聂九吾曰∶痘出八九日，脓浆充满，颜色苍蜡者上也。若无他证，勿药可也。然
痘出稠密而脓不甚满者，至此时饮食多减，痰涎多盛，宜用养胃开痰汤。（人参、白术、白
茯苓、炙甘草、莲肉、陈皮、半夏、山药、桔梗、楂肉
煎温服。灌脓时忌用术、苓、半夏，恐其干燥津液，脓浆不行也。至此时浆靥时可用矣。渴
者去半夏加麦冬、北五味，吐逆加藿香、砂仁。）
结靥其色蜡黄，一二日从头至两腿皆靥，由胸腹至脚背和额上一齐皆靥，落而
愈者吉。结靥时寒战或手足颤掉气败者，死。（急用补助气血，养脾胃药救之。）结靥时遍身皆
臭烂，如臭饼臭不能近，目中无神者，死。结靥时遍身发痒，抓破无脓，皮卷如豆壳
者，死。痘疤应落不落者，乃火盛也。宜柴苓汤加辰砂六一散，用蜜水调服，外用
滑石末敷之。痘靥不脱不渴，寒战切牙者，属虚寒也，宜木香散。作痒者，白芷、当
归、蝉蜕治之。痘疮灌浆已满，热毒已解，至收靥时，有数日不焦者，只看痘色如初，
无妨。（用八珍汤加牛蒡子、木通补脾利水自安。）痘后疤痕雪白，并无血色者，亦急用补助气血，
养脾胃，庶几可治。此时有咳逆者，（欲呼呃逆。）胃气上越也。取真黄土鼻边闻之，立止。
此时浆满或为寒所薄，一时痘俱紫黑，如紫葡萄色，必惊恐，急以上好肉桂磨汤或
煎服，立见如旧。有寒战切牙者，此真气外发而内虚寒也。宜建中汤大补之。（人参、蜜炙黄 、白
术、归身、川芎、附子、炮姜、肉桂、炙草、丁香、生姜一并同煎温服，一服立止，甚者不过二服。
收靥后寒战切牙者，同此方调治。或谓寒战切牙之证，有热有寒，如痘色红紫齐涌，掀发身热，烦躁作渴，大
便秘，小便赤涩，脉来洪数者，热也。盖胃热则切牙，肺热则寒战也。如痘色淡白，皮薄顶陷，身凉恶寒，大小
便利，脉来沉迟者，寒也。盖胃寒则切牙，肺寒则寒战也。此说当矣。然此证属寒者十九，属热者十一，见于
七八日之前，尤间有热属者，见于七八日之后，其热属者寡矣，是以不为热者立方。）九日十日间，脓浆足
而色苍蜡者，必且发热熏蒸，此回水之候也。盖真阳运化其水，自然消烁而收靥矣，
此虚寒证也。必身凉而手足冷，须大补气血而助之收结，宜用温表调中汤。（人参、白术、
白茯苓、官桂、蜜炙黄 、川芎、归身、炙甘草、炮姜、
防风、白芷、丁香、附子、生姜一片，同煎温服。）其有发热蒸蒸而当靥不靥者，毒瓦斯未解也。退
其热则痘自收，宜用清表散毒汤。（地骨皮、麦冬、花粉、牛蒡、连翘、当归、猪苓、泽泻、黄芩、木
通、生甘草，水煎温服。或用砂糖半酒杯、百沸汤调作一碗温服，谓之甘露回天饮，能令热退痘亦收好，但
毒盛者未必效。）调治吐泻，分别寒热用药，俱同前。痘靥时有外溃而脓水淋漓者，谓之
水靥，宜用新瓦为末，筛令极细，用绢袋包扑患处，若干痂堆不落，内又窨脓，即
以瓦粉用鸭蛋调敷，立收而落。（此浆满热极而溃也。）当靥时或忽然腹痛者，其痛着在中脘，
此热毒凝滞，瘀血作痛也。用消毒散血汤。（牛蒡、生白芍、桃仁、大黄、红花、没药、乳香水煎，一
服立止。又有中恶忽然腹痛者死。）结痂浓实无他证者，不必服药。结痂后发热或烦渴者，当
辨其虚实寒热调治，发热壮盛，胸腹手足
头面俱热，大便秘涩，小便赤涩者，余毒盛也，即当解毒，大连翘饮主之。若解毒
迟，则痂落后必发痈毒。（连翘、牛蒡、柴胡、当
归、赤芍、防风、木通、车前子、荆芥、黄芩、滑石、山
栀、甘草、蝉蜕同煎。大便秘者加酒炒大黄。）若其发热稍缓，头热面不甚热，手心脚心热，手
背脚背不热，精神困倦，大小便利者，虚热也。宜补中益气汤。（人参、黄 、白术、归身、
柴胡、升麻、川芎、炙甘草、陈皮，渴者加麦冬、五味子同煎服。）痂落还元后，或痂落一半后，忽然
遍身大热者，余毒欲发痈也。或手足四肢，头项胸背有一二处热甚者，即痈之所在也。
