肾败毒深，必难救矣。然男子成婚破阳之后，出痘腰痛者尚可疗，以其虚于后天也；若童子出痘腰痛者，多难
治，乃先天之不足，为真虚也。（《冯氏锦囊》）
痘出腰痛，最为恶候。古云解毒以泻少阴之邪，发表以通太阳之经，使邪气不得深入，痘虽稠密，或可
愈也。此亦可谓知治法矣。予谓泻少阴之邪，则以黑豆为主；通太阳之经，则以羌活为使。○杂证腰痛，多不能
仰，痘出腰痛，多不能俯。（《痘诀余义》）
变黑与腰痛之证，俱属火盛热极而然。火灼肌肤故色黑，火热亢极，肾水枯竭，故腰痛。独不观夫腰痛而
后出者，其色干枯，非红则紫，非紫则黑，是变黑腰痛之证，其属火也明矣。治必大用清凉解毒，于见点之初
斟酌下之，可使热毒得解，然后调理气血，庶可挽回于万一。（翁仲仁）
痘疮初发腰痛，宜以人参败毒散发之。倘无紫色，而用下法，必不能救。大抵重发散以透出其毒，此诚上
策。（朱一麟）
腹胀腹痛
痘疹腹痛者，由毒郁于三阴。脐以上属太阴，当脐属少阴，小腹属厥阴，须分别治之。腹胀者，毒聚于肠
胃也。治法俱当升发，解利痘毒，兼分利小便，使毒瓦斯上下分消，则痛胀自止。故曰痛随利解，胀以利消。亦
有乳食停滞不消，而致腹胀者，当以升发解利药中加入消食之品，所伤之物，审其寒热。又有数日不大便者，
大便行而痛胀自止，未可骤用硝、黄也。（《金镜录》）
毒郁痛胀者重，伤食痛胀者轻。○伤食腹痛，在胃脘及当脐；痘出不快而腹痛者，在脐之下。（许宣治）
渴
疮疹渴者，里热也。盖三焦者，水谷之道路，津液者，水谷之精华，变化流行，以灌溉乎三焦者也。疮疹
之火，起之于内，销烁水谷，不得以变化津液，灌溉脏腑，故渴也。又疮本稠密，
津液外泄，化为脓浆，不能滋养真气，亦渴也。小渴者，常病也，不须治之；大渴者，视其虚实，以法治之，
不可以冷水梨瓜等物与食，恐损脾胃，致生灾异。○如发热时便大渴者，热在里也，葛根解毒汤主之。不止，更
加黄连以泻心火之有余；黄柏、知母以滋肾水之不足。舌润则生，舌如芒刺则死。盖舌乃心之苗，少阴之脉，
系于舌本也。如发热自利而渴者，津液不足也，黄芩汤加参、术、麦冬主之。○丹溪云∶初热烦躁，渴而引饮者，
急以凉药解其标。○钱氏云∶身热烦渴，腹满而喘，大小便涩赤，闷乱大吐，此当利其小便。（《证治准绳》）
痘际渴者，常也。但有应不应，须辨之∶如在二、三朝，身热而渴者，此毒郁于里，热邪熏灼，治宜透托；
如在四朝以后，身热而渴者，此津液外泄，化为脓浆，治宜补益。此皆应也。惟在痂后，则毒化无邪，而反渴
者，则是真阴消耗，火毒反炽，此不应也，急与滋阴解毒，保液生津。渴减者吉，否则必变喘胀而危。○凡渴
多属于热，然皆由脏腑津液燥槁所致，实非有余也。至若腹胀而渴，或泻而渴，或足冷而渴，或惊悸而渴，或
身温而渴，或身热面白而渴，或寒战而渴，或气急切牙而渴，或饮水而转渴不已，以上九证，尤非实热，急宜
温补救里，滋养津液。若认为热证治之，危亡立见。（《冯氏锦囊》）
痘家自首至尾，无有不渴，津液外潮故也。勿尽作热治。（《金镜录》）
便秘
痘疹发热，大便欲润。若二、三日不行，宜急利之。恐肠胃不通，营卫不行，疮出转密也。（万密斋）
凡秘结当分三部∶上结宜降气清凉；中结宜行气活血；下结宜以蜜导通之。如痘出四、五日不大便者，
乃气血成浆，又因血热，不须治之，只宜清凉活血，而便自通。（翁仲仁）
起胀时，有数日不大便，而烦闷作痛者，此毒盛而秘也，宜
清毒活血汤去参、 ，加牛膝，倍紫草、当归，服时入生蜜。若仍不通，用猪胆汁滴入谷道中，不可用硝、黄
大下，致生变证。（《慈幼筏》）
古人云∶凡痘起胀灌脓之际，若无内证者，任其大便数日不行，不可妄下，以泄元气。世因以便秘为贵，
甚有热壅之证，不特不敢用下，反加温补以禁固之，致使热壅愈加，痘毒不得伸越，正气不得舒畅，变证不测，
是皆热壅失治之过也。又宜微下之，以泄其壅热，但须审其秘结之因以治之，不必重在硝、黄，有伤元气也。
（《冯氏锦囊》）
起胀行浆，不大便者无妨，只见泄泻死，不曾见便结死。（《橡村痘诀》）
泻
一、二日泻者，多是挟热，只宜疏托，不必止泻。○四、五朝泄泻数行，痘色顿减，即当治泻；若痘色
可观，只宜升发。○痘起胀时，骤泻不止，危在旦夕，服异功散不效者，急用豆蔻丸、白术散止之。若热毒作
泻，用加味四苓散。○痘出七日，忽大泻者，气陷也，急宜涩之。若浆色正，根线紧绕，虽泻无妨；浆色不正，
根盘不化，血散不敛，毒在内也，如命何？○九日、十日，半痂而作泻者，不必虑，乃阳气内回，非灌浆时比
也，保婴加苓、术治之。切忌涩剂，误用后，必不食而作痢，留邪热在内故也。（《慈幼筏》）
疮疹所忌，内虚泄泻。凡觉腹疼，或漉漉响，趋小腹者，此欲作利，九味理中汤治之。不止，此开肠洞
泄，惟涩剂可以收之，用豆蔻丸。不止，则用真鸦片配莲肉粉止之。庸医每不敢用，恐涩住邪气，不知涩剂之
去滑，犹寒剂之去热，热剂之去寒，是谓对证之药，今既滑泻不已，自当收涩，又何疑焉？如服涩剂而又不止，
则根本已拨，无能为矣。《经》曰∶仓廪不藏者，是门户不要也。《金匮》曰∶六腑气绝于外者手足寒，五脏
气绝于内者
下利不止。五夺之中，此为最甚。但正气内脱者，淹延而死；邪气内陷者，烦渴而死。（《证治准绳》）
治泻投诃子、肉蔻以止之，兼用白术、茯苓以渗湿健脾胃，尚宜多用升麻以升提痘毒出表。若独治泻，恐
痘不升发，必成倒塌。○气虚痘证，或饮食调理失宜，致伤脾胃，遂成泄泻。津液下陷，虚火上盛必渴；元气
下陷，虚阳上壅，下气不续必喘。夫渴与喘，实证也，起于泄泻之后，斯为津亡而渴，气虚而喘。治渴宜白术
散；渴泻不止，用异功散；治喘宜独参汤。（翁仲仁）
吐泻
痘初吐泻，不可骤止，吐乃出热，泻乃出毒。盖热毒壅于胃口，火气炎上，但宜表痘，痘出而吐自止，
不可用辛燥之药。盖暴病非寒，况痘本热毒耶？至若痘后干呕者，是冲任虚火上冲，犯于清道，脏败毒攻之恶
候也。宜分阴阳，利小便。盖治干呕证，当以利小便为主。（《冯氏锦囊》）
痘初吐泻无妨，出后忌之，起胀尤忌。吐泻喘渴、蛔虫自出、直视、便下肠垢者死。（《医学入门》）
初热吐利者，黄芩加半夏汤。起胀灌脓时，吐利并作，宜急治之。寒者益黄散、理中汤；热者黄芩半夏汤。
后吐泻，亦分冷热∶冷者亦宜益黄、理中辈；热者四苓散、竹叶石膏汤、竹茹汤。更审吐利所出之物，如吐
酸水，利下色黄，或青绿，其气臭者，热也。若吐清水，利下清白，不臭者，寒也，未可作热治。（万密斋）
见蛔
痘证三日以前见蛔者，因热毒内攻，肠胃不能兼容，故蛔出也。若痘色焦红稠密，其证危矣。若痘色明润
稀疏，治宜安蛔清火，平胃散加乌梅、使君、黄连、防风。五、六日后，根窠微红而蛔出者，多因脾虚所致，
保元汤加姜、桂、乌梅。十三、四日吐出蛔者死，便出多者凶。吐出之蛔，生者尚可治，死者不可治。
○痘后热毒在胃则吐蛔，热毒在肠则下蛔。若不急治，虫无所食，则食脏食肛，而为狐惑证矣。○亦有不吐利，
但闻食气即吐蛔者，此胃虚，蛔无所根据，为热所迫故也，必食已易饥，治宜理中汤加乌梅、川椒、黄连。若属
虚寒，则不能食。（《仁端录》）
咳嗽
肺主气，其变动为咳，咳者，肺证也。痘疹发热之初，便见咳嗽者，肺为五脏之华盖，疮疹之火上熏乎肺，
肺叶焦举，故气逆而咳也。疮疹既出，其咳更增者，此喉咙有疮，淫淫如痒，习习如梗，故咳也。疮疹收后而
咳者，此卫气弱，腠理疏，风寒外袭，肺气逆而不收，故亦咳也。○凡痘出盛咳嗽者，此肺中有火，或咽喉有
疮作痒也，甘桔汤加牛蒡子，多服良。（《证治准绳》）
呛水
咽以咽物，喉以候气。咽居后而通于胃，喉居前而通于肺。肺无下窍，如橐 然，能受清虚之气，不受有
形之物。喉上有物若悬乳，名曰会厌。凡物入口，则舌抵上 ，会厌必 其喉，故水谷但入咽，而不入喉。若
痘生于会厌，则舌强不利开阖矣。干物间可入咽，水饮或漏入喉，所以呛也，汤药不入，故不可治。○其或舌
上有疮，烂破疼痛强硬，不能延纳水谷，亦使水入则呛，食入则吐，俟其疮平则安矣。（《证治准绳》）
七日以前，痘色红紫而兼此证者，乃火气炎上，热毒壅塞故也；痘色灰白不起而兼此证者，乃气血虚弱，
肺胃受伤故也。二者俱是逆证。七日以后，外痘蒸长，而有此证者，是内痘亦长，故致如此。外痘结痂，内痘
亦，不治自愈。察其毒盛之痘，于咽喉干燥之先，用甘桔汤解毒，加麦冬、栝蒌、牛蒡、元参、荆芥之类，
清其气道，不使热毒有犯，则可免患。（翁仲仁）
失音
痘疮初出，声音洪亮者，形病而气不病也；未发声音不出者，形不病而气病也∶既发声不出者，形气俱病
也。○有心火刑肺而
失音者，肺属金主声，中有二十四空，凡发诸语言者，皆空中之气鼓动也。五行金空则鸣，实则哑。痘疮之
火起于心，上熏于肺，肺气胀郁，故窍塞而无声也。以导赤散合甘桔汤加牛蒡子主之。○有痘毒归肾而失音者，
《经》曰∶会厌者，音声之户也。痘黑陷伏，则毒归于肾，邪气客于会厌，则厌不能发，开阖不利，故卒哑也。
○有喉舌溃烂而失音者。咽喉者，所以司呼吸，发音声，犹管 也。毒火上熏，咽喉先受，贲门、会厌、舌
之位，皆痘所聚。初出之时，失于调治，以致咽喉肿塞，管 窄狭，舌本强硬，呼吸不利，音声不出矣。此上
二证，治之则难。○若七日以后，痘疮成浆之际，而失音者，乃气喉有痘，初出细小不觉，及至肌表之痘成浆，
喉中之痘亦成浆，其毒壅盛，管 窄狭，故出声不清，而为咽哑也。大率七日以前失音者，并为逆证；七日以
后失音者，不治自愈。盖外痘结痂，则喉中之痘自痊故也。当用甘桔汤服之于未发之前，清其气道，使毒不犯。
此预治之法，不可不知。○若痘疮 后而失音者，乃余毒上攻于咽，以致肿痛干涩，声音不出，宜甘露饮、甘
桔防风汤、元参升麻汤主之。（王好古）
寒战切牙
痘证有寒战切牙者，或谓心火热甚，亢极而战，反兼水化，此为内热；或曰俱属于寒，如严冬之气，伏阳
在内，不胜其寒，故手足战栗，而齿自动。皆未得其旨也。斯证有先后之序，用药有缓急之宜∶七日以前寒
战者，乃心火亢极，上熏肺金，而孔窍闭塞，故寒战也，当以表热治之；七日以前切牙者，乃阳明胃经走上下
齿龈，邪并阳明，故切牙也，主胃热，宜清之；七日以后寒战者，乃阴凝于阳，阳分虚，则阴入气道而作寒战
