（又痘母，见前怪痘形证）
痘发痈毒者，亦名痘母。经曰∶痘前发母者凶，痘后发母者半吉半凶，大都毒发不透，
必发痈疽，故蕴结于经络之间。然其壅结也犹无足虑，而惟其不能消散，及治之不得其法，
则乃为可虑。然散之之法，当知要领，其在虚实之辨而已。如痘痈之有大毒者，不得不为解
毒，有大热者，不得不为清火，俟火毒略清，盒饭调理脾气。其有外虽见热而内本不足者，
则当专用托法，务令元气完固，饮食不减，则毒无不化，何害之有？若不察根本强弱，而但
知攻毒清火，则无不伤脾，多致饮食日减，营气日削，脓血不化，毒日以陷，而痘变百出矣。
所以痘疮始末，皆当以脾气为主，苟不知此，则未有中气虚败而痘能保全者。
一、痘痈初起，壅盛疼痛，元气无损，饮食如常者，宜先用连翘归尾煎，或仙方活命饮
以解其毒，俟毒瓦斯稍平，即当用四君、归、 之类，以补托元气。
一、凡用托里之剂，如痈毒内无大热，亦无便闭烦渴等证，或素非强盛之质，或以阴
毒深陷，形不 突，不红肿，不化脓，痛有不甚者，此其毒皆在内，俱速宜用托里之药，以六
气煎加金银花、甘草节、防风、荆芥、白芷、穿山甲、牛蒡子之类，如阳气不足者，仍可加
肉桂、附子，用酒水各半煎服，或全用酒煎亦可，或托里消毒散俱可酌用。
一、凡内热晡热而饮食少思者，多属脾胃不足，血气虚弱，宜六气煎或温胃饮，加金银
花、白芷。若痈毒色白而作痒者，气虚也，治同上。若根赤而作痒者，血虚血热也，宜四
物汤加丹皮、白芷。若肿而不溃者，血气虚也，托里消毒散或加肉桂。若溃而不收者，脾
气虚也，宜六气煎或六物煎加肉桂。
一、凡饮食如常而内外俱热，痈毒肿痛，或烦渴，或大小便俱热涩者，宜大连翘饮，或
仙方活命饮，可间
用之。若饮食如常，内热作痛，或兼口舌生疮者，宜间用射干鼠粘子汤。
一、痘毒发痈，有结硬实热难解者，宜排毒散。
一、痘后发痈疖者，乃痘中未尽之毒，留于经铬肢节而为痈肿也，或解毒，或清火，各有
所宜。凡欲表里兼解者，宜柴胡麦门冬散；欲润肠解毒者，宜消毒散及四顺清凉饮；欲凉血解
毒者，宜犀鱼地黄汤；欲清火利便解毒者，宜大连翘饮。
（另外，痘母这一概念，在前文关于怪痘形态和证候的章节中已有论述）
痘疮引发痈毒的情况，也被称为“痘母”。《内经》说：在痘疹发出之前出现痘母的预后凶险，在痘疹发出之后出现痘母的则吉凶参半。这大多是因为痘毒未能透发出来，必然会在体内蕴结形成痈疽，从而阻滞在经络之间。然而，这种壅滞结聚本身尚不足为虑，真正令人担忧的是它无法消散，以及治疗时方法不当。因此，消散的方法应当掌握要领，关键在于辨别虚实。例如，对于痘痈中毒邪严重的，不得不采用解毒法；热势炽盛的，不得不采用清火法。等到火热毒邪稍微清除后，就应当调理脾气。对于那些外表虽然显现热象但内在本质元气不足的，则应当专门使用托法，务必使元气完固，饮食不减少，这样毒邪自然能够化解，又有什么危害呢？如果不考察根本元气的强弱，只知道攻伐毒邪、清泻火热，那么无不损伤脾胃，多数导致饮食日渐减少，营气日渐耗损，脓血无法化生，毒邪日益内陷，从而导致痘疮变证百出。所以，痘疮从头到尾，都应当以顾护脾气为主，如果不懂得这一点，就没有中气虚弱败坏而痘疮还能保全的案例。
一、痘痈初起，壅盛且疼痛剧烈，但元气未受损，饮食如常的，适宜先用连翘归尾煎，或者仙方活命饮来解除其毒邪，等到毒邪气势稍平复，就应当使用四君子汤、当归等药物，来补益和托举元气。
一、凡是使用托里方法的药剂，如果痈毒内部没有大热，也没有大便闭塞、烦躁口渴等症状，或者患者体质本来就不强壮，或者是阴毒深陷，疮形不突起，不红肿，不化脓，疼痛不剧烈的，这些毒邪都在内部，都应当迅速使用托里的药物。可以用六气煎加入金银花、甘草节、防风、荆芥、白芷、穿山甲、牛蒡子等药物；如果阳气不足，仍然可以加入肉桂、附子，用酒和水各一半煎服，或者全用酒煎也可以，或者托里消毒散都可以酌情使用。
一、凡是内有热象、傍晚发热且饮食缺乏思虑的，多属于脾胃不足，血气虚弱，适宜用六气煎或温胃饮，加入金银花、白芷。如果痈毒颜色发白且瘙痒的，是气虚，治疗方法同上。如果根部发红且瘙痒的，是血虚兼血热，适宜用四物汤加入丹皮、白芷。如果肿胀但不溃破的，是血气虚，可用托里消毒散或加入肉桂。如果溃破后不能收敛愈合的，是脾气虚，适宜用六气煎或六物煎加入肉桂。
一、凡是饮食如常但内外俱热，痈毒肿痛，或者烦躁口渴，或者大小便都热涩不畅的，适宜用大连翘饮，或者仙方活命饮，可以交替使用。如果饮食如常，内热引起疼痛，或者兼有口舌生疮的，适宜交替使用射干鼠粘子汤。
一、痘后发生痈疖的，是痘疹中未尽的毒邪，停留在经络肢体关节处而形成的痈肿，或者解毒，或者清火，各有适宜的用法。凡是想要表里同时解毒的，适宜用柴胡麦门冬散；想要润肠解毒的，适宜用消毒散及四顺清凉饮；想要凉血解毒的，适宜用犀鱼地黄汤；想要清火利小便解毒的，适宜用大连翘饮。
