用发缠指头，蘸井花水拭口令净。又用浓煮粟米汁，以绵缠箸头拭之，更以 过黄丹掺之，即愈。
又方 治鹅口疮，不能食乳。
用地鸡擂水，涂疮即愈。（地鸡，即匾虫也，人家砖石下多有之。）
治小儿口疮，泻心汤用黄连，为细末，蜜水调服。
治小儿口疮，用黄柏、细辛各等分，为细末，敷之。
治小儿颏上生疮，痛痒难忍，用白杨木枝，烧于刀上出沥敷之，及治鹅口疮神效。
治小儿走马牙疳，用白矾置于五倍子内， 过为末敷之。
治小儿脐风撮口，因脐断伤风，或尿在胞中，遂成脐风，发热面赤，啼声不出，名曰撮口风。
瞿麦（五分） 蝎稍（四个） 僵蚕（七个） 赤脚金头蜈蚣（一条）
上为细末，鹅毛管吹些少入鼻中，如喷嚏叫声可治，后用薄荷汁调与服之。
论
《内经》曰∶诸痛痒疮疡，皆属心火。夫小儿痘疹之证，最为酷疾，不日之间，死生反掌。盖因胎毒藏于命门，遇
岁火太过，热毒流行之年，则痘毒因之而发作矣。一发则出于心肝脾肺四脏而肾无留邪者，为吉。若初发便作腰痛，见
点则紫黑者多死，盖毒瓦斯留于肾间而不发越故耳。钱氏虽有百祥丸大下之法，然活者十无一二。大抵痘疮之法，多归重
于脾肺二经，盖脾主肌肉，而肺主皮毛，故遍身为之斑斓也。其为证也，宜发越不宜郁滞，宜红活凸绽，不宜紫黑陷伏。
疮出之后，医者当察色详证，以辨表里虚实用药。其吐泻不能食为里虚，不吐泻能食为里实，灰白色陷顶多汗为表虚，
红活凸绽无汗为表实，又诸痛为实，诸痒为虚，外快内痛为内实外虚，外痛内快为内虚外实。里实而补，则结痈毒；表
实而复用实表之药，则溃烂不结痂也。如表虚者，疮易出而难靥；表实者，疮难出而易收；里实，则出快而轻；里虚，
则发迟而重；表实里虚，则陷伏倒靥；里实表虚，则发慢收迟。治之之法，三日以前未见红点，必用升麻汤、参苏饮之
类以发其表，务令微汗为度。若未汗，如表犹未解，虽略见红点隐约于肌肉间，而升散开发之剂尚未可除。凡见出迟发
慢者，根窠欠红冷者，盒饭忧虑调摄，切勿袖手待毙。夫古人用药，寒热迥别，主意不同。医者再宜臆度寒暄，推详运
气而治。如陈文中之木香散、异功散，用丁、附、姜、桂等峻热之药，而与内经病机不合，丹溪特发挥其误，亦有用得
其当者，屡获捷效。若刘河间、张子和辈，悉用芩、连、大黄等寒凉之剂，丹溪亦曰酒炒芩、连各解痘毒，根据法用之而
获安者，亦不少也。今之医者往往不同，根据陈氏而行者多用热药，宗刘张而治者多用凉剂，是故不偏于热则偏于寒，此
刻舟求剑之道也。
愚按《内经》有曰∶寒者热之，热者寒之，微者逆之，甚者从之。又曰∶逆者正治，从者反治，从少从多，观其事
也。陈氏用从治之法，权也；刘张用正治之法，常也。然皆不外乎参、术、 、草、芎、归、茯苓、芍药等补气血药
为主治焉，亦当看时令寒热，缓急施治，固不可执一见也。杨氏曰∶痘疮发于肌肉，阳明胃气主之，脾土一温，胃气随
畅，决无陷伏之患。汤氏曰∶如庖人笼蒸之法，但欲其松耳。沧洲翁吕复，折衷众说，着方立论适中，用药寒热攻补，
斟酌时宜，未尝执一治也，学人能遵守其法而行之，庶无一偏之患矣。
方法
夫小儿痘疮，大抵与伤寒相似，发热烦躁，脸赤唇红，身痛头疼，乍寒乍热，喷嚏呵欠，喘嗽痰涎。始发之时，有
因伤风伤寒而得，有时气传染而得，有因伤食发热呕吐而得，有因跌扑惊恐蓄血而得。或为目窜惊搐如风之证，或口舌
咽喉肚腹疼痛，或烦躁狂闷昏睡，或自汗，或下利，或发热，或不发热，证候多端，卒未易辨，必须以耳冷尻冷验之。
盖疡疹属阳，肾脏无证，其耳与尻俱属肾，故肾之所部独冷，又不若视其耳后有红脉赤缕为之真，如此可以稽验矣。治
疗之法。首尾俱不可妄下，但温凉之剂兼而济之，解毒和中安表而已。虚者益之，实者损之，寒者温之，热者清之，是
为权度。昔人有喻云∶如庖人笼蒸之法，但欲其松耳。盖毒发于表，如苟妄汗，则荣卫益虚，重令开泄，转增疮烂，由
是风邪乘间，变证者多矣。毒根于里，如苟妄下，则内气益虚，毒不能出而返入焉，由是土不胜水，变黑归肾，身体振
寒，耳尻反热，眼合肚胀，其疮黑陷，十无一生。汗下二说，古人深戒。以此观疮疹证状，虽与伤寒相似，而其治法实
异，伤寒从表入里，疮疹从里出表故也。解肌之法，葛根、升麻、紫、苏之类可也。其或气实烦躁，热炽大便秘结，则
