陈文宿先生云∶痘疮十一日至十二日,当靥不靥,身热闷乱不宁,卧则哽气,腹胀泄泻,寒战切牙,急用异功散加
木香、当归,以救阴阳表里助其收靥。窃谓∶前症若手足并冷,属脾胃虚寒,宜用十二味异功散。手足微冷,属脾胃虚
弱,宜用五味异功散加木香。若手足热,大便秘,属脾胃实热,宜用清凉饮,救其阴,以抑其阳。
一小儿痘,寒战切牙,泻渴腹胀,手足冷,时仲夏,饮沸汤口不知热,先君谓脾气虚寒,用十二味异功散,一剂顿
安;又用五味异功散,调补而愈;再用参 四圣散而痊。
一小儿痘不结痂,发热饮汤,哽气腹胀,此脾气虚弱,用五味异功散、参 四圣散而愈。后噫气下气,欲服枳壳之
类。余谓∶噫气属心火虚,下气属脾气虚。朝用六君子汤加姜、桂,夕用补中益气汤而愈。
一小儿哽气喘咳,腹胀下气,手足不冷不热,此脾虚不能摄气而腹胀下气,肺虚不能摄气而哽气喘咳,用五味异功
散加升麻而愈。
一小儿痘将愈,足冷哽气腹痛,手冷至肾,唇青面白,属脾胃虚寒也,用五味异功散加附子二剂,足稍温;又用六
君、姜、桂一剂,诸症渐退,乃去姜、桂,服之而痊。
一小儿痘不结痂,作渴饮冷,大便秘结,此肠胃有热也,先用清凉饮末一钱,大便和而顿靥;又用人参麦门冬
散、八珍汤而痊。
一小儿痘不结痂,用补中益气汤、地黄丸料煎服而愈。次年毕姻后,寒热作渴,头晕,脉洪数,按之微细,此脾肾
虚火上炎也,以前药各加肉桂五分,引火归经而愈。
一小儿痘不靥发热,因乳母有肝火,用加味逍遥散、人参白术散,母子俱服而热止;又用柴胡麦门冬散而痊。
一小儿十五岁,久而结痂,寒热往来,脉洪数,按之无力,用十全大补汤而痊。后因劳寒热复发,用补中益气汤而
安。
六君子汤 治脾气虚弱,或因克伐之剂,亏损中气,饮食少思,或痘疮不起发,灌浆结痂。
人参 白术(炒) 茯苓 陈皮(炒) 半夏(汤洗) 甘草(炒。各等分)
上三五钱,姜枣水煎,徐徐服。
四君子汤(即六君子汤去陈皮、半夏)
四顺清凉饮 王海藏先生云∶痘疹脓贯而不焦者,由治失清凉之法,内外热毒,无以收敛。譬如五谷得阳气而
成熟,得阴气而结实,用清凉饮子下之。(方见大便不通)
十二味异功散(方见顶陷灰白)
人参麦门冬散(方见发热口渴)
柴胡麦门冬散(方见作痒搔破)
加味逍遥散(方见欲靥不靥)
补中益气汤
五味异功散(二方见寒战切牙)
参 四圣散
十全大补汤(二方见腹胀气促)
人参白术散(即七味白术散)
地黄丸(二方见发热属阴属阳)
陈文宿先生说:痘疮发病到第十一、十二日,应当结痂却未结痂,身体发热、烦闷躁动不安,躺下时咽喉气逆(哽气),腹部胀满、腹泻,寒战且牙齿打颤,此时应紧急使用异功散加木香、当归,以救助阴阳表里,帮助其收靥结痂。我认为:前述症状如果手足都冰冷,属于脾胃虚寒证,适宜使用十二味异功散;如果手足微微发冷,属于脾胃虚弱证,适宜使用五味异功散加木香;如果手足发热,大便秘结,属于脾胃实热证,适宜使用清凉饮,以救阴液,抑制阳热。
有一个小儿出痘,出现寒战切牙、腹泻口渴、腹胀、手足冰冷,当时正值仲夏,喝滚烫的水却感觉不到烫,我的父亲认为这是脾气虚寒,使用了十二味异功散,一剂药后病情立刻安定;接着又用五味异功散调理补益而痊愈;最后再用参四圣散服用而彻底康复。
另一个小儿出痘不结痂,发热想喝水,咽喉气逆、腹胀,这是脾气虚弱所致,使用五味异功散、参四圣散而痊愈。后来出现嗳气和排气增多,想要服用枳壳之类的药物。我说:嗳气属于心火虚,排气增多属于脾气虚。早晨服用六君子汤加生姜、肉桂,晚上服用补中益气汤,从而痊愈。
还有一个小儿咽喉气逆、气喘咳嗽,腹胀、排气增多,手足不冷也不热,这是脾虚不能统摄气机导致腹胀和排气增多,肺虚不能统摄气机导致咽喉气逆、气喘咳嗽,使用五味异功散加升麻而痊愈。
又一个小儿痘疮将要痊愈,脚冷、咽喉气逆、腹痛,手冷直到肾脏部位,嘴唇青紫、面色苍白,属于脾胃虚寒证,使用五味异功散加附子,服用两剂后双脚稍微回暖;接着又用六君子汤加生姜、肉桂,服用一剂后各种症状逐渐消退,于是去掉生姜、肉桂,继续服用而痊愈。
又一个小儿痘疮不结痂,感到口渴想喝冷水,大便秘结,这是肠胃有热,先用清凉饮粉末一钱,大便调和后痘疮立即结痂;接着用人参麦门冬散、八珍汤而痊愈。
又一个小儿痘疮不结痂,使用补中益气汤、地黄丸料煎服而痊愈。第二年结婚后,出现忽冷忽热、口渴、头晕,脉象洪大而数,重按则微细,这是脾肾阴虚导致虚火上炎,以前面提到的药物各加肉桂五分,引火归元而痊愈。
又一个小儿痘疮未结痂且发热,因为乳母有肝火,让母子共同服用加味逍遥散、人参白术散,热势停止;接着用柴胡麦门冬散而痊愈。
又一个十五岁的小儿,痘疮久不结痂,寒热往来,脉象洪大数急,重按无力,使用十全大补汤而痊愈。后来因劳累导致虚寒发热复发,使用补中益气汤而安定。
六君子汤 治疗脾气虚弱,或因攻伐类药物损伤,导致中气亏损,饮食减少思虑,或者痘疮不起发、灌浆、结痂困难。
人参、白术(炒)、茯苓、陈皮(炒)、半夏(热水洗)、甘草(炒)。以上药材各等分。
每次取三五钱,用生姜、大枣水煎煮,慢慢服用。
四顺清凉饮 王海藏先生说:痘疹脓疱饱满但不焦枯的,是因为治疗时失去了清凉的方法,内外热毒无法收敛。这就好比五谷得到阳气而成熟,得到阴气而结实,使用清凉饮子通下。(方剂见“大便不通”条)
十二味异功散(方剂见“顶陷灰白”条)
柴胡麦门冬散(方剂见“作痒搔破”条)
