痘类
凡痘疮紧小充实者，名珍珠痘，易壮易 ；高硕饱满者，此名大痘，早壮迟收；四围起，中心陷者，名
茱萸痘；平扁不突者，名蒸饼痘。有凶有吉，稀者轻，密者重。○痘初出，面部胸背手足已见红点，不起发，
不成浆，随即收敛，若加气促、声哑、闷乱者即死，此陷证也。若无此等候，名曰试痘，五、七日后，复发热
而出，其痘必重。○初出如蚊蚤咬痕，三日后反不见者，名反关痘，五日死。○初出三两成丛，根脚坚硬成
块者，此名痘母，六、七日死。○初出红肿结硬，似瘤非瘤，似痈非痈者，亦名痘母，三、五日死。（三证宜
真人解毒汤救之）。○初出便成血 或水 ，随即破坏者，此名烂痘，二、三日死。○起发时，中有干黑者，此
名鬼痘，宜用胭脂油涂之，勿使蔓延。若不急治，则乍起乍塌，当 不 ，淹缠而死。○起发时，枯燥不润，
塌伏不起，皮肤皱揭者，此名干痘，五、六日躁满喘急而死。○起发时，皮嫩易破，摸之温手者，此名温痘，
六、七日痒塌而死。○起发时，疮色娇艳，皮薄光润者，此名嫩痘，八、九日不能成痂，痒塌而死。○灌浆时，
疮头有孔，浆水漏者，此名漏痘，五、六日后痒塌而死。○发热五、六日，应出不出，以灯照之，皮肤隐有红点，
色脉和平，别无逆证，忽眩冒汗出者，毒从汗解，此名冒痘，无壅遏之患，乃吉兆也。○头面疮破，服补药后，
复肿复灌，或遍身无疮处又出一层者，谓之补痘，虽过期延日，若饮食不减，不为大害。○溃烂不 ，臭不可
闻者，名为烂痘。亦有收 无事者，只要胃气不衰，饮食如故，不作烦躁，则为可治，内服
八珍汤或四味消毒饮，外敷败草散。○痘色红甚，而渴饮不止者，名曰燥痘，治宜犀角地黄汤。○痘有小孔者，
名曰蛀痘，此因表虚，腠理不密。失治则大泄元气，不起不发。宜保元汤，或六气煎，加糯米、川芎、丁香，
提气灌脓，内补其孔，孔满而痘自起。○出齐中有独红独大，摸之皮软不碍手者，此为贼痘。三日外变成水 ，
甚至紫黑，亦危证也。急用银针挑破，胭脂油涂之。（《景岳全书》）
蛆痘者，假湿热之气化，由脓血而成形，夏天患痘，成就迟者，每多有之。痘虽美而势必恶，外用银针挑
之，桑叶薄荷汤洗之，蛆去而痒自止。有谓蛆痘不死者，以其枭毒尽发于外也；有谓蛆痘必死者，如物朽生虫
之义也。宜兼证之美恶以验之。（冯楚瞻）
痘有至佳者，随出随长，随长随灌，尖圆红润，稍见浆而即 ；又有至奇者，随出随长，随长即 ，不见
脓汁，名为旱痘。二者俱不必服药。○疔之结也，由热毒壅盛，失于解利，内不能入，而结于隧道空隙之处。恶
痘疔结，逆转顺矣。但结在前后心者必死，结在耳门喉下者亦死。辨法勿以黑痘作疔。盖黑痘犹痘也；疔则陷
入肉中，形如螺盖，捏之有核，割之不痛。 后疔烂，七日前后者，四圣丹主之。（《慈幼筏》）
大人痘
大人无轻痘，缘其毒之久蓄也。久蓄之毒，气之轻者不足以感动，必待天行疫疠之年，始能相感，治与婴
幼大异。婴幼七情未干，混元未破，痘之出，一味治痘，而且肤薄腠疏，自能易出易长。若二十以上为难，三
十以上更难，其所难者，在男则有酒色之伤，在女则有经产之患，真元既破，表气复坚，痘点繁密，有能送毒
出外，无内陷之忧者鲜矣。治法疏托以后，大约男子以滋肾为先，女子以养肝为本，松肌透毒，相机而动，无
使伤我气血，则得之矣。（《橡村痘诀》）
年长出痘，男女欲火已动，其初即见膝痛腰酸，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，余每用六味汤
加龟胶、元参、秋石获效。（叶天士）
出幼之童，嗜欲开，血气耗，虚火炎蒸，或烦或渴，或咽痛，鼻时出血，毒盛不任温补，当是时，参麦清
补汤频服于五、六日前，犹或可救。若七、八日不成脓，非参归鹿茸汤不可。（《慈幼筏》）
孕妇痘
孕妇出痘，始终以安胎为主，不可犯动其胎，其初以参苏饮发之，出后安胎散为佳。（万密斋）
孕妇出痘，气血虚则胎不安，气血热则胎不安，气血滞则胎不安。故安胎散参、苓、术、草所以补气，归、
芎、芍药所以养血，黄芩所以清热，香、砂、紫苏、陈皮、大腹皮所以行滞。（《医方考》）
治孕妇痘，要无失时，胎之堕也，非血热，必气虚，药投其时，皆有安胎之妙。○痘证堕胎，审在何时∶
在初出，补而升之；在起胀，补而清之；在行浆，则峻补之。又当视其根晕，散与不散，为生死证验。（程华仲）
孕妇出痘，在于初出之时胎落者，则血气虽虚，然热毒亦因走泄，兼之未经起胀灌浆，则血气未曾外耗，
倘痘非险逆，加以大补托里，每多可生。至于收 之时胎落者，则毒已出表，亦多无事，但重虚而元气易脱，
宜倍补益耳。若正当起胀灌浆而胎落者，则气血衰败，内外两虚，既不能逐毒以外出，则毒必乘虚而内攻，为
不救者多矣。（《冯氏锦囊》）
出痘行经
女人月事，时至必行，浆行经至，险也。痘之成功，全藉气血，气虚可为，血虚难为，痘不倒陷，根晕不
散，犹可冀生，倒陷根散者死。治法，养其阳以生其阴。若证属血热，又有得行经而反吉者。然在见点起胀时，
非灌脓时所宜也。（程华仲）
逆证死期
痘之失治，必至于死，然死之日、死之状何如？沈虚明曰∶郁而不出者，三日死；出而不齐者，六日死；
不起胀者，九日死；不灌浆者，十二日死。凡内攻之痘，皆死于十二日之前；不成痂者，十五日死。又毒陷于
脾者，泄泻而死；毒壅于胃者，干枯焦黑而死；郁毒未解者，喘促而死；火毒未解者，外剥而死。（程华仲）
方药
保元一方，痘家立命之根也。小儿气血未充，肌肤未实，补益之法，不可不讲，故翁氏论痘，以此方冠首。
善治者，于浆汁欲行之际，早知补助之法，导其生长之机，使浆成毒化，气血无亏，有何变证。倘热毒未除，
佐以清凉，或浆足之后，再为清解，是顺理也。今医不知顺理，专事倒行，无论寒、热、虚、实，执其套法，
初以升、葛、荆、防、羌活之属虚其表，大便稍不利，即以枳实、硝、黄之属虚其里，继以芩、连、栀子、犀
角、羚羊、紫草、红花、生地、木通之类，以凝涩其气血。气血既凝，毒何由化？以致浆汁不行，变证百出，
无可奈何，然后以参、 救之，复何益哉！要知犀角、地黄，古人非不用也，但用于血热毒壅之证耳。真正热
毒之证，形色俱盛，表里俱实者，十中不过一、二，认证的确，即应清凉，然亦当照顾元气。要知热毒虽甚，
非气血无以运化。因思古人取义曰松肌、曰透肌、曰解毒、曰化毒、曰蒸壮、曰养浆，莫非生生之意也。保元
可离乎？医者能知以保元治痘，则应清者必不致于过寒，应下者必不致于过猛。时存一保元之念，则清之下之，
面面皆保元也。不知保元之法，妄行克伐，其罪可胜言哉！○时医治痘，动云我遵《金镜录》，一保元汤且不
知用，即或用之，亦多杂而不纯，是不知用补法也。地骨皮消壅热于筋骨之间，且能清肃脏腑。用羌活散郁，
而不知用地骨皮，是不知用散法也。大腹皮使热毒从毛窍中出。用十神解毒，而不知用腹皮，是不知用清法也。
治痘诸方，以此三法为重，此之不讲，其他尚何说哉！○善补者，清即是补，犀角地黄汤，养
阴补水之剂，补水可以胜火，补水可以生浆也；下亦是补，火毒壅闭，气为所食，血为所煎，急下存阴也。若
但执参、 而云补，陋矣！○大黄、朴、硝之收放，人所易知；黄连、石膏之收放，人所难晓。故议下易，议
清难。○痘未尽出，火势甚者，不得不急清。石膏可用，黄连、犀角不可用，石膏气轻能解肌故也。○痘未尽
出，元气虚者，人参可用，黄 不可用，黄 能固表故也。○或问麻黄与麻痘无涉，古人麻痘方中，亦有用者，
何也？予曰∶麻痘正发，适感寒邪，外束其表，何由得出？用麻黄以散寒邪，寒邪解，而麻痘出矣。○不独麻
黄非麻痘之药，即羌活亦非麻痘之药。《金镜录》羌活散郁汤，是去风之药，亦非治痘之药也。寒邪外束用麻
黄，风邪外闭用羌活，亦犹仲景麻黄、桂枝之别也。○或问麻痘初发，麻黄、羌活俱不可用，以何方为主治？
予曰∶升麻葛根汤，为麻痘而设也。麻痘出于脏腑，升麻一味，能升阳气于至阴之下，是为对证之药。○痘有
热在表者，表热甚则干枯，荆、防、蝉蜕、地骨、红花之属是也；有热在里者，里热甚则闭结，硝、黄、枳实、
犀角、地黄之属是也。表虚则痒，参、 剂中引以防风；里虚则泻，参、术剂中佐以木香、炙甘草。能如此用
药，则功力自专。○热在气分则发 ，热在血分则发斑。书云∶牡丹皮去血中之毒，壮热繁红为圣药；地骨皮
去气中之毒，毛焦热甚是良工。古人如此分辨，世俗何故不晓？○气血亏败之中，犹当视其有毒、无毒。一味
虚而无毒，则参、 、归、芍、羊肉、乳酒不妨并用；若虚中夹毒，补剂虽施，亦恐难受。如必欲援救，补剂
中只加炒黄连数分。凡虚中夹毒之证，五、六朝早用参、 ，剂中必兼解毒。犀角、地黄、石膏之类，切不
