古哲方论，虽已备纂前集，然书亦有未及之论，未尽之旨，兼之今古不同，气化迥
异，谨将近时所见，及临症治按，并用药活法，不揣周陋，统列于后，以补所遗。
凡先见耳廓内而多者，属肾经，大凶。若兼腰痛等候必死。一凡眉棱，一片灰白而
密甚者，必至哑呛不食，九十朝决凶。一眼合之后，流泪如脓，淋漓不断者。必变坏
症，不治，慎勿轻视之。一痂后眼开红色者凶。一凡吐甚见痘者，头回必多。一凡凶恶
痘症，若骤见起势。须至六七日后，方保无虞。盖至七日，则五脏皆已传遍，常见起势
二三日，忽变而死者，盖五脏胜复之理也。凡一脏正气之衰败，必由一脏邪气之强胜，
胜已并衰同归于尽，犹灯尽复明，皆无根之火，故难久耳。一痘毒发于足内踝者必死，
盖毒发于肾，故见太溪脉之所也。一痘初舌上先起白色者凶，盖由丹田元阳有亏，而气无发生之本矣。
甚哉！大地之气日薄，而人所禀之气亦日虚也。张少年临症痘疮之难出而成内溃者
十之一二，不能灌浆者十之二三，不能收靥还元者十之四五，盖天禀尚壮，得以耐病
也。肾元充足，毒不能内伏也。至于麻疹难出，及既出而余热不退，喘促成凶者，百之
四五。岂期今也，有因肾元亏损，不能升发送毒出表，而成内溃者十之三四；有因疏表
毒物太过，正气无力主持，任其药力之猛，毒势之锐，冲激一涌而出。然腠里未疏，气
血两弱，何能周行肢体！形高耸而粗肥，色润泽而华美，所以头面独多者，火毒炎上
也。其形如麸如 者，发热未久，腠理闭塞，俗云地皮未熟，而气虚无力透出，药毒
猛逐，出表之象也。其色如疹如丹者，热毒逼烁而荣气逆行于肌表也。然如麸如 之
形，即身中之气。如疹如丹之色，即身中之血，既将气血赶出于肌表，复谓火毒炽盛，
寒凉解毒，清胃化斑，气血既不能续运于中，寒凉复伤胃气于内，欲不乘虚复陷，其
可得乎！是以十伤七八。有因气血不充，调治未善，以致毒化未完，血气先竭，因而致
毙者，十之五六。凡此者，皆因禀受既亏，所谓火与元气势不两立，元气虚而所胜之火
毒益盛矣。至于疹也，半因腑毒，半属时行，全关乎气血之浓薄以为重轻，更赖乎调
治之宜否以为损益，古人禀赋既浓，且淡泊节爱，腑毒原轻，是以易透易回。今人膏粱
炙爆，寒暄素逆，禀元则薄，受毒偏深，是以稍有传染势便沉困，治者悉遵古法，尽
作有余之治，且以疹要清凉，痘要温为定论，以致阳虚不能升发者。头面不起，阴虚
不能退阳者，余热不退，阴气未全之弱质，何堪久热之伤阴？以致昏沉不食，喘促烦
躁，中气日虚。如以疏表透托风药，则愈耗其阴。如以清肺解毒凉药，则徒伤其胃。泄
泻一来，上热下寒，喘促益甚，复谓之毒归肺，肆进苦寒，危亡立至！殊不知，气血不
和，偏阴偏阳之谓毒，能使气血和，阴阳
平，而毒化矣。故张立全真一气汤，去人参以治麻疹头面不起，壮热不食，喘促昏沉，
上热下寒之候，无一不效。盖内以熟地为君者，取养阴以化阳也。以白术、炒麦冬为佐
者，一以托住中气，得以耐病，一以清肺生水，更可制肝。以牛膝、五味子为引者，用
牛膝以抑浮阳之上壅，用五味子以敛浊阴之下归。以制附子为使者，令其直达下焦，引
熟地以滋阴降火，引麦味以纳气藏源，真阴一得，焦烁顿除，气血一和，阴阳自适，透
者透而回者回，喘促昏沉之凶状；顿为瓦解。或以附子大热，白术大燥，五味子大敛
为疑，殊不知，附子无姜桂则不热，同熟地阴药，便能滋阴，降火最速也。白术而有熟
地则不燥，熟地、麦冬数药而无白术在内，则力小而软，且中气缓弱，何能运药成功！
附子通经达络，斩关夺旗，既有白术驾驱，复借五味酸敛，则直固丹田，其阴翳之毒，
何足虑也！附子之力虽大，然疏泄太过，则气殚散而不收，惟其一加收敛，则疏泄通经
之力愈大，犹之严冬阳气闭藏固密，而后阳春之发生蕃茂，更加火炮，而外皮坚固，而
药之内发有力，方能声震遐迩，以此攻毒，何毒不推！以此通经，何经不达！以此降
火，何火不藏！以此滋阴，何阴不长！诚神功也。更有向患阴虚久嗽，寸强尺弱，麻疹
隐伏，但脉宜于地黄汤，而不宜于疏表风药者，张竟照脉立方，以六味加肉桂、五味
子，不二剂而疹透嗽减，神清思食，热退而痊。此即前方内有附子之大力，而不虑五味
子之小技，其义同也。时都门麻疹致毙者，十有四五，余总按脉用药，悉以救阴救阳为
主，而夭枉者从无一人，诚为治疹法外之遗，故不必以疹多实热，斑有假阳为定论，
更不必以斑疹分，但当以虚实别。疹之虚者，即以治斑之法治疹，斑之实者，即以治
疹之法治斑。至于痘疮初起，凡属肾元不足者，便宜按尺脉之阴阳亏损，固其天真以虚
肾元，送毒出经，切勿误用苦寒以遏热毒在内，便成内溃莫救。至于外无风寒闭寒，及
肥白皮细肉脆之婴儿，重豢养之子弟，切勿重加疏表，以致正气无主，乘势而奔溃而出
矣。倘腠理素虚，邪毒炽盛，不待药力而一齐涌出者，便宜乘其临时毒尽在表，其热其
势，姑在少缓之时，五脏六腑，正在苟安之际，此时于中只有正虚乘势，急察阴阳之偏
损，对脉填补，应犯而犯，似乎无犯，五六朝来，已有充灌成浆之具矣。若到灌脓期
限，火毒之势复炽，滋补之药，便多碍手难投，即滋补之功，亦难骤于应手，余有求情
论，专悉其义，在痘疹发热门，如此挽救，十可一活。至于不能收靥还元者，非气血不