此在浆脓不满而结痂浮薄者，速收速落者多有之，急宜用大连翘饮以退其热，大便
秘者加酒炒大黄微利之。如热不退，须连服几剂，必须热退身凉，痈毒方可内消。此
时又有忽然头顶大痛者，余毒上攻也。或因多服热药所致，若不急治，其毒必注于
两目，而目病大作矣。宜用大连翘饮去木通、车前、滑石，加升麻、桔梗、川芎、薄
荷服数剂，以解上攻之毒，庶可免目患。痂落后有精神困倦，饮食减少，胸腹头顶手
足心发热而烦渴者，内虚也。仍用补中益气汤主之。或有虽不发热而倦怠嗜卧，不
思饮食，或手足冷，或津液少而渴，或瘢白不红，（血虚危证。）皆内虚之候也。亦宜补中
益气汤调治，不然恐生他证。须知出痘多者，收结之时，还元之后，五脏真气发泄
已多，一身血气耗散已尽，虽或毒瓦斯未净而其正气极虚，是以用凉药解毒，必须用
酒炒制。其体气弱者，或时加人参、 、归、芎之类以救血气，切不可因其有热证而遽
投以生三黄、生栀子、生大黄、生石膏之类，此时正气微弱，骤用寒凉峻攻，多有
一投而辄毙者，戒之戒之。治痘之家，既谨其始，又必谨其终。盖痘之危险不测者
有二∶一曰毒甚，一曰体虚。当其未出之时，或三五日而速毙者，皆因毒盛也，及
其结痂还元之时，或误投一药，误进一饮一食而辄毙者，皆因体虚也。然毒盛欲出
不出者，能顺其势以导之出，而不妄施解毒，以阻遏拂逆之，则未必致毙，故前论
再三戒谕，深为谨始者虑也。体虚者能察其虚而补养之，又防其虚而不峻攻之，则
可保无虞，惟玩其收结还元，而忽易不加谨者，多致误事，故又深为谨终者警也。
喜泰顺曰∶痘至八九日来，已结干红痂 ，如或少有不顺，至此方起脓窠，行
浆既已饱满，收痂次第而行。若遇身重发热，停浆不易收成，此则阳亢阴虚，引以
清凉收敛。浆足气促，或因痰壅而然；忽而发惊，或乃小便秘结。再见气虚而陷塌，
倒靥而黑焦。一则温补可兴，一则攻发可活。泄泻安宁，大虚少毒，肺寒则下脓粘，
脏毒必然便血，挫喉声哑，浆行饱满，塌痒切牙，便实声清尤可活。靥来痂硬变证，
终无痂脱如麸，须愁余毒攻发，或致太过，溃烂难行收拾。身热若见燎人，泡发燎浆
可畏，空遗痘壳，不能成痂，则为浆清。热重腹胀，喘呼而塌靥，皆因毒入内攻。出
来不贯黄浆痂 ，犹如血赤，若能解毒于先，此证断之终美。胃气绝则口唇肿硬，肝
热甚则目睛吊白。喘急发于泻后，总是气虚而断，便泻致以烦渴，岂为实热而然。泄
泻而烦渴不止，理必升提，好饮而发渴愈甚，热难援救。气虚寒战，痘疮无恙。即
温病浆足难收，便实热蒸，须解利进清凉以助结枷，用补法而防过益。斟酌咸宜，庶无后悔。
又曰∶痘成痂 ，虽云生意已成，余毒变迁，尤未得为可喜。是故眼合腹胀，犹
蹈危机，虚浮不退，尚罹凶咎。痂或成而反致失声，前 恐为黑靥；肿未消而眼已
先开，眼开疑是内攻。阳气极而狂叫喘呼，肠胃伤而啼哭不宁。以致风寒入胃，则痢
下脓粘，热渗膀胱，则小便尿血。热毒逗留不化，结痂而壮热憎寒，经络各遗余毒，
日晡而潮热往来。发在午前为实证，烦渴腮红，申过方作是阴虚，便调减食。他如
撮唇弄舌，心经热甚何疑；扶肚抬胸，肺
胃毒冲有准。身热燎人便秘，恐成暴急惊风；悠悠潮热便溏，久变慢脾风搐。验丧
明于眼合羞明，辨口疳于唇焦龈黑。实热下注，大肠必有秘结之祸，虚寒客留脏内，
乃成泄泻之 。喘渴须分虚实。验证切勿差讹。欲观痂落之余，再审瘢根之色。桃
红光润，荣卫俱安；紫黑干枯，尚留热毒。粉白为气血之虚，周过也应身逝；牙疳状
走风之凶，月余亦见长驱。遍体赤斑，乃是失于解利；浑身青紫，恐为感冒风寒。余
毒未消，不时为痈为疖；见风太早，犹防复发疮痍。此是先肾之秘诀，匪人切勿以胡传。
