发热神昏闷乱成，妄言喘满腹腰疼，不食不眠搐不止，干呕失血证逆凶。
[注]
发热神昏，闷乱妄言，毒伏于心也，
喘满喘急，毒伏于肺也，
腹疼毒伏于脾也，
腰疼毒伏于肾也，
不食不眠，毒伏于胃也，
惊搐不止，毒伏于肝也，
不时干呕失血，吐血尿血，是毒攻气血内乱也，
此皆为不治之逆证，势多凶也。
%
痘出发热固自内，必因其诱使之然，时气风寒惊食热，表裹虚实随证参，
表热恶寒而无汗，裹热有汗溲便难，气弱热微不足治，形实热盛有余看。
[注]
痘出发热者，谓痘本火毒，故未出先发热也，
自内，谓其热，自内达外也，
必因其诱使之然者，谓必因其四时不正，风寒邪气使之发热也，
惊，谓外触异物，
跌扑惊吓使之发热也，
食，谓内伤食滞使之发热也，
热，谓内热积久因而热发于外也，
内外既有所困之邪，又当以表里虚实，随证参详施治也，
表热者，谓发热在表，则恶寒而无汗也，
里热者，谓发热在里，则有汗小便短涩大使燥虽也，
气弱热微者，谓形气不足发热微轻也，
形实热盛者，谓形气有余，发热太甚也，
医者果能临时详察，因证施治，则汗下清补之法自得其宜矣。
%
发热升麻葛根汤，表邪痘疹两得力，升麻葛根赤芍草，证随宜加法最良，
无汗表实加麻薄，便柲腹痛裹大黄，形怯气弱参耆入，热盛犀连荆蒡防，
尿涩通滑车前子，惊搐荆防钩连羊，烦渴石膏麦冬粉，欬嗽前桔杏苏桑，
伤食腹热查芽枳，下利芩连呕半姜，咽痛蒡梗身羌独，头痛荆穗芎芷羌．
[注]
痘出发热当以升麻葛根汤为主，以其能发表邪透痘疹，两得之良方也，
然必随证加佐使之品斯为尽善，
如身热无汗者，此表实也，本方中加麻黄薄荷，
如大小便秘，腹作痛者，此里实也，本方中加大黄，
如形气怯弱者，禀赋不足也，本方中加人参黄耆，
热盛者，内热炽盛也，本方中加犀角，黄连，荆芥，牛蒡子，防风，
如小便短涩者，热结膀胱也，本方中加木通，滑石，车前子，
如发惊搐者，肝心有热也，
本方中加荆芥，防风，钩藤钩，川黄连，羚羊角，
如烦渴者，内热盛也，本方中加石膏，麦冬，花粉，
如欬嗽喘急统，肺郁风邪也，
本方中加前胡，枯梗，杏仁，苏叶，桑皮，
如伤食腹皮热者，胃中停滞也，本方中加山查，麦芽，枳壳，
如下利者，肠胃热滞也，本方中加黄连，黄芩，
如作呕者，胸膈有痰饮也，本方中加半夏，生姜，
如咽痛者，火在上焦也，本方中加牛蒡子，苦桔梗，
如偏身酸疼者，外染风寒也，本方中加羌活，独活，
如头痛者，上冒风寒也，本方中加荆芥穗，川芎，白芷，羌活，
此治发热之大略，又贵临时详察融会贯通也。
(升麻葛根汤) 升麻 葛根 赤芍药 生甘草 引加芫荽水煎服。
%
归宗汤
形实无表毒火盛，所以归宗主大黄，地芍查青通荆蒡，壮热爪紫肢厥凉，
恶热头汗蒸蒸汗，便秘谵语烦躁狂，大渴唇焦舌生刺，失血腰痛不寻常．
[注]
发热之初，形实者，形气壮实也，
无表者，无风寒表邪也，
若证见毒火太盛，法当攻之，所以用归宗汤者，
因其以大黄为主也，
而佐使生地，赤芍，山查，青皮，木通，荆芥穗，牛蒡子也，
痘末见点，如壮热不已，毒火炽盛也，
爪甲色紫，血热凝滞也，
四肢厥冷，同阳证见者，热深厥深也，
恶热，内热盛也，
头汗出，胃热上蒸也，
通身蒸蒸汗出，毒火内迫津液也，
大小便闭，肠胃热结也，
谵语胃热也，
烦躁狂乱，毒火扰心神也，
大渴，引饮，毒火灼津液也，
唇口焦裂，舌生芒刺，毒火胄热并盛也，
失血者，口中失血，小便尿血也，皆缘火毒迫血妄行也，
其腰痛不寻常者，毒攻肾位也，
以上诸证，非险则逆，若见之急用此方峻攻火毒，
庶可挽回，少有逡巡瞻顾，则无及矣。
（归宗汤）
大黄 生地黄 赤芍药 山查 青皮 木通 荆芥穗 牛蒡子炒
引加灯心水煎服。
%
清解散
痘惊清解升葛蒡，荆防甘草桔连芩，蝉翘芎前查通紫，表羌苏芷弱者参。
[注]
痘欲出而发惊搐者，皆由其毒不得快然宣发，而郁于经也，
其现证则面赤心烦，口渴手足抽搐，俱以清解散主之，
或因风寒朿于表者，其现证则无汗头痛，身体疼痛，欬嗽喷悌，
本方中加羌活，苏叶，白芷，以表发之，
若兼形气虚弱者，
其现证则面色浅淡，身体微热，匹肢微温，倦怠嗜卧，
本方中加人参，黄耆，以托之。
(清解散)
防风 荆芥 牛蒡子炒 生甘草 升麻 葛根 桔梗 黄连 黄芩
蝉蜕 紫草茸 川芎 前胡 山查 木通 连翘去心
引加生姜灯心水煎服。
%
宽中透毒饮
伤食宽中透毒饮，葛桔前青朴枳查，麦蝉翘蒡连荆草，便秘大黄木通加。
[注]
痘欲出，发热有现证，呕吐烦渴，大便酸臭，此兼伤食也，
以宽中透毒饮主之，
若更大便秘，小便赤涩，腹热闷痛者，此兼滞热也，
本方中加大黄木通通利之。
(宽中透毒饮)
葛根 桔梗 前胡 青皮 厚朴姜炒 枳壳麸炒 南山查 麦芽炒 蝉蜕
连翘去心 牛蒡子炒研 黄连 荆芥穗 甘草生 引加生姜灯心水煎服。
%
[Adverse Syndromes of Fever]
When fever is accompanied by coma, mental confusion, chest oppression, restlessness, delirious speech, wheezing and chest fullness, abdominal and lumbar pain, inability to eat or sleep, continuous convulsions, dry retching, or hemorrhage (such as hematemesis or hematuria), it indicates an adverse syndrome where pathogenic toxins attack the Qi and Blood causing internal chaos. The condition is generally perilous.
[Note]
Fever with coma, chest oppression, restlessness, and delirious speech indicates toxins lodged in the Heart;
Wheezing, chest fullness, and rapid breathing indicate toxins lodged in the Lung;
