〔钱氏法〕疮疹惟用温平药治之，不可妄下，及妄攻发，受风冷。（海藏云∶温平者、
非热剂，如荆芥、薄荷、防风、牛蒡子、甘草之类。《活人》鼠粘子汤，与洁古解毒防风
汤相兼选用是也。丹溪云∶鼠粘子、连翘、山楂、甘草，此四味，痘疮始终必用之药。）诊睦
亲宫中十大王疮疹云∶疮疹始终出，未有他证不可下，但当用平和药，频与乳食，不受风冷
可也。如疮疹三日不出，或出不快，即微发之（鼠粘子汤之类），如疮发后不多出，即加药（如一
日一帖即加至二帖），加药不出，
即大发之，（升麻葛根防风羌活独活麻黄桂枝之类。）如发后不多，及脉平无证，即疮本稀，
不可更发也。有大热者当利小便，小热者当解毒。（利小便、四圣散之类。）若不快，勿发，勿
下攻，止用抱龙丸治之。疮疹若起，能食者大黄丸下一二行即止。有大热者当利小便。有
小热者宜解毒。若黑紫干陷者，百祥丸下之，不黑者，慎勿下。身热烦躁，腹满而
喘，大小便涩，面赤闷乱大吐，此当利小便。不瘥者，宣风散下之也。若五七日痂
不焦，是内发热气，蒸于皮中，故疮不得焦痂也，宜宣风散导之，用生犀角磨汁解
之，使热不生，必着痂矣。
〔东垣师弟法〕〔洁〕论曰∶ 疹之病，其为证各异。疮发 肿于外，属少阳三
焦相火也，谓之 。小红靥行皮肤中不出者，属少阴君火也，谓之疹。凡显 疹，
若自吐泻者，不可妄治而多吉，谓邪气上下皆出也。大凡 疹首尾皆不可下。（云云，
详前汗下条。）
安里解毒防风汤
防风（一两） 地骨皮 黄 芍药 荆芥 枳壳 鼠粘子（各等分）
上为末。水煎四五钱服。若能食而大便实，宜当归丸微利之。
当归丸 枣变百祥丸（并大便秘）
〔垣〕消毒救苦汤 治 证悉具，消化便令不出，若已出，稀者再不生 。十一月立
此方，随四时加减，惟通造化、明药性者能之。
麻黄根 羌活 防风 升麻 黄柏（酒炒。各五分） 柴胡 川芎 细辛 本 葛根
黄芩（酒炒） 苍术（各二分） 黄连 归身（各三分） 苏木 白术 甘草（生） 橘皮（各一分）
吴茱萸（半分） 红花（少许） 连翘（半钱，初出者减，出大者加） 生地黄（五分）
上 咀。每服五钱，水二大盏，煎至一盏，去滓，稍热服。 疹者，因内伤必
出， 乃荣气逆故也，大禁牵牛、巴豆、峻药，宜半夏、枳实、大黄、益智仁、
之类去泻止吐，若耳尖冷、呵欠、睡惊、嚏喷、眼涩，知必出 也，宜∶
升麻 葛根 白芍药 甘草 归身 连翘（各等分）
上 咀。水煎服。此定法也，后、随证加减∶
如肺出脓 ，先显喘嗽，或气高而喘促，少加人参黄芩以泻伏火，而补元气。
如心出小红 ，必先见嗌干惊悸，身热肌肉肿，脉弦洪，少加黄连。如命门出瘾
疹，必先骨痛身热，其疼痛不敢动摇，少加生地、黄柏。诸 疹皆为阴证疮，皆
因内伤乳食，脾胃不足，荣气逆行，虽火势内炽，阴覆其外，故钱氏制四物升麻
汤发之，如有传变证，根据加减法服之。
〔世〕如疹痘，则发于脾，宜陈氏人参清膈散。（疹者皮肤隐隐如麻名曰麻子。）
水者，多因伤寒热毒而发，宜升麻散及羌活散。
〔丹溪分气血虚实〕〔丹〕小儿痘疹，分气血虚实，以四君、四物、酒炒芩、连等
服之。气虚，参术加解毒药。血虚，四物加解毒药。〔娄〕加解毒药者，酒炒
芩连是也。海藏云∶解毒者，三黄汤、金花丸之类。
痘疹分人之清浊，就形气上取勇怯。痘疮紫，属血热，凉血为主。白，属气
虚，补气为主。中黑陷而外白色、起迟者，则补气中略带凉血药。
〔万〕痘疮主治，解表、和中、解毒三法也。解表，兼发散之义，使邪气尽出
于外，不使留伏于中，如防风、白芷、荆芥穗、升麻、葛根、柴胡、桂枝之属。
和中，专主脾胃，兼助血气，使里气常实，血气不亏，助养痘疮而待其成，不致痒
塌倒陷，如黄 、人参、白芍药、当归、木香、陈皮之属。解毒，只泻火凉血清
气，使毒邪有制，不为正害，如山豆根、大力子、紫草、连翘、芩、连、栀子
之属。
〔翁〕〔仲仁分气虚血热热壅三证〕（辨法详虚实条）凡气虚之证，初发身热手足厥冷，
乍凉乍热，精神倦怠，肌肉 白，饮食减少，四肢倦而睡卧安静，便清自调，虚证无
疑。未见点前用参 饮加轻剂发散，如紫苏、防风、白芷。见点之后用参 饮加轻
剂，如川芎、桔梗。见点四日之后重用参 饮随病加减处治。七八日浆足之后，保
婴百补汤调养气血而已。此证末稍塌陷黑靥者，多用木香异功散收功。凡血热之
证，初发身热壮盛，腮红脸赤，毛焦色枯，烦躁渴欲饮水，日夜啼哭，睡卧不宁，
好睡冷处，小便赤涩，热证无疑。未出之前，升麻葛根汤或升麻流气饮虽皆可服，
总不若十神解毒汤为稳。未出至见点三四日后，热证悉平，势将行浆，从太乙保和
汤加减。八九日浆足之后，则有保婴百补汤调养之。此证七八日间，有紫黑干枯及
青灰干黑陷者，则有夺命大造、谈笑博金、一字金，或百祥、牛李、猪尾、独神
等方，皆可审用。惟经泄泻之后有黑陷干红者，则从木香异功散治之。此祖宗世业
不传之秘，万试万中者也。凡热毒壅遏之证，初发身热壮盛，腮红脸赤，毛焦皮
燥，气粗喘满，腹胀烦躁，狂言谵语，睡卧不宁，大便秘结，小便赤涩，面浮眼胀，
多啼多怒，的系热毒壅遏，未见点时，先须升麻葛根汤一服，随服羌活散郁汤。至
见点三日之内，诸证悉平，势将行浆，则服益元透肌散加减。浆足之后，服婴童百
补汤调养而已。六七日外有紫黑干枯及青灰干白陷者，则有夺命大造、谈笑博金、
一字金、百祥、牛李、猪尾、独神等方，皆可审用。惟曾经泄泻，有木香异功证，
则从木香异功散治之。治虚弱痘证有二法，的系气虚，则宜补气，气虚易寒，又
宜温之，温补一法之中，酌量轻重处治，方为妙用。治血热壅遏有五法，表热盛
则痘必干枯，表太凉则冰伏，内热盛则秘结，内太凉则泄泻，气壅盛则腹胀喘满，
热毒为所抑而不得伸越、则腹胀狂乱，毒瓦斯弥盛则表里受重、而婴童难任，是故治
痘之法，在安表、和中、匀气、透肌、解毒五者而已。安其表，使无干枯冰伏之
患。和其中，使无便结泄泻之变。匀其气，使无壅盛喘满之过。透其肌，使热毒得
以伸越而达表。解其毒，使内外有所分消。五者不失，则血热壅遏之证势虽绵密，
