带下。是脾土亏损。不能摄水也。六君子汤加炮姜以实之。甚者补中益气汤加白芍半夏。久
服自除。如脾土湿热下流者。六君子汤加柴胡黄芩丹皮白芍。如恼怒伤肝者。加味逍遥散加人参
。亏损者。起于劳力。面色痿黄。不思饮食。脉必大而无力。且迟。腰酸。湿热者。起于饮食不
节。或多嗜酒。带色必兼黄浊而浓。脉必大而有力。兼见腰酸。恼怒者。以前诸症俱无。但见面
色常带红。胸中觉闷热。脉必弦数而有力。
淋症。妇女俱属肝经湿火。或小肠移热。一味逍遥散加味。（如属小肠移热者。合导赤散尤捷
。）若见发热。便属阴虚。疏肝益
肾汤。（胎产淋带诸症。须看薛长洲订妇人良方。近见邯郸遗稿中亦有精论。宜参之。）
发热时。先看有痘情。然后用药。何谓痘情。必先见耳冷。尻冷脚冷。眼如含水。懒于言笑，
是也。斯时投以加味葛根汤。服至见点。
升麻 葛根 前胡 桔梗 山楂 青皮 木通
荆芥 抚芎 灯心 甘草
三日后。用红花汤。
红花 蝉蜕 前胡 桔梗 山楂 木通 荆芥
抚芎 升麻 灯心 甘草
如服加味葛根汤后而不见点。是毒盛也。其症必重。若热甚。气闷。谵语。腰无力。冬月即
于葛根汤加麻黄一钱。夏月加石膏一钱。甚者加至二钱。如冬月热甚。过四五日。重症已见。而
舌灰白色者。亦须以石膏合麻黄用之。夏月苏叶薄荷。俱可进退用之。如见点如糠粞齐布。热甚
口臭。此脾经痘也。死不治矣。
如见点三日痘已齐。而热不退。此是毒盛。危候见矣。须以凉药凉血。红花汤去升麻抚芎山楂。加
生地丹皮与之。然此是干红候。百不一活。五六日已过。痘脚已齐。浆势欲行矣。服桔梗汤。
桔梗 前胡 红花 荆芥 蝉蜕 僵蚕 大力 灯心 通草
又三日。发热起顶。浓浆至矣。当和其毒。
丹皮 丹参 花粉 连翘 荆芥 木通 僵蚕
其有变白色而发痒者。气血亏也。五味异功散加白芍。以救其元气。虚甚者。加人参白术五六
钱。大剂用之。自然有救。或泥于庸医发未尽而禁补。或反咎发表欠透。以致今日内陷者。此杀
人之论。不可信也。信手大补。下一二剂。必然窠下浆来。生气勃然矣。即有 掐破者。亦自循
皮烂臭而回生。有一种变黑者。乃毒盛变黑归肾。火盛水反制之。从其化也。非真有毒能归肾经
也。要在放点时。必然部位不妙。或根窠脚地。有不如式。医者须先决。到某日。变黑归肾而死。
又有一种灰白色者。亦毒盛也。然不痒。须以当归黄连汤与之。
当归 黄连 生地 银花 花粉 大力 荆芥 僵蚕 丹皮 灯草
自行起发至顶已起矣。至第六日。当有回意。用保元汤。
人参 黄 甘草
至七八日。竟用加味异功散。加白术。
人参 黄 白芍 茯苓 陈皮 甘草 煨姜
大枣
如浆有不起。顶不充满而发痒。窠壳脱落如梅花片。下发泻者。虚甚也。五味异功散加黄
木香。甚者。附子肉桂吴茱萸俱当用。
见点至回。十二日矣。斯时惟恐摧折之余。虚寒必甚。医者须谨慎将养之。切莫以为结痂在
迩。不足虑也。一味加味异功散。直服至脱痂而色红。方以饮食补之。
初起时。发热一二日。便抽搐惊叫。不省人事。眼直。或闪烁无定。或舞唇弄舌鱼口角弓等
症。此是心经痘也。不必慌忙。但用加味葛根汤。当此之时。痘已隐隐在皮肤间矣。细看自然吉顺
。凡心经痘决稀。自起至收。只要顺序调理。决无变症。
肺经痘。见点热久。或少见咳嗽。点数不多。不过百余粒。吉多凶少。竟可不药。不过发热时。
用几剂表药而已。
肝经痘。吉凶相半。然要论岁气。有岁气合者。其痘必吉居八九。凶者或有一二。吉者。发
热见点起浆结痂。按日而来。其有传变者。皆属肝经。古云肝经多变是也。肝经痘。不大不小。
颗数调匀。
脾经痘。最恶。发热时。必如火烙。放点时。必如芝麻。五六日。定胃烂口臭。五六日内。
芝麻点内忽然发 。九日必死矣。
肾经痘。发热时。昏沉壮热。四五日。尚不见点。忽然于腰下发 。十二日必死矣。
初放点。必要在两颊间鼻上。然后看太阳部位俱有。便是吉痘。歌曰。绕唇带颊方为吉。额
角眉心总是凶。有面部未见。而额下一片簇簇而来。凶痘也。不治。有面部不见。而胸脯簇簇一片
。及背上簇簇一HT 先见。俱不祥。
面部一见。四肢必朗朗而来。总之。顺不嫌多。逆怕一点。即弥月小儿紧密亦何妨。但要调
护得法而已。树小花多。此俗论也。
如儿小甚。不能服药。不可强与。乳母服药以过其气可也。此论道理如是。若论小儿初生。
不过一点精血
凝聚耳。初无饮食之毒。寒暑风露之感。根于天者吉。勿药可也。但得乳母谨慎。切戒油腻爆炙