可用，以其不利于痒泻也。炒黄连解毒而不作泻，且与火微则痒之义相合，故可少加。○痘有清凉太过，气血
凝滞不行，虽有小浆，路不见充畅者，参、 剂中宜少加温药佐之。温药中要温而不辛者，予取枸杞一味，与
归、芍、羊肉相合，用之得宜，每每
收效。○便滑，笋尖切不可用，不但滑利，且能耗脓。笋有刮肠篦之名，虚证用之，后成痒泻，多致不救。○
鸡汁、羊肉，皆系助脓神品，温补汤中无浓于此。鸡冠血大毒，不可用，羊脑亦不可用。《纲目》云∶诸脑皆
有毒，不可食，食之损人。○痘中鲜发，助脓之味，温热者多，火毒未清，难受温补，鸡汁、羊肉之属，辄
多败事。蛤蜊性寒，能发毒化浆而不助火，若灰白痒泻之痘，不图温补，而求此，殆矣。○予师治痘，首尾必
加防风、山楂，或清或补，皆得其利。谓予曰∶凉药加疏通之味，则不凝滞；补药加疏通之味，庶毋壅遏。且
更有妙处，如防风一味，既能领清凉药至表而清疮窠之毒，又能领气血药至表而酿疮窠之脓，用药惟在心灵，
须令方中有活泼之机，才称妙着。予谓山楂与防风不同，防风有生发之机，故与参、 并用皆妙；山楂不但于
参、 有碍，凡能消腻者，必能耗脓，六朝后不可轻用，如欲调气，易木香可也。○予治痘无奇法，前半着力
在领毒归窠，后半担心在气血载毒之力竭。领毒归窠，则腹皮、贯众二味宜早，加防风一味为向导；载毒之力
全在气血，气血之助，全仗参、 。○痘家用药，药味不宜多，多则杂，如气虚宜参、 ，甚则分两加重，一
切补气药无过于此。血虚宜归、芍、地黄，甚则鸡汁、羊肉、鹿茸、脐带，一切补血药无过于此。气血双补，
亦止此数味，所加佐使，不过一、二味，及三、四味而止。攻发，则大桑虫、猪尾膏为正兵；清凉解毒，则
黄连、犀角、石膏、生地为最重。所加疏表通利，亦不过三、四味而止。时辈煎方，合之药引，多至二、三
十味，杂而无绪，取效难矣。（《橡村痘诀》）
痘疹，形质之病也。形质之本在精血。熟地至静之性，至甘至浓之味，实精血形质中第一纯浓之药。凡痘
疮起发、灌浆收敛之用，以参、 配之，其功乃倍。且得升、柴则能发散，得桂、附则能回阳，得参、 则入
气分，得归、芍则入血分。今见痘家伤寒家多不用此，岂古人之未及耶？抑不知四物汤为何物耶？
○桑虫，亦名桑蚕。不知创自何人，用以发痘。今医以为奇品，竟相传用。考本草痘疹诸书，皆所不载。审其
性质，不过为阴寒湿毒之虫耳。惟其有毒，所以亦能发痘；惟其寒湿，所以最能败脾。且发痘不从血气，而从
毒药，痘虽起而中则败矣。此与揠苗者何异？矧以湿毒侵脾，弱稚何堪？故每见多服桑虫者，毒发则唇肤俱裂，
脾败则泄泻不止，前车既覆，后可鉴矣！○凡发痘之药，用本不同。有以毒攻毒而发痘者，如穿山甲、人牙、
蝉蜕之属是也；有解毒清毒而发痘者，如紫草、红花、牛蒡、犀角、木通、连翘之属是也；有升提气血而发痘
者，如芎、芷、荆芥、升麻之属是也；有解散寒邪而发痘者，如麻、桂、柴、葛、防风、紫苏、葱白之属是也；
有行气行滞，以通雍塞而发痘者，如丁香、木香、陈皮、浓朴、山楂、大黄之属是也；有益火回阳，健脾止
泻而发痘者，如桂、附、干姜、肉蔻之属是也。凡此，孰非发痘之法？然但可为佐，必以血气为主。（《景岳全书》）
人参补气生浆，虚证用之甚善，如火毒未清，妄用之，其祸立见，务要仔细。黄 亦然。有温补已到，
痘疮分类
凡是痘疮形态紧缩、细小且充实的，称为珍珠痘，容易成熟也容易结痂；形态高耸硕大且饱满的，称为大痘，成熟较早但收靥（结痂脱落）较晚；四周隆起而中心凹陷的，称为茱萸痘；平坦低矮且不突出的，称为蒸饼痘。这些痘形有凶险和吉祥之分，稀疏的病情轻，密集的病情重。○痘疮刚发出时，面部、胸部、背部及手足已经出现红点，但不能起发（隆起），不能化脓成浆，随即就收敛闭合，如果伴有气促、声音嘶哑、神志烦闷混乱等症状，就会死亡，这叫做陷证（痘毒内陷）。如果没有上述症状，称为试痘，五到七天后再次发热并出痘，这种痘必然严重。○初出时像蚊虫叮咬的痕迹，三天后反而看不见的，称为反关痘，五天死。○初出时两三颗聚集在一起，根部坚硬结成块状的，称为痘母，六到七天死。○初出时红肿坚硬，像瘤又不是瘤，像痈又不是痈的，也叫痘母，三到五天死。（这三种证候宜用真人解毒汤抢救。）○初出时就变成血疱或水疱，随即破溃的，称为烂痘，两三天死。○在起发阶段，中间有干枯变黑的，称为鬼痘，宜用胭脂油涂抹，防止蔓延。如果不紧急治疗，就会忽起忽塌，难以愈合，拖延致死。○在起发阶段，干燥枯槁不滋润，塌陷伏卧不起，皮肤皱缩揭起的，称为干痘，五到六天因烦躁胀满、气喘急促而死。○在起发阶段，皮薄嫩易破，摸起来手温的，称为温痘，六到七天因瘙痒塌陷而死。○在起发阶段，疮色娇艳，皮薄光润的，称为嫩痘，八到九天不能结痂，因瘙痒塌陷而死。○在灌浆阶段，疮头有孔，浆液漏出的，称为漏痘，五到六天后因瘙痒塌陷而死。○发热五到六天，应该出痘却未出，用灯照看，皮肤隐约可见红点，脉象平和，没有其他逆证，突然眩晕冒汗的，这是毒邪随汗而解，称为冒痘，没有壅遏之患，是吉兆。○头面部的疮破溃，服用补药后，又肿胀又灌浆，或者遍身无疮的地方又长出一层痘的，称为补痘，虽然过期延日，但如果饮食不减，不算大害。○溃烂不愈合，臭不可闻的，名为烂痘。也有收靥无事的情况，只要胃气不衰，饮食如常，不出现烦躁，就可以治疗，内服八珍汤或四味消毒饮，外敷败草散。○痘色红得厉害，且口渴饮水不止的，称为燥痘，治疗宜用犀角地黄汤。○痘上有小孔的，称为蛀痘，这是因为表虚，腠理不致密。失治则大量耗泄元气，导致痘不起发。宜用保元汤，或六气煎，加糯米、川芎、丁香，以提气灌脓，内补其孔，孔填满而痘自然起发。○出齐后其中有单独发红发大，摸起来皮软不碍手的，此为贼痘。三天后变成水疱，甚至紫黑，也是危重证候。急用银针挑破，用胭脂油涂抹。（《景岳全书》）
蛆痘，是假借湿热之气化生，由脓血而成形，夏天患痘，成就迟缓的，往往多有此症。痘虽美观但病势凶恶，外用银针挑破，用桑叶薄荷汤清洗，蛆虫去除后瘙痒自然停止。有人说蛆痘不死，是因为枭毒全部发散于体外；有人说蛆痘必死，如同物体腐烂生虫的道理。应当结合兼证的善恶来验证。（冯楚瞻）
痘疮有极好的，随出随长，随长随灌浆，尖圆红润，稍见浆液即成熟；又有极奇特的，随出随长，随长即成熟，不见脓汁，称为旱痘。这两种情况都不必服药。○疔疮的形成，是由于热毒壅盛，未能及时解利，毒邪不能内入，而结聚在经络隧道的空隙之处。恶痘并发疔疮结聚，是逆转顺证了。但是结聚在心前区或心后区的必死，结聚在耳门或喉下的也死。辨别方法不要将黑痘误作疔疮。因为黑痘还是痘；疔则是陷入肉中，形状像螺盖，捏之有核，割之不痛。疔疮溃烂后，七日前发病者，用四圣丹主治。（《慈幼筏》）
成人痘
成年人没有轻症的痘，因为其毒邪蓄积已久。蓄积已久的毒邪，轻浅的气机不足以感动它，必须等到天行疫疠之年，才能相互感应，治疗方法与婴幼儿大不相同。婴幼儿七情未扰，元气未破，痘疮发出，只需一味治痘，而且他们肤薄腠疏，自然容易出痘容易生长。如果二十岁以上就难治，三十岁以上更难治，所难之处在于，男子有酒色之伤，女子有经产之患，真元既已破损，表气又坚固，痘点繁密，能够送毒出外、没有内陷忧虑的很少了。治疗方法在疏托之后，大致上男子以滋肾为先，女子以养肝为本，松解肌表透发毒邪，相机而动，不要损伤我的气血，就对了。（《橡村痘诀》）
年长出痘，男女欲火已动，起初就见膝盖疼痛、腰部酸痛，咽喉窒塞疼痛欲闭，苦辛寒药必定无效，宜用甘咸寒药滋水制火，佐以解毒。六到七天来痛势日渐缓和，聂氏有参麦清补方，我常用六味地黄汤加龟胶、玄参、秋石获得疗效。（叶天士）
出幼之后的儿童，嗜欲开启，血气耗损，虚火炎蒸，或烦渴，或咽痛，鼻时常出血，毒盛不能耐受温补，在这个时候，参麦清补汤在五到六天前频服，或许还可以救。如果七到八天不成脓，非用参归鹿茸汤不可。（《慈幼筏》）
孕妇出痘，始终以安胎为主，不可犯动其胎气，初期用参苏饮发之，出痘后用安胎散为佳。（万密斋）
孕妇出痘，气血虚则胎不安，气血热则胎不安，气血滞则胎不安。所以安胎散中人参、茯苓、白术、甘草用来补气，当归、川芎、芍药用来养血，黄芩用来清热，香附、砂仁、紫苏、陈皮、大腹皮用来行滞。（《医方考》）
治疗孕妇痘，要不错失时机，胎堕的原因，不是血热，就是气虚，药物投用适时，都有安胎的妙处。○痘证导致堕胎，审察在哪个时期：在初出期，补而升之；在起胀期，补而清之；在行浆期，则峻补之。还应当观察其根晕，散开与不散开，作为生死证候的验证。（程华仲）
