余之此稿，曾刊于《世界医报》(张赞臣与余合编)，病而殇者，即余之第三女也。今当写此稿时，回忆三十年前之情况，如在目前，犹觉心酸肠折也。女名玖儿，年才三岁，聪明异常儿。时余充本县第三区小学校长，学生唱歌，儿仿效之，与风琴合拍，音节不讹。先严慈以下，无不爱之。适余姨母来余家，亦颇钟爱。因姨弟早亡，无有孙息，迨返家时，必欲偕玖儿俱去。先严慈及余均不可，而内子反乎为母之常情，抱女置姨怀，促之发车而去。先慈亦以姨无嗣，不忍拦阻，心纵不舍，而亦无如之何。
孰意车行不数里，玖儿不见亲人，始则四顾寻望，继则啼哭不已。虽经姨母哄骗，仍然哭不绝声。当日野风亦大，土车行程十八里，始至其家。立以糖果杂食，罗置其前，哄之食以止其啼。五日之中，凡一日三餐，以鱼肉荤腻之品啖之。或一经啼哭，又以糖果杂食甘之。此时之病根已伏矣，而孰知之耶。至第六日晨．姨母忽乘车而至。抱玖儿下车人室，面有愁容，蒙儿以巾。余合家一见，知儿必病矣，惊询之，果然。察其症状，如上文所述，并将儿携去后之情形，详细告知，而深自悔，不应将儿带去也。当时儿送至后，立即随原车而去。
先严诊察后，立即处方与服。一剂不效，再剂亦不效，渐见严重。盖先严以爱孙女心切，反而不敢用重药，此亦人之恒情也。余心颇急，看此实火之证，热已内陷，昏谵并作。其他症状，均险象环生，如上文所述。忽思王孟英之言日，与其坐以待毙，不如含药而亡。乃急书泻心承气合增液法加味方大剂，而密与之，不告先严知也。待服药之后，神情甚安。不数小时，大便即通，泻出恶臭污秽之粪甚多。体温大降，牙龈不腐，口臭亦大减，周身皮肤，已转润泽。察其面色、耳纹、指纹、舌苔，却为病退之征，略思饮食，似病已去其七八者，合家欢忭。
先严旋戒余曰：汝用此方，侥幸治愈此孩，亦大幸事，但慎勿过剂，过犹不及也。余是时以得失心太重，颇然先严之言。当日只与梨汁藕粉汤等品，神情绝佳。嗣思此孩，连日来进苦水已多，决至次日再加减一方与服。夜间亦甚安，次日上午亦然。约至下午三时，忽又觉烦躁，体温渐炽。余大惧，急照前方原量与服，不意丝毫无效。夜间更甚，牙龈复烂，口中复出臭气。虽连服前方，皆无寸效。症状时时加剧，延至第三日夜间，添喘而殇。
余以转机之病，忽大反变，中心痛切，莫可名状。以后凡遇疹毒热甚，不能外出，转而内陷者，辄重用前方与之，甚或加犀角、羚羊尖，连服数剂，均获救治，无一死者。是亦死了一个女儿，添了一个经验，才能救了多少小孩。如次列两条，皆其佐证。独惜吾女之病，造之于他人之手，而吾女之殇，夺之于己掌之上。至今思之，犹觉有余痛也。
泻心承气合增液法加昧方上川连一钱生黄芩三钱生大黄三钱元明粉三钱(分冲)大麦冬四钱鲜石斛五钱鲜生地五钱生石膏一两金银花四钱净连翘四钱生梨汁半茶杯(冲)鲜竹叶五十片麻疹热厥险证六龄儿童，患生麻疹，医药罔效。三日即内陷，烦躁不安，两目发青而上耸，鼻道干燥灰黑，而鼻翼煽张，舌苔满腻燥黄，而边缘紫绛，口出恶臭，周身亢热无汗，大便不通，小溲短赤，扬手掷足，指纹青紫，扪其心部，热甚炙手，而手足发冷，此所谓热厥也。先令委儿于泥土地上，次与泻心承气增液法加味方，大泻之后，皮肤通汗，一剂知，二剂已矣。
同乡人谭焕文，夫妇年过四旬，始生一子，爱之愈恒。
时在1929年初夏，余初来沪设诊。谭以余为内外科，故儿初病时，未延余治。经他医连治三日，均无效果。至第三日，忽然内陷，症状如上文所述。其戚左姨，谓与其坐以待亡，不知延余医师以药试之，观其后果如何，谭然之。余既至，见症状如此，顿感心酸。盖忆及余玖儿之证，与此儿相伯仲也。
正诊察间，谭之老父，即病儿之祖，曳杖而至。大声叱焕文夫妇曰：“儿已将死，奄奄一息，何必费钱费钞。医生岂神仙耶，请医生速去，不必将有用之钱，用之于无用之地也。”余闻其言，去留两难。适有乡人在侧，扶谭父外出，并对之言曰：“老人家对儿女则可，当医生如此发言，则医生大难堪矣。”此时谭夫妇向余道歉，请为设法。余稍凝神，乃为之处方。案上载明证属危险，姑拟一方，聊尽人事而已。后列之方药，则为余数年前亡女玖儿所服之方也。并嘱令将病儿置于泥土地上，任其反复，再续服此方，余即辞去。
迨一服之后，不三小时，大便畅解，黑垢异常，热臭之极。继则皮肤通汗而润泽，热度渐减。服二煎后，又解大便两次。热势更减，烦躁渐安，目睛之青色，指纹之紫色，均渐减退，舌苔亦退其半，鼻翼亦不掮张矣。次晨复延余诊，余心大慰。心记玖儿之病，以停药一日而伤，今不可再蹈覆辙矣。乃将原方减量约三分之一，令再服一剂。大便续下三次，第三日续有轻缓，已略思粥汤矣。乃将次日方再减量与之。并与以粥汤、藕粉及稀薄之牛奶等，每三小时一次。在一星期内，以粥渐加稠，且莫多食，禁食他物。盖积滞方去，恐伤脾胃，而余火复炎也。
余之所以用此方，认为发疹是一事，夹证是一事，最须看清。此儿之证，其夹证与余玖儿相同。即独养子之过爱，平素必多杂食，此为一般人之恒情，而病根已伏于此矣，故敢用此大剂耳。所谓置之死地而后生，岂不然哉。然死一稚女，救活他孩。喜乐与悲伤，真难明也。
