治瘟疫自肺传心，其人无故自笑，精神恍惚，言语错乱。
生石膏（一两，捣细） 人参（二钱） 犀角（二钱） 羚羊角（二钱） 朱砂（三分，研细） 牛黄（一分，研
细）
将药前四味共煎汤一茶盅，送服朱砂、牛黄末。
此证属至危之候，非寻常药饵所能疗治。故方中多用珍异之品，借其宝气以解入心之热毒也。
瘟疫之毒未入心者，最忌用犀角。而既入心之后，犀角又为必须之药。
瘟疫之毒，随呼吸之气传入，原可入肺。心与肺同居膈上，且左心房之血脉管与右心房之回血管，又皆与
肺循环相通，其相传似甚易。而此证不常有者，因有包络护于心上代心受邪，由包
络下传三焦，为手厥阴，少阳脏腑之相传，此心所以不易受邪也。愚临证二十余年，仅遇一媪患此证，为拟此
方，服之而愈。
治小儿出疹，表里俱热。或烦躁引饮，或喉疼声哑，或喘逆咳嗽。
生石膏（一两，捣细） 知母（六钱） 羚羊角（二钱） 金线重楼（钱半，切片） 薄菏叶（二钱） 青连
翘（二钱） 蝉蜕（钱半，去足土） 僵蚕（二钱）
用水煎取清汤一盅半，分二次温饮下，以服后得微汗为佳。若一次得微汗者，余药仍可再服。若服一次即
得大汗者，余药当停服。此药分量，系治七八岁以上者，若七八岁以下者，可随其年之大小，斟酌少用。或将
药减半或用三分之一皆可。
喉疼声哑者，可将石膏加重五钱，合前得两半。若疹出不利者，用鲜苇根（活水中者更佳）一大握去节水
煎沸，用其水煎药。
疹证多在小儿，想小儿脏腑间原有此毒，又外感时令之毒瓦斯而发，则一发表里俱热。若温病初得之剧者，
其阳明经府之间，皆为热毒之所弥漫。故治此证，始则发表，继则清解，其有实热者，皆宜用石膏。至喉疼声
哑者，尤为热毒上冲，石膏更宜放胆多用。惟大便滑泻者，石膏、知母皆不宜用，可去此二药，加滑石一两、
甘草三钱。盖即滑泻亦非凉证，因燥渴饮水过多，脾胃不能运化故也，故加滑石以利其小便，甘草以和其脾胃，
以缓水饮下趋之势。若其滑泻之甚者，可用拙拟滋阴宣解汤，既可止泻，又可表疹外出也。然此证最忌滑泻，
恐其毒因滑泻内陷即不能外出。若服以上方而滑泻不止，可用生山药两许，轧细煮作粥，再将熟鸡子黄两三枚
捏碎调粥中服之，其滑泻必止。泻止后，再徐徐以凉药清补之。
奉天友人朱××之子，年五岁。于庚申立夏后，周身壮热，出疹甚稠密，脉甚洪数，舌苔白浓，知其疹而兼
瘟也。欲以凉药清解之，因其素有心下作疼之病，出疹后，贪食鲜果，前一日犹觉疼，又不敢投以重剂。遂勉
用生石膏、玄参各六钱，薄荷叶、蝉蜕各一钱，连翘二钱。晚间服药，至翌日午后视之，其热益甚，喉疼，气
息甚粗，鼻翅煽动，且自鼻中出血少许，有烦躁不安之意。愚不得已，重用生石膏三两，玄参、麦冬（带心）
各四钱，仍少佐以薄荷叶、连翘诸药。俾煎汤二茶盅，分三次温饮下。至翌日视之，则诸证皆轻减矣。然余热
犹炽，而大便虽下一次，仍系燥粪。询其心犹发热，脉仍有力。遂于凉解药中，仍用生石膏一两，连服两剂，
壮热始退。继用凉润清解之剂调之全愈。
按∶此证初次投以生石膏、玄参各六钱，其热不但不退而转见增加，则石膏之性原和平，确非大凉可知也。
至其证现种种危象，而放胆投以生石膏三两，又立能挽回，则石膏对于有外感实热诸证，直胜金丹可知。此证
因心下素有疼病，故石膏、玄参初止用六钱。若稍涉游移，并石膏、玄参亦不敢用，再认定疹毒，宜托之外出
