痘后中气多虚，有感必伤，尤宜防护。尝有小儿痘后，收靥脱痂，安然无事，一遇暑热所侵，或秽恶所触，即成痧
胀。往往有忽然生变，人多认为恶痘所致，即痘科任事者，亦以为然，竞不知其痧之为害有如斯也。
治验∶
一胡丹 子，七岁，八月出痘脱痂光洁，饮食如常，行步如旧。迨二十五朝，忽然叫喊不已，发晕欲死，皆以为
恶痘余毒使然。求余治之，左右手六部俱微细而伏，余思恶痘余毒兆变，脉当沉紧有力，今微细而伏若此，脉症不合，
视其痧筋，历历可指，刺出紫黑毒血，不愈。用荆芥银花汤合和脾宣化饮，稍冷冻饮料之即苏。后小腹痛，变为痢疾，用当
归五钱，山楂一钱、熟大黄五分、加童便微温饮之，稍安后，独有用当归、山楂四剂而痊。
一张可久女十五岁，痘后三十二朝，忽然发晕沉重，不能转侧。延余延医，右脉微细，左脉洪大，时一歇指。视其
指头黑色，青筋历历，刺出毒血，不愈。用降香桃花散合枳实大黄汤稍冷冻饮料之，不愈。用三香丸微温服，而痊。后伤食，
为秽气所触，腹痛，刮痧，服棱术汤加明矾二分，微冷冻饮料之而安。
孕妇之痧，最易伤胎；产后之痧，须防恶阻，较之平人更甚，当急为救疗。庶于痧毒未攻坏脏腑之时，可以施治。
若属暗痧，发于此时，胎前痧脉；溷于有孕，产后痧脉，杂于恶阻，又无心腹痛剧，痧从暗发。须当究其症候，察其
声色，看有痧筋，急宜刺破，肌肤痧拥，尤重油盐，至若痧毒横行，肆攻脏腑，莫可挽回，慎毋草草以误人也。
治验∶
一赵方亨内室，怀娠六月，寒热交作，烦闷不安。延余时，痧在始发，脉固未现，初不觉其为痧，用药不应，忽尔
昏沉。次日，余诊左手脉伏，面目微黑，乃识其痧，刺腿弯青筋六针，出毒血，少愈。用桑寄生、红花、香附、益母草、
荆芥、细辛、卜子、神曲冲砂仁末，微冷服而安，后用小柴胡汤退热，又参苓归地健脾养血乃痊。
痘疹痊愈后，人体中气大多虚弱，一旦感受外邪必然受损，因此尤其需要加以防护。我曾见过小儿在痘疹消退、痂皮脱落后，原本安然无恙，但一遇到暑热侵袭，或接触污秽恶浊之气，就会立刻引发痧胀。这种情况往往突然发生变故，人们多认为是恶毒痘疹所致，即使是专门从事痘科治疗的医生也这样认为，却不知痧的危害竟然如此严重。
治疗案例：
一位胡姓人家的儿子，七岁大，八月时出痘并结痂脱落，皮肤光洁，饮食正常，行动如常。到了第二十五天，忽然大声叫喊不止，头晕目眩几乎要死去，大家都认为是恶痘余毒导致的变证。求我诊治，发现其左右手六部脉象都微细且潜伏难寻。我思考恶痘余毒引发的变证，脉象应当沉紧有力，如今脉象微细而伏，脉症不符。查看其身上的痧筋，清晰可辨，针刺放出紫黑色的毒血，病情未愈。于是使用荆芥银花汤合和脾宣化饮，稍微放凉后服用，患者随即苏醒。后来出现小腹痛，转变为痢疾，使用当归五钱、山楂一钱、熟大黄五分，加入童便（儿童尿液）微温服用，症状稍安之后，仅用当归和山楂四剂药便痊愈。
另一位张可久的女儿，十五岁，痘后第三十二天，忽然感到头晕沉重，无法翻身转动。请我去诊治，右脉微细，左脉洪大，脉搏偶尔有间歇。观察其手指头呈黑色，青筋清晰可见，针刺放出毒血，病情未愈。使用降香桃花散合枳实大黄汤，稍微放凉后服用，仍未见效。改用三香丸微温服用，病就好了。后来因饮食积滞，又受秽气触碰，导致腹痛，进行刮痧，服用棱术汤加明矾二分，稍微放凉后服用便安定下来。
孕妇患痧，最容易损伤胎儿；产后患痧，必须防止恶阻反应加重，这比普通人更为严重，应当紧急救治。趁着痧毒尚未攻坏脏腑之时施治，尚有机会挽回。如果属于暗痧，在此时发作，胎前的痧脉容易混淆于怀孕脉象中，产后的痧脉容易混杂于恶阻症状中，如果没有剧烈的心腹疼痛，且痧毒从内部隐伏发作，就必须仔细探究其症候，观察其神色声音，查看是否有痧筋，急宜刺破。若肌肤表面痧毒壅盛，则更加重视油盐等辅助疗法。至于痧毒横行，肆意攻伐脏腑，那就无可挽回了，务必谨慎，切勿草率行事而误人性命。
治疗案例：
赵方亨的妻子，怀孕六个月，寒热交替发作，烦闷不安。请我去诊视时，痧毒刚刚发出，脉象确实还未显现，起初并未察觉是痧，用药无效，忽然陷入昏沉。第二天，我诊察其左手脉象伏匿，面目微微发黑，这才识别出是痧毒，针刺腿部腘窝处的青筋六针，放出毒血，病情稍有好转。使用桑寄生、红花、香附、益母草、荆芥、细辛、莱菔子、神曲，冲入砂仁末，微冷服用后安定下来，后来用小柴胡汤退热，再用参苓归地汤健脾养血，最终痊愈。
After the recovery from smallpox, the middle Qi (Vital Energy of the Middle Jiao) is often deficient; any pathogenic invasion will inevitably cause damage, so special protection is advisable. I have observed cases where children, after the scabs of smallpox had fallen off and they were seemingly fine, suddenly developed Sha Zhang (Sha distension/swelling) upon exposure to summer-heat or foul odors. These conditions often change abruptly. People generally attribute them to malignant smallpox toxins, and even specialists in smallpox treatment share this view, failing to realize that Sha can be so harmful.
