雍论曰。朱氏作活人书。亦多取蕲水庞安常之说。至论疮泡。则
二家之说如冰炭。朱氏谓疮疹首尾皆不可下。庞氏谓未发欲发。疮
斑未见。皆宜下之。疮已瘥而再下之。何其一说相戾如此。雍曰。考
汉魏医方无所见。至东晋王 。始有治时行热恶毒疮方。随巢元方
始有疫疠 疮论候。其言皆不甚详。此大疾也。杀人不异伤寒。何其
轻易简略如此。故庞氏疑当时热毒未甚。鲜有死者。雍谓不然。上古
岐黄之时。其病尚与今日无异。安有中古反不同也。王中令既以属
时行。巢氏又以为疫病。则此疾当详见于时行疫病中。今亡矣。伤寒
以仲景论故存得详备。时行瘟疫以无仲景治法。故后世之说不得
同。仲景金匮玉函之书。千百不存一二。安知时行疫疾不亡逸于其
间乎。然疮疹舍庞氏朱氏二家。则别无可取之论。雍疑其相反。无所
适从。尝闻先兄子若曰。朱氏之论。后世不可易之常道也。此法当独
得于朱氏。雍曰。然则庞氏之言失乎。兄曰。医道精微。言所不能尽
述。使医之明如庞氏。则可用庞氏之法。不然。则一从朱氏。虽不肖
者。亦可 而及也。闻此方释然。又有东平钱乙仲阳。以治小儿名
家。及论疮疹。亦稍支离。滞于五脏五色。究其说终不出于二氏之
门。然仲阳老于医。论症用药。有可取者。故系于朱庞二氏之后。
雍曰活人书（下原文佚）病患肌肉发斑（下原文佚）
疮疹始是温毒（下原文佚）伤寒（下原文佚）
初言止此。不比其他。亦未尝言斑疹。岂言之而亡逸欤。故医家
所论温毒等症。多非仲景言。时行温疫。至今未详者详此。或谓疮疹
与伤寒相类。谓其头痛壮热之类同也。非谓所感之同也。仲景曰。其
冬有非节之暖。名曰冬温。冬温之毒。与伤寒大异。故庞氏曰。凡觉
冬间有非节之暖。疮毒未发。即如法下之。则庞氏亦以为冬温之毒
矣。然如朱氏二家论症。皆如温毒。而不欲明言者。以仲景无正说故
也。以雍观之。疮疹即温毒之一。晋人既名为时行。热毒疮。即温毒
疮矣。又何疑为。其感疾本与伤寒同。皆感于冬。藏于肌肤。至春而
发。是其同也。而仲景言与大异者。伤寒感至寒之气。温毒感冬温之
气。是其所以为异也。然有成疮疹者。亦有不成疮疹者。总其名。皆
谓之温毒也。雍谓感冬温非节之暖。藏于皮肤之中。至春夏而其毒
发。郁积之盛。熏炮肌骨已久。一旦发出于外。必皆溃烂为疮而后
已。不但能为一汗而已。然温毒成疮有数种。曰脓胞。又名豌豆疮。
曰水 。又名麻子疮。曰麸疮。亦名麸疹。又有瘾疹斑烂。皆其类。其
轻者。世俗以其形象名之。本其所感深重为脓胞。千金之后。名曰豌
豆疮。次者为水 。轻者为麸疮。脓胞生七日方长。贯脓成痂。然后
愈。其日未满而干者。谓之倒靥也。水 生数日。圆满水出则愈。麸
疮随出则焦。他处再出再焦。如是遍及其身。三者皆忌倒靥。大者倒
靥则色紫。甚则脓血欲干。故变黑。有黑者一二日尚可以药再发。黑
者多则难药已。水 疮水如铃。倒靥则色干不明。麸疮才出多。忽不
见。是倒靥也。虽麸疮倒靥。亦能杀人。以温毒之气。复入五内也。非
感温毒之气。因时行暴发者。多不杀人。故疮家畏风畏寒。畏涂凉
水凉药。大畏下。皆恐毒瓦斯倒靥于内。当欲谨避风处。若时尚寒。则
难出表。虽温不可太暖。不可服热药。朱氏所云但服升麻汤者。最为
要法。疹病多暴感。非冬温之气所成。病甚轻。不成疮。但作瘾疹。起
有赤白二种。世俗所谓风尸者是也。须服药。亦可涂治。虽无倒靥之
患。亦有毒瓦斯入腹之忧。千金小儿泽兰汤。即其药也。又有一种。斑
发如描画。遍身灿烂如锦文者。又如火丹发。虽无瘾疹。起亦如瘾
疹。内外治之。色淡则愈。伤寒发斑。见本文。
雍论曰。诸家论疮疹可下不可下。世人不能无惑。雍详二法本
于伤寒。伤寒冬感至寒之气。藏于肌肤骨髓之中。为腠理闭密不得
出。至春腠理开疏而后发于表。医者发表中病。则从经为汗而出于
表。发不当。或遇毒瓦斯甚重。则不能出。因传阴经。遂入于里。至里无
可发之理。候其入胃。则下之。五脏之毒。其根在胃。根去则诸脏之
毒随去。若有余毒在里。表未能入。间值胃中毒根已下。则在表之
毒。如断根之蓬。随其所在作汗而出矣。故伤寒有汗而愈。有下而
愈。下者亦必先泄后作汗而愈也。疮 之家。本无汗下症。其初冬感
于非节之温气。藏于肌骨。时方外寒。腠理闭密不得出。至春腠理开
疏而发。其藏于肤腠者。发为麸疮。藏于肌肉者。发为麻子疮。藏于
骨髓者。发为豌豆疮。既发为疮。则无发汗之理。惟用解肌药以托
之。庶其易出也。毒瓦斯既作疮而出。不复入里。亦如伤寒大汗之后。
