万密斋治案云∶甘大文从余学医，长男发热。余见之曰∶疹也。三日之内不出，身凉内热，毒火内伏，故
烦而坐卧不安也。不急治且危。文泣求医。余乃用葛根汤加麻黄、石膏以发之，一服疹尽出，色白不红。余曰∶
此血虚也。用四物汤加防风，一服色变红，随愈。
又云∶吴道松四肢病疹，或治之三日，疹不出，烦躁甚，欲用荆防败毒散。曰∶此皆发热之药，无解毒之
用，况天大热，又无时令之药一二味在内，则阳愈胜，阴愈亏，阳明不和，此疹之所以不出也。以东垣凉膈散
加玄参、升麻，一服疹出，三日起。
又云∶郧阳杨举人子，疹后利下鲜血，余授一方，用当归梢、生地黄、白芍药、炒条芩、炒黄连、人参、
生甘草、枳壳、乌梅肉，调理而安。时郡中出疹，但病利血者，杨公授此方，皆效。
又云∶同郡周小川，族人一小女疹后咳嗽失声。余授一方，以甘桔汤加炒牛蒡子、炒枯芩、天花粉作散，
薄荷叶汤调，再煎一沸，服之而愈。
孙东宿治案云∶万历甲戌，其年自仲秋徂冬， 子盛行。三月内，余所治男妇婴孩共七十二人。苕之望族，
沈姓最着。大中丞观颐公当考功时，幼君 喘嗽不宁，声哑发热，泄泻，斑紫不敛，余以小无比散愈之。
又云∶程晓山中风，归而逆余诊。时其子仅七岁，中疹一月余矣，发热如故，咳嗽声哑，肌削骨立，头发
尽秃，众医束手，举家亦堕泪而已。余以诊，晓山见之曰∶举家惊惶，谓此儿不保耶。此疳证，疳因疹后虚
热而发，以大芦荟丸治之，可获万全。君家初不问余者，谓余非幼科专门也。不知此特大方家余事，而
为制药服之，药未尽而病瘳。
江应宿治案云∶一儿三岁，患疹出迟而早没，热而咳嗽，昏闷不食。余诊视曰∶疹出不透，因风寒没早，
宜急发之，以葱煮麻黄八分，四物换生地加杏仁、天花粉、葱、姜，煎服。重复出一身，比前更多，三日没
尽而愈。凡疹证出自六腑，宜养阴抑阳，刚剂决不可服。犯之即发喘渴闷乱，失于收救，多致夭折。如参、 、
半夏、白术、当归温燥之药，亦所当忌。只宜清热养血。如出迟者，少加升散之药送之，达表而已。
又云∶表侄女九岁，出疹没早，发咳嗽，大发热，肌瘦，不饮食，唾呕痰沫甚多，延半月余。余往视之曰∶
血虚病也。以四物汤加杏仁、阿胶、麦冬、五味、炮姜，一服热退身凉，痰咳俱止，再剂而愈。
方荫山治案云∶程氏子二岁，出疹因出迟没早，发喘大热，舌短不乳，昏沉，医皆不治。余以玄参、茯苓、
甘草、麦冬、升麻、陈皮、干葛、麻黄、兜铃、黄芩、知母、犀角、石膏，名曰犀角石膏汤，一服证减半，二
服愈。
《太函集》云∶吴桥以医名里中，有兄子始孩，屡日发热蒸蒸，惊搐昏愦，众医不知所出。桥诊之曰∶疹
也，寒邪外乘，闭而不出，是呱呱耳。饮药也已数，中气乃伤，药不足恃也。当置沸汤一瓶，撤其盖，令保母
抱子坐汤侧稍远，摊被围之，汤气自远熏蒸，少饮药内托，疹出而解。无何，丛睦汪氏子病如之，仍用向法，
并效。其稳类如此，故乡人称良焉。
缪希雍治案云∶贺知忍少子病痧疹，家人不知，尚以肉饭与之。余适至，惊曰∶此痧疹之极重者，何易
视之。以西河柳两许，杂以玄参三钱，知母五钱，贝母三钱，麦门冬两许，石膏两半，竹叶七十片，二剂而痧
尽。现遍体皆赤，连进四剂，薄暮矣。知忍曰∶儿今无恙乎？余曰∶痧虽出尽，烦躁不止，尚不可保。再以
石膏三两，知母一两，麦门冬三两，加黄芩、黄连、黄
柏各五钱，西河柳一两，竹叶二百片，浓煎饮之，烦躁遂定而瘥。
霖按∶缪氏西河柳用如许之多。独不虑其温升太过乎？
每用辄以石膏监制，殆即仲景麻黄、石膏同用之意也。虽然，遇禀赋怯弱之儿，险矣。
朱济川治案云∶一儿元月发疹，身肢隐见不振，而头面不出，面色青白，喘胀闷乱，右寸脉微。余谓正气
虚不能逐邪上升于头面，宜补益而助升发为主，以麻黄桂枝汤加人参二钱，水煎服。又以芫荽、防风煎汤，浴
洗头面手足，疹透证平而愈。
又云∶一儿疹正出而恣食停滞，腹饱便秘，壮热谵语。余谓食壅而毒不化，以大黄、枳实、栝蒌仁、浓朴、
甘草、黄连利之，而尚喘嗽壮热，脉迟肢冷，以附子理中汤，又归芍六君子汤治之愈。
又云∶一儿身热咳嗽，疹出隐隐，医以疹药发之，不见不没。余谓隐疹也，由客受风寒，郁而不散，非若
中腑之正疹也。以芎苏散治之愈。
又云∶一儿疹出弥盛，形如锦纹，而间有头粒色赤，壮热烦躁，舌苔，便秘。余谓斑疹并行，以调胃承气
汤利之，又白虎汤合葛根汤治之愈。
又云∶一儿身热疹出吐泻，余谓初出疹而吐泻者，乃阳火得泄，吉兆也。以升麻葛根汤表之，疹尽透而愈。
亦有兼伤食吐利者，前方加消化之药。
又云∶一女出疹，药用寒凉，又食生梨，一二疹即殒没，喘急胸满，面青肢冷，眼合声哑，昏晕。余谓毒
为寒郁，反毒内攻而然也。以麻黄汤加葛根、紫苏、甘草、桔梗、生姜服之，外以被覆，得汗而苏。疹复出，
喘甚于前。余谓骤用麻黄燥烈之药，致毒火盛而肺气热也，宜清润之，以甘草、桔梗、牛蒡、前胡、杏仁、玄
参、知母、天花粉、黄芩、麦门冬治喘息而愈。
又云∶一娠妇疹出热甚，堕胎而难产。余以鱼胶三寸烧灰存性，麝香一分，共研末，好酒调下，即产。若
难之甚，及横生，用鱼胶一尺，制如前法，虽立产其子，不能生矣。
又云∶一孕妇疹出热甚，小腹痛而漏血。余谓热盛触动其胎，以升麻葛根汤加荆芥、紫苏、条芩、当归、川
芎、阿胶、白术、陈皮、砂仁治之，血止愈。亦有不同前治，胎堕而子母俱亡，或子亡母存。
又云∶一儿疹虽尽出，而喘胀便秘，壮热谵语。余谓毒壅不尽出，以黄连、枳实、栝蒌仁、桑白皮、地骨
皮、知母、石膏、人中黄治之愈。
又云∶一儿疹后咽喉肿痛，余谓余毒不解，以甘桔汤加牛蒡、射干、玄参、连翘、知母治之，又葛槿散吹
之而愈。
又云∶一子新婚出疹后，痰嗽不已。众谓余毒不尽，用清解药而痰愈炽。余谓阴亏而火炎无制，故午后潮
热而咳甚也。治宜壮水为主，以六味地黄丸料，加麦冬、知母治之愈。
又云∶一儿疹后干咳嗽不续，余谓医过发散，致肺气虚耗，以小异功散加麦门冬、五味子、贝母、桔梗治
之愈。
又云∶一儿疹后走马牙疳，龈溃穿鼻，诸医不效，余以黄牯牛粪后尖，瓦上 存性，为末，人中白 为末，
黄柏为末，等分，和匀，吹之，溃窍渐长，龈齿俱生而愈。
又云∶一儿疹后干咳不已，余谓疹时过于解散，肺气虚耗，宜补脾肺为主。不信，只以清火止嗽药，其背
渐驼，腿足细小，终身痼疾。亦有嗽久而胸高肿满，状如龟胸。启云先生曰∶疹后久嗽则金衰，金衰不能生肾
水，肾主骨髓，肾无生气，则骨枯而髓减，风寒乘虚而入于髓，其邪凝滞，故腰脊不举而为斯疾也。治法先以
防风散驱其邪，又八味地黄丸加人参、杜仲、牛膝、当归、石斛、何首乌、米仁、菟丝子、萆 、鹿茸蜜丸，
又以驱风壮筋活血膏贴其凸处，又灸肺俞穴、膈俞穴。一儿患此，余诊右脉
缓弱，谓脾肺不足，先以人参、白术、茯苓、陈皮、甘草、贝母、当归、芍药、米仁、石斛，水煎服，脾土稍
固，又以前方法治之，腿足渐而生肉，背驼稍愈，但不能脱然如故。
沈明生治案云∶沈翰臣妇咳嗽发热，或认为不足，遽用六味地黄汤以滋阴分，既而咳逆更剧。诊之脉浮且
数，风热干乎肺家，宜用疏表之剂，服下遍身发出红疹。二剂咳差缓而仍未透，更用辛凉等味，以清表热，仍
