如含水之状，身体微汗潮润，则出最轻，若气喘鼻干作呕惊狂者最重。初见如芥子如米尖，再后成片，红色者
轻，紫色者险，黑色者逆，不可视为泛常。死生虽由天命，岂可用药失序，致令夭亡。务宜辨寒虚实，察毒瓦斯
浅深，庶人事始尽也。大抵初发热时，必当微表，见形即宜清凉。一种初起眼白赤红，声哑唇肿作渴，腰痛腹
胀，人事不清，口鼻出血，烦乱狂叫不安，闭塞不出，即大凶候也。服大剂清凉解毒药后，若能现出者，或可
得生。鼻内流血者重，口内流血者毒尤重。又一种初时失于清解，过于发热，以致后来元气虚弱，毒瓦斯停内，
口鼻出血腥臭，骨瘦不堪，或生牙疳，身热不退，终成坏证，不可不慎。此证日出三次，三日九次为顺。总宜
出透，毒瓦斯得净，即无他患。一种奶痧风疹，此类感风热而出，乃皮肤小疾，服疏风清热之药即愈，不在此痧
疹中论也。
痧疹与痘疮不同，未见形并初见形时微表或可，如太过则胃气受伤，反令停毒攻肺，生痰作喘，以致闭塞
难现。若服发表药而不出者，此热结在内，速宜清凉行利，则肺窍清而毛孔易开，痧疹乃现。今之愚夫愚妇，
表痧痘多用樱桃、荔枝核、葱头等物。不知此数种性热，大不相宜。轻者服之转重，重者变逆。惟发表时只
宜羌活、荆芥少加一二味，兼佐以连翘、牛蒡子、观音柳、紫草、石膏。此种实为专司发痧之药，其性虽凉，
而能通
肺达表，故不可少。
一种痧疹初起，四肢逆冷，乃火极似水之故，不可妄投热药。宜当利下清凉，痧现自然渐和也。
痧疹吐虫解虫，皆系热盛。大约吐者重，而解者轻。用药以清热为主，如黄芩、栀子、丹皮。若吐虫解虫
在出痧之后者，可加乌梅一二，痧前则忌。
痧疹前后泻利，不宜用药速止。如泻黄红色，乃内有伏热，加黄连、黄芩、车前子可也。
痧疹后眼目赤红者，当用生地、菊花、决明子、蒺藜、归尾、柴胡、红花等味。一种痧后面色青白，骨瘦不
堪，元气损伤，肝脾血少成痞，眼懒睁畏明，似害非害，宜服健脾肥儿丸，或服六味地黄丸，庶可渐愈。一切疏
风治眼之药，万不可妄投。不但痧后当如此，凡小儿病后失调成疳疾痞眼者，俱当如此医治，养血健脾为主。倘
大便泄泻稀白水者，归脾汤、补中益气汤对证要药也。若泻黄水者，则又在热论，即不宜服此。
痧疹发热二三日或四五日末见形，疑似之间，用防风发表汤。
防风发表汤
防风（五分） 干葛（八分） 红花（三分） 枳壳（七分，炒） 甘草（五分） 桔梗（八分） 苏梗
（六分） 川芎（五分） 荆芥（六分） 当归（六分） 陈皮（六分） 杏仁（一钱，炒） 山楂肉（二钱）
白水煎。
朱纯嘏曰；可去陈皮，加牛蒡子七分、连翘壳五分。
痧疹见形一二日，内服解毒快斑汤。
解毒快斑汤 托表凉解，活血化毒。
连翘（七分） 荆芥（六分） 防风（六分） 牛蒡子（六分） 生地（二钱） 蝉蜕（三枚） 归尾（六分）
山楂肉（二钱） 桔梗（八分） 川芎（五分） 干葛（八分） 黄芩（八分，酒炒） 紫草（八分）
白水煎，或加观音柳五分。
朱纯嘏曰∶此方可用，再加生犀角磨汁和药同服更好。
痧疹见形二三日内，色红烦躁，出不透快，宜服竹叶石膏汤。
竹叶石膏汤
竹叶（三片） 红花（三分） 生地（二钱） 石膏（三钱） 花粉（八分） 陈皮（五分） 甘草
（五分） 黄连（五分，微炒） 僵蚕（五条） 连翘（六分） 玄参（一钱） 牛蒡子（六分） 桑皮（一钱）
如大便不解，加生大黄二钱，再不解即加玄明粉二钱，惟热毒重盛者方可。如泻红水或作烦渴，亦加大黄。
痧疹四五六日回时，尚有余毒留于肺胃，咳嗽气粗，外热不退者，服清肺饮。
清肺饮
竹叶（二片） 生地（二钱） 柴胡（六分） 麦冬（一钱） 玄参（一钱） 桔梗（八分） 僵蚕（五条）
甘草（五分） 陈皮（六分） 黄芩（八分） 归尾（八分） 知母（八分） 石膏（二钱）
白水煎。
朱纯嘏曰∶此方可用，引加灯芯五尺同煎服。
痧后面色青白，唇淡气弱，宜服调元健脾保肺汤。
调元健脾保肺汤 并治痧后瘦弱成疳疾。
黄 白茯 丹皮 陈皮 沙参 白芍（酒炒） 人参 当归 百合 甘草
如大便不实，泻白色者，加木香、白术；如泻黄色，加酒炒黄芩、车前子、黄连。
朱纯嘏曰∶此方宜加薏米、麦冬、建莲肉同煎服。
痧后痢疾下红白，乃肺经余毒流注大肠，或饮食失调，宜服健脾解毒汤。
健脾解毒汤
炒黄连（七分） 泽泻（八分） 山药（八分） 甘草（五分） 炒扁豆（一钱五分） 白芍（酒炒，六分）
茯苓（八分） 木香（一分） 山楂肉（一钱） 丹皮（七分） 白术（七分，炒） 陈皮（五分）
如无黄连，加蜜水炒黄柏亦可。身体虚弱，面青唇白加沙参三分，晚米二钱。
痧后口疮牙疳等患，宜服清胃败毒汤。
清胃败毒汤
僵蚕 丹皮 甘草 生地 连翘 桑皮 沙参 茯苓 黄柏（蜜炒） 银花
如体虚加白术。
朱纯嘏曰∶此方不敢遽以为是。
痧后口疮牙疳，宜搽救苦散。
救苦散
人中白（五钱， ） 飞青黛（二分） 冰片（一分） 僵蚕（一钱） 寒水石（井水飞细，三钱）
共为细末，先以苦茶拭口随搽。此药富贵之家加牛黄二分研入，其效更速。
