〔海〕小儿 疹初发，未能辨认间，但求所出之由，因内因外及不因外内，随其
所伤，如法服饵，防其变故，抑其盛气，比之他证，尤不可缓。或发或泻，或解其
肌，或化其毒，求其所起之由，凉血清肺，调其脏腑，平其饮食，谨其禁忌，严其
养摄，适其寒温，将理有法，俾尽其道，使出无不快之经，成无不痂之溃，既愈之
后，不致游毒流汗虚腠，目疾膜翳，疮疖痈瘤，喉闭嗌肿，潮热汗泄，此治 之大
略也。（海藏所谓 即痘也非心为 之 ）又云∶外者外治，内者内治，中外皆和，其 自出。
至于恶寒者发之，表大热者夺之，渴者清之，大便秘结者下之，小便不通者利之，
惊者安之，泄者分之，可以执一为哉？大抵伤寒同治，随经用药，最为高论。假令
五日已里，诸病与 疹不能辨别者，不可疑作 疹，必须发之，但各从其所伤应见
治之，皆不妨 出，若强发之，其变不可胜数矣。如外伤，升麻汤主之。内伤，
枳实丸主之。大便 者，枳术丸主之。若伤冷者温之，神应丸。恶寒者发之，
宜防风苍术汤。表大热者，夺之，此表者，通言三阳也，夫阳盛者，气必上行，
言夺者，治之不令上行也，是知无三阳表证，有三阳里证染于有形也，此言表，总
三阳之名也。渴者清之，大渴者白虎汤（暑月用之）。小渴者凉膈散。（凉膈散，去硝黄加甘
桔者、稳。）大便秘结者下之，桃仁承气汤、四顺饮子、柴胡饮子、选用，察其在气在血，
必内实能食而秘者可用，但当微微润之。小便不通者利之，导赤散、八正散、之
类，当求上下二焦何经而用之。惊者安之，凉惊丸。重者泻之，泻青丸。泄者
分之，寒则异功散、四君子汤。热则泽泻茯苓汤。〔吕〕凡疮欲出而未出，因发搐
者，是外感风寒之邪，而内发心热也，宜王氏惺惺散或人参葛根汤、木香参苏饮。
凡疮欲出未出而吐利者，是中焦停寒，或夹宿食也，宜四君子汤加砂仁、陈皮或
和中散，如夹宿食者用紫霜丸。〔张〕治痘，全在发热之初看其热势微甚，微者固
不必治，甚者当解则解，当汗则汗，当下则下，使毒瓦斯得以发泄，则后去不能为害，
痘亦稀少平顺，失此不治，则热毒渐盛，难以解救，大抵此际热甚，非汗则表不解，
非下则里不解，然药味之轻重，当随病势之微甚而用之。〔垣〕痘证少具，痘未发，
与升麻汤三五钱，带热服之，待其身表温和，痘证已显，止药。如其身凉，痘证未出，只
时时与甘桔汤宽胸膈，利咽喉。大便酸臭，不消化，畏食或吐，乃内伤饮食，宜枳术
丸。伤冷食饮，神应丸。如见伤食，又见痘证，先与不犯大黄、巴豆、药克化过，再
与升麻汤，如食重伤，前药不能过，再与犯大黄、巴豆药过之。（此须分证之表里虚实而斟酌
之，先里后表，亦非古法，如克化药不能过，多是脾气虚、而克化药又重伤之，若无
便秘里实之证，其可遽用大黄巴豆下之乎。）凡初发疑似，但肌表热而无内伤证者，宜用辛凉
之剂调之，以四物解肌汤主之。或云，凡发热疑似之间，宜用人参败毒散一剂以发之，是
与不是，一发便明，大抵疮疹只要发尽，不使留伏于中也。凡发表，宜保婴丹加姜葱煎汤化下，
一也。或升麻葛根汤去升麻，加苏叶姜葱，二也。或羌活散加制砂、姜葱，三也。此可行之于
已发热之时。未发热之前不可行也，既见红点之后亦不可行，恐表虚故也，如或行之，只
宜参苏饮调保婴丹，浓盖取汗。凡初发表，要看天时，如时大寒，则腠理闭密，
气血凝涩，防其发泄得迟，有毒瓦斯壅遏之变，以辛热之药发之，宜桂枝葛根汤、五
积散去干姜主之。如时大热，则腠理开张，气血淖泽，防其发泄太急，有溃烂之
变，以辛凉之药解之，宜升麻葛根汤、双解散主之。如不寒不热，天气温和，只
人参败毒散，甚佳。〔翁〕小儿出痘，凡里有大热，当利小便，使心火有所引导，
虽不用凉药，其热自去矣，导赤散主之。若里有小热，不宜利小便，当解毒，
若小热利小便，反泄肾气，宜犀角地黄汤、消毒饮。〔万〕或曰，痘疮发热，
何以能预识其轻重而解之耶？曰∶凡发热乍进乍退，气色明莹，精神如常，大
小便调，能食不渴，目清唇润，此毒轻也，痘必稀疏，纵出多，亦自易发易靥。
如壮热不减，气色惨暗，精神昏闷，大便或秘或泻，不能食，目赤唇焦，此毒
甚也，痘必稠密，宜预解之。其出疏者，防其有伏，未可便许为疏，但看热减
渴止，精神爽快，清便自调，能食，更无他苦，是真疏且轻也。或曰，既识
其候，知痘稠密，何以解之，曰诸疮皆属于心，心之华在面，如初发热，青筋
现露，目中泪出，此毒发于肝，肝木生心火，从后来者为实邪，肝为水泡，风
火相扇，必作瘙痒，宜先解肝之毒。面赤如锦，额上红筋露现，谵妄多惊，此毒发
于心，心火自旺为正邪，君主不明，必有陷伏，不治。口干唇焦，面黄而燥，此毒
发于脾，心火生脾土，从前来者为虚邪，脾为 ，心为疹，必有夹 夹疹，又脾主
肌肉，为火所灼，必作溃烂，宜先解心脾之毒。面色 白，鼻中干燥，或流清涕，
或衄出，此毒发于肺，心火刑肺金，乘其所胜为微邪，宜略解肺之毒。面色黑气如
烟浮，目中见鬼，头热足冷，此毒发于肾，肾水克心火为贼邪，必成黑陷不治。
疮疹发热，热气微者，其毒必少，痘出自疏，易发易靥，不须服药。热气甚者，
其毒必多，痘出自密，难发难靥，且多他变，宜预解之，宜连翘升麻汤或如圣汤并
合代天宣化丸主之。或有热微痘出反密者，其人必口燥渴，唇焦烈，小便赤少，
大便秘，身虽不大热，却蒸蒸然，此毒深热亦深，故表不大热、而里热也，宜急解
之。若烦渴引饮，大热如炙，头痛如破，或自汗，或无汗，宜白虎汤主之，甚者
石膏用至半斤，溽暑之时有此症，尤宜用之。或有热甚痘出反疏者，其人必不渴，
唇润，目中无赤脉，大小便调，身虽大热，但 然，此毒浅热亦浅，故表热里气
和也，只以升麻葛根汤。乍凉乍热，疮疹常候，若遍身如火，昼夜不休，此心火
亢甚，脾土益燥，为失其常，宜消详表里证候以施治也，如口燥渴，目赤，唇焦，
大小便不利，此表里俱热也，双解散、或连翘升麻汤、或黄连解毒汤（烦躁）、送下七物
升麻丸（四方俱本条）。如咽喉痛，甘桔汤加牛蒡子，或射干鼠粘子汤（俱咽喉）加桔梗，使咽喉
爽快，胸膈开豁，失今不治，他日咽喉闭塞，水入则呛，谷入则呕，暴哑失音，悔
之无及。
如初发热时时恶寒，身振振摇动如疟之状，其人卫气素虚，荣血亦弱，不能逼
