痘蛆者，假湿热之气化，由脓血而成形，夏天患痘，成就迟者，每多有之，然痘
而有此则虽美痘，势必恶痒，外宜银簪挑去，或用经霜桑叶，及野薄荷煎汤洗之，其
蛆自去而痒自止。有谓蛆痘不死者，以其枭毒尽发于外也。有谓蛆痘必死者，如物朽而
生虫之义也，宜兼候之美恶以验之。
水火者，阴阳之迹也。坎离者，水火之位也。心肾者，坎离之配也。阴根于阳，阳
根于阴，互为其根，所以能变合而生万物，故心配离而生血，是阳中有阴乃真阴也。肾
配坎而生气，是阴中有阳，乃真阳也。心中之血，即肾中之真水而灌溉滋濡，水之德
也。肾中之气即心中之真火而 嘘鼓动，火之象也。然水善而火恶，况人之两肾，左
则为水右则为火，《经》曰∶七节之旁，中有小心。小心者，命门相火也。以其为君之
相，故云小心，以其行君之令，故云命门也。以一水立于二火之间，其不胜也，明
矣。运之于中而使火不赫曦，水不涸流者，有神以主之也。所谓神者，何物也？太虚之
中，神之栖也。然水火不并立，摄处稍偏，则各有胜负盛衰之变，况疮疹之火，起于命
门之下，二火相合。所谓得助者，强也。是以相火复挟君火之势，肆其猖撅，销灼燔
的，无所不至，阳道常乏，火一赫HT ，真水亦亡矣。真水既亡，津液暴绝，则其气
滞，其发燥槁，不能润乎皮毛，滋乎腠理，疮中之血，亦干而黑矣。是变黑者，血色本
赤而干则黑也。谓之归肾者，盖血本肾中之阴血，于则肾水亦干矣，此是肾虚之症也，
岂有肾实为邪之理？而何世用泻肾之药？况肾主虚耶！钱仲阳为幼医之祖，所制百祥
丸，泻膀胱之水，合脾胃复旺者，乃后人溯度仲阳之意，非其立方之心耳。殊不知大戟
者，又泻小肠之药也。心与小肠为表里，今不直泻其心而泻其合，使心火下降，肾水上
升，得阴阳交媾之道，毒瓦斯去而真气不绝者，得活恒多，况导赤散亦仲阳所制，亦泻
小肠之药哉！但与百祥丸略有宽猛耳。若必以百祥丸为泻膀胱之药，母实泻子为论，则
黑陷似乎肾实，且失本草之性而有千里之谬矣。
凡物生地下则赤，稍长则白，萎落则黄，枯稿则黑，及婴儿初生则赤，稍长则白，疾病
则黄，老死则黑，万物皆资一阳之气以有生，此四色者，乃一阳之气处变者也。痘疮由出
现而起发，起发而成浆，成浆而结痂，亦人身中一阳之气流行也。再令四时而言之，其出
现而赤，是合春气发生之令也。起发稍变而白，是合夏气长养之令也。成浆而黄，是合秋
气成实之令也。结 而黑是合冬气闭藏之令也。苟出现而黑，是春行冬令矣。起发而黑，
是夏行冬令矣。成浆而黑，是秋行冬令矣。及结 而又不着痂，脓水浸润者，此又冬行春
夏之令，是皆不循递变之次，谓之逆者此也。然黑痘有二，一则干枯变黑者，此名倒陷，乃
邪火太炽，真水枯涸也。是为归肾之症不治。一则痘色变黑，未至干弱，此疫毒之气所谓火
发而熏昧者此也，可用归、柏、生地、赤芍、酒红花以凉血；黄 、人参、生甘草以泻火补元
气；酒炒苓连、牛蒡、连翘、升麻以解毒；防风、荆芥以制表；再加烧人屎一钱，连进十数日，
常有活者焉。
夫痘疹之毒，自内而出，冲突气血，发达腠理，其初出一点血，是亦身中之气血，
被毒驱逐，现于皮肤之外耳。故其成形者，气也。成色者，血也。若毒火太盛，煎熬气
血，乃先至之气则削矣，先至之血则枯矣。气削血枯，疮色即黑，腠理反闭，毒不得
出。复入于里，遂成陷伏，此乃毒瓦斯郁遏，非外感风寒，内虚吐利，杂气触犯者可比。
凡为良工而处此，合下即下，合利即利，合发即发，或解其里，或解其表，应变出奇，
勿泥常法可也。时其以黑疮曰鬼痘，或曰痘疔者，是深恶而畏之之词也，最宜急治，迟
则蔓延。
凡痘原有凡疮未愈，或疮初愈而瘢嫩，是以至痘出时，某处毒集愈盛，攒聚成片，
形色黑溃者，急须针刺破之，吮去毒血，以四圣散治之。如疮焦黑浑身皆是者，看其大
