自入夏以来，各处发生猩红热，互相传染。天气炎热而病益加多加剧，治不如法，恒至不救。夫猩红
热非他，即痧疹而兼温病也。尝实验痧疹之证，如不兼温病，其将出未出之先，不过微有寒热，或头微疼，或
眼胞微肿，或肢体微酸懒，或食欲不振。其疹既出之后，其表里虽俱觉发热，而实无炽盛之剧热。治之者
始终投以清表（痧疹始终宜用表药然宜表以辛凉不宜表以温热）解毒之剂，无不愈者。即或始终不服药，听其
自出自靥，在一星期间亦可自愈。此以其但有疹毒之热，而无温病之热相助为虐，故其病易愈耳。
至于疹而兼温者，则与斯迥异。其初病之时疹犹未出，即表里壮热，因疹毒之热尚未萌芽，而温病之
热已炽盛也。治之者宜将薄荷、连翘、蝉蜕诸托表之药，与玄参、沙参、天花粉诸清里之药并用。其连翘
可用三钱，薄荷叶、蝉蜕可各用钱半，玄参、沙参、花粉可各用五钱，再少加金银花、甘草解毒。若虑其痧疹
不能透达，可用鲜茅根二两（如无可代以鲜芦根）水煮数沸，取清汤数盅，以之代水煎药，煎汤一大盅，
温服，其疹必完全透出矣。或以外更用鲜茅根数两煎四五沸以其汤代茶，更佳。
若其痧疹虽皆透发于外，而火犹炽盛，且深入阳明之府，其舌从前白者至此则渐黄，心中烦热异常，或
气粗微喘，鼻翅 动，或神昏谵语，脑膜生炎，其大便干燥，小便赤涩，此乃阳明
胃腑大实之候。而欲治阳明胃腑之实热，《伤寒论》白虎汤原为
千古不祧之良方。为其兼有疹毒，可于方中加连翘二钱，羚羊角一钱（另煎兑服或锉细末送服或以金银花二
钱代之），再用鲜茅根或鲜芦根煮汤，以之代水煎药。方中若用生石膏二两，可煎汤两盅，分两次温服。若用
生石膏三两，可煎汤三盅，分三次温服。一剂热未清者，可服至数剂，以服后热退，大便仍不滑泻为度。
若其胃腑虽有大热，因小便不利而大便滑泻者，白虎汤又不可骤服。宜先用滑石、生怀山药各一两，生
杭芍八钱，连翘、蝉蜕各钱半，甘草三钱（此方即拙拟滋阴宣解汤），煎汤一大盅服之，其滑泻当即
止。泻止之后，热犹不退者，宜于初次方中加滑石六钱，服之以退其热，仍宜煎汤数盅，徐徐温服。至于
大热已退，疹已见靥，而其余热犹盛者，宜再治以滋阴清热解毒之剂，而仍少加托表之药佐之。方用玄参
八钱，沙参、花粉各五钱，连翘、金银花、鲜芦根各三钱，甘草二钱，可连服数剂。其热降序，药剂亦宜随之
降序，迨服至其热全消停服。以上诸方，若遇证兼喉痧者，宜于方中加射干、生蒲黄各三钱。惟治大便滑
泻方中不宜加。可外用硼砂、生寒水石各二钱，梅片、薄荷冰各一分，共研细吹喉中。
猩红热本非危险之证，而所以多危险者，以其证现白虎汤证时，医者不敢放胆用白虎汤治之也。至愚治
此证时，不但胃腑大实之候可放胆投以大剂白虎汤；即当其疹初见点，其人表里壮热，脉象浮洪，但问其大
便实者，恒用生石膏一两或两半煎汤，送服西药阿斯匹林二分，周身得微汗，其疹全发出而热亦退矣。
曾治一六七岁幼女，病温半月不愈。其脉象数而有力，肌肤热而干涩，其心甚烦躁，辗转床上不能
安卧。疑其病久阴亏，不堪外感之灼热，或其痧疹之毒伏藏未能透出，是以其病之现状若斯。问其大便，三
日未行。投以大剂白虎加人参汤，以生山药代粳米，又为加连翘二钱，蝉蜕一钱，煎汤两盅，分数次温饮下。
连服二剂，大便通下，大热已退，心中仍骚扰不安。再诊其脉，
已还浮分，疑其余热可作汗解，遂用阿斯匹林一瓦和白糖冲水服之，周身得微汗，透出白痧若干，病遂愈。由
斯知阿斯匹林原可为透发痧疹之无上妙药。而石膏质重气轻原亦具透表之性，又伍以最善发表之阿斯匹林，其
凉散之力尽透于外，化作汗液而不复留中（石膏煮水毫无汁浆是以不复留中），是以胃腑之热未实而亦可用
也。愚临证五十年，治此证者不知凡几，其始终皆经愚一人治者，约皆能为之治愈也。
