热结旁流：Heat Bind with Circumfluence

梁某，男，28岁，诊断为流行性乙型脑炎住院。 28-year-old male, whose family name was Liang. The patient was diagnosed with epidemic cerebrospinal meningitis and hospitalized.


小承气汤药方 大黄12克(酒洗) 厚朴6克(炙，去皮)枳实9克(大者，炙) 病已6日，曾连服中药清热、解毒、养阴之剂，病势有增无减。会诊时，体温高40.3℃，脉象沉数有力，腹满微硬，哕声连续，目赤不闭，无汗，手足妄动，烦躁不宁，有欲狂之势，神昏谵语，四肢微厥，昨日下利纯青黑水，此虽病邪羁踞阳明、热结旁流之象，但未至大实满，而且舌苔秽腻，色不老黄，未可与大承气汤，乃用小承气汤法微和之。 He had been ill for six days, and during this time he had taken heat-clearing, detoxifying and yin-nourishing medicines, but the disease only worsened. During the consultation, the patient’s temperature was 40.3º C, his pulse was deep, rapid and forceful, his abdomen felt full and a littlehard. Other symptoms included continuous hiccup, red and staring eyes, no sweating, uncontrollable twitching of the hands and feet, with vexation, agitation and restlessness. At times he was comatose and delirious with cold limbs. For the last two days he had diarrhea with green and black liquid. Doctor Pu Fuzhou thought that although the evil had occupied the yangming causing heat-bind fecaloma with circumfluent watery discharge [the retention of heat evil bound the stool and caused watery diarrhea], it was not totally a repletion pattern. Moreover, although his tongue coating was greasy the color was not deep yellow, so he could not be given Major Order the Qi Decoction. Accordingly, Dr Pu decided on a milder treatment using Minor Order the Qi Decoction.
服药后，哕止便通，汗出厥回，神清热退，诸症豁然，再以养阴和胃之剂,调理而愈。 After taking the medicine all the symptoms were alleviated: the hiccup stopped and defecation became normal, aftersweating the fever abated, his limbs became warm, and his mind became clear. To complete the cure, Pu Fuzhou then prescribed a yin-nourishing and stomach-regulating formula.

曲丽芳摘自《蒲辅周医案》 ——Pu Fuzhou’s Case Studies
Translators: Zhao Shenshen and QuLifang

Glossary 1. epidemiccerebrospinal meningitis [内科] 流行性脑脊膜炎 2. detoxify [di:'tɒksifai] vt. 使解毒，去毒
3. twitch [ twitʃ] vi. 抽搐；抽动；阵痛 4. fecaloma n. 球状硬便；粪结 5. alleviate [ə'li:vieit]vt. 减轻，缓和 6. circumfluence[sə 'kʌmflʊəns] n. 环流；周流 7. vexation [vek'seɪʃ(ə)n] n. 苦恼；恼怒；令人烦恼的事 8. agitation [ædʒɪ'teɪʃ(ə)n] n. 激动；搅动；煽动；烦乱 9. comatose ['kəʊmətəʊs] adj. 昏迷的；昏睡状态的；麻木的；怠惰的 10. delirious [dɪ'lɪrɪəs] adj. 发狂的；神志昏迷的；精神错乱的