【因】风温时毒。先犯少阳阳明。续被暴寒搏动而发。乃三阳合病。状类伤寒。以
其胸膈赤肿热痛。故见形定名曰赤膈伤寒。病亦多发于春令。
【证】初起先发热恶寒。头疼身痛。继即胸膈 赤肿病HT 。甚或外发紫 。舌苔边红
。中黄糙起刺。甚或黄中夹现黑点。若胸中剧疼。口秽喷人。痰嗽气喘。咯出浊唾腥臭
者。毒已内陷伤肺。欲酿内痈。舌苔多白浓起腐。
【脉】左浮弦急数。右洪盛弦滑者。张石顽所谓赤膈属少阳风热。非正伤寒。实则
二阳合病之风温时毒。猝被太阳客寒引动而发也。
【治】法当内外兼施。内治、轻则荆防败毒散加减。冲犀角汁（一瓢）。金汁（一
两）。重则通圣消毒散加减。（方载大头伤寒治法中）。表里双解以逐毒。表证已退。
内火尚盛。神昏谵语。便闭溺涩者。急用解毒承气汤加紫雪。泻火逐HT 毒以清神。若呓语痉
厥。暴注下迫者。急以犀羚竹石汤（犀角八分、羚角一钱、鲜竹叶心三钱、
石膏六钱、赤芍、连翘、紫草各二钱、银花露二两冲）。调下至宝丹（一粒）。泻火熄
风以清心。若二便已利。神识亦清。尚咳出浊痰腥臭。甚或吐脓。胸中犹隐隐痛。舌苔白
腐满布。脉右寸滑数而实。时毒伤肺成痈者。急用加味苇茎汤。〔生苡仁五钱、栝蒌仁
四钱、光桃仁、川贝母、甘草节各钱半、银花、连翘各二钱、制月石八分、陈芥菜卤
两瓢、（冲）先用活水芦根、鲜菩提根、鲜冬瓜皮子各二两、前汤代水。〕降气行
血以宣肺痹。败脓去腐以清肺毒。毒除痛止。而肺火不清者。继与桑丹泻白汤。加野百
合（钱半）。白及、合欢皮（各一钱）、鲜野菰根（二两）。鲜白茅根、鲜菩提根（各一
两、上三味煎汤代水）。凉泻肺中之伏火。清敛肺脏之溃穴。终与二冬二母散。加西洋
参绵 皮（各钱半）、鲜石斛（四钱）。清养气液以善后。外治、以细银针刺肿处出紫
血。即以薄棉拭干滋水。随用解毒清凉散（芙蓉叶、大青叶各五钱、青黛、人中黄、
各二钱、共研末、鲜菊叶、天荷叶、捣汁调匀用）。涂敷之。泄其热毒以消肿。使其速
愈。
【秀按】石顽老人治此证。初以荆防败毒散去参。（荆芥、防风各钱半、柴胡、
前胡、羌活、独活、枳壳、桔梗、牛蒡、薄荷、赤苓、川芎、甘中黄各一钱、临服冲
金汁一杯。）加条芩、川连、犀角、紫荆皮为主。表证退。便燥结者。以凉膈散为主。
若有半表半里证者。小柴胡汤去参加枳、桔。又以棱针刺血泄毒。大旨与俞法相同。惟
毒陷伤肺。酿成内痈。大抵由病家初起失治。继由医家纵横杂治所致。或由肺痈外溃。
胸前遂赤肿发 。果如是。则俞张荆防败毒散加减。亦不适当。甚矣。临病辨证之难乎
其难也。
【廉勘】赤膈伤寒。如张石顽。俞根初两前哲。所述病状。显然内痈伤寒。外科诊
治居者多。若先由肺痈。而后胸胁赤肿发 者。曾经治愈四人矣。均仿洄溪老人肺痈法
例。幸而收功。徐氏曰、肺痈病。脓已成者。《金匮》
虽云始萌可救。脓成则死。然多方治之。竟有生者。盖予平日因此证甚多。集唐人以来
治肺痈之法。用甘凉之药以清其火。滋润之药以养其血。滑降之药以祛其痰。芳香之药
以通其气。更以珠黄之药解其毒。金石之药填其空。兼数法而行之。屡试必效。此真肺
痈正治之良法。而非自炫其能之谎语也。惟《徐氏医案》。往往有法无药。此亦巧于藏拙。
一则避后人吹毛求疵。一则欲后学勤求古训。博采众方之深意耳。今年秋。吾绍某部中
一兵士。处州人姓陈名士卿者。夏初患肺病。屡服西药。痰嗽病终莫能愈。夏末初秋。
患暑湿兼寒夹食。初次邀诊。见病患面赤如朱。胸膈赤肿。昏厥不语。已五昼夜。口秽
喷人。唇焦齿黑。目瞪口噤。四肢厥冷。按其胸腹。灼热异常。大便水泻如注。臭秽难
闻。溺短赤涩。脐间冲脉。动跃震手。诊其脉两寸陷下似伏。两关尺沉弦搏数。愈按愈
盛。抉其口。望其舌。焦紫起刺。层层黑晕。遂以摄氏表检验温度。已达一百另五度。
遂断为暑湿病中之坏热症。遂立俞氏解毒承气汤。加紫雪（九分）、品三物白散（一分、
方用桔梗五分、川贝四分、巴霜一分、嘱药肆现研匀细、以药汤频频调下。）进一煎后
。时隔四点多钟。毫无变动。又进次煎。毕、即大吐臭痰一瓯。乃开言。云腹中如锥刺
