大头瘟2(颜面丹毒)
刘某，男，60岁
初诊
素来嗜好烟酒，形体瘦弱，工作过于劳累，一周前曾感冒，至今未愈。从5月1日开始发烧头痛，恶寒，咽痛，面部略红，曾有医生诊为外感，子服辛温解表药：桂枝6克，白芍10克，炙草3克，生姜3克，大枣七枚。一剂后即面目红肿，体温升至39℃，咽红肿痛，病势沉重。即请某医诊治，诊为大头瘟，用普济消毒饮原方，未加减：升麻3克，柴胡3克，连翘10克，薄荷3克，马勃3克，牛蒡子6克，芥穗6克，僵蚕6克，元参15克，银花10克，板兰根10克，苦梗6克，甘草6克，一付。药后发热更重，体温39.3℃，面目红肿加剧，激流黄水，皮肤作痒，咽红肿痛，嗜睡，夜间神志欠清，舌红口干，苔黄且腻，两脉洪滑且数，大便未通，小便短少色深。此温毒蕴热挟湿，误服辛温之桂枝汤，又服升、柴、芥穗之升阳疏风，致使热势鸱张，病已深重，防其神昏致厥。姑以清气热兼以解毒，凉血分而化其湿，辛辣荤腥皆忌。
紫草10克，地丁草10克，连翘30克，金银花30克，黄连6克，黄芩10克，赤芍10克，蚤休10克，僵蚕6克，片姜黄6克，二付，外用赛金化毒散15克油调外敷(或如意金黄散醋调外敷)。
二诊
服上方二剂后，体温降至37.6℃，两脉洪滑，数象已退，面目红肿亦减，仍有黄水，但量不多，皮肤作痒，咽红口苦，夜寐稍安，大便通而不畅小溲黄少。温毒蕴热渐减，湿邪仍在，再以疏风燥湿，凉血解毒。
蚤休10克，蝉衣6克，赤芍10克，黄芩10克，黄柏6克，苍术3克，片姜黄6克，僵蚕6克，银花25克，白鲜皮10克，焦三仙各6克，三付。另用如意金黄散10克，外敷。
三诊
前药服三剂之后，身热退净，面肿已消，滋流黄水亦止，两脉弦滑，舌红苔白，胃纳已开，二便如常，皮肤痒势已退，再以凉血疏风，化湿止痒。
连翘10克，忍冬藤25克，赤芍10克，黄芩10克，黄连4.5克，地丁草10克、川草解10克，花槟榔、地肤子各10克，焦三仙各10克，三付
上药又连服三付之后，身热已退净，面目肿势已退而滋流黄水未作，饮食二便如常，嘱其忌荤腥鱼肉等物，后半月恢复正常。
[按]：此为大头瘟误治案。素嗜烟酒，内热必重；身形瘦弱，阴伤可知；感证初起，即有咽痛发热，是温邪上受之征。医反用桂枝汤攻其表，宜其如煽风点火之用，红肿暴作矣。次用普济消毒原方，方中升散太过，助火燎原，故症愈重，神且昏矣。先生断然用清热凉血解毒之剂，兼以燥湿利湿，使邪有去路，连进而愈。其忌食辛辣腥腥荤之嘱，尤为重要，当细心揣摩品味，不可忽视之。
烂（疒丹）痧 (猩红热)
宋某某，男，25岁
初诊
发热2～3天，今晨面部、胸腹、四肢皮肤斑疹红晕，咽痛喉肿，扁桃腺肿大化脓，有白腐，今日体温39.5℃，口周围苍白，舌红尖部起刺，状似杨梅，根部黄厚，质绛且干，自觉头晕心烦急躁，不能入睡，唇焦破裂流血，大便二日耒行，小便赤短深红。此温邪蕴热，气营两燔，烂喉痹痧重证。姑以凉营透斑，清气泄热，防其逆传昏厥或高烧，忌食荤腥甜黏油重之品。
连翘1 5克，忍冬花30克，紫草9克，生石膏24克，知母9
克，元参45克，生草10克，地丁9克，花粉9克，僵蚕9克，杏仁9克，鲜茅芦根各45克，香犀角O 6克(冲)，二付
二诊
药后胸腹四肢皮肤（疒丹）痧已透，神志清楚，身热渐减，体温38℃，咽痛喉肿皆减，扁桃腺肿见轻，仍有白腐，舌绛起刺，状如杨梅，根部黄厚，两日来，夜寐尚安，心烦也减，唇仍焦破，大便已通不多日，小便短红，烂喉痹痧重证，热毒壅滞，窜扰营分，今日已见转机，再以清透热毒，凉营育阴，病势虽见好转，然毒热甚重，防其逆传。
蝉衣4.5克，生石膏24克，元参45克，山栀6克，连翘30克，银花30克，丹皮9克，黄芩9克，竹叶6克，鲜茅芦根各45克 活犀角O.3克(冲)，二付
三诊
身热渐退，神志也清，体温37.4℃，皮肤痹痧已透齐，咽痛止而喉肿也退，大便每日一次小便黄少，心烦已除，夜寐甚安，舌苔渐化，红刺已退，唇仍色深紫，病势已减，余热未清，再以甘寒育阴，凉营解毒。病已向愈，防其反复，饮食寒暖诸应适宜。
细生地30克，肥知母9克，淡竹叶3克，连翘24克，银花24克，丹皮9克，元参30克，赤芍9克，北沙参30克，冬瓜皮30克，三付
四诊
身热退净，皮肤已渐脱屑，神志甚清，精神好，饮食如常，二便自调，舌苔化净，舌质略红，两脉细弱力差，烂糇瘪痧已愈，再以调理肠胃，以后天补先天之法。
北沙参24克，细生地24克，赤白芍各9克，冬瓜皮30克，茯苓皮24克，焦麦芽9克，鸡内金9克，四付
五诊
烂喉（疒丹）痧已愈，皮肤脱屑未齐，诸恙皆平，胃纳甚佳，夜寐安稳，病已愈，用散剂调理。
焦三仙各150克，鸡内金150克，砂仁3克，共研细末，每早晚各服9克，加糖9克，开水冲服，其味酸甜，又助消化，病后最宜。
[按]：中医所谓烂喉（疒丹）痧相当于现代医学的猩红热。其发病急骤，病情凶险，属温毒之类。其临床特征以遍体痧疹如丹，并见咽喉红肿腐烂，故名烂喉（疒丹）痧。舌质红绛如杨梅，名杨梅舌，一身皮肤潮红，唯环口唇四周苍白，名口唇苍白圈。此二者具有诊断意义。中医认为本病为感受时气温毒，热毒入于营血，极易痉厥动风。故治疗必须用重剂清热凉血解毒，方克有济。切不可掺入风药发表。此例患者即典型的烂喉痔痧重症，故药诊即重用清热凉血解毒，随着热毒渐消，于原法中逐渐增加育阴之药如玄参、生地黄、北沙参等，终以调理肠胃为善后之法。虽有以后天补先天之语，而用药却以疏调肠胃为主，可见本病恢复期也不宜补。
烂喉（疒丹）痧2(猩红热)
张某某，男，56岁
初诊
从本月2日开始，发烧较重，体温38.7℃，自觉头晕，胸闷，心烦急躁，阵阵恶寒，周身酸痛，咽痛口渴，近一周来夜间不得入睡，曾服银翘解毒丸六丸，APC六片，皆未见效。本月4日请邻居医生看视，认为感冒风寒，随开一方，桂枝9克，防风9克，葛根6克，荆芥3克，生姜三片，红糖30克，水煎分服。一付。今晨病势突然增重，发烧40℃，神志时清时昧，面部青暗，口鼻苍白，舌绛起刺，状若杨梅。苔根厚而黄干，咽喉肿痛白腐，呼吸粗促，口干欲饮，时有谵语孙便赤步，大便三日未行，胸部似有斑点不多，两手脉象沉涩不畅，按之弦细数有力。温邪蕴热，内闭于肺，气营两燔，本当清营泄热，误服辛温表散之剂，温热炽甚，阴分过伤，势将昏厥，防成烂喉（疒丹）痧，且火郁内闭，深恐本不胜病，姑予一方，以慰来者之望，备候高明政定。
