痘疮既出。全藉脾胃安和。进纳饮食。则易浆易靥。自四五日以至痂落之后。饮食不减。二
便如常。虽不起发不红绽。或陷塌。用药得宜。可保无虞。若乳食减少。兼之泄泻。则元气日衰。
虽无前证。日后必至有变。药亦难效。岂能保其无事哉。若胸前稠密。毒瓦斯伤脾减食者。消毒饮
加黄芩、山楂、紫草、人参。有伤食腹胀不食者。枳术丸。有痘出太多。中气暴虚不食者。四君
子加糯米。有痘已痂起而不能食。身无热者。调补脾胃为主。凡四五日前不食而便秘者。此毒盛
于里。犹为可治。至六七日后。反不能食。则变证百出。纵药何益。有禀受壮实而发于五岁之外
者。又不可一例而论也。又有痘起之后。能食易饥者。此胃大热。不久而变生焉。大便秘者。四
顺饮加连翘、牛蒡微利之。不秘者。芍药汤加茯苓、木通、牛蒡子以和之。又有饥欲食而不能者
。必喉舌有痘。难于吞嚼也。
凡痘疹发热。有呕吐者。有泄泻者。有吐利兼作者。有干呕而哕者。有不食者。皆毒火所致
。不可骤止。吐利中有疏通之义。治宜平和疏透。引毒达表。则吐泻自止。如不止。兼调脾胃。
如干呕而哕。为胃虚火逆最危之兆。宜橘皮茱连散。以安胃气清火毒。有不嗜食者。此脾受热毒
。当升提发散。俾毒得外出。饮食自进。若误认呕吐泄泻不食为里寒而
用丁、桂、姜、附。转增烦剧也。误认呕吐泄泻不食为里虚而用参、 、苓、术。反增壅遏也。
此专为痘疹初出未透者而言。若浆正行时而吐利不食者。乃脾胃虚弱。多有内虚倒 喘胀之患。
凡长发起顶灌浆时。泄泻俱为险候。急用白术、茯苓以渗泄健脾。人参、黄 以助元托里。诃子
肉果以止泻。佐以升提之药。使无壅遏之患。若不升发。难免倒 之虞。如见心烦干呕而哕。此
脏败毒攻。最为凶候。二陈加黄连、木通、灯心、竹叶。夏月。四苓散以利小便。利而不通者危
。至如泄泻而手足热面赤者。热也。弱者。白术散加竹叶、陈皮。强者。泻黄散。若下午泻甚。
上午泻稀。此伤食。平胃散加山楂、麦芽。厥冷。加干姜。或益黄散补之。泻利而呕逆厥冷。理
中汤加木香。上午泻甚。下午不泻者。脾虚也。朝用白术散。夕用豆蔻丸。泻出腥臭秽滞者。肠
胃热也。葛根黄芩黄连汤。泻而失气者。气下泄也。白术散加升麻、防风提之。若受寒邪。或食
冷物。而泄泻清冷。痘色灰白顶陷。或手足厥而寒颤切牙者。陈氏木香散、异功散。疮虽正而吐
泻。或下血。俱为逆候。若但吐不泻。无痰。益黄散。有痰。二陈汤。吐而身热烦渴。腹满气促。
大小便涩而赤者。当利小便。若先吐而后出痘。足蜷不伸。声哑热蒸者。虽有清浆不治。陈文宿
云。痘疮泻水谷。或白色。或淡黄者。陈氏木香散送豆蔻丸。不愈。异功散救之。
After the eruption of smallpox, the body relies entirely on the harmonious function of the Spleen and Stomach. If food intake is normal, pus formation and scabbing will occur easily. From the fourth or fifth day until the scabs fall off, if dietary intake does not decrease and urination and defecation remain normal, even if the pustules do not rise or turn red, or if they collapse (inversion), as long as the medication is appropriate, safety can be ensured. If milk and food intake decrease accompanied by diarrhea, the primordial Qi will decline daily. Although there are no prior severe symptoms, changes will inevitably occur later, and medications will be difficult to take effect; how can one ensure safety? If the chest area has dense eruptions and toxic heat damages the Spleen reducing appetite, use Xiaodu Yin (Detoxification Decoction) added with Huangqin (Scutellariae Radix), Shanzha (Crataegi Fructus), Zicao (Arnebiae Radix seu Lithospermi Radix), and Renshen (Ginseng Radix et Rhizoma). For cases of food stagnation causing abdominal distension and anorexia, use Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill). For cases where excessive eruption causes sudden deficiency of Middle Qi leading to anorexia, use Sizijunzi Tang (Four Gentlemen Decoction) added with Nuomi (Oryza Sativa Var. Glutinosa Semen). For cases where scabs have formed but the patient cannot eat and has no fever, focus on regulating and tonifying the Spleen and Stomach. For those who cannot eat and have constipation in the first four or five days, this indicates abundant toxin in the interior, which is still treatable. However, if after six or seven days the patient suddenly cannot eat, myriad complications will arise, and what benefit would medication bring? Individuals with robust constitution developing smallpox after age five should not be treated uniformly. Additionally, for those who can eat and feel hungry easily after eruption, this indicates excessive Stomach heat, which will lead to complications soon. For constipation, use Sishun Yin (Four Smoothness Decoction) added with Lianqiao (Forsythiae Fructus) and Niubangzi (Arctii Fructus) to mildly promote bowel movement. For non-constipation, use Shaoyao Tang (Peony Decoction) added with Fuling (Poria), Mutong (Akebiae Caulis), and Niubangzi to harmonize. For those feeling hunger but unable to swallow, it is likely due to lesions in the throat and tongue making chewing and swallowing difficult.
