疮疹发热，与伤寒相似，但伤寒只见一经形证，若疮疹则面燥腮赤，呵欠顿闷，乍凉乍热，多睡咳嗽，喷嚏
惊悸，吐利手足稍冷， 凉耳凉也。然发热者，疮疹常候也，不可尽除之，但热微毒亦微，热甚毒亦甚。
初发热时精神清爽，唇鼻滋润，更无他证者，此热在表，其疮必疏，不须施治。初发热时浑身壮热，
然不渴，清便自调，此邪在表，拂郁于皮肤之间，宜以轻扬之剂发之，升麻葛根汤主之（初热），甚则羌活汤主之（本条）。
初发热时，其热烙手，目赤鼻干唇燥，小便赤，大便秘，烦闷不安，此表里俱热，毒瓦斯壅遏，宜发表攻里，
双解散主之（初热）。初发热时，表不大热，其人烦躁不安，此热在里也，以三黄丸微利之（本条）。初发热时，或乘疫
疠之气，人参败毒散主之（初热）。初发热时，或为风寒所袭，出不快者，桂枝葛根汤、羌活汤、双解散去大黄
主之（三方俱见初热）。
痘疮之证，其初不免于发热者，未出，毒邪在里，煎熬气血，熏蒸脏腑而然，疮既现形，则毒泄而热解，所以疮
出热退者，疮本必疏。若疮已出，热不少减，此毒蕴于中，其势方张，其疮必密，宜急解其毒，连翘升麻汤（见形）加
防风、
荆芥穗、地骨皮，或解毒防风汤（大法）加升麻，或东垣鼠粘子汤（见形）兼服代天宣化丸（预防），服药之后，
疮或不出，或再出，其热顿减者，为气和也。热若不减，疮渐加多，再消详大小便何如，大便不通，七物升麻丸（初热）。
小便不利，连翘汤（小便不利）。小大便俱不通，八正散（小便不利）。自利者，黄芩汤（自利）加白头翁、酒黄连、
调赤石脂末，里气和，毒解矣。
如更加渴，烦躁不已，或谵妄，或腹胀满气促，或自利不止，手足厥冷，此逆证勿治。如疮已出，但微发热，不须
治之，盖疮疹属火，非热不能成就也（以上见形而热）。
钱氏云∶有大热，则当利小便。小热当解毒。大热，谓身热脉实，大小便秘，津液燥而渴，惧其变生他疾，故利
小便，八正散、通关散，大便润者连翘汤（三方俱见小便不利），导赤散（心）加人参、麦门冬，使心火有所导引，则虽
不用冷药，热亦自减去矣，疮痘不至热过，不为冷误，甚为良法。小热解毒之说，谓小热不解，大热必
生，利其小便、则虑损气，故但可解毒而已，甘桔汤（咽喉）加牛蒡子、荆芥穗（以上起发而热。）
如疮浆脓已成，毒瓦斯已尽，又复发热者，俗呼为干浆，不须施治。
如结痂之后，其热不退者，此邪气未尽，正气未复，热微者不须治之，热甚者当视其虚实。
羌活汤
羌活 川芎 防风 山栀子 龙胆草 当归（各等分） 甘草（减半）
上锉细。加薄荷叶少许，淡竹叶水一盏，煎七分，去滓，温服无时。
加味葛根汤 治痘失表，发热谵语。
升麻 葛根 赤芍 甘草 桔梗 柴胡 荆芥 防风 连翘 牛蒡子 木通
上，水煎服。
如圣汤 治痘已出，身热如火。
紫草 升麻 葛根 白芍 甘草 木通 猴梨
各等分，加姜一片，葱白三茎，水煎，热服。心烦，加麦门冬、赤茯苓。烦
渴，加生脉散。七八九日身如火者，加酒炒黄芩、地骨皮。
柴胡麦门冬汤 治痘壮热，经日不退。
柴胡 麦门冬 甘草 人参 玄参 龙胆草
上，水煎服，热退，即止。一方，无人参。
〔丹〕胡宅痘疮发热，此血少有余毒也。
陈皮 白术 当归身 白芍药（各三钱） 牛蒡子（研破，炒，二钱） 木通 犀角 生甘草 川芎（各一钱半）
上，分六帖，水盏半煎，食前，稍热服。
〔活〕连翘散 治一切热，兼治疮疹如神。
连翘 防风 栀子 甘草（各等分）
上为末。水煎服。（海藏云，治热在外而不厥，此少阳药也。）
易老云凉膈去大黄、芒硝者，能解六经中热，此不惟解热，治小儿 疹热候，亦使
发之，则本药与防风荆芥二物各半，白水煎服。
〔河〕栀子金花丸
黄芩 黄连 黄柏 山栀（炒。各等分）
上为末。滴水、丸如豆子大。每服五丸，白汤下。
〔钱〕三黄丸 治诸热。
黄芩（半两） 大黄（煨） 黄连（各二钱半）
上为细末。糊丸，绿豆大。每服五七丸至十五二十丸，食后，米饮送下。
上，钱氏云∶有小热者解毒。海藏谓∶解毒者，三黄丸、金花丸、之类是也。
四圣散 〔海藏〕紫草木通汤（二方俱见形） 导赤散（心） 八正散（小便不利）
〔丹〕有初起烦躁谵语，狂渴引饮，若饮水，则后来靥不齐，急以凉药解其标，如益元散之类可用。
上五方，利小便、退热之剂，钱氏云∶有大热者，利小便。又云∶身热烦渴，
腹满而喘，大小便涩，面赤闷乱大吐，此当利小便，盖此用导赤散之类是也。
〔钱〕 宣风散
槟榔（两个） 陈皮 甘草（各半两） 牵牛（四两，半生半熟）
上为细末。三二岁蜜汤调下五分，以上一钱，食前。易老加防风。
通膈丸 利上下气血药也。
大黄 牵牛 木通（各等分）
上为细末。滴水、丸如粟粒大。每服三五十丸，量儿大小虚实加减。
上，钱氏云∶有大热，利小便不瘥者，宜宣风下之。
[Fever]
