〔钱〕疮疹，惟用温平药治之，不可妄下及妄攻发，受风冷。（海藏云∶温平者，非热剂，如荆芥、薄荷、
防风、牛蒡子、甘草之类，《活人》鼠粘子汤、洁古解毒防风汤相兼选用是也。丹溪云∶鼠粘子、连翘、
山楂、甘草此四味，痘疮始终必用之药。）
〔钱〕诊睦亲宫中十大王疮疹云∶疮疹始终出，未有他证，不可下，但当用平和药，频与乳食，不受风冷
可也。如疮疹三日不出，或出不快，即微发之。（鼠粘子汤之类。）如疮发后不多出，即加药。（如一日一帖，即
加至二帖。）加药不出，即大发之。（升麻、葛根、防风、羌活、独活、麻黄、桂枝之类。）如发后不多，
及脉平无证，即疮本稀，不可更发也。有大热者，当利小便。小热者，当解毒。（利小便，四圣散之类。）
若不快，勿发，勿下攻，止用抱龙丸治之。疮疹若起能食者，大黄丸下，一二行即止。有大热者，当利小
便。有小热者，宜解毒。若黑紫干陷者，百祥丸下之。不黑者，慎勿下。身热烦躁，腹满而喘，大小便涩，
面赤闷乱，大吐，此当利小便。不瘥者，宣风散下之也。若五七日痂不焦，是内发热气蒸于皮中，故疮不
得焦痂也。宜宣风散导之，用生犀角磨汁解之，使热不生，必着痂矣。
〔洁〕论曰∶ 疹之病，其为证各异。疮发 肿于外，属少阳三焦相火也，谓之 。小红靥行皮肤中不出
者，属少阳君火也，谓之疹。凡显 疹，若自吐泻者，不可妄治而多吉，谓邪气上下皆出也。大凡 疹首尾皆
不可下，恐动则生变，此谓少阳通表，宜和之也。当先安里解毒，次微发之。解毒须安五脏，防风汤是也。如
大便不秘者，须微发之，药宜钱氏方中选而用之。如大便过秘，宜微利之，当归丸、枣变百祥丸是也。初知
疹，若使之并出，小儿难禁，是以别生他症也。首尾不可下者，首曰上焦，尾曰下焦，若既吐利，安可下？
便宜安里。若不吐泻者，先与安里药三五服。如能食而大便秘结内实者，宜疏利之。若内虚而利者，宜用
安里药一二服，末后一服调以微发之药。要之安里之药多，发表之药少，秘则微疏之，令邪气勿壅并而能作
番次出，使儿易禁也。身温者顺，身凉者逆，二者宜多服防风汤和之。
安里解毒防风汤
防风（一两） 地骨皮 黄 芍药 荆芥 枳壳 鼠粘子（各等分）
上为末，水煎四五钱服。若能食而大便实，宜当归丸微利之。
当归丸、枣变百祥丸（二方并见痘疮大便秘门。）
〔海〕夫 之为病，皆由子在母腹中时浸渍，食母血秽，蕴而成毒，皆太阴湿土壅滞君相二火之所作也。
因小儿真气既盛，正气又旺，邪无所容，或遇天寒，或因伤表，或因伤里， 由是而出焉。治当何如？外者外
治，内者内治，中外皆和，其 自出。至于恶寒者发之，表大热者夺之，渴者清之，大便秘结者下之，小便不
通者利之，惊者安之，泄者分之，可以执一为哉，大抵伤寒同治，随经用药，最为高论。假令五日以里，诸病与
疹不能别辨者，不可疑作 疹，必须发之。但各从其所伤应见治之，皆不妨 出。若强发之，其变不可胜数
矣。前人言首尾俱不可下者，为 未显于表，下则邪气不得伸越，此脉证有表而无里，故禁首不可下也。尾不
可下者，为 毒已显于外，内无根蒂，大便不实，无一切里证，下之则 气逆陷，故禁尾不可下也。又言温暖
盖覆，不令通风，以 未出或身表凉而恶寒，或天令寒而恶冷，温暖盖覆，不令通风也。 若已出，身热天暄，
何必用盖覆而不使之通风乎？后人执此二句首尾俱不敢下，温燠不令通风，不知天令之所加，人身之所盛，致
使误人多矣。大抵前人之言，随时应变，后之人不知其变，故常执而不移也。噫，首尾俱不可下者，以其始终
脏腑元无凝滞也。若有一切里证，及大便结者，安得不下？温暖不使之通风，以其发在冬时，故如此也。若发
在夏时， 虽未出，亦不用此也。 之用药，大率以脉为主，浮中沉之脉，平举按之候，察其虚实，定其中外，
则可以万全矣。
如外伤，升麻汤主之。（方见本门。）内伤，枳实丸主之。大便 者，枳术丸主之。若伤冷者温之，神
应丸。（三方俱见内伤饮食。）恶寒者发之，宜防风苍术汤。（方见本门前条。）表大热者夺之，此表者通言
三阳也，夫阳盛者气必上行，言夺者治之不令上行也。是知无三阳表证，有三阳里证，染于有形也。此言表，
总三阳之名也。渴者清之，大渴者白虎汤。（暑月用之。）小渴者，凉膈散。（凉膈散去硝黄加甘桔者稳。）
大便秘结者下之，桃仁承气汤、四顺饮子、柴胡饮子选用。察其在气在血，必内实能食而秘者可用，但当微微
润之。小便不通者利之，导赤散、八正散之类，当求上下二焦何经而用之。惊者安之，凉惊丸；重者泻之，
泻青丸。泄者分之，寒则异功散、四君子汤，热则泽泻茯苓汤。
小儿 疹初发，未能辨认间，但求所出之由，因内因外，及不因外内，随其所伤，如法服饵，防其变故，
抑其盛气，比之他证，尤不可缓，或发或泻，或解其肌，或化其毒，求其所起之由，凉血清肺，调其脏腑，平
其饮食，谨其禁忌，严其养摄，适其寒温，将理有法，俾尽其道，使出无不快之经，成无不痂之溃。既愈之后，
不致游毒流汗虚腠，目疾膜翳，疮疖痈瘤，喉闭嗌肿，潮热汗泄，此治 之大略也。凡未出而发搐者，是外感
风寒之邪，内发心热之所作也，当用茶粉下解毒丸、犀角地黄汤主之。一发出便密如针头，情势重者，合轻其
表而凉其内，连翘升麻汤。若 已发密重，微喘饮水者，有热证，用去风药微下之。若出不快，清便自调，知
其在表不在里，当微发，升麻葛根汤。若青干黑陷，身不大热，大小便涩，则是热在内，煎大黄汤下宣风散。
若身表大热者，表证未罢，不可下。若 已出，见小热，小便不利，当以八正散利之。若已发后有余毒未散，
复有身热疮肿之类，当茶粉下解毒丸。凡疮疹已出后有声音者，乃形病而气不病也。疮疹未出，先声音不出者，
