吴氏又可曰∶疫邪留血分，里气壅闭，非下不能发斑，斑出则毒邪从外解矣。如下后斑
渐出，更不可大下。设有下证，宜少与承气缓缓下之。若复大下则元气下振，斑毒内陷则危，宜托里举斑汤。
吴氏举斑汤
白芍药（一钱） 当归（一钱） 升麻（五分） 柴胡（七分） 白芷（七分） 穿山甲（二钱，炙） 生姜（一
片）上七味水煎温服。
如下后斑毒隐伏，反见循衣摸床，直视撮空，脉渐微者危。本方加人参三钱得补，发出
者生，补不及者死。妊娠时疫设用三承气，须随施治不可过虑，慎勿惑于参术安胎之说，病
家见用承气先自惊疑，更加左右有粗知医者，从旁嘈杂必致掣肘，遂令子母皆大不祥。若应
下之证，反用补剂安胎，热毒愈炽，胎愈不安，耗气搏血，胞胎何赖。是以古人有悬钟之喻，
梁腐而钟未有不落者，惟用承气逐去其邪，火毒消散，淡 顿为清凉，气回而胎自固。当此
证候大黄反为安胎圣药，历治历当，母子俱安。若见腹 腰痛，此将欲坠之候，服药亦无及矣，须预言之。
费氏建中曰∶一友朱良老，其阃怀娠六月，出疹于隆冬，躁乱不宁，燔热如火。道中一
友以宽气养血安胎为主，佐以甘桔牛蒡蝉蜕荆芥疏肌透发。三朝疹非不透，热终如火，烦
渴不已，嗽而增喘，彻夜无眠，至五日不惟不寐，并不能就枕，不惟喘急，并不能出声，面如
土色，目睛直视，手指厥冷，渴想西瓜，六脉绝无，影响其娠，追下小腹，痛楚难禁，身无安
放，立刻可毙，举家但顾，得母无恙足矣。余殆无药，惜其未得一对病之剂，觉有不忍，为热
肠所迫，以大黄五钱，石膏一两，滑石生地各七钱，炒黑麻黄三分，佐以赤芍丹皮牛蒡荆芥
地丁木通甘桔，以芦笋煎汤代水，二剂后诸证稍缓。遍觅一大西瓜，陆续以济其渴，又二剂
其疹又透，诸证减半，而娠不追下矣。前方减麻黄仍以二剂，面颜顿转，喘定而得伏枕，热
渴亦杀大半，娠即安然，但咳嗽不止，前方去大黄赤芍丹皮减石膏滑石及半，加元参花粉
黄芩金银花二剂，热渴俱平，胃气大开。遽垂毙重证，幸而复生，尚须调理，见安和而遂弗
药。越数日后娠复不安，但不追下，饮食减半，复有余热，口内生疳，以消斑快毒汤减蝉蜕丹
皮赤芍加金银花天花粉佐以消疳散吹之全愈。是证所用汤剂据常格，胎前所大忌者，而
得既保其母，并安其娠，见有病病受，不第无
损于胎，正见所以安之之妙。疹与痘虽异，其所异者惟气虚痘耳，若烈毒之证原同一轨，令
是证但留其母犹畏大黄等味，利畏害并存，尚费踌躇，竟尔子母俱全，凡志医者可不深思，而潜玩也耶。
消斑快毒汤 治痘有夹疹夹斑，肤红如醉者此汤主之。
连翘 元参 生地 牛蒡子 木通 蝉蜕 丹皮 荆芥穗 黄连 甘草 地丁 赤
芍极热者加大黄 加灯心二十茎。
消疳解毒散 治痘疹后牙疳。
薄荷（五分） 儿茶（一钱） 冰片（一分） 人中白（三钱 ） 天花粉（一钱） 生甘草（五分） 飞青
黛（一钱） 黄连（五分） 西牛黄（一分） 珠子粉（二分） 雨前茶（五分） 硼砂（一钱）
研极细，以无声为度，先以浓茶拭净方吹。
上编曰述古下。
吴又可说：疫邪滞留于血分，导致里气壅塞闭阻，如果不使用下法就不能使斑疹发出，斑疹发出后毒邪才能从体表解除。如果在使用下法后斑疹逐渐发出，就不可再使用峻猛的下法。假如仍有可下的证候，应当少量给予承气汤类方剂，缓缓通下。如果再次峻下，则会导致元气下陷脱失，斑毒内陷就会危及生命，此时宜用托里举斑汤。
吴氏托里举斑汤
白芍药（一钱） 当归（一钱） 升麻（五分） 柴胡（七分） 白芷（七分） 穿山甲（二钱，炙） 生姜（一片）以上七味药用水煎煮，温服。
如果使用下法后斑毒隐伏不出，反而出现循衣摸床、直视、撮空手等危重症状，且脉象逐渐微弱，病情危急。在本方中加入人参三钱以补益正气，促使斑毒发出者可以存活；若补益不及者则死亡。妊娠期间感染时疫，即使需要使用三承气汤，也应根据具体情况施治，不必过度顾虑。千万不要被“人参、白术安胎”的说法所迷惑。患者家属看到使用承气汤会先自惊疑，再加上旁边有些略懂医术的人在一旁嘈杂议论，必然会造成掣肘，最终导致母子都不幸。如果是应当使用下法的证候，反而使用补剂来安胎，会使热毒更加炽盛，胎元更加不安，耗伤气血，胞胎依靠什么来维持呢？因此古人有悬钟的比喻，梁柱腐朽了，悬挂的钟没有不坠落的道理。只有使用承气汤驱除邪气，火毒消散，体内顿时转为清凉，气机恢复而胎元自然稳固。在这种证候下，大黄反而成为安胎的圣药，治疗屡试屡验，母子俱安。如果见到腹部和腰部疼痛，这是胎元即将堕落的征兆，服药也已经来不及了，必须预先告知。
