例一刘姓，男，4岁。身热颇壮，下痢日数十行，先白后粉，里急后重，且下蛔虫一条。舌苔白，两脉细弦滑数。湿热积滞蕴蓄胃肠，亟以芳香疏通。鲜佩兰4．5克鲜霍香4．5克煨葛根3克焦苍术4．5克大豆卷9克马齿苋9克香连丸9克
(布包)范志曲12克花摈榔9克使君子9克沉香屑0。3克焦楂炭9克赤苓12克建泻9克2剂。复诊：病清无甚变化，原方加焦枯芩4．5克。三诊：身热得汗而解，下痢亦减，赤少白多，后重渐减，矢气已通，口渴思饮。湿热渐减，积滞仍多，拟再以钱仲阳法加减。煨葛根2．1克大豆卷9克焦枯芩4．5克赤小豆9克全当归9克赤芍9克、青皮3克沉香屑0．9克槟榔炭9克香连丸9克(布包)马齿苋9克莱菔子9克焦苍术4．5克生熟麦芽12克赤苓12克建泻9克
(冯仰曾整理：汪逢春医案，《中医杂志》8：549，1958）
例二高某,女，4岁。196Q年5月23日入院。住院号：72778。寒战、发热20小时，呕吐频繁，痢下粘冻样脓血便，神志不清。入院后大便日数十次，仍不省人事，今晨抽风。曾给四环素，冬眠灵，非那根；输“5：6：7”溶液一份，推入静脉。入院当日中医会诊：患儿神昏，尿闭七小时，颈抗(+),瞳孔缩小，腹软。肝肋下4．5厘米，剑下4厘米；脾未触及。舌面较糙，舌苔厚腻，脉象弦细而数。印象：中毒性痢疾合并脑症。辨证：毒热下痢，阳气郁闭不宣，关窍闭塞。治法：开窍熄风，清热导滞。方药：局方至宝丹2丸，每日二次，每次半丸。荡痢平24片，一日二次，每次6片。服法：以上均鼻饲。5月24日复诊：昨服药后，当晚七时神志逐渐清醒，已有尿，今晨热退神清，颈软，仍便脓血。停局方至宝丹、继服荡痢平，一日二次，每次8片。5月29日复诊：大便日下二次，为黄色成形使，便后仍有粘液，五天来体温均正常，本日带荡痢平五天量出院。附方：荡痢平(川连6克广木香4．5克白头翁9克秦皮6克山植炭9克川厚朴4．5克血余炭9克霍香梗4．5克车前子9克谷芽炭9克麦芽炭9克。制成片剂，每片0．3克）。(《何世英儿科医案》）
例三肖孩，女，7岁，本院干部家属
(临时病历号：712）。1964年11月2日初诊，病痢延久，将近半载。每痢必痛，痛则必痢。痢下不爽，里急后重，水粪夹杂，红白相间。轻者一日数次，重者一日十数次。屡经治疗，未获显效。面黄肌瘦，精神困顿，食欲减退，体重减轻。下痢经久，肠胃受伤。脉濡数，苔黄厚而腻，湿热蕴毒，踞于肠曲，兼挟食滞；纠集为伍。睹此症情，调治颇难，攻伤正，补恋邪，姑以清热解毒，理气和血，调肠导滞之剂试治。白头翁3克川雅连2．4克广木香2．4克槟榔3克贯众炭3克地榆炭4．5克山楂炭6克诃子肉1．8克3剂。11月7日复诊：脉已转缓，苔现薄腻，大使次数减少为一日二、三次，红白消失，且已成形。前方既效，毋庸更张。原方加白扁豆9克。3剂。3剂药后，大便正常，食入知馨，体重渐增，诸恙向愈，此后一直未再复发。(张笑平整理：陈粹吾医案选录，《江苏中医》8：29，1965）
【评按】关于小儿痢疾，清·陈复正《幼幼集成》指出“积毒内郁”是发病的重要因素，失贤认识到此病的传染性，并认为疫毒痢是小儿痢疾中之危重病证，当以清肠解毒为主要治法。
例一为湿热积滞，汪氏用芳香疏通以清热利湿、疏表导滞，由于患儿下蛔虫，故于方中加入使君子，是为兼治之法。
例二为中毒性痢疾合并脑症，中医辨证除有疫毒痢主症外，并见神昏，阳气郁遏，关窍闭塞，症势危急，患儿不能口服药剂，遂以局方至宝合“荡痢平”鼻饲之以开窍熄风，清热导滞。其中荡痢平为何氏治小儿菌痢的常规经验用方。此例在斟酌治法方面，心思较为细密。
例三为慢性痢疾
(古称“久痢”），病理为湿热夹有食滞，方以白头翁、川连、贯众清热解毒，木香、槟榔、山楂行气导滞；地榆炭等诸炭类药和血；柯子厚肠，合槟榔、山楂一涩一通，一缩一张，调整了肠胃蠕动。全方配伍严密，治标顾本，虽属久恙，竟数剂而效。
(十）小儿咽白喉吴某,男，6岁，1960年3月2日入院。住院号：28495。发热咽痛三天，经门诊快速培养咽分泌物，白喉杆菌(+),收入中医白喉病房。检查：两侧扁桃腺高度肿大，被有大片伪膜，咽峡发赤，右侧腭下淋巴腺肿大，体温38℃。舌苔微黄，脉象细数辨证：阴虚肺燥。治法：养阴清肺。方药：养阴清肺汤1剂，煎200毫升，分二次服用，外用二号吹喉药，每日六次吹喉。3月3日复诊：体温突然增高至40℃，精神不振，咽肿痛益甚，伪膜不减。舌苔黄腻，脉象转实大而数。病势发展转为毒热炽盛，改以清热解毒为主。穿山甲9克皂角刺9克乳香3克没药4．5克薄荷4.5克天花粉9克生石膏18克白芷4.5克川贝、赤芍各9克金银花24克连翘12克麦冬12克元参、丹皮各9克。3月4日复诊：体温降至正常，精神好转，咽肿减轻，大部分伪膜剥脱。苔腻轻，脉象转弦细。仍服前药不变。3月5日复诊：右侧扁桃腺尚肿，两侧伪膜完全消失。脉象重现细弱，苔消舌红。阳盛已解，阴虚又显，仍改服养阴清肺汤一剂。3月15日:体温正常，脉象和缓，一般情况好转，停药观察。3月31日连作三次咽分泌物培养(-)，痊愈出院。附方：二号吹喉药(煅龙骨、硼砂各9克珍珠4．5克冰片3克青黛6克共研细未，混匀，吹喉，一日数次）。
(《何世英儿科医案》
【评按】此案符合一般咽白喉的典型病理，但毒热炽盛，故单用养阴清肺汤不效，必须加强清热解毒。复诊方用山甲、皂刺有利于伪膜的剥脱；毒热控制后，仍以养阴清肺治其本。案中二号吹喉散为何氏验方。外治轻型白喉有效，但用于此案，似嫌病重药轻。
(十一）丹痧
例一丹痧密布，遍体肌红，身热汗微，喉关白腐，脉濡数，病已四日，白苔未化，不渴、溺清。阳虚之质，感受时邪，治当兼顾。荆芥穗4．5克炒防风4．5克牛蒡子9克射干4.5克马勃2．1克蝉衣4．5克(先煎）桔梗4．5克甘草2．1克黄附子9克活磁石30克(先煎）
(徐仲才整理：徐小圃氏儿科经验简介，《上海中医药杂志》4：5，1962）
例二王，幼。丹痧发于遍身，骨节酸痛异常，喉痛，此喉痧重症。舌红起刺如杨梅，是其特征。浮萍5克前胡5克板蓝根9克紫草2．4克山栀皮9克蒲公英9克薄荷6克大力子9克射干2．4克丹皮6克连翘9克六一散9克白茅根30克(打）另：玄明粉30克，水冲多次漱口。二诊：喉痧重症，表之后当清之。小蓟9克玄参9克麦冬9克连翘9克升麻2．4克板蓝根9克知母9克银花9克生山栀9克通草3克鳖甲24克(先煎）藏青果5枚。另：陈莱菔英120克，煎汤代茶。外吹锡类散。三诊：再投养阴凉血之属。鲜生地12克小蓟9克白薇9克麦冬9克夏枯草9克梗通1．5克玄参9克浮萍草5克四诊：喉痧寻愈，一身关节疼痛，不利转侧。浮萍草6克西河柳9克豨莶草9克桃仁泥9克丹皮9克薄荷6克白芍9克汉防己12克，海桐皮七克晚蚕砂9克包）(《章次公医案》）
例三小儿年9岁，患腥红热
(烂喉痧）之病，邀余诊视。查其脉象数而有力，舌苔白厚，发热头痛，恶心呕吐,颈部、腋下已有小红点。处以生石膏30克，蝉退9克，连翘15克，南银花24克，白茅根9克。药无终剂，疹子全回(外风侵袭之故），小儿烦躁不安，呼吸迫促，另邀他医治疗，谓石膏用之不当而致如此。服荆芥，防风温散之剂，小儿之病愈重。复求余诊，仍主原方，增石膏为120克，加广犀角9克。服药后全身红疹出现，小儿安然，呼吸自如。仍以原方减石膏为60克，3剂而痊。
(郭可明：关于临床用石膏的一点经验介绍，《中医杂志》3：148，1956）
【评按】丹痧为烂喉丹,痧之简称，亦名喉痧。相当于西医所称之猩红热。由吸受时行疫毒所致。临床以发热、身发丹痧，喉关白腐，杨梅舌为主症。治以辛凉透泄，清咽解毒为主。
例一丹痧案。患儿为阳虚体质，故予清透方中加入黄附子，为标本兼顾、权变之治。
例二为喉痧重症，治以辛凉透表，解毒利咽。由于患儿血热阴伤,故于二诊起，结合养阴凉血之品，是为丹痧后期常用治法。此例外用锡类散吹喉，能加强清咽消肿之功。又丹痧不宜辛温解毒，或过早使用大剂苦寒泻下药，临床当须谨记。例三以大剂石膏为主，配合广角、银翘解毒清热；蝉衣宣散风热透疹，茅根清热主津。药味少而主治明确，功专效宏。
(十二）惊风
例一杨姓，、女，13岁。壮热不退，神志昏乱，狂妄躁扰，手足掣搐，二脉数实，舌苔黄腻；便结五天，而矢气频仍，有汗而溲长。辨证：阳明经腑实热。治法8当急下存津。方药：川朴3克生枳实6克西锦纹9克元明粉9克紫雪丹3克(分二次化服）。复诊：昨晚汗出较多，而神志依然昏迷，腑气仍未通行，小溲反不通畅，苔化舌绛，是实火逗留胃府，势已化燥。拟白虎汤以透邪热，紫雪丹以清解热毒。生石膏60克知母9克生甘草3克鲜竹叶五十片鲜生地30克花粉9克陈粳米30克(包）紫雪丹3克(分二次化服）。三诊：药后下宿矢半盂，小溲通而色赤，神识顿清，知饥索食，舌苔滋润，热和脉静，但”余邪未靖，虑其死灰复燃,续进竹叶、白虎二剂。后经调理而愈。
