毒瓦斯在表宜散,在里宜下,此为不易之法也。今疮痘热在表,却用疏转其里,是表里不
分,是故有人于一言一字,无不审之。其在表宜散,在里宜下。其疮疹是热毒在表,每每妄
下,虚其里则至于夭伤多矣。殊不知伤寒身扇,在表者不可下,故《活人书》论疮疹身热耳
冷,尻冷咳嗽,辄用利药,即毒瓦斯入里,杀人尤甚刀刃。疮疹固有下者,自有可下证,别具
其详矣。
疮疹出太盛而面黄,大便黑色,烦喘燥渴,或腹胀,此为有瘀血在里故也,宜以犀角地
黄汤。及治疮疹中鼻衄吐血,毒瓦斯未尽,有余瘀血,皆可服之。然出得太盛燥渴者,服甘草
散,其未出者亦可服之。烦喘甚者,以麻黄汤,咽痛而嗽者,入麝香服之,尤妙,出迟者,
与紫草饮子为良。
伤寒男体面黄,女面赤,增寒而口中无热,呵欠顿闷项急也。疮疹则腮赤燥,多喷嚏,
悸动昏倦,四肢冷。伤寒当散,疮疹当温,平匀气面赤腮赤之不同。又有诸热证,蒸为疮痘
,虽始终各变,当随证而治之,不可泥于一曲。
善治病者,期于未然,不善治者,治已然。 昔人论升麻汤,未能辨认,间可服之,是
疮子未发,未见斑点之前,可以内消,所以服之。若已发见斑点者,不可服。盖升麻汤性大
寒故也。已发而服升麻汤,是以出齐结痂 之后,方服解余毒也。往往人未知此,见斑点既
出而后服之,令肌凉而反不得出,为害极多。用胡荽酒则曰已发未发皆可服之。胡荽辟一切
恶气冲触。外护之用胡荽酒者,酒胡荽于床帐左右上下,安之可辟恶气,疮疹正宜用之,非
升麻汤之比。故知升麻汤未辨认间服之,能消诸蕴热,而解毒于未然。及其斑已见,则当以
和平药安养之。升麻葛根性大寒,疮疹既出而服之,则反使寒弱,为出迟,为寒中,为陷伏
。小儿禀受实者庶几,或所禀怯弱者,最为大害,不可不知。故方书有直言疮疹可下者,有
直言不可下者,人之禀受不同,方宜又异,岂可执于一偏而不知变?且北方冬月则风寒冰烈
,南方除夜天气温和,花卉亦发,万物亦应时丰,四季皆无毒热酷寒之害,以此观之,所禀
既异,所治亦殊,在临时随宜而用之,不可下与可下,自有证候,故执泥者乃医之病矣。
Toxic heat located in the exterior should be dispersed; toxic heat located in the interior should be purged. This is an unchangeable principle. Currently, with the heat of sores and pox located in the exterior, yet using methods to drain or redirect towards the interior, this constitutes a failure to distinguish between exterior and interior. Therefore, some individuals scrutinize every word and character carefully. Toxic heat in the exterior should be dispersed; toxic heat in the interior should be purged. These sores and pox involve heat-toxin in the exterior, yet people often recklessly apply purgatives, causing deficiency in the interior and leading to premature death and injury frequently. They fail to realize that in *Shanghan* (Cold Damage), where the body is hot, if the pathogen is in the exterior, it must not be purged. Thus, the *Huoren Shu* (Book of Living People) discusses sores and pox: when there is body heat but cold ears and coldness at the sacrum accompanied by coughing, if laxative drugs are used indiscriminately, the toxin enters the interior, killing people even more severely than blades. Sores and pox certainly have cases suitable for purging, and there are specific indications for purging, which are detailed elsewhere.
When sores and pox erupt excessively with a yellowish complexion, black stool, irritability, panting, dryness, thirst, or abdominal distension, this indicates blood stasis in the interior. The appropriate formula is Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). It is also used for epistaxis and hematemesis during the course of sores and pox, where the toxin is not fully cleared and residual blood stasis remains. However, for those with excessive eruption and dryness/thirst, Gancao San (Licorice Powder) should be taken; it can also be taken for those whose lesions have not yet erupted. For severe irritability and panting, Mahuang Tang (Ephedra Decoction) is indicated. For sore throat and cough, adding Moschus (She Xiang) is particularly effective. For delayed eruption, Zicao Yinzi (Arnebia Drink) is beneficial.
In *Shanghan*, males may present with a yellowish face, while females may have a reddish face, increased aversion to cold, a sensation of no heat in the mouth, yawning, sudden mental fog, and neck stiffness. In contrast, sores and pox present with red, dry cheeks, frequent sneezing, palpitations, drowsiness, fatigue, and cold limbs. *Shanghan* requires dispersal, whereas sores and pox require warming. There are differences in balanced qi flow versus facial and cheek redness. Furthermore, various heat syndromes can steam into sores and pox. Although the progression varies, treatment must follow the specific syndrome, avoiding rigid adherence to a single perspective.
A skilled healer aims to prevent disease before it arises; an unskilled healer treats disease after it has manifested. Past discussions on Shengma Tang (Cimicifuga Decoction) suggest it can occasionally be taken if not carefully distinguished. This is because before the pox erupts and spots appear, internal resolution is possible, hence its use. However, once spots have appeared, it must not be taken due to its strongly cold nature. Taking Shengma Tang after eruption leads to situations where only after the rash fully emerges and scabs form does one take remedies to clear residual toxins. Often, people do not understand this; taking it after spots appear cools the skin and prevents proper eruption, causing significant harm. Using Huixie Jiu (Coriander Wine), however, states it can be taken whether erupted or not. Coriander repels all evil qi. Externally, for protection, Huixie Jiu involves placing wine-soaked coriander around the bed curtains to ward off evil qi, which is highly suitable for sores and pox, unlike Shengma Tang. Thus, taking Shengma Tang before careful distinction can eliminate accumulated heat and resolve toxins preemptively. Once spots appear, mild and harmonizing formulas should be used to nourish the body. Shengma and Gegen have strongly cold properties; taking them after eruption causes cold weakness, delayed eruption, cold invasion, or sinking/obscuration. Children with robust constitution might tolerate it, but those with weak constitution suffer greatly. This must be known. Medical texts state some sores and pox can be purged, others cannot. Since constitutions differ and appropriate formulas vary, how can one stick to one bias without flexibility? Moreover, in northern winters, wind-cold and ice are fierce; in southern New Year's Eve, weather is mild, flowers bloom, and all things flourish according to season, free from extreme heat or cold hazards. Observing this, since constitutions differ, treatments differ. One must adapt to circumstances. Whether purging is indicated or not depends on specific signs; thus, rigid adherence is a flaw in physicians.