论痘首推钱仲阳陈文中二家。钱用寒凉。陈用温热。确乎相左。丹溪祖钱非陈。分解毒和中安
表为要。以犀角地黄汤为主方。举世宗之。莫敢异议。后之万氏。以脾胃为主。魏氏以保元为主。
皆从二家脱化。费建中救偏。悉以石膏大黄。胡氏辄投汗下。松江东地。多宗秦镜明。京口江
宁。咸推管柽保赤。吾苏悉遵翁仲仁金镜录。可谓家喻户晓者。其取长在看不在乎治。看法精
确。有可以前知之巧妙。后之翟氏聂氏。深以气血盈亏。解毒化毒。分晰阐扬钱陈底蕴。超出诸
家。因分别太多。读者目眩心愦。不若翁仲仁 荛悦口也。然眼目之功。须宗翁氏。而汇治讲究。参之诸家可矣。姑举
看法。
大凡发热三日。而后见标。是其常。好以热势参详见症。定其吉凶。翁仲仁鑫镜录甚明。兹不复赘。其未刻悉补入。
伤寒邪由外入。痘子热从内起。但时邪引动而出。与伤寒两途。
周岁小儿。初热即现惊搐昏迷之状最多。世俗谓惊痘最好。此言未必皆然。方书云。先惊后痘者生。先痘后惊者死。频
频惊厥。最多闷痘。盖痘由肾至肝至心脾及肺。自里至外。自深及浅。未发之前。痘热先已内动。目现水晶光芒。肾热
也。水生木而入肝。木生火而入心。火生土而入脾。土生金而入肺。其先天痘毒。从至阴以过阳。全藉身中元气。领载
充长。以化毒为浆。浆必浓浓苍老而始结痂。毒已外泄。元气内返。斯无变症。周岁以内。身小元弱。常有热一日即出。
亦有顺痘。但须看神气静躁。热势轻重。见点徐徐而出。既出即长。热缓安乳。便是好症。若神气虽安。热亦不盛。痘
点虽不多。形呆色钝。或作头 足落。脉懈不束筋骨。隐隐叹息。或短气如喘。或呕或泻。最多闷症。
若二三日间。痘苗已长。色亦颇好。竟夜终日。烦躁不止。最防隐处发疔。及发斑夹疹等症。
一发热烦躁。标点虽见。热躁愈加。细询无忽。再参兼症。为六气郁遏者。从时气治。为内伤停滞
者。从里症治。亦有表里两解治。亦有下夺者。但下法。寒凉之中。必须活血理气。防其凝涩冰伏。
初起必三次而出。热止即齐。其赠点亦有陆续发出者。须看颜色灵活。生气顷刻转机变化为
要。察形辨症。治法用药。表药活血疏肌。次则凉血解毒。实热便闭者。微下之。虚弱气怯者。忌进
疏解寒凉。间有虚寒弱稚。初发身不大热。四肢皆冷。吐乳泻乳。痘点不长。闻声悠悠欲绝。望色
惨淡无形。恰在一二朝间。余见程氏女。年甫半龄。布痘极多。痘形 。色淡白。前症迭见。近地幼
科。佥用荆防蒡蝉红花楂肉木通胡荽笋尖之属。方虽写而示以凶危。延余诊视。余曰毒重气
虚。法在不治。但身无热。见症虚寒。不因疠气表邪。焉用表药。考万氏始终以脾胃为主。以理中
汤加丁桂与服一剂。肢暖呕止。再服利缓痘起。再用参归鹿茸二服。以钱氏异功散而愈。
凡看痘。先论儿体强弱。辨肌色。如色白多气虚。色苍多血热。形象 羸有宿病。或渴乳。肌柔白
嫩者。痘必鲜明。苍黑皮粗者。色必暗晦。羸瘦病质。色燥形枯。必须辨根据期长养。内症安和。
病躯出痘。即平常无奇。亦难调理。歌诀云。形体羸瘦骨如柴。肌肉枯焦神思衰。遍体铺排如此
痘。纵能浆足亦堪嗟。
一初见腰痛足 。不能起立者死。此毒伏于肾。
一初见腹胀胸高。续增喘哕者死。
一初见目睛呆瞪。或暗无光。或黑白高低。皆属紧闷症。
一初见痘。烦躁不止。即防疔斑。疔必现于隐处。多死。
一初见痘。痘不续发。斑色深紫。渐变蓝黑。六日内死。
一初见痘。紫斑渐起。痘反隐伏。此名紫斑白闷。
一初见痘。痘斑间杂。若似酒朱点墨必死。
以上皆论初见看法。以定凶危。发齐热退后。皆无诸恶症。翁仲仁云。三日四日。痘出当齐。点至
足心。势方安静。若论幼小之儿。气血易周。常有未及三日。而发齐者。年长之体。四日以外。犹有
赠发者。痘子稀少。数不盈百。不必点至足心。仲仁大意。谓发齐安静。无虑变症。然须辨明痘形
痘色。是何等呈色。身体强壮。痘属上中。方可许其无虑。倘幼小弱质。或病后。或带别病而后布
痘。未可见痘好浪许。再以冬夏气候审详。可以百千无误。
今世用方 初见宜解肌疏表通套法（十六味）
荆芥（四日不用） 防风（三日不用） 前胡（三日不用） 牛蒡（四日不用） 紫草（二三日便滑忌）
木通 红花 甘草 赤芍 天虫 楂肉 川芎 连翘 桔梗 广皮 蝉蜕（三四日不用）
方书中。未见点。用升麻葛根汤。今人不用。伍氏方法。见点忌升麻。后人谓葛根。表疏亦忌。
此轻扬升表通套药。若里症急须两解。
伍氏方。一二日用羌防透肌汤。今人不用。恶其辛温气雄也。一二日壮热气促。烦渴便秘。痘粒
不发。翁仲仁云。若非风寒壅遏定是气虚不振。愚谓近世布痘。每盛发于君相风木燥金司令。
盖非火不发也。火郁发之。升阳散火是已。但前症若里热甚重。煎灼脂液。苟非苦寒下夺。佐以
升表。不能用也。费建中方颇为中的。
石膏 大黄 连翘 赤芍 青皮（腹痛用） 楂肉 花粉 紫草 木通 丹皮（辛凉入血）
犀角（辛凉通血）
发齐后用黄连。
凡寒凉清火解毒。必佐活血疏畅。恐凝滞气血也。
实热便秘。通用凉膈 通圣 前胡枳壳汤 四顺清凉饮
痘四日发足。伍氏遵古方。用牛蒡熟末三分。用荸荠汁酒酿炖热调匀。临服刺入生鸡冠血十
余滴与服。毒轻者即起光润之色。世皆宗之。
发齐已四五日。用凉血解毒汤药。伍氏名四圣饮。非扁鹊原方。
生地 连翘 银花 红花 甘草 天虫 桔梗 紫草（便滑用紫铫）
血热加丹皮犀角 火盛加黄连石膏羚羊角 有斑加金汁元参 头面不起加川芎
鸡冠血 咽喉痛加射干元参山豆根 狂乱躁扰加地龙汁 毒重血凝加猪尾血
冰片（量儿大小用） 近世凉血解毒多用地丁银花汤煎药。
凡看痘。初起要根盘。其痘易长绽。倘尖瘦不肥多险。成浆之后。务要根盘即化一线。圈红紧附。
顶满滚圆。是为毒化。若顶陷顶皱。根盘黯僵。其毒与气血交凝。实宜攻。虚宜补。
实火宜清。攻不宜早。看来火色大赤。痘形色湿润。方可攻托。否则搔擦立至。干剥毒陷不治。
虚有血虚气虚之分。血虚为热。气虚为寒。但虚热与实热不同。虚热用滋清方药。
痘顶属气。根盘属血。气领血载。毒得 炼化浆。凡体强质实者多火。以清凉之剂。火解浆成误
补则痈。痈者。壅也。其气虚血弱。色必淡白。形不雄伟。或顶陷。或皮皱。内症则恶心。少食便溏。年
少未进谷食者。肠胃薄劣。最多虚症。七日以来。元气用事。不能胜毒。使之外出。多有内陷致变
者。余最究心是症。调之应手取效。魏氏保元汤。聂氏参归鹿茸汤。陈氏木香异功散。肠滑不禁。
用七味豆蔻丸。白术散。理中汤。多获奇效。甚者必用三服。
大凡儿肌白嫩者多虚症。苍黑者多实火。虽为大概。亦属至要。白嫩发痘。色必鲜艳。勿谓便是
善症。苍黑发痘。色必晦昧。勿便许为凶。总以神气安静。颜色日换。形象渐长便吉。
六七日伍氏内托散。
生黄 甘草 陈皮 川芎 当归 白糯米 防风 天虫 角刺 银花
血热者不用 防芎归 表疏者去天虫角刺 血热仍用丹皮地黄紫草连翘羚羊
猪尾鸡冠鸡鸣散达表之药 猪尾膏通里之药
保元汤
人参 黄 炙草
加川芎当归名芎归保元 虚寒加肉桂 升顶加鹿茸 气滞正气加广皮浓朴 泻加木香肉果
质弱加坎 河车 呕逆加丁香浓朴
参归鹿茸汤
人参 当归 鹿茸 黄 龙眼肉 炙草
木香散
人参 木香 丁香 大腹皮 桂心 青皮 诃子 半夏 甘草 前胡 赤苓
异功散
人参 木香 官桂 广皮 当归 茯苓 丁香 白术 附子 肉果 浓朴 半夏
豆蔻丸
肉果 木香 砂仁 枯矾 诃子 龙骨 赤石脂
白术散 四君加藿香木香。
七八九日。频用清凉。痘火色既退。浆不能透。或有半浆。顶有箬笠之形。不克充灌。今人多用桑
虫浆生用。鸡冠血生用。同酒浆和服。倘攻起。少顷后呆滞者。须用补托。
伍氏攻发药用老人牙 研极细。加麝香少许。每服二三分。名黑灵丹。
右天虫乃疏表风药 山甲乃攻经隧风药。一味为末。酒浆服。曰独胜散。
凡虫蚁皆攻。无血者走气。有血者走血。飞者升。地行者降。凡浆足声音哑者不妨。骤喘痰升者
大忌。翁仲仁云。挫喉声哑。浆行饱满亦无妨。盖痘浆因热气以炼成。必升腾以达头面。肺位最
高。热上蒸迫。肺先受损。是以声出不扬。倘喘急扶肚抬胸。乃火毒归肺。必不治矣。
火毒归肺。幼科每用珠子牛黄膏连之属。多不效。余遵孙思邈苇茎汤。或仲景葶苈大枣汤。间
有效者。肺气壅遏。苦寒直下。已过病所。故无效。
方书以六七日以前寒战属肺热。六七日以后寒战属气虚。六七日以前切牙属胃热。六七日
以后切牙属血虚。亦属定论。
八九日痒塌切牙。痘不起浆。或灰白。或涸或瘪。危险极矣。速速温补。亦可望生。翁仲仁云。塌陷
切牙。便实声清犹可治。声清则上无热壅痰聚。便实则腑阳未至尽泄。所以温补得效耳。木
香散 异功散。
八九日顺痘。浆色苍黄。毒瓦斯悉化。亦云垂成。须谨防护持。搔损流脓裂血。倘正气大泄。毒从虚陷。常有不治之
患。斯时预嘱伴母勿懈。使痂靥干结。肌肉完固。便是全功。若痘已破碎。声不哑