泻心承气合增液法加昧方上川连一钱生黄芩三钱生大黄三钱元明粉三钱(分冲)大麦冬四钱鲜石斛五钱鲜生地五钱生石膏一两五钱金银花四钱净连翘四钱生梨汁半茶杯(冲)鲜竹叶五十片麻疹喘促险证七龄儿童，仲冬患生麻疹。医用清凉透托之方，不效，而身热如焚。至第三日疹色渐暗而内陷，唇焦舌燥，苔腻异常，胸部炙手。大便则一日稀薄，二日粘腻，三日不通。脘口按之作痛，气息喘促，鼻翼掮张颇甚，鼻道干燥无涕。以泻心承气增液法加石膏、羚羊角主之，一剂转，二剂平，三剂痊矣。
盐城人徐怀清，住羊尾桥西梅泉里，有子女各一。女九龄，子七龄。先是女患麻疹，而继传其子。女轻而愈，子重而险，证如上文所述。三四日间，已五易其医，嗣延余诊。
余见其症状，与谭子仿佛，惟肺热太重，恐不用羚羊角，因而遗误，则亦余之过也。因询其病前日常所食，则亦如谭子之无节。乃为之处方，以泻心承气增液法加生石膏、羚羊角。令其先以冷开水，服下羚羊角粉，次服汤药，以观其效。
徐即如法服之。下午三时服药，约至四时，气息即较平。五时余，大便即解，粘腻黑污，如胶如酱，但量尚不多。至七时续服二煎，八时后连解大便二次。便色已转深黄，较之黑污已减轻矣，气息大平。次日复诊，察其热已大减，皮肤润泽，疹点复又透出，色红而微带紫，虽不甚多，而胸背四肢，点点可数，约有四五十粒。余知腑气一通，肺气已开，故皮毛亦开，余邪外透，此大佳事。因减羚羊角为三分，令其再服一剂，便色渐转淡黄，于是诸症悉退矣。后再服清理余邪、扶持正气之剂，而告痊可。
泻心承气增液法加石膏羚羊角方上川连一钱生黄芩三钱生大黄三钱元明粉三钱(分冲)鲜石斛五钱鲜生地五钱生石膏一两五钱净连翘三钱天花粉三钱羚羊角粉四分生梨汁半茶杯(冲)鲜竹叶五十片痘疮痘疮实热险证痘疹不起，实火内结。他医误进温补，延至五朝，头面碎密，胸腹稀少，舌苔干燥，唇焦出血，鼻干无涕，肌肤灼热，扪之炙手，以致腠理不开，痘难外出，大便不解，烦躁不安，谵语神昏，大渴引饮，奄奄一息，生死反掌。姑以犀羚泻火汤主之，得此大剂凉下，腑通肺开，皮毛亦开，痘立起发而赶浆，终脱险境。
阜宁顾允卿之子，年13岁。于九月出痘，二十日见点，始延甲医某治之。甲医见痘不起发，用参、芪、归、芎、肉桂、僵蚕、炮甲、皂刺、桑树虫之属，以温补烘托之。至四朝依然不起，热度更高，次延乙医某诊之。乙知甲医之误，改进活血化毒清热之剂，如红花、紫草、大贝、知母、连翘、石膏之属。无如该乙医胆小，石膏虽用至一两，奈因病重药轻，且又泥于活血，故仍不能见效。乙医复托人转告顾君曰：“此死症也，我无疗治之法矣。”顾君一闻此言，其伤悲焦急为何如，此第五朝之情形也。
时余出诊于他方，顾君急以长途电话招余回。余诊之，见其颜面碎密，犹如蚕子，唇下成饼，两颐及颔下，只有绿豆大五六粒之亮壳痘而已，胸腹甚少，背部亦不多，两臀成片，均如蚕子，而不成为痘，腿以下更无论矣。肌肤炙手，唇焦裂口，咽喉疼痛，舌苔焦裂断津，鼻腔燥而出血，大渴引饮，谵语神昏，奄奄一息。余观此情形，随问曰：“在未发热未见点之前，曾食何物否?”顾君沉思少顷，忽曰：“先生不问，余几忘之矣，发热前曾食蟹也。”余又问曰：“曾服何药否。”顾君急取甲医及乙医方笺与余。余审视一过曰：“乙医之方，虽未完全到窍，然尚无害大事。甲医之方，实误之矣。但余既来，当处一方，以尽人事。服不服主权在君，好与否我不负责，君能许我，我即处一方，否则余不处方也。”于是得顾君之一诺，为之处方，以犀羚泻火汤主之。
顾君取方笺，至药肆购药，适甲医过而见之，讶问曰：“此方杀人之方也，令郎之痘症，补托之尚恐难起，何能凉下?一用此方。岂有不痘毒内陷，而早送其生命者耶。”顾君无法，复延乙医商之。乙医对余所处之方，不加可否。盖乙医虽知余为撤手一着，而究以一派凉下、分量太重为畏途。复又延余，请三人会商办法。余既至，先聆甲医之教言，次余起谓“此症热炽之极，脏腑热燔于内，肌肤热灼于外，痘为热灼，焉能外出。犹之久旱不雨，地质干燥，毫无润泽之气，又为暴日所蒸晒，谷何能生芽长发。必须倾盆大雨，气候转凉，大质沾润，谷方可生。此孩之痘症，势亦同此，非用大凉大下之剂，清其内外之实热不为功。且其发热之前，曾食蟹，下药更不可不用。夫如是，热度减退，腠理始开，毛窍始透，痘乃可出。此乃实热证，如怕服凉下之药，命恐不旋踵矣。”语毕，余即兴辞而去。
余去后，甲医亦去，临行复告病家日，“此方万不可服，下喉即死。”甲既去，有顾君之友施赵卿者，谓顾曰：“我虽不知医，今见余医师之方，有胆有识，决非无经验之可比。
病已至此，生死一发，不妨一试，死马当作活马医也。”乙医亦漫应曰：“别无他法，只好一试而已。”于是乃决定服余方。待磨成羚羊角粉，至服方时，已至夜深十二时矣。
次晨黎明时，顾君扣门入，欣欣然喜曰：“昨夜服药后，至四更时泻一次，天将明又泻一次，解下污垢燥黑之粪不少。腹中似尚未清，但高热已见减低，痘亦陆续外出矣，烦再诊之。”余偕之去，见痘果外出，为数不少，色转红活，不似以前之焦枯，热已较减，而昏谵亦不作。诚转机矣。余乃将前方中之犀角一钱，减为五分，羚羊角六分，减为四分，仍令先服之。另为之注射握姆纳丁(Omnadin)两针，以增加体内蛋白质，使其抗毒力加强。至第三诊，又减大黄至一钱五分(次诊、三诊在六朝)。第五诊除去大黄，第六诊除去犀角、羚羊角，减石膏为二两，其他诸药，逐渐酌减分量(五诊、六诊在七朝)。直至第十诊，方除去石膏而不用(十诊在九朝)。计此孩先后所服石膏，约有三斤之多。
