之冷热，大便如常，是亦疮疹之一顺也。如起发之时忽然泄泻，此宜急止之，恐肠
胃虚，真气脱也，须辨冷热虚实，如泻而手足冷，面色青白，疮不红（绽）者，冷证也，
理中汤丸、豆蔻丸（俱泄利）、益黄散（脾）、甚则陈氏木香散（泄利）、异功散（出不快）皆
可用也。泻下之物黄又酸臭，渴，手足心热，面赤，疮红绽 发者，热证也，黄芩汤、
（泄利）五苓散（惊搐）主之。脾胃怯弱，精神慢而不食者为虚，当温养之，益黄散。身热中满，渴
而不食者为实，当清利之，五苓散。其人或脏气自脱，或因服寒药，致令疮毒
陷入大肠，泻下如豆汁，或便脓血，或便黑汁，口内臭气，唇焦目闭，加腹胀者必死之
证。方论详泄泻本门。
不二散 治痘当起胀灌浆时泄泻不止，以此止之，只一服愈，如服此不已，是元气
已脱，不可为矣。
莲肉（炒，去心，一两） 真鸦片（二钱，另研）
上，各取净末，和匀。每服三四分，米饮调下。此方不但止泻，亦治烦、痒、
二证。夫固大肠之滑脱、易知也，敛心火之浮游、难知也。
〔手足〕痘疮起发欲透，惟四肢稍远，难得均齐，必脾胃素强能食多者，不须
虑此，若脾胃素弱又食少者，手足上疮常发不透，盖脾主四肢，脾虚则不能行其津
液溉灌四肢，所以发迟，以补脾为主快 越婢汤，如不令透，其后手足必作痈毒。
又手足疮痘，多发水泡者，此肝乘脾也，先泻肝，羌活汤（发热）加柴胡。后补脾，人参
白术散（渴）去葛根加桂。如见而复隐，起而复塌，色紫黑者，此肾乘脾，不可治。
快 越婢汤
黄 （炙） 白芍药 桂枝 防风 甘草（炙）
上锉细。加生姜一片，枣一枚，水煎，温服，不拘时。
〔头面〕头面属阳，疮疹亦属阳，以类相从，故出现、起发、收靥自头面始，
升生浮长，阳之性也，痘疮起发，头面以渐肿大，升生浮长之性，不须忧恐，只要
疮子磊落红活，光壮肥泽，待至成脓之后，毒化结痂，而肿亦渐消矣。如疮粘连通
串，模糊成饼者，又要红活润泽，以快 汤、消毒饮（并见形）合而饮之，或消毒化 汤
以解其毒，更以甘桔汤（咽喉）加牛蒡子相间与之，以利咽喉，宽胸膈，令饮食无阻也。
又以神应膏护目（见形）。若灰白青黄干燥，疮面肤起者，皆死证也。其头面肿，有不闭
目者，毒浅而轻，有闭目者，毒深而重，亦待疮熟肿消而目自开，若疮未成，肿消
目开者，此陷也，勿治。
消毒化 汤
升麻 柴胡 桔梗 甘草 龙胆草 牛蒡子 连翘 防风 蝉蜕 密蒙花
上锉细。加淡竹叶十片，水一盏半，煎一盏，去滓，食后服。
凡将起发，头面预肿者，此时行疫疠之气，名大头瘟，其毒最酷，急用羌活救
苦汤解之。
羌活救苦汤
羌活 白芷 川芎 蔓荆子 防风 桔梗 黄芩 大力子 连翘 升麻 人中
黄（各等）
上锉碎。加薄荷叶七片，水一盏，煎七分，去滓，食后温服。
〔痘疔〕痘疹之毒，自内而出，冲突气血，发散腠理，初出一点血，乃身中气
血被毒驱逐，现于皮肤之外，其成形者气也，成色者血也，毒火太甚，煎熬气血，
先至之气则削矣，血则枯矣，气削血枯，腠理反闭，毒不得出，未免复入于里，遂
成陷伏，时人以黑疮子为痘疔，又曰鬼痘者，深恶而畏之词也。此乃毒瓦斯郁遏，非
外感风寒，内虚吐利，杂气触犯者可比，古人立方，如大小便秘，腹胀烦躁者则下
之，但大小便秘者，则利小便解毒，自利者以泻脓血为顺，水谷为逆，却不立方，
以毒虽入腹，皆泻出也，攻之则无所攻，补之则不可补，昏闷不醒者，用龙脑膏（黑陷）
以去心中之邪。枯黑不起者，或内用无价散（倒靥）以解在里之邪，或外用水杨汤（见前）、四圣
散（痘疔），胭脂涂法（见形）以解其表，使邪气得出，皆良法也。为工者，合下即下，合利即
利，合发即发，或解其里，或解其表，应变出奇，勿泥常法可也。
〔发 〕痘疮发 ，亦与黑陷相类，外出内入虽不同，而毒瓦斯壅郁则一也。或
发水 ，或发血 ，或赤、或紫、或黑，但见此证，十无一生。然亦有似是而非者
不可不辨，其人身上原有灌疮或破伤，疮未痊，或虽痊瘢痕尚嫩，一旦痘出，则疮
瘢四围，痘必簇者，物从其类之理也，发生之后，必然作 者腐败，皮肉气色先
变，宜与完肤有别也，治此者先以针刺破，吮去恶血，后以胭脂涂法（见形）合百花膏（收
靥）敷之。此疮又易作痒，起发之后，常宜以茵陈熏法（见前）熏之，勿令爪伤，若被爬搔，
则反复灌烂，淹延不愈，变为疳蚀坏疮。以致不治者多矣。〔袁〕痘起六七朝，脓
浆未曾充裕，头面身背或手足关轴遽起水 ，或似葡萄样，或似鹳子大，或如被单
联盖，因肝荣不能以资 ，而肺金窃势以凌侮，准服三化丹。歌曰∶七朝泡起势相
凌，三化丹中二味金，白术茯苓俱二两，四般法制用工深，一两要同归酒浸，一两
和却乳参蒸，一两再和雄附煮，一两分与炒米停，为末必须甜醴服，自然泡里注黄
金。痘里起泡，多患乎脓浆不能充灌，若虚泡结轴，十中八九泡内微有脓浆。滋养
元气，振援两仪，寒剥之剂，毫不可投，或单用浑天汤和人参酒服。但恐痒作而泡
溃，死在旦夕耳。
〔起发不透〕痘疹起发欲透，磊落尖圆，光壮肥泽者上也。根脚横开，皮起水
涨者次也。顶皮不起，根脚不开，犹是先出之形，不见新生之水，此谓起发不透。
审查证候，如气本实者，必曾感风寒，以桂枝葛根汤（初热）合夺命丹（见形）发之。如气本
虚，必不能食或吐利，以人参白术散（渴）合夺命丹以补中气，而发表邪。如欲成陷伏
者，根据前四法治之。若时日已多，发犹不透，或烦躁不安者，此毒热在里，心恶热，
以导赤散（心）送服牛黄清心丸（痘烦躁）以解散热毒，导引心火也。或啼哭者，凡人五脏平
和，则神宇安静，今五脏蕴毒，内外蒸郁，神不安舍，以导赤散送服安神丸（痘谵妄）使
郁热解散，神宇清快也。若谵言妄有见闻，时狂叫者，此五脏热毒蕴积，阳气独盛，
