万痘疮初出一点血，只成小小血 ，起发则渐长大，血化成水为水 ，至水
转作脓 ，始成实矣，成实之时，却要个个成脓，肥泽饱满，根脚红活又苍蜡色，
如此者，可以刻定日数，而知收靥之期。痘疮初出，或中心陷下者，或顶平者，或
根窠白色者，其人能食，或治不乖方，以至起发之后，陷者尽起，平者复尖，白淡
者变红活，窠中血水，已化为脓，夫陷起平尖，起发可谓透矣，红活饱满，气血可
谓足矣，水化为脓，毒亦解矣，表无痒痛之证，里无吐泻之证，是表里又无病矣，
如此者，坐待收靥，不可妄投汤剂。痘子轻者，常作三四次出，有大小，有先后，
起发亦作三四次，先出者先起，后出者后起，大者自大，小者自小，亦如初出之样，
待至养浆，则先长者先作浆，后长者后作浆，大小亦如之，磊落分明，不相粘连者
上也。痘子密者，长大胖壮，以至作浆，未有不相串者，只要陷者尽起，无处不透，
转成脓浆，次也。脓成之后，毒瓦斯已解，无复留伏矣。人言痘疮只到成脓，则毒瓦斯
化解，便称无患，不知脓亦有凶有吉，如疮皮坚浓，脓浆混浊，约束完固，无少破
损，此真吉兆。若疮皮软薄，脓水清淡，渗漏淫湿，易于破损，此犹凶也。惟疮久
熟，时日已过，当靥不靥者，则脓复化为水，皮亦易破，勿根据此论。
痘疮起发之初，已当避风寒，远人物，节饮食，守禁戒，到此养浆之时，比之
起发，尤加谨焉可也。盖前此，人病未久，气血犹强，足以御乖戾之变，至此则气
耗血亏，精神减损，少有乖戾，不能任之，况疮始成就，尤易触犯，不可不加谨矣。
如天大热，则彻去衣被，令常清凉，但谨门窗帷帐，勿使邪风透入。天大寒，则添
浓盖覆，令常温暖，更用亲人左右夹之。房室中可明亮勿绝灯火，常烧辟秽香加乳
香，令香气袭入，日夜常用一人看视，互相更代，勿令疲倦，恐或作痒，为之抚摩，
莫使误破，以致灌烂，结痂不美。
辟秽香
苍术（一斤） 大黄（半斤）
上锉细。捻放火炉中烧之，不可间断。
〔不作脓〕凡痘疮出欲尽，发欲透，至于养脓，便要成脓。饱满者，脓已成也。
混浊者，脓之形也。黄白者，脓之色也。若当作脓之时，犹是空壳，此气载毒行，
血不附气，毒者血也，血既不至，则毒犹伏于血中而不出，四物汤（失血）合紫草饮（见形）
加蝉蜕主之。如已成水，清淡灰白，不能作脓，此气血俱虚，所有之水，乃初时一
点血，气解而为水，非自内潮起之水，十全大补汤（汗）主之。此二证者，为痒 ，为
痈毒，不可不知也。痘疮初发之后，正待作脓，却不作脓者，此与不起发而黑陷者
分四证同论。如感风寒，则当温散，桂枝葛根汤（初热）加黄 、白芷、防风。毒瓦斯盛，
则宜托里解毒利小便，紫草饮子（起发）、连翘汤（便闷）相间服之。大便秘者，宣风散（痘发热）。
内虚，宜温里，十全大补汤、陈氏木香散（泻）。触犯，宜熏解，内服紫草饮，外用茵陈
熏法（起发）。若烦躁昏闷者，龙脑膏（黑陷）。薛氏云∶若灰白色，或痒而脓不贯，用紫
草、四君、木香。色赤，或痒而脓不贯，用紫草木通汤（出不快）。贯而脓清稀，用参
内托散（痒 ）。不应，加附子，缓则不救。《秘要》云∶顶陷无脓为逆，急用保元加川
芎、肉桂、归、芍、木香、糯米、煎熟加人乳、好酒温服。色白如水晶，内无脓者，
宜保元加糯米，人乳好酒进之。
按∶病者元气素弱。或出痘时因稠密故，服解毒之药太多。或起发时曾有吐
利等证。俱伤元气，虽用参 等助发脓浆，而犹恐元气薄弱，止灌清浆，或缺而
不满，且有痒 、痈毒、之虑，宜于煎药内加上好鹿茸，及咽紫河车丸药，仍进
八味二花散为妙。曾见痘疮初出磊落，起发亦透，只待结脓窠之时，却不作脓，
往往变为坏证者。或因其人不能食，脾胃虚，又自利不知调理者。或出未匀，发
未透，毒瓦斯陷伏，妄谈稀疏者。此皆人事之不修，非干时毒而然也。
六一汤 专发痘疮之脓。
黄 （六钱） 甘草（炙，一钱）
上 咀。每服二钱，水六分煎，入酒二分同煎至半盏，温服。更加橄榄同煎尤
好。加山药亦得。
助浆丸 治痘疮七八日，浆稀不来者，急服。
黄 （蜜炙，三两） 白芍药（酒炒） 当归（酒洗。各一两半） 鹿茸（鲜润、色如琥珀，作
鹿角胶香者，乳炙） 紫河车（酒洗去红筋，炙干） 白术（煨） 人参（各一两）
上为细末，炼蜜为丸如芡实大。每服一二丸，炒糯米煎汤，化下。
参 四圣散（起发） 秘传大透肌散（见形）
升天散 即灌脓起顶散。治痘灰白，或红紫黑陷干枯，或清水不成浆，八九日十日
皆可服。
人参（六分） 黄 山楂（各八分） 白术（土炒） 当归 川芎 橘红（各五分） 甘草（三分）
淫羊藿 穿山甲（土炒黄） 木香（各二分） 肉桂（三厘，此引经之药，多则痒）
上，姜一片，枣一枚，水煎服，或为末服亦可。如呕吐，生姜汤下。泻，米
饮下。肚痛，神曲煎汤下。烦躁，麦门冬汤下。渴，用麦门、五味子煎汤
下。吐泻，藿香、陈皮汤下。痘不成浆，多服数帖，无妨。
补浆汤 痘灰白不起壮，或浆清。
淫羊藿（三分，多则发痒） 人参 当归 山楂（各八分） 穿山甲（土炒，三分） 黄 （一钱半） 枸杞
子（一钱） 川芎 甘草 陈皮（各五分） 木香（二分） 白术（土炒，六分） 官桂（三厘）
黄豆（三十粒）
笋尖（三个）
上，加姜枣糯米，水煎服。一方，有白芷、防风。
治痘白色带寒战方 痘标六七朝，正要翕会脓浆，遽乃色白洋洋，无红活鼎峻之美，
有土铁塌陷之凶，火热不退，而有寒战之状宜服。田单火牛汤
人参 黄 蓼子（择细叶者是，若川蓼则大叶，叶中有青点，宜细辨之，和穿山甲炒，
甲气尽、去甲） 当归（各二钱） 附子（一钱） 甘草（五分） 桂（三分） 橘红（八分）
上，水煎服。
〔脾胃〕痘疮已长，脓浆欲成之时，专以脾胃为主，脾胃强则气血充实，自然
脓浆易成，饱满坚浓，不须服药。脾胃弱则气血衰少，不能周灌于身，使之作浆，
虚软清淡，虽有浆亦水而已，宜十全大补汤（汗）去地黄加木香，或人参白术散（渴）去葛
根加黄 、官桂，多服乃佳。然脾胃强弱，于食多少，大便坚利求之，食少大便坚者，
脾胃之气犹足也，若泄泻则脾胃益虚，四君子汤（不能食）送下豆蔻丸（泻）利止，复以人参
白术散去葛根加黄 、官桂、服之。便清，要能食，不能食者亦根据上法。如能食
大便坚，数日未更衣者，用胆导法（大梗秘）通之，使气得疏通，荣卫和畅，不致 烂也。
〔泄泻〕痘疮出形起发，并不宜泄泻，恐里气虚，毒邪不出，反成陷伏，故以
泄利非佳兆也。若成浆之时，尤不宜利，比之于前，殆有甚焉。盖前此为病未久，
脾胃尚强，足以任之，今则病久，津液已衰，脾胃已弱，若复泄泻，则仅存之气，
重竭于内，方张之毒，不能成于外，或为痒 ，或为倒靥，或寒战切牙，虚惫而死，
轻则人参白术散去葛根加木香、官桂、黄 ，甚则陈氏木香散（泻）异攻散（出不快）肉豆蔻
丸（泻）可以并进。不效，亟服不二散（起发）。
