疮疹发热，与伤寒相似，但伤寒只见一经形证，若疮疹则面燥腮赤，呵欠顿闷，乍凉乍热，多睡咳嗽，喷嚏
惊悸，吐利手足稍冷， 凉耳凉也。然发热者，疮疹常候也，不可尽除之，但热微毒亦微，热甚毒亦甚。
初发热时精神清爽，唇鼻滋润，更无他证者，此热在表，其疮必疏，不须施治。初发热时浑身壮热，
然不渴，清便自调，此邪在表，拂郁于皮肤之间，宜以轻扬之剂发之，升麻葛根汤主之（初热），甚则羌活汤主之（本条）。
初发热时，其热烙手，目赤鼻干唇燥，小便赤，大便秘，烦闷不安，此表里俱热，毒瓦斯壅遏，宜发表攻里，
双解散主之（初热）。初发热时，表不大热，其人烦躁不安，此热在里也，以三黄丸微利之（本条）。初发热时，或乘疫
疠之气，人参败毒散主之（初热）。初发热时，或为风寒所袭，出不快者，桂枝葛根汤、羌活汤、双解散去大黄
主之（三方俱见初热）。
痘疮之证，其初不免于发热者，未出，毒邪在里，煎熬气血，熏蒸脏腑而然，疮既现形，则毒泄而热解，所以疮
出热退者，疮本必疏。若疮已出，热不少减，此毒蕴于中，其势方张，其疮必密，宜急解其毒，连翘升麻汤（见形）加
防风、
荆芥穗、地骨皮，或解毒防风汤（大法）加升麻，或东垣鼠粘子汤（见形）兼服代天宣化丸（预防），服药之后，
疮或不出，或再出，其热顿减者，为气和也。热若不减，疮渐加多，再消详大小便何如，大便不通，七物升麻丸（初热）。
小便不利，连翘汤（小便不利）。小大便俱不通，八正散（小便不利）。自利者，黄芩汤（自利）加白头翁、酒黄连、
调赤石脂末，里气和，毒解矣。
如更加渴，烦躁不已，或谵妄，或腹胀满气促，或自利不止，手足厥冷，此逆证勿治。如疮已出，但微发热，不须
治之，盖疮疹属火，非热不能成就也（以上见形而热）。
钱氏云∶有大热，则当利小便。小热当解毒。大热，谓身热脉实，大小便秘，津液燥而渴，惧其变生他疾，故利
小便，八正散、通关散，大便润者连翘汤（三方俱见小便不利），导赤散（心）加人参、麦门冬，使心火有所导引，则虽
不用冷药，热亦自减去矣，疮痘不至热过，不为冷误，甚为良法。小热解毒之说，谓小热不解，大热必
生，利其小便、则虑损气，故但可解毒而已，甘桔汤（咽喉）加牛蒡子、荆芥穗（以上起发而热。）
如疮浆脓已成，毒瓦斯已尽，又复发热者，俗呼为干浆，不须施治。
如结痂之后，其热不退者，此邪气未尽，正气未复，热微者不须治之，热甚者当视其虚实。
羌活汤
羌活 川芎 防风 山栀子 龙胆草 当归（各等分） 甘草（减半）
上锉细。加薄荷叶少许，淡竹叶水一盏，煎七分，去滓，温服无时。
加味葛根汤 治痘失表，发热谵语。
升麻 葛根 赤芍 甘草 桔梗 柴胡 荆芥 防风 连翘 牛蒡子 木通
上，水煎服。
如圣汤 治痘已出，身热如火。
紫草 升麻 葛根 白芍 甘草 木通 猴梨
各等分，加姜一片，葱白三茎，水煎，热服。心烦，加麦门冬、赤茯苓。烦
渴，加生脉散。七八九日身如火者，加酒炒黄芩、地骨皮。
柴胡麦门冬汤 治痘壮热，经日不退。
柴胡 麦门冬 甘草 人参 玄参 龙胆草
上，水煎服，热退，即止。一方，无人参。
〔丹〕胡宅痘疮发热，此血少有余毒也。
陈皮 白术 当归身 白芍药（各三钱） 牛蒡子（研破，炒，二钱） 木通 犀角 生甘草 川芎（各一钱半）
上，分六帖，水盏半煎，食前，稍热服。
〔活〕连翘散 治一切热，兼治疮疹如神。
连翘 防风 栀子 甘草（各等分）
上为末。水煎服。（海藏云，治热在外而不厥，此少阳药也。）
易老云凉膈去大黄、芒硝者，能解六经中热，此不惟解热，治小儿 疹热候，亦使
发之，则本药与防风荆芥二物各半，白水煎服。
〔河〕栀子金花丸
黄芩 黄连 黄柏 山栀（炒。各等分）
上为末。滴水、丸如豆子大。每服五丸，白汤下。
〔钱〕三黄丸 治诸热。
黄芩（半两） 大黄（煨） 黄连（各二钱半
上为细末。糊丸，绿豆大。每服五七丸至十五二十丸，食后，米饮送下。
上，钱氏云∶有小热者解毒。海藏谓∶解毒者，三黄丸、金花丸、之类是也。
四圣散 〔海藏〕紫草木通汤（二方俱见形） 导赤散（心） 八正散（小便不利）
〔丹〕有初起烦躁谵语，狂渴引饮，若饮水，则后来靥不齐，急以凉药解其标，如益元散之类可用。
上五方，利小便、退热之剂，钱氏云∶有大热者，利小便。又云∶身热烦渴，
腹满而喘，大小便涩，面赤闷乱大吐，此当利小便，盖此用导赤散之类是也。
〔钱〕 宣风散
槟榔（两个） 陈皮 甘草（各半两） 牵牛（四两，半生半熟）
上为细末。三二岁蜜汤调下五分，以上一钱，食前。易老加防风。
通膈丸 利上下气血药也。
大黄 牵牛 木通（各等分）
上为细末。滴水、丸如粟粒大。每服三五十丸，量儿大小虚实加减。
上，钱氏云∶有大热，利小便不瘥者，宜宣风下之。
【疮疹发热】
疮疹引起的发热，与伤寒相似，但伤寒仅表现为某一经络的病证，而疮疹则见面部干燥、两腮发红，频繁打呵欠、神情倦怠，忽冷忽热，嗜睡咳嗽，打喷嚏，惊悸，呕吐腹泻且手足稍冷（凉耳指耳朵发凉）。然而，发热是疮疹的常见征候，不能完全消除它。热度轻微则毒邪轻微，热度严重则毒邪严重。
