〔薛〕漏疮之证，因禀气血不足，或久病血气虚弱，或儿肝脾食积内热，不能生
肌，或乳母七情不和，脾气不能收敛。当审其所因，调补元气，佐以如圣饼、葱熨、
之类为善。若用流气、破血、追蚀、等药，反为败证矣，余当参各门主之。
钱氏曰∶夫胎在腹中，月至六七，则已成形，食母腹中秽液入儿五脏，食至十
月，即秽液满胃，至生时，儿口中犹有不洁，产母以手拭净，则无疾病，俗以黄连、
汞粉，下其脐粪之秽，此亦母之不洁余气入儿脏中，本先因微寒，又遇风寒，邪气
相搏，而成痘疹也。未出欲作之时，热动五脏，则五脏之证先见，初欲病时，先呵欠
顿闷惊悸，乍凉乍热，手足冷，面腮颊赤燥，咳嗽喷嚏，此五脏证俱见也。呵欠顿
闷者肝也。时发惊悸者心也。乍凉乍热、手足冷者脾也。面赤、腮颊赤、咳嗽喷嚏
者肺也。惟肾无候，以在府下不能食秽故也。凡疮疹乃五脏毒，若出归一证，
肝水 ，肺脓庖，心为 ，脾为疹，肾虽无证，其候恶者，疮变倒靥而黑陷，则归
肾也，此由不慎风冷而不能食，内虚所致也。东垣曰∶ 疹始出之证，必先见面
燥腮亦，目胞亦赤，呵欠顿闷，乍热乍凉，咳嗽喷嚏，足稍冷，多睡，睡惊，并疮
疹之证。或生脓泡大 ，或生小红 ，或生瘾疹，此三等不同，何故俱显上证而后
乃出。盖以上诸证，太阳寒水起于右肾之下，煎熬左肾，足太阳膀胱寒水夹脊逆流，
上头下额，逆手太阳丙火不得传道，逆于面上，故显是证，盖壬癸寒水克丙丁热火
故也。诸 证皆从寒水逆流而出也。医者当知此理，乃敢用药。夫胞者，一名赤宫，
一名丹田，一名命门，男子藏精施化，妇人击胞有孕，俱为生化之源，非五行也，
非水，亦非火，此天地之异名也，象坤土之生万物也。夫人之始生也，血海始净一
日二日，精胜其血，则为男子，三日四日五日血脉已旺，精不胜血，则为女子，乃
二物相搏，长先身生谓之神，又谓之精。其子在母腹，十月之间，随母呼吸，呼
吸者阳气也，而生动作，滋益精气神，饥渴皆随母血，儿随日长，筋骨皮肉，血脉
形气俱足，十月降生，口中尚有恶血，啼声一发，随吸而下，此恶血复归命门胞中，
僻于一隅，隐伏而不发，直至儿因内伤乳食、湿热之气下陷，合于肾中，二火交攻，
荣气不从，逆于肉理，恶血乃发。诸 疹皆出于肾水，其疡后聚肉理，归于阳明，
故三番 始显之证，皆足太阳壬膀胱克丙小肠，其始出皆见于面，终归于阳明肉理，
热化为脓者也，二火炽盛，反胜寒水，遍身俱出，此皆从足太阳传变中来也。万
氏曰∶痘疹之原，有论秽毒者，有论淫火者，有论时行正病者，靡有定论，将谓秽
毒淫火耶，则一岁之中，大而郡县，小而村落，病者相似，而死相继，未必人人若
此之甚也。将谓时行正病邪，何以自少至老，但作一度，厥后再无传染也。盖父母
于子，一体而分，精血之毒，已蓄于阳施阴化之始，固不待诞生之顷，咽其血而后
有胎毒也。况男子惜其气以养其精，女子耗其气以养其血，一失所养，即贻他日之
患，子之受于父母者虽殊，其为毒则一也，岂有男子淫火起于气，为阳毒而易治，
女子淫火起于血，为阴毒而难治之理邪。至于天行正病，亦有其时，但观夫年之所
加，及有四时不正之气，即知有是正病也，然则待时而发者，胎毒也，或速而危，或
徐而持，或暴而死者，气之微甚所使也，发则其毒泄矣，所以终身但作一度，后有
其气，不复传染焉。痘为胎毒，昭昭矣，其间或疏而轻，或蜜而重，或重变轻，
或轻变重，变化叵测，是又有说也。疏而轻者，始终如一，蜜而重者，变怪百出，
或因父母相传而然，或因疫疠相染而然，或因鬼疰相着而然，杳冥恍惚，出于闻见，
思虑之所不及，此与智者道之，痴人前不必说梦也，何者？盖痘疹之毒，父母原自
有之，虽尝作过一番，而脏腑、经络、皮毛、肌肉、骨髓、之间，余毒犹有存
者，一旦分形化气，注之于子，其毒亦随之泄矣，所以子之疮瘢，多肖亲也，加之调摄
失宜，放恣无忌，其毒益甚，疮痘之候沉困危笃者，未必非父母之所致也，凡子之
侏儒跛 ，必肖于亲，况疹痘之毒乎。且人受天地之气以生，天地之气变，人之气
亦变，或遇迁正失守，淫胜郁复之纪，德令乖常，眚 迭见，自然厉气传染，
证候相似，所以轻则俱轻，重则俱重，若有主之者，是则疫疠之所为也。故人之疠
疾而死者，向导不散，游魂往来，随气而行，常以其气，疰于平人而为之疾，如瘵
癞之传染，然形质庞浓，福泽悠远者不能相及，苟体虚福薄之人，阴阳舛乱之岁，
则膏肓之坚，台骀之祟，互相染着，反复变化，术不能禁，工不能治也，此非鬼疰
之害乎。夫治此三者当奈何？曰必为之豫解其毒，平其气，迁其处，庶乎可免矣。
按∶痘疹之发，显是天行时气，厘市村落，互相传染，轻则俱轻，重则俱重，
虽有异于众者，十之一二而已，岂可概谓胎毒哉。然疫疠终身不染者，比比皆是，
而痘疹无一人得免，疫疠一染之后，不能保其不再染，而痘疮一发不再发，则胎
毒之说，又何可尽废乎。至谓淫火秽血，古亦有之，而何独无痘疹之患，欲以破
胎毒之说，则又不然。天下之无而忽有者多矣，草有名虞美人者，虞美人项王宠
姬也，为项王死，世哀之，为之歌，对草倚声凄恸，而草辄摇，草无情识也，方
其未有楚，则宠姬亦无，况有草耶？一切众生，自妄颠倒，而成三界，如之，又
何疑乎痘疹。
【薛己】漏疮这一病症，是由于先天禀赋气血不足，或者久病导致血气虚弱，或者是小儿肝脾有食积内热，不能生肌长肉，或者是乳母七情不和，脾气不能收敛。应当审查其病因，调补元气，配合使用如圣饼、葱熨等方法为好。如果使用流气、破血、追蚀等药物，反而会导致病情败坏，其余内容可参考各章节的主治原则。