乃形不病而气病也。若疮疹出而声音不出者，是形气俱病也，当清其肺气，宜用八风汤，并凉膈散去硝、
黄亦可。
〔丹〕小儿痘疹，分气血虚实，以四君子、四物、酒炒芩、连等服之。气虚，参、术加解毒药。血虚，四
物加解毒药。
上加解毒者，酒炒黄芩、炒黄连是也。海藏云∶解毒者，三黄汤、金花丸之类。
〔丹〕痘疮分人之清浊，就形气上取勇怯。痘疮黑，属血热，凉血为主。白属气虚，补气为主。中黑陷而
外白色起迟者，则补气中略带凉血药。
〔陈〕痘疮未出已出之间，或泻渴，或腹胀，或气促，谓之里虚，速与十一味木香散治之。如已出之间，
其疮不光泽，不起发，根窠不红，谓之表虚，速与十二味异功散治之。如已出之间，其疮不光泽，不起发，根
窠不红，或泻渴，或腹胀，或气促，是表里俱虚也，速与十二味异功散送下七味肉豆蔻丸治之。（丹溪云∶
木香异功散二药治寒的当，若虚而不寒者，祸不旋踵。）如疮始出一日至十日，浑身壮热，大便黄，是表里
俱实也，其疮必光泽，必起发，必饱满，必易靥而不致损伤。若无他疾，不宜服药。表里俱实者，易出易靥；
表里俱虚者，易出难靥。表虚难出，里虚难靥，随症治之。
〔张巽之〕治痘要法，吐泻少食为里虚，陷伏倒靥灰白为表虚，二者俱见为表里俱虚，全用异功散救之，
甚至姜、附、灵砂亦可用。若止里虚，减官桂。若止表虚，减肉豆蔻，不减官桂、丁香。若能食便秘而陷伏倒
靥者，为里实，当用钱氏及丹溪下法。若不吐泻能食为里实，里实而补，则结痈毒。红活绽凸为表实，
表实而用表药，则溃烂不结痂。凡痘但见 点，便忌葛根汤，恐发得表里俱虚也。
〔丹〕读前人之书，当知其立言之意，苟读其书而不知其意，求适于用不可得也。痘疮之论，钱氏为详。
历举源流经络，分明表里虚实，开陈施治之法，而又证以论辨之言，深得着书垂教之体，学人读而用之，如求
方员于规矩，较平直于准绳，引而伸之，触类而长之，可为无穷之应用也。今人不知致病之因，不求立方之意，
仓卒之际，据证验方，谩尔一试，设有不应，并其书而废之，不思之甚也。近因《局方》之教久行，《素问》
之学不讲，抱疾谈医者，类皆喜温而恶寒，喜补而恶解利，忽得陈氏方论，皆用燥热补剂，其辞确，其文简，
欢然用之，翕然信之，遂以为钱氏不及陈氏远矣。或曰∶子以陈氏方为不足欤？曰∶陈氏方，诚一偏之论。虽
然，亦可谓善求病情者，其意大率归重于太阴一经。盖以手太阴属肺，主皮毛。足太阴属脾，主肌肉。肺金恶
寒而易于感，脾土恶湿而无物不受。观其用丁香、官桂，所以治肺之寒也，用附、术、半夏，所以治脾之湿也。
使脾与肺果有寒与湿而兼有虚也，量而与之，中病则已，何伤之有？今也不然，但见出迟者，身热者，泄泻者，
惊悸者，气急者，渴思饮者，不问寒热虚实，率投木香散、异功散，间有偶中，随手获效，设或误投，祸不旋
踵。何者？古人用药制方，有向导，有监制，有反佐，有因用。若钱氏方，固未尝废细辛、丁香、白术、参、
，率有监制辅佐之药，不专务于温补耳。然其用寒凉者多，而于补助一法，略示端绪，未曾深及，痴人之前，
不可说梦，钱氏之虑至矣。亦将以候达者扩充推展用之耳。虽然渴者用温药，痒塌者用补药，自陈氏发之，迥
出前辈。然其多用桂、附、丁香辛芳燥热，恐未为适中也。何者？桂、附、丁香辈，当有寒而虚者，固是的当，
虚而未必寒者，其为患当何如耶？陈氏立方之时，必有挟寒而用一偏之方，宁不过于热乎？予尝会诸家之粹，
求其意而用之，实未敢据其成方。至正甲申，阳气早动，正月间，邑间痘疮不越一家，率投陈氏方，童幼死者
百余人。虽由天数，吾恐人事亦或未之尽也。
〔钱〕伤寒男体重面黄，女面赤喘息急，各憎寒，口中气热，呵欠顿闷，项急；疮疹则腮赤躁多，
喷嚏悸动，昏倦，四肢冷。伤寒当发散之，疮疹当温平之，有大热者宜解毒。昏睡喜嚏悸者，将发疮疹。
〔垣〕辨 证∶呵欠 喷嚏 睡中急惊 耳尖冷 眼涩
辨伤寒∶口热 口中醋气 奶瓣不消 腹中疼痛
〔钱〕疮疹候∶面燥腮赤，目胞亦赤，呵欠顿闷，乍凉乍热，咳嗽嚏喷，足稍冷，夜卧惊悸多睡。此疮疹
症，天行之病也。
睦亲宫十太尉疮疹，众医治之。王曰∶疹未出属何脏腑？一医言胃气热，一医言伤寒不退，一医言在母腹
中有毒。钱氏曰∶若言胃气热，何以乍凉乍热？若言母腹中有毒，属何脏也？医曰∶在脾胃。钱氏曰∶在脾胃
何以惊悸？皆无以对。钱氏曰∶夫胎在腹中，月至六七则已成形，食母腹中秽液，入儿五脏，食至十月，即秽
液满胃，至生时儿口中犹有不洁，产母以手拭净，则无疾病，俗以黄连、汞粉下其脐粪之秽，此亦母之不洁余
气，入儿脏中，本先因微寒入，遇风寒邪气相搏，而成痘疹也。未出欲作之时，热动五脏，则五脏之症先见，
初欲病时，先呵欠顿闷惊悸，乍凉乍热，手足冷，面腮颊赤燥，咳嗽喷嚏，此五脏症俱见也。呵欠顿闷者，肝
也。时发惊悸者，心也。乍凉乍热手足冷者，脾也。面赤腮颊赤咳嗽喷嚏者，肺也。惟肾无候，以在腑下，不
能食秽故也。凡疮疹乃五脏毒，若出归一症，肝水 ，肺脓 ，心为 ，脾为疹，肾虽无症，其候恶者，疮变
倒靥而黑陷，则归肾也。此由不慎风冷，而不能食内虚所致也。今太尉疹子无他证，当用平和药为治，因用抱
龙丸数服愈。（海藏云∶“本先因微寒入”一句，并“由不慎风冷而不能食内虚”一句，勿认作寒证，用抱龙
丸即知 疹多热也。）
疮疹始出之时，五脏症见，惟肾无候，但见平症，耳尻凉耳凉是也。尻耳俱属于肾，其居北方主冷也。
〔垣〕 疹始出之症，必先见面燥腮赤，目胞亦赤，呵欠顿闷，乍热乍凉，咳嗽喷嚏，足稍冷，多睡，睡
