壅之证，效大而功用极妙。若骤用寒凉如芩、连、升麻之类，则热为寒气所抑，
不得伸越，逗遛经络，为疽为疖者有之，水伏硬闭者有之，至于人参、黄 、白
术、茯苓温补之剂，误用则其壅盛，祸不旋踵，他如丁、桂、木香、姜、附、
之类，以热攻热，杀人立至，尤宜戒慎。故发热之初，至见点之后，并宜以本方
处治，根据后法而加减之。
羌活散郁汤加减法
初发身热壮盛，腮红面赤，毛焦皮燥，咳嗽喘急者，加升麻。烦渴，加天花粉、
干葛。腹胀，喘急鼻塞，面赤若怒，毛直及枯，加麻黄。便秘，加当归、枳壳，
甚则加大黄。呕吐，加猪苓、泽泻、橘皮，禁用生姜、丁香、木香、半夏。洞泄，
加升麻，禁用白术、茯苓、豆蔻、龙骨等剂。喘嗽恶风，加桑皮、紫苏。失血，
加犀角、地黄、黄连。发 ，加黄连、黄芩、山栀。小便赤涩，加滑石、山栀、
地黄、芍药。鼻衄，加黄芩、犀角。惊悸，加木通、山栀。搐，加青皮。不思饮
食，加山楂。伤食，加山楂、神曲麦芽。见点二三日间出不快利，加鼠粘子、山
楂、蝉蜕，名透肌散。烦红赤色，加生地黄、红花、牡丹皮，去白芷、防风。皮
急肉紧，身热壮甚，加葛根、前胡。
见点三日之内，并根据本方加减，及三日之后，痘疮出齐，血 已成，而前证悉
平，不得复用此方，恐发散太过，难于行浆，另有方药在后。其禁用药剂，并从
血热痘证法而裁治之，故此方不立禁忌辨。
太乙保和汤 （又名紫草透肌汤）
专治血热痘证服十神解毒汤后，热证悉去，内外和平，见点三日之后，不易长
大，粗肌者用之，则能保和元气，活血解毒，助痘成浆，易痂易落也。
桔梗 紫草 川芎 山楂 木通 人参 红花 生地黄 甘草 糯米（五十粒）
上，用灯心七根，姜一片，水一钟，煎六分，温服。
便涩腹胀，加大腹皮。繁红不润，加当归、蝉蜕。出不快，加鼠粘子。陷
塌，加黄 。痛，加白芷。不匀，加防风。水泡，加白术、芍药。嗽，
加五味子、麦门冬。渴，加麦门冬。痒，加白术、芍药。
七八日后浆足，身复壮热，便秘烦渴，腹胀喘急，前胡枳壳汤。浆足，禁用此
方，另立汤饮在后。
益元透肌散 专治壅热痘证，服羌活散郁汤后，壅证悉开，气血和平，见点三四日
后不肥大者、不成浆者、用之，则能匀气解毒，透肌达表，领出元阳，助痘成浆，
而易结脓窠也。加减与保和汤同论，浆足之后，另有保婴百补汤在后。
即太乙保和汤去生地、红花，加蝉蜕、鼠粘子、陈皮。
上，水一钟，加灯心十四根，枣二枚，煎六分，温服。
保婴百补汤 专治痘疮八九日浆足之后，别无他证，并以此方调理气血，资养脾胃，
不拘实、热二痘，皆可服之，惟气虚证八九日后，本方加黄 二钱、官桂少许，若有别证，在审虚
实随证加减而已。
当归 芍药 地黄 白术 人参 茯苓 山药 甘草
上，水一钟，枣二枚，煎六分，温服。
〔陈氏惟主温补〕〔陈〕痘疮未出已出之间，或泻渴，或腹胀，或气促，谓之里
虚，速与十一味木香散治之。如已出之间，其疮不光泽，不起发，根窠不红，谓
之表虚，速与十二味异功散治之。如已出之间，其疮不光泽，不起发，根窠不红，
或泻渴，或腹胀，或气促，是表里俱虚也，速与十二味异功散送下七味肉豆蔻丸治
之。（丹溪云∶木香、异功散二药，治寒的当，若虚而不寒者，祸不旋踵。）如疮始
出一日至十日，浑身壮热，大便黄，是表里俱实也，其疮必光泽，必起发，必饱满，必易靥，
而不致损伤，若无他疾，不宜服药。表里俱实者易出易靥，表里俱虚者易出难靥，表虚难出，
里虚难靥，随证治之。张巽之《治痘要法》吐泻少食为里虚，陷伏倒靥灰白为表
虚，二者俱见，为表里俱虚，全用异功散救之，甚至姜、附、灵砂亦可用。若止
里虚，减官桂，若止表虚，减肉豆蔻，不减官桂、丁香。若能食便秘而陷伏倒靥者，
为里实，当用钱氏及丹溪下法。若不吐泻，能食为里实，里实而补，则结痈毒。红
活绽凸，为表实，表实而用表药，则溃烂不结痂。凡痘，但见 点，便忌葛根汤，
恐发得表里俱虚也。
〔丹〕读前人之书，当知其立言之意，苟读其书而不知其意，求适于用，不可得
也。痘疮之论，钱氏为详，历举源流，经络分明，表里虚实，开陈施治之法，而又
证以论辨之言，深得着书垂教之体，学人读而用之，如求方圆于规矩，较平直于准
绳，引而伸之，触类而长之，可为无穷之应用也。今人不知致病之因，不求立方之
意，仓卒之际，据证检方，谩尔一试，设有不应，并其书而废之，不思之甚也。近
因《局方》之教久行，《素问》之学不讲，抱疾谈医者，类皆喜温而恶寒，喜补而恶
解利，忽得陈氏方论，皆用燥热补剂，其辞确，其文简，欢然用之，翕然信之，遂
以为钱氏不及陈氏远矣。或曰，子以陈氏方为不足欤？曰陈氏方诚一偏之论，虽然，
亦可谓善求病情者，其意大率归重于太阴一经，盖以手太阴属肺，主皮毛，足太阴
属脾，主肌肉，肺金恶寒而易于感，脾土恶湿而无物不受，观其用丁香、官桂，所
以治肺之寒也，用附、术、半夏，所以治脾之湿也，使脾与肺果有寒与湿而兼有虚
也，量而与之，中病则已，何伤之有。今也不然，但见出迟者、身热者、泄泻者、
惊悸者、气急者、渴思饮者，不问寒热虚实，率投木香散、异功散，间有偶中，随
手获效，设或误投，祸不旋踵。何者？古人用药制方，有向导，有监制，有反佐，
有因用，若钱氏方，固未尝废细辛、丁香、白术、参 ，率有监制辅佐之药，不专
务于温补耳，然其用寒凉者多，而于补助一法，略示端绪，未曾深及，痴人之前不
可说梦，钱氏之虑，至矣！亦将以候达者扩充推展用之耳。虽然，渴者用温药，痒
塌者用补药，自陈氏发之，迥出前辈，然其多用桂、附、丁香，辛芳燥热，恐未为
适中也。何者？桂附丁香辈当有寒而虚者，固是的当，虚而未必寒者，其为患当何
