小儿出痘若疼痛，皆因毒火未发清，疏散清解是妙方，葛根四物渴极应。
[注]
经曰：诸痛为实。又曰：热盛则痛。
皆缘痘毒之火未能尽解，故不时作痛也，
痘初出痛者，因毒未发透也，升麻葛根汤主之，
痘出稠密而作痛者，毒盛血热也，加味四物汤主之，
若收靥时痛甚闷乱者不治。
(升麻葛根汤) 方见发热证治
(加味四物汤) 当归 赤芍 荆芥穗 防风 红花 丹皮 牛蒡子炒 连翘去心
川芎 生地黄 水煎服。
(方歌)
毒盛加味四物汤，当归赤芍合荆防，红花丹皮牛蒡子，连翘川芎生地黄。
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痘中杂证
痘之始终喜音清，毒热壅塞哑无声，喉中有痘不须治，若是毒攻甘桔宁。
[注]
音者心之声也，心气上达于肺而作音，肺清则音清，肺热则音哑，
如痘当灌浆而音哑者，此喉中有痘碍于气道，
待外痘收靥，而内痘自清，不必施治，
若未尝灌，而音已先哑者，此热毒壅遏肺窍而然也，宜加味甘桔汤治之。
(加味甘桔汤)
射干 牛蒡子炒 玄参 连翘去心 麦门冬去心 栀子炒
苦桔梗 甘草生 水煎服。
(方歌)
加味甘桔治失音，射干牛蒡与玄参，连翘麦冬炒栀子，桔梗甘草共和匀。
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痘中杂证
热盛衄血犀角汤，脾不统血参术良，热注肠胃四物治，脾虚便血归脾尝。
[注]
血属阴，诸经赖以养育，痘疮资以成功，一为毒火熏灼，
则血随火动，迫而妄行，上则为衄血，下则为便血，
痘色紫滞，燥热口渴而衄者，此毒火刑金也，犀角地黄汤主之，
靥后余毒乘脾而衄者，此脾虚不能统血归经也，人参白术散主之，
外俱用发灰散吹入鼻中，
若毒火炽甚，流注大肠，大便下血，加味四物汤主之，
设痘色灰白陷下而便血者，此脾气虚弱不能摄血，宜归脾汤主之，
至若大吐血溺血，及七窍出血，变在反掌，不必服药。
(犀角地黄汤) 犀角镑 丹皮 生地 白芍 水煎服。
(方歌)
毒火上冲频衄血，犀角地黄汤效捷，犀角螃与牡丹皮，生地白芍共煎列。
(人参白术散) 方见喘证。
(发灰散)
用少壮无病人之乱发，以皂角煮水，洗净油气，焙干，
用新瓦罐一个，填入内令满，净瓦片盖口，盐泥封之，
炭火围罐之半，煆一炷香取出，候冷研细，
吹鼻中，或用发灰二分，童便七分，酒三分调服，亦可止血。
(加味四物汤) 当归 白芍酒炒 生地 牡丹皮 荆芥炒黑 川芎
黄芩 黄连 地榆 水煎服
(方歌)
加味四物使血宜，归芍生地牡丹皮，荆芥炒黑川芎配，黄芩黄连共地榆。
(归脾汤) 人参 白术土炒 甘草炙 黄耆蜜炙 枣仁炒研 远志去心
龙眼肉 茯神 当归 木香煨 引用姜枣水煎服。
(方歌)
归脾汤治脾气虚，人参白术草黄耆，枣仁远志龙眼肉，茯神当归木香宜。
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痘中杂证
小儿出痘疹如果出现疼痛，都是因为毒火未能彻底发散清除。疏散清解是妙方，若口渴极甚则应使用葛根四物汤。
[注]
《内经》说：各种疼痛多属于实证。又说：热邪炽盛则会导致疼痛。
这都是因为痘毒之火未能完全解除，所以不时产生疼痛。
痘疹刚发出时疼痛，是因为毒邪未能透发出来，主方用升麻葛根汤；
痘疹发出后稠密且疼痛的，是毒邪盛、血分热的表现，主方用加味四物汤；
如果在痘疹收靥（结痂脱落）时疼痛剧烈且伴有烦闷扰乱症状的，属于不治之症。
(升麻葛根汤) 方剂见发热证治章节。
(加味四物汤) 组成：当归、赤芍、荆芥穗、防风、红花、丹皮、炒牛蒡子、去心连翘、川芎、生地黄。水煎服。
