例三李某某，男，5个月，因发热咳喘已十一天转入某医院。住院检查：体重6．3公斤，缺氧1度，肺部扣诊浊音，听诊有水泡音，调线发现有大片实化。血化验：白细胞总数：24，200／立方毫米，中性68％，淋巴32％。咽培养有大肠杆菌，咽拭子分离为Ⅲ型腺病毒。诊断：腺病毒肺炎并发心力衰竭。病程与治疗：持续高热无汗，四肢不温，咳嗽喘促，音哑，痰阻不利，面青，口周微发绀，呼吸不匀，舌红无苔，脉滑微数。此证虽见舌红脉数，肺阴受伤之候，而高热无汗，面青唇绀，喘咳痰滞。仍属风痰阻塞，肺气郁痹，急宜疏风开肺宣痹，方药：僵蚕3克前胡2．4克牛蒡子3克桔梗2．4克杏仁3克射干2．4克甘草1．5克竹叶3克苇根9克葱白2寸。复诊(4月：2日）：连服二剂，未获汗、惟四肢转温，表气仍闭，余证不减。遂改用射干麻黄汤加减，开肺宣痹，和胃涤痰。处方：射干1.5克麻黄0．9克细辛1.5克紫菀2．4克五味子10粒半夏3克茯苓3克化橘红3克甘草1．5克(炙）苏子2．1克(炒）生姜2片大枣2枚(劈）、再服2剂后，乃获全身淅淅汗出，肺胃和调,诸证渐除，病遂告愈。
(《蒲辅周医案》
例四李××、1岁半。患儿咳嗽，痰盛，发烧一周，因气喘鼻煽一天入院。体温39℃，呼吸60次／分，精神差，无汗。舌苔薄白，脉浮数。西医诊断：肺炎。x线胸透：右肺下野炎变。辨证：风温犯肺。治法：清热解毒，辛凉透表。方药：用麻杏石甘汤加味。麻黄3克杏仁9克甘草6克生石膏12克银花6克连翘9克桔梗6克芥穗12克鲜芦根30克。治疗经过：入院第二天，身热退(36．7℃），精神好转、咳喘减轻，痰减少，食欲不振，舌苔黄白垢腻。表邪已解，余热未尽。前方去芥穗，加枳壳12克。第3～4天体温正常，咳喘继减，食欲渐增。舌净，脉缓。宜辛凉轻剂以奠其后，用桑菊饮加减，第三天痊愈出院。、《赵锡武医疗经验》
例五何××，男孩，九个半月。病历号，68068。1962年12月10日初诊。患儿因咳嗽月余，日渐加重，且发热作喘，经某院诊为支气管肺炎(极重型）。体温39.8℃，精神不佳，时时烦扰昏睡，呼吸促迫，鼻扇肋动，喘憋(给氧气吸入），面赤唇红，大便每日8～9次，有奶瓣，粘而色黄，小便黄少，脉浮数有力。辨证：肺内蕴热，感受温邪，邪热充斥内外，的伤津液。治法:清热解毒，宣肺疏解，少佐益阳。方药：芥穗3．6克板蓝4.5克薄荷1.5克花粉6克炒栀3克元参6克射干1．8克麻黄0．9克杏仁3克安宫牛黄散0．9克(分三次服）服药三剂病情好转，体温渐降至正常，喘平，咳嗽有痰，大便正常，眠食均佳，上方去牛黄散加减，再予数剂告愈。
(祁振华治验，邵慧中整理：小儿肺炎辨证用药的经、、验介绍，《中医杂志》10：8，1964）
例六曹某某，女孩，9个月，病历号：68264。患儿因咳五天，身热二天，喘憋半天，经某院急诊
(因高烧服退热药后，体温突降），诊为重型小叶性肺炎，喘息性支气管炎合并心力衰竭。来诊时体温36℃，精神萎靡，喘憋鼻扇(给氧气吸入），胸部膨隆，喘气抬肩，气道痰鸣，大便日一次正常，小便略少，面色灰白，暗而不泽、口鼻周围青紫，舌苔薄白，舌质红）口内干而少津，脉数疾。听诊两肺密集细小水泡音，心率174次／分。辨证：温邪入肺，表邪不尽，正气已虚。治法：清热解毒，益阴宣肺解肌。方药：青蒿6克葛根3克麻黄0．3克元参4．5克牛黄散0．3克(分三次服）。服药当天夜间，体温回升至39℃，不久即自然下降。次日体温正常，精神好转，喘减微咳，撤氧气吸入，上方去牛黄散、青蒿、葛根，加麦冬、花粉各4.5克，射干2．4克。服六剂后肺罗音消失，痊愈停药，经追访未复发。
(祁振华洽验，邵慧中整理：小儿肺炎辨证用药的经验介绍，《中医杂志》10：8，1964）
【评按】小儿肺炎多属祖国医学温热病范畴，既是常见多发病，又是对小儿健康生命具有较大威胁性的病证。临床以身热、咳喘、胸痛、鼻煽为主症。中医认为以外感风寒、风热，肺气失宣，内蕴痰热，邪闭肺络为其主要病因、病理。治疗以宣肺定喘、清化痰热为大法。
例一为大叶性肺炎，中医辨证属风寒束表而肺热炽盛，表里俱热，邪热闭肺。由于邪在肺经气分，日晡热甚，热灼肺络，故于辛凉解表、清肺化痰的同时，加用羚羊、甲壬金散(赵氏经验方）等，直折内外之热，使病速愈。例二、例三为腺病毒肺炎，例二中医辨证为外寒内饮，属于伤寒的范畴，故治以宣肺，发散风寒，温化寒饮为主、方用小青龙加石膏汤，加石膏者，因风寒束肺、郁而化热故，是为兼治之法。当证情缓解后，继用调和肺胃、化痰祛湿，是为先宣后降治法。
例三为风寒犯肺，症见高热无汗，咳喘痰滞）面青唇给等症。已见舌红脉数。为肺阴伤之征，似不宜汗，但由于患者无汗，肺气郁闭，急则治标，当以辛温开闭取汗，表邪解而阴液存，是为治疗中的变法、例四为风温犯肺，用麻杏石甘汤参入银翘散中主药以清热解毒，辛凉透表；复诊以辛凉轻剂善其后。此案反映了赵氏善于揉合经方、时方于一炉，见效颇快。
例五为肺内蕴热复感受温邪。以致邪热充斥内外，津液的伤，治宜清解疏宣，少佐益阴之品，方中加入安宫牛黄丸(《温病条辨》方）能加强清热解毒，兼开痰热之闭，临床适用于肺炎热毒炽盛、痰热内闭患者。
例六为重型小叶性肺炎、喘息性支气管炎合并心力衰竭。辨证为温邪袭肺，表邪不尽而正气已虚。祁氏治以清肺解毒，开肺气之闭为主，益阴解肌为佐。牛黄散则不宜久用，以其寒凉伤正，终以清热润肺法收功。
(三）顿咳乔女，10月，病历号：99534。二十日来阵咳频作，气呛成顿，咳剧则呕，咳后可听到吼声、痰鸣，精神饮食欠佳。肌肤不丰，二便自调，经治疗无效，转诊来院。查体：心肺腹无明显异常，舌无垢腻，指纹淡紫，诊为百日咳。辨证：痰热互结，邪阻肺络。治法：清肺化痰。方药：炙百部5克南橘络5克炙桑皮6克川贝3克黄芩5克瓜蒌皮10克麦冬10克知母6克蜜杷叶6克焦麦芽10克服药3剂，痰热渐退，阵咳由每20～30分钟一次，减少到每1～3小时一次。每次由顿咳10分钟减少至2分钟左右，诸症大减，原方又服六剂。热已解，痰尽退，偶有一至二声轻咳，睡眠、饮食、二便如常，再予清肺化痰宁嗽之剂，善后调理。南橘络5克炙桑皮6克川贝5克黄芩6克焦麦芽10克知母5克麦冬10克炒杏仁3克蜜杷叶10克《赵心波儿科临床经验选编》）
【评按】顿咳即百日咳，中医又有鹭鸶咳、疫咳等病名。系因感受时邪而发病，婴幼儿最为多见。此例病已二十余日，证属痰热互结，邪阻肺络，故治以清肃肺金、化痰宁嗽法。凡顿咳大忌过早使用收敛之品，否则恋邪易生他病。此案疏方主治明确，照顾兼症，选药精审可取。
(四）麻疹
例一热已三日，有汗，咳呛痰多，鼻流清涕，大便溏泄，舌白润，脉浮数，痧子将布，恐其下陷。川桂枝3克粉葛根6克水炙升麻3克白杏仁9克象贝母9克桔梗4．5克蝉衣3克、茯苓9克天将壳5只
(徐仲才整理：徐小圃儿科经验简介，《上海中医药杂志》4：5，1962）
例二杨××，半岁。1958年春出麻疹，已灰；忽转“肺炎”，发热喘咳，喉间痰鸣，鼻翼扇动，面转青象，指纹青紫出二关，大便泻绿水，小便短赤。此系疹后元阳内虚，寒痰壅闭，肺肾之气不接，清肃失降而致。即以小青龙加附子主之。附片30克(先煎2～3小时）干姜12克法夏5克细辛3克麻黄3克五味子1．5克、桂尖10克杭芍6克甘草6克服后旋即呕吐涎痰盏许，次日复诊，喘咳稍减，发热已退其半，再以四逆、二陈汤加肉桂，少佐麻绒、细辛主之。附片50克(先煎2～3小时）干姜12克半夏5克陈皮6克茯苓13克肉桂30克
(研未，泡水兑入）甘草10克炙麻绒3克细辛2．5克服后，又吐不少涎痰，喘咳已去十之八九，鼻扇痰鸣已止，大便转黄而溏，小便淡黄，略进稀粥，颜面、指纹已转红润。上方去麻、辛、陈皮，连服2剂而愈。
(《吴佩衡医案》）
