治瘟疫表里俱热，头面肿疼，其肿或连项及胸。亦治阳毒发斑疹。
荷叶（一个用周遭边浮水者良鲜者尤佳） 生石膏（一两，捣细） 真羚羊角（二钱，另煎兑服）
知母（六钱） 蝉蜕（三钱，去足土） 僵蚕（二钱） 金线重楼（二钱，切片） 粉甘草（钱半）
荷叶禀初阳上升之气，为诸药之舟楫，能载清火解毒之药上至头面，且其气清郁，更能解毒逐秽，施于疫
毒诸证尤宜也。至于叶宜取其浮水者，以贴水而生，得水面轻气最多，故善发表。
如浮萍之生于水面，而善发汗也。
金线重楼，一名蚤休，一名紫河车草。味甘而淡，其解毒之功，可仿甘草。然甘草性温，此药性凉，以解
一切热毒，尤胜于甘草，故名蚤休。言若中一切蛊毒，或蝎螫蛇咬、或疮疡用之而皆可早早止住。古蚤与早，
原相通也。古谚赞蚤休曰∶“七叶一枝花，深山是我家。痈疽遇着我，一似手捻拿。”盖此物七叶对生茎腰，
状如莲花一朵，自叶中心出茎，至巅开花一朵，形扁而黄，花上有黄丝下垂，故又名金线重楼。重楼者，其叶
与花似各作一层也。其名紫河车草者，盖紫河为初生之地点，其处蕃多，可采之盈车，俗名为草河车误矣。其
形状皮色皆如干姜。若皮不黄，而微带紫色者，其味必微辣而不甘，含毒性，即不可用。若无佳者，方中不用
此味亦可。
羚羊角与犀角，皆性凉而解毒。然犀禀水土之精气而生，为其禀土之精，故能入胃，以消胃腑之实热。为
其禀水之精，故又能以水胜火兼入心中，以消心脏本体之热力。而疫邪之未深入者，转因服犀角后，心气虚冷，
不能捍御外邪，致疫邪之恣横，竟犯君主之宫，此至紧要之关系，医者不可不知。羚羊角善清肝胆之火，兼清
胃腑之热。其角中天生木胎，性本条达，清凉之中，大具发表之力。与石膏之辛凉，荷叶、连翘之清轻升浮者
并用，大能透发温疫斑疹之毒火郁热，而头面肿处之毒火郁热，亦莫不透发消除也。曾治一六岁孺子，出疹三
四日间，风火内迫，喘促异常。单投以羚羊角三钱，须臾喘止，其疹自此亦愈。夫疹之毒热，最宜表散清解，
乃至用他药表散清解无功，势已垂危，而单投以一味羚羊角，即能挽回，其最能清解而兼能表散可知也。且其
能避蛊毒，《神农本草经》原有明文。疫病发斑，皆挟有毒疠之气也。
僵蚕乃蚕将脱皮时，因受风不能脱下，而僵之蚕。因其病风
而僵，故能为表散药之向导，而兼具表散之力。是以痘疹不出者，僵蚕最能表出之。不但此也，僵蚕僵而不腐，
凡人有肿疼之处，恐其变为腐烂，僵蚕又能治之，此气化相感之妙也。
疫与寒温不同。寒温者，感时序之正气。因其人卫生之道，于时序之冷暖失宜，遂感其气而为病。其病
者，偶有一二人，而不相传染。疫者，感岁运之戾气。因其岁运失和，中含毒瓦斯，人触之即病。《内经》刺法
论所谓无问大小，病状相似者是也。其病者，挨户挨村，若摇役然，故名曰疫，且又互相传染也。《内经》本
病论有五疫之名，后世约分为寒疫、温疫。治温疫，世习用东垣普济消毒饮。治寒疫，世习用巢谷世圣散子。
然温疫多而寒疫少，拙拟之清盂汤，实专为治温疫设也。
一妇人，年四十许，得大头瘟证。头面肿大疼痛，两目肿不能开，上焦烦热，心中怔忡。彼家误为疮毒，
竟延疡医治疗。医者自出药末，敷头面，疼稍愈。求其出方治烦热怔忡，彼言专习外科，不管心中之病。时愚
应他家延请，适至其村，求为延医。其脉洪滑有力，关前益甚，投以清盂汤，将方中石膏改用二两，煎汁两茶
盅，分二次温饮下，尽剂而愈。
一人，年二十余，得温疫。三四日间头面悉肿，其肿处，皮肤内含黄水，破后且溃烂。身上间有斑点，
闻人言，此证名大头瘟。其溃烂之状，又似瓜瓤瘟，最不易治。惧甚，求为诊视。其脉洪滑而长，舌苔白而微