僵蚕9克，蝉衣6克，片姜黄6克，杏仁6克，炒牛蒡6克，元参30克，连翘24克，银花15克，前胡3克，浙贝母12克，鲜茅芦根各60克，另用鲜九节菖蒲根15克，煎汤送服神犀丹一丸，犀角末O.6克(分二次汤药送下)，一付
二诊
前药服后，遍身温疹一涌而出，色深皆重，身热略退，体温38 5℃，神志渐清，已能言语，自述心烦渴饮，欲食冰，两脉已由沉涩转为弦滑细数，口唇鼻梁仍苍白，舌绛如琳，尖部起刺，根部焦黄而厚，口味甚臭，大便虽通不多，小便赤少，咽喉肿痛白腐，不能吞咽，胸闷较轻，呼吸粗促已缓。温毒蕴热，已成烂喉痔痧，火郁渐解，气营交织，病势甚重，再以清气热以解温毒，凉营血兼透癌痧，饮食寒暖，慎之又慎。
僵蚕6克，蝉衣6克，姜黄6克，生石膏24克，黄芩9克，竹叶6克，连翘24克，银花24克，紫草9克，地丁草9克，川叹母6克，局方至宝丹二丸，分二次用鲜九节菖蒲根30克洗净打烂，煎汤送下。先服汤药。一付
三诊
今诊脉弦滑而按之濡滑略数，周身温疹已透，身热渐退，神志清楚，体温37.5℃，舌苔根部仍黄，尖部起刺已减，面部青暗也退，口周围苍白消失，大便通畅，色探味臭，小便仍黄，但尿量增加，咽红肿已愈，拟以养阴生津，兼去余鄂之法。
细生地30克，赤芍9克，姜黄6克，连翘12克，石斛18克，北沙参30克+麦门冬12克，川贝母6克，鲜茅芦根各30克，焦三仙各9克，丹皮9克，三付
四诊
身热退净，皮肤脱屑，体温正常，纳答欠馨，二便自调，两脉沉濡小滑，拟一善后处理方：
茯苓24克，冬瓜皮30克，生山药30克，炒熟苡仁30克，半夏9克，陈皮6克，焦三仙各9克，五付
五诊
诸恙皆安，皮肤脱屑已净，饮食、睡眠、二便如常，病已痊愈。
[按]；本例为烂喉痹痧误治案。烂喉痹痧为热毒深入血分，治疗最忌表散。赵师尝述本世纪二三十年代问北京地区流行此病，死亡率很高，凡用风药发表者无不即成坏症。后医政局接纳几位名医的建议，明令禁用风药，告示传诸药肆，凡处方中含风药者一概拒付。此病本属热盛，再以风药发表，则无疑于火上浇油，而成燎原之热，以致难以救疗。车例即困误用表散，致神志昏蒙，火邪内闭，痹痧不能畅发。故用升降散加清热解毒，凉营开窍之品，升降气机，宣透郁火，服药后（疒丹）痧一涌而出，即神识转清，内闭已解。继用气营两清，解毒透疹。待瘟疹已透，热毒渐泄，则及时加入养阴生津之药，最后仍以调理脾胃收功。
赵师的父亲赵友琴先生在本世纪二三十年代曾救治了许多烂喉痔痧患者，积累了丰富的经验；赵师的老师汪逢春先生擅长温病治疗，对烂喉（疒丹）痧有独到见解。现将二人辨治烂喉痛痧的经验分述于下，以备参考。
赵友琴先生辨治烂喉痔痧的经验
温邪化热，深入营血，郁于肌表，发为温疹，遍体隐约，舌干绛液少，脉弦滑急数，心烦不寐，咽肿且痛，大便未解，此为温疹重证，阴分大伤，出而未透，亟以凉营育阴宣透为务。
生地黄一两，玄参一两，蝉衣一钱，僵蚕二钱，连翘三钱，银花一两，生石膏一两，知母三钱，鲜石斛五钱，鲜芦根一两，安宫牛黄散三分，二次分冲。
汪逢春先生辨治烂喉痹痧的经验
温疹一涌而出，壮热口渴，遗体红晕，舌绛且干，肥刺满布，苔黄垢厚，脉象滑数，面目口唇皆青，心烦，夜不能寐，此属温毒化热，胃肠积滞尚重，深恐神昏致厥，饮食寒暖，皆须小心，防其增重，禁用风药。
连翘四钱，忍冬藤一两，赤芍三钱，紫草三钱，地丁三钱，大青叶一两，元参五钱，焦麦芽四钱，犀角粉一分冲服。
(汪逢春先生是本世纪二十世纪四十年代北京地区“四大名医”之一)
温毒(急性颌下淋巴结炎)
张某某，女，24岁
初诊
该患者就诊时发烧九天，体温波动于38.5℃～39℃之间，颌下有一5cm× 5cm大小之肿物，西医诊为“急性颌下淋巴结炎”，用青霉素、四环毒效果不佳。现患者发热不退，仍觉恶寒，面色黯黄，颌下有一包块，大如鸡卵，质地坚硬，按之疼痛，皮肤不红，护之亦不灼手，咽喉红肿而痛，纳谷不甘，大便三日未解，脉沉弦而数，按之有力，舌红苔白根腻。此属火郁三焦，少阳枢机不利，气血壅滞而成，拟升降散加散。
白僵蚕3克(为末，冲服)，蝉衣6克，片姜黄10克，生大黄6克，柴胡6克，金银花10克，皂角刺5克，黄芩10克，苦桔梗6克，生甘草6克，三付。
二诊
药后热退身凉，诸症霍然，顽下肿物仅有枣核大小，唯食纳不甘，乏力。以竹叶石膏汤、益胃汤加减收功。
[按]：颌下核起而肿痛，伴发热恶寒，咽红肿痛，大便秘结，是感时邪毒气，俗称时疫疙痞是也。症属热壅于内，三焦不利，气血壅滞，结聚而不得发越也。故升降散疏利气机，流行血气，加柴芩疏解步阳枢机，金银花清热解毒，皂角刺消痈破结，桔梗、甘草清咽利膈。服药三付，不仅热退身凉，而且颌下肿块消散大半。升降散之善治时疫，消肿散结，历用不爽，亦在于先生善于加减化裁也。
【背景信息】
书名：赵绍琴临证验案精选上 章节：正文(8/33) 类别：综合
大头瘟2（颜面丹毒）
刘某，男，60岁
初诊
患者平素嗜好烟酒，身体瘦弱，工作过度劳累。一周前曾患感冒，至今未愈。从5月1日开始出现发烧、头痛、恶寒、咽痛，面部略微发红。曾有医生诊断为外感，给予辛温解表药：桂枝6克，白芍10克，炙甘草3克，生姜3克，大枣七枚。服用一剂后，面目迅速红肿，体温升至39℃，咽喉红肿疼痛，病情加重。随即请另一位医生诊治，诊断为“大头瘟”，使用普济消毒饮原方，未做加减：升麻3克，柴胡3克，连翘10克，薄荷3克，马勃3克，牛蒡子6克，芥穗6克，僵蚕6克，元参15克，银花10克，板兰根10克，苦梗6克，甘草6克，共一付。服药后发热更重，体温达39.3℃，面目红肿加剧，渗出黄色液体，皮肤瘙痒，咽喉红肿疼痛，嗜睡，夜间神志不清，舌红口干，苔黄且腻，两脉洪滑且数，大便未通，小便短少色深。此为温毒蕴热挟湿，误服辛温的桂枝汤，又服用升麻、柴胡、芥穗等升阳疏风之品，致使热势猖獗，病情深重，需防止其出现神昏致厥。暂以清气分热兼以解毒，凉血分而化湿，忌食辛辣荤腥。
