〔袁〕先哲云∶臭痘不死，以其得化泄阳明之毒瓦斯故耳，若臭而黑烂成窝者，元气亏损，亦死之证也。患
此者，须服定金汤。
定金汤方
绵黄 人参 炒术 当归 白芍药 生地黄 白茯苓 甘草 白芷 防风 荆芥 升麻
入芫荽一握，白银一块，灯心二十茎，同煎服。
予每诊臭痘脓血流溢者生，臭不枭痒者生，臭不延人者生，臭不抓脱者生，臭不黑烂者生，犯此，须以芫荽、艾
叶烧，辟其秽气，随用升麻、紫苏汤揩挹其臭处，净洁其衣服床被，即服前方，无不获全，若顶
胁胸颈气窝处凹烂黑臭，洞见筋骨者，必死之痘也。四明俞氏用寒水丹掺之，亦可。
寒水丹
鸡骨灰（带血肉，烧过） 银朱（各一钱） 冰片 赤石脂（各五分） 棕衣灰（二分）
上研细末。洗净，徐徐掺之。
〔袁〕天地间，有形化者，有气化者，形化者由于胎卵，气化者忽焉成形，痘之有蛆，形化、气化、兼之
也。近有华峰道人，隐吴山治痘，有一小儿患痘，时届十
一月，感发之候，痘经正顺，囊廓鼎竦，忽头项上恶痒难忍，手搔难禁，遂于溃破处将银簪挑之，则见其虫
如丝，细而长有寸，遂以香油取尽，花椒汤洗之，痒即止。愚按∶寒冬蛰令，岂有虫乎，兹乃气化然也。又
有一患痘者，时值炎热之际，头项上如前作痒，予视之，见其虫如米粒，囊中或二三盘据焉，此乃蝇蚋聚
啮脓血，形化然也。先哲云蛆痘不死，以其枭毒尽发于外也。
治痘疮生蛆方
经霜桑叶 野薄荷
煎汤洗之，其蛆自去，或先用艾条熏之，后增紫苏、甘草、煎汤洗之。禁雄黄、矾石、等药。
【验头面】论曰∶轻者头面少。又，胡荽酒法不欲喷头面。以诸阳之会在于头，心之华在于面，痘为阳毒，
而心主之，故痘疮头面稠密者重。头面预肿者凶。头面疮破烂腥臭者凶。欲占疮之轻重吉凶，莫如头面也。
人之一身，内则心为君主，外则头为元首，病有真心痛，真头痛，以见不可轻犯也。经曰∶头者精明之府，头
倾视深，精神弃矣，故占人之生死者亦莫如头，凡疮初出，从他处先见，渐登于头，
起发收靥皆然，他皆有疮，而头独稀，此佳兆也。若于头额之间先出，先戴浆，先干收，先破损，其疮稠密
无缝，肉下浮肿，皮上溅起粗肤者皆凶。惟疮遍身俱收，而头上不收，或熟自破，或脓出结如堆者，不须怪。
盖天地之化，孤阳不生，孤阴不长，阳变阴合，彼此相成，头者诸阳之会，无阴相济，所以难收也。又
病闭目摇头者死，此阳脉不治，谓之心绝也。
经曰∶十二经脉，三百六十五络，其气皆上走于面，而走空窍。又，肝开窍于目，肺开窍于鼻，脾开窍于
口，心、肾开窍于耳。又，修真家云∶面有七窍，内应乎心。又，相术但观人之面，以知祸福，可见面不
可败也。凡疮稠密，七窍闭塞，败面者凶，以脏腑经络之气皆病也。又，诸阳皆聚于面，痘为阳毒，初出
之时，必先于面，然面有部位，其候不同，额属心，离火之位，火性急烈，不可轻犯，凡疮出现、泡浆、干
收，先从额上起者凶。左颊属肝，震木之位，右颊属肺，兑金之位，二处不论先后，但疮欲磊落坚浓，若模糊
成块，浮嫩易破，溃烂灌肿者凶，盖肝藏魂、肺藏魄，肝肺俱败，魂魄以离，故凡病两腮冷或木硬者死。颏属
肾，坎水之位，此处先出、先壮、先靥者吉，盖疮疹出于肾则吉，入于肾则凶也。鼻属脾，坤土
之位，亦不论先后，但不欲模糊，早干收也，若未成浆，鼻头先干黄色凶，此脾土将败，真脏色见也。
〔薛〕闻人氏云∶痘疹属火证，其面色赤者为顺，甚者为热。若肝木克制脾土，致面色青者，是为逆也，
急用四君、升麻、柴胡，调补脾胃，色正才治。窃谓前证若伤食而呕吐搐搦，脾气受伤而泻利搐搦或厥逆，
皆慢脾风之渐也，用人参理中汤（泄利）加柴胡、钓藤钩治之，或有少误，多致不起。若有痘毒内外郁蒸，发
出遇风寒相搏，凝滞于肌肉，遍身皮肤青色者，用透肌散。胃伤则生风呕吐，脾伤则生风厥逆，用
五味异功散加天麻。若疮密热盛便秘，饮冷面赤者，用犀角解毒散。灌浆之后，发热烦躁，作渴面赤者，用
当归补血汤。足热腰痛，目睛赤者地黄丸。皆要法也。一小儿出痘饮冷过多，腹痛面青，手足并冷。此寒邪伤
脾而虚寒也，用附子理中汤一剂而痛止，用人参一两、姜一钱二剂而脓灌，又用人参煎汤代茶与饮，月余而靥。
一小儿出痘面色青，手足冷。此寒水侮土也，非十二味异功散不能救。不信，乃服疏通之药，殁而遍身皆青。
人中为阴阳之分，故赵子昂以泰卦象之，人中而上，分为三部，人中而下，亦
分为三部，发际之上，阳之上也，两眉之间，阳之中也，山根以下，阳之下也。自口至两乳间，阴之上也，
自心蔽骨至阴毛际，阴之中也，自阴而下，阴之下也。凡疮之出现、起发、收靥，自人中而分，上下循序，
阴阳和畅，虽多且密，亦可言吉，若或舛差，虽是稀少，亦可言凶，此有伏也。
发热之时，面色明莹者吉，面赤若涂抹者重，此邪气拂郁于阳明胃与大肠也，阳明经上循于面，故赤也，
宜以清凉解毒之药少通利之。面垢惨黯者凶，疮疹之火，发自少阳，面垢者，少阳候见也，《针经》云∶少
阳病甚则面微壅，宜表里双解，盖少阳从中治也。
【验耳目鼻】经曰∶肾通窍于耳。耳者，肾之外候也，肾之为脏，水脏也，天一生水，受气之初，先生
