〔万〕《活人书》云∶伤寒下之太早，热气乘虚入胃，发 。下之太迟，热留胃中，发 。胃烂，亦发 。
者，乃热毒郁遏，煎熬阴血，血得热而不解，浮于肌肉为 ，足阳明胃主之。痘疮初出，皮肉红肿，片片如
锦纹者，此夹 也，以辛凉之药解之，其 渐退，疮本坚实者吉，否则皮肤 烂，疮易瘙痒，所谓皮嫩易破者
是也。如赤 成块，其肉浮肿结硬者，又名丹瘤，其毒最酷，疮未成就，此先溃烂，工不能治。夹 痘，
亦用荆防败毒散主之， 退，可治。〔张〕痘出而夹 者，
痘毒随脏而出，其毒发之势最为迅疾，或血太过而气不及，则卫气疏缺，不能密护脉络，而致太过之血，夹毒上浮，
亦乘毒出之势而发为痈也，较前夹疹者稍为易治，如痘起齐，其内必虚， 多从内解，如不解，以升麻汤加归、
芍主之。又有或结痂后而发者，余毒热盛，煎熬肉分，其 必烂，以消毒散（出不快）加归、芍、防风，盛则
用连翘汤（痘大小便秘），烂处以生肌散（溃烂）敷之。若夹毒初出，色赤如火，乃毒滞不能宣发之故，以四顺饮（发
热）利之，如大便利一二次，而 或退，则血附气位，急用四君子汤（不能食）加 、姜、枣、与服，以防其损陷，
如不止，加肉豆蔻必止。〔翁〕用玄参升麻汤（咽喉）、黄芩、荆芥、白芍、归、芎，在初多用表散，在后多用解利，
红易退，紫 稍难，蓝 不可治矣。〔娄〕用白虎汤。〔袁〕痘中夹 ，阳明受枭炎之毒盛而然，丁、桂、之药，纤
毫莫可投也，张半仙用黄连解毒汤以治夹 之痘，则失之太寒。钱氏用槟榔大黄以疗痘中之 ，则失之太峻。总不
如犀角地黄汤以彻内阳明之郁毒，五龙化 汤以消外蚊咬之血纹，内外夹攻，表里调和，斯能复全矣。愚
治痘里夹 者极多，但见形就是 ，不见痘样者热毒峻烈，克全者十止三四，两日而 见者，速清逐为尚，患此
者必烦躁谵语，渴饮不宁，刘禅师用地龙汁和犀角水
投服，亦心得治 之法者矣。
山栀子汤 治痘疮及 毒，状如蚊蚤所啮，毒盛黑色者。
山栀子仁 白藓皮 赤芍药 升麻（各一两） 寒水石 甘草（各五钱）
上为细末。每服一钱，水八分，紫草、薄荷各少许，同煎至五分，去滓，放温服。
袁氏方
紫草 红花 犀角 木通 芍药 生地黄 茯苓 甘草 蝉蜕
灯草、金银煎服。外加荆芥、紫苏、木通、荔枝壳、凤凰脱、升麻、杨枝，浓煎汤，浴之。
阳毒升麻汤 面赤，狂言，烦躁，腰背疼，下利，脉浮，喉痛。
升麻（五钱） 犀角 射干 黄芩 人参 甘草（各二钱半）
上，水煎服。
阴毒升麻汤 治阴 。
升麻 当归 川椒 鳖甲 雄黄 甘草
上，水煎服。
【夹瘿】〔袁〕夹瘿，为痰毒凝结而成也，或结于项颈，或结于耳后，或结于腋下，大者如桃，小者似李，长
者似瓜，短者似枣，身烙烦渴，势若不凶，痘三四日而瘿作，则毒随痘泄，脓随痘灌，自可挽全而无害。倘
瘿红肿将脓，而痘随标焉，吾恐毒脓一溃，元气嚣漓，痘焉能表暴充灌乎。七八之期，痘已黄蜡，而瘿作焉，
保护元气，消毒祛邪，竟获绥全之庆，虽溃无妨。治法在乎审日期之先后，视元气之浓薄，纪男女之大小，范
时令之寒暑，庶几免紊错之愆矣。瘿已红肿而痘标焉，法宜托里，毒盛消其毒，元虚补其元，木通、桔梗，解毒
而彻关锁，恶实、生地，除枭而祛荣炎，甘草清理诸邪，蝉蜕祛风辟毒，芍药泄诸经之郁火，荆芥散阳明之
风邪，诸药缺一不可也。痘起遂发瘿，治以补托，为芩连之药不可用，耗烁之剂不宜投，消痰解毒为尚。痘标而瘿
破流脓出血，自致元气虚亏，大用黄 卫元汤可也，人参、黄 、川归、红花、桔梗、芍药、甘草、防风、煎服。
痘两三日而瘿毒仍作，急用三消散，半夏、川归、茯苓、甘草、木通、红花、生地、芍药、牛蒡子、天花粉、蝉蜕、灯
草煎服。痘七八日充灌而瘿作，宜服冲和饮子，人参、
