1．舒幼。湿疹一身皆是，痒不可耐，口糜。凡皮肤病，用药清其肠胃一也；局部保持清洁二也。
苦参3克，地肤子3．9克，苍术3克，黄柏3克，牛膝5克，苡仁18克，萆薢6克，冬瓜子皮各6克，银花6克，山栀皮9克。
[按]先生认为，风疹、湿疹一类皮肤病，在稚子多因胃肠不洁引起。此案用四妙散加苦参、地肤子、银花、栀皮等清热利湿。
2．蒋女。其寒热与右腕红起瘰成点状有关。每由细菌从淋巴窜入而导致。
紫草茸9克，净连翘12克，大青叶9克，紫地丁12克，荠菜花12克，西河柳9克，绿豆衣15克，忍冬藤12克，白茅根1扎。另：外用海带包之。
3．卢幼。皮肤有湿疹者，如有热而小溲短，慎防一身浮肿。连翘9克，黄芩5克，荠菜花9克，嫩白薇5克，金银花9克，绿豆衣9克，苦参5克，冬葵子6克。
[按]病理学告诉我们：凡化脓性皮肤病等由链球菌感染引起的疾患，多能产生变态反应，而发生急性肾小球肾炎。先生的提示，对临床医生有所助益。
1．孙男。大黄牡丹皮汤，仲景本为肠痈而设。盖阑尾炎虽能通便，植物性下剂则不相宜，或者此方用于轻症。假使阑尾周围化脓溃穿，此方不可妄投!病者是轻症。
熟锦纹9克，冬瓜子15克，生苡仁24克，败酱草15克，粉丹皮12克，桃仁12克，白芍12克，生甘草6克，七厘散1．2克(分2次吞服)。
二诊：仲景治肠痈，用大黄牡丹皮汤治急性者，薏苡附子败酱散治慢性者。病者为慢性，复入当归赤小豆汤。
炮附子9克，败酱草24克，赤小豆30克，苡仁30克，全当归12克，杭白芍15克，粉甘草9克。
2．葛幼。据其目前之证候，最危殆处有二：①多汗，脉伏，肢冷；②腹壁板硬而痛，手不可近。上者心脏衰弱，下者腹膜发炎，此二者危症也。
炮附片9克，杭白芍9克，青皮6克，全当归9克，潞党参9克，延胡索9克，五灵脂9克(洗)，两头尖9克(洗）炮姜炭3克，炙乳没各3克，炙甘草5克，败酱草30克(煎汤代水)。另：川乌12克、草乌12克、红花6克、毛姜9克、升麻2．4克、白芷9克，共研细末，葱汁、白蜜调敷腹部。
[按]此证颇似急腹症所引起的中毒性休克，所谓腹膜炎、心衰正是此意。案中指明病情危殆，方用参、附回阳救逆，振奋心力：归、芍、青皮、延胡、炮姜、乳、没理气和营止痛；灵脂、两头尖、败酱草攻瘀导浊消炎。外敷剂取其消炎镇痛作用。附睾炎
黄柏5克，粉丹皮9克，冬葵子9克，土牛膝12克，泽泻9克，大小蓟各9克，桃仁泥9克，荔枝核12克，生侧柏时30克(煎汤代水)。另：金银花12克，生山栀9克，代茶。二诊：睾丸炎除局部疗法外，清凉解毒，通利二便。金银花12克，大小蓟各9克，丹皮9克，蚤休5克，土牛膝9克，桃仁12克，夏枯草9克，菊花9克，蒲公英9克，粉萆薢9克，车前子叶各9克，甘草梢5克，生熟锦纹各6克，玄明粉12克(分2次冲入)。
三诊：睾丸炎虽未消尽，但已不如前之焮红胀大。土茯苓24克，凤尾草12克，生山栀9克，马鞭草12克，黄柏5克，银花15克，蒲公英9克，小蓟9克，蚤休5克，山慈姑3克(切片)。
四诊：治睾丸炎不外通利二便，消炎尚是次要。郁李仁9克(打)，小蓟12克，马鞭草9克，丹皮9克，冬葵子9克，桃仁泥12克，苦参片5克，黄柏3克，甘草3克。
[按]此案系湿热壅遏所致，治以通利二便为主，辅以清热、解毒、散结之品。盖利小便使湿热有出路，通大便亦能促进毒素之排泄。然必有大便难之症，而后始可通之。
1．殷女。凡外疡有脓者，如是起伏热，慎防细菌窜入血分，酿成败血症。
紫地丁12克，连翘12克，金银花15克，杭菊花9克，黑山栀9克，淡竹茹6克，炒枣仁9克，白茅根1扎。
2．龚男。左牙龈浮肿、腐烂，波及颊部粘膜均肿，此虽轻症，处置不当，可以引起败血症。
板蓝根9克，川连2．4克，连翘12克，忍冬花12克，大青叶9克，桑叶9克，玄参9克，白茅根1扎。另：六神丸，每次服10粒，日2次。
