《圣惠》治小儿疟发后，肚胀兼头面浮肿。宜服防葵散方
防葵 柴胡（去苗） 川大黄（锉碎，微炒） 桑根白皮（锉。各用半两，《婴孺》各用一分） 甘
草（一分，炙微赤，锉）
上件药捣，粗罗为散。每服一钱。以水一小盏，煎至五分，去滓温服，日三服。量儿大小加减服之。（《婴孺》
方》云∶忌菘菜、油腻、生冷、粘滑物。乳母同忌。）
《圣惠》论∶婴孩患疹痘、疮子者，皆是积热在于脏腑，蒸郁热毒散于四肢。小儿皮肉嫩弱，多成此疾。凡
食乳婴孩，汤药不可与童儿同。同疗则药过剂，必有损也。盖由饮啜热乳在于脏腑，热极方成此疾。腑热生
于细疹，脏热生于痘疮。若用汤药，宜疗于乳母也。又绝乳婴孩患者，由积热伏在于脾肺之间，而不早以汤药
疗于病源，养热行于四肢荣卫之中，渐透皮表成疹痘，而乃出于脓水也。婴儿之性，自然阳盛而阴微也。脏腑
阴阳气逆，大小便多秘不通也。才觉是此疾，即可便与疏利，即轻患也。若疹痘已出，即不可疏转。若疹痘出
定，却宜利大小肠。按扁鹊及仓公论云∶疗于婴孩，服以汤散，性有可饵之者，不可饵之者。宜先和节阴阳，
调治荣卫，方利脏腑，即热气渐解也。凡绝乳婴孩生于疹痘，或未出以前，是此疾候。按扁鹊论云∶可先以油
剂服之（方见疮疹初出门中）行解。四肢热极，或疹痘已出，不可以油，可服平和汤药疗于肝脏，解于败热。虑毒攻肝，
后冲于眼目，生于障翳，今睹时医及疾患之家，疹痘未出以前多是误认疾候，皆以他药解之。其间或饵以燥药，
或饵以冷药，不无夭伤。时医用药，直候疮疹子出，病家方觉，患者住饵，医者拱手。已患之后，俗多禁饵，
致大小便不通，不能调于汤药，和于脏腑，遂停败热在于脏腑之间，攻于肝脏，疹痘才愈，致令冲于眼目，成
于障翳。不过医治，瞳人眼目遂损，因兹无所见也。
《养生必用》论治疮疹曰∶阳明主肌肉，疮疹毒瓦斯泄于肌肉，始觉必以利药利之，宣其毒也。又其始难知，
盖与伤寒和类，不可不审也。小儿身热、耳冷、尻冷、咳嗽、疮疹候也。又一岁之中，疮疹大小相类，此
疫气也。当作疫气治之。伤寒至阳明经亦用利药，须是未见是疮疹。疑贰之间乃可利；及见是疮疹，不可
利也。
钱乙论疮疹候∶面燥腮赤，目胞亦赤，呵欠顿闷，乍凉乍热，咳嗽嚏喷，手足稍冷，夜卧惊悸、多睡，并
疮疹证。此天行之病也，惟用温凉药治之，不可妄下及妄攻发。受风冷，五脏各有一证∶肝脏水 ；肺脏脓 ；
心脏斑；脾脏疹；归肾变黑。惟斑疹病后或发痫，余疮难发痫矣。木胜脾，木归心故也。若凉惊，用凉丸。温
惊，用粉红丸。（方并见一切惊门中。）
钱乙论∶小儿在胎十月，食五脏血秽，生下则其毒当出。故疮疹之状，皆五脏之液。肝主泪，肺主涕，心
主血，脾为裹血。其疮出有五名∶肝为水 ，以泪出如水，其色青小；肺为脓 ，以涕稠浊、色白而大；心为
斑，主心血，色赤而小，次于水 ；脾为疹，小次斑疮，其主裹血，故色亦黄浅也。涕泪出多，故脓 水 皆
大。血营于内，所出不多，故斑疹皆小也。病 者，涕泪俱少，譬胞中容水，水去则瘦故也。始发潮热，三日
以上，热运入皮肤，即发疮疹而不甚多者，热留肤腠之间故也。潮热随脏出，如早食潮热不已，为水 之类也。
疮疹如出之时，五脏证见，惟肾无候，但见平证耳。KT 凉、耳凉是也。KT 、耳俱属于肾，其居北方，主冷也。
若疮黑陷，而耳、KT 反热者，为逆也。若用百祥丸、牛李膏各三服不愈者，死病也。凡疮疹若出，辨视轻重。
若一发便出尽者，必重也。疮夹疹者，半轻半重也。出稀者，轻；里外肥红者，轻。外黑里赤者，微重也；外
白里黑者，大重也。疮端里黑点如针孔者，势剧也。青干紫陷、昏睡汗出不止，烦躁热渴，腹胀啼喘，大小便
不通者，困也。凡疮疹，当乳母慎口，不可令饥及受风冷，必归肾而变黑难治也。有大热者，当利小便；有小
热者，宜解毒。若黑紫干陷者，百祥丸下之。（方见疮疹倒 门中。）不黑者，慎勿下。更看时月轻
重，大抵疮疹属阳，出
则为顺，故春夏病为顺，秋冬病为逆。冬月肾王，又盛寒，病多归肾变黑，又当辨。春脓 ，夏黑陷，秋斑子，
冬疹子，亦不顺也。虽重病犹十活四五，黑者无问何时，十难救一。其候或寒战、噤牙；或身黄肿紫，宜急
以百祥丸下之。复恶寒不已，身冷出汗、耳KT 反热者，死病也。何以然？肾气大王，脾虚不能制故也。下后
身热气温、欲饮水者，可治。以脾土胜肾，寒去而温热也。治之宜解毒，不可妄下。妄下则内虚，多归于肾。
若能食而痂头焦起，或未焦而喘实者，可下之。身热烦渴、腹胀而喘、大小便涩、面赤、闷乱大吐，此当利小
便，不瘥者，宣风散下之（方见慢惊风门中）。若五七日痂不焦，是内发热，气蒸于皮中，故疮不得焦
痂也。宜宣风散导
之，用生犀磨汁解之，使热不生，必着痂矣。疮疹由内相胜也。惟斑疹能作搐，疹为脾所生，脾虚而肝王乘之。
木来胜土，热气相击，动于心神。心喜为热，神气不安，因搐成痫。斑子为心所主，心生热，热则生风，风属
于肝、二脏相搏，风火相争，故发搐也。治之当泻心肝，补其母，栝蒌汤主之。（方见慢惊风门中。）疮黑
而忽泻，便脓血
并痂皮者顺，水谷不消者逆。何以然？且疮黑属肾，脾气本强，或旧服补脾药，脾气得实。肾虽用事，脾可制之。
今疮入腹为脓血及连痂皮得出，是脾强肾退，即病出而安也。米谷及泻乳不化者，是脾虚不能制肾，故自泄也，
此必难治。
钱乙论疮疹标本云∶睦亲宫十太尉病疮疹，众医治之。王曰∶疹未出，属何脏腑？一医言∶胃大热。一医
言∶伤寒不退。一医言∶在母腹中有毒。钱氏曰∶若言胃热，何以乍凉乍热？若言母腹中毒发，属何脏也？医
曰∶在脾胃。钱曰∶既在脾胃，何以惊悸？医无对。钱曰∶夫胎在腹中，月至六七则已成形，食母秽液入儿五
脏，食至十月，满胃管中，至生之时，口有不洁，产母以手拭净，则无疾病。俗以黄连汁压之，云下脐粪及涎
秽也。此亦母之不洁，余气入儿脏中，本先因微寒入而成。疮疹未出，五脏皆见病证。内一脏受秽多者，乃出
疮疹。初欲病时，先呵欠、顿闷、惊悸、乍凉乍热、手足冷、面腮燥赤、咳嗽时嚏、此五脏证具也。呵欠顿闷，
肝也；时发惊悸，心也；乍凉乍热、手足冷、脾也；面目腮颊赤、嗽嚏，肺也。惟肾无候，以在腑下，不能食