。或如刀割。疼剧不可忍。同人为其抚摩一句钟。乃大泻黑垢一滩。次日上午又邀诊视
。察其脉两寸起而数促。关尺如昨。舌苔只退黑晕一层。二便均闭。躁则狂言乱话。静
则独语而笑。温度计仅退一度。惟四肢不厥而转温。于原方略为加减。去紫雪及三物白
散。加犀角汁一瓢（约计一钱）、鲜车前草汁一瓢。与金汁和匀同冲。安宫牛黄丸（一颗
）、生锦纹又加二钱。服两煎后。连下黑垢两次。热度昏谵依然。咳吐臭痰如米粥状。则
加多矣。满屋臭不可闻。同人皆为之掩鼻。从此连诊七日。皆从前方加减。或减安宫牛
黄丸。加王孟英新定牛黄清心丸。或仍用紫雪（四分）、品绛雪（一分）。或减西瓜硝。
加风化硝。臭痰日吐两瓯。黑垢一日一次。多则两次。惟小便逐次加多。色终紫赤混浊
。温度退至百另一度半。昏谵犹多。清晨时神识较清。略能应对一二语。脉搏数而不弦
。脐中冲动渐底。舌苔白腐满布。略现黑点。约计生川军已服
至三两。金汁已有九两。紫雪服至二钱余分。牛黄丸等服至六颗。外感之暑湿食滞。已
去大半。乃一意疗其肺痈。改与俞氏加味苇茎汤。磨冲太乙紫金丹（一颗）遵徐氏甘凉
清火。芳香通气之法。连诊五日。皆从此方加减。去紫金丹。加紫金片。或加新绛、旋
覆、橘络。通其肺络。或加竹沥、梨汁、鲜石菖蒲汁。豁其臭痰。或加制月石、甘中黄
、尿浸石膏。解其毒以防腐。连诊五日。忽然寒战壮热。手足躁扰。头面胸背遍发黑
疮。而胸膈赤肿始退。臭痰全无。日吐白痰两瓯。或痰中带脓。或夹紫血。如丝如珠
。谵语大减。神识转清。但睡醒后。仍有昏言。面唇转白。体亦憔悴。脉搏小数微弦。
舌苔白腐大减。胃动思食。口燥善饮。改用顾晓澜八汁饮去西瓜汁、荷叶汁。（甘蔗汁
、藕汁、梨汁、芦根汁、鲜生地汁、鲜茅根汁各一酒杯、重汤炖温服。）加麦冬汁（
二匙）、淡竹沥（二瓢）、解KT 草根汁（一瓢）甘润养胃。以补其血。连服四剂。胃口大
开。每飧食粥一大瓯。日夜须服五飧。而痰中血丝血珠。终不能除。胸中尚隐隐痛。大
便已转嫩黄。时溏时燥。改用《古今录验》桔梗汤。（白桔梗、生甘节、归身、白术、
各一钱、生苡仁五钱、生桑皮三钱、细生地二钱、败酱草八分。）加北沙参（四钱）甜
石莲（钱半、杵）双补肺脾以清余毒。另服王氏圣灵丹加减。（珠粉、西黄各三分、
琥珀六分、滴乳石、制月石、尿浸石膏各一钱、没石子、辰砂各五分各药研细、
入磨坊中倒挂飞面丝五钱五分、研和极匀、妙在飞面丝善走肺中细管。）每用五分。以
鲜茅根、鲜菩提根（各一两）、煎汤送下。日夜各一服、服完、胸痛止、痰血除、益信
徐氏珠黄等品解其毒。金石等药填其空之说。精确不磨也。且知马培之麝香走窜。盗泄
真气。肺痈忌服之说。亦难拘执也。终以《金匮》麦门冬汤、加霍石斛、生玉竹（各三
钱）、气液双补以善后。幸而其人年壮体实。病乃霍然。起居饮食如常矣。
【荣斋按】“赤膈伤寒”，廉臣先生谓即系“肺痈”。我细勘俞氏所述症状，大部
份可以说是与肺痈相符合的，只有“甚或外发紫 ”一语，却与肺痈证对不起来。讲到治
法∶廉臣先生用“紫雪九分品三物白散一分。”
这确是一个效方。一九五五年四月号《中医杂志》载王焕庭治肺痈用桔梗白散的两个治
例，就是活生生的事实。江阴曹颖甫先生治肺痈，也主张先用开泄，继用清养，与俞何
两先生的疗法是一致的。曹先生说∶“凡治此症，痈脓结聚肺部，当开泄肺气，清其郁
热，为第一步。及肺脏气疏，咯痰不畅，则以决去痈脓为第二步。及腥臭之痰出尽，而
胶痰之未成脓者，尚吐之不已，则以破除痰结为第三步。及胶痰渐少，肺之破碎处当用
补救，则以扶养肺阴为第四步。惟补救之方，推千金黄昏汤为最。黄昏即合欢皮，张璐
玉称其两干相着，即粘合不解，取其粘性实足以补肺脏之罅漏，而收其全功，较世传白
芨尤为稳当。敢布腹心，以告同道。”这种经验介绍，使俞氏用“白及，合欢皮”以“
清敛肺脏之溃穴”的方法，得曹先生为之解说和证明，不但理明心得，而且疗效愈彰。
