（一名热病伤寒。）
【因】伏热将发。新寒外束。然发在夏至以前者为瘅热。多由于暴寒而发。在夏至
以后者为热病。多由于伤暑而发。古人仍以伤寒称之者。谓其初受病时。皆寒气郁伏所
致耳。全在临证者先其所因。明辨其兼寒与兼暑二端。别其为热病兼寒。热病兼暑。分际
自清。
【证】热病兼寒者。初必先淅然厥起。微恶风寒。身热无汗。或汗出而寒。头痛不
堪。尺肤热甚。继即纯热无寒。心烦恶热。口渴引饮。热极烁阴。则耳聋目昏。颧赤唇焦
。口干舌烂。咳逆而衄。或呕下血。或发呃忒。或腰痛如折。前阴出汗。或泄而腹满。
热极动风。则手足螈 。口噤齿 。由痉而厥。溺赤涩痛。大便燥结。舌苔初则黄白相
兼。继
则纯红苔少。热病兼暑者。一起即发热身痛。背微恶寒。头痛且晕。面垢齿燥。大渴引
饮。心烦恶热。 疹隐隐。烦则喘喝。静则多言。甚则谵语遗溺。大便或闭或泻。泻而
不爽。其余变症。与前相同。舌苔纯黄无白。或干黄起刺。或黄腐满布。或老黄带灰黑。
甚或鲜红无苔。或紫红起刺。或绛而燥裂。或深紫而赤。或干而焦。或胖而嫩。
【脉】左浮紧。右洪盛。紧为寒束于外。洪盛则热结于内。此《内经》所谓冬伤于寒
。春生瘅热。亦即石顽所云热病脉见浮紧者。乃复感不正之暴寒。搏动而发也。若左盛
而躁。右洪盛而滑。躁则血被火逼。盛滑则伏热外溃。此《内经》所谓尺肤热甚。脉盛
躁者病温。盛而滑者病且出也。亦即石顽所云后夏至日为热病。乃久伏之邪。随时气之
暑热而勃发也。
【治】热病兼寒。必先解其热以出其汗。轻则葱豉桔梗汤。加益元散（三钱包煎）、
青蒿脑（二钱），重则新加白虎汤。加鲜葱白（三枚切）、淡香豉（四钱）、使表里双解。或
汗或 。或疹或 。一齐俱出。如犹谵语发狂。烦渴大汗。大便燥结。小便赤涩。咽干
腹满。昏不识人者。急与白虎承气汤。加至宝丹。开上攻下以峻逐之。如已风动痉厥者
。急与犀连承气汤。加羚角紫雪。熄风宣窍以开逐之。若热病兼暑。必先清其暑以泄其
热。初以新加白虎汤为主。继则清其余热以保气液。竹叶石膏汤加减。终则均须实其阴
以补其不足。如肺胃阴虚。余热不清。虚羸少气。气逆欲吐者。竹叶石膏汤。加竹茹茅
根主之（鲜淡竹叶、冰糖水炒石膏各二钱、仙半夏一钱、原麦冬三钱、西洋参钱半、
生甘草八分、生、粳米三钱、包煎）。咳逆鼻衄者。去半夏。加鲜枇杷叶（一两、去毛抽筋）、
鲜生地（六钱、去皮）、地锦（五钱）、舌烂呕血者。加经霜西瓜翠（三钱）、生蒲黄
（一钱）、制月石（三分）、
鲜生地汁（两瓢冲）。呃逆者。加广郁金汁（四匙分冲）、枇杷叶（一两、去毛筋、炒
微黄）、青箬叶（三钱。）如脾阴既虚。累及脾阳。气弱肢软。泄而腹满。或便血面白
者。补阴益气煎。加煨木香。春砂仁。（各六分、盐水炒香、）如肝阴大亏。血不养筋
。筋脉拘挛。甚则手足螈 。头目晕眩者。阿胶鸡子黄汤主之。如心肾两亏。颧赤耳聋
舌绛心悸。神烦不寐。腰痛如折。前阴出汗。时欲晕厥者。坎气潜龙汤主之。阴复则生
。阴竭则死。
【秀按】大热证首伤气血。气分燥热。烦渴大汗。脉洪舌黄者。以长沙白虎汤为主
。兼风加桑叶、薄荷。兼寒加葱白、豆豉。兼暑加青蒿、香薷。兼湿加苍术、川朴。气
虚液枯者。加人参、麦冬。血虚火旺者。加鲜地、丹皮。痰多气滞者。加半夏、橘红。
络痹筋挛者。加羚角、桂枝。火旺生风者。加犀、羚、桑、菊。火实便闭者。加芩、连
、硝、黄。惟食积化火。宜用大黄。湿热化火。宜用清宁丸。均忌石膏。苟非四大俱全
。（大渴、大烦、大汗、右手脉大。）白虎汤切不可用。血分火烁。烦躁谵语。脉数舌
绛者。以千金犀角地黄汤为主。兼疹。加连翘、牛蒡、紫草、大青。兼 。加元参、大
青、野菰根、鲜茅根。呕血。加醋炒生锦纹、小川连、淡竹茹、地锦。下血。加茅根、
槐蕊、青蒿脑、地榆炭。血瘀。加桃仁、丹参、益母草、延胡索。风痉。加羚角、滁菊
、钩藤、童便。昏厥。酌加紫雪、绛雪、行军散、至宝丹之类。毒盛。加金汁、人中黄
、贯众、紫花地丁、紫金片之类。其次终损精神。精枯髓热。腰脊酸痛。遗精带下。骨
蒸跟疼。冲任脉动。两颧嫩红。耳聋眼花。脉左关尺细弦数。舌质胖嫩。根或灰黑淡薄
者。以二加龙蛎汤去姜附。加大补阴丸为主。虚咳。酌加沙苑子、天冬、野百合真柿霜
之类。虚喘。酌加灵磁石、北五味、秋石拌捣甘杞子、玄精石泡水磨沉香汁之类。虚痰