能续运于中，即脾胃有失化源之本耳。调理脾胃，补益真元，长养气血，元气胜而毒自
消弭，此易见之理也。
信乎？无形之真阴真阳，而为生人之本，且治痘须察人元气，而不可凭乎形质也。余六
儿干德，因禀母气不足，形肥 白，肉胜于骨，大便燥结，便甚苦楚，不知者以为脾胃壮
实，此实肠中少津，所以大便燥结，肠中少气，所以大便艰难，且过岁之内，时患气从脐下
直奔而上，咳嗽不已。或用人参一钱，带衣胡桃一枚，同煎服而愈，后用此不效，乃用八味
加牛膝、五味子煎服甚安，即以此作丸，每早白汤化服钱余。然不耐疾病，而偏疾病最多，或
旬日一病，或半月一病，病即委顿不堪。余凡审其受寒发热，乃阳不足也。即用辛温卫气
之药以散之，加生姜、苓、术、参、苏、薄、桂之类。如受热发热，乃阴不足也，即用辛润荣
气之药以胜之，如养荣汤地黄汤之类。如停滞发热，乃脾气不足也，即用壮脾之中，佐
以推扬谷气以化之，如孤阳浮越而发热不已，必审其因于脾虚者甘温以除之，因于阴
中水虚者，壮水以制之，因于阴中火虚者。益火之原以消之，务使壮火仍为少火，而归
藏于中，断勿纵其壮火力穷于外，盖病发有余之日，即正气不足之时，设徒从标攻治，
则正气不足，而药更不足之，虚者日虚，精神何自而长？故如此调治以来，疾病渐少，
精神渐生，但肉胜于骨，形肥 白，得之先天也。时以出痘必犯肾虚，内溃之患为
忧，不意将及二周，而当五月五日，身热汗多，烦躁殊甚，发热不及一日，而即见点于
天庭右太阳，色白无光彩，摸之不碍手，余欲攻之，则恐一齐拥出，余欲任之，则汗多
身热，能不虑其向来不足之肾阴，益令熬煎枯竭耶！况肾阴一竭，则阴火愈旺而烦躁愈
甚，壮火蚀气，则正气益虚，而困顿益增，痘将何所假借以呈真形华其色，而得煦之濡
之之用哉！断不可以循常治痘之法为用矣。故一朝只用大料六味地黄汤加丹、柴，令乳
母连服二剂，惟使肾阴不竭，而煦濡有力，毒自不能况匿于肾也，二朝痘虽渐见，已无
内溃之虞，但痘白与肉色无殊，身与四肢粗肥，而上隐隐如 ，此阴虚不能华色、阳虚
不能上达，况身热汗多，烦躁如故，而神气更疲，则阴津阳气，前柱于外，可不托住中
气，填补真阴，滋其化源，抑此烦躁，敛其浮越之阳，以逐阴翳之毒降其淆浊之气，以
令清阳之升耶！故用熟地六钱，炒白术二钱，牛膝二钱，炒燥苓冬一钱五分，五味子
四分，极甜肉桂去尽粗皮者六分。服后壮热少减，溃汗少敛，烦躁少宁，痘疮陆续渐出
矣。三朝四肢甚是起泛，其头面虽见而不长，且色白与肉无殊，余思气血大虚，不待
言矣。且元首见点未全，四肢便已起胀，囊有水色，此脾元不足，肝肆强阳，四肢一
松，元首见点，起胀更难矣。况将来水泡发痒，可立而待也。乃用芎、归、苓、术、炙
草、桂心、天虫、角刺、煨姜。大枣为引，早晨服一剂不用人参者，晚间照此再服一
剂，内加人参钱余。所谓应犯而犯，似乎无犯，岂拘古人人参戒用于三日之前为定论
乎！四朝痘虽起而无神，其色白如故，惟有大补气血兼重脾元为主，其药参、 、芎、
归、苓、术、桂心、炙草、天虫、甲片、角刺、煨姜、大枣为引，五朝形虽稍起而无神
色，虽稍红而甚淡，药惟参、 、归、桂、炙草、天虫、甲片，角刺，补托而已，六朝
形虽稍长，而晦滞，色虽淡红而枯燥，余思此原先天真阴真阳不足，今虽大补气血，尚
不足以尽之，盖滋水兼得养血，养血兼不得滋水也，乃用熟地六钱以滋水，肉桂八分以
补火，人参三钱以驾驱药力补助真元，七朝平足，水泡已甚，而面上枯槁不荣，其大便
得来间日一次，甚干燥者，今忽便溏二次，而失气甚频，则熟地补阴之功，缘中气甚
虚，虽有参桂，不能运津液外达以成浆，而任其下陷之势，以失气便溏，则中气愈虚，
能保其不泄泻无脓倒陷乎！乃用人参五钱以保元，白术二钱以固中，制附子六分以通经
达络，溃坚腐脓，恐走下太速，用炙甘草六分以缓之，四味力大功专，中气赖以得充，
津液凭斯外运，但欲宣扬鼓舞，使津液无为不达，乃桂枝之能欤、乃用三分以为使，如
此一剂，将数日调养之精华，一夜头面身体尽化浓浆，而熟腐清水之泡，变为浓浊。但
疼痛烦啼，乃煎生脉饮，以补接元气，养其酿浆之势，恐不耐痛苦，神气一伤，浆势反
致退去也。八九十朝以来，惟早晚各用生脉饮一服化服，平时所服加味八味丸钱余，乃
根据部结痂，精神日长，饮食胜前，烦渴躁急，俱为全愈。如是善为调摄，痘后尚然手
背浮肿，脚肿更甚，余思此因胃气甚虚，四肢无所禀受，其脚更肿者，气虚不能升举
也。乃用人参一钱五分，炙黄 一钱二分，炒白术二钱，茯苓一钱五分，炙甘草六分，
酒炒当归一钱，酒炒白芍八分，蜜酒炒升麻柴胡各三分，煨姜大枣为引，煎服数剂，虚
肿乃退，但爪甲色黄而燥，乃肝荣不足也。足痿不能立，此肾元大虚也。乃用六味加地
骨皮、建莲肉为丸；每日早服二钱，滋肝肾以助筋骨之用，日中以八珍糕养脾胃，以助
化源之需。
余长孙大业，禀赋先天阴分不足，且平
时酷嗜甜物果饼，而粥饭甚是根据希，以致脾虚湿热，大便素溏，外生疮疥，内蓄蛔虫。
时年五岁，当五月发热见痘，红紫而无润色，朝暮全不易眼，乃久患疮疥，血少血热
而且血滞也。奈胃气久虚，湿热太重，一二三朝无非升托清解凉血，如升麻，干葛、蝉
退、天虫、甘桔、牛蒡、生地、木通、紫草、笋尖之类，无如谷气久虚，蛔虫大厥，
