〔丹〕痘风,分气血虚实,以日子守之,多带气血不足。虚则黄 生血之剂助之,略佐以风药。实则白芍、黄芩
为君,连翘、白芷、续断之类为佐。若属寒,陈氏方可用。〔薛〕前证,更当分痘疮已出未出,已靥未靥,外邪
所伤,内
虚火动。若未出而搐搦,热毒内蕴也,紫草快 汤加钓藤钩。已出红绽而搐搦,热毒作痛也,东垣消毒散加钓藤钩。
灌脓而搐搦,血气虚也,参 四圣散加钓藤钩。若靥后而搐搦,血气尤虚也,八珍汤加钓藤钩。或目 ,或直视者,
风火相搏也,柴胡栀子散,或六味地黄丸加柴胡、山栀。或口角流涎者,木乘土也,五味异功散加升麻、柴胡、
钓藤钩。或目赤眵泪者,肝血虚而生风也,四物汤加柴胡、钓藤钩。或角弓反张者,水不生木也,六味地黄丸加柴胡、
当归,随用补中益气汤加天麻、钓藤钩,不可直用治风之药。盖风药能燥血散气,必验其手足冷、热、温和、三证,
而用补泻调理之法,庶无误矣。如婴儿,当审乳母而治之。〔万〕痘后忽遍身青黑色,手足螈 ,口噤涎潮,角弓反张,
语言謇涩者,此中风也。疮痘方愈,荣卫正弱,不知避忌,
忽遇节令气交,八方不正之气乘虚而入,故为此证,宜消风散二钱入蝉蜕末一钱,分为三服,投生姜薄荷汁及酒各数点,
温汤浸之,连二三服,或作瘾疹,或再出肤疹而愈。
〔丹〕杨氏女年十余岁,痘发不透,靥落后,骨节痛,食少,夜间或热,此余毒在内,
虚甚难于疏导,须在补中有通,此方主之。
当归 白术 陈皮(各一钱) 牛膝(五分) 通草 甘草根(炙) 苏梗(各三分) 犀角(二分)
上 咀。生姜三片,水煎,温服。
男子七岁,痘疮初出不透,毒瓦斯攻内,骨节作痛,两足不可直,瘢痕欠红活,脉浮而和,小便赤少。
当归身 白术(各一钱) 陈皮 木通 犀角屑 人参 茯苓(各五分) 甘草(炙,少许)
上,分二帖,煎服。
消风散
人参 羌活 川芎 甘草(炙) 防风 荆芥穗 白茯苓 蝉蜕(去毒) 浓朴 白僵蚕
(炒) 陈皮(去白) 藿香叶(各半两)
上为末。每服二钱,茶清调下。
紫草快 汤(见形出不快) 东垣消毒散(大法) 参 四圣散(灌脓) 八珍汤(虚羸)
柴胡栀子散(热) 六味地黄丸(肾) 五味异功散(吐泻) 四物汤(失血) 补中益气汤(虚
羸)
当归补血汤治痘疮血气亏损发搐,热渴喜饮,脉洪大而虚,重按如无者。(发热)
【丹波元坚】痘疮引发的风证,需分辨气血的虚实,并依据病程日期来把握治疗时机,多数情况伴有气血不足。若属虚证,使用黄色药材组成的生血方剂以辅助治疗,略微佐以祛风药物。若属实证,以白芍、黄芩为君药,连翘、白芷、续断等药为佐药。若属于寒证,可使用陈氏的方剂。
【薛己】上述病症,更应当区分痘疮是否已经发出、是否已经结痂,以及是由外邪损伤还是内虚火动引起。如果痘疮未出而出现抽搐,是热毒内蕴所致,用紫草快肌汤加钓藤钩。如果痘疮已出且红绽而抽搐,是热毒作痛所致,用东垣消毒散加钓藤钩。如果处于灌脓期而抽搐,是气血虚弱所致,用参苓四圣散加钓藤钩。如果结痂后仍抽搐,说明气血更加虚弱,用八珍汤加钓藤钩。如果出现眼睛斜视或直视,是风火相搏所致,用柴胡栀子散,或六味地黄丸加柴胡、山栀。如果口角流涎,是肝木乘脾土所致,用五味异功散加升麻、柴胡、钓藤钩。如果目赤多眵流泪,是肝血虚而生风所致,用四物汤加柴胡、钓藤钩。如果出现角弓反张,是水不生木(肾水不能滋养肝木)所致,用六味地黄丸加柴胡、当归,随后酌情使用补中益气汤加天麻、钓藤钩,不可直接使用治风药物。因为祛风药物能燥血散气,必须验证手足冷、热、温和这三种证候,然后采用补泻调理的方法,这样才能不出差错。如果是婴儿患病,应当审查乳母的情况并进行治疗。
【万全】痘疮之后突然全身呈现青黑色,手足抽搐,牙关紧闭,口水涌出,角弓反张,言语不清,这是中风证。疮痘刚刚痊愈,营卫正气正弱,如果不注意避忌,忽然遇到节气交替,八方不正之气乘虚而入,所以出现这种病症,宜用消风散二钱,加入蝉蜕末一钱,分为三次服用,送服生姜薄荷汁及酒各数滴,并用温汤浸泡身体,连续服用二三剂,或者出现瘾疹,或者再次发出肤疹而痊愈。
【丹波元坚】杨姓女子十多岁,痘疮发出不透,结痂脱落后,骨节疼痛,食欲减退,夜间有时发热,这是余毒在内,体质极虚难以疏导,必须在补益中兼有疏通,此方主治。
当归、白术、陈皮(各一钱),牛膝(五分),通草,甘草根(炙),苏梗(各三分),犀角(二分)。
以上药物切碎。生姜三片,水煎,温服。
男子七岁,痘疮初出不透,毒瓦斯攻入体内,骨节疼痛,两脚不能伸直,瘢痕颜色不够红活,脉象浮而和缓,小便赤少。
当归身、白术(各一钱),陈皮,木通,犀角屑,人参,茯苓(各五分),甘草(炙,少许)。
以上药物,分两帖,煎服。
消风散:人参、羌活、川芎、甘草(炙)、防风、荆芥穗、白茯苓、蝉蜕(去毒)、浓朴、白僵蚕(炒)、陈皮(去白)、藿香叶(各半两)。
以上药物研为细末。每次服用二钱,用茶清调下。
紫草快肌汤(用于痘形出不快);东垣消毒散(通用大法);参苓四圣散(用于灌脓期);八珍汤(用于虚羸);柴胡栀子散(用于热证);六味地黄丸(用于肾虚);五味异功散(用于吐泻);四物汤(用于失血);补中益气汤(用于虚羸)。
[Dan] Wind syndrome induced by smallpox should be differentiated according to the deficiency or excess of Qi and Blood, and treatment should be timed according to the days of the disease course. It is mostly accompanied by a deficiency of Qi and Blood. If it is a deficiency pattern, blood-nourishing agents (formulas composed of yellow herbs) are used to assist, slightly supplemented with wind-dispelling herbs. If it is an excess pattern, Bai Shao (Radix Paeoniae Alba) and Huang Qin (Radix Scutellariae) serve as the sovereign drugs, while Lian Qiao (Fructus Forsythiae), Bai Zhi (Radix Angelicae Dahuricae), and Xu Duan (Radix Dipsaci) serve as assistant drugs. If it belongs to a cold pattern, Chen's formula can be used.