黄。问其心中，惟觉烦热，嗜食凉物。遂晓之曰，此证不难治。头面之肿烂，周身之斑点，无非热毒入胃而随
胃气外现之象。能放胆服生石膏，可保全愈。遂投以青盂汤，方中石膏改用三两，知母改用八钱，煎汁一大碗，
分数次温饮下。一剂病愈强半。翌日，于方中减去荷叶、蝉蜕，又服一剂全愈。
按∶发斑之证异于疹者，以其发处不高，以手拂之，与肤平也。其证有阳毒、阴毒之分。阳毒发斑，系
阳明毒热伤血所致。
阴毒发斑，或为寒疫之毒，或因汗吐下后中气虚乏，或因过服凉药，遂成阴证，寒伏于下，逼其无根之火上独
熏肺而发斑。其色淡红，隐隐见于肌表，与阳证发斑色紫赤者不同。愚生平所治发斑，皆系阳证。至阴证实未
之见，其证之甚少可知。然正不可因阴证者甚少，而阴阳之际不详辨也。今采古人阳毒阴毒发斑治验之案数条
于下，以备参观。庶几胸有定见，临证时不至误治也。
吕沧洲云∶一人伤寒十余日，身热而静，两手脉尽伏。医者以为坏证，弗与药。余诊之，三部脉举按皆无，
舌苔滑，两颧赤如火，语言不乱，因告之曰∶此子必大发赤斑，周身如锦纹。夫血脉之波澜也，今血为邪热所
搏，掉而为斑，外现于皮肤，呼吸之气无形可倚，犹沟渠之水虽有风不能成波澜也，斑消则脉出矣。及揭其衾，
而赤斑烂然。与白虎加人参汤，化其斑脉乃复常。按∶发斑至于无脉，其证可谓险矣。即遇有识者，细诊病情，
以为可治，亦必谓毒火郁热盘踞经络之间以阻塞脉道之路耳。而沧洲独断为发斑则伤血，血伤则脉不见。是诚
沧洲之创论，然其言固信而有征也。忆己亥春，尝治一少年吐血证。其人大口吐血，数日不止，脉若有若无，
用药止其血后，脉因火退，转分毫不见。愚放胆用药调补之，竟得无恙（此证详案在寒降汤下）。夫吐血过多
可至无脉，以征沧洲血伤无脉之说确乎可信。此阳毒发斑也。
许叔微治一人，内寒外热而发斑。六脉沉细，肩背胸胁斑出数点，随出随隐，旋更发出，语言狂乱，非谵
语也，肌表虽热，以手按之，须臾冷透如冰。与姜附等药数服后，得大汗而愈。此阴毒发斑也。
吴仁斋治一人，伤寒七八日，因服凉药太过，遂变身冷，手足厥逆，通身黑斑，惟心头温暖，乃伏火也。
诊其六脉沉细，昏沉不知人事，亦不能言语，状似尸厥。遂用人参三白汤，加熟附子半枚、干姜二钱，水煎服
下。待一时许，斑色渐红，手足渐暖。
而苏醒后，复有余热不清，此伏火后作也。以黄连解毒汤、竹叶石膏汤调之而愈。此阴毒发斑中有伏阳也。
虞天民曰∶有内伤证，亦出斑疹，但微见红。此胃气极虚，一身之火游行于外。当补益气血，则中有主而
气不外游，荣有养而血不外散，此证尤当慎辨。洪吉人解之曰∶按此证与阳毒发斑不同，亦与阴毒发斑不同，
其方当用补中益气汤，加归、芍之类。
瘟毒之病，有所谓羊毛瘟者（亦名羊毛疹），其证亦系瘟疫，而心中兼有撩乱之证。若视其前后对心处有
小痤（俗名疙瘩），以针鼻点之，其顶陷而不起，其中即有白毛，当以针挑出之。若恐挑之不净，可用发面馍
馍去皮，杂以头发，少蘸香油，周身搓擦。再审其证之虚实凉热，投以治疫病之药，即愈。此证古书不载，而
今人患此证者甚多，其白毛，即周身之汗毛，大抵因有汗受风闭其毛孔，而汗毛不能外出，因不外出，所以作
白色（若用黄酒和荞麦面擦之更好）。
治疗瘟疫导致表里俱热，头面部肿胀疼痛，肿胀有时延伸至颈部及胸部。也用于治疗阳毒引起的发斑疹。
荷叶（一个，以周边浮在水面的为佳，新鲜的更好） 生石膏（一两，捣碎成细粉） 真羚羊角（二钱，单独煎煮后兑入药汁服用）
知母（六钱） 蝉蜕（三钱，去除足部和泥土） 僵蚕（二钱） 金线重楼（二钱，切片） 粉甘草（一钱半）
