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Varicella (smallpox) is categorized into Qi deficiency and Blood deficiency, requiring tonification. For Qi deficiency, use Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Rhizome) combined with detoxifying herbs; for Blood deficiency, add detoxifying herbs to Si Wu Tang (Four Substances Decoction). When varicella first erupts and the color is white, immediately use a major formula to tonify Qi and Blood, including Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Rhizome), [missing character], Chuan Xiong (Szechwan Lovage Rhizome), Sheng Ma (Cimicifugae Rhizome), Gan Ge (Puerariae Radix), Gan Cao (Licorice Root), Mu Xiang (Aucklandiae Radix), Ding Xiang (Caryophylli Flos), Jiu Xi Dang Gui (Angelica Sinensis Radix washed with wine), and Bai Shao (White Peony Root). If there is diarrhea, add He Zi (Chebulae Fructus), Rou Dou Kou (Myristicae Semen), and Jiu Huang Qin Lian (Scutellariae Radix and Coptidis Rhizome fried with wine); these are called detoxifying drugs. Once red spots appear, Gegen Tang (Kudzu Decoction) is contraindicated, as it may cause exterior deficiency. Vomiting, diarrhea, and poor appetite indicate interior deficiency; absence of vomiting/diarrhea and ability to eat indicate interior excess. Tonifying an interior excess condition will lead to carbuncles and sores. Sunken or inverted lesions indicate exterior deficiency; grayish-white color also indicates exterior deficiency, sometimes treated with calcined human feces. Red, vibrant, and protruding lesions indicate exterior excess; using exterior-releasing herbs on an exterior excess condition will cause ulceration and failure to form scabs. The presence of both vomiting/diarrhea and sunken lesions indicates simultaneous exterior and interior deficiency. Severe black sunken lesions are also treated with calcined human feces, mixed with water and taken orally, according to Zhang Hezi's prescription. When varicella is about to erupt or has just started, if family members are affected, this medicine should be taken prophylactically to reduce severity. The prescription consists of the three-cun section of Loofah fruit near the stem, burned with skin and seeds to ash while retaining its properties, ground into powder, and eaten dry with rock sugar. Adding Cinnabar powder enhances efficacy.

Varicella treatment considers the patient's clear/turbid constitution and courage/weakness based on physique. There are two types of black sunken lesions caused by Qi deficiency preventing complete expulsion of toxic factors; treat with Jiu Huang Qi (Astragali Radix fried with wine), Jiu Zi Cao (Arnebiae Radix fried with wine), and Ren Shen (Ginseng Root), following the above method. As lesions are about to heal, if the color is pale, assist with blood-tonifying herbs like Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Szechwan Lovage Rhizome), and Jiu Xi Shao Yao (Paeoniae Radix Alba washed with wine), or add Hong Hua (Carthami Flos). If the color is purple as lesions heal, it indicates heat; use cooling herbs to resolve toxicity, such as Sheng Ma (Cimicifugae Rhizome), Ge Gen (Puerariae Radix), Huang Lian (Coptidis Rhizome), Huang Qin (Scutellariae Radix), Gui Zhi (Cinnamomi Ramulus), and Lian Qiao (Forsythiae Fructus). Severe cases require Xi Jiao (Rhinocerotis Cornu) to strongly resolve varicella toxicity. Ashy-white and quiet lesions are viewed as cold; courageous, dry, and [missing character] erupting lesions are viewed as heat.

