第一方（脉案）暑滞积热，浊垢壅阻不宣，头痛而晕，肌烧如灼，皖愎郁闷、攻痛，泛逆呕吐，滴水不下，大解泄稀，舌苔腻，脉弦滑而紧。症系表里兼重，暑热兼湿，法宜苦降辛通、芳香化浊，以图挽回，占希之年，病邪缠绵，失治多日，内闭可虑，合议立方待高明裁定。咏案文字有鄙俚句怯，以系他人执笔，不便干涉，今仍其旧。鲜薄荷—钱五川连二钱以吴萸八分合水另煎郁金一钱飞滑石四钱鲜石菖蒲三钱鲜藿香二钱枯芩一钱竹茹一钱枳壳钱五紫蔻仁钱五鲜荷叶四钱鲜佩兰二钱广；陈皮钱五金银花四钱法半夏一钱另用灶心土一两鲜枇把叶一钱通草—钱先煎水八杯，再用此水煎以上各药，煎妥二小杯，冲入真紫雪丹一钱，一杯五分俟药已冷，先将病人鼻孔摄紧，不会闻知药味一气饮下一小杯，日服三次。此症唯一难关，即系剧烈之呕吐，滴水不存，连日在医院均系注射，不能服药。故用此法。七月六日第二方（脉案）服前药幸得未吐，（伊家大喜，据云十余日见水即吐，呕逆不止，此为第一次受药也）肌热较退，暑滞积热，羁困不宣，胸腹痞闷，呕吐稍平，烦扰不安，神志时时昏迷，大解泄溏粘稠，便数忽多忽少，舌苔腻，咏弦滑．呕热略减，此内闭各窍，略见开通，然仍属险期，再以芳香苦辛，宣清、通化、肃降、升达中焦论治。
鲜石菖蒲四钱川连一钱另以吴萸四分合煎鲜苇根—-两鲜藿香二钱枯芩一钱竹茹三钱银花四钱益元散四钱麸炒枳壳一钱五连翘二钱郁金一钱五广陈皮一钱五槟榔片一钱五扁豆皮四钱高梁米五钱鲜荷梗四钱炒莱菔子一钱，余以此药味太劣，呕症不欲用之，此乇君主张加入，并识之，紫雪丹八分，分二次冲入，杏仁一钱通草—钱仍以灶心土——两照前法煎服。七月七日第三方（脉案）服药后，呕逆已平，<此是大效，起死回生，在此一着）痰沫仍多：神志不清，手心烧灼，烦渴痞闷不安，大解泄利黄稠而粘，重坠腹疼，舌苔腻，脉弦滑，暑滞湿热与气互结，难期立化，再以原方略加宣开之品，以冀解除暑滞，宣通清窍。
鲜薄荷一钱五金银花四钱益元散四钱鲜藿香二钱连翘二钱郁金一钱五鲜佩兰—钱五川连一钱五另以吴萸五分煎水麸炒枳壳一钱五扁豆花三钱枯芩一钱广木香—饯五鲜石菖蒲四钱青陈皮一钱五橘红二钱通草一钱莱菔子一钱木香槟榔丸三钱高梁米五钱鲜荷叶四钱紫雪丹八分，分二次冲入此药煎妥，分二杯，早晚各服一杯，不需用手术矣。七月八日。
第四方（脉案）呕吐已平，肌热时甚时轻，大解热泄，腹疼重坠，次数频多，烦满痞闷，口渴思凉，神志转清，（此是佳兆）舌苔薄腻，脉弦滑而紧，暑滞浊热，留连肠胃，症势虽碱，湿热仍未全除，再以原方加减治之。
鲜薄荷一钱川连一钱五另以吴萸五分煎水炒益元散四钱鲜藿香一钱枯芩一钱通草一钱鲜石菖蒲四钱杭芍四钱麸炒枳壳一钱莱菔子一钱金银花四钱广木香一钱五栀子皮一钱香豆鼓二钱连翘一钱扁豆皮二钱鲜荷叶四钱．香附米一钱鲜佩兰—钱．郁金一钱五紫雪丹七分，分二次冲入，水煎分二次服。七月九日第五方（脉案）暑滞积热，粘滞肠胃，肌热未尽，大解次数虽减，所下粘滞未净腹仍坠痛，烦渴痞闷，舌苔腻，脉弦滑。所幸渐能饮食，精神已清，不致发生他变，再以宣通、清化、肃降为主，病去八、九，可望痊愈矣。
金银花四钱炒白芍四钱木香槟榔丸三钱布包香附米二钱鲜佩兰二钱益元散四钱炒黄芩一钱莱菔子一钱薏仁四钱广木香一钱五枳壳一钱五麸炒扁豆皮四钱鲜荷叶四钱川连一钱五郁金一钱五通草一钱鲜石菖蒲二钱此方约服五、六剂痊愈。
此温病逆传最危险之一例，最有研究之趣味，此症西医亦断定为肠窒扶斯并无错误，何以有用尽种种方法，竟不能治愈，且愈止吐而吐更甚，愈退热而热愈甚邪？于此可以证明中西医必各有所长，各有所短，中西药必各有所宜，绝不能强为拢合。余既主张用西药，即讲西医医理，用中药，即讲中医医理，方能彻底认识治法。最大目的，在使病者不死，又何可固执一途耶？余主张只学西医，不能完全适用于现代之病症，不学正当精纯之中医，亦不能适用于一般之病症。所可虑者，中医只学浅近西医之皮毛，即自命为通西医，有志之西医，研究中医，又苦于不得良师，只于五里雾中自古中医市侩故意捏造玄虚，使入迷惑，反将灵验精纯之医药，陇以烟雾，坏根即在于此。学得腐败不灵之中医，即自命为通中医，牵强拉扯，直欲将中西医混为一谈，危哉危哉，杀人之机会更多矣。此暑温与其他温病，大同小异，温病之可以致人死命，内闭一症，（即此症）最为难治．此方最灵，试验多矣。此症在庸中医，必用小陷胸汤，再下一等之庸中医，必用承气汤，再下一等之庸中医，见有表热：便解表发汗而用桂枝汤。但用小陷胸汤，必无效，用承气汤、桂枝汤，一剂而精神昏迷狂躁，必致上竭下厥，立成不治之绝症矣。此余阅历四十年之实验谈，并非武断。亲见此症误于中药者，不知凡几，笔难尽述。凡遇此逆传重症，呕逆昏迷，头痛烦躁身热（七八日之后）务宜仿照此方法，百试百验也。王芝亭君为山东安邱县老医，经验宏富，迩时年已六旬，为全镇治温病之圣手，余在当时方中年，论症多与此君合，故此症为余最得意之一例，以后遇有此症，无不应手奏效也。
以上所列医验，多系危笃之温病，不论春夏秋冬，各种温病，除略加一、二味因时令所用之药外，例如暑温，则加藿香、益元散等。其最有效之药，则为连翘、金银花、桑叶、菊花、鲜石菖蒲、鲜佩兰、鲜薄荷、鲜藿香、黄连、黄芩、郁金、牛黄、犀角、紫雪丹等。盖此症一见内闭征兆，例如剧烈之呕逆，顽固之肌热，精神昏迷或发狂，四肢或厥逆，即速以以上各药，大剂加减与服，百试百验，活人多矣。对此症常用之中药，例如生地、元参、半夏、花粉或瓜蒌等，用之得当，亦有效。但大黄、芒硝峻下之品，用之必格外谨慎，虽有必不得已用之者，然用不得当，则流弊大也。盖此内闭危症，纯是秽浊上壅，其邪不纯在肠胃，故芳香、辛开、苦降皆为不二法门，其治法远胜西医，何啻倍蓰。此症最难治者，为呕逆及昏迷发狂，应注意。余治温病，何止千百，幸无大误，差堪自信，选录各案，多系危乎其危并非普通小恙，所拟之方，均系百试百验，所揭示禁用之药，亦系治此症最易误犯者，竭诚相告，愿读余书者，实地试验也。温病必不得已时，脉沉实肠胃大热方可试用泻药，总以先用木香槟榔丸或小量之熟大黄，或西药中之甘汞锭分量宜小，且不可与中药同时并用等，缓缓下之，得便即止，万不可骤用大量，戒之戒之，认症不确，宁以缓用为是。
温病当正规之发热、身痛、头痛等症，以清解而愈；肠热甚者？泻利潮热，下之而愈；人皆能治，不必细述。所最可畏者；即为逆传心包络一症，致死之由，皆在于此。医者认症及病家稍有错误，必致断送性命，愿读余书者，对于本病，逆传之理论及各医案，三致意焉。
中医瑰宝苑 止园医话er
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痧疹（三）痧疹痧子、疹子、瘟疹，瘤子、丹痧、斑疹、风疹、瘾疹、骚疹，均中医书此症之别名，西医则分麻疹与猩红热二种（发疹窒扶斯及药物发疹从略），传染极速，且小儿患者尤多，不可忽也。
（原因）中医书谓疹乃温毒内蕴、外感时疠（不正之气）而发，虽有肺疹、胃疹之分，风、寒、暑、湿、燥、火之别。实则此症原因，极易明了，所谓疹本六气客邪，风寒暑湿，必从火化，此火字即足以概之，不必画蛇添足，反致滋人迷惑。西医谓本病之原因，由于空气及物体（例如患者所用衣物）介入者（由人传人）之传染等说，亦与中医说相通，惟有创伤之时，尤易传染，此理则中医不讲也。