两肾，而一阴藏焉，又有相火存乎命门之中，疮疹发热耳独凉者，疮疹为火，肾不受邪，存水之主以制阳光也。
如耳反热，则水不胜火，将有归肾之变。痘疮之候，先观耳后有红缕者，盖手少阳三焦之脉，从膻中上出缺盆，
系耳后，直上出耳角。红者火色也，此疮疹之火，发自少阳，自见于其经也。凡疮自耳先出，未及成浆，耳
轮先靥者，渐萌归肾之势矣。
目别见
经曰∶肺通窍于鼻，疮疹发热之初喷嚏者，火邪上干于肺，外应于鼻，而痒则嚏。鼻干黑燥者，火刑于金，金
体本燥，得火反甚，急宜清金泻火，以解其毒。鼻衄者，血得热而妄行，故衄出于鼻，急与凉血泻火，以解其毒。
鼻流清涕者疹也，疹发于心，心肺相连，以火炼金，热极而反化为水也。疮出之后，鼻塞不通者热也，火主 胀。疮
已成浆收靥之时，鼻塞不得息者，此鼻内有疮，脓涕粘结，可用金银小簪子以通之。如疮未成浆，鼻端先干
者凶，经曰∶脏真高于肺，以行荣卫阴阳也，邪火刑肺，肺败不能输精于皮毛，故皮毛焦枯，先见于鼻，荣卫不行，
阴阳不续，以渐遍身皆干枯而死矣。凡疮变坏，鼻中血出者，涕自流出者，鼻孔开张喘急者，肺绝之候，皆死证也。
【验唇口牙齿】脾之窍，通于口，其华在唇四白。《脉诀》曰∶应唇通口气。疮疹发热之初，口中和，唇色红
润者吉。如口燥唇裂，其毒必甚，急解之。疮出稠密，唇口疮子相粘，诸疮未发，此疮先已戴浆，诸疮未收，此疮先
已焦黑者凶。面疮肿灌，唇上疮裂，成块干溅者重。如疮出太密，口中臭气者，脏腑败坏，故臭出于口
也。疮欲变坏，唇上缩者，脾绝也。唇下自呷者，鱼口也。口中涎如胶粘者，脾津竭也。皆不可治。疹家唇
口生疮声哑者，狐惑证也。不急治之，杀人。
上片牙隶于坤土，乃足阳明胃脉之贯络也，下片牙隶于干金，乃手阳明大肠脉之贯络也。疮疹发热之初，
口开，前板齿燥者里热也，宜以清凉之剂微解之。切牙者，牙乃骨之余，肾主骨，寒战切牙，毒归于肾，必死。
如发热切牙者，有欠则为肝热，有上窜，则为心热，此欲作搐也。疮已收靥，牙龈溃烂者，此肉疮未得平复
也，勿作走马疳疮治之，疹后牙龈溃烂，血出肉黑气臭者，此方是走马疳也。
【验喉舌】咽喉别见
舌者，心之候。《脉诀》曰∶外应舌，将荥。又，脾之脉，络于舌，舌之在人，延纳饮食，主持声音，
其用亦大矣，疮疹发热，其舌红润者吉。舌燥如芒刺者，里热甚也，急解之。《针经》曰∶热病口干舌黑者死。
吐舌者，脾有热也，脾脏微热，则舌络微紧，时时舒舌，勿用冷药及下之，或饮水者，医疑为热而下之，误也，
饮水者，脾胃虚，津液少故耳。疮出之后，舌上稠密，出如堆粟，破如蜂窠者危，更加饮水则呛，食物则哕，
声哑不出者，必死之证。疮出太甚，弄舌者凶。
【验颈项】经曰∶东风生于春，病在肝，俞在颈项。颈项者，生气之本也。又曰∶天气通于肺，地气通于嗌。天
食人以五气，喉者气之所由也，故喉主天气，地食人以五味，咽者味之所由也，故咽主地气。颈项者，咽喉之管
束也。又，三阳之脉自颈而上，三阴之脉自颈而还，颈项者阴阳之道路也。痘疮之候，颈项欲疏，若
缠项而出，稠密太甚者，谓之锁项，废其管束，阻其道路，上不得降，下不得升，内者不出，外者不入，经曰∶出
入废则神机化灭，升降息则气立孤危。此死之征也。凡病深项软者死，骨败也。
【验胸腹】经曰∶凡刺胸腹者，必避五脏。胸腹者，脏腑之郭也。又曰∶鬲肓之上，中有父母。盖言心肺也，
故痘疮轻者胸前无，胸腹出太甚者必重也。其中于脏，各有期日，凡病深喘急，胸骨扇动者，肺焦胀也，左乳下
动脉突出者，宗脉绝也，皆不可治。疮疹腹痛者，毒未尽也，更宜详审。
【验手足】四肢者，诸阳之本，疮出欲疏，其发欲透，其靥欲齐。如应出不出，应发不发，应收不收，此脾
胃气虚不能旁达四肢也。发热，手寻衣领、乱捻物者，肝热也。手掐眉目鼻口者，肺热也。手足搐搦者，心肝风
火相搏也。各随其脏而泻
之。足凉者，此常候也，疮疹肾不受邪，肾主足，故足宜凉。手足冷者，脾脏怯也，四肢皆禀气于胃而不得至经，
必因于脾，乃得禀也，脾怯，不能为胃行其津液，故冷耳，宜温之。疮已出现，手足多水泡者，此肝胜脾衰，
为鬼贼，宜急治之，不久便生痒塌也。如遍身皆发，手足不透，是空壳者，此脾胃虚弱，津液耗竭，荣卫凝
涩，故其毒亦郁而不发也，不能食者死，能食者必发痈疽。疮势太甚，手足冷者不治。疮未成浆，手足皮脱者必
死。疮已正靥，惟足不收者，足为纯阴，无阳相济，所以收迟，《玉函经》曰∶孤阳寡阴即不中，譬取鳏夫及寡
妇。如疮始成浆，他处未收，手足心先靥者，其后必生怪疾也。疮靥之后，手足关节肿痛者，必发痈也。疮
痒，手足搔乱者凶。
【验寝卧】夫卫气者，昼则行阳，夜则行阴，行阳则寤，行阴则寐，人之常也。疮疹发热便昏睡者，心主热，
脾主困，心受气于脾，故发热昏睡，此常候也。起卧不时者，内有热也，必多陷伏之变。合面卧者，里热也。
大抵疮疹始终安寝者吉，盖气血强盛，荣卫流行，邪出于表而不在里则神安，神安则志定，是以得安寝也。