〔便秘手足厥冷〕痘疮手足和暖为贵，养浆之时，手足发热，手足必有汗，此
毒热郁于中，必大小便不通，脉沉滑数疾，宜利之，三乙承气汤（大便秘）去芒硝主之。
手足厥逆者，此阳气欲脱，必白利不止，或吐，脉沉细微弱，或浮大而虚，宜急温
之，理中汤（泻）加熟附子，或陈氏异攻散（出不快）。服药后手足和暖者生，厥者死。若大便
秘，小便不通，烦躁狂妄，腹胀喘而渴，脉沉滑数，疮不起者，此陷伏之证，为
阳厥，百祥丸（黑陷）三乙承气汤主之。
〔烦躁〕疮痘始终贵于安静，脓成之时，毒已化解，脏腑平和，神宇爽快，尤
宜安静也。若忽加烦躁不得眠者，但就痘子上辨之，如脓多清淡，尚不满足，此毒犹
在里，未得尽出也，龙脑膏主之（黑陷）。如脓已成，又饱满，因发热干浆而烦者，此宜利
小便，导赤散主之（心）。如疮子太密，脓成之后，心血亏虚，虚烦不得眠者，四物汤
（失血）去川芎，加人参、麦门冬、栀子仁。又，酸枣仁汤（烦躁）主之。
〔错喉呕哕〕凡痘疮密，咽中亦有之，成浆之时，咽疮早熟，肉虚皮薄，易致
破损，疮瘢新嫩，触之即痛，痂皮沾滞，痰涎缠裹，所以堵塞，饮食难入，勉强吞
咽，则为疼痛所苦，痰涎所隔，是以水入则呛，谷入则呕也。如语言清亮者可治，
甘桔汤（咽喉）加牛蒡子、天花粉利咽膈，化痰涎，惟多饮之，自然平愈。若声哑嗄，
语言不出者，咽喉溃烂，不可治矣。
〔痒〕凡痘疮皮嫩色娇者，到成脓时，多生瘙痒，先当调理，勿令有此可也。
若失于早治而发痒者，内服消风化毒汤（痒 ），外用茵陈熏法（起发）。破者以白龙散（痒 ）敷
之。大抵痘疮作痒，乃是恶候，吉少凶多，如其人能食，或大便坚，抓破之处，复
灌成脓，原无痘处续出，大小不等，虽尽痒破，可治，内服十全大补汤（汗）、苦参丸（痘癞）
间而与之，外以灭瘢救苦散（痘癞）合百花膏（收靥）涂之。若瘙痒之时，其人颠倒闷乱，抓破
之处，不复肿灌，或成坑窟，或即干黑，或皮自脱，又加以呛水呕食，水浆不入，
或泄泻，或寒战切牙，或失声，或手足厥逆，或狂叫，皆死证也。
〔头面〕凡视痘疮，以正面为主，五脏精华，皆萃于面故也。身上疮有痒者，
或至抓破，不能为害，惟正面疮，不可犯动一处，苟于眉目鼻面之间抓破一处，此
肺有热也，急用甘桔汤（咽喉）加牛蒡子以解之，其痒即止，乃佳兆也。若痒不止，浸淫
渐开，气愈泄而痒愈急，必至满面抓破而死。凡痘疮起发养浆之时，额上疮如火烧
汤浇之状，溃烂破坏，无复完肤。或两颊之傍亦如是样，不待爬搔而自破烂者，以
渐而开，沙崩之势，莫之能御，壳焦水去，似靥非靥，阳气脱而死。痘疮作浆之
初，面上诸疮未尽成脓。或鼻准头疮先干如橘子色者。或眉心疮自干黑者。或唇上
疮焦黑者。或两耳上疮自收者。或两颊疮如饼中间干陷者。此名倒陷，乃死之候，
不可认作正收，对人妄言。
〔手足〕手足痘疮最要脓浆饱满，乃脾胃强，气血足也。若灰白色，或清淡水，
或虚馁鳖塌，此脾胃弱，快 越婢汤主之。如此者纵得收靥，之后必手足腕膝及关
节之处，发痈毒也。
快 越婢汤（起发）
〔肩背臀〕痘疮初出起发，邪气虽旺，正气亦强，足以任之，至于成浆，则气
血渐耗，精神渐弱，有不胜之状，起止艰难，多喜仰卧，惟肩膊背臀之疮，展转摩
擦，最受亏苦，若痘子好者，自然坚浓，耐久不破。其次则收靥稍迟，脓熟自溃。
最可恶者，如汤火之 ，水去皮脱。又疮自破，清水非脓，黑 干焦，是皆不治
之证。
〔漏浆〕歌曰∶才试浆时未饱囊，疮头有孔漏脓浆，依然团聚封疮孔，泄去真
津毒瓦斯藏。盖痘疮作脓窠之时，最要皮浓，包裹完固，若脓未成，忽然疮头有孔，
其水漏出，或结聚成团，堆于孔外者，或水去窠空，自干黑者，俗名漏疮，必死。
若脓熟之后，窠皮亦熟，浆水沸出，因而结靥，此头额正面之间多有之，俗谓之堆
屎收，不可以漏疮例论，盖漏疮脓未成，堆屎收脓过熟也。
〔咽喉不利涕唾稠粘〕疮痘者，每至作脓窠之时，咯唾痰涎，稠粘脓结，或有
脓血夹杂者，咽喉不利，饮食亦少，此肺受火邪，津液不足，故多粘痰，喉舌牙齿
之间，疮溃血出，惟用甘桔汤（咽喉）加牛蒡子、天花粉清肺化痰，利咽膈，直待收靥之
后，自然平和，不可妄用大凉之剂。
〔睡梦呢喃〕痘内之脓，皆身中之血熏蒸而成，疮痘稠密，脓血周遍，津液消
耗，心主血，血虚则舍空，故心热者虚烦不得眠，酸枣仁汤（烦躁）主之。心虚者，喜睡
梦中呢喃，如与人言者，多怪诞之事，唤之不醒，安神丸主之（谵妄）。若昏闷甚者，先
以龙脑膏（黑陷）开其心窍，后以安神丸，人参、麦门冬汤下。
〔腹痛〕痘疮初出腹痛者，毒在里也。起发不透腹痛者，陷伏也。若作脓，则
毒已出，又无陷伏，忽然腹痛，其人不大便者，必然燥屎也，当归丸、胆导法（俱大便秘）
以通之。便清者，必受冷也，急与理中汤加桂（腹痛）或黄 建中汤（腹痛）加木香主之。痘
疮，其出已尽，其发已透，其脓已成，表无邪也。能食小便清，大便润，里无邪也。
一向平安，忽然腹胀作痛，烦躁喘促，痘疮色变如灰木之状，此必伤食得之，先以
丁香脾积丸（宿食）原物汤下去其宿食，后以人参白术散（渴）去葛根、加青陈橘皮，与养脾丸
（宿食）相间调之。
万氏指出，痘疮刚发出时，起初只是一点血，只形成小小的血疱；待其起发时逐渐长大，血液化成水液成为水疱；到了水疱转为脓疱时，才算真正成熟。在成熟之时，要求每一个痘粒都化脓，饱满润泽，根部红润鲜活且呈苍蜡色。像这样的痘疮，可以根据日期推算出结痂的时间。
如果痘疮刚发出时，有的中心凹陷，有的顶部平坦，有的根脚颜色苍白，但患者饮食正常，或者治疗没有违背法度，那么在起发之后，凹陷的都能隆起，平坦的都能变尖，苍白淡白的都能变为红润鲜活，根窠中的血水已化为脓液。这样看来，凹陷者隆起、平坦者变尖，说明起发已经透彻；红润饱满，说明气血充足；水化为脓，说明毒邪已解；体表没有痒痛的症状，体内没有呕吐腹泻的症状，这说明表里都没有病证了。像这样的情况，只需静待结痂，不可胡乱投用汤药。
痘子较轻的，通常分三四次发出，有大有小，有先有后；起发也分三四次，先发出的先起发，后发出的后起发，大的依然大，小的依然小，也像刚发出时的样子。等到养浆阶段，长得早的先成浆，长得晚的后成浆，大小情况也是如此，颗粒磊落分明，互不粘连，这是上等的表现。痘子密集的，虽然长得胖壮，直到作浆，没有不互相串连的，只要凹陷的都能隆起，无处不透，转变成脓浆，算是次一等。脓成之后，毒气已经化解，不再留伏体内。人们常说痘疮只要到成脓阶段，毒气化解，便称无忧，却不知道脓也有凶吉之分。如疮皮坚硬浓厚，脓浆混浊，包裹完固，没有丝毫破损，这才是真正的吉兆。如果疮皮软薄，脓水清淡，渗漏湿淫，容易破损，这仍然是凶险的征兆。只有那些痘疮久熟，时日已过，应当结痂却不结痂的，则脓又会化为水，皮也容易破，不要依据上述理论来判断。
