徐仲光治一儿，浆足，为秽气所触，倒靥焦黑，四肢肿痛。幸其能食便调，正不留邪，必发痈也，用内托
解毒之剂而愈。
一儿七朝痘顺，有行浆之势，两臂膊肿大如瓜，幸能食便调。此少阳经虚，毒滞不散也，补其阳而肿自愈。
用参、 、甘、桂、归、芍、陈、芷、羌活、人中黄治之，浆足肿渐消而愈。
一儿痘症相同，不补，浆虽满，痂肿处成脓，竟损一目。
一儿五朝，两臂肿痛，用解散药而浆不充，毒不退，反寒战作痒，危甚。此急治其表，而失于补托也。保
元汤加丁、桂、术、橘治之，浆足而痂。后以托解药，其毒成脓而愈。
一痘密而内强，过于补益而生痈肿，烦躁，口渴便秘，以三黄丸利之，再用清解之剂调理，肿消而愈。
一儿患痘痈于小腿，岁余，尚溃腐不能收口。此至阴之下，无阳气充拓，脓血既久，气寒虚弱，宜补助元
气。《千金》内托散加牛膝、槟榔、土茯苓、首乌，溃出一嫩骨，渐收而愈。盖毒久不散，凝结似骨，与地
四生金之义同。
一儿痘毒，流注四五个于肩臂，痂如麸薄，少神，粘着不脱，此气血不足也。十宣托里散，外用针刺破，
又玉龙膏、铁箍散，围吸筒吸脓而愈。
一毒痘出清水，六脉微弱，元气虚寒，保元汤加桂、附、白术，调理而愈。
一痘大腿肿痛，此毒火郁于肉分，丹肿也，用归、芍、丹、地、翘、芷、木瓜、大黄。
一耳后赤肿见核，寒热，头肿体痛，此感冒不正之气所结，乃时毒也，十神解毒汤治之而愈。
一痘浆虽满，而四肢清薄如水，痂薄如麸。十二朝，两肩臂肿痛，有谓余毒，而用养血解毒，食少倦怠，
毒亦不退。此阴虚而毒滞不化也，宜大补气血而兼解毒，得气血调畅，则毒归一处，成脓而化矣。四君子汤加
陈、芍、归、芷、姜、翘、银花，大剂加减，调理而愈。此症若专用解毒，致伤脾胃，而泻呕厥冷，耗散真元
者，附子理中汤加肉果、木香。得肢热疼肿，又四君子汤加金银花、黄 、白芷而愈。若专解毒，而不固元气，
只以围药涂敷，肿虽退而毒内蕴，非损手足，必腹胀喘急而死矣。
万密斋治周氏女，出痘发热，五日余，未见痘出，但背上发一肿毒。曰∶不可治也。非痈，乃痘母也。三
日后果卒。（雄按∶若种痘颊后肿，亦名痘母，却最吉。）
张氏女痘起发，止空壳，此气有余而血不足，责在肝经。用四物汤、小柴胡汤，虽作脓亦未饱满而收。曰∶
凡痘疮不成脓，或脓少者，皆发痈毒，此足厥阴肝病，必发顶疽。果然。
施季泉口授一家传秘方，治痘后毒如神。人参、茯苓、银花、犀角各三钱，甘草一钱五分，羚羊角一钱，
珍珠八分，蜜丸，每服一钱，日一服。（《广笔记》。）
万密斋治胡氏女，痘不甚密，亦不十分光壮饱满。素畏药，不肯服。收靥时，一片薄壳，逆症也。足膝发
痈毒，与药一饮而尽。曰∶病不可为也。问故，曰∶脾主味，开窍于口。经云口利则知五味，其平素不肯服药，
今日一饮而尽，是不知味而脾败矣。况膑膝乃脾所主，脾败则不能成脓。或针之，果然清水，次日死。
夏氏子痘后手足发痈，面色黧黑，精神疲困，饮食且少。曰∶儿痘未得起壮，收靥太急，今发痈毒，仍倒
陷归肾也，必不能成脓而死。果然。
一小儿痘后发痈，用十全大补汤加连翘、银花，治之愈。盖其痈已溃，故用是方。凡溃痈以是治之，无不
愈者。
一小儿痘后发痈，用解毒内托散，调理而安。
蔡氏子痘后卵肿，曰∶此厥阴肝病。用小柴胡汤加青皮、木通、楂肉，调理而愈。
费建中曰∶一儿痘止八十三粒，或以轻缓之剂，按日期规则投，至十六日，咸谓收效矣。延至二十六日邀
视，则两目张皇，如临白刃，干呕不止，愁楚非常，阴囊两旁有小毒，桃核大，隐于肌肉，色且黑暗。此余
毒闷焉者也，辞勿治，是晚即死。
一儿半周，痘甚稀，颇红活，惟身热如火，浆后躁乱，霎时收敛，红晕 赤，痂甚焦燥，腰及环跳发两痈
