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歌曰
耳后筋纹淡淡红。疏疏磊磊决无凶。若然紫黑青白色。任是轩岐枉费功。
耳后红筋赤一条。又无枝叶上面高。将来必主心经痘。头面若稀不必忧。
耳边紫黑鱼刺形。纷纷却向里边行。将来必主肝经痘。满身斑黑八朝冥。
耳后苍筋痘主稀。头大尾尖人不知。将来必主脾经痘。向外排行疏更奇。
耳后淡白乱如麻。纷纷俱往外头爬。将来必主脾经痘。形如蚕种七朝嗟。
痘。疹忌触十四款。
腋下狐臭气。沟渠浊恶气。房中淫液气。妇人经候气。诸般白腥气。酒醉荤腥气。硫黄
毒药
痘之发与杂症不同。杂症只在一经。痘则五脏之症俱见。古云似伤寒者。亦大概言也。
寒由
外入。痘自里出。故恶寒无汗。头痛脊强。左额青纹。面色惨而不舒。此伤寒之所有。而痘
症之所无也。两眼含泪。臭气出粗。睡中微惊。耳纹现。恶热不恶寒。此痘症之所有。而伤
寒之所无也。五脏症已详。
凡初热时。睡中微悸。鼻气出粗斯二者仅可作痘症验有云。中指独冷。耳尻冷等说不必
信。
痘者豆也。肖其形则生。不肖其形则死。形之不肖。元神竭矣。尖圆而凸。周净而耸。
形之
有神者也。如麸如沸。如疹如疥如蚕种。如蛇皮。如蚊迹。如蚤斑。如汤泡。如火刺形之无
神者也。形而无神。可冀生乎。至如色也。欲如春花之在露。不欲如秋草之经霜。红白两分
。明润光活。色之有彩者也。如腻粉。如枯骨。如红米饭。如猪肝色。色之无彩者也形不有
神。色不现形。生意可知矣。呜呼神彩。其生死之门户也。
凡看痘。先看元气。痘儿元气。非有非无唯心领意会耳。已如形色初善。而终变恶者。元
气内
竭也。形色初恶。而终归善者。元气内强也。元气本也。形色末也。故善者必求本。
人知痘藉气血。不知痘之所藉。尤有超于气血者。元气是也。盖元气盛则气血流通而领
遂。
有负戴并行祛毒。痘必应期而开落。元气一亏则在外者内不续。在内者外不固。毒肆妄行。
或出或入。而为外剥内攻矣。调养真元。补益气血。诚治痘完策。不得已而欲攻。他症中病
即已。经曰常毒治病。十去其八。无毒治病。十去其九。
夫包血成圆者气也。气能拘血制毒。则痘窠必圆。尖而周净。附气成晕者血也。血能附
气制
毒。则痘晕必光明而红活。顶陷者气之虚。塌陷者气之离。晕枯者血之虚。根散者血之离。
圆也。晕也。气血之所为也。而所以成圆成晕者。气血不得专主也。
根窠者。血之晕。脓者血之腐。故六日之前。专看根窠。无根窠。必不贯脓。六日以后
。专看脓色。无脓色。必难收靥。此理也势也。
无形者。根据有形。有形者。附无形。互相根据附。固天地之道。亦气血之道也。气之离
。不
由血之散乎。故自气血交后。常观根窠为凭准。粗紧红活。生意沛然。若微细而不现不敛。
且黯淡。则气将飞去。而必不克制毒矣。是故内攻根散者死。内攻而根血犹附。非毒作楚。
必三因致之。顶白根红。气血分也。在四五日间不分。则后必作痒。顶冲根附。气血交也。
在六七日不交。则后必有变。至是而根白地清。起势勃勃。可不药而愈。若深红壮热。疔将
作也。四日用清。六日用补。乃治常痘绳厘。
气血有常。而不能盈于常。而能自亏于常。然亦有盈者。何也。毒壅于气。火搏于血耳
。斑者血有余也。泡者气多甚也。经曰。邪气甚则实。精真气夺则虚。
凡形色大恶。气血不交。浆不成似为死症若精神爽朗。便食如故。而天庭上有一二颗悦
目者。犹可发毒。作臭烂而愈何者。毒在外不在内故也。
毒停肌肉则发肿。毒滞皮肤则作臭。肌肉阳明主之属土。皮肤太阴主之属金。痈肿土象
。腥臭象金。亦各从其类也。
书谓红斑生。紫斑者死。黑斑。蓝斑。百不救一。亦有红死。而紫斑。蓝斑。得生者。
斑血热也。失于解利则发斑。恶痘斑出。热所必然。无论颜色。
但天庭疏朗。形色善而斑出。又当别论。昔一斑症。诸医莫治。召予视之。已七日矣。斑分
上中下。上红斑。中紫斑。下青斑。视其痘则绽凸疏朗。内含清水。色虽黑黯。而精神爽健
。视唇舌则多苔燥。予曰。失解故也。进以清凉自愈。后果然由是。书不可拘也。察形色。
验唇舌。是准疔之结也。亦热毒壅甚。失于解利。内不能入而结。随道空隙之所。恶痘疔结
。逆转为顺矣。但结前后心者死。结耳门喉下者死。辨疔有法。慎无以黑毒作疔。黑痘犹痘
也。疔则陷入肉中。形如螺盖捏之有核。割不知痛。其白根或长寸许。医多误认靥后疔烂。
生肌散治之。
痘之所恃者。血为养而气为充也。故眼鼻必欲封合。眼合则神不驰。鼻封则气不
逐。神气内荣。而毒不为制伏者鲜矣。抑又有微甚。塞而有涕。美之征也。鼻塞而窍外干黑