紫草10克，地丁草10克，连翘30克，金银花30克，黄连6克，黄芩10克，赤芍10克，蚤休10克，僵蚕6克，片姜黄6克，共二付。外用赛金化毒散15克用油调匀外敷（或用如意金黄散醋调外敷）。
二诊
服用上方二剂后，体温降至37.6℃，两脉仍洪滑，但数象已退，面目红肿减轻，仍有黄水渗出，但量不多，皮肤瘙痒，咽红口苦，夜间睡眠稍安，大便通畅但不顺畅，小便黄少。温毒蕴热逐渐减轻，湿邪仍在，再以疏风燥湿，凉血解毒。
蚤休10克，蝉衣6克，赤芍10克，黄芩10克，黄柏6克，苍术3克，片姜黄6克，僵蚕6克，银花25克，白鲜皮10克，焦三仙各6克，共三付。另用如意金黄散10克，外敷。
三诊
前方服用三剂之后，身热退尽，面肿已消，滋流黄水亦止，两脉弦滑，舌红苔白，胃纳已开，二便如常，皮肤痒势已退，再以凉血疏风，化湿止痒。
连翘10克，忍冬藤25克，赤芍10克，黄芩10克，黄连4.5克，地丁草10克，川草解10克，花槟榔、地肤子各10克，焦三仙各10克，共三付。
上方又连续服用三付之后，身热已退净，面目肿势已退，滋流黄水未再发作，饮食二便如常，嘱其忌食荤腥鱼肉等物，半月后恢复正常。
[按]：此为大头瘟误治案。平素嗜好烟酒，内热必重；身形瘦弱，可知阴液受损；感受病邪初起，即有咽痛发热，这是温邪从上受入的征象。医生反而用桂枝汤攻其表，适宜像煽风点火一样，导致红肿暴作。其次使用普济消毒饮原方，方中升散太过，助火燎原，故症状更重，甚至神志昏迷。先生断然使用清热凉血解毒之剂，兼以燥湿利湿，使邪气有去路，连续进服而痊愈。其忌食辛辣腥荤之嘱，尤为重要，当细心揣摩品味，不可忽视。
烂喉痹痧 (猩红热)
宋某某，男，25岁
初诊
发热2～3天，今晨面部、胸腹、四肢皮肤斑疹红晕，咽痛喉肿，扁桃腺肿大化脓，有白腐，今日体温39.5℃，口周围苍白，舌红尖部起刺，状似杨梅，根部黄厚，质绛且干，自觉头晕心烦急躁，不能入睡，唇焦破裂流血，大便二日未行，小便赤短深红。此为温邪蕴热，气营两燔，烂喉痹痧重证。暂以凉营透斑，清气泄热，防止其逆传昏厥或高烧，忌食荤腥甜黏油重之品。
连翘15克，忍冬花30克，紫草9克，生石膏24克，知母9克，元参45克，生甘草10克，地丁9克，花粉9克，僵蚕9克，杏仁9克，鲜茅芦根各45克，香犀角0.6克(冲服)，共二付。
二诊
药后胸腹四肢皮肤烂喉痹痧已透发，神志清楚，身热渐减，体温38℃，咽痛喉肿皆减，扁桃腺肿见轻，仍有白腐，舌绛起刺，状如杨梅，根部黄厚，近两日来，夜寐尚安，心烦也减，唇仍焦破，大便已通但量少，小便短红。烂喉痹痧重证，热毒壅滞，窜扰营分，今日已见转机，再以清透热毒，凉营育阴，病势虽见好转，然毒热甚重，防止其逆传。
蝉衣4.5克，生石膏24克，元参45克，山栀6克，连翘30克，银花30克，丹皮9克，黄芩9克，竹叶6克，鲜茅芦根各45克，活犀角0.3克(冲服)，共二付。
三诊
身热渐退，神志也清，体温37.4℃，皮肤痹痧已透齐，咽痛止而喉肿也退，大便每日一次，小便黄少，心烦已除，夜寐甚安，舌苔渐化，红刺已退，唇仍色深紫，病势已减，余热未清，再以甘寒育阴，凉营解毒。病已向愈，防止其反复，饮食寒暖诸应适宜。
细生地30克，肥知母9克，淡竹叶3克，连翘24克，银花24克，丹皮9克，元参30克，赤芍9克，北沙参30克，冬瓜皮30克，共三付。
四诊
身热退净，皮肤已渐脱屑，神志甚清，精神好，饮食如常，二便自调，舌苔化净，舌质略红，两脉细弱力差，烂喉痹痧已愈，再以调理肠胃，以后天补先天之法。
北沙参24克，细生地24克，赤白芍各9克，冬瓜皮30克，茯苓皮24克，焦麦芽9克，鸡内金9克，共四付。
五诊
烂喉痹痧已愈，皮肤脱屑未齐，诸恙皆平，胃纳甚佳，夜寐安稳，病已愈，用散剂调理。
焦三仙各150克，鸡内金150克，砂仁3克，共研细末，每早晚各服9克，加糖9克，开水冲服，其味酸甜，又助消化，病后最宜。
[按]：中医所谓烂喉痹痧相当于现代医学的猩红热。其发病急骤，病情凶险，属温毒之类。其临床特征以遍体痧疹如丹，并见咽喉红肿腐烂，故名烂喉痹痧。舌质红绛如杨梅，名杨梅舌，一身皮肤潮红，唯环口唇四周苍白，名口唇苍白圈。此二者具有诊断意义。中医认为本病为感受时气温毒，热毒入于营血，极易痉厥动风。故治疗必须用重剂清热凉血解毒，方克有济。切不可掺入风药发表。此例患者即典型的烂喉痹痧重症，故药诊即重用清热凉血解毒，随着热毒渐消，于原法中逐渐增加育阴之药如玄参、生地黄、北沙参等，终以调理肠胃为善后之法。虽有以后天补先天之语，而用药却以疏调肠胃为主，可见本病恢复期也不宜补。
烂喉痹痧2(猩红热)
张某某，男，56岁
初诊
从本月2日开始，发烧较重，体温38.7℃，自觉头晕，胸闷，心烦急躁，阵阵恶寒，周身酸痛，咽痛口渴，近一周来夜间不得入睡，曾服银翘解毒丸六丸，APC六片，皆未见效。本月4日请邻居医生看视，认为感冒风寒，随开一方，桂枝9克，防风9克，葛根6克，荆芥3克，生姜三片，红糖30克，水煎分服。一付。今晨病势突然增重，发烧40℃，神志时清时昧，面部青暗，口鼻苍白，舌绛起刺，状若杨梅。苔根厚而黄干，咽喉肿痛白腐，呼吸粗促，口干欲饮，时有谵语，小便赤步，大便三日未行，胸部似有斑点不多，两手脉象沉涩不畅，按之弦细数有力。温邪蕴热，内闭于肺，气营两燔，本当清营泄热，误服辛温表散之剂，温热炽甚，阴分过伤，势将昏厥，防成烂喉痹痧，且火郁内闭，深恐本不胜病，姑予一方，以慰来者之望，备候高明政定。
僵蚕9克，蝉衣6克，片姜黄6克，杏仁6克，炒牛蒡6克，元参30克，连翘24克，银花15克，前胡3克，浙贝母12克，鲜茅芦根各60克，另用鲜九节菖蒲根15克，煎汤送服神犀丹一丸，犀角末0.6克(分二次汤药送下)，共一付。
二诊
前药服后，遍身温疹一涌而出，色深皆重，身热略退，体温38.5℃，神志渐清，已能言语，自述心烦渴饮，欲食冰，两脉已由沉涩转为弦滑细数，口唇鼻梁仍苍白，舌绛如琳，尖部起刺，根部焦黄而厚，口味甚臭，大便虽通不多，小便赤少，咽喉肿痛白腐，不能吞咽，胸闷较轻，呼吸粗促已缓。温毒蕴热，已成烂喉痹痧，火郁渐解，气营交织，病势甚重，再以清气热以解温毒，凉营血兼透疹痧，饮食寒暖，慎之又慎。