Fever caused by smallpox and chickenpox resembles that of cold damage (Shanghan), but cold damage manifests only as symptoms of a single meridian, whereas smallpox/chickenpox presents with dry face, red cheeks, yawning with drowsiness, alternating chills and fever, excessive sleepiness, coughing, sneezing, palpitations with fright, vomiting and diarrhea, and slightly cold hands and feet (cool ears are also indicative). However, fever is a common symptom of smallpox/chickenpox and should not be completely eliminated. Mild heat implies mild toxin, while severe heat implies severe toxin.
At the initial stage of fever, if the spirit is clear, lips and nose are moist, and there are no other symptoms, this indicates heat in the exterior; the lesions will necessarily be sparse, and no treatment is required. At the initial stage of fever, if there is high fever throughout the body but no thirst, and urination and defecation are normal, this indicates pathogenic factors in the exterior, constrained within the skin. It is appropriate to use light, ascending, and dispersing agents to induce sweating and release the exterior. The primary formula is Shengma Gegen Tang (Cinnamon Twig and Pueraria Decoction) for the initial heat stage; in severe cases, Qianghuo Tang (Notopterygium Decoction) may be used. At the initial stage of fever, if the heat burns upon touch, eyes are red, nose is dry, lips are cracked, urine is dark red, stool is constipated, and there is restlessness and oppression, this indicates heat in both the interior and exterior, with toxic qi stagnating. It is appropriate to employ methods to release the exterior and purge the interior. The primary formula is Shuangjie San (Double Resolution Powder) for the initial heat stage. At the initial stage of fever, if the exterior is not significantly hot but the patient is restless and irritable, this indicates heat in the interior; treat with Sanhuang Wan (Three Yellows Pill) to mildly promote bowel movement. At the initial stage of fever, if it is due to epidemic pestilence qi, Renshen Baidu San (Ginseng Detoxification Powder) is indicated. At the initial stage of fever, if it is due to wind-cold invasion causing slow eruption, Guizhi Gegen Tang (Cinnamon Twig and Pueraria Decoction), Qianghuo Tang (Notopterygium Decoction), or Shuangjie San (Double Resolution Powder) without Dahuang (Rhubarb Rhizome) are indicated (all three formulas are seen in the initial heat stage).