天津许姓学生，年八岁，于庚申仲春出疹，初见点两日即靥。家人初未介意。迟数日，忽又发热，其父
原知医，意其疹毒未透，自用药表之，不效。延他医治疗，亦无效，延愚诊视，其脉象细数有力，肌肤甚热，
问其心中，亦甚热，气息微喘，干咳无痰，其咽喉觉疼，其外咽喉两旁各起疙瘩大如桃核之巨者，抚
之则疼，此亦疹毒未透之所致也。且视其舌苔，已黄，大便数日未行，知其阳明府热已实，必须清热与表散
之药并用，方能有效。遂为疏方∶鲜茅根半斤（切碎），生石膏二两（捣细），西药阿斯匹林一瓦半。先将
茅根、石膏水煮四五沸，视茅根皆沉水底，其汤即成。取清汤一大碗，分三次温饮下，每饮一次，送服阿斯匹
林半瓦。初次饮后，迟两点钟再饮第二次。若初服后即出汗，后二次阿斯匹林宜少用。如法将药服完，翌日
视之，上半身微见红点，热退强半，脉亦较前平和，喉疼亦稍轻，其大便仍未通下。遂将原方茅根改用五两，
石膏改用两半，阿斯匹林改用一瓦，仍将前二味煎汤分三次送服阿斯匹林。服后疹出见多，大便通下，
表里之热已退十之八九，咽喉之疼又轻，惟外边疙瘩则仍旧。愚恐其所出之疹仍如从前之靥急，俾每日用鲜
茅根四两以之煮汤当茶外，又用金银花六钱，甘草三钱，煎汤一大杯，分三次温服，每次送梅花点舌丹一
丸（若在大人可作两次服每次送服二丸）。如此四日，疙瘩亦消无芥蒂矣。
按∶此证脉仅细数有力，原非洪大有力，似石膏可以少用，而方中犹用生石膏二两及两半者，因与若干
之茅根同煮，而茅根之渣可以减去石膏之力也。再此证若于方中多用羚羊角数钱，另煎汤兑药中服之，亦可
再将疹表出。而其价此时太昂，无力之家实办不到，是以愚拟得茅根、石膏、阿斯匹林并用以代之。凡证
之宜用羚羊角者，可将此三味为方治之也。且此三味并用，又有胜于但用羚羊角之时也（
羚羊角解下有治愈之案可参观）。
自入夏以来，各地发生猩红热，互相传染。天气炎热而病情日益加重，治疗不得法，常常导致无法救治。所谓猩红热并非其他疾病，就是痧疹兼有温病。我曾实验观察痧疹的病症，如果不兼有温病，在疹子将要发出尚未发出的时候，不过稍微有点怕冷发热，或者头部轻微疼痛，或者眼睑轻微肿胀，或者肢体轻微酸懒，或者食欲不振。疹子发出之后，虽然体表和体内都感觉发热，但实际上并没有炽盛剧烈的热象。治疗者始终使用清表（痧疹始终适宜用解表药，但宜用辛凉解表，不宜用温热解表）解毒的药物，没有不痊愈的。即使始终不服药，听任其自然发出和消退，在一周左右也可以自愈。这是因为只有疹毒的热，而没有温病的热相互助长为害，所以病情容易痊愈。
至于疹子兼有温病的，就与此完全不同。刚发病的时候疹子还没有发出，就已经表里壮热，因为疹毒的热还没有萌芽，而温病的热已经炽盛了。治疗者应当将薄荷、连翘、蝉蜕等托表透疹的药物，与玄参、沙参、天花粉等清里热的药物并用。其中连翘可用三钱，薄荷叶、蝉蜕各可用钱半，玄参、沙参、花粉各可用五钱，再少量加入金银花、甘草解毒。如果担心痧疹不能透发出来，可以用鲜茅根二两（如果没有可以用鲜芦根代替），用水煮几沸，取澄清的汤液几盅，用它代替水来煎药，煎成一盅汤，温服，疹子必定能完全透出。或者另外再用鲜茅根数两，煎四五沸，用其汤液代替茶水饮用，效果更好。
如果痧疹虽然都已经透发于外，但火气仍然炽盛，且深入阳明胃腑，舌苔从前白的到此逐渐变黄，心中烦热异常，或者呼吸粗重微喘，鼻翼扇动，或者神志昏迷胡言乱语，脑膜发炎，大便干燥，小便赤涩，这是阳明胃腑大实的证候。想要治疗阳明胃腑的实热，《伤寒论》中的白虎汤原本是千古不变的良方。因为它兼有疹毒，可以在方中加入连翘二钱，羚羊角一钱（另煎兑服或研成细末送服，或用金银花二钱代替），再用鲜茅根或鲜芦根煮汤，用它代替水煎药。方中如果用生石膏二两，可煎成两盅汤，分两次温服。如果用生石膏三两，可煎成三盅汤，分三次温服。一剂后热未清的，可以服用至数剂，以服药后热退，大便仍不滑泻为标准。
