蒡、薄清解外热，甘草缓中，杏仁定喘。服二剂，苗虽出透而色皆紫黑，人事更觉沉重，饮食一点不能下。余
悄谓其家曰∶疹书有云，淡红者生，紫黑者死。其家骇怖无似。余复安之曰∶岂真死证耶，但其证极险耳。
此为内热甚而血结也。其证舌
干口臭，恶热喜冷，声音响亮，仍用黄芩、麦冬、阿胶以清内热而润肺燥，加以丹皮泻血中之热，合红花之活
血者以散血结，蝉蜕、牛蒡解其外毒，黄连、甘草解其内毒。连进三剂，人事渐安，饮食渐可，紫黑渐退，而痧
疹塌矣。然有阴邪内盛者，苗亦紫黑，法宜驱阴回阳。其证舌润不渴，声低息短，恶寒喜热，与此不同。
又云∶天瑞之子，大热大渴，舌干口苦，咽喉肿痹，气喘腹痛，下痢红白，小便赤热，苗色紫而暗滞。此
为火邪充斥三焦，俱为热壅，伤津而渴，触肺而喘，上攻而为喉痹，下迫而便红白。精津血脉受其煎熬，故苗
色不红活。口苦者，少阳之里热也。方用柴胡、黄芩清解少阳，大黄通泻三焦实热，栀子引三焦之火屈曲下行，
生地、紫草以解血分之热，杏仁定喘，桔梗开提，甘草和中。服一剂，诸证略杀，但腹痛未减，小便如故。是
夜用神砂六一散二钱，桔梗煎汤化服。使桔梗通天气于地道，则气不滞而壅自疏，六一散开支河以泻小肠之热。
一服而小便通，腹痛即愈。次日苗转红活，诸证俱已。于是方中减去柴胡、黄芩、大黄、栀仁，更加当归、茯
苓，数剂而痊愈矣。
许宣治治案云∶胡旭如子三岁，秋间患疟痢，两月未痊，正气大亏。传染出疹，发热咳嗽，痧点隐隐，淡
白不现，气不足以息，目无神，四肢冷。余曰∶痧初见无补法，此儿正气虚，当破格用药。因以荆、防、蝉蜕、
前胡各四分，人参、升麻、甘草、桔梗各三分，生姜少许，一剂而痧透。除去升麻，加入牛蒡，二剂而喘息定，
痧渐退。
又云∶毕以时女，冬至出痧疹，胃火本盛，唇燥舌苔，呕渴，疹方出未透，忽受寒邪，鼻煽喘促，嗽声不
出，面色青，四肢冷。延余视时，势已危矣。余用麻黄、苏叶、前胡、杏仁、防风、荆芥各五分，芫荽一钱，
石膏一两，投药后暖覆片时，火势尽发。除去麻黄、苏叶，加入桔梗、连翘、山栀、牛蒡四味，又
一服，满口发出白疮，糜烂不能食。除去荆、防、芫荽，再加花粉、木通，数日而痊。
又云∶张锦雯孙女，出疹四朝，面上已收，热已退，忽然腹痛啼叫，四肢冷，闷倒在地。余曰∶疹已四朝，
出透热退，今忽腹痛，是虫动也。无热证，黄连即不可用，乌梅又不可用。正踌躇间，适有榧在盘，即命以榧
肉十枚，捣碎煎水饮之，不移时而止。药贵当，不在峻与缓也。
又云∶张佩西长孙文芳，隆冬出疹，发热呕吐，痧点隐隐不透。延余至，初用疏托药，服后呕吐不止，
心烦燥渴。至夜，乃于疏托药中加石膏五钱，吐仍不止，长虫出，少停又吐，又出长虫。至夜半共计吐出长虫一
十八条，忽然人事昏闷，四肢厥冷，一息奄奄欲绝。余见其举家惊惶，亦难措手。因思生死关头，在此一刻，
无可推委。乃复切其脉，滑数有力，遂放胆用药。缘此子胃火本盛，加以红炉密室，叠障重茵，火郁于内，则
肺胃伤，津液竭，表气不通，故得。得欲呕，呕甚则虫不得安，故随呕而出。忽然昏闷厥冷者，乃壮火食气，
热深者厥亦深。参之唇舌，全是火证。前所用升麻、石膏而不效者，病重而药剂轻也。乃用石膏四两，知母、
黄连、山栀、花粉各一钱，升麻、葛根、防风、荆芥、赤芍、牛蒡各六分，芫荽八分，甘草四分。一剂之后，
反令揭去重裘，卧未超时，火势尽发，壮热面赤，痧出如堆。再进一服，横身皆透，热势渐减，热减则药亦当
退除，去荆、防、芫荽、黄连，加入连翘、木通，石膏减半。至晚热复甚，心烦燥渴，无可如何，复用黄连、
石膏，如前数，始得安卧热平。二三日，痧色焦紫不退，知其热甚伤阴，乃用养阴退阳之剂，生地五钱，丹皮、
麦冬各三钱，桔梗、牛蒡、栀仁、花粉各一钱，石膏五钱，甘草五分。守过七朝，共计服过石膏二斤，黄连一
两。治痧疹数十年，火证之甚无过于此。当昏闷厥逆之时，傍有虑其昏脱者，命煎独参汤灌之，非余力主清凉，
顷成不救矣。
吁！可畏哉！
又云∶江氏子，出疹七朝，下痢，日夜近百度，后重红白，发热烦渴。余用升麻、石膏。桔梗、甘草、枳壳、
木通、黄芩、黄连，一剂而痢减半，能食粥，二剂止。
又云∶吴氏子，疹出三朝，热甚烦渴，喘嗽音哑。其儿欠乳，三岁不能行，兼之提散太过，肺气与阴液皆亏。
大剂养阴，生地二钱，麦冬二钱，沙参一钱，丹皮八分，桔梗八分，甘草五分，炒栀子八分，知母八分，加梨汁
半杯冲服。服药后喘渐定，热渐平，安卧片时，阴得所养。连服数剂，嗽减音开，调理而愈。此证若周旋俗手，
用提散药，死矣。
又云∶曹序林先生次孙三岁，出痧，体素弱，三朝热未退，两颊未透，唇口干燥，精神困倦，咳无力，大便
日五六次。正气已亏，难循常法，方用人参、麦冬、桔梗、防风、炒栀子、茯苓、甘草。二剂而泄止疹透，精神
渐转。惟咳嗽未平，人参易沙参，再加牛蒡、北杏仁，二剂痰嗽渐减。犹有余热，再加丹皮、料豆，二剂而痊。
痧证用人参，昔曾治胡旭如子痢后出痧，升麻葛根汤中加用取效，今已三十年始得再用。痧疹固宜清与散，有
正气虚不能任药者，亦宜活法，故记之。
又云∶孙儿炎寿出痧已过七朝，四五朝少服疏表一剂，痧没后热未退，人事不爽，知其肺家余毒未清。
至九朝午后热甚，口舌生疮，有时痰嗽气促。热退时脉平，小热来时脉数。大热服清热保肺之剂，安卧能乳，
人事理宜清爽，而大势沉困，呻吟不定，故复论之。大热七日多汗，表气与阴液皆虚也。小便清利，里热亦降
也。大便泄且多次黄黑色，虽为夹热下痢，肠胃亦虚也。唇舌疮是心脾二家蕴热所发， 乳无所苦，亦无大害，
且既发为口疮，其无内陷可知也。食乳饮药之后，不移时便泄，不能停蓄，肠胃愈虚也。痰嗽喘促无已时者，
为实为闭。有时而止，安卧而定，非实闭也，是肺金受火邪之克，正气虚，痰不营运
也。合而论之，虽曰余热尚存，当以正气为主，酌以补而不滞之剂治之，人参三分，麦冬六分，橘红三分，茯苓
六分，料豆一钱，地骨皮五分，炒栀子五分，桔梗五分，甘草三分。卯时服药，辰巳二时相安，午后复发热，
呻吟，唇红面赤，脉来滑数。肺热犹甚，人参易沙参，再加枯芩三分。服药后热又渐平。十朝心脾二经热平，
故午前退。肺热仍在，故午后犹热，热来时呻吟脉大，唇红颊赤，眼角生脂。书云∶脏腑之伤，肺则尤甚。是
以昨加黄芩得效。因思病重药轻，虽效而热难尽除，前方用沙参，再守一剂。十一朝午前安静，午后犹热，
热则痰嗽气促。欲除痰当清热，欲平热当养阴，痧后养阴退阳，千古大法，生地、麦冬、丹皮、料豆、炒栀子、
叭胆杏仁、橘红、茯苓、牛蒡子、桔梗、甘草。十二朝午热减半，精神渐转，前方再守一剂。十三朝停药。十
四朝右腮发红，午后又热，口疮又发，舌尖下一大疮，金黄色，复与清心之剂，连翘、山栀、桔梗、甘草、牛
蒡子、贝母、麦冬、料豆、枳壳、木通，二剂平矣。痘证多心脾热，故多用黄连；痧疹多肺热，故宜黄芩、
山栀。黄芩有二种，一种色黄而中空者，一种色绿而中实者。中空者名枯芩，肺欲空，故宜之。中实者名条芩，
又名子芩，肠欲实，故宜之。痧疹用枯芩，不必酒炒。止痢安胎，皆用条芩。
又云∶西溪文学汪聚之，年二十八，胃中素有停饮，丙辰仲春传染出痧。初服升麻葛根汤加荆、防、蝉蜕、
甘、桔，痧疹应药而出，疏疏表透，烦热不宁。二朝再用前方，痧出始透，面部胸背绵密如堆，颜色焦紫，唇
裂舌苔，烦躁依然不定，据此痧证理应重用清凉。自言胸中痞闷，不时咯出寒痰青白色。本证宜温，痧出火甚
宜清，权宜之计，当重治痧一边。四朝荆、防、甘、桔，少加连翘、赤芍、炒山栀之类，烦虽有时而定寒痰涌
出，日夜各一二盂。外证唇裂口干，大便不解。石膏虽不敢用，清润之品加入花粉、麦冬二味。服药片时，寒
痰涌起，胃中闭
塞，外见痧色焦紫，唇裂音哑。用药实在两难，踌躇再四，淡剂守之。至五朝，视其表已尽透，痧色微有回意，
所苦者胸闭耳，遂与二陈、甘、桔、杏仁、炒栀子之类，药入相安，食少加。守定二陈以平饮，甘桔以开音。
守过七朝，饮平热退，音亦渐开。如此火毒燔灼，而芩、连、石膏竟不能用。麦冬之不受者，饮不利于滋；炒
