丙午夏四月，塞道掌侄孙兆某者，病疫已十一日，原诊辞以备后事。塞公另延一医，用理中汤，兆某妻
舅工部员外伊芳公，素精医术，不肯与服。曰∶若治此症，非余某不可。其家因有人进谗言予用药过峻，
惧不敢请，伊芳公力争，恳予甚切。予因知遇之感，慨然同往。诊其脉，沉细而数；验其症，周身斑点，紫
黑相间，加以郁冒直视，谵语无伦，四肢如冰，呃逆不止，舌卷囊缩，手足动摇，似若循衣。此实危症，
幸而两目红赤，嘴唇焦紫，验其是热。查看前方，不过重表轻凉，此杯水投火，愈增其焰，以致变症蜂起。
予用大剂，更加玄参三钱，大青叶二钱，使其内化外解，调服四磨饮。本家惧不敢服，伊芳公身任其咎，亲
身煎药，半日一夜，连投二服，呃逆顿止，手足遂温，次日脉转洪数，身忽大热，以毒外透也。予向伊芳公曰∶
按法治之，二十一日得痊。但此剂不过聊治其焰，未拔其根，药力稍懈，火热复起。一方服至五日，病势
大减，药亦减半。服至八日，药减三分之二，去大青叶。服至十日，药减四分之三，以后诸症全退，饮食
渐进。计服石膏五斤十四两，犀角四两六钱，黄连三两四钱，举家狂喜，始悔进谗言之误也。
右营守府费公名存孝者，年近七旬，癸丑四月，病疫已八日矣。诊其脉，细数无至；观其形色，如蒙
垢，头汗如蒸，昏愦如痴，谵语无伦，身不大热，四肢振摇且冷，斑疹隐于皮内，紫而且赤，幸不紧束。
此疫毒内伏，症亦危矣。如斑不透，毒无所泄，终成闷症，毙在十四日。查看前方，不外荆、防、升、葛。
不知毒火壅遏之症不清，内热不降，斑终不出，徒肆发表，愈增其势，燔灼火焰，斑愈遏矣。予用大剂，
石膏八两，犀角六钱，黄连五钱，加大青叶三钱，升麻五分。使毒火下降，领斑外透，此内化外解，浊降
清升之法。次日，周身斑现，紫赤如锦，精神若明若昧，身亦大热，手足遂温，间有逆气上冲，仍照本方
加生地一两，紫草三钱，调服四磨饮。其侄惧逆气上冲，予曰∶无妨，服此即止。进门时，见又帖有堂
号，因问曰∶又延医乎？其侄曰∶相好请来，但诊其脉，不服药耳。予曰∶予治此症，前人未有，昨日敢
服此方令叔活矣。然见者必以为怪，君其志之。后医者至，果见予方，大叱其非，曰∶一身斑疹，不按古
法，用如许寒凉水注，斑疹如何能透？急宜提表，似或可救，即用荆、防、升、葛，更加麻黄，连服二煎，及至半夜，
呃逆连声，四肢逆冷，足凉过膝。举家惊惶，追悔莫及。守城而进，叩门求见，问其所以，曰∶变矣。问服何方？曰∶
他方。予曰∶既服他方，仍请他治之。其侄见予不往，权将四磨饮原方，连灌二煎，呃逆顿止，手足遂温。转恳予素契
者，登门叩恳，予怜其以官为家，又系异乡人，仍按本方大剂调治，二十一日全愈。计用石膏五斤四两，犀角五两二钱，
黄连四两八钱。此癸丑四月间事也。
【附一：紫黑呃逆治验】
丙午年夏季四月，担任塞道掌一职的侄孙兆某，患瘟疫已十一日。原诊治医生已辞别，准备后事。塞公另请了一位医生，使用了理中汤（温中散寒、补气健脾的方剂），兆某的妻舅、工部员外郎伊芳公，向来精通医术，不肯让他服药。他说：“若要治疗此症，非我不可。”家中因此有人进谗言，说我的用药过于峻猛，家属畏惧不敢邀请，伊芳公极力争取，恳切请求我去诊治。我因感念知遇之恩，慨然同往。诊察其脉象，沉细而数；观察其症状，周身出现斑点，紫黑相间，伴有头昏目眩、直视不动、胡言乱语、四肢冰冷、呃逆不止、舌体卷缩、阴囊收缩、手足动摇，似乎有循摸衣被的动作。这确实是危重病症，幸好双眼红赤，嘴唇焦紫，据此可验证为热证。查看之前的处方，不过是重用解表药而轻视清热凉血药，这如同杯水车薪投于烈火之中，反而增加了火势，导致变证蜂拥而起。我使用大剂量药物，另外加入玄参三钱、大青叶二钱，使其内部化解、外部透解，并调服四磨饮（行气降逆的方剂）。家属畏惧不敢服用，伊芳公亲自承担后果，亲手煎药，经过半天一夜，连续服用两剂，呃逆顿时停止，手足逐渐回暖。次日脉象转为洪数，身体突然发高热，这是毒邪向外透发的表现。我对伊芳公说：“按照此法治疗，二十一日可以痊愈。但这副药只是暂时压制火势，并未拔除病根，若药力稍有松懈，火热之邪会再次兴起。”一方服用至第五天，病势大大减轻，药量也减半。服用至第八天，药量减少三分之二，去掉大青叶。服用至第十天，药量减少四分之三，此后各种症状全部消退，饮食逐渐恢复。共计服用石膏五斤十四两，犀角四两六钱，黄连三两四钱。全家狂喜，开始后悔听信了进谗言的错误。
右营守府费公名存孝者，年龄近七十岁，癸丑年四月，患瘟疫已八日。诊察其脉象，细数且间歇无至；观察其神色形态，如同蒙受污垢，头部出汗如蒸腾状，神志昏迷恍惚如痴，胡言乱语，身体不大发热，四肢颤抖且寒冷，斑疹隐伏于皮内，颜色紫而且红，幸好不紧束。这是疫毒内伏，症状也很危险。如果斑疹不能透出，毒邪就没有宣泄途径，最终会形成闷症，在第十四天死亡。查看之前的处方，不外乎荆芥、防风、升麻、葛根等药。不知道毒火壅遏的病症不清除，内热不下降，斑疹终究出不来，徒劳地发散表邪，只会增加病势，使火焰燔灼，斑疹更加被遏制。我使用大剂量药物，石膏八两，犀角六钱，黄连五钱，加大青叶三钱，升麻五分。使毒火下降，引领斑疹向外透发，这是内部化解、外部透解，浊气下降、清气上升的方法。次日，周身斑疹显现，紫红如锦缎，精神似清似昧，身体也发高热，手足逐渐回暖，间或有逆气上冲，仍照原方加入生地一两、紫草三钱，调服四磨饮。他的侄子畏惧逆气上冲，我说：“不要紧，服用此药即可停止。”进门时，看见又贴有堂号（指新请医生的告示），于是问道：“又请医生了吗？”他的侄子说：“是好朋友请来的，但只诊脉，不给药。”我说：“我治疗此症，前人未有先例，昨天敢服用此方，令叔就活过来了。然而看到的人必定觉得奇怪，请您记下来。”后来的医生到了，果然看到我的处方，大声斥责其错误，说：“一身斑疹，不按古法，用如此多的寒凉水注药，斑疹怎么能透发？急宜提升发表，或许还可以救，立即使用荆芥、防风、升麻、葛根，再加麻黄，连续服用两煎。等到半夜，呃逆连声，四肢逆冷，脚凉超过膝盖。全家惊慌，追悔莫及。守城官员进城敲门求见，询问原因，我说：“病情变化了。”问服了什么方子？回答说：“其他方的药。”我说：“既然服了其他方的药，仍请其他医生治疗吧。”他的侄子见我不到场，权且将四磨饮原方，连续灌下两煎，呃逆顿时停止，手足回暖。转而恳求我与他有交情的人，登门叩头恳求，我怜悯他以官邸为家，又是异乡人，仍按原方大剂量调理治疗，二十一天完全痊愈。共计使用石膏五斤四两，犀角五两二钱，黄连四两八钱。这是癸丑四月间的事情。
[Appendix 1: Treatment of Hiccups with Purple-Black Eruptions]