如果胃腑虽然有大的热邪，但因为小便不利而导致大便滑泻的，白虎汤又不可以立即服用。应当先用滑石、生怀山药各一两，生杭芍八钱，连翘、蝉蜕各钱半，甘草三钱（这个方子就是我拟定的滋阴宣解汤），煎成一盅汤服用，滑泻应当立即停止。泻止之后，热仍然不退的，应当在初次方中加入滑石六钱，服用以退热，仍然应当煎成几盅汤，慢慢温服。至于大热已经退去，疹子已经见靥（消退），但余热仍然旺盛的，应当再用滋阴清热解毒的药物，并少量加入托表透疹的药物辅助。方用玄参八钱，沙参、花粉各五钱，连翘、金银花、鲜芦根各三钱，甘草二钱，可以连续服用数剂。随着热度降低，药剂剂量也应当随之递减，等到热全部消除就停药。以上各方，如果遇到兼有喉痧的病例，应当在方中加入射干、生蒲黄各三钱。唯独治疗大便滑泻的方子中不宜加。可以外用硼砂、生寒水石各二钱，梅片、薄荷冰各一分，共同研细吹入喉中。
猩红热本来不是危险的病症，之所以多危险，是因为出现白虎汤证时，医生不敢放手用白虎汤治疗。至于我治疗此病时，不但胃腑大实的证候可以放手投以大剂量白虎汤；即使在疹子刚初见点时，病人表里壮热，脉象浮洪，只要问其大便结实，经常使用生石膏一两或一两半煎汤，送服西药阿斯匹林二分，周身得到微微出汗，疹子全部发出而热也就退了。
曾治疗一个六七岁的小女孩，患温病半个月不好。脉象数而有力，肌肤热而干涩，心里非常烦躁，在床上辗转不能安卧。怀疑她病久阴亏，不堪受外感灼热的影响，或者是痧疹之毒伏藏未能透出，所以病情现状如此。问其大便，三天未行。投以大剂量白虎加人参汤，用生山药代替粳米，又加入连翘二钱，蝉蜕一钱，煎成两盅汤，分几次温饮下。连续服用两剂，大便通下，大热已退，心中仍然骚扰不安。再次诊脉，脉象已回到浮分，怀疑余热可以通过汗解，于是用阿斯匹林一瓦和白糖冲水服之，周身得到微微出汗，透出一些白痧，病就好了。由此可知阿斯匹林原本可以作为透发痧疹的无上妙药。而石膏质重气轻，原本也具有透表的性质，又配合最善于发表阿斯匹林，其凉散之力尽透于外，化作汗液而不留在体内（石膏煮水毫无汁浆所以不留在体内），所以胃腑之热未实的时候也可以使用。我临证五十年，治疗这种病的不知有多少，始终都由我一个人治疗的，大约都能治愈。
天津许姓学生，八岁，在庚申年仲春出疹，刚初见点两天就消退了。家人起初没在意。过了几天，忽然又发热，他父亲原懂医，认为疹毒未透，自己用药解表，无效。请其他医生治疗，也无效，请我诊治，脉象细数有力，肌肤很热，问其心中也很热，气息微喘，干咳无痰，咽喉觉得疼，外面咽喉两旁各起疙瘩大如桃核那么大，抚摸则疼，这也是疹毒未透所致。再看舌苔，已经发黄，大便几天未行，知道阳明腑热已实，必须清热与解表药并用，才能有效。于是为他开方：鲜茅根半斤（切碎），生石膏二两（捣细），西药阿斯匹林一瓦半。先将茅根、石膏水煮四五沸，看茅根都沉到水底，汤就成了。取清汤一大碗，分三次温饮下，每次喝一次，送服阿斯匹林半瓦。第一次喝完，隔两个小时再喝第二次。如果初服后就出汗，后两次阿斯匹林应少用。按法将药服完，第二天看，上半身微见红点，热退了大半，脉也比较平和，喉疼也稍轻，大便仍未通下。于是将原方茅根改用五两，石膏改用一两半，阿斯匹林改用一瓦，仍将前两种药煎汤分三次送服阿斯匹林。服后疹出较多，大便通下，表里之热已退十之八九，咽喉之疼又轻，只是外面的疙瘩还照旧。我恐怕所出的疹子仍像从前那样迅速消退，于是每天用鲜茅根四两煮汤当茶喝，另外用金银花六钱，甘草三钱，煎汤一大杯，分三次温服，每次送梅花点舌丹一丸（如果是大人可以做两次服，每次送服二丸）。这样四天，疙瘩也消得干干净净了。
