痘疮既出之后。二三日间足心齐见。渐渐长发。肥润光泽。面目渐肿。灌浆为吉。若三四日
内隐于肌肤不长发者。此元气虚也。快斑汤、透肌散催之。色不红活。紫草快斑汤。若身面俱起。
手足四肢不能长发者。桂桂汤加防风、黄 。若见吐泻口渴。手足指清而不长发者。此内虚寒也。
陈氏木香散。并鸡冠血和酒酿灌之。外以胡荽酒微喷衣被。若四五日虽见长起。颜色淡白陷顶者。
此气虚也。参 内托散加糯米。虽不白亦不红活。陷顶者。此血虚也。四物汤合保元。若色赤而
兼痒者。血虚有热也。四物汤换生地加犀角、连翘。若气虚有热。保元汤加连翘、木通、桔梗、
忍冬。若痘顶色白。连肉红肿。而痘反不肿。口燥唇焦者。九日死。急以化毒汤加生地、川芎。
调二宝散救之。若色红根散不长发者。此血热而气不相根据。大鼠粘子汤加紫草。若色虽红而焦。
口干不起发。紫草饮加红花、酒芩、连翘、芍药。若大便秘结。内有实热不发者。消毒饮加犀角。
或四圣散加枳壳、黄芩、山楂、穿山甲。若大便利。口渴不发者。此内虚热。七味白术散。若自
利不渴者。此内虚寒。理中汤加木香。若出迟而小便涩滞。咳嗽有痰。生圣散。起迟而小便赤涩。
四圣散去黄 加连翘、升麻。虚则紫草木通汤。若夏月暑气熏炙。烦渴不发。四苓散加门冬、竹
叶。冬月冷气所侵。寒凛不发者。陈氏木香散。寒颤渴泻。饮沸汤口不知热。陈氏异功散。作渴。
饮冰水口不知寒。实则四顺饮。虚则地黄丸。手足不冷。饮汤温和者。钱氏异功散。若鼻塞声重。
咳嗽不发者。此风寒所侵。人参败毒散加荆、防。若血气虚弱。偶为外秽所触。伏陷不发。内服参
内托散。外烧胡荽、乳香辟之。触犯风寒邪秽。黑陷不起。夺命丹。至如长发之际头面多者。自然肿
胀目闭。然不要目胞光亮。若应肿闭不肿闭。此毒郁于内。不得起越。急用托里快斑汤。肿者吉。
否者凶。肿后忽然平塌目开。此为气泄。急用参 内托散加穿山甲、糯米。浆满后无别变证而不
回者。参 内托散加白芍、连翘。复肿吉。否者凶。又有头面太多。将起发时头先肿大者。此天
行大头病。急宜羌活救苦汤。解者吉。否者凶。此证易肿易消。六七日变为痒塌。呛水错喉。声
哑痰喘倒陷。百无一生矣。若六七日不起发。颜色不正。虽能灌浆。亦难保十一二朝之变也。痘
不起发。皮粗色晦而隐于肉下者。此脾肺俱虚也。须防七日之变。八日之喘。陈文宿云。痘疮出
不快。误言毒瓦斯壅盛。用药宣利解散。致脏腑受冷。营卫涩滞。则气不能充贯。其疮不起发。不
光泽。不充满。不结实。不能成痂。多致痒塌烦躁喘渴而死。翁仲仁云。起胀发顶虽起。而四围
淡白枯涩者。属血虚。有四围虽收。起晕而顶陷者。属气虚。顶陷色白。气血俱虚。保元汤加芎、
归、肉桂之类。起胀时痘上有小孔而色淡者。此腠理不密。元气开泄也。保元汤加桂。若色黑者。
为火毒炽盛。又当凉血解毒。痘起其孔自密。海藏云。痘疮身后出不快者。足太阳经也。身前出
不快者。足阳明经也身侧出不快者。足少阳经也。若便利调和而出不快者。热在表也。又有上中
下三部。先上部。次中部。后下部。出齐自愈。又有作三次出者。钱氏云。三日不快不出。用消
毒之药仍不出。脉平静者本稀也。不必服药。大凡五六日间。当解毒补托。七八日间。毒瓦斯不能
盍出而反入于内。必用药祛出之。此大法也。
痘疮发出之后，在二三天内足心部位也同时出现，逐渐生长丰满，肥润光泽，面目逐渐肿胀，灌浆为吉兆。如果在三四天内隐伏于肌肤表面不生长，这是元气虚弱的表现，用快斑汤、透肌散来催发。如果颜色不红润鲜活，用紫草快斑汤。如果身体面部都起痘，但手足四肢不能生长的，用桂枝汤加防风、黄芪。如果出现呕吐腹泻、口渴，手足指头发凉且不生长的，这是内部虚寒，用陈氏木香散，并配合鸡冠血和酒酿灌服。外部用胡荽酒轻微喷洒衣被。如果在四五天内虽然见到痘疹长出，但颜色淡白、顶端凹陷的，这是气虚，用人参内托散加糯米。如果颜色既不白也不红润鲜活，且顶端凹陷的，这是血虚，用四物汤合保元汤。如果颜色红赤并且兼有瘙痒的，是血虚有热，用四物汤换生地黄加犀角、连翘。如果是气虚有热，用保元汤加连翘、木通、桔梗、忍冬藤。如果痘顶颜色白，周围连肉红肿，但痘疹反而不肿，口燥唇焦的，九天后会死亡，急需用化毒汤加生地黄、川芎，调服二宝散来抢救。如果颜色红但根部散漫不生长的，这是血热而气不相依附，用大鼠粘子汤加紫草。如果颜色虽红但干枯，口干不起发的，用紫草饮加红花、酒黄芩、连翘、芍药。如果大便秘结，内部有实热导致不发的，用消毒饮加犀角，或者用四圣散加枳壳、黄芩、山楂、穿山甲。如果大便通畅，口渴但不发的，这是内部虚热，用七味白术散。如果自利（腹泻）且不渴的，这是内部虚寒，用理中汤加木香。如果出痘迟且小便涩滞，咳嗽有痰的，用生圣散。出痘迟且小便赤涩的，用四圣散去黄芪加连翘、升麻。属于虚证的用紫草木通汤。如果是夏季暑气熏蒸，烦渴不发的，用四苓散加麦冬、竹叶。冬季受冷气侵袭，寒冷凛冽不发的，用陈氏木香散。出现寒颤、口渴、腹泻，喝沸水却感觉不到热的，用陈氏异功散。出现口渴，喝冰水却感觉不到冷的，实证用四顺饮，虚证用地黄丸。手足不冷，喝温水舒服的，用钱氏异功散。如果鼻塞声重，咳嗽不发的，这是风寒所侵，用人参败毒散加荆芥、防风。如果血气虚弱，偶然被外秽之气触碰，导致痘疹伏陷不发的，内服人参内托散，外部烧胡荽、乳香以辟邪。触犯风寒邪秽，导致黑陷不起的，用夺命丹。至于在生长阶段头面部位多的，自然会肿胀闭目，但不要眼胞光亮。如果应该肿胀却不肿胀，应该闭目却不闭目，这是毒气郁结在内，不能起越，急需用托里快斑汤。肿胀的是吉兆，否则是凶兆。肿胀后忽然平塌睁眼的，这是气泄，急需用人参内托散加穿山甲、糯米。浆满后没有其他变证而不回缩的，用人参内托散加白芍、连翘。再次肿胀为吉，否则为凶。又有头面太多，在将起发时头部先肿大的，这是天行大头病，急需羌活救苦汤。能化解的是吉兆，否则是凶兆。这种证候容易肿也容易消，六七天变为痒塌，呛水错喉，声音嘶哑痰喘倒陷，百无一生了。如果六七天不起发，颜色不正，虽然能灌浆，也难以保全十一二天的变化。痘疹不起发，皮肤粗糙颜色晦暗而隐于肉下的，这是脾肺俱虚，必须防备七天的变化，八天的气喘。陈文宿说：痘疮出不快，误说是毒瓦斯壅盛，用药宣利解散，导致脏腑受冷，营卫涩滞，则气不能充贯，其疮不起发，不光泽，不充满，不结实，不能成痂，多导致痒塌烦躁喘渴而死。翁仲仁说：起胀发顶虽然起来，但四周淡白枯涩的，属于血虚；有四周虽然收敛，起晕而顶部凹陷的，属于气虚；顶部凹陷颜色白的，气血俱虚，用保元汤加川芎、当归、肉桂之类。起胀时痘上有小孔且颜色淡的，这是腠理不密，元气开泄，用保元汤加桂枝。如果颜色黑的，为火毒炽盛，又应当凉血解毒，痘起其孔自然致密。海藏说：痘疮身后出不快的，是足太阳经的问题；身前出不快的，是足阳明经的问题；身侧出不快的，是足少阳经的问题。如果大小便调和而出痘不快，是热在表。又有上中下三部，先上部，次中部，后下部，出齐自愈。又有分三次出的。钱乙说：三天不快不出，用消毒之药仍然不出，脉平静的，是本来的痘疹稀疏，不必服药。大凡五到六天之间，应当解毒补托，七到八天之间，毒瓦斯不能尽出反而入于内，必用药将其祛出，这是大法。
