黄柏 黄连（各五钱） 黄丹（一两，水飞） 轻粉（一钱） 洗疮后以药敷之。
蛇床子为末，韭根煎洗，腊猪油调敷。
东丹 绿豆粉 白矾（各一钱） 调敷。
盖痘本先天之气，感父母受胎时火毒而藏于左肾者也。轻者其发缓，其流远，故心、脾
、肺
生之意；后宜清凉，象秋冬之气，所以符其收藏之义也。此其大略。其间有时令
、禀气、轻重、水火、寒温、阴阳之不同，宜温矣而反
凉之，宜凉也反当温之。其人禀赋本强，清之可发；本弱者扶之可兴。时炎也，非清不流；
时寒也，非温不行。火盛凉之，水盛温之。发于阳者，清以和之；发于阴者，温以畅之。最
忌者，知发而不知收，盖发之易而收之难，收而不收者，发而过伤者也。最喜者，扶而不重
，顾其归路，保其真元也。故非大风大寒固结其腠理者，毒不可轻服也，非大虚大弱者，补
不重剂也。治在温凉寒热之间，调其出入，无过不及，则得过半矣。初热疑似之间，而辨法
有四∶一看脉，二看耳，三视目，四辨指。总以时气决之，遇火多疹，遇木多痘。一看脉者
，盖痘出于左肾，疹出于右肾，如左肾尺部脉气动，疾正逢痘发之候，则二三月前可知矣。
变动而甚则近，微则尚远，总之与伤寒一样，但伤寒起于膀胱腑而表，痘起于肾而里，伤寒
与痘俱先看尺，但有表里脏腑之别耳，未用此脉不变动以行其兆者。此看脉也。二看耳者，
肾通窍于耳，其初发必先动于少阳胆经，木主动，胆与肝为表里，肝主筋，故耳边必有青筋
见于耳叶及廓者，盛则启发近，微者浅而远，倘微而发近，则痘必轻。此看耳也。三视目，
目者五脏精华外见之所也，瞳子属肾，肾气欲发，必有浮光见于目，肾主水，目中有水气，
是肾气动而欲痘也，其远近轻重，亦以色之浅深验之。此视目之法也。四辨指者，三焦亦少
阳也，三焦之脉，贯五脏六腑之经，三焦少阳属手，其气动必见于五指。寒者，水之气也，
故发热而五指独寒者，乃肾气见于三焦而痘之候也。此四者再以时令合之，无不验矣。痘证
养阳救阴，盖二阳之病发心脾也。六日之前，清凉解毒；六日之后，当作虚证治之。五日之前
，消毒解咽喉；五日之后，宜补。
人之一身，以胃气为主，胃气即天气，天气升则地气方化而后万物生长。痘初出于阳而
后传于阴，左肾足，胃亦足，木行旺地，是真阴也，气血冲和，邪从何来？黑陷乃胃欠真气，邪
化于火，心以血养，血被火涸，心神失守，故病归肾。邪深因虚而起，有余易治，不足难扶
，肾防受邪，初出宜滋阴解毒，不使火土干涸，一出暗昧，神昏气促，带白腰痛，非肾而何
？何从救解？若解而不散，阳陷于阴分，血之阳无上升耳。宜养阳为主，不可再攻，攻则正空
而邪反实，损伤胃气，不救一也。
二阳之病发于心脾，痘以二阳为主，已出未出，自汗吐下，虽急不可过用寒凉，过寒则
真气受伤矣。肝肾有益，脾胃受害，再勿汗、吐、下焉。盖肝气即胃气，喜湿热以养。升麻，麻
疹不宜用，防咽喉痛也；痘证恐灌脓之时，泄而倒塌，故用之也。小便赤而渴者，升麻葛根
汤加木瓜、连翘之类。泻而小便清，食伤腹痛不渴，五苓、神曲、木香之类。或吐下无汗，
不可妄投发表，待神至自和。已出者，宜养芽，不使枯槁，宜保元汤加芎、归；一半未出者
，加前胡、桔梗、羌活之类。火盛仍热，去保元，用消毒饮退火。如吐泻先已伤脾矣，过用
出一二日，大便闭结，是血枯肾无以济也。又恐灌浆时喉痛而泄，痘不起发，宜早行清
凉，重用芎、归并消毒饮。痰涎壅塞甚，狂言，加石膏；便闭燥热，用大黄。若早用补法，必成
或外有斑疹，是表实而风热郁于血分也。宜苏葛汤，重用前胡、桔梗、羌活、防风、连
翘、
三五日，其痘红紫，四物汤并解毒。疏痘全在前胡。热盛必用沙参。如尽用寒凉，反逼
四五日，赖胃助生发之气，非善食即无滋润也。如无他证，用保元、芎、归，仍热甚，
用消
用寒凉，陷胃无生发之气，至八九日灰白痒塌，喉痛呕恶，非胃病而何？不救六也。
六七日阴中之阴，尽付于外，而内则空虚，如锅中甑内之气，妙不可言，阳长一分，阴
长一分。用芍药使血归护，保元加芎、归、肉桂，再用白芷、木香行滞，不可太用热药，恐涸而
八九日气血尽归于外，则内虚无疑。如脓黄蜡色，不须治之。若疮嫩淡白，保元、白芷
养阴丹。靥后干燥，发热渴盛，宜救津液，恐津涸阴绝，不救八也。
九十日上体真结痂，下体不至则泻，不必忧之，阳复内回，气血下达，不比六七日起灌
之时可惧也。保元、四君子之类。反用寒凉止塞，致不思饮食，不救九也。
十二三日邪已结完，宜气平回阳。面上真痂下多水泡，四君、山楂利之。面上湿疤，遍
体发毒，保元合四物加银花、连翘之属。或血泡，或旧疮成坑不收，更加发热，胃无生生之气，
凡小儿痘证发热，苏葛散一剂，令其表和；见点，消毒饮。血药随证加减。
凡痘初热之时，即宜葛根汤。盖痘发于阴分，从阳引阴，此为至当也。
痘因表药太过，遂至不发，用理中汤一吐，其痘尽出。
凡痘唇口破裂，口干不渴，的系血燥，用芎归汤加连翘，或四物加莲子之类。大便闭，
痘起灌脓，饮食不进者，紫苏汤磨山豆根，服之即开。外痂薄宜滋润之。泄泻寒战切牙
麻初出于阴而传于阳。人之一身，惟火甚速。肺金居上，畏火者也；脾土居中，畏木者也。
火炎上则肺有亏矣。火宜发之。疏通血脉、滋润皮毛而肺无伤，则左肾足，木得其润泽，肝