1．吴男。此第四性病，现代研究，知为独立疾患，其病原物与淋浊不同，古代称为横痃。
全当归9克，桃仁泥12克，金银花12克，蒲公英12克，京赤芍9克，淮牛膝9克，连翘12克，紫地丁12克，小金丹1粒。
2．胡男。横痃如见热，便是酿脓之象。此方清与下并用，清者有杀菌解毒之意，而下则在通便排毒。
土牛膝15克，蒲公英12克，土茯苓30克，贯仲9克，丹皮9克，甘草节5克，桃仁泥18克。
其他
1．何男。右颊皮肤掀红，但不如流火之光洁成片，颌下淋巴结亦肿胀。其治法亦可进普济消毒饮。
外用：黄柏9克，象贝9克，马勃3克，大青叶9克，芙蓉叶15克，共研细末，蜜糖调敷。
2．方弟。口角热疮，多见于冬令，燥故也。霜桑叶9克，桑白皮9克，天花粉9克，干地黄15克，甘菊花9克，肥知母9克，玉竹9克，冬瓜子9克，白茅根1扎，粉甘草3克。
3．丁幼。热旬日还不退，其特点为左鼠蹊部疼痛，下及腿足。嫩白薇9克，京赤芍6克，败酱草9克，马齿苋9克，蒲公英9克，小蓟9克，泽泻6克，金银花12克，粉丹皮9克。
二诊：药后左耻骨之痛大定。药多祛瘀和营之属，或者其效在此。其腹膨大，旬日不更衣，下之。
海南片9克，黑白丑各5克，郁李仁12克，玄明粉9克(分冲)，草决明9克，江枳实9克，芦荟2．4克，皂角子9克。
4．马男。痔症下血，单宁类当复入缓下剂。
生地榆15克，川黄柏9克，北秦皮9克，乌梅6克，马齿苋30克，蒲公英15克，杭白芍9克，桑椹子12克，千金驻车丸15克。
5．余男。3日来面部红肿而痛，本人以为痄腮，用靛青外敷，其肿更甚。其实是大头瘟，亦丹毒一类也。
银花9克，连翘9克，野菊花9克，丹皮9克，赤芍9克，小蓟12克，夏枯草9克，紫花地丁9克，蒲公英9克，茺蔚子9克。
[按]大头瘟系感受时邪疫毒而致，以其头部红肿如斗，甚者咽痛、耳聋，故名。此证似属颜面丹毒，故谓"亦丹毒一类"。此病初起多从耳下开始，易与痄腮混淆，然继之则向面部、头额、颈项发展，且全身症状较痄腮严重。吴鞠通提出用普济消毒饮，先生立方偏重凉血解毒，以其面部红肿，为血分之热毒肆扰。
1. 舒姓幼儿。全身遍布湿疹，瘙痒难忍，伴有口腔糜烂。治疗皮肤病，一要用药清理肠胃；二要局部保持清洁。
苦参3克，地肤子3.9克，苍术3克，黄柏3克，牛膝5克，薏苡仁18克，萆薢6克，冬瓜子与冬瓜皮各6克，金银花6克，山栀皮9克。
[按语] 章次公先生认为，风疹、湿疹等皮肤病，在儿童多因胃肠不洁引起。此案使用四妙散（清热利湿的基础方）加苦参、地肤子、金银花、山栀皮等药物以清热利湿。
2. 蒋姓女性。其寒热症状与右腕部红肿起瘰疬样点状皮疹有关。这通常是由细菌从淋巴系统侵入所致。
紫草茸9克，净连翘12克，大青叶9克，紫花地丁12克，荠菜花12克，西河柳9克，绿豆衣15克，忍冬藤12克，白茅根一扎。另：外用海带包裹患处。
3. 卢姓幼儿。患有皮肤湿疹者，若出现发热且小便短少，需警惕全身浮肿的发生。
连翘9克，黄芩5克，荠菜花9克，嫩白薇5克，金银花9克，绿豆衣9克，苦参5克，冬葵子6克。
[按语] 病理学告诉我们：凡由链球菌感染引起的化脓性皮肤病等疾患，多能产生变态反应，进而发生急性肾小球肾炎。先生的提示，对临床医生有所助益。
1. 孙姓男孩。大黄牡丹皮汤，是张仲景原本为肠痈（阑尾炎）而设立的方剂。虽然阑尾炎可以通过通便来缓解，但植物性泻药则不适宜，或许此方适用于轻症。假如阑尾周围化脓溃破穿孔，此方不可随意使用！患者属于轻症。
熟锦纹（大黄）9克，冬瓜子15克，生薏苡仁24克，败酱草15克，粉丹皮12克，桃仁12克，白芍12克，生甘草6克，七厘散1.2克（分2次吞服）。