若气血衰弱，荣卫滞涩，邪在于里而热，心恶热，则神不安，神不安则志不宁，是
以烦躁、闷乱、谵妄、而不得眠也。亦有毒伏于中，神丧气脱，僵卧如尸，呼之不应，饮食不知者，不可以
嗜卧论，乃死证也。
【验饮食】经曰；人以水谷为本。故人绝水谷则死，仲景曰∶水入于经，其血乃成，谷入于胃，脉道乃行，
可见水谷之悍气为卫，精气为荣，水去则荣散，谷消则卫亡矣。凡痘疮能食者，虽重亦吉，不能食者，虽轻亦
危也，然有不能食而生，能食而死者何也？盖不能饮食者，脏腑内实，大便不行，有平日之谷气以为之主，
疮成之后，自消谷气、而思食矣。其能饮食者，邪热杀谷，即叔和所谓口干饶饮水，多食亦肌虚者也，将不久
而变生焉。惟疹家多不能食，以口中不和，不思食也。余详不能食门。
【袁氏按语】先哲曾说：患臭痘而不死的人，是因为痘毒得以通过化泄阳明经的毒邪而排出体外。但如果痘疮发臭且黑烂成坑，则是元气亏损的表现，属于死证。患有此症者，必须服用定金汤。
定金汤方剂组成：
绵黄芪、人参、炒白术、当归、白芍药、生地黄、白茯苓、甘草、白芷、防风、荆芥、升麻。
煎服时加入芫荽一握、白银一块、灯心草二十茎，一同煎煮后服用。
我每次诊治臭痘患者，发现脓血流溢的能活，发臭但不剧烈瘙痒的能活，臭味不传染给他人的能活，抓破后不脱落的能活，发臭但不黑烂的能活。若出现上述不良情况，需用芫荽和艾叶焚烧以驱除秽气，随后用升麻、紫苏汤擦拭患处，保持衣物床铺洁净，再服用前方，没有不能痊愈的。如果痘疮在头顶、胁部、胸部、颈部及气窝处凹陷腐烂、发黑发臭，甚至洞见筋骨，必然是死证。四明俞氏使用寒水丹外敷，也可以。
寒水丹方剂组成：
鸡骨灰（带血肉，烧过）、银朱（各一钱）、冰片、赤石脂（各五分）、棕衣灰（二分）。
以上药物研成细末。洗净患处后，徐徐撒布药粉。
【袁氏按语】天地间，生物的形成有“形化”和“气化”两种。“形化”源于胎生或卵生，“气化”则是突然形成形体。痘疮中生蛆，是兼有“形化”和“气化”的特点。近来有位华峰道人，隐居吴山治疗痘疮，曾遇到一个患儿，时值十一月，正值痘疹发作之际，痘疹发展正常，囊廓隆起，但忽然头项部恶痒难忍，手搔不止。于是用银簪挑破溃破处，看见虫子如丝线般细长，长约一寸，随即用香油取出干净，再用花椒汤清洗，瘙痒即止。我认为：寒冬蛰伏之时，哪里会有虫子呢？这乃是“气化”所致。又有一个患痘者，时值炎热季节，头项部像前例一样发痒，我看他，看见虫子如米粒大小，囊中有的盘踞两三个，这是苍蝇蚊子聚集叮咬脓血，属于“形化”。先哲说：患蛆痘不死，是因为毒邪全部发散于体表。
治疗痘疮生蛆的方法：
用经霜桑叶、野薄荷煎汤清洗，蛆虫自会去除；或者先用艾条熏蒸，然后增加紫苏、甘草，煎汤清洗。禁止使用雄黄、矾石等药物。
【验头面】论述说：病情轻的，头面部痘疮较少。另外，胡荽酒法不宜喷洒头面部。因为诸阳之脉汇聚于头部，心的荣华表现在面部，痘疮属于阳毒，由心所主，所以痘疮在头面部稠密的病情重。头面部预先肿胀的预后凶险。头面部疮疡破烂、腥臭的预后凶险。想要判断痘疮的轻重吉凶，没有比观察头面部更好的了。人的一身，内部心脏为君主，外部头部为元首，疾病有真心痛、真头痛，说明这些部位不可轻易侵犯。《内经》说：头是精明之府，头倾视深，精神就抛弃了，所以判断人的生死，也没有比观察头部更好的了。凡是疮疹初出，从其他部位先出现，逐渐蔓延到头部，起发、收靥都是如此，其他部位都有疮，唯独头部稀疏，这是佳兆。如果在额头之间先出痘，先结浆，先干燥收敛，先破损，其疮稠密无缝，皮下浮肿，皮上溅起粗肤的，都是凶兆。只有全身疮疡都已收敛，而头上未收敛，或者自然破裂，或者脓出结成堆状的，不必奇怪。因为天地造化，孤阳不生，孤阴不长，阳变阴合，彼此相成。头是诸阳之会，若无阴气相助，所以难以收敛。又有病闭目摇头的，属死证，这是阳脉不治，称为心绝。
《内经》说：十二经脉，三百六十五络，其气血都上行走于面部，并通达空窍。另外，肝开窍于目，肺开窍于鼻，脾开窍于口，心、肾开窍于耳。另外，修真家说：面部有七窍，内应乎心。另外，相术只看人的面部，就能知道祸福，可见面部不可败坏。凡是疮疡稠密，七窍闭塞，面部败坏的预后凶险，因为脏腑经络之气都已病损。另外，诸阳皆聚于面部，痘疮为阳毒，初出之时，必先在面部显现，然而面部有部位之分，其征候不同。额部属心，离火之位，火性急烈，不可轻犯，凡疮出现、泡浆、干收，先从额上起的预后凶险。左颊属肝，震木之位；右颊属肺，兑金之位。这两处不论先后，只要疮欲磊落坚浓，若模糊成块，浮嫩易破，溃烂灌肿的预后凶险，因为肝藏魂、肺藏魄，肝肺俱败，魂魄离散，所以凡病两腮冷或木硬的必死。颏部属肾，坎水之位，此处先出、先壮、先靥的预后吉，因为疮疹出于肾则吉，入于肾则凶也。鼻部属脾，坤土之位，也不论先后，只是不希望模糊，早干收。若未成浆，鼻头先干黄的预后凶，这是脾土将败，真脏色现。