血润则脾血藏，脾阴又何伤乎？脾通血脉，胃主四肢，胃气上升，肺津乃降，滋生元气，万
物生长，心之神化，脾得其真火，化从何起？盖火是邪，邪从虚起，有余易去，不足难扶。
未出之先，肺先受邪，当发其表，邪从汗散。假如救汗不至，或汗多，疹或隐或见凶，皆是
元气不足，脾虚不统故也。当补脾阴之不足，血药之中，少加参、桂，亦无害也。庸医未见
其理，谓麻宜清凉，痘宜温补；痘有先清后补之别，则麻无有温之之意。求汗不至，不可再
攻，攻则化而为火，肺热无救，一也。未出或已出，自汗吐下，真气已伤，脾肺先受害也。
麻以二脏为主，切宜斟酌，再无汗、吐、下也。胃喜湿热而上升，清气下陷，小便赤而渴者
，葛根、前胡、桔梗、甘草、牛蒡、连翘、木通之类；或饮食所伤，腹痛泄泻，小便清而不
渴，属寒，五苓加神曲，山楂、砂仁之类；或吐下无汗，不可再攻，宜缓候，待养得神至自
和，不可不察。元气虚弱，照根据常例行之，医死而不悔者多矣。自经汗、吐、下者十余日不
退，久病无阳，宜阳生阴长，四物加参可也。热甚加沙参，不可过用寒凉，过用则脾气绝，
二也。出作两次而不齐者，已出者宜养芽，不使枯槁，用芎、归、赤芍、木通；未出者宜表
，苏葛加前胡、桔梗、牛蒡，喉痛加元参；或血经妄行，宜犀角地黄汤，或升麻葛根汤加沉
香、栀子、连翘之属，切莫忘阴而攻表，以成阴血动，三也。麻不宜发绽，绽者凶；亦不宜
隐，隐而不现无神者毙。出未至足，便作出尽，不行消毒，纯用寒凉，使里血凝滞而阴不发
越，热传于血室，或吐或下，或热郁于内，变成疳劳，或一月、二月而安，或传而至死，四
也。已出三四日而不没者，内有热也，四物加芩、连、栀子、木通；七八日后有热，
内虚而邪盛不散，当扶正以却邪，宜养阴以滋脾肺，
使无克胜，黄芩、白芍、灯心、人参、沙参、天冬、麦冬、当归、山药、莲子，烦加竹叶、
枣仁，看轻重加减治之，不养阴而误滋阴，五也。痰涎涌甚，谵语发渴，属里，宜救阴，宜
白虎汤；若用消毒饮疏散正气，肺绝而亡，六也。大便闭，经血燥，宜用芎归汤加红花、麻
仁，因血虚不能养肝，胃气不能上升故也；而反用柴胡，泻肝血致肾绝，七也。出一二日，
满口细疮，全无空地，火郁宜发之，消毒散加甘草、桔梗、牛蒡、木通、连翘；如反纯用寒
凉，逼毒内攻，八也。靥后口内黑点疮者凶，恐胃烂不治，或一月、半月余热不退，发渴属
虚，宜生脉散兼四物汤，调养气血，不致干涸，但久病无阳，莫根据常例治之，致脾虚不食，
或四五六日口舌硬疮，变成疳疾，或致胃烂，宜消毒，甘桔加元参、沙参、炮姜；如反用白
虎，损伤胃气，九也。麻后痢，只因脾虚不醒，宜用芎、归，白痢煨生姜，赤痢香连丸，切
莫大下，泻痢不愈，宜大补气血；若大下则泄尽元气，黄胀而死，十也。
发表一节，冬用麻黄、羌活、白芷，并消毒饮；春、夏用苏葛根加连翘、甘草、桔梗，
喉痛
用之。呕用陈皮、贝母、姜汁、竹茹。前后咳嗽，乃风寒所感，宜表中却邪。过于清者绝胃
家生发之气，过于补者动胃火，二者皆非疹之正治。惟补阳中之阴，随证施治，莫偏于寒，
莫偏于热，则元气足，易起易发；若元气衰则毒郁于表，表热而火土涸，真阴绝而不救矣。
黄柏、黄连（各五钱）、黄丹（一两，用水飞法处理）、轻粉（一钱）。在清洗疮口后，将药物敷于患处。
将蛇床子研成粉末，用韭菜根煎水清洗，再用腊月猪油调和后外敷。
东丹、绿豆粉、白矾（各一钱），调和后外敷。
痘疹本是先天之气，因感受父母受孕时的火毒，而藏匿于左肾之中。病情轻的，发作缓慢，病程长远，所以治疗初期应顺应心、脾、肺生发之意；后期宜用清凉之法，以象秋冬收藏之气，以此符合其收藏的道理。这是大概的原则。其间有时令气候、禀赋气质、病情轻重、水火盛衰、寒温差异、阴阳偏颇等不同情况，该用温法反而用了凉法，该用凉法反而用了温法。如果患者禀赋本来强盛，用清法可以促使痘疹发出；禀赋本弱，用扶正法可以使正气兴起。时令炎热时，不清热则痘疹难出；时令寒冷时，不温通则痘疹难行。火邪盛者用凉法，水邪盛者用温法。发于阳分的，用清法来调和；发于阴分的，用温法来通畅。最忌讳的是，只知道让痘疹发出，却不知道如何收敛。因为发出容易，收敛难，收不住是因为发出过度而受伤了。最喜欢的是，扶助正气而不重压，顾护其归路，保全其真元。所以如果不是大风大寒固结腠理的情况，毒素不可轻易用药攻伐；如果不是大虚大弱的情况，补益不可用重剂。治疗在于温凉寒热之间，调节其出入，不过分也无不足，就能掌握大半了。在初起发热疑似阶段，辨别方法有四条：一看脉象，二看耳朵，三视眼睛，四辨手指。总体以时令气候来判断，遇火多出疹，遇木多出痘。
一看脉象：痘疹出于左肾，疹出于右肾。如果左肾尺部脉气发动，疾速且正好逢到痘疹发出的时候，那么两三个月前就可以知道了。变动剧烈则病近，微弱则病远。总之与伤寒一样，但伤寒起于膀胱腑而在表，痘疹起于肾而在里。伤寒与痘疹都先看尺脉，只是有表里脏腑的区别罢了，没有使用此脉象不变动以显示征兆的情况。这就是看脉的方法。
二看耳朵：肾通窍于耳，痘疹初发必先触动少阳胆经。木性主动，胆与肝互为表里，肝主筋，所以耳边必有青筋见于耳叶及耳廓者，青筋旺盛则启发近，微弱者浅而远。倘若微弱却发得近，则痘疹必轻。这就是看耳的方法。