费建中先生说：有一位朋友叫朱良老，他的妻子怀孕六个月，在隆冬季节出疹，烦躁扰乱不得安宁，身体发热如火烧。路上遇到一位朋友，主张以宽理气机、养血安胎为主，辅以甘草、桔梗、牛蒡子、蝉蜕、荆芥等药物疏解肌表、透发疹毒。三天后疹子并非没有透出，但热势终归像火一样，烦渴不止，咳嗽并加重气喘，整夜无法入睡。到了第五天，不仅不能入睡，甚至无法躺下枕头，不仅气喘急促，甚至无法出声，面色如土色，两眼直视，手指冰冷，渴望吃西瓜，六脉几乎摸不到，感觉胎儿向下坠落，小腹疼痛难以忍受，身体无处安放，立刻可能死亡，全家只顾着担心，只要母亲平安就满足了。我手头几乎没有合适的药，可惜没有找到对症的方剂，心中不忍，受热心肠驱使，使用了大黄五钱，石膏一两，滑石、生地各七钱，炒黑麻黄三分，辅以赤芍、丹皮、牛蒡子、荆芥、地丁、木通、甘草、桔梗，用芦笋煎汤代替水煎药。服用两剂后各种症状稍微缓解。遍寻一个大西瓜，陆续给她解渴，又服用两剂，疹子再次透出，各种症状减半，而且胎儿不再下坠。前方减去麻黄，仍然服用两剂，面色顿时好转，气喘平息并能躺下枕头，热感和口渴也减轻大半，胎元安然，只是咳嗽不止。前方去掉大黄、赤芍、丹皮，减少石膏、滑石的一半，加入玄参、天花粉、黄芩、金银花，服用两剂，热感和口渴都平复，胃气大开。这原本垂死的重症，幸好得以复活，还需要调理，见其安康就不再用药。过了几天后胎元又不安，但不再下坠，饮食减半，还有余热，口腔内生疮，使用消斑快毒汤减去蝉蜕、丹皮、赤芍，加入金银花、天花粉，辅以消疳散吹敷，完全痊愈。这个证候所用的汤剂按照常规是产前大忌的，但却既保全了母亲，又安定了胎元，可见有病则病受之，不仅无损于胎，正体现了安胎的奥妙。疹与痘虽然不同，其不同之处仅在于气虚导致的痘症罢了，若是烈毒的证候原本就是同一机理。如今这个证候只保留母亲尚且畏惧大黄等药物，利弊共存，还让人犹豫不决，竟然能母子俱全，凡是立志学医的人能不深思并潜心玩味吗？
消斑快毒汤 治疗痘症夹杂疹或斑，皮肤红得像喝醉了一样，此汤主治。
连翘 玄参 生地 牛蒡子 木通 蝉蜕 丹皮 荆芥穗 黄连 甘草 地丁 赤芍 极热者加大黄 加灯心草二十茎。
消疳解毒散 治疗痘疹之后出现的牙疳。
薄荷（五分） 儿茶（一钱） 冰片（一分） 人中白（三钱） 天花粉（一钱） 生甘草（五分） 飞青黛（一钱） 黄连（五分） 西牛黄（一分） 珠子粉（二分） 雨前茶（五分） 硼砂（一钱）
研磨成极细粉末，以无声响为标准，先用浓茶擦拭干净后再吹入患处。
上编叙述古代医案结束。
Wu Keyou stated: When epidemic pathogens remain in the blood level, causing stagnation and closure of the interior qi, purgation is required to manifest macules; once macules appear, the toxic pathogens can be resolved from the exterior. If macules gradually appear after purgation, strong purgation must not be used again. If there are still indications for purgation, a small amount of Chengqi Tang (Cassia Decoction) should be given slowly to induce mild purgation. If strong purgation is repeated, the primordial qi will collapse downward, leading to internal sinking of macule toxins, which is critical; at this time, Tuoli Jubang Tang (Decoction to Support Interior and Raise Macules) is indicated.
Wu's Tuoli Jubang Tang
Bai Shaoyao (White Peony Root, 1 qian) Danggui (Angelica Sinensis Root, 1 qian) Shengma (Cimicifugae Rhizoma, 0.5 qian) Chaihu (Bupleuri Radix, 0.7 qian) Baizhi (Angelicae Dahuricae Radix, 0.7 qian) Chuanshanjia (Pangolin Scales, 2 qian, roasted) Shengjiang (Fresh Ginger, 1 slice) The above seven ingredients are decocted in water and taken warm.