如耶！陈氏立方之时，必有挟寒而用一偏之方，宁不过于热乎。予尝会诸家之粹，
求其意而用之，实未敢据其成方。至正甲申，阳气早动，正月间，邑间痘疮不越一
家，率投陈氏方，童幼死者百余人，虽由天数，吾恐人事亦或未之尽也。
王汝言曰∶若痘疮虚怯，淡白色痒塌，此属虚寒，宜用陈文中方。若发热壮盛，
齐勇红紫色燥痒，此属热毒，急宜凉血解毒。自陈文中方盛行后，属虚寒者率得生，
属热毒者悉不救。痘是胎毒，古人治法只解毒，然气血虚，则送毒瓦斯不出，及不能
成就，故陈文中之法亦千载妙诀，补前人之未备者，但温补之法既行，而解毒之旨遂
隐，故救得一边，又害了一边。
凡治痘子，要识证候，如痘脚稀疏，根窠红润，不泻不渴，乳食不减，四肢温
和，身无大热，如此候者不须服药，惟善调护以待成就而已。若痒塌寒战，切牙渴
不止，痘紫黑色，喘渴不宁，灰白色顶陷，腹胀，头温足冷，闷乱，饮水，气促，泄泻渴，
如此候者，不必服药，虽强治之，亦无功也。
凡治痘疮，善攻不如善守，表里无邪，不须妄治。有等贪利之人，不分虚实，
妄投汤丸，谓曾治某病、治某病，贪天功以为己有，以致虚虚实实，致生变异，误
人性命，此医之罪也。
〔用药〕〔万〕凡痘子，用药须分气血虚实，毒瓦斯微甚而治，故灰白者、不起发
者、痒塌者、吐利者、寒战切牙者、手足冷者，皆气虚也，宜用补气之剂。疮干者、
不红活者、脓水少者，皆血虚也，宜用补血之剂。稠密者、 肿者、红紫者，皆毒
甚也，宜用解毒之剂。陷伏者兼气血解毒治之。凡用补气，宜四君子汤，如疮带
湿，或有自利，用之可也。若疮干者，白术燥津液，茯苓渗津液，或便秘实者，不
可用也。凡用补血，宜四物汤，如疮干，或色大娇，用之可也。若不能食者，生地
黄泥膈，白芍药收敛肠胃，不可用也。凡解毒，不过黄连、黄芩、黄柏、栀子、
连翘、牛蒡子、升麻之属，俱用酒制，恐寒凉反损脾胃也。若欲行表，须少加桂
枝，他如紫草、山豆根、葛根之类，则不必用酒制矣。凡用解毒药，要别脏腑，
分阴阳而治之，如黄连解心火，黄芩解肺火，栀子解肝火，黄柏解肾与三焦火，石
膏解脾胃火，木通解小肠火，黄芩又解大肠火，连翘、牛蒡子解疮毒火，山豆根、
紫草解痘毒火，升麻解疫毒火，各有主治不同也。又，岁半以上，属阳，心肺主事，
宜芩、连多用之，岁法以下，属阴，肾肝主事，宜黄柏、栀子多用之。
秘传八味二花散
桃花蕊（五钱） 梅花蕊（二味不拘多少，阴干，共一两六钱二分） 穿山甲（取四足者，
酒炒，一两） 朱砂（水飞过，一两） 紫河车（水洗去红筋，焙干，为末，一具） 天灵
盖（一具，以皂角煎汤洗净，酥制，为末，四方共一钱七分） 鹿茸（去毛，酥制，三方共一两二钱）
人参（官拣者，一两）
上，各为末。痘疹未出之先，以朱砂一两为君，梅花二钱、桃花三钱，共一处
和匀，每服五分或三分或二分半，用雄鸡与酒二杯灌之与食，倒悬刺血入杯中，
以热酒调前药，同服。初发不起，以梅花一两为君，加桃花一钱，天灵盖五分。
气血虚，灰白色，用紫河车一两为君，加天灵盖一钱，鹿茸一钱五分，梅花一钱，
桃花一钱或八分。黑陷不起，以穿山甲一两为君，加桃花一钱，梅花八分，天
灵盖七分，麝香五分。气血虚不能灌浆，以鹿茸一两为君，加紫河车二钱，桃
花一钱，梅花八分，天灵盖七分，麝香五分，人参一钱。气血虚不能收靥，以
鹿茸一两为君，天灵盖五分，桃花七分，梅花九分。落靥之后，瘢色白，气血
虚，以人参一两为君，加紫河车二钱，鹿茸一钱，梅花一钱五分。以上咸仿首
条服法。
保生散
紫河车（制如前） 龟板（酥炙，一分） 鹿茸（酥炙，各一两）
上为末。量儿大小用。血虚川归、茯苓、紫草汤下，气虚人参、黄 、甘草汤下。
痘疮出现壅滞的证候，虽然症状表现严重，但治疗得当则功效极为奇妙。如果突然使用黄芩、黄连、升麻等寒凉药物，那么热邪会被寒气遏制，无法向外透发，滞留于经络之中，导致发生疽或疖的情况；或者导致水湿内停、小便硬闭的情况。至于人参、黄芪、白术、茯苓等温补方剂，如果误用，会使壅盛之邪更甚，灾祸立刻降临。其他如丁香、肉桂、木香、干姜、附子等温热药物，以热攻热，会立即致人死亡，尤其应当戒慎小心。因此，从发热初期到见点之后，都适宜使用本方（指前文提到的羌活散郁汤）进行治疗，并根据后文所述的方法进行加减。
羌活散郁汤加减法：
初起时身体壮热，腮部发红，面色赤红，毛发焦枯，皮肤干燥，咳嗽气喘急促的，加升麻。烦躁口渴的，加天花粉、葛根。腹部胀满，气喘急促，鼻塞，面色赤红如同发怒，毛发直立且枯槁的，加麻黄。便秘的，加当归、枳壳，严重的加大黄。呕吐的，加猪苓、泽泻、陈皮，禁用生姜、丁香、木香、半夏。腹泻的，加升麻，禁用白术、茯苓、豆蔻、龙骨等药物。气喘咳嗽怕风的，加桑白皮、紫苏。出血的，加水牛角、生地黄、黄连。发出斑疹的，加黄连、黄芩、山栀。小便赤涩的，加滑石、山栀、生地黄、芍药。鼻出血的，加黄芩、水牛角。惊悸的，加木通、山栀。抽搐的，加青皮。不想饮食的，加山楂。伤食的，加山楂、神曲、麦芽。见点后两三天间出痘不顺畅的，加牛蒡子、山楂、蝉蜕，名为透肌散。面部烦扰红赤色的，加生地黄、红花、牡丹皮，去掉白芷、防风。皮肤紧绷肌肉拘急，身体壮热的，加葛根、前胡。
见点后三日之内，都根据本方进行加减；到了三日之后，痘疮出齐，血络已成，而前面的证候全部平息，不得再复用此方，恐怕发散太过，难以行浆结痂，另有方药在后面。其禁用的药剂，都按照血热痘证的法则来裁断治疗，所以这个方子不单独列出禁忌辨析。
太乙保和汤（又名紫草透肌汤）
专门治疗血热痘证，服用十神解毒汤后，热证全部去除，内外平和，见点三日之后，痘疮不易长大，肌肤粗糙者使用它，能够保护调和元气，活血解毒，帮助痘疮成浆，容易结痂脱落。
