夫痘疹未出而腹痛者,斑毒内攻也。至于痘后,则毒瓦斯常解,无复壅遏而腹痛者,
其症有二∶有因大便不通,燥尿作痛者;有因胃虚不能消谷而腹痛者。燥尿痛者,病在
下焦,伤食痛者,病在上焦此皆手不可按者也。如原食少,大便常润,忽尔作痛者,虚
寒症也。此病在中焦,必喜热手摩按者是也。上者消之,下者利之,中者温之。
夫痘远发渴,亦是常症,惟至痘后毒解,则渴症亦当愈矣。如忽渴欲饮水者,是
心胃二经受其邪热,故乃咽燥膈焦而然也,必能食而大便秘,小便赤,舌燥咽干,宜人
参白虎汤加黄连主之。若食少而大小便调,虽好饮传伏汤,其咽间不燥者,此脾胃虚而
津液不足也,宜人参麦冬散加减主之。如身热作渴,手足微冷者,是脾胃气虚,不能以
行津液也,宜人参白术散主之。如腹胀泄泻,或寒战切牙者,是脾胃虚寒也,宜十一
味木香散主之。如泄泻气促,手足并受者。是脾气脱陷也,宜十二味异攻散主之。
痘后盗汗自汗者,肌肉虚,卫气弱,荣血热也,治宜清心调元为主。盗汗偏于养
阴,自汗专于补阳,此其治也。若浑身,如水而发润者,或汗出如珠者,皆亡阳之症。治何益焉?
痘后失因者,多出余毒热邪。迫血妄行也。然因脾虚不能统血者亦有之。自鼻而出
者,投以玄参地黄汤;自溺出者,则用八正散;自大便出者,则用桃仁承气汤,先削其
热邪,次各导血归经而已。如大便秘者,并用因顺气凉饮主之。然衄者,热在卫而不动
于内,溺便者,热在荣而有伤于中,故衄症轻而便者为重,然阴虚火动而迫血妄行者。
宜养阴以敛之。若阳虚不能摄血而行者,宜补脾以统之,勿概用清凉也。
痘疹尚未发出时出现腹痛,是斑毒内攻所致。到了痘疹发出之后,毒气通常已经解除,不再因壅滞遏阻而腹痛;若此时仍出现腹痛,主要有两种情况:一种是因为大便不通,燥屎阻滞引起的疼痛;另一种是因为胃气虚弱,不能消化食物而引起的腹痛。燥屎阻滞导致的疼痛,病位在下焦;饮食积滞导致的疼痛,病位在上焦。这两种情况的腹痛,患者都拒绝按压腹部。如果原本进食很少,大便平时保持湿润,突然发生腹痛的,属于虚寒证。这种病位在中焦,患者一定喜欢用温热的手抚摸按压。对于上焦的病证采用消导法,下焦的病证采用通利法,中焦的病证采用温补法。
痘疹消退后出现口渴,也是常见症状,但等到痘疹后期毒邪已解,口渴症状也应当痊愈。如果突然感到口渴想要饮水,这是心经和胃经受邪热侵袭,导致咽喉干燥、胸膈焦灼所致,患者必定能进食且大便秘结,小便颜色深红,舌面干燥、咽喉干涩,适宜用人参白虎汤加入黄连为主进行治疗。如果进食少但大小便正常,虽然喜欢饮用传伏汤(此处原文可能有误,结合语境及后文“咽间不燥”,应指虽欲饮但咽不干),且咽喉部没有干燥感的,这是脾胃虚弱导致津液不足,适宜用人参麦冬散加减为主治疗。如果身体发热并伴有口渴,手足微微发冷的,这是脾胃气虚,不能输布津液所致,适宜用人参白术散为主治疗。如果出现腹胀腹泻,或者寒战咬牙的症状,这是脾胃虚寒,适宜用十一味木香散为主治疗。如果出现腹泻且呼吸急促,手足厥冷的,这是脾气下陷脱失,适宜用十二味异攻散为主治疗。
痘疹后期出现盗汗或自汗,是因为肌肉虚弱,卫气衰弱,营血有热,治疗应以清心安神、调理元气为主。盗汗的治疗侧重于滋养阴液,自汗的治疗侧重于补益阳气,这就是它们的治疗区别。如果全身皮肤像水浸一样湿润,或者出汗如珠粒状,这都是亡阳的危重证候,此时再治疗还有什么益处呢?