腹痛呕吐，药亦难受，尺许之虫，一吐数条，愈吐愈虚，愈虚愈吐，粒米不进，势甚
野狼狈。五六朝来，惟为温补攻托，以壮中虚倒陷，其药参、 、炙草、当归、熟地、山
药、甲片、角刺、肉桂、煨姜、大枣为引，奈服后少顷亦吐。七八朝来，痘虽起胀，然
上吐下泻而津液不能外达，痘囊何能湿润成浆？乃用人参五钱，白术三钱，炮姜一钱二
分，炙草六分，附子八分，如此大药到口亦吐，余思药力虽大，下咽未能即达经络，可
以吐出，惟烧酒入咽，即直透丹田，外达经络，不能吐出者，乃于药内加烧酒三匙服
之，始能半吐半受内，仍泄泻不止，外仍干涸无脓，皆因脾元中气素虚，不能营运津
液，以濡润百骸，而三焦肠胃之腠理，怫郁结滞致密，所以纵复多饮于中，终不能浸润
于外，以致内湿外干也。乃用人参三钱保元以为君，炒白术二钱固中以为臣，炙甘草四
分，缓其下行以为佐，麻黄去节汤泡酒浸炒焦黄八分，仗其轻扬之性，率领诸药外达皮
肤，生附子六分，通经达络，溃坚腐脓，并以为使，煨姜三片，止呕和中，助阳达表
以为引，如是一剂，驱肠胃湿热之气外达皮囊，而尽化为脓，久凝久滞之毒，一剂顿为
瓦解，湿热既清，其蛔虫之久蓄于内者，亦难自安，前后共出一十六条，自后惟饮独参
汤调理，饮食切戒甘肥，痂落之后，日进六味地黄丸二钱，而饮食精神，俱为倍长。
古代哲人的方论，虽然已经在之前的集中编纂完备，但书中也有未能涉及的论述和未尽的旨意。加之古今不同，气候气化差异巨大，我谨慎地将近期所见、临症治疗记录以及用药的灵活方法，不顾自己学识浅陋，全部列在后面，以补充遗漏之处。
凡是先出现在耳廓内且数量多的，属于肾经，大凶。如果兼有腰痛等症状，必定死亡。凡眉毛棱骨处，呈现一片灰白色且密集严重的，必然导致失音呛咳、不能进食，到第九十天决定吉凶（通常主凶）。眼睛闭合后，流泪如脓，淋漓不断的，必然变为坏症，无法治愈，千万不要轻视它。结痂后眼睛睁开呈红色的，主凶。凡是呕吐严重并出现痘疹的，初次发作时数量一定很多。凡是凶恶的痘症，如果突然呈现出起势，必须等到六七日后，才能保无危险。因为到了第七天，五脏之气都已经传遍全身。常见刚起势二三天，忽然变化而死亡的，这是五脏胜复（五行生克制约）的道理。凡是某一脏的正气衰败，必然由另一脏邪气的强盛引起，邪气强盛与正气衰败一同走向终结，就像灯油将尽时的回光返照，都是无根之火，所以难以持久。痘毒发于足内踝处的，必定死亡，这是因为毒发于肾，所以见于太溪脉所在的位置。痘疹初起时舌上先出现白色的，主凶，这是因为丹田元阳亏损，气没有发生的根本了。
唉！大地的气候日益迫近衰薄，人所禀受的气也日益虚弱。张景岳年轻时临症所见，痘疮难出而成内溃的占十分之一二，不能灌浆的占十分之二三，不能收靥还元的占十分之四五，这是因为当时的人天禀尚且强壮，能够耐受疾病；肾元充足，毒邪不能内伏。至于麻疹难出，以及已经发出而余热不退，喘促导致凶险的，占十分之四五。哪里想到现在，有人因为肾元亏损，不能升发送毒出表，而成内溃的占十分之三四处；有人因为疏表透毒太过，正气无力主持，任由药力猛烈，毒势锐利，冲激一涌而出。然而腠理未疏，气血两弱，怎么能周行于肢体！形体高耸而粗肥，色泽润泽华美，所以头面部位特别多的，是火毒炎上的缘故。其形态像麸皮或糠秕样的，是因为发热不久，腠理闭塞，俗话说是“地皮未熟”，而气虚无力透出，药毒猛烈追逐，是毒邪出表的象。其颜色像疹子或丹砂样的，是热毒逼灼而营气逆行于肌表。然而像麸皮糠秕一样的形态，就是身体中的气；像疹子丹砂一样的颜色，就是身体中的血。既然已经将气血赶出于肌表，又说是火毒炽盛，使用寒凉解毒、清胃化斑的方法，气血既不能在内部继续运行，寒凉药又在内部损伤胃气，想要不乘虚再次下陷，怎么可能呢！因此十个人中有七八个受伤。有人因为气血不充，调治不善，以致毒邪转化未完，血气先竭，因而致死的，占十分之五六。所有这些情况，都是因为禀受亏虚，所谓火与元气势不两立，元气虚而所胜的火毒更加旺盛了。至于疹病，一半因腑毒，一半属时行疫气，全关乎气血的浓薄来决定轻重，更依赖调治是否适宜来决定损益。古人禀赋浓厚，且饮食淡泊节制，腑毒原本轻微，所以容易透发也容易收回。今人饮食膏粱炙爆，寒暑失调，禀赋薄弱，受毒偏深，所以稍有传染势头便沉困，医者都遵循古法，全都当作有余之证来治，并且认为疹要清凉、痘要温补是定论，导致阳虚不能升发的，头面不起；阴虚不能退阳的，余热不退。阴气未全的弱质，怎么能承受久热的伤阴？以致昏沉不食，喘促烦躁，中气日渐虚弱。如果用疏表透托的风药，就会更加耗损其阴。如果用清肺解毒的凉药，就会徒然损伤其胃。一旦泄泻发生，上热下寒，喘促更加严重，又说是毒归肺，肆意进用苦寒药，危亡立刻到来！殊不知，气血不和，偏阴偏阳称为毒，能使气血调和，阴阳平衡，而毒邪自然化解。所以张景岳创立全真一气汤，去掉人参来治疗麻疹头面不起，壮热不食，喘促昏沉，上热下寒的候证，没有不有效的。其中用熟地为君药，是取养阴以化阳的意思。用白术、炒麦冬为佐药，一是为了托住中气，得以耐受疾病，一是为了清肺生水，更可制约肝木。用牛膝、五味子为引经药，是用牛膝来抑制浮阳之上壅，用五味子来收敛浊阴之下归。