〔薛〕陈文宿先生云∶疮痘涕唾稠粘，身热鼻干，大便如常，小便黄赤，用人参清膈散。如痰实壮热，胸中
烦闷，大便坚实，卧则喘急，用前胡枳壳散。窃谓前证若肺胃实热，气郁痰滞，或大便秘结，小便赤涩，烦渴
饮冷，宜用人参清膈散表散外邪，疏通内热，使邪不壅滞。若毒蕴脏腑，大便秘结，用前胡枳壳散疏导其里，
调和荣卫，使邪自解散。若痰嗽涕唾，鼻塞不利，宜用惺惺散或参苏饮发散外邪，
庶元气不伤，痘疮轻而易愈。
人参清膈散（痘咳嗽） 前胡枳壳汤（痘喘） 惺惺散 参苏饮（俱痘初热）
海藏云∶痘疹初出后，声音洪亮，形病而气不病也。痘疹未发，声音不出，形不病而气病也。疮疹既发，声音
不出，形气俱病也。气病宜补肺散加黄 。形气俱病宜用八风汤或凉膈散去硝黄主之。小儿禀赋素弱者，宜预服十奇散。
补肺散
阿胶（一钱半，炒成珠） 牛蒡子（炒，三分） 马兜铃（半钱） 甘草（二分半） 杏仁（三粒，去皮尖）
糯米（一钱，炒） 加生黄 （五分）
上为末，分二服。水一小盏，煎六分，食后，时时与之。
八风散（即八风汤）
藿香（半两，去土） 白芷 前胡（去芦。各一两） 黄 甘草（炙） 人参（各二两） 羌活 防风（各三两）
上为末。每服一钱，用薄荷少许，煎汤调服。
凉膈散（发热） 十奇散（即十宣散见起发）
有心火刑肺而失音者，肺属金主声，中有二十四空，凡发诸语言者，皆其空中之气鼓动也，五行金空则鸣，实则哑，
疮疹之火起于心，上熏于肺，肺气胀郁，故窍塞而无声也，以导赤散（心）合甘桔汤（咽喉）加炒牛蒡子主之，
或用人参平肺散。若津液不足，虚火熏蒸者宜用地黄丸（肾）。
有毒归肾而失声者，经曰∶足之少阴，上系于舌，络于横骨，终于会厌，会厌者，音声之户也，舌者，音声之机也，
横骨者，神气所使，主发舌者也。疮黑陷伏，则毒入肾，邪气上客于厌，则厌不能发，发不能出，开阖不利，故猝哑也。
有喉舌溃烂而失声者，咽喉者，所以司呼吸，纳饮食，发音声，犹管龠也，毒火上熏，咽喉先受，贲门、会厌、舌
之位，皆疮所聚，初出之时，失于调治，以致咽喉肿塞，管龠窄狭，舌本强硬，呼吸不能，饮食不入，音声不
出矣。此上二证，治之则难。
若七日后痘疮成浆之际而失音者，乃气喉有痘，初出细小不觉，及至肌表之痘成浆，喉中之痘亦成浆，其毒
壅盛，则气出管龠窄狭，故所出之声不清，而为咽哑也。大率七日前失音者并为逆证，七日后而有者不治自愈，盖
外痘结痂则喉之痘自痊故也。当用甘桔汤服于已发未发之前，所以清其气道，使毒不犯，此预治之法，不可不知。
若痘疮靥后而失音者，余毒过盛，上攻于咽，以致肿痛干涩，声音不出，宜甘
露饮（咽喉）甘桔防风汤（咽喉）天花散、玄参升麻汤（咽喉）主之。
天花散 治痘疹后失音。
天花粉 桔梗 茯苓 诃子 石菖蒲 甘草（各五钱）
上为极细末。用水调在碗内，小竹七茎，小荆芥七茎，缚作一束，点火就碗内煎，临睡服，每服一钱。
清肺散 治患痘咽干声哑。
麻黄（一钱五分） 麦门冬 桔梗（各二钱） 知母 荆芥 天花粉（各一钱） 诃子 菖蒲（各八分）
上锉。分为二服，入竹沥姜汁，水煎服。
栀子菖蒲汤 治小儿痘证，因热毒生风，喑哑不语。
栀子（一钱三分） 石菖蒲 紫草茸（各一钱二分） 山豆根 生犀 黄连（各一钱一分） 羌活 木
通白僵蚕 杏仁 韭子 鼠粘子（各一钱） 升麻 蝉蜕 薄荷（七分）
上锉散。每服五钱，水煎，食远服。
紫河车散 治小儿痘疮，毒瓦斯不解，上攻咽喉，声音不出，舌颊生疮，遏逆烦闷，潮热面赤。
紫河车（即金线重楼） 茜根 贯众（各三钱） 白芍药 甘草（炙。各五钱）
上，每服三钱，生姜一片，水煎服。一方，有牛蒡子。
噙化丸
薄荷叶（二两） 诃子肉（七钱） 桔梗（一两） 甘草（七钱） 栝蒌皮穣（一两） 白僵蚕（炒，七钱
）风化硝（五钱） 黍粘子（炒，一两）
上，为极细末。炼蜜丸、如芡实大。噙化燕津。儿小不能噙，则调化，频抹其口中。