初起发热时，若精神清爽，嘴唇和鼻子滋润，没有其他症状，说明热邪在表，疮疹必然稀疏，不需要治疗。初起发热时，若全身高热但不口渴，大小便正常，说明邪气在表，郁结于皮肤之间，宜用轻扬升散的方剂发散，主方为升麻葛根汤（用于初热阶段），严重时可用羌活汤（本条所述情况）。
初起发热时，若热度烫手，眼睛红赤、鼻子干燥、嘴唇干裂，小便黄赤，大便秘结，烦躁不安，说明表里俱热，毒邪壅滞，宜采用解表攻里的方法，主方为双解散（用于初热阶段）。初起发热时，若体表不太热，但患者烦躁不安，说明热邪在里，可用三黄丸轻微通下（本条所述情况）。初起发热时，若是感染了疫疠之气，主方为人参败毒散（用于初热阶段）。初起发热时，若是被风寒侵袭导致痘疹透发不畅，可用桂枝葛根汤、羌活汤，或双解散去掉大黄（三方均见于初热阶段）。
痘疮发病初期难免发热，这是因为痘疹未出时，毒邪在体内，煎熬气血，熏蒸脏腑所致。当疮疹发出后，毒邪外泄，热势自解，所以疮疹发出后热退的，说明痘疮原本稀疏。如果疮疹已发出，热势并未减轻，说明毒邪蕴结于内，势头正盛，痘疮必然密集，应紧急解毒，可用连翘升麻汤（见形阶段）加防风、荆芥穗、地骨皮，或解毒防风汤（大法）加升麻，或东垣鼠粘子汤（见形阶段）兼服代天宣化丸（预防用药）。服药后，若痘疹发出或再次发出，热势顿时减退，这是正气调和的表现。若热势不减，痘疹逐渐增多，再仔细查看大小便情况：大便不通，用七物升麻丸（初热阶段）；小便不利，用连翘汤（小便不利阶段）；大小便都不通，用八正散（小便不利阶段）；自行腹泻的，用黄芩汤（自利阶段）加白头翁、酒黄连，并调入赤石脂末，待里气调和，毒邪解除。
如果更加口渴，烦躁不止，或出现胡言乱语，或腹胀满、气短急促，或腹泻不止、手足厥冷，这是逆证，不可治疗。如果疮疹已发出，只是轻微发热，不需要治疗，因为疮疹属火，没有热势就不能成熟（以上为见形阶段的热证）。
钱乙说：有大热时，应当利小便。小热时应当解毒。所谓大热，是指身体发热、脉象实大，大小便闭塞，津液干燥而口渴，担心由此变生其他疾病，所以要利小便，可用八正散、通关散，若大便润者用连翘汤（三方均见于小便不利阶段），导赤散（心经）加人参、麦门冬，使心火有所引导，这样即使不用寒凉药，热势也会自然减退，痘疮不至于过热，也不致因误用冷药而受损，这是很好的方法。关于小热解毒的说法，是指小热不解，必会发展为大热，利小便又担心损伤正气，所以只可解毒而已，可用甘桔汤（咽喉）加牛蒡子、荆芥穗（以上为起发阶段的热证）。
如果疮疹浆脓已成，毒邪已尽，却又重新发热，俗称为“干浆”，不需要治疗。
如果结痂之后，热势不退，说明邪气未尽，正气未复。热势轻微的无需治疗，热势严重的应当辨别虚实。
【羌活汤】
组成：羌活、川芎、防风、山栀子、龙胆草、当归（各等分），甘草（减半）。
制法：切碎。加少许薄荷叶，淡竹叶水一盏，煎至七分，去渣，随时温服。
【加味葛根汤】
主治：痘疹失于发表，发热谵语。
组成：升麻、葛根、赤芍、甘草、桔梗、柴胡、荆芥、防风、连翘、牛蒡子、木通。
制法：水煎服。
【如圣汤】
主治：痘疹已出，身热如火。
组成：紫草、升麻、葛根、白芍、甘草、木通、猴梨（各等分）。
制法：加生姜一片，葱白三茎，水煎，热服。心烦者，加麦门冬、赤茯苓。烦渴者，加生脉散。七八九日身热如火者，加酒炒黄芩、地骨皮。
【柴胡麦门冬汤】
主治：痘疹壮热，多日不退。
组成：柴胡、麦门冬、甘草、人参、玄参、龙胆草。
制法：水煎服，热退即停服。另一版本无人参。
【丹溪案】
胡家痘疮发热，这是血少而有余毒。
组成：陈皮、白术、当归身、白芍药（各三钱），牛蒡子（研破，炒，二钱），木通、犀角、生甘草、川芎（各一钱半）。
制法：分六帖，用水一盏半煎，饭前稍热服。
【活人书·连翘散】
主治：一切热证，兼治疮疹如神效。
组成：连翘、防风、栀子、甘草（各等分）。
制法：研为细末。水煎服。（海藏云：治疗热邪在外而不四肢厥冷，这是少阳经的药物。）
易老云：凉膈散去大黄、芒硝，能解六经中的热邪，这不仅解热，治疗小儿疹热证候，也能促使发越，此时原药与防风、荆芥各半，白水煎服。
【河间·栀子金花丸】
组成：黄芩、黄连、黄柏、山栀（炒，各等分）。
制法：研为细末，滴水泛丸如豆大。每服五丸，白开水送下。
【钱氏·三黄丸】
主治：各种热证。
组成：黄芩（半两）、大黄（煨）、黄连（各二钱半）。
制法：研为细末，糊丸，绿豆大。每服五七丸至十五二十丸，饭后米饮送下。
上文钱氏云：有小热者解毒。海藏谓：解毒者，指三黄丸、金花丸之类。
四圣散 〔海藏〕紫草木通汤（二方均见于见形阶段） 导赤散（心经） 八正散（小便不利）
【丹溪】
有初起烦躁谵语，狂渴引饮，若饮水，则后来收靥不齐，急以凉药解其标，如益元散之类可用。
