凡出疹者多有五六日不饮食,此胃为邪气所侵,亦为邪气所养,故不食亦不妨,切不
可着意治之,只宜治疹,疹疮出尽,毒瓦斯渐解,即思饮食。尤不可与面食,虽用粥饮,每次只
可少与,候神气清爽,身全不热,渐渐加添,但宜少而频也。凡出疹之先,平昔过用面食者,
正出时吃面食者,或胃气渐开即思面食而用早者,因动胃火,以致清涕不来,身体作热,两
眼看手,咬指抠鼻,撕口唇皮,及撕眼札毛者,此皆疹后食复之病也,当清肺解毒加消导之剂治之。
凡患疹之人,不拘大小,自起至收,必皆喜饮凉水,(可与花露代)此不必禁,但宜少不
宜多,宜频不宜顿,则毒瓦斯随之渐解。
凡疹子渴喜饮水,纯是火邪,肺焦胃干,心火内亢故也。初发热发渴者,升麻葛根汤加
天花粉麦门冬,渴甚者人参白虎汤合黄连解毒汤主之。
凡疹子发热,或自汗,或鼻衄者,不须止之,此亦散越之义。汗者毒从汗散,衄者毒从
衄解,但不可太过,如汗太多人参白虎汤或合黄连解毒汤,衄太多者元参地黄汤。
凡疹有初热而见烦扰谵妄狂乱者,宜升麻葛根汤调辰砂益元散主之。
疹收之后余热未尽,日夜烦躁,谵语狂乱者,辰砂益元散用灯心汤调下,或四苓散加灯
心黄连黄芩调水飞辰砂五分主之。
痘疹咽痛亦是常候,乃火毒上熏而然也。切勿以喉痹同论,妄用针刺,盖此非喉痹痈
肿,原无恶血可去也。痘疹喉痛,只是咽干作痛宜甘桔汤加牛蒡子,或射干鼠粘子汤细细
咽之,更以玉钥匙吹之。(德按∶咽喉肿痛若果烂喉痧毒外闭内陷者,大忌冰片牛黄凉遏)
In all cases of exanthema (rash), patients often refrain from eating for five to six days. This occurs because the Stomach is invaded by pathogenic factors, yet also sustained by them; thus, lack of appetite is not a major concern. One must not deliberately treat the anorexia but should focus solely on treating the exanthema. Once the rash eruptions are fully manifested and the toxic heat gradually dissipates, appetite will naturally return. It is particularly important to avoid giving wheat-based foods (mian shi). Even when providing rice gruel or liquids, only small amounts should be given at a time. Only after the patient's spirit becomes clear and the body is completely free of fever should food intake be gradually increased, adhering to the principle of small, frequent meals.
For those who have consumed excessive amounts of wheat-based foods prior to the onset of exanthema, or who consume such foods during the eruption, or whose Stomach Qi begins to recover prematurely leading to early consumption of these foods, the resulting stimulation of Stomach Fire may cause symptoms such as absence of clear nasal discharge, body heat, staring at hands, biting fingers, picking the nose, peeling lip skin, and pulling out eyelashes. These are all conditions of relapse due to improper diet following exanthema. They should be treated with formulas that clear the Lungs, resolve toxicity, and promote digestion.
Regardless of age, patients suffering from exanthema invariably prefer drinking cool water (flower dew can be used as a substitute) from the onset until recovery. This preference need not be prohibited, but it should be taken in small, frequent sips rather than large quantities at once, allowing the toxic heat to gradually dissipate.
Thirst and desire for water in exanthema patients are entirely due to Fire pathogens, causing dryness and scorching of the Lungs, dryness of the Stomach, and hyperactivity of Heart Fire. In the initial stage of fever and thirst, Shengma Gengen Tang (Cimicifugae et Puerariae Decoction) added with Tianhuafen (Trichosanthis Radix) and Maimendong (Ophiopogonis Radix) should be used. For severe thirst, Renshen Baizhu Tang (Ginseng and White Tiger Decoction) combined with Huanglian Jiedu Tang (Coptis Detoxification Decoction) is indicated.
If exanthema patients present with fever, spontaneous sweating, or epistaxis (nosebleed), these symptoms need not be forcibly stopped, as they represent the dispersal of pathogens. Sweating indicates the dispersion of toxins through sweat, while epistaxis indicates the resolution of toxins through bleeding. However, one must ensure these processes do not become excessive. If sweating is profuse, Renshen Baizhu Tang or combined Huanglian Jiedu Tang should be administered. If epistaxis is profuse, Yuanshen Dihuang Tang (Scrophulariae et Rehmanniae Decoction) is indicated.
If exanthema presents with initial fever accompanied by restlessness, delirium, and manic behavior, Shengma Gengen Tang (Cimicifugae et Puerariae Decoction) mixed with Chen Sha Yiyuan San (Cinnabar and Yiyuan Powder) should be used.
After the exanthema has subsided, if residual heat remains causing day-and-night restlessness and delirious speech, Chen Sha Yiyuan San (Cinnabar and Yiyuan Powder) should be taken with Dengxin Cao Tang (Juncus Decoction). Alternatively, Siling San (Four-Ingredient Powder) added with Dengxin Cao (Junci Medulla), Huanglian (Coptidis Rhizoma), and Huangqin (Scutellariae Radix), mixed with water and administered with 5 fen of Fei Chen Sha (Washed Cinnabar), is indicated.
Sore throat associated with variola or exanthema is a common manifestation, caused by the upward薰 (fuming/burning) of Fire-toxicity. It must not be conflated with Hou Bi (throat obstruction/angina), nor should blind needle pricking be employed, as this condition is not an abscess or swelling of the throat where no evil blood needs to be removed. For sore throat and dryness associated with variola/exanthema, Ganjie Tang (Licorice and Platycodon Decoction) added with Niubangzi (Arctii Fructus), or Shegan Niu Bang Zi Tang (Belamcandae and Arctii Fructus Decoction), should be swallowed slowly. Additionally, Yuyaochi (Jade Key Powder) can be insufflated into the throat. (Note: If sore throat and swelling are caused by Lanhou Sha [scarlet fever-like toxin] closing externally and sinking internally, the use of cooling and astringent agents like Bingpian (Borneol) and Niuhuang (Calculus Bovis) is strictly contraindicated.)