疮疹之候。古今皆云大率与伤寒相似。然亦有小异也。其初觉之时。头痛体重。面赤气粗。壮热多睡。惊悸
呵欠。顿闷咳嗽。呕逆嚏喷。此皆同也。其疮疹者。不恶寒而恶热。面色与四肢俱赤。眼睛黄。手足厥。唇红。
耳尖冷。KT 骨冷。小便赤。大便秘。其脉三部皆洪数绝大不定。是其候也。此小异耳。伤寒者宜发散解之。疮疹
者宜温平处方，惟不可妄发妄下。又不可令受风冷。其疮疹乃儿在母胎中之时。食母血秽。滋养儿五脏之气。至
生下以后。其毒不拘何时。须当出矣。惟年小者。皮肤嫩软。疮出快易。（谓数岁以下者）若长大者。皮肤浓
硬。疮出艰难。（谓数岁以上者）然小儿所蓄胎中秽毒。因中寒温，蕴发生热。三日以上。热运入皮肤。始如蚊
蚤咬成赤点。或如沙粟瘾疹风HT 之类。渐渐出而作疮也。前人言疮疹有表里证。其疮皮浓。如赤根白头。渐加赤
肿有脓。瘥迟者谓之大痘。此谓里证。发于脏也。其疮皮薄。如水泡。破即易干者。谓之水痘。此为表证。发于
府也。此言虽简。然未尽善。此但言脓 水泡二种。外斑疹又不知属何所主也。不若钱之所论。其疮出有五名。
以属五脏之液。其状有五象。以属五脏之色。肝为水泡主泪。以泪出清如水。其色青而大。肺为脓 主涕。以涕
出浊如脓。其色白而大，心为斑主血。其色赤而稍
大。脾为疹主裹血。其色黄赤而小。肾为倒 。其色黑。（细说在后）诸脏内惟涕泪出多。故水泡脓 皆大。血
营于内。所出不多。故斑子疹子皆小也。又病水泡脓 者。涕泪俱少。以液从疮出故也。譬如泡中容水。水去则
泡瘦矣。凡疮疹初欲出之时。则五脏证皆见。以热并动于五脏也。及至已出时。乃得归一脏者。以一脏受秽多而
毒瓦斯盛也。亦有两证三证同出者。所受同而并发也。（细说在后）昔钱乙治睦亲宅十太尉疹子。与众医坐上问
曰。疹未出何属。一曰胃热。一曰伤寒不退。一曰在母腹中时有毒。乙曰。若言胃热。何乍凉乍热。若言伤寒不
退。七日之外。则为再经。何证不相应。若言母腹中之毒。今发属何脏。皆无以对。乙复曰。儿在母胎中。至六
七月已成形。食母腹中秽液。入儿五脏。至十月即秽液满胃。至生时。儿口中犹有不洁。产母以物拭清。又以黄
连汞粉下其脐粪之秽。此母秽液不洁。余气在儿脏中。因遇寒温邪气相搏。而发热出成
疮疹也。未出欲作之时。热动五脏。则五脏之证皆见。呵欠顿闷者肝也。时发惊悸者心也。乍凉乍热。手足冷
者脾也。面颊赤。咳嗽嚏喷者肺也。惟肾无证。以其肾在腑下。不能食其胃液。其候平者。但KT 冷耳冷者是也。
KT耳俱属于肾。居北方。主冷故也。疮既出则归一脏。肝为水泡。肺为脓 。心为斑。脾为疹。肾虽无证。其候
恶者。疮变倒 而黑陷。则归肾也。此由不慎风冷内虚所致。疮黑陷KT 耳反热者逆也。今十太尉疹子无他证。当
用平和药为治。用抱龙丸数服而愈。其方在本集载之。
凡疮疹欲出者。身必发热。其发亦自有时。随脏所主。如早晨发热不已为水泡。日午发热不已为斑。晡时发
热不已为疹。日晚发热不已为脓 。发热三日以上。热运入皮肤即出也。其热重者疮亦重。其热轻者疮亦轻。方
其身热疮未出之时。须审认证候子细。不可有误。误则为害大矣。且疮疹欲作之时皆身热。热则疮亦未出。热至三
四日乃歇。疮方出也。若腹痛者。是腹中先出。眼涩者。是眼中先出。咽喉口舌痛者。嘴
先出也。若三日以后不出。或出不快。热留肤腠之间故也。当以药微发之。止可服升麻葛根汤抱龙丸之类。
药平平者。或儿身不甚热者。与少胡荽酒饮之。此微发不出。即加药发之。既发之后。出不多。脉平无他证者。
即是疮本稀
也。不可更发。若不能审察病势轻重。但务多以热药发之。则热药熏蒸。疮出转难。别生热证。大小便不通。更
以药下之。便致危殆。此误之甚矣。若疮欲发之时。有大热甚者。只可与利小便。如觉热极毒盛。服常药不可
及者。宜微与利之。以减其毒。不可大利。须是子细。常与看觑。虽夜间亦不住用灯观照。若未有赤红点子出
时。乃可与微利。若已有出者。则不可利也。钱乙有曰。身热烦渴。腹满而喘。大小便秘涩。面赤闷乱。大吐
者。当利小便。不瘥者。微导痢之。此亦疮疹未出之前。有此热湿之证。解而不减。乃可与微利之。张涣亦曰。
疮疹未出。脉洪数甚大不定。而小便赤。大便秘者。此证正宜疏利。涣频年在禁中及在外治此证甚多。皆获安
愈。亦与上证并同者也。若红点未出之前。无此热实之证者。亦不可利。朱肱曰。伤寒身热在表。固不可下。
疮疹身热在表。亦不可下。盖伤寒与疮疹一体之病。是以伤寒证中有出疮疹之候也。世人不学。妄云疮疹初觉
未出时。宜先利。其毒已出者。不可利。若出已定。脓血太盛者。亦可与利。此皆非也。大抵疮疹首尾皆不可
下。此言甚善。医者当务从之。若能审察疮疹于未出之前，别无热毒之证者。不可与下。有热毒之证。轻者
与利小便。重者利小便不减。方可与微下。若已出者。慎不可下。至出足已定。亦未可与下。须直候疮痂焦落。
美饮食。能举动之后。方可与解余毒药下之。亦不可用 药过多。如此则无误矣。是以疮疹变黑陷者。多因误
投冷药。妄乱下之。及不慎风冷。乳食不饱。内虚脾弱所致也。故儿病疮疹。不得令受风冷。冬月必在暖处。夏
月虽不可壅遏。亦须避其风凉。在凉荫处则可。又当频频喂饲乳食。常令饱足。无令饥馁。今俗辈多禁食饵。殊
不知饥则内虚。脾胃气弱。别生他证也。且疮疹欲发之时。身必壮热。二三日渐凉。疮方始出。其出快。疮红
肥。脉浮大而数者。毒瓦斯出也。若疮出多。却身热疼痛者。是内热外疮 之所作。至出尽则凉也。庸工不明。见
身热疼痛。以为热盛。便投凉药。致身反凉而疮出不快。变黑 倒陷。脉沉细坏乱。到此病家方觉。医者拱手。
如是夭伤。诚可哀惜。昔仓公扁鹊论小儿疾证。汤药有可服不可服之别。宜先顺阴阳。次调荣卫。然后方利脏
腑。古圣立言垂法。为后世逆治之戒。岂可忽诸。故众病之中。憔疮疹切忌妄下为最。昔钱乙治睦亲宅一
