干紫黑煤青黯,面目胸腹稠密,咽喉攒缠,发不出而喘,没早而喘,循衣摸床,谵语撮
空,厥逆螈 ,神昏志丧,喘急不嗽,通关不嚏,口张肩耸,胸高突起,舌干唇燥,搦手摇
头,目无液泪,乃火邪炽盛,余毒内攻,肺窍不通也。
身热喘胀,人事不省,口鼻出血,面色青白干枯者,乃闷疹也,不治。
疹后饮食动止如常,乃卒心腹绞痛,遍身汗出如水者,此因元气虚弱,失于调养,外虽
无病,内实虚损,偶为寒邪所袭,谓之中恶,朝发夕死,夕发朝死。
疹后须避风寒,切戒水湿,如或不谨,遂致终身咳嗽疮疥,无有愈期。
疹后大忌猪羊鸡鱼虾蟹之类,恐惹终身恶累,若食莱菔则终身有心糟之患,诸如此类
随处留神,必先叮嘱告戒。
或热或退而后出者,轻。
淡红滋润,头面匀净而多者,轻。
发透三日而渐没者,轻。
头面不出者,重。
红紫干燥者,重。
冒风没早者,重。
热移大肠变痢者,重。
目睛无神者,不治。
黑暗干枯一出即没者,不治。
气喘,心前吸者,不治。
鼻煽口张,撮唇弄舌者,不治。
鼻准青,粪色黑者,不治。
疳疮色白为胃烂,不治。
喉肿色黑为内陷,不治。
疹之一证比痘尤甚,若调理失宜祸不旋踵。痘由胎毒外邪感触而发,其情势多少轻重
吉凶自可豫断;疹虽由感受邪气而发,然轻者可重,重者可轻,皆在于调养得宜。故必避风
寒,节饮食,斯为至要。若误食鸡鱼,则终身皮肤如鸡皮之状,凡遇天行出疹之时,又复重
出。若误食猪肉,则每岁出疹之时,必然痢下脓血。若误食咸酸,令人咳不止。误食五辛令
人生惊悸。所以通禁必待四十九日之后方可食肉,才无禁忌。苟或不慎,邪内伏,轻变重,
重者死,业医者当嘱病家谨守,慎之,戒之。
德按∶秦氏《痘疹折衷》余藏写本所引汤药不全,令录数方于后。
羌活散
羌活 防风 白芷 荆芥穗 川芎 地骨皮 甘草 连翘 柴胡 牛蒡子 大腹皮。
芦荟肥儿丸
三棱 莪术 青皮(俱醋炒) 陈神曲 黄连 胡黄连 使君肉 芦荟 槟榔 香附 陈皮 麦芽 芜
夷南木香 有癖块加阿魏 干漆
化慝丸
芜荑 芦荟 青黛 川芎 白芷梢 胡黄连 虾蟆灰
开豁腠理汤
升麻 葛根 羌活 荆芥 防风 前胡 柴苏 牛蒡子 陈皮 甘草 桔梗 枳壳
上十二味水煎服。
疹色呈现干枯、紫黑、煤青或暗青色,且面目胸腹部皮疹稠密,咽喉肿胀缠塞,疹子发不出来并伴有气喘,未出齐即出现气喘,患者出现循衣摸床(手指无意识地在衣物或被褥上摸索)、谵语(胡言乱语)、撮空(手在空中虚抓)等症状,四肢厥冷抽搐,神志昏迷意志丧失,气喘急促但不咳嗽,鼻窍不通不打喷嚏,口张肩耸,胸部高耸突起,舌干唇燥,手部痉挛摇头,眼睛没有泪水,这是火邪炽盛,余毒内攻,肺窍闭塞不通所致。
身体发热伴气喘腹胀,人事不省,口鼻出血,面色青白干枯的,属于闷疹(疹毒内陷),无法治愈。
出疹后饮食起居如常,突然发生心腹绞痛,全身出汗如水样的,这是因为元气虚弱,缺乏调养,虽然外表看似无病,内部实则虚损,偶然被寒邪侵袭,称为中恶,早晨发作晚上死亡,晚上发作早晨死亡。
出疹后必须避开风寒,严格戒除水湿,如果不谨慎,会导致终身咳嗽、生疮长疥,没有痊愈的日期。
出疹后大忌吃猪、羊、鸡、鱼、虾、蟹等食物,恐怕会惹来终身的恶疾累赘;如果吃了萝卜(莱菔),则终身会有心中烦闷糟粕之患,诸如此类的事情要处处留心,必须先叮嘱告诫病人。
或者热退之后才出疹子的,病情较轻。
疹色淡红滋润,头面部均匀洁净且数量多的,病情较轻。
疹子透发三天后逐渐消退的,病情较轻。
头面部不出疹子的,病情重。
疹色红紫干燥的,病情重。
眼睛无神的,无法治愈。
疹色黑暗干枯,一出即隐没的,无法治愈。
鼻翼扇动口张,嘴唇收缩弄舌的,无法治愈。
鼻头青色,粪便黑色的,无法治愈。
喉部肿胀颜色发黑表示疹毒内陷,无法治愈。
疹证比痘证更为严重,如果调理不当,灾祸立刻就会降临。痘证是由胎毒和外邪感触而发,其情势多少、轻重、吉凶自然可以预先判断;疹证虽然也是由感受邪气而发,但轻的可以变重,重的可以变轻,都在于调养是否得当。所以必须避开风寒,节制饮食,这是最重要的。如果误食鸡肉鱼肉,则终身皮肤像鸡皮一样粗糙,凡遇到天行(流行性)出疹的时候,又会重新发作。如果误食猪肉,则每年出疹的时候,必然拉下脓血便。如果误食咸酸食物,令人咳嗽不止。误食五辛(葱、蒜、韭、薤、兴渠等辛辣刺激性食物)让人产生惊悸。所以通禁必须等到四十九天之后才可以吃肉,才没有禁忌。如果不谨慎,邪气内伏,轻症变重症,重症导致死亡,从业的医生应当嘱咐病人家属谨守医嘱,慎重对待,引以为戒。
德按:秦氏《痘疹折衷》中余收藏的手写本所引用的汤药不全,现在记录几个方剂在后面。
羌活散
羌活、防风、白芷、荆芥穗、川芎、地骨皮、甘草、连翘、柴胡、牛蒡子、大腹皮。
芦荟肥儿丸
三棱、莪术、青皮(都用醋炒)、陈神曲、黄连、胡黄连、使君子肉、芦荟、槟榔、香附、陈皮、麦芽、芜荑、南木香。有癖块(腹部肿块)加阿魏、干漆。