三视眼睛：眼睛是五脏精华外现的地方，瞳仁属肾。肾气欲发，必有浮光见于眼中。肾主水，目中有水气，这是肾气动而欲出痘的征兆。其远近轻重，也以颜色的深浅来验证。这就是视目的方法。
四辨手指：三焦也是少阳经。三焦的经脉，贯通五脏六腑的经络。三焦少阳属于手经，其脉气必然显现于五指。寒是水的气化表现，所以发热而唯独五指寒冷的，乃是肾气显现于三焦，是痘疹发出的征兆。这四点再结合时令气候，无不灵验。
痘证的护理在于养阳救阴，因为“二阳之病发于心脾”。六日之前，用清凉解毒法；六日之后，当作虚证治疗。五日之前，消毒解咽喉之毒；五日之后，宜用补法。
人的一身，以胃气为主。胃气即天气，天气上升然后地气才能化生，万物才能生长。痘疹初出于阳而后传于阴，左肾充足，胃气也充足，木行旺地，这是真阴。气血冲和，邪气从何而来？黑陷是因为胃缺乏真气，邪气化火，心靠血滋养，血被火烤干，心神失守，所以病归于肾。邪气深重因虚而起，有余易治，不足难扶。肾防止受邪，初出宜滋阴解毒，不使火土干涸。一出暗昧，神昏气促，带白腰痛，这不是肾病是什么？从何救解？如果解散而不发散，阳气陷入阴分，血的阳气无法上升。宜以养阳为主，不可再攻伐，攻伐则正气空虚而邪气反实，损伤胃气，这是不救的第一种情况。
“二阳之病发于心脾”，痘疹以二阳为主。已出未出，自汗吐下，虽然急迫也不可过用寒凉，过寒则真气受伤。肝肾有益，脾胃受害，再勿用汗、吐、下法。盖肝气即胃气，喜湿热以养。升麻，麻疹不宜用，防咽喉痛；痘证恐怕在灌脓之时，泄而倒塌，所以才用升麻。小便赤而渴者，用升麻葛根汤加木瓜、连翘之类。泻而小便清，食伤腹痛不渴，用五苓散、神曲、木香之类。或吐下无汗，不可妄投发表药，待神气至自然调和。已出的，宜养芽，不使枯槁，用保元汤加川芎、当归；一半未出的，加前胡、桔梗、羌活之类。火盛仍热，去保元汤，用消毒饮退火。如吐泻先已伤脾，过用……（原文此处似有脱漏，依文意推测为误治导致）出一二日，大便闭结，是血枯肾无以济也。又恐灌浆时喉痛而泄，痘不起发，宜早行清凉，重用川芎、当归并消毒饮。痰涎壅塞甚，狂言，加石膏；便闭燥热，用大黄。若早用补法，必成……（原文此处似有脱漏，依文意推测为变证）或外有斑疹，是表实而风热郁于血分也。宜苏葛汤，重用前胡、桔梗、羌活、防风、连翘……（原文此处似有脱漏）三五日，其痘红紫，用四物汤并解毒。疏痘全在前胡。热盛必用沙参。如尽用寒凉，反逼……（原文此处似有脱漏）四五日，赖胃助生发之气，非善食即无滋润也。如无他证，用保元、川芎、当归，仍热甚，用消……（原文此处似有脱漏）用寒凉，陷胃无生发之气，至八九日灰白痒塌，喉痛呕恶，这不是胃病是什么？不救的第六种情况。
六七日阴中之阴，尽付于外，而内则空虚，如锅中甑内之气，妙不可言，阳长一分，阴长一分。用芍药使血归护，保元汤加川芎、当归、肉桂，再用白芷、木香行滞，不可太用热药，恐涸而……（原文此处似有脱漏）八九日气血尽归于外，则内虚无疑。如脓黄蜡色，不须治之。若疮嫩淡白，用保元汤、白芷、养阴丹。靥后干燥，发热渴盛，宜救津液，恐津涸阴绝，不救的第八种情况。
九十日上体真结痂，下体不至则泻，不必忧之，阳复内回，气血下达，不比六七日起灌之时可惧也。用保元汤、四君子汤之类。反用寒凉止塞，致不思饮食，不救的第九种情况。
十二三日邪已结完，宜气平回阳。面上真痂下多水泡，用四君子汤、山楂利之。面上湿疤，遍体发毒，用保元汤合四物汤加银花、连翘之属。或血泡，或旧疮成坑不收，更加发热，胃无生生之气，凡小儿痘证发热，苏葛散一剂，令其表和；见点，用消毒饮。血药随证加减。
凡痘初热之时，即宜葛根汤。盖痘发于阴分，从阳引阴，此为至当也。
痘因表药太过，遂至不发，用理中汤一吐，其痘尽出。
凡痘唇口破裂，口干不渴，的确系血燥，用芎归汤加连翘，或四物汤加莲子之类。大便闭，痘起灌脓，饮食不进者，用紫苏汤磨山豆根，服之即开。外痂薄宜滋润之。泄泻寒战切牙……（原文此处似有脱漏，转入麻疹论述）麻初出于阴而传于阳。人之一身，惟火甚速。肺金居上，畏火者也；脾土居中，畏木者也。火炎上则肺有亏矣。火宜发之。疏通血脉、滋润皮毛而肺无伤，则左肾足，木得其润泽，肝血润则脾血藏，脾阴又何伤乎？脾通血脉，胃主四肢，胃气上升，肺津乃降，滋生元气，万物生长，心之神化，脾得其真火，化从何起？盖火是邪，邪从虚起，有余易去，不足难扶。未出之先，肺先受邪，当发其表，邪从汗散。假如救汗不至，或汗多，疹或隐或见凶，皆是元气不足，脾虚不统故也。当补脾阴之不足，血药之中，少加参、桂，亦无害也。庸医未见其理，谓麻宜清凉，痘宜温补；痘有先清后补之别，则麻无有温之之意。求汗不至，不可再攻，攻则化而为火，肺热无救，这是第一种错误。未出或已出，自汗吐下，真气已伤，脾肺先受害也。麻以二脏为主，切宜斟酌，再无汗、吐、下也。胃喜湿热而上升，清气下陷，小便赤而渴者，用葛根、前胡、桔梗、甘草、牛蒡、连翘、木通之类；或饮食所伤，腹痛泄泻，小便清而不渴，属寒，用五苓散加神曲、山楂、砂仁之类；或吐下无汗，不可再攻，宜缓候，待养得神至自和，不可不察。