与犀角地黄汤或人参败毒散，又或紫草饮多服亦能利之。故虽云大便不通者，少与大黄，尤宜仔细斟酌，不可妄用猛浪。
如小便赤涩者，分利小便，则热气有所渗而出。凡热不可骤遏，但轻解之。若无热，则疮又不能发也。
凡痘疹春夏为顺，秋冬为逆。
凡痘疹分人清浊，就形气上取勇怯。
凡痘疹，但觉身热，证似伤寒，疑似未明，盒饭先与惺惺散或参苏饮。热甚者，升麻葛根汤、人参败毒散。若见红
点，便忌葛根汤、恐发得表虚也。
凡痘疮初欲出时，身发热，耳尻冷，呵欠咳嗽面赤，必是出痘之
候，便宜服升麻葛根汤加山楂、大力子，其疮出必稀少而易愈。
凡痘疮初出时，或未出时，宜服后药，多者可少，少者可无，重者可令轻也。一方用苦丝瓜（俗名天萝）近蒂三寸，
连皮子烧存性，细研，砂糖拌，干吃，入朱砂尤妙。又方，以朱砂一味为细末，看儿大小，或半钱或一钱，蜜水调服。
亦云多者可少，少者可无。
凡痘疮发热之时，更以恶实子为末，蜜调贴囟门，免眼障之患。
凡痘疮初出之际，须看胸前，若稠密，急宜服消毒饮加山楂、黄芩、酒洗紫草。减食者，加人参。
凡痘疮初出之时色白者，盒饭大补气血，参、术、 、芎、升麻、干葛、甘草、木香、丁香、酒当归、白芍药。如
大便泄，加诃子、肉豆蔻。
凡痘疮初起发时，自汗不妨，盖湿热熏蒸故也。甚者，当以参 等实表之药，以防其难靥也。
凡痘疮初起发时，烦躁谵语，狂渴引饮，若饮水则后来靥不齐，急以凉药解其标，如益元散之类。
凡痘疮已出，可少与化毒汤。出不快者，加味四圣散、紫草饮子、紫草木香汤、快斑散、丝瓜汤之类。
凡痘疮出稠密甚者，人参败毒散、犀角地黄汤。
凡痘疮疏则毒少，密则毒甚，宜以清凉之药解之，酒炒芩、连之类，虽数服亦不妨，庶无害眼之患。
凡痘疮炉灰色白净者，作寒者。紫黑色者，齐涌者，烦躁者，作热者。黑属血热，凉血为主。白属气虚，补气为主。
中黑陷而外白、起得迟者，则相兼而治。
凡痘疮当分表里虚实，吐泻少食为里虚，不吐泻能食为里实，里实而补则结痈毒。陷伏倒靥灰白色者为表虚，红活
凸绽者为表实，表实而复实其表，则溃烂不结痂也。表虚不起发者，或用烧人屎验。
凡痘疮须分气虚血虚，用补药。气虚者，人参、白术加解毒药。血虚者，四物汤加解毒药。酒炒芩、连各解毒。盖
芩、连为疮家之要药，加酒炒以制其峻寒之性，独存清凉解毒之能，是故痘疮之症，当用以杀其毒耳。
凡痘疮虽分气血虚实，大抵多属气血不足，然当于不足中以别其优劣，而以补气血药中分轻重为用，以平为期耳。
有挟外邪而实者，少加防风等药。
大法，活血调气，安表和中，轻清消毒，温凉之剂，兼而治之，此平治之法也。温如黄 、当归、木香辈，凉如前
胡、干葛、升麻辈，佐之以川芎、白芍药、枳壳、桔梗、羌活、木通、紫草之属，则可以调适矣。
黑陷二种，因气虚而毒瓦斯不能尽出者，酒炒黄 、紫草、人参等药。
凡黑陷甚者，亦用烧人屎，别用无病小儿粪烧存性，蜜水调服。一方用人、猫、猪、犬四粪，于腊月烧灰，名万金
散。
痒塌者，于形色脉上分虚实，实则脉有力气壮，虚则脉无力气怯。痒以实表之剂，加凉血药。实痒如大便不通者，
以大黄等寒凉之药少与之，下其结粪。气怯轻者，用淡蜜水调滑石末，以鹅翎刷疮上润之。
疮干者宜退火，止用轻清之剂，荆芥、薄荷、升麻、干葛之类。
疮湿者，肌表间有湿气也，宜泻湿药白芷、防风之类，盖风药能胜湿也。
咽喉痛者，如圣散、鼠粘子汤。
喘满气壅者，麻黄黄芩汤。
烦渴者，甘草散、乌梅汤。
下利呕逆者，木香理中汤。
颜色正者，以前法平治则安。将欲成就，脚色淡者，宜助血药，用当归、川芎、酒芍药之类、或少加红花以润血色。
将成就之际，脚色紫者属热，用凉药解其毒，升麻葛根汤炒芩、连及连翘之类。甚者必用犀角，盖犀角大解痘毒。
将靥时金白色如豆壳者，盖因初起时饮水多，其靥不齐，名曰倒靥，不好，宜服实表之药，及消息大小便何如，大
便秘宜利大便，小便秘宜利小便。如小便赤涩者，大连翘汤、甘露饮。大便秘结，内烦外热者，小柴胡汤加枳壳最稳当，
或少服四顺清凉饮子。
夫疮疹用药固有权度，大小二便不可不通，其大便看所下黄黑色，其毒瓦斯已盛，不可多与热剂，但少用化毒汤可也，