【薛己按】陈文宿先生曾说：痘疮患儿出现鼻涕和唾液粘稠，身体发热，鼻干，大便正常，小便黄赤，应使用人参清膈散。如果痰实且壮热，胸中烦闷，大便坚实，躺下时喘急，使用前胡枳壳散。我认为上述病症若属于肺胃实热，气机郁滞、痰湿停滞，或者大便秘结，小便赤涩，烦躁口渴喜冷饮，适宜用人参清膈散来疏散外邪，疏通内热，使邪气不致壅滞。如果毒邪蕴结在脏腑，大便秘结，使用前胡枳壳散疏导里实，调和营卫，使邪气自然解散。如果有痰嗽、鼻涕唾液多，鼻塞不通利，适宜用惺惺散或参苏饮发散外邪，这样元气不受伤，痘疮轻浅容易痊愈。
人参清膈散（用于痘疮咳嗽） 前胡枳壳汤（用于痘疮气喘） 惺惺散 参苏饮（均用于痘疮初起发热）
张元素（海藏）说：痘疹刚发出后，声音洪亮，这是形体有病而正气未病。痘疹尚未发出，声音不出，这是形体无病而正气已病。痘疹已经发出，声音不出，这是形气和正气都病了。正气病适宜用补肺散加黄芪。形气和正气都病适宜用八风汤或凉膈散去掉硝石和黄芩来主治。小儿先天禀赋素来虚弱的，适宜预先服用十奇散。
补肺散
阿胶（一钱半，炒至成珠状） 牛蒡子（炒，三分） 马兜铃（半钱） 甘草（二分半） 杏仁（三粒，去皮尖） 糯米（一钱，炒） 加生黄芪（五分）
以上药物研为细末，分两次服用。用水一小盏，煎至六分，饭后，时时喂服。
八风散（即八风汤）
藿香（半两，去土） 白芷 前胡（去芦，各一两） 黄芪 甘草（炙） 人参（各二两） 羌活 防风（各三两）
以上药物研为细末。每次服用一钱，用少许薄荷，煎汤调服。
有心火刑克肺金而导致失音的，肺属金主声音，肺中有二十四空窍，凡是发出语言声音的，都是这些空窍中的气体鼓动所致，五行中金空则鸣响，金实则哑。痘疹之火起于心，向上熏蒸于肺，肺气胀满郁结，所以窍道闭塞而没有声音，以导赤散（清心）合甘桔汤（利咽喉）加炒牛蒡子来主治，或者用人参平肺散。如果是津液不足，虚火熏蒸导致的，适宜用地黄丸（补肾）。
有毒邪归入肾而导致失声的，医经说：足少阴肾经，上行系于舌根，联络于横骨，终于会厌。会厌，是声音出入的门户；舌，是声音发出的机关；横骨，受神气支配，主要发动舌头运动。痘疮黑陷伏匿，则毒邪入肾，邪气上客于会厌，则会厌不能开合，声音发不出，即使想发也发不出来，开阖不利，所以突然失音。
有喉舌溃烂而导致失声的，咽喉，是用来主管呼吸、接纳饮食、发出声音的，就像管龠（古代乐器或排箫）一样。毒火上熏，咽喉先受其害，贲门、会厌、舌的位置，都是痘疮聚集之处。初出之时，如果治疗调理不当，导致咽喉肿塞，管龠窄狭，舌根强硬，呼吸不畅，饮食不进，声音出不来了。以上两种证候，治疗起来比较困难。
如果在七日后痘疮成浆阶段出现失音的，是因为气喉部位有痘疮，初出时细小没察觉，等到肌肤表面的痘疮成浆，喉中的痘疮也成浆，毒邪壅盛，导致气道狭窄，所以发出的声音不清，成为咽哑。大体上前七日内失音的都属于逆证，七日后出现的往往不治自愈，因为外部痘疮结痂，喉中的痘疮自然痊愈的缘故。应当在痘疮已发或未发之前服用甘桔汤，以此清利气道，使毒邪不侵犯，这是预防性治疗方法，不可不知道。
如果痘疮收靥（结痂脱落）后出现失音的，是余毒过盛，向上攻冲于咽喉，导致肿痛干涩，声音不出，适宜用甘露饮（治咽喉）、甘桔防风汤（治咽喉）、天花散、玄参升麻汤（治咽喉）来主治。
天花散 治疗痘疹后失音。
天花粉 桔梗 茯苓 诃子 石菖蒲 甘草（各五钱）
以上药物研为极细末。用水调在碗内，取小竹七茎，小荆芥七茎，捆成一束，点火在碗内煎煮，临睡前服用，每次一钱。
清肺散 治疗患痘疮咽干声哑。
麻黄（一钱五分） 麦门冬 桔梗（各二钱） 知母 荆芥 天花粉（各一钱） 诃子 菖蒲（各八分）
以上药物切碎。分为两次服用，加入竹沥、姜汁，水煎服。
栀子菖蒲汤 治疗小儿痘证，因热毒生风，喑哑不语。
栀子（一钱三分） 石菖蒲 紫草茸（各一钱二分） 山豆根 生犀角 黄连（各一钱一分） 羌活 木通 白僵蚕 杏仁 韭子 鼠粘子（各一钱） 升麻 蝉蜕 薄荷（七分）
