（凡一十五首，共二十五方）
痘疮初起身先热，轻重吉凶何以别？热轻毒浅吉堪云，热重毒深凶可说。
凡发热乍进乍退与微热者，其痘必稀而轻，毒亦浅，不必服药；若蒸蒸作热，烦躁昏眩，其痘必密而重，毒
亦深，宜发表解毒托里，加味葛根汤。
初逢热渴邪藏里，切忌冰瓜与冷水。生津止渴是良图，小渴任之而已矣。
凡发热作渴，因痘毒内蒸，销其津液，故令口干而渴。微者频以炒米汤与之，切不可以冷水、冻柿、柑梨、
西瓜、菱角之类，食之反伤胃气，亦不可以椒姜汤饮之，恐生疮毒而有他变。渴甚不止，宜解毒葛根汤。
如痘已出齐，或起发，或收靥而渴不止者，宜人参麦冬散。
如泄泻不止而作渴者，此脾胃虚弱，津液枯也，宜七味白术散。
腹痛刚逢发热时，毒攻于里报君知。大肠秘结须攻下，莫待临危悔已迟。
书云∶发热腹中痛，痘疮毒内攻，发多生不久，发少更防痈。可见痘疹腹痛，即是毒瓦斯内攻，盒饭托里化
毒为上，不可逡巡以生他变。若饮食如常而腹痛者，宜化毒汤。如大便秘结，烦躁作渴而腹痛者，宜三黄解毒
汤；若泄泻而腹痛者，宜建中托里汤。
发热腰疼毒伏留，几人逢此得优游。人参败毒真奇绝，痛减疮稀病可瘳。
凡痘疹发热腰痛，其证最恶，速用人参败毒散托之。服药痛止者吉，不止者凶。
初时发热多风搐，要识病源属肝木。木能胜土又归心，风火相争脾不足。
凡痘疮发热有作搐者，因木邪盛而侮土，以导赤散加辰砂服之即止。此痘甚好，以搐搦发散于四肢故也。
如痘应出不出，而搐搦不止，宜泻青导赤散解之；服药后搐止，但心烦啼叫，用麦冬导赤散清之。
若痘已收靥，余热不退而作搐，此大虚之候，多不可救。但父母不忍坐视，强而治之，当以宁神汤合抱龙
丸，倍加人参服之。轻者可愈。
热时吐泻相兼作，上下毒伸无郁遏。三焦火盛热中求，日久须防脾胃弱。
凡痘疮发热，有呕吐者，有泄泻者，有吐泻兼作者，不可骤止，令毒上下得出。但痘疮现形，吐泻即止者，
吉兆也。如久不止，先以理中汤和之；如仍不止，以豆蔻丸止之。服药后吐泻既止，更服调中汤，使脾气实，其
痘易壮易靥也。
狂言躁扰疑逢鬼，神识昏迷热在里。镇心解毒以平期，谵妄不休应不起。
凡痘疮发热，妄有所见而谵语者，或昏昏好睡，梦中呓语喃喃，或狂走，寻衣摸床，皆毒瓦斯内攻，神识不清
所致也。急用镇心解毒之药，以辰砂导赤散主之，服药神情复旧者吉，不止则凶，不可治也。
浑身发热四肢寒，脾胃虚衰阴冷干。益气补中应令暖，仍前疮盛急寻棺。
凡痘疮浑身宜热，独耳尻二处宜凉，所以痘疹之证，头宜凉，手足宜温。若反冷者，此脾胃虚弱也。四肢
脾胃所司，宜补中益气，扶其中气斯可矣。
发热熏蒸血妄行，不知何道血如倾？但从鼻出方无忌，别道来时祸立萌。
人身之血不可妄动。痘疹之火，熏烁于内，迫血妄行，随火而动。或从口出，或从大小便出，皆死证也。
但从鼻出者，或有可救之机，宜玄参解毒汤清之。若烦躁闷乱，出血不止，此阳痘出血之证，多不可治。
晨昏发热浑无歇，口舌生疮唇破裂。咽喉塞痛食难尝，方用黄连及甘桔。
凡痘未出而热不止，昼夜烦躁，口舌生疮，唇裂咽痛，此毒火熏蒸，其热甚急，治
不宜缓，急以黄连解毒汤合甘桔汤治之。服药不效者，不治。
微微热汗吉之机，腠理疏通毒发稀。但恐汗多阳气弱，调元固胃效无违。
凡痘疹发热自汗，此不必治。盖腠理疏通，毒瓦斯发越，无郁遏也。所以古人喻如庖人蒸笼之法，但欲其松
耳。如恐汗出太多，卫气反弱，痘疮不能成就，用调元汤以止之。
恶热憎寒且战兢，表虚邪正两相凌。但将柴葛加官桂，升散余邪吉可称。
痘疹所忌者寒战。如发热之时，憎寒振振战动者，其人表气素虚，痘疹欲出不出，留连于肌腠之间，邪正交
争。振战，火之象也，宜柴葛桂枝汤升散之。
发热绵绵不现形，其间凶吉费调停。解肌托里须斟酌，施治详明内外宁。
凡痘发热三日便出者，常期也。如过四五日犹不出，热势绵绵无休歇者，吉凶之兆未可卜也，急与解肌托
里，分内外治之。疏者吉，密者凶。
如劳苦之人，皮肤粗浓，腠理闭塞，及风寒外感，疮为外邪所遏，不易出者，此外因也。宜麻黄解毒汤。
如因虚吐泻，毒瓦斯内陷而不出，及伤饮食，陈物菀 肠胃之间，与毒合并，郁而不出者，此内因也。体虚
者，以托里十补汤托之，体实者，以枳实导滞汤微利之。
发表之时少定方，古人专用葛根汤。能通权变知增减，何必劳劳问短长。
时师治痘，方其发热，但知用葛根汤，一见红点，便禁而不用，此乃不知权变者也。如痘见热除，表里无
邪，所以不可再用葛根汤；若痘已见，热甚不退，此毒深于内。尚恐葛根汤，力小不足胜任，宁可止而不饮耶！