大王儿疹子。始用一李医。以药妄下之。其疹稠密。乃召乙。乙见大惊曰。若非转下。则为逆病也。
王曰。已下之。乙曰。疹始出。未有他证。不可下。但用平和之药。频与乳食。不受风冷可也。如三日外。出不
快者。当根据次发之。有大热者。当利小便。如疮痂起能食者。微利一两行即止。今先下早。疮未尽出而稠密已
盛。为难治。此误也。纵虽得安。其病有三。一者疥。二者痈。三者赤目。李不能治。经三日黑陷。复召乙。乙
曰。幸不发寒。未致困也。盖疮黑者归肾。肾旺胜脾。土不能制水。脾虚寒战。则难治也。今未发寒。乃用药
泻膀胱之腑。腑若不实。则肾之脏自不盛也。乃得安愈。或曰。何不泻肾。以肾主虚。而不受泻。若二服不效。加
寒则死矣。乙之治方。本集载之。
凡疮疹欲作。有发惊搐搦者。以疹疮由热所生。心主热而为惊。又热则生风。风属肝。心肝二脏风火相搏。
故发惊搐也。轻者疮出热去则自愈。重者亦当泻其心肝之盛也。又有因惊而发疮疹者。惊本亦由热作。治当退热
定惊。庸工不明。更以热药发之。致发热入表。表热而斑出也。昔钱乙治四王宫五大尉。因坠秋千。发惊搐搦。
前医以热药发散。不愈。召乙。乙曰。本乃急惊。后生大热。初当合用利惊药治之。今发散乃逆也。乙用药退解
之。至三日肌肤尚热。乙曰。更二日不愈。必发疮疹。盖热不能出也。后二日果疮疹出。以药治之。七日愈。其
钱乙治方。本集载之。
凡疮疹出有轻重逆顺。轻重者。若只出一般。或出作数次者轻。若三两般同出。或一次便出尽者重。出稀者
轻。出密者重。里红外肥者轻。外黑里赤者重。里外俱黑者大重。疮端里有黑点如针孔者。势剧也。青干紫陷。
昏睡汗出不止。烦躁热渴。腹满而喘。大小便不通者。困也。逆顺者。先发脓 。后发疹子者顺。先发水 。后
发疹子者逆。先发脓 。后发水泡多者顺。少者逆。先发水泡。后发斑子多者逆。少者顺。先发疹子。后发斑子
顺。先出疹子斑子者。后必更出水泡脓 。先出水泡脓 者。后必不出疹子斑子。盖以水泡脓 重而毒瓦斯出甚。
斑子疹子轻而毒瓦斯出微。甚者必带了微者也。微者不带甚者故也。予家有数小儿。皆先出疹子。次出水泡。次出
脓。共三次而已。其先出疹子者。或恐有斑子兼出。以斑疹相似。此两般乃子母
之藏。故又轻重顺逆更看时月。大抵疮疹之病。在表属阳。出则为顺。不出则为逆。春夏病之则顺。秋冬病之则
逆。又冬月肾旺寒冷之时。病者多归肾而变黑也。又当辨春脓 。夏黑 。秋斑子。冬疹子者。亦不顺也。病虽
重。疮红肥犹当十活四五。若黑陷者。无问何时。十难救一。其候寒战牙噤。或身肿疮黑紫者。急以药泻膀胱之
府。以减肾气而救之。若服药后身热气温。欲饮水者可治。以脾气生而胜肾。寒冷去而温热生也。若服药之后。
恶寒不已。身冷汗出。耳KT 反热者。死候也。以肾大旺。脾虚不能制也。
凡疮疹出多。稠密遍身。其势太甚。儿甚苦之。及变黑倒 不出者。急以猪血脑子救之。沈存中侍郎有方。
治疮疹欲发。及伏陷危困者。取腊月猪血。瓶盛。挂风中令干。每用半枣大。加生龙脑豆许。温酒下。甚效。予
家有小女病伤寒。但腰痛。昼夜号哭。手足厥冷。日加昏困。形证极恶。予疑是倒发疮子。先不蓄此药。急令就
屠家处买少生猪血。时盛暑。血已败恶。无可奈何。遂多以龙脑和而灌之。一服遂得少睡。须臾一身疮点出。获
安。不尔几死。
凡疮疹若黑陷而忽泻。便脓血。并痂皮者。此却为顺也。如水谷乳食不化者逆也。何以然。且疮黑属肾。今
脾气本壮。或旧服补脾药。脾气得实。肾虽用事。脾能制之。今虽入腹。为脓血及痂皮得出。是脾强肾退。即出
而安也。若泻米谷。乳食不化者。是脾虚不能制肾。则自泄也。此必难治。
凡疮疹若婴小及乳下儿病者。不可与稚一等为治。妄施汤药。小者宜少少服药。惟忌多服。服则反为累也。
又令母慎口。又不可令儿失饥。避其风冷。及用药调理乳母为佳。若断乳儿患者。亦当
审其轻重大小用药，如至八九岁以上。至十岁外者。方可施药也。
凡疮疹儿病大盛。遍身溃烂。脓血沾粘衣衾。睡卧不得。及有疮成片段无皮。或作窦穴。痘痈脓血多。盛者
用腊月黄牛粪。日干烧灰。铺一寸许浓。令在上卧之。及掺其疮溃无皮之处。即愈。一方用黑牛粪烧灰敷。亦
得。
凡疮疹儿病面上有者。才脓出。急以真酥润之。频润为佳。才有痂。便揭去更润之。纵虽揭损。有少血亦
不妨。但以酥或面油涂润
之。若不润及揭迟。则疮痂干硬不落。有碍肉生。即隐成瘢子也。此理昭然。人多不晓。反谓揭早成瘢。甚误
也。
凡疮疹切忌杂人。恐有汗气狐臭触之。又不可令儿闻秽恶臭物也。故左右不可阙于胡荽。以胡荽能御汗
气。及辟诸恶气故也。家有数儿。一儿既患。余儿次皆及之。盒饭为备以防之。以秽气转相传染
也。儿能食者。可时与少葡萄食之。盖能利小便。及取恶秽出快之义也。
凡疮疹儿患者。切不可洗面。恐生水入眼。即损眼也。若初欲发时。验得的当。急以胭脂或药涂儿面
目周遭。令疮不上面入眼也。若疮入眼者。是毒瓦斯入于肝经。上冲于目。若
疮初出时。觉眼肿痛。便与时时开眼看之。睛上无疮。即不妨矣。若有疮。须服药治之。睛破者无奈也。若疮干以
后。无故眼肿痛者。是余毒不尽所攻也。又疮疼已发，及或入眼。切要慎口。止可食粥及鲫鱼青鱼鹌子。余鱼
及猪羊等物皆不可食。最忌者鸡卵鸭子。食之即目盲，漫若卵白之状。
凡疮疹儿病出尽。至痂焦落。身已凉。喜饮食。能起动者。以清凉饮子浓煎。量大小与服。微痢一两行。去
其余毒即安。无后病也。若不下。则后恐发热为肿腮鼻衄下痢。世人不用此法者。于此数证。或不能免也。
凡疮疹治疗之法。初觉之时。身热未出。证候未明。未能辨认者。与升麻葛根汤消毒散服。若热二三日。证
候已明者。则涂面目。辟秽气。若出快。别无他证者。平和药调之。出不快者发之。出太盛者散之，变黑 者救