也，宜以气虚治之；七日以后切牙者，乃阳陷于阴，阴分虚，则阳入血道而作切牙也，主血虚，宜补之。是七
日前有此证者属热而凶，七日后有此证者属虚而有可治，须兼痘色，辨其吉凶。然二证多发于痘后，属虚无疑，
虽有少热，亦余热耳。（《金镜录》）
此证以七日前后分治固是，然不若初、中、末分治为盒饭。初出，面色晃白，而寒栗齿动者，寒束其表，
毒不得越，温以散之；痘后气虚不振者，温补以建其中。皆不易之法。惟五、六、七朝，浆行未行，浆足未足
之际，而忽见寒战切牙之证者，虚实之分，必参之形色而始决。（许宣治）
汗
痘疮自汗者，以阴中之火自里达外，皮肤为之缓，腠理为之疏，津液流行，故多自汗。但得身常潮润，此
乃阴阳调和，血脉通畅，实为美证。盖热随汗减，毒随汗散，邪不能留，则易出易解，不必治之。然只宜微汗，
不宜大汗，若汗出过多，则气泄卫弱，恐难收 ，或为痒塌寒战，此则速宜固表，以敛其汗。又有汗出不止，
其热反甚者，此邪热在表，阴为阳扰，速宜清火解毒，阳邪退，而汗自敛。（张景岳）
谵妄
谵妄者，妄有闻见，而语言无伦也。此由热盛正虚，以故神识不清。夫言为心声，心热则多言，睡中呢喃
者，热之微也；若寤而语言差谬，热则甚矣。亦有胃热而谵语者，但大便必硬，数日不更衣方是。○窃谓前证
多因初起热盛，失于解利所致。然有因痘毒未尽者，有因胃经有热者，有因肺经有热者，有因心脾有热者，凡
作渴发热，手足指冷，或大便秘结而谵妄者，俱内有热也。○痘初发热便妄言，此为恶候。盖毒攻于里，心志
昏惑，神识不清而然。○若发热时无此证，因便秘多日始有之，此内热也。先以宣风散解利其热，后以导赤散
肾气败坏，毒邪深重，必定难以救治。然而男子在结婚破阳之后，出痘疹并伴有腰痛的症状还可以治疗，这是因为他的虚损在于后天；如果是童男童女出痘疹并伴有腰痛，大多难以治疗，这是先天禀赋不足，属于真正的虚证。（《冯氏锦囊》）
痘疹发出时出现腰痛，是最为凶险的征候。古人说解毒以泻除少阴经的邪气，发表以疏通太阳经的经络，使邪气不能深入体内，即使痘疹稠密，或许可以痊愈。这也可以说是懂得治疗方法了。我认为泻除少阴经的邪气，应以黑豆为主药；疏通太阳经的经络，应以羌活为引经药。○杂病引起的腰痛，大多不能仰卧；痘疹引起的腰痛，大多不能俯身。（《痘诀余义》）
痘疹变黑与腰痛的症状，都属于火盛热极所致。火热灼烧肌肤所以颜色发黑，火热亢盛到了极点，肾水枯竭，所以腰痛。难道没有观察到先腰痛而后出痘的情况吗？那些痘色干枯，不是红色就是紫色，不是紫色就是黑色，可见痘疹变黑和腰痛的症状，确实属于火证。治疗必须大用清凉解毒的药物，在痘疹刚见点的时候斟酌使用下法，可以使热毒得到解除，然后调理气血，或许有一线生机可以挽回。（翁仲仁）
痘疮初发时出现腰痛，适宜用人参败毒散发散透邪。如果没有出现紫色痘色，而使用下法，必定无法救治。大体上重视发散以透出毒邪，这确实是上策。（朱一麟）
腹胀腹痛
痘疹出现腹痛，是由于毒邪郁结在三阴经。脐以上属于太阴脾经，正对肚脐处属于少阴肾经，小腹属于厥阴肝经，需要分别进行治疗。腹胀，是毒邪积聚在肠胃。治疗方法都应当升发透邪，解利痘毒，兼以分利小便，使毒气上下分消，那么疼痛和胀满自然停止。所以说疼痛随着二便通利而解除，胀满随着通利而消除。也有因为乳食停滞不消化，而导致腹胀的，应当在升发解利的药物中加入消食的药物，仔细审查所伤食物的寒热性质。又有几天不大便的，大便通畅后疼痛和胀满自然停止，不可骤然使用芒硝、大黄等峻下药。（《金镜录》）
毒邪郁结导致的疼痛胀满病情较重，伤食导致的疼痛胀满病情较轻。○伤食引起的腹痛，部位在胃脘及肚脐周围；痘疹出不顺畅引起的腹痛，部位在肚脐以下。（许宣治）
口渴
疮疹出现口渴，是里热的表现。三焦是水谷运行的道路，津液是水谷的精华，变化流行，用来灌溉三焦。疮疹的火气，产生于体内，销蚀水谷，使得水谷不能转化为津液来灌溉脏腑，所以出现口渴。另外疮疹本身稠密，津液外泄，化为脓浆，不能滋养真气，也会引起口渴。轻微口渴，是常见病症，不需要特别治疗；严重口渴，要视其虚实，按照相应方法治疗，不可以给患者吃冷水、梨、瓜等生冷食物，恐怕损伤脾胃，导致发生其他灾祸变异。○如果在发热时就出现严重口渴，说明热邪在里，主方用葛根解毒汤。如果症状不止，再加黄连以泻心火的有余；加黄柏、知母以滋补肾水的不足。舌苔湿润则生，舌面如芒刺则死。因为舌是心的苗窍，少阴经脉系于舌本。如果发热且自利（腹泻）而口渴，是津液不足，主方用黄芩汤加人参、白术、麦冬。○丹溪说：初起发热烦躁，口渴想喝水的，急忙用凉药解除标症。○钱乙说：身体发热烦渴，腹部胀满气喘，大小便涩滞色赤，闷乱剧烈呕吐，这应当通利小便。（《证治准绳》）
痘疹期间的口渴，是常见现象。但有应该有的和不应该有的，必须辨别：如果在第二、三天，身体发热而口渴，这是毒邪郁结在里，热邪熏灼，治疗宜透托；如果在第四天以后，身体发热而口渴，这是津液外泄，化为脓浆，治疗宜补益。这些都属于正常的反应。只有在结痂之后，毒已化尽无邪，反而出现口渴的，这是真阴消耗，火毒反而炽盛，这是不正常的反应，急忙给予滋阴解毒、保液生津的药物。口渴减轻的是吉兆，否则必然转变为喘胀而危及生命。○凡是口渴多属于热，但都是由脏腑津液干燥枯槁所致，实际上并非有余的热邪。至于像腹胀而渴，或者腹泻而渴，或者脚冷而渴，或者惊悸而渴，或者身体温和而渴，或者身体发热面色苍白而渴，或者寒战而渴，或者气息急促咬牙而渴，或者饮水后反而更加口渴不止，以上九种证候，尤其不是实热，急忙应当温补救里，滋养津液。如果认为是热证来治疗，危险死亡立刻就会到来。（《冯氏锦囊》）
患痘疹的人从头到尾，没有不口渴的，是因为津液外泄的缘故。不要全部当作热证来治疗。（《金镜录》）
便秘
痘疹发热时，大便应当保持润泽。如果两三天不通行，应当急忙通便。恐怕肠胃不通畅，营卫运行受阻，痘疹反而长得更密集。（万密斋）
凡是便秘应当分上中下三部治疗：上结适宜降气清凉；中结适宜行气活血；下结适宜用蜜导法通便。如果痘疹发出四五天不大便，这是气血化成脓浆，又因为血热，不需要特别治疗，只宜清凉活血，大便自然通畅。（翁仲仁）
在起胀阶段，有几天不大便，并且烦闷作痛的，这是毒盛而便秘，适宜用清毒活血汤去掉人参、[此处原文缺字，推测为某药]，加牛膝，加倍紫草、当归，服药时加入生蜂蜜。如果仍然不通，用猪胆汁滴入肛门中，不可使用芒硝、大黄猛烈攻下，以致产生变证。（《慈幼筏》）
古人说：凡是痘疹起胀灌脓的时候，如果没有内证，任凭大便几天不行，不可妄用下法，以免泄耗元气。世人因为把便秘看作珍贵，甚至有热壅的证候，不仅不敢用下法，反而加用温补药来固涩，致使热壅更加严重，痘毒不能伸展越出，正气不能舒畅，产生不可预测的变证，这都是热壅失治的过错。又应当轻微通下，以泄去壅积的热邪，但必须审察便秘的原因来治疗，不必重在芒硝、大黄，以免损伤元气。（《冯氏锦囊》）
起胀行浆期间，不大便的无妨，只见泄泻致死，没见过便秘致死的。（《橡村痘诀》）
腹泻
第一、二天腹泻的，多是挟带热邪，只宜疏托，不必止泻。○第四、五天腹泻数次，痘色顿时减退，就应当治疗腹泻；如果痘色尚可，只宜升发透邪。○痘疹起胀时，突然腹泻不止，危在旦夕，服用异功散无效的，急忙用豆蔻丸、白术散止泻。如果是热毒引起的腹泻，用加味四苓散。○痘疹发出七天，忽然大泻的，是气陷，急忙应当固涩。如果浆色正常，根部紧绕，虽然腹泻也无妨；如果浆色不正常，根部盘结不化，血液散漫不收敛，毒邪在内，性命堪忧？○第九天、第十天，半结痂时出现腹泻的，不必忧虑，这是阳气内回，不同于灌浆时期，用保婴丹加茯苓、白术治疗。切忌使用收涩剂，误用后，必定会导致不进食而变成痢疾，因为留住了邪热在体内的缘故。（《慈幼筏》）
疮疹所忌讳的，是内虚导致的泄泻。凡是觉得腹痛，或者肠鸣漉漉作响，急趋小腹的，这是将要作痢疾，用九味理中汤治疗。如果不止，这是开肠洞泄，只有收涩剂可以收敛，用豆蔻丸。如果还不停止，就用真鸦片配莲肉粉来止泻。庸医往往不敢用，恐怕收涩住邪气，不知道收涩剂去除滑脱，就像寒剂去除热邪，热剂去除寒邪一样，这叫对症的药，现在既然滑泻不止，自然应当收涩，又有什么可怀疑的呢？如果服用收涩剂仍然不止，那么根本已经动摇，无能为力了。《内经》说：仓廪不藏守的，是门户不坚固。《金匮要略》说：六腑之气绝于外则手足寒冷，五脏之气绝于内则下利不止。五夺之中，这是最严重的。但是正气内脱的，拖延而死；邪气内陷的，烦渴而死。（《证治准绳》）
治疗腹泻投用诃子、肉豆蔻来止泻，兼用白术、茯苓来渗湿健脾胃，还应当多用升麻来提升提举痘毒出表。如果单独治疗腹泻，恐怕痘毒不能升发，必然造成塌陷。○气虚的痘证，或者饮食调理失当，导致损伤脾胃，于是形成泄泻。津液下陷，虚火上盛必然口渴；元气下陷，虚阳上壅，下气不续必然气喘。口渴和气喘本是实证，但起因于泄泻之后，这才是津亡而渴，气虚而喘。治疗口渴宜用白术散；渴泻不止，用异功散；治疗气喘宜用独参汤。（翁仲仁）
吐泻
痘疹初起吐泻，不可骤然止住，呕吐是排出热邪，腹泻是排出毒邪。因为热毒壅塞在胃口，火气炎上，只宜透发痘疹，痘疹发出后呕吐自然停止，不可使用辛燥的药物。因为暴病非寒，何况痘疹本身就是热毒呢？至于痘疹后干呕的，是冲任虚火上冲，侵犯清道，脏气败坏毒邪攻击的恶候。应当分辨阴阳，通利小便。因为治疗干呕证，应当以通利小便为主。（《冯氏锦囊》）
痘疹初起吐泻无妨，出疹后忌讳吐泻，起胀阶段尤其忌讳。吐泻气喘口渴、蛔虫自行排出、直视、大便排出肠垢的，预后不良致死。（《医学入门》）
初起发热吐利的，用黄芩加半夏汤。起胀灌脓时，吐利并作，应当急忙治疗。属寒的用益黄散、理中汤；属热的用黄芩半夏汤。痘后吐泻，也分冷热：属寒的也用益黄散、理中汤之类；属热的用四苓散、竹叶石膏汤、竹茹汤。更要审察吐利所出的物质，如吐出酸水，拉下黄色或青绿色，气味臭秽的，是热证。如果吐出清水，拉下清白，不臭的，是寒证，不可当作热证治疗。（万密斋）
见蛔
