陈文宿先生云∶痘疮出不快，误言毒瓦斯壅盛，用药宣利解散，致脏腑受冷，荣卫涩滞，则血气不能充实，其疮不起
发，不光泽，不充满，不结实，不能成痂，多致痒塌烦躁，喘渴而死。窃谓海藏云∶痘疮出不快，如身后出不快者，足
太阳经也，用荆芥甘草防风汤。如身前出不快者，足阳明经也，用升麻葛根汤。身侧出不快者，足少阳经也，用防风芍
药甘草汤。若便利调和而出不快者，热在表也，宜葛根汤微发之。又有上中下三部，先上部，次中部，又次下部，才出
齐而自愈。又有作三次而出者。钱氏云∶三日不快不出，用消毒之药，仍不出，脉平静者本稀也，不必服药。大凡五六
日间，当解毒补托，以尽发于表。七八日间毒瓦斯不能尽出，而反入于内，必用药驱出之。《痘疹方》云∶疮起迟而小便
涩滞，咳嗽有痰，用仙圣散。出而不长，隐于肌肤，用人参透肌散。色赤而出不快，用紫草透肌散。出而不匀，用升均
汤。出而不长不贯，用参 四圣散。出而色不红活，用紫草快斑汤。出而小便赤涩，用紫草木通汤。出而浆不回，用参
内托散。若色赤而兼痒者，属血虚有热，用四物、牡丹皮。色白而兼痒者，属气虚有热，用五味异功散加当归、木
香。若发热大便秘者，用犀角消毒散。发热大便调和者，用人参麦门冬饮。寒战渴泻，饮沸汤口不知热，用十二味异功
散。作渴饮冰雪，口不知寒，用四顺饮、地黄丸。手足不冷，饮汤温和者，用五味异功散，或托里散。
一小儿发热痘出身凉，根颗红活。余谓表里血气皆实，而不用药，后果然。凡三四日前先发热而痘出，或热一次，
凉一次而痘出者，毒势轻也，皆不必用药。其血气实而托里，血气虚而宣毒者，多致有误。
一小儿痘出不快，色次红活，此血气虚弱，用参 四圣散，出而色赤，再剂，色红活起发，又用透肌散而靥。
一小儿第九日痘将靥而热不止，脉滑而数，皆为不治，先君谓痘未尽耳，非败症。遂用快 汤一剂，果出一番，至
十七日而痂落。
一男子发热咳嗽，嚏喷面燥，腮颊目胞皆赤，遍身赤 ，余谓此心脏痘疹之状也。彼因疑惑而未用药饵，旬余赤
皆为脓 ，且红活起发，余谓痘疹明矣，既红活起发，不必服药。至十七日大便下脓血，疮痂而痊。
紫草透肌散 治痘疮色赤不快或痒塌。
紫草 蝉蜕 木通 芍药 甘草（炙，各等分）
上每服三钱，水煎。
人参透肌散 治痘疮虚而有热，虽能出快而不齐整，隐于肌肤间者。
人参 紫草（如无，红花代之） 白术 茯苓 当归 芍药 木通 蝉腿 甘草 糯米（各等分）
上每服三钱，水一盏半，煎半盏，徐徐服。
紫草木通散 治痘疹出不快，小便赤涩。
紫草 木通 人参 茯苓 糯米（各等分） 甘草（减半）
上每服二钱，水煎。
防风芍药甘草汤
防风 芍药 甘草
上每服一二钱，水煎。
荆芥甘草防风汤
荆芥 甘草 防风（各等分）
上每服一钱，水煎。
升均汤 治痘疮已出不均，或吐泻热渴。
升麻 干葛 芍药 人参 白术 茯苓 甘草 紫草茸（如无，红花代之）
上每服三五钱，姜水煎，量服之。
四物汤 治痘疮血虚发热，或烦躁不寐，作痒色赤。
当归 熟地黄（各二钱） 芍药（炒） 川芎（各一钱）
上水煎服。
仙圣散 治痘出不快，小便赤涩，咳嗽有痰。
紫草 枳壳 黄 甘草 木通（各等分）
上每服二钱，水煎。
十二味异功散（方见痘灰白色）
葛根汤
参 内托散（二方见腹胀气促）
升麻葛根汤（方见水痘麻痘）
紫草快 汤（方见大便不通）
四物汤（方见痘疮出迟）
人参麦门冬散（方见前）
参 四圣散（方见腹胀气促）
五味异功散（方见寒战切牙）
犀角消毒散（方见发 ）
清凉散（方见大便不通）
地黄丸（方见痘疮发热属阴属阳）
陈文宿先生说：痘疮发出迟缓，如果错误地认为是毒气壅盛，使用药物进行通利和解散治疗，会导致脏腑受寒，营卫运行涩滞，使得血气不能充实。这样痘疮就不能起发，没有光泽，不饱满，不结实，不能结痂，多导致瘙痒塌陷、烦躁、气喘口渴而死亡。我认为海藏先生说过：痘疮发出迟缓，如果是从背部开始发出迟缓的，属于足太阳经病变，用荆芥甘草防风汤。如果是从身体前面开始发出迟缓的，属于足阳明经病变，用升麻葛根汤。如果是从身体侧面开始发出迟缓的，属于足少阳经病变，用防风芍药甘草汤。如果大小便正常但痘疮发出迟缓的，是热邪在表，适宜用葛根汤轻微发汗。又有分为上、中、下三部，先从上部出，再从中部出，最后从下部出，等全部出齐就会自愈。又有分三次发出的情况。钱乙说：三天内痘疮不出或出得慢，用解毒的药物；如果仍然不出，脉象平静的，是因为痘疹本来稀疏，不必服药。大凡在五六天期间，应当解毒补托，使痘疹完全发于体表。到了七八天，毒气不能完全发出，反而陷入体内，必须用药将其驱出。《痘疹方》说：痘疮起发迟缓且小便涩滞，咳嗽有痰，用仙圣散。痘疮发出但不生长，隐没在肌肤间，用人参透肌散。痘疮颜色红赤且发出迟缓，用紫草透肌散。痘疮发出不均匀，用升均汤。痘疮发出但不生长且不连贯，用参四圣散。痘疮发出但颜色不红润鲜活，用紫草快斑汤。痘疮发出且小便红赤涩痛，用紫草木通汤。痘疮发出但浆液不回缩，用参内托散。如果颜色红赤兼有瘙痒的，属于血虚有热，用四物汤加牡丹皮。颜色白兼有瘙痒的，属于气虚有热，用五味异功散加当归、木香。如果有发热且大便秘结的，用犀角消毒散。发热但大便正常的，用人参麦门冬饮。有寒战、口渴、腹泻，喝热水却感觉不到热的，用十二味异功散。想喝冰雪水，喝冷水却感觉不到冷的，用四顺饮、地黄丸。手足不冷，喝温水舒服的，用五味异功散，或托里散。
有一个小孩发热出痘后身体转凉，痘根颗粒红润鲜活。我说这是表里血气都充实，所以不用药，后果然如此。凡是前三四天先发热然后痘出，或者热一次、凉一次然后痘出的，说明毒势轻，都不必用药。那些血气充实却用托里法（补益），血气虚弱却用宣毒法（发散）的，大多会导致误治。
有一个小孩痘疮发出迟缓，颜色次红鲜活，这是血气虚弱，用参四圣散，痘出后颜色变红，再服两剂，颜色变得红润鲜活并起发，又用透肌散直到结痂。
有一个小孩第九天痘疮即将结痂但热势不止，脉象滑而数，这都是不治之症，先父认为这是因为痘毒未尽，不是败症。于是用快斑汤一剂，果然又发出一番痘疹，到第十七天结痂脱落。
