一论手拳不展。禀受肝气怯弱。致筋挛搐。两手伸展无力。宜服
当归 薏苡仁 秦艽 米仁 枣仁 防风 羌活（各等分）
上为末。炼蜜为丸。如鸡头实大。麝香汤化下。量儿大小服之。
一论脚拳不展。所禀肾气不足。荣气未充。脚指拳缩无力。不能伸放。宜服。
当归身（酒洗） 川牛膝（去芦酒洗） 山茱萸肉 人参 牡丹皮 怀生地黄 补骨脂
上为末。炼蜜为丸。如芡实大。空心。盐汤送下。
一治富翁子。八岁不能步履。皆因看得太娇。放不落手。儿身未得土气。以致肌肉软
脆。
筋骨薄弱。用黄土放入夹袄内与穿。内服地黄丸。加人参、鹿茸、牛膝、虎胫骨。服未半料
儿能行矣。
一治小儿禀赋。肾经虚热。耳内生疮。或肌肉消瘦。骨节皆露。名节疳。六味丸加鹿茸
、牛膝各一两。五味子四两。若颅解不合。牙齿不生。眼睛不黑。腿软难行。最宜此药。
夫痘疮者。乃胎毒之所致也。婴儿在胎之时。感其秽毒之气。藏于脏腑之中。发时有远
近之
不同耳。若值寒暄不常之候。痘疹由是而发。因其所受浅深。而为稀调焉。大抵始发之时。
有因外感风寒而得者。有因内伤饮食而得者。有因时气传染而得者。有因跌扑惊恐而得者。
大凡初起。未见红点。与伤寒相类。发热烦躁。脸赤唇红。身痛头疼。乍寒乍热。喷嚏呵欠
喘嗽痰涎等症。身热未明。疑似之间。急须表散。可服败毒散。以微发其汗。则胎毒随汗
而解。而痘疹亦随发而出矣。痘苗一见之际。则禁表药。恐发得表虚故也。惟视痘之稀稠。
稀者轻。不须用药。而稠者重。宜以九味神功散以化其毒。痘自出至齐。宜此加减用之。
除诸病。毒已解尽。又看痘之起胀如何。如痘不起胀。此元气虚也。宜保元汤主之。而痘必
起胀。又看痘之贯脓如何。如痘不贯脓。此气血虚也。宜内托散。加人乳好酒。此贯脓之
巧法也。贯脓已满。又看收靥如何。若当靥不靥。灰陷黑陷。呕吐白沫。为表虚。宜木香散治
之。若当靥不靥。寒战切牙。痒塌泄泻。为里虚。宜异功散治之。有过服热药。以致热毒猖
狂。血气弥盛。痘烂不靥者。宜小柴胡汤。猪尾膏解之。收靥已毕。又看痘后有无余毒。
若余毒盛。必因过服附子。热毒失解。聚而不散。以致浑身手足赤肿。成痈毒也。宜消毒饮
、五福化毒丹治之。又有毒攻。发为诸病。宜随症而疗之。大凡痘疮七日以前为里实。不可
投温燥之药。能助毒也。八日以后为里虚。不可投寒凉之剂。能伐生气也。但世俗不分寒热
但见痘出不快。举手悉用陈氏治虚寒热药。殊不知痘疮属燥热者多。急以丹溪凉血解毒治
之。若概投热剂。岂无死者。今不知致病之因。又不求立方之意。仓卒之际。据症检方。漫
尔一试。设有不应。并其书而废之。不思之甚也。余观陈氏。其意大率归重于太阴一经。
盖以手太阴为肺。主皮毛。足太阴为脾。主肌肉。肺金恶寒。而易于外感。脾土恶湿。而无
物不受。观其用丁香、姜、桂。所以治肺之寒。用术、附、半夏。所以治脾之湿。使肺果有
寒脾果有湿。而兼有虚也。量而与之。中病则已。何伤之有。今徒见疮之出迟者。身热者。
泄利者。惊悸者。气急者。渴思饮水者。不问寒热虚实。率投木香散、异功散。间有偶中。
随有功效。设或误投。祸不旋踵。何者。古人用药制方。有向道。有监制。有反佐。有因用
陈氏之方。其时必痘疮而挟寒者。其用燥热补之。故其宜也。今未挟寒。而用一偏之方
宁不过于热乎。余尝会诸家之粹。求其意而用之。实未敢据其成方也。若痘疮虚寒淡白色。
痒塌属虚寒。宜用之。若发热壮盛。齐涌红紫色。燥痒。此属热毒。宜凉血。自陈氏方盛行后。属
虚寒者率得生。属热毒者愁不救。痘是胎毒。古人治法。只解毒。然气血虚。则又送毒瓦斯不
出
及不能成就。故陈氏之法既行。而解毒之旨遂隐。只顾救其虚寒之痘。而不能治其燥热之
疮也。余思治法。陈氏与丹溪寒热兼用。俱不可废如痘疮陷顶。灰白色。寒战闷乱。腹胀泄
泻
者。属虚寒。只用异功等方治之。如热甚红紫。燥痒。属热毒者。急宜用凉血之药。消毒等
散。相兼而用之。岂有不中其病耶。余谓痘疹。乃小儿之酷疾。生死反掌。古人论之不一。
有见于寒者。有见于热者。习者不可执一而误赤子之生。何也。盖痘疹乃胎毒所致。初生小
儿。失于拭去口中秽毒者。一误也。及长。失于未用预解胎毒免痘之方者。二误也。初起发
热
有当汗而不汗者。三误也。将出之际。有不当汗而汗者。四误也。既出之后。有毒盛当解而
不解者。五误也。起胀贯脓之时。有当补虚而不补虚者。六误也。有首尾症平。不当下而下
者。七误也。有首尾实热。当下而不下者。八误也。有首尾虚寒。当温补而不温补者。九误
也。有过服热药。致痘疮后余毒。当解毒而不解毒者。十误也。凡此十误。当预慎之。务加
通变。故曰。寒者温之。热者凉之
虚者补之。实者泻之。又曰。化而裁之。神而明之。若斯治者。庶免小儿夭枉之祸耶。
