凡疮未出而利者，邪气并于里，肠胃热甚，而传化失常也，黄芩汤主之。如自
利清白色者，为里寒，理中汤主之。
黄芩汤
黄芩（一钱半） 甘草（炙，一钱） 白芍药（六钱）
上锉细。加大枣二枚，水一盏，煎七分，温服，食前。
疮已出而利者，邪气并于表，正气方逐邪气，主乎表而不主里，则里气虚，不能停纳水谷，故亦自利也，
宜从气虚而治（九味理中汤倍人参，加黄 、白芍药）。
九味理中汤
人参（二钱） 白术 干姜（炮） 诃子肉 茯苓 木香 藿香叶 肉豆蔻（煨） 甘草（炙，各一钱）
水煎，食前通口服。
疮疹所忌，内虚泄泻，凡觉腹疼，或漉漉响趋小腹者，皆欲作利，宜先以法治
之（九味理中汤）。治之不止，此开肠洞泄，惟涩剂可以收之（豆蔻丸，不止，则用真鸦片配莲肉粉止之）。
庸医每不敢用涩药，恐涩住邪气，不知邪气之盛，莫如伤寒，而张仲景治挟热自利，每用石脂，盖涩剂之去滑，
犹寒剂之去热，热剂之去寒，是谓对证之药，今既滑泄不已，自当收涩，又何疑焉。如服涩剂而又不止，则根
本已拨，无能为矣。经曰∶仓廪不藏者，是门户不要也。《金匮要略》曰∶六腑气绝于外者，手足寒，五脏气绝
于内者，利不止。五夺之中，此为最甚，但正气内脱者淹延而死，邪气内陷者烦渴而死，此为异耳。
陈氏豆蔻丸 治痘疹泄泻。
木香 砂仁 白龙骨 诃子肉 肉豆蔻（面裹煨。各半两） 赤石脂 枯白矾（各七钱半）
上为末。糊丸，如黍米大。一岁三十丸，三岁百丸，温米饮下。泻止，勿服。
自起发以至收靥，大便常宜坚实，忽然自利者，理中汤丸主之。
理中汤丸
人参 白术 甘草 干姜（各等分）
上锉碎。水二盏，煎一盏，去滓，温服。若欲为丸，研细末，炼蜜丸，如弹子大。每用一丸，白汤化下。
参术丸 治小儿脾胃伤冷，外热里寒，不思饮食，身常壮热，大便或溏，色白。或患疮疹身有大热，
因食冷物或冷药过度，或泻，或腹胀，或已出疮疹瘢白无血色。此由里寒脾胃伏冷，荣卫不行，致令毒瓦斯内伏不出，
宜服之，其疮瘢白无血色者，皆从瘢白四围，红晕再起，作脓结痂而愈。
人参 白术 干姜（炮） 甘草（炙。各一分）
上为细末。米糕泡糊、为丸如麻子大。每服百余丸，温水吞下，或米饮亦得，乳食前服。前世之书如仲景诸论治伤
寒云∶轻者用理中汤，重者用四逆汤。此乃胃足阳明经而感寒邪，脾胃乃为中州之府，故用理中汤，曰辛甘发散为阳，
以退寒邪也。理中汤炼蜜丸而嚼下，曰理中丸，盖添蜜，甘以入脾胃，嚼而便化于中焦。今参术丸以粳米糕为丸，取
其难化，服在脾胃，渗漉渐得消化，则中焦得暖，脾土喜燥，其热自归，此所以能治热也。
胃主腐熟水谷，大肠主传送已化之物，故食多少，可以知人谷气之虚实，大便滑涩，可以知人脏腑之冷热，大便如
常，是亦疮疹之一顺也。如起发之时，忽然泄泻，此宜急止之，恐肠胃虚，真气脱也，须辨冷热虚实，如泻而手
足冷，面色青白，疮不红绽者，冷证也，理中汤丸、豆蔻丸、益黄散（脾），甚则陈氏木香散、异功散（出不快）皆可用
也。泻下之物黄又酸臭，渴，手足心热，面赤，疮红绽 发者，热证也，黄芩汤、五苓散（惊）主之。脾胃怯弱，精神
慢而不食者为虚，当温养之，益黄散。身热中满，渴而不食者为实，当清利之，五苓散。其人或脏气自脱，或因服寒
药，致令疮毒陷入大肠，泻下如豆汁，或便脓血，或便黑汁，口内臭气，唇焦目闭，加腹胀者，必死之证。
如因饮冷水自利者，所谓湿胜则濡泄也，宜温中利小便，以理中丸温中，以五苓散利小便去水。
如因伤食自利者，所出酸臭，所谓饮食自倍，肠胃乃伤也，宜先去其积，丁香脾积丸（伤食），后补脾胃，益
黄散（脾）。
如结痂之时暴泄不止者，消息所出之物，痂皮脓血者顺，水谷不分者逆，如利脓血不止者，此热毒下流也，
香连丸主之。
香连丸（一名香橘丸）
黄连（一两，以茱萸五钱同炒，去萸不用） 木香（半两） 石莲子（取肉，二钱半） 陈皮（半两）
上为末。醋调神曲糊、为丸如麻子大。每服二三十丸，陈仓米汤下。
〔丹〕陈牙儿十九岁，出痘，有红 ，吐泻而渴。
苍术（一钱） 白术（三钱） 阵皮（二钱） 黄 茯苓 甘草（炙） 缩砂 当归（各一钱半）
姜三片，同煎服。
从子六七岁时，患疮痘发热，微渴自利。一小方脉视之，用木香散，每帖又增丁香十粒，予切疑焉。观
其出迟，因问自利而气弱，察其所下皆臭滞陈积，因肠胃热蒸而下也，恐非有寒而虚，遂急止之，已投一帖矣。
继以黄连解毒汤加白术，与十帖以解丁香之热，利止疮亦出，其后肌常有微热，而手足生痈疖，与凉剂调补，
逾月而安。一男子十余岁出痘，热时出，根脚密，呕吐不食，腰背骨节痛，大渴喉痛，腹亦痛，全不食者半月余，
