痘疮内外宜宣畅，秘结气血鲜流荡，大便不通四顺宜，小便秘涩八正当。
[注]
凡出痘，二便最喜通畅，以痘属毒火，惟通畅然后经络疏利，
气血流动而无壅遏之患，
一有不通，则毒火不能外达，必致内攻而生患，
初出大便秘者，四顺清凉饮主之，小便秘者，八正散主之，
若至成浆时，切勿轻用。
(四顺清凉饮) 白芍药 当归身 甘草生 生大黄 水煎服。
(方歌)
四顺清凉治秘结，大便不通毒火烈，白芍当归大黄草，急急煎服效最捷。
(八正散) 车前子 瞿麦 扁蓄 栀子仁 大黄 甘草生 木通 滑石 引用灯心水煎服。
(方歌)
八正散治小便秘，车前瞿麦与扁蓄，栀子大黄木通草，更入滑石煎成服。
%
痘中杂证
初热作泻柴苓先，脾虚冷泻木香煎，色黄酸臭胃苓治，灌浆虚滑豆蔻丸。
[注]
痘证不喜秘结，更忌泻利，
初出时泻，尚具开通之功，火热由利而解，
若泻甚，则是邪气并于肠胃，迫而下降，使传化失常也，宜柴苓汤主之，
起胀时泻，于足逆冷，痘不起，其色淡白，此冷泻也，
以陈氏木香散主之，
如中满恶食，泻黄酸臭，手足心热，面赤疮红，此胃热作泻，
以胃苓汤主之，
惟成浆时尤为紧要，盖痘疮至此，津液已衰，脾胃已弱，复加泄泻，
则百变丛生，急以豆蔻丸主之。
(柴苓汤) 黄芩 半夏姜炙 白术土炒 甘草生 赤茯苓 猪苓 泽泻
柴胡 用生姜灯心 水煎服。
(方歌)
痘形末见如泄泻，柴苓疏利功最捷，芩半术甘赤茯苓，猪苓柴胡共泽泄。
(陈氏木香散) 方见厥逆。
(胃苓汤)
陈皮 厚朴姜炒 赤茯苓 苍术米泔水浸炒 猪苓 泽泻 白术土炒
引用灯心 水煎服。
(方歌)
里实作泻胃苓治，陈皮厚朴赤茯苓，苍术猪苓并泽泻，减桂倍术效无穷。
(豆蔻丸)
白龙骨煆 肉豆蔻面裹煨去油 木香煨 砂仁 诃黎勒肉各五钱面裹
赤石脂七钱半煨 白枯矾三钱 共为细末，麴糊为丸，如黍米大，
每服三五十丸，米饮下。
%
痘中杂证
痘疮在表里之间应当保持宣通畅达，若出现秘结则气血运行不畅。大便不通适宜用四顺清凉饮，小便涩滞适宜用八正散。
[注]
凡是出痘，大小二便最喜通畅，因为痘疮属于毒火之邪，只有通畅才能使经络疏利，气血流动而没有壅塞遏制的祸患。一旦有不通畅的情况，毒火就不能向外透达，必然导致向内攻伐而产生祸患。初起时大便秘结的，以四顺清凉饮为主治方；小便秘涩的，以八正散为主治方。如果到了成浆阶段，千万不要轻易使用这些泻下药物。
(四顺清凉饮) 白芍药、当归身、生甘草、生大黄，水煎服。
(方歌)
四顺清凉治疗秘结，大便不通毒火猛烈，白芍、当归、大黄、甘草，急急煎服效果最快。
(八正散) 车前子、瞿麦、扁蓄、栀子仁、大黄、生甘草、木通、滑石，引用灯心草水煎服。
(方歌)
八正散治疗小便秘涩，车前、瞿麦与扁蓄，栀子、大黄、木通、甘草，再加入滑石煎成服用。
痘疮中的杂证
初热期出现腹泻先用柴苓汤，脾虚冷泻用木香散煎服，粪便色黄酸臭用胃苓汤治疗，灌浆期虚滑泄泻用豆蔻丸。
[注]
痘证不喜欢秘结，更忌讳腹泻。
初起时腹泻，尚具有开通的作用，火热之邪可以通过腹泻而解除。
如果腹泻严重，则是邪气并聚于肠胃，逼迫而下陷，导致传化功能失常，适宜用柴苓汤主治。
起胀期出现腹泻，伴有足部逆冷，痘疹不起发，颜色淡白，这是冷泻。
以陈氏木香散主治。
如果出现脘腹胀满、厌恶饮食，腹泻粪便黄且酸臭，手足心发热，面色红赤，疮色红，这是胃热引起的腹泻。
以胃苓汤主治。
到了成浆阶段尤为紧要，因为痘疮到了这个阶段，津液已经衰少，脾胃已经虚弱，再加上泄泻，
那么各种病变就会丛生，急需以豆蔻丸主治。
(柴苓汤) 黄芩、姜制半夏、土炒白术、生甘草、赤茯苓、猪苓、泽泻、柴胡，用生姜和灯心草为引，水煎服。
(方歌)
痘形尚未显现如泄泻，柴苓汤疏利功效最快，黄芩、半夏、白术、甘草、赤茯苓，猪苓、柴胡共配泽泻。
(陈氏木香散) 方剂见厥逆章节。
(胃苓汤)
陈皮、姜炒厚朴、赤茯苓、米泔水浸炒苍术、猪苓、泽泻、土炒白术，引用灯心草，水煎服。
(方歌)
里实作泻用胃苓汤治疗，陈皮、厚朴、赤茯苓，苍术、猪苓并泽泻，减去肉桂加倍白术，效果无穷。
(豆蔻丸)
煅白龙骨、面裹煨去油的肉豆蔻、煨木香、砂仁、诃黎勒肉各五钱（面裹），
煨赤石脂七钱半、白枯矾三钱，共研为细末，用神曲糊制作成丸，如黍米大小，
每次服用三五十丸，米汤送下。
痘疮中的杂证
Both the interior and exterior of smallpox should be kept open and unobstructed; constipation prevents the free flow of Qi and Blood. For unyielding stool, Si Shun Qing Liang Yin is appropriate; for difficult and scanty urination, Ba Zheng San is appropriate.