例三任幼，3岁。初诊1月10日。痧隐不达，高热气喘，咳嗽不爽，舌质绛红，口渴神烦，大便溏泄，秽臭难闻，此系热迫大肠。前医进葛根芩连汤加减，未获寸效。诊得脉象弦大且数，唇焦起裂。辨证：邪已入营，阴津亏损，势有化燥劫液之虑。治法：养阴救液，凉营透表。方药：鲜石斛15克鲜生地21克淡豆豉9克粉丹皮4．5克京川贝4．5克带心连翘6克黑山栀皮9克广郁金4．5克淡芩4．5克鲜茅根30克(去心）复诊
(1月12日）：投以红炉泼水之法，汗畅疹达，色殷甚密，热退烦定，便泄亦止，气喘大为减轻。可见气有余便是热，热有余便是火。火能熄，热能退，则气渐平而身渐安矣。鲜沙参12克鲜生地15克丹皮4．5克银花4．5克川贝4.5克甜白杏仁9克冬瓜子9克鲜苇根30克赤芍4．5克
(奚咏裳治验，奚伯初整理：奚氏儿科经验简介，《上海中医药杂志》6：5，1962）
例四：郑某某之侄，年甫髫龄。孩体乳痰上壅：以致疹不出表，温邪熏蒸，咽喉肿痛。患儿疹隐而未透，咳嗽气急，痰多，喉关有声，咽喉红碎。指纹隐隐，此即张廉《麻疹阐注》所谓“痰闭”之症。辨证：麻疹痰闭，痧火不得外泄，上延烂喉。治法：宣痹通血，化痰透达
(“通血”为孙复初《麻疹要诀》所载，近贤梁达樵亦时用之）。方药：广郁金9克(生打）泡射干2．1克光杏仁9克牛蒡子9克(杵）丹参6克鲜薄荷12克象贝母9克赤芍6克元参9克制僵蚕9克鲜枇杷叶五片(去毛）鲜茅根30克(去心）紫菀9克另用西月石0．9克月雄精0．6克猴枣0．3克，研细末，茅根汤送下。效果：一剂而痰降气平，2剂而麻疹透足，继用清肃而瘳。
(《重印全国名医验案类编》周小农医案）
例五王××，男，3岁。其母代述：“小儿发烧已4～5天，麻疹上半身已出齐，忽然面色发青，气急鼻扇，已出疹子，全部收没”。检查：体温40．5℃，脉搏洪数，指纹紫色达辰关，唇焦齿枯，疹子陷没处，留紫斑痕。诊断：麻疹早收，合并肺炎。方用“解热救肺回疹汤”，一剂后，喘急鼻扇减轻，再剂后周身疹子全透，惟续发走马牙府，溃穿极快，右口角开胡桃大一孔，牙齿脱落二个，即用加味清胃饮：生地黄6克，全当归6克，粉丹皮6克，生石膏18克，黑栀皮4．5克，川黄连3克，金石斛6克，水煎服，连用3剂，病势顿挫。外用马鸣散：人中白3克，蚕蜕纸3克，文蛤3克，硼砂1.2克，枯矾1．5克，共为细未，吹患处。续用多日，逐渐愈合。1957年5月经随访，仅于牙府穿破处遗留一点疤痕。附方：清热救肺口疹汤：炙麻黄9克光杏仁9克生石膏18克生甘草3克禹银花6克开连翘6克牛蒡子6克干芦根12克天花粉9克净蝉衣2．4克化橘红3克生黄芪4．5克
(裴慎：疹麻的辨证与治疗，《江西中医药》3：29，1959）
【评按】麻疹为儿科四大证之一。其发病初如外感风寒，临床以发热、微恶寒，目泪出，鼻流清涕，咳嗽、喷嚏，皮肤疹出为主症。其中又以出疹为辩证中的关键，《幼幼集成》所谓“其形若疥，其色若丹，随出随没，乍隐乍现”。古书多认为属于“胎毒”为病，而《麻疹拾遗》指出：“麻疹之发，多为天行疠气传染”。其治疗大法，初宜辛凉
(或辛温）透表，疹出宜清热解毒，佐以透疹；如有严重合并症，当区别不同症情予以辨治。
例一麻疹已三日，疹形将布，由于患儿大便溏泄，虑其疹毒下陷。徐氏认为在麻疹病程中，不乏肺家风寒之症，故不可概用辛凉(麻疹初热期。《医宗金鉴》有宣毒发表汤，功能祛风清热，后世用之多效，属麻疹辛凉法的常用方），此案方宗升麻葛根汤(《阎氏小儿方论》方），属辛温透达法。其加减法为：有汗加桂枝，无汗加麻黄；烦渴加石膏；面青肢冷，阳虚者，宜早用附子。徐氏另有一透发麻疹的外用方，药用生麻黄、西河柳、紫背浮萍各15克，鲜芫荽12克(如无鲜品，可用芫荽干9克）。上药加黄酒半斤，和水煮沸，令水蒸气满布病室，时时用热毛巾敷头面，可助麻疹透达。例二虽属麻疹合并肺炎，但系虚寒重症，因其寒痰壅闭，初治以小青龙加附子汤，后治以四逆、二陈加味方，着重于抉阳温化，治疗大法与
例二迥异。例三邪已入营，阴津亏损，有化燥劫津之虑，故急用养阴救津，凉营透表，奚氏喻为“红炉泼水之法”，是为麻疹变证权变之治，例四为麻疹痰闭，兼有温邪熏蒸，咽喉肿痛。案中用宣痹通血、化痰透达法，开痰闭以透闷疹；另用月石，猴枣同雄精并用，功能豁痰解毒，故其效甚著。
例三：患者李某某，男性，5个月大，因发热、咳嗽、气喘持续11天转入某医院。住院检查显示：体重6.3公斤，存在一度缺氧，肺部叩诊呈浊音，听诊可闻及水泡音，X线检查发现有大片实变影。血液化验结果：白细胞总数24,200/立方毫米，中性粒细胞占68%，淋巴细胞占32%。咽部培养检出大肠杆菌，咽拭子分离出Ⅲ型腺病毒。西医诊断：腺病毒肺炎并发心力衰竭。病程与治疗经过：患儿持续高热且无汗，四肢不温暖，咳嗽气喘急促，声音嘶哑，痰液阻滞不畅，面色发青，口周轻微发绀，呼吸不均匀，舌质红而无苔，脉象滑而微数。此证候虽然出现舌红脉数的表现，提示肺阴受损的迹象，但鉴于高热无汗、面青唇绀、喘咳痰滞等症状，仍属于风痰阻塞、肺气郁闭的证型。治疗急宜疏风开肺、宣通痹阻。方药组成：僵蚕3克、前胡2.4克、牛蒡子3克、桔梗2.4克、杏仁3克、射干2.4克、甘草1.5克、竹叶3克、芦根9克、葱白2寸。复诊（4月2日）：连续服用两剂后，未出汗，仅四肢转温，表气仍然闭塞，其余症状未见减轻。遂改用射干麻黄汤加减，以开肺宣痹、和胃涤痰。处方：射干1.5克、麻黄0.9克、细辛1.5克、紫菀2.4克、五味子10粒、半夏3克、茯苓3克、化橘红3克、甘草1.5克（炙）、苏子2.1克（炒）、生姜2片、大枣2枚（劈开）。再服用两剂后，全身淅淅然出汗，肺胃功能调和，诸症逐渐消除，疾病痊愈。
（出自《蒲辅周医案》）
例四：患者李××，1岁半。患儿咳嗽，痰多，发烧一周，因气喘、鼻翼扇动一天入院。体温39℃，呼吸频率60次/分，精神差，无汗。舌苔薄白，脉象浮数。西医诊断：肺炎。X线胸透显示右肺下野炎症病变。中医辨证：风温犯肺。治法：清热解毒，辛凉透表。方药：使用麻杏石甘汤加味。麻黄3克、杏仁9克、甘草6克、生石膏12克、金银花6克、连翘9克、桔梗6克、荆芥穗12克、鲜芦根30克。治疗经过：入院第二天，身热退去（体温36.7℃），精神好转，咳喘减轻，痰量减少，食欲不振，舌苔变为黄白垢腻。此时表邪已解，余热未尽。前方去掉荆芥穗，加入枳壳12克。第3～4天体温正常，咳喘继续减轻，食欲逐渐增加。舌苔干净，脉象缓和。宜用辛凉轻剂以巩固疗效，使用桑菊饮加减。第三天痊愈出院。
（出自《赵锡武医疗经验》）
例五：患者何××，男孩，九个半月。病历号：68068。1962年12月10日初诊。患儿因咳嗽月余，日渐加重，且伴有发热、气喘，经某医院诊断为支气管肺炎（极重型）。体温39.8℃，精神不佳，时时烦躁昏睡，呼吸急促迫促，鼻翼扇动，肋间凹陷，喘憋（给予氧气吸入），面赤唇红，大便每日8～9次，含有奶瓣，粘稠色黄，小便黄少，脉象浮数有力。中医辨证：肺内蕴热，感受温邪，邪热充斥内外，灼伤津液。治法：清热解毒，宣肺疏解，少佐益阳之品。方药：荆芥穗3.6克、板蓝根4.5克、薄荷1.5克、天花粉6克、炒栀子3克、玄参6克、射干1.8克、麻黄0.9克、杏仁3克、安宫牛黄散0.9克（分三次服）。服药三剂后病情好转，体温逐渐降至正常，喘息平息，咳嗽有痰，大便正常，睡眠和饮食均佳。上方去掉牛黄散并加减，再予数剂告愈。
（祁振华治验，邵慧中整理：小儿肺炎辨证用药的经验介绍，《中医杂志》10:8，1964）
