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[Tang] Shengfu San (Raw Aconite Powder): Treats rotting foot sores. Grind raw Fuzi (Aconiti Lateralis Radix Preparata) into powder, mix with flour and water to form a paste, apply externally to the affected area until healed.

[Qian Yi] For Chuangzhen (exanthematous diseases such as smallpox and measles), only mild and neutral medicines should be used for treatment. One must not recklessly use purgatives or force sweating/attacking methods, nor allow exposure to wind and cold. (Zhang Yuansu, also known as Haizang, stated: "Mild and neutral" does not refer to hot-acting agents, but rather herbs like Jingjie (Schizonepetae Herba), Bohe (Menthae Haplocalycis Herba), Fangfeng (Saposhnikoviae Radix), Niubangzi (Arctii Fructus), and Gancao (Glycyrrhizae Radix et Rhizoma). Using Huoren's Shuniuzi Tang (Burdock Fruit Decoction) together with Jiegu's Jiedu Fangfeng Tang (Detoxifying Saposhnikovia Decoction) is an example. Zhu Danxi stated: Niubangzi (Arctii Fructus), Lianqiao (Forsythiae Fructus), Shanzha (Crataegi Fructus), and Gancao (Glycyrrhizae Radix et Rhizoma) are four herbs that must be used throughout the entire course of treating Douchuang (smallpox).)

[Qian Yi] Regarding the diagnosis of the Ten Great Prince of Mumin Palace suffering from Chuangzhen: If the exanthem emerges steadily from beginning to end without other accompanying symptoms, purgation should not be used. Instead, mild medicines should be administered frequently along with breast milk and food, while avoiding exposure to wind and cold. If the exanthem has not emerged after three days, or emerges slowly, it should be mildly dispersed (e.g., using Shuniuzi Tang). If the eruption is sparse after emerging, the dosage should be increased (e.g., from one decoction per day to two). If it still does not emerge despite increasing the dosage, it should be strongly dispersed (using herbs such as Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Duohuo (Angelicae Pubescentis Radix), Mahuang (Ephedrae Herba), and Guizhi (Cinnamomi Ramulus)). If the eruption remains sparse after dispersion, and the pulse is calm with no other symptoms, it indicates the eruption was naturally sparse; do not force further dispersion. If there is severe heat, promote urination (e.g., using Sisheng San). If there is slight heat, clear heat and resolve toxicity. If the eruption does not progress, do not disperse or purge; instead, use Baolong Wan (Dragon-Holding Pill). If the patient can eat after the eruption appears, use Dahuang Wan (Rhubarb Pill) to purge; stop after one or two bowel movements. Severe heat requires promoting urination; slight heat requires clearing heat and resolving toxicity. If the lesions are black, purple, dry, and sunken, use Baixiang Wan (Hundred-Auspicious Pill) to purge. If not black, absolutely avoid purgation. If there is fever, restlessness, abdominal fullness with wheezing, difficulty in urination and defecation, red face with confusion, and severe vomiting, promote urination. If unimproved, use Xuanfeng San (Dispersing Wind Powder) to purge. If scabs do not dry up by the fifth or seventh day, it is because internal heat steams the skin, preventing scab formation. Use Xuanfeng San to guide out the pathogen, and grind fresh Xijiaojiao (Rhino Ceratoss) juice to resolve heat; once heat subsides, scabs will form.

[Zhang Yuansu] Discusses: The manifestations of Zhen (measles/rash) vary. Sores swelling externally belong to the Shaoyang Sanjiao (Triple Burner) Ministerial Fire, called "Chuang" (sores). Small red spots moving within the skin but not emerging belong to the Shaoyang Sovereign Fire, called "Zhen" (rash). Generally, if Chuang or Zhen presents with spontaneous vomiting and diarrhea, do not treat recklessly as prognosis is good; this indicates pathogens exiting from above and below. Generally, neither at the beginning nor the end of Chuang/Zhen should purgation be used, lest it cause complications. This refers to Shaoyang connecting to the exterior, suitable for harmonization. First, stabilize the interior and resolve toxicity, then mildly disperse. Resolving toxicity requires stabilizing the five zang organs; Fangfeng Tang is suitable. If stool is not constipated, mildly disperse, selecting formulas from Qian's prescriptions. If stool is severely constipated, mildly purge, using Danggui Wan (Angelica Pill) or Zaobian Baixiang Wan (Date-Modified Hundred-Auspicious Pill). Initially knowing of rash, if forced to erupt all at once, children cannot tolerate it, leading to other syndromes. The reason for not purging at start or end: Start refers to Upper Jiao, End refers to Lower Jiao; if vomiting/diarrhea have occurred, how can purgation be used? It is better to stabilize the interior. If no vomiting/diarrhea, give interior-stabilizing medicine 3-5 doses. If able to eat and stool is constipated/internal excess, gently purge. If internal deficiency with diarrhea, use interior-stabilizing medicine 1-2 doses, and the final dose should be combined with mild dispersing medicine. In summary, more interior-stabilizing medicine, less exterior-dispersing medicine. If constipated, gently purge to prevent pathogen stagnation and allow batched eruption, making it easier for the child to tolerate. Warm body indicates favorable prognosis; cool body indicates unfavorable. Both cases benefit from frequent Fangfeng Tang for harmonization.

