血热一症，须分虚实。有血虚之血热，宜凉宜补。血盛之血热，宜凉宜治。古人未
之悉，何也？凡痘初见点，内热殊甚，脉息洪数，而痘色则白，不知者认为气虚则误
矣。此乃气盛血虚血热，故不能华色，以同毒出外，气余而血不足，故形起而色白也。
然血虚则热，故发至血入痘窠，三四朝来，皆变紫色黑色，或见黑斑，方知血热，欲治
何及！故不可不知，及不可不预为地步。惟血旺者，则起势便紫，了然血热之症分明，
然治血虚之血热症，大宜凉血兼补血，盖此症常多热势虽清，无血贯浆而成干陷。惟血
旺之血热者，则大宜独与凉血，而用治之之法，其凉血剂中，尤宜升托，否则血凝毒滞
矣。至于气虚兼血热者，则血热易于干紫，故凉血法所必宜。而气虚又难鼎峻，故攻托
尤宜倍常，但六日前血热症犹在，尚有火势，其症似实，治至血热渐清，则症日复渐
虚，而且日复渐寒，泄泻寒战，势必所至，故始惟宜清托，迨至看来血热之势，退一
分，即须与气虚之症做一分地步矣。凡有伤脾动气之品，不可徒顾日前而用，一至血热
将清，气虚已甚者，便宜凉血剂中佐以人参补托，尤须用药配治为妙，可急则急，可缓
则缓，在人之神巧，得之于心，应之于手，太早则助热为殃，略迟则补虚不及，每有直
至寒战泄泻并见，投以补剂，无如服后即泻，泻后又服，药力难停于中，功效难应于
手，此迟滞者之罪也。复有血热稍清，气虚未甚，荣卫方和，才有白色行浆之势，治者
即用参 峻补，以致反生热势，内则咽疼音哑，外则干红倒塌，此太早者之罪也。故凡
治者，于气虚兼血热症候，在清托药宜已，补托药应投之际，大宜审究，稍有太过不
及。便有死生两路，至于人大气虚，痘密毒多。血热势清而气虚则甚者，若应大用参
，便每日人参两许。亦为常法，但必兼以托里，如天虫，角刺之类，或佐姜，桂鼓舞
之功，方可从毒外走而痘得充灌之益。否则，补中固宜，而外达则缓，如应大用参、
，持疑减少，则正不胜邪，焉能抵当其毒，服药后虽暂有应验，但力薄难久，少顷
则平塌如故，不过延缓时日，焉能化毒成功？故元气少虚者，参、 虽少。正气自能
协运药力而周行以见功者，元气大虚者，无力帮扶，全赖参 势大，再得姜桂鼓舞，方
能营运获效，所以有少则壅滞之语也。此张心诚求之之法，敢笔于后，以补所遗，若气
虚而肺火旺者，用参勿用 可也。
蒋老先生之令孙女，年方半周，才热半日而即见痘，面色向来 白，余早料其出
痘，当必细密浆清者也。果至见点，不但稠密无隙，其胸背手足之间，如 窠形蛇皮段
者，不一而足，面上之痘，方及三朝，干枯灰白，背项之痘，紫陷不荣，要知元气既弱
而且滞，荣血不能从气以宣行，故面似气虚，身如血热，实因气血不能周流，所以滞
而为紫，根窠平塌散漫，实皆气虚所致，乃立进温补充托，早晨午后各一剂，人参各四
钱，冲药服之，晚间另煎人参三钱，浓汁单服，其药不过芎、归、 、桂、天虫、角
刺、山药、炙草之类，自四朝以至七八朝，峻补毫不少缓，平塌者，渐至高耸，枯陷
者，渐至润泽，清淡者渐至浓浓，其为蛇皮 巢之处，变成水泡溃烂而已。此治气血大
虚血凝气滞而似血热之药按也。
一儿年五岁，大便素溏，饮食素少，且素内热而生疮疥，一日发热甚吐，乃延余
视，右额有贼痘两日矣。即挑破用油胭脂封之，更兼呛嗽殊甚，发表药内，倍加清利咽
喉，至次日见点，色甚红紫，仍用利咽表托凉血，次日红紫不减，而头面身体俱甚密，
顶甚平陷，乃以前方倍加透托，至四日红紫略减，平陷如故，可喜者声清不痛，此清利
之妙也。至五日顶原不甚起，紫色原不退，欲全催浆、血热为碍，欲再凉血，恐气虚之
症，易见泄泻，乃于透托之中，而半清半补以催浆，至六日形色如故，乃用前方冲入人
参服之，至次日空虚，又出无数赠痘，前痘顶带白色，但根脚原紫，乃用前方倍用人
参，始乃渐渐有浆一二分，至八九日泄泻切牙，痘色灰白，此血热稍清，而气虚症已全
见矣。乃用保元汤加姜桂，而泄泻切牙俱止，但浆色原如是，至次日往视，已有靥者
矣。此因气虚血热兼血虚，且又密甚，则浆无由而成，幸赠痘一来，毒势少泄，且起势
便与清利，故始虽即呛嗽音哑，而灌脓幸无喉痛难食之患。且每见气虚兼血热者，五六
日际，血热少解，气虚尤甚，泄泻灰白倒塌，势所必至，此时用参，一泻竟过，则参
力无益，故早为地步。凡动气伤脾之味，素勿敢投，透托助脾之药，早已为用，至如血
热虽未清，而气虚已要紧，则人参原用，紫草亦投，犹恐紫草之寒，倍加粘米之制，谨
慎扶来，今浆虽清淡，然痘出无空地，且素患疮疥血少，难以成浆，但毒已外出，故能
食而不腹胀，神清而不喘促，当尽力调补，使中气不馁，十二日外气血少复，自能祛成
痈，毒无容地，自寻外窍而出矣。果至十五日发一大痈于头顶，乃毒有定位可补托矣，若
不补托，则痘疤即白，不能抵当其毒，于是外用吸毒膏药，使毒高耸易脓，傍用围
药，使不致毒瓦斯散漫，溃伤肌肉，内服补托解毒之剂，三十日而脓始尽，靥方脱完，疤
竟红活而全愈。此治血少血热，兼气虚逆痘之药按也。
一王姓几年岁余患痘，四朝延予视，痘虽四朝，窠粒大起，且天庭一片如云，糊涂
灰白，舌有白苔，子曰此痘毒未经传出，寒伏丹田，大宜升提透托，一剂而起，二剂红
活、三剂后而颧骨身体，俱有浆来，但天庭一片灰白如故，乃用参、 、炙草、官桂之
类，始得鼎峻成脓，收靥而愈。若是则云掩天庭，虽为死症，亦不可尽弃也。此治气虚
逆症变顺，侥幸成功者之药按也。
部主政徐老先生之令玄孙，未及一周，而患痘甚密，颧骨形若蚕种，色似胭脂，咳
嗽便溏，精神甚弱，且向生疮疥，气血两虚，更为逆候。奈主人谆谆求治，余乃重用
凉血养血透托之药，三四朝来，红紫少减，而颧骨已有干枯者矣。余曰∶此痘大多，而
血甚少，无以为充灌之用，势难成浆，毒人何解？内攻之祸，理所必至；惟尽吾力，与
毒相争，毒欲内攻，竭力以抵托之，气血欲尽，竭力以补接之，气血得继生于后，痘疮
自无黑靥于表，脏腑之气得生发于中，火毒之邪可消解于外，勿少有疏虞，致毒乘隙内
