其子在腹中，十月之间随母呼吸。呼吸者阳气也，而生动作，滋益精气神，饥渴皆随母血，儿随日长，筋骨皮
肉血脉形气俱足，十月降生，口中尚有恶血，啼声一发，随吸而下，此恶血复归命门胞中，僻于一隅，隐伏而
不发，直至儿因内伤乳食，湿热之气下陷，合于肾中，二火交攻，荣气不从，逆于肉理，恶血乃发。诸 疹皆
出于肾水，其疡后聚肉理，归于阳明，故三番 始显之症，皆足太阳壬膀胱克丙小肠，其始出皆见于面，终
归于阳明肉理，热化为脓者也。二火炽盛，反胜寒水，遍身俱出，此皆从足太阳传变中来也。
〔钱〕始发潮热，三日以上，热晕入皮肤，即发疮疹，而不甚多者，热留皮腠之间，潮热随脏出，如早食
潮热不已，为水泡之类也。（巳午潮热为 ，申酉潮热为脓 ，辰戌丑未潮热为疹也。）
〔王〕验 法∶若三日未觉形迹，当以生酒涂身上，时时看之，状如蚤痕者是也。或曰∶伤寒伤食潮热，
与疹不能辨者，宜以辛凉之剂调之，五日已里发出即汗，五日已外无者，非 也，各随应见而治之。
〔阎〕治小儿壮热昏睡，伤风，风热疮疹，伤食皆相似，未能辨认间，服升麻葛根汤、惺惺散、小柴胡汤
甚验，盖此数药通治之不致误也。惟伤食则大便酸臭，不消化，畏食或吐，宜以药下之。（海藏云∶宜以药下
之者，当察其所伤何物，生硬寒热不等，不可遽以巴豆之类大毒之药下之。升麻葛根汤，太阴阳明也。惺惺散，
治风热咽不利，脾不和，少阳渴，小便不利也。小柴胡汤，治往来寒热，胸胁微痛，少阳也。然欲知其经，
当以脉别之。）
小儿耳冷尻冷，手足乍暖乍凉，面赤，时嗽时嚏，惊悸，此疮疹欲发候也。未能辨认间，服升麻汤、消毒
散，已发未发皆宜服。仍用胡荽酒、黄柏膏。暑月烦躁，食后与白虎汤、玉露散。热盛，与紫雪。咽喉或生疮，
与甘桔汤、甘露散，余根据前说。大人小儿同治法，惟大小不同耳。（海藏云∶消毒散，太阳药也。
白虎汤，治身热目疼鼻干不得卧，阳明药也。甘露散，肺肾药也。甘桔汤，少阳药也。紫雪，天冬、麦冬、黄芩、生
地为血剂。玉露散，肺肾药也。石膏、寒水石为气剂，以上五方，皆泻时暑之药。）
升麻葛根汤 治伤寒瘟疫，风热壮热头痛，疮疹已、未发，并宜服之。
升麻 葛根 芍药 甘草（炙。各等分）
上同为细末，每服四钱，水一盏半，煎至一盏，无时温服。（海藏云∶升麻葛根汤，太阳阳明之药。
陈文中云∶身热腹痛者，身热泄泻者，身热惊悸者，身热汗出者，身热足冷者，俱不宜服升麻葛根汤。
张巽之云∶凡痘见 点，忌葛根汤，恐发得表虚也。）
惺惺散 治小儿风热疮疹，伤寒时气，头痛壮热，目涩多睡，咳唾气壅，鼻塞清涕。
白术 桔梗 细辛 栝蒌根 人参 茯苓 甘草（各等分）
上 咀，每服二钱，水一盏，生姜三片，入薄荷三叶，煎至半盏，时时与服。《活人》云∶加防风、
川芎，亦各随经也。（海藏云∶惺惺散，治风热咽不利，脾不和，少阳渴小便不利也。）
上二方发表平剂。
王朝奉四物解肌汤
芍药 黄芩 升麻 葛根
每服四钱，水一盏．煎至七分，去渣服。或云∶小儿伤寒疫疠，潮热疮疹，五日已衰，疑似不能辨别者，
并皆辛凉之剂调之，即以四物汤解肌之类。（海藏云∶此论即有表也。若内伤，腹中有物，未得大便而发
热者，当以食药去其物则可。若得便后仍发热在表者，亦宜此解肌汤，比钱氏升麻葛根汤减甘草加黄芩，
以有表热之意也。）
〔田〕防风苍术汤 治小儿邪热在表，恶风恶寒，疮疹未出，可解表发 疹。
防风（半两） 苍术 石膏（各一两） 甘草（炙，半两） 川芎 黄芩（各二两）
上为粗末，每服二钱，生姜三片，薄荷七叶，水煎，日二服。（此方恶寒者宜用之。）
上二方辛凉之剂，表有热者宜之。
大便酸臭不消化，畏食或吐，乃内伤饮食，宜枳术丸。伤冷食饮，神应丸。
〔丹〕一男子年十六岁，发热而昏，目无视，耳无闻，两手脉皆豁大而略数，知其为劳伤矣。时里中多发
痘者，虽不知人，与药则饮，与粥则食，遂教以参、 、当归、苍术、陈皮，大料浓与之，饮至二十
余帖，痘始出。又二十帖，则成脓 ，身无全肤。或曰∶病劳可畏，何不用陈氏全方治之？予曰∶此但
虚耳，无寒也，只前方守之。又数十帖而安。后询其病因，为先四五日恐有出痘之患，遂极力采樵，
连日出汗甚多。
〔钱〕五脏各有一证∶肝脏水 ，肺脏脓 ，心脏 ，脾脏疹，归肾变黑。
〔海〕肝脏水 ，色或青；肺脏脓 ，色或白；脾脏疹，或如麸糠色；心脏 ，其色赤；变归肾则色黑矣。