钱乙说：胎儿在腹中，到了第六七个月，就已经成形，食用母亲腹中的秽液进入胎儿五脏，吃到第十个月，秽液就充满了胃，到出生时，婴儿口中还有不洁之物，产母用手擦拭干净，就不会有疾病；世俗用黄连、汞粉来下胎粪的秽物，这也是母体的不洁余气进入胎儿脏腑中，本来先因微寒，又遇到风寒，邪气相互搏结，从而形成痘疹。在未出疹欲发之时，热动五脏，则五脏的症状先显现，刚要发病时，先出现呵欠、顿闷、惊悸，忽冷忽热，手足冷，面颊腮部红赤干燥，咳嗽喷嚏，这是五脏症状都显现了。呵欠顿闷的是肝经病变。时常发生惊悸的是心经病变。忽冷忽热、手足冷的是脾经病变。面赤、腮颊赤、咳嗽喷嚏的是肺经病变。只有肾没有候症，因为肾位于下部，不能食用秽液的原因。凡是疮疹都是五脏的毒，如果出疹归于一证，肝为水疱，肺为脓疱，心为斑，脾为疹，肾虽然没有证候，但其预后不良者，疮变倒靥而黑陷，则是归于肾，这是由于不慎风冷而不能进食，内虚所致。李东垣说：疹子刚开始出现的症状，必定先见面部燥涩腮红，眼睑也红，呵欠顿闷，忽热忽凉，咳嗽喷嚏，脚稍冷，多睡，睡中惊醒，这些都是疮疹的症状。或者生脓泡大疱，或生小红点，或生瘾疹，这三种情况不同，为什么都要先显现上述症状然后才出疹？大概是因为以上诸证，太阳寒水起于右肾之下，煎熬左肾，足太阳膀胱寒水夹脊逆流，上头下额，逆手太阳丙火不得传导，逆于面上，所以显现这些症状，这是因为壬癸寒水克丙丁热火的关系。诸疮疹证皆从寒水逆流而出。医者应当知晓此理，才敢用药。胞宫，一名赤宫，一名丹田，一名命门，男子藏精施化，妇人击胞受孕，都是生化之源，不属于五行，既不是水，也不是火，这是天地的异名，象征坤土生万物。人开始生成时，血海刚净一日二日，精胜血，则为男子，三日四日五日血脉已旺，精不胜血，则为女子，这是两物相搏，先生于身前的称为神，又叫做精。胎儿在母腹中，十月之间，随母亲呼吸，呼吸者是阳气，而生动作，滋益精气神，饥渴都随母血，儿随日长，筋骨皮肉，血脉形气俱足，十月降生，口中尚有恶血，啼声一发，随吸而下，这恶血复归命门胞中，僻居一隅，隐伏而不发，直到小儿因内伤乳食、湿热之气下陷，合于肾中，二火交攻，荣气不从，逆于肉理，恶血乃发。诸疮疹皆出于肾水，其疡后聚肉理，归于阳明，所以三番始显之证，皆是足太阳壬膀胱克丙小肠，其始出皆见于面，终归于阳明肉理，热化为脓者也，二火炽盛，反胜寒水，遍身俱出，这都是从足太阳传变中来。万全说：痘疹的起源，有论说是秽毒的，有论说是淫火的，有论说是时行正病的，没有定论，如果说秽毒淫火，那么一年之中，大的郡县，小的村落，患病者相似，而死者的相继不断，未必人人如此严重。如果说时行正病，为什么自少至老，只做一度，此后再无传染？大概父母与子女，一体而分，精血之毒，已蓄于阳施阴化之初，并不待诞生之顷，咽其血而后有胎毒。况且男子惜其气以养其精，女子耗其气以养其血，一旦失养，即贻害日后之患，子女所受于父母的虽然不同，但其为毒则是一样的，难道有男子淫火起于气，为阳毒而易治，女子淫火起于血，为阴毒而难治的道理吗？至于天行正病，也有其时，只要观察年份所加，以及有四时不正之气，就知道有是正病。然而待时而发的是胎毒，有的速而危，有的徐而持，有的暴而死者，是气的微甚所使然，发作则其毒泄矣，所以终身只做一度，后有此气，不再传染。痘为胎毒，昭然若揭，其间有的疏而轻，有的密而重，有的重变轻，有的轻变重，变化莫测，这又有说法。疏而轻者，始终如一，密而重者，变怪百出，或因父母相传而然，或因疫疠相染而然，或因鬼疰相着而然，杳冥恍惚，出于闻见，思虑之所不及，此与智者道之，痴人前不必说梦。为什么呢？盖痘疹之毒，父母原本就有，虽然曾经发作一番，而脏腑、经络、皮毛、肌肉、骨髓之间，余毒犹有存者，一旦分形化气，注之于子，其毒亦随之泄矣，所以子女的疮瘢，多像父母，加之调摄失宜，放恣无忌，其毒益甚，疮痘之候沉困危笃者，未必不是父母所致。凡子女的侏儒跛足，必像父母，何况疹痘之毒呢？况且人受天地之气以生，天地之气变，人之气亦变，或遇迁正失守，淫胜郁复之纪，德令乖常，灾眚迭见，自然厉气传染，证候相似，所以轻则俱轻，重则俱重，若有主之者，是则疫疠之所为也。故人之疠疾而死者，向导不散，游魂往来，随气而行，常以其气，疰于平人而为之疾，如瘵癞之传染，然形质庞浓，福泽悠远者不能相及，苟体虚福薄之人，阴阳舛乱之岁，则膏肓之坚，台骀之祟，互相染着，反复变化，术不能禁，工不能治也，这不是鬼疰之害吗？治疗这三者应当如何？曰：必须预先解其毒，平其气，迁其处，庶几可免矣。按：痘疹之发，显是天行时气，城乡村落，互相传染，轻则俱轻，重则俱重，虽有异于众者，十之一二而已，岂可概谓胎毒哉。然而疫疠终身不染者，比比皆是，而痘疹无一人得免，疫疠一染之后，不能保其不再染，而痘疮一发不再发，则胎毒之说，又何可尽废乎。至于谓淫火秽血，古亦有之，而何独无痘疹之患，欲以破胎毒之说，则又不然。天下之无而忽有者多矣，草有名虞美人者，虞美人项王宠姬也，为项王死，世哀之，为之歌，对草倚声凄恸，而草辄摇，草无情识也，方其未有楚，则宠姬亦无，况有草耶？一切众生，自妄颠倒，而成三界，如之，又何疑乎痘疹。
[Xue Ji] The syndrome of fistula and sores (Lou Chuang) arises from congenital deficiency of Qi and Blood, or chronic illness leading to weakness of Qi and Blood, or internal heat due to food stagnation in the Liver and Spleen of the child, preventing the generation of muscle tissue, or emotional disharmony in the nursing mother causing the Spleen Qi to fail in its astringent function. One should investigate the etiology, tonify and regulate Yuan Qi, and assist with treatments such as Rusheng Biscuit (Rusheng Bing) and scallion moxibustion (Cong Yun). If one uses drugs that circulate Qi, break Blood, or cauterize/erode tissues, it will instead lead to a deteriorating condition; for other details, refer to the main principles in respective chapters.
