见点三日，死生判矣，断于此时，方称高列开窍，唯面部要紧，面者诸会之真，天
庭印堂，尤面部最要紧者。师曰∶天庭为看
痘把柄，何者，元神所归也。元神者，元气也。小儿出痘，不过气、血、毒三字，气血
又元气所统也。元气胜毒，开落应期，毒胜元气，内攻外剥，毒既胜矣。又安望元气之复胜哉。
天庭先见先起，先灌先靥，密而痒（毒盛气不足），惨而黯（毒盛血不足），皆死症也。毒从虚发，信矣哉。
凡见点磊落，摸过碍手，颜色润泽，眼部以下先见，身热渐退，吉症也。盖此等磊
落碍手，稀而有神者也，色润泽，谓有彩也。天庭后见，元气内固也，反是者逆。
叶锡侯曰∶毒盛从上部先见，毒微从下部先见，如火之盛，而必先有焰于上也。不
由血领气拘，而先上头额者，则毒固可知，而生死亦从可知矣。
痘初出时，三五相连者，后必密，单见者稀，毒之浅深，于此可以预决。
形属气，色属血，两者俱可验吉凶，定生死，人何专言血而不及气。气无形难知，血
有形易见，故见点三日，色如猪肝者死，如红米饭者死，毒散漫于皮肤，如洗过大红绸
者重。虽然，面部上有数十颗神彩奕奕者，尚可救活。师曰∶不虑形恶，虑无神；不虑色
恶，虑无彩。形绽而凸，彩润而明，恶症紧要处，见有一二红活可爱，虽凶亦吉。何者？元气犹存也。
程占五曰∶有一二红活可爱，虽凶亦吉。何庸妄者，必诿之不治。病家又有眼不识高
明，甘视其孩抱之呼号而莫之救，哀哉。
大都自眉以上见点，有神彩悦目可爱，仍不琐屑，又不歪邪，虽遍身稠密，杂症百出，
总不至于死。悦目二字，即予笔舌，亦难尽述，在学人心领意会而已。
见点头焦神躁，舌苔而色或紫者，是血分毒炽，而未必不由内热也。
见点白如水珠者重，若稀疏不密，人素色黄，而痘颇起发，气至而血不至也。当散
火。倘神不内宁，痘日增多，顶尖作 子形，
毒大盛也，恐非药所愈。
见两日而大便尚秘，舌上无苔，知是血热，非毒壅也，急行清解，本方加枳壳、明
粉治之，否则恐灌浆时。呕痛作泻而不起，本方内芎、归宜倍用。
见点色白不红，不可便作虚治。白而无神，唇舌淡白，或吐或泻，虚症也。若白而
起色，唇舌赤红，非虚也。三日后渐变深紫，其误人不浅，见点脚冰冷者，不必虑之，
气未下行也。
初见时，大小不一。有色点如沸者，曰夹疹，本方加救苦丹治之。又有一等琐屑红
点，隐隐肉间，曰夹痧，治亦同之。丹毒亦然。但有此症，必正痘悦目可爱，方为痧疹
之夹。不然，是痘也，最当别之。又有痘出数颗，而夹疹遍身，圆净疏朗，形色红活，现
两日而尽没，见者莫不惊愕。然此疹也，非痘也。痘没必闷乱烦躁，此则宁静，且正痘
显然，故知其为疹也。治以平剂自愈。然未没时，亦难识认。
点见身热，毒未尽也，但所感不同，有寒气外郁者，有热气内郁者，均散之。
见点自汗，有生者，有死者，丹溪谓自汗无妨，指形色善者言也。若汗出而颜色日变必死，不可不极辨之。
凡痘出不快，须审时药之，冬则寒郁，夏则热郁。然亦有虚实之别。唇舌滋润无苔，当从虚治。
见点色白，不甚起发，唇舌淡莹，或吐或泻，或腹胀，或自汗肢冷，神气怯弱，须从虚例。
见点在于肚脐，或在肛门，而四围成堆者，皆重症也。
初见数颗于山根上者重，才出而声遂变，亦重。
痘出数点，而面目即光亮如瓜，口中气臭，勃勃冲人，必至发斑吐血而死。
见点先于眉上，或两太阳出数粒，突起光亮，少顷即没，此贼痘也，必死。
有初出爱人，皮薄光亮，一两日即长大，是未至而至，疠气使然也，后必痒塌而死。凡
患诸疮毒未愈，或疮毒新愈，而见点于此者重，此阳毒也。若疮不干红，虽重不死。