(董水樵治验，董廷瑶介绍：董氏儿科经验简介，《上海中医药杂志》10：1．1962）
例二崔××，男，2岁。发热12天，高烧时抽风。发热前一周，大便每日3～4次，黄色稀薄，经治疗高热不退，突然四肢抽搐，角弓反张，急诊入院。检查：体温39．4℃，神志不清，呼吸困难，口唇发绀，晴半露凝视，阵发抽搐，喉中痰声漉漉。脉沉滑，舌淡红，有散在红色颗粒，无苔。划跖试验阳性，腹壁反射消失，腱反射亢进。腰穿：脑脊液压力增高，外观微浑，呈毛玻璃样，涂片发现结核杆菌，诊断为结核性脑膜炎。辨证：疫毒化火，肝风内扰。治法：清热泄火，熄风醒神。方药：百部18克夏枯草15克鲜佩兰、功劳叶、重楼各12克钩藤、黄连、连翘各9克胆南星6克天竺黄、僵蚕各4．5克全蝎3克。送服安宫牛黄丸半丸。二诊：前方连服2剂，身热稍退，抽搐缓解,喉中痰鸣不甚显著，呼吸好转，神志仍未完全清醒，体温38℃。深黄色粘液便，日行2～3次。脉滑数，是热邪有外达之机，肝风有潜熄之倾向。仍以清热熄风为主，而佐以醒神开窍。方药：功劳叶15克菖蒲、夏枯草、百部、丹皮各9克山慈菇、黄连、胆南星各6克全蝎3克娱蚣：条犀角0．9克羚羊粉、朱砂、浪毒各0．6克牛黄、雄黄各0.3克后六味同研，冲服。三诊：前方连服3剂后，体温已降至37.5℃。有时抽搐发作，时间较前短暂。神志清醒，知饥思食，呼吸均匀，转侧自如。后又连服3剂，热仍未退尽。抽搐有时发作。脉稍数，滑象较软，是湿热尚未肃清，肝风有时内动，仍宜宣透湿热，解毒熄风。方药：钩藤15克连翘12克功劳叶、百部各9克胆南星、山慈菇、僵蚕各6克全蝎3克蜈蚣1条羚羊粉0．9克琥珀、犀角、朱砂、狼毒各0．6克牛黄、雄黄各0．3克(后七味同研，冲服）。服4剂后,身热已退，体温接近正常，抽搐不作，大便正常，食欲不好，恶心欲呕，脉沉弦虚。后以养阴生津、健脾和胃之剂调理而愈。
(《邢锡波医案选》
例三任某,男，1岁8个月，1957年2月14日人院，16日会诊。神识不清。颜面苍白，口周青紫，呼吸困难，晨起口角抖颤,两手抽搐，指纹沉滞发紫。经医院诊断为大叶性肺炎。前几日因饮食失调，即现发热，随时躁扰不宁。辨证，积滞化热,气不宣泄，兼之气血不和，为风邪所中，故发而为惊。治法：宜先导滞清热，以减风势。方药：连翘3克黄芩3克稻芽6克枳壳3克花粉6克云苓6克石斛3克焦楂3克益元散6克二诊：热势未退，泄泻色青，惊动不安，两目直视，颜色苍白，止而再搐。此乃肝木乘脾而生虚风之证，宜予柔肝、滋水和血之剂而挽危急。生地6克丹皮6克枣皮6克茯神6克泽泻3克淮药6克白芍6克当归6克钩藤6克薄荷叶3克桑寄生6克用伏龙肝煮水煎药。三诊：服上药两剂，不再发搐，似已有回生之意，但仍痰满胸喉，面白喘急，神识未清,躁扰不宁，以滋水定风、法痰逐滞为治。白芍6克生地6克法夏8克、云苓6克泽泻3克丹皮6克淮药6克枣皮6克礞石滚痰丸9克(分二次用煎剂化开兑服）。四诊：服药周时后，泻下稠痰风涎，咽喉已无壅塞不利之象，较前安静宁贴，虽仍喘咳，亦已大有转机。以清燥润肺，祛痰定喘为治。云苓6克花粉6克麦冬6克山栀皮6克连翘6克苦杏仁6克石斛6克川贝母4.5克礞石滚痰丸9克
【背景信息】
书名：近现代名医验案类编 章节：正文(37/53) 类别：医论
【待处理原文】
案例一：患者刘姓，男性，4岁。身体发热显著，每日腹泻数十次，起初排出白色粘液，随后变为粉色粘液，伴有腹痛窘迫、肛门重坠感（里急后重），且排出一条蛔虫。舌苔白，双侧脉象细弦滑数。辨证为湿热积滞蕴结于胃肠，急需使用芳香药物以疏通气机。处方：鲜佩兰4.5克，鲜藿香4.5克，煨葛根3克，焦苍术4.5克，大豆卷9克，马齿苋9克，香连丸9克（布包），范志曲12克，花槟榔9克，使君子9克，沉香屑0.3克，焦山楂炭9克，赤茯苓12克，建泻9克。共2剂。复诊：病情无明显变化，原方加入焦黄芩4.5克。三诊：身体发热通过出汗得以解除，腹泻减轻，便中红色粘液减少而白色粘液较多，肛门重坠感逐渐减轻，矢气已通，口渴想喝水。湿热逐渐减退，但积滞仍然较多，拟定采用钱仲阳的方法进行加减治疗。处方：煨葛根2.1克，大豆卷9克，焦黄芩4.5克，赤小豆9克，全当归9克，赤芍9克，青皮3克，沉香屑0.9克，槟榔炭9克，香连丸9克（布包），马齿苋9克，莱菔子9克，焦苍术4.5克，生麦芽与熟麦芽各12克，赤茯苓12克，建泻9克。
（冯仰曾整理：汪逢春医案，《中医杂志》8：549，1958）
案例二：患者高某，女性，4岁。1960年5月23日入院。住院号：72778。寒战、发热20小时，频繁呕吐，痢下粘冻样脓血便，神志不清。入院后大便每日数十次，仍不省人事，今晨出现抽搐。曾给予四环素、冬眠灵、非那根；输注“5:6:7”溶液一份，静脉推注。入院当日中医会诊：患儿神志昏迷，尿闭七小时，颈部抵抗试验阳性（颈抗+），瞳孔缩小，腹部柔软。肝脏肋下4.5厘米，剑突下4厘米；脾脏未触及。舌面较粗糙，舌苔厚腻，脉象弦细而数。印象：中毒性痢疾合并脑病。辨证：毒热下痢，阳气郁闭不宣，关窍闭塞。治法：开窍熄风，清热导滞。方药：局方至宝丹2丸，每日二次，每次半丸。荡痢平24片，一日二次，每次6片。服法：以上药物均通过鼻饲给药。5月24日复诊：昨日服药后，当晚七时神志逐渐清醒，已有排尿，今晨热退神清，颈部变软，但仍便脓血。停用局方至宝丹，继服荡痢平，一日二次，每次8片。5月29日复诊：大便每日两次，为黄色成形便，便后仍有粘液，五天来体温均正常，本日带荡痢平五天量出院。附方：荡痢平（川黄连6克，广木香4.5克，白头翁9克，秦皮6克，山楂炭9克，川厚朴4.5克，血余炭9克，藿香梗4.5克，车前子9克，谷芽炭9克，麦芽炭9克。制成片剂，每片0.3克）。（《何世英儿科医案》）
案例三：肖姓儿童，女性，7岁，本院干部家属
（临时病历号：712）。1964年11月2日初诊，患痢疾日久，将近半年。每次腹痛必伴腹泻，腹泻不爽，里急后重，水粪夹杂，红白相间。轻者一日数次，重者一日十几次。屡经治疗，未获显效。面色萎黄，肌肉消瘦，精神困顿，食欲减退，体重减轻。下痢经久，肠胃受伤。脉濡数，苔黄厚而腻，湿热蕴毒，踞于肠曲，兼挟食滞；纠集为伍。目睹此症情，调治颇难，攻邪伤正，补益恋邪，姑以清热解毒，理气和血，调肠导滞之剂试治。处方：白头翁3克，川雅连2.4克，广木香2.4克，槟榔3克，贯众炭3克，地榆炭4.5克，山楂炭6克，诃子肉1.8克。3剂。11月7日复诊：脉已转缓，苔现薄腻，大便次数减少为一日二、三次，红白消失，且已成形。前方既效，毋庸更张。原方加白扁豆9克。3剂。3剂药后，大便正常，食入知味，体重渐增，诸恙向愈，此后一直未再复发。（张笑平整理：陈粹吾医案选录，《江苏中医》8：29，1965）
【评按】关于小儿痢疾，清代陈复正《幼幼集成》指出“积毒内郁”是发病的重要因素，失智者认识到此病的传染性，并认为疫毒痢是小儿痢疾中之危重病证，当以清肠解毒为主要治法。
案例一为湿热积滞，汪氏用芳香疏通以清热利湿、疏表导滞，由于患儿下蛔虫，故于方中加入使君子，是为兼治之法。
案例二为中毒性痢疾合并脑病，中医辨证除有疫毒痢主症外，并见神昏，阳气郁遏，关窍闭塞，症势危急，患儿不能口服药剂，遂以局方至宝合“荡痢平”鼻饲之以开窍熄风，清热导滞。其中荡痢平为何氏治小儿菌痢的常规经验用方。此例在斟酌治法方面，心思较为细密。
案例三为慢性痢疾
（古称“久痢”），病理为湿热夹有食滞，方以白头翁、川连、贯众清热解毒，木香、槟榔、山楂行气导滞；地榆炭等诸炭类药和血；诃子厚肠，合槟榔、山楂一涩一通，一缩一张，调整了肠胃蠕动。全方配伍严密，治标顾本，虽属久恙，竟数剂而效。
（十）小儿咽白喉
吴某，男，6岁，1960年3月2日入院。住院号：28495。发热咽痛三天，经门诊快速培养咽分泌物，白喉杆菌(+),收入中医白喉病房。检查：两侧扁桃腺高度肿大，被有大片伪膜，咽峡发赤，右侧腭下淋巴腺肿大，体温38℃。舌苔微黄，脉象细数。辨证：阴虚肺燥。治法：养阴清肺。方药：养阴清肺汤1剂，煎200毫升，分二次服用，外用二号吹喉药，每日六次吹喉。3月3日复诊：体温突然增高至40℃，精神不振，咽肿痛益甚，伪膜不减。舌苔黄腻，脉象转实大而数。病势发展转为毒热炽盛，改以清热解毒为主。穿山甲9克，皂角刺9克，乳香3克，没药4.5克，薄荷4.5克，天花粉9克，生石膏18克，白芷4.5克，川贝母、赤芍各9克，金银花24克，连翘12克，麦冬12克，元参、丹皮各9克。3月4日复诊：体温降至正常，精神好转，咽肿减轻，大部分伪膜剥脱。苔腻轻，脉象转弦细。仍服前药不变。3月5日复诊：右侧扁桃腺尚肿，两侧伪膜完全消失。脉象重现细弱，苔消舌红。阳盛已解，阴虚又显，仍改服养阴清肺汤一剂。3月15日：体温正常，脉象和缓，一般情况好转，停药观察。3月31日连作三次咽分泌物培养(-)，痊愈出院。附方：二号吹喉药（煅龙骨、硼砂各9克，珍珠4.5克，冰片3克，青黛6克，共研细末，混匀，吹喉，一日数次）。