孕妇出痘，在初出之时胎落的，则血气虽虚，但热毒也因走泄而减轻，加之未经起胀灌浆，则血气未曾外耗，倘若痘非险逆，加以大补托里，大多可以存活。至于收靥之时胎落的，则毒已出表，也多无大事，但重伤虚损而元气易脱，宜加倍补益。若正当起胀灌浆而胎落的，则气血衰败，内外两虚，既然不能逐毒外出，则毒必乘虚内攻，大多是不治之症。（《冯氏锦囊》）
出痘行经
女人月经，时至必行，痘浆行而月经至，是险证。痘疮的成功，全赖气血，气虚尚可，血虚难为，痘不倒陷，根晕不散，还可希望生存，倒陷根散的则死。治疗方法，养其阳以生其阴。若证属血热，又有得行经而反吉的。但在见点起胀时，不适合行经。（程华仲）
逆证死期
痘疮失治，必至于死，然而死的日子、死的状况如何？沈虚明说：郁结而不出痘的，三天死；出痘不齐的，六天死；不起胀的，九天死；不灌浆的，十二天死。凡内攻的痘，都死于十二天之前；不成痂的，十五天死。另外毒陷于脾的，因泄泻而死；毒壅于胃的，因干枯焦黑而死；郁毒未解的，因喘促而死；火毒未解的，因外剥而死。（程华仲）
方药
保元一方，是痘家立命的根本。小儿气血未充，肌肤未实，补益之法，不可不讲，所以翁氏论痘，以此方冠首。善于治疗的医生，在浆汁欲行之时，早知补助之法，引导其生长之机，使浆成毒化，气血无亏，有什么变证呢？倘若热毒未除，佐以清凉，或浆足之后，再为清解，这是顺理成章。现在的医生不知顺理，专事倒行逆施，无论寒、热、虚、实，固执其套法，初起用升麻、葛根、荆芥、防风、羌活之类虚其表，大便稍不利，即用枳实、芒硝、大黄之类虚其里，继用黄芩、黄连、栀子、犀角、羚羊角、紫草、红花、生地、木通之类，以凝涩其气血。气血既已凝涩，毒邪如何化解？以致浆汁不行，变证百出，无可奈何，然后用参、芪补救，又有什么益处呢！要知道犀角、地黄，古人并非不用，只是用于血热毒壅的证候罢了。真正热毒的证候，形色俱盛，表里俱实的，十中不过一、二，认证确切，即应清凉，但也应当照顾元气。要知道热毒虽甚，没有气血无以运化。想到古人取义曰松肌、曰透肌、曰解毒、曰化毒、曰蒸壮、曰养浆，莫非都是生生之意吗？保元汤可以离开吗？医者能知以保元治痘，则该清的必不至于过寒，该下的必不至于过猛。心中常存一个保元的念头，则清之下之，面面皆是保元。不知保元之法，妄行克伐，其罪岂可胜言哉！○当时医生治痘，动不动就说我遵循《金镜录》，连一个保元汤都不知道用，即使用了，也多杂而不纯，这是不懂用补法。地骨皮消除筋骨之间的壅热，且能清肃脏腑。用羌活散郁，而不知道用地骨皮，这是不懂用散法。大腹皮使热毒从毛窍中出。用十神解毒，而不知道用腹皮，这是不懂用清法。治痘诸方，以这三法为重，这三法不讲，其他还有什么说的呢！○善于补益的，清即是补，犀角地黄汤，是养阴补水之剂，补水可以胜火，补水可以生浆也；下亦是补，火毒壅闭，气被所食，血被所煎，急下存阴也。如果只执着于参、芪而称之为补，那就浅陋了！○大黄、朴硝的收放，人所易知；黄连、石膏的收放，人所难晓。所以议下容易，议清难。○痘未尽出，火势甚盛的，不得不急清。石膏可用，黄连、犀角不可用，因为石膏气轻能解肌的缘故。○痘未尽出，元气虚的，人参可用，黄芪不可用，因为黄芪能固表的缘故。○有人问麻黄与麻痘无涉，古人在麻痘方中，也有用的，为什么呢？我说：麻痘正发，恰好感受寒邪，外束其表，何由得出？用麻黄以散寒邪，寒邪解，而麻痘出矣。○不仅麻黄不是麻痘的药，即羌活也不是麻痘的药。《金镜录》羌活散郁汤，是去风之药，也不是治痘的药。寒邪外束用麻黄，风邪外闭用羌活，也就像张仲景麻黄、桂枝的区别一样。○有人问麻痘初发，麻黄、羌活俱不可用，以何方为主治？我说：升麻葛根汤，是为麻痘而设的。麻痘出于脏腑，升麻一味，能升阳气于至阴之下，是为对证之药。○痘有热在表者的，表热甚则干枯，荆芥、防风、蝉蜕、地骨皮、红花之类是也；有热在里者的，里热甚则闭结，芒硝、大黄、枳实、犀角、地黄之类是也。表虚则痒，参、芪剂中引以防风；里虚则泻，参、术剂中佐以木香、炙甘草。能如此用药，则功力自专。○热在气分则发疹，热在血分则发斑。书云：牡丹皮去血中之毒，壮热繁红为圣药；地骨皮去气中之毒，毛焦热甚是良工。古人如此分辨，世俗为何不晓？○气血亏败之中，犹当视其有毒、无毒。一味虚而无毒，则参、芪、归、芍、羊肉、乳酒不妨并用；若虚中夹毒，补剂虽施，亦恐难受。如必欲援救，补剂中只加炒黄连数分。凡虚中夹毒之证，五到六朝早用参、芪，剂中必兼解毒。犀角、地黄、石膏之类，切不可用，因为它们不利于痒泻。炒黄连解毒而不作泻，且与火微则痒之义相合，故可少加。○痘有清凉太过，气血凝滞不行，虽有小浆，路不见充畅者，参、芪剂中宜少加温药佐之。温药中要温而不辛的，我取枸杞一味，与归、芍、羊肉相合，用之得宜，每每收效。○便滑，笋尖切不可用，不但滑利，且能耗脓。笋有刮肠篦之名，虚证用之，后成痒泻，多致不救。○鸡汁、羊肉，皆系助脓神品，温补汤中无浓于此。鸡冠血大毒，不可用，羊脑亦不可用。《纲目》云：诸脑皆有毒，不可食，食之损人。○痘中鲜发，助脓之味，温热者多，火毒未清，难受温补，鸡汁、羊肉之类，辄多败事。蛤蜊性寒，能发毒化浆而不助火，若灰白痒泻之痘，不图温补，而求此，殆矣。○我老师治痘，首尾必加防风、山楂，或清或补，皆得其利。对我说：凉药加疏通之味，则不凝滞；补药加疏通之味，庶毋壅遏。且更有妙处，如防风一味，既能领清凉药至表而清疮窠之毒，又能领气血药至表而酿疮窠之脓，用药惟在心灵，须令方中有活泼之机，才称妙着。我认为山楂与防风不同，防风有生发之机，故与参、芪并用皆妙；山楂不但于参、芪有碍，凡能消腻者，必能耗脓，六朝后不可轻用，如欲调气，易木香可也。○我治痘无奇法，前半着力在领毒归窠，后半担心在气血载毒之力竭。领毒归窠，则腹皮、贯众二味宜早，加防风一味为向导；载毒之力全在气血，气血之助，全仗参、芪。○痘家用药，药味不宜多，多则杂，如气虚宜参、芪，甚则分两加重，一切补气药无过于此。血虚宜归、芍、地黄，甚则鸡汁、羊肉、鹿茸、脐带，一切补血药无过于此。气血双补，亦止此数味，所加佐使，不过一、二味，及三、四味而止。攻发，则大桑虫、猪尾膏为正兵；清凉解毒，则黄连、犀角、石膏、生地为最重。所加疏表通利，亦不过三、四味而止。时辈煎方，合之药引，多至二、三十味，杂而无绪，取效难矣。（《橡村痘诀》）
痘疹，是形质之病。形质之本在精血。熟地黄具有至静之性，至甘至浓之味，实为精血形质中第一纯浓之药。凡痘疮起发、灌浆收敛之用，以参、芪配之，其功乃倍。且得升麻、柴胡则能发散，得桂枝、附子则能回阳，得参、芪则入气分，得当归、芍药则入血分。今见痘家伤寒家多不用此，难道古人之未及耶？还是不知四物汤为何物耶？
○桑虫，亦名桑蚕。不知创自何人，用以发痘。今医以为奇品，竟相传用。考本草痘疹诸书，皆所不载。审其性质，不过为阴寒湿毒之虫耳。惟其有毒，所以亦能发痘；惟其寒湿，所以最能败脾。且发痘不从血气，而从毒药，痘虽起而中则败矣。这与揠苗助长有何区别？况且以湿毒侵脾，弱稚何堪？故每见多服桑虫者，毒发则唇肤俱裂，脾败则泄泻不止，前车既覆，后可鉴矣！○凡发痘之药，用本不同。有以毒攻毒而发痘者，如穿山甲、人牙、蝉蜕之类是也；有解毒清毒而发痘者，如紫草、红花、牛蒡、犀角、木通、连翘之类是也；有升提气血而发痘者，如川芎、白芷、荆芥、升麻之类是也；有解散寒邪而发痘者，如麻黄、桂枝、柴胡、葛根、防风、紫苏、葱白之类是也；有行气行滞，以通雍塞而发痘者，如丁香、木香、陈皮、厚朴、山楂、大黄之类是也；有益火回阳，健脾止泻而发痘者，如桂枝、附子、干姜、肉豆蔻之类是也。凡此，孰非发痘之法？然但可为佐，必以血气为主。（《景岳全书》）
人参补气生浆，虚证用之甚善，如火毒未清，妄用之，其祸立见，务要仔细。黄芪亦然。有温补已到，
Classification of Smallpox