无阴气以和之，大便必不利，以当归丸（便闷）微利之，再行胆导法（便闷），使无留滞，易
快利也，甚则三乙承气汤主之（便闷）。若昏不知人，腹胀喘呼，死证也。
鸡鸣散 男女发热三四五日，或痘未形，或痘形隐隐，或才形于外而不能快利，或
烦躁谵语，或腹疼呕吐，或痰喘恶渴，急服此药，则毒自表出矣。
炒术 当归 川芎 甘草 大力子 茯苓 木通 桔梗 蝉蜕 升麻 橘红 山楂 红花
灯草生姜煎，临服，入雄鸡血并酒，妙。
震蛰丹 小儿热三四朝，痘或隐隐伏于皮肤，或形于头面一二颗，或标于身体四五
颗，上不宜补，下不宜泻，当服震蛰丹。穿山甲四钱，酒洗净，和砂仁、陈米炒，
卷去砂仁米，用白芍酒浆煮焙四钱，红曲三钱，蟾酥三钱，和匀，共研细为末。
每用酒浆量儿大小增减，大者一分，小者半分，若逾十二三岁者斟酌加之，用升
麻煎酒调服，其效立见。
天元接髓丹 男子十七八岁，或二三十岁，破阳亏元，倏一时患痘，稀少者虽年大
无妨，倘多密连布，欲其鼎峻充灌，势必难矣，急服天元接髓丹。
歌曰∶男儿阳破痘来临，不遇奇方坐视沉，天元接髓丹功捷，世上医家尽不明，
真正酒浆澄十碗，一毫酸苦莫相侵，人参黄 各二两，橘蝉归地半加赢，鹿茸乳
炙一两半，附桂半两要调停，慢火瓮中煨熟后，去滓出火莫胡斟，每钟人乳三杯
和，薄薄生姜二片存，再匀一沸仍温服，立建奇功若有神。此方，屡获明效，但
制法要详明，当归去头尾，怀地拣粗软，人参觅清河，黄 选绵白，橘红连本蒂，
蝉蜕要身全，附子连皮脐，官桂削外皮，煨时度候，只以米熟验之，人乳取来就
不宜过夜入尘。辛酉年杭城邵语溪子年二十六岁，平素寡弱，患痘，痘势沉匿不
起，单以此方倍加人参服之，竟后保全。
内托散 痘不起发，根窠不红，或灰白色，切牙寒战等证。
人参 黄 甘草 川芎 当归 防风 白芷 桔梗 白芍 浓扑 木香 肉桂
上，姜一片，枣一枚，水煎服。色红紫者，去肉桂、木香，加紫草、蝉蜕。
浆不满，水酒各半煎服。色淡白者，去防风、白芷，加糯米。大便燥，加人乳。
治孩儿百日里痘。歌曰∶全蝎要身全，五个蜜焙干，蝉蜕不可脱，完身又完足，五
个酒浆洗，和炒研细末，再加酒芍药，砂糖调来服，自然痘森森，那怕月不足。
月里患痘，稀美者多，密恶者少，变蒸未逾，猛浪之剂不宜妄投，是方斟酌，百
投百效。
痘至五六朝，忽然手脚牵缩一团，不知者以为惊使然耳，岂知阳明受枭毒之熬铄，
而筋络不能荣血以滋养故也，谓之一把缚，须服羚羊散。歌曰∶
白玉羚羊一两霜，木通紫草生地黄，芍药僵蚕全蝎桔，橘红甘草荆芥防，按法
服来随妥贴，误看惊治即多伤。此痘多起于四五六朝则为是，若起于两三朝则为
惊缩，若起于八九朝则作寒战，治之可也，羚羊角必取其锐尖处用之。
〔阳毒〕七日前阳毒者，凡疮也，以儿未出痘之先，或生疥疮，有形窠而成脓，
因而发热出痘者。或凡疮未痊，因而出痘者。或凡疮方结成瘢，因而出痘者。盖凡
疮未痊，及初结瘢处，肉分必虚，毒趋虚处而出，故阳疮阳毒，杂为一党，气血俱
盛，则易成浆，气血衰弱，则枯燥干红，与诸疮俱不成浆，治法与顶陷同。
起发最忌泄泻，故特着之，其他证候如发热、痛痒、腹胀、烦躁、谵妄等，各有本门，宜就彼中查之，兹不赘叙。
〔起发吉凶〕痘疮放标以后，渐渐起胀，先出者先起，后出者后起，微红光泽，
根窠明润，面目渐肿，能食无杂证者吉。大抵痘胀一分，则毒出一分，至六七日不
尽胀，又黑色者死。鼻有涕，口有涎，眼有泪者，可治，俱无者，大凶。凡痘子
已出，自放标之日算起，如当起发，不应有浆先有戴浆者。如当作浆，不应收靥便
有干收者。此皆恶候，治之无功。口唇者，脾之外候，人以脾胃为本，不宜受伤，
如初发热，唇焦裂者，此毒发于脾，便宜用泻黄散解之，不知早治，痘子之出，簇
于唇，及至起发之初，诸痘尚未试浆，此痘已熟，内带黄浆者，此恶候也，待诸痘
成浆，此疮已靥，唇皮捣脱，渐变呕食呛水，昏睡而死矣。大抵起发之初，疮头便
戴白浆者，不分何处，并非佳兆，不特口唇为然，盖痘疮初出一点血，血化为水，
水化为脓，脓成而毒解，此自然之序也。若初出之时半是水 ，或才起发，便有带
浆者，或未成脓，即干收者，火性躁急，失其自然之序，不应至而至，所谓早发还
先萎也，此毒火所为，倏忽之间，焰息气尽而死矣。痘疮最要以渐起发，磊落红
活，如一发都起，无复颗粒，模糊串连，不红活，带灰白色，面上浮肿如锡饼形，
此恶候也，其人能食，大小便如常，无它证候者吉，若食顿减，或原不能食者凶。
凡起发之时，痘疮稠密，又见陷伏、烦躁、狂叫之证，或口中出臭气者，此毒火熏煎，
肺烂胃败之气也。或不饮食失声者，此咽喉肿烂也。寒战切牙者，邪传肾也。或闷
乱者，神已丧也。或体寒者，阳脱也。或呕或泻者，肠胃俱败也。经云∶五脏气绝
于内者利不止，六腑气绝于外者手足厥。凡见以上诸证者，皆不可治。
（痘疹）出疹时的冷热情况，如果大便正常，这也是痘疹顺证的一种表现。如果在起发阶段突然发生泄泻，此时应当立即止泻，因为担心肠胃虚弱导致真气脱失。必须辨别是冷证还是热证、虚证还是实证：如果腹泻且手足冰冷，面色青白，痘疮不红（绽开），这是冷证，理中汤丸、豆蔻丸（均用于泄利）、益黄散（调理脾脏）、严重时可用陈氏木香散（用于泄利）、异功散（用于痘出不快）等方剂均可使用。如果泻下物色黄且酸臭，口渴，手足心发热，面赤，痘疮红活绽发，这是热证，用黄芩汤（用于泄利）、五苓散（用于惊搐）为主治疗。脾胃怯弱，精神萎靡且不进食的是虚证，应当温养，用益黄散。身体发热、腹部胀满、口渴但不进食的是实证，应当清利，用五苓散。如果患者脏腑之气自行脱失，或者因服用寒凉药物，导致痘毒陷入大肠，泻下物如豆汁，或便脓血，或便黑汁，口中有臭气，嘴唇焦裂，眼睛闭合，加上腹部胀满的，是必死的证候。方论详见泄泻本门。