毒快出，使毒邪留连于经络之中，欲出不出，与正相争，故振振者火之象也，以柴
葛桂枝汤加黄 主之，疮出即愈。不可错认作寒战，妄投陈氏辛热之剂以误人也。
古人养生或治病者，常顺四时之气，谓之勿伐天和，如春夏养阳，秋冬养阴，
饮食起居，各有攸宜。凡疮疹发热之时，其初发表解肌，四时各有主方，春用羌活
汤（痘发热），夏用五苓散（惊），秋用参苏饮，冬用五积散，四时通用人参败毒散。又如春肝
旺，风木主事，调养之法，宜四物汤（失血）加防风、黄芩、木香、青皮、羌活，以折
风木之胜，又以四君子汤（不能食）加白芍药、桂心，以补脾之受制，相间服之。
夏心旺，热火主事，宜黄连解毒汤（烦躁）加麦门冬、五味子，以补肺之不足。秋肺
旺，燥金主事，宜泻白散（肺）合甘桔汤（咽喉）加牛蒡子、马兜苓，以散肺中之邪，又
以四物汤去川芎，加天麦门冬、天花粉，以润其燥。冬肾旺，寒水主事，宜五积
散以散表之寒，理中汤（泄利）加黄 、炙木香、丁香，以胜里之寒。此四时之治法也。
如天有暴风，连日不止，恐有风邪，桂枝葛根汤。夏月盛暑，或非时之热，人
参白虎汤（渴）。冬月严寒，或非时之寒，四君子汤加桂枝、生姜。久雨湿盛，五苓散
加苍术。此四候者，必疮变色有异证，可根据其法治之，苟无他候，不可妄治也，惟
谨帷幕，远风寒，毋令大热，毋令大寒，但常和暖，更常服蝉蜕膏，盖此膏能御风
邪，辟恶气，透肌快 疹也。房室之中，常烧辟秽香（禁忌），勿得间断。
凡初发热二三日间有惊搐者，以导赤散（心、）羌活汤（痘发热）、辰砂散（本条）主之。大便
秘者，三黄丸（发热）微利之。小便涩少者，导赤散。渴甚者，葛根解毒汤（痘渴）。腹中痛
者，桂枝大黄汤（痘腹痛）。腰痛者，人参败毒散（本条）。自利者，黄芩汤（痘泄利）。吐利者，
黄芩加半夏汤（痘吐利）。如脾胃素弱，自利清白者，理中汤丸（痘泄利）、或四君子汤（不能食）、肉
豆蔻丸（痘泄利）合而服之。余详各门。
〔发表〕
升麻汤 治大人小儿时气瘟疫，头痛足冷，脉数发热，肢体烦疼，及疮疹疑二之间，
并宜服之。或未经解利而疮毒已发。又云，证候未全，或未明者，但可与解散之
也。又云，患疮疹，大便自如常者，亦可服升麻汤。盖用升麻，其性苦寒无毒，
主解百毒，杀鬼邪，辟瘟瘴蛊毒，中恶腹痛，咽喉口疮，皆毒也，疮痘亦毒故也。
其次用葛根，性平，治消渴大热，解肌发表，出汗开腠理，治头痛。升麻葛根二
药，皆治伏热毒动，心恍惚，惊悸烦躁，大抵疮疹是蕴热毒，葛根解热，升麻去
毒也。病热而药性微寒，冷热相攻，则芍药治时行寒热，又活血痹，使疮痘易出
也，又利小便，疮疹有大热者，则利小便也。次有甘草调和之，况《新书》言，
疮疹渴燥甚者，亦用炙草散主之。四者解毒治热，调荣卫，为治疮疹之要药也。
为其疑二之间，非疮疹伏热而发热者，有伤寒、伤风、伤食、惊证兼患疮疹，而
禀气怯者皆发虚热，而非实热，若服之，是疮疹者则毒减而愈，他证者反以为害，
不能尽述其由，但有壮热而面青目白，睛不黄赤，大便不秘，小便清者，皆不可
服，里无蕴热故也。此药治未发疮疹之前，疮疹已愈之后，服之消毒故也，非正
出时服。
升麻 葛根 芍药 甘草（等分）
上为粗末。每服二钱，水一盏，同煎至半盏，去滓温服，不拘时候。亦可为细
末，汤调服。身心烦热即温服，寒多即热服。
海藏云∶升麻葛根汤，太阳阳明之药。陈文中云∶身热腹痛者、身热泄泻者、
身热惊悸者、身热汗出者、身热足冷者，俱不宜服升麻葛根汤。张巽之云∶凡
痘见 点，忌葛根汤，恐发得表虚也。万氏曰∶古人谓但见红点，便不可服升
麻葛根汤，恐发得表虚也。此盖为痘疏毒少者言，后人不达立言之旨，遽谓凡出
痘子才见红点，真不可服，殊不知升麻葛根汤四味，乃发表解毒、疏通血气、升
降阴阳之剂，痘出太密，正宜常服以解之，令陷者升之，燥者润之，郁者疏之，
过者平之，阴精不衰，而阳毒不亢也。苟谓痘疏毒少者，虽他药不可服，况葛根
汤乎。
古人治痘，以葛根汤为主，后世好奇，多立方法，法愈多而治愈难矣，苟能变
通，自发热以至收靥，葛根汤皆可增损用之，不特发表解肌而已，今以葛根汤为
主治，随证立增损法于后。
初发热解表，加柴胡、羌活、白芷、桔梗、防风。口干渴，内热也，加葛粉、
天花粉、麦门冬。自利，加条实黄芩生用。呕吐，加半夏、生姜。腹中痛，
加木香、青皮、枳壳、山楂肉。腰疼，加独活、北细辛。头疼，加羌活、
本、蔓荆子。惊搐，加木通、生地黄、灯心。小便少，加木通、车前子、瞿
麦。大便秘，加大黄。衄血，加山栀仁、玄参、生地黄。
发热三四日，热不减，加解毒药大力子、连翘、紫草、桔梗。疮不出，加防
风、蝉蜕、荆芥穗、红花子。眼痛，加密蒙花、柴胡、龙胆草。
疮出太稠密，加人参、当归、木香、紫草、大力子、防风、桔梗。咽痛，加
桔梗、连翘。疮干或带紫，或色大赤者，血热也，加当归稍、生地黄、红花、
地骨皮、牡丹皮。疮灰白色平陷者，气虚也，加人参、黄 、防风、木香、官
桂。手足疮不起，脾胃不足也，加防风、官桂、人参、黄 。
疮密起发不透，又渴者，此津液不足，加人参、麦门冬、天花粉。泄泻者，
里虚也，加人参、白术、诃子、白茯苓。疮不着痂者，湿热也，加黄 、防风、
官桂、白术。（李氏，加紫苏五分，笋尖、山楂、牛蒡子各一钱，冬月加制过麻黄一钱。）
惺惺散 治数证，皆为纯阳人所用，古人处为小儿药，非乃里寒者可服，且以药对
其证用之意，大抵浑身壮热，必由风热疮疹，伤寒时气，且先与之也，其头痛目
涩鼻流清涕者，用细辛。喘粗者，用桔梗、人参。多睡者，用茯苓。恐伤寒时气乘
里弱者，用白术也。治风热疮疹，栝蒌根也。栝蒌，味苦寒，治身热，烦满大热，
除肠胃中痼热，八疸面黄，燥渴，通月水，止小便利，热而胸痹不下乳，阳
【背景信息】
书名：幼科证治准绳 作者：王肯堂 朝代：明 章节：初热证治(1/3) 类别：综合
【白话翻译】
