杨氏子疹后痢下鲜血，用当归梢、生地、白芍、条芩炒、黄连炒、人参、甘草、枳壳、乌梅而愈。凡出疹
利血者，此方皆效。
钱乙诊睦亲宫中十大王疮疹云∶曰∶疮疹始终出，未有他证，不可下，但当用平和药，频与乳食，不受风
冷可也。如疮疹三日不出，或出不快，即微发之。（鼠粘子汤之类。）如疮发后，不多出即加药。（如一日一帖，
即加至二贴。）加药不出，即大发之。（升麻、葛根、羌活、防风、独活、麻黄、桂枝之类。）如发后不多，
及脉平无症，即疮本稀，不可更发也。有大热者，当利小便。小热者，当解毒。（利小便，四圣散之类。）若不快，
勿攻勿下，止用抱龙丸治之。若有大热能食者，大黄下一二行即止。若黑紫干陷者，百祥丸下之，不黑慎勿下。
身热烦躁，腹满而喘，大小便涩，面赤闷乱，大吐，此当利小便。不瘥者，宜宣风散下之也。若五七日痂不焦，
是内热气蒸于皮中，故疮不得焦痂也，宜宣风散导之，用生犀角磨汁解之，使热不生，必着痂也。（此条议论有
极是者，有未尽协者，分别观之可也。）
睦亲宫十太尉疮疹，众医治之。王曰∶疹未出，属何脏腑？一医言胃气热，一医言伤寒不退，一医言在母
腹中有毒。属何脏也？医曰∶在脾胃。钱氏曰∶何以惊悸？皆无所对。钱氏曰∶夫胎在腹，月至六七，则已成
形，食母腹中秽液，入儿五脏，食至十月，即秽液满胃。至生时，儿口犹不洁，产母以手拭净，则无疾病。俗
以黄连、汞粉下其邪秽之粪，此亦由不洁余气入儿脏中，本先因微寒，又遇风寒，邪气相搏，而痘疹成也。未
出欲作之时，热动五脏，则五脏之证先见。初欲病时，先呵欠烦闷，惊悸，乍凉乍热，手足冷，面腮颊赤燥，
咳嗽喷嚏，此五脏症俱见也。呵欠烦闷者，肝也。时发惊悸者，心也。乍凉乍热，手足冷者，脾也。面腮颊赤
燥，咳嗽喷嚏者，肺也。惟肾无候。以在腑下，不能食故也。凡疮疹乃五脏毒，若出归一症，汗水泡心为斑，
脾为疹。肾虽无症，其后恶者，疹变倒靥而黑陷，则归肾也。此由不慎风冷，而不能食，内虚所致也。今太尉
疹子无他症，当用平和药为治，因用抱龙丸数服愈。（海藏云∶本先因微寒入一句，并由不慎风冷而不能食
内虚一句，勿认作寒症，用抱龙丸，即知斑疹之多热也。）
吴桥治侄孙始孩，累日发热蒸蒸，惊搐 愦，众医不知所以。桥曰∶麻也，寒邪外乘，闭而不出，是呱呱
耳。饮药已数，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，稍拥被围之，汤气自远
熏蒸，少饮药内托，麻出而解。后汪氏子病如子，亦用此法并效。
薛立斋治一小儿，患疹作痛，发热烦渴，欲服清凉饮下之。诊其脉不实，举指不数，此邪在经络也，不可
下，遂用解毒防风汤，二剂而愈。此症小儿多患之，须审在表在里，及邪之微甚而治之。王海藏曰∶前人云，
首尾俱不可下者何也？曰∶首不可下者，谓斑未见于表，下则邪气不得伸越，此脉症有表而无里，故禁首不可
下也。尾不可下者，谓斑毒已显于外，内无根蒂，大便不实，无一切里症，下则斑逆陷，故禁尾不可下也。
一儿作痒发热，以消毒犀角饮，一剂作吐泻，此邪气上下俱出也，毒自解。少顷，吐泻俱止，其症果消。
吐泻后，脉见七至，此小儿和平之脉也，邪已尽矣。不须治，果愈。洁古云∶斑疹之病，其为症各异。发 肿
于外者，属少阳三焦相火也，谓之斑。小红行皮肤之中不出者，属少阴君火也，谓之疹。凡显斑疹，若自吐泻
者，慎勿乱治而多吉，谓邪火上下皆出也。斑疹并出，小儿虽禁，是以别生他症也。首尾不可下，大抵安理之
药多，发表之药少。秘则微疏之，令邪气不拥，并令其次第出，使儿易见也。身温暖者顺，身凉者逆。
沈明生治沈翰臣妇，咳嗽发热。或认为不足，遂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。二剂咳瘥缓，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。沈笑曰∶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，然质浊味浓，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，
尤乘病变之机。自来善用六味者，（何曾善用，止可谓之滥用。）无过薛立斋。假使九原可作，视近日之汤法
盛行，能无掩口葫芦哉。
痧疹者，手太阴肺，足阳明胃，二经之火热也。小儿居多，大人亦时有之。殆时气温疫之类，其症类多咳
嗽，多嚏，眼中多泪，多泄泻，多痰，多热，多渴，多烦闷，甚则躁乱咽痛，唇焦神昏，是其候也。治法当以
清凉发散为主，药用辛寒、甘寒、苦寒，以升发之。惟忌酸收，最宜辛散。误施温补，祸不施踵。辛散如荆芥
穗、干葛、西河柳、石膏、麻黄、鼠粘子；清凉如元参、栝蒌根、薄荷、竹叶、青黛；甘寒如麦冬、生甘草、
蔗浆；苦寒如黄芩、黄连、黄柏、贝母、连翘，皆应用之物也。量症轻重，制剂大小，中病即已，无太过焉。
痧疹乃肺胃热邪所致，初发时多咳嗽，宜清热透毒，不得止咳。疹后咳嗽，但用贝母、栝蒌根、甘草、麦