朱纯嘏曰∶此方轻证亦颇有验，重证恐未必能奏全功也。
痧疹咽喉肿痛，不拘初起回后，用二圣散。
二圣散
苦参（三钱） 白僵蚕（二钱）
共为细末吹入。
有一种痧痘大吐大泻而后见者，甚轻，与作恶心干呕者不同，用药微表和平安胃为主，宜服和中汤。
和中汤
归身（七分） 陈皮（五分） 甘草（五分） 白术（八分，炒） 柴胡（六分） 防风（六分） 白
茯（七分） 白芍（酒炒，六分） 干葛（八分） 丹皮（五分） 桔梗（七分）
白水煎。
有种病后瘦弱唇白气虚，感时气出痧疹者，宜服加味逍遥散。
加味逍遥散 体弱气虚，痧出白色，少红活者，俱可服。
薄荷 白茯 归身 炒白术 丹皮 陈皮 柴胡 炒白芍 麦冬 甘草 干葛
白水煎。
痧疹不拘前后，痰多咳嗽，有风有热者，俱宜服抱龙丸。
抱龙丸
钩藤（一两） 桔梗（二两） 天麻（二两） 陈胆星（四两） 陈皮（一两） 薄荷（一两） 僵
蚕（五钱） 川贝母（一两，去心） 升麻（五钱）
共为极细末，炼蜜成丸，如弹子大，朱砂为衣。乳孩每服半丸，大者每服一丸，白滚水下。若外感风邪，用
防风五分煎汤调下。若内热，用竹叶汤调下。
痧疹咳嗽，气喘唇红，结热在内，烦躁不安，口鼻出血，不拘前后俱宜服犀角解毒化痰清火丸。
犀角解毒化痰清火丸
归尾（八钱） 连翘（一两） 赤芍（六钱） 生犀角（一两） 生地（二两） 丹皮（一两） 紫草（一两）
牛蒡子（三钱） 花粉（一两） 黄连（三钱） 薄荷 川贝母（一两，去心） 甘草梢（一两）
共为细末，炼蜜成丸，如弹子大，每服一丸，竹叶汤化下。犀杯不入药。
痧后失调，体瘦气弱，或成疳疾，或泄泻等证，宜服健脾肥儿丸。
健脾肥儿丸
人参（三钱） 黄 （一两，蜜炙） 炒神曲（二两） 扁豆（一两，炒） 白术（一两） 甘草（六钱）
生黄连（三钱） 山楂肉（二两） 陈皮（五钱） 白芍（六钱，炒） 当归身（八钱） 橘红（五钱） 白
茯苓（一两） 山药（一两） 地骨皮（六钱） 百合（八钱）
共为细末，炼蜜成丸，如弹子大。每食远白滚水下一丸。不用人参亦可。
朱纯嘏曰∶凡蜜丸俱忌食葱。
痧后咳嗽，内热不清，心神慌乱，夜卧不安，脾虚，或生疮疥，宜服天真膏。
天真膏
生苡仁 麦冬（去心） 玄参 沙参 生地 生黄 桑皮（各四两） 丹皮 茯神 当归 白茯苓
炒枣仁 紫菀 橘红（各二两）
取长流水，用砂锅，桑柴文武火熬成珠，上好白蜜收成，盛瓷器内。每服三五茶匙，白滚水调服。
霖按∶聂氏三方，已得要领。孟氏治法较备，然亦不能出其范围。但两家皆为近世所宗，并录之以作后学
楷式。
张隐庵曰∶痘乃先天之毒，疹属后天之邪，先天止有水火，后天始备五行。产下发声吮乳，肇自后天，是以
发声之时，口中有毒即咽下，而归于阳明。故 之毒瓦斯发于阳明，上达于肺，出于皮毛，肺主气而外合皮毛。是
以痘毒走于血分，而气以化之为顺； 毒走于气分，而血以和之为顺。若走于血分而见云头紫赤斑者，逆也。
乃气分之毒，更速于痘。若停留于胃，则烂牙龈；阻滞在肺，则为鼻煽喘急。发表疏里，清热解毒，事在
良医之临证妙用者也。夫气为阳，血为阴。痘乃精血中毒，故应四时之生长收藏，以合地支之数。 乃气分之毒，
是以一日三烹，三而三之，以应阳九之终。痘发于阴，故宜头面稀疏，不喜独参阳位； 发于阳，故喜大烹头面，
不宜惟在心胸。此人之阴阳血气，应天地自然之道也。
治 主方
葛根 桔梗 荆芥 牛蒡子 防风 杏仁 甘草 橘皮
上方用泉水煎服，再随四时之气而加减用之。如寒闭者，宜麻黄。热闭者，宜石膏。食闭者，宜枳朴、山楂。
热甚者，加黄
芩、黄连。毒甚者，加白花地丁、西河柳。渴者加知母。喘者倍杏仁。里实者加葶苈、牵牛。盖痘疹有血气之分，
而用药亦宜分别。如大黄、大戟，血分之泻药也；葶苈、牵牛，气分之泻药也。黄连形垒如连珠，泻心火之药也；
黄芩外肌皮而内腐空，故名空肠，又名腐肠，乃泻肺而清肌表之药也。肺主气而心主血，故清痘之热毒，宜以连
为君，而芩为佐；清 之热毒，宜以芩为君，而连佐之。又如金银花，花开黄白，藤名忍冬，能启阴气而解气
分、血分之热毒，盖黄走血而白走气也，故解痘毒者宜之，而 毒亦可。若夫白花地丁，又专于 证者也。此用
药之大关目，学人引伸触类，微妙无穷。
霖按∶张氏论治处方，皆极精妙。用药辨别气血，尤具卓识。惟述原踪前人之误，云痧疹为后天胎血咽入之
毒，亦智者之一失也。余长子坤生即闷绝，经时始苏，稳婆将口中秽血拭去，咸谓必无痧痘之险，比长，痘出虽
稀，痧疹颇重，年二十死于瘵。始信古人之言，未可深泥。
章虚谷论痘疹之源，谓痘为先天之毒，成于父母媾精
之初；疹属后天。儿在胎时，呼吸之息，不由口鼻，唯一缕脐带通于子宫，与母呼吸相贯。父母不能节欲，欲火
即由脐带中随儿阖辟之息而入。吸由于肾，肾主闭藏，故毒蕴于肾脏也。此说似觉近理。但痘疹同是命门伏毒，
感于阴，则发痘；感于阳，则发疹。阴主血，以气为固；阳主气，藉血为资。此中阴阳互根之至理在焉。然虽云