袭，乃重用滋补充托，日服二剂，每剂人参五钱，倘大便一次，必另煎人参三钱单服，
其药如炒干熟地、山药、角刺、天虫、人参、黄 、炙草，后加肉桂，六七日后，白
如锡片者，变黄色而少润；薄靥贴肉者，渐高耸而成浓痂，颧骨地阁之痘从未有浆者，
至八九日来，靥如石榴，高浓光彩，抑人参无形，生出有形之功欤，十二日外元气少复
驱毒外达，为溃疮，为痈疽，为口疳，乃随症施治。两月方能全愈，彭令亲深明医理，
日同诊视，常曰∶此非治痘，乃做痘也。此气血两虚之逆痘峻补挽回者之药按也。
一朱姓儿年九岁，发热如烙，口臭斑紫腰疼，痘则密如蚕种，顶陷而紫，真血热而
兼真气虚也。余用大剂透托，清凉化斑之剂，如天虫、穿山甲、丹皮、生地、红花、玄
参、粘子、川芎、羚羊角、桔梗、陈皮、甘草之类，以地龙煎汤，加笋尖三个。紫草五钱，痘既
出齐。原用前方加减，更入酒炒黄连五分，清凉攻托。至四五朝来，火势少解，乃去黄连，只用
前方加减。六朝血热稍清，泄泻随作，但毒因峻药托住，故不陷伏。余曰∶今可用力而有生
机矣。盖此症虽有十分气虚，而兼有十分血热，设火症一日未清，而补药一日难服，实为碍手，
既难投补，则此十分之气虚，何以图治？今泄泻一来，虚症纯见，大补之药，便可斗胆无虑
矣。但向患肺热，而有咽痛音哑呛嗽之症。故黄 不可，惟倍用人参，及扶脾清肺托浆
之药，早晚各服一剂，每剂人参五钱。九朝浆半灌而水泡居多，有如汤泡火烧之状，因
痘细密如蛇皮，而无空地，兼禀气又薄，血少气虚，不能周灌，所以皮囊连患清水成
泡，乃仍用补托，兼为实脾，使气血以渐而生，余毒自消化于外，果至十三日痘作溃烂
大臭，乃取松花外掺，内服补托解毒健脾，渗水之剂，渐得干靥，实同脱壳，此诚大危
之症，峻攻峻补，以挽回者也。此治真血热真气虚之逆症，而峻攻峻补挽回者之药按也。
旧治药按甚多，姑举数条，以证气虚血热危症之治，按有症候雷同，或按论
少略不能宣明病情者，俱置勿录。
血热这一病症，必须区分虚证和实证。有因血虚导致的血热，治疗宜用凉血兼补血的方法；有因血盛导致的血热，治疗宜用凉血兼清解的方法。古人对此没有完全阐明，为什么呢？凡是痘疮刚出现红点时，体内热势非常严重，脉象洪大而数，但痘色却是白色的。不了解情况的人误认为是气虚，这就错了。这其实是气盛而血虚、血热的表现，所以痘色不能红润，无法与毒邪一同透出体表。因为气有余而血不足，所以痘形隆起但颜色发白。然而，血虚则生热，所以当痘疮发展至血液进入痘窠（痘根），经过三四天后，都会变成紫色或黑色，或者出现黑斑，这时才知道是血热，想要治疗已经来不及了！所以必须事先知晓，并提前做好准备。只有那些气血旺盛的人，痘疮起势时就呈现紫色，这样血热的症状就十分明显。但是，治疗因血虚导致的血热症，非常适宜采用凉血兼补血的方法，因为这种病症常常表现为虽然热势已清，但因无血充盈痘浆而导致干陷。而对于气血旺盛的血热症，则非常适宜单独使用凉血法，并配合透托的治疗方法，如果在凉血剂中不加入升提透托的药物，就会导致血液凝滞、毒邪滞留。至于气虚兼有血热的情况，那么血热容易发展为干枯紫暗，所以凉血法是必须的。而气虚又难以承受峻猛的攻托药物，所以透托的力度应加倍谨慎。但在六天之前，血热的症状仍然存在，还有火势，症状看似实证，治疗到血热逐渐清除后，症状就会一天比一天显得虚弱，而且一天比一天更寒，出现泄泻、寒战等症状是必然的趋势。所以起初只宜采用清托法，等到看来血热的势头退去一分，就必须针对气虚的症状做相应的准备。凡是伤脾耗气的药物，不可只顾眼前的病情而使用，一旦血热将清，气虚已经很严重时，就应当在凉血剂中佐以人参进行补托，用药配伍调理最为巧妙，该急则急，该缓则缓，全凭医生的神巧，心得手应。太早使用补药会助热为害，稍微延迟则补虚不及，常常出现直到寒战泄泻并见时，才投用补剂，结果服药后立即腹泻，泻后再服，药力难以停留在中焦，功效难以发挥，这是用药迟滞者的过错。又有血热稍清，气虚尚不严重，营卫刚刚调和，刚有白色行浆的趋势，医生就用参茸等药峻补，以致反而产生热势，内则咽喉疼痛声音嘶哑，外则痘疮干枯红赤塌陷，这是用药过早者的过错。所以凡是在治疗气虚兼血热症候时，在清托药应该停止、补托药应该投入的时机，非常需要仔细审察研究，稍有太过或不及，就有生死两条路可走。至于人体大气极度虚弱，痘疮密集毒邪多，血热势头已清但气虚很严重的，如果应当大用人参，每天用人参一两左右，也是常法，但必须兼用托里药物，如僵蚕、皂角刺之类，或者佐以生姜、肉桂鼓舞阳气之功，才能使毒邪从外排出，痘疮得到充灌的益处。否则，补益固然是适宜的，但向外透达的速度就会缓慢，如果应当大用人参却犹豫减少用量，则正气不胜邪气，怎么能抵挡住毒邪呢？服药后虽然暂时有效，但药力薄弱难以持久，一会儿后又恢复平塌如故，不过是延缓时日，怎么能化解毒邪取得成功呢？所以元气轻微虚弱的，人参、黄芪即使量少，正气自然能协助运化药力而周行见效；元气大虚的，无力帮扶，全靠人参、黄芪气势宏大，再得姜桂鼓舞，才能营运获效，所以说“少则壅滞”。这是张心诚探求的方法，敢记录在后面，以补充遗漏。如果是气虚而肺火旺的，用人参而不用黄芪就可以了。
蒋老先生的孙女，年龄刚满周岁，发热半天就见到痘疮，面色向来苍白，我早就预料她出痘，必定细密且浆液清稀。果然到了见点的时候，不但稠密无缝隙，其胸背手足之间，像窠形蛇皮段一样的，不计其数。面上的痘疮，刚过三天，就干枯灰白；背项部的痘疮，紫暗凹陷不荣润。要知道元气既弱而且滞涩，营血不能随气宣行，所以面部似气虚，身体像血热，实则是气血不能周流，所以滞涩而变紫，根窠平塌散漫，实在都是气虚所致。于是立即进服温补充托之药，早晨午后各一剂，每剂人参四钱，冲药服用；晚间另煎人参三钱，浓汁单独服用。药物不过是川芎、当归、黄芪、肉桂、僵蚕、皂角刺、山药、炙甘草之类。从第四天到第七八天，峻补毫不松懈，平塌的渐渐高耸，干枯凹陷的渐渐润泽，清淡的渐渐浓稠，那些像蛇皮巢穴的地方，变成了水泡溃烂而已。这是治疗气血大虚、血凝气滞而类似血热症的医案。