聂九吾说：痘疮发出八九天后，脓浆充满，颜色呈苍黄色的是上佳之象。如果没有其他症状，可以不用服药。然而，如果痘疮出得稠密但脓浆不够饱满，到了这个时候饮食大多减少，痰涎增多，适宜使用养胃开痰汤。（方剂组成：人参、白术、白茯苓、炙甘草、莲子肉、陈皮、半夏、山药、桔梗、山楂肉。煎好后温服。在灌脓阶段忌用白术、白茯苓、半夏，恐怕它们会干燥津液，导致脓浆运行不畅。到了结痂阶段就可以使用了。口渴的去掉半夏，加入麦冬、北五味子；呕吐逆气的加入藿香、砂仁。）
结痂时颜色蜡黄，一两天内从头到双腿都结痂，由胸腹到脚背和额头一起结痂，脱落后痊愈的是吉兆。结痂时如果出现寒战或手足颤抖、气息衰败的，主死。（紧急使用补益气血、调养脾胃的药物来救治。）结痂时全身都臭烂，像臭饼一样气味难闻不能靠近，眼中没有神气的，主死。结痂时全身发痒，抓破后没有脓，皮肤卷曲像豆壳一样的，主死。痘疤应该脱落却不脱落的，是火气旺盛所致。适宜用柴苓汤加辰砂六一散，用蜜水调服，外用滑石末敷贴。痘痂不脱落且不口渴，寒战咬牙的，属于虚寒证，适宜用木香散。发痒的，用白芷、当归、蝉蜕治疗。痘疮灌浆已满，热毒已解，到了收痂的时候，有几天不焦枯的，只要看痘色如初，就没有妨碍。（可用八珍汤加牛蒡子、木通，补脾利水自然安宁。）痘后疤痕雪白，完全没有血色的，也紧急使用补益气血、调养脾胃的药物，或许还可以治疗。这个时候如果有咳逆（想要呼出呃逆）的症状，是胃气上越的表现。取真黄土放在鼻边闻它，立刻停止。这个时候浆液满盈或因受寒侵袭，一时之间痘疮全部变成紫黑色，像紫葡萄的颜色，必定惊恐，紧急用上好的肉桂磨成汤或者煎服，立刻见到恢复如旧。有寒战咬牙的，这是真气外发而内部虚寒。适宜用建中汤大补。（方剂组成：人参、蜜炙黄芪、白术、当归身、川芎、附子、炮姜、肉桂、炙甘草、丁香、生姜，一并同煎温服，一服立刻停止，严重的不过两服。收痂后出现寒战咬牙的，用此方调理。有人说寒战咬牙的病症，有热证也有寒证，比如痘色红紫齐涌，肿胀发热，烦躁口渴，大便秘结，小便赤涩，脉象洪数的，是热证。因为胃热则咬牙，肺热则寒战。比如痘色淡白，皮薄顶陷，身体凉爽怕冷，大小便通畅，脉象沉迟的，是寒证。因为胃寒则咬牙，肺寒则寒战。这种说法是正确的。然而这个病症属寒的占十分之九，属热的占十分之一，出现在七八天之前的，偶尔有属热的，出现在七八天之后的，属热的就很少了，因此不为热证专门立方的。）第九天第十天，脓浆充足而颜色苍黄的，必定还会发热熏蒸，这是回水的征候。因为真阳运化水分，自然消烁而结痂，这是虚寒证。必定身体凉爽而手脚冰冷，必须大补气血来帮助收结，适宜用温表调中汤。（方剂组成：人参、白术、白茯苓、官桂、蜜炙黄芪、川芎、当归身、炙甘草、炮姜、防风、白芷、丁香、附子、生姜一片，同煎温服。）那些发热蒸蒸且该结痂却不结痂的，是毒瓦斯未解。退去热邪则痘疮自然收敛，适宜用清表散毒汤。（方剂组成：地骨皮、麦冬、花粉、牛蒡子、连翘、当归、猪苓、泽泻、黄芩、木通、生甘草，水煎温服。或者用砂糖半酒杯、滚开水调成一碗温服，称为甘露回天饮，能让热退痘亦收好，但毒盛者未必有效。）调理吐泻，分别寒热用药，都同前面所述。痘痂时有外部溃烂而脓水淋漓的，称为水痂，适宜用新瓦烧成粉末，筛得非常细，用绢袋包裹扑撒患处，如果干痂堆积不落，里面又蕴积脓液，就用瓦粉用鸭蛋清调敷，立刻收敛脱落。（这是因为浆液满盈热极而溃烂。）当结痂时如果忽然腹痛，疼痛固定在中脘穴部位，这是热毒凝滞，瘀血作痛。用消毒散血汤。（方剂组成：牛蒡子、生白芍、桃仁、大黄、红花、没药、乳香，水煎，一服立刻停止。又有中恶忽然腹痛的，主死。）结痂浓实没有其他症状的，不必服药。