（附∶坎离互根汤）
自鼠疫之证流毒甚烈，医者对于此证未之前闻，即治疗此证未有专方，致患此证者百中难愈二三，
良可慨也。不知此证发生之初，原是少阴伤寒中之热证类，至极点始酝酿成毒，互相传染。今欲知此
证之原因及治法，须先明少阴伤寒之热证。
尝读《伤寒论》少阴篇，所载之证有寒有热，论者多谓寒水之气直中于少阴，则为寒证；自三阳传来，则
为热证。执斯说也，何以阴病两三日即有用黄连阿胶汤及大承气汤者？盖寒气侵人之重者，若当时窜入阴为
少阴伤寒之寒证。其寒气侵人之轻者，伏于三焦脂膜之中，不能使人即病，而阻塞气化之流通，暗
生内热，后因肾脏虚损，则伏气所化之热即可乘虚而入肾。或肾中因虚生热，与伏气所化之热相招引，伏气
为同气之求，亦易入肾，于斯虚热实热，相助为虐，互伤肾阴，致肾气不能上潮于心，多生烦躁（此少阴病有心
中烦躁之理）。再者，心主脉，而属火，必得肾水之上济，然后阴阳互根，跳动常旺；今既肾水不上潮，则
阴阳之气不相接续，失其互根之妙用，其脉之跳动多无力（此少阴病无论寒热其脉皆微细之理）。人
身之精神与人身之气化原相凭根据，今因阴阳之气不相接续，则精神失其凭根据，遂不能振作而昏昏欲睡
（此少阴病但欲寐之理）。且肾阴之气既不能上潮以濡润上焦，则上焦必干而发热，口舌无津，肺脏因干
热而咳嗽，咽喉因干热而作痛，此皆少阴之兼证，均见于少阴篇者也。《内经》谓∶“冬伤于寒，春必病
温”，此言伏气化热为病也。然其病未必入少阴也。《内经》又谓∶“冬不藏精，春必病温”，此则多系
伏气化热乘虚入少阴之病，因此病较伏气入他脏而为病者难于辨认，且不易治疗，故于冬伤于寒春必温病
之外，特为明辨而重申之也。盖同是伏气发动，窜入少阴为病，而有未届春令先发于冬令者，则为少阴伤
寒，即系少阴伤寒之热证，初得之即宜用凉药者也；其感春阳之萌动而后发，及发于夏，发于秋者，皆可为
少阴温病，即温病之中有郁热，其脉象转微细无力者也。其病虽异而治法则同也。既明乎此，试再进而论鼠疫。
鼠疫之证初起，其心莫不烦躁也；其脉不但微细，恒至数兼迟（间有初得脉洪数者乃鼠疫之最轻者）；
其精神颓败异常，闭目昏昏，不但欲睡，且甚厌人呼唤；其口舌不但发干，视其舌上，毫无舌苔，而舌
皮干亮如镜；其人不但咳嗽咽痛，其肺燥之极，可至腐烂，呕吐血水（奉天人言辛亥年此证垂危时多呕吐血水）。
由斯而论，鼠疫固少阴热证之至重者也。虽其成鼠疫之后，酿为毒菌，互相传染，变证歧出，有为结
核性者，有为败血性者。而当其起点之初，大抵不外上之所述也，然此非愚之凭空拟议也，试举一案以征之∶
一九二一年，黑龙江哈尔滨一带鼠疫盛行，奉天防范甚严，未能传染入境。惟银行之间互相交通，鼠疫之
毒菌因之有所传染。有银行施××，年三十余，发生肺炎性鼠疫，神识时明时愦，恒作谵语，四肢逆冷，
心中发热，思食凉物，小便短赤，大便数日未行。其脉沉细而迟，心虽发热，而周身肌肤之热度无异
常人，且闭目昏昏似睡，呼之眼微开，此诚《伤寒论》少阴篇所谓但欲寐之景象也。其舌上无苔，干亮如镜，
喉中亦干甚，且微觉疼，时作干咳，此乃因燥生热，肾气不能上达，阴阳不相接续，
故证象、脉象如此，其为鼠疫无疑也。此证若燥热至于极点，肺
叶腐烂，咳吐血水，则不能治矣。犹幸未至其候，急用药调治，尚可挽回。其治之之法，当以润燥清热为主，
又必须助其肾气，使之上达，与上焦之阳分相接续而成坎离相济之实用，则脉变洪大，始为吉兆。爰为疏方于下∶
生石膏（三两捣细） 知母（八钱） 玄参（八钱） 生怀山药（六钱） 野台参（五钱） 甘草（三钱）
共煎汤三茶盅，分三次温饮下。
按∶此方即白虎加人参汤以山药代粳米，而又加玄参也。方中之意∶用石膏以清外感之实热；用山药、知
母、玄参以下滋肾阴、上润肺燥；用人参者，诚以热邪下陷于少阴，遏抑肾气不能上达，而人参补而兼升之
力既能助肾气上达，更能助石膏以逐除下陷之热邪，使之上升外散也；且凡阴虚兼有实热者，恒但用白
虎汤不能退热，而治以白虎加人参汤始能退热，是人参与石膏并用，原能立复真阴于邪热炽盛之时也。
将药三次服完，身热，脉起，舌上微润，精神亦明了，惟大便犹未通下，内蕴之热犹未尽清。俾即原方
再服一剂，其大便遂通下，余热亦遂尽消矣。为此证无结核败血之现象，而有肺燥、
舌干、喉疼之征，故可名之为肺炎性鼠疫也。
后又治一人，其病之状况大致皆与前证同，惟其脉之沉细及咽喉之干疼则较前尤甚，仍投以前方，俾用
鲜白茅根煎汤，以之代水煎药，及将药煎成，又调入生鸡子黄同服。服后效验异常，
因名其方为坎离互根汤。爰将其方详细录出，以备医界之采用。
【坎离互根汤】
生石膏（三两捣细） 知母（八钱） 玄参（八钱） 野台参（五钱）
生怀山药（五钱） 甘草（二钱） 鸡子黄（三枚） 鲜茅根（四两切碎）
先将茅根煎数沸，视茅根皆沉水底，取其汤以之代水，煎方
中前六味，取汤三盅，分三次温服下。每服一次，调入生鸡子黄一枚。此方比前方多鸡子黄，而又以茅根
汤煎药者，因鸡子黄生用善滋肾润肺，而茅根禀少阳最初之气，其性凉而上升，能发起脉象之沉细也。上方，
乃取《伤寒论》少阴篇黄连阿胶汤与太阳篇白虎加人参汤之义，而合为一方也。黄连阿胶汤原黄连、黄芩、芍
