咳嗽声哑，饮食挫喉。腹胀气促，闷乱不宁。渴泻不止，切牙寒战。疮嫩易破，痒塌不止。紫黑灰色，顶陷喘渴。
红 标现之图
一日∶一日先退热放标者必轻，又放标后一日身凉稀密已定，仍热烦躁尚未尽，有两三次出热方定，红现者吉，或
隐或现者凶。
二日∶二日如粟米大，稀而红满者吉。二日顶陷，灰白色者次之。
三日∶三日尖满如珠者吉，灰白色者次之。三日必出定，已后身反发热，闷乱烦渴者凶。
标疮绽灌浓之图
初发∶有两三次出大小不一等，先出者先灌浆，后出者后灌浆，如水珠光泽。根窠红活者吉。
如珠∶不渴泻闷烦者，不必服药。微渴微痒不泻者不妨，亦不须服药。
根活∶若一齐并出稠密灰白色，顶陷烦躁渴泻者，急宜治之。
疮已饱满如脓窠将收，渐至苍蜡色，有等无脓有黄白色。自放标一日为始，至七日收靥，至十日收完，此为正
病。有迁延八九日方靥，至十四五日方完亦有之。但不泻渴闷乱，其疮饱满无陷，手按之坚硬皆好。将收时渐退红肿或
疮中收靥，觉有黄蜡色，或外面先靥根下皱皮。男从面收至头背，女从面收至胸腹，收后离肉不粘易脱俱好。有微渴痒
痛，有身收完足收迟亦不妨，身微热不能食者亦有之，只怕疮嫩易破，闷乱痒塌者凶。
靥后余症
疮疹收靥之后，预宜调理。就有出外，不避风寒，不节饮食，偏无病者，莫非胃物理壮，亦宜仔细。病初痊，脏腑
初安，脾胃尚弱，动止饮食过度复病，喘咳腹胀必凶。又血气尚弱，动止太早，病复皆凶。况肌肉娇嫩，冒风易得感寒，
头痛身热，则难治矣。
腹胀气促根窠不赤之症
陈文宿先生云∶痘疮已出未愈之间，或泻渴腹胀气促，其疮不光泽，不起发，根窠不红，谓之表虚也。先与十一味
木香散，以和五脏之气，后与十二味异功散送七味肉豆蔻丸，以助脏腑之气。窃谓痘疮既出，不光泽，不起发，不红
活，或泄泻作渴，或肚腹作胀，或气促作喘，寒战切牙，或手足指冷，肢体挛缩，作渴饮汤，阳气亏损，内虚寒而外假
热也，用十二味异功散。若作渴饮汤，手足不冷者，脾胃虚弱也，用五味异功散。凡痘疮先出不如式，后出而红活，或
成片，色赤而秽气者俱无妨。
一小儿出痘，四日腹胀泻渴，脾胃虚寒也，用十二味异功散一剂，又用参 内托散，贯脓靥而忽寒热切牙，此脓贯
而阳气亏损也，用参附汤、独参汤而愈。
一小儿痘，四日腹胀泻渴，气促体倦，此脾气虚也，用人参白术散加木香煎送四神丸一服，诸症顿止。但脓迟作
渴，此表里血气俱虚，用参 四圣散、大补汤而愈。
一小儿痘疮作渴腹胀，小便不利，此邪气壅滞也，用木
通芍药汤一剂，诸症稍愈；用参 四圣散，其浆渐贯，用参 内托散，结靥而愈。
一小儿痘疮将愈，腹胀，手足或冷或热，此阳气虚寒也，先用十二味异功散，手足不冷，此阳气渐复也，乃用五
味异功散加木香而愈。
一小儿痘疮，大便利而小便秘，腹胀作喘，手足并冷，此脾气虚也，先用葶苈、木香一剂，又用五味异功散加木香
二剂而愈。后腹胀不食，口角流涎，仍用五味异功散而痊。
一小儿痘疮将愈，忽腹胀泄泻，侵晨为甚，饮食不化，余谓脾胃虚弱，朝用人参白术散，夕用二神丸而泻止；又
用参 内托散兼托里散而靥。
一小儿痘疮腹胀泄泻，饮食不化，此脾肾气虚，用人参白术散、豆蔻丸而愈。
参 内托散 治里虚发痒，疮不溃，倒靥。
人参 黄 （炒） 当归 川芎 浓朴（姜制） 防风（各五分） 桔梗 白芷 官桂（各三分） 紫草（五分）
木香 甘草（各三分）
上入糯米一撮，水煎量服之。寒战切牙，饮水泻渴，亦宜服之。
参 四圣散 治痘疮已出六七日，不能长，不生脓，或痒塌。
当归 芍药（炒） 黄 川芎（各五分） 白术 茯苓 紫草（如无，红花代之） 木通 防风（各三分） 糯
米（二百粒）
上水煎，母同服。
葶苈木香散 治大便自利，小便涩滞，喘嗽腹胀，不能食。多服为妙。
猪苓 泽泻 茯苓 白术 官桂（各五分） 滑石（二钱） 葶苈 木通 木香 甘草（各五分）
上水煎，量大小服之。
木通芍药汤 治痘疮作渴腹胀，小便不利。
木通 芍药 白术（各五分） 川芎 陈皮 干葛（各三分） 甘草（二分）
上水煎服。
十全大补汤
当归 川芎 白芍药（炒） 熟地黄 人参 白术 白茯苓 甘草（炒） 黄 （炒） 官桂（各等分）
上水煎，量儿大小服。
参附汤 治痘疹阳气虚寒，切牙寒战，手足并冷，或吐泻不食，饮沸汤不知热。用独参汤加好真附炮如法者，
每剂先加一钱，未应多加之，更不应，加至四五钱，或等分亦不妨。但用之以运其阳气。如已脱者不治。
独参汤 治阳气虚弱，痘疮不起发，不红活，或脓清不满，或结痂迟缓，或痘痕色白，或嫩软不固，或脓水不