黄、麦门、柴胡、防风、荆芥、芍药、茯苓、炒白术、桔梗、连翘、当归、栝蒌根，频进四服，自愈矣。歌曰∶
木通生地并黄 ，桔梗当归芍药俱，大力蝉蜕兼甘草，白茯僵蚕效实奇，上焦加味升麻引，贝母门冬不可遗，
下焦牛膝相资助，紧觅山姑倍用之，热多荆芥随多少，疼极还寻白芷医。愚按方治证，须验时日，若
头面尽肿而瘿肿，则诸痘决不能鼎峻，多致损伤。
【夹丹】〔袁〕痘里发丹，内热之极而然也，不宜遽用极寒透里之剂，若标两三日，竟以化 汤徐徐浴之，
内服生地、牛蒡子、芍药、甘草、木通、荆芥穗，其毒自消矣。若用猪胆、京墨、冰片涂之，竟罹其害，慎之！
头面项颈，倘如蛇缠硬肿，火烧疼痛，枭毒辏于上，宜用炒黄连、紫草、车前子、栀子等药。余治痘丹，
准前药加减，单用露桃花二钱，即丹收痘朗，若肿疼，须加柴胡、羌活、生地、芍药倍之。有用凤尾草独煎汤饮，
岂知山蕨即凤尾草名也，性极寒而沉走，恐伤于痘，不可轻用。
【夹疮疡】〔袁〕痘里夹疮，痘迎疮见隙而盘据，愈加多密矣，痘起气虚，风痒自作，宜用紫苏、荆芥汤
浴之，随用芍药、生地、防风、黄 、白术、僵蚕、甘草、
蝉蜕等药服之可也。若男女种患杨梅恶疮，痛不可忍，而痘适标其间，李少阳用蜗牛丹以治，但香油、皂子仁、不
可轻用。若患肥疳疮，如松香、轻粉、飞丹、雄黄，皆不可涂也。歌曰∶黄 芍药直僵蚕，生地防风白术联，甘
草红花牛蒡子，酒煎来服效难言，若是杨梅疮破烂，牛黄土茯倍加焉，痛极乳香些少助，自然疮可
痘安痊。余历验小儿痘种于疮疡中，痘虽美丽，势必枭痒，若不按法制汤以浴，痘蹲聚于疮隙，奚克鼎峻，尹头陀专
以香马兰藤煎汤，浴夹疮疡之痘，允得镇痘之妙，但香马兰有三种，分别青红白，根浮上红者甚佳，采用则可。
治法，升麻、黄 、为君，芍药、生地、为臣，羌活、防风、为佐，甘草、蝉蜕为使，此准格也。
【夹损伤】〔袁〕痘标一两日，或致扑跌，或犯金石所伤，则脾脉亏损而血气走散，痘终受其阻厄，李少
阳用孩骨胡桃酒以治，则失之峻利，况胡桃又作泻之物，用之不宜。王近川用归尾桃仁汤以治，则失之狂妄，
痘中岂宜破败其血者耶。准根据刘半塘拱元散，人参、黄 、当归、红花、伏凤雏、蝉蜕、防风、芍药、甘草以
补托其内，用文蛤、棕灰 于伤处，以收敛其外可也。若损而不破者，用虾蟆皮贴之，徐徐以手摩抚，若是汤泼
火烙者，不宜敷以生冷之药，以凝滞其痘也。歌
曰∶损伤须觅伏凤雏，土鳖参 蝉蜕驰，橘红甘草当归合，再入红花防地俱。昔黄舍人次子十三岁，患痘两朝，上
楼失足，损伤头额，致血淋漓，父母痛哭，以为痘中损伤，必不能生矣，请予视治，即将前方倍下参、 、归、地、
连进四服而痘遂鼎灌，身带不宁，加茯神、桂心，外单用棕灰敷之，不半月而自靥脱全美。但痛甚者少加乳香，若
外伤重、痕阔，弗克收痂，用白芨、白蔹、象皮末掺之，自痊。
【背景信息】
书名：证治准绳·幼科 作者：王肯堂 朝代：明 章节：夹 类别：综合
【待处理原文翻译】
〔万全〕《活人书》说：伤寒病如果攻下太早，热气趁虚进入胃中，引发丹毒（皮肤红肿热痛如涂丹砂的病症）。如果攻下太迟，热邪滞留胃中，也会引发丹毒。胃腑腐烂，同样会引发丹毒。
所谓丹毒，是由于热毒郁结遏制，煎熬阴血，血液受热后无法消散，浮溢于肌肉之间形成的，由足阳明胃经所主。痘疮刚发出时，皮肉红肿，一片片像织锦上的花纹一样，这是夹带丹毒的情况，用辛凉性质的药物来解除它，丹毒逐渐消退，痘疮本身坚实的是吉兆；否则皮肤溃烂，痘疮容易瘙痒，这就是所说的皮肤娇嫩容易破损的情况。如果是赤色丹毒结成块状，肌肉浮肿结硬，又名叫丹瘤，这种毒性最猛烈，痘疮尚未成熟，此处先溃烂，医生难以治愈。夹带丹毒的痘疮，也用荆防败毒散为主方治疗，丹毒消退后，就可以治愈。