荷叶禀受初升阳气上升之气，作为诸药的载体（舟楫），能载着清火解毒的药物上行至头面部，且其气味清香疏郁，更能解毒驱除秽浊之气，施用于疫毒诸证尤为适宜。至于荷叶宜选取浮在水面上的，因为它贴水而生，获得水面轻清之气最多，所以善于发表邪气。就像浮萍生长在水面，善于发汗一样。
金线重楼，又名蚤休，又名紫河车草。味道甘而淡，其解毒的功效，可以参照甘草。然而甘草性温，此药性凉，用来解除一切热毒，尤其胜过甘草，所以名叫蚤休。意思是如果中了各种蛊毒，或被蝎子蜇、蛇咬，或疮疡肿毒，用它都能早早止住。“蚤”与“早”古时相通。古谚语称赞蚤休说：“七叶一枝花，深山是我家。痈疽遇着我，一似手捻拿。”大概这种植物七片叶子对生在茎腰处，形状像一朵莲花，从叶中心长出茎，直到顶端开一朵花，花形扁而黄，花上有黄色丝状物下垂，所以又名金线重楼。重楼的意思是，它的叶子和花似乎各作一层。它名字叫紫河车草，是因为紫色河流是它初生的地点，那里繁殖很多，可以采集得装满车子，俗名误称为草河车。它的形状和皮色都像干姜。如果皮不黄，而微带紫色，味道必定微辣而不甘，含有毒性，就不可使用。如果没有好的，方剂中不用这味药也可以。
羚羊角与犀角，都性凉而能解毒。然而犀角禀受水土的精气而生，因为它禀受土的精华，所以能入胃，以消除胃腑的实热。因为它禀受水的精华，所以又能以水胜火，兼入心中，以消除心脏本体的热力。而疫邪尚未深入的时候，反而因为服用犀角后，心气变得虚冷，不能抵御外邪，导致疫邪肆意横行，竟然侵犯君主之宫（心脏），这是至关重要的关系，医者不可不知道。羚羊角善于清泻肝胆之火，兼清胃腑的热。它的角中天生有木质胎元，本性条达舒畅，在清凉之中，具有强大的发表力量。与石膏的辛凉，荷叶、连翘的清轻升浮之性并用，大能透发温疫斑疹的毒火郁热，而头面肿胀处的毒火郁热，也没有不透发消除的。曾治疗一个六岁的孩子，出疹子三四天，风火内迫，喘息急促异常。单用羚羊角三钱投药，片刻间喘息停止，疹子从此也痊愈了。疹子的毒热，最适合表散清解，以至于用其他药物表散清解无效，病情已经垂危，而单用一味羚羊角，就能挽回局面，可知它最能清解而又兼能表散。而且它能避蛊毒，《神农本草经》原有明文记载。疫病发斑，都挟带有毒疠之气。
僵蚕是蚕将要脱皮时，因为受风不能脱下，而僵死的蚕。因为它因病风而僵，所以能成为表散药的向导，并且兼具表散的力量。因此痘疹出不来的，僵蚕最能将其表发出来。不仅如此，僵蚕僵死而不腐烂，凡人有肿痛的地方，恐怕变成腐烂，僵蚕又能治疗它，这是气化相感的奇妙之处。
疫病与寒温病不同。寒温病，是感受时序的正气。因为人的卫生之道，对于时序的冷暖失于适宜，于是感受其气而生病。患病的人，偶尔有一两个人，而不互相传染。疫病，是感受岁运的戾气。因为岁运失和，中含有毒瓦斯，人触碰到它就生病。《内经》刺法论所说的不分大小，病症相似的就是这类。患病的人，挨家挨户，挨村挨寨，像摇役传布一样，所以名叫疫，而且又互相传染。《内经》本病论有五疫的名称，后世大约分为寒疫、温疫。治疗温疫，世人习惯用东垣的普济消毒饮。治疗寒疫，世人习惯用巢谷的世圣散子。然而温疫多而寒疫少，我拟定的清盂汤，确实是专为治疗温疫设立的。
一个四十岁左右的妇人，得了大头瘟证。头面肿大疼痛，两眼肿得睁不开，上焦烦热，心中怔忡。她家人误认为是疮毒，竟然请外科医生治疗。医生自己拿出药末，敷在头面，疼痛稍好。请求他开出方子治疗烦热怔忡，他说专门习外科，不管心中的病。当时我正被另一家邀请，恰好到这个村子，请求我为她看病。她的脉象洪滑有力，关前部位尤其明显，投以清盂汤，将方中的石膏改用二两，煎汁两茶盅，分两次温服，服完一剂而痊愈。