有一个男子发热咳嗽，打喷嚏，面部干燥，腮颊和眼睑都发红，全身皮肤红赤，我说这是心脏痘疹的症状。他因为疑惑而没有用药，十几天后红色部分都化为脓疱，并且红润鲜活地起发，我说这确实是痘疹，既然已经红润鲜活地起发，就不必再服药。到第十七天大便排出脓血，结痂而痊愈。
紫草透肌散 治疗痘疮颜色红赤发出迟缓或瘙痒塌陷。
紫草 蝉蜕 木通 芍药 甘草（炙，各等分）
以上每服三钱，用水煎煮。
人参透肌散 治疗痘疮虚而有热，虽然能发出较快但不整齐，隐没在肌肤间的。
人参 紫草（如果没有，用红花代替） 白术 茯苓 当归 芍药 木通 蝉腿 甘草 糯米（各等分）
以上每服三钱，用水一盏半，煎至半盏，慢慢服用。
紫草木通散 治疗痘疹发出迟缓，小便红赤涩痛。
紫草 木通 人参 茯苓 糯米（各等分） 甘草（减半）
以上每服二钱，用水煎煮。
荆芥甘草防风汤
荆芥 甘草 防风（各等分）
以上每服一钱，用水煎煮。
升均汤 治疗痘疮已发出但不均匀，或伴有呕吐腹泻、发热口渴。
升麻 干葛 芍药 人参 白术 茯苓 甘草 紫草茸（如果没有，用红花代替）
以上每服三五钱，用姜水煎煮，酌情服用。
四物汤 治疗痘疮血虚发热，或烦躁失眠，作痒色赤。
当归 熟地黄（各二钱） 芍药（炒） 川芎（各一钱）
以上用水煎服。
仙圣散 治疗痘出不快，小便红赤涩痛，咳嗽有痰。
紫草 枳壳 黄芩 甘草 木通（各等分）
以上每服二钱，用水煎煮。
十二味异功散（方剂见“痘灰白色”条下）
葛根汤
参内托散（两个方剂见“腹胀气促”条下）
升麻葛根汤（方剂见“水痘麻痘”条下）
紫草快斑汤（方剂见“大便不通”条下）
四物汤（方剂见“痘疮出迟”条下）
人参麦门冬散（方剂见前文）
参四圣散（方剂见“腹胀气促”条下）
五味异功散（方剂见“寒战切牙”条下）
犀角消毒散（方剂见“发斑”条下）
清凉散（方剂见“大便不通”条下）
地黄丸（方剂见“痘疮发热属阴属阳”条下）
Mr. Chen Wensu said: When smallpox eruptions are slow to appear, if it is mistakenly believed that the pathogenic heat-toxin is congested and excessive, and medicines are used to promote purgation and resolve the exterior, it will cause the internal organs to suffer from cold, leading to stagnation of Ying (Nutritive) and Wei (Defensive) Qi. Consequently, Blood and Qi cannot become sufficient, causing the lesions to fail to rise, lack luster, be insufficiently full, not firm, and unable to form scabs. This often leads to itching, collapse, restlessness, panting, thirst, and death. I hold that Mr. Haizang stated: When smallpox eruptions are slow to appear, if those on the posterior part of the body are slow, it belongs to the Foot-Taiyang Meridian; use Jingjie Gancao Fangfeng Tang (Schizonepeta, Licorice, and Saposhnikovia Decoction). If those on the anterior part of the body are slow, it belongs to the Foot-Yangming Meridian; use Shengma Gegen Tang (Cimicifuga and Pueraria Decoction). If those on the lateral parts of the body are slow, it belongs to the Foot-Shaoyang Meridian; use Fangfeng Shaoyao Gancao Tang (Saposhnikovia, Peony, and Licorice Decoction). If bowel movements and urination are harmonious but eruptions are slow, the heat is in the Exterior; it is appropriate to use Gegen Tang (Pueraria Decoction) to induce slight sweating. There is also a pattern where eruptions occur in three stages: first the upper part, then the middle, and finally the lower part; when all have appeared, they heal spontaneously. There are also cases where eruptions occur in three batches. Qian Yi said: If eruptions do not appear or appear slowly within three days, use detoxifying medicines; if they still do not