Clinical Cases:
1. The son of a Mr. Hu, aged seven, had his smallpox erupt and scab over in August. His skin was smooth, diet normal, and movement unchanged. On the twenty-fifth day, he suddenly screamed incessantly, felt dizzy as if dying, and everyone believed it was due to residual toxins from malignant smallpox. Upon my examination, the pulses in all six positions of both wrists were faint, thin, and deep-hidden. I reasoned that if it were a transformation caused by residual smallpox toxins, the pulse should be deep, tight, and forceful. The current faint and hidden pulse contradicted the symptoms. Observing his Sha veins (distended subcutaneous veins), they were clearly palpable. After puncturing and draining purple-black toxic blood, there was no improvement. I then prescribed Jingjie Yinhua Tang (Scutellaria and Forsythia Decoction) combined with He Pi Xuan Hua Yin (Spleen-Harmonizing and Transformation-Dispersing Drink), administered slightly cooled. He recovered consciousness shortly after. Later, he suffered lower abdominal pain and developed dysentery. I used Dang Gui (Radix Angelicae Sinensis) 5 qian, Shan Zha (Fructus Crataegi) 1 qian, and Shu Da Huang (Prepared Rhizoma et Radix Rhei) 5 fen, mixed with fresh urine (Tong Bian) and given warm. Symptoms eased slightly, but full recovery required four doses of Dang Gui and Shan Zha alone.
2. The daughter of Zhang Kelou, aged fifteen, on the thirty-second day after smallpox, suddenly experienced severe dizziness and heaviness, unable to turn her body. Upon consultation, the right pulse was faint and thin, while the left pulse was surging and large, with occasional intermittent beats. Her fingertips appeared black, and green veins were clearly visible. Puncturing and draining toxic blood yielded no result. Jiangxiang Taohua San (Aquilaria and Peach Blossom Powder) combined with Zhishi Dahuang Tang (Immature Bitter Orange and Rhubarb Decoction) was given slightly cooled, without success. Finally, Sanxiang Wan (Three Fragrances Pill) was administered warm, leading to recovery. Later, due to food stagnation and exposure to foul air, she suffered abdominal pain. Scraping therapy (Gua Sha) was performed, and Lengzhu Tang (Borneol and Curcuma Decoction) with 2 fen of Ming Fan (Alumen) was given slightly cooled, resulting in stability.
Sha in pregnant women easily harms the fetus; Sha in postpartum women requires vigilance against E Zu (nausea/vomiting during pregnancy/postpartum complications), which is more severe than in ordinary individuals. Urgent treatment is necessary to intervene before Sha toxins destroy the Zang-Fu organs. If it is "Dark Sha" (hidden Sha) occurring at these times, the Sha pulse may be confused with the pregnancy pulse, and the postpartum Sha pulse may be mixed with E Zu symptoms. Without severe heart or abdominal pain, and with Sha manifesting internally, one must carefully investigate the symptoms, observe the voice and complexion, check for Sha veins, and urgently puncture them. If Sha congestion is prominent on the skin, oil and salt therapies are particularly important. However, if Sha toxins run rampant and attack the Zang-Fu organs uncontrollably, recovery is impossible. One must be cautious and not act rashly to endanger lives.
Clinical Case:
The wife of Zhao Fangheng, six months pregnant, suffered alternating chills and fever, restlessness, and discomfort. When consulted, the Sha toxin was just beginning to emerge, and the pulse had not yet manifested distinctly. Initially, Sha was not suspected, and medication failed. She suddenly fell into a coma. The next day, her left pulse was found to be deep-hidden, and her face and eyes were slightly dark. Recognizing it as Sha, I punctured six points on the blue veins in the popliteal fossa (back of the knee), draining toxic blood. She improved slightly. A decoction of Sang Ji Sheng (Taxillus), Hong Hua (Carthamus), Xiang Fu (Cyperus), Yi Mu Cao (Leonurus), Jing Jie (Schizonepeta), Xi Xin (Asarum), Bo Zi (Raphanus Shenqu), and Shen Qu (Medicated Leaven), mixed with Sha Ren (Amomum) powder, was taken slightly cool, bringing relief. Subsequently, Xiao Chai Hu Tang (Minor Bupleurum Decoction) was used to reduce fever, followed by Shen Ling Gui Di Tang (Ginseng, Poria, Angelica, and Rehmannia Decoction) to strengthen the Spleen and nourish Blood, leading to complete recovery.