The rash appears dry, purple-black, coal-blue, or dark cyan. It is dense on the face, eyes, chest, and abdomen. The throat is swollen and obstructed. The rash fails to erupt, accompanied by wheezing. Wheezing occurs before the rash has fully emerged. The patient exhibits involuntary movements such as picking at clothes (xúnyī mōchuáng), delirium (shānyǔ), grasping at empty air (cuōkōng), cold extremities with convulsions (juénì yuánlèi), coma with loss of spirit, rapid breathing without cough, blocked nasal passages preventing sneezing, open mouth with raised shoulders, protruding chest, dry tongue and lips, hand spasms with head shaking, and eyes lacking tears. This indicates blazing fire pathogen, internal attack by residual toxins, and blockage of the lung orifices.
Body heat with wheezing and abdominal distension, unconsciousness, bleeding from the mouth and nose, and a blue-white, dry, and withered complexion indicate "Men Zhen" (Muffled Rash / Internalized Rash). This condition is incurable.
After the rash subsides, if diet and activity are normal, but sudden severe colic occurs with profuse sweating like water, this is due to deficiency of Yuan Qi (Original Qi) and lack of proper care. Although there are no external symptoms of disease, the interior is actually deficient. An accidental invasion by cold pathogen is termed "Zhong E" (Sudden Evil Attack). Death may occur in the morning if onset is in the evening, or in the evening if onset is in the morning.
After the rash, one must avoid wind and cold, and strictly avoid dampness and water. If not cautious, it may lead to lifelong cough, sores, and scabies, with no date for recovery.
After the rash, it is strictly forbidden to eat pork, mutton, chicken, fish, shrimp, crab, etc., lest they provoke lifelong chronic ailments. If radish (Láifú) is eaten, it may cause lifelong internal stagnation and discomfort. Such matters require constant vigilance and must be clearly instructed and warned against beforehand.
If the fever subsides before the rash appears, the condition is mild.
If the rash is pale red, moist, evenly distributed on the head and face, and abundant, the condition is mild.
If the rash fully erupts and gradually fades after three days, the condition is mild.
If the rash does not appear on the head and face, the condition is severe.
If the rash is red-purple and dry, the condition is severe.
