小儿疮疹，大抵与伤寒相似，发热，烦躁，脸赤唇红，身痛头疼，乍寒乍热，喷嚏呵欠，嗽喘痰涎。
始发之时，有因伤风伤寒而得，有因时气传染而得，有因伤食呕吐而得，有因跌扑、惊恐、蓄血而得。或
为窜眼惊搐，如风之证，或口舌、咽喉、肚腹疼痛，或烦躁、狂闷、昏睡，或自汗，或下痢，或发热，或
不发热，证候多端，卒未易辨，亦须以耳冷、 冷、足冷验之。盖疮疹属阳，肾脏无症，耳与 、足俱属
于肾，故肾之所部独冷，又不若视其耳后有红脉赤缕为真，于此可以稽验矣。调护之法，首尾俱不可汗下，
但温凉之剂兼而济之，解毒和中安表而已。虚者益之，实者损之，冷者温之，热者平之，是为权度借喻而言，
亦如庖人笼蒸之法，但欲其松耳！盖毒发于表，如苟妄汗，则荣卫一虚，重令开泄，转增疮烂，由是风邪
乘间变症者有之；毒根于里，如苟妄下，则内气一虚，
毒不能出而返入焉，由是土不胜水，变黑归肾，身体振寒，耳 反热，眼合，肚胀，其疮黑陷，十无一生。
汗、下二说，古人深戒。以此观之，疮疹症状虽与伤寒相似，而其治法实与伤寒不同。伤寒从表入里，疮
疹所发从里出表故也。如欲解肌，干葛、紫苏可也。其或气实烦躁热炽，大便秘结，则与犀角地黄汤或人
参败毒散，又或紫草饮多服，亦能利之。故虽云大便不通者，少与大黄尤宜，仔细斟酌之，若小便赤少者，
分利小便则热气有所渗而出。凡热不可骤遏，但轻解之；若无热，则疮又不能发也。
凡疮疹，春夏为顺，秋冬为逆。
疮疹分人清浊，就形气上取勇怯。
凡已发未发，并与紫苏饮。但觉身热，症似伤寒，若未见疮，疑似未明，且先与惺惺散、参苏饮，
或人参、羌活辈，热甚则与升麻葛根汤、人参败毒散。但一见红点，便忌葛根汤，恐发得表虚也。
凡痘疮初欲出时，身发热，鼻尖冷，呵欠，咳嗽，面赤，方是痘出之候，便宜服升麻葛根汤加山楂、大
力子，其疮稀疏而易愈。
凡痘初出时或未见时，宜服后方，多者令少，重者令轻。方以丝瓜近蒂三寸，连瓜子皮烧灰存性，为
末，砂糖拌干吃。入朱砂末亦可。又方朱砂为末，蜜水调服，多者可减，少者可无。
凡痘疮发热之时，便以恶实子为末，蜜调贴囱门上，免有患眼之疾。
凡初出之际，须看胸前，若稠密，急宜消毒饮加山楂、黄芩、酒洗紫草，减食加人参。
初出之时色白者，便大补气血，参、 、芎、术、升麻、干葛、甘草、木香、丁香、酒洗当归、白芍药，
若大便泻，加诃子、肉豆蔻。
初起时自汗不妨，盖湿热熏蒸而然故也。
有初起烦躁，谵语，狂，渴引饮，若饮水则后来靥不齐，急以凉药解其标，如益元散之类亦可用。
凡疮已出，可少与化毒汤。
出不快者，加味四圣散、紫草饮子、紫草木香汤、紫草木通汤，或快斑散、丝瓜汤。
出太甚者，人参败毒散、犀角地黄汤。
疏则无毒，密则有毒，以凉药解之，虽数帖亦不妨，无害眼之患。
炉灰色白静者，作寒看。
齐涌者，燥者， 发者，作热看。黑属血热，凉血为主。
白属气虚，补气为主。
中黑陷而外白，起得迟者，则相兼而治。
凡痘疮分表里、虚实。吐泻少食为里虚，不吐泻
能食为里实。里实而补，则结痈毒。陷伏倒靥为表虚。灰白者亦表虚，或用烧人屎。红活绽凸为表实，表实
而复补表，则要溃烂不结痂。
痘疮分气虚、血虚，用补药。气虚者，人参、白术加解毒药；血虚者，四物汤中加解毒药。
痘疮分气血虚实，多带气血不足。虚则黄 ，生血活血之剂助之，略佐以风药；实则白芍药为君，黄
芩亦为君，佐以白芷、连翘、续断之类。
调解之法，活血、调气、安表、和中、轻清消毒、温凉之剂兼而治之，二者得兼而已。温如当归、黄 、