冬、苦梗、元参、薄荷，以清余热，消痰壅，则自愈，慎勿用五味子收敛之剂。多喘，喘者，热邪拥于肺也，
慎勿用定喘药，惟应大剂竹叶、石膏，加西河柳两许，元参、薄荷各二钱。如冬天寒甚，疹毒为寒气郁于内，
不得透出者，加蜜酒炒麻黄，一剂立止。凡热势甚者，即用白虎汤加西河柳，切忌过用升麻，服之必喘。多泄
泻，慎勿止泻，惟用黄连、升麻、干葛、甘草，则泻自止。（藜按∶此却未妥，泻乃肺移热于大肠，仍以清肺
为主。）疹家不忌泻，泻则阳明之热邪得解，是亦表里分消之义也。疹后泄泻及便脓血，皆由热邪内陷故也，
大忌止涩，仍用升麻、干葛、白芍、甘草、扁豆、黄连。便脓血则加滑石，必自愈。疹后牙疳最急，外用雄黄、
牛粪，先 存性，研极细，加真冰片一分，研匀吹之，内用连翘、荆芥穗、元参、干葛、升麻、（藜按∶二
味宜再酌。）黄连、甘草、生地，煎好，加犀角汁二三十匙调服，缓则不可救药。疹后元气不复，脾胃虚弱，
宜用白芍、炙草为君，莲肉、
扁豆、山药、青黛、麦冬、龙眼肉为臣，多服必渐愈，慎勿轻用参、术。疹后生疮不已，余毒未尽也，用金银
花、连翘、荆芥穗、元参、甘草、生地、鳖虱、胡麻、黄连、木通，浓煎饮之良。（《广笔记》。）
叶天士曰∶痧属阳，肺经邪初起，必从表治。症见头痛喘急，咳嗽气粗，口恶。一日二日即发者轻，三五
日者重。阳病七日外，隐伏不透，邪反内攻，喘不止，必腹痛秘闷，危矣。治法宜苦辛清热，凉膈去硝、黄。
方书谓足阳明胃疹，如云布密，或大颗如痘，但无根盘。方书谓手太阴肺疹，但有点粒，无片片者，用辛
散解肌。冬月无汗，壮热喘急，用麻黄、杏，如华盖散、三拗汤。夏月无汗，用辛凉解肌，葛根、前胡、薄荷、
防风、香薷、牛蒡、桔梗、木通之属。
古人以表邪口渴即加葛根，以其升阳明胃津。热甚烦渴，用石膏辛寒解肌，无汗忌用。
凡疮疹辛凉为宜用，连翘辛凉，翘出众草，能升能清，最利幼科，能解小儿六经诸热。
春令发疹从风温，夏季从暑，风暑蓄湿，秋令从热烁燥气，冬月从风寒。
疹宜通，泄泻为顺。下痢五色者，亦无妨。惟二便不利者，最多凶症，治法大忌止泻。疹本六气客邪，风
寒暑湿，必从火化。疹既外发，世人皆云邪透，孰谓出没之际，升必有降，胜必有复。常有疹外发，内热不
除，致咽哑龈腐，喘急腹胀，下痢不食，烦躁昏沉，竟以告毙者，皆属里症不清致变。须分三焦受邪属多，或
兼别病累瘁，须细体认。上焦药用清凉，中焦药用苦辛寒，下焦药用咸。（徐灵胎曰∶当用清涤内邪之法。）
上焦药气味宜轻，以肺主气，皮毛属肺之合。外邪宜辛胜，里甚宜苦胜。若不烦渴，病日多，邪郁不清，
可淡渗以泄气分。（徐灵胎曰∶叶氏用药，专重气味，此语本之《内经》，即《神农本草》亦首列之。但终当深
知其药，专治其病，各有功能，然后再于其中，择气味之合者而用之，方得《内经》、《本草》之旨。兹徒知
其气味，则终无主见也。）
中焦药疹火在中，为阳明燥化，多气多血。用药味苦寒为宜。若日多，胃津消烁，苦则助燥劫津，甘寒宜用。
下焦药咸苦为主，若热毒下注成痢，不必咸以软坚，但取苦味坚阴燥湿。
古人以疹为经腑之病，忌温燥涩补，所谓痘宜温暖，疹宜清凉也。然常有气弱体虚，表散寒凉非法，淹淹
酿成损怯。此但阴伤为多，救阴必扶持胃汁。气衰者亦有之，当益气。稚年阳体，纯刚之药忌用。幼科方书歌
括曰∶赤疹遇清凉而消，白疹得温暖而解。此温字即后人酒酿，柽木粗草纸，木绵纱之属，（徐灵胎曰∶不
是此温法。）虽不可不和，然近年用者多无益。（徐灵胎曰∶小儿外治之法最多。）
疳疹湿盛热蒸，口舌咽喉疳蚀，若不速治，有穿腮破颊，咽闭喘促告毙矣。治之宜早，外治另有专方。若
汤方法，必轻淡能解上病，或清散亦可。
疹痢乃热毒内陷，与伤寒协热邪尽则痢止同清，忌升提，忌补涩。轻则分利宣通，重则苦寒解毒。
杨氏之子出疹后出现痢疾，排出鲜血，使用当归梢、生地、白芍、炒条芩、炒黄连、人参、甘草、枳壳、乌梅而痊愈。凡是出疹期间伴有下血症状的，此方都有效。
钱乙诊治睦亲宫中十大王的疮疹时说：“如果疮疹从头到尾顺利发出，没有其他兼证，不可使用泻下法，只应当用平和的药物，频繁给予乳食，避免受风冷即可。如果疮疹三天不出，或者发出不顺畅，就轻微地发散它。（如鼠粘子汤之类。）如果疮疹发出后，数量不多就增加药量。（比如一天一帖，就增加到两帖。）增加药量后仍不发出来，就大力发散它。（如升麻、葛根、羌活、防风、独活、麻黄、桂枝之类。）如果发散后仍然发得不充分，且脉象平和没有症状，说明原本疮疹就稀疏，不可再强行发散。如果有大热的，应当通利小便。小热的，应当解毒。（通利小便，可用四圣散之类。）如果病情不缓解，不要攻伐也不要泻下，只用抱龙丸治疗。如果有大热且能进食的，用大黄泻下一两次就停止。如果疮色黑紫干枯内陷的，用百祥丸泻下，如果不黑千万不要泻下。身体发热烦躁，腹部胀满且气喘，大小便涩滞不通，面色红赤闷乱，剧烈呕吐，这应当通利小便。如果不愈，宜用宣风散泻下。如果五到七天后结痂不焦枯，是因为体内热气蒸腾于皮肤之中，所以疮不能形成焦痂，宜用宣风散导泄，用生犀角磨汁解毒，使热气不生，必然能结痂。（这条议论有非常正确的地方，也有不够周全的地方，需要分别看待。）