二诊：张仲景治疗肠痈，用大黄牡丹皮汤治疗急性期，用薏苡附子败酱散治疗慢性期。患者属于慢性期，加入当归赤小豆汤。
炮附子9克，败酱草24克，赤小豆30克，薏苡仁30克，全当归12克，杭白芍15克，粉甘草9克。
2. 葛姓幼儿。根据其目前的证候，最危险之处有二：①多汗，脉象伏匿，四肢冰冷；②腹壁板硬且疼痛，手不可触碰。前者心脏衰弱，后者腹膜发炎，这两者都是危重症。
炮附片9克，杭白芍9克，青皮6克，全当归9克，潞党参9克，延胡索9克，五灵脂9克（洗净），两头尖9克（洗净），炮姜炭3克，炙乳香和没药各3克，炙甘草5克，败酱草30克（煎汤代水）。另：川乌12克、草乌12克、红花6克、毛姜9克、升麻2.4克、白芷9克，共研细末，用葱汁和白蜜调匀敷于腹部。
[按语] 此证颇似急腹症所引起的中毒性休克，所谓腹膜炎、心衰正是此意。案中指明病情危殆，方中用人参、附子回阳救逆，振奋心力；当归、白芍、青皮、延胡索、炮姜、乳香、没药理气和营止痛；五灵脂、两头尖、败酱草攻瘀导浊消炎。外敷剂取其消炎镇痛作用。
黄柏5克，粉丹皮9克，冬葵子9克，土牛膝12克，泽泻9克，大蓟和小蓟各9克，桃仁泥9克，荔枝核12克，生侧柏叶30克（煎汤代水）。另：金银花12克，生山栀9克，代茶饮用。二诊：治疗睾丸炎除局部疗法外，还需清凉解毒，通利大小便。
金银花12克，大蓟和小蓟各9克，丹皮9克，蚤休5克，土牛膝9克，桃仁12克，夏枯草9克，菊花9克，蒲公英9克，粉萆薢9克，车前子和车前叶各9克，甘草梢5克，生熟大黄各6克，玄明粉12克（分2次冲入）。
三诊：睾丸炎虽未完全消退，但已不像之前那样焮红胀大。
土茯苓24克，凤尾草12克，生山栀9克，马鞭草12克，黄柏5克，金银花15克，蒲公英9克，小蓟9克，蚤休5克，山慈姑3克（切片）。
四诊：治疗睾丸炎不外乎通利大小便，消炎尚是次要的。
郁李仁9克（捣碎），小蓟12克，马鞭草9克，丹皮9克，冬葵子9克，桃仁泥12克，苦参片5克，黄柏3克，甘草3克。
[按语] 此案系湿热壅遏所致，治以通利大小便为主，辅以清热、解毒、散结之品。因为利小便使湿热有出路，通大便亦能促进毒素之排泄。然而必须有便秘的症状，然后才可以采用通下的方法。
1. 殷姓女性。凡是外部疮疡有脓者，如果出现发热起伏不定，需警惕细菌窜入血分，酿成败血症。
紫花地丁12克，连翘12克，金银花15克，杭菊花9克，黑山栀9克，淡竹茹6克，炒枣仁9克，白茅根一扎。
2. 龚姓男性。左牙龈浮肿、腐烂，波及颊部粘膜均肿胀，这虽是轻症，处置不当，可以引起败血症。
板蓝根9克，川黄连2.4克，连翘12克，忍冬花12克，大青叶9克，桑叶9克，玄参9克，白茅根一扎。另：六神丸，每次服用10粒，每日2次。
1. 吴姓男性。这是第四性病，现代研究知其为独立疾患，其病原物与淋浊不同，古代称为横痃。
全当归9克，桃仁泥12克，金银花12克，蒲公英12克，京赤芍9克，淮牛膝9克，连翘12克，紫花地丁12克，小金丹1粒。
2. 胡姓男性。横痃如果见到发热，便是酿脓的迹象。此方清法与下法并用，清法有杀菌解毒之意，而下法则在通便排毒。
土牛膝15克，蒲公英12克，土茯苓30克，贯众9克，丹皮9克，甘草节5克，桃仁泥18克。
其他
1. 何姓男性。右颊皮肤掀红，但不如流火（丹毒）之光洁成片，颌下淋巴结亦肿胀。其治法也可进普济消毒饮。
外用：黄柏9克，象贝母9克，马勃3克，大青叶9克，芙蓉叶15克，共研细末，蜜糖调敷。
2. 方姓弟弟。口角热疮，多见于冬季，原因是燥邪所致。
霜桑叶9克，桑白皮9克，天花粉9克，干地黄15克，甘菊花9克，肥知母9克，玉竹9克，冬瓜子9克，白茅根一扎，粉甘草3克。
3. 丁姓幼儿。发热十几天还不退，其特点为左鼠蹊部疼痛，向下延伸至腿足。