脉浮弦洪而数。与参、 、归、术、炙甘草、陈皮、半、茯、生姜煎服之。至五日色淡，又加桂些少，归、
再用酒制。至七日痒甚，加丁香三粒、附子些少，痒止。至八日九日渴大作而腹泄泻，痒甚。至十日寒战，
遂用白术为君， 、陈、苓、炙甘、芩、归为臣。至十一日不靥，或痒，或谵语，但守前药，半月后自吐出痰多而安。
〔陈〕十一味木香散 治疹痘腹胀、渴，其效如神。（必须审察的是寒证、六脉虚细、身不甚热，或发寒，
或呕吐肚腹痛，或身体四肢俱冷者可用。此方出《集验》）。
木香 大腹皮 人参 官桂 赤茯苓 青皮（去白） 前胡 诃子皮 半夏 丁香 甘草（炙。各三两）
上 咀。每服二钱，水一盏，姜三片煎，空心，温服。
异功散《集验方》疮痘头温足冷，腹胀泻渴。（方见痘出不快）
〔海〕疮疹不渴，藏寒下利，四君子加干姜减半主之。痘疹大便不固，痘渐黑陷，小儿乳母同服。
人参 白茯苓 肉豆蔻 黄 （各半两） 甘草（炙，二钱）
上 咀。每服一钱，水半盏，姜五片，枣一枚，煎三分。乳母倍服。若大泻手足厥冷，加附子，用验。
治中散 虚寒泻利，不进饮食。
黄 人参 茯苓 白术 川芎 当归 肉桂（各五钱） 肉豆蔻（面包煨熟取去油） 丁香（一
钱半） 木香（三钱）
上为末。每五岁用五分，好热酒调下，衣被盖暖，少顷，痘变红活而起。
When diarrhea occurs before the eruption of smallpox/variolae, it indicates that pathogenic factors have merged into the interior, causing excessive heat in the intestines and stomach (Changwei), leading to dysfunction in digestion and transmission. Huangqin Tang (Scutellaria Decoction) is the primary treatment. If there is spontaneous diarrhea with clear, white excrement, it indicates interior cold (Lihan), and Lizhong Tang (Regulate the Middle Decoction) is the primary treatment.
Huangqin Tang (Scutellaria Decoction)
Huangqin (Radix Scutellariae, 1.5 qian) Gancao (Radix Glycyrrhizae Preparata, 1 qian) Baishao (Radix Paeoniae Alba, 6 qian)
The above herbs are finely chopped. Add two Jujubae Fructus (Date), one lamp of water, decoct until seven-tenths remain, take warm, before meals.
When diarrhea occurs after the eruption of smallpox/variolae, it indicates that pathogenic factors have merged into the exterior, and the righteous qi (Zhengqi) is expelling the pathogens. The pathology is primarily at the exterior rather than the interior, resulting in deficiency of interior qi, which cannot retain food and fluids, thus causing spontaneous diarrhea. Treatment should focus on qi deficiency (use Jiwei Lizhong Tang [Nine-Ingredient Regulate the Middle Decoction] with doubled Renshen [Ginseng], plus Huangqi [Astragalus] and Baishao [White Peony Root]).