When the smallpox lesions are tight, small, and full, they are called "Pearl Pox" (Zhenzhu Dou), which mature easily and scab over easily. When they are tall, large, and plump, they are called "Large Pox" (Da Dou), which mature early but scab over late. When the surrounding areas are raised while the center is depressed, they are called "Dogwood Pox" (Zhuyu Dou). When they are flat, low, and not protruding, they are called "Steamed Cake Pox" (Zhengbing Dou). These forms can be either ominous or auspicious; sparse cases are mild, while dense cases are severe. ○ When smallpox first appears, red spots may already be visible on the face, chest, back, hands, and feet, but if they fail to rise (qi fa), fail to suppurate into pus, and immediately retract, accompanied by shortness of breath, hoarseness, and mental confusion, death will ensue. This is known as "Collapse Syndrome" (Xian Zheng) where the toxin sinks inward. If these symptoms are absent, it is called "Trial Pox" (Shi Dou); if fever recurs and new pox appear after five to seven days, the condition will be severe. ○ If initially appearing like mosquito bites but disappearing after three days, it is called "Reverse Gate Pox" (Fanguan Dou), leading to death in five days. ○ If two or three lesions cluster together with a hard, nodular base, it is called "Pox Mother" (Dou Mu), leading to death in six to seven days. ○ If initially red, swollen, and hard, resembling a tumor but not one, or an abscess but not one, it is also called "Pox Mother," leading to death in three to five days. (These three conditions should be treated urgently with Zhenren Jiedu Tang.) ○ If blood blisters or water blisters form immediately upon appearance and rupture soon, it is called "Rotting Pox" (Lan Dou), leading to death in two to three days. ○ During the rising phase, if the center becomes dry and black, it is called "Ghost Pox" (Gui Dou); apply胭脂 oil (Yanzhi You) to prevent spread. Without urgent treatment, the lesions will fluctuate between rising and collapsing, leading to prolonged suffering and death. ○ During the rising phase, if the skin is dry, shriveled, and collapsed, it is called "Dry Pox" (Gan Dou), leading to death from restlessness, distension, and asthma in five to six days. ○ During the rising phase, if the skin is tender and easily broken, feeling warm to the touch, it is called "Warm Pox" (Wen Dou), leading to death from itching and collapse in six to seven days. ○ During the rising phase, if the lesions are bright red and shiny, it is called "Tender Pox" (Nen Dou), failing to scab in eight to nine days and leading to death from itching and collapse. ○ During the filling phase, if holes form on the lesion heads and pus leaks out, it is called "Leaking Pox" (Lou Dou), leading to death from itching and collapse after five to six days. ○ After five to six days of fever, if pox should appear but do not, yet faint red spots are visible under light, with a peaceful pulse and no adverse signs, sudden dizziness and sweating indicate the toxin is resolving through sweat. This is called "Emerging Pox" (Mao Dou), a good omen without obstruction. ○ If head and facial sores break, and after taking tonics, swelling and pus formation recur, or a new layer of pox appears on previously clear skin, it is called "Supplemental Pox" (Bu Dou). Although delayed, if appetite remains unchanged, it is not a major harm. ○ If ulcers do not heal and emit a foul odor, it is named "Rotting Pox." Some cases resolve without issue provided stomach qi is strong, appetite is normal, and there is no irritability. Internal treatment involves Bazhen Tang or Siwei Xiaodu Yin, applied externally with Baicao San. ○ If pox are intensely red with unquenchable thirst, it is called "Dry Pox" (Zao Dou), treated with Xijiao Dihuang Tang. ○ If pox have small holes, it