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、蓄血而得。或
为窜眼惊搐，如风之证，或口舌、咽喉、肚腹疼痛，或烦躁、狂闷、昏睡，或自汗，或下痢，或发热，或
不发热，证候多端，卒未易辨，亦须以耳冷、 冷、足冷验之。盖疮疹属阳，肾脏无症，耳与 、足俱属
于肾，故肾之所部独冷，又不若视其耳后有红脉赤缕为真，于此可以稽验矣。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，是为权度借喻而言，
亦如庖人笼蒸之法，但欲其松耳！盖毒发于表，如苟妄汗，则荣卫一虚，重令开泄，转增疮烂，由是风邪
乘间变症者有之；毒根于里，如苟妄下，则内气一虚，
毒不能出而返入焉，由是土不胜水，变黑归肾，身体振寒，耳 反热，眼合，肚胀，其疮黑陷，十无一生。
汗、下二说，古人深戒。以此观之，疮疹症状虽与伤寒相似，而其治法实与伤寒不同。伤寒从表入里，疮
疹所发从里出表故也。如欲解肌，干葛、紫苏可也。其或气实烦躁热炽，大便秘结，则与犀角地黄汤或人
参败毒散，又或紫草饮多服，亦能利之。故虽云大便不通者，少与大黄尤宜，仔细斟酌之，若小便赤少者，
分利小便则热气有所渗而出。凡热不可骤遏，但轻解之；若无热，则疮又不能发也。
凡疮疹，春夏为顺，秋冬为逆。
疮疹分人清浊，就形气上取勇怯。
凡已发未发，并与紫苏饮。但觉身热，症似伤寒，若未见疮，疑似未明，且先与惺惺散、参苏饮，
或人参、羌活辈，热甚则与升麻葛根汤、人参败毒散。但一见红点，便忌葛根汤，恐发得表虚也。
凡痘疮初欲出时，身发热，鼻尖冷，呵欠，咳嗽，面赤，方是痘出之候，便宜服升麻葛根汤加山楂、大
力子，其疮稀疏而易愈。
凡痘初出时或未见时，宜服后方，多者令少，重者令轻。方以丝瓜近蒂三寸，连瓜子皮烧灰存性，为
末，砂糖拌干吃。入朱砂末亦可。又方朱砂为末，蜜水调服，多者可减，少者可无。
凡痘疮发热之时，便以恶实子为末，蜜调贴囱门上，免有患眼之疾。
凡初出之际，须看胸前，若稠密，急宜消毒饮加山楂、黄芩、酒洗紫草，减食加人参。
初出之时色白者，便大补气血，参、 、芎、术、升麻、干葛、甘草、木香、丁香、酒洗当归、白芍药，
若大便泻，加诃子、肉豆蔻。
初起时自汗不妨，盖湿热熏蒸而然故也。
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，如益元散之类亦可用。
凡疮已出，可少与化毒汤。
出不快者，加味四圣散、紫草饮子、紫草木香汤、紫草木通汤，或快斑散、丝瓜汤。
出太甚者，人参败毒散、犀角地黄汤。
疏则无毒，密则有毒，以凉药解之，虽数帖亦不妨，无害眼之患。
炉灰色白静者，作寒看。
齐涌者，燥者， 发者，作热看。黑属血热，凉血为主。
白属气虚，补气为主。
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。陷伏倒靥为表虚。灰白者亦表虚，或用烧人屎。红活绽凸为表实，表实
而复补表，则要溃烂不结痂。
痘疮分气虚、血虚，用补药。气虚者，人参、白术加解毒药；血虚者，四物汤中加解毒药。
痘疮分气血虚实，多带气血不足。虚则黄 ，生血活血之剂助之，略佐以风药；实则白芍药为君，黄
芩亦为君，佐以白芷、连翘、续断之类。
调解之法，活血、调气、安表、和中、轻清消毒、温凉之剂兼而治之，二者得兼而已。温如当归、黄 、
木香辈，凉如前胡、干葛、升麻辈，佐之以川芎、白芍药、枳壳、桔梗、羌活、木通、紫草之属，则可以
调适矣。
黑陷二种，因气虚而毒瓦斯不能尽出者，酒炒黄 、紫草、人参辈。
黑陷甚者，亦用烧人屎，蜜水调服。出子和方。
痒塌者，于形色脉上分虚实。实则脉有力，气壮；虚则无力。虚痒，以实表之剂加凉血药；实痒，如大
便不通者，以大黄寒凉之药少与之，下其结粪。
气怯轻者，用淡蜜水调滑石末，以羽润疮上。
疮干者，宜退火，止用轻剂，荆芥、升麻、葛根之类。
湿者，用泻湿，乃肌表间湿，宜用风药白芷、防
风之类。
上引用升麻、葛根；下引用槟榔、牛膝∶助以贝母、忍冬草、白芷、栝蒌之类。
若咽喉痛者，大如圣散、鼠粘子汤。