After the eruption of smallpox, if lesions appear simultaneously on the soles of the feet within two to three days, gradually becoming plump, moist, and lustrous, with gradual swelling of the face and eyes, and subsequent filling with pus, this is an auspicious sign. If within three or four days the lesions remain hidden under the skin without growing, this indicates deficiency of Yuan Qi (Original Qi). Use Kuai Ban Tang (Rapid Eruption Decoction) or Tou Ji San (Muscle-Penetrating Powder) to promote eruption. If the color is not red and vibrant, use Zicao Kuai Ban Tang (Arnebia Rapid Eruption Decoction). If lesions erupt on the body and face but fail to grow on the hands, feet, and limbs, use Guizhi Tang (Cinnamon Twig Decoction) plus Fangfeng (Saposhnikovia Root) and Huangqi (Astragalus Root). If vomiting, diarrhea, thirst, cold extremities, and failure to erupt occur, this indicates internal deficiency-cold. Use Chen's Muxiang San (Costus Root Powder), administered with chicken comb blood mixed with fermented rice wine. Externally, lightly spray clothes and bedding with Hu Su Jiu (Coriander Wine). If after four or five days lesions have emerged but are pale white with depressed centers, this indicates Qi deficiency. Use Renshen Neituo San (Ginseng Internal-Supporting Powder) plus glutinous rice. If the color is neither white nor red/vibrant, and the center is depressed, this indicates Blood deficiency. Use Siwu Tang (Four Substances Decoction) combined with Baoyuan Tang (Protect the Origin Decoction). If the color is red and accompanied by itching, this indicates Blood deficiency with Heat. Use Siwu Tang substituting Shengdi Huang (Rehmannia Root) and adding Xijiao (Rhinoceros Horn - *Note: Substitute with Buffalo Horn in modern practice*) and Lianqiao (Forsythia Fruit). If there is Qi deficiency with Heat, use Baoyuan Tang plus Lianqiao, Mutong (Akebia Stem), Jiegeng (Platycodon Root), and Rendong Teng (Honeysuckle Stem). If the pustule apex is white, surrounding flesh is red and swollen, yet the pustule itself fails to swell, accompanied by dry mouth and scorched lips, death will occur on the ninth day. Urgently administer Huadu Tang (Resolve Toxin Decoction) plus Shengdi Huang and Chuanxiong, mixed with Erbao San (Two Treasures Powder) for rescue. If the color is red but the base is diffuse and fails to grow, this indicates Blood Heat with Qi failing to anchor. Use Dashu Nianzi Tang (Great Rat Sticky Seed Decoction) plus Zicao (Arnebia Root). If the color is red but dry, with a dry mouth and failure to erupt, use Zicao Yin (Arnebia Drink) plus Honghua (Safflower), Jiu Huangqin (Wine-processed Scutellaria Root), Lianqiao, and Shaoyao (Peony Root). If constipation occurs due to internal excess Heat preventing eruption, use