嗽，复作泻不已，咸归咎寒凉。余笑曰∶非也，肺受风邪，邪变为热。经云∶邪并于阳，则阳热而阴虚。始则
疹在欲出未出之际，火上炎于手太阴而作嗽；今则疹在欲收未收之时，热下移于手阳明而作泻。是属斑疹家常
候，何足怪乎？行且止矣。果越两日而嗽宁泻止，身凉疹退。按斑疹之候虽异，斑疹之治略同。是岁丁未，湿
土司天，而春夏之交，燥旱殊甚，盖犹袭乎昨岁燥金在泉之余气耳。是以初当凉解而不利乎温散，次当寒润而
不利于温补。六味地黄丸之属，虽若相宜，然质独味浓，不惟不能达表，抑且锢蔽外邪，施诸疹退而余热未清
之时，稍为近理。今初热始嗽，辄为用之，是非滋阴乃滋害也。况以丸为汤，已非古人本意，而专投泛用，尤
乖病变之机。自来善用六味者无过薛立斋，假使九泉有知，视近日之汤法盛行，能无掩口胡卢哉。
柴屿青治案云∶候补汪某年二十余，因感时气出疹，过服石膏等剂，身热泄泻，两耳皆聋，绝不思食，脉
之两尺微弱，舌上干燥，毫无津液。本属阴亏，况大寒之剂，不但伤阳，亦且伤阴。用麦冬五钱，滋阴以清虚
热，陈皮以和胃气，加西河柳一钱，以清疹毒。次日热微泻止，舌亦觉润，惟左寸脉微洪，加小生地二钱，木
通一钱，菊叶一钱，三日热退思食。因是月应选，身软耳聋，虑不能过堂掣签。谓已平复十九日，当投补剂，
定可全愈。后果如言，竟得赴选。
冯楚瞻治案云∶沈氏儿发热数日，见痧疹才一日，面上尽
没，神气困极，蛔从口出，不一而足，数日不食，下泻上喘，唇口焦裂，五心壮热，手足指尖皆冷，脉细数无
伦，两尺更弱，咸谓疹毒归脏，胃热故蛔连出也。不知神气欲脱，五脏俱困，脾虚不能纳谷，虫无所食，又兼
虚火熏蒸，脏腑燥热，虫不安而出耳。况诸斑疹多由内伤失调，脾胃不足以荣，是以阳气逆行，阴覆于外。血
盛气壮，则色红而 发；血虚气弱，则色白而隐伏。有何毒之轻重乎？面上退缩者，阳虚不能升发也；喘促者，
气唯续也；唇焦者，脾津耗竭也；五心壮热者，阴亏火烁也；泄泻不食者，真火衰而脾不运也；寸关细数尺弱
者，气虚血虚，虚火上浮而不藏也。急则治标，缓则治本。今者之急，本气欲脱也。倘谓痧疹余毒，解利清托，
恐神气先尽矣。乃以熟地六钱，丹皮一钱，麦冬三钱，牛膝二钱，制附六分，一剂假热全消，真虚毕露，神气
更倦。此阴已少复，当补气以助其发生，前方另煎人参二钱冲服，神气渐复，喘促全安。饮粥微呕，乃胃气久
虚之故也。再用前方加炒黄白术二钱，去丹皮，仍以参汤冲服，四剂全愈。
吕用晦治案云∶姚江钱 都子五岁，病疹泄泻，儿医谓 毒，最宜于泻，不复顾忌，以清火为急，寒凉纵
进，病势殊剧，来邀余。视面色两颧嫩红，时切牙喘急，口渴甚，饮水不绝，脉洪缓如平壮人。余曰∶脾急矣。
速投人参、白术、当归、黄 、陈皮、甘草、茯苓、木香以救之，一剂觉安。次日有邻族人来候，惊阻之曰∶
误矣！小儿有专门，岂可令腐儒治之。吾所闻 病以发散清凉解毒为主，今半身 潮未退，而用温补，必不救
矣。其家惧，遂不敢再服。间二日， 都复来见余曰∶诸证复如故，如何？余曰∶岂有是理哉？君戏我耳。
曰∶日来实不服尊剂。乃述其故。余曰∶君试急归，令郎天柱倒矣。别去顷之，驰至曰∶果如公言，奈何？急
服前方何如？余曰∶前方救虚也。今加寒矣，非桂附不能挽也。曰∶颧红喘急，口渴饮水，俱是热
证，而公独言虚寒何也？曰∶阴竭于内，阳散于外，而寒凉复逼之，阳无所归，内真寒而外假热。此立斋先生
所发《内经》微旨，非深究精蕴者不能信也。 都归，违众服之，一剂而天柱直，二剂而喘渴止，三剂起行，
嬉戏户外。
舒驰远治案云∶老庚者，年二十有七，夏月出疹，头身微热，苗色淡红，咽喉痛甚，时医误用柴、葛、牛
子、甘、桔等药，转加作泄，大泄数次，疹顿沉没，咽喉转闭，口不能言，人事恍惚，晕眩欲绝。时天有在坐，
余谓天有曰∶此证全是一团阴寒在里，若用疹家通套药，必不可生。天有曰∶何以言之？余曰∶若内实有火，
苗当紫赤，何得淡红。且咽喉虽痛而不赤肿，又无烦渴恶热等症，明明肾脏虚寒，阴火上攻也。且阳和布令，
百体顺昌。痧疹属阳，必纯阳始得出透。见点之时，如萌芽初吐，遇阴惨肃杀之气，摧残所生，靡有孑遗。今
值此阴邪横发，埋没真阳，而疹不沉没者，几希矣。惟是陡进附子、干姜、半夏、甘草、白术、茯苓、肉桂、
黄，温补兼行，以驱阴回阳，俾驳劣悉返冲和，乃得功收再造。危乎，微乎！
霖按∶此三案大同小异，要是千百中一二，未可执为程法也。大抵痧疹之发，干诸肺胃，治之但宜松透，
一切温燥补涩之剂，不可入也。然虽非正治，存之以备一格耳。
又云∶从侄经千，年三十，出疹，初热时心中烦躁，腹内疼热，甚为剥床。彼因问三豆汤可服乎？余曰∶
可急煎服。于是心腹烦热乃解，苗不出现，人事晕眩，咳逆喘促，鼻靥煽动。详察其证，知其为热毒壅塞于肺，
肺壅则津液不行，肌窍不开，苗故不见。因用黄芩以清里热，阿胶、麦冬以润肺燥，桔梗开提肺气，柴、葛、
万密斋治疗医案记载：甘大文跟随我学习医术，他的长子出现发热症状。我诊察后说：“这是痧疹（一种出疹性传染病）。如果在三天内疹子没有透发出来，身体表面变凉但体内发热，说明毒火潜伏在体内，所以孩子感到烦躁、坐立不安。如果不及时救治会有生命危险。”甘大文哭着请求医治。我便使用葛根汤加入麻黄、石膏来发散邪气，服用一剂药后，疹子全部透出，颜色发白而不红。我说：“这是因为血虚所致。”于是使用四物汤加入防风，服用一剂后疹色变红，随即痊愈。
又记载：吴道松四肢患有疹病，经过三天治疗，疹子仍未透出，烦躁非常严重，有人想用荆防败毒散。我说：“这些都是发热的药物，没有解毒的功效，况且天气大热，方中又没有一两味顺应时令的药物，这样会导致阳气更盛，阴液更亏，阳明经不和，这就是疹子不能透出的原因。”我用东垣的凉膈散加入玄参、升麻，服用一剂后疹子透出，三天后痊愈。
又记载：郧阳杨举人的儿子，在出疹后出现下痢鲜血的症状。我传授给他一个方子，使用当归梢、生地黄、白芍药、炒黄芩、炒黄连、人参、生甘草、枳壳、乌梅肉进行调理，病情安定。当时郡中流行疹病，凡是患痢疾便血的，杨公传授此方，都有效验。
又记载：同郡周小川，其族中一个小女孩出疹后咳嗽失声。我传授给她一个方子，以甘桔汤加入炒牛蒡子、炒枯黄芩、天花粉制成散剂，用薄荷叶汤调服，再煎煮一沸，服用后痊愈。
孙东宿治疗医案记载：万历甲戌年，从仲秋到冬天，疹病盛行。三个月内，我治疗的男女婴孩共七十二人。苕溪一带的望族沈家最为著名。大中丞观颐公在担任考功员外郎时，他的小儿子气喘咳嗽不得安宁，声音嘶哑发热，伴有泄泻，斑疹紫暗且不收敛。我使用小无比散治好了他。
又记载：程晓山中风，回家后让我诊脉。当时他的儿子才七岁，患疹病已有一个多月，仍然发热，咳嗽声音嘶哑，肌肉消瘦骨瘦如柴，头发全部脱落，众医生束手无策，全家也只能流泪而已。我诊脉后，晓山看见我说：“全家惊慌，认为这孩子保不住了吧？”我说：“这是疳证，疳证是因为出疹后虚热引发的，使用大芦荟丸治疗，可以完全治愈。”程家起初不问我，是认为我不是儿科专家。却不知道这不过是大方家（擅长内科的大夫）的余事，让他们制药服用，药还没吃完病就好了。