张元素（号海藏）说：小儿出痘疹初期，在还不能辨认清楚的时候，只要探求其发病的原因，无论是内因、外因还是非内外因所致，根据其所受的伤害，依法服药，以防病情变化，抑制邪气的盛势。这比治疗其他病症更加不可迟缓。或者通过发汗，或者通过泻下，或者通过解肌，或者通过化解毒邪，探求其起因，凉血清肺，调理脏腑，平衡饮食，谨慎禁忌，严格护理，适应寒温变化，调理有法，使其遵循正道，使患儿出痘过程没有不快之感，结痂溃烂顺利。痊愈之后，不至于让游毒流注、虚腠出汗，引发眼疾膜翳、疮疖痈瘤、喉闭咽肿、潮热汗泄等症。这是治疗的概要。（张元素所说的“疹”即指痘，并非心为疹之误。）他又说：病在外者用外治法，病在内者用内治法，内外调和，痘疹自然透出。至于恶寒的，用发散法；表大热的，用攻夺法；口渴的，用清热法；大便秘结的，用泻下法；小便不通的，用利尿法；惊悸的，用安神法；泄泻的，用分利法。怎么能拘泥于一种方法呢？大体上伤寒的治疗原则相同，随经用药，是最高的理论。假如在五日内，各种病症与痘疹不能辨别时，不要怀疑是痘疹而不敢治，必须发散，但各自根据其受伤应见的症状进行治疗，都不妨碍痘疹发出。如果强行发散，其变证不可胜数。如外伤（指外感），用升麻汤主治。内伤（指内伤饮食），用枳实丸主治。大便溏泄的，用枳术丸主治。若伤冷食的，用温法，神应丸主治。恶寒的，用发散法，宜防风苍术汤。表大热的，用攻夺法，这里的“表”，通指三阳经。阳气盛的，气必上行，所谓“夺”，是指治疗不让其上行。由此可知，若无三阳表证，而有三阳里证染于有形之质。这里说的“表”，总括了三阳之名。口渴的，用清热法，大渴的用白虎汤（暑月使用）。小渴的用凉膈散（凉膈散去掉硝黄加甘桔，是为了稳妥）。大便秘结的，用泻下法，桃仁承气汤、四顺饮子、柴胡饮子选用，观察病在气分还是血分，必须是内实能食且秘结的才可用，但应当微微润下即可。小便不通的，用利尿法，导赤散、八正散之类，应当求上下二焦何经病变而用之。惊悸的，用安神法，凉惊丸主治。重的，用泻法，泻青丸主治。泄泻的，用分利法，寒证的用异功散、四君子汤。热证的用泽泻茯苓汤。
吕复说：凡是痘疮欲出而未出，因发搐（抽搐）的，是外感风寒之邪，而内发心热也，宜王氏惺惺散或人参葛根汤、木香参苏饮。凡是痘疮欲出未出而吐利的，是中焦停寒，或夹宿食也，宜四君子汤加砂仁、陈皮或和中散，如夹宿食的用紫霜丸。
张景岳说：治疗痘疮，全在于发热之初看其热势微甚，微者固然不必治，甚者当解则解，当汗则汗，当下则下，使毒瓦斯得以发泄，则后来不能为害，痘亦稀少平顺。失此不治，则热毒渐盛，难以解救。大体此时热甚，非汗则表不解，非下则里不解。然而药味的轻重，应当随病势的微甚而用之。
李东垣说：痘证刚具备苗头，痘未发，给升麻汤三五钱，带热服之，待其身表温和，痘证已显，停药。如其身凉，痘证未出，只时时给甘桔汤宽胸膈，利咽喉。大便酸臭，不消化，畏食或吐，乃内伤饮食，宜枳术丸。伤冷食饮，神应丸。如见伤食，又见痘证，先给不犯大黄、巴豆的药克化过，再给升麻汤，如食重伤，前药不能过，再给犯大黄、巴豆的药过之。（这需要分证之表里虚实而斟酌，先里后表，也不是古法，如克化药不能过，多是脾气虚，而克化药又重伤之，若无便秘里实之证，岂可遽用大黄巴豆下之乎？）凡初发疑似，但肌表热而无内伤证者，宜用辛凉之剂调之，以四物解肌汤主治。有人说，凡发热疑似之间，宜用人参败毒散一剂以发之，是与不是，一发便明。大体痘疹只要发尽，不使留伏于中也。凡发表，宜保婴丹加姜葱煎汤化下，这是一法。或升麻葛根汤去升麻，加苏叶姜葱，这是二法。或羌活散加制砂仁、姜葱，这是三法。这些可行于已发热之时。未发热之前不可行也，既见红点之后亦不可行，恐表虚故也。如或行之，只宜参苏饮调保婴丹，浓盖取汗。凡初发表，要看天时，如时大寒，则腠理闭密，气血凝涩，防其发泄得迟，有毒瓦斯壅遏之变，以辛热之药发之，宜桂枝葛根汤、五积散去干姜主治。如时大热，则腠理开张，气血淖泽，防其发泄太急，有溃烂之变，以辛凉之药解之，宜升麻葛根汤、双解散主治。如不寒不热，天气温和，只用人参败毒散，甚佳。
翁仲仁说：小儿出痘，凡里有大热，当利小便，使心火有所引导，虽不用凉药，其热自去矣，导赤散主治。若里有小热，不宜利小便，当解毒，若小热利小便，反泄肾气，宜犀角地黄汤、消毒饮。
万全说：有人说：痘疮发热，何以能预识其轻重而解之耶？回答说：凡发热乍进乍退，气色明莹，精神如常，大小便调，能食不渴，目清唇润，此毒轻也，痘必稀疏，纵出多，亦自易发易靥。如壮热不减，气色惨暗，精神昏闷，大便或秘或泻，不能食，目赤唇焦，此毒甚也，痘必稠密，宜预解之。其出疏者，防其有伏，未可便许为疏，但看热减渴止，精神爽快，清便自调，能食，更无他苦，是真疏且轻也。
有人说：既识其候，知痘稠密，何以解之？回答说：诸疮皆属于心，心之华在面。如初发热，青筋现露，目中泪出，此毒发于肝，肝木生心火，从后来者为实邪，肝为水泡，风火相扇，必作瘙痒，宜先解肝之毒。面赤如锦，额上红筋露现，谵妄多惊，此毒发于心，心火自旺为正邪，君主不明，必有陷伏，不治。口干唇焦，面黄而燥，此毒发于脾，心火生脾土，从前来者为虚邪，脾为斑，心为疹，必有夹斑夹疹，又脾主肌肉，为火所灼，必作溃烂，宜先解心脾之毒。面色㿠白，鼻中干燥，或流清涕，或衄出，此毒发于肺，心火刑肺金，乘其所胜为微邪，宜略解肺之毒。面色黑气如烟浮，目中见鬼，头热足冷，此毒发于肾，肾水克心火为贼邪，必成黑陷不治。
疮疹发热，热气微者，其毒必少，痘出自疏，易发易靥，不须服药。热气甚者，其毒必多，痘出自密，难发难靥，且多他变，宜预解之，宜连翘升麻汤或如圣汤并合代天宣化丸主治。或有热微痘出反密者，其人必口燥渴，唇焦烈，小便赤少，大便秘，身虽不大热，却蒸蒸然，此毒深热亦深，故表不大热、而里热也，宜急解之。若烦渴引饮，大热如炙，头痛如破，或自汗，或无汗，宜白虎汤主治，甚者的石膏用至半斤，溽暑之时有此症，尤宜用之。或有热甚痘出反疏者，其人必不渴，唇润，目中无赤脉，大小便调，身虽大热，但翕然，此毒浅热亦浅，故表热里气和也，只以升麻葛根汤。乍凉乍热，疮疹常候，若遍身如火，昼夜不休，此心火亢甚，脾土益燥，为失其常，宜消详表里证候以施治也，如口燥渴，目赤，唇焦，大小便不利，此表里俱热也，双解散、或连翘升麻汤、或黄连解毒汤（烦躁）、送下七物升麻丸（四方俱本条）。如咽喉痛，甘桔汤加牛蒡子，或射干鼠粘子汤（俱咽喉）加桔梗，使咽喉爽快，胸膈开豁，失今不治，他日咽喉闭塞，水入则呛，谷入则呕，暴哑失音，悔之无及。
