疹后热不除，忽作搐者，不可与急惊风同论，用导赤散加人参、麦门冬送服安神丸。小便清者可治，短少
者不可治，宜服抱龙丸。
导赤散 治心热发搐。
生地黄 木通 甘草（炙，各等分）
上锉细，加淡竹叶七片，水一盏，煎七分，去渣，温服。（一方加人参、麦门冬）
安神丸
当归身 麦门冬 白茯苓 黄芩 甘草（各半两） 朱砂（一两） 龙脑（二分半）
上为末，汤浸蒸饼和 猪心血捣匀，丸如黍米大，每服十丸，灯芯汤下。
抱龙丸（又名琥珀抱龙丸） 治痘惊。
真琥珀 天竺黄 白檀香 白茯苓 人参（各一两半） 粉草（去节，三钱） 枳壳（麸炒，一两） 枳
实（麸炒，一两） 辰砂（水飞，五两） 金箔（一百片，筛） 山药（炒熟，一两） 胆星（一两）
上各取细末，再筛和匀，每药一两，取新汲水一两，重入乳钵内杵匀，丸如弹子大，阴干，勿用日晒，（晒）
则燥裂矣。每服一丸，薄荷叶煎汤化下。
凡疹后牙根黑烂，肉腐血出，臭息冲人者，曰走马疳，马鸣散主之。若面颊浮肿，环口青黑，颊漏齿脱，
唇崩鼻坏者，死证也。如唇口多疮，其声嗄哑者，曰狐惑，以化 丸主之。更烦躁昏闷失声者，死证也。
马鸣散 治走马疳良方。
人中白（即溺桶底白垢也，以物刮取，用新瓦盛之，火 过如白盐乃佳，半两） 马鸣退（即蚕蜕纸也，
火烧过，二分半） 五倍子（生，一分。另用一分，同矾 枯） 白矾（二分，捶碎。另取五倍子一分，入
矾干内，以火 枯）
共为细末，用浓米泔浸，洗净拭干，以此药敷之。
化 丸
蜀椒（取开口者，炒去汗，二分） 黄连（半两） 苦楝根白皮（阴干，二分）
共为末，用乌梅肥者七个，艾汤浸，去核，捣烂和丸，艾汤下。
疹后泄利日久不已者，曰休息痢。不可妄施涩剂，以成霸功。宜黄芩汤（方见前）合天水散（方见前），与
香橘丸相间治之。若呕吐不能食者，名噤口。更肠滑不止，或下鲜血，或如尘水者，皆死证也。
香橘丸
木香（半两） 黄连（一两，以吴茱萸五钱同炒，去吴茱萸不用） 石莲子（取肉二钱半） 陈皮（半两）
上为末，醋调神曲糊为丸，如麻子大。每服二三十丸，陈仓米汤送下。
疹子收后微咳者，此肺气未平也，不须调治。若咳转甚，喘气逆气，发则连绵不已者，此肺中伏火，金虚叶
焦，故咳也，宜人参清膈散主之。身热者，麦冬清肺汤主之。若咳久不止，面浮目胞肿，胸高而喘，息则耸肩，
血自口鼻出，面色青或赤，鼻燥昏闷，摇头摆手者，皆死证也。
人参清膈散 治肺热鼻干，涕唾稠粘。
人参 柴胡 当归 白芍药 知母 白术 黄 （炙） 地骨皮 紫菀 茯苓 甘草 桑白皮 桔梗（各五分）
黄芩（二分半） 滑石（七分半） 石膏（七分）
上锉细，加姜如钱大三片，水一盏，煎七八分，去渣，食后温服。
麦冬清肺汤 治疹后咳嗽不止。
天门冬 麦门冬（各去心） 知母 贝母 杏仁（去皮尖，炒，研） 地骨皮（各等分）
共锉片，水一盏，煎七分，去滓，温服。
疹家通禁鸡、鱼、炙、 、盐、醋之类。直过七七之后，方可食之。惟宜食淡，不可纵口，致生他疾也。
曾见痘疹收后，动止出入，饮食如常，忽然心腹绞痛而死者，还是元气怯弱，乘以疫疠之气，正不能胜邪，
邪伏于中，外
若无病，内已亏损，故一中而死，谓之中恶。
凡小儿初生未盈月者，遍身红点，俗呼奶疹者是也。此由胎中受热，故生下发见于皮肤，不可作时行疹子
论，妄用汤剂。盖脏腑娇脆，气血怯弱，不能胜汤丸也，宜用溯源解毒汤与乳母服之。
溯源解毒汤 解胎毒之良方。
当归身 川芎 连翘 人参 白芍药 生地黄 黄连 甘草（生） 陈皮 木通（各等分）
上锉细，加淡竹叶十片，水一盏，煎半盏，去渣，温服无时。
凡天行，若病大便硬结，热留胃中，故发斑，不可以疹子同治，妄用发表之剂，反增危剧。宜用人参白虎汤
（方见前）去人参，加大青、玄参、生地黄主之。大便秘者，以三黄丸微利之。
三黄丸 解毒，里实者可用。
黄芩（五钱） 黄连 大黄（各二钱半）
上为细末，雪水捣丸，绿豆大，朱砂为衣，每服五七丸，食前灯芯汤下。
张景岳曰∶万氏治疹，发表之法极尽随时制宜之善。然发表之义，亦最不易。如营卫不足而疹有不能出者，
其证甚多，若徒知发之，而不知滋之，非惟不能发，且恐穷其源矣。如伤寒三表之法，实亦有关于此。
又曰∶治疹诸条，皆极详妥。其中惟泻喘二证则最多疑似，盖二证之由疹毒，固当如其治矣。然有不因疹
毒，或以脾气本弱，而过用寒药，或以误食生冷，致伤脾胃而为泄泻者，虽曰由疹而发，然实非疹毒之病。但察
其别无热证热脉，而兼色白气馁者，便须速救脾气。若执谓疹毒，则无不危矣。又如气喘一证，大有虚实。盖十
喘九虚，若察其本，非火证，又非外邪，或以大泻，或以大汗而致喘者，必皆气脱之候。凡此二者，不可不加细察
也。
霖按∶痧疹一证，宋元以来，杂入痘门。所谓气血不分，阴阳淆混。万氏独辟蚕丛，别开蹊迳，指后学之
津梁，拯婴儿于衽席，厥功甚伟。其论治之精，已无异议。惟相隔几及四百年，天运转移，风气日薄，因时制
变，未可拘牵。当师其法，勿泥其方，斯深得其心者矣。
朱济川曰∶夫疹亦胎毒也，比痘稍轻。然中有脏腑之分，发因时气之击。（春温夏热秋凉冬寒，此四时之
正气也。冬宜寒而反温，则阳气发泄太早，至春必发疹也。故经曰∶冬居温暖，春必痘疹。又曰∶少阳客脏，则
丹疹外发。）证分虚实之异，治有补泻之殊。然其证之发也，类于伤寒，寒热头疼，目泪汪汪，鼻流清涕，呕
吐泄泻，喘嗽喷嚏，谵妄溺涩，饮食不进，烦躁闷乱，睡卧不宁。此因阳火攻击，以致毒乘于脾，热流于心，而
干于肺。盖肺主皮毛，脾主肌肉，疹之出赖二脏以行其毒，惟利于发得透彻，则毒尽出皮肤，内热自清，则无患
矣。所以疹之出，必咳嚏衄血，呕吐泄泻也。若其初发，自头面先见，而至足为齐。头面淡红，愈多为佳，其
形若芥子细密，其色若桃花红活，隐见二三番，三四日渐没。人事安宁，饮食如常，二便清调，此其顺也。若亢热
喘急，发不能出，或一出即没，或冒风没早，或虽出而紫黑无神，或淡白干枯，或身肢虽见而头面不出，及加喘
胀胸高肩息，狂言谵语，或口鼻出血，搦手摇头，寻衣摸床，饮食不进，哕恶便秘，口出尸气，此皆不治。若喘
嗽烦闷，睡卧不安，二便坚闭，饮食不进，疹虽出而紫滞，乃毒火炽盛，治宜清解为主。若疹虽透而色淡白，干
咳不续，减食便溏，精神疲倦，乃中气不足，宜固中气而兼清肺为主。一有正气不足，不能逐邪外出，致毒伏于
内，喘胀而死，俗名闷疹也。间有风寒外袭，闭其腠理，或饮食停滞而气道窒塞，以致疹不易出。治宜疏利为主。