喘满气壅者，麻黄黄芩汤。烦渴者，甘草散、乌梅汤。下痢呕逆者，木香理中汤。
颜色正者，如上治将欲成就，却色淡者，宜助血药，用当归、川芎、酒洗芍药之类，或加红花。
将成就之际，却紫色者，属热，用凉药解其毒，升麻、葛根、酒炒黄芩、黄连及连翘之类，甚者犀角
大解痘毒。
灰白色将靥时如豆壳者，盖因初起时饮水多，其靥不齐，俗呼倒靥。不好但服实表之剂，消息他大小
便，如大便秘通大便，小便秘通小便。
小便赤涩者，大连翘饮、甘露饮。
大便秘结，内烦外热者，小柴胡汤加枳壳最当，或少用四顺清凉。
疮疹用药，固有权度。大小二
便一或秘焉，则肠胃壅遏，脉络凝滞，毒瓦斯无从发泄，眼闭，声哑，肌肉黧黑，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，喷其衣服，并以浓绵盖之；若犹未也，独圣散入
木香煎汤；若其疮已黑，乃可用钱仲阳宣风散加青皮主之。钱氏云∶黑陷青紫
者，百祥丸下之；不黑者，谨勿下。余知其所下者，泻膀胱之邪也。又云∶下后身热，气温欲饮水者，可
治；水谷不消，或寒战者，为逆。余知其脾强者，土可以治水也，百祥丸太峻，当以宣风散代之。泻后温
脾，则用人参、茯苓、白术等分，浓朴、木香、甘草各半为妙。盖疮发肌肉，阳明主之，脾土一温，胃气
随畅，独不可消胜已泄之肾水乎！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。
近时小儿痘疮，止宗陈文中木香散、异功散。殊不知彼时立方之时，为运气在寒水司天，时令又值严
冬大寒，为因寒郁遏，痘疮不红绽，故用辛热之剂发之。今人不分时令寒热，一概施治，误人多矣。时值
温热，山野农家贫贱之人，其或偶中也。
丹溪痘疮治法最为明备，近世通用陈文中木香、异功等方，乃一偏之术。若痘疮虚怯淡白色痒塌，此
属虚寒，宜用陈文中方；若发热壮盛，齐涌，红紫色，瘙痒，此属热毒，急宜凉血解毒。自陈文中方盛
行后，属虚寒者率得生，属热毒者悉不救。痘是胎毒，古人治法只解毒，然气血虚则逆，毒瓦斯不出及不能成
就。故陈文中之法，亦千载妙诀，补前人之未备者。
但温补之法既行，而解毒之旨遂隐，故救得一边，又害了一边。今必详究丹溪，二法通用，斯无弊也。
痘疮属虚寒者，直可延至十数日后方死；属毒盛转紫色者，不过七、八日。盖痘是胎毒，自内出外，
二、三日方出齐，毒瓦斯尚在内，出至六日则当尽发于表，七、八、九日成脓而结痂矣。若毒瓦斯盛，不能尽
出，过六日，毒反内入脏腑，故须于六日以前，毒瓦斯该出之时，急服凉血解毒之药以驱出之，六日以后，
医无及矣，故其死最急。若虚弱毒瓦斯少者，只是气血不足，不能贯脓成就，故绵延日久而后死。此虚实轻
重之分也。
痘疮多者，是毒瓦斯多，便先宜解毒，然多则恐气血周贯不足，故随后亦宜兼补药以助成脓血。
愚按痘疹之疾，乃胎禀之热毒，由内发外，虽为有余之症，当泻不当补，然儿体有虚实，积毒有轻重，
又在变而通之。考之钱、陈二先生虽俱名家，然就而折衷之，则陈为较优。盖钱之用药偏于清凉，而陈之
治法温凉并行，以其深究阴阳造化之妙，故于病之真寒假热与夫真热假寒，罔不知之真而见之定，随症异
宜，未尝执泥。假如病属虚热，而元气未至亏损者，施之以钱氏之法，则固当矣。若病气、元气俱虚或俱
实者，而不以陈法治之，鲜不致误。且小儿之痘疹，譬即大人之痈疽，治法无异。其热毒蕴于五内，致二
便不利，烦热作渴，脉沉实，须用托里、疏通、和荣卫三法。观陈氏异功散、人参白术散、前胡枳壳汤等
方，其药品深为得宜，治者详订而遵之可也。
The rashes and pox in children are generally similar to *Shanghan* (Cold Damage Disease), manifesting as fever, irritability, red face and lips, body pain and headache, alternating chills and fever, sneezing and yawning, cough, asthma, and phlegm-saliva.
