痘疮根窠薄劣。浆汁板滞不活。而枯黄色晦者曰板黄。若方广天庭板黄而余者润活。痈毒必
结于脑项。若腮脸板黄而四肢润美。痈毒必发于肩阜。若肚腹板黄。痈毒必发于曲池三里。若背
脊板黄。痈毒必结于两轴尻骨。如遍身板黄。颈项前后板黄。头面板黄。眼眶唇上板黄。两胁茎
囊板黄。皆死证也。愚按板黄皆由胃热能食。食滞蕴积于中。
胃气不得宣通而致。非痘之根气本然也。治者能达斯意。急与苦寒消导。大便秘者当微利之。热
滞去而内外宣通。乌有痈毒之患哉。
闻人规云。痘疮 赤。大便不通。小便如血。或结痈毒。身痘破裂出血。乃内火炽盛失于解
利。急用犀角地黄、小柴胡加生地黄、及四顺饮之类。薛氏云。若心脾热甚。犀角地黄汤。心肝
热甚。小柴胡加生地黄。若大便不通。先用四顺饮。次用犀角地黄汤。若色赤 痛。二便不通。
急用活命饮加硝、黄。若色赤 痛。恶寒发热。活命饮加麻黄。若因乳母怒火。加味逍遥散。
闻人规云。痘疮斑烂之证。因当发散而不发散。则毒瓦斯闭塞。以致喘促闷乱。不当发散而误
发散。则毒随阳气暴出于外。遍身皮肉溃烂。治宜调脾胃。进饮食。大便调和。脾胃健旺。毒瓦斯
自解。而无目赤咽痛吐衄等证。若发表过甚。大便自利。急用理中丸。豆蔻丸以救其里。亦有痘
疮如蚊所啮。面色黑。乃危证也。若小便秘结烦躁。导赤散加山栀、犀角、赤芍。自利不食者。
不可用。盖毒发于表而妄汗之。腠理开泄。营卫益虚。转增斑烂。由是风邪乘虚变证者有之。若
毒蕴于里而妄下之。则内气益虚。毒不能出。而反入焉。由是土不胜水。变黑归肾。身体振寒。
两耳尻冷。眼合腹胀。其
疮黑陷。十无一生。医者审之。
痘疮的根部基底薄弱低劣，浆液浑浊停滞而不鲜活，呈现出枯黄且色泽晦暗的状态，这被称为“板黄”。如果只有天庭部位出现板黄而其余部位润泽鲜活，痈毒必定结聚在脑部和颈部。如果腮部和面部出现板黄而四肢润泽美好，痈毒必定发作在肩部和背部隆起处。如果腹部和肚脐周围出现板黄，痈毒必定发作在曲池穴和足三里穴附近。如果背部脊柱出现板黄，痈毒必定结聚在两胁、骶骨和尾椎部位。如果是全身都出现板黄，或者颈项前后、头顶面部、眼眶及嘴唇上方、两胁部以及阴囊部位出现板黄，这些都是死证。
我按语认为，板黄都是因为胃中有热且食欲亢进，导致食物停滞蕴积在中焦，使得胃气不能宣通所致，这并不是痘疮本身根气的本来状态。治疗者如果能明白这个意思，应当紧急使用苦寒性质的药物来消除积滞。大便秘结的患者应当轻微通便泻下。待热邪和积滞去除，内外气机宣通，哪里还会有痈毒的祸患呢？
闻人规说：痘疮颜色发红赤，大便不通畅，小便像血一样（或尿血），或者结成痈毒，身上痘疹破裂出血，这是由于体内火气炽盛，失去了清解和通利的治疗。紧急时应当使用犀角地黄汤、小柴胡汤加生地黄，以及四顺饮之类的方剂。薛氏说：如果是心脾热势很盛，用犀角地黄汤；如果是心肝热势很盛，用小柴胡汤加生地黄。如果大便秘结不通，先用四顺饮，再用犀角地黄汤。如果痘色红赤且疼痛，二便不通，紧急时使用活命饮加入芒硝、大黄。如果痘色红赤且疼痛，伴有恶寒发热，使用活命饮加入麻黄。如果是由于乳母发怒引起，使用加味逍遥散。
闻人规说：痘疮斑烂的病症，是因为应当发散表邪而没有发散，导致毒瓦斯闭塞，从而引起气喘急促、胸闷烦乱。如果不应当发散却误用了发散法，那么毒气会随着阳气突然暴出于体表，导致遍身皮肉溃烂。治疗应当调理脾胃，促进饮食摄入，使大便调和。脾胃健旺，毒瓦斯自然解除，就不会出现眼睛红赤、咽喉疼痛、吐血衄血等症状。如果发表（发散）过度，导致大便自利（腹泻），紧急时使用理中丸、豆蔻丸来救里阳。也有痘疮像被蚊子叮咬一样，面色发黑，这是危重证候。如果小便秘结、烦躁不安，使用导赤散加入山栀、犀角、赤芍。如果出现自利（腹泻）且不进食的情况，则不可使用上述清热凉血之剂。这是因为毒邪发于体表却妄用发汗法，导致腠理开泄，营卫之气更加虚弱，反而加重了斑烂。由此风邪乘虚而入产生变证的有这种情况。如果毒邪蕴积在体内却妄用攻下法，那么内气更加虚弱，毒邪不能排出，反而陷入体内。由此导致土（脾）不胜水（肾），毒邪变黑归入肾脏，身体战栗恶寒，两耳和尻骨寒冷，眼睛闭合、腹胀，疮疡黑陷，十个人中没有能活过一个的。医生们务必审慎对待。
The base of the smallpox pustules is thin and inferior, the pus is turbid, stagnant, and lacks vitality. When it appears withered, yellow, and dull in color, it is called "Ban Huang" (Stiff Yellow). If only the forehead (Tian Ting) exhibits Ban Huang while the rest of the body remains moist and vital, the carbuncle toxin will likely accumulate in the brain and neck region. If the cheeks and face show Ban Huang while the four limbs remain moist and beautiful, the carbuncle toxin will likely erupt on the shoulders and upper back. If the abdomen shows Ban Huang, the toxin will likely erupt near the Quchi (LI11) and Zusanli (ST36) acupoints. If the spine shows Ban Huang, the toxin will likely accumulate in the flanks, sacrum, and coccyx. If the entire body exhibits Ban Huang, or if the neck (front and back), scalp, face, eye orbits, upper lip, flanks, and scrotum show Ban Huang, these are all fatal signs.
In my analysis, Ban Huang arises from heat in the stomach accompanied by excessive appetite, leading to food stagnation and accumulation in the middle jiao, thereby preventing the free flow of Stomach Qi. This is not the natural state of the root Qi of the smallpox itself. A practitioner who understands this principle should urgently administer bitter-cold herbs to resolve stagnation. For patients with constipation, mild purgation should be used. Once the heat and stagnation are cleared and the internal and external Qi mechanisms are unblocked, there will be no risk of carbuncle toxins.
