聂九吾曰∶痘出五六日内至八九日,若
脓浆不行,亦当参归鹿茸汤托之。(黄 生用,不必加减。)若脓浆不起,则无生意矣。若有四
五分脓,犹可望生。
脓浆不满,鸡冠酒亦可用。用三五年以上大雄鸡,先将好酒一杯顿温,次刺鸡
冠血滴入和匀,仍顿温服之,服后或燥痛一时无妨,其鸡不可杀。
又有一种出痘稠密,毒火既盛,然元气虚,血气弱,津液枯竭不能制火,以致
虚火炎蒸,或烦或渴,或咽喉痛,或鼻时出血,难在温补,痘必不能成浆结痂。大
凡年长之男女,嗜欲久开,血气既耗者多有此证,最为难治。时医见其多热候,率
用清凉如犀角地黄汤之类,不知原因血气不能胜毒瓦斯而致有此证。今又纯用寒凉,则
血气愈亏损矣,而毒瓦斯愈肆行,岂复有可生之理。是以此等痘证,时医治之,十无
一生,殊可哀怜,今特制参麦清补汤以调之。(人参、麦门冬、白花粉、生黄 、前胡、牛蒡、炙
草、生甘草、炒白芍、当归、红花、大川芎、生地、桔梗、山楂肉、元眼肉三个同煎温服。遇此证者,
此药须当频频服)
起发灌脓时有吐泄者,证各不同。
吐有两端,吐而酸苦有声,吐讫反快者,毒光上腾也。栀连二陈汤止之。(此痘色
必紫红,去白陈皮、炙甘草、白茯苓、制半夏、姜汁炒黄连、姜汁炒栀子,煎缓缓服,吐止即勿服,苓半恐燥
阳明也。)吐而有物无声,不酸不苦,吐讫困倦不思饮食者,胃气虚也,参砂和胃散主之。(痘色必淡。)
泄有两端,泄而粪黄臭秽,小便赤涩者,毒瓦斯奔越也。痘色必红紫,加味四苓
散主之。(治热泄,猪苓、木通、泽泻、赤苓、车前子、黄连、黄芩、牛蒡、灯心一团,食前服。)泄而粪青白
滑利者,虚寒也,痘色必淡白,参术散主之。(止泻良方,专治虚寒,白术、人参、白茯苓、砂仁、
炙甘草、薏仁、莲肉、神曲、楂肉、肉豆蔻、柯子、陈皮、南木香为细末,每用二钱,清米汤调,食前温服。儿
有不肯服者,入稀粥内和服亦可。)如虚滑不止,兼用七味豆蔻丸。(肉豆蔻、柯子、砂仁、南木香、白
龙骨、赤石脂、枯白矾,面糊为丸,如绿豆大,每用清
水饮下三十丸,或研碎入粥服。此等丸散治痘之家必须预制,以防虚滑泄泻,若痘起胀或收结时,骤然泄泻不
止,危在旦夕矣。然止泻用汤药多不效,有服至异功散而不止者,惟此丸散可以立止。惟毒热作泻加味四苓散可止。)
起胀灌脓时,或有六七日不大便而塞闷作痛者,毒盛而秘也。用清毒活血汤去
参,加怀牛膝二钱,紫草、当归各加至二钱,煎药熟去渣,入生蜜半酒杯服之。如
又不通,用前药加酒炒大黄三钱微利之;若仍不通,用猪胆汁滴入谷道中即通。终不
可用硝黄大下,恐下后变他证则危矣。
身凉而汗不止者,归 汤主之。(当归身、炙黄 、酸枣仁,水煎服。)
有痰用白附子,熟水磨服,切不可用二陈汤,恐燥阳明,孤阳无阴,不能施化也。至收靥时用之无妨。
邵氏曰∶灌脓先嫩黄色,一日半后老 黄色,一日半二便如常,饮食照旧者,吉。
灌脓时乳母可服参药补之,自有好乳哺儿,以助后天之元气无亏也。灌浆时切不可让
儿乱塌乱抓,若任其抓破,泄其正气无救。灌浆时枯焦忽转红黄者,必是阴骘而来也。
灌浆时先黄色甚好,后头焦白面,浇薄渐成平头者,死。灌浆时根粒如清水泡而软
者,七日死。灌浆时先浆脓碍手渐破者,死。灌浆时先泡如红黄色者可爱,忽然烂破气
败者,死。灌浆时臭脓臭气熏人,又痒又疼者,当用清解汤救之。灌浆时又热又寒,
闭塞二便不通,目自开者,六日后死。灌浆时手足二心并前后心各有一粒,黑陷无
脓,又兼腰亦是一粒黑子者,死。灌浆时痛不止者,气滞也。(保元汤加木香山楂以行滞气。)
灌浆时痒塌不止者,血盛也。血味本咸,淹淅皮肉,所以作痒。(保元汤倍加黄 、芍药以制血
气盛。)浆足时作痒不妨。灌脓时成片作烂,脓水不干,内宜大补气血,外用败草散敷之。
如顶平脚阔,浆水不满足,用十全大补汤加木香、干姜治之。灌脓时色白如水晶,内
无脓者,宜内托散加丁香、干姜,木香散加糯米、人乳酒服。(歌曰∶痘色虚明似水晶,莫将