Mr. Chen Wensu stated: On the eleventh to twelfth day of smallpox, when the lesions should be crusting over but fail to do so, accompanied by fever, restlessness, and irritability; upon lying down, there is throat obstruction with gas (Gengqi), abdominal distension, diarrhea, chills, and teeth grinding. In such urgent cases, Yigong San (Yi Gong Powder) augmented with Muxiang (Aucklandiae Radix) and Danggui (Angelicae Sinensis Radix) should be used immediately to rescue Yin and Yang, exterior and interior, and assist in the crusting process. I opine that if the aforementioned symptoms present with coldness in both hands and feet, it belongs to Spleen-Stomach Deficiency-Cold, and Shierwei Yigong San (Twelve-Ingredient Yi Gong Powder) is appropriate. If the hands and feet are slightly cold, it belongs to Spleen-Stomach Weakness, and Wutou Yigong San (Five-Ingredient Yi Gong Powder) augmented with Muxiang is appropriate. If the hands and feet are hot and stool is constipated, it belongs to Spleen-Stomach Excess-Heat, and Qingliang Yin (Cooling Decoction) is appropriate to nourish Yin and suppress Yang.
A child with smallpox presented with chills, teeth grinding, diarrhea, thirst, abdominal distension, and cold extremities. It was midsummer, and the child drank boiling water without feeling the heat. My father diagnosed this as Spleen-Qi Deficiency-Cold and prescribed Shierwei Yigong San. After one dose, the condition stabilized immediately. Subsequently, Wutou Yigong San was used for regulation and tonification, leading to recovery. Finally, Shen Si Sheng San (Shen Four-Sage Powder) was administered to ensure complete cure.
Another child with smallpox failed to crust, exhibited fever, thirst, throat obstruction with gas, and abdominal distension. This was attributed to Spleen-Qi Weakness. Treatment with Wutou Yigong San and Shen Si Sheng San resulted in recovery. Later, the child developed belching (Yiqi) and excessive flatulence, and wished to use Zhiqiao (Fructus Aurantii). I stated that belching belongs to Heart-Fire Deficiency, and excessive flatulence belongs to Spleen-Qi Deficiency. Morning administration of Liujunzi Tang (Six-Gentleman Decoction) added with Shengjiang (Zingiberis Rhizoma Recens) and Rongui (Cinnamomi Cortex) and evening administration of Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting Qi) led to recovery.