谓为于可为之时则从，为于不可为之时则凶，指险症也。至见点如蛇皮，如蚕种，如
蚊迹，如瘙斑，如汤泡，如火刺，如青黑蓝斑，或身如被杖，发斑而唇肿口臭，或锁项，
或蒙头，或断腰，或无根，或色粉白如枯骨，或胸高气喘，七孔流血，或面纹如橘皮，形
色不正而惊狂，并腰痛腹疼不止，可为乎？不可为乎？
书谓见点吐紫黑血者不治。向有潘姓女六岁，见点两日，夜间吐紫数升，举家惊恐，
即老医亦因吐血而去，余详之，非毒也，大补脾胃而痊。何者，唇舌滋润，内无毒也。形
色两善，外无毒也。血去而神宁，血有余也。女父素患血症，此之吐血，是子乘父余，乃
热激动，故一涌而出，非毒也。倘用犀角解毒，得无殒乎？古云∶尽信书不如无书。
凡谓断腰无根，必诸痘形色不善方是。苟形色圆泽，即腰脚无，又何妨哉。
十神解毒汤 治身热毛焦，皮燥腮红，额红点红，烦渴引饮，睡卧不宁，小便赤涩等症
当归 川芎 生地 赤芍 丹皮 红花 连翘 木通 甘草 桔梗 灯心 葱白 大腹皮 淡竹叶
身热壮盛，皮急肉紧，加干葛、前胡、地骨皮。
出不快，加山楂、大力子、蝉蜕。
作痒，加桂枝。
作痛，加防风、黄芩。
唇燥舌苔，加热见愁。（备用方）
夹疹，下救苦丹。（备用方）
发红斑，加元参、犀角，下热见愁。
眼眶红肿流泪，加柴胡、胆草、热见愁，外用护法。
咳嗽，加杏仁、桑皮。
咽痛，加元参、射干，外行吹法。
黑陷疔毒，加赛春雷，外点四圣丹。（备用方）
失血干呕，加犀角、热见愁。
呕吐，加陈皮、黄连、猪苓、泽泻。
溺血，加犀角、生地。
溺短涩，加车前、地肤子。
便秘，加枳壳、杏仁、苏梗，倍当归。
便黑，加犀角、桃仁、黄连。
腹胀喘满，目怒而浮，毛直皮焦，加麻黄，下救苦丹。
秘而喘者，加千里马。（备用方）
烦满身热，加花粉、麦冬。调满天秋。（备用方）
泄泻，加猪苓、泽泻。
谵言狂乱，加石膏、知母，调满天秋。
腰痛，加羌活、独活。
伤食膨胀，加楂、朴、曲芽。
腹痛有三∶伤食，和中丸。毒攻冲，救苦丹。气滞，加青皮、木香。
凡腹痛俱宜千里马下之，一通即已，不可过。过则毒瓦斯内作，反成他症。
四日五日毒瓦斯盛者，加楂、芷、笋尖。痘至四日，理该易方。若毒盛未除，何可轻易。
唯加人参四五分足矣，此名唤浆法。
凡遇热苔，热见愁不可缺。有下症，千里马不可缺。有壅遏症，救苦丹不可缺。痘
欲出不出，干紫焦枯，黑陷疔毒，赛春雷不可缺。若唇舌红赤，小便短少，身热烦渴，痘
色干红者，满天秋不可缺。大都凡见热症，满天秋乃第一要药。
或曰∶热见愁、千里马，皆苦寒药也，子以舌苔，用热见愁固矣。乃所谓下症者何也。
曰∶谓舌苔过甚耳。曰∶有舌苔而作泻可乎？曰可。通因通用，此之谓也。
曰∶壅热者谓何？曰∶谓毒盛郁遏耳。何以验之？曰∶腹胀喘满，目怒面浮，毛直皮
枯，欲出不出，蒸蒸然烦，翕翕然热是也。
见点出现后的三天内，患儿的生死预后即可判定。此时做出的判断，才称得上是高明的开窍诊断法。其中面部最为关键，因为面部是诸阳经汇聚之处。天庭（前额中央）和印堂（两眉之间），尤其是面部最重要的部位。老师说：天庭是观察痘疹的关键所在，为什么呢？因为它是元神（人体生命活动的根本精神与元气）所归聚的地方。元神，就是元气。小儿出痘，不过涉及气、血、毒这三个字，而气血又是由元气统摄的。如果元气胜过毒邪，痘疹就会按照正常周期开放和结痂；如果毒邪胜过元气，就会导致内部攻伐、外部溃烂。既然毒邪已经占上风，又怎能指望元气重新战胜它呢？