Abdominal pain indicates toxins lodged in the Spleen;
Lumbar pain indicates toxins lodged in the Kidney;
Inability to eat and sleep indicates toxins lodged in the Stomach;
Continuous fright and convulsions indicate toxins lodged in the Liver;
Intermittent dry retching and hemorrhage (including hematemesis and hematuria) indicate toxins attacking the Qi and Blood, causing internal disorder;
These are all untreatable adverse syndromes, and the prognosis is generally poor.
[Differentiation of Fever upon Eruption of Smallpox/Measles]
The fever occurring when eruptions (smallpox/measles) emerge originates internally from fire-toxins, but it is inevitably triggered by external factors. These triggers include seasonal pathogens, wind-cold, fright, food stagnation, or internal heat. Treatment must be adjusted according to the differentiation of exterior/interior and deficiency/excess.
If it is exterior heat, symptoms include aversion to cold and absence of sweat;
If it is interior heat, symptoms include presence of sweat, scanty dark urine, and difficult/dry defecation;
If it is weak Qi with mild heat, the patient has insufficient physical strength and mild fever, requiring no aggressive treatment;
If it is robust physique with excessive heat, the patient is physically strong with intense heat, which should be treated as an excess syndrome.
[Note]
"Fever upon eruption" refers to the fact that eruptions are essentially fire-toxins, so fever occurs before the spots appear;
"From within" means the heat radiates from the interior to the exterior;
"Inevitably caused by triggers" means it is provoked by improper seasonal climates (such as wind-cold pathogens);
"Fright" refers to fever induced by external startling objects or falls/fright;
"Food" refers to fever induced by internal dietary stagnation;
"Heat" refers to accumulated internal heat manifesting externally over time;
Since there are pathogenic factors obstructing both inside and out, one must carefully examine the exterior/interior and deficiency/excess patterns to apply appropriate treatments;
"Exterior heat" means heat is at the surface, hence aversion to cold and no sweat;
"Interior heat" means heat is in the organs, hence sweating, scanty urine, and dry stool;
"Weak Qi with mild heat" means insufficient constitution and mild fever;
"Robust physique with excessive heat" means sufficient constitution and severe fever;
If physicians can carefully observe at the moment and treat according to the syndrome, methods such as diaphoresis, purgation, clearing heat, and tonification will be applied appropriately.
