夫人习尚不同。趋舍各异。痘疹一门。向得涵高兄采辑诸家方论。备列医通。其间方药多有
以意参易者。惜乎笔削未竣。完璧难求。志儿心折其学。因命续貂。系以麻疹诸例。庶不失先哲
二者并名之义云。
小儿在胎时。食母五脏血秽。生后其毒当出。故痘疹所发。皆五脏之液。肝水泡。其色青小。
肺脓泡。色白而大。心为斑。其色赤小。脾为疹。其色赤黄。疮疹欲出。五脏证具。惟肾无候。
但耳凉尻冷是也。疮疹出时。辨视轻重。一发便出尽者。必重也。疮夹疹者。半轻半重也。出稀
者轻。里外微红者轻。外黑里赤者。微重也。外白里黑者。大重也。疹端里黑点如针孔者。势甚
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。困极也。凡疮疹当令乳母
慎口。不可令饥。及受风冷。致归肾变黑难治也。有大热当利小便。有小热宜解毒。若黑紫干陷者。
百祥丸下之。不黑者慎勿下。更看时月轻重。大抵痘疹属阳。出则春夏为顺。秋冬为逆。又当辨
春脓泡。夏黑陷。秋斑。冬疹。亦不顺也。黑者。无问何时。十难救一。其候寒战噤牙。或身黄
肿紫。急宜百祥丸下之。复恶寒不已。身冷汗出。耳尻反热者死。肾气大旺。脾虚不能制故也。
下后身热气温。欲饮水者可治。脾旺胜肾。寒去而温热也。治之宜解毒。不可妄下。下则内虚。多归于肾。
若能食而痂头焦起。或未焦而喘。实者。四顺清凉饮下之。若身热烦渴。腹满而喘。大小便涩。
面赤闷乱大吐。此当利小便。不瘥者。宣风散下之。若五六日痂不焦。是内发热。热湿蒸于皮中。
故痂不得焦。宜宣风散导之。用生犀磨汁解之。便热退痂脱矣。疮疹欲出。先欠呵顿闷。肝也。
时发惊悸。心也。乍凉乍热。手足冷多睡。脾也。面腮颊赤。咳嗽喷嚏。肺也。此四脏证俱见。
惟黑者属肾也。疮疹乃五脏之毒。内一脏受秽多者。出则归其脏矣。
People's customs and habits differ, and their choices and rejections vary. Regarding the category of smallpox and measles (Douzhen), previously, my brother Han Gao collected and compiled formulas and theories from various schools, listing them comprehensively in *Yitong* (Comprehensive Medical Guide). The medicinal prescriptions therein were often modified according to personal judgment. Alas, the editing was not completed, making a perfect version hard to obtain. Admiring Zhi'er's scholarly dedication, I ordered him to continue the work with supplementary additions, attaching cases of measles, so as not to lose the original intent of the ancient sages who named both diseases together.
While in the womb, the infant consumes the blood impurities of the mother's five zang organs. After birth, these toxins must be expelled. Therefore, the eruptions of smallpox and measles are manifestations of the fluids of the five zang organs: the Liver corresponds to blisters (shui pao), which are blue-green and small; the Lungs correspond to pustules (nong pao), which are white and large; the Heart corresponds to macules/petechiae (ban), which are red and small; the Spleen corresponds to papules/rash (zhen), which are red-yellow. When the eruptions are about to appear, signs of all five zang organs are present, except for the Kidney, which shows no external signs other than cool ears and a cold sacrum (kao).
To distinguish severity when eruptions appear: those that erupt completely at once are severe; those where sores are mixed with rash are moderately severe; sparse eruptions are mild; slight redness inside and out is mild; black exterior with red interior is slightly severe; white exterior with black interior is very severe; if the tip of the rash has black dots like needle holes inside, the condition is critical; cyanosis, dryness, purple depression, lethargy, incessant sweating, restlessness, heat, thirst, abdominal distension, crying and wheezing, and obstruction of urination and defecation indicate extreme exhaustion.
During eruptions, the nursing mother should be cautious with her diet and avoid letting the infant go hungry or be exposed to wind and cold, otherwise the toxin may retreat into the Kidneys, turning black and becoming difficult to treat. For high fever, promote diuresis; for low fever, resolve toxicity. If the lesions are black, purple, dry, and depressed, administer Baixiang Wan (Hundred-Auspicious Pills) to purge; if not black, do not purge. Consider the season for severity assessment. Generally, smallpox and measles belong to Yang; eruption in Spring and Summer is favorable (Shun), while in Autumn and Winter is unfavorable (Ni). One must also note that eruptions of pustules in Spring, black depression in Summer, macules in Autumn, and rashes in Winter are all unfavorable. Black lesions, regardless of the season, have a mortality rate of nine out of ten. Signs include chills and teeth grinding, or yellowish swollen purple body. Urgently administer Baixiang Wan to purge. If chills persist after purging, accompanied by cold sweat and heat returning to the ears and sacrum, it is a fatal sign due to excessive Kidney Qi and Spleen deficiency failing to control it. If after purging, body heat remains but pulse temperature normalizes and thirst arises, it is treatable, indicating Spleen Earth overcoming Kidney Water, removing cold and transforming into warmth. Treatment should focus on resolving toxicity; do not recklessly purge, as this causes internal deficiency and allows toxins to retreat to the Kidneys. If the patient can eat and scabs become dry and raised, or if there is wheezing before scabbing, indicating excess syndrome, administer Sixun Qingliang Yin (Four-Obstacles Clearing and Cooling Decoction) to purge. If there is fever, irritability, thirst, abdominal fullness, wheezing, difficulty in urination and defecation, facial redness, mental confusion, and severe vomiting, promote diuresis. If ineffective, use Xuanfeng San (Wind-Dispersing Powder) to purge. If scabs do not dry after five to six days, it indicates internal heat steaming dampness within the skin, preventing scabbing. Use Xuanfeng San to guide out the pathogen, combined with fresh Rhinoceros Horn juice (Sheng Xi) to resolve toxicity; once stool flows freely, heat subsides and scabs fall off.
Before eruptions appear, yawning and drowsiness indicate the Liver; frequent palpitations and fright indicate the Heart; alternating cold and heat, cold extremities, and excessive sleep indicate the Spleen; red cheeks and face, coughing, and sneezing indicate the Lungs. These four zang signs are visible, while black coloration belongs to the Kidney. Eruptions are toxins of the five zang organs; whichever internal organ accumulates more turbidity will manifest its specific eruption pattern.