毒也。不知未出之毒不可解，但当汲汲逐之于外也。余深悟其理，而鉴其失，徘徊顾虑，为未出以前诸证设法，
辨其寒、热、虚、实以施治∶实热者，宣发其壅滞，以逐毒出外；虚寒者，补助其血气，以逐毒出外。一以救前
哲之失，一以醒后人之迷，虽轩岐复起，不易吾言矣。（聂久吾）
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
三法，以犀角地黄汤为主方。后之万氏以脾胃为主，魏氏以保元为主，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 《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，可以前知。后之翟氏、聂氏，深以气血盈亏，解
毒化毒，分析阐扬钱、陈底蕴，因分别太多，读者目眩心愦，不若翁仲仁刍荛悦口也。然眼目之功，须宗翁氏，
而汇治讲究，参之诸家可矣。○自古治痘名家，各有精确卓识，虽各有所偏，实所以相济也。先生治痘，寒热攻
补，不胶于一见。如毒火深伏，气血壅遏者，藉芳香以搜逐，用紫雪丹；气滞血凝，毒重火伏者，治以酒大黄、
石膏、青皮、桃仁、荆芥 犀角、猪尾血；肝肺毒火不宣，气血有焦燔之势者，用犀角、羚羊、紫草、丹皮、石
膏、鲜生地；元气不支，阳虚毒陷，而见灰白湿烂，泄泻呕恶者，用辛香温煦，如陈文中之法；气血极虚，而
浆清塌痒，全无实证相兼者，当峻补气血，用参归鹿茸汤、坎煦汤；气虚，莫外乎保元及四君子；血虚，不离
于四物及补血汤。又有气虚血热者，补气之中兼凉血；血虚气滞者，补血之中佐辛香。用攻法须分部位经络，
用补法当辨寒热燥湿。过清则有冰伏之虑，偏热则有液涸之虞。夫痘虽以形色辨吉凶，然内证尤为紧要。如痘
点既起，或不慎风寒，则营卫凝涩，或纵恣饮食，则气机呆钝，以致身热不食，腹膨呕泻，浆水不行。不究病
因，但执清凉腻补，常有凶危之变。亦有痘形虽重，若形神安静，便食如常，声音清响，调理得宜，亦可转危
而安。大凡形老而色鲜明者，虽稠密，变幻恒少；形嫩而色晦滞者，虽稀疏，变幻恒多。表里相参，审证的确，
设法处治，方无贻误。至于逆证已见，虽昔名医亦莫能救。小儿夭枉者不可胜数，迩来幸有种痘一法，实可挽
回造化，此诚补痘科之未备，而为上乘之法也。正痘有先贤诸成法，避险有种痘之良方，痘证于是乎全矣。
（《临证指南》）
疫
痘毒之在人身，若子之在母腹，当其生时，始而腹痛，而破
胞，而倒转，而生，皆天地自然之运动，初无子害母之理。痘之出，始而发热，而见点，而蒸长灌脓，与生产
何异？子既不害母，痘岂害人乎哉！其害人者，相引动之岁气也。岁气之中，复有疫气行乎其间，岁气亦不害
人，其害人者疫气也。○痘之死，死于疫，非死于痘也。人生谁不出痘，人之体质，自有虚实，虚则补，
实则泻，何致于死？惟疫气行乎其间，虚证欲补，疫气隔之，使不受补；实证欲攻，疫气乘之，使不受攻。痘
方出，疫气掩之，使不得出；既出矣，当起壮成脓，疫气扰之，使不成脓；既成脓矣，则毒化而出，疫气乘之，
顷成痒塌、倒 之变。皆疫之为害也。○疫之为害，一时传染，惟闭证为甚。一见斑闭证出，即知疫证行矣。
○疫之从鼻入者为闭，肺主皮毛故也；从口入者为斑，胃主肌肉故也。口鼻俱感，则为斑闭，急宜表里双解，
麻黄石膏汤、升麻石膏汤、羌活散郁汤入硝、黄，皆表里双解之法。用之不应者，只能通表里，不能散疫也。○
一见琐屑隐隐，有模糊之势者，必是疫毒壅遏，纵然出透，必难成浆。○毒，主气也；疫，客气也。疫气有时
而乘，或乘于出，或乘于灌，或乘于 ，忽然而变，须要识得是疫，于应用剂中加解疫之味。○解疫之药，与
开表通利之药，宜相辅而行。如苍术、青蒿、白芷，则芳香之气与荆、防、羌活、升麻之类，和为开表之用；
如槟榔、犀角，则与硝、黄、石膏、生地之类，并为攻里之用；如腹皮、贯众、人中黄之类，则表里皆通，同
为解疫之用。○天行疫气，小儿感之，证见大热烦躁，痘点隐隐，呕吐啼叫，药不得入，天时亢甚，急掘鲜黄
土两石摊地上，铺蒲席，卧儿于上，神安片时，有热解而痘得出者。又法用雄鸡一只劈开，合儿胸堂，窠脚扎
定，一、二时亦有毒解而痘得出者。盖毒解则胃通，胃通则食、药得入，此验过之法，便而易行，不得已时，
皆可用也。（《橡村痘诀》）
痘证，先贤立论甚详，但近时气候变迁，竟有不同于向日者，莫甚于伏毒而为时疠壅遏。初起寒热悠悠，
腰腹并无痛楚；两朝
见点，亦色润而形单，并非要害之处，身热未解，得嚏便通，根窠虽立，不易掀发；一到三朝，神蒙气喘，斑
点全无，唇不肿，口不渴，毒伏内攻，迅如反掌。虽进芳香双解大剂劫夺，一无奏绩，亦末如之何也已矣。
（《吴医汇讲》）
夹斑疹丹痧瘿
磊磊如云头成片者为丹；色淡形浮，扪之碍手者为疹；红紫深入肉中，如蚤所咬，扪之不碍手者为斑。莫
不由热而生。更有一片红紫，热甚啼叫者，名赤游丹，又名火丹。皆以其形色而名之也。发于头面四肢者轻，
胸腹阴囊者重。此证只宜清凉，不宜过表。予用芩、连、栀、柏取效，势迫者急宜砭之。予尝治痘初标发热鼻
衄，遍身发出紫斑，斑多于痘，用十神解毒合犀地黄汤，连进三日，斑退痘起成浆而愈。盖血热之斑可治，时
疫之斑不可治。毒到肌肉之斑可治，毒伏在胃之斑不可治也。（《橡村痘诀》）
书谓红斑者生，紫斑者死，黑斑、蓝斑百不救一。虽然，亦有红斑死，而紫斑、蓝斑得生者。夫斑，血热
也，失于解利则发斑，恶痘斑出，势所必然，无论颜色皆死。但得天庭疏朗，痘形色善，又当别论。○先出疹，
疹收而痘始出，曰垫疹；疹与痘并出，疹收而痘始长，曰夹疹；痘出有小小颗粒堆于痘上，曰罩痘；痧痘出皮
肉间，隐隐有斑点，大小不一，曰夹斑；皮肉间艳色红赤，如云头突起成片，曰丹毒； 后痂落疹出，曰盖疹。
种种不同，要皆痘毒之浮游散漫于皮肤间者，只当于痘中求治法，不可与正经麻疹斑毒同科。○初见大小不一，
有点色如痱者，曰夹疹；又有一等琐屑红点，隐隐肉间，曰夹痧。治亦同法，丹毒亦然。但须正痘悦目，方为
痧疹之夹，不然是痘也，最当别晰。又有痘出数颗，面部夹疹，遍身圆净疏朗，形色红活，出见两日而尽没者，
莫不惊愕，然此疹也，非痘也。痘没必闷乱烦躁，此则安静，且正痘显然，故知其为疹也，治以平剂自愈。然
未没时，亦难识认。（《慈幼筏》）
痘出夹疹，谓之两虎蹲栏。盖痘宜补而不宜泻，泻则不长养；疹宜泻而不宜补，补则多喘逆。然在痘初只
宜透托，既可托痘，又兼发疹，疹出即解，两安无碍。惟在灌脓之际，不可太发，宜于助浆剂中去参、 加入
牛蒡、桔梗、蝉蜕、僵蚕等药助浆，兼理肺气，肺气既清，则阳毒自散。至于痘后发者，则单治疹可也。又凡
先见疹子，而夹出如水痘者，此是正痘，因疹子耗去营血，故白似水痘。但与发散疹子，疹散而痘自成，不可
认作水痘。盖疹子从不夹水痘也。○肤疹者，乃热毒发越而然。出时形如麻状，但色赤成片为异耳，治宜清凉
解毒，疹散痘出，自必稀朗。又有瘾疹者，隐隐于皮肤之间，发时多痒，亦与解毒为主。更有谓痧者，其形如
粟，尖圆而稍碍指，总属热毒所发，名殊而源一也。○夹丹者，血热也。痘未出时见者，宜升提发散，用紫草、
升麻、牛蒡、蝉蜕、川芎、荆、防、桔梗、干葛之类，痘出而丹自没。过用寒凉，痘必冰伏。若痘出三、四日
间见者，则宜凉血解毒，用生地、牛蒡、木通、荆芥、犀角、紫草之类。然须看其颜色何如，红紫者热极也，
白者痰湿也，至于青黑，不可为矣。○夹瘿一证，多属痘毒痰结而成，或结于项颈，或结于耳后，或结于腋下。
大者如桃，小者如李。初起证候如常，次则身烙发渴而变凶危。若痘在三、四日而瘿作者，则毒随痘泄，脓随
痘灌，自可无害，只宜治痘为主。倘瘿肿将脓，而痘随标，瘿脓一溃，元气浇漓，痘焉能灌？惟宜培元补托，
兼与消痰解毒。若在七、八之期，痘已黄蜡，瘿溃无妨。但气血重耗之后，宜保护元气，佐以消痰解毒耳。
（《冯氏锦囊》）
凡痘发斑，实热者，谓之阳斑，以犀角、黄连、生地等治之；虚寒者，谓之阴斑，以参、 等治之。○川
连解毒，发斑可用，但嫌其枯燥，倘证兼便秘者，虽火毒盛，不可妄用。盖治痢用川连，喜其燥湿，痘要湿润，
何可妄用！○发斑用芩、连等药，不可过剂，若专一寒凉，则毒凝滞，不出不胖。不可不知。（《仁端录》）
水
痘疹发水 者，乃气有余，血不足之证也。凡痘疹毒盛火炽之时，火不能炎上，水不得润下，搏激于皮肤
之间而为水 。若沸釜焉，下之火盛，则釜内之水必然发泡。亦有脾虚不能制水，以致水溢皮肤而为水 者，
治当补脾顺气，而虚 自实矣。凡 之白者，气之虚；白而有清水者，气之实； 红紫者，血之热。皆热毒未
出，而贼邪先为之害也。气虚者为空 ，宜补气；气实者为水 ，宜利湿；红紫者为血 ，宜清热。（《金镜录》）
予师曰∶气热夹毒则发 ，血热夹毒则发斑。予曰∶毒壅于气则发 ，火搏于血则发斑。其理一也。○发
斑之痘，人知其恶而畏之，发 之痘，病家多不知畏者，误以为痘起也。治法宜补者多，宜清者少，大概参、
为君，灰白者以温佐之，红紫者以清佐之。○ 红紫者，是肝火激成，剂中加生白芍最妙。（许宣治）
惊
有热一、二日，忽然啼叫，目窜手掣，如惊搐之状。但惊风发搐，必有痰涎上涌，此则无痰涎为异。只宜
托痘，痘出而惊自定，不得妄用镇惊之剂，以压其毒。（《橡村痘诀》）
痘先惊者多吉，痘后惊者多凶。何也？痘未出之先，热蕴于内，故作惊搐，痘出惊止，而内无凝滞，故吉；
痘出之后，气血虚弱，复感风寒，热毒反滞，又毋敢轻易发散清利，故凶。（翁仲仁）
小儿初热，即见惊搐昏迷之状，俗谓惊痘最好，此言未必皆然。若频惊厥，最多闷痘。（叶天士）
惊发痘后，书云莫救者，是指目闭无神，而兼吐泻，唇白肢冷者言也。如痰热内甚，小便闭涩，或素有惊
疾，又当别论。服安神定惊之剂，亦自收功。（《慈幼筏》）
痘至五、六朝，忽然手足牵缩一团，不知者以为惊搐使然，岂知阳明受枭毒之熬铄，而经络不得营血以滋
养故也，谓之一把缚，须服羚羊散。○此证多见于四、五、六朝。若见于两、三朝，
则为惊搐；若见于八、九朝，则作寒战治之。（《证治准绳》）
啼哭
小儿出痘，而昼夜啼哭者，当辨其虚、实、表、里而治之。有内未得出，或外未得散，而啼哭者，此毒瓦斯
不解之使然也；有阳邪火盛，红赤掀突而啼哭者，此痘盘疼痛之使然也；有心肾本虚，邪热乘阴而啼哭者，此
或神志不摄，或烦热不安之使然也；有饮食不节，或偶停滞而啼哭者，此胃气不和，腹痛腹胀之使然也。知
此之由，而辨得其真，则内未出者，表之托之；外未散者，解之化之；火盛者清其热；神虚者养其阴。若痘毒
