小儿出痘若疼痛，皆因毒火未发清，疏散清解是妙方，葛根四物汤极应。
【注】经曰∶诸痛为实，又曰∶热盛则痛。皆缘痘毒之火未能尽解，故不时作痛也。痘
初出痛者，因毒未发透也，升麻葛根汤主之。痘出稠密而作痛者，毒盛血热也，加味四物
汤主之。若收靥时痛甚闷乱者，不治。
升麻葛根汤（方见发热证治）
加味四物汤
当归 赤芍 荆芥穗 防风 红花 丹皮 牛蒡子（炒） 连翘（去心） 川芎 生地黄
水煎服。
【方歌】毒盛加味四物汤，当归赤芍合荆防，红花丹皮牛蒡子，连翘川芎生地黄。
痘之始终喜音清，毒热壅塞哑无声，喉中有痘不须治，若是毒攻甘桔宁。
【注】音者，心之声也。心气上达于肺而作音，肺清则音清，肺热则音哑。如痘当灌
浆而音哑者，此喉中有痘碍于气道，待外痘收靥，则内痘自清，不必施治。若未长灌而
音已先哑者，此热毒壅遏肺窍而然也，宜加味甘桔汤治之。
加味甘桔汤
射干 牛蒡子（炒） 元参 连翘（去心） 麦门冬（去心） 栀子（炒） 苦桔梗 甘草（生）
水煎服。
【方歌】加味甘桔治失音，射干牛蒡与元参，连翘麦冬炒栀子，桔梗甘草共和匀。
热盛衄血犀角汤，脾不统血参术良，热注肠胃四物治，脾虚便血归脾尝。
【注】血属阴，诸经赖以养育，痘疮资以成功。一为毒火熏灼，则血随火动，迫而妄
行，上则为衄血，下则为便血。痘色紫滞，燥热口渴而衄者，此毒火刑金也，犀角地黄汤
主之。靥后余毒乘脾而衄者，此脾虚不能统血归经也，人参白术散主之，外俱用发灰散
吹入鼻中。若毒火炽甚，流注大肠，大便下血，加味四物汤主之。设痘色灰白陷下而便
血者，此脾气虚弱不能摄血，宜归脾汤主之。至若大吐血、尿血及七窍出血，变在反掌，不
必服药。
犀角地黄汤
犀角（镑） 丹皮 生地 白芍
水煎服。
【方歌】毒火上冲频衄血，犀角地黄汤效捷，犀角镑与牡丹皮，生地白芍共煎列。
人参白术散（方见喘证）
发灰散
用少壮无病患之乱发，以皂角煮水，洗净油气焙干。用新瓦罐一个，填入内令满，净
瓦片盖口，盐泥封之。炭火围罐之半， 一炷香取出，候冷研细，吹鼻中。或用发灰二
分，童便七分，酒三分调服，亦可止血。
加味四物汤
当归 白芍（酒炒） 生地 牡丹皮 荆芥（炒黑） 川芎 黄芩 黄连 地榆
水煎服。
【方歌】加味四物便血宜，归芍生地牡丹皮，荆芥炒黑川芎配，黄芩黄连共地榆。
归脾汤
人参 白术（土炒） 甘草（炙） 黄 （蜜炙） 枣仁（炒、研） 远志（去心）
龙眼肉 茯神 当归 木香（煨）
引用姜、枣，水煎服。
【方歌】归脾汤治脾气虚，人参白术草黄 ，枣仁远志龙眼肉，茯神当归木香宜。
小儿出痘若出现疼痛，都是因为毒火未能彻底发散清除，采用疏散和清解的方法是最好的方策，葛根四物汤非常有效。
【注】经典医籍说：各种疼痛属于实证；又说：热邪炽盛则导致疼痛。这都是因为痘毒之火未能完全解除，所以不时产生疼痛。痘疹刚发出时疼痛，是因为毒邪未能透发出来，用升麻葛根汤主治。痘疹发出稠密且疼痛的，是毒邪盛、血分热的表现，用加味四物汤主治。如果在收靥（结痂脱落）阶段疼痛剧烈且伴有烦闷扰乱症状的，属于不治之症。
加味四物汤
当归、赤芍、荆芥穗、防风、红花、丹皮、牛蒡子（炒）、连翘（去心）、川芎、生地黄。
用水煎服。
【方歌】毒盛加味四物汤，当归赤芍合荆防，红花丹皮牛蒡子，连翘川芎生地黄。
痘疹从开始到结束，都喜好声音清脆，若毒热壅塞咽喉则声音嘶哑甚至无声。如果喉中有痘疹阻碍气道导致失音，不需要特殊治疗；若是毒热攻冲导致的失音，可用甘桔宁（即加味甘桔汤）治疗。
【注】声音，是心的外在表现。心气上达于肺从而产生声音，肺气清肃则声音清脆，肺有热邪则声音嘶哑。如痘疹正处于灌浆期而声音嘶哑的，这是因为喉中有痘疹阻碍了气道，等待外部痘疹收靥后，内部痘疹自然消退，不必进行治疗。如果痘疹尚未进入灌浆期而声音先嘶哑的，这是热毒壅遏肺窍所致，宜用加味甘桔汤治疗。
加味甘桔汤
射干、牛蒡子（炒）、元参、连翘（去心）、麦门冬（去心）、栀子（炒）、苦桔梗、甘草（生）。
用水煎服。
【方歌】加味甘桔治失音，射干牛蒡与元参，连翘麦冬炒栀子，桔梗甘草共和匀。
热盛导致鼻衄（鼻出血）用犀角汤，脾虚不能统摄血液用人参白术散效果好，热邪注入肠胃用四物汤治疗，脾气虚弱导致便血用归脾汤尝试治疗。
【注】血属阴，各条经脉依靠它来滋养，痘疮也依赖它才能成功痊愈。一种情况是毒火熏灼，导致血液随火势妄动，被迫溢出脉外，向上则为鼻衄，向下则为便血。痘色紫暗滞涩，伴有燥热口渴而鼻衄的，这是毒火刑克肺金（肺主皮毛，开窍于鼻），用犀角地黄汤主治。收靥后余毒侵袭脾脏而导致鼻衄的，这是脾气虚弱不能统摄血液回归经脉，用人参白术散主治，外部同时使用发灰散吹入鼻中。如果毒火极其炽盛，流注大肠，导致大便下血，用加味四物汤主治。假如痘色灰白凹陷且伴随便血的，这是脾气虚弱不能固摄血液，宜用归脾汤主治。至于大吐血、尿血以及七窍出血的情况，病情变化极快（反掌之间），不必服药。
犀角地黄汤
犀角（镑片）、丹皮、生地、白芍。
用水煎服。
【方歌】毒火上冲频衄血，犀角地黄汤效捷，犀角镑与牡丹皮，生地白芍共煎列。
人参白术散（方剂见喘证章节）
发灰散
取年轻健康无病患者的乱发，用皂角煮水洗净油脂并焙干。用一个新瓦罐，填入头发令其满，用干净的瓦片盖住罐口，用盐泥密封。在罐身一半周围用炭火烘烤，燃一炷香的时间后取出，待冷却后研成细粉，吹入鼻中。或者取发灰二分，童便七分，酒三分调和服用，也能止血。