而多用发表之品，则翌日现证之危险，必更加剧，即后投以大剂凉药，亦不易挽回也。目睹耳闻，知孺子罹瘟
疹之毒，为俗医药误者甚多，故于记此案时，而再四详为申明。
瘟疫之证，虽宜重用寒凉，然须谨防其泄泻。若泄泻，则气机内陷，即无力托毒外出矣。是以愚用大剂寒
凉，治此等证时，必分三四次徐徐温服下，俾其药力长在上焦，及行至下焦，其寒凉之性已为内热所化，自无泄
泻之弊。而始终又须以表散之药辅之，若薄荷、连翘、蝉蜕、僵蚕之类，则火消毒净，疹愈之后亦断无他患矣。
至若升麻、羌活之药，概不敢用。友人刘××，精通医学。曾治一孺子，出疹刚见点即回。医者用一切药，皆不能
表出。毒瓦斯内攻，势甚危急，众皆束手。刘××投以《伤寒论》麻杏甘石汤，一剂疹皆发出，自此遂愈。夫麻杏
甘石汤，为汗后、下后、汗出而喘无大热者之方，刘××用以治疹，竟能挽回人命于顷刻，可为善用古方者矣
（用此方者，当视其热度之高低，热度高者石膏用一两，麻黄用一钱，热度低者石膏用一两，麻黄用二钱）。
治疗瘟疫病邪从肺脏传变至心脏，患者出现无故自笑、精神恍惚、言语错乱的症状。
生石膏（一两，捣碎成细粉） 人参（二钱） 犀角（二钱） 羚羊角（二钱） 朱砂（三分，研成细粉） 牛黄（一分，研成细粉）
将前四味药共同煎煮成一茶盅的药汤，用此药汤送服朱砂和牛黄的粉末。
这种证候属于极度危险的状况，不是寻常药物所能治疗的。因此方中多使用珍贵稀有的药材，借助它们的宝气来解除侵入心脏的热毒。
瘟疫的毒邪尚未进入心脏时，最忌讳使用犀角。而一旦毒邪进入心脏之后，犀角又是必须使用的药物。
瘟疫的毒邪随着呼吸之气传入，原本可以进入肺脏。心脏与肺脏同处膈肌之上，且左心房的血脉管与右心房的回血管，都与肺循环相通，所以病邪在两者之间传变似乎很容易。但这种证候不常见的原因，是因为有“心包络”保护在心外，代替心脏承受邪气，病邪由心包络下传至三焦，属于手厥阴心包经与手少阳三焦经脏腑之间的传变，这就是心脏不容易直接受邪的原因。我临诊二十多年，仅遇到一位老妇人患此证，为她拟定此方，服用后痊愈。
治疗小儿出疹子，表里俱热。或者烦躁口渴引饮，或者喉咙疼痛声音嘶哑，或者气喘逆咳。
生石膏（一两，捣碎成细粉） 知母（六钱） 羚羊角（二钱） 金线重楼（一钱半，切片） 薄荷叶（二钱） 青连翘（二钱） 蝉蜕（一钱半，去除足部和泥土） 僵蚕（二钱）
用水煎取清汤一盅半，分两次温服，以服药后微微出汗为最佳。如果一次服药后就微微出汗，剩下的药还可以继续服用。如果服药一次就出大汗，剩下的药应当停止服用。这个药量是针对七八岁以上儿童的，如果是七八岁以下的儿童，可以根据年龄大小酌情减少用量。或者将药量减半或只用三分之一都可以。
对于喉咙疼痛声音嘶哑的，可以将石膏加重五钱，加上前面的总量达到两半。如果疹子发出不畅利的，用一大把鲜苇根（生长在活水中的更好），去掉节部的水，用这水来煎药。
疹证多见于小儿，推测小儿脏腑间原本就有这种毒邪，又外感时令的毒瓦斯而发作，从而导致表里俱热。如果温病初起严重的，其阳明经腑之间，都被热毒所弥漫。所以治疗这种证候，开始时要发表透疹，随后要清热解表，如果有实热的，都适宜使用石膏。至于喉咙疼痛声音嘶哑的，更是热毒上冲的表现，石膏更应大胆多用。只有大便滑泻的，石膏、知母都不宜使用，可以去掉这两味药，加入滑石一两、甘草三钱。因为即使是滑泻也不是寒证，而是因为燥渴饮水过多，脾胃不能运化所致，所以加滑石以利小便，加甘草以调和脾胃，减缓水饮下趋的趋势。如果滑泻严重的，可以使用我拟定的滋阴宣解汤，既可以止泻，又可以透发疹毒外出。然而这种证候最忌讳滑泻，恐怕毒邪因滑泻内陷而不能外出。如果服用上述方剂后滑泻不止，可以用生山药约一两，轧碎煮成粥，再将熟鸡蛋黄两三枚捏碎调入粥中服用，滑泻必定停止。泻止后，再慢慢用凉药进行清补调理。