Among varicella herbs, Niu Bang Zi (Arctii Fructus), Lian Qiao (Forsythiae Fructus), Shan Zha (Crataegi Fructus), and Gan Cao (Licorice Root) are essential throughout the course. Lesions that are entirely white and resemble bean shells during healing result from excessive water intake at onset, causing uneven healing (inverted healing), which has a poor prognosis. Use only exterior-firming agents, monitoring bowel and bladder function: unblock bowels if constipated, unblock urine if retention occurs. Restlessness, delirium, and extreme thirst with drinking at onset may lead to uneven healing if water is consumed; urgently use cooling herbs to address superficial symptoms, such as Yi Yuan San (Benefit the Primordial Powder). Itching and collapsing lesions are differentiated by pulse and complexion: excess presents with strong pulse and robust qi; deficiency presents with weak pulse and timid qi. Mild cases are treated with smooth stone powder mixed in light honey water, applied with a feather. Deficiency-type itching requires exterior-firming agents plus blood-cooling herbs. Excess-type itching with constipation requires a small amount of Da Huang (Rhei Radix et Rhizoma) or other cooling herbs to purge accumulated stool. Sparse lesions lack toxicity; sticky lesions contain toxicity, requiring cooling herbs; dozens of doses are acceptable without harm, preventing eye complications. Dry lesions require fire-clearing; wet lesions require damp-draining. Fire-clearing uses mild agents like Jing Jie (Schizonepetae Herba), Sheng Ma (Cimicifugae Rhizome), and Ge Gen (Puerariae Radix). Damp-draining targets surface dampness using wind-dispersing herbs like Bai Zhi (Angelicae Dahuricae Radix) and Fang Feng (Saposhnikoviae Radix). Eye involvement requires Shan Zhi Zi (Gardeniae Fructus), Jue Ming Zi (Cassiae Semen), Chi Shao (Red Peony Root), Gui Wei (Angelicae Sinensis Radix tail), Qin Lian (Scutellariae Radix and Coptidis Rhizome), Fang Feng (Saposhnikoviae Radix), Lian Qiao (Forsythiae Fructus), Sheng Ma (Cimicifugae Rhizome), and Jie Geng (Platycodonis Radix) in a small dose, powdered and taken. Loss of vision after 100 days resolves naturally as Qi and Blood recover.

Varicella carbuncles are mostly excess toxins from blood heat; treatment differs by location and must not be delayed. Suppurated lesions require cooling herbs as main treatment: Chi Shao (Red Peony Root), Gan Cao Jie (Licorice Root joint), Lian Qiao (Forsythiae Fructus), Jie Geng (Platycodonis Radix). Ascending guidance uses Sheng Ma (Cimicifugae Rhizome) and Ge Gen (Puerariae Radix); descending guidance uses Bing Lang (Arecae Semen) and Niu Xi (Achyranthis Bidentatae Radix), assisted by Bei Mu (Fritillariae Bulbus), Ren Dong Cao (Lonicerae Japonicae Caulis et Folium), Bai Zhi (Angelicae Dahuricae Radix), and Gua Lou (Trichosanthis Fructus). Constipation requires Da Huang (Rhei Radix et Rhizoma). Chills and fever require Huang Qin (Scutellariae Radix) and Huang Bo (Phellodendri Cortex). Black varicella indicates blood heat, treated primarily with blood-cooling; white indicates deficiency, treated primarily with Qi-tonification. Central black sunkenness with delayed peripheral eruption requires combined treatment. Initial spontaneous sweating is acceptable due to damp-heat steaming. Varicella wind patterns follow daily progression, often showing Qi and Blood insufficiency; deficiency is treated with Huang Qi (Astragali Radix) and blood-generating/moving formulas with slight wind-dispersing herbs; excess uses Bai Shao (White Peony Root) and Huang Qin (Scutellariae Radix) as sovereigns, assisted by Bai Zhi (Angelicae Dahuricae Radix), Lian Qiao (Forsythiae Fructus), and Xu Duan (Dipsaci Radix). Cold patterns use Chen Shi's formula.

Formula for resolving varicella toxicity: Si Gua (Loofah Fruit), Sheng Ma (Cimicifugae Rhizome), Jiu Shao Yao (Peony Root fried with wine), Sheng Gan Cao (Raw Licorice Root), Hei Dou (Black Soybean), Shan Zha (Crataegi Fructus), Chi Xiao Dou (Adzuki Bean), Xi Jiao (Rhinocerotis Cornu). Decoct in water and take.