【薛氏按语】闻人氏说：痘疹属于火证，面色赤者为顺，甚者为热。若肝木克制脾土，导致面色青的，是为逆证，急用四君子汤、升麻、柴胡，调补脾胃，颜色正常后才进行治疗。我认为前述证候若因伤食而呕吐搐搦，脾气受伤而泻利搐搦或厥逆，都是慢脾风的征兆，用人参理中汤（治泻利）加柴胡、钩藤治疗，若有少许误治，多导致死亡。若有痘毒内外郁蒸，发出时遇风寒相搏，凝滞于肌肉，遍身皮肤青色者，用透肌散。胃伤则生风呕吐，脾伤则生风厥逆，用五味异功散加天麻。若疮密热盛便秘，饮冷面赤者，用犀角解毒散。灌浆之后，发热烦躁，作渴面赤者，用当归补血汤。足热腰痛，目睛赤者用地黄丸。这些都是要法。一个小儿出痘饮冷过多，腹痛面青，手足并冷。这是寒邪伤脾而虚寒，用附子理中汤一剂而痛止，用人参一两、生姜一钱，二剂后脓液灌注，又用人参煎汤代茶饮用，月余后结痂。一个小儿出痘面色青，手足冷。这是寒水侮土，非十二味异功散不能救。不信，乃服疏通之药，死后遍身皆青。
人中为阴阳之分界，所以赵子昂以泰卦象征之。人中而上，分为三部；人中而下，亦分为三部。发际之上，为阳之上；两眉之间，为阳之中；山根以下，为阳之下。自口至两乳间，为阴之上；自心蔽骨至阴毛际，为阴之中；自阴而下，为阴之下。凡疮的出现、起发、收靥，自人中而分，上下循序，阴阳和畅，虽多且密，也可言吉，若或舛差，虽是稀少，也可言凶，这里有伏笔。
发热之时，面色明莹者吉，面赤若涂抹者重，这是邪气拂郁于阳明胃与大肠，阳明经上循于面，故赤，宜以清凉解毒之药少通利之。面垢惨黯者凶，疮疹之火，发自少阳，面垢者，少阳候见也，《针经》云：少阳病甚则面微壅，宜表里双解，盖少阳从中治也。
【验耳目鼻】《内经》说：肾通窍于耳。耳是肾之外候。肾为水脏，天一生水，受气之初，先生两肾，而一阴藏焉，又有相火存乎命门之中。疮疹发热耳独凉者，疮疹为火，肾不受邪，存水之主以制阳光也。如耳反热，则水不胜火，将有归肾之变。痘疮之候，先观耳后有红缕者，盖手少阳三焦之脉，从膻中上出缺盆，系耳后，直上出耳角。红者火色也，此疮疹之火，发自少阳，自见于其经也。凡疮自耳先出，未及成浆，耳轮先靥者，渐萌归肾之势矣。
目别见
《内经》说：肺通窍于鼻。疮疹发热之初喷嚏者，火邪上干于肺，外应于鼻，而痒则嚏。鼻干黑燥者，火刑于金，金体本燥，得火反甚，急宜清金泻火，以解其毒。鼻衄者，血得热而妄行，故衄出于鼻，急与凉血泻火，以解其毒。鼻流清涕者疹也，疹发于心，心肺相连，以火炼金，热极而反化为水也。疮出之后，鼻塞不通者热也，火主胀。疮已成浆收靥之时，鼻塞不得息者，此鼻内有疮，脓涕粘结，可用金银小簪子以通之。如疮未成浆，鼻端先干者凶，经曰：脏真高于肺，以行荣卫阴阳也，邪火刑肺，肺败不能输精于皮毛，故皮毛焦枯，先见于鼻，荣卫不行，阴阳不续，以渐遍身皆干枯而死矣。凡疮变坏，鼻中血出者，涕自流出者，鼻孔开张喘急者，肺绝之候，皆死证也。
【验唇口牙齿】脾之窍，通于口，其华在唇四白。《脉诀》曰：应唇通口气。疮疹发热之初，口中和，唇色红润者吉。如口燥唇裂，其毒必甚，急解之。疮出稠密，唇口疮子相粘，诸疮未发，此疮先已戴浆，诸疮未收，此疮先已焦黑者凶。面疮肿灌，唇上疮裂，成块干溅者重。如疮出太密，口中臭气者，脏腑败坏，故臭出于口也。疮欲变坏，唇上缩者，脾绝也。唇下自呷者，鱼口也。口中涎如胶粘者，脾津竭也。皆不可治。疹家唇口生疮声哑者，狐惑证也。不急治之，杀人。
上片牙隶于坤土，乃足阳明胃脉之贯络也，下片牙隶于干金，乃手阳明大肠脉之贯络也。疮疹发热之初，口开，前板齿燥者里热也，宜以清凉之剂微解之。切牙者，牙乃骨之余，肾主骨，寒战切牙，毒归于肾，必死。如发热切牙者，有欠则为肝热，有上窜，则为心热，此欲作搐也。疮已收靥，牙龈溃烂者，此肉疮未得平复也，勿作走马疳疮治之，疹后牙龈溃烂，血出肉黑气臭者，此方是走马疳也。
【验喉舌】咽喉别见
舌者，心之候。《脉诀》曰：外应舌，将荥。又，脾之脉，络于舌，舌之在人，延纳饮食，主持声音，其用亦大矣，疮疹发热，其舌红润者吉。舌燥如芒刺者，里热甚也，急解之。《针经》曰：热病口干舌黑者死。吐舌者，脾有热也，脾脏微热，则舌络微紧，时时舒舌，勿用冷药及下之，或饮水者，医疑为热而下之，误也，饮水者，脾胃虚，津液少故耳。疮出之后，舌上稠密，出如堆粟，破如蜂窠者危，更加饮水则呛，食物则哕，声哑不出者，必死之证。疮出太甚，弄舌者凶。
【验颈项】《内经》说：东风生于春，病在肝，俞在颈项。颈项者，生气之本也。又曰：天气通于肺，地气通于嗌。天食人以五气，喉者气之所由也，故喉主天气，地食人以五味，咽者味之所由也，故咽主地气。颈项者，咽喉之管束也。又，三阳之脉自颈而上，三阴之脉自颈而还，颈项者阴阳之道路也。痘疮之候，颈项欲疏，若缠项而出，稠密太甚者，谓之锁项，废其管束，阻其道路，上不得降，下不得升，内者不出，外者不入，经曰：出入废则神机化灭，升降息则气立孤危。此死之征也。凡病深项软者死，骨败也。