亦不足忧矣。
参 饮（即保元汤） 专治元气虚弱，精神倦怠，肌肉柔慢，面青 白，饮食少
进，睡卧宁静而不振者，不分已出未出皆治。
人参（一钱） 黄 （二钱） 甘草（五分，初热生用，出定炙用）
杨仁斋谓其能补益元气，更名保元汤，盖为元气虚弱者立也。后世治痘者多
主之，不分元气虚实之异，概用于血热毒壅之证，是为以实攻实，岂不误哉。
上，用水一钟，姜一片，煎四五分，不拘时服。
参 饮加减禁忌法
如前虚证，辨认不瘥，以此方为主，前后始终，皆不可易，中间杂证兼见，虽
或不同，要皆气虚所致，则以本方而斟酌加减之，毋得过投发散、苦寒、之剂。
初热未出之际，只可少济以开提匀气之功如桔梗、川芎、之类。浆足之后，助以
收敛如白术、芍药、茯苓、焉尔。
出不快，加川芎、官桂。禁用蝉蜕、鼠粘子、人牙、紫草。小便赤，加大腹
皮、茯苓。禁用车前、滑石、瞿麦、山栀。大便溏，加白术、茯苓、肉果。禁
用猪苓、诃子、龙骨、矾石。小便短涩，加大腹皮、木通。禁用滑石、瞿麦。
大便实秘，加酒炒当归。禁用大黄、枳壳、生地。泄泻，加白术、肉果、木香。
禁用龙骨、石脂、枯矾。呕吐，加干姜、丁香、橘皮。禁用半夏。烦渴，加
麦门冬、芍药、五味子。禁用天花粉、葛根、乌梅、半夏。减食，加白术、人
参、神曲。禁用山楂、砂仁。伤食，加神曲、麦芽、山楂。禁用枳实、蓬术、
三棱、巴豆、大黄。喘急在三四日前者，加桔梗、蝉蜕、杏仁。风，则微散
之，加紫苏、防风、枳实。痰，则从痰治，加杏仁、贝母。有虚证见者，决
非实喘，不过是毒不得外达，上乘于肺耳，禁用麻黄、莱菔、苏子、枳壳下气
等药。六七日后，或先曾泄泻而后气喘者，虚之极也，加人参则喘自止。腹
胀，加大腹皮、浓朴，兼发散开提。禁用枳壳、莱菔宽中下气等药，仍视小便
秘、与伤食否，亦有伤于生冷，或寒气郁遏而然，从内伤外感而治。内伤，用
丁香、官桂、神曲、木香。外感，用防风等药发散治之。当热不热，四五日
间手足厥冷，冰硬不起，加丁香、官桂、炙黄 、川芎。夏月减丁香。四肢不
起，加肪风，减川芎。浆不足，加白术、当归、川芎。灌水泡，加白术、防
风、白芷、芍药。灌清浆，加白术、茯苓。喘嗽，加五味子、杏仁、麦门冬。
禁用天花粉、桑白皮。发痒，加川芎、当归、芍药、白术、茯苓。禁用僵蚕、
蒺藜。痒甚，外用茵陈烧烟熏之。禁用沐浴发散之药，恐成气脱。
十神解毒汤 专治身发壮热，腮红脸赤，毛焦色枯，已出未出，三日以前痘点烦红，
燥渴欲饮，睡卧不宁，小便赤涩者，此热盛也，并皆治之。
当归尾 生地黄 红花 牡丹皮 赤芍药 桔梗 木通 大腹皮 连翘 川芎
此方，治血热痘疹，以凉血行血为主，佐以桔梗、川芎，有开提发散之功，引
以大腹皮、木通，有疏利热毒之效，臣以连翘、牡丹皮，有解毒之良，用此以治
血热痘疹，则能内外分消，热毒虽盛，庶几解散，表里自然和平矣。古人用黄连
解毒汤，恐骤用寒凉，不惟冰伏热毒，及出不快，抑且热毒为其所抑，则郁于脏
腑，或肚痛腹胀，内溃而死者有之，岂若此方用之为稳当，若不得已而用黄连芩
檗，亦须酒炒，一以制其寒凉之性，一以助其上行之势，借连、檗以解毒耳。
十神解毒汤加减法
身热壮盛，加葛根、前胡。毒盛绵密，加荆芥、鼠粘子。渴，加天花粉、竹叶、
滑石。小便尿血，加犀角、山栀。大便黑，加犀角、黄连，或桃仁。吐血干呕，
加黄连、犀角。发红 ，加犀角、黄芩、黄柏、山栀、玄参。小便赤，加山栀。
小便短涩，加猪苓、泽泻。小便秘，加滑石、瞿麦。大便秘，加枳壳、前胡。大
便秘，喘，加枳壳、前胡、大黄。烦躁，加麦门冬、天花粉。烦渴，狂乱谵语，
加知母、麦门冬、石膏。呕吐，加猪苓、泽泻、黄连。咽喉痛，加甘草、鼠粘
子、荆芥。泄泻，加猪苓、泽泻、防风。呕，加橘皮。
以上，并用灯心十四根，水煎服。
血热痘证，热毒弥盛，然毒瓦斯无所分消，只宜重用升提发散，使毒得以达表而
从外解，引以渗泄，使热得以润下而从内消，佐以清凉消毒，行血凉血之剂，则
痘虽稠密，亦能消散，自易浆而易化也，所谓轻其表而凉其内，此方盖得安表、
和中、解毒、三法尽善，诚痘科之神方也。丹溪曰∶热者清之，实者平之，其此
方之谓欤。是故发热至见点之后，三日以前，毒瓦斯未尽达表，内外弥盛，血热之
证悉具，辨认不瘥，并只以本方处治之，切不得下参、 、白术、茯苓补气之
药于热证，未浆之前，如误而用之，是谓以实攻实，腹胀气喘，狂乱谵语，咽喉
肿痛，口舌生疮，变证百出，所谓邪得补而愈盛也。呕吐泄泻，慎不得用半夏、
丁、桂、干姜、木香、藿香、诃子、肉果，如误而用之，则是以热助热，气得热
而愈亢也，燥证，必至咽疼狂乱，失血便秘，无所不至矣。至于龙骨、枯矾、涩
滞之物，且能使气道阻塞，是欲其出而闭之门也，腹胀之患生，而喘急之势至矣，
尤宜戒之。及至血 已成，气血定位，头顶白光，势将行浆，又宜易方，另行
别议。
羌活散郁汤 专治实热壅盛，郁遏不得达表，气粗喘满，腹胀烦躁，狂言谵语，睡
卧不宁，大小便秘，毛竖面浮，眼张若怒，并有神效。并为风寒外搏，出不快者
同治。
防风 羌活 白芷 荆芥 桔梗 地骨皮 川芎 连翘 甘草 紫草 大腹皮 鼠粘子
上，为粗散。水一钟，灯心十四根，煎六分，温服。
身初发热，及见点之际，毒瓦斯壮盛，外为风寒所抑，或肌肉粗浓，腠理坚闭，
肌窍不通，经络阻塞，使清气不得引毒达表循窍而出，则热毒壅遏于内，为腹胀，
为喘急，为秘结，为狂烦，为惊搐，为失血，皮燥毛直，面急眼胀，睡卧不宁，
惊啼多哭，此热毒壅遏之证，辨认不瘥，急宜用发散开提之剂，佐以和解透肌之
法，则热毒不壅，而其出自易矣。羌活、白芷、防风，有升提发散解毒之长，桔
梗有开提匀气之能，荆芥、连翘、鼠粘善解郁热，地骨皮消壅热于筋骨之间，
且能整肃脏腑，紫草滑肌通窍，大腹皮引热下行，使内外有所分消，用此以治热