僵蚕6克，蝉衣6克，姜黄6克，生石膏24克，黄芩9克，竹叶6克，连翘24克，银花24克，紫草9克，地丁草9克，川贝母6克，局方至宝丹二丸，分二次用鲜九节菖蒲根30克洗净打烂，煎汤送下。先服汤药。共一付。
三诊
今诊脉弦滑而按之濡滑略数，周身温疹已透，身热渐退，神志清楚，体温37.5℃，舌苔根部仍黄，尖部起刺已减，面部青暗也退，口周围苍白消失，大便通畅，色深味臭，小便仍黄，但尿量增加，咽红肿已愈，拟以养阴生津，兼去余邪之法。
细生地30克，赤芍9克，姜黄6克，连翘12克，石斛18克，北沙参30克，麦门冬12克，川贝母6克，鲜茅芦根各30克，焦三仙各9克，丹皮9克，共三付。
四诊
身热退净，皮肤脱屑，体温正常，纳食欠馨，二便自调，两脉沉濡小滑，拟一善后处理方：
茯苓24克，冬瓜皮30克，生山药30克，炒熟苡仁30克，半夏9克，陈皮6克，焦三仙各9克，共五付。
五诊
诸恙皆安，皮肤脱屑已净，饮食、睡眠、二便如常，病已痊愈。
[按]：本例为烂喉痹痧误治案。烂喉痹痧为热毒深入血分，治疗最忌表散。赵师尝述本世纪二三十年代北京地区流行此病，死亡率很高，凡用风药发表者无不即成坏症。后医政局接纳几位名医的建议，明令禁用风药，告示传诸药肆，凡处方中含风药者一概拒付。此病本属热盛，再以风药发表，则无疑于火上浇油，而成燎原之热，以致难以救疗。本例即因误用表散，致神志昏蒙，火邪内闭，痹痧不能畅发。故用升降散加清热解毒，凉营开窍之品，升降气机，宣透郁火，服药后烂喉痹痧一涌而出，即神识转清，内闭已解。继用气营两清，解毒透疹。待瘟疹已透，热毒渐泄，则及时加入养阴生津之药，最后仍以调理脾胃收功。
赵师的父亲赵友琴先生在本世纪二三十年代曾救治了许多烂喉痹痧患者，积累了丰富的经验；赵师的老师汪逢春先生擅长温病治疗，对烂喉痹痧有独到见解。现将二人辨治烂喉痹痧的经验分述于下，以备参考。
赵友琴先生辨治烂喉痹痧的经验
温邪化热，深入营血，郁于肌表，发为温疹，遍体隐约，舌干绛液少，脉弦滑急数，心烦不寐，咽肿且痛，大便未解，此为温疹重证，阴分大伤，出而未透，亟以凉营育阴宣透为务。
生地黄一两，玄参一两，蝉衣一钱，僵蚕二钱，连翘三钱，银花一两，生石膏一两，知母三钱，鲜石斛五钱，鲜芦根一两，安宫牛黄散三分，二次分冲。
汪逢春先生辨治烂喉痹痧的经验
温疹一涌而出，壮热口渴，遗体红晕，舌绛且干，肥刺满布，苔黄垢厚，脉象滑数，面目口唇皆青，心烦，夜不能寐，此属温毒化热，胃肠积滞尚重，深恐神昏致厥，饮食寒暖，皆须小心，防其增重，禁用风药。
连翘四钱，忍冬藤一两，赤芍三钱，紫草三钱，地丁三钱，大青叶一两，元参五钱，焦麦芽四钱，犀角粉一分冲服。
(汪逢春先生是本世纪二十世纪四十年代北京地区“四大名医”之一)
温毒(急性颌下淋巴结炎)
张某某，女，24岁
初诊
该患者就诊时发烧九天，体温波动于38.5℃～39℃之间，颌下有一5cm× 5cm大小之肿物，西医诊为“急性颌下淋巴结炎”，用青霉素、四环素效果不佳。现患者发热不退，仍觉恶寒，面色黯黄，颌下有一包块，大如鸡卵，质地坚硬，按之疼痛，皮肤不红，扪之亦不灼手，咽喉红肿而痛，纳谷不甘，大便三日未解，脉沉弦而数，按之有力，舌红苔白根腻。此属火郁三焦，少阳枢机不利，气血壅滞而成，拟升降散加减。
白僵蚕3克(为末，冲服)，蝉衣6克，片姜黄10克，生大黄6克，柴胡6克，金银花10克，皂角刺5克，黄芩10克，苦桔梗6克，生甘草6克，共三付。
二诊
药后热退身凉，诸症霍然，颌下肿物仅有枣核大小，唯食纳不甘，乏力。以竹叶石膏汤、益胃汤加减收功。
[按]：颌下核起而肿痛，伴发热恶寒，咽红肿痛，大便秘结，是感时邪毒气，俗称时疫疙痞是也。症属热壅于内，三焦不利，气血壅滞，结聚而不得发越也。故升降散疏利气机，流行血气，加柴芩疏解少阳枢机，金银花清热解毒，皂角刺消痈破结，桔梗、甘草清咽利膈。服药三付，不仅热退身凉，而且颌下肿块消散大半。升降散之善治时疫，消肿散结，历用不爽，亦在于先生善于加减化裁也。
Background Information
Book: Selected Clinical Cases of Zhao Shaoqin, Vol. 1; Chapter: Main Text (8/33); Category: Comprehensive
Da Tou Wen 2 (Facial Erysipelas)
Patient Liu, Male, 60 years old
First Visit
The patient has a long-standing habit of smoking and drinking alcohol, is physically frail, and has been overworked. He contracted a cold one week ago, which has not yet resolved. Starting from May 1st, he developed fever, headache, aversion to cold, sore throat, and slight facial redness. A previous doctor diagnosed it as an external contraction and prescribed diaphoretic herbs for warming the exterior: Guizhi (Cinnamon Twig) 6g, Baishao (White Peony Root) 10g, Zhigancao (Honey-fried Licorice Root) 3g, Shengjiang (Fresh Ginger) 3g, and Dazao (Jujube) seven pieces. After one dose, his face and eyes became severely