用制附子为使药，令其直达下焦，引导熟地以滋阴降火，引导麦冬、五味子以纳气藏源，真阴一旦得到滋养，焦烁顿除，气血一旦调和，阴阳自然舒适，该透发的透发，该收回的收回，喘促昏沉的凶险状貌，顿时瓦解。有人或许对附子的大热、白术的大燥、五味子的大敛感到怀疑，殊不知，附子没有干姜、肉桂就不热，同熟地等阴药配合，便能滋阴，降火最快。白术如果有熟地配合就不燥，熟地、麦冬等药如果没有白术在内，则药力小而软弱，况且中气缓弱，怎么能运化药物取得成功！附子通经达络，斩关夺旗，既有白术驾驭，又借五味子的酸敛，就能直固丹田，那阴翳之毒，有什么可忧虑的！附子的力量虽然大，但如果疏泄太过，则气散而不收，只有加上收敛，则疏泄通经的力量更大，就像严冬阳气闭藏固密，而后阳春的发生蕃茂，再加上火炮加工，使外皮坚固，药力内发有力，才能声震遐迩，以此攻毒，什么毒不能推倒！以此通经，什么经不能到达！以此降火，什么火不能潜藏！以此滋阴，什么阴不能生长！真是神功啊。更有向来患阴虚久嗽，寸脉强尺脉弱，麻疹隐伏，脉象适宜用地黄汤，而不适宜用疏表风药的，张景岳竟然照脉立方，用六味地黄丸加肉桂、五味子，不到两剂而疹透嗽减，神清思食，热退而痊愈。这就是前方内有附子的大力，而不虑五味子的小技，其道理相同。当时京城麻疹致死的，十分之四五，我总按脉用药，都以救阴救阳为主，而夭折枉死者从无一人，这确实是治疹法之外的遗存，所以不必以疹多实热、斑有假阳为定论，更不必以斑疹分治，只应当以虚实辨别。疹的虚证，就用治斑的方法来治疹；斑的实证，就用治疹的方法来治斑。至于痘疮初起，凡是属于肾元不足的，就应当按尺脉的阴阳亏损，固护天真以充实肾元，送毒出经，千万不要误用苦寒药以遏制热毒在内，便成内溃无法救治。至于外无风寒闭郁，及肥白皮细肉脆的婴儿，被重重豢养的子弟，千万不要重加疏表，以致正气无主，乘势奔溃而出。倘若腠理素虚，邪毒炽盛，不待药力而一齐涌出的，就应当乘其临时毒尽在表，其热其势，姑且在稍缓之时，此时五脏六腑，正在苟安之际，这时中间只有正虚乘势，急察阴阳的偏损，对脉填补，应犯而犯，似乎无犯，五六朝来，已有充灌成浆的条件了。若到了灌脓期限，火毒之势复炽，滋补之药，就多碍手难投，即滋补之功，也难骤于应手，我有求情论，专门详尽其义，在痘疹发热门，如此挽救，十人可以活一个。至于不能收靥还元的，不是气血不能在内部继续运行，就是脾胃失去了化源的根本。调理脾胃，补益真元，长养气血，元气胜而毒自然消弭，这是容易看到的道理。
确实如此！无形之真阴真阳，是做人的根本，而且治痘须察看人的元气，而不能凭借形质。我的第六个孩子干德，因为禀受母气不足，形体肥胖色白，肉多于骨，大便燥结，排便非常痛苦，不知情的人以为他脾胃壮实，这其实是肠中少津，所以大便燥结；肠中少气，所以大便艰难。而且在过岁之内，时常患病气从脐下直奔而上，咳嗽不止。或者用人参一钱，带衣胡桃一枚，同煎服而痊愈，后来用此法不效，于是用八味地黄丸加牛膝、五味子煎服很安稳，就以此做成丸药，每早用白开水化服一钱多。然而不耐疾病，反而生病最多，有时十天一次病，有时半个月一次病，病了就委顿不堪。我凡是审察他受寒发热，那是阳不足，就用辛温卫气之药来发散，加生姜、茯苓、白术、人参、紫苏、薄荷、肉桂之类。如受热发热，那是阴不足，就用辛润荣气之药来制胜，如养荣汤、地黄汤之类。如停滞发热，那是脾气不足，就在壮脾之中，佐以推扬谷气来化解它。如孤阳浮越而发热不已，必审察其因于脾虚的，用甘温来消除；因于阴中水虚的，壮水来制约；因于阴中火虚的，益火之源来消除。务必使壮火仍为少火，而归藏于中，断不要放纵其壮火力穷于外，因为病发有余之日，就是正气不足之时，如果仅仅从标症攻治，则正气不足，而药力更不足，虚者日虚，精神从哪里增长？所以这样调治以来，疾病渐少，精神渐生，只是肉多于骨，形体肥胖色白，这是得自先天。时常担心出痘必犯肾虚，有内溃的祸患，没想到将近两周，正当五月五日，身热汗多，烦躁殊甚，发热不到一天，就见点于天庭右太阳穴处，色白无光彩，摸之不碍手。我想攻之，恐怕一齐拥出；我想放任它，那么汗多身热，能不忧虑他那向来不足的肾阴，更加熬煎枯竭吗？况且肾阴一竭，则阴火愈旺而烦躁愈甚，壮火蚀气，则正气益虚，而困顿益增，痘将依靠什么来呈现真形华其色，而得到煦之濡之的作用呢！断不可以循常规治痘的方法来用了。所以第一天只用大料六味地黄汤加丹皮、柴胡，令乳母连服两剂，只使肾阴不竭，而煦濡有力，毒自然不能隐匿于肾。第二天痘虽渐见，已无内溃之虞，但痘色白与肉色无殊，身与四肢粗肥，而上隐隐如糠秕样，这是阴虚不能华色、阳虚不能上达，况且身热汗多，烦躁如故，而神气更疲，则阴津阳气，前柱于外，可不托住中气，填补真阴，滋其化源，抑此烦躁，敛其浮越之阳，以逐阴翳之毒，降其淆浊之气，以令清阳之升耶！所以用熟地六钱，炒白术二钱，牛膝二钱，炒燥苓冬一钱五分，五味子四分，极甜肉桂去尽粗皮者六分。服后壮热少减，溃汗少敛，烦躁少宁，痘疮陆续渐出了。第三天四肢甚是起泛，其头面虽见而不长，且色白与肉无殊。我思虑气血大虚，不言而喻。且元首见点未全，四肢便已起胀，囊有水色，这是脾元不足，肝肆强阳，四肢一松，元首见点，起胀更难了。