干，或时作痒，或畏风寒。用好人参一两、生姜五片、大枣五枚，水二钟，煎八分，徐徐温服。婴儿乳母亦服。
胡荽酒
用胡荽一把，以好酒二钟煎一两沸，令乳母含喷儿遍儿头面，并房中须烧胡荽香，能辟除秽气，使痘疹出快。若痘
疹已出而饮食少思，宜用枣子燃炙，儿闻枣香尤能开胃、进饮食、解毒瓦斯。若因饮食停滞，未及消导者，不宜用。
托里消毒散
托里散（二方见痘痈）
七味白术散（即人参白术散，方见痘疮属阴属阳）
十一味木香散
十二味异功散（二方见痘灰白色）
五味异功散（方见痘寒战切牙）
肉豆蔻
二神丸
四神丸（三方见泻渴切牙）
[Background Information]
Book: Baoying Cuoyao (Essentials for Protecting Infants)
Author: Xue Kai
Dynasty: Ming
Chapter: Untreatable Five Syndromes
Category: Gynecology and Pediatrics
[English Translation]
Cough with hoarse voice, difficulty swallowing food. Abdominal distension, shortness of breath, restlessness and irritability. Unremitting thirst and diarrhea, teeth chattering and shivering. Pox lesions are tender and prone to rupture, with unceasing itching and collapse. The color is purple, black, or gray; the apex is depressed, accompanied by panting and thirst.
Diagram of Red Marks Appearing (Illustration regarding the appearance of red marks in pox)
Day One: If fever subsides first and then pox appears on the first day, the condition will definitely be mild. Furthermore, after one day since the appearance of pox, if the body temperature and the density of the pox have stabilized, but fever and irritability persist, it takes two or three episodes of fever for the pox to stabilize. If the red marks appear clearly, it is a good omen; if they appear intermittently or hide, it is a bad omen.
Day Two: On the second day, if the pox are the size of millet grains, sparse, red, and full, it is a good omen. If on the second day the apex is depressed and the color is grayish-white, it is secondary.
Day Three: On the third day, if the tips are full like pearls, it is a good omen; if grayish-white, it is secondary. By the third day, the pox must have fully erupted. If afterwards the body develops fever again, accompanied by restlessness, irritability, and intense thirst, it is a bad omen.