奉天友人朱××的儿子，五岁。在庚申年立夏之后，全身壮热，出疹非常稠密，脉象洪数，舌苔白厚，知道他是疹病兼有瘟毒。想用凉药清热解表，因为他平素有胃脘疼痛的病史，出疹后贪吃鲜果，前一天还觉得疼，所以不敢投用重剂。于是勉强使用生石膏、玄参各六钱，薄荷叶、蝉蜕各一钱，连翘二钱。晚间服药，到第二天午后去看他，热度更加严重，喉咙痛，气息粗重，鼻翼煽动，并且鼻孔少量出血，有烦躁不安的意思。我不得已，重用生石膏三两，玄参、麦冬（带心）各四钱，仍然少量佐以薄荷叶、连翘等药。让药煎成两茶盅汤，分三次温服。到第二天再看，各种症状都减轻了。然而余热依然炽盛，虽然大便排了一次，仍然是干结的粪便。询问得知心中仍发热，脉象仍然有力。于是在凉解药中，继续使用生石膏一两，连续服用两剂，壮热才退去。接着用凉润清解的药剂调理，完全痊愈。
按语：这个证候初次投以生石膏、玄参各六钱，热度不但没退反而增加，这说明石膏的性质原本平和，确实不是大寒之药可知。至于证候出现种种危象，而大胆投以生石膏三两，又能立刻挽回局面，说明石膏对于有外感实热诸证，简直胜过金丹可知。这个证候因为心下素有疼痛疾病，所以石膏、玄参起初只用了六钱。如果稍犹豫不决，连石膏、玄参也不敢用，再认定是疹毒，应该托毒外出而多用发表的药物，那么第二天出现的危险症状，必定更加剧烈，即使后来投以大剂量的凉药，也不容易挽回了。亲眼目睹、亲耳听闻，知道孩童遭受瘟疹毒邪，被庸医误治的情况很多，所以在记录这个医案时，再三详细申明。
瘟疫的证候，虽然适宜重用寒凉药物，但必须谨防其引起泄泻。如果发生泄泻，则气机内陷，就没有力量托毒外出了。所以我在使用大剂量寒凉药物治疗这类证候时，一定分三四次徐徐温服，使药力长久停留在上焦，等到运行到下焦时，寒凉的性质已经被内热所化解，自然没有泄泻的弊端。而且始终需要用发散表邪的药物辅助，如薄荷、连翘、蝉蜕、僵蚕之类，这样火消毒净，疹子痊愈后也绝对不会有其他祸患了。至于升麻、羌活这类药物，一概不敢使用。友人刘××，精通医学。曾治疗一个孩童，出疹刚见到红点就消退回去。医生用各种药，都不能透发出来。毒瓦斯内攻，形势非常危急，大家都束手无策。刘××投用《伤寒论》中的麻杏甘石汤，一剂药后疹子全部发出，从此痊愈。夫麻杏甘石汤，是治疗发汗后、攻下后，汗出而喘、没有大热的方子，刘××用来治疗疹病，竟能顷刻间挽回人命，可以说是善于运用古方的人了（使用此方者，应当视其热度高低而定，热度高者石膏用一两，麻黄用一钱；热度低者石膏用一两，麻黄用二钱）。
To treat plague where the pathogen transmits from the Lung to the Heart, manifesting as spontaneous laughter without cause, mental confusion, and disordered speech.
