第二十六章．治瘟疫瘟疹方

Chapter 26. herbs for infectious disease and plague.

1．青盂汤

1. Qingyu Tang

治瘟疫表里俱热，头面肿疼，其肿或连项及胸。亦治阳毒发斑疹。
This formula is used for infectious disease and plague, in which the patient has fever boty inside and on the body surface. He has swelling and pain in the head; the swelling may expand to the neck and chest. It is also used for Yang-poison with macula on the skin. The infectious disease here means any kinds of infectious diseases termed by western medicine.

荷叶（一个用周遭边浮水者良鲜者尤佳） 生石膏（一两，捣细） 真羚羊角（二钱，另煎兑服）知母（六钱） 蝉蜕（三钱，去足土） 僵蚕（二钱） 金线重楼（二钱，切片） 粉甘草（钱半）
Heye (lotus leaves) one, (the leave with arounding edge floating up and the fresh leaves are the best choice), Shigao 30 gram (grind), Lingyang horn (antelope horn) 6 gram (grind, drink with herbal tea from other ingredients), Zhimu 18 gram, Chantui (cicada slough) 9 gram (remove feet and soil), Jiangcan (dried silkworm) 6 gram, Jinxianchonglu (Chinese Paris Rhizome ) 6 gram (chop into pieces), Gancao 4.5 gram.

荷叶禀初阳上升之气，为诸药之舟楫，能载清火解毒之药上至头面，且其气清郁，更能解毒逐秽，施于疫毒诸证尤宜也。至于叶宜取其浮水者，以贴水而生，得水面轻气最多，故善发表。如浮萍之生于水面，而善发汗也。
The lotus leaves bears the raising Qi of the early Yang. It words as the ship for all other herbs. It brings the Fire-cleansing and Poison-dissolving herbs up to the head. For its light in herbal nature, it can clear the stagnation, and can further more dissolve the poison and dirty stuff. It is especially suitable in the treatment of the infectious disease and plague. The reason to use the leaves that floating above the water is that the leaves that growing attaching the water bears more light Qi, so that it is better to disperse surface. This is similar to the duckweed. It grows on the water surface and has strong effect to create sweat.

金线重楼，一名蚤休，一名紫河车草。味甘而淡，其解毒之功，可仿甘草。然甘草性温，此药性凉，以解一切热毒，尤胜于甘草，故名蚤休。言若中一切蛊毒，或蝎螫蛇咬、或疮疡用之而皆可早早止住。古蚤与早，原相通也。古谚赞蚤休曰：“七叶一枝花，深山是我家。痈疽遇着我，一似手捻拿。”盖此物七叶对生茎腰，状如莲花一朵，自叶中心出茎，至巅开花一朵，形扁而黄，花上有黄丝下垂，故又名金线重楼。重楼者，其叶与花似各作一层也。其名紫河车草者，盖紫河为初生之地点，其处蕃多，可采之盈车，俗名为草河车误矣。其形状皮色皆如干姜。若皮不黄，而微带紫色者，其味必微辣而不甘，含毒性，即不可用。若无佳者，方中不用此味亦可。
The Jinxianchonglu has another name as Zaoxiu, or as Ziheche grass. It is sweet and light in taste. Its ability to dissolve poison is similar to the herb Gancao. But the Gancao is warm in herbal nature, but this herb is cold in nature. To dissolve Hot poison, this one is better than the Gancao, so it is called Zaoxiu (Zao here means insect in Chinese; Xiu means to disappear.) If a person is attacked or invaded by various insects, or bitten by scorpions and snakes, of if the skin has ulcer or broken, use this herb would stop the problem sooner in early stage. In ancient Chinese, the Zao also means the “early”. There is a old saying to admire the Zaoxiu: “Seven leaves with one flower, deep mountain is my home. If the pus, carbuncle, or deep rooted ulcer meets me, all would be dissolved (by me).”  … If the skin of the herb grass is mild purple, its taste would be mild spicy and not sweet, it would be poisoning too. Such herb type should not be used. If there is no nice Zaoxiu, omit it from the formula.