不二散 治疗痘疮在起胀灌浆时泄泻不止，用此方止泻，只需服一次即可痊愈；如果服用后仍不止泻，说明元气已经脱失，就无法救治了。
莲肉（炒，去心，一两） 真鸦片（二钱，另研）
以上各取净末，混合均匀。每次服用三四分，用米饮调服。此方不仅能止泻，也能治疗烦、痒两种症状。固护大肠滑脱容易理解，收敛心火浮游则难以知晓。
〔手足〕痘疮起发欲透达全身，只有四肢稍远，难得均匀齐整。如果脾胃素来强健、能食多者，不必担忧这种情况；如果脾胃素来虚弱又食少者，手足上的痘疮常发不透，因为脾主四肢，脾虚则不能输送津液灌溉四肢，所以发痘迟缓，治疗以补脾为主，用快越婢汤。如果不令其透发，后来手足必然发生痈毒。
另外，手足上的痘疮多发水泡的，这是肝木乘克脾土，先泻肝，用羌活汤（用于发热）加柴胡。后补脾，用人参白术散（用于口渴）去葛根加桂。如果见而复隐，起而复塌，颜色紫黑的，这是肾水乘克脾土，不可治。
快越婢汤
黄芪（炙） 白芍药 桂枝 防风 甘草（炙）
以上锉细。加生姜一片，枣一枚，水煎，温服，不拘时间。
〔头面〕头面部属阳，疮疹也属阳，同类相从，所以出现、起发、收靥都从头面部开始，这是升生浮长，属于阳的特性。痘疮起发时，头面部逐渐肿大，这是升生浮长的本性，不必忧虑恐惧，只要痘粒磊落红活，光泽壮实肥润，等到成脓之后，毒化解结痂，肿胀也会逐渐消退。如果痘疮粘连通串，模糊成片像饼一样的，又要红活润泽，用快越汤、消毒饮（均见于见形期）合起来服用，或者用消毒化毒汤来解其毒，再用甘桔汤（用于咽喉）加牛蒡子交替服用，以利咽喉，宽胸膈，使饮食无阻。又用神应膏保护眼睛（见于见形期）。如果痘色灰白青黄干燥，疮面皮肤隆起的，都是死证。头面部肿，有睁眼不闭目的，说明毒浅而轻；有闭目的，说明毒深而重，也要等到疮熟肿消后眼睛自然睁开；如果疮未成脓，肿消而目开的，这是陷伏，不要治疗。
消毒化毒汤
升麻 柴胡 桔梗 甘草 龙胆草 牛蒡子 连翘 防风 蝉蜕 密蒙花
以上锉细。加淡竹叶十片，水一盏半，煎至一盏，去渣，饭后服用。
凡将要起发时，头面部预先肿胀的，这是时行疫疠之气，名叫大头瘟，其毒性最烈，急用羌活救苦汤解除。
羌活救苦汤
羌活 白芷 川芎 蔓荆子 防风 桔梗 黄芩 大力子 连翘 升麻 人中黄（各等量）
以上锉碎。加薄荷叶七片，水一盏，煎至七分，去渣，饭后温服。
〔痘疔〕痘疹之毒，从体内发出，冲击气血，发散腠理，初出一点血，是身中气血被毒驱逐，显现于皮肤之外，其成形的是气，成色的是血。毒火太盛，煎熬气血，先到之气被削弱，血则枯竭，气削血枯，腠理反而闭塞，毒不得外出，难免复入于里，遂成陷伏。时人把黑疮子称为痘疔，又叫鬼痘，这是深恶痛绝和畏惧的说法。这乃是毒瓦斯郁遏所致，不是外感风寒、内虚吐利、杂气触犯可以相比的。古人立方的原则是：如果大小便秘，腹胀烦躁的则攻下它；但如果是大小便秘的，则通利小便解毒；如果是自利的，以泻出脓血为顺，泻出水谷为逆，却不立攻下之方，因为毒虽然入腹，都会通过泻出排出，攻之则无物可攻，补之则不可补。昏闷不醒的，用龙脑膏（用于黑陷）以去除心中之邪。枯黑不起的，或内服无价散（用于倒靥）以解在里之邪，或外用水杨汤（见于前文）、四圣散（用于痘疔），胭脂涂法（见于见形期）以解其表，使邪气得出，都是良法。作为医生，该下的就下，该利的就利，该发的就发，或解其里，或解其表，应变出奇，不要拘泥于常法。
〔发疱〕痘疮发疱，也与黑陷相似，虽然外出内入不同，但毒瓦斯壅郁是一样的。或者发水泡，或发血泡，或赤、或紫、或黑，只要见到这种证候，十无一活。然而也有似是而非的，不可不辨别。其人身上原有灌疮或破伤，疮未痊愈，或虽愈瘢痕尚嫩，一旦痘出，则疮瘢四周，痘必簇集，这是物从其类的道理，发生之后，必然作腐溃，皮肉气色先变，宜与完肤有别。治疗此症先用针刺破，吮去恶血，后用胭脂涂法（见于见形期）合百花膏（用于收靥）敷之。此疮又易作痒，起发之后，常宜用茵陈熏法（见于前文）熏之，勿令抓伤，如果被爬搔，则反复灌烂，拖延不愈，变为疳蚀坏疮。以致不治的多矣。〔袁〕痘起六七朝，脓浆未曾充裕，头面身背或手足关节处突然起水泡，或似葡萄样，或似鹳子大，或如被单联盖，因肝荣不能资助，而肺金窃势以凌侮，准服三化丹。歌曰：七朝泡起势相凌，三化丹中二味金，白术茯苓俱二两，四般法制用工深，一两要同归酒浸，一两和却乳参蒸，一两再和雄附煮，一两分与炒米停，为末必须甜醴服，自然泡里注黄金。痘里起泡，多患乎脓浆不能充灌，若虚泡结轴，十中八九泡内微有脓浆。滋养元气，振援两仪，寒剥之剂，毫不可投，或单用浑天汤和人参酒服。但恐痒作而泡溃，死在旦夕耳。
〔起发不透〕痘疹起发欲透达，磊落尖圆，光壮肥泽的是上佳。根脚横开，皮起水涨的是次等。顶皮不起，根脚不开，还是先出的形状，不见新生之水，这叫起发不透。审查证候，如果气本实的，必定曾感风寒，用桂枝葛根汤（用于初热）合夺命丹（见于见形期）发之。如果气本虚，必定不能食或吐利，用人参白术散（用于口渴）合夺命丹以补中气，而发表邪。如果欲成陷伏的，根据前四种方法治疗。如果时日已多，发犹不透，或烦躁不安的，这是毒热在里，心恶热，用导赤散（用于心）送服牛黄清心丸（用于痘烦躁）以解散热毒，导引心火。或啼哭的，凡人五脏平和，则神宇安静，今五脏蕴毒，内外蒸郁，神不安舍，用导赤散送服安神丸（用于痘谵妄）使郁热解散，神宇清快。如果谵言妄有见闻，时狂叫的，这是五脏热毒蕴积，阳气独盛，无阴气以和之，大便必不利，用当归丸（用于便闷）微利之，再行胆导法（用于便闷），使无留滞，易快利，甚则用三乙承气汤主之（用于便闷）。如果昏不知人，腹胀喘呼，是死证。