江应宿治疗医案记载：一个三岁儿童，患疹病出得迟缓且过早隐没，发热并咳嗽，神志昏闷不想进食。我诊视后说：“疹子出不透彻，是因为风寒导致疹毒过早隐没，应当紧急发散。用葱白煮麻黄八分，四物汤换用生地黄，加入杏仁、天花粉、葱、姜，煎服。重新透发出一身汗，比之前更多，三天后疹毒排尽而痊愈。凡疹证出自六腑，应当养阴抑阳，刚燥的药物绝对不可服用。如果误服就会引发气喘、口渴、胸闷烦乱，失去抢救时机，多导致夭折。像人参、附子、半夏、白术、当归这些温燥的药物，也应当禁忌。只宜清热养血。如果出疹迟缓者，可少量加入升散的药物送之，目的是达表而已。”
又记载：表侄女九岁，出疹过早隐没，引发咳嗽，高热，肌肉消瘦，不吃东西，呕吐痰沫很多，拖延了半个月多。我去看她后说：“这是血虚病。”使用四物汤加入杏仁、阿胶、麦冬、五味子、炮姜，服用一剂后热退身凉，痰咳俱止，再服两剂而痊愈。
方荫山治疗医案记载：程氏子两岁，出疹因为出得迟缓且过早隐没，引发气喘高热，舌短不能吸乳，昏沉，医生都不治。我用玄参、茯苓、甘草、麦冬、升麻、陈皮、干葛、麻黄、兜铃、黄芩、知母、犀角、石膏，名为犀角石膏汤，服用一剂后症状减半，服用两剂后痊愈。
《太函集》记载：吴桥以医术闻名于乡里，他有哥哥的儿子刚开始还是婴儿时，连续几天发热蒸腾，惊厥抽搐昏迷，众医生不知如何处置。吴桥诊察后说：“这是疹病，寒邪外袭，闭塞而不能透出，就像呱呱啼哭的婴儿一样。喝药已经几次，中气已经受伤，药物不足以依赖。应当放置一瓶沸水，去掉盖子，让保姆抱着孩子坐在离水瓶稍远的地方，摊开被子围住，热水蒸气从远处熏蒸，同时少量饮用具有内托作用的药物，疹子透出而病解。不久，丛睦汪家的儿子患病也是如此，仍用上述方法，也有效。他的稳妥类似如此，所以乡人称他为良医。”
缪希雍治疗医案记载：贺知忍的小儿子患痧疹，家人不知道，还用肉饭喂他。我恰好到了，惊讶地说：“这是极其严重的痧疹，怎么能轻视它呢？”我用西河柳二两，杂以玄参三钱，知母五钱，贝母三钱，麦门冬二两，石膏一两半，竹叶七十片，服用两剂后痧疹透尽。现在遍体皆赤，继续连进四剂，到了傍晚。知忍问：“孩子现在没事了吗？”我说：“痧虽然出尽了，但烦躁不止，还不能保证安全。”再用石膏三两，知母一两，麦门冬三两，加黄芩、黄连、黄柏各五钱，西河柳一两，竹叶二百片，浓煎饮之，烦躁遂定而痊愈。
霖按语：缪氏使用如此大量的西河柳。难道不担心其温升太过吗？每次使用都用石膏来监制，大概也就是张仲景麻黄、石膏同用的意思。虽然如此，遇到禀赋怯弱的儿童，是很危险的。
朱济川治疗医案记载：一个儿童正月发疹，身体四肢隐约可见精神不振，而头面部不出疹，面色青白，气喘腹胀胸闷烦乱，右寸脉微弱。我认为正气虚弱不能驱赶邪气上升到头面，应当以补益和助升发为主，使用麻黄桂枝汤加入人参二钱，水煎服。又以芫荽、防风煎汤，洗浴洗头面手足，疹子透发症状平息而痊愈。
又记载：一个儿童疹子正在发出时恣意饮食导致停滞，腹部饱胀便秘，高热谵语。我认为食积壅塞导致毒邪不能化解，使用大黄、枳实、栝蒌仁、厚朴、甘草、黄连利下，但仍然气喘咳嗽高热，脉迟肢冷，使用附子理中汤，后又用归芍六君子汤治疗而愈。
又记载：一个儿童身体发热咳嗽，疹子隐隐约约，医生用疹药发散，不见透出也不见隐没。我认为这是隐疹，由客受风寒，郁结不散，不像中腑的正疹那样。使用芎苏散治疗而愈。
又记载：一个儿童疹子出得非常旺盛，形状如锦纹，中间有头粒色赤，高热烦躁，舌苔厚，便秘。我认为斑疹并行，使用调胃承气汤利下，又用白虎汤合葛根汤治疗而愈。
又记载：一个儿童身体发热出疹并吐泻，我认为初出疹而吐泻，是阳火得以宣泄，是吉兆。使用升麻葛根汤解表，疹子透尽而愈。也有兼伤食吐利的，前方加消化药物。
又记载：一个女孩出疹，用药寒凉，又吃生梨，一两天疹子即殒没，气喘急促胸满，面色青四肢冷，眼合声哑，昏晕。我认为毒为寒邪郁闭，反致毒邪内攻所致。使用麻黄汤加葛根、紫苏、甘草、桔梗、生姜服用，外部用被子覆盖，得汗而苏醒。疹子再次复出，气喘比之前更甚。我认为骤然使用麻黄这种燥烈药物，导致毒火盛而肺气热，应当清润，使用甘草、桔梗、牛蒡、前胡、杏仁、玄参、知母、天花粉、黄芩、麦门冬治疗喘息而愈。
又记载：一个孕妇出疹热势很盛，堕胎且难产。我用鱼胶三寸烧灰存性，麝香一分，共研末，好酒调下，立即生产。如果难产非常严重，以及横位分娩，用鱼胶一尺，制作如前法，虽然能立即生产，但孩子不能存活。
又记载：一个孕妇出疹热势很盛，小腹痛且漏血。我认为热盛触动胎气，使用升麻葛根汤加荆芥、紫苏、黄芩、当归、川芎、阿胶、白术、陈皮、砂仁治疗，血止而愈。也有不按前面方法治疗，胎堕而母子俱亡，或子亡母存的。
又记载：一个儿童疹子虽已尽出，但气喘腹胀便秘，高热谵语。我认为毒邪壅滞未尽出，使用黄连、枳实、栝蒌仁、桑白皮、地骨皮、知母、石膏、人中黄治疗而愈。
又记载：一个儿童出疹后咽喉肿痛，我认为余毒未解，使用甘桔汤加牛蒡、射干、玄参、连翘、知母治疗，又用葛槿散吹之而愈。
又记载：一个儿子新婚出疹后，痰嗽不已。众人认为是余毒不尽，用清解药而痰更炽盛。我认为阴亏而火炎无制，所以午后潮热而咳甚。治疗应当以壮水为主，使用六味地黄丸料，加麦冬、知母治疗而愈。
又记载：一个儿童出疹后干咳断续，我认为医生过度发散，导致肺气虚耗，使用小异功散加麦门冬、五味子、贝母、桔梗治疗而愈。
又记载：一个儿童出疹后患走马牙疳，牙龈溃烂穿鼻，众医无效，我用黄牯牛粪后尖，瓦上煅存性，为末，人中白为末，黄柏为末，等分，和匀，吹之，溃窍渐长，龈齿俱生而愈。
又记载：一个儿童出疹后干咳不已，我认为疹时过于解散，肺气虚耗，应当以补脾肺为主。不信，只用清火止嗽药，其背逐渐驼，腿足细小，终身痼疾。也有咳嗽久而胸高肿满，状如龟胸。启云先生说：“疹后久嗽则金衰，金衰不能生肾水，肾主骨髓，肾无生气，则骨枯而髓减，风寒乘虚而入于髓，其邪凝滞，故腰脊不举而为斯疾也。”治法先以防风散驱其邪，又用八味地黄丸加人参、杜仲、牛膝、当归、石斛、何首乌、米仁、菟丝子、萆薢、鹿茸蜜丸，又以驱风壮筋活血膏贴其凸处，又灸肺俞穴、膈俞穴。一个儿童患此病，我诊右脉缓弱，认为脾肺不足，先用人参、白术、茯苓、陈皮、甘草、贝母、当归、芍药、米仁、石斛，水煎服，脾土稍固，又以前方法治疗，腿足渐而生肉，背驼稍愈，但不能脱然如故。
沈明生治疗医案记载：沈翰臣的妻子咳嗽发热，有人认为是不足，遽用六味地黄汤以滋阴分，既而咳逆更剧。诊之脉浮且数，风热干乎肺家，宜用疏表之剂，服下遍身发出红疹。二剂咳差缓而仍未透，更用辛凉等味，以清表热，仍嗽，复作泻不已，咸归咎寒凉。我笑曰：“非也，肺受风邪，邪变为热。经云：‘邪并于阳，则阳热而阴虚。’始则疹在欲出未出之际，火上炎于手太阴而作嗽；今则疹在欲收未收之时，热下移于手阳明而作泻。是属斑疹家常候，何足怪乎？行且止矣。”果越两日而嗽宁泻止，身凉疹退。按斑疹之候虽异，斑疹之治略同。是岁丁未，湿土司天，而春夏之交，燥旱殊甚，盖犹袭乎昨岁燥金在泉之余气耳。是以初当凉解而不利乎温散，次当寒润而不利于温补。六味地黄丸之属，虽若相宜，然质独味浓，不惟不能达表，抑且锢蔽外邪，施诸疹退而余热未清之时，稍为近理。今初热始嗽，辄为用之，是非滋阴乃滋害也。况以丸为汤，已非古人本意，而专投泛用，尤乖病变之机。自来善用六味者无过薛立斋，假使九泉有知，视近日之汤法盛行，能无掩口胡卢哉。