痘疹后期出现鼻衄(流鼻血),多是由于余留的热毒邪气逼迫血液妄行所致。但也有因为脾虚不能统摄血液的情况。从鼻腔流出的,投用玄参地黄汤;从小便排出的,则使用八正散;从大便排出的,则使用桃仁承气汤,先清除热邪,其次引导血液回归经脉。如果大便秘结的,统一使用因顺气凉饮为主治疗。然而,鼻衄是热邪在卫分而未深入体内,二便出血是热邪在营分且损伤了中焦,所以鼻衄症较轻而二便出血较重。如果是阴虚火旺逼迫血液妄行的,适宜滋阴以收敛止血。如果是阳虚不能固摄血液运行的,适宜补脾以统摄血液,不要一概使用清凉药物。
When abdominal pain occurs before the eruption of smallpox or measles, it is caused by the internal attack of macule and pustule toxins. After the eruption, the toxic qi usually dissipates, and there is no longer obstruction causing abdominal pain. If abdominal pain persists after the eruption, there are two main presentations: one is pain caused by dry fecal impaction due to constipation; the other is pain caused by stomach deficiency failing to digest food. Pain from dry feces indicates pathology in the Lower Jiao (Lower Burner); pain from food stagnation indicates pathology in the Upper Jiao (Upper Burner). In both cases, the abdomen is tender to touch and patients reject pressure. If the patient originally had a poor appetite and normally has moist stools but suddenly develops abdominal pain, this is a Deficiency-Cold syndrome. The pathology lies in the Middle Jiao (Middle Burner), and patients invariably prefer warm hand massage. For conditions in the Upper Jiao, use resolving methods; for the Lower Jiao, use purgative/drainage methods; for the Middle Jiao, use warming methods.
Thirst after the resolution of smallpox/measles is also a common symptom. However, once the toxins have resolved in the post-eruption stage, the thirst should also subside. If sudden thirst with a desire to drink water occurs, it is because the Heart and Stomach meridians are affected by pathogenic heat, leading to dry throat and scorched diaphragm. The patient will likely be able to eat, suffer from constipation, dark urine, dry tongue, and dry throat. This is appropriately treated with Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) added with Huang Lian (Coptis Rhizome). If the patient eats little but bowel movements and urination are normal, and although they desire drinks like Chuan Fu Tang, their throat is not dry, this indicates Spleen and Stomach deficiency with insufficient body fluids. This is appropriately treated with Ren Shen Mai Men Dong San (Ginseng and Ophiopogon Powder) modified. If fever accompanied by thirst and slightly cold hands and feet occur, this indicates Spleen and Stomach Qi deficiency failing to distribute body fluids. This is appropriately treated with Ren Shen Bai Zhu San (Ginseng and Atractylodes Macrocephala Powder). If abdominal distension and diarrhea occur, or if there is chattering teeth due to cold shivers, this indicates Spleen and Stomach Deficiency-Cold. This is appropriately treated with Shi Yi Wei Mu Xiang San (Eleven-Ingredient Costus Powder). If diarrhea occurs with rapid breathing and cold extremities, this indicates Spleen Qi sinking and collapse. This is appropriately treated with Shi Er Wei Yi Gong San (Twelve-Ingredient Yi Gong Powder).
Night sweats or spontaneous sweating after the eruption of smallpox/measles result from weak muscles, weak Wei Qi (Defensive Qi), and hot Ying Blood (Nutritive Blood). Treatment should focus on clearing the Heart and regulating Yuan Qi (Original Qi). Night sweats are treated primarily by nourishing Yin, while spontaneous sweating is treated primarily by tonifying Yang. If the entire body feels wet as if soaked in water, or if sweat beads up like pearls, these are signs of Yang Collapse (Wang Yang). What benefit can treatment bring at this stage?
Epistaxis (nosebleed) after the eruption of smallpox/measles is mostly caused by residual toxic heat forcing blood to move recklessly. However, it can also be due to Spleen deficiency failing to control blood. For bleeding from the nose, Xuan Shen Di Huang Tang (Scrophularia and Rehmannia Decoction) is administered. For bleeding from urination, Ba Zheng San (Eight-Goodness Powder) is used. For bleeding from defecation, Tao Ren Cheng Qi Tang (Peach Kernel and Rheum Decoction) is used, first to reduce the heat pathogen, and subsequently to guide the blood back into its vessels. If the stool is hard and dry, Yin Shun Qi Liang Yin (Yin Shun Qi Cooling Drink) is used universally. Epistaxis indicates heat in the Wei level that does not disturb the interior significantly; bleeding from urination or defecation indicates heat in the Ying level damaging the middle. Therefore, epistaxis is mild, while bleeding from the lower orifices is severe. If Yin deficiency causes Fire agitation forcing blood to move recklessly, nourish Yin to consolidate and stop bleeding. If Yang deficiency fails to secure blood allowing it to flow recklessly, tonify the Spleen to control blood. Do not indiscriminately use cooling agents.