此五色，凡痘疹一色者善，或二色三色相合而作者凶。第一大小不等。
小儿在胎十月，食五脏秽血，生下则其毒当出，故疮疹之状，皆五脏之液。肝主泪，肺主涕，心主血，脾
为裹血。其疮出有五名，肝为水 ，其液出如水，其色青而小；肺为脓 ，以涕稠浊如脓，其色白而大；心为
主血，其色赤而小，次于水 ；脾为疹，其色赤黄而小。涕泪出多，故脓 水 皆大。血荣于内，所出不多，
故疹皆小。又病水 脓 者，涕泪俱少，以液从疮出故也。譬如泡中容水，水去则泡瘦矣。
上水 者，俗谓之水痘也。脓 者，俗谓之痘子也。 者，俗谓之 子也。疹者，俗谓之麻子也。痘之
形状最大，水痘次之， 又次之，麻子最小，隐隐如麻子也。
更看时月重轻。大抵疮疹属阳，出则为顺，故春夏病为顺，秋冬病为逆。冬月肾旺又盛寒，病多归肾变黑。
又当辨春脓 ，夏黑陷，秋 子，冬疹子，亦不顺也。
凡疮疹只出一般者善。先发脓 ，后发疹子者顺。先发水 ，后发疹子者逆。先发脓 ，后水 多者顺，
少者逆。先发水 ，后发 子，多者逆，少者顺。先发疹子，后发 子者顺。先发脓 ，后发 子者逆。（海藏云∶
此一句足以知杂出者诸脏相合而不齐也，用药亦难矣。前断云五色各随五脏，亦有二色相合，或有三色，即无
定也。此与前后脓水 疹大小不同，先后逆顺大意相若。）
凡疮疹若出辨视轻重∶若一发便出尽者，必重也；痘夹疹者，半轻半重也；出稀者轻；里外肥红者轻；外
黑里白者微重也；外白里黑者，大重也；疮端里黑如针孔者，热剧也；青干黑陷，昏睡，汗出不止，烦
躁热渴，腹胀啼喘，大小便不通者，困也。凡疮疹当乳母慎口，不可令饥，及受风寒，必归肾变黑难治。
（海藏云∶或热极反兼水化者，亦能变黑，当以凉药主之，不可不察，以脉别之可也。或有出色正者，内
素有热，头反陷，色或灰青似黑，中有针眼下陷，当急以青凉药疏之。便结者，大黄、牵牛之类。便
软者，金花丸之类主之。）
〔陈〕轻者作三次出，大小不一等，头面稀少，眼中无根窠红，肥满光泽。重者一齐并出，密如蚕种，
身热腹胀，疮灰白色，稠密无缝，泻渴不止，头温足冷。轻变重，犯房室，不忌口，先曾泻，饮冷水，
饵凉药。重变轻，避风寒，常和暖，大便稠，不燥渴，忌生冷，忌外人。
上饮冷水甘凉药，若内有实热者，不须忌之。
二日三日痘疮始见，微微才出，如粟米大，或如黍米大，或如绿豆大，似水珠光泽明净者佳，不须服药。
四日五日，痘疮大小不等，根窠红活，光泽明净者轻。如稠密陷顶，灰白色，泻渴者重。六日七日，痘疮肥红
光泽者轻。如身温气促，口干腹胀，足指冷者重。八日九日，痘疮长足肥满，苍蜡色者轻。如寒战闷乱，腹胀
烦渴，气急切牙者，至重也。十日十一日，痘疮当靥，疮痂欲落而愈。如身热闷乱，腹胀泄泻，寒战切牙者重。
〔钱〕黄柏膏 如疮疹已出，此药涂面，次用胡荽酒外治法。
黄柏（一两） 绿豆粉（二两） 甘草（四两） 红花（二两）
上同为细末，生油调，从耳前至眼眶并浓涂之，日三两次。如早涂疮不至面，纵有亦少。（彭氏云∶
痘疹护眼，人多用胭脂。据亢医云∶不如钱氏黄柏膏最好，诸家护眼法无出此方也。）
〔萧〕痘疮初出，用鼠粘子为末，水调敷囟门，并无患眼，亦妙。
胡荽酒
胡荽一味，细切，四两，以好酒二盏，煎一二沸，入胡荽再煎少时，用物合定，放温，每吸一大口，
微喷从顶至足匀遍，勿喷头面，病患左右常令有胡荽气，即能辟去污气，疮疹出快。
〔丹〕痘疹初出时，或未出时，见时人有患者，宜预服此药，多者令少，重者令轻。以丝瓜近蒂三寸，连
皮子烧灰存性，为末，砂糖拌匀，干吃。入朱砂末更妙。
〔垣〕消毒救苦汤 治 症悉具，消化便令不出；若已出稀者，再不生 。十一月立此方，随四时加减，惟通造
化，明药性者能之。
麻黄根 羌活 防风（各五分） 柴胡 川芎（各二分） 细辛 本（二分） 升麻（五分） 葛根 黄芩（酒
炒。
各二分） 黄连（三分） 黄柏（酒炒，五分） 红花（少许） 苏木（一分） 归身（三分） 吴茱萸（半分） 白
术（一分）
苍术（二分） 甘草（生） 橘皮（各一分） 连翘（半钱，初出者减，出大者加） 生地（五分）
上 咀，每服五钱，水二大盏，煎至一盏，去渣，稍热服。 疹者因内伤必出 ，乃荣气逆故也，大禁牵
牛、巴豆峻药，宜半夏、枳实、大黄、益智仁之类去泻止吐。若耳尖冷，呵欠睡惊，嚏喷眼涩，知必出 也。宜
升麻 葛根 白芍药 甘草 归身 连翘（各等分）
上 咀，水煎服。此定法也，后随症加减。