之。又毒攻咽喉口舌。则肿痛生疮。毒冲心胸者。则烦渴躁闷。毒入大小肠。则大小便不通。或遗泻下血。毒攻
肝经。则目生障 。疮生于睛。则损瞳人。以至灭疮瘢。退余热。一切诸候。皆随证用
药。其乳下儿患者。可令乳母同服其药。则病得易愈。
升麻葛根汤
治疮疹初觉未出。身热不能辨认。恐是伤寒惊风。变蒸温壮。疑惑之间。皆可与服。
升麻 葛根 芍药 甘草（炙各等分）
疮疹的证候，古今都说是大体上与伤寒相似。然而也有细微的不同之处。在刚开始察觉的时候，（患儿）头痛、身体沉重，面色发红、呼吸粗重，高热、嗜睡，惊悸、打哈欠，突然胸闷咳嗽，呕吐逆气、打喷嚏喷涕。这些症状都是相同的。至于疮疹这种病，不恶寒而恶热，面部和四肢都发红，眼睛发黄，手脚冰凉，嘴唇红，耳尖冷，膝盖骨冷，小便赤黄，大便秘结。其脉象三部皆洪大、数急、极大且不定，这就是它的征候。这是细微的不同罢了。伤寒适宜用发散的方法解除它；疮疹适宜用温和平和的方剂治疗，只不可胡乱发汗或攻下。又不可让患儿受风冷侵袭。那疮疹，是婴儿在母胎之中时，食用了母体的血秽，从而滋养了婴儿五脏之气。到出生以后，其中的毒邪不论何时，都必须发出。只是年幼的孩子，皮肤嫩软，疮疹发出得快且容易。（指几岁以下的孩子）如果长大的孩子，皮肤浓密坚硬，疮疹发出就艰难。（指几岁以上的孩子）然而小儿所蓄积的胎中秽毒，因为感受寒温之邪，蕴积而生热。三天以上，热气运行进入皮肤，开始像蚊虫叮咬形成红点，或者像沙粒粟米般的瘾疹风团之类，渐渐发出并变成疮疡。前人说疮疹有表里证，那种疮皮厚，像有红色根部白色头部的，逐渐加重红肿化脓，痊愈迟缓的称为“大痘”，这叫做里证，发于脏。那种疮皮薄，像水泡一样，破了就容易干燥的，称为“水痘”，这叫表证，发于腑。这种说法虽然简略，但未尽善尽美。这里只说了脓疱和水泡两种，外发的斑疹又不知道属于什么主司呢？不如钱乙的论述，他说疮疹发出有五种名称，归属于五脏之液；其形态有五种象，归属于五脏之色。肝为水泡，主泪，因为眼泪流出清亮如水，其色青而较大；肺为脓疱，主鼻涕，因为鼻涕流出浑浊如脓，其色白而较大；心为斑，主血，其色红而稍大；脾为疹，主裹血，其色黄赤而小；肾为倒靥，其色黑。（详细解说在后面）。诸脏之中只有鼻涕眼泪流出多，所以水泡脓疱都大。血营于内，流出不多，所以斑子疹子都小。又有患水泡脓疱病的，鼻涕眼泪都少，因为津液从疮疹发出的缘故。譬如泡中容纳水，水去则泡瘦了。凡是疮疹刚要发出的时候，五脏的证候都会显现，因为热邪同时扰动五脏。等到已经发出的时候，才归于某一脏，是因为某一脏受秽毒多而毒气旺盛。也有两证三证同时发出的，是所受相同而并发。（详细解说在后面）。从前钱乙治疗睦亲宅十太尉的疹子，与众医生坐在堂上问道：“疹子未出时属于哪一脏？”一位医生说胃热，一位医生说伤寒不退，一位医生说在母腹中有毒。钱乙说：“如果说胃热，为什么忽冷忽热？如果说伤寒不退，过了七天之外，就是再传一经，为什么证候不相符合？如果说母腹中的毒，现在发作属于哪一脏？”众人都无法回答。钱乙又说：“婴儿在母胎中，到六七个月已经成形，食用母腹中的秽液，进入婴儿五脏，到十月时秽液充满胃部，到出生时，婴儿口中还有不洁之物，产母用物品擦拭干净，又用黄连汞粉清理脐带粪便的秽物，这是母体秽液不洁，余气留在儿脏中，因为遇到寒温邪气相搏，而发热出成疮疹。”在未出欲作之时，热动五脏，则五脏的证候都会显现。打哈欠胸闷的是肝，时常发生惊悸的是心，忽冷忽热、手脚冷的是脾，面颊红、咳嗽打喷嚏的是肺。只有肾没有证候，因为肾在腑下，不能食其胃液。其证候平和的，只是膝盖骨冷、耳朵冷而已。膝盖和耳朵都属于肾，位居北方，主冷，所以如此。疮既发出则归于某一脏，肝为水泡，肺为脓疱，心为斑，脾为疹。肾虽然没有证候，但其证候凶险的，疮变为倒靥而黑陷，则归于肾。这是由于不慎受风冷导致内虚所致。疮黑陷、膝盖耳朵反而热的，是逆证。如今十太尉的疹子没有其他证候，应当用平和的药来治疗，服用几次抱龙丸就好了。其方剂在本集中有记载。
凡是疮疹将要发出的，身体必定发热，其发作也有固定的时间，随着脏腑所主不同而不同。如早晨发热不止是为水泡，日午发热不止是为斑，傍晚发热不止是为疹，天晚发热不止是为脓疱。发热三天以上，热气运行进入皮肤就会发出。热势重的疮也重，热势轻的疮也轻。正当身体发热、疮未发出之时，必须仔细审察认证候，不可有误，误了则危害很大。况且疮疹欲作之时皆身热，热则疮也未出，热至三四天才歇息，疮方才发出。若腹痛的，是腹中先出；眼涩的，是眼中先出；咽喉口舌痛的，是嘴里先出。若三天以后不出，或发出得不快，是热留存在肤腠之间的缘故。应当用药微微发汗。只可服用升麻葛根汤、抱龙丸之类的药。药性平平的，或者患儿身体不太热的，给少许胡荽酒饮用。这是微微发汗不出，就加药发汗。既发之后，发出得不多，脉象平和无其他证候的，就是疮本来稀疏，不可再发。如果不能审察病势轻重，只务求多用热药发汗，则热药熏蒸，疮发出转难，另生热证，大小便不通，再以药攻下，便致危殆。这是很大的错误。若疮欲发之时，有大热严重的，只可与利小便的药。如果觉得热极毒盛，服用平常药不能达到的，宜微微给予利小便药，以减轻其毒。不可大利小便，须是仔细，常常看护。虽夜间也不停止用灯照看。若未有赤红点子出来时，才可与微利小便药。若已有出来的，则不可利小便。钱乙曾说：“身热烦渴，腹满而喘，大小便秘涩，面赤闷乱，大吐者，当利小便。不愈者，微导痢疾。”这也是疮疹未出之前，有此热湿之证，解表而不减，才可与微利小便药。张涣也说：“疮疹未出，脉洪数甚大不定，而小便赤，大便秘者，此证正宜疏利。”张涣多年在禁中及在外治疗此证很多，都获安愈，也与上述证候相同。若红点未出之前，无此热实之证的，也不可利小便。