痘疮起发的初期，就应当避风寒、远离人群、节制饮食、遵守禁忌，到了养浆这个时候，比起起发时，更要谨慎小心。因为在此之前，人患病不久，气血还强盛，足以抵御乖戾的变化；到了这时，气耗血亏，精神减损，稍有乖戾之气，就不能承受了，何况疮刚开始成就，更容易受到触犯，不可不加以谨慎。
如果天气大热，就要撤去衣被，让身体保持清凉，但要谨守门窗帷帐，不要让邪风透入。如果天气大寒，就要增加厚盖覆盖，让身体保持温暖，更要用亲人在左右夹护。房室中可以明亮，但不要断绝灯火，经常燃烧辟秽香并加入乳香，让香气袭入，日夜常用一人看护，互相更替，不要让看护人疲倦，恐怕孩子感到瘙痒，为其抚摩，不要使其误抓破，导致灌烂，影响结痂美观。
辟秽香
苍术（一斤） 大黄（半斤）
以上切碎细末。捏成团放在火炉中烧，不可间断。
〔不作脓〕凡是痘疮快要出尽，想要透发，到了养脓阶段，便要成脓。饱满的，是脓已成。混浊的，是脓的形态。黄白色的，是脓的颜色。如果在应当作脓的时候，还是空壳，这是气载毒行，血不附气，毒在血中，血既然不到，那么毒仍潜伏在血中而不出，用四物汤（用于失血）合紫草饮（用于见形期）加蝉蜕来主治。如果已经成了水，清淡灰白，不能作脓，这是气血俱虚，所剩下的水，只是最初的一点血，气散而为水，不是从内部潮涌而起的水，用十全大补汤（用于汗证）来主治。这两种证候，如果是瘙痒，或者是痈毒，不可不知道。痘疮初发之后，正待作脓，却不作脓的，这与不起发而黑陷的情况分为四种证候一同论述。如感受风寒，则应当温散，用桂枝葛根汤（用于初热期）加黄芪、白芷、防风。毒气旺盛，则宜托里解毒利小便，紫草饮子（用于起发期）、连翘汤（用于便闷）交替服用。大便秘结的，用宣风散（用于痘发热）。内虚，宜温里，用十全大补汤、陈氏木香散（用于泻证）。触犯外邪，宜熏解，内服紫草饮，外用茵陈熏法（用于起发期）。如果烦躁昏闷的，用龙脑膏（用于黑陷证）。薛氏说：如果颜色灰白，或者瘙痒而脓不贯通，用紫草、四君子汤、木香。颜色赤红，或者瘙痒而脓不贯通，用紫草木通汤（用于出不快）。脓贯通但脓清稀，用参内托散（用于瘙痒）。如果不奏效，加附子，迟缓则无法挽救。《秘要》说：顶部凹陷无脓为逆证，急用保元汤加川芎、肉桂、当归、芍药、木香、糯米，煎熟后人乳、好酒温服。颜色白如水晶，内部无脓的，宜用保元汤加糯米，用人乳、好酒送服。
按语：病人元气素来虚弱。或者出痘时因为痘疹稠密，所以服用了太多解毒的药物。或者起发时曾有呕吐腹泻等证。这些都损伤了元气，虽然用人参、黄芪等帮助发脓浆，但仍然担心元气薄弱，只能灌注清浆，或者缺损而不饱满，且有瘙痒、痈毒的顾虑，宜在煎药内加上好的鹿茸，以及服用紫河车丸药，仍然进服八味二花散为好。曾见过痘疮刚发出时磊落，起发也透彻，只待结脓窠的时候，却不作脓，往往变为坏证的。或者因为其人不能进食，脾胃虚弱，又自行腹泻不知调理的。或者出痘不均匀，发痘不透，毒气陷伏，妄谈稀疏的。这些都是人事修养不够，并非时毒所致。
六一汤 专门发散痘疮之脓。
黄芪（六钱） 甘草（炙，一钱）
以上切碎。每服二钱，水六分煎，入酒二分同煎至半盏，温服。再加橄榄同煎更好。加山药也可以。
助浆丸 治疗痘疮七八日，浆稀不来的，急服。
黄芪（蜜炙，三两） 白芍药（酒炒） 当归（酒洗。各一两半） 鹿茸（鲜润、色如琥珀，制成鹿角胶香的，用乳汁炙） 紫河车（酒洗去红筋，炙干） 白术（煨） 人参（各一两）
以上研为细末，炼蜜为丸如芡实大。每服一二丸，炒糯米煎汤，化开服用。
升天散 即灌脓起顶散。治疗痘色灰白，或红紫黑陷干枯，或清水不成浆，八九日十日皆可服。
人参（六分） 黄芪 山楂（各八分） 白术（土炒） 当归 川芎 橘红（各五分） 甘草（三分） 淫羊藿 穿山甲（土炒黄） 木香（各二分） 肉桂（三厘，此引经之药，多则致痒）
以上加姜一片，枣一枚，水煎服，或研为末服也可以。如果呕吐，用生姜汤送下。腹泻，用米饮送下。肚痛，用神曲煎汤送下。烦躁，用麦门冬汤送下。口渴，用麦门冬、五味子煎汤送下。吐泻，用藿香、陈皮汤送下。痘不成浆，多服几帖，无妨。
补浆汤 痘色灰白不起壮，或者浆清稀。
淫羊藿（三分，多则发痒） 人参 当归 山楂（各八分） 穿山甲（土炒，三分） 黄芪（一钱半） 枸杞子（一钱） 川芎 甘草 陈皮（各五分） 木香（二分） 白术（土炒，六分） 官桂（三厘） 黄豆（三十粒） 笋尖（三个）
以上加姜、枣、糯米，水煎服。另一方，有白芷、防风。
治痘白色带寒战方 痘标六七朝，正要翕会脓浆，突然颜色白洋洋，没有红活鼎峻之美，有土铁塌陷之凶，火热不退，而有寒战之状宜服。田单火牛汤
人参 黄芪 蓼子（择细叶者是，若川蓼则大叶，叶中有青点，宜细辨之，和穿山甲炒，甲气尽、去甲） 当归（各二钱） 附子（一钱） 甘草（五分） 桂（三分） 橘红（八分）
以上水煎服。
〔脾胃〕痘疮已经长出，脓浆将要形成的时候，专以脾胃为主，脾胃强则气血充实，自然脓浆易成，饱满坚浓，不须服药。脾胃弱则气血衰少，不能周灌于身，使之作浆，虚软清淡，虽有浆也只是水而已，宜用十全大补汤（用于汗证）去地黄加木香，或人参白术散（用于渴证）去葛根加黄芪、官桂，多服乃佳。然而脾胃强弱，可以从食量多少、大便坚利来求取，食少大便坚硬的，脾胃之气犹足也，如果泄泻则脾胃益虚，用四君子汤（用于不能食）送下豆蔻丸（用于泻证）止泻，恢复后用参苓白术散去葛根加黄芪、官桂服用。大便清稀，要能进食，不能进食的也根据上述方法。如果能进食大便坚硬，数日未排便的，用胆导法（用于大便秘结）通之，使气得疏通，荣卫和畅，不至于溃烂。
〔泄泻〕痘疮出形起发，并不宜泄泻，恐怕里气虚，毒邪不出，反成陷伏，所以泄利不是佳兆。如果到了成浆的时候，尤其不宜利，比之于前，甚至更严重。因为此前为病未久，脾胃尚强，足以承受，现在则病久，津液已衰，脾胃已弱，如果再泄泻，则仅存之气，重竭于内，方张之毒，不能成于外，或者为瘙痒，或者为倒靥，或者寒战切牙，虚惫而死，轻则用人参白术散去葛根加木香、官桂、黄芪，甚则陈氏木香散（用于泻证）、异攻散（用于出不快）、肉豆蔻丸（用于泻证）可以并进。不效，亟服不二散（用于起发期）。
〔便秘手足厥冷〕痘疮手足和暖为贵，养浆之时，手足发热，手足必有汗，这是毒热郁于中，必大小便不通，脉沉滑数疾，宜利之，用三乙承气汤（用于大便秘结）去芒硝主治。手足厥逆的，这是阳气欲脱，必白利不止，或者呕吐，脉沉细微弱，或者浮大而虚，宜急温之，用理中汤（用于泻证）加熟附子，或陈氏异攻散（用于出不快）。服药后手足和暖者生，厥逆者死。如果大便秘，小便不通，烦躁狂妄，腹胀喘而渴，脉沉滑数，疮不起的，这是陷伏之证，为阳厥，用百祥丸（用于黑陷证）、三乙承气汤主治。