（《何世英儿科医案》）
【评按】此案符合一般咽白喉的典型病理，但毒热炽盛，故单用养阴清肺汤不效，必须加强清热解毒。复诊方用山甲、皂刺有利于伪膜的剥脱；毒热控制后，仍以养阴清肺治其本。案中二号吹喉散为何氏验方。外治轻型白喉有效，但用于此案，似嫌病重药轻。
（十一）丹痧
案例一：丹痧密布，遍体肌红，身热汗微，喉关白腐，脉濡数，病已四日，白苔未化，不渴、溺清。阳虚之质，感受时邪，治当兼顾。荆芥穗4.5克，炒防风4.5克，牛蒡子9克，射干4.5克，马勃2.1克，蝉衣4.5克（先煎），桔梗4.5克，甘草2.1克，黄附子9克，活磁石30克（先煎）。
（徐仲才整理：徐小圃氏儿科经验简介，《上海中医药杂志》4：5，1962）
案例二：王姓幼儿。丹痧发于遍身，骨节酸痛异常，喉痛，此喉痧重症。舌红起刺如杨梅，是其特征。浮萍5克，前胡5克，板蓝根9克，紫草2.4克，山栀皮9克，蒲公英9克，薄荷6克，大力子9克，射干2.4克，丹皮6克，连翘9克，六一散9克，白茅根30克（打）。另：玄明粉30克，水冲多次漱口。二诊：喉痧重症，表之后当清之。小蓟9克，玄参9克，麦冬9克，连翘9克，升麻2.4克，板蓝根9克，知母9克，银花9克，生山栀9克，通草3克，鳖甲24克（先煎），藏青果5枚。另：陈莱菔英120克，煎汤代茶。外吹锡类散。三诊：再投养阴凉血之属。鲜生地12克，小蓟9克，白薇9克，麦冬9克，夏枯草9克，梗通1.5克，玄参9克，浮萍草5克。四诊：喉痧寻愈，一身关节疼痛，不利转侧。浮萍草6克，西河柳9克，豨莶草9克，桃仁泥9克，丹皮9克，薄荷6克，白芍9克，汉防己12克，海桐皮七克，晚蚕砂9克（包）。（《章次公医案》）
案例三：小儿年9岁，患猩红热
（烂喉痧）之病，邀余诊视。查其脉象数而有力，舌苔白厚，发热头痛，恶心呕吐,颈部、腋下已有小红点。处以生石膏30克，蝉退9克，连翘15克，南银花24克，白茅根9克。药无终剂，疹子全回（外风侵袭之故），小儿烦躁不安，呼吸迫促，另邀他医治疗，谓石膏用之不当而致如此。服荆芥，防风温散之剂，小儿之病愈重。复求余诊，仍主原方，增石膏为120克，加广犀角9克。服药后全身红疹出现，小儿安然，呼吸自如。仍以原方减石膏为60克，3剂而痊。
（郭可明：关于临床用石膏的一点经验介绍，《中医杂志》3：148，1956）
【评按】丹痧为烂喉丹,痧之简称，亦名喉痧。相当于西医所称之猩红热。由吸受时行疫毒所致。临床以发热、身发丹痧，喉关白腐，杨梅舌为主症。治以辛凉透泄，清咽解毒为主。
案例一丹痧案。患儿为阳虚体质，故予清透方中加入黄附子，为标本兼顾、权变之治。
案例二为喉痧重症，治以辛凉透表，解毒利咽。由于患儿血热阴伤,故于二诊起，结合养阴凉血之品，是为丹痧后期常用治法。此例外用锡类散吹喉，能加强清咽消肿之功。又丹痧不宜辛温解毒，或过早使用大剂苦寒泻下药，临床当须谨记。例三以大剂石膏为主，配合广角、银翘解毒清热；蝉衣宣散风热透疹，茅根清热主津。药味少而主治明确，功专效宏。
（十二）惊风
案例一：杨姓，女，13岁。壮热不退，神志昏乱，狂妄躁扰，手足掣搐，二脉数实，舌苔黄腻；便结五天，而矢气频仍，有汗而溲长。辨证：阳明经腑实热。治法：当急下存津。方药：川朴3克，生枳实6克，西锦纹9克，元明粉9克，紫雪丹3克（分二次化服）。复诊：昨晚汗出较多，而神志依然昏迷，腑气仍未通行，小溲反不通畅，苔化舌绛，是实火逗留胃府，势已化燥。拟白虎汤以透邪热，紫雪丹以清解热毒。生石膏60克，知母9克，生甘草3克，鲜竹叶五十片，鲜生地30克，花粉9克，陈粳米30克（包），紫雪丹3克（分二次化服）。三诊：药后下宿矢半盂，小溲通而色赤，神识顿清，知饥索食，舌苔滋润，热和脉静，但”余邪未靖，虑其死灰复燃,续进竹叶、白虎二剂。后经调理而愈。
（董水樵治验，董廷瑶介绍：董氏儿科经验简介，《上海中医药杂志》10：1．1962）
案例二：崔××，男，2岁。发热12天，高烧时抽风。发热前一周，大便每日3～4次，黄色稀薄，经治疗高热不退，突然四肢抽搐，角弓反张，急诊入院。检查：体温39．4℃，神志不清，呼吸困难，口唇发绀，晴半露凝视，阵发抽搐，喉中痰声漉漉。脉沉滑，舌淡红，有散在红色颗粒，无苔。划跖试验阳性，腹壁反射消失，腱反射亢进。腰穿：脑脊液压力增高，外观微浑，呈毛玻璃样，涂片发现结核杆菌，诊断为结核性脑膜炎。辨证：疫毒化火，肝风内扰。治法：清热泄火，熄风醒神。方药：百部18克，夏枯草15克，鲜佩兰、功劳叶、重楼各12克，钩藤、黄连、连翘各9克，胆南星6克，天竺黄、僵蚕各4．5克，全蝎3克。送服安宫牛黄丸半丸。二诊：前方连服2剂，身热稍退，抽搐缓解,喉中痰鸣不甚显著，呼吸好转，神志仍未完全清醒，体温38℃。深黄色粘液便，日行2～3次。脉滑数，是热邪有外达之机，肝风有潜熄之倾向。仍以清热熄风为主，而佐以醒神开窍。方药：功劳叶15克，菖蒲、夏枯草、百部、丹皮各9克，山慈菇、黄连、胆南星各6克，全蝎3克，蜈蚣：条犀角0．9克，羚羊粉、朱砂、浪毒各0．6克，牛黄、雄黄各0．3克（后六味同研，冲服）。三诊：前方连服3剂后，体温已降至37.5℃。有时抽搐发作，时间较前短暂。神志清醒，知饥思食，呼吸均匀，转侧自如。后又连服3剂，热仍未退尽。抽搐有时发作。脉稍数，滑象较软，是湿热尚未肃清，肝风有时内动，仍宜宣透湿热，解毒熄风。方药：钩藤15克，连翘12克，功劳叶、百部各9克，胆南星、山慈菇、僵蚕各6克，全蝎3克，蜈蚣1条，羚羊粉0．9克，琥珀、犀角、朱砂、狼毒各0．6克，牛黄、雄黄各0．3克（后七味同研，冲服）。服4剂后,身热已退，体温接近正常，抽搐不作，大便正常，食欲不好，恶心欲呕，脉沉弦虚。后以养阴生津、健脾和胃之剂调理而愈。
（《邢锡波医案选》）
案例三：任某,男，1岁8个月，1957年2月14日人院，16日会诊。神识不清。颜面苍白，口周青紫，呼吸困难，晨起口角抖颤,两手抽搐，指纹沉滞发紫。经医院诊断为大叶性肺炎。前几日因饮食失调，即现发热，随时躁扰不宁。辨证，积滞化热,气不宣泄，兼之气血不和，为风邪所中，故发而为惊。治法：宜先导滞清热，以减风势。方药：连翘3克，黄芩3克，稻芽6克，枳壳3克，花粉6克，云苓6克，石斛3克，焦楂3克，益元散6克。二诊：热势未退，泄泻色青，惊动不安，两目直视，颜色苍白，止而再搐。此乃肝木乘脾而生虚风之证，宜予柔肝、滋水和血之剂而挽危急。生地6克，丹皮6克，枣皮6克，茯神6克，泽泻3克，淮药6克，白芍6克，当归6克，钩藤6克，薄荷叶3克，桑寄生6克，用伏龙肝煮水煎药。三诊：服上药两剂，不再发搐，似已有回生之意，但仍痰满胸喉，面白喘急，神识未清,躁扰不宁，以滋水定风、法痰逐滞为治。白芍6克，生地6克，法夏8克、云苓6克，泽泻3克，丹皮6克，淮药6克，枣皮6克，礞石滚痰丸9克（分二次用煎剂化开兑服）。四诊：服药周时后，泻下稠痰风涎，咽喉已无壅塞不利之象，较前安静宁贴，虽仍喘咳，亦已大有转机。以清燥润肺，祛痰定喘为治。云苓6克，花粉6克，麦冬6克，山栀皮6克，连翘6克，苦杏仁6克，石斛6克，川贝母4.5克，礞石滚痰丸9克
Background Information
Book Title: Compilation of Verified Cases by Famous Modern and Contemporary Physicians
Chapter: Main Text (37/53)
Category: Medical Discussion