〔张景岳〕痘疮发出而夹带丹毒的，痘毒随着脏气外发，其毒势发作最为迅猛。或者是血分太过而气分不足，导致卫气疏漏缺失，不能严密保护脉络，致使过多的血液夹带毒邪上浮，也乘着毒邪外出的势头而发为痈肿，这比之前提到的夹带疹子的情况稍微容易治疗。如果痘疮起发整齐，体内必然虚弱，毒邪多从内部化解；如果不能化解，用升麻汤加入当归、白芍为主方治疗。又有在结痂后发作为丹毒的，余毒热盛，煎熬肌肉组织，皮肤必然溃烂，用消毒散（适用于痘出不快）加入当归、白芍、防风，热盛则用连翘汤（适用于痘大小便秘），溃烂处用生肌散（适用于溃烂）敷贴。如果夹带的毒邪初出时，颜色红得像火一样，这是毒邪停滞不能宣发透达的缘故，用四顺饮（适用于发热）通利它，如果大便通畅一两次，而丹毒有所消退，那么血液依附于气的位置，急忙用四君子汤（适用于食欲不振）加入人参、生姜、大枣给患者服用，以防正气受损下陷，如果腹泻不止，加入肉豆蔻一定能止住。
〔翁仲仁〕用玄参升麻汤（适用于咽喉肿痛）、黄芩、荆芥、白芍、当归、川芎，在初期多用发散表邪的方法，后期多用解毒利湿的方法，红色丹毒容易消退，紫色丹毒稍难，蓝色丹毒不可治了。
〔袁氏〕痘疮中夹带丹毒，是因为阳明经受枭炎之毒盛所致，丁（天丁，即皂角刺）、桂（肉桂）这类药物，丝毫不能投用。张半仙用黄连解毒汤来治疗夹带丹毒的痘疮，就失之过于寒凉。钱乙用槟榔大黄来治疗痘中的丹毒，就失之过于峻猛。总不如用犀角地黄汤来彻除内在阳明的郁积毒邪，用五龙化斑汤来消除外部蚊虫叮咬般的血纹，内外夹攻，表里调和，这样才能恢复健康。我治疗痘疮里夹带丹毒的情况极多，只要见到形态就是丹毒，不见痘样者，说明热毒峻烈，能完全治愈的十人中只有三四成。两天后丹毒显现的，以迅速清解驱逐为尚。患此症的人必定烦躁谵语，口渴饮水不得安宁。刘禅师用地龙汁混合犀角水投服，也是心得治疗丹毒的方法啊。
山栀子汤 治疗痘疮及丹毒，症状像被蚊子跳蚤叮咬，毒盛呈黑色的。
山栀子仁 白藓皮 赤芍药 升麻（各一两） 寒水石 甘草（各五钱）
以上研为细末。每次服用一钱，用水八分，紫草、薄荷各少许，同煎至五分，去渣滓，放温后服用。
袁氏方
紫草 红花 犀角 木通 芍药 生地黄 茯苓 甘草 蝉蜕
灯心草、金银花煎服。外加荆芥、紫苏、木通、荔枝壳、凤凰脱（一种草药或偏方名）、升麻、杨枝，浓煎汤，用来洗浴。
阳毒升麻汤 主治面赤，狂言，烦躁，腰背疼，下利，脉浮，喉痛。
升麻（五钱） 犀角 射干 黄芩 人参 甘草（各二钱半）
以上，用水煎服。
阴毒升麻汤 治疗阴毒（阴寒毒邪）。
升麻 当归 川椒 鳖甲 雄黄 甘草
以上，用水煎服。
【夹瘿】〔袁氏〕夹带瘿瘤，是由痰毒凝结而成的，或者结在项颈，或者结在耳后，或者结在腋下，大的像桃子，小的像李子，长的像瓜，短的像枣，身体灼热烦渴，形势看起来不凶险，如果在痘疮三四日时出现瘿瘤，那么毒邪随痘疮泄出，脓液随痘疮灌注，自然可以挽回保全而无害。倘若瘿瘤红肿将要化脓，而痘疮却随之枯萎，我恐怕毒脓一旦溃破，元气耗竭，痘疮怎么能表暴充盈灌注呢？到了七八天的时候，痘疮已经变成黄蜡色，此时出现瘿瘤，保护元气，消毒祛邪，竟然能获得绥靖保全的喜庆，即使溃破也无妨。治疗方法在于审察日期先后，视元气浓薄，记录男女大小，规范时令寒暑，或许可以避免错乱失误的过失。瘿瘤已经红肿而痘疮枯萎，法宜托里透毒，毒盛则消其毒，元气虚则补其元，木通、桔梗，解毒而通达关锁，牛蒡子、生地，清除枭毒而祛除荣分之炎，甘草清理诸邪，蝉蜕祛风辟毒，芍药泄诸经之郁火，荆芥散阳明之风邪，诸药缺一不可。