痧子一症。亦是胎毒流行所感不时之气而发也。与痘疮不同。其生死一类。毒之始发于脾。流于
心。入于肺肾则无恙。入于肝目泪出不止。入于肺涕流不干。嗽甚烦躁不安。以火照之。隐隐于皮肤
之下。以手摸之。磊磊于肌肤之间。其形如疥。其色若丹。随出随没。乍有乍无。肿而兼隐。肤赤明
朗者为吉。最嫌煤黑。百无一生。喜衄血。毒从衄解。身凉者吉。咽痛
者凶。治宜生津养血。食少者救胃和脾。秘结者疏利。郁热者解肌。则令中和。一出连绵三四日者不
收。乃毒火太甚。急用化斑汤解毒汤。迟迟出不快者亦表解之类。切忌酸醋梅浆冷水等物。鸡鱼五辛
之物过七七日无忌。
者点也。色赤而有点无头粒者是也。痧有头粒小而随出即没。没而又出。俱是心火乘于肺金。
挟痰而作。有伤寒从表而发。以白虎汤玄参升麻汤化 汤治之。亦有可汗可下。俱在通圣散中消息治
之。黑 者乃胃烂而出。不可救之。
保元汤内有人参二钱。黄 三钱。甘草一钱。水一钟半。姜一斤。煎服。此方原是东垣先生所制。
药性平和。甘温专补中气。能泄虚火。固表助阳外护内使阴血附焉。气血和顺。一身真元无恙。而痘
自无坏乱之理极明矣。故名之保元汤。先三日。潮热之时。看儿大小。用药剂亦大小。内加苏叶一二
钱。不饮食。乃气
郁。加山楂木香。热甚加薄荷干葛。如痘毒壅塞不行。加桂。取其味辛能发散耳。次三日。见标之时。
三日内加减主方用人参八分。白术黄 各一钱。甘草三分。五味三分。姜一片。枣二枚。煎服。如痘
顺加当归枸杞。如逆则加川芎桂各三分。如渴加麦门冬天花粉。次贯浆三日。加减主方用人参黄 白
术甘草麦门冬川芎熟地黄当归加姜枣糯米煎服。胃弱加山楂。浆不起加白酒人乳。额上不起加川芎。
面不起加升麻。腹上不起加桔梗。腰腿不起加牛膝。手上不起加桂枝。厥逆加附子。泄泻加赤茯白芍。
冷泄加炒干姜。靥速加柴胡连翘黄芩白芍。靥迟加桂干姜。次三日落痂时。用药主方陈皮白术茯苓半
夏当归枳实八分甘草姜煎服。如落痂迟加人参黄 升麻枣子。痂收速加黄芩连翘。痘痛加赤芍黄连黄
芩栀子炒如痘痒加羌活白芷蒺藜赤芍蝉蜕。气虚加人参黄 白术等类。其余群方见于后。
痧疹这一病症，也是由于胎毒受到不时之气（时令邪气）流行感染而引发的。它与痘疮不同。其生死预后主要取决于毒邪的传变路径：毒邪起初发于脾，流窜至心，若进入肺肾则无大碍；若进入肝，则导致眼睛流泪不止；若进入肺，则鼻涕流个不停，咳嗽剧烈且烦躁不安。用火光照看，可见皮疹隐隐约约出现在皮肤之下；用手触摸，感觉颗粒分明地隆起在肌肤之间。其形状像疥疮，颜色像丹砂，随出随没，时有时无。肿胀中兼有隐现，肤色红润明亮的是吉兆；最忌讳颜色黑如煤炭，出现这种情况百无一活。喜欢鼻出血，因为毒邪可以通过衄血得以解除，身体转凉者为吉；咽喉疼痛者为凶。治疗应当生津养血。饮食减少者需救胃和脾；大便秘结者需疏利通便；郁热者需解肌清热，从而使机体恢复中和状态。如果皮疹一出就连绵三四天不退收，这是毒火太盛的表现，急需使用化斑汤、解毒汤。如果出疹迟缓、不快，也属于表证未解之类。切忌食用酸醋、梅浆、冷水等物。鸡肉、鱼肉及五辛之物，过了七七日之后便无禁忌。
“痧”即点状皮疹。颜色红赤且有斑点但没有头粒（脓头/硬结）的就是痧疹。痧疹有头粒小且随出即没，没了又出来的情况，都是心火乘袭肺金，挟带痰浊所致。有的类似伤寒从体表发出，用白虎汤、玄参升麻汤或化斑汤治疗。也有可以发汗或攻下的治法，都可在通圣散中斟酌处理。黑痧则是胃烂而出，不可救治。
保元汤内有人参二钱，黄芪三钱，甘草一钱，水一碗半，生姜一两（原文“姜一斤”疑为笔误或特定计量，此处依常理及上下文语境，结合明代度量衡习惯，通常指适量生姜，但忠实原文翻译为生姜），煎服。此方原是李东垣先生所制。药性平和，甘温之品专门补益中气，能清泄虚火，固护体表，助阳外护，使内部阴血依附。气血调和顺畅，一身真元无恙，那么痘疮自然没有败坏混乱的道理，这非常明显。所以命名为保元汤。在出痘前三天，潮热之时，根据患儿大小决定用药剂量。方内加苏叶一二钱。如果不进食，是气机郁滞，加山楂、木香。热势甚重加薄荷、干葛。如果痘毒壅塞不通，加桂枝，取其味辛能发散的作用。出痘后第二三天，见标（出疹）之时，三日内加减主方用人参八分，白术、黄芪各一钱，甘草三分，五味子三分，生姜一片，大枣二枚，煎服。如果痘顺加当归、枸杞。如果痘逆则加川芎、桂枝各三分。如果口渴加麦门冬、天花粉。再次贯浆三日，加减主方用人参、黄芪、白术、甘草、麦门冬、川芎、熟地黄、当归，加生姜、大枣、糯米煎服。胃弱者加山楂。浆液不起加白酒、人乳。额头不起加川芎。面部不起加升麻。腹部不起加桔梗。腰腿不起加牛膝。手上不起加桂枝。厥逆加附子。泄泻加赤茯苓、白芍。冷性泄泻加炒干姜。痂壳收得快的加柴胡、连翘、黄芩、白芍。痂壳收得慢的加桂枝、干姜。第三次落痂时，用药主方用陈皮、白术、茯苓、半夏、当归、枳实八分、甘草，加生姜煎服。如果落痂迟加人参、黄芪、升麻、枣子。痂收得快加黄芩、连翘。痘痛加赤芍、黄连、黄芩、栀子（炒）。如果痘痒加羌活、白芷、蒺藜、赤芍、蝉蜕。气虚加人参、黄芪、白术等类。其余众多方剂见于后文。