If after purgation the macule toxins remain hidden and do not emerge, instead presenting with symptoms such as grasping at bedclothes, staring fixedly, and picking at empty air, accompanied by a gradually faint pulse, the condition is critical. Adding Renshen (Ginseng Radix et Rhizoma, 3 qian) to the base formula to tonify qi and promote emergence of macules leads to survival; if tonification is insufficient, death ensues. During pregnancy with epidemic disease, even if San Chengqi Tangs (Three Cassia Decoctions) are necessary, treatment must be applied according to the specific presentation without excessive worry. One must not be confused by the theory that Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) secure the fetus. Patients' families may panic upon seeing Chengqi Tang used, and laypeople with superficial medical knowledge may interfere, causing obstruction, ultimately resulting in misfortune for both mother and child. If purgation is indicated but tonifying agents are used to secure the fetus, heat toxins will become more intense, making the fetus more unstable, consuming qi and blood, leaving no basis for the fetal sac. Thus, ancients used the metaphor of a bell hanging from a beam: if the beam rots, the bell inevitably falls. Only by using Chengqi Tang to expel pathogens, dissipating fire toxins, turning the interior cool, restoring qi, and naturally securing the fetus can safety be achieved. In such conditions, Dahuang (Rhei Radix et Rhizoma) becomes a sacred herb for securing the fetus; treatments have repeatedly succeeded, ensuring safety for both mother and child. If abdominal and lumbar pain appears, indicating imminent miscarriage, medication is futile, and this must be predicted in advance.