嫩白薇9克，京赤芍6克，败酱草9克，马齿苋9克，蒲公英9克，小蓟9克，泽泻6克，金银花12克，粉丹皮9克。
二诊：服药后左侧耻骨疼痛基本平息。药物多为祛瘀和营之属，或许疗效在此。其腹部膨大，十天未排便，采用攻下法。
海南片（番泻叶）9克，黑白丑（牵牛子）各5克，郁李仁12克，玄明粉9克（分次冲入），草决明9克，江枳实9克，芦荟2.4克，皂角子9克。
4. 马姓男性。痔疮下血，单宁类成分应当重新加入缓下剂中。
生地榆15克，川黄柏9克，北秦皮9克，乌梅6克，马齿苋30克，蒲公英15克，杭白芍9克，桑椹子12克，千金驻车丸15克。
5. 余姓男性。三天来面部红肿而痛，本人以为是痄腮（流行性腮腺炎），用靛青外敷，其肿更甚。其实是大头瘟，也属于丹毒一类。
金银花9克，连翘9克，野菊花9克，丹皮9克，赤芍9克，小蓟12克，夏枯草9克，紫花地丁9克，蒲公英9克，茺蔚子9克。
[按语] 大头瘟系感受时邪疫毒而致，以其头部红肿如斗，甚者咽痛、耳聋，故名。此证似属颜面丹毒，故谓“亦丹毒一类”。此病初起多从耳下开始，易与痄腮混淆，然继之则向面部、头额、颈项发展，且全身症状较痄腮严重。吴鞠通提出用普济消毒饮，先生立方偏重凉血解毒，以其面部红肿，为血分之热毒肆扰。
1. Patient Shu (child). Eczema covers the entire body, with unbearable itching and oral ulcers. In treating skin diseases, one must use medication to clear the intestines and stomach; secondly, keep the local area clean.
*Radix Sophorae Flavescentis* (Kushen) 3g, *Fructus Kochiae* (Qufuzi) 3.9g, *Rhizoma Atractylodis Macrocephalae* (Cangzhu) 3g, *Cortex Phellodendri* (Huangbai) 3g, *Radix Achyranthis Bidentatae* (Niuxi) 5g, *Semen Coicis* (Yiren) 18g, *Rhizoma Dioscoreae Hypoglaucae* (Bixie) 6g, *Pericarpium Citrini Reticulatae Viride* (Dongguazi) and *Exocarpium Citri Reticulatae* (Dongguapi) 6g each, *Flos Lonicerae Japonicae* (Jinyinhua) 6g, *Pericarpium Gardeniae Jasminoidis* (Shanzhi Pi) 9g.
[Commentary] Mr. Zhang Cigong believed that skin diseases such as urticaria and eczema in children are often caused by intestinal and gastric impurity. This case uses Si Miao San (Four Marvels Powder, a basic formula for clearing heat and draining dampness) added with Kushen, Qufuzi, Jinyinhua, and Shanzhi Pi to clear heat and drain dampness.