栀子之可用者，苦降而不泥膈也。此实用药相机之权宜。日与其令伯守明先生斟酌立方，始终不用苦寒，大便
解而里热泄，旬日收功。若遇偏执之流，孟浪之手，胃气一伤，鲜有不败事者。用药之难，执成方以应变，可
乎？
又云∶南源方氏子九岁，长夏出疹，两颊未透。医者不识时势，用升麻葛根不应，误加麻黄一剂，疹出而
大汗神困，烦渴喘促，又不知转手养阴救肺，以致胸骨高起，如嗽久龟胸之状，请余治。余曰∶痧疹表不透，
当提散。夏令表虚，提散太过，六腑之火尽发，肺受其殃，热拥胸膈，势已危矣。急用生沙参、麦冬、料豆各
二钱，丹皮一钱，石膏五钱，枯芩、杏仁、桔梗、木通各五分，枳壳、甘草各三分，一剂热势稍平。除去木通、
枳壳，加入栀仁、地骨，热退七八。守服养阴数剂，胸骨渐平。其次子七岁，疹后潮热十余日，咳嗽喉痛，米
粒难吞，四肢痿软，不能坐立，其初出亦曾服过麻黄。余曰∶此表散太过，津液尽夺，肺热叶焦，发为痿蹶，
有自来矣。亦宜泻火保金，使津液渐回，庶几可治。方用生沙参、麦冬各二钱，石膏三钱，桔梗、栀仁、山豆
根、地骨、牛蒡、杏仁、料豆各一钱，枳壳、甘草各三分，一剂喉痛止，二剂能食粥。除去栀仁、枳壳，五六
剂而能行矣。龟胸、肺痿二证，疹后所未见者，故续记之。若非过用提散，误用麻黄，当无此证。夏令治疹，
医者可不慎乎。
余春山治案云∶戊申夏月，有程姓延余治疹，肩舆未到已毙。询问其故，云∶出疹已两日。据医云，疹
发未透，数进升麻葛根汤而烦渴不已，随即疹没烦躁。医云，疹为风闭，令着复
衣，关闭房内，冀其复出。儿未能语，惟将手贴冷处少安，且欲扯门环外出之势，均禁不许，遂发痉而亡。吾
乡有 麻之说，贻误已久，医家病家未知改悟，惜哉！此儿之命，明系热郁亡阴，邪陷风动致殆也。余到之日，
第二儿亦发热，关闭房内，啼哭极甚。余急令抱出，其家仍惧感风。余曰∶前证既经关闭房内损伤，姑易旧章，
试看如何。适出房外，哭遂止。余令脱去夹衣，笑容可掬。余曰∶病未经药，已去大半矣。举家均以为奇。
再与清燥卫生汤，方用生石膏、知母、蒌皮、芦根、南沙参、杏仁、姜汁、炒木通、生牛子、当归、细辛、
梨皮、芹汁，服一剂。次早疹出鲜活，傍暮疹遂没。举家复忧，疑是房外感风疹闭。余曰∶无虑。儿既安然乳
食，且已退热，此是邪轻，因治得法，一药而愈。惟咳嗽未止，余邪未清，令用杏仁、麦冬、芦根、梨皮煎茶，
频饮痊愈。其家方知前几误治。
章虚谷治案云∶孝廉黄笑山先生令媛，年十余岁，出 见点已五日，经幼科以常例升提表散之药治之，其
毒总不透发，气喘鼻煽，日夜烦扰，其状甚危。余诊脉虚弱带数，惟左关尺沉弦而滞，知为肾肝蕴毒未出，
乃重用玄参，佐知母、归须、赤芍、犀角、羚羊、连翘、甘草。一剂服之，其夜即能稍睡。次日脉象松动，惟
口大渴，犹喘急鼻煽，是热毒已达肺胃，又重加石膏，数剂后渐安而愈。盖玄参滋水解毒，能启发肾气，归须、
赤芍疏通血络，犀羚皆透发之品，与连翘、知母、甘草，从手足厥阴引毒直达肺胃，从表而出，故一剂即效。可
见确为内毒未出。而世俗皆认作外毒内陷，惟屡用升散，大泄肺气，以致喘急烦扰而危殆者，不可计数，良由
平素未明此理故也。吾愿天下后世，切须究心，勿泥成法，勿拘旧说，庶可保全生命。再按，是证乃热毒内
伏，故以清凉透发见效。其有先天元阳薄弱而毒难转化者，于凉透之剂稍佐附子，助其元阳，送毒而出，否则
难以透发。此在临证者随宜变化。即此一证，可以隅反也。
王孟英治案云∶溽暑之令， 疹盛行，幼科仅知套药，升柴防葛乱施。殆亦疫疠之病，造化默行其杀运欤。
陈仰山家患此者十余人，其长郎书芾孝廉之女势最剧，以 甫出而汛至也，医者却走，始延余。视之脉滑而数，
舌绛大渴，面赤失音，不食便泻。曰∶此由发散太过，火盛风炽，气血两燔，气分之邪由泻而略泄其焰，营分
之热由汛而稍解其焚，岂可畏其脱陷，妄投止涩耶。与西洋参、石膏、知母、麦冬、犀角、生地、连翘、甘草、
牛蒡子、薄荷清解体表之热，甘草缓和脾胃之气，杏仁平息气喘。服用两剂后，疹点虽已透发，但颜色皆呈紫黑色，患儿精神更加沉重，饮食完全无法入口。我悄悄对其家人说：“疹病医书有云，疹色淡红者生，紫黑者死。”其家人惊恐万分。我又安慰他们说：“这难道真是死证吗？只是病情极其险恶罢了。这是因为体内热毒极盛导致血液凝滞。此证表现为舌干口臭，厌恶热气喜欢冷物，声音洪亮。仍用黄芩、麦冬、阿胶以清泄内热并滋润肺燥，加入丹皮泻除血分之热，配合红花活血以消散血结，蝉蜕、牛蒡子解除体表之毒邪，黄连、甘草解除体内之毒邪。连续服用三剂后，患儿精神逐渐安定，饮食渐可进食，紫黑色逐渐消退，痧疹也平复了。然而若有阴寒邪气内盛的，疹点也会呈紫黑色，治法应当驱散阴寒、回阳救逆。此证表现为舌润不渴，声音低微气息短促，厌恶寒冷喜欢温热，与此不同。”
又说：天瑞的儿子，高热大渴，舌干口苦，咽喉肿痛闭塞，气喘腹痛，下痢红白相杂，小便赤热，疹色紫暗滞涩。这是火邪充斥三焦，均为热邪壅滞，损伤津液而致口渴，邪气犯肺而致喘，上攻咽喉而为喉痹，下迫大肠而便下红白脓血。精血津液受火热煎熬，所以疹色不红润鲜活。口苦，是少阳经里的热邪。方用柴胡、黄芩清解少阳经热，大黄通泻三焦实热，栀子引导三焦之火屈曲下行，生地、紫草解除血分之热，杏仁定喘，桔梗宣提肺气，甘草调和脾胃。服用一剂后，诸症稍减，但腹痛未减轻，小便如故。当夜用神砂六一散二钱，以桔梗煎汤化服。使桔梗通达天气于地道，则气机不滞而壅塞自疏，六一散开支河以泻小肠之热。服一次后小便通畅，腹痛即愈。次日疹色转红活，诸症俱消。于是方中减去柴胡、黄芩、大黄、栀子，再加当归、茯苓，数剂后痊愈。
许宣治治疗案例记载：胡旭如之子三岁，秋季患疟疾和痢疾，两个月未愈，正气大亏。又传染出疹，发热咳嗽，痧点隐隐约约，颜色淡白不显，气息不足以喘息，眼神无神，四肢冰冷。我说：“痧疹初起没有补益之法，此儿正气虚弱，应当破格用药。”因此用荆芥、防风、蝉蜕、前胡各四分，人参、升麻、甘草、桔梗各三分，生姜少许，一剂后痧疹透发。除去升麻，加入牛蒡子，两剂后喘息平定，痧疹渐退。
又说：毕以时的女儿，冬至日发出痧疹，胃火本盛，嘴唇干燥舌苔厚，呕吐口渴，疹刚发出尚未透发，忽然感受寒邪，鼻翼煽动气喘急促，咳嗽声不出，面色青灰，四肢冰冷。请我去看时，病情已经危急。我用麻黄、苏叶、前胡、杏仁、防风、荆芥各五分，芫荽一钱，石膏一两，投药后用暖被覆盖片刻，火势全部发散出来。除去麻黄、苏叶，加入桔梗、连翘、山栀、牛蒡子四味药，再服一次，满口发出白疮，糜烂不能进食。除去荆芥、防风、芫荽，再加天花粉、木通，数日后痊愈。
又说：张锦雯的孙女，出疹第四天，面部疹子已收，热已退，忽然腹痛啼叫，四肢冰冷，闷倒在地。我说：“疹已四天，透发且热退，现在忽然腹痛，是虫动所致。没有热证，黄连不可用，乌梅也不可用。”正犹豫间，恰好盘中有榧子，就命令取榧肉十枚，捣碎煎水饮下，不一会儿疼痛停止。用药贵在恰当，不在于峻猛或缓和。
又说：张佩西的长孙文芳，隆冬季节出疹，发热呕吐，痧点隐隐不透。请我去诊治，起初用疏托药，服后呕吐不止，心烦燥渴。到了晚上，在疏托药中加入石膏五钱，呕吐仍不止，吐出蛔虫，稍停又吐，又吐出蛔虫。到半夜共计吐出蛔虫十八条，忽然人事昏闷，四肢厥冷，气息奄奄欲绝。我看他全家惊慌失措，也难以下手。心想生死关头，在此一刻，无可推委。于是再次切脉，脉滑数有力，于是大胆用药。因为这个孩子胃火本盛，加上红炉密室，层层铺垫重褥，火郁于内，则肺胃受伤，津液枯竭，表气不通，所以容易得病。想要呕吐，呕吐剧烈则蛔虫不得安宁，所以随呕吐而出。忽然昏闷厥冷的，是壮火食气，热深则厥亦深。参看唇舌，全是火证。之前所用升麻、石膏而不效，是因为病重而药剂轻。于是用石膏四两，知母、黄连、山栀、天花粉各一钱，升麻、葛根、防风、荆芥、赤芍、牛蒡子各六分，芫荽八分，甘草四分。一剂之后，反而让人揭开重裘，躺卧不到一小时，火势全部发散，壮热面赤，痧出如堆。再进一服，全身透发，热势渐减。热减则药也应当退除，去掉荆芥、防风、芫荽、黄连，加入连翘、木通，石膏减半。到了晚上热又加重，心烦燥渴，无可奈何，再用黄连、石膏，照前面的剂量，才得以安卧热平。两三天后，痧色焦紫不退，知道是热甚伤阴，于是用养阴退阳的方剂，生地五钱，丹皮、麦冬各三钱，桔梗、牛蒡子、栀子仁、天花粉各一钱，石膏五钱，甘草五分。坚守过七天，共计服用石膏二斤，黄连一两。治疗痧疹数十年，火证之严重没有超过这个的。当昏闷厥逆之时，旁边有人担心昏脱，命令煎独参汤灌服，如果不是我力主清凉，顷刻间就不救了。
