丹溪云∶疮干者宜退火,湿者宜泻湿。退火止用轻剂,荆芥、升麻、葛根、
连翘之类。泻湿,乃肌表间湿,宜用风药防风、白芷之类。痘初起时,自汗不
妨,盖湿热熏蒸而起故也。
夫物湿则润泽,燥则干枯,荣枯之分,血实主之,故血者,所以营阴阳,濡皮
毛,流关节也。疮本疏者,血不在多,而易充足,疮本稠密,贵乎血之有余矣,苟
血有余,则经脉流行,沦于肌肤,浃于皮毛,灌溉滋润,肥泽长养,自然形色鲜明,
根窠红活也。如血不足,则经脉壅遏,窠囊空虚,黑燥而不鲜明也,枯萎而不肥泽
也,皮肤皴揭而启裂也。经曰∶诸涩枯涸,干劲皴揭,皆属于燥。又曰∶燥胜则干。
由其人血常不足,加之以毒火熏灼,反兼燥金之化,精血并竭,是以有此证也。法
宜活血养液,散热解毒,清金润燥,则干涸可回,观夫疮之荣枯,而得养血之理。
其或湿气太过,疮本浸淫,犯之则破,溃烂难靥者,此又火极而兼水化也,脾强则
生,脾弱则死。
病有标本,治有先后,有从标者,有从本者,有先标后本者,有先本后标者,
有标本兼治者,视其急缓,不可胶柱而鼓瑟也。痘疮之候,自人身而言,气血为本,
疮疹为标,自疮疹而言,疮疹为本,别证为标,如疮子稠密,在标之病也,视其气
之不匀,血之不周,以匀气活血,兼行解毒,此则标本兼治也。疮若起发,气或虚
者补其气,血或虚者补其血,此缓则治其本也。气血充实,疮或壅遏者,单行托里
解毒之剂,此急则治其标也。疮势太甚,咽喉肿痛者,以治咽喉为主,此急则治其
标也。疮势太甚,自利不止者以自利为主,此急则治其标也。利久不止,渐成坏证,
救里发表,兼而行之,此亦标本兼治也。先救其里,后攻其表,此则先标后本也。
大小便秘,烦躁喘呼者急利之,此急则治其标也。疮势太甚,烦渴不止,以解毒为
主,兼治其渴,此先本而后标也。凡此之类,扩而充之,以尽其余,则治不紊矣。
朱丹溪说:痘疮干燥的应当用轻剂退火,潮湿的应当泻除湿邪。退火只需使用药性轻清的方剂,如荆芥、升麻、葛根、连翘之类。泻湿,是指肌表之间的湿气,适宜使用祛风药如防风、白芷之类。痘疮初起时,自汗并不妨碍治疗,这是因为湿热熏蒸所致。
事物湿润则润泽,干燥则干枯,荣(营养)与枯(枯萎)的区别,由血液是否充盈来决定,所以血的作用是营运阴阳,濡养皮毛,流通关节。痘疮原本稀疏的,血液不需要太多就能充足;痘疮原本稠密的,贵在血液有余。如果血液有余,那么经脉流行,渗透于肌肤,通达于皮毛,灌溉滋润,肥泽长养,自然形色鲜明,疮根红活。如果血液不足,那么经脉壅塞阻滞,疮囊空虚,黑燥而不鲜明,枯萎而不肥泽,皮肤皱缩揭裂。《内经》说:各种涩滞枯涸、干硬皱揭的症状,都归属于燥。又说:燥气胜则导致干燥。这是由于病人本身血液常不足,加上毒火熏灼,反而兼有燥金的化象,精血枯竭,因此出现这种证候。治法应当活血养液,散热解毒,清肺润燥,那么干涸之症可以恢复,观察痘疮的荣枯,就可以明白养血的道理。如果有湿气太过,痘疮本来浸淫,触碰则破溃,腐烂难以结痂的,这是火极而兼有水化的表现,脾气强则生,脾气弱则死。
疾病有标和本,治疗有先后顺序,有的从标论治,有的从本论治,有的先治标后治本,有的先治本后治标,有的标本兼治,要根据病情的急缓来决定,不可拘泥固执。就痘疮的证候而言,从人体整体来说,气血是本,疮疹是标;从疮疹本身来说,疮疹是本,其他兼证是标。例如痘疮子粒稠密,属于标部的病,要观察其气是否均匀,血是否周流,以调匀气机、活血为主,兼行解毒,这就是标本兼治。痘疮若已起发,气虚的补其气,血虚的补其血,这是缓则治其本。气血充实,但痘疮仍有壅遏不通的,单用托里解毒的药剂,这是急则治其标。痘疮势态太盛,咽喉肿痛的,以治疗咽喉为主,这是急则治其标。痘疮势态太盛,腹泻不止的,以止泻为主,这是急则治其标。腹泻久了不止,逐渐形成坏证,救里解表同时进行,这也是标本兼治。先救里,后攻表,这是先标后本。大小便秘结,烦躁喘呼的,紧急通利二便,这是急则治其标。痘疮势态太盛,烦渴不止的,以解毒为主,兼治口渴,这是先本而后标。凡此种种,推而广之,穷尽其理,那么治疗就不会混乱了。
Zhu Danxi stated: For dry sores, fire should be reduced; for damp sores, dampness should be drained. Reducing fire requires only mild agents, such as Jingjie (Schizonepetae Herba), Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), and Lianqiao (Forsythiae Fructus). Draining dampness refers to dampness in the muscle and skin layer, which is suitable for treatment with wind-dispelling herbs such as Fangfeng (Saposhnikoviae Radix) and Baizhi (Angelicae Dahuricae Radix). At the initial stage of smallpox, spontaneous sweating is not a hindrance, as it arises from the steaming of damp-heat.
