徐仲光曰∶一痘后痂未尽脱,遍身黄肿,壮热腹满漏赤者,乃脾胃素有湿热,而兼余毒不尽也。宜消积渗
湿解毒,以五补散加米仁、连翘、山栀、竹叶、防风、白术、苍术、浓朴、茯苓。
一痘后浮肿,皮薄而光,手按成窟,咳渴便涩。乃痘后饮食伤脾,脾虚不能制水,水渍妄行,浸渍脾土,
渗透皮肤故肿耳。其喘咳者,水妄行不能制火,火盛刑金也。又曰∶水气上行侵肺,最为难治。其小便涩者,
由金为火克,失其降下之令,不能输化也。治宜补中行湿,清热利便之药,以实脾饮、五脾散、石千散治之。
一痘后遍身发肿,余毒攻冲也,以满天星草同水杨根、银花、马蔺头,各捣汁,和匀服。满天星叶如芫荽,
多生墙下阴湿之处。
一痘后小便不利,腰以下肿,乃脾胃气虚,不能制肾水,水溢下焦故也。当利小便,以五苓散,间服牡蛎
散,又六君加泽泻。
一痘后遍身赤肿,发为赤游风者,乃余毒不尽解,而又恣食煎炒辛热之物,熏蒸肠胃,热与血搏而然,宜
犀角解毒汤。
一痘后腮颊赤肿,为遁毒风者,乃客风蓄于皮肤,流注而为顽核赤色也,内服解毒汤,外敷玉龙散。
一夏月痘,浆足收靥,溺赤短涩,外肾肤囊赤肿通明,乃膀胱热甚,毒瓦斯流于小肠,以八正散及化毒汤治
之。
万密斋治一男子,年二十余,痘甚密,起发时,肿异常,面如锡饼,形状可畏。喜其饮食如常,大小便调,
安静而睡。或欲投木香散。曰∶痘疹无疾,不须服药。色白者,痘出太多,气血不能周偏也,数日后自收靥矣。
果然。
一小儿痘甚密,不甚起发,面如锡饼,食少而渴。或欲投木香散。曰∶儿无吐泻里虚之症,不可用也。乃
以保元汤加当归、赤芍、防风、桔梗、牛蒡,调理而安。
一妇人年二十四五,痘甚密而肿甚,身无完肤,七八日后,眉心唇上有成浆者。或谓正当作脓之时。曰∶
未也。面疮带赤,犹是血色未曾化水,遽尔成脓,此恶候也,后必溃烂而死。果然。
唐大尹子,年十二,痘靥后,右肩发红肿,非毒也。或以针刺之,其手遂不能举。视之,其手不痛,但软
弱无力,不能自举,必用左手持之,乃能举,此血热气虚也。盖肝主筋,资血以养,寒则缩,热则胀,惟补气
养血则愈。用参、 、术、草、芎、归、川断、木香、桔梗、苡仁、防风为末,山药糊丸,服半月而愈。
一小儿痘后洗浴,面目一身俱肿,此水气也。用四君子汤以补脾去湿,加黄 以实表,防风以胜肌表之湿,
麻黄以逐脾间之水,一服肿减半。再以钱氏异功散加猪苓、泽泻而安。
徐仲光说:有一个痘疮结痂尚未完全脱落,全身发黄肿胀,高热、腹部胀满、嘴唇发红的患者,这是脾胃素来有湿热,又兼有余毒未清所致。适宜采用消积滞、渗湿邪、解毒的方法,使用五补散加入薏苡仁、连翘、山栀、竹叶、防风、白术、苍术、厚朴、茯苓。
另一个痘疮后出现浮肿,皮肤薄而光亮,用手按压留下凹陷(指凹性水肿),伴有咳嗽、口渴、小便涩滞不通。这是痘疮后因饮食损伤脾胃,脾虚不能制约水液,导致水湿泛滥妄行,浸渍脾土,渗透皮肤故而肿胀。其气喘咳嗽的症状,是因为水气妄行不能制约心火,导致火气旺盛克制肺金(五行中火克金,肺属金)。又说:水气上行侵犯肺部,是最难治疗的。其小便涩滞的原因,是由于肺金被火气克制,失去了肃降下行的功能,不能正常输布和转化水液。治疗应当采用健脾益气、祛除湿邪、清热利小便的药物,使用实脾饮、五脾散、石千散来治疗。
还有一个痘疮后全身发红肿胀,这是余毒攻冲所致,使用满天星草同水杨根、金银花、马蔺头,分别捣取汁液,混合均匀后服用。满天星的叶子像芫荽,多生长在墙下的阴湿处。
又一个痘疮后小便不利,腰部以下肿胀,这是脾胃气虚,不能制约肾水,导致水液溢于下焦的缘故。应当通利小便,使用五苓散,间服牡蛎散,或者六君子汤加泽泻。
又一个痘疮后全身赤色肿胀,发作成赤游风(一种急性皮肤感染性疾病),这是余毒未尽解,而又恣意食用煎炸炒制的辛热食物,熏蒸肠胃,热邪与血相搏结所致,适宜使用犀角解毒汤。
又一个痘疮后面部腮颊赤色肿胀,称为遁毒风,这是外感风邪蓄积于皮肤,流注而成顽固的核状赤色肿块,内服解毒汤,外敷玉龙散。
又有一夏季患痘的患者,浆液饱满后结痂,但尿色红短涩滞,外生殖器及阴囊赤色肿胀透明,这是膀胱热盛,毒气流注于小肠,使用八正散及化毒汤治疗。
万密斋治疗一名男子,二十多岁,痘疹非常密集,起发时肿胀异常,面部像锡饼一样,形状可怕。但他饮食如常,大小便正常,安静睡眠。有人想投用木香散。万密斋说:痘疹没有兼夹疾病,不需要服药。面色苍白,是因为痘出太多,气血不能周遍濡养,数日后自然会收靂结痂。果然如此。
另一个小儿痘疹非常密集,不太起发,面部像锡饼,吃得少且口渴。有人想投用木香散。万密斋说:孩子没有呕吐腹泻等里虚的症状,不可使用。于是使用保元汤加入当归、赤芍、防风、桔梗、牛蒡子,调理后痊愈。
又有一名二十四五岁的妇人,痘疹非常密集且肿胀严重,身上没有完好的皮肤,七八天后,眉心唇上有形成脓浆的迹象。有人说正当是化脓的时候。万密斋说:还不是。面部的疮疡带红色,说明还是血色未能化为脓水,如果遽然成脓,这是恶候,后来必然溃烂而死。果然应验。
唐大尹的儿子,十二岁,痘疮结痂后,右肩发生红肿,这不是毒气所致。有人用针刺破它,那只手随即不能举起。查看发现,那只手不痛,只是软弱无力,不能自己举起,必须用左手扶着才能举起来,这是血热气虚的表现。肝主筋,依靠血液滋养,寒则收缩,热则肿胀,只有补气养血才能痊愈。使用人参、[此处原文缺字,推测为黄芪或类似补气药]、白术、甘草、川芎、当归、川断、木香、桔梗、薏苡仁、防风研为末,山药糊丸,服用半月而愈。
另一个小儿痘疮后洗浴,面目全身都肿胀,这是水气所致。使用四君子汤以补脾去湿,加入[此处原文缺字,推测为黄芪]以固表,防风以祛除肌表之湿,麻黄以驱逐脾间之水,一服药后肿胀减半。再用钱氏异功散加猪苓、泽泻而痊愈。
