小儿疮疹。大抵与伤寒相似。发热烦躁。脸赤唇红。身痛头疼。乍寒乍热。喷嚏呵欠。嗽喘
痰涎。始发之时。有因伤风伤寒而得。有因时气传染而得。有因伤食呕吐而得。有因跌扑惊恐瘀
血而得。或为窜眼惊搐如风状。或口舌咽喉肚腹疼痛。或烦躁狂闷。昏睡自汗。或下利。或潮热。
证候多端。卒未易辨。须以耳冷尻冷足冷验之。盖疮疹属阳。肾脏无证。耳与尻足俱属肾。故独
冷。又不若视其耳后有红脉赤缕为真候。调护之法。首尾俱不可汗下。但温凉之剂。兼而济之。
解毒和中。安表而已。虚者益之。实者损之。冷者温之。热者平之。是为权度。如庖人笼蒸之法。
但欲其松耳。盖毒发于表。如苟妄汗。则营卫一虚。开泄疮烂。由是风邪乘间变证者有之。毒根
于里。如苟妄下。则内气益虚。毒不能出而返入焉。由是土不胜水。变黑归肾。身作振寒。耳尻
反热。腹胀黑陷。十无一生。汗下二说。古人深戒。以此视之。疮疹证状。虽与伤寒相似。而治
法实不同。伤寒从表入里。疮疹从里出表故也。如欲解肌。葛根、紫苏可也。其或气实烦躁。热
炽便秘。则犀角地黄汤。或紫草饮。多服亦能利之。故虽云大便不通少与大黄。尤宜斟酌。若小
便赤少者。分利小
便。则热气有所渗出。凡热不可骤遏。但宜轻解。若无热。又不能起发也。疮疹分人清浊。就形
气上取勇怯。凡已发未发。但觉身热。证似伤寒。疑似未明。先与惺惺散、参苏饮。热甚。则升
麻汤、人参败毒散。（张涵高曰。上方俱难应用。当以轻剂透表为妥。）一见红点。便忌葛根。恐
发则表虚也。凡痘疮初欲出时。身热鼻尖冷。呵欠咳嗽面赤。便宜升麻汤加山楂、大力子。则疮
稀疏易愈。凡痘疮发热时。法以恶实子为末。蜜调贴囟门。免有患眼之疾。凡初出之际。须看胸
前。稠密。急宜消毒饮加楂肉、黄芩、紫草。减食。禁加人参。初出之时色白者。便大补气血。
参、 、术、草、桂、芍、芎、归。若大便泻。加木香、肉豆蔻。初起时自汗不妨。盖湿热熏蒸
而然。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。凡
疮已出。可频与化毒汤。（当去升麻。）出不快者。加味四圣散。或紫草饮、紫草木通汤。及快
斑汤。出太甚者。人参败毒散。色赤。犀角地黄汤。疏则无毒。密则毒盛。宜多服凉药解之。庶
无害眼之患。炉灰色白静者作寒看。齐涌者燥者 发者作热治。黑属血热。凉血为主。白属气虚。
补气为先。中黑陷而外白。起得迟者。则相兼而治。凡痘疮分表里虚实。吐泻少食为里虚。不吐
泻能食为里实。里实而补则结痈毒。陷伏倒 灰白者为表虚。红活绽起为表实。表实而复补表。
则溃烂不结痂。痘疮分气血虚实。虚则黄 养营活血之剂。佐以风药。实则芍药、黄芩为君。佐
以白芷、连翘之类。调解之法。活血调气。安表和中。轻清消毒。兼而治之。温如当归、黄 。
凉如前胡、葛根。佐以川芎、白芍、枳壳、桔梗、羌活、木通、紫草之属。则可以调适矣。黑陷
二种。因气虚而毒不能尽出者。酒炒黄 、紫草、人参辈。黑陷甚者。用烧人矢。蜜水调服。痒
塌者。于形色脉上分虚实。实则脉有力。气壮红紫。虚则脉无力。色淡平塌。虚痒。以参、 实
表之剂加凉血药。实痒。如大便不通。少与大黄寒凉之药下其结粪。气怯轻者。用淡蜜水调滑石
末。以羽润疮上。疮干宜退火。只用
轻剂。荆芥、防风、牛蒡之类。上引用升麻、葛根。下引用槟榔、牛膝。佐以贝母、忍冬、白芷、
栝蒌之类。若咽喉痛者。鼠粘子汤、如圣饮选用。喘满气壅者。麻黄汤加黄芩、白芍、石膏。烦
渴泻利者。乌梅与绿豆、黑豆作汤。时温服之。泻利呕逆者。理中汤加木香。将欲成就却色淡者。
宜助血气。芎、归、芍药、红花之类。将欲成就却色紫者。宜凉血解毒。生地、芩、连、连翘之
类。甚者。犀角大解痘毒。淡白色将靥时如豆壳者。盖因初起时饮水多。其靥不齐。俗呼为倒靥。
但服实表之剂。消息二便。如大便秘。通大便。小便秘。通小便。小便赤涩。大连翘汤、甘露饮。
大便秘结。内烦外热者。小柴胡加枳壳最当。或少与四顺清凉饮。疮疹用药。固有权度。大小二
便不可不通。其大便自下黄黑。则毒已成。不必多与汤剂。但稍与化毒汤。不用亦可。二便一或
闭焉。则肠胃壅遏。脉络凝滞。毒无从泄。眼闭声哑。不旋踵而告变矣。陷入者。加味四圣散。
更以胡荽酒薄敷其身。浓敷其足。喷其衣被。并浓盖之。若犹未也。独圣散入木香煎汤。若其疮
已黑。乃可用钱氏宣风散加青皮。钱氏云。黑陷青紫者。百祥丸下之。不黑者慎勿下。知其所下
者。泻膀胱之邪也。又云。下后身热。气温欲饮水者可治。寒战者为逆。知其脾强。土可以制水
也。百祥丸太峻。宜以宣风散代之。泻后温脾。当用人参、茯苓、白术等分。浓朴、木香减半为
妙。盖疮发肌肉。阳明为主。脾土一温。胃气随畅。何惮不消弭已泄之肾水乎。此钱氏不刊之秘
旨也。其坏疮者。一曰内虚泄泻。二曰外伤风冷。三曰变黑归肾。近时痘疹。多宗陈文中木香散
异功散。殊不知彼时立方之时。为严冬大寒郁遏。痘疮不得红绽。故用辛热之剂发之。今人不分
时令寒热。一概施治。误人冬矣。夫渴者用温药。痒塌者用补药。自陈氏发之。迥出前辈。然其
立方多用燥热。或未适中。恐其立方之际。必有挟寒而虚者设也。痘疹多是毒瓦斯盛。便先宜解毒。
然恐气血周贯不定。故随后亦宜兼补。以助成脓血也。
Pediatric variola (smallpox) and exanthems generally resemble Shaoyang disease (a syndrome caused by pathogenic factors affecting the Shaoyang channel). Symptoms include fever, irritability, red face, red lips, body pain, headache, alternating chills and fever, sneezing, yawning, cough, wheezing, and increased phlegm. At the onset, the condition may arise from wind-cold invasion, transmission of seasonal epidemic qi, food stagnation with vomiting, or blood stasis due to falls, trauma, or fright. It