痘疹初发热时。目赤肿者。风热上攻也。四五日间目赤者。火毒盛而上熏也。痘后目赤肿者。
余毒郁于心脾也。 痘疹出多。至灌浆时。自然眼闭。然干靥之后。又当开眼。若仍闭不开者。
此毒瓦斯上攻于目。急宜清解余毒。甚则凉膈散加荆芥、牛蒡、蝉蜕。大抵过期不开。即当以舌舔
润。去其眵污自开。 痘疮害目。不在于初。而在收靥之后。皆由头面痘密。脓血胶固。或破烂
而复肿灌。毒火郁蒸。内攻于目。又或痘出太盛。成就迟缓。过服辛热。失于清解。或逼受火气。
或衣衾过浓。或客冒风寒。或恣食诸卵。皆能害目。治当活血解毒。得血活其毒即解。切不可概
用凉剂。恐冰凝血脉。终成痼疾也。亦不可点香窜之药。谷精散、决明散、密蒙散、神功散、羚
羊散等方选用。 初见点时有痘丛生目中。急须移痘丹移之。庶无害眼之患。方虽似诞。而功效
特奇。不可因其异而忽诸。若三日后根气已定。不可移也。轻者以象牙磨水。点入移之。
痘疮平塌倒 破烂之证。用药得以收靥者。余毒发泄未尽。必循经络而出。发为痈毒。看何
经络而用药。俱以托里解毒为主。如未溃肿硬者。排毒散。随元气虚实加减。外用生黄豆嚼烂罨
之。或大黄酒煮。入真绿豆粉敷之。或蛇蜕蘸生豆浆贴之。若溃肿而脓未透。解毒内托散加白芷、
鲮鲤甲。外用海石细研蜜调敷之。如已溃脓尽者。十宣散加连翘、忍冬。凡痘后余毒发痈。根赤
而作痒者。气虚也。四君子加当归、芍药。色赤而肿痛者。血热也。四物汤换生地加犀角、鲮鲤甲
、连翘、忍冬。肿而不溃者。气血两虚也。托里消毒散。溃而不愈者。脾气虚弱也。六君子加归、
、忍冬。若发于皮肤之外。或大片小片如涂朱。或作核肿痛。不可摸者。此名紫丹瘤。五内毒
盛。虽用解毒药。亦难消散。从上发者。过心即死。从下发者。过肾则死。急以瓷锋砭去恶血。
毒肿未平。再与砭之。更须内夺其毒。得以开泄也。若皮肤发出隐隐红斑搔痒。或红块者。俗名
盖痘痧。消毒饮加防风。若收靥安好。忽然手足厥冷。此脾气虚弱。不可认作寒证。参 内托散
加桂枝。若手足忽然拘挛。不能屈伸者。此外感风寒湿三气。勿用发散耗血之药。十全大补汤。
用桂枝、苍术。骨节痛。加羌、防。有痘疮收靥后。忽然下痢脓血者。此毒瓦斯流入大肠。须二三日
间。听其下尽。然后清热利小便。再后补脾健胃。不可用止涩之剂。若热毒蕴蓄于肺。闭塞咽喉。
则口张不食。欲吐不吐。干呕声嘶。此胃中有疮腐烂。最凶之兆。急用消毒饮加甘、桔、黑参、
牛蒡、竹叶。并磨犀角水救之。迟则咽烂而死。若腹痛胀满。烦躁气急者。此毒入于脾。当用枳
实导滞汤利之。否则喘急厥冷。难治矣。若痘后胜常饮食。日渐羸瘦。此气血两亏。胃中虚火也
。钱氏异功
散、四物汤。并加黄连。相间服之。更节饮食为要。若大便秘结。毒盛血枯也。消毒饮加生地黄、
麻仁、杏仁以润之。因多服热药燥结者。消毒饮加麻仁、芍药、山栀。若口舌生疮。赤者为心脾
蕴热。宜凉膈散。白者为心肺有热。宜清肺汤。外以青布蘸水拭净。用马鸣散掺之。收靥时。口
舌生疮。及患齿疳者。皆由余毒不解。乘于阳明。而熏逼上焦也。宜清胃化毒。甘露饮加犀角、
连翘。咽痛者。亦由余毒留于管龠。肺受火淫而为肿痛也。如圣饮。若收靥之后。目闭不开。或
生翳膜。疼痛昏暗者。俱宜凉血解毒清心泻肝。随证治之。若收靥未齐。忽发余毒。而身面目睛
俱赤者。难治。翁仲仁云。痘疮既靥之后。或成痈肿。人固知为余毒矣。不知气高而喘息作声。
撷背抬肚者。余毒之在肺也。痰涎稠粘。切牙戛齿。泄泻不止而口臭者。余毒之在脾胃也。盗汗
出于胸前。向午则热而渴者。余毒之在心包也。睡中多惊。身常发热。余毒之在肝也。耳叶与
尻常热。余毒之在肾也。眼合不开。身肿不消。壮热不清。郁郁不乐。诸经皆有余毒也。又须知
发于巅顶及胸者。为心经之毒。发于臂肘及背者。肺经之毒。发于胁膝及筋聚处者。肝经之毒。
发于七节之傍及尻上者。肾经之毒。发于正面及咽者。胃经之毒。肝肺及胃之毒多易治。心毒多