辛辣酒醋等物。勿犯污秽不洁之气足矣。时取茵陈烧之。悬酒喷胡荽于床间。以发其气。儿自安
稳也。如以数日内之婴儿。亦如童子按方投药。痘虽吉而凶矣。何也。以其脏腑脆薄。未得水谷之
气也。如根于天者凶。即药亦何效哉。
痘初发时。要他泻。泻一通。则痘起发几分。何也。毒传腑也。是里传表也。点一有。即禁
泻。如不止而痘色渐白。面色晃晃而白。急以六君子汤。加煨姜救之。不可泥于毒未尽。而犹多
畏忌也。如果毒盛而泻。则婴儿必捏 不安。口渴唇红。面色壅盛。气粗。如点不齐。不可用寒
凉。只发表足矣。如齐而犹泻。虽黄连亦所必用即于葛根汤加黄连七分可也。
肚痛一症。最恶候也。未见点而痛。葛根汤加麻黄亦可。有痛而身弯不能立者。肾败矣。不
治。见点肚痛。亦须发之。痘色不变者可治。起顶发浆时而痛。是虚。五味异功散加白芍。
寒战切牙。初起者。毒盛也。然切牙者多。而寒战者少。起浆之后。寒战切牙者。悉属虚。
黄白术散。甚者。加煨姜桂附。
Leukorrhea. This is caused by the deficiency of Spleen Earth, which fails to control water dampness. Liu Jun Zi Tang (Six Gentlemen Decoction) with Pao Jiang (Roasted Ginger) can be used to tonify it. In severe cases, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Bai Shao (White Peony Root) and Ban Xia (Pinellia Tuber) should be used. Long-term administration will naturally eliminate the condition. If it is due to Damp-Heat flowing downward from Spleen Earth, Liu Jun Zi Tang (Six Gentlemen Decoction) with Chai Hu (Bupleurum Root), Huang Qin (Scutellaria Root), Dan Pi (Moutan Cortex), and Bai Shao (White Peony Root) should be used. If it is caused by anger injuring the Liver, Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) with Ren Shen (Ginseng Root) should be used. Deficiency arising from overwork presents with sallow complexion, loss of appetite, a pulse that is large but forceless and slow, accompanied by soreness and weakness of the lower back. Damp-Heat arises from irregular diet or excessive alcohol consumption; the leukorrhea color is necessarily yellow, turbid, and thick, with a pulse that is large and forceful, also accompanied by soreness and weakness of the lower back. Anger-injury presents without the aforementioned symptoms, only showing a reddish complexion, a sensation of stifling heat in the chest, and a pulse that is wiry, rapid, and forceful.