睦亲宫十太尉患疮疹，众医生医治他。王爷问：“疹子还没出来，属于哪个脏腑？”一个医生说胃气热，一个医生说伤寒未退，一个说在母腹中有毒。属于哪个脏呢？医生说：在脾胃。钱乙问：“为什么会有惊悸症状？”众医都无法回答。钱乙说：“胎儿在腹中，到了六七个月时已经成形，吞食母腹中的秽液，进入婴儿五脏，吃到十个月时，秽液充满胃部。到出生时，婴儿口中仍有不洁之物，产母用手擦拭干净，就不会生病。世俗常用黄连、汞粉来给婴儿排泄邪秽之粪，这也是因为不洁余气进入婴儿脏腑，本来先因轻微受寒，又遇到风寒，邪气相互搏结，从而形成痘疹。在未出欲作之时，热动五脏，则五脏的症状先显现。刚想发病时，先呵欠烦闷，惊悸，忽冷忽热，手脚冰凉，面颊腮部红赤干燥，咳嗽喷嚏，这是五脏症状都显现了。呵欠烦闷的是肝。时常惊悸的是心。忽冷忽热、手脚凉的是脾。面颊腮部红赤干燥、咳嗽喷嚏的是肺。只有肾没有征候。因为它位于腑之下，不能进食的缘故。凡是疮疹都是五脏的毒，如果发出后归于一症，汗水泡心为斑，脾为疹。肾虽然没有症状，但后来恶化的，疹子变倒靥而黑陷，则归于肾。这是由于不慎受风冷，而不能进食，导致内虚所致。现在太尉的疹子没有其他症状，应当用平和药物治疗，因此用了抱龙丸几服就好了。（海藏说：‘本先因微寒入’一句，以及‘由不慎风冷而不能食内虚’一句，不要认作寒症，用抱龙丸，就知道斑疹多属热证了。）”
吴桥治疗侄孙始孩，连续几天发热蒸蒸，惊搐昏愦，众医生不知道原因。吴桥说：“这是麻疹，寒邪外乘，闭塞而不出，是呱呱（婴儿）的病症。服药已多次，中气受损，药物不足以依赖。应当放一瓶沸水，去掉盖子，让保姆抱着孩子坐在汤瓶旁边，稍微盖被围住它，汤气从远处熏蒸，少量服用内托的药，麻疹发出而病解。后来汪氏的儿子患病如出一辙，也用此法并见效。”
薛立斋治疗一个小孩，患疹子疼痛，发热烦渴，想要服用清凉饮来泻下。诊察他的脉象不实，举指不数急，这是邪气在经络，不可泻下，于是用解毒防风汤，两剂而愈。这种病症小儿多患，必须审察是在表还是在里，以及邪气的轻重而治疗。王海藏说：“前人说，首尾都不可泻下，为什么呢？说：开头不可泻下，是指斑毒尚未见于体表，泻下则邪气不得伸越，这是脉症有表而无里，所以禁止开头不可泻下。结尾不可泻下，是指斑毒已显于外，内部无根蒂，大便不实，没有一切里症，泻下则斑毒逆陷，所以禁止结尾不可泻下。”
一个小孩瘙痒发热，用消毒犀角饮，一剂后出现吐泻，这是邪气上下都出来了，毒自然解除。过了一会儿，吐泻都停止，症状果然消退。吐泻后，脉象见七至，这是小儿和平的脉象，邪气已尽。不需要治疗，果然痊愈。洁古说：“斑疹的病，其症状各异。发肿于外的，属于少阳三焦相火，称为斑。小红行于皮肤之中不出来的，属于少阴君火，称为疹。凡是显现斑疹，如果自行吐泻的，千万不要乱治而大多吉利，说是邪火上下都出来了。斑疹并出，小儿虽然禁忌（攻下），是因为别生他症。首尾不可泻下，大体上安理的药物多，发表的药物少。秘结则轻微疏利，令邪气不壅拥，并令其次第发出，使小儿容易看见。身体温暖的是顺证，身体凉的是逆证。”
沈明生治疗沈翰臣的妻子，咳嗽发热。有人认为是不足，于是用六味地黄汤以滋阴分，随后咳逆更剧烈。诊察她，脉浮且数，风热干犯肺家，宜用疏表的药剂。服用后，遍身发出红疹。两剂后咳嗽减轻，但仍未透发，再用辛凉等味以清表热。仍然咳嗽，又发作腹泻不止，大家都归咎于寒凉。沈笑曰：“不是这样。肺受风邪，邪变为热。经云：邪并于阳，则阳热而阴虚。开始时疹子在欲出未出之际，火上炎于手太阴而作嗽，现在疹子在欲收未收之时，热下移于手阳明而作泻，这是斑疹的常见症状，有什么可奇怪的？即将停止了。”果然过了两天，咳嗽安宁腹泻停止，身体凉疹退。按：斑疹的候虽异，斑疹的治疗略同。这一年丁未年湿土司天，而春夏之交，燥旱殊甚，大概是袭取去年燥金在泉的余气罢了。所以初起应当凉解，而不利于温散；次起应当寒润，而不利于温补。六味地黄丸之类的，虽然看似适宜，然而质地浑浊味道浓厚，不但不能达表，反而锢蔽外邪。施用于疹退而余热未清之时，稍为近理。现在初热始嗽，就为之使用，这不是滋阴，乃是滋害。况且把丸药改为汤剂，已不是古人的本意，而专投泛用，更是乘病变之机。自来善用六味的，（何曾善用，只可谓之滥用。）不过薛立斋。假使九原可作，看近日汤法盛行，能不掩口葫芦吗？
痧疹，是手太阴肺、足阳明胃二经的火热。小儿居多，大人也时有之。大概是时气温疫之类，其症状多咳嗽，多嚏，眼中多泪，多泄泻，多痰，多热，多渴，多烦闷，甚至躁乱咽痛，唇焦神昏，这是它的候。治法当以清凉发散为主，药用辛寒、甘寒、苦寒，以升发之。惟忌酸收，最宜辛散。误施温补，祸不旋踵。辛散如荆芥穗、干葛、西河柳、石膏、麻黄、鼠粘子；清凉如元参、栝蒌根、薄荷、竹叶、青黛；甘寒如麦冬、生甘草、蔗浆；苦寒如黄芩、黄连、黄柏、贝母、连翘，都是应用之物。量症轻重，制剂大小，中病即已，无太过焉。