解毒升麻汤最良，红斑虽见饮何妨。时师胶柱无变通，一见红斑未敢尝。
凡痘发热，初用解毒之剂，详见各条之下，此不重赘，但附葛根汤加减之例于后，俾临证择用可也。
(Comprising fifteen songs, involving twenty-five formulas)
When the smallpox rash first appears, the body initially develops a fever. How to distinguish between mild and severe conditions, and auspicious and ominous signs? A mild fever with shallow toxin indicates an auspicious prognosis; a heavy fever with deep-seated toxin indicates an ominous prognosis.
In cases where the fever fluctuates or is merely slight, the rash will necessarily be sparse and the condition mild, with shallow toxin; medication is not required. However, if there is persistent high heat accompanied by restlessness, dizziness, and confusion, the rash will necessarily be dense and the condition severe, with deep-seated toxin. In such cases, one should employ methods to release the exterior, clear heat, resolve toxicity, and support the interior using Modified Gegen Decoction (Puerariae Radix Decoction).
When encountering initial fever and thirst, it is because the pathogenic factor is hidden within the interior. One must strictly avoid ice-cold melons and cold water. Generating fluids and relieving thirst is the proper approach; for mild thirst, allowing nature to take its course is sufficient.
Fever accompanied by thirst occurs because the smallpox toxin steams internally, consuming body fluids, thus causing dry mouth and thirst. For mild cases, frequently administering fried rice soup is appropriate. One must absolutely not consume cold water, frozen persimmons, citrus fruits, pears, watermelons, or water chestnuts, as these damage stomach qi. Nor should one drink pepper and ginger tea, lest it provoke skin sores and cause other complications. If thirst is extreme and unrelenting, Jiexu Gegen Tang (Gegen Decoction for Resolving Toxicity) should be used.
