幼年温热诸证，多与痧疹并至。然温热之病，初得即知。至痧疹初得，其毒恒内伏而外无现象，或迟至
多日始出；又或不能自出，必俟服托表之药而后能出。若思患预防，宜于治温热之时，少用清表痧疹之药。不
然，恐其毒盘结于内，不能发出，其温热之病亦不能愈也。愚临证数十年，治愈温热兼痧疹者不胜计，莫
不于治温热药中，时时少加以清表痧疹之品，以防痧疹之毒内蕴而不能透出。故恒有温热之病，经
他医治疗旬日不愈，势极危险，后经愚为延医，遂发出痧疹而愈者。今略登数案于下，以为征实。
奉天马氏幼女，年六七岁，得温病，屡经医治，旬余病势益进，亦遂委之于命，不复治疗。适其族
家有幼子得险证，经愚治愈，因转念其女病犹可治，殷勤相求。其脉象数而有力，肌肤热而干涩，卧床上展转
不安，其心中似甚烦躁。以为病久阴亏，不堪外感之灼热，或其痧疹之毒伏藏于内，久未透出，是以其病之
现状如是也。问其大便，数日一行。遂为疏方，生石膏细末二两，潞党参四钱，玄参、天冬、知母、生怀山
药各五钱，连翘，甘草各二钱，蝉蜕一钱，煎汤两盅，分数次温饮下。连服二剂，大热已退，大便通下，其精
神仍似骚扰不安。再诊其脉，较前无力而浮。疑其病已还表，其余热当可汗解，用西药阿斯匹林二分强，
和白蔗糖水冲服下。周身微汗，透出白痧若干而愈。乃知其从前展转骚扰不安者，因其白痧未发出也。为
每剂中皆有透表之品，故其病易还表，而其痧疹之毒复亦易随发汗之药透出也。
又∶奉天刘××之幼女，年五岁，周身发热，上焦躁渴，下焦滑泻，迁延日久，精神昏愦，危至极点，
脉象数而无力，重诊即无。为疏方用生怀山药一两，滑石八钱，连翘、生杭芍、甘草
各三钱，蝉蜕、羚羊角（此一味另煎当水饮之煎至数次尚有力）各一钱半，煎汤一盅半，
分三次温服下，周身发出白痧，上焦烦渴、下焦滑泻皆愈。
按∶此方即滋阴宣解汤加羚羊角也。凡幼年得温热病即滑泻者，尤须防其痧疹之毒内伏不能外出（
滑泻则身弱恒无力托痧疹之毒外出），此方既能清热止泻，又能表毒外出，所以一药而愈也。
奉天王××子，年二十八岁，周身发热，出白痧甚密。经医调治失宜，迁延至旬日，病益加剧。医者
又欲用大青龙汤减去石膏，王××疑其性热，不敢用，延愚为之延医。其周身发热，却非大热，脉数五至，似
有力而非洪实，舌苔干黑，言语不真，其心中似怔忡，又似烦躁，自觉难受莫支。其家人谓其未病之时，实劳
心过度，后遂得此病。参之脉象病情，知其真阴内亏，外感之实热又相铄耗，故其舌干如斯，心中之怔忡
烦躁又如斯也。问其大便，数日未行，似欲便而不能下通。遂疏方用生石膏细末三两，潞党参五钱，生山药
五钱，知母、天花粉各八钱，连翘、甘草各二钱，生地黄一两半，蝉蜕一钱，俾煎汤三盅，分三次温饮
下，又嘱其服药之后，再用猪胆汁少调以醋，用灌肠器注射之，以通其大便，病家果皆如所嘱。翌日视之，
大便已通下，其灼热、怔忡、烦躁皆愈强半，舌苔未退而干黑稍瘥。又将凉方减石膏之半，生地黄改用一两。
连服三剂，忽又遍身出疹，大便又通下，其灼热怔忡烦躁始全愈。恐其疹出回急，复为开清毒托表之
药，俾服数剂以善其后。
按∶此证既出痧矣，原不料其后复出疹，而每剂药中皆有透表之品者，实恐其蕴有痧毒未尽发出也。
而疹毒之终能发出，实即得力于此。然非临时细细体察，拟方时处处周密，又何能得此意外之功效哉！
又∶此证非幼科，亦因温而兼疹，故连类及之，且俾人知温而兼疹之证，非独幼科有之，即
壮年亦间有之也。
幼年时期患温热类疾病，大多与痧疹同时发作。然而温热病在初起时就能被知晓；而痧疹在初期，其毒邪往往潜伏在内，外表没有明显征象，有的要延迟多日才发出来；还有的不能自行发出，必须等待服用具有透表作用的药物后才能发出。如果想在发病前进行预防，应当在治疗温热病的时候，少量加入一些能够清解并透发痧疹的药物。否则，恐怕毒邪会在体内盘结郁滞，无法发散出来，这样温热病也就不能痊愈了。我临证诊治几十年，治愈的兼有痧疹的温热病患者不计其数，无不都是在治疗温热的方药中，时常少量加入清解透发痧疹的药物，以防止痧疹毒邪内蕴而不能透出。所以常有这样的情况：温热病经过其他医生治疗十几天仍不愈，病情极其危险，后来请我去诊治，于是痧疹发出后便痊愈了。现在略录几则医案如下，作为实证依据。
奉天马氏家的幼女，六七岁，得了温病，多次就医治疗，十多天后病情反而加重，家属便听天由命，不再治疗。恰好她同族家里有个幼子患了险证，经我治愈，家属因此转念认为她女儿的病还可以治，便殷勤地请求诊治。诊察其脉象数而有力，肌肤发热且干燥涩滞，躺在床上辗转反侧、不安宁，心中似乎非常烦躁。我认为这是病程日久导致阴液亏损，无法承受外感之灼热，或者是痧疹的毒邪潜伏在内，长久未能透出，所以呈现出这种病状。询问其大便情况，几天才排便一次。于是为她开具处方：生石膏细末二两，潞党参四钱，玄参、天冬、知母、生怀山药各五钱，连翘、甘草各二钱，蝉蜕一钱，煎取汤剂两盅，分几次温服。连续服用两剂后，大热已退，大便通畅排出，但精神仍然显得焦躁不安。再次诊察其脉象，较之前无力且浮。怀疑病邪已经回归到体表，其余留的热邪应当可以通过发汗解除，于是使用西药阿斯匹林二分强，用白蔗糖水冲服。周身微微出汗，透出若干白痧而痊愈。这才知道从前她辗转焦躁不安，是因为白痧尚未发出的缘故。因为每剂药中都有透表的药物，所以病邪容易回归体表，而痧疹的毒邪也更容易随着发汗的药物透出体外。