秽故也。凡疮疹，乃五脏毒，若出归一证，则肝水 ，肺脓 ，心斑，脾疹，惟肾不食毒秽而无诸证。疮黑者
属肾，由不慎风冷而不饱，内虚也。又用抱龙丸数服愈。（方见风热门中。）以其别无他候，故未发出，
则见五脏证；已出，则归一脏也。
钱乙论热传疮疹云∶四大王宫五太尉，因坠秋千发惊搐，医以发热药治之，不愈。钱氏曰∶本急惊，后生
大热，当先退其热。以大黄丸、玉露散、惺惺丸加以牛黄、龙、麝解之，不愈，至三日，肌肤尚热。钱曰∶更二
日不愈，必发斑疮，盖热不能出也。他医初用药发散，发散入表，表热即斑生。本初惊时，当用利惊药下之，
今发散乃逆也。后二日，果斑出。以必胜膏治之，（方见疮疹倒 门中。）七日愈。
钱乙论疮疹有误云∶睦亲宅一大王病疮疹，始用一李医，又召钱氏。钱留抱龙丸三服，李以药下之，其疹
稠密。钱见大惊曰∶若非转下则为逆病！王言∶李已用药下之。钱曰∶疮疹始出，未有他证，不可下也。但当
用平和药，频与乳食，不受风冷可也。如疮疹三日不出，或出不快，即微发之，微发不出，即加药；不出，即
大发之。如大发后不多，及脉平无证者，即疮本稀，不可更发也。有大热者，当利小便；小热者，当解毒。若
出快，勿发勿下。故止用抱龙丸治之（方见同前），疮痂若起，能食者，大黄丸下之（方未见，）一二
行即止。今先下一日，疮
疹未能出尽而稠密甚，则难治，此误也。纵得安，其病有三∶一者，疥；二者，痈；三者，目赤。李不能治。
经三日黑陷，复召钱氏，曰∶幸不发寒而病未困也。遂用百祥丸为药（方见同前，）以牛李膏为
助（方见疮疹倒 门中，）各一大
服。至五日间，疮复红活，七日而愈。盖黑者，归肾也。肾王胜脾，土不克水，故脾虚寒战，则难治。所用百
祥丸者，以泻膀胱之腑，腑若不实，脏自不盛也。何以不泻肾？曰∶肾主虚，不受泻，若二服不效，即加寒而死。
钱乙论伤寒疮疹同异云∶伤寒，男体重，面黄；女面赤，喘急，增寒；各口中气热，呵欠、顿闷、项急也。
疮疹则腮赤燥，多喷嚏，悸动，昏倦，四肢冷。伤寒常发散之。治疮疹行温平；有大热者，解毒。余见前说。
钱乙附方论小儿耳冷、KT 冷，手足乍冷乍热，面赤，时嗽时嚏，惊悸，此疮疹欲发也。未能辨认间，服升
麻葛根汤（方见单伤寒门中）、消毒散（方见疮疹攻咽痛门），已发未发皆宜服。仍用胡荽酒（方见疮疹初出
门）、黄柏膏（见疮疹护面目门，《圣惠方》
同。）暑月烦躁，食后与白虎汤（方见实热门、）玉露散（方见惊热门中。）热盛与紫雪（方见疮疹攻咽
痛门），咽痛或生疮，与甘桔汤（方见实热门）
甘露饮子。（方见疮疹攻咽痛门。）余根据钱氏说。大人同。
张涣论∶小儿疮疹之疾与大人伤寒病相似，虽治疗不同，盖或愈或危，皆六七日之间。小儿往往多有此疾，
岂不慎哉！且疮疹皆由积热在于脏腑，蒸郁热毒发于四肢。小儿皮肉嫩弱，多成此疾。邪热在脏，即生痘疮。
盖脏属阴，大体难治。若邪热在腑，则生细疹，腑属阳，大体易治。且如乳下婴儿，周 已里至二三岁宜少服
药。量其轻重，将汤药与乳母服之，其乳母切宜诸般忌慎。若汤药与儿，多服则反为累也。若五六岁至十岁已
外童儿，则方可施为汤药。然邪气热多在脾肺间，若不求其本，早以汤药治之，养热气行于四肢，即利害甚多。
盖童男长大，则肌肤稍实，毒瓦斯难出。若方觉似疮疹，便早疏利，即热轻易疗。盖小儿疮疹未出以前，或热乘
于心，心神易动，即发惊痫。若医者汤药不相投，即危殆矣。若疹痘已出长快，自不可动利，正如大人伤寒下
之早也。且如古之名医，不出仓公、扁鹊、孙思邈、巢元方辈。论小儿疾症，汤药有可服者，有不可服者，宜
先服顺阴阳、调荣卫后方利脏腑，即热渐除。又扁鹊论曰∶小儿疮疹未出以前，多是误认，以他药解之，或以燥
药，或以冷药，不无夭伤，深戒。时医及病家慎之！至时拱手无及。又疮疹欲出，切宜护目。若热冲于眼目，
致损瞳人。世间小儿疮疹多入眼目，遂生障翳。凡小儿稍大，六岁至十四岁，皆属童男。初觉头痛壮热，腰背
疼重。热甚则手足厥冷，却似挟寒，全在详察脉理疾状。脉但多洪数，甚大不定。若小便多赤，大便多秘，此
证正宜先疏利也。应疮疹早出，若才出，皆不可转利也。涣顷时禁中供应汤药，屡尝调治，此证皆获宁愈。在
外治过尤多，盖不敢越古人之论。
《疹痘论》∶夫疹痘疮者，因热积脏腑，蒸郁毒瓦斯而生。若腑间伏热，则生细疹、赤疮，俗呼为麻子是也。
若脏间伏热，则生痘疮，形如豌豆者是也。其始也，热毒积于脾肺之间，治之不早，流注四肢荣卫之中而成
其疾。初觉受病，多似伤寒，而身色与四肢俱赤，壮热头痛，腰脊疼，只鼻耳尖冷，足指冷，兼咳嗽，眼青黄
色也。小便、大便秘，两手脉洪数者，乃是疹痘之症也。其有冬月天气温暖，仍感乖候之气，未即发动，至春
又被积寒所折，毒瓦斯不得泄，至夏初得热，其春寒方解，冬温毒瓦斯始发者；及有不因冬温，四时自天行者；又
有小儿热毒之气，伤天令不时之气而发者；有感寒邪伏热毒真元之气，被热毒邪气浑杂而发者。近世医流议者
云∶痘疮始于魏晋，香港脚肇于晋末，或云∶建武中于南阳征虏得之，仍呼为虏疮。或言∶永徽四年，此疾自东
域流于海内。且人之有生，脏腑受寒热邪气而为病，凡感之者则受。若言今有古无，岂可同草木之类所产有方，
而苗裔留传于天下哉？巢氏又呼为发疮及呼为胞疮、麸疮，此皆分阴阳所受。人凡觉冬有非节之暖，当疮未发
而预防之，先急下其毒。凡春冬之间，未尝无此疾。夭枉者，十有五六，而因医死者大半。盖证候形色所发不
同，致有误认。其候有∶三五日遍身粟生，时作咳嗽、耳尖冷、毛寒肌慢、眼涩不开、作寒欲以温暖覆之者。
初觉之时，当用薄荷散微微发汗，次进调中散，（二方见疮疹已出未出门。）疮即自愈。服薄荷散汗未出者，亦服调中散，
即汗出渐渐解。若作寒热其脉反迟者，进脱齿散。（方见疮疹出不快门。）或患者寒热不定，
目涩、耳鼻冷，此邪毒不传诸
[Background Information]