Another formula: Treats varicella whether erupted or not. Zhu Sha (Cinnabar). Powdered, taken with honey water. Dosage adjusted by severity.

Varicella external application: Bei Mu (Fritillariae Bulbus), Nan Xing (Arisaematis Rhizoma processed with alum), Jiang Can (Bombyx Batryticatus), Tian Hua Fen (Trichosanthis Radix), Han Shui Shi (Halloysitum Rubrum, largest quantity), Bai Zhi (Angelicae Dahuricae Radix), Cao Wu (Aconiti Radix lateralis preparata), Da Huang (Rhei Radix et Rhizoma), Zhu Ya Zao Jiao (Tortoiseshell-shaped Gleditsia Spine). Powdered, mixed with vinegar for application.

[Appendix] Pediatric rash resembles typhoid fever: fever, restlessness, red face/lips, body/head pain, alternating chills/fever, sneezing/yawning, cough/wheezing/phlegm. Causes include wind-cold injury, seasonal contagion, or food stagnation. Symptoms vary: restlessness/coma, spontaneous sweating, dysentery, fever/no fever. Differentiation relies on cold ears, [missing character], and cold feet, as rash is Yang and Kidney shows no symptoms; ears/feet belong to Kidney, thus cold. Ear posterior red veins confirm diagnosis. Care prohibits purgatives initially/finally; use warm/cool harmonizing herbs for detoxification, middle-jiao support, and exterior stabilization. Muscle-releasing uses Ge Gen (Puerariae Radix) and Zi Su (Perillae Folium). Excess heat with constipation uses Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction) or Ren Shen Bai Du San (Ginseng and Detoxification Powder). Zi Cao Yin (Arnebiae Decoction) aids evacuation. Small amounts of Da Huang (Rhei Radix et Rhizoma) for constipation require caution. Red scant urine benefits from diuretics to vent heat. Heat should be gently resolved; absence of heat prevents eruption. Zi Su Yin (Perilla Decoction) suits all stages, adjusting for deficiency/excess/cold/heat. Analogy: steaming requires looseness. Wrong sweating opens Ying/Wei, worsening ulcers; wrong purging depletes Zheng Qi, leading to Kidney transformation: tremors, hot ears, closed eyes, distended abdomen, black necrotic lesions, high mortality. Qian Yi stated: Black/purple sunkenness treated with Baixiang Wan (Hundred Auspicious Pills); non-black strictly avoid purging. Purging drains Bladder pathogen. Post-purge fever/thirst indicates treatability; indigestion/chills indicate reversal. Strong Spleen Earth controls Water. Baixiang Wan is too harsh; replace with Xuan Feng San (Disperse Wind Powder). Post-purge Spleen warming uses Ren Shen (Ginseng Root), Fu Ling (Poria), Bai Zhu (Atractylodes Rhizome) equally, plus Hou Po (Magnoliae Officinalis Cortex), Mu Xiang (Aucklandiae Radix), Gan Cao (Licorice Root). Stomach governs muscles; warm Spleen frees Stomach Qi, resolving leaked Kidney Water. This is Qian's secret. Zhu Zhenheng stated: Rash prohibits laxatives. Purgatives drive toxin inward, fatal. Rash differs from typhoid: typhoid moves interiorly; rash erupts exteriorly. Purging empties interior, trapping toxin; sweating empties Ying/Wei, worsening ulcers. Both methods are forbidden. Harmonization uses blood-moving/Qi-regulating, exterior-stabilizing/middle-harmonizing, mild detoxifying, warm/cool combinations. Warm: Dang Gui (Angelicae Sinensis Radix), Huang Qi (Astragali Radix), Mu Xiang (Aucklandiae Radix). Cool: Qian Hu (Peucedani