痘疮起发随即出现瘿瘤，治疗以补托为主，黄芩、黄连这类药物不可用，耗损烁伤的药剂不宜投用，以消痰解毒为尚。痘疮枯萎而瘿瘤破溃流脓出血，自然导致元气虚亏，大用黄芪卫元汤即可，人参、黄芪、川当归、红花、桔梗、芍药、甘草、防风，煎服。痘疮两三天而瘿毒仍然发作，急忙用三消散，半夏、川当归、茯苓、甘草、木通、红花、生地、芍药、牛蒡子、天花粉、蝉蜕、灯心草煎服。痘疮七八日充灌而瘿瘤发作，宜服冲和饮子，人参、黄芪、麦门冬、柴胡、防风、荆芥、芍药、茯苓、炒白术、桔梗、连翘、当归、栝蒌根，频繁进服四剂，自愈了。歌诀说：木通生地并黄芪，桔梗当归芍药俱，大力（牛蒡子）蝉蜕兼甘草，白茯僵蚕效实奇，上焦加味升麻引，贝母门冬不可遗，下焦牛膝相资助，紧觅山姑（山慈菇）倍用之，热多荆芥随多少，疼极还寻白芷医。我按方治证，必须验证时日，如果头面尽肿而瘿肿，那么诸痘决不能鼎盛峻发，多致损伤。
【夹丹】〔袁氏〕痘疮里发丹毒，是内热至极所致，不宜立即使用极寒透里的药剂，如果痘标两三天，竟以化斑汤徐徐洗浴，内服生地、牛蒡子、芍药、甘草、木通、荆芥穗，其毒自然消除。如果用猪胆、京墨、冰片涂擦，竟然遭受其害，谨慎！头面项颈，如果像蛇缠一样硬肿，火烧疼痛，枭毒聚集于上部，宜用炒黄连、紫草、车前子、栀子等药。我治疗痘丹，根据前药加减，单用露桃花二钱，丹毒收敛痘疮明朗，如果肿疼，须加柴胡、羌活、生地、芍药加倍。有用凤尾草单独煎汤饮用，岂知山蕨就是凤尾草的名字，性质极寒而沉走，恐怕伤于痘疮，不可轻用。
【夹疮疡】〔袁氏〕痘疮里夹带疮疡，痘疮迎着疮口缝隙盘踞，更加密集了。痘疮起发时气虚，风痒自作，宜用紫苏、荆芥汤洗浴，随后用芍药、生地、防风、黄芪、白术、僵蚕、甘草、蝉蜕等药服用即可。如果男女种患杨梅恶疮，痛不可忍，而痘疮恰好长在疮隙之间，李少阳用蜗牛丹来治疗，但香油、皂子仁，不可轻用。如果患肥疳疮，如松香、轻粉、飞丹、雄黄，都不可涂擦。歌诀说：黄芪芍药直僵蚕，生地防风白术联，甘草红花牛蒡子，酒煎来服效难言，若是杨梅疮破烂，牛黄土茯倍加焉，痛极乳香些少助，自然疮可痘安痊。我历验小儿痘疮种于疮疡中，痘疮虽然美丽，势必枭痒，如果不按法制汤洗浴，痘疮蹲聚于疮隙，怎能鼎盛峻发？尹头陀专门以香马兰藤煎汤，洗浴夹带疮疡的痘疮，确实得到镇痘的妙法，但香马兰有三种，分别青红白，根部浮上红色的甚佳，采用则可以。治疗方法，升麻、黄芪，作为君药，芍药、生地，作为臣药，羌活、防风，作为佐药，甘草、蝉蜕，作为使药，这是准则格律。
【夹损伤】〔袁氏〕痘疮标出后一两天，或者导致扑跌，或者犯金石所伤，则脾脉亏损而血气走散，痘疮最终受到阻碍厄运，李少阳用孩儿骨胡桃酒来治疗，就失之峻利，况且胡桃又是泻下的物品，使用它不适宜。王近川用归尾桃仁汤来治疗，就失之狂妄，痘疮中哪里适合破败其血的药剂呢？依据刘半塘拱元散，人参、黄芪、当归、红花、伏凤雏（土鳖虫别名）、蝉蜕、防风、芍药、甘草来补托其内，用文蛤、棕灰敷于伤处，以收敛其外即可。如果损伤而没有破溃的，用虾蟆皮贴敷，慢慢用手抚摸，如果是汤泼火烙的，不宜敷以生冷之药，以免凝滞痘疮。歌诀说：损伤须觅伏凤雏，土鳖参芪蝉蜕驰，橘红甘草当归合，再入红花防地俱。昔日黄舍人次子十三岁，患痘两天，上楼失足，损伤头额，致使血流淋漓，父母痛哭，认为痘疮中损伤，必定不能生存，请我诊治，即将前方加倍人参、黄芪、当归、生地，连续进服四剂而痘疮遂鼎盛灌注，身体不安宁，加茯神、桂心，外用单用棕灰敷贴，不到半月而自然结痂脱落全美。但痛甚者少加乳香，如果外伤重、疤痕宽，不能收痂，用白芨、白蔹、象皮末掺撒其上，自然痊愈。