（症候）中医论病：无潜伏期、前驱期之名称，故此症初起，只得先以倦怠为始，继则发热、头痛、喘急、咳嗽、呕恶，此时鼻涕眼泪加多，眼含水痕，尤为显明，西医所谓加答儿性症候是也。发热愈甚，颜面皮肤肿胀，约三、四日或一、二日，始见疹形发出。发热一，二日即出者轻，四、五日始出者重，若至六、七日千热，而疹子隐伏不透者最危险，—现即隐者更险。疹分二种，胃疹则如云密布，肺疹由点点分明。西医书谓①麻疹，先必有二度发热，发于皮肤粘膜及结膜，（例如门内、眼内等皮）故有流泪、咳嗽等现象，始则颜面，以次至于颈千四肢，均现界限分明．大如亚麻仁之赤斑，其中央有小丘疹甚多，（发疹朗）此时期内热最高，约再过一、二日，热渐退，第三、四日，疹乃消，第五、六日落屑，第八至十日为恢复期。②猩红热，发热恶寒，咽疼甚剧，头痛，疲劳，或痉挛，或呈脑膜炎症状，阅一、二日，即有大如帽针头，或亚麻仁之鲜红色密丛之疹，发于颈部及胸部．遍及全身，蔓延而成红斑，（甚则颇似草红纸色，疹中实含浆液脓汁，惟口唇及颐部，发疹者甚少，舌苔初现白色，第四、五日，则为赤色（覆盆子舌）即中医所谓深绛色舌苔也。中医肺疹但有颗粒无片状者之说，近似西医之麻疹；胃疹之说如云密布，漫无根盘近似西医之猩红热。所谓湿蒸热盛，口舌咽喉疳软，龈腐咽闭，穿腮破喉，喘促等险象，皆系猩红热并发白喉及肺炎之症。然中医治此二种疹病之法，大同小异，虽有肺胃之分，实则皆系注重肺胃，兼筹并顾，原无各别治法，似无庸过事区分。兹为预防本病之蔓延传染，不得不将麻疹与猩红热二症鉴别之点，根据西医医理，分述大略如下：1．麻疹，此症特异之点，在前驱期第二日终，软口盖俗称内上膛之处即粘膜发内疹，此时加答儿之症状极显明，例如结膜加答儿，则二目羞明流泪；鼻加答儿，则喷嚏流涕；咽头气管加答儿，则咽痛咳嗽等。再则为麻疹各斑之间？必有健康之皮肤中医所渭界限分明为之界限，绝不融合。猩红热则否，往往愈出愈多，如一片草红纸样。其次，则麻疹先发于颜面，而后及于全身，其发热症状，则在前驱期，恶寒发热一、二月，即觉热退轻减，此时往往认为偶尔感冒，巳告愈。乃再隔一、二月，忽然又发热，遂即渐渐发疹，此即所谓麻疹之二度注意此—二字发热，此皆麻疹之特异状态也。
2．猩红热，此症中医俗名烂喉痧，即此名称，循名责实，已可认定此症之性质。盖此症最多并发实扶的斯，（即白喉，重者一，二日即肿烂致命。）口腔、腭下腺及颈部淋巴腺，皆肿张，胙腮等类更有特具之覆盆子舌，绛赤色其疹与疹之间，愈红愈重？渐渐肿帐潮红融成一片。界限不分且其疹之发生，先自锁骨下与颈部为始，而后及于全身，但无论如何潮红，面部发疹甚少．尤其口之周围，多现苍白色，而无一疹，此猩红热特异之状态也。此症并发之白喉，最为危险，不呵不知，第三星期以后续发之肾脏灸、（颜面浮肿，尿量短浊，有大量沉淀物）肺炎等症，亦危险，故疹后更宜谨慎。
【背景信息】
书名：止园医话 章节：正文(17/29) 类别：医论
【待处理原文】
第一方（脉案）暑滞积热，浊垢壅阻不宣，头痛而晕，肌烧如灼，皖愎郁闷、攻痛，泛逆呕吐，滴水不下，大解泄稀，舌苔腻，脉弦滑而紧。症系表里兼重，暑热兼湿，法宜苦降辛通、芳香化浊，以图挽回，占希之年，病邪缠绵，失治多日，内闭可虑，合议立方待高明裁定。咏案文字有鄙俚句怯，以系他人执笔，不便干涉，今仍其旧。鲜薄荷—钱五川连二钱以吴萸八分合水另煎郁金一钱飞滑石四钱鲜石菖蒲三钱鲜藿香二钱枯芩一钱竹茹一钱枳壳钱五紫蔻仁钱五鲜荷叶四钱鲜佩兰二钱广；陈皮钱五金银花四钱法半夏一钱另用灶心土一两鲜枇把叶一钱通草—钱先煎水八杯，再用此水煎以上各药，煎妥二小杯，冲入真紫雪丹一钱，一杯五分俟药已冷，先将病人鼻孔摄紧，不会闻知药味一气饮下一小杯，日服三次。此症唯一难关，即系剧烈之呕吐，滴水不存，连日在医院均系注射，不能服药。故用此法。七月六日第二方（脉案）服前药幸得未吐，（伊家大喜，据云十余日见水即吐，呕逆不止，此为第一次受药也）肌热较退，暑滞积热，羁困不宣，胸腹痞闷，呕吐稍平，烦扰不安，神志时时昏迷，大解泄溏粘稠，便数忽多忽少，舌苔腻，咏弦滑．呕热略减，此内闭各窍，略见开通，然仍属险期，再以芳香苦辛，宣清、通化、肃降、升达中焦论治。
鲜石菖蒲四钱川连一钱另以吴萸四分合煎鲜苇根—-两鲜藿香二钱枯芩一钱竹茹三钱银花四钱益元散四钱麸炒枳壳一钱五连翘二钱郁金一钱五广陈皮一钱五槟榔片一钱五扁豆皮四钱高梁米五钱鲜荷梗四钱炒莱菔子一钱，余以此药味太劣，呕症不欲用之，此乇君主张加入，并识之，紫雪丹八分，分二次冲入，杏仁一钱通草—钱仍以灶心土——两照前法煎服。七月七日第三方（脉案）服药后，呕逆已平，<此是大效，起死回生，在此一着）痰沫仍多：神志不清，手心烧灼，烦渴痞闷不安，大解泄利黄稠而粘，重坠腹疼，舌苔腻，脉弦滑，暑滞湿热与气互结，难期立化，再以原方略加宣开之品，以冀解除暑滞，宣通清窍。
鲜薄荷一钱五金银花四钱益元散四钱鲜藿香二钱连翘二钱郁金一钱五鲜佩兰—钱五川连一钱五另以吴萸五分煎水麸炒枳壳一钱五扁豆花三钱枯芩一钱广木香—饯五鲜石菖蒲四钱青陈皮一钱五橘红二钱通草一钱莱菔子一钱木香槟榔丸三钱高梁米五钱鲜荷叶四钱紫雪丹八分，分二次冲入此药煎妥，分二杯，早晚各服一杯，不需用手术矣。七月八日。
第四方（脉案）呕吐已平，肌热时甚时轻，大解热泄，腹疼重坠，次数频多，烦满痞闷，口渴思凉，神志转清，（此是佳兆）舌苔薄腻，脉弦滑而紧，暑滞浊热，留连肠胃，症势虽碱，湿热仍未全除，再以原方加减治之。
鲜薄荷一钱川连一钱五另以吴萸五分煎水炒益元散四钱鲜藿香一钱枯芩一钱通草一钱鲜石菖蒲四钱杭芍四钱麸炒枳壳一钱莱菔子一钱金银花四钱广木香一钱五栀子皮一钱香豆鼓二钱连翘一钱扁豆皮二钱鲜荷叶四钱．香附米一钱鲜佩兰—钱．郁金一钱五紫雪丹七分，分二次冲入，水煎分二次服。七月九日第五方（脉案）暑滞积热，粘滞肠胃，肌热未尽，大解次数虽减，所下粘滞未净腹仍坠痛，烦渴痞闷，舌苔腻，脉弦滑。所幸渐能饮食，精神已清，不致发生他变，再以宣通、清化、肃降为主，病去八、九，可望痊愈矣。
金银花四钱炒白芍四钱木香槟榔丸三钱布包香附米二钱鲜佩兰二钱益元散四钱炒黄芩一钱莱菔子一钱薏仁四钱广木香一钱五枳壳一钱五麸炒扁豆皮四钱鲜荷叶四钱川连一钱五郁金一钱五通草一钱鲜石菖蒲二钱此方约服五、六剂痊愈。
此温病逆传最危险之一例，最有研究之趣味，此症西医亦断定为肠窒扶斯并无错误，何以有用尽种种方法，竟不能治愈，且愈止吐而吐更甚，愈退热而热愈甚邪？于此可以证明中西医必各有所长，各有所短，中西药必各有所宜，绝不能强为拢合。余既主张用西药，即讲西医医理，用中药，即讲中医医理，方能彻底认识治法。最大目的，在使病者不死，又何可固执一途耶？余主张只学西医，不能完全适用于现代之病症，不学正当精纯之中医，亦不能适用于一般之病症。所可虑者，中医只学浅近西医之皮毛，即自命为通西医，有志之西医，研究中医，又苦于不得良师，只于五里雾中自古中医市侩故意捏造玄虚，使入迷惑，反将灵验精纯之医药，陇以烟雾，坏根即在于此。学得腐败不灵之中医，即自命为通中医，牵强拉扯，直欲将中西医混为一谈，危哉危哉，杀人之机会更多矣。此暑温与其他温病，大同小异，温病之可以致人死命，内闭一症，（即此症）最为难治．此方最灵，试验多矣。此症在庸中医，必用小陷胸汤，再下一等之庸中医，必用承气汤，再下一等之庸中医，见有表热：便解表发汗而用桂枝汤。但用小陷胸汤，必无效，用承气汤、桂枝汤，一剂而精神昏迷狂躁，必致上竭下厥，立成不治之绝症矣。此余阅历四十年之实验谈，并非武断。亲见此症误于中药者，不知凡几，笔难尽述。凡遇此逆传重症，呕逆昏迷，头痛烦躁身热（七八日之后）务宜仿照此方法，百试百验也。王芝亭君为山东安邱县老医，经验宏富，迩时年已六旬，为全镇治温病之圣手，余在当时方中年，论症多与此君合，故此症为余最得意之一例，以后遇有此症，无不应手奏效也。