〔烦躁〕疮痘始终贵在安静，脓成的时候，毒已化解，脏腑平和，神宇爽快，尤宜安静。如果忽然加重烦躁不得眠的，但就痘子上辨别，如脓多清淡，尚不满足，这是毒犹在里，未得尽出也，用龙脑膏主治（黑陷证）。如脓已成，又饱满，因发热干浆而烦的，这宜利小便，导赤散主治（心经）。如疮子太密，脓成之后，心血亏虚，虚烦不得眠的，用四物汤（用于失血）去川芎，加人参、麦门冬、栀子仁。另外，酸枣仁汤（用于烦躁）主治。
〔错喉呕哕〕凡是痘疮密集，咽中也有，成浆的时候，咽疮早熟，肉虚皮薄，易致破损，疮瘢新嫩，触之即痛，痂皮沾滞，痰涎缠裹，所以堵塞，饮食难入，勉强吞咽，则为疼痛所苦，痰涎所隔，是以水入则呛，谷入则呕也。如语言清亮者可治，甘桔汤（用于咽喉证）加牛蒡子、天花粉利咽膈，化痰涎，惟多饮之，自然平愈。如果声哑嗄，语言不出者，咽喉溃烂，不可治矣。
〔痒〕凡是痘疮皮嫩色娇的，到成脓时，多生瘙痒，先当调理，勿令有此可也。如果失于早治而发痒的，内服消风化毒汤（用于瘙痒），外用茵陈熏法（用于起发期）。破者以白龙散（用于瘙痒）敷之。大抵痘疮作痒，乃是恶候，吉少凶多，如其人能食，或大便坚，抓破之处，复灌成脓，原无痘处续出，大小不等，虽尽痒破，可治，内服十全大补汤（用于汗证）、苦参丸（用于痘癞）间而与之，外以灭瘢救苦散（用于痘癞）合百花膏（用于收靥期）涂之。如果瘙痒之时，其人颠倒闷乱，抓破之处，不复肿灌，或成坑窟，或即干黑，或皮自脱，又加以呛水呕食，水浆不入，或泄泻，或寒战切牙，或失声，或手足厥逆，或狂叫，皆死证也。
〔头面〕凡视痘疮，以正面为主，五脏精华，皆萃于面故也。身上疮有痒的，或者至抓破，不能为害，惟正面疮，不可犯动一处，苟于眉目鼻面之间抓破一处，这是肺有热也，急用甘桔汤（用于咽喉证）加牛蒡子以解之，其痒即止，乃佳兆也。如果痒不止，浸淫渐开，气愈泄而痒愈急，必至满面抓破而死。凡痘疮起发养浆之时，额上疮如火烧汤浇之状，溃烂破坏，无复完肤。或两颊之傍亦如是样，不待爬搔而自破烂者，以渐而开，沙崩之势，莫之能御，壳焦水去，似靥非靥，阳气脱而死。痘疮作浆之初，面上诸疮未尽成脓。或鼻准头疮先干如橘子色者。或眉心疮自干黑者。或唇上疮焦黑者。或两耳上疮自收者。或两颊疮如饼中间干陷者。此名倒陷，乃死之候，不可认作正收，对人妄言。
〔手足〕手足痘疮最要脓浆饱满，乃脾胃强，气血足也。如果灰白色，或清淡水，或虚馁鳖塌，这是脾胃弱，用快斑越婢汤主治。如此者纵得收靥，之后必手足腕膝及关节之处，发痈毒也。
快斑越婢汤（用于起发期）
〔肩背臀〕痘疮初出起发，邪气虽旺，正气亦强，足以任之，至于成浆，则气血渐耗，精神渐弱，有不胜之状，起止艰难，多喜仰卧，惟肩膊背臀之疮，展转摩擦，最受亏苦，如果痘子好的，自然坚浓，耐久不破。其次则收靥稍迟，脓熟自溃。最可恶者，如汤火之伤，水去皮脱。又疮自破，清水非脓，黑痂干焦，是皆不治之证。
〔漏浆〕歌曰：才试浆时未饱囊，疮头有孔漏脓浆，依然团聚封疮孔，泄去真津毒瓦斯藏。盖痘疮作脓窠之时，最要皮浓，包裹完固，如果脓未成，忽然疮头有孔，其水漏出，或结聚成团，堆于孔外者，或水去窠空，自干黑者，俗名漏疮，必死。如果脓熟之后，窠皮亦熟，浆水沸出，因而结靥，此头额正面之间多有之，俗谓之堆屎收，不可以漏疮例论，盖漏疮脓未成，堆屎收脓过熟也。
〔咽喉不利涕唾稠粘〕疮痘者，每至作脓窠之时，咯唾痰涎，稠粘脓结，或者有脓血夹杂者，咽喉不利，饮食亦少，这是肺受火邪，津液不足，故多粘痰，喉舌牙齿之间，疮溃血出，惟用甘桔汤（用于咽喉证）加牛蒡子、天花粉清肺化痰，利咽膈，直待收靥之后，自然平和，不可妄用大凉之剂。
〔睡梦呢喃〕痘内的脓，皆身中之血熏蒸而成，疮痘稠密，脓血周遍，津液消耗，心主血，血虚则舍空，故心热者虚烦不得眠，酸枣仁汤（用于烦躁）主治。心虚者，喜睡梦中呢喃，如与人言者，多怪诞之事，唤之不醒，安神丸主治（谵妄证）。如果昏闷甚者的，先以龙脑膏（用于黑陷证）开其心窍，后以安神丸，人参、麦门冬汤下。
〔腹痛〕痘疮初出腹痛的，毒在里也。起发不透腹痛的，陷伏也。如果作脓，则毒已出，又无陷伏，忽然腹痛，其人不大便的，必然燥屎也，当归丸、胆导法（均用于大便秘结）以通之。便清的，必受冷也，急与理中汤加桂（用于腹痛）或黄芪建中汤（用于腹痛）加木香主治。痘疮，其出已尽，其发已透，其脓已成，表无邪也。能食小便清，大便润，里无邪也。一向平安，忽然腹胀作痛，烦躁喘促，痘疮色变如灰木之状，这必伤食得之，先以丁香脾积丸（用于宿食）原物汤下去其宿食，后以人参白术散（用于渴证）去葛根、加青陈橘皮，与养脾丸（用于宿食）相间调之。
Wan Shi pointed out that when smallpox first appears, it initially presents as a single drop of blood, forming only a small bloody blister. As it begins to rise and develop, it gradually enlarges; the blood transforms into fluid, becoming a vesicle (water blister). It is not until the vesicle turns into a pustule (pus blister) that it is considered truly mature. At the time of maturation, it is required that every lesion suppurates, becoming plump, lustrous, with a red and vibrant root base and a pale wax-like color. Lesions presenting in this manner allow for the prediction of the scabbing date based on the timeline.
