初热大渴解毒汤，血热前耗凉血良，成浆津泄麦冬散，靥后伤津生脉强。
[注]
渴由毒火燔灼，内伤津液而作也，
如初发热即大渴者，里热盛也，宜葛根解毒汤治之，
痘出稠密，色艳作渴者，此血热毒盛也，凉血解毒汤主之，
成浆津液外泄而作渴者，人参麦冬散主之，
靥后脾虚，内伤津液而作渴者，生脉六均汤主之。
(葛根解毒汤) 葛根 升麻 天花粉 甘草生 麦门冬去心
生地 茅根 引用灯心水煎服。
(方歌)
葛根解毒汤清热，津液上潮火自泄，升葛花粉生甘草，麦冬生地茅根列。
(凉血解毒汤) 方见结痂落痂证治。
(人参麦冬散) 人参 白术土炒 甘草生 葛根粉煨 麦冬去心
升麻 引用糯米水煎服。
(方歌)
人参麦冬效通仙，津液外泄治易痊，参术甘草煨葛粉，麦冬升麻糯米煎。
(生脉六均汤) 人参 五味子 麦门冬去心 陈皮 半夏姜制
茯苓 白术土炒 甘草炙 引用乌梅水煎服。
(方歌)
生脉六均医脾弱，泄泻伤津大渴作，人参五味麦门冬，陈半苓术甘草合。
%
痘中杂证
爪自便清厥属寒，木香理中汤可痊，爪紫便赤为热厥，金花承气乃良煎。
[注]
痘中厥逆之证，
有因气血虚寒发厥者，有因毒热郁闪发厥者，
爪甲色白，小便清利，其痘色更见灰陷泻泄不食等证，
此外阳衰内阴盛，乃寒厥也，以加减陈氏木香散主之，
寒甚者附子理中汤主之，
若爪甲色红，小便赤涩，其痘色更见紫黑烦躁闷乱等证，
此系阳毒内攻，热极反寒，是热厥也，
宜栀子金花汤治之，里实者承气汤下之。
(加减陈氏木香散) 人参 肉桂 茯苓 半夏姜制 白术土炒 丁香
肉豆蔻面裹煨 甘草炙 诃子肉面裹煨 木香煨 引用生姜水煎服。
(方歌)
木香散疗中外寒，参桂茯苓半夏攒，白术丁香肉豆蔻，甘草诃子木香研。
(附子理中汤) 人参 附子制 甘草炙 白术土炒 干姜 水煎服。
(方歌)
附子理中治虚寒，中外无阳莫留连，人参附子炙甘草，白术干姜一同煎。
(栀子金花汤) 黄芩 黄连 黄蘖 大黄 栀子 水煎服。
(方歌)
热厥栀子金花汤，热极反寒服最良，黄芩黄连并黄蘖，大黄栀子共煎尝。
(承气汤) 厚朴姜炒 枳实麸炒 大黄 水煎服。
(方歌)
承气汤能除火热，裹实不便毒气结，厚朴枳实川大黄，煎服便利毒即泄。
%
痘中杂证
初热大渴解毒汤，血热前耗凉血良，成浆津泄麦冬散，靥后伤津生脉强。
[注]
口渴是由毒火炽盛灼烧，内伤津液而引发的。
如痘疹刚发热时就出现严重口渴的，是里热亢盛，适宜用葛根解毒汤治疗；
痘疹出得稠密，颜色鲜艳且伴有口渴的，这是血热毒盛，以凉血解毒汤为主治方剂；
痘疹进入化脓期（成浆），津液外泄而导致口渴的，用人参麦冬散主治；
痘疹收靥（结痂脱落）后，因脾虚内伤津液而导致口渴的，用生脉六均汤主治。
(葛根解毒汤) 组成：葛根、升麻、天花粉、生甘草、去心的麦门冬、生地、茅根。引用灯心草水煎服。
(方歌)
葛根解毒汤清热，津液上潮火自泄，升葛花粉生甘草，麦冬生地茅根列。
(凉血解毒汤) 方剂见“结痂落痂证治”章节。
(人参麦冬散) 组成：人参、土炒白术、生甘草、煨葛根粉、去心麦冬、升麻。引用糯米水煎服。
(方歌)
人参麦冬效通仙，津液外泄治易痊，参术甘草煨葛粉，麦冬升麻糯米煎。
(生脉六均汤) 组成：人参、五味子、去心麦门冬、陈皮、姜制半夏、茯苓、土炒白术、炙甘草。引用乌梅水煎服。
(方歌)
生脉六均医脾弱，泄泻伤津大渴作，人参五味麦门冬，陈半苓术甘草合。
%
痘中杂证
爪甲清冷厥属寒，木香理中汤可痊，爪紫便赤为热厥，金花承气乃良煎。
[注]
痘疹中出现的厥逆（四肢冰冷）证候，
有因气血虚寒导致发厥的，有因毒热郁闭闪伏导致发厥的，
若指甲色白，小便清长通畅，其痘色更呈现灰暗下陷、腹泻、不食等症状，
这是外阳衰微、内阴盛极，属于寒厥，以加减陈氏木香散主治，
寒邪严重的，用附子理中汤主治；
如果指甲色红，小便赤涩不通，其痘色更呈现紫黑、烦躁闷乱等症状，
这是阳毒内攻，热极反现寒象，属于热厥，
适宜用栀子金花汤治疗，若里有实邪积滞的，用承气汤攻下。
(加减陈氏木香散) 组成：人参、肉桂、茯苓、姜制半夏、土炒白术、丁香、面裹煨肉豆蔻、炙甘草、面裹煨诃子肉、煨木香。引用生姜水煎服。
(方歌)
木香散疗中外寒，参桂茯苓半夏攒，白术丁香肉豆蔻，甘草诃子木香研。
(附子理中汤) 组成：人参、制附子、炙甘草、土炒白术、干姜。水煎服。
(方歌)
附子理中治虚寒，中外无阳莫留连，人参附子炙甘草，白术干姜一同煎。
(栀子金花汤) 组成：黄芩、黄连、黄蘖、大黄、栀子。水煎服。
(方歌)
热厥栀子金花汤，热极反寒服最良，黄芩黄连并黄蘖，大黄栀子共煎尝。
(承气汤) 组成：姜炒厚朴、麸炒枳实、大黄。水煎服。
(方歌)
承气汤能除火热，裹实不便毒气结，厚朴枳实川大黄，煎服便利毒即泄。
%
痘中杂证
Churetsu Daiku Kaidokuto, Xue Re Qian Hao Liang Xue Liang, Cheng Jiang Jin Xie Maidong San, Ye Hou Shang Jin Sheng Mai Qiang.
[Note]
Thirst arises from the blazing and scorching of toxic fire, which internally injures body fluids (Jin Ye).
If severe thirst occurs immediately upon the initial fever, it indicates excessive heat in the interior; Ge Gen Jie Du Tang (Kudzu Root Decoction for Resolving Toxicity) is appropriate for treatment.