本微，而无故啼哭者，多由饮食内伤，或二便秘结，去其停滞，通其壅闭，务令表里和畅，营卫通行，则神安
而痘善矣。（《景岳全书》）
腰痛
痘初腰痛，是毒伏于肾而不出；痘后腰痛，是毒已出外而复归于肾。故痘中腰痛，初时虑其难出，后来虑
其难成。《经》云∶痘毒归肾者死。（《仁端录》）
痘疮发热而先腰痛者，最忌证也。《经》曰∶腰者肾之府。又曰∶太阳所至为腰痛。盖足太阳膀胱，为十
二经之首，其脉侠脊循膂络肾。痘疮之毒，起于右肾之下，而循太阳散于诸经，自里达表也。初热而腰即痛，
此邪由膀胱直入于肾，关节不利耳。宜解毒以泻少阴之邪，发表以通太阳之经，使邪气不得深入，则疮虽稠密，
或可愈也。治若少缓，则太阳之邪，由表以传于阳；少阴之邪，由里以传于阴；表里受病，阴阳俱伤，则营卫
之脉不行，脏腑之气不通，或为不出，或为痒塌，或为黑陷，终莫救矣。更有因肾经虚怯，相火内烁，真阴不
得胜邪，以致腰痛者，初宜升发达表，俟其出后，即与地黄丸料，以防变黑归肾，乃克有济。此证多因禀赋不
足，谓之折腰痘。○腰主于肾，人之一大关节也。血气流通则安，血凝气滞则痛。肾实则屈伸壮，肾虚则屈伸
难。故腰痛乃痘证之切忌也。初热而痛者，是蕴毒初动，火热亢极，
肾水亏虚也，治宜升发而兼清解。若痘出干枯者，即宜养血；若肾元大虚而痛者，倍加滋阴补肾之剂。否则，
毒邪。不知道未发出的毒邪不可直接解毒，而应当急切地将其驱逐于体外。我深刻领悟其中的道理，并借鉴其失误，在痘疹未发出之前的各种证候中寻求对策，辨别其寒、热、虚、实以实施治疗：对于实热证，宣发疏通其壅滞，以将毒邪驱逐出体外；对于虚寒证，补助其血气，以将毒邪驱逐出体外。这既是为了补救前代医家的失误，也是为了唤醒后人的迷误，即使是黄帝和岐伯复活，也不会改变我的言论。（聂久吾）
论述痘疹，首先推崇钱仲阳和陈文中两家，钱氏使用寒凉药，陈氏使用温热药，确实截然相反。丹溪效法钱氏而非陈氏，分为解毒、和中、安表三法，以犀角地黄汤为主方。后来的万氏以脾胃为主，魏氏以保元汤为主，费建中纠正偏颇全用石膏、大黄，胡氏动辄投用汗下之法。松江东地多宗奉秦镜明；京口江宁都推崇管《保赤》；我们苏州完全遵循翁仲仁的《金镜录》。可以说是家喻户晓。他们取长的地方在于看诊（观察），不在于治疗。看法精确，可以预知病情。后来的翟氏、聂氏，深深从气血盈亏、解毒化毒方面，分析阐扬钱、陈二人的底蕴，因为区分太多，读者眼花缭乱、心神昏乱，不如翁仲仁的见解通俗易懂。然而观察眼目的功夫，必须宗奉翁氏，而综合治疗讲究，参考各家即可。○自古以来治疗痘疹的名家，各有精确卓越的见识，虽然各有所偏，实际上却是相互补充的。先生治疗痘疹，寒热攻补，不拘泥于一种见解。如毒火深伏，气血壅遏者，借助芳香药物来搜逐毒邪，使用紫雪丹；气滞血凝，毒重火伏者，用酒大黄、石膏、青皮、桃仁、荆芥、犀角、猪尾血治疗；肝肺毒火不宣，气血有焦灼之势者，用犀角、羚羊角、紫草、丹皮、石膏、鲜生地；元气不支，阳虚毒陷，而出现灰白湿烂、泄泻呕恶者，用辛香温煦的方法，如陈文中的方法；气血极虚，而浆清塌痒，完全没有实证相兼者，应当峻补气血，用人参归鹿茸汤、坎煦汤；气虚，莫过于保元汤及四君子汤；血虚，离不开四物汤及补血汤。又有气虚血热者，在补气之中兼用凉血药；血虚气滞者，在补血之中佐以辛香药。使用攻法必须分部位经络，使用补法当辨别寒热燥湿。过用清凉则有冰伏的顾虑，偏用温热则有津液枯竭的忧虑。痘疹虽然以形色辨别吉凶，但内证尤为紧要。如痘点已经发出，如果不慎受风寒，则营卫凝涩，或放纵饮食，则气机呆钝，以致身热不食、腹部膨隆呕吐腹泻、浆水不行。不探究病因，只执着于清凉腻补，常有凶危的变化。也有痘形虽然严重，如果形神安静，饮食如常，声音清响，调理得宜，也可以转危为安。大凡形态老练而颜色鲜明者，虽然稠密，变幻通常较少；形态娇嫩而颜色晦暗滞涩者，虽然稀疏，变幻通常较多。表里参合，审证确切，设法处治，才不会贻误时机。至于逆证已经出现，即使是昔日的名医也不能挽救。小儿夭折的不计其数，近来幸好有种痘一法，实在可以挽回造化，这确实是补足了痘科治疗的不足，是上乘的方法。正痘有先贤的各种成法，避险有种痘的良方，痘证于是乎完备了。（《临证指南》）
疫
痘毒在人身，就像孩子在母腹中，当孩子出生时，开始腹痛，然后破胞，然后倒转，然后出生，都是天地自然的运动，起初没有子害母的道理。痘疹的发出，开始发热，然后见点，然后蒸长灌脓，与生产有什么不同？孩子既然不害母亲，痘疹难道害人吗？害人的，是相互引动的岁气。岁气之中，又有疫气行走在其中，岁气也不害人，害人的是疫气。○痘疹的死，死于疫气，不是死于痘毒。人生谁不出痘，人的体质自有虚实，虚则补，实则泻，怎么会致死？只有疫气行走在其中，虚证想要补，疫气阻隔它，使补药不受；实证想要攻，疫气趁势攻击它，使攻药无效。痘疹刚发出，疫气掩盖它，使不得发出；已经发出了，应当起壮成脓，疫气扰乱它，使不成脓；已经成脓了，则毒化解而出，疫气趁势攻击，顷刻变成痒塌、倒靥的变化。都是疫气造成的危害。○疫气的危害，一时传染，只有闭证最为严重。一见斑闭证出现，就知道疫证在流行了。○疫气从鼻入的为闭证，肺主皮毛的缘故；从口入的为斑证，胃主肌肉的缘故。口鼻都感受，则为斑闭证，急宜表里双解，麻黄石膏汤、升麻石膏汤、羌活散郁汤加入芒硝、大黄，都是表里双解的方法。用了无效的，只能通表里，不能散疫气。○一见琐屑隐隐，有模糊之势的，必定是疫毒壅遏，纵然发出透彻，也难得成浆。○毒，主气；疫，客气。疫气有时乘虚而入，或乘于发出时，或乘于灌脓时，或乘于结痂时，忽然变化，须要识别是疫气，在应用剂中加入解疫的药物。○解疫的药，与开表通利的药，宜相辅而行。如苍术、青蒿、白芷，则芳香之气与荆芥、防风、羌活、升麻之类，和合为开表之用；如槟榔、犀角，则与芒硝、大黄、石膏、生地之类，并为攻里之用；如腹皮、贯众、人中黄之类，则表里皆通，同为解疫之用。○天行疫气，小儿感受，证见大热烦躁，痘点隐隐，呕吐啼叫，药不得入，天时亢盛，急掘鲜黄土两石摊在地上，铺蒲席，让孩子卧在上面，神志安宁片刻，有热解而痘得出的。又法用雄鸡一只劈开，贴合孩子胸堂，脚窝扎定，一两个时辰也有毒解而痘得出的。大概毒解则胃通，胃通则饮食、药物得入，这是验证过的方法，简便易行，不得已时，都可以使用。（《橡村痘诀》）
痘证，先贤立论很详细，但近时气候变迁，竟然有不同于过去的，没有比伏毒而为时疠壅遏更严重的。初起寒热悠悠，腰腹并无疼痛；两天见点，也是色润而形单，并非要害之处，身热未解，打个喷嚏便通畅，根窠虽然立住，不易掀发；一到三天，神蒙气喘，斑点全无，嘴唇不肿，口不渴，毒伏内攻，迅如反掌。虽然进服芳香双解大剂劫夺，一无奏效，也无可奈何了。（《吴医汇讲》）
夹斑疹丹痧瘿
磊磊如云头成片的是丹；色淡形浮，摸之碍手的是疹；红紫深入肉中，像被跳蚤咬的，摸之不碍手的是斑。无不由于热而生。更有一片红紫，热甚啼叫的，名叫赤游丹，又名火丹。都是以其形色来命名的。发于头面四肢的轻，发于胸腹阴囊的重。此证只宜清凉，不宜过用发表。我用黄芩、黄连、栀子、黄柏取效，势迫者急宜砭刺。我曾治疗痘初标发热鼻衄，遍身发出紫斑，斑多于痘，用十神解毒合犀角地黄汤，连进三日，斑退痘起成浆而愈。大概血热之斑可治，时疫之斑不可治。毒到肌肉之斑可治，毒伏在胃之斑不可治。（《橡村痘诀》）
书说红斑者生，紫斑者死，黑斑、蓝斑百不救一。虽然如此，也有红斑死，而紫斑、蓝斑得生的。夫斑，是血热，失于解利则发斑，厌恶痘斑出，势所必然，无论颜色皆死。但得天庭疏朗，痘形色善，又当别论。○先出疹，疹收而痘始出，叫垫疹；疹与痘并出，疹收而痘始长，叫夹疹；痘出有小小颗粒堆于痘上，叫罩痘；痧痘出皮肤间，隐隐有斑点，大小不一，叫夹斑；皮肉间艳色红赤，如云头突起成片，叫丹毒；结痂后痂落疹出，叫盖疹。种种不同，都要在痘中求治法，不可与正经麻疹斑毒同科。○初见大小不一，有点色如痱子的，叫夹疹；又有一等琐屑红点，隐隐肉间，叫夹痧。治疗也同法，丹毒亦然。但须正痘悦目，方为痧疹之夹，不然就是痘，最当分别清楚。又有痘出数颗，面部夹疹，遍身圆净疏朗，形色红活，出见两日而尽没的，莫不惊愕，然这是疹，不是痘。痘没必闷乱烦躁，此则安静，且正痘显然，故知其为疹，治以平剂自愈。然而未没时，也难识别。（《慈幼筏》）
痘出夹疹，叫做两虎蹲栏。大概痘宜补而不宜泻，泻则不长养；疹宜泻而不宜补，补则多喘逆。然而在痘初只宜透托，既可托痘，又兼发疹，疹出即解，两安无碍。只在灌脓之际，不可太发，宜于助浆剂中去人参、黄芪，加入牛蒡、桔梗、蝉蜕、僵蚕等药助浆，兼理肺气，肺气既清，则阳毒自散。至于痘后发的，则单治疹即可。又凡先见疹子，而夹出如水痘的，这是正痘，因疹子耗去营血，故白似水痘。但与发散疹子，疹散而痘自成，不可认作水痘。大概疹子从不夹水痘。○肤疹者，乃热毒发越而然。出时形如麻状，但色赤成片为异耳，治宜清凉解毒，疹散痘出，自必稀朗。又有瘾疹者，隐隐于皮肤之间，发时多痒，亦与解毒为主。更有谓痧的，其形如粟，尖圆而稍碍指，总属热毒所发，名殊而源一也。○夹丹者，血热。痘未出时见的，宜升提发散，用紫草、升麻、牛蒡、蝉蜕、川芎、荆芥、防风、桔梗、干葛之类，痘出而丹自没。过用寒凉，痘必冰伏。若痘出三、四日间见的，则宜凉血解毒，用地黄、牛蒡、木通、荆芥、犀角、紫草之类。然须看其颜色如何，红紫者热极，白者痰湿，至于青黑，不可为矣。○夹瘿一证，多属痘毒痰结而成，或结于项颈，或结于耳后，或结于腋下。大的如桃，小的如李。初起证候如常，次则身烙发渴而变凶危。若痘在三、四日而瘿作的，则毒随痘泄，脓随痘灌，自可无害，只宜治痘为主。倘瘿肿将脓，而痘随标，瘿脓一溃，元气浇漓，痘焉能灌？惟宜培元补托，兼与消痰解毒。若在七、八之期，痘已黄蜡，瘿溃无妨。但气血重耗之后，宜保护元气，佐以消痰解毒耳。（《冯氏锦囊》）
凡痘发斑，实热的，叫阳斑，用犀角、黄连、生地等治疗；虚寒的，叫阴斑，用人参、黄芪等治疗。○川连解毒，发斑可用，但嫌其枯燥，倘若证兼便秘的，虽火毒盛，不可妄用。大概治痢用川连，喜其燥湿，痘要湿润，何可妄用！○发斑用芩、连等药，不可过剂，若专一寒凉，则毒凝滞，不出不胖。不可不知。（《仁端录》）
水痘