Fei Jianzhong said: A friend, Zhu Lianglao, had his wife pregnant for six months who developed macules in deep winter, restless and agitated, with body heat burning like fire. A friend encountered on the road advocated primarily regulating qi and nourishing blood to secure the fetus, assisted by Gancao (Licorice Root), Jiegeng (Platycodon Root), Niubangzi (Arctii Fructus), Chantui (Cicadae Periostracum), and Jingjie (Schizonepetae Spica) to release the muscle layer and vent the macules. After three days, although macules were not entirely unvented, the heat persisted like fire, with incessant irritability and thirst, coughing worsening into asthma, sleeplessness all night. By the fifth day, not only was sleep impossible, but lying down was unbearable; not only was breathing rapid, but speaking was impossible. The face was earth-colored, eyes stared fixedly, fingers were cold, craving watermelon, with six pulses nearly imperceptible. There was a sensation of the fetus descending, severe lower abdominal pain intolerable, restlessness everywhere, imminent death. The family cared only for the mother's survival. I had few suitable medicines, regretting not having a precise prescription, driven by compassion, I prescribed Dahuang (Rhei Radix et Rhizoma, 5 qian), Shigao (Gypsum Fibrosum, 1 liang), Huashi (Talcum, 7 qian), Shengdi (Rehmanniae Radix, 7 qian), Chao Hei Mahuang (Roasted Black Ephedra Herba, 0.3 fen), assisted by Chishao (Red Peony Root), Danpi (Moutan Cortex), Niubangzi (Arctii Fructus), Jingjie (Schizonepetae Spica), Dideng (Oldenlandia Herb), Mutong (Akebiae Caulis), Gancao (Licorice Root), Jiegeng (Platycodon Root). Decocted in Luzhu (Asparagus Fern Stem) soup instead of water. After two doses, symptoms slightly eased. A large watermelon was found and given intermittently for thirst. After another two doses, macules emerged again, symptoms halved, and the fetus ceased descending. The previous formula had Mahuang removed and continued for two doses; complexion improved, asthma settled allowing lying down, heat and thirst reduced by more than half, fetus safe, though cough persisted. The formula had Dahuang, Chishao, Danpi removed, Shigao and Huashi reduced by half, adding Yuanshen (Scrophulariae Radix), Tianhuafen (Trichosanthis Radix), Huangqin (Scutellariae Radix), Yinjinhua (Lonicerae Flos), for two doses. Heat and thirst resolved, stomach qi opened. This critical condition near death fortunately recovered, requiring further regulation; upon seeing health restored, medication ceased. Days later, fetal instability returned but without descent, food intake halved, residual heat remained, mouth sores appeared. Xiaoban Kaidu Tang (Decoction to Clear Macules and Rapidly Detoxify) with Chantui, Danpi, Chishao removed, Yinjinhua, Tianhuafen added, assisted by Xiaogansan (Powder to Eliminate Gum Rot) blown into the mouth, resulted in complete recovery. The decoctions used here are typically contraindicated in pregnancy, yet both mother and fetus were preserved. This demonstrates that when disease exists, it bears the treatment; not only is the fetus unharmed, but the efficacy of securing the fetus is revealed. Although macules and pox differ, the difference lies only in deficiency-type pox; severe toxic cases follow the same principle. In this case, saving the mother while fearing herbs like Dahuang created hesitation due to coexisting benefits and harms, yet both mother and child were saved. Physicians should deeply reflect and ponder this.
Xiaoban Kaidu Tang Treats pox complicated by macules or rashes, with skin red as if drunk.
Lianqiao (Forsythiae Fructus) Yuanshen (Scrophulariae Radix) Shengdi (Rehmanniae Radix) Niubangzi (Arctii Fructus) Mutong (Akebiae Caulis) Chantui (Cicadae Periostracum) Danpi (Moutan Cortex) Jingjie Sui (Schizonepetae Spica) Huanglian (Coptidis Rhizoma) Gancao (Licorice Root) Dideng (Oldenlandia Herb) Chishao (Red Peony Root) For extreme heat, add Dahuang (Rhei Radix et Rhizoma); add Dengxincao (Junci Medulla, 20 stems).
Xiaogan Jiedu San Powder to Eliminate Gum Rot and Detoxify Treats gum rot after pox or macules.
Bohe (Menthae Haplocalycis Herba, 0.5 fen) Ercha (Camelia Sinensis Catechu, 1 qian) Bingpian (Borneolum Syntheticum, 0.1 fen) Renzhongbai (Human Calculus, 3 qian) Tianhuafen (Trichosanthis Radix, 1 qian) Sheng Gancao (Raw Licorice Root, 0.5 fen) Fei Qingdai (Prepared Indigo Naturalis, 1 qian) Huanglian (Coptidis Rhizoma, 0.5 fen) Xi Niu Huang (Calculus Bovis, 0.1 fen) Zhuzi Fen (Pearl Powder, 0.2 fen) Yuqian Cha (Pre-Mineral Spring Tea, 0.5 fen) Pengsha (Borax, 1 qian) Grind to extremely fine powder, until silent. First wipe clean with strong tea, then blow into the lesion.
The upper volume concludes with ancient narratives.