不入阴经。自无可下之毒。故治伤寒之法。惟在汗下。而疮 之家。
无汗下也。然诸家有言下者。亦有三说。其一方盛冬感非节之温气。
腠理闭密不得出之时。其毒瓦斯无所宣泄。不过上攻头目胸膈。必头
热眼赤。口疮喉闭。若见其症。预先下之。则温毒尽去。至春夏不复
作疮 矣。此一可下之时也。庞氏所云。凡觉冬间有非节之暖。疮毒
未发欲发时。即如法下之。次第服预防之药。则毒瓦斯内消。无使入里
永不可出必毙而后已。此一可下之时也。其二则疮 黑陷倒靥。是
大恶候。轻者犹可用药再发。发之不出。是疮毒入深。不能再至表。
因而深入。急下之。则可活矣。是十死一生之候。不得已而下。他无
救之之术。此二可下之时也。其三疮 既愈。余毒不已。发为大痈。
既溃出脓血。又别发痈。相续不已。世谓之 痈。必解利之而后已。
是时病患疮方愈。未得食力。气血虚羸。下之甚危道主。藉医者斟
酌用药。然不下则毙。亦不得也。此三可下之时也。舍是三者。皆不
可下矣。朱氏云。小儿疏转。切忌用丸子药。当以大黄川芎等分。
咀作汤液。以荡涤蕴热。此说甚良。雍谓宜加甘草。大黄倍之。此常
器之所用也。盛冬初感未发之时。宜用此汤。及作 痈之后。亦宜用
此。但少加剂。未效。再服之。惟疮作黑陷倒靥。发之不出者。须朱氏
无比散。及钱氏百祥丸。前所言大黄川芎药。亦不可用也。此病原不
见于仲景。故无定论。不免详言之。庶无惑焉。
雍曰。东晋中书令王 。有伤寒身验方云。KT 桦木皮浓汁冷冻饮料。
主伤寒时行热毒疮特良。此即今之豌豆疮。当时谓之时行热毒疮
也。故庞氏方中。载桦皮饮子者本之此。至巢氏论疫疠 疮候。曰。
热毒盛则生豌豆疮。周匝遍身。状如火疮。色赤头白者毒轻。色黑
紫黯者毒重。亦名为登豆。此即热毒疮。至巢氏而后。有 疮、豌豆
之名。至今呼之。以二者考之。则疮谓为温毒疮不谬也。凡冬感于
寒。纵其病热甚极。不过为斑为黄。终不成疮。惟感冬温非节之暖者
则成疮。故庞朱皆言温毒之为疮。而王中令巢氏皆以热疮为时行。
为疫病。诸家虽异同。其实一也。
雍曰。余家值小儿将作疮疹。未辨伤寒时行。即根据朱氏法。先服
升麻葛根汤。服之疮未出。而恶风发热。头痛。诸症不罢者。即是药
性缓。次日更兼败毒散服之。若是疮子。一夕便出。或不成疮。亦以
汗解。仍能解疮毒。重者便轻。屡验。
又曰。疮疹变出恶症者。多是豌豆。以其毒瓦斯盛故也。其他唯服
药有误。则有恶症。不误服药者。无恶症也。
又曰。麸疹虽不成疮。亦头焦皮起。如麸片然。若瘾疹则暴发。
初无表症。亦不退皮。愈后便消。故世谓疹子为麸疮。其毒虽轻。若
误服凉药。则盛出之际。一夕忽不见。便是倒靥。毒瓦斯入里。亦能杀人。以牛李膏发之。
又曰。贫下之家养小儿。素无暖衣衾。亦无酒肉滋味。至其感
病。只是时行所感。候其气散。即便安愈。豪贵之家。温燠太过。饮食
无度。既感时行之气。人事又为之助。是两毒相攻。所以多生异症。
遇冬温时。小儿午间常服牛蒡消毒饮甚好。
又曰。疮疹大畏大小便不快。恶症便生。急须通之。用牛李膏通
大便。麝香膏通小便。大妙。
又曰。钱氏所谓五七日痂不焦。以内热蒸皮中。此只是毒瓦斯未
尽。亦不须宣风散。但服牛李膏。
又曰。牛李膏亦是旧方。不止钱氏用。正是疮疹本药。如宣风散
是外来。借功自不同。所以贵牛李膏者。以出未快者。可以出之。多
者可以解之。在表者。可因而越之。在里者。可引而竭之。是疮疹八
面可用之药。故凡疮疹。皆先服之。
又曰。牛李膏奇处。正在能分毒瓦斯。在表者使出。在里使下。表
里并用。两不为妨。同时供应。毒势已衰。诸药皆无是之妙。天生神
物为人用。非只此一物。第人未能尽知之耳。
又曰。疮疹初发。固不必用牛李膏。才见出得稠密。或大小便不
快。或出不快。烦闷渴甚者。便与服之。牛李二种。稍大而黑紫者奇。
微小而深黑者劣。微小者。即早李也。本草共为一物。
又曰。凡豌豆疮根边色红活。疮颗圆满如珠者。大好。初生亦未
便圆。日渐长也。疮根色红淡。疮颗不圆好。盒饭表发。仍频看觑。雍
有一孙四五岁。患此已数日。背上疮盛。而根色淡而不红活。疮颗已
半平半陷。间有紫黑色者。急与牛李膏二服。不见色回。再取猪尾血
滴研龙脑。水调服。时已日暮。少顷。灯下视之。疮根复红活如初。次
早陷疮皆起。累日再长。圆满焦痂而愈。但病身中痛异常。手不可
触。病后羸极。如两次伤寒也。是岁一房同时患者。皆毒重稠密烦
渴。皆用牛李膏下黑涎而愈。
又曰。牛李膏之上。惟猪尾膏奇。但猪尾膏非恶候不用。不若牛