柴屿青治疗医案记载：候补官员汪某二十多岁，因感时气出疹，过服石膏等剂，身热泄泻，两耳皆聋，绝不思食，脉之两尺微弱，舌上干燥，毫无津液。本属阴亏，况大寒之剂，不但伤阳，亦且伤阴。用麦冬五钱，滋阴以清虚热，陈皮以和胃气，加西河柳一钱，以清疹毒。次日热微泻止，舌亦觉润，惟左寸脉微洪，加小生地二钱，木通一钱，菊叶一钱，三日热退思食。因是月应选，身软耳聋，虑不能过堂掣签。谓已平复十九日，当投补剂，定可全愈。后果如言，竟得赴选。
冯楚瞻治疗医案记载：沈氏儿发热数日，见痧疹才一日，面上尽没，神气困极，蛔从口出，不一而足，数日不食，下泻上喘，唇口焦裂，五心壮热，手足指尖皆冷，脉细数无伦，两尺更弱，咸谓疹毒归脏，胃热故蛔连出也。不知神气欲脱，五脏俱困，脾虚不能纳谷，虫无所食，又兼虚火熏蒸，脏腑燥热，虫不安而出耳。况诸斑疹多由内伤失调，脾胃不足以荣，是以阳气逆行，阴覆于外。血盛气壮，则色红而发；血虚气弱，则色白而隐伏。有何毒之轻重乎？面上退缩者，阳虚不能升发也；喘促者，气唯续也；唇焦者，脾津耗竭也；五心壮热者，阴亏火烁也；泄泻不食者，真火衰而脾不运也；寸关细数尺弱者，气虚血虚，虚火上浮而不藏也。急则治标，缓则治本。今者之急，本气欲脱也。倘谓痧疹余毒，解利清托，恐神气先尽矣。乃以熟地六钱，丹皮一钱，麦冬三钱，牛膝二钱，制附六分，一剂假热全消，真虚毕露，神气更倦。此阴已少复，当补气以助其发生，前方另煎人参二钱冲服，神气渐复，喘促全安。饮粥微呕，乃胃气久虚之故也。再用前方加炒黄白术二钱，去丹皮，仍以参汤冲服，四剂全愈。
吕用晦治疗医案记载：姚江钱都子五岁，病疹泄泻，儿医谓疹毒，最宜于泻，不复顾忌，以清火为急，寒凉纵进，病势殊剧，来邀余。视面色两颧嫩红，时切牙喘急，口渴甚，饮水不绝，脉洪缓如平壮人。余曰：“脾急矣。”速投人参、白术、当归、黄芪、陈皮、甘草、茯苓、木香以救之，一剂觉安。次日有邻族人来候，惊阻之曰：“误矣！小儿有专门，岂可令腐儒治之。吾所闻疹病以发散清凉解毒为主，今半身疹潮未退，而用温补，必不救矣。”其家惧，遂不敢再服。间二日，钱都复来见余曰：“诸证复如故，如何？”余曰：“岂有是理哉？君戏我耳。”曰：“日来实不服尊剂。”乃述其故。余曰：“君试急归，令郎天柱倒矣。”别去顷之，驰至曰：“果如公言，奈何？”急服前方何如？余曰：“前方救虚也。今加寒矣，非桂附不能挽也。”曰：“颧红喘急，口渴饮水，俱是热证，而公独言虚寒何也？”曰：“阴竭于内，阳散于外，而寒凉复逼之，阳无所归，内真寒而外假热。此立斋先生所发《内经》微旨，非深究精蕴者不能信也。”钱都归，违众服之，一剂而天柱直，二剂而喘渴止，三剂起行，嬉戏户外。
舒驰远治疗医案记载：老庚者，年二十有七，夏月出疹，头身微热，苗色淡红，咽喉痛甚，时医误用柴、葛、牛子、甘、桔等药，转加作泄，大泄数次，疹顿沉没，咽喉转闭，口不能言，人事恍惚，晕眩欲绝。时天有在坐，余谓天有曰：“此证全是一团阴寒在里，若用疹家通套药，必不可生。”天有曰：“何以言之？”余曰：“若内实有火，苗当紫赤，何得淡红。且咽喉虽痛而不赤肿，又无烦渴恶热等症，明明肾脏虚寒，阴火上攻也。且阳和布令，百体顺昌。痧疹属阳，必纯阳始得出透。见点之时，如萌芽初吐，遇阴惨肃杀之气，摧残所生，靡有孑遗。今值此阴邪横发，埋没真阳，而疹不沉没者，几希矣。惟是陡进附子、干姜、半夏、甘草、白术、茯苓、肉桂、黄芪，温补兼行，以驱阴回阳，俾驳劣悉返冲和，乃得功收再造。危乎，微乎！”
霖按语：此三案大同小异，要是千百中一二，未可执为程法也。大抵痧疹之发，干诸肺胃，治之但宜松透，一切温燥补涩之剂，不可入也。然虽非正治，存之以备一格耳。
又记载：从侄经千，年三十，出疹，初热时心中烦躁，腹内疼热，甚为剥床。彼因问三豆汤可服乎？余曰：“可急煎服。”于是心腹烦热乃解，苗不出现，人事晕眩，咳逆喘促，鼻靥煽动。详察其证，知其为热毒壅塞于肺，肺壅则津液不行，肌窍不开，苗故不见。因用黄芩以清里热，阿胶、麦冬以润肺燥，桔梗开提肺气，柴、葛……
Wan Mizhai's Medical Case Record: Gan Dawen studied medicine under me. His eldest son developed a fever. Upon examination, I said, "This is sha zhen (a rash-causing infectious disease). If the rash does not erupt within three days, the body surface becomes cool while internal heat persists, indicating that toxic fire is latent inside. This causes irritability and restlessness. Immediate treatment is necessary, otherwise it will be critical." Gan Dawen wept and begged for treatment. I prescribed Gegen Tang (Pueraria Decoction) with added Mahuang (Ephedrae Herba) and Shigao (Gypsum Fibrosum) to disperse the pathogen. After one dose, the rash fully erupted but appeared white rather than red. I stated, "This indicates blood deficiency." I then prescribed Siwu Tang (Four Substances Decoction) with Fangfeng (Saposhnikoviae Radix). After one dose, the rash color turned red, and the patient recovered.