例六：患者曹某某，女孩，9个月，病历号：68264。患儿因咳嗽五天，身热两天，喘憋半天，经某医院急诊诊治（因高烧服用退热药后，体温突降），诊断为重型小叶性肺炎，喘息性支气管炎合并心力衰竭。来诊时体温36℃，精神萎靡，喘憋鼻扇（给予氧气吸入），胸部膨隆，喘气抬肩，气道痰鸣，大便每日一次正常，小便略少，面色灰白，暗而不泽，口鼻周围青紫，舌苔薄白，舌质红，口内干而少津，脉象数疾。听诊双肺密集细小水泡音，心率174次/分。中医辨证：温邪入肺，表邪不尽，正气已虚。治法：清热解毒，益阴宣肺解肌。方药：青蒿6克、葛根3克、麻黄0.3克、玄参4.5克、牛黄散0.3克（分三次服）。服药当天夜间，体温回升至39℃，不久即自然下降。次日体温正常，精神好转，喘息减轻微咳，撤除氧气吸入，上方去掉牛黄散、青蒿、葛根，加入麦冬、花粉各4.5克，射干2.4克。服用六剂后肺部啰音消失，痊愈停药，经随访未复发。
（祁振华治验，邵慧中整理：小儿肺炎辨证用药的经验介绍，《中医杂志》10:8，1964）
【评按】小儿肺炎多属于祖国医学温热病的范畴，既是常见多发病，又是对小儿健康生命具有较大威胁性的病证。临床以身热、咳喘、胸痛、鼻煽为主症。中医认为以外感风寒、风热，导致肺气失宣，内蕴痰热，邪闭肺络为其主要病因和病理机制。治疗以宣肺定喘、清化痰热为基本大法。
例一为大叶性肺炎，中医辨证属风寒束表而肺热炽盛，表里俱热，邪热闭肺。由于邪在肺经气分，日晡（下午3-5点）热甚，热灼肺络，故于辛凉解表、清肺化痰的同时，加用羚羊角、金礞石散（赵氏经验方）等，直折内外之热，使病速愈。例二、例三为腺病毒肺炎，例二中医辨证为外寒内饮，属于伤寒的范畴，故治以宣肺，发散风寒，温化寒饮为主，方用小青龙加石膏汤，加石膏者，因风寒束肺、郁而化热故，是为兼治之法。当证情缓解后，继用调和肺胃、化痰祛湿，是先宣后降的治法。
例三为风寒犯肺，症见高热无汗，咳喘痰滞，面青唇绀等症。虽已见舌红脉数，为肺阴伤之征，似不宜发汗，但由于患者无汗，肺气郁闭，急则治标，当以辛温开闭取汗，表邪解而阴液存，这是治疗中的变法。例四为风温犯肺，用麻杏石甘汤参入银翘散中主药以清热解毒，辛凉透表；复诊以辛凉轻剂善其后。此案反映了赵氏善于揉合经方、时方于一炉，见效颇快。
例五为肺内蕴热复感受温邪，以致邪热充斥内外，津液受伤，治宜清解疏宣，少佐益阴之品，方中加入安宫牛黄丸（《温病条辨》方）能加强清热解毒，兼开痰热之闭，临床适用于肺炎热毒炽盛、痰热内闭患者。
例六为重型小叶性肺炎、喘息性支气管炎合并心力衰竭。辨证为温邪袭肺，表邪不尽而正气已虚。祁氏治以清肺解毒，开肺气之闭为主，益阴解肌为佐。牛黄散则不宜久用，以其寒凉伤正，终以清热润肺法收功。
（三）顿咳（百日咳）：乔女，10个月，病历号：99534。二十日来阵发性咳嗽频繁发作，气呛成顿，咳剧则呕吐，咳后可听到吼声、痰鸣，精神饮食欠佳。肌肤不丰盈，二便自调，经治疗无效，转诊来院。查体：心肺腹无明显异常，舌无垢腻，指纹淡紫，诊断为百日咳。辨证：痰热互结，邪阻肺络。治法：清肺化痰。方药：炙百部5克、南橘络5克、炙桑皮6克、川贝母3克、黄芩5克、瓜蒌皮10克、麦冬10克、知母6克、蜜枇杷叶6克、焦麦芽10克。服药3剂，痰热渐退，阵咳由每20～30分钟一次，减少到每1～3小时一次。每次由顿咳10分钟减少至2分钟左右，诸症大减，原方又服六剂。热已解，痰尽退，偶有一至二声轻咳，睡眠、饮食、二便如常，再予清肺化痰宁嗽之剂，善后调理。南橘络5克、炙桑皮6克、川贝母5克、黄芩6克、焦麦芽10克、知母5克、麦冬10克、炒杏仁3克、蜜枇杷叶10克。
（《赵心波儿科临床经验选编》）
【评按】顿咳即百日咳，中医又有鹭鸶咳、疫咳等病名。系因感受时邪而发病，婴幼儿最为多见。此例病已二十余日，证属痰热互结，邪阻肺络，故治以清肃肺金、化痰宁嗽法。凡顿咳大忌过早使用收敛之品，否则恋邪易生他病。此案疏方主治明确，照顾兼症，选药精审可取。
（四）麻疹
例一：热已三日，有汗，咳呛痰多，鼻流清涕，大便溏泄，舌白润，脉浮数，痧子将布，恐其下陷。川桂枝3克、粉葛根6克、水炙升麻3克、白杏仁9克、象贝母9克、桔梗4.5克、蝉衣3克、茯苓9克、天将壳5只。
（徐仲才整理：徐小圃儿科经验简介，《上海中医药杂志》4:5，1962）
例二：杨××，半岁。1958年春出麻疹，疹已灰暗；忽转“肺炎”，发热喘咳，喉间痰鸣，鼻翼扇动，面转青色，指纹青紫出二关，大便泻绿水，小便短赤。此系疹后元阳内虚，寒痰壅闭，肺肾之气不接，清肃失降而致。即以小青龙加附子汤主之。附片30克（先煎2～3小时）、干姜12克、法半夏5克、细辛3克、麻黄3克、五味子1.5克、桂尖10克、杭芍6克、甘草6克。服后旋即呕吐涎痰盏许，次日复诊，喘咳稍减，发热已退其半，再以四逆汤、二陈汤加肉桂，少佐麻绒、细辛主之。附片50克（先煎2～3小时）、干姜12克、半夏5克、陈皮6克、茯苓13克、肉桂30克（研末，泡水兑入）、甘草10克、炙麻绒3克、细辛2.5克。服后，又吐不少涎痰，喘咳已去十之八九，鼻扇痰鸣已止，大便转黄而溏，小便淡黄，略进稀粥，颜面、指纹已转红润。上方去掉麻黄、细辛、陈皮，连服2剂而愈。
（《吴佩衡医案》）
例三：任幼，3岁。初诊1月10日。痧隐不达，高热气喘，咳嗽不爽，舌质绛红，口渴神烦，大便溏泄，秽臭难闻，此系热迫大肠。前医进葛根芩连汤加减，未获寸效。诊得脉象弦大且数，唇焦起裂。辨证：邪已入营，阴津亏损，势有化燥劫液之虑。治法：养阴救液，凉营透表。方药：鲜石斛15克、鲜生地21克、淡豆豉9克、粉丹皮4.5克、京川贝4.5克、带心连翘6克、黑山栀皮9克、广郁金4.5克、淡黄芩4.5克、鲜茅根30克（去心）。复诊（1月12日）：投以红炉泼水之法，汗畅疹达，色殷甚密，热退烦定，便泄亦止，气喘大为减轻。可见气有余便是热，热有余便是火。火能熄，热能退，则气渐平而身渐安矣。鲜沙参12克、鲜生地15克、丹皮4.5克、银花4.5克、川贝4.5克、甜白杏仁9克、冬瓜子9克、鲜苇根30克、赤芍4.5克。
（奚咏裳治验，奚伯初整理：奚氏儿科经验简介，《上海中医药杂志》6:5，1962）
例四：郑某某之侄，年甫髫龄。孩体乳痰上壅，以致疹不出表，温邪熏蒸，咽喉肿痛。患儿疹隐而未透，咳嗽气急，痰多，喉关有声，咽喉红碎。指纹隐隐，此即张廉《麻疹阐注》所谓“痰闭”之症。辨证：麻疹痰闭，痧火不得外泄，上延烂喉。治法：宣痹通血，化痰透达。（“通血”为孙复初《麻疹要诀》所载，近贤梁达樵亦时用之）。方药：广郁金9克（生打）、泡射干2.1克、光杏仁9克、牛蒡子9克（杵）、丹参6克、鲜薄荷12克、象贝母9克、赤芍6克、元参9克、制僵蚕9克、鲜枇杷叶五片（去毛）、鲜茅根30克（去心）、紫菀9克。另用西月石0.9克、雄精0.6克、猴枣0.3克，研细末，茅根汤送下。效果：一剂而痰降气平，2剂而麻疹透足，继用清肃而瘳。
（《重印全国名医验案类编》周小农医案）
例五：王××，男，3岁。其母代述：“小儿发烧已4～5天，麻疹上半身已出齐，忽然面色发青，气急鼻扇，已出疹子，全部收没”。检查：体温40.5℃，脉搏洪数，指纹紫色达辰关，唇焦齿枯，疹子陷没处，留紫斑痕。诊断：麻疹早收，合并肺炎。方用“解热救肺回疹汤”，一剂后，喘急鼻扇减轻，再剂后周身疹子全透，惟续发走马牙疳，溃穿极快，右口角开胡桃大一孔，牙齿脱落二个，即用加味清胃饮：生地黄6克，全当归6克，粉丹皮6克，生石膏18克，黑栀皮4.5克，川黄连3克，金石斛6克，水煎服，连用3剂，病势顿挫。外用马鸣散：人中白3克，蚕蜕纸3克，文蛤3克，硼砂1.2克，枯矾1.5克，共为细末，吹患处。续用多日，逐渐愈合。1957年5月经随访，仅于牙疳穿破处遗留一点疤痕。附方：清热救肺回疹汤：炙麻黄9克、光杏仁9克、生石膏18克、生甘草3克、禹州银花6克、开封连翘6克、牛蒡子6克、干芦根12克、天花粉9克、净蝉衣2.4克、化橘红3克、生黄芪4.5克。
（裴慎：麻疹的辨证与治疗，《江西中医药》3:29，1959）