以上所列医验，多系危笃之温病，不论春夏秋冬，各种温病，除略加一、二味因时令所用之药外，例如暑温，则加藿香、益元散等。其最有效之药，则为连翘、金银花、桑叶、菊花、鲜石菖蒲、鲜佩兰、鲜薄荷、鲜藿香、黄连、黄芩、郁金、牛黄、犀角、紫雪丹等。盖此症一见内闭征兆，例如剧烈之呕逆，顽固之肌热，精神昏迷或发狂，四肢或厥逆，即速以以上各药，大剂加减与服，百试百验，活人多矣。对此症常用之中药，例如生地、元参、半夏、花粉或瓜蒌等，用之得当，亦有效。但大黄、芒硝峻下之品，用之必格外谨慎，虽有必不得已用之者，然用不得当，则流弊大也。盖此内闭危症，纯是秽浊上壅，其邪不纯在肠胃，故芳香、辛开、苦降皆为不二法门，其治法远胜西医，何啻倍蓰。此症最难治者，为呕逆及昏迷发狂，应注意。余治温病，何止千百，幸无大误，差堪自信，选录各案，多系危乎其危并非普通小恙，所拟之方，均系百试百验，所揭示禁用之药，亦系治此症最易误犯者，竭诚相告，愿读余书者，实地试验也。温病必不得已时，脉沉实肠胃大热方可试用泻药，总以先用木香槟榔丸或小量之熟大黄，或西药中之甘汞锭分量宜小，且不可与中药同时并用等，缓缓下之，得便即止，万不可骤用大量，戒之戒之，认症不确，宁以缓用为是。
温病当正规之发热、身痛、头痛等症，以清解而愈；肠热甚者？泻利潮热，下之而愈；人皆能治，不必细述。所最可畏者；即为逆传心包络一症，致死之由，皆在于此。医者认症及病家稍有错误，必致断送性命，愿读余书者，对于本病，逆传之理论及各医案，三致意焉。
中医瑰宝苑 止园医话er
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痧疹（三）痧疹痧子、疹子、瘟疹，瘤子、丹痧、斑疹、风疹、瘾疹、骚疹，均中医书此症之别名，西医则分麻疹与猩红热二种（发疹窒扶斯及药物发疹从略），传染极速，且小儿患者尤多，不可忽也。
（原因）中医书谓疹乃温毒内蕴、外感时疠（不正之气）而发，虽有肺疹、胃疹之分，风、寒、暑、湿、燥、火之别。实则此症原因，极易明了，所谓疹本六气客邪，风寒暑湿，必从火化，此火字即足以概之，不必画蛇添足，反致滋人迷惑。西医谓本病之原因，由于空气及物体（例如患者所用衣物）介入者（由人传人）之传染等说，亦与中医说相通，惟有创伤之时，尤易传染，此理则中医不讲也。
（症候）中医论病：无潜伏期、前驱期之名称，故此症初起，只得先以倦怠为始，继则发热、头痛、喘急、咳嗽、呕恶，此时鼻涕眼泪加多，眼含水痕，尤为显明，西医所谓加答儿性症候是也。发热愈甚，颜面皮肤肿胀，约三、四日或一、二日，始见疹形发出。发热一，二日即出者轻，四、五日始出者重，若至六、七日千热，而疹子隐伏不透者最危险，—现即隐者更险。疹分二种，胃疹则如云密布，肺疹由点点分明。西医书谓①麻疹，先必有二度发热，发于皮肤粘膜及结膜，（例如门内、眼内等皮）故有流泪、咳嗽等现象，始则颜面，以次至于颈千四肢，均现界限分明．大如亚麻仁之赤斑，其中央有小丘疹甚多，（发疹朗）此时期内热最高，约再过一、二日，热渐退，第三、四日，疹乃消，第五、六日落屑，第八至十日为恢复期。②猩红热，发热恶寒，咽疼甚剧，头痛，疲劳，或痉挛，或呈脑膜炎症状，阅一、二日，即有大如帽针头，或亚麻仁之鲜红色密丛之疹，发于颈部及胸部．遍及全身，蔓延而成红斑，（甚则颇似草红纸色，疹中实含浆液脓汁，惟口唇及颐部，发疹者甚少，舌苔初现白色，第四、五日，则为赤色（覆盆子舌）即中医所谓深绛色舌苔也。中医肺疹但有颗粒无片状者之说，近似西医之麻疹；胃疹之说如云密布，漫无根盘近似西医之猩红热。所谓湿蒸热盛，口舌咽喉疳软，龈腐咽闭，穿腮破喉，喘促等险象，皆系猩红热并发白喉及肺炎之症。然中医治此二种疹病之法，大同小异，虽有肺胃之分，实则皆系注重肺胃，兼筹并顾，原无各别治法，似无庸过事区分。兹为预防本病之蔓延传染，不得不将麻疹与猩红热二症鉴别之点，根据西医医理，分述大略如下：1．麻疹，此症特异之点，在前驱期第二日终，软口盖俗称内上膛之处即粘膜发内疹，此时加答儿之症状极显明，例如结膜加答儿，则二目羞明流泪；鼻加答儿，则喷嚏流涕；咽头气管加答儿，则咽痛咳嗽等。再则为麻疹各斑之间？必有健康之皮肤中医所渭界限分明为之界限，绝不融合。猩红热则否，往往愈出愈多，如一片草红纸样。其次，则麻疹先发于颜面，而后及于全身，其发热症状，则在前驱期，恶寒发热一、二月，即觉热退轻减，此时往往认为偶尔感冒，巳告愈。乃再隔一、二月，忽然又发热，遂即渐渐发疹，此即所谓麻疹之二度注意此一二字发热，此皆麻疹之特异状态也。
2．猩红热，此症中医俗名烂喉痧，即此名称，循名责实，已可认定此症之性质。盖此症最多并发实扶的斯，（即白喉，重者一，二日即肿烂致命。）口腔、腭下腺及颈部淋巴腺，皆肿张，胙腮等类更有特具之覆盆子舌，绛赤色其疹与疹之间，愈红愈重？渐渐肿帐潮红融成一片。界限不分且其疹之发生，先自锁骨下与颈部为始，而后及于全身，但无论如何潮红，面部发疹甚少．尤其口之周围，多现苍白色，而无一疹，此猩红热特异之状态也。此症并发之白喉，最为危险，不呵不知，第三星期以后续发之肾脏灸、（颜面浮肿，尿量短浊，有大量沉淀物）肺炎等症，亦危险，故疹后更宜谨慎。
【翻译内容】
第一段（脉案记录）：暑邪停滞，积热内生，污浊垢腻之物壅塞阻滞，气机不得宣通，导致头痛且眩晕，肌肤灼热如火烧，脘腹部郁闷不适、攻窜作痛，伴有恶心呕吐，滴水难进，大便稀薄，舌苔厚腻，脉象弦滑而紧。此证属于表里同病且病情严重，暑热夹杂湿气。治疗法则应当采用苦味药以降泄、辛味药以通阳，配合芳香药物以化除湿浊，以此谋求挽回生机。患者正值壮年，但病邪缠绵难愈，延误治疗多日，出现内闭（邪气闭塞体内重要通道）的危险情况令人担忧。经过商议拟定处方，等待高明医生裁定。咏（作者自称）的病历文字有些粗俗笨拙，因为是他人代笔，不便干涉修改，现在保持原样。鲜薄荷一钱五分，黄连二钱，另取吴茱萸八分与水单独煎煮；郁金一钱，飞滑石四钱，鲜石菖蒲三钱，鲜藿香二钱，黄芩一钱，竹茹一钱，枳壳五分，紫蔻仁五分，鲜荷叶四钱，鲜佩兰二钱，广陈皮五分，金银花四钱，法半夏一钱，另取灶心土一两，鲜枇杷叶一钱，通草一钱。先将上述药物用水八杯先煎，再用此水煎煮其余各药，煎好后得到两小杯药液，冲入真紫雪丹一钱（约一杯五分）。待药液冷却后，先将病人的鼻孔捏紧，使其闻不到药味，一口气喝下一小杯，每日服用三次。此症唯一的难关就是剧烈的呕吐，滴水不进，连日来在医院都是靠注射维持，无法口服药物。所以采用这种方法。七月六日。
第二段（脉案记录）：服用前面的药物后，幸好没有再呕吐。（家属非常高兴，据他们说十多天来见水就吐，呕逆不止，这是第一次服药见效）肌肤的热度稍微减退，但暑邪停滞积热，依然羁留困阻不得宣散，胸腹部痞闷，呕吐稍微平息，心中烦扰不安，神志时常昏迷，大便稀薄粘稠，排便次数忽多忽少，舌苔厚腻，脉象弦滑。呕吐和热度略微减轻，这说明内部闭塞的各窍道略微有了开通的迹象，然而仍然处于危险时期。再次采用芳香、苦辛的药物，通过宣散清利、通化解浊、肃降肺气、升达中焦的方法进行治疗。