【病因】风温时毒。首先侵犯少阳经和阳明经。随后被暴发的寒邪搏结触动而发病。这是三阳经同时受病的合病。症状类似伤寒。因为患者胸膈部位红肿热痛。所以根据外形特征定名为赤膈伤寒。此病也多发生在春季。
【证候】初起先出现发热恶寒。头痛身体疼痛。接着胸膈部位红肿病变。甚至外部发出紫色斑点。舌苔边缘发红。中部黄厚粗糙且起刺。严重时黄色中夹杂现出黑点。如果胸中剧烈疼痛。口气秽浊喷人。咳嗽气喘。咯出浑浊唾液且气味腥臭的。说明毒邪已经内陷损伤肺脏。将要酿成内部痈脓。舌苔多为白厚腻且起腐。
【脉象】左手脉浮弦急数。右手脉洪盛弦滑的。这是张石顽所说的赤膈属于少阳风热。不是真正的伤寒。实际上是二阳合病的风温时毒。突然被太阳经受客寒引动而发作。
【治法】应当内外兼治。内治法：轻症用荆防败毒散加减。冲服犀角汁（一瓢）。金汁（一两）。重症用通圣消毒散加减。（方剂记载在大头伤寒治法中）。表里双解以驱逐毒邪。表证已退。内火仍然旺盛。神志昏迷胡言乱语。大便闭塞小便涩滞的。急用解毒承气汤加紫雪。泻火逐毒以清醒神志。如果出现说梦话、痉挛厥逆。急性腹泻伴有肛门紧迫感的。急用犀羚竹石汤（犀角八分、羚羊角一钱、鲜竹叶心三钱、石膏六钱、赤芍、连翘、紫草各二钱、银花露二两冲服）。调服至宝丹（一粒）。泻火熄风以清心。如果大小便已通利。神志也清醒了。仍然咳出浑浊腥臭的痰。甚至吐出脓液。胸中仍然隐隐作痛。舌苔白腐满布。脉象右寸部滑数而实的。这是时毒伤肺形成痈脓的。急用加味苇茎汤。〔生薏苡仁五钱、瓜蒌仁四钱、光桃仁、川贝母、甘草节各一钱半、银花、连翘各二钱、制月石八分、陈芥菜卤一瓢（冲服）先用活水芦根、鲜菩提根、鲜冬瓜皮子各二两煎汤代水。〕降气行血以宣通肺痹。排脓去腐以清除肺毒。毒除痛止。但肺火未清的。继用桑丹泻白汤。加野百合（一钱半）。白及、合欢皮（各一钱）、鲜野菰根（二两）。鲜白茅根、鲜菩提根（各一两、上三味煎汤代水）。凉泻肺中的伏火。清敛肺脏的溃烂处。最后用二冬二母散。加西洋参绵皮（各一钱半）、鲜石斛（四钱）。清养气液以善后。外治法：用细银针刺肿处放出紫血。随即用薄棉拭干滋水。随时用解毒清凉散（芙蓉叶、大青叶各五钱、青黛、人中黄、各二钱、共研末、鲜菊叶、天荷叶、捣汁调匀使用）。涂敷患处。泄其热毒以消肿。使其迅速痊愈。
【秀按】石顽老人治疗此证。起初用荆防败毒散去人参。（荆芥、防风各一钱半、柴胡、前胡、羌活、独活、枳壳、桔梗、牛蒡、薄荷、赤苓、川芎、甘中黄各一钱、临服用时冲入金汁一杯。）加条芩、川连、犀角、紫荆皮为主药。表证退去。大便干燥结滞的。以凉膈散为主。如果有半表半里的证候。用小柴胡汤加枳壳、桔梗。又用棱针刺血泄毒。大意与俞氏的方法相同。只是毒邪内陷损伤肺脏。酿成内部痈脓。大抵是因为病人初起失治。随后由医生杂乱治疗所致。或者是由肺痈外部溃破。胸前遂红肿发出紫色斑点。果真如此。那么俞氏和张氏的荆防败毒散加减。也不恰当。可见临证辨证的困难啊！
【廉勘】赤膈伤寒。像张石顽、俞根初两位前辈所述的症状。明显是内痈伤寒。外科诊治居多。如果是先由肺痈。而后胸胁红肿发出紫色斑点的。曾经治愈四人。都仿照洄溪老人的肺痈法则。幸而取得疗效。徐氏说：肺痈病。脓已成形的。《金匮要略》虽然说初期可救。脓成则死。然而多方治疗。竟然有存活的。大概因为我平日因此证很多。收集唐人以来的治肺痈方法。用甘凉药物以清其火。滋润药物以养其血。滑降药物以祛其痰。芳香药物以通其气。再用珠黄类药物解其毒。金石类药物填其空洞。兼用数法而行。屡试必效。这真是肺痈正治的好方法。而不是自夸能力的谎话。只是《徐氏医案》往往有法无药。这也是巧妙隐藏短处。一则避免后人吹毛求疵。二则希望后学勤奋寻求古训。广泛采集各方之方的深意罢了。今年秋天。我绍兴某部队中一名士兵。处州人姓陈名士卿的。夏初患肺病。多次服用西药。咳嗽痰多病终不能愈。夏末初秋。患暑湿兼寒夹食积。初次邀请诊治。见病患面色红如朱砂。胸膈红肿。昏厥不语。已达五昼夜。口气秽浊喷人。嘴唇焦裂牙齿发黑。眼睛瞪大嘴巴紧闭。四肢冰冷。按压其胸腹。灼热异常。大便水泻如注。臭秽难闻。小便短赤涩滞。