swollen and red, body temperature rose to 39°C, and his throat became swollen and painful, indicating a worsening condition. Another doctor was consulted and diagnosed "Da Tou Wen" (Big Head Plague), prescribing the original formula Puji Xiaodu Yin without modifications: Shengma (Cimicifugae Rhizoma) 3g, Chaihu (Bupleuri Radix) 3g, Lianqiao (Forsythiae Fructus) 10g, Bohe (Menthae Haplocalycis Herba) 3g, Mabo (Stemonitis Radix) 3g, Niubangzi (Arctii Fructus) 6g, Jiesui (Schizonepetae Spica) 6g, Jiangcan (Bombyx Batryticatus) 6g, Yuan Shen (Scrophulariae Radix) 15g, Yinhua (Lonicerae Japonicae Flos) 10g, Banlangen (Isatidis Radix) 10g, Kugeng (Platycodonis Radix) 6g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, for one dose. After taking the medicine, the fever intensified, reaching 39.3°C; facial swelling worsened with exudation of yellow fluid; skin itching occurred; throat remained swollen and painful; lethargy set in; consciousness was unclear at night; tongue was red with dry mouth; coating was yellow and greasy; both pulses were surging, slippery, and rapid; bowel movements were absent; urine was scanty and dark. This indicates warm-toxin accumulation with heat and dampness. The misprescription of the acrid-warm Guizhi Tang, followed by Yang-raising and wind-dispersing herbs like Shengma, Chaihu, and Jiesui, caused the heat to rage and the disease to deepen. There is a risk of coma and convulsions. Temporarily, clear Qi-level heat and detoxify, cool Blood level and resolve dampness. Avoid spicy and greasy foods.
Zicao (Arnebiae Radix seu Lithospermi Radix) 10g, Dingcaocao (Violariae Herba) 10g, Lianqiao 30g, Jinyinhua (Lonicerae Japonicae Flos) 30g, Huanglian (Coptidis Rhizoma) 6g, Huangqin (Scutellariae Radix) 10g, Chishao (Paeoniae Radix Rubra) 10g, Zhexie (Paris Polyphyllae Rhizoma) 10g, Jiangcan 6g, Pian Jianghuang (Curcumae Longae Rhizoma) 6g, for two doses. Externally apply Saijin Huadu San 15g mixed with oil (or Ruyi Jinhuang San mixed with vinegar).
Second Visit
After two doses of the above prescription, body temperature dropped to 37.6°C; pulses remained surging and slippery but lost their rapid quality; facial swelling reduced; yellow fluid still exuded but in small amounts; skin itching persisted; throat was red with bitter taste; sleep improved slightly; bowel movement was patent but not smooth; urine was yellow and scanty. Warm-toxin heat is gradually subsiding, but dampness remains. Continue with wind-dispersing and damp-drying, cooling blood and detoxifying.