(方歌)
毒盛加味四物汤，当归赤芍合荆防，红花丹皮牛蒡子，连翘川芎生地黄。
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痘疹中的杂证
痘疹从头到尾都喜好声音清脆，若毒热壅塞咽喉导致声音嘶哑甚至无声，若喉中有痘疹阻塞不必治疗；若是毒邪攻冲所致，可用甘桔汤宁利咽喉。
[注]
声音是心的外在表现，心气上达于肺而发出声音，肺气清肃则声音清脆，肺热则声音嘶哑。
如痘疹正处于灌浆期而出现声音嘶哑的，这是因为喉中有痘疹阻碍了气道，
等到外部痘疹收靥，内部痘疹自然消退，不必施治。
如果尚未灌浆，声音却先嘶哑的，这是热毒壅遏肺窍所致，宜用加味甘桔汤治疗。
(加味甘桔汤) 组成：射干、炒牛蒡子、玄参、去心连翘、去心麦门冬、炒栀子、苦桔梗、生甘草。水煎服。
(方歌)
加味甘桔治失音，射干牛蒡与玄参，连翘麦冬炒栀子，桔梗甘草共和匀。
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痘疹中的杂证
热盛导致的鼻出血用犀角汤，脾虚不能统摄血液用人参白术散疗效好，热邪注入肠胃用四物汤治疗，脾气虚弱导致的便血可用归脾汤尝试。
[注]
血属于阴液，各条经脉依靠它来滋养，痘疮的成功也依赖它。一旦受到毒火熏灼，
血液就会随着火势妄动，被迫溢出脉外，向上则为鼻衄（鼻出血），向下则为便血。
痘色紫暗滞涩，伴有燥热口渴且出现鼻衄的，这是毒火刑克肺金的表现，主方用犀角地黄汤；
收靥后余毒侵袭脾脏导致鼻衄的，这是脾气虚弱不能统摄血液回归经脉的表现，主方用人参白术散；
外部均可使用发灰散吹入鼻中止血；
若毒火炽盛，流注大肠，导致大便下血，主方用加味四物汤；
假设痘色灰白凹陷且出现便血的，这是脾气虚弱不能固摄血液，宜用归脾汤主方；
至于大吐血、尿血，以及七窍出血，病情变化极快（反掌之间），不必服药。
(犀角地黄汤) 组成：镑犀角、丹皮、生地、白芍。水煎服。
(方歌)
毒火上冲频衄血，犀角地黄汤效捷，犀角螃与牡丹皮，生地白芍共煎列。
(人参白术散) 方剂见喘证章节。
(发灰散)
取年轻健康无病者的乱发，用皂角煮水洗净油脂，焙干，
用一个新瓦罐，填满头发，用干净的瓦片盖住罐口，用盐泥密封，
用炭火围绕罐身一半的高度，煅烧一炷香的时间取出，冷却后研成细粉，
吹入鼻中，或用二分发灰，七分童便，三分酒调服，也能止血。
(加味四物汤) 组成：当归、酒炒白芍、生地、牡丹皮、炒黑荆芥、川芎、黄芩、黄连、地榆。水煎服。
(方歌)
加味四物使血宜，归芍生地牡丹皮，荆芥炒黑川芎配，黄芩黄连共地榆。
(归脾汤) 组成：人参、土炒白术、炙甘草、蜜炙黄耆、炒研枣仁、去心远志、龙眼肉、茯神、当归、煨木香。引用姜枣水煎服。
(方歌)
归脾汤治脾气虚，人参白术草黄耆，枣仁远志龙眼肉，茯神当归木香宜。
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痘疹中的杂证
If a child suffering from smallpox experiences pain, it is all due to the toxic heat failing to be fully dispersed and cleared. Dispersing and clearing is the excellent method; if extreme thirst occurs, Gegen Siwu Decoction should be used.