Xu Zhongguang stated: In a case where pox scabs had not fully fallen off and the whole body was yellow and swollen, accompanied by high fever, abdominal distension, and red lips, this indicated that the spleen and stomach originally harbored damp-heat, compounded by residual toxins not yet cleared. The appropriate treatment is to eliminate accumulations, promote diuresis to drain dampness, and detoxify, using Wu Bu San (Five Tonics Powder) added with Coicis Semen (Yiyiren, 薏苡仁), Forsythiae Fructus (Lianqiao, 连翘), Gardeniae Fructus (Shanzhi, 山栀), Bambusae Folium (Zhuye, 竹叶), Saposhnikoviae Radix (Fangfeng, 防风), Atractodis Rhizoma Bai (Baizhu, 白术), Atractodis Rhizoma Cang (Cangzhu, 苍术), Magnoliae Officinalis Cortex (Houpo, 浓朴), and Poria (Fuling, 茯苓).
In another case of post-pox edema, the skin was thin and shiny, leaving an indentation upon pressure, accompanied by cough, thirst, and dysuria. This resulted from dietary injury to the spleen after the pox; spleen deficiency failed to control water metabolism, causing water to flood and act recklessly, soaking into the spleen earth and penetrating the skin, thus causing swelling. The wheezing and coughing occurred because rampant water failed to control heart fire, leading to excessive fire insulting lung metal (Fire overacts on Metal in Five Elements theory). It is also said: Water qi ascending to invade the lungs is the most difficult to treat. The dysuria arises because lung metal is controlled by fire, losing its descending function and failing to distribute and transform fluids. Treatment should employ herbs that tonify the middle, dry dampness, clear heat, and promote urination, such as Shi Pi Yin (Realize the Spleen Decoction), Wu Pi San (Five Spleens Powder), and Shi Qian San, to treat the condition.
In a case of generalized red swelling after pox due to residual toxins attacking, one should use Man Tian Xing Cao (Stellariae Herba or similar local herb used here), Shui Yang Gen (Salicis Root), Lonicerae Japonicae Flos (Jinyinhua, 银花), and Iris Tectorii Rhizoma (Malingtou, 马蔺头), crush each separately to extract juice, mix evenly, and administer orally. The leaves of Man Tian Xing resemble Coriandri Fructus (Yansui, 芫荽) and grow abundantly in shady, damp places under walls.