【评按】麻疹为儿科四大证之一。其发病初如外感风寒，临床以发热、微恶寒，目泪出，鼻流清涕，咳嗽、喷嚏，皮肤疹出为主症。其中又以出疹为辩证中的关键，《幼幼集成》所谓“其形若疥，其色若丹，随出随没，乍隐乍现”。古书多认为属于“胎毒”为病，而《麻疹拾遗》指出：“麻疹之发，多为天行疠气传染”。其治疗大法，初宜辛凉（或辛温）透表，疹出宜清热解毒，佐以透疹；如有严重合并症，当区别不同症情予以辨治。
例一麻疹已三日，疹形将布，由于患儿大便溏泄，虑其疹毒下陷。徐氏认为在麻疹病程中，不乏肺家风寒之症，故不可概用辛凉（麻疹初热期，《医宗金鉴》有宣毒发表汤，功能祛风清热，后世用之多效，属麻疹辛凉法的常用方），此案方宗升麻葛根汤（《阎氏小儿方论》方），属辛温透达法。其加减法为：有汗加桂枝，无汗加麻黄；烦渴加石膏；面青肢冷，阳虚者，宜早用附子。徐氏另有一透发麻疹的外用方，药用生麻黄、西河柳、紫背浮萍各15克，鲜芫荽12克（如无鲜品，可用芫荽干9克）。上药加黄酒半斤，和水煮沸，令水蒸气满布病室，时时用热毛巾敷头面，可助麻疹透达。例二虽属麻疹合并肺炎，但系虚寒重症，因其寒痰壅闭，初治以小青龙加附子汤，后治以四逆、二陈加味方，着重于抉阳温化，治疗大法与例一迥异。例三邪已入营，阴津亏损，有化燥劫津之虑，故急用养阴救津，凉营透表，奚氏喻为“红炉泼水之法”，是为麻疹变证权变之治。例四为麻疹痰闭，兼有温邪熏蒸，咽喉肿痛。案中用宣痹通血、化痰透达法，开痰闭以透闷疹；另用月石，猴枣同雄精并用，功能豁痰解毒，故其效甚著。
Case 3: Patient Li Moumou, male, 5 months old, was transferred to a certain hospital due to fever, cough, and wheezing persisting for 11 days. Hospital examination showed: body weight 6.3 kg, Grade I hypoxia, dullness on lung percussion, vesicular breath sounds on auscultation, and X-line examination revealed large areas of consolidation. Blood test results: total white blood cell count 24,200/mm³, neutrophils 68%, lymphocytes 32%. Throat culture detected Escherichia coli, and throat swab isolated Type III adenovirus. Western medical diagnosis: Adenovirus pneumonia complicated by heart failure. Course of illness and treatment: The patient had persistent high fever without sweating, cold limbs, rapid cough and wheezing, hoarseness, phlegm obstruction, cyanotic complexion, slight perioral cyanosis, irregular breathing, red tongue with no coating, and slippery, slightly rapid pulse. Although the red tongue and rapid pulse indicated damage to Lung Yin, given the symptoms of high fever without sweating, cyanotic face, perioral cyanosis, and wheezing with stagnant phlegm, it still belonged to the pattern of Wind-Phlegm obstruction and Qi stagnation in the Lungs. Urgent treatment should focus on dispersing Wind, opening the Lungs, and relieving obstruction. Prescription: Bombyx Batryticatus (Jiangcan) 3g, Peucedanum Root (Qianhu) 2.4g, Arctium Fruit (Niubangzi) 3g, Platycodon Root (Jiegeng) 2.4g, Apricot Seed (Xingren) 3g, Belamcanda Rhizome (Shéyán) 2.4g, Licorice Root (Gāncǎo) 1.5g, Bamboo Leaf (Zhúyè) 3g, Reed Rhizome (Wěigēn) 9g, Scallion White (Cōngbái) 2 cun. Follow-up visit (April 2): After taking two doses, no sweat was produced, only the limbs became warm, the exterior Qi remained closed, and other symptoms did not improve. Therefore, Shegan Mahuang Decoction (Belamcanda and Ephedra Decoction) was modified to open the Lungs, relieve obstruction, harmonize the Stomach, and eliminate phlegm. Prescription: Belamcanda Rhizome (Shéyán) 1.5g, Ephedra Herb (Máhuáng) 0.9g, Asarum Root (Xìxīn) 1.5g, Aster Root (Zǐwǎn) 2.4g, Schisandra Berry (Wǔwèizǐ) 10 grains, Pinellia Tuber (Bànxia) 3g, Poria (Fúlíng) 3g, Exocarpium Citri Reticulatae Viride (Huàjúhóng) 3g, Licorice Root (Gāncǎo) 1.5g (roasted), Perilla Fruit (Sūzǐ) 2.1g (stir-fried), Fresh Ginger (Shēngjiāng) 2 slices, Jujube (Dàzǎo) 2 pieces (split). After taking two more doses, the whole body sweated profusely, Lung and Stomach functions harmonized, and all symptoms gradually disappeared, leading to recovery.
(From *Medical Cases of Pu Fuzhou*)