便何如？大便秘者，内服承气汤，外用水杨汤浴法；大便利者，内服十全大补汤，外亦
用水杨汤浴法。然有谓之肾虚者，有谓之肾实者，总之，虚者正气虚，实者邪气实也。
痘蛆，是指假借湿热之气化生，由脓血而形成的虫体。夏季患痘且病程进展缓慢者，往往容易出现这种情况。然而，若痘疮出现这种蛆虫，即使是原本形态美好的痘疮，也必然会导致严重的瘙痒。外治方面，适宜用银簪挑除，或者使用经霜的桑叶以及野薄荷煎汤清洗，这样蛆虫自然会去除，瘙痒也会停止。有一种说法认为长痘蛆不会死亡，是因为枭毒（恶毒之邪）全部发散于体表了；另一种说法认为长痘疽必死无疑，就像物体腐烂才会生虫的道理一样，应当结合观察痘疹的美恶来验证病情预后。
水和火，是阴阳的外在表现。坎和离，是水和火的卦位象征。心和肾，是坎离二卦的配合体现。阴根源于阳，阳根源于阴，二者互为根本，所以能够变化融合而生化万物。因此，心配合离卦而生血，这是阳中有阴，才是真阴。肾配合坎卦而生气，这是阴中有阳，才是真阳。心中的血，就是肾中的真水，起到灌溉滋润的作用，这是水的德性。肾中的气，就是心中的真火，起到吹嘘鼓动的作用，这是火的象态。然而，水性善而火性恶。况且人的两肾，左边属水，右边属火，《黄帝内经》说：“第七节脊椎旁边，中间有小心。”所谓“小心”，指的是命门相火。因为它作为君主的辅佐，所以称为“小心”；因为它执行君主的命令，所以称为“命门”。以一汪静水立于两团烈火之间，它无法承受火势，这是显而易见的。在中焦运转调节，使火势不至于过于猛烈，水源不至于干涸枯竭的，是有“神”在其中主宰。所谓的“神”，是什么东西呢？它是栖息于太虚之中的精神本体。然而，水火不能并存无制，只要摄养之处稍有偏颇，就会各自产生胜负盛衰的变化。何况疮疹之火，起于命门之下，两股火势相互结合。所谓得到助力的，就是强盛的意思。因此，相火又挟持着君火的势头，肆意猖狂，销蚀灼烧，无所不至。阳气之道本就常显不足，一旦火势猛烈，真水也就消亡了。真水既然消亡，津液突然断绝，那么气机就会停滞，皮肤毛发变得干燥枯槁，不能润泽皮毛、滋养腠理，疮中的血液也会干枯变黑。所谓变黑，是因为血色本红，干枯后则变黑。称之为“归肾”，是因为血本是肾中的阴血，此时肾水也已经干涸了，这是肾虚的症状，哪里有肾实证导致邪气的道理？为什么世人要用泻肾的药物呢？况且肾主虚证啊！钱乙（字仲阳）是儿科医学的祖师，他所制作的百祥丸，是泻膀胱之水的药物，结合脾胃功能恢复旺盛的情况来看，这是后人推测钱乙的心意，并非他创立方剂的初衷。殊不知大戟也是泻小肠的药物。心与小肠互为表里，现在不直接泻心火，而是泻其相合的小肠，使心火下降，肾水上承，符合阴阳交媾的道理，毒气去除而真气不绝，这样存活的人很多。况且导赤散也是钱乙所制，同样是泻小肠的药物，只是与百祥丸相比略有宽缓与猛烈的区别罢了。如果一定要把百祥丸当作泻膀胱的药，按照“实则泻其子”的理论，那么黑陷似乎像是肾实，但这不仅违背了本草药物的本性，而且会产生千里之谬。
凡是物体生长在地下时呈红色，稍微长大变白，枯萎凋落变黄，干枯死亡变黑。婴儿刚出生时肤色红润，稍长变白，生病时发黄，老死时发黑。万物都依赖一股阳气才能生存，这四种颜色，是一股阳气在不同变化阶段的表现。痘疮从出现到起发，起发而成浆，成浆而结痂，这也是人身中一股阳气流行的过程。再联系四季来说，痘疮出现时呈红色，符合春季阳气生发的时令；起发时稍微变白，符合夏季阳气长养的时令；成浆时变黄，符合秋季阳气成实的时令；结痂时变黑，符合冬季阳气闭藏的时令。如果在出现时就变黑，这是春季行冬季的肃杀之令；在起发时变黑，这是夏季行冬季之令；在成浆时变黑，这是秋季行冬季之令；等到结痂时又不结痂，脓水浸润，这又是冬季行春夏的生发之令。这些都是不遵循递变次序的表现，称之为“逆”。然而黑痘有两种情况：一种是干枯变黑的，名叫“倒陷”，这是因为邪火太炽盛，真水枯涸所致，属于“归肾”症状，难以治愈；另一种是痘色变黑，但尚未达到干枯脆弱的程度，这是疫毒之气所谓“火发而熏昧”的情况，可以使用当归、侧柏叶、生地黄、赤芍、酒炒红花来凉血；使用黄芪、人参、生甘草来泻火补元气；使用酒炒的黄芩、黄连、牛蒡子、连翘、升麻来解毒；使用防风、荆芥来疏解表邪；再加上一钱烧过的陈年人屎，连续服用十几天，常常有救活的案例。