痘疹证三天以前见到蛔虫排出的，是因为热毒内攻，肠胃不能兼容，所以蛔虫排出。如果痘色焦红稠密，病情危急。如果痘色明润稀疏，治疗宜安蛔清火，用平胃散加乌梅、使君子、黄连、防风。五、六天后，痘根微红而蛔虫排出的，多因脾虚所致，用保元汤加生姜、肉桂、乌梅。十三、四天吐出蛔虫的预后不良，便出蛔虫多的凶险。吐出的蛔虫，活的还可以治疗，死的不可治疗。○痘疹后热毒在胃则吐蛔，热毒在肠则下蛔。如果不急忙治疗，虫子没有食物吃，就会吃内脏和肛门，形成狐惑证。○也有不吐不泻，只是闻到食物气味就吐蛔的，这是胃虚，蛔虫无所依附，被热邪逼迫的缘故，必定是吃完容易饿，治疗宜用理中汤加乌梅、川椒、黄连。如果属于虚寒，则不能进食。（《仁端录》）
咳嗽
肺主气，其变动表现为咳嗽，咳嗽是肺的证候。痘疹发热之初，就出现咳嗽的，是因为肺为五脏之华盖，疮疹之火向上熏蒸肺部，肺叶焦枯举起，所以气逆而咳。疮疹既已发出，咳嗽反而增加的，这是因为喉咙有疮，感觉瘙痒不适，如有异物梗塞，所以咳嗽。疮疹收靥后出现咳嗽的，这是因为卫气虚弱，腠理疏松，风寒外袭，肺气逆乱不能收敛，所以也咳嗽。○凡是痘疹旺盛时咳嗽严重的，这是肺中有火，或者咽喉有疮作痒，用甘桔汤加牛蒡子，多服有效。（《证治准绳》）
呛水
咽部用来吞咽食物，喉部用来呼吸气体。咽居后而通向胃，喉居前而通向肺。肺没有下窍，像风箱一样，只能接受清虚之气，不能接受有形之物。喉上有物像悬挂的乳头，名叫会厌。凡食物入口，舌头抵住上颚，会厌必闭塞喉部，所以水谷只进入咽，而不进入喉。如果痘疹生在会厌，那么舌头僵硬不利，开阖失常。干物间或可进入咽，水饮漏入喉，所以发生呛咳，汤药无法进入，所以不可治。○或者舌上有疮，腐烂破溃疼痛强硬，不能延纳水谷，也使水入则呛，食入则吐，等到疮平复则安定了。（《证治准绳》）
七日以前，痘色红紫而兼有此证的，是火气炎上，热毒壅塞的缘故；痘色灰白不起而兼有此证的，是气血虚弱，肺胃受伤的缘故。这两种都是逆证。七日以后，外痘蒸长，而有此证的，是内痘也在生长，所以导致这样。外痘结痂，内痘也愈合，不治自愈。观察毒盛的痘疹，在咽喉干燥之前，用甘桔汤解毒，加麦冬、栝楼、牛蒡子、玄参、荆芥之类，清肃气道，不让热毒侵犯，就可以避免患病。（翁仲仁）
失音
痘疮初出，声音洪亮的，是形病而气不病；未发病时声音不出来的，是形不病而气病；既发声却出不来的，是形气俱病。○有心火刑克肺金而导致失音的，肺属金主声，中有二十四空，凡发出各种语言，都是空中之气鼓动所致。五行中金空则鸣，实则哑。痘疮之火起于心，上熏于肺，肺气胀郁，所以窍塞而无声。用导赤散合甘桔汤加牛蒡子主治。○有痘毒归肾而导致失音的，《内经》说：会厌，是音声的门户。痘疹黑陷伏匿，则毒归于肾，邪气客居于会厌，则会厌不能发动，开阖不利，所以突然失音。○有喉舌溃烂而导致失音的。咽喉，是用来司掌呼吸，发音声的，像管乐器一样。毒火上熏，咽喉先受邪，贲门、会厌、舌的位置，都是痘疹聚集之处。初出之时，失于调治，以致咽喉肿塞，管腔狭窄，舌本强硬，呼吸不利，音声出不来了。以上两种证候，治疗很难。○如果七日以后，痘疮成浆之际，而失音的，是气喉有痘，初出细小不觉察，等到肌表的痘成浆，喉中的痘也成浆，毒邪壅盛，管腔狭窄，所以出声不清，而为咽哑。大体上前七日失音的，都为逆证；七日后失音的，不治自愈。因为外痘结痂，喉中的痘自然痊愈的缘故。应当在未发作之前用甘桔汤服用，清肃气道，使毒邪不侵犯。这是预治的方法，不可不知道。○如果痘疮结痂后而失音的，是余毒上攻于咽，以致肿痛干涩，声音不出，宜用甘露饮、甘桔防风汤、玄参升麻汤主治。（王好古）
寒战切牙
痘疹证有寒战切牙的，有人说是心火热甚，亢极而战，反兼水化，这是内热；有人说都归属于寒，像严冬之气，伏阳在内，不胜其寒，所以手足战栗，牙齿自动。都没有得其旨意。此证有先后顺序，用药有缓急适宜：七日以前寒战的，是心火亢极，上熏肺金，而孔窍闭塞，所以寒战，应当以表热治疗；七日以前切牙的，是阳明胃经行走于上下齿龈，邪气并入阳明，所以切牙，主胃热，宜清解；七日以后寒战的，是阴凝于阳，阳分虚，则阴入气道而作寒战，宜以气虚治疗；七日以后切牙的，是阳陷于阴，阴分虚，则阳入血道而作切牙，主血虚，宜补益。是七日前有此证的属热而凶险，七日后有此证的属虚而有可治之机，必须兼看痘色，辨别吉凶。然而二证多发生于痘后，属虚无疑，虽然有少许热，也是余热罢了。（《金镜录》）
此证以七日前后分治固然正确，但不如初、中、末分治更为妥当。初出时，面色晃白，而寒栗齿动的，是寒束其表，毒不得越出，宜温散；痘后气虚不振的，宜温补以建立中气。都是不易之法。惟独五、六、七天，浆行未行，浆足未足的之际，而忽见寒战切牙的证候的，虚实之分，必须参合形色才能决定。（许宣治）
汗
痘疮自汗的，是因为阴中之火从里达外，皮肤为之松弛，腠理为之疏泄，津液流行，所以多自汗。只要身体经常潮润，这是阴阳调和，血脉通畅，实在是美证。因为热随汗减，毒随汗散，邪气不能停留，则易出易解，不需要治疗。然而只宜微汗，不宜大汗，如果汗出过多，则气泄卫弱，恐怕难收靥，或者成为瘙痒塌陷寒战，这时急忙应当固表，以收敛其汗。又有汗出不止，其热反而加重的，这是邪热在表，阴为阳扰，急忙应当清火解毒，阳邪退去，而汗自然收敛。（张景岳）
谵妄
谵妄，是胡乱看见听见，而语言没有条理。这是由于热盛正虚，所以神识不清。言语是心声，心热则多言，睡中呢喃，是热邪轻微；如果醒着时语言错谬，热邪就很严重了。也有胃热而谵语的，但大便必定硬，几天不排便才是。○我认为前证多因初起热盛，失于解利所致。然而有因痘毒未尽的，有因胃经有热的，有因肺经有热的，有因心脾有热的，凡是出现口渴发热，手足指冷，或者大便秘结而谵妄的，都是内有热邪。○痘初发热便胡言乱语，这是恶候。因为毒邪攻于里，心志昏惑，神识不清所致。○如果发热时没有此证，因便秘多日才有此证，这是内热。先用宣风散解利其热，后用导赤散
If the Kidney Qi is exhausted and the pathogenic toxin is deep-seated, it will certainly be difficult to save. However, for men who have engaged in sexual intercourse (breaking Yang) after marriage, if they develop chickenpox/smallpox with lower back pain, it can still be treated because their deficiency lies in the acquired constitution; whereas for children who develop chickenpox/smallpox with lower back pain, it is mostly difficult to treat, as this is due to congenital insufficiency, representing a true deficiency. (From *Feng Shi Jin Nang*)
Lower back pain appearing during the eruption of chickenpox/smallpox is the most ominous sign. The ancients stated that detoxification should drain the pathogen from the Shaoyin channel, and releasing the exterior should unblock the Taiyang channel, preventing the pathogen from penetrating deeply. Even if the eruptions are dense, recovery might be possible. This can indeed be considered knowing the treatment method. I believe that to drain the Shaoyyin pathogen, Black Soybean (*Sojae Semen Nigrum*) should be the main herb; to unblock the Taiyang channel, Notopterygii Rhizoma et Radix (*Qianghuo*) should be used as a guiding herb. ○ Lower back pain from miscellaneous diseases mostly prevents supine posture, while lower back pain from chickenpox/smallpox mostly prevents flexion. (From *Dou Jue Yu Yi*)
The conditions of eruptions turning black and lower back pain both result from excessive fire and extreme heat. Fire scorching the skin causes black color; when fire is extremely hyperactive and Kidney Water is depleted, lower back pain occurs. Have you not observed cases where lower back pain precedes the eruptions? Their color is dry and withered, either red or purple, or purple or black. Thus, it is clear that the conditions of turning black and lower back pain belong to fire. Treatment must heavily employ cooling and detoxifying herbs. At the initial appearance of spots, one should cautiously use purgation to resolve the heat-toxin, then regulate Qi and Blood, so that there might be a slim chance of recovery. (Weng Zhongren)