上述五个方子，都是利小便、退热的药剂。钱氏云：有大热者，利小便。又云：身热烦渴，腹满而喘，大小便涩，面赤闷乱大吐，这应当利小便，大概这里用的是导赤散之类。
【钱氏·宣风散】
组成：槟榔（两个），陈皮、甘草（各半两），牵牛（四两，半生半熟）。
制法：研为细末。两三岁儿童用蜜汤调下五分，以上一钱，饭前服用。易老加防风。
【通膈丸】
功效：通利上下气血的药。
组成：大黄、牵牛、木通（各等分）。
制法：研为细末，滴水泛丸如粟粒大。每服三五十丸，根据患儿大小虚实加减。
上文钱氏云：有大热，利小便不愈者，宜用宣风散攻下。
[Febrile Syndrome of Smallpox and Chickenpox]
The fever caused by smallpox and chickenpox resembles that of Cold Damage (Shanghan), but while Cold Damage manifests only as symptoms of a single meridian, smallpox and chickenpox present with dry face, red cheeks, frequent yawning, lethargy, alternating chills and fever, drowsiness, coughing, sneezing, palpitations, vomiting, diarrhea, and slightly cold hands and feet (cool ears refer to coolness of the ears). However, fever is a common sign of these eruptions and should not be completely suppressed. Mild heat indicates mild toxin, while severe heat indicates severe toxin.
At the initial stage of fever, if the spirit is clear, lips and nose are moist, and there are no other symptoms, the heat is in the exterior; the eruptions will likely be sparse, requiring no treatment. At the initial stage, if there is high fever throughout the body but no thirst, and urination and defecation are normal, the pathogen is in the exterior, constrained within the skin. It is appropriate to use light, ascending, and dispersing formulas to release the exterior. The main formula is Shengma Gegen Tang (Cinnamon Twig and Kudzu Decoction) for the initial heat phase; in severe cases, Qianghuo Tang may be used.
At the initial stage, if the heat feels scalding to the touch, eyes are red, nose and lips are dry, urine is dark red, stool is constipated, and there is restlessness and oppression, this indicates heat in both the interior and exterior with stagnation of toxic factors. The method of releasing the exterior and purging the interior is indicated, with Shuangjie San (Double Release Powder) as the main formula for the initial heat phase. At the initial stage, if the exterior is not significantly hot but the patient is irritable and