如初发热时时恶寒，身振振摇动如疟之状，其人卫气素虚，荣血亦弱，不能逼毒快出，使毒邪留连于经络之中，欲出不出，与正相争，故振振者火之象也，以柴葛桂枝汤加黄芪主治，疮出即愈。不可错认作寒战，妄投陈氏辛热之剂以误人也。
古人养生或治病者，常顺四时之气，谓之勿伐天和，如春夏养阳，秋冬养阴，饮食起居，各有攸宜。凡疮疹发热之时，其初发表解肌，四时各有主方，春用羌活汤（痘发热），夏用五苓散（惊），秋用参苏饮，冬用五积散，四时通用人参败毒散。又如春肝旺，风木主事，调养之法，宜四物汤（失血）加防风、黄芩、木香、青皮、羌活，以折风木之胜，又以四君子汤（不能食）加白芍药、桂心，以补脾之受制，相间服之。夏心旺，热火主事，宜黄连解毒汤（烦躁）加麦门冬、五味子，以补肺之不足。秋肺旺，燥金主事，宜泻白散（肺）合甘桔汤（咽喉）加牛蒡子、马兜铃，以散肺中之邪，又以四物汤去川芎，加天麦门冬、天花粉，以润其燥。冬肾旺，寒水主事，宜五积散以散表之寒，理中汤（泄利）加黄芪、炙木香、丁香，以胜里之寒。此四时之治法也。
如天有暴风，连日不止，恐有风邪，桂枝葛根汤。夏月盛暑，或非时之热，人参白虎汤（渴）。冬月严寒，或非时之寒，四君子汤加桂枝、生姜。久雨湿盛，五苓散加苍术。此四候者，必疮变色有异证，可根据其法治之，苟无他候，不可妄治也，惟谨帷幕，远风寒，毋令大热，毋令大寒，但常和暖，更常服蝉蜕膏，盖此膏能御风邪，辟恶气，透肌快出疹也。房室之中，常烧辟秽香（禁忌），勿得间断。
凡初发热二三日间有惊搐者，以导赤散（心）、羌活汤（痘发热）、辰砂散（本条）主治。大便秘者，三黄丸（发热）微利之。小便涩少者，导赤散。渴甚者，葛根解毒汤（痘渴）。腹中痛者，桂枝大黄汤（痘腹痛）。腰痛者，人参败毒散（本条）。自利者，黄芩汤（痘泄利）。吐利者，黄芩加半夏汤（痘吐利）。如脾胃素弱，自利清白者，理中汤丸（痘泄利）、或四君子汤（不能食）、肉豆蔻丸（痘泄利）合而服之。余详各门。
【发表】
升麻汤 治大人小儿时气瘟疫，头痛足冷，脉数发热，肢体烦疼，及疮疹疑二之间，并宜服之。或未经解利而疮毒已发。又云，证候未全，或未明者，但可与解散之也。又云，患疮疹，大便自如常者，亦可服升麻汤。盖用升麻，其性苦寒无毒，主解百毒，杀鬼邪，辟瘟瘴蛊毒，中恶腹痛，咽喉口疮，皆毒也，疮痘亦毒故也。其次用葛根，性平，治消渴大热，解肌发表，出汗开腠理，治头痛。升麻葛根二药，皆治伏热毒动，心恍惚，惊悸烦躁，大抵疮疹是蕴热毒，葛根解热，升麻去毒也。病热而药性微寒，冷热相攻，则芍药治时行寒热，又活血痹，使疮痘易出也，又利小便，疮疹有大热者，则利小便也。次有甘草调和之，况《新书》言，疮疹渴燥甚者，亦用炙草散主治。四者解毒治热，调营卫，为治疮疹之要药也。为其疑二之间，非疮疹伏热而发热者，有伤寒、伤风、伤食、惊证兼患疮疹，而禀气怯者皆发虚热，而非实热，若服之，是疮疹者则毒减而愈，他证者反以为害，不能尽述其由，但有壮热而面青目白，睛不黄赤，大便不秘，小便清者，皆不可服，里无蕴热故也。此药治未发疮疹之前，疮疹已愈之后，服之消毒故也，非正出时服。
升麻 葛根 芍药 甘草（等分）
上为粗末。每服二钱，水一盏，同煎至半盏，去滓温服，不拘时候。亦可为细末，汤调服。身心烦热即温服，寒多即热服。
海藏云：升麻葛根汤，太阳阳明之药。陈文中云：身热腹痛者、身热泄泻者、身热惊悸者、身热汗出者、身热足冷者，俱不宜服升麻葛根汤。张巽之云：凡痘见斑点，忌葛根汤，恐发得表虚也。万氏曰：古人谓但见红点，便不可服升麻葛根汤，恐发得表虚也。此盖为痘疏毒少者言，后人不达立言之旨，遽谓凡出痘子才见红点，真不可服，殊不知升麻葛根汤四味，乃发表解毒、疏通血气、升降阴阳之剂，痘出太密，正宜常服以解之，令陷者升之，燥者润之，郁者疏之，过者平之，阴精不衰，而阳毒不亢也。苟谓痘疏毒少者，虽他药不可服，况葛根汤乎。
古人治痘，以葛根汤为主，后世好奇，多立方法，法愈多而治愈难矣，苟能变通，自发热以至收靥，葛根汤皆可增损用之，不特发表解肌而已，今以葛根汤为主治，随证立增损法于后。
初发热解表，加柴胡、羌活、白芷、桔梗、防风。口干渴，内热也，加葛粉、天花粉、麦门冬。自利，加条实黄芩生用。呕吐，加半夏、生姜。腹中痛，加木香、青皮、枳壳、山楂肉。腰疼，加独活、北细辛。头疼，加羌活、藁本、蔓荆子。惊搐，加木通、生地黄、灯心。小便少，加木通、车前子、瞿麦。大便秘，加大黄。衄血，加山栀仁、玄参、生地黄。
发热三四日，热不减，加解毒药大力子、连翘、紫草、桔梗。疮不出，加防风、蝉蜕、荆芥穗、红花子。眼痛，加密蒙花、柴胡、龙胆草。
疮出太稠密，加人参、当归、木香、紫草、大力子、防风、桔梗。咽痛，加桔梗、连翘。疮干或带紫，或色大赤者，血热也，加当归稍、生地黄、红花、地骨皮、牡丹皮。疮灰白色平陷者，气虚也，加人参、黄芪、防风、木香、官桂。手足疮不起，脾胃不足也，加防风、官桂、人参、黄芪。
疮密起发不透，又渴者，此津液不足，加人参、麦门冬、天花粉。泄泻者，里虚也，加人参、白术、诃子、白茯苓。疮不着痂者，湿热也，加黄芪、防风、官桂、白术。（李氏，加紫苏五分，笋尖、山楂、牛蒡子各一钱，冬月加制过麻黄一钱。）
惺惺散 治数证，皆为纯阳人所用，古人处为小儿药，非乃里寒者可服，且以药对其证用意，大抵浑身壮热，必由风热疮疹，伤寒时气，且先与之也，其头痛目涩鼻流清涕者，用细辛。喘粗者，用桔梗、人参。多睡者，用茯苓。恐伤寒时气乘里弱者，用白术也。治风热疮疹，栝楼根也。栝楼，味苦寒，治身热，烦满大热，除肠胃中痼热，八疸面黄，燥渴，通月水，止小便利，热而胸痹不下乳，阳
[Background Information]
Book: Youke Zhengzhi Zhunsheng (Standard for Diagnosis and Treatment of Pediatric Diseases)