况且将来水泡发痒，可以立而待也。于是用川芎、当归、茯苓、白术、炙甘草、桂心、天虫、角刺、煨姜、大枣为引，早晨服一剂不用人参的，晚间照此再服一剂，内加人参一钱多。所谓应犯而犯，似乎无犯，岂拘泥于古人人参戒用于三日之前的定论呢！第四天痘虽起而无神，其色白如故，只有以大补气血兼重脾元为主，其药用人参、黄芪、川芎、当归、茯苓、白术、桂心、炙甘草、天虫、甲片、角刺、煨姜、大枣为引。第五天形虽稍起而无神色，虽稍红而甚淡，药惟用人参、黄芪、当归、桂、炙甘草、天虫、甲片、角刺，补托而已。第六天形虽稍长，而晦滞，色虽淡红而枯燥，我思虑这原是先天真阴真阳不足，现在虽大补气血，尚不足以尽之，盖滋水兼得养血，养血兼不得滋水也，于是用熟地六钱以滋水，肉桂八分以补火，人参三钱以驾驭药力补助真元。第七天平足，水泡已甚，而面上枯槁不荣，其大便得来间日一次，甚干燥者，现在忽便溏二次，而失气甚频，则熟地补阴之功，缘中气甚虚，虽有参桂，不能运津液外达以成浆，而任其下陷之势，以失气便溏，则中气愈虚，能保其不泄泻无脓倒陷乎！于是用人参五钱以保元，白术二钱以固中，制附子六分以通经达络，溃坚腐脓，恐走下太速，用炙甘草六分以缓之，四味力大功专，中气赖以得充，津液凭斯外运，但欲宣扬鼓舞，使津液无为不达，乃桂枝之能欤，于是用三分以为使。如此一剂，将数日调养之精华，一夜头面身体尽化浓浆，而熟腐清水之泡，变为浓浊。但疼痛烦啼，于是煎生脉饮，以补接元气，养其酿浆之势，恐不耐痛苦，神气一伤，浆势反致退去也。八九十朝以来，惟早晚各用生脉饮一服化服，平时所服加味八味丸一钱多，乃根据部结痂，精神日长，饮食胜前，烦渴躁急，俱为全愈。如是善为调摄，痘后尚然手背浮肿，脚肿更甚，我思虑这因胃气甚虚，四肢无所禀受，其脚更肿者，气虚不能升举也。于是用人参一钱五分，炙黄芪一钱二分，炒白术二钱，茯苓一钱五分，炙甘草六分，酒炒当归一钱，酒炒白芍八分，蜜酒炒升麻柴胡各三分，煨姜大枣为引，煎服数剂，虚肿乃退，但爪甲色黄而燥，乃肝荣不足也。足痿不能立，此肾元大虚也。于是用六味地黄丸加地骨皮、建莲肉为丸；每日早服二钱，滋肝肾以助筋骨之用，日中以八珍糕养脾胃，以助化源之需。
我的长孙大业，禀赋先天阴分不足，而且平时酷嗜甜物果饼，而粥饭很少吃，以致脾虚湿热，大便素溏，外生疮疥，内蓄蛔虫。当时年五岁，当五月发热见痘，红紫而无润色，朝暮全不易眼，乃是久患疮疥，血少血热而且血滞也。无奈胃气久虚，湿热太重，一二三朝无非升托清解凉血，如升麻、干葛、蝉退、天虫、甘桔、牛蒡、生地、木通、紫草、笋尖之类，无奈谷气久虚，蛔虫大厥，腹痛呕吐，药亦难受，尺许之虫，一吐数条，愈吐愈虚，愈虚愈吐，粒米不进，势甚狼狈。五六朝来，只为温补攻托，以壮中虚倒陷，其药用人参、黄芪、炙甘草、当归、熟地、山药、甲片、角刺、肉桂、煨姜、大枣为引，无奈服后少顷亦吐。七八朝来，痘虽起胀，然上吐下泻而津液不能外达，痘囊何能湿润成浆？于是用人参五钱，白术三钱，炮姜一钱二分，炙草六分，附子八分，如此大药到口亦吐，我思虑药力虽大，下咽未能即达经络，可以吐出，惟烧酒入咽，即直透丹田，外达经络，不能吐出者，于是于药内加烧酒三匙服之，始能半吐半受内，仍泄泻不止，外仍干涸无脓，皆因脾元中气素虚，不能营运津液，以濡润百骸，而三焦肠胃之腠理，怫郁结滞致密，所以纵复多饮于中，终不能浸润于外，以致内湿外干也。于是用人参三钱保元以为君，炒白术二钱固中以为臣，炙甘草四分，缓其下行以为佐，麻黄去节汤泡酒浸炒焦黄八分，仗其轻扬之性，率领诸药外达皮肤，生附子六分，通经达络，溃坚腐脓，并以为使，煨姜三片，止呕和中，助阳达表以为引，如此一剂，驱肠胃湿热之气外达皮囊，而尽化为脓，久凝久滞之毒，一剂顿为瓦解，湿热既清，其蛔虫之久蓄于内者，亦难自安，前后共出一十六条，自后惟饮独参汤调理，饮食切戒甘肥，痂落之后，日进六味地黄丸二钱，而饮食精神，俱为倍长。
Ancient philosophers' prescriptions and theories, although comprehensively compiled in previous volumes, still contain discussions not covered and principles not fully expounded. Furthermore, ancient and modern times differ, and the transformation of Qi (vital energy) is vastly different. I have carefully listed recent observations, clinical treatment records, and flexible methods of medication application, disregarding my own limited knowledge, to supplement what has been omitted.