may manifest as toxin invading the eyes causing convulsions resembling wind-stroke, or pain in the mouth, tongue, throat, and abdomen; irritability, mania, stuffiness, drowsiness, and spontaneous sweating; diarrhea; or tidal fever. The manifestations are diverse and difficult to distinguish abruptly. One must verify by checking if the ears, sacrum (coccyx), and feet are cold. Since exanthems belong to Yang syndromes and the Kidney presents no direct symptoms, while the ears, sacrum, and feet all belong to the Kidney, these areas alone become cold. This is not as definitive as observing red veins and threads behind the ears as true signs. Nursing and treatment methods should neither use diaphoresis (sweating therapy) nor purgation (downward-draining therapy) from beginning to end. Instead, use warm and cool agents jointly to detoxify, harmonize the middle, and stabilize the exterior. Deficiency is tonified, excess is reduced, cold is warmed, and heat is cooled; this constitutes the standard for treatment. It is like the method of steaming in a bamboo basket: one only desires it to be loose and permeable. Because the toxin erupts on the exterior, reckless diaphoresis will weaken Ying (Nutritive Qi) and Wei (Defensive Qi), leading to open pores and ulcerated sores, allowing Wind pathogens to enter and cause complications. If the toxin root lies in the interior, reckless purgation will further deplete internal Qi, preventing toxin expulsion and causing it to retreat inward. Consequently, Earth fails to control Water, toxins turn black and return to the Kidney, presenting with tremors and aversion to cold, hot ears and sacrum, abdominal distension, and black sunken lesions; ten out of ten cases result in death. The theories of diaphoresis and purgation were deeply cautioned against by ancient masters. Thus, although exanthem symptoms resemble Shaoyang disease, the treatment methods differ fundamentally because Shaoyang disease moves from exterior to interior, whereas exanthems move from interior to exterior. To resolve the muscle layer, Radix Puerariae (Ge Gen) and Perilla Leaf (Zi Su Ye) may be used. If Qi is full with irritability, blazing heat, and constipation, Rhinoceros Horn and Rehmannia Decoction (Xi Jiao Di Huang Tang) or Arnebia Drink (Zi Cao Yin) can be taken in large amounts to promote drainage. Therefore, even when mentioning small amounts of Radix Rheomi (Da Huang) for constipation, caution is required. If urine is scanty and dark red, promoting urination allows heat to seep out. Heat should not be abruptly suppressed but lightly dispersed. Without heat, eruption cannot occur.