Wen Ren Gui stated: When smallpox lesions are red, bowel movements are obstructed, urine resembles blood or contains blood, carbuncles form, or skin lesions rupture and bleed, this indicates excessive internal fire due to a failure in clearing and promoting free flow. Urgent treatment requires formulas such as Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), Xiaochaihu Tang (Minor Bupleurum Decoction) added with Sheng Dihuang (Rehmanniae Radix), or Sishun Yin (Four Smooth Infusion). Dr. Xue stated: If Heart and Spleen heat is severe, use Xijiao Dihuang Tang; if Heart and Liver heat is severe, use Xiaochaihu Tang added with Sheng Dihuang. If constipation is present, first use Sishun Yin, followed by Xijiao Dihuang Tang. If the lesions are red and painful with obstruction of both bowel and bladder, urgently use Miting Yin (Life-Saving Infusion) added with Mangxiao (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma). If the lesions are red and painful accompanied by aversion to cold and fever, use Miting Yin added with Mahuang (Ephedrae Herba). If caused by the nursing mother's anger, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder).
Wen Ren Gui stated: The condition of smallpox erosion and ulceration occurs when dispersing methods should have been used but were not, causing toxic vapors to become blocked, leading to panting, distress, and confusion. Conversely, if dispersing methods are mistakenly applied when they are contraindicated, the toxin follows Yang Qi and violently erupts outward, causing widespread ulceration of the skin and flesh. Treatment should focus on regulating the Spleen and Stomach, promoting dietary intake, and harmonizing the bowels. When the Spleen and Stomach are robust, the toxic vapors will resolve naturally, preventing symptoms such as red eyes, sore throat, hematemesis, and epistaxis. If exterior-dispersing methods are overused, leading to spontaneous diarrhea, urgently use Lizhong Wan (Regulate the Middle Pill) or Doukou Wan (Cardamom Pill) to rescue the interior Yang. There are also cases where smallpox lesions resemble mosquito bites and the complexion turns black, which is a critical sign. If urination is obstructed with irritability, use Daochi San (Guide Out Redness Powder) added with Zhizi (Gardeniae Fructus), Xijiao (Rhinocerotis Cornu), and Chishao (Paeoniae Radix Rubra). However, if there is spontaneous diarrhea and anorexia, these cooling and blood-cooling formulas must not be used. This is because when the toxin is at the exterior, reckless sweating opens the pores, further depleting Ying and Wei Qi, thereby worsening the erosion. Consequently, Wind pathogens may invade due to deficiency, causing complications. If the toxin is retained internally and purgatives are recklessly administered, the internal Qi becomes further depleted, the toxin cannot exit, and instead sinks inward. This leads to Earth failing to control Water, causing the toxin to turn black and return to the Kidney. Symptoms include tremors and aversion to cold, cold ears and sacrum, closed eyes, abdominal distension, and blackened, sunken lesions. In such cases, fewer than one in ten survives. Physicians must exercise extreme caution.