Book: Youyou Xinshu (New Book for Infants and Children) Author: Liu Fang Dynasty: Song Chapter: Post-Malaria Head and Face Edema No. 22 / Volume 18 / Discussion on Sores and Rashes Part 1 (1/3)(1/2) Category: Comprehensive
The *Shenghui Fang* (Prescriptions of the Holy Wisdom) treats infants and children who, after a malaria attack, develop abdominal distension accompanied by edema of the head and face. It is appropriate to administer the *Fang Kui San* (Akebia Powder).
Ingredients include: *Fang Kui* (Radix Bupleuri? Note: Context suggests Akebia root or similar, strictly transliterated as Fang Kui), *Chai Hu* (Bupleuri Radix - remove seedlings), *Chuan Da Huang* (Rhei Radix et Rhizoma - chopped, slightly stir-fried), *Sang Gen Bai Pi* (Mori Cortex - chopped. Each uses half tael; in *Ying Ru*, each uses one fen), *Gan Cao* (Glycyrrhizae Radix et Rhizoma - one fen, honey-fried until slightly red, chopped).
Crush the above medicines and sieve coarsely to make a powder. Take one qian per dose. Add one small cup of water, decoct until reduced to five fen, remove the dregs, and take warm. Administer three times daily. Adjust the dosage according to the age and size of the child. (The *Ying Ru Fang* states: Avoid Chinese cabbage, greasy foods, raw/cold foods, and sticky/smooth foods. The nursing mother must also observe these dietary restrictions.)
(Regarding Macules, Papules, Chickenpox, and Smallpox) There are sixteen categories in total.
The *Shenghui Fang* discusses: Infants and children suffering from rashes, smallpox, or sores all have accumulated heat residing in the Zang-Fu organs, steaming and stagnating toxic heat that disperses to the four limbs. Because infants' skin and flesh are tender and weak, they frequently develop this disease. For infants still breastfeeding, herbal decoctions should not be administered directly to the child. Treating the child directly results in an excessive dosage, which inevitably causes harm. This is because drinking hot milk leads to heat accumulation in the Zang-Fu organs; only when the heat reaches its extreme does this disease form. Heat in the Fu organs generates fine rashes, while heat in the Zang organs generates smallpox/pustules. If using herbal decoctions, treatment should be directed at the nursing mother. Furthermore, for weaned infants who contract this illness, it is due to accumulated heat lurking between the Spleen and Lungs. If the source of the disease is not treated early with decoctions, the nourishing heat qi circulates through the Ying and Wei of the four limbs, gradually penetrating the skin