或不用亦可。若大小二便一有秘结，则肠胃壅遏，脉结气滞，毒瓦斯无从发泄，目闭声哑，肌肉黧黑，不旋踵而变矣。陷
入者，加味四圣散，更以胡荽酒薄敷其身，浓敷其足，喷其床帐衣被，并以浓绵衣盖之。若未起，独圣散入木香煎服。
若其疮已黑，乃可用宣风散加青皮。钱氏云∶黑陷青紫者，百祥丸下之，不黑者慎勿下。余知其所下者，泻膀胱之
邪也。又云∶下后身气温欲饮水者，可治；水谷不消或寒战者，为逆。余知其脾强者，土可以制水也。百祥丸恐太峻，
当以宣风散代之。泻后温脾，则用人参、茯苓、白术等分，浓朴、木香、甘草各减半为妙。盖疮发肌肉，阳明主之，脾
土一温，胃气随畅，独不可消胜已泄之肾水乎？此钱氏不刊之秘旨也。
其坏疮者，一曰内虚泄泻，二曰外伤风寒，三曰变黑归肾。
近时治痘疮者，悉宗陈文中木香散、异功散，殊不知彼立方之时，必运气在寒水司天之令，及值严冬大寒，为因气
郁遏，痘疮不得起发红绽，故用辛热之剂发之，其宜也。今人不分时令寒热，一 施治，误人多矣。或有虽值温热之时，
山野农家贪贱之人，其或偶中一二，不可以为常法也。
（以上丹溪方法凡三十三条）
愚按∶陈氏木香散、异功散二方，乃《素问》从治之法，又谓之热因热用者也。盖痘疮热毒怫郁于内而不得起发，
故用丁、附、木香、桂心、豆蔻等辛散劫郁之剂一二服劫而开之，使向之郁于内者，尽因药气而发越乎外，故痘子陷伏
灰白色者，皆翕然红活凸绽，而内无遗邪矣，切勿过剂。如一二服后劫不起者，亦不可多与，多则反助其毒，转增黑烂，
咽闭声沉而死。近世儒医，悉引内经病机诸痛痒疮疡皆属心火之语，以正陈氏之失，此知常而不知权之论也。
故使后学狐疑不决，当用而不敢用，是以袖手待毙，哀哉！
痘疮初发时五脏形证（一）
面及腮颊赤，喷嚏，属肺。呵欠顿闷，属肝。时发惊悸，属心。乍凉乍热，手足冷，多睡，属脾。尻凉、耳凉，肾
之平症。一方∶肾在腑下，不受秽浊，独无证。
痘疮五脏形色（二）
肝脏发水 。（色微青，以液为泪，故 色如水，其形小。）
肺脏发脓 。（色多白，以液为涕，故脓稠浊如涕，其形大。）
脾脏发疹。（脾为裹血，其色如浅黄，或如糠麸，其形小如斑。）
心脏发斑。（其色主血，故纯赤，其形小，次于水 。）
肾脏居下，独不受秽毒，故无候，但耳尻冷耳。若痘疮黑陷，耳及尻反热者，为逆。
斑痘所发之源（三）
夫婴儿之胚 也，必资胎养以长其形焉。缘母失节慎，纵欲恣餐，感其秽毒之气，藏之脏腑，近自孩提，远至童稚，
值寒暄不常之候，疮疹由是而发，因其所受浅深而为稀稠焉，其原实保于心。一云∶相火之气所为，故入于肺则成脓 ，
俗名豌豆，亦名麻豆，以相火乘金，故破肌也。入于肝则成水疹，俗名麸疮。入于脾则成瘾疹。入于心则成斑，以火处
于子母之分，不伤皮毛，彰君之德也。或云∶疮发 肿于外者，属少阳三焦火也，谓之斑。色小红而行于皮肤中出者，
属少阴君火也，谓之疹。杨氏曰∶痘疮发于肌肉，阳明胃气主之，脾土一温，胃气随畅，土可胜水，决无陷伏之患。
辨内外因（四）
凡疮欲出而未出，因发搐者，是外感风寒之邪而内发心热也，宜王氏惺惺散，或升麻葛根汤、木香参苏饮。
凡疮欲出未出而吐利者，是中焦停寒，或挟宿食也，宜四君子汤加砂仁、陈皮，或和中散。如挟宿食者，用紫霜丸。
惺惺散（王氏）
白术（炒） 桔梗（去芦） 细辛 人参 茯苓 甘草 栝蒌根（各三分）
上细切，作一服，入薄荷叶三片，水一盏，煎七分，时时与之。
升麻葛根汤
升麻 葛根 芍药 甘草（炙，各一钱）
上细切，作一服，水一盏，煎七分，温服无时。
Use hair wrapped around the finger, dip it in well water collected at dawn (Jinghua Shui), and wipe the mouth clean. Then use thickly boiled millet juice, wrap cotton around the chopstick head to wipe the lesion, and sprinkle processed Huangdan (Yellow Cinnabar) powder on it; this will cure it.