If the rash disappears prematurely due to exposure to wind, the condition is severe.
If the heat transfers to the Large Intestine causing dysentery, the condition is severe.
If the eyes lack spirit, the condition is incurable.
If the rash is dark black and dry, disappearing immediately upon emergence, the condition is incurable.
If there is wheezing and retraction above the heart during inspiration, the condition is incurable.
If the nostrils flare, the mouth is open, the lips are pursed, and the tongue is manipulated, the condition is incurable.
If the tip of the nose is blue and the stool is black, the condition is incurable.
If gangrenous sores are white, indicating stomach rot, the condition is incurable.
If the throat is swollen and black, indicating internal collapse of the rash, the condition is incurable.
The rash syndrome is more severe than smallpox. If management is improper, disaster will follow swiftly. Smallpox arises from fetal toxins and external pathogenic influences; its severity and prognosis can be predicted. Although rash also arises from pathogenic invasion, mild cases can become severe, and severe cases can become mild, depending entirely on proper nursing. Therefore, avoiding wind and cold, and regulating diet are paramount. If chicken or fish is mistakenly consumed, the skin may become rough like chicken skin for life, and the rash may recur during epidemic outbreaks. If pork is mistakenly consumed, bloody purulent dysentery will inevitably occur during annual rash seasons. If salty or sour foods are mistakenly consumed, persistent cough results. If five pungent spices (Wǔ Xīn) are mistakenly consumed, palpitations and fright occur. Thus, meat consumption must be prohibited for 49 days to avoid taboos. If not careful, pathogens remain latent internally; mild cases become severe, and severe cases lead to death. Practitioners must instruct patients' families to adhere strictly to these precautions.
De notes: The handwritten copy of Qin's *Dou Zhen Zhe Zhong* that I possess contains incomplete herbal prescriptions. I record several formulas below.
Qiang Huo San (Notopterygium Powder)
Qiang Huo (Notopterygii Rhizoma et Radix), Fang Feng (Saposhnikoviae Radix), Bai Zhi (Angelicae Dahuricae Radix), Jing Jie Sui (Schizonepetae Spica), Chuan Xiong (Chuanxiong Rhizoma), Di Gu Pi (Lycii Cortex), Gan Cao (Glycyrrhizae Radix et Rhizoma), Lian Qiao (Forsythiae Fructus), Chai Hu (Bupleuri Radix), Niu Bang Zi (Arctii Fructus), Da Fu Pi (Arecae Pericarpium).
Lu Hui Fei Er Wan (Aloe Pill for Enlarging the Stomach)
San Leng (Sparganii Rhizoma), E Zhu (Curcumae Rhizoma), Qing Pi (Citri Reticulatae Pericarpium Viride - all stir-fried with vinegar), Chen Shen Qu (Massa Medicata Fermentata), Huang Lian (Coptidis Rhizoma), Hu Huang Lian (Picrorhizae Rhizoma), Shi Jun Rou (Quisqualis Semen), Lu Hui (Aloe), Bing Lang (Areca Semen), Xiang Fu (Cyperi Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Mai Ya (Hordei Fructus Germinatus), Wu Yi (Terminalia Chebulae Fructus), Nan Mu Xiang (Aucklandiae Radix). For abdominal masses, add A Wei (Asafetida) and Gan Qi (Drymarchon Corais - note: traditional toxic herb, often replaced in modern practice).
Hua Te Wan (Pill for Dissolving Malignancy)
Wu Yi (Terminalia Chebulae Fructus), Lu Hui (Aloe), Qing Dai (Indigo Naturalis), Chuan Xiong (Chuanxiong Rhizoma), Bai Zhi Shao (Angelicae Dahuricae Radix Tip), Hu Huang Lian (Picrorhizae Rhizoma), Xia Ma Hui (Bufo Toxin Ash).
Kai Huo Cou Li Tang (Decoction for Opening Interstices)
Sheng Ma (Cimicifugae Rhizoma), Ge Gen (Puerariae Lobatae Radix), Qiang Huo (Notopterygii Rhizoma et Radix), Jing Jie (Schizonepetae Spica), Fang Feng (Saposhnikoviae Radix), Qian Hu (Peucedani Radix), Chai Su (Perillae Folium), Niu Bang Zi (Arctii Fructus), Chen Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma), Jie Geng (Platycodonis Radix), Zhi Ke (Aurantii Fructus Immaturus).
Boil the above twelve herbs in water and take orally.