Case 4: Patient Li XX, 1.5 years old. The child had cough, excessive phlegm, and fever for one week, admitted due to wheezing and nasal flaring for one day. Temperature 39°C, respiratory rate 60 breaths/min, poor spirit, no sweat. Tongue coating thin and white, floating and rapid pulse. Western medical diagnosis: Pneumonia. Chest X-ray fluoroscopy showed inflammatory changes in the lower field of the right lung. TCM syndrome differentiation: Wind-Warmth invading the Lungs. Treatment method: Clear heat and detoxify, release the exterior with acrid-cool herbs. Prescription: Maxing Shigan Decoction (Ephedra, Apricot Seed, Gypsum, and Licorice Decoction) modified. Ephedra Herb (Máhuáng) 3g, Apricot Seed (Xingren) 9g, Licorice Root (Gāncǎo) 6g, Raw Gypsum (Shēng Shígāo) 12g, Honeysuckle Flower (Yínghuā) 6g, Forsythia Fruit (Liánqiào) 9g, Platycodon Root (Jiegeng) 6g, Schizonepeta Spike (Jièsuì) 12g, Fresh Reed Rhizome (Xiān Lúgēn) 30g. Treatment course: On the second day of admission, fever subsided (36.7°C), spirit improved, cough and wheezing decreased, phlegm reduced, but appetite was poor, and tongue coating became greasy yellow-white. The exterior pathogen had been resolved, but residual heat remained. Schizonepeta Spike was removed from the previous prescription, and Aurantium Fruit (Zhīqiào) 12g was added. By days 3-4, temperature was normal, cough and wheezing continued to decrease, appetite gradually increased. Tongue coating cleared, pulse became slow. A mild acrid-cool formula was used to consolidate the effect, using Sangju Decoction (Mulberry Leaf and Chrysanthemum Decoction) modified. The patient was discharged cured on the third day.
(From *Medical Experience of Zhao Xiwu*)
Case 5: Patient He XX, boy, nine and a half months. Medical record number: 68068. First consultation on December 10, 1962. The child had cough for over a month, worsening progressively, accompanied by fever and wheezing. Diagnosed at another hospital as Bronchopneumonia (extremely severe type). Temperature 39.8°C, poor spirit, frequent irritability and drowsiness, rapid and labored breathing, nasal flaring, intercostal retraction, wheezing and suffocation (given oxygen inhalation), red face and lips, stool 8-9 times daily containing milk curds, sticky and yellow, scanty yellow urine, floating, rapid, and forceful pulse. TCM syndrome differentiation: Heat accumulating in the Lungs, contracting Warm pathogen, pathogenic heat filling interior and exterior, damaging body fluids. Treatment method: Clear heat and detoxify, ventilate the Lungs and resolve the exterior, with a small amount of Yang-nourishing herbs. Prescription: Schizonepeta Spike (Jièsuì) 3.6g, Isatis Root (Bǎnlán) 4.5g, Mint (Bòhe) 1.5g, Trichosanthes Root (Huāfěn) 6g, Stir-fried Gardenia (Chǎo Zhī) 3g, Scrophularia Root (Yuánshēn) 6g, Belamcanda Rhizome (Shéyán) 1.8g, Ephedra Herb (Máhuáng) 0.9g, Apricot Seed (Xingren) 3g, Angong Niuhuang San (Calculus Bovis Pill) 0.9g (taken in three doses). After three doses, condition improved, temperature gradually returned to normal, wheezing stopped, cough with phlegm persisted, stool normalized, sleep and diet were good. Calculus Bovis Pill was removed from the prescription, modified, and continued for several doses until cure.