脐间冲脉。跳动震手。诊其脉两寸陷下似伏。两关尺沉弦搏数。越按越盛。撬开其口。看其舌。焦紫起刺。层层黑晕。于是用摄氏表检验温度。已达一百零五度。于是断定为暑湿病中的坏热症。于是立俞氏解毒承气汤。加紫雪（九分）、品三物白散（一分、方用桔梗五分、川贝四分、巴霜一分、嘱药店现研匀细、以药汤频频调服。）进一煎后。时隔四点多钟。毫无变动。又进第二煎。完毕。即大吐臭痰一碗。才开口说话。说腹中如锥刺。或如刀割。疼痛剧烈不可忍受。同事为其按摩一小时。才大泻黑垢一堆。次日上午又邀请诊治。察其脉两寸升起而数促。关尺如昨日。舌苔只退黑晕一层。二便均闭。躁动时狂言乱语。安静时自言自语而笑。温度计仅退一度。只有四肢不冷而转温。在原方基础上稍为加减。去掉紫雪及三物白散。加犀角汁一瓢（约计一钱）、鲜车前草汁一瓢。与金汁和匀同冲。安宫牛黄丸（一颗）、生锦纹又加二钱。服两煎后。连下黑垢两次。热度昏谵依然。咳吐臭痰如米粥状。则加多矣。满屋臭不可闻。同事都为之掩鼻。从此连续诊治七日。皆从前方加减。或减安宫牛黄丸。加王孟英新定牛黄清心丸。或仍用紫雪（四分）、品绛雪（一分）。或减西瓜硝。加风化硝。臭痰日吐两碗。黑垢一日一次。多则两次。惟小便逐次加多。色终紫赤混浊。温度退至一百零一度半。昏谵犹多。清晨时神识较清。略能应对一二句话。脉搏数而不弦。脐中冲动渐平。舌苔白腐满布。略现黑点。约计生大黄已服至三两。金汁已有九两。紫雪服至二钱余分。牛黄丸等服至六颗。外感之暑湿食滞。已去大半。乃一意疗其肺痈。改与俞氏加味苇茎汤。磨冲太乙紫金丹（一颗）遵徐氏甘凉清火。芳香通气之法。连续诊治五日。皆从此方加减。去掉紫金丹。加紫金片。或加新绛、旋覆、橘络。通其肺络。或加竹沥、梨汁、鲜石菖蒲汁。豁其臭痰。或加制月石、甘中黄、尿浸石膏。解其毒以防腐。连续诊治五日。忽然寒战壮热。手足躁扰。头面胸背遍发黑疮。而胸膈红肿始退。臭痰全无。日吐白痰两碗。或痰中带脓。或夹紫血。如丝如珠。谵语大减。神识转清。但睡醒后。仍有昏言。面唇转白。身体亦憔悴。脉搏小数微弦。舌苔白腐大减。胃动思食。口燥善饮。改用顾晓澜八汁饮去西瓜汁、荷叶汁。（甘蔗汁、藕汁、梨汁、芦根汁、鲜生地汁、鲜茅根汁各一酒杯、重汤炖温服。）加麦冬汁（二匙）、淡竹沥（一瓢）、解KT草根汁（一瓢）甘润养胃。以补其血。连服四剂。胃口大开。每餐食粥一大碗。日夜须服五餐。而痰中血丝血珠。终不能除。胸中尚隐隐痛。大便已转嫩黄。时溏时燥。改用《古今录验》桔梗汤。（白桔梗、生甘节、归身、白术、各一钱、生薏苡仁五钱、生桑皮三钱、细生地二钱、败酱草八分。）加北沙参（四钱）甜石莲（一钱半、杵）双补肺脾以清余毒。另服王氏圣灵丹加减。（珠粉、西黄各三分、琥珀六分、滴乳石、制月石、尿浸石膏各一钱、没石子、辰砂各五分各药研细、入磨坊中倒挂飞面丝五钱五分、研和极匀、妙在飞面丝善走肺中细管。）每用五分。以鲜茅根、鲜菩提根（各一两）、煎汤送下。日夜各一服、服完、胸痛止、痰血除、益信徐氏珠黄等品解其毒。金石等药填其空之说。精确不磨也。且知马培之麝香走窜。盗泄真气。肺痈忌服之说。亦难拘执也。终以《金匮》麦门冬汤、加霍石斛、生玉竹（各三钱）、气液双补以善后。幸而其人年壮体实。病乃霍然。起居饮食如常矣。
【荣斋按】“赤膈伤寒”。廉臣先生谓即系“肺痈”。我仔细考证俞氏所述症状。大部分可以说是与肺痈相符合的。只有“甚或外发紫斑”一语。却与肺痈证对不起来。讲到治法：廉臣先生用“紫雪九分配三物白散一分。”这确是一个效方。一九五五年四月号《中医杂志》载王焕庭治肺痈用桔梗白散的两个治例。就是活生生的事实。江阴曹颖甫先生治肺痈。也主张先用开泄。继用清养。与俞何两先生的疗法是一致的。曹先生说：“凡治此症。痈脓结聚肺部。当开泄肺气。清其郁热。为第一步。及肺脏气疏。咯痰不畅。则以决去痈脓为第二步。及腥臭之痰出尽。而胶痰之未成脓者。尚吐之不已。则以破除痰结为第三步。及胶痰渐少。肺之破碎处当用补救。则以扶养肺阴为第四步。惟补救之方。推千金黄黄昏汤为最。黄昏即合欢皮。张璐玉称其两干相着。即粘合不解。取其粘性实足以补肺脏之罅漏。而收其全功。较世传白芨尤为稳当。敢布腹心。以告同道。”这种经验介绍。使俞氏用“白及，合欢皮”以“清敛肺脏之溃穴”的方法。得曹先生为之解说和证明。不但理明心得。而且疗效愈彰。