羚羊角与犀角，皆性凉而解毒。然犀禀水土之精气而生，为其禀土之精，故能入胃，以消胃腑之实热。为其禀水之精，故又能以水胜火兼入心中，以消心脏本体之热力。而疫邪之未深入者，转因服犀角后，心气虚冷，不能捍御外邪，致疫邪之恣横，竟犯君主之宫，此至紧要之关系，医者不可不知。羚羊角善清肝胆之火，兼清胃腑之热。其角中天生木胎，性本条达，清凉之中，大具发表之力。与石膏之辛凉，荷叶、连翘之清轻升浮者并用，大能透发温疫斑疹之毒火郁热，而头面肿处之毒火郁热，亦莫不透发消除也。

The Lingyang Jiao (antelope horn) and the Xiniu horn (Rhinocerotidae), both are cold in nature and can dissolve poison or detoxify. … But the Xinmiu horn can dissolve the Stomach sthenic Fire and the heart Fire. If the plague Xie Qi has not invaded deep, the drink of the Xiniu horn, the body will feel asthenic cold in heart, fail to defense the invading Xie Qi, so that the Xie Qi invades into the heart without defense force from the body. This is very important concept. Medical doctor must know this and always keep it in mind. The Lingyang horn is good to clear the Fire in the Liver and Gall bladder, as well as the Fire in the Stomach. … It also bears ability to disperse Xie Qi from body surface. When it is used together with the Shigao, for its spicy-cooling nature, the lotus leaves and Lianqiao, for its light-floating nature, it can expel the poisoning Fire, so as to dissolve the swelling in the head and neck.

曾治一六岁孺子，出疹三四日间，风火内迫，喘促异常。单投以羚羊角三钱，须臾喘止，其疹自此亦愈。夫疹之毒热，最宜表散清解，乃至用他药表散清解无功，势已垂危，而单投以一味羚羊角，即能挽回，其最能清解而兼能表散可知也。且其能避蛊毒，《神农本草经》原有明文。疫病发斑，皆挟有毒疠之气也。
I treated a child, 6 years of old. On the third and fourth day of measles, he got Wind-Fire invading inside. He had strong asthma and short of breath. He was given the Lingyang horn 9 gram, and very soon, the asthma stopped. The measles was dissolved from then. For the poison-Fire in the measles like infectious disease, it needles surface-dispersing and Fire-clearing therapy. If the other herbs do not work, the life condition is in danger, the use of the Lingyang horn alone usually can save the life. Apparently, it can disperse the surface and can also clear the poison-Fire. It can also prevent the insect toxic, which has been well documented in the book《Shennong Bencao Jin》. Whenever an infectious disease is with the skin rash and/or bleeding on skin, it is usually accompanied with the poisoning Qi.

僵蚕乃蚕将脱皮时，因受风不能脱下，而僵之蚕。因其病风而僵，故能为表散药之向导，而兼具表散之力。是以痘疹不出者，僵蚕最能表出之。不但此也，僵蚕僵而不腐，凡人有肿疼之处，恐其变为腐烂，僵蚕又能治之，此气化相感之妙也。
The dried silkworm, … is good at as the guider for surface-dispersing herbs. It self has also the surface-dispersing ability. For this, if the pox cannot be develop into mature, the dried silkworm can promote its mature to show fully on the skin. In addition, the dried silkworm is withered but not rotten. If there is swelling and painful spot on the body, and if fearing its rotten, use the dried silkworm. This is “to use the similar to treat the similar” principle.

疫与寒温不同。寒温者，感时序之正气。因其人卫生之道，于时序之冷暖失宜，遂感其气而为病。其病者，偶有一二人，而不相传染。疫者，感岁运之戾气。因其岁运失和，中含毒气，人触之即病。《内经》刺法论所谓无问大小，病状相似者是也。其病者，挨户挨村，若摇役然，故名曰疫，且又互相传染也。《内经》本病论有五疫之名，后世约分为寒疫、温疫。治温疫，世习用东垣普济消毒饮。治寒疫，世习用巢谷世圣散子。然温疫多而寒疫少，拙拟之清盂汤，实专为治温疫设也。
The infectious disease and the plague are different from the Shanghan disease and the Wen disease. For the Shanghan disease and the Wen disease, the body is attacked by normal seasonal Qi in the nature. The seasonal Qi invades into the body, due to the body defense Qi is weak. Only one or two persons may have the disease at the time. The disease does not pass from one person to another. However, the infectious disease, or in severe case, the plague, pass from person to person, no matter the age of the person and all share similar symptoms and clinic results. They are caused by annual Li Qi, (Li here means the poison Qi). For it is annual Li Qi, the disease from one year is different from another year. The infectious disease is also called Yi disease in Chinese. In the boo《Nei Jing》, there are five kinds of Yi disease. Later doctors usually separate them into the Cold Yi and the Hot Yi. For the Cold Yi disease, the herbal formula of Shishenzi San is used. For the Hot Yi disease, the Puji Xiaodu Yin is the choice. However, the Hot Yi is more than the Cold Yi. The Qingyu Tang here is for the Hot Yi.