【验胸腹】《内经》说：凡刺胸腹者，必避五脏。胸腹者，脏腑之郭也。又曰：鬲肓之上，中有父母。盖言心肺也，故痘疮轻者胸前无，胸腹出太甚者必重也。其中于脏，各有期日，凡病深喘急，胸骨扇动者，肺焦胀也，左乳下动脉突出者，宗脉绝也，皆不可治。疮疹腹痛者，毒未尽也，更宜详审。
【验手足】四肢者，诸阳之本，疮出欲疏，其发欲透，其靥欲齐。如应出不出，应发不发，应收不收，此脾胃气虚不能旁达四肢也。发热，手寻衣领、乱捻物者，肝热也。手掐眉目鼻口者，肺热也。手足搐搦者，心肝风火相搏也。各随其脏而泻之。足凉者，此常候也，疮疹肾不受邪，肾主足，故足宜凉。手足冷者，脾脏怯也，四肢皆禀气于胃而不得至经，必因于脾，乃得禀也，脾怯，不能为胃行其津液，故冷耳，宜温之。疮已出现，手足多水泡者，此肝胜脾衰，为鬼贼，宜急治之，不久便生痒塌也。如遍身皆发，手足不透，是空壳者，此脾胃虚弱，津液耗竭，荣卫凝涩，故其毒亦郁而不发也，不能食者死，能食者必发痈疽。疮势太甚，手足冷者不治。疮未成浆，手足皮脱者必死。疮已正靥，惟足不收者，足为纯阴，无阳相济，所以收迟，《玉函经》曰：孤阳寡阴即不中，譬取鳏夫及寡妇。如疮始成浆，他处未收，手足心先靥者，其后必生怪疾也。疮靥之后，手足关节肿痛者，必发痈也。疮痒，手足搔乱者凶。
【验寝卧】夫卫气者，昼则行阳，夜则行阴，行阳则寤，行阴则寐，人之常也。疮疹发热便昏睡者，心主热，脾主困，心受气于脾，故发热昏睡，此常候也。起卧不时者，内有热也，必多陷伏之变。合面卧者，里热也。大抵疮疹始终安寝者吉，盖气血强盛，荣卫流行，邪出于表而不在里则神安，神安则志定，是以得安寝也。若气血衰弱，荣卫滞涩，邪在于里而热，心恶热，则神不安，神不安则志不宁，是以烦躁、闷乱、谵妄、而不得眠也。亦有毒伏于中，神丧气脱，僵卧如尸，呼之不应，饮食不知者，不可以嗜卧论，乃死证也。
【验饮食】《内经》说：人以水谷为本。故人绝水谷则死，仲景曰：水入于经，其血乃成，谷入于胃，脉道乃行，可见水谷之悍气为卫，精气为荣，水去则荣散，谷消则卫亡矣。凡痘疮能食者，虽重亦吉，不能食者，虽轻亦危也，然有不能食而生，能食而死者何也？盖不能饮食者，脏腑内实，大便不行，有平日之谷气以为之主，疮成之后，自消谷气、而思食矣。其能饮食者，邪热杀谷，即叔和所谓口干饶饮水，多食亦肌虚者也，将不久而变生焉。惟疹家多不能食，以口中不和，不思食也。余详不能食门。
[Note by Yuan] The sages of old said: Those who suffer from foul pox (Chou Dou) and do not die do so because the toxin is able to be transformed and discharged through the Yangming channel. However, if the pox becomes foul, black, and rotten with pits forming, it indicates a deficiency of Yuan Qi (Original Qi), which is a sign of death. Patients suffering from this condition must take Dingjin Tang (Stabilize Gold Decoction).
Formula for Dingjin Tang (Stabilize Gold Decoction):
Mian Huangqi (Astragali Radix), Renshen (Ginseng Radix), Chao Baizhu (Fried Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), Baishao Yao (Paeoniae Radix Alba), Sheng Dihuang (Rehmanniae Radix Recens), Bai Fuling (Poria), Gancao (Glycyrrhizae Radix et Rhizoma), Baizhi (Angelicae Dahuricae Radix), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Herba), Shengma (Cimicifugae Rhizoma).
Add one handful of Yuansu (Coriandri Fructus), one piece of silver, and twenty stems of Dengxincao (Junci Medulla) to the decoction, boil together, and take orally.