Shigao (Gypsum Fibrosum, 1 liang, crushed into fine powder) Renshen (Ginseng Radix et Rhizoma, 2 qian) Xijiao (Rhinocerotis Cornu, 2 qian) Lingyangjiao (Saiga Tataricae Cornu, 2 qian) Zhusha (Cinnabaris, 3 fen, ground into fine powder) Niuhuang (Calculus Bovis, 1 fen, ground into fine powder)
Decoct the first four ingredients together to obtain one teacup of decoction, and use this liquid to administer the powders of Zhusha and Niuhuang.
This syndrome represents a critical condition that cannot be treated with ordinary medicines. Therefore, the prescription uses many precious and rare substances, borrowing their "treasured qi" to resolve the heat-toxin invading the Heart.
When the plague toxin has not yet entered the Heart, the use of Xijiao is strictly contraindicated. However, once the toxin has entered the Heart, Xijiao becomes an essential herb.
The plague toxin enters via respiration and can originally affect the Lung. The Heart and Lung reside together above the diaphragm, and the pulmonary veins in the left atrium and pulmonary arteries in the right atrium are connected to the pulmonary circulation, making transmission between them seemingly easy. This syndrome is uncommon because the Pericardium (Pericardium) protects the Heart, bearing the pathogen on behalf of the Heart. The pathogen transmits downward from the Pericardium to the Sanjiao (Triple Burner), representing a transmission between the Hand-Jueyin Pericardium and Hand-Shaoyang Sanjiao organs; thus, the Heart is difficult to directly invade. In my twenty-plus years of clinical practice, I encountered only one elderly woman with this syndrome, prescribed this formula, and she recovered.
To treat children's measles/rash with exterior and interior heat simultaneously. Or irritability with thirst for drinking, or sore throat with hoarseness, or wheezing and coughing.
Shigao (Gypsum Fibrosum, 1 liang, crushed into fine powder) Zhimu (Anemarrhenae Rhizoma, 6 qian) Lingyangjiao (Saiga Tataricae Cornu, 2 qian) Jinzhong Choulou (Paris polyphylla var. yunnanensis, 1.5 qian, sliced) Boheye (Menthae Haplocalycis Folium, 2 qian) Qing Lianqiao (Forsythiae Fructum, 2 qian) Chantui (Bombyx Batryticatus, 1.5 qian, cleaned of feet and soil) Jiangcan (Bombyx Batryticatus, 2 qian)
Decoct in water to obtain one and a half cups of clear decoction, taken warm in two doses. It is ideal if slight sweating occurs after administration. If slight sweating occurs after one dose, the remaining medicine may still be taken. If profuse sweating occurs after one dose, the remaining medicine should be stopped. These dosages are for children aged seven to eight years or older. For children under seven to eight years old, reduce the dosage according to age. Halving the dose or using one-third is acceptable.
For those with sore throat and hoarseness, increase Shigao by 5 qian, totaling 1.5 liang combined with previous amounts. If the rash fails to erupt smoothly, boil a large handful of fresh Weigen (Reed Rhizome, preferably from living water), removing the nodes, and use this water to decoct the herbs.
Rash syndromes mostly occur in children. It is presumed that children inherently possess this toxin within their zang-fu organs, which erupts upon contracting seasonal toxic vapors externally, resulting in simultaneous exterior and interior heat. If wind-heat disease is severe at onset, the Yangming Channel and Fu-organs are filled with heat-toxin. Thus, treatment begins with releasing the exterior, followed by clearing and resolving heat. For excess heat, Shigao is appropriate. Sore throat and hoarseness indicate heat-toxin rushing upward, warranting bold and increased use of Shigao. However, if there is loose stool/diarrhea, neither Shigao nor Zhimu should be used; remove these two and add Huashi (Talcum, 1 liang) and Gancao (Glycyrrhizae Radix et Rhizoma, 3 qian). Loose stool here is not due to cold syndrome but rather excessive intake of water due to dryness-thirst, overwhelming the Spleen and Stomach's transformation capacity. Huashi promotes urination to drain dampness, while Gancao harmonizes the Spleen and Stomach, slowing the downward rush of fluids. For severe loose stool, use my formulated Ziyin Xuanjie Tang (Nourishing Yin and Venting Decoction), which stops diarrhea and helps vent the rash outward. However, loose stool is most contraindicated in this syndrome, as it risks the toxin sinking inward and preventing outward expulsion. If loose stool persists after taking the above formulas, cook roughly 1 liang of Shanyao (Dioscoreae Rhizoma) into a thick porridge, mix in two or three crushed cooked egg yolks, and consume. The loose stool will stop. After cessation, gradually use cooling and nourishing agents for recovery.