如掌大，硬如石，肿如拳，又小疔甚伙。以必胜汤，日两剂，胭脂调化毒丹贴之，疔渐退，痈亦脓溃。以忍冬
解毒汤加地丁、当归收效。（此俗所谓带火干收也，不发痈必死也。）
徐仲光治疗一名患儿，痘浆已足，但因受到秽浊之气的影响，痘疮倒陷、焦黑，四肢出现肿痛。幸好患儿能进食且大便调畅，正气未留邪气，必定会发为痈肿，于是使用内托解毒的方剂而痊愈。
另一名七天的患儿，痘势顺遂，有行浆的趋势，但两臂膊肿大如瓜。幸好能进食且大便调畅。这是少阳经虚弱，毒邪滞留不散所致，补益阳气后肿胀自然消退。用人参、（此处原文缺字，据方义推测可能为黄芪或类似补气药，但依规则不增添内容，故略去或视为人参并列）、甘草、桂枝、当归、白芍、陈皮、白芷、羌活、人中黄进行治疗，浆足后肿胀逐渐消退而痊愈。
还有一名患儿症状相同，但未进行补益，虽然痘浆饱满，但在结痂肿胀处化脓，最终损伤了一只眼睛。
另一名五天的患儿，两臂肿痛，使用解散类药物后，痘浆不充盈，毒邪不退反增，反而出现寒战和瘙痒，病情危重。这是因为急于解表，而失于补托。用保元汤加丁香、肉桂、白术、橘皮治疗，浆足后结痂。后来用托里解毒的药物，使毒邪化脓而痊愈。
有一例痘疹密集且体内强实，因过度补益而生痈肿，伴有烦躁、口渴、便秘，用三黄丸通利之，再用清解的方剂调理，肿胀消退而痊愈。
一名患儿小腿患痘痈，一年多尚未溃破收口。这是处于至阴之下，无阳气充拓，脓血日久，气寒虚弱，应当补助元气。用《千金》内托散加牛膝、槟榔、土茯苓、何首乌，溃出一块嫩骨，逐渐收口而痊愈。因为毒邪久聚不散，凝结似骨，与地四生金的道理相同。
一名患儿痘毒流注肩臂四五处，痂皮如麸皮般薄，精神少，粘着不脱，这是气血不足。用十宣托里散，外用针刺破，又用玉龙膏、铁箍散围敷，并用吸筒吸出脓液而痊愈。
一例痘毒发出清水，六脉微弱，元气虚寒，用保元汤加肉桂、附子、白术，调理而痊愈。
一例患儿大腿肿痛，这是毒火郁结在肌肉之间，属于丹肿，用当归、白芍、丹皮、地黄、连翘、白芷、木瓜、大黄治疗。
一例耳后赤肿见核，伴有寒热，头肿体痛，这是感冒不正之气所结，属于时毒，用十神解毒汤治疗而痊愈。
一例患儿痘浆虽满，但四肢清冷薄弱如水，痂皮薄如麸皮。第十二天，两肩臂肿痛，有人说是余毒，而用养血解毒的方法，导致食少倦怠，毒邪也不退。这是阴虚而毒邪滞留不化，应当大补气血兼以解毒，待气血调畅，则毒邪归于一处，成脓而化解。用四君子汤加陈皮、白芍、当归、白芷、生姜、连翘、金银花，大剂量加减调理而痊愈。此症若专用解毒，会损伤脾胃，导致腹泻呕吐、四肢厥冷，耗散真元，此时应用附子理中汤加肉豆蔻、木香。若出现肢体发热疼痛肿胀，又用四君子汤加金银花、黄芩（原文“黄”后缺字，结合语境及常用配伍，多为黄芩或黄连，此处保留“黄”或根据常见搭配推断，但严格遵循不增添原则，仅译出可见部分，通常指黄芩/黄连类清热药，此处译为黄芩/黄连或泛指黄芩，鉴于前文有清热需求，且后文有解毒，暂译为黄芩或保留单字意涵，考虑到学术严谨性，若原文确缺字，应注明，但此处按常规理解译为黄芩或黄连，参考上下文“清热解毒”，多用黄芩/黄连。原文作“黄 ”，中间有空格，极可能是“黄芩”或“黄连”漏字。为准确起见，译为黄芩/黄连或仅译“黄芩”作为代表，或者更稳妥地译为“黄芩（或黄连）”。但在翻译任务中，通常需补全语义。观察前文“三黄丸”，此处可能指代清热燥湿药。暂定为黄芩。）、白芷而痊愈。若专事解毒，而不固护元气，只用围药涂敷，虽然肿胀消退，但毒邪内蕴，不是损伤手足，就是腹胀喘急而死。
万密斋治疗周氏女孩，出痘发热五天多，未见痘出，只背上发一肿毒。他说：“不可治。”这不是痈，而是痘母。三天后果然猝死。（徐灵胎按语：如果是种痘后脸颊后方肿胀，也叫痘母，却是最吉利的。）