一个五岁的孩子，大便向来稀溏，饮食向来很少，而且素来内热而生疮疥。一天发热严重并呕吐，于是请我去诊治。右额头已有贼痘两天了。随即挑破并用油胭脂封贴，再加上呛咳非常严重，在发表药中加倍加入清利咽喉的药物。到第二天见点，颜色很红紫，仍然用利咽表托凉血的方法。第二天红紫不减，而头面身体都很密集，痘顶很平陷。于是用前方加倍增加透托之力。到第四天红紫略减，平陷依旧，可喜的是声音清脆不痛，这是清利药物的妙处。到第五天痘顶原本就不怎么起，紫色原本不退，想完全催浆，血热成为阻碍；想再凉血，恐怕气虚的症状容易出现泄泻。于是在透托之中，半清半补以催浆。到第六天形色依旧，于是用前方冲入人参服用。到第二天空虚处，又长出无数赠痘（继发痘），前痘顶部带白色，但根部原为紫色。于是用前方倍加人参，才开始渐渐有一二分浆液。到第八九日出现泄泻、切牙（咬牙），痘色灰白，这是血热稍清，而气虚症状完全显现了。于是用保元汤加生姜、肉桂，泄泻和切牙都停止了，但浆色原本如此。到第二天再去查看，已经有结痂的了。这是因为气虚血热兼血虚，而且痘疮很密，所以浆液无从形成。幸好赠痘一出，毒势稍微宣泄，而且起势就给予清利，所以开始虽然有呛咳声音嘶哑，但灌脓时幸亏没有喉痛难食的祸患。而且常见气虚兼血热的情况，在五六天时，血热稍解，气虚尤其严重，出现泄泻、灰白倒塌，是必然的趋势。此时用人参，如果一泻而过，则人参的药力就没有益处，所以要早做准备。凡是动气伤脾的味道，素来不敢投用，透托助脾的药物，早已使用。至于血热虽未清，但气虚已经很紧急，则人参原方使用，紫草也投用，还担心紫草的寒性，加倍加入粘米（糯米）来制约，谨慎扶持。现在浆液虽然清淡，但痘出无空地，而且素患疮疥血少，难以成浆，但毒已外出，所以能进食而不腹胀，神志清醒而不喘促。应当尽力调补，使中气不馁，十二日外气血稍微恢复，自然能祛毒成痈，毒无容身之地，自然寻找外窍而出。果然到第十五天在头顶发出一个大痈，这是毒有定位可以补托了。如果不补托，则痘疤即白，不能抵挡毒邪。于是外用吸毒膏药，使毒高耸易脓，旁边用围药，使毒瓦斯不散漫，溃伤肌肉。内服补托解毒之剂，三十日脓才排尽，痂才脱完，疤痕竟红活而痊愈。这是治疗血少血热、兼气虚逆痘的医案。
一个姓王的儿童，一岁多患痘，第四天请我去看。痘虽过了四天，但痘窠颗粒大起，而且天庭一片如云，糊涂灰白。舌上有白苔。我说此痘毒未经传出，寒伏丹田，非常适宜升提透托。一剂后痘起，二剂后红活，三剂后颧骨身体都有浆液来，但天庭一片灰白依旧。于是用人参、黄芪、炙甘草、官桂之类，才得以峻补成脓，收靥而愈。像这样云掩天庭，虽然是死症，也不可完全放弃。这是治疗气虚逆症变顺，侥幸成功的医案。
部主政徐老先生的曾孙，未满一周岁，患痘很密，颧骨形状像蚕种，颜色像胭脂，咳嗽便溏，精神很弱，而且向来生疮疥，气血两虚，更是逆候。无奈主人恳切求治，我便重用凉血养血透托的药物。三四天后，红紫稍减，而颧骨已有干枯的了。我说：这痘大多，而血甚少，没有用来充灌的物质，势难成浆，毒入体内如何解脱？内攻的祸患，理所必至；只有尽我的力量，与毒相争，毒欲内攻，竭力抵托它，气血欲尽，竭力补接它，气血得以继生于后，痘疮自然没有在表面黑靥，脏腑之气得以生发于中，火毒之邪可消解于外，不要稍有疏忽，致使毒邪乘隙内袭。于是重用滋补充托，每天服两剂，每剂人参五钱。如果大便一次，必另煎人参三钱单独服用。药物如炒干熟地、山药、皂角刺、僵蚕、人参、黄芪、炙甘草，后来加入肉桂。六七日后，白如锡片的，变成黄色而少润；薄靥贴肉的，渐渐高耸而成浓痂；颧骨地阁从未有浆的痘，到第八九天，痂如石榴，高浓光彩。难道是人参无形中生出了有形之功吗？十二日外元气稍复，驱毒外达，化为溃疮、痈疽、口疳，乃随症施治。两个月才能痊愈。彭令亲深明医理，每天同诊视，常说：这不是治痘，是做痘啊。这是气血两虚之逆痘峻补挽回的医案。
一个姓朱的儿童，九岁，发热如火烙，口臭斑紫腰疼，痘则密如蚕种，顶陷而紫，真是血热而兼真气虚。我用大剂透托、清凉化斑的药剂，如僵蚕、穿山甲、丹皮、生地、红花、玄参、粘子、川芎、羚羊角、桔梗、陈皮、甘草之类，用地龙煎汤，加笋尖三个、紫草五钱。痘既出齐，原用前方加减，更加入酒炒黄连五分，清凉攻托。到第四五天，火势稍解，于是去掉黄连，只用前方加减。第六天血热稍清，泄泻随之发作，但毒因峻药托住，所以不陷伏。我说：现在可用力而有生机了。因为这个症虽有十分气虚，而兼有十分血热，设若火症一日未清，而补药一日难服，实为碍手。既然难投补药，那么这十分的气虚，何以图治？现在泄泻一来，虚症纯见，大补之药，便可斗胆无虑了。但他向来患肺热，而有咽痛音哑呛咳的症状。所以黄芪不可用，惟独倍加人参，以及扶脾清肺托浆的药物，早晚各服一剂，每剂人参五钱。第九天浆液半灌而水泡居多，有如汤泡火烧之状，因为痘细密如蛇皮，而无空地，兼禀气又薄，血少气虚，不能周灌，所以皮囊连患清水成泡。于是仍用补托，兼为实脾，使气血以渐而生，余毒自消化于外。果然到第十三天痘作溃烂大臭，于是取松花外掺，内服补托解毒健脾渗水之剂，渐渐得干靥，实同脱壳。这诚然是大危之症，峻攻峻补以挽回的医案。这是治疗真血热真气虚之逆症，而峻攻峻补挽回的医案。