元气虚弱，照根据常例行之，医死而不悔者多矣。自经汗、吐、下者十余日不退，久病无阳，宜阳生阴长，用四物汤加人参可也。热甚加沙参，不可过用寒凉，过用则脾气绝，这是第二种错误。出作两次而不齐者，已出者宜养芽，不使枯槁，用川芎、当归、赤芍、木通；未出者宜表，苏葛汤加前胡、桔梗、牛蒡，喉痛加元参；或血经妄行，宜犀角地黄汤，或升麻葛根汤加沉香、栀子、连翘之属，切莫忘阴而攻表，以成阴血动，这是第三种错误。麻不宜发绽，绽者凶；亦不宜隐，隐而不现无神者毙。出未至足，便作出尽，不行消毒，纯用寒凉，使里血凝滞而阴不发越，热传于血室，或吐或下，或热郁于内，变成疳劳，或一月、二月而安，或传而至死，这是第四种错误。已出三四日而不没者，内有热也，用四物汤加黄芩、黄连、栀子、木通；七八日后有热，内虚而邪盛不散，当扶正以却邪，宜养阴以滋脾肺，使无克胜，用黄芩、白芍、灯心、人参、沙参、天冬、麦冬、当归、山药、莲子，烦加竹叶、枣仁，看轻重加减治之，不养阴而误滋阴，这是第五种错误。痰涎涌甚，谵语发渴，属里，宜救阴，宜白虎汤；若用消毒饮疏散正气，肺绝而亡，这是第六种错误。大便闭，经血燥，宜用芎归汤加红花、麻仁，因血虚不能养肝，胃气不能上升故也；而反用柴胡，泻肝血致肾绝，这是第七种错误。出一二日，满口细疮，全无空地，火郁宜发之，用消毒散加甘草、桔梗、牛蒡、木通、连翘；如反纯用寒凉，逼毒内攻，这是第八种错误。靥后口内黑点疮者凶，恐胃烂不治，或一月、半月余热不退，发渴属虚，宜生脉散兼四物汤，调养气血，不致干涸，但久病无阳，莫根据常例治之，致脾虚不食，或四五六日口舌硬疮，变成疳疾，或致胃烂，宜消毒，甘桔汤加元参、沙参、炮姜；如反用白虎汤，损伤胃气，这是第九种错误。麻后痢，只因脾虚不醒，宜用川芎、当归，白痢煨生姜，赤痢香连丸，切莫大下，泻痢不愈，宜大补气血；若大下则泄尽元气，黄胀而死，这是第十种错误。
发表一节，冬用麻黄、羌活、白芷，并消毒饮；春、夏用苏葛根加连翘、甘草、桔梗，喉痛用之。呕用陈皮、贝母、姜汁、竹茹。前后咳嗽，乃风寒所感，宜表中却邪。过于清者绝胃家生发之气，过于补者动胃火，二者皆非疹之正治。惟补阳中之阴，随证施治，莫偏于寒，莫偏于热，则元气足，易起易发；若元气衰则毒郁于表，表热而火土涸，真阴绝而不救矣。
**Huangbai (Phellodendri Cortex), Huanglian (Coptidis Rhizoma)** (each 5 qian), **Huandan (Lead Monoxide)** (1 liang, processed by water levigation), **Qingfen (Calomelas)** (1 qian). After washing the sores, apply the medicine to the affected area.
Powdered **Shechuangzi (Cnidii Fructus)**, wash with decoction of **Jiu Gen (Allii Tuberosi Rhizoma et Radix)**, and mix with lard from the twelfth lunar month for external application.
**Dongdan (Red Lead Powder)**, **Lvdou Fen (Mung Bean Starch)**, **Baifan (Alumen)** (each 1 qian), mix and apply externally.
Smallpox originates from congenital qi, harboring fire-toxin received during conception in the left kidney. In mild cases, eruption is slow and the course is long; thus, early treatment should follow the generative intent of the Heart, Spleen, and Lung. Later treatment should be cooling, resembling the energy of autumn and winter, to accord with the principle of storage. This is the general principle. There are variations due to seasonal climate, constitutional qi, severity, abundance of fire/water, cold/heat, and yin/yang imbalances. If warming is indicated but cooling