后至十三朝，日晡寒热，有如疟状，知为元气大伤，故呈此疟状。余乃改以保元汤为主，佐以清余热、解余毒之剂，数服而痊。
犀羚泻火汤方乌犀角(冲磨)一钱羚羊角尖(磨冲)六分生石膏四两生大黄三钱上川连二钱生黄芩三钱银花一两净连翘五钱生山栀五钱鲜生地一两鲜石斛一两鲜竹叶五十片活水芦芽五两，熬水煎药，先服犀、羚，冷开水下，次服汤药。
痘疮虚寒险证幼儿初发微热，继则感染天花，出于肤面。医初用炮甲、皂刺，嗣用党参、黄芪，然均无效。至四朝不见起发，改用清凉，证立转危，奄奄一息。余察其面现苍白，身体瘦弱，知为失乳，询之果然。急以温阳益气汤托之，是夕喃喃不安，次日晨，痘果起胀矣。
阜宁有葛剑吾者，充县立师范教师。其幼子才三岁，初发微热，继则感染天花。但虽已见点，不见起发，延医治之。医用炮甲、皂刺之属，不效。继用党参、黄芪之品，又不效。至四朝仍不起胀，乃改用清凉之品，则一变而为不能食，迅至奄奄一息。葛君大惧，急延余诊，意其万一希望也。余既偕去，途中即告余前此之医药过程。既至入室，察其子面色苍白，身体瘦弱，气已咻咻若不相续。问曰：此孩素来失乳否?曰然，因乳汁不充，改以乳粉代之，故小儿营养不良也。
余察其体温尚较常温为低，且手足发凉，痘形有内陷之势，知为又虚又寒之证，又加误用清凉，当然更变危候矣。
My manuscript was previously published in the *World Medical Journal* (co-edited by Zhang Zancen and myself). The child who died of illness was my third daughter. As I write this now, recalling the situation from thirty years ago, it seems as if it were happening before my eyes, and I still feel heartbroken. Her name was Jiu'er, only three years old at the time, exceptionally intelligent for a child. At that time, I served as the principal of the Third District Primary School in our county. When students sang songs, she would imitate them, keeping rhythm with the accordion, with accurate pitch. From my grandparents to my parents, everyone loved her. My aunt happened to visit our home and also doted on her greatly. Since my uncle had passed away early and they had no grandchildren, when she returned home, she insisted on taking Jiu'er with her. Both my father and I disagreed, but my wife, contrary to a mother's usual instinct, held the daughter and placed her in her aunt's arms, urging the car to depart. My grandmother, because her sister had no heirs, could not bear to stop her; although reluctant, she felt helpless.
Who would have thought that within a few li of travel, Jiu'er, seeing no relatives, first looked around searching, then began to cry incessantly. Despite coaxing by her aunt, the crying did not cease. The wild wind was strong that day, and the dirt road journeyed eighteen li before arriving at her aunt's home. Immediately, candies and various snacks were placed before her to coax her into eating and stop the crying. For five days, she was fed