2. Female patient Jiang. Her chills and fever are related to redness and swelling on the right wrist, presenting as nodular spots. This is usually caused by bacteria entering via the lymphatic system.
*Radix Lithospermi* (Zicao Rong) 9g, *Fructus Forsythiae* (Lianqiao) 12g, *Folium Isatidis* (Daqingye) 9g, *Herba Violae* (Zididing) 12g, *Flos Capsellae* (Qicai Hua) 12g, *Ramulus Salicis Capreae* (Xihe Liu) 9g, *Testa Phaseoli Radiati* (Lv Dou Yi) 15g, *Caulis Lonicerae Japonicae* (Rendong Teng) 12g, *Radix Imperatae* (Baimaogen) one bundle. Additionally: Apply kelp externally wrapped around the affected area.
3. Patient Lu (child). For patients with skin eczema, if fever occurs accompanied by short urine, one must be cautious of generalized edema.
*Fructus Forsythiae* (Lianqiao) 9g, *Cortex Scutellariae* (Huangqin) 5g, *Flos Capsellae* (Qicai Hua) 9g, *Radix Blepharocalyx* (Nen Baiwei) 5g, *Flos Lonicerae Japonicae* (Jinyinhua) 9g, *Testa Phaseoli Radiati* (Lv Dou Yi) 9g, *Radix Sophorae Flavescentis* (Kushen) 5g, *Semen Malvae* (Dongkuizi) 6g.
[Commentary] Pathology tells us: Diseases caused by streptococcal infection, such as suppurative skin diseases, often produce allergic reactions, leading to acute glomerulonephritis. Mr. Zhang's warning is helpful for clinicians.
Appendicitis, Peritonitis
1. Male patient Sun. Dahuang Mudan Pi Tang was originally established by Zhang Zhongjing for intestinal abscess (appendicitis). Although appendicitis can be relieved by promoting bowel movements, plant-based laxatives are not suitable; perhaps this formula is used for mild cases. If suppuration and perforation occur around the appendix, this formula should not be used recklessly! The patient has a mild case.
Prepared Rhizoma Polygoni Cuspidati (Shu Jinwen/Dahuang) 9g, *Pericarpium Citrulli* (Dongguazi) 15g, Raw *Semen Coicis* (Sheng Yiren) 24g, *Herba Patriniae* (Baijiangcao) 15g, Cortex Moutan Radicis (Fen Danpi) 12g, *Semen Persicae* (Taoren) 12g, *Radix Paeoniae Alba* (Baishao) 12g, Raw *Radix Glycyrrhizae* (Sheng Gancao) 6g, Qili San 1.2g (taken in two doses orally).
Second visit: Zhang Zhongjing treated intestinal abscess using Dahuang Mudan Pi Tang for acute cases and Yiyi Fuzi Baijiang San for chronic cases. The patient is in the chronic stage, so Danggui Chixiao Dou Tang is added.
Processed *Radix Aconiti Lateralis Preparata* (Pao Fuzi) 9g, *Herba Patriniae* (Baijiangcao) 24g, *Semen Phaseoli Angularis* (Chixiaodou) 30g, *Semen Coicis* (Yiren) 30g, Whole *Radix Angelicae Sinensis* (Quangui Danggui) 12g, Hang *Radix Paeoniae Alba* (Hang Baishao) 15g, Powdered *Radix Glycyrrhizae* (Fen Gancao) 9g.
2. Patient Ge (child). Based on current symptoms, there are two most dangerous aspects: ① Profuse sweating, pulse hidden, cold limbs; ② Board-like hardness and pain in the abdominal wall, intolerant to touch. The former indicates heart failure, the latter peritonitis; both are critical conditions.