桔梗、紫草、川芎、山楂、木通、人参、红花、生地黄、甘草、糯米（五十粒）。
以上药材，用灯心草七根，生姜一片，水一碗，煎至六分，温服。
小便涩滞腹胀的，加大腹皮。颜色繁红不润泽的，加当归、蝉蜕。出痘不顺畅的，加牛蒡子。痘疮塌陷的，加黄芪。疼痛的，加白芷。痘色不均匀的，加防风。水泡的，加白术、芍药。咳嗽的，加五味子、麦门冬。口渴的，加麦门冬。瘙痒的，加白术、芍药。
七八日后浆足，身体再次壮热，便秘烦躁口渴，腹胀气喘急促，使用前胡枳壳汤。浆足之后，禁用此方，另立汤饮在后面。
益元透肌散 专门治疗壅热痘证，服用羌活散郁汤后，壅滞证候全部开通，气血平和，见点三四天后痘疮不肥大、不成浆者使用它，能够匀气解毒，透达肌表，引出元阳，帮助痘疮成浆，容易结成脓窠。加减方法与保和汤相同论述，浆足之后，另有保婴百补汤在后面。
即太乙保和汤去掉生地黄、红花，加蝉蜕、牛蒡子、陈皮。
以上药材，水一碗，加灯心草十四根，大枣二枚，煎至六分，温服。
保婴百补汤 专门治疗痘疮八九日浆足之后，没有其他证候，都用此方调理气血，资养脾胃，不拘泥于实证、热证两种痘疮，都可以服用，只有气虚证在八九日后，本方加黄芪二钱、官桂少许，如果有其他证候，在审察虚实后随证加减而已。
当归、芍药、地黄、白术、人参、茯苓、山药、甘草。
以上药材，水一碗，大枣二枚，煎至六分，温服。
〔陈氏惟主温补〕〔陈文中〕痘疮未出已出之间，或者腹泻口渴，或者腹胀，或者气促，这叫做里虚，迅速用十一味木香散治疗它。如果已经出痘之间，痘疮不光泽，不起发，根脚不红，这叫做表虚，迅速用十二味异功散治疗它。如果已经出痘之间，痘疮不光泽，不起发，根脚不红，或者腹泻口渴，或者腹胀，或者气促，这是表里俱虚，迅速用十二味异功散送下七味肉豆蔻丸治疗它。（丹溪说：木香散、异功散这两种药，治疗寒证确实恰当，如果是虚而不寒的，灾祸立刻降临。）如果痘疮刚出一日至十日，浑身壮热，大便黄色，这是表里俱实，痘疮必然光泽，必然起发，必然饱满，必然容易结痂，而不致损伤，如果没有其他疾病，不宜服药。表里俱实者容易出痘容易结痂，表里俱虚者容易出痘难结痂，表虚难出，里虚难结痂，随证治疗。张巽之《治痘要法》认为吐泻少食为里虚，陷伏倒靥灰白为表虚，二者同时出现，为表里俱虚，全用异功散救治，甚至姜、附、灵砂也可以使用。如果只是里虚，减去官桂，如果只是表虚，减去肉豆蔻，不减官桂、丁香。如果能进食但便秘且陷伏倒靥的，为里实，应当用钱氏及丹溪的下法。如果不吐泻，能进食为里实，里实而用补法，则会结痈毒。红活绽凸，为表实，表实而用解表药，则会溃烂不结痂。凡是痘疮，只要见到斑点，就忌用葛根汤，恐怕发散导致表里俱虚。
〔朱丹溪〕读前人的书，应当知道他们立论的本意，如果读了书却不知道他们的本意，想要寻求适用，是不可能的。关于痘疮的论述，钱乙最为详细，历举源流，经络分明，表里虚实，陈述施治的方法，又用论辨的语言加以验证，深得著书垂教的精神，学人读了并使用它，就像用圆规矩尺求方圆，用准绳测平直一样，引申开来，触类旁通，可以无穷地应用。现在的人不知道致病的原因，不探究立方的本意，仓促之际，根据证候查找方子，随意尝试一下，假使没有效验，就把书也废弃掉，这是不思量得很啊。近来因为《局方》的教法长久流行，《素问》的学问不讲求，抱病谈论医术的人，大多喜欢温补而厌恶寒凉，喜欢补益而厌恶解利，忽然得到陈氏的方论，都用燥热补剂，言辞确切，文字简练，高兴地使用它，一致相信它，于是认为钱氏不如陈氏远矣。有人说，你认为陈氏的方子不足取吗？我说陈氏的方子诚然是一偏之论，虽然如此，也可以说是善于探求病情的人，他的意图大体上归重于太阴一经，大概因为手太阴属肺，主管皮毛，足太阴属脾，主管肌肉，肺金恶寒而易于感受外邪，脾土恶湿而无物不受，看他用丁香、官桂，是用来治疗肺的寒，用附子、白术、半夏，是用来治疗脾的湿，如果脾与肺果真有寒与湿并且兼有虚，斟酌给予，中病就好了，有什么伤害呢。现在却不是这样，只要见到出痘迟的、身热的、泄泻的、惊悸的、气急的、渴思饮的，不问寒热虚实，一律投用木香散、异功散，偶尔有碰巧中的，随手获效，假使误投，灾祸立刻降临。为什么呢？古人用药制方，有向导，有监制，有反佐，有因用，像钱氏的方子，固然未曾废除细辛、丁香、白术、参、芪，率都有监制辅佐的药物，不专门致力于温补罢了，然而他使用寒凉的较多，而在补助这一法上，略示端绪，未曾深入，对痴人之前不可说梦，钱氏的考虑，到了极致了！也将以此等待通达之人扩充推展使用。虽然如此，口渴的用温药，痒塌的用补药，自从陈氏提出，迥出前辈，然而他多用桂、附、丁香，辛芳燥热，恐怕未必适中。为什么呢？桂附丁香这类药，当有寒而虚者，固然是恰当的，虚而未必寒者，其危害该是怎样的呢！陈氏立方之时，必定是挟寒而用一偏之方，宁可过于热乎。我曾综合诸家的精华，探求其本意而使用，实在不敢依据他的成方。至正甲申年，阳气早动，正月间，县里的痘疮不超过一家，一律投用陈氏方，童幼死者百余人，虽由天数，我恐怕人事也未尽全力啊。
王汝言说：如果痘疮虚怯，淡白色痒塌，这属于虚寒，宜用陈文中的方子。如果发热壮盛，齐勇红紫色燥痒，这属于热毒，急宜凉血解毒。自陈文中的方子盛行后，属虚寒的大多得救，属热毒的都不可救。痘是胎毒，古人治法只解毒，然而气血虚，则送毒瓦斯不出，以及不能成就，所以陈文中之法也是千载妙诀，补充前人之未备者，但温补之法既行，而解毒之旨遂隐，所以救得一边，又害了一边。