[Wan Quan] The *Huoren Shu* (Book of Living People) states: If Shaoyang disease (Shaoyang syndrome, a stage in Shanghan theory) is treated with purgatives too early, heat qi enters the Stomach due to deficiency, triggering Dan Du (erysipelas, characterized by red, hot, swollen skin). If purgatives are used too late, heat remains in the Stomach, also triggering Dan Du. If the Stomach tissue rots, it similarly triggers Dan Du.
Dan Du arises from heat-toxin stagnation and suppression, which boils and consumes Yin blood. When blood is heated but not resolved, it floats into the muscles, governed by the Foot-Yangming Stomach Meridian. When smallpox lesions first appear, if the skin and flesh are red and swollen, resembling patterns on brocade, this indicates Smallpox complicated by Dan Du. It should be resolved with acrid-cool herbs. As the Dan Du gradually recedes, if the smallpox base is firm, it is an auspicious sign; otherwise, the skin will ulcerate, and the smallpox may become itchy, which refers to the condition where tender skin breaks easily. If red Dan Du forms clumps with swollen and hard flesh, it is called Dan Liu (erysipelas tumor), which has the most severe toxicity. If the smallpox has not yet matured but this area ulcerates first, it is difficult for physicians to treat. For smallpox complicated by Dan Du, Jingfang Baidu San (Astragalus and Saposhnikovia Decoction to Overcome Toxicity) is primarily used. Once the Dan Du subsides, it can be cured.