When lower back pain appears at the initial onset of chickenpox/smallpox, Ren Shen Bai Du San (Ginseng Decoction to Overcome Pathogens) should be used to disperse and vent. If there is no purple discoloration, using purgation will certainly fail to save the patient. Generally, emphasizing dispersion to vent out the toxin is truly the superior strategy. (Zhu Yilin)
Abdominal Distension and Pain
Abdominal pain in chickenpox/smallpox arises from toxin stagnation in the Three Yin channels. Above the umbilicus belongs to the Taiyin Spleen channel; directly at the umbilicus belongs to the Shaoyin Kidney channel; the lower abdomen belongs to the Jueyin Liver channel, and they must be treated separately. Abdominal distension indicates toxin accumulation in the intestines and stomach. The treatment method should generally involve ascending and dispersing, resolving and benefiting the chickenpox/toxin, combined with separating and draining urine, so that the toxic qi dissipates up and down, and the pain and distension will naturally stop. Hence it is said: pain resolves with free passage, distension dissipates with drainage. There are also cases of abdominal distension caused by food stagnation, where digestive herbs should be added to ascending and dispersing formulas, carefully assessing the cold or heat nature of the ingested food. In cases of several days without bowel movement, once stool passes, pain and distension stop spontaneously; one should not abruptly use Magnolia Bark (*Xiebai*), Mirabilite (*Mangxiao*), or Rhubarb (*Dahuang*). (From *Jing Lu*)
Toxin stagnation causing pain and distension is severe; food injury causing pain and distension is mild. ○ Food-injury abdominal pain is located in the epigastrium and around the umbilicus; abdominal pain due to slow eruption is located below the umbilicus. (Xu Xuanzhi)
Thirst
Thirst in rashes indicates interior heat. The Sanjiao (Triple Burner) is the pathway for water and grain; Jin Ye (Body Fluids) are the essence of water and grain, transforming and circulating to irrigate the Sanjiao. The fire of rashes originates internally, consuming water and grain, preventing them from transforming into Jin Ye to irrigate the Zang-Fu organs, thus causing thirst. Additionally, since the rashes are dense, Jin Ye leaks externally and transforms into pus, failing to nourish True Qi, also causing thirst. Mild thirst is a common condition and requires no treatment; severe thirst must be treated according to deficiency or excess. One must not give cold water, pears, melons, etc., lest they damage the Spleen and Stomach and cause further complications. ○ If severe thirst occurs immediately upon fever, the heat is in the interior; Ge Gen Jie Du Tang (Kudzu Root Decoction to Resolve Toxin) is the primary formula. If it persists, add Coptis Rhizome (*Huanglian*) to drain excess Heart Fire; add Phellodendron Bark (*Huangbai*) and Anemarrhena Rhizome (*Zhimu*) to nourish deficient Kidney Water. A moist tongue indicates survival; a tongue like thorns indicates death. The tongue is the sprout of the Heart, and the Shaoyin meridian connects to the root of the tongue. If fever is accompanied by spontaneous diarrhea and thirst, it indicates insufficient Jin Ye; Huang Qin Tang (Scutellaria Decoction) plus Ginseng (*Renshen*), Atractodes Rhizome (*Baizhu*), and Ophiopogon Tuber (* Maidong*) is indicated. ○ Danxi said: For initial fever, irritability, and thirst with desire to drink, urgently use cooling herbs to resolve the branch symptoms. ○ Qianyi said: For body heat, irritability, thirst, abdominal fullness, wheezing, scanty dark urination, restlessness, and severe vomiting, one should promote diuresis. (From *Zheng Zhi Zhun Sheng*)