In the case of smallpox, fever is inevitable at the beginning because before eruption, the toxic pathogen is inside, boiling blood and qi, and steaming the zang-fu organs. Once the lesions appear, the toxin is released and the heat resolves; thus, those whose heat subsides after eruption have inherently sparse lesions. If the heat does not decrease after eruption, it indicates toxin accumulation internally with vigorous pathological momentum, implying dense lesions. Urgent detoxification is required. Use Liaoqiao Shengma Tang (Forsythia and Cimicifuga Decoction) [seen in the manifestation stage] plus Fangfeng (Saposhnikovia Root), Jingjiesui (Schizonepeta Spike), and Digupi (Phellodendron Bark); or Jiedu Fangfeng Tang (Detoxifying Saposhnikovia Decoction) [general principle] plus Shengma (Cimicifuga Rhizome); or Dongyuan Niuzangzi Tang (Dongyuan's Arctostaphylos Decoction) [seen in the manifestation stage] combined with Ditian Xuanhua Wan (Heavenly Announcement Transformation Pill) for prevention. After taking medicine, if lesions do not erupt or re-erupt, and heat suddenly decreases, this indicates harmonious qi. If heat does not decrease and lesions gradually increase, carefully examine urination and defecation: if stool is unpassable, use Qiwu Shengma Wan (Seven-Ingredient Cimicifuga Pill) [initial heat]; if urination is difficult, use Liaoqiao Tang (Forsythia Decoction) [urinary difficulty]; if both urination and defecation are blocked, use Bazheng San (Eight-Ingredient Corrective Powder) [urinary difficulty]; if spontaneous diarrhea occurs, use Huangqin Tang (Scutellaria Decoction) [spontaneous diarrhea] plus Baitouweng (Pulsatilla Root), Jiuhuanglian (Wine-processed Coptis Rhizome), and mixed with Chishizhi powder (Red Halloysite), so that interior qi harmonizes and toxin resolves.
If accompanied by increased thirst, incessant irritability, delirium, abdominal distension with shortness of breath, or incessant diarrhea with cold extremities, this is a adverse syndrome (Ni Zheng) and is untreatable. If lesions have erupted but only slight fever remains, no treatment is needed, as smallpox/chickenpox belongs to fire and requires heat to mature (above refers to fever during the manifestation stage).
Qian Yi stated: For great heat, one should promote urination. For slight heat, one should resolve toxicity. "Great heat" refers to body fever, solid pulse, constipation of both stool and urine, dry fluids with thirst, fearing the generation of other diseases; thus, promote urination using Bazheng San (Eight-Ingredient Corrective Powder), Tongguan San (Passage-Pass Powder), or Liaoqiao Tang (Forsythia Decoction) if stool is moist (these three formulas are seen under urinary difficulty); Daochi San (Guide Out Red Powder) [for Heart] plus Renshen (Ginseng Root) and Maimendong (Ophiopogon Tuber) to guide heart fire downward. In this way, even without cold medicines, heat will naturally subside, preventing excessive heat in lesions and avoiding errors from cold medicines; this is an excellent method. Regarding resolving toxicity for slight heat: if slight heat is unresolved, great heat must arise. Promoting urination risks damaging qi, so one should only resolve toxicity, using Ganji Tang (Licorice and Platycodon Decoction) [for throat] plus Niubangzi (Arctostaphylos Seed) and Jingjiesui (Schizonepeta Spike) (above refers to fever during the rising stage).