[Zhang Jingyue] In cases where smallpox appears complicated by Dan Du, the smallpox toxin follows the Zang organs to emerge externally. The momentum of the toxin's eruption is extremely rapid. This may occur when Blood is excessive while Qi is insufficient, causing Wei Qi (Defensive Qi) to be sparse and deficient, unable to tightly protect the meridians and vessels. Consequently, the excess Blood carries toxin upward, erupting as carbuncles along with the toxin's outward movement. This is slightly easier to treat than smallpox complicated by rashes. If the smallpox rises uniformly, the interior must be deficient; the toxin often resolves internally. If it does not resolve, Shengma Tang (Cimicifuga Decoction) added with Dang Gui (Angelica Sinensis) and Bai Shao (White Peony Root) is used. There are also cases where Dan Du erupts after scabbing. Excess residual heat-toxin boils the muscle tissue, causing the skin to ulcerate. Xiaodu San (Toxin-Resolving Powder) [indicated for slow eruption] added with Dang Gui, Bai Shao, and Fang Feng (Saposhnikovia Root) is used. If heat is severe, Lianqiao Tang (Forsythia Decoction) [indicated for constipation] is used. Ulcerated areas are dressed with Shengji San (Flesh-Regenerating Powder) [indicated for ulcers]. If the complicating toxin initially appears bright red like fire, it is due to toxin stagnation preventing dissemination. Sishun Yin (Four Compliance Drink) [indicated for fever] is used to promote drainage. If bowel movements occur once or twice and the Dan Du recedes, the Blood adheres to the Qi level. Immediately, Sijunzi Tang (Four Gentlemen Decoction) [indicated for anorexia] added with Ren Shen (Ginseng), Sheng Jiang (Fresh Ginger), and Da Zao (Jujube) should be administered to prevent Qi collapse. If diarrhea persists, Dou Kou (Nutmeg) will stop it.
[Weng Zhongren] Xuan Shen Sheng Ma Tang (Scrophularia and Cimicifuga Decoction) [indicated for sore throat], Huang Qin (Scutellaria Root), Jing Jie (Schizonepeta), Bai Shao, Dang Gui, and Chuan Xiong (Sichuan Lovage Rhizome) are used. Early stages favor dispersing methods; later stages favor resolving and draining methods. Red Dan Du is easy to resolve; purple Dan Du is slightly difficult; blue Dan Du is incurable.
[Lou Quanshan] uses Baihu Tang (White Tiger Decoction).
[Yuan Shi] Smallpox complicated by Dan Du occurs because the Yangming Meridian is overwhelmed by fierce inflammatory toxins. Drugs such as Ding (Tian Ding, i.e., Gleditsia Spine) and Gui (Cinnamon Twig) must absolutely not be used. Zhang Banxian used Huanglian Jiedu Tang (Coptis Decoction to Resolve Toxin) to treat smallpox with Dan Du, which was too cold. Qian Yi used Bing Lang (Areca Nut) and Da Huang (Rhubarb) to treat Dan Du in smallpox, which was too harsh. It is best to use Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) to clear internal Yangming郁毒 (stagnant toxin), and Wulong Huaban Tang (Five Dragons Spot-Resolving Decoction) to eliminate external blood-streaks resembling mosquito bites. By attacking internally and externally, harmonizing the interior and exterior, health can be restored. I have treated many cases of smallpox complicated by Dan Du. Whenever the morphology shows Dan Du without typical smallpox features, the heat-toxin is fierce; only three or four out of ten recover completely. If Dan Du appears within two days, rapid clearing and expulsion are essential. Patients suffer from irritability, delirium, thirst, and restlessness. Chan Shi Liu employed Earthworm Juice mixed with Rhino Horn Water for administration, demonstrating his expertise in treating Dan Du.
Shanzhizi Tang (Gardenia Decoction) treats smallpox and Dan Du presenting like mosquito or flea bites, with severe blackened toxicity.
Shanzhizi Ren (Gardenia Seed), Baixianpi (Dictamnus Bark), Chishaoyao (Red Peony Root), Shengma (Cimicifuga Rhizome) (each 1 liang), Hanshuishi (Calcitum), Gancao (Licorice Root) (each 5 qian).
Grind into fine powder. Take 1 qian per dose, boil with 8 fen of water, plus a little Zicao (Arnebia Root) and Bohe (Mint Leaf), decoct until 5 fen remains. Strain and take warm.
Yuan Shi Formula
Zicao, Honghua (Safflower), Xijiao (Rhino Horn - *Note: Use synthetic substitute or Anibis Cornu in modern practice*), Mutong (Akebia Stem), Shaoyao (Peony Root), Shengdihuang (Rehmannia Root), Fuling (Poria), Gancao, Chantui (Cicada Slough).
Decoct with Dengcao (Juncus Effusus) and Jinyinhua (Honeysuckle). Additionally, decoct Jingjie, Zisu (Perilla Leaf), Mutong, Lizhi Qiao (Lychee Shell), Fenghuang Tuo, Shengma, and Yangzhi (Willow Branch) in strong soup for bathing.
Yangdu Shengma Tang (Yang-Toxin Cimicifuga Decoction) treats facial redness,狂言 (wild speech), irritability, lower back pain, diarrhea, floating pulse, and sore throat.