Anli Jiedu Fangfeng Tang (Interior-Stabilizing, Detoxifying, Saposhnikovia Decoction)
Fangfeng (Saposhnikoviae Radix) (1 liang), Diguxpi (Lycii Cortex), Huangqi (Astragali Radix), Shaoyao (Paeoniae Radix), Jingjie (Schizonepetae Herba), Zhike (Aurantii Fructus Immaturus), Niubangzi (Arctii Fructus) (equal parts).
Grind into powder, decoct in water, take 4-5 qian. If able to eat and stool is solid, use Danggui Wan to mildly purge.
Danggui Wan, Zaobian Baixiang Wan (See Douchuang Large Stool Constipation Section for both formulas.)

[Zhang Yuansu] States: Chuang disease arises from immersion in the womb, consuming maternal blood impurities, accumulating into toxicity due to Taiyin damp-earth stagnation and Sovereign/Ministerial fire. Because the child's true qi is strong and righteous qi is vigorous, pathogens have no place to reside. Encountering cold weather, external injury to the exterior, or internal injury to the interior causes Chuang to emerge. How to treat? External injuries treated externally, internal injuries treated internally; if middle and exterior are harmonized, Chuang emerges naturally. For chills, disperse; for severe exterior heat, seize/clear it; for thirst, clear it; for constipation, purge; for urinary obstruction, promote urination; for fright, calm; for diarrhea, separate/drain. Can one stick to one method? Generally, treat similarly to Shanghan (Cold Damage), prescribing according to meridians, which is the highest theory. If within five days, various illnesses cannot be distinguished from rash, do not doubt it as Chuang/Zhen; must disperse. Treat each according to its injury; this does not hinder Chuang emergence. Forced dispersion leads to countless complications. Predecessors said "do not purge at start or end": Start means Chuang not yet visible on surface; purging prevents pathogen expansion. This is pulse/syndrome showing exterior but no interior, hence forbidden to purge at start. End means Chuang toxin already visible externally, no internal root, stool not solid, no interior syndrome; purging causes Chuang qi to reverse and sink, hence forbidden to purge at end. Also, warm covering without ventilation is for when Chuang has not emerged, body surface is cool/chills, or weather is cold. If Chuang has emerged, body is hot, weather warm, why cover and block ventilation? Later generations stuck to these two phrases, fearing purgation and blocking ventilation, ignoring heavenly timing and human vitality, causing many errors. Predecessors' words adapted to times; later generations failed to adapt, sticking rigidly. Alas, "do not purge at start or end" applies because viscera were never stagnant initially. If any interior syndrome or constipation exists, how can one not purge? Warm covering without ventilation applies because it occurs in winter. If in summer, even if Chuang has not emerged, this method is not used. Medication for Chuang primarily relies on pulse: floating, middle, deep; light, moderate, heavy pressure; observe deficiency/excess, determine interior/exterior, then success is assured.
For external injury, Shengma Tang is primary. For internal injury, Zhishi Wan is primary. For loose stools, Zhizhu Wan is primary. For cold injury, warm with Shenyin Wan. (All three in Internal Injury/Diet Section.) For chills, disperse with Fangfeng Cangzhu Tang. For severe exterior heat, clear it (exterior here refers generally to Three Yang meridians; Yang excess causes qi to ascend upward; "clearing/seizing" means treating to prevent upward ascent). Knowing there is no Three Yang exterior syndrome, but Three Yang interior syndrome, stained by有形 (form/substance). Thirst cleared: severe thirst uses Baihu Tang (for summer); slight thirst uses Liangge San (remove Mangxiao and Dahuang, add Gancao and Jiegeng for stability). Constipation purged: Taoren Chengqi Tang, Sishun Yinzi, Chaihu Yinzi selected based on Qi/Blood location; must have internal excess, ability to eat, and constipation; use gentle moistening purgation. Urinary obstruction promoted: Daochi San, Bazheng San selected based on Upper/Lower Jiao meridian involvement. Fright calmed: Liangjing Wan; severe cases purged with Xieqing Wan. Diarrhea separated: cold uses Yigong San, Sijunzi Tang; heat uses Zexie Fuling Tang.
When pediatric Chuangzhen first emerges and cannot be identified, seek the cause: internal, external, or neither. Follow the injury, administer according to method, prevent changes, suppress excessive qi. Compared to other syndromes, urgency is higher. Disperse, purge, release muscle layer, or resolve toxicity. Seek origin, cool blood, clear lung, regulate viscera, balance diet, observe taboos, strict care, adjust warmth/coolness. Manage with method, ensure complete recovery, smooth eruption, firm scabbing. After recovery, prevent wandering toxins, sweating, empty pores, eye diseases (membranes/opacities), boils/tumors, throat closure/swelling, tidal fever/sweating. This is the general principle of treating Chuang.
If convulsions occur before eruption, it is external wind-cold invading and internal heart heat arising. Use Cha Fen (Tea Powder) to deliver Jiedu Wan, or Xijiao Dihuang Tang. If eruption is dense like needle heads and severe, lightly disperse exterior and cool interior with Lianqiao Shengma Tang. If eruption is dense/heavy with slight wheezing/drinking, indicating heat, use wind-dispersing herbs with mild purgation. If eruption is slow, stool/urine normal, knowing it is exterior not interior, mildly disperse with Shengma Gegen Tang. If blue/dry/black/sunken with no high fever and difficult urination/defecation, heat is internal; decoct Dahuang Tang to deliver Xuanfeng San. If body surface very hot, exterior syndrome not resolved, do not purge. If Chuang emerged with slight heat and difficult urination, use Bazheng San to promote urination. If residual toxin remains after eruption with fever/sores, use Cha Fen to deliver Jiedu Wan. If voice remains after Chuang emerges, shape is diseased but qi is not. If voice lost before Chuang emerges, shape is not diseased but qi is. If Chuang emerges but voice is lost, both shape and qi are diseased; clear lung qi, use Bafeng Tang, or Liangge San without Mangxiao/Dahuang.