伏毒，亦必待六气之火相激而动。其痘疹多发于子午卯酉之年者，为少阴君火，司天在泉故也。盖人身命门伏
藏之火，与司天在泉之火相搏激而后发。试观极北之蒙古不发痘疹，曷何故欤？乃寒水凝结之乡，君火之令不行
耳。《肘后》论言痘疹名虏疮，为马伏波征南所染，传入中国。南位离火，得气最先，固是天运之转移，而六气
之火相引人身之火，昭然可证，又何必纷纷
臆度哉！
高士宗曰∶ 犹错也，皮肤甲错之谓也。俗名曰 ，实系疹也。红点隐隐，谓之隐疹。疹之根源，乃毫毛
之内，皮腠之间，因于寒致血凝涩，其凝涩之血散发于皮肤之外，则发而为疹。盖人身通体毫毛之气，肺所主
也。毫毛之内，腠理之外，则秉胞中之血，热肉充肤，淡渗皮毛，肝所主也。皮肤寒而血凝涩，始焉凝涩，继
欲流通，则发热咳嗽，散而发疹。疹之发也，有稀少，有稠密。极稀少者，不过数点，以及数十点；极稠密者，
则周身头面无有空隙。医者不知其故，见有数点，即行攻发。若皮肤肌腠之间果有凝涩，则发热咳嗽，自当涌
出。其不能即出者，非肌肉不和，即气虚不振。治之之法，当以红花、归、芎、荆、柴、羌、丹之剂，和其肌
表；或以桂枝、 、术、归、芍、苓、甘之剂，助其气虚。若概以苏、麻、前、杏、芩、连、石膏之剂投之，
其气虚不出者，此为虚其原本，本自稀少者。此为无故受贼，非惟疹不能出，其经脉表里受亏，致身大热而喘
急生。愈热愈表，愈喘愈发，轻者重，重者死矣。盖痘之发也，见有一二点，其势必出；疹之发也，见有一二
点，可出可不出。若肌表果有凝涩之疹，则身热咳嗽，其势自出。若无疹则止，此数点不能再增。善治者明乎
此理，不行攻发，但调其经络，和其荣卫，虚者补之，寒者温之，则热退身安而愈。无奈蒙昧不明，当疹毒盛
行之时，见有数点即行攻发，转攻转剧，愈发愈危，必致真脏虚败而死，真可痛耳。夫痘毒起于肾，不从经脉
If the rash appears as if holding water, and the body has a slight sweat that is moist, it indicates the mildest condition. If there is panting, dry nose, vomiting, convulsions, or mania, it indicates the most severe condition. Initially, the rash resembles mustard seeds or rice grains, and later spreads into patches. Red color indicates mildness, purple indicates danger, and black indicates an adverse prognosis; it should not be regarded as ordinary. Although life and death are determined by destiny, how can one cause premature death by disordered medication? It is essential to differentiate between cold and heat, deficiency and excess, and to observe the depth of the toxin, so that human efforts are fully exerted. Generally, when fever first begins, mild release of the exterior is necessary. Once the rash appears, cooling medications should be used. Another condition involves initial redness of the whites of the eyes, hoarseness, swollen lips, thirst, lower back pain, abdominal distension, confusion, bleeding from the mouth and nose, restlessness, screaming, or blocked eruption without appearance; these are all ominous signs. After taking large doses of cooling and detoxifying medicines, if the rash can erupt, there may be a chance of survival. Bleeding from the