者。毒不陷也。无妨。
伍氏方用芍药汤。
炒白芍 苡仁 茯苓 地骨皮 银花 百合 山药 建莲
十一二日。渐次成痂之际。极好之症。必有咳嗽。或夜暮身热。世俗幼科。佥云毒瓦斯未尽。概投苦
寒。多有胃减废食。酿成痘劳童怯者。吾尝论痘自肾脏骨髓之中。由肝主筋。心主血脉。脾主肌
肉。肺主皮毛。从内之外。毒乃涣释。收疤之时。真气归里。肺合皮毛。是为末传。处位高。
体清肃。从前灌胀成痂。蒸迫之气。受亏已极。气泄为咳矣。况投利湿下注药而结痂。其上焦已经转燥。若
毒仍留伏。焉能收靥。此断断然也。再论幼稚。阳常有余。阴未充长。布痘至于结痂。一身脂液大
损。其阴气告匮可知。故暮夜属阴时。为烦为热者。正内经云。阴虚生内热也。昔西郊吴氏女。年
甫四岁。痘系顺症。幼科调治。至浆满成痂之日。忽发烦躁。夜热不寐。晨起安然。医用保元。及钱
氏五味异功加芍药与服。热躁益加。又更一医曰。毒瓦斯未尽。乃误补之故。用桑虫浆。暨凉解药。
服后躁热甚。而添泄泻。邀余视之。睹浆痂形色。询平素起居。时日当午。即用六味地黄汤一服
而安。此二条。人多忽而不究。故辨及之。旬朝后嗽。大法以甘寒生津胃药。
蔗浆 麦冬 沙参 绿豆皮 地骨皮 甘草 玉竹 甜杏仁
解余毒药。全以不伤胃气为主。若用芩连必须酒制。翟聂二氏辨之详矣。平和无奇断不败事。
如三豆饮之属。若金银花一味。本草称解毒不寒。余见脾胃虚弱者。多服即泻。伍氏用连翘饮
子。亦取平和。
痘毒痈疡。热症十有七八。虚寒十有二三。甚至骨出腐败。亦有愈者。但外科大忌用火炼升药。
其诊看之法。亦如疡毒。须分阴阳耳。
痘疳湿盛生热。强者用苦寒清降。以苦能去湿也。若阻咽废食。以及穿腮破颊者难治。
年长出痘。男女欲火已动。其初即现膝痛腰酸。咽喉窒痛欲闭。苦辛寒药。必不效验。宜甘咸寒。
滋水制火。佐以解毒。六七日来。痛势日缓。聂氏有参麦清补方。余每用钱氏六味。加龟胶元参
秋石获效者甚多。
若浆不肯起。频吐粘涎者凶。
凡恶痘。凶危瞬刻。如诸闷症。不过三五日。已发而缩。其危最速。总在七日内。再若
蒙头。锁喉。悬镜。缠腰。蜘窠。蚕种等。为十恶症。其袁氏十八恶症。今人未尝齿及。如此等痘。
治之不易。难望全生。更有糖沙夹斑。十朝危期。又根枝虽好。布于岁内幼小之儿。必八九风
波不治。半浆毒陷之变。必毙于十一二四之期。若能食者。十救一二。
痘至八九旬日外无浆。则里毒不化。必呛哑瘙痒。痰潮不食。眼开。条款难以尽言。危期速矣。常
有忽然连串片片之痘。裂水形如松脂桃胶外露。转眼堆聚。内症渐安。变凶转吉。更有旬朝内
外。干板涸如焦锅巴状。毫无生气。忽从地角承浆诸处。裂缝流臭水。渐升头额。堆肿高浓若糊
脸。名曰发臭。毒泄即当补托。迟则气脱。
论治痘疹，首推钱仲阳和陈文中两家。钱氏用药偏于寒凉，陈氏用药偏于温热，两者观点截然相反。朱丹溪尊崇钱氏而排斥陈氏，主张将解毒、和中、安表作为治疗的关键，以犀角地黄汤作为主方，当时世人皆宗奉此法，无人敢提出异议。后来的万全（万密斋），以调理脾胃为主；魏之琇，以保元汤为主。他们的学说都是从钱、陈两家的基础上演变而来的。费建中致力于纠正时弊，完全使用石膏和大黄；胡慎柔则动辄使用发汗和攻下的方法。在松江、东地一带，多宗奉秦镜明的学说；在京口、江宁地区，都推崇管柽的《保赤》之法；我们苏州地区，完全遵循翁仲仁的《金镜录》，可以说是家喻户晓。他们取胜的关键在于“看”（诊断观察）而不在于“治”（药物治疗），看法精确，有可以预先判断病情的巧妙之处。后来的翟氏、聂氏，深入阐发了气血盈亏、解毒化毒的理论，详细剖析并弘扬了钱、陈两家的底蕴，超出了其他各家。但因为分别论述得太多，读者容易眼花缭乱、心神困惑，不如翁仲仁的学说那样通俗易懂。然而，在诊察眼目方面，必须宗奉翁氏的方法，同时汇集各家治疗方法加以研究参考就可以了。这里姑且列举一下诊察的方法。
大凡发热三天后，痘疹才显现出来，这是正常的情况。通常根据热势的轻重来参详具体的症状，从而判定吉凶。翁仲仁的《金镜录》讲得很明白，这里不再赘述。其余未刻印的部分全部补入。
伤寒的病邪是从外部侵入的，痘疹的热是从内部发起的。只是时令邪气引动痘毒外出，这与伤寒是两条不同的路径。
周岁以内的小儿，初起发热时就出现惊厥抽搐、昏迷状态的非常多。世俗认为“惊痘”是最好的预后，这种说法未必完全正确。医书说：先惊厥后出痘的能活，先出痘后惊厥的会死。频繁惊厥，最容易导致闷痘（痘毒内陷）。大概痘毒由肾传至肝，再传至心、脾及肺，从体内向体表，从深层向浅层发展。在未发出之前，痘热已经在体内活动，眼睛呈现出水晶般的光芒，这是肾热的表现。水（肾）生木（肝）而入肝，木生火（心）而入心，火生土（脾）而入脾，土生金（肺）而入肺。先天的痘毒，从至阴经至阳而出，全靠身体中的元气，引领承载，充盛生长，将痘毒化为脓浆。脓浆必须浓稠苍老才能结痂。痘毒已经向外发泄，元气回归体内，这样就没有变证。周岁以内的小儿，身体小、元气弱，常有发热一天就出痘的情况，也有顺症。但必须看神气的静躁、热势的轻重，见点徐徐而出，既出即长，热势缓和、吃奶安稳，就是好症。如果神气虽然安静，热势也不盛，但痘点虽然不多，形态呆板、色泽迟钝，或者头足脱落，脉象松懈不能束筋骨，隐隐叹息，或者短气像喘一样，或者呕吐或腹泻，最多见的是闷症。
如果在二三天间，痘苗已经长出，颜色也很好，却整夜整天烦躁不止，最要防备隐处发生疔疮，以及发斑夹疹等症。
一发热就烦躁，标点虽然见到，但热躁更加厉害，仔细询问不要疏忽，再参合兼症。如果是六气郁遏导致的，按时气病治疗；如果是内伤停滞导致的，按里症治疗。也有表里双解的治疗方法，也有用下法攻逐的。但是用下法时，在寒凉药中，必须配合活血理气药，防止气血凝涩冰伏。
初起痘点必定分三次发出，热止即齐。其赠点（陆续发出的痘点）也有陆续发出的。必须看颜色是否灵活，生气顷刻间的转机变化是关键。察形辨症，治法用药，先用表药活血疏肌，其次用凉血解毒药。实热便秘者，轻微攻下；虚弱气怯者，忌用疏解寒凉药。间有虚寒体弱的幼儿，初发时身体不大热，四肢都冷，吐乳泻乳，痘点不长，闻声悠悠欲绝，望面色惨淡无形，恰在一两天之间。我曾见过程氏的女儿，年仅半岁，布痘极多，痘形扁平，色淡白，前述症状接连出现。当地儿科医生，都用荆芥、防风、牛蒡子、蝉蜕、红花、山楂肉、木通、胡荽、笋尖之类的药。方子虽然开了，但暗示病情凶危。请我诊治，我说：毒重气虚，法在不治。但身体无热，见症属虚寒，不是因为疠气表邪，哪里用得着表药？考察万全始终坚持以脾胃为主，用理中汤加丁香、肉桂给患儿服用一剂，手脚变暖，呕吐停止。再服，腹泻减缓，痘点起发。再用人参、当归、鹿茸服用两剂，最后用钱乙的异功散而痊愈。
凡是看痘，先论小儿体质的强弱，辨别肤色。如色白多气虚，色苍黑多血热。形象瘦弱有宿病的，或者渴乳，肌肤柔软白嫩的，痘必鲜明；苍黑皮粗的，色必暗晦；羸瘦病质，色燥形枯，必须辨别根据时期长久调养，使内症安和。病躯出痘，即使平常无奇，也难调理。歌诀说：形体羸瘦骨如柴，肌肉枯焦神思衰。遍体铺排如此痘，纵能浆足亦堪嗟。
一见初见眼睛呆瞪，或者暗淡无光，或者黑白高低不平，都属于紧闷症。
一见初见痘，烦躁不止，就要防备疔斑。疔必出现在隐蔽处，多死。
以上都是论初见时的诊察方法，用来判定凶危。发齐热退后，都没有这些恶症。翁仲仁说：三到四天，痘出应当齐备，点至足心，局势方才安静。如果论幼小的小孩，气血易周流，常有不到三天就发齐的。年长一点的体质，四日以外，还有陆续发出的。痘子稀少，数不超过一百，不必点至足心。翁仲仁的大意是说，发齐安静，就不用担心变症。然而必须辨明痘形痘色，是何等呈色。身体强壮，痘属上中等级，才可以允许其无忧虑。倘若幼小弱质，或者病后，或者带别病而后布痘，不可看见痘好就轻易许诺无事。再结合冬夏气候详细审察，可以百千无误。
当今世面用的方子，初见宜用解肌疏表的通套法（十六味）：
荆芥（第四天不用）、防风（第三天不用）、前胡（第三天不用）、牛蒡子（第四天不用）、紫草（第二三天大便滑泄者忌用）、木通、红花、甘草、赤芍、僵蚕、山楂肉、川芎、连翘、桔梗、广陈皮、蝉蜕（第三四天不用）。
方书中，未见点时，用升麻葛根汤。今人不用。伍氏的方法，见点时忌用升麻，后人认为葛根疏表也忌用。
这是轻扬升表的通套药。如果里症急迫，须要表里两解。
伍氏方，一二日用羌防透肌汤，今人不用。厌恶它辛温气雄。一二日壮热气促，烦渴便秘，痘粒不发。翁仲仁说：如果不是风寒壅遏，定是气虚不振。我认为近世布痘，每盛发于君相风木燥金司令之时。盖非火不发也。火郁发之，升阳散火是已。但如果前述病症里热甚重，煎灼脂液，如果不靠苦寒下夺，佐以升表，是不能用的。费建中的方子颇为中肯。
