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For the two types of Sha Zhen (a rash-causing infectious disease), the methods of ascending and dispersing (Sheng San) and clearing heat and cooling (Qing Liang) should be used in combination; neither should be neglected. In severe cases, Shi Gao (Gypsum Fibrosum) must be used, while Xi Jiao (Rhinoceros Horn) is strictly contraindicated.

Prescription: Sheng Ma (Cimicifugae Rhizoma), Ge Gen (Puerariae Lobatae Radix), Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Chi Shao (Paeoniae Radix Rubra), Yuan Shen (Scrophulariae Radix), Lian Qiao (Forsythiae Fructus), Yin Hua (Lonicerae Japonicae Flos), Niu Bang Zi (Arctii Fructus), Shan Zhi Zi (Gardeniae Fructus), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma Preparatum), Jie Geng (Platycodonis Radix); alternatively, add Jiang Can (Bombyx Batryticatus), Chan Tui (Cicadae Periostracum), or Xi He Liu (Salicis Capreae Ramulus).

In the fourth month of summer during the Ji Chou year, at the time of Xiao Man (Grain Buds) solar term, damp earth was the prevailing pathogenic factor. My wife, Ms. Pan, aged forty-seven, suddenly suffered from headache, fever, cough, and aversion to wind. She continued her labor without avoiding wind and cold, resulting in throat pain as if cut by a knife, hoarseness, hemoptysis, swelling on both sides behind the ears and along the neck, and white rashes appearing all over her arms and chest, resembling grains of sand. Her bones and sinews felt sore and weak, she had constipation and abdominal fullness, bitter taste in the mouth but no thirst, and her pulse was soggy, stagnant, choppy, and rapid. I decocted three qian of Xi He Liu (Salicis Capreae Ramulus) with Gan Cao (Glycyrrhizae Radix et Rhizoma), Jie Geng (Platycodonis Radix), Niu Bang Zi (Arctii Fructus), Zhu Ye (Bambusae Folium), and Lu Gen (Phragmitis Rhizoma) to brew a soup, taking one pill of Yu Xue Jiu Ku Dan (Jade Snow Saving Life Pill) mixed into it. Instantly, the white rashes turned red, spread throughout the body, and the neck swelling gradually subsided. However, swallowing tea remained obstructed. After taking another pill of Yu Xue Dan, all ailments vanished, and she recovered so quickly that it was imperceptible.

When my wife’s white rashes appeared, her throat had already become ulcerated. Due to previous dysfunction at the Jiache acupoint (ST6) and trismus (lockjaw) preventing her mouth from opening, she only felt throat pain like a knife cut when eating or drinking, coughed up foul-smelling pus and blood causing people to cover their noses, and could not open her mouth to inspect the throat ulcers. No medicated powder was blown into the throat. This demonstrates that throat pain is a common symptom of Sha Zhen. However, when promoting the eruption of Sha Zhen, it is strictly forbidden to misdiagnose it as Hou Feng (wind affecting the throat) and use cooling agents to suppress it. Patients must be instructed to avoid certain foods and keep away from wind. Once the Sha Zhen eruptions are complete, the throat pain will heal naturally. Such dangerous and severe conditions can lead to death or recovery in an instant; how can one not fear them?

I still recall that in the Jia Xu year of the Tongzhi era, the younger sister-in-law of Mr. You Jianquan suffered from epidemic throat sha (Hou Sha). Her throat was swollen and closed, blocked by white necrotic tissue, and her neck was swollen like a gourd. She could not swallow even a drop of water, and any liquid medicine taken entered her nose and was expelled. My fellow townsman, Mr. Zhang Tingquan, and I misdiagnosed this as Hou Bi (obstruction of the throat) and treated it improperly, leading to a worsening condition day by day. We specially invited the elderly physician Mr. Huang Juquan from Shanghai to diagnose her. He asked, "Have you taken cooling medicines? Have you used throat powders?" He stated that the condition was critical, but fortunately, there was no dyspnea, so it could still be saved. Generally, Hou Sha is caused by the failure to store yang energy during winter, leading to latent qi erupting internally, combined with external closure by wind and cold, resulting in rotting throat. How can cooling suppression be used again? Therefore, using throat powders is strictly contraindicated. If Bing Pian (Borneolum Syntheticum) and Xi Huang (Calculus Bovis) are used, the more they are applied, the worse it becomes, and the deeper the ulceration. One should only promote the release of toxins and vent the exterior to allow Sha Zhen to emerge outward, which will naturally resolve all symptoms. Sister-in-law Jianquan’s condition worsened due to the suppression caused by cooling medicines, but she recovered after being administered exterior-releasing formulas. I then had a sudden enlightenment: as the proverb says, "Being familiar with the Tangtou Ge (Song of Formulas) is inferior to having extensive clinical experience." From now on, I shall constantly strive for improvement. I record this here to remember my past mistakes.

On the Flower Morning (Chao) of February in the Xin Mao year of the Guangxu era, Chi Tingzi Ling De, aged sixty-one.