鸡鸣散 男女发热三四五日，或痘未形，或痘形隐隐，或才形于外而不能快利，或烦躁谵语，或腹疼呕吐，或痰喘恶渴，急服此药，则毒自表出矣。
炒术 当归 川芎 甘草 大力子 茯苓 木通 桔梗 蝉蜕 升麻 橘红 山楂 红花
灯草生姜煎，临服，入雄鸡血并酒，妙。
震蛰丹 小儿热三四朝，痘或隐隐伏于皮肤，或形于头面一二颗，或标于身体四五颗，上不宜补，下不宜泻，当服震蛰丹。穿山甲四钱，酒洗净，和砂仁、陈米炒，卷去砂仁米，用白芍酒浆煮焙四钱，红曲三钱，蟾酥三钱，和匀，共研细为末。每用酒浆量儿大小增减，大者一分，小者半分，若逾十二三岁者斟酌加之，用升麻煎酒调服，其效立见。
天元接髓丹 男子十七八岁，或二三十岁，破阳亏元，倏一时患痘，稀少者虽年大无妨，倘多密连布，欲其鼎峻充灌，势必难矣，急服天元接髓丹。
歌曰：男儿阳破痘来临，不遇奇方坐视沉，天元接髓丹功捷，世上医家尽不明，真正酒浆澄十碗，一毫酸苦莫相侵，人参黄芪各二两，橘蝉归地半加赢，鹿茸乳炙一两半，附桂半两要调停，慢火瓮中煨熟后，去滓出火莫胡斟，每钟人乳三杯和，薄薄生姜二片存，再匀一沸仍温服，立建奇功若有神。此方，屡获明效，但制法要详明，当归去头尾，怀地拣粗软，人参觅清河，黄芪选绵白，橘红连本蒂，蝉蜕要身全，附子连皮脐，官桂削外皮，煨时度候，只以米熟验之，人乳取来就不宜过夜入尘。辛酉年杭城邵语溪子年二十六岁，平素寡弱，患痘，痘势沉匿不起，单以此方倍加人参服之，竟后保全。
内托散 痘不起发，根窠不红，或灰白色，切牙寒战等证。
人参 黄芪 甘草 川芎 当归 防风 白芷 桔梗 白芍 浓朴 木香 肉桂
以上，姜一片，枣一枚，水煎服。色红紫者，去肉桂、木香，加紫草、蝉蜕。
浆不满，水酒各半煎服。色淡白者，去防风、白芷，加糯米。大便燥，加人乳。
治孩儿百日里痘。歌曰：全蝎要身全，五个蜜焙干，蝉蜕不可脱，完身又完足，五个酒浆洗，和炒研细末，再加酒芍药，砂糖调来服，自然痘森森，那怕月不足。
月里患痘，稀美者多，密恶者少，变蒸未逾，猛浪之剂不宜妄投，是方斟酌，百投百效。
痘至五六朝，忽然手脚牵缩一团，不知者以为惊使然耳，岂知阳明受枭毒之熬铄，而筋络不能荣血以滋养故也，谓之一把缚，须服羚羊散。歌曰：
白玉羚羊一两霜，木通紫草生地黄，芍药僵蚕全蝎桔，橘红甘草荆芥防，按法服来随妥贴，误看惊治即多伤。此痘多起于四五六朝则为是，若起于两三朝则为惊缩，若起于八九朝则作寒战，治之可也，羚羊角必取其锐尖处用之。
〔阳毒〕七日前阳毒者，凡疮也，以儿未出痘之先，或生疥疮，有形窠而成脓，因而发热出痘者。或凡疮未痊，因而出痘者。或凡疮方结成瘢，因而出痘者。盖凡疮未痊，及初结瘢处，肉分必虚，毒趋虚处而出，故阳疮阳毒，杂为一党，气血俱盛，则易成浆，气血衰弱，则枯燥干红，与诸疮俱不成浆，治法与顶陷同。
起发最忌泄泻，故特着之，其他证候如发热、痛痒、腹胀、烦躁、谵妄等，各有本门，宜就彼中查之，兹不赘叙。
〔起发吉凶〕痘疮放标以后，渐渐起胀，先出者先起，后出者后起，微红光泽，根窠明润，面目渐肿，能食无杂证者吉。大抵痘胀一分，则毒出一分，至六七日不尽胀，又黑色者死。鼻有涕，口有涎，眼有泪者，可治，俱无者，大凶。凡痘子已出，自放标之日算起，如当起发，不应有浆先有戴浆者。如当作浆，不应收靥便有干收者。此皆恶候，治之无功。口唇者，脾之外候，人以脾胃为本，不宜受伤，如初发热，唇焦裂者，此毒发于脾，便宜用泻黄散解之，不知早治，痘子之出，簇于唇，及至起发之初，诸痘尚未试浆，此痘已熟，内带黄浆者，此恶候也，待诸痘成浆，此疮已靥，唇皮捣脱，渐变呕食呛水，昏睡而死矣。大抵起发之初，疮头便戴白浆者，不分何处，并非佳兆，不特口唇为然，盖痘疮初出一点血，血化为水，水化为脓，脓成而毒解，此自然之序也。若初出之时半是水疱，或才起发，便有带浆者，或未成脓，即干收者，火性躁急，失其自然之序，不应至而至，所谓早发还先萎也，此毒火所为，倏忽之间，焰息气尽而死矣。痘疮最要以渐起发，磊落红活，如一发都起，无复颗粒，模糊串连，不红活，带灰白色，面上浮肿如锡饼形，此恶候也，其人能食，大小便如常，无它证候者吉，若食顿减，或原不能食者凶。
凡起发之时，痘疮稠密，又见陷伏、烦躁、狂叫之证，或口中出臭气者，此毒火熏煎，肺烂胃败之气也。或不饮食失声者，此咽喉肿烂也。寒战切牙者，邪传肾也。或闷乱者，神已丧也。或体寒者，阳脱也。或呕或泻者，肠胃俱败也。经云：五脏气绝于内者利不止，六腑气绝于外者手足厥。凡见以上诸证者，皆不可治。
(Cold and heat during eruption) Regarding the cold or heat conditions during the eruption of pox, if the stool is normal, this is also considered a favorable progression (Shun syndrome) of the pox. If diarrhea suddenly occurs during the eruptive stage, it is imperative to stop it immediately, as there is a risk of Qi depletion due to deficiency of the Stomach and Intestines. One must differentiate