If pustules are dense, with a bright red color accompanied by thirst, this signifies blood heat and abundant toxicity; Liang Xue Jie Du Tang (Blood-Cooling and Toxicity-Resolving Decoction) is the primary formula.
If thirst arises during the suppuration stage (Cheng Jiang) due to the external loss of body fluids, Ren Shen Mai Dong San (Ginseng and Ophiopogon Powder) is indicated.
If thirst occurs after the crusting and shedding stage (Ye) due to Spleen deficiency and internal injury to body fluids, Sheng Mai Liu Jun Tang (Sheng Mai Six-Harmonies Decoction) is indicated.
(Ge Gen Jie Du Tang / Kudzu Root Decoction for Resolving Toxicity)
Ingredients: Puerariae Lobatae Radix (Ge Gen), Cimicifugae Rhizoma (Sheng Ma), Trichosanthis Radix (Tian Hua Fen), raw Glycyrrhizae Radix et Rhizoma (Sheng Gan Cao), Ophiopogonis Tuber (Mai Men Dong, heart removed), Rehmanniae Radix (Sheng Di), Imperatae Rhizoma (Mao Gen).
Decoct with Juncus effusus (Deng Xin Cao) water.
(Fang Ge / Formula Verse)
Ge Gen Jie Du Tang clears heat, allowing body fluids to rise and fire to dissipate naturally; Kudzu root, Trichosanthes root, raw licorice, Ophiopogon, Rehmannia, and Imperata are listed.
(Liang Xue Jie Du Tang / Blood-Cooling and Toxicity-Resolving Decoction)
See the section on "Crusting and Shedding Scabs" for the formula details.
(Ren Shen Mai Dong San / Ginseng and Ophiopogon Powder)
Ingredients: Ginseng Radix et Rhizoma (Ren Shen), Atractylodis Macrocephalae Rhizoma (Bai Zhu, stir-fried with soil), raw Glycyrrhizae Radix et Rhizoma (Sheng Gan Cao), Puerariae Lobatae Radix powder (Ge Gen Fen, baked), Ophiopogonis Tuber (Mai Men Dong, heart removed), Cimicifugae Rhizoma (Sheng Ma).
Decoct with Glinis Semen (Nuomi) water.
(Fang Ge / Formula Verse)
Ren Shen Mai Dong has efficacy surpassing immortals, easily curing cases where body fluids leak externally; Ginseng, Atractylodes, licorice, and baked kudzu powder, along with Ophiopogon, Cimicifuga, and glutinous rice decoction.
(Sheng Mai Liu Jun Tang / Sheng Mai Six-Harmonies Decoction)
Ingredients: Ginseng Radix et Rhizoma (Ren Shen), Schisandrae Fructus (Wu Wei Zi), Ophiopogonis Tuber (Mai Men Dong, heart removed), Citri Reticulatae Pericarpium (Chen Pi), Pinelliae Tuber (Ban Xia, processed with ginger), Poria (Fu Ling), Atractylodis Macrocephalae Rhizoma (Bai Zhu, stir-fried with soil), roasted Glycyrrhizae Radix et Rhizoma (Zhi Gan Cao).
