（凡三十一首，共四十六方）
借问何为痘后痈？只因平塌少成脓，毒邪蕴聚难消散，透节寻关出要冲。
凡痘初出一点血，由血而化至脓，脓成而毒解矣。若出形之后，应起发不起发，应成脓不成脓，一片空壳，
状如蛇皮，或平塌破损，都无脓水，本为死证。缘其人脾胃素强，又能饮食，亦可以引日收效。只是毒邪
蕴蓄于里，必寻出路于关节之间而为痈肿，但发一二处可治，若流注于手足，发之不止，肿
灌不愈，久而死矣。
痘痈先要明经络，解毒调元兼里托。决脓去毒急施功，莫待残形变为恶。
凡痈之发，先看在何经络，分气血多少而治之，次看人之虚实，以解毒托里为先，不可乱施敷药，以致毒不
得出，内炎筋骨而成坏证。如肿而未成脓者，用必胜膏贴之；已成脓者，将铍针决破其脓，以生肌散敷之。若
肿毒而元气素弱者，以十六味流气饮流通之；若气血虚而泄泻者，加附子以温之；若元气素强者，用连翘解毒汤
主之；如痈毒日久，脓血去多者，以十全大补汤扶元解毒。
恶证无如痘后丹，皮肤蕴火毒相干。看他所发归何部？心肾之经治亦难。
赤火丹瘤，恶候也，流移红肿，其痛手不可近。痘疮之后，有发丹瘤者，因蓄火太甚，不能发泄，郁于肌肉
之间，故发而为丹。从头上起过心即死，从足下起过肾即死，内服玄参化毒汤解之，外用磁锋砭法。
瘾疹何为痘后呈？肌肤蕴毒未全清。若教发尽无停滞，免得重重怪证生。
瘾者，皮肤间隐隐成疙瘩也，俗人谓之风丹；疹者，皮肤点点状如蚊蚤咬迹也。痘后发瘾疹，因毒火未发
尽，藏于皮肤之间，或搔痒因抓而成，或因受风火相搏而成，皆吉兆也，正欲其发泄，无使停留以变他证。如
发太甚，内服防风败毒散，外以益元散拭之。益元散，方见前。
痘已收成靥不干，或时出血病难安。从前毒瓦斯藏肌表，蚀肉伤肌不忍看。
此与前顽疮不收相同。凡觉痘疮当靥不靥，即防此证，当内服大补汤，外以绵茧散敷之，绵茧散方见前。
翳膜何为眼内攒？怪他热毒壅于肝。还睛去翳多奇术，点洗徒招废弃端。
小儿出痘之时，即用黄柏膏和胭脂涂眼，防斑疮入眼也。但斑疮入眼，本不在初，多在收靥之时，或满面破
烂，重复肿灌，脓血胶固，毒火郁蒸在内，其斑疮入眼；或痘出
已甚，成就迟缓，医用辛热之药发之，亦令斑疮入眼；又或收靥之时，喜淡辛热，谓之干浆，以致二火相煽，亦
令斑疮入眼。但在白珠上不必治，久而自去，惟在黑轮上者，或掩蔽瞳仁，急用密蒙花散治之。
两目今朝乍畏明，肝虚邪火暗伤睛。凉肝养血功无比，能使双眸炯炯清。
凡痘后双目见明不开，暗则开者，谓之羞明，宜凉肝明目散治之；若向暗处亦不开者，却防目中有疮，当如
上法治之。
收后缘何便下红？多由倒陷毒归中。利完脓血应须愈，强治翻为聚怨丛。脓血痂皮一路来，任他自止莫疑
猜。和中清热施残着，劫涩轻投病转乘。
痘后忽利脓血，待其自止，然后用和中清热之剂，不可便用止涩。但痢势甚者，宜黄连解毒汤清解之，脓血
尽后，宜和中汤。
痘证从前无倒陷，缘何脓血利无时？大肠郁火多潜毒，解毒通肠贵早施。
痘无倒陷之证，却有脓血之痢。由于平日食煎炒，素有积热，今因痘后气血虚，不能胜积，故痢脓血也，此
名滞下，必然肠鸣作痛，里急后重。或因痘出之后，饮食太多，水停作泄，热毒乘虚入里，便下脓血，此名肠垢，
宜调胃承气汤以彻其毒，次用黄芩汤调其阴阳。
最怕收成呕哕频，咽疼胃弱毒潜湮。错喉呛水宜施治，干哕无声死作邻。
有声有物谓之呕，有物无声谓之吐，有声无物谓之哕。食谷即吐谓之错喉，饮水而喷谓之呛水。今痘后凡有
此等，由热毒壅塞胃口，故令呕吐；咽门涩塞，故令错喉呛水也。惟干呕乃胃疮腐烂，不能纳谷，故时时张口，
似吐不吐，乃不治之证；亦有咽喉作痛，而呕吐失声者，乃咽喉腐烂，亦不可治。惟但呕吐，陈皮竹茹汤；咽喉
痛，甘桔汤。
身已清安热不除，或因毒甚或元虚。调元解毒分投用，寒热分明效自如。
痘既收靥，则毒解而热当除矣。如热一
向不已，非毒瓦斯之余烈，必元气之素虚，惟以脉辨之，如脉数形勇，烦躁而热，引邪气实也，宜知母解毒汤；
如脉迟形怯，热而喜睡，此正气虚也，宜黄芩调元汤。
收后浑身一向温，乍然发热细评论。内伤外感须分治，此个真机妙法门。
痘靥之后，一向温暖和平，并无余热，今忽发热，不可以余毒未解，正气之虚同论，必因外感风寒。其证头
目昏痛，恶寒脉浮，宜桂枝汤。
或因内伤饮食，其证肚腹饱闷，不喜饮食，其脉弦滑，以补中益气汤加消导药而运用之。
食饮如常腹里疼，盖由脾弱化难能。看他虚实行消导，方显明良三折肱。
收靥之后，忽然腹疼，或呕或泄，不思饮食，此伤食之证。虚则用补中益气汤治之，如无吐利腹痛、气急，
宜丁香脾积丸下之。若腹满而痛，烦闷不宁，此毒火入中，急用雄黄解毒丸利之，不然渐加喘急、手足厥冷，
则难治矣。
收后缘何食不思？偶然伤食少人知。补脾消导为良法，强忍成疳悔后迟。
一向能食，收后反不能食，闻食气即呕逆，此必食伤，甚则以脾积丸（方见前），治之，微则以保和丸调之。若
隐忍不急求治，久则消瘦，渐成疳痨矣。
寒热缠身似疟侵，不分早晚应期临。只缘脾胃多虚弱，补气升阳贵酌斟。
此因痘后气血两伤，阴虚则内热，阳虚则外寒，乍寒乍热，俨然疟疾。切不可以为疟治，但以补中益气汤升
举之，其病自愈。
收后浑身手足寒，好将气血作虚看。六经脉细如将脱，急早回阳病自安。
凡痘收靥之后，手足厥冷，六脉沉细，元气大虚，急用调元生脉散以温之，稍用寒凉，必取败亡也。
强打精神睡思昏，终朝何事不惺惺？此因毒解神虚倦，气血和平体自宁。
收靥而好睡，乃毒解神虚，此常事也，不必调治。有等苟且之流，欺人不知而取利；庸下之徒，妄用汤丸
而致祸者，戒之戒之！
睡思沉沉不识人，恍疑中酒妄言频。只因热伏心包络，保护心君妙入神。