Case 1: Liu, male, 4 years old. Significant body heat, diarrhea dozens of times a day, initially discharging white mucus, later turning to pink mucus, accompanied by abdominal pain with urgent defecation and tenesmus (a sensation of incomplete defecation with straining), and passage of one Ascaris lumbricoides (roundworm). Tongue coating is white; bilateral pulses are fine, wiry, slippery, and rapid. Syndrome differentiation: Damp-heat and food stagnation accumulating in the stomach and intestines. Urgent treatment requires aromatic herbs to unblock the qi mechanism. Prescription: Fresh Peilan (Eupatorium fortunei Herba) 4.5g, fresh Huoxiang (Agastache rugosa Herb) 4.5g, Wei Gegen (Prepared Puerariae Radix) 3g, Jiao Cangzhu (Charred Atractylodis Rhizoma) 4.5g, Da Dou Juan (Glycine max Sprout) 9g, Machixian (Portulacae Herba) 9g, Xianglian Wan (Fragrant Coptis Pill) 9g (wrapped in cloth for decoction), Fan Zhi Qu (Fan Zhi Qu) 12g, Hua Binglang (Arecae Semen) 9g, Shijunzi (Quisqualis Indica Fruit) 9g, Chenxiang Shu (Aquilariae Lignum Resinatum) 0.3g, Jiao Zhazao (Charred Crataegi Fructus) 9g, Chi Ling (Poria with Red Sandalwood) 12g, Jian Xie (Alismatis Rhizoma) 9g. Total 2 doses. Follow-up visit 1: No significant change in condition; add Jiao Huangqin (Charred Scutellariae Radix) 4.5g to the original prescription. Follow-up visit 2: Body heat resolved through sweating; diarrhea decreased; red components in stool reduced while white components increased; tenesmus gradually subsided; flatus passed; thirst with desire to drink. Damp-heat gradually subsiding, but stagnation remains substantial. Treatment plan: Modify according to the method of Qian Zhongyang. Prescription: Wei Gegen (Prepared Puerariae Radix) 2.1g, Da Dou Juan (Glycine max Sprout) 9g, Jiao Huangqin (Charred Scutellariae Radix) 4.5g, Chi Xiaodou (Vigna umbellata Seed) 9g, Quan Danggui (Angelicae Sinensis Radix) 9g, Chi Shao (Paeoniae Radix Rubra) 9g, Qingpi (Citri Reticulatae Pericarpium Viride) 3g, Chenxiang Shu (Aquilariae Lignum Resinatum) 0.9g, Binglang Tan (Charred Arecae Semen) 9g, Xianglian Wan (Fragrant Coptis Pill) 9g (wrapped in cloth for decoction), Machixian (Portulacae Herba) 9g, Laifuzi (Raphani Semen) 9g, Jiao Cangzhu (Charred Atractylodis Rhizoma) 4.5g, Sheng Maiya (Raw Hordei Fructus Germinatus) and Shu Maiya (Cooked Hordei Fructus Germinatus) 12g each, Chi Ling (Poria with Red Sandalwood) 12g, Jian Xie (Alismatis Rhizoma) 9g.
(Collected by Feng Yangzeng: Wang Fengchun's Medical Cases, *Journal of Traditional Chinese Medicine* 8:549, 1958)
Case 2: Gao, female, 4 years old. Admitted on May 23, 1960. Hospital No.: 72778. Chills and fever for 20 hours, frequent vomiting, dysenteric discharge of sticky purulent blood-like stool, unconsciousness. After admission, bowel movements occurred dozens of times daily, still unconscious; convulsions occurred this morning. Previously treated with Tetracycline, Chlorpromazine (Winter Sleep Spirit), and Diphenhydramine (Phenergan); infused with one unit of "5:6:7" solution via intravenous push. TCM consultation on the day of admission: Child is comatose, anuria for seven hours, nuchal rigidity (+), pupils constricted, abdomen soft. Liver palpable 4.5 cm below costal margin, 4 cm below xiphoid process; spleen not palpable. Tongue surface rough, coating thick and greasy, pulse wiry, fine, and rapid. Impression: Toxic dysentery complicated by encephalopathy. Syndrome differentiation: Toxic heat causing dysentery, yang qi depressed and unable to circulate, orifices blocked. Therapeutic principle: Open orifices and extinguish wind, clear heat and guide out stagnation. Prescription: Ju Fang Zhi Bao Dan (Official Formula Treasure Pill) 2 pills, twice daily, half a pill each time. Dang Li Ping (Dysentery-Clearing Tablet) 24 tablets, twice daily, 6 tablets each time. Administration: All medications administered via nasogastric tube. Follow-up on May 24: After taking medicine