论曰。斑疹之病。其状各异。疮发 肿于外。属少阳三焦相火。谓之斑。小红靥行于皮肤之中不出者。
属少阴君火也。谓之
疹。凡显斑证者。若自吐泻者。慎勿治。则多吉。谓邪气上下皆出也。大凡疮疹。首尾皆不可下。恐妄动而生
变。此谓少阳通表宜和之也。当先安其里以解毒。次微发之。安里解毒者。谓能安和五脏。防风汤是也。如大
便不秘。次微发之。微发之药。钱氏方中甚多。宜选用之。如大便过秘。宜微利之。当归丸枣变百祥丸是也。
初知是斑疹。若便发之。令斑并出。小儿难禁。是使别生他证也。首尾不可下者。首曰上焦。尾曰下焦。若已
吐利。不可下也。便宜安里药三五服。如能食大便秘者内实。宜微疏利之。若内虚而利者。宜安里药三五服。
末后一服。调微发之药服之。大抵用安里之药多。发表之药少。秘则微疏之。邪气不并出。能作番次。使小儿
易禁也。身温者顺。身凉者逆。则宜服防风汤以和之。
防风汤
防风（一两） 地骨皮 黄 芍药 枳壳 荆芥穗 牛蒡子（以上各半两）
上为细末。温水调下。或为粗末。煎服二三钱。更妙。
治大便秘而内实能食。宜当归丸。
当归（五钱） 黄连（二钱半） 大黄（二钱） 甘草（一钱炙）
先将当归熬作膏子。入药三味为丸。渐次服十丸。妙。
治斑疹大便秘结。枣变百祥丸。
大戟（去骨一两） 枣（三个去核）
上二味。用水一碗。煎至水尽为度。去大戟不用。将枣焙干。可和剂旋丸。从少至多。以利为度。
五脏病各有所见证
热则从心。寒则从肾。嗽而气上则从肺。风从肝。泻从脾。假令泻见嗽而气上。脾肺病也。泻白益黄散合
而服之。又宜黄芩浓朴汤白术浓朴汤。谓脾苦湿肺苦燥气则上逆也。其证先泻。
又兼面色黄。肠鸣呦呦者是也。如见渴热多者。当服浓朴汤。不渴热少者。当服白术浓朴汤。其他五胜若有兼
证。皆如此类。然更详后说。四时经移用药。
假令春分前。风寒也。宜用地黄羌活防风。或地黄丸及泻青丸相间服之。春分后。风热也。宜用羌活防风
黄芩。或泻青丸用导赤散下之。立夏之后。热也。用三黄丸导赤散。夏至后。湿热也。宜导赤泻黄散合而服之。
或黄芩甘草白术茯苓之类。为胜湿之药。立秋后。宜用益黄散泻白散。陈皮浓朴人参木香之类。秋分后。用泻白
散。立冬之后。地黄丸主之。谓肾不受泻也。大凡小儿斑疹。已发有疮有声音者。乃形病气不病也。无疮无声
音者。乃气病形不病也。有疮而无声音者。是形气俱病也。后一证。当清利肺气。八风汤或凉膈散。大黄芒硝
亦可。或如圣汤加大黄。或八味羌活汤加大黄。此是春时发斑。谓之曰风斑耳。疮疹者。内经云。痛痒疮疡。
皆属心火。斑子者。是相君行命三焦真阳气之所作也。若气入肺。变脓胞。入肝为水胞。自病为斑。心乃君火。
入于皮作瘾疹。为肺主皮毛。心不害肺金。此乃君之德也。未疮而发搐。乃外感寒邪内发心热而发搐。用茶汤
下解毒丸。或犀角地黄汤主之。已发便稠密。情势如针头者。当轻发其表凉其内。连翘升麻汤主之。若斑已发
稠密甚而微喘。饮水有热证。当以去风药微下之。若出不快。清便自调。知为在表不在里。当微发之。升麻葛
根汤主之。若有干黑陷身不大热。大小便涩。则知热在内。当煎大黄汤。下宣风散。身表大热者。表证未罢。
不可利大便。若斑疹已出。见小热小便不利者。当利小便。已发后有余毒不散。为复有身热痈疮之类。当用解
毒之药。
论述说：斑和疹这两种病，其症状表现各不相同。疮疡发作，肿胀于体表，归属于少阳三焦相火，称为“斑”；小红点隐行于皮肤之中而不透发出来的，归属于少阴君火，称为“疹”。凡是出现斑证的患者，如果伴有自发性呕吐或腹泻，千万不要使用攻下法治疗，这样大多会吉利（预后良好）。这是因为邪气通过上下途径都排出了。大凡疮疹疾病，从头到尾都不可以使用攻下法，恐怕妄动正气而产生变证。这叫做少阳经通达体表，适宜用和解的方法。应当先安定内部以解除毒素，然后轻微地发散表邪。所谓安定内部、解除毒素，是指能够安和五脏，防风汤就是这样的方剂。如果大便并不秘结，接着就轻微发散表邪。轻微发散的药物，钱乙的医方中有很多，应该选用。如果大便过于秘结，适宜轻微通利大便，当归丸或枣变百祥丸就是这样的方剂。
刚开始知道是斑疹时，如果立刻强力发散，导致斑点同时全部发出，小儿难以承受，这会导致产生其他变证。所谓从头到尾不可攻下，这里的“首”指上焦，“尾”指下焦。如果已经发生呕吐或腹泻，不可攻下，适宜服用三五服安定内部的药物。如果能进食且大便秘结，属于内实，适宜轻微疏利通便。如果内部虚弱且有腹泻，适宜服用三五服安定内部的药物。最后一服，配合服用轻微发散的药物。大体上使用安定内部的药物较多，发表的药物较少。大便秘结则轻微疏利，使邪气不集中爆发，能分批次排出，让小儿容易承受。身体温暖的为顺证，身体发凉的为逆证，此时适宜服用防风汤来调和。
防风汤
防风（一两） 地骨皮 黄芩 芍药 枳壳 荆芥穗 牛蒡子（以上各半两）
将上述药物研成细末，用温水调服。或者制成粗末，煎煮后服用二三钱，效果更好。
治疗大便秘结且内实、能进食的情况，适宜用当归丸。
当归（五钱） 黄连（二钱半） 大黄（二钱） 甘草（一钱，炙）
先将当归熬制成膏状，加入其余三种药物制成丸剂，逐渐服用十丸，效果很好。
治疗斑疹大便秘结，用枣变百祥丸。
大戟（去心皮一两） 枣（三个，去核）
将这两味药，用水一碗，煎至水干为止，去掉大戟不用，将枣焙干，可以随宜制作丸剂。从少量开始逐渐增加，以大便通畅为度。
五脏病变各有其见证
