凡气虚之证。初发身热。手足厥冷。乍凉乍热。精神倦怠。肌肉 白。饮食减少。睡卧安宁。
清便自调。此皆虚证无疑。未见点前。用保元汤加紫苏、防风、白芷以发散之。见点后。以保元
汤加川芎、桔梗以开提之。见点四五日后。仍用保元汤随证加减处治。七八日浆足之后。宜四君
子加归、芍、山药以调养之。大便实者。加熟地以兼补其阴。若证见虚寒。不妨加肉桂倍参、
以温补之。如见塌陷黑 。多用陈氏木香、异功收功。凡血热之证。初发壮热。腮红脸赤。毛焦
色枯。烦躁。渴欲饮水。日夜啼哭。睡卧不宁。好睡冷处。小便赤涩。此皆热证无疑。未出之前。
升麻汤加生地、芎、归、红花、鼠粘、连翘。以凉血解毒。见点三四日后。热证渐平。将欲灌浆。
紫草木通汤加生地、川芎、桔梗、红花、山楂之类。八九日浆足之后。亦宜四君子加养血药调理
之。若七八日根脚红晕不化。或紫黑干枯。及青灰干黑陷者。皆由血热之故。急宜清热凉血为主。
切勿误用补气之药。则营血愈虚愈热矣。惟泄泻之后。变黑陷干红者。则从小剂木香、异功治之。
凡热毒壅遏之证。初发身热面赤。气粗喘满。腹胀烦躁。谵语狂言。睡中惊妄。二便秘涩。面浮
眼胀。多啼多怒。此皆热甚无疑。未见标时。先须升麻汤一服。随加羌、防、荆芥、川芎、连翘、
紫草、白芷、桔梗、鼠粘子。以清热透表。至见点三日之内。诸证向宁。势将行浆。紫草木通汤
加川芎、桔梗、山楂、蝉蜕、鼠粘子之类。浆足之后。亦宜四君子加养血药调理之。若六七日外。
根窠连肉通红。或紫黑干枯及青灰干白陷者。此皆气虚血燥。毒邪壅盛之故。急宜凉血解毒。兼
调中气为主。切不可轻用温补。惟曾泄泻。内气暴虚而陷。则当小剂木香、异功救之。
In cases of Qi deficiency, the initial presentation includes fever, cold extremities, alternating chills and heat, mental fatigue, pale muscles, reduced appetite, yet with peaceful sleep and normal urination and defecation. These are undoubtedly deficiency syndromes. Before the eruption appears, Baoyuan Tang (Preserve the Origin Decoction) is administered with added Perilla Leaf (Zisu), Saposhnikovia Root (Fangfeng), and Angelica Dahurica Root (Baizhi) to disperse the pathogen. After the eruption appears, Baoyuan Tang is used with added Ligusticum Wallichii Rhizome and Rhizome (Chuanxiong) and Platycodon Root (Jiegeng) to lift and raise the Qi. Four or five days after the eruption, Baoyuan Tang is still employed with modifications based on specific symptoms. After seven to eight days, when the pustules are full of pus, Sijunzi Tang (Four Gentlemen Decoction) combined with Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root), and Chinese Yam (Shanyao) is suitable for nourishment. If constipation occurs, Prepared Rehmannia Root (Shudi) is added to tonify Yin. If signs of deficiency-cold are present, Cinnamon Bark (Rougui) is added, and the dosage of Ginseng (Renshen) is doubled to warm and tonify. In cases of collapsed, blackish-purple lesions, Chen's Muxiang San (Aucklandia Powder) or Yigong San (Extraordinary Work Powder) are frequently used to conclude treatment.
In cases of Blood heat, the initial presentation includes high fever, flushed cheeks and red face, dry and brittle hair, restlessness, thirst with desire to drink water, day-and-night crying, restless sleep, preference for cool places, and scanty, painful urination. These are undoubtedly heat syndromes. Before the eruption appears, Shengma Tang (Cimicifuga Decoction) is administered with added Raw Rehmannia Root (Shengdi), Chuanxiong, Dang Gui, Safflower Honghua, Burdock Fruit (Niubang), and Forsythia Fruit (Lianqiao) to cool the Blood and resolve toxicity. Three or four days after the eruption, as the heat gradually subsides and the pustule-filling stage approaches, Zicao Mutong Tang (Arnebia and Akebia Decoction) is used with additions such as Shengdi, Chuanxiong, Jiegeng, Honghua, and Hawthorn Fruit (Shanzha). After eight or nine days, when the pustules are full, Sijunzi Tang combined with Blood-nourishing herbs is also suitable for regulation. If, after seven or eight days, the base of the lesion remains red and swollen without resolving, or becomes purple-black and dry, or presents as cyan-gray, dry, and sunken, these are caused by Blood heat. Immediate treatment should focus on clearing heat and cooling the Blood. Do not mistakenly use Qi-tonifying herbs, as this will further deplete the Ying Blood and intensify the heat. Only in cases where diarrhea precedes the appearance of black, sunken, dry, and reddish lesions should small doses of Muxiang San and Yigong San be used.
In cases of Heat-Toxin obstruction, the initial presentation includes fever, red face, coarse breathing with asthma and chest fullness, abdominal distension, restlessness, delirious speech, manic behavior, nocturnal惊悸 (startle/delusion), constipation and difficult urination, facial edema, swollen eyes, excessive crying, and anger. These are undoubtedly signs of extreme heat. Before the visible signs of the eruption appear, one dose of Shengma Tang is given first, followed by additions of Qiang Huo (Notopterygium Rhizome), Fangfeng, Jing Jie (Schizonepeta Spike), Chuanxiong, Lianqiao, Zicao (Arnebia Root/Lithospermum Root), Baizhi, Jiegeng, and Niubang Zi (Burdock Fruit) to clear heat and vent the exterior. Within three days of the eruption, as symptoms stabilize and the pustule-filling phase begins, Zicao Mutong Tang is used with additions of Chuanxiong, Jiegeng, Shanzha, Cicada Slough (Chantui), and Niubang Zi. After the pustules are full, Sijunzi Tang combined with Blood-nourishing herbs is suitable for regulation. If, after six or seven days, the lesion base and surrounding skin are intensely red, or become purple-black and dry, or cyan-gray, dry, and white-sunken, these result from Qi deficiency, Blood dryness, and abundant Toxin-Heat. Emergency treatment should prioritize cooling the Blood and resolving toxicity, while simultaneously regulating Middle-Jiao Qi. Warm-tonifying herbs must not be used lightly. Only in cases where prior diarrhea has caused a sudden collapse of internal Qi leading to sunken lesions should small doses of Muxiang San and Yigong San be used for rescue.