石膏、大黄、连翘、赤芍、青皮（腹痛用）、山楂肉、花粉、紫草、木通、丹皮（辛凉入血）、犀角（辛凉通血）。
发齐后用黄连。
凡是寒凉清火解毒，必佐活血疏畅，恐怕凝滞气血。
实热便秘，通用凉膈散、通圣散、前胡枳壳汤、四顺清凉饮。
痘四日发至足部，伍氏遵古方，用牛蒡子熟末三分，用荸荠汁、酒酿炖热调匀，临服刺入生鸡冠血十余滴与服。毒轻者即起光润之色，世人都宗奉此法。
发齐已四五日，用凉血解毒汤药。伍氏名四圣饮，不是扁鹊的原方。
生地、连翘、银花、红花、甘草、僵蚕、桔梗、紫草（便滑用紫铫）。
血热加丹皮、犀角；火盛加黄连、石膏、羚羊角；有斑加金汁、元参；头面不起加川芎、鸡冠血；咽喉痛加射干、元参、山豆根；狂乱躁扰加地龙汁；毒重血凝加猪尾血；冰片（量儿大小用）。近世凉血解毒多用地丁、银花汤煎药。
凡是看痘，初起要看根盘，其痘易长绽。如果尖瘦不肥多险。成浆之后，务要根盘即化一线，圈红紧附，顶满滚圆，是为毒化。如果顶陷顶皱，根盘黯僵，其毒与气血交凝，实宜攻，虚宜补。
实火宜清，攻不宜早。看来火色大赤，痘形色湿润，方可攻托。否则搔擦立至，干剥毒陷不治。
虚有血虚气虚之分。血虚为热，气虚为寒。但虚热与实热不同，虚热用滋清方药。
痘顶属气，根盘属血。气领血载，毒得炼化浆。凡是体质强壮结实的多火，以清凉之剂，火解浆成。误补则痈。痈者，壅也。其气虚血弱，色必淡白，形不雄伟，或顶陷，或皮皱。内症则恶心，少食便溏。年少未进谷食者，肠胃薄劣，最多虚症。七日以来，元气用事，不能胜毒，使之外出，多有内陷致变者。我最究心是症，调之应手取效。魏之琇的保元汤，聂的参归鹿茸汤，陈氏的木香异功散。肠滑不禁，用七味豆蔻丸、白术散、理中汤，多获奇效。甚者必用三服。
大凡小儿肌肤白嫩的多虚症，苍黑的多实火。虽为大概，亦属至要。白嫩发痘，色必鲜艳，勿谓便是善症。苍黑发痘，色必晦昧，勿便许为凶。总以神气安静，颜色日换，形象渐长便吉。
六七日伍氏内托散：
生黄芪、甘草、陈皮、川芎、当归、白糯米、防风、僵蚕、皂角刺、银花。
血热者不用防芎归；表疏者去僵蚕、皂角刺；血热仍用丹皮、地黄、紫草、连翘、羚羊角。
猪尾、鸡冠、鸡鸣散达表之药；猪尾膏通里之药。
保元汤：
人参、黄芪、炙甘草。
加川芎、当归名芎归保元；虚寒加肉桂；升顶加鹿茸；气滞正气加广皮、厚朴；泻加木香、肉果。
质弱加坎炁、紫河车；呕逆加丁香、厚朴。
木香散：
人参、木香、丁香、大腹皮、桂心、青皮、诃子、半夏、甘草、前胡、赤茯苓。
异功散：
人参、木香、官桂、广陈皮、当归、茯苓、丁香、白术、附子、肉果、厚朴、半夏。
七八九日，频用清凉，痘火色既退，浆不能透，或有半浆，顶有箬笠之形，不克充灌。今人多用桑虫浆生用，鸡冠血生用，同酒浆和服。倘攻起，少顷后呆滞者，须用补托。
伍氏攻发药用老人牙研极细，加麝香少许，每服二三分，名黑灵丹。
右僵蚕乃疏表风药，山甲乃攻经隧风药。一味为末，酒浆服，曰独胜散。
凡是虫蚁皆攻，无血者走气，有血者走血。飞者升，地行者降。凡是浆足声音哑者不妨，骤喘痰升者大忌。翁仲仁说：挫喉声哑，浆行饱满亦无妨。盖痘浆因热气以炼成，必升腾以达头面。肺位最高，热上蒸迫，肺先受损，是以声出不扬。倘喘急扶肚抬胸，乃火毒归肺，必不治矣。
火毒归肺，幼科每用珠子、牛黄膏连之属，多不效。我遵孙思邈苇茎汤，或仲景葶苈大枣汤，间有效者。肺气壅遏，苦寒直下，已过病所，故无效。
方书以六七日以前寒战属肺热，六七日以后寒战属气虚。六七日以前切牙属胃热，六七日以后切牙属血虚。亦属定论。
八九日痒塌切牙，痘不起浆，或灰白，或涸或瘪，危险极矣。速速温补，亦可望生。翁仲仁说：塌陷切牙，便实声清犹可治。声清则上无热壅痰聚，便实则腑阳未至尽泄。所以温补得效耳。木香散、异功散。
八九日顺痘，浆色苍黄，毒瓦斯悉化，亦云垂成。须谨防护持，搔损流脓裂血。倘正气大泄，毒从虚陷，常有不治之患。斯时预嘱伴母勿懈，使痂靥干结，肌肉完固，便是全功。若痘已破碎，声不哑者，毒不陷也，无妨。
伍氏方用芍药汤：
炒白芍、苡仁、茯苓、地骨皮、银花、百合、山药、建莲。
十一二日，渐次成痂之际，极好之症，必有咳嗽，或夜暮身热。世俗幼科，都说毒瓦斯未尽，概投苦寒，多有胃减废食，酿成痘劳童怯者。我曾论痘自肾脏骨髓之中，由肝主筋，心主血脉，脾主肌肉，肺主皮毛，从内之外，毒乃涣释。收疤之时，真气归里，肺合皮毛，是为末传。处位高，体清肃，从前灌胀成痂，蒸迫之气，受亏已极，气泄为咳矣。况投利湿下注药而结痂，其上焦已经转燥。若毒仍留伏，焉能收靥，此断断然也。再论幼稚，阳常有余，阴未充长。布痘至于结痂，一身脂液大损，其阴气告匮可知。故暮夜属阴时，为烦为热者，正内经云：阴虚生内热也。昔西郊吴氏女，年仅四岁，痘系顺症，幼科调治，至浆满成痂之日，忽发烦躁，夜热不寐，晨起安然。医用保元，及钱氏五味异功加芍药与服，热躁益加。又更一医曰：毒瓦斯未尽，乃误补之故。用桑虫浆，暨凉解药，服后躁热甚，而添泄泻。邀余视之，睹浆痂形色，询平素起居，时日当午，即用六味地黄汤一服而安。此二条，人多忽而不究，故辨及之。旬朝后嗽，大法以甘寒生津胃药。
蔗浆、麦冬、沙参、绿豆皮、地骨皮、甘草、玉竹、甜杏仁。
解余毒药，全以不伤胃气为主。若用芩连必须酒制，翟聂二氏辨之详矣。平和无奇断不败事。如三豆饮之属。若金银花一味，本草称解毒不寒，我见脾胃虚弱者，多服即泻。伍氏用连翘饮子，亦取平和。
痘毒痈疡，热症十有七八，虚寒十有二三。甚至骨出腐败，亦有愈者。但外科大忌用火炼升药。其诊看之法，亦如疡毒，须分阴阳耳。
痘疳湿盛生热，强者用苦寒清降，以苦能去湿也。若阻咽废食，以及穿腮破颊者难治。
年长出痘，男女欲火已动，其初即现膝痛腰酸，咽喉窒痛欲闭。苦辛寒药，必不效验。宜甘咸寒，滋水制火，佐以解毒。六七日来，痛势日缓。聂氏有参麦清补方，我每用钱氏六味地黄丸，加龟胶、元参、秋石，获效者甚多。
凡是恶痘，凶危瞬刻。如诸闷症，不过三五日，已发而缩，其危最速，总在七日内。再若蒙头、锁喉、悬镜、缠腰、蜘窠、蚕种等，为十恶症。其袁氏十八恶症，今人未尝齿及。如此等痘，治之不易，难望全生。更有糖沙夹斑，十朝危期。又根枝虽好，布于岁内幼小之儿，必八九风波不治。半浆毒陷之变，必毙于十一二四之期。若能食者，十救一二。
痘至八九旬日外无浆，则里毒不化，必呛哑瘙痒，痰潮不食，眼开。条款难以尽言，危期速矣。常有忽然连串片片之痘，裂水形如松脂桃胶外露，转眼堆聚，内症渐安，变凶转吉。更有旬朝内外，干板涸如焦锅巴状，毫无生气，忽从地角承浆诸处，裂缝流臭水，渐升头额，堆肿高浓若糊脸，名曰发臭。毒泄即当补托，迟则气脱。
In the treatment of smallpox (Dou), the first authorities to be recommended are Qian Zhongyang and Chen Wenzhong. Qian's approach uses cold and cool natured medicines, while Chen's approach uses warm and hot natured medicines; their views are indeed contradictory. Zhu Danxi followed Qian and rejected Chen, emphasizing detoxification, harmonizing the middle jiao (Zhong Jiao), and stabilizing the exterior (Biao) as the key principles, using Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) as the primary formula. The world at that time adhered to this method, and no one dared to dissent. Later, Wan Quan (Wan Muzhai) focused on the spleen and stomach, while Wei Zhixiu focused on Baoyuan Tang (Preserve the Origin Decoction). Their theories were all transformations derived from the