Author: Wang Kentang
Dynasty: Ming
Chapter: Initial Heat Syndrome Treatment (1/3)
Category: Comprehensive
[English Translation]
Zhang Yuansu (styled Haizang) said: In the early stage of smallpox or chickenpox in children, when it is difficult to distinguish clearly, one should seek the cause of onset. Whether due to internal causes, external causes, or neither, treatment should be administered according to the specific injury, preventing complications and suppressing the excess pathogenic qi. This requires more urgency than treating other syndromes. Treatment may involve diaphoresis (inducing sweating), purgation, releasing the muscle layer, or resolving toxicity. By identifying the origin, cooling the blood and clearing the lungs, regulating the zang-fu organs, balancing diet, observing taboos, strictly managing care, and adapting to cold and warmth, with proper management, the eruption process will proceed smoothly without distress, and scabbing will occur normally. After recovery, there should be no residual toxins flowing into the pores causing sweating, nor eye diseases like corneal opacity, skin boils, throat obstruction, tidal fever, or spontaneous sweating. This is the general principle of treatment. (Haizang's term "zhen" refers to smallpox, not a heart-related rash.) He further stated: For exterior conditions, use external treatments; for interior conditions, use internal treatments. When both interior and exterior are harmonized, the rash will emerge naturally. For chills, use dispersing methods; for high exterior heat, use draining methods; for thirst, use clearing methods; for severe constipation, use purgative methods; for urinary retention, use promoting urination methods; for fright, use calming methods; for diarrhea, use separating and draining methods. How can one adhere rigidly to a single approach? Generally, the treatment principles for Cold Damage (Shanghan) are similar, but medication must follow the affected meridian, which is considered the highest theory. If within five days, various symptoms cannot be distinguished from smallpox/chickenpox, do not hesitate to treat it as such; dispersal is necessary, but tailored to the specific injury. However, forced dispersal can lead to countless complications. For external injuries (exogenous pathogens), Shengma Tang (Cinnamon Twig Decoction - *Note: Text says Shengma Tang, usually Ephedra/Cinnamomum context but here likely distinct formula*) is