surface to form rashes and smallpox, eventually discharging pus and water. The nature of infants is naturally characterized by abundant Yang and deficient Yin. When the Yin and Yang qi of the Zang-Fu organs become rebellious, bowel movements and urination are often constipated and blocked. As soon as this disease is suspected, one should immediately administer laxatives or draining agents; the condition will then be mild. If the rash or smallpox has already erupted, one must not use purgatives or draining methods. However, after the rash/smallpox has fully emerged and stabilized, it becomes appropriate to promote the movement of the Large and Small Intestines. According to the discussions of Bian Que and Cang Gong: When treating infants, some herbal decoctions and powders are suitable for ingestion, while others are not. One should first harmonize and regulate Yin and Yang, and adjust the Ying and Wei, before promoting the drainage of the Zang-Fu organs; thus, the pathogenic heat will gradually resolve. For weaned infants developing rashes or smallpox, whether before eruption or during the prodromal phase, this constitutes the disease pattern. According to Bian Que's discussion: One may initially administer oil-based preparations (see formula in "Discussion on Early Stage of Sores and Rashes") to facilitate resolution. If the four limbs are extremely hot, or if the rash/smallpox has already erupted, oil preparations should not be used; instead, mild and balanced herbal decoctions should be administered to treat the Liver and resolve toxic heat. One must worry about toxic pathogens attacking the Liver and subsequently rushing to the eyes, causing cataracts or visual obstructions (Zhang Yi). Currently, physicians and families often misidentify the symptoms before the rash/smallpox erupts and use other medications to resolve them. Some administer drying drugs, others cold drugs, leading to premature death or injury. Physicians wait until the sores/rashes appear before acting; by then, the family realizes the mistake, the patient stops medication, and the physician stands helpless. After onset, folk customs often prohibit medication, leading to constipation and inability to harmonize the Zang-Fu via decoctions. Consequently, toxic heat remains trapped in the Zang-Fu, attacks the Liver, and even after the rash/smallpox heals, rushes to the eyes, forming cataracts. Without proper medical intervention, the pupils and eyes are damaged, resulting in blindness.