如肺出脓 ，先显喘嗽，或气高而喘促，少加人参、黄芩，以泻伏火而补元气。如心出小红 ，必先见嗌
干惊悸，身热，肌肉肿，脉弦洪，少加黄连。如命门出瘾疹，必先骨痛身热，其疼痛不敢动摇，少加生地、
黄柏。诸 疹皆为阴症疮，皆因内伤乳食，脾胃不足，荣气逆行。虽火势内炽，阴覆其外，故钱氏制四物
升麻汤发之。如有传变症，根据加减法服之。
〔世〕如疹痘则发于脾，宜陈氏人参清膈散。（疹者皮肤隐隐如麻，名曰麻子。）水 者多因伤寒热毒而发，
宜升麻散及羌活散。
〔丹〕疮干者宜退火，湿者用泻湿。退火止用轻剂，荆芥、升麻、葛根、连翘之类；泻湿乃肌表间湿，宜
用风药，防风、白芷之类。痘初起时，自汗不妨，盖湿热熏蒸而起故也。
〔世〕痘疮不治症有七∶一戛齿，痘黑陷，喉中涎喘，因先受风冷，血气虚弱，即变此症。二憎寒困倦，
痘子缩伏。三疮作坑，内无脓血，或黑色泡，或疮迹作黑色。四痘痈壅肿，痘毒变疳，口臭，龈烂牙落。五声
哑气噎，或咽药腹中鸣。六痘初出，而半在皮肤带紫黑色不出者。七误于疏转，气哑者。凡出前后心密，及两
手心两足心密者，皆不可治。
〔陈〕论痘不治有五∶痒塌，寒战，切牙，烦躁不止。紫黑色，喘渴不宁。头温，足冷，闷乱欲饮水。目
睛上视，啮齿气促，泄泻不止。灰白色，陷顶，腹胀，喘渴不止。
〔《活》〕小儿疮疹，与伤寒相类。头痛，身热，足冷，脉数。疑似之间，只与升麻汤解肌，兼治疮子，
已发未发皆可服。但不可疏转，此为大戒。伤寒身热，固不可下。疮疹发热在表，犹不可转。世人不学，乃云
初觉以药利之，宣其毒也，误矣。（海藏云∶此论虽当，在经则可，若热甚过极，足冷，或内伤腹热足冷，宜
以寒药如洗心调胃及化食药通膈之类主之。然当求责脏腑秘与不秘，脉道何如耳。许氏云∶上热下冷，伤食也。
疹初热，手足亦冷，惟伤寒一身尽热，不与足冷相类，此伤食非伤冷也。若伤冷，不宜用。王德孚用感应丸
治之。）痘疮已出，不可疏转。出得已定，脓血太盛，却用疏利，亦非也。（海藏云∶此言若在经而出不尽者
为当，若腹胃有垢腻，便时后重如痢疾，及脉滑在里者，亦当微下。）大抵疮疹首尾皆不可下。（海藏云∶脏腑
有凝滞者，不可拘此。）小儿身耳尻冷，咳嗽，辄用利药即害人。（海藏云∶此言里和而少阳之气在经热者，故
用化毒犀角汤为气出里，若气未出，里未尽，求责疏利亦可。）凡治疹痘，才泻则令内陷，决不可轻易转下。
惟大小便多日不利，宜微微利之。及痘已靥，尚有余热停留，或作热，或作疮痍，或成痈，宜四顺饮下之，不特
消余毒，亦免生他症，累试累验。每见疹痘者，服发表麻黄药出汗，阳气尽出肤表，遂至 烂脏虚，虚则腹痛自
利，或作寒战，或作阴痫，死者多矣。
〔陈〕痘疮自初出至已愈之际，父母切忌房事。
〔世〕凡痘疮，勿令亲近狐臭漏腋者，房中淫欲者，及妇人经候，醉酒荤秽，硫黄蚊药，一切腥臊疫污蒸
湿，误烧油发，五辛，泼粪淋尿，熬油煎卵，俱当忌之。
〔海〕疮疹，忌外人及秽触之物，虽不受风冷，亦不可拥遏，常令衣服得中，并温凉处坐卧。
The fetus in the womb, over ten months, grows by following the mother's breathing. Breathing is Yang Qi; its movement nourishes and supplements Essence, Qi, and Spirit. Hunger and thirst follow the maternal blood. As days pass, the child's sinews, bones, skin, flesh, blood vessels, form, and Qi all develop fully. Upon birth after ten months, there is still foul blood in the mouth. With the first cry, upon inhalation, this foul blood is expelled downward. This foul blood returns to the Mingmen (Gate of Life) and Baozhong (Uterus), residing in a corner, hidden