[Pathogenesis] Wind-warmth seasonal toxins. First invade the Shaoyang (Lesser Yang) and Yangming (Yang Brightness) meridians. Subsequently triggered by violent cold pathogens combing with the internal heat to manifest. This is a combined disease of the three Yang meridians. The presentation resembles Taiyang cold damage. Because the chest and diaphragm are red, swollen, hot, and painful. It is named "Red Diaphragm Cold Damage" based on its visible characteristics. This disease also frequently occurs in spring.
[Symptoms] Initially presenting with fever and aversion to cold. Headache and body pain. Followed immediately by redness and swelling of the chest and diaphragm. Even external eruption of purple macules. Tongue coating red at the edges. Yellow, rough, and prickly in the center. Severely, black spots may appear within the yellow coating. If severe pain in the chest. Foul breath offensive to others. Cough with asthma. Expectoration of turbid saliva with a fishy odor indicates that the toxin has sunk inward damaging the Lung. It is about to form an internal abscess. The tongue coating is mostly thick white and putrid.
[Pulse] Left pulse floating, wiry, rapid, and urgent. Right pulse surging, abundant, wiry, and slippery. As Zhang Shiwan stated, Red Diaphragm belongs to Shaoyang wind-heat. It is not true cold damage. In reality, it is wind-warmth seasonal toxin of the combined disease of two Yang meridians. Suddenly triggered by exogenous cold invading the Taiyang (Greater Yang) meridian.