唉！真令人敬畏啊！
又说：江氏之子，出疹七天后下痢，日夜近一百次，里急后重，大便红白相间，发热烦渴。我用升麻、石膏、桔梗、甘草、枳壳、木通、黄芩、黄连，一剂后痢疾减半，能喝粥，两剂后止住。
又说：吴氏之子，出疹三天，热甚烦渴，喘嗽音哑。这个孩子缺乳，三岁还不能行走，加之提散药太过，肺气与阴液皆亏损。用大剂养阴药，生地二钱，麦冬二钱，沙参一钱，丹皮八分，桔梗八分，甘草五分，炒栀子八分，知母八分，加梨汁半杯冲服。服药后喘渐平定，热渐平息，安卧片刻，阴气得所滋养。连服数剂，咳嗽减少声音开扬，调理后痊愈。此证如果遇到庸俗医生，用提散药，必死无疑。
又说：曹序林先生的次孙三岁，出痧，体质素来虚弱，三天后热未退，两颊疹未透，唇口干燥，精神困倦，咳嗽无力，大便每天五六次。正气已亏，难以遵循常法，方用人参、麦冬、桔梗、防风、炒栀子、茯苓、甘草。两剂后泄止疹透，精神渐转。只有咳嗽未平，将人参换为沙参，再加牛蒡子、北杏仁，两剂后痰嗽渐减。还有余热，再加丹皮、料豆，两剂后痊愈。痧证用人参，以前曾治疗胡旭如之子痢后出痧，在升麻葛根汤中加入取得疗效，如今已过三十年才再次使用。痧疹固然宜清散，但有正气虚不能耐受药物者，也应当灵活变通，所以记录下来。
又说：孙子炎寿出痧已过七天，四五天时少服了一剂疏表药，痧没后热未退，精神尚可，知道是肺家余毒未清。到了第九天午后热甚，口舌生疮，有时痰嗽气促。热退时脉象平和，小热来时脉数。大热时服用清热保肺之剂，安卧能吃奶，精神理应清爽，但大势沉困，呻吟不定，所以重新论述。大热七天多汗，表气与阴液皆虚。小便清利，说明里热也降。大便泄且多次黄黑色，虽然是夹热下痢，肠胃也虚。唇舌生疮是心脾二家蕴热所发，吃奶没有痛苦，也没有大害，而且既然发了口疮，可知没有内陷。吃奶服药后，不一会儿就泄，不能停蓄，肠胃更虚。痰嗽喘促无休止时，是为实闭。有时停止，安卧而定，不是实闭，是肺金受火邪克制，正气虚，痰不运化。综合来看，虽说余热尚存，应当以正气为主，斟酌用补而不滞的方剂治疗，人参三分，麦冬六分，橘红三分，茯苓六分，料豆一钱，地骨皮五分，炒栀子五分，桔梗五分，甘草三分。卯时服药，辰巳二时相安，午后复发热，呻吟，唇红面赤，脉来滑数。肺热犹甚，将人参换为沙参，再加枯黄芩三分。服药后热又渐平。第十天心脾二经热平，所以午前退热。肺热仍在，所以午后犹热，热来时呻吟脉大，唇红颊赤，眼角生脂。书云：“脏腑之伤，肺则尤甚。”因此昨天加黄芩得效。心想病重药轻，虽有效但热难尽除，前方用沙参，再守一剂。十一朝午前安静，午后犹热，热则痰嗽气促。欲除痰当清热，欲平热当养阴，痧后养阴退阳，千古大法，用地地、麦冬、丹皮、料豆、炒栀子、叭喇胆杏仁、橘红、茯苓、牛蒡子、桔梗、甘草。十二朝午热减半，精神渐转，前方再守一剂。十三朝停药。十四朝右腮发红，午后又热，口疮又发，舌尖下一大疮，金黄色，复与清心之剂，连翘、山栀、桔梗、甘草、牛蒡子、贝母、麦冬、料豆、枳壳、木通，两剂后平复。痘证多心脾热，故多用黄连；痧疹多肺热，故宜黄芩、山栀。黄芩有两种，一种色黄而中空者，一种色绿而中实者。中空者名枯芩，肺喜空，故宜之。中实者名条芩，又名子芩，肠喜实，故宜之。痧疹用枯芩，不必酒炒。止痢安胎，皆用条芩。
又说：西溪文人汪聚之，年二十八岁，胃中素有停饮，丙辰年仲春传染出痧。初服升麻葛根汤加荆芥、防风、蝉蜕、甘草、桔梗，痧疹应药而出，疏疏表透，烦热不宁。第二天再用前方，痧出始透，面部胸背绵密如堆，颜色焦紫，唇裂舌苔，烦躁依然不定，据此痧证理应重用清凉。自言胸中痞闷，不时咯出寒痰青白色。本证宜温，痧出火甚宜清，权宜之计，当重治痧一边。第四天用荆芥、防风、甘草、桔梗，少加连翘、赤芍、炒山栀之类，烦虽有时而定寒痰涌出，日夜各一二盂。外证唇裂口干，大便不解。石膏虽不敢用，清润之品加入天花粉、麦冬二味。服药片刻，寒痰涌起，胃中闭塞，外见痧色焦紫，唇裂音哑。用药实在两难，踌躇再四，用淡剂守之。到了第五天，视其表已尽透，痧色微有回意，所苦者是胸闭耳，遂与二陈汤、甘草、桔梗、杏仁、炒栀子之类，药入相安，食少加。守定二陈以平饮，甘桔以开音。守过七天，饮平热退，音亦渐开。如此火毒燔灼，而黄芩、黄连、石膏竟不能用。麦冬之不受者，因为饮不利于滋；炒栀子之可用者，因为苦降而不泥膈也。此实用药相机之权宜。每日与其伯父守明先生斟酌立方，始终不用苦寒，大便解而里热泄，旬日收功。若遇偏执之流，孟浪之手，胃气一伤，鲜有不败事者。用药之难，执成方以应变，可以吗？
又说：南源方氏之子九岁，长夏出疹，两颊未透。医者不识时势，用升麻葛根不应，误加麻黄一剂，疹出而大汗神困，烦渴喘促，又不知转手养阴救肺，以致胸骨高起，如久嗽龟胸之状，请我去治。我说：“痧疹表不透，当提散。夏令表虚，提散太过，六腑之火尽发，肺受其殃，热拥胸膈，势已危矣。”急用生沙参、麦冬、料豆各二钱，丹皮一钱，石膏五钱，枯黄芩、杏仁、桔梗、木通各五分，枳壳、甘草各三分，一剂后热势稍平。除去木通、枳壳，加入栀子仁、地骨皮，热退七八。守服养阴数剂，胸骨渐平。其次子七岁，疹后潮热十余日，咳嗽喉痛，米粒难吞，四肢痿软，不能坐立，其初出亦曾服过麻黄。我说：“此表散太过，津液尽夺，肺热叶焦，发为痿蹶，有自来矣。”也宜泻火保金，使津液渐回，庶几可治。方用生沙参、麦冬各二钱，石膏三钱，桔梗、栀子仁、山豆根、地骨皮、牛蒡子、杏仁、料豆各一钱，枳壳、甘草各三分，一剂后喉痛止，二剂能喝粥。除去栀子仁、枳壳，五六剂后能行走了。龟胸、肺痿二证，是疹后所未见的，所以续记之。若非过用提散，误用麻黄，当无此证。夏令治疹，医者可不慎乎。
余春山治疗案例记载：戊申年夏季，有程姓请我去治疹，轿子还没到病人已死。询问其原因，说是出疹两天。据医生说，疹发未透，数次进服升麻葛根汤而烦渴不已，随即疹没烦躁。医生说，疹为风邪闭塞，令穿复衣，关闭房内，希望其复出。孩子不会说话，只将手贴冷处稍安，且有扯门环外出的趋势，均禁止不许，遂发痉而亡。我家乡有“痧”的说法，贻误已久，医家病家未知改悟，可惜啊！这个孩子的命，明显是热郁亡阴，邪陷风动致死。我到那天，第二个儿子也发热，关闭房内，啼哭极甚。我急忙令抱出，其家仍惧感风。我说：“前证既经关闭房内损伤，姑且改变旧章，试试看如何。”适逢出房外，哭遂止。我令脱去夹衣，笑容可掬。我说：“病未经药，已去大半矣。”举家均以为奇。再给予清燥卫生汤，方用生石膏、知母、瓜蒌皮、芦根、南沙参、杏仁、姜汁、炒木通、生牛蒡子、当归、细辛、梨皮、芹菜汁，服一剂。次早疹出鲜活，傍暮疹遂没。举家复忧，疑是房外感风疹闭。我说：“无虑。儿既安然乳食，且已退热，此是邪轻，因治得法，一药而愈。惟咳嗽未止，余邪未清，令用杏仁、麦冬、芦根、梨皮煎茶，频饮痊愈。其家方知前几误治。”
章虚谷治疗案例记载：孝廉黄笑山先生的女儿，年十余岁，出疹见点已五日，经幼科以常例升提表散之药治之，其毒总不透发，气喘鼻煽，日夜烦扰，其状甚危。我诊脉虚弱带数，惟左关尺沉弦而滞，知道是肾肝蕴毒未出，乃重用玄参，佐知母、归须、赤芍、犀角、羚羊角、连翘、甘草。一剂服之，其夜即能稍睡。次日脉象松动，惟口大渴，犹喘急鼻煽，是热毒已达肺胃，又重加石膏，数剂后渐安而愈。盖玄参滋水解毒，能启发肾气，归须、赤芍疏通血络，犀羚皆透发之品，与连翘、知母、甘草，从手足厥阴引毒直达肺胃，从表而出，故一剂即效。可见确为内毒未出。而世俗皆认作外毒内陷，惟屡用升散，大泄肺气，以致喘急烦扰而危殆者，不可计数，良由平素未明此理故也。吾愿天下后世，切须究心，勿泥成法，勿拘旧说，庶可保全生命。再按，是证乃热毒内伏，故以清凉透发见效。其有先天元阳薄弱而毒难转化者，于凉透之剂稍佐附子，助其元阳，送毒而出，否则难以透发。此在临证者随宜变化。即此一证，可以隅反也。