如果天庭处痘点先出现、先隆起、先灌浆、先结痂，这是好现象；但如果痘点密集且发痒（说明毒盛气虚），或者颜色惨淡晦暗（说明毒盛血虚），这些都是死症。毒邪从虚弱之处发出，确实如此啊。
凡是痘点分布磊落分明，摸起来碍手（指痘粒突起明显），颜色润泽光亮，且在眼部以下先出现，身体发热逐渐消退，这是吉兆。像这样磊落碍手的痘点，虽然稀疏但很有神采；颜色润泽，是指有光彩。如果天庭处痘点后出现，说明元气在内稳固；反之则为逆证。
叶锡侯说：毒邪旺盛时，痘点从上部先出现；毒邪轻微时，痘点从下部先出现，就像火势旺盛时，火焰必然先在上方燃烧一样。如果不是由血液引领、气机拘束，而是先出现在头额部位，那么毒邪的性质就可以知道了，生死的预断也就随之可知了。
痘疹刚出来时，三五颗连在一起的，后来必定密集；单独出现的则稀疏。毒邪的深浅，由此可以预先决断。
形态属于气，颜色属于血，两者都可以验证吉凶，决定生死，人们为什么只谈血而不谈气呢？气无形所以难以察觉，血有形所以容易看见。因此，在见点三天后，如果颜色像猪肝那样死黑为死症，像红米饭那样暗红也为死症，毒邪散漫于皮肤，像洗过的大红绸那样鲜艳则为重症。尽管如此，如果面部上有几十颗痘点神采奕奕，还可以救活。老师说：不必担忧形态恶劣，要担忧没有神采；不必担忧颜色恶劣，要担忧没有光彩。形态绽开而凸起，色泽滋润明亮，即使在恶症紧要关头，见到有一两颗红润可爱，虽然是凶险之症，最终也能转为吉祥。为什么呢？因为元气还存在。
程占五说：有一两颗红润可爱，虽然是凶险之症，最终也能转为吉祥。那些庸医，一定要推诿说无法治疗。病人家属又有眼不识高明，甘心看着孩子怀抱中呼号呻吟却不去救治，真是悲哀啊。
大抵来说，自眉毛以上出现痘点，如果有神采悦目可爱，依然不琐碎杂乱，又不歪斜邪恶，即使遍身稠密，杂症百出，总不至于死亡。“悦目”这两个字，即使用我的笔舌也难以尽述，全凭学习者的内心领悟和意会罢了。
见点时头顶头发焦枯，神情烦躁，舌苔厚腻且颜色发紫的，这是血分毒热炽盛，而且未必不是由内热引起的。
见点白色如水珠状的病情较重，如果稀疏不密，人平时面色黄，而痘疹颇能起发，这是气已至而血未至的表现。应当疏散火邪。倘若神志不能安宁，痘疹日益增多，痘顶呈尖刺状，这是毒邪大盛，恐怕不是药物所能治愈的。
见点两天后大便仍然秘结，舌上没有苔垢，知道是血热，而不是毒邪壅滞。应紧急进行清热解表治疗，在本方中加入枳壳、明矾粉来治疗，否则恐怕在灌浆时会发生呕吐、腹痛、腹泻而痘疹不起的情况，本方中的川芎、当归宜加倍使用。
见点颜色白而不红，不可以立刻当作虚证治疗。如果白色且无神采，嘴唇舌头淡白，或者有呕吐或腹泻，才是虚证。如果是白色但能起色，嘴唇舌头赤红，就不是虚证。三日后逐渐变成深紫色，这种误诊害人很深。见点时脚部冰冷的，不必忧虑，这是因为气还没有下行。
初现时，痘点大小不一。有色点像沸水翻滚一样的，叫做夹疹，用本方加救苦丹治疗。又有一种琐碎的红点，隐隐约约在肌肉之间，叫做夹痧，治疗方法也相同。丹毒也是如此。但是有此症状，必须正痘悦目可爱，才能算是痧疹夹杂。不然，那就是单纯的痘病，最应当加以辨别。又有痘出了几颗，而疹子遍布全身，圆净疏朗，形色红润活泼，出现两天后就全部消退，见到的人没有不惊愕的。然而这是疹，不是痘。痘消退时必定闷乱烦躁，而这个则很宁静，且正痘明显，所以知道它是疹。用平和的药剂治疗就能自愈。然而在疹子未消退时，也很难识别辨认。