木香辈，凉如前胡、干葛、升麻辈，佐之以川芎、白芍药、枳壳、桔梗、羌活、木通、紫草之属，则可以
调适矣。
黑陷二种，因气虚而毒瓦斯不能尽出者，酒炒黄 、紫草、人参辈。
黑陷甚者，亦用烧人屎，蜜水调服。出子和方。
痒塌者，于形色脉上分虚实。实则脉有力，气壮；虚则无力。虚痒，以实表之剂加凉血药；实痒，如大
便不通者，以大黄寒凉之药少与之，下其结粪。
气怯轻者，用淡蜜水调滑石末，以羽润疮上。
疮干者，宜退火，止用轻剂，荆芥、升麻、葛根之类。
湿者，用泻湿，乃肌表间湿，宜用风药白芷、防
风之类。
上引用升麻、葛根；下引用槟榔、牛膝∶助以贝母、忍冬草、白芷、栝蒌之类。
若咽喉痛者，大如圣散、鼠粘子汤。
喘满气壅者，麻黄黄芩汤。烦渴者，甘草散、乌梅汤。下痢呕逆者，木香理中汤。
颜色正者，如上治将欲成就，却色淡者，宜助血药，用当归、川芎、酒洗芍药之类，或加红花。
将成就之际，却紫色者，属热，用凉药解其毒，升麻、葛根、酒炒黄芩、黄连及连翘之类，甚者犀角
大解痘毒。
灰白色将靥时如豆壳者，盖因初起时饮水多，其靥不齐，俗呼倒靥。不好但服实表之剂，消息他大小
便，如大便秘通大便，小便秘通小便。
小便赤涩者，大连翘饮、甘露饮。
大便秘结，内烦外热者，小柴胡汤加枳壳最当，或少用四顺清凉。
疮疹用药，固有权度。大小二
便一或秘焉，则肠胃壅遏，脉络凝滞，毒瓦斯无从发泄，眼闭，声哑，肌肉黧黑，不旋踵而告变矣。
陷入者，加味四圣散，更以胡荽酒薄敷其身，浓敷其足，喷其衣服，并以浓绵盖之；若犹未也，独圣散入
木香煎汤；若其疮已黑，乃可用钱仲阳宣风散加青皮主之。钱氏云∶黑陷青紫
者，百祥丸下之；不黑者，谨勿下。余知其所下者，泻膀胱之邪也。又云∶下后身热，气温欲饮水者，可
治；水谷不消，或寒战者，为逆。余知其脾强者，土可以治水也，百祥丸太峻，当以宣风散代之。泻后温
脾，则用人参、茯苓、白术等分，浓朴、木香、甘草各半为妙。盖疮发肌肉，阳明主之，脾土一温，胃气
随畅，独不可消胜已泄之肾水乎！此钱氏不刊之秘旨也。
其坏疮者，一曰内虚泄泻，二曰外伤风冷，三曰变黑归肾。
近时小儿痘疮，止宗陈文中木香散、异功散。殊不知彼时立方之时，为运气在寒水司天，时令又值严
冬大寒，为因寒郁遏，痘疮不红绽，故用辛热之剂发之。今人不分时令寒热，一概施治，误人多矣。时值
温热，山野农家贫贱之人，其或偶中也。
丹溪痘疮治法最为明备，近世通用陈文中木香、异功等方，乃一偏之术。若痘疮虚怯淡白色痒塌，此
属虚寒，宜用陈文中方；若发热壮盛，齐涌，红紫色，瘙痒，此属热毒，急宜凉血解毒。自陈文中方盛
行后，属虚寒者率得生，属热毒者悉不救。痘是胎毒，古人治法只解毒，然气血虚则逆，毒瓦斯不出及不能成
就。故陈文中之法，亦千载妙诀，补前人之未备者。
但温补之法既行，而解毒之旨遂隐，故救得一边，又害了一边。今必详究丹溪，二法通用，斯无弊也。
痘疮属虚寒者，直可延至十数日后方死；属毒盛转紫色者，不过七、八日。盖痘是胎毒，自内出外，
二、三日方出齐，毒瓦斯尚在内，出至六日则当尽发于表，七、八、九日成脓而结痂矣。若毒瓦斯盛，不能尽
出，过六日，毒反内入脏腑，故须于六日以前，毒瓦斯该出之时，急服凉血解毒之药以驱出之，六日以后，
医无及矣，故其死最急。若虚弱毒瓦斯少者，只是气血不足，不能贯脓成就，故绵延日久而后死。此虚实轻
重之分也。
痘疮多者，是毒瓦斯多，便先宜解毒，然多则恐气血周贯不足，故随后亦宜兼补药以助成脓血。
愚按痘疹之疾，乃胎禀之热毒，由内发外，虽为有余之症，当泻不当补，然儿体有虚实，积毒有轻重，