朱肱说：“伤寒身热在表，固不可下；疮疹身热在表，亦不可下。”盖伤寒与疮疹是一体之病，是以伤寒证候中有出疮疹的征候。世人不学习，妄说疮疹初觉未出时，宜先利小便。其毒已出的，不可利。若出已定，脓血太盛的，亦可与利。这都是不对的。大抵疮疹首尾皆不可下，这话很对。医者应当遵从。若能审察疮疹在未出之前，别无热毒之证的，不可与下药。有热毒之证，轻者与利小便，重者利小便不减，方可与微下。若已出的，慎不可下。至出足已定，也未可与下。须一直等到疮痂焦落，饮食美好，能举动之后，方可与解余毒药下之。也不可用药过多。如此则无误了。是以疮疹变黑陷的，多因误投冷药，妄乱攻下，及不慎风冷，乳食不饱，内虚脾弱所致。故儿病疮疹，不得令受风冷，冬月必在暖处，夏月虽不可壅遏，亦须避其风凉，在凉荫处则可。又当频频喂饲乳食，常令饱足，无令饥馁。今俗辈多禁食饵，殊不知饥则内虚，脾胃气弱，别生他证也。且疮疹欲发之时，身必壮热，二三日渐凉，疮方才始出。其出快，疮红肥，脉浮大而数的，是毒瓦斯出也。若疮出多，却身热疼痛的，是内热外疮之所作，至出尽则凉也。庸工不明，见身热疼痛，以为热盛，便投凉药，致身反凉而疮出不快，变黑倒陷，脉沉细坏乱，到此病家方觉，医者拱手，如是夭伤，诚可哀惜。昔仓公扁鹊论小儿疾证，汤药有可服不可服之别，宜先顺阴阳，次调荣卫，然后方利脏腑。古圣立言垂法，为后世逆治之戒，岂可忽诸。故众病之中，惟疮疹切忌妄下为最。昔钱乙治疗睦亲宅一大王儿的疹子，始用一个李医，以药妄下之，其疹稠密，乃召钱乙。钱乙见大惊曰：“若非转下，则为逆病也。”王曰：“已下之。”钱乙曰：“疹始出，未有他证，不可下。但用平和之药，频与乳食，不受风冷可也。如三日外，出不快者，当根据次发之。有大热者，当利小便。如疮痂起能食者，微利一两行即止。今先下早，疮未尽出而稠密已盛，为难治，此误也。纵虽得安，其病有三：一者疥，二者痈，三者赤目。”李医不能治，经三日黑陷，复召钱乙。钱乙曰：“幸不发寒，未致困也。盖疮黑者归肾，肾旺胜脾，土不能制水，脾虚寒战，则难治也。今未发寒，乃用药泻膀胱之腑，腑若不实，则肾之脏自不盛也。”乃得安愈。或曰：“何不泻肾？以肾主虚，而不受泻。若二服不效，加寒则死矣。”钱乙之治方，本集载之。
凡是疮疹欲作，有发惊搐搦的，因为疹疮由热所生，心主热而为惊，又热则生风，风属肝，心肝二脏风火相搏，故发惊搐也。轻者疮出热去则自愈，重者亦当泻其心肝之盛也。又有因惊而发疮疹的，惊本亦由热作，治当退热定惊。庸工不明，更以热药发之，致发热入表，表热而斑出也。昔钱乙治疗四王宫五大尉，因坠秋千，发惊搐搦，前医以热药发散，不愈，召钱乙。钱乙曰：“本乃急惊，后生大热，初当合用利惊药治之。今发散乃逆也。”钱乙用药退解之，至三日肌肤尚热，钱乙曰：“更二日不愈，必发疮疹。盖热不能出也。”后二日果疮疹出，以药治之，七日愈。其钱乙治方，本集载之。
凡是疮疹出有轻重逆顺。轻重者，若只出一般，或出作数次者轻。若三两般同出，或一次便出尽者重。出稀者轻，出密者重。里红外肥者轻，外黑里赤者重，里外俱黑者大重。疮端里有黑点如针孔的，势剧也。青干紫陷，昏睡汗出不止，烦躁热渴，腹满而喘，大小便不通的，困也。逆顺者，先发脓疱，后发疹子者顺。先发水泡，后发疹子者逆。先发脓疱，后发水泡多的顺，少的逆。先发水泡，后发斑子多的逆，少的顺。先发疹子，后发斑子顺。先出疹子斑子的，后必更出水泡脓疱。先出水泡脓疱的，后必不出疹子斑子。盖以水泡脓疱重而毒瓦斯出甚，斑子疹子轻而毒瓦斯出微。甚者必带了微者也，微者不带甚者故也。予家有数小儿，皆先出疹子，次出水泡，次出脓，共三次而已。其先出疹子的，或恐有斑子兼出，以斑疹相似，此两般乃子母之藏，故又轻重顺逆更看时月。大抵疮疹之病，在表属阳，出则为顺，不出则为逆。春夏病之则顺，秋冬病之则逆。又冬月肾旺寒冷之时，病者多归肾而变黑也。又当辨春脓疱，夏黑靥，秋斑子，冬疹子的，亦不顺也。病虽重，疮红肥犹当十活四五。若黑陷的，无问何时，十难救一。其候寒战牙噤，或身肿疮黑紫的，急以药泻膀胱之府，以减肾气而救之。若服药后身热气温，欲饮水的可治，以脾气生而胜肾，寒冷去而温热生也。若服药之后，恶寒不已，身冷汗出，耳朵膝盖反而热的，死候也。以肾大旺，脾虚不能制也。
凡是疮疹出多，稠密遍身，其势太甚，儿甚苦之。及变黑倒靥不出的，急以猪血脑子救之。沈存中侍郎有方，治疮疹欲发，及伏陷危困者，取腊月猪血，瓶盛，挂风中令干，每用半枣大，加生龙脑豆许，温酒下，甚效。予家有小女病伤寒，但腰痛，昼夜号哭，手足厥冷，日加昏困，形证极恶，予疑是倒发疮子，先不蓄此药，急令就屠家处买少生猪血，时盛暑，血已败恶，无可奈何，遂多以龙脑和而灌之，一服遂得少睡，须臾一身疮点出，获安，不尔几死。
凡是疮疹若黑陷而忽泻，便脓血，并痂皮的，此却为顺也。如水谷乳食不化的者逆也。何以然？且疮黑属肾，今脾气本壮，或旧服补脾药，脾气得实，肾虽用事，脾能制之。今虽入腹，为脓血及痂皮得出，是脾强肾退，即出而安也。若泻米谷，乳食不化的，是脾虚不能制肾，则自泄也。此必难治。
凡是疮疹若婴小及乳下儿病的，不可与稚一等为治，妄施汤药。小者宜少少服药，惟忌多服，服则反为累也。又令母慎口，又不可令儿失饥，避其风冷，及用药调理乳母为佳。若断乳儿患者，亦当审其轻重大小用药，如至八九岁以上，至十岁外者，方可施药也。
凡是疮疹儿病大盛，遍身溃烂，脓血沾粘衣衾，睡卧不得，及有疮成片段无皮，或作窦穴，痘痈脓血多，盛者用腊月黄牛粪，日干烧灰，铺一寸许浓，令在上卧之，及掺其疮溃无皮之处，即愈。一方用黑牛粪烧灰敷，亦得。
凡是疮疹儿病面上有的，才脓出，急以真酥润之，频润为佳。才有痂，便揭去更润之。纵虽揭损，有少血亦不妨，但以酥或面油涂润之。若不润及揭迟，则疮痂干硬不落，有碍肉生，即隐成瘢子也。此理昭然，人多不晓，反谓揭早成瘢，甚误也。
