痧疹之种类，大率如下∶
一、灌脓浆之痧疹
号行浆疹子，其状颇似痘而实则不同，痘必有顶盘，疹虽有浆而颗粒必不坚，根盘
必无红晕。此由平日其人湿盛，或脾胃虚
弱所致。若贯脓后不结痂者，此元气亏损也，当大补脾胃为主，不可误认邪热未尽而与清热退火之剂。
二、疹夹痘
乃痧疹之中，夹有痘疮者，此由毒瓦斯太盛，故一齐涌出。疹以风邪外感之毒为多，痘以胎毒内发之毒为
多。二者相杂，症号难治，盖治痘宜温，治疹宜凉也。然细察虚实寒热，亦有活法可求。譬如虚者热不盛而疹
痘俱少者，则宜参用治痘之法，以托痘为主；实者赤晕发 者，则宜用治疹之法，或频进化斑汤，则疹
毒自解，而痘自起。
三、奶疹子
小儿初生未盈月，忽遍身发红点也。此证由于胎中受热，又适染时行症而起，故生下便发。小儿脏腑
娇嫩，不必服药，宜以治痧痘套方大剂，与乳母饮之，更令乳母避风寒，忌房事，食淡茹清，切忌冷水、瓜
果、鸡、鱼、炙、 、酸醋、五辛、糖蜜、香鲜之物，犯之则皮毛闭塞，毒瓦斯难泄，遂变黑而死。如渴极欲
水，只与葱白汤以滋之。
更有发斑一证，形式与疹不同，治法亦有稍异。考痧疹为点形，斑为片形，痧疹颗粒突起，视之有形，
摸之有物，斑则一片红紫，视之有形，摸之无物，此斑与疹之分别也。然发斑亦有 肿者，大都斑而兼痧疹，
其上微突者为疹，其下成片者为斑也。斑有阳斑、阴斑之分，凡其色淡者，微如蚊迹者，但胸背或手足
间有稀少微红之点，而其人安静者，此阴斑也。阴斑决不夹于痧疹之中，可姑置勿论。若阳斑者，或由
胃热，或由血沸，或独发，或痧疹透后血分郁热亢甚，亦多发斑，大都以鲜明红赤为顺，色紫为重，色黑
如煤者百无一痊也。故病至发斑，大忌用辛温以助其热势，轻者犹可用辛凉，则参照治痧疹之法以治之，亦
可通用。至于重者，则概宜寒凉之剂，以平其炎炎之势，或酌通
瘀之剂，以泄其壅塞之毒，倘误用温剂，势必红斑变紫，紫斑成
黑也。此外，有所谓风疹者，由脾虚血热，或受风邪而作，其形浮肿成片成块，愈搔愈甚，宜疏气除湿之品，
不可专用风药。又有瘾疹，由脾家蓄热，更兼风湿，故隐隐发点粒，似肿非肿，多发痒或不仁，以其隐现于
肌肉，故曰瘾疹，时或壮热恶寒有若似疹，实则非疹也，宜宣发风湿主之。又有痱疹，即夏月痱子之极
盛者，其粒大如粟米，皮肤尽赤，多生项下夹窝内胯，肥儿易患之，外科书谓之暑毒，宜居凉爽之处，不必服
药。若爪破皮，易变成脓疮，宜用药敷扑，以免溃烂。又有冻疹，因寒冬天地之气闭塞，交春风动，易袭虚
人之皮毛，则发色白形如鱼子之疹点，惟不遍及一身，周时收没，即无痕点，亦宜宣发风湿主之。凡此
数者，虽非正痧疹而有似之者，故同类而共论之。
附方
（一）保元加减汤 治痘家虚者，及行浆疹子，灌脓后不结痂（通常痘疹及水痘白 之类，不可用）。
炙黄 （三钱） 人参（三钱） 炙甘草（一钱） 肉桂（五分） 当归（二钱） 白术（二钱）
犹有余毒者，加连翘、绿豆，宜升者加升麻，宜利气者加陈皮，宜收者加白芍。
（二）化斑汤 治毒留肺胃。
人参 甘草 知母 石膏 桔梗 连翘 升麻 竹叶 牛蒡 地骨皮
一方有玄参、犀角、粳米，无桔梗、连翘、升麻、竹叶、牛
蒡、地骨皮、人参，体实去人参，热甚加鲜生地、犀角。
（三）消风散 治脾热风湿，瘾疹冻疹。
茯苓 蝉衣 川芎 僵蚕 人参 藿香 防风 荆芥 甘草
清水煎服。
（四）调中散 治风疹。
藿香 枳实 砂仁 甘草 苍术 茯苓 陈皮 青皮 半夏
浓朴
清水煎服。
（五）苦参汤 治痱疹。水煎作洗汤，临洗入猪胆汁四五个。
苦参 菖蒲
（六）鹅黄散 外用。治痱疹，作粉扑用。
绿豆粉 滑石 黄柏 轻粉
痧疹的种类，大致如下：
一、化脓性浆液型痧疹
称为“行浆疹子”，其形态颇似痘疮，但实际上不同。痘疮一定有顶盘（中心隆起部分），而疹子即使有浆液，颗粒也一定不坚硬，根盘（底部红肿范围）一定没有红晕。这是由于患者平时体内湿气过重，或脾胃虚弱所致。如果化脓后不结痂，这是元气亏损的表现，治疗应当以大补脾胃为主，不可错误地认为邪热未尽而使用清热退火的药剂。
二、疹夹痘