Xiaodu Yin (Detoxify Toxin Drink) plus Xijiao, or Sixiang San (Four Sages Powder) plus Zhike (Bitter Orange Fruit), Huangqin, Shanzha (Hawthorn Fruit), and Chuanshanjia (Pangolin Scales). If stool is loose, thirst is present, but eruption fails, this indicates internal deficiency-Heat. Use Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder). If spontaneous diarrhea occurs without thirst, this indicates internal deficiency-cold. Use Lizhong Tang (Regulate the Middle Decoction) plus Muxiang (Aucklandia Root). If eruption is delayed with turbid urine, cough, and phlegm, use Shengsheng San (Generate Life Powder). If eruption is delayed with dark, turbid urine, use Sixiang San removing Huangqi, adding Lianqiao and Shengma (Cimicifuga Rhizome). For deficiency patterns, use Zicao Mutong Tang (Arnebia and Akebia Decoction). In summer, if stifling heat causes irritability, thirst, and failure to erupt, use Siling San (Four Poria Powder) plus Maidong (Ophiopogon Tuber) and Zhuye (Bamboo Leaf). In winter, if cold invasion causes shivering and failure to erupt, use Chen's Muxiang San. If chills, thirst, diarrhea, and drinking boiling water without feeling heat occur, use Chen's Yigong San (Chen's Extraordinary Assistance Powder). If thirst occurs, drinking ice water without feeling cold, excess patterns use Sishun Yin (Four Smoothness Drink), while deficiency patterns use Dihuang Wan (Rehmannia Pill). If extremities are not cold and warm drinks are comfortable, use Qian's Yigong San (Qian's Extraordinary Assistance Powder). If nasal congestion, heavy voice, cough, and failure to erupt occur due to Wind-Cold invasion, use Renshen Baidu San (Ginseng Resisting Epidemic Powder) plus Jingjie (Schizonepeta Spike) and Fangfeng. If Qi and Blood are weak, and accidental contact with external filth causes lesions to subside and fail to erupt, internally administer Renshen Neituo San; externally burn Hu Su (Coriander) and Rushiang (Frankincense) to dispel evil. If Wind-Cold and evil filth cause black, depressed, non-erupting lesions, use Tuoming Dan (Life-Restoring Pill). During the growth phase, excessive lesions on the head and face naturally cause swelling and closed eyes; however, eyelids should not be bright/luminous. If expected swelling and eye closure do not occur, toxin is郁 (stagnant) internally and cannot rise; urgently use Tuoli Kuai Ban Tang (Support Interior Rapid Eruption Decoction). Swelling is auspicious; absence is ominous. Sudden flattening and opening of eyes after swelling indicates Qi leakage; urgently use Renshen Neituo San plus Chuanshanjia and glutinous rice. After pus fills, if no other complications arise but the lesion does not retract, use Renshen Neituo San plus Shaoyao and Lianqiao. Re-swelling is auspicious; otherwise, ominous. If the head swells excessively before eruption due