Where lesions first appear inside the ear auricle and are numerous, it belongs to the Kidney Meridian, indicating a severe ominous prognosis. If accompanied by symptoms such as lower back pain, death is certain. Where the brow ridge presents a dense, grayish-white patch, it inevitably leads to aphonia, choking, and inability to eat, with the outcome determined at ninety days (usually fatal). After eye closure, if tearing flows like pus without stopping, it inevitably transforms into a deteriorating condition that is untreatable; do not underestimate this. If eyes open after scabbing with redness, it is ominous. Where vomiting is severe and acneiform eruptions appear, the initial eruption will be abundant. For severe and malignant acneiform eruptions, if they suddenly show an eruptive trend, one must wait until the seventh or eighth day to ensure safety. By the seventh day, the Qi of the five Zang organs has circulated throughout the body. It is common for patients to die suddenly after two or three days of eruption due to the principle of mutual overcoming and recovery among the five Zang organs. The decline of Zheng Qi (Upright Qi) in one organ is necessarily caused by the excessive strength of Xie Qi (Pathogenic Qi) in another; when excess overcomes deficiency, both perish together, similar to the final flicker of a dying lamp, which is fire without roots, hence difficult to sustain. When toxin erupts at the medial malleolus of the foot, death is certain, as the toxin originates from the Kidney, manifesting at the Taixi (KI3) pulse location. When acneiform eruptions first begin, if white patches appear on the tongue first, it is ominous, indicating a deficiency of Yuan Yang (Primordial Yang) in the Dantian, leaving Qi without a root for generation. Alas! The Qi of the earth is becoming increasingly thin, and the Qi inherited by humans is also becoming increasingly deficient.
In Zhang Jingyue's youth, clinically, one or two out of ten cases of acne had difficulty erupting and led to internal collapse; two or three out of ten failed to fill with pus; four or five out of ten failed to resolve scabs and restore vitality. This was because people at that time had robust constitutions and could withstand disease; their Kidney Yuan was sufficient, preventing toxin from hiding internally. Regarding measles, one or two out of ten had difficulty erupting, and four or five out of ten had lingering residual heat leading to panting and ominous outcomes. However, nowadays, three or four out of ten cases suffer internal collapse due to Kidney Yuan deficiency failing to ascend and send toxin to the exterior; two or three out of ten suffer from excessive surface-releasing treatments where Zheng Qi lacks strength to control, allowing fierce medicinal power and sharp toxin force to surge out. Yet, with pores unopened and Qi and Blood weak, how can they circulate through the limbs? The body appears tall and bulky, with lustrous and beautiful coloration, especially on the head and face, due to Fire Toxin flaring upward. Forms resembling bran or chaff indicate short-term fever with closed pores; colloquially called "the ground skin not ripe," where Qi deficiency fails to push toxin out, but fierce medicinal pursuit forces it to the surface. Colors resembling macules or cinnabar indicate Heat Toxin burning and Ying Qi (Nutritive Qi) reversing onto the muscle surface. The bran-like form represents the body's Qi; the macule/cinnabar color represents the body's Blood. Having driven Qi and Blood to the surface, yet claiming Fire Toxin is excessive, and using cold-cooling detoxification and stomach-clearing methods, Qi and Blood cannot continue circulating internally, and cold medicines damage Stomach Qi internally. How can they not sink again due to deficiency? Thus, seven or eight out of ten are injured. Five or six out of ten die because Qi and Blood were insufficient, treatment was improper, toxin transformation was incomplete, and Qi and Blood exhausted prematurely. All these cases result from constitutional deficiency; Fire and Yuan Qi are incompatible. As Yuan Qi becomes deficient, the conquering Fire Toxin becomes even stronger. Measles are half due to Fu Organ toxins and half due to seasonal epidemics, depending on the thickness of Qi and Blood for severity, and relying on appropriate treatment for improvement. Ancients had thick constitutions, simple diets, and moderation, so Fu toxins were light, making eruption and resolution easy. Modern people consume rich foods, suffer from climate irregularities, have thin constitutions, and deep toxin accumulation, so slight contagion leads to severe debilitation. Physicians follow ancient methods, treating all as Excess patterns, believing measles require cooling and acne require warming. This causes Yang deficiency failing to ascend, leading to no eruption on the head/face; Yin deficiency failing to retreat Yang, leading to lingering residual heat. Weak constitutions with incomplete Yin cannot withstand prolonged heat damaging Yin, leading to lethargy, anorexia, panting, irritability, and daily depletion of Middle Qi. Using wind medicines for surface release consumes Yin further; using lung-clearing cold medicines damages Stomach Qi. Once diarrhea occurs, upper heat and lower cold worsen panting. Claiming toxin returns to the Lung and administering bitter-cold medicines leads to immediate danger. One must know that disharmony of Qi and Blood, whether biased toward Yin or Yang, constitutes Toxin. Harmonizing Qi and Blood and balancing Yin and Yang resolves the toxin. Therefore, Zhang Jingyue created Quan Zhen Yi Qi Tang (Complete True Single Qi Decoction), removing Ginseng to treat measles with no head/face eruption, high fever, anorexia, panting, lethargy, upper heat, and lower cold, achieving universal efficacy. Shu Di Huang (Prepared Rehmannia Root) is the Sovereign herb, nourishing Yin to transform Yang. Bai Zhu (Atractylodes Macrocephala Rhizome) and Chao Mai Dong (Fried Ophiopogon Tuber) are Assistant herbs: one supports Middle Qi to withstand disease, the other clears Lung water to generate fluids and controls Liver Wood. Niu Xi (Achyranthes Bidentata Root) and Wu Wei Zi (Schisandra Chinensis Fruit) are Guide herbs: Niu Xi suppresses