凡收后昏睡，连日不醒，口中妄语，或有醒时，亦似醉人，每多错语，此热邪攻心。心君不肯受邪，传于包
络，宜导赤解毒汤清之，或用安神丸亦佳。
收靥之余搐搦萦，责其火毒未全清。清心散火风应退，发作无休命必倾。
痘出发热作搐，此常候也。若收靥之后反发搐者，乃疮发未透，毒火内侵故也。然此候发于收靥之余，血气
已衰，治之甚难，宜清神散火汤。如药对病者可治，若连发不已，死证也。
身已康宁手足挛，分明血少致斯愆。补脾养血诚仙诀，不遇知音莫浪传。
凡痘后手足忽然挛拘，不能屈伸转运，乃血少不能养筋，又或外被风寒水湿以致然耳。不可用发散并疏风之
药，以耗其血，只宜当归桂枝汤补脾养血，则手足自和。
痘后还愁咳嗽多，总由毒火肺中磨。清金降火兼调气，肩息胸高若命何！
痘疹之后，惟肺受伤，至于收靥毒解，宜乎宁矣。若反咳嗽喘急，乃毒火流入肺中也，当清金降火，宜宁肺
汤保肺解毒。服药嗽不止，胸高龟壳肩息者不治。
忽尔浑身肿胀形，或风或水食偏停。肿因肺受宜清表，胀属脾家利解宁。
痘收之后，或面目浮，四肢肿，此属于肺。因表虚而受风寒，仍宜汗解，用加味五皮汤。
若腹胀如鼓，眼胞微肿，此属于脾。由脾胃虚，饮水过多。蓄湿于内，所食过多，积热于中，仍宜利解，宜
浓朴汤；倘属虚胀，不可妄攻，但宜莱菔子丸。
小便宜清偶涩迟，膀胱蓄热少人知。不将导赤为良法，只恐迁延有变时。
凡痘疹，小便始终宜清，若收后不利，此热积膀胱，宜加减导赤散以清其心。
便贵滋荣乍觉难，谁知肠胃液津干。润肠胆导宜兼用，纵有余邪便后安。
凡大便始终须宜润泽，一二日一次为佳。若至于收靥后而大便秘结，乃痘出太多，血枯气不润肠，宜润肠
丸兼胆导法（方见前。）
腠理疏通雨汗倾，卫虚荣弱两无情。建中自汗汤偏胜，盗汗归黄六味平。
经曰∶卫气者，所以温肌肉，充皮毛，肥腠理，司开合也。痘疮之后，卫气受伤，故收靥之后，卫弱而汗
出也。醒时常出为自汗，宜建中汤；睡着而出者为盗汗，当归六黄汤。
血在身中本自宁，火邪迫血血违经。鼻中细出堪调治，便尿中来命不停。
痘收靥后，忽见血证，大为危候。盖鼻血出于肺，吐血出于胃，溺血出于小肠，便血出于大肠，皆由毒入于内，迫
血妄行，急
宜凉血地黄汤止之。服药后血不止者，不治。
忽吐蛔虫证已非，要知内热又常饥。但闻食臭虫斯出，呕吐心烦虫作威。
伤寒吐蛔，责之胃寒；痘证吐蛔，责之里热。由热毒拂郁于里，又不能食，虫无所养，但闻食臭即涌出者，
宜黄连止蛔汤。
炎炎胃火成疳蚀，辛热频餐阳毒炽。牙龈臭烂怕穿腮，药有神功休论值。
凡痘疮后牙龈生疮，时时出血，谓之牙宣；呼吸息臭，谓之息露。此走马疳也。由热在阳明、少阳，宜内服
洗心散，外以蚕蜕散敷之。
如舌上生疮，赤者谓之赤口疮，此热在心脾二经，内服洗心散，外用阴阳散敷之；其疮白者，名白口疮，又名
鹅口疮，此热在心肺二经，亦服洗心散，外以朱矾散敷之。
食饮缘何不发肌，多因气血两相亏。和平丸散常宜服，偏热偏寒愈见离。
凡儿素常肌肥，痘后羸瘦，虽能饮食，而不为肌肤，乃气血虚故也。治之须兼阴阳，不可偏胜，偏阳则伤血，
偏阴则伤气，愈见乖
离矣。阴日宜服参苓白术散，阳日宜服当归益荣丸。
痘后分明皮肉娇，切宜保护在昏朝。风寒暑湿常宜避，洗拭构挝祸莫饶。痘后中虚食易伤，辛香生冷莫轻
尝。若贪口腹浑无忌，犯却中和变内伤。
此二条言收后调理之法。在外也，皮肤薄嫩，易于感冒，若不避风寒暑湿，梳洗搏抬，则至于痈肿者有之，
生疮癣者有之；在内也，肠胃并弱，难于克化，若不分生熟软硬、寒热凉温，任意食之，则成胀满者有之，
至于泻痢者亦有之。可不慎欤！
（共三十一首，总计四十六个方剂）
问：为什么会出现痘后痈肿？只因为痘疹平塌、难以化脓，导致毒邪蕴结聚集难以消散，必须透过关节缝隙，寻找关键穴位以排出毒邪。
凡是痘疹初出时只是一点血，由血转化为脓，脓成之后毒邪也就解除了。如果痘疹发出后，该起发而不发，该成脓而不成脓，呈现一片空壳，形状像蛇皮一样，或者平塌破损，完全没有脓水，这本是死证。但如果患者脾胃素来强健，又能进食，也可以拖延时日等待收效。只是毒邪蕴蓄在体内，必然会在关节之间寻找出路而形成痈肿，只要发作在一两处还可以治疗；如果流注于手足，发作不止，肿胀灌注不愈，时间久了就会死亡。
痘后痈肿首先要明确经络，解毒调元兼以托里透毒。决破脓液去除毒邪需紧急施治，不要等到残损的形体变成恶证才后悔。
凡是痈肿发作，先要看它在哪条经络，根据气血多少来治疗，其次看患者的虚实，以解毒托里为先，不可乱用外敷药物，导致毒邪不能外出，内攻筋骨而成坏证。如肿胀但未成脓的，用必胜膏贴敷；已成脓的，用铍针决破排脓，然后敷上生肌散。如果肿毒且元气素弱的，用十六味流气饮流通气血；如果气血虚且伴有泄泻的，加附子以温补；如果元气素强的，用连翘解毒汤为主治疗；如果痈毒日久，脓血流失过多的，用十全大补汤扶助元气并解毒。
恶证没有比痘后丹瘤更严重的了，皮肤蕴积火毒相互干扰。看它发作归属于哪个部位？心肾经络的病变治疗也很困难。
赤火丹瘤是恶候，红肿流移，疼痛剧烈到手不能触碰。痘疮之后，有发丹瘤的，是因为蓄积的火毒太盛，不能发泄，郁结在肌肉之间，所以发为丹毒。从头上起病过心经即死，从足下起病过肾经即死，内服玄参化毒汤解除，外用磁锋砭法放血。
为什么痘后会呈现瘾疹？肌肤蕴积的毒邪未完全清除。如果能让它发尽而没有停滞，就可以避免产生各种怪异的证候。
“瘾”是指皮肤间隐隐形成疙瘩，俗人称为风丹；“疹”是指皮肤点点状如蚊蚤叮咬的痕迹。痘后发瘾疹，是因为毒火未发尽，藏匿于皮肤之间，或者是搔痒因抓挠而成，或者是受风火相搏而成，这都是吉兆，正希望它们发泄出来，不要让它们停留而变成其他证候。如果发作太甚，内服防风败毒散，外用益元散擦拭。益元散的方子见前文。