two schools of Qian and Chen. Fei Jianzhong aimed to correct biases by exclusively using Shigao (Gypsum Fibrosum) and Dahuang (Rhei Radix et Rhizoma); Hu Shenrou frequently employed sweating and purging methods. In the Songjiang and Dongdi regions, people mostly followed the teachings of Qin Jingming; in the Jingkou and Jiangning areas, Guan Cheng's "Baochi" (Protecting Infants) methods were highly regarded; in our Suzhou region, everyone strictly followed Weng Zhongren's "Jinjing Lu" (Golden Mirror Record), which can be said to be known to every household. Their success lay in "observation" rather than "treatment," with precise diagnostic views and cleverness in predicting outcomes beforehand. Later scholars like Shi and Nie deeply elaborated on the盈亏 (deficiency and excess) of qi and blood, and the detoxification and transformation of toxins, meticulously expounding upon the foundations laid by Qian and Chen, surpassing other schools. However, because they distinguished too many categories, readers might become dazzled and confused, whereas Weng Zhongren's teachings are more accessible and pleasing to the palate. Nevertheless, for examining the eyes, one must follow Master Weng's methods, while also compiling and studying treatments from various schools. Here, I will briefly list the observational methods.
Generally, if fever lasts for three days before the rash appears, this is the normal course. One usually judges auspicious or inauspicious outcomes by referring to the severity of the fever and observing specific symptoms. Weng Zhongren's "Jinjing Lu" explains this clearly, so I will not repeat it here. The remaining unpublished parts are added below.
Shanghan (Cold Damage) pathogens enter from the outside, whereas the heat of smallpox arises from within. It is merely that seasonal pathogens trigger the eruption, which is a different pathway from Shanghan.
For infants under one year old, it is very common to see convulsions, coma, and confusion immediately upon the onset of fever. The secular view holds that "Jing Dou" (Smallpox accompanied by fright/convulsions) has the best prognosis, but this statement is not entirely accurate. Medical texts state: those who have convulsions before the rash appear survive, while those who have convulsions after the rash appear die. Frequent convulsions most often lead to "Men Dou" (stagnant smallpox/toxin trapped inside). Generally, the toxin moves from the Kidney to the Liver, then to the Heart, Spleen, and Lung, progressing from the interior to the exterior, from deep to shallow. Before eruption, the smallpox heat already stirs internally, manifesting as a crystal-like brilliance in the eyes, indicating Kidney heat. Water (Kidney) generates Wood (Liver) and enters the Liver; Wood generates Fire (Heart) and enters the Heart; Fire generates Earth (Spleen) and enters the Spleen; Earth generates Metal (Lung) and enters the Lung. The congenital smallpox toxin passes from the extreme yin to the yang, relying entirely on the body's Yuan Qi (Original Qi) to lead and carry it, enriching and growing it, transforming the toxin into pus. The pus must be thick and mature to form scabs. Once the toxin is excreted externally and the Yuan Qi returns internally, there will be no complicated cases. Infants under one year old have small bodies and weak Yuan Qi; some may erupt after just one day of fever, which can still be a favorable case. However, one must observe whether the spirit is calm or agitated, and the severity of the fever. If spots appear slowly, grow steadily, the fever subsides, and breastfeeding is peaceful, it is a good sign. If the spirit is calm and the fever is not severe, but the spots are few, dull in shape and color, or falling off at the head and feet, with a pulse that is loose and fails to bind the sinews and bones, accompanied by faint sighing, shortness of breath resembling asthma, vomiting, or diarrhea, these are most likely cases of stagnant smallpox.