[Xue] Regarding the aforementioned symptoms, one must further distinguish whether the smallpox lesions have erupted or not, and whether they have crusted over or not, as well as whether the cause is external pathogenic invasion or internal deficiency fire activation. If convulsions occur before eruption, it is due to heat-toxin accumulation internally; use Zicao Kua Ji Tang (Zicao Rapid Eruption Decoction) plus Gou Teng Hook (Uncariae Ramulus cum Uncis). If convulsions occur after eruption when lesions are red and blooming, it is due to heat-toxin causing pain; use Dongyuan Xiaodu San (Dongyuan Detoxification Powder) plus Gou Teng Hook. If convulsions occur during the suppuration stage, it is due to Qi and Blood deficiency; use Shen Ling Sisheng San (Ginseng and Atractylodes Four-Saints Powder) plus Gou Teng Hook. If convulsions persist after crusting, Qi and Blood are even more deficient; use Bazhen Tang (Eight-Treasure Decoction) plus Gou Teng Hook. If eyes deviate or stare fixedly, it is due to wind-fire clashing; use Chaihu Zhizi San (Bupleurum and Gardenia Powder) or Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus Chai Hu (Radix Bupleuri) and Shan Zhi (Fructus Gardeniae). If saliva flows from the corner of the mouth, it is due to Liver Wood overacting on Spleen Earth; use Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder) plus Sheng Ma (Rhizoma Cimicifugae), Chai Hu, and Gou Teng Hook. If eyes are red with discharge and tearing, it is due to Liver Blood deficiency generating wind; use Siwu Tang (Four-Substance Decoction) plus Chai Hu and Gou Teng Hook. If opisthotonos occurs, it is due to Water failing to generate Wood (Kidney Water failing to nourish Liver Wood); use Liuwei Dihuang Wan plus Chai Hu and Dang Gui (Radix Angelicae Sinensis), followed by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Tianma (Rhizoma Gastrodiae) and Gou Teng Hook. One must not directly use wind-dispelling medicines. This is because wind-dispelling herbs can dry Blood and scatter Qi. One must verify the conditions of cold, hot, and moderate hands and feet, and then apply tonifying or purging regulatory methods to avoid errors. For infants, treatment should consider the nursing mother's condition.