The *Yangsheng Biyong* (Essentials for Health Preservation) discusses the treatment of sores and rashes: The Yangming channel governs the muscles. The toxic qi of sores and rashes exudes into the muscles; upon initial detection, one must use draining herbs to promote drainage and vent the toxicity. Initially, it is difficult to distinguish because it resembles Taiyang Shanghan (Cold Damage). One must examine carefully. Signs in children include body heat, cold ears, cold buttocks, and coughing—these are signs of impending sores/rashes. Throughout the year, if sores/rashes appear similar in size regardless of severity, this indicates epidemic Qi (Yi Qi) and should be treated as such. In Taiyang Shanghan reaching the Yangming channel, draining herbs are also used, but only when the diagnosis of sores/rashes is not yet confirmed. Draining is permissible during doubt; once sores/rashes are confirmed, draining is contraindicated.
Qian Yi discusses the signs of sores/rashes: Dryness of the face with red cheeks, redness of the eye sockets, yawning and mental fogginess, alternating chills and fever, coughing and sneezing, slightly cold hands and feet, night-time sleep disturbance with palpitations, and excessive sleepiness—all are signs of sores/rashes. This is an epidemic disease; it should be treated only with warm-cooling herbs. Do not recklessly use purgatives or aggressive diaphoretic/emetic methods. Exposure to wind-cold results in specific signs for each Zang organ: Liver produces vesicles (Shui Pao); Lungs produce pustules (Nong Pao); Heart produces macules (Ban); Spleen produces papules (Zhen); Kidney transformation results in blackening. Only after macules/rashes does epilepsy occur; other sores rarely cause epilepsy. This is due to Wood overacting on Earth and Wood returning to Fire. For cool-type convulsions, use Cool Pills. For warm-type convulsions, use Pink Red Pills. (Formulas see All Convulsion Categories.)
Qian Yi discusses: During the ten months in the womb, the fetus consumes blood and impurities of the five Zang organs. Upon birth, this toxicity must be expelled. Thus, the manifestations of sores/rashes are fluids of the five Zang organs. The Liver governs tears; the Lungs govern nasal mucus; the Heart governs blood; the Spleen wraps blood. There are five names for the eruptions: Liver manifests as vesicles (Shui Pao); tears flow like water, color is greenish and small. Lungs manifest as pustules (Nong Pao); mucus is thick and turbid, color is white and large. Heart manifests as macules (Ban); governing heart blood, color is red and small, secondary to vesicles. Spleen manifests as papules (Zhen); smaller than macules, governing wrapped blood, so color is yellowish and pale. Abundant mucus and tears result in large pustules and vesicles. Blood nourishes internally and is not discharged much, so macules and papules are small. In cases where the patient has little mucus and tears, it is akin to a bladder losing water, becoming emaciated. Initial tidal fever lasting more than three days, with heat moving into the skin, causes few eruptions because heat remains in the skin and interstices. Tidal fever follows the Zang organs; if tidal fever persists after morning meals, it belongs to the category of vesicles. When sores/rashes emerge, signs of the five Zang organs appear, except for the Kidney, which shows no specific sign but rather normal signs. Cool fontanelle (Xin Kou/KT) and cold ears indicate this. The fontanelle and ears belong to the Kidney, located in the North, governing cold. If sores are black and sunken, but ears and fontanelle are hot, this is a counter-indication (Ni). If *Bai Xiang Wan* (Hundred Fragrance Pill) and *Niu Li Gao* (Ox Plum Paste) are taken for three doses without improvement, it is a fatal case. When sores/rashes emerge, assess severity. If they erupt completely in one wave, the condition is severe. Sores mixed with rashes are moderately severe. Sparse eruptions are mild; plump and red inside and out is mild. Black outside and red inside is slightly severe; white outside and black inside is very severe. Black dots like needle holes at the base of sores indicate severe progression. Green, dry, purple, sunken, coma, continuous sweating, irritability, thirst, abdominal distension, crying and wheezing, and blockage of urine and stool indicate critical exhaustion. For all sores/rashes, the nursing mother must guard her diet, avoid letting the infant go hungry, and prevent exposure to wind-cold; otherwise, the condition will revert to the Kidney, turn black, and become difficult to treat. With high fever, promote urination; with mild fever, resolve toxicity. If black, purple, dry, and sunken, use *Bai Xiang Wan* to purge. (See Sores/Rashes Reversal Category.) If not black, do not purge. Consider the season and severity. Generally, sores/rashes belong to Yang; emergence is favorable (Shun). Thus, spring and autumn illnesses are