痘疹的毒气，从体内向外发出，冲击气血，发达腠理，初出的一点血，也是身体中的气血，被毒气驱逐，显现于皮肤之外罢了。所以构成痘疮形状的是气，决定痘疮颜色的是血。如果毒火太盛，煎熬气血，那么先到达的气就会被削弱，先到达的血就会枯竭。气弱血枯，疮色就会变黑，腠理反而闭塞，毒气无法排出，重新陷入体内，遂形成陷伏，这是毒气郁遏所致，不是外感风寒、内伤吐利或杂气触犯所能比拟的。凡是高明的医生处理这种情况，该攻下的就攻下，该通利的就通利，该发汗的就发汗，或者解其里证，或者解其表证，应变出奇招，不要拘泥于常规法则即可。当时有人将黑疮称为“鬼痘”或“痘疔”，这是极度厌恶和畏惧的说法，最宜紧急治疗，拖延则会蔓延扩散。
凡是原有普通疮疡未愈，或者疮疡刚愈而瘢痕娇嫩，以致到了出痘时，某处毒气聚集更加旺盛，攒聚成片，形色黑溃烂的，急需针刺破，吮去毒血，用四圣散治疗。如果疮疡焦黑遍布全身，要看其大便情况如何？如果大便秘结，内服承气汤，外用温水杨汤洗浴法；如果大便通畅，内服十全大补汤，外用同样使用温水杨汤洗浴法。然而有人说这是肾虚，有人说这是肾实，总之，虚证是正气虚，实证是邪气实。
Dengue maggots refer to insects formed from pus and blood, generated by the transformation of damp-heat qi. This condition often occurs in summer cases of smallpox where the progression is slow. However, if such maggots appear on even aesthetically good lesions, severe itching will inevitably ensue. Externally, it is appropriate to remove them with a silver hairpin, or wash with decoctions made from mulberry leaves that have been frosted, or wild mint; this will naturally cause the maggots to disappear and the itching to cease. Some claim that patients with maggot-infested lesions do not die because the malignant toxins are fully expelled to the exterior. Others argue that such patients must die, analogous to how worms arise only from rotting matter; one should observe the quality (good or bad) of the lesions to verify the prognosis.