药、阿胶、鸡子黄并用。为此时无真阿胶，故以玄参代之；为方中有石膏、知母，可以省去黄连、黄芩诸药。
西人谓鸡子黄中含有副肾髓质之分泌素，故能大滋肾中真阴，实为黄连阿胶汤中之主药，而不以名汤者，以
其宜生调入而不可煎汤也。是以单用此一味，而黄连阿胶汤之功用仍在。至于白虎加人参汤中去粳米，
而以生山药代之，以山药之性既能和胃（原方用粳米亦取其和胃），又能助玄参、鸡子黄滋肾也。用白虎汤
以解伏气之热，而更加人参者，取人参与石膏并用，最善生津止渴，以解寒温之燥热，而其补益之
力，又能入于下焦，以助肾气之上达，俾其阴阳之气相接续，其脉之微细者可变为洪大，而邪可外透矣。
继又服之，脉之洪大者渐臻于和平，而病即全愈矣。
咳嗽者，加川贝母三钱。咽喉疼者，加射干三钱。呕吐血水者，加三七细末二钱，犀角、羚羊角细末各
一钱，三味和匀，分三次送服，或但用三七亦可。其大便不实者，宜斟酌缓服。若大便滑泻者，非下焦有寒，
实因小便不利，宜服拙拟滋阴清燥汤，滑泻止后，再服前方，又宜将方中石膏减作二两，生山药倍作一
两，缓缓与服。其脉象间有不微细迟缓，而近于洪数者，此乃鼠疫之最轻者，治以此方，一服当即速愈。总之，
此证燥热愈甚，则脉愈迟弱，身转不热。若服药后脉起身热，则病机已向愈矣。
愚初治此证时，曾但用白虎加人参汤，以生山药代粳米，治愈后，拟得此方，奏效尤捷。
或疑寒温之证皆不传染，鼠疫既为少阴寒温证之剧者所成，
何以独易传染？不知其传染之毒菌，皆生于病终不愈，甚至脏腑溃败，或因阴阳之气久不接续，血脉之流
通可至闭塞，因闭塞而成腐败，此皆足以酿毒以相传染也，少阴寒温之未变鼠疫者，其剧不至此，所以
不传染也。至此证之因传染而成者，其毒愈酝酿而愈甚，即病不甚剧而亦可传他人。所以此病偶有见端，
即宜严为防范也。
此证之传变，又分数种。后观哈尔滨斯年报告之病状，实甚复杂，今录其原文于下，以备参考。
一九二一年春，哈尔滨报告文。斯年鼠疫之病状∶染后三日至七日，为潜伏期。先有头痛、眩晕、食欲不
振、倦怠、呕吐等前驱证。或有不发前驱证者。继则恶寒、战栗，忽发大热，达39℃一40℃以上，或稽留，
或渐次降下，淋巴管发生肿胀。在发热前或发热之一二日内，即发肿块一个，有时一侧同发两个，
如左股腺与左腋窝腺而并发是也。该肿块或化脓，或消散，殊不一定。大部沉嗜眠睡（此即少阴证之但欲寐之
理），夜间每发谵语。初期多泄泻二三次。尿含蛋白（此伤肾之征）。病后一二日，肝脾常见肥大。轻证三四
日体温下降可愈。重证二日至七日多心脏麻痹（其脉象细微同于少阴病脉可知）。
此证可分腺肿性、败血性、肺炎性百斯笃（即鼠疫）三种。腺肿百斯笃最占多数，一处或各处之淋巴管并
其周遭组织俱发炎证。其鼠 腺及大腿上三角部之淋巴腺尤易罹之。腋窝腺及头部腺次之。又间侵后头腺、
肘前后腺、耳前后腺、膝 腺等。其败血性百斯笃，发大如小豆之斑，疼痛颇甚，且即变为脓 ，或更
进而变坏疽性溃疡，又有诱起淋巴腺炎者。肺炎性百斯笃之证，剧烈殊甚，一如加答儿性肺炎或格
鲁布肺炎，咯出之痰中含有百斯笃菌，乃最猛恶者也。
上段述鼠疫之情状，可为详悉尽致，而竟未言及治法，想西医对于此证并无确实之治法也。且其谓轻
证三四日体温下降可愈；至其重证，体温不下降，岂不可用药使之下降？至言重证垂危，恒至心脏麻痹，推
其麻痹之由，即愚所谓肾气不上达于心，其阴阳之气不相接续，心脏遂跳动无力，致脉象沉迟细弱也。此
证若当其大热之初，急投以坎离互根汤，既能退热，又能升达肾气，其心脏得肾气之助，不至麻痹，即不难
转危为安也。又其谓大部沉嗜眠睡，与愚所经历者之状似昏睡，皆有少阴病但欲寐之现象，亦足征愚谓此证
系伏气化热入肾变成者，原非无稽之谈也。特是愚前用之方，因在奉天未见传染之毒，所以治法不备。
后阅《山西医志》，载有厦门吴锡璜《鼠疫消弭及疗法》一篇，其用药注重解毒，实能匡愚所不逮，爰
详录之于下，以备治斯证者之采取。
原文∶疫菌既染，危险万状。大略分为腺鼠疫、肺鼠疫二种。其为证也，先犯心脏，使心力衰弱；
凡脉搏如丝，即为疫毒侵犯心脏唯一之确据。其次体温速升，头痛眩晕，或作呕吐，渐渐意识朦胧，陷于昏
睡谵语，状态痴呆，行步蹒跚，眼结膜强度充血，舌带白色，如锻石撒上，或污紫如熟李，颈腺、腋窝、大
腿上近阴处起肿胀疼痛，剧烈者三日即死。其神气清者，可多迁
延数日。寻常用方，有效有不效。兹将历试有效者，详细录出，以公诸医界。
【王孟英治结核法】
初起用王孟英治结核方合神犀丹多服累效。方用金银花二两，蒲公英二两，皂刺钱半，粉甘草一钱。
呕者，去甘草，加鲜竹茹一两，若无鲜竹茹，可以净青黛三钱代之。大便秘、热重者，加大黄三钱，
水煎合神犀丹服。如仍不止，用藏红花二钱煎汤，送服真熊胆二分，即止。此方用蒲公
英、金银花、皂刺合神犀丹，不但解毒，兼能解血热、散血滞，实为治鼠疫结核之圣药。若白泡疔，本
方去皂刺，加白菊花一两。兼黑痘，用神犀丹、紫金锭间服。
达樵云∶“病者发头疼，四肢倦怠，骨节禁锢，或长红点，或发丹疹，或呕或泻，舌干喉痛，间有猝
然神昏、痰涌、窍闭者，此系秽毒内闭，毒瓦斯攻心，宜用芳香辟秽、解毒护心之品，辟秽驱毒饮主之。”
