伏温化热，燔灼血络，因致络血外溢，邪热即随血而泄，于病机犹为顺象。乃有邪热郁于血络，不得外达
，其在于肺，肺主皮毛则为疹，其在于胃，胃主肌肉则为斑。有斑疹各发，不相交涉者；有斑疹兼发，不能分
晰者。总之以清营透邪，疏络化斑为主。凡外面斑疹透齐，即神清热解者为吉。若斑疹虽透，而里热不解，则
热郁已甚，其势必有变端。当随其见证，小心斟酌。又有一种烂喉丹痧，此于伏温之中，兼有时行疫毒。发热
一二日，头面胸前，稍有痧疹见形，而喉中已糜烂矣。此证
小儿居多，其病之急者，一二日即见坏证。如面色青晦，痰塞音哑，气急腹硬，种种恶候，转瞬即来，见此者
多致不救。此等急症，初起即宜大剂清菅解毒，庶可挽回万一。若稍涉迟延，鞭长莫及矣。
鲜生地为此证清营泄热必用之药。欲兼疏散之意，重则用豆豉同打，轻则用薄荷叶同打，均可。丹皮清血
中伏热，且味辛主散，炒黑用之最合。银花清营化毒，元参清咽滋水，均为此症必要之药。
治肺疹初起，须兼透达者，于清营方中，用牛蒡、蝉衣以透发之。古方治斑毒，用化斑汤（白虎合犀、地
之类）或玉女煎之类。然须烦热多汗者，乃为合剂。若热不甚，汗不畅，遽投石膏，恐有邪机冰伏之弊，临用
时宜加斟酌。黄玉楸于此证，用浮萍为表药，颇有思路，可取用之。
塘市孙蕴之大令郎，聪颖异常，年甫十步，十三经已能背诵，且能举其大意。蕴翁视之，不啻掌上珠也。
丁亥秋，专信邀诊。余夜船赴之，至明晨抵塘市，已不及救矣。蕴翁曰∶大儿已死。次儿后一天起病，今已两
天矣，病状与大儿纤毫无异。以大儿之死例之，则次儿至今夜五鼓时，亦将不救矣。姑为我视之，尚可挽救否？
余视之，面色青晦不语，惟烦躁阵作。发躁时将臂内搔挖，若不知痛楚者。挖破处，血亦紫黯不流。舌质紫刺
如杨梅，喉间板黄不腐。余细审，乃疫毒闭于营中，不能外达而毒攻心肺，故其死若是之速。此证属阴毒、阳
毒之类，在古书中虽无确当治法，而以意测之，欲图挽回，必使疫毒有外泄之路，乃有生机。遂令其用犀角磨
汁，鲜生地、大黄绞汁，再合元参、丹皮、银花等化毒泄热之品，陆续灌之。至黄昏，得大便溏黑者两次。灌
至天明，尽药两茶盏，又得大便溏黑者两次。余再视之，神情较能灵动，舌上黄苔浮腻，喉间起腐。仍用前法
，加入金汁，合养阴之意，如前灌之。一日夜服三、四碗，大小便始畅，腹硬亦平。其上半如颈、项、肩、肘
，下部如腰脊、髀关、膝
、等处，凡肢节交接之处，从前有紫痕僵块者，至此皆红肿作脓。不特
咽喉溃烂，并肛门亦溃烂流脓。余力守养阴活血、泄热化毒之方，两旬以后，咽喉及通身之溃烂，均得以此收
功。惟大便中仍有脓瘀杂下，余参用内痈治法，又月余始痊。是役也，余用犀、地、大黄、多进不撤，人皆骇
之。不知此证之热毒，亦非寻常所有。设迟回审慎，兼顾其虚，无论如此重病，不能挽救于垂危∶即使当时就
挽，而后半如此波涛，亦断不能收全功于万一也。
伏气温邪化热，燔灼血络，导致络脉中的血液外溢，邪热随即随着血液的排出而得以宣泄，这在病机上属于顺证。然而，也有邪热郁结在血络中，无法向外透达的情况。如果邪热在于肺，因肺主皮毛，就会发为疹；如果邪热在于胃，因胃主肌肉，就会发为斑。有的患者斑和疹分别发出，互不混杂；有的患者斑和疹同时发出，难以清晰区分。治疗总以清营透邪、疏络化斑为主要原则。凡是外表的斑疹透发齐全，且神志清醒、热势消退的，属于吉兆。如果斑疹虽然透发，但体内热邪仍未解除，说明热郁非常严重，病情必然会出现变端。应当根据具体的见证，谨慎斟酌处理。
又有一种烂喉丹痧，这是在伏温的基础上，兼夹了时行疫毒。发热一两天后，头面胸前稍有痧疹显现，但咽喉已经糜烂。这种病症多见于小儿，发病急骤的，一两天内就会出现坏证。如面色青暗晦滞，痰液阻塞声音嘶哑，气促腹胀坚硬等种种恶候，转瞬即至，出现这些症状的多致死亡。这类急症，初起就应使用大剂量的清热解毒药物，或许还能挽回万一。如果稍有延误，就鞭长莫及了。
鲜生地黄是此证清营泄热的必用之药。想要兼顾疏散之意，重症用豆豉同捣，轻症用薄荷叶同捣，都可以。牡丹皮清除血中伏热，且味辛主散，炒黑使用最为合适。金银花清营化毒，玄参清咽滋水，都是此症必要的药物。
治疗肺疹初起，需要兼用透达方法的，在清营方中加入牛蒡子、蝉蜕来透发。古方治疗斑毒，使用化斑汤（白虎汤合犀角、生地之类）或玉女煎之类。但是必须是有烦热多汗症状的，才适合使用这些方剂。如果热势不重，汗出不畅，贸然投用石膏，恐怕有使邪气冰伏的弊端，临用时宜加斟酌。黄玉楸对此证，使用浮萍作为表药，颇有思路，可以取用。
塘市孙蕴之的大公子，聪颖异常，年仅十岁，十三经已能背诵，且能举出其大意。孙翁视之，如同掌上明珠一般。丁亥年秋天，孙翁专函邀请诊治。我夜间乘船前往，到次日清晨抵达塘市，已经来不及救治了。孙翁说：“大儿子已经死了。二儿子第二天起病，到现在已经两天了，病情与大儿子毫无差异。以大儿子的死例来看，二儿子到今天夜里五更时分，也将不治了。姑且请您看看，是否还可以挽救？”
我诊视他，面色青暗晦滞不语，只有烦躁阵发性发作。发作烦躁时将手臂内侧抓挠，好像不知道疼痛一样。抓破处，血液紫暗不流。舌质紫红有刺，像杨梅舌，咽喉间板状发黄但不腐烂。我仔细审察，这是疫毒闭阻在营分中，不能外达而毒攻心肺，所以死亡如此迅速。此证属于阴毒、阳毒之类，在古书中虽然没有确切的治法，但以意推测，想要图谋挽回，必须使疫毒有外泄的途径，才有生机。于是令其用犀角磨汁，鲜生地、大黄绞汁，再配合玄参、牡丹皮、金银花等化毒泄热的药物，陆续灌服。到了黄昏，大便溏黑两次。灌药直到天明，共服药两茶盏，又得大便溏黑两次。我再诊视他，神情较之前灵动，舌上黄苔浮腻，咽喉间开始起腐。仍用前法，加入金汁，结合养阴之意，如前灌服。一天一夜服用三四碗，大小便始通畅，腹部硬满也平复。其上半身如颈、项、肩、肘，下半身如腰脊、髀关、膝等处，凡肢节交接之处，从前有紫痕僵块的，至此都红肿化脓。不仅咽喉溃烂，连肛门也溃烂流脓。我竭力坚守养阴活血、泄热化毒的方剂，二十天后，咽喉及全身的溃烂，均以此收功。只是大便中仍有脓瘀杂下，我参考内痈的治法，又过一个月才痊愈。这次诊疗中，我使用犀角、生地、大黄，大量进服而不撤换，人们都对此感到惊骇。却不知道此证的熱毒，并非寻常所有。如果迟疑审慎，兼顾其虚证，无论如此重病，不能在垂危之际挽救；即使当时勉强挽救，而后半段病情波涛汹涌，也绝对不能完全收功。