又在变而通之。考之钱、陈二先生虽俱名家，然就而折衷之，则陈为较优。盖钱之用药偏于清凉，而陈之
治法温凉并行，以其深究阴阳造化之妙，故于病之真寒假热与夫真热假寒，罔不知之真而见之定，随症异
宜，未尝执泥。假如病属虚热，而元气未至亏损者，施之以钱氏之法，则固当矣。若病气、元气俱虚或俱
实者，而不以陈法治之，鲜不致误。且小儿之痘疹，譬即大人之痈疽，治法无异。其热毒蕴于五内，致二
便不利，烦热作渴，脉沉实，须用托里、疏通、和荣卫三法。观陈氏异功散、人参白术散、前胡枳壳汤等
方，其药品深为得宜，治者详订而遵之可也。
小儿的疮疹，大体上与伤寒相似，表现为发热、烦躁、面部发红嘴唇红润、身体疼痛头痛、忽冷忽热、打喷嚏呵欠、咳嗽气喘伴有痰涎。
在发病初期，有的因为伤风或伤寒而得病，有的因为时行疫气传染而得病，有的因为饮食积滞呕吐而得病，有的因为跌打损伤、惊恐或瘀血内停而得病。或者出现邪毒窜入眼睛、惊厥抽搐等类似风证的病症，或者口舌、咽喉、腹部疼痛，或者烦躁、狂闷、昏睡，或者自汗，或者腹泻痢疾，或者发热，或者不发热，证候多种多样，突然之间难以辨别，也必须通过检查耳朵、手心和脚是否发凉来验证。因为疮疹属于阳证，肾脏没有明显的症状表现，而耳朵、手心（文中“ ”指掌心）和脚都属于肾所主，所以肾所管辖的部位唯独寒冷，这不如观察耳后是否有红丝赤脉那样真实可靠，从这里可以进行检查验证。护理调治的方法，从头到尾都不可以使用发汗或攻下的方法，只是用温凉性质的药物兼施，起到解毒、调和脾胃、安固体表的作用罢了。虚弱的就补益它，实盛的就削减它，寒凉的就温煦它，热盛的就平抑它，这是为了权宜衡量而打的比方，也就像厨师蒸笼蒸东西的方法，只希望蒸汽疏松而已！因为毒邪发于体表，如果胡乱使用发汗法，那么营卫之气就会虚弱，再次导致腠理开泄，反而增加疮疡溃烂，因此风邪乘虚而入产生变证的就有；毒邪根结于体内，如果胡乱使用攻下法，那么内脏之气就会虚弱，毒邪不能排出反而内陷，因此脾土不能克制肾水，导致毒邪变黑归并于肾，身体战栗恶寒，耳朵和手心反而发热，眼睛闭合，腹部胀满，疮色黑陷，十个人中没有能活下来的。发汗和攻下这两种说法，古人深深告诫不要妄用。由此看来，疮疹的症状虽然与伤寒相似，但其治疗方法实际上与伤寒不同。伤寒的病邪是从表入里，而疮疹的发作是从里出表。如果想要解除肌表之邪，可以使用干葛（葛根）、紫苏。那些气实、烦躁、热势炽盛、大便秘结的，则给予犀角地黄汤或人参败毒散，或者多服用紫草饮，也能起到通利作用。所以说虽然大便不通，少量给予大黄尤其适宜，需要仔细斟酌。如果小便赤少，分利小便则热气有所渗透而出。凡是热邪不可骤然遏制，只能轻微地疏解它；如果没有热邪，那么疮疹又不能发出。
凡是疮疹，春夏季节发作为顺证，秋冬季节发作为逆证。
疮疹要分辨人的清浊体质，从形体气质上判断其勇怯强弱。
凡是已经发作或未发作的，都给予紫苏饮。只要觉得身体发热，症状像伤寒，如果还没见到疮点，疑似不明朗，暂且先给予惺惺散、参苏饮，或者人参、羌活之类的药物，热势很重的则给予升麻葛根汤、人参败毒散。只要一见红点，就忌用葛根汤，恐怕会导致表虚。
凡是痘疮刚开始要发出的时候，身体发热，鼻尖发冷，打呵欠，咳嗽，面色发红，这才是痘疮发出的征兆，此时适宜服用升麻葛根汤加山楂、牛蒡子，这样疮点稀疏就容易痊愈。