者死。封而有泪生之兆也。眼封而沿眶涂煤者死。眼封当在五六日间。若未肿过而封后必有
眼疾。痘少者不封。或封而才靥即退。
气血之分。犹清浊之本乎上下也。气血之交。犹阴阳之互为根据附也。当分不分。毒结之
。当交不交。毒隔之。知升阳散郁。何不分之患。知清热解毒。何不交之患。痘之形症有四。曰
毒壅曰血热。曰气虚。曰血虚。又虚实有四。表里虚实是也。见点稠密。形不尖耸。色惨黯
。而皮间欲出不出。此毒壅也。见点深红而渐变紫黑夹疹夹斑血热也。顶陷皮薄。平塌不
振
喘促。面浮。皮毛焦。肌肤痛。表实也。精神困倦。唇舌淡白。曰里虚。狂乱气甚。渴饮善
食。唇燥而舌见黄白苔者。里实也。毒壅也。血热也。同为表里之实。血虚也。气虚也。同
为表里之虚。此又一而二。二而一者也。壅者疏之。热者凉之。虚者补之。实者泻之。不实
不虚。以平调之。明此八者。思过半矣。虽然辨寒热虚实。尤当用舌作纲领。
大都症候相似。气运使然也。彼与此一般症状无殊。非气运而何。故干涸者。火郁胜。
吐泻
而肉肿者。土郁胜。枯燥喘促。金郁胜。彼此凝伏。水郁胜。郁而不出。木郁胜。火则清之
。土则平之。金则润之。水则温之。木则发之。书云。责之于症。求之于经。其此之谓乎。
谅形体用药。上工也。小儿脏腑。易虚易实。体实剂过。犹为之损。况弱乎。凡痘极光
泽。
极荣灌。至回谢日。而忽变逆。谁之咎欤。形体素虚。理宜补益。不察而爱行攻劫。使人元
气一驱而出。外虽荣灌。内实耗蠹。欲不死者得乎。谅形体者。非泥于形。而审形。形之
神也。痘陷有五。有白陷。有红陷。有灰陷。有紫陷。有黑陷。皆责气虚。而后人责以用补
误矣。彼之论陷。有深究其源。唇舌滋润。身不壮热。唯痘色迁变而陷。故责以气虚。若唇
燥舌苔。壮热燎人。焦紫其色。而凹陷不起。果虚乎。抑毒耶。妄执补益。犹按图索骥耳。
予治陷不然。有外实则解之。有内实则清之下之。内外无症。则平剂以调之。不惟治陷。即
始终亦然。药随舌转。症由舌痊。呜呼。舌之功大矣哉。
舌通五内。人知之而莫之用。不由指示。临局必迷。熟知此乃用药枢纽也。药有寒者。
凉者
。温者。热者。令之枢纽在手。则纵横颠倒。一自我出。而是非。而利害。皆置勿论。且易
虚易实。小儿也。使无定见而谓不枉人命。吾未知前信。
治痘有四。节次务要不紊。紊则气血颠倒。火毒肆虐。而诸症蜂作矣。故惊者。狂者。
吐者。泻者。斑者。疹者。腰疼腹痛者。肉肿痘不肿者。水呛错喉
者。皆当发不发。毒郁三焦。停滞气道也。焦紫者。枯黑者。渴者。燥者。发疔毒者。胃烂
口臭者。皆当清不清。阳明内热所致。当补不补。则为白陷。为泄泻。为痒塌。为倒靥。
外
剥内攻。中气虚也。当渗泄不渗泄。则反壮热。或少食。或泻不止。或肌肉作疰疖而疤烂。
何者。脾湿内淫也。标离而异。本合而同。药当其节。变症息矣。不应四法。必三因乘之。
六气外袭。为外因。惊恐内动。为内因。调摄失宜。为不内外因。四法正也。三因奇也。奇
正互用。两得之矣。
治痘症。不治杂症。万古秘论也。杂症有日。痘症止两七耳。且痘中之症。缘失治而作
。今犹治症不治痘。将症愈甚。而痘愈惫矣。
[Ear Pattern Diagram] (Image placeholder)
The song says:
The vein patterns behind the ears are faintly red, sparse and distinct, definitely indicating no ominous signs. If they appear purple, black, cyan, or white, even if Bian Que and Qi Bo were alive, their efforts would be in vain.
A single red vein behind the ear, without branches above and positioned high, will inevitably correspond to Heart Meridian smallpox. If the lesions on the head and face are sparse, there is no need to worry.
Purple-black fish-spine shaped patterns on the side of the ear, spreading inward, will inevitably correspond to Liver Meridian smallpox. The whole body will present with black spots, leading to death by the eighth day.