indicated. For internal injuries (dietary), Zhishi Wan (Immature Bitter Orange Pill) is indicated. For loose stools, Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill) is indicated. For cold injury, warm the body with Shenyin Pill. For chills, disperse with Fangfeng Cangzhu Tang (Saposhnikovia and Atractylodes Macrocephala Decoction). For high exterior heat, drain using the concept that "biao" (exterior) refers generally to the Three Yang meridians. Excess yang causes qi to ascend; "draining" means preventing this upward surge. Thus, if there are no Three Yang exterior signs but interior signs exist affecting tangible structures, "biao" here encompasses all Three Yang names. For thirst, clear heat: extreme thirst uses Baihu Tang (White Tiger Decoction, suitable for summer); mild thirst uses Liangge San (Cool the Diaphragm Powder, modified by removing Rhubarb and Mirabilite, adding Licorice and Platycodon for stability). For severe constipation, purge using Taoren Chengqi Tang, Sishun Yinzi, or Chaihu Yinzi, selecting based on whether the pathology is in the Qi or Blood level, applicable only if there is interior excess with appetite but constipation, using gentle moistening laxatives. For urinary retention, promote urination using Daochi San or Bazheng San, determining the affected Jiao and meridian. For fright, calm with Liangjing Wan; severe cases use Xieqing Wan. For diarrhea, separate and drain: cold type uses Yigong San or Sijunzi Tang; heat type uses Zexie Fuling Tang.
Lu Fu said: When rashes are about to erupt but have not yet appeared, accompanied by convulsions, this is due to exogenous Wind-Cold invading externally and Heart-Heat arising internally. Use Wangshi Xingxing San, Renshen Gegen Tang, or Muxiang Shenru Yin. When vomiting and diarrhea occur before eruption, it indicates Cold stagnation in the Middle Jiao or retained food. Use Sijunzi Tang with Amomum and Tangerine Peel, or Hezhong San. If caused by retained food, use Zishuang Wan.
Zhang Jingyue said: Treating smallpox depends entirely on assessing the intensity of fever at its onset. Mild fever needs no special treatment; severe fever requires resolution, sweating, or purging to allow toxin expulsion, preventing future harm and ensuring sparse, smooth eruptions. Neglecting this allows heat-toxin to intensify, becoming hard to resolve. At this stage, high heat requires sweating to resolve the exterior or purging to resolve the interior. Medication dosage must match the severity.