Another record states: Wu Daosong suffered from limb rashes. After three days of treatment, the rash had not erupted, and he was extremely irritable. Someone suggested using Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Overcome Toxicity). I said, "These are all heating herbs without detoxifying properties. Moreover, given the intense summer heat, the formula lacks herbs to harmonize the season. This will exacerbate Yang excess and Yin deficiency, leading to disharmony in the Yangming channel, which is why the rash fails to erupt." I used Liangge San (Cooling Chest Powder) by Dongyuan with added Xuanshen (Scrophulariae Radix) and Shengma (Cimicifugae Rhizoma). After one dose, the rash erupted, and the patient recovered in three days.
Another record states: The son of Scholar Yang from Yunyang experienced bloody diarrhea after the rash. I provided a prescription containing Danggui Shao (Tip of Angelica Sinensis Root), Shengdihuang (Rehmanniae Radix Recens), Baishao (White Peony Root), Chao Huangqin (Fried Scutellariae Radix), Chao Huanglian (Fried Coptidis Rhizoma), Renshen (Ginseng Radix et Rhizoma), Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma), Zhike (Aurantii Fructus Immaturus), and Wumei Rou (Mume Fructus Flesh). The condition stabilized. During the local outbreak of rash, this prescription proved effective for patients with bloody dysentery associated with the rash.
Another record states: A young girl from the Zhou family in the same county developed cough and loss of voice after the rash. I prescribed Ganjie Tang (Licorice and Platycodon Decoction) with Chao Niubangzi (Fried Arctii Fructus), Chao Kuhuqin (Fried Scutellariae Radix), and Tianhuafen (Trichosanthis Radix) made into a powder. It was taken with Boheye Tang (Menthae Haplocalycis Decoction), boiled once more, and the patient recovered.
Sunongsu's Medical Case Record: In the Jiaxu year of the Wanli era, from mid-autumn to winter, rash diseases were prevalent. Within three months, I treated 72 children and adults. The Shen family, a prominent clan in Tiao Creek, was notable. When Guan Yi Gong, a Grand Secretary serving as an Official of Evaluations, had his young son suffering from wheezing, coughing, hoarseness, fever, diarrhea, and purple, non-resolving macules, I cured him using Xiaowubi San (Small Five-Immortal Powder).
Another record states: Cheng Xiaoshan suffered a stroke and asked me to examine him. His seven-year-old son had had the rash for over a month, still febrile, with cough, hoarseness, emaciation, and total hair loss. Doctors were helpless, and the family wept. I examined the child. Xiaoshan said, "The family is panicked, thinking the child cannot survive." I replied, "This is Gan syndrome (malnutrition syndrome), triggered by post-rash deficient heat. Daluwei Wan (Large Aloe Pill) will cure him completely." The Cheng family initially doubted me, believing I was not a pediatric specialist, unaware that this was merely a supplementary skill for general practitioners. They prepared the medicine, and the child recovered before finishing the course.