At the onset, some cases arise from wind-cold or cold damage, some from seasonal epidemic contagion, some from food stagnation and vomiting, and some from falls, fright, or blood stasis. Symptoms may include toxin invading the eyes with convulsions resembling wind patterns, pain in the mouth, tongue, throat, and abdomen, irritability, mania, oppression, drowsiness, spontaneous sweating, dysentery, fever, or absence of fever. The clinical presentations are diverse and difficult to distinguish abruptly; one must also verify by checking if the ears, palms, and feet are cold. Since rashes and pox belong to Yang, and the Kidney shows no specific symptoms, while the ears, palms, and feet all belong to the Kidney's domain, the parts governed by the Kidney are uniquely cold. However, this is less definitive than observing red veins and threads behind the ears for verification. Regarding care and treatment, neither diaphoresis (sweating) nor purgation should be used from beginning to end. Instead, warm and cool agents should be combined to detoxify, harmonize the middle jiao, and stabilize the exterior. Deficiency is tonified, excess is reduced, cold is warmed, and heat is balanced. This is a metaphorical principle for flexibility, much like a cook steaming food in a basket—only ensuring it is loose! Because the toxin emerges at the exterior, reckless use of diaphoresis will weaken Ying and Wei Qi, causing further opening and leakage, thereby worsening ulceration, allowing wind pathogens to enter and cause complications. If the toxin is rooted internally, reckless purgation will weaken internal Qi, preventing toxin expulsion and causing it to retreat inward. Consequently, Earth fails to control Water, leading to blackening and return to the Kidney, characterized by tremors and aversion to cold, hot ears and palms, closed eyes, abdominal distension, and black sunken lesions, with almost no survivors. Ancient masters strictly warned against these two methods. Thus, although rash symptoms resemble Cold Damage, the treatment differs fundamentally: Cold Damage moves from exterior to interior, whereas rashes emerge from interior to exterior. To resolve the muscle layer, Kudzu Root (*Puerariae Radix*) and Perilla Leaf (*Perillae Folium*) are suitable. For cases with excess Qi, irritability, intense heat, and constipation, Rhinoceros Horn and Rehmannia Decoction (*Xijiao Dihuang Tang*) or Ginseng and Imperata Decoction (*Renshen Baidu San*) can be used, or frequent administration of Arnebia Drink (*Zicao Yin*) can promote purgation. Even with constipation, small doses of Rhubarb (*Rhei Radix et Rhizoma*) are appropriate after careful consideration. For scanty dark urine, promoting urination allows heat to drain out. Heat should not be abruptly suppressed but gently resolved; without heat, the rash cannot erupt.
Generally, rashes in spring and summer are favorable (Shun), while those in autumn and winter are unfavorable (Ni).
Rashes should be differentiated by the patient's clear/turbid constitution and assessed for courage/weakness based on physique and Qi.
For rashes whether erupted or not, Perilla Drink (*Zisu Yin*) is administered. If fever is felt and symptoms resemble Cold Damage but no rash is visible, initially use Xin Xin Powder (*Xingxing San*), Ginseng and Perilla Drink (*Renshen Sugu Yin*), or herbs like Ginseng (*Ren Shen*) and Notopterygium Root (*Qiang Huo*). If heat is severe, use Kudzu and Poria Decoction (*Shengma Gegen Tang*) or Ginseng and Imperata Decoction (*Renshen Baidu San*). Once red spots appear, Gegen Tang is contraindicated to avoid causing exterior deficiency.
When smallpox is about to erupt, symptoms include fever, cold nose tip, yawning, cough, and red face. At this stage, Kudzu and Poria Decoction (*Shengma Gegen Tang*) added with Hawthorn Fruit (*Shanzha*) and Butterbur Fruit (*Niubangzi*) is appropriate, resulting in sparse lesions that heal easily.
When smallpox is just erupting or not yet visible, the following formula is suitable to reduce severity. Take three inches of loofah stem near the peduncle, including seeds and skin, burn to ash retaining properties, powder it, and mix with rock sugar for oral intake. Cinnabar powder may be added. Another method uses Cinnabar powder mixed with honey water.
During fever of smallpox, Butterbur fruit powder mixed with honey applied to the fontanelle prevents eye complications.