王孟英治疗案例记载：溽暑之令，痧疹盛行，幼科仅知套药，升麻、柴胡、防风、葛根乱施。殆亦疫疠之病，造化默行其杀运欤。陈仰山家患此者十余人，其长子书芾孝廉之女病情最剧，以痧甫出而月经至也，医者却走，始延余。视之脉滑而数，舌绛大渴，面赤失音，不食便泻。曰：“此由发散太过，火盛风炽，气血两燔，气分之邪由泻而略泄其焰，营分之热由汛而稍解其焚，岂可畏其脱陷，妄投止涩耶。”与西洋参、石膏、知母、麦冬、犀角、生地、连翘、甘草、
Bullaozi (Arisaematis Rhizoma Preparatum) and Bohe (Menthae Haplocalycis Herba) clear and resolve external heat; Gancao (Glycyrrhizae Radix et Rhizoma) moderates the middle jiao; Xingren (Armeniacae Semen Amarum) calms wheezing. After taking two doses, although the rash had fully erupted, its color was entirely purple-black, consciousness became more heavy, and no food or drink could be taken. I quietly said to the family: "Rash medical texts state that a pale red color indicates survival, while purple-black indicates death." The family was terrified. I comforted them again, saying: "Is this truly a death case? It is merely extremely dangerous. This is due to extreme internal heat causing blood stasis. The symptoms include dry tongue, foul breath, aversion to heat and preference for cold, and loud voice. Continue using Huangqin (Scutellariae Radix), Maidong (Ophiopogonis Radix), and Ejiao (Asini Corii Colla) to clear internal heat and moisten lung dryness; add Danpi (Moutan Cortex) to drain heat from the blood level; combine with Honghua (Carthami Flos) to invigorate blood and dissipate blood stasis; Chantui (Cicadae Periostracum) and Bullaozi (Arisaematis Rhizoma Preparatum) to resolve external toxins; Huanglian (Coptidis Rhizoma) and Gancao (Glycyrrhizae Radix et Rhizoma) to resolve internal toxins. After continuously taking three doses, consciousness gradually stabilized, diet gradually recovered, purple-black color faded, and the rash collapsed. However, if there is excessive internal yevil (cold pathogen), the rash may also appear purple-black; the treatment method should be to dispel yin and restore yang. Symptoms include a moist tongue without thirst, low voice and short breath, aversion to cold and preference for heat, which differs from the above.
It is also stated: Tianrui's son suffered from high fever and intense thirst, dry tongue with bitter taste, swollen and obstructed throat, wheezing and abdominal pain, dysentery with red and white pus and blood, red and hot urination, and rash color purple and dull. This is fire evil filling the Sanjiao (Triple Burner), all caused by heat congestion, damaging fluids leading to thirst, attacking the lung leading to wheezing, attacking upward causing throat obstruction, and pressing downward causing red and white dysentery. Essence, fluids, and blood vessels are boiled by heat, so the rash color is not vibrant. Bitter taste in the mouth indicates interior heat of the Shaoyang (Lesser Yang) channel. The formula uses Chaihu (Bupleuri Radix) and Huangqin (Scutellariae Radix) to clear and resolve Shaoyang heat; Dahuang (Rhei Radix et Rhizoma) to purge solid heat from the Sanjiao; Zhizi (Gardeniae Fructus) to guide fire from the Sanjiao downwards; Shengdi (Rehmanniae Radix) and Zicao (Lithospermi Radix) to resolve heat in the blood level; Xingren (Armeniacae Semen Amarum) to calm wheezing; Jiegeng (Platycodonis