一妇人，年四十许，得大头瘟证。头面肿大疼痛，两目肿不能开，上焦烦热，心中怔忡。彼家误为疮毒，竟延疡医治疗。医者自出药末，敷头面，疼稍愈。求其出方治烦热怔忡，彼言专习外科，不管心中之病。时愚应他家延请，适至其村，求为延医。其脉洪滑有力，关前益甚，投以清盂汤，将方中石膏改用二两，煎汁两茶盅，分二次温饮下，尽剂而愈。
A lady was 40 years. She had the big-head pestilence. Her head and face was swelling severely, so much so that she could not open the eyes. She felt annoying hot in the Upper Jiao and palpitation too. The family thought it was a deep ulcer, so asked surgical doctor to treat. The doctor put out his herbal powder, applied it on the head, and the pain was reduced somehow. The family asked to prescribe for the annoying hot and palpitation, the doctor said he only learn the surgical treatment, not the internal medicine. Her family later invited me to come. When I saw her, her pulse was waving, slippery and strong, especially on the Chun position. She was given the Qingyu Tang, in which the Shigao was changed to 60 gram. The herbal tea was given to drink twine. After finish the herbal tea, the condition was solved.

一人，年二十余，得温疫。三四日间头面悉肿，其肿处，皮肤内含黄水，破后且溃烂。身上间有斑点，闻人言，此证名大头瘟。其溃烂之状，又似瓜瓤瘟，最不易治。惧甚，求为诊视。其脉洪滑而长，舌苔白而微黄。问其心中，惟觉烦热，嗜食凉物。遂晓之曰，此证不难治。头面之肿烂，周身之斑点，无非热毒入胃而随胃气外现之象。能放胆服生石膏，可保全愈。遂投以青盂汤，方中石膏改用三两，知母改用八钱，煎汁一大碗，分数次温饮下。一剂病愈强半。翌日，于方中减去荷叶、蝉蜕，又服一剂全愈。
A man, 20 years of old, got the Hot Yi disease. On the third and the fourth day, his head was swelling very much. In the swelling part, there contained yellow water under the skin. After break, the skin turned ulcer. His body had also bleeding dots. It was heard that it is the big head pestilence. The outlook of the skin with ulcer appeared as the inner of a watermelon. It is very difficult to treat. He cared very much and came to me for help. His pulse was waving, slippery and long. His tongue covering was white and slight yellow. When asked, he said he felt annoying hot and craved for cold drink and food. I told him that it was not so difficult to treat. Either the swelling and broken ulcer or the bleeding dots on the skin, all are due to the spread of Hot poisoning Qi spill from stomach to the body. To use Shigao bravely, there would have no worry. He was given the Qingyu Tang, in which the Shigao was 90 gram, Zhimu was 24 gram. The herbal tea was drunk. The next day, the disease was improved a lot. The formula was modified by removal of the Heye and Chantui. After drink of the second herbal tea, the condition was solved.