[Shengma Gegen Tang and its Modifications]
For treating fever during eruptions, Shengma Gegen Tang (Cinnamon Twig and Pueraria Decoction) is the primary choice. It effectively releases exterior pathogens and promotes the eruption of rashes. The base formula consists of Rhizoma Cimicifugae (Shengma), Radix Puerariae Lobatae (Gegen), Radix Paeoniae Rubra (Chishao), and Radix Glycyrrhizae Preparata (Gancao). Modifications should be made based on the specific syndrome for best results:
For absence of sweat and exterior excess, add Herba Ephedrae (Mahuang) and Folium Menthae Haplocalycis (Bohe);
For constipation, abdominal pain, and interior excess, add Radix et Rhizoma Rhei (Dahuang);
For timidity and Qi deficiency, add Radix Ginseng (Renshen) and Radix Astragali Membranacei (Huangqi);
For excessive heat, add Cornu Rhinocerotis (Xijiao - *note: substitute with Rhinoceros Horn substitute in practice*), Radix Scutellariae (Huanglian), Herba Schizonepetae (Jingjie), Fructus Armeniacae Vulgaris (Niubangzi), and Radix Saposhnikoviae (Fangfeng);
For scanty/difficult urination, add Caulis Akebiae (Mutong), Talcum (Huashi), and Semen Plantaginis (Cheqianzi);
For fright and convulsions, add Herba Schizonepetae (Jingjie), Radix Saposhnikoviae (Fangfeng), Spina Gleditsiae Sinensis (Gouteng), Radix Scutellariae (Huanglian), and Cornu Saigae Tataricae (Lingyangjiao);
For irritability and thirst, add Lapis Gypsum Fibrosus (Shigao), Radix Ophiopogonis (Maidong), and Radix Platycodonis (Huafen);
For cough and wheezing, add Radix Peucedani (Qianhu), Radix Platycodonis (Jiegeng), Semen Pruni Armeniacae (Xingren), Folium Perillae (Zuye), and Cortex Morii Radicis (Sangbai);
For food stagnation with abdominal heat, add Fructus Crataegi (Shanzha), Fructus Hordei Germinatus (Maiya), and Pericarpium Citri Reticulatae Viride (Zhike);
For diarrhea, add Radix Scutellariae (Huanglian) and Radix Scutellariae Baicalensis (Huangqin);
For vomiting, add Rhizoma Pinelliae Preparata (Banxia) and Rhizoma Zingiberis Recens (Shengjiang);
For sore throat, add Fructus Armeniacae Vulgaris (Niubangzi), Radix Platycodonis (Jiegeng), Radix Notopterygii (Qianghuo), and Radix Angelicae Pubescentis (Duhuo);
For headache, add Herba Schizonepetae Tenuifolia (Jingsui), Rhizoma Chuanxiong (Chuanxiong), Radix Angelicae Dahuricae (Baizhi), and Radix Notopterygii (Qianghuo).
[Note]
Fever upon eruption should primarily use Shengma Gegen Tang because it releases exterior pathogens and promotes eruption;
However, auxiliary herbs must be added according to the syndrome for perfection.
For example, fever with no sweat indicates exterior excess; add Mahuang and Bohe to the base formula;
For example, constipation and abdominal pain indicate interior excess; add Dahuang to the base formula;
For example, timidity and weakness indicate congenital insufficiency; add Renshen and Huangqi to the base formula;
For example, excessive heat indicates blazing internal heat; add Xijiao, Huanglian, Jingjie, Niubangzi, and Fangfeng to the base formula;
For example, scanty urine indicates heat binding in the Bladder; add Mutong, Huashi, and Cheqianzi to the base formula;
For example, fright and convulsions indicate heat in the Liver and Heart; add Jingjie, Fangfeng, Gouteng, Huanglian, and Lingyangjiao to the base formula;
For example, irritability and thirst indicate intense internal heat; add Shigao, Maidong, and Huafen to the base formula;
For example, cough and rapid breathing indicate Wind-Cold stagnating in the Lung; add Qianhu, Jiegeng, Xingren, Zuye, and Sangbai to the base formula;
For example, food stagnation with hot abdomen indicates gastric retention; add Shanzha, Maiya, and Zhike to the base formula;
For example, diarrhea indicates intestinal-thermal stagnation; add Huanglian and Huangqin to the base formula;
For example, vomiting indicates phlegm-fluids in the Chest and Diaphragm; add Banxia and Shengjiang to the base formula;
For example, sore throat indicates Fire in the Upper Jiao; add Niubangzi and Jiegeng to the base formula;
For example, generalized body ache indicates external Wind-Cold invasion; add Qianghuo and Duhuo to the base formula;
For example, headache indicates Wind-Cold affecting the head; add Jingsui, Chuanxiong, Baizhi, and Qianghuo to the base formula;
This outlines the general principles for treating fever. Crucially, physicians must observe carefully at the time and integrate their knowledge comprehensively.