appear and the pulse is calm, it is because the eruption was originally sparse, and medication is unnecessary. Generally, during the fifth to sixth day, one should detoxify and tonify/support to ensure complete eruption at the surface. By the seventh to eighth day, if the toxin cannot fully erupt and instead sinks inward, medicines must be used to drive it out. The *Douzhen Fang* (Smallpox and Measles Formulas) states: If eruptions rise slowly with obstructed urination, cough, and phlegm, use Xiansheng San (Immortal Sage Powder). If eruptions appear but do not grow, remaining hidden in the skin and muscles, use Renshen Touji San (Ginseng Skin-Penetrating Powder). If eruptions are red and slow to appear, use Zicao Touji San (Arnebia Skin-Penetrating Powder). If eruptions are uneven, use Shengjun Tang (Even-Rising Decoction). If eruptions are slow to grow and not continuous, use Shen Si Sheng San (Four Sages Ginseng Powder). If eruptions appear but are not vibrant and red, use Zicao Kuaiban Tang (Arnebia Rapid-Blanching Decoction). If eruptions appear with red and obstructed urination, use Zicao Mutong Tang (Arnebia and Akebia Decoction). If the pus does not return after appearing, use Shen Neituo San (Ginseng Interior-Supporting Powder). If the color is red with itching, it indicates Blood deficiency with Heat; use Siwu Tang (Four Substances Decoction) plus Mudanpi (Moutan Cortex). If the color is white with itching, it indicates Qi deficiency with Heat; use Wuwei Yigong San (Five-Ingredient Extraordinary Efficacy Powder) plus Danggui (Angelicae Sinensis Radix) and Muxiang (Aucklandiae Radix). If there is fever with constipation, use Xijiao Xiaodu San (Rhinoceros Horn Detoxification Powder). If there is fever with normal stools, use Renshen Maidong Yin (Ginseng and Ophiopogon Drink). If there is chills, thirst, diarrhea, and drinking boiling water feels neither hot, use Shi'erwei Yigong San (Twelve-Ingredient Extraordinary Efficacy Powder). If there is thirst for ice/snow and drinking cold water feels neither cold, use Sishun Yin (Four-Harmony Drink) and Dihuang Wan (Rehmannia Pill). If hands and feet are not cold and drinking warm water feels comfortable, use Wuwei Yigong San (Five-Ingredient Extraordinary Efficacy Powder) or Tuoli San (Supporting Interior Powder).