One discusses hand fist (Hand Fist) not extending. Due to congenital deficiency of Liver Qi (Liver Qi), causing tendon spasms and convulsions, the two hands lack strength to extend. It is suitable to take:
Angelicae Sinensis Radix (Danggui), Coicis Semen (Yiyiren), Gentianae Macrophyllae Radix (Qinjiao), Coicis Semen (Miren), Ziziphi Spinosae Semen (Zaoren), Saposhnikoviae Radix (Fangfeng), Notopterygii Rhizoma et Radix (Qianghuo) (equal parts).
The above are ground into powder. Refined honey is used to make pills, the size of a chestnut (Euphorbiae Lathyris Semen or Euryales Semen). Dissolve in Moschus Decoction for administration. Dosage depends on the child's age and size.
One discusses foot fist (Foot Fist) not extending. Due to congenital insufficiency of Kidney Qi (Kidney Qi) and unfulfilled Ying Qi (Nutritive Qi), the toes curl up with no strength, unable to straighten and release. It is suitable to take:
Angelicae Sinensis Radix (Danggui) body (washed with wine), Achyranthis Bidentatae Radix (Chuan Niuxi) (remove rhizome, washed with wine), Corni Fructus (Shanzhuyu), Ginseng Radix (Renshen), Moutan Cortex (Mudanpi), Rehmanniae Radix Preparata (Huai Shengdihuang), Psoraleae Fructus (Buguzhi).
The above are ground into powder. Refined honey is used to make pills, the size of a chestnut (Euryales Semen). Take on an empty stomach, delivered with salt water.
One treats a wealthy man's son. At eight years old, he could not walk. This was entirely because he was treated too delicately; his hands were never let go. The child's body did not receive the Qi of Earth, resulting in soft and fragile muscles, and weak sinews and bones. Place loess (yellow earth) inside a padded jacket for him to wear. Internally administer Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), adding Ginseng Radix (Renshen), Cervi Cornu Pantotrichum (Lurong), Achyranthis Bidentatae Radix (Niuxi), and Tibia Corvi Tigridis (Hujinggu). Before half a dose was consumed, the child could walk.