Thirst during chickenpox/smallpox is common but must be distinguished as appropriate or inappropriate. If occurring on days 2-3 with fever and thirst, the toxin is stagnant in the interior, scorched by heat; treatment should focus on venting and supporting. If occurring after day 4 with fever and thirst, Jin Ye has leaked externally to form pus; treatment should focus on tonification. These are appropriate responses. Only if thirst occurs after scabbing, when the toxin has transformed and no pathogen remains, is it inappropriate. This indicates consumption of True Yin and blazing fire-toxin; urgently administer Yin-nourishing and detoxifying herbs to preserve fluids and generate Jin Ye. If thirst decreases, it is auspicious; otherwise, it will likely transform into wheezing and distension, becoming critical. ○ Generally, thirst belongs to heat, but all result from dryness and withering of Zang-Fu Jin Ye, not actually an excess of heat. As for cases of thirst with abdominal distension, or thirst with diarrhea, or cold feet with thirst, or palpitations with fright and thirst, or warm body with thirst, or fever with pale face and thirst, or chills with thirst, or rapid breathing with teeth grinding and thirst, or drinking yet remaining thirsty—these nine conditions are especially not excess heat. Urgently employ warming methods to rescue the interior and nourish Jin Ye. If treated as heat, danger and death will follow immediately. (From *Feng Shi Jin Nang*)
Patients with chickenpox/smallpox are rarely without thirst from beginning to end, due to external leakage of Jin Ye. Do not treat all as heat. (From *Jing Lu*)
Constipation
During fever from chickenpox/smallpox, stool should be moist. If it does not pass for two or three days, urgent relief is needed. Fear that intestinal blockage will hinder Ying and Wei circulation, causing eruptions to become denser. (Wan Mizhai)
Constipation should be divided into upper, middle, and lower sections: Upper constipation benefits from descending Qi and cooling; middle constipation benefits from moving Qi and invigorating Blood; lower constipation benefits from honey suppositories. If no bowel movement occurs four or five days after eruption, this is because Qi and Blood are forming pus, and due to blood heat, no special treatment is needed; only cooling and blood-invigorating measures are required, and stool will pass naturally. (Weng Zhongren)
During the swelling stage, if there is no bowel movement for several days accompanied by irritability and pain, this is toxin excess causing constipation. Qing Du Huo Xue Tang (Clear Toxin and Invigorate Blood Decoction), removing Ginseng [and another herb], adding Achyranthes Root (*Niuxi*), doubling Purple Perilla Seed (*Zicao*) and Angelica Sinensis Root (*Danggui*), taken with raw honey, is indicated. If still blocked, pig bile drops inserted into the anus may be used. Do not use Mirabilite or Rhubarb for strong purgation, lest complications arise. (From *Ci You Fa*)
The ancients said: During the swelling and suppuration stages of chickenpox/smallpox, if there are no internal symptoms, allow stool to remain absent for several days; do not recklessly purge, to avoid draining Yuan Qi. The world regards constipation as precious; some even have heat-stagnation patterns but dare not use purgatives, instead adding warming tonics to secure, causing heat stagnation to worsen, preventing toxin release and Qi smoothness, leading to unpredictable complications. This is all due to mismanagement of heat stagnation. Mild purgation should be used to drain stagnant heat, but the cause of constipation must be assessed; reliance on Mirabilite and Rhubarb should be avoided to prevent damaging Yuan Qi. (From *Feng Shi Jin Nang*)
No bowel movement during swelling and pus formation is acceptable; only diarrhea leads to death, never constipation. (From *Xiang Cun Dou Jue*)
Diarrhea