结痂后发热或烦渴的，应当辨别虚实寒热进行调理，发热壮盛，胸腹手足头面都热，大便秘涩，小便赤涩的，是余毒旺盛，就应当解毒，以大连翘饮为主治方。如果解毒迟缓，则痂落后必然发生痈毒。（方剂组成：连翘、牛蒡子、柴胡、当归、赤芍、防风、木通、车前子、荆芥、黄芩、滑石、山栀、甘草、蝉蜕同煎。大便秘结的加酒炒大黄。）如果发热稍缓，头部热面部不甚热，手心脚心热，手背脚背不热，精神困倦，大小便通畅的，是虚热。适宜用补中益气汤。（方剂组成：人参、黄芪、白术、当归身、柴胡、升麻、川芎、炙甘草、陈皮，口渴的加麦冬、五味子同煎服。）痂落还元后，或者痂落一半后，忽然全身大热的，是余毒想要发作痈肿。或者手足四肢、头项胸背有一两处热势严重的，就是痈肿所在之处。这是在浆脓不满而结痂浮薄的情况下，快速收结快速脱落的很多有这样的情况，紧急适宜用大连翘饮来退热，大便秘结的加酒炒大黄轻微通便。如果热不退，必须连服几剂，必须热退身凉，痈毒才可以内消。这个时候又有忽然头顶剧烈疼痛的，是余毒上攻。或者因为多服热药所致，如果不紧急治疗，毒气必定注入两眼，而导致眼病大作。适宜用大连翘饮去掉木通、车前子、滑石，加入升麻、桔梗、川芎、薄荷服用几剂，以解除上攻的毒气，或许可以避免眼患。痂落后有精神困倦，饮食减少，胸腹头顶手足心发热而烦渴的，是内虚。仍然用补中益气汤主治。或者有虽然不发热但倦怠嗜卧，不想饮食，或者手脚冷，或者津液少而口渴，或者疤痕白不红的（血虚危重证候），都是内虚的征候。也适宜用补中益气汤调理，不然恐怕产生其他病症。须知出痘多的时候，收结之时，还元之后，五脏真气发泄已经很多，一身血气耗散已经耗尽，虽然可能毒瓦斯未净但其正气极虚，因此用凉药解毒，必须用酒炒制。体质弱的，或者时常加入人参、黄芪、当归、川芎之类来救补血气，切不可因为有热证就立即投以生三黄（黄连、黄芩、黄柏）、生栀子、生大黄、生石膏之类，此时正气微弱，骤然用寒凉峻猛攻伐，多有投药即死的，切记切记。治痘的家庭，既然谨慎于开始，又必须谨慎于结束。大概痘疮危险不可测度的有两种：一是毒甚，一是体虚。当其未发出的时候，或者三五天就迅速死亡的，都是因为毒盛所致，等到结痂还元的时候，或者误投一药，误进一饮一食就死亡的，都是因为体虚所致。然而毒盛想要出来却出不来的，能顺应其趋势引导它出来，而不妄加解毒，以阻遏违背它的，那么未必致死，所以前面的论述再三告诫，是为谨慎开始的人考虑。体虚的人能观察其虚弱而补养它，又防止其虚弱而不峻猛攻伐它，那么可以保证无虞，只是玩弄其收结还元，而忽视不加谨慎的，多导致误事，所以又深深为谨慎结束的人警示。
喜泰顺说：痘疮到了八九天，已经结干红痂，如果稍微有不顺，到这里才起脓窠，行浆既然已经饱满，收痂按次序进行。如果遇到身体沉重发热，停浆不易收成，这是阳亢阴虚，用清凉收敛的方法。浆足气促，或者因为痰壅所致；忽然发惊，或者小便秘结。再见气虚而陷塌，倒靥而黑焦。一则温补可兴起，一则攻发可活命。泄泻安宁，大虚少毒，肺寒则下脓粘，脏毒必然便血，挫喉声哑，浆行饱满，塌痒咬牙，大便实声音清朗尤其可活。痂来痂硬变证，终无痂脱如麸皮，须愁余毒攻发，或者导致太过，溃烂难以收拾。身体热若见燎人，泡发燎浆可畏，空遗痘壳，不能成痂，则为浆清。热重腹胀，喘呼而塌痂，皆因毒入内攻。出来不贯黄浆痂，犹如血赤，若能解毒于先，此证断言最终美好。胃气绝则口唇肿硬，肝热甚则目睛吊白。喘急发于泻后，总是气虚而断绝，便泻致使烦渴，岂是实热所致。泄泻而烦渴不止，理必升提，好饮而发渴愈甚，热难救援。气虚寒战，痘疮无恙。即使温病浆足难收，大便实热蒸，须解利进清凉以帮助结痂，用补法而防过益。斟酌咸宜，庶无后悔。
