夫有痘疹收后,举止饮食,已复如常,忽然遍身汗出如水,或只心腹绞痛而死者,
此是元气尚亏,外虽无病,里实空虚。一感疫疠不正之气,正不胜邪。一中而死谓之中
恶也。间有用人参汤研苏合香丸服之而苏,殆如大人之因虚而暴中之类欤。
痘后发痈多在骨节间,疹后余毒每在口日内,何也?盖痘毒之余,多留肝肾,疹毒
之余,多留肺胃,故夫治疹,始与解表,使其即出,次与清凉。使其易回。否则始也,
其毒不能尽达于表,乃热流于心,毒甚于脾,心火亢甚,其势炎上,遇窍而发,既而
没也。又不能滋阴清解,则小热变成大热,小毒受成大毒,腑毒为阳,炎上越表而浅,
脏毒为阴,沉下滞里而深,脏腑阴阳既异,骨髓肤腠殊途。一则骤发而为目病口疳。一
则出于骨里,传于脉外,移于皮肤,乃溃而成,其多在骨节者,因病久郁,滞气不周,
行血不流畅,毒滞于关节也。疹后久咳嗽者,因心火亢甚,焚灼肺金,金体本燥,至
此而燥愈甚,嗽久气逆而不收也。其多传痢者,肺与大肠为表里,肺父邪而移于大肠也。
头面先见,次而两颐透出,乃至于足,形若芥子,色若桃花,作二三番齐透,神气
安宁,饮食二便调和者,顺候也。头面发透,粒肥而多,淡红滋润,三日而渐没者,轻。
凡是患过痘疹(天花与麻疹)病愈之后,患者的举止和饮食已经恢复正常,却突然全身大汗淋漓如水,或者仅仅因为心腹部剧烈绞痛而死亡的,这是因为元气仍然亏损,虽然外表看似没有疾病,但体内实际上处于空虚状态。一旦感染了疫疠不正之气,正气无法战胜邪气。其中毒而死的情况被称为“中恶”(急性中毒或暴死)。偶尔有用参汤送服苏合香丸而苏醒的案例,这大概类似于成年人因身体虚弱而突发中风的状况吧。
痘疮痊愈后引发的痈肿多发生在骨节之间,麻疹痊愈后的余毒往往残留在口舌咽喉部位,为什么呢?因为痘毒的残余,大多滞留于肝肾;疹毒的残余,大多滞留于肺胃。所以治疗麻疹,起初应当使用解表法,促使疹毒尽快透发出来;随后使用清凉法,使疹毒容易消退。如果不这样做,起初毒邪不能完全透达于体表,就会热邪流入心脏,毒邪在脾脏变得严重。心火亢盛,火势炎上,遇到孔窍就发作,随后隐没。如果不能滋阴并清解热毒,那么小热会变成大热,小毒会演变成大毒。腑部的毒邪属于阳,性质炎上,越出体表而位置较浅;脏器的毒邪属于阴,性质沉下,停滞于体内而位置较深。脏腑阴阳既然不同,骨髓与皮肤腠理的路径也各异。一种情况是突然发作导致眼疾和口疮;另一种情况则是出于骨骼内部,传导至脉管之外,转移至皮肤,最终溃烂形成。那些多发生在骨节部位的,是因为病程长久郁结,滞气运行不周遍,血液运行不流畅,毒邪停滞在关节所致。麻疹后长期咳嗽的,是因为心火亢盛,焚烧灼伤肺金(肺),肺体本燥,到了这个时候干燥更加严重,咳嗽日久导致气机上逆而不能收敛。那些多转化为痢疾的,是因为肺与大肠互为表里,肺受邪气影响而传变给大肠。
头面部先出现疹点,接着两颊透出,直至足部,形态像芥菜籽一样,颜色像桃花一样红艳,分两三次一齐透发,神志安宁,饮食和二便调和的,这是顺症(预后良好的征象)。头面部疹子发透,颗粒肥大且数量多,呈淡红色且滋润,三天后逐渐隐没的,病情较轻。
In cases where, after the resolution of smallpox and measles (Xiaozhen), the patient's movements and diet have returned to normal, sudden profuse sweating all over the body like water occurs, or death ensues solely due to severe colic in the heart and abdomen. This is because the primordial Qi (Yuanqi) remains deficient; although there appears to be no disease on the exterior, the interior is actually empty. Upon contracting the abnormal qi of epidemic pestilence, the righteous Qi fails to overcome the pathogenic factor. Death resulting from such poisoning is termed "Zhong E" (Acute Poisoning or Sudden Collapse). Occasionally, patients may regain consciousness by taking Ginseng Decoction with Suhexiang Wan, which is somewhat similar to adults suffering from sudden stroke due to deficiency.
Abscesses (Yong) occurring after smallpox are mostly located between bone joints, while residual toxins from measles often remain in the mouth and throat area. Why is this? The residual toxins of smallpox tend to linger in the Liver and Kidney, whereas the residual toxins of measles tend to linger in the Lung and Stomach. Therefore, in treating measles, one should initially employ the method of releasing the exterior (Jiebiao) to facilitate immediate eruption, followed by cooling methods to ensure easy resolution. Otherwise, if the toxin cannot fully reach the exterior initially, heat flows into the Heart, and toxicity becomes severe in the Spleen. With excessive Heart Fire blazing upward, it erupts at orifices and then subsides. If Yin-nourishing and clearing-resolving methods are not applied, minor heat transforms into major heat, and minor toxicity evolves into major toxicity. Toxin in the Fu organs belongs to Yang, blazes upward, emerges at the exterior, and is shallow; toxin in the Zang organs belongs to Yin, sinks downward, stagnates in the interior, and is deep. Since Zang and Fu, Yin and Yang differ, the pathways of bone marrow and skin/cuticle also diverge. One scenario involves sudden onset leading to eye diseases and oral ulcers; the other emerges from within the bones, transmits outside the vessels, shifts to the skin, and eventually ulcerates. Those occurring mostly in bone joints result from long-standing disease stagnation, uneven circulation of stagnant Qi, unsmooth blood flow, and toxin stagnation in the joints. Persistent coughing after measles is caused by excessive Heart Fire burning the Metal of the Lung; since the Lung constitution is naturally dry, dryness becomes even more severe here, causing prolonged coughing with rebellious Qi that cannot descend. Cases transforming into dysentery occur because the Lung and Large Intestine are exterior-interior pairs; the Lung receives the pathogen and transmits it to the Large Intestine.
When spots first appear on the head and face, then emerge on both cheeks, extending down to the feet, resembling mustard seeds in shape and peach blossoms in color, erupting completely in two or three waves, accompanied by calm spirit, harmonious diet, and regular urination and defecation, this indicates a favorable prognosis (Shun Hou). When spots on the head and face are fully erupted, granules are plump and numerous, pale red and moist, and gradually fade after three days, the condition is mild.