nose indicates severe illness, while bleeding from the mouth indicates even heavier toxicity. Another scenario occurs when initial clearing and resolving were neglected, leading to excessive fever, which subsequently weakens the primordial qi and causes toxins to stagnate internally. This results in bloody discharge from the mouth and nose with a foul odor, emaciation, gum disease (erythema gangrenosum), persistent fever, and ultimately becomes a deteriorated condition; caution is imperative. For this condition, three eruptions per day and nine over three days are considered favorable. The total goal is to ensure complete eruption so that toxins are cleared, preventing other complications. There is also "milk sha" and wind-rash, which arise from contracting wind-heat and are minor skin diseases; they heal with wind-dispersing and heat-clearing herbs and are not discussed here as sha-rash.
Sha-rash differs from smallpox. Mild exterior-releasing methods are acceptable before and just after the rash appears; however, excessive releasing damages stomach qi, causing toxins to attack the lungs, generate phlegm, induce panting, and block eruption. If the rash does not appear after taking exterior-releasing drugs, it indicates internal heat accumulation. Rapid cooling and purging should be employed to clear the lung orifices and open pores, allowing the rash to emerge. Ignorant people often use cherry pits, lychee kernels, and scallion heads for treating sha and smallpox. These substances are hot in nature and highly inappropriate. Mild cases worsen, and severe cases become adverse. Only during exterior release should Nonghuo (Nostalgiae Radix) and Jingjie (Schizonepetae Herba) be used sparingly, supplemented by Lianqiao (Forsythiae Fructus), Niubangzi (Arctii Fructus), Guanyinliu (Salicis Tomentosae Ramulus), Zicao (Lithospermi Radix), and Shigao (Gypsum Fibrosum). These are specific herbs for inducing sha eruption; although cool in nature, they unblock the lungs and reach the exterior, making them indispensable.