又说：痘成痂，虽云生意已成，余毒变迁，尤未得为可喜。因此眼合腹胀，犹蹈危机，虚浮不退，尚罹凶咎。痂或成而反致失声，前恐为黑靥；肿未消而眼已先开，眼开疑是内攻。阳气极而狂叫喘呼，肠胃伤而啼哭不宁。以致风寒入胃，则痢下脓粘，热渗膀胱，则小便尿血。热毒逗留不化，结痂而壮热憎寒，经络各遗余毒，日晡而潮热往来。发在午前为实证，烦渴腮红，申过方作是阴虚，便调减食。他如撮唇弄舌，心经热甚何疑；扶肚抬胸，肺胃毒冲有准。身热燎人便秘，恐成暴急惊风；悠悠潮热便溏，久变慢脾风搐。验丧明于眼合羞明，辨口疳于唇焦龈黑。实热下注，大肠必有秘结之祸，虚寒客留脏内，乃成泄泻之 。喘渴须分虚实。验证切勿差讹。欲观痂落之余，再审瘢根之色。桃红光润，荣卫俱安；紫黑干枯，尚留热毒。粉白为气血之虚，周过也应身逝；牙疳状走风之凶，月余亦见长驱。遍体赤斑，乃是失于解利；浑身青紫，恐为感冒风寒。余毒未消，不时为痈为疖；见风太早，犹防复发疮痍。此是先肾之秘诀，匪人切勿以胡传。
Nie Jiwu said: When smallpox lesions appear for eight or nine days, and the pustules are full with a grayish-yellow color, this is an excellent sign. If there are no other symptoms, medication may be omitted. However, if the smallpox lesions are dense but the pus is not sufficiently full, at this stage dietary intake often decreases while phlegm and saliva increase; it is appropriate to use Yangwei Kaitan Decoction (Stomach-Nourishing and Phlegm-Resolving Decoction). [Ingredients: Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Baifuling), Prepared Licorice Root (Zhigancao), Lotus Seed (Lianrou), Tangerine Peel (Chenpi), Pinellia Tuber (Banxia), Chinese Yam Rhizome (Shanyao), Platycodon Root (Jiegeng), Hawthorn Fruit (Zharou). Decoct and take warm. During the pus-filling stage, avoid using Baizhu, Baifuling, and Banxia, as they may dry up body fluids and hinder pus formation. They can be used during the scabbing stage. For thirst, remove Banxia and add Ophiopogon Tuber (Maidong) and Schisandra Berry (Beiweimei); for vomiting and reflux, add Agastache Herb (Huoxiang) and Amomum Fruit (Sharen).]