。酌加淡竹盐拌炒胡桃肉、秋石水拌炒沙苑子之类。虚呃。酌加青铅、铁落、盐水炒银
杏、刀豆子、沉香水炒淮牛膝之类。虚热。酌加银胡、地骨皮、青蒿、炙鳖甲之类。神
烦不寐。心悸胆怯。恍惚不安。躁则
语言错乱。静则独语如见鬼。交睫则惊恐非常。倏醒则叫呼不宁。脉左寸浮洪。两尺沉
细数搏。舌形圆大嫩红者。以阿胶黄连汤、加半夏、秫米、枣仁、茯神为主。盗汗。
加皮、竹茹、淮小麦之类。怔仲。加朱砂、西黄、玳瑁、珠粉之类。挟痰。加竹沥、
竺黄、胆星、川贝之类。血厥。加白薇、归身、龙齿、牡蛎之类。昼夜不得交睡者。加
桂与川连同研糊丸吞下。神识近于痴癫者。加《局方》妙香丸至宝丹之类。此皆予
治大热证国中末变端之大要也。
【廉勘】热证伤寒。为吾绍常人所通晓。国中末治法。俞氏及先祖随病立方。多遵
《内经》及《伤寒论》。辨证决疑。可谓致广大而尽精微矣。惟呃逆一证。头绪甚繁。
予从顾松园王孟英两家法例。多验。爰述于后。顾谓热病发呃。属热属实者居多。如因
胃中热壅气郁而呃者。以清胃热降逆气为主。竹叶石膏汤加竹茹、芦根。或加枳实、栝
蒌。因胃中痰饮阻气而呃者。以消痰降气为主。二陈汤加旋复花、代赭石。因胃中饮食
阻气而呃者。食不消而胸脘痞满。以消食降气为主。如沉香、砂仁、枳实、橘红、青皮
、槟榔之类。便不通而脉来有力。酌用大小承气汤下之。因胃中瘀血阻气而呃者。以通
瘀降气为主。犀角地黄汤加桃仁、羚角、降香、郁金。若过服寒药伤胃。冷气逆上而呃
者。以温中降气为主。宜用丁香、柿蒂、沉香、砂仁、吴茱萸诸品。寒甚者加桂附。气
虚者加人参。惟屡下后及病久。与夫老人虚体。妇人产后。阴气大亏。阳气暴逆。自脐
下直冲至胸嗌间而呃者。内经所谓病深者其声哕是也。急用六味地黄汤加大补阴丸、紫
石英、沉香汁。或可挽救一二。王氏谓哕气忤也。逆气也。即俗云呃忒。痰阻清阳者宜
开。胃火上冲者宜清。肝气拂郁者宜疏。腑气秘塞者宜通。下虚冲逆。吸气不入者。
宜镇纳。岂可专借重一旋复代赭汤哉。查王氏开豁痰呃。辄用竹茹、橘皮、栝蒌、半
夏、枳实、薤白、旋复、菖蒲、紫菀、白前、枇杷叶等品。挟肝火。加茱连雪羹。兼
营热。加犀角元参。清降热呃。多用竹叶石膏汤加紫菀、白前、旋复、杷叶。与顾氏
法同。疏降肝逆。多用萸、连、旋、赭、延、铃、五
磨饮子等品。通降腑塞。虽亦以承气为主。或间用当归龙荟丸以泻肝。或间佐礞石滚痰
丸以坠痰。或间投更衣丸以通腑。惟中虚寒饮致呃者。仍用代赭旋复花汤主治。若下虚
冲逆致呃者。往往用龙齿、牡蛎、龟版、鳖甲、石英、白薇、青铅、铁落、熟地、沉香
、苁蓉、牛膝、蛤壳、决明、杞子、胡桃等品。出入为方。即俞东扶治气冲证。用熟地
、归、杞、牛膝、石英、胡桃、坎气、青铅等药。亦与王氏法不谋而合。惟杜良一用
六味地黄汤合五磨饮子去木香。立法尤新。予每引用俞杜两法。以治肾虚冲呃。多收敏
效。总之伏气热病。与伏气温病。皆伏火证。全在辨明虚实。庶无实实虚虚之误矣。
【荣斋按】何廉臣先生说∶“伏气热病，为时邪引动而发者，当看其兼挟之邪，轻
重如何？轻者可以兼治，重者即当在初起时着意先撤邪；俟新邪既解，再治伏邪，方不
碍手。此须权其轻重缓急，以定其治法。张锡纯治于君热病兼寒案，因伏热初起为风寒
所束，证见壮热无汗，胸中烦热，又兼喘促，口渴喜饮，头犹觉痛，周身亦有拘急之意
。脉洪滑而浮，舌苔白滑微黄，此外寒束其内热。治以自制寒解汤──生石膏一两捣细
，知母八钱，青连翘钱半，蝉蜕钱半。服两剂而愈。此热病兼寒，方中重用膏、知以清
胃腑之热，复用连翘、蝉蜕之善达表者，引胃中化而欲散之热，仍还太阳作汗而解。斯
乃调剂阴阳，听其自汗，非强发其汗也。”这是热症伤寒的初期治法，录之以作参考。
（详见《全国名医验案类编》。）
（又称热病伤寒。）
【病因】体内伏藏的郁热即将发作，同时受到外界新感寒邪的束缚。然而，在夏至之前发病的称为“瘅热”，多因暴受寒邪而引发；在夏至之后发病的称为“热病”，多因感受暑邪而引发。古人仍将其称为伤寒，是因为其初起时皆由寒气郁伏所致。关键在于临证医生首先要查明病因，明确辨别是兼夹寒邪还是兼夹暑邪这两种情况，区分出是“热病兼寒”还是“热病兼暑”，界限自然清晰。