痘疹发水泡的，乃气有余，血不足的证候。凡痘疹毒盛火炽之时，火不能炎上，水不得润下，搏激于皮肤之间而为水泡。若沸釜焉，下之火盛，则釜内的水必然发泡。也有脾虚不能制水，以致水溢皮肤而为水泡的，治当补脾顺气，而虚泡自实矣。凡泡之白的，气的虚；白而有清水的，气的实；泡红紫的，血的热。都是热毒未出，而贼邪先为之害。气虚者为空泡，宜补气；气实者为水泡，宜利湿；红紫者为血泡，宜清热。（《金镜录》）
我的老师说：气热夹毒则发泡，血热夹毒则发斑。我说：毒壅于气则发泡，火搏于血则发斑。其理是一样的。○发斑的痘，人知其恶而畏之，发泡的痘，病家多不知畏的，误以为痘起也。治法宜补的多，宜清的少，大概人参、黄芪为君，灰白的以温佐之，红紫的以清佐之。○泡红紫的，是肝火激成，剂中加生白芍最妙。（许宣治）
惊
有热一、二日，忽然啼叫，目窜手掣，如惊搐之状。但惊风发搐，必有痰涎上涌，此则无痰涎为异。只宜托痘，痘出而惊自定，不得妄用镇惊之剂，以压其毒。（《橡村痘诀》）
痘先惊的多吉，痘后惊的多凶。为什么呢？痘未出之前，热蕴于内，故作惊搐，痘出惊止，而内无凝滞，故吉；痘出之后，气血虚弱，复感风寒，热毒反滞，又不敢轻易发散清利，故凶。（翁仲仁）
小儿初热，即见惊搐昏迷之状，俗谓惊痘最好，此言未必皆然。若频惊厥，最多闷痘。（叶天士）
惊发痘后，书云莫救的，是指目闭无神，而兼吐泻，唇白肢冷的而言。如痰热内甚，小便闭涩，或素有惊疾，又当别论。服安神定惊之剂，亦自收功。（《慈幼筏》）
痘至五、六朝，忽然手足牵缩一团，不知者以为惊搐使然，岂知阳明受枭毒之熬铄，而经络不得营血以滋养故也，叫一把缚，须服羚羊散。○此证多见于四、五、六朝。若见于两、三朝，则为惊搐；若见于八、九朝，则作寒战治之。（《证治准绳》）
啼哭
小儿出痘，而昼夜啼哭的，当辨其虚、实、表、里而治之。有内未得出，或外未得散，而啼哭的，此毒瓦斯不解之使然；有阳邪火盛，红赤掀突而啼哭的，此痘盘疼痛之使然；有心肾本虚，邪热乘阴而啼哭的，此或神志不摄，或烦热不安之使然；有饮食不节，或偶停滞而啼哭的，此胃气不和，腹痛腹胀之使然。知此之由，而辨得其真，则内未出的，表之托之；外未散的，解之化之；火盛的清其热；神虚的养其阴。若痘毒本微，而无故啼哭的，多由饮食内伤，或二便秘结，去其停滞，通其壅闭，务令表里和畅，营卫通行，则神安而痘善矣。（《景岳全书》）
腰痛
痘初腰痛，是毒伏于肾而不出；痘后腰痛，是毒已出外而复归于肾。故痘中腰痛，初时虑其难出，后来虑其难成。《经》说：痘毒归肾者死。（《仁端录》）
痘疮发热而先腰痛的，最忌证候。《经》说：腰者肾之府。又说：太阳所至为腰痛。大概足太阳膀胱，为十二经之首，其脉侠脊循膂络肾。痘疮之毒，起于右肾之下，而循太阳散于诸经，自里达表。初热而腰即痛，此邪由膀胱直入于肾，关节不利耳。宜解毒以泻少阴之邪，发表以通太阳之经，使邪气不得深入，则疮虽稠密，或可愈也。治若少缓，则太阳之邪，由表以传于阳；少阴之邪，由里以传于阴；表里受病，阴阳俱伤，则营卫之脉不行，脏腑之气不通，或为不出，或为痒塌，或为黑陷，终莫救矣。更有因肾经虚怯，相火内烁，真阴不得胜邪，以致腰痛的，初宜升发达表，俟其出后，即与地黄丸料，以防变黑归肾，乃克有济。此证多因禀赋不足，谓之折腰痘。○腰主于肾，人之一大关节也。血气流通则安，血凝气滞则痛。肾实则屈伸壮，肾虚则屈伸难。故腰痛乃痘证之切忌也。初热而痛的，是蕴毒初动，火热亢极，肾水亏虚，治宜升发而兼清解。若痘出干枯的，即宜养血；若肾元大虚而痛的，倍加滋阴补肾之剂。否则，
Poison (Du, 毒). One does not know that the poison which has not yet erupted cannot be resolved directly; rather, one should anxiously strive to expel it outward. I have deeply comprehended this principle and learned from its failures, pondering carefully to devise methods for the various syndromes before eruption. I differentiate between cold, heat, deficiency, and excess to apply treatment: For excess-heat patterns, one should diffuse and unblock stagnation to drive the poison outward; for deficiency-cold patterns, one should tonify blood and qi to drive the poison outward. This is done both to remedy the mistakes of past sages and to awaken the confusion of future generations. Even if Huangdi (Yellow Emperor) and Qibo were to rise again, they would not change my words. (Nie Jiuwu)
In discussing smallpox (Dou, 痘), the first names to be recommended are Qian Zhongyang and Chen Wenzhong. Qian used cold-cooling herbs, while Chen used warm-heating herbs; their approaches are indeed diametrically opposed. Danxi followed Qian rather than Chen, dividing treatment into three methods: resolving poison, harmonizing the middle, and stabilizing the exterior, with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) as the main formula. Later, Wan focused on the spleen and stomach, Wei focused on Baoyuan Tang (Preserve the Origin Decoction), Fei Jianzhong corrected deviations by using solely Shigao (Gypsum Fibrosum) and Dahuang (Rhei Radix et Rhizoma), and Hu frequently administered sweating and purging methods. In Songdong, the eastern region mostly followed Qin Jingming; in Jingkou and Jiangning, Guan's Baochi (Protect the Infant) was highly regarded; in our Suzhou area, everyone strictly adhered to Weng Zhongren's Jinjinglu (Golden Mirror Record). These can be said to be known to every household. Their strength lies in observation (Kan, 看), not in treatment. Precise observation allows one to predict the condition. Later, Zhai and Nie deeply analyzed and elaborated on the foundations of Qian and Chen regarding the fluctuation of qi and blood, and the resolution and transformation of poison. However, because they distinguished too many categories, readers became dazzled and confused, whereas Weng Zhongren's insights were more accessible. Nevertheless, for the skill of observation, one must follow Weng, while for comprehensive treatment discussion, referring to various schools is sufficient. ○ Since ancient times, famous masters of treating smallpox have each possessed precise and outstanding insights. Although each had biases, these actually complemented each other. Mr. [Chen Shigong] treated smallpox without being rigidly attached to a single viewpoint regarding cold/heat or attack/tonification. When poison-fire was deeply hidden and qi-blood was obstructed, he used aromatic herbs to search out and expel, employing Zixue Dan (Purple Snow Pill); when qi stagnation and blood