【辟秽驱毒饮】
西牛黄（八分研冲） 人中黄（三钱） 九节菖蒲（五分） 靛叶（钱半）
忍冬蕊（五钱鲜者蒸露亦可） 野郁金（一钱）
水煎服。如见结核，或发斑，或生疔，加藏红花八分、桃仁三钱、熊胆四分（送服）。大渴引饮，汗多，
加犀角、金汁。神昏谵语，宜用至宝丹或安宫牛黄丸，开水和服，先开内窍。此证初起，不可即下，审其
口燥，神昏，热炽，有下证者，先辟秽解毒，然后议下，每获效。下法用大黄煮汤，泡紫雪丹五分良。忌
早用大苦大寒，以致冰闭。若脉道阻滞，形容惨淡，神气模糊，恶核痛甚者，宜用解毒活血汤。
连翘（三钱） 柴胡（二钱） 葛根（二钱） 生地（五钱）
赤芍（三钱） 红花（五钱） 桃仁（八钱） 川朴（一钱后下）
当归（钱半） 甘草（二钱） 苏木（二两）
轻证初起，每三点钟服一次。危证初起，两点钟服一次，或合数剂熬膏，连连服之。或热，或渴，或
出汗，或吐血，加生石膏一两，芦根汁一杯，和药膏服，并多服羚羊角及犀角所磨之汁。孕妇加桑寄生一两、
黄芩一两，略减桃仁、红花。
热甚口燥无津，脉象洪数，唇焦大渴者，用清瘟败毒饮。项
肿者，俗名虾蟆瘟，用普济消毒饮（二方俱见《温热经纬》），多服必效。吐红涎
者，鲜芦根取汁和服。便秘者，加大黄三钱。
《千金方》曰∶“恶核病者，肉中忽有核，累大如李核，小如豆粒，皮肉 痛，壮热 索，恶寒是也。
（附：坎离互根汤）
自从鼠疫这种病症流毒甚为猛烈，医生们对于此病从未听说过，治疗此病也没有专门的方剂，导致患此病的人中一百个难得治愈两三个，实在令人感慨。不知道此病发生之初，原本属于少阴伤寒中的热证类型，发展到极点才开始酝酿成毒，互相传染。现在想要了解此病的原因及治法，必须先明白少阴伤寒的热证。
曾经阅读《伤寒论》少阴篇，其中记载的病症有寒证也有热证，评论者大多认为寒水之气直接侵入少阴经，就形成寒证；从三阳经传来，就形成热证。坚持这种说法，为什么阴病在两三天后就有使用黄连阿胶汤和大承气汤的情况？大概寒气侵袭人体较重的，如果当时窜入阴经成为少阴伤寒的寒证。寒气侵袭人体较轻的，潜伏在三焦脂膜之中，不能使人立即发病，而是阻塞气化的流通，暗中产生内热，后来因为肾脏虚损，那么伏匿之气所化生的热就可以乘虚进入肾脏。或者肾中因为虚而生热，与伏匿之气所化生的热相互招引，伏匿之气因为同气相求，也容易进入肾脏，于是虚热和实热互相助长为害，共同损伤肾阴，导致肾气不能上潮于心，多产生烦躁（这就是少阴病心中烦躁的道理）。再者，心主血脉，属火，必须得到肾水的上济，然后阴阳互根，心跳才能旺盛；现在既然肾水不上潮，那么阴阳之气不相接续，失去了互根的妙用，其脉搏跳动多无力（这就是少阴病无论寒热脉象都微细的道理）。人的精神与人身的气化原本相互依赖，现在因为阴阳之气不相接续，精神失去依赖，于是不能振作而昏昏欲睡（这就是少阴病但欲寐的道理）。而且肾阴之气既然不能上潮以濡润上焦，那么上焦必然干燥而发热，口舌无津液，肺脏因为干燥热而咳嗽，咽喉因为干燥热而疼痛，这些都是少阴病的兼证，都见于少阴篇中。《内经》说：“冬天感受寒邪，春天必定得温病”，这是说伏匿之气化热致病。然而这病未必进入少阴经。《内经》又说：“冬天不藏精，春天必定得温病”，这多半是伏匿之气化热乘虚进入少阴经的病，因为这个病比伏匿之气进入其他脏腑致病更难辨认，且不易治疗，所以在“冬伤于寒春必温病”之外，特别明确辨别并重申这一点。大概同样是伏匿之气发动，窜入少阴经致病，有未到春季而在冬季先发的，就是少阴伤寒，即属于少阴伤寒的热证，刚得病时就宜用凉药；那些感受春季阳气萌动而后发，以及发于夏季、秋季的，都可以称为少阴温病，即温病中有郁热，其脉象转为微细无力的。虽然病症不同但治法相同。既然明白了这些，再进而讨论鼠疫。
鼠疫初起，心中无不烦躁；其脉不但微细，往往兼见数而迟（间有初得时脉象洪数的，那是鼠疫中最轻的）；精神颓败异常，闭目昏昏，不但想睡，而且非常厌恶被人呼唤；口舌不但发干，看其舌面上，毫无舌苔，而舌皮干燥光亮如镜子；人不但咳嗽咽痛，肺燥到了极点，甚至腐烂，呕吐血水（奉天人说辛亥年此病垂危时多呕吐血水）。由此而论，鼠疫确实是少阴热证中最严重的。虽然发展成鼠疫后，酿造成毒菌，互相传染，变证百出，有的成为淋巴结炎型，有的成为败血型。但在其起点之初，大抵不外乎上述所述，然而这不是我凭空臆测的，试举一个案例来证明：
一九二一年，黑龙江哈尔滨一带鼠疫盛行，奉天防范很严，未能传染入境。只有银行之间互相交通，鼠疫的毒菌因此有所传染。有一位姓施的银行职员，三十多岁，发生肺炎性鼠疫，神识有时清醒有时糊涂，经常说胡话，四肢逆冷，心中发热，想吃凉物，小便短赤，大便几天未行。其脉沉细而迟，心里虽然发热，但周身肌肤的温度与常人无异，且闭目昏昏似睡，叫唤时眼睛微微睁开，这确实是《伤寒论》少阴篇所说的“但欲寐”的景象。其舌上没有苔，干燥光亮如镜子，喉咙也很干，且微觉疼痛，时常干咳，这是因为燥生热，肾气不能上达，阴阳不相接续，所以证候、脉象如此，这无疑是鼠疫。此病如果燥热到了极点，肺叶腐烂，咳吐血水，就不能治了。幸好还没到那个程度，急忙用药调治，还可以挽回。治疗的方法，应当以润燥清热为主，又必须帮助肾气，使其上达，与上焦的阳分相接续而成坎离相济的实际效用，那么脉象变为洪大，才是吉兆。于是开方如下：