(Shengma Gegen Tang): Composed of Rhizoma Cimicifugae (Shengma), Radix Puerariae Lobatae (Gegen), Radix Paeoniae Rubra (Chishao), and Raw Radix Glycyrrhizae (Sheng Gancao). Decoct with Coriandrum Sativum (Yansui) as a guide.
[Guizong Tang]
If the patient has a robust physique, no exterior pathogen, but blazing toxin-fire, Guizong Tang is used, with Radix et Rhizoma Rhei (Dahuang) as the chief herb. Auxiliary herbs include Radix Rehmanniae Preparata (Shengdi), Radix Paeoniae Rubra (Chishao), Fructus Crataegi (Shanzha), Pericarpium Citri Reticulatae (Qingpi), Caulis Akebiae (Mutong), Herba Schizonepetae Tenuifolia (Jingsui), and Fructus Armeniacae Vulgaris (Niubangzi). Symptoms include persistent high fever, purple nails, cold limbs, aversion to heat, sweating on the head, profuse steaming sweat, constipation, delirium, irritability, mania, extreme thirst, cracked lips, prickly tongue, hemorrhage, and unusual lower back pain.
[Note]
At the onset of fever, "robust physique" refers to strong physical constitution;
"No exterior" means absence of Wind-Cold exterior pathogens;
If the syndrome shows excessive toxin-fire, the treatment method should be purgation. Hence, Guizong Tang is used because it features Dahuang as the chief herb;
Auxiliary herbs are Shengdi, Chishao, Shanzha, Qingpi, Mutong, Jingsui, and Niubangzi;
When eruption spots first appear, if high fever persists, it indicates blazing toxin-fire;
Purple nail beds indicate blood heat and stasis;
Cold limbs, seen in Yang syndromes, indicate "deep heat leads to deep cold" (Re Shen Jue Shen);
Aversion to heat indicates intense internal heat;
Sweating on the head indicates Stomach Heat steaming upward;
Profuse whole-body steaming sweat indicates toxin-fire forcing fluids outward;
Constipation indicates intestinal-thermal binding;
Delirium indicates Stomach Heat;
Irritability and mania indicate toxin-fire disturbing the Heart Spirit;
Extreme thirst with drinking indicates toxin-fire scorching body fluids;
Cracked lips and prickly tongue indicate simultaneous toxicity and Stomach Heat;
Hemorrhage (oral bleeding or hematuria) is caused by fire-toxin forcing blood to move recklessly;
Unusual lower back pain indicates toxin attacking the Kidney region;
The above syndromes are either dangerous or adverse. If observed, this potent formula must be used urgently to purge toxin-fire, potentially saving the life. Any hesitation will render treatment futile.
(Guizong Tang): Composed of Radix et Rhizoma Rhei (Dahuang), Raw Radix Rehmanniae (Sheng Dihuang), Radix Paeoniae Rubra (Chishao), Fructus Crataengi (Shanzha), Pericarpium Citri Reticulatae (Qingpi), Caulis Akebiae (Mutong), Herba Schizonepetae Tenuifolia (Jingsui), and Fried Fructus Armeniacae Vulgaris (Niubangzi). Decoct with Juncus Effusus (Dengxincao) as a guide.
