〔万〕痘癞者，热毒拂郁，气血虚弱，肌肉败坏。经云∶热胜则肉腐者是也。正理论曰∶脉浮而大，浮为
风虚，大为气强，风气相抟，必成瘾疹，身体为痒，痒者名为泄风，久久为大癞。凡气血充实者，外无虚风，
内无强邪，必无是病，惟气血素虚者，不能荣卫于身，易感天地肃杀之气，皮肉之内，虚风居之，兼以痘疹秽
毒，疫疠恶气，击搏燔灼，流散四布，随空而出，所以疮本稠密，身无完肤，瘙痒
难任，肌肉溃烂，而痘癞成矣。急用大补气血，清热解毒之法，庶可求全，若待败面堕鼻，唇崩目盲，肢体残伤，
不至殒命，亦为废人矣。凡疮破成癞者，用十全大补汤（汗）苦参丸合而服之，外用灭瘢救苦散（收靥）涂之。
苦参丸
苦参（一两） 白蒺藜 胡麻 牛蒡子（各半两） 甘草（二钱半）
共为末。酒调面、为丸。竹叶汤下。
经曰∶热胜则肿。大抵毒之盛者必肿，毒微者不肿。凡疮出尽，应期起发，头面以渐浮肿者，此毒火发越，聚
于三阳之分，欲作脓血，故宜皮肉 肿也。设当起发之时，头面不肿者，必疮本磊落，毒瓦斯轻浅，虽尔作脓，
根不占处，所以不肿，不须治之。如疮本模糊，起发不肿者，此毒伏于内，不即发泄，不可以毒轻论也。
如起发肿大，皮肉如常，疮尖而圆，粒粒分明者，此佳兆也。若皮色鲜红、疮本成串，粘聚平塌者，若疮色灰白
成饼、如锡面者，若疮焦紫无水者，皆凶兆也。有先
起发头面预肿者，此兼疫毒之气，名大头瘟者是也。腮颔预肿者，此名虾蟆瘟也，须兼疫气而治，多凶少吉。
大凡疮肿者，直至干浆结痂之时，毒化而肿消矣，故应肿不肿，应消不消者，谨提防之。
凡疮肿胀，面浮目闭者，急与解毒、护目、救咽喉、相兼治之，内用消毒化斑汤（起发），外用神应膏（见形）
护目。凡疮肿胀，切防瘙痒，正面之中，不可少有破损者，苟生痒破，沙崩之势渐不可为，邪气内陷，真气外
泄，肿消而死矣。但得破者复灌，消者复肿，饮食如常，大小便自调者，变凶为吉，用十全大补汤（汗）、苦参丸（痘
癞）合而治之。如疮色灰白，面肿如锡饼者，但看其人脏腑何如，若能食，大便调，小便长，
无他苦者，多吉。若不能食，吐利并作，或生瘙痒者，多凶。
如头面预肿，或腮颊预肿者，此时行疫毒也，并用羌活救苦汤主之。
羌活救苦汤（见起发）
万全指出：痘癞，是由于热毒拂郁（阻滞不畅），气血虚弱，导致肌肉败坏。《内经》说：“热邪偏胜则肌肉腐烂”，说的就是这种情况。《正理论》说：“脉象浮而大，浮表示风邪与虚证，大表示气盛，风邪与正气相互搏结，必然形成瘾疹（皮肤红肿瘙痒的皮疹），身体发痒，这种痒症称为泄风，日久便演变为严重的癞疾。”凡是气血充实的人，外无虚风侵袭，内无强盛邪气，必定不会得这种病；只有那些素来气血虚弱的人，不能使营卫之气荣养全身，容易感受天地间肃杀之气，虚风居于皮肉之内，再加上痘疹的秽毒、疫疠的恶气，相互击搏燔灼，流散遍布，随着毛孔排出，所以疮疡原本稠密，身上没有完好的皮肤，瘙痒难以忍受，肌肉溃烂，从而形成了痘癞。此时必须急用大补气血、清热解毒的方法，才可能保全生命；如果等到面部溃败脱落、鼻子塌陷、嘴唇崩裂、双目失明、肢体残伤，即使不致死，也会成为废人。
凡是疮破后形成癞疾的，使用十全大补汤（用于汗法阶段）与苦参丸合服，外用灭瘢救苦散（用于收靥阶段）涂抹。
苦参丸配方：苦参（一两）、白蒺藜、胡麻、牛蒡子（各半两）、甘草（二钱半）。
以上药物共研为末，用酒调和面粉，制成丸药。用竹叶汤送服。
经文说：“热邪偏胜则肿胀。”大致来说，毒邪旺盛的必然肿胀，毒邪轻微的则不肿。凡是痘疮出齐后，按期起发，头面逐渐浮肿的，这是毒火发散，聚集在三阳经部位，准备化脓成血，所以会出现皮肉肿胀的情况。如果在应当起发的时候，头面不肿，那一定是痘疮根基磊落分明，毒瓦斯轻浅，虽然会化脓，但根基不占据大片区域，所以不肿，这种情况不需要治疗。如果痘疮根基模糊，起发时不肿，这是毒邪伏藏在体内，没有立即发泄出来，不能认为是毒邪轻微。
如果起发时肿大，皮肉形态正常，疮顶圆锐，颗粒分明的，这是吉兆。如果皮色鲜红、疮根连成片、粘聚平塌的；或者疮色灰白像饼状、表面如锡光一样的；或者疮体焦紫干枯无水的，都是凶兆。
有在起发前头面预先肿胀的，这是兼夹了疫毒之气，称为大头瘟。腮部下颌预先肿胀的，称为虾蟆瘟，必须兼治疫气，大多凶险少吉利。
大凡疮疡肿胀，直到干浆结痂的时候，毒邪化解而肿胀消退。所以，应该肿而不肿，应该消而不消的，要谨慎提防。
凡是疮疡肿胀，面部浮肿眼睛闭合的，急忙给予解毒、护目、救咽喉的方法综合治疗，内服消毒化斑汤（用于起发阶段），外用神应膏（见于见形阶段）保护眼睛。