is called "Borer Pox" (Zhu Dou), caused by exterior deficiency and loose pores. Untreated, it depletes yuan qi, preventing eruption. Treat with Baoyuan Tang or Liuqi Jian, adding Nuomi, Chuanxiong, and Dingxiang to promote qi, fill pus, and repair holes internally until filled, allowing natural eruption. ○ Among fully erupted pox, if one is uniquely red and large, soft to touch, it is called "Thief Pox" (Ze Dou). After three days, turning into blisters or purple-black indicates a critical condition. Urgently puncture with a silver needle and apply Yanzhi You. (Jingyue Quanshu)
"Maggot Pox" (Qu Dou) arises from damp-heat transformation forming from pus and blood, common in summer cases with delayed maturation. Though aesthetically pleasing, the prognosis is poor. Externally, puncture with a silver needle and wash with Sangye Bohe Tang. Removal of maggots stops itching. Some say Maggot Pox is not fatal because toxins are expelled outward; others say it is fatal, akin to rot causing worms. Verify based on accompanying signs. (Feng Chuzhan)
Excellent smallpox cases progress rapidly: erupting, growing, and filling with pus simultaneously, round and red, maturing quickly upon seeing fluid. Extraordinary cases erupt and grow but mature without visible pus, called "Drought Pox" (Han Dou). Neither requires medication. ○ Carbuncles (Ding) form due to excessive heat-toxin stagnation unresolved, lodging in meridional gaps. Malignant pox with carbuncle formation represents a reversal to favorable progression. However, carbuncles at the anterior or posterior heart region are fatal, as are those at the ear gate or throat. Differentiate black pox from carbuncles: black pox remains pox; carbuncles sink into flesh, resemble snail shells, feel nodular when pressed, and are painless when cut. For carbuncle ulceration occurring within seven days, use Sisheng Dan. (Ciyou Fa)
Adult Smallpox
Adults suffer no mild smallpox because their toxins have accumulated for a long time. Such deep-seated toxins require epidemic years to manifest, differing significantly from infantile treatment. Infants, free from emotional disturbances and primordial integrity intact, require only direct treatment for pox; their thin skin and loose pores facilitate easy eruption and growth. Cases over twenty are difficult; over thirty are harder. The difficulty lies in men's damage from wine and sex, and women's damage from menstruation and childbirth. With depleted yuan qi and toughened exterior, dense pox rarely escape internal collapse. Post-treatment focuses on dispersing and supporting: men prioritize nourishing kidney yin, women prioritize nourishing liver blood, loosening muscle tissue to vent toxins, acting opportunistically without damaging qi and blood. (Xiangcun Doujue)
For adults with emerging desires, initial symptoms include knee pain, lumbar soreness, and throat obstruction/pain. Bitter, acrid, cold herbs are ineffective. Use sweet, salty, cold herbs to nourish water and control fire, assisted by detoxification. Pain eases after six to seven days. Nie’s Shenmai Qingbu Fang is effective; I often use Liuwei Dihuang Tang plus Guijiao, Xuanshen, and Qius Shi. (Ye Tianshi)
Children past infancy have opened desires and consumed qi/blood, leading to deficient fire steaming, irritability, thirst, sore throat, or epistaxis. Toxin excess precludes warm tonics. Frequent administration of Shenmai Qingbu Tang five to six days prior may save them. If no pus forms by day seven or eight, Shenguilurong Tang is essential. (Ciyou Fa)