惊；并疮疹之症，或生脓泡大 ，或生小红 ，或生瘾疹，此三等不同，何故俱显上症而后乃出？盖以上诸症，
太阳寒水起于右肾之下，煎熬左肾；足太阳膀胱寒水夹脊逆流，上头下额，逆手太阳丙火，不得传道，逆于面
上，故显是症。盖壬癸寒水，克丙丁热火故也。诸 症皆从寒水逆流而出也，医者当知此理，乃敢用药。夫胞
者，一名赤宫，一名丹田，一名命门，男子藏精施化，妇人系胞有孕，俱为生化之源，非五行也，非水亦非火，
此天地之异名也，象坤土之生万物也。夫人之始生也，血海始净一日二日，精胜其血则为男子，三日四日五日，
血脉已旺，精不胜血，则为女子。乃二物相搏，长先身生谓之神，又谓之精，道与释二门谓之本来面目是也。
【汤】生附散：治疗烂脚疮。将生附子研成粉末，用面粉和水调匀后敷在患处，即可痊愈。
【钱乙】对于疮疹（天花、麻疹等出疹性疾病），只宜使用温和平和的药物进行治疗，不可随意使用泻下药或强行发汗攻伐，以免受风冷侵袭。（张元素即海藏云：所谓“温平”，并非指热性药剂，而是像荆芥、薄荷、防风、牛蒡子、甘草这类药物，《活人书》中的鼠粘子汤与洁古的解毒防风汤配合选用即是此意。朱丹溪云：牛蒡子、连翘、山楂、甘草这四味药，是治疗痘疮从头到尾必须使用的药物。）
【钱乙】诊断睦亲宫中十大王的疮疹时说：疮疹从头至尾顺利发出，且没有其他兼夹症状，不可使用泻下法，只应当使用平和的药物，频繁给予乳汁和食物，避免受风冷即可。如果疮疹三天仍未发出，或者发出缓慢，就轻微地发散它。（如使用鼠粘子汤之类。）如果疮发出后数量不多，就增加药量。（例如原本一天一帖药，就增加到两帖。）如果增加药量后仍不发出，就大力发散它。（如使用升麻、葛根、防风、羌活、独活、麻黄、桂枝之类。）如果发散后仍然很少，且脉象平稳无其他症状，说明疮本来就很稀疏，不可再强行发散。如果有大热的症状，应当通利小便。（通利小便可用四圣散之类。）如果是小热，应当清热解毒。（若不出，不要发散，也不要泻下攻伐，只用抱龙丸治疗。）如果疮疹发出后患儿能进食，可用大黄丸泻下，大便一二行后即停止。有大热者，当利小便；有小热者，宜解毒。如果疮色黑紫干枯内陷，用百祥丸泻下。如果不黑，切勿泻下。如果身体发热烦躁，腹部胀满且喘息，大小便涩滞，面色红赤烦闷混乱，剧烈呕吐，这应当通利小便。若不好转，用宣风散泻下。如果五到七天后痂皮不焦枯，是因为体内热气蒸腾于皮肤中，所以疮不能形成焦痂。宜用宣风散导泄，用生犀角磨汁解毒，使热气不生，必然能结痂。
【张元素】论述说：疹病的证候各不相同。疮肿发于外部，属于少阳三焦相火，称为“疮”。小红点散布在皮肤中出不来的，属于少阳君火，称为“疹”。凡是出现疮疹，如果伴有自发性呕吐腹泻的，不可妄加治疗而多能自愈，这是因为邪气从上下两方面都排出了。大凡疮疹从头到尾都不可以泻下，恐怕泻下会导致病情变化，这是说少阳经通达体表，适宜调和。应当先安固里气并解毒，其次轻微发散。解毒必须安固五脏，防风汤就是此类。如果大便不通秘结的，须轻微发散，药物宜从钱氏方剂中选择使用。如果大便过于秘结，宜轻微通便，当归丸、枣变百祥丸即是此类。初知患疹，如果让疹子一下子全部发出，小儿难以承受，因此会生出其他病症。从头到尾不可泻下的原因：开头指上焦，结尾指下焦，如果已经吐利，怎能再用泻下？便宜宜安固里气。如果不吐泻，先给安里药服用三五次。如果能进食且大便秘结内实，宜疏利通便。如果内虚而腹泻，宜用安里药服用一两次，最后一次服药时配合轻微发散的药物。总之，安里的药多，发表的药少，便秘则轻微疏通，使邪气不要壅滞积聚而能分批发出，使小儿容易承受。身体温暖的为顺证，身体发凉的为逆证，这两种情况宜多服防风汤来调和。
安里解毒防风汤
防风（一两） 地骨皮 黄芪 芍药 荆芥 枳壳 牛蒡子（各等分）
以上研为末，水煎服四五钱。如果能进食且大便结实，宜用当归丸轻微通便。
当归丸、枣变百祥丸（这两个方子均见痘疮大便秘结门。）
【张元素】认为：疮这种病，都是由胎儿在母腹中时浸渍，食用母体血液污秽，蕴积而成毒，这都是太阴湿土壅滞以及君火、相火作用的结果。因为小儿真气既盛，正气又旺，邪气无处容身，或者遇到天寒，或者因外伤表，或者因内伤里，疮由此而出。治疗应当如何？外感的治外，内伤的治内，内外皆调和，疮自然发出。至于恶寒的发散它，表大热的清除它，口渴的清解它，大便秘结的泻下它，小便不通的通利它，惊悸的安神定惊，泄泻的分消它，怎么能拘泥于一法呢？大体上与伤寒同治，随经络用药，这是最高明的论断。假如五天内，各种病症与疹无法分辨的，不可怀疑作疮疹，必须发散。但各自从其受伤应见的症状治疗，都不妨碍疮发出。如果强行发散，其变证不可胜数。前人说从头到尾都不可以泻下，是因为疮未显于体表，泻下则邪气不得伸展越出，这是脉证有表而无里，所以禁止开头不可泻下。结尾不可泻下，是因为疮毒已显于外，内部没有根基，大便不实，无一切里证，泻下则疮气逆陷，所以禁止结尾不可泻下。又说温暖覆盖，不让通风，是因为疮未出或身体表面凉而恶寒，或天气寒冷而恶冷，所以要温暖覆盖，不让通风。如果疮已出，身体热天气暖，何必还要覆盖而不让它通风呢？后人执着这两句话，从头到尾都不敢泻下，温暖不让通风，不知天时变化和人体盛衰，导致误人很多。大体上前人的话，随时应变，后人不知其变，所以常固执不移。唉，说从头到尾都不可以泻下，是因为其始终脏腑原本没有凝滞。如果有一切里证，及大便结者，怎能不下？温暖不让通风，是因为发生在冬天，所以如此。如果发生在夏天，即使疮未出，也不用此法。治疗疮用药，大体以脉象为主，浮中沉之脉，平举按之候，察其虚实，确定其中外，就可以万无一失了。