Processed *Radix Aconiti Lateralis Preparata* (Pao Fupian) 9g, Hang *Radix Paeoniae Alba* (Hang Baishao) 9g, *Pericarpium Citrini Reticulatae Viride* (Qingpi) 6g, Whole *Radix Angelicae Sinensis* (Quangui Danggui) 9g, *Radix Codonopsis Pilosae* (Lu Dangshen) 9g, *Rhizoma Corydalis* (Yanhusuo) 9g, *Resina Trogopterori* (Wulingzhi) 9g (washed), *Rhizoma Belamcandae* (Liangtoujian) 9g (washed), Charred *Rhizoma Zingiberis Recens* (Pao Jiangtan) 3g, Honey-fried *Resina Mastichis* and *Resina Olibani* (Zhi Rumu) 3g each, Honey-fried *Radix Glycyrrhizae* (Zhi Gancao) 5g, *Herba Patriniae* (Baijiangcao) 30g (decocted to replace water). Additionally: *Radix Aconiti Kusnezoffii* (Chuanwu) 12g, *Radix Aconiti Karakolicum* (Caowu) 12g, *Radix Carthami Tinctorii* (Honghua) 6g, *Rhizoma Smilacis Glabrae* (Maojiang) 9g, *Rhizoma Cimicifugae* (Shengma) 2.4g, *Radix Angelicae Dahuricae* (Baizhi) 9g, ground into fine powder, mixed with green onion juice and white honey, applied to the abdomen.
[Commentary] This condition resembles toxic shock induced by acute abdomen, meaning peritonitis and heart failure. The case notes indicate critical illness; the formula uses Ginseng and Aconite to restore yang and rescue from collapse, revitalizing heart function; Danggui, Baishao, Qingpi, Yanhusuo, Paojiang, Rumu regulate qi and nourish blood to stop pain; Wulingzhi, Liangtoujian, and Baijiangdao attack stasis, guide out turbidity, and reduce inflammation. The external application aims for anti-inflammatory and analgesic effects.
Epididymitis
Male patient Mao. Epididymo-orchitis is formed by damp-heat.
*Cortex Phellodendri* (Huangbai) 5g, Cortex Moutan Radicis (Fen Danpi) 9g, *Semen Malvae* (Dongkuizi) 9g, *Radix Cyathulae Officinalis* (Tu Niuxi) 12g, *Radix Alismatis Orientalis* (Zexie) 9g, *Herba Leonuri* (Daji) and *Herba Hieracii Umbellati* (Xiaoji) 9g each, *Semen Persicae* paste (Taoren Ni) 9g, *Fructus Litchi* (Lizhihe) 12g, Fresh *Folium Platycladi* (Sheng Ceboye) 30g (decocted to replace water). Additionally: *Flos Lonicerae Japonicae* (Jinyinhua) 12g, Raw *Fructus Gardeniae Jasminoidis* (Sheng Shanzhi) 9g, taken as tea.
Second visit: Treating orchitis involves local therapy plus cooling, detoxification, and promoting urination and defecation.
*Flos Lonicerae Japonicae* (Jinyinhua) 12g, *Herba Leonuri* (Daji) and *Herba Hieracii Umbellati* (Xiaoji) 9g each, Cortex Moutan Radicis (Danpi) 9g, *Rhizoma Paridis* (Zhexiu) 5g, *Radix Cyathulae Officinalis* (Tu Niuxi) 9g, *Semen Persicae* (Taoren) 12g, *Caulis Cistanches* (Xiakucao) 9g, *Flos Chrysanthemi Morifolii* (Juhua) 9g, *Herba Taraxaci* (Gongying) 9g, *Rhizoma Dioscoreae Hypoglaucae* (Fen Bixie) 9g, *Semen Plantaginis* and *Folium Plantaginis* (Cheqianziye) 9g each, Tip of *Radix Glycyrrhizae* (Gancao Shao) 5g, Raw and Prepared Rhizoma Polygoni Cuspidati (Sheng Shu Jinwen) 6g each, *Sal Nitrati* (Xuanmingfen) 12g (mixed in two doses).
Third visit: Orchitis has not completely subsided, but is no longer as red and swollen as before.
*Rhizoma Smilacis Glabrae* (Tufuling) 24g, *Herba Pteris Multifida* (Fengweicao) 12g, Raw *Fructus Gardeniae Jasminoidis* (Sheng Shanzhi) 9g, *Caulis Marli* (Mabiancao) 12g, *Cortex Phellodendri* (Huangbai) 5g, *Flos Lonicerae Japonicae* (Jinyinhua) 15g, *Herba Taraxaci* (Gongying) 9g, *Herba Hieracii Umbellati* (Xiaoji) 9g, *Rhizoma Paridis* (Zhexiu) 5g, Bulb *Bulbus Coelomone* (Shancigu) 3g (sliced).
Fourth visit: Treating orchitis mainly involves promoting urination and defecation; reducing inflammation is secondary.