The syndrome of Blood Heat must be differentiated into deficiency and excess. There is Blood Heat caused by Blood Deficiency, which should be treated with cooling and tonifying methods; there is Blood Heat caused by Blood Excess, which should be treated with cooling and resolving methods. Why did the ancients not fully elucidate this? When pustules first appear as red spots, the internal heat is extremely severe, and the pulse is surging and rapid, yet the color of the pustules is white. Those who do not understand may mistakenly attribute this to Qi Deficiency. This is actually a condition of Qi Excess combined with Blood Deficiency and Blood Heat, so the pustules cannot become ruddy and fail to expel the toxin outward together. Because Qi is in surplus while Blood is insufficient, the pustule shape rises but the color is white. However, Blood Deficiency generates Heat. Therefore, when the disease progresses to the stage where blood enters the pustule base (douke) and after three or four days, the color changes to purple or black, or black spots appear, one then realizes it is Blood Heat, but it is too late to treat! Thus, one must know this in advance and prepare accordingly. Only those with robust Blood and Qi will have pustules that rise with a purple hue from the onset, making the symptoms of Blood Heat clear. However, for treating Blood Heat due to Blood Deficiency, it is highly appropriate to use cooling blood methods combined with blood tonification. This is because such cases often present with cleared heat potential, but without sufficient blood to fill the pustule pulp, leading to dry collapse. For Blood Heat due to robust Blood and Qi, it is highly appropriate to use solely cooling blood methods combined with resolution techniques. In cooling blood formulas, it is especially important to include lifting and promoting agents; otherwise, blood coagulation and toxin stagnation will occur. As for conditions of Qi Deficiency combined with Blood Heat, Blood Heat easily leads to dry purple discoloration, so cooling blood methods are essential. Yet, Qi Deficiency makes it difficult to tolerate harsh attacking and promoting drugs, so the intensity of promoting agents should be doubled with caution. Before the sixth day, if Blood Heat symptoms persist and fire energy remains, the presentation may seem like an Excess syndrome. As treatment clears the Blood Heat, the symptoms will gradually appear more deficient and colder day by day, inevitably leading to diarrhea and chills. Therefore, initially, only clearing and promoting methods are suitable. Once the trend of Blood Heat recedes by even a fraction, one must immediately prepare for