古云∶痘疹之病，皆由父母胎毒伏于命门相火之中，故每遇二火之令，或主客温热之气，即触
发而动，此痘疹属阳，固无疑矣。然阳毒阳邪，无热不成，亦无热不散，所以非热不能出现，非热
不能起发，非热不能化浆，非热不能干浆，此痘疮之终始，不能无热，亦不可无热也。但热贵其微，
不宜其甚。盖热甚者毒必甚，而痘亦必重；热微者毒亦微，而痘出必轻；无热则不成不化，此热固
痘之常也，所以凡治痘疮，不可尽除其热，若必欲尽去之，则未有不成阴证而败者矣。
一、痘有三火，盖痘、疹二证，皆言为火者是矣。然轩岐之火义有三，曰太过，曰平气，曰不
及也。太过之火，是谓赫曦，炎烈之气也，其毒盛，治宜清解。平气之火，是谓升明，蕃茂之气也，
其毒平，不必治之。不及之火，是谓伏明，屈伏之气也，其毒陷，治宜培补。此阴中有阳，阳中有
阴之大义，而亦痘疹万病之法旨，使不知此，尚敢云医。
一、治热当知微甚，及有毒无毒，斯无谬误。盖痘疹属阳，无不发热。若外虽发热，而内则不
渴，或饮食二便如常，此蒸痘之热耳，热虽在表而内则无病，万万不可妄治。其有热之甚者，痘毒
必甚，此不得不为调理，若甚于发热之初，必为之表散；若甚于见点之后，必为之清解。钱氏曰∶
热甚而大小便闭则利之。如果有热毒实邪，则不得骤用补阳之剂，致令毒瓦斯壅盛，则热终不退，反
为害矣。
一、假热非热，假寒非寒，见有不真，误治则死。如文中主温补，仲阳主凉泻，虽若各有所主，
然无非因病而药，各有所宜，是以二者皆不可偏用。但得中和，斯为贵耳。余见近日幼科，多不知
陈氏之心法，但见痘
疮，则无论是虚是实，开口止知解毒，动手只是寒凉，百证千家，若同一辙，岂必尽皆实热乎？如
实热果真，白非凉泻不可，然必内外俱热，方是热证，内外俱实，方是实证。但其中有似实非实，
似热非热者最多，此不可不察之真而审之确也。故凡见外证虽若实热，而内察则无，如口不甚渴，
二便通利，或见微溏，或禀赋素弱，或脉息不强，或声色不振，或脏气多阴，或饮食不化，或胀满
呕恶，或吐蛔，或倦睡，或畏寒，或作痒，或多惊恐，或筋惕肉 之辈，虽见有热，此皆热在表而
不在里，总属无根之火，非真热证也。最忌寒凉。若垫而妄用，则必致败脾，无一免矣。
一、痘疮热甚者，毒之盛也，其痘必多；热微者毒亦微，其痘必少。痘既出而热不减者，痘必
日增，见点后而热渐退者，痘必疏矣。或有微热而痘反密，其内热必甚？而或见烦躁，或二便热
燥，此毒深热亦深也，宜清其内而兼解其表。或有热甚而痘反稀者，以外虽热而内则不热，此毒
浅热亦浅也。
一、痘疮初热之治法，详发热三朝治法条中。
一、治阳邪实热之法。表里挟邪俱热者，柴葛煎、连翘升麻汤。表热不解而里无热者，疏邪饮、
苏葛汤、柴归饮。表里俱热而邪实者，双解散。内热毒盛者，东垣凉膈散，或解毒防风汤。热毒炽
盛，痘疮紫赤，烦躁者，搜毒煎，或大连翘饮，或犀角地黄汤。阴虚血少，燥热神昏者，四物汤或
二阴煎。阴虚血热而大便不通者，四顺清凉饮。大便不通，实热内壅而胸膈胀闷者，前胡枳壳汤，
或三黄丸。二便俱不利而实热内滞者，通关散。小水赤涩而邪热内蓄者，导赤散、六一散。心火盛
而惊搐多痰者，万氏牛黄清心丸，或七味安神丸。痘疮稠密，身热毒盛，养营退热解毒者，鼠粘子
汤、柴胡麦门冬散。
一、纯阳无阴之证，凡发热谵语，狂妄躁乱，大渴大烦，如见鬼祟，大便秘结，小便赤涩，六
脉滑数急疾，是皆火毒内炽之证，当用前法，酌而治之。
陈氏曰∶凡痘疹壮热，经曰不除，如无他证，只用六味柴胡麦门冬散治之。如不愈，服七味白
术散。凡身壮热，大便坚实，或口舌生疮，咽喉肿痛，皆疮毒未尽也，用射干鼠粘子汤。如不应，
用七味人参白术散。
程氏曰∶痘疮前后，凡有烧热不退，并属血虚血热，只宜四物汤按证加减。渴加麦门冬、犀角
汁，嗽加栝蒌霜，有痰加贝母、橘红。切忌人参、白术、半夏之属，倘误用之，为害不小。盖痘疮
属阳，血多虚耗，今但滋阴补血，其热自退，此即养阴退阳之义也。