coagulation occurred with heavy poison and hidden fire, he treated with Jiudahuang (Wine-processed Rhubarb), Shigao (Gypsum Fibrosum), Qingpi (Aurantii Fructus Pericarpium), Taoren (Persicae Semen), Jingjie (Schizonepetae Herba), Xijiao (Rhinocerotis Cornu), and Zhuweixue (Porci Cauda Sanguis); when liver-lung poison-fire was not dispersed and qi-blood showed signs of scorching, he used Xijiao (Rhinocerotis Cornu), Lingyangjiao (Saigae Tataricae Cornu), Zicao (Arnebiae Radix), Danpi (Moutan Cortex), Shigao (Gypsum Fibrosum), and Xianshengdi (Rehmanniae Radix Recens); when yuanqi (original qi) could not support itself, yang deficiency led to poison sinking, presenting with gray-white moist rotting, diarrhea, vomiting, and nausea, he used pungent-aromatic warming methods, such as those of Chen Wenzhong; when qi-blood was extremely deficient, with clear fluid, collapsed lesions, and itching, without any accompanying excess patterns, one should vigorously tonify qi and blood, using Shen Gui Lurong Tang (Ginseng, Angelica, and Deer Antler Decoction) or Kanxu Tang; for qi deficiency, Baoyuan Tang (Preserve the Origin Decoction) and Sijunzi Tang (Four Gentlemen Decoction) are paramount; for blood deficiency, Siwu Tang (Four Substances Decoction) and Buxue Tang (Tonify Blood Decoction) are essential. For cases of qi deficiency with blood heat, cooling blood is added to qi-tonifying formulas; for blood deficiency with qi stagnation, pungent-aromatic herbs are added to blood-tonifying formulas. When using attacking methods, one must distinguish locations and meridians; when using tonifying methods, one must differentiate cold, heat, dryness, and dampness. Overuse of cooling carries the risk of "ice-stagnation" (Bingfu, 冰伏); bias toward heat carries the risk of fluid exhaustion. Although smallpox prognosis is based on shape and color, internal symptoms are particularly crucial. If after eruption, one is careless about wind-cold, ying (nutritive) and wei (defensive) become stagnant; if one indulges in diet, qi mechanism becomes dull, leading to fever, anorexia, abdominal distension, vomiting, diarrhea, and failure of pustule formation. Without investigating the cause, but merely adhering to cooling and cloying tonics, dangerous changes often occur. There are also cases where the rash is severe, but if the spirit and form are calm, appetite is normal, voice is clear, and care is appropriate, danger can turn to safety. Generally, if the shape is mature and color bright, even if dense, transformations are few; if the shape is tender and color dull/stagnant, even if sparse, transformations are many. By combining interior/exterior analysis and confirming the syndrome precisely, one can treat effectively without error. Once adverse syndromes appear, even past famous doctors cannot save them. The number of children dying is countless. Fortunately, there is now the method of inoculation (Zhongdou, 种痘), which can truly restore nature's work. This truly supplements the deficiencies of smallpox therapy and is a superior method. With established methods from past sages for natural smallpox and good prescriptions for inoculation to avoid risks, smallpox treatment is thus complete. (Lin Zheng Zhi Nan / Guide to Clinical Practice)
Epidemic (Yi, 疫)
The poison of smallpox in the human body is like a child in the mother's womb. At birth, there is initial abdominal pain, then breaking the sac, turning, and finally birth. These are all natural movements of heaven and earth; initially, there is no concept of the child harming the mother. The eruption of smallpox begins with fever, then spots appear, then steaming, growing, and filling with pus. How is this different from childbirth? Since the child does not harm the mother, how can smallpox harm people? What harms people is the annual climate (Suiqi, 岁气) that induces it. Within the annual climate, epidemic qi (Yiqi, 疫气) moves among them. The annual climate itself does not harm people; what harms people is the epidemic qi. ○ Death from smallpox is due to epidemic qi, not the smallpox poison itself. Who does not get smallpox? Human constitutions vary in deficiency and excess. Deficiency requires tonification, excess requires purging. How can this lead to death? Only when epidemic qi intervenes: for deficiency