Another prescription: Treats E Kou Chuang (Candidiasis of the mouth/oral thrush), where the infant cannot feed.
Grind Di Ji (Ground Chicken/Trogopterus dung) with water, apply to the sores; this will cure it. (Di Ji refers to Trogopterus Dung, commonly found under bricks and stones in households.)
To treat pediatric oral ulcers, use Huanglian (Coptidis Rhizome) from Xie Xin Tang (Drain the Epigastrium Decoction), grind into fine powder, and take mixed with honey water.
To treat pediatric oral ulcers, use equal parts of Huangbai (Phellodendri Cortex) and Xixin (Asari Radix et Rhizoma), grind into fine powder, and apply topically.
To treat sores on a child's chin that are painful and intensely itchy, burn branches of Baiyangmu (Populus Tomentosa) on a knife until the resin drips out, and apply the resin; this is also miraculous for treating E Kou Chuang.
To treat Zou Ma Ya Gan (Noma/Gangrenous stomatitis) in children, place Baifan (Alum) inside Wu Beizi (Galla Chinensis), calcine, grind into powder, and apply.
To treat Qi Feng Cuo Kou (Neonatal tetanus with jaw lock) in children: This arises from wind invasion after umbilical cord cutting, or urine retention in the bladder, leading to Qi Feng. Symptoms include fever, red face, and inability to cry, named Cuo Kou Feng.
Qumai (Dianthi Herba) (5 fen)
Xie Shao (Scorpion tail) (4 pieces)
Jiang Can (Bombyx Batryticatus) (7 pieces)
Chi Jiao Jin Tou Wu Gong (Centipede with red feet and golden head) (1 piece)
Grind all into fine powder. Use an goose feather tube to blow a small amount into the nose. If sneezing and crying occur, it is treatable. Afterwards, mix with mint juice and administer orally.
Discussion
The *Nei Jing* (Inner Canon) states: "All pain, itching, sores, and ulcers belong to Heart Fire." Pediatric variola (smallpox/chickenpox) is among the most severe diseases; life and death can reverse in an instant. This is generally because fetal toxins reside in the Mingmen (Gate of Life); when encountering years of excessive Sui Huo (Annual Fire) and prevalent heat toxins, the variola toxin is triggered to erupt. If upon eruption, the toxins exit through the Heart, Liver, Spleen, and Lung meridians without remaining in the Kidney, it is auspicious. If lower back pain appears at the onset, or if the spots appear purple-black, death is likely, because the toxic qi remains stagnant in the Kidney and fails to vent outward. Although Qian Yi proposed the method of using Baixiang Wan (Hundred Auspicious Pills) for drastic purgation, only one or two in ten survive. Generally, methods for treating variola emphasize the Spleen and Lung meridians, because the Spleen governs muscles and the Lung governs skin and hair, hence the mottled rash over the body. In terms of syndrome differentiation, it is suitable for venting and dispersing rather than stagnation; it should be red, vibrant, convex, and spreading, not purple-black and sunken. After the rash erupts, physicians must observe the color and carefully differentiate syndromes to determine whether the exterior/interior or deficiency/excess patterns exist for medication. Vomiting, diarrhea, and inability to eat indicate Interior Deficiency; no vomiting/diarrhea with ability to eat indicates Interior Excess. Ashy-white color, sunken tops, and profuse sweating indicate Exterior Deficiency; red, vibrant, convex appearance without sweating indicates Exterior Excess. Various pains indicate Excess; various itchings indicate Deficiency. Comfort outside but pain inside indicates Internal Excess and External Deficiency; pain outside but comfort inside indicates Internal Deficiency and External Excess. Treating Interior Excess with tonification leads to carbuncle formation; treating Exterior Excess again with exterior-strengthening drugs leads to ulceration without scabbing. If Exterior Deficient, the rash emerges easily but heals slowly; if Exterior Excess, the rash is hard to emerge but heals quickly; if Interior Excess, the eruption is rapid and mild; if Interior Deficient, the eruption is delayed and severe; if Exterior Excess and Interior Deficient, the rash sinks or inverts; if Interior Excess and Exterior Deficient, the eruption is slow and healing is delayed. The treatment method: Before three days pass and before red spots appear, one must use Shengma Tang (Cimicifugae Decoction) or Shen Su Yin (Ginseng and Perilla Drink) to release the exterior, aiming for slight sweating. If there is no sweat, as if the exterior is unresolved, even if faint red spots are visible in the muscles, the ascending and dispersing agents should not yet be discontinued. For those with delayed emergence and slow eruption, with pale and cold bases, one must worry and adjust care meticulously; do not stand by and wait for death. Ancient physicians used drugs with vastly different hot/cold properties and differing main intentions. Physicians should deduce climate changes and analyze the Six Qi (Yunqi) to treat accordingly. For example, Chen Wenzhong's Muxiang San (Aucklandia