鲜石菖蒲四钱，黄连一钱，另取吴茱萸四分合煎；鲜苇根一两，鲜藿香二钱，黄芩一钱，竹茹三钱，金银花四钱，益元散四钱，麸炒枳壳一钱五分，连翘二钱，郁金一钱五分，广陈皮一钱五分，槟榔片一钱五分，扁豆皮四钱，高粱米五钱，鲜荷梗四钱，炒莱菔子一钱。我因为觉得这味药味道太差，呕吐的病人不想用，但这王君主张加入，并记录下来。紫雪丹八分，分两次冲入；杏仁一钱，通草一钱，仍然用灶心土一两，按照之前的方法煎服。七月七日。
第三段（脉案记录）：服药后，呕逆已经平息，（这是巨大的疗效，起死回生，关键在于这一招）痰沫仍然很多，神志不清，手心灼热，心烦口渴，痞闷不安，大便稀薄黄稠且粘，腹部沉重坠痛，舌苔厚腻，脉象弦滑。暑邪停滞湿热与气机相互纠结，难以期望立刻化解，再次在原方基础上稍微增加一些宣散开通的药物，希望能解除暑邪停滞，宣通清窍。
鲜薄荷一钱五分，金银花四钱，益元散四钱，鲜藿香二钱，连翘二钱，郁金一钱五分，鲜佩兰一钱五分，黄连一钱五分，另取吴茱萸五分煎水；麸炒枳壳一钱五分，扁豆花三钱，黄芩一钱，广木香五分，鲜石菖蒲四钱，青皮和陈皮各一钱五分，橘红二钱，通草一钱，莱菔子一钱，木香槟榔丸三钱，高粱米五钱，鲜荷叶四钱，紫雪丹八分，分两次冲入。此药煎好，分两杯，早晚各服一杯，不需要使用手术了。七月八日。
第四段（脉案记录）：呕吐已经平息，肌肤热度有时重有时轻，大便热性腹泻，腹部疼痛且有沉重下坠感，次数频繁，烦闷痞塞，口渴想喝凉水，神志转为清醒，（这是好的征兆）舌苔薄腻，脉象弦滑而紧。暑邪停滞浊热，留恋在肠胃，病情虽然减轻，但湿热仍未完全清除，再次在原方基础上加减治疗。
鲜薄荷一钱，黄连一钱五分，另取吴茱萸五分煎水；炒益元散四钱，鲜藿香一钱，黄芩一钱，通草一钱，鲜石菖蒲四钱，杭白芍四钱，麸炒枳壳一钱，莱菔子一钱，金银花四钱，广木香一钱五分，栀子皮一钱，香豉二钱，连翘一钱，扁豆皮二钱，鲜荷叶四钱，香附米一钱，鲜佩兰一钱，郁金一钱五分，紫雪丹七分，分两次冲入，水煎分两次服用。七月九日。
第五段（脉案记录）：暑邪停滞积热，粘滞在肠胃，肌肤热度尚未完全消退，大便次数虽然减少，但排出的粘滞物未净，腹部仍有坠痛，心烦口渴，痞闷，舌苔厚腻，脉象弦滑。庆幸的是逐渐能够进食，精神已经清醒，不会发生其他变故，再次以宣通、清化、肃降为主要治法，病去八九，有望痊愈。
金银花四钱，炒白芍四钱，木香槟榔丸三钱（布包），香附米二钱，鲜佩兰二钱，益元散四钱，炒黄芩一钱，莱菔子一钱，薏苡仁四钱，广木香一钱五分，枳壳一钱五分，麸炒扁豆皮四钱，鲜荷叶四钱，黄连一钱五分，郁金一钱五分，通草一钱，鲜石菖蒲二钱。此方大约服用五六剂即可痊愈。
这是温病逆传（病邪不按正常顺序传变，直接深入脏腑）最危险的一个案例，最有研究的趣味。西医也将此症诊断为肠伤寒（Typhoid Fever，文中译为“肠窒扶斯”），并没有错误。为什么用尽了各种方法，竟然不能治愈，而且越止吐呕吐越严重，越退热热度越高呢？由此可以证明中医和西医必然各有长处，也各有短处，中药和西药必然各有适宜的情况，绝不能强行混合。我既然主张用西药，就要讲西医的医理；用中药，就要讲中医的医理，这样才能彻底认识治疗方法。最大的目的是让病人不死，又何必固执于某一种途径呢？我主张只学习西医，不能完全适用于现代的病症；不学习正宗精纯的中医，也不能适用于一般的病症。令人担忧的是，中医只学了西医浅显的皮毛，就自命为通晓西医；有志向的西医研究中医，又苦于得不到良师，只在迷雾中摸索。自古以来，中医市侩故意捏造玄虚，使人迷惑，反而将灵验精纯的医药笼罩在烟雾中，败坏根基就在这里。学得腐败不灵的中医，就自命为通晓中医，牵强附会，简直想把中西医混为一谈，危险啊危险，害人的机会更多了。这种暑温与其他温病大同小异，温病之所以能致人死亡，内闭这一症（即此症）最为难治。这个方子最灵验，试验了很多次。遇到这种病症，平庸的中医一定会用小陷胸汤，再低一等的平庸中医，一定会用承气汤，再低一等的平庸中医，见到有表热，就解表发汗而用桂枝汤。但如果用小陷胸汤，必定无效；用承气汤、桂枝汤，一剂下去就会导致精神昏迷狂躁，必然导致上竭下厥，立刻成为不治的绝症。这是我经历四十年来的实验总结，并非武断。亲眼看到此症被中药误治的，不知有多少，笔墨难以尽述。凡是遇到这种逆传重症，出现呕逆昏迷、头痛烦躁身热（在发病七八天后），务必模仿此方法，百试百验。王芝亭先生是山东安丘县的老医生，经验丰富，当时年已六十岁，是全镇治疗温病的圣手。我当时正值中年，辨证论治大多与此君相符，所以此症是我得意之作，以后遇到此症，无不随手奏效。
以上所列医疗经验，多是危重的温病，不论春夏秋冬，各种温病，除了略微加一两种因时令所用的药物外，例如暑温，则加藿香、益元散等。其中最有效的药物，则是连翘、金银花、桑叶、菊花、鲜石菖蒲、鲜佩兰、鲜薄荷、鲜藿香、黄连、黄芩、郁金、牛黄、犀角、紫雪丹等。只要此症一见内闭征兆，例如剧烈的呕逆，顽固的肌肤高热，精神昏迷或发狂，四肢厥冷，就迅速以上述各药，大剂量加减服用，百试百验，救活的人很多。对此症常用的中药，例如生地、玄参、半夏、花粉或瓜蒌等，用得恰当，也有效。但是大黄、芒硝这类峻猛泻下的药物，使用必须格外谨慎，虽然有不得已要用的时候，但如果使用不当，流弊很大。因为这种内闭危症，纯粹是秽浊之气上壅，邪气不仅仅在肠胃，所以芳香、辛开、苦降都是不二法门，其治疗效果远超西医，何止一倍两倍。此症最难治的是呕逆以及昏迷发狂，需要注意。我治疗温病，何止千百例，幸好没有大失误，还算自信。选录的各案，多是极其危险的，并非普通小病，所拟定的方子，都是百试百验，所揭示禁用的药物，也是治疗此症最容易误犯的，竭诚相告，希望读我书的人，实地试验。温病在不得已的情况下，脉象沉实、肠胃大热才可以试用泻药，总之先用木香槟榔丸或小量的熟大黄，或者西药中的甘汞锭，分量宜小，且不可与中药同时并用等，缓缓泻下，得大便即止，万万不可骤然使用大量，切记切记，辨证如果不准确，宁可缓慢使用为宜。
温病如果表现为正规的发热、身痛、头痛等症状，用清热解表的方法就能痊愈；肠道热盛的，出现腹泻、潮热，用泻下的方法就能痊愈；这些大家都能够治疗，不必细述。最令人畏惧的，就是逆传心包络这一症，致死的原因都在于此。医生辨证和病人家属稍有错误，必定导致丧命，希望读我书的人，对本病逆传的理论及各医案，要再三留意。
中医瑰宝苑 止园医话
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痧疹（三）：痧疹、痧子、疹子、瘟疹、瘤子、丹痧、斑疹、风疹、瘾疹、骚疹，都是中医书中此症的别名，西医则分为麻疹与猩红热两种（发疹性伤寒及药物引起的皮疹从略），传染性极快，且小儿患者尤其多，不可忽视。
（原因）中医书认为疹是由于温毒内蕴，外感时行疠气（不正之气）而发作，虽然有肺疹、胃疹之分，风、寒、暑、湿、燥、火之别。实际上此症的原因，极易明了，所谓疹本是六气客邪，风寒暑湿，必然从火化，这个“火”字就足以概括，不必画蛇添足，反而导致让人迷惑。西医认为本病的原因，是由于空气及物体（例如患者所用衣物）介入者（由人传人）的传染等说法，也与中医说法相通，只有在有创伤的时候，更容易传染，这个道理中医不讲。
