痘证证前施治合法，痘后余恙，可以尽无，所患者不过虚。
则调补之中，略寓清化可也。至痘前失治，则痘后余恙滋多。兹
择要述之如下。
一痘后不喜食者，向不能食，痘后愈甚者，此脾胃气虚，宜
七珍散补之。又痘前能进食，痘后又骤加，以致恶食不食者，此
脾虚伤食也，宜木香大安丸调之。
一痘后唇不遮齿者，此由气血两虚，急宜大补，否则必成慢惊之证。
一痘后自汗盗汗者，此由卫气弱荣血热所致，宜保元汤、当归六黄汤间服，兼服败蒲散。
一痘后咳嗽者，此肺中余邪未尽，宜甘桔汤合泻白散，加马兜铃等清之。有鼻渊者，宜用丝瓜藤烧灰
吹之，内服丝瓜、黄芩、栀子、牛蒡、甘草之属。
一痘后呕吐者，此证多由余热在胃所致。凡乳入口即吐，面色青白，手足冷，二便自利者，此冷吐也，
宜益黄散。凡心烦作渴，食乳甚急，聚满胸中，然后吐出如射，面色带赤，手足心
热，居处喜凉者，此热吐也，宜橘皮、生姜、竹茹之属。至伤食而呕，闻食嗅即欲吐者，宜木香大安丸。
一痘后腹痛者，由大便未通，燥屎作痛，宜下之。由食少便润，忽尔作痛，喜用手按摩，此为虚
宜培补。至于伤食作痛者，宜木香大安丸。
一痘后泄泻者，能食、口渴、脉盛为热入大肠，宜黄芩汤加川连。食少不渴，脉微小者，此里气虚不
能禁固水谷也，宜四君子汤加诃子、肉豆蔻之属。
一痘后吐蛔者，由热毒聚于肠胃而蛔不安也，宜黄芩汤加半夏、乌梅、川椒之属。
一痘后手足拘挛，屈伸不便者（与外感暴作之抽掣不同），此气血不能荣养筋骨所致，宜十全大补
汤去地黄、茯苓，加川断或川乌之属。
一痘后出血者，此因余毒邪热，迫血妄行所致，宜清血解毒。
此外有后痘发热、乳肿、发痈三症，虽似轻恙，最为难治，忽视之，每成危证。发热由于余热留流。
凡病后余热最不易退，痧痘之后为尤甚，治宜分别虚实。凡大便难，小便赤，能食而烦
渴者，此实热也，宜先用四顺散之属，以解里热，后用升麻葛根汤加地骨皮以解表热；凡大便不闭，小
便不赤，坐立振摇，饮食不进者，此虚热也，宜保元汤加知母、麦冬，甚则可加干姜附
子。浮肿多由虚而脾气不行，其皮如鼓，按之难下，当理气为主，宜人参五皮散。其有感湿而肿者，多
足下先肿，其形光亮，按之有窝起，好饮而小便赤涩，当健脾利水为主，宜用苍术、木
通、浓朴、车前、滑石、瞿麦、泽泻、猪苓、茯苓皮、大腹皮之属，俟小便自利，其肿自消；因感冒而
肿者，多头面先肿而身热口渴，宜用升麻、柴胡、茯苓、木通、车前、防风、大腹皮、甘
草、姜、葱汁水煎服，使微汗而肿自退；因血不行而肿者，其皮；肤之内，隐隐皆有血路，当活血为主，
用四物汤加人参、陈皮、香附、木通、茯苓。总之，浮肿一证，初起能表则表，继则以五皮汤为主方，而至
浮胀如鼓，按之微急者，皆脾虚，宜培土健运为主。发痈由于痘疮余毒，留藏经络，失于解利，外不得泄于皮
肤，内不得入于脏腑，致东流西注，一有着处即成痈毒，多生于肌肉空虚处，或肢节动摇处。毒浅者，
只生结核疮疖，毒重者，头项、胸胁、手足、肢节一齐 肿作痛，流注起伏，根深蔓引，轻则溃筋脱骨，
为残废之疾，重则竟致死亡。治宜人参败毒散、五福化毒丹。大都肿而不溃者，气血两虚宜托，已成
脓者宜清解，溃后宜清补兼施，而溃后不愈，则培土健运扶气以使其收敛。至
于详悉治法，则宜参考外科医籍也。
附方
（一）七珍散 开胃养气，温脾进食。
人参 白术 黄 （蜜炙） 山药 茯苓 粟米 甘草（各等分）
研为细末，加姜、枣，清水煎服。
（二）木香大安丸 治脾虚食积，呕吐泄泻。
木香（二钱） 黄连 陈皮 白术（各三钱） 枳实 山楂肉 连翘
神曲 麦芽（炒） 砂仁 莱菔子（各一钱五分）
（三）当归六黄汤 治血虚盗汗，内热晡热。
当归 生地 熟地 黄柏 黄芩 黄连（各一钱） 黄 （炒，二钱）
（四）败蒲散 治睡中多汗。
故蒲扇（烧存性）
研细末，乌梅汤下。
（五）益黄散 治小儿脾胃虚寒，乳食不化，腹痛泄利。
陈皮 青皮 诃子 甘草 丁香
（六）十全大补汤 治气血两虚。方见本章第四节。