Dysuria. In women, this belongs to Damp-Fire in the Liver Meridian or Heat transferring from the Small Intestine. Yi Wei Xiao Yao San (One-Gentleman Modified Free and Easy Wanderer Powder) with modifications is used. (If it belongs to Heat transferring from the Small Intestine, combining it with Dao Chi San (Guide Out Redness Powder) yields particularly swift results.) If fever is observed, it indicates Yin Deficiency, treated with Shu Gan Yi Shen Tang (Soothe the Liver and Tonify the Kidney Decoction). (For dysuria and leukorrhea occurring during pregnancy and postpartum, one must refer to Xue Li Zhai's compiled *Fu Ren Liang Fang* (Good Advice for Women). Recently, refined discussions have also appeared in *Han Dan Yi Gao*, which should be consulted.)
When fever occurs, first observe for signs of smallpox before administering medication. What are the signs of smallpox? They are manifested by cold ears, cold sacrum, and cold feet; eyes appearing as if holding water; and reluctance to speak or smile. At this time, administer Jia Wei Ge Gen Tang (Modified Kudzu Root Decoction). Continue administration until spots appear.
Sheng Ma (Cimicifugae Rhizoma), Ge Gen (Puerariae Lobatae Radix), Qian Hu (Peucedani Radix), Jie Geng (Platycodonis Radix), Shan Zha (Crataegi Fructus), Qing Pi (Citri Reticulatae Pericarpium Viride), Mu Tong (Akebiae Caulis),
Jing Jie (Schizonepetae Herba), Fu Xiong (Ligusticum Chuanxiong Rhizoma), Deng Xin Cao (Junci Medulla), Gan Cao (Glycyrrhizae Radix et Rhizoma).
After three days, use Hong Hua Tang (Carthamus Decoction).
Hong Hua (Carthami Flos), Chan Tui (Cicadae Periostracum), Qian Hu (Peucedani Radix), Jie Geng (Platycodonis Radix), Shan Zha (Crataegi Fructus), Mu Tong (Akebiae Caulis), Jing Jie (Schizonepetae Herba),
Fu Xiong (Ligusticum Chuanxiong Rhizoma), Sheng Ma (Cimicifugae Rhizoma), Deng Xin Cao (Junci Medulla), Gan Cao (Glycyrrhizae Radix et Rhizoma).
If no spots appear after taking Jia Wei Ge Gen Tang (Modified Kudzu Root Decoction), it indicates vigorous Toxin. The symptoms will necessarily be severe. If heat is intense, with chest oppression, delirium, and weak lower back, add Ma Huang (Ephedrae Herba) 1 qian in winter. Add Shi Gao (Gypsum Fibrosum) 1 qian in summer. In severe cases, increase to 2 qian. If heat is intense in winter, and after four or five days severe symptoms appear with a grayish-white tongue coating, Shi Gao (Gypsum Fibrosum) and Ma Huang (Ephedrae Herba) must be combined. In summer, Su Ye (Perillae Folium) and Bo He (Menthae Haplocalycis Herba) can be adjusted as needed. If spots appear scattered like bran all over the body, with intense heat and foul breath, this is Spleen Meridian smallpox. It is a death case, untreatable.
If spots appear and become uniform within three days, yet fever persists, this indicates vigorous Toxin, signaling a critical condition. Cooling blood with cooling herbs is required. Remove Sheng Ma (Cimicifugae Rhizoma), Fu Xiong (Ligusticum Chuanxiong Rhizoma), and Shan Zha (Crataegi Fructus) from Hong Hua Tang (Carthamus Decoction), and add Di Gu Pi (Lycii Cortex) and Dan Pi (Moutan Cortex). However, this is the "Dry Red" pattern, where fewer than one in a hundred survive. After five or six days, when the base of the pustules is complete and pus formation is about to begin, administer Jie Geng Tang (Platycodon Decoction).
Jie Geng (Platycodonis Radix), Qian Hu (Peucedani Radix), Hong Hua (Carthami Flos), Jing Jie (Schizonepetae Herba), Chan Tui (Cicadae Periostracum), Jiang Can (Bombyx Batryticatus), Da Li (Niu Da Li, *Forsythiae Suspensae Fructus* or similar local herb contextually used here, often interpreted as Niu Bang Zi or similar in some texts, but literally 'Big Strength'), Deng Xin Cao (Junci Medella), Tong Cao (Tetrapanacis Medulla).