favorable, winter and summer are unfavorable (Ni). In winter, the Kidney is prosperous, and extreme cold causes many cases to revert to the Kidney and turn black; this requires differentiation. Spring pustules, summer black sunken sores, autumn macules, winter papules are also unfavorable. Even with severe illness, four or five out of ten survive; with blackening, hardly one out of ten survives regardless of timing. Symptoms may include chills, locked jaw, yellow swelling, purple discoloration; urgently use *Bai Xiang Wan* to purge. If chills persist, body becomes cold with sweating, and ears/fontanelle become hot, it is a fatal case. Why? The Kidney Qi is dominant, and Spleen deficiency fails to control it. After purging, if body heat returns, temperature normalizes, and thirst arises, it is treatable. Spleen Earth overcomes Kidney Water, cold dissipates, and warmth returns. Treatment should resolve toxicity; do not recklessly purge. Reckless purging causes internal deficiency, often reverting to the Kidney. If the patient can eat and scabs are dry and raised, or if not dry but with asthma and excess, purging is acceptable. Body heat, irritability, thirst, abdominal distension, asthma, difficulty in urination/defecation, red face, confusion, and severe vomiting require promoting urination; if ineffective, use *Xuan Feng San* to purge. (See Slow Convulsion Category.) If scabs do not dry after five to seven days, it is internal heat steaming the skin, preventing scabbing. Use *Xuan Feng San* to guide it, apply fresh rhino horn juice to resolve heat, ensuring heat does not generate, and scabs will form. Sores/rashes arise from internal mutual overcoming. Only macules/rashes cause convulsions. Papules are generated by the Spleen; Spleen deficiency allows Liver Wood to invade. Wood overcomes Earth, heat qi strikes, disturbing the Heart Spirit. The Heart delights in heat; when Spirit is unsettled, convulsions lead to epilepsy. Macules are governed by the Heart; Heart generates heat, heat generates wind, wind belongs to the Liver. Two Zang organs contend, wind and fire struggle, causing convulsions. Treatment should drain Heart and Liver, tonify their mothers, primarily using *Gua Lou Tang*. (See Slow Convulsion Category.) If sores turn black and suddenly diarrhea occurs, passing pus/blood and scabs is favorable; undigested food/grain is unfavorable. Why? Black sores belong to the Kidney. Spleen Qi is originally strong; if previously taking Spleen-tonifying herbs, Spleen Qi is solid. Although Kidney is active, Spleen can control it. Now, sores entering the abdomen discharge pus/blood and scabs; this indicates Spleen strength and Kidney retreat, meaning the disease exits and peace returns. Undigested rice/grain and milk in diarrhea indicates Spleen deficiency failing to control Kidney, causing spontaneous diarrhea; this is difficult to treat.
Qian Yi discusses the root and branch of sores/rashes: The Ten Taifels of Mumin Palace suffered from sores/rashes. Many physicians treated him. The Prince asked: Before the rash emerges, which Zang organ does it belong to? One physician said: Stomach excessive heat. Another said: Shanghan not resolved. Another said: Toxicity from the maternal womb. Qian Shi said: If Stomach heat, why alternating chills and fever? If maternal toxicity, which Zang? Physician said: Spleen and Stomach. Qian said: Since in Spleen/Stomach, why palpitations? Physician had no answer. Qian said: The fetus in the womb, by month six or seven, is formed. Maternal impure fluids enter the child's five Zang organs. By month ten, the stomach tube is full. At birth, the mouth is unclean. The mother wipes it clean, preventing disease. Folk custom uses Coptis chinensis juice to suppress it, claiming to expel umbilical feces and saliva. This is maternal impurity; residual qi enters the child's Zang organs, originally caused by slight cold invasion. Before sores/rashes emerge, all five Zang organs show disease signs. The Zang organ receiving the most impurity will manifest the sores/rashes. Initially, signs include yawning, mental fogginess, palpitations, alternating chills/fever, cold hands/feet, dry/red cheeks, coughing/sneezing—these are complete Zang signs. Yawning/fogginess: Liver. Palpitations: Heart. Alternating chills/fever/cold hands/feet: Spleen. Red cheeks/face, cough/sneeze: Lungs. Kidney has no sign because it is lower in the Fu organs and does not consume impurities. All sores/rashes are five-Zang toxicity. If they emerge归属于 one sign, then Liver vesicles, Lung pustules, Heart macules, Spleen papules; Kidney does not consume toxic impurity and has no such signs. Black sores belong to Kidney, due to carelessness regarding wind-cold and hunger, causing internal deficiency. Again, several doses of *Bao Long Wan* cured it. (See Wind-Heat Category.) Because there were no other signs, before emergence, five-Zang signs appeared; after emergence, it归属于 one Zang.