yesterday, consciousness gradually returned at 7 PM; urination resumed; fever subsided and consciousness cleared this morning; neck flexibility improved; still passing pus and blood in stool. Stop Ju Fang Zhi Bao Dan; continue Dang Li Ping, twice daily, 8 tablets each time. Follow-up on May 29: Bowel movements twice daily, yellow formed stool, with residual mucus after defecation; temperature normal for five days; discharged with a five-day supply of Dang Li Ping. Supplementary Formula: Dang Li Ping (Chuan Lian Lian [Coptidis Rhizoma] 6g, Guang Mu Xiang [Aucklandiae Radix] 4.5g, Bai Tou Weng [Pulsatillae Radix] 9g, Qin Pi [Fraxini Cortex] 6g, Shan Zhi Tan [Charred Crataegi Fructus] 9g, Chuan Hou Po [Magnoliae Officinalis Cortex] 4.5g, Xue Yu Tan [Charred Hominis Sanguis Succidus] 9g, Huo Xiang Geng [Agastache Rugosae Caulis] 4.5g, Che Qian Zi [Plantaginis Semen] 9g, Gu Ya Tan [Charred Hordei Fructus Germinatus] 9g, Mai Ya Tan [Charred Hordei Fructus Germinatus] 9g. Made into tablets, 0.3g per tablet.) (*He Shiying's Pediatric Medical Cases*)
Case 3: Xiao, female, 7 years old, family member of hospital staff.
(Temporary Medical Record No.: 712). First visit on November 2, 1964. Dysentery has persisted for nearly half a year. Every episode of dysentery is accompanied by pain; pain necessitates defecation. Dysenteric discharge is unsatisfactory, with tenesmus, mixed water and feces, alternating red and white. Mild cases occur several times a day; severe cases up to ten-plus times. Multiple treatments yielded no obvious effect. Complexion sallow, emaciated, mental fatigue, poor appetite, weight loss. Chronic dysentery has injured the stomach and intestines. Pulse is soggy and rapid; coating is thick, yellow, and greasy. Damp-heat and toxin accumulate, residing in intestinal coils, combined with food stagnation. Given this clinical presentation, treatment is difficult; attacking pathogens harms healthy qi, tonifying retains pathogens. Tentatively treat with a formula to clear heat and detoxify, regulate qi and harmonize blood, adjust intestines and guide out stagnation. Prescription: Bai Tou Weng (Pulsatillae Radix) 3g, Chuan Ya Lian [Coptidis Rhizoma] 2.4g, Guang Mu Xiang (Aucklandiae Radix) 2.4g, Bing Lang (Arecae Semen) 3g, Guan Zhong Tan (Charred Cyrtomii Rhizoma) 3g, Di Yu Tan (Charred Sanguisorbae Radix) 4.5g, Shan Zha Tan (Charred Crataegi Fructus) 6g, He Zi Rou (Pericarpium Terminaliae Chebulae) 1.8g. 3 doses. Follow-up on November 7: Pulse has slowed, coating is thin and greasy, bowel movements reduced to two or three times daily, red and white components disappeared, stool formed. Since the previous formula was effective, no changes needed. Add Bai Bian Dou (Dolichos Lablab Seed) 9g to the original prescription. 3 doses. After 3 doses, bowel movements normalized, food tasted good, weight gradually increased, all symptoms improving, no recurrence since. (Collected by Zhang Xiaoping: Selected Cases of Chen Cuiwu, *Jiangsu Journal of Traditional Chinese Medicine* 8:29, 1965)
[Commentary] Regarding pediatric dysentery, Chen Fuzheng in the Qing Dynasty's *You You Ji Cheng* pointed out that "accumulated toxin internal depression" is an important factor in disease onset. [Note: The text mentions "Shi Xiao San" which seems like a typo for recognizing infectious nature, but literally says "Shi Xiao San recognized..."]. It recognizes the contagious nature of this disease and considers epidemic toxic dysentery as a critical condition among pediatric dysenteries, requiring clearing intestinal heat and detoxification as the main treatment.