按：发斑之证异于疹者，以其发处不高，以手拂之，与肤平也。其证有阳毒、阴毒之分。阳毒发斑，系阳明毒热伤血所致。阴毒发斑，或为寒疫之毒，或因汗吐下后中气虚乏，或因过服凉药，遂成阴证，寒伏于下，逼其无根之火上独熏肺而发斑。其色淡红，隐隐见于肌表，与阳证发斑色紫赤者不同。愚生平所治发斑，皆系阳证。至阴证实未之见，其证之甚少可知。然正不可因阴证者甚少，而阴阳之际不详辨也。今采古人阳毒阴毒发斑治验之案数条于下，以备参观。庶几胸有定见，临证时不至误治也。
Comments: the disease with the spot is different from that with the pox or rash. The spot is not higher than the skin, but the pox or rash is higher than the skin. The pestilence with the spot is separated into the Yang poison (called Yangdu in Chinese) and the Yin poison (also called Yindu in Chinese) condition. The Yangdu with the spot is due to the damage of blood by the Hot poison. The Yindu with spot can be due to the poison from the Cold yi disease, or due to Middle Qi deficiency after a sweat therapy, vomiting therapy or a bowel-cleansing therapy, or to large amount intake of Cold herbs. All of these can cause the body into a Yin condition, in which the Cold is hold and steal in the Lower Jiao of the body, which presses the no-root Fire rushing up to smoke the Lung. In the Yindu condition, the spot is mild or slight red in color, slightly seen on the skin, not as the spot in the Yangdu, in which the spot is fresh red or purple in color. In my life, I only saw the Yangdu with spot, never saw a Yindu with spot yet. Apparently the Yindu disease with spot is very rare. But, we should not make distinquishment between the Yangdu spot and the Yindu spot in clinic work, due to the rare of the Yindu condition. Here I cited the case report for the treatment of the Yangdu and Yindu, as reference. Only if you understand everything in your heart, could you feel confidence in the later diagnosis and treatment without any mistake.

吕沧洲云：一人伤寒十余日，身热而静，两手脉尽伏。医者以为坏证，弗与药。余诊之，三部脉举按皆无，舌苔滑，两颧赤如火，语言不乱，因告之曰：此子必大发赤斑，周身如锦纹。夫血脉之波澜也，今血为邪热所搏，掉而为斑，外现于皮肤，呼吸之气无形可倚，犹沟渠之水虽有风不能成波澜也，斑消则脉出矣。及揭其衾，而赤斑烂然。与白虎加人参汤，化其斑脉乃复常。按：发斑至于无脉，其证可谓险矣。即遇有识者，细诊病情，以为可治，亦必谓毒火郁热盘踞经络之间以阻塞脉道之路耳。而沧洲独断为发斑则伤血，血伤则脉不见。是诚沧洲之创论，然其言固信而有征也。忆己亥春，尝治一少年吐血证。其人大口吐血，数日不止，脉若有若无，用药止其血后，脉因火退，转分毫不见。愚放胆用药调补之，竟得无恙（此证详案在寒降汤下）。夫吐血过多可至无脉，以征沧洲血伤无脉之说确乎可信。此阳毒发斑也。
Dr. Lu Cangzhou said: a man had Shanghan disease for ten days. He had hot in the body but silent. The pulse on the both hands was hidden, hard to feel. Doctor thought that it was as damaged condition (e.g. a condition after a wrong treatment), refused to use any herbs for treatment. When I saw him, the pulse was hard to feel. The tongue covering was slippery; the check is red in color, but the speech was not in disorder. So, I told the family: the patient would have a lot of red spots and his whole body would be as animal skin with strips of red lines. …. After use of Baihu Jia Renshen Tang, the spot disappeared and the pulse appeared.   Comments: when the skin spot develops to no pulse to feel, it is very dangerous condition. Only with doctor who knows such condition, with careful treatment, could the condition be saved. It must be declared that, it is a condition, in which the poisoning-Fire and stagnated Hot hold in and between the meridians to block the blood vessels. Here, Dr. Cangzhou said that the spot would damage the blood. When the blood is damaged, there would have no pulse to feel. This is his creation. His statement can be believed since there is such case report to support. I remembered, one spring, I treated a youth with blood vomit. He vomited blood heavily for several days without stop. The pulse was as there was, as there was not. After use of the herbs to stop the blood, the pulse became disappeared (hard to feel) due to the Fire disappeared. I bravely used nourishing herbs to support his condition, the case was cured (see the case report in detail in the Hanjiang Tang). Apparently, to vomit blood to much could cause no pulse. This is to support the statement by Dr. Cangzhou that, if the blood is damaged, there could have no pulse to feel. This is discussion for Yangdu spot condition

许叔微治一人，内寒外热而发斑。六脉沉细，肩背胸胁斑出数点，随出随隐，旋更发出，语言狂乱，非谵语也，肌表虽热，以手按之，须臾冷透如冰。与姜附等药数服后，得大汗而愈。此阴毒发斑也。
Dr. Xu Shuwei treated one case. The person had inside Cold, but outside Hot and had spots. His pulse was deep and thin. There are several spots on the shoulder, back, chest and side of abdomen. The spots came and vanished, and came again very soon. He talked in mad, but not a delirious speech. The skin surface was hot, but if felt with hand, very soon it became cold as ice. He was given Ginger and Fuzi several doses. The condition was solved after sweat. This is the Yindu spot condition.