to many facial lesions, this is Tianxing Datou Bing (Epidemic Big Head Disease); urgently use Qianghuo Jiuku Tang (Notopterygium Relief from Suffering Decoction). Resolution is auspicious; otherwise, ominous. This condition easily swells and resolves; by six or seven days it may become itchy and collapsed, causing choking on water, throat obstruction, hoarseness, phlegmic wheezing, and collapse, with almost no survivors. If lesions fail to erupt after six or seven days, with abnormal color, even if they fill with pus, survival beyond eleven or twelve days is unlikely. Lesions that fail to erupt, with rough skin, dull color, and hidden beneath the flesh, indicate simultaneous deficiency of Pi (Spleen) and Fei (Lung); beware of changes on the seventh day and asthma on the eighth day. Chen Wensu stated: Delayed eruption mistakenly attributed to excess toxin, treated with purgatives and dispersants, leads to cold damage to Zang-Fu organs, stagnation of Ying (Nutritive) and Wei (Defensive) Qi, preventing Qi from filling and penetrating. The lesions fail to erupt, lack luster, fullness, and firmness, and fail to form scabs, often leading to death from itching, collapse, irritability, asthma, thirst, and restlessness. Weng Zhongren stated: Although the pustule apex rises during swelling, if the periphery is pale, white, dry, and rough, it belongs to Blood deficiency. If the periphery has retracted but a halo remains with a depressed apex, it belongs to Qi deficiency. Depressed apex with white color indicates both Qi and Blood deficiency; use Baoyuan Tang plus Chuanxiong, Danggui (Angelica Sinensis), Rougui (Cinnamon Bark), etc. Small pores on lesions during swelling with pale color indicate loose Cou Li (Intercellular Spaces) and leaking Yuan Qi; use Baoyuan Tang plus Guizhi. Black color indicates blazing Fire-Toxin; cool Blood and resolve toxin, and the pores will naturally tighten. Haizang stated: Delayed eruption on the posterior body relates to Zu Taiyang Jing (Foot-Taiyang Meridian); anterior body relates to Zu Yangming Jing (Foot-Yangming Meridian); lateral body relates to Zu Shaoyang Jing (Foot-Shaoyang Meridian). If bowel movements and urination are harmonious but eruption is slow, Heat is in the Exterior. There are Upper, Middle, and Lower regions; eruption starting from Upper, then Middle, then Lower, resolving when complete, is normal. Some erupt in three waves. Qian Yi stated: If lesions do not erupt quickly after three days, and detoxifying herbs fail to induce eruption, but the pulse is calm, the original scarcity is benign; no medication is needed. Generally, between five and six days, one should resolve toxins and support the interior. Between seven and eight days, if toxins cannot fully exit and instead enter inward, medication must be used to expel them. This is the general principle.