[Method of Qian Yi] For the treatment of chuangzhen (exanthematous diseases such as smallpox and measles), only use medicines with a mild and neutral nature. Do not recklessly use purgatives, nor recklessly apply diaphoretic or attacking methods, to avoid exposing the patient to wind-cold pathogens. (Zhang Yuansu, also known as Haicang, stated: "Mild and neutral" does not refer to hot-natured medicines, but rather to herbs like Jingjie (Schizonepetae Herba), Bohe (Menthae Haplocalycis Herba), Fangfeng (Saposhnikoviae Radix), Niubangzi (Arctii Fructus), and Gancao (Glycyrrhzae Radix et Rhizoma). The Shuniuzi Tang (Arctii Fructus Decoction) from *Huoren* should be selected in conjunction with Jiegu's Jiedu Fangfeng Tang (Detoxifying Saposhnikovia Decoction). Zhu Danxi stated: Niubangzi (Arctii Fructus), Lianqiao (Forsythiae Fructus), Shanzha (Crataegi Fructus), and Gancao (Glycyrrhzae Radix et Rhizoma) are four herbs that must be used throughout the entire course of variola.) Wang Da Shan, the Tenth Prince of Muqin Palace, discussed chuangzhen, stating: Throughout the eruption of chuangzhen, if no other symptoms requiring purgation appear, purgatives should not be used. One should only use mild medicines, frequently provide milk and food, and avoid exposure to wind and cold. If chuangzhen do not erupt after three days, or if their eruption is sluggish, slight diaphoresis should be induced (using formulas like Shuniuzi Tang). If the eruption is sparse after starting, the dosage should be increased (e.g., from one decoction per day to two). If they still do not erupt despite increased dosage, strong diaphoresis should be employed (using herbs like Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Mahuang (Ephedrae Herba), and Guizhi (Cinnamomi Ramulus)). If, after diaphoresis, the eruption remains sparse and the pulse is calm without other symptoms, it indicates that the eruption was originally sparse, and further forcing of eruption is contraindicated. In cases of high fever, promoting urination is indicated; for low-grade fever, clearing heat and detoxifying is indicated. (Promoting urination can be done with Sisheng San (Four Saints Powder).) If eruption is sluggish, do not induce diaphoresis or purge; instead, use Baolong Wan (Dragon-Holding Pill). If chuangzhen have erupted and the patient can eat, Dahuang Wan (Rhubarb Pill) may be used to induce bowel movement once or twice, then stop. High fever requires promoting urination; low-grade fever requires clearing heat and detoxifying. If lesions