论曰∶微汗而邪无蓄，便清而毒无壅。且如肠胃结而疏利弗缓，腠理窒而发散毋迟。衄血而
邪从衄解，利下而毒以利松。咽喉肿痛，降火为急；烦渴不已，解毒为先。饮食减常须救胃，语言谵妄必清心。
时令冷兮投辛热，时令凉兮用辛温。时令既温，辛凉无阻；时方炎热，辛寒可施。故曰∶必先岁气，毋伐天和。
治疹之要，先宜解散为主。解散则皮肤通畅，腠理开豁，则毒尽透解，则无余邪之为后灾。若不知解散，
或药误温寒，或坐视犯禁，使邪不尽泄，留蓄于中，变证百出。或烦躁闷乱，泻利失血，目赤口疳，不食便秘，
喉痛声哑，喘嗽痰涎，疔痈疮肿等证见矣。古人曰∶治别虚实，法宜变通。所谓活泼泼地，是神术也。
今人以疹为轻，不能调护，乃为风寒外束，及为生冷内伤，郁遏毒瓦斯而不得外达，欲出不出，或一出即没，
反毒内攻，噬脐何及。医者亦以为易治，孟浪用药而不知禁，往往误人，不为已咎也，可痛可惜。
疹之出有中腑之正疹，有风寒发疹，有厉毒发疹，有内伤发疹，不可不辨。然中腑之正疹者，辛凉而发之。
风寒发疹者，辛温而汗之。厉毒发疹者，辛寒而清之。内伤发疹者，苦平而利之也。
凡疹之出，虽先以发散为贵，若表实不易透，或风寒壅遏者，发解可也；若表虚自汗，疹毒易出而妄投之，
岂免虚虚之祸乎？临疹当辨虚实，不同一治。
凡出疹首尾，慎不可用燥悍之药者，盖疹从肺始，肺属金而西兑胜燥之方，性勇悍而少柔，喜清润而畏燥
烈，故曰疹要清凉。投清凉则升，用燥烈则HT （HT 音吉，气急也）。倘不得已，而用麻黄、桑皮等性燥之药，
必蜜炒，再加性润之药佐之，以折其悍气则可矣。若误用之，则金愈燥烈，譬犹滔天之焰，复添以油，岂有不
毙之理哉？
孙东宿曰∶痧疹咳嗽喘急，每用痘门中大、小无比散，每服
五七分，大者一钱，即刻喘定，而睡醒后神安气和而愈。屡用屡验。乃引热毒从小便出也。
大无比散 治热毒大甚，惊狂谵语引饮，豆疮红紫黑陷。
桂府滑石（飞过，六两） 粉草（一两） 辰砂（飞，三钱） 雄黄（飞，一钱）
上末，每三五岁服一钱，十岁服二钱。发热之初用败毒散调下亦能稀豆。若报豆后，用灯芯汤下。
小无比散 治痘壮热口渴，小水涩，大便秘，口气热，烦躁不宁，或焦紫或红斑。自发热至起壮时
有热者，皆可用。痘后余热亦可用。
桂府滑石（飞过，六两） 石膏（飞过，一两） 粉草 寒水石（各五钱） 郁金（蝉肚小者，甘草汤
煮，干为末，七钱）
上俱制净末和匀，每五岁者服二钱，大人再加。冬月灯芯汤下。夏月井水调下。热甚不解者，井水磨犀角
汁调下。若红紫顶陷不起，加穿山甲末一分，麝香半分，紫草煎汤，加酒一二匙调下即起。
王肯堂曰∶万氏云，疹属少阴心火，心火旺则刑肺金，治疹专以肺为主。按∶既是心火刑肺金，即是贼邪，
其证当重，何反轻于痘？余每治痧疹，但据见证，以泻白散加减，大剂投之即至，危困之证无不愈者。其他时
师用苦寒降火，辛温发表，而频于危亡者，不可胜数，安在其为心火刑肺也。
泻白消毒散
桔梗 甘草（各一钱） 浮萍（晒干，二钱） 牛蒡子（炒研） 荆芥穗（各一钱半） 桑白皮 地骨
皮（二味自采鲜者，各三钱）
上为粗末，每服三五钱，水一盏，煎六分，滤清服。
霖按∶疹因伏气热邪干肺者，此方有散泻肺热，保定肺气之功。若疹因外感风寒所闭，诚有如吴鞠通所论恋
定邪气之祸，临证之士不可不慎也。
聂久吾曰∶痧疹形如沙，痘疹形如豆，皆象其形而名之也。
沙痘俱胎毒，而痘出五脏，脏属阴，阴主闭藏，其毒深而难皆；痧出六腑，腑属阳，阳主发散，其毒浅而易散。
脏阴多虚寒，故痘可温补；腑阳多实热，故痧宜解散。然痧虽属腑，而其热毒之气上蒸于肺，肺主皮毛，实受其
毒，是以发热之初虽似伤寒，而肺家见证独多∶咳嗽喷嚏，鼻流清涕，眼胞肿，眼泪汪汪，面肿腮赤是也。治之
之法，惟在宣发其毒，以尽出之于外。虽红肿之甚，状如漆疮，亦不足虑，以其既发于外，即可免内攻，不若痘
家之必顾其收结也。此证若调治得法，十可十全；而调治失宜，则杀人亦如反掌。
痧疹初发热，欲出未出时，宜用宣毒发表汤。
宣毒发表汤
升麻（八分） 葛根（八分） 桔梗 防风（去芦。各五分） 荆芥 薄荷 甘草（各三分） 牛蒡子
（炒香研细） 前胡 枳壳（炒） 木通 连翘（去心蒂，研碎） 淡竹叶（各六分）
天气大热加炒黄芩八分，大寒加蜜炙麻黄八分。
霖按∶前论天气大寒，只宜置之燠室，谨避风寒，且天气虽寒，而人身之热毒未必减云云。此因天气大寒，
即加麻黄，何矛盾之甚耶？愚意审因寒闭，麻黄不可不加。若体质素弱，不能送毒外达，非独麻黄不可误用，
即升散太过，肺气大泄，而烦喘危殆者，余见多矣。宜于升散剂中重加玄参，滋水解毒，以启发肾气，庶免
虚虚之祸。斯临证之工，最当详察者也。
痧已出而红肿大甚；宜用化毒清表汤。
化毒清表汤
连翘 黄连 地骨皮 葛根 牛蒡（炒香，研细） 黄芩 知母 天花粉 山栀（炒） 玄参（各八分）
桔梗 前胡 木通（各六分） 甘草 薄荷 防风（各三分）
口渴加麦门冬（去心一钱），白石膏（ 研三钱），大便涩加酒炒大黄一钱（二分）。
有毒瓦斯流注而成痢者，宜用清热导滞汤。
清热导滞汤
黄连 条芩 白芍 枳壳（炒） 山楂肉（各一钱） 浓朴（去皮，姜汁炒） 青皮 槟榔（各六分）
牛蒡子 当归 甘草 连翘（各五分）
红多者加红花三分、地榆五分，秘涩甚者加酒炒大黄一钱二分。
孟介石曰∶痧疹属肺属火，系禀胎毒蕴积本经，亦因感岁气而出，发热五七日方得见形。初时咳嗽涕泪，目
疹子发出后，发热不退，突然发生抽搐的，不能与急惊风混为一谈，应使用导赤散加入人参、麦门冬，送服安神丸。如果小便清长，说明可以治疗；如果小便短少，则难以治愈，适宜服用抱龙丸。
导赤散：治疗心热引起的抽搐。
生地黄、木通、甘草（炙，各等分）。
以上药材切碎，加淡竹叶七片，水一盏，煎至七分，去渣，温服。（另一方加入人参、麦门冬）
安神丸：
当归身、麦门冬、白茯苓、黄芩、甘草（各半两）、朱砂（一两）、龙脑（二分半）。
以上研为细末，用汤浸泡蒸饼和药，加入猪心血捣匀，制成如黍米大小的丸剂，每次服用十丸，灯芯草汤送下。
抱龙丸（又名琥珀抱龙丸）：治疗痘疮惊风。
真琥珀、天竺黄、白檀香、白茯苓、人参（各一两半）、粉草（去节，三钱）、枳壳（麸炒，一两）、枳实（麸炒，一两）、辰砂（水飞，五两）、金箔（一百片，筛过）、山药（炒熟，一两）、胆星（一两）。
