的神明，这就是开透法能够使人起死回生，成为最紧要、最珍贵的良法的原因。试列举其方略如下：
一、开窍透络的方法，即叶天士所说的“清络热必兼芳香，开里窍以清神识”。里窍就是神出入的清窍，属于心和脑。因为神以心为宅舍，以囟门为门户（据《六书精蕴》说），而其出入的窍穴，能外见的只有眼睛，因为心脉上连目系，而目系上通于脑。所以瞳孔散大的是心神虚散，目光不明的是脑被火灼烧，眼眶凹陷的是脑气虚脱，眼睛瞪视直视的是脑髓无气，瞳孔停止转动，舌强不能言语的，是脑与心神气俱脱，所以昏厥如尸体。王清任在《医林改错》中说：脑髓中一时没有气，不但没有灵机，必定一时死亡。这确实阐明了厥闭的精义。络是指络脉（即西医所说的静脉），有阴络和阳络之分：阳络即胃的大络，阴络即肺、脾、心包、肝、肾、冲脉、督脉的内络，在内络之间，尤其多孙络（即西医所说的微丝血管），介于脉络之间，是交通经络的细血管。在脏腑方面，则以心包络和肝冲脉最多。因为心包主血也主脉，横向通达四布；肝主藏血，也主四合回管，上通于脑而后贯穿督脉；冲脉为血海，导气向上，导血向下，依附于胃而通于胞中。由此看来，邪热内陷入络，不仅限于心包一症，即使药物清除透达络热的功效，也各有不同侧重；然而总以犀角、羚羊角、西黄（麝香）、龙脑（冰片）、蟾酥、玳瑁、西瓜硝等为最有效用，而麝香更是开窍透络、壮脑提神的主药。所以凡是治疗邪热内陷，里络壅闭，堵塞神气出入之窍而导致神识昏迷的，不论蒙闭、痉厥，首先推荐瓜霜紫雪（方省庵方）、犀珀至宝丹（廉臣验方）二方作为先锋，安宫牛黄丸（鞠通条辨方）、新定牛黄清心丸（王孟英方）、局方紫雪（医通更定方）次之，牛黄膏（河间六书方）、厥症返魂丹（准绳类方）又次之，而以局方妙香丸、局方来复丹作为后劲。总之，热陷神昏，必须先辨别陷入的深浅，区分轻重以确定方剂。如热初熏蒸到心经，心烦多言，偶尔有糊涂话，邪虽陷但尚浅且轻，只需使用丹溪清心汤去掉硝黄，以泄卫透营即可。等到邪陷入心包，妄言妄见，疑鬼疑神，邪陷渐深且重，先用茶竹灯心汤（细芽茶五分，卷心竹叶三十片，灯心两小帚）调服万氏牛黄丸一颗至两颗，大多奏效。如果服药后仍不清醒，反而昏厥不语，完全不能省察人事，则是邪热直陷心脏，极深且重，急用新定牛黄清心丸或安宫牛黄丸，甚或将瓜霜紫雪丹调入石氏犀地汤剂中以开透，还可以侥幸保全十分之一二；或者使用加减服蛮煎（祝春渠歌方集论方）调入厥症返魂丹四五丸，也可以侥幸保全十分之一；如果无效，必然导致内闭外脱而死亡；这是热陷深浅的次第，用药轻重的方法。然而昏沉虽然属于热深，却有夹痰浊、夹湿秽、夹胃实、夹血结、夹毒攻、夹冲逆的区别，但无不关系到神经。分布于心肺胃三经的，即第十对迷走神经，主管心肺胃的知觉运动，凡邪结在此神经，人的知觉就会昏迷；即使是肝肾冲督，也有交感神经反射的作用。由此推论，肺主气，气闭而神昏迷的，是由于痰浊迷漫神经，所以叫痰迷，也叫痰厥。治疗宜先用卧龙丹（西黄、金箔各四分，梅冰、荆芥、闹羊花各二钱，麝香、辰砂各五分，猪牙皂角钱半，细辛一钱，灯心灰二钱五分，共研细末）搐鼻取嚏，以通肺窍；接着用导痰开关散（过玉书治疔汇要方）开水调服一钱，以吐出稠痰；如果痰虽吐出但神志仍不醒，急用犀角三汁饮（犀角汁五匙，生萝卜汁半碗，梨汁三瓢，雪水三煎沸，和入三汁即服）调入炼雄丹（明雄黄一分，牙硝六分，研细同入铜勺内，微火熔化拨匀，待如水时，急滤清者于碗内，待其将凝，即印成锭）三厘或五厘，徐徐冷灌，一日三次，每见有吐出清痰粘涎数碗而神识全清；最后以枇杷叶饮子（外台方）调入岩制川贝（顾松园方）一二方，去除余痰以整肃肺气，或者用二陈汤善后；这是治疗痰厥重症的方法。如果病情较轻，加味导痰汤（感症宝筏方）也有效。夹湿秽而神昏迷的，是由于湿热郁蒸过极，迷蒙神经，所以叫湿蒙。治疗用芳香辟秽，辛淡开闭，藿朴夏苓汤去掉蔻朴，加细辛三分，白芥子八分，芦根一两，滑石五钱，煎汤代水，乘热即饮，蒙闭即开，屡验不爽；严重时调入太乙紫金丹一丸，投无不效。如果热势稍重，宜用清凉透热，芳烈宣窍，清芳透邪汤（鲜石菖蒲叶钱半，泽兰叶二钱、薄荷叶八分，青蒿脑钱半，鲜茅根四十支，水芦根一两，解毒万病丹一锭，即紫金锭加雄黄、琥珀各五钱。徐洄溪验方）也屡投辄验，樊师每用藿朴二陈汤也屡验，或者去掉本方中的紫金片，磨冲苏合香丸一颗，尤其有效。夹胃实而神昏迷的，多属胃热蒸脑，脑筋起炎，神即昏蒙，头摇目瞪；延及脊脑筋也发炎，则手足发痉，甚至角弓反张。因为胃为五脏六腑之海，其清气上注于目，其悍气上冲于头，循咽喉，上走空窍，循眼系，入络脑，脑为元神之府，所以胃热蒸脑，无不发现神经诸病，此为温热病最多的证候，方法已详细记载在攻里篇，这里不再赘述。夹血结而神昏迷的，是蓄血迷乱神经，蓄血在上焦的属于心包络，症状必定脉细肢厥，胸痹痛厥，所以叫血结胸。治法宜横开旁达，加味桂枝红花汤（叶氏温病论方）、四逆散合白薇汤（廉臣验方）二方最效，严重时调入厥症返魂丹五粒，屡验；蓄血在中焦的属于脾络，症状必定脘痛串胁，脉涩肢厥，胀痛在左胁者居多，所以名叫脾胀。和血逐邪汤（鳖血柴胡、荆芥穗、制香附、嫩苏梗、秦艽各钱半，川朴、枳壳各一钱，抚芎八分，益母草、泽兰各三钱，绛通一钱，生姜皮二分。沈月光验方）很有效，五枝松针汤（紫苏旁枝钱半，川桂枝五分，樟树嫩枝、桃树嫩枝各五寸，酒炒嫩桑枝二尺，青松针八钱煎汤代水。廉臣验方）也有效，重则加鳖甲煎丸（张仲景方）四五钱，或加宽膨散（叶氏验方）一钱，奏功最捷；蓄血在下焦的属于肝络冲脉，症状必定左脉弦涩，手足厥冷，大便溏黑，小便自利，神昏如狂。治宜宣气解结，透络通瘀，叶氏加减小柴胡汤（天士论温二十则方）、舒氏增损小柴胡汤（驰远伤寒集注方）、四逆散合白薇汤。三方酌情选用。拖延久了必然变成肝胀血蛊，治宜开郁通络，如新加绛复汤（徐氏医学举要方）、开郁通络饮（薛瘦吟医赘方）、开郁正元散（金鉴妇科心法方）、当归活血汤（医通方）、代抵当丸（寒温条辨方）、无极丸（本草纲目方）、回生至宝丹（华氏妇科验方）、桃仁承气合逍遥散加味（王馥原验方）之类，临时对症选用即可。夹毒攻而神昏迷的，是血毒攻心，名叫血闭，其症状有三种：一是温毒烁血，血毒攻心，治法宜峻下，已详前攻里篇；二是产后结瘀，血毒攻心，回生至宝丹最灵验，黑神丸（洄溪验方）最稳妥而有效；三是溺毒入血，血毒攻心，甚或血毒上脑，症状极危，急宜通窍开闭，利溺逐毒，导赤泻心汤（陶节庵伤寒六书方）调入犀珀至宝丹，或导赤散合加味虎杖散（廉臣验方）调入局方来复丹二三钱，尚可侥幸保全一二。这些都是治疗实症的开透法。如果夹冲逆而神昏痉厥的，症状属阴虚火亢，治法宜镇摄，不在此例。
二、强心提神法，适用于温热病已经经过汗、下、清、透治疗后，内伤气血精神，而病人由疲倦逐渐转为昏沉，由昏沉逐渐转为深度昏迷，乃是大虚即将脱失的危重病症，急需强壮心机，兴奋神经，不得不在开透法中筹划一种特开生面的峻补提陷法，这样九死一生的人或许还能救活一条命，这与普通的调补法截然不同。其法有四：
一是强壮心脑，如参归鹿茸汤（聂久吾方）冲入葡萄酒（东西方医生用以壮脑提神，近来已盛行）一瓢，人参养荣汤（和剂局方）冲入鹿茸酒一瓢，补中益气汤加鹿茸血片三分（程祖植医学新报方）之类，能治疗脑气衰弱、心神虚散的，只有这三方力量最大且见效最快，是急救大虚昏沉的峻剂。