[Zhu Danxi] Pediatric Douchuang distinguishes Qi/Blood deficiency/excess. Use Sijunzi Tang, Siwu Tang, wine-fried Huangqin (Scutellariae Radix), Lianqiao (Forsythiae Fructus). For Qi deficiency, Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma) plus detoxifying herbs. For Blood deficiency, Siwu Tang plus detoxifying herbs.
Detoxifying herbs added include wine-fried Huangqin and fried Huanglian (Coptidis Rhizoma). Zhang Yuansu states: Detoxifying agents include Sanhuang Tang (Three-Yellow Decoction), Jinhua Wan (Golden Flower Pill).

[Zhu Danxi] Douchuang distinguishes people's clarity/turbidity, courage/timidity based on physique. Black Douchuang belongs to Blood Heat, main treatment is cooling blood. White belongs to Qi Deficiency, main treatment is tonifying Qi. Black center with sunken exterior and late white elevation requires tonifying Qi with slight blood-cooling herbs.

[Chen Wenzhong] Between pre-eruption and post-eruption, if diarrhea/thirst, abdominal distension, or shortness of breath occur, it is called Interior Deficiency; quickly treat with Shi Yi Wei Muxiang San (Eleven-Ingredient Aucklandia Powder). If post-eruption, lesions lack luster, do not elevate, roots are not red, it is Exterior Deficiency; quickly treat with Shi Er Wei Yigong San (Twelve-Ingredient Extraordinary Merit Powder). If post-eruption, lesions lack luster, do not elevate, roots not red, plus diarrhea/thirst/distension/shortness of breath, it is Exterior-Interior Dual Deficiency; quickly treat with Shi Er Wei Yigong San delivering Qiwei Roudoukou Wan (Seven-Ingredient Myristica Pill). (Zhu Danxi notes: Muxiang Yigong San treats cold accurately; if deficient but not cold, disaster follows immediately.) If eruption lasts 1-10 days, whole body high fever, yellow stool, it is Exterior-Interior Dual Excess. Lesions will be lustrous, elevated, full, easy to scab, without damage. If no other illness, do not medicate. Dual excess: easy to erupt and scab. Dual deficiency: easy to erupt, hard to scab. Exterior deficiency: hard to erupt. Interior deficiency: hard to scab. Treat according to syndrome.