the Qi Deficiency aspect. One must not blindly use herbs that damage the Spleen and deplete Qi just because they were used previously. Once Blood Heat is about to clear and Qi Deficiency becomes severe, it is best to add Ginseng (Renshen) to the cooling blood formula for tonification and promotion. The skillful combination of medicines is crucial: act urgently when needed, slowly when appropriate. This depends on the physician's acuity, derived from the mind and applied by the hand. Acting too early aids heat and causes disaster; acting slightly late fails to tonify deficiency adequately. It often happens that by the time chills and diarrhea appear simultaneously, tonics are administered, but the patient suffers immediate diarrhea after ingestion. Repeated dosing fails to retain the medicinal power in the middle jiao, rendering efficacy ineffective; this is the fault of delayed action. Conversely, when Blood Heat is slightly cleared and Qi Deficiency is not yet severe, and Ying-Wei (Nutritive and Defensive Qi) are harmonizing, showing signs of white pus formation, if the physician uses heavy tonics like Ginseng and Deer Antler (Lurong) too soon, it may generate heat internally, causing sore throat and hoarseness, and externally causing dry, red, collapsed pustules; this is the fault of acting too early. Therefore, when treating Qi Deficiency combined with Blood Heat, at the juncture where clearing-promoting herbs should cease and tonifying-promoting herbs should begin, careful examination is vital. Any excess or insufficiency can lead to life or death. For patients with severe systemic Qi Deficiency, dense pustules, and abundant toxins, where Blood Heat has cleared but Qi Deficiency is severe, if large doses of Ginseng are indicated, using approximately one tael per day is standard practice. However, this must be combined with interior-promoting herbs like Bombyx Batryticatus (Tianchong) and Gleditsia Sinensis Spine (Jiaoci), or supplemented with Ginger (Shengjiang) and Cinnamon Twig (Guizhi) to encourage function, allowing toxins to exit outward and pustules to fill properly. Otherwise, while internal tonification is correct, external expulsion will be slow. If one hesitates and reduces the dose of Ginseng when large amounts are needed, righteous Qi cannot overcome pathogenic factors, nor can it withstand the toxin. Although there may be temporary response after medication, the weak potency