In the fourth month of summer in the Bingwu year, Mr. Zhao, my nephew who served as the Administrator of Sai Dao, had suffered from epidemic plague for eleven days. The original attending physician had resigned, preparing for the worst. Master Sai invited another physician who prescribed Lizhong Tang (Cinnamon Twig and Ginger Decoction). Mr. Yi Fanggong, the brother-in-law of Mr. Zhao’s wife and an Assistant Director in the Ministry of Works, who was well-versed in medical arts, refused to let him take the medicine. He stated, "If this condition is to be treated, it must be by me." Due to slander within the family claiming that my prescriptions were too harsh, the relatives were afraid to invite me. Mr. Yi strongly advocated for my invitation and pleaded earnestly. Moved by their trust, I readily went with them. Upon examination, the pulse was deep, fine, and rapid; the symptoms included purple-black macules interspersed on the whole body, accompanied by dizziness, fixed gaze, incoherent speech, ice-cold limbs, incessant hiccups, curled tongue, retracted scrotum, trembling hands and feet, and a tendency to pick at bedclothes. This was indeed a critical condition. Fortunately, the eyes were red and the lips scorched and purple, confirming a heat syndrome. Reviewing the previous prescriptions, they merely emphasized releasing the exterior while neglecting clearing heat and cooling blood. This was like throwing a cup of water into a fire, increasing the flames, leading to a proliferation of complications. I used a large dose of medication, adding Xuan Shen (Radix Scrophulariae) 3 qian and Da Qing Ye (Folium Isatidis) 2 qian, to resolve internally and release externally, administered alongside Simo Yin (Four-Monk Decoction). The family was too fearful to administer it, so Mr. Yi took full responsibility and decocted the medicine himself. After half a day and one night, two doses were given consecutively. The hiccups stopped immediately, and the limbs warmed. The next day, the pulse became surging and rapid, and the body suddenly became very hot, indicating the toxin was being expelled outward. I told Mr. Yi, "Following this method, recovery will occur in twenty-one days. However, this prescription only temporarily suppresses the fire but does not eradicate the root cause. If the medicinal force slackens, the heat will rise again." By the fifth day of taking the prescription, the disease significantly subsided, and the dosage was halved. By the eighth day, the dosage was reduced by two-thirds, and Da Qing Ye was removed. By the tenth day, the dosage was reduced by three-quarters, after which all other symptoms completely receded, and dietary intake gradually improved. In total, Shi Gao (Gypsum Fibrosum) 5 jin 14 liang, Xi Jiao (Cornu Rhinocerotis) 4 liang 6 qian, and Huang Lian (Rhizoma Coptidis) 3 liang 4 qian were consumed. The entire family was overjoyed and regretted listening to the slander.