Qian Yi stated: When the fetus is in the womb, by the sixth or seventh month, it has already taken form, consuming the turbid fluids of the mother which enter the five Zang organs. By the tenth month, these turbid fluids fill the stomach. At birth, there remains unclean matter in the infant's mouth. If the mother wipes it clean with her hand, no disease occurs. However, folk custom uses Coptis Rhizome (Huanglian) and Mercury Powder (Gfen) to purge the turbid meconium from the umbilicus. This introduces residual impure Qi from the mother into the infant's Zang organs. Originally caused by slight cold, combined with exposure to wind-cold, pathogenic factors clash, resulting in smallpox and chickenpox (Douzhen). Before the eruption begins, heat stirs the five Zang organs, so their symptoms appear first. Initially, when the disease is about to manifest, there are yawning, drowsiness, palpitations, alternating chills and fever, cold extremities, red and dry cheeks, coughing, and sneezing. These indicate that symptoms of all five Zang organs are present. Yawning and drowsiness relate to the Liver. Frequent palpitations relate to the Heart. Alternating chills and fever with cold extremities relate to the Spleen. Red face and cheeks with coughing and sneezing relate to the Lung. Only the Kidney shows no specific signs because it is located inferiorly and does not consume turbid fluids. All sores and rashes are toxins of the five Zang organs. If eruptions converge into one syndrome: Liver manifests as vesicles (Shui Pao), Lungs as pustules (Nong Pao), Heart as macules (Ban), Spleen as papules/rash (Zhen). Although the Kidney has no specific sign, if the prognosis is poor, with sores turning inward and becoming black and depressed, this indicates regression to the Kidney. This is caused by carelessness regarding wind-cold and inability to eat, leading to internal deficiency. Li Dongyuan said: The initial signs of rash eruption must include dry facial skin, red cheeks, red eyelids, yawning, drowsiness, alternating hot and cold, coughing, sneezing, slightly cold feet, excessive sleep, and waking startled. These are all signs of Douzhen. Whether large pustules, small red spots, or urticaria-like rashes appear, why do these upper symptoms precede the eruption? It is because Taiyang Cold Water originates below the right Kidney, simmering the left Kidney. Foot-Taiyang Bladder Cold Water flows counter-current along the spine, ascending to the head and