[Annotation]
The Classics state: "All pains belong to excess." It also states: "When heat is excessive, pain results."
This is because the fire of the smallpox toxin has not been completely resolved, causing intermittent pain.
When pain occurs at the initial eruption of the rash, it is because the toxin has not been fully expressed; Shengma Gegen Tang (Cimicifugae et Puerariae Decoction) is the primary formula.
When the rash is dense and painful, it indicates abundant toxin and heat in the blood; Jiawei Siwu Tang (Modified Four Substances Decoction) is the primary formula.
If severe pain accompanied by restlessness and confusion occurs during the crusting stage, it is incurable.
(Shengma Gegen Tang) See the section on Fever for the formula.
(Jiawei Siwu Tang) Composition: Danggui (Angelicae Sinensis Radix), Chishao (Moutan Cortex Radix), Jingjie Sui (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Honghua (Carthami Flos), Danpi (Moutan Cortex), fried Niubangzi (Arctii Fructus), Lianqiao (Forsythiae Fructus) with heart removed, Chuanxiong (Ligustici Chuanxiong Rhizoma), Shengdihuang (Rehmanniae Radix). Decoct in water and take orally.
(Rhyme Formula)
For abundant toxin, use Modified Four Substances Decoction,
Danggui and Chishao combined with Jingjie and Fangfeng,
Honghua, Danpi, and Niubangzi,
Lianqiao, Chuanxiong, and Shengdihuang.
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Miscellaneous Syndromes of Smallpox
Throughout the course of smallpox, clear voice is preferred; if toxic heat obstructs the throat leading to hoarseness or silence, treatment may not be necessary if there are lesions in the throat; however, if the toxin attacks the area, Ganjie Tang (Licorice and Platycodon Decoction) can soothe the throat.
[Annotation]
Voice is the sound of the Heart; Heart Qi ascends to the Lung to produce voice. If Lung Qi is clear, the voice is clear; if Lung Heat exists, the voice becomes hoarse.
If hoarseness occurs during the pustule-filling stage, this is because lesions in the throat obstruct the airway.
Wait until the external rash crusts over, and the internal lesions will naturally clear; no treatment is needed.
If hoarseness occurs before the pustule-filling stage, this is due to heat-toxin obstructing the Lung orifices; Jiawei Ganjie Tang (Modified Licorice and Platycodon Decoction) should be used.
(Jiawei Ganjie Tang) Composition: Shegan (Belamcandae Rhizoma), fried Niubangzi (Arctii Fructus), Xuanshen (Scrophulariae Radix), Lianqiao (Forsythiae Fructus) with heart removed, Maimendong (Ophiopogonis Tuber) with heart removed, fried Zhizi (Gardeniae Fructus), Kujiegeng (Platycodonis Radix), raw Gancao (Glycyrrhizae Radix et Rhizoma). Decoct in water and take orally.
(Rhyme Formula)
Modified Licorice and Platycodon Decoction treats loss of voice,
Shegan, Niubangzi, and Xuanshen,
Lianqiao, Maimendong, and fried Zhizi,
Jiegeng and Gancao harmonized together.
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Miscellaneous Syndromes of Smallpox
For epistaxis due to excessive heat, Xijiao Tang (Rhinoceros Horn Decoction) is used; for poor blood control by the Spleen, Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Powder) is effective; for heat pouring into the Intestines and Stomach, Siwu Tang (Four Substances Decoction) treats it; for hematochezia due to Spleen deficiency, Guipi Tang (Restore the Spleen Decoction) can be tried.