Water and fire are the traces of Yin and Yang. Kan and Li represent the positions of water and fire, respectively. The Heart and Kidney correspond to the pairing of Kan and Li. Yin roots in Yang, and Yang roots in Yin; they serve as mutual foundations, enabling transformation and combination to generate all things. Thus, the Heart corresponds to Li and generates Blood; this is Yin within Yang, constituting True Yin. The Kidney corresponds to Kan and generates Qi; this is Yang within Yin, constituting True Yang. The Blood in the Heart is essentially the True Water of the Kidney, providing irrigation and nourishment, which reflects the virtue of Water. The Qi in the Kidney is essentially the True Fire of the Heart, providing inspiration and agitation, which reflects the image of Fire. However, Water is benevolent while Fire is malevolent. Moreover, in the two Kidneys, the left belongs to Water and the right to Fire. The *Classic* states: "Beside the seventh vertebra, there is a 'Small Heart'." This 'Small Heart' refers to the Ministerial Fire of the Mingmen (Gate of Life). It is called 'Small Heart' because it acts as the assistant to the Sovereign (Emperor), and it is called 'Mingmen' because it executes the Sovereign's commands. With one body of Water standing between two fires, its inability to withstand the fire is obvious. What regulates this balance in the middle, preventing the fire from becoming excessive and the water from drying up, is the 'Shen' (Spirit) that governs it. What is this 'Shen'? It resides in the Great Void. However, Water and Fire cannot coexist without regulation; slight imbalance in their preservation leads to fluctuations in dominance and decline. Especially since the fire of sores and rashes originates below the Mingmen, combining with another fire. What is described as 'assisted' implies strength. Therefore, the Ministerial Fire joins the momentum of the Sovereign Fire, acting recklessly and destructively, consuming and burning everything. The Way of Yang is inherently deficient; once the fire flares up intensely, the True Water perishes. Once True Water perishes, body fluids abruptly cease, causing Qi stagnation. The skin and hair become dry and withered, unable to moisten the integument or nourish the interstices. The blood within the lesions dries and turns black. This change to black occurs because blood is originally red but turns black when dried. It is termed 'Returning to the Kidney' because blood is originally Yin-Blood of the Kidney, and at this stage, Kidney Water is also exhausted. This is a symptom of Kidney Deficiency. How could there be a principle of Kidney Excess causing evil? Why does the world use herbs to drain the Kidney? Furthermore, the Kidney primarily manifests deficiency! Qian Yi (courtesy name Zhongyang), the ancestor of pediatric medicine, formulated Baixiang Wan, which drains Water from the Bladder. Considering the recovery of Spleen and Stomach function, later generations speculated on Qian Yi's intent, but this may not reflect his original formulation logic. Unbeknownst to them, Daji (Euphorbiae Humifusae Radix) is also an herb that drains the Small Intestine. The Heart and Small Intestine are interior-exteriorly related. By draining the paired organ (Small Intestine) rather than directly draining the Heart, Heart Fire descends and Kidney Water ascends, achieving the Tao of Yin-Yang interaction. Toxins are removed while True Qi remains intact, leading to survival in many cases. Moreover, Daochi San was also formulated by Qian Yi and similarly drains the Small Intestine, differing from Baixiang Wan only in mildness versus potency. If one insists on viewing Baixiang Wan as draining the Bladder and applies the theory of 'draining the son when the mother is excess,' then black depression might seem like Kidney Excess. However, this contradicts the nature of materia medica and leads to grave errors.