Diagram of Pox Blooming and Suppurating (Illustration regarding the blooming and suppurating of pox lesions)
Initial Eruption: The pox erupt in two or three waves, varying in size. Those that appear first suppurate first, and those that appear later suppurate later, shining like water droplets. If the base (root) is red and vibrant, it is a good omen.
Like Pearls: If there is no thirst, diarrhea, restlessness, or irritability, medication is not necessary. If there is slight thirst, slight itching, and no diarrhea, it is harmless, and medication is also unnecessary.
Vibrant Base: If all pox erupt simultaneously, densely packed, grayish-white, with depressed apices, accompanied by irritability, thirst, and diarrhea, urgent treatment is required.
When the pox lesions are full like pus-filled sacs and begin to scab, they gradually turn into a pale waxy color. Some may lack pus and appear yellowish-white. Starting from the first day of eruption, scabbing occurs by the seventh day, and completion by the tenth day; this is the normal course. There are cases where scabbing is delayed until the eighth or ninth day, or even completion until the fourteenth or fifteenth day. As long as there is no diarrhea, thirst, or restlessness, the pox are full without depression, and hard to the touch, these are favorable signs. During the scabbing phase, redness and swelling gradually subside, or scabs form within the lesions, feeling yellowish-waxy, or the skin at the root outside scabs first. In boys, scabbing proceeds from the face to the head and back; in girls, from the face to the chest and abdomen. After scabbing, if they detach easily from the flesh and fall off, it is good. Cases with slight thirst, itching, and pain, or where body scabbing completes but foot scabbing is delayed, are acceptable. Cases with slight fever and inability to eat also exist. However, if the pox are tender and prone to rupture, accompanied by restlessness, irritability, itching, and collapse, it is a bad omen.
Residual Symptoms After Scabbing (Regulation after scabbing)
After the pox have scabbed, preventive regulation is advisable. Even if the pox have erupted, failing to avoid wind and cold, or failing to regulate diet, even in previously healthy individuals, unless their spleen and stomach are naturally strong, caution is needed. When the disease has just healed and the internal organs have just stabilized, the spleen and stomach are still weak. Overexertion or excessive eating can cause relapse, leading to panting, cough, and abdominal distension, which are ominous. Additionally, blood and qi are still weak; early overexertion causing relapse is ominous. Moreover, the muscles are tender; exposure to wind makes one susceptible to cold, leading to headache and fever, which are difficult to treat.
Syndrome of Abdominal Distension, Shortness of Breath, and Non-Red Base
Mr. Chen Wensu said: Between the eruption and healing of smallpox, if diarrhea, thirst, abdominal distension, and shortness of breath occur, and the pox are lusterless, do not rise, and have a non-red base, this is called Exterior Deficiency. First administer Shiyiwei Muxiang San (Eleven-Ingredient Costus Powder) to harmonize the Qi of the five zang organs, then administer Shi'erwei Yigong San (Twelve-Ingredient Extraordinary Merit Powder) to deliver Qiwei Roudoukou Wan (Seven-Ingredient Myristica Pill) to assist the Qi of the zang-fu organs. I believe that once the pox have erupted, if they are lusterless, do not rise, are not red and vibrant, or if there is diarrhea with thirst, abdominal distension, shortness of breath with panting, shivering with teeth chattering, cold fingers and toes, limb contraction, thirst for hot drinks, this indicates depletion of Yang Qi, interior deficiency-cold with exterior false-heat. Use Shi'erwei Yigong San. If there is thirst for hot drinks but the hands and feet are not cold, it is Spleen-Stomach weakness; use Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder). Generally, if the initial pox do not follow the standard pattern, but subsequent ones are red and vibrant, or appear in patches, red in color but foul-smelling, it is not a concern.
A child developed smallpox. On the fourth day, abdominal distension, diarrhea, and thirst appeared, indicating Spleen-Stomach deficiency-cold. One dose of Shi'erwei Yigong San was used, followed by Shenqi Neituo San (Ginseng and Astragalus Internal Support Powder). When pus filled and scabs formed, sudden shivering and teeth chattering occurred, indicating depletion of Yang Qi due to pus formation. Shenfu Tang (Ginseng and Aconite Decoction) and Dushen Tang (Single Ginseng Decoction) were used, resulting in recovery.