以上药物切碎捣散。每次服用五钱，水煎，饭远时服用。
紫河车散 治疗小儿痘疮，毒瓦斯不解，向上攻冲咽喉，声音不出，舌颊生疮，气逆烦闷，潮热面赤。
紫河车（即金线重楼） 茜根 贯众（各三钱） 白芍药 甘草（炙，各五钱）
以上药物，每次服用三钱，生姜一片，水煎服。另一方，加牛蒡子。
噙化丸
薄荷叶（二两） 诃子肉（七钱） 桔梗（一两） 甘草（七钱） 栝蒌皮瓤（一两） 白僵蚕（炒，七钱） 风化硝（五钱） 黍粘子（炒，一两）
以上药物，研为极细末。炼蜜制成丸药，如芡实大小。含化生津润喉。幼儿太小不能含化的，则调化后，频繁涂抹其口中。
[Commentary by Xue Ji] Mr. Chen Wensu stated: In cases of smallpox where nasal discharge and saliva are thick and sticky, accompanied by fever, dry nose, normal stool, and yellow-red urine, Ren Shen Qing Ge San (Ginseng Decoction to Clear the Diaphragm) should be used. If there is phlegm accumulation with high fever, chest oppression, solid stool, and wheezing when lying down, Qian Hu Zhi Ke San (Peucedanum and Aurantium Decoction) should be used. I believe that if the aforementioned symptoms are due to excess heat in the Lung and Stomach, Qi stagnation with phlegm obstruction, or constipation with red, scanty urine, irritability, thirst, and a preference for cold drinks, Ren Shen Qing Ge San is suitable to release exterior pathogens and clear internal heat, preventing pathogenic stagnation. If toxins are accumulated in the Zang-Fu organs with constipation, Qian Hu Zhi Ke San should be used to drain interior excess and harmonize Ying and Wei (Nutritive and Defensive levels), allowing pathogens to resolve naturally. If there is cough with phlegm, excessive nasal discharge and saliva, and nasal congestion, Xing Xing San (Wonderful Powder) or Shen Su Yin (Ginseng and Perilla Drink) should be used to disperse exterior pathogens, thereby preserving Yuan Qi (Original Qi) and ensuring the smallpox is mild and easily cured.