Powder) and Yigong San (Extraordinary Skill Powder) use harsh hot drugs like Dingxiang (Caryophylli Flos), Fuzi (Aconiti Lateralis Radix Preparata), Jiangtang (Zingiberis Rhizoma), and Guirou (Cinnamomi Cortex), which conflicts with the *Nei Jing*'s pathogenesis theory. Zhu Danxi specifically elaborated on these errors, yet there were occasions where they were used appropriately, yielding rapid effects. Conversely, Liu Wansu and Zhang Zihe used cold-cooling agents like Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizome), and Dahuang (Rhei Radix et Rhizoma). Danxi also stated that wine-fried Huangqin and Huanglian can resolve variola toxins; many achieved peace using this method. Modern physicians often disagree: those following Chen mostly use hot drugs, while those following Liu and Zhang mostly use cooling agents. Thus, they either lean towards heat or cold, which is the way of carving a mark on a boat to find the sword (rigid adherence to old rules).
My commentary: The *Nei Jing* states: "Treat cold with heat, treat heat with cold. For mild cases, use contrary treatment; for severe cases, use following treatment." It also says: "Contrary treatment is standard treatment; following treatment is counter-treatment. Follow more or less depending on the situation." Chen's use of following treatment is flexibility; Liu and Zhang's use of standard treatment is convention. However, neither departs from using Ren Shen (Ginseng), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Dang Gui (Angelicae Sinensis Radix), Fu Ling (Poria), and Bai Shao (Paeoniae Radix Alba) to tonify Qi and Blood as the main treatment. One must also consider seasonal cold/heat and treat according to urgency; one must not adhere to a single view. Yang Shi said: "Variola erupts in the muscles, governed by Yangming Stomach Qi. Once the Spleen Earth is warm, Stomach Qi flows smoothly, and there will be no risk of sinking/stagnation." Tang Shi said: "It is like the method of a cook steaming in a basket; the key is to keep it loose." Lu Fu of Cangzhou reconciled various theories, formulated prescriptions and arguments moderately, and weighed cold/hot and attack/tonification according to timing, never adhering to one method. If students follow his methods, they may avoid bias.
Methods
Pediatric variola is largely similar to Shang Han (Cold Damage): fever, irritability, red face and lips, body pain, headache, alternating chills and fever, sneezing, yawning, wheezing, coughing, and phlegm. At the initial stage, it may arise from wind-cold damage, seasonal epidemic transmission, food injury with fever/vomiting, or trauma/fright with blood stasis. Symptoms may include eye deviation and convulsions resembling wind, pain in the mouth/tongue/throat/abdomen, irritability, mania, drowsiness, spontaneous sweating, diarrhea, fever, or absence of fever. The syndromes are diverse and difficult to distinguish suddenly; one must verify using cold ears and cold coccyx. Since sores/rashes belong to Yang and the Kidney shows no symptoms, and both ears and coccyx belong to the Kidney, the area governed by the Kidney is uniquely cold. This is less reliable than observing red veins and threads behind the ears, which is truer. Treatment principles: Do not recklessly purge from start to finish. Combine warming and cooling agents to detoxify, harmonize the middle, and stabilize the exterior. Tonify deficiency, drain excess, warm cold, clear heat. This is the standard. An ancient analogy: Like a cook steaming in a basket, just ensure it is loose. Because the toxin erupts at the surface, reckless sweating depletes Ying and Wei further, causing open pores and worsening ulceration, allowing wind pathogens to enter and cause complications. If the root of the toxin is internal, reckless purging depletes internal Qi, preventing toxin expulsion and causing it to retreat inward. This leads to Earth failing to control Water, turning black and returning to the Kidney, with body tremors, aversion to cold, hot ears and coccyx, closed eyes, abdominal distension, black sunken sores, and almost certain death. Both sweating and purging are strictly warned against by ancients. Thus, although variola resembles Shang Han in symptoms, its treatment differs: Shang Han moves from exterior to interior, while variola moves from interior to exterior. For releasing the muscles, Gegen (Puerariae Radix), Shengma (Cimicifugae Rhizoma), Zisu (Perillae Folium), etc., are suitable. If there is Qi excess, irritability, intense heat, and constipation, give Xijiao Dihuang Tang (Rhinohorn and Rehmannia Decoction) or Renshen Baidu San (Ginseng and Detoxification Powder), or drink Zicao Yin (Arnebiae Root Drink) frequently to promote bowel movement. Even if constipated, use Dahuang (Rhei Radix et Rhizoma) sparingly and cautiously; do not use aggressively. If urine is red and scanty, promote urination to allow heat to渗 (seep) out. Heat should not be abruptly suppressed; gently resolve it. Without heat, the rash cannot erupt.