Shazhen (Scarlet Fever/Rash) is a condition caused by the interaction of fetal toxins with epidemic seasonal pathogens. It differs from smallpox. Its prognosis depends on the pathogenic heat's trajectory: initially originating in the Spleen and flowing to the Heart, it remains harmless if entering the Lung or Kidney; if entering the Liver, it causes uncontrollable tearing; if entering the Lung, it causes persistent runny nose, severe coughing, and restlessness. Under light, the rash appears faintly beneath the skin; upon touch, it feels distinctively raised between the muscle and skin. Its shape resembles scabies, its color resembles cinnabar, appearing and disappearing intermittently. Swelling accompanied by partial concealment, with bright red skin, indicates a favorable outcome; blackness resembling coal is most dreaded, with almost no survivors. Epistaxis (nosebleed) is preferred as it allows toxin release; cooling of the body is auspicious; sore throat is ominous. Treatment should focus on generating fluids and nourishing blood. For poor appetite, rescue the Stomach and harmonize the Spleen; for constipation, promote unblocking and purging; for stagnant heat, resolve the muscle layer to restore harmony. If the rash persists continuously for three to four days without receding, it indicates excessive toxic fire, requiring immediate use of Huaban Tang (Spot-Resolving Decoction) and Jiedu Tang (Detoxification Decoction). Delayed or slow eruption also belongs to unresolved exterior patterns. Acidic substances like vinegar, plum juice, and cold water are strictly contraindicated. Chicken, fish, and five pungent spices are permissible after seven weeks.
"Sha" refers to macular spots. Reddish spots without papules indicate Sha-rash. Small-headed Sha that appears and disappears rapidly, recurring repeatedly, results from Heart Fire invading Lung Metal, complicated by phlegm. Some resemble Taiyang disease erupting from the exterior, treated with Baihu Tang (White Tiger Decoction), Xuanshen Shengma Tang (Scrophulariae Radix and Cimicifugae Rhizoma Decoction), or Huaban Tang. Methods involving sweating or purging can be considered within Tongsheng San (Universal Salvation Powder). Black Sha indicates gastric necrosis and is incurable.