一、痘后余热发热证治，俱详痘后余毒条中。
古人说：痘疹这类疾病，都是由父母的胎毒潜伏在命门相火之中，所以每当遇到二火当令的时候，或者主气客气出现温热之气时，就会触发并发作，这痘疹属于阳证，是毫无疑问的。然而阳毒和阳邪，没有热就不能形成，也没有热就不能消散，所以没有热痘就不能发出，没有热痘就不能起发，没有热痘就不能化脓成浆，没有热痘就不能结痂干燥，这是痘疮从开始到结束的过程，不能没有热，也不可以没有热。但是热贵在轻微，不适宜过于严重。因为热严重的毒必然严重，而痘也必然严重；热轻微的毒也轻微，而痘出必然轻浅；没有热则不能形成也不能化脓，这热确实是痘疮形成的常态，所以凡是治疗痘疮，不能完全清除其热，如果一定要完全去除它，就没有不成阴证而败坏的案例了。
一、痘有三火，大概痘、疹两种病症，都说它们是火证是正确的。然而轩岐（指黄帝与岐伯）关于火的义理有三种，叫做太过，叫做平气，叫做不及。太过的火，称为赫曦，是炎热猛烈的气，它的毒盛，治疗宜用清解法。平气的火，称为升明，是蕃茂生长的气，它的毒平和，不必治疗。不及的火，称为伏明，是屈伏潜藏的气，它的毒陷落，治疗宜用培补法。这是阴中有阳、阳中有阴的大道理，也是痘疹万病的关键宗旨，如果不明白这个，还敢自称医生吗？
一、治疗热证应当知道热的程度轻重，以及是否有毒无毒，这样才不会出错。大概痘疹属于阳证，无不发热。如果外表虽然发热，但内部却不口渴，或者饮食和二便如常，这是蒸腾痘毒的热而已，热虽然在体表但内部没有病，万万不可胡乱治疗。那些热很严重的，痘毒必然严重，这不得不进行调理，如果在发热初期就很严重，必须用表散法；如果在见点之后还很严重，必须用清解法。钱乙说：热很重而且大小便闭塞就要通利二便。如果有热毒实邪，就不能突然使用补阳的药物，致使毒瓦斯壅塞旺盛，那么热最终不会退去，反而成为害处了。
一、假热不是真热，假寒不是真寒，见到不真实的症状，误治就会致死。比如文中主张温补，仲阳（钱乙）主张凉泻，虽然各自有所侧重，但无非是根据病情用药，各有适宜之处，所以两者都不可偏用。只要得到中和，这才是珍贵的。我见到最近的儿科医生，大多不知道陈氏的心法，只要见到痘疮，无论是虚证还是实证，开口只知道解毒，动手只是用寒凉药，百证千家，好像走的是同一条路，难道一定都是实热吗？如果真是实热，确实非凉泻不可，但必须内外都热，才是热证，内外都实，才是实证。但其中有很多看似实而非实、看似热而非热的情况，这是不可以不察明真实并审慎确定的。所以凡是见到外部症状好像实热，但内部检查却没有，比如口不太渴，二便通利，或者见轻微腹泻，或者禀赋素来虚弱，或者脉息不强，或者声音神色不振，或者脏气多属阴，或者饮食不消化，或者胀满呕恶，或者吐蛔虫，或者疲倦嗜睡，或者畏寒，或者作痒，或者多惊恐，或者筋惕肉瞤之类的表现，虽然见到有热，这都是热在表而不在里，总属于无根之火，不是真热证。最忌讳寒凉药。如果垫着（此处疑为“遂”或“若”之误，意即如果）妄用寒凉药，则必定导致脾胃败坏，没有能幸免的了。
一、痘疮热严重的，是毒气盛的表现，其痘必然多；热轻微的毒也轻微，其痘必然少。痘既已发出而热不退的，痘必然日益增多；见点后而热逐渐退去的，痘必然稀疏了。或者有轻微发热而痘反而密集的，其内热必然很严重？并且可能见到烦躁，或者二便热燥，这是毒深热也深，宜清其内热兼解表邪。或者有热很重而痘反而稀疏的，因为外表虽热但内部不热，这是毒浅热也浅。
一、治疗阳邪实热的方法。表里挟邪俱热的，用柴葛煎、连翘升麻汤。表热不解而里没有热的，用疏邪饮、苏葛汤、柴归饮。表里俱热且邪气实的，用双解散。内热毒盛的，用东垣凉膈散，或解毒防风汤。热毒炽盛，痘疮紫赤，烦躁的，用搜毒煎，或大连翘饮，或犀角地黄汤。阴虚血少，燥热神昏的，用四物汤或二阴煎。阴虚血热而大便不通的，用四顺清凉饮。大便不通，实热内壅而胸膈胀闷的，用前胡枳壳汤，或三黄丸。二便都不通利而实热内滞的，用通关散。小便赤涩而邪热内蓄的，用导赤散、六一散。心火盛而惊搐多痰的，用万氏牛黄清心丸，或七味安神丸。痘疮稠密，身热毒盛，养营退热解毒的，用鼠粘子汤、柴胡麦门冬散。