fish and meat, rich and greasy foods, three times a day. Whenever she cried, she was further appeased with candies and snacks. At this point, the root of the disease had already taken hold, though who could have known? On the morning of the sixth day, the aunt suddenly arrived by carriage. Holding Jiu'er out of the car and into the room, her face showed sorrow, covering the child's head with a towel. Upon seeing this, our whole family knew the child must be ill. We asked in surprise, and indeed, she was. Observing her symptoms, as described above, and hearing the detailed account of what happened after she was taken away, we deeply regretted taking her. After delivering the child, the aunt immediately returned on the original carriage.
After my grandfather examined her, he immediately prescribed medicine for her to take. One dose was ineffective, two doses were also ineffective, and the condition gradually worsened. This was because my grandfather, out of deep love for his granddaughter, dared not use heavy medication, which is human nature. I was very anxious; this was clearly a excess-fire syndrome, with heat having sunk inward, accompanied by coma and delirium. Other symptoms, as described above, were full of perilous signs. Suddenly, I recalled Wang Mengying's words: "Rather than sitting and waiting for death, better to die holding medicine." I hastily wrote a large-dose prescription combining Xiexin Chengqi Tang (Drain the Epigastrium and Purge the Intestines Decoction) with Zengye Tang (Increase Fluids Decoction), modified, and secretly gave it to the child without informing my grandfather. After taking the medicine, her expression became very calm. Within a few hours, her bowels moved, passing a large amount of foul-smelling, filthy stool. Her body temperature dropped significantly, her gums stopped rotting, bad breath greatly decreased, and her skin became moist. Observing her complexion, ear veins, fingerprint, and tongue coating, these were all signs of the disease receding. She began to desire food slightly, suggesting the illness was gone by seventy or eighty percent, and the whole family rejoiced.