危。肾毒不必治也。大抵血热毒盛而发者。其毒必 肿色赤。能食便秘。并宜消毒饮加解毒凉血药
。胃气实者。排毒散微下之。若气虚毒盛而发。其毒必漫肿色淡。食少便滑。虽用参、 内托。
多不可治。若用犀角、芩、连、地黄之属。是速其毙也。如遍身流注清水。延绵不已者。不治。
痘疹刚开始发热时，如果眼睛发红肿胀，这是风热之邪上攻所致。发病四五天后眼睛发红，是火毒炽盛向上熏蒸所致。出痘之后眼睛红肿，是余毒郁结在心脾两经所致。
痘疹发出较多，到了灌浆阶段，眼睛自然会闭合。然而等到干痂脱落之后，眼睛应当重新睁开。如果仍然闭着不睁开，这是毒气上攻于目，急需清解余毒。严重时可用凉膈散加入荆芥、牛蒡子、蝉蜕。大抵来说，过期不睁眼的，可以用舌头舔润，去除眼屎污垢，眼睛自然就会睁开。
痘疮损害眼睛，不在于初期，而在于收靂（结痂）之后。这都是因为头面部痘疹密集，脓血胶结固着，或者破损后又肿胀灌浆，毒火郁积蒸腾，向内攻冲于目。又或者痘疹发出太盛，成熟迟缓，过服辛热药物，未能及时清解，或者受到火热之气逼迫，或者衣被过厚，或者感受风寒客邪，或者恣意食用各种蛋类食物，都能伤害眼睛。治疗应当活血解毒，血液流通则毒邪自解。切不可一概使用寒凉药剂，恐怕导致血脉冰凝，最终形成顽固疾病。也不可点用香窜类药物。可选用谷精散、决明散、密蒙散、神功散、羚羊散等方剂。
刚见痘点时，如果有痘疹丛生眼中，必须急用移痘丹将其移出，这样才能避免害眼的祸患。此方虽然看似荒诞，但功效特别奇特，不可因其怪异而忽视它。如果三天后根气已定，就不能再移了。轻症可以用象牙磨水，滴入眼中以移出痘疹。
痘疮出现平塌倒陷、破烂的证候，用药后能够收靂的，说明余毒发泄未尽，必然顺着经络而出，发为痈毒。需观察是哪条经络受病而用药，都以托里解毒为主。如未溃破且肿硬者，用排毒散，根据元气虚实进行加减。外用生黄豆嚼烂敷贴。或用大黄酒煮，加入真绿豆粉外敷。或用蛇蜕蘸取生豆浆贴敷。若已溃破肿胀但脓液未透，用解毒内托散加白芷、鲮鲤甲。外用海浮石细研，蜂蜜调匀外敷。如已溃破且脓液排尽者，用十宣散加连翘、金银花。凡是痘后余毒发为痈肿，根部红赤且作痒的，是气虚，用四君子汤加当归、芍药。色红赤且肿痛的是血热，用四物汤换生地，加犀角、鲮鲤甲、连翘、金银花。肿胀但不溃破的是气血两虚，用托里消毒散。溃破但不愈合的是脾气虚弱，用六君子汤加当归、金银花。
若发于皮肤之外，或大片小片如涂朱砂，或结成肿块肿痛、不可触摸的，这名叫紫丹瘤。这是五脏内毒盛极，虽然用解毒药，也难以消散。从上部发作的，毒气过心即死；从下部发作的，毒气过肾则死。急需以瓷锋刺破放出恶血，毒肿未平，再次刺破。更须内服药物夺其毒邪，得以开泄。若皮肤发出隐隐红斑搔痒，或红块，俗名盖痘痧，用消毒饮加防风。
若在收靂后安好，忽然手足厥冷，这是脾气虚弱，不可误认为寒证，用人参内托散加桂枝。若手足忽然拘挛，不能屈伸，这是外感风寒湿三气，勿用发散耗血的药物，用十全大补汤。用桂枝、苍术。骨节痛，加羌活、防风。
有痘疮收靂后，忽然下痢脓血的，这是毒气流入大肠，须二三天间，听任其泻尽，然后清热利小便，之后再补脾健胃，不可用止涩的药物。若热毒蕴蓄于肺，闭塞咽喉，则张口不食，想吐吐不出，干呕声嘶，这是胃中有疮腐烂，是最凶险的征兆。急用消毒饮加甘草、桔梗、黑参、牛蒡子、竹叶，并磨犀角水急救。迟则咽喉腐烂而死。
若腹痛胀满，烦躁气急，这是毒入于脾，当用枳实导滞汤通利。否则喘急厥冷，就难治了。若痘后饮食如常，日渐消瘦，这是气血两亏，胃中虚火。用钱氏异功散、四物汤，并加黄连，交替服用。节制饮食是关键。
若大便秘结，是毒盛血枯，用消毒饮加生地黄、麻仁、杏仁以润肠通便。因多服热药导致燥结的，用消毒饮加麻仁、芍药、山栀。若口舌生疮，红色的是心脾蕴热，宜用凉膈散。白色的是心肺有热，宜用清肺汤。外用青布蘸水擦拭干净，用马鸣散掺敷。
