倒靥浆清陷不红，痘壳皮皱痂不成，速用加味保元剂，气充血足痘收功。
【注】倒靥者，浆色清稀不足，根脚淡白无晕，遍体形如豆壳，疮皮皱而似结非结，至
收靥时终不成痂。此因气血两虚，乏领载之力也。宜加味保元汤治之。
\r倒靥图\p03-b24a43.bmp\r
加味保元汤
人参 黄 （蜜炙） 甘草（炙） 全当归（酒洗） 白芍（酒炒） 木香（煨）
白术（土炒） 官桂
引用老米，水煎服。
【方歌】加味保元治倒靥，人参黄 甘草协，当归白芍广木香，白术官桂效更捷。
痘疔枭毒乱正疮，色紫黑黯形坚强，先出先长妨诸痘，针刺随贴四圣良。
【注】痘疔之成，由枭毒蕴伏，锢蔽于肌肉之间，痘未出疔先出，痘未长疔先长，其
色紫黑，其形坚强，五脏各有所见∶心疔色赤，起于颧阜胸乳之处；肝疔色紫，起于左
太阳、左胁、眼胞、两臀阜之处；脾疔色先黄后黑，起于腮颊、中庭、口角、肚腹、手
足之处；肺疔色先灰后黑，起于右太阳、右胁、颈项、喉突之处；肾疔色黑，起于地阁、
后颈、耳窖、背窬、腰脊、阳茎之处。见时急用银针刺破，以泄毒血。刺后用四圣膏贴
患处。若迟延不治，能使痘当发不发，当胀不胀，当灌不灌，而百变生矣。
\r痘疔图\p03-b24a44.bmp\r
四圣膏
绿豆（四十九粒） 豌豆（俱烧灰存性，四十九粒） 珍珠（ ，一分）
头发（烧灰，一分）
上为细末，以棉燕脂水调和成膏。将银针拨开疮头，然后涂之。
痘疹出现倒靥时，浆液清稀，痘体下陷且颜色不红，痘壳皮肤皱缩，无法形成正常的痂皮。此时应迅速使用加味保元剂治疗，使气充血足，痘疹即可收功痊愈。
【注】所谓倒靥，是指痘浆颜色清稀不足，痘根周围淡白无红晕，全身痘疹形如豆壳，疮皮皱缩看似结痂却未真正结成，到了该收靥的时候最终也无法结痂。这是因为气血两虚，缺乏承载和推动的力量所致。适宜用加味保元汤来治疗。
加味保元汤
人参、黄芪（用蜂蜜炙烤）、甘草（炙烤）、全当归（用酒清洗）、白芍（用酒炒制）、木香（煨制）、白术（用土炒制）、官桂。
引用老米作为药引，加水煎煮后服用。
【方歌】加味保元汤治疗倒靥，人参、黄芪与甘草协同作用，当归、白芍配合广木香，加上白术和官桂，疗效更加快捷。
痘疔如同枭毒扰乱正常痘疹，颜色紫黑晦暗，形态坚硬强实。如果痘疔先于其他痘疹长出，会妨碍其余痘疹的生长发育。此时先用针刺破，随即贴上四圣膏，效果良好。
【注】痘疔的形成，是由于枭毒蕴藏潜伏，固结闭塞在肌肉之间。痘疹尚未发出，痘疔先发出；痘疹尚未长大，痘疔先长大。其颜色紫黑，形态坚硬。五脏各有对应的痘疔表现：心疔颜色发红，起于颧骨隆起处、胸部和乳房部位；肝疔颜色发紫，起于左侧太阳穴、左侧胁部、眼睑、两侧臀部隆起处；脾疔颜色先黄后黑，起于腮颊、中庭、口角、腹部、手足部位；肺疔颜色先灰后黑，起于右侧太阳穴、右侧胁部、颈项、喉结部位；肾疔颜色发黑，起于下巴、后颈部、耳道、背部腰臀、腰脊、阴茎部位。发现时急需用银针刺破，以泄出毒血。刺破后使用四圣膏贴敷患处。如果拖延不治，会导致痘疹应当发出而发不出，应当胀大而胀不大，应当灌浆而不灌浆，从而产生各种变证。
四圣膏
绿豆（四十九粒）、豌豆（全部烧成灰但保留药性，四十九粒）、珍珠（一钱一分）、头发（烧成灰，一钱一分）。
以上药物研成细末，用棉燕脂水调和成膏状。先用银针拨开疮头，然后涂抹此膏。
When smallpox lesions present as "Dao Ye" (inverted healing), the pustular fluid is clear and thin, the lesions are sunken and lack redness, the scab skin is wrinkled, and a normal crust fails to form. At this stage, Jiawei Baoyuan Decoction should be administered immediately to replenish Qi and Blood, allowing the smallpox to complete its course and heal.