（症候）中医论述疾病：没有潜伏期、前驱期的名称，所以此症初起，只能先以倦怠开始，接着出现发热、头痛、喘急、咳嗽、恶心呕吐，此时鼻涕眼泪增多，眼睛含水痕，尤为明显，这就是西医所谓的卡他性（Catarrhal）症候。发热越厉害，颜面皮肤肿胀，约三、四天或一、两天，才见到疹形发出。发热一、两天就出的较轻，四、五天才出的较重，如果到了六、七天高热，而疹子隐伏不透的最危险，一出即隐的更险。疹分两种，胃疹则像云密布，肺疹则由点点分明。西医书说①麻疹，先前必须有二度发热，发于皮肤粘膜及结膜，（例如眼睑内、眼内等部位）所以有流泪、咳嗽等现象，起初在颜面，依次到颈部及四肢，都呈现界限分明、大如亚麻仁的赤斑，其中央有很多小丘疹，（发疹期）此时期内热最高，约再过一、两天，热渐退，第三、四天，疹乃消退，第五、六天脱屑，第八至十天为恢复期。②猩红热，发热恶寒，咽痛剧烈，头痛，疲劳，或痉挛，或呈脑膜炎症状，过一、两天，就有大如帽针头，或亚麻仁的鲜红色密集丛集的疹，发于颈部及胸部，遍及全身，蔓延而成红斑，（甚至颇似草红纸色，疹中实际含浆液脓汁，只有口唇及颏部，发疹的很少，舌苔初现白色，第四、五天，则为赤色（覆盆子舌），即中医所谓深绛色舌苔。中医肺疹只有颗粒无片状的说法，近似西医的麻疹；胃疹的说法如云密布，漫无根盘，近似西医的猩红热。所谓湿蒸热盛，口舌咽喉溃烂，牙龈腐烂咽喉闭塞，穿腮破喉，喘促等险象，都是猩红热并发白喉及肺炎的症状。然而中医治疗这两种疹病的方法，大同小异，虽然有肺胃之分，实际上都是注重肺胃，兼顾并顾，原本没有分别的治疗方法，似乎无需过分区分。现在为了预防本病的蔓延传染，不得不将麻疹与猩红热两种病症鉴别的要点，根据西医医理，分述大致如下：1．麻疹，此症特异的地方，在前驱期第二日结束，软腭俗称内上膛之处即粘膜发内疹，此时卡他的症状极明显，例如结膜卡他，则双目羞明流泪；鼻卡他，则喷嚏流涕；咽头气管卡他，则咽痛咳嗽等。再则为麻疹各斑之间，必有健康的皮肤，中医所谓界限分明谓之界限，绝不融合。猩红热则不然，往往越出越多，如一片草红纸样。其次，则麻疹先发于颜面，而后及于全身，其发热症状，则在前驱期，恶寒发热一、两天，就觉得热退轻减，此时往往认为偶尔感冒，已经痊愈。乃再隔一、两天，忽然又发热，遂即渐渐发疹，此即所谓麻疹的二度发热，注意此“二”字发热，此皆麻疹的特异状态也。
2．猩红热，此症中医俗名烂喉痧，凭此名称，循名责实，已可认定此症的性质。盖此症最多并发白喉（即白喉，重的一、两天即肿烂致命），口腔、腭下腺及颈部淋巴腺，皆肿胀，腮腺等类更有特有的覆盆子舌，绛赤色。其疹与疹之间，愈红愈重，渐渐肿胀潮红融成一片，界限不分。且其疹的发生，先自锁骨下与颈部开始，而后及于全身，但无论如何潮红，面部发疹很少，尤其口的周围，多现苍白色，而无一疹，此猩红热特异的状态也。此症并发的白喉，最为危险，不可不知，第三星期以后续发的肾炎、（颜面浮肿，尿量短浊，有大量沉淀物）、肺炎等症，也危险，所以疹后更宜谨慎。
[Background Information]
Book: Zhiyuan Yihua (Medical Conversations from the Zhi Garden)
Chapter: Main Text (17/29)
Category: Medical Discussion
[First Prescription (Pulse Case)]
Summerheat stagnation and accumulated heat, with turbid filth obstructing and failing to disperse, causing headache and dizziness. The skin burns as if on fire. The epigastrium and hypochondrium feel depressed and painful with attacking sensations. There is nausea, vomiting, inability to swallow even a drop of water, and loose stools. The tongue coating is greasy, and the pulse is wiry, slippery, and tight. This syndrome involves both exterior and interior aspects being severe, with summerheat complicated by dampness. The treatment method should employ bitter drugs to descend and acrid drugs to unblock, combined with aromatic herbs to transform turbidity, in an attempt to reverse the condition. Although the patient is in the prime of life, the pathogenic factors are lingering. Having been untreated for many days, there is concern about internal closure (obstruction of internal pathways). After discussion, a prescription was formulated awaiting the judgment of a skilled physician. The text of Yong's case record contains some vulgar or clumsy phrases because it was written by someone else; interference is inappropriate, so it remains unchanged. Fresh Mint (Bohe) 1.5 qian, Coptis Rhizome (Chuanlian) 2 qian, separately decocted with Evodia Fruit (Wuyu) 0.8 fen in water; Curcuma Aromatica (Yujin) 1 qian, Prepared Talcum (Fei Huashi) 4 qian, Fresh Acorus Tatarinowii (Shichangpu) 3 qian, Fresh Agastache (Huoxiang) 2 qian, Scutellaria Baicalensis (Kuang Qin) 1 qian, Bamboo Shavings (Zhuru) 1 qian, Aurantium Fructus (Zhiqiao) 0.5 qian, Amomum Villosum (Zike Ren) 0.5 qian, Fresh Lotus Leaf (Heye) 4 qian, Fresh Pogostemon (Peilan) 2 qian, Tangerine Peel (Guang Chenpi) 0.5 qian, Lonicera