痘疹已经收敛结痂却不干燥，有时出血则病情难安。从前的毒瓦斯藏匿于肌表，腐蚀肌肉损伤肌肤，不忍直视。
这与前文的顽疮不收口相同。凡是觉得痘疮到了该结痂的时候却不结痂，就要防备此证，应当内服大补汤，外用绵茧散敷之，绵茧散的方子见前文。
翳膜为什么积聚在眼内？责怪热毒壅塞于肝脏。还有还睛去翳的奇妙医术，单纯点洗只会招致废弃无用。
小儿出痘时，就用黄柏膏和胭脂涂眼，防止斑疮入眼。但斑疮入眼，本来不在初期，多在收靥之时，或者满面破烂，再次肿胀灌注，脓血胶固，毒火郁蒸在内，导致斑疮入眼；或者痘出得太厉害，成就迟缓，医生用辛热药物发散，也导致斑疮入眼；又或者在收靥之时，喜好淡味辛热食物，称为干浆，以致二火相煽，也导致斑疮入眼。但在白珠（巩膜）上不必治疗，久了自然会消退，只有在黑轮（角膜/瞳孔区域）上的，或者遮蔽瞳仁的，急用密蒙花散治疗。
两目今天突然畏光，肝虚邪火暗中伤害眼睛。凉肝养血的功效无比，能使双眸炯炯清澈。
凡是痘后双目见强光不开，暗处则开的，称为羞明，宜用凉肝明目散治疗；如果向暗处也不开，却要防备眼中长疮，应当按上述方法治疗。
收靥后为什么大便下红？多由倒陷导致毒邪归中。利完脓血应该痊愈，强行止涩反而成为怨毒丛聚。脓血痂皮一路下来，任它自止不要怀疑猜忌。和中清热作为收尾手段，劫涩药轻投会使病情加重。
痘后忽然痢下脓血，等待其自止，然后用和中清热的药剂，不可立即使用止涩药。但痢疾势重的，宜用黄连解毒汤清解，脓血尽后，宜用和中汤。
痘证从前没有倒陷，为什么脓血痢疾无休止？大肠郁火潜藏毒邪，解毒通肠贵在早施。
痘没有倒陷的证候，却有脓血的痢疾。由于平日食用煎炒食物，素有积热，现在因为痘后气血虚，不能胜纳积热，所以痢下脓血，这名叫滞下，必然肠鸣作痛，里急后重。或者因为痘出之后，饮食太多，水停造成泄泻，热毒乘虚入里，便下脓血，这名叫肠垢，宜用调胃承气汤彻除其毒，次用黄芩汤调和阴阳。
最怕收靥后呕吐呃逆频繁，咽痛胃弱毒邪潜伏湮没。呛喉呛水适宜治疗，干哕无声死期临近。
有声有物叫呕，有物无声叫吐，有声无物叫哕。吃食物就吐叫错喉，喝水就喷叫呛水。现在痘后凡是有这些情况，是由热毒壅塞胃口，所以令呕吐；咽门涩塞，所以令错喉呛水。只有干呕乃是胃疮腐烂，不能纳谷，所以时时张口，似吐不吐，是不治之证；也有咽喉作痛，而呕吐失声的，乃是咽喉腐烂，也不可治。只有单纯呕吐的，用陈皮竹茹汤；咽喉痛的，用甘桔汤。
身体已经清安但热不退，可能是因为毒邪严重或元气虚弱。调元解毒分头使用，寒热分明疗效自然。
痘既收靥，则毒解而热应当消除。如果热一直不停止，不是毒瓦斯之余烈，必是元气素虚，只有通过脉象辨别，如脉数形勇，烦躁而热，这是引邪气实，宜用知母解毒汤；如脉迟形怯，热而喜睡，这是正气虚，宜用黄芩调元汤。
收靥后浑身一向温暖，突然发热需仔细评论。内伤外感须分别治疗，这个真机是妙法门。
痘靥之后，一向温暖和平，并无余热，现在忽发热，不可以余毒未解、正气之虚同论，必定是因为外感风寒。其证头目昏痛，恶寒脉浮，宜用桂枝汤。
或者因为内伤饮食，其证肚腹饱闷，不喜欢饮食，其脉弦滑，用补中益气汤加消导药来运用治疗。
食饮如常但腹里疼，盖由脾弱消化无能。看它是虚还是实进行消导，才能显明良医的高超技艺。
收靥之后，忽然腹痛，或呕或泄，不思饮食，这是伤食的证候。虚则用补中益气汤治疗，如果没有吐利腹痛、气急，宜用丁香脾积丸下之。如果腹满而痛，烦闷不宁，这是毒火入中，急用雄黄解毒丸利之，不然逐渐加重喘急、手足厥冷，就难治了。
收靥后为什么不想吃东西？偶然伤食少有人知道。补脾消导是良法，强忍成疳后悔已晚。
一向能食，收靥后反而不能食，闻食气即呕逆，这必是食伤，甚则以脾积丸（方见前）治疗，轻微的用保和丸调理。如果隐忍不急求治，久了则消瘦，渐成疳痨。
寒热缠身似疟疾侵袭，不分早晚应时而临。只缘脾胃多虚弱，补气升阳贵在斟酌。
这是因为痘后气血两伤，阴虚则内热，阳虚则外寒，乍寒乍热，俨然疟疾。切不可以为疟疾治疗，但以补中益气汤升举阳气，其病自愈。
收靥后浑身手足寒冷，好将气血当作虚证来看待。六经脉细如将脱，急早回阳病自安。
凡是痘收靥之后，手足厥冷，六脉沉细，元气大虚，急用调元生脉散以温之，稍用寒凉，必取败亡。
强打精神却思睡昏沉，整天为何不清醒？这是因为毒解神虚疲倦，气血和平身体自然安宁。
收靥而好睡，乃毒解神虚，这是常事，不必调治。有等苟且之徒，欺人不知而取利；庸下之徒，妄用汤丸而致祸者，戒之戒之！
睡思沉沉不识人，恍惚疑中酒妄言频频。只因热伏心包络，保护心君妙入神。
凡是收后昏睡，连日不醒，口中妄语，或有醒时，亦似醉人，每多错语，这是热邪攻心。心君不肯受邪，传于包络，宜用导赤解毒汤清之，或用安神丸亦佳。
收靥之余抽搐萦绕，责其火毒未全清。清心散火风应退，发作无休命必倾。
痘出发热作搐，这是常候。若收靥之后反发搐者，乃疮发未透，毒火内侵故也。然此候发于收靥之余，血气已衰，治之甚难，宜用清神散火汤。如药对病者可治，若连发不已，是死证。
身体已经康宁但手足挛拘，分明是血少导致此过失。补脾养血诚然是仙诀，不遇知音莫乱传。
凡是痘后手足忽然挛拘，不能屈伸转运，乃血少不能养筋，又或外被风寒水湿以致如此。不可用发散并疏风之药，以耗其血，只宜当归桂枝汤补脾养血，则手足自和。
痘后还愁咳嗽多，总由毒火肺中磨。清金降火兼调气，肩息胸高若命何！
痘疹之后，惟肺受伤，至于收靥毒解，宜乎宁矣。若反咳嗽喘急，乃毒火流入肺中也，当清金降火，宜用宁肺汤保肺解毒。服药嗽不止，胸高龟壳肩息者不治。