are black, purple, dry, and sunken, Baixiang Wan (Hundred Auspicious Pills) should be used to purge; if not black, purging is strictly forbidden. If there is body heat, restlessness, abdominal fullness, wheezing, difficulty in urination and defecation, red face, chest oppression, confusion, and severe vomiting, promoting urination is indicated. If improvement does not occur, Xuanfeng San (Dispersing Wind Powder) should be used to purge. If by the fifth or seventh day the scabs are not dry and burnt, it is due to internal heat steaming the skin, preventing scab formation. Xuanfeng San should be used to guide out the heat, and raw Xijiao (Rhinocerotis Cornu) ground into juice should be used to clear heat, ensuring heat does not persist, so that scabbing will occur.
[Method of Li Dongyuan and his disciples] Zhang Yuansu discussed: The manifestations of zhen (measles/rash) vary. Chuang (sores/ulcers) swelling on the exterior belongs to the Shaoyang Sanjiao (Triple Burner) Ministerial Fire, called Chuang. Small red spots scattered in the skin that do not protrude belong to the Shaoyin Junfire, called Zhen. Generally, if Chuang or Zhen appears with spontaneous vomiting and diarrhea, do not treat recklessly as it often resolves favorably, indicating that pathogenic factors are exiting through both upper and lower pathways. Generally, neither Chuang nor Zhen should be purged from beginning to end. (See previous section on sweating and purging.)
Anli Jiedu Fangfeng Tang (Anli Detoxifying Saposhnikovia Decoction)
Fangfeng (Saposhnikoviae Radix, 1 liang) Digupi (Lycii Cortex), Huangqi (Astragali Radix), Shaoyao (Paeoniae Radix), Jingjie (Schizonepetae Herba), Zhike (Aurantii Fructus Immaturus), Niubangzi (Arctii Fructus) (equal parts).
Grind into powder. Decoct 4-5 qian with water and take orally. If the patient can eat and has solid stool, Danggui Wan (Angelica Sinensis Pill) should be used to mildly promote bowel movement.
Danggui Wan (Angelica Sinensis Pill); Zaobian Baixiang Wan (枣变百祥丸 - used for severe constipation).
Li Dongyuan's Xiaodu Jiuku Tang (Detoxification and Suffering-Relief Decoction) treats cases where all signs of chuang are present. If digestion is restored, eruption can be prevented; if already erupted, sparse eruptions will not grow further. This formula was established in November and adjusted according to the four seasons; only those who understand natural transformation and herb properties can apply it.