[Treatment] The method should combine internal and external treatments. Internal treatment: For mild cases, use Jingfang Baidu San (Schizonepeta and Saposhnikovia Decoction for Expelling Toxins) modified. Mix with Xijiao Zhi (Rhinoceros Horn Juice) (one scoop). Jinzhi (Human Feces Ferment) (one tael). For severe cases, use Tongsheng Xiaodu San (Unimpeded Toxin-Expelling Decoction) modified. (The formula is recorded in the treatment methods for Big Head Cold Damage). Resolve both exterior and interior to expel the toxin. If the exterior syndrome has subsided. But internal fire remains excessive. With coma and delirium. Constipation and dysuria. Urgently use Jiedu Chengqi Tang (Detoxifying Purgative Decoction) plus Zixue (Purple Snow). Purge fire and expel toxin to clarify the spirit. If there is muttering in sleep, spasms, or syncope. Or acute diarrhea with tenesmus. Urgently use Xiling Zhushi Tang (Rhinoceros-Horn Antelope-Horn Bamboo-Shield Decoction) (Rhinoceros Horn 8 fen, Antelope Horn 1 qian, Fresh Bamboo Leaf Heart 3 qian, Gypsum 6 qian, Red Peony Root, Forsythia, Arnebia each 2 qian, Silver Flower Dew 2 liang mixed in). Administer Zhibao Dan (Treasure of Ultimate Value Pill) (one pill). Purge fire and extinguish wind to clear the heart. If bowel and bladder movements have normalized. And consciousness is clear. Yet still coughing up turbid, foul-smelling sputum. Or even vomiting pus. With lingering dull pain in the chest. Tongue coating white and putrid covering the whole surface. Pulse right Cun position slippery, rapid, and excess. This indicates seasonal toxin damaging the Lung forming an abscess. Urgently use Jiawei Weijing Tang (Modified Reed Rhizome Decoction). [Raw Coix Seed 5 qian, Trichosanthes Kernel 4 qian, Peach Kernel, Fritillaria Cirrhosa Bulb, Licorice Root Tip each 1.5 qian, Honeysuckle, Forsythia each 2 qian, Borax 0.8 fen, Aged Mustard Green Brine 1 scoop (mixed in). First decoct Living Water Reed Rhizome, Fresh Bodhi Root, Fresh Winter Melon Peel each 2 liang to replace water.] Descend qi and move blood to open lung obstruction. Drain pus and remove decay to clear lung toxin. After toxin removal and pain cessation. If lung fire is not cleared. Continue with Sangdan Xiebai Tang (Mulberry Bark and Dandelion Decoction to Drain White). Add Wild Lily Bulb (1.5 qian). Bletilla Striata Rhizome, Albizia Bark (each 1 qian), Fresh Wild Zigzag Fern Rhizome (2 liang). Fresh Imperata Rhizome, Fresh Bodhi Root (each 1 liang, decoct these three to replace water). Cool-drain latent fire in the Lung. Clear and astringe ulcerated areas of the Lung. Finally use Erdong Ermu San (Two Winter and Two Mother Powder). Add American Ginseng Cortex (each 1.5 qian), Fresh Dendrobium (4 qian). Clear-nourish qi and fluids to conclude treatment. External treatment: Prick the swollen area with fine silver needles to release purple blood. Wipe dry the exudate with thin cotton. Immediately apply Jiedu Qingliang San (Detoxifying Cooling Powder) (Hibiscus Leaf, Isatis Leaf each 5 qian, Indigo Naturalis, Human Manure Ash each 2 qian, ground into powder. Fresh Chrysanthemum Leaf, Heavenly Lotus Leaf, crushed and juiced to mix evenly). Apply topically. Vent heat-toxin to reduce swelling. Promote rapid healing.
[Xiu's Commentary] Elder Shiwan treated this syndrome. Initially using Jingfang Baidu San (Schizenepta and Saposhnikovia Decoction for Expelling Toxins) without Ginseng. (Schizonepeta, Saposhnikovia each 1.5 qian, Bupleurum, Peucedanum, Notopterygium, Angelica Dahurica, Aurantium, Platycodon, Arctium, Mint, Red Poria, Ligusticum, Sweet Urine Ash each 1 qian. Mix with one cup of Jinzhi just before administration.) Added Scutellaria Baicalensis Root, Coptis Chinensis Rhizome, Rhinoceros Horn, Broussonetia Papyrifera Bark as main herbs. After exterior syndrome subsides. And stool becomes dry and constipated. Use Liangge San (Cooling Diaphragm Powder) as the main formula. If there are half-exterior half-interior symptoms. Use Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Aurantium and Platycodon. Also use lancet to prick blood to vent toxin. The general idea is similar to Yu's method. Only when toxin sinks damaging the Lung forming an internal abscess. It is generally due to initial neglect by the patient. Followed by chaotic treatment by physicians. Or external rupture of Lung Abscess. Leading to redness and swelling of the chest and eruption of purple macules. If so. Then Yu and Zhang's modified Jingfang Baidu San would be inappropriate. How difficult it is to differentiate syndromes in clinical practice!