收靂时，口舌生疮及患齿疳的，都是由余毒不解，乘袭阳明经，熏逼上焦所致。宜清胃化毒，用甘露饮加犀角、连翘。咽痛，也是由余毒留于管龠（咽喉），肺受火淫而为肿痛，用如圣饮。
若收靂之后，眼睛闭不开，或生翳膜，疼痛昏暗的，都宜凉血解毒、清心泻肝，随证治疗。若收靂不齐，忽然发余毒，而身、面、目睛都红的，难治。翁仲仁说：痘疮既靂之后，或成痈肿，人们固然知道是余毒。但不知气息高促而喘息有声，耸肩抬肚的，是余毒在肺。痰涎稠粘，切牙磨牙，泄泻不止且口臭的，是余毒在脾胃。盗汗出于胸前，午后发热口渴的，是余毒在心包。睡中多惊，身体常发热，是余毒在肝。耳叶与尾骶常热，是余毒在肾。眼睛合不上，身体肿胀不消，壮热不退，郁郁不乐，是诸经皆有余毒。
又须知发于巅顶及胸部的，为心经之毒；发于臂肘及背部的，为肺经之毒；发于胁膝及筋聚处的，为肝经之毒；发于七节之旁及尻上的，为肾经之毒；发于正面及咽部的，为胃经之毒。肝、肺及胃的毒大多易治，心毒多危重，肾毒不必治（指预后不良或难治）。
大抵血热毒盛而发的，其毒必肿胀色赤，能食便秘，并宜用消毒饮加解毒凉血药。胃气实者，用排毒散轻微通下。若气虚毒盛而发，其毒必漫肿色淡，食少便溏，虽用人参内托散，也多不可治。若用犀角、黄芩、黄连、地黄之类，是加速其死亡。如遍身流注清水，延绵不已的，不治。
When the smallpox/rash initially begins to fever, if the eyes are red and swollen, it is due to wind-heat attacking upwards. If the eyes are red after four or five days of onset, it is because fire-toxin is abundant and steaming upwards. If the eyes are red and swollen after the eruption, it is because residual toxin is stagnating in the Heart and Spleen.
If many rashes have erupted, by the time of pus-filling, the eyes will naturally close. However, after the scabs dry and fall off, the eyes should reopen. If they remain closed, this indicates that toxic vapors are attacking the eyes; one must urgently clear and resolve the residual toxins. In severe cases, Liang Ge San (Cooling the Diaphragm Powder) with Jingjie (Schizonepetae Herba), Niubangzi (Arctii Fructus), and Chantui (Cicadae Periostracum) should be used. Generally speaking, if the eyes do not open past the expected time, licking them moistly with the tongue to remove ocular discharge will cause them to open naturally.