Exanthems require distinguishing clear and turbid constitutions and assessing courage or timidity based on physique and Qi. Whether erupted or not, if fever is felt and symptoms resemble Shaoyang disease with unclear differentiation, first administer Jingwei Decoction (Xing Xing San) or Ginseng and Perilla Decoction (Shen Su Yin). If heat is severe, use Cimicifuga Decoction (Sheng Ma Tang) or Ginseng and Counteracting Toxin Powder (Ren Shen Bai Du San). (Zhang Hangao stated: The above formulas are difficult to apply; using light agents to vent the exterior is appropriate.) Once red spots appear, avoid Radix Puerariae (Ge Gen) fearing exterior deficiency after eruption. When smallpox initially attempts to emerge, accompanied by fever, cold nose tip, yawning, cough, and red face, Cimicifuga Decoction (Sheng Ma Tang) added with Hawthorn Fruit (Shan Zha) and Arnebia Seed (Niu Bang Zi) makes lesions sparse and easy to heal. During fever, grind Arnebia Seeds into powder, mix with honey, and apply to the fontanelle to prevent eye diseases. Upon initial eruption, inspect the chest; if dense, urgently use Detoxification Drink (Xiao Du Yin) with Hawthorn Peel, Scutellaria Root (Huang Qin), and Arnebia Root (Zi Cao). Reduce food intake and prohibit adding Ginseng. If color is white upon initial eruption, vigorously tonify Qi and Blood using Ginseng, Atractylodes Macrocephala (Bai Zhu), Licorice (Gan Cao), Cinnamon Twig (Gui Zhi), White Peony Root (Bai Shao), Ligusticum Chuanxiong (Chuan Xiong), and Angelica Sinensis (Dang Gui). If diarrhea occurs, add Amomum Villosum (Mu Xiang) and Myristica Fragrans (Rou Dou Kou). Spontaneous sweating at onset is acceptable due to damp-heat steaming. Cases with initial irritability, delirium, mania, and excessive thirst requiring drinking lead to uneven scabbing later; urgently use cooling agents like Yi Yuan San to address the branch. Once eruptions appear, frequently administer Detoxifying Decoction (Hua Du Tang) (remove Cimicifuga). For slow eruption, use Modified Four Sages Powder (Jia Wei Si Sheng San), Arnebia Drink (Zi Cao Yin), Arnebia and Akebia Decoction (Zi Cao Mu Tong Tang), or Ban Eruption Decoction (Kuai Ban Tang). For excessive eruption, use Ginseng and Counteracting Toxin Powder (Ren Shen Bai Du San). For red color, use Rhinoceros Horn and Rehmannia Decoction (Xi Jiao Di Huang Tang). Sparse lesions lack toxin severity; dense ones have strong toxin, requiring frequent cooling agents to prevent eye damage. Gray-white and quiet lesions indicate cold; surging, dry, or erupting lesions indicate heat. Black indicates Blood heat, treated primarily with blood-cooling agents. White indicates Qi deficiency, treated primarily with Qi-tonifying agents. Central black sinking with peripheral white and delayed eruption requires combined treatment.