Qian Yi discusses heat transmitting to sores/rashes: The Fifth Taifei of Sidawang Palace fell from a swing, developed convulsions. Physicians treated with heating herbs, without success. Qian Shi said: Originally acute convulsion, later developed high fever. Must first reduce heat. Used *Da Huang Wan*, *Yu Lu San*, *Xing Xing Wan* plus buffalo horn, dragon bone, and musk to resolve. Unsuccessful. After three days, skin still hot. Qian said: If not resolved in two more days, macules will surely erupt because heat cannot exit. Other physicians initially used diaphoretics to release exterior; exterior heat led to macule generation. Originally, during convulsion, purgative anti-convulsants should have been used; now diaphoresis is contrary. Two days later, macules indeed erupted. Treated with *Bi Sheng Gao*. (See Sores/Rashes Reversal Category.) Healed in seven days.
Qian Yi discusses errors in treating sores/rashes: A Great Wang of Mumin Residence suffered from sores/rashes. Initially treated by Physician Li, then Qian was summoned. Qian left three doses of *Bao Long Wan*. Physician Li used purgatives; the rash became dense. Qian was greatly alarmed, saying: If not transformed downward, it becomes a counter-indication! The Prince said: Physician Li already used purgatives. Qian said: Sores/rashes just emerging, with no other signs, must not be purged. Should only use mild herbs, frequent breast milk/food, and avoid wind-cold. If sores/rashes do not emerge in three days, or emerge slowly, mildly induce eruption; if mild induction fails, increase dosage; if still no emergence, strongly induce. If after strong induction few emerge, and pulse is calm with no signs, the sores were originally sparse; do not induce further. High fever: promote urination. Mild fever: resolve toxicity. If emerging quickly, do not induce or purge. Thus, only use *Bao Long Wan* (See same). If scabs rise and patient can eat, use *Da Huang Wan* to purge (Formula not seen here), stop after one or two stools. Now, purging one day early, sores/rashes could not fully emerge and became very dense; this is difficult to treat, an error. Even if peaceful, three diseases follow: 1. Scabies; 2. Carbuncles; 3. Red eyes. Physician Li could not treat. After three days, black sunken sores appeared; Qian was summoned again, saying: Fortunately, no chills, and the disease is not exhausted. Then used *Bai Xiang Wan* as medicine (See same), assisted by *Niu Li Gao* (See Sores/Rashes Reversal Category), one large dose each. Within five days, sores returned to red and vibrant; healed in seven days. Black belongs to Kidney. Kidney prosperity overcomes Spleen; Earth cannot control Water, thus Spleen deficiency with chills makes it difficult to treat. *Bai Xiang Wan* drains the Bladder Fu organ; if the Fu is not full/excess, the Zang naturally will not be excessive. Why not drain the Kidney? The Kidney governs deficiency and cannot accept draining; if two doses fail, adding cold herbs causes death.
Qian Yi discusses similarities and differences between Shanghan and sores/rashes: Shanghan: Men have heavy body, yellow face; Women have red face, rapid breathing, increased chills; All have hot breath, yawning, mental fogginess, stiff neck. Sores/rashes: Red dry cheeks, frequent sneezing, palpitations, drowsiness, cold four limbs. Shanghan is often treated with diaphoresis. Sores/rashes are treated with warm-mild methods; with high fever, resolve toxicity. See previous discussion.
Qian Yi adds formulas: Infant with cold ears, cold fontanelle, alternating cold/hot hands/feet, red face, intermittent cough/sneeze, palpitations—this is impending sores/rashes. Before recognition, administer *Sheng Ma Ge Gen Tang* (See Single Shanghan Category), *Xiao Du San* (See Sores/Rashes Throat Pain Category); suitable whether emerged or not. Also use *Hu Sui Jiu* (See Sores/Rashes Early Eruption Category), *Huang Bo Gao* (See Sores/Rashes Eye Protection Category, same as *Shenghui Fang*). In summer months with irritability, give *Bai Hu Tang* after eating (See Excess Heat Category), *Yu Lu San* (See Convulsion Category). With intense heat, give *Zi Xue* (See Sores/Rashes Throat Pain Category). With sore throat or ulcers, give *Gan Jie Tang* (See Excess Heat Category), *Gan Lu Yin Zi* (See Sores/Rashes Throat Pain Category). Remainder follows Qian Shi's theory. Same for adults.