见点时身体发热，说明毒邪未尽。但感受不同，有的寒气郁结在外部，有的热气郁结在内部，都应当发散。
见点时自汗，有存活的，有死亡的。朱丹溪说自汗无妨，是指形色良好的情况而言。如果出汗而颜色一天天变坏，必定死亡，不可不仔细辨别。
凡是痘出不快，必须审察时节用药。冬天则是寒邪郁结，夏天则是热邪郁结。然而也有虚实之别。嘴唇舌头滋润无苔，应当从虚证治疗。
见点颜色白，不太起发，嘴唇舌头淡莹，或者有呕吐或腹泻，或者腹胀，或者自汗肢冷，神气怯弱，必须从虚证例处理。
见点位于肚脐，或者肛门，而四周成堆的，都是重症。
初见几颗在山根（鼻根部）上的病情重，刚出来声音就改变，也是重症。
痘出了几点，而面目立即光亮如瓜，口中气息臭秽，勃勃冲向人，必定发展到发斑吐血而死。
见点先于眉毛上，或者在两太阳穴处出几粒，突起光亮，一会儿就消退，这是贼痘，必定死亡。
有初出时看似可爱，皮薄光亮，一两日即长大，这是未到之时而至，是疠气所致，后来必定因瘙痒塌陷而死。凡是患有各种疮毒未愈，或者疮毒新愈，而在此时见点的病情重，这是阳毒。如果疮口不干红，虽然重但不死。
所谓“在可为之时则顺，在不可为之时则凶”，指的是险症。至于见点像蛇皮，像蚕种，像蚊子痕迹，像搔抓出的斑块，像汤水泡，像火刺，像青黑蓝斑，或者身体像被杖打一样，发斑而嘴唇肿口臭，或者锁项（颈部僵硬），或者蒙头（头部肿胀），或者断腰（腰部凹陷），或者无根（根基不稳），或者颜色粉白如枯骨，或者胸高气喘，七窍流血，或者面部纹理如橘皮，形色不正而惊狂，并腰痛腹疼不止，这还能治吗？还是不能治呢？
书中说见点时吐出紫黑色血液的不治。以前有个姓潘的六岁女孩，见点两天，夜间吐出紫黑色血数升，全家惊恐，就连老医生也因为吐血而放弃治疗。我详细诊察，认为这不是毒邪，而是通过大补脾胃而痊愈。为什么呢？嘴唇舌头滋润，内部没有毒邪。形色两方面都好，外部没有毒邪。血去而神志安宁，说明血有余。女孩的父亲素来患有血症，这次女孩的吐血，是子女承袭父亲的血余之气，乃是被热邪激动，所以一涌而出，并非毒邪。如果使用犀角解毒，岂不是要丧命吗？古话说：完全相信书本不如没有书本。
凡是说断腰无根的，必须是诸痘形色不好才是。如果形色圆润光泽，即使腰脚部分没有痘，又有什么妨碍呢？
十神解毒汤 治疗身体发热、毛发焦枯、皮肤干燥、腮红、额头红点红、烦渴引饮、睡卧不宁、小便赤涩等症状。
药材：当归、川芎、生地、赤芍、丹皮、红花、连翘、木通、甘草、桔梗、灯心、葱白、大腹皮、淡竹叶。
若身热壮盛，皮肤紧绷肌肉紧张，加干葛、前胡、地骨皮。
若痘出不快，加山楂、大力子（牛蒡子）、蝉蜕。
若作痒，加桂枝。
若作痛，加防风、黄芩。
若唇燥舌苔，加热见愁。（备用方）
若夹疹，下救苦丹。（备用方）
若发红斑，加元参、犀角，下热见愁。
若眼眶红肿流泪，加柴胡、胆草（龙胆草）、热见愁，外用护法药。
若咳嗽，加杏仁、桑皮（桑白皮）。
若咽痛，加元参、射干，外行吹法。
若黑陷疔毒，加赛春雷，外点四圣丹。（备用方）
若失血干呕，加犀角、热见愁。
若呕吐，加陈皮、黄连、猪苓、泽泻。
若溺血，加犀角、生地。
若溺短涩，加车前子、地肤子。
若便秘，加枳壳、杏仁、苏梗，倍用当归。
若便黑，加犀角、桃仁、黄连。
若腹胀喘满，眼睛怒视而浮肿，毛发直皮肤焦，加麻黄，下救苦丹。
若秘结而喘，加千里马。（备用方）
若烦满身热，加花粉、麦冬。调满天秋。（备用方）
若泄泻，加猪苓、泽泻。
若谵言狂乱，加石膏、知母，调满天秋。