Radix), Ge Gen (Puerariae Radix), Sheng Ma (Cimicifugae Rhizome). Assist with Chuan Xiong (Szechwan Lovage Rhizome), Shao Yao (Peony Root), Zhi Ke (Aurantii Fructus), Jie Geng (Platycodonis Radix), Qiang Huo (Notopterygii Rhizoma et Radix), Mu Tong (Akebiae Caulis), Zi Cao (Arnebiae Radix), Gan Cao (Licorice Root). For pediatric fever resembling typhoid before eruption, use Xing Xing San (Yawning Powder), Shen Su Yin (Ginseng and Perilla Decoction), or Ren Shen Qiang Huo San (Ginseng and Notopterygium Powder). High fever uses Sheng Ma Ge Gen Tang (Cimicifuga and Kudzu Decoction) or Ren Shen Bai Du San. Post-eruption uses Hua Du Tang (Resolve Toxicity Decoction). Slow eruption uses Jiawei Sixiang San (Modified Four Saints Powder), Zi Cao Yin, Zi Cao Mu Xiang Tang, Zi Cao Mu Tong Tang, Kuai Ban San, or Si Gua Tang. Excessive eruption uses Ren Shen Bai Du San or Xi Jiao Di Huang Tang. Red scant urine uses Da Lian Qiao Tang, Gan Lu Yin, or Mai Men Dong Wu Ling San. Constipation/internal heat uses Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Zhi Ke, or Si Shun Qing Liang Yin. Sore throat uses Da Ru Sheng Tang or Niu Bang Zi Tang. Wheezing/distension uses Ma Huang Huang Qin Tang (Ephedra and Scutellaria Decoction). Chest/abdominal fullness uses Zhi Ke Jie Geng Tang or Er Chen Tang with Zhi Ke. Thirst uses Gan Cao San or Wu Mei Tang. Dysentery/vomiting uses Mu Xiang Li Zhong Tang or Gan Cao Gan Jiang Tang. Sunken lesions use Jiawei Sixiang San, Hu Sui Jiu (Coriander Wine) applied thinly on body, thickly on feet, sprayed on clothes, covered with thick cotton. If ineffective, Du Sheng San with Musk and aged wine, or Mu Xiang decoction. Black lesions use Qian Yi's Xuan Feng San with Qing Pi. Bowel/bladder patency is crucial. Self-diarrhea with yellow/black stool indicates reduced toxin; minimal Hua Du Tang suffices. Obstruction causes congestion, stagnant collaterals, undischarged toxin, closed eyes/silence, blackened flesh, rapid deterioration. Bad lesions: internal deficiency diarrhea, external wind-cold, blackening returning to Kidney. Spring/summer favorable; autumn/winter adverse. Early dense chest lesions need Xiao Du Yin with Shan Zha, Jiu Xi Huang Qin, Zi Cao, reduced diet, added Ren Shen. Pre-eruption fever/cold nose/yawning/cough/red face indicates eruption; use Sheng Ma Ge Gen Tang with Shan Zha and Niu Bang Zi for sparse/easy healing. Fever stage: apply E Shi Zi (Arctii Fructus) powder with honey to fontanelle to prevent eye disease. Recent times use Shangdang Chen Wenzhong's Mu Xiang San or Yi Gong San. These were formulated during Cold Heaven periods in deep winter for cold-constrained non-red eruptions using acrid-warm herbs. Modern indiscriminate use causes errors. Suitable only for warm seasons/poor rural populations.

Attached Formulas:

Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction): Xi Jiao (1 liang), Sheng Di Huang (2 liang), Chi Shao (3 qian), Mu Dan Pi (1 liang). Coarse powder. 3 qian for 3-year-old, decoct in water.

Ren Shen Bai Du San (Ginseng and Detoxification Powder): Ren Shen, Fu Ling, Zhi Gan Cao, Qian Hu, Chuan Xiong, Qiang Huo, Du Huo, Jie Geng, Chai Hu (all cleaned), Zhi Ke (flour-fried, de-seeded, 0.5 liang each). Coarse powder. 2 qian per dose, 1 cup water, 2 slices ginger,少许 mint, decoct, warm.