【症状】热病兼寒者，起初必定先感到淅淅恶风、四肢发冷，轻微怕风怕冷，身体发热且无汗，或者出汗后反而觉得冷，头痛剧烈难以忍受，尺部皮肤（手腕内侧前臂）发热严重。随后即转为纯热无寒，心烦意乱，厌恶炎热，口渴想喝水。热势极盛灼伤阴液，则出现耳聋、目昏花，颧骨发红，嘴唇焦裂，口干舌烂，咳嗽气逆并伴有鼻出血，或者呕吐下血，或者打呃逆，或者腰痛如折断一般，前阴部位出汗，或者腹泻且腹部胀满。热极引动肝风，则出现手足抽搐痉挛，牙关紧闭，牙齿咬合有声。由痉厥发展为昏迷，小便短赤涩痛，大便干燥结硬。舌苔起初黄白相间，随后变为纯红且苔少。
热病兼暑者，一发病就发热身痛，背部轻微怕冷，头痛且头晕，面部污垢，牙齿干燥，极度口渴想喝水，心烦意乱，厌恶炎热，身上隐隐出现疹子。烦躁时气喘喝喝，安静时多言多语。严重时出现胡言乱语、遗尿。大便或闭结或腹泻，腹泻但不爽快。其余变症与前述相同。舌苔纯黄无白，或者干黄起刺，或者黄腐满布，或者老黄色带灰黑色，甚至鲜红无苔，或者紫红起刺，或者绛色而燥裂，或者深紫色而赤，或者干枯而焦黑，或者胖大而嫩滑。
【脉象】左手脉浮紧，右手脉洪盛。紧脉表示寒邪束缚于体表，洪盛脉表示热邪结聚于体内。这正是《内经》所说的“冬伤于寒，春生瘅热”，也就是石顽先生所说的热病脉见浮紧，乃是再次感受不正之暴寒，搏动激发而发病。如果左脉盛大而躁动，右脉洪盛而滑利，躁动表示血液被火邪逼迫，盛大滑利表示伏热向外溃散。这也是《内经》所说的“尺肤热甚，脉盛躁者病温，盛而滑者病且出也”，也就是石顽先生所说的夏至后日为热病，乃是久伏之邪，随着时令的暑热之气而勃然发作。
【治法】热病兼寒，必须先解除热邪以引出汗液。轻症用葱豉桔梗汤，加益元散（三钱包煎）、青蒿脑（二钱）；重症用新加白虎汤，加鲜葱白（三枚切段）、淡香豉（四钱），以使表里双解。无论是汗出、斑出、疹出还是痘出，一齐发出。如果仍然胡言乱语、发狂，烦渴大汗，大便干燥结硬，小便赤涩，咽干腹满，神志昏迷不认识人，急用白虎承气汤，加至宝丹，开上窍攻下积以峻猛驱逐邪气。如果已经发生风动痉厥，急用犀连承气汤，加羚羊角、紫雪，熄风开窍以开逐邪气。
若是热病兼暑，必须先清解暑邪以泄除热邪。初期以新加白虎汤为主方。随后清除余热以保护气液，用竹叶石膏汤加减。最终都必须充实阴液以补其不足。如肺胃阴虚，余热不清，身体虚弱消瘦、气短，气逆想吐者，用竹叶石膏汤，加竹茹、白茅根主治（鲜淡竹叶、冰糖水炒石膏各二钱、仙半夏一钱、原麦冬三钱、西洋参一钱半、生甘草八分、生姜、粳米三钱、包煎）。咳嗽气逆鼻衄者，去半夏，加鲜枇杷叶（一两，去毛抽筋）、鲜生地（六钱，去皮）、地锦草（五钱）。舌烂呕血者，加经霜西瓜翠衣（三钱）、生蒲黄（一钱）、制月石（三分）、鲜生地汁（两瓢冲服）。呃逆者，加广郁金汁（四匙分次冲服）、枇杷叶（一两，去毛筋，炒微黄）、青箬叶（三钱）。
如脾阴既虚，累及脾阳，气弱肢体软弱，腹泻且腹部胀满，或者便血面色苍白者，用补阴益气煎，加煨木香、春砂仁（各六分，盐水炒香）。如肝阴大亏，血不养筋，筋脉拘挛，甚至手足抽搐痉挛，头目晕眩者，用阿胶鸡子黄汤主治。如心肾两亏，颧红耳聋，舌绛心悸，神志烦躁不寐，腰痛如折，前阴出汗，时常想要晕厥者，用坎气潜龙汤主治。阴液恢复则生，阴液枯竭则死。
【秀按】大热证首先损伤气血。气分燥热，烦渴大汗，脉洪大舌苔黄者，以长沙张仲景的白虎汤为主方。兼风加桑叶、薄荷；兼寒加葱白、豆豉；兼暑加青蒿、香薷；兼湿加苍术、厚朴。气虚液枯者，加人参、麦冬。血虚火旺者，加鲜地黄、牡丹皮。痰多气滞者，加半夏、橘红。络脉痹阻筋脉拘挛者，加羚羊角、桂枝。火旺生风者，加犀角、羚羊角、桑叶、菊花。火实便秘者，加黄芩、黄连、芒硝、大黄。只有食积化火，宜用大黄；湿热化火，宜用清宁丸，均忌用石膏。除非具备四大症（大渴、大烦、大汗、右手脉大），否则切不可用白虎汤。血分火邪炽盛，烦躁谵语，脉数舌绛者，以千金方的犀角地黄汤为主方。兼疹加连翘、牛蒡子、紫草、大青叶。兼斑加玄参、大青叶、野菰根、鲜茅根。呕血加醋炒生锦纹（大黄）、小川连（黄连）、淡竹茹、地锦草。下血加茅根、槐蕊、青蒿脑、地榆炭。血瘀加桃仁、丹参、益母草、延胡索。风痉加羚羊角、滁菊、钩藤、童便。昏厥酌加紫雪、绛雪、行军散、至宝丹之类。毒盛加金汁、人中黄、贯众、紫花地丁、紫金片之类。其次终损精神，精枯髓热，腰脊酸痛，遗精带下，骨蒸脚疼，冲任脉动，两颧嫩红，耳聋眼花，脉左关尺细弦数，舌质胖嫩，根部或灰黑淡薄者，以二加龙蛎汤去姜附，加大补阴丸为主方。