生石膏（三两捣细） 知母（八钱） 玄参（八钱） 生怀山药（六钱） 野台参（五钱） 甘草（三钱）
共煎汤三茶盅，分三次温饮下。
按语：这个方子就是白虎加人参汤用山药代替粳米，而又加了玄参。方中的意思：用石膏来清外感的实热；用山药、知母、玄参来下滋肾阴、上润肺燥；用人参，确实是因为热邪下陷于少阴，遏制肾气不能上达，而人参补益兼升提的力量既能帮助肾气上达，更能帮助石膏驱逐下陷的热邪，使其上升外散；而且凡是阴虚兼有实热的，常常单用白虎汤不能退热，而用白虎加人参汤才能退热，是人参与石膏并用，原本能在邪热炽盛之时立刻恢复真阴。将药分三次服完，身热退了，脉象起来了，舌上微润，精神也明了，只是大便还没有通下，内蕴的热还没有完全清除。让他立即原方再服一剂，其大便遂通下，余热也就全部消除了。因为这个病没有结核败血的现象，而有肺燥、舌干、喉疼的征象，所以可以称之为肺炎性鼠疫。
后来又治疗一个人，其病情状况大致都与前一个病例相同，只是其脉象沉细及咽喉干疼比前一个更严重，仍然投以前方，让他用鲜白茅根煎汤，以此代替水煎药，等到药煎好后，又调入生鸡蛋黄一同服用。服药后效果异常好，因此将此方命名为坎离互根汤。于是将其方详细记录出来，以备医界采用。
【坎离互根汤】
生石膏（三两捣细） 知母（八钱） 玄参（八钱） 野台参（五钱）
生怀山药（五钱） 甘草（二钱） 鸡子黄（三枚） 鲜茅根（四两切碎）
先将茅根煎煮几沸，看到茅根都沉在水底，取其汤以此代替水，煎方中前六味，取汤三盅，分三次温服下。每次服用一次，调入生鸡蛋黄一枚。这个方子比前方多了鸡蛋黄，而又用茅根汤煎药，是因为鸡蛋黄生用善于滋肾润肺，而茅根禀受少阳最初之气，其性凉而上升，能发起脉象的沉细。上方，是取《伤寒论》少阴篇黄连阿胶汤与太阳篇白虎加人参汤的意义，而合为一个方子。黄连阿胶汤原是用黄连、黄芩、芍药、阿胶、鸡子黄并用。因为此时没有真阿胶，所以用玄参代替；因为方中有石膏、知母，可以省去黄连、黄芩等药。西方人说鸡蛋黄中含有副肾上腺髓质的分泌素，所以能大滋肾中真阴，实为黄连阿胶汤中的主药，而不以此命名汤剂，是因为它宜生调入而不可煎汤。所以单用这一味药，黄连阿胶汤的功效依然存在。至于白虎加人参汤中去掉粳米，而以生山药代替，因为山药的性质既能和胃（原方用粳米也是取其和胃），又能帮助玄参、鸡子黄滋肾。用白虎汤来解伏匿之气的热，而更加人参，是取人参与石膏并用，最善于生津止渴，以解寒温的燥热，而其补益的力量，又能进入下焦，以助肾气上达，使阴阳之气相接续，其脉象微细的可以变为洪大，而邪气可向外透发。继续服用，脉象洪大的逐渐趋于平和，病就全愈了。
咳嗽的，加川贝母三钱。咽喉痛的，加射干三钱。呕吐血水的，加三七细末二钱，犀角、羚羊角细末各一钱，三味混合均匀，分三次送服，或者只用三七也可以。其大便不成形的，应斟酌缓慢服用。如果大便滑泻的，不是下焦有寒，实在是因为小便不利，宜服我自己拟定的滋阴清燥汤，滑泻停止后，再服前方，又应将方中石膏减作二两，生山药加倍为一两，缓缓给予服用。其脉象间有不微细迟缓，而接近洪数的，这是鼠疫中最轻的，用此方治疗，一服当即迅速痊愈。总之，此病燥热越厉害，则脉象越迟弱，身体反而不热。如果服药后脉象起来身热，则病机已向愈了。
我起初治疗此病时，曾单用白虎加人参汤，用生山药代替粳米，治愈后，才拟定此方，奏效尤其快捷。
有人怀疑寒温类病症都不传染，鼠疫既然是少阴寒温证中最严重的病症所形成，为什么唯独容易传染？不知道其传染的毒菌，都生于病终不愈，甚至脏腑溃败，或因阴阳之气久不接续，血脉的流通可至闭塞，因闭塞而成腐败，这些都足以酿毒以互相传染，少阴寒温未变成鼠疫的，其严重程度不到这一步，所以不传染。至于此病因传染而成的，其毒越酝酿越厉害，即使病不是很严重也可传染他人。所以此病偶有苗头，就应严格防范。
此病的传变，又分几种。后来观察哈尔滨斯年报告的病状，其实很复杂，现将原文录在下面，以备参考。
一九二一年春，哈尔滨报告文。斯年鼠疫的病状：感染后三日至七日，为潜伏期。先有头痛、眩晕、食欲不振、倦怠、呕吐等前驱症状。也有不发前驱症状的。继则恶寒、战栗，忽发高热，达39℃一40℃以上，或稽留，或渐渐降下，淋巴管发生肿胀。在发热前或发热的一二日内，即发肿块一个，有时一侧同时发两个，如左股腺与左腋窝腺并发是也。该肿块或化脓，或消散，殊不一定。大部分嗜睡（这就是少阴证但欲寐的道理），夜间常发谵语。初期多泄泻二三次。尿含蛋白（这是伤肾的征象）。病后一二日，肝脾常见肥大。轻证三四日体温下降可愈。重证二日至七日多心脏麻痹（其脉象细微同于少阴病脉可知）。
此病可分为腺肿性、败血性、肺炎性百斯笃（即鼠疫）三种。腺肿百斯笃最占多数，一处或各处的淋巴管及其周遭组织俱发炎证。其鼠蹊腺及大腿上三角部的淋巴腺尤易罹患。腋窝腺及头部腺次之。又间侵后头腺、肘前后腺、耳前后腺、膝腘腺等。其败血性百斯笃，发大如小豆之斑，疼痛颇甚，且即变为脓疱，或更进而变坏疽性溃疡，又有诱起淋巴腺炎者。肺炎性百斯笃之证，剧烈殊甚，一如卡他性肺炎或格鲁布肺炎，咯出之痰中含有百斯笃菌，乃最猛恶者也。