Pregnant Women with Smallpox
Treatment for pregnant women with smallpox must prioritize fetal safety, avoiding any disturbance to the fetus. Initially use Rensu Yin to induce eruption; post-eruption, Antai San is optimal. (Wan Mizhai)
Smallpox in pregnancy causes fetal instability due to qi/blood deficiency, heat, or stagnation. Antai San uses Renshen, Fuling, Baizhu, Gancao to tonify qi; Danggui, Chuanxiong, Shaoyao to nourish blood; Huangqin to clear heat; Xiangfu, Sharen, Zisuxie, Chenpi, Dafupi to move stagnation. (Yifang Kao)
Treating smallpox in pregnancy requires timing. Fetal loss stems from blood heat or qi deficiency. Timely medication ensures fetal safety. Assess fetal loss timing: during initial eruption, tonify and lift; during swelling, tonify and clear; during pus filling, strongly tonify. Observe the root halo: scattered vs. intact determines survival. (Cheng Huazhong)
If fetal loss occurs during initial eruption, qi/blood are weak but toxin has leaked out, and since swelling/filling hasn't occurred, external consumption is minimal. If not dangerous, strong interior-tonifying support often saves both. If fetal loss occurs during scabbing, toxin is exteriorized, usually safe, though extreme depletion risks yuan qi collapse; double tonification is needed. If fetal loss occurs during swelling/filling, qi/blood are exhausted, internal/external deficiency prevails. Unable to expel toxin outward, it attacks inward, mostly fatal. (Fengshi Jinnang)
Menstruation during Smallpox Eruption
Menstruation arriving with pus formation is dangerous. Success relies on qi and blood. Qi deficiency is manageable; blood deficiency is difficult. If pox do not collapse and roots remain intact, survival is possible; collapse and scattering indicate death. Treatment: nourish yang to generate yin. In blood-heat cases, menstruation might be auspicious, but not during spotting/swelling phases. (Cheng Huazhong)
Adverse Signs and Death Timing
Untreated smallpox leads to death. Shen Xuming states: Stagnant/unerupted dies in 3 days; uneven eruption dies in 6 days; no swelling dies in 9 days; no pus filling dies in 12 days. All internal-attacking pox die before day 12; non-scabbing dies on day 15. Toxin sinking to spleen causes death by diarrhea; toxin blocking stomach causes death by drying/blackening; unresolved stagnant toxin causes death by asthma; unresolved fire toxin causes death by external erosion. (Cheng Huazhong)
Formulas and Medicinals
Baoyuan Tang is the lifeline of smallpox treatment. Children lack sufficient qi/blood and solid skin, making tonification essential. Weng places this formula first. Skilled practitioners anticipate the need for supplementation during pus formation, guiding growth so pus matures and toxin transforms without qi/blood deficit. If heat-toxin persists, assist with cooling; after adequate pus, clear residual heat. Modern doctors act contrary to reason, using rigid protocols regardless of pattern. Early stage: Shengma, Gegen, Jingjie, Fangfeng, Qianghuo weaken the exterior. Mild constipation: Zhishi, Xiaoshi, Dahuang weaken the interior. Later: Huangqin, Huanglian, Zhizi, Xijiao, Lingyangjiao, Zicao, Honghua, Shengdi, Mutong congeal qi/blood. Congealed qi/blood cannot transform toxin, leading to failed pus and myriad complications. Only then do they resort to Renshen, Huangqi, too late! Note: Xijiao and Dihuang were used by ancients only for blood-heat/toxin-stagnation patterns. True heat-toxin patterns (exuberant form/color, excess interior/exterior) are rare (1-2 in 10). Even then, protect yuan qi. Heat-toxin requires qi/blood for transformation. Ancients emphasized loosening muscle, venting muscle, detoxifying, transforming toxin, steaming/maturing, and nourishing pus—all promoting life. Can Baoyuan be abandoned? Knowing Baoyuan prevents excessive cold in clearing or excessive force in purging. Keeping Baoyuan in mind makes all clearing/purging supportive. Ignoring Baoyuan and using harsh draining methods is sinful. ○ Contemporary doctors claim to follow Jinjing Lu but ignore Baoyuan Tang or use impure versions, showing ignorance of tonification. Digupi clears bone/joint heat and purifies organs. Using Qianghuo for depression without Digupi shows ignorance of dispersion. Dafupi vents heat-toxin via pores. Using Shishen Jiedu without Dafupi shows ignorance of clearing. These three methods are paramount; ignoring them renders other discussions moot. ○ True tonification includes clearing (Xijiao Dihuang Tang nourishes yin/water to overcome fire and generate pus) and purging (urgent purging preserves yin against fire-toxin constriction). Clinging only to Renshen/Huangqi as tonification is shallow. ○ Da Huang/Po Xiao regulation is easy; Huanglian/Shigao regulation is hard. Purging is easier to prescribe than clearing. ○ Unerupted pox with intense fire requires urgent clearing. Shigao is usable (light qi resolves muscle); Huanglian/Xijiao are not. ○ Unerupted pox with deficient yuan qi allows Renshen but not Huangqi (Huangqi consolidates exterior). ○ Why use Mahuang in Ma Dou (Measles-like pox)? If cold pathogen binds exterior during eruption, Mahuang disperses cold, allowing eruption. ○ Qianghuo is also not specific to Ma Dou; Qianghuo San Yu Tang treats wind, not pox. Cold binding uses Mahuang; Wind closing uses Qianghuo, analogous to Zhang Zhongjing’s Mahuang/Guizhi distinction. ○ If Mahuang/Qianghuo are contraindicated in early Ma Dou, use Shengma Gegen Tang. Shengma lifts yang from profound yin, targeting the source. ○ Exterior heat causes dryness (Jingjie, Fangfeng, Chantui, Digupi, Honghua); Interior heat causes constipation (Xiaoshi, Dahuang, Zhishi, Xijiao, Dihuang). Exterior deficiency causes itching (add Fangfeng to Renshen/Huangqi); Interior deficiency causes diarrhea (add Muxiang, Zhi Gancao to Renshen/Baizhu). Such precision ensures efficacy. ○ Heat in qi level causes macules (Zhen); heat in blood level causes spots (Ban). Mudanpi removes blood toxin (best for high fever/redness); Digupi removes qi toxin (best for dry hair/fever). Ancients distinguished these clearly; why does modern practice ignore this? ○ Amidst qi/blood depletion, assess presence of toxin. Pure deficiency allows concurrent use of Renshen, Huangqi, Danggui, Shaoyao, mutton, milk, wine. Deficiency with trapped toxin tolerates tonics poorly. Rescue by adding fried Huanglian to tonics. For deficiency-with-toxin, use Renshen/Huangqi mornings days 5-6, combining detoxification. Avoid Xijiao, Dihuang, Shigao as they worsen itching/diarrhea. Fried Huanglian detoxifies without causing diarrhea, aligning with "mild fire causes itching." ○ Over-clearing causes qi/blood stagnation despite minor pus. Add mild warming herbs (Gouqi combined with Danggui, Shaoyao, mutton) to Renshen/Huangqi formulas for success. ○ Avoid bamboo shoots for loose stools; they drain and consume pus. Bamboo shoots scrape intestines; in deficiency, they cause itching/diarrhea, often fatal. ○ Chicken broth