between cold and heat, and deficiency and excess: if diarrhea is accompanied by cold hands and feet, a bluish-white complexion, and pox that are not red (blooming), it indicates a Cold Syndrome. In such cases, Lizhong Tang Wan (Coptis and Atractylodes Decoction Pills), Doukou Wan (Cardamom Pills), Yihuang San (Yellow-Protecting Powder for Spleen), and in severe cases, Chen's Muxiang San (Aucklandia Powder for Diarrhea) or Yigong San (Extraordinary Efficacy Powder for Slow Eruption) can be used. If the discharge is yellow with a sour and foul odor, accompanied by thirst, hot palms and soles, facial redness, and pox that are red and blooming, it indicates a Heat Syndrome. In this case, Huangqin Tang (Scutellaria Decoction for Diarrhea) and Wuling San (Five-Ingredient Powder with Poria for Convulsions) should be primarily administered. If the Spleen and Stomach are weak, with listlessness and anorexia, it is a Deficiency Syndrome; treatment should focus on warming and nourishing, using Yihuang San. If there is fever, abdominal fullness, thirst, but anorexia, it is an Excess Syndrome; treatment should focus on clearing and draining, using Wuling San. If the patient suffers from spontaneous collapse of Zang-Qi, or if the use of cold-natured medicines causes the pox toxin to sink into the Large Intestine, resulting in diarrhea resembling bean juice, pus and blood in the stool, black fluid in the stool, foul breath, cracked lips, closed eyes, and abdominal distension, these are signs of certain death. Detailed discussions on formulas can be found in the section on Diarrhea.
Bu'er San (Two-Non-Powder) treats persistent diarrhea during the swelling and pustule-filling stages of smallpox. It stops diarrhea with just one dose. If the diarrhea persists after administration, it indicates that Yuan-Qi (Original Qi) has collapsed, and the condition is incurable.
Lianrou (Lotus Seed Core, stir-fried, removed core, 1 liang) Zhen Yopian (True Opium, ground separately, 2 qian)
Grind each into fine powder and mix evenly. Take 3-4 fen per dose, mixed with rice water. This formula not only stops diarrhea but also treats irritability and itching. While securing the sliding collapse of the Large Intestine is easy to understand,敛 (astringing) the floating Heart Fire is difficult to comprehend.