按：此证脉仅细数有力，原本不是洪大有力，似乎石膏可以少用，但方中仍用生石膏二两及一两半的原因，是因为与若干量的茅根同煮，而茅根的渣滓可以减弱石膏的药力。再者此证如果在方中多用羚羊角数钱，另煎汤兑入药中服，也可以再将疹子透发出来。但其价格此时太昂贵，无力之家实在办不到，所以我拟定用茅根、石膏、阿斯匹林并用以此替代。凡是适宜用羚羊角的证候，可以将这三味药作为方剂治疗。而且这三味药并用，又有胜过只用羚羊角的时候（羚羊角解下有治愈的案例可以参考）。
Since entering summer, scarlet fever has occurred in various places, spreading through infection. The hot weather causes the disease to increase in number and severity; if treated improperly, it often leads to untreatable conditions. Scarlet fever is nothing other than measles (sha zhen) combined with warm diseases (wen bing). I have experimentally observed cases of measles: if not complicated by warm diseases, before the rash emerges, there are only slight chills and fever, or mild headache, slightly swollen eyelids, slight limb soreness and lethargy, or loss of appetite. After the rash emerges, although both exterior and interior feel feverish, there is actually no intense heat. Treatments that consistently use clearing and releasing exterior agents (for measles, releasing exterior agents are always appropriate, but should be acrid-cool rather than acrid-warm) and detoxifying herbs result in recovery without exception. Even if no medication is taken and one allows the rash to emerge and resolve naturally, self-healing can occur within a week. This is because there is only the heat of the rash toxin, without the assisting harm of warm disease heat, so the illness is easy to cure.