一个二十多岁的人，得了温疫。三四天时间头面全部肿胀，肿胀处皮肤内含黄水，破溃后甚至烂掉。身上间或有斑点，听人说，这个证名叫大头瘟。那溃烂的样子，又像瓜瓤瘟，最不容易治疗。非常恐惧，请求为我诊视。他的脉象洪滑而长，舌苔白而微黄。问他心里，只觉得烦热，想吃凉的东西。于是告诉他，这个证不难治。头面的肿烂，周身的斑点，无非是热毒入胃而随胃气外现的现象。能放胆服用生石膏，可以保全痊愈。于是投以青盂汤，方中石膏改用三两，知母改用八钱，煎汁一大碗，分数次温服。一剂病好了大半。第二天，在方中减去荷叶、蝉蜕，又服一剂完全痊愈。
按：发斑的证候异于疹子，因为发出来的地方不高，用手抚摸，与皮肤平齐。这个证有阳毒、阴毒之分。阳毒发斑，是阳明毒热伤血所致。
阴毒发斑，或者是寒疫的毒，或者是因为汗、吐、下之后中气虚乏，或者因为过服凉药，遂成阴证，寒伏于下，逼迫无根之火向上独熏肺而发斑。颜色淡红，隐隐见于肌表，与阳证发斑色紫赤的不同。我生平所治疗的发斑，都是阳证。至于阴证实在没有见过，可知这种证很少见。然而正因为阴证很少，更不可不在阴阳之际详细辨别。现在采集古人关于阳毒阴毒发斑治疗的案例数条在下面，以备参考。这样胸中有定见，临证时不至于误治。
吕沧洲说：一个人伤寒十多天，身体发热但神志安静，两手脉象全部伏匿。医生认为是坏证，不给药。我诊察他，三部脉举按都没有，舌苔滑，两颧红得像火一样，语言不乱，于是告诉他说：这个人一定会大发赤斑，周身像锦纹一样。血脉是有波澜的，现在血被邪热搏结，动荡而成斑，外现于皮肤，呼吸之气无形可依附，就像沟渠的水虽然有风也不能形成波澜一样，斑消则脉出现了。等到揭开被子，赤斑灿烂可见。给予白虎加人参汤，化去斑脉才恢复正常。按：发斑到了没有脉的程度，这个证可以说是危险了。即使遇到有见识的人，仔细诊察病情，认为可治，也必定认为是毒火郁热盘踞在经络之间阻塞了脉道。而吕沧洲独自断定是发斑则伤血，血伤则脉不见。这确实是吕沧洲的创论，然而他的话确实可信且有验证。回忆己亥年春天，曾治疗一个少年吐血证。这个人大口吐血，几天不止，脉象若有若无，用药止住血后，脉因火退，反而分毫不见。我放胆用药调补，竟然得以无恙（这个证的详细案例在寒降汤下）。吐血过多可导致无脉，以此证明吕沧洲血伤无脉的说法确实可信。这是阳毒发斑。
许叔微治疗一个人，内寒外热而发斑。六脉沉细，肩背胸胁斑出几点，随即隐没，转而又发出，语言狂乱，不是谵语，肌表虽然热，用手按压，一会儿冷透如冰。给予姜附等药几服后，得大汗而痊愈。这是阴毒发斑。
吴仁斋治疗一个人，伤寒七八天，因为服凉药太过，于是变身为身冷，手足厥逆，通身黑斑，只有心头温暖，这是伏火。诊察他的六脉沉细，昏沉不知人事，也不能言语，状似尸厥。于是用人参三白汤，加熟附子半枚、干姜二钱，水煎服下。等待约一小时，斑色渐红，手足渐暖。
苏醒后，还有余热不清，这是伏火复发的表现。用黄连解毒汤、竹叶石膏汤调理而痊愈。这是阴毒发斑中有伏阳。
虞天民说：有内伤证，也会出斑疹，但微微见到红色。这是胃气极虚，一身之火游行于外。应当补益气血，则中有主而气不外游，营有养而血不外散，这个证尤其应当谨慎辨别。洪吉人解释它说：按这个证与阳毒发斑不同，也与阴毒发斑不同，方剂应当用补中益气汤，加当归、芍药之类。
