痘疮未愈痢随生，湿热伤中证非轻，白属伤气四君剂，红属伤血四物灵。
【注】凡痘疮未愈而患痢疾者，乃湿热郁于肠胃，致伤气血而然也，痘必滞黯无色。治
当清热除湿，调理气血为主。白痢属气，加味四君子汤主之；赤痢属血，加味四物汤主
之；赤白相兼者，合而用之。
加味四君子汤
茯苓 白术（土炒） 人参 陈皮 木香（煨） 甘草（炙） 黄连（姜炙） 黄芩
水煎服。
【方歌】加味四君妙如神，茯苓白术共人参，陈皮木香炙甘草，姜炒川连配黄芩。
加味四物汤
川芎 当归 生地 黄芩（酒炒） 川连（酒炒） 木香 白芍（炒）
水煎服。
【方歌】加味四物治赤痢，川芎当归共生地，酒炒黄芩合川连，木香白芍调成剂。
见点作痒葛根汤，灌浆痒塌大补良，触犯暴痒熏避秽，急煎内托免毒藏。
【注】经曰∶诸痒为虚。又曰∶火微则痒。治者须分别治之。痘方出而身痒者，此邪气
欲出，腠理严密，其火游溢往来，故不时作痒，加味升麻葛根汤主之。灌浆时，痘色淡
白平塌，便溏懒食，浆清作痒者，此脾胃弱气血虚也，十全大补汤主之。如秽气触犯而
暴痒者，外用避秽香熏之，内服内托散送毒外出，庶无内攻之患。至于将敛而作痒者，此
脓成毒化，荣卫和畅也，与疮疖将痊作痒者同论，不必服药。
加味升麻葛根汤
升麻 葛根 防风 淡豆豉 赤芍 桂枝 甘草（生）
水煎服。
【方歌】加味升麻葛根汤，痘出作痒最堪尝，升葛防风淡豆豉，赤芍桂枝甘草良。
十全大补汤（方见结痂落痂证治）
避秽香
苍术 大黄 茵陈（等分）
上锉细，枣肉为饼。炉中烧之，能避邪秽。
内托散
黄 （蜜炙） 人参 川芎 当归 白芷 木香（煨） 桔梗 浓朴（姜炒）
甘草（炙） 肉桂 防风
引用姜、枣，水煎服。
【方歌】内托散防毒内攻，黄 人参与川芎，当归白芷木香桔，浓朴甘草桂防风。
If the smallpox rash has not yet healed and dysentery follows, it indicates that damp-heat has injured the middle jiao (Middle Burner), and the condition is not mild. White dysentery belongs to qi injury and can be treated with Sijunzi Tang (Four Gentlemen Decoction); red dysentery belongs to blood injury and can be treated with Siwu Tang (Four Substances Decoction).
[Note] Whenever a patient suffers from dysentery while the smallpox rash has not yet healed, it is caused by damp-heat stagnating in the intestines and stomach, leading to damage of qi and blood; the pustules will necessarily appear dull, dark, and colorless. Treatment should focus on clearing heat, removing dampness, and regulating qi and blood. White dysentery involves the qi level and is primarily treated with Jiawei Sijunzi Tang (Modified Four Gentlemen Decoction); red dysentery involves the blood level and is primarily treated with Jiawei Siwu Tang (Modified Four Substances Decoction); if both red and white are present, the two formulas are combined.
Jiawei Sijunzi Tang (Modified Four Gentlemen Decoction)
Poria (Fu Ling), Atractylodes Macrocephala Rhizome (Bai Zhu, stir-fried with earth), Ginseng Radix (Ren Shen), Tangerine Peel (Chen Pi), Aucklandia Root (Mu Xiang, baked), Licorice Root (Gan Cao, honey-fried), Coptis Rhizome (Huang Lian, ginger-fried), Scutellaria Root (Huang Qin).
Decoct in water and take orally.
[Formula Song] The modified Four Gentlemen works like magic,
With Poria, Atractylodes, and Ginseng in the bag.
Tangerine peel, Aucklandia, and honey-fried Licorice,
Along with Coptis fried in ginger and Scutellaria nice.