Jiang Yingsu's Medical Case Record: A three-year-old boy had delayed and prematurely resolved rash, accompanied by fever, cough, lethargy, and anorexia. I diagnosed incomplete eruption due to early suppression by wind-cold. I urgently prescribed Ma Huang (Ephedrae Herba) boiled with Congbai (Allii Fistulosi Bulbus) at 8 fen, modified Siwu Tang (Four Substances Decoction) replacing Shudi with Shengdihuang, adding Xingren (Armeniacae Semen Amarum), Tianhuafen (Trichosanthis Radix), Congbai, and Jiang (Zingiberis Rhizoma). After taking it, the rash re-erupted profusely, and the patient recovered in three days. Generally, rashes originating from the Fu organs require nourishing Yin and suppressing Yang; harsh/drying medicines must be avoided. Misuse leads to asthma, thirst, and delirium, often causing death. Warming-drying herbs like Renshen (Ginseng Radix et Rhizoma), Fuzi (Aconiti Lateralis Radix Preparata), Banxia (Pinelliae Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), and Danggui (Angelicae Sinensis Radix) are contraindicated. Only clearing heat and nourishing blood is appropriate. For delayed eruption, slight dispersing agents may be added to reach the exterior.
Another record states: My cousin's nine-year-old daughter had premature resolution of rash, leading to cough, high fever, emaciation, anorexia, and excessive vomiting of phlegm for over half a month. I diagnosed blood deficiency and prescribed Siwu Tang (Four Substances Decoction) with Xingren (Armeniacae Semen Amarum), Ejiao (Colla Corii Asini), Maidong (Ophiopogonis Radix), Wuweizi (Schisandrae Chinensis Fructus), and Paojiang (Prepared Zingiberis Rhizoma). One dose stopped fever and cooled the body; two doses cured the cough and phlegm.
Fang Yinshan's Medical Case Record: A two-year-old son of the Cheng family had delayed and prematurely resolved rash, resulting in asthma, high fever, short tongue, inability to nurse, and lethargy. Doctors gave up. I used Xuanshen (Scrophulariae Radix), Fuling (Poria), Gancao (Glycyrrhizae Radix et Rhizoma), Maidong (Ophiopogonis Radix), Shengma (Cimicifugae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Gegen (Puerariae Lobatae Radix), Mahuang (Ephedrae Herba), Dailing (Stemonae Radix), Huangqin (Scutellariae Radix), Zhimu (Anemarrhenae Rhizoma), Xijiao (Rhinocerotis Cornu - *Note: Substitute with Buffalo Horn in modern practice*), and Shigao (Gypsum Fibrosum), named Xijiao Shigao Tang (Rhino Horn and Gypsum Decoction). Symptoms halved after one dose; cured after two.
Taihan Ji records: Wu Qiao was known for his medical skills in his hometown. His brother's infant son had persistent steaming fever, convulsions, and coma. Doctors were baffled. Wu Qiao diagnosed rash suppressed by cold pathogens. He noted that previous medications had damaged the Middle Qi. Instead of relying solely on herbs, he placed a bottle of boiling water nearby, removed the lid, and had the nurse hold the child near it, covered with blankets, allowing steam to fumigate the child gently while administering mild internal-supporting herbs. The rash erupted, and the illness resolved. A similar case in the Wang family responded to the same method. His prudence earned him respect as a good doctor.
Miao Xiyong's Medical Case Record: He Zhiren's youngest son suffered severe sha zhen. Unaware, the family fed him meat. Upon arrival, I exclaimed, "This is extremely severe sha zhen! How can it be underestimated?" I prescribed Xihe Liu (Tamarici Cacumen) 2 liang, mixed with Xuanshen (Scrophulariae Radix) 3 qian, Zhimu (Anemarrhenae Rhizoma) 5 qian, Beimu (Fritillariae Cirrhosae Bulbus) 3 qian, Maimendong (Ophiopogonis Radix) 2 liang, Shigao (Gypsum Fibrosum) 1.5 liang, and Zhu Ye (Bambusae Folium) 70 pieces. After two doses, the rash fully erupted, turning the body red. I continued with four doses. By evening, Zhiren asked if the child was safe. I replied, "Although the rash has erupted, persistent irritability remains; safety is not guaranteed." I prescribed Shigao (Gypsum Fibrosum) 3 liang, Zhimu (Anemarrhenae Rhizoma) 1 liang, Maimendong (Ophiopogonis Radix) 3 liang, plus Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Huangbai (Phellodendri Cortex) 5 qian each, Xihe Liu (Tamarici Cacumen) 1 liang, and Zhu Ye (Bambusae Folium) 200 pieces, decocted strongly. Irritability ceased, and the child recovered.
Lin's Commentary: Miao used such a large amount of Xihe Liu. Is there no concern about excessive warming and ascending? He always uses Shigao (Gypsum Fibrosum) to control it, likely following Zhang Zhongjing's principle of combining Mahuang (Ephedrae Herba) and Shigao (Gypsum Fibrosum). However, for children with weak constitutions, this is dangerous.
Zhu Jichuan's Medical Case Record: A child had rash in the first lunar month. The body showed faint signs of weakness, with no rash on the head or face, pale-blue complexion, asthma, distension, and confusion. The right Cun pulse was faint. I reasoned that deficient Zheng Qi could not drive pathogens upward to the head and face. Treatment should focus on tonifying and assisting ascent. I prescribed Mahuang Guizhi Tang (Ephedra and Cinnamon Twig Decoction) with Renshen (Ginseng Radix et Rhizoma) 2 qian, decocted in water. Additionally, I washed the head, face, hands, and feet with a decoction of Yuanscong (Coriandri Fructus) and Fangfeng (Saposhnikoviae Radix). The rash penetrated, symptoms subsided, and the child recovered.
Another record states: A child ate excessively during rash eruption, causing food stagnation, abdominal fullness, constipation, high fever, and delirium. I attributed this to food obstruction preventing toxin resolution. I used Dahuang (Rhei Radix et Rhizoma), Zhishi (Aurantii Fructus Immaturus), Gualou Ren (Trichosanthis Semen), Houpo (Magnoliae Officinalis Cortex), Gancao (Glycyrrhizae Radix et Rhizoma), and Huanglian (Coptidis Rhizoma) to purge. However, asthma, cough, high fever, slow pulse, and cold limbs persisted. I then used Fuzi Lizhong Tang (Aconite Decoction to Warm the Middle) followed by Guishao Liujunzi Tang (Angelica and Peony Six-Gentlemen Decoction) to cure.
Another record states: A child had fever and cough with faint rash. Doctors used rash-dispersing herbs, but the rash neither emerged nor resolved. I diagnosed hidden rash caused by external wind-cold stagnation, distinct from typical Fu organ rash. I cured it with Xiong Su San (Ligusticum and Perilla Powder).
Another record states: A child had abundant rash resembling brocade patterns, with some red papules, high fever, irritability, thick tongue coating, and constipation. I diagnosed simultaneous macules and rash. I used Tiaowei Chengqi Tang (Regulating the Stomach and Purging Down Decoction) to purge, followed by Baihu Tang (White Tiger Decoction) combined with Gegen Tang (Pueraria Decoction) to cure.
Another record states: A child had fever, rash, vomiting, and diarrhea. I considered initial vomiting and diarrhea during rash eruption as a sign of Yang fire venting, which is auspicious. I used Shengma Gegen Tang (Cimicifuga and Pueraria Decoction) to release the exterior. The rash fully penetrated, and the child recovered. If accompanied by food injury, digestive herbs are added to the above formula.