瘟毒的病，有所谓羊毛瘟的（也叫羊毛疹），这个证也是瘟疫，而心中兼有撩乱的症状。如果看其前后对心处有小痤疮（俗名疙瘩），用针鼻点刺，其顶陷而不起，其中就有白毛，应当用针挑出来。如果怕挑不干净，可用发面馍馍去皮，混杂头发，少蘸香油，周身搓擦。再审查这个证的虚实凉热，投以治疗疫病的药，即愈。这个证古书不记载，而今人患这个证的人很多，那些白毛，就是周身的汗毛，大概是因为有汗受风闭塞毛孔，而汗毛不能外出，因为不外出，所以作白色（如果用黄酒和荞麦面擦更好）。
Treats epidemic febrile diseases with heat in both the exterior and interior, swelling and pain of the head and face, where the swelling may extend to the neck and chest. It also treats macules and rashes caused by Yang Toxin (Yang Du).
Lotus Leaf (one piece, preferably floating on the water surface, fresh is best) Raw Gypsum Fibrosum (Shi Gao, 50g, crushed into fine powder) Real Antelope Horn (Lingyang Jiao, 7.5g, decocted separately and mixed into the medicine liquid)
Anemarrhena Rhizome (Zhi Mu, 22.5g) Cicada Slough (Chan Tui, 10g, feet and soil removed) Stiff Silkworm (Jiang Can, 6.5g) Paris Polyphylla (Jin Xian Chong Lou, 6.5g, sliced) Powdered Licorice Root (Fen Gan Cao, 5.6g)
The Lotus Leaf inherits the qi of rising initial yang, acting as a carrier for the various herbs, capable of carrying clearing-fire and detoxifying medicines upward to the head and face. Its fragrance clears stagnation and further detoxifies while removing turbid pathogens, making it particularly suitable for epidemic toxin syndromes. Regarding the leaf, one should select those floating on the water because they grow close to the water surface and absorb the most light and clear qi from the water, thus being good at releasing the exterior. This is similar to Duckweed (Fu Ping) growing on the water surface, which is good at inducing sweating.