凡是痘疮刚发出或还没发出的时候，适宜服用后面的方子，多的让它减少，重的让它减轻。方子是用丝瓜靠近蒂部三寸的部分，连同瓜子皮一起烧成灰保留药性，研为细末，用砂糖拌干吃。加入朱砂细末也可以。另一个方子是朱砂研为细末，用蜜水调服，多的可以减少，少的可以不用。
凡是痘疮发热的时候，就用牛蒡子研为细末，蜂蜜调匀贴在囟门上，可以避免发生患眼的疾病。
凡是刚发出的时候，必须看胸前部位，如果稠密，急需消毒饮加山楂、黄芩、酒洗过的紫草，减少饮食并加入人参。
刚发出时颜色白的，就大力补益气血，用人参、白术、川芎、白术、升麻、干葛、甘草、木香、丁香、酒洗当归、白芍药，如果大便泻，加诃子、肉豆蔻。
初起时自汗不妨碍，这是因为湿热熏蒸的缘故。
有初起时烦躁、说胡话、狂躁、口渴想喝水的，如果喝水则后来结痂不齐，急忙用凉药解除标症，如益元散之类也可以使用。
凡是疮已发出，可以少量给予化毒汤。
发出缓慢的，加味四圣散、紫草饮子、紫草木香汤、紫草木通汤，或者快斑散、丝瓜汤。
稀疏则无毒，稠密则有毒素，用凉药解除，即使连服几帖也无妨，不会有害眼的隐患。
炉灰色白安静的，当作寒证看待。
齐涌而出的，干燥的，瘙痒发作的，当作热证看待。黑色属于血热，以凉血为主。
白色属于气虚，以补气为主。
中间黑陷而外面白，起发迟缓的，则综合两者进行治疗。
凡是痘疮要分辨表里、虚实。吐泻、食欲少为里虚，不吐泻、能食为里实。里实证却用补法，则会结成痈毒。塌陷伏倒、结痂反向为表虚。灰白色的也是表虚，或者使用烧过的人屎。红活绽凸为表实，表实证如果再补表，则要溃烂不结痂。
痘疮要分气虚、血虚，使用补药。气虚的，用人参、白术加解毒药；血虚的，在四物汤中加解毒药。
痘疮分气血虚实，大多带有气血不足。虚证则面色黄白，用生血活血的药剂辅助，稍微佐以风药；实证则以白芍药为君药，黄芩也为君药，佐以白芷、连翘、续断之类的药物。
调解的方法，活血、调气、安表、和中、轻清解毒、温凉药物兼施治疗，二者兼顾即可。温性的如当归、黄芪、木香之类，凉性的如前胡、干葛、升麻之类，佐以川芎、白芍药、枳壳、桔梗、羌活、木通、紫草等属类，就可以调适了。
黑陷有两种，是因为气虚而毒气不能完全排出的，用酒炒黄芪、紫草、人参之类。
黑陷严重的，也用烧过的人屎，蜜水调服。出自张子和的方子。
瘙痒塌陷的，从形色脉象上分辨虚实。实证则脉有力，气壮；虚证则无力。虚痒，用实表的药剂加凉血药；实痒，如大便不通的，用大黄寒凉的药物少量给予，攻下结粪。
气怯轻微的，用淡蜜水调滑石末，用羽毛润湿疮面。
上部引用升麻、葛根；下部引用槟榔、牛膝：辅助以贝母、忍冬草、白芷、栝蒌之类。
喘满气壅的，用麻黄黄芩汤。烦渴的，用甘草散、乌梅汤。下痢呕逆的，用木香理中汤。
颜色正常的，如上法治疗将欲成就，却颜色淡的，宜助血药，用当归、川芎、酒洗芍药之类，或者加红花。
将欲成就之际，却呈紫色的，属于热，用凉药解其毒，升麻、葛根、酒炒黄芩、黄连及连翘之类，严重的用犀角大解痘毒。
灰白色将结痂时像豆壳一样的，盖因初起时饮水过多，其结痂不齐，俗称倒靥。不好，只服用实表的药剂，观察他的大小便，如大便秘结的通大便，小便秘结的通小便。
大便秘结，内烦外热的，用小柴胡汤加枳壳最恰当，或者少量用四顺清凉饮。
疮疹用药，固然有权衡标准。大小二便一旦秘结，则肠胃壅塞遏止，脉络凝滞，毒气无从发泄，眼睛闭合，声音嘶哑，肌肉黧黑，转眼之间就会发生变故。