restless, the heat is in the interior; Sanhuang Wan (Three Yellows Pill) can be used to induce mild purgation. If the initial fever is due to epidemic pestilence qi, Renshen Baidu San (Ginseng Detoxification Powder) is indicated. If the initial fever is caused by wind-cold invasion leading to poor eruption, Guizhi Gegen Tang, Qianghuo Tang, or Shuangjie San without Dahuang (Rhubarb) may be used.
In the early stage of variola (smallpox), fever is inevitable because before the eruption, the toxic factor is internal, boiling blood and qi, and steaming the zang-fu organs. Once the lesions appear, the toxin is vented externally, and the heat resolves; thus, fever subsiding after eruption indicates originally sparse lesions. If the eruption has appeared but the fever does not decrease, the toxin is retained internally with vigorous momentum, indicating dense lesions. Urgent detoxification is required. Liaoqiao Shengma Tang (Forsythia and Cimicifuga Decoction) added with Fangfeng (Saposhnikovia Root), Jingjiesui (Schizonepeta Spike), and Digupi (Phellodendron Bark); or Jiedu Fangfeng Tang (Detoxifying Saposhnikovia Decoction) added with Shengma (Cimicifuga Rhizome); or Dongyuan Niuzangzi Tang (Burdock Seed Decoction by Li Dongyuan) taken concurrently with Taitian Xuanhua Wan (Heavenly Announcement Transformation Pill) for prevention. After medication, if eruptions appear or reappear and the fever suddenly decreases, this indicates harmonious qi. If the fever persists and eruptions increase, examine the urination and defecation: if stool is blocked, use Qiwu Shengma Wan (Seven-Ingredient Cimicifuga Pill); if urination is difficult, use Liaoqiao Tang (Forsythia Decoction); if both are blocked, use Bazheng San (Eight-Ingredient Corrective Powder); if spontaneous diarrhea occurs, use Huangqin Tang (Scutellaria Decoction) added with Baitouweng (Pulsatilla Root), Jiuhuanglian (Wine-processed Coptis Rhizome), and mixed with Chishizhi powder (Red Halloysite). When the interior qi harmonizes, the toxin is resolved.