However, when measles is complicated by warm diseases, it is completely different. At the onset, before the rash emerges, there is already intense heat in both exterior and interior, because the heat of the rash toxin has not yet sprouted, while the heat of the warm disease is already blazing. Treatment should combine exterior-releasing and rash-promoting herbs such as Bohe (Menthae Haplocalycis Herba), Lianqiao (Forsythiae Fructus), and Chantui (Cicadae Periostracum) with interior-clearing herbs such as Xuanshen (Scrophulariae Radix), Shashen (Glehniae Radix), and Tianhuafen (Trichosanthis Radix). Lianqiao can be used at 3 qian, Bohe Ye and Chantui each at 1.5 qian, and Xuanshen, Shashen, and Tianhuafen each at 5 qian. A small amount of Jinyinhua (Lonicerae Japonicae Flos) and Gancao (Glycyrrhizae Radix et Rhizoma) can be added for detoxification. If concerned that the rash may not fully emerge, fresh Maogen (Imperatae Rhizoma) 2 liang (or fresh Lugeng [Arundininis Caulis] as substitute) can be boiled in water for a few minutes. Take several bowls of the clear decoction to replace water for decocting other herbs. Decoct into one bowl, take warm. The rash will surely emerge completely. Alternatively, boil several liang of fresh Maogen for four or five boils and drink the decoction as tea, which is even better.
If the rash has emerged externally but fire heat remains intense and has penetrated deep into the Yangming Stomach Fu organ, the tongue coating changes from white to yellow. There is extreme restlessness and heat in the heart, coarse breathing with slight panting, flaring of nasal alae, delirium, meningeal inflammation, dry stool, and dark, scanty urine. This indicates a great excess syndrome of the Yangming Stomach Fu. To treat this excess heat in the Yangming Stomach Fu, Baihu Tang (White Tiger Decoction) from *Shanghan Lun* is an eternal excellent formula. Since it is complicated by rash toxin, add Lianqiao 2 qian and Lingyangjiao (Capri Cervi Cornu) 1 qian (decoct separately and mix, or grind into powder and take orally; alternatively, substitute with Jinyinhua 2 qian). Use fresh Maogen or Lugeng decoction to replace water for decocting. If using Sheng Shigao (Gypsum Fibrosum) 2 liang, decoct into two bowls, take warm in two doses. If using Sheng Shigao 3 liang, decoct into three bowls, take warm in three doses. If heat persists after one dose, continue for several doses until heat subsides and stool does not become loose.
If there is great heat in the stomach fu but accompanied by difficult urination leading to loose stools, Baihu Tang should not be administered immediately. Instead, first use Huashi (Talcum), Sheng Huaishanyao (Dioscoreae Hypoglaucae Rhizoma) each 1 liang, Sheng Hangshao (Paeoniae Radix Alba) 8 qian, Lianqiao and Chantui each 1.5 qian, and Gancao 3 qian (this is my formula Ziyin Xuanjie Tang). Decoct into one bowl and take. Loose stools should stop immediately. If heat persists after diarrhea stops, add Huashi 6 qian to the initial formula to reduce heat. Decoct into several bowls and take warm slowly. Once major heat has subsided and the rash has resolved, but residual heat remains strong, treat again with yin-nourishing, heat-clearing, and detoxifying agents, supplemented by a small amount of exterior-releasing herbs. Use Xuanshen 8 qian, Shashen and Tianhuafen each 5 qian, Lianqiao, Jinyinhua, and fresh Lugeng each 3 qian, and Gancao 2 qian. Can be taken continuously for several doses. As heat decreases, dosage should correspondingly decrease until heat is completely eliminated and administration stops. For these formulas, if throat sha (scarlatina-like throat condition) is present, add Shegan (Belamcandae Rhizoma) and Sheng Puhuang (Typhae Pollen) each 3 qian. Do not add these to the formula for treating loose stools. Externally, apply Pengsha (Borax), Sheng Hanshui Shi (Calcitum) each 2 qian, Meipian (Borneolum Syntheticum), and Bohe Bing (Mentholum) each 1 fen, grind finely, and insufflate into the throat.
Scarlet fever is inherently not dangerous; its danger arises because physicians hesitate to boldly use Baihu Tang when the Baihu Tang syndrome appears. In my treatment, not only can large doses of Baihu Tang be used boldly for great excess in the stomach fu, but even when the rash first appears with intense exterior-interior heat and floating-hong pulse, if the stool is solid, I frequently use Sheng Shigao 1 liang or 1.5 liang decocted to send down Aspirin 2 fen. Profuse slight sweating ensues, the rash fully emerges, and heat subsides.