If the rash has fully erupted, or is in the rising stage, or in the crusting stage, yet thirst persists, Renshen Maidong San (Ginseng and Ophiopogon Powder) is indicated.
If diarrhea is unceasing accompanied by thirst, this indicates spleen and stomach deficiency with withered fluids; Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder) is indicated.
Abdominal pain occurring simultaneously with initial fever signals that the toxin is attacking the interior. If the large intestine is constipated, purgation is necessary; do not wait until the critical stage to regret being too late.
Texts state: "Fever with abdominal pain indicates internal attack by smallpox toxin; numerous eruptions suggest imminent death, while few eruptions require vigilance against abscesses." Thus, abdominal pain during smallpox signifies internal toxin attack. The superior strategy is to support the interior and transform toxicity. Hesitation may lead to further complications. If dietary intake remains normal but abdominal pain exists, Huadu Tang (Toxin-Resolving Decoction) is indicated. If accompanied by constipation, restlessness, thirst, and abdominal pain, Sanhuang Jiedu Tang (Three-Yellow Toxin-Resolving Decoction) is indicated. If accompanied by diarrhea and abdominal pain, Jianzhong Tuoli Tang (Interior-Supporting Decoction) is indicated.
Fever accompanied by lower back pain indicates toxin retention. Few survive this condition comfortably. Ren Shen Bai Du San (Ginseng and Detoxification Powder) is truly miraculous; as pain subsides and the rash becomes sparse, the disease can be cured.
Fever with lower back pain in smallpox is a most malignant sign. Immediately use Ren Shen Bai Du San to support the interior and expel toxins. If pain ceases after medication, it is auspicious; if not, it is ominous.
Initial fever often presents with wind-induced convulsions. Recognize that the root lies in Liver Wood. Excessive Liver Wood overacts on Spleen Earth and affects the Heart, leading to a struggle between Wind and Fire and resulting in Spleen deficiency.
Convulsions during smallpox fever occur due to excessive Liver Wood pathogen overacting on Spleen Earth. Administer Daochi San (Guide Out Redness Powder) with Cinnabar (Chensha); convulsions will cease. This is a favorable sign, as convulsions help disperse toxins to the limbs.
If the rash should erupt but fails to do so, and convulsions persist, Xieqing Daochi San (Drain Green and Guide Out Redness Powder) should be used to resolve the condition. After convulsions cease but irritability and crying remain, Maidong Daochi San (Ophiopogon Guide Out Redness Powder) clears the heart.
If convulsions occur after the rash has crusted, with residual heat remaining, this is a sign of severe deficiency, often incurable. Reluctant parents insisting on treatment should administer Ning Shen Tang (Spirit-Calming Decoction) combined with Baolong Wan (Embracing Dragon Pill), with doubled Ginseng dosage. Mild cases may recover.
Vomiting and diarrhea occurring simultaneously with fever indicate toxins extending upward and downward without obstruction. When Sanjiao (Triple Burner) fire is excessive, seek relief through clearing heat; beware of spleen and stomach weakness over time.
During smallpox fever, vomiting, diarrhea, or both may occur. Do not abruptly stop them; allow toxins to exit from above and below. If vomiting and diarrhea cease once the rash manifests, it is an auspicious omen. If they persist, first harmonize with Lizhong Tang (Regulate Middle Decoction); if still uncontrolled, use Doukou Wan (Cardamom Pill). Once controlled, administer Tiaozhong Tang (Middle-Harmonizing Decoction) to strengthen spleen qi, facilitating robust rash development and crusting.
Delirious speech and agitation suggest mental disturbance; coma indicates heat trapped in the interior. Use heart-calming and detoxifying agents to restore balance. Unremitting delirium suggests a fatal outcome.
Smallpox fever with hallucinations, muttering in sleep, running wildly, or groping at bedding results from internal toxin attack clouding the spirit. Urgently use heart-calming and detoxifying herbs, primarily Zhensha Daochi San (Cinnabar Guide Out Redness Powder). Recovery of mental clarity is auspicious; persistence is ominous and incurable.