If thirst increases, irritability persists, delirium occurs, abdominal distension and shortness of breath arise, or diarrhea is unceasing with cold extremities, these are adverse signs (Ni Zheng) and should not be treated. If the eruption has appeared but only slight fever remains, no treatment is needed, as eruptions belong to fire and require heat to mature (above refers to febrile conditions during the eruption stage).
Qian Yi stated: For severe heat, promote urination. For mild heat, resolve toxicity. Severe heat refers to body fever, solid pulse, blockage of urination and defecation, dry fluids with thirst, fearing transformation into other diseases; hence, promoting urination is necessary using Bazheng San, Tongguan San, or Liaoqiao Tang if stool is moist (all three formulas seen under difficulty in urination). Daochi San (Heart Meridian) added with Renshen (Ginseng) and Maimendong (Ophiopogon Tuber) guides heart fire, so even without cold medicines, heat will subside naturally, preventing excessive heat or damage from mistaken cold usage, which is an excellent method. Regarding resolving toxicity for mild heat: if mild heat is unresolved, it will become severe; promoting urination risks damaging qi, so only resolving toxicity is advisable, using Ganjie Tang (Licorice and Platycodon Decoction) added with Niubangzi (Burdock Fruit) and Jingjiesui (above refers to febrile conditions during the rising stage).
If the pus is formed and toxins exhausted, yet fever recurs, commonly called "dry pus," no treatment is needed.
After scabbing, if fever persists, it indicates incomplete elimination of pathogens and recovery of healthy qi. Mild fever requires no treatment; severe fever requires differentiation of deficiency and excess.
[Qianghuo Tang]
Ingredients: Qianghuo (Notopterygium Rhizome), Chuanxiong (Ligusticum Rhizome), Fangfeng (Saposhnikovia Root), Shanzhizi (Gardeniae Fructus), Longdancao (Gentiana Radix), Danggui (Angelica Sinensis) in equal parts; Gancao (Licorice Root) halved.
Preparation: Coarsely powdered. Add a little Boheye (Mint Leaf), decoct one cup of Danzhuyexue (Lophatherum Water) to七分 (70%), strain, and take warm at any time.
[Jiawei Gegen Tang]
Indications: Smallpox failing to release via sweating, with fever and delirium.
Ingredients: Shengma (Cimicifuga Rhizome), Gegen (Puerariae Radix), Chishao (Paeoniae Radix Rubra), Gancao (Licorice Root), Jiegeng (Platycodon Root), Chaihu (Bupleuri Radix), Jingjie (Schizonepeta Spike), Fangfeng (Saposhnikovia Root), Liaoqiao (Forsythiae Fructus), Niubangzi (Arctii Fructus), Mutong (Akebia Caulis).
Preparation: Decoct in water and take.
[Rusheng Tang]
Indications: Smallpox erupted, body heat like fire.
Ingredients: Zicao (Lithospermi Radix), Shengma (Cimicifuga Rhizome), Gegen (Puerariae Radix), Baishao (Paeoniae Radix Alba), Gancao (Licorice Root), Mutong (Akebia Caulis), Houli (Monkey Pear - *Note: Likely a local variant or typo for another herb, kept as transliteration*) in equal parts.
Preparation: Add one slice of Jiangsheng (Fresh Ginger) and three stalks of Congbai (Scallion White), decoct in water, and take hot. For mental distress, add Maimendong (Ophiopogon Tuber) and Chi Fuling (Polyporus with Mycelium). For vexation and thirst, add Shengmai San (Generate Pulse Powder). For intense heat on days 7-9, add Jiuhuangqin (Wine-processed Scutellaria Root) and Digupi (Phellodendri Cortex).
[Chaihu Maimendong Tang]
Indications: Severe fever of smallpox persisting for days.