In my clinical practice, I have observed that patients with foul pox survive if there is pus and blood flowing out; if the odor is present but without severe itching; if the odor does not spread to others; if scratching does not cause the scabs to fall off; and if the odor is present without blackening and rotting. If these adverse conditions occur, burn Yuansu (Coriandri Fructus) and Aiye (Artemisiae Argyi Folium) to dispel the foul odor. Then, wipe the affected area with a decoction of Shengma (Cimicifugae Rhizoma) and Zisu (Perillae Folium), keep clothing and bedding clean, and subsequently administer the aforementioned formula. Recovery is almost certain. However, if the pox on the crown, flanks, chest, neck, or acupoints becomes sunken, rotten, black, and foul, exposing bone and tendon, it is inevitably fatal. Yu Shi from Siming used Hanshui Dan (Cold Water Powder) externally, which is also effective.
Formula for Hanshui Dan (Cold Water Powder):
Jigu Hui (Ash of Chicken Bone, including flesh and blood, calcined), Yinzhu (Cinnabar, each 1 qian), Bingpian (Borneolum Syntheticum), Chishizhi (Halloysit Rubra, each 0.5 qian), Zongyi Hui (Ash of Palm Fiber, 0.2 fen).
Grind all ingredients into a fine powder. Clean the affected area and sprinkle the powder gently.
[Note by Yuan] In the world, living things are formed through "Xinghua" (Form Transformation) and "Qihua" (Qi Transformation). Xinghua arises from viviparity or oviparity, while Qihua occurs suddenly as form takes shape. The presence of maggots in pox involves both Xinghua and Qihua. Recently, a Daoist named Huafeng, practicing in Wushan, treated a child with pox in November, during the typical eruption phase. The pox developed normally, with raised vesicles, but suddenly the head and neck became intolerably itchy, causing uncontrollable scratching. Using a silver hairpin to pierce the ruptured areas revealed worms like silk threads, long and thin, about one cun in length. They were removed using sesame oil, and the area was washed with a Sichuan pepper decoction, stopping the itch immediately. I reason: In the deep winter hibernation period, how could there be worms? This is due to Qihua. Another patient with pox, during a hot summer day, experienced similar itching on the head and neck. Upon examination, I saw worms like rice grains, some coiling two or three times in the vesicles. This is caused by flies and mosquitoes gathering to feed on pus and blood, which is Xinghua. The sages said: Those with maggot pox do not die because the toxin is fully expelled outward.
Treatment for Maggots in Pox:
Decoct Sangye (Mori Folium) that has been frosted and Ye Bohe (Menthae Haplocalycis Herba) to wash the area; the maggots will naturally disappear. Alternatively, fumigate first with Moxa sticks, then add Zisu (Perillae Folium) and Gancao (Glycyrrhizae Radix et Rhizoma) to the decoction for washing. Do not use Xionghuang (Realgar) or Fanshi (Alumen).
[Examination of Head and Face] It is stated: Mild cases have fewer lesions on the head and face. Furthermore, the method of Huixu Wine should not be sprayed on the head and face. Because the head is the meeting point of all Yang channels, and the face reflects the flourishing of the Heart, and pox is a Yang toxin governed by the Heart, dense lesions on the head and face indicate severe disease. Premature swelling of the head and face is ominous. Broken, stinking lesions on the head and face are ominous. To judge the severity and prognosis of pox, nothing is better than observing the head and face. In the human body, the Heart is the monarch internally, and the head is the chief externally. Diseases such as True Heart Pain and True Headache show that these areas must not be lightly offended. The Classics state: The head is the mansion of clarity and spirit; if the head tilts and eyes are sunken, the spirit is abandoned. Thus, to judge life and death, nothing is better than observing the head. When sores first appear elsewhere and gradually ascend to the head, during eruption, maturation, and crusting, if other areas have sores but the head remains sparse, this is a good omen. If sores first appear on the forehead, crust first, dry first, break first, are densely packed without gaps, with subcutaneous swelling and rough skin elevation, these are ominous signs. Only if sores on the entire body have crusted over, but the head has not, or if they rupture naturally or ooze pus forming mounds, need not be strange. Heaven and Earth's transformation requires neither pure Yang nor pure Yin alone; Yang changes and Yin combines, complementing each other. The head is the meeting of all Yangs; without Yin to assist, it is difficult to crust. Cases of closed eyes and shaking head are fatal, indicating failure of Yang channels, termed Heart Exhaustion.
The Classics state: The twelve meridians and 365 collaterals all ascend to the face and open into orifices. The Liver opens into the eyes, the Lung into the nose, the Spleen into the mouth, and the Heart and Kidney into the ears. Cultivators say: The seven orifices on the face correspond internally to the Heart. Physiognomy judges fortune by the face, showing the face must not fail. Dense sores with blocked seven orifices and facial decay are ominous, as Qi of organs and meridians is diseased. All Yang gathers in the face; pox is Yang toxin, appearing first on the face. However, facial regions differ. The forehead belongs to the Heart, position of Li Fire; Fire is fierce and easily offended. Sores appearing, blistering, and crusting first on the forehead are ominous. The left cheek belongs to the Liver, position of Zhen Wood; the right cheek belongs to the Lung, position of Dui Metal. Regardless of order, if sores are rugged and thick, but become blurred into clumps, soft and prone to rupture, ulcerating and swelling, prognosis is poor, as Liver stores Hun (Ethereal Soul) and Lung stores Po (Corporeal Soul); failure of Liver and Lung leads to separation of souls. Coldness or hardness of both cheeks is fatal. The chin belongs to the Kidney, position of Kan Water; early appearance, strength, and crusting here are auspicious, as pox emerging from Kidney is good, entering Kidney is bad. The nose belongs to the Spleen, position of Kun Earth. Regardless of order, blurriness and early drying are undesirable. If before blistering, the nasal tip dries yellow, prognosis is bad, indicating Spleen Earth failing and True Organ Color appearing.