Smallpox damaging the eyes does not occur in the initial stage but after the scabbing phase. This is all caused by dense rashes on the head and face where pus and blood become fixed, or where broken lesions swell and fill again, causing toxic fire to stagnate and steam, internally attacking the eyes. Alternatively, if the rash erupts too profusely and matures slowly, excessive use of acrid-warm herbs fails to clear and resolve the heat, or exposure to fire-qi occurs, or clothing/bedding is too thick, or contraction of wind-cold pathogens, or indulgence in eating various eggs—all these can damage the eyes. Treatment should focus on invigorating blood and resolving toxins; when blood circulation improves, the toxin resolves. One must absolutely avoid using cold/cold-natured medicines indiscriminately, lest they congeal the blood vessels and lead to chronic disease. Also, aromatic/pungent eye drops should not be used. Formulas such as Gujing San (Valerian Flower Powder), Jueming San (Cassia Seed Powder), Mimeng San (Buddleja Powder), Shengong San (Miraculous Efficacy Powder), or Lingyang San (Antelope Horn Powder) may be selected.
When the first spots appear, if rashes grow densely within the eyes, Yidao Dan (Rash Transferring Pill) must be urgently applied to transfer them out, thereby avoiding eye damage. Although this formula seems absurd, its efficacy is extraordinary; do not neglect it because of its strangeness. If three days pass and the root qi has stabilized, it cannot be transferred anymore. For mild cases, ivory ground in water can be dripped into the eyes to effect the transfer.
For cases of flat, inverted, or ulcerated smallpox lesions where medication allows scabbing to form, residual toxins have not been fully expelled and must exit via the meridians, manifesting as carbuncles/toxins. Medication should be chosen based on the affected meridian, primarily focusing on supporting the interior and resolving toxins. For un-ulcerated, swollen, and hard lesions, Pai Du San (Draining Toxin Powder) is used, adjusted according to the deficiency or excess of Yuan Qi (Original Qi). Externally, raw soybeans chewed into a paste can be applied, or rhubarb boiled in wine mixed with true mung bean powder for application, or snake skin dipped in raw soy milk applied. For ulcers that are swollen but pus has not penetrated, Jie Du Nei Tuo San (Resolving Toxin and Supporting Interior Powder) with Baizhi (Angelicae Dahuricae Radix) and Lingli Jia (Manis Squama) is used. Externally, Haishi (Magnitum) finely ground and mixed with honey is applied. For ulcers already drained of pus, Shi Xuan San (Ten Acupoints Powder) with Lianqiao (Forsythiae Fructus) and Rendong Teng (Lonicerae Japonicae Caulis et Flos) is used.
Whenever residual toxins from smallpox manifest as carbuncles: if the base is red and itchy, it indicates Qi deficiency; Si Jun Zi Tang (Four Gentlemen Decoction) with Danggui (Angelicae Sinensis Radix) and Shaoyao (Paeoniae Radix) is used. If red, hot, and painful, it indicates Blood heat; Si Wu Tang (Four Substances Decoction) with Shengdi Huang (Rehmanniae Radix Recens) replacing Shu Di Huang, plus Xijiao (Rhinocerotis Cornu), Lingli Jia, Lianqiao, and Rendong Teng is used. If swollen but not ulcerated, it indicates dual deficiency of Qi and Blood; Tuo Li Xiao Du San (Support Interior and Eliminate Toxin Powder) is used. If ulcerated but not healing, it indicates Spleen Qi deficiency; Liu Jun Zi Tang (Six Gentlemen Decoction) with Danggui and Rendong Teng is used.
If lesions appear on the skin surface, appearing as large or small patches like vermilion, or forming nodules that are painful, swollen, and untouchable, this is called Zi Dan Liu (Purple Carbuncle Nodule). This indicates extreme internal toxicity in the Five Zang organs; even with detoxifying herbs, resolution is difficult. If it arises from above and reaches the Heart, death ensues; if from below and reaching the Kidney, death ensues. Urgently prick with a porcelain blade to release evil blood. If swelling persists, prick again. Internally, drugs must be used to drain the toxin and promote excretion. If faint red macules or patches appear on the skin with itching, commonly known as Gai Dou Sha (Covering Rash Mumps), Xiao Du Yin (Detoxifying Decoction) with Fangfeng (Saposhnikoviae Radix) is used.
If, after safe scabbing, sudden coldness of hands and feet occurs, this is Spleen Qi deficiency; do not mistake it for a Cold syndrome. Cannei Tuo San (Ginseng Internal Support Powder) with Guizhi (Cinnamomi Ramulus) is used. If sudden spasms and inability to flex/extend limbs occur, this is external contraction of Wind, Cold, and Dampness; do not use dispersing herbs that consume Blood. Shi Quan Da Bu Tang (Complete Great Tonifying Decoction) with Guizhi and Cangzhu (Atractylodis Rhizoma) is used. For joint pain, add Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng.