and dormant, not manifesting until later. It manifests only when internal injury from milk and food causes damp-heat to sink, combining with the Kidney fire. The two fires attack each other, causing Ying (Nutritive) Qi to fail to flow smoothly, reversing into the muscle tissue, at which point the foul blood erupts. All rashes originate from Kidney Water. Afterward, they gather in the muscle tissue and return to the Yangming channel. Thus, symptoms that appear after three rounds are due to the Foot Taiyang Ren Bladder overcoming Hand Shaoyang Bing Small Intestine. Initially appearing on the face, they ultimately return to the Yangming muscle tissue, where heat transforms into pus. When the two fires are blazing, they overcome Cold Water, causing eruptions all over the body. These all result from transmission via the Foot Taiyang channel.
[Qian Yi] Initial tidal fever lasts more than three days. Heat mist penetrates the skin, immediately causing sores and rashes. If not numerous, it indicates heat remaining between the skin and interstices. Tidal fever follows organ Qi outward. If morning meal-induced tidal fever persists, it forms blister-like lesions. (Tidal fever during Si and Wu hours forms water blisters; Shen and You hours form pus blisters; Chen, Xu, Chou, and Wei hours form rashes.)
[Wang Haogu] Examination method: If no signs appear after three days, apply raw wine to the body and observe frequently. Lesions resembling flea bites are indicative. Some say: Differentiating tidal fever from Shanghan (Cold Damage) or food stagnation from rashes can be difficult. Use acrid-cool formulas to regulate. If eruption and sweating occur within five days, it is confirmed. If none appear after five days, it is not a rash. Treat according to corresponding manifestations.