A child had smallpox. On the fourth day, abdominal distension, diarrhea, thirst, shortness of breath, and fatigue appeared, indicating Spleen Qi deficiency. Ren Shen Bai Zhu San (Ginseng and Atractylodes Macrocephala Powder) with added Muxiang (Costus Root), decocted and taken with one dose of Sishen Wan (Four Spirits Pill), stopped all symptoms immediately. However, delayed pus formation with thirst indicated deficiency of both interior and exterior blood and qi. Shenqi Sisheng San (Ginseng and Astragalus Four Sages Powder) and Da Bu Tang (Great Tonifying Decoction) were used, resulting in recovery.
A child had smallpox with thirst, abdominal distension, and dysuria, indicating stagnation of pathogenic qi. Mutong Shaoyao Tang (Akebia and Peony Decoction) was administered for one dose, slightly improving symptoms. Shenqi Sisheng San was used, allowing the pus to gradually fill. Shenqi Neituo San was used, leading to scabbing and recovery.
A child's smallpox was nearing recovery, but abdominal distension occurred, with hands and feet alternating between cold and hot, indicating Yang Qi deficiency-cold. Shi'erwei Yigong San was used first. Once the hands and feet were no longer cold, indicating gradual restoration of Yang Qi, Wuwei Yigong San with added Muxiang was used, resulting in recovery.
A child had smallpox with free stool but constipated urine, abdominal distension, panting, and cold hands and feet, indicating Spleen Qi deficiency. Tingli and Muxiang were administered for one dose, followed by Wuwei Yigong San with added Muxiang for two doses, resulting in recovery. Later, abdominal distension, anorexia, and salivation at the corners of the mouth occurred; Wuwei Yigong San was used again, leading to cure.
A child's smallpox was nearing recovery when sudden abdominal distension and diarrhea occurred, worse in the early morning, with undigested food in stool. This was considered Spleen-Stomach weakness. Renshen Baizhu San was given in the morning, Ershen Wan (Two Spirits Pill) in the evening, stopping the diarrhea. Shenqi Neituo San combined with Tuoli San (Internal Support Powder) was used for scabbing.
A child had smallpox with abdominal distension, diarrhea, and undigested food, indicating Spleen-Kidney Qi deficiency. Renshen Baizhu San and Doukou Wan (Cardamom Pill) were used, resulting in recovery.
Shenqi Neituo San (Ginseng and Astragalus Internal Support Powder): Treats interior deficiency causing itching, non-ulcerated sores, and inverted scabbing.
Ingredients: Ren Shen (Ginseng), Huang Qi (Astragalus, stir-fried), Dang Gui (Angelica Sinensis), Chuan Xiong (Ligusticum), Hou Po (Magnolia Bark, ginger-processed), Fang Feng (Saposhnikovia, each 5 fen); Jie Geng (Platycodon), Bai Zhi (Angelica Dahurica), Guan Gui (Cinnamon Twig, each 3 fen); Zi Cao (Arnebia, 5 fen); Mu Xiang (Aucklandia), Gan Cao (Licorice, each 3 fen).
Preparation: Add a pinch of glutinous rice, decoct in water, and take according to tolerance. Suitable for shivering, teeth chattering, drinking water with diarrhea and thirst.
Shenqi Sisheng San (Ginseng and Astragalus Four Sages Powder): Treats smallpox that has erupted for six or seven days but fails to grow, produce pus, or presents with itching and collapse.
Ingredients: Dang Gui (Angelica Sinensis), Shao Yao (Peony, stir-fried), Huang Qi (Astragalus), Chuan Xiong (Ligusticum, each 5 fen); Bai Zhu (Atractylodes Macrocephala), Fu Ling (Poria), Zi Cao (Arnebia; substitute Hong Hua/Safflower if unavailable), Mu Tong (Akebia), Fang Feng (Saposhnikovia, each 3 fen); Glutinous Rice (200 grains).
Preparation: Decoct in water. The mother should consume it together.
