东垣丹溪之书大行于世今之医者见其不用古方率皆效颦辄自制方治病药性不明处方无法
卤莽
乱投反致变症多端遂难识治若非平日熟读本草深究内经而轻自制方者鲜不误人也(王汝言续
医论)
痘疹自汉以前方书不载至拓拔魏时始有方药自唐迄宋有董汲钱乙挺然独出着方立论羽翼
圣经
最为有功近时慈溪赵继宗着小儿痘疹全书板行于世余始读其序窃谓继钱乙之后者一人及读至
终篇详加考究与序大异其书总出六十二方其间喜用紫草蝉壳大力子露蜂房四味如是者凡四十
六
方抑何其偏戾如此耶若小儿气实有风邪热毒者用之可也设使气虚血虚表里不实大便自利灰白
色顶陷切牙寒战等症其可轻用之乎按胡大卿痘疹方论云紫草虽是疮疹家圣药然性寒利大肠若
大便结者可用又云蝉壳八日之后忌用鼠粘子即大力子有虚寒者禁之按本草图经云露蜂房味
苦咸气平有毒主惊痫蛊毒肠痔肿毒风牙等症并不及小儿痘疹赵氏每方用之此用药之一误也小
儿柔脆弱质前哲用药恒少剂不过三四钱赵氏动辄用一两六七钱此用药之二误也或内虚泄泻或
头温足冷或烦渴或腹胀或气喘或寒战切牙此表里俱虚也赵氏则日不可便谓之里虚乃伤食伤冷
所致既曰伤食伤冷泄泻主治仍用鼠粘子紫草此用药之三误也甚至痒塌内虚作泻气促者复投寒
凉之剂此用药之四误也赵氏既云寒战切牙脾胃受冷鼠粘子紫草苦参更不忍舍殊不知寒冷太过
脾胃清纯之气宁无损乎经曰五脏皆禀气于胃胃者五脏之本胃气一虚其死可立而待杨仁斋有云
诸热不可骤去宜轻解之盖痘疮无热则不能起发比之种豆值天时暄暖则易生古人用药审度寒暄
推详运气苟热一偏之见其误人也必矣余岂好辩哉亦幼吾幼之意云尔
李东垣和朱丹溪的著作在世间广泛流传，如今的医生见到他们不使用古方，便都盲目模仿，擅自自制方剂来治病。由于对药性不明，处方没有法度，鲁莽行事，乱投药物，反而导致变症百出，于是难以识别和治疗。如果不是平日熟读《本草》，深入探究《内经》，而轻易自制方剂的人，很少有不误人的。（出自王汝言《续医论》）
痘疹（天花和麻疹等儿童出疹性传染病）在汉代以前的方书中没有记载，直到北魏拓跋氏时期才开始有相关的方药。从唐代到宋代，董汲、钱乙等人脱颖而出，著书立说，辅助经典，最为有功。近来慈溪人赵继宗撰写了《小儿痘疹全书》，刻版发行于世。我开始阅读他的序言时，私下认为他是继钱乙之后唯一能承前启后的人。但读到全书终篇并详细考究后，发现与序言大相径庭。该书总共列出了六十二个方子，其中喜欢使用紫草、蝉壳、牛蒡子、露蜂房这四味药，像这样的情况共有四十六个方子，为什么偏颇乖谬到了这种地步呢？如果小儿体质气实，患有风邪热毒者，使用这些药物是可以的。假如遇到气虚、血虚、表里都不充实、大便自利（腹泻）、粪便呈灰白色、痘顶凹陷、咬牙、寒战等症状，怎么可以轻易使用这些药物呢？
根据胡大卿《痘疹方论》的说法：紫草虽然是治疗疮疹的圣药，但其性寒凉，通利大肠，如果大便干结者可以使用。又说：蝉壳在发病八日后忌用；鼠粘子即牛蒡子，对于有虚寒症状者禁服。根据《本草图经》记载：露蜂房味道苦咸，气平，有毒，主治惊痫、蛊毒、肠痔、肿毒、风牙等症，并没有提到适用于小儿痘疹。赵氏在每个方子里都用它，这是用药的第一个错误。
小儿体质柔弱脆弱，前代名医用药剂量通常很少，不过三四钱。赵氏动辄使用一两、六七钱，这是用药的第二个错误。或者出现内虚泄泻，或者头温足冷，或者烦渴，或者腹胀，或者气喘，或者寒战咬牙，这些都是表里俱虚的表现。赵氏却说不能立刻认定为里虚，认为是伤食或受冷所致。既然说是伤食或受冷导致的泄泻，主治方向应该针对此，但他仍然使用牛蒡子和紫草，这是用药的第三个错误。甚至对于瘙痒塌陷、内虚作泻、气促的患者，反而投以寒凉的药剂，这是用药的第四个错误。
赵氏既然说寒战咬牙是脾胃受冷，牛蒡子、紫草、苦参又都不忍舍弃，殊不知寒冷太过，会损伤脾胃清纯之气吗？《内经》说：五脏都禀受于胃气，胃是五脏的根本。胃气一旦虚弱，死亡就在眼前。杨仁斋曾说：各种热证不可骤然去除，宜轻缓地解除。大概痘疮如果没有热象就不能起发，这就像种豆子遇到天气温暖就容易生长一样。古人用药审慎考量寒暖，推详运气变化。如果持有偏颇的一己之见，那误人必定严重。我难道是好辩吗？也是出于爱护幼小之心罢了。
The works of Li Dongyuan and Zhu Danxi are widely circulated in the world. Physicians today, seeing that they do not use ancient prescriptions, blindly imitate them and arbitrarily create their own formulas to treat diseases. Due to a lack of understanding of drug properties and a lack of methodology in prescribing, they act rashly and indiscriminately administer drugs, which instead leads to numerous complications, making it difficult to identify and treat the conditions. Unless one has diligently studied the *Bencao* (Materia Medica) and deeply investigated the *Neijing* (Inner Canon) in daily life, those who lightly create their own formulas rarely avoid causing harm. (From Wang Ruyan's *Xu Yilun*)
Dermatological eruptions (such as smallpox and measles) were not recorded in medical texts prior to the Han Dynasty. It was not until the time of the Tuoba Wei dynasty that relevant prescriptions and medicines began to appear. From the Tang to the Song dynasties, Dong Ji and Qian Yi emerged prominently, authoring books and establishing theories that supported the classics, contributing greatly. Recently, Zhao Jizong from Cixi published his *Xiao'er Douzhen Quan Shu* (Complete Book of Pediatric Smallpox and Eruptions), which was printed and distributed. When I first read its preface, I privately thought he was the only person capable of succeeding Qian Yi. However, after reading through the entire volume and conducting detailed research, I found