and mutton are supreme for promoting pus, strongest in warm tonics. Chicken comb blood is highly toxic; sheep brain is toxic (Bencao Gangmu warns against all brains). ○ Fresh eruptions favor warm/promoting foods, but if fire-toxin is unclarified, warm tonics fail. Clam (Geli) is cold, promotes toxin resolution/pus without aiding fire, suitable for gray-white/itchy-diarrhea types seeking warmth, but risky otherwise. ○ My teacher always added Fangfeng and Shanzhu to smallpox formulas, benefiting both clearing and tonifying. He stated: Cooling herbs need dispersing agents to prevent stagnation; Tonics need dispersing agents to prevent blockage. Fangfeng leads cooling herbs to the surface to clear follicle toxin and leads qi/blood herbs to ferment pus in follicles. Prescribing requires spiritual sensitivity and dynamic balance. I argue Shanzhu differs from Fangfeng. Fangfeng promotes growth, harmonizing with Renshen/Huangqi. Shanzhu hinders Renshen/Huangqi; anything reducing greasiness consumes pus. Avoid after day six; use Muxiang for qi regulation instead. ○ My method lacks novelty: First half focuses on guiding toxin into follicles (use Dafupi, Guanzhong early, Fangfeng as guide); Second half worries about qi/blood capacity to carry toxin. Carrying power relies on qi/blood, supported by Renshen/Huangqi. ○ Smallpox prescriptions should be concise. Qi deficiency: Renshen, Huangqi (increase dose if needed). Blood deficiency: Danggui, Shaoyao, Shengdi (or chicken broth, mutton, Lurong, Umbilical Cord if severe). Dual tonification uses few herbs; assistants limited to 1-4. Offensive herbs: Large Silkworm, Pig Tail Paste. Cooling/Detoxifying: Huanglian, Xijiao, Shigao, Shengdi. Dispersing/Clearing agents limited to 3-4. Contemporary prescriptions mix 20-30 herbs with guides, chaotic and ineffective. (Xiangcun Doujue)
Rash/Pox are disorders of form/substance, rooted in essence and blood. Shudihuang is the purest, richest herb for essence/blood/form. Combined with Renshen/Huangqi, its efficacy doubles. It disperses with Shengma/Chaihu, restores yang with Guizhi/Fuzi, enters qi level with Renshen/Huangqi, and enters blood level with Danggui/Shaoyao. Why do contemporary practitioners avoid it? Did ancients overlook it, or do they not understand Siwu Tang?
○ Sangchong (Silkworm) is unknown in origin but used to induce pox. Modern doctors revere it. Yet, materia medica and pox texts omit it. Its nature is yin-cold-damp-toxic insect. Its toxicity induces pox; its cold-dampness damages spleen. Inducing pox via poison rather than qi/blood ruins the interior despite surface eruption—akin to pulling shoots to help them grow. Damp-toxin invading spleen is unbearable for children. Many who take Sangchong suffer lip/skin cracking and relentless diarrhea. Let previous failures be a warning. ○ Herbs inducing pox vary: Toxic attack (Chuanshanjia, Renya, Chantui); Detoxifying/Clearing (Zicao, Honghua, Niubang, Xijiao, Mutong, Lianqiao); Lifting qi/blood (Chuanxiong, Baizhi, Jingjie, Shengma); Dispelling cold (Mahuang, Guizhi, Chaihu, Gegen, Fangfeng, Zisuxie, Congbai); Moving qi/stagnation (Dingxiang, Muxiang, Chenpi, Houpo, Shanzhu, Dahuang); Warming fire/restoring yang (Guizhi, Fuzi, Ganjiang, Roukou). All induce pox, but only as assistants; qi/blood must be primary. (Jingyue Quanshu)
Renshen tonifies qi and generates pus, excellent for deficiency. Misuse with unresolved fire-toxin brings immediate disaster; exercise caution. Huangqi is similar. Warm tonification reaches...