Li Dongyuan said: When smallpox signs are just emerging but not yet visible, administer Shengma Tang (3-5 qian) warm. Stop when the body surface becomes mild. If the body is cool and rash hasn't appeared, frequently give Ganjie Tang to open the chest and benefit the throat. Sour-smelling, undigested stool, aversion to eating or vomiting indicates dietary injury; use Zhizhu Wan. Cold food injury uses Shenyin Pill. If dietary injury coincides with smallpox signs, first use non-purgative herbs to digest, then Shengma Tang. If severe, use herbs containing Rhubarb or Croton. (This requires distinguishing interior/exterior and deficiency/excess; treating interior before exterior is not ancient practice; if digestive herbs fail, it may be Spleen Qi deficiency worsened by harsh drugs; without true interior excess, avoid Rhubarb/Croton.) For initial suspected cases with surface heat but no internal injury, use acrid-cool agents like Siwu Jiemo Tang. Some suggest Ren Shen Bai Du San to induce eruption; clarity comes from trial. The goal is complete eruption without lingering toxins. For dispersing, use Baoying Dan with Ginger and Scallion decocted, or Gegen Tang minus Shengma plus Perilla/Ginger/Scallion, or Qianghuo San with processed Amomum/Ginger/Scallion. These are for when fever has started, not before, nor after red spots appear (to avoid exterior deficiency). If used after spots appear, mix Shenru Yin with Baoying Dan and cover thickly to sweat. Consider weather: severe cold closes pores, risking toxin stagnation; use acrid-warm herbs like Guizhi Gegen Tang or Wuji San minus Dried Ginger. Severe heat opens pores, risking rapid eruption and ulceration; use acrid-cool herbs like Gegen Tang or Shuangjie San. Moderate weather favors Ren Shen Bai Du San.
Weng Zhongren said: For smallpox with significant interior heat, promote urination to guide Heart Fire out; heat resolves without cold herbs, using Daochi San. For mild interior heat, do not promote urination (as it drains Kidney Qi); instead, resolve toxicity using Xijiao Dihuang Tang or Xiaodu Yin.
Wan Quan said: How to predict severity? If fever fluctuates, complexion is bright, spirit normal, bowels/bladder regular, appetite good, lips moist, toxin is light; eruptions will be sparse and easy to heal. If persistent high fever, dull complexion, lethargy, irregular bowels, anorexia, red eyes/scorched lips, toxin is heavy; eruptions will be dense, requiring preemptive resolution. Sparse eruptions might hide latent toxins; true lightness is confirmed by reduced fever/thirst, good spirit, and regular functions.
Regarding dense eruptions: All sores relate to the Heart, whose brilliance shows on the face. Early green veins and tearing indicate Liver toxin (Wood generating Fire, excess pathogen); wind-fire causes itching, resolve Liver toxin first. Red face like brocade, forehead veins, delirium/fright indicate Heart toxin (self-waning Fire, positive pathogen); ruler unclear implies sinking toxin, untreatable. Dry mouth/scorched lips/yellow dry face indicate Spleen toxin (Fire generating Earth, deficient pathogen); Spleen governs muscles, prone to ulceration, resolve Heart-Spleen toxin. Pale face, dry nose/clear discharge/epistaxis indicate Lung toxin (Fire punishing Metal, slight pathogen), slightly resolve Lung toxin. Black smoky complexion, hallucinations, hot head/cold feet indicate Kidney toxin (Water overcoming Fire, thief pathogen), leading to black depression, untreatable.
Mild heat = light toxin = sparse eruption = no meds needed. Severe heat = heavy toxin = dense eruption = preemptive resolution with Lianqiao Shengma Tang, Rusheng Tang, or Dai Tian Xuanhua Wan. If heat is mild but eruption is dense, with dry mouth/scorched lips/red scant urine/constipation despite mild surface heat, this is deep interior heat; resolve urgently. If extreme thirst, burning heat, headache, sweating/no sweat, use Baihu Tang (up to half jin Gypsum in humid summer). If heat is severe but eruption is sparse, with no thirst/moist lips/no red eye vessels/regular bowels, this is shallow heat with harmonious interior; use Gegen Tang. Alternating cold/heat is common; whole-body fire-like heat day and night indicates excessive Heart Fire and dry Spleen Earth; treat based on exterior/interior signs. Mouth dry/red eyes/scorched lips/urinary difficulty = exterior-interior heat; use Shuangjie San, Lianqiao Shengma Tang, or Huanglian Jiedu Tang (for irritability) followed by Qiwu Shengma Wan. Sore throat: Ganjie Tang with Niu Bang Zi, or Shegan Niu Bang Zi Tang with Jie Geng to clear throat/chest; neglect leads to closure, choking, aphonia.
Initial fever with chills/shaking like malaria indicates deficient Wei Qi and Ying Blood, unable to force toxin out, causing stagnation in collaterals. Treat with Chaige Guizhi Tang plus Huangqi; heals upon eruption. Do not mistake for rigor mortis and wrongly use Chen's acrid-warm formulas.
Ancients followed seasonal Qi (Do not harm Heavenly Harmony): Nourish Yang in Spring/Summer, Yin in Autumn/Winter. For rash fever, initial dispersal varies by season: Spring Qianghuo Tang, Summer Wuling San, Autumn Shenru Yin, Winter Wuji San; Ren Shen Bai Du San is universal. Spring Liver excess: Siwu Tang plus Fangfeng/Huangqin/Muxiang/Qingpi/Qianghuo to subdue Wind-Wood; Sijunzi Tang plus Baishao/Rougui to tonify constrained Spleen. Summer Heart excess: Huanglian Jiedu Tang plus Maidong/Wuweizi to tonify Lung. Autumn Lung excess: Xiebai San combined with Ganjie Tang plus Niu Bangzi/Madouling to scatter Lung evil; Siwu Tang minus Chuanxiong plus Tian/Maidong/Tianguafen to moisten dryness. Winter Kidney excess: Wuji San to scatter exterior cold; Lizhong Tang plus Huangqi/Zhimuxiang/Dingxiang to overcome interior cold.