痧疹乃肺胃热邪所致，初发时多咳嗽，宜清热透毒，不得止咳。疹后咳嗽，但用贝母、栝蒌根、甘草、麦冬、苦梗、元参、薄荷，以清余热，消痰壅，则自愈，慎勿用五味子收敛之剂。多喘，喘者，热邪拥于肺也，慎勿用定喘药，惟应大剂竹叶、石膏，加西河柳两许，元参、薄荷各二钱。如冬天寒甚，疹毒为寒气郁于内，不得透出者，加蜜酒炒麻黄，一剂立止。凡热势甚者，即用白虎汤加西河柳，切忌过用升麻，服之必喘。多泄泻，慎勿止泻，惟用黄连、升麻、干葛、甘草，则泻自止。（藜按：此却未妥，泻乃肺移热于大肠，仍以清肺为主。）疹家不忌泻，泻则阳明之热邪得解，是亦表里分消之义也。疹后泄泻及便脓血，皆由热邪内陷故也，大忌止涩，仍用升麻、干葛、白芍、甘草、扁豆、黄连。便脓血则加滑石，必自愈。疹后牙疳最急，外用雄黄、牛粪，先存性，研极细，加真冰片一分，研匀吹之，内用连翘、荆芥穗、元参、干葛、升麻、（藜按：二味宜再酌。）黄连、甘草、生地，煎好，加犀角汁二三十匙调服，缓则不可救药。疹后元气不复，脾胃虚弱，宜用白芍、炙草为君，莲肉、扁豆、山药、青黛、麦冬、龙眼肉为臣，多服必渐愈，慎勿轻用参、术。疹后生疮不已，余毒未尽也，用金银花、连翘、荆芥穗、元参、甘草、生地、鳖虱、胡麻、黄连、木通，浓煎饮之良。（《广笔记》。）
叶天士说：“痧属阳，肺经邪初起，必从表治。症见头痛喘急，咳嗽气粗，口恶。一日二日即发者轻，三五日者重。阳病七日外，隐伏不透，邪反内攻，喘不止，必腹痛秘闷，危矣。治法宜苦辛清热，凉膈去硝、黄。方书谓足阳明胃疹，如云布密，或大颗如痘，但无根盘。方书谓手太阴肺疹，但有点粒，无片片者，用辛散解肌。冬月无汗，壮热喘急，用麻黄、杏，如华盖散、三拗汤。夏月无汗，用辛凉解肌，葛根、前胡、薄荷、防风、香薷、牛蒡、桔梗、木通之属。古人以表邪口渴即加葛根，以其升阳明胃津。热甚烦渴，用石膏辛寒解肌，无汗忌用。凡疮疹辛凉为宜用，连翘辛凉，翘出众草，能升能清，最利幼科，能解小儿六经诸热。春令发疹从风温，夏季从暑，风暑蓄湿，秋令从热烁燥气，冬月从风寒。疹宜通，泄泻为顺。下痢五色者，亦无妨。惟二便不利者，最多凶症，治法大忌止泻。疹本六气客邪，风寒暑湿，必从火化。疹既外发，世人皆云邪透，孰谓出没之际，升必有降，胜必有复。常有疹外发，内热不除，致咽哑龈腐，喘急腹胀，下痢不食，烦躁昏沉，竟以告毙者，皆属里症不清致变。须分三焦受邪属多，或兼别病累瘁，须细体认。上焦药用清凉，中焦药用苦辛寒，下焦药用咸。（徐灵胎曰：当用清涤内邪之法。）上焦药气味宜轻，以肺主气，皮毛属肺之合。外邪宜辛胜，里甚宜苦胜。若不烦渴，病日多，邪郁不清，可淡渗以泄气分。（徐灵胎曰：叶氏用药，专重气味，此语本之《内经》，即《神农本草》亦首列之。但终当深知其药，专治其病，各有功能，然后再于其中，择气味之合者而用之，方得《内经》、《本草》之旨。兹徒知其气味，则终无主见也。）中焦药疹火在中，为阳明燥化，多气多血。用药味苦寒为宜。若日多，胃津消烁，苦则助燥劫津，甘寒宜用。下焦药咸苦为主，若热毒下注成痢，不必咸以软坚，但取苦味坚阴燥湿。古人以疹为经腑之病，忌温燥涩补，所谓痘宜温暖，疹宜清凉也。然常有气弱体虚，表散寒凉非法，淹淹酿成损怯。此但阴伤为多，救阴必扶持胃汁。气衰者亦有之，当益气。稚年阳体，纯刚之药忌用。幼科方书歌括曰：赤疹遇清凉而消，白疹得温暖而解。此温字即后人酒酿，柽木粗草纸，木绵纱之属，（徐灵胎曰：不是此温法。）虽不可不和，然近年用者多无益。（徐灵胎曰：小儿外治之法最多。）疳疹湿盛热蒸，口舌咽喉疳蚀，若不速治，有穿腮破颊，咽闭喘促告毙矣。治之宜早，外治另有专方。若汤方法，必轻淡能解上病，或清散亦可。疹痢乃热毒内陷，与伤寒协热邪尽则痢止同清，忌升提，忌补涩。轻则分利宣通，重则苦寒解毒。”
The son of the Yang family developed dysentery with fresh blood after suffering from measles (Shazhen). He was cured using Danggui Shao (Tail of Angelica Sinensis), Dihuang (Rehmannia Root), Baishao (White Peony Root), Chao Tiaoqin (Stir-fried Scutellaria Root), Chao Huanglian (Stir-fried Coptis Rhizome), Renshen (Ginseng), Gancao (Licorice Root), Zhike (Aurantium Fructus), and Wumei (Mume Fruit). This formula is effective for all cases of bleeding during the eruption of rashes.