李膏可常用。虽恶候未出。使见热盛。便先解之。猪尾膏如无龙脑。
即用麝香。麝香大通小便。小便快则毒自衰。曾用之验。
又曰。恶候。二膏不效。方可下。雍尝见一病。医者用无比散下
之。立愈。惟百祥丸不亲见用之者。雍以多用前二膏。故未尝至于用
大下药。
又曰。活人等书诸方。如升麻汤。固必先用。疮出不快。烦躁不
眠者。用升麻汤、黄芩加木香汤。毒攻咽喉心烦者。用牛蒡子汤。咽
喉肿者。如圣汤、牛李膏、猪尾膏。疮毒入眼成翳者。用通圣干柿。皆
亲经用。殊效。
又曰。疮毒好攻人眼目。须预防之。方感此患。便以蝉蜕去土。
入热水放冷。乘温日饮。至疾愈。毒瓦斯永不入眼。温冷任服。甚验。
郭雍论述道：朱氏编写《活人书》，也大量采纳了蕲水庞安常的观点。但在论述疮疹时，两家的说法却像冰和炭一样截然相反。朱氏认为疮疹从头到尾都不可使用下法（泻下），而庞氏则认为在疮疹尚未发出或正要发出、斑纹还未显现时，都应当使用下法；甚至在疮疹已经痊愈后再次使用下法。这两种说法为何如此相互矛盾呢？
郭雍说：考察汉魏时期的医方，并没有见到相关记载。直到东晋的王叔和，才开始有治疗时行热毒疮的方子。随后巢元方才有关于疫疠疮的论候。他们的言辞都不甚详细。这是一种大疾，杀人并不亚于伤寒，为何记载得如此轻易简略呢？因此庞氏怀疑当时热毒不严重，很少有人死亡。我认为不是这样。上古岐伯与黄帝时代，这种病与今日并无不同，难道中古时期反而不同吗？王叔和既然将其归属于时行病，巢氏又认为是疫病，那么此疾应当在时行疫病中有详细记载，但现在已失传。伤寒因为经过张仲景的论述，所以保存得详尽完备；时行瘟疫因为没有张仲景的治疗法则，所以后世的说法不能统一。张仲景的《金匮玉函》之书，千百中存不到一二，怎知时行疫疾没有亡佚在其中呢？然而关于疮疹，除了庞氏和朱氏两家之外，就没有其他可取的论述了。我怀疑他们观点相反，让人无所适从。曾听先兄之子郭若说：“朱氏的论述，是后世不可更改的常道。这种方法应当唯独由朱氏掌握。”我说：“那么庞氏的话就错了吗？”兄长说：“医道精微，言语不能完全尽述。如果医生高明如庞氏，就可以采用庞氏的方法；否则，就完全遵循朱氏。即使是才能平庸的人，也可以达到及格水平。”听到这番话后，我心中豁然开朗。又有东平的钱乙（字仲阳），是以治疗小儿闻名的专家，但他在论述疮疹时，也稍显支离破碎，拘泥于五脏五色之论。究其学说，终究没有跳出朱、庞二家的门户。然而钱乙老于医术，论症用药有可取之处，所以将他的内容附在朱、庞二家之后。
郭雍说：《活人书》（原文此处缺失）病患肌肉发斑（原文此处缺失）。
疮疹始是温毒（原文此处缺失）。
伤寒（原文此处缺失）。
起初只说到这里，不像其他篇章那样详细，也未曾提及斑疹，难道是说了之后亡佚了吗？所以医家所论述的温毒等症，大多不是张仲景所言。时行温疫，至今不详的，在此处详细说明。有人说疮疹与伤寒相似，是指头痛壮热等症状相同，并非指感受的病邪相同。张仲景说：“冬天有不正常的温暖，称为冬温。冬温的毒气，与伤寒大不相同。”所以庞氏说：“凡是觉得冬天有不正常的温暖，疮毒未发或欲发时，就依法使用下法。”那么庞氏也将此视为冬温之毒了。然而像朱氏两家论述病症，都像温毒，而不愿明言的原因，是因为张仲景没有正论的缘故。在我看来，疮疹就是温毒的一种。晋代人既称之为时行热毒疮，那就是温毒疮了，还有什么可疑的呢？其感疾原本与伤寒相同，都是感于冬季，藏于肌肤，到春季才发作，这是相同之处。而张仲景说“大异”的地方在于：伤寒感受的是至寒之气，温毒感受的是冬温之气，这就是它们不同的原因。然而有的形成疮疹，有的不形成疮疹，总称其名，都叫作温毒。我认为感受了冬季非节令的温暖，藏于皮肤之中，到了春夏季节，其毒气发作，郁积旺盛，熏蒸肌骨已久，一旦发散于外，必定都会溃烂成疮而后停止，不仅仅是一汗而已。然而温毒成疮有好几种：叫做脓胞，又名豌豆疮；叫做水疱，又名麻子疮；叫做麸疮，又名麸疹。又有瘾疹斑烂，都属于这一类。轻的，世俗以其形象命名。本其所感深重而成脓胞，千金方之后，名为豌豆疮；次者为水疱；轻者为麸疮。脓胞生七日才长大，化脓结痂，然后痊愈。如果日子未满就干枯的，叫做倒靥。水疱生数日，圆满出水则愈。麸疮随出随即焦枯，其他地方再出再焦，如此遍及全身。这三种都忌讳倒靥。大的倒靥则颜色紫暗，严重的脓血欲干，所以变黑。有黑色的，一两天还可以用药使其重新发出；黑色多的则难治。