若腰痛，加羌活、独活。
若伤食膨胀，加山楂、厚朴、曲芽。
腹痛有三种：伤食，服和中丸。毒攻冲，服救苦丹。气滞，加青皮、木香。
凡是腹痛都适宜用千里马通便，一通即可，不可过量。过量则毒瓦斯在内发作，反而形成其他病症。
第四五日毒瓦斯盛者，加山楂、白芷、笋尖。痘至第四天，按理该换方。如果毒盛未除，怎么可以轻易换方？
只需加入人参四五分就够了，这名叫浆法。
凡是遇到热苔，热见愁不可缺少。有下症（便秘等实证），千里马不可缺少。有壅遏症，救苦丹不可缺少。痘欲出不出，干紫焦枯，黑陷疔毒，赛春雷不可缺少。如果嘴唇舌头红赤，小便短少，身热烦渴，痘色干红，满天秋不可缺少。大抵凡见热症，满天秋是第一要药。
有人问：热见愁、千里马，都是苦寒药，你用热见愁治疗舌苔固然是对的。那么所谓的下症是什么呢？
回答说：是指舌苔过于严重罢了。
问：有舌苔而作泻可以吗？
答：可以。这就是“通因通用”的道理。
问：什么是壅热？
答：是指毒邪盛大郁结阻滞。如何验证呢？答：腹胀喘满，眼睛怒视面浮，毛发直皮肤枯，痘欲出不出，蒸蒸发烦，翕翕发热就是这样。
Three days after the appearance of spots (the initial eruption of smallpox), life and death are determined. A judgment made at this time can be called a high-level opening-orifice diagnosis. The face is particularly critical, as it is the convergence point of all Yang meridians. The Tianting (Forehead Center) and Yintang (Between the Eyebrows) are especially crucial areas on the face. The Master said: "Tianting is the handle for observing smallpox." Why? Because it is where the Yuan Shen (Primordial Spirit/Essence) resides. Yuan Shen is Yuan Qi (Primordial Qi). In children suffering from smallpox, it boils down to three characters: Qi, Blood, and Toxin. Qi and Blood are governed by Yuan Qi. If Yuan Qi overcomes the Toxin, the lesions will open and scab according to schedule. If the Toxin overcomes Yuan Qi, it will attack internally and cause external erosion. Once the Toxin has gained the upper hand, how can one expect Yuan Qi to regain dominance?