热证多从心经显现，寒证多从肾经显现，咳嗽且气逆多从肺经显现，风证多从肝经显现，腹泻多从脾经显现。假设见到腹泻兼有咳嗽和气逆，这是脾肺两脏的病。可以将泻白散和益黄散合起来服用。又适宜用黄芩厚朴汤和白术厚朴汤。这是因为脾怕湿，肺怕燥，气机上逆的缘故。这种病症先表现为腹泻，又兼见面色发黄、肠鸣辘辘。如果见到口渴、发热多的，应当服用厚朴汤；不渴、发热少的，应当服用白术厚朴汤。其他四时五行若有兼夹证候，都是如此类推。然而更要详细参考后面的说法，根据四季经气移易来用药。
假设在春分之前，是风寒之邪，适宜用地黄、羌活、防风，或者地黄丸及泻青丸交替服用。春分之后，是风热之邪，适宜用羌活、防风、黄芩，或者用泻青丸配合导赤散送服。立夏之后，是热邪，用三黄丸和导赤散。夏至之后，是湿热之邪，适宜将导赤散和泻黄散合起来服用，或者用黄芩、甘草、白术、茯苓之类作为胜湿的药物。立秋之后，适宜用益黄散和泻白散，如陈皮、厚朴、人参、木香之类。秋分之后，用泻白散。立冬之后，用地黄丸为主治，这是因为肾不受泻的缘故。
大凡小儿斑疹，已经发出且有疮疡、有声音的，是形体有病而气机未病；没有疮疡、没有声音的，是气机有病而形体未病；有疮疡而没有声音的，是形与气都病了。后一种情况，应当清利肺气，可用八风汤或凉膈散，大黄、芒硝也可以，或者如圣汤加大黄，或者八味羌活汤加大黄。这是在春季发出的斑，称为“风斑”。
关于疮疹，《内经》说：“痛痒疮疡，皆属于心火。”斑疹，是相火与君火共同行使使命，由三焦真阳气所化生的。如果邪气入肺，变为脓疱；入肝，变为水疱；自病则为斑。心乃君火，侵入皮肤则形成瘾疹，因为肺主皮毛，心不伤害肺金，这是君火的德行。
在未出疮之前就发生抽搐，是外感寒邪、内发心热所致，用茶汤送服解毒丸，或者犀角地黄汤主治。如果斑疹发出后便稠密，情势像针头一样，应当轻微发散表邪、清凉内部，用连翘升麻汤主治。如果斑疹已经发出，稠密得很且微喘，饮水时有热证，应当用祛风药轻微攻下。如果斑疹出不快，大小便正常，知道病位在表不在里，应当轻微发散，用升麻葛根汤主治。如果有干燥黑陷、身体不大热、大小便涩滞，则知道热邪在内，应当煎大黄汤，送服宣风散。如果身体表面大热，说明表证未罢，不可通利大便。如果斑疹已经发出，见轻微发热、小便不利，应当通利小便。斑疹发出后有余毒不散，再次出现身热、痈疮等症，应当使用解毒的药物。
It is stated that the diseases of macules (ban) and papules (zhen) present with various symptoms. Sores erupting with swelling on the exterior belong to the Shaoyang Sanjiao (Triple Burner) Ministerial Fire, and are called "macules" (ban). Small red spots moving within the skin without emerging belong to the Shaoyin Sovereign Fire, and are called "papules" (zhen). In cases where macule symptoms appear, if spontaneous vomiting or diarrhea occurs, one must strictly avoid purgative treatment; this often leads to a favorable prognosis, as the pathogenic factors are expelled from both above and below. Generally, for sores and rashes, purgatives should not be used from beginning to end, lest reckless movement cause complications. This refers to the Shaoyang channel connecting to the exterior, which should be harmonized. One should first stabilize the interior to resolve toxicity, then slightly release the exterior. Stabilizing the interior and resolving toxicity means harmonizing the Five Zang organs, such as using Fangfeng Tang (Saposhnikovia Decoction). If the stool is not constipated, proceed to slightly release the exterior. There are many formulas in Qian Yi's works for slight exterior release, which should be selected. If the stool is severely constipated, mild purgation is appropriate, such as Danggui Wan (Angelica Pill) or Zaibian Baixiang Wan (Jujube-Modified Baixiang Pill).