即在痧疹之中，夹杂有痘疮的情况。这是由于毒气太盛，所以一齐涌出。疹子多由外感风邪之毒引起，痘疮多由胎毒内发之毒引起。两者混杂，症状难以治疗，因为治疗痘疮宜用温法，治疗疹子宜用凉法。然而仔细辨别虚实寒热，也有灵活的治疗方法可寻。例如，体质虚者，热势不盛且疹痘都少的，则适宜参考治痘的方法，以托毒外出为主；体质实者，赤色红晕明显发作的，则适宜采用治疹的方法，或者频繁服用化斑汤，那么疹毒自然解除，痘疮也会自行发出。
三、奶疹子
小儿出生未满一个月，忽然全身发红点。此证由于胎儿在母体内受热，又恰逢感染时行疫病而起，所以出生后便发作。小儿脏腑娇嫩，不必给婴儿服药，适宜用治疗痧痘的大剂量套方，让乳母饮用，并令乳母避开风寒，禁止房事，饮食清淡素食，切忌食用冷水、瓜果、鸡肉、鱼类、烧烤食物、咸味食品、酸醋、五辛（五种辛辣蔬菜）、糖蜜、香味鲜美的食物，触犯这些禁忌会导致皮毛闭塞，毒气难以排泄，于是变黑而死。如果口渴极度想喝水，只给予葱白汤来滋润。
另外还有发斑这一证候，形态与疹子不同，治疗方法也有稍许差异。考察痧疹为点状，斑为片状；痧疹颗粒突起，看起来有形，摸起来有物；斑则是一片红紫色，看起来有形，摸起来无物，这是斑与疹的区别。然而发斑也有肿胀的情况，大多是斑兼带痧疹，上面微微突起的是疹，下面成片的是斑。斑分为阳斑和阴斑。凡是颜色淡的，微如蚊迹的，只在胸背或手足间有稀少微红的点，且患者神情安静的，这是阴斑。阴斑绝不会夹杂在痧疹之中，可以暂且搁置不论。如果是阳斑，可能由于胃热，或血沸腾，或单独发作，或在痧疹透发后血分郁热亢盛，也容易多发斑，大多以鲜明红赤为顺症，颜色紫为重症，颜色黑如煤炭的百无一救。所以病发展到发斑阶段，大忌使用辛温药物以助长热势，轻症还可以用辛凉药物，参照治疗痧疹的方法来治疗，也可以通用。至于重症，则一概适宜用寒凉药剂，以平息其炎炎之势，或者酌情选用通瘀药剂，以泄其壅塞之毒，倘若误用温剂，势必导致红斑变紫，紫斑成黑。此外，有所谓的风疹，由脾虚血热，或受风邪而引起，其形态浮肿成片成块，越抓越严重，适宜用疏气除湿的药物，不可专用祛风药。又有瘾疹，由脾脏蓄积热气，更兼风湿，所以隐隐发出点粒，似肿非肿，多发生痒或麻木，因为它隐现于肌肉之间，所以叫瘾疹，有时壮热恶寒看似像疹子，实际上不是疹子，适宜用宣发风湿的方法主治。又有痱疹，即夏季痱子最严重的情况，其颗粒大如粟米，皮肤全部发红，多生在颈部腋下、胯部，肥胖的儿童容易患此病，外科书籍称之为暑毒，适宜居住在凉爽的地方，不必服药。如果抓破皮肤，容易变成脓疮，适宜用药粉敷扑，以免溃烂。又有冻疹，因寒冬天地之气闭塞，交春风动，容易侵袭虚弱之人的皮毛，则发出颜色白形如鱼子的疹点，惟独不遍及全身，一周时间消退，不留痕迹，也适宜用宣发风湿的方法主治。以上几种，虽然并非正宗痧疹但有相似之处，所以作为同类一起讨论。
附方
（一）保元加减汤 治疗痘家体虚者，以及行浆疹子，化脓后不结痂（通常痘疹及水痘白疱之类，不可用）。
炙黄芪（三钱） 人参（三钱） 炙甘草（一钱） 肉桂（五分） 当归（二钱） 白术（二钱）
如果还有余毒，加连翘、绿豆；适宜升提者加升麻；适宜利气者加陈皮；适宜收敛者加白芍。
（二）化斑汤 治疗毒气滞留肺胃。
人参 甘草 知母 石膏 桔梗 连翘 升麻 竹叶 牛蒡子 地骨皮
一方中有玄参、犀角、粳米，无桔梗、连翘、升麻、竹叶、牛蒡子、地骨皮、人参，体质壮实者去人参，热甚加鲜生地、犀角。
（三）消风散 治疗脾热风湿，瘾疹冻疹。
茯苓 蝉蜕 川芎 僵蚕 人参 藿香 防风 荆芥 甘草
清水煎服。
（四）调中散 治疗风疹。
藿香 枳实 砂仁 甘草 苍术 茯苓 陈皮 青皮 半夏 厚朴
清水煎服。
The types of scarlet-like rashes are roughly as follows:
I. Purulent Vesicular Scarlet Rash