[Annotation]
Blood belongs to Yin and nourishes all meridians; successful smallpox recovery depends on it. Once scorched by toxic fire,
blood moves with the fire and flows recklessly, exiting the vessels. Upward, it causes epistaxis; downward, it causes hematochezia.
If the rash color is purple and stagnant, accompanied by dryness, heat, thirst, and epistaxis, this is toxic fire punishing Metal (Lung); Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is the primary formula.
If epistaxis occurs after crusting due to residual toxin attacking the Spleen, this is Spleen deficiency failing to control blood returning to the vessels; Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Powder) is the primary formula.
Externally, Fazhui San (Hair Ash Powder) can be blown into the nose.
If toxic fire is extremely intense and flows into the Large Intestine, causing hematochezia, Jiawei Siwu Tang (Modified Four Substances Decoction) is the primary formula.
If the rash color is gray-white and sunken with hematochezia, this is Spleen Qi deficiency failing to secure blood; Guipi Tang (Restore the Spleen Decoction) is the primary formula.
As for massive hematemesis, hematuria, or bleeding from the seven orifices, changes occur rapidly (in the time it takes to flip a hand); medication is unnecessary.
(Xijiao Dihuang Tang) Composition: Bang Xijiao (Hornis Rhinocerotis - *Note: Substitute with legal alternatives in modern practice*), Danpi (Moutan Cortex), Shengdi (Rehmanniae Radix), Baishao (Paeoniae Radix Alba). Decoct in water and take orally.
(Rhyme Formula)
Toxic fire rushing upward causes frequent epistaxis,
Xijiao Dihuang Tang acts swiftly;
Bang Xijiao and Mudanpi,
Shengdi and Baishao decocted together.
(Renshen Baizhu San) See the section on Asthma for the formula.
(Fazhui San)
Take hair from a young, healthy person without illness, wash off grease with water boiled with Gengjiao (Tofu Branches), dry by baking,
fill a new clay jar completely with the hair, cover the mouth with a clean tile, seal with salt mud,
surround half the jar with charcoal fire, calcine for the duration of one incense stick, remove, cool, and grind into fine powder.
Blow into the nose, or mix two parts hair ash with seven parts children's urine and three parts wine, then take orally; this can also stop bleeding.
(Jiawei Siwu Tang) Composition: Danggui (Angelicae Sinensis Radix), Jiuchao Baishao (Paeoniae Radix Alba fried with wine), Shengdi (Rehmanniae Radix), Mudanpi (Moutan Cortex), Chaohei Jingjie (Schizonepetae Spica fried until black), Chuanxiong (Ligustici Chuanxiong Rhizoma), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Diyu (Sanguisorbae Radix). Decoct in water and take orally.
(Rhyme Formula)
Modified Four Substances Decoction regulates blood appropriately,
Guipai, Baishao, Shengdi, and Mudanpi,
Chaohei Jingjie paired with Chuanxiong,
Huangqin and Huanglian with Diyue.
(Guipi Tang) Composition: Renshen (Ginseng Radix et Rhizoma), Tuchao Baizhu (Atractylodis Macrocephalae Rhizoma stir-fried with soil), Zhi Gancao (Glycyrrhizae Radix et Rhizoma honey-roasted), Mi Zhi Huangqi (Astragali Radix honey-roasted), Zaoren (Zizyphi Semen) fried and ground, Yuanzhi (Polygalae Radix) with heart removed, Longyanrou (Longan Aril), Fushen (Poria with Wood), Danggui (Angelicae Sinensis Radix), Wei Muxiang (Aucklandiae Radix roasted). Use Ginger and Jujube water as guide, decoct and take orally.
(Rhyme Formula)
Guipi Tang treats Spleen Qi deficiency,
Renshen, Baizhu, Gancao, and Huangqi,
Zaoren, Yuanzhi, and Longyanrou,
Fushen, Danggui, and Muxiang are suitable.
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Miscellaneous Syndromes of Smallpox