Qian Yi diagnosed the rash of the Ten Great King in the Muqin Palace, stating: "If the sores and rashes erupt completely from beginning to end without other symptoms, purgation should not be used; only mild and harmonizing medicines should be given frequently along with milk and food, avoiding wind and cold. If the sores do not appear within three days or fail to erupt smoothly, a mild diaphoretic approach should be employed (such as Niubangzi Tang [Arctii Fructus Decoction]). If the sores appear but are sparse, increase the dosage (e.g., from one decoction per day to two). If they still do not appear after increasing the dose, use strong diaphoretics (such as Shengma, Gegen, Qianghuo, Fangfeng, Duhuo, Mahuang, Guizhi). If even after diaphoresis the eruption remains sparse, and the pulse is calm with no symptoms, it indicates that the rash was originally sparse, and forcing further eruption is contraindicated. For high fever, promote urination. For slight heat, resolve toxicity (promoting urination can be done with Sisheng San [Four Saints Powder]). If there is no improvement, avoid aggressive purging; instead, use Baolong Wan [Dragon-Embracing Pill]. If there is high fever but the patient can eat, use Dahuang (Rhubarb) to induce bowel movement once or twice and then stop. If the sores are black, purple, dry, and sunken, use Baixiang Wan [Hundred Auspicious Pills] to purge; if not black, absolutely do not purge. For body heat, irritability, abdominal fullness, wheezing, difficulty in urination and defecation, red face, confusion, and severe vomiting, promote urination. If this fails, use Xuanfeng San [Wind-Releasing Powder] to purge. If scabs do not dry up after five to seven days, it is because internal heat steams the skin, preventing scabbing. Use Xuanfeng San to guide out the heat, and apply Sheng Xijiao (Fresh Rhino Horn) juice to resolve toxicity, ensuring heat does not persist, which will lead to scabbing. (This discussion has valid points and some shortcomings; they should be viewed separately.)"