Jiwei Lizhong Tang (Nine-Ingredient Regulate the Middle Decoction)
Renshen (Radix Ginseng, 2 qian) Baizhu (Rhizoma Atractylodis Macrocephalae) Ganjiang (Rhizoma Zingiberis Preparatus) Hezirou (Semen Arecae Preparatum) Fuling (Poria) Muxiang (Radix Aucklandiae) Huoxiangye (Herba Agastaches) Roudoukou (Semen Myristicae Preparatum) Gancao (Radix Glycyrrhizae Preparata, 1 qian each)
Decoct in water, take orally before meals.
Contraindicated in the treatment of variolae/rash is internal deficiency with diarrhea. Whenever abdominal pain is felt, or there is a gurgling sound rushing towards the lower abdomen, these are precursors to impending diarrhea. Treatment should be initiated immediately (using Jiwei Lizhong Tang). If diarrhea persists despite treatment, this indicates intestinal sliding and incontinence; only astringent agents can arrest it (such as Doukou Wan [Cardamom Pill]; if ineffective, use real opium mixed with Lotus Seed Powder to stop diarrhea).
Quack physicians often dare not use astringent drugs, fearing they will trap pathogenic factors. However, they do not realize that no pathogenic factor is more vigorous than in Shanghan (Cold Damage diseases). Zhang Zhongjing, when treating spontaneous diarrhea accompanied by heat, frequently used Shizhi (Red Clay). It can be said that using astringents to treat sliding/incontinence is analogous to using cold agents to treat heat or hot agents to treat cold; these are called appropriate symptomatic treatments. Since sliding diarrhea is now unceasing, astringency is naturally indicated; what is there to doubt? If diarrhea continues even after taking astringents, the root has been uprooted, and nothing can be done. The Classic says: "When the granaries cannot be stored, it is because the gates are not secure." The Jingui Yaolue states: "When the qi of the six fu organs fails externally, hands and feet become cold; when the qi of the five zang organs fails internally, diarrhea does not cease." Among the Five Deprivations (Wuduo), this is the most severe. However, if righteous qi collapses internally, death comes after a lingering course; if pathogenic factors sink internally, death comes from irritability and thirst; these are the differences in their modes of death.
Chen's Doukou Wan treats diarrhea due to variolae/rash.
Muxiang (Radix Aucklandiae) Sharen (Fructus Amomi) Bailonggu (Os Draconis et Ossis Mastodi) Hezirou (Semen Arecae Preparatum) Roudoukou (Semen Myristicae, wrapped in flour and roasted, 0.5 liang each) Chishizhi (Lapis Kaolinii) Kubaijian (Alumen Exsiccatum, 0.75 liang each)
Grind into powder. Make pills with paste, size of Setaria italica seeds. For one-year-olds, 30 pills; for three-year-olds, 100 pills, taken with warm rice drink. Stop administration once diarrhea ceases.
From the initial emergence to the scabbing phase, stools should generally be firm. Sudden spontaneous diarrhea should be treated with Lizhong Tang or Lizhong Wan (Regulate the Middle Pill).
Lizhong Tang/Wan (Regulate the Middle Decoction/Pill)
Renshen (Radix Ginseng) Baizhu (Rhizoma Atractylodis Macrocephalae) Gancao (Radix Glycyrrhizae Preparata) Ganjiang (Rhizoma Zingiberis Preparati, equal parts)
Chop finely. Two lamps of water, decoct to one lamp, remove dregs, take warm. To make pills, grind to fine powder, mix with refined honey, form pills size of quail eggs. Take one pill dissolved in warm water per dose.
Shenzhu Wan (Ginseng and Atractylodes Pill) treats pediatric spleen-stomach injury from cold, external heat with internal cold, loss of appetite, persistent high fever, loose stools that are pale. Or, during variolae with high fever, due to excessive consumption of cold foods/medicines, or resulting in diarrhea, abdominal distension, or pale, bloodless rash scars. This is caused by internal cold and latent cold in the spleen-stomach, obstructing Ying and Wei circulation, trapping toxic heat inside preventing eruption. Taking this medicine allows pale scars to develop red halos around them, suppurate, scab, and heal.