吴仁斋治一人，伤寒七八日，因服凉药太过，遂变身冷，手足厥逆，通身黑斑，惟心头温暖，乃伏火也。诊其六脉沉细，昏沉不知人事，亦不能言语，状似尸厥。遂用人参三白汤，加熟附子半枚、干姜二钱，水煎服下。待一时许，斑色渐红，手足渐暖。而苏醒后，复有余热不清，此伏火后作也。以黄连解毒汤、竹叶石膏汤调之而愈。此阴毒发斑中有伏阳也。
Dr. Wu Renzai reported a case. The person had Shanghan disease for seven to eight days. Due to over intake of Cold herbs, his body turned cold, as well as the hands and feet. The body was all over with black spots, only the heart felt warm. It was a hidden Fire condition. His pulse was deep and thin. He lost consciousness, could not talk, appearing as a dead body. He was given the Renshen Sanbai Tang, with addition of Fuzi 15 gram and Ganjiang 6 gram. After drink of the herbal tea for one hour about, the spot turned gradually red in color, and the feet and hands became warm. After wake up, he still had Hot residue, which is the onset of the hidden Fire. He was then given the Huanglian Jiedu Tang and Zhuye Shigao Tang for the treatment. This is the Yindu spot with hidden Yang. 

虞天民曰：有内伤证，亦出斑疹，但微见红。此胃气极虚，一身之火游行于外。当补益气血，则中有主而气不外游，荣有养而血不外散，此证尤当慎辨。洪吉人解之曰：按此证与阳毒发斑不同，亦与阴毒发斑不同，其方当用补中益气汤，加归、芍之类。
Dr. Yu Tianming said: the inner damage could also have spot, but it is slightly red in color. This is due to the very weak in the Stomach Qi, so the whole body Fire floating outside. In this case, it should be used to nourish the Qi and blood. When the Middle part of the body has the “king”, the Qi would not move out, and the blood would not spill out. This condition needs very careful diagnosis. Dr. Hong Jiren explained: this condition is different from the Yangdu spot, or from the Yindu spot. The condition here needs the Buzhong Yiqi Tang for the treatment, with the addition of Danggui and Baishao, and so on.

瘟毒之病，有所谓羊毛瘟者（亦名羊毛疹），其证亦系瘟疫，而心中兼有撩乱之证。若视其前后对心处有小痤（俗名疙瘩），以针鼻点之，其顶陷而不起，其中即有白毛，当以针挑出之。若恐挑之不净，可用发面馍馍去皮，杂以头发，少蘸香油，周身搓擦。再审其证之虚实凉热，投以治疫病之药，即愈。此证古书不载，而今人患此证者甚多，其白毛，即周身之汗毛，大抵因有汗受风闭其毛孔，而汗毛不能外出，因不外出，所以作白色（若用黄酒和荞麦面擦之更好）。

For the pestilence condition, there is one called sheep hair pestilence, which also belongs to the Yi disease, but the person feels stirring shacking feeling in the heart. By look, there is small skin rash on the front sternum and the corresponding back skin. Punch it with needle. If its tip sinks, not raises up, there would be a white hair in it. Use the needle to pick it out. If fearing there the pick is not completely, you can try to use the bread which is originally used for ferment. Peel the bread, mix it with hair, dip it in little sesame oil, to apply and massage it over the body. Then depending on the sthenic or asthenic, Cold or Hot condition of the body, use the corresponding herbal therap. It will cure. The condition was not indicated in ancient medical books, but there are many such cases in clinic. The white hair is the the normal body hair. Mostly due to the Wind attack, which blocks the hair hole, so the hair on the skin could not go out, so unable to go out, so it appears as white in color (it would be better to use the wine and soba powder to massage the skin).

2．护心至宝丹

2. Huxin Zhibao Dan

 治瘟疫自肺传心，其人无故自笑，精神恍惚，言语错乱。
This formula is used when the pestilence or plague moves from the Lung to the Heart. the person laughs without any reason; the mind is cloudy; and the speech is mass and in disorder.

生石膏（一两，捣细） 人参（二钱） 犀角（二钱） 羚羊角（二钱） 朱砂（三分，研细） 牛黄（一分，研细）
Shigao 30 gram (grind), Renshen 6 gram, Xiniu horn 6 gram, Lingyang horn 6 gram, Zhusha 0.9 gram (grind), Niuhuang (bezoar) 0.3 gram (grind).