（七）人参五皮散 治痘后浮肿，由于脾气不行者。
人参 大腹皮 陈皮 桑皮 姜皮 白术 茯苓皮 官桂 麦冬 木香 泽泻 车前子 木通
痘疹在发病前若能采取正确的治疗方法，那么痘疹痊愈后的残余症状就可以完全消除，即使有遗留问题，也不过是虚证。因此在调理补益的同时，稍微加入一些清热化湿的药物即可。如果在痘疹发病前未能及时正确治疗，那么痘疹痊愈后的残余症状就会很多。这里选择重要的几种情况叙述如下：
一是痘疹后不喜欢吃东西的，如果是以前就不能吃，痘疹后更加严重的，这是脾胃气虚，适宜用七珍散来补益。又有一种情况是痘疹前能进食，痘疹后突然加重，导致厌恶食物甚至不吃，这是脾虚伤食，适宜用木香大安丸来调理。
一是痘疹后嘴唇不能遮盖牙齿的，这是由于气血两虚，急需大补，否则必然形成慢惊风证。
一是痘疹后自汗（白天不因活动而自然出汗）和盗汗（夜间睡眠中出汗）的，这是由于卫气虚弱、营血热所致，适宜交替服用保元汤和当归六黄汤，并兼服败蒲散。
一是痘疹后咳嗽的，这是肺中残余邪气未尽，适宜用甘桔汤合泻白散，加入马兜铃等药物来清肺。如果有鼻渊（鼻窦炎），适宜用丝瓜藤烧成灰吹入鼻腔，内服丝瓜、黄芩、栀子、牛蒡子、甘草这类药物。
一是痘疹后呕吐的，这种证候多由余热在胃所致。凡是乳汁入口即吐，面色青白，手脚冰冷，大小便正常的，这是冷吐，适宜用益黄散。凡是心烦口渴，吃奶很急，乳汁积聚在胸中，然后喷射状吐出，面色带红，手心脚心发热，喜欢待在凉爽地方的，这是热吐，适宜用橘皮、生姜、竹茹这类药物。至于因伤食而呕吐，闻到食物气味就想吐的，适宜用木香大安丸。
一是痘疹后腹痛的，如果是因为大便不通，燥屎引起疼痛，适宜用泻下法。如果因为吃得少、大便润软，忽然发生疼痛，喜欢用手按摩腹部，这是虚证，适宜培补。至于因伤食引起的疼痛，适宜用木香大安丸。
一是痘疹后泄泻的，如果能进食、口渴、脉象盛大，说明热邪进入大肠，适宜用黄芩汤加川黄连。如果吃得少、不渴、脉象微小，这是里气虚弱不能固摄水谷，适宜用四君子汤加诃子、肉豆蔻这类药物。
一是痘疹后吐蛔虫的，这是由于热毒聚集在肠胃导致蛔虫不安，适宜用黄芩汤加半夏、乌梅、川椒这类药物。
一是痘疹后手足拘挛，屈伸不便的（这与外感病突然发作的抽搐不同），这是由于气血不能荣养筋骨所致，适宜用十全大补汤去掉地黄、茯苓，加入川断或川乌这类药物。
一是痘疹后出血的，这是由于残余毒邪热迫血妄行所致，适宜凉血解毒。
此外还有痘后发热、乳肿、发痈这三种症状，虽然看似轻微病症，但最难治疗，如果忽视它，往往变成危重证候。发热是由于余热留滞流动。凡是病后余热最不容易消退，痧痘之后尤其严重，治疗应当分别虚实。凡是大便困难，小便赤红，能进食且烦躁口渴的，这是实热，适宜先用四顺散这类药物，以解除里热，后用升麻葛根汤加地骨皮以解除表热；凡是大便不闭结，小便不赤红，坐立不安摇动，饮食不进的，这是虚热，适宜用保元汤加知母、麦冬，严重时甚至可以加干姜、附子。浮肿多由虚证导致脾气运行不畅，皮肤像鼓一样，按压后凹陷难起，当以理气为主，适宜用人参五皮散。其中有因感受湿邪而肿的，多从足下先肿，形状光亮，按压有坑起，喜欢喝水且小便赤涩，当以健脾利水为主，适宜用苍术、木通、厚朴、车前子、滑石、瞿麦、泽泻、猪苓、茯苓皮、大腹皮这类药物，等到小便通畅，肿胀自然消退；因感冒而肿的，多从头面先肿且身热口渴，适宜用升麻、柴胡、茯苓、木通、车前子、防风、大腹皮、甘草、生姜、葱汁煎水服用，使微微出汗则肿胀自退；因血行不畅而肿的，其皮肤之内，隐隐都有血络阻滞，当以活血为主，用四物汤加人参、陈皮、香附、木通、茯苓。总之，浮肿一证，初起能用汗法解表则解表，继则以五皮汤为主方，而至浮胀如鼓，按压微紧的，都是脾虚，适宜以培土健运为主。发痈是由于痘疮余毒，留藏在经络，失于疏解通利，外不能发泄于皮肤，内不能进入脏腑，导致流注各处，一旦有所停留就形成痈毒，多生于肌肉空虚处，或肢节动摇处。毒浅的，只生结核疮疖，毒重的，头项、胸胁、手足、肢节一齐肿痛，流注起伏，根深蔓延，轻则溃烂筋骨导致残疾，重则竟致死亡。治疗适宜用人参败毒散、五福化毒丹。大都肿胀而不溃破的，气血两虚宜用托毒法，已成脓的宜用清解法，溃破后宜清补兼施，而溃破后不愈合，则培土健运扶正以使其收敛。至于详细的治法，适宜参考外科医籍。