At initial eruption, check the chest. If dense, urgently use Detoxification Drink (*Xiaodu Yin*) added with Hawthorn Fruit (*Shanzha*), Scutellaria Root (*Huangqin*), and wine-washed Arnebia Root (*Zicao*), reducing diet and adding Ginseng (*Ren Shen*).
If lesions are white upon eruption, strongly tonify Qi and Blood using Ginseng (*Ren Shen*), Atractylodes Rhizome (*Baizhu*), Ligusticum Rhizome (*Chuanxiong*), Atractylodes Rhizome (*Baizhu*), Kudzu Root (*Shengma*), Kudzu Root (*Gegen*), Licorice Root (*Gancao*), Costus Root (*Muxiang*), Clove (*Dingxiang*), wine-washed Angelica Sinensis Root (*Danggui*), and White Peony Root (*Baishao*). Add Chebula Fruit (*Hezi*) and Myristica Seed (*Roudoukou*) if diarrhea occurs.
Spontaneous sweating at onset is acceptable due to damp-heat steaming.
Cases with initial irritability, delirium, mania, and thirst requiring drinking indicate uneven scabbing later. Urgently treat the branch with cooling formulas like Yi Yuan San.
Once eruptions appear, slightly administer Huadu Tang.
For slow eruption, use Modified Four Sages Powder (*Jiawei Sisheng San*), Zicao Yin, Zicao Muxiang Tang, or Kuaiban San, Loofah Soup.
For excessive eruption, use Renshen Baidu San or Xijiao Dihuang Tang.
Sparse lesions imply no toxin; dense ones imply toxin. Cooling agents resolve this; multiple doses are safe without harming the eyes.
Gray-white and quiet lesions indicate Cold.
Simultaneous eruption, dryness, and itching indicate Heat. Black indicates Blood Heat, treated primarily by cooling Blood. White indicates Qi Deficiency, treated primarily by tonifying Qi.
Central black sinking with peripheral whiteness and delayed eruption requires combined treatment.
Differentiate smallpox by Exterior/Interior and Deficiency/Excess. Vomiting, diarrhea, and poor appetite indicate Interior Deficiency; no vomiting/diarrhea and good appetite indicate Interior Excess. Tonifying Interior Excess causes carbuncles. Sunken/reverted scabs indicate Exterior Deficiency. Gray-white also indicates Exterior Deficiency; burnt human feces may be used. Red, vibrant, protruding lesions indicate Exterior Excess. Tonifying Exterior Excess causes ulceration without scabbing.
Differentiate Qi/Blood Deficiency using tonics. Qi Deficiency: Ginseng (*Ren Shen*) and Atractylodes Rhizome (*Baizhu*) with detoxifiers. Blood Deficiency: Four Substances Decoction (*Siwu Tang*) with detoxifiers.
Smallpox often involves Qi/Blood insufficiency. Deficiency presents with sallow complexion; use blood-generating/moving agents with slight wind-dispelling herbs. Excess uses White Peony Root (*Baishao*) and Scutellaria Root (*Huangqin*) as sovereigns, assisted by Angelica Dahurica Root (*Baizhi*), Forsythia Fruit (*Lianqiao*), and Drynaria Rhizome (*Xuduan*).
Regulation involves activating Blood, regulating Qi, stabilizing Exterior, harmonizing Middle, light/clear detoxification, and combining warm/cool agents. Warm agents: Dang Gui, Huang Qi, Muxiang. Cool agents: Qian Hu, Gegen, Shengma. Assistants: Chuanxiong, Baishao, Zhike, Jiegeng, Qianghuo, Mutong, Zicao.
Black sinking has two types: Qi Deficiency preventing full toxin expulsion. Treat with wine-fried Huang Qi, Zicao, Ren Shen. Severe black sinking uses burnt human feces with honey water (Zihehe's formula).
Itchy/sunken lesions differentiate by pulse/form. Excess: strong pulse/Qi. Deficiency: weak pulse. Itchy Deficiency: exterior-stabilizing agents + blood-coolers. Itchy Excess with constipation: small dose of Dahuang to purge stool.
Mild Qi weakness: dilute honey water with Talcum Powder (*Huashi*) applied with feather.
Dry lesions: reduce fire with mild agents like Jingjie, Shengma, Gegen.
Dampness: drain dampness using wind herbs like Baizhi, Fangfeng.
Upper body: Shengma, Gegen. Lower body: Binglang, Niuxi. Assist with Beimu, Jinyinhua, Baizhi, Gualou.
Throat pain: Da Rusheng San, Shi Niu Zi Tang.