Case 1 involves damp-heat and stagnation. Mr. Wang used aromatic herbs to clear heat, promote diuresis, release the exterior, and guide out stagnation. Since the child passed roundworms, Shijunzi (Quisqualis Indica Fruit) was added to the formula as a concurrent treatment.
Case 2 is toxic dysentery complicated by encephalopathy. TCM syndrome differentiation includes main symptoms of epidemic toxic dysentery, plus coma, depressed yang qi, and blocked orifices. The condition is critical, and the child cannot take oral medication. Therefore, Ju Fang Zhi Bao Dan combined with "Dang Li Ping" was administered via nasogastric tube to open orifices, extinguish wind, clear heat, and guide out stagnation. Dang Li Ping is Mr. He's routine empirical formula for treating pediatric bacillary dysentery. This case demonstrates meticulous consideration in determining the treatment method.
Case 3 is chronic dysentery (ancient term: "Long-standing Dysentery"). The pathology is damp-heat combined with food stagnation. The formula uses Bai Tou Weng, Chuan Lian, and Guan Zhong to clear heat and detoxify; Mu Xiang, Bing Lang, and Shan Zha to move qi and guide out stagnation; Di Yu Tan and other charred herbs to harmonize blood; He Zi to thicken the intestines. Combined with Bing Lang and Shan Zha, it creates a balance of astringency and movement, contraction and expansion, adjusting gastrointestinal motility. The overall formula coordination is rigorous, treating both symptoms and root causes. Although it is a long-standing illness, effectiveness was achieved in just a few doses.
(X) Pediatric Diphtheria
Wu, male, 6 years old, admitted on March 2, 1960. Hospital No.: 28495. Fever and sore throat for three days. Rapid culture of pharyngeal secretion in outpatient department positive for Corynebacterium diphtheriae. Admitted to TCM Diphtheria Ward. Examination: Bilateral tonsils highly swollen, covered with large pseudomembranes, pharynx red, right subpalatine lymph nodes swollen, temperature 38°C. Tongue coating slightly yellow, pulse fine and rapid. Syndrome differentiation: Yin deficiency with lung dryness. Therapeutic principle: Nourish yin and clear lungs. Prescription: Yang Yin Qing Fei Tang (Nourish Yin Clear Lung Decoction) 1 dose, decocted to 200ml, taken in two divided doses. Externally use No. 2 Throat Blowing Powder, blowing into throat six times daily. Follow-up on March 3: Temperature suddenly rose to 40°C, spirit listless, sore throat and swelling worsened, pseudomembranes unchanged. Tongue coating yellow and greasy, pulse became solid, large, and rapid. Disease progression turned to excessive toxic heat. Changed treatment to primarily clearing heat and detoxifying. Chuanshanjia (Pangolin Scale) 9g, Zaojiaoci (Gleditsiae Spina) 9g, Rushi (Frankincense) 3g, Moyao (Myrrh) 4.5g, Bohe (Menthae Haplocalycis Herba) 4.5g, Tianhuafen (Trichosanthis Radix) 9g, Sheng Shigao (Raw Gypsum Fibrosum) 18g, Baizhi (Angelicae Dahuricae Radix) 4.5g, Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) and Chi Shao (Paeoniae Radix Rubra) 9g each, Jinyinhua (Lonicerae Japonicae Flos) 24g, Lianqiao (Forsythiae Fructus) 12g, Maidong (Ophiopogonis Radix) 12g, Yuan Shen (Scrophulariae Radix) and Dan Pi (Moutan Cortex) 9g each. Follow-up on March 4: Temperature returned to normal, spirit improved, throat swelling reduced, most pseudomembranes shed. Coating less greasy, pulse became wiry and fine. Continue previous medication unchanged. Follow-up on March 5: Right tonsil still swollen, pseudomembranes on both sides completely disappeared. Pulse reappeared fine and weak, coating gone, tongue red. Yang excess resolved, yin deficiency again apparent. Changed back to Yang Yin Qing Fei Tang 1 dose. March 15: Temperature normal, pulse gentle, general condition improved, stop medication and observe. March 31: Three consecutive pharyngeal secretions cultures negative, discharged cured. Supplementary Formula: No. 2 Throat Blowing Powder (Duan Longgu [Calcined Os Draconis et Ossis Ferreum] 9g, Peng Sha [Borax] 9g, Zhenzhu [Pearl] 4.5g, Bingpian [Borneolum Syntheticum] 3g, Qingdai [Indigo Naturalis] 6g. Grind into fine powder, mix well, blow into throat several times a day.)
(*He Shiying's Pediatric Medical Cases*)
[Commentary] This case fits the typical pathology of pharyngeal diphtheria, but due to excessive toxic heat, using Yang Yin Qing Fei Tang alone was ineffective; strengthening heat-clearing and detoxification was necessary. The follow-up formula uses Pangolin Scale and Gleditsiae Spina to facilitate pseudomembrane shedding; after controlling toxic heat, Yang Yin Qing Fei was used to treat the root cause. No. 2 Throat Blowing Powder in the case is Mr. He's verified formula. External treatment is effective for mild diphtheria, but for this case, it seems the disease is severe and the medication light.
(XI) Scarlet Fever (Dan Sha)
Case 1: Dan Sha (scarlet rash) dense, body skin red, slight body heat and sweat, white decay at throat gate, pulse soggy and rapid. Illness has lasted four days, white coating not transformed, no thirst, clear urine. Constitution of yang deficiency, contracted seasonal pathogen. Treatment must consider both. Jingjie Sui (Schizonepetae Spica) 4.5g, Chao Fangfeng (Saposhnikoviae Radix fried) 4.5g, Niubangzi (Arctii Fructus) 9g, Shegan (Belamcandae Rhizoma) 4.5g, Mabo (Macrostemonis Flos) 2.1g, Chan Yi (Bombyx Batryticatus) 4.5g (decoct first), Jiegeng (Platycodonis Radix) 4.5g, Gancao (Glycyrrhizae Radix et Rhizoma) 2.1g, Huang Fuzi (Aconiti Lateralis Radix Praeparata) 9g, Huo Cishi (Magnetitum) 30g (decoct first).