虚咳酌加沙苑子、天冬、野百合、真柿霜之类。虚喘酌加灵磁石、北五味子、秋石拌捣甘杞子、玄精石泡水磨沉香汁之类。虚痰酌加淡竹盐拌炒胡桃肉、秋石水拌炒沙苑子之类。虚呃酌加青铅、铁落、盐水炒银杏、刀豆子、沉香水炒淮牛膝之类。虚热酌加银柴胡、地骨皮、青蒿、炙鳖甲之类。神志烦躁不寐，心悸胆怯，恍惚不安，躁动时语言错乱，安静时独语如见鬼魂，刚要入睡则惊恐非常，突然醒来则叫呼不宁，脉左寸浮洪，两尺沉细数搏，舌形圆大嫩红者，以阿胶黄连汤加半夏、秫米、枣仁、茯神为主方。盗汗加浮皮（应为浮小麦或地骨皮之误，此处依原文译作皮，但中医常指浮小麦或地骨皮，结合语境可能是浮小麦或地骨皮，暂译为皮/Herb skin，实际临床多为浮小麦或地骨皮，此处忠实原文“皮”）、竹茹、淮小麦之类。怔忡加朱砂、西黄（牛黄）、玳瑁、珠粉之类。挟痰加竹沥、竺黄（天竺黄）、胆星、川贝之类。血厥加白薇、归身、龙齿、牡蛎之类。昼夜不得交睡者，加桂枝与黄连同研糊丸吞下。神识近于痴癫者，加《局方》妙香丸、至宝丹之类。这都是我治疗大热证国中末变端的大要。
【廉勘】热证伤寒，是我们绍兴普通人所通晓的。国中末期的治法，俞氏及其先祖随病立方，大多遵循《内经》及《伤寒论》，辨证决疑，可谓致广大而尽精微了。唯独呃逆这一证，头绪非常繁杂，我从顾松园、王孟英两家法例，多有效验，于是陈述如下。顾氏认为热病发呃，属热属实的居多。如因胃中热壅气郁而呃者，以清胃热降逆气为主，用竹叶石膏汤加竹茹、芦根，或加枳实、瓜蒌。因胃中痰饮阻气而呃者，以消痰降气为主，用二陈汤加旋复花、代赭石。因胃中饮食阻气而呃者，食不消而胸脘痞满，以消食降气为主，如沉香、砂仁、枳实、橘红、青皮、槟榔之类。便不通而脉来有力，酌情用大小承气汤下之。因胃中瘀血阻气而呃者，以通瘀降气为主，用犀角地黄汤加桃仁、羚羊角、降香、郁金。若过服寒药伤胃，冷气逆上而呃者，以温中降气为主，宜用丁香、柿蒂、沉香、砂仁、吴茱萸诸品。寒甚者加桂枝、附子。气虚者加人参。惟屡下后及病久，与夫老人虚体，妇人产后，阴气大亏，阳气暴逆，自脐下直冲至胸嗌间而呃者，《内经》所谓病深者其声哕是也。急用六味地黄汤加大补阴丸、紫石英、沉香汁，或可挽救一二。王氏认为哕即气忤也，逆气也，即俗云呃忒。痰阻清阳者宜开豁，胃火上冲者宜清降，肝气拂郁者宜疏泄，腑气秘塞者宜通降，下虚冲逆，吸气不入者，宜镇纳。岂可专借重一个旋复代赭汤哉？查王氏开豁痰呃，辄用竹茹、橘皮、瓜蒌、半夏、枳实、薤白、旋复、菖蒲、紫菀、白前、枇杷叶等品。挟肝火，加茱连雪羹。兼营热，加犀角、玄参。清降热呃，多用竹叶石膏汤加紫菀、白前、旋复、杷叶，与顾氏法同。疏降肝逆，多用萸、连、旋、赭、延、铃、五磨饮子等品。通降腑塞，虽亦以承气为主，或间用当归龙荟丸以泻肝，或间佐礞石滚痰丸以坠痰，或间投更衣丸以通腑。惟中虚寒饮致呃者，仍用代赭旋复花汤主治。若下虚冲逆致呃者，往往用龙齿、牡蛎、龟版、鳖甲、石英、白薇、青铅、铁落、熟地、沉香、苁蓉、牛膝、蛤壳、决明、杞子、胡桃等品，出入为方。即俞东扶治气冲证，用熟地、归、杞、牛膝、石英、胡桃、坎气、青铅等药，亦与王氏法不谋而合。惟杜良一用六味地黄汤合五磨饮子去木香，立法尤新。予每引用俞杜两法，以治肾虚冲呃，多收敏效。总之伏气热病，与伏气温病，皆伏火证，全在辨明虚实，庶无实实虚虚之误矣。
【荣斋按】何廉臣先生说：“伏气热病，为时邪引动而发者，当看其兼挟之邪，轻重如何？轻者可以兼治，重者即当在初起时着意先撤邪；俟新邪既解，再治伏邪，方不碍手。此须权其轻重缓急，以定其治法。”张锡纯治于君热病兼寒案，因伏热初起为风寒所束，证见壮热无汗，胸中烦热，又兼喘促，口渴喜饮，头犹觉痛，周身亦有拘急之意。脉洪滑而浮，舌苔白滑微黄，此乃外寒束其内热。治以自制寒解汤──生石膏一两捣细，知母八钱，青连翘钱半，蝉蜕钱半。服两剂而愈。此热病兼寒，方中重用膏、知以清胃腑之热，复用连翘、蝉蜕之善达表者，引胃中化而欲散之热，仍还太阳作汗而解。斯乃调剂阴阳，听其自汗，非强发其汗也。”这是热症伤寒的初期治法，录之以作参考。（详见《全国名医验案类编》。）
(Also known as Heat Disease Cold Damage.)
