一余外甥孙汪宣,六岁,向日体气虚弱,偶尔感寒,或食凉物,即喘泻发热。素知其中
虚生寒,宜用温补,不宜寒凉。乾隆甲寅年出痘,医师开方,皆是生地、银花等药。余曰∶
药性与气体相违,何能对症?因改用补中益气汤加姜、桂,四剂、痘疮结痂而愈。
一江姓子,二岁,发热三日,痘已出齐,亦不甚多。痘科欲以大黄、连翘等药灌之。余
曰∶此药灌下,作泻一二次痘即收矣。彼不信,作泻后痘果收。痘科用雏鸽子煮水灌之,次
日忽有小痘暴出。余曰∶宜用补也明矣。奈痘师仍用小药数粒,泻利不止而毙。
一使女喜连,五岁,发热一日,红点遍身成片,痘师曰∶此名火燎苗,十二日症也,万
不一活,坚云不必服药。余徉应之,乃以大补元煎二剂,脾胃较健,四剂而苗齐浆足,惟形
色晦暗,且不结痂,七剂而痂结,十剂而全愈矣。医曰∶此痘能生,万不可解。
一余胞侄文豹,周岁,出疹失于表散,叠用寒凉,泄泻呕吐,唇焦舌黑,已成慢惊,危
在呼吸。余往视之,谓医曰∶此凉药逼火上冲之故,外虽极热,内实真寒。医曰∶唇焦舌黑
,岂非实火!余曰∶泄泻便清,岂非虚寒!天下岂有大便泻,小便清之实火乎?医不能答。
用
案
一魏明府之子,三岁,出痘甚稀,痘科用凉药数剂,幸此儿体旺,虽未大泻,而黑斑不
退,知其真火被清也。痘后月余,顶间忽发一毒,皮色不变,大如酒杯,此凉药凝滞故也。
余用大温中饮,数剂而消。
一舒友子,十岁,满头溃烂,清脓血水,几数十处。其父云∶此痘毒也,半年不愈。取
出向日药方,都是连翘、生地等凉药。乃知是寒凉入胃,火无所根据,上冲头顶,此即所谓虚
阳贯顶也,宜引火归源之法,用大补元煎兼加散药,每日一剂,十日全愈。
一余胞侄,七岁,在常州、出痘甚稀,医师以凉药败毒,当时虽未塌陷,而形状已野狼狈
不堪,一月后,右腿发一大疽,皮色不变。医师坚称火毒,仍以生地、银花、黄芩、山楂、
山栀等药治之,一剂而脾胃更减,神气昏沉,二剂而呕吐泄泻,三剂而随服随吐。庸医不知
药不对症,故胃中不受,而曰∶吐药不吐味,以致疮色晦暗,又数日不溃而殂。
一六安僧人某者,风雅能诗,二旬外发热出痘,予往视,见其颗粒稀疏,根盘红活,问
其饮食有味,二便如常,彼求方药,予曰∶如此好痘,可以不药。次日,有痘师往,彼为之
泻火各种凉药,每剂加大黄三钱,连服三剂,泻利不止,痘疮塌陷,绝口不食,数日而逝。
虚弱人出痘,误服大黄、真是毒药,试验甚确,未敢隐讳,治痘者切宜猛省。
一予外孙汪陵,丙辰五月,尚未一周,向日便溏腰软,气血不足可知,忽发热一日,周
身出痘,稠密成片,痘顶各有小孔破流黄水,目瞠不能暂瞑,昼夜下利十余次,乳汁入口即
从下窍流出,肛门无沿,空洞一穴。《痘书》云∶肛门如竹筒者不治。群医袖手。余曰∶此
即前发热论中所谓阴毒太重,阳气大虚症也,非大加温补,万不能生。即将大补元煎,每剂
用附子二钱,肉桂三钱,炮姜一钱五分,丁香末五分,胡椒末三分,浓煎滤汁,昼夜频频灌
之,药汁入口已从下窍流出,一连九次,灌完一剂。见者曰∶不必再灌,待时而已。幸其母
细心体贴,曰∶药虽流出,似觉较少,且灌药一次,目瞑片刻,定是效验。于是照原方不改
分毫,如前法,每日一剂。又三剂,此儿竟能假寐片时,泻下之物青黑中带有黄色,知其胃
气生动也。照原方又进三剂,肛门有沿,泻利稍止,痘顶小孔长满,且已起发,全灌清浆。
照原方加龙骨末、粟壳各一钱,又进四剂,痘已全然结痂,至第十三日,痘痂落尽,斑点全
无,肚腹亦好。闻者莫不称奇。余识得此儿是虚寒之症,用药得宜,故有效耳。寻常泄泻者
亦可治。以上见《遂牛编》。
我外甥孙汪宣,六岁,向来体质虚弱,偶尔感受寒邪,或食用生冷食物,就会引发喘促、腹泻和发热。素知他中焦虚寒,适宜使用温补之法,不宜用寒凉药物。乾隆甲寅年(1734年)他出痘疮,医师开的方子,都是生地、银花等寒凉药。我说:“药性与体质相违背,怎么能对症呢?”于是改用补中益气汤加生姜、肉桂,服用四剂后,痘疮结痂而痊愈。
有一个姓江的孩子,两岁,发热三天,痘疮已经出齐,数量也不算多。痘科医生打算用大黄、连翘等药灌服。我说:“如果用这些药灌下去,导致腹泻一两次,痘疮就会收敛。”他们不信,结果孩子腹泻后,痘疮果然收敛了。痘科医生又用雏鸽子煮水给他喝,第二天突然爆出许多小痘。我说:“这明显应该用补法了。”无奈痘师仍然只给几粒小药,导致孩子腹泻不止而死。
有一个使女叫喜连,五岁,发热一天,全身出现成片红点。痘师说:“这叫火燎苗,是十二日死症,万无一活,坚决说不必服药。”我假装答应,却用大补元煎两剂,使她脾胃功能稍健,再服四剂,痘苗饱满浆足,只是形色晦暗,且不结痂,又服七剂后结痂,十剂后完全痊愈。医生说:“这种痘能生出,万万不可轻视。”
我的亲侄儿文豹,周岁,出疹时未能及时发散,屡次使用寒凉药,导致泄泻呕吐,嘴唇焦裂,舌色发黑,已成慢惊风,危在旦夕。我去诊治,对医生说:“这是凉药逼迫虚火上冲的缘故,外表虽然极热,内里其实是真寒。”医生说:“嘴唇焦裂、舌头发黑,难道不是实火吗?”我说:“泄泻且大便清稀,难道不是虚寒吗?天下哪有腹泻且小便清长的实火证呢?”医生无言以对。
案列:魏明府的儿子,三岁,出痘很稀疏,痘科医生用了几剂凉药,幸好这孩子体质强壮,虽然没有严重腹泻,但黑斑不退,可知是真火被清除了。出痘后一个多月,头顶忽然长出一个毒疮,皮色不变,大如酒杯,这是凉药凝滞导致的。我用大温中饮,数剂后消散。