Known as "Xingjiang Zhenzi" (Rash with Flowing Pus), its appearance is somewhat similar to smallpox but actually different. Smallpox must have a distinct central prominence (Dingpan), whereas even if the rash has pus, the granules must not be hard, and the base (Genpan) must lack a red halo. This is caused by excessive dampness in the body during normal times, or by spleen and stomach deficiency. If it does not scab after purulation, this indicates a loss of Yuan Qi (Primordial Qi). Treatment should focus primarily on greatly tonifying the spleen and stomach; one must not mistakenly assume that pathogenic heat remains and administer heat-clearing and fire-reducing agents.
II. Rash Intermingled with Smallpox
This refers to cases where smallpox lesions are intermingled within the scarlet rash. This occurs because the toxic qi is too abundant, causing both to erupt simultaneously. Rashes are mostly caused by toxins from external wind-pathogens, while smallpox is mostly caused by toxins arising internally from fetal toxicity. When these two mix, the symptoms are difficult to treat, as treating smallpox requires warm methods, while treating rashes requires cool methods. However, by carefully observing deficiency/excess and cold/heat, there are flexible treatment approaches. For example, in deficient cases where heat is not intense and both rash and smallpox are sparse, it is appropriate to refer to smallpox treatment methods, focusing on supporting the eruption of smallpox. In excess cases with prominent red halos, it is appropriate to use rash treatment methods, such as frequently administering Huaban Tang (Spot-Resolving Decoction); then the rash toxin will naturally resolve, and the smallpox will emerge on its own.