If upon initial eruption, some lesions are depressed in the center, some have flat tops, and some have pale roots, but the patient can eat normally, or the treatment has not deviated from proper methods, then after the rising phase, the depressed ones will all elevate, the flat ones will become pointed, and the pale ones will turn red and vibrant. The bloody fluid within the follicles will have transformed into pus. In such cases, the elevation of depressions and sharpening of flats indicate that the rising process has been thorough; the redness and fullness indicate sufficient Qi and Blood; the transformation of fluid to pus indicates the resolution of toxins; the absence of itching or pain on the exterior and vomiting or diarrhea on the interior indicate that neither the exterior nor interior is diseased. Under such conditions, one should simply wait for scabbing and must not recklessly administer decoctions.
Mild cases of smallpox often erupt in three or four waves, varying in size and timing; they also rise in three or four waves, with earlier eruptions rising first and later ones rising later. Large lesions remain large, and small ones remain small, resembling their initial state. During the nourishing-pus stage, those that appeared early form pus first, and those appearing late form pus later, maintaining their relative sizes. They stand out clearly without adhering to each other, which is the best outcome. In dense cases, although the lesions grow plump and robust, they inevitably interconnect up to the pus-forming stage. As long as the depressed areas elevate completely, penetration is thorough, and they transform into pus, it is considered a secondary outcome. Once pus is formed, the toxic qi has resolved and no longer lingers in the body. People often say that once smallpox reaches the pus-forming stage, the toxins are resolved, and there is no cause for worry; however, they do not realize that pus can be either auspicious or ominous. If the skin is thick and tough, the pus is turbid, and the containment is intact without any rupture, this is a true auspicious sign. If the skin is soft and thin, the pus water is clear and scanty, leaking and damp, and easily ruptured, this remains an ominous sign. Only in cases where the lesions have matured for a long time, the appropriate time for scabbing has passed, yet scabbing does not occur, causing the pus to revert to fluid and the skin to break easily, should one not apply the above theory.
At the initial stage of smallpox rising, one must avoid wind and cold, stay away from people, regulate diet, and observe taboos. At the nourishing-pus stage, caution must be even greater than during the rising stage. Previously, the illness was recent, and Qi and Blood were still strong, sufficient to resist aberrant changes. By this stage, Qi is depleted, Blood is deficient, and spirit is diminished; slight aberrant influences cannot be borne. Moreover, since the sores are just beginning to form, they are easily offended, requiring utmost caution.