此痘看为轻,十一二日防痒塌,十四五日命须倾。)
喜泰顺曰∶六七日之期,须候浆行半足,虚疮方见分明。毒重而壅遏者,干枯
退缩,紫艳黑陷;气盛而起发者,饱满荣光;血虚而不附者,根窠不紧不华;气虚
而不会者,顶陷不尖而软。头面行浆而四肢未起,见之切莫慌张;腿 发泡而脸额
焦枯,见之且休欢喜。既已惧其发呛,且又虑其喘急;发呛愁其失声,喘急恐其腹
胀。饮食不多,或至脏虚而内陷;水浆频进,恐来泄泻而发颠。调理失宜,倒戈反
掌,热甚烦渴,到此休以实论。再加溏泄,此时断作虚看,大用参、苓、姜、蚕、木
香等剂。热甚烦渴亦有热泻,何可概为虚论?但热毒郁遏,身必壮热,点必红紫结
实碍手,唇必焦裂,粪必恶气冲人,宜用大黄、石膏、川连等药以清其毒。若是无
分皮肉,一般红肿头大如瓜,音哑作呛,寒战切牙,谵语妄言,手寻衣领,食不下咽,此死候也。
聂九吾说:痘疹发出后五到六天,直到八九天时,如果脓浆不能顺利生成,也应当使用参归鹿茸汤来托毒外出。(黄生用此方,不需要加减药物。)如果脓浆完全不起,那就没有了生机。如果有四五分的脓浆,还抱有希望存活。
如果脓浆不满,也可以使用鸡冠酒。选用三年以上的大公鸡,先将一杯好酒温热,然后刺破鸡冠,将血滴入酒中搅拌均匀,再次温热后服用。服后如果出现燥痛,暂时不要紧,这只鸡不可以杀掉。
又有一种情况是痘疹出得稠密,毒火已经很盛,但是元气虚弱,气血不足,津液枯竭无法制约火邪,导致虚火上炎蒸腾,出现烦躁或口渴,或者咽喉疼痛,或者鼻子不时出血。这种情况难以进行温补治疗,痘疹必然不能成浆结痂。凡是年长的男女,由于长期纵欲耗损,气血已经亏损的人,多有这种病症,最为难治。当时的医生看到他们有很多热象,通常使用犀角地黄汤等清凉药物,却不知道原因是气血不能抵御毒瓦斯而导致出现这种证候。现在又纯用寒凉药物,那么气血会更加亏损,而毒瓦斯会更加肆虐,哪里还有存活的道理。因此这类痘疹证候,当时医生治疗,十人中没有一人能活,实在令人哀怜。现在我特别配制参麦清补汤来调理。(人参、麦门冬、天花粉、生黄芪、前胡、牛蒡子、炙甘草、生甘草、炒白芍、当归、红花、大川芎、生地黄、桔梗、山楂肉、桂圆肉三枚,同煎温服。遇到这种证候的患者,此药必须频繁服用。)
在起发灌脓期间,如果有呕吐腹泻的,证候各不相同。
呕吐有两种情况,呕吐物酸苦且有声音,吐完后反而感觉舒服的,是毒气上腾所致。用栀连二陈汤止呕。(这种痘色必定紫红,方中去掉白陈皮、炙甘草、白茯苓、制半夏,加入姜汁炒黄连、姜汁炒栀子,煎煮后缓缓服用,呕吐停止后就不要再服,因为茯苓和半夏恐怕会燥伤阳明经。)呕吐有物但无声响,不酸不苦,吐完后感到困倦不想吃东西的,是胃气虚弱所致,主方用参砂和胃散。(痘色必定淡白。)
腹泻也有两种情况,腹泻粪便黄臭秽浊,小便赤涩的,是毒瓦斯奔越所致。痘色必定红紫,主方用加味四苓散。(治疗热性腹泻,猪苓、木通、泽泻、赤茯苓、车前子、黄连、黄芩、牛蒡子、灯心草一团,饭前服用。)腹泻粪便青白滑利的,是虚寒所致,痘色必定淡白,主方用参术散。(止泻良方,专门治疗虚寒,白术、人参、白茯苓、砂仁、炙甘草、薏苡仁、莲子肉、神曲、山楂肉、肉豆蔻、诃子、陈皮、南木香研为细末,每次用二钱,用清米汤调匀,饭前温服。小孩不肯服的,可以混入稀粥内一起服用。)如果是虚滑不止,兼用七味豆蔻丸。(肉豆蔻、诃子、砂仁、南木香、白龙骨、赤石脂、枯白矾,用面糊做成丸子,如绿豆大小,每次用清水送下三十丸,或者研碎混入粥中服用。这类丸散治疗痘疹的家庭必须预先制备,以防虚滑泄泻,如果在痘疹起胀或收结时,突然腹泻不止,就危险在旦夕之间了。然而止泻用汤药大多无效,有服用异功散仍不止泻的,只有这种丸散可以立即止住。只有毒热引起的腹泻,加味四苓散可以止住。)