In another type of sha-rash, the limbs are cold at onset due to extreme heat resembling water. Hot herbs must not be administered blindly. Cooling purgatives should be used; once the rash appears, the condition will naturally harmonize.
Vomiting worms or passing worms during sha-rash are caused by intense heat. Vomiting worms indicates severity, while passing worms indicates mildness. Medication should focus on clearing heat, using Huangqin (Scutellariae Radix), Zhizi (Gardeniae Fructus), and Danpi (Moutan Cortex). If worm expulsion occurs after the rash, Wumei (Mume Fructus) may be added; if before the rash, it is contraindicated.
Diarrhea or dysentery before or after sha-rash should not be stopped hastily with medication. Yellow-red stool indicates latent heat inside; add Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), and Cheqianzi (Plantaginis Semen).
Red eyes after sha-rash require Dihuang (Rehmanniae Radix), Juhua (Chrysanthemi Flos), Juemingzi (Cassiae Semen), Jili (Tribuli Fructus), Guiwei (Angelicae Sinensis Radix), Chaihu (Bupleuri Radix), and Honghua (Carthami Flos). Another presentation involves blue-white complexion, emaciation, damaged primordial qi, liver-spleen blood deficiency forming masses, reluctance to open eyes, photophobia, and ambiguous symptoms. Jianpi Fei'er Wan (Spleen-Strengthening Child-Nourishing Pill) or Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) should be taken for gradual recovery. Wind-dispersing eye treatments must never be used indiscriminately. This applies not only post-sha but also to children who develop malnutrition (kankei) or eye disorders due to poor post-illness care; treatment should focus on nourishing blood and strengthening the spleen. If diarrhea presents as watery white stool, Guipi Tang (Restore the Spleen Decoction) or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) are appropriate. If yellow water is passed, it belongs to heat patterns, and these decoctions are unsuitable.
For sha-rash fever lasting two to four days without visible rash, Fangfeng Fabiao Tang (Saposhnikovia Exterior-Release Decoction) is used.
Fangfeng Fabiao Tang
Fangfeng (5 fen) Gegen (8 fen) Honghua (3 fen) Zhike (7 fen, stir-fried) Gancao (5 fen) Jiegeng (8 fen) Sugeng (6 fen) Chuanxiong (5 fen) Jingjie (6 fen) Danggui (6 fen) Chenpi (6 fen) Xingren (1 qian, stir-fried) Shanzha Rou (2 qian)
Decoct in water.
Zhu Chungu stated: Remove Chenpi, add Niubangzi (7 fen) and Lianqiao Qiao (5 fen).
When the rash has appeared for one to two days, Neifu Jiedu Kuaiban Tang (Internal Detoxification and Rapid Rash-Expelling Decoction) is administered.
Jiedu Kuaiban Tang: Releases the exterior, clears heat, invigorates blood, and transforms toxins.
Lianqiao (7 fen) Jingjie (6 fen) Fangfeng (6 fen) Niubangzi (6 fen) Shengdi (2 qian) Chantui (3 pieces) Guiwei (6 fen) Shanzha Rou (2 qian) Jiegeng (8 fen) Chuanxiong (5 fen) Gegen (8 fen) Huangqin (8 fen, wine-fried) Zicao (8 fen)
Decoct in water, optionally adding Guanyinliu (5 fen).
Zhu Chungu stated: This formula is usable; adding raw Xijiao (Rhinocerotis Cornu) ground into juice and mixed with the medicine is better.
Within two to three days of rash appearance, if the color is red and there is irritability with incomplete eruption, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) is suitable.
Zhuye Shigao Tang
Zhuye (3 slices) Honghua (3 fen) Shengdi (2 qian) Shigao (3 qian) Huafen (8 fen) Chenpi (5 fen) Gancao (5 fen) Huanglian (5 fen, lightly stir-fried) Jiangcan (5 strips) Lianqiao (6 fen) Xuanshen (1 qian) Niubangzi (6 fen) Sangpi (1 qian)
If stool is not passed, add Sheng Dahuang (2 qian); if still blocked, add Xuanmingfen (2 qian), only for severe heat-toxin cases. If red water is passed or thirst/irritability occurs, also add Dahuang.
On the fourth to sixth day, as the rash recedes, residual toxins remain in the lungs and stomach, causing cough, coarse breathing, and persistent external heat. Qingfei Yin (Lung-Clearing Drink) is prescribed.