Renshen (Radix Ginseng) Baizhu (Rhizoma Atractylodis Macrocephalae) Ganjiang (Rhizoma Zingiberis Preparati) Gancao (Radix Glycyrrhizae Preparata, 1 fen each)
Grind to fine powder. Use steamed rice cake soaked in paste to form pills size of Sesame seeds. Take over 100 pills with warm water or rice drink, before milk/food intake.
Ancient texts like Zhang Zhongjing's discussions on Shanghan state: mild cases use Lizhong Tang, severe cases use Sini Tang (Frigid Extremities Decoction). This is because the Foot Yangming Stomach Meridian is affected by cold pathogens. The spleen and stomach are the central earth department; thus, Lizhong Tang is used, based on the principle that "acrid-sweet disperses yang" to retreat cold pathogens. Lizhong Wan is made by refining honey into pills and chewing them; the addition of honey makes sweet flavors enter the spleen-stomach, dissolving quickly in the middle jiao. Current Shenzhu Wan uses glutinous rice cake for pills, intending slow digestion. As it stays in the spleen-stomach, it slowly permeates and digests, warming the middle jiao. Since spleen earth prefers dryness, heat returns to its proper place; this is how it treats heat.
The Stomach governs the rotting and ripening of food and fluids; the Large Intestine governs the transportation of digested residues. Thus, food intake indicates the deficiency or excess of Gu Qi (Grain Qi); stool consistency indicates the cold or heat of the zang-fu organs. Normal stool is also a favorable sign in variolae. If sudden diarrhea occurs during the eruptive stage, it must be stopped urgently to prevent depletion of True Qi due to intestinal weakness. Differentiate between cold, heat, deficiency, and excess. Diarrhea with cold hands/feet, blue-white complexion, and non-red/non-exploded rash indicates Cold Syndrome; use Lizhong Tang/Wan, Doukou Wan, Yihuang San (for Spleen), or in severe cases Chen's Muxiang San, Yigong San (for slow eruption). Diarrhea of yellow, sour-smelling material, with thirst, hot palms/soles, red face, and red/exploded rash indicates Heat Syndrome; use Huangqin Tang or Wuling San (for Convulsions). Spleen-stomach weakness with lethargy and anorexia is Deficiency; warm and nourish with Yihuang San. Body heat with fullness, thirst without desire to eat is Excess; clear and drain with Wuling San. If organ qi spontaneously collapses, or due to cold medicines causing toxin sinking into the Large Intestine, resulting in bean-water-like stool, pus/blood in stool, black fluid, foul breath, cracked lips, closed eyes, and abdominal distension, this is a fatal syndrome.
Spontaneous diarrhea from drinking cold water is termed "Dampness excess leading to loose stools"; warm the middle and promote urination, using Lizhong Wan to warm the middle and Wuling San to promote urination and remove water.
Spontaneous diarrhea from food stagnation presents with sour/foul odor, described as "excessive diet injures the intestines and stomach"; first eliminate accumulation with Dingxiang Pi Ji Wan (for Food Stagnation), then tonify spleen-stomach with Yihuang San (for Spleen).
If violent unceasing diarrhea occurs during scabbing, observe the excrement: scabs/pus/blood is favorable; undigested food/water is unfavorable. Unceasing pus/blood diarrhea indicates downward flow of Heat-Toxin; treat with Xianglian Wan.
Xianglian Wan (also known as Xiangju Wan)
Huanglian (Radix Coptidis, 1 liang, stir-fried with 5 qian Evodiae Fructus, discard Evodia) Muxiang (Radix Aucklandiae, 0.5 liang) Shilianzi (Fructus Nelumbinis Semen, flesh only, 2.5 qian) Chenpi (Pericarpium Citri Reticulatae, 0.5 liang)
Grind to powder. Mix with vinegar and Shenqu paste, form pills size of Sesame seeds. Take 20-30 pills with aged rice soup.
[Dan] Chen Ya'er, age 19, had smallpox with red papules, vomiting, diarrhea, and thirst.
Cangzhu (Rhizoma Atractylodis Lanceae, 1 qian) Baizhu (Rhizoma Atractylodis Macrocephalae, 3 qian) Chenpi (Pericarpium Citri Reticulatae, 2 qian) Huangqi (Radix Astragali) Fuling (Poria) Gancao (Radix Glycyrrhizae Preparata) Suosha (Fructus Amomi Rotundus) Danggui (Radix Angelicae Sinensis, 1.5 qian each)
Three slices of Shengjiang (Rhizoma Zingiberis Recens), decoct together and take.