又：奉天刘××的幼女，五岁，周身发热，上焦燥渴，下焦滑泻（腹泻如水），迁延日久，精神昏沉迷糊，危险到了极点，脉象数而无力，重按即无。为她开具处方：生怀山药一两，滑石八钱，连翘、生杭芍、甘草各三钱，蝉蜕、羚羊角（这一味药单独煎煮当水喝，煎多次仍有药效）各一钱半，煎取汤剂一盅半，分三次温服。服药后周身发出白痧，上焦的烦渴和下焦的滑泻都痊愈了。
按语：这个方子就是滋阴宣解汤加上羚羊角。凡是幼年患温热病就出现滑泻的，尤其需要防止痧疹毒邪内伏不能外出（因为滑泻会导致身体虚弱，常常无力托举痧疹毒邪外出）。此方既能清热止泻，又能使毒邪从表透出，所以一剂药就能治愈。
奉天王××的儿子，二十八岁，周身发热，出的白痧非常密集。经过医生调理治疗不当，拖延到十天，病情更加加剧。医生又想用大青龙汤减去石膏，王××怀疑该药性热，不敢使用，便请我去诊治。他周身发热，却不是大热，脉数达到五至，似乎有力但不是洪实，舌苔干黑，言语不清，心中似乎心悸怔忡，又似乎烦躁，自觉难受难以支撑。他的家人说他在未生病之前，确实劳心过度，随后便得了这个病。参考脉象和病情，知道他真阴内部亏损，外感的实热又在消耗煎熬，所以舌头干成这样，心中的怔忡烦躁也如此。询问其大便，几天未行，想排便但不能通下。于是开具处方：生石膏细末三两，潞党参五钱，生山药五钱，知母、天花粉各八钱，连翘、甘草各二钱，生地黄一两半，蝉蜕一钱，嘱咐煎取汤剂三盅，分三次温服。又嘱咐服药之后，再用少许猪胆汁调醋，用灌肠器注射，以通便，病人家属果然照做。第二天去看，大便已经通下，灼热、怔忡、烦躁等症状减轻了一半以上，舌苔未退但干黑色稍有好转。又将凉性方剂中的石膏减半，生地黄改为一两。连续服用三剂后，忽然遍身出疹，大便又通下，灼热、怔忡、烦躁才完全痊愈。担心疹子发出太急，又为他开了清解毒邪、托毒外出的药物，让他服用几剂以善后。
按语：这个证候既然已经出了痧，原本没料到后面还会出疹，而每剂药中都有透表药物的原因，实在是担心蕴藏的痧毒未尽发出。而疹毒最终能发出，实际上得力于此。然而如果不是临时仔细体察，拟方时处处周密，怎么能得到这意外的功效呢！
又：这个证候不属于儿科范畴，也是因温热兼有疹子，所以连带提及，并且让人们知道温热兼疹的证候，不仅儿科有，壮年人中间也有。
In childhood, various febrile diseases (feverish conditions) often occur simultaneously with sand-rash (a type of exanthem). However, febrile diseases are known from the onset; whereas for sand-rash, its pathogenic toxin tends to lie latent internally without external manifestations initially. It may take several days to appear, or it may fail to emerge spontaneously, requiring the administration of herbs that release the exterior to facilitate its emergence. If one wishes to prevent complications proactively, when treating febrile diseases, one should add a small amount of herbs that clear heat and release the exterior to treat sand-rash. Otherwise, there is a risk that the toxin will knot up internally and fail to be expelled, in which case the febrile disease also cannot be cured. In my decades of clinical practice, I have treated countless cases of febrile diseases complicated by sand-rash. In all these cases, I consistently added a small amount of herbs that clear heat and release the exterior to treat sand-rash to the formulas for febrile diseases, to prevent the sand-rash toxin from being retained internally and failing to penetrate outward. Consequently, it often happens that a febrile disease, after ten days of treatment by other physicians without improvement and presenting a critical condition, can be cured once the sand-rash emerges under my care. Herein, I briefly record several cases as evidence.