A child had fever followed by eruptions, then became cool, with roots and granules red and vibrant. I said this indicates both Exterior and Interior, Blood and Qi are substantial, so no medicine was needed; indeed, this proved correct. In general, if fever precedes eruptions by three to four days, or if fever comes and goes before eruptions, the pathogenic force is light, and medication is unnecessary. Those with substantial Blood and Qi who receive Tonifying Interior treatments, or those with deficient Blood and Qi who receive Promoting Toxin release treatments, often lead to errors.
A child had slow smallpox eruptions with secondary redness and vitality, indicating deficiency of Blood and Qi; Shen Si Sheng San (Four Sages Ginseng Powder) was used. After eruptions appeared red, two more doses were given, resulting in vibrant redness and rising; then Touji San (Skin-Penetrating Powder) was used until scabbing occurred.
A child on the ninth day had persistent fever as smallpox was about to scab, with a slippery and rapid pulse; these are generally considered untreatable. My late father believed this was due to incomplete toxin expulsion, not a collapsing syndrome. Thus, Kuaiban Tang (Rapid-Blanching Decoction) was administered once, resulting in another round of eruptions; by the seventeenth day, the scabs fell off.
A man had fever, cough, sneezing, dry face, red cheeks and eyelids, and generalized red skin. I said this is the manifestation of Heart-related smallpox/measles. Due to doubt, he did not take medicine. After ten-plus days, the red areas turned into pustules, becoming red and vibrant with rising; I confirmed it was smallpox/measles. Since it was already red and vibrant, no further medicine was needed. By the seventeenth day, pus and blood passed in stool, scabs formed, and he recovered.
Zicao Touji San (Arnebia Skin-Penetrating Powder): Treats smallpox with red color, slow appearance, or itching/collapse.
Zicao (Radix Arnebiae/Lithospermi), Chantui (Periostracum Cicadae), Mutong (Caulis Akebiae), Shaoyao (Radix Paeoniae Rubra/Alba), Gancao (Radix Glycyrrhizae, honey-fried), equal parts.
Take 3 qian per dose, decoct in water.
Renshen Touji San (Ginseng Skin-Penetrating Powder): Treats smallpox with deficiency and heat, where eruptions appear relatively fast but irregularly, hiding in the skin/muscles.
Renshen (Radix Ginseng), Zicao (Radix Arnebiae/Lithospermi; substitute Honghua if unavailable), Baizhu (Rhizoma Atractylodis Macrocephalae), Fuling (Sclerotium Poriae), Danggui (Radix Angelicae Sinensis), Shaoyao (Radix Paeoniae), Mutong (Caulis Akebiae), Chantui (Periostracum Cicadae), Gancao (Radix Glycyrrhizae), Nuomi (Oryza Sativa Glutinosa), equal parts.