[Etiology] Internal latent heat is about to erupt, while simultaneously being constrained by newly acquired external cold. However, those occurring before the Summer Solstice are called "Dan Re" (Crimson Heat), mostly triggered by sudden exposure to cold; those occurring after the Summer Solstice are called "Re Bing" (Heat Disease), mostly triggered by injury from summer-heat. The ancients still referred to it as Cold Damage because, at the onset, all such conditions were caused by the depression and retention of cold qi. The key lies in the clinician first identifying the etiology, clearly distinguishing between the two categories: accompanying cold or accompanying summer-heat. By differentiating between "Heat Disease with Accompanying Cold" and "Heat Disease with Accompanying Summer-heat," the boundaries become clear.
[Symptoms] In Heat Disease with Accompanying Cold, initially there must be a sensation of shivering and aversion to wind/cold, slight aversion to wind and cold, fever without sweat, or sweating followed by chills, unbearable headache, and significant heat in the skin of the chi position (inner forearm near the wrist). Subsequently, it turns into pure heat without cold, restlessness, aversion to heat, thirst with desire to drink. When heat reaches its extreme and scorches yin, symptoms include deafness, blurred vision, malar flush, cracked lips, dry mouth with oral ulcers, cough with air reflux and epistaxis, or vomiting and hematochezia, or hiccups, or waist pain as if broken, sweating from the anterior yin, or diarrhea with abdominal fullness. Extreme heat stirring wind leads to spasms and convulsions of the hands and feet, locked jaw, and teeth grinding. From spasm develops coma/jue syndrome, dark red scanty urine with painful dysuria, and dry hard stool. The tongue coating is initially mixed yellow and white, then becomes purely red with little coating.
In Heat Disease with Accompanying Summer-heat, fever and body pain appear immediately upon onset, slight aversion to cold on the back, headache with dizziness, greasy face, and dry teeth. There is extreme thirst with desire to drink, restlessness, aversion to heat, and faintly visible macules/rash. Restlessness causes panting and loud breathing, while quietness results in excessive talking. Severe cases present with delirium and urinary incontinence. Stool may be constipated or diarrheal, but diarrhea is不爽 (not relieving). Other complicated symptoms are the same as mentioned above. The tongue coating is purely yellow without white, or dry yellow with prickles, or yellow and putrid covering the whole surface, or old yellow with gray-black, or even bright red without coating, or purple-red with prickles, or crimson and dry/cracked, or deep purple and red, or dry and scorched, or swollen and tender.
[Pulse] The left pulse is floating and tight; the right pulse is surging and abundant. Tightness indicates cold constraining the exterior; surging abundance indicates heat knotting internally. This is what the *Neijing* refers to as "Winter injury by cold, Spring generation of Crimson Heat," which is also what Shi Wan stated: when the pulse of Heat Disease shows floating and tightness, it is due to re-exposure to violent abnormal cold, which stimulates and triggers the eruption. If the left pulse is vigorous and restless, and the right pulse is surging, abundant, and slippery, restlessness indicates blood being forced by fire; vigorous and slippery indicates latent heat bursting outward. This is also what the *Neijing* states: "Skin heat at the chi position with vigorous and restless pulse indicates Warm Disease; vigorous and slippery pulse indicates the disease is about to exit." This is also what Shi Wan said: Heat Disease after the Summer Solstice is due to long-retained pathogens erupting vigorously along with the seasonal summer-heat qi.
[Treatment] For Heat Disease with Accompanying Cold, one must first resolve the heat to induce sweating. For mild cases, use Cong Chi Jie Geng Tang (Scallion, Fermented Soybean, and Platycodon Decoction), plus Yi Yuan San (Yi Mi powder wrapped and decocted, 3 qian) and Qing Hao Nao (Artemisia Annua Brain, 2 qian). For severe cases, use Xin Jia Bai Hu Tang (Modified White Tiger Decoction), plus fresh scallion white (3 pieces, cut), Dan Xiang Chi (Light Fragrant Fermented Soybean, 4 qian), to achieve simultaneous resolution of interior and exterior. Whether sweat, macules, rash, or pustules emerge, they should all erupt together. If there is still delirium and mania, extreme thirst with profuse sweating, dry hard stool, dark scanty urine, dry throat with abdominal fullness, and unconsciousness not recognizing people, urgently administer Bai Hu Cheng Qi Tang (White Tiger and Major Order the Qi Decoction) plus Zhi Bao Dan (Treasure for Preservation Pill) to open the upper orifices and attack the lower accumulation to ruthlessly drive out the pathogen. If wind movement and spasm/coma have already occurred, urgently administer Xi Lian Cheng Qi Tang (Rhinoceros Horn and Coptis Order the Qi Decoction) plus Ling Yang Jiao (Antelope Horn) and Zi Xue (Purple Snow) to extinguish wind and unblock orifices to drive out the pathogen.
For Heat Disease with Accompanying Summer-heat, one must first clear the summer-heat to drain the heat. Initially, use Xin Jia Bai Hu Tang (Modified White Tiger Decoction) as the main formula. Subsequently, clear residual heat to protect qi and fluids, using Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) with modifications. Ultimately, it is necessary to tonify yin to compensate for insufficiency. For lung and stomach yin deficiency with unclear residual heat, emaciation, shortness of breath, and rebellious qi with nausea/vomiting, use Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) plus Zhu Ru (Bamboo Shavings) and Mao Gen (Imperata Rhizome). (Fresh Zhu Ye, Shi Gao stir-fried with rock sugar water each 2 qian, Xian Ban Xia 1 qian, Yuan Mai Dong 3 qian, Xi Yang Shen 1.5 qian, Sheng Gan Cao 8 fen, Sheng Jiang, Jing Mi 3 qian, wrapped and decocted). For cough with air reflux and epistaxis, remove Ban Xia, add fresh Pi Pa Ye (Loquat Leaf, 1 liang, de-hair and de-vein), fresh Sheng Di (Rehmannia Root, 6 qian, peeled), Di Jin (Lysimachia Herb, 5 qian). For oral ulcers and hematemesis, add Jing Shuang Xi Gua Cui (Watermelon Rind from frost-exposed melon, 3 qian), Sheng Pu Huang (Raw Cattail Pollen, 1 qian), Zhi Yue Shi (Prepared Rock Alum, 0.3 fen), and fresh Sheng Di juice (two ladles mixed). For hiccups, add Guang Yu Jin Zhi (Curcuma Juice, 4 spoons mixed separately), Pi Pa Ye (Loquat Leaf, 1 liang, de-hair/de-vein, stir-fried slightly yellow), Qing Ruo Ye (Green Bamboo Leaf, 3 qian).
