痰因津液贮留生，痘疮之火炼而成，加味二陈斟酌用，灌浆保元化毒宁。
【注】痰乃津液贮留胸中而生。盖痘毒之火，耗炼其津液，上壅气道，喉中作声，宜
清气化痰，不可骤用金石之药，恐伤真气，以加味二陈汤治之。若灌浆时见此证，则禁用
二陈汤。但于助浆剂中少佐清气化痰之品，如保元化毒汤加橘红、贝母、桔梗、麦冬，甚
妥。
加味二陈汤
麦门冬（去心） 前胡 栝蒌仁 陈皮 半夏（姜制） 茯苓 甘草（生） 枳壳（麸炒）
桔梗 杏仁（炒去皮、尖） 黄芩
引用生姜，水煎服。
【方歌】痘证多痰宜二陈，麦冬前胡栝蒌仁，陈皮半夏茯苓草，枳桔杏仁共黄芩。
保元化毒汤（方见起胀证治）
毒热熏蒸火灼金，肺气上逆咳嗽频，初热见点杏苏饮，收靥清膈二陈神。
【注】咳嗽者，有声有痰也。因痘毒之火上熏于肺，故气逆而发为咳嗽。如初发热见
此者，宜杏苏饮主之。偶感风寒者，亦用此药。自起胀至成浆而咳嗽者，由喉间有痘，道
路窄狭，痘收自愈，不必服药。结靥后咳嗽者，乃卫气虚弱，腠理开张；或因风寒者，均
宜人参清膈散治之。因余热者，宜加味二陈汤治之。
杏苏饮（方见喘证）
人参清膈散
人参 黄 （生） 茯苓 白术（土炒） 黄芩 当归 白芍（微炒） 知母（生）
桔梗 甘草（生） 柴胡 滑石（飞） 紫菀 地骨皮 桑皮（炒）
引用生姜，水煎服。
【方歌】清膈散疗靥后咳，参 苓术苓归芍，知桔甘草柴滑石，紫菀地骨桑皮合。
加味二陈汤（方见痰证）
Phlegm is generated from the retention and accumulation of body fluids, refined by the fire of smallpox. The modified Erchen Decoction (Two-Chen Decoction) should be used with discretion; during the pustule-filling stage, Baoyuan Huadu Decoction (Support-Yuan Resolve-Toxin Decoction) is employed to resolve toxins and stabilize the condition.
[Note] Phlegm arises from the retention of body fluids in the chest. Generally, the fire of smallpox toxin consumes and refines these fluids, causing upward obstruction of the airway and producing sounds in the throat. It is appropriate to employ methods that clear heat and transform phlegm; one should not abruptly use mineral drugs (Jinshi), as this may damage true Qi (Zhenqi). Therefore, the Modified Erchen Decoction is used for treatment. If this symptom appears during the pustule-filling stage, Erchen Decoction is strictly contraindicated. Instead, a small amount of herbs that clear heat and transform phlegm should be added to the formula supporting fluid filling, such as adding Ju Hong (Tangerine Peel), Bei Mu (Fritillaria Bulb), Jie Geng (Platycodon Root), and Mai Dong (Ophiopogon Tuber) to Baoyuan Huadu Decoction, which is highly appropriate.
Modified Erchen Decoction (Jiawei Erchen Tang)
* Men Dong (Ophiopogonis Radix, heart removed)
* Qian Hu (Peucedani Radix)
* Gua Lou Ren (Trichosanthis Semen)
* Chen Pi (Citri Reticulatae Pericarpium)
* Ban Xia (Pinelliae Rhizoma, prepared with ginger)
* Fu Ling (Poria)
* Gan Cao (Glycyrrhizae Radix et Rhizoma, raw)
* Zhi Ke (Aurantii Fructus Immaturus, bran-fried)
* Jie Geng (Platycodonis Radix)
* Xing Ren (Armeniacae Semen Amarum, fried, skin and tip removed)
* Huang Qin (Scutellariae Radix)
Reference: Fresh Ginger. Decoct in water and take orally.
[Formula Song] For smallpox conditions with much phlegm, Erchen is suitable;
Men Dong, Qian Hu, and Gua Lou are key.
Chen Pi, Ban Xia, Fu Ling, and Gan Cao combined,
With Zhi, Jie, Xing Ren, and Huang Qin aligned.
Baoyuan Huadu Decoction (See Treatment for Swelling Stage)
Toxic heat steams and scorches Lung Metal (Fei Jin), causing rebellious Lung Qi and frequent coughing. In the initial heat stage when spots appear, Xingsu Yin (Apricot and Perilla Drink) is indicated; during the scabbing stage, Qingge Erchen San (Clear-Diaphragm Two-Chen Powder) is effective.
[Note] Coughing refers to symptoms involving both sound and phlegm. Because the fire of smallpox toxin steams upward into the Lungs, Lung Qi rebels, resulting in coughing. If this occurs during the initial fever and spot appearance, Xingsu Yin is the primary treatment. Even if caused by occasional exposure to wind-cold, this formula is also used. If coughing occurs from the swelling stage through to the pus-filling stage, it is due to the presence of pustules in the throat narrowing the passage; the condition will resolve naturally after the pustules dry up, and no medication is necessary. If coughing occurs after scabbing forms, it is due to deficient Wei Qi (Defensive Qi) and open pores (Couli); whether caused by wind-cold or other factors, Ren Shen Qingge San (Ginseng Clear-Diaphragm Powder) is appropriate. If caused by residual heat, Modified Erchen Decoction is suitable.
Xingsu Yin (See Asthma Section)
Ren Shen Qingge San (Ginseng Clear-Diaphragm Powder)
* Ren Shen (Ginseng Radix)
* Huang Qi (Astragali Radix, raw)
* Fu Ling (Poria)
* Bai Zhu (Atractylodis Macrocephalae Rhizoma, earth-fried)
* Huang Qin (Scutellariae Radix)
* Dang Gui (Angelicae Sinensis Radix)
* Bai Shao (Paeoniae Radix Alba, lightly fried)
* Zhi Mu (Anemarrhenae Rhizoma, raw)
* Jie Geng (Platycodonis Radix)
* Gan Cao (Glycyrrhizae Radix et Rhizoma, raw)
* Chai Hu (Bupleuri Radix)
* Hua Shi (Talcum, flown/washed)
* Zi Wan (Kadsurae Longifoliae Fructus)
* Di Gu Pi (Lycii Cortex)
* Sang Bai Pi (Mori Cortex, fried)
Reference: Fresh Ginger. Decoct in water and take orally.
[Formula Song] Qingge San treats post-scab coughing,
Ren Shen, Fu Ling, Bai Zhu, Dang Gui, and Bai Shao combining.
Zhi Mu, Jie Geng, Gan Cao, Chai Hu, and Hua Shi follow,
Zi Wan, Di Gu Pi, and Sang Bai Pi complete the bowl.
Modified Erchen Decoction (See Phlegm Section)