二是急救阴阳，如陶氏回阳急救汤（黑附块、安边桂、川姜各五分，别直参、湖广术、辰茯神各一钱，姜半夏、炒橘白各七分，炙甘草五分，五味子三分，麝香三厘冲）最为奇妙。凡是治疗温热病凉泻太过，克伐元阳而阳虚神散的，大多有效，这是节庵老名医得意的方子，妙在参附桂与麝香同用，世俗都知道麝香是散气通窍的药，却不知道它其实是壮脑补神的要药，读过丁氏实验化学新本草及曹氏麝香辨的人都深知这一点，可惜我们医学界大多茫然无知。其次如冯氏全真一气汤（别直参二钱，提麦冬五钱，北五味三分，大熟地五七钱至一两，江西术三钱，淡附片一钱，酒蒸怀牛膝二钱）也很好，凡是治疗湿热症劫伤太甚，阴损及阳而神沉不语的颇为灵验，这是楚瞻锦囊中得意的方子，功效在于一派滋养阴液之中，得参附气化，使上能散津于肺，下能输精于肾，且附子得牛膝引火下行，不为食气的壮火，而为生气的少火，大有云腾致雨的妙处，所以救阴最快。陶、冯二方虽然同为急救阴阳的良剂，但一则注重阳气，一则注重阴气，临症用方时务必注意。
三是复脉振神，如复脉汤冲入参桂养荣酒一瓢奏功最快，其次千金生脉散煎汤冲鹿茸酒一瓢也灵验。二方的功效，在于酒能提神，刺激血液的循环，以强壮心机而复经脉的营运，这样脉搏就不会停息而神志也会因此清醒。
四是开闭固脱，其症状有两种：一是内闭而外脱，内闭者是络闭，外脱者是气脱。叶天士说：平时心虚有痰，外热一陷，里络就闭，人即昏厥发痉。如果不急开其闭，或者开闭不得其法，必定导致心气与肺气不相顺接，而其人肤冷汗出，躁扰不卧，脉细而急疾，便成为气脱的症状了。此时急救之法，急宜开其内闭，固其外脱，如叶氏加减复脉汤去掉苡仁、枇杷叶，加绵皮钱半，北五味念粒，调入牛黄清心丸；严重时陶氏回阳急救汤，调入叶氏神犀丹，还可以侥幸保全十分之一二。二是外闭而内脱，外闭者，是邪束阳郁的意思；内脱者，是阳盛阴涸的意思。多由温热病兼风兼寒的证候，不先祛风散寒以解表，早用苦寒直降，导致表不解而邪陷入内。此时仍以轻扬发表者解其外而外不闭，如邵氏热郁汤、五叶芦根汤之类，以撤热存阴者救其内而内不脱，如竹叶石膏汤、加减竹叶石膏汤之类，都可以酌情选用以奏功。一方并治，如外台三黄石膏汤、杨氏增损三黄石膏汤之类。如果胸腹胀满，痛而拒按，大便不通的，急宜下之，方法详见攻里篇。这些都是补虚提陷的方法。与开透法虽然迥异，但用意相同。只是治疗外闭内脱，则不在此例。谨述适宜于开透及提陷诸症如下：
邪热初蒸心经的证候：心神不安，睡多梦语，醒时自清，甚则心神渐烦而多言，然而所言都是日用常行之事，没有糊涂话，夜间或有一二谵语，但仍然清白语居多，舌红苔粘，小便黄赤，里热重而表热反轻，胸闷不舒。
邪陷心包，热深厥深的证候：神昏谵语，言多妄见妄闻，甚至疑鬼疑神，人所未见未闻，然而对而呼之犹省人语，舌色绛而尚有粘腻似苔非苔，望之若干，手扪之尚有津液，两目大小眦赤，唇红耳聋，心中热痛，拒按而软，四肢厥冷，指甲青紫，大便溏黑极臭，或下鲜血，小便黄赤涩痛。
邪热深入心脏的证候：神昏不语，不省人事，如痴如醉，形若尸厥，面有笑容，目瞪直视，舌硬或卷短，舌苔红中有黑点黑中有红点，身冷肢厥，胸中独热按之灼手，神气虽醒似睡，时作鼾睡声，齿龈结瓣，紫如干漆。
按：这些见证，虽然是脏气将绝的证候，如果囊不缩，面不青，息不高，喉颡不直，鼻不扇，耳不焦，不鱼目，不鸦口，尚有一线生机，大剂急救，频频灌服，药能下咽至胃者，还可以侥幸保全十分之一。如目珠不轮，瞳神散大，舌色淡灰无神，遗溺自汗的，必死不治。
热陷痰迷的证候：终日神昏嗜睡，似寐非寐，或烦躁狂言，或错语呻吟，或独语如见鬼，或喉中有水鸡声，不语如尸厥，口吐粘涎，胸虽满痛，按之则软，鼻扇气急，舌绛而润，扪之粘腻，或舌虽欲伸退场门而抵齿难骤伸者，甚或闷乱搐搦，状如惊痫。
热陷湿蒙的证候：胸膈痞满，心烦懊侬，两眼欲闭，神昏谵语，舌苔白滑甚或黄腻，小便短涩黄热，大便溏而不爽，面色油腻，口气秽浊，耳聋干呕。
热陷血厥的证候：神昏如醉，呼之即觉，与之言亦知人事，若任其自睡而心放，即神昏谵语，甚或昏厥不语，身重胸痛，四肢厥逆，粪虽硬而大便反易，色紫黑，小便自利，舌色紫暗而润。
Any formula that possesses the functions of aromatic opening of orifices, acrid-cool penetrating of collaterals, strengthening of the heart mechanism, and excitation of nerves is referred to as the "Kaitou Method" (Opening and Penetrating Method). The distinction lies in that one removes excess to penetrate pathogenic factors, while the other tonifies deficiency to lift sunken qi. This is a crucial method for treating critical conditions such as warm-heat latent pathogens sinking internally leading to coma, obstruction, and collapse. Emergency rescue cannot be achieved without this method. Although these critical conditions arise from pathogenic accumulation in the pericardium, lungs, heart, stomach, liver, inner kidneys, Chong vessel, and Du vessel, they are invariably related to the brain and its system (the brain system, called "nerves" in Western medicine and "Shenjing" in Eastern medicine). This is because the brain is the mansion of the primordial spirit (Yuan Shen), and the heart is the organ storing the spirit. The mind's clarity depends on the brain to remain ethereal and unclouded, enabling wisdom and self-awareness, possessing various principles to respond to myriad situations. However, if steamed by pathogenic heat, confused by phlegm-dampness, obscured by blood-heat stasis, or attacked by blood toxins, the mind may become confused, even leading to manic confusion, dizziness, dullness, closure, spasms, or syncope, with a complete loss of consciousness; if syncope does not recover, it must be due to internal closure and external