Another child presented with throat obstruction, wheezing, cough, abdominal distension, and excessive flatulence, with extremities neither cold nor hot. This indicated that Spleen-Deficiency failed to control Qi, causing abdominal distension and flatulence, while Lung-Deficiency failed to control Qi, causing throat obstruction, wheezing, and cough. Treatment with Wutou Yigong San added with Shengma (Cimicifugae Rhizoma) resulted in recovery.
Another child, whose smallpox was nearing resolution, presented with cold feet, throat obstruction, abdominal pain, cold hands extending to the kidney region, cyanotic lips, and pale complexion. This belonged to Spleen-Stomach Deficiency-Cold. Five-ingredient Yi Gong Powder added with Fuzi (Aconiti Lateralis Radix Preparata) was administered for two doses, after which the feet became slightly warm. Then, Liujunzi Tang added with Shengjiang and Rongui was given for one dose, gradually alleviating all symptoms. The ginger and cinnamon were then removed, and continued administration led to recovery.
Another child with smallpox failing to crust presented with thirst, desire for cold drinks, and constipation. This indicated Heat in the Intestines and Stomach. Initially, one qian of Qingliang Yin powder was administered. Once the stool normalized, the lesions crusted over immediately. Subsequently, Renshen Maidong San (Ginseng and Ophiopogon Powder) and Bazhen Tang (Eight-Treasure Decoction) were used to achieve recovery.
Another child with smallpox failing to crust was treated with Buzhong Yiqi Tang and Dihuang Wan (Rehmannia Pill) decocted and taken orally, resulting in recovery. The following year, after marriage, the child experienced alternating chills and fever, thirst, dizziness, and a pulse that was flooding and rapid but thready and fine upon deep pressure. This was diagnosed as Deficient Fire flaming upward due to Spleen-Kidney Yin Deficiency. Previous prescriptions were supplemented with five fen of Rougui (Cinnamomi Cortex) to guide fire back to its source, leading to recovery.
Another child with smallpox not yet crusted and presenting with fever had a wet nurse suffering from Liver-Fire. Both mother and child took Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) and Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Powder), which stopped the fever. Subsequently, Chaihu Maidong San (Bupleurum and Ophiopogon Powder) was used for complete recovery.
A fifteen-year-old child had smallpox that lingered without crusting, presenting with alternating chills and fever, a flooding and rapid pulse that was powerless upon deep pressure. Shiquan Dabu Tang (Perfect Golden Great Tonifying Decoction) was administered, resulting in recovery. Later, due to fatigue, deficiency-cold fever recurred, and Buzhong Yiqi Tang was used to stabilize the condition.
Liujunzi Tang (Six-Gentleman Decoction): Treats Spleen-Qi Weakness, or damage to Middle Qi caused by purgative agents, resulting in poor appetite or difficulties in smallpox eruption, suppuration, and crusting.
Ingredients: Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried), Fuling (Poria), Chenpi (Citri Reticulatae Pericarpium, stir-fried), Banxia (Pinelliae Rhizoma, washed with hot water), Gancao (Licorice Root, stir-fried). All ingredients in equal proportions.
Dosage: Take 3–5 qian, decoct with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus), and take slowly.
Sijunzi Tang (Four-Gentleman Decoction): Identical to Liujunzi Tang but without Chenpi and Banxia.
Sishun Qingliang Yin (Four-Orientations Cooling Decoction): Mr. Wang Haicang stated: When smallpox pustules are full but not scorched, it is due to the failure to employ cooling methods during treatment, leaving internal and external heat toxins unable to resolve. Just as grains mature under Yang Qi and solidify under Yin Qi, Qingliang Yin Zi (Cooling Decoction) should be used to purge downward. (Formula see entry "Constipation")
Shierwei Yigong San (Twelve-Ingredient Yi Gong Powder): (Formula see entry "Sunken Top and Ashy White")
Renshen Maidong San (Ginseng and Ophiopogon Powder): (Formula see entry "Fever and Thirst")
Chaihu Maidong San (Bupleurum and Ophiopogon Powder): (Formula see entry "Itching and Scratching")
Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder): (Formula see entry "Desire to Crust but Failure to Do So")
Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting Qi)
Wutou Yigong San (Five-Ingredient Yi Gong Powder): (See two formulas under "Chills and Teeth Grinding")
Shen Si Sheng San (Shen Four-Sage Powder)
Shiquan Dabu Tang (Perfect Golden Great Tonifying Decoction): (See two formulas under "Abdominal Distension and Shortness of Breath")
Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Powder): Identical to Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder).
Dihuang Wan (Rehmannia Pill): (See two formulas under "Fever Belonging to Yin or Yang")