水疱疮水如铃铛，倒靥则色干不明。麸疮刚出来很多，忽然不见，这就是倒靥。即使是麸疮倒靥，也能杀人，因为温毒之气重新进入五脏六腑。如果不是感受温毒之气，而是因时行暴发的，大多不杀人。所以患疮疹的人怕风怕冷，怕涂抹凉水凉药，最害怕使用下法，都是担心毒瓦斯倒靥于内。应当谨慎避开风口，如果天气尚寒，则难以透出体表。虽然要保暖，但不可太暖，不可服用热药。朱氏所说的只服用升麻汤，是最为重要的方法。疹病多是暴感，不是由冬温之气形成的，病情很轻，不成疮，只表现为瘾疹，起病时有赤白两种，世俗所谓的风尸就是这类。需要服药，也可以涂治。虽然没有倒靥的祸患，也有毒瓦斯入腹的忧虑。千金方的小儿泽兰汤，就是这类药物。又有一种，斑发如描画，遍身灿烂如锦纹者，又像火丹发作，虽然没有瘾疹，起病也像瘾疹，内外治疗，颜色淡则愈。伤寒发斑，见本文。
郭雍论述道：各家论述疮疹可下不可下，世人不能没有疑惑。我详细分析这两种方法本源于伤寒。伤寒冬感至寒之气，藏于肌肤骨髓之中，导致腠理闭密不得外出。到春天腠理开疏后才发于体表。医生发表中病，则从经络化为汗而出于表。如果发汗不当，或者遇到毒瓦斯很重，则不能外出，因而传入阴经，遂进入体内。到了体内，没有发汗的道理，等到邪气入胃，则使用下法。五脏的毒，其根在胃，根除则诸脏的毒随之而去。如果有余毒在里，表证未能解除，间或遇到胃中毒根已下，则在表的毒，如同断根的蓬草，随着所在之处化作汗而出。所以伤寒有汗而愈的，有下而愈的，下法也是必须先泄后作汗而愈。疮疹之家，本来没有汗下症。其初冬感受非节令的温气，藏于肌骨，此时外面寒冷，腠理闭密不得外出。到春天腠理开疏而发作。藏于肤腠的，发为麸疮；藏于肌肉的，发为麻子疮；藏于骨髓的，发为豌豆疮。既然已经发为疮，就没有发汗的道理，只用解肌药来托举它，希望它容易发出。毒瓦斯既作疮而出，不再入里，也如同伤寒大汗之后，不入阴经，自然没有可下的毒。所以治疗伤寒的方法，只在汗和下，而疮疹之家，没有汗下法。然而各家说有可以下的，也有三种说法。其一是在盛冬感受非节令的温气，腠理闭密不得出的时候，毒瓦斯无处宣泄，不过上攻头目胸膈，必然头热眼赤，口疮喉闭。如果见到这些症状，预先使用下法，则温毒尽去，到春夏不再发作疮疹。这是一个可以下的时机。庞氏所说：“凡是觉得冬天有不正常的温暖，疮毒未发或欲发时，就依法使用下法，次第服用预防的药物，则毒瓦斯内消，不让其入里，永远不可出，必死而后已。”这是另一个可以下的时机。其二则是疮疹黑陷倒靥，是大恶候。轻的还可以用药重新发出，发不出来，是疮毒入深，不能再至体表，因而深入，紧急使用下法，则可以存活。这是十死一生的候象，不得已而下，没有其他救治之术。这是第二个可以下的时机。其三则是疮疹已经痊愈，余毒不止，发为大痈，已经溃出脓血，又另外发痈，相续不已，世谓之痈疽。必须解利之后才停止。这时病人疮刚愈，没有得到饮食之力，气血虚羸，使用下法非常危险。主要靠医生斟酌用药。然而不下则死，也不得不这样做。这是第三个可以下的时机。除此之外，都不可下。朱氏说：“小儿腹泻转利，切忌用丸子药。应当用大黄、川芎等分，切碎作汤液，以荡涤蕴热。”这个说法很好。我认为应该加甘草，大黄加倍。这是常器之所用的方法。盛冬初感未发之时，适宜用此汤。及作痈之后，也适宜用此汤，只是稍微减少剂量。如果没有效果，再服用。只有疮作黑陷倒靥，发不出来的，必须用朱氏的无比散，以及钱氏的百祥丸。前面所说的大黄川芎药，也不可用了。此病原不见于张仲景书中，所以没有定论，不免详细说明，希望没有疑惑。
郭雍说：东晋中书令王叔和有伤寒身验方云：“桦木皮浓汁冷冻饮料，主治伤寒时行热毒疮特别良效。”这就是现在的豌豆疮，当时称为时行热毒疮。所以庞氏方中记载桦皮饮子，本于此。到巢氏论疫疠疮候时说：“热毒盛则生豌豆疮，周匝遍身，状如火疮，色赤头白者毒轻，色黑紫黯者毒重，也名为登豆。”这就是热毒疮。到巢氏之后，才有痘疮、豌豆之名，至今称呼它们。用这两者考证，则称疮为温毒疮不错误。凡冬天感受寒邪，纵然病热很极端，不过是发斑发黄，最终不成疮。只有感受冬季非节令的温暖才会成疮。所以庞、朱都说温毒之为疮，而王叔和、巢氏都以热疮为时行、为疫病。各家虽然异同，其实是一样的。
郭雍说：我家遇到小儿将要发作疮疹，未辨别是伤寒还是时行，就根据朱氏的方法，先服用升麻葛根汤。服之疮未出，而恶风发热、头痛，诸症不罢的，就是药性缓，次日更兼败毒散服用。如果是疮子，一夕便出。或不成疮，也以汗解，仍能解疮毒。重的变轻，屡试有效。