(Additionally, the concept of "Dou Mu" [Placental-like Ductule/Toxic Nodule] has been discussed in the preceding section regarding abnormal smallpox morphologies and syndromes.)
When smallpox triggers carbuncles or toxic swellings, it is also referred to as "Dou Mu". The *Classic of Internal Medicine* states: If Dou Mu appears before the eruption of smallpox, the prognosis is ominous; if it appears after the eruption, the prognosis is half auspicious and half ominous. This is mostly because the toxic pathogen fails to vent outward, inevitably accumulating to form carbuncles and sores, thereby obstructing the meridians and collaterals. However, this stagnation and accumulation itself is not yet a matter for grave concern; what is truly worrisome is its inability to dissipate, as well as improper treatment methods. Therefore, the method of dissipation must grasp the key principle, which lies in distinguishing between deficiency (Xu) and excess (Shi). For instance, in cases of severe toxicity in smallpox carbuncles, detoxification is indispensable; in cases of intense heat, clearing fire is indispensable. Once the fire-toxin is slightly cleared, one should then regulate the Spleen Qi. In cases where there is apparent heat on the exterior but underlying insufficiency of Yuan Qi (Primal Qi), one should exclusively employ the supporting method (Tuo Fa), ensuring that Yuan Qi remains intact and dietary intake does not diminish. In such scenarios, the toxin will naturally transform, posing no harm. However, if one fails to examine the strength of the root constitution and only knows how to attack toxins and clear fire, the Spleen and Stomach will invariably be damaged. This often leads to a daily decrease in dietary intake, a daily depletion of Ying Qi (Nutritive Qi), failure to transform pus and blood, progressive internal sinking of the toxin, and consequently, a hundred variations of smallpox complications. Thus, from beginning to end of smallpox treatment, priority must always be given to protecting Spleen Qi. Without understanding this, there are no cases where smallpox can be preserved when the Middle Qi (Zhong Qi) is deficient and failing.