Paris Polyphylla, also known as Zao Xiu or Zi He Che Cao. It tastes sweet and bland. Its detoxifying efficacy can be compared to Licorice Root (Gan Cao). However, while Licorice Root is warm in nature, this herb is cool, making it superior to Licorice Root in resolving all kinds of heat toxins, hence the name Zao Xiu (Early Restraint), implying that if poisoned by various gu poisons, or stung by scorpions/snakes, or suffering from sores and ulcers, using it can stop them early. "Zao" and "Zao" were interchangeable in ancient times. An ancient proverb praises Zao Xiu: "Seven leaves, one flower; deep mountains are my home. If carbuncles and sores meet me, they are grasped like clay." This plant has seven leaves opposite each other on the stem waist, resembling a lotus flower. A stem grows from the center of the leaves to the top, blooming into one flower. The flower is flat and yellow, with yellow filaments hanging down, hence the name Jin Xian Chong Lou (Golden Thread Heavy Tower). "Chong Lou" means its leaves and flowers seem to form layers. Its name Zi He Che Cao comes from the fact that purple rivers are its birthplace, where it reproduces abundantly enough to fill a cart; the common name Cao He Che is erroneous. Its shape and skin color resemble dried ginger. If the skin is not yellow but slightly purple, the taste will be slightly spicy and not sweet, containing toxicity, and thus unusable. If high-quality ones are unavailable, this herb may be omitted from the formula.
Antelope Horn (Lingyang Jiao) and Rhinoceros Horn (Xijiao) are both cool in nature and detoxifying. However, Rhinoceros Horn inherits the essence of earth and water. Because it inherits the essence of earth, it enters the stomach to eliminate excess heat in the stomach fu-organ. Because it inherits the essence of water, it uses water to overcome fire and enters the heart to eliminate heat in the heart organ itself. When epidemic pathogens have not yet deeply penetrated, taking Rhinoceros Horn may cause heart qi to become deficient and cold, unable to defend against external pathogens, leading the epidemic pathogens to run rampant and invade the palace of the monarch (the heart). This is a critical relationship that physicians must know. Antelope Horn is good at clearing fire from the liver and gallbladder, and also clears heat from the stomach. The horn naturally contains a woody core, possessing a free-flowing nature. Within its coolness, it possesses strong power to release the exterior. Used together with the acrid-cool Raw Gypsum Fibrosum (Shi Gao), and the light-clearing and ascending Lotus Leaf (He Ye) and Forsythia Fruit (Lian Qiao), it greatly penetrates and releases the toxic fire and stagnant heat of epidemic macules and rashes, and the toxic fire and stagnant heat in swollen areas of the head and face are also thoroughly released and eliminated. I once treated a six-year-old child who, three or four days after rash eruption, suffered from extreme panting due to internal wind-fire. Administering only 15g of Antelope Horn stopped the panting almost instantly, and the rash healed thereafter. The toxic heat of rashes is best treated by releasing the exterior and clearing/resolving. Even when other drugs fail to release and clear, and the condition is critical, administering only Antelope Horn can reverse the situation, proving its ability to clear/resolve and release the exterior. Moreover, it avoids gu poison, as stated in the *Shennong Bencao Jing*. Epidemic macule eruptions all carry toxic miasma qi.
Stiff Silkworm (Jiang Can) is a silkworm that dies stiffly because it cannot shed its skin due to wind invasion during molting. Because it becomes stiff due to wind pathogen, it serves as a guide for exterior-releasing medicines and possesses exterior-releasing power itself. Therefore, for cases where pustules or rashes do not erupt, Stiff Silcoworm is best at bringing them out. Furthermore, Stiff Silkworm remains stiff without rotting. For any human swelling and pain, fearing it might turn into rotting tissue, Stiff Silkworm can treat it. This is the wonder of mutual induction of qi transformation.