is used, or if cooling is indicated but warming is used: if the constitution is strong, clearing can promote eruption; if weak, supporting can restore vitality. In hot seasons, without clearing, eruption cannot flow; in cold seasons, without warming, movement cannot occur. Excess fire requires cooling; excess water requires warming. Eruptions arising from yang are harmonized with clearing; those from yin are unblocked with warming. The greatest taboo is knowing how to induce eruption but not how to consolidate it. Eruption is easy to induce but difficult to consolidate; failure to consolidate results from excessive eruption causing injury. The ideal approach supports without overburdening, guards the return path, and preserves true yuan qi. Therefore, unless there is severe wind-cold congealing the cou-li (skin and interstices), toxins should not be lightly attacked with drugs; unless there is severe deficiency and weakness, tonification should not use heavy doses. Treatment lies between warming, cooling, cold, and heat, regulating entry and exit without excess or deficiency, achieving more than half the cure. In the initial fever stage where differentiation is difficult, four methods are used: first, inspect the pulse; second, examine the ears; third, observe the eyes; fourth, distinguish the fingers. Generally, determine by seasonal qi: encountering fire leads to more rashes, encountering wood leads to more smallpox.
First, inspect the pulse: Smallpox arises from the left kidney, rashes from the right kidney. If the pulse at the chi position of the left kidney moves vigorously and coincides with the time of eruption, one could have known this two to three months prior. Severe changes indicate proximity to eruption; mild changes indicate distance. Essentially similar to Shanghan (Cold Damage), but Shanghan originates from the Bladder fu organ and is exterior, while smallpox originates from the Kidney and is interior. Both Shanghan and smallpox prioritize the chi pulse, differing only in exterior/interior and fu/zang distinctions. This is the method of pulse inspection.