When scabs form with a waxy yellow color, and within one or two days the scabbing extends from the head down to both legs, covering the chest, abdomen, feet dorsum, and forehead simultaneously, healing after shedding is auspicious. If chills or trembling of hands and feet occur during scabbing, accompanied by failing qi, death is indicated. (Urgently use herbs that tonify qi and blood and nourish the spleen and stomach to rescue.) If the entire body becomes foul and rotting during scabbing, emitting an odor like rotten cakes that is unbearable, and the eyes lack spirit, death is indicated. If the entire body itches during scabbing, scratching reveals no pus, and the skin curls like bean shells, death is indicated. If the smallpox scars should fall off but do not, it is due to excessive fire. It is appropriate to use Chai Ling Tang (Bupleurum and Poria Decoction) plus Chen Sha Liu Yi San (Cinnabar Six-to-One Powder), mixed with honey water for oral administration, and apply Talcum Powder (Huashi) externally. If the scabs do not shed and there is no thirst, but chills and teeth grinding occur, it belongs to deficiency-cold; Muxiang San (Costus Root Powder) is appropriate. If itching occurs, treat with Angelica Dahurica Root (Baizhi), Dang Gui (Angelica Sinensis), and Cicada Slough (Chantui). When smallpox pustules are fully filled and heat-toxins have resolved, but during the scabbing phase some do not dry for several days, as long as the lesion color remains original, there is no harm. (Use Bazhen Tang (Eight-Treasure Decoction) plus Niubangzi (Arctium Fruit) and Mutong (Akebia Stem) to tonify the spleen and promote urination for natural peace.) If post-smallpox scars are snow-white with no blood color, urgently use herbs to tonify qi and blood and nourish the spleen and stomach; perhaps treatment is still possible. At this time, if there is coughing and retching (desire to hiccup), it indicates stomach qi rebelling upward. Smelling real yellow earth near the nose will stop it immediately. If the pustules are full but affected by cold, causing the lesions to turn purple-black like purple grapes, panic ensues; urgently grind high-quality Cinnamon Twig (Rougui) into decoction or administer orally, and recovery will be seen immediately. With chills and teeth grinding, this indicates true qi emerging externally while internal deficiency-cold exists. Jianzhong Tang (Middle-Warming Decoction) is appropriate for major tonification. [Ingredients: Ginseng Radix et Rhizoma (Renshen), Honey-fried Astragalus Root (Huangqi), Atractylodis Macrocephalae Rhizoma (Baizhu), Angelicae Sinensis Radix (Guishen), Szechwan Lovage Rhizome (Chuanxiong), Prepared Aconite Lateralis Radix (Fuzi), Roasted Ginger (Paojiang), Cinnamon Twig (Rougui), Prepared Licorice Root (Zhigancao), Clove Bud (Dingxiang), Fresh Ginger (Shengjiang). Decoct together and take warm. One dose stops it immediately; severe cases require no more than two doses. For chills and teeth grinding after scabbing, regulate with this formula. Some say chills and teeth grinding can be either heat or cold: if lesions are bright red-purple, swelling and heat are prominent, irritability and thirst exist, stool is constipated, urine is red and scanty, and pulse is flooding and rapid, it is heat. Stomach heat causes teeth grinding; lung heat causes chills. If lesions are pale white, skin is thin and depressed, body is cool and aversion to cold exists, bowel movements and urination are free, and pulse is deep and slow, it is cold. Stomach cold causes teeth grinding; lung cold causes chills. This theory is correct. However, nineteen percent of these cases are cold, ten percent are heat. Heat appearing before the seventh or eighth day is occasional; heat appearing after the seventh or eighth day is rare. Therefore, no specific formula is provided for heat.] On the ninth or tenth day, when pus is sufficient and color is grayish-yellow, fever and steaming sensation must occur; this is the stage of fluid return. True yang transforms fluids, naturally evaporating them for scabbing; this is a deficiency-cold syndrome. The body must be cool with cold extremities; major tonification of qi and blood is required to assist scabbing. Wenbiao Tiaozhong Tang (Warm Exterior and Regulate Middle Decoction) is appropriate. [Ingredients: Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Baifuling), Official Cinnamon Bark (Guangui), Honey-fried Astragalus Root (Huangqi), Szechwan Lovage Rhizome (Chuanxiong), Angelicae Sinensis Radix (Guishen), Prepared Licorice Root (Zhigancao), Roasted Ginger (Paojiang), Saposhnikovia Root (Fangfeng), Angelica Dahurica Root (Baizhi), Clove Bud (Dingxiang), Prepared Aconite Lateralis Radix (Fuzi), Fresh Ginger slice. Decoct together and take warm.] Those who steam with fever and fail to scab when they should, have unresolved toxin-waste. Resolving the heat allows the smallpox to resolve naturally; Qingbiao Sandu Tang (Clear Exterior and Dispel Toxin Decoction) is appropriate. [Ingredients: Cortex Lycii (Digupi), Ophiopogon Tuber (Maidong), Trichosanthes Root (Huafen), Arctium Fruit (Niubang), Forsythia Fruit (Lianqiao), Angelicae Sinensis Radix (Danggui), Polyporus (Zhuling), Alisma Rhizome (Zexie), Scutellaria Root (Huangqin), Akebia Stem (Mutong), Raw Licorice Root (Shenggancao). Decoct in water and take warm. Alternatively, mix half a wine cup of sugar cane juice with boiling water to make one bowl, take warm; this is called Ganlu Huitian Yin (Sweet Dew Heaven-Returning Drink), which can reduce heat and help scabbing, but may not be effective if toxins are strong.] For regulating vomiting and diarrhea, differentiate