凡是疮疡肿胀，务必防止瘙痒，面部正中不可稍有破损。如果因生痒而抓破，沙崩之势逐渐发展就难以救治了，邪气内陷，真气外泄，肿胀消退而死。只要能使破损处重新灌注脓液，消退处重新肿胀，饮食如常，大小便自然调畅的，就能变凶为吉，使用十全大补汤（用于汗法阶段）、苦参丸（用于痘癞）合方治疗。
如果疮色灰白，面部肿胀如锡饼状，只看这个人的脏腑状况如何，如果能进食，大便调畅，小便通长，没有其他痛苦，大多吉利。如果不能进食，呕吐腹泻并作，或者产生瘙痒的，大多凶险。
如果头面预先肿胀，或者腮颊预先肿胀的，这是时行疫毒所致，都用羌活救苦汤主治。
羌活救苦汤（参见起发章节）
Wan Quan pointed out: "Dou Lai" (smallpox-derived leprosy-like condition) is caused by heat-toxin stagnation and obstruction, deficiency of Qi and Blood, leading to the decay of muscles. The *Neijing* states: "When heat prevails, flesh rots," which refers to this situation. The *Zheng Lilun* states: "A pulse that is floating and large; floating indicates wind and deficiency, while large indicates strong Qi. When wind and Qi contend with each other, urticaria (skin redness, swelling, and itching rashes) must form, causing body itching. This type of itching is named 'Xie Feng' (draining wind). Over time, it develops into severe leprosy." Individuals with sufficient Qi and Blood are free from external deficient wind and internal strong pathogens, so they will certainly not contract this disease. Only those who have a constitutional deficiency of Qi and Blood cannot allow Ying-Wei (Defensive and Nutritive Qi) to nourish the body, making them susceptible to the killing energy of heaven and earth. Deficient wind resides within the skin and flesh, compounded by the filth-toxin of smallpox/rash and the malignant qi of epidemics. These factors strike, scorch, and burn, spreading widely and exiting through the pores. Consequently, the sores are originally dense, leaving no intact skin on the body, with unbearable itching, muscle ulceration, thus forming Dou Lai. At this point, one must urgently employ methods to greatly tonify Qi and Blood and clear heat-toxins to seek preservation of life. If one waits until the face decays and falls off, the nose collapses, lips rupture, eyes go blind, and limbs are maimed, even if death does not occur, the person will become disabled.