Pale veins behind the ear indicate sparse smallpox. Lesions with large heads and pointed tails are unnoticed by others. This will inevitably correspond to Spleen Meridian smallpox. The lesions arrange outwardly, appearing even more sparse and peculiar.
Faint white patterns behind the ear, chaotic like hemp, crawling outward, will inevitably correspond to Spleen Meridian smallpox. The shape resembles silkworm eggs, sighing by the seventh day (indicating critical condition).
Fourteen taboos for smallpox and rashes:
Fox odor from axillae, turbid foul odor from ditches, sexual fluids odor, menstrual blood odor of women, various white fishy odors, odor of alcohol intoxication and meat/fish, sulfur and toxic drugs, etc.
The eruption of smallpox differs from miscellaneous diseases. Miscellaneous diseases involve only one meridian, whereas smallpox manifests symptoms of all five Zang organs. The ancients said it "resembles Taiyang disease," which is a general statement.
Cold pathogens enter from the exterior, while smallpox toxins emerge from the interior. Therefore, aversion to cold, absence of sweat, headache, stiffness of the spine, blue patterns on the left forehead, and a pale, uncomfortable complexion are characteristics of Taiyang disease but not of smallpox. Tears in both eyes, coarse breathing with foul odor, slight startle during sleep, appearance of ear patterns, aversion to heat rather than cold, are characteristics of smallpox but not of Taiyang disease. The symptoms of the five Zang organs have been detailed previously.
During the initial fever stage, slight palpitations during sleep and coarse nasal breathing can serve as indicators for smallpox. Claims such as "coldness of the middle finger alone" or "coldness of the ear lobe" should not be believed.