Shengma (5 qian), Xijiao, Shegan (Belamcanda Rhizome), Huang Qin, Renshen, Gancao (each 2.5 qian).
Decoct in water and take.
Yindu Shengma Tang (Yin-Toxin Cimicifuga Decoction) treats Yin Toxin (Yin-cold pathogenic factor).
Shengma, Dang Gui, Chuanjiao (Sichuan Pepper), Biejia (Turtle Shell), Xionghuang (Realgar), Gancao.
Decoct in water and take.
[Complicated by Goiter/Ying] [Yuan Shi] Complicating Ying (goiter-like swelling) is formed by phlegm-toxin coagulation. It may knot at the neck, behind the ears, or in the axillae. Large ones resemble peaches, small ones plums, long ones melons, short ones dates. The body feels burning with irritability and thirst. Although the situation seems not fierce, if Ying appears on the 3rd or 4th day of smallpox, the toxin drains with the smallpox, and pus fills with the smallpox, allowing recovery without harm. However, if Ying becomes red, swollen, and suppurative while the smallpox marks fade, I fear that once the toxic pus ruptures, Yuan Qi (Original Qi) will be exhausted, and how can the smallpox then fill and erupt? If Ying appears during the 7th or 8th day when smallpox has turned yellow-wax colored, protecting Yuan Qi and resolving toxin/dispelling evil can still ensure safety, even if it ruptures. Treatment depends on assessing the sequence of days, the thickness of Yuan Qi, gender/age, and seasonal climate. Ying that is red/swollen with fading smallpox requires interior-supporting methods: resolve toxin if severe, tonify Yuan if deficient. Mutong and Jiegeng (Platycodon Root) resolve toxin and open locks; Niuxiangzi (Burdock Fruit) and Shengdi (Rehmannia) remove fierce toxins and clear Ying-fire; Gancao clears various evils; Chantui dispels wind and detoxifies; Shaoyao drains depression-fire in meridians; Jingjie disperses Wind-Evil in Yangming. All herbs are indispensable. If Ying erupts immediately upon smallpox rising, treatment focuses on tonifying and supporting; Huang Qin (Scutellaria) and Lian Huan (Coptis) are contraindicated, as are draining/consumptive agents; resolving phlegm and detoxifying is preferred. If smallpox fades and Ying ruptures leaking pus/blood, causing Yuan Qi deficiency, large doses of Huangqi Weiyuan Tang (Astragalus Supporting Original Qi Decoction) are suitable: Renshen, Huangqi, Chuan Gui, Honghua, Jiegeng, Shaoyao, Gancao, Fangfeng, decocted and taken. If Ying-toxin recurs on days 2-3, urgently use Sansan Xiao (Three Dissolutions Powder): Banxia (Pinellia), Chuan Gui, Fuling, Gancao, Mutong, Honghua, Shengdi, Shaoyao, Niubangzi (Burdock Fruit), Tianhuafen (Trichosanthes Root), Chantui, Dengcao, decocted and taken. If Ying appears on days 7-8 when smallpox is filling, drink Chonghe Yinzi (Harmonizing Drink): Renshen, Huangqi, Maidong (Ophiopogon), Chaihu (Bupleurum), Fangfeng, Jingjie, Shaoyao, Fuling, Chao Baizhu (Fried Atractylodes), Jiegeng, Lianqiao (Forsythia), Dang Gui, Gualougen (Trichosanthes Root). Take four doses frequently for self-healing. Song says: Mutong, Shengdi, and Huangqi; Jiegeng, Dang Gui, Shaoyao all present; Niuxiangzi, Chantui, and Gancao; Bai Fu, Jiangcan show true wonder; Add Shengma for Upper Jiao guidance; Beimu, Maidong must not be omitted; Nixi assists Lower Jiao; Shan Cigu used doubly; More Jingjie for Heat; White芷 (Angelica Dahurica) for extreme pain. My analysis: Verify timing against symptoms. If head/face are fully swollen with Ying, smallpox cannot rise vigorously, leading to damage.