将药前四味共煎汤一茶盅，送服朱砂、牛黄末。
Cook the herbal ingredients, except the Zhusha and Niuhuang, into herbal tea. Drink the Zhusha and Niuhuang with the herbal tea for swallow.

此证属至危之候，非寻常药饵所能疗治。故方中多用珍异之品，借其宝气以解入心之热毒也。
This is a extremely urgent condition that risks the life. Ordinary herbs would be strong enough to solve the condition. So, the formula contains many rare ingredients, to borrow its valuable energy for the treatment of the Hot-poison in the heart.

瘟疫之毒未入心者，最忌用犀角。而既入心之后，犀角又为必须之药。
If the poison of the pestilence does not come into the heart, the Xiniu horn should not be used. But if it has invaded in the heart, it must be used.

瘟疫之毒，随呼吸之气传入，原可入肺。心与肺同居膈上，且左心房之血脉管与右心房之回血管，又皆与肺循环相通，其相传似甚易。而此证不常有者，因有包络护于心上代心受邪，由包络下传三焦，为手厥阴，少阳脏腑之相传，此心所以不易受邪也。愚临证二十余年，仅遇一媪患此证，为拟此方，服之而愈。

The poison of the pestilence or the plague, goes into the body through the breath. Originally it is in the lung… and theoretically it is easy to move into the heart. But in clinic it is no so. This is because, in Chinese medicine, the heart shell protects the heart. The poison comes from the lung to the heart shell, then down to the three Jiao, then the hand Jueyin and hand Shaoyang. This is the reason that the heart is not affected by the poison. In my past twenty years of clinic, I only met one old lady, who had such condition that affect the heart. She was given this formula and cured. 

3．清疹汤

3. Qingzhen Tang. 

治小儿出疹，表里俱热。或烦躁引饮，或喉疼声哑，或喘逆咳嗽。
This formula is used for child skin rash, with hotness in both inside and outside of the body.

生石膏（一两，捣细） 知母（六钱） 羚羊角（二钱） 金线重楼（钱半，切片） 薄菏叶（二钱） 青连翘（二钱） 蝉蜕（钱半，去足土） 僵蚕（二钱）
Shigao 30 gram (grind), Zhimu 18 gram, Lingyang horn 6 gram, Jinxian Chonglu 4.5 gram (Chop), Bohe 6 gram, green Lianqiao 6 gram, Chantui 4.5 gram (remove feet and soil), Jiangcan 6 gram.

用水煎取清汤一盅半，分二次温饮下，以服后得微汗为佳。若一次得微汗者，余药仍可再服。若服一次即得大汗者，余药当停服。此药分量，系治七八岁以上者，若七八岁以下者，可随其年之大小，斟酌少用。或将药减半或用三分之一皆可。

喉疼声哑者，可将石膏加重五钱，合前得两半。若疹出不利者，用鲜苇根（活水中者更佳）一大握去节水煎沸，用其水煎药。
Cook the herbal ingredient to collect one and half cup of herbal tea. Drink the tea twice to get sweat after drink. If the person gets sweat after the first drink, the remaining herbs can still be drunk. If the sweat is very heavy after the first drink, stop to drink the remaining tea. The amount of herbs in the formula is for child more than seven years of old. For the younger child, the dose can be reduced according to the age, or reduce it to one third. If the child has pain in throat and had hoarse voice, add the Shigao 15 gram more (so totally 45 gram). If the rash does not come out completely, use fresh Luwei (reed) root (better to use the one that grows in flowing water) a bundle, to cook the herbal tea and use this herbal tea to cook the herbal tea for other ingredients.