If the spots appear first and rise first in the Tianting area, filling with pus and scabbing early, these are good signs. However, if the spots are dense and itchy (indicating Excess Toxin and Deficient Qi), or pale and dull (indicating Excess Toxin and Deficient Blood), these are fatal conditions. It is indeed true that toxins emerge from weakness.
When spots are distinct and well-spaced, feel raised to the touch, have a lustrous color, appear first below the eyes, and body heat gradually subsides, these are auspicious signs. Such distinct, raised spots, though sparse, possess spirit; a lustrous color indicates vitality. If spots appear late in the Tianting area, it signifies that Yuan Qi is solidified internally; the opposite is an adverse sign.
Ye Xihou said: "When toxin is abundant, spots appear first from the upper part; when toxin is slight, they appear first from the lower part, just as a strong fire must first show flames above." If they appear on the head and forehead not led by blood or constrained by Qi, the nature of the toxin can be known, and thus life and death can be predicted.
When smallpox first emerges, spots appearing in clusters of three to five will likely become dense later; those appearing singly will remain sparse. The depth of the toxin can be predicted from this.
Form belongs to Qi, color belongs to Blood. Both can verify auspiciousness or inauspiciousness and determine life or death. Why do people only discuss Blood and neglect Qi? Qi is formless and hard to perceive, while Blood is有形 (has form) and easy to see. Therefore, three days after the appearance of spots, if the color resembles pig liver, it is fatal; if it resembles red rice grains, it is also fatal. If the toxin is scattered on the skin like washed bright red silk, the condition is severe. Nevertheless, if there are dozens of spots on the face with brilliant spirit, recovery is still possible. The Master said: "Do not worry about ugly form, worry about lack of spirit; do not worry about ugly color, worry about lack of luster." If the form is open and convex, and the color is moist and bright, even in critical malignant cases, seeing one or two red and lively spots means that although the prognosis is ominous, it will turn auspicious. Why? Because Yuan Qi still exists.
Cheng Zhanwu said: "Seeing one or two red and lively spots means that although ominous, it will turn auspicious." Fools always claim it is untreatable. Families who fail to recognize brilliance may sadly watch their crying infants without seeking help.
Generally, if spots appear above the eyebrows with spirit and are pleasing to the eye, not琐碎 (trivial/cluttered), nor crooked or evil, even if dense all over the body with various complications, death is unlikely. The term "pleasing to the eye" is hard to describe fully; it relies on the student's intuitive understanding.
If the scalp hair is scorched and the mind restless upon spotting, with a thick coating or purple tongue, this indicates blazing toxin in the Blood level, possibly due to internal heat.
If spots are white like water droplets, the condition is heavy. If sparse, and the person usually has a yellow complexion but the spots rise well, it indicates Qi has arrived but Blood has not. Fire should be dispersed. If the spirit is not calm internally and spots increase daily with pointed tops, toxin is extremely abundant, and medication may not cure it.
If two days after spotting, stool remains constipated with no tongue coating, it indicates Blood Heat, not toxin stagnation. Urgently clear and resolve using the base formula with Zhike (Fructus Aurantii) and Mingfen (Alumen). Otherwise, during the pus-filling stage, vomiting, pain, diarrhea, and failure to rise may occur. Use Xiong (Rhizoma Chuanxiong) and Gui (Radix Angelicae Sinensis) in double doses.
White spots that are not red should not immediately be treated as deficiency. White with no spirit, pale lips/tongue, vomiting/diarrhea indicate deficiency. White with rising color, red lips/tongue indicate non-deficiency. Turning deep purple after three days is a serious misdiagnosis. Cold feet upon spotting need not be worried about; Qi has not yet descended.