上段叙述鼠疫的情状，可谓详尽无遗，竟然没提到治法，想必西医对此病并无确实的治法。且其说轻证三四日体温下降可愈；至于重证，体温不下降，难道不可用药使之下降？至言重证垂危，恒至心脏麻痹，推究其麻痹的原因，就是我所说的肾气不上达于心，其阴阳之气不相接续，心脏遂跳动无力，致脉象沉迟细弱也。此病若当其大热之初，急投以坎离互根汤，既能退热，又能升达肾气，其心脏得肾气之助，不至麻痹，即不难转危为安也。又说大部分嗜睡，与我经历的昏睡状态相似，都有少阴病但欲寐的现象，也足以证明我说此病是伏气化热入肾变成的，原非无稽之谈。特别是我之前用的方子，因为在奉天未见传染的毒，所以治法不完善。
后来阅读《山西医志》，载有厦门吴锡璜《鼠疫消弭及疗法》一篇，其用药注重解毒，确实能弥补我的不足，于是详细录之于下，以备治疗此病者采取。
原文：疫菌既染，危险万状。大体分为腺鼠疫、肺鼠疫二种。其为证也，先犯心脏，使心力衰弱；凡脉搏如丝，即为疫毒侵犯心脏唯一之确据。其次体温速升，头痛眩晕，或作呕吐，渐渐意识朦胧，陷于昏睡谵语，状态痴呆，行步蹒跚，眼结膜强度充血，舌带白色，如锻石撒上，或污紫如熟李，颈腺、腋窝、大腿上近阴处起肿胀疼痛，剧烈者三日即死。其神气清者，可多迁延数日。寻常用方，有效有不效。兹将历试有效者，详细录出，以公诸医界。
【王孟英治结核法】
初起用王孟英治结核方合神犀丹多服累效。方用金银花二两，蒲公英二两，皂刺钱半，粉甘草一钱。
呕者，去甘草，加鲜竹茹一两，若无鲜竹茹，可以净青黛三钱代之。大便秘、热重者，加大黄三钱，水煎合神犀丹服。如仍不止，用藏红花二钱煎汤，送服真熊胆二分，即止。此方用蒲公英、金银花、皂刺合神犀丹，不但解毒，兼能解血热、散血滞，实为治鼠疫结核之圣药。若白泡疔，本方去皂刺，加白菊花一两。兼黑痘，用神犀丹、紫金锭间服。
达樵说：“病人发头疼，四肢倦怠，骨节禁锢，或长红点，或发丹疹，或呕或泻，舌干喉痛，间有猝然神昏、痰涌、窍闭者，这是秽毒内闭，毒瓦斯攻心，宜用芳香辟秽、解毒护心之品，辟秽驱毒饮主之。”
【辟秽驱毒饮】
西牛黄（八分研冲） 人中黄（三钱） 九节菖蒲（五分） 靛叶（钱半）
忍冬蕊（五钱鲜者蒸露亦可） 野郁金（一钱）
水煎服。如见结核，或发斑，或生疔，加藏红花八分、桃仁三钱、熊胆四分（送服）。大渴引饮，汗多，加犀角、金汁。神昏谵语，宜用至宝丹或安宫牛黄丸，开水和服，先开内窍。此病初起，不可即下，审其口燥，神昏，热炽，有下证者，先辟秽解毒，然后议下，每获效。下法用大黄煮汤，泡紫雪丹五分良。忌早用大苦大寒，以致冰闭。若脉道阻滞，形容惨淡，神气模糊，恶核痛甚者，宜用解毒活血汤。
连翘（三钱） 柴胡（二钱） 葛根（二钱） 生地（五钱）
赤芍（三钱） 红花（五钱） 桃仁（八钱） 川朴（一钱后下）
当归（钱半） 甘草（二钱） 苏木（二两）
轻证初起，每三点钟服一次。危证初起，两点钟服一次，或合数剂熬膏，连连服之。或热，或渴，或出汗，或吐血，加生石膏一两，芦根汁一杯，和药膏服，并多服羚羊角及犀角所磨之汁。孕妇加桑寄生一两、黄芩一两，略减桃仁、红花。
热甚口燥无津，脉象洪数，唇焦大渴者，用清瘟败毒饮。项肿者，俗名虾蟆瘟，用普济消毒饮（二方俱见《温热经纬》），多服必效。吐红涎者，鲜芦根取汁和服。便秘者，加大黄三钱。
(Attachment: Kanli Hugen Decoction)
Since the plague (Yi Fei, 瘟疫) has spread with such virulent toxicity, physicians have never heard of this condition before. There are no specialized prescriptions for treating it, resulting in a situation where out of every hundred patients, hardly two or three can be cured. This is truly lamentable. It is unknown that at its onset, this condition originally belongs to the heat syndrome type within Shaoyin Cold Damage (Shao Yin Shang Han, 少阴伤寒). Only when it reaches its extreme does it ferment into toxicity and transmit mutually. To understand the cause and treatment of this condition now, one must first clarify the heat syndrome of Shaoyin Cold Damage.