Jiawei Siwu Tang (Modified Four Substances Decoction)
Ligusticum Chuanxiong Rhizome (Chuan Xiong), Angelica Sinensis Radix (Dang Gui), Rehmannia Root (Sheng Di), Scutellaria Root (Huang Qin, wine-fried), Coptis Rhizome (Chuan Lian, wine-fried), Aucklandia Root (Mu Xiang), Paeonia Lactiflora Radix (Bai Shao, stir-fried).
Decoct in water and take orally.
[Formula Song] Modified Four Substances treats red dysentery well,
Chuan Xiong and Dang Gui with Sheng Di dwell.
Scutellaria wine-fried joins with Coptis too,
Aucklandia and Bai Shao blend the remedy through.
When the rash spots appear accompanied by itching, Gegen Tang (Kudzu Decoction) is used; during the filling stage, if itching and collapse occur, great supplementation is beneficial; if sudden itching is triggered by foul odors, fumigation with Bi Hui Xiang (Avoiding Filth Incense) is applied, and Neituo San (Internal Support Powder) is decocted urgently to prevent toxin retention inside.
[Note] The Classics state: "All itching arises from deficiency." It also states: "Weak fire causes itching." Practitioners must differentiate and treat accordingly. When the rash has just emerged and the body itches, this is because the pathogenic factor desires to exit, but the couli (pores) are tight, causing fire to wander back and forth, resulting in intermittent itching; Jiawei Shengma Gegen Tang (Modified Ephedra and Kudzu Decoction) is used. During the filling stage, if the pustules are pale, flat, and collapsed, with loose stools, poor appetite, clear pus, and itching, this indicates spleen and stomach weakness with qi and blood deficiency; Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) is used. If sudden itching is caused by contact with filth, external fumigation with Bi Hui Xiang is used, and internally, Neituo San is taken to expel toxins outward, thereby avoiding the danger of internal attack. As for itching occurring just before scabbing, this indicates that pus has formed and toxins have transformed, and the ying (nutritive) and wei (defensive) qi are harmonious and flowing smoothly; this is discussed similarly to itching when sores and boils are about to heal, and no medication is necessary.
Jiawei Shengma Gegen Tang (Modified Ephedra and Kudzu Decoction)
Ephedra Stem (Sheng Ma), Kudzu Root (Ge Gen), Saposhnikovia Root (Fang Feng), Prepared Soybean (Dan Dou Chi), Red Peony Root (Chi Shao), Cinnamon Twig (Gui Zhi), Licorice Root (Gan Cao, raw).
Decoct in water and take orally.
[Formula Song] Modified Shengma Gegen Tang,
Itching upon rash emergence is its task.
Sheng Ma, Ge Gen, Fang Feng, and Dan Dou Chi,
Chi Shao, Gui Zhi, and Gan Cao make it rich.
Shiquan Dabu Tang (See treatment for crusting and falling off stages for formula details)
Bi Hui Xiang (Avoiding Filth Incense)
Atractylodes Rhizome (Cang Zhu), Rhubarb (Da Huang), Artemisia Capillaris Herba (Yin Chen) in equal parts.
Grind finely into powder, form into cakes with jujube paste. Burn in a stove to ward off evil filth.
Neituo San (Internal Support Powder)
Astragalus Root (Huang Qi, honey-fried), Ginseng Radix (Ren Shen), Ligusticum Chuanxiong Rhizome (Chuan Xiong), Angelica Sinensis Radix (Dang Gui), Angelica Dahurica Root (Bai Zhi), Aucklandia Root (Mu Xiang, baked), Platycodon Root (Jie Geng), Magnolia Bark (Nong Po, ginger-fried), Licorice Root (Gan Cao, honey-fried), Cinnamon Bark (Rou Gui), Saposhnikovia Root (Fang Feng).
Add fresh ginger and jujubes, decoct in water, and take orally.
[Formula Song] Neituo San prevents toxins from attacking inward,
With Astragalus, Ginseng, and Chuan Xound.
Dang Gui, Bai Zhi, Mu Xiang, and Jie Gao,
Nong Po, Gan Cao, Rou Gui, and Fang Feng follow.