[Wan] After smallpox, if the whole body suddenly turns cyan-black, with convulsions of hands and feet, locked jaw, flooding saliva, opisthotonos, and slurred speech, this is stroke syndrome. Just as the sores heal, Ying and Wei (Nutritive and Defensive Qi) are weak. If precautions are ignored and one encounters seasonal qi transitions, evil qi from all directions enters due to deficiency, causing this syndrome. One should use Xiaofeng San (Wind-Expelling Powder) 2 qian, mixed with 1 qian of Cicada Slough powder, divided into three doses. Administer with a few drops of ginger-mint juice and wine, and soak in warm water. After two or three doses, urticaria may appear, or skin rashes may re-emerge, leading to recovery.
[Dan] Yang's daughter, aged over ten, had incomplete smallpox eruption. After crusting fell off, she experienced joint pain, poor appetite, and occasional night fevers. This indicates residual toxins remaining internally. The deficiency is severe, making dredging difficult; thus, one must incorporate unblocking within tonification. This formula governs such cases:
Dang Gui (Radix Angelicae Sinensis), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Chen Pi (Pericarpium Citri Reticulatae) (each 1 qian); Niu Xi (Radix Achyranthis Bidentatae) (5 fen); Tong Cao (Medulla Tetrapanacis); Gan Cao Gen (Radix Glycyrrhizae Uralensis, honey-fried); Su Geng (Caulis Perillae) (each 3 fen); Xi Jiao (Cornu Rhinocerotis) (2 fen).
Crush the herbs. Add three slices of fresh ginger, decoct in water, and take warm.
A seven-year-old boy had incomplete initial smallpox eruption. Toxins attacked internally, causing joint pain and inability to straighten both legs. The scars lacked vibrant redness. The pulse was floating and harmonious, and urine was scanty and dark.
Dang Gui Shen (Body of Radix Angelicae Sinensis), Bai Zhu (each 1 qian); Chen Pi, Mu Tong (Caulis Akebiae), Xi Jiao Xie (Cut Horn of Rhinoceros), Ren Shen (Radix Ginseng), Fu Ling (Sclerotium Poriae Cocos) (each 5 fen); Gan Cao (honey-fried, a small amount).
Divide into two doses, decoct, and take.
Xiaofeng San (Wind-Expelling Powder): Ren Shen, Qiang Huo (Rhizoma Notopterygii), Chuan Xiong (Rhizoma Chuanxiong), Gan Cao (honey-fried), Fang Feng (Radix Saposhnikoviae), Jing Jie Sui (Herba Schizonepetae), Bai Fu Ling, Chan Tui (Exuvio Cicadae, de-toxified), Hou Po (Cortex Magnoliae Officinalis), Bai Jiang Can (Bombyx Batryticatus, stir-fried), Chen Pi (exocarp removed), Huo Xiang Ye (Folium Pogostemonis) (each half liang).
Grind into powder. Take 2 qian per dose, mixed with clear tea liquor.
[Zicao Kua Ji Tang (for slow eruption); Dongyuan Xiaodu San (general principle); Shen Ling Sisheng San (for suppuration); Bazhen Tang (for emaciation); Chaihu Zhizi San (for heat); Liuwei Dihuang Wan (for Kidney); Wuwei Yigong San (for vomiting/diarrhea); Siwu Tang (for blood loss); Buzhong Yiqi Tang (for emaciation)].
Danggui Buxue Tang treats convulsions caused by Qi and Blood depletion from smallpox, accompanied by fever, thirst with desire to drink, and a pulse that is large and empty but vanishes upon heavy pressure. (Fever)