One treats children's congenital constitution. Deficient heat in the Kidney Meridian (Kidney Channel). Sores grow inside the ears, or muscles emaciate, and bone joints are all exposed. This is named Jie Gan (Joint Malnutrition). Add Cervi Cornu Pantotrichum (Lurong) and Achyranthis Bidentatae Radix (Niuxi), one tael each, to Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), and Schisandrae Fructus (Wuweizi), four taels. If the fontanelle does not close, teeth do not erupt, eyes are not dark, and legs are weak making walking difficult, this medicine is most suitable.
Regarding variola (smallpox), it is caused by fetal toxin (Tai Du). When the infant is in the womb, it feels the qi of filth and toxin, which hides within the Zang-Fu organs (Viscera and Bowels). The onset varies in time. If encountering irregular changes between cold and warmth, the variola rash erupts from this. Depending on the depth of the toxin received, the density becomes sparse or dense. Generally, at the initial stage, some cases arise from external contraction of Wind-Cold (Wind-Cold), some from internal injury of diet, some from epidemic qi transmission, and some from falls or fright.
Generally, at the very beginning, before red spots appear, the symptoms resemble Taiyang Disease (Sun-Yang Disease). There is fever and irritability, red face and lips, body pain and headache, alternating chills and fever, sneezing and yawning, wheezing, coughing, and phlegm-saliva. When body heat is unclear and there is doubt, urgent dispersal via the exterior is required. Ba Du San (Poison-Defeating Powder) can be taken to induce slight sweating, so that the fetal toxin resolves with the sweat, and the variola rash follows to emerge. Once the variola seedlings are seen, exterior-dispersing medicines are prohibited, lest they cause exterior deficiency. One should only observe the density of the variola. Sparse cases are mild and require no medicine; dense cases are severe, and Jiu Wei Shen Gong San (Nine-Ingredient Divine Merit Powder) should be used to transform the toxin. From the emergence to the maturation of the variola, this formula should be used with modifications to eliminate various pathologies.
Once the toxin is fully resolved, observe how the variola swells. If the variola does not swell, this is Yuan Qi (Primal Qi) deficiency. Bao Yuan Tang (Protect the Origin Decoction) should be the main treatment. If the variola must swell, observe how it fills with pus. If the variola does not fill with pus, this is Qi and Blood deficiency. Nei Tuo San (Internal Support Powder) added with human milk and good wine is suitable; this is a clever method for filling with pus. Once filled with pus, observe the scabbing. If it should scab but does not, presenting as gray depression or black depression, vomiting white foam, this is exterior deficiency. Mu Xiang San (Aucklandia Powder) should treat it. If it should scab but does not, with chills, grinding teeth, itching collapse, and diarrhea, this is interior deficiency. Yi Gong San (Extraordinary Merit Powder) should treat it. If hot medicines were overused, causing rampant heat toxin and flourishing blood and qi, leading to rotting variola that does not scab, Xiao Chai Hu Tang (Minor Bupleurum Decoction) and Zhu Wei Gao (Pig Tail Paste) should resolve it. After scabbing is complete, check if there is residual toxin post-variola. If residual toxin is strong, it must be due to overusing Aconiti Lateralis Radix Preparata (Fuzi), where heat toxin failed to resolve, gathered and did not disperse, causing redness and swelling of the whole body and limbs, forming carbuncle toxin. Xiao Du Yin (Toxin-Disinfecting Drink) and Wu Fu Hua Du Dan (Five Blessings Toxin-Transforming Pill) should treat it. There are also cases where toxin attacks, manifesting as various diseases; these should be treated according to symptoms.