[Yan Xiaozhong] For pediatric high fever, lethargy, wind-cold, wind-heat sores/rashes, and food stagnation—which present similarly—before differentiation, administering Shengma Gegen Tang (Cinnamon Twig and Kudzu Decoction), Xingxing San (Awakening Powder), or Xiao Chaihu Tang (Minor Bupleurum Decoction) is highly effective, as these formulas treat broadly without error. Only food stagnation presents with sour-smelling, undigested stool, aversion to eating, or vomiting, requiring purgatives. [Haizang notes: Purgation should target the specific ingested substance, varying in nature (raw, hard, cold, hot). Do not hastily use harsh toxins like Radix Crotonis (Badou). Shengma Gegen Tang treats Taiyin and Yangming channels. Xingxing San treats wind-heat throat obstruction, Spleen disharmony, Shaoyang thirst, and dysuria. Xiao Chaihu Tang treats alternating chills and fever, slight chest/hypochondriac pain, belonging to Shaoyang. Determine the channel via pulse diagnosis.]
Pediatric cold ears and buttocks, alternating warm/cool hands and feet, red face, intermittent cough/sneezing, and palpitations indicate impending rash eruption. Before differentiation, administer Shengma Tang (Cimicifuga Decoction) or Xiaodu San (Detoxification Powder), suitable for both pre- and post-eruption stages. Also apply Huisu Jiu (Coriander Wine) and Huangbai Gao (Phellodendron Ointment). For summer irritability, give Baihu Tang (White Tiger Decoction) or Yulu San (Jade Dew Powder) after meals. For intense heat, give Zixue (Purple Snow). For throat sores, give Ganjie Tang (Licorice and Platycodon Decoction) or Ganlu San (Sweet Dew Powder). Adult and pediatric treatments are identical, differing only in dosage. [Haizang notes: Xiaodu San is a Taiyang formula. Baihu Tang treats body heat, eye pain, nasal dryness, and insomnia (Yangming). Ganlu San targets Lung/Kidney. Ganjie Tang targets Shaoyang. Zixue contains Tian Dong, Mai Dong, Huang Qin, and Sheng Di Huang (Blood-level agents). Yulu San targets Lung/Kidney. Shi Gao and Hanshui Shi are Qi-level agents. All five clear seasonal summer heat.]
Shengma Gegen Tang (Cimicifuga and Kudzu Decoction): Treats Shanghan plague, wind-heat high fever/headache, and rashes (pre/post-eruption).
Ingredients: Shengma (Cimicifetae Rhizoma), Gegen (Puerariae Lobatae Radix), Shaoyao (Paeoniae Radix Alba), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) in equal parts.
Grind to fine powder. Take 4 qian per dose with 1.5 cups water, decoct to 1 cup. Warm take anytime. [Haizang: Taiyang/Yangming formula. Chen Wenzhong: Contraindicated for fever with abdominal pain, diarrhea, palpitations, sweating, or cold feet. Zhang Xunzhi: Avoid Gegen Tang when spots appear, fearing exterior deficiency.]
Xingxing San (Awakening Powder): Treats pediatric wind-heat rashes, Shanghan epidemic, headache, high fever, dry eyes, somnolence, cough/phlegm congestion, nasal congestion/clear discharge.
Ingredients: Baizhu (Atractylodis Macrocephalae Rhizoma), Jiegeng (Platycodonis Radix), Xixin (Asari Radix et Rhizoma), Gualougen (Trichosanthis Radix), Renshen (Ginseng Radix), Fuling (Poria), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) in equal parts.
Cut into pieces. Take 2 qian per dose with 1 cup water, 3 slices ginger, 3 mint leaves. Decoct to half cup. Administer frequently. *Liuren* adds Fangfeng and Chuanxiong based on channel. [Haizang: Treats wind-heat throat obstruction, Spleen disharmony, Shaoyang thirst/dysuria.]
These two are mild exterior-releasing formulas.
Wang Chaofeng Siwu Jiexi Tang (Four Substances Muscle-Releasing Decoction):
Shaoyao, Huangqin, Shengma, Gegen.
Take 4 qian per dose with 1 cup water, decoct to 0.7 cup, strain. Some say: For pediatric Shanghan/plague, tidal fever/rashes declining after five days where differentiation is unclear, use acrid-cool formulas like Siwu Tang for muscle release. [Haizang: This addresses exterior patterns. For internal injury with abdominal mass and fever before bowel movement, use food-digesting purgatives. If fever remains in the exterior after bowel movement, this Jiexi Tang is suitable. Compared to Qian’s Shengma Gegen Tang, it removes Gancao and adds Huangqin to address exterior heat.]