Radix) to raise lung qi; Gancao (Glycyrrhizae Radix et Rhizoma) to harmonize the spleen and stomach. After one dose, symptoms slightly decreased, but abdominal pain remained unchanged, and urination was normal. That night, Yili San (Six-to-One Powder) with Shensha (Cinnabar) 2 qian was taken dissolved in Jiegeng (Platycodonis Radix) decoction. This allows Jiegeng (Platycodonis Radix) to connect heaven's qi with earth's channels, so qi does not stagnate and congestion is relieved; Yili San (Six-to-One Powder) opens side channels to drain heat from the small intestine. After one dose, urination became smooth, and abdominal pain healed immediately. The next day, the rash turned red and vibrant, and all symptoms disappeared. Thus, Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Dahuang (Rhei Radix et Rhizoma), and Zhizi (Gardeniae Fructus) were removed from the formula, and Danggui (Angelicae Sinensis Radix) and Fuling (Poria) were added. After several doses, he recovered.
Xu Xuanzhi's case record states: Hu Xuru's son, aged three, suffered from malaria and dysentery in autumn, unresolved for two months, with significant depletion of healthy qi. He contracted the rash, with fever and cough, faint rash spots, pale white color, insufficient breath, spiritless eyes, and cold limbs. I said: "There is no tonification method for initial rash eruption; this child has deficient healthy qi, so extraordinary measures must be taken." Therefore, Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Chantui (Cicadae Periostracum), and Qianhu (Peucedani Radix) were used at 4 fen each; Renshen (Ginseng Radix), Shengma (Cimicifugae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), and Jiegeng (Platycodonis Radix) at 3 fen each, with a little fresh ginger. After one dose, the rash erupted. Shengma (Cimicifugae Rhizoma) was removed, and Niubangzi (Arctii Fructus) was added. After two doses, wheezing settled, and the rash gradually receded.
It is also stated: Bi Yishi's daughter developed the rash on the Winter Solstice. She naturally had strong stomach fire, dry lips, thick tongue coating, vomiting, and thirst. The rash had just emerged but not fully erupted when she suddenly caught cold pathogen, resulting in nasal flaring, rapid breathing, inability to cough sound, blueish complexion, and cold limbs. When I examined her, the condition was critical. I used Mahuang (Ephedrae Herba), Ziye (Perillae Folium), Qianhu (Peucedani Radix), Xingren (Armeniacae Semen Amarum), Fangfeng (Saposhnikoviae Radix), and Jingjie (Schizonepetae Spica) at 5 fen each, Yuansu (Coriandri Fructus) at 1 qian, and Shigao (Gypsum Fibrosum) at 1 liang. After administering the medicine, she was covered warmly for a moment, and the fire energy fully erupted. Mahuang (Ephedrae Herba) and Ziye (Perillae Folium) were removed, and Jiegeng (Platycodonis Radix), Lianqiao (Forsythiae Fructus), Zhizi (Gardeniae Fructus), and Niubangzi (Arctii Fructus) were added. After another dose, white sores appeared all over the mouth, causing ulceration and inability to eat. Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), and Yuansu (Coriandri Fructus) were removed, and Huafen (Trichosanthis Radix) and Mutong (Akebiae Caulis) were added. After several days, she recovered.