My grandfather soon warned me: "You used this formula and luckily cured this child, which is fortunate, but be careful not to overdose. More is worse than enough." At that time, burdened by concerns over gain and loss, I agreed with my grandfather. That day, I only gave her pear juice and lotus root starch soup, and her spirits were excellent. Later, thinking the child had consumed much bitter liquid over the past few days, I decided to add another modified prescription for the next day. The night was peaceful, and so was the next morning. Around 3 PM, however, she suddenly became irritable, and her temperature rose gradually. I was terrified and hurriedly administered the previous prescription at the original dosage, but to no avail. The night grew worse; her gums rotted again, and foul breath returned. Although she continued to take the same prescription, there was no effect. Symptoms intensified constantly, and by the night of the third day, she developed wheezing and died.
I was heartbroken beyond description by the sudden reversal of a turning point in the illness. Thereafter, whenever I encountered cases where measles toxin was severe and failed to erupt outward, sinking inward instead, I heavily relied on the previous formula, even adding Rhinoceros Horn (Xijiao) and Antelope Horn (Lingyangjiao). Continuous administration of several doses resulted in successful rescue in every case, with no deaths. Thus, the death of one daughter brought an experience that saved many children. The following two cases serve as evidence. It is only pity that my daughter's illness was caused by others' hands, yet her death was taken by my own hand. Even now, thinking of it brings lingering pain.
**Modified Xiexin Chengqi Tang combined with Zengye Tang:** Chuanlian (Coptidis Rhizoma) 1 qian, Sheng Huangqin (Scutellariae Radix) 3 qian, Sheng Dahuang (Rhei Radix et Rhizoma) 3 qian, Yuanmingfen (Natrii Sulfas) 3 qian (dissolved separately), Da Maidong (Ophiopogonis Tuber) 4 qian, Xian Shihu (Dendrobii Caulis) 5 qian, Xian Shengdi (Rehmanniae Radix) 5 qian, Sheng Shigao (Gypsum Fibrosum) 1 liang, Jinyinhua (Lonicerae Japonicae Flos) 4 qian, Jing Lianqiao (Forsythiae Fructum) 4 qian, Sheng Lizhi (Pyrus Sinkiangensis Juice) half teacup (mixed in), Xian Zhuye (Bambusae Folium) 50 leaves.
**Measles Heat-Jue Critical Case:** A six-year-old child suffered from measles, with medical treatment ineffective. By the third day, the rash sank inward. The child was restless and uneasy, eyes greenish and staring upward, nasal passages dry and gray-black with alar flaring, tongue coating thick, greasy, dry, and yellow with purple-red edges, foul breath, high fever without sweat, constipation, scanty dark urine, waving hands and kicking feet, blue-purple fingerprints, intense heat upon palpation of the epigastrium while extremities were cold—this is called "Heat-Jue" (heat collapse). First, the child was laid on muddy ground, then given the modified Xiexin Chengqi Zengye Tang. After purging heavily, sweat appeared uniformly on the skin. One dose showed improvement, two doses led to recovery.
Tan Huanwen, a fellow townsman, and his wife were past forty when they finally had a son, whom they loved excessively. In early summer 1929, I had just set up my clinic in Shanghai. Mr. Tan considered me proficient in both internal and external medicine, so when the child first fell ill, he did not consult me. Three days of treatment by other doctors yielded no results. On the third day, the condition suddenly sank inward, with symptoms as described above. His relative, Aunt Zuo, suggested that rather than waiting for death, they should try my medicine to see the outcome. Mr. Tan agreed. Upon arrival, seeing the symptoms, I felt heartbroken, recalling that my daughter Jiu'er's condition was similar.
While examining, Mr. Tan's elderly father, the child's grandfather, arrived leaning on a cane. He loudly rebuked the couple: "The child is dying, barely breathing. Why waste money? Is a doctor a god? Please leave; do not spend useful money on useless things." Hearing this, I was torn between staying and leaving. A fellow townsman nearby helped escort Mr. Tan outside, telling him, "It is fine to speak thus to your children, but saying this about a doctor puts us in a difficult position." The Tan couple apologized and asked me to help. After concentrating for a moment, I prescribed. I noted on the chart that the condition was dangerous and this was merely an attempt to do my duty. The prescription listed below was the same one my deceased daughter Jiu'er had taken years prior. I instructed them to place the sick child on muddy ground, allow her to move freely, continue the medication, and then I departed.
After one dose, within three hours, the bowels moved freely, passing abnormal black filth, extremely hot and foul. Subsequently, sweat appeared uniformly on the skin, becoming moist, and the fever gradually subsided. After the second decoction, two more bowel movements occurred. The fever decreased further, irritability calmed, the greenish hue of the eyes and purple color of the fingerprints faded, the tongue coating receded by half, and alar flaring ceased. The next morning, upon re-examination, I felt great relief. Remembering that Jiu'er died due to stopping medication for one day, I resolved not to repeat this mistake. I reduced the original prescription by about one-third and ordered another dose. Bowel movements continued three times; by the third day, the condition eased slightly, and she desired porridge. I further reduced the next day's prescription. I provided porridge, lotus root starch, and thin milk, every three hours. Over a week, the porridge was gradually thickened, avoiding overeating and other foods. Since stagnation had just cleared, I feared damaging the spleen and stomach, allowing residual fire to flare up again.