If between the second and third days, the smallpox buds have grown and the color is quite good, yet the child remains restless and irritable day and night, one must guard against the appearance of Ding (carbuncles) in hidden areas, as well as macules and rashes mixed with the smallpox.
If there is irritability upon the onset of fever, and although spots are visible, the heat and restlessness increase further, careful inquiry without negligence is required, combined with an analysis of accompanying symptoms. If caused by the stagnation of the Six Qi, treat according to seasonal diseases; if caused by internal injury and stagnation, treat according to interior syndromes. There are also methods for resolving both exterior and interior simultaneously, or using purgative methods. However, when using purgatives, among cold-cooling herbs, one must include blood-activating and qi-regulating herbs to prevent coagulation and freezing stagnation.
Initially, spots must appear in three batches; once the fever stops, they should be complete. Supplementary spots may also emerge continuously. One must observe if the color is lively, as the rapid change of vital energy is crucial. By examining the form and distinguishing symptoms, the treatment methods and medications involve using exterior-releasing herbs to activate blood and unblock the muscles, followed by blood-cooling and detoxifying herbs. For excess heat with constipation, mild purgation is used; for weakness and timidity, exterior-releasing and cold-cooling herbs are contraindicated. Occasionally, there are weak children with deficiency-cold, where the initial eruption shows little fever, cold limbs, vomiting milk, diarrhea, failure of spots to rise, faint voice, and a pale, formless complexion, occurring within one or two days. I once treated a daughter of the Cheng family, aged only half a year, who had numerous eruptions. The spots were flat, pale white, and the aforementioned symptoms appeared sequentially. Local pediatricians prescribed herbs such as Jingjie (Schizonepeta), Fangfeng (Saposhnikovia), Niubangzi (Arctium), Chantui (Cicada Slough), Honghua (Carthamus), Shan Zha (Crataegus), Mutong (Akebia), Huisu (Coriander), and Sunjian (Bamboo Shoot Tip). Although the prescription was written, they hinted at a dangerous prognosis. Upon my consultation, I stated: The toxin is heavy and qi is deficient, making it untreatable by standard means. However, since there is no fever and the symptoms indicate deficiency-cold, and it is not due to pestilential qi or exterior pathogens, why use exterior-releasing drugs? Examining Wan Quan's approach, which always prioritizes the spleen and stomach, I administered Lizhong Tang (Regulate the Middle Decoction) with Dingxiang (Caryophylli Flos) and Rougui (Cinnamomi Cortex). After one dose, the limbs warmed and vomiting stopped. After another dose, diarrhea slowed and spots rose. Then, two doses of Renshen (Ginseng), Danggui (Angelicae Sinensis Radix), and Lurong (Cervi Cornu Pantotrichum) were given, followed by Yi Gong San (Extraordinary Efficacy Powder) from Qian Yi, resulting in recovery.