[Note]
In cases of eruptive diseases like smallpox, the free passage of both stool and urine is highly desirable because the disease is attributed to toxic fire. Only through patency can the meridians be smoothed, allowing the smooth circulation of Qi and Blood without the risk of stagnation and obstruction. If there is any blockage, the toxic fire cannot reach the exterior and will inevitably attack the interior, causing complications. In the initial stage, if constipation occurs, Si Shun Qing Liang Yin (Four-Obedience Cooling Decoction) is the primary formula; if urinary difficulty occurs, Ba Zheng San (Eight-Righteous Powder) is the primary formula. However, during the pustule formation stage, these purgative formulas must not be used lightly.
(Si Shun Qing Liang Yin [Four-Obedience Cooling Decoction]) Bai Shao Yao (Radix Paeoniae Alba), Dang Gui Shen (Radix Angelicae Sinensis - root body), Sheng Gan Cao (Raw Radix Glycyrrhizae), Sheng Da Huang (Raw Radix et Rhizoma Rhei). Decoct in water and take orally.
(Decoction Song)
Si Shun Qing Liang treats constipation, where unyielding stool indicates fierce toxic fire;
Bai Shao, Dang Gui, Da Huang, and Gan Cao,
Decoct urgently and take for the swiftest effect.
(Ba Zheng San [Eight-Righteous Powder]) Che Qian Zi (Semen Plantaginis), Qu Mai (Herba Dianthi), Bian Xu (Herba Polygoni Avicularis), Zhi Zi Ren (Semen Gardeniae), Da Huang (Radix et Rhizoma Rhei), Sheng Gan Cao (Raw Radix Glycyrrhizae), Mu Tong (Caulis Akebiae or Caulis Tetrasepalae Spirematostegiae), Hua Shi (Talcum). Use Deng Xin Cao (Medulla Junci) as a guide, decoct in water and take orally.
(Decoction Song)
Ba Zheng San treats difficult and scanty urination, with Che Qian, Qu Mai, and Bian Xu;
Zhi Zi, Da Huang, Mu Tong, and Gan Cao,
Add Hua Shi, decoct, and take.