Ren Shen Qing Ge San (for smallpox cough) | Qian Hu Zhi Ke Tang (for smallpox wheezing) | Xing Xing San | Shen Su Yin (all for early fever stage of smallpox)
Zhang Yuansu (Hai Zang) said: After smallpox/rash first appears, if the voice is loud, it indicates pathology in the Form (Xing) but not in the Qi. If smallpox/rash has not yet erupted and the voice is absent, it indicates no pathology in the Form but pathology in the Qi. If smallpox/rash has erupted but the voice is absent, both Form and Qi are diseased. For Qi pathology, Bu Fei San (Lung Tonifying Powder) with Huang Qi (Astragalus) is indicated. For both Form and Qi pathology, Ba Feng Tang (Eight Winds Decoction) or Liang Ge San (Cool the Diaphragm Powder) without Xiao Shi (Mirabilite) and Huang Qin (Scutellaria) is indicated. Children with innate constitutional weakness should take Shi Qi San (Ten Miracles Powder) prophylactically.
Bu Fei San
E Jiao (Donkey-Hide Gelatin, 1.5 qian, fried until pearl-like) Niu Bang Zi (Arctii Fructus, fried, 3 fen) Ma Dou Ling (Aristolochiae Fructus, 0.5 qian) Gan Cao (Licorice Root, 2.5 fen) Xing Ren (Prunus Seed, 3 grains, skin and tip removed) Nu Mi (Glutinous Rice, 1 qian, fried) plus Sheng Huang Qi (Raw Astragali Radix, 5 fen).
Grind all into powder, divide into two doses. Boil with one small cup of water until reduced to 60%, administer frequently after meals.
Ba Feng San (i.e., Ba Feng Tang)
Huo Xiang (Pogostemonis Herba, 0.5 liang, cleaned) Bai Zhi (Angelicae Dahuricae Radix) Qian Hu (Peucedani Radix, de-rhizome, each 1 liang) Huang Qi (Astragali Radix) Gan Cao (Licorice Root, honey-fried) Ren Shen (Ginseng Radix et Rhizoma, each 2 liang) Qiang Huo (Notopterygii Rhizoma et Radix) Fang Feng (Saposhnikoviae Radix, each 3 liang).
Grind into powder. Take 1 qian per dose, mix with a little Bo He (Menthae Haplocalycis Herba), decoct in water, and take as a suspension.
Liang Ge San (for fever) | Shi Qi San (i.e., Shi Xuan San, see eruption stage)
Loss of voice due to Heart Fire insulting Lung Metal: The Lung belongs to Metal and governs sound; it contains twenty-four hollow spaces. All speech sounds result from the vibration of Qi within these spaces. In Five Elements theory, Metal rings when hollow and becomes mute when solid. The fire of smallpox originates in the Heart and steams upward to the Lung, causing Lung Qi distension and stagnation, thus blocking the orifices and resulting in silence. Treat with Dao Chi San (Clear Heart Powder) combined with Gan Jie Tang (Licorice and Platycodon Decoction) plus fried Niu Bang Zi, or use Ren Shen Ping Fei San (Ginseng to Calm the Lung Powder). If caused by insufficient Jin Ye (Body Fluids) and steaming by Deficient Fire, treat with Di Huang Wan (Rehmannia Pill).
Loss of voice due to Toxin entering the Kidney: The Classics state: The Foot Shaoyin (Kidney) meridian ascends to tie to the tongue, connects to the Heng Gu (Transverse Bone), and ends at the Hui Yan (Epiglottis). The Hui Yan is the gate of voice; the Tongue is the mechanism of voice; the Heng Gu is directed by Shen Qi (Spiritual Qi) and primarily moves the tongue. When smallpox turns black and sinks inward, toxin enters the Kidney. Pathogenic Qi attacks the epiglottis, causing it to fail in opening and closing; thus, voice cannot emerge, leading to sudden aphonia.
Loss of voice due to ulceration of throat and tongue: The throat governs respiration, ingestion of food, and phonation, akin to a pipe or reed. Toxic fire steams upward, affecting the throat first. The positions of the Fen Men (Cardia), Hui Yan, and Tongue become sites of pustule accumulation. If initial treatment and regulation are inadequate, throat swelling and blockage occur, narrowing the airway, stiffening the tongue root, impairing respiration and swallowing, and silencing the voice. These two conditions are difficult to treat.
If loss of voice occurs on the seventh day during the pustule-forming stage, it is because pustules exist in the glottis/trachea. Initially minute and unnoticed, when cutaneous pustules form pus, the laryngeal pustules also mature. Excessive toxin accumulation narrows the airway, causing hoarseness. Generally, aphonia before the seventh day is a adverse sign (Ni Zheng); aphonia after the seventh day often resolves spontaneously as external scabbing heals the internal laryngeal lesions. Prophylactic administration of Gan Jie Tang before or after eruption clears the airway and prevents toxin invasion; this preventive method must be known.