忽然浑身肿胀形，或风或水食偏停。肿因肺受宜清表，胀属脾家利解宁。
痘收之后，或面目浮肿，四肢肿，这属于肺。因表虚而受风寒，仍宜汗解，用加味五皮汤。
如果腹胀如鼓，眼胞微肿，这属于脾。由脾胃虚，饮水过多。蓄湿于内，所食过多，积热于中，仍宜利解，宜用浓朴汤；倘属虚胀，不可妄攻，但宜用莱菔子丸。
小便宜清偶涩迟，膀胱蓄热少人知。不将导赤为良法，只恐迁延有变时。
凡是痘疹，小便始终宜清，若收后不利，这是热积膀胱，宜用加减导赤散以清其心。
大便贵滋润荣乍觉难，谁知肠胃液津干。润肠胆导宜兼用，纵有余邪便后安。
凡是大便始终须宜润泽，一二日一次为佳。若至于收靥后而大便秘结，乃痘出太多，血枯气不润肠，宜用润肠丸兼胆导法（方见前）。
腠理疏通雨汗倾，卫虚荣弱两无情。建中自汗汤偏胜，盗汗归黄六味平。
经曰：卫气者，所以温肌肉，充皮毛，肥腠理，司开合也。痘疮之后，卫气受伤，故收靥之后，卫弱而汗出也。醒时常出为自汗，宜用建中汤；睡着而出者为盗汗，用当归六黄汤。
血在身中本自宁，火邪迫血血违经。鼻中细出堪调治，便尿中来命不停。
痘收靥后，忽见血证，大为危候。盖鼻血出于肺，吐血出于胃，溺血出于小肠，便血出于大肠，皆由毒入于内，迫血妄行，急宜用凉血地黄汤止之。服药后血不止者，不治。
忽然吐蛔虫证已非，要知内热又常饥。但闻食臭虫斯出，呕吐心烦虫作威。
伤寒吐蛔，责之胃寒；痘证吐蛔，责之里热。由热毒拂郁于里，又不能食，虫无所养，但闻食臭即涌出者，宜用黄连止蛔汤。
炎炎胃火成疳蚀，辛热频餐阳毒炽。牙龈臭烂怕穿腮，药有神功休论值。
凡是痘疮后牙龈生疮，时时出血，谓之牙宣；呼吸息臭，谓之息露。这是走马疳。由热在阳明、少阳，宜内服洗心散，外用蚕蜕散敷之。
如舌上生疮，赤者谓之赤口疮，此热在心脾二经，内服洗心散，外用阴阳散敷之；其疮白者，名白口疮，又名鹅口疮，此热在心肺二经，亦服洗心散，外以朱矾散敷之。
食饮缘何不发肌，多因气血两相亏。和平丸散常宜服，偏热偏寒愈见离。
凡儿素常肌肥，痘后羸瘦，虽能饮食，而不为肌肤，乃气血虚故也。治之须兼阴阳，不可偏胜，偏阳则伤血，偏阴则伤气，愈见乖离矣。阴日宜服参苓白术散，阳日宜服当归益荣丸。
痘后分明皮肉娇，切宜保护在昏朝。风寒暑湿常宜避，洗拭构挝祸莫饶。痘后中虚食易伤，辛香生冷莫轻尝。若贪口腹浑无忌，犯却中和变内伤。
这两条讲收后调理之法。在外也，皮肤薄嫩，易于感冒，若不避风寒暑湿，梳洗搏抬，则至于痈肿者有之，生疮癣者有之；在内也，肠胃并弱，难于克化，若不分生熟软硬、寒热凉温，任意食之，则成胀满者有之，至于泻痢者亦有之。可不慎欤！
(Thirty-one poems in total, comprising forty-six prescriptions)
Q: Why do carbuncles (carbuncle) occur after smallpox? It is solely because the lesions are flat and fail to suppurate, causing toxic pathogens to accumulate and gather, making them difficult to dissipate. One must penetrate the joints and seek key acupoints to discharge the vital passages.
When smallpox first appears, it starts as a drop of blood, which transforms into pus from the blood. Once pus forms, the toxic pathogen is resolved. If after eruption, the lesions should rise but do not, or should suppurate but do not, presenting as empty shells resembling snake skin, or being flat, collapsed, and broken with no pus or fluid, this is originally a death syndrome. However, if the person's Spleen and Stomach are inherently strong and they can eat, one can wait for recovery over time. The toxic pathogen accumulates internally and must find an exit between the joints, forming carbuncles. If only one or two areas erupt, it is treatable; if it flows to the hands and feet, erupts incessantly, and swelling persists without healing, death will ensue after a long period.