If the weather is extremely hot, remove clothing and bedding to keep the body cool, but ensure doors, windows, and curtains are secure to prevent evil winds from entering. If the weather is extremely cold, add thick covers to keep the body warm, and have family members sit close on both sides for warmth. The room should be bright, with lamps never extinguished. Frequently burn "Bi Hui Xiang" (Dispel Filth Incense) with added Ru Xiang (Frankincense), allowing the fragrance to permeate. Day and night, one person should watch over the patient, rotating shifts to avoid fatigue. Fear that the child may itch; gently massage them to prevent accidental scratching, which could lead to suppuration and rotting, resulting in unsightly scarring.
**Bi Hui Xiang (Dispel Filth Incense)**
Cang Zhu (Rhizoma Atractylodis Macrocephalae, 1 jin) Da Huang (Radix et Rhizoma Rhei, 0.5 jin)
Chop finely. Shape into balls and burn in a stove continuously without interruption.
**[Failure to Form Pus]** When smallpox is about to finish erupting and desires to penetrate, reaching the nourishing-pus stage, it must form pus. Plumpness indicates pus is formed. Turbidity indicates the shape of pus. Yellowish-white indicates the color of pus. If at the time pus should form, the lesions remain empty shells, this signifies Qi carrying toxin while Blood fails to adhere to Qi. Toxin resides in Blood; if Blood does not arrive, toxin remains latent in the Blood and does not emerge. Treat with Si Wu Tang (Four Substances Decoction, for blood loss) combined with Zi Cao Yin (Arnebiae Decoction, for appearance stage) plus Chan Tui (Cicada Slough). If it has already become fluid, clear and grayish-white, unable to form pus, this indicates deficiency of both Qi and Blood. The remaining fluid is merely the initial drop of blood, dispersed by Qi into fluid, not fluid surging from within. Treat with Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction, for sweating disorders). These two patterns—itching or carbuncle-toxin—must be understood. After initial eruption, if pus should form but does not, discuss this alongside non-rising black depression under four patterns. If affected by wind-cold, use warm dispersal: Gui Zhi Ge Gen Tang (Cinnamon Twig and Pueraria Decoction, for initial heat) plus Huang Qi (Astragali Radix), Bai Zhi (Angelicae Dahuricae Radix), Fang Feng (Saposhnikoviae Radix). If toxic qi is abundant, use interior-boosting, detoxifying, and diuretic methods: alternate Zi Cao Yin Zi (Arnebiae Decoction, for rising stage) and Lian Qiao Tang (Forsythiae Decoction, for abdominal stuffiness). For constipation, use Xuan Feng San (Disperse Wind Powder, for fever). For internal deficiency, use warming interior methods: Shi Quan Da Bu Tang or Chen Shi Mu Xiang San (Chen's Costus Root Powder, for diarrhea). For external offense, use fumigation and resolution: internally take Zi Cao Yin, externally use Yin Chen Fumigation Method (for rising stage). For irritability and drowsiness, use Long Nao Gao (Borneol Ointment, for black depression). Xue Shi said: If grayish-white, or itchy with non-penetrating pus, use Zi Cao (Arnebiae Radix), Si Jun Zi Tang (Four Gentlemen Decoction), and Mu Xiang (Aucklandiae Radix). If red, or itchy with non-penetrating pus, use Zi Cao Mu Tong Tang (Arnebiae and Uncaria Decoction, for slow eruption). If penetrating but pus is clear and thin, use Shen Nei Tuo San (Ginseng Interior-Boosting Powder, for itching). If ineffective, add Fu Zi (Aconiti Lateralis Radix Praeparata); delay leads to death. *Mi Yao* states: Depression at the apex with no pus is a counter-indication; urgently use Bao Yuan Tang (Protect the Origin Decoction) plus Chuan Xiong (Ligustici Chuanxiong Rhizoma), Rou Gui (Cinnamomi Cortex), Dang Gui (Angelicae Sinensis Radix), Shao Yao (Paeoniae Radix), Mu Xiang, Nuomi (Oryza Sativa Glutinosa Semen). Boil well, add Ren Ru (Human Placenta) and good wine, serve warm. If white like crystal with no internal pus, use Bao Yuan Tang plus Nuomi, served with human placenta and good wine.
**Commentary:** Patients with inherent weak Yuan Qi, or those who took too many detoxifying herbs due to dense eruption, or those who experienced vomiting and diarrhea during the rising stage, all damage Yuan Qi. Although using Ren Shen (Ginseng Radix) and Huang Qi helps promote pus formation, fear remains of weak Yuan Qi leading only to clear pus, deficiency, lack of fullness, and risks of itching or carbuncles. It is advisable to add high-quality Lu Rong (Cervi Cornu Pantotrichum) to the decoction, administer Zi He Che Wan (Placenta Pills), and continue Ba Wei Er Hua San (Eight-Ingredient Two-Flower Powder). I have seen cases where smallpox erupted clearly and rose thoroughly, but failed to form pus at the scabbing stage, often turning into complicated syndromes. This occurs due to inability to eat, spleen-stomach deficiency with self-induced diarrhea and lack of regulation, or uneven eruption and incomplete penetration with latent toxins, wrongly attributed to sparsity. These are failures of care, not caused by seasonal toxins.
**Liu Yi Tang (Six-One Decoction)** Specifically promotes smallpox pus.
Huang Qi (Astragali Radix, 6 qian) Gan Cao (Licorice Radix, prepared, 1 qian)
Chop. Take 2 qian per dose, decoct in 6 fen water with 2 fen wine until half a cup remains. Serve warm. Adding Gan Lan (Canarium Album Seed) is better. Shan Yao (Dioscoreae Rhizoma) is also acceptable.
**Zhu Jiang Wan (Pus-Assisting Pill)** For smallpox on days 7-8 with thin, absent pus; take urgently.
Huang Qi (Astragali Radix, honey-fried, 3 liang) Bai Shao Yao (Paeoniae Radix Alba, wine-fried) Dang Gui (Angelicae Sinensis Radix, wine-washed, 1.5 liang each) Lu Rong (Cervi Cornu Pantotrichum, fresh/moist/amber-colored, processed like deer horn glue, milk-fried) Zi He Che (Human Placenta, wine-washed to remove red veins, dried) Bai Zhu (Atractylodis Macrocephalae Rhizoma, baked) Ren Shen (Ginseng Radix, 1 liang each)
Grind to fine powder, make pills with refined honey the size of Euryale Seed. Take 1-2 pills, dissolve in stir-fried Nuomi (Glutinous Rice) decoction.
**Shen Qi Si Sheng San (Ginseng and Astragalus Four Sages Powder, for rising stage)** Mi Chuan Da Tou Ji San (Secretly Transmitted Great Muscle-Penetrating Powder, for appearance stage)
**Sheng Tian San (Ascend to Heaven Powder)** Also known as Guan Nong Qi Ding San (Suppurating Pus Apex-Raising Powder). For grayish-white smallpox, or red/purple/black depressed/dry lesions, or clear fluid failing to form pus. Can be taken on days 8-10.