加味四物汤
当归、白芍（酒炒）、生地、牡丹皮、荆芥（炒黑）、川芎、黄芩、黄连、地榆。
用水煎服。
【方歌】加味四物便血宜，归芍生地牡丹皮，荆芥炒黑川芎配，黄芩黄连共地榆。
归脾汤
人参、白术（土炒）、甘草（炙）、黄芪（蜜炙）、枣仁（炒、研）、远志（去心）、龙眼肉、茯神、当归、木香（煨）。
引用生姜、大枣，用水煎服。
【方歌】归脾汤治脾气虚，人参白术草黄芪，枣仁远志龙眼肉，茯神当归木香宜。
If a child suffering from smallpox experiences pain, it is all due to the toxic fire not being thoroughly dispersed and cleared. Dispersing and clearing are the best methods; Gegen Siwu Tang (Kudzu Root and Four Substances Decoction) is highly effective.
[Note] The classics state: "All pains belong to excess syndromes," and also: "When heat is excessive, pain occurs." This is because the fire of the smallpox toxin has not been completely resolved, causing intermittent pain. When smallpox lesions first emerge with pain, it is because the toxin has not fully erupted; Shengma Gegen Tang (Ephedra and Kudzu Root Decoction) is indicated. When smallpox lesions are dense and painful, it indicates abundant toxin and heat in the blood; Jiawei Siwu Tang (Modified Four Substances Decoction) is indicated. If severe pain accompanied by restlessness occurs during the scabbing stage, it is incurable.
Shengma Gegen Tang (See formula for Fever Syndrome Treatment)
Jiawei Siwu Tang (Modified Four Substances Decoction)
Danggui (Angelicae Sinensis Radix), Chishao (Paeoniae Radix Rubra), Jingjie Sui (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Honghua (Carthami Flos), Danpi (Moutan Cortex), Niubangzi (Arctii Fructus, stir-fried), Lianqiao (Forsythiae Fructus, heart removed), Chuanxiong (Ligustici Chuanxiong Rhizoma), Shengdihuang (Rehmanniae Radix).
Decoct in water and take orally.
[Formula Song] For abundant toxin, Modified Four Substances Decoction applies,
Combining Danggui, Chishao, Jingjie, and Fangfeng together.
Honghua, Danpi, and Niubangzi follow,
With Lianqiao, Chuanxiong, and Shengdihuang completing the list.
Throughout the onset to resolution of smallpox, clear voice is preferred. If toxic heat obstructs the throat, the voice becomes hoarse or silent. If hoarseness is caused by smallpox lesions blocking the airway in the throat, no specific treatment is needed; if it is caused by toxic heat attacking, Ganjie Ning (Gancao and Jiegeng Decoction) should be used.