[Tian Zongwu] Fangfeng Cangzhu Tang (Saposhnikovia and Atractylodes Decoction): Treats pediatric pathogenic heat in the exterior, aversion to wind/cold, unruptured rashes. Releases exterior and induces rash.
Ingredients: Fangfeng (Saposhnikoviae Radix, 0.5 liang), Cangzhu (Atractylodis Rhizoma, 1 liang), Shigao (Gypsum Fibrosum, 1 liang), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma, 0.5 liang), Chuanxiong (Ligusticum Chuanxiong Rhizoma, 2 liang), Huangqin (Scutellariae Radix, 2 liang).
Coarse powder. Take 2 qian per dose with 3 slices ginger, 7 mint leaves. Decoct in water. Twice daily. (Suitable for aversion to cold.)
These two are acrid-cool formulas for exterior heat.
Sour-smelling, undigested stool, aversion to eating/vomiting indicates internal food injury. Use Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill). For cold food injury, use Shenyin Wan.
[Zhu Danxi] A 16-year-old male presented with fever, coma, blindness, deafness, and large, slightly rapid pulses. Diagnosed as labor injury. During a local plague, though unconscious, he drank medicine and ate porridge when offered. Prescribed Renshen, Huangqi, Danggui, Cangzhu, and Chenpi in large doses. After 20+ doses, rashes erupted. After another 20 doses, pus formed, leaving no intact skin. Asked why not use Chen’s full formula? I replied: This is pure deficiency, no cold. Stick to the formula. After dozens more doses, he recovered. Cause: Fear of rash eruption led to excessive woodcutting and sweating for several days.
[Qian Yi] Each Zang has one syndrome: Liver produces water blisters, Lungs produce pus blisters, Heart produces macules, Spleen produces papules/rashes, Kidney turns black.
[Haizang] Liver water blisters may be green; Lung pus blisters may be white; Spleen rashes may be bran-colored; Heart macules are red; Kidney transformation is black. Uniform color is auspicious; mixed colors (2-3) are ominous. First, assess size inequality.
Fetuses consume Zang filth-blood for ten months. Post-birth, toxins must exit; thus, sore shapes reflect Zang fluids. Liver governs tears, Lungs govern nasal mucus, Heart governs blood, Spleen envelops blood. Five types of eruptions: Liver = water blisters (fluid like water, green, small); Lungs = pus blisters (mucus thick like pus, white, large); Heart = blood macules (red, small, secondary to water blisters); Spleen = rashes (red-yellow, small). Abundant mucus/tears make pus/water blisters large. Blood nourishes internally, excretes little, making rashes small. Conversely, if mucus/tears are scarce, fluid exits via sores, shrinking them (like a bubble losing water).
Water blisters = Shuidou (Water Pox). Pus blisters = Douzi (Smallpox). Macules = Banzi (Spots). Rashes = Mazizi (Measles). Size order: Smallpox > Water Pox > Spots > Measles (smallest, faint).
Assess seasonality. Rashes are Yang; eruption is smooth. Spring/Autumn illness is smooth; Winter/Spring is reverse. Winter Kidney prosperity + cold leads to blackening. Differentiate: Spring pus blisters, Summer black depression, Autumn spots, Winter measles are also unfavorable.
Single-type eruption is good. Order: Pus blisters then rashes (smooth); Water blisters then rashes (reverse); Pus blisters then many water blisters (smooth); Few water blisters (reverse); Water blisters then many spots (reverse); Few spots (smooth); Rashes then spots (smooth); Pus blisters then spots (reverse). [Haizang: Mixed eruptions indicate disordered Zang harmony, complicating treatment. Colors vary by Zang; fixed rules do not apply. Similar to previous logic on size/order.]
Severity assessment: Erupting all at once = severe; Smallpox mixed with rashes = moderate; Sparse = mild; Plump/red inside/out = mild; Black outside/white inside = slightly severe; White outside/black inside = very severe; Black center like needle hole = extreme heat; Green/dry/black/depressed, lethargy, profuse sweat, irritability/thirst, abdominal distension/breathlessness, constipation = critical. Nursing mothers must avoid dietary indiscretion, hunger, and wind/cold to prevent Kidney blackening. [Haizang: Extreme heat mimicking water transformation causes blackening; use cooling herbs, verify via pulse. Normal color but depressed head/grey-green/black with needle-hole depression requires urgent cooling/dispersing. Constipation: Dahuang/Fu Ling. Loose stool: Jinhua Wan.]