cannot last long, and the pustules quickly return to flatness, merely delaying time rather than resolving the toxin. For mild Yuan Qi (Primal Qi) deficiency, even small doses of Ginseng and Astragalus Membranaceus (Huangqi) allow righteous Qi to assist in circulating the medicinal power effectively. For severe Yuan Qi deficiency, lacking strength to support, one relies heavily on the strong momentum of Ginseng and Huangqi, aided by Ginger and Cinnamon, to achieve operational efficacy. Hence the saying that "insufficient dosage leads to stagnation." This method was sought by Zhang Xincheng and is recorded here to supplement omissions. If Qi Deficiency is accompanied by Lung Fire, use Ginseng but avoid Huangqi.
The granddaughter of Elder Jiang, aged only one year old, developed fever for half a day before appearing with pustules. Her complexion had always been pale. I predicted early on that her pustules would be fine, dense, and produce clear pus. Indeed, upon appearance, they were densely packed without gaps, resembling snake-skin patterns across the chest, back, hands, and feet. By the third day, facial pustules were dry, gray, and white; back and neck pustules were purple, sunken, and un-nourished. Knowing that Yuan Qi was both weak and stagnant, and Nutritive Blood could not circulate with Qi, the face appeared Qi Deficient while the body resembled Blood Heat. Actually, it was the failure of Qi and Blood to circulate uniformly, causing stagnation and purple discoloration. The bases were flat and scattered, truly caused by Qi Deficiency. I immediately prescribed warm tonifying and promoting decoctions, one dose each morning and afternoon, containing four qian of Ginseng per dose, taken mixed with other herbs. In the evening, another three qian of Ginseng were decocted separately and taken as a concentrated juice. The ingredients included Ligusticum Chuanxiong Rhizome (Xiong), Angelica Sinensis Radix (Gui), Huangqi, Cinnamon Twig (Gui), Tianchong, Jiaoci, Dioscorea Oppata Rhizome (Shanyao), and Licorice Root (Gancao). From the fourth to the seventh or eighth day, heavy tonification continued without relaxation. Flat areas gradually rose; dry, sunken areas became moist; clear fluids became thick. Areas resembling snake-skin nests turned into blisters and ulcers. This is a case record of treating apparent Blood Heat caused by severe Qi and Blood Deficiency, Blood Stasis, and Qi Stagnation.