When the Ten Taifui of Muqin Palace suffered from sores and rashes, various physicians treated him. The Prince asked, "Which organ system does the unemerged rash belong to?" One physician said it was stomach heat; another said it was unresolved cold damage (Shanghan); a third said it was toxin acquired in the womb. Which zang organ is it? The physician replied, "It belongs to the spleen and stomach." Qian Yi asked, "Why is there palpitation and fright?" None could answer. Qian Yi said, "When the fetus is in the womb, by the sixth or seventh month, its form is complete. It swallows impure fluids from the mother's abdomen, entering the infant's five zang organs. By the tenth month, these impure fluids fill the stomach. At birth, the infant's mouth is still unclean; if the mother wipes it clean with her hand, disease will not occur. Common practice uses Huanglian (Scutellaria Root) and Hongfen (Cinnabar powder) to purge the toxic feces, but this allows residual impurity to enter the infant's organs. Originally caused by slight cold, combined with wind-cold, the pathogenic factors struggle, forming acne and rashes. Before eruption, when heat stirs the five zang organs, their symptoms appear first. Initially, there are yawning and restlessness, palpitations, alternating chills and fever, cold extremities, red and dry cheeks, coughing, and sneezing—symptoms of all five zang organs. Yawning and restlessness indicate the liver. Palpitations indicate the heart. Alternating chills/fever and cold limbs indicate the spleen. Red/dry cheeks, cough, and sneezing indicate the lungs. Only the kidney shows no signs because it is located below the fu organs and does not receive food. Sores and rashes are toxins of the five zang organs. If they merge into one symptom, sweat-soaked sores on the heart become macules (Ban), while those on the spleen become papules (Zhen). Although the kidney has no specific sign, if the condition worsens later with inverted, black, and sunken rashes, it returns to the kidney. This is due to exposure to wind-cold and inability to eat, leading to internal deficiency. Since the Taifui's rash has no other symptoms, treat with mild medicines. Several doses of Baolong Wan resulted in recovery. (Haizang noted: Do not mistake 'originally slight cold' or 'internal deficiency from wind-cold/poor appetite' as cold syndromes; using Baolong Wan reveals that macules and rashes are mostly heat syndromes.)"
Wu Qiao treated his nephew's young child who had been feverish for several days with convulsions and confusion. Physicians did not know the cause. Wu Qiao said, "This is measles. External cold pathogens have blocked the pores, preventing eruption. It is merely an infant's illness. Medications have damaged the middle qi and are no longer reliable. Place a bottle of boiling water, remove the lid, and have the nurse hold the child beside it, covering them slightly with a blanket. The steam will gently fumigate the child. Administer small amounts of internal-supporting medicine. Once the measles eruptate, the illness will resolve. Later, Wang's son had similar symptoms and was also cured by this method."
Xue Lizhai treated a child with painful, feverish, and thirsty rashes. The parents wanted to use Qingliang Yin [Cooling Drink] to purge. Xue found the pulse neither solid nor rapid, indicating the pathogen was in the meridians, not suitable for purging. He used Jiedu Fangfeng Tang [Detoxifying Saposhnikovia Decoction], and the child recovered in two doses. This condition is common in children; treatment must distinguish between exterior and interior locations and the severity of the pathogen. Wang Haizang stated: "Why do predecessors say purging is forbidden at both the beginning and end? Purging is forbidden at the beginning because macules have not yet appeared on the surface; purging prevents the pathogen from extending outward. This presents exterior symptoms without interior excess, hence purging is forbidden. Purging is forbidden at the end because the macule toxin is already manifest externally, lacking an internal root, with loose stools and no interior symptoms. Purging would cause the macules to collapse inward, hence it is forbidden."