forehead, reversing Hand-Taiyang Fire (Bing Fire) and preventing its transmission, rising to the face, thus displaying these symptoms. This is due to Ren-Gui Cold Water overcoming Bing-Ding Fire. All Douzhen syndromes emerge from counter-flowing Cold Water. Physicians must understand this principle before prescribing. The Bao Gong (Womb/Uterus), also called Chi Gong, Dan Tian, or Ming Men, stores essence and facilitates transformation in men, and receives conception in women. It is the source of life generation, not belonging to the Five Elements, neither Water nor Fire, but an alternative name for Heaven and Earth, symbolizing Kun Earth generating all things. At the beginning of human formation, after the Sea of Blood clears for one or two days, Essence overcomes Blood, resulting in a male. On the third, fourth, or fifth day, Blood vessels become vigorous, Essence fails to overcome Blood, resulting in a female. This is the interaction of two substances; what is born prior to the body is called Shen (Spirit) or Jing (Essence). During the ten months in the womb, the fetus breathes with the mother. Breathing is Yang Qi, promoting movement and nourishing Jing, Qi, and Shen. Hunger and thirst follow maternal blood. As the child grows daily, sinews, bones, flesh, blood vessels, form, and Qi become complete. Upon birth at ten months, foul blood remains in the mouth. With the first cry, inhalation draws it down; this foul blood returns to the Ming Men and Bao Gong, hiding in a corner, latent and inactive. Until the child suffers internal injury from milk/food or damp-heat sinking, combining with the Kidney, where two fires attack each other, Ying Qi fails to follow its course, reverses in the muscle layers, and the foul blood erupts. All rashes originate from Kidney Water. After ulceration, tissue regeneration returns to the Yangming channel. Thus, the initial signs involve Foot-Taiyang Ren Bladder overcoming Hand-Taiyang Bing Small Intestine. Eruptions initially appear on the face but ultimately return to Yangming muscle layers, where heat transforms into pus. When the two fires are blazing, they overcome Cold Water, causing eruptions over the whole body. This all stems from transmission via Foot-Taiyang. Wan Quan said: Regarding the origin of smallpox and chickenpox, some argue it is turbid toxin, others say excessive fire, others claim it is seasonal epidemic disease. There is no fixed theory. If it were turbid toxin or excessive fire, then within a year, whether in large counties or small villages, patients