凡是治疗痘子，要识别证候，如痘脚稀疏，根脚红润，不泻不渴，乳食不减，四肢温和，身无大热，这样的证候不需要服药，只要善于调护以待成就而已。如果痒塌寒战，切牙渴不止，痘紫黑色，喘渴不宁，灰白色顶陷，腹胀，头温足冷，闷乱，饮水，气促，泄泻渴，这样的证候，不必服药，虽然强行治疗，也没有功效。
凡是治疗痘疮，善于攻伐不如善于防守，表里没有邪气，不要妄加治疗。有那些贪图利益的人，不分虚实，妄投汤丸，说曾治某病、治某病，贪天之功以为己有，以致虚虚实实，导致产生变异，误人性命，这是医者的罪过。
〔用药〕〔万全〕凡是痘子，用药须分气血虚实，毒瓦斯微甚而治，所以灰白色的、不起发的、痒塌的、吐利的、寒战切牙的、手足冷的，都是气虚，宜用补气之剂。疮干的、不红活的、脓水少的，都是血虚，宜用补血之剂。稠密的、肿大的、红紫的，都是毒甚，宜用解毒之剂。陷伏的兼气血解毒治之。凡是用补气，宜四君子汤，如疮带湿，或有自利，可以用。如果疮干者，白术燥津液，茯苓渗津液，或者便秘实者，不可以用。凡是用补血，宜四物汤，如疮干，或颜色太娇嫩，可以用。如果不能进食者，生地黄泥膈，白芍药收敛肠胃，不可以用。凡是用解毒，不过黄连、黄芩、黄柏、栀子、连翘、牛蒡子、升麻之类，都用酒制，恐怕寒凉反而损伤脾胃。如果想要行表，须少加桂枝，其他如紫草、山豆根、葛根之类，则不必用酒制了。凡是用解毒药，要辨别脏腑，分阴阳而治之，如黄连解心火，黄芩解肺火，栀子解肝火，黄柏解肾与三焦火，石膏解脾胃火，木通解小肠火，黄芩又解大肠火，连翘、牛蒡子解疮毒火，山豆根、紫草解痘毒火，升麻解疫毒火，各有主治不同。又，岁半以上，属阳，心肺主事，宜芩、连多用，岁半以下，属阴，肾肝主事，宜黄柏、栀子多用。
秘传八味二花散
桃花蕊（五钱） 梅花蕊（两味不拘多少，阴干，共一两六钱二分） 穿山甲（取四足者，酒炒，一两） 朱砂（水飞过，一两） 紫河车（水洗去红筋，焙干，为末，一具） 天灵盖（一具，以皂角煎汤洗净，酥制，为末，四方共一钱七分） 鹿茸（去毛，酥制，三方共一两二钱） 人参（官拣者，一两）。
以上各为末。痘疹未出之前，以朱砂一两为君，梅花二钱、桃花三钱，共一处和匀，每服五分或三分或二分半，用雄鸡与酒二杯灌之与食，倒悬刺血入杯中，以热酒调前药，同服。初发不起，以梅花一两为君，加桃花一钱，天灵盖五分。气血虚，灰白色，用紫河车一两为君，加天灵盖一钱，鹿茸一钱五分，梅花一钱，桃花一钱或八分。黑陷不起，以穿山甲一两为君，加桃花一钱，梅花八分，天灵盖七分，麝香五分。气血虚不能灌浆，以鹿茸一两为君，加紫河车二钱，桃花一钱，梅花八分，天灵盖七分，麝香五分，人参一钱。气血虚不能收靥，以鹿茸一两为君，天灵盖五分，桃花七分，梅花九分。落靥之后，瘢色白，气血虚，以人参一两为君，加紫河车二钱，鹿茸一钱，梅花一钱五分。以上都仿照首条服法。
保生散
紫河车（制如前） 龟板（酥炙，一分） 鹿茸（酥炙，各一两）。
以上为末。量儿大小用。血虚用川归、茯苓、紫草汤下，气虚用人参、黄芪、甘草汤下。
In cases of *Yong* (obstruction/stagnation) in smallpox, although the symptoms are severe, the therapeutic effect can be extremely profound if treated correctly. If cold and cooling herbs such as Huangqin (Scutellariae Radix), Lianlian (Coptidis Rhizoma), and Shengma (Cimicifugae Rhizoma) are used abruptly, the heat will be suppressed by the cold qi, unable to extend and emerge, lingering in the meridians, leading to carbuncles or boils; or causing water retention and hard constipation. As for warming and tonifying agents like Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Fuling (Poria), if misused, they will exacerbate the stagnation and abundance, bringing disaster immediately. Others such as Dingxiang (Caryophylli Flos), Rougui (Cinnamomi Cortex), Muxiang (Aucklandiae Radix), Jiang (Zingiberis Rhizoma), and Fuzi (Aconiti Lateralis Radix Praeparata), using heat to attack heat, can cause death instantly, and extreme caution is required. Therefore, from the initial fever until after the eruption of spots, it is appropriate to treat with this formula (referring to Qianghuo San Yu Tang mentioned previously), adding or subtracting ingredients according to the methods described later.