[Appendix 1: Treatment of Coma and Hiccups]
Mr. Fei Cunxiao, Commander of the Right Camp, was nearly seventy years old. In the fourth month of the Guichou year, he had suffered from epidemic plague for eight days. His pulse was fine, rapid, and intermittent; his complexion appeared dull and dirty, sweat poured from his head like steam, he was comatose and delirious with incoherent speech, his body was not highly febrile, his limbs trembled and were cold, and eruptions were hidden beneath the skin, appearing purple and red, though not tightly constricted. This indicated epidemic toxins lurking internally, a dangerous condition. If the eruptions did not emerge, the toxins would have no outlet, eventually resulting in a stifling syndrome and death by the fourteenth day. The previous prescriptions consisted mainly of Jing Jie (Schizonepetae Herba), Fang Feng (Saposhnikoviae Radix), Sheng Ma (Cimicifugae Rhizoma), and Ge Gen (Puerariae Lobatae Radix). They failed to clear the obstruction caused by toxic fire; without descending internal heat, eruptions could not emerge. Blindly dispersing the exterior only exacerbated the condition, intensifying the burning fire and further suppressing the eruptions. I used a large dose: Shi Gao (Gypsum Fibrosum) 8 liang, Xi Jiao (Cornu Rhinocerotis) 6 qian, Huang Lian (Rhizoma Coptidis) 5 qian, Da Qing Ye (Folium Isatidis) 3 qian, and Sheng Ma (Cimicifugae Rhizoma) 5 fen. This directed the toxic fire downward and guided the eruptions outward, employing the method of resolving internally, releasing externally, descending turbidity, and ascending clarity. The next day, eruptions appeared all over the body, purple-red like brocade. His spirit was fluctuating between lucid and confused, his body became very hot, and his limbs warmed. Occasionally, rebellious qi surged upward. I adhered to the original formula, adding Sheng Di Huang (Radix Rehmanniae Preparata) 1 liang and Zi Cao (Radix Arnebiae) 3 qian, administered with Simo Yin (Four-Monk Decoction). His nephew feared the rebellious qi, but I said, "No harm, it will cease upon ingestion." Upon entering, I saw another notice posted, asking if another doctor had been invited. The nephew replied, "A friend has been invited, but he only diagnosed the pulse and did not prescribe medicine." I said, "My treatment for this condition is unprecedented; yesterday, your uncle survived because he dared to take this prescription. Observers will surely find it strange, so please record this." When the subsequent doctor arrived, he saw my prescription and loudly criticized it, stating, "With eruptions all over the body, one should not follow ancient methods by using such large amounts of cold and watery herbs; how can eruptions emerge? It is urgent to lift and release the exterior, perhaps saving the patient. Immediately use Jing Jie, Fang Feng, Sheng Ma, and Ge Gen, plus Ma Huang (Ephedrae Herba), and decoct twice." By midnight, hiccups sounded continuously, limbs became cold and reversed, and coldness extended past the knees. The family panicked and deeply regretted their actions. The city commander entered the city, knocked on the door to seek an audience, and asked the reason. I said, "The condition has changed." Asked what medicine was taken, he replied, "Medicine from another source." I said, "Since you took medicine from another source, please consult another physician." Seeing that I did not come, the nephew temporarily administered two decoctions of the original Simo Yin (Four-Monk Decoction). The hiccups stopped immediately, and the limbs warmed. They then begged a close associate of mine to visit and plead on their behalf. Pitying that he lived in an official residence and was a stranger in a foreign land, I continued treating him with the original large-dose prescription. He fully recovered in twenty-one days. Total usage: Shi Gao (Gypsum Fibrosum) 5 jin 4 liang, Xi Jiao (Cornu Rhinocerotis) 5 liang 2 qian, and Huang Lian (Rhizoma Coptidis) 4 liang 8 qian. This occurred in April of the Guichou year.