以上各取细末，再次筛匀混合，每药一两，取新汲水一两，放入乳钵内杵匀，制成如弹子大小的丸剂，阴干，不要用日晒（晒）则会干燥开裂。每次服用一丸，薄荷叶煎汤化开送下。
凡是疹后牙根黑烂，肌肉腐烂出血，口臭冲人的，称为走马疳，以马鸣散为主治。如果面颊浮肿，口周青黑，脸颊漏齿脱落，嘴唇崩裂鼻子损坏的，是死证。如果唇口多疮，声音嘶哑的，称为狐惑，以化毒丸为主治。如果出现烦躁昏闷失声的，也是死证。
马鸣散：治疗走马疳的良方。
人中白（即尿桶底部的白垢，用物刮取，用新瓦盛放，火煅烧过像白盐那样才好，半两）、马鸣退（即蚕蜕纸，火烧过，二分半）、五倍子（生用，一分。另取一分，同明矾枯制）、白矾（二分，捶碎。另取五倍子一分，入矾中干煅枯制）。
共研为细末，用浓米泔水浸泡，洗净拭干，以此药敷患处。
化毒丸：
蜀椒（取开口者，炒去汗，二分）、黄连（半两）、苦楝根白皮（阴干，二分）。
共研为末，用七个肥大的乌梅，艾汤浸泡，去核，捣烂和药成丸，艾汤送下。
疹后泄泻日久不止的，称为休息痢。不可乱用收涩药物，以求速效。宜用黄芩汤（方见前）合天水散（方见前），与香橘丸交替治疗。如果呕吐不能进食的，名为噤口痢。如果更出现肠滑不止，或下鲜血，或大便如尘水样的，都是死证。
香橘丸：
木香（半两）、黄连（一两，以吴茱萸五钱同炒，去吴茱萸不用）、石莲子（取肉二钱半）、陈皮（半两）。
以上研为末，醋调神曲糊为丸，如麻子大。每次服用二三十丸，陈仓米汤送下。
疹子消退后轻微咳嗽的，这是肺气未平复，不需要调治。如果咳嗽加重，气喘气逆，发作时连绵不断的，这是肺中伏火，肺气虚弱叶焦，所以咳嗽，宜用人参清膈散主治。身体发热的，用麦冬清肺汤主治。如果咳嗽久治不愈，面部浮肿眼睑肿，胸部高耸而喘，呼吸时耸肩，血从口鼻流出，面色青或红，鼻燥昏闷，摇头摆手的，都是死证。
人参清膈散：治疗肺热鼻干，涕唾稠粘。
人参、柴胡、当归、白芍药、知母、白术、黄芪（炙）、地骨皮、紫菀、茯苓、甘草、桑白皮、桔梗（各五分）、黄芩（二分半）、滑石（七分半）、石膏（七分）。
以上切碎，加生姜如钱币大三片，水一盏，煎至七八分，去渣，饭后温服。
麦冬清肺汤：治疗疹后咳嗽不止。
天门冬、麦门冬（各去心）、知母、贝母、杏仁（去皮尖，炒，研）、地骨皮（各等分）。
共锉成片，水一盏，煎至七分，去滓，温服。
患疹病的人普遍禁忌吃鸡、鱼、烤肉、油腻、盐、醋之类食物。直到度过七七四十九天之后，才可以食用。只适宜吃清淡食物，不可放纵口腹，导致产生其他疾病。
曾见过痘疹消退后，行动出入、饮食如常，忽然心腹绞痛而死去的，这还是元气怯弱，乘上了疫疠之气，正气不能战胜邪气，邪气潜伏在体内，外表若无病，内部已亏损，所以一接触就死亡，称为中恶。
凡是小儿初生未满月的，遍身红点，俗呼奶疹的就是这种。这是由于胎中受热，所以生下后发见于皮肤，不可当作时行疹子论治，妄用汤剂。因为脏腑娇嫩脆弱，气血怯弱，不能承受汤丸药的药力，适宜用溯源解毒汤让乳母服用。
溯源解毒汤：解胎毒的良方。
当归身、川芎、连翘、人参、白芍药、生地黄、黄连、甘草（生）、陈皮、木通（各等分）。
以上切碎，加淡竹叶十片，水一盏，煎至半盏，去渣，随时温服。
凡是时行疫病，如果病人大便硬结，热邪留在胃中，所以发斑，不可以按疹子同治，妄用发表的药物，反而增加危重程度。宜用人参白虎汤（方见前）去掉人参，加大青、玄参、生地黄主治。大便秘结的，用三黄丸轻微通便。
三黄丸：解毒，里实证者可用。
黄芩（五钱）、黄连、大黄（各二钱半）。
以上研为细末，雪水捣丸，绿豆大，朱砂为衣，每次服用五七丸，食前灯芯草汤送下。
张景岳说：万氏治疗疹子，发表的方法极尽随时制宜的好处。然而发表的义理，也是最不容易掌握的。如营卫不足而疹子有不能发出的，症状很多，如果只知道发散，而不知道滋补，不仅不能发出，恐怕还会耗尽源头。如伤寒三表的方法，实际上也与此有关。
又说：治疗疹子的各种条目，都非常详细妥当。其中只有泄泻和喘息两个证候最多疑似，这两个证候由疹毒引起，固然应当按此治疗。但是有不因疹毒，或者因为脾气本弱，而过用寒药，或者误食生冷，损伤脾胃而导致泄泻的，虽然说是由疹子引发，但实际上不是疹毒的病。只要观察其没有别的热证热脉，而兼有面色白、气息不足的，就必须迅速救补脾气。如果固执认为是疹毒，就没有不危险的。又如气喘这一证，大有虚实之分。大概十喘九虚，如果考察其根本，不是火证，又不是外邪，或者因为大泻，或者因为大汗而导致喘息的，必定都是气脱的症状。凡此二者，不可不加仔细考察。
叶霖按语：痧疹这一证候，宋元以来，混杂入痘科门类。所谓气血不分，阴阳混淆。万氏独自开辟道路，别开蹊径，指引后学的津梁，拯救婴儿于床席之间，厥功甚伟。其论治的精妙，已无异议。只是相隔几近四百年，天时运气转移，风气日益淡薄，因时制宜变化，不可拘泥牵强。应当学习他的方法，不要拘泥于他的方剂，这才是深得他心意的人。
朱济川说：疹子也是胎毒，比痘疮稍轻。然而其中有脏腑的区别，发病原因受时气冲击。（春温夏热秋凉冬寒，这是四时的正气。冬天应该寒冷却反而温暖，则阳气发泄太早，到春天必然发疹子。所以经书说：冬天居处温暖，春天必发痘疹。又说：少阳客脏，则丹疹外发。）证候分为虚实不同，治疗有补泻差异。然而其证候发作时，类似于伤寒，寒热头痛，眼泪汪汪，鼻涕流清涕，呕吐泄泻，喘嗽喷嚏，谵妄小便涩滞，饮食不进，烦躁闷乱，睡卧不宁。这是因为阳火攻击，致使毒邪乘于脾，热流于心，而干扰于肺。肺主皮毛，脾主肌肉，疹子的发出依赖这两脏来行其毒，只利于发得透彻，则毒尽出皮肤，内热自然清除，就没有祸患了。所以疹子的发出，必然伴有咳嗽、打喷嚏、鼻衄、呕吐、泄泻。如果初发时，自头面先出现，而至足部为齐整。头面淡红，越多越好，形状像芥子细密，颜色像桃花红活，隐现二三番，三四日渐消退。人事安宁，饮食如常，二便清调，这是顺证。如果亢热喘急，疹子发不出来，或者一出即没，或者冒风早没，或者虽然出来但紫黑无神，或者淡白干枯，或者身体四肢虽见而头面不出，以及加上喘胀胸高肩息，狂言谵语，或者口鼻出血，搦手摇头，寻衣摸床，饮食不进，呃逆恶心便秘，口出尸气，这些都不治。如果喘嗽烦闷，睡卧不安，二便坚闭，饮食不进，疹子虽然出来但紫滞，是毒火炽盛，治疗宜以清解为主。如果疹子虽然透发但色淡白，干咳不续，减食便溏，精神疲倦，是中气不足，宜固护中气兼清肺为主。一旦正气不足，不能驱逐邪气外出，致使毒邪潜伏在内，喘胀而死，俗名闷疹。间或有风寒外袭，闭塞腠理，或者饮食停滞而气道窒塞，以致疹子不易发出。治疗宜以疏利为主。
