凡小儿初病耳冷 冷手足乍温乍凉发热面赤时嗽时嚏惊悸耳后有红赤脉缕定是痘疹证候
急宜发表使脏腑胎毒及外感不正之气尽从汗散则痘出稀少然表药必在红点未见之前也既汗之
后身热不退不可便用凉药恐毒瓦斯不能发也
作二次出 大小不一等 头面稀少 眼中无 根窠红润 肥满光泽 前后心少
一齐并出 形如蚕种 赤红干燥 灰白色
头温足冷 身温腹胀 稠密泻渴
一发热一日即出痘者太重发热二日出亦重微微发热三日后乃见者轻四五日后身凉乃见者
尤轻盖因热散其毒也
一小儿初发热忽然惊搐少刻即苏必出痘疹此名惊痘甚为稳当
一麻痘作热类似疹候麻乃腑受病属阳易于调理虽不服药亦能自愈又恐吃毒冒风为之逆也
一痘初出与麻疹痱疮颇略相似若根窠红顶圆尖起坚实碍指者正痘也若根不红顶虚软略有
一发热身出红点一二日即成水珠明亮者乃是水痘亦因胎毒所发但与正痘少轻耳如无余症
亦不必治
一发热一日遍身出红点如蚊虫咬者决非痘疮乃是热毒为风寒所遏不能发越故也当于发热
求治热退点散
一痘疮先看根脚何如若根脚起血色红滑者此生意也虽有陷血亦可调治若根脚平不红不起
血死不活虽轻难治譬犹种豆地肥根活苗虽枯弱尚可灌溉而有生意若土焦根死灌之何益
一痘疹初见形时内有小红点如蚊蚤咬者名血痘一名痘 不退不起者不治
一痘疮虽稀根叶全白无血色三四日偏起胀痘大按之空软此名贼痘气血大虚至贯脓时便成
水泡大若葡萄内是清水无脓皮薄白如纸擦破即死
凡痘疮须认得轻重表里虚实寒热
一痘疮一日至二三日方齐大小不等红润尖圆此轻候也不须求治
一痘疮一齐弄出红紫成片密如蚕种烦渴焦枯此重候也治之无益
一表实其症色红身润顶圆光亮坚实碍指
一里实其症大便干润小便黄多饮食如常口微微干
此二症不必用药
一表虚其症色白作痒不成浆顶陷寒战身冷
一里虚其症大便泄泻作渴腹胀喘促切牙
此二症宜急实表里
一表热其症色红紫根窠成片焦枯肌肤壮热顶赤紫黑
一里热其症大便秘结小便赤色身热口渴引饮狂言发惊
此二症急宜清凉解毒
一表寒其症身凉疮不起发根窠淡白不红绽
一里寒其症吐泻腹胀气冷谷食不化二便清利色灰顶陷
此二症急宜温中补元气
一根窠红润小便清利大便如常能食不渴安卧神清此表里皆清也
凡是小儿初起病时,出现耳朵发冷、手脚忽冷忽热、发热、面色发红、时而咳嗽时而打喷嚏、惊悸不安,且耳后有红色血丝脉络显现,这必定是痘疹的证候。此时应当紧急使用发表药物,使脏腑内的胎毒以及外感不正之气全部通过汗液发散出去,这样痘疮就会出得稀少。然而,解表药必须在红点尚未出现之前使用。如果已经发汗后,身体发热仍然不退,不可立即使用寒凉药物,恐怕痘毒无法透发。
(若痘疮)分两次发出,大小不一,头面部较少,眼中无痘,痘根红润饱满,光泽肥满,前胸和后背较少。
(若痘疮)一齐并发,形状像蚕种一样,颜色赤红干燥,呈灰白色;头部温热而足部寒冷,身体温热但腹部胀满,痘疮稠密并伴有腹泻和口渴。
有的小儿发热一天就出痘,病情较重;发热两天才出痘,病情也重;微微发热,三天后才见痘出的,病情较轻;发热四五天后身体变凉才见痘出的,病情尤其轻,这是因为热势消散,痘毒也随之散发。
有的小儿刚开始发热,忽然出现惊厥抽搐,片刻后即苏醒,这必定要出痘疹,这种情况称为“惊痘”,预后非常稳妥。
有的麻疹发热,症状类似疹候。麻疹属于腑受病,属性为阳,容易调理,即使不服药也能自愈,但又恐怕因饮食中毒或冒受风寒而导致病情逆乱。
有的痘疮初出时,与麻疹、痱子颇为相似。如果痘根红润、顶部圆尖、隆起坚实、碍手触之者,是正痘。如果痘根不红、顶部虚软略有凹陷者……
有的小儿发热,身上出现红点,一二天即变成明亮的水珠,这是水痘,也是由胎毒引发,但比正痘稍轻。如果没有其他兼症,也不必治疗。
有的小儿发热一天,遍身出现红点,像蚊虫叮咬的样子,这决不是痘疮,而是热毒被风寒遏制,不能透发所致。应当在发热阶段求治,待热退则红点消散。
看痘疮首先要观察痘根脚的情况。如果痘根脚隆起,血色红滑,这是有生机之象,即使出现陷伏出血也可以调治。如果痘根脚平坦、不红、不起隆、血色死暗,则无生机,虽然病情轻也难治愈。这就好比种豆,土地肥沃、根部存活,苗虽枯弱尚可灌溉而有生机;如果土壤焦枯、根部死亡,灌溉又有什么益处呢?