Zi Cao Yin (Arnebiae Decoction): Zi Cao (1 liang). Fine cut, steep in boiling water, cover tightly, drink warm gradually. Zi Cao promotes bowel movement and gentle eruption.

Baixiang Wan (Hundred Auspicious Pills): Hong Ya Da Ji (Red-toothed Spurge Root), dried, boiled in rice water until soft, bones removed, sun-dried, boiled again in original juice until dry, powdered, water pills sized like millet. 10-20 pills per dose, taken with crushed sesame soup.

Xuan Feng San (Disperse Wind Powder): Bing Lang (2 pieces), Chen Pi, Zhi Gan Cao (0.5 liang each), Hei Chou (4 liang, half raw/half cooked). Powder. 1 qian per dose with honey water.

Xing Xing San (Yawning Powder): Treats pediatric wind-heat and typhoid/rash fever. Bai Fu Ling, Xi Xin, Jie Geng, Gua Lou Gen, Ren Shen, Zhi Gan Cao, Bai Zhu, Chuan Xiong (equal parts). Powder. 1 qian decocted with 3 mint leaves.

Shen Su Yin (Ginseng and Perilla Decoction): Qian Hu, Ren Shen, Su Ye, Ge Gen, Ban Xia (soaked 7 times, ginger juice processed), Fu Ling, Zhi Ke, Chen Pi, Gan Cao, Jie Geng. Cut, decoct with ginger/jujube, warm.

Ren Shen Qiang Huo San (Ginseng and Notopterygium Powder): Qiang Huo, Du Huo, Chai Hu, Ren Shen, Chuan Xiong, Zhi Ke, Fu Ling (0.5 liang each), Qian Hu, Bei Jie Geng, Tian Ma, Di Gu Pi, Zhi Gan Cao (2.5 qian each). Add Ma Huang, Bo He, Cong Bai, decoct. After sweating with residual heat, use this minus Ma Huang, add Zi Cao. If 3-5 spots visible, add Zi Cao, Chen Pi, Chi Shao to clear heat/gentle eruption. Mix with 0.5 qian Chen Sha powder to control fetal toxin.

Sheng Ma Ge Gen Tang (Cimicifuga and Kudzu Decoction): Ge Gen, Sheng Ma, Bai Shao, Zhi Gan Cao (4 liang each). Coarse powder. 4 qian per dose, 1.5 cups water, decoct to 1 cup, warm.

Hua Du Tang (Resolve Toxicity Decoction): Zi Cao Rong (0.5 liang), Sheng Ma, Gan Cao. Cut, decoct 2 qian with 50 glutinous rice grains.

Jiawei Sixiang San (Modified Four Saints Powder): Zi Cao, Mu Tong, Huang Qi, Chuan Xiong, Mu Xiang (equal parts), Zhi Gan Cao (half). Coarse powder, decoct. Add Zhi Ke for constipation; 100 glutinous rice grains for normal stool. Yang Shi said: Glutinous rice detoxifies and promotes eruption.

Zi Cao Mu Xiang Tang (Arnebiae and Aucklandia Decoction): Treats slow eruption with diarrhea. Zi Cao, Mu Xiang, Fu Ling, Bai Zhu (equal parts), Zhi Gan Cao (slight). Add glutinous rice. Yang Shi: Zi Cao promotes bowels, assisted by Bai Zhu/Mu Xiang.

Zi Cao Mu Tong Tang (Arnebiae and Akebia Decoction): Zi Cao, Ren Shen, Mu Tong, Fu Ling, Nu Mi (equal parts), Gan Cao (half). Cut, decoct 2 qian, warm. Add Nan Mu Xiang for internal deficiency with loose stools.

Kuai Ban San (Rapid Spotting Powder): Zi Cao, Chan Ke, Ren Shen, Bai Shao (1 fen each), Mu Tong (1 qian), Zhi Gan Cao (0.5 qian). Cut, decoct 2 qian, warm.