Zhang Huan discusses: Pediatric sores/rashes resemble adult Shanghan, though treatments differ. Recovery or danger occurs within six to seven days. Children often suffer this disease; how careful must one be! Sores/rashes arise from accumulated heat in Zang-Fu, steaming toxic heat emitting to four limbs. Children's skin/flesh are tender, prone to this disease. Pathogenic heat in Zang generates smallpox/pustules. Zang belongs to Yin, generally difficult to treat. Pathogenic heat in Fu generates fine rashes. Fu belongs to Yang, generally easy to treat. For nursing infants, up to two or three years old, medication should be minimal. Assess severity, administer decoctions to the nursing mother; she must strictly observe dietary restrictions. Giving decoctions directly to the child, if overdosed, causes burden. For children aged five to ten or older, decoctions can be administered. However, pathogenic heat mostly resides between Spleen and Lungs. If the root is not sought and treated early with decoctions, nourishing heat qi moves to four limbs, causing great harm. As boys grow, skin/flesh become firmer, making toxin expulsion difficult. If sores/rashes are suspected, early purging/drainage makes heat light and easy to treat. Before sores/rashes emerge, heat may overwhelm the Heart, easily moving the Heart Spirit, causing convulsions/epilepsy. If physician's decoctions are mismatched, danger ensues. Once sores/rashes emerge rapidly, do not move/drains, just as premature purging in adult Shanghan is dangerous. Ancient famous physicians include Cang Gong, Bian Que, Sun Simiao, Chao Yuanfang. Discussing pediatric diseases, some decoctions are suitable, others not. First take herbs to harmonize Yin/Yang, adjust Ying/Wei, then drain Zang-Fu, heat gradually removes. Bian Que also says: Before sores/rashes emerge, often misidentified, treated with other drugs, drying or cold drugs, causing premature death. Deeply warn against this. Physicians and families beware! Too late when time comes. Also, protect eyes when sores/rashes want to emerge. If heat rushes to eyes, damaging pupils. Pediatric sores/rashes often enter eyes, generating cataracts. Children aged six to fourteen are considered young males. Initial headache, high fever, heavy back/waist pain. Severe heat causes cold extremities, resembling cold binding; entirely depends on detailed pulse and symptom examination. Pulse is usually surging and rapid, very large and irregular. If urine is dark red, stool constipated, this pattern suits early drainage. Early emerging sores/rashes, once emerged, must not be drained. Zhang Huan previously supplied decoctions in the palace, frequently treated, and these cases recovered peacefully. Treated many outside, dare not exceed ancient theories.
*Zhen Dou Lun* (Discussion on Rashes and Smallpox): Rashes and smallpox arise from heat accumulating in Zang-Fu, steaming toxic qi. If latent heat in Fu organs generates fine rashes/red sores, commonly called chickenpox/moles. If latent heat in Zang organs generates smallpox/pustules, shaped like peas. Initially, heat-toxin accumulates between Spleen and Lungs; if not treated early, flows into Ying/Wei of four limbs, forming disease. Initial symptoms resemble Shanghan, body color and four limbs red, high fever, headache, back/spine pain, only nose/ear tips cold, toe tips cold, plus cough, yellow/green eyes. Urine/stool constipated, both hands surging-rapid pulse—these are rash/smallpox signs. Cases where winter weather is warm, still contracting abnormal Qi, not immediately activating; in spring, compressed by accumulated cold, toxic qi cannot vent; in early summer, getting heat, spring cold resolves, winter-warm toxic qi starts erupting; also those not due to winter-warm, naturally epidemic across four seasons; also pediatric heat-toxin Qi injuring seasonal improper Qi; also feeling cold pathogen with latent heat-toxin true Yuan Qi, mixed with heat-toxin pathogen erupting. Recent medical circles discuss: Smallpox started in Wei-Jin; Hong Kong foot (Gout?) originated late Jin; or obtained by Nanyang Zhenglu during Jianwu era, called Prisoner Sores. Or said: Yonghui Year 4, this disease flowed from Eastern regions to inland. Humans born, Zang-Fu receive cold/heat pathogens becoming ill; whoever contracts it suffers. If saying present exists but past did not, how can it be like plants produced in specific places, leaving descendants transmitted worldwide? Chao Shi also calls it Fa Chuang (Eruptive Sores) and Bao Chuang (Womb Sores)/Fu Chuang (Bran Sores), dividing by Yin/Yang contraction. Whenever people feel non-seasonal warmth in winter, prevent before sores erupt, urgently purge the toxin. Between spring and winter, this disease never absent. Five or six out of ten die prematurely, most dying due to medical error. Because symptom patterns and colors differ, leading to misidentification. Signs include: Three to five days, millet-like bumps all over body, occasional cough, cold ear tips, cold hair/slow skin, dry eyes unable to open, feeling cold wanting warmth covering. At initial detection, use *Bo He San* to mildly sweat, then advance *Tiao Zhong San* (Two formulas see Sores/Rashes Emerged/Not Emerged Category). Sores self-heal. If *Bo He San* sweat not out, also take *Tiao Zhong San*, sweat out gradually resolving. If chills/fever with reverse slow pulse, advance *Tuo Chi San* (See Sores/Rashes Not-Emerging Fast Category). Or patient chills/fever unstable, dry eyes, cold nose/ears, this pathogenic toxin not transmitting to...