痘疹刚见形时,内部有小红点如蚊蚤叮咬者,名为“血痘”。如果痘出不退、不起发者,不治。
痘疮虽然稀疏,但痘根叶全白无血色,三四天后反而起胀,痘体大按之空软,这叫“贼痘”,是气血大虚的表现。到了化脓期便成为水泡,大如葡萄,内含水清而无脓,皮薄白如纸,擦破即死。
有的痘疮一至二天才齐出,大小不等,红润尖圆,这是轻证候,不需要求治。
有的痘疮一齐发出,红紫成片,密集如蚕种,烦躁口渴,焦枯,这是重证候,治疗也无益。
里实证的症状:大便干润,小便黄多,饮食如常,口微微干燥。
这两种症候不必用药。
表虚证的症状:痘色白,作痒,不成浆,顶部凹陷,寒战,身体冷。
里虚证的症状:大便泄泻,口渴,腹胀,喘促,切牙(磨牙)。
这两种症候宜急补表里。
表热证的症状:痘色红紫,痘根成片焦枯,肌肤壮热,顶部赤紫黑。
里热证的症状:大便秘结,小便赤色,身体热,口渴引饮,胡言乱语,发惊。
这两种症候急宜清凉解毒。
Whenever a child initially falls ill with cold ears, alternating cold and warm hands and feet, fever, red face, intermittent coughing and sneezing, palpitations, and the appearance of red vascular patterns behind the ears, this is definitely a sign of smallpox (Xiaochuan). At this time, it is urgent to use exterior-releasing medications to allow the fetal toxins within the zang-fu organs and the pathogenic qi from external infections to dissipate entirely through sweating, thereby resulting in fewer eruptions. However, exterior-releasing medicines must be administered before the red macules appear. If body heat persists after sweating, cooling medicines should not be used immediately, lest the toxin fail to erupt.
(Eruptions) that emerge in two waves, varying in size, sparse on the head and face, absent in the eyes, with red and plump roots, full and glossy appearance, and sparse distribution on the anterior and posterior chest.
(Eruptions) that erupt simultaneously, resembling silkworm eggs, appearing crimson-red and dry, or grayish-white; accompanied by warmth in the head and coldness in the feet, warmth in the body but abdominal distension, dense eruptions with diarrhea and thirst.