[Chen Wenzhong] Mild cases erupt in three waves, unequal sizes, sparse on face, no red roots in eyes, plump/shiny. Severe cases erupt simultaneously, dense as silkworm eggs, fever/abdominal distension, grey-white, seamless, persistent diarrhea/thirst, warm head/cold feet. Mild turning severe: sexual activity, dietary laxity, prior diarrhea, cold water, cooling meds. Severe turning mild: avoiding wind/cold, warmth, formed stool, no thirst, avoiding cold/raw/outsiders.
Drinking cold water/green-cools is permitted if interior excess heat exists.
Days 2-3: Tiny eruptions (millet/mung bean size), shiny/clear = good. No meds needed.
Days 4-5: Unequal size, red/vibrant roots, shiny = mild. Dense/depressed/grey-white/diarrhea/thirst = severe.
Days 6-7: Plump/red/shiny = mild. Warm body/fast breath/dry mouth/abdominal distension/cold toes = severe.
Days 8-9: Full/plump, waxy grey = mild. Chills/confusion/distension/thirst/jaw clenching = critical.
Days 10-11: Crusting/falling = healing. Fever/confusion/diarrhea/chills/jaw clenching = severe.
[Qian Yi] Huangbai Gao (Phellodendron Ointment): Apply to face after eruption, followed by Huisu Jiu external treatment.
Ingredients: Huangbai (Phellodendri Cortex, 1 liang), Lvdou Fen (Vigna Mungo Powder, 2 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 4 liang), Honghua (Carthami Flos, 2 liang).
Fine powder, mix with raw oil. Apply thickly from ear front to eye orbit, 2-3 times daily. Early application prevents facial spread. [Peng: Rouge used for eyes, but Kangyi prefers Huangbai Gao as superior.]
[Xiao]: Mouse burdock root powder applied to fontanelle with water prevents eye complications.
Huisu Jiu (Coriander Wine): 4 liang finely cut Coriandrum Sativum Fructus, decocted in 2 cups good wine. Boil briefly, add coriander, simmer. Cover, cool. Inhale deeply, spray lightly from head to foot (avoid face). Maintain coriander scent around patient to dispel turbidity and accelerate eruption.
[Zhu Danxi]: Prophylactic measure when seeing others with rash. Burn 3 cun of loofah near stem (with skin/pulp) to ash. Mix with brown sugar, take dry. Adding Cinnabar is better.
[Li Dongyuan] Xiaodu Jiuku Tang (Detoxification and Salvation Decoction): Prevents eruption if digestion is complete; stops new eruptions if sparse. Formulated in November, adjusted seasonally. Requires understanding of natural laws and herb properties.
Ingredients: Mahuang Gen (Ephedrae Radix et Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix, 5 fen each); Chaihu (Bupleuri Radix), Chuanxiong (Ligusticum Chuanxiong Rhizoma, 2 fen each); Xixin (Asari Radix et Rhizoma), Ben Cao (Ligustici Rhizoma, 2 fen); Shengma (Cimicifetae Rhizoma, 5 fen); Gegen (Puerariae Lobatae Radix), Huangqin (Scutellariae Radix, wine-fried, 2 fen each); Huanglian (Coptidis Rhizoma, 3 fen); Huangbai (Phellodendri Cortex, wine-fried, 5 fen); Honghua (Carthami Flos,少许); Sumu (Sappan Lignum, 1 fen); Guishen (Angelicae Sinensis Radix, 3 fen); Wuzhuyu (Evodiae Fructus, 0.5 fen); Baizhu (Atractylodis Macrocephalae Rhizoma, 1 fen); Cangzhu (Atractylodis Rhizoma, 2 fen); Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma), Ju Pi (Citri Reticulatae Pericarpium, 1 fen each); Lianqiao (Forsythiae Fructus, 0.5 qian, reduce if early, increase if large); Sheng Di Huang (Rehmanniae Radix, 5 fen).
Cut pieces. Take 5 qian with 2 large cups water, decoct to 1 cup, strain, drink warm. Rash eruption due to internal injury/Ying reversal. Strictly forbid harsh purgatives (Qian Niu, Badou). Use Banxia, Zhishi, Dahuang, Yizhiren to stop vomiting/diarrhea. Signs of eruption: cold ear tips, yawning, startle sleep, sneezing, dry eyes. Formula: Shengma, Gegen, Baishaoyao, Gancao, Guishen, Lianqiao (equal parts). Decoct. Fixed method, adjust by symptoms.