Second, examine the ears: The Kidney opens into the ears. Initial eruption must disturb the Shaoyang Gallbladder channel. Wood governs movement; the Gallbladder and Liver are exterior-interior pairs; the Liver governs sinews. Thus, green veins must appear on the earlobe and helix. Abundant veins indicate imminent eruption; mild veins indicate shallow and distant eruption. If mild yet erupting soon, the smallpox will be light. This is the method of ear examination.
Third, observe the eyes: The eyes are where the essence of the five zang organs manifests externally. The pupil belongs to the Kidney. When Kidney qi desires to erupt, floating light appears in the eyes. The Kidney governs water; water qi in the eyes indicates Kidney qi moving and impending smallpox. Its distance and severity are verified by the depth of color. This is the method of eye observation.
Fourth, distinguish the fingers: The Sanjiao (Triple Burner) is also Shaoyang. The Sanjiao meridians penetrate the channels of the five zang and six fu organs. Hand Shaoyang Sanjiao qi manifests in the five fingers. Cold is the qi of water; thus, fever with coldness unique to the five fingers indicates Kidney qi manifesting in the Sanjiao, a sign of smallpox eruption. Combining these four with seasonal climate ensures accuracy.
Smallpox management focuses on nourishing yang and saving yin, as "diseases of the two yang organs originate in the Heart and Spleen." Before the sixth day, use cooling and detoxifying methods; after the sixth day, treat as deficiency. Before the fifth day, detoxify and relieve the throat; after the fifth day, use tonification.
The human body relies primarily on Stomach qi. Stomach qi is heavenly qi; when heavenly qi ascends, earthly qi transforms, allowing all things to grow. Smallpox initially emerges from yang and transmits to yin. If the left Kidney is sufficient and Stomach qi is sufficient, and Wood is flourishing, this is true yin. With harmonious qi and blood, where does evil come from? Black depression occurs because the Stomach lacks true qi, transforming evil into fire. The Heart is nourished by blood; when blood is dried by fire, the heart spirit loses its residence, so the disease returns to the Kidney. Deep evil arises from deficiency; excess is easy to treat, deficiency is hard to support. To prevent the Kidney from receiving evil, initial eruption requires nourishing yin and detoxifying, preventing fire and earth from drying up. Dark eruption, confusion, shortness of breath, white discharge, and lower back pain—this is not Kidney pathology? How to rescue? If dispersal fails to vent, yang sinks into the yin portion, and the yang of blood cannot ascend. Prioritize nourishing yang; do not attack again. Attacking empties righteous qi and strengthens evil, damaging Stomach qi, which is the first case of untreatability.
"Diseases of the two yang organs originate in the Heart and Spleen." Smallpox centers on the two yang. Whether erupted or not, spontaneous sweating, vomiting, or purgation—even if urgent—should not overuse cold/cooling herbs, as excessive cold injures true qi. While benefiting Liver and Kidney, it harms the Spleen and Stomach; thus, avoid sweating, vomiting, and purging. Liver qi is Stomach qi, preferring damp-heat for nourishment. Shengma (Cimicifugae Rhizoma) is unsuitable for measles to prevent sore throat; for smallpox, it is used fearing collapse during pus formation. For red urine and thirst, use Shengma Gegen Tang (Cimicifuga and Kudzu Decoction) plus Mugua (Chaenomelis Fructus) and Lianqiao (Forsythiae Fructus). For diarrhea with clear urine, food stagnation abdominal pain without thirst, use Wuling San (Five-Ingredient Powder with Poria) plus Shenqu (Massa Medicata Fermentata) and Muxiang (Aucklandiae Radix). If vomiting/purging with no sweat, do not recklessly administer releasing agents; wait for spirit to arrive and self-harmonize. For erupted lesions, nourish buds to prevent withering, using Baoyuan Tang (Preserve Origin Decoction) plus Xiong (Chuanxiong Rhizoma) and Gui (Angelicae Sinensis Radix); for half-erupted, add Qianhu (Peucedani Radix), Jiegeng (Platycodonis Radix), and Qianghuo (Notopterygii Rhizoma et Radix). If fire is abundant and heat persists, discard Baoyuan Tang and use Xiaodu Yin (Detoxify Poison Infusion) to reduce fire. If vomiting/diarrhea has already injured the Spleen... [text fragment] ...one or two days later, constipation indicates blood depletion and Kidney failing to assist. Fearing throat pain and diarrhea during pus formation with poor eruption, employ early cooling, heavily using Xiong, Gui, and Xiaodu Yin. For severe phlegm-saliva obstruction and delirium, add Shigao (Gypsum Fibrosum); for constipation and dry heat, use Dahuang (Rhei Radix et Rhizoma). Early tonification may cause... [text fragment] ...or external macules/rashes, indicating exterior excess and wind-heat stagnating in the blood portion. Use Sugé Tang (Perilla and Kudzu Decoction), heavily using Qianhu, Jiegeng, Qianghuo, Fangfeng (Saposhnikoviae Radix), Lianqiao... [text fragment] ...three to five days later, if pustules are red-purple, use Siwu Tang (Four Substances Decoction) combined with detoxification. Clearing smallpox relies entirely on Qianhu. Severe heat requires Shashen (Glehniae Radix). Using only cold/cooling herbs forces... [text fragment] ...four to five days later, relying on Stomach to aid generating qi; without good appetite, there is no moistening. Without other symptoms, use Baoyuan, Xiong, Gui; if heat remains severe, use Xiao... [text fragment] ...using cold/cooling traps the Stomach, depriving it of generating qi. By eight to nine days, gray-white, itchy, collapsed pustules, throat pain, and nausea indicate Stomach disease, which is the sixth case of untreatability.