would be similar, and deaths would succeed one another, yet not everyone suffers so severely. If it were seasonal epidemic disease, why does it occur only once in a lifetime from youth to old age, with no subsequent contagion? Parents and children share one body divided; the toxicity of essence and blood accumulates from the beginning of Yang giving and Yin transforming. It does not wait until birth to swallow blood to create fetal toxin. Moreover, men conserve Qi to nourish Essence, while women expend Qi to nourish Blood. Once nourishment is lost, future ailments arise. Though what children inherit from parents differs, the nature of the toxin is the same. Is there really a principle that male excessive fire arising from Qi is Yang toxin and easy to treat, while female excessive fire arising from Blood is Yin toxin and difficult to treat? As for seasonal epidemic disease, it has its timing. Observing the annual influences and irregular Qi of the four seasons reveals such diseases. However, those that erupt according to time are fetal toxins. Some are rapid and critical, some slow and lingering, some sudden and fatal, depending on the strength of Qi. Once erupted, the toxin is released; hence, it occurs only once in a lifetime. Even if the pathogen exists later, there is no further contagion. That smallpox is a fetal toxin is evident. Among them, some are sparse and mild, some dense and severe, some severe turning mild, some mild turning severe. Changes are unpredictable. There is another explanation. Sparse and mild cases remain consistent throughout. Dense and severe cases exhibit myriad variations. This may be due to transmission from parents, infection by epidemics, or attachment by ghostly pathogens (Gu Zhu). These phenomena are obscure, beyond ordinary perception and thought. Discuss this with the wise; do not speak dreams to fools. Why? Because the toxin of Douzhen originally resides in the parents. Even after having suffered it once, residual toxins remain in the Zang organs, meridians, skin, muscles, and bone marrow. Upon separation of form and transformation of Qi, injecting into the child, the toxin is also excreted. Therefore, the scars of children often resemble those of their parents. Coupled with improper care and unrestrained behavior, the toxin becomes more severe. Cases of Douzhen being deep,困 (trapped), critical, and desperate are not necessarily unrelated to parental causes. Just as children who are dwarfs or lame resemble their parents, how much more so the toxin of