Mahuanggen (Ephedrae Radix et Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Shengma (Cimicifugae Rhizoma), Huangbai (Phellodendri Cortex, wine-fried, each 5 fen), Chaihu (Bupleuri Radix), Chuanxiong (Chuanxiong Rhizoma), Xixin (Asari Radix et Rhizoma), Bencao (Ligustici Rhizoma), Gegen (Puerariae Lobatae Radix), Huangqin (Scutellariae Radix, wine-fried), Cangzhu (Atractylodis Rhizoma, each 2 fen), Huanglian (Coptidis Rhizoma), Dangguishen (Angelicae Sinensis Radix, each 3 fen), Sumu (Sappan Lignum), Baizhu (Atractylodis Macrocephalae Rhizoma), Gancao (Glycyrrhzae Radix et Rhizoma, raw), Chenpi (Citri Reticulatae Pericarpium, each 1 fen), Wuzhuyu (Evodiae Fructus, 0.5 fen), Honghua (Carthami Flos, a little), Lianqiao (Forsythiae Fructus, 0.5 qian; reduce if just erupting, increase if abundant), Shengdihuang (Rehmanniae Radix, 5 fen).
Cut into pieces. Take 5 qian per dose, decoct with two large bowls of water until one bowl remains, strain, and drink while slightly warm. Zhen (rash) erupts due to internal injury, causing rebellion of Ying (Nutritive) Qi. Strictly prohibit harsh drugs like Qianniu (Pharbitidis Semen) and Badou (Crotonis Fructus). Use Banxia (Pinelliae Rhizoma), Zhishi (Aurantii Fructus Immaturus), Dahuang (Rhei Radix et Rhizoma), Yizhiren (Alpiniae Oxyphyllae Semen) etc. to stop diarrhea and vomiting. If ear tips are cold, yawning, startle during sleep, sneezing, and eyes feel dry, eruption is imminent. Use:
Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), Baishaoyao (Paeoniae Radix Alba), Gancao (Glycyrrhzae Radix et Rhizoma), Dangguishen (Angelicae Sinensis Radix), Lianqiao (Forsythiae Fructus) (equal parts).
Cut into pieces. Decoct with water and take orally. This is the standard method; adjust later based on symptoms:
If Lung meridian pus forms, showing first wheezing/cough or rapid breathing, add small amounts of Ren Shen (Ginseng Radix) and Huangqin (Scutellariae Radix) to drain latent fire and tonify Yuan Qi (Original Qi).
If Heart meridian shows small red spots, preceded by dry throat, palpitations, body heat, muscle swelling, and wiry-hong pulse, add small amounts of Huanglian (Coptidis Rhizoma). If Mingmen (Gate of Life) shows nettle-rash, preceded by bone pain, body heat, and immobility due to pain, add small amounts of Shengdi (Rehmanniae Radix) and Huangbai (Phellodendri Cortex). All chuang/zhen are Yin-type sores, caused by internal injury from diet/milk, spleen/stomach deficiency, and rebellion of Ying Qi. Although fire burns internally, Yin covers externally. Thus, Qian Yi created Siwu Shengma Tang (Four Substances Shengma Decoction) to vent it. If transmission occurs, follow adjustment rules.
[World Physicians' View] For rash/smallpox erupting from the Spleen, use Chen Shi's Renshen Qingge San (Ginseng Clearing Diaphragm Powder). (Rash refers to skin rashes hidden like millet seeds, called Mazizi.) Water pox (Varicella) often arises from cold damage heat-toxin; use Shengma San (Cimicifuga Powder) and Qianghuo San (Notopterygium Powder).
[Zhu Danxi on Qi/Blood Deficiency/Excess]** Zhu Danxi differentiated pediatric variola/exanthems by Qi/Blood deficiency/excess, using Sijunzi Tang (Four Gentlemen Decoction), Siwu Tang (Four Substances Decoction), wine-fried Huangqin (Scutellariae Radix), and Huanglian (Coptidis Rhizoma). For Qi deficiency, add Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) to detoxifying herbs. For Blood deficiency, add Siwu Tang (Four Substances Decoction) to detoxifying herbs. Lou Quanshan noted that "detoxifying herbs" refer to wine-fried Huangqin and Huanglian. Haicang stated that detoxifying herbs include Sanhuang Tang (Three Yellows Decoction) and Jinhua Wan (Golden Flower Pill).
Differentiate patients' clarity/turbidity and courage/fear based on physique. Purple variola indicates Blood Heat, treated primarily by cooling Blood. White indicates Qi Deficiency, treated primarily by tonifying Qi. Black/sunken center with white exterior and delayed eruption requires tonifying Qi with slight Blood-cooling herbs.
[Wan Mi Zhai] The main treatments for variola are Release Exterior, Harmonize Middle, and Detoxify. Release Exterior involves dispersing to expel pathogens outward, preventing retention inside, using Fangfeng (Saposhnikoviae Radix), Baizhi (Angelicae Dahuricae Radix), Jingjie Sui (Schizonepetae Spica), Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), Chaihu (Bupleuri Radix), Guizhi (Cinnamomi Ramulus). Harmonize Middle focuses on Spleen/Stomach, assisting Qi/Blood to keep interior strong, nourishing variola until maturity, preventing itching/collapse, using Huangqi (Astragali Radix), Renshen (Ginseng Radix), Baishaoyao (Paeoniae Radix Alba), Danggui (Angelicae Sinensis Radix), Muxiang (Aucklandiae Radix), Chenpi (Citri Reticulatae Pericarpium). Detoxify involves draining fire, cooling Blood, regulating Qi to control toxin, using Shandougen (Millettiae Specifcae Radix), Dalizi (Arctii Fructus), Zicao (Leonuri Herba), Lianqiao (Forsythiae Fructus), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructus).