Case 1: A young girl of the Ma family in Fengtian, aged six or seven, contracted a warm disease. After multiple treatments, her condition worsened after more than ten days. Her family resigned themselves to fate and ceased treatment. Coincidentally, a young boy in her clan house had suffered from a critical condition which I had cured. This led them to reconsider that their daughter’s illness was still treatable, and they earnestly requested my consultation. Her pulse was rapid and forceful; her skin was hot, dry, and rough; she tossed and turned restlessly in bed, and her mind seemed extremely irritable. I reasoned that due to the prolonged illness, yin deficiency had occurred, making her unable to withstand the scorching heat of the external contraction, or perhaps the toxin of sand-rash was hidden internally and had not yet emerged, thus causing this clinical presentation. Upon inquiry, her bowel movements occurred only once every few days. I prescribed the following: Raw Gypsum Powder (Shi Gao) 2 liang, Radix Codonopsis (Lu Dang Shen) 4 qian, Radix Scrophulariae (Xuan Shen), Fructus Asperi (Tian Dong), Rhizoma Anemarrhenae (Zhi Mu), and Raw Dioscoreae Hypoglaucae Caulis (Sheng Huai Shan Yao) each 5 qian, Flos Forsythiae (Lian Qiao) and Radix Glycyrrhizae (Gan Cao) each 2 qian, Periostracum Cicadae (Chan Tui) 1 qian. Decocted in two zhong of water, taken in divided doses while warm. After two doses, the high fever subsided, and bowel movements became regular, but her spirit remained restless and agitated. On re-examination, her pulse was weaker and floating compared to before. I suspected that the pathogen had returned to the exterior and that the remaining residual heat could be resolved through sweating. Therefore, I administered 2 fen of Aspirin dissolved in white sucrose water. She sweated slightly all over her body, and some white sand-rash emerged, leading to recovery. It was then understood that her previous restlessness was due to the unemerged white sand-rash. Because each dose contained herbs that release the exterior, the pathogen easily returned to the surface, and the sand-rash toxin was easily expelled along with the sweat-inducing action of the herbs.
