痘疮解毒。以利小便为要。小便不利。乃热毒始于下焦。连翘防风汤。赤涩有血者。犀角地
黄汤加木通。茎中痛者。合益元散。延久则身热躁闷。喘渴焦紫。或生痈破裂。或口疮咽肿。或
内作脓血。变证不测。大抵未出之先。热甚而小便不利。恐欲起惊。导赤散微解之。初出不快。
小便赤涩者。生圣散。长发灌浆时溺涩者。五苓散加木通。收靥之后。小便不利。烦热而渴。猪
苓汤。若肺热气化不行。小水不通。五苓散探吐之。元气虚弱。不能清理传道者。补中益气加门
冬、车前。肺虚不能滋其化源。生脉散加黄 、甘草。膀胱不能吸引肺气。钱氏异功散加麦冬、五
味。胃热小便赤涩不通。生圣散。肝热小便癃闭。龙胆泻肝汤。肾热水道不行。导赤散。肾虚肝
热。小便枯约。生料六味去萸加麦冬。
痘疮未出之先。先曾下痢。此元气已亏。起灌最难满足。升发剂中必兼实脾为要。又须辨
其寒热赤白。如痘色紫赤。口躁咽干。小水短涩。痢下鲜赤。此风能动血也。三奇散、四苓散参
用。若痘色淡白。四肢清冷。小水清利。痢下晦淡。此水液清冷也。补中益气汤、陈氏异功散参
用。有食积而腹急胀痛者。平胃散加山楂、木通。若至二七内外而泻痢脓血。为余毒未尽。热移
大肠。兼之湿热相并。红白交作。四苓散加芩、连、山楂、木通、连翘。大抵痘后利脓血。为五液注下。
最危之兆。若以痢治而峻用苦寒。不旋踵而告变矣。
To resolve toxicity in smallpox (Variola), the key lies in promoting urination. If urination is obstructed, it indicates that heat-toxin originates in the Lower Jiao (Lower Burner). Lianqiao Fangfeng Tang (Forsythia and Saposhnikovia Decoction) may be used. If urine is red, astringent, and contains blood, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) with Mutong (Akebia Caulis) should be added. If there is pain in the urethra, Yi Yuan San (Benefit the Primordial Powder) should be combined. If the condition persists for a long time, symptoms such as fever, restlessness, oppression, panting, thirst, and scorched purple tongue or lips may appear; carbuncles may develop and rupture; mouth ulcers and throat swelling may occur; or internal suppuration and bloody stools may arise. These complications are unpredictable. Generally, before the eruption of lesions, if heat is severe and urination is difficult, one should fear the onset of convulsions (Jing Feng); Daochi San (Guide Out Red Powder) can be used to gently resolve the heat. If the eruption is slow initially and urine is red and astringent, Shengsheng San (Holy Generation Powder) is indicated. During the stage of hair growth and pustule formation, if urination is astringent, Wuling San (Five-Ingredient Powder with Poria) with Mutong (Akebia Caulis) should be used. After the crusting phase, if urination is obstructed accompanied by vexation, heat, and thirst, Zhuling Tang (Polyporus Decoction) is appropriate. If lung heat causes failure of Qi transformation leading to blocked urination, Wuling San (Five-Ingredient Powder with Poria) can be used with emetic therapy to probe the condition. If Yuan Qi (Primal Qi) is deficient and unable to clear and conduct normally, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Maidong (Ophiopogon Tuber) and Cheqianzi (Plantago Seed) should be used. If Lung deficiency fails to nourish the source of transformation (fluid generation), Shengmai San (Generate the Pulse Powder) with Huangqi (Astragalus Root) and Gancao (Licorice Root) should be used. If the Bladder fails to attract Lung Qi, Qian Shi Yigong San (Dr. Qian’s Extraordinary Efficacy Powder) with Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Fruit) should be used. If stomach heat causes red, astringent, and blocked urination, Shengsheng San (Holy Generation Powder) is indicated. If liver heat causes strangury (difficulty or inability to urinate), Longdan Xiegan Tang (Gentian Liver-Draining Decoction) should be used. If kidney heat causes obstruction of the water pathways, Daochi San (Guide Out Red Powder) is appropriate. If kidney deficiency coexists with liver heat, resulting in dry and scanty urination, Shengliuwei Dihuang Wan (Raw Six-Ingredient Rehmannia Pill) without Shanzhuyu (Cornus Fruit) plus Maidong (Ophiopogon Tuber) should be used.
Before the eruption of smallpox lesions, if dysentery has occurred previously, this indicates that Yuan Qi (Primal Qi) is already depleted, making it difficult for the lesions to rise and fill properly. In using ascending and diffusing formulas, it is essential to simultaneously strengthen the Spleen. One must also differentiate between cold/heat nature and red/white stool characteristics. If the lesions are purple-red, with dry mouth, parched throat, short and astringent urine, and fresh red dysenteric stools, this indicates wind stirring blood. Sanchi San (Three Marvels Powder) and Siling San (Four-Ingredient Powder) may be used in combination. If the lesions are pale white, with cold limbs, clear and profuse urine, and dull, pale dysenteric stools, this indicates cold and clear fluids. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Chen Shi Yigong San (Chen’s Extraordinary Efficacy Powder) may be used in combination. If food stagnation causes abdominal urgency and distending pain, Pingwei San (Calm the Stomach Powder) with Shanzha (Hawthorn Fruit) and Mutong (Akebia Caulis) should be used. If around the 14th day, dysentery with pus and blood occurs, this indicates residual toxin not yet cleared, with heat transferring to the Large Intestine, compounded by damp-heat, resulting in mixed red and white stools. Siling San (Four-Ingredient Powder) with Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Shanzha (Hawthorn Fruit), Mutong (Akebia Caulis), and Lianqiao (Forsythia Fruit) should be used. Generally, dysentery with pus and blood after smallpox indicates the downward pouring of the five body fluids, which is a sign of extreme danger. If treated as ordinary dysentery with harsh bitter-cold herbs, the condition will deteriorate rapidly.