[Hands and Feet] When pox are erupting and trying to penetrate the body, the limbs, being further away, are often less uniform. If the Spleen and Stomach are naturally strong and the patient eats well, there is no need to worry. However, if the Spleen and Stomach are naturally weak and the patient eats little, the pox on the hands and feet often fail to erupt fully. This is because the Spleen governs the four limbs; Spleen deficiency prevents the transportation of fluids to irrigate the limbs, causing delayed eruption. Treatment focuses on tonifying the Spleen using Kuai Yuebi Tang (Rapidly Opening Breathing Obstruction Decoction). If allowed to remain un-erupted, abscesses will likely develop on the hands and feet later.
Additionally, when pox on the hands and feet develop into vesicles, this indicates Liver Wood overacting on Spleen Earth. First, drain the Liver using Qianghuo Tang (Notopterygium Decoction for Fever) added with Chaihu (Bupleurum). Then, tonify the Spleen using Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Powder for Thirst) with Gegen (Kudzu Root) removed and Rougui (Cinnamon Bark) added. If the pox appear and then disappear, rise and then collapse, turning purple-black, this indicates Kidney Water overacting on Spleen Earth, which is incurable.
Kuai Yuebi Tang
Huangqi (Astragalus Root, honey-fried) Baishao (White Peony Root) Guizhi (Cinnamon Twig) Fangfeng (Saposhnikovia Root) Gancao (Licorice Root, honey-fried)
Cut into fine pieces. Add one slice of Shengjiang (Fresh Ginger) and one Jzao (Jujube). Decoct in water and take warm at any time.
[Head and Face] The head and face belong to Yang, and pox also belong to Yang; like attracts like, so eruption, rising, and crusting begin at the head and face. This upward growth and floating expansion are characteristics of Yang. During the eruptive stage, the head and face gradually swell; this is the nature of upward growth and should not cause alarm. As long as the pox are distinct, red, and vibrant, shining and plump, once pus forms and toxins resolve into scabs, the swelling will gradually subside. If pox are confluent, blurred into cake-like patches, yet still red and moist, combine Kuaixue Tang (Blood-Invigorating Decoction) and Xiaodu Yin (Toxin-Clearing Tea) [both seen in the manifestation stage] and drink them together, or use Xiaodu Huadu Tang (Toxin-Clearing and Pus-Resolving Decoction) to resolve the toxin. Additionally, alternate with Ganjie Tang (Licorice and Platycodon Decoction for Throat) added with Niubangzi (Arctium Fruit) to benefit the throat, widen the chest and diaphragm, and ensure smooth swallowing. Apply Shenying Gao (Miraculous Ointment) to protect the eyes [seen in the manifestation stage]. If the pox are gray-white, green-yellow, dry, and the skin surface is raised, these are signs of death. Head and face swelling with open eyes indicates shallow and mild toxin; closed eyes indicate deep and severe toxin. Wait for the pox to mature and swelling to subside before the eyes open naturally. If the eyes open while the pox have not formed pus and swelling has subsided, this is sinking/collapse; do not treat.
Xiaodu Huadu Tang
Shengma (Cimicifuga Rhizome) Chaihu (Bupleurum Root) Jiegeng (Platycodon Root) Gancao (Licorice Root) Longdancao (Gentiana Root) Niubangzi (Arctium Fruit) Lianqiao (Forsythia Fruit) Fangfeng (Saposhnikovia Root) Chantui (Cicada Slough) Mimenghua (Blind-Cherry Flower)
Cut into fine pieces. Add ten slices of Danzhuye (Light Bamboo Leaf). Decoct 1.5 cups of water to 1 cup. Strain and take after meals.
If the head and face swell prematurely before the eruptive stage, this is caused by epidemic pestilence qi, known as Datou Wen (Big Head Plague). Its toxicity is most fierce; urgently use Qianghuo Jiuku Tang (Notopterygium Rescue and Relief Decoction) to resolve it.
Qianghuo Jiuku Tang
Qianghuo (Notopterygium Rhizome) Baizhi (Angelica Dahurica Root) Chuanxiong (Ligusticum Rhizome) Manjingzi (Vitex Fruit) Fangfeng (Saposhnikovia Root) Jiegeng (Platycodon Root) Huangqin (Scutellaria Root) Dali Zi (Arctium Fruit) Lianqiao (Forsythia Fruit) Shengma (Cimicifuga Rhizome) Renzhonghuang (Human Ice, equal parts)
Cut into fragments. Add seven leaves of Bohe (Mint). Decoct 1 cup of water to 0.7 cups. Strain and take warm after meals.
[Dou Ding / Smallpox Carbuncle] The toxin of pox emerges from within, impacting Qi and Blood, and dispersing through the interstices. The initial emergence of a drop of blood represents Qi and Blood driven out of the body by the toxin and appearing on the skin. The form is constituted by Qi, and the color by Blood. If the toxic fire is too intense, it boils and consumes Qi and Blood. The Qi arrives first and is depleted; the Blood becomes dry. With depleted Qi and dry Blood, the interstices close instead of opening. The toxin cannot exit and inevitably sinks back inward, leading to collapse/sinking. People commonly call black pox "Dou Ding" (Pox Carbuncle) or "Gui Dou" (Ghost Pox), terms expressing deep aversion and fear. This condition results from the stagnation of toxic vapors and is not comparable to external contraction of Wind-Cold, internal deficiency with vomiting/diarrhea, or contact with miscellaneous pathogens. Ancient physicians established prescriptions based on symptoms: if there is constipation of both urine and feces, abdominal distension, and restlessness, purge it. However, for constipation, promoting urination resolves the toxin; for spontaneous diarrhea, discharging pus and blood is favorable, while discharging food/water is unfavorable. No specific purgative formula was created because although the toxin enters the abdomen, it is expelled via diarrhea; attacking it leaves nothing to attack, and tonifying it is contraindicated. For coma and unconsciousness, Longnao Gao (Borneol Ointment for Black Collapse) is used to remove pathogenic factors from the Heart. For dry, black, non-rising pox, internally administer Wuji San (Priceless Powder for Inverted Crusting) to resolve internal pathogens, or externally apply Shuiyang Tang (Willow Soup - see previous text), Sixian San (Four-Saint Powder for Pox Carbuncle), or the Rouge Application Method (see manifestation stage) to resolve exterior pathogens, allowing the evil to exit. These are all excellent methods. Physicians should purge when appropriate, promote urination when appropriate, vent when appropriate, resolve interior or exterior pathogens accordingly, adapt with ingenuity, and not adhere rigidly to standard methods.