一、纯阳无阴的证候，凡是发热谵语，狂妄躁乱，大渴大烦，像看见鬼怪一样，大便秘结，小便赤涩，六脉滑数急疾，这些都是火毒内炽的证候，应当用前面的方法，斟酌后治疗。
陈氏说：凡是痘疹壮热，经云不除，如果没有其他症状，只用六味柴胡麦门冬散治疗。如果不愈，服用七味白术散。凡是身体壮热，大便坚实，或者口舌生疮，咽喉肿痛，都是疮毒未尽，用射干鼠粘子汤。如果无效，用七味人参白术散。
程氏说：痘疮前后，凡是有烧热不退，都属于血虚血热，只宜用四物汤按证加减。口渴加麦门冬、犀角汁，咳嗽加栝蒌霜，有痰加贝母、橘红。切忌人参、白术、半夏之类，如果误用它们，危害不小。大概痘疮属阳，血多虚耗，现在只要滋阴补血，其热自然退去，这就是养阴退阳的道理。
一、痘后余热发热证治，都详细记载在“痘后余毒”条中。
The ancients said: Diseases such as smallpox and measles all arise from fetal toxins hidden within the Mingmen (Gate of Life) and Xianghuo (Ministerial Fire). Therefore, whenever the influence of the "two fires" prevails, or when pathogenic warm and hot qi acts as either the host or guest factor, these toxins are triggered and manifest. Thus, it is undoubtedly that smallpox and measles belong to Yang syndromes. However, Yang pathogens and toxic heat cannot form without heat, nor can they dissipate without heat. Hence, without heat, the eruption cannot occur; without heat, the lesions cannot rise and develop; without heat, pus cannot form; and without heat, scabs cannot dry. This continuity of heat is essential throughout the course of smallpox, neither absent nor excessive. Heat should be mild rather than severe. Severe heat implies severe toxicity and severe lesions; mild heat implies mild toxicity and mild lesions. Without heat, formation and transformation fail. This regulation of heat is the norm for smallpox. Therefore, in treating smallpox, one must not completely eliminate heat. If one insists on removing all heat, the condition will invariably degenerate into a Yin syndrome and fail.