Decoct with Mume Fructus (Wu Mei) water.
(Fang Ge / Formula Verse)
Sheng Mai Liu Jun treats Spleen weakness, where diarrhea injures fluids causing severe thirst; Ginseng, Schisandra, Ophiopogon, Citrus peel, Pinellia, Poria, Atractylodes, and licorice combine.
%
Miscellaneous Syndromes in Smallpox
Zhao Zi Bian Qing Jue Shu Han, Mu Xiang Li Zhong Tang Ke Quan, Zhao Zi Bian Chi Wei Re Jue, Jin Hua Cheng Qi Nai Liang Jian.
[Note]
In smallpox, the syndrome of Jue Ni (cold limbs/reversal) can arise from:
Qi and Blood deficiency and cold leading to reversal, or
Toxic heat stagnation and entrapment leading to reversal.
If the fingernails are pale, urination is clear and profuse, and the smallpox lesions appear grayish, depressed, accompanied by diarrhea and anorexia,
this indicates exterior Yang decline and interior Yin excess, constituting Cold Jue (Cold Reversal); Jia Jian Chen Shi Mu Xiang San (Modified Chen's Costus Powder) is indicated.
For severe cold, Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) is indicated.
If the fingernails are red, urination is scanty and dark, and the smallpox lesions appear purple-black, accompanied by restlessness and confusion,
this indicates internal attack by Yang toxin, where extreme heat manifests as cold (Reversal due to Heat); Zhi Zi Jin Hua Tang (Gardenia Golden Flower Decoction) is appropriate. If there is interior excess accumulation, Cheng Qi Tang (Descending the Qi Decoction) should be used to purge.
(Jia Jian Chen Shi Mu Xiang San / Modified Chen's Costus Powder)
Ingredients: Ginseng Radix et Rhizoma (Ren Shen), Cinnamomi Cortex (Rou Gui), Poria (Fu Ling), Pinelliae Tuber (Ban Xia, processed with ginger), Atractylodis Macrocephalae Rhizoma (Bai Zhu, stir-fried with soil), Tingtitis Flos (Ding Xiang), Myristicae Semen (Rou Dou Kou, wrapped in flour and baked), roasted Glycyrrhizae Radix et Rhizoma (Zhi Gan Cao), Terminalia Chebulae Fructus (He Zi Rou, wrapped in flour and baked), Aucklandiae Radix (Mu Xiang, baked).
Decoct with Zingiberis Rhizoma Recens (Sheng Jiang) water.
(Fang Ge / Formula Verse)
Mu Xiang San treats cold in both interior and exterior; Ginseng, Cinnamon, Poria, and Pinellia gather; Atractylodes, Tingtitis flower, Myristica seed, licorice, Terminalia, and Costus root are ground.
(Fu Zi Li Zhong Tang / Aconite Regulate the Middle Decoction)
Ingredients: Ginseng Radix et Rhizoma (Ren Shen), prepared Aconiti Lateralis Radix (Fu Zi), roasted Glycyrrhizae Radix et Rhizoma (Zhi Gan Cao), Atractylodis Macrocephalae Rhizoma (Bai Zhu, stir-fried with soil), Zingiberis Rhizoma (Gan Jiang).
Decoct with water.
(Fang Ge / Formula Verse)
Fu Zi Li Zhong treats deficiency-cold, do not linger when interior and exterior lack Yang; Ginseng, prepared Aconite, roasted licorice, Atractylodes, and dried ginger are decocted together.
(Zhi Zi Jin Hua Tang / Gardenia Golden Flower Decoction)
Ingredients: Scutellariae Radix (Huang Qin), Coptidis Rhizoma (Huang Lian), Phellodendri Cortex (Huang Bo), Rheii Radix et Rhizoma (Da Huang), Gardeniae Fructus (Zhi Zi).
Decoct with water.
(Fang Ge / Formula Verse)
Re Jue (Heat Reversal) is treated with Zhi Zi Jin Hua Tang, most effective for extreme heat manifesting as cold; Scutellaria, Coptis, and Phellodendrum, along with Rheum and Gardenia, are jointly decocted.
(Cheng Qi Tang / Descending the Qi Decoction)
Ingredients: Magnoliae Officinalis Cortex (Hou Po, stir-fried with ginger), Immature Bitter Orange (Zhi Shi, bran-roasted), Rheii Radix et Rhizoma (Da Huang).
Decoct with water.
(Fang Ge / Formula Verse)
Cheng Qi Tang eliminates fire and heat, resolving accumulated excess and constipation where toxic qi knots; Magnolia bark, Immature Bitter Orange, and Rheum, when decocted and taken, relieve obstruction and allow toxic qi to drain.
%
Miscellaneous Syndromes in Smallpox