I used this formula because erupting the rash is one matter, and accompanying syndromes are another; clarity is essential. This child's accompanying syndrome was identical to my daughter Jiu'er's. An only child, overly pampered, likely consumed irregular snacks, embedding the disease root—a common human tendency. Hence, I dared to use such a heavy dose. As the saying goes, "Place in a desperate situation to survive," is it not true? Yet, one young girl died, and another child lived. Joy and sorrow are hard to distinguish.
**Modified Xiexin Chengqi Tang combined with Zengye Tang:** Chuanlian 1 qian, Sheng Huangqin 3 qian, Sheng Dahuang 3 qian, Yuanmingfen 3 qian (dissolved separately), Da Maidong 4 qian, Xian Shihu 5 qian, Xian Shengdi 5 qian, Sheng Shigao 1.5 liang, Jinyinhua 4 qian, Jing Lianqiao 4 qian, Sheng Lizhi half teacup (mixed in), Xian Zhuye 50 leaves.
**Measles Wheezing Critical Case:** A seven-year-old child contracted measles in mid-winter. Doctors used cooling and dispersing formulas without effect, resulting in burning fever. By the third day, the rash darkened and sank inward. Lips were scorched, tongue dry, coating abnormally greasy, chest hot to touch. Stools were loose on day one, sticky on day two, and obstructed on day three. Pain upon pressing the epigastrium, rapid breathing, severe alar flaring, dry nasal passages without discharge. Treated primarily with Xiexin Chengqi Zengye Tang plus Shigao (Gypsum Fibrosum) and Lingyangjiao (Antelope Cornu). Improved after one dose, stabilized after two, recovered after three.
Xu Huaiqing from Yancheng, residing at Meiquanli west of Yangwei Bridge, had one daughter and one son. The daughter was nine, the son seven. The daughter first contracted measles and recovered mildly; the son subsequently contracted it and suffered a severe, critical condition as described above. Within three to four days, five doctors had treated him before I was consulted.
Seeing his symptoms similar to Tan's son, but with heavier lung heat, I feared missing the opportunity by not using Lingyangjiao (Antelope Cornu). I asked about his diet prior to illness, which was also irregular like Tan's son. I prescribed Xiexin Chengqi Zengye Tang plus Sheng Shigao (Gypsum Fibrosum) and Lingyangjiao (Antelope Cornu). Instructed him to first swallow Lingyangjiao powder with cold boiled water, then take the herbal decoction to observe effects.
Mr. Xu followed the method. Taking medicine at 3 PM, breathing normalized by 4 PM. By 5 PM, stools passed, sticky and black like paste, though volume was small. Continuing the second decoction at 7 PM, two more bowel movements occurred after 8 PM. Stool color turned dark yellow, lighter than black filth, breathing greatly stabilized. Re-examination the next day showed significant fever reduction, moist skin, and rash re-emerging red with slight purple tint. Though not numerous, about 40-50 spots were countable on chest, back, and limbs. Knowing fu qi (bowel energy) was unblocked, lung qi opened, and pores released, allowing residual pathogens to exit outward, this was excellent. I reduced Lingyangjiao to 3 fen and ordered another dose. Stool color gradually turned pale yellow, and all symptoms receded. Subsequently, formulas clearing residual pathogens and supporting healthy qi were administered until recovery.
**Xiexin Chengqi Zengye Tang plus Shigao and Lingyangjiao Formula:** Chuanlian 1 qian, Sheng Huangqin 3 qian, Sheng Dahuang 3 qian, Yuanmingfen 3 qian (dissolved separately), Xian Shihu 5 qian, Xian Shengdi 5 qian, Sheng Shigao 1.5 liang, Jing Lianqiao 3 qian, Tianhuafen (Trichosanthis Radix) 3 qian, Lingyangfen (Antelope Cornu Powder) 4 fen, Sheng Lizhi half teacup (mixed in), Xian Zhuye 50 leaves.