Regarding fever during smallpox, some present with vomiting, some with diarrhea, some with both, some with dry heaving and hiccuping, and some with anorexia. All are caused by toxic fire. Do not abruptly stop these symptoms, as vomiting and diarrhea contain the principle of unblocking. Treatment should be mild and dispersing, guiding toxins to the surface, after which vomiting and diarrhea will cease naturally. If they persist, regulate the Spleen and Stomach concurrently. Dry heaving with hiccups indicates deficient Stomach Qi with rebellious fire, a critical sign; use Jupi Zhulian San (Tangerine Peel, Evodia, and Coptis Powder) to calm Stomach Qi and clear toxic fire. Anorexia due to heat-toxin in the Spleen requires lifting and dispersing methods to allow toxins to exit outward, restoring appetite. Misinterpreting vomiting, diarrhea, and anorexia as interior cold and using Dingxiang (Caryophylli Flos), Rougui (Cinnamomi Cortex), Ganjiang (Zingiberis Rhizoma), and Fuzi (Aconiti Lateralis Radix Praeparata) will worsen irritability and severity. Misinterpreting them as interior deficiency and using Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), and Gancao (Glycyrrhizae Radix et Rhizoma) will increase stagnation. This advice applies specifically to early-stage smallpox that has not yet fully erupted. If vomiting, diarrhea, and anorexia occur during the pus-filling stage, it indicates Spleen-Stomach weakness, often leading to internal inversion (dao die), wheezing, and distension. During the rising and pus-filling stages, diarrhea is a dangerous sign; urgently use Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuling (Poria) to leach out dampness and strengthen the Spleen, Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix) to assist Yuan Qi and support the interior, Heziren (Terminalia Chebulae Fructus) and Roudoukou (Myristicae Semen) to stop diarrhea, assisted by lifting herbs to prevent stagnation. Without lifting, there is a risk of inversion. Restlessness, dry heaving, and hiccups indicate organ failure and attacking toxins, a most ominous sign; use Erchen Tang (Two-Cured Decoction) added with Huanglian (Coptidis Rhizoma), Mutong (Akebiae Caulis), Dengxincao (Junci Medulla), and Zhuyeqing (Bambusa Leaves). In summer, use Siling San (Four Porias Powder) to promote urination. Failure to urinate after promotion is critical. Diarrhea with hot extremities and red face indicates heat syndrome. For weak patients, use Baizhu San (Atractylodes Powder) added with Zhuye (Bamboo Leaves) and Chenpi (Citri Reticulatae Pericarpium); for strong patients, use Xiehuang San (Drain Yellow Powder). Diarrhea worse in the afternoon and loose in the morning indicates food stagnation; use Pingwei San (Peace the Stomach Powder) added with Shanzha (Crataegi Fructus) and Maiya (Hordei Fructus Germinatus). Add Ganjiang (Zingiberis Rhizoma) for cold limbs. Alternatively, use Yihuang San (Benefit the Spleen Powder) to tonify. Diarrhea with vomiting, reversal, and cold limbs requires Lizhong Tang (Regulate the Middle Decoction) added with Muxiang (Aucklandiae Radix). Diarrhea worse in the morning and absent in the afternoon indicates Spleen deficiency; use Baizhu San (Atractylodes Powder) in the morning and Doukou Wan (Cardamom Pill) in the evening. Foul-smelling, turbid diarrhea indicates Heat in the Intestines and Stomach; use Gegen Qinlian Tang (Kudzu and Coptis Decoction). Diarrhea with flatus indicates Qi sinking downward; use Baizhu San (Atractylodes Powder) added with Shengma (Cimicifugae Rhizoma) and Fangfeng (Saposhnikoviae Radix) to lift. Diarrhea with clear, cold stools due to cold pathogen or cold food consumption, accompanied by gray-white, inverted pustules, cold limbs, chills, and teeth grinding, requires Chen's Muxiang San (Chen's Aucklandia Powder) or Yigong San (Extraordinary Assistance Powder). Normal lesions with vomiting/diarrhea or hematochezia are adverse signs. Vomiting without diarrhea and phlegm uses Yihuang San (Benefit the Spleen Powder); with phlegm, use Erchen Tang (Two-Cured Decoction). Vomiting with fever, thirst, abdominal fullness, shortness of breath, and scanty red urine requires promoting urination. Vomiting preceding eruption, curling legs, hoarseness, and steaming heat indicate incurability despite pus formation. Chen Wensu stated: Smallpox diarrhea with watery stool, white or pale yellow color, is treated with Chen's Muxiang San (Chen's Aucklandia Powder) delivered with Doukou Wan (Cardamom Pill); if ineffective, Yigong San (Extraordinary Assistance Powder) is used for rescue.