Ingredients: Chaihu (Bupleuri Radix), Maimendong (Ophiopogon Tuber), Gancao (Licorice Root), Renshen (Ginseng), Xuanshen (Scrophulariae Radix), Longdancao (Gentiana Radix).
Preparation: Decoct in water and take. Stop when fever subsides. Another version excludes Renshen.
[Danxi Case]
Hu family's smallpox fever: This is blood deficiency with residual toxin.
Ingredients: Chenpi (Citrus Peel), Baizhu (Atractylodes Rhizome), Dangguishen (Ginseng Root Body), Baishaoyao (White Peony Root) each 3 qian; Niubangzi (crushed, fried) 2 qian; Mutong (Akebia Caulis), Xijiao (Rhinoceros Horn - *Historical term, now substituted with Buffalo Horn*), Sheng Gancao (Raw Licorice), Chuanxiong (Ligusticum Rhizome) each 1.5 qian.
Preparation: Divide into six doses. Decoct in 1.5 cups of water. Take slightly warm before meals.
[Huo Ren Shu · Liaoqiao San]
Indications: All types of heat, miraculous for treating eruptions.
Ingredients: Liaoqiao (Forsythiae Fructus), Fangfeng (Saposhnikovia Root), Zhizi (Gardeniae Fructus), Gancao (Licorice Root) in equal parts.
Preparation: Powdered. Decoct in water and take. (Haizang said: Treats heat outside without cold extremities; this is a Shaoyang meridian formula.)
Yi Lao stated: Removing Dahuang (Rhubarb) and Mangxiao (Mirabilite) from Liangge San allows resolution of heat in the six meridians. This not only clears heat but also treats pediatric rash heat, promoting eruption. Use half the original formula and half Fangfeng and Jingjie, decocted in plain water.
[Hejian · Zhizi Jinhua Wan]
Ingredients: Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Huangbai (Phellodendron Bark), Zhizi (Gardeniae Fructus, fried) in equal parts.
Preparation: Powdered. Mix with water to form pills the size of beans. Take five pills per dose with white boiled water.
[Qian Shi · Sanhuang Wan]
Indications: Various heat syndromes.
Ingredients: Huangqin (Scutellaria Root) 0.5 liang; Huanglian (Coptis Rhizome) and Huangbo (Phellodendron Bark, baked) each 2.5 qian.
Preparation: Fine powder. Make pills with paste, size of mung beans. Take 5-7 to 15-20 pills after meals with rice water.
As mentioned above, Qian Shi said: Resolve toxicity for mild heat. Haizang stated: Resolving toxicity refers to Sanhuang Wan, Jinhua Wan, etc.
Four Saints Powder [Haizang] Zicao Mutong Tang (both formulas seen in eruption stage) Daochi San (Heart Meridian) Bazheng San (Difficulty in Urination)
[Danxi]
Initial restlessness, delirium,狂渴 (wild thirst) drinking water; if water is drunk, later scabbing will be uneven. Urgently resolve the branch with cooling medicines, such as Yiyuan San.
The above five formulas are agents for promoting urination and reducing fever. Qian Shi said: For severe heat, promote urination. He also said: Body heat, vexation, thirst, abdominal fullness, panting,涩 (astringency/blockage) of urination and defecation, red face, oppression, confusion, and massive vomiting indicate the need to promote urination, typically using Daochi San.
[Qian Shi · Xuanfeng San]
Ingredients: Binglang (Areca Seed) two pieces; Chenpi (Citrus Peel), Gancao (Licorice Root) each 0.5 liang; Qianniu (Morning Glory Seed) 4 liang, half raw half cooked.
Preparation: Fine powder. For children aged 3-2 years, mix with honey water and take 0.5 fen; for older children, up to 1 qian. Take before meals. Yi Lao adds Fangfeng.
[Tongge Wan]
Function: Agents to regulate qi and blood in the upper and lower jiao.
Ingredients: Dahuang (Rhubarb Rhizome), Qianniu (Morning Glory Seed), Mutong (Akebia Caulis) in equal parts.
Preparation: Fine powder. Mix with water to form pills the size of millet seeds. Take 30-50 pills per dose, adjusting according to the child's age and constitution.
As mentioned above, Qian Shi said: For severe heat where promoting urination fails, use Xuanfeng San to purge.