Ren Shen (Ginseng Radix, 6 fen) Huang Qi (Astragali Radix) Shan Zha (Crataegi Fructus, 8 fen each) Bai Zhu (Atractylodis Macrocephalae Rhizoma, soil-fried) Dang Gui (Angelicae Sinensis Radix) Chuan Xiong (Ligustici Chuanxiong Rhizoma) Ju Hong (Citri Reticulatae Pericarpium Rubrum, 5 fen each) Gan Cao (Licorice Radix, 3 fen) Yin Yang Huo (Epimedii Folium) Chuan Shan Jia (Manis Squama, soil-fried yellow) Mu Xiang (Aucklandiae Radix, 2 fen each) Rou Gui (Cinnamomi Cortex, 3 li, a guiding herb; excess causes itching)
Add 1 slice of Sheng Jiang (Zingiberis Rhizoma Freshum) and 1 Zao (Jujubae Fructus). Decoct in water and take, or grind to powder. For vomiting, take with Sheng Jiang Tang. For diarrhea, take with Mi Yin (Rice Drink). For abdominal pain, take with Shen Qu (Massa Medicata Fermentata) decoction. For irritability, take with Mai Men Dong Tang (Ophiopogonis Decoction). For thirst, take with Mai Men Dong (Ophiopogonis Radix) and Wu Wei Zi (Schisandrae Fructus) decoction. For vomiting/diarrhea, take with Huo Xiang (Agastaches Herba) and Chen Pi (Citri Reticulatae Pericarpium) decoction. For smallpox failing to form pus, take several more doses without harm.
**Bu Jiang Tang (Pus-Nourishing Decoction)** For grayish-white, non-robust smallpox or clear pus.
Yin Yang Huo (Epimedii Folium, 3 fen, excess causes itching) Ren Shen (Ginseng Radix) Dang Gui (Angelicae Sinensis Radix) Shan Zha (Crataegi Fructus, 8 fen each) Chuan Shan Jia (Manis Squama, soil-fried, 3 fen) Huang Qi (Astragali Radix, 1.5 qian) Gou Qi Zi (Lycii Fructus, 1 qian) Chuan Xiong (Ligustici Chuanxiong Rhizoma) Gan Cao (Licorice Radix) Chen Pi (Citri Reticulatae Pericarpium, 5 fen each) Mu Xiang (Aucklandiae Radix, 2 fen) Bai Zhu (Atractylodis Macrocephalae Rhizoma, soil-fried, 6 fen) Guan Gui (Cinnamomi Cortex, 3 li) Huang Dou (Sojae Semen Preparatum, 30 grains) Sun Jian (Bambusae Caulis Acumen, 3 pieces)
Add Sheng Jiang, Zao, and Nuomi. Decoct in water and take. Another formula includes Bai Zhi and Fang Feng.
**Formula for White Smallpox with Chills** On days 6-7 of smallpox, when pus should coalesce, suddenly appearing pale/white without red vibrancy, showing earthy iron depression, with unrelenting heat and chills. **Tian Dan Huo Niu Tang (Field Fire Ox Decoction)**
Ren Shen (Ginseng Radix) Huang Qi (Astragali Radix) Liao Zi (Polygoni Multiflori Folium, select fine leaves; if Chuan Liao, leaves are large with green spots, distinguish carefully. Stir-fry with Chuan Shan Jia until shell scent dissipates, remove shell) Dang Gui (Angelicae Sinensis Radix, 2 qian each) Fu Zi (Aconiti Lateralis Radix Praeparata, 1 qian) Gan Cao (Licorice Radix, 5 fen) Gui (Cinnamomi Cortex, 3 fen) Ju Hong (Citri Reticulatae Pericarpium Rubrum, 8 fen)
Decoct in water and take.
**[Spleen and Stomach]** When smallpox has grown and pus is forming, focus primarily on Spleen and Stomach. Strong Spleen/Stomach leads to充盈 Qi/Blood, naturally forming plump, thick pus without medication. Weak Spleen/Stomach leads to deficient Qi/Blood, unable to circulate fully to form pus, resulting in weak, clear fluid rather than true pus. Use Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) minus Di Huang (Rehmanniae Radix) plus Mu Xiang, or Ren Shen Bai Zhu San (Ginseng and Atractylodes Powder, for thirst) minus Ge Gen (Puerariae Radix) plus Huang Qi and Guan Gui. Take frequently for best results. Assess Spleen/Stomach strength by appetite and stool consistency. Low appetite with hard stool indicates sufficient Spleen/Stomach Qi. Diarrhea indicates further deficiency; treat with Si Jun Zi Tang (Four Gentlemen Decoction, for anorexia) sending down Dou Kou Wan (Cardamom Pill, for diarrhea) until stopped, then resume Ren Shen Bai Zhu San minus Ge Gen plus Huang Qi and Guan Gui. If stool is clear but appetite is poor, follow the above method. If eating well but constipated for days, use Dan Dao Fa (Gallbladder Suppository Method, for constipation) to unblock, ensuring Qi flows smoothly and Ying/Wei harmonize to prevent rotting.
**[Diarrhea]** Smallpox eruption and rising stages should not involve diarrhea, as it risks interior Qi deficiency, preventing toxin expulsion and causing depression. Thus, diarrhea is an ill omen. Especially during pus formation, it is worse than before. Previously, illness was recent, Spleen/Stomach strong enough to bear it. Now, illness is prolonged, fluids depleted, Spleen/Stomach weak. Further diarrhea exhausts remaining Qi internally, preventing external toxin resolution, leading to itching, inverted scabbing, chills/jaw-clenching, exhaustion, and death. Mild cases: Ren Shen Bai Zhu San minus Ge Gen plus Mu Xiang, Guan Gui, Huang Qi. Severe cases: Chen Shi Mu Xiang San, Yi Gong San (for slow eruption), Rou Dou Kou Wan (Cardamom Pill) can be used together. If ineffective, urgently take Bu Er San (Two-Not Powder, for rising stage).
**[Constipation and Cold Extremities]** Warm hands/feet are precious. During pus nourishment, hot hands/feet with sweat indicate toxic heat stagnating internally, causing constipation/urinary retention, with deep/slippery/rapid pulse. Promote urination/stool: San Yi Cheng Qi Tang (Three-Yi Purging Decoction, for constipation) minus Mang Xiao (Natrii Sulfas). Cold extremities indicate impending Yang collapse, with continuous white diarrhea or vomiting, deep/fine/weak pulse or floating/vacuous pulse. Urgently warm: Li Zhong Tang (Regulate the Middle Decoction, for diarrhea) plus Shu Fu Zi (Prepared Aconite), or Chen Shi Yi Gong San. Survival if hands/feet warm after medicine; death if cold. If constipation, urinary retention, irritability/wandering, abdominal distension/pain, panting/thirst, deep/slippery/rapid pulse, and non-rising sores, this is depression syndrome, Yang Jue (Cold Extremity). Treat with Bai Xiang Wan (Hundred Auspicious Pill, for black depression) and San Yi Cheng Qi Tang.