For post-smallpox carbuncles, one must first clarify the meridians, resolve toxicity, regulate Yuan Qi, and employ interior support. Draining pus to remove toxicity requires urgent action; do not wait until the damaged form becomes a malignant condition.
Whenever a carbuncle erupts, first observe which meridian it affects and treat according to the abundance or scarcity of Qi and Blood. Next, assess the patient's deficiency or excess, prioritizing detoxification and interior support. Do not indiscriminately apply external plasters, which may prevent the toxin from exiting and cause internal inflammation of muscles and bones, leading to a disastrous condition. For swelling that has not yet formed pus, apply Bisheng Gao (Victory Paste). For those where pus has formed, pierce it with a Pi Zhen (Bich Needle) to drain the pus, then apply Shengji San (Flesh-Regenerating Powder). If the swelling/toxicity occurs in someone with inherently weak Yuan Qi, use Shi Liu Wei Liuqi Yin (Sixteen-Ingredient Flowing Qi Decoction) to circulate Qi. If there is Qi and Blood deficiency accompanied by diarrhea, add Fuzi (Aconite Root) to warm. If Yuan Qi is inherently strong, use Lianqiao Jiedu Tang (Forsythia Detoxification Decoction) as the main treatment. If the carbuncle/toxicity has persisted for a long time with significant loss of pus and blood, use Shiquan Dabu Tang (Perfect Ten Tonifying Decoction) to support Yuan Qi and resolve toxicity.
Among malignant conditions, none are worse than Danliu (Red Fire Carbuncle) after smallpox, where fire-toxin accumulates in the skin and interferes with each other. Observe which region it affects; treatments for Heart and Kidney meridians are also difficult.
Chi Huo Danliu (Red Fire Carbuncle) is a malignant sign, characterized by flowing redness and swelling, with pain so severe that the hand cannot bear to touch it. After smallpox, some develop Danliu due to excessive accumulation of fire-toxin that cannot vent, stagnating between muscles, thus manifesting as Dan Du (Carbuncle). If it starts from the head and crosses the Heart meridian, death ensues; if it starts from the feet and crosses the Kidney meridian, death ensues. Internally administer Xuanshen Huadu Tang (Scrophularia Detoxification Decoction) to resolve it; externally use Ci Feng Bian Fa (Magnetic Edge Cupping/Bloodletting Method).