floating Yang ascending, Wu Wei Zi gathers turbid Yin descending. Zhi Fu Zi (Prepared Aconite Lateral Root) is the Envoy herb, reaching the Lower Jiao directly, guiding Shu Di Huang to nourish Yin and descend fire, and guiding Mai Dong and Wu Wei Zi to grasp Qi and store its source. Once True Yin is nourished, scorched dryness is removed; once Qi and Blood harmonize, Yin and Yang become comfortable; eruption and resolution occur naturally, and ominous panting/lethargy disintegrates instantly. Some doubt the heat of Fu Zi, dryness of Bai Zhu, and astringency of Wu Wei Zi. However, Fu Zi is not hot without Ginger and Cinnamon; combined with Yin herbs like Shu Di Huang, it nourishes Yin and descends fire rapidly. Bai Zhu is not drying with Shu Di Huang; without Bai Zhu, Shu Di Huang and Mai Dong lack strength and softness. With weak Middle Qi, how can medicine succeed? Fu Zi penetrates meridians and collaterals, breaking barriers. Guided by Bai Zhu and aided by Wu Wei Zi's astringency, it secures the Dantian, making Yin-shading toxins negligible. Although Fu Zi is powerful, excessive dispersal scatters Qi. Adding astringents enhances its meridian-penetrating power, like winter storing Yang tightly for spring growth. Processed with fire, the outer shell hardens, internal power strengthens, resonating far and wide. With this, what toxin cannot be pushed away? What meridian cannot be reached? What fire cannot be stored? What Yin cannot grow? Truly miraculous. For chronic Yin deficiency cough with strong Cun pulse and weak Chi pulse, with hidden measles suitable for Di Huang Tang but not wind medicines, Zhang prescribed Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) plus Rou Gui (Cinnamon Bark) and Wu Wei Zi. Within two doses, measles erupted, cough decreased, spirit cleared, appetite returned, heat subsided, and recovery occurred. This matches the logic of using Fu Zi's power without fearing Wu Wei Zi's mildness. In the capital, four or five out of ten measles cases died. I always diagnosed by pulse and treated, focusing on saving Yin and Yang, with zero premature deaths. This is a lost method outside standard measles treatment. Do not fixate on measles being Excess-Heat or spots having false Yang; distinguish only by Deficiency and Excess. Treat Deficient measles with Spot-treatment methods; treat Excess spots with Measles-treatment methods. For early acne, if Kidney Yuan is insufficient, check Chi pulse for Yin/Yang deficiency, secure Tian Zhen (Heavenly Truth) to tonify Kidney Yuan, and send toxin out via meridians. Do not mistakenly use bitter-cold medicines to trap heat toxin internally, causing untreatable internal collapse. For infants with no external wind-cold closure, fat/white/delicate skin, or pampered children, do not heavily use surface-releasing medicines, causing Zheng Qi to lose control and toxin to burst out uncontrollably. If pores are inherently weak and toxin is fierce, surging out without medicinal aid, wait for the moment when toxin is entirely on the surface and organs are temporarily stable. Quickly examine Yin/Yang imbalance, tonify according to pulse, act decisively though appearing passive. By the fifth or sixth day, conditions for filling with pus will be ready. If entering the pus-filling stage, Fire Toxin reignites, making tonics difficult to administer. My "Qiu Qing Lun" discusses this in detail. Such rescue efforts save one in ten. Failure to resolve scabs and restore vitality results from either Qi/Blood failing to circulate internally or Spleen/Stomach losing their source of transformation. Regulating Spleen/Stomach, tonifying True Yuan, and nourishing Qi/Blood allows Yuan Qi to overcome toxin naturally.
Indeed, formless True Yin and True Yang are the root of human life. Treating acne requires observing Yuan Qi, not physical form. My sixth child, Gande, inherited insufficient maternal Qi, was fat/white with more flesh than bone, had dry constipation and painful defecation. Laypeople thought his Spleen/Stomach were strong, but he actually lacked intestinal fluids and Qi. He often experienced Qi rushing up from below the navel with incessant coughing within the first year. Using 1 qian of Ren Shen (Ginseng Root) and one whole Hu Tao (Walnut) decocted together cured him. Later, this failed, so Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia) plus Niu Xi and Wu Wei Zi worked well. Made into pills, taken with warm water each morning. He was prone to illness, getting sick every 10-15 days with severe debilitation. I diagnosed chills/fever as Yang deficiency, using acrid-warm Wei Qi medicines like Sheng Jiang (Fresh Ginger), Fu Ling (Poria), Bai Zhu, Ren Shen, Zi Su (Perilla Leaf), Bo He (Mint), and Rou Gui. Fever/heat was diagnosed as Yin deficiency, using acrid-moist Ying Qi medicines like Yang Rong Tang (Nourish Ying Decoction) or Di Huang Tang (Rehmannia Decoction). Stagnation fever was Spleen Qi deficiency, using Spleen-strengthening methods with grain-Qi promoting agents. Floating Yang fever was investigated: if Spleen deficiency, use sweet-warm; if Yin-water deficiency, strengthen Water; if Yin-fire deficiency, benefit Fire source. Ensure vigorous fire becomes mild fire and stores internally. Never let vigorous fire exhaust externally. Disease excess indicates Zheng Qi deficiency. Attacking symptoms alone depletes Zheng Qi further, worsening deficiency and hindering spirit growth. With this regulation, illnesses decreased, spirit grew. Fat/white constitution was congenital. Worried about Kidney deficiency causing internal collapse during acne eruption, near two weeks old on May 5th, he had fever, profuse sweating, severe irritability. Eruptions appeared on the right Taiyang area of the forehead within a day, white, lusterless, soft to touch. I feared aggressive treatment would cause mass eruption, but ignoring it risked exhausting his deficient Kidney Yin with sweat/heat. Exhausted Kidney Yin increases Yin fire and irritability; vigorous fire consumes Qi, increasing weakness. How can acne show true form/color without nourishment? Standard methods were unsuitable. Day 1: Large dose Liu Wei Di Huang Wan plus Dan Pi (Moutan Bark) and Chai Hu (Bupleurum Root), administered to the wet nurse for two doses, to preserve Kidney Yin