在起胀灌脓时,如果有六七天不大便,导致腹部堵塞闷痛,这是毒盛而便秘。用清毒活血汤去掉人参,加入怀牛膝二钱,紫草、当归各加至二钱,煎药熟后去渣,加入半酒杯生蜜服用。如果仍然不通,用前面的药加入酒炒大黄三钱轻微通便;如果仍然不通,用猪胆汁滴入肛门中即可通畅。最终不可用芒硝、大黄猛烈攻下,恐怕攻下后变生其他证候就会危险了。
身体凉爽但汗出不止的,主方用归芪汤。(当归身、炙黄芪、酸枣仁,水煎服用。)
有痰的用白附子,用温水磨服,千万不可用二陈汤,恐怕燥伤阳明经,导致孤阳无阴,不能施化。到了收靥(结痂脱落)时使用就没有妨碍。
邵氏说:灌脓期先呈嫩黄色,一天半后变成老黄色,一天半后大小便正常,饮食照旧的,吉利。
灌脓时乳母可以服用参类药物治疗以补益自己,自然会有好乳汁哺育婴儿,以助后天之元气不亏损。灌浆时千万不可让婴儿乱抓乱挠,如果任由其抓破,泄失正气就无法挽救了。灌浆时干枯焦黑忽然转为红黄色的,一定是积德行善得来的福报。
灌浆时先呈黄色很好,后来头部焦白面部,浇薄逐渐变成平头的,死。灌浆时根部颗粒像清水泡一样软的,七日死。灌浆时先有脓浆碍手逐渐破裂的,死。灌浆时先有泡如红黄色的可爱,忽然烂破气息败坏的,死。灌浆时臭脓臭气熏人,又痒又疼的,应当用清解汤救治。灌浆时又热又寒,闭塞大小便不通,眼睛自开的,六日后死。灌浆时手足心以及前后心各有一粒黑陷无脓的,又兼腰部也有一颗黑子的,死。灌浆时疼痛不止的,是气滞所致。(保元汤加木香、山楂以行滞气。)
灌浆时瘙痒塌陷不止的,是血盛所致。血味本咸,浸渍皮肉,所以作痒。(保元汤加倍黄芪、芍药以制约血气盛。)浆足时作痒不妨碍。灌脓时成片腐烂,脓水不干,内服宜大补气血,外用败草散敷贴。如果顶平脚阔,浆水不满足,用十全大补汤加木香、干姜治疗。灌脓时颜色白如水晶,内部没有脓的,宜用内托散加丁香、干姜,木香散加糯米、人乳酒服用。(歌诀说:痘色虚明似水晶,莫将此痘看为轻,十一二日防痒塌,十四五日命须倾。)
喜泰顺说:六七天这个时期,必须等待浆行半足,虚疮才能看得分明。毒重而壅遏的,干枯退缩,紫艳黑陷;气盛而起发的,饱满荣光;血虚而不附着的,根窠不紧不华;气虚而不会聚的,顶陷不尖而软。头面行浆而四肢未起的,见到切莫慌张;腿部发泡而脸额焦枯的,见到且休欢喜。既然已经害怕发呛,又忧虑喘急;发呛愁其失声,喘急恐其腹胀。饮食不多,或者导致脏虚而内陷;水浆频进,恐怕引来泄泻而发颠。调理失宜,倒戈反掌,热甚烦渴,到此不要以实证论治。再加溏泄,此时断定为虚证,大用参、苓、姜、蚕、木香等药剂。热甚烦渴也有热泻,怎么可以一概作为虚证论治?但是热毒郁遏,身体必定壮热,痘点必定红紫结实碍手,嘴唇必定焦裂,粪便必定恶气冲人,宜用大黄、石膏、川连等药以清其毒。如果是无分皮肉,一般红肿头大如瓜,音哑作呛,寒战切牙,谵语妄言,手寻衣领,食不下咽,这是死候。
Nie Jiwu stated: From the fifth to sixth day after the eruption of smallpox, up to the eighth or ninth day, if the pus and plasma do not proceed normally, one should also use Shenguilurong Tang (Ginseng, Angelica, and Deer Antler Decoction) to support the body's qi and expel toxins. (Huang Sheng used this formula without modifications.) If the pus and plasma fail to rise at all, there is no hope for life. However, if there is four or five parts of pus, survival is still possible.