Japonica (Jinyinhua) 4 qian, Pinellia Ternata (Fabanxia) 1 qian, Hearth Earth (Zaoxintu) 1 liang (used separately), Fresh Loquat Leaf (Pipaye) 1 qian, Thunbergia Fritillaria (Tongcao) 1 qian. First decoct these ingredients in eight cups of water, then use this water to decoct the remaining herbs. Once decocted, obtain two small cups of liquid. Add one qian of genuine Zixue Dan (Purple Snow Pill), which amounts to approximately one cup and five fen. Wait for the medicine to cool. Pinch the patient's nostrils tightly so they cannot smell the medicine, and have them drink one small cup in one go. Administer three times daily. The only critical difficulty in this case is the severe vomiting, where not even a drop of water can be retained. For several consecutive days at the hospital, intravenous injections were used because oral medication was impossible. Hence, this method was employed. July 6th.
[Second Prescription (Pulse Case)]
Fortunately, after taking the previous medicine, vomiting did not occur. (The family was overjoyed, stating that for over ten days, seeing water caused immediate vomiting with incessant retching. This was the first time the medicine was effective.) The body heat has slightly subsided. Summerheat stagnation and accumulated heat remain trapped and undispersed. There is chest and abdominal fullness and stuffiness. Vomiting has slightly calmed down, but there is restlessness and anxiety. Consciousness is occasionally clouded. Stools are loose, sticky, and viscous. Bowel movement frequency varies between high and low. The tongue coating is greasy, and the pulse is wiry and slippery. Vomiting and heat have slightly decreased. This indicates that the internally closed orifices have slightly opened. However, the condition still belongs to a dangerous period. Treatment continues with aromatic, bitter, and acrid herbs to ventilate clarity, transform turbidity, direct qi downward, and ascend the middle jiao.
Fresh Acorus Tatarinowii (Shichangpu) 4 qian, Coptis Rhizome (Chuanlian) 1 qian, separately decocted with Evodia Fruit (Wuyu) 0.4 fen; Fresh Reed Rhizome (Xian Weigen) 1 liang, Fresh Agastache (Huoxiang) 2 qian, Scutellaria Baicalensis (Kuang Qin) 1 qian, Bamboo Shavings (Zhuru) 3 qian, Lonicera Japonica (Yinhua) 4 qian, Yi Yuan San 4 qian, Bran-fried Aurantium Fructus (Zhiqiao) 1.5 qian, Forsythia Suspensa (Lianqiao) 2 qian, Curcuma Aromatica (Yujin) 1.5 qian, Tangerine Peel (Guang Chenpi) 1.5 qian, Areca Seed (Binglang Pian) 1.5 qian, Dolichos Lablab (Biandou Pi) 4 qian, Sorghum Vulgare (Gaoliang Mi) 5 qian, Fresh Lotus Stem (He Geng) 4 qian, Fried Radish Seed (Laifuzi) 1 qian. I considered this herb too unpleasant-tasting and reluctant to use it for vomiting patients, but Mr. Wang insisted on its inclusion, so I note it here. Zixue Dan (Purple Snow Pill) 0.8 fen, divided into two doses to be mixed in. Almond Seed (Xingren) 1 qian, Thunbergia Fritillaria (Tongcao) 1 qian. Still use Hearth Earth (Zaoxintu) 1 liang and decoct/administer according to the previous method. July 7th.