[Weng Zhongren on Qi Deficiency, Blood Heat, Heat Stagnation] (See Deficiency/Excess section for differentiation). For Qi Deficiency: Initial stage shows body heat with cold extremities, alternating cold/heat, mental fatigue, soft/pale muscles, reduced appetite, limb weakness, quiet sleep, normal stools/urine. Before spots appear, use Shenqi Yin (Ginseng-Astragalus Drink) with mild dispersants like Zisu (Perillae Folium), Fangfeng (Saposhnikoviae Radix), Baizhi (Angelicae Dahuricae Radix). After spots appear, use Shenqi Yin with mild agents like Chuanxiong (Chuanxiong Rhizoma), Jiegeng (Platycodonis Radix). After four days, heavily use Shenqi Yin adjusted to condition. After seven/eight days when pus is full, use Baoying Baibu Tang (Infant Protection Hundred Tonics Decoction) to nourish Qi/Blood. If slight collapse/black scabs occur at the end, use Muxiang Yigong San (Aucklandia Extraordinary Merit Powder) to conclude treatment. For Blood Heat: Initial stage shows intense fever, red cheeks/face, dry/brittle hair, restlessness/thirst, crying day/night, restless sleep, preference for cool places, dark/scanty urine. Before eruption, Shengma Gegen Tang or Shengma Liuqi Yin can be used, but Shishen Jiedu Tang (Ten Gods Detoxifying Decoction) is safer. Three to four days after appearance, when heat subsides and pus formation begins, adjust Taiyi Baohe Tang (Supreme Harmony Preservation Decoction). After eight/nine days when pus is full, use Baoying Baibu Tang. If purple/black/dry or cyan-gray/sunken lesions occur between days 7-8, use Duoming Dazao (Life-Restoring Great Creation), Tanxiao Bojin (Laughing Gold Acquisition), Yizi Jin (One Character Gold), Baixiang Wan, Niuli Wan, Zhuwei Wan, Dushen Wan, etc., used judiciously. If black/sunken/red lesions occur after diarrhea, use Muxiang Yigong San. This is a secret ancestral method, highly effective. For Heat-Toxin Stagnation: Initial stage shows intense fever, red cheeks/face, dry skin/hair, rough breathing/wheezing, abdominal distension/restlessness, delirium, restless sleep, constipation, dark/scanty urine, facial/eye swelling, excessive crying/anger. Before spots, administer one dose of Shengma Gegen Tang, followed by Qianghuo San Yu Tang (Notopterygium Dispersing Stagnation Decoction). Within three days of appearance, when symptoms subside and pus formation begins, use Yiyuan Touji San (Primordial Muscle-Penetrating Powder) adjusted. After pus is full, use Yingtong Baibu Tang. If purple/black/dry or cyan-gray/white-sunken lesions occur after six/seven days, use Duoming Dazao, Tanxiao Bojin, Yizi Jin, Baixiang Wan, Niuli Wan, Zhuwei Wan, Dushen Wan, etc., used judiciously. If Muxiang Yigong pattern exists after diarrhea, use Muxiang Yigong San. Treating weak variola has two methods: If Qi Deficient, tonify Qi; since Qi deficiency leads to cold, warm it. Adjust warmth/tonification based on severity. Treating Blood Heat Stagnation has five methods: Excessive exterior heat causes dryness; too much cooling causes ice-trapping; excessive interior heat causes constipation; too much interior cooling causes diarrhea; Qi stagnation causes distension/wheezing; suppressed heat-toxin causes distension/manic behavior; overwhelming toxin burdens interior/exterior making it hard for infants to bear. Thus, treating variola requires: Calming Exterior, Harmonizing Middle, Regulating Qi, Penetrating Muscle, Detoxifying. Calm Exterior prevents dryness/ice-trapping. Harmonize Middle prevents constipation/diarrhea. Regulate Qi prevents excessive stagnation/wheezing. Penetrate Muscle allows heat-toxin to reach surface. Detoxify allows internal/external dispersion. If these five are maintained, even dense Blood Heat Stagnation is manageable.
Shenqi Yin (i.e., Baoyuan Tang) specifically treats Yuan Qi (Original Qi) deficiency: mental fatigue, soft muscles, blue/pale face, poor appetite, quiet but listless sleep. Effective whether before or after eruption.
Renshen (Ginseng Radix, 1 qian), Huangqi (Astragali Radix, 2 qian), Gancao (Glycyrrhzae Radix et Rhizoma, 5 fen; raw for initial heat, roasted after eruption stabilizes).
Yang Renzhai believed it tonifies Yuan Qi, renaming it Baoyuan Tang (Preserve Original Decoction), established for Yuan Qi deficiency. Later physicians used it indiscriminately for Blood Heat/Toxin Stagnation regardless of Qi status, which is "attacking excess with excess," an error.