[Zhang Xunzhi] Key methods for treating Douchuang: Vomiting/diarrhea, low appetite indicate Interior Deficiency. Sunken/inverted, gray-white lesions indicate Exterior Deficiency. Both present indicate Dual Deficiency; fully use Yigong San to save. Even Jiang (Ginger), Fu (Aconite), Lingsha (Cinnabar) may be used. If only Interior Deficiency, reduce Guigui (Cassiae Cortex). If only Exterior Deficiency, reduce Roudoukou (Myristica Seed), do not reduce Guigui or Dingxiang (Caryophylli Flos). If able to eat, constipated, with sunken/inverted lesions, it is Interior Excess; use Qian's or Danxi's purging methods. If no vomiting/diarrhea, able to eat, it is Interior Excess; tonifying Interior Excess leads to carbuncle/toxin. Red, active, protruding lesions indicate Exterior Excess; using exterior-dispersing herbs for Exterior Excess leads to ulceration without scabbing. Whenever Douchuang shows rash points, avoid Gegen Tang, lest it cause Dual Deficiency.

[Zhu Danxi] Reading predecessors' books, one must understand their intent. Reading without understanding intent makes application impossible. Qian Yi's discussion on Douchuang is most detailed. He traces origins, meridians, clearly distinguishes interior/exterior, deficiency/excess, outlines treatment methods, and proves with dialectical statements, embodying the spirit of writing for teaching. Students reading and applying it are like seeking square/circle with compass/square, measuring straightness with plumb line; extending and expanding, touching categories and growing them, allows infinite application. Modern people do not know causes of disease, do not seek intent of formulas. In haste, they match symptoms to formulas, try randomly. If ineffective, they discard the book. Very thoughtless. Recently, due to long-standing influence of Ju Fang (Formulary of the Imperial Medical Bureau) and neglect of Suwen (Yellow Emperor's Inner Canon) studies, sick patients discussing medicine prefer warm over cold, tonification over resolving/purging. Suddenly obtaining Chen's formula theory, all using dry-hot tonics, concise text, definite claims, they happily use and believe it, thinking Qian is far inferior to Chen. Someone asks: Do you think Chen's formulas are insufficient? I say: Chen's formulas are indeed one-sided. However, he is good at seeking disease conditions; his intent focuses heavily on the Taiyin meridian. Hand Taiyin belongs to Lung, governs skin/hair. Foot Taiyin belongs to Spleen, governs muscles. Lung Metal dislikes cold and is easily invaded; Spleen Earth dislikes dampness and accepts everything. Observing his use of Dingxiang (Caryophylli Flos), Guigui (Cassiae Cortex) to treat Lung Cold; Fuzi (Aconiti Lateralis Radix Preparata), Baizhu (Atractylodis Macrocephalae Rhizoma), Banxia (Pinelliae Tuber) to treat Spleen Damp. If Spleen and Lung truly had cold/damp with deficiency, measure and give; if hitting the disease, what harm? Now, however, seeing delayed eruption, fever, diarrhea, fright, shortness of breath, thirst, regardless of cold/heat, deficiency/excess, they indiscriminately use Muxiang San, Yigong San. Occasionally effective, but if misused, disaster follows. Why? Ancients' formulas had guides, controllers, antagonists, and specific uses. Qian's formulas did not abandon Xixin (Asari Radix), Dingxiang, Baizhu, Renshen, Huangqi (Astragali Radix); they always had controlling/supporting herbs, not solely focusing on warm-tonifying. However, he used more cold/cooling herbs, briefly hinting at tonification, not going deep. Before fools, do not speak dreams; Qian's caution was thorough. He waited for those who could expand and apply it. Although Chen initiated using warm herbs for thirst and tonics for itching/collapse, surpassing predecessors, his frequent use of Guigui, Fuzi, Dingxiang (pungent-aromatic-dry-hot) may not be appropriate. Guigui, Fuzi, Dingxiang are appropriate for cold-deficiency, but for deficiency without cold, what harm? When Chen formulated, he likely had cold-clause bias, perhaps too hot? I synthesized experts' essences, sought intent, applied carefully, dare not rely on fixed formulas. In Jiashen year of Zhengtong, Yang qi moved early. In January, smallpox in the county rarely spared a family. All used Chen's formulas; over a hundred children died. Though due to heaven's mandate, I fear human effort was also lacking.