Additions and Subtractions to Qianghuo San Yu Tang:
If at the onset there is high fever, red cheeks, flushed face, dry and brittle hair, dry skin, cough, and rapid breathing, add Shengma (Cimicifugae Rhizoma). For irritability and thirst, add Tianhuafen (Trichosanthis Radix) and Gange (Puerariae Radix). For abdominal distension, rapid breathing, nasal congestion, flushed face resembling anger, and straight, withered hair, add Mahuang (Ephedrae Herba). For constipation, add Danggui (Angelicae Sinensis Radix) and Zhike (Aurantii Fructus), and in severe cases, Dahuang (Rhei Radix et Rhizoma). For vomiting, add Zhuling (Polyporus), Zexie (Alismatis Rhizoma), and Chenpi (Citri Reticulatae Pericarpium); ginger, dingxiang, muxiang, and Banxia (Pinelliae Rhizoma) are forbidden. For diarrhea, add Shengma; Baizhu, Fuling, Doukou (Cardamomi Fructus), and Longgu (Fossilia Ossis Mastodi) are forbidden. For wheezing, cough, and aversion to wind, add Sangbaipi (Mori Cortex) and Zisu (Perillae Folium). For bleeding, add Xijiao (Rhinocerotis Cornu), Shengdihuang (Rehmanniae Radix), and Huanglian (Coptidis Rhizoma). For the appearance of rashes, add Huanglian, Huangqin (Scutellariae Radix), and Shanzhi (Gardeniae Fructus). For dark and scanty urination, add Huashi (Talcum), Shanzhi, Shengdihuang, and Shaoyao (Paeoniae Radix Alba). For epistaxis, add Huangqin and Xijiao. For palpitations and fright, add Mutong (Akebiae Caulis) and Shanzhi. For convulsions, add Qingpi (Citri Reticulatae Pericarpium Viride). For loss of appetite, add Shanzha (Crataegi Fructus). For food stagnation, add Shanzha, Shenqu (Massa Medicata Fermentata), and Maiya (Hordei Fructus Germinatus). Between two and three days after spotting, if eruption is not smooth, add Niubangzi (Arctii Fructus), Shanzha, and Chantui (Cicadae Periostracum), named Touji San (Muscle-Penetrating Powder). For facial irritation and redness, add Shengdihuang, Honghua (Carthami Flos), and Mudanpi (Moutan Cortex); remove Baizhi (Angelicae Dahuricae Radix) and Fangfeng (Saposhnikoviae Radix). For tight skin and tense muscles with high fever, add Gegen (Puerariae Radix) and Qianhu (Peucedani Radix).