and nourish toxin. Day 2: Eruptions visible, no internal collapse risk, but white like flesh, limbs bulky, faint bran-like texture. Yin deficiency failing to color, Yang deficiency failing to ascend. Sweat/heat/irritability persisted, spirit tired. Tonify Middle Qi, fill True Yin, nourish source, calm irritability, gather floating Yang, dispel Yin-shading toxin, descend turbid Qi, ascend clear Yang. Prescription: Shu Di Huang 6 qian, Chao Bai Zhu 2 qian, Niu Xi 2 qian, Chao Ling/Mai Dong 1.5 qian, Wu Wei Zi 4 fen, pure Rou Gui 6 fen. Fever/sweat/irritability reduced, eruptions emerged gradually. Day 3: Limbs rising well, head/face slow, white like flesh. Qi/Blood severely deficient. Head points incomplete, limbs swelling with fluid. Spleen Yuan deficient, Liver Yang rampant. Limb relaxation makes head eruption harder. Vesicles/itching imminent. Prescription: Xiong Gui (Ligusticum/Saussurea), Dang Gui (Angelica Sinensis), Fu Ling, Bai Zhu, Zhi Gan Cao (Honey-fried Licorice), Gui Xin (Cinnamon Heart), Tian Chong (Silkworm), Jiao Ci (Hedgehog Spine), Wei Jiang (Baked Ginger), Da Zao (Jujube) as guide. Morning dose: No Ren Shen. Evening dose: Add Ren Shen >1 qian. Act decisively despite appearances, ignoring ancient taboos against Ginseng before day three. Day 4: Eruptions rose but lacked spirit, white as before. Major Qi/Blood tonification focusing on Spleen Yuan. Prescription: Ren Shen, Huang Qi (Astragalus Root), Xiong Gui, Dang Gui, Fu Ling, Bai Zhu, Gui Xin, Zhi Gan Cao, Tian Chong, Jia Pian (Tortoise Plastron), Jiao Ci, Wei Jiang, Da Zao. Day 5: Slight rise, dull color, pale red. Tonification/support only. Prescription: Ren Shen, Huang Qi, Dang Gui, Gui, Zhi Gan Cao, Tian Chong, Jia Pian, Jiao Ci. Day 6: Slight growth, dull, pale dry red. Congenital True Yin/Yang deficiency. Tonifying Qi/Blood insufficient. Nourish Water and nourish Blood simultaneously. Prescription: Shu Di Huang 6 qian to nourish Water, Rou Gui 8 fen to tonify Fire, Ren Shen 3 qian to drive medicine and support True Yuan. Day 7: Flat feet, vesicles severe, face withered. Intermittent dry stools now frequent loose stools/farting. Shu Di Huang's Yin-nourishing effect failed due to weak Middle Qi; Ren Shen/Gui couldn't transport fluids to form pus. Risk of sinking/diarrhea/no pus. Prescription: Ren Shen 5 qian to protect Yuan, Bai Zhu 2 qian to secure Middle, Zhi Fu Zi 6 fen to penetrate meridians/soften hardness/pus, Zhi Gan Cao 6 fen to slow descent. Four herbs strongly tonify Middle Qi and transport fluids. Add Gui Zhi (Cinnamon Twig) 3 fen to encourage fluid distribution. One dose transformed days of essence into thick pus overnight, turning watery blisters into thick turbid fluid. Pain/crying managed with Sheng Mai Yin (Generate Pulse Drink) to connect Yuan Qi and nurture pus formation, preventing spirit damage from pain. Days 8-10: Sheng Mai Yin morning/evening, plus modified Ba Wei Wan pills daily. Scabs formed, spirit/food intake improved, irritability/thirst resolved. Post-acne hand/foot edema due to weak Stomach Qi failing to nourish limbs and Yang failing to lift. Prescription: Ren Shen 1.5 qian, Zhi Huang Qi 1.2 qian, Chao Bai Zhu 2 qian, Fu Ling 1.5 qian, Zhi Gan Cao 6 fen, Jiu Chao Dang Gui 1 qian, Jiu Chao Bai Shao (White Peony Root) 8 fen, Mi Jiu Chao Sheng Ma (Cimicifuga) & Chai Hu 3 fen each, Wei Jiang/Da Zao guide. Edema resolved. Yellow/dry nails indicated Ying deficiency of Liver. Leg weakness indicated severe Kidney Yuan deficiency. Prescription: Liu Wei Di Huang Wan plus Di Gu Pi (Lycium Bark) and Jian Lian Rou (Lotus Seed) pills, 2 qian morning, to nourish Liver/Kidney for sinews/bones. Daytime: Ba Zhen Gao (Eight-Treasure Cake) to nourish Spleen/Stomach/source.
My eldest grandson, Daye, had congenital Yin deficiency, loved sweets/snacks, ate little porridge/rice, leading to Spleen deficiency with damp-heat, chronic loose stools, external sores/scabies, internal roundworms. Age five, May fever/acne, red-purple without luster, eyes stuck shut day/night due to long-term sores causing blood deficiency, heat, and stasis. Stomach Qi long deficient, damp-heat heavy. Days 1-3: Ascending/supporting, clearing, cooling, blood-cooling herbs like Sheng Ma (Cimicifuga), Ge Gen (Kudzu Root), Chan Tui (Cicada Slough), Tian Chong, Gan/Jie (Licorice/Fritillaria), Niu Bang (Burdock), Sheng Di (Rehmannia), Mu Tong (Akebia), Zi Cao (Arnebia), Sun Jian (Bamboo Shoot Tip). Grain Qi deficient, roundworm rebellion, abdominal pain/vomiting, unable to keep medicine down. Foot-long worms vomited repeatedly, worsening deficiency/vomiting cycle, anorexia, desperate situation. Days 5-6: Warm-tonifying/supporting to strengthen Middle deficiency/prevent collapse. Prescription: Ren Shen, Huang Qi, Zhi Gan Cao, Dang Gui, Shu Di Huang, Shan Yao (Dioscorea), Jia Pian, Jiao Ci, Rou Gui, Wei Jiang, Da Zao. Vomited shortly after ingestion. Days 7-8: Eruptions rose/swelled, but vomiting/diarrhea prevented fluid transport, blisters couldn't moisten/form pus. Prescription: Ren Shen 5 qian, Bai Zhu 3 qian, Pao Jiang (Roasted Ginger) 1.2 qian, Zhi Gan Cao 6 fen, Fu Zi 8 fen. Even large doses vomited. Medicine didn't reach meridians quickly enough. Added 3 spoons of Sha Jiu (Burning Wine) to penetrate Dantian/meridians immediately, preventing vomiting. Half absorbed, half vomited. Diarrhea continued, exterior dry/no pus. Spleen/Middle Qi inherently weak, failing to transport fluids to moisten body, Three Jiao/intestine pores congested/dense. Internal dampness, external dryness. Prescription: Ren Shen 3 qian (Sovereign, protect Yuan), Chao Bai Zhu 2 qian (Minister, secure Middle), Zhi Gan Cao 4 fen (Assistant, slow descent), Ma Huang (Ephedra Stem) processed with wine/fire 8 fen (Guide, light/yang nature leads medicine to skin), Sheng Fu Zi (Raw Aconite) 6 fen (Envoy, penetrates meridians/softens hardness/pus), Wei Jiang 3 slices (Guide, stops vomiting/middle harmonizes/Yang reaches surface). One dose expelled damp-heat from intestines to skin, converted to pus, dissolved stagnant toxin. Clearing damp-heat made internal roundworms uneasy; 16 expelled total. Afterwards: Du Shen Tang (Single Ginseng Decoction) for regulation, avoid sweet/greasy food. After scab fall: Liu Wei Di Huang Wan 2 qian daily. Food/spirit doubled.