陷入的，用加味四圣散，再用胡荽酒薄敷其身，浓敷其足，喷其衣服，并用厚绵覆盖；如果还不行，用独圣散加木香煎汤；如果疮已黑，才可用钱仲阳的宣风散加青皮主治。钱乙说：黑陷青紫的，用百祥丸攻下；不黑的，千万不要攻下。我知道他所下的，是泻膀胱的邪气。又说：下之后身热，气温想喝水的，可治；水谷不消化，或者寒战的，为逆证。我知道他脾强的，土可以治水，百祥丸太峻猛，应当用宣风散代替。泻后温脾，则用人参、茯苓、白术各等分，厚朴、木香、甘草各半量配合为妙。因为疮发于肌肉，由阳明经主司，脾土一温暖，胃气随之通畅，难道不能消除胜过的已泄的肾水吗！这是钱乙不可刊改的秘密旨意。
那些坏疮的，一是内虚泄泻，二是外伤风冷，三是变黑归肾。
近时小儿痘疮，只遵循陈文中的木香散、异功散。却不知道他们当时立方的时候，是因为运气在寒水司天，时令又正值严冬大寒，因为寒邪郁遏，痘疮不红绽，所以用辛热的药剂发散它。现在人不分时令寒热，一概施治，误人很多。时值温热，山野农家贫贱之人，或许偶然有效。
丹溪的痘疮治法最为明备，近世通用陈文中的木香、异功等方，乃是一偏之术。如果痘疮虚怯淡白色瘙痒塌陷，这属于虚寒，适宜用陈文中的方子；如果发热壮盛，齐涌，红紫色，瘙痒，这属于热毒，急忙宜凉血解毒。自从陈文中的方子盛行后，属于虚寒的都得以生存，属于热毒的都未能救治。痘是胎毒，古人治法只解毒，然而气血虚则逆，毒气不出及不能成就。所以陈文中的方法，也是千年的妙诀，弥补前人的未备之处。
但是温补之法既然施行，而解毒的宗旨就隐没，所以救得一边，又害了一边。现在必须详细研究丹溪，两法通用，这才没有弊端。
痘疮属于虚寒的，直可延至十数日后才死；属于毒盛转紫色的，不过七、八日。因为痘是胎毒，从内出外，二、三天才出齐，毒气还在内，出至六日则应当全部发于体表，七、八、九日成脓而结痂了。如果毒气盛，不能完全排出，过了六日，毒反而内入脏腑，所以须在六日以前，毒气该出的时候，急忙服用凉血解毒的药以驱出它，六日以后，医生就无法救治了，所以其死最急迫。如果虚弱毒气少的，只是气血不足，不能贯脓成就，所以绵延日久而后死。这是虚实轻重的分别。
痘疮多的，是毒气多，便先宜解毒，然而多则恐怕气血周贯不足，所以随后也宜兼用补药以助成脓血。
我按语：痘疹之疾，乃是胎禀的热毒，由内发外，虽为有余之症，当泻不当补，然而儿体有虚实，积毒有轻重，又在变而通之。考证钱乙、陈文中两位先生虽都是名家，然而就其折衷来看，则陈氏较为优秀。因为钱乙的用药偏于清凉，而陈中的治法温凉并行，因为他深入探究阴阳造化的奥妙，所以对于病的真寒假热与夫真热假寒，没有不知道的，真正见到定论，随症适宜，未曾固执泥守。假如病属虚热，而元气未至亏损的，施用钱氏的方法，则固然恰当。若病气、元气俱虚或俱实的，而不以陈中法治之，很少不致误。而且小儿的痘疹，譬如大人的痈疽，治法无异。其热毒蕴于五脏之内，导致二便不利，烦热作渴，脉沉实，须用托里、疏通、和荣卫三法。观陈氏的异功散、人参白术散、前胡枳壳汤等方，其药品深为得宜，治者详细订正而遵行就可以了。
The rashes and pox in children are generally similar to *Shanghan* (Cold Damage Disease), manifesting as fever, irritability, red face and lips, body pain and headache, alternating chills and fever, sneezing and yawning, cough, asthma, and phlegm-saliva.