Zhexie 10g, Chan Yi (Cicadae Periostracum) 6g, Chishao 10g, Huangqin 10g, Huangbai (Phellodendri Cortex) 6g, Cangzhu (Atractylodis Rhizoma) 3g, Pian Jianghuang 6g, Jiangcan 6g, Yinhua 25g, Baixianpi (Dictamni Cortex) 10g, Jiao Sanxian (Charred Hawthorn, Medicated Leaven, and Immature Barley) 6g each, for three doses. Additionally, apply Ruyi Jinhuang San 10g externally.
Third Visit
After three doses of the previous prescription, fever completely subsided; facial swelling disappeared; exudation stopped; pulses were wiry and slippery; tongue was red with white coating; appetite returned; bowel and bladder functions normalized; skin itching ceased. Continue with cooling blood, dispersing wind, resolving dampness, and stopping itching.
Lianqiao 10g, Rendongteng (Lonicerae Caulis) 25g, Chishao 10g, Huangqin 10g, Huanglian 4.5g, Dingcaocao 10g, Chuan Xie (likely referring to a specific herb or typo for Chuan Bei Mu or similar, context suggests damp-resolving/detoxifying, kept as Chuan Caojie per text though likely typo for Chuan Bei or similar, strictly translating text: Chuan Caojie 10g), Hua Binglang (Arecae Semen) 10g, Difuzi (Kochiae Fructus) 10g, Jiao Sanxian 10g each, for three doses.
After continuing these three doses, fever remained gone; facial swelling receded; no more exudation; diet and excretion normal. Advised to avoid meat and fish. Recovered normally after half a month.
[Commentary]: This is a case of Da Tou Wen treated incorrectly. Long-term smoking and drinking imply heavy internal heat; frailty indicates Yin deficiency. Initial symptoms of sore throat and fever suggest warm pathogen entering from above. The doctor mistakenly used Guizhi Tang to attack the exterior, akin to fanning flames, causing sudden severe swelling. Subsequently, using the original Puji Xiaodu Yin, the ascending and dispersing properties were too strong, fueling the fire, leading to worse symptoms and coma. Dr. Zhao decisively used clearing heat, cooling blood, and detoxifying agents, combined with drying and promoting urination to resolve dampness, providing a pathway for pathogens to exit. Continuous administration led to recovery. The advice to avoid spicy and greasy foods is crucial and should be carefully considered.
Lan Hou Bi Sha (Scarlet Fever)
Patient Song, Male, 25 years old
First Visit
Fever for 2-3 days. This morning, macular rash with erythema appeared on face, chest, abdomen, and limbs. Sore throat, swollen pharynx, tonsillar enlargement with suppuration and white pseudomembrane. Body temperature today 39.5°C. Pale area around the mouth. Tongue red with prickles at the tip, resembling a bayberry; root coating thick, yellow, substance crimson and dry. Patient feels dizzy, irritable, anxious, unable to sleep. Lips are cracked, burnt, and bleeding. Bowel movement absent for two days; urine dark red and scanty. This is warm pathogen accumulating heat, simultaneous burning of Qi and Ying levels, a severe case of Lan Hou Bi Sha. Temporarily use cooling Ying level to vent rashes, clear Qi level to drain heat, preventing retrograde transmission leading to coma or high fever. Avoid meat, sweets, sticky, and oily foods.
Lianqiao 15g, Rendonghua (Lonicerae Japonicae Flos) 30g, Zicao 9g, Sheng Shigao (Gypsum Fibrosum) 24g, Zhimu (Anemarrhenae Rhizoma) 9g, Yuan Shen 45g, Sheng Gancao (Licorice Root) 10g, Diding 9g, Huafen (Trichosanthis Radix) 9g, Jiangcan 9g, Xingren (Armeniacae Semen Amarum) 9g, Xian Maobigen and Xian Lubigen (Imperatae Rhizoma and Imperatae Rhizoma) 45g each, Xiang Xijiao (Rhinocerotis Cornu) 0.6g (taken with decoction), for two doses.
Second Visit
After medication, the scarlet fever rash on chest, abdomen, and limbs has fully erupted. Consciousness is clear. Fever is gradually decreasing, temperature 38°C. Throat pain and swelling have reduced; tonsillar swelling is lighter, but white pseudomembrane persists. Tongue is crimson with prickles, resembling a bayberry; root coating thick and yellow. Sleep has been peaceful for the past two nights; irritability has decreased. Lips remain cracked. Bowel movement is patent but scanty; urine is short and red. Severe Lan Hou Bi Sha, heat-toxin stagnation disturbing Ying level. Today shows signs of improvement. Continue clearing and venting heat-toxin, cooling Ying and nourishing Yin. Although condition is improving, heat-toxin is still heavy; prevent retrograde transmission.
Chan Yi 4.5g, Sheng Shigao 24g, Yuan Shen 45g, Shanzhi (Gardeniae Fructus) 6g, Lianqiao 30g, Yinhua 30g, Danpi (Moutan Cortex) 9g, Huangqin 9g, Zhuye (Bambusae Folium) 6g, Xian Maobigen and Xian Lubigen 45g each, Huo Xijiao (Rhinocerotis Cornu) 0.3g (taken with decoction), for two doses.
Third Visit
Fever gradually subsiding; consciousness clear; temperature 37.4°C. Rash fully erupted. Throat pain stopped, pharyngeal swelling receded. Bowel movement once daily; urine yellow and scanty. Irritability removed; deep sleep achieved. Tongue coating thinning; red prickles receding. Lips still dark purple. Condition improving, residual heat not cleared. Continue with sweet-cold nourishing Yin, cooling Ying and detoxifying. Disease heading towards recovery; prevent relapse. Diet and warmth should be appropriate.
Xi Shengdi (Rehmanniae Radix Preparata) 30g, Fei Zhimu 9g, Dan Zhuye 3g, Lianqiao 24g, Yinhua 24g, Danpi 9g, Yuan Shen 30g, Chishao 9g, Beishashen (Glehniae Radix) 30g, Dongguapi (Benincasae Exocarpium) 30g, for three doses.
Fourth Visit
Fever completely gone; skin peeling gradually; consciousness very clear; good spirit; normal diet; bowel and bladder regulated; tongue coating cleared; tongue substance slightly red; pulses fine, weak, and lacking force. Lan Hou Bi Sha cured. Continue regulating stomach and intestines, using the method of tonifying congenital essence via acquired foundation.