Another record states: A girl took cold-natured herbs and ate raw pears, causing the rash to vanish quickly. She developed rapid breathing, chest fullness, blue face, cold limbs, closed eyes, hoarseness, and fainting. I diagnosed toxin suppressed by cold, forcing inward attack. I prescribed Mahuang Tang (Ephedra Decoction) with Gegen (Puerariae Lobatae Radix), Zisu (Perillae Folium), Gancao (Glycyrrhizae Radix et Rhizoma), Jiegeng (Platycodonis Radix), and Shengjiang (Zingiberis Rhizoma Recens). Covered with blankets, she sweated and regained consciousness. The rash re-emerged with worse asthma. I reasoned that sudden use of drying/hot Mahuang (Ephedrae Herba) exacerbated toxic fire and lung heat. I prescribed moistening/clearing herbs: Gancao (Glycyrrhizae Radix et Rhizoma), Jiegeng (Platycodonis Radix), Niubangzi (Arctii Fructus), Qianhu (Peucedani Radix), Xingren (Armeniacae Semen Amarum), Xuanshen (Scrophulariae Radix), Zhimu (Anemarrhenae Rhizoma), Tianhuafen (Trichosanthis Radix), Huangqin (Scutellariae Radix), and Maimendong (Ophiopogonis Radix) to cure the asthma.
Another record states: A pregnant woman had severe fever with rash, leading to miscarriage and difficult labor. I burned 3 cun of Yujiao (Fish Maw/Collagen) to ash, mixed with 1 fen of Muxiang (Moschus), powdered it, and administered with fine wine. Delivery occurred immediately. For severe dystocia or breech presentation, 1 chi of Yujiao (Fish Maw/Collagen) prepared similarly allows immediate delivery, though the fetus may not survive.
Another record states: A pregnant woman had severe fever with rash, lower abdominal pain, and bleeding. I attributed this to heat disturbing the fetus. I prescribed Shengma Gegen Tang (Cimicifuga and Pueraria Decoction) with Jingjie (Schizonepetae Spica), Zisu (Perillae Folium), Huangqin (Scutellariae Radix), Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Ejiao (Colla Corii Asini), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), and Sharen (Amomi Fructus). Bleeding stopped, and the condition resolved. Failure to treat this way could result in fetal loss and death of mother and child, or death of the child only.
Another record states: A child had fully erupted rash but suffered asthma, distension, constipation, high fever, and delirium. I diagnosed incomplete toxin expulsion. I used Huanglian (Coptidis Rhizoma), Zhishi (Aurantii Fructus Immaturus), Gualou Ren (Trichosanthis Semen), Sangbaipi (Mori Cortex), Digupi (Lycii Cortex), Zhimu (Anemarrhenae Rhizoma), Shigao (Gypsum Fibrosum), and Renzhonghuang (Human Excrement Yellow) to cure.
Another record states: A child had sore throat and swelling after rash. I diagnosed residual toxins. I used Ganjie Tang (Licorice and Platycodon Decoction) with Niubangzi (Arctii Fructus), Shegan (Belamcandae Rhizoma), Xuanshen (Scrophulariae Radix), Lianqiao (Forsythiae Fructus), and Zhimu (Anemarrhenae Rhizoma). Additionally, Gejin San (Kudzu and Hibiscus Powder) was insufflated into the throat to cure.
Another record states: A son had persistent phlegm-cough after rash following his wedding. Others attributed it to residual toxins and used clearing/resolving herbs, worsening the phlegm. I diagnosed Yin deficiency with uncontrolled Fire, causing afternoon tidal fever and severe cough. Treatment focused on nourishing Water (Yin). I used Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) base with Maidong (Ophiopogonis Radix) and Zhimu (Anemarrhenae Rhizoma) to cure.
Another record states: A child had intermittent dry cough after rash. I diagnosed Lung Qi deficiency due to excessive dispersing by previous doctors. I used Xiaoyigong San (Minor Extraordinary Assistance Powder) with Maimendong (Ophiopogonis Radix), Wuweizi (Schisandrae Chinensis Fructus), Beimu (Fritillariae Cirrhosae Bulbus), and Jiegeng (Platycodonis Radix) to cure.
Another record states: A child developed Gangrenous Mouth Ulcers (Zouma Yagan) after rash, with gum ulceration penetrating the nose. Previous treatments failed. I used dried cow dung tip, calcined on a tile, powdered, mixed with Renzhongbai (Calcinatus Natrii Carbonas) powder and Huangbai (Phellodendri Cortex) powder in equal parts, and insufflated it. The ulcers healed, gums regenerated, and the child recovered.
Another record states: A child had persistent dry cough after rash. I diagnosed Lung Qi deficiency from excessive dispersion during the rash phase, recommending Spleen and Lung tonification. Ignoring this, they used only cooling/cough-suppressing herbs. The child developed a hunched back and thin legs, a lifelong disability. Some develop pigeon chest from chronic cough. Mr. Qiyun stated: "Chronic cough after rash depletes Metal (Lung); Metal depletion fails to generate Kidney Water. The Kidneys govern marrow; without vital energy, bones wither and marrow diminishes. Wind-cold enters the marrow, stagnates, and causes spinal immobility." Treatment first uses Fengsang San (Wind-Expelling Powder) to dispel pathogens, then Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) with Renshen (Ginseng Radix et Rhizoma), Duzhong (Eucommiae Cortex), Niuxi (Achyranthis Bidentatae Radix), Danggui (Angelicae Sinensis Radix), Shihu (Dendrobii Caulis), Heshouwu (Polygoni Multiflori Radix), Yimi (Coicis Semen), Tusizi (Cuscutae Semen), and Bibai (Dioscoreae Hypoglaucae Rhizoma), formed into honey pills with Lurong (Cervi Cornu Pantotrichum). Fengzhuang Jin Huoxue Gao (Wind-Dispersing, Tendon-Strengthening, Blood-Invigorating Plaster) is applied to convexities. Feishu (BL13) and Geshu (BL17) acupoints are moxa-ed. For a child with this condition and weak/soft Right pulses, indicating Spleen/Lung deficiency, I first used Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Beimu (Fritillariae Cirrhosae Bulbus), Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix Alba), Yimi (Coicis Semen), and Shihu (Dendrobii Caulis) decocted. Once Spleen Earth stabilized, I used the previous methods. Legs gained flesh, back curvature improved slightly, but full recovery was not achieved.
Shen Mingsheng's Medical Case Record: Shen Hanchen's wife had cough and fever. Mistakenly diagnosed as deficiency, Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) was used to nourish Yin, worsening the cough. Pulse was floating and rapid; Wind-Heat invaded the Lungs. I prescribed exterior-releasing herbs. Red rash erupted all over the body. After two doses, cough eased but rash remained untransmitted. I added Acrid-Cool herbs to clear exterior heat. Cough persisted, followed by diarrhea. Others blamed Cold-Clear herbs. I laughed, "Incorrect. Lung affected by Wind transforms into Heat. The Classic says: 'When pathogens combine with Yang, Yang becomes hot and Yin becomes deficient.' Initially, rash was about to erupt; Fire flared up the Hand-Taiyin channel causing cough. Now, rash is about to recede; Heat moves down the Hand-Yangming channel causing diarrhea. This is common in macule/rash cases. It will stop soon." Indeed, after two days, cough and diarrhea ceased, body cooled, and rash faded. Although manifestations differ, treatment principles are similar. In the Dingwei year, Wet Earth governed the Heaven, causing extreme drought in spring/summer, lingering from the previous year's Dry Metal. Thus, initial treatment requires Cooling-Resolving, not Warming-Dispersing; subsequent treatment requires Cold-Moistening, not Warming-Tonifying. Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) seems suitable but is rich/heavy, failing to reach the exterior and trapping pathogens. It is only reasonable when residual heat lingers after rash fades. Using it at the onset of fever/cough is nourishing harm, not Yin. Converting pills to decoctions deviates from ancient intent. Blind application ignores pathological changes. Even Xue Lizhai, master of Liuwei, would sigh if he saw modern misuse.