又说：疮疹变出恶症的，多是豌豆疮，因为其毒瓦斯盛的原因。其他的唯服药有误，则有恶症。不误服药的，无恶症。
又说：麸疹虽不成疮，也头焦皮起，如麸片然。若瘾疹则暴发，初无表症，也不退皮，愈后便消。所以世谓疹子为麸疮。其毒虽轻，若误服凉药，则在盛出之际，一夕忽不见，便是倒靥。毒瓦斯入里，也能杀人。用牛李膏使其发出。
又说：贫下之家养小儿，素无暖衣衾，也无酒肉滋味，到其感病，只是时行所感，候其气散，即便安愈。豪贵之家，温燠太过，饮食无度，既感时行之气，人事又为之助，是两毒相攻，所以多生异症。遇冬温时，小儿午间常服牛蒡消毒饮甚好。
又说：疮疹大畏大小便不快，恶症便生，急须通之。用牛李膏通大便，麝香膏通小便，大妙。
又说：钱氏所谓五七日痂不焦，以内热蒸皮中，这只是毒瓦斯未尽，也不须宣风散，但服牛李膏。
又说：牛李膏亦是旧方，不止钱氏用，正是疮疹本药。如宣风散是外来，借功自不同。所以贵牛李膏者，以出未快者，可以出之；多者可以解之；在表者，可因而越之；在里者，可引而竭之。是疮疹八面可用之药。故凡疮疹，皆先服之。
又说：牛李膏奇处，正在能分毒瓦斯。在表者使出，在里使下。表里并用，两不为妨。同时供应，毒势已衰，诸药皆无是之妙。天生神物为人用，非只此一物，第人未能尽知之耳。
又说：疮疹初发，固不必用牛李膏。才见出得稠密，或大小便不快，或出不快，烦闷渴甚者，便与服之。牛李二种，稍大而黑紫者奇。微小而深黑者劣。微小者，即早李也。本草共为一物。
又说：凡豌豆疮根边色红活，疮颗圆满如珠者，大好。初生亦未便圆，日渐长也。疮根色红淡，疮颗不圆好。盒饭表发，仍频看觑。我有一孙四五岁，患此已数日，背上疮盛，而根色淡而不红活，疮颗已半平半陷，间有紫黑色者。急与牛李膏二服，不见色回。再取猪尾血滴研龙脑，水调服。时已日暮，少顷，灯下视之，疮根复红活如初。次早陷疮皆起，累日再长，圆满焦痂而愈。但病身中痛异常，手不可触。病后羸极，如两次伤寒也。是岁一房同时患者，皆毒重稠密烦渴，皆用牛李膏下黑涎而愈。
又说：牛李膏之上，惟猪尾膏奇。但猪尾膏非恶候不用，不若牛李膏可常用。虽恶候未出，使见热盛，便先解之。猪尾膏如无龙脑，即用麝香。麝香大通小便，小便快则毒自衰。曾用之验。
又说：恶候，二膏不效，方可下。我曾见一病，医者用无比散下之，立愈。惟百祥丸不亲见用之者。我以多用前二膏，故未尝至于用大下药。
又说：活人等书诸方，如升麻汤，固必先用。疮出不快，烦躁不眠者，用升麻汤、黄芩加木香汤。毒攻咽喉心烦者，用牛蒡子汤。咽喉肿者，如圣汤、牛李膏、猪尾膏。疮毒入眼成翳者，用通圣干柿，皆亲经用，殊效。
Guo Yong discussed: Zhu Shi's *Huoren Shu* (Book of the Living) also extensively adopted the views of Pang Anchang from Qishui. However, when discussing chuangzhen (smallpox/rubella-like eruptions), the theories of the two schools were as contradictory as ice and charcoal. Zhu Shi held that purgation (downward-draining method) should never be used from the beginning to the end of chuangzhen. In contrast, Pang Shi argued that purgation was appropriate before the eruption appeared or while it was about to appear, even if the macules had not yet manifested; furthermore, he suggested using purgation again after the eruption had healed. Why were their statements so mutually contradictory?