At the onset, some cases arise from wind-cold or cold damage, some from seasonal epidemic contagion, some from food stagnation and vomiting, and some from falls, fright, or blood stasis. Symptoms may include toxin invading the eyes with convulsions resembling wind patterns, pain in the mouth, tongue, throat, and abdomen, irritability, mania, oppression, drowsiness, spontaneous sweating, dysentery, fever, or absence of fever. The clinical presentations are diverse and difficult to distinguish abruptly; one must also verify by checking if the ears, palms, and feet are cold. Since rashes and pox belong to Yang, and the Kidney shows no specific symptoms, while the ears, palms, and feet all belong to the Kidney's domain, the parts governed by the Kidney are uniquely cold. However, this is less definitive than observing red veins and threads behind the ears for verification. Regarding care and treatment, neither diaphoresis (sweating) nor purgation should be used from beginning to end. Instead, warm and cool agents should be combined to detoxify, harmonize the middle jiao, and stabilize the exterior. Deficiency is tonified, excess is reduced, cold is warmed, and heat is balanced. This is a metaphorical principle for flexibility, much like a cook steaming food in a basket—only ensuring it is loose! Because the toxin emerges at the exterior, reckless use of diaphoresis will weaken Ying and Wei Qi, causing further opening and leakage, thereby worsening ulceration, allowing wind pathogens to enter and cause complications. If the toxin is rooted internally, reckless purgation will weaken internal Qi, preventing toxin expulsion and causing it to retreat inward. Consequently, Earth fails to control Water, leading to blackening and return to the Kidney, characterized by tremors and aversion to cold, hot ears and palms, closed eyes, abdominal distension, and black sunken lesions, with almost no survivors. Ancient masters strictly warned against these two methods. Thus, although rash symptoms resemble Cold Damage, the treatment differs fundamentally: Cold Damage moves from exterior to interior, whereas rashes emerge from interior to exterior. To resolve the muscle layer, Kudzu Root (*Puerariae Radix*) and Perilla Leaf (*Perillae Folium*) are suitable. For cases with excess Qi, irritability, intense heat, and constipation, Rhinoceros Horn and Rehmannia Decoction (*Xijiao Dihuang Tang*) or Ginseng and Imperata Decoction (*Renshen Baidu San*) can be used, or frequent administration of Arnebia Drink (*Zicao Yin*) can promote purgation. Even with constipation, small doses of Rhubarb (*Rhei Radix et Rhizoma*) are appropriate after careful consideration. For scanty dark urine, promoting urination allows heat to drain out. Heat should not be abruptly suppressed but gently resolved; without heat, the rash cannot erupt.
Generally, rashes in spring and summer are favorable (Shun), while those in autumn and winter are unfavorable (Ni).
Rashes should be differentiated by the patient's clear/turbid constitution and assessed for courage/weakness based on physique and Qi.
For rashes whether erupted or not, Perilla Drink (*Zisu Yin*) is administered. If fever is felt and symptoms resemble Cold Damage but no rash is visible, initially use Xin Xin Powder (*Xingxing San*), Ginseng and Perilla Drink (*Renshen Sugu Yin*), or herbs like Ginseng (*Ren Shen*) and Notopterygium Root (*Qiang Huo*). If heat is severe, use Kudzu and Poria Decoction (*Shengma Gegen Tang*) or Ginseng and Imperata Decoction (*Renshen Baidu San*). Once red spots appear, Gegen Tang is contraindicated to avoid causing exterior deficiency.
When smallpox is about to erupt, symptoms include fever, cold nose tip, yawning, cough, and red face. At this stage, Kudzu and Poria Decoction (*Shengma Gegen Tang*) added with Hawthorn Fruit (*Shanzha*) and Butterbur Fruit (*Niubangzi*) is appropriate, resulting in sparse lesions that heal easily.
When smallpox is just erupting or not yet visible, the following formula is suitable to reduce severity. Take three inches of loofah stem near the peduncle, including seeds and skin, burn to ash retaining properties, powder it, and mix with rock sugar for oral intake. Cinnabar powder may be added. Another method uses Cinnabar powder mixed with honey water.
During fever of smallpox, Butterbur fruit powder mixed with honey applied to the fontanelle prevents eye complications.
At initial eruption, check the chest. If dense, urgently use Detoxification Drink (*Xiaodu Yin*) added with Hawthorn Fruit (*Shanzha*), Scutellaria Root (*Huangqin*), and wine-washed Arnebia Root (*Zicao*), reducing diet and adding Ginseng (*Ren Shen*).