Why does Yin Zhen (Urticaria/Rash) appear after smallpox? Because the toxin retained in the skin and muscles has not been fully cleared. If allowed to erupt completely without stagnation, it prevents the emergence of various strange syndromes.
"Yin" refers to hidden bumps under the skin, commonly called Feng Dan (Wind Carbuncle); "Zhen" refers to dot-like marks on the skin resembling mosquito bites. Post-smallpox urticaria/rash occurs because the fire-toxin has not fully erupted and hides between the skin layers, or arises from scratching due to itching, or from wind-fire interaction. These are auspicious signs, indicating a desire for venting; do not let them stagnate and transform into other syndromes. If eruptions are too severe, internally administer Fangfeng Baidu San (Saposhnikovia Resolving Toxin Powder) and externally wipe with Yiyuan San (Benefit Origin Powder). See previous text for the formula of Yiyuan San.
Smallpox has scabbed but remains dry, occasionally bleeding, making the illness unstable. Previously, toxic vapors hid in the muscle surface, corroding flesh and damaging skin, unbearable to look at.
This is similar to the stubborn sores mentioned earlier. Whenever smallpox fails to scab when it should, guard against this syndrome. Internally administer Dabu Tang (Great Tonifying Decoction) and externally apply Mianjian San (Silkworm Cocoon Powder). See previous text for the formula of Mianjian San.
Why do nebulae accumulate inside the eyes? Blame heat-toxin congesting in the Liver. There are miraculous techniques for restoring vision and removing nebulae; mere washing and dropping merely leads to uselessness.
When children have smallpox, Huangbai Gao (Phellodendron Paste) mixed with Zhigan (Alkermes) is applied to the eyes to prevent lesions from entering the eyes. However, lesions entering the eyes usually do not happen initially but during the scabbing phase. Or if the face is extensively ulcerated and swells again with sticky pus and blood, internal郁蒸 (stagnant steaming) of fire-toxin causes lesions to enter the eyes. Or if smallpox erupts excessively and matures slowly, doctors use acrid-hot herbs to induce sweating, also causing lesions to enter the eyes. Or during scabbing, preference for bland acrid-hot foods, called Gan Jiang (Dry Pus), causes dual fires to fan each other, also causing lesions to enter the eyes. Treatment is unnecessary for white pearls (sclera) as they disappear naturally over time; only for black wheels (cornea/pupil area), especially if obscuring the pupil, urgently use Mimenghua San (Cacalia Flower Powder).
Both eyes suddenly fear light today; Liver deficiency and evil fire secretly damage the pupils. Cooling the Liver and nourishing Blood has unparalleled merit, making both eyes clear and bright.
Whenever post-smallpox eyes refuse to open in bright light but open in darkness, it is called Xiuming (Shyness to Light), treated with Liangganning Mingmu San (Cooling Liver Brightening Eyes Powder). If they do not open even in darkness, guard against ulcers in the eyes and treat as above.
Why does red stool occur after scabbing? Mostly due to inversion causing toxins to return to the center. After purging pus and blood, it should heal; forcing cessation creates a gathering of resentment/toxins. With pus, blood, and scabs coming together, let it stop naturally without suspicion. Harmonize the middle and clear heat as a finishing move; lightly using astringents aggravates the disease.
Suddenly experiencing pus and bloody diarrhea after smallpox, wait for it to stop naturally, then use harmonizing and heat-clearing agents; do not immediately use astringents. However, for severe dysentery, use Huanglian Jiedu Tang (Coptis Detoxification Decoction) to clear and resolve; after pus and blood cease, use Hezhong Tang (Harmonize Middle Decoction).
If there was no inversion in the smallpox course, why is there endless pus and bloody diarrhea? Large Intestine stagnant fire harbors hidden toxins; resolving toxicity and unblocking the intestines is best done early.
Smallpox presents no inversion syndrome, yet there is dysentery with pus and blood. This is due to habitual consumption of fried foods, creating accumulated heat. Now, due to Qi and Blood deficiency after smallpox, unable to overcome the accumulated heat, dysentery with pus and blood occurs, named Zhixia (Stagnant Downfall), inevitably with borborygmus, pain, tenesmus, and heaviness in the rectum. Or due to overeating after eruption, water retention causing diarrhea, heat-toxin enters the interior through deficiency, resulting in pus and bloody stool, named Changgou (Intestinal Mucus). Use Tiaowei Chengqi Tang (Regulate Stomach Purgative Decoction) to eliminate its toxicity, followed by Huangqin Tang (Scutellaria Decoction) to harmonize Yin and Yang.
Most feared is frequent vomiting and hiccups after scabbing; sore throat and weak Stomach allow toxins to lurk. Choking on food/water requires treatment; silent hiccups signal imminent death.
Vomiting with sound and matter is Ou (Vomit); matter without sound is Tu (Eject); sound without matter is Yue (Hiccup). Vomiting immediately after eating is Cuo Hou (Throat Error); spraying upon drinking is Qiang Shui (Water Choke). Now, post-smallpox occurrences of these are due to heat-toxin blocking the Stomach gate, causing vomiting; throat obstruction causes choking. Only dry heaving indicates Stomach ulceration/rottenness, inability to accept food, opening mouth frequently, seeming to vomit but not, which is untreatable. Also, sore throat with vomiting and loss of voice indicates throat rot, also untreatable. For simple vomiting, use Chenpi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction); for sore throat, use Ganjie Tang (Licorice and Platycodon Decoction).
Body is calm but heat persists; either due to severe toxin or deficient Yuan Qi. Regulate Yuan Qi and resolve toxicity separately; clear distinction between cold and heat yields natural efficacy.