Chai Yuqing's Medical Case Record: Candidate Wang, 20s, contracted seasonal qi and developed rash. Overuse of Shigao (Gypsum Fibrosum) caused fever, diarrhea, deafness, anorexia, weak Chi pulses, and dry tongue. Originally Yin deficiency, aggravated by Cold herbs damaging both Yang and Yin. I used Maidong (Ophiopogonis Radix) 5 qian to nourish Yin and clear deficient heat, Chenpi (Citri Reticulatae Pericarpium) to harmonize Stomach Qi, and Xihe Liu (Tamarici Cacumen) 1 qian to clear rash toxin. Next day, fever subsided, diarrhea stopped, tongue moistened. Left Cun pulse became slightly surging; I added Xiaoshengdi (Rehmanniae Radix) 2 qian, Mutong (Akebiae Caulis) 1 qian, and Juye (Chrysanthemi Indici Folium) 1 qian. Fever resolved, appetite returned in three days. Concerned about failing the selection exam due to weakness/deafness, I waited until day 19 of recovery to prescribe tonics. He recovered fully and passed the exam.
Feng Chuzhan's Medical Case Record: Shen's son had fever for days. Rash appeared for one day, then vanished from the face. Spirit was exhausted, roundworms vomited, anorexia for days, diarrhea below, asthma above, cracked lips/mouth, five-center high fever, cold fingertips, fine/rapid pulse without order, weaker Chi pulses. Others thought rash toxin entered organs and Stomach heat caused worms. I knew spirit was collapsing, five Zang were distressed, Spleen deficiency prevented grain intake, worms starved, and deficient Fire steamed organs, causing worms to exit. Most rashes stem from internal injury and Spleen/Stomach weakness. Yang rebels, Yin covers the exterior. Strong Blood/Qi yields red rash; Weak Blood/QI yields white/faint rash. Where is the difference in toxicity? Facial retraction indicates Yang deficiency failing to ascend; Asthma indicates Qi exhaustion; Cracked lips indicate Spleen fluid depletion; Five-center fever indicates Yin deficiency with Fire scorching; Diarrhea/anorexia indicates True Fire decline and Spleen failure; Fine/rapid Cun/Guan and weak Chi indicate Qi/Blood deficiency with floating deficient Fire. Treat acute symptoms first, root later. Current urgency is collapsing Zheng Qi. Clearing toxins might exhaust spirit further. I used Shudi (Rehmanniae Radix Preparata) 6 qian, Danpi (Moutan Cortex) 1 qian, Maidong (Ophiopogonis Radix) 3 qian, Niuxi (Achyranthis Bidentatae Radix) 2 qian, and Zhi Fuzi (Prepared Aconiti Lateralis Radix) 6 fen. One dose eliminated false heat, revealing true deficiency; spirit grew more tired. Yin had slightly recovered; now tonify Qi to aid generation. Added Renshen (Ginseng Radix et Rhizoma) 2 qian decocted separately to the previous formula. Spirit gradually recovered, asthma resolved. Mild vomiting after drinking porridge indicated long-term Stomach Qi deficiency. I added Chao Huang Baizhu (Fried Atractylodis Macrocephalae Rhizoma) 2 qian, removed Danpi (Moutan Cortex), continued Renshen (Ginseng Radix et Rhizoma) decoction. Four doses cured.
Lv Yonghui's Medical Case Record: Qian Du's five-year-old son had rash with diarrhea. Pediatricians claimed toxins should be purged, prioritizing clearing Fire with Cold herbs, worsening the condition. I saw tender red cheeks, teeth grinding, rapid asthma, severe thirst, continuous drinking, and洪缓 (surging-slow) pulse like a healthy adult. I said, "Spleen is critical." Urgently prescribed Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), Huangqi (Astragali Membranacei Radix), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Fuling (Poria), and Muxiang (Aucklandiae Radix). One dose brought relief. Next day, neighbors warned against treating a child with "rotten scholar" herbs, claiming rash requires dispersing/cooling/detoxifying, and warming-tonics would fail. Family feared and stopped medication. Two days later, Qian Du returned, symptoms relapsed. I predicted "Heavenly Pillar has fallen" (severe collapse). He rushed back confirming my words. I advised taking the previous tonic. He asked why I called it Deficient-Cold when cheeks were red and thirst existed. I explained: "Yin exhausted internally, Yang scattered externally. Cold herbs forced Yang without refuge, creating Internal True Cold and External False Heat. This reveals the subtle meaning of the Neijing by Mr. Lizhai,可信 only to those who deeply investigate." Qian Du defied others, took the medicine. Heavenly Pill straightened in one dose; asthma/thirst stopped in two; walking/playing in three.
Shu Chi Yuan's Medical Case Record: Lao Geng, 27, had summer rash with slight head/body heat, pale-red spots, severe sore throat. Doctors mistakenly used Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix), Niubangzi (Arctii Fructus), Gancao (Glycyrrhizae Radix et Rhizoma), Jiegeng (Platycodonis Radix), causing diarrhea. After several episodes of severe diarrhea, rash sank/vanished, throat closed, mutism, confusion, near-fainting. Tian You was present. I told Tian You, "This is pure Yin-Cold inside. Standard rash drugs will kill him." Tian You asked why. I said, "If internal Fire existed, spots would be purple-red, not pale-red. Throat pain without redness/swelling, no thirst/aversion to heat, clearly indicates Kidney Deficient-Cold with Yin Fire attacking. Yang harmony ensures health. Rash is Yang; only Pure Yang allows eruption. At appearance, like sprouts, encountering Yin/Killing Qi destroys them. With rampant Yin Evil burying True Yang, survival is rare. We must abruptly administer Fuzi (Aconiti Lateralis Radix Preparata), Ganjiang (Zingiberis Rhizoma), Banxia (Pinelliae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Rougui (Cinnamomi Cortex), and Huangqi (Astragali Membranacei Radix) to warm-tonify, expel Yin, restore Yang, and return chaos to harmony. Dangerous yet subtle!"
Lin's Commentary: These three cases are similar, representing 1 in 1000. Do not take them as standard rules. Generally, rash affects Lung/Stomach; treatment should loosen/penetrate. All warming-drying/tonifying/astringent herbs are contraindicated. Though not standard treatment, they are preserved as alternative patterns.
Another record states: Cousin Jingqian, 30, had rash. Initial fever caused mental irritability and abdominal burning pain. He asked if Sandou Tang (Three Bean Decoction) could be taken. I said, "Decoct and drink urgently." Heart/abdominal heat resolved, but spots did not appear, dizziness ensued, cough/asthma increased, nasal flaring observed. Detailed examination revealed Heat-Toxin blocking Lungs; Lung blockage prevents fluid flow and pore opening, hence no spots. I used Huangqin (Scutellariae Radix) to clear interior heat, Ejiao (Colla Corii Asini) and Maidong (Ophiopogonis Radix) to moisten Lung dryness, Jiegeng (Platycodonis Radix) to raise Lung Qi, and Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix)...