collapse. Why? Human spirit resides in the heart, and the heart's agility relies on Qi. If brain Qi is weak and Lung Qi collapses, the heart will inevitably paralyze and die; thus, both Eastern and Western physiology correctly identifies the heart, lungs, and brain as the three major essential meridians of the human body. Treatment should first address the cause, resolve accumulations, tonify deficiencies, and lift sunken qi to restore the heart master's spiritual clarity. This is why the Kaitou Method can bring the dying back to life and is considered the most urgent and precious excellent method. Its strategies are listed below:
1. Opening Orifices and Penetrating Collaterals: As Ye Tianshi stated, "Clearing collateral heat must include aromatics, opening interior orifices to clear spiritual consciousness." Interior orifices are the clear orifices through which the spirit enters and exits, belonging to the heart and brain. Since the spirit takes the heart as its residence and the fontanelle as its gate (according to *Liushu Jingyun*), the only orifice visible externally is the eye, because the heart meridian connects upward to the eye system, which in turn connects upward to the brain. Therefore, dilated pupils indicate vacuity and scattering of heart spirit; unclear vision indicates the brain being scorched by fire; sunken eye sockets indicate vacuity and collapse of brain Qi; fixed staring eyes indicate lack of Qi in brain marrow; pupils stopping rotation and stiff tongue unable to speak indicate simultaneous collapse of brain and heart spirit Qi, resulting in syncope resembling a corpse. Wang Qingren stated in *Yilin Gaicuo*: "If there is no Qi in the brain marrow for a moment, not only is there no spiritual mechanism, but death occurs immediately." This truly elucidates the essence of syncope and closure. Collaterals refer to collateral vessels (veins in Western medicine), divided into Yin and Yang collaterals: Yang collaterals are the great collaterals of the stomach; Yin collaterals are the interior collaterals of the lungs, spleen, pericardium, liver, kidneys, Chong, and Du vessels. Among interior collaterals, there are particularly many Sun collaterals (capillaries in Western medicine), situated between main collaterals, serving as fine blood vessels for communication. In the zang-fu organs, the pericardium and liver-Chong are the most abundant. Because the pericardium governs blood and vessels, spreading horizontally; the liver stores blood and governs venous return, connecting upward to the brain and then piercing the Du vessel; the Chong vessel is the sea of blood, guiding Qi upward and blood downward, attaching to the stomach and connecting to the uterus. From this, we see that pathogenic heat sinking into collaterals is not limited to the pericardium alone; even drugs clearing collateral heat have different focuses. However, rhinoceros horn, antelope horn, musk, borneol, toad venom, tortoise shell, and watermelon nitre are generally the most effective, with musk being the primary drug for opening orifices, penetrating collaterals, strengthening the brain, and refreshing