In another case of post-pox difficulty in urination and swelling below the waist, this was due to spleen and stomach qi deficiency failing to control kidney water, causing water to overflow into the lower jiao. One should promote urination using Wu Ling San (Five Ingredient Powder with Poria), administered intermittently with Mu Li San (Oyster Shell Powder), or Liu Jun Zi Tang (Six Gentlemen Decoction) added with Alismatis Rhizoma (Zexie, 泽泻).
In a case of generalized red swelling after pox manifesting as Chi You Feng (Red Roaming Wind, a type of acute cellulitis), this was caused by residual toxins not fully resolved, combined with indulgence in fried, roasted, and pungent-hot foods, steaming the intestines and stomach, where heat contended with blood. The appropriate formula is Xi Jiao Jie Du Tang (Rhinoceros Horn Detoxification Decoction).
In a case of red swelling of the cheeks and face after pox, termed Dun Du Feng (Escaping Toxin Wind), this resulted from exogenous wind pathogens accumulating in the skin and flowing into channels to form stubborn, red nodules. Internal treatment uses Jie Du Tang (Detoxification Decoction), and external application uses Yu Long San (Jade Dragon Powder).
In a summer pox case where the eruption filled with pus and scabbed, but urine was red, short, and scanty, with red, swollen, and transparent scrotum and external genitalia, this indicated severe bladder heat with toxic vapors flowing into the small intestine. It was treated with Ba Zheng San (Eight Corrective Ingredients Powder) and Hua Du Tang (Transform Toxin Decoction).
Wan Mizhai treated a man in his twenties whose pox was very dense. During the eruptive stage, swelling was abnormal, making the face look like a tin cake, a frightening appearance. However, his appetite was normal, bowel movements and urination were regular, and he slept quietly. Someone suggested using Mu Xiang San (Costus Root Powder). Wan Mizhai said: "Since there are no complicating diseases with the pox, medication is unnecessary. The pale complexion indicates that too many pox have erupted, depleting qi and blood so they cannot circulate fully; after a few days, it will naturally scab." This proved correct.
In another case of a child with very dense pox that did not erupt well, with a face like a tin cake, poor appetite, and thirst, someone suggested Mu Xiang San. Wan Mizhai said: "The child has no symptoms of vomiting, diarrhea, or interior deficiency, so it must not be used." Instead, he used Bao Yuan Tang (Protect the Origin Decoction) added with Dang Gui (Angelicae Sinensis Radix), Chi Shao (Paeoniae Radix Rubra), Fang Feng (Saposhnikoviae Radix), Jie Geng (Platycodonis Radix), and Niuxiangzi (Arctii Fructus), regulating the patient until recovery.
A woman aged twenty-four or twenty-five had very dense and severely swollen pox, with no intact skin on her body. After seven or eight days, pustules formed at the glabella and lips. Someone claimed this was the proper time for suppuration. Wan Mizhai said: "Not yet. The facial sores are red, indicating that the blood has not yet transformed into pus. If it suppurates abruptly, this is a malignant sign, and she will likely die from ulceration later." This indeed came true.
The son of Grand Administrator Tang, aged twelve, developed red swelling on the right shoulder after the pox scabbed. This was not due to toxin. Someone pricked it with a needle, after which the arm became unable to lift. Examination showed no pain, only weakness and inability to lift voluntarily, requiring support from the left hand. This indicated heat in the blood and deficiency of qi. Since the liver governs the sinews and nourishes them with blood, cold causes contraction and heat causes swelling, only by tonifying qi and nourishing blood can it heal. He prescribed a powder of Ren Shen (Ginseng Radix), [missing character, likely Huang Qi], Bai Zhu (Atractodis Rhizoma Bai), Gan Cao (Licorice Root), Chuan Xiong (Chuanxiong Rhizome), Dang Gui (Angelicae Sinensis Radix), Chuan Duan (Dipsaci Radix), Mu Xiang (Aucklandiae Radix), Jie Geng (Platycodonis Radix), Yi Yi Ren (Coicis Semen), and Fang Feng (Saposhnikoviae Radix), made into pills with yam paste, taken for half a month until cured.
Another child, after bathing following pox, developed swelling of the face, eyes, and whole body, indicating water qi retention. Si Jun Zi Tang (Four Gentlemen Decoction) was used to tonify the spleen and remove dampness, added with [missing character, likely Huang Qi] to secure the exterior, Fang Feng (Saposhnikoviae Radix) to overcome surface dampness, and Ma Huang (Ephedrae Herba) to expel water between the spleen layers. After one dose, the swelling reduced by half. Subsequently, Qian Shi Yi Gong San (Master Qian's Extra Efficacy Powder) added with Zhu Ling (Polyporus) and Zexie (Alismatis Rhizoma) brought about recovery.