Variola appearing in Spring/Summer is favorable; in Autumn/Winter is unfavorable.
Differentiate variola by person's clarity/turbidity and assess courage/weakness based on physique and Qi.
For any variola where fever suggests Shang Han but diagnosis is unclear, first give Xingxing San (Waking Powder) or Renshen Su Yin. For high fever, use Shengma Gegen Tang or Renshen Baidu San. Once red spots appear, avoid Gegen Tang to prevent weakening the exterior.
When variola is about to emerge, with fever, cold ears/coccyx, yawning, cough, and red face, it is definitely the sign of eruption. Immediately take Shengma Gegen Tang plus Shan Zha (Crataegi Fructus) and Niu Bang Zi (Arctii Fructus); the rash will be sparse and easy to heal.
When variola is emerging or not yet emerged, take the following remedies: reduce dosage if severe, omit if mild, lighten heavy cases. One formula uses Ku Si Gua (Bitter Loofah, common name Tian Luo), 3 cun near the stem, burned with skin and seeds to retain nature, ground fine, mixed with brown sugar, eaten dry; adding Zhusha (Cinnabar) is excellent. Another formula uses only Zhusha ground fine; dose half or one qian based on age, mixed with honey water. Also states: reduce if severe, omit if mild.
During fever of variola, apply Emishi Zi (Arctii Fructus) powder mixed with honey to the fontanelle to prevent eye complications.
At the initial emergence of variola, check the chest. If dense, urgently take Xiaodu Yin (Detoxification Drink) plus Shan Zha, Huang Qin (Scutellariae Radix), and wine-washed Zicao (Arnebiae Radix). If appetite is reduced, add Ren Shen (Ginseng).
If variola spots are white upon early emergence, greatly tonify Qi and Blood: Ren Shen, Bai Zhu, Gan Cao, Chuan Xiong, Shengma, Gan Ge (Puerariae Radix), Mu Xiang (Aucklandiae Radix), Ding Xiang (Caryophylli Flos), wine-dosed Dang Gui, Bai Shao. If diarrhea occurs, add He Zi (Terminalia Chebulae Fructus) and Rou Dou Kou (Myristicae Semen).
During early eruption, spontaneous sweating is acceptable due to damp-heat steaming. If severe, use Renshen (Ginseng) and Huang Qi (Astragali Radix) to strengthen the exterior and prevent failure to heal.
During early eruption, if there is irritability, delirium, mania, and extreme thirst, drinking water may lead to uneven healing. Urgently use cooling drugs to address the branch, such as Yiyuan San (Benefit Origin Powder).
After variola has erupted, give a small amount of Huadu Tang (Resolve Toxin Decoction). For slow eruption, use Jiawei Sisheng San, Zicao Yinzi, Zicao Muxiang Tang, Kuaiban San, or Sigua Tang.
For dense/severe eruptions, use Renshen Baidu San or Xijiao Dihuang Tang.
Sparse eruptions mean less toxin; dense means more toxin. Resolve with cooling drugs like wine-fried Huang Qin and Huang Lian; multiple doses are safe to avoid eye damage.
Ashy-white and clean sores indicate Cold. Purple-black, swelling, and irritability indicate Heat. Black belongs to Blood Heat, primarily cool blood. White belongs to Qi Deficiency, primarily tonify Qi. Central black sinking with peripheral white and slow eruption requires combined treatment.
Differentiate variola by exterior/interior and deficiency/excess. Vomiting/diarrhea and poor appetite indicate Interior Deficiency; no vomiting/diarrhea and good appetite indicate Interior Excess. Tonifying Interior Excess causes carbuncles. Sunken/inverted ash-white sores indicate Exterior Deficiency; red/vibrant/convex sores indicate Exterior Excess. Strengthening an already Excess exterior causes ulceration without scabbing. For Exterior Deficient non-erupting sores, test with burnt human feces.
Differentiate Qi vs. Blood deficiency in variola for tonification. Qi Deficiency: Ren Shen, Bai Zhu plus detoxifiers. Blood Deficiency: Siwu Tang plus detoxifiers. Wine-fried Huang Qin and Huang Lian detoxify. They are essential for sores; wine-frying moderates their harsh cold nature, retaining only cooling detoxification. Thus, they are used in variola to kill toxins.