Guo Yong said: Examining medical prescriptions from the Han and Wei dynasties, no such records are found. It was not until Wang Shuhe of the Eastern Jin Dynasty that prescriptions for treating epidemic heat-toxin chuang first appeared. Subsequently, Chao Yuanfang provided discussions on the manifestations of epidemic pestilence chuang. Their descriptions were not very detailed. This is a severe disease, killing people just as effectively as Shanghan (Cold Damage). Why were the records so casual and brief? Therefore, Pang Shi suspected that the heat-toxin at that time was not severe, and few people died. I believe this is incorrect. During the ancient times of Qi Bo and Huang Di, this disease was no different from today; how could it have been different in the middle antiquity? Since Wang Shuhe classified it under epidemic diseases, and Chao Shi regarded it as an epidemic pestilence, this disease should have been detailed in the sections on epidemic and pestilential diseases, but these are now lost. Shanghan survived in detail because of Zhang Zhongjing's treatise. Epidemic and pestilential diseases lack Zhang Zhongjing's therapeutic methods, so later generations' theories cannot be unified. Zhang Zhongjing's *Jingui Yufan* (Golden Cabinet Jade Box) has less than one or two parts surviving out of thousands. How do we know that epidemic diseases did not perish within them? However, regarding chuangzhen, apart from the theories of Pang Shi and Zhu Shi, there are no other valuable discussions. I suspect their opposing views leave people with nowhere to turn. I once heard my elder brother's son, Guo Ruo, say: "Zhu Shi's theory is the unchangeable constant principle for future generations. This method should be uniquely possessed by Zhu Shi." I asked: "Then is Pang Shi's statement wrong?" My brother replied: "The Way of Medicine is profound and subtle; words cannot fully express it. If a physician is as enlightened as Pang Shi, he may use Pang Shi's methods. Otherwise, he should strictly follow Zhu Shi. Even an incompetent practitioner can reach an acceptable level." Hearing this, I felt suddenly enlightened. There was also Qian Yi (courtesy name Zhongyang) from Dongping, a renowned expert in pediatric medicine. Yet, when discussing chuangzhen, his theories were somewhat fragmented, stuck on the five zang organs and five colors. Ultimately, his discourse did not transcend the schools of Zhu and Pang. However, Qian Yi was experienced in medicine, and his symptom analysis and medication choices had merit. Therefore, I appended his content after Zhu and Pang.
Guo Yong said: [Text missing] Patients with muscle macules [Text missing]. Chuangzhen originates from wind-heat toxin [Text missing]. Shanghan [Text missing]. The initial discussion ends here, unlike other chapters which are more detailed, and does not mention macules and rashes. Was it spoken of and then lost? Thus, the wind-heat toxin and similar syndromes discussed by physicians are mostly not from Zhang Zhongjing. Epidemic wind-heat, which remains unclear today, is detailed here. Some argue that chuangzhen is similar to Shanghan because symptoms like headache and high fever are the same, not because the pathogenic factor is the same. Zhang Zhongjing stated: "Unseasonable warmth in winter is called Winter-Warmth. The toxin of Winter-Warmth is vastly different from Shanghan." Therefore, Pang Shi said: "Whenever one feels unseasonable warmth in winter, before or when the chuang toxin is about to erupt, one should use purgation according to the method." Thus, Pang Shi also considered this as Winter-Warmth toxin. However, Zhu Shi and others described the syndrome as resembling wind-heat toxin but were reluctant to state it explicitly because Zhang Zhongjing lacked a definitive treatise on it. In my view, chuangzhen is a type of wind-heat toxin. Since the Jin people named it epidemic heat-toxin chuang, it is indeed wind-heat toxin chuang. What is there to doubt? The infection originally resembles Shanghan: both are contracted in winter, hidden in the skin and muscles, and manifest in spring. This is the similarity. The difference noted by Zhang Zhongjing lies in the etiology: Shanghan is caused by extreme cold qi, while wind-heat toxin is caused by winter-warmth qi. This is why they differ. Some develop chuangzhen, some do not. Generally, they are all called wind-heat toxin. I believe that contracting unseasonable warmth in winter hides the toxin in the skin. When spring and summer arrive, the toxin erupts. Due to intense accumulation and long-term steaming of the muscles and bones, once it manifests externally, it must ulcerate into chuang before subsiding. It is not merely resolved through sweating. However, wind-heat toxin chuang has several types: Nongbao (Pustular), also known as Wandou Chuang (Pea Pox); Shuibao (Vesicular), also known as Mazi Chuang (Measles-like); and Fuchuang (Bran-like), also known as Fuzhen. Also included are Yin Zhen (Urticaria-like) and ban lan (macular erosion). Lighter cases are named by their appearance in common parlance. The deepest infection leads to Nongbao, later called Wandou Chuang in the *Qianjin Fang*. Intermediate is Shuibao. Lightest is Fuchuang. Nongbao takes seven days to mature, suppurates, forms scabs, and then heals. If it dries up before the days are complete, it is called Dao Ye (Reversal/Retraction). Shuibao matures in a few days, fills with water, and heals upon rupture. Fuchuang appears and quickly scorches/dries; if it reappears elsewhere, it scorches again, spreading over the body. All three types fear Dao Ye. Severe Dao Ye results in purple coloration; if pus and blood dry up, it turns black. Black lesions appearing within one or two days can still be treated to re-emerge; extensive blackening is difficult to cure. Shuibao looks like bells; Dao Ye makes them dry and dull. Fuchuang appearing abundantly then suddenly disappearing indicates Dao Ye. Even Fuchuang Dao Ye can be fatal because the wind-heat toxin re-enters the internal organs. Non-toxin-induced epidemic outbreaks rarely kill. Therefore, patients with chuangzhen fear wind and cold, fear applying cool water or medicines, and most fear purgation, all worrying about the toxin retracting internally. One should avoid drafts. If weather is cold, eruption is hindered. Warmth is needed but not excessive heat; hot medicines should be avoided. Zhu Shi's advice to only use Shengma Gegen Tang (Cimicifuga and Pueraria Decoction) is the most crucial method. Zhenbing (Rash diseases) are often acute infections, not formed by winter-warmth qi. They are mild, do not form chuang, and present only as Yin Zhen, with red and white variants, commonly known as Feng Shi. Medication and topical treatment are required. Although there is no risk of Dao Ye, there is a concern of toxin entering the abdomen. The *Qianjin Fang*'s Xiao'er Zelan Tang (Child's Laurel Decoction) is applicable. Another type presents with macules like paintings, brilliant across the body like brocade, resembling Huodan (Fire Erysipelas). Though lacking Yin Zhen, the onset resembles it. Internal and external treatment leads to healing if the color fades. Shanghan macules are discussed in the main text.