cold and heat for medication, same as previously described. If external ulceration with dripping pus occurs during scabbing, it is called "water scab." Use powder made from new roof tiles, sifted very finely, packed in silk bags, and applied to the affected area. If dry scabs pile up without falling and pus accumulates inside, apply tile powder mixed with duck egg white to achieve immediate resolution and shedding. (This occurs when pus is full, heat is extreme, and ulceration happens.) If sudden abdominal pain occurs during scabbing, localized at the Zhongwan point, it is due to heat-toxin stagnation and blood stasis causing pain. Xiaodu Sanxue Tang (Detoxify and Resolve Blood Stasis Decoction) is appropriate. [Ingredients: Arctium Fruit (Niubang), Raw White Peony Root (Shengbaishao), Peach Kernel (Taoren), Rhubarb (Dahuang), Safflower (Honghua), Myrrh (Moyao), Frankincense (Ruxiang). Decoct in water; one dose stops pain immediately. Sudden abdominal pain due to evil invasion results in death.] If scabs are thick and solid with no other symptoms, no medication is needed. If fever or irritability/thirst occurs after scabbing, differentiate deficiency/excess and cold/heat for regulation. If fever is intense, with heat in chest, abdomen, hands, feet, head, and face, constipation, and red/scanty urine, residual toxin is strong; detoxification is required, primarily using Dalianqiao Yin (Large Forsythia Drink). If detoxification is delayed, carbuncles will likely erupt after scab shedding. [Ingredients: Forsythia Fruit (Lianqiao), Arctium Fruit (Niubang), Bupleurum Root (Chaihu), Angelicae Sinensis Radix (Danggui), Red Peony Root (Chishao), Saposhnikovia Root (Fangfeng), Akebia Stem (Mutong), Plantago Seed (Cheqianzi), Schizonepeta Spike (Jingjie), Scutellaria Root (Huangqin), Talcum (Huashi), Gardenia Fruit (Shanzhi), Licorice Root (Gancao), Cicada Slough (Chantui). Decoct together. Add wine-fried Rhubarb (Dahuang) if constipated.] If fever is slightly milder, head is hot but face is not very hot, palms and soles are hot but backs of hands and feet are not, spirit is fatigued, and bowel/urinary functions are free, it is deficiency-heat. Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) is appropriate. [Ingredients: Ginseng Radix et Rhizoma (Renshen), Astragalus Root (Huangqi), Atractylodis Macrocephalae Rhizoma (Baizhu), Angelicae Sinensis Radix (Guishen), Bupleurum Root (Chaihu), Cimicifuga Rhizome (Shengma), Szechwan Lovage Rhizome (Chuanxiong), Prepared Licorice Root (Zhigancao), Tangerine Peel (Chenpi). Add Ophiopogon Tuber (Maidong) and Schisandra Berry (Wuweizi) if thirsty.] After scab shedding and restoration, or halfway through shedding, if sudden whole-body high fever occurs, residual toxin is attempting to erupt as a carbuncle. If one or two areas on limbs, neck, chest, or back are intensely hot, those are the sites of carbuncles. This often happens when pustules were insufficient but scabs formed thinly and fell quickly. Urgently use Dalianqiao Yin to reduce heat; add wine-fried Rhubarb if constipated to mildly purge. If heat persists, continue for several doses until heat subsides and body cools, allowing internal resolution of carbuncles. If sudden severe headache at the vertex occurs, residual toxin is attacking upward. This may also result from excessive consumption of warming herbs. If not treated urgently, toxin will invade the eyes, causing severe eye disease. Use Dalianqiao Yin removing Mutong, Cheqianzi, and Huashi, adding Cimicifuga Rhizome (Shengma), Platycodon Root (Jiegeng), Szechwan Lovage Rhizome (Chuanxiong), and Mint (Bohe) for several doses to resolve upward-attacking toxin, thereby avoiding eye complications. If fatigue, reduced appetite, heat in chest/abdomen/head/palms/soles, and irritability/thirst occur after scab shedding, it is internal deficiency. Continue using Buzhong Yiqi Tang. If there is no fever but fatigue, desire to lie down, anorexia, cold extremities, dry mouth/thirst, or white/non-red scars (critical blood deficiency), these are signs of internal deficiency. Buzhong Yiqi Tang is also appropriate; otherwise, other syndromes may arise. Note that abundant smallpox eruption depletes the true qi of the five zang organs and exhausts blood and qi throughout the body during scabbing and restoration. Although residual toxin may remain, righteous qi is extremely deficient. Therefore, when using cooling herbs for detoxification, they must be wine-fried. For weak constitutions, occasionally add Ginseng (Renshen), Astragalus (Huangqi), Angelica (Danggui), and Szechwan Lovage (Chuanxiong) to rescue blood and qi. Do not abruptly administer raw Sanhuang (Three Yellows: Scutellaria, Phellodendron, Gentiana), raw Gardenia (Zhizi), raw Rhubarb (Dahuang), or raw Gypsum (Shigao) just because heat signs exist. At this time, righteous qi is weak; sudden use of harsh cold purgatives often leads to death. Beware! Treaters of smallpox must be cautious at the beginning and the end. There are two unpredictable dangers in smallpox: one is severe toxin, the other is weak constitution. Death within three to five days before eruption is due to strong toxin. Death upon taking wrong medicine or food during scabbing/restoration is due to weak constitution. For strong toxin preventing eruption, guide it out by following its trend without reckless detoxification that blocks flow; thus, previous warnings emphasize caution at the start. For weak constitution, observe deficiency and tonify, avoiding harsh purgatives; this ensures safety. Neglecting caution during scabbing/restoration often leads to errors; thus, warnings emphasize caution at the end.