it vastly different from the preface. The book contains a total of sixty-two formulas, among which four ingredients—Zicao (Arnebiae Radix seu Cortex, 紫草), Chanshao (Cicadae Periostracum, 蝉壳), Niu Bang Zi (Arctii Fructus, 牛蒡子/大力子), and Lu Feng Fang (Vespa Velutina Nest, 露蜂房)—are frequently used. This occurs in forty-six of the formulas. Why is it so biased and aberrant? If a child has strong Qi and suffers from wind-pathogen heat-toxin, using these drugs may be acceptable. But what if the child has deficient Qi and Blood, with both exterior and interior lacking solidity, spontaneous diarrhea, grayish-white stool, depressed pustule tops, teeth grinding, and chills? How can such drugs be lightly administered?
According to Hu Daqing's *Douzhen Fang Lun*: Although Zicao is considered a sacred medicine for treating skin eruptions, its nature is cold and it promotes bowel movement; thus, it can be used if the stool is constipated. It also states: Chanshao should be avoided after the eighth day of illness; Niu Bang Zi (also known as Shu Niu Zi) is contraindicated for those with deficiency-cold. According to the *Bencao Tujing*: Lu Feng Fang tastes bitter and salty, has a neutral nature, and is toxic. It treats convulsions, gu-poison, intestinal hemorrhoids, swelling/toxins, and wind-related toothache, but does not mention applicability to pediatric dermatological eruptions. Zhao uses it in every formula; this is the first error in medication.
Children have fragile constitutions. Ancient sages typically prescribed small doses, no more than three or two qian. Zhao often prescribes one liang or six to seven qian; this is the second error. Symptoms such as internal deficiency with diarrhea, warmth of the head with cold feet, irritability and thirst, abdominal distension, panting, or chills and teeth grinding indicate both exterior and interior deficiency. Zhao argues that one cannot immediately diagnose interior deficiency, attributing it instead to food stagnation or cold injury. Even if diagnosed as diarrhea caused by food stagnation or cold, he still prescribes Niu Bang Zi and Zicao; this is the third error. Furthermore, for patients with itching, collapsed lesions, internal deficiency with diarrhea, and rapid breathing, he administers cold-natured agents; this is the fourth error.
Zhao claims that chills and teeth grinding result from cold injuring the Spleen and Stomach, yet he refuses to abandon Niu Bang Zi, Zicao, and Kushen. He fails to realize that excessive coldness damages the pure and clear Qi of the Spleen and Stomach. The *Jing* (Canon) states: All five Zang organs receive Qi from the Stomach; the Stomach is the root of the five Zang organs. Once Stomach Qi is deficient, death follows swiftly. Yang Renzhai stated: Heat syndromes should not be abruptly cleared but rather gently resolved. Generally, without heat, dermatological eruptions cannot erupt and rise, similar to how beans grow easily when the weather is warm. Ancients carefully weighed cold and heat, analyzing climatic influences. Holding a biased view will inevitably cause great harm. Do I enjoy arguing? No, it is merely out of my desire to protect the young.