论曰：微汗则邪气无蓄积，便清则毒邪无壅滞。况且如肠胃结滞而疏利不可迟缓，腠理闭塞而发散不可迟疑。鼻衄则邪气从衄解，利下则毒邪以利松。咽喉肿痛，降火为急；烦渴不已，解毒为先。饮食减少须救胃，语言谵妄必清心。时令冷则投辛热，时令凉则用辛温。时令既温，辛凉无阻；时令正炎热，辛寒可施。所以说：必须先察岁气，不要伐害天和。
治疗疹子的关键，先宜解散为主。解散则皮肤通畅，腠理开豁，则毒邪尽透解，则没有余邪成为后患。如果不知解散，或者药物误用温寒，或者坐视触犯禁忌，使邪气不尽泄，留蓄于中，变证百出。或者烦躁闷乱，泄利失血，目赤口疳，不食便秘，喉痛声哑，喘嗽痰涎，疔痈疮肿等证候出现了。古人说：辨别虚实，法宜变通。所谓活泼泼地，是神术。
今人认为疹子轻，不能调护，乃被风寒外束，及被生冷内伤，郁遏毒瓦斯而不能外达，欲出不出，或者一出即没，反致毒邪内攻，噬脐何及。医者也都以为容易治疗，孟浪用药而不知禁忌，往往误人，不认为是自己的过错，可悲可惜。
疹子的发出有中腑的正疹，有风寒发疹，有厉毒发疹，有内伤发疹，不可不辨别。然而中腑的正疹，用辛凉发散。风寒发疹，用辛温发汗。厉毒发疹，用辛寒清解。内伤发疹，用苦平疏利。
凡是疹子的发出，虽然先以发散为贵，如果表实不易透发，或者风寒壅遏的，发散解除是可以的；如果表虚自汗，疹毒易出而妄投发散药，岂能避免虚虚之祸吗？临证当辨别虚实，不能用同一方法治疗。
凡是出疹从头到尾，慎不可用燥悍的药物，因为疹从肺开始，肺属金而西兑胜燥之方，性勇悍而少柔，喜清润而畏燥烈，所以说疹要清凉。投清凉则升，用燥烈则气急（HT 音吉，气急也）。倘若不得已，而用麻黄、桑皮等性燥的药物，必须蜜炒，再加性润的药物佐助，以折其悍气就可以了。如果误用，则金愈燥烈，譬如滔天之焰，再添加油，岂有不死的道理？
孙东宿说：痧疹咳嗽喘急，常用痘科中的大、小无比散，每次服用五七分，大的服用一钱，即刻喘定，而睡醒后神安气和而痊愈。屡用屡验。这是引热毒从小便排出。
大无比散：治疗热毒大甚，惊狂谵语引饮，豆疮红紫黑陷。
桂府滑石（飞过，六两）、粉草（一两）、辰砂（飞，三钱）、雄黄（飞，一钱）。
以上研末，每三五岁服用一钱，十岁服用二钱。发热之初用败毒散调下也能稀痘。若报豆后，用灯芯草汤送下。
小无比散：治疗痘壮热口渴，小便涩，大便秘，口气热，烦躁不宁，或焦紫或红斑。自发热至起壮时有热的，皆可用。痘后余热也可用。
桂府滑石（飞过，六两）、石膏（飞过，一两）、粉草、寒水石（各五钱）、郁金（蝉肚小者，甘草汤煮，干为末，七钱）。
以上都制净末和匀，每五岁服用二钱，大人再加。冬月灯芯草汤送下。夏月井水调下。热甚不解者，井水磨犀角汁调下。如果红紫顶陷不起，加穿山甲末一分，麝香半分，紫草煎汤，加酒一二匙调下即起。
王肯堂说：万氏说，疹属少阴心火，心火旺则刑肺金，治疗疹子专以肺为主。按：既然是心火刑肺金，即是贼邪，其证应当重，为何反而轻于痘？我每次治疗痧疹，只根据见证，以泻白散加减，大剂投之即至，危困之证无不愈者。其他时师用苦寒降火，辛温发表，而频于危亡的，不可胜数，哪里是在心火刑肺呢？
泻白消毒散：
桔梗、甘草（各一钱）、浮萍（晒干，二钱）、牛蒡子（炒研）、荆芥穗（各一钱半）、桑白皮、地骨皮（二味自采鲜者，各三钱）。
以上为粗末，每次服用三五钱，水一盏，煎六分，滤清服。
叶霖按语：疹因伏气热邪干肺的，此方有散泻肺热，保定肺气之功。如果疹因外感风寒所闭，诚有如吴鞠通所论述的恋定邪气的祸患，临证的医生不可不谨慎。
沙痘都是胎毒，而痘出五脏，脏属阴，阴主闭藏，其毒深而难解；痧出六腑，腑属阳，阳主发散，其毒浅而易散。脏阴多虚寒，故痘可温补；腑阳多实热，故痧宜解散。然而痧虽属腑，而其热毒之气上蒸于肺，肺主皮毛，实受其毒，是以发热之初虽似伤寒，而肺家见证独多：咳嗽喷嚏，鼻涕流清涕，眼胞肿，眼泪汪汪，面肿腮赤是也。治疗的方法，只在宣发其毒，以尽出于外。虽然红肿得很厉害，状如漆疮，也不足虑，因为其既发于外，即可免内攻，不像痘家一定要顾及其收结。此证如果调治得法，十可十全；而调治失宜，则杀人亦如反掌。
宣毒发表汤：
升麻（八分）、葛根（八分）、桔梗、防风（去芦。各五分）、荆芥、薄荷、甘草（各三分）、牛蒡子（炒香研细）、前胡、枳壳（炒）、木通、连翘（去心蒂，研碎）、淡竹叶（各六分）。
天气大热加炒黄芩八分，大寒加蜜炙麻黄八分。
叶霖按语：前论天气大寒，只宜置之燠室，谨避风寒，且天气虽寒，而人身之热毒未必减少云云。此因天气大寒，即加麻黄，何矛盾之甚耶？愚意审因寒闭，麻黄不可不加。若体质素弱，不能送毒外达，非独麻黄不可误用，即升散太过，肺气大泄，而烦喘危殆者，余见多矣。宜于升散剂中重加玄参，滋水解毒，以启发肾气，庶免虚虚之祸。斯临证之工，最当详察者也。
化毒清表汤：
连翘、黄连、地骨皮、葛根、牛蒡（炒香，研细）、黄芩、知母、天花粉、山栀（炒）、玄参（各八分）、桔梗、前胡、木通（各六分）、甘草、薄荷、防风（各三分）。
口渴加麦门冬（去心一钱），白石膏（研三钱），大便涩加酒炒大黄一钱（二分）。
清热导滞汤：
黄连、条芩、白芍、枳壳（炒）、山楂肉（各一钱）、浓朴（去皮，姜汁炒）、青皮、槟榔（各六分）、牛蒡子、当归、甘草、连翘（各五分）。
红多者加红花三分、地榆五分，秘涩甚者加酒炒大黄一钱二分。
After the eruption of macules, if fever persists and convulsions suddenly occur, it should not be discussed as acute wind-stroke (Ji Jing Feng). Use Dao Chi San (Cyan Powder) with added Ginseng Radix et Rhizoma (Renshen) and Ophiopogon Tuber (Maidong), administered with An Shen Wan (Spirit-Calming Pill). If urination is clear, it is treatable; if urine is scanty, it is untreatable. It is advisable to take Bao Long Wan (Dragon-Embracing Pill).
