痧疹二证升散清凉宜合用之，不可偏废，甚者须用石膏，切忌犀角。
升麻 葛根 柴胡 黄芩 赤芍 元参 连翘 银花 牛蒡子 山栀子 生甘草 桔梗 或加僵
蚕蝉蜕 西河柳
岁己丑夏四月，小满节湿土客气，山妻潘氏年四十七，忽患头疼身热咳嗽，恶风，仍然
操作，不避风寒，乃致咽痛如割音嘎咯血，耳后项颈两旁掀肿，手臂胸膺遍现白疹，形同沙
粒；筋骨酸软，便秘饱闷，口苦不渴，脉濡滞而涩急，用西河柳三钱煎甘桔牛蒡子竹叶芦根
汤冲服玉雪救苦丹一颗，顷刻白疹变为红色，周身透达颈肿渐平。惟咽茶扦格，再服玉雪丹
一丸，诸恙若失，不觉其全愈如斯之速也。当山妻患出白疹，喉中早已腐烂，缘向来颊车不
利，牙关闭紧不能开齿，饮食惟觉喉HT 痛如刀
割，咳出臭恶脓血令人掩鼻，不得张口可看烂喉，亦不吹药，可见喉痛是痧疹之常。但当透
发痧疹，大忌错认喉风禁用吹药凉遏，切嘱戒口避风。痧疹出齐则喉痛自愈，如此凶恶重证
生死易如反掌，可不惧哉。犹忆同治甲戌尤君剑泉弟妇曾患时疫喉痧，咽喉肿闭，白腐壅
塞，项颈拥肿如瓠，滴水不能下咽，汤药入口，仍由鼻孔喷出。予与同乡张君听泉误认喉痹，
医不如法，日见沉重，特请上海耆医黄翁菊泉来诊，乃问曰∶曾服凉药乎？已经吹药乎？证
势危险矣，然幸未喘促尚可挽救，大凡喉痧多因冬不藏阳，伏气内发，风寒外闭致成烂喉，
岂可再用凉遏，所以大忌吹药，若用冰片犀黄愈吹愈坏，愈烂愈深。但当宣毒发表透达痧疹
外出自然诸恙解化，剑泉弟妇服凉药而遏抑加剧，投表剂而宣透告痊。予于是憬然大悟，
谚所谓熟读汤头歌，不如得临证多。而今而后时时勉夫。爰书于此以志从前之过。
光绪辛卯二月花朝赤霆子凌德时年六十又一。
治疗痧疹（一种发疹性传染病）的两个证型，升散透邪与清凉解毒法应当合并使用，不可偏废一方。病情严重者必须使用石膏，切忌使用犀角。
处方：升麻、葛根、柴胡、黄芩、赤芍、元参（玄参）、连翘、银花（金银花）、牛蒡子、山栀子、生甘草、桔梗；或者加入僵蚕、蝉蜕、西河柳。
己丑年夏季四月，正值小满节气，湿气当令（湿土客气）。我的妻子潘氏，四十七岁，突然患头痛、身体发热、咳嗽、怕风。她仍然坚持劳作，不避风寒，导致咽喉疼痛如刀割，声音嘶哑咯血，耳后及颈项两侧红肿，手臂和胸膺部遍布白色皮疹，形状如同沙粒；筋骨酸软无力，便秘且腹部饱闷，口苦但不口渴，脉象濡滞而涩急。我用西河柳三钱煎煮甘桔牛蒡子竹叶芦根汤，冲服玉雪救苦丹一颗，顷刻间白色皮疹变为红色，周身透发，颈部肿胀逐渐消退。只是吞咽茶水仍有阻碍，再服用玉雪丹一丸，各种病症消失，不知不觉痊愈得如此迅速。
当我的妻子出现白疹时，喉咙早已腐烂。因为她向来颊车穴部位不利索，牙关紧闭不能张口，饮食只觉喉咙痛如刀割，咳出恶臭脓血令人掩鼻，无法张口查看喉中腐烂情况，也没有吹药治疗。由此可见，喉痛是痧疹的常见症状。但在透发痧疹时，大忌错认为喉风而禁用吹药凉遏，务必嘱咐戒口并避免受风。痧疹出齐后，喉痛自然痊愈。像这样凶险严重的病症，生死往往在瞬息之间，怎能不害怕呢？
我还记得同治甲戌年，尤君剑泉的弟妇曾患时疫喉痧，咽喉肿胀闭塞，白色腐物壅塞，颈项肿大如葫芦，滴水不能下咽，汤药入口仍从鼻孔喷出。我与同乡张君听泉误诊为喉痹，治疗方法不当，病情日渐加重。特地邀请上海老中医黄翁菊泉来诊治。他问道：“曾经服用过凉药吗？已经用过吹药了吗？”指出证势危险了，但幸好没有气喘急促，还可以挽救。大凡喉痧多因冬天阳气不藏，伏气在内发作，加上风寒外闭，导致烂喉，岂可再用凉药遏抑？所以大忌使用吹药，如果使用冰片、犀黄等药，越吹越坏，腐烂越深。只应当宣毒发表，使痧疹透达外出，自然诸症化解。剑泉弟妇因服用凉药导致遏抑加剧，投用表剂宣透后告愈。我于是恍然大悟，谚语所说“熟读汤头歌，不如临证经验丰富”，确实如此。从今以后要时时勉励自己。特记录于此以铭记从前的过错。
光绪辛卯年二月花朝日，赤霆子凌德，时年六十一岁。
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.