When examining smallpox, first discuss the child's physical strength and distinguish skin color. Pale white indicates qi deficiency; dark/cyan indicates blood heat. A thin, emaciated appearance suggests chronic illness; excessive thirst for milk or soft, white, tender skin indicates the smallpox will be bright. Dark, coarse skin indicates dull color. Emaciation and dryness require long-term nourishment based on the stage, ensuring interior harmony. Even ordinary smallpox in a sickly body is difficult to manage. The rhyme states: "Emaciated form, bones like firewood; withered muscles, depleted spirit. Such widespread eruptions, even with full pustules, are lamentable."
If upon first sight, there is lower back pain, leg weakness, and inability to stand, it is fatal. This indicates toxin latent in the Kidney.
If upon first sight, there is abdominal distension and high chest, followed by worsening wheezing and hiccups, it is fatal.
If upon first sight, the eyes are staring blankly, dim, lacking luster, or with uneven black and white pupils, all belong to tight-stagnation syndromes.
If upon first sight, the child is constantly irritable, fear carbuncles and macules. Carbuncles appear in hidden areas and are often fatal.
If upon first sight, the smallpox does not continue to erupt, macules are deep purple, gradually turning blue-black, death occurs within six days.
If upon first sight, purple macules begin to rise, but the smallpox recedes, this is called "Purple Macules with White Stagnation."
If upon first sight, smallpox and macules are intermixed, resembling wine red dotted with ink, death is certain.
The above discusses the initial observational methods to determine auspicious or inauspicious outcomes. After eruption is complete and fever subsides, none of these malignant signs should be present. Weng Zhongren said: By the third or fourth day, eruptions should be complete, reaching the soles of the feet, and the condition should stabilize. For young children, whose qi and blood circulate easily, eruptions may complete in less than three days. For older children, eruptions may continue beyond four days. If the smallpox is sparse, numbering less than a hundred, it need not reach the soles. Weng Zhongren's main point is that complete eruption with stability removes worry about complications. However, one must distinguish the form and color of the smallpox. Only if the body is strong and the smallpox is of upper-middle quality can one be assured. If the child is young, weak, post-illness, or suffering from other diseases, do not lightly declare safety just because the smallpox looks good. Further, carefully consider the winter and summer climates to ensure accuracy.
Current formulas for the initial stage favor general muscle-relieving and exterior-releasing methods (Sixteen Ingredients):
Jingjie (Schizonepetae Herba) - not used on day 4; Fangfeng (Saposhnikoviae Radix) - not used on day 3; Qianhu (Peucedani Radix) - not used on day 3; Niubangzi (Arctii Fructus) - not used on day 4; Zicao (Leonuri Herba) - contraindicated if stool is loose on days 2-3; Mutong (Akebiae Caulis); Honghua (Carthami Flos); Gancao (Glycyrrhizae Radix et Rhizoma); Chishao (Paeoniae Radix Rubra); Tianchong (Bombyx Batryticatus); Shan Zha (Crataegi Fructus); Chuanxiong (Chuanxiong Rhizoma); Lianqiao (Forsythiae Fructus); Jiegeng (Platycodonis Radix); Guangpi (Citri Reticulatae Pericarpium); Chantui (Cicadae Periostracum) - not used on days 3-4.
Medical texts prescribe Shengma Gegen Tang (Cimicifugae and Puerariae Decoction) before spots appear, but modern practitioners do not use it. Wu's method contraindicates Shengma when spots appear, and later scholars also contraindicate Gegen for its dispersing nature.
These are light, ascending, exterior-releasing generic drugs. If interior syndrome is urgent, simultaneous resolution of exterior and interior is needed.
Wu's formula uses Qiangfang Touji Tang (Notopterygii and Saposhnikoviae Muscle-Penetrating Decoction) on days 1-2, but modern practitioners avoid it due to its acrid-warm and potent nature. On days 1-2, with high fever, rapid breathing, irritability, thirst, and constipation, and no eruption, Weng Zhongren said: If not due to wind-cold stagnation, it must be qi deficiency failing to uplift. I believe recent smallpox outbreaks often occur during periods governed by Ministerial Fire, Wind-Wood, and Dryness-Metal. Fire must erupt to allow eruption. "Fire depression requires venting"; raising yang and scattering fire is appropriate. However, if the preceding symptoms involve severe interior heat burning fluids, bitter-cold purgation assisted by exterior-raising herbs is necessary. Fei Jianzhong's formula is quite accurate.
Shigao (Gypsum Fibrosum); Dahuang (Rhei Radix et Rhizoma); Lianqiao (Forsythiae Fructus); Chishao (Paeoniae Radix Rubra); Qingpi (Citri Reticulatae Pericarpium Viride) - for abdominal pain; Shan Zha (Crataegi Fructus); Huafen (Trichosanthis Radix); Zicao (Leonuri Herba); Mutong (Akebiae Caulis); Danpi (Moutan Cortex) - acrid-cool entering blood; Xijiao (Rhinocerotis Cornu) - acrid-cool unblocking blood.
After completion, use Huanglian (Coptidis Rhizoma).
Any cold-cooling, fire-clearing, and detoxifying treatment must be assisted by blood-activating and smoothing herbs to prevent stagnation of qi and blood.
For excess heat and constipation, generally use Liangge San (Cool the Diaphragm Powder), Tongsheng San (Unimpeded Generation Powder), Qianhu Zhike Tang (Peucedani and Aurantii Fructus Decoction), or Sishun Qingliang Yin (Four-Obedience Cooling Drink).
On the fourth day, when eruptions reach the feet, Wu's follows ancient formulas using Niubangzi powder (three fen), mixed with water chestnut juice and fermented rice wine, heated, and ten drops of fresh rooster comb blood added before administration. For mild toxin, the spots become smooth and lustrous; the world follows this method.
On the fourth or fifth day after completion, use blood-cooling and detoxifying decoctions. Wu's calls this Sisheng Yin (Four Sages Drink), not the original formula of Bian Que.
Shengdi (Rehmanniae Radix); Lianqiao (Forsythiae Fructus); Yinhua (Lonicerae Japonicae Flos); Honghua (Carthami Flos); Gancao (Glycyrrhizae Radix et Rhizoma); Tianchong (Bombyx Batryticatus); Jiegeng (Platycodonis Radix); Zicao (Leonuri Herba) - use Zi Diao (purple clay pot) if stool is loose.
Add Danpi (Moutan Cortex) and Xijiao (Rhinocerotis Cornu) for blood heat; add Huanglian (Coptidis Rhizoma), Shigao (Gypsum Fibrosum), and Lingyangjiao (Saigae Tataricae Cornu) for intense fire; add Jinzhi (Calaminis Nigra) and Xuanshen (Scrophulariae Radix) for macules; add Chuanxiong (Chuanxiong Rhizoma) and Jiguanxue (Roostri Combis Sanguis) if head/face spots fail to rise; add Shegan (Belamcandae Rhizoma), Xuanshen (Scrophulariae Radix), and Shandougen (Sophorae Tonkinensis Radix) for sore throat; add Dilong (Pheretima) juice for mania/restlessness; add Zhuweixue (Porci Cauda Sanguis) for heavy toxin and blood coagulation; Bingpian (Borneolum Syntheticum) - dosage depends on age. Modern blood-cooling and detoxifying often use Dideng (Violaris Herba) and Yinhua (Lonicerae Japonicae Flos) decoction.