Dao Chi San (Cyan Powder): Treats convulsions caused by Heart Heat.
Sheng Di Huang (Rehmanniae Radix), Mu Tong (Akebiae Caulis), Gan Cao (Licorice Root, honey-fried, equal parts).
Crush finely, add seven leaves of Dan Zhu Ye (Bambusae Folium), one cup of water, decoct until three-sevenths remain, remove dregs, and take warm. (Another formula adds Renshen and Maidong).
An Shen Wan (Spirit-Calving Pill):
Dang Gui Shen (Angelicae Sinensis Radix, root body), Maidong, Bai Fu Ling (Poria), Huang Qin (Scutellariae Radix), Gan Cao (equal parts, half tael each), Zhu Sha (Cinnabar, one tael), Long Nao (Borneolum Syntheticum, two-and-a-half fen).
Grind into powder, mix with steamed bread dough soaked in decoction, pound evenly with pig heart blood, make pills the size of millet seeds. Take ten pills per dose, down with Deng Xin Tang (Junci Medulla Decoction).
Bao Long Wan (Dragon-Embracing Pill, also known as Hu Po Bao Long Wan): Treats convulsions from smallpox.
Zhen Hu Po (Genuine Succinum), Tian Zhu Huang (Calamina), Bai Tan Xiang (Santalum Album Lignum), Bai Fu Ling, Ren Shen (each one-and-a-half liang), Fen Cao (Licorice Root, nodes removed, three qian), Zhi Qiao (Aurantii Fructus, bran-fried, one liang), Zhi Shi (Aurantii Fructus Immaturus, bran-fried, one liang), Chen Sha (Cinnabar, water-triturated, five liang), Jin Bo (Gold Leaf, one hundred pieces, sifted), Shan Yao (Dioscoreae Rhizoma, stir-fried ripe, one liang), Dan Xing (Arisaematis Cum Bile).
Take fine powders of each, sieve and mix evenly. For every one liang of medicine, take one liang of fresh drawn water, pound evenly in a mortar, make pills the size of a bullet, dry in shade, do not use sun drying (drying in sun) will cause dryness and cracking. Take one pill per dose, dissolve in Bo He Ye (Menthae Haplocalycis Folium) decoction.
If after macule eruption the gum roots turn black and rot, flesh decays and bleeds, and foul breath assaults people, this is called Zou Ma Gan (Running Horse Gangrene), treated primarily with Ma Ming San (Horse Cry Powder). If cheeks are swollen, around the mouth blue-black, cheeks leak and teeth fall out, lips collapse and nose is destroyed, it is a death syndrome. If there are many sores on lips and mouth, and voice is hoarse, this is called Hu Huo (Fox or Infection), treated primarily with Hua Du Wan (Toxin-Resolving Pill). If accompanied by restlessness, coma, loss of voice, it is also a death syndrome.
Ma Ming San (Horse Cry Powder): A good prescription for Running Horse Gangrene.