Generalized fever with cold limbs indicates spleen and stomach deficiency and yin cold. Tonify qi and supplement the middle to restore warmth. If the rash remains severe despite warming measures, the prognosis is poor (prepare for coffin).
Generally, the body should be warm during smallpox, except for the ears and sacrum which should be cool. The head should be cool, and extremities warm. Cold extremities indicate spleen and stomach deficiency. Since limbs are governed by the spleen and stomach, tonify the middle qi with Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction).
Intense heat steaming causes blood to move recklessly. Hemorrhage from the nose is relatively safe; hemorrhage from other orifices portends immediate disaster. Blood should not move recklessly. Smallpox fire scorches internally, forcing blood to follow the heat. Bleeding from the mouth or bowels/bladder is a death sign. Nasal bleeding offers a chance for rescue; use Xuanshen Jiedu Tang (Scrophularia Toxin-Resolving Decoction) to clear heat. Restlessness with unceasing bleeding indicates malignant yang smallpox hemorrhage, usually incurable.
Day and night fever without respite, ulcers on tongue and mouth, cracked lips, and sore throat obstructing food intake. Use Huanglian Ganjie Tang (Coptis and Licorice-Katier Decoction).
Persistent fever before eruption, day and night restlessness, oral ulcers, cracked lips, and sore throat indicate intense toxic fire. Treatment must not be delayed. Urgently use Huanglian Jiedu Tang (Coptis Toxin-Resolving Decoction) combined with Ganjie Tang. Ineffectiveness implies incurability.
Slight fever with spontaneous sweating is auspicious, indicating open pores and dispersed toxins. However, excessive sweating weakens yang qi; use Tiaoyuan Guwei Tang (Origin-Regulating and Stomach-Firming Decoction) to prevent this.
Spontaneous sweating during smallpox fever requires no treatment, as open pores allow toxin dispersion. Ancient texts compare this to steaming baskets, requiring looseness. If excessive sweating threatens wei qi and rash maturation, use Tiaoyuan Tang to stop sweating.
Aversion to heat, aversion to cold, and shivering indicate exterior deficiency with pathogen-righteous qi conflict. Use Chaihu Gegen Tang (Bupleurum and Pueraria Decoction) plus Guizhi (Cinnamon Twig) to ascend and disperse residual pathogens for a good outcome.
Shivering during fever is contraindicated in smallpox. Shivering indicates inherent exterior deficiency, with the rash lingering in the muscle layer due to pathogen-righteous qi struggle. Shivering reflects fire; use Chaige Guizhi Tang to disperse.
Continuous fever without rash emergence requires careful judgment of auspicious/ominous signs. Employ muscle-releasing and interior-supporting methods, distinguishing interior/exterior treatments. Sparse rash is auspicious; dense is ominous.
For laborers with thick skin and closed pores, or those with external wind-cold blocking the rash, use Mahuang Jiedu Tang (Ephedra Toxin-Resolving Decoction). For internal causes like deficiency-induced diarrhea trapping toxins, or food stagnation merging with toxins, use Tuoli Shibu Tang (Interior-Supporting Ten-Tonic Decoction) for deficient constitutions, or Zhishi Daoshi Tang (Immature Bitter Orange Guiding Stagnation Decoction) for robust constitutions to mildly purge.
Regarding exterior-releasing methods, ancient texts specifically used Gegen Tang. Understanding flexibility and modification is key, rather than rigid adherence.
Contemporary physicians only use Gegen Tang during fever and stop upon seeing red spots, lacking flexibility. If heat resolves after eruption, Gegen Tang is unnecessary. However, if heat persists after eruption, the toxin is deep inside; stopping medication would be unwise. Even if Gegen Tang seems weak, Shengma Jiedu Tang (Cimicifuga Toxin-Resolving Decoction) is superior. Contemporary physicians fear using it upon seeing red spots, lacking adaptability.
Initial use of detoxifying agents is detailed in respective sections. Here, examples of Gegen Tang modifications are provided for clinical reference.