**[Irritability]** Smallpox values tranquility throughout. When pus forms, toxins resolve, organs harmonize, spirit refreshes; tranquility is essential. Sudden irritability/insomnia requires examining sores. If pus is clear/scant and incomplete, toxin remains internal; use Long Nao Gao (Borneol Ointment, for black depression). If pus is formed/plump but irritability arises from fever drying pus, promote urination: Dao Chi San (Guide Out Redness Decoction, Heart channel). If sores are too dense, post-pus formation, Heart Blood deficiency causes empty irritability/insomnia: Si Wu Tang minus Chuan Xiong, plus Ren Shen, Mai Men Dong, Zhi Zi Ren (Gardenia Seed). Alternatively, Suan Zao Ren Tang (Ziziphus Decoction, for irritability).
**[Throat Issues, Vomiting, Hiccups]** Dense smallpox affects the throat. During pus formation, throat sores mature early; flesh is weak, skin thin, prone to rupture. New scars are tender and painful to touch. Scabs stick, phlegm entangles, causing blockage, difficulty swallowing. Forced swallowing causes pain/phlegm obstruction; water causes choking, food causes vomiting. Clear speech indicates treatability: Gan Jie Tang (Licorice and Catalpa Decoction, for throat) plus Niu Bang Zi (Arctii Fructus), Tian Hua Fen (Trichosanthis Radix) to benefit throat/chest, resolve phlegm. Frequent drinking leads to natural recovery. Hoarse voice/inability to speak indicates throat ulceration; untreatable.
**[Itching]** Tender, delicate-skinned smallpox often itches at pus formation. Regulate first to prevent. If missed and itching occurs: internally Xiao Feng Hua Du Tang (Wind-Dispelling Toxin-Resolving Decoction, for itching); externally Yin Chen Fumigation Method. For ruptured lesions, apply Bai Long San (White Dragon Powder, for itching). Generally, itching is a bad omen, mostly ominous. If patient eats well, stool is hard, scratched areas refill with pus, new sores appear elsewhere, varying sizes, even if all itch/break, it is treatable. Internally alternate Shi Quan Da Bu Tang and Ku Shen Wan (Sophora Pill, for smallpox leprosy); externally apply Mie Ban Jiu Ku San (Scar-Eradicating Bitter Rescue Powder) mixed with Bai Hua Gao (Hundred Flower Ointment, for scabbing). If during itching, patient is confused/disordered, scratched areas do not swell/refill, forming pits, drying black, or peeling, accompanied by choking/vomiting, inability to drink/eat, diarrhea, chills/jaw-clenching, loss of voice, cold extremities, or screaming, these are death signs.
**[Head and Face]** Examine smallpox primarily on the front, as Five Zang essences gather there. Body sores that itch or break are harmless. Frontal sores must not be touched. Scratching face/nose/eyes indicates Lung Heat; urgently use Gan Jie Tang plus Niu Bang Zi to resolve; itching stops, a good sign. If itching persists, spreads, Qi leaks, itching intensifies, leading to full-face scratching death. During rising/pus stage, forehead sores looking like scalded/burned skin, ulcerated, no intact skin, or cheeks similarly breaking without scratching, opening gradually like sand collapsing, uncontrollable, crusts burning/fluid leaving, resembling scabs but not, leads to Yang collapse death. Early pus stage: facial sores not fully suppurated. Nose tip drying orange-red, glabella drying black, lips burning black, ears retracting, cheeks flattening/drying centrally. This is "Inverted Depression," a death sign, do not mistake for normal scabbing.
**[Hands and Feet]** Smallpox on hands/feet requires plump pus, indicating strong Spleen/Stomach and sufficient Qi/Blood. Grayish-white, clear fluid, or sunken/shell-like indicates weak Spleen/Stomach; treat with Ku Ban Yue Bi Tang (Fast Rash Yuebi Decoction, for rising stage). Even if scabbing occurs, abscesses will later develop at wrists/knees/joints.
**Ku Ban Yue Bi Tang (Fast Rash Yuebi Decoction, for rising stage)**
**[Shoulders, Back, Buttocks]** Initial eruption/rising: pathogenic Qi strong, Righteous Qi strong, able to bear. Pus formation: Qi/Blood deplete, spirit weak, unable to bear, difficult movement, preferring supine position. Sores on shoulders/back/buttocks suffer most from friction. Good sores are naturally thick/tough, durable. Secondary: delayed scabbing, spontaneous rupture when ripe. Worst: burns/blister-peeling, spontaneous rupture with clear fluid (not pus), black dry crusts. Untreatable.
**[Leaking Pus]** Verse: "Just testing pus, sac not full, sore head has hole leaking pus. Gather to seal hole, drain true juice, toxin hides." When forming pus follicles, thick skin containing pus firmly is crucial. If pus not formed, sudden hole leaks fluid, or clusters outside, or empties/dries black, commonly called "Leaking Sore," fatal. If pus ripe, follicle skin ripe, pus boils out, scabbing forms, common on forehead/front face, commonly called "Pile Poop Scabbing," not same as leaking sore. Leaking sore: pus not formed. Pile Poop: pus over-ripe.
**[Throat Discomfort, Thick Saliva]** At pus follicle stage, expectoration of thick sticky phlegm/pus, sometimes mixed with blood, throat discomfort, reduced intake. Lung affected by Fire, fluid insufficient, causing sticky phlegm. Ulcerated sores in mouth/teeth bleed. Use Gan Jie Tang plus Niu Bang Zi, Tian Hua Fen to clear Lung, resolve phlegm, benefit throat. Wait for scabbing for natural harmony; do not recklessly use major cooling agents.
**[Sleep Talking]** Pus in smallpox is steamed from body Blood. Dense sores, widespread pus/blood, fluid consumption. Heart governs Blood; Blood deficiency leaves residence empty. Heart Heat causes empty irritability/insomnia: Suan Zao Ren Tang. Heart Deficiency causes sleep talking, delirious speech, waking impossible: An Shen Wan (Calming Spirit Pill, for delirium). Severe drowsiness: first Long Nao Gao to open heart orifices, then An Shen Wan with Ren Shen/Mai Men Dong Tang.
**[Abdominal Pain]** Initial eruption pain: toxin in interior. Rising incomplete pain: depression. Pus formation: toxin out, no depression. Sudden pain with constipation: dry feces. Treat with Dang Gui Wan (Angelica Pill) or Dan Dao Fa (both for constipation). Clear stool indicates cold: urgently Li Zhong Tang plus Gui (Cinnamon) or Huang Qi Jian Zhong Tang (Astragalus Establish Middle Decoction) plus Mu Xiang. Smallpox fully erupted, risen, suppurated, no exterior evil. Eating well, clear urine, moist stool, no interior evil. Peaceful then sudden distension/pain, irritability/panting, sores turning ash-gray: food injury. First Ding Xiang Pi Ji Wan (Clove Spleen Accumulation Pill) with vomit residue decoction to remove old food, then Ren Shen Bai Zhu San minus Ge Gen plus Qing/Chen Ju Pi, alternating with Yang Pi Wan (Nourish Spleen Pill, for old food).