*Semen Pruni Armeniacae* (Yuliren) 9g (crushed), *Herba Hieracii Umbellati* (Xiaoji) 12g, *Caulis Marli* (Mabiancao) 9g, Cortex Moutan Radicis (Danpi) 9g, *Semen Malvae* (Dongkuizi) 9g, *Semen Persicae* paste (Taoren Ni) 12g, Slices of *Radix Sophorae Flavescentis* (Kushen Pian) 5g, *Cortex Phellodendri* (Huangbai) 3g, *Radix Glycyrrhizae* (Gancao) 3g.
[Commentary] This case is caused by stagnation of damp-heat. Treatment focuses on promoting urination and defecation, assisted by herbs that clear heat, detoxify, and dissipate nodules. Promoting urination provides an exit for damp-heat, while promoting defecation facilitates toxin excretion. However, purgation is only indicated when constipation is present.
Septicemia
1. Female patient Yin. For external sores with pus, if fever fluctuates, one must guard against bacteria entering the blood level, causing septicemia.
*Herba Violae* (Zididing) 12g, *Fructus Forsythiae* (Lianqiao) 12g, *Flos Lonicerae Japonicae* (Jinyinhua) 15g, Hang *Flos Chrysanthemi Indici* (Hang Juhua) 9g, Blackened *Fructus Gardeniae Jasminoidis* (Hei Shanzhi) 9g, Light *Caulis Bambusae in Taenia* (Danzhuru) 6g, Stir-fried *Semen Ziziphi Spinosae* (Chao Zaoren) 9g, *Radix Imperatae* (Baimaogen) one bundle.
2. Male patient Gong. Swelling and rotting of the left gums, spreading to swollen buccal mucosa. Although this is a mild case, improper handling can lead to septicemia.
*Radix Isatidis* (Banlangen) 9g, *Rhizoma Coptidis* (Chuanlian) 2.4g, *Fructus Forsythiae* (Lianqiao) 12g, *Flos Lonicerae Japonicae* (Rendonghua) 12g, *Folium Isatidis* (Daqingye) 9g, *Folium Mori* (Sangye) 9g, *Radix Scrophulariae* (Xuanshen) 9g, *Radix Imperatae* (Baimaogen) one bundle. Additionally: Liushen Wan, 10 pills per dose, twice daily.
Bubo (Inguinal Lymphadenopathy)
1. Male patient Wu. This is "fourth disease" (venereal disease); modern research shows it is an independent disease with a different pathogen from gonorrhea. It was called bubo in ancient times.
Whole *Radix Angelicae Sinensis* (Quangui Danggui) 9g, *Semen Persicae* paste (Taoren Ni) 12g, *Flos Lonicerae Japonicae* (Jinyinhua) 12g, *Herba Taraxaci* (Gongying) 12g, Jing *Radix Paeoniae Rubra* (Jing Chishao) 9g, Huai *Radix Achyranthis Bidentatae* (Huai Niuxi) 9g, *Fructus Forsythiae* (Lianqiao) 12g, *Herba Violae* (Zididing) 12g, Xiaojin Dan 1 pill.
2. Male patient Hu. If bubo presents with fever, it indicates suppuration. This formula combines clearing and purging methods. Clearing has the intent of killing bacteria and detoxifying; purging aims at promoting bowel movement to expel toxins.
*Radix Cyathulae Officinalis* (Tu Niuxi) 15g, *Herba Taraxaci* (Gongying) 12g, *Rhizoma Smilacis Glabrae* (Tufuling) 30g, *Rhizoma Cibotii Barometz* (Guanzhong) 9g, Cortex Moutan Radicis (Danpi) 9g, Joint of *Radix Glycyrrhizae* (Gancao Jie) 5g, *Semen Persicae* paste (Taoren Ni) 18g.
Others
1. Male patient He. Redness and swelling on the right cheek, but not as smooth and patchy as erysipelas (Liuhuo). Submandibular lymph nodes are also swollen. Treatment can proceed with Puji Xiaodu Yin.
Puji Xiaodu Yin taken internally.
Externally: *Cortex Phellodendri* (Huangbai) 9g, *Bulbus Fritillariae Thunbergii* (Xiangbei) 9g, *Fungus Tremella* (Mabo) 3g, *Folium Isatidis* (Daqingye) 9g, *Folium Hibisci Mutabilis* (Furongye) 15g, ground into fine powder, mixed with honey and sugar, applied topically.