[Note by Xue] Wenren Shi said: Pox belongs to Fire syndrome; red face is favorable, extreme red indicates heat. If Liver Wood controls Spleen Earth causing blue face, it is unfavorable; urgently use Sijunzi Tang (Four Gentlemen Decoction), Shengma (Cimicifugae Rhizoma), and Chaihu (Bupleuri Radix) to tonify and regulate Spleen and Stomach; treat only after color normalizes. I believe if the above symptoms involve food stagnation with vomiting and convulsions, or Spleen Qi injury with diarrhea, convulsions, or cold limbs, these are gradual signs of Slow Spleen Wind. Use Renshen Lizhong Tang (Ginseng and Ginger Decoction for the Middle Jiao) for diarrhea, adding Chaihu (Bupleuri Radix) and Gouteng Uncariae Ramulus cum Uncis (Uncariae Ramulus cum Uncis) for treatment. Minor errors often lead to death. If internal and external toxin stagnation erupts, encountering wind-cold, stagnating in muscles causing cyanosis of the whole body, use Touji San (Penetrating Muscle Powder). Stomach injury causes wind and vomiting; Spleen injury causes wind and cold limbs; use Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder) with Tianma (Gastrodiae Rhizoma). If sores are dense, heat is high, constipation, drinking cold water, and red face, use Xijiao Jiedu San (Rhinoceros Horn Detoxification Powder). After blistering, if fever, irritability, thirst, and red face occur, use Danggui Buxue Tang (Danggui Tonifying Blood Decoction). Hot feet, lower back pain, and red eyes indicate usage of Dihuang Wan (Rehmannia Pill). These are essential methods. A child drank too much cold water during pox eruption, resulting in abdominal pain, blue face, and cold hands and feet. This is cold pathogen injuring Spleen causing deficiency-cold; one dose of Fuzi Lizhong Tang (Aconite and Ginger Decoction for the Middle Jiao) stopped pain; one liang of Renshen (Ginseng Radix) and one qian of Shengjiang (Zingiberis Rhizoma Recens) for two doses led to pus formation; drinking Renshen decoction as tea led to crusting after a month. Another child had blue face and cold limbs during pox; this is Cold Water insulting Earth, requiring Twelve-Ingredient Yigong San (Twelve-Ingredient Extraordinary Merit Powder) to save. Disbelieving, he took dispersing drugs and died with cyanosis of the whole body.
The Renzhong (philtrum) divides Yin and Yang. Zhao Ziang symbolized it with Tai Hexagram. Above Renzhong, divided into three parts: above hairline is Upper Yang; between eyebrows is Middle Yang; below Shangen (root of nose) is Lower Yang. From mouth to nipples is Upper Yin; from xiphoid process to pubic hair is Middle Yin; below pubis is Lower Yin. Eruption, maturation, and crusting proceeding orderly from Renzhong up and down, with harmonious Yin and Yang, even if dense, can be auspicious. If chaotic, even if sparse, can be ominous; there is a hidden principle.
During fever, bright and clear complexion is auspicious; red face as if painted is severe, indicating pathogenic Qi stagnating in Yangming Stomach and Large Intestine. Yangming meridian ascends to face, hence red; use cooling detoxifying herbs to mildly promote urination. Dirty and dark face is ominous; fire of pox originates from Shaoyang; dirty face indicates Shaoyang manifestation. *Needle Classic* states: Severe Shaoyang disease causes slight facial swelling; use simultaneous exterior-interior resolution, treating Shaoyang from the center.
[Examination of Eyes, Ears, and Nose] The Classics state: Kidney opens into the ear. Ear is external manifestation of Kidney. Kidney is Water organ; Heaven generates One Water; at conception, two Kidneys form first, containing one Yin, with Ministerial Fire in Mingmen. During pox fever, if ears alone are cool, it means pox is Fire, Kidney does not accept pathogen, preserving Water Master to control Solar Heat. If ears are hot, Water cannot overcome Fire, risking return to Kidney. In pox, observe red lines behind ears first; Hand-Shaoyang Sanjiao meridian ascends from Danzhong, exits Clavicle, connects behind ear, goes straight to ear angle. Red is Fire color; fire of pox originates from Shaoyang, manifesting in its meridian. If sores appear first from ear, before blistering, if ear helix crusts first, trend of returning to Kidney begins. See Eyes separately.
The Classics state: Lung opens into the nose. Sneezing at onset of pox fever indicates Fire pathogen affecting Lung externally responding to nose; itching causes sneezing. Dry, black, and cracked nose indicates Fire punishing Metal; Metal is naturally dry, Fire makes it worse; urgently clear Metal and purge Fire to resolve toxin. Epistaxis occurs when blood moves recklessly due to heat; urgently cool blood and purge Fire. Clear runny nose indicates rash; rashes originate from Heart; Heart and Lung connected, Fire melts Metal, extreme heat transforms into Water. Nasal congestion after eruption indicates heat; Fire governs distension. During blistering and crusting, nasal blockage due to sores inside nose with sticky pus and discharge; use small gold/silver needle to clear. If nose tip dries before blistering, ominous. Classics state: Visceral Truth is higher than Lung, distributing Ying and Wei, Yin and Yang. Evil Fire punishes Lung; Lung fails to transmit essence to skin/hair; skin/hair dry and withered, first seen in nose; Ying and Wei stop, Yin and Yang disconnect, leading to whole-body dryness and death. Bad transformation with nasal bleeding, spontaneous discharge, wide nostrils with panting are signs of Lung Exhaustion, all fatal.
[Examination of Lips, Mouth, and Teeth] Spleen opens into mouth, flourishing in lips and four whites. *Pulse Resolution* states: Corresponds to lips, connecting breath. At onset of pox fever, neutral mouth and moist red lips are auspicious. Dry mouth and cracked lips indicate severe toxin; urgently resolve. Dense sores with sticky lip/mouth sores; if other sores haven't erupted, this one blisters first; if others haven't crusted, this one turns black first—ominous. Swollen face sores with cracked lips forming dry clumps are severe. Too many sores with foul breath indicates visceral decay, hence odor from mouth. Shrinking lips indicate impending deterioration, sign of Spleen Exhaustion. Lower lip twitching is Fish Mouth. Sticky saliva indicates Spleen fluid exhaustion. All incurable. Rash patients with mouth/lip sores and hoarse voice have Huhuo Syndrome; urgent treatment required, otherwise fatal.