A five-year-old child, whose stool had always been loose and diet scanty, and who suffered from internal heat causing skin sores, presented with severe fever and vomiting. Upon examination, two "thief pustules" (small, isolated pustules) were found on the right forehead for two days. They were pricked and sealed with oil and rouge. Severe choking cough required adding throat-clearing herbs to the exterior-releasing formula. On the second day, spots appeared, very red and purple. Throat-clearing, exterior-releasing, promoting, and blood-cooling methods were continued. Redness and purple did not diminish on the third day; head, face, and body were very dense, with flat, sunken tops. The previous formula was modified to increase promoting power. By the fourth day, redness/purple lightened slightly, but flatness remained. Fortunately, the voice was clear and painless, demonstrating the efficacy of throat-clearing. On the fifth day, tops still did not rise, purple persisted. To fully induce pus, Blood Heat was an obstacle; to cool blood again risked diarrhea due to Qi Deficiency. Thus, a semi-clearing, semi-tonifying approach was used to induce pus. By the sixth day, appearance remained unchanged. Ginseng was added to the previous formula. The next day, empty spaces produced numerous secondary pustules ("zeng dou"). Previous pustules had white tops but purple roots. Ginseng dosage was doubled. Gradually, 10-20% pus formed. By the eighth/ninth day, diarrhea and teeth-grinding occurred; pustule color turned gray-white. Blood Heat had slightly cleared, but Qi Deficiency was fully manifest. Baoyuan Tang with Ginger and Cinnamon stopped diarrhea and teeth-grinding, though pus quality remained poor. By the next day, some scabs formed. This case involved Qi Deficiency, Blood Heat, and Blood Deficiency, with dense pustules preventing pus formation. The emergence of secondary pustules helped vent the toxin. Early clearing and cooling prevented severe throat pain during pus formation. Commonly, in Qi Deficiency with Blood Heat, around days five/six, as Blood Heat subsides, Qi Deficiency worsens, leading to inevitable diarrhea, gray-white color, and collapse. Using Ginseng at this stage, if followed by diarrhea, loses its benefit; hence, preparation must be early. Herbs damaging Qi/Spleen are avoided. Promoting herbs aiding Spleen are used early. Even if Blood Heat is not fully cleared, if Qi Deficiency is urgent, Ginseng and Zicao (Arnebiae Radix seu Lithospermi Radix) are used. To counteract Zicao's coldness, sticky rice (Nimi) is added to moderate it. Although pus is thin, since toxins have exited externally, the patient eats without abdominal distension and breathes clearly without panting. Efforts should focus on regulating and tonifying to prevent Middle Qi collapse. After day twelve, slight recovery of Qi and Blood allows natural toxin expulsion via abscess formation. Indeed, on day fifteen, a large abscess appeared on the vertex, indicating a localized toxin amenable to tonification. Without tonification, scars would remain white and unable to resist toxins. External absorbent plasters promoted pus elevation; surrounding agents prevented toxin dispersion and muscle damage. Internal tonifying, promoting, detoxifying agents led to complete pus drainage and scab shedding by day thirty, resulting in full recovery with healthy red scars. This is a case record of treating inverted pustules due to Blood Deficiency, Blood Heat, and Qi Deficiency.
A Wang family child, over one year old, presented with pustules on the fourth day. Pustule bases were significantly raised. The forehead area was cloud-like, muddy, and gray-white. Tongue coating was white. I stated that the toxin had not been transmitted out, with cold hiding in the Dantian. Lifting and promoting therapy was highly indicated. One dose resulted in rising; two doses showed redness and vitality; by the third dose, pus appeared on cheeks and body. However, the forehead remained gray-white. Ginseng, Huangqi, roasted Licorice, and official Cinnamon were used to achieve heavy tonification and pus formation, leading to scabbing and recovery. Even "cloud covering the forehead," considered a fatal sign, should not be entirely abandoned. This is a case record of transforming Qi Deficiency inverted symptoms into favorable ones, achieving success through luck.