如外伤，升麻汤主治。（方子见本门。）内伤，枳实丸主治。大便溏泄者，枳术丸主治。如果伤冷则温之，神应丸。（这三个方子均见内伤饮食门。）恶寒的发散，宜防风苍术汤。（方子见本门前条。）表大热的清除，此表泛指三阳经，阳气盛者气必上行，说“夺”是指治疗不让其上行。可知无三阳表证，有三阳里证，染于有形之物。此言表，总括三阳之名。口渴的清解，大渴者用白虎汤。（暑月使用。）小渴者，凉膈散。（凉膈散去芒硝大黄加甘草桔梗较稳妥。）大便秘结的泻下，桃仁承气汤、四顺饮子、柴胡饮子选用。察其在气在血，必须内实能食且便秘者可用，但应当微微润下。小便不通的通利，导赤散、八正散之类，应当求索上下二焦何经而用之。惊悸的安神，凉惊丸；重者泻之，泻青丸。泄泻的分消，寒则异功散、四君子汤，热则泽泻茯苓汤。
小儿疮疹初发，未能辨认期间，只求找出发出的原因，因内因外，及不因外内，随其所伤，依法服用，防止变故，抑制盛气，比其他病症尤其不可迟缓，或发散或泻下，或解肌，或化毒，寻求其起因，凉血清肺，调理脏腑，平衡饮食，谨慎禁忌，严格调养，适应寒温，将理有法，使其发出无不顺畅，结成无不坚痂。痊愈之后，不致使游毒流汗虚腠，目疾膜翳，疮疖痈瘤，喉闭咽肿，潮热汗泄，这是治疗疮的大略。凡未出而发搐的，是外感风寒之邪，内发心热所致，当用茶粉送下解毒丸、犀角地黄汤主治。一出即密如针头，情势重的，合轻其表而凉其内，连翘升麻汤。如果疮已发密重，微喘饮水的，有热证，用祛风药轻微泻下。如果出不快，清便自调，知其在表不在里，当轻微发散，升麻葛根汤。如果青干黑陷，身体不大热，大小便涩，则是热在内，煎大黄汤送下宣风散。如果身体表面大热，表证未罢，不可泻下。如果疮已出，见小热，小便不利，当以八正散利之。如果已发后有余毒未散，复有身热疮肿之类，当茶粉送下解毒丸。凡疮疹已出后有声音的，乃形病而气不病。疮疹未出，先声音不出，乃形不病而气病。如果疮疹出而声音不出，是形气俱病，当清其肺气，宜用八风汤，并凉膈散去硝、黄亦可。
【朱丹溪】小儿痘疹，分气血虚实，以四君子汤、四物汤、酒炒黄芩、黄连等服用。气虚，人参、白术加解毒药。血虚，四物汤加解毒药。
上加解毒的，是酒炒黄芩、炒黄连。张元素云：解毒的，是三黄汤、金花丸之类。
【朱丹溪】痘疮分人的清浊，就形体气质上取勇怯。痘疮黑，属血热，以凉血为主。白属气虚，以补气为主。中间黑陷而外面白色起得迟的，则在补气中略带凉血药。
【陈文中】痘疮未出已出之间，或泻渴，或腹胀，或气促，称为里虚，速与十一味木香散治疗。如已出之间，其疮不光泽，不起发，根窠不红，称为表虚，速与十二味异功散治疗。如已出之间，其疮不光泽，不起发，根窠不红，或泻渴，或腹胀，或气促，是表里俱虚，速与十二味异功散送下七味肉豆蔻丸治疗。（朱丹溪云：木香异功散二药治疗寒证恰当，如果虚而不寒，祸患立刻到来。）如疮始出一日至十日，浑身壮热，大便黄，是表里俱实，其疮必光泽，必起发，必饱满，必易靥而不致损伤。若无他疾，不宜服药。表里俱实者，易出易靥；表里俱虚者，易出难靥。表虚难出，里虚难靥，随症治疗。
【张巽之】治疗痘疮的要法，吐泻少食为里虚，陷伏倒靥灰白为表虚，二者俱见为表里俱虚，全用异功散救治，甚至姜、附、灵砂也可用。如果只里虚，减官桂。如果只表虚，减肉豆蔻，不减官桂、丁香。如果能食便秘而陷伏倒靥，为里实，当用钱氏及丹溪的下法。如果不吐泻能食为里实，里实而补，则结痈毒。红活绽凸为表实，表实而用表药，则溃烂不结痂。凡痘但见疹点，便忌葛根汤，恐发得表里俱虚。
【朱丹溪】读前人之书，当知其立言之意，如果读其书而不知其意，求适于用不可得。痘疮之论，钱乙最为详细。历举源流经络，分明表里虚实，开陈施治之法，而又证以论辨之言，深得着书垂教之体，学人读而用之，如求方圆于规矩，较平直于准绳，引而伸之，触类而长之，可为无穷之应用也。今人不知致病之因，不求立方之意，仓卒之际，据证验方，漫尔一试，设有不应，并其书而废之，不思之甚也。近因《局方》之教久行，《素问》之学不讲，抱疾谈医者，类皆喜温而恶寒，喜补而恶解利，忽得陈氏方论，皆用燥热补剂，其辞确，其文简，欢然用之，翕然信之，遂以为钱氏不及陈氏远矣。或曰：你以陈氏方为不足吗？我说：陈氏方，诚然是一偏之论。虽然，也可谓善于探求病情者，其意大体归重于太阴一经。盖以手太阴属肺，主皮毛。足太阴属脾，主肌肉。肺金恶寒而易于感，脾土恶湿而无物不受。观其用丁香、官桂，所以治肺之寒也，用附子、白术、半夏，所以治脾之湿也。使脾与肺果有寒与湿而兼有虚也，量而与之，中病则已，何伤之有？现在不是这样，只见出迟者，身热者，泄泻者，惊悸者，气急者，渴思饮者，不问寒热虚实，率投木香散、异功散，间有偶中，随手获效，设或误投，祸不旋踵。为何？古人用药制方，有向导，有监制，有反佐，有因用。若钱氏方，固未尝废细辛、丁香、白术、人参、黄芪，率有监制辅佐之药，不专务于温补耳。然而其用寒凉者多，而于补助一法，略示端绪，未曾深及，痴人之前，不可说梦，钱氏之虑至矣。亦将以候达者扩充推展用之耳。虽然渴者用温药，痒塌者用补药，自陈氏发之，迥出前辈。然而其多用桂、附、丁香辛芳燥热，恐未为适中。为何？桂、附、丁香辈，当有寒而虚者，固是的当，虚而未必寒者，其为患当何如耶？陈氏立方之时，必有挟寒而用一偏之方，宁不过于热乎？我曾综合诸家精华，求其意而用之，实未敢据其成方。至正甲申年，阳气早动，正月间，县里痘疮不超过一家，率投陈氏方，童幼死者百余人。虽由天数，我恐人事也未尽全力。