Baoyuan Tang contains Ren Shen (Ginseng Radix et Rhizoma) 2 qian, Huang Qi (Astragali Radix) 3 qian, Gan Cao (Licorice Root) 1 qian, water 1.5 zhong, and Ginger 1 jin [Note: likely a textual error for smaller quantity], decocted and taken orally. This formula was originally created by Mr. Li Dongyuan. Its properties are mild and sweet-warm, specifically tonifying Middle Qi, clearing deficient fire, securing the exterior, assisting Yang, protecting internally so Yin Blood adheres. When Qi and Blood are harmonious and true Yuan Qi is intact, smallpox will not deteriorate, which is evident. Hence named Baoyuan Tang. Three days prior to eruption, during tidal fever, adjust dosage according to the child's size. Add Su Ye (Perilla Leaf) 1-2 qian. If anorexic due to Qi stagnation, add Shan Zha (Hawthorn Fruit) and Mu Xiang (Aucklandiae Radix). If heat is severe, add Bo He (Menthae Haplocalycis Herba) and Gan Ge (Puerariae Radix). If toxin obstruction prevents eruption, add Gui Zhi (Cinnamon Twig) for its acrid dispersing action. On the second to third day, when marks appear, the modified main formula uses Ren Shen 8 fen, Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Huang Qi each 1 qian, Gan Cao 3 fen, Wu Wei Zi (Schisandrae Fructus) 3 fen, one slice of Ginger, and two Jujubes, decocted and taken. If the eruption is smooth, add Dang Gui (Angelicae Sinensis Radix) and Gou Qi Zi (Lycii Fructus). If adverse, add Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Gui Zhi each 3 fen. If thirsty, add Mai Men Dong (Ophiopogonis Tuber) and Tian Hua Fen (Trichosanthis Radix). During the pustule formation phase (three days), the modified main formula uses Ren Shen, Huang Qi, Bai Zhu, Gan Cao, Mai Men Dong, Chuan Xiong, Shu Di Huang (Rehmanniae Radix Preparata), Dang Gui, plus Ginger, Jujube, and Glutinous Rice, decocted and taken. For weak stomach, add Shan Zha. If pus fails to form, add Bai Jiu (White Wine) and Ren Ru (Human Milk). If forehead lesions fail to rise, add Chuan Xiong. If facial lesions fail to rise, add Sheng Ma (Cimicifugae Rhizoma). If abdominal lesions fail to rise, add Jie Geng (Platycodonis Radix). If waist and leg lesions fail to rise, add Niu Xi (Achyranthis Bidentatae Radix). If hand lesions fail to rise, add Gui Zhi. For reversal/cold limbs, add Fu Zi (Aconiti Lateralis Radix Preparata). For diarrhea, add Chi Fu Ling (Poria with Hostwood) and Bai Shao (Paeoniae Radix Alba). For cold-type diarrhea, add Chao Gan Jiang (Fried Zingiberis Rhizoma). For rapid scabbing, add Chai Hu (Bupleuri Radix), Lian Qiao (Forsythiae Fructus), Huang Qin (Scutellariae Radix), and Bai Shao. For delayed scabbing, add Gui Zhi and Gan Jiang. During the scab shedding phase, the main formula uses Chen Pi (Citri Reticulatae Pericarpium), Bai Zhu, Fu Ling (Poria), Ban Xia (Pinelliae Rhizoma Preparatum), Dang Gui, Zhi Shi (Aurantii Fructus Immaturus) 8 fen, Gan Cao, plus Ginger, decocted and taken. If scabbing is delayed, add Ren Shen, Huang Qi, Sheng Ma, and Jujube. If scabs fall quickly, add Huang Qin and Lian Qiao. For painful lesions, add Chi Shao (Paeoniae Radix Rubra), Huang Lian (Coptidis Rhizoma), Huang Qin, and Zhi Zi (Gardeniae Fructus fried). For itchy lesions, add Qiang Huo (Notopterygii Rhizoma et Radix), Bai Zhi (Angelicae Dahuricae Radix), Ji Li (Tribuli Fructus), Chi Shao, and Chan Tui (Cicadae Periostracum). For Qi deficiency, add Ren Shen, Huang Qi, Bai Zhu, etc. Other formulas are listed subsequently.