Generally, before the seventh day of variola, it is interior excess (Interior Excess); warm-dry medicines cannot be administered as they assist the toxin. After the eighth day, it is interior deficiency (Interior Deficiency); cold-cool agents cannot be administered as they attack vital energy. However, worldly people do not distinguish between cold and heat; seeing slow eruption of variola, they invariably use Chen's heat medicines for deficiency-cold. They do not know that most variolas belong to dry-heat. Urgently treat with Danxi's blood-cooling and toxin-resolving methods. If heat agents are generally administered, will there not be deaths? Now, people do not know the cause of disease, nor seek the meaning of the prescription. In haste, they check formulas based on symptoms and try them randomly. If ineffective, they discard the book. This is extremely thoughtless.
I observe Chen's intent largely focuses on the Taiyin channel. Hand Taiyin belongs to Lung, governing skin and hair; Foot Taiyin belongs to Spleen, governing muscles. Lung Metal dislikes cold and is prone to external contraction; Spleen Earth dislikes dampness and accepts everything. Observing his use of Clove, Ginger, and Cinnamon, these treat Lung cold; using Atractylodes, Aconite, and Pinellia, these treat Spleen dampness. If Lung indeed has cold, Spleen indeed has dampness, and both have deficiency, administering them in measured amounts stops when the disease is hit. What harm is there? Now, merely seeing late eruption, fever, diarrhea, palpitations, shortness of breath, and thirst for water, without asking about cold/heat or deficiency/excess, they uniformly administer Mu Xiang San and Yi Gong San. Occasionally hitting the mark yields efficacy. But if misadministered, disaster follows swiftly. Why? Ancient doctors using prescriptions had direction, supervision, counter-assistance, and causality. Using Chen's formula, the variola must have been complicated by cold then; using dry-hot tonification was thus appropriate. Now, without cold complication, using a biased formula is surely too hot. I have gathered the essence of various schools, sought their meaning, and used them. I dare not rely on his fixed formulas. If variola is deficiency-cold, pale white, itching and collapsing belonging to deficiency-cold, it is suitable to use. If fever is vigorous, erupting uniformly in red-purple, dry and itching, this belongs to heat toxin; blood cooling is suitable. Since Chen's formula became prevalent, those belonging to deficiency-cold mostly survived, while those belonging to heat toxin worried about non-rescue. Variola is fetal toxin. Ancient treatment methods only resolved toxin. However, with Qi and Blood deficiency, toxin vapor cannot be sent out and cannot mature. Thus, since Chen's method spread, the purport of resolving toxin became hidden. Only saving deficiency-cold variola was considered, unable to treat dry-heat sores.
I consider treatment methods. Both Chen and Danxi used cold and heat together; neither should be discarded. For example, if variola sunken crown, gray-white, chills, confusion, abdominal distension, and diarrhea belong to deficiency-cold, only Yi Gong San etc. should treat it. If heat is severe, red-purple, dry and itching, belonging to heat toxin, urgently use blood-cooling medicines, Xiao Du San etc., combined. How could it not hit the disease? I say variola is a cruel disease of children, life and death turning like a palm. Ancients discussed it differently; some saw cold, some saw heat. Practitioners cannot hold to one view and mistake the life of infants. Why? Because variola is caused by fetal toxin. For newborns, failing to wipe away oral filth/toxin is the first error. Growing up, failing to use pre-resolving fetal toxin formulas to prevent variola is the second error. Initial fever, having indications for sweating but not sweating is the third error. About to erupt, having no indication for sweating but sweating is the fourth error. After eruption, toxin strong indicating resolution but not resolving is the fifth error. Swelling and pus-filling time, having indications for tonifying deficiency but not tonifying is the sixth error. Symptoms peaceful from start to finish, having no indication for purging but purging is the seventh error. Real-heat from start to finish, having indication for purging but not purging is the eighth error. Deficiency-cold from start to finish, having indication for warming-tonifying but not doing so is the ninth error. Overusing heat medicines causing residual toxin post-variola, having indication for resolving toxin but not doing so is the tenth error. All these ten errors should be cautiously avoided in advance. Flexibility is essential. Thus it is said: Cold is warmed, heat is cooled, deficiency is tonified, excess is purged. It is also said: Transform and cut, divine and illuminate. Treating in this manner might avoid the tragedy of infant premature death.