If loss of voice occurs after the crusts fall off (Yan Hou), it is due to residual toxin attacking the throat, causing swelling, pain, dryness, and silence. Treat with Gan Lu Yin (Sweet Dew Drink), Gan Jie Fang Feng Tang (Licorice, Platycodon, and Saposhnikovia Decoction), Tian Hua San (Trichosanthes Powder), or Xuan Shen Sheng Ma Tang (Scrophulariae and Cimicifugae Decoction).
Tian Hua San treats aphonia after smallpox/rash.
Tian Hua Fen (Trichosanthis Radix) Jie Geng (Platycodi Radix) Fu Ling (Poria) He Zi (Terminalia Chebula Reticulata) Shi Chang Pu (Acori Tatarinowii Rhizoma) Gan Cao (Licorice Root, each 5 qian).
Grind into fine powder. Mix with water in a bowl. Bind seven stalks of bamboo and seven stems of Jing Jie (Schizonepetae Herba) together, ignite, and boil over the bowl. Take before sleep, 1 qian per dose.
Qing Fei San treats dry throat and hoarseness in smallpox.
Ma Huang (Ephedrae Herba, 1.5 qian) Mai Dong (Ophiopogonis Radix) Jie Geng (Platycodi Radix, each 2 qian) Zhi Mu (Anemarrhenae Rhizoma) Jing Jie (Schizonepetae Herba) Tian Hua Fen (Trichosanthis Radix, each 1 qian) He Zi (Terminalia Chebula Reticulata) Chang Pu (Acori Tatarinowii Rhizoma, each 8 fen).
Cut into pieces. Divide into two doses. Add Zhu Li (Bamboo Sap) and Jiang Zhi (Ginger Juice), decoct in water, and take.
Zhi Zi Chang Pu Tang treats pediatric smallpox with aphonia and mutism due to wind generated by heat-toxin.
Zhi Zi (Gardeniae Fructus, 1.3 qian) Shi Chang Pu (Acori Tatarinowii Rhizoma) Zi Cao Rong (Arnebiae Radix, each 1.2 qian) Shan Dou Gen (Sophorae Tonkinensis Radix) Sheng Xi Jiao (Rhinocerotis Cornu) Huang Lian (Coptidis Rhizoma, each 1.1 qian) Qiang Huo (Notopterygii Rhizoma et Radix) Mu Tong (Akebiae Caulis) Bai Jiang Can (Bombyx Batryticatus) Xing Ren (Prunus Seed) Jiu Zi (Allii Tuberosi Semen) Shu Niu Zi (Arctii Fructus, each 1 qian) Sheng Ma (Cimicifugae Rhizoma) Chan Tui (Cicadae Periostracum) Bo He (Menthae Haplocalycis Herba, 7 fen).
Cut and crush. Take 5 qian per dose, decoct in water, and take far from meals.
Zi He Che San treats pediatric smallpox where toxin fails to resolve, attacks the throat causing aphonia, sores on tongue and cheeks, Qi rebellion with oppression, tidal fever, and facial redness.
Zi He Che (Placenta Humana, i.e., Chou Wu Geng/Jacobaeae Herba - *Note: Text identifies Zi He Che as Chou Wu Geng here, though traditionally distinct*) Qian Gen (Rubiae Radix) Guan Zhong (Cyrtomii Rhizoma, each 3 qian) Bai Shao Yao (Paeoniae Radix Alba) Gan Cao (Licorice Root, honey-fried, each 5 qian).
Take 3 qian per dose with one slice of Sheng Jiang (Zingiberis Rhizoma Recens), decoct in water. Another formula adds Niu Bang Zi.
Qin Hua Wan
Bo He Ye (Menthae Haplocalycis Herba, 2 liang) He Zi Rou (Terminalia Chebula Reticulata Flesh, 7 qian) Jie Geng (Platycodi Radix, 1 liang) Gan Cao (Licorice Root, 7 qian) Gua Lou Pi Rang (Benincasae Exocarpium Pulp, 1 liang) Bai Jiang Can (Bombyx Batryticatus, fried, 7 qian) Feng Hua Xiao (Natrii Sulfas Efflorescens, 5 qian) Shu Niu Zi (Arctii Fructus, fried, 1 liang).
Grind into extremely fine powder. Make pills with refined honey, size of Euryale Seed. Hold in mouth to dissolve and generate fluids. For infants unable to hold, dissolve and frequently smear inside the mouth.