the spirit. Thus, for treating pathogenic heat sinking internally, blocking interior collaterals, obstructing the orifices of spirit Qi entry and exit, causing coma regardless of obstruction or spasms/syncope, the priority is given to Guashuang Zixue (Fang Shengan's Formula) and Xipai Zhibao Dan (Lianchen's Verified Formula) as vanguard agents; Angong Niuhuang Wan (Ju Tong's Treatise Formula), Xin Ding Niuhuang Qingxin Wan (Wang Mengying's Formula), and Jufang Zixue (Yitong Revised Formula) follow; Niuhuang Gao (Hejian Liushu Formula) and Juezhuang Fanhun Dan (Zhunsheng Lei Formula) are next; finally, Jufang Miaoxiang Wan and Jufang Laifu Dan serve as rear support. In summary, for heat-sinking coma, one must first distinguish the depth of sinking and severity to determine the formula. If heat initially steams the Heart meridian, causing restlessness, excessive talking, and occasional confused speech, though the pathogen has sunk, it is still shallow and mild; simply using Danxi Qingxin Tang removing Mangxiao and Dahuang to drain Wei and penetrate Ying is sufficient. When the pathogen sinks into the pericardium, causing delirious speech and hallucinations, suspecting ghosts and spirits, the sinking is deeper and heavier; first use Chazhu Dengxin Tang (Fine bud tea 5 fen, curled bamboo leaf 30 pieces, rush pith two small brooms) to administer one to two pills of Wanshi Niuhuang Wan, which often proves effective. If still unconscious after administration, worsening into syncope and muteness with total loss of consciousness, the pathogenic heat has directly sunk into the heart, extremely deep and severe; urgently use Xin Ding Niuhuang Qingxin Wan or Angong Niuhuang Wan, or even mix Guashuang Zixue Dan into Shi's Xidi Tang decoction to open and penetrate, offering a slight chance of survival; or use Jiajian Fu Man Jian (Zhu Chunqu's Song Formula Collection) mixed with four or five pills of Juezhuang Fanhun Dan, also offering a slight chance. If ineffective, internal closure and external collapse will lead to death; this outlines the sequence of heat sinking depth and the method of medication dosage. However, although dullness stems from deep heat, it may involve accompanying turbid phlegm, damp filth, stomach excess, blood stasis, toxin attack, or Chong rebellion, all relating to nerves. Distributed in the Heart, Lung, and Stomach meridians is the tenth cranial nerve, the Vagus nerve, governing perception and movement of these organs; pathogenic accumulation here causes perceptual coma; even the Liver, Kidney, Chong, and Du have sympathetic reflex actions. Extending this logic, the Lung governs Qi; Qi closure causing mental confusion is due to turbid phlegm confusing nerves, hence called Phlegm Confusion or Phlegm Syncope. Treatment should first use Wolong Dan (Xihuang and Gold Leaf each 4 fen, Meibing, Jingjie, Yaoyanghua each 2 qian, Shexiang and Chen Sha each 5 fen, Zhu Ya Zaojiao 1.5 qian, Xixin 1 qian, Dengxin Hui 2.5 qian, ground to fine powder) insufflated into the nose to induce sneezing, opening Lung orifices; then use Daotan Kaiguan San (Guo Yushu's Liao Huibiao Formula) taken