Wheezing/distension: Mahuang Huangqin Tang. Irritability/thirst: Gancao San, Wumei Tang. Dysentery/vomiting: Muxiang Lizhong Tang.
Normal color healing but pale: tonify Blood with Dang Gui, Chuanxiong, wine-washed Shaoyao, or Honghua.
Purple color during healing indicates Heat: cool and detoxify with Shengma, Gegen, wine-fried Huangqin, Huanglian, Lianqiao. Severe cases use Rhinoceros Horn (*Xijiao*) for major detoxification.
Gray-white scabbing like bean shells indicates "reverted scab" (*Daoye*) from excessive early drinking. Use exterior-stabilizing agents and regulate bowels/bladder.
Dark/scanty urine: Dalianqiao Yin, Ganlu Yin.
Constipation with internal烦/external heat: Xiao Chaihu Tang + Zhike, or small dose of Sishun Qingliang Yin.
Medication for rashes requires balance. Constipation blocks intestines/channels, trapping toxin, leading to closed eyes, hoarseness, blackened muscles, and rapid deterioration.
Sunken lesions: Jiawei Sisheng San, plus Huixie wine applied thinly on body, thickly on feet, sprayed on clothes, covered with thick cotton. If ineffective, Dusheng San + Muxiang decoction. If black, Qian Zhongyang's Xuanfeng San + Qingpi. Qian Yi stated: Black/purple sinking requires Baixiang Wan purgation; non-black requires caution against purgation. Purging drains Bladder pathogen. Post-purgation fever/thirst is treatable; indigestion/shivering is adverse. Strong Spleen Earth controls Water. Baixiang Wan is too harsh; replace with Xuanfeng San. Post-purgation Spleen warming: Ren Shen, Fuling, Baizhu equal parts; Houpo, Muxiang, Gancao half parts. Muscle eruption is governed by Yangming; warming Spleen unites Stomach Qi, eliminating excess Kidney Water. This is Qian Yi's secret doctrine.
Bad sores result from: 1. Interior Deficiency diarrhea, 2. Exterior wind-cold injury, 3. Blackening returning to Kidney.
Recent treatments rely solely on Chen Wenzhong's Muxiang San and Yigong San. These were formulated when Cold Water ruled the climate during deep winter, causing cold constraint preventing red eruption, thus requiring acrid-hot dispersants. Modern practitioners ignore seasonal heat/cold, applying uniformly, causing many errors. Effective only coincidentally in warm seasons for poor rural folk.
Danxi's methods are most comprehensive. Using Chen's formulas alone is biased. Pale/itchy/sunken = Deficiency-Cold → Chen's formulas. High fever/protrusion/red-purple/itchy = Heat-Toxin → Cool Blood/Detoxify. Since Chen's popularity, Deficiency-Cold survives, Heat-Toxin dies. Smallpox is fetal toxin; ancients focused on detoxification. Qi/Blood deficiency leads to reversal/incomplete resolution. Chen's methods fill ancient gaps.
However, emphasizing tonification hides detoxification principles, saving one side while harming the other. One must study Danxi and combine both methods.
Deficiency-Cold smallpox lasts 10+ days before death. Heat-Toxin turning purple dies in 7-8 days. Fetal toxin emerges outward, fully erupting by day 2-3, remaining inside until day 6 when it should be fully exteriorized. Days 7-9 form pus and scabs. If toxin is excessive and doesn't exit, it re-enters organs after day 6. Urgent cooling/detoxification is needed before day 6. After day 6, treatment fails, causing rapid death. Weak toxin cases die slowly due to Qi/Blood insufficiency failing to form pus. This distinguishes deficiency/excess severity.
Abundant smallpox means abundant toxin; prioritize detoxification first, then add tonics to support pus/blood formation due to potential Qi/Blood insufficiency.
Commentary: Smallpox/rash is fetal heat-toxin emerging outward. Though an Excess condition requiring purgation rather than tonification, pediatric constitutions vary, and toxin depth varies, requiring flexible application. Comparing Qian Yi and Chen Wenzhong, Chen is superior. Qian favors cooling; Chen combines warm/cool, understanding true/false heat/cold nuances. For Deficiency-Heat with intact Yuan Qi, Qian's method is appropriate. For simultaneous Qi/Yuan Deficiency or Excess, Chen's method avoids error. Pediatric smallpox resembles adult carbuncles. Internal heat-toxin causing bowel/bladder obstruction, irritability, thirst, deep-solid pulse requires: 1. Supporting Interior, 2. Unblocking, 3. Harmonizing Ying/Wei. Chen's Yigong San, Renshen Baizhu San, Qian Hu Zhike Tang are well-formulated and should be followed.