Epidemic diseases differ from Cold-Warm diseases. Cold-Warm diseases result from contracting the regular qi of the seasons. Due to improper hygiene regarding seasonal temperature changes, one contracts the qi and falls ill. Those affected are occasionally one or two individuals, without contagion. Epidemic diseases result from contracting the aberrant qi of the year's movement. Due to disharmony in the year's movement, containing toxic vapors, contracting it causes illness immediately. As described in the *Neijing* Treatise on Acupuncture Methods: regardless of age, symptoms are similar. Those affected spread house to house, village to village, like messengers, hence named "Yi" (Epidemic), and they are contagious. The *Neijing* Treatise on Original Diseases mentions five types of Yi, later roughly divided into Cold Yi and Warm Yi. To treat Warm Yi, the world habitually uses Dong Yuan's Pu Ji Xiao Du Yin. To treat Cold Yi, the world habitually uses Chao Gu's Shi Sheng San Zi. However, Warm Yi is more common than Cold Yi. My proposed Qing Yu Tang is specifically designed to treat Warm Yi.
A woman, around forty years old, suffered from Da Tou Wen (Big Head Plague). Her head and face swelled and pained, eyes swollen shut, upper jiao烦热 (irritated heat), and palpitations. Her family mistakenly thought it was sore toxin and consulted a surgeon. The surgeon applied his own powder to the head and face, slightly relieving pain. When asked for a prescription for the irritability and palpitations, he said he specialized in surgery and did not treat internal heart conditions. At that time, I was invited by another family in the same village and agreed to see her. Her pulse was surging, slippery, and forceful, especially at the Guan position. I administered Qing Yu Tang, changing the Raw Gypsum Fibrosum (Shi Gao) to 100g. Decocted into two teacups of liquid, taken warm in two doses. She recovered after finishing the dose.
A man, over twenty years old, contracted Warm Yi. Within three or four days, his head and face completely swelled. The swollen skin contained yellow fluid, breaking open and ulcerating. Spots appeared intermittently on his body. Hearing people call this Da Tou Wen, and seeing the ulceration resembled Gua Rang Wen (Melon Rind Plague), which is hardest to treat, he was terrified and sought my diagnosis. His pulse was surging, slippery, and long. Tongue coating was white and slightly yellow. He reported feeling only irritated heat and craving cold foods. I told him this case is not difficult to treat. The swelling and ulceration of the head and face, and spots on the body, are merely manifestations of heat toxin entering the stomach and emerging externally following stomach qi. By boldly taking Raw Gypsum Fibrosum (Shi Gao), full recovery can be ensured. I administered Qing Yu Tang, changing Raw Gypsum Fibrosum (Shi Gao) to 150g and Anemarrhena Rhizome (Zhi Mu) to 30g. Decocted into a large bowl, taken warm in multiple doses. After one dose, half the illness was cured. The next day, Lotus Leaf (He Ye) and Cicada Slough (Chan Tui) were removed from the formula, and after one more dose, complete recovery occurred.
Note: Macule eruptions differ from rashes in that their raised sites are not elevated; touching them feels level with the skin. This syndrome is divided into Yang Toxin and Yin Toxin. Yang Toxin macule eruption is caused by Yangming toxic heat injuring blood.
Yin Toxin macule eruption is either due to Cold Yi toxin, or deficiency of middle qi after sweating, vomiting, or purging, or excessive use of cold medicines leading to Yin syndrome. Cold hides below, forcing rootless fire upward to burn the lungs alone, causing macules. The color is pale red, faintly visible on the muscle surface, differing from the purple-red color of Yang syndrome macules. All macule cases I have treated in my life were Yang syndromes. I have never seen Yin syndrome cases, indicating their rarity. However, precisely because Yin cases are rare, one must not fail to distinguish carefully between Yin and Yang. Below are collected several ancient cases of treating Yang/Yin Toxin macule eruptions for reference, so that one has firm views and avoids misdiagnosis clinically.