[Fa Pao / Vesicle Formation] Pox vesicle formation is similar to black collapse. Although external emergence and internal sinking differ, the congestion and stagnation of toxic vapors are the same. Whether vesicles contain water, blood, or are red, purple, or black, seeing this sign means ten out of ten cases are fatal. However, there are deceptive appearances that must be distinguished. If the patient originally had infected wounds or injuries that were not healed, or scars that were tender, and new pox emerge clustered around these old scars, this follows the principle of "things follow their kind." After emergence, these areas will inevitably become putrid, changing skin color and texture, distinct from healthy skin. Treatment involves pricking with a needle, sucking out bad blood, and applying the Rouge Application Method combined with Baihua Gao (Hundred-Flower Ointment for Crusting). These lesions easily itch. After eruption, fumigate with Yinchen Fumigation Method (see previous text) regularly to prevent scratching. If scratched, they will repeatedly ulcerate, delay healing, and transform into gangrenous necrotic ulcers, often leading to untreatable conditions. [Yuan] On the 6th or 7th day of pox eruption, if pus is insufficient and sudden vesicles appear on the head, face, back, or joints—resembling grapes, stork eggs, or connected sheets—it is because Liver Blood fails to nourish, allowing Lung Metal to usurp power and oppress. Prescribe Sanhua Dan (Three-Transformations Pill). Verse: *On the seventh day, vesicles rise in conflicting patterns, / In Sanhua Dan, two metallic elements act. / Two taels each of Atractylodes and Poria, / Four processing methods require deep effort. / One tael soaked in Angelica wine, / One tael steamed with Ginseng and Milk. / One tael boiled with Borneol and Aconite, / One tael stopped with fried rice. / Powder taken with sweet wine, / Naturally fills vesicles with gold.* Pox vesicles often occur when pus cannot fill adequately. If vesicles are empty at joints, nine out of ten have slight pus inside. Nourish Yuan-Qi and support Yin-Yang; absolutely avoid cold-draining agents. Alternatively, use Huntian Tang (Cosmic Sphere Decoction) mixed with Ginseng Wine. Fear that itching causes rupture, leading to death within days.
[Incomplete Eruption] Ideal pox eruption is distinct, pointed, round, shiny, strong, and plump. Secondary quality shows spreading roots and skin swelling with fluid. Tertiary quality (Incomplete Eruption) shows no elevation of the apex, no spreading of the root, retaining the initial appearance without new fluid generation. Assess the syndrome: If Qi is inherently solid, there was likely Wind-Cold contraction; use Guizhi Gegen Tang (Cinnamon Twig and Kudzu Decoction for Initial Fever) combined with Duoming Dan (Life-Seizing Pill - see manifestation stage) to vent. If Qi is inherently deficient, with anorexia, vomiting, or diarrhea, use Renshen Baizhu San combined with Duoming Dan to tonify Middle Qi and release exterior pathogens. If impending collapse/sinking, follow the previous four treatments. If many days pass without full eruption, or with restlessness, this indicates Toxic Heat in the Interior; the Heart dislikes heat. Use Daochi San (Guide Out Red Powder for Heart) to deliver Niuhuang Qingxin Wan (Calves' Horn Clearing Heart Pill for Pox Restlessness) to clear heat-toxin and guide Heart Fire. For crying: When Five Zang are harmonious, Spirit is calm. Now, with Toxin hidden in Five Zang and steaming internally/externally, Spirit is unsettled. Use Daochi San to deliver Anshen Wan (Spirit-Calming Pill for Pox Delirium) to dissipate stagnant heat and clarify Spirit. For delirium, hallucinations, and screaming: This indicates accumulation of Heat-Toxin in Five Zang, excessive Yang Qi without Yin to harmonize, and constipation. Use Danggui Wan (Angelica Pill for Abdominal Distress) to mildly purge, followed by Gallbladder Enema Method to prevent stagnation. In severe cases, use San Yi Chengqi Tang (Three-Yi Da-Du Decoction for Constipation). Coma, abdominal distension, and wheezing are signs of death.
Jiming San (Rooster-Crowing Powder) For men and women with fever for 3-5 days, or pox not yet visible, faintly visible, barely visible but not progressing rapidly, or with restlessness/delirium, abdominal pain/vomiting, phlegm-wheezing/thirst. Urgently take this medicine to expel toxin from the exterior.
Chao Zhu (Stir-fried Atractylodes) Danggui (Angelica Sinensis) Chuanxiong (Ligusticum) Gancao (Licorice) Dali Zi (Arctium) Fuling (Poria) Mutong (Akebia) Jiegeng (Platycodon) Chantui (Cicada) Shengma (Cimicifuga) Juhong (Tangerine Peel) Shanzha (Hawthorn) Honghua (Safflower)
Decoct with Dengcao (Juncus) and Shengjiang (Ginger). Before taking, add Rooster Blood and Wine. Excellent.
Zhenzhe Dan (Thunder-Stirring Pill) For children with fever for 3-4 days, where pox are faintly hidden in skin, or 1-2 on head/face, or 4-5 on body. Upper body should not be tonified, lower body should not be purged. Administer Zhenzhe Dan. Shanjiapia (Pangolin Scale, 4 qian, washed in wine), stir-fried with Sharen (Cardamom) and aged rice, discard cardamom and rice. Baishao (White Peony, 4 qian, boiled in wine and dried). Hongqu (Red Yeast Rice, 3 qian). Chan Su (Toad Venom, 3 qian). Mix and grind to fine powder. Dosage varies by age: large children 1 fen, small children 0.5 fen; adjust for those over 12-13 years. Take with Shengma decocted in wine for immediate effect.
Tianyuan Jiesui Dan (Heavenly Origin Marrow-Replenishing Pill) For men aged 17-18 or 20-30 who have depleted Yuan Qi through sexual activity and suddenly contract pox. If sparse, age is not a concern. If dense and confluent, filling is difficult; urgently take Tianyuan Jiesui Dan.