[Lian's Verification] Red Diaphragm Cold Damage. As described by predecessors Zhang Shiwan and Yu Genchu. The symptoms clearly indicate internal abscess cold damage. Mostly diagnosed and treated by surgeons. If initially Lung Abscess. Followed by redness and swelling of chest and hypochondrium with purple macules. I have cured four such cases. All imitating the methods of Elder Huixi for Lung Abscess. Fortunately achieving success. Mr. Xu said: For Lung Abscess. When pus has formed. Although *Jinkui Yaolue* states early stage can be saved. Once pus forms death ensues. However, through various treatments. Survival is possible. Probably because I encounter this syndrome often. I collected methods for treating Lung Abscess since the Tang Dynasty. Using sweet-cool drugs to clear fire. Moistening drugs to nourish blood. Slippery-descending drugs to expel phlegm. Aromatic drugs to unblock qi. Further using pearl-yellow drugs to resolve toxin. Mineral-metal drugs to fill cavities. Combining several methods. It is consistently effective. This is truly the correct treatment for Lung Abscess. Not boasting words. However, *Xu's Medical Cases* often has methods without formulas. This is also a clever way to hide shortcomings. Firstly to avoid nitpicking by later generations. Secondly to encourage students to diligently seek ancient teachings and extensively collect prescriptions. This autumn. A soldier in our Shaoxing unit. Named Chen Shiqing from Chuzhou. Suffered from lung disease in early summer. Took Western medicine repeatedly. Cough and sputum could not be cured. Late summer and early autumn. Suffered from summer-dampness combined with cold and food stagnation. Invited for consultation initially. Saw patient face red as cinnabar. Chest and diaphragm red and swollen. Comatose and mute for five days and nights. Foul breath offensive. Lips cracked teeth black. Eyes wide mouth closed. Limbs cold. Palpating chest and abdomen. Extremely hot. Diarrhea watery like pouring. Foul smell unbearable. Urine short red and dysuric. Chong vessel at umbilicus. Pulsating violently. Pulse both Cun positions sunken resembling hidden. Guan and Chi positions deep, wiry, forceful, and rapid. Becoming stronger with pressure. Opened mouth. Observed tongue. Scorched purple with prickles. Layer upon layer of black halos. Used Celsius thermometer to check temperature. Reached 105 degrees Fahrenheit (approx 40.5°C). Diagnosed as severe heat syndrome in summer-dampness disease. Prescribed Yu's Jiedu Chengqi Tang (Detoxifying Purgative Decoction). Added Zixue (Purple Snow) (9 fen), Pin Sanwu Baisan (Grade A Three-Ingredient White Powder) (1 fen, Formula uses Platycodon 5 fen, Fritillaria 4 fen, Croton Seed 1 fen. Instructed pharmacy to grind fresh and fine. Mix frequently with medicinal soup). After one decoction. Four hours passed. No change. Administered second decoction. Finished. Immediately vomited a bowl of foul sputum. Spoke. Said abdomen felt like needle pricks. Or knife cutting. Pain unbearable. Colleagues massaged for one hour. Then defecated a pile of black filth. Next morning invited again. Checked pulse. Both Cun rose and became rapid and intermittent. Guan and Chi same as yesterday. Tongue coating lost only one layer of black halo. Bowel and bladder closed. Restless muttering. Quiet self-talking and smiling. Thermometer dropped only one degree. Only limbs no longer cold but warm. Slightly modified original formula. Removed Zixue and Sanwu Baisan. Added Xijiao Zhi (Rhinoceros Horn Juice) one scoop (approx 1 qian). Fresh Plantago Asiatica Juice one scoop. Mixed with Jinzhi. Angong Niuhuang Wan (One pill). Raw Rheum Palmatum root added 2 qian. After two decoctions. Defecated black filth twice. Fever, coma, and delirium remained. Coughed foul sputum like rice porridge. Increased significantly. Room smelled unbearable. Colleagues covered noses. Consulted continuously for seven days. Modified from previous formula. Sometimes removed Angong Niuhuang Wan. Added Wang Mengying's New Ding Niuhuang Qingxin Wan. Or kept Zixue (4 fen). Pin Jiangxue (1 fen). Sometimes removed Watermelon Nitre. Added Weathered Nitre. Vomited two bowls of foul sputum daily. Black filth once daily. More often twice. Urine gradually increased. Color finally purple-red and turbid. Temperature dropped to 101.5°F (approx 38.6°C). Coma and delirium still frequent. Consciousness clearer in morning. Could respond with one or two sentences. Pulse rapid but not wiry. Umbilical pulsation subsided. Tongue coating white and putrid covering whole surface. Slight black spots appeared. Approximate total intake: Raw Rhubarb 3 taels. Jinzhi 9 taels. Zixue over 2 qian. Niuhuang Wan etc. 6 pills. Exogenous summer-dampness and food stagnation. Largely eliminated. Focused solely on treating Lung Abscess. Changed to Yu's Jiawei Weijing Tang (Modified Reed Rhizome Decoction). Ground and mixed Ta Yi Zi Jin Dan (One pill). Following Mr. Xu's method of sweet-cool clearing fire. Aromatic unblocking qi. Consulted five days consecutively. Modified from