III. Milk Rash
This occurs when an infant, under one month old, suddenly develops red spots all over the body. This condition arises from heat accumulated in the womb combined with exposure to epidemic pathogens at birth. Since infants' zang-fu organs are delicate, medication for the infant is unnecessary. Instead, a large-dose standard formula for treating scarlet-rash/smallpox should be administered to the nursing mother. The mother should avoid wind and cold, abstain from sexual intercourse, eat a light vegetarian diet, and strictly avoid cold water, melons/fruits, chicken, fish, roasted foods, salty items, vinegar, the "Five Pungent Spices," honey/sugar, and fragrant/fresh foods. Violating these taboos causes pore closure, preventing toxin expulsion, leading to blackening and death. If extremely thirsty, only Scallion White Decoction (Congbai Tang) should be given to moisten.
Additionally, there is the syndrome of "Fa Ban" (Eruptive Macules/Patches), which differs in form from rashes and has slightly different treatment methods. Examining the characteristics: Sha Zhen (Scarlet Rash) presents as dot-shaped, while Ban (Macules/Patches) presents as patch-shaped. Sha Zhen granules protrude, appearing formed visually and palpable physically; Ban appears as a single red-purple patch, visible but not palpable as a distinct object. This distinguishes Ban from Zhen. However, some eruptions involve swelling, mostly being a combination of Ban and Sha Zhen; the slightly protruding upper part is Zhen, while the lower flat part is Ban. Ban is divided into Yang Ban and Yin Ban. Cases with pale color, faint marks like mosquito bites, sparse red dots only on the chest/back or limbs, and a calm patient demeanor are classified as Yin Ban. Yin Ban never intermingles with Sha Zhen and can be temporarily disregarded. Yang Ban may result from stomach heat, boiling blood, spontaneous eruption, or severe stagnant heat in the blood level after the rash has erupted. Generally, bright red is favorable, purple indicates severity, and black like coal is almost invariably fatal. Therefore, once the disease reaches the stage of erupting macules, pungent-warm herbs are strictly contraindicated as they exacerbate heat. Mild cases may still use pungent-cool herbs, following the treatment principles for Sha Zhen. Severe cases generally require cold-cooling agents to quell the intense heat, or blood-invigorating agents to drain obstructive toxins. Mistakenly using warm agents will inevitably cause red patches to turn purple, and purple patches to turn black.
Furthermore, there is "Feng Zhen" (Wind Rash), caused by spleen deficiency with blood heat or wind-pathogen invasion. Its form is swollen, appearing in patches or blocks, worsening with scratching. It requires herbs that regulate qi and drain dampness, not solely wind-dispelling drugs. There is also "Yin Zhen" (Hidden Rash), caused by heat accumulation in the spleen combined with wind-dampness. It presents as faintly emerging granules, seemingly swollen but not truly so, often causing itching or numbness. Because it hides within the muscles, it is called Yin Zhen. It may present with high fever and aversion to cold resembling a rash, but is not a true rash; it should be treated primarily by diffusing wind and dampness. There is also "Fei Zhen" (Prickly Heat), which is the most severe form of summer prickly heat. The granules are as large as millet seeds, the skin is entirely red, and it commonly occurs in the neck, axillae, and groin. Obese children are prone to it; surgical texts call it Summer-Toxicity. It is best managed by staying in cool places without medication. If scratched open, it easily becomes pustules; topical powder application is recommended to prevent ulceration. There is also "Dong Zhen" (Cold Rash), caused by the closure of heaven-and-earth qi in deep winter, followed by spring winds invading the pores of deficient individuals. It presents as white, fish-roe-like spots, not covering the whole body, resolving within a week without traces. It is also treated primarily by diffusing wind and dampness. These several types, though not orthodox Sha Zhen, are similar enough to be discussed together as a category.