Once smallpox has scabbed, toxin is resolved and heat should cease. If heat persists, it is either residual violence of toxic vapors or inherent deficiency of Yuan Qi. Differentiate by pulse: if pulse is rapid, constitution vigorous, irritable and hot, it is excess of pathogenic qi, use Zhimu Jiedu Tang (Anemarrhena Detoxification Decoction); if pulse is slow, constitution timid, hot and sleepy, it is deficiency of healthy qi, use Huangqin Tiaoyuan Tang (Scutellaria Regulate Origin Decoction).
After scabbing, body is consistently warm, suddenly feverish—examine carefully. Internal injury and external contraction require different treatments; this true mechanism is a wonderful gate.
After scabbing, the body is consistently warm and peaceful with no residual heat. Now sudden fever should not be equated with unresolved residual toxin or deficiency of healthy qi, but must be due to external contraction of Wind-Cold. Symptoms include dizziness, headache, aversion to cold, and floating pulse; use Guizhi Tang (Cinnamon Twig Decoction).
Or due to internal dietary injury, symptoms include abdominal fullness and distension, dislike of food, wiry and slippery pulse; use Buzhong Yiqi Tang (Tonify Middle Augment Qi Decoction) added with digestive herbs.
Diet and drink are normal but abdomen hurts; covered by weak Spleel and difficulty digesting. Assess deficiency or excess for digestion; only then does the skilled physician show mastery.
After scabbing, sudden abdominal pain, or vomiting/diarrhea, loss of appetite, this is Food Injury syndrome. For deficiency, use Buzhong Yiqi Tang; if no vomiting, diarrhea, abdominal pain, or急促 breathing, use Dingxiang Pi Ji Wan (Clove Spleen Accumulation Pill). If abdominal fullness and pain, restlessness, this is fire-toxin entering the center, urgently use Xionghuang Jiedu Wan (Realgar Detoxification Pill); otherwise, gradually worsening panting and cold extremities become difficult to treat.
Why no appetite after scabbing? Occasional food injury is rarely known. Tonify Spleen and promote digestion is the good method; enduring it leads to infantile malnutrition (Gan Syndrome), regretting too late.
Previously able to eat, now unable after scabbing, smelling food causes nausea/vomiting; this must be food injury. Severe cases use Pi Ji Wan (see previous), mild cases use Baohe Wan (Preserve Harmony Pill) to regulate. If endured without urgent treatment, emaciation follows, gradually becoming Gan Lao (Malnutrition Consumption).
Chills and fever entangle the body like malaria, arriving on schedule regardless of day or night. Only due to Spleen and Stomach weakness; tonifying Qi and raising Yang requires discretion.
This is due to dual injury of Qi and Blood after smallpox; Yin deficiency causes internal heat, Yang deficiency causes external chills, alternating chills and fever resembling malaria. Do not treat as malaria; instead, use Buzhong Yiqi Tang to raise and lift, and the illness heals itself.
After scabbing, whole body and extremities are cold; view as Qi and Blood deficiency. Six pulses fine as if about to depart, urgently restore Yang and the illness calms.
After smallpox scabbing, cold extremities, deep and fine six pulses, great deficiency of Yuan Qi, urgently use Tiaoyuan Shengmai San (Regulate Origin Generate Pulse Powder) to warm; slight use of cold/cool herbs leads to defeat and death.
Struggling spirit but sleepy and confused, why all day not alert? This is due to resolved toxin, deficient Shen (Spirit), and fatigue; Qi and Blood peaceful, body naturally tranquil.
Sleeping well after scabbing is due to resolved toxin and deficient Shen, a common occurrence, requiring no treatment. Some opportunistic people deceive the ignorant for profit; mediocre practitioners recklessly use decoctions and pills causing disaster. Beware! Beware!
Deep sleep unaware of people, hallucinating drunkenness and frequent nonsense speech. Only because heat hides in Pericardium Luo; protecting the Heart Monarch is miraculous.
Post-scabbing coma, unconscious for days, speaking nonsense, or waking up looking drunk and speaking wrongly, this is Heat Evil attacking the Heart. The Heart Monarch refuses to accept evil, transmitting to the Pericardium Luo; use Daochi Jiedu Tang (Guide Out Red Detoxification Decoction) to clear, or Anshen Wan (Calming Spirit Pill) is also good.
Convulsions persist after scabbing; blame fire-toxin not fully cleared. Clear Heart and scatter fire, wind should retreat; continuous发作 leads to inevitable collapse.
Fever and convulsions during smallpox eruption are common. If convulsions recur after scabbing, it is because sores did not fully erupt and fire-toxin invades internally. However, this syndrome occurs after scabbing when Qi and Blood are already depleted, making treatment very difficult; use Qingshen Sanhuo Tang (Clear Spirit Scatter Fire Decoction). If the medicine matches the disease, it is treatable; if continuous convulsions, it is a death syndrome.
Body is healthy but limbs contract; clearly caused by Blood deficiency leading to this error. Tonify Spleen and nourish Blood is truly a divine secret; do not spread it rashly without knowing friends.
Sudden limb contraction/inability to flex/extend after smallpox is due to Blood deficiency failing to nourish tendons, or external contraction of Wind-Cold-Water-Dampness. Do not use dispersing or wind-dispelling herbs to consume Blood; only use Danggui Guizhi Tang (Angelica Cinnamon Twig Decoction) to tonify Spleen and nourish Blood, then limbs naturally harmonize.
Still worried about much coughing after smallpox; total grinding by fire-toxin in the Lungs. Clear Metal, descend fire, and regulate Qi; shoulder breathing and high chest, what hope for life!
After measles/smallpox, only the Lungs are injured. Upon scabbing and toxin resolution, it should be calm. If instead coughing and panting accelerate, fire-toxin has flowed into the Lungs; clear Metal and descend fire, use Ningfei Tang (Pacify Lung Decoction) to protect Lungs and resolve toxin. If cough persists after medication, with high chest, turtle-shell appearance, and shoulder breathing, it is untreatable.