Generally, objects growing underground are red; as they grow slightly, they turn white; withering makes them yellow; and desiccation makes them black. Infants are red at birth, turn white as they grow, yellow when ill, and black upon death. All things rely on a single pulse of Yang Qi for life. These four colors represent the variations of this single Yang Qi. Smallpox progresses from eruption to development, from development to pustule formation, and from pustules to scabbing; this is the circulation of Yang Qi within the body. Relating this to the four seasons: the initial red eruption corresponds to the Spring command of generation; the whitening during development corresponds to the Summer command of growth; the yellowing into pustules corresponds to the Autumn command of fruition; and the blackening into scabs corresponds to the Winter command of storage. If eruption is black, it is Winter's command acting in Spring. If development is black, it is Winter's command acting in Summer. If pustule formation is black, it is Winter's command acting in Autumn. If scabbing fails to form and pus infiltrates, it is Spring/Summer commands acting in Winter. These deviations from the sequential order are termed 'Reverse' (Ni). There are two types of black smallpox: one is dry and black, named 'Inverted Depression' (Dao Xian), caused by excessive pathogenic fire and exhaustion of True Water; this is the 'Returning to Kidney' syndrome and is incurable. The other type is black in color but not yet dry or fragile; this is due to epidemic toxin described as 'fire flare-up causing obscuration.' Treatment may involve Gui (Angelicae Sinensis Radix), Baiye (Platycladi Cacumen), Shengdi Huang (Rehmanniae Radix), Chi Shao (Paeoniae Radix Rubra), and Jiu Honghua (Carthami Flos prepared with wine) to cool Blood; Huangqi (Astragali Radix), Renshen (Ginseng Radix), and Sheng Gancao (Glycyrrhizae Radix et Rhizoma Preparata) to clear fire and tonify Yuan Qi; Jiuhuang Qin, Huanglian (Coptidis Rhizoma), Niubangzi (Arctii Fructus), Lianqiao (Forsythiae Fructus), and Shengma (Cimicifugae Rhizoma) to resolve toxicity; Fangfeng (Saposhnikoviae Radix) and Jingjie (Schizonepetae Spica) to release the exterior; plus one qian of burnt human feces, administered continuously for over ten days, often resulting in survival.
The toxin of smallpox and rashes emerges from within, disrupting Qi and Blood, and expanding the interstices. The initial drop of blood is simply the body's own Qi and Blood driven out by the toxin to the skin surface. Thus, the shape is formed by Qi, and the color by Blood. If toxic fire is too intense, it boils Qi and Blood; the arriving Qi is depleted, and the arriving Blood is dried up. Depleted Qi and dried Blood cause the lesion color to turn black, and the interstices close reversely, trapping the toxin inside. It re-enters the interior, forming depression and伏藏 (hidden retention). This is caused by toxin stagnation, unlike external wind-cold invasion, internal deficiency with vomiting/diarrhea, or miscellaneous qi contact. A skilled physician handling this should purge if indicated, promote urination/bowel movement if indicated, or induce sweating if indicated; resolve interior or exterior syndromes accordingly, adapting with ingenuity, without rigid adherence to standard methods. At that time, black lesions were feared terms like 'Ghost Smallpox' or 'Smallpox Carbuncle'; urgent treatment is essential to prevent spread.
If ordinary sores remain unhealed, or scars are tender after healing, when smallpox erupts, toxin may accumulate excessively at certain sites, clustering into patches that are black and ulcerated. These require immediate puncture with needles, suction of toxic blood, and treatment with Sisheng San. If lesions are scorched black all over, check the stool. If constipated, administer Chengqi Tang internally and bathe in warm Shuiyang Decoction externally. If bowel movements are free, administer Shiquan Dabu Tang internally and bathe in warm Shuiyang Decoction externally. Some attribute this to Kidney Deficiency, others to Kidney Excess. In essence, Deficiency involves weakness of Righteous Qi, while Excess involves abundance of Pathogenic Qi.