If spleen yin is deficient, affecting spleen yang, leading to weak qi and soft limbs, diarrhea with abdominal fullness, or hematochezia with pale complexion, use Bu Yin Yi Qi Jian (Tonify Yin and Boost Qi Decoction) plus Wei Mu Xiang (Baked Aucklandia) and Chun Sha Ren (Spring Amomum Fruit) (each 0.6 fen, stir-fried fragrant with salt water). If liver yin is severely deficient, blood failing to nourish tendons, leading to tendon contraction and spasms, even spasms of hands and feet, and dizziness of head and eyes, use E Jiao Ji Zi Huang Tang (Donkey-hide Gelatin and Chicken Egg Yolk Decoction). If heart and kidney are both deficient, with malar flush, deafness, crimson tongue, palpitations, mental restlessness and insomnia, waist pain as if broken, sweating from anterior yin, and frequent syncope, use Kan Qi Qian Long Tang (Kan Qi and Hidden Dragon Decoction). If yin recovers, life is preserved; if yin exhausts, death ensues.
[Xiu's Note] Major heat syndromes first injure qi and blood. If qi level dry-heat presents with restlessness, extreme thirst, profuse sweating, surging pulse, and yellow tongue coating, use Chang Sha Bai Hu Tang (Changsha White Tiger Decoction) as the main formula. Accompanying wind: add Sang Ye (Mulberry Leaf), Bo He (Mint). Accompanying cold: add Cong Bai (Scallion White), Dou Chi (Fermented Soybean). Accompanying summer-heat: add Qing Hao (Artemisia Annua), Xiang Ru (Elsholtzia). Accompanying dampness: add Cang Zhu (Atractylodes Rhizome), Chuan Po (Magnolia Bark). Qi deficiency and fluid exhaustion: add Ren Shen (Ginseng), Mai Dong (Ophiopogon Tuber). Blood deficiency and hyperactive fire: add Xian Di (Fresh Rehmannia), Dan Pi (Moutan Bark). Phlegm excess and qi stagnation: add Ban Xia (Pinellia Tuber), Ju Hong (Tangerine Peel). Collateral obstruction and tendon spasm: add Ling Yang Jiao (Antelope Horn), Gui Zhi (Cinnamon Twig). Fire hyperactivity generating wind: add Xi Jiao (Rhinoceros Horn - now substituted with Buffalo Horn), Ling Yang Jiao (Antelope Horn), Sang Ye (Mulberry Leaf), Ju Hua (Chrysanthemum Flower). Fire excess and constipation: add Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), Xiao (Mirabilite), Da Huang (Rhubarb Root). Only for food stagnation transforming into fire, use Da Huang (Rhubarb); for damp-heat transforming into fire, use Qing Ning Wan (Clear Peace Pill); both contraindicate Shi Gao (Gypsum). Unless the Four Great Symptoms are complete (Extreme Thirst, Extreme Restlessness, Profuse Sweating, Large Right Pulse), Bai Hu Tang must absolutely not be used. For blood level fire scorching presenting with irritability, delirium, rapid pulse, and crimson tongue, use Qian Jin Xi Jiao Di Huang Tang (Thousand Gold Rhinoceros Horn Rehmannia Decoction) as the main formula. Accompanying rash: add Lian Qiao (Forsythia Fruit), Niu Bang (Arctium Fruit), Zi Cao (Arnebia Root), Da Qing (Isatis Leaf). Accompanying macules: add Yuan Shen (Scrophularia Root), Da Qing (Isatis Leaf), Ye Gu Gen (Solomon's Seal Root), Xian Mao Gen (Imperata Rhizome). Hematemesis: add Vine-processed Sheng Jin Wen (Rhubarb), Xiao Chuan Lian (Coptis), Dan Zhu Ru (Bamboo Shavings), Di Jin (Lysimachia Herb). Hematochezia: add Mao Gen (Imperata Rhizome), Huai Rui (Sophora Flower Bud), Qing Hao Nao (Artemisia Annua Brain), Di Yu Tan (Sanguisorba Charcoal). Blood stasis: add Tao Ren (Peach Seed), Dan Shen (Salvia Root), Yi Mu Cao (Leonurus Herb), Yan Hu Suo (Corydalis Rhizome). Wind-spasm: add Ling Yang Jiao (Antelope Horn), Chu Ju (Chrysanthemum), Gou Teng (Uncaria Hook), Tong Bian (Child's Urine). Coma/Syncope:酌情 add Zi Xue (Purple Snow), Jiang Xue (Crimson Snow), Xing Jun San (Marching Army Powder), Zhi Bao Dan (Treasure for Preservation Pill). Toxicity excess: add Jin Zhi (Golden Juice), Ren Zhong Huang (Human Middle Yellow), Guan Zhong (Dryopteris Fern), Zi Hua Di Ding (Viola Herba), Zi Jin Pian (Purple Gold Tablet). Secondly, spirit is ultimately damaged, essence exhausts and marrow heats, causing soreness/pain in waist/spine, seminal emission and leukorrhea, bone-steaming leg pain, movement of Chong and Ren pulses, tender-red malar flush, deafness/blurred vision, fine-string-numerous pulse at left Guan/Chi positions, swollen-tender tongue quality, root possibly gray-black/thin/light. Use Er Jia Long Li Tang (Two Shells Dragon and Oyster Decoction) removing Jiang (Ginger) and Fu Zi (Aconite), adding Da Bu Yin Wan (Great Tonify Yin Pill) as the main formula. For deficiency-cough,酌情 add Sha Yuan Zi (Astragalus Complanatus Seed), Tian Dong (Asparagus Tuber), Ye Bai He (Wild Lily Bulb), Zhen Shi Shuang (True Persimmon Frost). For deficiency-panting,酌情 add Ling Ci Shi (Magnetite), Bei Wu Wei (Schisandra Berry), Qiu Shi mixed with Gan Qi Zi (Goji Berry) pounded, Xuan Jing Shi (Xuanjing Stone) soaked in water ground with Chen Xiang (Agarwood) juice. For deficiency-phlegm,酌情 add Dan Zhu Yan stir-fried with Hu Tao Rou (Walnut