If the pus and plasma are insufficient, Jiguanjiu (Rooster Comb Wine) can also be used. Select a large rooster that has been raised for more than three years. First, warm a cup of good wine, then prick the comb to drip blood into the wine, mix well, and warm it again before administration. Some dryness and pain after taking the medicine is not a concern; the rooster should not be killed.
There is another type where the smallpox eruptions are dense, and the toxic fire is already intense, yet the primordial qi is deficient, and the blood and qi are weak. The body fluids are exhausted and cannot control the fire, leading to deficient fire flaming upward. Symptoms may include irritability or thirst, sore throat, or frequent nosebleeds. It is difficult to apply warming and tonifying methods in such cases, and the smallpox will likely fail to form pus and crusts. This condition is common in older males and females who have indulged in desires for a long time, depleting their blood and qi. It is extremely difficult to treat. Contemporary physicians, seeing many heat signs, typically use cooling formulas like Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), unaware that the cause is the inability of blood and qi to overcome the toxic pathogens. Using pure cold and cooling herbs now would further damage blood and qi, allowing the toxic pathogens to spread even more wildly. Is there any logic for survival in such cases? Therefore, among contemporary physicians treating these types of smallpox cases, ten out of ten die, which is truly pitiable. I have specially prepared Shenmai Qingbu Tang (Ginseng and Ophiopogon Clearing and Tonifying Decoction) to regulate this. (Ren Shen [Ginseng Root], Mai Dong [Ophiopogon Tuber], Tian Hua Fen [Trichosanthes Root], Sheng Huang Qi [Raw Astragalus Root], Qian Hu [Peucedani Radix], Niu Bang Zi [Arctii Fructus], Zhi Gan Cao [Prepared Licorice Root], Sheng Gan Cao [Raw Licorice Root], Chao Bai Shao [Stir-fried White Peony Root], Dang Gui [Angelica Sinensis Root], Hong Hua [Carthamus Flower], Da Chuan Xiong [Ligusticum Rhizome], Sheng Di Huang [Rehmannia Root], Jie Geng [Platycodon Root], Shan Zha Rou [Crataegus Flesh], Yuan Yan Rou [Longan Aril, three pieces]. Decoct together and take warm. Patients with this condition must take this medicine frequently.)
During the rising and suppurating stages, vomiting and diarrhea may occur, presenting different syndromes.
Vomiting has two aspects. Vomiting sour and bitter substances with sound, feeling relieved after vomiting, indicates toxic qi ascending. Use Zhilian Erchen Tang (Gardenia and Coptis Two-Aged Decoction) to stop it. (The smallpox color must be purple-red. Remove Chen Pi [Tangerine Peel], Zhi Gan Cao [Prepared Licorice Root], Bai Fu Ling [Poria], and Zhi Ban Xia [Prepared Pinellia]; add Jiang Zhi Chai Hu [Ginger-processed Coptis] and Jiang Zhi Zhi Zi [Ginger-processed Gardenia Fruit]. Decoct and take slowly. Stop taking when vomiting ceases, as Fu Ling and Ban Xia may dry out the Yangming channel.) Vomiting substanceless material without sound, neither sour nor bitter, followed by fatigue and loss of appetite, indicates deficiency of stomach qi. The main formula is Shensha Hewei San (Ginseng and Amomum Harmonizing Stomach Powder). (The smallpox color must be pale.)