Upper teeth belong to Kun Earth, connected to Foot-Yangming Stomach meridian; lower teeth belong to Qian Metal, connected to Hand-Yangming Large Intestine meridian. At onset of fever, open mouth with dry front teeth indicates interior heat; use mild cooling agents. Grinding teeth: Teeth are surplus of bone, Kidney governs bone; chattering teeth with cold shivers indicates toxin returning to Kidney, fatal. Grinding teeth with fever: yawning indicates Liver heat; upward staring indicates Heart heat; signs of impending convulsion. Gum ulceration after crusting means flesh sores not healed; do not treat as Running Horse Gangrene. Post-rash gum ulceration with black flesh, bloody discharge, and foul odor is indeed Running Horse Gangrene.
[Examination of Throat and Tongue] See Throat separately.
Tongue is manifestation of Heart. *Pulse Resolution* states: Externally corresponds to tongue, managing Ying. Spleen meridian connects to tongue. Tongue receives food/drink and controls voice, great utility. Fever with red moist tongue is auspicious. Dry tongue like thorns indicates severe interior heat; urgently resolve. *Needle Classic* states: Heat disease with dry mouth and black tongue is fatal. Protruding tongue indicates Spleen heat; slight Spleen heat causes slight tongue vein tightness, frequent tongue protrusion. Do not use cold purgatives or give water; doctors mistaking this for heat and purging is error; giving water is for Spleen/Stomach deficiency and low fluids. Dense sores on tongue like millet piles, breaking like honeycomb after eruption is critical; drinking causes choking, eating causes hiccups, hoarse voice without sound is fatal. Excessive sores with tongue playing is ominous.
[Examination of Neck] Classics state: East wind born in Spring, disease in Liver, Shu points in neck. Neck is root of vital Qi. Also: Heaven Qi connects to Lung, Earth Qi connects to Pharynx. Heaven feeds Five Qi, throat is passage, thus throat governs Heaven Qi. Earth feeds Five Flavors, pharynx is passage, thus pharynx governs Earth Qi. Neck binds throat/pharynx. Three Yang meridians ascend from neck; Three Yin meridians return from neck; neck is road of Yin/Yang. In pox, neck should be sparse. If wrapping neck with excessive density, called Lock Neck, disabling binding, blocking road, unable to descend/rise, internal/external exchange blocked. Classics state: Cessation of entry/exit destroys Spirit Mechanism; cessation of ascent/descent isolates Qi Establishment. Sign of death. Deep disease with soft neck is death, bone decay.
[Examination of Chest and Abdomen] Classics state: Needling chest/abdomen must avoid five Zang organs. Chest/abdomen are walls of viscera. Above diaphragm/meng, parents exist (Heart/Lung). Light pox has no chest lesions; excessive chest/abdominal eruption is severe. Invasion of Zang organs has specific timelines. Deep disease with panting and rib flaring indicates Lung burning/distension; prominent artery below left breast indicates Zong Mai exhaustion; both incurable. Abdominal pain in pox indicates incomplete toxin resolution; examine carefully.
[Examination of Hands and Feet] Four limbs are roots of all Yang. Sores should be sparse, eruption penetrating, crusting uniform. Failure to erupt, mature, or crust indicates Spleen/Stomach Qi deficiency unable to reach limbs. Fever with hand seeking collar/tangling objects indicates Liver heat. Pinching brows/eyes/nose/mouth indicates Lung heat. Convulsions of hands/feet indicate Heart/Liver wind-fire combat. Purge according to affected Zang. Cool feet are normal; pox Fire, Kidney doesn't accept pathogen, Kidney governs feet, so feet should be cool. Cold hands/feet indicate Spleen weakness; limbs receive Qi from Stomach but must pass through Spleen; Spleen weak cannot transport fluids, hence cold; warm them. Blistered hands/feet after eruption indicates Liver overcoming Spleen decline, Ghost Thief; treat urgently, soon itching/collapse. Whole body eruption but hands/feet not penetrating, empty shells, indicates Spleen/Stomach weakness, fluid exhaustion, Ying/Wei stagnation, toxin郁 not erupting; inability to eat is death; ability to eat leads to carbuncles. Extreme severity with cold hands/feet is incurable. Skin shedding on hands/feet before blistering is fatal. Normal crusting but feet not crusting: feet are pure Yin, lacking Yang assistance, hence slow crusting. *Yukan Jing* states: Solitary Yang/Wide Yin is unfit, like widower/widow. If blistering starts, other areas not crusted, but foot palms crust first, later strange diseases will arise. Joint swelling/pain after crusting indicates carbuncle. Itching with chaotic scratching of hands/feet is ominous.
[Examination of Sleep] Wei Qi travels Yang by day, Yin by night; Yang travel wakes, Yin travel sleeps, normal. Pox fever with lethargy/sleep: Heart governs heat, Spleen governs fatigue; Heart receives Qi from Spleen, hence fever/lethargy, normal. Restless sleep indicates interior heat, likely sinking/submerged changes. Sleeping face-down indicates interior heat. Generally, peaceful sleep throughout pox is auspicious; strong Qi/Blood, smooth Ying/Wei, pathogen on exterior, spirit calm, mind settled, hence sleep. Weak Qi/Blood, stagnant Ying/Wei, pathogen interior with heat, Heart dislikes heat, spirit unsettled, mind restless, hence irritability/confusion/delirium/insomnia. Toxin hidden inside, spirit lost/Qi escaped, rigid lying like corpse, unresponsive, unaware of food/drink, not mere sleepiness, but death sign.
[Examination of Diet] Classics state: Humans rely on water/grain as root. Deprived of water/grain, humans die. Zhongjing said: Water enters meridians, blood forms; grain enters Stomach, pulse channels flow. Visible: vigorous Qi of water/grain is Wei, essence Qi is Ying; water gone, Ying scatters; grain consumed, Wei perishes. Pox patients who can eat, even if severe, is auspicious; those who cannot eat, even if mild, is dangerous. Why some die unable to eat, live able to eat? Unable to eat: viscera full internally, stool not moving, daily grain Qi sustains host; after sore formation, naturally consumes grain Qi, craving food. Able to eat: evil heat kills grain, i.e., Shuhe's description of dry mouth craving water, eating much but muscle deficient; changes will arise soon. Rash patients mostly cannot eat due to mouth discomfort and lack of appetite. Details in "Inability to Eat" section.