The great-grandson of Director Xu, under one year old, presented with very dense pustules. Cheekbones resembled silkworm eggs, colored like rouge. Symptoms included cough, loose stools, and weak spirit. History of skin sores indicated dual Qi and Blood Deficiency, constituting an inverted prognosis. Despite earnest requests for treatment, I heavily employed blood-cooling, blood-nourishing, and promoting herbs. By days three/four, redness/purple decreased, but cheekbone pustules began drying. I noted: Many pustules but little Blood, insufficient for filling; pus formation is difficult; internal attack of toxin is inevitable. We must strive against the toxin. If toxin attacks inward, we promote strongly; if Qi/Blood exhausts, we tonify strongly. If Qi/Blood regenerates, no black scabs will form on the surface; Zang-Fu Qi generates internally; Fire-Toxin resolves externally. Avoid negligence allowing toxin to invade. Heavy nourishing and promoting were used, two doses daily, each containing five qian of Ginseng. If one bowel movement occurred, three qian of Ginseng were decocted separately. Ingredients included stir-fried Rehmannia Glutinosa Radix Preparata (Shudi), Shanyao, Jiaoci, Tianchong, Ginseng, Huangqi, and roasted Licorice. Cinnamon Bark (Rougui) was added later. By days six/seven, white, tin-like areas turned yellow and moist; thin scabs adhering to flesh rose into thick crusts. Pustules on cheekbones and chin, previously without pus, formed pomegranate-like, high, bright crusts by days eight/nine. Did Ginseng create tangible results from intangible power? After day twelve, slight Yuan Qi recovery drove toxin outward, manifesting as ulcers, carbuncles, or mouth ulcers, treated symptomatically. Full recovery took two months. Peng Lingqin, deeply understanding medical principles, observed daily, stating: "This is not treating pustules, this is 'making' pustules." This is a case record of salvaging inverted pustules due to dual Qi and Blood Deficiency through heavy tonification.
A Zhu family child, nine years old, presented with burning fever, bad breath, purple macules, waist pain, and dense pustules resembling silkworm eggs, with sunken purple tops. This was true Blood Heat combined with true Qi Deficiency. I used large doses of promoting and cooling-macule-resolving formulas, including Tianchong, Pangolin Scales (Chanshujia), Moutan Cortex (Danpi), Rehmannia Glutinosa Radix (Shengdi), Carthamus Tinctorius Flos (Honghua), Scrophularia Ningpoensis Radix (Xuanshen), Plantago Asiatica Seed (Nanzi), Ligusticum Chuanxiong Rhizome (Chuanxiong), Saiga Tataricus Cornu (Lingyangjiao), Platycodon Grandiflorus Radix (Jiegeng), Tangerine Peel (Chenpi), and Licorice. Decoction was prepared with Earthworm (Dilong), plus three bamboo shoots and five qian of Zicao. After all pustules emerged, the previous formula was modified with five fen of wine-fried Coptis Chinensis Rhizome (Huanglian) for cooling and attacking promotion. By days four/five, fire energy lessened; Huanglian was removed. By day six, Blood Heat slightly cleared, followed by diarrhea. However, toxin did not sink due to strong promoting agents. I said: Now effort can yield survival. Although this case has ten parts Qi Deficiency and ten parts Blood Heat, if fire persists, tonics are hard to administer. With diarrhea now present, pure deficiency is revealed, allowing bold use of heavy tonics. However, history of Lung Heat with sore throat, hoarseness, and cough contraindicates Huangqi. Instead, double Ginseng and use herbs supporting Spleen, clearing Lung, and promoting pus. Two doses daily, each with five qian of Ginseng. By day nine, half-filled pus, mostly blisters, resembling scalds. Due to dense, snake-skin-like pustules with no space, thin constitution, and deficient Blood/Qi unable to circulate fully, fluid accumulated in sacs forming blisters. Tonification and Spleen-strengthening were continued to gradually generate Qi/Blood and digest residual toxin externally. By day thirteen, pustules ulcerated with foul odor. Pine pollen was applied externally; internally, tonifying, promoting, detoxifying, Spleen-supporting, and diuretic herbs were given. Gradual drying and scabbing occurred, like molting. This was a critical case salvaged by aggressive attacking and tonifying. This is a case record of treating true Blood Heat and true Qi Deficiency inverted symptoms, salvaged by aggressive methods.
Many historical case records exist; these few are cited to demonstrate the treatment of critical Qi Deficiency and Blood Heat. Records with similar syndromes or insufficient explanation are omitted.