Differentiate exterior/interior and deficiency/excess in smallpox. Vomiting, diarrhea, and poor appetite indicate Interior Deficiency; no vomiting/diarrhea and good appetite indicate Interior Excess. Tonifying Interior Excess leads to carbuncles. Gray-white indicates Exterior Deficiency; red and active eruption indicates Exterior Excess. Repeatedly tonifying Exterior Excess leads to ulceration without scabbing. Differentiate Qi/Blood deficiency/excess. Deficiency uses Astragalus and Angelica to nourish Ying and invigorate Blood, assisted by Wind-dispersing herbs. Excess uses White Peony and Scutellaria as sovereign herbs, assisted by Angelica Dahurica (Bai Zhi) and Forsythia (Lian Qiao). Regulation involves invigorating Blood, regulating Qi, stabilizing exterior, harmonizing middle, light clearing, and detoxification. Warm agents include Angelica and Astragalus. Cool agents include Peucedanum (Qian Hu) and Radix Puerariae. Assist with Ligusticum, White Peony, Aurantium (Zhi Ke), Platycodon (Jie Geng), Notopterygium (Qiang Huo), Akebia (Mu Tong), and Arnebia. Two types of black sinking: one due to Qi deficiency preventing toxin expulsion, treated with wine-fried Astragalus, Arnebia, and Ginseng. Severe black sinking uses Calcined Human Feces (Zhong Ren Shi) mixed with honey water. Itching and collapsing lesions require differentiating deficiency/excess via form, color, and pulse. Excess: strong pulse, robust Qi, red-purple color. Deficiency: weak pulse, pale color, flat collapse. Deficient itching uses Ginseng and Astragalus to solidify exterior plus blood-cooling herbs. Excess itching with constipation uses small doses of Radix Rheomi (Da Huang) to purge hardened stool. Mild Qi deficiency uses dilute honey water with Talcum (Hua Shi) applied with feathers. Dry crusts require reducing fire with light agents like Schizonepeta (Jing Jie), Saposhnikovia (Fang Feng), and Arnebia Seed. Upper guidance uses Cimicifuga and Radix Puerariae; lower guidance uses Areca Seed (Bing Lang) and Achyranthes (Niu Xi). Assist with Fritillaria (Bei Mu), Honeysuckle (Ren Dong), Angelica Dahurica, and Trichosanthes (Gua Lou). For sore throat, select Arnebia Seed Decoction (Shu Niu Zi Tang) or Ru Sheng Yin. For wheezing and Qi congestion, use Ephedra Decoction (Ma Huang Tang) with Scutellaria, White Peony, and Gypsum. For irritability, thirst, and diarrhea, decoct Mume Fruit (Wu Mei) with Mung Bean and Black Bean, taking warm occasionally. For diarrhea and vomiting, use Gastrodia and Bupleurum Decoction (Li Zhong Tang) with Amomum. For fading color near healing, assist Blood/Qi with Ligusticum, Angelica, White Peony, and Safflower. For purple color near healing, cool Blood and detoxify with Rehmannia, Scutellaria, Coptis, and Forsythia. Severe cases use Rhinoceros Horn to greatly resolve toxin. Pale white lesions resembling bean shells during scabbing indicate excessive fluid intake earlier, causing uneven scabbing (Dao Ye); treat with exterior-solidifying agents and regulate bowels/bladder. Constipation requires unblocking bowels; scanty dark urine requires Da Lian Qiao Tang or Gan Lu Yin. Constipation with internal vexation and external heat responds best to Xiao Chai Hu Tang with Aurantium, or small doses of Si Shun Qing Liang Yin.
Medication for exanthems has standards; bowel and bladder movements must not be blocked. Yellow-black stool indicates formed toxin; large doses of decoctions are unnecessary, slight Hua Du Tang suffices. Blockage of both causes intestinal obstruction, stagnant collaterals, trapped toxin, closed eyes, hoarse voice, and rapid deterioration. Sunken lesions use Modified Four Sages Powder, externally applied with Coriander Wine thinly on body, thickly on feet, sprayed on clothes, and covered densely. If ineffective, Du Sheng San with Amomum decocted. If black, use Qian's Xuan Feng San with Qing Pi. Qian Yi stated: Black-blue sinking uses Bai Xiang Wan to purge; non-black cases must not be purged. Purging eliminates Bladder pathogen. Post-purge fever and desire to drink indicate curability; chills indicate adverse prognosis, showing strong Spleen Earth controlling Water. Bai Xiang Wan is too harsh; replace with Xuan Feng San. Post-purge Spleen warming uses equal parts Ginseng, Poria, and Atractylodes, with half dose of Magnolia Bark and Amomum. Skin eruptions relate to Stomach/Muscle (Yangming); warming Spleen frees Stomach Qi, resolving leaked Kidney Water. This is Qian's secret doctrine. Damaged sores stem from: 1. Internal deficiency diarrhea, 2. External wind-cold injury, 3. Black sinking returning to Kidney. Recent treatments follow Chen Wenzhong's Mu Xiang San and Yi Gong San, ignoring that their formulas addressed severe winter cold suppressing red eruption, thus using acrid-hot agents. Modern practitioners ignore seasons, applying uniformly, causing harm. Thirst treated with warm meds, itching with tonics originated from Chen, surpassing predecessors, yet his formulas often used drying-hot herbs, possibly assuming concurrent cold-deficiency. Smallpox toxins are vigorous; detoxification precedes, followed by tonification to aid pus/blood formation.