I once read the Shaoyin Chapter of *Treatise on Cold Damage Diseases* (*Shang Han Lun*, 《伤寒论》), which records both cold and heat syndromes. Commentators mostly believe that if cold-water qi directly strikes the Shaoyin meridian, it forms a cold syndrome; if transmitted from the Three Yang meridians, it forms a heat syndrome. Adhering to this theory, how can we explain cases where Yin diseases use Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) and Dachengqi Tang (Major Order the Qi Decoction) after only two or three days? Generally, when cold qi invades the body heavily, if it penetrates into the Yin meridians at that time, it becomes the cold syndrome of Shaoyin Cold Damage. When cold qi invades lightly, it lies dormant within the membranes of the Sanjiao (Triple Burner), failing to cause immediate illness but blocking the flow of Qi transformation, secretly generating internal heat. Later, due to Kidney deficiency, the heat transformed from the latent pathogen can enter the Kidney vacuously. Or, if heat is generated within the Kidney due to deficiency, it attracts the heat transformed from the latent pathogen. The latent pathogen, seeking similar energy, easily enters the Kidney. Thus, deficient heat and excess heat assist each other in causing harm, jointly injuring Kidney Yin. This prevents Kidney Qi from ascending to moisten the Heart, often causing restlessness (this explains the rationale for mental restlessness in Shaoyin disease). Furthermore, the Heart governs the vessels and belongs to Fire; it requires the upward assistance of Kidney Water to achieve mutual rooting of Yin and Yang, ensuring vigorous pulsation. Now, since Kidney Water does not ascend, the Qi of Yin and Yang fails to connect, losing the subtle function of mutual rooting. Consequently, the pulse beats weakly (this explains why pulses in Shaoyin disease, whether cold or heat, are typically fine and minute). The spirit of a person and the body's Qi transformation originally rely on each other. Now, because the Qi of Yin and Yang does not connect, the spirit loses its foundation, becoming unable to振奋 (invigorate) and leading to drowsiness (this explains the "desire to sleep" in Shaoyin disease). Moreover, since Kidney Yin Qi cannot ascend to moisten the Upper Jiao, the Upper Jiao becomes dry and feverish. The mouth and tongue lack fluids, the Lungs cough due to dryness-heat, and the throat hurts due to dryness-heat. These are all accompanying syndromes of Shaoyin, found in the Shaoyin chapter. The *Neijing* states: "If harmed by cold in winter, warm disease will occur in spring." This refers to illness caused by latent Qi transforming into heat. However, the disease may not necessarily enter the Shaoyin. The *Neijing* also states: "If essence is not stored in winter, warm disease will occur in spring." This mostly refers to illnesses where latent Qi transforms into heat and enters the Shaoyin vacuously due to deficiency. Because this disease is harder to identify and treat than latent Qi entering other Zang organs, it is specifically distinguished and reiterated beyond the statement about winter cold causing spring warm disease. Generally, when latent Qi activates and enters the Shaoyin to cause disease, if it occurs in winter before the spring season arrives, it is Shaoyin Cold Damage, specifically the heat syndrome of Shaoyin Cold Damage, requiring cooling medicines immediately upon onset. If it manifests after feeling the stirring of Spring Yang, or in summer and autumn, it can be called Shaoyin Warm Disease, characterized by stagnant heat within warm diseases and pulses turning fine, minute, and weak. Although the diseases differ, the treatment principles are the same. Having clarified this, let us further discuss the plague.
At the onset of the plague, there is invariably mental restlessness. The pulse is not only fine and minute but often rapid yet slow (occasionally, an initial surging and rapid pulse indicates the mildest form of plague). The spirit is exceptionally depleted, eyes closed and drowsy, not just desiring sleep but strongly disliking being called. The mouth and tongue are not only dry; observing the tongue surface reveals no coating, and the tongue skin is dry and shiny like a mirror. The patient not only coughs and has a sore throat; the Lung dryness can reach the point of rotting, accompanied by vomiting blood and water (people from Fengtian stated that during the critical stage of this disease in the Xinhai year, vomiting blood and water was common). From this perspective, the plague is indeed the most severe form of the Shaoyin heat syndrome. Although after developing into the plague, it ferments into toxic bacteria and transmits mutually, leading to diverse complications such as bubonic or septicemic forms, its starting point generally aligns with the above description. However, this is not my baseless speculation. Let me cite a case to prove it:
In 1921, the plague prevailed in Harbin, Heilongjiang. Fengtian had strict prevention measures and avoided infection. However, due to communication between banks, the plague's toxic bacteria were transmitted among them. A bank employee surnamed Shi, in his thirties, developed pneumonic plague. His consciousness fluctuated between clarity and confusion, and he frequently spoke deliriously. His four limbs were cold, his heart felt hot, he desired cool foods, his urine was short and red, and he had not had a bowel movement for several days. His pulse was deep, fine, and slow. Although his heart felt hot, his body temperature was normal, and he lay with eyes closed, drowsy, opening them slightly only when called. This is precisely the scene described in the Shaoyin Chapter of *Shang Han Lun* as "desire to sleep." His tongue had no coating, was dry and shiny like a mirror, his throat was very dry and slightly painful, and he had occasional dry coughs. This is due to dryness generating heat, Kidney Qi failing to ascend, and Yin-Yang Qi failing to connect. Thus, the symptoms and pulse indicate undoubtedly that this is the plague. If the dryness-heat reaches its extreme, causing lung tissue rot and hemoptysis, it becomes incurable. Fortunately, it had not reached that stage. Urgent medication could still reverse the condition. The treatment method should focus on moistening dryness and clearing heat, while also assisting Kidney Qi to ascend, connecting with the Yang aspect of the Upper Jiao to achieve the practical effect of Kan-Li mutual assistance. Only when the pulse changes to surging and large is it a auspicious sign. Therefore, I prescribe the following formula:
Raw Gypsum (San liang, crushed finely) Anemarrhena Rhizome (Ba qian) Scrophularia Root (Ba qian) Raw Huai Yam (Liu qian) Wild Taishen (Wu qian) Licorice Root (San qian)
Decoct together to make three tea cups of decoction, take warm in three doses.
Note: This formula is Baizhu Jia Renshen Tang (White Tiger plus Ginseng Decoction) with Yam replacing Rice Sprout, plus Scrophularia Root. The intent of the formula: Use Gypsum to clear external excess heat; use Yam, Anemarrhena, and Scrophularia to nourish Kidney Yin below and moisten Lung dryness above; use Ginseng because the heat pathogen has sunk into Shaoyin, suppressing Kidney Qi so it cannot ascend. Ginseng's tonifying and ascending power helps Kidney Qi rise and assists Gypsum in expelling the sunken heat pathogen upwards and outwards. Moreover, in cases of Yin deficiency with excess heat, using Baizhu Tang alone often fails to reduce fever, whereas Baizhu Jia Renshen Tang succeeds. The combination of Ginseng and Gypsum can restore True Yin even when evil heat is blazing. After taking the medicine in three doses, the body heat subsided, the pulse rose, the tongue became slightly moist, and the spirit cleared. However, the stool had not passed, and internal heat was not fully cleared. He took one more dose of the original formula, after which the stool passed, and residual heat vanished. Since this case lacked bubonic or septicemic phenomena but presented signs of Lung dryness, dry tongue, and sore throat, it can be named Pneumonic Plague.