1. There are three types of fire in smallpox. It is correct to describe both smallpox and measles as fire-related conditions. However, according to Huangdi and Qibo, the concept of fire has three aspects: Excess (Tai Guo), Normal (Ping Qi), and Deficiency (Bu Ji). Excess fire, termed Hexi, represents intense and blazing qi with severe toxicity, requiring clearing and resolving methods. Normal fire, termed Shengming, represents flourishing and growing qi with balanced toxicity, requiring no specific treatment. Deficient fire, termed Fuming, represents subdued and latent qi with sinking toxicity, requiring tonification and supplementation. This principle of Yin containing Yang and Yang containing Yin is fundamental to understanding myriad diseases related to smallpox and measles. Ignorance of this principle disqualifies one from claiming medical expertise.
1. In treating heat, one must discern its degree (mild vs. severe) and whether toxicity is present to avoid errors. Smallpox and measles, being Yang conditions, always involve fever. If there is external fever but internal absence of thirst, with normal diet and bowel/bladder functions, this is merely the steaming heat of the toxin. The heat is superficial, and the interior is unaffected; thus, reckless treatment must be avoided. When heat is severe, toxicity is also severe, necessitating regulation. If severe at the initial fever stage, exterior-releasing methods are required; if severe after the appearance of spots, clearing and resolving methods are needed. Qian Yi stated: "If heat is severe accompanied by constipation of both bowels and bladder, purgation is indicated." If there is genuine heat-toxin excess, sudden use of Yang-tonifying agents must be avoided, as this may cause toxic accumulation and persistent heat, causing harm.
1. False heat is not true heat; false cold is not true cold. Misinterpreting deceptive symptoms leads to fatal errors. For instance, while some texts advocate warming and tonifying, others (like Qian Yizhi) advocate cooling and purging. Both approaches are valid depending on the specific pathology and should not be used exclusively. Balance is paramount. I observe that many modern pediatricians lack Chen Wensu's diagnostic insights. Upon seeing smallpox, regardless of deficiency or excess patterns, they indiscriminately prescribe detoxification and cold-cooling herbs. This uniform approach assumes all cases are excess-heat, which is incorrect. While cooling and purging are necessary for genuine excess-heat, true heat-excess requires both exterior and interior heat signs, and true excess requires fullness in both. However, many cases mimic excess-heat without being so, requiring careful differentiation. For example, if external signs suggest excess-heat but internal examination reveals no such signs—such as slight thirst, free urination and defecation, loose stools, constitutional weakness, weak pulse, dull complexion, Yin-predominant organ states, indigestion, abdominal distension, vomiting, expulsion of roundworms, lethargy, aversion to cold, pruritus, frequent fright, tremors, or muscle twitching—the heat is superficial, not interior. These represent rootless fire, not true heat syndrome. Cold-cooling herbs are strictly contraindicated here. Their misuse inevitably damages the Spleen and Stomach, leading to failure.
1. Severe heat in smallpox indicates abundant toxicity and numerous lesions; mild heat indicates mild toxicity and fewer lesions. If fever persists after eruption, lesions will increase daily. If fever subsides gradually after spot appearance, lesions will be sparse. Conversely, mild fever with dense lesions suggests severe internal heat, often accompanied by irritability and hot/dry excretions, indicating deep-seated toxicity and heat, requiring internal clearing and exterior resolving. Severe fever with sparse lesions suggests superficial heat and shallow toxicity, as the interior remains cool.
1. Treatment for initial fever in smallpox is detailed in the section "Treatment Methods for the First Three Days of Fever."
1. Methods for treating Yang-pathogen excess-heat:
- Exterior and Interior Excess Heat: Chaige Decoction (Bupleurum and Kudzu Decoction), Lqiaoshengma Tang (Forsythia and Cimicifuga Decoction).
