〔钱〕五脏各有一证 肝脏水 肺脏脓 心脏 脾脏疹 归肾变黑。〔海〕
肝脏水 色或青，肺脏脓 色或白，脾脏疹或如麸糠色，心脏 其色赤，变归肾则
色黑矣，此五色。凡痘疹，一色者善，或二色三色相合而作者凶。第一大小不等
小儿在胎十月，食五脏秽血，生下则其毒当出，故疮疹之状，皆五脏之液，肝主泪，
肺主涕，心主血，脾为裹血。其疮出有五名，肝为水 ，以泪出如水，其色青而小。
肺为脓 ，以涕稠浊如脓，其色白而大。心为 ，主血，其色赤而小，次于水 。
脾为疹，其色赤黄，而小。涕泪出多，故脓 、水 皆大，血荣于内，所出不多，
故、疹皆小。又，病水 、脓 者涕泪俱少，以液从疮出故也，譬如泡中容
水，水去，则泡瘦矣。〔娄〕上水 者，俗谓之水痘也。脓 者，俗谓之痘子也。
者，俗谓之 子也。疹者，俗谓之麻子也。痘之形状最大，水痘次之， 、 、
又次之，麻子最小，隐隐如麻子也。〔张〕四脏之疮，名状不同，肝为水 ，肝之
液为泪，泪出如水，其色微青而小。肺为脓 ，肺之液为涕，涕如脓，色微白而大。
心主血，其疮为 ，色赤而小。脾主裹血，其疮为疹，色赤黄而浅。此言其初发之
状不同如此，及五七日后，不问其初出自何脏，悉成血 ，血 成脓 ，脓 之后，
结痂 而愈矣。或谓肺为脓 ，而血 之后又成脓 何耶？盖肺为脓 者，言其初
出淡淡如脓，其色白而非黄，若血 后所结脓 ，乃其疮已熟，包裹黄脓，其色黄
而非白，所言脓 虽同，而所以为脓 则不同也。又如脾为疹，亦自其初出色黄微
亦，有小 疮而言之耳，其成脓结痂，收靥而愈，与所谓肤疹者，名同而实则大不
同也。心为 ，与所谓温毒、冬温、发 者，亦大不同。〔万〕凡疮疹五脏见证，
要察何脏之证为甚，即主其脏之毒多，如肝证毒多者，必发水 ，生瘙痒，成目疾，
宜预解肝之毒，羌活汤加青皮、柴胡。肺证毒多者，必增喘嗽烦渴不止，手掐眉
目鼻面，宜预解肺之毒，泻白散合甘桔汤，加牛蒡子、天花粉。心证毒多者，必
伏不起，谵妄饮水，烦哭切牙，宜预解心之毒，导赤散加黄连、辰砂。脾证毒多
者，必成灰白色，痒 吐利，宜预保养脾胃，以解其毒，四君子汤、调元汤，加白
芍药、防风、连翘。肾不见平证，耳 俱热者，死候也。
羌活汤（发热） 泻白散（肺） 甘枯汤（咽喉） 导赤散（心） 四君子汤（吐泻）
调元汤（即保元汤）
【钱乙】五脏各自有一种证候：肝脏对应水痘，肺脏对应脓疱，心脏对应斑疹（此处原文缺字，据上下文及后世校勘多指“斑”或“疹”，结合后文“心为𤸃”，暂译为“赤斑/血疹”），脾脏对应疹子，归入肾脏则变为黑色。【海藏】肝脏的水痘，颜色可能发青；肺脏的脓疱，颜色可能发白；脾脏的疹子，颜色可能像麸皮糠色；心脏的赤斑，颜色发红；如果病邪归于肾脏，则颜色变黑，这就是五色。凡是痘疹，只呈现一种颜色的预后良好，如果出现两种或三种颜色混合出现的，则预后凶险。第一，大小不等的小儿在母胎中十月，食用了五脏的秽浊之血，出生后体内的毒邪应当外发，所以疮疹的形态，都是五脏津液的体现。肝主泪，肺主涕，心主血，脾统摄血液。其疮疹发出有五种名称：肝表现为水痘，因为泪水流出如水，颜色青而颗粒小；肺表现为脓疱，因为鼻涕稠浊如脓，颜色白而颗粒大；心表现为赤斑，主血，颜色红而颗粒小，次于水痘；脾表现为疹子，颜色赤黄，颗粒小。因为涕泪排出较多，所以脓疱和水痘都较大；血液荣养于内，排出不多，所以赤斑和疹子都较小。另外，患水痘、脓疱病的患儿涕泪俱少，因为津液从疮疹外泄的缘故，就像水泡里装着水，水出去了，水泡就瘪了。【娄全善】上面的水痘，俗称水痘；脓疱，俗称痘子；赤斑，俗称𤸃子；疹子，俗称麻子。痘的形状最大，水痘次之，赤斑、𤸃又次之，麻子最小，隐隐约约像麻子一样。【张元素】四脏的疮疹，名称和形态不同。肝表现为水痘，肝的津液是泪，泪水流出如水，颜色微青且颗粒小；肺表现为脓疱，肺的津液是涕，鼻涕如脓，颜色微白且颗粒大；心主血，其疮表现为赤斑，颜色红而颗粒小；脾主裹血，其疮表现为疹，颜色赤黄且浅。这是说它们初发时的形态不同如此。等到五七日后，不论最初出自哪一脏，最终都变成血痂，血痂化脓，脓溃之后，结痂而痊愈。有人问：肺表现为脓疱，为什么在血痂之后又形成脓疱呢？大概肺表现为脓疱，是说它初出时淡淡如脓，颜色白而不是黄；若血痂后所结成的脓疱，乃是疮已成熟，包裹着黄脓，颜色黄而不是白。所说的脓疱虽然同名，但形成脓疱的原因却不同。又如脾表现为疹，也是从其初发时颜色黄微显，有小疮而言的，等到化成脓、结痂、收靥而愈，与所谓的肤疹，名字相同但实质大不相同。心的赤斑，与所谓的温毒、冬温、发斑等，也截然不同。【万全】凡是疮疹五脏见证，关键在于观察是哪一脏的证候严重，即说明该脏的毒邪较多。如肝证毒邪多的，必然发生水痘，产生瘙痒，形成眼疾，应当预先解除肝毒，用羌活汤加青皮、柴胡；肺证毒邪多的，必然增加喘咳、烦渴不止，用手抓挠眉目鼻面，应当预先解除肺毒，用泻白散合甘桔汤，加牛蒡子、天花粉；心证毒邪多的，必然伏陷不起，谵语妄言、想喝水，烦躁哭泣、咬紧牙关，应当预先解除心毒，用导赤散加黄连、辰砂；脾证毒邪多的，必然变成灰白色，瘙痒、呕吐腹泻，应当预先保养脾胃，以解其毒，用四君子汤、调元汤，加白芍药、防风、连翘。肾没有平和的证候，如果耳朵和手脚都发热，是死症。
羌活汤（主治发热） 泻白散（主治肺） 甘桔汤（主治咽喉） 导赤散（主治心） 四君子汤（主治吐泻） 调元汤（即保元汤）
[Qian Yi] Each of the five Zang organs has a corresponding manifestation: the Liver corresponds to *shuidou* (water pox), the Lungs to *nongbao* (pus-filled blisters), the Heart to *banzhen* (macules and papules), the Spleen to *zhen* (rash), and if it归属于 the Kidneys, it turns black. [Hai Zang] The water pox of the Liver may appear greenish; the pus-filled blisters of the Lungs may appear white; the rash of the Spleen may resemble the color of bran; the