Attached Formulas
(1) Baoyuan Modified Decoction (Baoyuan Jiajian Tang)
Indications: Deficiency in smallpox cases, and Xingjiang Zhenzi (Purulent Rash) where scabbing fails to occur after purulation. (Note: Not for typical smallpox/rash or chickenpox blisters).
Ingredients: Roasted Astragali Radix (Huangqi, 3 qian), Ginseng Radix (Renshen, 3 qian), Roasted Glycyrrhizae Radix et Rhizoma (Gancao, 1 qian), Cinnamomi Cortex (Rougui, 5 fen), Angelicae Sinensis Radix (Danggui, 2 qian), Atractylodis Macrocephalae Rhizoma (Baizhu, 2 qian).
Modifications: If residual toxin remains, add Forsythiae Fructus (Lianqiao) and Vigna radiata (Lvdou). If ascending action is needed, add Cimicifugae Rhizoma (Shengma). If qi-regulating action is needed, add Citri Reticulatae Pericarpium (Chenpi). If astringent action is needed, add Paeoniae Radix Alba (Baishao).
(2) Huaban Tang (Spot-Resolving Decoction)
Indications: Toxin retained in Lung and Stomach.
Ingredients: Ginseng Radix (Renshen), Glycyrrhizae Radix et Rhizoma (Gancao), Anemarrhenae Rhizoma (Zhimu), Gypsum Fibrosum (Shigao), Platycodonis Radix (Jiegeng), Forsythiae Fructus (Lianqiao), Cimicifugae Rhizoma (Shengma), Bambusae Folium (Zhuye), Arctii Fructus (Niubang), Lycii Cortex (Digupi).
Alternative Prescription: Contains Scrophulariae Radix (Xuanshen), Rhinocerotis Cornu (Xijiao), Oryza Sativa (Jingmi); lacks Jiegeng, Lianqiao, Shengma, Zhuye, Niubang, Digupi, Renshen. For robust constitutions, remove Renshen. For intense heat, add Rehmanniae Radix Recens (Xianshengdi) and Rhinocerotis Cornu (Xijiao).
(3) Xiaofeng San (Wind-Dispersing Powder)
Indications: Spleen heat with wind-dampness, Yin Zhen, Dong Zhen.
Ingredients: Poria (Fuling), Bombyx Batryticatus (Chanyi), Chuanxiong Rhizome (Chuanxiong), Bombyx Batryticatus (Jiangcan), Ginseng Radix (Renshen), Agastaches Herba (Huoxiang), Saposhnikoviae Radix (Fangfeng), Schizonepetae Spica (Jingjie), Glycyrrhizae Radix et Rhizoma (Gancao).
Preparation: Decoct in clear water and take orally.
(4) Tiaozhong San (Middle-Regulating Powder)
Indications: Feng Zhen (Wind Rash).
Ingredients: Agastaches Herba (Huoxiang), Immature Bitter Orange (Zhishi), Amomi Fructus (Sharen), Glycyrrhizae Radix et Rhizoma (Gancao), Atractylodis Rhizoma (Cangzhu), Poria (Fuling), Citri Reticulatae Pericarpium (Chenpi), Citri Reticulatae Pericarpium Viride (Qingpi), Pinelliae Rhizoma (Banxia), Magnoliae Officinalis Cortex (Houpo).
Preparation: Decoct in clear water and take orally.
(5) Kushen Tang (Sophora Decoction)
Indications: Fei Zhen (Prickly Heat).
Preparation: Decoct in water for washing. Add 4-5 pig gallbladders immediately before washing.
Ingredients: Sophorae Flavescentis Radix (Kushen), Acori Tatarinowii Rhizoma (Changpu).
(6) Ehuang San (Goose-Yellow Powder)
Usage: External application. Indications: Fei Zhen, used as a dusting powder.
Ingredients: Vigna Radiatae Semen Pulvis (Lvdou Fen), Talcum (Huashi), Phellodendri Cortex (Huangbai), Calomelas (Qingfen).