For sudden wind: Guizhi Gegen Tang. Summer heat: Ren Shen Baizhu Tang (for thirst). Winter cold: Sijunzi Tang plus Guizhi/Shengjiang. Dampness: Wuling San plus Cangzhu. These require specific signs; otherwise, maintain warmth, avoid wind/cold extremes, and use Chantui Gao to repel wind/toxins. Burn Huixiang incense in rooms.
Fits in first 2-3 days: Daochi San, Qianghuo Tang, Chensha San. Constipation: Sanhuang Wan (mild purge). Scanty urine: Daochi San. Extreme thirst: Gegen Jiedu Tang. Abdominal pain: Guizhi Dahuang Tang. Lower back pain: Ren Shen Bai Du San. Spontaneous diarrhea: Huangqin Tang. Vomiting/diarrhea: Huangqin Banxia Tang. Weak Spleen/Stomain with clear diarrhea: Lizhong Wan/Sijunzi Tang/Roudoukou Wan combined. See other sections for details.
[Dispersing Exterior]
Shengma Tang treats adults/children with epidemic fevers, headache, cold feet, rapid pulse, fever, limb pain, and uncertain rash stages. Also for unrelieved toxin. Clarifies ambiguous signs. Safe even with normal bowels. Shengma is bitter/cool/non-toxic, resolves hundred toxins, expels ghosts/plagues, treats abdominal pain/throat ulcers (all toxic). Gegen is neutral, treats thirst/heat, releases muscle/exterior, induces sweating, treats headache. Both treat hidden heat-toxin, palpitations, irritability. Rash involves accumulated heat-toxin; Gegen clears heat, Shengma removes toxin. Shaoyao treats alternating cold/heat, invigorates blood, facilitates eruption, promotes urination. Gancao harmonizes. For extreme thirst, roasted Gancao powder is used. These four detoxify, regulate Ying-Wei, and are essential for rash.
Contraindications: Not for non-rash fever (Cold Damage, Wind Strike, Food Retention, Fright) with weak constitution causing deficient heat. Contraindicated in strong fever with blue face/white eyes/pale sclera, non-constipated bowels, clear urine (no interior heat). Used before eruption or after recovery to detoxify, not during active eruption.
Formula: Shengma, Gegen, Shaoyao, Gancao (equal parts). Coarse powder. 2 qian per dose, boil in 1 cup water to half cup. Warm take, any time. Can be fine powder mixed with water. Take warm for heat, hot for cold.
Haizang: Shengma Gegen Tang belongs to Taiyang/Yangming. Chen Wenzhong: Avoid if fever with abdominal pain, diarrhea, palpitations, sweating, or cold feet. Zhang Xuanzhi: Avoid once spots appear (fear of exterior deficiency). Wan Quan: Ancients said avoid once red spots appear. This applies to sparse/light toxin cases. Later doctors misunderstood; for dense eruptions, frequent use is appropriate to lift sinking, moisten dryness, disperse stagnation, and balance Yin/Yang without depleting essence or allowing Yang toxin to flare. If toxin is light, even other drugs are unsuitable, let alone Gegen Tang.
Ancients used Gegen Tang as main formula; later generations added complexity, making cure harder. With flexibility, Gegen Tang can be modified from fever onset to scabbing, not just for dispersing. Modifications:
Initial fever: Add Chaihu, Qianghuo, Baizhi, Jiegeng, Fangfeng.
Dry mouth/thirst (internal heat): Add Gegen Fen, Tianguafen, Maidong.
Diarrhea: Add raw Huangqin.
Vomiting: Add Banxia, Shengjiang.
Abdominal pain: Add Muxiang, Qingpi, Zhike, Shan Zha.
Back pain: Add Duhuo, Xixin.
Headache: Add Qianghuo, Gaoben, Manjingzi.
Convulsions: Add Mutong, Shengdi, Dengxin.
Scanty urine: Add Mutong, Cheqianzi, Qumai.
Constipation: Add Dahuang.
Epistaxis: Add Zhizi, Xuanshen, Shengdi.
Day 3-4 fever persists: Add解毒 (Detox) herbs: Nuli Zi, Lianqiao, Zicao, Jiegeng.
Rash not emerging: Add Fangfeng, Chantui, Jingjie, Honghua.
Eye pain: Add Mimenghua, Chaihu, Longdan Cao.
Too dense: Add Renshen, Danggui, Muxiang, Zicao, Nuli Zi, Fangfeng, Jiegeng.
Sore throat: Add Jiegeng, Lianqiao.
Dry/Purple/Red sores (Blood heat): Add Danggui Shao, Shengdi, Honghua, Digupi, Mudan Pi.
Gray/White/Flat sores (Qi deficiency): Add Renshen, Huangqi, Fangfeng, Muxiang, Guirui.
Extremity sores flat (Spleen/Stomach insufficiency): Add Fangfeng, Guirui, Renshen, Huangqi.
Dense but not fully raised + thirst (Fluid deficiency): Add Renshen, Maidong, Tianguafen.
Diarrhea (Interior deficiency): Add Renshen, Baizhu, Hezi, Fuling.
No scabbing (Damp-Heat): Add Huangqi, Fangfeng, Guirui, Baizhu. (Li Shi adds Zisu, Sun Jian, Shan Zha, Niubangzi; Winter add processed Mahuang).
Xingxing San: For pure Yang constitutions, originally pediatric. Not for interior cold. Matches symptoms: Headache/dry eyes/runny nose -> Xixin. Wheezing -> Jiegeng, Renshen. Sleepiness -> Fuling. Fear of Cold Damage attacking weak interior -> Baizhu. For Wind-Heat Rash -> Gualou Gen (Bitter/Cool, treats fever/fullness, removes chronic gut heat, jaundice, thirst, regulates menstruation, stops excessive urination, treats chest bi/lactation issues).