Beishashen 24g, Xi Shengdi 24g, Chi Baishao (Red and White Paeony Roots) 9g each, Dongguapi 30g, Fulingpi (Poria Cum Cochlea Cortex) 24g, Jiao Maiya (Charred Hordei Fructus Germinatus) 9g, Jineijin (Galli Gigerii Endothelium Corneum) 9g, for four doses.
Fifth Visit
Lan Hou Bi Sha cured; skin peeling incomplete; all symptoms resolved; excellent appetite; stable sleep. Disease cured. Use powder for regulation.
Jiao Sanxian 150g each, Jineijin 150g, Sharen (Amomi Fructus) 3g. Grind into fine powder. Take 9g morning and evening, add 9g sugar, dissolve in boiling water. Sweet and sour taste, aids digestion, most suitable post-illness.
[Commentary]: Traditional Chinese Medicine's "Lan Hou Bi Sha" corresponds to modern Scarlet Fever. It has acute onset and dangerous course, belonging to warm toxins. Clinical features include widespread scarlet-like rash and swollen, rotting throat. Tongue crimson like a bayberry is called "Bayberry Tongue"; pale ring around lips amidst red skin is called "Pale Lip Ring." These two have diagnostic significance. TCM believes this disease is caused by seasonal warm toxins; heat-toxin enters Ying and Blood levels, easily causing spasms, convulsions, and wind stirring. Treatment must use heavy doses of clearing heat, cooling blood, and detoxifying agents. Wind-dispersing drugs for releasing the exterior must not be added. This patient had a typical severe case. Initially, heavy clearing heat, cooling blood, and detoxifying agents were used. As heat-toxin subsided, Yin-nourishing herbs like Xuanshen, Shengdihuang, and Beishashen were gradually added. Finally, regulating stomach and intestines served as follow-up care. Although "tonifying congenital via acquired" is mentioned, the medication focused on regulating stomach and intestines, showing that tonification is not suitable during the recovery phase.
Lan Hou Bi Sha 2 (Scarlet Fever)
Patient Zhang, Male, 56 years old
First Visit
Since the 2nd of this month, severe fever, temperature 38.7°C. Dizziness, chest tightness, irritability, paroxysmal chills, generalized body ache, sore throat, thirst. Insomnia for nearly a week. Took six pills of Yinqiao Jiedu Wan and six APC tablets with no effect. On the 4th, a neighbor doctor diagnosed wind-cold cold and prescribed: Guizhi 9g, Fangfeng (Saposhnikoviae Radix) 9g, Gegen (Puerariae Lobatae Radix) 6g, Jingjie (Schizonepetae Spica) 3g, Shengjiang three slices, Hongtang (Brown Sugar) 30g, decocted and taken in divided doses. One dose. This morning, condition suddenly worsened; fever 40°C; consciousness fluctuating between clear and obscure; face dark blue/pale; nose and mouth pale; tongue crimson with prickles, resembling a bayberry. Root coating thick, yellow, and dry; throat swollen, painful, with white pseudomembrane; breathing coarse and rapid; dry mouth wanting to drink; occasional delirium; urine dark red; bowel movement absent for three days; few spots on chest; pulses deep, choppy, unsmooth, wiry, fine, rapid, and forceful upon pressure. Warm pathogen accumulating heat, internally closed in Lung, simultaneous burning of Qi and Ying levels. Should have cleared Ying and drained heat. Mistakenly took acrid-warm exterior-releasing agents; heat flared, Yin severely damaged. Risk of coma; prevention of Lan Hou Bi Sha. Fire depression and internal closure; fear that constitution cannot withstand disease. Prescribe one formula to satisfy hope, awaiting expert correction.
Jiangcan 9g, Chan Yi 6g, Pian Jianghuang 6g, Xingren 6g, Chao Niubang (Fried Arctii Fructus) 6g, Yuan Shen 30g, Lianqiao 24g, Yinhua 15g, Qianhu (Peucedani Radix) 3g, Zhebeimu (Fritillariae Thunbergii Bulbus) 12g, Xian Maobigen and Xian Lubigen 60g each. Separately, decoct fresh Jiujie Changpu Gen (Acori Tatarinowii Rhizoma) 15g to take with one pill of Shenxi Dan (Divine Calyx Pill) and 0.6g Xijiao Powder (divided into two doses with decoction), for one dose.
Second Visit
After previous medicine, warm rash erupted all over body, dark and severe color. Fever slightly subsided, temperature 38.5°C. Consciousness gradually clearing; able to speak. Complains of irritability, thirst, desire for ice. Pulses changed from deep/choppy to wiry/slippery/fine/rapid. Lips and nasal bridge still pale. Tongue crimson like coral, prickles at tip, root scorched yellow and thick. Bad breath. Bowel movement patent but scanty; urine dark and scanty. Throat swollen, painful, white pseudomembrane, unable to swallow. Chest tightness lighter; breathing less rapid. Warm-toxin accumulating heat, now Lan Hou Bi Sha. Fire depression gradually resolving; Qi and Ying intertwined; condition severe. Clear Qi heat to resolve warm toxin, cool Ying blood and vent rash. Careful with diet and warmth.
Jiangcan 6g, Chan Yi 6g, Jianghuang 6g, Sheng Shigao 24g, Huangqin 9g, Zhuye 6g, Lianqiao 24g, Yinhua 24g, Zicao 9g, Didingcao 9g, Chuan Beimu (Fritillariae Cirrhosae Bulbus) 6g. Ju Fang Zhibao Dan (Formula Treasure Pill) two pills, divided into two doses, taken with decoction of washed and mashed fresh Jiujie Changpu Gen 30g. Take decoction first. One dose.
Third Visit
Pulse wiry and slippery, soft and slippery with slight rapidity upon pressure. Warm rash fully erupted. Fever gradually subsiding. Consciousness clear. Temperature 37.5°C. Tongue root coating still yellow; tip prickles reduced. Facial darkness receded; pale ring around mouth disappeared. Bowel movement smooth, dark and foul-smelling. Urine still yellow but volume increased. Throat redness and swelling healed. Plan to nourish Yin and generate fluids, eliminating residual pathogens.
Xi Shengdi 30g, Chishao 9g, Jianghuang 6g, Lianqiao 12g, Shihu (Dendrobii Caulis) 18g, Beishashen 30g, Maidong (Ophiopogonis Radix) 12g, Chuan Beimu 6g, Xian Maobigen and Xian Lubigen 30g each, Jiao Sanxian 9g each, Danpi 9g, for three doses.