[Third Prescription (Pulse Case)]
After taking the medicine, vomiting and retching have ceased. (This is a major effect, bringing the dying back to life, hinging on this single step.) Phlegm foam remains abundant. Consciousness is unclear. Palms are burning. There is irritability, thirst, stuffiness, and discomfort. Stools are yellow, thick, sticky, and loose. There is a heavy sensation and abdominal pain. Tongue coating is greasy. Pulse is wiry and slippery. Summerheat stagnation, damp-heat, and qi are mutually knotted, making rapid resolution unlikely. Again, the original formula is slightly modified with added dispersing and opening agents, hoping to resolve summerheat stagnation and open the clear orifices.
Fresh Mint (Bohe) 1.5 qian, Lonicera Japonica (Jinyinhua) 4 qian, Yi Yuan San 4 qian, Fresh Agastache (Huoxiang) 2 qian, Forsythia Suspensa (Lianqiao) 2 qian, Curcuma Aromatica (Yujin) 1.5 qian, Fresh Pogostemon (Peilan) 1.5 qian, Coptis Rhizome (Chuanlian) 1.5 qian, separately decocted with Evodia Fruit (Wuyu) 0.5 fen in water; Bran-fried Aurantium Fructus (Zhiqiao) 1.5 qian, Dolichos Lablab Flower (Biandou Hua) 3 qian, Scutellaria Baicalensis (Kuang Qin) 1 qian, Aucklandia Root (Guang Muxiang) 0.5 qian, Fresh Acorus Tatarinowii (Shichangpu) 4 qian, Qingpi and Chenpi 1.5 qian each, Exocarpium Citri Reticulatae (Juhong) 2 qian, Thunbergia Fritillaria (Tongcao) 1 qian, Radish Seed (Laifuzi) 1 qian, Muxiang Binglang Wan 3 qian, Sorghum Vulgare (Gaoliang Mi) 5 qian, Fresh Lotus Leaf (Heye) 4 qian, Zixue Dan (Purple Snow Pill) 0.8 fen, divided into two doses to be mixed in. Once decocted, divide into two cups. Take one cup in the morning and one in the evening. Surgery is no longer needed. July 8th.
[Fourth Prescription (Pulse Case)]
Vomiting has ceased. Body heat fluctuates in intensity. Stools are hot and diarrheal. Abdominal pain feels heavy and dragging, with frequent occurrences. There is irritability, fullness, and stuffiness. Thirst for cold drinks. Consciousness has cleared up. (This is a favorable sign.) Tongue coating is thin and greasy. Pulse is wiry, slippery, and tight. Summerheat stagnation and turbid heat linger in the intestines and stomach. Although the severity has lessened, damp-heat has not been completely eliminated. Treatment continues with modifications of the original formula.
Fresh Mint (Bohe) 1 qian, Coptis Rhizome (Chuanlian) 1.5 qian, separately decocted with Evodia Fruit (Wuyu) 0.5 fen in water; Stir-fried Yi Yuan San 4 qian, Fresh Agastache (Huoxiang) 1 qian, Scutellaria Baicalensis (Kuang Qin) 1 qian, Thunbergia Fritillaria (Tongcao) 1 qian, Fresh Acorus Tatarinowii (Shichangpu) 4 qian, Hang Shaoyao (White Peony Root) 4 qian, Bran-fried Aurantium Fructus (Zhiqiao) 1 qian, Radish Seed (Laifuzi) 1 qian, Lonicera Japonica (Jinyinhua) 4 qian, Aucklandia Root (Guang Muxiang) 1.5 qian, Gardenia Bark (Zhizi Pi) 1 qian, Fermented Soybean (Xiang Douchi) 2 qian, Forsythia Suspensa (Lianqiao) 1 qian, Dolichos Lablab (Biandou Pi) 2 qian, Fresh Lotus Leaf (Heye) 4 qian, Cyperus Rotundus (Xiangfu Mi) 1 qian, Fresh Pogostemon (Peilan) 1 qian, Curcuma Aromatica (Yujin) 1.5 qian, Zixue Dan (Purple Snow Pill) 0.7 fen, divided into two doses to be mixed in. Decoct in water and divide into two doses for administration. July 9th.
[Fifth Prescription (Pulse Case)]
Summerheat stagnation and accumulated heat are sticky in the intestines and stomach. Body heat has not fully resolved. Although bowel movement frequency has decreased, the sticky discharge is not yet complete, and abdominal dragging pain persists. There is irritability, thirst, and stuffiness. Tongue coating is greasy. Pulse is wiry and slippery. Fortunately, dietary intake is gradually improving, and mental clarity has returned, preventing other complications. Treatment focuses again on dispersing and unblocking, clearing and transforming, and directing qi downward. With the disease 80-90% resolved, recovery is expected.
Lonicera Japonica (Jinyinhua) 4 qian, Stir-fried White Peony Root (Baishao) 4 qian, Muxiang Binglang Wan 3 qian (wrapped in cloth), Cyperus Rotundus (Xiangfu Mi) 2 qian, Fresh Pogostemon (Peilan) 2 qian, Yi Yuan San 4 qian, Stir-fried Scutellaria Baicalensis (Huangqin) 1 qian, Radish Seed (Laifuzi) 1 qian, Coix Seed (Yiren) 4 qian, Aucklandia Root (Guang Muxiang) 1.5 qian, Aurantium Fructus (Zhiqiao) 1.5 qian, Bran-fried Dolichos Lablab (Biandou Pi) 4 qian, Fresh Lotus Leaf (Heye) 4 qian, Coptis Rhizome (Chuanlian) 1.5 qian, Curcuma Aromatica (Yujin) 1.5 qian, Thunbergia Fritillaria (Tongcao) 1 qian, Fresh Acorus Tatarinowii (Shichangpu) 2 qian. This prescription should cure the condition after approximately five to six doses.
This is one of the most dangerous cases of Wenbing (Warm Disease) with Ni Chuan (Reverse Transmission), and it is highly interesting for study. Western medicine also correctly diagnosed this as Typhoid Fever ("Chang Zhifu Si"). Why could various methods not cure it? Why did anti-emetics worsen vomiting, and antipyretics increase fever? This proves that Traditional Chinese Medicine (TCM) and Western Medicine (WM) each have strengths and weaknesses, and Chinese and Western medicines each have their appropriate indications. They cannot be forcibly merged. If I advocate using WM, I must explain WM theory; if using CM, I must explain CM theory, to thoroughly understand the treatment. The ultimate goal is to save the patient's life. Why insist on a single approach? I argue that studying only WM cannot fully apply to modern diseases; nor can studying improper or impure CM apply to general diseases. What is worrying is that some CM practitioners learn only superficial WM knowledge and claim proficiency in WM. Ambitious WM practitioners studying CM suffer from lack of good teachers, wandering in fog. Since ancient times, charlatans have fabricated mysticism, confusing people and obscuring effective, pure medicine with smoke. This corrupts the foundation. Those who learn corrupt, ineffective CM claim proficiency, forcing a merger of CM and WM. How dangerous! This increases the chance of killing patients. This Shuwen (Summerheat Warmth) is largely similar to other Wenbing. The most difficult aspect of Wenbing leading to death is Neibi (Internal Closure), i.e., this syndrome. This formula is most effective, tested many times. Incompetent CM doctors would definitely use Xiao Xiongtang (Minor Chest-Hamstring Decoction). Lower-tier incompetent doctors would use Chengqitang (Order the Qi Decoction). Even lower-tier incompetent doctors, seeing exterior heat, would treat the exterior with sweating and use Guizhitang (Cinnamon Twig Decoction). Using Xiao Xiongtang will definitely be ineffective. Using Chengqitang or Guizhitang will cause mental confusion, mania, and agitation after one dose, leading to exhaustion above and cold below, instantly becoming an incurable terminal illness. This is my forty-year experimental experience, not arbitrary. I have witnessed countless cases misdiagnosed/mistreated by CM. It is hard to describe all. Whenever encountering such severe Ni Chuan cases with vomiting, coma, headache, irritability, and fever (after seven to eight days), one must imitate this method. It works every time. Mr. Wang Zhiting is an old doctor from Anqiu County, Shandong, with rich experience. He was sixty years old at the time and a master of treating Wenbing in the town. I was in my prime then, and our diagnoses often aligned. Thus, this case is one of my proudest successes. Subsequent encounters with this syndrome yielded immediate results.