【钱乙】伤寒男体重面黄，女面赤喘息急，各憎寒，口中气热，呵欠顿闷，项急；疮疹则腮赤躁多，喷嚏悸动，昏倦，四肢冷。伤寒当发散之，疮疹当温平之，有大热者宜解毒。昏睡喜嚏悸者，将发疮疹。
【李杲】辨疮疹证：呵欠、喷嚏、睡中急惊、耳尖冷、眼涩。
辨伤寒：口热、口中醋气、奶瓣不消、腹中疼痛。
【钱乙】疮疹候：面燥腮赤，目胞亦赤，呵欠顿闷，乍凉乍热，咳嗽嚏喷，足稍冷，夜卧惊悸多睡。此疮疹症，天行之病也。
睦亲宫十太尉疮疹，众医治之。王曰：疹未出属何脏腑？一医言胃气热，一医言伤寒不退，一医言在母腹中有毒。钱氏曰：若言胃气热，何以乍凉乍热？若言母腹中有毒，属何脏也？医曰：在脾胃。钱氏曰：在脾胃何以惊悸？皆无以对。钱氏曰：夫胎在腹中，月至六七则已成形，食母腹中秽液，入儿五脏，食至十月，即秽液满胃，至生时儿口中犹有不洁，产母以手拭净，则无疾病，俗以黄连、汞粉下其脐粪之秽，此亦母之不洁余气，入儿脏中，本先因微寒入，遇风寒邪气相搏，而成痘疹也。未出欲作之时，热动五脏，则五脏之症先见，初欲病时，先呵欠顿闷惊悸，乍凉乍热，手足冷，面腮颊赤燥，咳嗽喷嚏，此五脏症俱见也。呵欠顿闷者，肝也。时发惊悸者，心也。乍凉乍热手足冷者，脾也。面赤腮颊赤咳嗽喷嚏者，肺也。惟肾无候，以在腑下，不能食秽故也。凡疮疹乃五脏毒，若出归一症，肝水疱，肺脓疱，心为斑，脾为疹，肾虽无症，其候恶者，疮变倒靥而黑陷，则归肾也。此由不慎风冷，而不能食内虚所致也。今太尉疹子无他证，当用平和药为治，因用抱龙丸数服愈。（张元素云：“本先因微寒入”一句，并“由不慎风冷而不能食内虚”一句，勿认作寒证，用抱龙丸即知疮疹多热也。）
疮疹始出之时，五脏症见，惟肾无候，但见平症，耳尻凉耳凉是也。尻耳俱属于肾，其居北方主冷也。
【李杲】疮疹始出之症，必先见面燥腮赤，目胞亦赤，呵欠顿闷，乍热乍凉，咳嗽喷嚏，足稍冷，多睡，睡惊；并疮疹之症，或生脓泡大疱，或生小红点，或生瘾疹，此三等不同，何故俱显上症而后乃出？盖以上诸症，太阳寒水起于右肾之下，煎熬左肾；足太阳膀胱寒水夹脊逆流，上头下额，逆手太阳丙火，不得传道，逆于面上，故显是症。盖壬癸寒水，克丙丁热火故也。诸疮疹症皆从寒水逆流而出也，医者当知此理，乃敢用药。夫胞者，一名赤宫，一名丹田，一名命门，男子藏精施化，妇人系胞有孕，俱为生化之源，非五行也，非水亦非火，此天地之异名也，象坤土之生万物也。夫人之始生也，血海始净一日二日，精胜其血则为男子，三日四日五日，血脉已旺，精不胜血，则为女子。乃二物相搏，长先身生谓之神，又谓之精，道与释二门谓之本来面目是也。
[Tang] Shengfu San (Raw Aconite Powder): Treats rotting foot sores. Grind raw Fuzi (Aconiti Lateralis Radix Preparata) into powder, mix with flour and water to form a paste, apply externally to the affected area until healed.
[Qian Yi] For Chuangzhen (exanthematous diseases such as smallpox and measles), only mild and neutral medicines should be used for treatment. One must not recklessly use purgatives or force sweating/attacking methods, nor allow exposure to wind and cold. (Zhang Yuansu, also known as Haizang, stated: "Mild and neutral" does not refer to hot-acting agents, but rather herbs like Jingjie (Schizonepetae Herba), Bohe (Menthae Haplocalycis Herba), Fangfeng (Saposhnikoviae Radix), Niubangzi (Arctii Fructus), and Gancao (Glycyrrhizae Radix et Rhizoma). Using Huoren's Shuniuzi Tang (Burdock Fruit Decoction) together with Jiegu's Jiedu Fangfeng Tang (Detoxifying Saposhnikovia Decoction) is an example. Zhu Danxi stated: Niubangzi (Arctii Fructus), Lianqiao (Forsythiae Fructus), Shanzha (Crataegi Fructus), and Gancao (Glycyrrhizae Radix et Rhizoma) are four herbs that must be used throughout the entire course of treating Douchuang (smallpox).)