Another Formula: Zi Cao Rong (5 qian), Chen Pi (2 qian), Huang Qi (3 qian), Chi Shao (5 qian), Zhi Gan Cao (3 qian). Cut, add 100 glutinous rice grains. >3 years: 3 qian; <3 years: 1 qian. Stop when lesions spread evenly to limbs.

Si Gua Tang (Loofah Decoction): Si Gua burned with skin/seeds to ash, powdered, mixed with water. Yang Shi: Best for eruption. Add Gan Cao/Zi Cao optionally.

Da Lian Qiao Tang (Major Forsythia Decoction): Lian Qiao, Qu Mai, Jing Jie, Mu Tong, Che Qian, Dang Gui, Fang Feng, Chai Hu, Chi Shao, Hua Shi, Chan Tui, Zhi Gan Cao (1 qian each), Huang Qin, Shan Zhi Zi (0.5 qian each). Cut, add Zi Cao per dose.

Gan Lu Yin (Sweet Dew Decoction): Sheng Di Huang, Shu Di Huang, Tian Men Dong (de-heart), Mai Men Dong (de-heart), Pi Pa Ye (de-hair), Zhi Ke (bran-fried, de-seeded), Huang Qin, Shi Hu, Shan Yin Chen, Zhi Gan Cao (equal parts). Cut. 2 qian per dose, 1 cup water, decoct to 0.8 cup, post-prandial.

Wu Ling San: See Summerheat category.

Xiao Chai Hu Tang: See Malaria category.

Si Shun Qing Liang Yin: Dang Gui, Chi Shao, Da Huang (cooked for deficiency, raw for excess), Gan Cao. Alternative: add Chen Pi/Nu Mi.

Ru Sheng Yin Zi: Jie Geng, Sheng Gan Cao, Chao Niu Bang Zi (2 qian each), Mai Men Dong (3 qian). Powder, decoct with bamboo leaves. Alternative: add Jing Jie/Fang Feng. Heavy cases: bamboo sap.

Niu Bang Zi Tang: Chao Niu Bang Zi (4 qian), Jing Jie Sui (2 qian), Gan Cao (1 qian), Fang Feng (0.5 qian). Fine powder, infuse in boiling water. Remove Fang Feng to name Xiao Du San.

Ma Huang Huang Qin Tang: Ma Huang (3 qian), Chi Shao, Huang Qin (2.5 qian each), Zhi Gan Cao, Gui Zhi (0.5 qian each). Coarse powder, decoct.

Jie Geng Zhi Ke Tang: Zhi Ke, Jie Geng (2 liang each), Zhi Gan Cao (0.5 liang). Cut, decoct with ginger.

Gan Cao San: Zhi Gan Cao, Gua Lou Gen (equal parts). Powder, decoct 1 qian.

Wu Mei Tang: Xiao Hei Dou, Lv Dou (1 he each), Wu Mei (2 pieces). Coarse cut, decoct in 1 bowl fresh water, strain, drink gradually.

Mu Xiang Li Zhong Tang: See Cold category. Add Mu Xiang, Gan Cao, Gan Jiang.

Du Sheng San: Chao Niu Bang Zi (5 qian), Bai Jiang Can (2.5 qian). Powder, add 3 Zi Cao stems, decoct. Three doses ensure eruption.

Another Formula: Chuan Shan Jia (Pangolin Scale) washed, fried golden, powdered. 0.5 qian per dose with少许 Musk, Mu Xiang decoction. Or Zi Cao decoction with Hong Xi Jiao.

Xiao Du Yin: Chao E Shi (4 liang), Zhi Gan Cao (1 liang), Fang Feng (0.5 liang), Jing Jie Sui (2 liang). Powder. Decoct Zi Cao, Nu Mi, Yuan Sui Zi soup, take post-meal/before sleep, 3 times daily.