[Qingjie San]
Qingjie San treats fright and convulsions during eruptions. Ingredients include Rhizoma Cimicifugae (Shengma), Radix Puerariae Lobatae (Gegen), Fried Fructus Armeniacae Vulgaris (Niubangzi), Herba Schizonepetae (Jingjie), Radix Saposhnikoviae (Fangfeng), Raw Radix Glycyrrhizae (Gancao), Radix Platycodonis (Jiegeng), Radix Scutellariae (Huanglian), Radix Scutellariae Baicalensis (Huangqin), Periostracum Cicadae (Chantui), Fructus Forsythiae (Lianqiao), Rhizoma Chuanxiong (Chuanxiong), Radix Peucedani (Qianhu), Fructus Crataegi (Shanzha), Caulis Akebiae (Mutong), and Radix Leonuri (Zicao). If exterior pathogens are present, add Radix Notopterygii (Qianghuo), Folium Perillae (Zuye), and Radix Angelicae Dahuricae (Baizhi). If constitution is weak, add Radix Ginseng (Renshen).
[Note]
Fright and convulsions occurring when eruptions are about to emerge are caused by toxin-fire failing to vent smoothly, leading to stagnation in the meridians;
Symptoms include red face, heart vexation, thirst, and limb convulsions, all treated with Qingjie San;
If caused by Wind-Cold binding the exterior, symptoms include absence of sweat, headache, body ache, cough, and sneezing;
Add Qianghuo, Zuye, and Baizhi to the base formula to release the exterior;
If accompanied by weak Qi and physique,
Symptoms include pale complexion, slight fever, warm limbs, fatigue, and desire to lie down;
Add Renshen and Huangqi to the base formula to support and expel toxins.
(Qingjie San): Composed of Radix Saposhnikoviae (Fangfeng), Herba Schizonepetae (Jingjie), Fried Fructus Armeniacae Vulgaris (Niubangzi), Raw Radix Glycyrrhizae (Sheng Gancao), Rhizoma Cimicifugae (Shengma), Radix Puerariae Lobatae (Gegen), Radix Platycodonis (Jiegeng), Radix Scutellariae (Huanglian), Radix Scutellariae Baicalensis (Huangqin), Periostracum Cicadae (Chantui), Radix Leonuri (Zicao), Rhizoma Chuanxiong (Chuanxiong), Radix Peucedani (Qianhu), Fructus Crataengi (Shanzha), Caulis Akebiae (Mutong), and Fructus Forsythiae (Lianqiao, heart removed). Decoct with Zingiberis Rhizoma Recens (Shengjiang) and Juncus Effusus (Dengxincao) as guides.
[Kuanzhong Toutu Yin]
Kuanzhong Toutu Yin treats food stagnation. Ingredients include Radix Puerariae Lobatae (Gegen), Radix Platycodonis (Jiegeng), Radix Peucedani (Qianhu), Pericarpium Citri Reticulatae Viride (Qingpi), Ginger-fried Caulis Magnoliae Officinalis (Houpo), Bran-fried Pericarpium Citri Reticulatae Viride (Zhike), Southern Fructus Crataegi (Nanshan Zha), Fried Fructus Hordei Germinatus (Maiya), Periostracum Cicadae (Chantui), Fructus Forsythiae (Lianqiao), Fried and Ground Fructus Armeniacae Vulgaris (Niubangzi), Radix Scutellariae (Huanglian), Herba Schizonepetae Tenuifolia (Jingsui), and Raw Radix Glycyrrhizae (Gancao). If constipated, add Radix et Rhizoma Rhei (Dahuang) and Caulis Akebiae (Mutong).
[Note]
When eruptions are about to emerge, fever presents with vomiting, irritability, thirst, and sour-smelling stool, indicating concurrent food stagnation;
Treat with Kuanzhong Toutu Yin;
If further presenting with severe constipation, dark/scanty urine, and hot/oppressive abdominal pain, indicating concurrent stagnant heat;
Add Dahuang and Mutong to the base formula to promote unblocking.
(Kuanzhong Toutu Yin): Composed of Radix Puerariae Lobatae (Gegen), Radix Platycodonis (Jiegeng), Radix Peucedani (Qianhu), Pericarpium Citri Reticulatae Viride (Qingpi), Ginger-fried Caulis Magnoliae Officinalis (Houpo), Bran-fried Pericarpium Citri Reticulatae Viride (Zhike), Southern Fructus Crataegi (Nanshan Zha), Fried Fructus Hordei Germinatus (Maiya), Periostracum Cicadae (Chantui), Fructus Forsythiae (Lianqiao, heart removed), Fried and Ground Fructus Armeniacae Vulgaris (Niubangzi), Radix Scutellariae (Huanglian), Herba Schizonepetae Tenuifolia (Jingsui), and Raw Radix Glycyrrhizae (Sheng Gancao). Decoct with Zingiberis Rhizoma Recens (Shengjiang) and Juncus Effusus (Dengxincao) as guides.