Upon initially identifying macules and papules, if they are forcefully released immediately, causing all spots to erupt simultaneously, children may not tolerate it, leading to other complications. The statement "no purgatives from beginning to end" refers to the "beginning" as the Upper Jiao and the "end" as the Lower Jiao. If vomiting or diarrhea has already occurred, purgatives are contraindicated; instead, three to five doses of interior-stabilizing medicine should be taken. If the patient can eat and has constipation, indicating internal excess, mild laxation is appropriate. If there is internal deficiency with diarrhea, three to five doses of interior-stabilizing medicine are appropriate. The final dose should be taken with slightly exterior-releasing medicine. Generally, more interior-stabilizing medicine is used, and less exterior-releasing medicine. If constipated, mildly purge; do not let pathogenic factors erupt together, but allow them to come out in batches, making it easier for children to tolerate. A warm body indicates a favorable course (shun), while a cool body indicates an unfavorable course (ni); in the latter case, Fangfeng Tang should be taken to harmonize.
Fangfeng Tang (Saposhnikovia Decoction)
Fangfeng (Radix Saposhnikoviae, 1 liang), Diguxpi (Cortex Lycii Radicis), Huangqin (Radix Scutellariae), Shaoyao (Radix Paeoniae Alba), Zhike (Fructus Aurantii Immaturus), Jingjie Sui (Herba Schizonepetae), Niubangzi (Fructus Arctii). (The above ingredients each weigh half a liang).
Grind into fine powder, take with warm water. Or grind into coarse powder, decoct and take 2-3 qian; this is better.
For severe constipation with internal excess and good appetite, Danggui Wan (Angelica Pill) is appropriate.
Danggui (Radix Angelicae Sinensis, 5 qian), Huanglian (Rhizoma Coptidis, 2.5 qian), Dahuang (Radix et Rhizoma Rhei, 2 qian), Gancao (Radix Glycyrrhizae Uralensis, 1 qian, honey-fried).
First, boil Danggui into a paste, add the other three medicines, and form pills. Take ten pills gradually; this is effective.
For macules and papules with severe constipation, use Zaibian Baixiang Wan (Jujube-Modified Baixiang Pill).