When examining smallpox, initially look at the base (root disk). The spots should grow and open easily. If pointed and thin, not plump, it is dangerous. After becoming pustules, the root disk must transform into a line, with a red circle tightly attached, and the top full and round, indicating toxin transformation. If the top is sunken/wrinkled and the root disk is dark/stiff, the toxin and qi/blood are coagulated. Excess requires attacking; deficiency requires tonifying.
Excess fire requires clearing; attacking should not be early. Only if the fire color is bright red and the spot form/color is moist can one attack and support. Otherwise, scratching leads immediately to dry peeling and toxin sinking, which is untreatable.
Deficiency is divided into blood deficiency and qi deficiency. Blood deficiency manifests as heat; qi deficiency as cold. But deficiency heat differs from excess heat; deficiency heat uses nourishing and cooling formulas.
The smallpox top belongs to qi; the root disk belongs to blood. Qi leads and blood carries; the toxin is transformed into pus. Strong constitutions often have fire; use cooling agents. Mis-tonification causes abscesses (Yong). Yong means obstruction. Weak qi and blood result in pale color, lack of majesty, sunken tops, or wrinkled skin. Interior symptoms include nausea, poor appetite, and loose stools. Young children not yet eating grains have thin intestines/stomachs and are prone to deficiency. From the seventh day onward, Yuan Qi takes charge but cannot overcome the toxin, leading to outward expulsion; many cases suffer inward sinking and complications. I focus intently on this condition, achieving effective results with regulation. Wei's Baoyuan Tang, Nie's Shen Gui Lu Rong Tang, Chen's Muxiang Yigong San. For slippery intestines, use Qiwai Doukou Wan (Seven-Ingredient Cardamom Pill), Baizhu San (Atractylodis Macrocephalae Powder), or Lizhong Tang, often obtaining miraculous effects. Severe cases require three doses.
Generally, children with white/tender skin have many deficiency cases; those with dark/coarse skin have many excess fire cases. Though general, this is crucial. White/tender eruptions are bright; do not assume this is always auspicious. Dark/coarse eruptions are dull; do not assume this is always inauspicious. Overall, calm spirit, changing colors daily, and gradual growth indicate auspiciousness.
On the sixth/seventh day, Wu's Neituo San (Interior-Supporting Powder):
Sheng Huangqi (Astragali Radix); Gancao (Glycyrrhizae Radix et Rhizoma); Chenpi (Citri Reticulatae Pericarpium); Chuanxiong (Chuanxiong Rhizoma); Danggui (Angelicae Sinensis Radix); Bai Nuomi (Oryza Sativa Glutinosa); Fangfeng (Saposhnikoviae Radix); Tianchong (Bombyx Batryticatus); Jiaoci (Unguis Spinae Cervi); Yinhua (Lonicerae Japonicae Flos).
Do not use Fang, Xiong, Gui for blood heat; remove Tianchong and Jiaoci for exterior looseness; for blood heat, still use Danpi (Moutan Cortex), Dihuang (Rehmanniae Radix), Zicao (Leonuri Herba), Lianqiao (Forsythiae Fructus), Lingyangjiao (Saigae Tataricae Cornu).
Zhuwei (Porci Cauda), Jiguan (Roostri Combis), Jiming San (Chicken-Crowing Powder) are exterior-reaching drugs; Zhuweigao (Porci Cauda Ointment) is interior-penetrating.
Baoyuan Tang (Preserve the Origin Decoction):
Renshen (Ginseng Radix et Rhizoma); Huangqi (Astragali Radix); Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma).
Add Chuanxiong (Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix) to name Xiong Gui Baoyuan; add Rougui (Cinnamomi Cortex) for deficiency-cold; add Lurong (Cervi Cornu Pantotrichum) to raise the top; add Guangpi (Citri Reticulatae Pericarpium) and Houpo (Magnoliae Officinalis Cortex) for qi stagnation; add Muxiang (Vladimiriae Radix) and Rouguo (Myristicae Semen) for diarrhea.
For weak constitution, add Kanqi (Umbilical Cord) and Heche (Placenta Hominis); for vomiting/reversal, add Dingxiang (Caryophylli Flos) and Houpo (Magnoliae Officinalis Cortex).
Shen Gui Lu Rong Tang (Ginseng, Angelica, and Deer Antler Decoction):
Renshen (Ginseng Radix et Rhizoma); Danggui (Angelicae Sinensis Radix); Lurong (Cervi Cornu Pantotrichum); Huangqi (Astragali Radix); Longyanrou (Longan Arillus); Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma).
Muxiang San (Vladimiriae Powder):
Renshen (Ginseng Radix et Rhizoma); Muxiang (Vladimiriae Radix); Dingxiang (Caryophylli Flos); Dafupi (Arecae Pericarpium); Guixin (Cinnamomi Ramulus); Qingpi (Citri Reticulatae Pericarpium Viride); Hezi (Terminaliae Chebulae Fructus); Banxia (Pinelliae Rhizoma); Gancao (Glycyrrhizae Radix et Rhizoma); Qianhu (Peucedani Radix); Chifuling (Poria cum Ligno Rosae);
Yigong San (Extraordinary Efficacy Powder):
Renshen (Ginseng Radix et Rhizoma); Muxiang (Vladimiriae Radix); Guangen (Cinnamomi Ramulus); Guangpi (Citri Reticulatae Pericarpium); Danggui (Angelicae Sinensis Radix); Fuling (Poria); Dingxiang (Caryophylli Flos); Baizhu (Atractylodis Macrocephalae Rhizoma); Fuzi (Aconiti Lateralis Radix Praeparata); Rouguo (Myristicae Semen); Houpo (Magnoliae Officinalis Cortex); Banxia (Pinelliae Rhizoma).
Doukou Wan (Cardamom Pill):
Rouguo (Myristicae Semen); Muxiang (Vladimiriae Radix); Sharen (Amomi Fructus); Kufan (Alumen); Hezi (Terminaliae Chebulae Fructus); Longgu (Fossilia Ossis Mastodi et Scapulae); Chishizhi (Halloysit Rubra).
Baizhu San (Atractylodis Macrocephalae Powder): Si Jun Zi Tang (Four Gentlemen Decoction) plus Huoxiang (Agastaches Herba) and Muxiang (Vladimiriae Radix).
On the seventh, eighth, ninth days, frequently use cooling agents. If the smallpox fire color subsides but pus does not penetrate, or only half-pustules form with a reed-cap shape unable to fill, modern practitioners often use raw Sangchong Jiang (Mulberry Silkworm Juice) and raw Jiguanxue (Rooster Comb Blood), mixed with wine and taken together. If they rise but become dull shortly after, tonification and support are needed.
Wu's attacking and promoting drug uses ground old human teeth, finely powdered, with a little Moshe (Musk), two to three fen per dose, named Heiling Dan (Black Spirit Pill).
Tianchong (Bombyx Batryticatus) is a wind-drug for releasing the exterior; Shan Jia (Mantis Ovipositor) is a wind-drug for penetrating meridians. One ingredient powdered, taken with wine, is called Dusheng San (Single Victory Powder).