The medical experiences listed above are mostly critical Wenbing cases. Regardless of season, for various Wenbing, except for adding one or two seasonal herbs (e.g., Huoxiang and Yi Yuan San for Shuwen), the most effective herbs are Lianqiao, Jinyinhua, Sangye, Juhua, Fresh Shichangpu, Fresh Peilan, Fresh Bohe, Fresh Huoxiang, Huanglian, Huangqin, Yujin, Niuhuang, Xijiao, and Zixue Dan. As soon as signs of Neibi appear—such as severe vomiting, stubborn high fever, mental confusion or mania, or limb coldness—quickly administer large doses of the above herbs with modifications. It works every time, saving many lives. Commonly used CM herbs for this condition, such as Shengdi, Xuanshen, Banxia, Huafen, or Gualou, are also effective if used appropriately. However,峻下 (drastic purgatives) like Dahuang and Mangxiao must be used with extreme caution. Although sometimes necessary, improper use causes great harm. Because this critical Neibi syndrome is purely turbid filth obstructing upwards, and the pathogen is not solely in the intestines and stomach, aromatic, acrid-opening, and bitter-descending methods are the only correct approaches. Their efficacy far surpasses WM, by many folds. The hardest parts to treat are vomiting/retching and coma/mania. Note these. I have treated thousands of Wenbing cases without major errors, giving me confidence. The selected cases are critically dangerous, not minor ailments. The prescribed formulas are proven effective. The prohibited herbs are those most easily misused. I share this sincerely. Readers are encouraged to test this practically. When WM laxatives are absolutely necessary for Wenbing, indicated by a deep, solid pulse and intense intestinal/stomach heat, try Muxiang Binglang Wan or a small amount of cooked Dahuang, or Calomel (WM). Dosage should be small. Do not combine with CM simultaneously. Purge slowly. Stop once stool is passed. Never use large doses suddenly. Beware! If diagnosis is uncertain, slow administration is better.
For standard Wenbing symptoms like fever, body ache, and headache, clearing and resolving leads to recovery. For severe intestinal heat with diarrhea and tidal fever, purging leads to recovery. These are commonly treated and need not be detailed. The most feared complication is Ni Chuan to the Pericardium Meridian. Death results from this. Any error by the doctor or family can be fatal. Readers should pay triple attention to the theory of Ni Chuan and the medical cases herein.
Chinese Medical Treasures: Zhiyuan Yihua
Author: Luo Zhiyuan
Proofreaders: Zhang Shaoshun, Guo Liuxia
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Measles/Rash (3): Shazhen, Shazi, Zhenzi, Wenzhen, Liuizi, Dansha, Banzhen, Fengzhen, Yinzhen, Saozhen are all alternative names for this syndrome in CM books. Western medicine divides it into Measles and Scarlet Fever (excluding exanthematous typhoid and drug eruptions). Transmission is extremely rapid, especially among children. It must not be ignored.
(Causes) CM books state that rash arises from internal accumulation of warm toxins and external contraction of epidemic pestilential qi (abnormal qi). Although distinctions are made between Lung Rash and Stomach Rash, and Wind, Cold, Summerheat, Dampness, Dryness, and Fire, the actual cause is easy to understand. Rash originates from the six climatic pathogens. Wind, Cold, Summerheat, and Dampness must transform into Fire. The character "Fire" suffices to summarize this. Adding more details is superfluous and confusing. Western medicine attributes the cause to transmission via air and objects (e.g., clothing used by patients) and person-to-person contact. This aligns with CM theory. However, the fact that trauma facilitates transmission is a point CM does not discuss.
(Symptoms) CM lacks terms for incubation period and prodromal phase. Thus, early onset presents initially with fatigue, followed by fever, headache, wheezing, cough, nausea, and vomiting. Increased nasal discharge and tearing, with watery eyes, are prominent. This corresponds to the catarrhal symptoms described in Western medicine. The higher the fever, the more swollen the facial skin. Rash typically appears after three to four days, or one to two days. Appearance within one or two days of fever onset indicates mild disease; appearance on the fourth or fifth day indicates severe disease. If high fever persists until the sixth or seventh day with rash hidden and unable to erupt, it is most dangerous. Rash appearing and immediately disappearing is even more perilous. Rash is divided into two types: Stomach Rash resembles dense clouds; Lung Rash appears as distinct dots. Western medicine states: 1. Measles: Must have two stages of fever. Eruption occurs on skin, mucous membranes, and conjunctiva (e.g., eyelids, eyes), causing tearing and coughing. It starts on the face, then spreads to the neck and limbs. Lesions are well-defined, red spots the size of flax seeds, with many small papules in the center (eruption stage). Heat peaks during this period. After one or two days, heat subsides. Rash fades on days three and four. Desquamation occurs on days five and six. Days eight to ten are the recovery period. 2. Scarlet Fever: Fever and chills, severe sore throat, headache, fatigue, convulsions, or meningeal symptoms. After one or two days, bright red, densely clustered rashes the size of hat pins or flax seeds appear on the neck and chest, spreading over the whole body to form erythema (sometimes resembling grass-red paper). Rashes contain serous pus. Lips and chin rarely show rash. Tongue coating is initially white. By days four and five, it becomes red (Raspberry Tongue), corresponding to the deep crimson tongue coating in CM. The CM concept of Lung Rash having only granules without patches approximates Western Measles. The Stomach Rash concept of dense clouds without roots approximates Western Scarlet Fever. Dangerous signs like severe damp-heat steaming, mouth/throat ulcers, gum rot, throat closure, cheek perforation, and panting are symptoms of Scarlet Fever complicated by Diphtheria and Pneumonia. However, CM treatment for these two rash diseases is largely similar. Despite Lung/Stomach distinctions, both focus on Lung and Stomach, considering both. There is essentially no separate treatment method, so excessive distinction is unnecessary. To prevent spread, we differentiate Measles and Scarlet Fever based on Western pathology:
1. Measles: Specific feature is the appearance of Koplik's spots (internal rash) on the soft palate (inner upper jaw) at the end of the second day of the prodrome. Catarrhal symptoms are very obvious: conjunctival catarrh causes photophobia and tearing; nasal catarrh causes sneezing and runny nose; pharyngeal/tracheal catarrh causes sore throat and cough. Between measles spots, healthy skin is visible (well-defined boundaries), never merging. Scarlet Fever differs: spots multiply and merge like a sheet of grass-red paper. Secondly, Measles starts on the face and spreads to the body. Fever symptoms occur in the prodrome. After one or two days of chills and fever, heat seems to subside, often mistaken for a resolved cold. Then, after another one or two days, fever returns suddenly, followed by gradual eruption. This is the "second degree" fever specific to Measles.
2. Scarlet Fever: Commonly known in CM as Lanhou Sha (Rotting Throat Rash). The name itself defines the nature. This syndrome frequently complicates with Diphtheria (swelling and ulceration leading to death in one or two days in severe cases). Oral, submandibular, and cervical lymph nodes swell. Cheeks may swell. Characteristic Raspberry Tongue (crimson red) is present. Between rashes, redness intensifies, swelling and flushing merge into one patch with indistinct boundaries. Eruption starts under the clavicle and neck, spreading to the body. Regardless of flushing, facial eruption is rare, especially around the mouth, which often appears pale with no rash. This is specific to Scarlet Fever. Complicated Diphtheria is most dangerous. Also dangerous are subsequent Nephritis (facial edema, scanty turbid urine with precipitates) and Pneumonia after the third week. Caution is required post-rash.