痘疮末愈痢随生，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
(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 白术炒 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。
%
痘中杂证
见点作痒葛根汤，灌浆痒塌大补良，触犯暴疮熏避秽，急前内托免毒藏。
[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，外用辟秽香熏之，
内服内托散迭毒外出，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，升葛防气淡豆豉，赤芍桂枝甘草良。
(十全大补汤) 方见结痂落痂证治。
(辟秽香)
苍术 大黄 茵陈 等分 以上锉细，枣肉为饼，炉中烧之，能辟邪秽。
(内托散)黄耆蜜炙 人参 川芎 当归 白芷 木香煨 桔梗 厚朴姜炒
甘草炙 肉桂 防风 引用姜枣水煎服。
(方歌)
内托散防毒内攻，黄耆人参与川芎，当归白芷木香桔，厚朴甘草桂防风。
%
痘中杂证
痘疮尚未痊愈，痢疾随即发生，这是湿热之邪损伤中焦脾胃，病情并不轻微。白痢属于气分受伤，宜用四君子汤加减治疗；红痢属于血分受伤，宜用四物汤加减治疗。
[注]
凡是痘疮未愈而并发痢疾的，
是由于湿热郁结在肠胃，导致气血受损所致。
痘疹必然色泽滞涩黯淡，治疗应当以清热除湿、调理气血为主。
白痢属气分病变，用加味四君子汤主治；
赤痢属血分病变，用加味四物汤主治；
赤白相兼的，将两方合用。
(加味四君子汤)
茯苓、土炒白术、人参、陈皮、煨木香、炙甘草、姜黄连、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、酒炒黄芩、酒炒川连、木香、炒白术，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。
%
痘疹中的杂证
痘疹刚出见点时若出现瘙痒，用葛根汤；灌浆期若瘙痒且痘形塌陷，用大补汤疗效好；若触犯秽气突发瘙痒，外用辟秽香熏蒸；急用内托散以防毒邪内藏。
[注]
《内经》说：各种瘙痒多因虚所致。又说：火邪微弱则痒。治疗者必须分别施治。
痘疹刚刚发出而身体瘙痒的，这是邪气欲出，但腠理致密，火邪游溢往来，所以不时作痒，
用加味升麻葛根汤主治；
灌浆时痘色淡白平塌，大便溏薄，食欲不振，浆液清稀且作痒的，这是脾胃虚弱、气血不足的表现，
用十全大补汤主治；
如果是被秽气触犯而突然瘙痒的，外用辟秽香熏蒸，
内服内托散促使毒邪外透，这样才没有毒邪内攻的祸患，
至于即将收靥（结痂）时作痒的，这是脓成毒化、营卫调和畅达的表现，
与疮疖即将痊愈时作痒的情况相同论述，不需要服药。
(加味升麻葛根汤) 升麻、葛根、防风、淡豆豉、赤芍、桂枝、生甘草，水煎服。
(方歌)
加味升麻葛根汤，痘出作痒最堪尝，升葛防气淡豆豉，赤芍桂枝甘草良。
(十全大补汤) 方剂见结痂落痂证治章节。
(辟秽香)
苍术、大黄、茵陈，等分。以上药材锉细，用枣肉做成饼状，在炉中烧之，能辟除邪秽之气。
(内托散) 蜜炙黄耆、人参、川芎、当归、白芷、煨木香、桔梗、姜炒厚朴、炙甘草、肉桂、防风，引用姜枣水煎服。
(方歌)
内托散防毒内攻，黄耆人参与川芎，当归白芷木香桔，厚朴甘草桂防风。
%
痘疹中的杂证
When the smallpox lesions have 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 is treated with Si Jun Zi Tang (Four Gentlemen Decoction); red dysentery belongs to blood injury and is treated with Si Wu Tang (Four Substance Decoction).
[Note]
In cases where dysentery occurs while smallpox has not yet healed,
it is caused by damp-heat stagnating in the intestines and stomach, leading to injury of qi and blood.
The smallpox lesions will necessarily appear dull, dark, and lacking luster. Treatment should focus on clearing heat, removing dampness, and regulating qi and blood.
White dysentery pertains to the qi level; Jia Wei Si Jun Zi Tang (Modified Four Gentlemen Decoction) is the primary formula.
Red dysentery pertains to the blood level; Jia Wei Si Wu Tang (Modified Four Substance Decoction) is the primary formula.
For mixed red and white dysentery, both formulas are used together.