Diarrhea on days 1-2 is mostly heat-clinging; only venting is needed, no need to stop diarrhea. ○ Diarrhea multiple times on days 4-5 with sudden fading of rash color requires treating diarrhea; if rash color is acceptable, only ascending and dispersing is needed. ○ Sudden continuous diarrhea during swelling is critical; if Yi Gong San (Four Gentlemen Decoction Modified) fails, Doucheng Wan (Areca Seed Pill) and Baizhu San (Atractodes Powder) should be used urgently to stop it. For heat-toxin diarrhea, Jia Wei Si Ling San (Modified Four Poria Powder) is used. ○ Sudden severe diarrhea on day 7 indicates Qi sinking; urgent astringency is needed. If pus color is normal and base is tight, diarrhea is harmless; if pus color is abnormal, base is unresolved, blood is scattered and not consolidating, toxin is internal, life is at risk. ○ Diarrhea on days 9-10 during partial scabbing need not be worried about; this is Yang Qi returning internally, different from the pus-filling stage. Bao Ying Dan plus Poria (*Fuling*) and Atractodes Rhizome (*Baizhu*) is used. Strictly avoid astringents; misuse will lead to anorexia and dysentery due to retained heat-toxin. (From *Ci You Fa*)
The taboo in rashes is internal deficiency causing diarrhea. Whenever abdominal pain or borborygmus is felt, or urgency to the lower abdomen occurs, indicating impending dysentery, Jiu Wei Li Zhong Tang (Nine-Ingredient Regulate Middle Decoction) treats it. If it persists, this is open-intestine profuse diarrhea, only astringents can collect it, using Doucheng Wan. If still not stopping, real Opium mixed with Lotus Seed powder stops it. Quack doctors dare not use these, fearing they trap pathogens, not knowing that astringents remove sliding just as cold herbs remove heat and hot herbs remove cold; these are correct symptomatic treatments. Now that sliding diarrhea is unceasing, astringency is natural, why doubt? If astringents fail, the root is uprooted, and nothing can be done. *Neijing* says: Failure of granaries to store indicates loose gates. *Jingui Yaolue* says: Six Fu organs Qi exhaustion externally causes cold hands/feet; Five Zang organs Qi exhaustion internally causes unceasing diarrhea. Among the Five Depletions, this is the worst. But if Zheng Qi collapses internally, death comes slowly; if pathogen sinks internally, death comes with irritability and thirst. (From *Zheng Zhi Zhun Sheng*)
Treating diarrhea with Terminalia Chebula Fruit (*Hezi*) and Areca Seed (*Roukou*) to stop it, combined with Atractodes Rhizome (*Baizhu*) and Poria (*Fuling*) to leach dampness and strengthen Spleen/Stomach, should also include heavy use of Cimicifuga Rhizome (*Shengma*) to ascend and vent the toxin to the exterior. If treating only diarrhea, fear the toxin will not ascend, leading to collapse. ○ In Qi-deficient rash cases, improper diet damages Spleen/Stomach, causing diarrhea. Jin Ye sinking and deficient Fire rising causes thirst; Yuan Qi sinking and deficient Yang obstructing upward causes shortness of breath. Thirst and shortness of breath are excess patterns arising after diarrhea, indicating fluid loss and Qi deficiency. Treat thirst with Baizhu San; persistent thirst and diarrhea with Yi Gong San; treat shortness of breath with Du Shen Tang (Single Ginseng Decoction). (Weng Zhongren)
Vomiting and Diarrhea
Initial vomiting and diarrhea in chickenpox/smallpox should not be stopped abruptly; vomiting expels heat, diarrhea expels toxin. Because heat-toxin blocks the stomach gate, Fire flares upward, only venting the rash is suitable; vomiting stops when rash emerges. Do not use acrid-dry herbs. Acute illness is not cold, especially since chickenpox/smallpox is inherently heat-toxin. Post-rash dry retching indicates Chong and Ren vessel deficient Fire rushing up, attacking clear pathways, a bad omen of organ failure and toxin attack. Differentiate Yin/Yang, promote diuresis. Treating dry retching prioritizes diuresis. (From *Feng Shi Jin Nang*)
Initial vomiting/diarrhea is fine; post-eruption vomiting/diarrhea is taboo, especially during swelling. Vomiting/diarrhea with wheezing/thirst, roundworm expulsion, fixed gaze, and passing intestinal mucus indicate death. (From *Yi Xue Ru Men*)
