疹子发热之初，其点未见而咳嗽咽疼，上气喘急，面目浮肿，时卧时起，心烦口干
者，此毒火内蒸而肺叶焦举也，宜甘桔汤合人参白虎汤加减主之。若初发热而吐利者，
此邪火内迫上焦则吐，下焦则利，中焦则吐利并多，治宜解毒发表清凉，不可收涩吐利
也。若里急后重而为滞下者，则少加大黄以微利之，是为纯热之症不可以作寒论，宜于
疹家吐利求之，勿从吐利滞下而治。若咽喉肿痛，不能饮食者，宜甘桔汤加牛蒡子之
类。若渴欲饮水者，此邪火外入，心火内炎，是以肺焦而胃干也。初发热而渴者，则
用升麻葛根汤，以表暴其邪，疹出而热毒自解出后而渴者，则用花粉、麦冬合黄连解毒
汤主之，其所宜饮者，绿豆灯心灼米汤，以生津解热而已。若恣饮冷水，重则毒瓦斯内攻
不救，轻则变成水蓄之症，水入于肺则喘，喘为咳；入于脾则为肿，为胀，为自利；入
于胃，则为吐，为哕；入于心，则为悸为惊，或为烦闷；入于肝则为肋痛；入于肾与
膀胱，则为小便不利，为囊肿，且余毒不清，变现诸症矣。
夫痘喜温暖，疹喜清凉，人皆知之，殊不知，痘当成实，而过暖亦烂。疹子初出而
过凉难形，治者须察时令寒暄，随机处变。知时大寒，则以桂枝葛根汤发之；大热则以
升麻葛根汤，合人参白虎汤发之；不寒不热，则以防荆散毒发之。如兼疫疠之气，则
以人参败毒散发之，须致温凉得所，则阴阳自和，而疹自然尽出，出尽即解，岂若痘之
必脓必靥而后己哉！虽然更有赤白之别存焉，赤疹必遇清凉而后解，白疹必遇温暖而
后消。更有明是疹子而至发热六七日己后，却不见出者，此皮肤坚浓，腠理闭密，又为
风寒袭之，或曾有吐利，是以气弱乃伏者，治宜急用托里发表之剂，外用胡荽煮酒喷
之。如久不大便，是以毒甚于里而内伏不出者，则用凉膈散，加牛蒡子发之解之。如再
不出，腹中胀痛，气上喘促，昏闷谵妄者，死症也。《经》曰∶邪气盛则实，然邪既盛
矣。非汗散何由而除，然发表不远，热非辛热，何由而解，但疹本属阳，兼之首耗阴
分，所以药忌燥焊者耳。奈世竟以寒凉概济。如始而用之则血凝毒滞，且火发而骤遏
之，则热毒难出，终而用之，则戕贼胃气且有余毒而冰之，则邪难外解，逗留经络。为
目疾滞下诸患矣。唱曰∶疹要清凉痘要温，清凉者，岂寒凉之谓欤！总宜观邪之盛衰。
时之寒热。如冬天不独不加以寒凉之剂，更有糟煮芫荽外擦之法。夏月则肉分开张，辛
热之品，固所禁用，既芫荽性略辛，虽为疹中要品，亦所当忌矣。
疹子发热初期，皮疹尚未显现，但出现咳嗽、咽喉疼痛，气逆喘急，面部和眼部浮肿，时而躺卧时而起身，心烦意乱、口干舌燥的情况，这是毒火在体内蒸腾导致肺叶焦枯上举所致，适宜使用甘桔汤合人参白虎汤加减来主治。如果在刚开始发热时就出现呕吐和腹泻，这是因为邪火在内逼迫上焦则引起呕吐，逼迫下焦则引起腹泻，逼迫中焦则呕吐和腹泻并见，治疗应当以解毒、发表、清凉为主，不可使用收涩药物来止吐止泻。如果有里急后重且大便带有脓血黏液（滞下）的情况，则在方剂中稍加大黄以轻微通利大便，这属于纯热证，不能当作寒证论治，应当在疹病的呕吐腹泻中寻找病因，不要单纯按照普通的呕吐腹泻或痢疾来治疗。如果咽喉肿痛，无法进食，适宜用甘桔汤加入牛蒡子之类的药物。如果口渴想喝水，这是邪火从外侵入，心火在内炎上，导致肺叶焦枯而胃中干燥。刚开始发热就口渴的，使用升麻葛根汤，通过发汗使邪气透发出来；皮疹发出后热毒自然解除，若出疹后仍然口渴的，则用天花粉、麦冬配合黄连解毒汤来主治，适宜饮用的饮品是绿豆灯心草煮米汤，以此来生津液、解热毒罢了。如果肆意饮用冷水，严重的会导致毒瓦斯内攻而无法救治，轻微的会转变为水湿停聚的病症，水进入肺则气喘，气喘引发咳嗽；进入脾则导致浮肿、胀满、自发性腹泻；进入胃则导致呕吐、呃逆；进入心则导致心悸、惊悸，或者烦闷；进入肝则导致胁肋疼痛；进入肾与膀胱，则导致小便不利、阴囊肿大，并且余毒不清，表现出各种症状。
痘疮喜欢温暖，疹子喜欢清凉，这是人人都知道的道理，但殊不知，痘疮长成时需要充实，如果过于温暖也会导致溃烂。疹子初出时如果过于清凉则难以透发成形，治疗者必须观察时令的寒暖，随机应变。知道时令大寒，就用桂枝葛根汤来发散；大热就用升麻葛根汤，合人参白虎汤来发散；不寒不热，就用防荆散毒发之。如果兼有疫疠之气，就用人参败毒散发散，必须做到温凉适度，那么阴阳自然调和，疹子自然能全部透出，透尽即痊愈，哪里像痘疮那样必须化脓结痂才算结束呢！虽然还有赤疹和白疹的区别存在，赤疹必须遇到清凉才能解除，白疹必须遇到温暖才能消退。更有明明是疹子，直到发热六七天之后，却不见发出的，这是因为皮肤坚硬厚实，腠理闭密，又被风寒侵袭，或者曾经有过呕吐腹泻，导致气虚而潜伏在内，治疗应当紧急使用托里发表的药剂，外用胡荽（香菜）煮酒喷洒身体。如果长时间不大便，是因为毒邪深伏于里而不能外出的，就用凉膈散，加入牛蒡子来发散和解毒。如果再次不出，腹部胀痛，气上冲喘促，神志昏闷说胡话的，是死症。《黄帝内经》说：邪气盛实就是实证，既然邪气已经强盛，不是通过发汗发散由什么途径去除呢？然而发表不远乎热，如果不是辛热之药，由什么途径来解除呢？只是疹子本属阳证，加上首先耗伤阴分，所以药物忌讳燥热辛辣罢了。无奈世人竟然一概用寒凉药物来救治。如开始时使用，则血液凝滞毒邪停滞，而且火热被突然遏制，则热毒难以透出；最终使用，则伤害胃气，况且有余毒被冰伏，则邪气难以向外解除，逗留于经络，成为眼疾、痢疾等各种病患。有人唱道：疹子要清凉，痘疮要温补，这里的“清凉”，难道是指寒凉吗？总应该观察邪气的盛衰和时令的寒热。如冬天不仅不加以寒凉药剂，更有用糟煮芫荽外擦的方法。夏天则毛孔张开，辛热之品固然禁用，既然芫荽性味略辛，虽然是疹病中的重要药材，也应当禁忌了。