舒友的儿子,十岁,满头溃烂,流出脓血水,几十处伤口。他父亲说:“这是痘毒,半年不愈。”取出往日的药方,都是连翘、生地等凉药。这才知道是寒凉入胃,火无所依附,上冲头顶,这就是所谓的“虚阳贯顶”,适宜用引火归源的方法,用大补元煎兼加散药,每日一剂,十日痊愈。
我的亲侄儿,七岁,在常州出痘,非常稀疏,医师用凉药败毒,当时虽然没塌陷,但形状已显得狼狈不堪。一个月后,右腿长了一个大疽,皮色不变。医师坚称是火毒,仍以生地、银花、黄芩、山楂、山栀等药治疗,一剂后脾胃更弱,神气昏沉;二剂后呕吐泄泻;三剂后随服随吐。庸医不知药不对症,所以胃中不能受纳,却说:“吐药但不吐味,导致疮色晦暗”,又过了几天不溃破就死了。
六安有一位僧人,风雅能诗,二十多岁发热出痘,我去诊治,见其颗粒稀疏,根盘红活,问其饮食有味,二便正常。他求方药,我说:“这么好的痘,可以不药。”第二天,有痘师前往,为他用了各种泻火的凉药,每剂加大黄三钱,连服三剂,导致腹泻不止,痘疮塌陷,绝食数日后去世。体虚之人出痘,误服大黄,真是毒药,试验非常确切,不敢隐瞒,治痘者切宜猛省。
我的外孙汪陵,丙辰年五月,尚未满一岁,向来大便溏薄、腰软,可知气血不足。忽然发热一天,周身出痘,稠密成片,痘顶各有小孔破流黄水,眼睛瞪着不能闭合,昼夜腹泻十余次,乳汁入口即从下窍流出,肛门无沿,空洞一穴。《痘书》说:“肛门如竹筒者不治。”众医袖手旁观。我说:“这就是前文发热论中所谓阴毒太重,阳气大虚的症候,非大加温补,万不能生。”即将大补元煎,每剂用附子二钱,肉桂三钱,炮姜一钱五分,丁香末五分,胡椒末三分,浓煎滤汁,昼夜频频灌服。药汁入口已从下窍流出,一连九次,灌完一剂。见者说:“不必再灌,等待时间罢了。”幸亏其母细心体贴,说:“药虽流出,似觉较少,且灌药一次,眼睛能闭片刻,定是有效。”于是照原方不改分毫,如前法,每日一剂。又服三剂,这孩子竟能假寐片刻,泻下之物青黑中带有黄色,知其胃气生动也。照原方又进三剂,肛门有沿,泻利稍止,痘顶小孔长满,且已起发,全灌清浆。照原方加龙骨末、粟壳各一钱,又进四剂,痘已全然结痂,至第十三日,痘痂落尽,斑点全无,肚腹亦好。闻者莫不称奇。我识得此儿是虚寒之症,用药得宜,故有效耳。寻常泄泻者亦可治。以上见《遂牛编》。
My nephew Sun Wangxuan, aged six, had always been constitutionally weak. Occasionally, upon contracting cold or consuming cold foods, he would develop wheezing, diarrhea, and fever. It was well known that his middle jiao deficiency generated internal cold, making warming and tonification appropriate, while cold-cooling herbs were contraindicated. In the year Jiayin of the Qianlong reign (1734), when he suffered from smallpox, the physician prescribed herbs such as Shengdi Huang (Rehmanniae Radix) and Yinhua (Lonicerae Japonicae Flos). I stated, "The properties of these medicines contradict his constitution; how can they be symptomatic?" Therefore, I changed to Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Shengjiang (Zingiberis Rhizoma Recens) and Rougui (Cinnamomi Cortex). After four doses, the smallpox pustules crusted over, and he recovered.
A child surnamed Jiang, aged two, had a fever for three days, and his smallpox had fully erupted but was not very numerous. The smallpox specialist intended to administer Dahuang (Rhei Radix et Rhizoma) and Lianqiao (Forsythiae Fructus) via gavage. I said, "If these drugs are administered, causing one or two episodes of diarrhea, the smallpox will retract." They did not believe me; indeed, after the diarrhea occurred, the smallpox did retract. The specialist then fed him water boiled from a young pigeon. The next day, many small pustules suddenly erupted. I said, "It is evident that tonification should be used." However, the smallpox doctor still administered only a few granules of minor medicine, leading to incessant diarrhea and death.