It is also stated: Zhang Jinwen's granddaughter, on the fourth day of the rash, the facial rash had subsided, and fever had ceased. Suddenly, she had abdominal pain, cried out, had cold limbs, and fainted. I said: "The rash has been present for four days, fully erupted, and fever has subsided. Sudden abdominal pain now indicates moving parasites. Without heat signs, Huanglian (Coptidis Rhizoma) cannot be used, nor can Wumei (Mume Fructus)." While hesitating, Feizi (Torreya Seed) happened to be on the plate. I ordered ten Fei meat pieces to be crushed, decocted in water, and given to drink. Within a short time, the pain stopped. Medication is valuable for being appropriate, not for being harsh or mild.
It is also stated: Zhang Peixi's eldest grandson, Wenfang, developed the rash in deep winter, with fever and vomiting, and faint, non-erupting rash spots. Upon my arrival, I initially used dispersing and supporting herbs. After taking them, vomiting continued incessantly, accompanied by mental restlessness, irritability, and thirst. At night, I added 5 qian of Shigao (Gypsum Fibrosum) to the dispersing formula. Vomiting continued, and roundworms were expelled. After a pause, vomiting resumed, and more roundworms were expelled. By midnight, eighteen roundworms had been vomited. Suddenly, consciousness became clouded, limbs became cold and inverted, and breath was faint and near cessation. Seeing the whole family in panic, I found it difficult to act. Thinking that the critical moment of life and death was upon us, with no room for hesitation, I palpated the pulse again; it was slippery, rapid, and forceful. Thus, I boldly prescribed medication. This child naturally had strong stomach fire. Added to the conditions of a red stove in a sealed room and multiple layers of bedding, fire was constrained internally, injuring the lungs and stomach, depleting fluids, and blocking exterior qi, making him susceptible to illness. The desire to vomit resulted in violent vomiting, disturbing the worms, causing them to be expelled. Sudden clouding and inversion were due to vigorous fire consuming qi; the deeper the heat, the deeper the inversion. Examining the lips and tongue revealed pure heat signs. The previous use of Shengma (Cimicifugae Rhizoma) and Shigao (Gypsum Fibrosum) failed because the disease was severe and the dosage light. Therefore, I used Shigao (Gypsum Fibrosum) 4 liang, Zhimu (Anemarrhenae Rhizoma), Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructus), and Huafen (Trichosanthis Radix) at 1 qian each; Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), ChiShao (Paeoniae Radix Rubra), and Niubangzi (Arctii Fructus) at 6 fen each; Yuansu (Coriandri Fructus) at 8 fen; and Gancao (Glycyrrhizae Radix et Rhizoma) at 4 fen. After one dose, contrary to expectation, heavy quilts were removed. Within an hour of lying down, fire energy fully erupted, causing high fever and red face, with rash erupting in piles. After another dose, the body fully erupted, and fever gradually decreased. As fever decreased, medication should also be reduced. Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Yuansu (Coriandri Fructus), and Huanglian (Coptidis Rhizoma) were removed, and Lianqiao (Forsythiae Fructus) and Mutong (Akebiae Caulis) were added; Shigao (Gypsum Fibrosum) was halved. In the evening, fever intensified again, with mental restlessness and thirst. With no other option, Huanglian (Coptidis Rhizoma) and Shigao (Gypsum Fibrosum) were reused at previous dosages, allowing him to sleep peacefully with fever subsiding. Two to three days later, the rash remained dark purple, indicating severe heat damaging yin. Thus, a yin-nourishing and fire-reducing formula was used: Shengdi (Rehmanniae Radix) 5 qian, Danpi (Moutan Cortex) and Maidong (Ophiopogonis Radix) 3 qian each; Jiegeng (Platycodonis Radix), Niubangzi (Arctii Fructus), Zhizi (Gardeniae Fructus), and Huafen (Trichosanthis Radix) 1 qian each; Shigao (Gypsum Fibrosum) 5 qian; Gancao (Glycyrrhizae Radix et Rhizoma) 5 fen. Adhering to this for seven days, a total of 2 jin of Shigao (Gypsum Fibrosum) and 1 liang of Huanglian (Coptidis Rhizoma) were consumed. In decades of treating rash, no heat syndrome was more severe than this. During the period of clouding and inversion, someone nearby feared collapse and ordered Du Shen Tang (Single Ginseng Decoction) to be灌fed. If I had not insisted on cooling, he would have died instantly. Alas! How awe-inspiring!
It is also stated: Jiang's son, after seven days of rash, developed dysentery, nearly one hundred episodes per day, with tenesmus and red/white discharge, fever, and thirst. I used Shengma (Cimicifugae Rhizoma), Shigao (Gypsum Fibrosum), Jiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Zhike (Aurantii Fructus), Mutong (Akebiae Caulis), Huangqin (Scutellariae Radix), and Huanglian (Coptidis Rhizoma). After one dose, dysentery halved, and he could eat porridge; after two doses, it stopped.
It is also stated: Wu's son, on the third day of rash, had intense fever, thirst, wheezing, cough, and hoarseness. The child lacked breast milk, could not walk at age three, and due to excessive dispersing treatment, both lung qi and yin fluids were depleted. A large dose of yin-nourishing herbs was used: Shengdi (Rehmanniae Radix) 2 qian, Maidong (Ophiopogonis Radix) 2 qian, Shashen (Glehniae Radix) 1 qian, Danpi (Moutan Cortex) 8 fen, Jiegeng (Platycodonis Radix) 8 fen, Gancao (Glycyrrhizae Radix et Rhizoma) 5 fen, Chao Zhizi (Gardeniae Fructus) 8 fen, Zhimu (Anemarrhenae Rhizoma) 8 fen, mixed with half a cup of pear juice. After medication, wheezing gradually settled, fever subsided, and he slept peacefully, nourishing the yin. After several doses, cough decreased, voice cleared, and he recovered with调理 (conditioning). If treated by ordinary doctors using dispersing methods, he would have died.
It is also stated: Cao Xulin's second grandson, aged three, developed rash. His constitution was weak. On the third day, fever persisted, rash had not erupted on cheeks, lips and mouth were dry, spirit was fatigued, cough was weak, and stool occurred 5-6 times daily. Healthy qi was depleted, making standard methods difficult. The formula used Renshen (Ginseng Radix), Maidong (Ophiopogonis Radix), Jiegeng (Platycodonis Radix), Fangfeng (Saposhnikoviae Radix), Chao Zhizi (Gardeniae Fructus), Fuling (Poria), and Gancao (Glycyrrhizae Radix et Rhizoma). After two doses, diarrhea stopped, rash erupted, and spirit improved. Only cough remained. Renshen (Ginseng Radix) was replaced with Shashen (Glehniae Radix), plus Niubangzi (Arctii Fructus) and Bei Xingren (Armeniacae Semen Amarum). After two doses, phlegm-cough decreased. Residual heat remained, so Danpi (Moutan Cortex) and Douli (Sojae Helvolae Semen) were added. After two doses, he recovered. Using Renshen (Ginseng Radix) for rash was previously effective in Hu Xuru's son's post-dysentery rash with Shengma Gegen Tang (Cimicifugae and Pueraria Decoction). Thirty years later, it was used again. Rash generally requires clearing and dispersing, but for those with deficient healthy qi unable to tolerate drugs, flexible methods are needed. Hence recorded.