orally with boiled water, one qian, to vomit thick phlegm; if consciousness remains unclear despite vomiting, urgently use Xijiao Sanzhi Yin (Rhinoceros horn juice 5 spoons, raw radish juice half bowl, pear juice three scoops, snow water boiled three times, mixed with the three juices and taken immediately) mixed with Lianxiong Dan (Ming Xionghuang 1 fen, Yaxiao 6 fen, ground fine, melted in copper spoon over low heat, stirred evenly, when liquid, filtered clear into bowl, molded into sticks when solidifying) 3 or 5 li, slowly administered cold, three times a day, often resulting in the expulsion of several bowls of clear sticky phlegm and full recovery of consciousness; finally, use Pipa Ye Yinzi (Waitai Formula) mixed with Yanzhi Chuanbei (Gu Songyuan's Formula) one or two doses to remove residual phlegm and regulate Lung Qi, or use Erchen Tang for consolidation; this is the method for severe Phlegm Syncope. For milder cases, Jiawei Daotan Tang (Ganzheng Baofa Formula) is also effective. For damp-filth causing coma, due to extreme stagnation and steaming of damp-heat confusing nerves, called Damp Obstruction, treat with aromatic dispersal of filth and acrid-light opening of closure; Huopo Xialing Tang removing Doukou and Houpo, adding Xixin 3 fen, Baijiezi 8 fen, Lugeng 1 liang, Huashi 5 qian, decocted as water substitute, drunk hot, opening obstruction reliably; severely, mix Taiyi Zijin Dan one pill, universally effective. If heat is slightly heavier, use cooling heat-penetrating and aromatic orifice-opening Qingfang Touxie Tang (Fresh Shichangpu leaf 1.5 qian, Zelane leaf 2 qian, Bohe leaf 8 fen, Qinghao Nao 1.5 qian, fresh Maogen 40 stalks, Shuilugeng 1 liang, Jiedu Wanbing Dan one stick, i.e., Zijin Ding added with Xionghuang and Hupo each 5 qian. Xu Huixi's Verified Formula) also proves effective upon repeated use; Master Fan often uses Huopo Erchen Tang with similar success, or removes Zijin Pian from this formula, grinds and mixes Suhe Xiang Wan one pill, especially effective. For stomach excess causing coma, mostly due to stomach heat steaming the brain, causing inflammation of brain nerves, leading to dullness, head shaking, and staring eyes; extending to spinal cord nerve inflammation causes limb spasms and opisthotonos. Since the stomach is the sea of the five zang and six fu organs, its clear Qi flows upward to the eyes, its fierce Qi rushes upward to the head, follows the throat, ascends to empty orifices, follows the eye system, enters collaterals to the brain, which is the mansion of primordial spirit; thus, stomach heat steaming the brain invariably manifests as nervous diseases, a common pattern in warm-heat diseases, detailed in the Purging Interior chapter, not repeated here. For blood stasis causing coma, accumulated blood confuses nerves; accumulated blood in the upper jiao belongs to the pericardium, presenting with fine pulse, cold limbs, chest bi pain and syncope, hence called Blood Bi-Xiong. Treatment should spread laterally and reach sideways; Jiawei Guizhi Honghua Tang (Ye's Wenbing Lun Formula) and Sini San combined with Baiwei Tang (Lianchen's Verified