A maid named Xilian, aged five, had a fever for one day, with red spots covering her body in patches. The smallpox doctor said, "This is called 'Fire-Scorched Seedlings,' a fatal condition on the twelfth day; there is no chance of survival, so medication is unnecessary." I feigned agreement but prescribed Dabu Yuanyuan Jian (Great Tonification of the Original Source Decoction) for two doses. Her spleen and stomach function improved slightly. After four more doses, the seedlings were full and filled with fluid, though their color was dull and they did not crust. After seven additional doses, they crusted; after ten doses, she fully recovered. The doctor remarked, "Such successful eruption must never be underestimated."
My paternal nephew Wenbao, aged one, suffered from measles without timely dispersal. Repeated use of cold-cooling herbs led to diarrhea, vomiting, cracked lips, and a black tongue, progressing to slow convulsions, with life hanging by a thread. Upon examination, I told the attending physician, "This is due to cold herbs forcing deficient fire upward. Although the exterior appears extremely hot, the interior is truly cold." The physician argued, "Cracked lips and a black tongue—could this not be excess heat?" I replied, "Diarrhea with clear stools—could this not be deficiency cold? Is there any case of excess heat accompanied by diarrhea and clear urine?" The physician could not answer.
Case Record: The son of Magistrate Wei, aged three, had sparse smallpox. The specialist used several doses of cooling herbs. Fortunately, the child's constitution was strong; although severe diarrhea did not occur, the dark spots did not fade, indicating that the true fire had been cleared. Over a month post-smallpox, a boil suddenly appeared on the vertex, unchanged in skin color, large as a wine cup, caused by the stagnation of cold herbs. I used Dawenzhong Yin (Great Warming of the Middle Decoction), which resolved it after several doses.