Smallpox (Dou) resembles beans; if its form mimics this, life is preserved; if not, death ensues. A distorted form indicates exhaustion of the Yuan Shen (Primordial Spirit). A sharp, round, convex shape with clean surroundings and erect posture indicates that the form possesses Shen (Spirit). Forms resembling bran, boiling bubbles, rashes, scabies, silkworm eggs, snake skin, mosquito bites, flea marks, hot water blisters, or fire thorns indicate that the form lacks Shen. If the form lacks Shen, how can survival be expected? Regarding color, it should resemble spring flowers with dew, not autumn grasses frosted. Clear distinction between red and white, bright, moist, and lustrous indicates color with Cai (Luster). Colors resembling talcum powder, dry bones, red rice grains, or pig liver indicate color lacking Luster. If the form lacks Shen and the color does not manifest, the vitality can be known. Alas! Shen and Cai are the gateway to life and death.
When examining smallpox, first assess the Yuan Qi (Primordial Qi). The Yuan Qi of a child with smallpox is neither existent nor non-existent; it must be understood through intuition. Just as forms and colors initially good but deteriorating later indicate internal exhaustion of Yuan Qi, and forms/colors initially bad but improving later indicate internal strengthening of Yuan Qi, Yuan Qi is the root, while forms and colors are the branches. Therefore, in favorable cases, one must seek the root.
People know that smallpox relies on Qi and Blood, but do not realize that what smallpox relies on transcends Qi and Blood, namely Yuan Qi. When Yuan Qi is abundant, Qi and Blood flow smoothly, carrying and supporting each other to expel toxins, allowing smallpox lesions to open and fall off on schedule. If Yuan Qi is deficient, the exterior cannot connect internally, and the interior cannot secure externally, causing toxins to act recklessly, either emerging or invading, leading to external erosion and internal attack. Nourishing the True Yuan and tonifying Qi and Blood is indeed the perfect strategy for treating smallpox. If attack is necessary, stop once the pathogen is addressed in other diseases. The Classic states: "For diseases treated with toxic herbs, remove eight-tenths of the disease; for diseases treated with non-toxic herbs, remove nine-tenths."
What encloses blood into a circle is Qi. Qi can constrain blood and control toxins, so the smallpox pit (Ke) becomes round, sharp, and clean. What attaches to Qi to form an areola (Yun) is Blood. Blood can attach to Qi and control toxins, so the areola becomes bright and lively red. Depression at the apex indicates Qi deficiency; collapse indicates Qi dispersion; withered areola indicates Blood deficiency; scattered roots indicate Blood dispersion. Roundness and areolas are the work of Qi and Blood, yet Qi and Blood cannot solely govern their formation.
The root pit is the areola of Blood; pus is the corruption of Blood. Therefore, before the sixth day, focus on the root pit; without a root pit, pus formation is impossible. After the sixth day, focus on the color of the pus; without pus color, crusting (Ye) is difficult. This is the principle and trend.
The formless relies on the formed; the formed attaches to the formless. Mutual reliance is the Way of Heaven and Earth, and also the Way of Qi and Blood. Does Qi dispersion not result from Blood scattering? Thus, after Qi and Blood interact, always observe the root pit as the standard. Rough, tight, red, and lively with abundant vitality is good. If fine, invisible, uncontracted, and dull, Qi is about to flee and cannot control the toxin. Therefore, internal attack with scattered roots leads to death. Internal attack with roots still attached to Blood, unless caused by toxins, must be due to the Three Causes. White apex and red root indicate separation of Qi and Blood. If not separated by days 4-5, itching will follow. Apex protruding and root attached indicate interaction of Qi and Blood. If not interacting by days 6-7, changes will occur. At this stage, if roots are white and ground clear, with vigorous rising momentum, recovery may occur without medicine. If deep red with high fever, Ding (carbuncle) is forming. Use clearing methods on day 4 and tonifying methods on day 6; these are the guidelines for ordinary smallpox.