Take 3 qian per dose, decoct in 1.5 sheng water until half remains, take slowly.
Zicao Mutong San (Arnebia and Akebia Powder): Treats slow smallpox/measles eruptions with red, obstructed urination.
Zicao (Radix Arnebiae/Lithospermi), Mutong (Caulis Akebiae), Renshen (Radix Ginseng), Fuling (Sclerotium Poriae), Nuomi (Oryza Sativa Glutinosa), equal parts; Gancao (Radix Glycyrrhizae), half amount.
Take 2 qian per dose, decoct in water.
Fangfeng Shaoyao Gancao Tang (Saposhnikovia, Peony, and Licorice Decoction)
Fangfeng (Radix Saposhnikoviae), Shaoyao (Radix Paeoniae), Gancao (Radix Glycyrrhizae).
Take 1-2 qian per dose, decoct in water.
Jingjie Gancao Fangfeng Tang (Schizonepeta, Licorice, and Saposhnikovia Decoction)
Jingjie (Herba Schizonepetae), Gancao (Radix Glycyrrhizae), Fangfeng (Radix Saposhnikoviae), equal parts.
Take 1 qian per dose, decoct in water.
Shengjun Tang (Even-Rising Decoction): Treats uneven smallpox eruptions, or vomiting/diarrhea with fever/thirst.
Shengma (Rhizoma Cimicifugae), Gan Ge (Radix Puerariae Lobatae), Shaoyao (Radix Paeoniae), Renshen (Radix Ginseng), Baizhu (Rhizoma Atractylodis Macrocephalae), Fuling (Sclerotium Poriae), Gancao (Radix Glycyrrhizae), Zicao Rong (Flos Arnebiae/Lithospermi; substitute Honghua if unavailable), equal parts.
Take 3-5 qian per dose, decoct in ginger water, adjust dosage accordingly.
Siwu Tang (Four Substances Decoction): Treats smallpox with Blood deficiency fever, restlessness, insomnia, itching, and redness.
Danggui (Radix Angelicae Sinensis), Shudihuang (Radix Rehmanniae Preparata), each 2 qian; Shaoyao (Radix Paeoniae, stir-fried), Chuanxiong (Rhizoma Chuanxiong), each 1 qian.
Decoct in water and take.
Xiansheng San (Immortal Sage Powder): Treats slow smallpox eruptions, red obstructed urination, cough with phlegm.
Zicao (Radix Arnebiae/Lithospermi), Zhike (Fructus Aurantii), Huangqin (Radix Scutellariae), Gancao (Radix Glycyrrhizae), Mutong (Caulis Akebiae), equal parts.
Take 2 qian per dose, decoct in water.
Shi'erwei Yigong San (Twelve-Ingredient Extraordinary Efficacy Powder) (Formula see entry "Ashy White Smallpox")
Gegen Tang (Pueraria Decoction)
Shen Neituo San (Ginseng Interior-Supporting Powder) (Two formulas see entry "Abdominal Distension and Shortness of Breath")
Shengma Gegen Tang (Cimicifuga and Pueraria Decoction) (Formula see entry "Water Pox and Measles")
Zicao Kuaiban Tang (Arnebia Rapid-Blanching Decoction) (Formula see entry "Constipation")
Siwu Tang (Four Substances Decoction) (Formula see entry "Slow Smallpox Eruptions")
Renshen Maidong San (Ginseng and Ophiopogon Powder) (Formula see preceding text)
Shen Si Sheng San (Four Sages Ginseng Powder) (Formula see entry "Abdominal Distension and Shortness of Breath")
Wuwei Yigong San (Five-Ingredient Extraordinary Efficacy Powder) (Formula see entry "Chills and Teeth Grinding")
Xijiao Xiaodu San (Rhinoceros Horn Detoxification Powder) (Formula see entry "Eruption of Macules/Papules")
Qingliang San (Cooling Powder) (Formula see entry "Constipation")
Dihuang Wan (Rehmannia Pill) (Formula see entry "Smallpox Fever: Yin vs Yang")