Within three days after spotting, additions and subtractions should follow this formula. After three days, when the smallpox lesions are fully erupted, blood vessels have formed, and previous symptoms have subsided, this formula must not be reused, lest excessive dispersion hinder the formation of pustules and scabs; other formulas are provided later. Prohibited medications should be managed according to the principles for treating bloody-heat smallpox syndromes, so no specific contraindications are listed for this formula.
Taiyi Baohe Tang (also known as Zicao Touji Tang)
Specifically treats bloody-heat smallpox syndromes. After taking Shishen Jiedu Tang, if heat symptoms have completely resolved and the interior and exterior are harmonious, but after three days of spotting the lesions do not grow well or the skin is rough, use this formula. It protects and harmonizes Yuan Qi (Original Qi), invigorates blood and resolves toxicity, assists in pustule formation, and facilitates scabbing and shedding.
Jiegeng (Platycodonis Radix), Zicao (Arnebiae Radix seu Lithospermi Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Shanzha, Mutong, Renshen, Honghua, Shengdihuang, Gancao (Glycyrrhizae Radix et Rhizoma), Nuomi (Oryzae Sativae Semen Glutinosis) (50 grains).
Take the above herbs, add seven stalks of Dengxincao (Junci Medulla), one slice of Shengjiang (Zingiberis Rhizoma Recens), and one cup of water. Decoct until six-tenths remain, and take warm.
For difficult urination and abdominal distension, add Dafupi (Arecae Pericarpium). For overly red and unmoistened lesions, add Danggui and Chantui. For slow eruption, add Niubangzi. For sunken lesions, add Huangqi. For pain, add Baizhi. For uneven color, add Fangfeng. For vesicles, add Baizhu and Shaoyao. For cough, add Wuweizi (Schisandrae Fructus) and Maidong (Ophiopogonis Radix). For thirst, add Maidong. For itching, add Baizhu and Shaoyao.
After seven or eight days, when pus is sufficient, if the body becomes hot again, with constipation, irritability, thirst, abdominal distension, and rapid breathing, use Qianhu Zhike Tang. Once pus is sufficient, this formula is prohibited; a different decoction is provided later.
Yiyuan Touji San
Specifically treats obstructive-heat smallpox syndromes. After taking Qianghuo San Yu Tang, if obstruction symptoms have cleared and qi and blood are harmonious, but after three or four days of spotting the lesions are not plump or fail to form pus, use this formula. It regulates qi and resolves toxicity, penetrates the muscle layer to reach the surface, guides out Yuan Yang (Original Yang), assists in pustule formation, and facilitates the formation of pustular cavities. Additions and subtractions are discussed similarly to Baohe Tang. After pus is sufficient, Baoying Baibu Tang is provided later.
This is Taiyi Baohe Tang minus Shengdihuang and Honghua, plus Chantui, Niubangzi, and Chenpi.
Take the above herbs, add one cup of water, fourteen stalks of Dengxincao, and two dates. Decoct until six-tenths remain, and take warm.
Baoying Baibu Tang
Specifically treats smallpox after nine or ten days when pus is sufficient and there are no other symptoms. Use this formula to regulate qi and blood, nourish the spleen and stomach. It can be taken regardless of excess or heat types of smallpox. Only for qi-deficiency syndromes after nine or ten days, add Huangqi (Astragali Radix) two qian and Guigui (Cinnamomi Cortex) a little to this formula. If there are other symptoms, adjust according to deficiency and excess.
Danggui, Shaoyao, Dihuang, Baizhu, Renshen, Fuling, Shanyao (Dioscoreae Rhizoma), Gancao.
Take the above herbs, add one cup of water and two dates. Decoct until six-tenths remain, and take warm.