Although variola differentiates Qi/Blood and Deficiency/Excess, it is largely Qi/Blood insufficiency. Differentiate quality within insufficiency, weigh tonics lightly/heavily, and aim for balance. If accompanied by external pathogens causing Excess, add minor amounts of Fang Feng (Saposhnikoviae Radix).
General principle: Invigorate blood, regulate Qi, stabilize exterior, harmonize middle, lightly clear toxins. Combine warming and cooling agents. This is balanced treatment. Warming: Huang Qi, Dang Gui, Mu Xiang. Cooling: Qian Hu (Peucedani Radix), Gan Ge, Shengma. Assist with Chuan Xiong, Bai Shao, Zhi Ke (Aurantii Fructus), Jie Geng (Platycodonis Radix), Qiang Huo (Notopterygii Rhizoma et Radix), Mutong (Akebiae Caulis), Zicao. This achieves harmony.
Two types of black sinking due to Qi Deficiency preventing full toxin expulsion: Use wine-fried Huang Qi, Zicao, Ren Shen.
For severe black sinking, use burnt human feces. Alternatively, use feces from healthy infants, burned to retain nature, mixed with honey water. One formula uses feces from humans, cats, pigs, and dogs, burned to ash in the twelfth lunar month, named Wanjinsan (Ten Thousand Gold Powder).
For itchy collapsing: Differentiate deficiency/excess via form/color/pulse. Excess: strong pulse, robust Qi. Deficiency: weak pulse, timid Qi. For itch, use exterior-strengthening agents plus blood-cooling drugs. For Excess itch with constipation, give minor Dahuang to purge hardened stool. For mild Qi timidity, brush diluted honey water with滑石 (Talcum) powder onto sores using a goose feather.
For dry sores: Clear fire using light/clear agents like Jingjie (Schizonepetae Spica), Bohe (Menthae Haplocalycis Herba), Shengma, Gan Ge.
For damp sores: Dampness in muscle/surface. Use damp-draining drugs like Baizhi (Angelicae Dahuricae Radix), Fang Feng. Wind drugs overcome dampness.
For sore throat: Rusheng San or Shuniuzi Tang (Arctii Fructus Decoction).
For wheezing/distension/qi congestion: Mahuang Huangqin Tang (Ephedra and Scutellaria Decoction).
For irritability/thirst: Gancao San or Wumei Tang (Mume Fructus Decoction).
For diarrhea/nausea/vomiting: Muxiang Lizhong Tang (Aucklandia and Middle-Warming Decoction).
For normal color: Balanced treatment brings peace. As healing approaches, if color is pale, assist blood with Dang Gui, Chuan Xiong, wine-fried Bai Shao, or minor Hong Hua (Carthami Flos) to moisten blood color.
As healing approaches, if color is purple, it indicates Heat. Use cooling drugs to resolve toxin: Shengma Gegen Tang with fried Huang Qin/Huang Lian and Lianqiao (Forsythiae Fructus). Severe cases require Xijiao (Rhinocerotis Cornu). Rhinohorn strongly resolves variola toxin.
When approaching healing, if gold-white like bean shells, it is due to excessive drinking during onset, causing uneven healing, named Daoye (Inverted Healing). This is unfavorable. Use exterior-strengthening drugs and monitor bowels/bladder. Constipation: promote bowel movement. Scanty urination: promote urination. Red/scanty urine: Dalianqiao Tang or Ganlu Yin. Constipation with internal irritability/external heat: Xiao Chaihu Tang plus Zhi Ke is safest; or minor Sishun Qingliang Yinzi.
Medication for variola has standards; bowels/bladder must not be blocked. Observe yellow/black stool; if toxin is abundant, avoid large amounts of hot drugs; minor Huadu Tang suffices or none. If bowels/bladder are blocked, intestines/stomach become congested, pulse knots, Qi stagnates, toxin cannot vent, eyes close, voice hoarse, muscles turn dark, and change occurs rapidly. For sinking: Jiawei Sisheng San. Apply Hu Su Ye (Perillae Leaf) wine thinly to body, thickly to feet, spray bed curtains/clothes, cover with thick cotton clothes. If not erupting: Dusheng San with Mu Xiang decocted. If sores are black: Xuanfeng San plus Qing Pi (Aurantii Fructus Pericarpium). Qian Yi said: Black/purple sinking use Baixiang Wan to purge; non-black do not purge. I know purging drains Bladder evil. He also said: Post-purge, if body warmth returns and thirst for water appears, it is treatable; if food/water undigested or chills occur, it is adverse. I know strong Spleen (Earth) controls Water. Baixiang Wan may be too harsh; replace with Xuanfeng San. Post-purge warm Spleen: Equal parts Ren Shen, Fu Ling, Bai Zhu; half dose Hou Po (Magnoliae Officinalis Cortex), Mu Xiang, Gan Cao. Since sores erupt in muscles governed by Yangming, warming Spleen smooths Stomach Qi, eliminating excessive Kidney Water. This is Qian Yi's unchangeable secret.