附方
（一）七珍散 开胃养气，温脾进食。
人参 白术 黄芪（蜜炙） 山药 茯苓 粟米 甘草（各等分）
研为细末，加姜、枣，清水煎服。
（二）木香大安丸 治脾虚食积，呕吐泄泻。
木香（二钱） 黄连 陈皮 白术（各三钱） 枳实 山楂肉 连翘 神曲 麦芽（炒） 砂仁 莱菔子（各一钱五分）
（三）当归六黄汤 治血虚盗汗，内热晡热。
当归 生地 熟地 黄柏 黄芩 黄连（各一钱） 黄芪（炒，二钱）
（四）败蒲散 治睡中多汗。
旧蒲扇（烧存性）
研细末，乌梅汤送服。
（五）益黄散 治小儿脾胃虚寒，乳食不化，腹痛泄利。
陈皮 青皮 诃子 甘草 丁香
（七）人参五皮散 治痘后浮肿，由于脾气不行者。
人参 大腹皮 陈皮 桑皮 姜皮 白术 茯苓皮 官桂 麦冬 木香 泽泻 车前子 木通
If appropriate treatment is administered before the eruption of smallpox, residual symptoms after recovery can be completely eliminated; any remaining issues would merely be deficiency syndromes. Therefore, within the context of regulation and tonification, slight inclusion of heat-clearing and damp-resolving agents is sufficient. If proper treatment is neglected before the eruption, numerous residual symptoms may persist afterward. The following selects key manifestations for description:
1. Infants who lose appetite after smallpox: If they previously had poor appetite which worsens post-eruption, this indicates Spleen-Stomach Qi deficiency; Qizhen San (Seven Treasures Powder) should be used to tonify. Conversely, if they previously ate well but suddenly develop aversion to food or refusal to eat post-eruption, this is Spleen deficiency with food stagnation; Muxiang Da'an Wan (Musk and Peaceful Mind Pill) should be used to regulate.
2. Infants whose lips cannot cover their teeth after smallpox: This results from dual deficiency of Qi and Blood. Urgent and substantial tonification is required; otherwise, it will inevitably progress to Slow Convulsion syndrome.