Formula) are most effective; severely, mix five pills of Juezhuang Fanhun Dan, frequently effective; accumulated blood in the middle jiao belongs to the spleen collaterals, presenting with epigastric pain radiating to hypochondrium, choppy pulse, cold limbs, mostly distending pain in left hypochondrium, hence named Pi Zhang. He Xue Zhu Xie Tang (Bie Xue Chaihu, Jingjie Sui, Zhi Xiangfu, Nen Sugen, Qinjiao each 1.5 qian, Chuan Pu, Zhike each 1 qian, Fujiong 8 fen, Yimucao, Zelane each 3 qian, Jiangtong 1 qian, Shengjiang Pi 2 fen. Shen Yueguang's Verified Formula) is very effective; Wuzhi Songzhen Tang (Zisu Pangzhi 1.5 qian, Chuan Guizhi 5 fen, Camphor tree tender branch, Peach tree tender branch each 5 cun, Wine-fried Mulberry branch 2 chi, Green Pine needle 8 qian decocted as water substitute. Lianchen's Verified Formula) is also effective; severely, add Biejia Jian Wan (Zhang Zhongjing's Formula) 4-5 qian, or add Kuapeng San (Ye's Verified Formula) 1 qian, achieving rapid results; accumulated blood in the lower jiao belongs to the liver collaterals and Chong vessel, presenting with wiry-choppy left pulse, cold limbs, loose black stool, free urination, manic-like coma. Treatment should circulate Qi, resolve knots, penetrate collaterals, and unblock stasis; Ye's Jiajian Xiao Chaihu Tang (Tianshi's Lunwen 20 Rules Formula), Shushi Zengsun Xiao Chaihu Tang (Chi Yuan Shanghan Jizhu Formula), and Sini San combined with Baiwei Tang. Use three formulas酌情ly. Prolonged cases will transform into Gan Zhang and Xue Gu, treated with opening depression and penetrating collaterals; Xinjia Jiangfu Tang (Xu's Yixue Juyao Formula), Kaiyu Tongluo Yin (Xue Shouyin's Yizhui Formula), Kaiyu Zhengyuan San (Jinjian Fujke Xinfa Formula), Danggui Huoxue Tang (Yitong Formula), Dai Di Dang Wan (Hanwen Tiaobian Formula), Wuji Wan (Bencao Gangmu Formula), Huisheng Zhibao Dan (Hua's Fujke Yanfang Formula), Tao Ren Chengqi combined with Xiaoyao San modified (Wang Fuyuan's Verified Formula), etc., selected according to symptoms. For toxin attack causing coma, blood toxin attacking the heart, named Blood Bi, presents with three types: one is warm-toxin scorching blood, blood toxin attacking the heart, treatment requires drastic purging, detailed in the Purging Interior chapter; one is postpartum blood stasis, blood toxin attacking the heart, Huisheng Zhibao Dan is most efficacious, Heishen Wan (Huixi's Verified Formula) is most stable and effective; one is urinary toxin entering blood, blood toxin attacking the heart, even ascending to the brain, extremely critical, urgently need to open orifices, resolve closure, promote urination, and expel toxins; Daochi Xiexin Tang (Tao Jian'an's Shanghan Liushu Formula) mixed with Xipai Zhibao Dan, or Daochi San combined with Jiawei Huzhang San (Lianchen's Verified Formula) mixed with 2-3 qian of Jufang Laifu Dan, offering a slight chance of survival. These are all Kaitou methods for excess patterns. For Chong rebellion causing coma and spasms/syncope, the pattern belongs to Yin deficiency with Fire hyperactivity, treatment requires calming and subduing, not included here.