macules/papules of the Heart are red; if the pathogen returns to the Kidneys, the color becomes black. These constitute the five colors. In general, for variola and exanthems, a single color indicates a favorable prognosis, whereas a mixture of two or three colors indicates an ominous prognosis. First, infants of varying sizes, having ingested the turbid blood of the five Zang organs during the ten months in the womb, must expel these toxins after birth. Therefore, the manifestations of sores and rashes are expressions of the fluids of the five Zang organs. The Liver governs tears, the Lungs govern nasal mucus, the Heart governs blood, and the Spleen envelops/controls blood. There are five names for these eruptions: The Liver manifests as *shuidou* (water pox) because tears flow like water, appearing greenish and small; the Lungs manifest as *nongbao* (pus-filled blisters) because nasal mucus is thick and turbid like pus, appearing white and large; the Heart manifests as *banzhen* (macules and papules), governing blood, appearing reddish and small, secondary to *shuidou*; the Spleen manifests as *zhen* (rash), appearing reddish-yellow and small. Because nasal mucus and tears are discharged abundantly, both *nongbao* and *shuidou* are larger; since blood nourishes internally and is not discharged as much, both *banzhen* and *zhen* are smaller. Furthermore, patients suffering from *shuidou* and *nongbao* have scanty nasal mucus and tears because the body fluids are expelled through the sores, similar to how a blister shrinks when the water inside is gone. [Lou Quanshan] The aforementioned *shuidou* is commonly known as waterpox; *nongbao* is commonly known as variola; *banzhen* is commonly known as sha-rash; *zhen* is commonly known as measles. Variola lesions are the largest, waterpox next, then macules/papules and rashes, with measles being the smallest, appearing faintly like millet seeds. [Zhang Huan] The sores of the four Zang organs differ in name and appearance. The Liver presents as *shuidou*, its fluid being tears which flow like water, slightly greenish and small. The Lungs present as *nongbao*, their fluid being nasal mucus which resembles pus, slightly whitish and large. The Heart governs blood, its sore being *banzhen*, reddish and small. The Spleen envelops blood, its sore being *zhen*, reddish-yellow and superficial. This describes their initial distinct appearances. However, after five to seven days, regardless of which organ they initially originated from, they all transform into blood spots (*xuexi*), blood spots turn into pus-filled blisters (*nongxi*), and after the pus-filled stage, scabs form and healing occurs. Some ask: If