patterns wanting tonification, epidemic qi blocks it, preventing the tonic from taking effect; for excess patterns wanting purging, epidemic qi takes advantage, preventing the purgative from working. Just as smallpox erupts, epidemic qi covers it, preventing eruption; once erupted, it should rise and fill with pus, but epidemic qi disturbs it, preventing pus formation; once pus forms, poison should resolve and exit, but epidemic qi strikes, causing sudden changes like itching, collapse, or inversion. All these harms are caused by epidemic qi. ○ The harm of epidemic qi spreads contagiously at once, most severely in closed patterns (Bi Zheng, 闭证). Once spot-closure appears, one knows the epidemic is circulating. ○ Epidemic qi entering through the nose causes closure (because Lung governs skin and hair); entering through the mouth causes spots (because Stomach governs muscle). Simultaneous infection of mouth and nose results in spot-closure, requiring urgent simultaneous release of exterior and interior. Mahuang Shigao Tang (Ephedra and Gypsum Decoction), Shengma Shigao Tang (Cimicifugae and Gypsum Decoction), and Qiango San Yu Tang (Notopterygii Dispelling Depression Powder) with Xiaoshi (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma) are all methods of simultaneous exterior-interior release. If these fail, they only open the exterior-interior but do not scatter the epidemic. ○ Seeing tiny, faint, indistinct spots with a blurred tendency indicates epidemic poison obstruction. Even if fully erupted, forming pus will be difficult. ○ Poison relates to qi; epidemic relates to guest qi. Epidemic qi may strike at various stages—eruption, pus-filling, or crusting—causing sudden changes. One must recognize it as epidemic and add anti-epidemic ingredients to standard formulas. ○ Anti-epidemic herbs should accompany exterior-opening and draining herbs. For example, Cangzhu (Atractylodis Rhizoma), Qinghao (Artemisiae Annuae Herba), and Baizhi (Angelicae Dahuricae Radix) provide aromatic qi to combine with Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix), and Shengma (Cimicifugae Rhizoma) for exterior opening; Binglang (Arecae Semen) and Xijiao (Rhinocerotis Cornu) combine with Xiaoshi (Natrii Sulfas), Dahuang (Rhei Radix et Rhizoma), Shigao (Gypsum Fibrosum), and Shengdi (Rehmanniae Radix) for interior purging; Fupi (Tuguan's bark/Magnolia bark context implied, likely Houpo or similar aromatic damp-draining), Guanzhong (Cyperi Rhizoma), and Renzhonghuang (Human Manure Ash) connect both exterior and interior for resolving epidemic. ○ Heavenly epidemic qi affecting children presents with high fever, irritability, faint spots, vomiting, crying, and inability to take medicine. If weather is excessively hot, dig two shi of fresh yellow earth, spread it on the ground, lay a reed mat, place the child on it. After a moment of calm, heat may resolve and spots may emerge. Another method: split a rooster, place it against the child's chest, tie feet securely. Within one or two hours, poison may resolve and spots emerge. Generally, when poison resolves, the stomach opens; when the stomach opens, food and medicine enter. This is a verified method, simple and easy to perform, usable when necessary. (Xiangcun Doujue / Smallpox Secrets from Oak Village)
Smallpox syndromes were discussed in detail by past sages, but recent climate changes have made conditions differ from the past, none more so than hidden poison obstructed by seasonal pestilence. Initially, there is lingering cold and fever, with no waist or abdominal pain. After two days, spots appear, moist in color and solitary in shape, not in critical areas. Fever persists; a sneeze brings relief. Roots establish but are hard to raise. By day three, spirit is clouded, asthma occurs, spots vanish, lips are not swollen, mouth is not thirsty. Poison hides and attacks internally, rapidly. Even large doses of aromatic dual-releasing powerful drugs yield no result; nothing can be done. (Wu Yi Hui Jiang / Collected Discussions of Wu Physicians)
Accompanied by Spots, Rash, Dan Sha, and Goiter