Qi and Blood have normal states but can become deficient within those states. However, there are also excess states. Why? Because toxins obstruct Qi and Fire combats Blood. Spots (Ban) indicate excess Blood; blisters (Pao) indicate excessive Qi. The Classic states: "Excess of evil qi constitutes Excess; loss of essence and true Qi constitutes Deficiency."
If forms and colors are extremely poor, Qi and Blood do not interact, and fluid fails to form, suggesting a fatal case, but if spirit is bright, appetite remains normal, and one or two pleasing lesions appear on the Tian Ting (Forehead), toxins can still be expelled, leading to recovery through putrefaction. This is because the toxin is external, not internal.
Toxin stagnating in muscles causes swelling; toxin stagnating in skin causes foul odor. Muscles are governed by the Yangming Meridian (Earth); skin is governed by the Taiyin Meridian (Metal). Abscesses represent Earth imagery; foul odor represents Metal imagery, each following its kind.
Books state that red spots survive, purple spots die, and black/blue spots are incurable in nearly all cases. Yet some die with red spots, while purple/blue spots survive. Spots are due to Blood Heat. Failure to resolve and promote leads to spotting. Malignant smallpox producing spots is necessarily due to heat, regardless of color.
However, if the Tian Ting is clear, forms and colors are good, and spots appear, the discussion differs. Once, I was called to treat a spot case where other physicians refused. It had been seven days. Spots were divided into upper (red), middle (purple), and lower (cyan). The smallpox lesions were convex and sparse, containing clear fluid. Although dark in color, the spirit was robust. The tongue had dry coating. I said, "This is due to failure to resolve." Administered cooling herbs, and he recovered. Thus, books should not be rigidly followed. Observing forms/colors and verifying tongue/lips is key to identifying Ding. It is also due to severe heat-toxin obstruction failing to resolve, leading to internal knotting in empty spaces, turning malignant Ding into favorable outcomes. However, Ding located at the heart front/back or ear/throat leads to death. Distinguishing Ding requires care; do not mistake black toxin for Ding. Black smallpox is still smallpox; Ding sinks into flesh, shaped like a snail shell, hard upon pressure, painless when cut, with white roots up to an inch long. Physicians often mistake post-crusting Ding for decay and treat with Shengji San.
Smallpox relies on Blood for nourishment and Qi for filling. Thus, eyes and nose must seal. Eye closure prevents Spirit from scattering; nose sealing prevents Qi from leaking. With Spirit and Qi flourishing internally, few toxins remain unconquered. There are degrees of severity. Nasal congestion with discharge is auspicious. Nasal congestion with dry black openings outside is fatal. Eye sealing with tears is a sign of life. Eye sealing with coal-like discoloration around orbits is fatal. Eye sealing should occur around days 5-6. If sealing occurs before swelling, eye disease will follow. Few lesions may not seal, or seal and retract immediately after crusting.
Separation of Qi and Blood is like clarity and turbidity originating from above and below. Interaction of Qi and Blood is like Yin and Yang relying on each other. Failure to separate when needed causes toxin knotting; failure to interact when needed causes toxin blockage. Knowing to raise Yang and scatter depression avoids separation issues; knowing to clear heat and detoxify avoids interaction issues. Smallpox manifestations include four types: Toxin Obstruction, Blood Heat, Qi Deficiency, and Blood Deficiency. There are also four types of Excess/Deficiency: Exterior/Interior Excess/Deficiency. Dense emergence, non-elevated shape, dull color, and lesions wanting to emerge but unable to indicate Toxin Obstruction. Deep red points turning purple-black, accompanied by rashes and spots, indicate Blood Heat. Depressed apex, thin skin, flat collapse, panting, facial edema, scorched hair/skin, painful muscles indicate Exterior Excess. Mental fatigue, pale lips/tongue indicate Interior Deficiency. Mania, excessive Qi, thirst, good appetite, dry lips, yellow-white tongue coating indicate Interior Excess. Toxin Obstruction and Blood Heat are both Exterior/Interior Excess. Blood Deficiency and Qi Deficiency are both Exterior/Interior Deficiency. These are one becoming two, two becoming one. Obstruction requires dispersing; Heat requires cooling; Deficiency requires tonifying; Excess requires purging; Neither Excess nor Deficiency requires balancing. Understanding these eight principles covers half the knowledge. However, distinguishing Cold/Heat and Excess/Deficiency especially requires using the tongue as the guideline.