Tingli Muxiang San (Descurainia and Costus Powder): Treats spontaneous diarrhea, dysuria, panting, cough, abdominal distension, and anorexia. Multiple doses are beneficial.
Ingredients: Zhu Ling (Polyporus), Ze Xie (Alisma), Fu Ling (Poria), Bai Zhu (Atractylodes Macrocephala), Guan Gui (Cinnamon Twig, each 5 fen); Hua Shi (Talcum, 2 qian); Ting Li (Descurainia Seed), Mu Tong (Akebia), Mu Xiang (Aucklandia), Gan Cao (Licorice, each 5 fen).
Preparation: Decoct in water, take according to age/size.
Mutong Shaoyao Tang (Akebia and Peony Decoction): Treats smallpox with thirst, abdominal distension, and dysuria.
Ingredients: Mu Tong (Akebia), Shao Yao (Peony), Bai Zhu (Atractylodes Macrocephala, each 5 fen); Chuan Xiong (Ligusticum), Chen Pi (Citrus Peel), Gan Ge (Pueraria, each 3 fen); Gan Cao (Licorice, 2 fen).
Preparation: Decoct in water and take.
Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction)
Ingredients: Dang Gui (Angelica Sinensis), Chuan Xiong (Ligusticum), Bai Shao Yao (White Peony, stir-fried), Shu Di Huang (Rehmannia), Ren Shen (Ginseng), Bai Zhu (Atractylodes Macrocephala), Bai Fu Ling (Poria), Gan Cao (Licorice, stir-fried), Huang Qi (Astragalus, stir-fried), Guan Gui (Cinnamon Twig, equal parts).
Preparation: Decoct in water, take according to the child's size.
Shenfu Tang (Ginseng and Aconite Decoction): Treats Yang Qi deficiency-cold in pox/rash, characterized by teeth chattering, shivering, cold hands and feet, vomiting/diarrhea/anorexia, and insensitivity to heat when drinking boiling water. Use Dushen Tang (Single Ginseng Decoction) plus properly prepared Zhen Fu Zi (True Aconite). Start with 1 qian per dose; if ineffective, increase dosage. If still ineffective, increase to 4-5 qian, or use equal parts. Its function is to move Yang Qi. If Yang Qi has collapsed, it is untreatable.
Dushen Tang (Single Ginseng Decoction): Treats Yang Qi weakness, smallpox that does not rise, is not red/vibrant, has thin/incomplete pus, delayed scabbing, white scars, tender/soft/unstable lesions, non-drying pus, frequent itching, or aversion to wind/cold. Use high-quality Ren Shen (Ginseng) 1 liang, Sheng Jiang (Fresh Ginger) 5 slices, Da Zao (Jujube) 5 pieces. Decoct in 2 zhong of water until 8 fen remains. Take slowly while warm. Infants and their nursing mothers may also take it.
Husu Jiu (Coriander Wine)
Use a handful of Hu Su (Coriander), decoct in 2 zhong of good wine until it boils for a moment. Let the nursing mother hold it in her mouth and spray it over the infant's head and face. Burn coriander incense in the room to dispel foul odors, helping the pox erupt quickly. If the pox have erupted but appetite is low, roast dates and let the infant smell the aroma; this particularly opens the stomach, promotes eating, and detoxifies. Do not use if caused by food stagnation that has not yet been guided out.
Tuoli Xiaodu San (Internal Support and Toxin Resolving Powder)
Tuoli San (Internal Support Powder - see Smallpox Carbuncle section for two formulas)
Qiwei Baizhu San (Seven-Ingredient Atractylodes Powder - i.e., Renshen Baizhu San, see Yin/Yang Smallpox section)
Shiyiwei Muxiang San (Eleven-Ingredient Costus Powder)
Shi'erwei Yigong San (Twelve-Ingredient Extraordinary Merit Powder - see Grayish-White Smallpox section for two formulas)
Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder - see Shivering/Teeth Chattering Smallpox section)
Rou Dou Kou (Myristica/Fragrant Seed)
Ershen Wan (Two Spirits Pill)
Sishen Wan (Four Spirits Pill - see Diarrhea/Thirst/Teeth Chattering section for three formulas)