If lesions are white upon eruption, strongly tonify Qi and Blood using Ginseng (*Ren Shen*), Atractylodes Rhizome (*Baizhu*), Ligusticum Rhizome (*Chuanxiong*), Atractylodes Rhizome (*Baizhu*), Kudzu Root (*Shengma*), Kudzu Root (*Gegen*), Licorice Root (*Gancao*), Costus Root (*Muxiang*), Clove (*Dingxiang*), wine-washed Angelica Sinensis Root (*Danggui*), and White Peony Root (*Baishao*). Add Chebula Fruit (*Hezi*) and Myristica Seed (*Roudoukou*) if diarrhea occurs.
Spontaneous sweating at onset is acceptable due to damp-heat steaming.
Cases with initial irritability, delirium, mania, and thirst requiring drinking indicate uneven scabbing later. Urgently treat the branch with cooling formulas like Yi Yuan San.
Once eruptions appear, slightly administer Huadu Tang.
For slow eruption, use Modified Four Sages Powder (*Jiawei Sisheng San*), Zicao Yin, Zicao Muxiang Tang, or Kuaiban San, Loofah Soup.
For excessive eruption, use Renshen Baidu San or Xijiao Dihuang Tang.
Sparse lesions imply no toxin; dense ones imply toxin. Cooling agents resolve this; multiple doses are safe without harming the eyes.
Gray-white and quiet lesions indicate Cold.
Simultaneous eruption, dryness, and itching indicate Heat. Black indicates Blood Heat, treated primarily by cooling Blood. White indicates Qi Deficiency, treated primarily by tonifying Qi.
Central black sinking with peripheral whiteness and delayed eruption requires combined treatment.
Differentiate smallpox by Exterior/Interior and Deficiency/Excess. Vomiting, diarrhea, and poor appetite indicate Interior Deficiency; no vomiting/diarrhea and good appetite indicate Interior Excess. Tonifying Interior Excess causes carbuncles. Sunken/reverted scabs indicate Exterior Deficiency. Gray-white also indicates Exterior Deficiency; burnt human feces may be used. Red, vibrant, protruding lesions indicate Exterior Excess. Tonifying Exterior Excess causes ulceration without scabbing.
Differentiate Qi/Blood Deficiency using tonics. Qi Deficiency: Ginseng (*Ren Shen*) and Atractylodes Rhizome (*Baizhu*) with detoxifiers. Blood Deficiency: Four Substances Decoction (*Siwu Tang*) with detoxifiers.
Smallpox often involves Qi/Blood insufficiency. Deficiency presents with sallow complexion; use blood-generating/moving agents with slight wind-dispelling herbs. Excess uses White Peony Root (*Baishao*) and Scutellaria Root (*Huangqin*) as sovereigns, assisted by Angelica Dahurica Root (*Baizhi*), Forsythia Fruit (*Lianqiao*), and Drynaria Rhizome (*Xuduan*).
Regulation involves activating Blood, regulating Qi, stabilizing Exterior, harmonizing Middle, light/clear detoxification, and combining warm/cool agents. Warm agents: Dang Gui, Huang Qi, Muxiang. Cool agents: Qian Hu, Gegen, Shengma. Assistants: Chuanxiong, Baishao, Zhike, Jiegeng, Qianghuo, Mutong, Zicao.
Black sinking has two types: Qi Deficiency preventing full toxin expulsion. Treat with wine-fried Huang Qi, Zicao, Ren Shen. Severe black sinking uses burnt human feces with honey water (Zihehe's formula).
Itchy/sunken lesions differentiate by pulse/form. Excess: strong pulse/Qi. Deficiency: weak pulse. Itchy Deficiency: exterior-stabilizing agents + blood-coolers. Itchy Excess with constipation: small dose of Dahuang to purge stool.
Mild Qi weakness: dilute honey water with Talcum Powder (*Huashi*) applied with feather.
Dry lesions: reduce fire with mild agents like Jingjie, Shengma, Gegen.
Dampness: drain dampness using wind herbs like Baizhi, Fangfeng.
Upper body: Shengma, Gegen. Lower body: Binglang, Niuxi. Assist with Beimu, Jinyinhua, Baizhi, Gualou.
Throat pain: Da Rusheng San, Shi Niu Zi Tang.
Wheezing/distension: Mahuang Huangqin Tang. Irritability/thirst: Gancao San, Wumei Tang. Dysentery/vomiting: Muxiang Lizhong Tang.