Diarrhea also has two aspects. Diarrhea with yellow, foul-smelling stool and dark, scanty urine indicates the rushing and overflowing of toxic pathogens. The smallpox color must be red-purple. The main formula is Jiawei Siling San (Modified Four-Poria Powder). (For treating heat-type diarrhea: Zhu Ling [Polyporus], Mu Tong [Akebia Stem], Ze Xie [Alisma Root], Chi Fu Ling [Red Poria], Che Qian Zi [Plantago Seed], Huang Lian [Coptis Rhizome], Huang Qin [Scutellaria Root], Niu Bang Zi [Arctii Fructus], Deng Xin Cao [Juncus Medulla]. Take before meals.) Diarrhea with greenish-white, slippery stool indicates deficiency-cold. The smallpox color must be pale white. The main formula is Shenshu San (Ginseng and Atractylodes Powder). (An excellent prescription for stopping diarrhea, specifically for deficiency-cold: Bai Zhu [Atractylodes Rhizome], Ren Shen [Ginseng Root], Bai Fu Ling [Poria], Sha Ren [Amomum Fruit], Zhi Gan Cao [Prepared Licorice Root], Yi Yi Ren [Coix Seed], Lian Rou [Lotus Seed Flesh], Shen Qu [Medicated Leaven], Zha Rou [Crataegus Flesh], Rou Dou Kou [Myristica Seed], Ke Zi [Chebula Fruit], Chen Pi [Tangerine Peel], Nan Mu Xiang [Costus Root]. Grind into fine powder. Take two qian each time, mixed with clear rice soup, warm and taken before meals. If children refuse to take it, mixing it into thin porridge is acceptable.) If deficiency-type sliding diarrhea does not stop, combine with Qiwei Doukou Wan (Seven-Ingredient Myristica Pills). (Rou Dou Kou [Myristica Seed], Ke Zi [Chebula Fruit], Sha Ren [Amomum Fruit], Nan Mu Xiang [Costus Root], Bai Long Gu [Fossilized Bone], Chi Shi Zhi [Halloysitum Rubrum], Ku Bai Fan [Calcined Alum]. Make pills with wheat paste, size of mung beans. Take thirty pills with clear water each time, or crush and mix into porridge. Families treating smallpox must prepare these pills and powders in advance to prevent deficiency-sliding diarrhea. If sudden, unceasing diarrhea occurs during the swelling or crusting stage, death is imminent. Decoctions for stopping diarrhea are often ineffective; some patients continue to have diarrhea even after taking Yigong San (Extraordinary Power Powder). Only these pills and powders can stop it immediately. Only toxic-heat-induced diarrhea can be stopped by Jiawei Siling San.)
During the swelling and suppurating stages, if there is no bowel movement for six or seven days, causing abdominal blockage, stuffiness, and pain, it is due to excess toxicity and constipation. Use Qingdu Huoxue Tang (Clear Toxins and Invigorate Blood Decoction), remove Ren Shen [Ginseng Root], add Huai Niu Xi [Achyranthes Root] 2 qian, increase Zi Cao [Arnebia Root] and Dang Gui [Angelica Sinensis Root] to 2 qian each. After decocting and removing dregs, add half a wine glass of raw honey and take. If still obstructed, add Jiu Chao Da Huang [Wine-processed Rheum Root] 3 qian to the previous medicine to mildly promote bowel movement. If still obstructed, insert pig bile into the anus to facilitate passage. Ultimately, do not use Mang Xiao [Mirabilite] and Da Huang [Rhubarb] for severe purgation, as post-purgation complications could be dangerous.
If the body is cool but sweating incessantly, the main formula is Gui Huang Tang (Angelica and Astragalus Decoction). (Dang Gui Shen [Angelica Sinensis Root Body], Zhi Huang Qi [Prepared Astragalus Root], Suan Zao Ren [Ziziphus Seed]. Decoct in water and take.)
If there is phlegm, use Bai Fu Zi [Typhonii Rhizoma], ground with warm water, and take. Do not use Erchen Tang (Two-Aged Decoction), as it may dry out the Yangming channel, leaving isolated yang without yin, unable to transform. It is safe to use during the crusting and falling-off stage.
Shao stated: During the suppurating stage, first appearing tender yellow, turning old yellow after one and a half days, with normal urination and defecation after one and a half days, and normal diet, is auspicious.