[Qian Yi] Regarding the diagnosis of the Ten Great Prince of Mumin Palace suffering from Chuangzhen: If the exanthem emerges steadily from beginning to end without other accompanying symptoms, purgation should not be used. Instead, mild medicines should be administered frequently along with breast milk and food, while avoiding exposure to wind and cold. If the exanthem has not emerged after three days, or emerges slowly, it should be mildly dispersed (e.g., using Shuniuzi Tang). If the eruption is sparse after emerging, the dosage should be increased (e.g., from one decoction per day to two). If it still does not emerge despite increasing the dosage, it should be strongly dispersed (using herbs such as Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Duohuo (Angelicae Pubescentis Radix), Mahuang (Ephedrae Herba), and Guizhi (Cinnamomi Ramulus)). If the eruption remains sparse after dispersion, and the pulse is calm with no other symptoms, it indicates the eruption was naturally sparse; do not force further dispersion. If there is severe heat, promote urination (e.g., using Sisheng San). If there is slight heat, clear heat and resolve toxicity. If the eruption does not progress, do not disperse or purge; instead, use Baolong Wan (Dragon-Holding Pill). If the patient can eat after the eruption appears, use Dahuang Wan (Rhubarb Pill) to purge; stop after one or two bowel movements. Severe heat requires promoting urination; slight heat requires clearing heat and resolving toxicity. If the lesions are black, purple, dry, and sunken, use Baixiang Wan (Hundred-Auspicious Pill) to purge. If not black, absolutely avoid purgation. If there is fever, restlessness, abdominal fullness with wheezing, difficulty in urination and defecation, red face with confusion, and severe vomiting, promote urination. If unimproved, use Xuanfeng San (Dispersing Wind Powder) to purge. If scabs do not dry up by the fifth or seventh day, it is because internal heat steams the skin, preventing scab formation. Use Xuanfeng San to guide out the pathogen, and grind fresh Xijiaojiao (Rhino Ceratoss) juice to resolve heat; once heat subsides, scabs will form.
[Zhang Yuansu] Discusses: The manifestations of Zhen (measles/rash) vary. Sores swelling externally belong to the Shaoyang Sanjiao (Triple Burner) Ministerial Fire, called "Chuang" (sores). Small red spots moving within the skin but not emerging belong to the Shaoyang Sovereign Fire, called "Zhen" (rash). Generally, if Chuang or Zhen presents with spontaneous vomiting and diarrhea, do not treat recklessly as prognosis is good; this indicates pathogens exiting from above and below. Generally, neither at the beginning nor the end of Chuang/Zhen should purgation be used, lest it cause complications. This refers to Shaoyang connecting to the exterior, suitable for harmonization. First, stabilize the interior and resolve toxicity, then mildly disperse. Resolving toxicity requires stabilizing the five zang organs; Fangfeng Tang is suitable. If stool is not constipated, mildly disperse, selecting formulas from Qian's prescriptions. If stool is severely constipated, mildly purge, using Danggui Wan (Angelica Pill) or Zaobian Baixiang Wan (Date-Modified Hundred-Auspicious Pill). Initially knowing of rash, if forced to erupt all at once, children cannot tolerate it, leading to other syndromes. The reason for not purging at start or end: Start refers to Upper Jiao, End refers to Lower Jiao; if vomiting/diarrhea have occurred, how can purgation be used? It is better to stabilize the interior. If no vomiting/diarrhea, give interior-stabilizing medicine 3-5 doses. If able to eat and stool is constipated/internal excess, gently purge. If internal deficiency with diarrhea, use interior-stabilizing medicine 1-2 doses, and the final dose should be combined with mild dispersing medicine. In summary, more interior-stabilizing medicine, less exterior-dispersing medicine. If constipated, gently purge to prevent pathogen stagnation and allow batched eruption, making it easier for the child to tolerate. Warm body indicates favorable prognosis; cool body indicates unfavorable. Both cases benefit from frequent Fangfeng Tang for harmonization.
Anli Jiedu Fangfeng Tang (Interior-Stabilizing, Detoxifying, Saposhnikovia Decoction)
Fangfeng (Saposhnikoviae Radix) (1 liang), Diguxpi (Lycii Cortex), Huangqi (Astragali Radix), Shaoyao (Paeoniae Radix), Jingjie (Schizonepetae Herba), Zhike (Aurantii Fructus Immaturus), Niubangzi (Arctii Fructus) (equal parts).
Grind into powder, decoct in water, take 4-5 qian. If able to eat and stool is solid, use Danggui Wan to mildly purge.
Danggui Wan, Zaobian Baixiang Wan (See Douchuang Large Stool Constipation Section for both formulas.)
[Zhang Yuansu] States: Chuang disease arises from immersion in the womb, consuming maternal blood impurities, accumulating into toxicity due to Taiyin damp-earth stagnation and Sovereign/Ministerial fire. Because the child's true qi is strong and righteous qi is vigorous, pathogens have no place to reside. Encountering cold weather, external injury to the exterior, or internal injury to the interior causes Chuang to emerge. How to treat? External injuries treated externally, internal injuries treated internally; if middle and exterior are harmonized, Chuang emerges naturally. For chills, disperse; for severe exterior heat, seize/clear it; for thirst, clear it; for constipation, purge; for urinary obstruction, promote urination; for fright, calm; for diarrhea, separate/drain. Can one stick to one method? Generally, treat similarly to Shanghan (Cold Damage), prescribing according to meridians, which is the highest theory. If within five days, various illnesses cannot be distinguished from rash, do not doubt it as Chuang/Zhen; must disperse. Treat each according to its injury; this does not hinder Chuang emergence. Forced dispersion leads to countless complications. Predecessors said "do not purge at start or end": Start means Chuang not yet visible on surface; purging prevents pathogen expansion. This is pulse/syndrome showing exterior but no interior, hence forbidden to purge at start. End means Chuang toxin already visible externally, no internal root, stool not solid, no interior syndrome; purging causes Chuang qi to reverse and sink, hence forbidden to purge at end. Also, warm covering without ventilation is for when Chuang has not emerged, body surface is cool/chills, or weather is cold. If Chuang has emerged, body is hot, weather warm, why cover and block ventilation? Later generations stuck to these two phrases, fearing purgation and blocking ventilation, ignoring heavenly timing and human vitality, causing many errors. Predecessors' words adapted to times; later generations failed to adapt, sticking rigidly. Alas, "do not purge at start or end" applies because viscera were never stagnant initially. If any interior syndrome or constipation exists, how can one not purge? Warm covering without ventilation applies because it occurs in winter. If in summer, even if Chuang has not emerged, this method is not used. Medication for Chuang primarily relies on pulse: floating, middle, deep; light, moderate, heavy pressure; observe deficiency/excess, determine interior/exterior, then success is assured.
For external injury, Shengma Tang is primary. For internal injury, Zhishi Wan is primary. For loose stools, Zhizhu Wan is primary. For cold injury, warm with Shenyin Wan. (All three in Internal Injury/Diet Section.) For chills, disperse with Fangfeng Cangzhu Tang. For severe exterior heat, clear it (exterior here refers generally to Three Yang meridians; Yang excess causes qi to ascend upward; "clearing/seizing" means treating to prevent upward ascent). Knowing there is no Three Yang exterior syndrome, but Three Yang interior syndrome, stained by有形 (form/substance). Thirst cleared: severe thirst uses Baihu Tang (for summer); slight thirst uses Liangge San (remove Mangxiao and Dahuang, add Gancao and Jiegeng for stability). Constipation purged: Taoren Chengqi Tang, Sishun Yinzi, Chaihu Yinzi selected based on Qi/Blood location; must have internal excess, ability to eat, and constipation; use gentle moistening purgation. Urinary obstruction promoted: Daochi San, Bazheng San selected based on Upper/Lower Jiao meridian involvement. Fright calmed: Liangjing Wan; severe cases purged with Xieqing Wan. Diarrhea separated: cold uses Yigong San, Sijunzi Tang; heat uses Zexie Fuling Tang.