Three days later, with fever rising to the apex and thick pus arriving, the toxin should be harmonized.
Dan Pi (Moutan Cortex), Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma), Hua Fen (Trichosanthis Radix), Lian Qiao (Forsythiae Fructus), Jing Jie (Schizonepetae Herba), Mu Tong (Akebiae Caulis), Jiang Can (Bombyx Batryticatus).
If the lesions turn white and itch, it indicates Qi and Blood deficiency. Wu Wei Yi Gong San (Five-Agent Extraordinary Efficacy Powder) with Bai Shao (White Peony Root) is used to rescue Yuan Qi. In severe deficiency, add Ren Shen (Ginseng Root) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) 5-6 qian, administered in large doses. Natural recovery will follow. Do not adhere to quacks who forbid tonification fearing incomplete eruption, nor blame insufficient releasing of the exterior causing internal collapse today; such are killing arguments and should not be believed. Blindly using strong tonics, taking one or two doses, will surely generate pus under the scabs, reviving vital energy. Even if scratched open, they will heal along the skin with rotting odor. One type turns black, indicating vigorous Toxin turning black and returning to the Kidney, where Fire excess suppresses Water, following transformation. It is not truly that Toxin returns to the Kidney Meridian. The key lies in the placement: if the location is unfavorable, or the base is irregular, the physician must predict beforehand that on a certain day, blackening returning to the Kidney will lead to death. Another type is grayish-white, also indicating vigorous Toxin, but without itching. Treat with Dang Gui (Angelicae Sinensis Radix) and Huang Lian (Coptidis Rhizoma) Tang.
Dang Gui (Angelicae Sinensis Radix), Huang Lian (Coptidis Rhizoma), Sheng Di Huang (Rehmanniae Radix), Yin Hua (Lonicerae Japonicae Flos), Hua Fen (Trichosanthis Radix), Da Li (Niu Da Li), Jing Jie (Schizonepetae Herba), Jiang Can (Bombyx Batryticatus), Dan Pi (Moutan Cortex), Deng Cao (Junci Medulla).
Spontaneous eruption reaches the apex. By the sixth day, there should be signs of recovery. Use Bao Yuan Tang (Preserve Origin Decoction).
Ren Shen (Ginseng Root), Huang Qi (Astragali Membranacei Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma).
By the seventh or eighth day, use Jia Wei Yi Gong San (Modified Extraordinary Efficacy Powder) with Bai Zhu (Atractylodis Macrocephalae Rhizoma).
Ren Shen (Ginseng Root), Huang Qi (Astragali Membranacei Radix), Bai Shao (White Peony Root), Fu Ling (Poria), Chen Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma), Wei Jiang (Roasted Ginger), Da Zao (Ziziphi Jujubae Fructus).
If pus does not form, the apex is not full, itching occurs, scabs fall off like plum blossom petals, and diarrhea ensues, it indicates severe deficiency. Use Wu Wei Yi Gong San (Five-Agent Extraordinary Efficacy Powder) with Huang Qi (Astragali Membranacei Radix) and Mu Xiang (Aucklandiae Radix). In severe cases, Fu Zi (Aconiti Lateralis Radix Praeparata), Rou Gui (Cinnamomi Cortex), and Wu Zhu Yu (Evodiae Fructus) should all be used.
From spotting to recovery, twelve days have passed. At this time, fear that after devastation, deficiency-cold must be severe. Physicians must care for the patient cautiously. Do not think that because scabbing is near, there is nothing to worry about. Continuously administer Jia Wei Yi Gong San (Modified Extraordinary Efficacy Powder) until scabs fall off and the skin turns red, then supplement with diet.
At the beginning, with fever for one or two days, convulsions, screaming, unconsciousness, staring eyes, flickering gaze, tongue protrusion, fish-mouth, or opisthotonos occur. This is Heart Meridian smallpox. Do not panic; simply use Jia Wei Ge Gen Tang (Modified Kudzu Root Decoction). At this time, spots are already faintly visible in the skin. Careful observation shows auspiciousness. Heart Meridian smallpox is invariably sparse. From eruption to resolution, as long as order is maintained, complications will not occur.