Guo Yong discussed: Various schools debate whether chuangzhen can be purged. People are confused. I analyze that both methods originate from Shanghan. Shanghan involves contracting extreme cold in winter, hiding in skin, muscles, and marrow, closing the cou li (pores) preventing exit. In spring, cou li open, and it manifests externally. If the physician releases the exterior correctly, it exits as sweat via the meridians. If release is improper or toxin is heavy, it fails to exit, transmits to Yin meridians, and enters the interior. Once inside, sweating is impossible. When it reaches the stomach, purgation is used. The toxin of the five zang organs roots in the stomach; removing the root removes the toxins of all organs. If residual toxin remains internally while the exterior is unresolved, and the stomach root is purged, the exterior toxin, like a severed weed, exits as sweat from its location. Thus, Shanghan cures via sweating or purgation; purgation often precedes sweating. Chuangzhen patients originally have no indications for sweating or purging. They contract unseasonable warmth in winter, hiding in muscles and bones. External cold closes cou li. In spring, cou li open, and it manifests. Hidden in superficial layers becomes Fuchuang; in muscles, Mazi Chuang; in marrow, Wandou Chuang. Once chuang forms, sweating is inappropriate. Only Ji Jie (Muscle-Releasing) herbs should be used to support eruption. Once toxin erupts as chuang, it does not re-enter the interior, similar to how Shanghan does not enter Yin meridians after profuse sweating. Thus, there is no toxin requiring purgation. Shanghan treatment relies on sweating and purging; Chuangzhen treatment does not. However, some advocate purging in three scenarios. First, during deep winter when unseasonable warmth closes cou li, toxin cannot vent, attacking head, eyes, chest, and diaphragm, causing hot head, red eyes, mouth ulcers, and throat obstruction. Preemptive purgation clears wind-heat toxin, preventing eruption in spring and summer. This is the first indication for purging. Pang Shi stated: "When unseasonable warmth is felt in winter, before or during eruption, purge according to method, followed by preventive meds, to dissipate toxin internally and prevent fatal retraction." This is the second indication. Second, Dao Ye (black depression/retraction) is a grave sign. Mild cases can be treated to re-emerge. If eruption fails, toxin has sunk deep. Emergency purgation may save life. This is a desperate measure (1 in 10 survival). This is the third indication. Third, after chuangzhen heals, residual toxin causes large abscesses (Yong). After suppuration, new abscesses continue. This requires clearing and draining. The patient is weak post-healing; purgation is dangerous but necessary to avoid death. This is the fourth indication. Outside these, purgation is contraindicated. Zhu Shi said: "For infants with diarrhea, pills are forbidden. Use equal parts Dahuang (Rhubarb) and Chuanxiong, decocted to clear stagnant heat." This is good. I suggest adding Gancao (Licorice) and doubling Dahuang, as Chang Qizhi did. Use this decoction during early winter pre-eruption and after abscess formation (reduce dose initially). If ineffective, repeat. For black depression/unerupted chuang, use Zhu Shi's Wubi San (Peerless Powder) or Qian Shi's Baixiang Wan (Hundred Auspicious Pills). Do not use Dahuang/Chuanxiong decoction here. Since this disease is absent in Zhang Zhongjing's works, there is no fixed rule, hence this detailed explanation to remove confusion.
Guo Yong said: Wang Shuhe, Central Book Director of Eastern Jin, had a verified Shanghan prescription: "Concentrated Birch Bark Juice, chilled, excellently treats Shanghan epidemic heat-toxin chuang." This is modern Wandou Chuang, then called epidemic heat-toxin chuang. Pang Shi's Birch Bark Drink derives from this. Chao Shi's discussion on epidemic chuang states: "Excessive heat-toxin produces Wandou Chuang, covering the body, like fire blisters. Red with white heads indicates light toxin; black-purple dark indicates heavy toxin, also called Dengdou." This is heat-toxin chuang. Post-Chao, terms Dou Chuang and Wandou emerged. Comparing these, calling chuang "wind-heat toxin chuang" is correct. Winter cold contraction, even with extreme heat, causes only macules or jaundice, never chuang. Only winter-warmth contraction causes chuang. Thus, Pang and Zhu attribute chuang to wind-heat toxin, while Wang and Chao call heat-chuang epidemic/pestilence. Despite differences, they are essentially the same.