Verse: *When male Yang breaks and pox arrive, / Without miraculous formula, sinking is inevitable. / Tianyuan Jiesui Dan works swiftly, / Yet doctors worldwide ignore it. / Ten bowls of clarified wine, / Let no sour or bitter touch. / Two taels each of Ginseng and Astragalus, / Half more Tangerine, Cicada, Angelica, Rehmannia. / One and half taels Deer Antler processed with milk, / Half tael Aconite and Cinnamon balanced. / Simmer slowly in earthenware, / Strain and cool, pour carefully. / Mix three cups of human milk per cup, / Keep two thin slices of ginger. / Boil once more and take warm, / Miracles performed as if divine.* This formula has proven effective repeatedly, but preparation must be precise: Remove head/tail of Danggui; select coarse/soft Huai Dihuang; find Qinghe Renshen; select soft/white Huangqi; keep Tangerine peel with stem; ensure complete Cicada slough; keep Aconite with skin/navel; peel outer bark of Guixin. Simmer until rice is cooked; test with rice. Human milk should not be kept overnight or exposed to dust. In the Xinyou year, Shao Yuxi's son, aged 26, usually frail, contracted pox that sank and failed to rise. Taking this formula with doubled Ginseng saved him.
Neituo San (Internal-Supporting Powder) For pox that fail to erupt, roots not red or gray-white, teeth-chattering, and chills.
Renshen (Ginseng) Huangqi (Astragalus) Gancao (Licorice) Chuanxiong (Ligusticum) Danggui (Angelica) Fangfeng (Saposhnikovia) Baizhi (Angelica Dahurica) Jiegeng (Platycodon) Baishao (White Peony) Noup (Magnolia Bark) Muxiang (Aucklandia) Rougui (Cinnamon Bark)
Add one slice of Ginger and one Jujao. Decoct in water. If red/purple, remove Cinnamon and Aucklandia, add Zicao (Arnebia) and Chantui. If pus is insufficient, decoct with half water/half wine. If pale white, remove Saposhnikovia and Angelica Dahurica, add Glutinous Rice. If dry stool, add Human Milk.
Treats infantile pox within 100 days. Verse: *Full Scorpion bodies, five roasted with honey, / Cicada slough must be intact, whole body and feet. / Wash five in wine, stir-fry and grind fine, / Add Wine-processed Peony, mix with sugar to take. / Naturally pox will stand dense, / Who fears incomplete months?* Pox within the first month are mostly sparse/good, rarely dense/bad. Before Bianzheng (transformation-evaporation) completes, harsh agents should not be used blindly. This formula, when weighed, is 100% effective.
On the 5th-6th day, if hands and feet suddenly contract into a ball, laypeople think it is convulsion. Actually, it is Yangming channel suffering from fierce toxin boiling, causing meridians to fail to nourish blood with essence. Called "One Hand Tie," must take Lingyang San (Antelope Horn Powder). Verse: *One tael frost-white Antelope Horn, / Mutong, Zicao, Sheng Dihuang. / Shaoyao, Jiangcan, Quanxie, Jie, / Juhong, Gancao, Jingjie, Fangfeng. / Follow method for proper fit, / Mistaking for convulsion causes harm.* This occurs mostly on days 4-6; if days 2-3, it is convulsive contraction; if days 8-9, it is chills. Treat accordingly. Use the sharp tip of Antelope Horn.
[Yang Du / Yang Toxin] Yang Toxin within seven days refers to any sore. Before pox eruption, if the child had impetigo forming pustules, then fever and pox erupted. Or any sore unhealed when pox erupted. Or scars just formed when pox erupted. Since unhealed sores and fresh scars represent deficient flesh, toxin flows to deficiency and erupts. Thus Yang Sores and Yang Toxin mix into one group. If Qi and Blood are strong, pus forms easily; if weak, they become dry/red and fail to form pus. Treatment is same as for inverted/collapsed pox.
Eruption stage most fears diarrhea, hence emphasized. Other syndromes like fever, pain/itch, abdominal distension, restlessness, delirium have their own sections; consult those, no repetition here.
[Eruption Auspiciousness/Misfortune] After pox mark appears, swelling gradually rises. Early ones rise first, late ones later. Slight redness, luster, bright/moist roots, gradual facial swelling, ability to eat without other symptoms = Auspicious. Generally, one unit of swelling equals one unit of toxin expulsion. If by day 6-7 swelling is incomplete and turns black = Death. Nasal mucus, oral saliva, eye tears = Treatable. Absence of all three = Great Misfortune. From the day marks appear, if eruption should occur but pus appears prematurely ("Dai Jiang"), or if pus stage should occur but dry crusting happens prematurely, these are ominous signs; treatment is futile. Lips reflect Spleen; Spleen/Stomach are root, should not be injured. Initial fever with cracked/scorched lips indicates toxin affecting Spleen; use Xiè Huáng San (Drain Yellow Powder) to resolve. If untreated early, pox cluster on lips. At early eruption, while others haven't tested for pus, this lip pox is ripe with yellow pus internally = Ominous. Wait for others to form pus, this lip pox crusts, lip skin peels off, gradually leading to vomiting/choking, lethargy, and death. Generally, if pox heads carry white pus immediately upon eruption, regardless of location, it is not auspicious, not just lips. Initial pox emerge as blood, blood turns to water, water turns to pus, pus forms and toxin resolves = Natural order. If initially half-water vesicles, or early eruption carries pus, or no pus forms but dry crusts appear, Fire nature is急躁 (impetuous), losing natural order. "Early emergence leads to premature withering." This is caused by toxic fire; in an instant, flame extinguishes, Qi ends, and death occurs. Pox must erupt gradually, distinct, red, vibrant. If all erupt at once, no individual grains, confluent, not red/vibrant, gray-white, face swollen like tin cakes = Ominous. If patient can eat, stool/urine normal, no other symptoms = Auspicious. If appetite suddenly decreases or never existed = Misfortune.
During eruption, if pox are dense, plus signs of collapse, restlessness, screaming, or foul breath, this is toxic fire roasting, indicating rotting Lungs and failing Stomach Qi. Inability to eat/speak indicates throat swelling/ulceration. Chills/teeth-chattering indicates Evil transmitting to Kidney. Confusion indicates Spirit lost. Body cold indicates Yang collapse. Vomiting/diarrhea indicates Stomach/Intestines failure. Classic says: "Five Zang Qi exhausted internally leads to unceasing diarrhea; Six Fu Qi exhausted externally leads to cold extremities." Seeing any of the above signs means incurable.