rashes and smallpox? Humans are born receiving the Qi of Heaven and Earth. When Heaven and Earth Qi change, Human Qi also changes. Encountering shifts in ruling Qi or loss of control, excessive victory and depression-rebound cycles, where virtues and commands deviate from norms, disasters repeatedly appear. Naturally, fierce Qi spreads contagiously, and syndromes are similar. Thus, mild cases are all mild, severe cases are all severe. If there is a controller, it is the work of epidemics. Therefore, those who die from leprosy/malignant diseases, their guides do not scatter, wandering souls come and go, following Qi, often transmitting this Qi to healthy people causing disease, similar to tuberculosis or leprosy contagion. However, those with robust constitutions and long blessings cannot be affected. In years of chaotic Yin and Yang, for those with weak bodies and thin fortunes, the solidity of the Gaohuang acupoints and the influence of Taitai spirits mutually infect, changing repeatedly. Techniques cannot restrain them, physicians cannot cure them. Is this not the harm of Gu Zhu? How should one treat these three types? Answer: One must preemptively resolve the toxin, calm the Qi, and move the location, so that avoidance might be possible. Commentary: The eruption of Douzhen clearly appears as seasonal epidemic Qi, spreading contagiously between cities and villages. Mild cases are all mild, severe cases are all severe. Except for one or two out of ten differing from the masses, how can one generally call it fetal toxin? Yet, those never infected by epidemics in their lifetime are common, whereas no one escapes Douzhen. After one infection with an epidemic, one cannot guarantee no re-infection, but after one outbreak of smallpox, there is no recurrence. Thus, can the theory of fetal toxin be entirely discarded? As for excessive fire and turbid blood, these existed in ancient times too, yet why was there no Douzhen affliction? To break the theory of fetal toxin is incorrect. There are many instances in the world of something non-existent suddenly appearing. Consider the flower named "Yu Meiren" (Beauty Yu). Yu Meiren was the favored concubine of King Xiang Yu. She died for him, and the world mourned her, composing songs. Leaning against the grass, singing sadly, the grass sways. Grass has no consciousness. When Chu did not exist, the concubine did not exist, let alone the grass? All sentient beings, through delusion and inversion, form the Three Realms. How could there be doubt about Douzhen?