When latent warm pathogenic factors transform into heat, they scorch and burn the collateral vessels, causing blood within the collaterals to extravasate. The evil heat then dissipates along with the blood, which is considered a favorable sign in the disease mechanism. However, there are cases where evil heat stagnates in the blood collaterals and cannot reach the exterior. If the heat resides in the Lung, since the Lung governs the skin and hair, macules (rash) will appear; if it resides in the Stomach, since the Stomach governs the muscles, patches (purpura/macules) will appear. Some patients present with macules and rashes appearing separately without intermingling; others have them appearing simultaneously, making them difficult to distinguish clearly. The general treatment principle focuses on clearing the Ying level (nutritive level), venting the pathogen, unblocking the collaterals, and resolving the patches. Generally, if the external macules and rashes are fully erupted, accompanied by clear spirit and resolved heat, it is an auspicious sign. If the macules and rashes are erupted but the interior heat remains unresolved, it indicates severe heat stagnation, and complications are inevitable. One must carefully consider the specific manifestations.
There is also a condition known as "Rotting Throat Dan Sha" (scarlet fever-like illness with throat ulceration). This arises from latent warm pathogens complicated by epidemic toxic factors of the season. After one or two days of fever, slight scarlet rash may appear on the head, face, and chest, while the throat has already begun to ulcerate. This condition is common in children. In acute cases, deteriorating signs may appear within one or two days. Symptoms such as a cyanotic and dull complexion, phlegm obstruction with hoarseness, shortness of breath, and abdominal hardness represent various ominous signs that appear suddenly; those presenting these signs often die. For such acute conditions, large doses of herbs to clear the Ying level and detoxify should be used at the onset to perhaps salvage the situation. Any delay renders treatment ineffective.