**Smallpox Excess-Heat Critical Case:** Smallpox failed to erupt, excess fire knotted internally. Other doctors mistakenly used warming and tonifying herbs, delaying until the fifth day. Head and face covered densely with pustules, chest and abdomen sparse, dry tongue coating, scorched lips bleeding, dry nose without discharge, burning skin hot to touch, preventing pore opening and eruption, constipation, restlessness, delirium, coma, extreme thirst, barely breathing, life hanging by a thread. Treated primarily with Xiling Xiehuo Tang (Rhino-Antelope Fire-Draining Decoction). With this heavy cooling and purging dose, fu and lung qi opened, pores released, smallpox erupted rapidly and filled with pus, ultimately escaping danger.
Son of Gu Yunqing from Funing, aged 13. Developed smallpox in September, spots appeared on the twentieth day, initially treated by Doctor Jia. Seeing no eruption, Doctor Jia used Renshen (Ginseng Radix), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Rougui (Cinnamomi Cortex), Jiangcan (Bombyx Batryticatus), Pao Jiashan (Testudinis Carapax et Plastrum processed), Zaoci (Gleditsiae Spina), Sangchong (Sangzhichong), etc., for warming and supporting. By the fourth day, still no eruption, fever higher. Next, Doctor Yi diagnosed. Knowing Doctor Jia's error, Doctor Yi switched to blood-invigorating, toxin-resolving, and heat-clearing agents like Honghua (Carthami Flos), Zicao (Arnebiae Radix), Dabeimu (Fritillariae Thunbergii Bulbus), Zhimu (Anemarrhenae Rhizoma), Lianqiao (Forsythiae Fructum), Shigao (Gypsum Fibrosum), etc. However, Doctor Yi was timid; although Shigao was used up to 1 liang, the dose was too light for the severity, and reliance on blood-invigorating methods prevented efficacy. Doctor Yi told Mr. Gu via intermediary: "This is a fatal case; I have no cure." Upon hearing this, Mr. Gu's grief and anxiety were indescribable. This was the situation on the fifth day.
At that time, I was consulting elsewhere. Mr. Gu urgently summoned me via long-distance phone. Upon examination, his face was densely covered with lesions like silkworm eggs, chin formed a cake-like mass, cheeks and jaw had only 5-6 shiny-shell pustules the size of mung beans, chest and abdomen sparse, back not much, buttocks成片 (patchy) like silkworm eggs but not forming proper pustules, legs below even worse. Skin burning hot, lips cracked, throat painful, tongue coating scorched and cracked with broken fluids, nasal passages dry and bleeding, extreme thirst, delirium, coma, barely breathing. Observing this, I asked: "Before fever and spots appeared, did he eat anything?" Mr. Gu pondered, then said: "If you hadn't asked, I almost forgot. He ate crabs before the fever." I asked: "Did he take any medicine?" Mr. Gu hurriedly handed me prescriptions from Doctors Jia and Yi. Reviewing them, I said: "Doctor Yi's prescription, while not perfectly targeted, does no major harm. Doctor Jia's prescription is truly erroneous. But since I am here, I will prescribe to do my utmost. Whether you take it is your choice; I am not responsible for the outcome. If you agree, I will prescribe; otherwise, I will not." Obtaining Mr. Gu's consent, I prescribed Xiling Xiehuo Tang (Rhino-Antelope Fire-Draining Decoction) as the primary formula.
Mr. Gu took the prescription to the pharmacy. Doctor Jia happened to pass by and saw it, asking in surprise: "This is a killing prescription! Your son's smallpox, even with tonifying and supporting, might fail to erupt; how can cooling and purging work? Using this will surely cause toxin sinking inward and early death." Unable to decide, Mr. Gu consulted Doctor Yi again. Doctor Yi neither approved nor disapproved of my prescription. Although knowing I was making a bold move, he feared the heavy cooling and purging dosage. They invited me again for a joint consultation. Upon arrival, I listened to Doctor Jia's advice, then stood and said: "This case has extreme heat blazing internally in organs and externally on skin. How can smallpox erupt under such scorching heat? It is like prolonged drought without rain; soil is dry, lacking moisture, steamed by violent sun. How can grain sprout and grow? Only torrential rain, cooling climate, and wetting the substance can allow growth. This child's smallpox follows the same logic. Without heavy cooling and purging to clear excess heat inside and out, it cannot succeed. Moreover, he ate crabs before fever, making purgatives indispensable. Thus, as heat subsides, pores open, hair follicles penetrate, and smallpox can emerge. This is an excess-heat syndrome. If afraid to take cooling purgatives, life may end shortly." Finishing speaking, I bid farewell and left.
After I left, Doctor Jia also departed, warning the family: "Do not take this prescription under any circumstances; it will kill upon ingestion." After Jia left, Mr. Gu's friend, Shi Zhaoqing, said to him: "Though I know nothing of medicine, seeing Dr. Yu's prescription shows courage and insight, incomparable to inexperienced practitioners. The condition is critical, life hangs by a thread; why not try? Treat a dead horse as if alive." Doctor Yi also casually agreed: "No other method, might as well try." Thus, they decided to take my prescription. By the time Antelope Horn powder was ground and ready for administration, it was midnight.