Initially, spots vary in size. Red spots like boiling water are called "Jia Zhen" (accompanied by rash). Treat with the base formula plus Jiuku Dan. Tiny red spots hidden in the flesh are called "Jia Sha" (accompanied by sand-rash); treatment is similar. Dan Du (erysipelas/toxic heat) is the same. However, for these to be considered accompanying rashes, the main smallpox must be pleasing. Otherwise, it is just smallpox and must be distinguished. Sometimes a few smallpox spots appear, followed by a full-body rash that is round, clean, sparse, red, and lively, disappearing completely in two days. Observers are amazed. This is a rash, not smallpox. Smallpox resolution causes restlessness; this case is calm, and main spots are obvious, confirming it is a rash. Treat with mild agents for self-healing. Recognition is difficult before resolution.
Fever upon spotting indicates toxin is not exhausted. Causes differ: external cold constraint or internal heat constraint; both require dispersion.
Spontaneous sweating upon spotting can mean life or death. Zhu Danxi said sweating is harmless, referring to good form and color. If sweating leads to worsening color, death is certain; careful distinction is needed.
For slow eruption, treat according to season: winter cold constraint, summer heat constraint. Differentiate deficiency/excess. Moist lips/tongue with no coating suggest deficiency treatment.
White spots, poor elevation, pale lips/tongue, vomiting/diarrhea, abdominal distension, spontaneous sweating, cold limbs, weak spirit require deficiency protocols.
Spots at the navel or anus, clustered around, are severe.
A few spots at Shan Gen (root of nose) are severe. Voice change upon emergence is also severe.
A few spots with face shining like a melon, foul breath rushing out, will lead to macules, hematemesis, and death.
Spots appearing first above eyebrows or temples, rising bright then vanishing quickly, are "Thief Pox," leading to death.
Appearing lovely initially, thin-skinned and bright, growing large in 1-2 days, arriving prematurely due to pestilential Qi, will end in itching and collapse death. New or healing sores with spotting indicate severe Yang Toxin. Non-red dry sores are severe but not fatal.
"Do what is possible, avoid what is impossible" refers to critical cases. Spots resembling snake skin, silkworm eggs, mosquito bites, scratch marks, soup blisters, fire thorns, blue-black patches, body like beaten flesh, macules with swollen lips/foul breath, locked neck, covered head, broken waist, rootless, powder-white like dead bones, chest qi with panting, bleeding from seven orifices, orange-peel facial texture, irregular form with convulsions, unceasing back/abdominal pain—are these treatable? Or not?
Books say vomiting purple-black blood upon spotting is untreatable. Previously, a six-year-old Pan girl vomited liters of purple blood on day two. Family panicked, old doctors left. I diagnosed it was not toxin, but cured by strongly tonifying Spleen/Stomach. Why? Moist lips/tongue, no internal toxin. Good form/color, no external toxin. Blood loss calmed spirit, indicating excess blood. Her father had a history of blood disorders; her vomiting was child inheriting father's residual Qi, agitated by heat, not toxin. Using Rhinoceros Horn (Xijiao) to detoxify would have killed her. As the saying goes: Better to have no books than to believe them entirely.
Saying "broken waist/rootless" applies only when form/color are bad. If round and lustrous, absence at waist/legs is harmless.
Shishen Jiedu Tang treats fever, scorched hair, dry skin, red cheeks/forehead/spots, thirst, restlessness, dark scanty urine.
Ingredients: Danggui (Radix Angelicae Sinensis), Chuanxiong (Rhizoma Chuanxiong), Shengdi (Radix Rehmanniae Preparata), Chi Shao (Radix Paeoniae Rubra), Danpi (Cortex Moutan), Honghua (Flos Carthami), Lianqiao (Fructus Forsythiae), Mutong (Caulis Akebiae), Gancao (Radix Glycyrrhizae), Jiegeng (Radix Platycodonis), Dengxin (Medulla Junci), Congbai (Bulbus Allii Cepae), Dafupi (Pericarpium Arecae), Danyezhu (Folium Phyllostachidis).
Add Gegen (Radix Puerariae), Qianhu (Radium Peucedani), Digupi (Cortex Lycii) for intense fever, tight skin/muscles.
Add Shanzha (Fructus Crataegi), Niu Bang Zi (Fructus Arctii), Chantui (Periostracum Cicadae) for slow eruption.
Add Guizhi (Ramulus Cinnamomi) for itching.
Add Fangfeng (Radix Saposhnikoviae), Huangqin (Radix Scutellariae) for pain.