Later, I treated another person whose condition was largely similar to the previous case, except that the deep-fine pulse and dry-sore throat were even more severe. I still prescribed the former formula, instructing him to decoct fresh Imperata Rhizome (Mao Gen) in water and use this water to decoct the herbs. After decoction, raw Chicken Egg Yolk was mixed in and taken. The effect was extraordinary, hence naming this formula Kanli Hugen Decoction. I record the formula in detail below for medical adoption.
[Kanli Hugen Decoction]
Raw Gypsum (San liang, crushed finely) Anemarrhena Rhizome (Ba qian) Scrophularia Root (Ba qian) Wild Taishen (Wu qian)
Raw Huai Yam (Wu qian) Licorice Root (Er qian) Chicken Egg Yolk (Three eggs) Fresh Imperata Rhizome (Si liang, chopped)
First, boil the Imperata Rhizome briefly until it sinks. Take the decoction to replace water for decocting the first six herbs. Obtain three cups of decoction, take warm in three doses. Mix in one raw Chicken Egg Yolk per dose. This formula adds Egg Yolk compared to the previous one and uses Imperata Rhizome decoction because raw Egg Yolk nourishes Kidney and moistens Lungs effectively, while Imperata Rhizome inherits the initial Qi of Shaoyang, is cool and ascending, and can raise a deep-fine pulse. The above formula combines the principles of Huanglian Ejiao Tang from the Shaoyin Chapter and Baizhu Jia Renshen Tang from the Taiyang Chapter of *Shang Han Lun*. Huanglian Ejiao Tang originally uses Coptis, Scutellaria, Peony, Donkey-Hide Gelatin, and Egg Yolk. Since true Donkey-Hide Gelatin was unavailable, Scrophularia was used as a substitute. Since Gypsum and Anemarrhena are present, Coptis and Scutellaria are omitted. Westerners state that Egg Yolk contains adrenal medulla secretion, thus greatly nourishing Kidney True Yin, making it the main herb of Huanglian Ejiao Tang. It is not named separately because it should be taken raw mixed in, not decocted. Using this single ingredient retains the efficacy of Huanglian Ejiao Tang. As for Baizhu Jia Renshen Tang, removing Rice Sprout and replacing it with Raw Yam works because Yam harmonizes the Stomach (as Rice Sprout did) and assists Scrophularia and Egg Yolk in nourishing the Kidney. Using Baizhu Tang resolves latent heat, and adding Ginseng utilizes the synergy of Ginseng and Gypsum to generate fluids and quench thirst, resolving dryness-heat. Its tonifying power enters the Lower Jiao to assist Kidney Qi ascent, allowing Yin-Yang Qi to connect, transforming fine-minutes pulses to surging-large ones, and allowing evil to penetrate outward. Upon continued administration, the surging-large pulse gradually normalized, and the disease was completely cured.
For cough, add Fritillaria Bulb (Chuan Bei Mu) 3 qian. For sore throat, add Belamcanda Rhizome (She Gan) 3 qian. For vomiting blood/water, add Powdered Notoginseng Root (Sanqi) 2 qian, Powdered Rhino Horn (Xijiao) 1 qian, and Powdered Antelope Horn (Lingyangjiao) 1 qian. Mix evenly and take in three doses, or use only Notoginseng. For loose stools, administer cautiously and slowly. For slippery diarrhea, it is not Lower Jiao cold but urinary difficulty; use Ziyin Qingzao Tang (My proposed formula). After diarrhea stops, resume the main formula, reducing Gypsum to 2 liang and doubling Raw Yam to 1 liang, administering slowly. If the pulse is occasionally not fine/slow but near surging/rapid, this is the mildest plague; one dose of this formula brings rapid cure. In summary, the greater the dryness-heat, the slower and weaker the pulse, and the less body heat. If pulse rises and body heats up after medication, the disease mechanism is improving.
When I first treated this condition, I used only Baizhu Jia Renshen Tang with Yam replacing Rice Sprout. After curing it, I devised this formula, which proved even more effective.
Some doubt that Cold-Warm diseases do not transmit. Since plague is formed from the most severe form of Shaoyin Cold-Warm disease, why is it uniquely contagious? It is unknown that the contagious toxic bacteria arise from prolonged non-recovery, organ decay, or long-term failure of Yin-Yang connection leading to vascular blockage and putrefaction, which ferment into toxicity for transmission. Shaoyin Cold-Warm diseases that do not become plague do not reach this severity, hence they are not contagious. For plague acquired via transmission, the more it ferments, the stronger the toxicity; even mild cases can transmit to others. Therefore, strict prevention is needed at the slightest sign.
The progression of this disease varies. Observing Dr. Si Nian's report from Harbin, the symptoms are complex. I record the original text below for reference.
Spring 1921, Harbin Report. Symptoms of the plague that year: Incubation period is 3 to 7 days post-infection. Prodromal symptoms include headache, vertigo, loss of appetite, fatigue, vomiting, etc. Some have no prodrome. Then follows chills, shivering, sudden high fever reaching 39°C–40°C+, lingering or gradually decreasing, with lymphatic swelling. One or sometimes two masses appear before or within 1-2 days of fever, e.g., left inguinal and left axillary glands simultaneously. The mass may suppurate or dissipate unpredictably. Most patients are lethargic (explaining the "desire to sleep" of Shaoyin syndrome), with nocturnal delirium. Initial stage often features 2-3 episodes of diarrhea. Urine contains protein (sign of Kidney injury). Liver and spleen enlargement is common 1-2 days post-onset. Mild cases recover in 3-4 days with temperature drop. Severe cases (days 2-7) often suffer cardiac paralysis (pulse fine/minute akin to Shaoyin disease).
This disease divides into Bubonic, Septicemic, and Pneumonic Pestis (Plague). Bubonic Pestis is most common, involving inflammation of lymph nodes and surrounding tissues in one or multiple sites. Inguinal and femoral triangle lymph nodes are most susceptible, followed by axillary and cervical nodes. Occipital, elbow, ear, and popliteal nodes may also be involved. Septicemic Pestis presents with bean-sized spots, severe pain, progressing to pustules or gangrenous ulcers, potentially inducing lymphadenitis. Pneumonic Pestis is extremely severe, resembling catarrhal or lobar pneumonia, with sputum containing Pestis bacilli; it is the most malignant form.