If pustules are formed and toxins exhausted, yet fever recurs, commonly called "dry pus," no treatment is required.
If fever persists after scabbing, it indicates incomplete elimination of pathogenic factors and recovery of healthy qi. Slight heat needs no treatment; severe heat requires differentiation of deficiency and excess.
Qianghuo Tang (Notopterygium Decoction)
Ingredients: Qianghuo (Notopterygium Rhizome), Chuanxiong (Ligusticum Rhizome), Fangfeng (Saposhnikovia Root), Shanzhizi (Gardeniae Fructus), Longdancao (Gentiana Root), Danggui (Angelica Sinensis Root) (equal parts); Gancao (Licorice Root) (half dose).
Preparation: Coarsely powdered. Add a little Boheye (Mentha Leaf), decoct one cup of Danzhuyeshui (Bamboo Leaf Water) to seven-tenths, remove dregs, and take warm at any time.
Jiawei Gegen Tang (Modified Pueraria Decoction) Treats smallpox where exterior release was neglected, causing fever and delirium.
Ingredients: Shengma (Cimicifuga Rhizome), Gegen (Pueraria Root), Chishao (Red Peony Root), Gancao (Licorice Root), Jiegeng (Platycodon Root), Chaihu (Bupleurum Root), Jingjie (Schizonepeta Spike), Fangfeng (Saposhnikovia Root), Liaoqiao (Forsythia Fruit), Niubangzi (Arctostaphylos Seed), Mutong (Akebia Caulis).
Preparation: Decoct in water and take.
Rusheng Tang (Like-Sage Decoction) Treats smallpox already erupted, with body heat like fire.
Ingredients: Zicao (Lithospermum Root), Shengma (Cimicifuga Rhizome), Gegen (Pueraria Root), Baishao (White Peony Root), Gancao (Licorice Root), Mutong (Akebia Caulis), Houli (Monkey Pear - likely a local variant or typo for another herb, kept as transliteration) (equal parts).
Preparation: Add one slice of Shengjiang (Fresh Ginger), three stalks of Congbai (Scallion White), decoct in water, and take hot. For mental distress, add Maimendong (Ophiopogon Tuber) and Chi Fuling (Red Poria). For irritability and thirst, add Shengmai San (Generate Pulse Powder). For body heat like fire on days 7-9, add Jiuhuangqin (Wine-processed Scutellaria Root) and Digupi (Phellodendron Bark).
Chaihu Maimendong Tang (Bupleurum and Ophiopogon Decoction) Treats severe smallpox fever persisting for days.
Ingredients: Chaihu (Bupleurum Root), Maimendong (Ophiopogon Tuber), Gancao (Licorice Root), Renshen (Ginseng Root), Xuanshen (Scrophularia Root), Longdancao (Gentiana Root).
Preparation: Decoct in water and take. Stop when heat subsides. Another version excludes Renshen (Ginseng Root).
[Zhu Danxi] Hu family's smallpox fever is due to blood deficiency with residual toxin.
Ingredients: Chenpi (Tangerine Peel), Baizhu (Atractylodes Macrocephala Rhizome), Dangguishen (Ginseng-like part of Angelica Root), Baishaoyao (White Peony Root) (each 3 qian), Niubangzi (Arctostaphylos Seed) (crushed, fried, 2 qian), Mutong (Akebia Caulis), Xijiao (Rhinoceros Horn - *Note: Substitute with Buffalo Horn in modern practice*), Sheng Gancao (Raw Licorice Root), Chuanxiong (Ligusticum Rhizome) (each 1.5 qian).
Preparation: Divide into six doses. Decoct in one and a half cups of water. Take slightly warm before meals.