Piles like cloud heads forming patches are Dan (Erythema); pale color, floating shape, rough to touch are Zhen (Rash); red-purple deep in flesh, like flea bites, smooth to touch are Ban (Macules). All arise from heat. Furthermore, a patch of red-purple with intense heat and crying is called Chiyou Dan (Red Roaming Erythema) or Huo Dan (Fire Erythema). Named by shape and color. Those on head, face, limbs are mild; those on chest, abdomen, scrotum are severe. This syndrome suits cooling, not excessive releasing. I achieved success with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructus), and Huangbai (Phellodendri Cortex). For urgent cases, bloodletting (Bian, 砭) is needed. I once treated early smallpox with fever and epistaxis, purple spots all over the body, more spots than pustules. Using Shishen Jiedu Tang (Ten Gods Poison-Resolving Decoction) combined with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) for three days, spots receded, pustules rose, filled with pus, and recovery ensued. Blood-heat spots are treatable; epidemic spots are not. Poison reaching muscle spots are treatable; poison hidden in stomach spots are not. (Xiangcun Doujue)
Books say red spots indicate life, purple spots indicate death, black/blue spots are incurable. Yet, some red spot cases die, while purple/blue spot cases live. Spots indicate blood heat. Failure to resolve leads to spots. It is inevitable that spots appearing alongside smallpox is ominous, regardless of color, indicating death. However, if the forehead (Tianting, 天庭) is clear and smallpox shape/color is good, the prognosis differs. ○ Rash appearing first, resolving before smallpox emerges is Dian Zhen (Cushion Rash); rash and smallpox emerging together, rash resolving before smallpox grows is Jia Zhen (Clasped Rash); small smallpox granules piled on top of smallpox is Zhao Dou (Canopy Pox); sand-pox appearing between skin and flesh with indistinct spots of varying sizes is Jia Ban (Clasped Spots); bright red-purple between skin and flesh, rising like cloud heads in patches is Dan Du (Erythema Toxin); crusts falling off after blisters, followed by rash emergence is Gai Zhen (Cover Rash). Various differences exist, but treatment must be sought within the smallpox framework, not equated with regular measles or spot toxins. ○ Initially seeing spots of varying sizes, colored like prickly heat, is Jia Zhen; another type of tiny red points faintly between flesh is Jia Sha (Clasped Sand). Treatment is similar; Dan Du is treated similarly. But primary smallpox must be pleasing to the eye to confirm it is merely clasped sand/rash; otherwise, it is smallpox, requiring clear differentiation. Also, if a few smallpox spots appear with facial rash, but the body is round, clean, sparse, bright red, and vanishes completely after two days, one might be startled, but this is rash, not smallpox. Smallpox disappearance causes agitation; this case is calm, and primary smallpox is obvious, confirming it as rash. Treating with a balanced formula leads to self-healing. However, identification is difficult before resolution. (Ci You Fa / Life-Saving Raft for Children)
Smallpox accompanied by rash is called Liang Hu Dun Lan (Two Tigers Guarding the Fence). Smallpox suits tonification, not purging; purging hinders nourishment. Rash suits purging, not tonification; tonification causes wheezing. However, early smallpox requires only penetrating support (Tuo, 托), which supports smallpox and releases rash simultaneously. Once rash emerges, both are safe. During pus-filling, avoid excessive releasing. In pus-supporting formulas, remove Renshen (Ginseng Radix) and Huangqi (Astragali Radix), add Niubangzi (Arctii Fructus), Jiegeng (Platycodonis Radix), Chantui (Cicadae Periostracum), and Jiangcan (Bombyx Batryticatus) to support pus and regulate lung qi. Clear lung qi, and yang poison disperses. If occurring after smallpox, treat rash alone. Also, if rash appears first, accompanied by water-like vesicles, this is true smallpox, as rash consumes ying-blood, making it white like water vesicles. Treat by releasing rash; once rash disperses, smallpox forms naturally. Do not mistake for water vesicles, as rash never accompanies water vesicles. ○ Skin rash arises from heat-toxin venting. Shape resembles measles, but red patches are distinct. Treatment suits cooling and resolving poison. Once rash disperses, smallpox emerges sparsely. Urticaria (Yinzhen, 瘾疹) appears faintly between skin, itchy upon emergence, treated