At dawn the next morning, Mr. Gu knocked on the door, joyfully saying: "After taking medicine last night, there was one bowel movement at the fourth watch, and another as dawn approached, passing considerable dirty, dry, black stool. Abdomen seems not fully clear, but high fever has decreased, and smallpox is emerging successively. Please examine again." I went with him, seeing smallpox indeed emerged, numerous in number, color turned red and vibrant, unlike previous scorched and withered state, fever reduced, delirium ceased. Truly a turning point. I reduced Xijiao (Rhinoceros Cornu) in the previous formula from 1 qian to 5 fen, and Lingyangjiao from 6 fen to 4 fen, instructing to take them first. Additionally, administered two injections of Omnadin to increase protein intake and strengthen anti-toxin resistance. By the third consultation, Dahuang (Rhei Radix et Rhizoma) was reduced to 1.5 qian (second and third consultations on the sixth day). By the fifth consultation, Dahuang was removed. By the sixth consultation, Xijiao and Lingyangjiao were removed, Shigao reduced to 2 liang, other herbs gradually reduced in dosage (fifth and sixth consultations on the seventh day). Until the tenth consultation, Shigao was finally removed (tenth consultation on the ninth day). In total, this child consumed approximately three jin of Shigao.
Later, on the thirteenth day, evening chills and fever resembling malaria appeared, indicating severe depletion of yuan qi (original qi), hence the malaria-like presentation. I changed the primary formula to Baoyuan Tang (Preserve the Origin Decoction), assisted by agents clearing residual heat and resolving residual toxins. After several doses, he recovered.
**Xiling Xiehuo Tang (Rhino-Antelope Fire-Draining Decoction):** Wuxijiao (Rhinoceros Cornu, ground and dissolved) 1 qian, Lingyangjiao Jian (Antelope Cornu Tip, ground and dissolved) 6 fen, Sheng Shigao (Gypsum Fibrosum) 4 liang, Sheng Dahuang (Rhei Radix et Rhizoma) 3 qian, Chuanlian (Coptidis Rhizoma) 2 qian, Sheng Huangqin (Scutellariae Radix) 3 qian, Yinhua (Lonicerae Japonicae Flos) 1 liang, Jing Lianqiao (Forsythiae Fructum) 5 qian, Sheng Shanzhi (Gardeniae Fructum) 5 qian, Xian Shengdi (Rehmanniae Radix) 1 liang, Xian Shihu (Dendrobii Caulis) 1 liang, Xian Zhuye (Bambusae Folium) 50 leaves, Huoshui Luya (Phragmitis Rhizoma fresh water infusion) 5 liang, decocted to cook herbs. Take Rhino and Antelope horns first with cold boiled water, then take the herbal decoction.
**Smallpox Deficiency-Cold Critical Case:** Toddler initially had mild fever, then contracted smallpox appearing on skin. Doctors initially used Pao Jiashan (Testudinis Carapax et Plastrum processed) and Zaoci (Gleditsiae Spina), later Dangshen (Codonopsis Radix) and Huangqi (Astragali Radix), but all were ineffective. By the fourth day, no eruption, switched to cooling agents, condition immediately turned critical, barely breathing. Observing pale face and emaciated body, knowing it was due to lack of breast milk, confirmed by inquiry. Urgently used Wenyang Yiqi Tang (Warm Yang and Boost Qi Decoction) to support. That night, mumbling restlessly; next morning, smallpox indeed swelled and erupted.
Ge Jianwu from Funing, a teacher at the County Normal School. His youngest son was only three years old, initially mild fever, then contracted smallpox. Although spots appeared, no eruption occurred, sought medical treatment. Doctors used Pao Jiashan and Zaoci, ineffective. Then used Dangshen and Huangqi, also ineffective. By the fourth day, still no swelling, switched to cooling agents, condition instantly turned to inability to eat, rapidly progressing to barely breathing. Mr. Ge terrified, urgently sought my consultation for a slim hope. Upon going with him, he recounted the previous medical history en route. Entering the room, observing pale face, emaciated body, gasping breath as if discontinuous. Asked: "Has this child always lacked breast milk?" Answered yes, due to insufficient milk, replaced with formula powder, causing malnutrition.
Observing body temperature lower than normal, cold extremities, smallpox shape showing tendency to sink inward, knowing it was a deficiency-cold syndrome, exacerbated by mistaken use of cooling agents, naturally leading to critical status.