3. Infants experiencing spontaneous sweating (daytime sweating without exertion) and night sweats (sweating during sleep) after smallpox: This is caused by weak Defensive Qi and Heat in Nutritive Blood. Baoyuan Tang (Protect the Origin Decoction) and Danggui Liuhuang Tang (Angelica Sinensis and Six Yellow Decoction) should be taken alternately, combined with Baipu San (Decayed Cattail Leaf Powder).
4. Infants coughing after smallpox: This indicates incomplete clearance of residual pathogenic factors in the Lungs. Ganjie Tang (Licorice and Platycodon Decoction) combined with Xiebai San (Drain White Powder), added with Aristolochiae Fructus (Madouling), should be used to clear the Lungs. For those with Nasal Polyps (Bi Yuan), burnt Silk Gourd Vine powder should be insufflated into the nose, while internal administration of Luffae Fructus, Scutellariae Radix, Gardeniae Fructus, Arctii Fructus, and Glycyrrhizae Radix et Rhizoma is recommended.
5. Infants vomiting after smallpox: This condition is mostly caused by residual Heat in the Stomach. If milk is vomited immediately upon ingestion, accompanied by a cyan-white complexion, cold extremities, and normal bowel/bladder movements, this is Cold Vomiting; Yihuang San (Yellow Protecting Powder) is indicated. If there is mental restlessness, thirst, urgent nursing, accumulation of milk in the chest followed by projectile vomiting, a reddish complexion, hot palms/soles, and preference for cool environments, this is Heat Vomiting; Citri Reticulatae Pericarpium, Zingiberis Rhizoma, and Bambusae Caulis in Taeniam are suitable. For vomiting due to food stagnation, where the smell of food induces nausea, Muxiang Da'an Wan is appropriate.
6. Infants with abdominal pain after smallpox: If caused by constipation and dry feces, purgation is indicated. If caused by poor intake and loose stools, with sudden pain relieved by massage, this is a Deficiency pattern requiring tonification. For pain due to food stagnation, Muxiang Da'an Wan is used.
7. Infants with diarrhea after smallpox: If the infant eats well, feels thirsty, and has a surging pulse, Heat has entered the Large Intestine; Huangqin Tang (Scutellaria Decoction) with Coptidis Rhizoma is indicated. If the infant eats little, feels no thirst, and has a minute pulse, this indicates Interior Qi deficiency failing to secure fluids and food; Sijunzi Tang (Four Gentlemen Decoction) added with Terminalia Chebulae Fructus and Myristicae Semen is appropriate.
8. Infants expelling roundworms after smallpox: This is due to Heat-Toxin accumulating in the intestines causing discomfort to the worms. Huangqin Tang added with Pinelliae Rhizoma, Pruni Semen Armeniacum Amarum, and Zanthoxyli Pericarpium is indicated.
9. Infants with spasms and limited mobility of hands and feet after smallpox (distinct from acute convulsions due to external contraction): This results from Qi and Blood failing to nourish sinews and bones. Shiquan Dabu Tang (Complete Great Tonifying Decoction), with Rehmanniae Radix and Poria removed, and Dipsaci Radix or Aconiti Lateralis Radix Preparata added, is suitable.
10. Infants with bleeding after smallpox: This is caused by residual toxins and pathogenic Heat forcing blood to move recklessly. Cooling blood and resolving toxicity is indicated.