Qingfei Yin
Zhuye (2 slices) Shengdi (2 qian) Chaihu (6 fen) Maidong (1 qian) Xuanshen (1 qian) Jiegeng (8 fen) Jiangcan (5 strips) Gancao (5 fen) Chenpi (6 fen) Huangqin (8 fen) Guiwei (8 fen) Zhimu (8 fen) Shigao (2 qian)
Decoct in water.
Zhu Chungu stated: This formula is usable; add Dengxincao (5 chi) as a guiding herb for decoction.
After the rash, if the complexion is blue-white, lips are pale, and breath is weak, Diaoyuan Jianpi Baofei Tang (Primordial-Qi Tonifying, Spleen-Strengthening, Lung-Nourishing Decoction) is indicated.
Diaoyuan Jianpi Baofei Tang: Also treats post-rash emaciation leading to kankei.
Huangqi Baifudanshi Mudanpi Chenpi Shashen Baishao (wine-fried) Renshen Danggui Baihe Gancao
If stools are loose and white, add Muxiang and Baizhu; if yellow, add wine-fried Huangqin, Cheqianzi, and Huanglian.
Zhu Chungu stated: Add Yimi, Maidong, and Jianlianrou to this formula for decoction.
Dysentery with red and white stool after rash, caused by residual lung toxins flowing into the large intestine or dietary irregularity, requires Jianpi Jiedu Tang (Spleen-Strengthening and Detoxifying Decoction).
Jianpi Jiedu Tang
Chao Huanglian (7 fen) Zexie (8 fen) Shanyao (8 fen) Gancao (5 fen) Chao Bian Dou (1.5 qian) Baishao (wine-fried, 6 fen) Fuling (8 fen) Muxiang (1 fen) Shanzha Rou (1 qian) Danpi (7 fen) Baizhu (7 fen, stir-fried) Chenpi (5 fen)
If Huanglian is unavailable, honey-fried Huangbai may be substituted. For weak bodies with blue face and pale lips, add Shashen (3 fen) and Wanmi (2 qian).
Mouth ulcers and gum disease after rash require Qingwei Baidu Tang (Stomach-Clearing and Toxin-Defeating Decoction).
Qingwei Baidu Tang
Jiangcan Danpi Gancao Shengdi Lianqiao Sangpi Shashen Fuling Huangbai (honey-fried) Yinhua
Add Baizhu for weakness.
Zhu Chungu stated: I dare not assert this formula is entirely correct.
For mouth ulcers and gum disease after rash, Jiuku San (Relief-from-Suffering Powder) should be applied topically.
Jiuku San
Renzhongbai (5 qian, calcined) Fei Qingdai (2 fen) Bingpian (1 fen) Jiangcan (1 qian) Hanshuishi (fine powder from well water, 3 qian)
Grind into fine powder. First wipe the mouth with bitter tea, then apply. Wealthy families may add Niuhuang (2 fen) for faster effect.
Zhu Chungu stated: This formula is effective for mild cases but may not achieve full success in severe cases.
For sore throat and swelling due to sha-rash, regardless of onset or recovery stage, Ersheng San (Two-Sage Powder) is used.
Ersheng San
Kushen (3 qian) Bai Jiangcan (2 qian)
Grind into fine powder and insufflate into the throat.
A type of sha-smallpox appearing after severe vomiting and diarrhea is very mild, differing from nausea and dry heaving. Treatment focuses on mild exterior release and harmonizing the stomach with Hezhong Tang (Harmonizing the Center Decoction).
Hezhong Tang
Guishen (7 fen) Chenpi (5 fen) Gancao (5 fen) Baizhu (8 fen, stir-fried) Chaihu (6 fen) Fangfeng (6 fen) Baifushi (7 fen) Baishao (wine-fried, 6 fen) Gegen (8 fen) Danpi (5 fen) Jiegeng (7 fen)
Decoct in water.
For post-illness emaciation, pale lips, qi deficiency, and sha-rash contracted from seasonal pathogens, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) is indicated.
Jiawei Xiaoyao San: Suitable for weak constitution, qi deficiency, white-colored rash with little vitality.
Bohe Baifushi Guishen Chao Baizhu Danpi Chenpi Chaihu Chao Baishao Maidong Gancao Gegen
Decoct in water.
For sha-rash with excessive phlegm and cough, with wind or heat, regardless of timing, Baolong Wan (Embracing Dragon Pill) is suitable.