[Note] Voice is the sound of the Heart. Heart Qi ascends to the Lung to produce voice; when Lung Qi is clear, the voice is clear; when Lung Heat exists, the voice is hoarse. If hoarseness occurs during the pustule-filling stage, it is because lesions in the throat obstruct the airway; wait for external lesions to scab over, and internal lesions will clear naturally without treatment. If hoarseness precedes the pustule-filling stage, it is due to heat-toxin obstructing the Lung orifices; Jiawei Ganjie Tang (Modified Licorice and Platycodon Decoction) is indicated.
Jiawei Ganjie Tang (Modified Licorice and Platycodon Decoction)
Shegan (Belamcandae Rhizoma), Niubangzi (Arctii Fructus, stir-fried), Yuanshen (Scrophulariae Radix), Lianqiao (Forsythiae Fructus, heart removed), Maimendong (Ophiopogonis Tuber, heart removed), Zhizi (Gardeniae Fructus, stir-fried), Kujiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix, raw).
Decoct in water and take orally.
[Formula Song] Modified Ganjie treats loss of voice,
With Shegan, Niubangzi, and Yuanshen combined.
Lianqiao, Maimendong, and stir-fried Zhizi,
Jiegeng and Gancao harmonize evenly.
Excessive heat causing epistaxis is treated with Xijiao Tang; poor Spleen control over blood is treated effectively with Renshen Baizhu San; heat pouring into the intestines and stomach is treated with Siwu Tang; Spleen deficiency causing hematochezia is treated with Guipi Tang.
[Note] Blood belongs to Yin and nourishes all meridians; smallpox relies on it for successful resolution. One scenario is toxic fire scorching, causing blood to move with the fire and extravasate recklessly; upward this manifests as epistaxis, downward as hematochezia. If the rash is purple and stagnant, accompanied by dryness, heat, and thirst with epistaxis, this is toxic fire punishing Metal (Lung); Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) is indicated. If residual toxin after scabbing attacks the Spleen causing epistaxis, this is Spleen deficiency failing to control blood returning to the vessels; Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Decoction) is indicated, with Fagui San (Hair Ash Powder) blown into the nose externally. If toxic fire is extremely intense, flowing into the Large Intestine causing hematochezia, Jiawei Siwu Tang (Modified Four Substances Decoction) is indicated. If the rash is gray-white and sunken with hematochezia, this is Spleen Qi deficiency failing to secure blood; Guipi Tang (Restore the Spleen Decoction) is indicated. As for massive hematemesis, hematuria, and bleeding from the seven orifices, changes occur rapidly ("in the time it takes to flip a hand"), and medication is unnecessary.
Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction)
Xijiao (Rhinocerotis Cornu, sliced), Danpi (Moutan Cortex), Shengdi (Rehmanniae Radix), Baishao (Paeoniae Radix Alba).
Decoct in water and take orally.
[Formula Song] Toxic fire rushing up causes frequent epistaxis,
Xijiao Dihuang Tang acts swiftly and effectively.
Sliced Xijiao and Mudanpi,
Shengdi and Baishao decocted together.
Renshen Baizhu San (See formula for Asthma Syndrome)
Fagui San (Hair Ash Powder)
Take loose hair from a young, healthy person without disease. Wash with water boiled with Zaojiao (Gleditsiae Sinensis Fructus) to remove grease, then bake dry. Fill a new earthenware jar completely with the hair. Cover the mouth with a clean tile, seal with salt mud. Surround half the jar with charcoal fire. After burning one incense stick's worth of time, remove and let cool. Grind into fine powder and blow into the nose. Alternatively, mix two parts hair ash, seven parts child's urine, and three parts wine, and take orally to stop bleeding.
Jiawei Siwu Tang (Modified Four Substances Decoction)
Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba, stir-fried with wine), Shengdi (Rehmanniae Radix), Mudanpi (Moutan Cortex), Jingjie (Schizonepetae Spica, stir-fried until black), Chuanxiong (Ligustici Chuanxiong Rhizoma), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Diyü (Sanguisorbae Radix).
Decoct in water and take orally.
[Formula Song] Modified Four Substances is suitable for hematochezia,
Combining Guishao, Shengdi, and Mudanpi.
Stir-fried black Jingjie paired with Chuanxiong,
Along with Huangqin, Huanglian, and Diyü.
Guipi Tang (Restore the Spleen Decoction)
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil), Gancao (Glycyrrhizae Radix et Rhizoma, honey-roasted), Huangqi (Astragali Radix, honey-roasted), Zaoren (Ziziphi Spinosae Semen, stir-fried and ground), Yuanzhi (Polygalae Radix, heart removed), Longyanrou (Longan Aril), Fushen (Poria cum Radix Pini), Danggui (Angelicae Sinensis Radix), Muxiang (Aucklandiae Radix, baked).
Use Jiang (Zingiberis Rhizoma) and Zao (Jujubae Fructus) as guides, decoct in water and take orally.
[Formula Song] Guipi Tang treats Spleen Qi deficiency,
With Renshen, Baizhu, Gancao, and Huangqi.
Zaoren, Yuanzhi, and Longyanrou,
Fushen, Danggui, and Muxiang are appropriate.