Additionally, three conditions—post-smallpox fever, breast swelling, and carbuncles—though seemingly mild, are difficult to treat. Neglecting them often leads to critical conditions. Fever arises from lingering residual Heat. Residual Heat after illness is hardest to resolve, especially after measles/smallpox; treatment must distinguish between Excess and Deficiency. If there is difficulty defecating, dark urine, good appetite with irritability and thirst, this is Excess Heat; use Sishun San (Four Smooth Powder) first to clear Interior Heat, followed by Shengma Gegen Tang (Cimicifugae and Puerariae Decoction) with Lycii Cortex to clear Exterior Heat. If bowels are not blocked, urine is not dark, and the infant sits/restlessly shakes with poor appetite, this is Deficiency Heat; Baoyuan Tang added with Anemarrhenae Rhizoma and Ophiopogonis Radix is used, potentially adding Zingiberis Rhizoma and Aconiti Radix Preparata for severe cases. Edema usually stems from Deficiency causing stagnant Spleen Qi; skin resembles a drum with pitting that recovers slowly. Regulation of Qi is primary; Ren Shen Wupi San (Ginseng Five Peel Powder) is indicated. For edema due to Dampness, swelling starts at the feet, skin is shiny with pitting, thirst is present with dark/scanty urine; strengthening Spleen and promoting urination is primary, using Atractylodis Rhizoma, Akebiae Caulis, Magnoliae Officinalis Cortex, Plantaginis Seed, Talcum, Dianthus Petals, Alismatis Rhizoma, Polyporus, Poria Peel, and Arecae Pericarpium until urination normalizes and swelling subsides. For edema due to Wind-Cold invasion, swelling starts on the head/face with fever/thirst; Shengma, Bupleuri Radix, Poria, Akebiae Caulis, Plantaginis Seed, Saposhnikoviae Radix, Arecae Pericarpium, Glycyrrhizae Radix, Ginger, and Scallion Juice decocted to induce slight sweating is used. For edema due to Blood stasis, visible subcutaneous vascular congestion requires activating Blood; Siwu Tang (Four Substances Decoction) added with Ginseng, Citri Reticulatae Pericarpium, Cyperi Rhizoma, Akebiae Caulis, and Poria is used. In summary, for initial edema, release the exterior if possible; subsequently, Wupi Tang (Five Peel Decoction) is the main formula. For distension like a drum with slight tension upon pressure, indicating Spleen Deficiency, strengthening Earth and promoting transformation is primary. Carbuncles result from smallpox residual toxins lodging in collaterals, failing to resolve externally through skin or internally through organs, leading to wandering flow and abscess formation where lodged. They often appear in areas of thin muscle or mobile joints. Mild toxin causes nodules/furuncles; severe toxin causes widespread swelling/pain in head, neck, chest, limbs, with deep roots and spreading nature. Mild cases cause tendon/bone destruction and disability; severe cases cause death. Treatment uses Renshen Baidu San (Ginseng and Detoxification Powder) and Wufu Huadu Dan (Five Blessings Toxin-Resolving Pill). Generally, non-ulcerated swelling with dual Qi/Blood deficiency requires supporting expulsion; formed pus requires clearing/resolving; post-ulceration requires clearing and tonifying simultaneously. Non-healing ulcers require strengthening Earth and supporting Qi for convergence. For detailed methods, consult surgical texts.
Attached Formulas:
(1) Qizhen San: Opens stomach, nourishes Qi, warms Spleen, promotes eating.
Ren Shen, Bai Zhu, Huang Qi (honey-fried), Shan Yao, Fu Ling, Su Mi, Gan Cao (equal parts).
Grind to fine powder, add Ginger and Jujube, decoct in water and take.
(2) Muxiang Da'an Wan: Treats Spleen deficiency with food stagnation, vomiting, diarrhea.
Mu Xiang (2 qian), Huang Lian, Chen Pi, Bai Zhu (3 qian each), Zhi Shi, Shan Zha Rou, Lian Qiao, Shen Qu, Mai Ya (stir-fried), Sha Ren, Lai Fu Zi (1.5 qian each).
(3) Danggui Liuhuang Tang: Treats Blood deficiency with night sweats and afternoon tidal fever.
Dang Gui, Sheng Di, Shu Di, Huang Bo, Huang Qin, Huang Lian (1 qian each), Huang Qi (stir-fried, 2 qian).
(4) Baipu San: Treats excessive sweating during sleep.
Old Cattail Fan (burnt to retain character).
Grind to fine powder, take with Sour Plum Decoction.
(5) Yihuang San: Treats pediatric Spleen-Stomach deficiency-cold, indigestion, abdominal pain, diarrhea.
Chen Pi, Qing Pi, He Zi, Gan Cao, Ding Xiang.
(6) Shiquan Dabu Tang: Treats dual Qi and Blood deficiency. See Section 4 of this chapter.
(7) Ren Shen Wupi San: Treats post-smallpox edema due to stagnant Spleen Qi.
Ren Shen, Da Fu Pi, Chen Pi, Sang Bai Pi, Jiang Pi, Bai Zhu, Fu Ling Pi, Guan Gui, Mai Dong, Mu Xiang, Ze Xie, Che Qian Zi, Mu Tong.