My nephew, aged 6-7, suffered from rash-fever, slight thirst, and spontaneous diarrhea. A minor physician diagnosed him and prescribed Muxiang San, adding ten cloves of Dingxiang (Flos Caryophylli) per dose. I suspected this. Observing his slow eruption, and noting his weak qi from diarrhea, and that his excrement was foul, stagnant, and old accumulation due to intestinal heat steaming downwards, I doubted it was cold-deficiency. I urgently stopped the diarrhea; he had already taken one dose. Subsequently, I gave Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity) with added Baizhu for ten doses to resolve the heat of Dingxiang. Diarrhea stopped, rash emerged. Later, he had slight skin heat and boils on hands/feet; cool agents were used for regulation and tonification, and he recovered after a month.
A man over ten years old had smallpox. During fever, eruptions were dense at the base, with vomiting, anorexia, back/joint pain, extreme thirst, sore throat, abdominal pain, and total anorexia for half a month. Pulse was floating, wiry, surging, and rapid. Prescribed Renshen, Huangqi, Danggui, Baizhu, Zhi Gancao, Chenpi, Banxia, Fuling, Shengjiang decocted. By day 5, color faded; add slight Gui Zhi (Ramulus Cinnamomi), wine-processed Danggui. By day 7, severe itching; add three Dingxiang, slight Fuzi (Radix Aconiti Lateralis Preparata), itching stopped. By days 8-9, severe thirst and abdominal diarrhea, severe itching. By day 10, chills; use Baizhu as Sovereign herb, Huangqi, Chenpi, Fuling, Zhi Gancao, Huang Qin (Radix Scutellariae), Danggui as Ministers. By day 11, no scabbing, intermittent itching or delirium; stick to previous prescription. After half a month, he vomited much phlegm and recovered.
[Chen] Shi Yi Wei Muxiang San (Eleven-Ingredient Aucklandia Powder) treats rash/smallpox abdominal distension and thirst, effective as magic. (Must verify: Cold Syndrome, empty/thin six pulses, body not very hot, or chills, or vomiting/abdominal pain, or cold limbs. Source: Jiyan Fang).
Muxiang (Radix Aucklandiae) Dafupi (Pericarpium Arecae) Renshen (Radix Ginseng) Guanzi Gui (Cortex Cinnamomi) Chifuling (Poria cum Rubro) Qingpi (Pericarpium Citri Reticulatae Viride, peeled) Qianhu (Radix Peucedani) Hezipi (Pericarpium Arecae) Banxia (Rhizoma Pinelliae Preparatum) Dingxiang (Flos Caryophylli) Gancao (Radix Glycyrrhizae Preparata, 3 liang each)
Chop coarsely. Take 2 qian per dose, one lamp of water, three slices of ginger, decoct, take warm on empty stomach.
Yigong San (Extraordinary Efficacy Powder) from *Jiyan Fang* treats rash/smallpox with warm head/cold feet, abdominal distension, diarrhea, thirst. (See "Slow Eruption" section).
[Hai] Rash/smallpox without thirst, organ cold with diarrhea: Si Jun Zi Tang (Four Gentlemen Decoction) plus Ganjiang (Rhizoma Zingiberis), halved dosage. Smallpox with loose stools, dark/sunken pustules: Child and wet-nurse take together.
Renshen (Radix Ginseng) Baifuling (Poria) Roudoukou (Semen Myristicae) Huangqi (Radix Astragali, 0.5 liang each) Gancao (Radix Glycyrrhizae Preparata, 2 qian)
Chop coarsely. Take 1 qian per dose, half lamp of water, five slices of ginger, one date, decoct to one-third. Wet-nurse doubles dose. If severe diarrhea with cold extremities, add Fuzi (Radix Aconiti Lateralis Preparata), effective.
Zhi Zhong San (Regulate Middle Powder) treats deficiency-cold diarrhea/anorexia.
Huangqi (Radix Astragali) Renshen (Radix Ginseng) Fuling (Poria) Baizhu (Rhizoma Atractylodis Macrocephalae) Chuanxiong (Rhizoma Chuanxiong) Danggui (Radix Angelicae Sinensis) Rougui (Cortex Cinnamomi Cassiae, 5 qian each) Roudoukou (Semen Myristicae, bread-roasted, oil removed) Dingxiang (Flos Caryophylli, 1.5 qian) Muxiang (Radix Aucklandiae, 3 qian)
Grind to powder. For every five years of age, take 0.5 fen, mixed with good hot wine. Keep warm with clothing/blankets. Soon, smallpox turns red/vibrant and rises.