(Collected by Xu Zhongcai: Introduction to Dr. Xu Xiaopu's Pediatric Experience, *Shanghai Journal of Traditional Chinese Medicine* 4:5, 1962)
Case 2: Wang, toddler. Dan Sha erupted over the whole body, extreme bone and joint soreness, sore throat. This is a severe case of throat scarlet fever. Tongue red with prickles like a bayberry, which is its characteristic. Fu Ping (Urticae Diffusae Herba) 5g, Qian Hu (Peucedani Radix) 5g, Banlangen (Isatidis Radix) 9g, Zicao (Leonuri Carthami Herba) 2.4g, Shan Zhi Pi (Gardeniae Cortex) 9g, Pugongying (Taraxaci Herba) 9g, Bohe (Menthae Haplocalycis Herba) 6g, Dalizi (Arctii Fructus) 9g, Shegan (Belamcandae Rhizoma) 2.4g, Dan Pi (Moutan Cortex) 6g, Lianqiao (Forsythiae Fructus) 9g, Liu Yi San (Six-to-One Powder) 9g, Bai Maogen (Imperatae Rhizoma) 30g (crushed). Additionally: Xuan Ming Fen (Mirabilite) 30g, dissolve in water, rinse mouth multiple times. Second visit: Severe throat scarlet fever, after releasing the exterior, should clear internally. Xiaoji (Cirsii Herba) 9g, Xuanshen (Scrophulariae Radix) 9g, Maidong (Ophiopogonis Radix) 9g, Lianqiao (Forsythiae Fructus) 9g, Shengma (Cimicifugae Rhizoma) 2.4g, Banlangen (Isatidis Radix) 9g, Zhimu (Anemarrhenae Rhizoma) 9g, Yinhua (Lonicerae Japonicae Flos) 9g, Sheng Zhizi (Gardeniae Fructus) 9g, Tongcao (Tetrapanacis Medulla) 3g, Biejia (Testudinis Carapax et Plastrum) 24g (decoct first), Zang Qingguo (Terminalia chebula Retz. var. tomentella) 5 pieces. Additionally: Chen Laifu Ying (Old Radish Stem) 120g, decoct soup to replace tea. Externally blow Xi Lei San (Xi Lei Powder) into throat. Third visit: Further administer nourishing yin and cooling blood agents. Xian Shengdi (Rehmanniae Radix Recens) 12g, Xiaoji (Cirsii Herba) 9g, Baiwei (Cleomidis Herba) 9g, Maidong (Ophiopogonis Radix) 9g, Xiakucao (Prunellae Spica) 9g, Gengtong (likely Tongcao or similar) 1.5g, Xuanshen (Scrophulariae Radix) 9g, Fuping Cao (Urticae Diffusae Herba) 5g. Fourth visit: Throat scarlet fever seeking cure, joint pain all over body, difficulty turning. Fuping Cao (Urticae Diffusae Herba) 6g, Xi Heliu (Salviae plebeiae Herba) 9g, Xixiancao (Siegesbeckiae Herba) 9g, Taoren Ni (Persicae Semen Paste) 9g, Dan Pi (Moutan Cortex) 9g, Bohe (Menthae Haplocalycis Herba) 6g, Baishao (Paeoniae Radix Alba) 9g, Han Fangji (Stephaniae Tetrandrae Radix) 12g, Haitongpi (Cryptocarya Alata Bark) 7g, Wancangsha (Bombyx Batryticatus processed with bran) 9g (wrapped). (*Zhang Cigong's Medical Cases*)
Case 3: Child aged 9 years, suffering from Scarlet Fever
(Rotten Throat Scarlets). Invited me to consult. Pulse rapid and forceful, tongue coating thick white, fever headache, nausea and vomiting, small red spots already appeared on neck and axilla. Prescribed Raw Gypsum 30g, Cicada Slough 9g, Forsythia 15g, Southern Honeysuckle 24g, Imperata Root 9g. Before finishing the medicine, rash completely receded (due to external wind invasion), child restless, breathing急促 (rapid/hurried). Invited another doctor who said improper use of Gypsum caused this. Took Jingjie and Fangfeng warm-dispersing agents, child's condition worsened. Returned to me for consultation, still adhered to original formula, increased Gypsum to 120g, added Wild Water Buffalo Horn 9g. After taking medicine, whole body red rash appeared, child calm, breathing free. Still using original formula, reduced Gypsum to 60g, 3 doses to recover.
(Guo Keming: An Introduction to Clinical Experience with Gypsum, *Journal of Traditional Chinese Medicine* 3:148, 1956)
[Commentary] Dan Sha is short for Lanhou Dan Sha, also named Hou Sha. Equivalent to Scarlet Fever in Western medicine. Caused by inhaling seasonal epidemic toxins. Clinically characterized by fever, body erupting Dan Sha, white decay at throat gate, and bayberry tongue. Treatment focuses on acrid-cool dispersing and venting, clearing throat and detoxifying.
Case 1 Dan Sha case. Child has yang deficiency constitution, so Huang Fuzi (Prepared Aconite Lateral Root) was added to the clearing and venting formula, representing a treatment considering both root and branch, and adapting to circumstances.
Case 2 is a severe throat scarlet fever case, treated with acrid-cool exterior-releasing, detoxifying, and throat-soothing. Since the child has blood heat and yin injury, starting from the second visit, nourishing yin and cooling blood agents were combined, which is a common late-stage treatment for Dan Sha. In this case, external application of Xi Lei San blowing into the throat can strengthen clearing throat and reducing swelling effects. Also, Dan Sha should not be treated with acrid-warm detoxifying agents, or early use of large doses of bitter-cold purgatives; this must be remembered clinically. Case 3 mainly uses large doses of Gypsum, combined with Buffalo Horn and Yin Qiao for detoxifying and clearing heat; Cicada Slough disperses wind-heat and vents rash, Imperata clears heat and generates fluids. Few ingredients but clear main treatment, specialized function and great efficacy.
(XII) Convulsion (Jing Feng)
Case 1: Yang, female, 13 years old. Persistent high fever, confused spirit, wild and agitated behavior, jerking and twitching of hands and feet, bilateral pulses rapid and solid, tongue coating yellow and greasy; constipation for five days, yet frequent flatus, sweating but long urine stream. Syndrome differentiation: Yangming channel and fu-organ excess heat. Therapeutic principle: Urgently purge to preserve fluids. Prescription: Chuan Pu (Magnoliae Officinalis Cortex) 3g, Sheng Zhishi (Immature Bitter Orange) 6g, Xi Jinwen (Rhei Radix et Rhizoma) 9g, Yuan Ming Fen (Mirabilite) 9g, Zi Xue Dan (Purple Snow Pill) 3g (dissolved and taken in two divided doses). Follow-up: Sweated more last night, but spirit remains comatose, fu qi (bowel gas) still not passing, urination反而 (instead) not smooth, coating transformed, tongue crimson. This indicates excess fire lingering in stomach fu, trend towards drying. Plan to use Bai Hu Tang (White Tiger Decoction) to vent evil heat, Zi Xue Dan to clear and resolve heat toxin. Raw Gypsum 60g, Zhi Mu (Anemarrhenae Rhizoma) 9g, Sheng Gancao (Raw Licorice Root) 3g, Fresh Zhu Ye (Bambusae Folium) 50 leaves, Xian Shengdi (Rehmanniae Radix Recens) 30g, Hua Fen (Trichosanthis Radix) 9g, Chen Jing Mi (Old Rice) 30g (wrapped), Zi Xue Dan (Purple Snow Pill) 3g (dissolved and taken in two divided doses). Third visit: After medicine, passed half a basin of accumulated stool, urination smooth and red-colored, consciousness instantly cleared, knows hunger and seeks food, tongue coating moist, heat harmonized, pulse quiet, but "residual evil not pacified," fear of ashes reigniting, continue Zhu Ye and Bai Hu Tang for two doses. Later recovered after regulation.