Initial fever with vomiting/diarrhea uses Huang Qin Ban Xia Tang (Scutellaria and Pinellia Decoction). During swelling/suppuration with simultaneous vomiting/diarrhea, treat urgently. Cold type: Yi Huang San (Benefit Yellow Powder), Li Zhong Tang (Regulate Middle Decoction); Heat type: Huang Qin Ban Xia Tang. Post-rash vomiting/diarrhea also differentiates cold/heat: Cold: Yi Huang, Li Zhong types; Heat: Si Ling San, Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction), Zhu Ru Tang (Bamboo Shavings Decoction). Examine vomit/stool: sour vomit, yellow/green foul stool indicates heat; clear watery vomit, clear stool without odor indicates cold, do not treat as heat. (Wan Mizhai)
Roundworms
Seeing roundworms before day 3 in rash cases is due to heat-toxin attacking internally, intestines/stomach unable to accommodate, so worms exit. If rash is dark red and dense, condition is critical. If rash is bright/moist and sparse, treat to calm worms and clear fire, using Ping Wei San plus Sour Plum (*Wumei*), Quinine (*Shijunzi*), Coptis (*Huanglian*), Saposhnikovia Root (*Fangfeng*). After days 5-6, roots slightly red with worm exit indicates mostly Spleen deficiency; Bao Yuan Tang plus Ginger (*Shengjiang*), Cinnamon Twig (*Guizhi*), Sour Plum (*Wumei*) is used. Worms vomited on days 13-14 indicate death; many passed in stool indicate凶 (ominous). Living worms can be treated; dead worms cannot. ○ Post-rash heat-toxin in Stomach causes vomiting worms; in Intestines causes passing worms. If not treated urgently, worms eat viscera/anus, forming Huhu syndrome. ○ Some do not vomit/diarrhea but vomit worms upon smelling food; this is Stomach deficiency, worms lacking attachment, forced by heat, often with quick hunger after eating. Treat with Li Zhong Tang plus Wumei, Sichuan Pepper (*Chuanjiao*), Huanglian. If cold-deficiency, cannot eat. (From *Ren Duan Lu*)
Cough
Lung governs Qi; its change manifests as cough. Cough is a Lung pattern. Initial fever with cough indicates Lung, the canopy of Zang organs, scorched by rash fire, causing Lung leaves to wither and Qi to rebel. Post-eruption worsening cough indicates throat ulcers causing itching/gagging sensation. Post-scabbing cough indicates weak Wei Qi, loose pores, wind-cold invasion, rebellious Lung Qi failing to consolidate. ○ Severe cough during abundant eruptions indicates Lung fire or throat ulcer itch; Gan Jie Tang (Licorice and Platycodon Decoction) plus Bullseed (*Niubangzi*) is beneficial. (From *Zheng Zhi Zhun Sheng*)
Choking on Water
Pharynx swallows food; Larynx regulates Qi. Pharynx connects to Stomach; Larynx connects to Lung. Lung has no lower opening, like a bellows, accepting only pure Qi, not solid matter. The Epiglottis hangs above the larynx. When food enters, tongue presses palate, epiglottis closes larynx, so food/water enters pharynx, not larynx. If rash forms on epiglottis, tongue becomes stiff, opening/closing impaired. Solid food may enter pharynx, but liquid leaking into larynx causes choking; medicine cannot enter, so untreatable. ○ Or ulcers on tongue cause pain/stiffness, preventing swallowing, causing choking/vomiting; resolves when ulcers heal. (From *Zheng Zhi Zhun Sheng*)
Before day 7, red/purple rash with this symptom indicates Fire flaring up, heat-toxin blocking; gray/white non-elevated rash indicates Qi/Blood deficiency, Lung/Stomach injury. Both are adverse. After day 7, external rash growing with this symptom indicates internal rash also growing; resolves spontaneously when external scabs. Observe toxin-heavy rashes; before throat dryness, use Gan Jie Tang to detoxify, plus Ophiopogon (* Maidong*), Trichosanthes Fruit (*Gualou*), Bullseed (*Niubangzi*), Scrophularia Root (*Yuanshen*), Schizonepeta (*Jingjie*) to clear airways, preventing heat-toxin invasion. (Weng Zhongren)
Loss of Voice