[Chen Shi Wei Zhu Wen Bu] [Chen Wenzhong] Between the time before and after smallpox eruption, if there is diarrhea and thirst, abdominal distension, or shortness of breath, this is called Interior Deficiency. Treat it rapidly with Shiyiwei Muxiang San (Eleven-Ingredient Aucklandia Powder). If the rash has erupted but lacks luster, does not rise, and the base is not red, this is called Exterior Deficiency. Treat it rapidly with Shiweiyi Gong San (Twelve-Ingredient Yi Gong Powder). If the rash has erupted, lacks luster, does not rise, the base is not red, accompanied by diarrhea/thirst, abdominal distension, or shortness of breath, this is Exterior and Interior Deficiency. Treat it rapidly with Shiweiyi Gong San administered with Qiwei Roudouwan (Seven-Ingredient Nutmeg Pills). (Danxi said: Muxiang San and Yi Gong San are appropriate for cold syndromes; if deficiency exists without cold, disaster will follow immediately.) If between one and ten days after eruption, the whole body is hot, and stool is yellow, this is Exterior and Interior Excess. The lesions will be lustrous, raised, full, and easily scabbed, without damage. If there are no other diseases, medication is unnecessary. Exterior and Interior Excess leads to easy eruption and scabbing; Exterior and Interior Deficiency leads to easy eruption but difficult scabbing; Exterior Deficiency makes eruption difficult, Interior Deficiency makes scabbing difficult. Treat according to the syndrome. Zhang Xunzhi's "Essential Methods for Treating Smallpox" states that vomiting, diarrhea, and poor appetite indicate Interior Deficiency; sinking, inverted scabs, and gray-white color indicate Exterior Deficiency. Both present together indicate Exterior and Interior Deficiency, treat entirely with Yi Gong San. Even Ginger, Aconite, and Lingsha may be used. If only Interior Deficiency, reduce Guigui; if only Exterior Deficiency, reduce Roudoukou, but do not reduce Guigui or Dingxiang. If able to eat but constipated with sinking/inverted scabs, it is Interior Excess, use Qian's and Danxi's purgative methods. If no vomiting/diarrhea and able to eat, it is Interior Excess; tonifying Interior Excess will lead to carbuncle-toxins. Red, lively, protruding lesions indicate Exterior Excess; using exterior-releasing drugs for Exterior Excess will lead to ulceration and failure to scab. For all smallpox, once spots appear, Gegen Tang is contraindicated, lest dispersion cause Exterior and Interior Deficiency.
[Zhu Danxi] When reading predecessors' works, one must understand their intent. If one reads without understanding the intent, seeking applicability is impossible. Regarding smallpox discussions, Qian Yi was the most detailed, tracing origins, clarifying meridians, distinguishing exterior/interior and deficiency/excess, stating treatment methods, and verifying with discursive arguments, deeply embodying the spirit of teaching through writing. Students who read and apply it find it as reliable as using compasses for circles and squares, or levels for straightness. Extending this, applying it to various cases allows for infinite application. Modern people do not know the causes of disease nor the intent behind prescriptions. In haste, they check formulas based on symptoms and try them casually. If ineffective, they discard the books, which is extremely thoughtless. Recently, due to the long-standing popularity of Ju Fang (Prescriptions of the Bureau of Taiyi), and neglect of Suwen studies, those discussing medicine while ill tend to prefer warming and tonifying over cooling and releasing. Suddenly encountering Chen's formulas, which use drying, hot, and tonifying agents, with precise words and simple text, they happily use and believe them, concluding that Qian is far inferior to Chen. Someone asks: Do you think Chen's formulas are inadequate? I say Chen's formulas are indeed a one-sided theory. However, he can be considered good at investigating disease conditions. His intent largely focuses on the Taiyin channel. Hand Taiyin belongs to the Lung, governing skin and hair; Foot Taiyin belongs to the Spleen, governing muscles. Lung Metal dislikes cold and is easily affected; Spleen Earth dislikes dampness and accepts everything. Using Dingxiang and Guigui treats Lung cold; using Aconite, Baizhu, and Banxia treats Spleen dampness. If Spleen and Lung truly have cold and dampness combined with deficiency, giving measured amounts that hit the mark causes no harm. Now, however, whenever one sees delayed eruption, fever, diarrhea, palpitations, rapid breathing, or thirst, regardless of cold/heat or deficiency/excess, Muxiang San and Yi Gong San are indiscriminately administered. Occasionally effective, but if misused, disaster follows immediately. Why? Ancient prescription-making included guiding agents, restraining agents, counter-assisting agents, and conditional usage. Qian's formulas did not abandon Xixin (Asari Radix), Dingxiang, Baizhu, Renshen, and Huangqi, but always included restraining and assisting agents, not solely focusing on warming and tonifying. He used more cooling agents, hinting at tonification but not delving deep. One cannot speak dreams to the foolish; Qian's considerations were thorough! He waited for enlightened individuals to expand upon them. Although Chen introduced using warming drugs for thirst and tonics for itching/pruritus, surpassing predecessors, his frequent use of Guigui, Aconite, and Dingxiang, which are pungent, aromatic, drying, and hot, may not be perfectly balanced. These drugs are appropriate for cold-deficiency, but what about deficiency without cold? At the time Chen formulated these, he likely addressed cold with a one-sided approach, perhaps leaning towards heat. I have synthesized the essence of various schools and applied their intents, daring not rely solely on his fixed formulas. In the Jiashen year of Zhizheng, yang qi moved early. In January, smallpox in the county was rare. Everyone used Chen's formulas, resulting in over a hundred child deaths. While partly due to fate, I fear human effort was also insufficient.
Wang Ruyan said: If smallpox is weak, pale white, itchy, and sunken, this belongs to deficiency-cold, suitable for Chen Wenzhong's formulas. If fever is high, lesions are bright red/purple, dry, and itchy, this belongs to heat-toxin, requiring rapid blood-cooling and toxin-resolving. Since Chen Wenzhong's formulas became popular, deficiency-cold cases mostly survived, while heat-toxin cases were incurable. Smallpox is fetal toxin; ancient methods focused only on resolving toxins. However, if qi and blood are deficient, toxins cannot be expelled or matured. Thus, Chen's method is a millennium-old secret, supplementing predecessors' omissions. But since warming-tonifying methods prevailed, the principle of toxin-resolution faded, saving one side while harming the other.