凡是疮疹切忌杂人，恐有汗气狐臭触之，又不可令儿闻秽恶臭物也。故左右不可阙于胡荽，以胡荽能御汗气，及辟诸恶气故也。家有数儿，一儿既患，余儿次皆及之，盒饭为备以防之，以秽气转相传染也。儿能食者，可时与少葡萄食之，盖能利小便，及取恶秽出快之义也。
凡是疮疹儿患者，切不可洗面，恐生水入眼，即损眼也。若初欲发时，验得的当，急以胭脂或药涂儿面目周遭，令疮不上面入眼也。若疮入眼的，是毒瓦斯入于肝经，上冲于目。若疮初出时，觉眼肿痛，便与时时开眼看之，睛上无疮，即不妨矣。若有疮，须服药治之，睛破者无奈也。若疮干以后，无故眼肿痛的，是余毒不尽所攻也。又疮疼已发，及或入眼，切要慎口，止可食粥及鲫鱼青鱼鹌子，余鱼及猪羊等物皆不可食，最忌者鸡卵鸭子，食之即目盲，漫若卵白之状。
凡是疮疹儿病出尽，至痂焦落，身已凉，喜饮食，能起动者，以清凉饮子浓煎，量大小与服，微痢一两行，去其余毒即安，无后病也。若不下，则后恐发热为肿腮鼻衄下痢，世人不用此法者，于此数证，或不能免也。
凡是疮疹治疗之法，初觉之时，身热未出，证候未明，未能辨认者，与升麻葛根汤消毒散服。若热二三日，证候已明者，则涂面目，辟秽气。若出快，别无他证者，平和药调之。出不快者发之，出太盛者散之，变黑靥者救之。又毒攻咽喉口舌，则肿痛生疮；毒冲心胸者，则烦渴躁闷；毒入大小肠，则大小便不通，或遗泻下血；毒攻肝经，则目生障翳，疮生于睛，则损瞳人。以至灭疮瘢，退余热，一切诸候，皆随证用药。其乳下儿患者，可令乳母同服其药，则病得易愈。
The manifestations of smallpox and chickenpox (Chuangzhen) have been described by both ancient and modern physicians as generally similar to Shanghan (Cold Damage). However, there are also minor differences. At the initial stage, symptoms include headache, heaviness of the body, flushed face, coarse breathing, high fever, excessive sleepiness, palpitations with fright, yawning, sudden chest oppression with coughing, vomiting, retching, sneezing, and spitting. These symptoms are common to both conditions. Regarding Chuangzhen specifically, the patient does not fear cold but fears heat; the face and limbs are all red, eyes appear yellowish, hands and feet are cold, lips are red, ear tips are cold, knees are cold, urine is reddish, and stool is constipated. The pulse at all three positions is surging (Hong), rapid (Shu), extremely large, and irregular. This constitutes the specific manifestation of Chuangzhen, representing the minor difference. For Shanghan, treatment should employ dispersing methods to resolve the pathogen. For Chuangzhen, mild and balanced prescriptions are appropriate; one must strictly avoid reckless sweating or purging, and prevent exposure to wind and cold.
Chuangzhen originates from when the fetus consumes maternal blood impurities in the womb, which nourishes the Qi of the five Zang organs. After birth, the toxicity within must eventually erupt. In young children, whose skin is tender and soft, eruptions appear quickly and easily (referring to children under a few years old). In older children, whose skin is thick and hard, eruptions are difficult to produce (referring to children over a few years old). The fetal impurities accumulated in the child, due to contraction of cold-warm pathogens, accumulate and generate heat. After more than three days, the heat circulates into the skin, initially appearing like mosquito bites forming red spots, or resembling sand-grain-sized urticaria or wind hives, gradually developing into sores.