Ren Zhong Bai (Human Urine Deposit, scraped off, stored in new tile, fired until white like salt, half liang), Ma Ming Tui (Silk Worm Molt, fired, two-and-a-half fen), Wu Bei Zi (Galla Chinensis, raw, one fen. Take another one fen separately, calcined with Ming Fan), Bai Fan (Alumen, two fen, crushed. Take another one fen of Wu Bei Zi, put in alum, dry-fire until calcined).
Grind together into fine powder. Soak in strong rice wash water, clean, wipe dry, apply this medicine externally.
Hua Du Wan (Toxin-Resolving Pill):
Shu Jiao (Sichuan Pepper, select open ones, fry until sweat disappears, two fen), Huang Lian (Coptidis Rhizoma, half liang), Ku Lian Gen Bai Pi (Meliae Cortex Albus, dried in shade, two fen).
Grind into powder. Take seven plump W Mei (Chinese Plum), soak in Ai Tang (Artemisiae Argyi Decoction), remove pits, pound into paste, mix with medicine to form pills, take with Ai Tang.
If diarrhea persists for a long time after macule eruption, it is called Xiu Xi Li (Resting Dysentery). Do not recklessly use astringents to seek quick success. Use Huang Qin Tang (Scutellaria Decoction) combined with Tian Shui San (Heavenly Water Powder), alternating treatment with Xiang Ju Wan (Fragrant Orange Pill). If vomiting prevents eating, it is named Jin Kou (Closed Mouth). If further intestinal sliding occurs without stopping, or passage of bright red blood, or stool like dust-water, all are death syndromes.
Xiang Ju Wan (Fragrant Orange Pill):
Mu Xiang (Costi Radix, half liang), Huang Lian (one liang, stir-fried with five qian of Wu Zhu Yu, discard Wu Zhu Yu), Shi Lian Zi (Stone Lotus Seed, meat two-and-a-half qian), Chen Pi (Citri Reticulatae Pericarpium, half liang).
Grind into powder, adjust with vinegar and Shen Qu (Medicated Leaven) paste to form pills the size of hemp seeds. Take twenty to thirty pills per dose, down with Chen Cang Mi Tang (Aged Rice Decoction).
If slight cough occurs after macules retract, this is due to Lung Qi not yet settling; no treatment is needed. If cough worsens, with panting and rebellious Qi, continuous attacks, this is latent fire in the Lung, deficiency of Metal causing leaf scorching, hence cough. Use Ren Shen Qing Ge San (Ginseng Clearing膈 Decoction) primarily. If body heat exists, use Mai Dong Qing Fei Tang (Ophiopogon Clearing Lung Decoction). If cough persists for a long time, face floats, eye bags swell, chest high and panting, breathing raises shoulders, blood flows from mouth and nose, face green or red, nose dry and comatose, shaking head and waving hands, all are death syndromes.
Ren Shen Qing Ge San (Ginseng Clearing膈 Decoction): Treats Lung heat with dry nose, thick sticky sputum.
Ren Shen, Chai Hu (Bupleuri Radix), Dang Gui, Bai Shao Yao (Paeoniae Radix Alba), Zhi Mu (Anemarrhenae Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Huang Qi (Astragali Radix, honey-fried), Di Gu Pi (Lycii Cortex), Zi Wan (Periplocae Radix), Fu Ling (Poria), Gan Cao, Sang Bai Pi (Mori Cortex), Jie Geng (Platycodonis Radix, each five fen), Huang Qin (two-and-a-half fen), Hua Shi (Talcum, seven-and-a-half fen), Shi Gao (Gypsum Fibrosum, seven fen).
Crush finely, add three slices of ginger the size of a coin, one cup of water, decoct until seven-or-eight tenths remain, remove dregs, take warm after meals.
Mai Dong Qing Fei Tang (Ophiopogon Clearing Lung Decoction): Treats persistent cough after macules.
Tian Men Dong (Asparagi Radix), Mai Dong (each remove heart), Zhi Mu, Bei Mu (Fritillariae Bulbus), Xing Ren (Pruni Semen, remove skin and tip, fry, grind), Di Gu Pi (equal parts).
Crush into slices, one cup of water, decoct until seven-tenths remain, remove residue, take warm.
Patients with macules generally prohibit chicken, fish, roasted food, grease, salt, vinegar, etc. Only after passing seventy-seven days can they eat these. Only light diet is suitable; do not indulge appetite to cause other diseases.
I have seen cases where after smallpox/macules retract, movement and diet were normal, but suddenly died of severe heart and abdominal pain. This is due to weak Yuan Qi (Original Qi) being attacked by epidemic pestilence Qi, Zheng Qi (Upright Qi) unable to overcome Xie Qi (Pathogenic Qi), Xie Qi lying hidden inside. Externally appearing healthy, internally already depleted, thus dying upon contact, called Zhong E (Sudden Evil Attack).
For infants under one month old, red spots all over the body, commonly called Nai Zhen (Milk Rash), are due to heat in the womb manifesting on skin after birth. Do not discuss as seasonal macules or recklessly use decoctions. Because Zang Fu (Viscera and Bowels) are delicate and fragile, Qi and Blood are weak, unable to withstand decoctions and pills. It is suitable to use Su Yuan Jie Du Tang (Source-Tracing Toxin-Resolving Decoction) for the nursing mother to take.
Su Yuan Jie Du Tang (Source-Tracing Toxin-Resolving Decoction): A good prescription for resolving fetal toxin.
Dang Gui Shen, Chuan Xiong (Ligustici Chuanxiong Rhizoma), Lian Qiao (Forsythiae Fructus), Ren Shen, Bai Shao Yao, Sheng Di Huang, Huang Lian, Gan Cao (raw), Chen Pi, Mu Tong (equal parts).
Crush finely, add ten leaves of Dan Zhu Ye, one cup of water, decoct until half a cup remains, remove dregs, take warm at any time.
In general epidemics, if the patient has hard constipation, heat remaining in the Stomach causing macules/spots, do not treat as regular macules. Recklessly using exterior-releasing agents will only increase severity. Use Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) removing Ren Shen, adding Da Qing (Isatidis Folium), Xuan Shen (Scrophulariae Radix), Sheng Di Huang primarily. If severe constipation, use San Huang Wan (Three Yellows Pill) to mildly purge.
San Huang Wan (Three Yellows Pill): Resolves toxin, usable for interior excess.
Huang Qin (five qian), Huang Lian, Da Huang (Rhei Radix et Rhizoma, each two-and-a-half qian).
Grind into fine powder, pound into pills the size of mung beans with snow water, coat with Zhu Sha. Take five to seven pills before meals, down with Deng Xin Tang.
Zhang Jingyue said: Wan's treatment of macules uses exterior-releasing methods excellently adapted to circumstances. However, the meaning of releasing the exterior is most difficult. For example, if Ying and Wei are insufficient and macules cannot emerge, symptoms vary greatly. If one only knows how to release but not nourish, not only will it fail to release, but it may exhaust the source. The three exterior-releasing methods of Shang Han (Cold Damage) are indeed related to this.