Most symptoms are similar due to Qi dynamics. Similar symptoms in different contexts are due to Qi dynamics. Dryness indicates Fire Depression dominance; vomiting/diarrhea with muscle swelling indicates Earth Depression dominance; dryness/panting indicates Metal Depression dominance; stagnation indicates Water Depression dominance; failure to erupt indicates Wood Depression dominance. Fire is cleared, Earth is balanced, Metal is moistened, Water is warmed, Wood is dispersed. The book says: "Blame the symptoms, seek in the Classics," referring to this.
Estimating medication based on physique is the skill of superior physicians. Children's Zang-Fu are prone to Deficiency and Excess. Over-medication for a strong constitution causes damage, let alone for a weak one. If smallpox is initially lustrous and full, but suddenly turns adverse at the resolution stage, whose fault is it? If the physique is inherently weak, tonification is appropriate. Failing to recognize this and using attacking/cathartic herbs drives out Yuan Qi. Though externally lustrous, internally it is depleted. How can death be avoided? Estimating physique means assessing the Spirit within the form. There are five types of depression: White, Red, Gray, Purple, and Black, all blamed on Qi Deficiency. Later physicians blame tonification errors. Their argument regarding depression involves deep source analysis: if lips/tongue are moist, no high fever, only color change and depression, then blame Qi Deficiency. If lips are dry, tongue has coating, high fever burns, color is scorched purple, and depression does not rise, is it truly Deficiency or Toxin? Blindly adhering to tonification is like searching for a steed by map. My treatment for depression differs: if Exterior Excess, resolve it; if Interior Excess, clear and purge it. If no symptoms internally/externally, use balancing formulas. This applies throughout the course. Medication follows the tongue; symptoms heal via the tongue. Ah! The power of the tongue is great.
The tongue connects to the Five Viscera. People know this but do not use it. Without guidance, confusion enses in practice. Knowing this is the pivot of medication is crucial. Herbs vary in Cold, Cool, Warm, and Hot properties. Holding the pivot allows mastery over their use. Right/wrong and benefit/harm are secondary. Since children are prone to Deficiency/Excess, without firm judgment, claiming no lives are wasted is doubtful.
Treating smallpox involves four methods, executed in order without disorder. Disorder leads to inverted Qi/Blood, rampant Fire-Toxin, and myriad symptoms. Therefore, cases of fright, mania, vomiting, diarrhea, spots, rashes, waist/abdominal pain, muscle swelling without lesion swelling, choking on water, indicate failure to erupt, causing Toxin Depression in the San Jiao and Stagnation in the Qi pathways. Scorched-purple, withered-black, thirsty, dry, developing Ding toxins, rotten stomach odor indicate failure to clear, caused by Yangming Internal Heat. Failure to tonify leads to White Depression, diarrhea, itching/collapse, inverted crusting, external erosion/internal attack, due to Middle Qi Deficiency. Failure to drain/diffuse leads to rebound high fever, poor appetite, incessant diarrhea, or muscle carbuncles/scarring, due to Internal Spleen Dampness. Markers differ, roots unite. Medication at the right stage stops transformation. Failure to apply the four methods invites the Three Causes. External invasion of Six Qi is External Cause; Internal movement of Fright/Terror is Internal Cause; Improper care is Non-External/Internal Cause. The four methods are Zheng (Orthodox); the three causes are Qi (Unorthodox). Using Zheng and Qi mutually achieves both.
Treating smallpox symptoms without treating miscellaneous diseases is an eternal secret. Miscellaneous diseases last longer; smallpox lasts only fourteen days. Moreover, symptoms in smallpox arise from mismanagement. Now, if one treats symptoms but not smallpox, symptoms worsen, and smallpox becomes more exhausted.