At the initial stage of fever in variola (smallpox-like rash), before the spots appear, if there is coughing, sore throat, rapid breathing with asthma, swelling of the face and eyes, restlessness alternating between lying down and getting up, irritability, and dry mouth, this is due to toxic fire steaming internally causing the lung lobes to become scorched and elevated. It is appropriate to use Ganjie Tang (Licorice and Platycodon Decoction) combined with Renshen Baizhu Tang (Ginseng and White Tiger Decoction) with modifications as the main treatment. If vomiting and diarrhea occur at the onset of fever, this is because pathogenic fire forces upward affecting the Upper Jiao causing vomiting, downward affecting the Lower Jiao causing diarrhea, or centrally affecting the Middle Jiao causing both. The treatment should focus on resolving toxicity, releasing the exterior, and clearing heat; astringents for stopping vomiting and diarrhea should not be used. If there is tenesmus and dysentery-like stool (Zhi Xia), slightly add Radix Rheei Preparata (Dahuang, 大黄) to mildly promote bowel movement. This is a pure heat syndrome and should not be treated as cold; one should seek the cause within the context of rash-related vomiting and diarrhea, rather than treating it merely as common vomiting/diarrhea or dysentery. If there is severe sore throat and swelling preventing eating, Ganjie Tang (Licoric and Platycodon Decoction) added with seeds of Fructus Armeniacae Amarum (Niu Bang Zi, 牛蒡子) is suitable. If there is thirst and desire to drink water, this indicates pathogenic fire entering from outside and Heart Fire flaring internally, resulting in scorched lungs and dry stomach. For thirst occurring at the onset of fever, Shengma Gegen Tang (Cimicifugae Rhizoma and Puerariae Radix Decoction) should be used to release the exterior and expel pathogens. After the rash appears and heat-toxin naturally resolves, if thirst persists, use Radix Polygoni Multiflori Preparata (Heshouwu, though here likely referring to Radix Scrophulariae/Xuan Shen or similar cooling herbs, but text says Huafen which is Trichosanthis Radix/Tian Hua Fen) Tian Hua Fen (Radix Trichosanthis), Radix Ophiopogonis (Maidong, 麦冬) combined with Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity). The appropriate beverage is a decoction of Mung Bean, Herba Centipedae (Deng Xin Cao, 灯心草), and roasted rice, to generate fluids and resolve heat. Indiscriminate consumption of cold water can lead to severe cases where toxic vapors attack internally leading to death, or mild cases transforming into water retention syndromes: water entering the Lung causes asthma and cough; entering the Spleen causes edema, distension, and spontaneous diarrhea; entering the Stomach causes vomiting and hiccups; entering the Heart causes palpitations, fright, or oppression; entering the Liver causes hypochondriac pain; entering the Kidney and Bladder causes difficulty in urination and scrotal swelling, while residual toxins remain unclear manifesting various symptoms.