All insects/ants attack; those without blood move qi; those with blood move blood. Flying ones ascend; earth-walking ones descend. If pus is full and voice is hoarse, it is acceptable; sudden asthma and rising phlegm are strictly contraindicated. Weng Zhongren said: Hoarseness from throat constriction is fine if pus is full. Smallpox pus is refined by heat and must ascend to the head/face. The Lung position is highest; heat steams upward, damaging the Lung first, hence the muffled voice. If asthma is urgent, requiring leaning forward and lifting the chest, it indicates fire-toxin returning to the Lung, which is untreatable.
For fire-toxin returning to the Lung, pediatricians often use Pearl and Calculus Bovis ointments, but they are often ineffective. I follow Sun Simiao's Weijing Tang (Eupatorium Decoction) or Zhang Zhongjing's Tingli Dazao Tang (Descurainiae Seed and Jujube Decoction), occasionally effective. If Lung qi is obstructed, bitter-cold downward purgation misses the disease site, hence ineffective.
Medical texts state: chills before the sixth/seventh day belong to Lung heat; chills after the sixth/seventh day belong to qi deficiency. Teeth grinding before the sixth/seventh day belongs to Stomach heat; teeth grinding after the sixth/seventh day belongs to blood deficiency. This is a fixed conclusion.
Itching, collapse, and teeth grinding on the eighth/ninth day, with no pus formation, gray-white color, drying, or shrinking, is extremely dangerous. Rapid warming and tonification may offer hope. Weng Zhongren said: Collapse and teeth grinding are treatable if stool is solid and voice is clear. Clear voice means no heat/phlegm congestion above; solid stool means fu-yang is not fully exhausted. Hence, warming and tonification work. Muxiang San, Yigong San.
Smooth smallpox on the eighth/ninth day, with yellowish-brown pus, toxin fully transformed, is nearly complete. Must guard carefully against scratching, suppuration, and bleeding. If righteous qi is greatly depleted and toxin sinks due to deficiency, there is often untreatable danger. At this time, instruct nurses not to slacken, ensuring scabs dry and flesh heals completely, achieving full success. If smallpox is broken but voice is not hoarse, toxin has not sunk, and it is harmless.
Wu's formula uses Shaoyao Tang (Peony Decoction):
Chao Baishao (Prepared Paeoniae Radix Alba); Yiren (Coicis Semen); Fuling (Poria); Digupi (Lycii Cortex); Yinhua (Lonicerae Japonicae Flos); Baihe (Lilii Bulbus); Shanyao (Dioscoreae Rhizoma); Jianlian (Nelumbinis Plumula).
On the eleventh/twelfth day, as scabs gradually form, it is an excellent sign. There must be coughing or evening fever. Secular pediatricians say toxin is not fully cleared and indiscriminately administer bitter-cold herbs, often reducing stomach function and causing loss of appetite,酿成 (brewing) smallpox consumption and childhood frailty. I have argued that smallpox originates from the Kidney marrow, passes through the Liver (tendons), Heart (blood vessels), Spleen (muscles), and Lung (skin/hair), dispersing from interior to exterior. During scar healing, true qi returns inward; the Lung governs skin/hair, marking the final transmission. Located high, pure and descending, the qi from previous swelling and scabbing has suffered extreme depletion, leaking as cough. Moreover, administering damp-draining downward herbs to form scabs dries the upper jiao. If toxin remains latent, how can scabs heal? This is certain. Furthermore, children have constant excess yang and insufficient yin. From eruption to scabbing, body fluids are greatly damaged, indicating yin deficiency. Thus, evening (yin time) irritability and fever align with the Classic of Internal Medicine: "Yin deficiency generates internal heat." Once, a girl of the Wu family in West Suburb, aged four, had smooth smallpox. Pediatric treatment until full pus and scabbing led to sudden irritability, night fever, insomnia, but peace in the morning. Doctors used Baoyuan Tang and Qian's Wuwei Yigong San with Shaoyao, increasing heat/restlessness. Another doctor said: Toxin not cleared, due to mistaken tonification. Used Sangchong Jiang and cooling/dispersing drugs, causing severe restlessness and diarrhea. Upon my visit, observing the pus/scab form and asking about daily routine, at noon, I administered Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) once, bringing peace. These two cases are often ignored, so I clarify them. For cough after ten days, the general method is sweet-cold herbs to generate fluids and benefit the stomach.
Zhe Jiang (Sugar Cane Juice); Maidong (Ophiopogonis Tuber); Shashen (Glehniae Radix); Ludoupi (Phaseoli Semen Cuticle); Digupi (Lycii Cortex); Gancao (Glycyrrhizae Radix et Rhizoma); Yuzhu (Polygonati Odorati Rhizoma); Tian Xingren (Sweet Almond).
Residual toxin removal focuses primarily on not damaging stomach qi. If using Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma), they must be wine-processed; Shi and Nie detailed this. Mild and unremarkable formulas do not cause harm, such as Sandou Yin (Three Beans Drink). As for Yinhua (Lonicerae Japonicae Flos), Materia Medica states it detoxifies without being cold, but I have seen those with weak spleen/stomach develop diarrhea with frequent use. Wu's uses Lianqiao Yinzi (Forsythia Drink), also seeking mildness.
Smallpox toxin and sores/ulcers: 70-80% heat syndromes, 20-30% deficiency-cold. Even bone exposure and corruption can heal. However, surgery strictly forbids fire-refined sublimates. Diagnostic methods are similar to ulcer toxins, requiring differentiation of yin and yang.
Smallpox ulcers with dampness generating heat: strong constitutions use bitter-cold clearing/descending, as bitterness removes dampness. If swallowing is blocked, food refused, or cheeks/jaws perforate, it is difficult to treat.
Older children erupting, with sexual desire active, initially show knee pain, waist soreness, and throat suffocation/pain. Acrid-warm-cold drugs are ineffective. Use sweet-salty-cold to nourish water and control fire, assisting with detoxification. After six/seven days, pain eases. Nie's Shenmai Qingbu Fang (Ginseng and Ophiopogon Clearing-Tonifying Formula); I often use Qian's Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) with Gujiao (Testudinis Carapax et Plastrum), Xuanshen (Scrophulariae Radix), and Qushi (Urini Concretio), achieving many successes.
If pus refuses to rise and frequent sticky saliva is vomited, it is ominous.
All malignant smallpox are dangerous in an instant. Like various stagnant syndromes, within three to five days, erupted spots retract, danger is fastest, always within seven days. Also, Head-Hiding, Throat-Locking, Hanging Mirror, Waist-Wrapping, Spider Nest, Silkworm Seed, etc., are the Ten Evils. Yuan's Eighteen Evils are rarely mentioned today. Such smallpox are hard to treat, with little hope for full survival. More so, Sugar-Sand mixed with macules, critical at ten days. Even if roots/branches are good, in infants within the year, nine or eight storms are untreatable. Half-pus toxin sinking changes die on the eleventh/twelfth/fourth days. If able to eat, one in ten survives.
Smallpox without pus after eighty to ninety days means interior toxin is not transformed, leading to choking, hoarseness, itching, phlegm flooding, refusal to eat, and open eyes. Clauses cannot exhaustively describe; danger period is swift. Often, suddenly connected patches of smallpox split, water leaking like pine resin or peach gum, accumulating quickly, interior symptoms gradually calming, turning from凶 (inauspicious) to吉 (auspicious). More commonly, within ten days, dry plates dry up like scorched rice crusts, devoid of vitality, suddenly cracking from corners and Chengjiang area, flowing foul water, gradually rising to forehead, swelling high and thick like face paste, named "Fa Chou" (Emitting Stench). When toxin excretes, tonification and support are immediate; delay leads to qi collapse.