When pediatric Chuangzhen first emerges and cannot be identified, seek the cause: internal, external, or neither. Follow the injury, administer according to method, prevent changes, suppress excessive qi. Compared to other syndromes, urgency is higher. Disperse, purge, release muscle layer, or resolve toxicity. Seek origin, cool blood, clear lung, regulate viscera, balance diet, observe taboos, strict care, adjust warmth/coolness. Manage with method, ensure complete recovery, smooth eruption, firm scabbing. After recovery, prevent wandering toxins, sweating, empty pores, eye diseases (membranes/opacities), boils/tumors, throat closure/swelling, tidal fever/sweating. This is the general principle of treating Chuang.
If convulsions occur before eruption, it is external wind-cold invading and internal heart heat arising. Use Cha Fen (Tea Powder) to deliver Jiedu Wan, or Xijiao Dihuang Tang. If eruption is dense like needle heads and severe, lightly disperse exterior and cool interior with Lianqiao Shengma Tang. If eruption is dense/heavy with slight wheezing/drinking, indicating heat, use wind-dispersing herbs with mild purgation. If eruption is slow, stool/urine normal, knowing it is exterior not interior, mildly disperse with Shengma Gegen Tang. If blue/dry/black/sunken with no high fever and difficult urination/defecation, heat is internal; decoct Dahuang Tang to deliver Xuanfeng San. If body surface very hot, exterior syndrome not resolved, do not purge. If Chuang emerged with slight heat and difficult urination, use Bazheng San to promote urination. If residual toxin remains after eruption with fever/sores, use Cha Fen to deliver Jiedu Wan. If voice remains after Chuang emerges, shape is diseased but qi is not. If voice lost before Chuang emerges, shape is not diseased but qi is. If Chuang emerges but voice is lost, both shape and qi are diseased; clear lung qi, use Bafeng Tang, or Liangge San without Mangxiao/Dahuang.
[Zhu Danxi] Pediatric Douchuang distinguishes Qi/Blood deficiency/excess. Use Sijunzi Tang, Siwu Tang, wine-fried Huangqin (Scutellariae Radix), Lianqiao (Forsythiae Fructus). For Qi deficiency, Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma) plus detoxifying herbs. For Blood deficiency, Siwu Tang plus detoxifying herbs.
Detoxifying herbs added include wine-fried Huangqin and fried Huanglian (Coptidis Rhizoma). Zhang Yuansu states: Detoxifying agents include Sanhuang Tang (Three-Yellow Decoction), Jinhua Wan (Golden Flower Pill).
[Zhu Danxi] Douchuang distinguishes people's clarity/turbidity, courage/timidity based on physique. Black Douchuang belongs to Blood Heat, main treatment is cooling blood. White belongs to Qi Deficiency, main treatment is tonifying Qi. Black center with sunken exterior and late white elevation requires tonifying Qi with slight blood-cooling herbs.
[Chen Wenzhong] Between pre-eruption and post-eruption, if diarrhea/thirst, abdominal distension, or shortness of breath occur, it is called Interior Deficiency; quickly treat with Shi Yi Wei Muxiang San (Eleven-Ingredient Aucklandia Powder). If post-eruption, lesions lack luster, do not elevate, roots are not red, it is Exterior Deficiency; quickly treat with Shi Er Wei Yigong San (Twelve-Ingredient Extraordinary Merit Powder). If post-eruption, lesions lack luster, do not elevate, roots not red, plus diarrhea/thirst/distension/shortness of breath, it is Exterior-Interior Dual Deficiency; quickly treat with Shi Er Wei Yigong San delivering Qiwei Roudoukou Wan (Seven-Ingredient Myristica Pill). (Zhu Danxi notes: Muxiang Yigong San treats cold accurately; if deficient but not cold, disaster follows immediately.) If eruption lasts 1-10 days, whole body high fever, yellow stool, it is Exterior-Interior Dual Excess. Lesions will be lustrous, elevated, full, easy to scab, without damage. If no other illness, do not medicate. Dual excess: easy to erupt and scab. Dual deficiency: easy to erupt, hard to scab. Exterior deficiency: hard to erupt. Interior deficiency: hard to scab. Treat according to syndrome.
[Zhang Xunzhi] Key methods for treating Douchuang: Vomiting/diarrhea, low appetite indicate Interior Deficiency. Sunken/inverted, gray-white lesions indicate Exterior Deficiency. Both present indicate Dual Deficiency; fully use Yigong San to save. Even Jiang (Ginger), Fu (Aconite), Lingsha (Cinnabar) may be used. If only Interior Deficiency, reduce Guigui (Cassiae Cortex). If only Exterior Deficiency, reduce Roudoukou (Myristica Seed), do not reduce Guigui or Dingxiang (Caryophylli Flos). If able to eat, constipated, with sunken/inverted lesions, it is Interior Excess; use Qian's or Danxi's purging methods. If no vomiting/diarrhea, able to eat, it is Interior Excess; tonifying Interior Excess leads to carbuncle/toxin. Red, active, protruding lesions indicate Exterior Excess; using exterior-dispersing herbs for Exterior Excess leads to ulceration without scabbing. Whenever Douchuang shows rash points, avoid Gegen Tang, lest it cause Dual Deficiency.