[Liu Wansu/Zhang Yuansu related] Liaoqiao San (Forsythia Powder) Treats all types of heat, and miraculously treats smallpox/chickenpox.
Ingredients: Liaoqiao (Forsythia Fruit), Fangfeng (Saposhnikovia Root), Zhizi (Gardeniae Fructus), Gancao (Licorice Root) (equal parts).
Preparation: Powdered. Decoct in water and take. (Haizang said: Treats heat outside without cold limbs; this is a Shaoyang meridian formula.)
Yilao (Zhang Yuansu) stated: Liangge San (Cool the Diaphragm Powder) without Dahuang (Rhubarb Rhizome) and Mangxiao (Mirabilite) can resolve heat in the six meridians. This not only resolves heat but also promotes eruption in pediatric smallpox/chickenpox heat syndromes. In such cases, use half the original formula and half each of Fangfeng (Saposhnikovia Root) and Jingjie (Schizonepeta Spike), decocted in plain water.
[Wang Haogu] Zhizi Jinhua Wan (Gardenia Golden Flower Pill)
Ingredients: Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Huangbai (Phellodendron Bark), Zhizi (Gardeniae Fructus) (fried, equal parts).
Preparation: Powdered. Mix with water to form pills the size of beans. Take five pills per dose with warm water.
[Qian Yi] Sanhuang Wan (Three Yellows Pill) Treats various heats.
Ingredients: Huangqin (Scutellaria Root) (0.5 liang), Dahuang (Rhubarb Rhizome) (roasted), Huanglian (Coptis Rhizome) (each 2.5 qian).
Preparation: Fine powder. Make pills with paste, size of mung beans. Take 5-7 to 15-20 pills per dose after meals, delivered with rice drink.
As mentioned above, Qian Yi said: Resolve toxicity for slight heat. Haizang stated: Resolving toxicity involves formulas like Sanhuang Wan (Three Yellows Pill) and Jinhua Wan (Golden Flower Pill).
Six Holy Powder [Haizang] Zicao Mutong Tang (Lithospermum and Akebia Decoction) [both formulas seen in manifestation stage] Daochi San (Guide Out Red Powder) [Heart] Bazheng San (Eight-Ingredient Corrective Powder) [Urinary Difficulty]
[Zhu Danxi] In early onset, if there is irritability, delirium, manic thirst leading to drinking, and if drinking leads to uneven scabs later, urgently use cold medicines to resolve the superficial symptoms, such as Yiyuan San (Benefit Origin Powder).
The above five formulas are agents for promoting urination and reducing fever. Qian Yi said: For great heat, promote urination. He also said: Body fever with irritability and thirst, abdominal fullness with wheezing,涩 (astringent/hard) urination and defecation, red face with oppression and confusion, and massive vomiting—this requires promoting urination, using formulas like Daochi San (Guide Out Red Powder).
[Qian Yi] Xuanfeng San (Dispel Wind Powder)
Ingredients: Binglang (Areca Seed) (two pieces), Chenpi (Tangerine Peel), Gancao (Licorice Root) (each 0.5 liang), Qianniu (Morning Glory Seed) (4 liang, half raw, half cooked).
Preparation: Fine powder. For children aged 2-3, mix with honey water and take 0.5 fen; older children take 1 qian, before meals. Yilao adds Fangfeng (Saposhnikovia Root).
Tongge Wan (Unblocking Diaphragm Pill) An agent to unblock qi and blood in the upper and lower jiao.
Ingredients: Dahuang (Rhubarb Rhizome), Qianniu (Morning Glory Seed), Mutong (Akebia Caulis) (equal parts).
Preparation: Fine powder. Mix with water to form pills the size of millet grains. Take 30-50 pills per dose, adjusting according to the child's age and deficiency/excess status.
As mentioned above, Qian Yi said: For great heat, if promoting urination fails, use Xuanfeng San (Dispel Wind Powder) to purge.