(Qi Zhenhua treated, Shao Huizhong organized: Introduction to Syndrome Differentiation and Medication for Pediatric Pneumonia, *Chinese Journal of Traditional Medicine* 10:8, 1964)
Case 6: Patient Cao Moumou, girl, 9 months, medical record number: 68264. The child had cough for five days, fever for two days, and wheezing/suffocation for half a day. Emergency diagnosed at another hospital (after antipyretics caused sudden temperature drop) as Severe Lobular Pneumonia, Asthmatic Bronchitis complicated by Heart Failure. Upon consultation, temperature was 36°C, listless spirit, wheezing and nasal flaring (given oxygen), distended chest, shoulder breathing, rattling phlegm in airways, normal stool once daily, slightly scanty urine, grayish-white complexion, dull luster, perioral cyanosis, thin white tongue coating, red tongue body, dry mouth with little saliva, rapid and frantic pulse. Auscultation revealed dense fine crackles in both lungs, heart rate 174 beats/min. TCM syndrome differentiation: Warm pathogen entering the Lungs, exterior pathogen not fully resolved, healthy Qi already deficient. Treatment method: Clear heat and detoxify, nourish Yin, ventilate the Lungs, and release the muscle layer. Prescription: Artemisia Annua (Qīnghāo) 6g, Kudzu Root (Gégēn) 3g, Ephedra Herb (Máhuáng) 0.3g, Scrophularia Root (Yuánshēn) 4.5g, Calculus Bovis San (Niúhuáng Sǎn) 0.3g (taken in three doses). That night after medication, temperature rose back to 39°C, then naturally dropped. Next day, temperature normal, spirit improved, wheezing reduced with slight cough, oxygen withdrawn. Calculus Bovis San, Artemisia Annua, and Kudzu Root were removed from the prescription, Ophiopogon Tuber (Màidōng) and Trichosanthes Root (Huāfěn) 4.5g each, and Belamcanda Rhizome (Shéyán) 2.4g were added. After six doses, lung rales disappeared, cured and stopped medication, no recurrence upon follow-up.
(Qi Zhenhua treated, Shao Huizhong organized: Introduction to Syndrome Differentiation and Medication for Pediatric Pneumonia, *Chinese Journal of Traditional Medicine* 10:8, 1964)
[Commentary] Pediatric pneumonia mostly belongs to the category of Warm Diseases in traditional Chinese medicine. It is a common and frequently occurring disease, yet poses a significant threat to children's health and life. Clinically, the main symptoms are fever, cough, wheezing, chest pain, and nasal flaring. TCM believes that external contraction of Cold-Wind or Wind-Warmth, leading to loss of Lung dispersion, internal accumulation of Phlegm-Heat, and pathogenic closure of Lung collaterals are the main etiology and pathology. The treatment principle focuses on ventilating the Lungs to stop wheezing and clearing Heat to transform Phlegm.
Case 1 is Lobar Pneumonia, differentiated in TCM as Cold-Wind binding the exterior with intense Lung Heat, resulting in heat in both interior and exterior, and pathogenic heat closing the Lungs. Since the pathogen is in the Qi level of the Lung meridian, heat peaks in the afternoon (Shen hour), burning Lung collaterals. Therefore, while using acrid-cool herbs to release the exterior and clear Lung Heat to transform Phlegm, Horn of Saiga Antelope (Língyáng Jiǎo) and Jinmengshi San (a formula by Dr. Zhao) were added to directly reduce heat in both interior and exterior, leading to quick recovery. Cases 2 and 3 are Adenovirus Pneumonia. Case 2 is differentiated as Exterior Cold with Internal Fluid Retention, belonging to the category of Cold Damage (Shānghán). Thus, treatment focused on ventilating the Lungs, dispersing Cold-Wind, and warming to transform Cold Fluid, using Xiao Qinglong Plus Gypsum Decoction (Minor Green Dragon Decoction plus Gypsum). Gypsum was added because Cold-Wind binding the Lungs stagnates and transforms into Heat, serving as a concurrent treatment. After symptom relief, Harmonizing Lung and Stomach, transforming Phlegm, and removing Dampness were used, representing a strategy of first dispersing then descending.
Case 3 is Cold-Wind invading the Lungs, presenting with high fever without sweat, cough/wheezing with stagnant phlegm, cyanotic face and lips. Although red tongue and rapid pulse indicate Lung Yin injury, suggesting sweating might be contraindicated, the patient has no sweat and Lung Qi is constrained. In acute situations, treating the branch is priority; thus, acrid-warm herbs were used to open closure and induce sweat. Resolving the exterior pathogen preserves Yin fluids, which is a flexible approach in treatment. Case 4 is Wind-Warmth invading the Lungs, using Maxing Shigan Decoction combined with principal herbs from Yinqiao Powder (Honeysuckle and Forsythia Powder) to clear heat, detoxify, and release the exterior with acrid-cool herbs; follow-up used a mild acrid-cool formula to conclude treatment. This case reflects Dr. Zhao's skill in integrating classical formulas (Jīngfāng) and contemporary formulas (Shífāng), achieving rapid results.
Case 5 involves Heat accumulating in the Lungs compounded by contracting a Warm pathogen, causing pathogenic heat to fill interior and exterior and damage fluids. Treatment should clear and resolve, ventilate and disperse, with a small amount of Yin-nourishing herbs. Adding Angong Niuhuang Wan (from *Treatise on Cold Pathogenic Diseases*) strengthens heat-clearing and detoxifying effects, and opens Phlegm-Heat closure, clinically applicable to patients with severe toxic heat and internal Phlegm-Heat closure in pneumonia.
Case 6 is Severe Lobular Pneumonia and Asthmatic Bronchitis complicated by Heart Failure. Differentiated as Warm pathogen attacking the Lungs, exterior pathogen not fully resolved, and healthy Qi already deficient. Dr. Qi treated by clearing Lung Heat and detoxifying, primarily opening Lung Qi closure, with nourishing Yin and releasing the muscle layer as an adjunct. Calculus Bovis San should not be used long-term as its cold nature damages healthy Qi; ultimately, clearing Heat and moistening the Lungs concluded the treatment.