(Dong Shuiqiao's Verified Case, Introduced by Dong Tingyao: Introduction to Dong Family Pediatric Experience, *Shanghai Journal of Traditional Chinese Medicine* 10:1, 1962)
Case 2: Cui XX, male, 2 years old. Fever for 12 days, convulsions during high fever. One week before fever, bowel movements 3-4 times daily, yellow and thin. After treatment, high fever did not subside, suddenly limbs convulsed, opisthotonos, emergency admission. Examination: Temperature 39.4°C, unconscious, dyspnea, cyanotic lips, eyes half-open staring, paroxysmal convulsions, rattling phlegm sound in throat. Pulse deep and slippery, tongue pale red, scattered red granules, no coating. Babinski sign positive, abdominal reflex absent, tendon reflex hyperactive. Lumbar puncture: Increased cerebrospinal fluid pressure, appearance slightly turbid, ground-glass like, smear found tubercle bacilli, diagnosed as Tuberculous Meningitis. Syndrome differentiation: Epidemic toxin transforming into fire, liver wind disturbing internally. Therapeutic principle: Clear heat and drain fire, extinguish wind and awaken spirit. Prescription: Baibu (Stemonae Radix) 18g, Xiakucao (Prunellae Spica) 15g, Fresh Peilan (Eupatorium fortunei Herba), Gong Lao Ye (Nandinae Folium), Chonglou (Paris Polyphyllae Rhizoma) 12g each, Gouteng (Uncariae Ramulus cum Uncis) 9g, Huanglian (Coptidis Rhizoma), Lianqiao (Forsythiae Fructus) 9g each, Dan Nanxing (Arisaema cum Bile) 6g, Tian Zhu Huang (Calami Turf) 4.5g, Jiang Can (Bombyx Batryticatus) 4.5g, Quan Xie (Scorpio) 3g. Administer with Ban Wan of Angong Niuhuang Wan (Angong Niuhuang Pill). Second visit: Previous formula taken for 2 doses, body heat slightly subsided, convulsions relieved, phlegm rattle in throat not very significant, breathing improved, consciousness not fully clear, temperature 38°C. Deep yellow mucous stool, 2-3 times daily. Pulse slippery and rapid, indicating heat evil has opportunity to exit externally, liver wind has tendency to subside. Still primarily clearing heat and extinguishing wind, assisted by awakening spirit and opening orifices. Prescription: Gong Lao Ye (Nandinae Folium) 15g, Chang Pu (Acori Tatarinowii Rhizoma), Xiakucao (Prunellae Spica), Baibu (Stemonae Radix), Dan Pi (Moutan Cortex) 9g each, Shancigu (Cremastrae Bulbus), Huanglian (Coptidis Rhizoma), Dan Nanxing (Arisaema cum Bile) 6g each, Quan Xie (Scorpio) 3g, Wugong (Scolopendra) 1 strip, Xi Jiao (Rhinocerotis Cornu) 0.9g, Lingyang Fen (Saiga Tataricae Cornu Powder), Zhusha (Cinnabaris), Langdu (Radix Saposhnikoviae processed?) 0.6g each, Niuhuang (Calculus Bovis), Xionghuang (Realgar) 0.3g each (last six herbs ground together, taken with water). Third visit: After taking previous formula for 3 doses, temperature dropped to 37.5°C. Occasional convulsions, shorter duration than before. Consciousness clear, knows hunger and desires food, breathing uniform, moving freely. Continued taking for 3 doses, heat not fully subsided. Occasional convulsions. Pulse slightly rapid, slippery image softer, indicating damp-heat not yet cleared, liver wind occasionally moves internally. Should still ventilate and transmit damp-heat, detoxify and extinguish wind. Prescription: Gouteng (Uncariae Ramulus cum Uncis) 15g, Lianqiao (Forsythiae Fructus) 12g, Gong Lao Ye (Nandinae Folium), Baibu (Stemonae Radix) 9g each, Dan Nanxing (Arisaema cum Bile), Shancigu (Cremastrae Bulbus), Jiang Can (Bombyx Batryticatus) 6g each, Quan Xie (Scorpio) 3g, Wugong (Scolopendra) 1 strip, Lingyang Fen (Saiga Tataricae Cornu Powder) 0.9g, Hupo (Electrum), Xi Jiao (Rhinocerotis Cornu), Zhusha (Cinnabaris), Langdu (Radix Saposhnikoviae processed?) 0.6g each, Niuhuang (Calculus Bovis), Xionghuang (Realgar) 0.3g each (last seven herbs ground together, taken with water). After taking 4 doses, body heat retreated, temperature near normal, convulsions ceased, bowel movements normal, poor appetite, nausea, pulse deep, wiry, and deficient. Later regulated with nourishing yin, generating fluids, strengthening spleen, and harmonizing stomach agents to recover.
(*Xing Xibo's Selected Medical Cases*)
Case 3: Ren, male, 1 year 8 months, admitted February 14, 1957, consulted on 16th. Unconscious. Pale face, perioral cyanosis, dyspnea, corner of mouth trembling in morning, hand convulsions, fingerprint deep and purple. Diagnosed with Lobar Pneumonia by hospital. A few days prior due to dietary irregularity, fever appeared, restlessness anytime. Syndrome differentiation: Stagnation transforming into heat, qi not venting, combined with qi and blood disharmony, struck by wind evil, thus developing convulsion. Therapeutic principle: Should first guide out stagnation and clear heat to reduce wind intensity. Prescription: Lianqiao (Forsythiae Fructus) 3g, Huangqin (Scutellariae Radix) 3g, Daoya (Oryzae Fructus Germinatus) 6g, Zhi Ke (Aurantii Fructus Immaturus) 3g, Hua Fen (Trichosanthis Radix) 6g, Yun Ling (Poria) 6g, Shihu (Dendrobii Caulis) 3g, Jiao Zha (Charred Crataegi Fractus) 3g, Yi Yuan San (Yi Yuan Powder) 6g. Second visit: Heat not subsided, diarrhea green-colored, startled and uneasy, eyes staring straight, complexion pale, stops then convulses again. This is liver wood overacting on spleen generating empty wind syndrome. Should give softening liver, nourishing water and harmonizing blood agents to save crisis. Shengdi (Rehmanniae Radix) 6g, Dan Pi (Moutan Cortex) 6g, Zao Pi (Ziziphi Spinosae Cortex) 6g, Fushen (Poria with Pine Root) 6g, Zexie (Alismatis Rhizoma) 3g, Huai Yao (Dioscoreae Rhizoma) 6g, Baishao (Paeoniae Radix Alba) 6g, Danggui (Angelicae Sinensis Radix) 6g, Gouteng (Uncariae Ramulus cum Uncis) 6g, Bohe Ye (Menthae Haplocalycis Folium) 3g, Sang Jisheng (Taxilli Caulis) 6g, decocted with Fulonggan (Dragon's House Earth). Third visit: After taking two doses of above medicine, no more convulsions, seems to have signs of recovery, but still phlegm filling chest and throat, pale face, panting urgently, consciousness unclear, restless. Treat with nourishing water to settle wind, resolving phlegm and driving out stagnation. Baishao (Paeoniae Radix Alba) 6g, Shengdi (Rehmanniae Radix) 6g, Fa Xia (Pinelliae Rhizoma Preparatum) 8g, Yun Ling (Poria) 6g, Zexie (Alismatis Rhizoma) 3g, Dan Pi (Moutan Cortex) 6g, Huai Yao (Dioscoreae Rhizoma) 6g, Zao Pi (Ziziphi Spinosae Cortex) 6g, Mengshi Gun Tan Wan (Mengshi Rolling Phlegm Pill) 9g (divided into two doses, dissolved in decoction and mixed). Fourth visit: After one week of taking medicine, discharged thick phlegm and wind saliva, throat no longer obstructed, quieter than before, although still coughing, greatly improved. Treat with clearing dryness and moistening lungs, resolving phlegm and calming wheezing. Yun Ling (Poria) 6g, Hua Fen (Trichosanthis Radix) 6g, Maidong (Ophiopogonis Radix) 6g, Shan Zhi Pi (Gardeniae Cortex) 6g, Lianqiao (Forsythiae Fructus) 6g, Ku Xing Ren (Pruni Semen) 6g, Shihu (Dendrobii Caulis) 6g, Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) 4.5g, Mengshi Gun Tan Wan (Mengshi Rolling Phlegm Pill) 9g.