Shu You’s son, aged ten, had his entire head ulcerated, oozing pus and bloody fluid from dozens of lesions. His father stated, "This is smallpox toxin, unresolved for half a year." Reviewing past prescriptions revealed frequent use of Lianqiao and Shengdi Huang. It became clear that cold herbs entered the stomach, leaving fire without a foundation, rushing upward to the head—this is what is termed "Deficient Yang Piercing the Vertex." The method of guiding fire back to its source was appropriate. Using Dabu Yuanyuan Jian combined with dispersing herbs, one dose daily, resulted in complete recovery within ten days.
My paternal nephew, aged seven, developed sparse smallpox in Changzhou. The physician used cold herbs to resolve toxicity. Although the lesions did not collapse initially, their appearance was already disordered. One month later, a large carbuncle appeared on the right leg with unchanged skin color. The physician insisted it was fire toxin and continued treating with Shengdi Huang, Yinhua, Huangqin (Scutellariae Radix), Shanzha (Crataegi Fructus), and Zhizi (Gardeniae Fructus). After one dose, spleen and stomach function worsened, and spirit became lethargic; after two doses, vomiting and diarrhea ensued; after three doses, everything taken was immediately vomited. The quack physician, unaware that the medicine did not match the syndrome and thus was rejected by the stomach, claimed, "The medicine is vomited but not the taste, causing the lesion color to become dull," and the child died a few days later without suppuration.
A monk from Lu'an, elegant and poetic, developed fever and smallpox in his twenties. Upon examination, I noted sparse particles with vibrant roots. He reported normal appetite and bowel/bladder functions. When he requested medication, I said, "With such favorable smallpox presentation, no medication is needed." The next day, another specialist visited and administered various cooling herbs to purge fire, adding Sanqian (three qian) of Dahuang per dose. After three consecutive doses, incessant diarrhea occurred, the smallpox collapsed, he refused food, and died within days. For individuals with weakness developing smallpox, mistakenly administering Dahuang is truly poisonous. This has been verified through practice, and I dare not conceal it. Practitioners treating smallpox must reflect deeply.
My grandson Wang Ling, in the fifth month of the Bingchen year, was under one year old. He historically had loose stools and soft waist, indicating insufficient qi and blood. Suddenly, after one day of fever, dense smallpox erupted all over his body. Each pustule had a small pore leaking yellow fluid. His eyes remained open, unable to close temporarily, and he suffered diarrhea more than ten times a day. Milk entered his mouth but flowed out from the lower orifice; his anus lacked margins, appearing as a hollow hole. The *Dou Shu* (Book on Smallpox) states: "An anus like a bamboo tube is incurable." Physicians stood by helplessly. I stated, "This is the syndrome of heavy yin toxicity and massive yang deficiency described earlier in the fever discussion. Without significant warming and tonification, survival is impossible." I prepared Dabu Yuanyuan Jian, using Fuzi (Aconiti Lateralis Radix Praeparata) 2 qian, Rougui 3 qian, Paojiang (Zingiberis Rhizoma Preparatum) 1.5 qian, Dingxiang (Caryophylli Flos) powder 0.5 fen, and Hujiao (Piperis Longi Fructus) powder 0.3 fen per dose. Boiled thickly and filtered, it was frequently administered day and night. The liquid exited through the lower orifice immediately upon entry. Despite nine attempts exhausting one dose, observers said, "No need to continue; just wait for time." Fortunately, his mother observed carefully, noting, "Although the medicine flows out, less seems to remain, and after each administration, his eyes close briefly. This must be effective." Thus, the original formula was unchanged, administered once daily as before. After three more doses, the child managed brief sleep. The stool turned green-black with yellow traces, indicating the revival of stomach qi. Following the same formula for three more doses, the anus regained margins, diarrhea slowed, the pores on the pustules filled, and they began to rise, filling with clear fluid. Adding Gulong (Ossis Ferreum Preparatum) powder and Susuqiao (Papaveris Pericarpium) 1 qian each to the original formula, four more doses were given. The smallpox fully crusted. By the thirteenth day, all crusts fell off, spots vanished completely, and the abdomen healed. Those who heard this marveled. I recognized this child’s condition as deficiency-cold; the appropriate medication yielded results. Ordinary diarrhea cases can also be treated similarly. The above is recorded in *Suniu Bian*.