(III) Pertussis (Whooping Cough): Qiao Girl, 10 months, medical record number: 99534. For twenty days, paroxysmal coughs occurred frequently, gasping into whoops, severe coughing induced vomiting, and a crowing sound/phlegm rattle heard after coughing. Poor spirit and diet. Underdeveloped skin, normal bowel and bladder movements, ineffective prior treatment, referred to our hospital. Physical exam: No obvious abnormalities in heart, lungs, or abdomen; tongue no greasy coating, pale purple fingerprint. Diagnosed as Pertussis. TCM syndrome differentiation: Phlegm-Heat knotting together, pathogen blocking Lung collaterals. Treatment method: Clear Lung Heat and transform Phlegm. Prescription: Roasted Stemona Root (Zhì Bǎibù) 5g, Tangerine Peel Network (Nán Júluò) 5g, Roasted Mulberry Root Bark (Zhì Sāngpí) 6g, Sichuan Fritillaria Bulb (Chuānbèi) 3g, Scutellaria Root (Huángqín) 5g, Trichosanthes Peel (Guālóu Pí) 10g, Ophiopogon Tuber (Màidōng) 10g, Anemarrhena Rhizome (Zhīmǔ) 6g, Honey-fried Loquat Leaf (Mì Páyè) 6g, Charred Barley (Jiāo Mài Yá) 10g. After 3 doses, Phlegm-Heat gradually receded, paroxysms reduced from every 20-30 minutes to every 1-3 hours. Duration reduced from 10 minutes to about 2 minutes per episode, major symptoms significantly reduced. Continued original prescription for 6 more doses. Heat resolved, Phlegm eliminated, occasional light coughs, sleep/diet/bowel/bladder normal. Further treatment with Lung-clearing, Phlegm-transforming, and cough-calming agents for convalescence. Tangerine Peel Network 5g, Roasted Mulberry Root Bark 6g, Sichuan Fritillaria Bulb 5g, Scutellaria Root 6g, Charred Barley 10g, Anemarrhena Rhizome 5g, Ophiopogon Tuber 10g, Stir-fried Apricot Seed 3g, Honey-fried Loquat Leaf 10g.
(*Selected Clinical Experience in Pediatrics by Zhao Xinbo*)
[Commentary] Pertussis is known as Whooping Cough in TCM, also called Egret Cough or Epidemic Cough. It occurs due to contracting seasonal pathogens, most commonly seen in infants and young children. This case has lasted over 20 days, with Phlegm-Heat knotting and pathogen blocking Lung collaterals. Thus, treatment focused on purifying Lung Metal, transforming Phlegm, and calming cough. Early use of astringent herbs is strictly contraindicated in Pertussis, as it may retain pathogens and cause other diseases. This case has clear therapeutic principles, addresses accompanying symptoms, and selects precise medications.
(IV) Measles
Case 1: Fever for three days, sweating, coughing with excessive phlegm, runny clear nose, loose stools, white moist tongue, floating rapid pulse. Rash about to erupt, fear of sinking inward. Cassia Twig (Guìzhī) 3g, Kudzu Root (Gégēn) 6g, Water-processed Cimicifuga Rhizome (Shēngmá) 3g, Apricot Seed (Xingren) 9g, Fritillaria Bulb (Bèimǔ) 9g, Platycodon Root (Jiegeng) 4.5g, Cicada Slough (Chányī) 3g, Poria (Fúlíng) 9g, Calyx of Abutilon (Tiānjiàngké) 5 pods.
(Xu Zhongcai organized: Brief Introduction to Pediatric Experience of Xu Xiaopu, *Shanghai Journal of Traditional Medicine* 4:5, 1962)
Case 2: Yang XX, half a year old. Contracted measles in spring 1958, rash turned gray/dull; suddenly developed "pneumonia," fever, wheezing, cough, rattling phlegm in throat, nasal flaring, cyanotic face, blue-purple fingerprint extending past two joints, watery green diarrhea, scanty dark urine. This is due to deficiency of Primordial Yang after measles, Cold-Phlegm obstruction, disconnecting Lung and Kidney Qi, failing to descend clearly. Treated primarily with Xiao Qinglong Plus Aconite Decoction (Minor Green Dragon Decoction plus Aconite). Prepared Aconite Root (Fùpiàn) 30g (decocted first for 2-3 hours), Dried Ginger (Gānjiāng) 12g, Processed Pinellia (Fǎxià) 5g, Asarum Root (Xìxīn) 3g, Ephedra Herb (Máhuáng) 3g, Schisandra Berry (Wǔwèizǐ) 1.5g, Cassia Twig Tip (Guìjiān) 10g, Hang Peony Root (Hángsháo) 6g, Licorice Root (Gāncǎo) 6g. Immediately vomited a cup of saliva-phlegm mixture. Next day follow-up: wheezing/cough slightly reduced, fever halved. Treated again with Sini Decoction (Four Reversal Decoction) and Erchen Decoction (Two Aged Herbs Decoction) plus Cinnamon Bark (Ròuguì), with small amounts of processed Ephedra (Máróng) and Asarum (Xìxīn). Prepared Aconite Root (Fùpiàn) 50g (decocted first for 2-3 hours), Dried Ginger (Gānjiāng) 12g, Pinellia (Bànxia) 5g, Tangerine Peel (Chénpí) 6g, Poria (Fúlíng) 13g, Cinnamon Bark (Ròuguì) 30g (ground, soaked water mixed in), Licorice Root (Gāncǎo) 10g, Roasted Ephedra Down (Zhì Máróng) 3g, Asarum Root (Xìxīn) 2.5g. Vomited much saliva-phlegm again, wheezing/cough reduced by 80-90%, nasal flaring/phlegm rattle stopped, stool turned yellow and loose, urine pale yellow, ate some thin porridge, face/fingerprint turned rosy. Removed Ephedra, Asarum, Tangerine Peel from prescription, took 2 more doses to cure.
(*Medical Cases of Wu Peiheng*)
Case 3: Young Ren, 3 years old. First consultation Jan 10. Rash hidden and not emerging, high fever, wheezing, unsatisfactory cough, crimson-red tongue body, thirst, mental restlessness, loose foul-smelling diarrhea (Heat forcing Large Intestine). Previous doctor used Gegen Qinlian Decoction (Kudzu and Scutellaria-Coptis Decoction) modified with no effect. Pulse string-like, large, and rapid, cracked dry lips. Syndrome differentiation: Pathogen entered Ying (Nutrient) level, Yin-fluids depleted, risk of drying and consuming fluids. Treatment method: Nourish Yin and rescue fluids, cool Ying level and release exterior. Prescription: Fresh Dendrobium Stem (Xiān Shíhú) 15g, Fresh Rehmannia Root (Xiān Shēngdì) 21g, Fermented Soybean (Dàndòuchǐ) 9g, Moutan Cortex (Fēn Dānpí) 4.5g, Beijing Fritillaria (Jīng Chuānbèi) 4.5g, Forsythia with Heart (Dàixīn Liánqiào) 6g, Black Gardenia Bark (Hēi Shānzhī Pí) 9g, Curcuma Tuber (Guǎng Yùjīn) 4.5g, Light Scutellaria (Dàn Huángqín) 4.5g, Fresh Imperata Rhizome (Xiān Máogēn) 30g (heart removed). Follow-up (Jan 12): Applied "splashing water on red-hot furnace" method, profuse sweat, rash emerged densely and deeply, heat subsided, restlessness settled, diarrhea stopped, wheezing greatly reduced. It can be seen that excess Qi becomes Heat, excess Heat becomes Fire. When Fire extinguishes and Heat retreats, Qi calms and body rests. Fresh Glehnia Root (Xiān Shāshēn) 12g, Fresh Rehmannia Root (Xiān Shēngdì) 15g, Moutan Cortex (Dānpí) 4.5g, Honeysuckle Flower (Yínhuā) 4.5g, Fritillaria (Chuānbèi) 4.5g, Sweet Apricot Seed (Tián Bái Xingrén) 9g, Benincasa Seed (Dōngguāzǐ) 9g, Fresh Imperata Rhizome (Xiān Wěigēn) 30g, Red Peony Root (Chìsháo) 4.5g.