2. Brother Fang. Hot sores at the corners of the mouth are common in winter due to dryness.
Frost-treated *Folium Mori* (Shuang Sangye) 9g, *Cortex Mori Radicis* (Sangbaipi) 9g, *Radix Trichosanthis* (Tianhuafen) 9g, Dry *Radix Rehmanniae* (Gan Dihuang) 15g, Sweet *Flos Chrysanthemi Morifolii* (Gan Juhua) 9g, Plump *Rhizoma Anemarrhenae* (Fei Zhimu) 9g, *Rhizoma Polygonati Odorati* (Yuzhu) 9g, *Pericarpium Citrulli* (Dongguazi) 9g, *Radix Imperatae* (Baimaogen) one bundle, Powdered *Radix Glycyrrhizae* (Fen Gancao) 3g.
3. Patient Ding (child). Fever persists for ten days without subsiding. The characteristic is pain in the left inguinal region, extending down to the legs and feet.
Young *Radix Blepharocalyx* (Nen Baiwei) 9g, Jing *Radix Paeoniae Rubra* (Jing Chishao) 6g, *Herba Patriniae* (Baijiangcao) 9g, *Herba Portulacae Oleraceae* (Machixian) 9g, *Herba Taraxaci* (Gongying) 9g, *Herba Hieracii Umbellati* (Xiaoji) 9g, *Radix Alismatis Orientalis* (Zexie) 6g, *Flos Lonicerae Japonicae* (Jinyinhua) 12g, Cortex Moutan Radicis (Fen Danpi) 9g.
Second visit: Pain in the left pubic bone has largely settled after medication. The drugs are mostly for removing stasis and harmonizing nutritive qi, which may be where the efficacy lies. Abdominal distension and no bowel movement for ten days require purgation.
Hainan Pian (Senna Leaf) 9g, Black and White *Semen Pharbitidis* (Hei Bai Chou) 5g each, *Semen Pruni Armeniacae* (Yuliren) 12g, *Sal Nitrati* (Xuanmingfen) 9g (mixed separately), *Semen Cassiae* (Caojueming) 9g, Jiang *Fructus Aurantii Immaturus* (Jiang Zhishi) 9g, *Fructus Aloe* (Lvhui) 2.4g, *Fructus Gleditsiae Sinensis* (Zaojiaozi) 9g.
4. Male patient Ma. Hematochezia from hemorrhoids requires adding tannins to mild laxatives.
Raw *Radix Sanguisorbae* (Sheng Diyu) 15g, Sichuan *Cortex Phellodendri* (Chuan Huangbai) 9g, Northern *Cortex Fraxini* (Bei Qinpi) 9g, *Fructus Mume* (Wumei) 6g, *Herba Portulacae Oleraceae* (Machixian) 30g, *Herba Taraxaci* (Gongying) 15g, Hang *Radix Paeoniae Alba* (Hang Baishao) 9g, *Fructus Morii* (Sangshenzi) 12g, Qianjin Zhuche Wan 15g.
5. Male patient Yu. Facial redness, swelling, and pain for three days. The patient thought it was mumps and applied indigo externally, worsening the swelling. Actually, it is Da Tou Wen (Big Head Plague), a type of erysipelas.
*Flos Lonicerae Japonicae* (Jinyinhua) 9g, *Fructus Forsythiae* (Lianqiao) 9g, *Flos Chrysanthemi Indici* (Ye Juhua) 9g, Cortex Moutan Radicis (Danpi) 9g, *Radix Paeoniae Rubra* (Chishao) 9g, *Herba Hieracii Umbellati* (Xiaoji) 12g, *Caulis Cistanches* (Xiakucao) 9g, *Herba Violae* (Zihua Diding) 9g, *Herba Taraxaci* (Gongying) 9g, *Fructus Viticis* (Chongweizi) 9g.
[Commentary] Da Tou Wen is caused by contracting epidemic toxic pathogens. It is named so because the head swells like a bean pot, and in severe cases, causes sore throat and deafness. This condition resembles facial erysipelas, hence "also a type of erysipelas." It often starts behind the ears, easily confused with mumps, but subsequently spreads to the face, forehead, and neck, with more severe systemic symptoms than mumps. Wu Jutong proposed using Puji Xiaodu Yin; Mr. Zhang's prescription focuses more on cooling blood and detoxifying, because the facial redness and swelling indicate heat-toxin disturbing the blood level.