痘后有余毒不散,发为瘾疹者,瘾者,隐隐而成疙瘩,抓搔瘙痒更多,其治宜内服
解毒防风汤,外用活蚬水以洗之。若色红而痒甚,抓破出血而犹痒者,此紫点风也,宜
用荆防。草胡麻、生地、牛蒡、赤芍、丹皮、连翘之类。胡麻,三十六风皆治之,而
搔痒者非此不除也,其疹者,皮间点点状如蚊蚤所咬之迹,或如小疥子者是也,宜内服
升麻葛根汤,不过随其轻重疏解而已。
凡痘疮自初以来,一向发热,至于瘥后,犹不退减者,此毒在心也。然亦有虚实
二症,如大便难,小便赤,能食而烦渴者,此实热也,宜先解里热而表热自解。如大便
不闭,小便不赤,坐立振摇,饮食不甚进者,此虚热也,以保元汤,加麦冬、知母。
虚甚者,加炒黑干姜,或熟附子少许,以引火归源。更有痘疮方愈,荣卫正虚,不知避
忌,忽遇节令气交,而乃八方不正之气,乘虚而入,病为中风,遍身青紫,口漱涎潮,
手足螈 ,身反强直者,治宜以消风散二三服,或有瘾疹而愈。更有靥后,失于调理,
以致阴阳偏胜,感冒风寒,寒郁为热,热盛生痰,风痰攻击,心火肝甚,痰乃上升,迷
塞心窍,是以忽然心迷仆倒,如癫如痫者,论治不出化痰清热镇心,然气血大虚之后,
风火多由假象,宜多从根本治之,先天肾不足者,地黄丸料主之;后天心脾不足者,十
全汤主之。
夫余热者,本虚热也。盖痘毒一解,则阴阳俱虚,痘后犹产后也。所谓火从空发之
义,其热多发于午后,但观两脸赤色,是其候也。虚甚则发热,热甚则谵语烦,理之必
然,切不可误作热治,此虚阳动作,谓之强阳,前后宜以保元汤,合四物汤加减,最要
预为调理,否则,日久成疳,喉痛咽哑,眼病疳蚀,风搐筋牵,走马牙疳诸疾,皆自此
而作矣。若口疳不食,吹乐不应者,胃烂也,不治。
痘疮痊愈后,若有余留的毒邪未能消散,引发瘾疹(一种皮肤瘙痒、起风团的病症),所谓“瘾”,是指皮疹隐隐约约形成疙瘩,抓挠后瘙痒加剧。治疗宜内服解毒防风汤,外用活蚬水清洗患处。如果皮疹颜色红且瘙痒剧烈,抓破出血后仍然瘙痒,这称为紫点风,适宜使用荆芥、防风、草胡麻、生地黄、牛蒡子、赤芍、牡丹皮、连翘等药物。胡麻能治疗三十六种风病,但对于搔痒之症,非此药不能去除。所谓的“疹”,是指皮肤间出现点点状如蚊虫叮咬的痕迹,或者像小疥疮一样的皮损,适宜内服升麻葛根汤,只需根据病情的轻重进行疏风解表即可。
凡是痘疮从初发到痊愈期间,一直发热,直到病愈后热度仍不减退的,这是毒邪在心经。然而也有虚实两种证型:如大便困难,小便短赤,食欲正常但心烦口渴的,属于实热证,宜先解除里热,表热自然随之而解。如大便不通畅但不闭塞,小便不红,坐立不安、身体颤抖,饮食摄入不多的,属于虚热证,用保元汤,加入麦冬、知母。虚损严重的,加入炒黑的干姜,或少许熟附子,以引火归源。更有痘疮刚刚痊愈,营卫正气虚弱,不知避忌风寒,忽然遇到节气交替,八方不正之气乘虚而入,导致中风,全身青紫,口吐涎沫,手足抽搐,身体反张强直,治疗宜服用消风散二至三剂,有的瘾疹随之痊愈。还有痘疮结痂脱落后,因失于调理,导致阴阳偏盛,感冒风寒,寒邪郁结化为热,热盛生痰,风痰上扰,心火肝火亢盛,痰浊上升,迷塞心窍,因此突然心神昏迷仆倒,症状如同癫证或痫证。论治不出化痰、清热、镇心之法,但在气血大虚之后,风火多属假象,宜多从根本调理。先天肾不足的,用地黄丸为主方;后天心脾不足的,用十全汤为主方。
所谓余热,本质上是虚热。因为痘毒一旦解除,阴阳两虚,痘后的状态类似于产后。这就是所谓“火从空发”的含义,其发热多发生在午后,只要观察患者两颊潮红,就是其征候。虚损严重则发热,热势甚则出现谵语烦躁,这是必然的道理,切不可误当作实热来治疗。此为虚阳浮动,称为“强阳”。前后宜用保元汤合四物汤加减,最重要的是预先进行调理,否则日久会形成疳积,出现喉痛咽哑、眼病疳蚀、风搐筋牵、走马牙疳等各种疾病,皆由此产生。如果口疳严重无法进食,吹药也不见效的,是胃气腐烂,属于不治之症。
After the resolution of smallpox, if residual toxins remain unresolved and manifest as urticaria (a skin condition characterized by itchy wheals), known as "yin," the rash appears faintly as raised bumps, with itching intensifying upon scratching. The treatment should involve internal administration of Jiedu Fangfeng Tang (Detoxifying Saposhnikovia Decoction) and external washing with fresh clam water. If the rash is red and intensely itchy, bleeding upon scratching yet still itching, this is termed Zidian Feng (Purple Spot Wind). It is appropriate to use herbs such as Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix), Caohuma (Sesami Fructus), Shengdihuang (Rehmanniae Radix), Niubangzi (Arctii Fructus), Chishao (Paeoniae Radix Rubra), Danpi (Moutan Cortex), and Lianqiao (Forsythiae Fructus). Sesame treats thirty-six types of wind disorders, but for itching, it is indispensable. The so-called "zhen" (rash) refers to dot-like marks on the skin resembling mosquito or flea bites, or similar to small scabies lesions. Internal administration of Shengma Gegen Tang (Cimicifugae et Puerariae Decoction) is suitable, adjusting the degree of dispersing and resolving according to the severity of the condition.