Daji (Radix Euphorbiae Pekinensis, heartwood removed, 1 liang), Zao (Fructus Jujubae, 3 pieces, pitted).
Take these two ingredients, decoct with one bowl of water until the water is exhausted. Remove Daji and discard. Dry the jujubes by baking, and prepare pills as needed. Start with a small amount and increase gradually, stopping when bowel movements become smooth.
Each of the Five Zang organs' diseases presents specific signs:
Heat manifests from the Heart, Cold from the Kidney, cough with Qi rebellion from the Lung, Wind from the Liver, and diarrhea from the Spleen. For example, if diarrhea is accompanied by cough and Qi rebellion, it is a disease of the Spleen and Lung. Xiebai San (Pulmonary Heat Resolving Powder) and Yihuang San (Yellow-Resolving Powder) can be combined and taken. Alternatively, Huangqin Houpo Tang (Scutellaria and Magnolia Bark Decoction) or Baizhu Houpo Tang (Atractylodes and Magnolia Bark Decoction) are suitable, because the Spleen dislikes dampness and the Lung dislikes dryness, leading to Qi rebellion. The symptoms start with diarrhea, accompanied by a sallow complexion and rumbling intestines. If thirst and significant heat are observed, Houpo Tang should be taken; if there is no thirst and little heat, Baizhu Houpo Tang should be taken. Other seasonal combinations follow similar logic. However, refer to the detailed explanations below regarding medication adjustments according to the shifting energies of the four seasons.
Before the Spring Equinox, it is Wind-Cold; use Dihuang, Qianghuo, and Fangfeng, or alternate Dihuang Wan and Xieqing Wan. After the Spring Equinox, it is Wind-Heat; use Qianghuo, Fangfeng, and Huangqin, or administer Xieqing Wan with Daochi San. After Start of Summer, it is Heat; use Sanhuang Wan and Daochi San. After Summer Solstice, it is Damp-Heat; combine Daochi San and Xiehuang San, or use herbs like Huangqin, Gancao, Baizhu, and Fuling to overcome dampness. After Start of Autumn, use Yihuang San and Xiebai San, such as Chenpi, Houpo, Renshen, and Muxiang. After the Autumn Equinox, use Xiebai San. After Start of Winter, use Dihuang Wan as the main treatment, because the Kidney does not accept purgation.
Generally, if pediatric macules and papules have erupted with sores and sounds, it means the Form is diseased but the Qi is not. If there are no sores and no sounds, the Qi is diseased but the Form is not. If there are sores but no sounds, both Form and Qi are diseased. In the latter case, clear and benefit Lung Qi using Bafeng Tang or Liangge San; Dahuang and Mangxiao are also acceptable. Or use Rusheng Tang with added Dahuang, or Bawei Qianghuo Tang with added Dahuang. This refers to macules erupting in spring, called "Wind Macules."
Regarding sores and rashes, the *Neijing* states: "Pain, itching, sores, and ulcers all belong to Heart Fire." Macules and papules are produced by the interaction of Ministerial and Sovereign Fires, generated by the True Yang Qi of the Sanjiao. If pathogenic Qi enters the Lung, it becomes pustules; if it enters the Liver, it becomes vesicles; if it affects itself, it becomes macules. The Heart is Sovereign Fire; entering the skin causes urticaria (yin zhen), because the Lung governs the skin and hair. The Heart does not harm Lung Metal, which is the virtue of the Sovereign.
Twitching before sores erupt indicates external Cold invasion triggering internal Heart Heat; treat with Jiedu Wan administered with tea water, or Xijiao Dihuang Tang. If macules erupt densely, resembling pinheads, lightly release the exterior and cool the interior using Lianqiao Shengma Tang. If macules are very dense with slight wheezing and signs of heat upon drinking water, use wind-dispelling herbs with mild purgation. If eruption is slow but stools and urine are normal, the pathogen is in the Exterior, not the Interior; lightly release the exterior using Shengma Gegen Tang. If macules are dry, black, depressed, with low-grade fever and difficult urination/defecation, heat is in the Interior; decoct Dahuang Tang and administer Xuanfeng San. If the body surface is very hot, the Exterior syndrome persists, and purgation is contraindicated. If macules have erupted with slight fever and difficult urination, promote urination. If residual toxicity remains after eruption, causing recurrent fever, abscesses, etc., use detoxifying herbs.