It is also stated: Grandson Yanshou had rash for over seven days. A light dispersing dose was taken on days 4-5. After rash subsided, fever persisted, but consciousness was clear, indicating residual lung toxin uncleaned. On the ninth day, afternoon fever was severe, with oral ulcers and occasional phlegm-cough with shortness of breath. Pulse was calm when fever subsided, rapid when slight fever returned. During high fever, heat-clearing and lung-protecting agents were given; he slept well and nursed, and consciousness should have been clear, but his overall state was heavy and groaning. Re-evaluation: Seven days of high fever and sweating indicate deficiency of exterior qi and yin fluids. Clear urination indicates interior heat has lowered. Loose, frequent yellow-black stools indicate damp-heat dysentery and intestinal deficiency. Oral ulcers stem from heart-spleen heat accumulation; nursing causes no distress, proving no internal collapse. Immediate diarrhea after nursing/medication indicates further intestinal weakness. Continuous phlegm-cough-wheezing suggests excess/closure, but intermittent relief and peaceful sleep indicate it is not true excess/closure, but rather lung metal suppressed by fire, with deficient healthy qi failing to transport phlegm. Overall, although residual heat remains, treatment should focus on healthy qi, using tonifying yet non-stagnating formulas: Renshen (Ginseng Radix) 3 fen, Maidong (Ophiopogonis Radix) 6 fen, Juhong (Citri Reticulatae Pericarpium Rubrum) 3 fen, Fuling (Poria) 6 fen, Douli (Sojae Helvolae Semen) 1 qian, Digupi (Bark of Lycii Radix) 5 fen, Chao Zhizi (Gardeniae Fructus) 5 fen, Jiegeng (Platycodonis Radix) 5 fen, Gancao (Glycyrrhizae Radix et Rhizoma) 3 fen. Taken at Mao hour, peace lasted until Chen/Si hours. Afternoon fever returned with groaning, red lips/face, and slippery-rapid pulse. Lung heat remained severe; Renshen (Ginseng Radix) replaced with Shashen (Glehniae Radix), plus Kuhu Qin (Withered Scutellariae Radix) 3 fen. Fever subsided again. On the tenth day, heart-spleen heat balanced, morning fever resolved. Afternoon fever persisted due to lingering lung heat, with groaning, large pulse, red lips/cheeks, and eye discharge. Text says: "Among organ injuries, lung injury is most severe." Hence adding Huangqin (Scutellariae Radix) yesterday was effective. Considering disease severity outweighed medication potency, though effective, heat was not fully cleared. Shashen (Glehniae Radix) formula continued for one more dose. On the eleventh day, morning quiet, afternoon fever with phlegm-cough. To remove phlegm, clear heat; to calm heat, nourish yin. Nourishing yin and reducing fire post-rash is an ancient principle: Shengdi (Rehmanniae Radix), Maidong (Ophiopogonis Radix), Danpi (Moutan Cortex), Douli (Sojae Helvolae Semen), Chao Zhizi (Gardeniae Fructus), Ba Da Xing Ren (Prunus Armeniaca Seed), Juhong (Citri Reticulatae Pericarpium Rubrum), Fuling (Poria), Niubangzi (Arctii Fructus), Jiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix et Rhizoma). On the twelfth day, afternoon fever halved, spirit improved; formula continued. Thirteenth day: stop medication. Fourteenth day: right cheek red, afternoon fever, recurrent oral ulcers, large golden-yellow sore under tongue tip. Again, heart-clearing agents: Lianqiao (Forsythiae Fructus), Zhizi (Gardeniae Fructus), Jiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Niubangzi (Arctii Fructus), Beimu (Fritillariae Bulbus), Maidong (Ophiopogonis Radix), Douli (Sojae Helvolae Semen), Zhike (Aurantii Fructus), Mutong (Akebiae Caulis). Two doses resolved it. Smallpox often involves heart-spleen heat, hence Huanglian (Coptidis Rhizoma); rash often involves lung heat, hence Huangqin (Scutellariae Radix) and Zhizi (Gardeniae Fructus). Huangqin (Scutellariae Radix) has two types: yellow and hollow (Kuhu Qin/Withered Scutellariae Radix), suitable for lung which desires emptiness; green and solid (Tiaoh Qin/Stem Scutellariae Radix), suitable for intestines which desire solidity. For rash, Kuhu Qin (Withered Scutellariae Radix) is used without wine-frying. For dysentery and stabilizing fetus, Tiaoh Qin (Stem Scutellariae Radix) is used.
It is also stated: Wang Juzhi, a scholar from Xixi, aged twenty-eight, had retained fluid in the stomach. In mid-spring of Bingchen year, he contracted rash. Initially took Shengma Gegen Tang (Cimicifugae and Pueraria Decoction) plus Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Chantui (Cicadae Periostracum), Gancao (Glycyrrhizae Radix et Rhizoma), Jiegeng (Platycodonis Radix). Rash erupted with medication, surface dispersed, but restlessness persisted. Second day, same formula; rash fully erupted, dense on face/chest/back, dark purple color, cracked lips, coated tongue, persistent irritability. Clearly, heavy cooling was indicated. He complained of chest fullness and expectoration of cold, blue-white phlegm. The root condition required warming, but rash-fire required clearing. Compromised strategy: focus heavily on treating the rash. Fourth day: Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Jiegeng (Platycodonis Radix), plus small amounts of Lianqiao (Forsythiae Fructus), Chishao (Paeoniae Radix Rubra), Chao Zhizi (Gardeniae Fructus). Irritability occasionally settled, but cold phlegm surged, 1-2 bowls day and night. External signs: cracked lips, dry mouth, constipation. Shigao (Gypsum Fibrosum) dared not be used; Huafen (Trichosanthis Radix) and Maidong (Ophiopogonis Radix) added for cooling/moistening. Shortly after medication, cold phlegm surged, stomach blocked, external rash dark purple, cracked lips, hoarse voice. Medication dilemma. Hesitated, then used mild formula to maintain. Fifth day: surface fully erupted, rash color slightly recovering. Main complaint: chest closure. Prescribed Er Chen Tang (Two-Aged Decoction), Gancao (Glycyrrhizae Radix et Rhizoma), Jiegeng (Platycodonis Radix), Xingren (Armeniacae Semen Amarum), Chao Zhizi (Gardeniae Fructus). Patient comfortable, appetite increased. Persisted with Er Chen Tang (Two-Aged Decoction) to calm fluid, Gan/Jie to open voice. Over seven days, fluid calmed, fever subsided, voice opened. Despite blazing fire-toxin, Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Shigao (Gypsum Fibrosum) could not be used. Maidong (Ophiopogonis Radix) rejected because fluid retention opposes moistening; Chao Zhizi (Gardeniae Fructus) acceptable because bitter descent does not clog diaphragm. This is pragmatic flexibility. Daily consultation with uncle Shouming avoided bitter-cold herbs. Stool resolved, interior heat drained, cured in ten days. Rigorous or reckless doctors would damage stomach qi and fail. Is sticking to fixed formulas adaptable? Difficult indeed.