Decoct with one cup of water and one slice of ginger until 4-5 fen remains. Take anytime.
Shenqi Yin Adjustment and Contraindications
For confirmed Qi deficiency, this formula is primary and unchanging throughout. For mixed symptoms arising from Qi deficiency, adjust this base formula. Avoid excessive dispersants or bitter-cold herbs.
During initial heat/pre-eruption, lightly aid lifting/regulating Qi with Jiegeng (Platycodonis Radix), Chuanxiong (Chuanxiong Rhizoma). After pus full, aid convergence with Baizhu (Atractylodis Macrocephalae Rhizoma), Shaoyao (Paeoniae Radix), Fuling (Poria).
Sluggish eruption: Add Chuanxiong, Guigui (Cinnamomi Ramulus). Prohibit Chan Tui (Cicadae Periostracum), Niubangzi (Arctii Fructus), Renya (Human Teeth), Zicao (Leonuri Herba). Dark urine: Add Dafupi (Trogopterori Fructus), Fuling (Poria). Prohibit Cheqian Cao (Plantaginis Herba), Huashi (Talcum), Qumai (Dianthi Herba), Shanzhi (Gardeniae Fructus). Loose stool: Add Baizhu, Fuling, Rouguo (Myristicae Semen). Prohibit Zhuling (Polyporus), Hezi (Terminaliae Fructus), Longgu (Fossilia Ossis Mastodi), Fanshi (Alumen). Scanty urine: Add Dafupi, Mutong (Akebiae Caulis). Prohibit Huashi, Qumai. Constipation: Add wine-fried Danggui (Angelicae Sinensis Radix). Prohibit Dahuang (Rhei Radix et Rhizoma), Zhike (Aurantii Fructus Immaturus), Shengdihuang (Rehmanniae Radix). Diarrhea: Add Baizhu, Rouguo, Muxiang (Aucklandiae Radix). Prohibit Longgu, Shizhi (Kaolinitum), Kufan (Alumen Calcined). Vomiting: Add Ganjiang (Zingiberis Rhizoma), Dingxiang (Caryophylli Flos), Chenpi (Citri Reticulatae Pericarpium). Prohibit Banxia (Pinelliae Rhizoma). Restlessness/thirst: Add Maidong (Ophiopogonis Radix), Shaoyao (Paeoniae Radix), Wuweizi (Schisandrae Fructus). Prohibit Tianhuafen (Trichosanthis Radix), Gegen, Wumei (Mume Fructus), Banxia. Reduced appetite: Add Baizhu, Renshen, Shenqu (Massa Medicata Fermentata). Prohibit Shanzha (Crataegi Fructus), Sharen (Amomi Fructus). Food stagnation: Add Shenqu, Maiya (Hordei Fructus Germinatus), Shanzha. Prohibit Zhishi (Aurantii Fructus Immaturus), Pengzhu (Curcumae Rhizoma), Sanleng (Sparganii Rhizoma), Badou, Dahuang. Wheezing early (days 3-4): Add Jiegeng, Chan Tui, Xingren (Prunus Semina). Wind: Mildly disperse with Zisu (Perillae Folium), Fangfeng, Zhishi. Phlegm: Treat phlegm with Xingren, Beimu (Fritillariae Bulbus). False asthma due to toxicity blocking Lung: Prohibit Mahuang, Laifu (Raphani Fructus), Suzi (Perillae Fructus), Zhishi. Asthma after day 6-7 or post-diarrhea indicates extreme deficiency; add Renshen to stop wheezing. Abdominal distension: Add Dafupi, Houpo (Magnoliae Officinalis Cortex), combined with dispersing/lifting. Prohibit Zhike, Laifu. Consider cold damage or external contraction. Internal injury: Use Dingxiang, Guigui, Shenqu, Muxiang. External contraction: Disperse with Fangfeng etc. Lack of heat with cold limbs (days 4-5): Add Dingxiang, Guigui, Zhi Huangqi, Chuanxiong. Reduce Dingxiang in summer. Limbs not warming: Add Fangfeng, reduce Chuanxiong. Insufficient pus: Add Baizhu, Danggui, Chuanxiong. Watery blisters: Add Baizhu, Fangfeng, Baizhi, Shaoyao. Clear pus: Add Baizhu, Fuling. Wheezing/cough: Add Wuweizi, Xingren, Maidong. Prohibit Tianhuafen, Sangbaipi (Mori Cortex). Itching: Add Chuanxiong, Danggui, Shaoyao, Baizhu, Fuling. Prohibit Jiangcan (Bombyx Batryticatus), Jili (Tribuli Fructus). Severe itching: Smoke mugwort (Yinchen) externally. Prohibit bathing/dispersing to prevent Qi collapse.
Shishen Jiedu Tang (Ten Gods Detoxifying Decoction) specifically treats intense fever, red cheeks/face, dry hair, pre/post-eruption red spots (first 3 days), thirst, restless sleep, dark urine (Heat Excess).
Dangguiwei (Angelicae Sinensis Radix), Shengdihuang (Rehmanniae Radix), Honghua (Carthami Flos), Mudanpi (Moutan Cortex), Chishaoyao (Paeoniae Radix Rubra), Jiegeng (Platycodonis Radix), Mutong (Akebiae Caulis), Dafupi (Trogopterori Fructus), Lianqiao (Forsythiae Fructus), Chuanxiong (Chuanxiong Rhizoma).