For cases where sores break and transform into leprosy-like conditions, use Shiquan Dabu Tang (Decoction for Ten Thousand Benefits, used in the sweating stage) combined with Kushen Wan (Pill of Sophora Root), taken together. Externally, apply Miecan Jiuku San (Powder to Eliminate Scars and Save from Suffering, used in the crusting stage).
Kushen Wan Formula: Kushen (Sophorae Flavescentis Radix, 1 liang), Baijili (Tribuli Fructus), Huma (Sesami Fructus), Niubangzi (Arctii Fructus) (each 0.5 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 2 qian 5 fen).
Grind all ingredients into powder. Mix with wine and flour to form pills. Take with Zhuye Decoction (Bamboo Leaf Decoction).
The classic states: "Heat prevailing causes swelling." Generally speaking, abundant toxins cause swelling, while mild toxins do not. When all sores have erupted and begin to develop according to schedule, if the head and face gradually swell, this indicates that heat-fire toxin is dispersing and gathering in the three Yang meridians, preparing to suppurate and form blood, hence the swelling of skin and flesh. However, if at the time when development should occur, the head and face do not swell, it means the base of the sores is distinct and prominent, and the toxin is light and superficial. Although suppuration may occur, the base does not occupy a large area, so there is no swelling; this requires no treatment. If the base of the sores is indistinct and blurry, and there is no swelling during development, this indicates the toxin is hidden internally and has not yet been vented; one cannot conclude that the toxin is mild.
If during development there is swelling, but the skin and flesh appear normal, with round and sharp sore tips and clearly defined grains, this is a favorable omen. If the skin color is bright red, the bases of the sores are connected in clusters, sticky and flat, or if the sore color is grayish-white like a cake with a surface resembling tin foil, or if the sores are scorched, purple, and dry without fluid, these are all ominous omens.
If the head and face swell prematurely before development, this is due to the concurrent presence of epidemic toxin, known as Datou Wen (Big Head Plague). If the cheeks and jaw swell prematurely, this is known as Xia Ma Wen (Toad Plague); it must be treated concurrently with epidemic measures, and the prognosis is mostly poor with little hope of recovery.
Generally, for swollen sores, until the stage of drying pus and forming scabs, the toxin transforms and the swelling subsides. Therefore, situations where swelling should occur but does not, or where swelling should subside but does not, require careful vigilance.
For cases of sore swelling with facial edema and closed eyes, urgently employ combined treatments of detoxification, eye protection, and throat rescue. Internally, use Xiaodu Huaban Tang (Decoction for Detoxification and Spot Resolution, used in the development stage); externally, apply Shenyin Gao (Miraculous Ointment, seen in the eruption stage) to protect the eyes.
For swollen sores, one must strictly prevent itching. There must be no damage to the center of the face. If scratching causes breaks, the momentum of sand-cracking becomes irreversible, pathogenic qi sinks inward, true qi leaks outward, and death occurs as swelling subsides. However, if broken areas can be refilled with pus, subsided areas can re-swell, diet remains normal, and bowel/bladder functions are naturally regulated, the ominous turns auspicious. Use Shiquan Dabu Tang (used in the sweating stage) and Kushen Wan (used for Dou Lai) combined for treatment.
If the sore color is grayish-white and the face swells like a tin cake, observe the patient's zang-fu organs. If they can eat, stools are regular, urine is long and clear, and there are no other sufferings, the prognosis is mostly good. If they cannot eat, vomiting and diarrhea occur simultaneously, or itching arises, the prognosis is mostly bad.
If the head and face swell prematurely, or the cheeks and jaw swell prematurely, this is due to seasonal epidemic toxins. Treat all such cases primarily with Qianghuo Jiuku Tang (Notopterygii Rhizoma et Radix Decoction for Saving from Suffering).
Qianghuo Jiuku Tang (See Development Stage)