Six to seven days, yin within yin is fully distributed outward, leaving the interior empty, like steam in a steamer basket—subtle and ineffable. As yang grows, yin grows. Use Shaoyao (Paeoniae Radix) to guide blood to protect; Baoyuan Tang plus Xiong, Gui, Rougui (Cinnamomi Cortex), plus Baizhi (Angelicae Dahuricae Radix) and Muxiang to move stagnation. Do not use too much hot medicine, fearing dryness... [text fragment] ...eight to nine days, qi and blood return entirely outward, confirming interior deficiency. If pus is yellow-wax colored, no treatment needed. If sores are tender and pale white, use Baoyuan Tang, Baizhi, and Yangyin Dan (Nourish Yin Pill). After crusting, dryness, fever, and intense thirst require saving fluids, fearing fluid depletion and yin extinction, which is the eighth case of untreatability.
By ninety days, the upper body forms true scabs; if the lower body does not, diarrhea occurs. Do not worry; yang returns inward, qi and blood descend. This is not as fearful as the pus-formation stage at six to seven days. Use Baoyuan Tang and Sijunzi Tang (Four Gentlemen Decoction). Conversely using cold/cooling to stop/seal causes loss of appetite, which is the ninth case of untreatability.
Twelve to thirteen days, evil is fully consolidated; aim to calm qi and restore yang. Many blisters under true scabs on the face: use Sijunzi Tang and Shan Zha (Crataegi Fructus) to drain. Wet scabs on the face, toxic eruption all over: combine Baoyuan Tang with Siwu Tang plus Yinhua (Lonicerae Japonicae Flos) and Lianqiao. Or blood blisters, or old sores forming pits that do not close, plus fever: Stomach lacks generating qi. For any pediatric smallpox fever, one dose of Sugé San (Perilla and Kudzu Powder) harmonizes the exterior; upon appearance of spots, use Xiaodu Yin. Adjust blood-invigorating herbs according to symptoms.
Whenever smallpox begins with fever, Gegen Tang (Kudzu Decoction) is appropriate. Since smallpox erupts from the yin portion, drawing yin from yang is most appropriate.
If smallpox fails to erupt due to excessive exterior-releasing drugs, use Lizhong Tang (Regulate the Middle Decoction) to induce vomiting, causing all smallpox to erupt.
For cracked lips and mouth in smallpox, dry mouth without thirst, definitely blood dryness: use Xiong Gui Tang (Chuanxiong and Angelica Decoction) plus Lianqiao, or Siwu Tang plus Lian Zi (Nelumbinis Semen). Constipation, pustule formation, inability to eat: grind Shandougen (Millettiae Speciosae Radix) in Zisu Tang (Perilla Decoction); administration opens the bowels. Thin external scabs require moistening. Diarrhea, chills, teeth grinding... [text fragment transitions to Measles] Measles initially emerge from yin and transmit to yang. In the human body, fire acts very quickly. Metal of the Lung resides above and fears fire; Earth of the Spleen resides in the center and fears Wood. Fire flaming upward depletes the Lung. Fire should be vented. Unblocking blood vessels and moistening skin/hair protects the Lung. Then the left Kidney is sufficient, Wood receives moisture, Liver blood is moist, Spleen blood is stored, and Spleen yin is unharmed. The Spleen connects to blood vessels; the Stomach governs the four limbs. Stomach qi ascends, Lung fluids descend, generating yuan qi, allowing all things to grow. The Spirit transformation of the Heart, the Spleen receives true fire; how does transformation arise? Fire is evil, arising from deficiency. Excess is easy to remove; deficiency is hard to support. Before eruption, the Lung first receives evil; release the exterior, letting evil scatter via sweat. If inducing sweat fails, or sweat is excessive, rash hidden or visible ominously—all due to insufficient yuan qi and Spleen deficiency failing to control. Supplement Spleen yin deficiency; adding Ren Shen (Ginseng Radix) and Gui Zhi (Cinnamon Twig) to blood herbs is harmless. Quack doctors, lacking understanding, claim measles require cooling and smallpox require warming; since smallpox has distinct clearing then tonifying phases, they assume no warming intent for measles. Seeking sweat without success, do not attack again; attacking transforms into fire, lung heat becomes untreatable—error one. Before or after eruption, spontaneous sweating/vomiting/purgation injures true qi, harming Spleen and Lung first. Measles center on two organs; careful consideration is needed; absolutely no sweating, vomiting, or purging. The Stomach prefers damp-heat and ascending; if clear qi sinks, red urine and thirst: use Gegen, Qianhu, Jiegeng, Gancao (Glycyrrhizae Radix et Rhizoma), Niubang (Arctii Fructus), Lianqiao, Mutong (Akebiae Caulis); or food injury, abdominal pain, diarrhea, clear urine without thirst, cold pattern: Wuling San plus Shenqu, Shan Zha, Sharen (Amomi Fructus); or