[Complicated by Erysipelas/Dan] [Yuan Shi] Dan erupting within smallpox results from extreme internal heat. Do not abruptly use extremely cold interior-penetrating agents. If smallpox marks appear for 2-3 days, bathe slowly with Huaban Tang (Spot-Resolving Decoction). Internally, take Shengdi, Niubangzi, Shaoyao, Gancao, Mutong, Jingjie Sui (Schizonepeta Tip); the toxin will naturally dissipate. Using Pig Gall, Jing Mo (Beijing Ink), or Bingpian (Borneol) topically causes harm; beware! If the head, face, neck, and nape are hard-swollen like snake-bites and burning painful, with fierce toxin gathering above, use fried Huanglian, Zicao, Cheqianzi (Plantago Seed), Zhizi (Gardenia), etc. My treatment of smallpox-Dan adjusts previous formulas. Using only Lu Tao Hua (Wild Peach Blossom) 2 qian resolves Dan and clarifies smallpox. If swollen/painful, add Chaihu, Qianghuo (Notopterygium), Shengdi, and double Shaoyao. Some use Fengweicao (Pteris Multifida) alone decocted and drunk; however, Shan Jue is Fengweicao, which is extremely cold and sinking, likely harming smallpox; do not use lightly.
[Complicated by Sores/Ulcers] [Yuan Shi] Smallpox complicating sores means smallpox occupies gaps between sores, becoming denser. Smallpox rising with Qi deficiency causes wind-itch. Bathe with Zisu (Perilla Leaf) and Jingjie soup. Then take Shaoyao, Shengdi, Fangfeng, Huangqi, Baizhu, Jiangcan (Silkworm), Gancao, Chantui. If suffering from Yangmei Chuang (Syphilis-like sore) with unbearable pain, and smallpox grows in the sores, Li Shaoyang used Woniu Dan (Snail Pill), but Xiangyou (Sesame Oil) and Zaoren (Soap Nut Kernel) must not be used lightly. If suffering from Feigan Chuang (Obesity-related sores), avoid applying Songxiang (Rosin), Qingfen (Calomel), Feidan (Red Lead), or Xionghuang (Realgar). Song says: Huangqi, Shaoyao, straight Jiangcan; Shengdi, Fangfeng, Baizhu linked; Gancao, Honghua, Niubangzi; Decocted in wine, efficacy hard to describe; If Yangmei Chuang is broken, double Niuhuang, Tushen, Fuling; For extreme pain, add a little Rushiang (Frankincense); Naturally sores heal, smallpox recovers. I have verified children's smallpox growing among sores; although beautiful, they itch fiercely. Without proper herbal baths, smallpox clusters in sores and cannot rise vigorously. Yin Toutuo specifically decocts Xiang Malan Teng (Aromatic Malan Vine) to bathe smallpox complicating sores, truly achieving the miracle of calming smallpox. Note: Xiang Malan has three types (green, red, white); the one with red roots floating upwards is best. Treatment principle: Shengma and Huangqi as Sovereign; Shaoyao and Shengdi as Ministers; Qianghuo and Fangfeng as Assistants; Gancao and Chantui as Envoys. This is the standard pattern.
[Complicated by Injury] [Yuan Shi] One or two days after smallpox marks appear, falls or metal injuries may occur, damaging the Spleen pulse and scattering Qi/Blood, obstructing smallpox. Li Shaoyang used Haigu Hutao Jiu (Child Bone Walnut Wine), which is too harsh; moreover, Hutao (Walnut) is purgative, making it unsuitable. Wang Jinchuan used Guiwei Taoren Tang (Tao Ren Decoction with Angelica Tail), which is reckless; breaking blood is inappropriate for smallpox. Based on Liu Bantang's Gongyuan San, use Renshen, Huangqi, Dang Gui, Honghua, Fufengchu (Eupolyphaga/Slat Beetle), Chantui, Fangfeng, Shaoyao, Gancao to tonify/support internally. Apply Wen Ge (Clam Shell) and Zonghui (Palm Ash) externally to the wound to astringe. If injured but unbroken, apply Xama Pi (Toad Skin) and gently massage. For scalds/burns, do not apply cold/raw drugs to avoid stagnating smallpox. Song says: For injury seek Fufengchu; Tubie, Renshen, Huangqi, Chantui gallop; Juhong, Gancao, Dang Gui combine; Add Honghua, Fangfeng, Dihu together. Formerly, Huang She Ren's second son, aged 13, had smallpox for two days, fell upstairs injuring forehead, bleeding profusely. Parents wept, believing survival impossible. I treated him, doubling Renshen, Huangqi, Dang Gui, Dihu in the formula. After four doses, smallpox rose vigorously. Body restless, added Fushen (Poria with Hostwood) and Guixin (Cinnamon Heart). Externally applied Zonghui alone. Within half a month, scabs fell off perfectly. For severe pain, add little Rushiang. For heavy external trauma/wide scars failing to crust, apply Baiji (Bletilla), Bailian (Lilium Bulb), Xiangpi (Elephant Skin) powder; natural recovery ensues.