[Note] "Dao Ye" refers to a condition where the pustular fluid is clear and insufficient, the base of the lesion is pale white without a surrounding red halo, and the body's lesions resemble bean shells. The lesion skin is wrinkled, appearing to scab but not truly forming one, ultimately failing to crust even when the healing phase arrives. This is caused by deficiency in both Qi and Blood, lacking the strength to carry and support the process. It is suitable for treatment with Jiawei Baoyuan Tang.
Jiawei Baoyuan Decoction
Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix) [honey-fried], Gan Cao (Glycyrrhizae Radix et Rhizoma) [roasted], Quan Dang Gui (Angelicae Sinensis Radix) [wine-washed], Bai Shao (Paeoniae Radix Alba) [wine-stir-fried], Mu Xiang (Aucklandiae Radix) [baked], Bai Zhu (Atractylodis Macrocephalae Rhizoma) [soil-fried], Guan Gui (Cinnamomi Cortex).
Use Lao Mi (aged rice) as a guide drug, decoct with water, and take orally.
[Prescription Song] Jiawei Baoyuan treats Dao Ye, Ren Shen, Huang Qi, and Gan Cao cooperate; Dang Gui, Bai Shao, and Guang Mu Xiang combine; Bai Zhu and Guan Gui make the effect more swift.
Dou Ding (Smallpox Carbuncle) carries fierce toxicity and disrupts normal lesions; its color is purple-black and dull, and its form is hard and strong. If it appears and grows before other smallpox lesions, it hinders their development. First, prick it with a needle, then apply Sisheng Gao (Four Sages Plaster); this is beneficial.
[Note] The formation of Dou Ding results from fierce toxicity accumulating and lurking, becoming entrenched between muscles. It appears before the smallpox erupts and grows before the smallpox enlarges. Its color is purple-black, and its form is hard. Each of the five Zang organs has specific manifestations: Xin Ding (Heart Carbuncle) is red in color and arises on the zygomatic prominence, chest, and breast area; Gan Ding (Liver Carbuncle) is purple in color and arises on the left Taiyang region, left hypochondrium, eyelids, and bilateral buttock prominences; Pi Ding (Spleen Carbuncle) is initially yellow then turns black and arises on the cheeks, Zhongting, corners of the mouth, abdomen, hands, and feet; Fei Ding (Lung Carbuncle) is initially gray then turns black and arises on the right Taiyang region, right hypochondrium, neck, and laryngeal prominence; Shen Ding (Kidney Carbuncle) is black in color and arises on the chin, posterior neck, ear canal, back and waist-hip region, lumbar spine, and penis. Upon discovery, urgently pierce with a silver needle to drain toxic blood. After piercing, apply Sisheng Gao to the affected area. If treatment is delayed, it will cause the smallpox to fail to erupt when it should, fail to swell when it should, and fail to fill with pus when it should, leading to various complications.
Sisheng Gao
Lu Dou (Mung Bean Seed) [49 grains], Wan Dou (Pea Seed) [burned to ash retaining efficacy, 49 grains], Zhen Zhu (Pearl) [1 qian 1 fen], Tou Fa (Human Hair) [burned to ash, 1 qian 1 fen].
Grind the above into fine powder, mix with Mian Yan Zhi Shui (Cotton Carmine Water) to form a paste. Use a silver needle to open the lesion head, then apply the paste.