primarily with resolving poison. Sha (Sand) resembles millet, pointed, round, slightly rough to touch, all arising from heat-toxin, differing in name but same source. ○ Accompanying Dan (Erythema) indicates blood heat. Seen before eruption, use lifting/releasing herbs like Zicao (Arnebiae Radix), Shengma (Cimicifugae Rhizoma), Niubangzi (Arctii Fructus), Chantui (Cicadae Periostracum), Chuanxiong (Ligustici Chuanxiong Rhizoma), Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix), Jiegeng (Platycodonis Radix), and Gegen (Puerariae Lobatae Radix). Smallpox emergence makes Dan disappear. Overuse of cold-cooling causes ice-stagnation. If seen on days 3-4, use cooling-blood/resolving-poison herbs like Shengdi (Rehmanniae Radix), Niubangzi (Arctii Fructus), Mutong (Akebiae Caulis), Jingjie (Schizonepetae Herba), Xijiao (Rhinocerotis Cornu), Zicao (Arnebiae Radix). Observe color: red-purple indicates extreme heat; white indicates phlegm-damp; green-black is incurable. ○ Accompanying Goiter (Ying, 瘿) is mostly formed by smallpox poison and phlegm knotting, located in neck, behind ears, or armpits. Large as peach, small as plum. Initial symptoms normal, then burning fever, thirst, becoming critical. If goiter appears on days 3-4, poison drains with smallpox, pus fills with smallpox, harmless; treat smallpox primarily. If goiter suppurates while smallpox is superficial, goiter rupture depletes yuanqi, hindering smallpox filling. Tonify origin/support, resolve phlegm/resolve poison. If on days 7-8, smallpox is yellow-wax, goiter rupture is acceptable. But after heavy qi-blood loss, protect yuanqi, assist with resolving phlegm/poison. (Feng Shi Jin Nang / Feng's Brocade Purse)
All smallpox with spots: Excess-heat is Yang Ban (Yang Spots), treated with Xijiao (Rhinocerotis Cornu), Huanglian (Coptidis Rhizoma), Shengdi (Rehmanniae Radix); deficiency-cold is Yin Ban (Yin Spots), treated with Renshen (Ginseng Radix) and Huangqi (Astragali Radix). ○ Chuanlian (Coptidis Rhizoma) resolves poison and treats spots, but is drying. If constipation accompanies, even with strong fire-toxin, do not use recklessly. Treating dysentery with Chuanlian relies on drying dampness; smallpox requires moisture, so reckless use is inadvisable. ○ Using Huangqin/Huanglian for spots must not be overdosed. Exclusive cold-cooling causes poison stagnation, preventing eruption and plumping. Must remember this. (Ren Duan Lu / Record of Benevolent Beginnings)
Water Vesicles
Smallpox/rash with water vesicles indicates excess qi and insufficient blood. When smallpox poison is strong and fire blazing, fire cannot flare up, water cannot moisten down, churning between skin to form vesicles. Like a boiling pot: if fire below is strong, water inside bubbles. Spleen deficiency failing to control water also causes water overflow into skin as vesicles. Treat by tonifying spleen and smoothing qi; deficiency vesicles will solidify. White vesicles indicate qi deficiency; white with clear water indicate qi excess; red-purple vesicles indicate blood heat. All mean heat-toxin has not exited, and evil pathogen harms first. Qi deficiency = empty vesicles, tonify qi; Qi excess = water vesicles, drain dampness; Red-purple = blood vesicles, clear heat. (Jin Jing Lu)
My teacher said: Qi-heat with poison causes vesicles; blood-heat with poison causes spots. I said: Poison obstructing qi causes vesicles; fire clashing with blood causes spots. The principle is the same. ○ People fear spots in smallpox, but families often do not fear vesicles, mistaking them for smallpox eruption. Treatment favors tonification over clearing. Generally, Renshen (Ginseng Radix) and Huangqi (Astragali Radix) are sovereign. Gray-white assisted by warming; red-purple assisted by clearing. ○ Red-purple vesicles are stirred by liver fire; adding Sheng Baishao (Paeoniae Radix Alba) to the formula is best. (Xu Xuanzhi)
Fright
With fever for one or two days, suddenly crying, eyes rolling, hands jerking, resembling fright convulsions. Unlike fright-wind convulsions which have phlegm-saliva surging, here there is no phlegm-saliva. Only support smallpox; once erupted, fright settles. Do not recklessly use calming-fright agents to suppress poison. (Xiangcun Doujue)