Miscellaneous Syndromes in Smallpox
During the initial heat stage, diarrhea is first treated with Chai Ling Tang; for Spleen deficiency cold diarrhea, Mu Xiang San decoction is used; for yellow, sour-smelling stool, Wei Ling Tang is used; for loose, slippery stools during the pustule formation stage due to deficiency, Dou Kou Wan is used.
[Note]
Eruptive diseases are unfavorable for constipation and even more so for diarrhea.
Diarrhea in the initial stage still possesses the function of opening and venting, allowing the pathogenic fire to resolve through evacuation.
If diarrhea is severe, it indicates that pathogenic factors have converged in the intestines and stomach, forcing downward movement and disrupting transportation and transformation functions; Chai Ling Tang is appropriate.
During the swelling stage, if diarrhea occurs accompanied by cold extremities, failure of the eruption to rise, and pale color, this is cold diarrhea.
Chen Shi Mu Xiang San (Mr. Chen's Costus Root Powder) is used.
If there is abdominal fullness, anorexia, yellow and sour-smelling diarrhea, hot palms and soles, red face, and red lesions, this is diarrhea caused by Stomach heat.
Wei Ling Tang is used.
The pustule formation stage is particularly critical. At this stage, the Body Fluids are depleted, and the Spleen and Stomach are weak. If diarrhea is added,
various complications may arise. Dou Kou Wan should be used urgently.
(Chai Ling Tang [Bupleurum and Poria Decoction]) Huang Qin (Radix Scutellariae), Ban Xia Jiang Zhi (Rhizoma Pinelliae Praeparatum cum Zingibere et Alumine), Bai Zhu Tu Chao (Rhizoma Atractylodis Macrocephalae Stir-fried with Earth), Sheng Gan Cao (Raw Radix Glycyrrhizae), Chi Fu Ling (Poria Cum Rosa), Zhu Ling (Poria), Ze Xie (Rhizoma Alismatis), Chai Hu (Radix Bupleuri). Use Sheng Jiang (Fresh Rhizoma Zingiberis) and Deng Xin Cao (Medulla Junci) as guides, decoct in water and take orally.
(Decoction Song)
When the smallpox rash has not yet appeared but diarrhea occurs, Chai Ling Tang's smoothing and draining action is most swift;
Huang Qin, Ban Xia, Bai Zhu, Gan Cao, and Chi Fu Ling,
Zhu Ling, Chai Hu, and Ze Xie work together.
(Chen Shi Mu Xiang San [Mr. Chen's Costus Root Powder]) See the section on Jue Ni (Reversal Cold).
(Wei Ling Tang [Stomach and Poria Decoction]) Chen Pi (Pericarpium Citri Reticulatae), Hou Po Jiang Chao (Cortex Magnoliae Officinalis Stir-fried with Ginger), Chi Fu Ling (Poria Cum Rosa), Cang Zhu Mi Jiang Shui Jin Chao (Rhizoma Atractylodis Lanceae Soaked in Rice Wash Water and Stir-fried), Zhu Ling (Poria), Ze Xie (Rhizoma Alismatis), Bai Zhu Tu Chao (Rhizoma Atractylodis Macrocephalae Stir-fried with Earth). Use Deng Xin Cao (Medulla Junci) as a guide, decoct in water and take orally.
(Decoction Song)
Interior excess causing diarrhea is treated with Wei Ling Tang;
Chen Pi, Hou Po, and Chi Fu Ling,
Cang Zhu, Zhu Ling, and Ze Xie;
Remove Gui Zhi and double the amount of Bai Zhu for endless efficacy.
(Dou Kou Wan [Cardamom Pill]) Bai Long Gu Huan (Fossilized Bones Calcined), Rou Dou Kou Mian Guo Wei Qu You (Nux Vomica Seed wrapped in flour, baked, and oil removed), Mu Xiang Wei (Costus Root baked), Sha Ren (Amomi Fructus), He Li Le Rou (Pericarpium Terminaliae Chebulae) each 5 qian (wrapped in flour);
Chi Shi Zhi Huan (Halloysitum Rubrum calcined) 7.5 qian, Bai Ku Fan (Alumen) 3 qian. Grind into fine powder, make pills with Qu Hu (Malt Paste) the size of millet seeds. Take 30-50 pills per dose, washed down with rice drink.
Miscellaneous Syndromes in Smallpox