1. When a smallpox carbuncle first arises, presenting with fullness, swelling, and severe pain, but without damage to Yuan Qi and with normal dietary intake, it is appropriate to initially use Lianqiao Guiwei Decoction (Forsythia and Angelica Caudata Decoction) or Xianfang Huoming Yin (Immortal Formula for Preserving Life) to resolve the toxin. Once the toxic qi subsides slightly, one should then use Sijunzi Tang (Four Gentlemen Decoction) combined with Danggui (Angelica Sinensis) and similar herbs to tonify and support Yuan Qi.
2. Whenever using formulas for supporting the interior, if there is no severe internal heat in the carbuncle/toxin, nor symptoms such as constipation, irritability, or thirst, or if the patient’s constitution is inherently weak, or if the Yin toxin has sunk deeply presenting with non-protruding lesions, lack of redness and swelling, absence of suppuration, and mild pain, the toxin resides internally. In all these cases, it is urgent to use interior-supporting herbs. One may use Liuqi Jian (Six Qi Decoction) added with Jinyinhua (Honeysuckle), Gancao Jie (Licorice Joint), Fangfeng (Saposhnikovia), Jingjie (Schizonepeta), Baizhi (Angelica Dahurica), Chuanshanjia (Pangolin Scale), and Niubangzi (Arctium Seed). If Yang Qi is insufficient, Rougui (Cinnamon Bark) and Fuzi (Aconite) may still be added. The decoction may be prepared with half wine and half water, or entirely with wine. Tuoli Xiaodu San (Interior-Supporting and Toxin-Resolving Powder) may also be used酌情ly.
3. In cases of internal heat, afternoon fever, and lack of appetite, this mostly belongs to Spleen and Stomach insufficiency and Qi-Blood weakness. It is appropriate to use Liuqi Jian or Wenwei Yin (Stomach-Warming Decoction), added with Jinyinhua and Baizhi. If the carbuncle/toxin is white in color and itchy, it indicates Qi deficiency; the treatment is the same as above. If the base is red and itchy, it indicates Blood deficiency with Blood heat; it is appropriate to use Siwu Tang (Four Substances Decoction) added with Danpi (Moutan Cortex) and Baizhi. If swollen but un-ulcerated, it indicates Qi-Blood deficiency; Tuoli Xiaodu San or Tuoli Xiaodu San added with Rougui may be used. If ulcerated but unable to heal/converge, it indicates Spleen Qi deficiency; Liuqi Jian or Liuwu Jian (Six Things Decoction) added with Rougui is appropriate.
4. In cases where dietary intake is normal but both interior and exterior present heat, accompanied by carbuncle/toxin swelling and pain, or irritability and thirst, or hot and stagnant urination and defecation, Dalianqiao Yin (Large Forsythia Decoction) or Xianfang Huoming Yin may be used alternately. If dietary intake is normal, internal heat causes pain, or is accompanied by mouth and tongue ulcers, Shegan Niuziangzi Tang (Belamcanda and Arctium Seed Decoction) may be used alternately.
5. When smallpox toxin causes carbuncles characterized by hard nodules and difficult-to-resolve Excess Heat, Paidu San (Toxin-Expelling Powder) is appropriate.
6. Carbuncles and furuncles appearing after smallpox are caused by residual toxin from the smallpox remaining in the meridians, limbs, and joints, forming swellings. Detoxification or clearing fire may be applied according to suitability. For those wishing to resolve both exterior and interior simultaneously, Chaihu Maidong San (Bupleurum and Ophiopogon Powder) is appropriate. For those wishing to moisten the intestines and resolve toxin, Xiaodu San (Detoxifying Powder) and Sixun Qingliang Yin (Six-Harmonies Cooling Decoction) are appropriate. For those wishing to cool the Blood and resolve toxin, Xi Yu Dihuang Tang (Rhinoceros Horn, Catfish, and Rehmannia Decoction) is appropriate. For those wishing to clear fire, promote urination, and resolve toxin, Dalianqiao Yin is appropriate.