He also said: All items treating macules are very detailed and appropriate. Among them, diarrhea and wheezing are the most confusing. Although these two conditions arise from macule toxin and should be treated accordingly, some are not caused by macule toxin, but by inherent weak Spleen Qi overusing cold medicines, or mistakenly eating raw/cold foods damaging Spleen and Stomach causing diarrhea. Although said to originate from macules, they are actually not macule toxin diseases. If observing no other heat signs or pulse, but with pale complexion and deficient energy, one must quickly rescue Spleen Qi. If insisting it is macule toxin, danger is inevitable. Regarding wheezing, there is great difference between deficiency and excess. Generally, nine out of ten wheezings are deficiency. If examining the root, it is not Fire syndrome, nor external pathogen, but caused by severe diarrhea or sweating leading to wheezing, it must be Qi collapse. These two aspects require careful examination.
Ye Lin notes: Since Song and Yuan dynasties, Sha Zhen (Macules/Rash) has been mixed into Smallpox categories. Qi and Blood are indistinguishable, Yin and Yang confused. Mr. Wan alone opened new paths, guiding students, saving infants, his merit is great. His discussion on treatment is precise and undisputed. However, nearly four centuries have passed, heavenly luck has shifted, customs have declined. One must adapt to times and change, not be bound by rigid rules. One should learn his methods, not stick to his formulas; this is truly understanding his intent.
Zhu Jichuan said: Macules are also fetal toxin, slightly lighter than smallpox. However, they involve different Zang Fu, and eruption is triggered by seasonal Qi. (Spring warmth, summer heat, autumn coolness, winter cold are the correct Qi of four seasons. Winter should be cold but is warm, causing Yang Qi to emit too early, leading to macules in spring. Thus classics say: Living warmly in winter causes smallpox/macules in spring. Also: Shaoyang guest organ causes Dan Zhen external eruption.) Syndromes differ in deficiency/excess, treatments differ in tonifying/purging. However, eruption resembles Shang Han: chills/fever, headache, watery eyes, runny nose, vomiting/diarrhea, wheezing/coughing/sneezing, delirium, dysuria, poor appetite, restlessness/confusion, restless sleep. This is because Yang Fire attacks, allowing toxin to enter Spleen, heat flows to Heart, interfering with Lung. Lung governs skin/hair, Spleen governs muscles. Macule eruption relies on these two organs to distribute toxin. Only if erupted thoroughly does toxin exit skin, internal heat clears, avoiding disaster. Thus eruption involves coughing, sneezing, epistaxis, vomiting, diarrhea. If initial eruption starts from head/face, reaching feet indicates completeness. Head/face pale red, more is better, shape dense like mustard seeds, color lively like peach blossoms, appearing/disappearing two or three times, fading in three-four days. Mental peace, normal diet, clear urination/stool, this is favorable. If hyperthermia, panting urgency, eruption fails, or appears then vanishes immediately, or vanishes early due to wind exposure, or appears purple/black dull, or pale white dry, or body limbs appear but head/face do not, plus panting/swelling, high chest, shoulder breathing, wild talk/delirium, mouth/nose bleeding, hand clenching/head shaking, seeking clothes/touching bed, poor appetite, hiccups/nausea/constipation, corpse-like breath, these are untreatable. If wheezing/cough/restlessness, restless sleep, hard constipation/poor appetite, eruption purple/stagnant, it is intense toxin-fire, treatment should focus on clearing/resolving. If eruption transparent but pale white, dry cough intermittent, reduced appetite/loose stool, fatigue, it is Middle Qi deficiency, treatment should consolidate Middle Qi and clear Lung. Once Zheng Qi is insufficient to expel Xie Qi, toxin lies hidden internally, causing death by panting/swelling, commonly called Men Zhen (Stifled Macules). Occasionally, external Wind-Cold closes Cou Li (interstices), or food stagnation blocks airways, making eruption difficult. Treatment should focus on dispersing/dredging.
Discussion states: Mild sweat prevents pathogen accumulation, clear urination prevents toxin obstruction. If intestines/stomach knotted, dredging must not delay; if interstices blocked, dispersing must not hesitate. Epistaxis resolves pathogen via nose, purging loosens toxin via bowels. Sore throat/swelling prioritizes descending fire; persistent thirst/confusion prioritizes resolving toxin. Reduced diet requires saving Stomach; delirious speech requires clearing Heart. Cold season uses acrid-warm; cool season uses acrid-warm. Warm season allows acrid-cool; hot season applies acrid-cold. Thus: First observe yearly Qi, do not harm Heavenly Harmony.
Key to treating macules is first dispersing. Dispersing makes skin smooth, interstices open, toxin fully penetrates/resolves, leaving no residual pathogen for later disaster. If dispersing is ignored, or medicine wrongly used warm/cold, or taboos violated, pathogen not fully excreted, lingering inside, myriad changes occur. Restlessness/confusion, diarrhea/blood loss, red eyes/mouth ulcers, anorexia/constipation, sore throat/hoarseness, wheezing/phlegm, carbuncles/swellings appear. Ancients said: Distinguish deficiency/excess, methods should be flexible. Being lively and adaptable is divine skill.
Modern people think macules are mild, neglect care, allowing Wind-Cold external constraint and Raw/Cold internal injury, suppressing toxin Qi preventing external reach, wanting to erupt but not, or erupting then vanishing, causing toxin internal attack, regretting too late. Doctors also think it easy to treat, rashly using medicine ignoring taboos, often harming people, not considering it their fault, pitiful.
Macule eruption includes Correct Macules of Middle Fu, Wind-Cold induced, Severe Toxin induced, Internal Injury induced; must distinguish. Correct Macules of Middle Fu use Acrid-Cool to release. Wind-Cold induced use Acrid-Warm to sweat. Severe Toxin induced use Acrid-Cold to clear. Internal Injury induced use Bitter-Ping to drain.
Generally, eruption values dispersing first. If exterior excess makes penetration difficult, or Wind-Cold obstructs, dispersing is acceptable; if exterior deficiency with spontaneous sweating, toxin easily emerges, reckless dispersing causes deficiency-of-deficiency disaster? Clinical practice must distinguish deficiency/excess, not treat uniformly.
Throughout macule eruption, strictly avoid harsh/drying medicines. Macules start from Lung, Lung belongs to Metal, West/Dui wins dryness, nature is brave/harsh lacking softness, likes moistening fears drying fierce. Thus macules need coolness. Coolness ascends, drying fierce causes Qi urgency (HT sound Ji, Qi urgency). If unavoidable to use drying medicines like Ma Huang (Ephedrae Herba), Sang Bai Pi (Mori Cortex), must honey-fry, add moistening medicines to assist, neutralizing harshness. Misuse makes Metal dryer, like flood flames adding oil, surely fatal.
Sun Dongsu said: Sha Zhen cough/wheezing urgency often uses Da Xiao Wu Bi San (Great/Little Unparalleled Powders) from Smallpox category. Five-to-seven fen per dose, large dose one qian, instantly stops wheezing, wakes peaceful and recovers. Frequently effective. Draws heat-toxin out via urination.
Da Wu Bi San (Great Unparalleled Powder): Treats severe heat-toxin, fright/delirium/thirst, smallpox red-purple-black depressed.
Gui Fu Hua Shi (Talcum, flown), Fen Cao (Licorice Root, one liang), Chen Sha (Cinnabar, flown, three qian), Xiong Huang (Realgar, flown, one qian).