Lung Meridian smallpox: prolonged fever after spotting, occasional cough, few spots, not exceeding a hundred. Auspiciousness outweighs peril. Medication may not even be necessary. Only a few doses of exterior-releasing herbs are needed during fever.
Liver Meridian smallpox: auspiciousness and peril are equal. However, consider the annual Qi. If compatible with the year's Qi, eight or nine out of ten cases are auspicious; one or two may be perilous. Auspicious cases progress daily through fever, spotting, pus formation, and scabbing. Variations belong to the Liver Meridian. As the ancients said, the Liver Meridian involves much change. Liver Meridian smallpox is neither large nor small, with uniform number.
Spleen Meridian smallpox: most malignant. During fever, heat feels like burning iron. At spotting, lesions resemble sesame seeds. By five or six days, stomach rot and foul breath are certain. Within five to six days, if blisters suddenly erupt within the sesame-like spots, death occurs on the ninth day.
Kidney Meridian smallpox: during fever, heavy lethargy and high fever. By four or five days, still no spots. If blisters suddenly erupt below the waist, death occurs on the twelfth day.
Initial spotting must appear between the cheeks and above the nose. Then check if Tai Yang areas are involved; if so, it is an auspicious smallpox. The song says: Around lips and cheeks is auspicious; forehead corners and glabella are always inauspicious. If facial spots are absent but clusters appear below the forehead, it is inauspicious and untreatable. If facial spots are absent but clusters appear on the chest and back first, it is also inauspicious.
Once facial spots appear, limbs will clearly follow. In general, smooth progression tolerates many spots; adverse progression fears even one spot. Even dense spots in a month-old infant are acceptable if managed correctly. "Small tree, many flowers" is a vulgar theory.
If the infant is too small to take medicine, do not force it. The nursing mother taking medicine to transmit its qi via milk is permissible. This is the principle. Newborns consist merely of condensed essence and blood, free from dietary toxins or wind-cold-dampness influences. Those rooted in Heaven are auspicious and require no medicine. Ensure the nursing mother is cautious, avoiding greasy, fried, spicy, alcoholic, and vinegar foods, and avoiding filth. Burning Artemisia capillaris (Yin Chen) occasionally and spraying wine with Coriander (Hu Sui) around the bed to disperse qi ensures infant stability. Treating a few-day-old infant with formulas intended for older children renders even auspicious smallpox perilous. Why? Because their organs are fragile and lack Qi from food and drink. If rooted in Heaven is perilous, medicine is ineffective.
During initial eruption, inducing diarrhea helps the spots erupt slightly. Why? Toxin transmits to the Fu organs, moving from interior to exterior. Once spots appear, stop diarrhea. If diarrhea continues and spots turn pale, face becomes bright white, urgently use Liu Jun Zi Tang (Six Gentlemen Decoction) with Wei Jiang (Roasted Ginger) to rescue. Do not adhere to the idea that toxin is not exhausted and remain overly cautious. If toxin is indeed vigorous with diarrhea, the infant will clench fists, feel restless, have dry mouth, red lips, flushed face, and rough breathing. If spots are uneven, avoid cold-cooling herbs; releasing the exterior is sufficient. If spots are even and diarrhea persists, even Huang Lian (Coptidis Rhizoma) is necessary; add 7 fen of Huang Lian (Coptidis Rhizoma) to Ge Gen Tang (Kudzu Root Decoction).
Abdominal pain is a most malignant sign. Pain before spotting can be treated with Ge Gen Tang (Kudzu Root Decoction) plus Ma Huang (Ephedrae Herba). Pain with inability to stand due to bending indicates Kidney failure, untreatable. Abdominal pain after spotting requires releasing the exterior. If spot color remains unchanged, it is treatable. Pain during apex rising and pus formation indicates deficiency; use Wu Wei Yi Gong San (Five-Agent Extraordinary Efficacy Powder) with Bai Shao (White Peony Root).
Chills and teeth-grinding at onset indicate vigorous Toxin. Teeth-grinding is common; chills are rare. After pus formation, chills and teeth-grinding all indicate deficiency. Use Huang Bai Zhu San (Yellow Atractylodes Powder). In severe cases, add Wei Jiang (Roasted Ginger), Gui (Cinnamon Twig/Cortex), and Fu Zi (Prepared Aconite Root).