Fresh Sheng Di Huang (Rehmanniae Radix Recens) is an essential herb for clearing the Ying level and draining heat in this condition. To incorporate dispersing properties, for severe cases, use Dou Chi (Fermented Soybean) pounded together; for mild cases, use Bo He Ye (Menthae Haplocalycis Folium) pounded together; both are acceptable. Dan Pi (Moutan Cortex) clears latent heat in the blood and, being pungent and dispersing, is best used when stir-fried until blacked. Jin Yin Hua (Lonicerae Japonicae Flos) clears the Ying level and transforms toxicity; Xuan Shen (Scrophulariae Radix) clears the throat and nourishes Yin/water; both are necessary for this syndrome.
For treating early-stage Lung rashes requiring venting and dissemination, add Niu Bang Zi (Arctii Fructus) and Chan Yi (Bombyx Batryticatus) to the Ying-clearing formula to promote eruption. Ancient formulas for treating patch-toxin use Hua Ban Tang (White Tiger Decoction combined with Xi Jiao/Rhinoceros Horn and Sheng Di Huang/Rehmannia Root) or Yu Nu Jian (Jade Woman Decoction). However, these are only suitable if the patient presents with irritability, heat, and profuse sweating. If the heat is not intense and sweating is inadequate, administering Shi Gao (Gypsum Fibrosum) abruptly may cause the pathogen to become "ice-frozen" (stagnant); thus, caution is required during application. Huang Yu Qiu suggested using Fu Ping (Urticae Flos) as an exterior-releasing agent for this condition, which shows good clinical reasoning and can be adopted.
The eldest son of Sun Yunzhi from Tangshi was exceptionally intelligent. At just ten years old, he could recite the Thirteen Classics and summarize their main ideas. His father, Mr. Sun, cherished him like a pearl in his palm. In the autumn of the Dinghai year, Mr. Sun sent a special letter inviting me for consultation. I traveled by night boat and arrived in Tangshi the next morning, but it was too late to save him. Mr. Sun said, "My eldest son has died. My second son fell ill the day after, and it has now been two days. His symptoms are identical to his brother's. Based on my eldest son's death, my second son will likely die by the fifth watch (3-5 AM) tonight. Please examine him; is there any hope of rescue?"
Upon examination, the boy had a cyanotic and dull complexion and did not speak, only experiencing paroxysmal irritability. During episodes of irritability, he scratched the inner sides of his arms as if feeling no pain. The scratched areas showed dark purple blood that did not flow. His tongue was purple with prickles, resembling a strawberry tongue, and his throat appeared plate-like yellow without necrosis. Upon careful scrutiny, I determined that epidemic toxin was closed within the Ying level, unable to vent outward, and attacking the Heart and Lungs, leading to such rapid death. This condition belongs to the category of Yin Toxin or Yang Toxin. Although ancient texts lack definitive treatments for it, by inference, to attempt a rescue, one must provide a pathway for the epidemic toxin to exit externally, thereby creating a chance for survival. I prescribed grinding Xi Jiao (Rhinoceros Cornu - *Note: Substitute with Water Buffalo Horn in modern practice*) into juice, squeezing fresh Sheng Di Huang (Rehmanniae Radix Recens) and Da Huang (Rhei Radix et Rhizoma) juice, and combining them with Xuan Shen (Scrophulariae Radix), Dan Pi (Moutan Cortex), and Jin Yin Hua (Lonicerae Japonicae Flos) to transform toxicity and drain heat, administered continuously. By dusk, the patient passed loose, black stool twice. Medication continued until dawn; after consuming two tea cups of medicine, he passed loose, black stool twice more. Re-examining him, his mental state became more alert. A floating, greasy yellow coating appeared on the tongue, and necrotic tissue formed in the throat. I maintained the previous method, adding Jin Zhi (Golden Juice - *fermented human feces filtrate*), incorporating Yin-nourishing principles, and administered as before. Over one day and night, he consumed three to four bowls. His urination and defecation finally became smooth, and abdominal distension subsided. Areas where purple marks and stiff masses previously existed—such as the neck, shoulders, elbows, waist, spine, hips, and knees, particularly at joint junctions—became red, swollen, and suppurated. Not only did the throat ulcerate, but the anus also ulcerated and discharged pus. I strictly adhered to the formula for nourishing Yin, invigorating blood, draining heat, and transforming toxicity. After twenty days, the ulcers throughout the throat and body healed. However, pus and blood clots still mixed in the stool. Referencing treatment methods for internal abscesses, he recovered after another month. In this case, I used large doses of Xi Jiao (Rhinoceros Horn), Sheng Di Huang (Rehmannia Root), and Da Huang (Rhubarb Root), continuing administration without withdrawal. People were shocked by this approach. They did not realize that the heat-toxin in this condition was extraordinary. Had I hesitated, exercised excessive caution, or attempted to address deficiency simultaneously, I would certainly not have saved him from critical danger. Even if I had managed to stabilize him initially, the subsequent turbulent course of the disease would have made complete recovery impossible.