vomiting/purgation with no sweat, do not attack again; wait patiently for spirit to arrive and self-harmonize. Qi and blood deficiency following standard protocols often leads to death without regret. After ten-plus days of sweating/vomiting/purgation without resolution, chronic illness lacks yang; yang generates yin, use Siwu Tang plus Renshen. Severe heat adds Shashen; do not overuse cold/cooling, as this destroys Spleen qi—error two. Eruption occurring twice unevenly: erupted parts need bud nourishment to prevent withering, using Xiong, Gui, Chishao (Paeoniae Radix Rubra), Mutong; unerupted parts need exterior release, Sugé Tang plus Qianhu, Jiegeng, Niubang, Yuan Shen (Scrophulariae Radix) for sore throat; or erratic blood menstruation, use Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) or Shengma Gegen Tang plus Chenxiang (Aquilariae Lignum), Zhizi (Gardeniae Fructus), Lianqiao. Do not forget yin to attack the exterior, causing yin-blood disturbance—error three. Measles should not burst open (bursting is ominous); nor should they hide (hidden without spirit is fatal). If eruption does not reach the feet but is declared complete, skipping detoxification and using only cold/cooling causes internal blood stagnation and yin failure to vent, heat transmitting to the Blood Chamber, vomiting or purging, or internal heat stagnation transforming into Gan Lao (Consumption), recovering in one or two months, or progressing to death—error four. Not resolving after three to four days indicates internal heat: Siwu Tang plus Huang Qin (Scutellariae Radix), Huang Lian, Zhizi, Mutong. Heat after seven to eight days indicates interior deficiency and abundant evil not scattering; support righteousness to expel evil, nourish yin to moisten Spleen and Lung, preventing overcoming, using Huang Qin, Baishao (Paeoniae Radix Alba), Deng Xin Cao (Junci Medulla), Renshen, Shashen, Tiandong (Asparagi Radix), Maidong (Ophiopogonis Radix), Dang Gui (Angelicae Sinensis Radix), Shanyao (Dioscoreae Rhizoma), Lian Zi. Add Zhuye (Bambusae Folium) and Zaoren (Ziziphi Spinosae Semen) for irritability; adjust based on severity. Nourishing yin mistakenly interpreted as tonifying yin—error five. Severe phlegm-saliva surging, delirium, thirst, interior pattern: save yin, use Baihu Tang (White Tiger Decoction); using Xiaodu Yin to disperse righteous qi leads to Lung exhaustion and death—error six. Constipation, blood dryness: use Xiong Gui Tang plus Honghua (Carthami Flos) and Huma (Cannabis Semen), because blood deficiency fails to nourish the Liver and Stomach qi fails to ascend; conversely using Chaihu (Bupleuri Radix) drains Liver blood leading to Kidney exhaustion—error seven. One to two days after eruption, fine sores covering the mouth with no space, fire stagnation requires venting: Xiaodu San (Detoxify Poison Powder) plus Gancao, Jiegeng, Niubang, Mutong, Lianqiao; conversely using only cold/cooling forces poison inward—error eight. Black spot sores inside the mouth after crusting are ominous, fearing stomach rot untreatable; or residual heat remaining for one or half a month, thirst indicating deficiency: use Shengmai San (Generate Pulse Powder) combined with Siwu Tang to regulate qi and blood, preventing dryness. But chronic illness lacks yang; do not follow standard protocols, causing Spleen deficiency and anorexia. Or four to six days, hard sores on tongue/mouth transforming into Gan Ji (Gan Disease), or stomach rot: use detoxification, Ganjie Tang (Licorice and Platycodon Decoction) plus Yuan Shen, Shashen, Paojiang (Prepared Ginger); conversely using Baihu Tang damages Stomach qi—error nine. Post-measles dysentery is solely due to Spleen deficiency failing to awaken: use Xiong, Gui; white dysentery with roasted ginger, red dysentery with Xianglian Wan (Costus and Coptis Pill). Do not purge heavily. If dysentery persists, greatly tonify qi and blood; heavy purging drains yuan qi, leading to yellow distension and death—error ten.
Regarding exterior release: Winter uses Mahuang (Ephedrae Herba), Qianghuo, Baizhi, and Xiaodu Yin; Spring/Summer uses Sugé Gen (Perilla Stem and Kudzu Root) plus Lianqiao, Gancao, Jiegeng, for sore throat. Vomiting uses Chenpi (Citri Reticulatae Pericarpium), Beimu (Fritillariae Bulbus), Jiangzhi (Zingiberis Juice), Zhuru (Bambusae Caulis in Taenia). Coughing before and after is caused by wind-cold; resolve exterior and expel evil. Over-clearing cuts off Stomach generating qi; over-tonifying stirs Stomach fire; neither is the correct treatment for rashes. Only nourish yin within yang, treat according to symptoms, do not bias toward cold or heat, then yuan qi is sufficient, easy to rise and erupt; if yuan qi declines, toxin stagnates in the exterior, exterior heat dries fire and earth, true yin exhausts and becomes untreatable.