- Unresolved Exterior Heat without Interior Heat: Shuxie Yin (Dispersing Pathogens Drink), Sugge Tang (Perilla and Kudzu Decoction), Chaigui Yin (Bupleurum and Angelica Decoction).
- Exterior and Interior Heat with Excess Pathogen: Shuangjie San (Double Resolution Powder).
- Severe Internal Heat-Toxin: Dongyuan Liangge San (Dongyuan's Cooling Diaphragm Powder) or Jiedu Fangfeng Tang (Detoxification and Saposhnikovia Decoction).
- Blazing Heat-Toxin with Purple/Red Lesions and Irritability: Soudu Jian (Toxin-Expelling Decoction), Da Lianqiao Yin (Major Forsythia Drink), or Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). *Note: Rhinoceros horn is now substituted with water buffalo horn in practice.*
- Yin Deficiency with Blood Deficiency, Dry Heat, and Confusion: Siwu Tang (Four Substance Decoction) or Eryin Jian (Two Yin Decoction).
- Yin Deficiency with Blood Heat and Constipation: Sishun Qingliang Yin (Four Smooth Clearing and Cooling Drink).
- Constipation with Internal Excess Heat Obstruction and Chest/Epigastric Fullness: Qianhu Zhike Tang (Peucedanum and Magnolia Bark Decoction) or Sanhuang Wan (Three Yellow Pill).
- Obstruction of Both Bowels and Urine with Internal Excess Heat Stagnation: Tongguan San (Passing the Barrier Powder).
- Scanty Red Urine with Internal Accumulation of Pathogenic Heat: Daochi San (Guiding Out Redness Powder) or Liuyi San (Six-to-One Powder).
- Excessive Heart Fire with Convulsions and Phlegm: Wan's Niuhuang Qingxin Wan (Wan's Buffalo Musk Clearing Heart Pill) or Qiwei Anshen Wan (Seven-Ingredient Calming Spirit Pill).
- Dense Lesions with High Fever and Toxicity, requiring Nourishment of Ying, Reduction of Heat, and Detoxification: Niuziqi Tang (Arctium Seed Decoction) or Chaihu Maidong San (Bupleurum and Ophiopogon Powder).
1. Pure Yang without Yin syndromes manifest as fever, delirium, madness, restlessness, extreme thirst and agitation, hallucinations ("seeing ghosts"), constipation, scanty red urine, and rapid, slippery, urgent pulses. These indicate blazing internal fire-toxin. Apply the aforementioned methods with appropriate adjustments.
Chen Wensu stated: For high fever in smallpox/measles persisting without other symptoms, use Liuwei Chaihu Maidong San (Six-Ingredient Bupleurum and Ophiopogon Powder). If ineffective, use Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder). For high fever, hard stools, mouth/tongue ulcers, or sore throat, residual toxin remains; use Shegan Niuziqi Tang (Belamcanda and Arctium Seed Decoction). If ineffective, use Qiweirenshen Baizhu San (Seven-Ingredient Ginseng and Atractylodes Macrocephala Powder).
Cheng Shi stated: Persistent burning heat before or after smallpox eruption indicates Blood Deficiency and Blood Heat. Treat with Siwu Tang (Four Substance Decoction) modified by symptoms. Add Maidong (Ophiopogon Tuber) and Xijiao (Rhinoceros Horn/Water Buffalo Horn) for thirst; add Gualou Shuang (Trichosanthes Powder) for cough; add Beimu (Fritillaria Bulb) and Juhong (Aged Tangerine Peel) for phlegm. Strictly avoid Renshen (Ginseng Root), Baizhu (Atractylodes Rhizome), and Banxia (Pinellia Tuber). Misuse causes significant harm. Since smallpox is a Yang condition consuming Blood, nourishing Yin and Blood naturally reduces heat, embodying the principle of "Nourishing Yin to Retreat Yang."
1. Treatment for residual heat fever after smallpox is detailed in the section "Residual Toxin After Smallpox."