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。
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痘中杂证
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，一收自愈，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 黄耆生 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 紫苑 地骨皮 桑皮炒 引用生姜水煎服。
(方歌)
清膈散疗靥后咳，参耆苓术芩归芍，知桔甘草柴滑石，紫苑地骨桑皮合。
(加味二陈汤) 方见痰证。
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痘中杂证
痰是由于津液在体内停滞积聚而生成的，痘疮的火热之邪煎熬津液也会形成痰。此时应斟酌使用加味二陈汤；若在痘疹灌浆期出现此证，则需使用保元化毒汤来扶助正气、化解毒邪并使其安宁。
[注释]
痰是津液停滞于胸中而形成的。
大概是因为痘毒的火热之邪耗损煎熬津液，导致气机上壅阻塞气道，喉咙中发出声响，适宜采用清气化痰的方法治疗，
不可突然使用金石类药物，恐怕会损伤人体的真气，应当用加味二陈汤来治疗。
如果在痘疹灌浆阶段见到这种证候，就禁止使用二陈汤，
只需在助长痘浆的方剂中少量佐以清气化痰的药物，
例如在保元化毒汤中加入橘红、贝母、桔梗、麦冬，非常妥当。
（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（生用），枳壳（麸炒），桔梗，杏仁（炒后去皮尖），黄芩。引用生姜水煎服。
（方歌）
痘证多痰宜用二陈汤，加入麦冬、前胡、栝蒌仁，
陈皮、半夏、茯苓、甘草，配合枳壳、桔梗、杏仁及黄芩。
（保元化毒汤）方剂见“起胀证治”章节。
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痘疹中的杂证
毒热熏蒸灼伤肺金，导致肺气上逆而频繁咳嗽。在初热见点阶段可用杏苏饮，在收靥阶段可用清膈散合二陈汤，效果神奇。
[注释]
咳嗽是指既有声音又有痰的症状，是因为痘毒之火熏蒸于肺，导致气机逆乱而引发咳嗽。
如果在初期发热见到这种情况，适宜用杏苏饮为主进行治疗，若是偶然感受风寒，也使用此药。
从起胀到成浆阶段出现咳嗽，是因为喉间有痘疹，呼吸道狭窄，待痘疹收敛后即可自愈，不必服药。
结痂后出现咳嗽，是因为卫气虚弱，腠理开张，或因感受风寒所致，均适宜用人参清膈散治疗；
如果是因余热未清所致，适宜用加味二陈汤治疗。
（人参清膈散）人参，黄耆（生用），茯苓，白术（土炒），黄芩，当归，白芍（微炒），知母（生用），桔梗，甘草（生用），柴胡，滑石（飞研），紫苑，地骨皮，桑皮（炒）。引用生姜水煎服。
（方歌）
清膈散治疗结痂后的咳嗽，人参、黄耆、茯苓、白术、黄芩、当归、白芍，
知母、桔梗、甘草、柴胡、滑石，紫苑、地骨皮、桑皮相合。
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痘疹中的杂证
Phlegm is generated from the stagnation and accumulation of body fluids, and can also be formed by the boiling effect of the fire from smallpox. In such cases, Jiawei Erchen Tang (Modified Two-Chen Decoction) should be used with discretion; if this syndrome appears during the pustule-filling stage, Baoyuan Huadu Tang (Protective Qi and Resolving Toxin Decoction) should be employed to support healthy qi, resolve toxins, and bring peace.
[Note]
Phlegm is produced when body fluids stagnate in the chest.
Generally, the fire of smallpox toxin consumes and boils the body 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 they may damage true qi. Instead, Jiawei Erchen Tang (Modified Two-Chen Decoction) should be used for treatment.
If this syndrome is observed during the pustule-filling stage, Erchen Tang (Two-Chen Decoction) is strictly contraindicated.
Instead, a small amount of herbs that clear heat and transform phlegm should be added to formulas that assist in filling the pustules.
For example, adding Ju Hong (Tangerine Peel), Bei Mu (Fritillaria Bulb), Jie Geng (Platycodon Root), and Mai Dong (Ophiopogon Tuber) to Baoyuan Huadu Tang (Protective Qi and Resolving Toxin Decoction) is highly appropriate.
(Jiawei Erchen Tang [Modified Two-Chen Decoction]) Men Dong (Ophiopogon Tuber, 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, bran-fried), Jie Geng (Platocodonis Radix), Xing Ren (Armeniacae Semen Amarum, fried, skin and tips removed), Huang Qin (Scutellariae Radix). Decoct with fresh ginger water.
(Verse Formula)
Smallpox syndromes with much phlegm are suitable for Erchen Tang,
Adding Men Dong, Qian Hu, and Gua Lou Ren;
Chen Pi, Ban Xia, Fu Ling, and Gan Cao,
Together with Zhi, Jie, Xing Ren, and Huang Qin.
(Baoyuan Huadu Tang [Protective Qi and Resolving Toxin Decoction]) See "Treatment of Swelling Stage" section.
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Miscellaneous Syndromes in Smallpox
Toxic heat steaming and burning lung metal causes rebellious lung qi and frequent coughing. During the initial fever and appearance of spots, Xing Su Yin (Apricot and Perilla Infusion) is indicated; during the scabbing stage, Qingge San (Clear Diaphragm Powder) combined with Erchen Tang (Two-Chen Decoction) is miraculous.
[Note]
Coughing refers to symptoms accompanied by both sound and phlegm. It occurs because the fire of smallpox toxin steams the lungs, causing rebellious qi and triggering coughing.
If seen during the initial fever stage, Xing Su Yin (Apricot and Perilla Infusion) should be primarily administered. If caused by accidental exposure to wind-cold, this same 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; it will heal itself upon resolution, and medication is unnecessary.
If coughing occurs after scabbing forms, it is due to weak defensive qi and open pores, or due to exposure to wind-cold. In all these cases, Renshen Qingge San (Ginseng Clear Diaphragm Powder) is appropriate.
If caused by residual heat, Jiawei Erchen Tang (Modified Two-Chen Decoction) is appropriate.
(Xing Su Yin [Apricot and Perilla Infusion]) See "Wheezing Syndrome" section.
(Renshen Qingge San [Ginseng Clear Diaphragm Powder]) Ren Shen (Ginseng Radix et Rhizoma), Huang Qi (Astragali Radix, raw), Fu Ling (Poria), Bai Zhu (Atractylodis Macrocephalae Rhizoma, soil-fried), Huang Qin (Scutellariae Radix), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba, lightly fried), Zhi Mu (Anemarrhenae Rhizoma, raw), Jie Geng (Platocodonis Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma, raw), Chai Hu (Bupleuri Radix), Hua Shi (Talcum, flown), Zi Wan (Asteris Radix), Di Gu Pi (Lycii Cortex), Sang Bai Pi (Mori Cortex, fried). Decoct with fresh ginger water.
(Verse Formula)
Qingge San treats post-scabbing cough,
With Ren Shen, Huang Qi, Fu Ling, Bai Zhu, Huang Qin, Dang Gui, and Bai Shao;
Zhi Mu, Jie Geng, Gan Cao, Chai Hu, and Hua Shi,
Combined with Zi Wan, Di Gu Pi, and Sang Bai Pi.
(Jiawei Erchen Tang [Modified Two-Chen Decoction]) See "Phlegm Syndrome" section.
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Miscellaneous Syndromes in Smallpox