Lung pus blisters: Asthma/cough, high qi/panting. Add Renshen, Huangqin to drain latent fire/nourish Yuan Qi. Heart red macules: Dry throat, palpitations, fever, muscle swelling, string-taut-large pulse. Add Huanglian. Mingmen itch-rash: Bone pain, fever, immobility due to pain. Add Sheng Di Huang, Huangbai. All rashes are Yin-sores due to internal milk/food injury, Spleen/Stomach deficiency, Ying reversal. Fire burns internally, Yin covers externally. Qian’s Siwu Shengma Tang releases them. Follow transmission protocols.
[Transmission] Rash/smallpox originates in Spleen. Use Chen’s Renshen Qingge San. (Rash = faint hemp-like skin marks). Water blisters often due to Shanghan heat-toxin. Use Shengma San and Qianghuo San.
[Zhu Danxi] Dry sores require fire reduction (light agents: Jingjie, Shengma, Gegen, Lianqiao). Wet sores require damp-draining (wind agents: Fangfeng, Baizhu). Initial sweating is acceptable due to damp-heat steaming.
[Transmission] Seven untreatable smallpox syndromes: 1. Jaw clenching, black depressed sores, salivary panting (from wind-cold/Qi-Blood weakness). 2. Aversion to cold, fatigue, shrunk sores. 3. Pitted sores, no pus/blood, black blisters/traces. 4. Abscess/swelling, toxin turning to ulcer, bad breath, gum rot/tooth loss. 5. Hoarseness/choking, abdominal rumbling when swallowing. 6. Partial purple-black non-erupting sores. 7. Mistaken purgation leading to Qi hoarseness. Dense sores on chest/back/palms/soles are untreatable.
[Chen Wenzhong] Five untreatable signs: Itching collapse, chills, jaw clenching, incessant irritability. Purple-black, panting/thirst/restlessness. Warm head/cold feet, confusion/thirst. Eyes rolling up, jaw clenching/fast breath, incessant diarrhea. Grey-white, depressed crown, abdominal distension, panting/thirst.
*[Liuren]* Pediatric rash resembles Shanghan: Headache, fever, cold feet, rapid pulse. In doubt, use Shengma Tang to release muscle/treat rash (pre/post). Never purge. Shanghan fever cannot be purged. Exterior rash fever cannot be turned inward. Laypeople mistakenly believe purging expels toxicity. [Haizang: Valid for channel heat. If extreme heat/cold feet or internal heat/cold feet, use cold herbs (Xi Xin, Tiao Wei, Hua Shi) to open diaphragm. Check Zang fu blockage/pulse. Xu: Upper heat/lower cold = food stagnation. Rash initial heat includes cold limbs; Shanghan is whole-body heat. Food stagnation differs from cold injury. Wang Defu uses Yinggan Wan.] Do not purge after eruption. If pus/blood excessive, purging is wrong. [Haizang: Valid if incomplete channel eruption. If abdominal grease/heaviness/dysentery-like pulse slippery interior, mild purging is okay.] Generally, never purge rash at start or end. [Haizang: Unless Zang fu stagnation exists.] Purging harms children with cold ears/buttocks/cough. [Haizang: Interior harmonious, Shaoyang channel heat. Use Huadu Xijiao Tang. If Qi not out/interior not cleared, mild purging acceptable.] Purging causes internal collapse. Only mildly promote bowels/bladder if blocked for days. After crusting, residual heat may cause fever/sores/abscesses. Use Sishun Yin to purge, clearing toxins/preventing sequelae. Proven effective. Sweating with Ma Huang exhausts Yang Qi to surface, causing organ decay/deficiency, abdominal pain/diarrhea, chills/Yin epilepsy, death.
[Chen Wenzhong] Parents must abstain from sex from eruption to recovery.
[Transmission] Avoid contact with fox odor, armpit leakage, sexually active individuals, menstruating women, drunk/meat-eaters, sulfur/mosquito coils, fishy/foul/epidemic humidity, burnt oil hair, five pungents, feces/urine spills, fried oil/eggs.
[Haizang] Avoid outsiders and filthy contacts. Even without wind-cold, do not restrict airflow. Keep clothing moderate, sit/lie in warm/cool places.