This formula treats Blood Heat variola by cooling/moving Blood, assisted by Jiegeng/Chuanxiong for lifting/dispersing, guided by Dafupi/Mutong to drain heat-toxin, supported by Lianqiao/Mudanpi for detoxification. It disperses heat-toxin internally and externally, bringing balance. Ancient use of Huanglian Jiedu Tang risks freezing heat-toxin with cold herbs, hindering eruption and trapping toxin in organs causing death. This formula is safer. If Huanglian/Huangqin/Huangbai are necessary, wine-fry them to mitigate coldness and assist ascending action, using them mainly for detoxification.
Shishen Jiedu Tang Adjustments
Intense fever: Add Gegen, Qianhu (Peucedani Radix). Dense/toxic: Add Jingjie, Niubangzi. Thirst: Add Tianhuafen, Zhuye (Bambusae Folium), Huashi. Hematuria: Add Xijiao (Rhinocerotis Cornu), Shanzhi. Black stool: Add Xijiao, Huanglian, or Taoren (Persicae Semen). Hematemesis/dry retching: Add Huanglian, Xijiao. Red rash: Add Xijiao, Huangqin, Huangbai, Shanzhi, Xuanshen (Scrophulariae Radix). Dark urine: Add Shanzhi. Scanty urine: Add Zhuling, Zexie (Alismatis Rhizoma). Urinary retention: Add Huashi, Qumai. Constipation: Add Zhike, Qianhu. Constipation+wheezing: Add Zhike, Qianhu, Dahuang. Restlessness: Add Maidong, Tianhuafen. Thirst/delirium: Add Zhimu (Anemarrhenae Rhizoma), Maidong, Shigao (Gypsum Fibrosum). Vomiting: Add Zhuling, Zexie, Huanglian. Sore throat: Add Gancao, Niubangzi, Jingjie. Diarrhea: Add Zhuling, Zexie, Fangfeng. Nausea: Add Chenpi.
Decoct with 14 strands of Dengxin (Junci Medulla) and water.
For Blood Heat variola with overwhelming toxin, heavy lifting/dispersing is needed to reach surface, aided by draining herbs to eliminate heat internally, plus cooling/detoxifying/moving Blood herbs. Even dense eruptions will resolve, form pus, and heal easily. This achieves "light exterior, cool interior," perfectly integrating Calming Exterior, Harmonizing Middle, and Detoxifying. As Danxi said: "Clear heat, level excess." From fever to appearance (first 3 days), if toxin hasn't reached surface and Blood Heat signs are clear, use this formula exclusively. Do NOT add tonics like Renshen, Huangqi, Baizhu, Fuling to Heat patterns before pus formation, as this is "attacking excess with excess," causing distension, wheezing, delirium, sore throat, mouth ulcers, and myriad complications ("evil strengthened by tonification"). For vomiting/diarrhea, strictly avoid Banxia, Dingxiang, Guizhi, Ganjiang, Muxiang, Huoxiang, Hezi, Rouguo, as this adds heat to heat, exacerbating dryness, leading to sore throat, mania, hemorrhage, constipation. Astringents like Longgu, Kufan block Qi channels, closing the exit, causing distension and wheezing. Once blood-pus forms and Qi/Blood settle, with white crown appearing and pus forming, change formula.
Qianghuo San Yu Tang (Notopterygium Dispersing Stagnation Decoction) specifically treats Excess Heat Stagnation unable to reach surface: rough breathing/wheezing, abdominal distension/restlessness, delirium, restless sleep, constipation, erect hair, swollen face, angry eyes. Also effective for wind-cold exterior constraint causing sluggish eruption.
Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Baizhi (Angelicae Dahuricae Radix), Jingjie (Schizonepetae Herba), Jiegeng (Platycodonis Radix), Digupi (Lycii Cortex), Chuanxiong (Chuanxiong Rhizoma), Lianqiao (Forsythiae Fructus), Gancao (Glycyrrhzae Radix et Rhizoma), Zicao (Leonuri Herba), Dafupi (Trogopterori Fructus), Niubangzi (Arctii Fructus).
Coarsely grind. Decoct one cup of water with 14 strands of Dengxin until 6 fen remains. Take warm.
At initial fever/appearance, toxin is strong. External wind-cold suppression, thick muscles, closed pores, blocked meridians prevent clear Qi from guiding toxin out. Heat-toxin stagnates internally causing distension, wheezing, constipation, mania, convulsions, hemorrhage, dry skin, erect hair, tense face, swollen eyes, restless sleep, crying. This is Heat-Toxin Stagnation. Immediately use dispersing/lifting herbs with harmonizing/penetrating methods. Qianghuo, Baizhi, Fangfeng lift/disperse/detoxify. Jiegeng lifts/regulates Qi. Jingjie, Lianqiao, Niubangzi clear stagnant heat. Digupi clears heat in bones/muscles and regulates organs. Zicao lubricates skin/pores. Dafupi guides heat downward for internal/external dispersion. Use this to treat heat...