Baolong Wan
Gouteng (1 liang) Jiegeng (2 liang) Tianma (2 liang) Chendanxing (4 liang) Chenpi (1 liang) Bohe (1 liang) Jiangcan (5 qian) Chuan Beimu (1 liang, heart removed) Shengma (5 qian)
Grind into extremely fine powder, form pills with refined honey, size of a bullet, coated with Zhusha. Infants take half a pill; older children take one pill, washed down with plain boiled water. For external wind pathogen, mix with Fangfeng (5 fen) decoction. For internal heat, mix with Zhuye Tang (Bamboo Leaf Decoction).
For sha-rash cough, panting, red lips, internal heat binding, irritability, and bleeding from mouth/nose, Xijiao Jiedu Huatan Qinghuo Wan (Rhino Horn Detoxification, Phlegm-Resolving, Fire-Clearing Pill) is indicated.
Xijiao Jiedu Huatan Qinghuo Wan
Guiwei (8 qian) Lianqiao (1 liang) Chishao (6 qian) Sheng Xijiao (1 liang) Shengdi (2 liang) Danpi (1 liang) Zicao (1 liang) Niubangzi (3 qian) Huafen (1 liang) Huanglian (3 qian) Bohe Chuan Beimu (1 liang, heart removed) Gancao Shao (1 liang)
Grind into fine powder, form pills with refined honey, size of a bullet. Take one pill dissolved in Zhuye Tang. Rhino horn cup is not included in the medicine.
For post-rash maladjustment, emaciation, qi weakness, kankei, or diarrhea, Jianpi Fei'er Wan (Spleen-Strengthening Child-Nourishing Pill) is prescribed.
Jianpi Fei'er Wan
Renshen (3 qian) Huangqi (1 liang, honey-roasted) Chao Shenqu (2 liang) Bian Dou (1 liang, stir-fried) Baizhu (1 liang) Gancao (6 qian) Sheng Huanglian (3 qian) Shanzha Rou (2 liang) Chenpi (5 qian) Baishao (6 qian, stir-fried) Dangguishen (8 qian) Juhong (5 qian) Baifushi (1 liang) Shanyao (1 liang) Digupi (6 qian) Baihe (8 qian)
Grind into fine powder, form pills with refined honey, size of a bullet. Take one pill far from meals with plain boiled water. Renshen may be omitted.
Zhu Chungu stated: All honey pills should avoid green onions.
For post-rash cough, unresolved internal heat, mental agitation, insomnia, spleen deficiency, or skin sores, Tianzhen Gao (True Innocence Paste) is indicated.
Tianzhen Gao
Sheng Yiren Maidong (heart removed) Xuanshen Shashen Shengdi Sheng Huangqi Sangpi (each 4 liang) Danpi Fushen Danggui Baifushi Chao Zaoren Ziwan Juhong (each 2 liang)
Use long-flowing water, clay pot, and mulberry wood fire to simmer into beads, add premium white honey to finish, store in porcelain. Take 3-5 tea spoons mixed with plain boiled water.
Ye Lin notes: Nie's three formulas have grasped the essentials. Meng's treatment methods are more comprehensive but remain within this scope. Both schools are respected in recent times; recording them serves as models for students.
Zhang Yin'an said: Smallpox is congenital toxin; rash is acquired evil. Congenital has only water and fire; acquired has the five elements. Birth, crying, and suckling originate from the acquired phase. Thus, upon crying, oral toxins are swallowed and directed to Yangming. Therefore, smallpox toxins emerge from Yangming, ascend to the lungs, and exit through the skin/hair. The lungs govern qi and connect to the skin. Hence, smallpox toxins move in the blood level, and qi transforming them is favorable; rash toxins move in the qi level, and blood harmonizing them is favorable. If toxins enter the blood level showing cloud-like purple spots, it is adverse. This qi-level toxin acts faster than smallpox. If lingering in the stomach, it rots gums; if blocking the lungs, it causes nasal flaring and panting. Releasing exterior, purging interior, clearing heat, and detoxifying depend on the physician's clinical skill. Qi is yang, blood is yin. Smallpox is toxin in essence/blood, corresponding to the four seasons and earthly branches. Rash is toxin in the qi level, cooking three times a day, multiplying to nine, corresponding to the end of yang nine. Smallpox emerges from yin, preferring sparse head/face, avoiding exclusive yang positions; rash emerges from yang, preferring abundant head/face, avoiding confinement to chest/heart. This reflects human yin-blood/qi aligning with natural dao.