2. Strengthening Heart and Refreshing Spirit Method: Applicable after warm-heat diseases have undergone sweating, purging, clearing, and penetrating treatments, causing internal injury to Qi, Blood, and Spirit, where the patient gradually becomes lethargic, then comatose, representing a critical state of severe deficiency impending collapse. Urgent strengthening of the heart mechanism and excitation of nerves is required. One must devise a special, potent tonifying and lifting method within the Kaitou framework, so that the nearly dead might survive, distinct from ordinary regulation and tonification. There are four methods:
First, strengthening heart and brain: Such as Shen Gui Rongsun Tang (Nie Jiuwu's Formula) mixed with one scoop of wine (widely used by East and West doctors to strengthen brain and refresh spirit); Renshen Yangrong Tang (Hejiju Formula) mixed with one scoop of Deer Horn Wine; Buzhong Yiqi Tang added with 3 fen of Deer Horn Blood slices (Cheng Zuzhi's Medical New Report Formula), etc. These three formulas are the most powerful and fastest acting for treating brain Qi weakness and heart spirit vacuity, serving as potent emergency remedies for severe deficiency and dullness.
Second, emergency rescue of Yin and Yang: Such as Tao's Huiyang Jiuji Tang (Hei Fu Kuai, Anbian Gui, Chuan Jiang each 5 fen, Biezhi Shen, Huguang Zhu, Chen Fushen each 1 qian, Jiang Banxia, Chao Jubai each 7 fen, Zhi Gancao 5 fen, Wuweizi 3 fen, Shexiang 3 li mixed in) is exquisite. It is highly effective for treating warm-heat diseases where excessive cooling and purging have damaged Primordial Yang, leading to Yang deficiency and spirit scattering. This is an outstanding formula from the renowned physician Tao Jian'an, brilliant in combining Ginseng, Aconite, Cinnamon, and Musk. While laypeople know Musk as a Qi-scattering and orifice-opening drug, they do not realize it is actually a key drug for strengthening the brain and supplementing spirit, as confirmed by Ding's Experimental Chemistry New Materia Medica and Cao's Musk Discrimination, yet our medical community largely ignores this. Secondly, Feng's Quanzhen Yiqi Tang (Biezhi Shen 2 qian, Ti Maidong 5 qian, Bei Wuwei 3 fen, Da Shudi 5-7 qian to 1 liang, Jiangxi Zhu 3 qian, Dan Fupian 1 qian, Wine-steamed Huainiuxi 2 qian) is also good, proving effective for damp-heat syndromes where劫伤 (severe damage) leads to Yin injury affecting Yang, causing dullness and muteness. This is Chu Zhan's secret weapon, working by nourishing Yin fluids while utilizing the Qi transformation of Ginseng and Aconite, allowing upper dispersion of fluids to the Lungs and lower transmission of essence to the Kidneys. With Aconite guided downward by Niuxi, it avoids becoming a destructive Fire and instead becomes a generating Young Fire, creating the miracle of clouds rising to bring rain, thus rescuing Yin rapidly. Although both Tao and Feng formulas are excellent for emergency Yin-Yang rescue, one emphasizes Yang Qi and the other Yin Qi; clinical application requires careful attention.
Third, restoring pulse and revitalizing spirit: Such as Fumai Tang mixed with one scoop of Shen Gui Yangrong Wine achieves rapid results; secondly, Qianjin Shengmai San decocted and mixed with one scoop of Deer Horn Wine is also effective. The efficacy of these two formulas lies in wine's ability to refresh spirit and stimulate blood circulation, thereby strengthening the heart mechanism and restoring meridian operation, preventing pulse cessation and clarifying spirit.