Things that are moist are nourishing, while those that are dry become withered. The distinction between "Rong" (Nourishment) and "Ku" (Withering) is governed by blood sufficiency. Therefore, blood serves to circulate Yin and Yang, moisten the skin and hair, and flow through the joints. If sores are originally sparse, blood does not need to be abundant to be sufficient; if sores are originally dense, it is crucial that blood is in excess. If blood is in excess, meridians flow smoothly, permeating the muscles and skin, reaching the hair follicles, irrigating and moisturizing, promoting growth and luster, resulting naturally in bright coloration and vibrant sore bases. Conversely, if blood is insufficient, meridians become obstructed, sore pockets are empty, appearing black and dry without brightness, withered without luster, and the skin becomes wrinkled, peeling, and cracked. The Classic states: "All cases of astringency, withering, drying, stiffness, and peeling belong to Dryness." It also states: "Excess of Dryness leads to dryness." This occurs because the patient's blood is chronically deficient, compounded by toxic fire scorching, which induces the transformation of Metal-Dryness, exhausting essence and blood, thus presenting this syndrome. The method should involve invigorating blood and nourishing fluids, dissipating heat and detoxifying, clearing the Lung and moistening dryness, so that dryness can be reversed. Observing the nourishment or withering of sores reveals the principle of nourishing blood. If dampness is excessive, and sores are originally oozing, breaking upon contact, and rotting with difficulty in healing, this indicates extreme Fire combined with Water transformation; strong Spleen Qi leads to survival, while weak Spleen Qi leads to death.
Diseases have a Biao (Branch/Symptom) and Ben (Root/Etiology), and treatments have a sequence. Some treat the Branch, some treat the Root, some treat the Branch first then the Root, some treat the Root first then the Branch, and some treat both simultaneously. One must judge based on urgency and cannot play the zither with fixed bridges (i.e., act rigidly). Regarding smallpox manifestations: from the perspective of the human body, Qi and Blood are the Root, and sores/rashes are the Branch; from the perspective of the sores themselves, the sores are the Root, and other accompanying symptoms are the Branch. For example, dense smallpox lesions constitute a Branch disease; one must observe whether Qi is uneven and Blood is unbalanced, regulating Qi and invigorating Blood while simultaneously detoxifying—this is treating both Root and Branch. If sores have erupted but Qi is deficient, tonify Qi; if Blood is deficient, tonify Blood—this is treating the Root when the condition is slow/mild. If Qi and Blood are sufficient but sores remain obstructed, use solely formulas for supporting interior Qi and detoxifying—this is treating the Branch when the condition is urgent/severe. If the smallpox progression is too severe with swollen and painful throat, treat the throat primarily—this is treating the Branch urgently. If the smallpox progression is too severe with persistent diarrhea, treat the diarrhea primarily—this is treating the Branch urgently. If diarrhea persists for a long time, gradually forming a deteriorated syndrome, rescue the Interior and release the Exterior simultaneously—this is also treating both Root and Branch. Rescue the Interior first, then attack the Exterior—this is treating the Branch first and the Root later. Constipation of both large and small bowels, accompanied by restlessness and wheezing, requires urgent purgation—this is treating the Branch urgently. If smallpox progression is too severe with persistent irritability and thirst, prioritize detoxification while addressing thirst—this is treating the Root first and the Branch later. Expanding upon these principles exhaustively ensures orderly treatment.