During the suppurating stage, the nursing mother can take ginseng medicines to tonify herself, ensuring good milk to nourish the infant, thereby preventing depletion of acquired primordial qi. During the filling stage, strictly prevent the infant from scratching randomly. If allowed to scratch and break the skin, the righteous qi will leak out, and there will be no rescue. If the smallpox turns from dry and scorched to red and yellow during the filling stage, it is surely due to accumulated virtue.
If the smallpox is initially yellow, which is very good, but later the head becomes scorched white and the face becomes thin and flat, it indicates death. If the base of the pustule is soft like a water blister during the filling stage, death occurs in seven days. If the pus feels rough and breaks gradually during the filling stage, it indicates death. If the blisters are initially red-yellow, which is favorable, but suddenly rot and decay with bad odor, it indicates death. If the pus smells foul and causes itching and pain during the filling stage, use Qingjie Tang (Clearing and Resolving Decoction) to save the patient. If the patient experiences alternating fever and chills, blocked urination and defecation, and spontaneous opening of the eyes during the filling stage, death occurs after six days. If there is one black, sunken, pus-less spot on the palms, soles, anterior chest, posterior chest, and one black spot on the waist during the filling stage, it indicates death. Unceasing pain during the filling stage indicates qi stagnation. (Baoyuan Tang added with Mu Xiang [Aucklandiae Radix] and Shan Zha [Crataegi Fructus] to move stagnant qi.)
Unceasing itching and collapse during the filling stage indicates excessive blood. Blood tastes salty; when it soaks the skin and flesh, it causes itching. (Baoyuan Tang doubled with Huang Qi [Astragali Radix] and Shao Yao [Paeoniae Radix] to restrain excessive blood qi.) Itching when the pus is full is not a problem. If patches rot and the pus remains wet during the filling stage, internally tonify qi and blood significantly, and externally apply Baicao San (Decayed Grass Powder). If the top is flat and the base is wide, and the pus is insufficient, use Shiquan Dabu Tang (Complete Great Tonifying Decoction) added with Mu Xiang [Aucklandiae Radix] and Gan Jiang [Zingiberis Rhizoma]. If the color is white like crystal with no internal pus during the filling stage, use Neituo San (Internal Support Powder) added with Ding Xiang [Caryophylli Flos] and Gan Jiang [Zingiberis Rhizoma], or Muxiang San (Aucklandiae Powder) taken with Mi [Glutinous Rice] and Ren Ru Jiu [Human Milk Wine]. (Song says: Smallpox color void and bright like crystal, do not view this case lightly. Guard against itching and collapse on the eleventh or twelfth day; life will decline on the fourteenth or fifteenth day.)
Xi Taishun stated: At the period of six or seven days, one must wait until the pus is half-full for the pustules to become clearly visible. Heavy toxicity with obstruction leads to dryness, shrinkage, purple brilliance, and black sinking. Abundant qi and rising lead to fullness and radiance. Deficient blood failing to adhere leads to loose and dull bases. Deficient qi failing to converge leads to sunken, non-pointed, and soft tops. If the face and head are filling with pus while the limbs have not risen, do not panic. If the legs are blistering while the face and forehead are scorched and dry, do not rejoice. One fears choking upon eruption and panting upon urgency; choking worries about loss of voice, and panting fears abdominal distension. Insufficient food intake may lead to visceral deficiency and internal collapse. Frequent intake of liquids may lead to diarrhea and convulsions. Improper regulation can reverse the situation instantly. With severe heat and irritability/thirst, do not diagnose as excess syndrome. With added loose stools, diagnose as deficiency at this time, and heavily use formulas containing Ren Shen [Ginseng Root], Fu Ling [Poria], Jiang [Ginger], Can [Bombyx Batryticatus], and Mu Xiang [Aucklandiae Radix]. Severe heat and irritability/thirst can also involve heat diarrhea; how can it generally be diagnosed as deficiency? However, if heat toxin is郁遏 (depressed and obstructed), the body must have high fever, the spots must be red-purple, solid, and rough to the touch, the lips must be cracked and scorched, and the stool must have a foul odor. Use Da Huang [Rhei Radix et Rhizoma], Shi Gao [Gypsum Fibrosum], and Chuan Lian [Meliae Cortex] to clear the toxicity. If the entire skin and flesh are generally red, swollen, with heads large as melons, hoarse voice, choking, shivering, teeth grinding, delirious speech, picking at clothes, and inability to swallow, this is a death omen.