Bad sores are caused by: 1. Internal deficiency diarrhea; 2. External wind-cold injury; 3. Turning black returning to Kidney.
Recent physicians treating variola follow Chen Wenzhong's Muxiang San and Yigong San, unaware that when these formulas were created, the Yunqi was Cold Water ruling Heaven, during deep winter cold. Qi was constrained, preventing variola from rising/reddening/spreading, so harsh hot drugs were used to vent them—this was appropriate. Now people ignore seasons/climate, applying uniformly, harming many. Even in warm times, rural poor might occasionally benefit, but this is not a standard method.
(Above are Danxi's methods, 33 items total)
My commentary: Chen's Muxiang San and Yigong San are methods of "Following Treatment" from *Su Wen*, also called "Treating heat with heat." Because variola heat toxin is constrained internally and cannot erupt, harsh dispersing drugs like Ding Xiang, Fu Zi, Mu Xiang, Gui Xin (Cinnamomi Ramulus), and Dou Kou (Amomi Fructus Rotundus) are used in 1-2 doses to break constraint and vent internal toxin outward. Thus, sunken/ash-white sores become red/vibrant/convex, and internal residue is cleared. Do not overdose. If 1-2 doses fail to vent, do not give more; excess aids toxin, worsens black rot, causes throat closure, silent voice, and death. Recent scholar-physicians cite *Nei Jing*: "All pain/itch/sores belong to Heart Fire" to correct Chen's error. This knows the constant but not the flexible. It leaves students hesitant, afraid to use necessary drugs, standing by waiting for death. Tragic!
Five Organs' Manifestations at Variola Onset (1)
Face/cheeks red, sneezing: Belongs to Lung.
Yawning, stuffiness: Belongs to Liver.
Frequent palpitations/fright: Belongs to Heart.
Alternating cold/heat, cold hands/feet, excessive sleep: Belongs to Spleen.
Cold coccyx, cold ears: Normal Kidney symptom. One source: Kidney is below, does not accept turbidity, shows no specific symptom.
Five Organs' Colors/Forms in Variola (2)
Liver generates water blisters. (Color slightly green, fluid is tear-like, so blister looks like water, shape small.)
Lung generates pus blisters. (Color mostly white, fluid is mucus-like, so pus is thick/turbid like mucus, shape large.)
Spleen generates rashes. (Spleen wraps blood, color pale yellow or like bran, shape small like macules.)
Heart generates macules. (Color governs blood, so pure red, shape small, secondary to water blisters.)
Kidney resides below, does not accept turbid toxin, so no specific sign, only cold ears/coccyx. If variola is black/sunken and ears/coccyx become hot, it is adverse.
Source of Macules/Variola (3)
Infant embryos rely on prenatal nourishment to grow. If the mother lacks restraint, indulges desires/diet, she contracts turbid toxin qi, storing it in organs. From toddlerhood to childhood, when weather fluctuates irregularly, sores/rashes erupt. Depth of infection determines sparsity/density; the origin is preserved in the Heart. One theory: Caused by Ministerial Fire. Entering Lung forms pus blisters (peas/mazidou), as Ministerial Fire attacks Metal, breaking flesh. Entering Liver forms water rashes (bran sores). Entering Spleen forms adult rashes. Entering Heart forms macules; Fire is in the Mother-Child relationship, not damaging skin/hair, showing the virtue of the Sovereign Fire. Another theory: Swelling outside belongs to Shaoyang Sanjiao Fire, called Macule. Small red spots moving in skin belong to Shaoyin Sovereign Fire, called Rash. Yang Shi said: Variola erupts in muscles, governed by Yangming Stomach Qi. Warming Spleen Earth smooths Stomach Qi; Earth controls Water, preventing sinking.
Differentiating Internal/External Causes (4)
If sores want to emerge but haven't, and convulsions occur: External wind-cold invading, internal Heart Heat erupting. Use Wang Shi's Xingxing San, or Shengma Gegen Tang, or Muxiang Renshen Su Yin.
If sores want to emerge but haven't, and vomiting/diarrhea occur: Cold stagnation in Middle Jiao or retained food. Use Sijunzi Tang plus Sha Ren (Amomi Fructus), Chen Pi (Citri Reticulatae Pericarpium), or Hezhong San. If retained food, use Zishuang Wan.
Xingxing San (Wang Shi)
Baizhu (Stir-fried) Jiegeng (Remove radicle) Xixin Renshen Fuling Gancao Gualougen (Trichosanthis Radix) (Each 3 fen)
Finely cut. One dose. Add 3 mint leaves. 1 cup water, decoct to 0.7 cup. Administer frequently.
Shengma Gegen Tang
Shengma Gegen Shaoyao Gancao (Honey-fried, Each 1 qian)
Finely cut. One dose. 1 cup water, decoct to 0.7 cup. Warm drink anytime.