The above description of plague is detailed but lacks treatment methods, suggesting Western medicine lacks definitive treatments. They claim mild cases recover in 3-4 days with temp drop; for severe cases with persistent high temp, why not use medicine to lower it? Regarding severe cases nearing death with cardiac paralysis, the cause is what I call Kidney Qi failing to reach the Heart, Yin-Yang disconnect, leading to weak heart beat and deep-slow-fine-weak pulse. If Kanli Hugen Decoction is administered urgently at the onset of high fever, it reduces heat and ascends Kidney Qi. With Kidney Qi support, the heart avoids paralysis, and crisis turns to safety. Their mention of lethargy matches my experience of drowsiness, both showing Shaoyin "desire to sleep," confirming my theory that this disease results from latent Qi transforming into heat entering the Kidney, not groundless talk. My previous formula lacked completeness because I hadn't seen the infectious toxin in Fengtian.
Later, reading *Shanxi Medical Journal*, I found Wu Xihuang's article "Eradication and Therapy of Plague" from Xiamen. His emphasis on detoxification compensates for my shortcomings. I record it below for practitioners.
Original Text: Once infected by epidemic bacteria, the danger is myriad. Roughly divided into Bubonic and Pneumonic Plague. The syndrome first attacks the Heart, weakening cardiac force; a thread-like pulse is the sole certain evidence of epidemic toxin invading the Heart. Secondly, temperature rises rapidly, with headache, vertigo, vomiting, gradually blurred consciousness, sinking into drowsy delirium, dementia, staggering gait, intense conjunctival congestion, white-coated tongue like sprinkled lime, or dark purple like ripe plum. Swelling and pain occur in neck, axilla, and upper inner thigh. Severe cases die in three days. Those with clear spirit may linger for days. Common formulas vary in efficacy. Here are tested effective ones for public use.
[Wang Mengying's Treatment for Buboes]
At onset, use Wang Mengying's Buboe Formula combined with Shenxi Pill repeatedly with good effect. Formula: Honeysuckle Flower (Liang Jin Ying Hua) 2 liang, Dandelion (Pu Gong Ying) 2 liang, Gleditsia Spine (Zao Ci) 1.5 qian, Powdered Licorice (Fen Gan Cao) 1 qian.
For vomiting, remove Licorice, add Fresh Bamboo Shavings (Xian Zhu Ru) 1 liang. If unavailable, use Clean Indigo Leaf Powder (Jing Qing Dai) 3 qian. For constipation and heavy heat, add Rhubarb (Da Huang) 3 qian. Decoct and take with Shenxi Pill. If uncontrolled, decoct Safflower (Zang Hong Hua) 2 qian in water to send down Real Bear Bile (Zhen Xiong Dan) 2 fen, stopping immediately. This formula, combining Dandelion, Honeysuckle, Gleditsia with Shenxi Pill, not only detoxifies but clears Blood Heat and disperses Blood stasis, truly a holy medicine for plague buboes. For White Blister Carbuncle, remove Gleditsia, add White Chrysanthemum (Bai Ju Hua) 1 liang. Accompanied by Black Pustule, alternate Shenxi Pill and Zijin Ding.
Da Qiao said: "Patient has headache, limb fatigue, joint stiffness, red spots, erysipelas, vomiting/diarrhea, dry tongue/throat, occasionally sudden coma, phlegm surge, orifice closure. This is turbid toxin internally blocked, attacking the Heart. Use aromatic turbidity-dispelling, detoxifying, heart-protecting agents. Pi Hui Qu Du Yin is primary."
[Pi Hui Qu Du Dispelling Turbidity and Toxicity Decoction]
Western Buffalo Stone (Xi Niu Huang) 8 fen (ground, taken with medicine) Human Midden Yellow (Ren Zhong Huang) 3 qian Nine-Joint Acorus (Jiu Jie Chang Pu) 5 fen Indigo Leaf (Dian Ye) 1.5 qian
Honeysuckle Bud (Ren Dong Rui) 5 qian (fresh steamed dew also acceptable) Wild Curcuma (Ye Yu Jin) 1 qian
Decoct in water. If buboes appear, or spots/carbuncles emerge, add Safflower 8 fen, Peach Kernel (Tao Ren) 3 qian, Bear Bile 4 fen (taken with medicine). For extreme thirst and sweating, add Rhino Horn (Xi Jiao) and Golden Juice (Jin Zhi). For coma/delirium, use Zhibao Pill or Angong Niuhuang Wan, taken with boiled water to open inner orifices first. At onset, do not purge immediately. Assess dry mouth, coma, blazing heat for purgative indications. First dispel turbidity and detoxify, then consider purging. Often effective. Purging method: Decoct Rhubarb, soak Zi Xue Dan (Purple Snow Pill) 5 fen. Avoid early use of bitter-cold herbs causing ice-blockage. If vessel obstruction, pale appearance, vague spirit, severe painful nodules, use Jiedu Huoxue Tang (Detoxify and Invigorate Blood Decoction).
Forsythia (Lian Qiao) 3 qian Bupleurum (Chai Hu) 2 qian Kudzu Root (Ge Gen) 2 qian Rehmannia Root (Sheng Di) 5 qian
Red Peony Root (Chi Shao) 3 qian Safflower (Hong Hua) 5 qian Peach Kernel (Tao Ren) 8 qian Magnolia Bark (Chuan Po) 1 qian (add later)
Angelica Root (Dang Gui) 1.5 qian Licorice (Gan Cao) 2 qian Sappan Wood (Su Mu) 2 liang
Mild cases at onset: take every 3 hours. Critical cases at onset: take every 2 hours, or combine several doses into paste for continuous intake. If fever, thirst, sweating, or hematemesis, add Raw Gypsum 1 liang, Reed Rhizome Juice (Lu Gen Zhi) 1 cup, mix with paste. Also consume more Antelope Horn and Rhino Horn juice. Pregnant women: add Dodder Seed (Sang Ji Sheng) 1 liang, Scutellaria Root (Huang Qin) 1 liang, slightly reduce Peach Kernel and Safflower.
For severe heat, dry mouth without fluid, surging-rapid pulse, scorched lips, extreme thirst, use Qingwen Baidu Yin (Clear Plague and Eliminate Toxin Decoction). For neck swelling (commonly called Frog Plague), use Puji Xiaodu Yin (Both formulas in *Wen Re Jing Wei*). Frequent use is effective. For spitting red saliva, take fresh Reed Rhizome juice. For constipation, add Rhubarb 3 qian.
*Treatment of Essential Prescriptions of the Golden Chamber* states: "Patients with E He (Malignant Nodules) suddenly develop nodules in the flesh, ranging from plum pit to bean size, with skin/flesh pain, high fever, aversion to cold."