Guo Yong said: When my family's child was about to erupt chuangzhen, without distinguishing Shanghan from epidemic, I followed Zhu Shi's method: first administer Shengma Gegen Tang. If chuang did not erupt, and aversion to wind, fever, headache persisted, indicating slow drug action, I added Baidu San (Toxin-Resolving Powder) the next day. If it was true chuangzhen, it erupted overnight. If it failed to form chuang, it resolved via sweating, still resolving chuang toxin. Severe cases became mild. This was repeatedly effective.
Also said: Grave symptoms in chuangzhen are mostly seen in Wandou Chuang due to heavy toxin. Other cases have grave symptoms only due to medication errors. Correct medication yields no grave symptoms.
Also said: Fuzhen does not form chuang but has scaly, bran-like peeling. Yin Zhen erupts suddenly without exterior symptoms, does not peel, and resolves after healing. Hence, rash is called Fuchuang. Though light toxin, misusing cool medicines during peak eruption causes sudden disappearance (Dao Ye), allowing toxin to enter internally and cause death. Use Niuli Gao (Cow Plum Ointment) to promote eruption.
Also said: Poor families raising children lack warm clothes/bedding and rich food. Illness is purely epidemic. Once qi disperses, health returns. Wealthy families are too warm and overeat. Contracting epidemic qi plus lifestyle factors creates dual toxin attack, leading to abnormal symptoms. During winter-warmth, giving children Niubang Xiaodu Yin (Arctium Detoxification Drink) at noon is beneficial.
Also said: Chuangzhen greatly fears difficulty in urination and defecation; grave symptoms arise. Urgent relief is needed. Use Niuli Gao for constipation and Shexiang Gao (Musk Ointment) for urinary retention. Very effective.
Also said: Qian Shi said scabs not drying after 5-7 days is due to internal heat steaming skin. This means toxin is not exhausted. Xuanfeng San is unnecessary; simply use Niuli Gao.
Also said: Niuli Gao is an old formula, used by Qian Shi and others, being the fundamental medicine for chuangzhen. Xuanfeng San is external/borrowed efficacy. Niuli Gao is valued because it promotes eruption if slow, resolves excess, lifts exterior pathogens, and drains interior pathogens. It is versatile for chuangzhen. Thus, it is given first.
Also said: The miracle of Niuli Gao is dividing toxin: expelling exterior, draining interior. Using both simultaneously does not conflict. Toxin power declines. No other herb matches this. Nature provides divine items for human use; humans just don't know them all.
Also said: Early chuangzhen need not use Niuli Gao. Once dense eruption, or difficulty in urination/defecation/eruption, or severe irritability/thirst occurs, administer it. Niuli (Cow Plum) slightly larger and black-purple is superior. Small and deep black is inferior. Small ones are early plums. Materia Medica classifies them as one item.
Also said: For Wandou Chuang, red and vibrant roots with round, pearl-like lesions are excellent. Initially not round, they grow daily. Pale red roots and irregular lesions are poor. Monitor frequently. My grandson, aged 4-5, suffered for days. Back lesions were abundant, roots pale/non-vibrant, lesions half-flat/half-depressed, some black-purple. Urgently gave two doses of Niuli Gao. Color did not return. Then took pig tail blood, mixed with Longnao (Borneol), and administered with water. It was dusk. Shortly after, by lamplight, roots returned to vibrant red. Next morning, depressed lesions rose, grew over days, formed round scabs, and healed. Body pain was severe, touch intolerable. Post-illness weakness resembled double Shanghan. That year, a whole household suffered simultaneously with heavy toxin, dense eruption, irritability, and thirst. All cured with Niuli Gao draining black phlegm.
Also said: Above Niuli Gao, only Zhutai Gao (Pig Tail Ointment) is miraculous. But Zhutai Gao is reserved for grave signs, unlike Niuli Gao for routine use. Even if grave signs haven't appeared, if heat is high, use it first. If Zhutai Gao lacks Borneol, use Musk. Musk strongly promotes urination; quick urination reduces toxin. Verified.
Also said: For grave signs, if the two ointments fail, then purge. I saw one case where a physician used Wubi San, curing immediately. I never personally saw Baixiang Wan used. Having used the former two ointments extensively, I never reached the point of using strong purgatives.
Also said: Formulas in *Huoren* etc., like Shengma Tang, must be used first. For slow eruption, irritability, insomnia, use Shengma Tang combined with Huangqin Jia Muxiang Tang (Scutellaria with Added Costus Decoction). For toxin attacking throat and heart causing irritability, use Niubangzi Tang (Arctius Seed Decoction). For swollen throat, use Rusheng Tang, Niuli Gao, Zhutai Gao. For toxin entering eyes causing opacity, use Tongsheng Dried Persimmon. All personally used with great effect.
Also said: Chuang toxin attacks eyes easily; prevention is necessary. Upon infection, take Chan Tui (Cicada Slough), cleaned, steeped in hot water, cooled, and drunk warm daily until recovery. Toxin will never enter eyes. Temperature does not matter. Very effective.