Add Re Jian Chou for dry lips/coated tongue. (Backup Formula)
Use Jiuku Dan for accompanied rash. (Backup Formula)
Add Xuanshen (Radix Scrophulariae), Xijiao (Cornu Rhinocerotis), use Re Jian Chou for red macules.
Add Chaihu (Radix Bupleuri), Danshen (Radix Salviae Miltiorrhizae - *Note: Text says Danshen/Caosh likely Longdan Cao*), Re Jian Chou for red/swollen tearing eyes; apply external Hu Fa.
Add Xingren (Semen Armeniacae Amarum), Sangpi (Cortex Mori Radicis) for cough.
Add Xuanshen, Shegan (Rhizoma Belamcandae) for sore throat; apply external blow method.
Add Sai Chun Lei for black depression/boils; apply external Si Sheng Dan. (Backup Formula)
Add Xijiao, Re Jian Chou for blood loss/dry retching.
Add Chenpi (Pericarpium Citri Reticulatae), Huanglian (Rhizoma Coptidis), Zhuling (Polyporus), Zexie (Rhizoma Alismatis) for vomiting.
Add Xijiao, Shengdi for hematuria.
Add Cheqian (Semen Plantaginis), Difuzi (Herba Kochiae) for scanty/difficult urination.
Add Zhike, Xingren, Sugeng (Caulis Perillae), double Danggui for constipation.
Add Xijiao, Taoren (Semen Persicae), Huanglian for black stool.
Add Mahuang (Herba Ephedrae), use Jiuku Dan for abdominal distension/panting, staring/swollen eyes, straight hair/dry skin.
Add Qianli Ma for constipation with panting. (Backup Formula)
Add Huafen (Radix Trichosanthis), Maidong (Rhizoma Ophiopogonis) for restlessness/fever. Mix Mantian Qiu. (Backup Formula)
Add Zhuling, Zexie for diarrhea.
Add Shigao (Gypsum Fibrosum), Zhimu (Rhizoma Anemarrhenae), mix Mantian Qiu for delirium/manic confusion.
Add Qianghuo (Rhizoma Notopterygii), Duhuo (Radix Angelicae Pubescentis) for backache.
Add Shanzha, Houpo (Cortex Magnoliae Officinalis), Quya (Massa Medicata Fermentata) for food stagnation/distension.
Abdominal pain has three types: Food stagnation, take Hezhong Wan. Toxin attacking, take Jiuku Dan. Qi stagnation, add Qingpi (Pericarpium Citri Reticulatae Viride), Muxiang (Radix Aucklandiae).
All abdominal pains should be purged with Qianli Ma until relieved; do not overdo. Over-purging causes toxin to act internally, creating other symptoms.
On days 4-5, if toxin is strong, add Shanzha, Baizhi (Radix Angelicae Dahuricae), Sunjian (Shoots of Bamboo). On day 4, formula should theoretically change. But if toxin remains strong, do not change lightly.
Just add Renshen (Radix Ginseng) 4-5 fen. This is called the "Pus Method."
For heat coating, Re Jian Chou is essential. For downward symptoms, Qianli Ma is essential. For stagnation/blockage, Jiuku Dan is essential. For spots wanting to emerge but failing, dry/purple/scorched, black depression/boils, Sai Chun Lei is essential. For red lips/tongue, scanty urine, fever/thirst, dry red spots, Mantian Qiu is essential. Generally, for heat syndromes, Mantian Qiu is the primary herb.
Question: Re Jian Chou and Qianli Ma are bitter-cold herbs. You use Re Jian Chou for tongue coating, correct. What are "downward symptoms"?
Answer: Refers to excessive tongue coating.
Question: Can one have tongue coating and diarrhea?
Answer: Yes. This is "treating obstruction with unblocking methods" (Tong Yin Tong Yong).
Question: What is "stagnant heat"?
Answer: Abundant toxin blocked and constrained. How to verify? Abdominal distension/panting, staring/swollen face, straight hair/dry skin, spots wanting to emerge but failing, steaming heat/restlessness, flickering heat.