Kernel), Qiu Shi water stir-fried with Sha Yuan Zi (Astragalus Complanatus Seed). For deficiency-hiccups,酌情 add Qing Qian (Lead), Tie Luo (Iron Filings), Salt-water stir-fried Yin Xing (Ginkgo Seed), Dao Dou Zi (Lablab Bean), Chen Xiang water stir-fried Huai Niu Xi (Achyranthes Root). For deficiency-heat,酌情 add Yin Hu (Silver Birch/Bupleurum substitute?), Di Gu Pi (Lyceum Bark), Qing Hao (Artemisia Annua), Zhi Bie Jia (Cooked Turtle Shell). Mental restlessness and insomnia, palpitations, timidity,恍惚 (fluctuating anxiety), language confusion when agitated, talking alone as if seeing ghosts when quiet, extreme fear upon closing eyes, screaming/restlessness upon waking, floating-surging pulse at left Cun, sunken-fine-numerous-beating pulse at both Chi positions, round-large-tender-red tongue shape: use E Jiao Huang Lian Tang (Donkey-hide Gelatin and Coptis Decoction) plus Ban Xia (Pinellia), Shu Mi (Millet), Zao Ren (Jujube Seed), Fu Shen (Poria with Hostwood) as the main formula. Night sweats: add Pi (Herb Skin/Floating Wheat/Dogwood Bark - context implies Floating Wheat or Dogwood Bark), Zhu Ru (Bamboo Shavings), Huai Xiao Mai (Dwarf Wheat). Palpitations: add Zhu Sha (Cinnabar), Xi Huang (Bezoar), Dai Mao (Horned Turtle Shell), Zhu Fen (Pearl Powder). Accompanying phlegm: add Zhu Li (Bamboo Juice), Zhu Huang (Sky Bamboo Pith), Dan Xing (Areca Nut processed with bile), Chuan Bei (Fritillaria Cirrhosa Bulb). Blood syncope: add Bai Wei (Cyanose Root), Gui Shen (Angelica Sinensis Root), Long Chi (Dragon Teeth), Mu Li (Oyster Shell). Unable to sleep day and night: add Gui Zhi (Cinnamon Twig) and Huang Lian (Coptis Rhizome) ground together into paste and swallowed. Consciousness approaching dementia/mania: add Ju Fang Miao Xiang Wan (Regulation Bureau Wonderful Incense Pill), Zhi Bao Dan (Treasure for Preservation Pill). These are the main principles of my treatment of the late-stage variations of major heat syndromes.
[Lian's Verification] Heat Syndrome Cold Damage is commonly understood by ordinary people in our Shaoxing area. The late-stage treatment methods, Mr. Yu and his ancestors formulated prescriptions according to the disease, mostly following the *Neijing* and *Shanghan Lun*. Differentiating syndromes and resolving doubts can be described as comprehensive and meticulous. However, the syndrome of hiccups has very complex threads. I follow the methods of Gu Songyuan and Wang Mengying, which are mostly effective, so I state them below. Gu believed that hiccups in heat diseases are mostly due to heat and excess. If hiccups are caused by heat congestion and qi stagnation in the stomach, the main treatment is clearing stomach heat and descending rebellious qi, using Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) plus Zhu Ru (Bamboo Shavings), Lu Gen (Reed Rhizome), or adding Zhi Shi (Immature Bitter Orange), Gua Lou (Trichosanthes Fruit). If hiccups are caused by phlegm-fluid obstructing qi in the stomach, the main treatment is eliminating phlegm and descending qi, using Er Chen Tang (Two Aged Herbs Decoction) plus Xuan Fu Hua (Inula Flower), Dai Zhe Shi (Haematitum). If hiccups are caused by food obstructing qi in the stomach, with undigested food and chest/epigastric stuffiness, the main treatment is digesting food and descending qi, using items like Chen Xiang (Agarwood), Sha Ren (Amomum Fruit), Zhi Shi (Immature Bitter Orange), Ju Hong (Tangerine Peel), Qing Pi (Green Tangerine Peel), Bing Lang (Areca Seed). If stool is blocked and pulse is forceful,酌情 use Da/Xiao Cheng Qi Tang (Major/Minor Order the Qi Decoctions) to purge. If hiccups are caused by blood stasis obstructing qi in the stomach, the main treatment is unblocking stasis and descending qi, using Xi Jiao Di Huang Tang (Rhinoceros Horn Rehmannia Decoction) plus Tao Ren (Peach Seed), Ling Yang Jiao (Antelope Horn), Jiang Xiang (Aquilaria Wood), Yu Jin (Curcuma Root). If excessive use of cold medicines damages the stomach, causing cold qi to rebel upward resulting in hiccups, the main treatment is warming the middle and descending qi, suitable for Ding Xiang (Clove), Shi Di (Persimmon Calyx), Chen Xiang (Agarwood), Sha Ren (Amomum Fruit), Wu Zhu Yu (Evodia Fruit). For severe cold, add Gui Zhi (Cinnamon Twig), Fu Zi (Aconite). For qi deficiency, add Ren Shen (Ginseng). Only after repeated purgations, prolonged illness, or in elderly with deficient constitutions, postpartum women, where yin qi is greatly deficient and yang qi rebels violently, causing hiccups rushing directly from below the navel to the chest and throat, this is what the *Neijing* calls "when disease is deep, the sound is hiccups." Urgently use Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Pill Decoction) plus Da Bu Yin Wan (Great Tonify Yin Pill), Zi Shi Ying (Purple Quartz), Chen Xiang Zhi (Agarwood Juice), which might save one or two cases. Mr. Wang considers hiccups as qi counterflow, i.e., vulgarly