A child with itchy fever was treated with Xiaodu Xijiao Yin [Toxin-Resolving Rhinoceros Horn Decoction]. After one dose, he vomited and had diarrhea, indicating the pathogen was exiting through both upper and lower orifices, resolving the toxicity. Soon after, vomiting and diarrhea stopped, and symptoms subsided. The pulse showed seven beats per breath, a normal pediatric pulse, indicating the pathogen was exhausted. No further treatment was needed, and the child recovered. Jiegu stated: "Symptoms of macules and rashes vary. Swelling on the exterior belongs to the Shaoyang Sanjiao Minister Fire, called macules. Small red spots remaining within the skin belong to the Shaoyin Sovereign Fire, called rashes. If macules/rashes appear with spontaneous vomiting/diarrhea, do not interfere; this is auspicious as the fire exits both ways. When macules and rashes erupt together, purging is contraindicated as it may cause other complications. Generally, harmonizing medicines are preferred over diaphoretics. If constipated, mildly loosen the bowels to prevent pathogen stagnation and allow orderly eruption. Warm body indicates favorable prognosis; cool body indicates unfavorable. Shen Mingsheng treated Shen Hanchen's wife for cough and fever. Others assumed deficiency and used Liuwei Dihuang Tang [Six-Ingredient Rehmannia Decoction] to nourish yin, worsening the cough. Shen found a floating and rapid pulse, diagnosing wind-heat attacking the lungs. He used exterior-releasing agents. After two doses, red rashes appeared all over, and cough improved but did not fully clear. He added acrid-cool herbs to clear exterior heat. Cough persisted, followed by persistent diarrhea. Everyone blamed the cold-natured medicines. Shen laughed, "Incorrect. Lung affected by wind transforms into heat. As the Classics state, when pathogen combines with yang, yang becomes hot and yin deficient. Initially, the rash was about to emerge, fire flared upward to the Hand-Taiyin Lung mer causing cough. Now, as the rash recedes, heat shifts downward to the Hand-Yangming Large Intestine meridian causing diarrhea. This is a common course of macules/rashes, nothing strange. It will stop soon." Indeed, after two days, cough ceased, diarrhea stopped, body cooled, and rashes faded. Note: While manifestations differ, treatments are similar. In the Dingwei year, damp-earth governed the heaven, but spring/summer were extremely dry, likely inheriting last year's dry-metal earth energy. Thus, initial treatment requires cooling resolution, not warming dispersion; subsequent treatment requires cold-moistening, not warming-tonifying. Liuwei Dihuang Wan [Six-Ingredient Rehmannia Pill], though seemingly appropriate, is heavy and cloying, failing to reach the exterior and instead trapping pathogens. It might be suitable only when rashes fade and residual heat remains. Using it initially for heat/cough is not nourishing yin but nourishing harm. Converting pills to decoctions deviates from ancient intent, and blind application exploits pathological changes. Even Xue Lizhai, known for using Liuwei well, arguably abused it. If he were alive today, seeing the prevalence of such decoctions, he would surely cover his mouth in dismay.
Sha Zhen (Scarlet Rash) is fire-heat of the Hand-Taiyin Lung and Foot-Yangming Stomach meridians. It is common in children but occurs in adults too. It resembles seasonal warm epidemics. Symptoms include cough, sneezing, tearing, diarrhea, phlegm, fever, thirst, irritability, and in severe cases, agitation, sore throat, cracked lips, and coma. Treatment focuses on cooling and dispersing, using acrid-cold, sweet-cold, and bitter-cold herbs to ascend and release. Avoid sour-astringents; prefer acrid-dispersants. Mistaken use of warming-tonics leads to disaster. Acrid-dispersants include Jingjie Sui (Schizonepeta Spike), Genge (Pueraria Root), Xihe Liu (Tamarix Twig), Shigao (Gypsum), Mahuang (Ephedra), Niubang Zi (Arctium Fruit). Cooling herbs include Xuanshen (Scrophularia Root), Gualou Gen (Trichosanthes Root), Bohe (Mint), Zhuye (Bamboo Leaf), Qingdai (Indigo Naturalis). Sweet-cold herbs include Maidong (Ophiopogon Root), Sheng Gancao (Raw Licorice), Zhe Jiang (Sugarcane Juice). Bitter-cold herbs include Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Huangbai (Phellodendron Bark), Beimu (Fritillaria Bulb), Lianqiao (Forsythia Fruit). Dosage depends on severity; stop when the disease is addressed, avoiding excess.
Sha Zhen is caused by lung-stomach heat. Early cough requires clearing heat and venting toxicity, not stopping cough. Post-rash cough should be treated with Beimu, Gualou Gen, Gancao, Maidong, Jiegeng (Platycodon Root), Xuanshen, Bohe to clear residual heat and resolve phlegm; avoid Wuweizi (Schisandra Berry) astringents. Wheezing indicates heat congesting the lungs; avoid anti-wheezing drugs. Use large doses of Zhuye, Shigao, plus Xihe Liu, Xuanshen, Bohe. In winter, if cold traps toxin internally, add Honey-Wine Stir-fried Mahuang. For severe heat, use Baihu Tang [White Tiger Decoction] plus Xihe Liu; avoid excessive Shengma (Cimicifuga), which causes wheezing. Diarrhea should not be stopped; use Huanglian, Shengma, Genge, Gancao to resolve it naturally. (Li notes: This is imperfect; diarrhea results from lung heat transferring to large intestine; focus on clearing lung heat.) Measles patients do not fear diarrhea; it resolves yangming heat, representing simultaneous exterior-interior resolution. Post-rash diarrhea and bloody stool result from heat sinking; avoid astringents. Use Shengma, Genge, Baishao, Gancao, Bian Dou (Lablab Bean), Huanglian. Add Huashi (Talcum) for bloody stool. Post-rash gum rot (Yagan) is urgent. Externally, use Xionghuang (Realgar), Niu Fen (Cow Manure) calcined, finely ground, mixed with Bingpian (Borneol), blown into gums. Internally, use Lianqiao, Jingjie Sui, Xuanshen, Genge, Shengma, Huanglian, Gancao, Dihuang decocted, mixed with Xijiao (Rhino Horn) juice. Delay is fatal. Post-rash weakness and spleen/stomach deficiency require Baishao and Zhi Gancao (Roasted Licorice) as sovereigns, with Lian Rou (Lotus Seed), Bian Dou, Shanyao (Dioscorea Rhizome), Qingdai, Maidong, Longyan Rou (Longan Aril) as ministers. Take frequently for gradual recovery; avoid Renshen (Ginseng) and Baizhu (Atractylodes). Persistent sores post-rash indicate residual toxin; use Jinyinhua (Honeysuckle), Lianqiao, Jingjie Sui, Xuanshen, Gancao, Dihuang, Bieshi (Tortoise Shell), Huma (Sesame), Huanglian, Mutong (Akebia Stem) decocted strongly. (From *Guang Biji*.)