In cases where fever persists from the onset of smallpox until after recovery without subsiding, the toxin resides in the Heart. However, there are two patterns: excess and deficiency. If there is difficulty in defecation, dark urine, normal appetite but with irritability and thirst, this indicates Excess Heat; one should first resolve the interior heat, and the exterior heat will naturally resolve. If defecation is not completely blocked, urine is not dark, the patient sits and stands restlessly with trembling, and food intake is poor, this indicates Deficiency Heat. Baoyuan Tang (Preserve the Origin Decoction) is used, supplemented with Maidong (Ophiopogonis Radix) and Zhimu (Anemarrhenae Rhizoma). In severe deficiency, charred Ganjiang (Zingiberis Rhizoma) or a small amount of Shufuzi (Aconiti Lateralis Radix Praeparata) is added to guide fire back to its source. Furthermore, when smallpox has just healed, Ying and Wei (Nutritive and Defensive Qi) are deficient. If precautions are neglected and seasonal climatic changes occur, pathogenic qi from all directions may invade due to deficiency, leading to Stroke (Zhongfeng). Symptoms include generalized cyanosis, drooling, convulsions of hands and feet, and opisthotonos. Treatment involves administering Xiaofeng San (Wind-Dispersing Powder) two to three doses, which may also resolve concurrent urticaria. Additionally, post-scabbing neglect may lead to imbalance of Yin and Yang, susceptibility to Wind-Cold, stagnation of Cold transforming into Heat, excessive Heat generating Phlegm, and Wind-Phlegm attacking. With hyperactive Heart Fire and Liver Fire, Phlegm rises and obstructs the Heart orifices, causing sudden collapse and loss of consciousness, resembling Epilepsy or Mania. Treatment focuses on resolving Phlegm, clearing Heat, and calming the Heart. However, following significant Qi and Blood depletion, Wind and Fire are often false manifestations; thus, treatment should primarily address the root. For congenital Kidney deficiency, Dihuang Wan (Rehmannia Pill) is indicated; for acquired Heart and Spleen deficiency, Shiquan Tang (Complete Ten Tonics Decoction) is indicated.
Residual heat is essentially Deficiency Heat. Once smallpox toxins are resolved, both Yin and Yang are depleted; the post-smallpox state is akin to the postpartum period. This aligns with the concept of "fire arising from emptiness." Fever typically occurs in the afternoon, evidenced by flushed cheeks. Severe deficiency causes fever; intense heat leads to delirium and irritability, which is inevitable. One must not mistakenly treat this as Excess Heat. This floating of Deficient Yang is termed "Strong Yang." Throughout the course, Baoyuan Tang combined with Siwu Tang (Four Substances Decoction) should be modified appropriately. Preemptive conditioning is crucial; otherwise, prolonged illness may lead to Infantile Malnutrition (Gan Syndrome), sore throat, hoarseness, ocular Gan erosion, wind-induced convulsions and tendon pulling, and gangrenous stomatitis (Zouma Yagan). If oral Gan is severe enough to prevent eating and topical medication is ineffective, it indicates rotting of the Stomach, which is incurable.