Ancient texts state that Chuangzhen has exterior and interior syndromes. Sores with thick skin, resembling red roots with white heads, progressively becoming swollen and suppurating, healing slowly, are called "large pox" (Da Dou); this is an interior syndrome originating from the Zang organs. Sores with thin skin, resembling blisters that dry easily after rupture, are called "water pox" (Shui Dou); this is an exterior syndrome originating from the Fu organs. Although this explanation is concise, it is incomplete, as it only mentions pustules and blisters, leaving external macules and papules undefined. Qian Yi’s discussion is superior: he stated that eruptions have five names corresponding to the fluids of the five Zang organs, and five appearances corresponding to the colors of the five Zang organs. The Liver governs blisters and tears; tears flow clear like water, are greenish, and relatively large. The Lungs govern pustules and nasal mucus; mucus flows turbid like pus, is whitish, and relatively large. The Heart governs macules and blood; the color is reddish and slightly large. The Spleen governs papules and wrapped blood; the color is yellowish-red and small. The Kidneys govern inverted crusts (Dao Ye); the color is black (detailed later). Among the Zang organs, only nasal mucus and tears flow abundantly, hence blisters and pustules are large. Blood nourishes internally and does not discharge much, hence macules and papules are small. In cases of blisters and pustules, nasal mucus and tears are scant because the fluids are discharged through the sores. It is like a blister containing water; when the water leaves, the blister shrinks.
When Chuangzhen is about to erupt, manifestations of all five Zang organs appear because heat disturbs all five Zang organs simultaneously. Once erupted, the condition tends to localize to one Zang organ because that organ bears the most impurity and strongest toxicity. Sometimes two or three syndromes erupt simultaneously due to shared origin and concurrent eruption (detailed later).
