余参陈无择是病必分三因。今痘疹一科。未言一字。何也。盖精于方脉。而不察于此是也。余虽
不敏。收陈一篇。以补古之未备。而使后学之了然。痘毒伏于命门。乃云养虎。如遇四时不正之气。
风寒疫疠。外感于皮毛。则腠理郁寒而为热。内攻脏腑。二火相煽。恶血发于膀胱。乃壬水克之。丙
火后归于阳明。
化出脓浆。此内毒因外感风寒疫疠之所作也。内因者。惊恐喜怒悲哀七情所击脏腑。脏腑击动郁火。
举发恶血赤扬。皮肤发热。亦出痘疹。此内因作也。不内外因者。跌仆坠压。打击推抢。或过食干硬
之物。不时恶毒等味。致伤脾气。脾气不能伸越则脏腑不和。内热遍传。胎毒并起。发而为之痘疹。
此为不内外伤也。治外伤则推运气察阴阳之逆顺。以升麻汤薄苏饮治之。以轻 其表热。而毒自出也。
治内伤者以升苏饮内加凉惊解毒等药治之。治不内外因者。当察其因何伤之打击饮食之毒。随症施治。
少加疏表。以化其痘毒。令儿自安。此三因之论毕矣。
夫小儿痘疹未显之先。发热之初。则烦躁脸赤。目胞赤。唇红。身体痛。头疼顿闷。呵欠。喘嗽。
惊HT 。喷嚏等症。此五脏外症悉具。而内毒烦冤。二三日后。毒归于一脏方显。是何脏受症也。归于
脾。则令人不食。呕吐泻痢腹痛。归于肝。则令人目赤多泪。乍凉乍热。归于心则惊悸烦躁腮赤作渴。
归于肺。则
喷嚏喘嗽。咽干发热谵语。归于肾则腰痛耳尻热。嘎牙振寒。眼合腹胀黑舌。此五脏独显之外症也。
又如伤风则恶风脉浮缓。伤寒必恶寒脉浮紧。伤食必恶食。气口脉必盛。如跌仆打压等伤。必有肿痛
于何处。则令人惊恐搐搦。喊叫昏睡闷乱等症。再加之一诊耳冷尻冷。四梢冷。又不若视耳后红脉赤
缕。目有水光。身微战动。如此诊视。最为的真秘之稽验若神。世少知之矣。
I refer to Chen Wuzhe's view that diseases must be classified into three categories of causes. However, in the specialty of smallpox and chickenpox (douzhen), there is no mention of this. Why is this? It is because previous scholars were proficient in pulse diagnosis but failed to investigate this aspect. Although I am not talented, I have collected Chen's essay to supplement the deficiencies of ancient texts, so that later students may understand it clearly.
The poison of douzhen lies dormant in the Mingmen (Gate of Life, the root of vitality located between the two kidneys), which is likened to "nurturing a tiger" (symbolizing a huge hidden danger). When encountering abnormal qi of the four seasons, or wind-cold and epidemic pestilence invading from the exterior through the skin and hair, the Couli (skin pores and interstices) become cold-stagnated and transform into heat. This attacks the Zang-Fu organs internally, causing the "two fires" (Heart Fire and Ministerial Fire) to fan each other. Evil blood (stagnant blood) erupts in the Bladder; at this time, Ren Water (Kidney Water) controls it, and Bing Fire (Small Intestine/Heart Fire) subsequently returns to the Yangming Meridian (Stomach Meridian), transforming into pus and serum. This is an internal toxin triggered by external contraction of wind-cold and epidemic pestilence.
The so-called internal cause refers to the impact of the Seven Emotions (Joy, Anger, Worry, Thought, Sadness, Fear, Fright) on the Zang-Fu organs. The organs are agitated, stirring up stagnant fire, causing evil blood to surge red and bright, with fever on the skin, also resulting in the eruption of douzhen. This is a disease caused by internal factors.
The so-called neither-internal-nor-external cause refers to falls, crushing, blows, pushes, or excessive consumption of dry and hard foods, as well as irregular ingestion of toxic or strange-tasting substances, which damage the Spleen Qi. When Spleen Qi cannot extend and rise smoothly, the Zang-Fu organs become disharmonious, internal heat spreads throughout the body, and fetal toxin (congenital latent toxin) arises together, manifesting as douzhen. This is a disease caused by neither-internal-nor-external injuries.
To treat external injuries (referring to external contractions like wind-cold), one must deduce the movement of Qi and verify the smoothness or reversal of Yin and Yang, treating with Shengma Tang (Ephedra Decoction) and Bosu Yin (Perilla Drink) to alleviate superficial heat, allowing the toxin to discharge naturally. To treat internal injuries, add cooling, calming fright, and detoxifying herbs to Bosu Yin for treatment. To treat neither-internal-nor-external causes, one must examine whether the injury was caused by physical trauma or dietary toxins, treating according to symptoms, slightly dispersing the exterior to resolve the douzhen toxin, thereby allowing the child to settle naturally. Thus concludes the theory of the three causes.
Before the rash of pediatric douzhen appears, at the initial stage of fever, symptoms such as restlessness, flushed face, red eyelids, red lips, body pain, headache with heaviness, yawning, wheezing and coughing, palpitations/fright, and sneezing occur. These external signs of the five Zang organs are all present, while the internal toxin is stifled and distressed. After two or three days, the toxin settles in one Zang organ, making the condition obvious. Which Zang organ is affected?
If the toxin settles in the Spleen, it causes loss of appetite, vomiting, diarrhea/dysentery, and abdominal pain;
If the toxin settles in the Liver, it causes red eyes with excessive tearing, alternating chills and fever;
If the toxin settles in the Heart, it causes palpitations, restlessness, flushed cheeks, and thirst;
If the toxin settles in the Lung, it causes sneezing, wheezing, coughing, dry throat, fever, and delirious speech;
If the toxin settles in the Kidney, it causes lower back pain, heat in the ears and sacrum, teeth grinding with chills, closed eyes, abdominal distension, and a black tongue.
These are the external signs manifested exclusively by each of the five Zang organs.
Furthermore, Wind Injury presents with aversion to wind and a floating, moderate pulse; Cold Injury necessarily presents with aversion to cold and a floating, tight pulse; Food Injury necessarily presents with aversion to food and a surging pulse at the Qikou position (Radial artery at the wrist, reflecting Lung and Spleen/Stomach status). For injuries such as falls or blows, there must be swelling and pain at specific locations, leading to symptoms of fright, convulsions, shouting, coma, sleepiness, and mental confusion. Additionally, if the ears, sacrum, and four extremities (tips of fingers and toes) are cold, it differs from observing red vascular threads behind the ears, watery luster in the eyes, and slight tremors of the body. Such diagnostic observation is the most authentic and secret verification method, effective as if divine. Few people in the world know this.