Normal color healing but pale: tonify Blood with Dang Gui, Chuanxiong, wine-washed Shaoyao, or Honghua.
Purple color during healing indicates Heat: cool and detoxify with Shengma, Gegen, wine-fried Huangqin, Huanglian, Lianqiao. Severe cases use Rhinoceros Horn (*Xijiao*) for major detoxification.
Gray-white scabbing like bean shells indicates "reverted scab" (*Daoye*) from excessive early drinking. Use exterior-stabilizing agents and regulate bowels/bladder.
Dark/scanty urine: Dalianqiao Yin, Ganlu Yin.
Constipation with internal烦/external heat: Xiao Chaihu Tang + Zhike, or small dose of Sishun Qingliang Yin.
Medication for rashes requires balance. Constipation blocks intestines/channels, trapping toxin, leading to closed eyes, hoarseness, blackened muscles, and rapid deterioration.
Sunken lesions: Jiawei Sisheng San, plus Huixie wine applied thinly on body, thickly on feet, sprayed on clothes, covered with thick cotton. If ineffective, Dusheng San + Muxiang decoction. If black, Qian Zhongyang's Xuanfeng San + Qingpi. Qian Yi stated: Black/purple sinking requires Baixiang Wan purgation; non-black requires caution against purgation. Purging drains Bladder pathogen. Post-purgation fever/thirst is treatable; indigestion/shivering is adverse. Strong Spleen Earth controls Water. Baixiang Wan is too harsh; replace with Xuanfeng San. Post-purgation Spleen warming: Ren Shen, Fuling, Baizhu equal parts; Houpo, Muxiang, Gancao half parts. Muscle eruption is governed by Yangming; warming Spleen unites Stomach Qi, eliminating excess Kidney Water. This is Qian Yi's secret doctrine.
Bad sores result from: 1. Interior Deficiency diarrhea, 2. Exterior wind-cold injury, 3. Blackening returning to Kidney.
Recent treatments rely solely on Chen Wenzhong's Muxiang San and Yigong San. These were formulated when Cold Water ruled the climate during deep winter, causing cold constraint preventing red eruption, thus requiring acrid-hot dispersants. Modern practitioners ignore seasonal heat/cold, applying uniformly, causing many errors. Effective only coincidentally in warm seasons for poor rural folk.
Danxi's methods are most comprehensive. Using Chen's formulas alone is biased. Pale/itchy/sunken = Deficiency-Cold → Chen's formulas. High fever/protrusion/red-purple/itchy = Heat-Toxin → Cool Blood/Detoxify. Since Chen's popularity, Deficiency-Cold survives, Heat-Toxin dies. Smallpox is fetal toxin; ancients focused on detoxification. Qi/Blood deficiency leads to reversal/incomplete resolution. Chen's methods fill ancient gaps.
However, emphasizing tonification hides detoxification principles, saving one side while harming the other. One must study Danxi and combine both methods.
Deficiency-Cold smallpox lasts 10+ days before death. Heat-Toxin turning purple dies in 7-8 days. Fetal toxin emerges outward, fully erupting by day 2-3, remaining inside until day 6 when it should be fully exteriorized. Days 7-9 form pus and scabs. If toxin is excessive and doesn't exit, it re-enters organs after day 6. Urgent cooling/detoxification is needed before day 6. After day 6, treatment fails, causing rapid death. Weak toxin cases die slowly due to Qi/Blood insufficiency failing to form pus. This distinguishes deficiency/excess severity.
Abundant smallpox means abundant toxin; prioritize detoxification first, then add tonics to support pus/blood formation due to potential Qi/Blood insufficiency.
Commentary: Smallpox/rash is fetal heat-toxin emerging outward. Though an Excess condition requiring purgation rather than tonification, pediatric constitutions vary, and toxin depth varies, requiring flexible application. Comparing Qian Yi and Chen Wenzhong, Chen is superior. Qian favors cooling; Chen combines warm/cool, understanding true/false heat/cold nuances. For Deficiency-Heat with intact Yuan Qi, Qian's method is appropriate. For simultaneous Qi/Yuan Deficiency or Excess, Chen's method avoids error. Pediatric smallpox resembles adult carbuncles. Internal heat-toxin causing bowel/bladder obstruction, irritability, thirst, deep-solid pulse requires: 1. Supporting Interior, 2. Unblocking, 3. Harmonizing Ying/Wei. Chen's Yigong San, Renshen Baizhu San, Qian Hu Zhike Tang are well-formulated and should be followed.