Fright before smallpox is auspicious; fright after is ominous. Why? Before eruption, heat accumulates internally causing convulsions; after eruption, convulsions stop, internal stagnation clears, hence auspicious. After eruption, qi-blood is weak, wind-cold re-infects, heat-toxin stagnates, and one dares not easily release/clear, hence ominous. (Weng Zhongren)
Children with initial fever showing fright convulsions/coma are popularly said to have "best" smallpox, but this is not always true. Frequent convulsions often lead to stifled smallpox. (Ye Tianshi)
Fright after smallpox, books say incurable, refers to closed eyes/lack of spirit, plus vomiting/diarrhea, white lips/cold limbs. If internal phlegm-heat is severe, urine blocked, or history of fright disease, discuss differently. Taking calming/settling-fright agents can still succeed. (Ci You Fa)
On days 5-6, sudden curling of hands/feet into a ball. Ignorants think it is fright convulsion, but it is actually yangming suffering from fierce poison scorching, meridians lacking ying-blood nourishment. Called "One Hand Binding," must服用 Lingyang San (Antelope Horn Powder). ○ This syndrome多见于 days 4-6. If seen on days 2-3, it is fright convulsion; if seen on days 8-9, treat as chills. (Zheng Zhi Zhun Sheng / Standard for Diagnosis and Treatment)
Crying
Children with smallpox crying day and night: differentiate deficiency/excess, exterior/interior to treat. Internal toxin not exiting or external toxin not dispersing causes crying due to unresolved toxic gas; yang evil/fire excess, red/swollen painful spots cause crying due to lesion pain; heart/kidney original deficiency, evil heat invading yin causes crying due to unsettled spirit or irritability; irregular diet or stagnation causes crying due to stomach disharmony, abdominal pain/distension. Knowing the cause and differentiating truly: internal not-out, release/support; external not-dispersed, resolve/transform; fire excess, clear heat; spirit deficiency, nourish yin. If smallpox poison is mild but crying无故 (without cause), mostly due to dietary injury or constipation. Remove stagnation, unblock obstruction, ensure interior-exterior harmony and ying-wei circulation, then spirit calms and smallpox improves. (Jing Quan Quan Shu / Complete Works of Jingyue)
Waist Pain
Early smallpox waist pain: poison hidden in kidney not exiting. Late smallpox waist pain: poison exited externally but returned to kidney. Thus, early waist pain worries about difficulty exiting; late waist pain worries about difficulty maturing. Classic says: Smallpox poison returning to kidney dies. (Ren Duan Lu)
Smallpox fever with prior waist pain is a most taboo syndrome. Classic says: Waist is the mansion of Kidney. Also: Taiyang arrival causes waist pain. Foot-Taiyang Bladder is head of twelve meridians, its vessel runs along spine, connects to Kidney. Smallpox poison originates below right Kidney, follows Taiyang to disperse through meridians, from interior to exterior. Early fever with immediate waist pain means evil enters Bladder directly to Kidney, joint dysfunction. Resolve poison to purge Shaoyin evil, release exterior to open Taiyang meridian, prevent evil from deepening. Then, though dense, cure possible. Delay treatment, Taiyang evil transmits from exterior to yang; Shaoyin evil transmits from interior to yin. Interior-exterior diseased, yin-yang injured, ying-wei vessels stop, zang-fu qi blocked. May fail to erupt, itch-collapse, or black depression, ultimately incurable. More cases due to Kidney meridian weakness, ministerial fire scorching internally, true yin unable to overcome evil, causing waist pain. Initially lift/release exterior; after eruption, give Dihuang Wan (Rehmannia Pill) material to prevent blackening/Kidney return, then effective. This syndrome often due to congenital insufficiency, called "Broken Waist Smallpox." ○ Waist governed by Kidney, a major joint. Qi-blood flow ensures peace; coagulation/stagnation causes pain. Kidney excess = strong flexion/extension; Kidney deficiency = difficult flexion/extension. Thus waist pain is a strict taboo in smallpox. Early fever pain: hidden poison moving, fire extreme, Kidney water deficient. Treat by lifting/clearing. If smallpox dries out, nourish blood; if Kidney origin greatly deficient, double yin-nourishing/Kidney-tonifying agents. Otherwise,