Sudden whole-body swelling shape; either Wind or Water or Food stagnation. Swelling due to Lung involvement should be cleared and released superficially; distension belonging to Spleen should be resolved by draining.
After smallpox scabbing, facial/limb edema belongs to the Lung. Due to exterior deficiency contracting Wind-Cold, still suitable for sweating resolution, use Jiawei Wupi Tang (Modified Five Peel Decoction).
If abdominal distension like a drum, eyelid slight swelling, this belongs to the Spleen. Due to Spleen/Stomach deficiency, excessive drinking, dampness accumulating internally, excessive eating, heat accumulating in the center, still suitable for draining resolution, use Nongpo Tang (Thick Bark Decoction); if it is deficiency distension, do not attack blindly, only use Laifuzi Wan (Radish Seed Pill).
Urine should be clear; occasional delay/stagnation, little knows bladder heat accumulation. Not using Daochi as a good method, fear delay brings changes.
For all smallpox/measles, urine should always be clear. If difficult after scabbing, this is heat accumulating in the Bladder; use Jiajian Daochi San (Modified Guide Out Red Powder) to clear the Heart.
Stool prefers moistening/nourishing; suddenly feels difficult, who knows intestinal fluids are dry? Moistening intestines and gallbladder guidance should be used together; even with residual toxin, peace comes after stool.
Stool should always be moist; once every one to two days is best. If constipation after scabbing, due to excessive smallpox eruption, blood dryness and Qi failing to moisten intestines, use Runchang Wan (Moisten Intestine Pill) combined with Gandao Method (Gallbladder Suppository Method) (see previous).
Pores open, sweat pours like rain; Wei Qi and Ying Blood weak, both indifferent. Jianzhong self-sweat decoction prevails; night sweats归于 Huangliu Ping (Six-Yellow Calm).
The Classics say: Wei Qi warms muscles, fills skin/hair, thickens pores, controls opening/closing. After smallpox, Wei Qi is injured, so after scabbing, weak Wei Qi causes sweating. Sweating while awake is Zihan (Spontaneous Sweat), use Jianzhong Tang (Establish the Middle Decoction); sweating while asleep is Daohan (Night Sweat), use Danggui Liuhuang Tang (Angelica Six-Yellow Decoction).
Blood within the body is originally peaceful; fire evil forces blood to violate channels. Fine flow from nose is treatable; flow from urine/feces, life does not stop.
After smallpox scabbing, sudden blood syndromes are highly critical. Nasal blood comes from Lungs, hematemesis from Stomach, hematuria from Small Intestine, hematochezia from Large Intestine; all due to toxins entering internally, forcing blood to run wildly. Urgently use Liangxue Dihuang Tang (Cool Blood Rehmannia Decoction) to stop it. If bleeding continues after medication, it is untreatable.
Suddenly vomiting roundworms, the syndrome is not [cold]; know internal heat and constant hunger. Only smelling food odor causes worms to emerge; vomiting and irritability, worms act tyrannically.
Cold Damage vomiting roundworms blames Stomach Cold; Smallpox vomiting roundworms blames Interior Heat. Due to heat-toxin stifled internally, inability to eat, worms lack nourishment, emerging upon smelling food odor; use Huanglian Zhihui Tang (Coptis Stop Worm Decoction).
Blazing Stomach fire forms Gan erosion; frequent acrid-hot meals intensify Yang toxicity. Gums rotten/smelly, fear cheek perforation; medicine has divine merit, do not discuss value.
After smallpox, gum ulcers with frequent bleeding are called Yaxuan (Gum Bleeding); foul breath is called Xilu (Breath Leak). This is Zouma Gan (Running Horse Gangrene). Due to heat in Yangming and Shaoyang meridians, internally administer Xixin San (Washing Heart Powder), externally apply Cantui San (Silkworm Cast-off Powder).
Sores on tongue, red ones called Chikou Chuang (Red Mouth Ulcer), heat in Heart and Spleen meridians; internally administer Xixin San, externally apply Yinyang San (Yin-Yang Powder); white sores named Baikou Chuang (White Mouth Ulcer) or Ekuo Chuang (Goose Mouth Ulcer), heat in Heart and Lung meridians; also take Xixin San, externally apply Zhufan San (Cinnabar Alum Powder).
Why do food/drink not build flesh? Mostly due to dual deficiency of Qi and Blood. Peaceful pills/powders should be taken regularly; leaning hot or cold increases deviation.
Children usually fleshy, emaciated after smallpox, though able to eat, do not build flesh, due to Qi and Blood deficiency. Treatment must combine Yin and Yang, not lean to one side; leaning Yang injures Blood, leaning Yin injures Qi, increasing deviation. On Yin days, take Shenling Baizhu San (Ginseng Atractylodes Poria White Atractylodes Powder); on Yang days, take Danggui Yirong Wan (Angelica Enrich Glory Pill).
Post-smallpox skin and flesh are delicate; protect diligently in dusk/morning. Avoid Wind-Cold-Summerheat-Dampness; bathing/rubbing/grasping disasters are not forgiven. Post-smallpox middle deficiency, food easily injured; acrid-aromatic/raw-cold do not lightly taste. If greedy for mouth/belly without taboo, violating harmony turns into internal injury.
These two lines discuss post-scabbing regulation methods. Externally, skin is thin/tender, prone to colds; if not avoiding Wind-Cold-Summerheat-Dampness, combing/bathing/lifting, carbuncles may arise, sores/scabies may grow. Internally, intestines/stomach are weak, hard to digest; if not distinguishing raw/cooked, soft/hard, cold/hot, eating arbitrarily, distension/fullness may result, or diarrhea/dysentery may occur. Can one not be cautious!