Grind powder. Three-to-five years old take one qian, ten years old take two qian. At fever onset, mix with Bai Du San (Decoction for Overcoming Pathogens) to thin smallpox. After reporting smallpox, take with Deng Xin Tang.
Xiao Wu Bi San (Little Unparalleled Powder): Treats smallpox high fever/thirst, dysuria, constipation, hot breath, restlessness, scorched purple/red spots. Usable from fever onset to rising stage with heat. Post-smallpox residual heat also usable.
Gui Fu Hua Shi (six liang), Shi Gao (Gypsum Fibrosum, flown, one liang), Fen Cao, Han Shui Shi (Halloysitum Rubrum, each five qian), Yu Jin (Curcumae Radix, small cicada belly type, boiled in Licorice decoction, dried powder, seven qian).
Mix prepared powders evenly. Five years old take two qian, adults add more. Winter take with Deng Xin Tang. Summer take with well water. Severe heat unresolved, grind Xi Jiao (Rhinocerotis Cornu) juice in well water to take. If red-purple depressed top, add Chuanshan Jia (Manis Squama) powder one fen, She Xiang (Moschus) half fen, Zi Cao (Arnebiae Radix) decoction with one-two spoons wine to take, rises immediately.
Wang Kentang said: Wan says macules belong to Shaoyin Heart Fire, Heart Fire flourishing punishes Lung Metal, treating macules focuses on Lung. Note: If Heart Fire punishes Lung Metal, it is thief pathogen, syndrome should be heavy, why lighter than smallpox? I treat Sha Zhen based on symptoms, using Xie Bai San (Draining White Decoction) modified, large doses work immediately, critical cases recover. Other contemporary doctors using bitter-cold descending fire, acrid-warm releasing, frequently facing danger/death, countless, where is Heart Fire punishing Lung?
Xie Bai Xiao Du San (Draining White Toxin-Resolving Decoction):
Jie Geng, Gan Cao (each one qian), Fu Ping (Lemna Minoris Herba, dried, two qian), Niu Bang Zi (Arctii Fructus, fried ground), Jing Jie Sui (Schizonepetae Spica, each one-and-a-half qian), Sang Bai Pi, Di Gu Pi (fresh picked, each three qian).
Coarse powder. Take three-to-five qian, one cup water, decoct six-tenths, filter clear, take.
Ye Lin notes: Macules due to latent Qi heat pathogen interfering with Lung, this formula disperses/drains Lung heat, secures Lung Qi. If macules closed by external Wind-Cold, indeed like Wujutong's discussed disaster of lingering pathogen, clinicians must be cautious.
Nie Jiuwu said: Sha Zhen shape like sand, Dou Zhen shape like beans, named after shape.
Sha and Dou are both fetal toxin. Dou emerges from Five Zang, Zang belongs to Yin, Yin governs closure/storage, toxin deep/hard to resolve; Sha emerges from Six Fu, Fu belongs to Yang, Yang governs dispersion, toxin shallow/easy to scatter. Zang Yin mostly deficiency-cold, thus Dou can be warmed/tonified; Fu Yang mostly excess-heat, thus Sha should be dispersed. Although Sha belongs to Fu, its heat-toxin Qi steams up to Lung, Lung governs skin/hair, truly receives toxin. Thus initial fever resembles Shang Han, but Lung symptoms predominate: cough/sneezing, runny nose, eyelid swelling, watery eyes, facial swelling/cheek redness. Treatment method lies in venting/toxin distribution, exhausting externally. Even if severe redness/swelling like lacquer burn, not worrying, because erupted externally avoids internal attack, unlike Dou family needing to consider resolution. This syndrome if treated properly, ten cures ten; if mishandled, kills easily.
Sha Zhen initial fever, wanting to emerge not yet, use Xuan Du Fa Biao Tang (Venting Toxin Exterior-Releasing Decoction).
Xuan Du Fa Biao Tang:
Sheng Ma (Cimicifugae Rhizoma, eight fen), Ge Gen (Puerariae Lobatae Radix, eight fen), Jie Geng, Fang Feng (Saposhnikoviae Radix, remove radicle. Each five fen), Jing Jie, Bo He (Menthae Haplocalycis Folium), Gan Cao (each three fen), Niu Bang Zi (fried fragrant ground), Qian Hu (Peucedani Radix), Zhi Qiao (fried), Mu Tong, Lian Qiao (remove heart/stalk, grind), Dan Zhu Ye (each six fen).
Weather very hot add Chao Huang Qin (fried Scutellariae Radix) eight fen; very cold add Mi Zhi Ma Huang (honey-fried Ephedrae Herba) eight fen.
Ye Lin notes: Previous discussion on very cold weather suggests staying in warm room, avoiding Wind-Cold, and although weather cold, human body heat-toxin likely not decreased. Why add Ma Huang for very cold weather? Contradictory! My opinion: Examining cause of cold closure, Ma Huang cannot be omitted. If constitution inherently weak, unable to send toxin outward, not only Ma Huang misuse, but excessive ascending/dispersing, Lung Qi major leakage, causing irritability/wheezing danger, I have seen many. Should heavily add Xuan Shen (Scrophulariae Radix) in ascending/dispersing agents, nourish Water/resolve toxin, inspire Kidney Qi, avoid deficiency-of-deficiency disaster. Clinicians must examine carefully.
Sha emerged, severe redness/swelling; use Hua Du Qing Biao Tang (Resolve Toxin Clear Exterior Decoction).
Hua Du Qing Biao Tang:
Lian Qiao, Huang Lian, Di Gu Pi, Ge Gen, Niu Bang (fried fragrant ground), Huang Qin, Zhi Mu, Tian Hua Fen (Trichosanthis Radix), Shan Zhi (Gardeniae Fructus, fried), Xuan Shen (each eight fen), Jie Geng, Qian Hu, Mu Tong (each six fen), Gan Cao, Bo He, Fang Feng (each three fen).
Thirst add Mai Dong (remove heart one qian), Bai Shi Gao (ground three qian); constipation add Jiu Chao Da Huang (wine-fried Rheum Palmatum Radix et Rhizoma) one qian (two fen).
Toxic Qi flowing into dysentery; use Qing Re Dao Zhi Tang (Clear Heat Guide Stasis Decoction).
Qing Re Dao Zhi Tang:
Huang Lian, Tiao Qin (Scutellariae Radix), Bai Shao, Zhi Qiao (fried), Shan Zha Rou (Crataegi Fructus flesh, each one qian), Hou Po (Magnoliae Officinalis Cortex, peel, ginger juice fried), Qing Pi (Citri Reticulatae Pericarpium Viride), Bing Lang (Arecae Semen, each six fen), Niu Bang Zi, Dang Gui, Gan Cao, Lian Qiao (each five fen).
Red dominant add Hong Hua (Carthami Flos) three fen, Di Yu (Sanguisorbae Radix) five fen; severe constipation add Jiu Chao Da Huang one qian two fen.
Meng Jieshi said: Sha Zhen belongs to Lung/Fire, inheriting fetal toxin accumulating in meridian, also due to sensing year Qi emerging. Fever five-seven days then visible form. Initially cough/runny nose/tears, eyes...