Main Formula for Treating Smallpox
Gegen Jiegeng Jingjie Niubangzi Fangfeng Xingren Gancao Jupi
Decoct in spring water, adjusting according to the four seasons. For cold blockage, use Mahuang. For heat blockage, use Shigao. For food blockage, use Zhishi, Houpo, Shanzha. For severe heat, add Huangqin, Huanglian. For severe toxin, add Baihua Diding, Xihe Liu. For thirst, add Zhimu. For panting, double Xingren. For interior excess, add Tingli, Qianniu. Smallpox and rash have distinctions between blood/qi levels, requiring differentiated medication. Dahuang, Daji are blood-level purgatives; Tingli, Qianniu are qi-level purgatives. Huanglian resembles linked pearls, purging heart fire; Huangqin has hollow interior, named Kongchang/Fuchang, purging lungs and clearing surface. Lungs govern qi, heart governs blood. For clearing smallpox heat-toxin, Huanglian is sovereign, Huangqin minister; for clearing rash heat-toxin, Huangqin is sovereign, Huanglian minister. Jin Yin Hua (yellow/white flowers, Ren Dong vine) opens yin qi to resolve qi/blood heat-toxin; yellow enters blood, white enters qi. Suitable for smallpox toxin, also for rash toxin. Baihua Diding specifically targets rash toxin. This is the key to medication; scholars should extend and touch upon categories, finding infinite subtleties.
Ye Lin notes: Zhang's discussions and prescriptions are exquisite. Differentiating blood/qi shows profound insight. However, tracing origins to claim rash is toxin from post-natal fetal blood swallowed is a mistake by wise men. My eldest son Kunsheng fainted, revived later. The midwife wiped dirty blood from his mouth; everyone believed no rash/smallpox risk. Growing up, smallpox was sparse, but rash was severe; he died of consumption at twenty. I now believe ancient words should not be rigidly adhered to.
Zhang Xugu discussed the origin of smallpox/rash: Smallpox is congenital toxin formed at conception; rash is acquired. In utero, respiration is via umbilical cord connecting to the uterus, syncing with the mother. Parents' lack of desire control allows desire-fire to enter via the cord during fetal breathing. Inhalation relates to kidneys, which store; thus toxin accumulates in kidneys. This seems reasonable. However, both share Mingmen latent toxin. Contact with yin causes smallpox; contact with yang causes rash. Yin governs blood, solidified by qi; yang governs qi, supported by blood. This embodies yin-yang mutual rooting. Latent toxin requires six qi fire agitation to activate. Smallpox/rash often occur in Zi/Wu/Mao/You years due to Shaoyin Junfire governing heaven/earth. Human Mingmen fire clashes with governing heaven/earth fire to erupt. Why does Mongolia not get smallpox/rash? It is a land of frozen cold water where Junfire command fails. *Zhouhou* states smallpox/rash are called "Prisoner Sores," contracted by Ma Fuobo in the south and brought to China. South corresponds to Li Fire, receiving qi earliest. This confirms heavenly shift and six qi fire attracting human fire, proving speculation unnecessary.
Gao Shizong said: "Sha" implies roughness, referring to skin crusting. Commonly called "sha," it is actually rash. Hidden red dots are "hidden rash." The root lies within hair follicles and interstices. Cold causes blood stasis; this stagnant blood disperses externally to form rash. Hair follicle qi is governed by lungs. Between follicles and interstices, womb blood heats flesh, permeates skin, governed by liver. Skin cold and blood stasis initially stagnate, then attempt flow, causing fever/cough and rash eruption. Rash density varies from sparse (points/tens) to dense (covering whole body). Physicians unaware of this attack eruption upon seeing points. If true stasis exists, fever/cough should surge outward. Failure to erupt indicates muscle disharmony or qi deficiency. Treatment: Use Honghua, Danggui, Chuanxiong, Jingjie, Chaihu, Qianghuo, Danpi to harmonize surface; or Guizhi, Fuzi, Baizhu, Danggui, Baishao, Fuling, Gancao to boost qi. Using Su, Mahuang, Qianhu, Xingren, Huangqin, Huanglian, Shigao for qi-deficient non-eruption depletes the root. Sparse rash becomes victimized unnecessarily. Not only does rash fail to erupt, meridians/surface suffer, causing high fever/panting/wind. More heat leads to more releasing, more panting to more eruption; mild becomes severe, severe becomes fatal. Smallpox, once seen, inevitably erupts; rash, once seen, may or may not. True stasis causes inevitable eruption via fever/cough. No rash means stopping; points won't increase. Good physicians understand this, avoid attacking, regulate meridians, harmonize Ying/Wei, tonify deficiency, warm cold; heat retreats, body calms, healing occurs. Ignorant physicians, during peak rash toxin, attack upon seeing points, worsening condition, leading to visceral failure and death. Truly painful. Smallpox toxin originates from kidneys, not from meridians...