Lu Cangzhou said: A person had Taiyang disease for ten-plus days, body heat but quiet spirit, both hands' pulses completely hidden. Physicians considered it a deteriorated syndrome and gave no medicine. I examined him; all three positions' pulses were imperceptible upon lifting and pressing. Tongue coating was slippery. Both cheeks were red like fire. Speech was coherent. I told him: This youth will definitely develop severe red macules, covering the body like brocade patterns. Blood vessels have waves. Now blood is agitated by evil heat, shaking into macules, appearing externally on the skin. Breath qi has no form to rely on, just as canal water cannot form waves even with wind. Once macules disappear, pulses will emerge. Upon uncovering him, bright red macules were clearly visible. Given Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction), the macules dissolved and pulses returned to normal. Note: Macule eruption reaching a state of no pulse is indeed dangerous. Even if an expert diagnoses it as treatable, they would surely think toxic fire and stagnant heat are entrenched in meridians blocking the pulse pathway. But Cangzhou uniquely determined that macule eruption injures blood, and blood injury leads to invisible pulses. This is indeed Cangzhou's innovative theory, yet his words are credible and verified. I recall in the spring of the Ji Hai year, treating a young man with hematemesis. He vomited large amounts of blood continuously for days. Pulse was faint. After using medicine to stop bleeding, as fire subsided, the pulse became imperceptible. I boldly used tonic medicine to regulate him, and he recovered safely (detailed case under Han Jiang Tang). Excessive blood loss can lead to no pulse, confirming Cangzhou's theory of blood injury causing invisible pulses. This is Yang Toxin macule eruption.
Xu Shumi treated a person with internal cold and external heat causing macule eruption. Six pulses were deep and thin. Several spots of macules appeared on shoulders, back, chest, and ribs, disappearing and reappearing cyclically. Speech was manic, not delirious. Skin surface was hot, but upon touch, quickly became cold as ice. After several doses of Ginger and Aconite medicines, profuse sweating occurred and he recovered. This is Yin Toxin macule eruption.
Wu Renzhai treated a person with Taiyang disease for seven-eight days. Due to excessive cooling medicine intake, body temperature dropped, limbs became cold and inverted, whole body black macules appeared, only the heart area remained warm, indicating hidden fire. Pulses were deep and thin. Patient was comatose, unresponsive, unable to speak, resembling corpse rigidity. Administered Ren Shen San Bai Tang (Ginseng Three Whites Decoction) plus half a cooked Aconite Root (Shu Fu Zi) and 7.5g Dried Ginger (Gan Jiang), decocted in water. After about an hour, macule color gradually turned red, limbs warmed.
After regaining consciousness, residual heat remained unclear, a recurrence of hidden fire. Regulated with Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity) and Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) until recovered. This is Yin Toxin macule eruption with hidden Yang.
Yu Tianmin said: There are internal injury syndromes that also produce macules/rashes, but only faint redness appears. This is extreme deficiency of stomach qi, with fire of the whole body wandering externally. One should tonify qi and blood. Then there is a master within, preventing qi from wandering outward; Ying has nourishment, preventing blood from scattering outward. This syndrome requires especially careful differentiation. Hong Jiren explained: According to this, the syndrome differs from Yang Toxin macule eruption and Yin Toxin macule eruption. The formula should use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Angelica Sinensis (Dang Gui) and Paeonia Lactiflora (Bai Shao).
Plague toxin diseases include what is called Yang Mao Wen (Wool Plague), also known as Yang Mao Zhen (Wool Rash). This syndrome is also an epidemic, accompanied by mental agitation. If small acne-like bumps (commonly called疙瘩) are seen on the front and back corresponding to the heart area, pricked with a needle tip, the top sinks and does not rise, revealing white hairs inside. These should be picked out with a needle. If afraid of incomplete removal, take dough bread peeled of skin, mix with hair, dip slightly in sesame oil, and rub over the whole body. Then examine the syndrome for deficiency/excess and cold/heat, administer epidemic treatment medicine, and recover. This syndrome is not recorded in ancient books, but many people suffer from it today. Those white hairs are actually body hair. Generally, sweat exposure to wind closes pores, preventing hair from exiting. Because it cannot exit, it turns white (rubbing with yellow wine and buckwheat flour is better).