Initial rash with loud voice: Form ill, Qi well. No voice before eruption: Form well, Qi ill. Voice starts but fails: Form and Qi both ill. ○ Heart Fire insulting Lung causes loss of voice. Lung governs Metal/Voice, has 24 hollows; speech is air vibrating in hollows. Metal sounds when hollow, is mute when solid. Rash fire rises from Heart to Lung, Lung Qi distends/stagnates, orifices block, voice lost. Dao Chi San combined with Gan Jie Tang plus Niubangzi treats it. ○ Kidney-directed toxin causes loss of voice. *Neijing* says: Epiglottis is the door of voice. Dark/depressed rash means toxin returns to Kidney; pathogen lodges in epiglottis, impeding movement/opening, causing sudden muteness. ○ Throat/tongue ulceration causes loss of voice. Throat governs respiration/voice, like a pipe. Toxic fire insults throat first;贲门, epiglottis, tongue base gather rash. Poor early treatment causes throat swelling/blockage, narrow pipe, stiff tongue, difficult breathing, no voice. These two are hard to treat. ○ Loss of voice during pus formation after day 7 indicates throat rash, initially tiny/unnoticed; when surface rash fills pus, throat rash also fills, toxin blocks, pipe narrows, voice unclear/muffled. Generally, pre-day 7 loss of voice is adverse; post-day 7 resolves spontaneously as external scabs heal. Use Gan Jie Tang prophylactically to clear airways. This preventive method is essential. ○ Post-scab loss of voice indicates residual toxin attacking throat, causing swelling/dryness/no voice. Gan Lu Yin (Sweet Dew Drink), Gan Jie Fang Feng Tang (Licorice, Platycodon, Schizonepeta Decoction), Yuanshen Shengma Tang (Scrophularia and Cimicifuga Decoction) are indicated. (Wang Haogu)
Chills and Teeth Grinding
Chills and teeth grinding in rash cases: Some say Heart Fire extreme causes shivering, mimicking Water transformation (internal heat); others say all belong to Cold, like winter, latent Yang inside cannot withstand cold, causing limb tremors/teeth moving. Neither is accurate. This condition has sequence; treatment has urgency. Pre-day 7 chills: Heart Fire extreme insults Lung Metal, orifices block, causing chills; treat as exterior heat. Pre-day 7 teeth grinding: Yangming Stomach channel runs through gums, pathogen merges Yangming, causing grinding; indicates Stomach heat, clear it. Post-day 7 chills: Yin condenses on Yang, Yang deficiency allows Yin to enter airway, causing chills; treat as Qi deficiency. Post-day 7 teeth grinding: Yang sinks into Yin, Yin deficiency allows Yang to enter blood vessel, causing grinding; indicates Blood deficiency, tonify it. Pre-day 7 signs are heat/adverse; post-day 7 are deficiency/treatable. Must check rash color for prognosis. However, these two signs mostly occur post-rash, definitely deficiency, any heat is residual. (From *Jing Lu*)
Dividing by pre/post day 7 is correct, but dividing by early/mid/late stage is better. Early stage, pale face with chills/teeth moving: Cold binds exterior, toxin cannot vent, warm to disperse. Post-rash Qi deficiency/flaccidity: Warm tonify to establish Middle. These are standard. Only on days 5-7, during pus transition, sudden chills/grinding requires distinguishing deficiency/excess via appearance/color. (Xu Xuanzhi)
Sweat
Spontaneous sweating in rash cases: Yin-fire reaches exterior from inside, skin relaxes, pores open, Jin Ye circulates, causing sweat. If body remains moist, this is Yin-Yang harmony, blood vessel smoothness, a good sign. Heat reduces with sweat, toxin disperses with sweat, pathogen stays not, easy eruption/resolution, no treatment needed. However, slight sweat is suitable, not heavy sweat. Excessive sweat drains Qi, weakens Wei, risking poor scabbing, itching/collapse/chills. Urgently secure exterior to收敛 (astringe) sweat. If sweat continues with increased heat, pathogen heat is in exterior, Yin disturbed by Yang, urgently clear fire/detoxify; as Yang pathogen retreats, sweat收敛s. (Zhang Jingyue)
Delirium
Delirium involves hallucinations and incoherent speech. Caused by heat excess and Zheng deficiency, leading to unclear consciousness. Speech is Heart's voice; Heart heat causes talking. Murmuring in sleep is mild heat; awake incoherence is severe heat. Stomach heat delirium accompanies hard stool/few bowel movements. ○ I believe previous cases resulted from initial heat excess untreated. Causes include unresolved toxin, Stomach heat, Lung heat, Heart/Spleen heat. Thirst, fever, cold fingers, constipation with delirium all indicate internal heat. ○ Delirium with initial fever is ominous: toxin attacks interior, Heart spirit confused, consciousness unclear. ○ If no delirium during fever, but develops after days of constipation, this is internal heat. First use Xuan Feng San to resolve heat, then Dao Chi San...