(Xi Yongchang treated, Xi Bochū organized: Brief Introduction to Pediatric Experience of Xi Family, *Shanghai Journal of Traditional Medicine* 6:5, 1962)
Case 4: Nephew of Zheng Moumou, young child. Child's milk-phlegm obstructed upward, preventing rash from reaching exterior, Warm pathogen steaming, causing sore throat and swelling. Rash hidden not transparent, cough with rapid breathing, excessive phlegm, sound at throat gate, red and fragmented throat. Fingerprint faint. This is the "Phlegm Closure" mentioned in Zhang Lian's *Clarification of Measles*. Syndrome differentiation: Measles Phlegm Closure, Sha fire cannot vent outward, spreading upward to rot throat. Treatment method: Ventilate obstruction and promote blood circulation, transform Phlegm and facilitate emergence. ("Promoting blood circulation" is recorded in Sun Fuchu's *Essentials of Measles*, often used by modern expert Liang Daqiao). Prescription: Curcuma Tuber (Guǎng Yùjīn) 9g (raw, pounded), Soaked Belamcanda Rhizome (Pào Shéyán) 2.1g, Guang Apricot Seed (Guāng Xingrén) 9g, Arctium Fruit (Niúbàngzǐ) 9g (pounded), Salvia Root (Dānshēn) 6g, Fresh Mint (Xiān Bòhe) 12g, Fritillaria Bulb (Xiàng Bèimǔ) 9g, Red Peony Root (Chìsháo) 6g, Scrophularia Root (Yuánshēn) 9g, Processed Silkworm (Zhì Jiāngcán) 9g, Fresh Loquat Leaves (Xiān Pípá Yè) 5 pieces (de-haired), Fresh Imperata Rhizome (Xiān Máogēn) 30g (heart removed), Aster Root (Zǐwǎn) 9g. Additionally, Use Litharge (Xī Yuèshí) 0.9g, Realgar Essence (Xióngjīng) 0.6g, Monkey Date (Hóuzǎo) 0.3g, ground to fine powder, taken with Imperata Rhizome decoction. Effect: One dose lowered phlegm and calmed Qi, two doses made measles fully emerge, continued with clearing/purifying herbs to recover.
(*Reprinted National Famous Doctors' Medical Cases Compilation - Zhou Xiaonong Cases*)
Case 5: Wang XX, male, 3 years old. Mother reported: "Child had fever for 4-5 days, upper body measles fully erupted, suddenly face turned cyanotic, rapid breathing/nasal flaring, erupted measles completely receded." Examination: Temperature 40.5°C, pulse surging and rapid, purple fingerprint reaching Chen joint, cracked lips, withered teeth, purple spots where rash receded. Diagnosis: Premature measles resolution, complicated by pneumonia. Formula used: "Heat-Resolving Lung-Saving Rash-Returning Decoction." After one dose, rapid breathing/nasal flaring reduced; after two doses, whole body rash fully emerged, but subsequently developed rapidly progressing gum rot (Zǒumǎ Yágān), ulcerating quickly, right corner of mouth opened like walnut-sized hole, two teeth fell out. Used Modified Qingwei Drink: Raw Rehmannia (Shēng Dìhuáng) 6g, Whole Angelica Sinensis (Quán Dāngguī) 6g, Moutan Cortex (Fēn Dānpí) 6g, Raw Gypsum (Shēng Shígāo) 18g, Black Gardenia Bark (Hēi Zhī Pí) 4.5g, Coptis Rhizome (Chuān Liánzhuì) 3g, Dendrobium (Jīn Shíhú) 6g, decocted in water, taken for 3 doses, disease势头 checked. External use: Ma Ming San (Ma Ming Powder): Human Tooth Ash (Rénzhōngbái) 3g, Silkworm Molting Paper (Cánduì Zhǐ) 3g, Clam Shell (Wénghé) 3g, Borax (Péngshā) 1.2g, Calcined Alum (Kūfán) 1.5g, ground to fine powder, blown onto affected area. Continued for many days, gradually healed. May 1957 follow-up: Only a small scar remained at the gum rot site. Attached Formula: Heat-Resolving Lung-Saving Rash-Returning Decoction: Roasted Ephedra (Zhì Máhuáng) 9g, Guang Apricot Seed (Guāng Xingrén) 9g, Raw Gypsum (Shēng Shígāo) 18g, Raw Licorice (Shēng Gāncǎo) 3g, Yuzhou Honeysuckle (Yǔ Yínhuā) 6g, Kaifeng Forsythia (Kāi Liánqiào) 6g, Arctium Fruit (Niúbàngzǐ) 6g, Dry Reed Rhizome (Gān Lúgēn) 12g, Trichosanthes Root (Tiānhuāfěn) 9g, Clean Cicada Slough (Jìng Chányī) 2.4g, Exocarpium Citri Reticulatae Viride (Huà Júhóng) 3g, Raw Astragalus Root (Shēng Huángqí) 4.5g.
(Pei Shen: Syndrome Differentiation and Treatment of Measles, *Jiangxi Journal of Traditional Chinese Medicine* 3:29, 1959)
[Commentary] Measles is one of the four major pediatric syndromes. Its onset resembles external contraction of Cold-Wind, clinically characterized by fever, slight aversion to cold, tearing eyes, runny clear nose, cough, sneezing, and skin rash eruption. Among these, rash eruption is key to differentiation. *Youyou Jicheng* states: "Its shape resembles scabies, its color resembles cinnabar, appearing and disappearing intermittently." Ancient texts often attribute it to "Fetal Toxin," while *Measles Shiyi* points out: "Measles eruption is mostly transmitted by epidemic pestilential Qi." The general treatment principle is initially to release the exterior with acrid-cool (or acrid-warm) herbs; when rash emerges, clear heat and detoxify, assisting with rash-promoting herbs; if severe complications arise, differentiate based on specific conditions.
Case 1: Measles for three days, rash about to spread. Due to loose stools, fear of toxin sinking inward. Dr. Xu believes that during the measles course, there are cases of Lung-Family Cold-Wind, so one cannot generally use acrid-cool herbs (Early heat stage of measles, *Yizong Jinjian* has Xuandu Fabiao Tang for dispelling wind and clearing heat, widely used later with good effect, belonging to common acrid-cool methods for measles). This case uses Shengma Gegen Decoction (*Yan's Pediatric Formulas*), belonging to acrid-warm releasing method. Modifications: Add Cassia Twig if sweating, add Ephedra if no sweat; add Gypsum if restless/thirsty; if cyanotic face/cold limbs indicating Yang deficiency, use Aconite early. Dr. Xu also has an external formula for promoting measles: Raw Ephedra, West River Willow, Purple Back Floating Fern each 15g, Fresh Coriander 12g (or dried 9g). Boil with half jin of yellow wine, let steam fill the room, apply hot towels to head/face occasionally to help rash emerge. Case 2, though measles complicated by pneumonia, is a severe deficiency-cold pattern due to Cold-Phlegm obstruction. Initially treated with Xiao Qinglong Plus Aconite Decoction, later with Sini and Erchen modified, focusing on rescuing Yang and warming transformation, differing greatly from Case 1. Case 3: Pathogen entered Ying level, Yin-fluids depleted, risk of drying/consuming fluids. Urgently used Yin-nourishing and fluid-rescuing, cooling Ying and releasing exterior. Dr. Xi likened this to "splashing water on a red-hot furnace," a flexible treatment for measles variations. Case 4: Measles Phlegm Closure, compounded by Warm pathogen steaming, sore throat. Used ventilating obstruction/promoting blood circulation and transforming Phlegm/method to open Phlegm closure and reveal hidden rash; additionally used Litharge, Monkey Date, and Realgar to resolve Phlegm and detoxify, hence effective.