Previously, Qian Yi treated the Tenth Taiveli of the Muqin Residence regarding his rash. Sitting with other physicians, he asked, "To which Zang organ does the un-erupted rash belong?" One physician said Stomach Heat; another said unresolved Shanghan; a third said toxicity from the womb. Qian Yi replied, "If it were Stomach Heat, why would there be alternating chills and fever? If it were unresolved Shanghan, after seven days it would enter a second transmission cycle; why do the symptoms not correspond? If it is womb toxicity, which Zang organ is currently manifesting?" None could answer. Qian Yi continued, "The fetus forms at six or seven months, consuming maternal impure fluids entering the five Zang organs. By ten months, the stomach is full. At birth, impurities remain in the mouth, wiped clean by the mother, and the umbilical feces are cleansed with Coptis Rhizoma (Huanglian) and calomel. Residual maternal impurities remain in the child's Zang organs. When encountering cold-warm pathogens, they clash, generating heat and causing Chuangzhen." Before eruption, heat moves the five Zang organs, revealing their signs: yawning and chest oppression indicate the Liver; frequent palpitations indicate the Heart; alternating chills/fever and cold extremities indicate the Spleen; flushed cheeks, coughing, and sneezing indicate the Lungs. Only the Kidney shows no specific sign because it resides below and does not consume gastric fluids. A peaceful Kidney sign is merely coldness in the knees and ears, as these belong to the Kidney, located in the North, governing cold. Once erupted, the condition localizes: Liver to blisters, Lungs to pustules, Heart to macules, Spleen to papules. If the Kidney is involved severely, the sores invert and turn black, indicating Kidney involvement. This results from failing to guard against wind-cold leading to internal deficiency. Black inversion with hot knees and ears is a adverse (Ni) sign. Since the Tenth Taiveli had no other symptoms, Qian Yi prescribed mild medicines, administering several doses of Baolong Wan (Embracing Dragon Pill), resulting in recovery. The formula is recorded in this collection.
Generally, when Chuangzhen is about to erupt, the body must be feverish, with timing varying by Zang organ: morning fever indicates blisters; noon fever indicates macules; late afternoon fever indicates papules; evening fever indicates pustules. After three days of fever, heat enters the skin and eruptions appear. Severe heat leads to severe sores; mild heat leads to mild sores. During the febrile phase before eruption, careful diagnosis is crucial; error causes great harm. Fever lasts three to four days before subsiding, allowing eruptions to appear. Abdominal pain suggests abdominal eruption first; gritty eyes suggest ocular eruption first; throat/tongue pain suggests oral eruption first. If eruptions do not appear after three days or are slow, it is due to heat lingering in the skin and interstices. Mild diaphoresis is needed using formulas like Shengma Gegen Tang (Cimicifugae et Puerariae Decoction) or Baolong Wan. For mild cases or low-grade fever, a little Coriandrum Sativum Wine (Husui Jiu) may be given. If mild diaphoresis fails, stronger diaphoretic herbs are added. After eruption, if output is sparse, pulse is calm, and no other symptoms exist, the sores are naturally sparse; do not induce further eruption. Failure to assess severity and using excessive hot diaphoretic herbs causes steaming, making eruption difficult, generating new heat syndromes, and causing constipation/urinary retention. Subsequent purging leads to danger. This is a grave error.
If high fever is severe during the pre-eruption phase, promote urination. If heat and toxicity are extreme and standard medicines fail, mildly promote urination to reduce toxicity. Do not excessively drain fluids; monitor closely, even at night with lamps. Urination-promoting drugs are only suitable before red spots appear; once erupted, do not use them. Qian Yi stated: "Fever, irritability, thirst, abdominal fullness, wheezing, constipation, flushed face, confusion, and severe vomiting require promoting urination. If ineffective, mildly induce diarrhea." This applies to pre-eruption heat-dampness syndromes unrelieved by resolving methods. Zhang Huan also noted: "Pre-eruption with surging, rapid, large, irregular pulse, red urine, and constipation requires gentle draining." Zhang treated many such cases successfully. If no heat-excess signs exist before red spots appear, do not drain. Zhu Gong said: "Shanghan with exterior fever cannot be purged; Chuangzhen with exterior fever also cannot be purged," as they share a pathological basis. Laypeople wrongly claim pre-eruption requires purging/drainage. Those with erupted toxins should not be drained. Even with abundant pus/blood post-eruption, drainage is incorrect. Generally, Chuangzhen should never be purged from start to finish. Physicians should adhere to this. If no heat-toxicity signs exist pre-eruption, do not purge. With heat-toxicity, mild cases get urination promotion; severe cases get mild purgation only if urination promotion fails. Post-eruption, absolutely do not purge. Even after complete eruption, wait until scabs fall off, appetite returns, and movement resumes before clearing residual toxins. Avoid excessive medication.
Black inversion often results from mistaken cold medicines, reckless purging, wind-cold exposure, or insufficient feeding leading to Spleen deficiency. Children with Chuangzhen must avoid wind-cold. In winter, keep warm; in summer, avoid drafts in cool shade. Frequent feeding ensures satiety; starvation causes internal deficiency and Spleen weakness. Folk customs often forbid eating, unaware that hunger weakens the Spleen and generates other syndromes. Initially, high fever occurs for two to three days, then subsides as sores appear. Fast eruption, red/plump sores, and floating-rapid-large pulse indicate toxin expulsion. Numerous sores with persistent fever/pain indicate internal heat and external sores; fever resolves upon completion. Quacks mistake this for excess heat and administer cooling medicines, causing body temperature to drop, eruption to stall, and sores to invert/blacken with deep-thin chaotic pulses. This tragic outcome was lamented by Cang Gong and Bian Que, who advised balancing Yin-Yang, regulating Ying-Wei, then benefiting Zang-Fu. Purging is the greatest taboo for Chuangzhen.
Qian Yi once treated a Prince's son with dense rash after a doctor recklessly purged him. Qian Yi warned that without reversal, it would become an adverse condition. The Prince confirmed purging occurred. Qian Yi stated: "Rash just erupted without other signs; do not purge. Use mild medicine, frequent feeding, and avoid wind-cold. If slow after three days, induce gently. High fever requires urination promotion. If scabs form and appetite returns, mild diarrhea suffices. Early purging makes dense, incomplete eruption difficult to treat. Even if recovered, complications include scabies, carbuncles, and red eyes." The original doctor failed. Three days later, black inversion occurred. Qian Yi returned, noting absence of chills meant the condition wasn't critical yet. Black sores indicate Kidney involvement; strong Kidney overcomes Spleen (Earth fails to control Water), causing Spleen deficiency and chills, which is difficult. Since chills hadn't started, Qian Yi used herbs to drain the Bladder Fu. If the Fu is not full, the Kidney Zang does not become excessive. The child recovered. Some asked why not drain the Kidney directly? Qian Yi explained the Kidney governs deficiency and cannot withstand direct draining; failure after two doses with added cold would cause death. The prescription is in this collection.