When treating smallpox, one must recognize syndromes. If lesion bases are sparse, roots are red and lustrous, no diarrhea/thirst, milk/food intake unchanged, limbs warm, no high fever, no medication is needed; simply care well and wait for maturation. If itchy/sunken, chills, teeth-grinding, incessant thirst, purple-black lesions, wheezing/thirst/restlessness, gray-white sunken tops, abdominal distension, warm head/cold feet, confusion, drinking, shortness of breath, diarrhea/thirst—such syndromes require no medication; even forced treatment is futile.
In treating smallpox, skillful defense is better than skillful attack. If exterior and interior are free of pathogens, do not treat recklessly. Some greedy practitioners, ignoring deficiency/excess, blindly administer decoctions and pills, claiming credit for cures, causing deficiency-to-excess and excess-to-deficiency errors, leading to mutations and death. This is the physician's sin.
[Medication] [Wan Quan] For smallpox, medication must distinguish qi/blood and deficiency/excess, and the severity of toxins. Gray-white, non-raised, itchy/sunken, vomiting/diarrhea, chills/teeth-grinding, cold hands/feet—all indicate qi deficiency, suitable for qi-tonifying agents. Dry lesions, non-lively color, scant pus—all indicate blood deficiency, suitable for blood-tonifying agents. Dense, swollen, red-purple lesions—all indicate severe toxin, suitable for toxin-resolving agents. Sunken lesions require combined qi/blood and toxin resolution. For qi tonification, Si Jun Zi Tang (Four Gentlemen Decoction) is suitable; if lesions are moist or spontaneous diarrhea occurs, it can be used. If lesions are dry, Baizhu dries fluids, Fuling leaches fluids; if constipated and excess, it is unsuitable. For blood tonification, Si Wu Tang (Four Substance Decoction) is suitable; if lesions are dry or color is too delicate, it can be used. If unable to eat, Shengdihuang clogs the chest, Shaoyao contracts intestines/stomach; it is unsuitable. For toxin resolution, agents include Huanglian, Huangqin, Huangbai (Phellodendri Cortex), Zhizi (Gardeniae Fructus), Lianqiao (Forsythiae Fructus), Niubangzi, Shengma, etc., all wine-processed to prevent cold-cooling from damaging spleen/stomach. To release the exterior, add a little Guizhi (Cinnamomi Ramulus). Others like Zicao, Shandougen (Sophorae Tonkinensis Radix), Gegen need not be wine-processed. When using toxin-resolving drugs, distinguish organs and yin/yang. Huanglian clears Heart fire, Huangqin clears Lung fire, Zhizi clears Liver fire, Huangbai clears Kidney and Sanjiao fire, Shigao (Gypsum Fibrosum) clears Spleen/Stomach fire, Mutong clears Small Intestine fire, Huangqin also clears Large Intestine fire, Lianqiao/Niubangzi clear sores/toxins fire, Shandougen/Zicao clear smallpox toxin fire, Shengma clears epidemic toxin fire. Each has specific indications. Above half-year age, belonging to Yang, Heart/Lung dominate; use more Huangqin/Huanglian. Below half-year age, belonging to Yin, Kidney/Liver dominate; use more Huangbai/Zhizi.
Secretly Transmitted Eight-Ingredient Two-Flower Powder
Taohua Rui (Peach Blossom Stamen) (5 qian), Meihua Rui (Plum Blossom Stamen) (unlimited amount, dried in shade, total 1 liang 6 qian 2 fen), Chuanshanjia (Manis Squama) (take four-footed ones, wine-fried, 1 liang), Zhusha (Cinnabar) (water-washed, 1 liang), Ziheche (Human Placenta) (wash off red veins, bake dry, powder, one placenta), Tianlinggai (Skull Cap of Human Skull) (one piece, wash with Sophora decoction, prepare with butter, powder, total 1 qian 7 fen), Lurong (Cervi Cornu Pantotrichum) (remove hair, prepare with butter, total 1 liang 2 qian), Renshen (selected official grade, 1 liang).
Grind each into powder. Before smallpox/rash eruption, use 1 liang Zhusha as the chief ingredient, mixed with 2 qian Meihua and 3 qian Taohua. Take 5 fen, 3 fen, or 2.5 fen per dose. Feed a rooster with two cups of wine, collect its blood into the cup by hanging it upside down and pricking it. Mix the medicine with hot wine and administer together. For initial failure to rise, use 1 liang Meihua as chief, add 1 qian Taohua and 5 fen Tianlinggai. For qi/blood deficiency, gray-white color, use 1 liang Ziheche as chief, add 1 qian Tianlinggai, 1.5 qian Lurong, 1 qian Meihua, and 1 qian or 8 fen Taohua. For black sinking/non-rising, use 1 liang Chuanshanjia as chief, add 1 qian Taohua, 8 fen Meihua, 7 fen Tianlinggai, and 5 fen Shexiang (Moschus). For qi/blood deficiency failing to fill pustules, use 1 liang Lurong as chief, add 2 qian Ziheche, 1 qian Taohua, 8 fen Meihua, 7 fen Tianlinggai, 5 fen Shexiang, and 1 qian Renshen. For qi/blood deficiency failing to scab, use 1 liang Lurong as chief, 5 fen Tianlinggai, 7 fen Taohua, 9 fen Meihua. After scab falling, if scar is white and qi/blood deficient, use 1 liang Renshen as chief, add 2 qian Ziheche, 1 qian Lurong, 1.5 qian Meihua. All above follow the first administration method.
Baosheng San
Ziheche (prepared as above), Guiban (Testudinis Carapax et Plastrum) (butter-fried, 1 fen), Lurong (butter-fried, 1 liang each).
Grind into powder. Dosage depends on child's size. For blood deficiency, take with Danggui, Fuling, Zicao decoction. For qi deficiency, take with Renshen, Huangqi, Gancao decoction.