疹证多在小儿，想小儿脏腑间原有此毒，又外感时令之毒气而发，则一发表里俱热。若温病初得之剧者，其阳明经府之间，皆为热毒之所弥漫。故治此证，始则发表，继则清解，其有实热者，皆宜用石膏。至喉疼声哑者，尤为热毒上冲，石膏更宜放胆多用。惟大便滑泻者，石膏、知母皆不宜用，可去此二药，加滑石一两、甘草三钱。盖即滑泻亦非凉证，因燥渴饮水过多，脾胃不能运化故也，故加滑石以利其小便，甘草以和其脾胃，以缓水饮下趋之势。若其滑泻之甚者，可用拙拟滋阴宣解汤，既可止泻，又可表疹外出也。然此证最忌滑泻，恐其毒因滑泻内陷即不能外出。若服以上方而滑泻不止，可用生山药两许，轧细煮作粥，再将熟鸡子黄两三枚捏碎调粥中服之，其滑泻必止。泻止后，再徐徐以凉药清补之。

The skin rash problem usually occurs in children. It might be due to the child has such poison or toxic in between the organs, which was triggered out by the seasonal Xie Qi invasion, thereforek, once the disease starts, the child has hot in both inside and outside of the body. This condition is similar to the Wen disease, in which the Hot poison accumulates and disperses among and in between the meridian and the organs of the Yangmng meridian/portion of the body. To treat this condition, it should use the surface-dispersing therapy in the early stage of the disease; later, use the Fire-cleansing therapy. If there is sthenic Fire, use Shigao. IF there is sour throat, suggesting the Hot poison rushing up, Shigao should be used in large amount. Only when the stool is slippery, either the Shigao or the Zhimu should not be used. In such case, remove the Shigao and Zhimu, but add Huashi 30 gram, and Gancao 9 gram. In such case, the slippery diarrhea does not mean a Cold condition, but it is due to the dryness and more drink of water, which cannot be metabolized by the Spleen-Stomach. The Huashi added is to smooth the urine and Gancao is to harmonize the Spleen-Stomach, to buffer the speed of the water down. If the slippery diarrhea is very severe, use my Ziyin Xuanjie Tang, which can work to stop the diarrhea and help to disperse the rash out. However, the rash condition worries the slippery diarrhea very much, since the poison may sink down alone with the diarrhea, and not disperse out to the skin. If above methods fail to stop the diarrhea, use Shanyao 30 gram or more, cook it into soup. Add two or three cooked egg yolk into the soup to drink. The slippery diarrhea must stop. After that, use cold herbs to solve the Fire gradually.

奉天友人朱××之子，年五岁。于庚申立夏后，周身壮热，出疹甚稠密，脉甚洪数，舌苔白浓，知其疹而兼瘟也。欲以凉药清解之，因其素有心下作疼之病，出疹后，贪食鲜果，前一日犹觉疼，又不敢投以重剂。遂勉用生石膏、玄参各六钱，薄荷叶、蝉蜕各一钱，连翘二钱。晚间服药，至翌日午后视之，其热益甚，喉疼，气息甚粗，鼻翅煽动，且自鼻中出血少许，有烦躁不安之意。愚不得已，重用生石膏三两，玄参、麦冬（带心）各四钱，仍少佐以薄荷叶、连翘诸药。俾煎汤二茶盅，分三次温饮下。至翌日视之，则诸证皆轻减矣。然余热犹炽，而大便虽下一次，仍系燥粪。询其心犹发热，脉仍有力。遂于凉解药中，仍用生石膏一两，连服两剂，壮热始退。继用凉润清解之剂调之全愈。
The son of my friend, Mr. Zhu in Fengtian city, was five years of old. In a summer, he had strong hot all over the body with rashes all over the body. His pulse was very waving and frequent. His tongue covering was white and thick. It was considered to be a rash disease with pestilence. It had considered to use cooling herbs to clear the Fire, but remembering that the child usually had pain in the upper abdomen; after coming of the rash, the child ate fresh fruit; he felt such pain the day before, so it was dared not to use the heavy dose. In the herbal formula prescribed contained Shigao 18 gram, Xuanshen 18 gram, Bohe 3 gram, Chantui 3 gram, and Lianqiao 6 gram. He was given the herbal tea to drink at the night. The next afternoon, the hot was ever worse, with sour throat, thick breath, nose wing flattening, and bleeding little from the nose, kind of annoyed or agitated feeling. For this, I had to use large amount of Shigao 90 gram, Xuanshen 12 gram, Maimendong 12 gram, with little Bohe and Lianqiao in it. The herbal tea was given to the child for three times to drink. The next day, every symptoms reduced, with only Hot remaining. Though the stool came out once, it was dry stool. When asked, the child said he felt hot in the heart. His pulse was strong. So, Shigao 30 gram was used to the other ingredients. The formula was drunk twice. The strong Hot disappeared. Later, the cooling herbs were used for a maintenance treatment.