the Lungs present as *nongbao*, why do pus-filled blisters form again after the blood spots? The reason is that when the Lungs present as *nongbao*, it refers to the initial eruption being faintly like pus, white rather than yellow. The pus formed after the blood spots represents matured sores enclosing yellow pus, yellow rather than white. Although both are called pus-filled blisters, the nature of the pus differs. Similarly, the Spleen presenting as *zhen* refers to the initial appearance of slight yellow discoloration with small sores; its progression to pus, scabbing, and resolution differs significantly in substance from what is termed cutaneous rash. The Heart presenting as *banzhen* is also vastly different from conditions such as warm-toxin, winter-warmth, or eruptive macules. [Wan Mizhai] In observing the five Zang manifestations of sores and rashes, one must identify which Zang's syndrome is most severe, indicating that this Zang harbors the most toxin. If the Liver syndrome involves heavy toxin, it will inevitably produce *shuidou*, itching, and eye diseases; one should preemptively resolve Liver toxin using Qianghuo Tang (Notopterygium Decoction) augmented with Qingpi (Aurantii Fructus Pericarpium) and Chaihu (Bupleuri Radix). If the Lung syndrome involves heavy toxin, it will inevitably exacerbate wheezing, coughing, restlessness, and unceasing thirst, with the patient scratching eyebrows, eyes, nose, and face; one should preemptively resolve Lung toxin using Xiebai San (Drain the White Powder) combined with Ganjie Tang (Licorice and Platycodon Decoction), augmented with Niubangzi (Arctii Fructus) and Tianhuafen (Trichosanthis Radix). If the Heart syndrome involves heavy toxin, the patient will lie prostrate, speak deliriously, desire water, cry irritably, and grind teeth; one should preemptively resolve Heart toxin using Daochi San (Guide Out the Red Powder) augmented with Huanglian (Coptidis Rhizoma) and Chen Sha (Cinnabar). If the Spleen syndrome involves heavy toxin, the skin will turn grayish-white, accompanied by itching, vomiting, and diarrhea; one should preemptively nourish and protect the Spleen and Stomach to resolve the toxin, using Sijunzi Tang (Four Gentlemen Decoction) or Tiaoyuan Tang (Regulate Origin Decoction), augmented with Baishao Yao (Paeoniae Radix Alba), Fangfeng (Saposhnikoviae Radix), and Lianqiao (Forsythiae Fructus). The Kidneys do not present with mild syndromes; if the ears and eyes are both hot, it is a sign of death.
Qianghuo Tang (for fever) Xiebai San (for Lungs) Ganjie Tang (for throat) Daochi San (for Heart) Sijunzi Tang (for vomiting and diarrhea) Tiaoyuan Tang (also known as Baoyuan Tang)