If dysentery with pus and blood suddenly occurs after scabbing, toxic vapors have entered the Large Intestine. Allow this to continue for two or three days until fully evacuated, then clear heat and promote urination, followed by tonifying the Spleen and strengthening the Stomach. Do not use astringents. If heat-toxin accumulates in the Lung, blocking the throat, resulting in an open mouth without eating, desire to vomit but unable to, dry heaving, and hoarseness, this indicates rotting sores in the Stomach—a most ominous sign. Urgently use Xiao Du Yin with Gancao (Glycyrrhizae Radix), Jiegeng (Platycodonis Radix), Heishen (Black Ginseng), Niubangzi, and Zhuye (Bambusae Folium), and apply ground Xijiao (Rhinocerotis Cornu) water. Delay leads to throat rot and death.
If abdominal pain, distension, irritability, and rapid breathing occur, the toxin has entered the Spleen; use Zhishi Dao Zhi Tang (Immature Bitter Orange Regulating Stagnation Decoction) to purgate. Otherwise, panting, cold extremities, and difficulty treating arise. If appetite remains normal after smallpox but emaciation progresses daily, this is dual deficiency of Qi and Blood with deficient fire in the Stomach. Qian Shi Yi Gong San (Master Qian’s Extraordinary Efficacy Powder) and Si Wu Tang, both added with Huanglian (Coptidis Rhizoma), should be taken alternately. Dietary restriction is essential.
If constipation occurs, it indicates toxin excess and Blood dryness; Xiao Du Yin with Shengdi Huang, Haren (Cannabis Semen), and Xingren (Prunus Armeniaca Semen) is used to moisten. If dryness results from excessive heat herbs, Xiao Du Yin with Haren, Shaoyao, and Shanzhi (Gardeniae Fructus) is used. If mouth/tongue ulcers appear: red ones indicate Heart/Spleen heat—use Liang Ge San; white ones indicate Lung/Heart heat—use Qing Fei Tang. Wipe clean externally with a green cloth dipped in water, then apply Maming San (Horse Cry Powder).
During scabbing, mouth/tongue ulcers and dental caries (Chi Gan) are due to unresolved residual toxin attacking the Yangming Meridian and steaming the Upper Jiao. Clear Stomach heat and transform toxin using Ganlu Yin (Sweet Dew Decoction) with Xijiao and Lianqiao. Sore throat is also due to residual toxin lingering in the Guan Yue (throat/pharynx), where the Lung suffers from Fire hyperactivity causing swelling and pain; Ru Sheng Yin (Like Sage Drink) is used.
After scabbing, if eyes remain closed, or membranes form, causing pain and dim vision, cool Blood, resolve toxins, clear Heart heat, and drain Liver fire according to symptoms. If scabbing is incomplete and residual toxin suddenly erupts, reddening body, face, and eyes, prognosis is poor. Weng Zhongren stated: After scabbing, carbuncles indicate residual toxin. However, high-pitched breathing with wheezing, lifting shoulders and belly to breathe, indicates residual toxin in the Lung. Thick sticky phlegm, grinding teeth, incessant diarrhea with foul breath indicates residual toxin in Spleen/Stomach. Night sweats on the chest, afternoon fever/thirst indicates residual toxin in Pericardium. Startling during sleep, constant low-grade fever indicates residual toxin in Liver. Heat in ears and coccyx indicates residual toxin in Kidney. Eyes closed, edema, persistent high fever, depression indicate residual toxin in all meridians.
Furthermore, eruptions on the vertex and chest belong to Heart Meridian toxin; arm/elbow/back belong to Lung Meridian toxin; flanks/knees/tendon gatherings belong to Liver Meridian toxin; seven-joint region and coccyx belong to Kidney Meridian toxin; face and throat belong to Stomach Meridian toxin. Liver, Lung, and Stomach toxins are generally easy to treat; Heart toxin is critical; Kidney toxin is incurable.
Generally, eruptions due to Blood heat and toxin excess present with swollen, red lesions, good appetite, and constipation; use Xiao Du Yin with detoxifying and blood-cooling herbs. If Stomach Qi is solid, use Pai Du San to mildly purge. If eruptions are due to Qi deficiency and toxin excess, presenting with diffuse pale swelling, poor appetite, and loose stools, even with Renshen Nei Tuo (Ginseng Internal Support), prognosis is poor. Using Xijiao, Huangqin (Scutellariae Radix), Huanglian, and Dihuang (Rehmanniae Radix) accelerates death. Generalized weeping serous fluid that persists indefinitely is incurable.