A friend from Fengtian, Mr. Zhu XX, had a five-year-old son. After Start of Summer in the Gengshen year, he presented with high fever, dense rash, surging and rapid pulse, and thick white tongue coating, indicating rash complicated by plague toxin. Intending to use cooling herbs to clear heat, I hesitated due to his history of epigastric pain and recent consumption of fresh fruits causing pain the day prior, avoiding heavy doses. I reluctantly prescribed Shigao (Gypsum Fibrosum) and Xuanshen (Scrophulariae Radix) 6 qian each, Boheye (Menthae Haplocalycis Folium) and Chantui (Bombyx Batryticatus) 1 qian each, and Lianqiao (Forsythiae Fructum) 2 qian. Evening administration led to worsening fever, sore throat, coarse breathing, nasal flaring, slight epistaxis, and irritability by the next afternoon. Compelled, I heavily prescribed Shigao (Gypsum Fibrosum) 3 liang, Xuanshen (Scrophulariae Radix) and Maidong (Ophiopogonis Radix, retaining the heart) 4 qian each, with minor additions of Boheye and Lianqiao. Decocted into two teacups, taken warm in three doses. By the next day, symptoms alleviated. Residual heat remained intense; although one bowel movement occurred, the stool was dry. Inquiry revealed continued internal heat and a forceful pulse. I continued Shigao (Gypsum Fibrosum) 1 liang within the cooling/resolving formula for two doses, finally reducing the high fever. Subsequent treatment with cooling, moistening, and clearing agents led to full recovery.
Note: Initially prescribing 6 qian each of Shigao and Xuanshen failed to reduce fever, proving Shigao's nature is mild/neutral, not severely cold. Conversely, boldly prescribing 3 liang of Shigao amidst critical signs immediately reversed the condition, demonstrating Shigao's superiority over gold pills for exterior excess heat syndromes. Due to pre-existing epigastric pain, initial doses were conservative. Hesitation would have prevented even these modest doses, leading to reliance on dispersing herbs to vent toxin, likely exacerbating danger and rendering later heavy cooling ineffective. Witnessing many pediatric plague-rash cases mismanaged by quacks, I elaborate on this case record.
Plague syndromes require heavy cooling herbs, but diarrhea must be guarded against. Diarrhea causes qi mechanism to sink inward, losing the power to expel toxin. Therefore, when using large doses of cold herbs, I divide them into three or four small, warm doses to keep medicinal strength in the Upper Jiao. By the time it reaches the Lower Jiao, the cold nature is transformed by internal heat, avoiding diarrhea. Always assist with exterior-dispersing herbs like Boheye, Lianqiao, Chantui, and Jiangcan. Once fire is cleared and toxin eliminated, no further complications arise post-rash. Herbs like Shengma (Cimicifugae Rhizoma) and Qianghuo (Notopterygii Rhizoma et Radix) are strictly avoided. Friend Liu XX, proficient in medicine, treated a child whose rash appeared then retreated. Other doctors failed to vent it; toxic vapors attacked inward, creating critical urgency. Liu XX prescribed Maxing Gan Shi Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) from Shanghan Lun. One dose caused complete eruption and cure. Maxing Gan Shi Tang is indicated for post-sweat/post-purge cases with sweating, wheezing, and no significant fever. Liu XX's successful application demonstrates mastery of ancient formulas (Dosage adjustment based on temperature: High temp - Shigao 1 liang, Mahuang 1 qian; Low temp - Shigao 1 liang, Mahuang 2 qian).