Case 2: Another case involved a five-year-old girl of Liu XX in Fengtian. She presented with generalized fever, upper jiao irritability and thirst, lower jiao loose diarrhea (slippery diarrhea), which persisted for a long time. Her spirit was confused and lethargic, reaching a critical state. Her pulse was rapid and weak, disappearing upon heavy pressure. I prescribed: Raw Dioscoreae Hypoglaucae Caulis (Sheng Huai Shan Yao) 1 liang, Talcum (Hua Shi) 8 qian, Flos Forsythiae (Lian Qiao), Raw Paeoniae Radix Alba (Sheng Bai Shao), and Radix Glycyrrhizae (Gan Cao) each 3 qian, Periostracum Cicadae (Chan Tui) and Cornu Saigae Tataricae (Ling Yang Jiao - decocted separately and drunk as water, retaining efficacy even after repeated decoctions) each 1.5 qian. Decocted in 1.5 zhong of water, taken in three divided doses while warm. Following the medication, white sand-rash emerged all over her body, and both the upper jiao irritability/thirst and lower jiao loose diarrhea were cured.
Note: This formula is Ziyin Xuanjie Tang (Nourishing Yin and Releasing Resolution Decoction) plus Cornu Saigae Tataricae (Ling Yang Jiao). For children who develop slippery diarrhea immediately upon contracting a warm disease, it is especially necessary to prevent the sand-rash toxin from lying latent internally and failing to exit (since slippery diarrhea weakens the body, often leaving insufficient strength to push the sand-rash toxin outward). This formula can both clear heat and stop diarrhea, and expel the toxin via the exterior, hence curing the disease with a single prescription.
Case 3: The son of Wang XX in Fengtian, aged twenty-eight, presented with generalized fever and dense white sand-rash. Due to improper medical management, the condition persisted for ten days and worsened. The physician intended to use Da Qing Long Tang (Major Blue Green Dragon Decoction) minus Raw Gypsum. Mr. Wang suspected the formula's heating nature and dared not use it, so he invited me to consult. He had generalized fever, but not severe heat; his pulse was rapid at five beats per breath, seemingly forceful but not surging and solid; his tongue coating was dry and black; his speech was incoherent; his heart seemed palpitations (palpitation) and irritable; he felt unbearable discomfort. His family stated that before falling ill, he had indeed overworked his mind, leading to this disease. Considering the pulse and symptoms, I determined that his true yin was deficient internally, and the external excess heat was further consuming and burning him, resulting in such dryness of the tongue and such palpitations/irritability. Inquiry revealed no bowel movement for several days; he felt the urge to defecate but could not pass stool. I prescribed: Raw Gypsum Powder (Shi Gao) 3 liang, Radix Codonopsis (Lu Dang Shen) 5 qian, Raw Dioscoreae Hypoglaucae Caulis (Sheng Shan Yao) 5 qian, Rhizoma Anemarrhenae (Zhi Mu) and Radix Trichosanthis (Tian Hua Fen) each 8 qian, Flos Forsythiae (Lian Qiao) and Radix Glycyrrhizae (Gan Cao) each 2 qian, Raw Rehmanniae Radix (Sheng Di Huang) 1.5 liang, Periostracum Cicadae (Chan Tui) 1 qian. Decocted in three zhong of water, taken in three divided doses while warm. I also instructed that after taking the medicine, enema with a mixture of pig bile and vinegar be administered to promote bowel movement, which the family did. The next day, upon examination, his bowels had moved, and the burning heat, palpitations, and irritability had improved by more than half. The tongue coating remained, but the dryness and blackness had slightly improved. I then reduced the dosage of Raw Gypsum in the cooling formula by half and changed Raw Rehmanniae Radix to 1 liang. After three consecutive doses, suddenly, a rash appeared all over his body, and his bowels moved again, at which point the burning heat, palpitations, and irritability completely resolved. Fearing the rash might emerge too rapidly, I prescribed another formula to clear toxicity and support the exterior to ensure a smooth recovery.
Note: Although this case already presented with sand-rash, I did not anticipate the subsequent appearance of a rash. The inclusion of exterior-releasing herbs in every dose was truly to prevent any remaining sand-rash toxin from being retained internally. The eventual emergence of the rash relied on this strategy. However, if I had not carefully observed the situation at the time and meticulously formulated the prescription, how could such unexpected efficacy have been achieved?
Furthermore, this case does not belong to pediatrics, but since it involved warmth complicated by a rash, I included it here to inform readers that warmth complicated by a rash occurs not only in children but also occasionally in adults.