Fourth, opening closure and securing collapse: Two symptoms exist: Internal closure with external collapse, where internal closure refers to collateral blockage and external collapse refers to Qi collapse. Ye Tianshi said: "Normally, if the heart is deficient with phlegm, once external heat sinks, interior collaterals close, leading to immediate syncope and spasms." If closure is not urgently opened, or opened improperly, Heart Qi and Lung Qi will fail to connect smoothly, resulting in cold sweat, restlessness, inability to lie down, fine and rapid pulse, indicating Qi collapse. The emergency method at this time is to urgently open internal closure and secure external collapse, such as Ye's Jiajian Fumai Tang removing Yiren and Pipa Ye, adding Mianpi 1.5 qian and Beiwuweizi numerous grains, mixed with Niuhuang Qingxin Wan; severely, Tao's Huiyang Jiuji Tang mixed with Ye's Shenxi Dan, offering a slight chance of survival. External closure with internal collapse: External closure means pathogen binding and Yang depression; internal collapse means Yang excess and Yin exhaustion. Often caused by warm-heat diseases complicated by wind and cold, where wind-cold is not first dispelled to release the exterior, and bitter-cold descending drugs are used early, leading to unresolved exterior and sinking pathogen. At this time, use light and ascending releasing agents to resolve the exterior and prevent closure, such as Shao's Reyu Tang or Wuye Lugeng Tang; use heat-clearing and Yin-preserving agents to rescue the interior and prevent collapse, such as Zhuye Shigao Tang or Jiajian Zhuye Shigao Tang; select appropriately. Combined formulas, such as Waitai Sanhuang Shigao Tang or Yang's Zengsun Sanhuang Shigao Tang. If chest/abdominal fullness, pain with refusal to press, and constipation occur, urgent purging is needed, detailed in the Purging Interior chapter. These are all tonifying deficiency and lifting sunken methods. Though distinct from Kaitou methods, the intent is the same. However, treating external closure with internal collapse is not included here. The following describes patterns suitable for Kaitou and lifting methods:
Pattern of Pathogenic Heat Initially Steaming Heart Meridian: Restless spirit, frequent dreaming and talking in sleep, clear upon waking; severely, increasing irritability and talkativeness, but speech concerns daily affairs without confusion; occasional delirium at night, but mostly coherent speech; red tongue with sticky coating, yellow-red urine, heavy interior heat with lighter exterior heat, chest stuffiness and discomfort.
Pattern of Pathogen Sinking into Pericardium, Deep Heat with Deep Cold Limbs: Coma and delirium, excessive delusional speech and hallucinations, suspecting ghosts and spirits, seeing/hearing things unseen/unheard by others, but responsive to calls; crimson tongue with sticky coating resembling moss but not quite, dry to look at but moist to touch, red corners of eyes, red lips, deafness, burning pain in chest refusing pressure but soft, cold limbs, purple-black nails, loose black foul-smelling stool or fresh blood, yellow-red painful urination.
Pattern of Pathogenic Heat Deeply Entering Heart: Coma and muteness, loss of consciousness, like a drunkard, resembling corpse-syncope, smiling face, fixed staring eyes, stiff or short curled tongue, red coating with black spots or black coating with red spots, cold body and limbs, isolated heat in chest burning to touch, spirit awake but sleeping, snoring sounds, gum crusts purple like dried lacquer.
Note: Although these signs indicate imminent organ failure, if the scrotum is not retracted, face not blue, breath not high, throat not straight, nose not flaring, ears not scorched, no fish-eye appearance, no crow-beak mouth, there is still a glimmer of hope. Large dose emergency rescue, frequent administration, if medicine reaches the stomach, there is a slight chance of survival. If eyeballs do not rotate, pupils dilated, pale grey tongue lacking spirit, enuresis and spontaneous sweating, death is certain and untreatable.
Pattern of Heat Sinking with Phlegm Confusion: All-day coma and somnolence, seeming asleep but not quite, or irritable manic speech, erroneous muttering, solitary talking as if seeing ghosts, frog-like sound in throat, mute like corpse-syncope, spitting sticky saliva, chest full/painful but soft on pressure, nasal flaring and rapid breathing, crimson moist tongue sticky to touch, or tongue wanting to extend but hitting teeth difficult to extend quickly, severely chaotic convulsions resembling epilepsy.
Pattern of Heat Sinking with Damp Obstruction: Chest/diaphragm stuffiness, vexation and oppression, eyes wanting to close, coma and delirium, white slippery coating or yellow-greasy coating, short/scanty yellow-hot urine, loose unsatisfactory stool, oily complexion, foul breath, deafness, dry retching.
Pattern of Heat Sinking with Blood Syncope: Coma like drunkenness, awakening upon call, aware of people when spoken to; if allowed to sleep freely, then coma and delirium; severely syncope and muteness, heavy body, chest pain, cold limbs, hard stool but easy passage, purple-black color, free urination, purple-dark moist tongue.
Pattern of Pathogenic Heat Knotting Stasis, Blood Toxin Attacking Heart: Coma like mania or epilepsy, laughing/cursing, wanting to bite people, purple-dark tongue, locked jaw difficult to open, or limb spasms.