It is well known that smallpox prefers warmth while rash prefers coolness. However, one must not ignore that smallpox requires substantial formation, and excessive warmth leads to ulceration. For early-stage rash, excessive coolness prevents eruption. Practitioners must observe seasonal climate changes and adapt accordingly. In severe cold, use Guizhi Gegen Tang (Cinnamon Twig and Pueraria Decoction) to release; in severe heat, use Shengma Gegen Tang (Cimicifugae Rhizoma and Puerariae Radix Decoction) combined with Renshen Baizhu Tang (Ginseng and White Tiger Decoction); in moderate conditions, use Fangjing San Du Fa (Prevention and荆 Herb Detoxification Powder) to vent. If epidemic qi is present, use Renshen Baidu San (Ginseng and Toxin-Resolving Powder). Ensuring proper warmth and coolness allows Yin and Yang to harmonize, allowing the rash to fully erupt and resolve, unlike smallpox which must suppurate and crust over. There are also distinctions between red and white rashes: red rashes require coolness to resolve, while white rashes require warmth to dissipate. If a patient has had fever for six or seven days without visible rash, it may be due to thick skin, closed pores, wind-cold invasion, or prior vomiting/diarrhea causing Qi deficiency and latent pathogens. Treatment urgently requires formulas that support the interior and release the exterior, externally spraying with wine boiled with Coriander (Hu Su Zi/Hu Sui, here Hu Su likely refers to Coriandrum sativum/Xiang Cai). If constipation persists due to deep internal toxin retention, use Liangge San (Cooling the Diaphragm Powder) added with Niu Bang Zi (Fructus Arctii). If still no eruption, accompanied by abdominal distension/pain, wheezing, confusion, and delirium, it is a fatal case. The Classic states: "Excess of pathogenic qi constitutes excess syndrome." Since pathogenic qi is abundant, only sweating and dispersing can remove it. Exterior-releasing methods often involve heat; without acrid-warm herbs, how can it be resolved? Rash belongs to Yang, and initially consumes Yin, so acrid-hot drugs are contraindicated. Yet, people indiscriminately use cold-cooling remedies. Early use causes blood stasis and toxin stagnation, suppressing fire makes heat-toxin hard to exit; late use damages Stomach Qi, and freezing residual toxins traps pathogens in meridians, leading to eye diseases and dysentery. It is said: "Rash needs coolness, Smallpox needs warmth." Does "coolness" mean cold-cooling? One must always assess the strength of pathogens and seasonal temperature. In winter, not only avoid cold-cooling formulas, but also apply fermented Coriander externally. In summer, when pores are open, acrid-hot items are forbidden; although Coriander is slightly acrid and important for rash, it should also be avoided.