this formula. Removed Zi Jin Dan. Added Zi Jin Pian. Or added Xin Jiang, Inula Flower, Tangerine Reticulate Vein. To unblock lung collaterals. Or added Bamboo Juice, Pear Juice, Fresh Acorus Tatarinowii Rhizome Juice. To expel foul sputum. Or added processed Borax, Sweet Urine Ash, Urine-Steeped Gypsum. To resolve toxin and prevent putrefaction. Consulted five days consecutively. Suddenly chills and high fever. Restless limbs. Black sores erupted all over head, face, chest, and back. Chest and diaphragm redness and swelling subsided. Foul sputum completely gone. Vomited two bowls of white sputum daily. Sometimes sputum contained pus. Or purple blood threads like pearls. Delirium greatly reduced. Consciousness clarified. But after waking. Still confused speech. Face and lips turned white. Body emaciated. Pulse slightly rapid and faintly wiry. Tongue coating white and putrid greatly reduced. Stomach active craving food. Dry mouth desiring drink. Changed to Gu Xiaolan's Bazhi Yin (Eight Juices Drink) removing Watermelon Juice and Lotus Leaf Juice. (Sugarcane Juice, Lotus Root Juice, Pear Juice, Reed Rhizome Juice, Fresh Rehmannia Juice, Fresh Imperata Juice each one wine glass. Warm in double boiler). Added Ophiopogon Juice (2 spoons). Light Bamboo Juice (1 scoop). Jie KT Grass Root Juice (1 scoop). Sweet-moistening to nourish stomach. To supplement blood. Taken for four doses. Appetite greatly opened. Ate one large bowl of porridge per meal. Five meals day and night. Blood threads and beads in sputum. Ultimately could not be removed. Lingering dull pain in chest. Stool turned tender yellow. Alternately loose and dry. Changed to *Gujin Luyan* Jiegeng Tang (Platycodon Decoction). (White Platycodon, Raw Licorice Joint, Angelica Sinensis Root, Atractylodes Macrocephala Rhizome each 1 qian. Raw Coix Seed 5 qian. Raw Mulberry Bark 3 qian. Fine Rehmannia Root 2 qian. Patrinia Herba 0.8 fen). Added Glehnia Root (4 qian). Sweet Stone Lotus Seed (1.5 qian, pounded). Dual tonify Lung and Spleen to clear residual toxin. Additionally take Wang's Shengling Dan modified. (Pearl Powder, Musk each 3 fen. Amber 6 fen. Mastic, Processed Borax, Urine-Steeped Gypsum each 1 qian. Myrobalan, Cinnabar each 5 fen. Grind all medicines finely. Add 5.5 mace of flying noodle silk from mill. Grind extremely uniform. The magic lies in flying noodle silk traveling well into fine lung tubes). Take 5 fen each time. Send down with decoction of Fresh Imperata Rhizome and Fresh Bodhi Root (each 1 liang). One dose day and night. After finishing. Chest pain stopped. Sputum-blood removed. Confirmed Mr. Xu's theory that pearl-yellow products resolve toxin. Mineral-metal products fill cavities. Precise and unchangeable. Also learned that Ma Peizhi's view on Musk wandering and leaking true qi. Contraindicated in Lung Abscess. Is also difficult to rigidly adhere to. Finally used *Jinkui* Maidong Tang (Ophiopogon Decoction). Added Huo Dendrobium, Raw Polygonatum Odoratum Rhizome (each 3 qian). Dual tonify qi and fluids to conclude treatment. Fortunately the person was young and strong. Disease vanished suddenly. Daily life and diet returned to normal.
[Rongzhai's Commentary] "Red Diaphragm Cold Damage". Mr. Lianchen stated it is essentially "Lung Abscess". I carefully verified the symptoms described by Yu. Most parts align with Lung Abscess. Except for the phrase "even external eruption of purple macules". Which does not match Lung Abscess syndrome perfectly. Regarding treatment: Mr. Lianchen used "Zixue 9 fen mixed with Sanwu Baisan 1 fen." This is indeed an effective formula. The April 1955 issue of *Chinese Medicine Journal* reported two cases of Wang Huanting treating Lung Abscess with Jiegeng Baisan. These are living facts. Mr. Cao Yingfu from Jiangyin treating Lung Abscess. Also advocated first using opening and draining. Then clearing and nourishing. Consistent with the therapies of Mr. Yu and Mr. He. Mr. Cao said: "For treating this syndrome. When abscess pus accumulates in the Lung. One must first open Lung qi and clear stagnant heat. This is the first step. When Lung qi is dispersed. But expectoration is difficult. Then resolve and expel abscess pus. This is the second step. When foul sputum is exhausted. But sticky phlegm not yet formed into pus. Continues to be coughed up. Then break phlegm knots. This is the third step. When sticky phlegm gradually decreases. Broken areas of Lung need repair. Then nourish Lung yin. This is the fourth step. For repair formulas. Qianjin Huanghun Tang is best. Hunhun refers to Albizia Bark. Zhang Lu Yu stated that when two trunks touch. They fuse inseparably. Taking advantage of its stickiness sufficiently repairs Lung fissures. Achieving full effect. More stable than commonly transmitted Bletilla. Dare to share my thoughts. To inform colleagues." This experience introduction. Makes Yu's use of "Bletilla, Albizia Bark" to "clear and astringe Lung ulcerated cavities". Explained and proven by Mr. Cao. Not only clarifies principles and insights. But also enhances efficacy.