Xi Taishun said: By the eighth or ninth day, smallpox should have formed dry red scabs. If there is slight irregularity, pustules may only now form. Once pus is full and scabbing proceeds in order, good. If heavy body and fever cause stagnation of pus and difficulty in scabbing, this is hyperactive yang and yin deficiency; use cooling and astringent methods. Full pus with shortness of breath may be due to phlegm obstruction; sudden fright or constipation of small urine may occur. If qi deficiency causes collapse, inverted scabs turning black and scorched appear. One case responds to warming tonification; another to resolving attack. Diarrhea calming indicates great deficiency with little toxin; lung cold causes sticky pus discharge; intestinal toxin causes bloody stool; throat trauma with hoarseness, full pus flow, collapsing itch, teeth grinding, firm stool, and clear voice indicate survivability. Hard scabs with changes, finally no scab shedding like bran, worry about residual toxin attacking; excess may cause difficult-to-manage ulceration. Body heat burning others, blistering with hot pus is fearful; empty shell remaining without scab formation indicates clear pus. Severe heat with abdominal distension, panting, and collapsed scabs all result from toxin attacking internally. Lesions lacking yellow pus/scabs, resembling blood red, if detoxified early, prognosis is excellent. Extinction of stomach qi causes swollen/hard lips; severe liver heat causes staring white eyes. Panting after diarrhea always indicates qi extinction; diarrhea causing irritability/thirst is not excess heat. Persistent diarrhea with unrelenting thirst requires lifting; excessive drinking worsening thirst makes heat hard to save. Qi deficiency with chills, smallpox is safe. Even if warm disease has full pus but hard to collect, firm stool with steaming heat requires clearing/detoxifying with cooling to aid scabbing; use tonification to prevent over-benefiting. Balance is suitable, avoiding regret.
Also said: Smallpox forming scabs means life intent is established, but residual toxin changes are not yet pleasant. Eye closure with abdominal distension steps into crisis; floating deficiency not receding brings disaster. Scab formation followed by loss of voice fears black scabs; swelling not subsided but eyes open first suspects internal attack. Extreme yang causes screaming/panting; intestinal/stomach injury causes restless crying. Wind-cold entering stomach causes dysentery with sticky pus; heat seeping into bladder causes hematuria. Heat-toxin lingering fails to transform; scabbing with high fever and aversion to cold leaves residual toxin in meridians, tidal fever at dusk. Morning onset is excess syndrome: irritability, thirst, red cheeks; afternoon onset is yin deficiency: adjust diet reducing intake. Other signs: lip puckering/tongue playing indicates heart meridian heat; holding belly/lifting chest indicates lung/stomach toxin impact. Burning body heat with constipation fears violent convulsions; lingering tidal fever with loose stools slowly transforms into slow spleen wind tremors. Verify blindness via eye closure/photophobia; distinguish mouth ulcers via scorched lips/black gums. Excess heat sinking downward causes large intestine constipation; deficiency-cold lodging in viscera causes diarrhea. Panting/thirst must differentiate deficiency/excess. Verification must not err. Observing post-scab shedding, re-examine scar root color. Peach-red glossy indicates healthy defensive and nutritive qi; purple-black dry indicates lingering heat-toxin. Powdery white indicates qi/blood deficiency, extending beyond expectation implies death; gum erosion resembling wind movement is ominous, visible after a month as driving force. Whole-body red spots indicate failure to clear/detoxify; whole-body cyanosis fears wind-cold invasion. Residual toxin not eliminated causes intermittent carbuncles/furuncles; early exposure to wind fears recurrence of sores. This is the secret of prior kidney transmission; do not pass it carelessly to unworthy persons.