Fourth Visit
Fever completely gone; skin peeling; normal temperature. Appetite poor. Bowel and bladder regulated. Pulses deep, soft, small, and slippery. Prescribe follow-up formula:
Fuling 24g, Dongguapi 30g, Sheng Shanyao (Dioscoreae Rhizoma) 30g, Chao Yiren (Coix Seed) 30g, Banxia (Pinelliae Rhizoma) 9g, Chenpi (Citri Reticulatae Pericarpium) 6g, Jiao Sanxian 9g each, for five doses.
Fifth Visit
All symptoms safe; skin peeling complete; diet, sleep, and excretion normal. Disease cured.
[Commentary]: This is a case of Lan Hou Bi Sha treated incorrectly. Heat-toxin deeply enters Blood level; treatment strictly forbids exterior release. Master Zhao recalled that in the 1920s-30s, this disease was prevalent in Beijing with high mortality. Any use of wind-dispersing drugs for exterior release resulted in bad outcomes. Later, medical authorities accepted recommendations from famous doctors, explicitly banning wind-dispersing drugs, notifying pharmacies to refuse prescriptions containing them. This disease belongs to excess heat; adding wind-dispersing drugs is like pouring oil on fire, creating uncontrollable heat. This case suffered from mistaken exterior release, leading to clouded consciousness, internal closure of fire evil, and inability of rash to erupt freely. Thus, Shengjiang San (Ascending-Descending Powder) was used with clearing heat, cooling blood, and opening orifices to regulate Qi mechanism and vent depressed fire. After taking medicine, rash erupted, consciousness cleared, and internal closure resolved. Then, simultaneous clearing of Qi and Ying, detoxifying, and venting rash. Once rash erupted and heat-toxin leaked, nourishing Yin and generating fluids was timely added. Finally, regulating spleen and stomach concluded treatment.
Master Zhao's father, Mr. Zhao Youqin, saved many patients with Lan Hou Bi Sha in the 1920s-30s, accumulating rich experience. Master Zhao's teacher, Mr. Wang Fengchun, specialized in warm diseases and had unique insights into Lan Hou Bi Sha. Their experiences are described below for reference.
Mr. Zhao Youqin's Experience in Treating Lan Hou Bi Sha
Warm pathogen transforms into heat, deeply enters Ying and Blood, stagnates in muscle surface, causing warm rash, faintly visible all over body. Tongue dry, crimson, little fluid. Pulse wiry, slippery, urgent, and rapid. Irritability, insomnia. Swollen and painful throat. Constipation. This is a severe warm rash case, major Yin injury, eruption incomplete. Urgently need to cool Ying, nourish Yin, and vent.
Sheng Dihuang (Rehmanniae Radix) 1 liang, Xuan Shen (Scrophulariae Radix) 1 liang, Chan Yi 1 qian, Jiangcan 2 qian, Lianqiao 3 qian, Yin Hua 1 liang, Sheng Shi Gao 1 liang, Zhi Mu 3 qian, Xian Shi Hu (Dendrobii Caulis) 5 qian, Xian Lu Gen 1 liang, Angong Niuhuang San (Calculus Bovis Pill) 3 fen, divided into two doses for mixing.
Mr. Wang Fengchun's Experience in Treating Lan Hou Bi Sha
Warm rash erupts all at once. High fever, thirst. Red flush on body. Tongue crimson and dry. Prickles everywhere. Coating yellow, dirty, and thick. Pulse slippery and rapid. Face, eyes, and lips all green/blue. Irritability, insomnia. This belongs to warm toxin transforming into heat, with heavy gastrointestinal stagnation. Fear of coma and convulsions. Careful with diet and warmth to prevent worsening. Strictly forbid wind-dispersing drugs.
Lianqiao 4 qian, Rendong Teng (Lonicerae Caulis) 1 liang, Chi Shao 3 qian, Zi Cao 3 qian, Di Ding 3 qian, Da Qing Ye (Isatidis Folium) 1 liang, Yuan Shen 5 qian, Jiao Mai Ya 4 qian, Xi Jiao Fen (Rhinocerotis Cornu Powder) 1 fen taken with water.
(Mr. Wang Fengchun was one of the "Four Great Famous Doctors" in Beijing in the 1940s.)
Wen Du (Acute Submandibular Lymphadenitis)
Patient Zhang, Female, 24 years old
First Visit
Patient presented with fever for nine days, temperature fluctuating between 38.5°C and 39°C. A 5cm x 5cm mass under the jaw. Western diagnosis: "Acute Submandibular Lymphadenitis." Penicillin and Tetracycline were ineffective. Current fever persists, still feels aversion to cold. Complexion dark yellow. Mass under jaw, size of chicken egg, hard texture, painful on pressure. Skin not red, not hot to touch. Throat red, swollen, and painful. Poor appetite. Constipation for three days. Pulse deep, wiry, and rapid, forceful upon pressure. Tongue red, coating white, root greasy. This belongs to fire depression in Triple Burner, Shaoyang pivot mechanism unfavorable, Qi and Blood stagnation. Prescribe Shengjiang San modified.
Bai Jiangcan (Bombyx Batryticatus) 3g (powder, taken with decoction), Chan Yi 6g, Pian Jianghuang 10g, Sheng Dahuang (Rhei Radix et Rhizoma) 6g, Chaihu 6g, Jinyinhua 10g, Zaojiaoci (Gleditsiae Spina) 5g, Huangqin 10g, Ku Jiegeng (Platycodonis Radix) 6g, Sheng Gancao 6g, for three doses.
Second Visit
After medicine, fever subsided, body cooled, all symptoms vanished. Jaw mass reduced to date-seed size. Only poor appetite and fatigue remain. Conclude with Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) and Yi Wei Tang (Benefit Stomach Decoction) modified.
[Commentary]: Swelling and pain of submandibular nodes, accompanied by fever, aversion to cold, throat redness/swelling/pain, and constipation, indicate contracting epidemic toxic qi, commonly known as "Shi Yi Ge Pi". Syndrome belongs to heat stagnation internally, Triple Burner unfavorable, Qi and Blood stagnation, clustering without ability to vent. Thus, Shengjiang San regulates Qi mechanism and circulates Blood/Qi; adding Chai Hu and Huang Qin resolves Shaoyang pivot; Jinyinhua clears heat and detoxifies; Zaojiaoci reduces abscess and breaks nodules; Jiegeng and Gancao clear throat and benefit diaphragm. After three doses, not only did fever subside, but jaw mass also dissipated significantly. Shengjiang San's efficacy in treating epidemics, reducing swelling and dissipating nodules, has always been reliable, due to Master's skill in modification.