If eruptions appear one day after the onset of fever, the condition is severe; if they appear two days after fever, the condition is also severe; if there is slight fever and eruptions appear after three days, the condition is mild; if the body cools down after four or five days and eruptions then appear, the condition is particularly mild, as the heat dissipates along with the toxin.
If a child suddenly experiences convulsions at the onset of fever but recovers quickly, eruptions will inevitably follow. This is called "Jing Dou" (Startled Smallpox), indicating a very stable prognosis.
Measles (Mazhen) fever resembles rash symptoms. Measles involves the fu organs and belongs to yang; it is easy to manage and can heal spontaneously even without medication, though one must guard against complications due to toxic ingestion or wind-cold exposure.
Initial eruptions may resemble measles or miliaria. If the root is red, the apex is round and pointed, and the eruption is firm and palpable, it is true smallpox (Zheng Dou). If the root is not red and the apex is soft and slightly depressed...
If a child has fever and develops red spots on the body that turn into bright vesicles within one or two days, this is chickenpox (Shuidou), also caused by fetal toxin but milder than true smallpox. If there are no other symptoms, treatment is unnecessary.
If a child has fever and develops red spots all over the body resembling mosquito bites one day after onset, this is definitely not smallpox, but rather heat toxin suppressed by wind-cold, preventing eruption. Treatment should focus on resolving the fever; once the fever subsides, the spots will dissipate.
When examining smallpox, first observe the base of the eruption. If the base is raised with red and smooth blood flow, there is vitality; even if involution occurs, it can be treated. If the base is flat, non-red, non-raised, and dark/dead in color, there is no vitality; even mild cases are difficult to treat. This is like planting beans: fertile soil and living roots allow weak seedlings to recover with irrigation; scorched soil and dead roots render irrigation useless.
When smallpox first appears, if there are tiny red spots inside resembling insect bites, it is called "Blood Smallpox" (Xue Dou). If eruptions do not progress or rise, the case is untreatable.
Although eruptions are sparse, if the roots and leaves are completely white without blood color, and after three to four days they swell and become large and soft upon pressure, this is called "Thief Smallpox" (Ze Dou), indicating severe deficiency of qi and blood. By the suppuration stage, they become blisters the size of grapes containing clear fluid without pus; the skin is thin and white as paper, and rupture leads to death.
In all cases of smallpox, one must distinguish severity, exterior/interior, deficiency/excess, and cold/heat.
Eruptions emerging evenly between one to two days, varying in size, red, round, and pointed, indicate a mild pattern requiring no specific treatment.
Eruptions erupting simultaneously, forming red-purple patches, dense as silkworm eggs, with irritability, thirst, and desiccation, indicate a severe pattern where treatment is futile.
Exterior Excess pattern: Eruptions are red, body is moist, apex is round and shiny, firm and palpable.
Interior Excess pattern: Stool is dry, urine is yellow and copious, appetite is normal, mouth is slightly dry.
These two patterns require no medication.
Exterior Deficiency pattern: Eruptions are white, itchy, fail to form pustules, apex is depressed, accompanied by chills and cold body.
Interior Deficiency pattern: Diarrhea, thirst, abdominal distension, panting, teeth grinding.
These two patterns urgently require tonification of both exterior and interior.
Exterior Heat pattern: Eruptions are red-purple, roots are patchy and scorched, body is hot, apex is crimson-purple-black.
Interior Heat pattern: Constipation, red urine, body heat, thirst with desire to drink, delirium, and fright.
These two patterns urgently require clearing heat and detoxifying.
Exterior Cold pattern: Body is cool, eruptions fail to rise, roots are pale white and non-red.
Interior Cold pattern: Vomiting and diarrhea, abdominal distension, cold qi, undigested food, clear urination and defecation, eruptions are gray with depressed apices.
These two patterns urgently require warming the middle and replenishing primal qi.
Red and plump roots, clear urination, normal stool, ability to eat without thirst, peaceful sleep, and clear spirit indicate clarity in both exterior and interior.