【方歌】痘里夹瘿生颈项，形如桃李瓜枣状，证兼身热多渴烦，
痰气凝结致此恙。
【注】此证结于颈项，或生耳后腋下，形如桃李枣瓜，身热烦
渴，由痰气凝结所致。痘初起即发瘿者，治宜托里、消
痰、解毒，如木通、桔梗、生地、甘草、蝉蜕、芍药、
荆芥等药，缺一不可；若芩连等药，及耗烁之剂，俱不
可用。若痘发在三四日而作瘿者，则毒随痘泄，毒随痘
灌，自可挽全而无害，宜服三消散。倘斯时红肿，将脓
一溃，则元气泄，而痘浆必不能充灌；乘未溃时，急用
黄耆卫元汤补之。若痘至七八日，灌浆时而发瘿者，冲
和饮子主之。若痘疮苔蜡色而作瘿者，宜消毒兼保元气
；溃后宜生肌玉红膏贴之。
方剂：三消散
组成：当归 赤芍
天花粉 甘草
牛蒡子（炒，研） 白茯苓
生地黄 红花
蝉蜕（去足、翅） 木通
半夏（制，各八分）
水二钟，灯心二十根，煎六分服。
【方歌】三消痘发三四日，痰凝结瘿须当治，归芍天花甘蒡苓，
生地红蝉通夏制。
又方：黄耆卫元汤
组成：黄耆 人参
当归 桔梗
红花 甘草（炙）
白芍（酒炒） 防风（各一钱）
水煎，不拘时服。
【方歌】黄耆卫元瘿肿起，已溃未溃急补之，人参归桔红花草，
防风芍药服无时。
又方：冲和饮子
组成：麦门冬（去心） 人参
桔梗 当归
黄耆 柴胡
白芍（酒炒） 白茯苓
天花粉 荆芥
防风 连翘（去心）
白术（土炒，各七分）
水煎服。
【方歌】冲和饮子麦门冬，参桔归耆柴芍苓，花粉荆防翘白术，
痘发七天痰气凝。
又方：生肌玉红膏（见溃疡门）
[Formula Song] When pox is accompanied by goiter (goiter-like swelling) on the neck, shaped like plums, peaches, melons, or dates, with symptoms of fever, thirst, and irritability, this condition is caused by the concretion of phlegm and qi.
[Note] This syndrome manifests as concretion in the neck, or behind the ears and in the axillae, resembling plums, peaches, dates, or melons, accompanied by fever, irritability, and thirst, caused by the concretion of phlegm and qi. If goiter appears at the initial stage of pox, treatment should employ methods to support the interior (supporting healthy qi), resolve phlegm, and detoxify, using herbs such as Tongcao (Akebiae Caulis), Jiegeng (Platycodonis Radix), Shengdi Huang (Rehmanniae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Chantui (Cicadae Periostracum), Shaoyao (Paeoniae Radix), and Jingjie (Schizonepetae Spica); none of these can be omitted. Herbs such as Huangqin (Scutellariae Radix) and Lianhua (Coptidis Rhizoma), as well as agents that consume and dry fluids, must not be used. If goiter develops three to four days after the onset of pox, the toxin is discharged with the pox, and the toxin is infused with the pox pus; naturally, recovery can be achieved without harm, and Sansan San (Three-Dispersal Powder) is suitable. However, if redness and swelling occur at this time and the pus ruptures, the primordial qi will leak, and the pox pus will inevitably fail to fill and infuse; before rupture occurs, use Huangqi Weiyuan Tang (Astragalus Qi-Safeguarding Decoction) urgently to tonify. If goiter appears during the seven-to-eight-day period when pox are filling with pus, Chonghe Yinzi (Harmonizing Decoction) is the primary formula. If pox lesions appear waxy in color and are accompanied by goiter, detoxification combined with preserving primordial qi is appropriate; after ulceration, Shengji Yuhong Gao (Flesh-Regenerating Jade-Red Ointment) should be applied topically.
Formula: Sansan San (Three-Dispersal Powder)
Composition: Danggui (Angelicae Sinensis Radix), Chishao (Paeoniae Radix Rubra), Tianhuafen (Trichosanthis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Niubangzi (Arctii Fructus, stir-fried and crushed), Baifuling (Poria), Shengdihuang (Rehmanniae Radix), Honghua (Carthami Flos), Chantui (Cicadae Periostracum, feet and wings removed), Mutong (Akebiae Caulis), Banxia (Pinelliae Rhizoma, prepared), each 8 fen.
Preparation: Decoct with two zhong of water and twenty roots of Dengxincao (Junci Medulla) until six fen remains, then take orally.
[Formula Song] Sansan San treats goiter formed three to four days after pox onset due to phlegm concretion; it contains Danggui, Shaoyao, Tianhuafen, Gancao, Niubangzi, Baifuling, Shengdihuang, Honghua, Chantui, Mutong, and prepared Banxia.
Another Formula: Huangqi Weiyuan Tang (Astragalus Qi-Safeguarding Decoction)
Composition: Huangqi (Astragali Radix), Renshen (Ginseng Radix), Danggui (Angelicae Sinensis Radix), Jiegeng (Platycodonis Radix), Honghua (Carthami Flos), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried), Baishao (Paeoniae Radix Alba, wine-fried), Fangfeng (Saposhnikoviae Radix), each 1 qian.
Preparation: Decoct in water and take at any time.
[Formula Song] Huangqi Weiyuan Tang treats rising goiter; whether ulcerated or not, urgent tonification is required; it contains Renshen, Danggui, Jiegeng, Honghua, Gancao, Fangfeng, and Baishao, taken without restriction of time.
Another Formula: Chonghe Yinzi (Harmonizing Decoction)
Composition: Maimendong (Ophiopogonis Radix, heart removed), Renshen (Ginseng Radix), Jiegeng (Platycodonis Radix), Danggui (Angelicae Sinensis Radix), Huangqi (Astragali Radix), Chaihu (Bupleuri Radix), Baishao (Paeoniae Radix Alba, wine-fried), Baifuling (Poria), Tianhuafen (Trichosanthis Radix), Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Lianqiao (Forsythiae Fructus, heart removed), Baizhu (Atractylodis Macrocephalae Rhizoma, soil-fried), each 7 fen.
Preparation: Decoct in water and take orally.
[Formula Song] Chonghe Yinzi contains Maimendong, Renshen, Jiegeng, Danggui, Huangqi, Chaihu, Baishao, Baifuling, Tianhuafen, Jingjie, Fangfeng, Lianqiao, and Baizhu; it addresses phlegm and qi concretion seven days after pox onset.
Another Formula: Shengji Yuhong Gao (Flesh-Regenerating Jade-Red Ointment) (See section on Ulcers)