Ye Tianshi stated: "Sha belongs to yang. Early lung meridian pathogens must be treated from the exterior. Symptoms include headache, wheezing, rough cough, aversion to cold. Eruption in 1-2 days is mild; 3-5 days is severe. If yang illness persists beyond 7 days without clear eruption, pathogen attacks inward, causing continuous wheezing, abdominal pain, and constipation—critical condition. Treatment uses acrid-bitter to clear heat, Liangge San [Cooling Chest Powder] without Xiaoshi (Mirabilite) and Dahuang. Texts describe Foot-Yangming Stomach rashes as dense like clouds or large like smallpox but without roots. Hand-Taiyin Lung rashes appear as dots without patches; treat with acrid-dispersants to resolve muscle layer. In winter, with no sweat, high fever, and wheezing, use Mahuang and Xingren (Apricot Seed) as in Huagai San [Canopy Powder] or San'ao Tang [Three Unblocking Decoction]. In summer, with no sweat, use acrid-cool dispersants like Genge, Qianhu (Peucedanum Root), Bohe, Fangfeng, Xiangru (Elsholtzia), Niubang Zi, Jiegeng, Mutong. Ancients added Genge for thirst due to exterior pathogen to raise yangming stomach fluids. For severe heat/thirst, use Shigao (acrid-cold) to resolve muscle; contraindicated if no sweat. All sores/rashes suit acrid-cools. Lianqiao is acrid-cool, rising above grasses, capable of ascending and clearing, beneficial for pediatrics, resolving heat in all six meridians. Spring rashes follow wind-warmth; summer follows summer-heat (often retaining dampness); autumn follows heat-drying; winter follows wind-cold. Rashes benefit from patency; diarrhea is favorable. Dysentery with five colors is acceptable. Only obstruction of urination/defecation indicates凶 (ominous) prognosis; purging diarrhea is taboo. Rashes stem from six qi pathogens transforming into fire. Though external eruption suggests pathogen exit, emergence involves descent and reversal. Often, external eruption leaves internal heat, causing hoarseness, gum rot, wheezing, abdominal distension, dysentery, anorexia, agitation, coma, and death—all due to unclear interior symptoms. Differentiate sanjiao involvement or concurrent diseases. Upper jiao uses cooling; middle jiao uses acrid-bitter-cold; lower jiao uses salty. (Xu Lingtai: Should use methods to clear internal pathogens.) Upper jiao herbs should be light in aroma/taste as lung governs qi and skin/hair are its exterior. Exterior pathogens favor acrid; severe interior favors bitter. If no thirst/irritability but prolonged illness with stagnant pathogen, use bland-leaching to drain qi level. (Xu Lingtai: Ye emphasizes aroma/taste based on *Neijing* and *Shennong Bencao*. However, one must deeply understand each herb's specific function before selecting by aroma/taste to truly grasp the classics. Knowing only aroma/taste lacks independent judgment.) Middle jiao rash fire is yangming dry transformation, abundant qi/blood. Bitter-cold is suitable. If prolonged, stomach fluids deplete; bitter aids dryness and consumes fluids; sweet-cold is preferred. Lower jiao uses salty-bitter. If heat-toxin sinks causing dysentery, do not use salty to soften hardness; use bitter to firm yin and dry dampness. Ancients viewed rashes as meridian/fu diseases, avoiding warming/dry/astringent/tonic methods—"smallpox suits warmth, rashes suit cooling." However, weak/vitality-depleted patients mishandled with cold-dispersants may develop chronic deficiency. Mostly yin injury; rescue yin by supporting stomach fluids. Qi deficiency exists; tonify qi. Children are yang bodies; avoid pure-gang (hot) drugs. Pediatric texts say: "Red rashes消 with cooling; white rashes resolve with warmth." This 'warmth' refers to post-era methods like fermented rice wine, Changmu (Cudrania) coarse paper, cotton gauze. (Xu Lingtai: Not this warming method.) Though sometimes necessary, recent use is often ineffective. (Xu Lingtai: Many external pediatric treatments exist.) Gan Zhen (Malnutrition Rash) with damp-heat steaming causes oral/pharyngeal erosion. Without prompt treatment, it leads to cheek perforation, airway closure, wheezing, and death. Treat early; external methods have specific formulas. Decoctions must be light/bland to resolve upper pathology or use clearing/dispersing. Rash-dysentery is heat-toxin sinking. Like Shanghan with coordinated heat where dysentery stops when pathogen exhausts, clear heat. Avoid lifting/astringent-tonics. Mild cases: separate and promote circulation; severe cases: bitter-cold detoxification."