(Modified Four Gentlemen Decoction)
Poria (Fuling), Atractylodes Macrocephala Rhizome (Baizhu) stir-fried with soil, Ginseng Radix (Renshen), Tangerine Peel (Chenpi), Aucklandia Root (Muxiang) roasted, Licorice Root (Gancao) honey-fried, Coptis Rhizome (Huanglian) fried with ginger, Scutellaria Root (Huangqin). Decoct in water.
(Decoction Verse)
The modified Si Jun Zi works miracles like divine power,
With Poria, Atractylodes, and Ginseng combined.
Tangerine peel, Aucklandia, and honey-fried Licorice root,
Coptis fried with ginger paired with Scutellaria root.
(Modified Four Substance Decoction)
Angelica Sinensis Radix (Chuanxiong), Angelica Sinensis Radix (Danggui), Rehmannia Glutinosa Root (Shengdi), Scutellaria Root (Huangqin) fried with wine, Coptis Rhizome (Chuanlian) fried with wine, Aucklandia Root (Muxiang), Atractylodes Macrocephala Rhizome (Baizhu) stir-fried. Decoct in water and take orally.
(Decoction Verse)
Modified Si Wu treats red dysentery,
Chuanxiong and Danggui born with Shengdi.
Scutellaria fried with wine combined with Chuanlian,
Aucklandia and White Peony adjust to form the preparation.
%
Miscellaneous Syndromes in Smallpox
When itching occurs at the initial eruption stage, use Gegen Tang (Kudzu Decoction); during the filling stage, if there is itching and collapse of the lesions, Da Bu Tang (Great Tonifying Decoction) is effective; if sudden itching is triggered by foul odors, externally fumigate with Bi Hui Xiang (Dispel Filth Fragrance); urgently use Nei Tuo San (Internal Support Powder) to prevent toxin entrapment.
[Note]
The Classics state: "All itching is due to deficiency." Also: "Weak fire causes itching." Practitioners must differentiate and treat accordingly.
When the body itches as the smallpox first erupts, this is because the pathogenic factor desires to exit, but the couli (pores) are tight, causing the fire to wander back and forth, hence the intermittent itching.
Jia Wei Shengma Gegen Tang (Modified Ephedra and Kudzu Decoction) is the primary formula.
During the filling stage, if the lesions are pale and flat, accompanied by loose stools, poor appetite, clear pus, and itching, this indicates spleen and stomach weakness with qi and blood deficiency.
Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) is the primary formula.
If sudden itching is caused by exposure to foul odors, externally fumigate with Bi Hui Xiang (Dispel Filth Fragrance).
Internally administer Nei Tuo San (Internal Support Powder) to promote the outward expulsion of toxins, thereby avoiding the danger of internal attack.
As for itching occurring just before healing (scabbing), this indicates that pus has formed, toxins have transformed, and ying and wei (nutritive and defensive qi) are harmonious and flowing smoothly.
This is discussed similarly to the itching seen when boils and sores are about to heal; no medication is necessary.
(Modified Ephedra and Kudzu Decoction)
Ephedra Stem (Shengma), Kudzu Root (Gegen), Saposhnikovia Root (Fangfeng), Prepared Soybean (Danshidou), Red Peony Root (Chishao), Cinnamon Twig (Guizhi), Raw Licorice Root (Sheng Gancao). Decoct in water and take orally.
(Decoction Verse)
Modified Shengma Gegen Tang,
Most suitable for itching upon eruption.
Shengma, Gegen, Fangfeng, Danshidou,
Chishao, Guizhi, and Licorice are excellent.
(Comprehensive Great Tonifying Decoction) See the section on scabbing and falling off.
(Dispel Filth Fragrance)
Atractylodes Rhizome (Cangzhu), Rhubarb (Dahuang), Artemisia Capillaris Herba (Yinchen), equal parts. The above herbs are finely chopped, formed into cakes with date flesh, and burned in a stove to dispel evil filth.
(Internal Support Powder)
Astragalus Root (Huangqi) honey-fried, Ginseng Radix (Renshen), Angelica Sinensis Radix (Chuanxiong), Angelica Sinensis Radix (Danggui), Angelica Dahurica Root (Baizhi), Aucklandia Root (Muxiang) roasted, Platycodon Root (Jiegeng), Magnolia Bark (Houpo) fried with ginger, Licorice Root (Gancao) honey-fried, Cinnamon Bark (Rougui), Saposhnikovia Root (Fangfeng). Decoct with fresh ginger and dates as guides.
(Decoction Verse)
Nei Tuo San prevents internal attack of toxins,
Huangqi and Renshen combined with Chuanxiong.
Danggui, Baizhi, Muxiang, Jiegeng,
Houpo, Gancao, Rougui, and Fangfeng.
%
Miscellaneous Syndromes in Smallpox