It is also stated: Fang's son from Nanyuan, aged nine, developed rash in mid-summer, cheeks not erupted. Doctor ignored seasonal factors, used Shengma Gegen Tang (Cimicifugae and Pueraria Decoction) without effect, mistakenly added Mahuang (Ephedrae Herba). Rash erupted with profuse sweating, fatigue, thirst, wheezing. Doctor failed to switch to yin-nourishing/lung-rescuing, leading to protruding sternum resembling pigeon chest from chronic cough. I said: "Rash not fully erupted requires lifting/dispersing. Summer exterior is deficient; excessive lifting/dispersing causes six fu organs' fire to erupt, harming lungs, heat congesting chest/diaphragm, critical condition. Urgently use Sheng Shashen (Glehniae Radix), Maidong (Ophiopogonis Radix), Douli (Sojae Helvolae Semen) 2 qian each; Danpi (Moutan Cortex) 1 qian; Shigao (Gypsum Fibrosum) 5 qian; Ku Huangqin (Withered Scutellariae Radix), Xingren (Armeniacae Semen Amarum), Jiegeng (Platycodonis Radix), Mutong (Akebiae Caulis) 5 fen each; Zhike (Aurantii Fructus), Gancao (Glycyrrhizae Radix et Rhizoma) 3 fen each. One dose slightly calmed fever. Remove Mutong (Akebiae Caulis), Zhike (Aurantii Fructus); add Zhiren (Gardeniae Fructus), Digupi (Bark of Lycii Radix). Fever reduced 70-80%. Persist with yin-nourishing doses; sternum flattened. Second son, aged seven, post-rash tidal fever for ten days, cough, sore throat, difficulty swallowing rice, limb weakness, inability to sit/stand. Also took Mahuang (Ephedrae Herba) initially. I said: "Excessive dispersing depleted fluids, lung heat scorched leaves, causing flaccidity syndrome. Must purge fire and protect metal, restoring fluids. Formula: Sheng Shashen (Glehniae Radix), Maidong (Ophiopogonis Radix) 2 qian each; Shigao (Gypsum Fibrosum) 3 qian; Jiegeng (Platycodonis Radix), Zhiren (Gardeniae Fructus), Shandougen (Millettiae Radix), Digupi (Bark of Lycii Radix), Niubangzi (Arctii Fructus), Xingren (Armeniacae Semen Amarum), Douli (Sojae Helvolae Semen) 1 qian each; Zhike (Aurantii Fructus), Gancao (Glycyrrhizae Radix et Rhizoma) 3 fen each. One dose stopped sore throat; two doses allowed porridge. Remove Zhiren (Gardeniae Fructus), Zhike (Aurantii Fructus); five-six doses allowed walking. Pigeon chest and lung flaccidity are rare post-rash complications, hence recorded. Without excessive dispersing and mistaken Mahuang (Ephedrae Herba), these would not occur. Summer rash treatment requires caution.
Yu Chunshan's case: Summer of Wushen year, Cheng family summoned me for rash; patient died before arrival. Inquiry revealed: Rash present two days. Doctor said rash incomplete, repeatedly gave Shengma Gegen Tang (Cimicifugae and Pueraria Decoction), causing relentless thirst/restlessness, then rash vanished. Doctor claimed wind closure, instructed heavy clothing, sealed room, hoping re-emergence. Child couldn't speak, pressed hand to cold places for relief, tried to leave, forbidden, then developed spasms and died. Local custom 'rash needs covering' has misled for long. Doctor/patient unaware, tragic. Death clearly due to heat constraint yin depletion, pathogen sinking wind stirring. Arriving next day, second son had fever, sealed room, crying violently. I ordered immediate removal. Family feared wind. I said: "Previous case damaged by sealing; let's try differently." Outside, crying stopped. Removed jacket, smiled. Said: "Disease already largely gone without meds." Family amazed. Prescribed Qing Zao Wei Sheng Tang (Clear Dryness Protect Health Decoction): Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), Loupi (Benincasae Exocarpium), Lugeng (Phragmitis Rhizoma), Nan Shashen (Glehniae Radix), Xingren (Armeniacae Semen Amarum), Jiangzhi (Zingiberis Rhizoma Recens Juice), Chao Mutong (Akebiae Caulis), Sheng Niuzi (Arctii Fructus), Danggui (Angelicae Sinensis Radix), Xixin (Asari Radix et Rhizoma), Lipi (Pyrus Communis Pericarpium), Qinji (Apii Japonici Juice). One dose. Next morning, rash vibrant; evening, rash vanished. Family worried, suspected wind closure outside. I said: "No worry. Child nursing/eating peacefully, fever gone. Light pathogen, correct treatment, cured in one dose. Cough remains, residual heat uncleaned. Use Xingren (Armeniacae Semen Amarum), Maidong (Ophiopogonis Radix), Lugeng (Phragmitis Rhizoma), Lipi (Pyrus Communis Pericarpium) as tea, frequent drinking cured it. Family realized prior errors.
Zhang Xugu's case: Xiaolian Huang Xiaoshan's daughter, over ten years old, rash visible for five days. Pediatrician used standard lifting/dispersing herbs; toxin did not erupt, with wheezing, nasal flaring, day/night restlessness, critical state. Pulse weak-rapid; left Guan/Chi deep-stringy-stagnant. Kidney-liver hidden toxin unexcreted. Heavy Xuan Shen (Scrophulariae Radix), assisted by Zhi Mu (Anemarrhenae Rhizoma), Guixu (Angelicae Sinensis Radix Tip), Chishao (Paeoniae Radix Rubra), Xijiao (Rhino CeratUs), Lingyangjiao (Saiga Tataricae Cornu), Lianqiao (Forsythiae Fructus), Gancao (Glycyrrhizae Radix et Rhizoma). One dose, slept slightly that night. Next day, pulse looser, only intense thirst, still wheezing/flaring. Heat-toxin reached lung/stomach. Heavy Shigao (Gypsum Fibrosum) added. Several doses, gradual recovery. Xuan Shen (Scrophulariae Radix) nourishes water/ detoxifies, stimulates kidney qi; Guixu (Angelicae Sinensis Radix Tip)/Chishao (Paeoniae Radix Rubra) unblock blood collaterals; Xijiao (Rhino CeratUs)/Lingyangjiao (Saiga Tataricae Cornu) are erupting agents; combined with Lianqiao (Forsythiae Fructus), Zhi Mu (Anemarrhenae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), guides toxin from Jueyin channels directly to lung/stomach, exiting via exterior. Hence effective in one dose. Confirms internal toxin unexcreted.世俗 (Common practice) mistakes internal toxin for external sinking, repeatedly using lifting/dispersing, severely depleting lung qi, causing wheezing/restlessness/critical state countless times. Due to ignorance of this principle. I urge future generations to study carefully, do not stick to fixed methods/old theories, to preserve life. Note: This case is heat-toxin hidden internally, so cooling/erupting effective. Those with congenital yuan yang weakness where toxin hard to transform, add small amount of Fuzi (Aconiti Lateralis Radix Praeparata) to cooling/erupting formula to assist yuan yang, sending toxin out, otherwise hard to erupt. Clinicians must adapt. This case illustrates general principles.
Wang Mengying's case: Humid summer, rash prevalent. Pediatricians only know set formulas, randomly using Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Fangfeng (Saposhnikoviae Radix), Gegen (Puerariae Lobatae Radix). Perhaps epidemic disease, nature silently executing killing cycle. Chen Yangshan's family, over ten cases. Eldest son Shufu's daughter most severe. Rash just erupted, menstruation started. Doctors refused treatment, then summoned me. Pulse slippery-rapid, crimson tongue, intense thirst, red face, loss of voice, anorexia, diarrhea. Said: "Due to excessive dispersing, fire盛 (abundant) wind fierce, qi/blood both燔 (blazing). Qi-level pathogen slightly drained via diarrhea; Ying-level heat slightly cooled via menstruation. How can we fear collapse/invasion and recklessly use astringents?" Prescribed Xiyangshen (American Ginseng Radix), Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), Maidong (Ophiopogonis Radix), Xijiao (Rhino CeratUs), Shengdi (Rehmanniae Radix), Lianqiao (Forsythiae Fructus), Gancao (Glycyrrhizae Radix et Rhizoma), ..."