I once treated a six- or seven-year-old girl who had suffered from a warm disease for half a month without improvement. Her pulse was rapid and forceful, skin hot and dry, mind extremely restless, tossing on the bed unable to sleep. Suspecting yin deficiency from prolonged illness made her intolerant to external heat, or that rash toxin was trapped and unable to emerge, causing this state. Upon inquiry, she had not had a bowel movement for three days. I prescribed a large dose of Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction), substituting Sheng Shanyao (Dioscoreae Rhizoma) for Jingmi (Oryzae Semen Germinalis), adding Lianqiao 2 qian and Chantui 1 qian. Decoct into two bowls, take warm in divided doses. After two doses, stool passed, major heat subsided, but mental restlessness persisted. Re-pulse diagnosis showed the pulse returning to the floating layer. Suspecting residual heat could be resolved via sweating, I gave Aspirin 1 wa dissolved in sugar water. Slight sweating ensued, some white rashes emerged, and the illness cured. Thus, Aspirin can serve as an supreme herb for promoting rash emergence. Shigao, being heavy in substance but light in qi, possesses exterior-releasing properties. Combined with Aspirin, the best exterior-releasing agent, its cooling and dispersing power penetrates outward, transforming into sweat without remaining in the middle jiao (Shigao decoction yields no viscous residue, hence does not remain internally). Therefore, it can be used even when stomach fu heat is not yet excessive. In fifty years of clinical practice, having treated countless such cases, those managed entirely by me were almost all cured.
A student surnamed Xu in Tianjin, eight years old, developed measles in mid-spring of the Gengshen year. The rash appeared for two days then vanished. Family initially disregarded it. Days later, fever returned. His father, knowing medicine, assumed incomplete rash emergence and self-administered exterior-releasing drugs, ineffective. Other doctors also failed. Upon my consultation, pulse was fine, rapid, and forceful; skin very hot; internal heat severe; slight panting; dry cough without phlegm; throat pain; external swelling beside throat like peach pits, painful to touch. This too resulted from trapped rash toxin. Tongue coating was yellow; stool absent for days. Yangming fu heat was confirmed excess. Heat-clearing and exterior-releasing herbs must be combined. Prescription: Fresh Maogen 0.5 jin (chopped), Sheng Shigao 2 liang (crushed), Aspirin 1.5 wa. Boil Maogen and Shigao for four to five boils until Maogen sinks. Take clear decoction, divide into three warm doses. Send down 0.5 wa Aspirin with each dose. Wait two hours between first and second dose. If sweating occurs after first dose, reduce Aspirin for subsequent doses. Following this, next day: upper body showed slight red spots, heat reduced significantly, pulse calmer, throat pain lighter, but stool still unpassed. Adjusted prescription: Maogen 5 liang, Shigao 1.5 liang, Aspirin 1 wa. Decoct first two herbs, divide into three doses with Aspirin. Result: more rash emerged, stool passed, exterior-interior heat reduced by 80-90%, throat pain lighter, but external swellings remained. Fearing rash might vanish quickly as before, prescribed daily fresh Maogen 4 liang boiled as tea. Additionally, Jinyinhua 6 qian, Gancao 3 qian decocted into one cup, taken warm in three doses, sending down one Wan Mei Hua Dian She Dan (Plum Blossom Pointing Tongue Pill) per dose (adults take two pills per dose). After four days, swellings disappeared completely.
Note: The pulse here was fine, rapid, and forceful, not hong-da (large and forceful), suggesting less Shigao might suffice. However, 2 liang or 1.5 liang of Sheng Shigao was used because it was boiled with substantial Maogen, whose residue reduces Shigao's potency. Furthermore, adding Lingyangjiao (Capri Cervi Cornu) 3-4 qian, decocted separately and mixed, could also promote rash emergence. But due to high cost, unaffordable for poor families, I devised using Maogen, Shigao, and Aspirin together as substitutes. Any case suitable for Lingyangjiao can be treated with these three ingredients. Moreover, their combination surpasses using Lingyangjiao alone (see case studies under Lingyangjiao section).