按：此证初次投以生石膏、玄参各六钱，其热不但不退而转见增加，则石膏之性原和平，确非大凉可知也。至其证现种种危象，而放胆投以生石膏三两，又立能挽回，则石膏对于有外感实热诸证，直胜金丹可知。此证因心下素有疼病，故石膏、玄参初止用六钱。若稍涉游移，并石膏、玄参亦不敢用，再认定疹毒，宜托之外出而多用发表之品，则翌日现证之危险，必更加剧，即后投以大剂凉药，亦不易挽回也。目睹耳闻，知孺子罹瘟疹之毒，为俗医药误者甚多，故于记此案时，而再四详为申明。
Comments: for this case, in the beginning, the Shigao was 18 gram, and the Xuanshen was also 18 gram. The hot did not disappear but more worse. Apparently, the Shigao is calm in herbal nature, not very cold. For the dangerous evidence, the Shigao was dared to used to 90 gram, so that the life was saved. Also apparently the Shigao is very valuable in the saving of life in the invading Fire condition. Due to the consideration that the child usually had pain in the stomach, the Shigao and Xuanshen used initially only 18 gram for each. If there was any hesitate, not dare to use the Shigao and Xuanshen, only believe that it was a rash condition, the surface-dispersing herbs were used mostly, the life would be risk right away. If this was the case, the use of large Cold herbs later would not be able to save the life. I have heard such cases many times, knowing that the child poison-rash conditions were usually mis-diagnosed and mis-treated. I cited these cases here for remind our doctors again.  

瘟疫之证，虽宜重用寒凉，然须谨防其泄泻。若泄泻，则气机内陷，即无力托毒外出矣。是以愚用大剂寒凉，治此等证时，必分三四次徐徐温服下，俾其药力长在上焦，及行至下焦，其寒凉之性已为内热所化，自无泄泻之弊。而始终又须以表散之药辅之，若薄荷、连翘、蝉蜕、僵蚕之类，则火消毒净，疹愈之后亦断无他患矣。
For the pestilence and plague condition, the large amount of Cold herbs should be used usually, but be careful not to create slippery diarrhea. If the slippery diarrhea indeed happens, the Body Qi would sink, which would have no power to push the Xie Qi out of the body. For this reason, when I use large amount of Cold herbs to treat such condition, I always ask the person to drink the herbal tea slowly and gradually, not let them to drink it once in a large volume, so that the healing effect would stay mostly in the upper part of the body. When the herbal cold moves down to the lower part of the body, the Cold nature has been harmonized by the body inner Hotness, so there is no side effect of causing slippery diarrhea. In addition the use of the heavy Cold herbs is accompanied by the help of surface-dispersing herbs, such as Bohe, Lianqiao, Chantui and Jiangcan, etc. By this way, the Fire can be cleansed, and the poison can be detoxified. After the vanish of the rash, there has no any remaining problems.

至若升麻、羌活之药，概不敢用。友人刘××，精通医学。曾治一孺子，出疹刚见点即回。医者用一切药，皆不能表出。毒气内攻，势甚危急，众皆束手。刘××投以《伤寒论》麻杏甘石汤，一剂疹皆发出，自此遂愈。夫麻杏甘石汤，为汗后、下后、汗出而喘无大热者之方，刘××用以治疹，竟能挽回人命于顷刻，可为善用古方者矣（用此方者，当视其热度之高低，热度高者石膏用一两，麻黄用一钱，热度低者石膏用一两，麻黄用二钱）。

The herbs such as the Shenma and Qianguo are dared not to use in the pestilence condition. My friend Mr. Liu, knew medicine well. He treated a child, who had skin rash showed but vanished soon. Doctors used various herbs but none could promote the rashes out. The poisoning Qi invaded inner and cause a life-threatening condition. No any doctor had idea what to do next. Mr. Liu used Maxingshigan Tang from the book 《Shang Han Lun》. One dose made the rashes out. The disease was cured from that time. The Maxingshigan Tang is the herbal formula originally used in asthma without big hot condition, which follows the sweat therapy, or a bowel-cleansing therapy. Mr. Liu used it to the rash-sink condition, and saved life. He is really a smart to use the ancient herbal therapy! (This formula should be used according to the level of the hotness in the body: if the body is very hot, use Shigao 30 gram, Mahuang 3 gram; if the hotness is low, use Shigao 30 gram, and Mahuang 6 gram.)