[Qian Yi] Shanghan (Cold Damage): Men have heavy body/yellow face; women have red face/rapid panting; all fear cold; hot breath in mouth; yawning/stifled sensation; stiff neck. Chuangzhen: Red swollen cheeks/restlessness, sneezing/frightened movement, drowsiness/fatigue, cold limbs. Shanghan should be dispersed; Chuangzhen should be treated with mild-neutral herbs; severe heat requires detoxification. Drowsiness, liking sneezing/fright indicates impending Chuangzhen.

[Li Dongyuan] Differentiating Chuangzhen Syndrome: Yawning, sneezing, acute fright during sleep, cold ear tips, dry eyes.
Differentiating Shanghan: Hot mouth, vinegar-like breath in mouth, undigested milk curds, abdominal pain.

[Qian Yi] Chuangzhen Signs: Dry face/red cheeks, red eyelids, yawning/stifled sensation, alternating cold/heat, coughing/sneezing, slightly cold feet, night-time fright/drowsiness. This is Chuangzhen syndrome, a pestilential disease.
Ten Grand Marshal of Mumin Palace had Chuangzhen, treated by many doctors. The Prince asked: Which organ does pre-eruption rash belong to? One doctor said Stomach Heat; another said unresolved Shanghan; another said toxin from mother's womb. Qian Yi said: If Stomach Heat, why alternating cold/heat? If womb toxin, which organ? Doctor said: Spleen/Stomach. Qian Yi said: Why fright in Spleen/Stomach? None could answer. Qian Yi said: Fetus in womb, by month 6-7 formed, consumes maternal impure fluids entering five zang. By month 10, stomach full of impurity. At birth, mouth still unclean; mother wipes clean, no disease. Folk uses Huanglian (Coptidis Rhizoma), Gongfen (Calomel) to purge umbilical feces; this is also maternal impure qi entering child's viscera. Originally caused by slight cold invasion, clashing with wind-cold pathogen, forming Douchuang. Before eruption, heat moves five zang, so zang symptoms appear first. Initial sickness: yawning/stifled/fright, alternating cold/heat, cold hands/feet, red/dry cheeks, cough/sneeze. These are five zang symptoms. Yawning/stifled: Liver. Fright: Heart. Alternating cold/heat/cold limbs: Spleen. Red cheeks/cough/sneeze: Lung. Only Kidney has no sign, as it is lower, does not consume impurity. All Chuangzhen are five zang toxins. If merging into one symptom: Liver becomes water blisters, Lung becomes pus blisters, Heart becomes macules, Spleen becomes rash. Kidney has no symptom, but if bad signs appear, lesion inverts and turns black/sunken, returning to Kidney. This is due to careless wind-cold and inability to eat/internal deficiency. Now the Marshal's rash has no other symptoms; treat with mild medicine, used Baolong Wan several doses, cured. (Zhang Yuansu notes: Do not mistake "originally slight cold" and "careless wind-cold/internal deficiency" as cold syndrome; using Baolong Wan shows Chuangzhen is mostly heat.)
At initial eruption, five zang symptoms appear, only Kidney has no sign, only flat symptoms seen: cool buttocks and ears. Buttocks and ears belong to Kidney, located North governing cold.

[Li Dongyuan] Chuangzhen initial symptoms: dry face/red cheeks, red eyelids, yawning/stifled, alternating heat/cold, cough/sneeze, cold feet, drowsiness, sleep fright; plus Chuangzhen symptoms: pus blisters/large blisters, small red spots, or nettle rash. These three differ, why show upper symptoms before eruption? Because Taiyang Cold Water rises from below right kidney, boiling left kidney; Foot Taiyang Bladder Cold Water flows counter-current along spine, up head/forehead, counteracts Hand Taiyang Bing Fire, cannot transmit, reverses on face, thus showing these symptoms. Ren/Gui Cold Water controls Bing/Ding Hot Fire. All Chuangzhen symptoms emerge from counter-flowing Cold Water. Doctors must know this to prescribe. Bao (Uterus/Womb) is also named Chigong, Dantian, Mingmen. Men store essence/spread transformation; women carry pregnancy in Bao. All are source of generation/transformation, not Five Elements, not Water or Fire, but different names of Heaven/Earth, resembling Kun Earth generating all things. At human conception, blood sea cleanses day 1-2; essence wins blood -> male. Day 3-5, blood vessels vigorous, essence loses to blood -> female. Two substances clash, growing prior to body is called Shen (Spirit), also Jing (Essence), Daoism/Buddhism call it Original Face.