[Zhu Danxi] Reading predecessors' books, one must understand their intent. Reading without understanding intent makes application impossible. Qian Yi's discussion on Douchuang is most detailed. He traces origins, meridians, clearly distinguishes interior/exterior, deficiency/excess, outlines treatment methods, and proves with dialectical statements, embodying the spirit of writing for teaching. Students reading and applying it are like seeking square/circle with compass/square, measuring straightness with plumb line; extending and expanding, touching categories and growing them, allows infinite application. Modern people do not know causes of disease, do not seek intent of formulas. In haste, they match symptoms to formulas, try randomly. If ineffective, they discard the book. Very thoughtless. Recently, due to long-standing influence of Ju Fang (Formulary of the Imperial Medical Bureau) and neglect of Suwen (Yellow Emperor's Inner Canon) studies, sick patients discussing medicine prefer warm over cold, tonification over resolving/purging. Suddenly obtaining Chen's formula theory, all using dry-hot tonics, concise text, definite claims, they happily use and believe it, thinking Qian is far inferior to Chen. Someone asks: Do you think Chen's formulas are insufficient? I say: Chen's formulas are indeed one-sided. However, he is good at seeking disease conditions; his intent focuses heavily on the Taiyin meridian. Hand Taiyin belongs to Lung, governs skin/hair. Foot Taiyin belongs to Spleen, governs muscles. Lung Metal dislikes cold and is easily invaded; Spleen Earth dislikes dampness and accepts everything. Observing his use of Dingxiang (Caryophylli Flos), Guigui (Cassiae Cortex) to treat Lung Cold; Fuzi (Aconiti Lateralis Radix Preparata), Baizhu (Atractylodis Macrocephalae Rhizoma), Banxia (Pinelliae Tuber) to treat Spleen Damp. If Spleen and Lung truly had cold/damp with deficiency, measure and give; if hitting the disease, what harm? Now, however, seeing delayed eruption, fever, diarrhea, fright, shortness of breath, thirst, regardless of cold/heat, deficiency/excess, they indiscriminately use Muxiang San, Yigong San. Occasionally effective, but if misused, disaster follows. Why? Ancients' formulas had guides, controllers, antagonists, and specific uses. Qian's formulas did not abandon Xixin (Asari Radix), Dingxiang, Baizhu, Renshen, Huangqi (Astragali Radix); they always had controlling/supporting herbs, not solely focusing on warm-tonifying. However, he used more cold/cooling herbs, briefly hinting at tonification, not going deep. Before fools, do not speak dreams; Qian's caution was thorough. He waited for those who could expand and apply it. Although Chen initiated using warm herbs for thirst and tonics for itching/collapse, surpassing predecessors, his frequent use of Guigui, Fuzi, Dingxiang (pungent-aromatic-dry-hot) may not be appropriate. Guigui, Fuzi, Dingxiang are appropriate for cold-deficiency, but for deficiency without cold, what harm? When Chen formulated, he likely had cold-clause bias, perhaps too hot? I synthesized experts' essences, sought intent, applied carefully, dare not rely on fixed formulas. In Jiashen year of Zhengtong, Yang qi moved early. In January, smallpox in the county rarely spared a family. All used Chen's formulas; over a hundred children died. Though due to heaven's mandate, I fear human effort was also lacking.
[Qian Yi] Shanghan (Cold Damage): Men have heavy body/yellow face; women have red face/rapid panting; all fear cold; hot breath in mouth; yawning/stifled sensation; stiff neck. Chuangzhen: Red swollen cheeks/restlessness, sneezing/frightened movement, drowsiness/fatigue, cold limbs. Shanghan should be dispersed; Chuangzhen should be treated with mild-neutral herbs; severe heat requires detoxification. Drowsiness, liking sneezing/fright indicates impending Chuangzhen.
[Li Dongyuan] Differentiating Chuangzhen Syndrome: Yawning, sneezing, acute fright during sleep, cold ear tips, dry eyes.
Differentiating Shanghan: Hot mouth, vinegar-like breath in mouth, undigested milk curds, abdominal pain.
[Qian Yi] Chuangzhen Signs: Dry face/red cheeks, red eyelids, yawning/stifled sensation, alternating cold/heat, coughing/sneezing, slightly cold feet, night-time fright/drowsiness. This is Chuangzhen syndrome, a pestilential disease.
Ten Grand Marshal of Mumin Palace had Chuangzhen, treated by many doctors. The Prince asked: Which organ does pre-eruption rash belong to? One doctor said Stomach Heat; another said unresolved Shanghan; another said toxin from mother's womb. Qian Yi said: If Stomach Heat, why alternating cold/heat? If womb toxin, which organ? Doctor said: Spleen/Stomach. Qian Yi said: Why fright in Spleen/Stomach? None could answer. Qian Yi said: Fetus in womb, by month 6-7 formed, consumes maternal impure fluids entering five zang. By month 10, stomach full of impurity. At birth, mouth still unclean; mother wipes clean, no disease. Folk uses Huanglian (Coptidis Rhizoma), Gongfen (Calomel) to purge umbilical feces; this is also maternal impure qi entering child's viscera. Originally caused by slight cold invasion, clashing with wind-cold pathogen, forming Douchuang. Before eruption, heat moves five zang, so zang symptoms appear first. Initial sickness: yawning/stifled/fright, alternating cold/heat, cold hands/feet, red/dry cheeks, cough/sneeze. These are five zang symptoms. Yawning/stifled: Liver. Fright: Heart. Alternating cold/heat/cold limbs: Spleen. Red cheeks/cough/sneeze: Lung. Only Kidney has no sign, as it is lower, does not consume impurity. All Chuangzhen are five zang toxins. If merging into one symptom: Liver becomes water blisters, Lung becomes pus blisters, Heart becomes macules, Spleen becomes rash. Kidney has no symptom, but if bad signs appear, lesion inverts and turns black/sunken, returning to Kidney. This is due to careless wind-cold and inability to eat/internal deficiency. Now the Marshal's rash has no other symptoms; treat with mild medicine, used Baolong Wan several doses, cured. (Zhang Yuansu notes: Do not mistake "originally slight cold" and "careless wind-cold/internal deficiency" as cold syndrome; using Baolong Wan shows Chuangzhen is mostly heat.)
At initial eruption, five zang symptoms appear, only Kidney has no sign, only flat symptoms seen: cool buttocks and ears. Buttocks and ears belong to Kidney, located North governing cold.
[Li Dongyuan] Chuangzhen initial symptoms: dry face/red cheeks, red eyelids, yawning/stifled, alternating heat/cold, cough/sneeze, cold feet, drowsiness, sleep fright; plus Chuangzhen symptoms: pus blisters/large blisters, small red spots, or nettle rash. These three differ, why show upper symptoms before eruption? Because Taiyang Cold Water rises from below right kidney, boiling left kidney; Foot Taiyang Bladder Cold Water flows counter-current along spine, up head/forehead, counteracts Hand Taiyang Bing Fire, cannot transmit, reverses on face, thus showing these symptoms. Ren/Gui Cold Water controls Bing/Ding Hot Fire. All Chuangzhen symptoms emerge from counter-flowing Cold Water. Doctors must know this to prescribe. Bao (Uterus/Womb) is also named Chigong, Dantian, Mingmen. Men store essence/spread transformation; women carry pregnancy in Bao. All are source of generation/transformation, not Five Elements, not Water or Fire, but different names of Heaven/Earth, resembling Kun Earth generating all things. At human conception, blood sea cleanses day 1-2; essence wins blood -> male. Day 3-5, blood vessels vigorous, essence loses to blood -> female. Two substances clash, growing prior to body is called Shen (Spirit), also Jing (Essence), Daoism/Buddhism call it Original Face.