Convulsions during pre-eruption occur because heat generates wind; Heart governs heat/fright, Liver governs wind. Wind-fire clashing causes convulsions. Mild cases resolve with eruption; severe cases require draining excess Heart/Liver. Sometimes fright triggers Chuangzhen; since fright stems from heat, treatment should clear heat and settle fright. Quacks mistakenly use hot diaphoretics, driving heat to the exterior and causing macules. Qian Yi treated a Fifth Taiveli who fell from a swing and developed convulsions. Previous doctors used hot diaphoretics unsuccessfully. Qian Yi diagnosed acute fright with subsequent high heat, stating initial treatment should have used anti-convulsant herbs; diaphoresis was contrary. He cleared heat. Three days later, skin remained hot; he predicted eruption in two days due to trapped heat. Eruption occurred, resolved in seven days.
Severity and favorable/unfavorable nature vary. Mild: single type or sequential eruption, sparse, red interior/plump exterior. Severe: multiple types simultaneous or total eruption, dense, black exterior/red interior, or entirely black. Needle-hole black dots indicate severe progression. Cyanotic/dry/purple/inverted sores, lethargy, profuse sweating, irritability, thirst, abdominal fullness/wheezing, and bowel/bladder obstruction indicate critical illness. Favorable sequence: pustules then papules; blisters then papules (many favorable, few unfavorable); blisters then macules (many unfavorable, few favorable); papules then macules. Unfavorable: papules/macules followed by blisters/pustules implies heavy toxin load; blisters/pustules alone imply light toxin load. Heavy cases usually accompany light ones. My family children showed papules, then blisters, then pustules. Seasonal variations matter: Chuangzhen is Yang/exterior; eruption is favorable, non-eruption is unfavorable. Spring/summer onset is favorable; autumn/winter is unfavorable. Winter cold favors Kidney/black inversion. Spring pustules, summer black inversion, autumn macules, winter papules are also unfavorable. Red/plump sores yield 40-50% survival even in severe cases; black inversion yields less than 10%. Chills/jaw lock, swelling, black-purple sores require urgent Bladder-draining herbs to reduce Kidney Qi. Recovery signs: warmth, thirst (Spleen overcoming Kidney). Death signs: persistent chills, cold sweat, hot ears/knees (Kidney excessive, Spleen deficient).
For dense, severe, or inverted black sores, use pig blood with borneol. Shen Cunzhong’s method: dried December pig blood half-date size with a bean-sized raw borneol, taken with warm wine. I once used fresh pig blood with borneol for my daughter with severe typhoid-like symptoms (lumbar pain, crying, cold extremities, lethargy), suspecting inverted sores. Despite spoiled blood due to summer heat, administration induced sleep and rapid eruption, saving her life.
If black inversion is followed by sudden diarrhea of pus/blood/scabs, it is favorable (Spleen strong controlling Kidney). Diarrhea of undigested food is unfavorable (Spleen weak unable to control Kidney), difficult to treat.
Infants and nursing infants require different treatment; avoid excessive decoctions. Small doses are best; overdosing burdens the body. Mothers should regulate diet, avoid starvation for the child, prevent wind-cold, and take regulating herbs themselves. For weaned children (8-10+ years), dosage can be adjusted based on severity.
For severe ulceration, pus/blood sticking to bedding, or open sinuses, apply ash from dried December yellow cow dung (or black cow dung) as a thick layer for lying or sprinkling on wounds.
Facial sores should be moistened with genuine butter (Su) immediately upon suppuration. Remove scabs promptly and re-moisten. Minor bleeding is acceptable. Delayed removal causes hard scabs, hindering tissue regeneration and causing scars.
Avoid visitors to prevent sweat/body odor contamination and foul smells. Keep Coriander (Husui) nearby to repel bad odors. Isolate affected children to prevent cross-infection. Feeding grapes helps promote urination and expel toxins.
Do not wash the face to prevent water entering eyes. Apply rouge or medicine around eyes at onset to prevent ocular involvement. Ocular involvement indicates toxin entering Liver meridian. If eyes swell/pain early, check frequently; no sores on cornea is safe. Sores on cornea require treatment; perforation is incurable. Post-drying eye swelling indicates residual toxin. Diet restriction is crucial: only congee, crucian carp, green fish, quail. Avoid poultry/pork/mutton. Eggs are strictly forbidden as they cause blindness resembling egg whites.
After complete eruption, scabbing, cooling, and return of appetite, administer concentrated Qingliang Yinzi (Cooling Drink) according to age/size to induce mild diarrhea (1-2 times), clearing residual toxins and preventing sequelae like mumps, epistaxis, or dysentery. Neglecting this risks these complications.
Initial treatment (unrecognized fever): Shengma Gegen Tang or Xiaodu San. Once recognized (2-3 days): apply facial protection, repel toxins. Fast eruption/no other signs: mild regulation. Slow eruption: induce. Excessive eruption: disperse. Black inversion: rescue. Throat/tongue sores, chest oppression, bowel/bladder issues, liver-meridian eye damage: treat according to symptoms. Nursing mothers may take medicine concurrently.
Shengma Gegen Tang (Cimicifugae et Puerariae Decoction)
Indications: Initial Chuangzhen with unrecognized fever, differential diagnosis including Shanghan, Jingfeng (Wind-Fright), Bianzheng (Transformation Fever), or Wen Zhuang (Warm Fever).
Ingredients: Cimicifugae Rhizoma (Shengma), Puerariae Radix (Gegen), Paeoniae Radix Alba (Shaoyao), Glycyrrhizae Radix et Rhizoma Preparata (Gancao Zhi) in equal parts.