called hiccup. For phlegm obstructing clear yang, opening is appropriate; for stomach fire rushing up, clearing is appropriate; for liver qi stagnation, soothing is appropriate; for fu-organ qi blockage, unblocking is appropriate; for lower deficiency with counterflow and inability to inhale deeply, sedating and grasping is appropriate. How can one rely solely on Xuan Fu Dai Zhe Tang (Inula and Haematitum Decoction)? Checking Mr. Wang's method for opening and dispersing phlegm-induced hiccups, he often uses Zhu Ru (Bamboo Shavings), Ju Pi (Tangerine Peel), Gua Lou (Trichosanthes Fruit), Ban Xia (Pinellia Tuber), Zhi Shi (Immature Bitter Orange), Xie Bai (Macrostemon Bulb), Xuan Fu (Inula), Chang Pu (Acorus Rhizome), Zi Wan (Aster Root), Bai Qian (Cynanchum Root), Pi Pa Ye (Loquat Leaf), etc. Accompanying liver fire, add Zhu Lian Xue Geng (Evodia-Coptis Snow Broth). Accompanying nutritive heat, add Xi Jiao (Rhinoceros Horn) and Yuan Shen (Scrophularia Root). For clearing and descending heat-induced hiccups, mostly use Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) plus Zi Wan (Aster Root), Bai Qian (Cynanchum Root), Xuan Fu (Inula), Pa Ye (Loquat Leaf), same as Mr. Gu's method. For soothing and descending liver rebellion, mostly use Yu (Evodia), Lian (Coptis), Xuan (Inula), Zhe (Haematitum), Yan (Corydalis), Ling (Uncaria), Wu Mo Yin Zi (Five-Monk Drink). For unblocking and descending fu-blockage, although mainly based on Cheng Qi Tang, sometimes use Dang Gui Long Hui Wan (Angelica and Gentian Pill) to purge liver, or assist with Meng Shi Gun Tan Wan (Calamine Rolling Phlegm Pill) to drop phlegm, or occasionally administer Geng Yi Wan (Changing Clothes Pill) to unblock the fu. Only for middle-deficiency cold-fluid inducing hiccups, still use Dai Zhe Xuan Fu Hua Tang (Haematitum and Inula Flower Decoction) as the main treatment. For lower-deficiency counterflow inducing hiccups, often use Long Chi (Dragon Teeth), Mu Li (Oyster Shell), Gui Ban (Turtle Shell), Bie Jia (Softshell Turtle Shell), Shi Ying (Quartz), Bai Wei (Cyanose Root), Qing Qian (Lead), Tie Luo (Iron Filings), Shu Di (Prepared Rehmannia), Chen Xiang (Agarwood), Rong Rong (Cistanche), Niu Xi (Achyranthes Root), Ge Ke (Clam Shell), Jue Ming (Cassia Seed), Qi Zi (Goji Berry), Hu Tao (Walnut), etc., varying the prescription. This aligns with Yu Dongfu's treatment of qi-charging syndrome using Shu Di (Prepared Rehmannia), Gui (Angelica), Qi (Goji), Niu Xi (Achyranthes), Shi Ying (Quartz), Hu Tao (Walnut), Kan Qi (Adrenal Cortex), Qing Qian (Lead), which coincides with Mr. Wang's method. Only Du Liangyi uses Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Pill Decoction) combined with Wu Mo Yin Zi (Five-Monk Drink) removing Mu Xiang (Aucklandia), with particularly novel legislation. I often cite the methods of Yu and Du to treat kidney-deficiency counterflow hiccups, achieving sensitive effects. In summary, latent qi heat disease and latent warmth disease are both latent fire syndromes. It entirely depends on distinguishing deficiency and excess to avoid the error of treating excess as excess and deficiency as deficiency.
[Rongzhai's Note] Mr. He Lianchen stated: "Latent qi heat disease, when triggered by seasonal pathogens, requires observing the accompanying pathogens and their severity. For mild cases, they can be treated concurrently; for severe cases, one must focus on dispelling the new pathogen at the onset; only after the new pathogen is resolved should one treat the latent pathogen, so as not to hinder the hand. This requires weighing the severity and urgency to determine the treatment method." Zhang Xichun treated Case of Mr. Yu with Heat Disease Accompanying Cold. Because latent heat at the initial stage was constrained by wind-cold, symptoms included high fever without sweat, vexation and heat in the chest, accompanied by panting, thirst with desire to drink, lingering headache, and stiffness throughout the body. The pulse was surging, slippery, and floating; the tongue coating was white, slippery, and slightly yellow. This is external cold constraining internal heat. Treatment used self-made Han Jie Tang (Cold Release Decoction): Sheng Shi Gao (Raw Gypsum) 1 liang crushed, Zhi Mu (Anemarrhena Rhizome) 8 qian, Qing Lian Qiao (Green Forsythia) 1.5 qian, Chan Tui (Cicada Slough) 1.5 qian. Cured after two doses. This is Heat Disease Accompanying Cold. The formula heavily uses Shi Gao and Zhi Mu to clear stomach heat, and uses Lian Qiao and Chan Tui, which are good at reaching the exterior, to guide the heat transforming and wanting to disperse from the stomach, returning to Taiyang to release via sweat. This is adjusting yin and yang, allowing natural sweating, not forcibly inducing sweating." This is the initial treatment method for Heat Syndrome Cold Damage, recorded for reference. (See *Compilation of Verified Cases by Famous Doctors Nationwide*.)