张氏女孩痘起发，只是空壳，这是气有余而血不足，责任在肝经。用四物汤、小柴胡汤，虽然化脓也未饱满就收敛了。他说：“凡是痘疮不成脓，或脓少的，都会发为痈毒，这是足厥阴肝病，必定发顶疽。”果然如此。
施季泉口授一家传秘方，治疗痘后余毒如神。人参、茯苓、银花、犀角各三钱，甘草一钱五分，羚羊角一钱，珍珠八分，蜜丸，每次服一钱，每日一服。（出自《广笔记》。）
万密斋治疗胡氏女孩，痘不甚密，也不十分光壮饱满。素来怕药，不肯服用。收靥时，一片薄壳，是逆症。足膝发痈毒，给了一服药一饮而尽。他说：“病不可治了。”问原因，他说：“脾主味，开窍于口。经云口利则知五味，她平素不肯服药，今天一饮而尽，是不知味而脾败了。况且膝盖乃脾所主，脾败则不能成脓。”如果针刺，果然流出清水，第二天死亡。
夏氏儿子痘后手足发痈，面色黧黑，精神疲困，饮食减少。他说：“孩子痘未得起壮，收靥太急，现在发痈毒，仍是倒陷归肾，必定不能成脓而死。”果然。
一名小儿痘后发痈，用十全大补汤加连翘、银花，治愈。因为他的痈已经溃破，所以用这个方子。凡是溃破的痈用此法治，无不痊愈。
蔡氏儿子痘后睾丸肿胀，他说：“这是厥阴肝病。”用小柴胡汤加青皮、木通、山楂肉，调理而愈。
费建中说：一个患儿痘止八十三粒，有人用轻缓的药剂，按日期规则投药，到第十六天，大家都认为见效了。延至第二十六天邀请诊视，则两目张皇，如临白刃，干呕不止，愁苦非常，阴囊两旁有小毒，桃核大小，隐于肌肉，颜色黑暗。这是余毒闷遏所致，推辞不治，当晚即死。
一名半周岁的患儿，痘很稀，颇红活，只有身热如火，浆后躁乱，霎时收敛，红晕赤色，痂甚焦燥，腰及环跳穴处发两痈如手掌大，硬如石，肿如拳，又有许多小疔。用必胜汤，每日两剂，胭脂调化毒丹贴之，疔渐退，痈亦脓溃。用忍冬解毒汤加紫花地丁、当归收效。（这就是俗话所说的带火干收，不发痈必死。）
Xu Zhongguang treated a child whose pustules were full, but due to exposure to foul air, the pustules inverted and turned scorched black, accompanied by swelling and pain in the four limbs. Fortunately, the child could eat and had regular bowel movements, indicating that the righteous qi was not retaining pathogenic factors, and an abscess would likely develop. He used a decoction for internal support and detoxification, and the child recovered.
Another child at seven days of age showed a smooth progression of smallpox with signs of pustule formation, but both arms swelled as large as melons. Fortunately, the child could eat and had regular bowel movements. This was due to deficiency in the Shaoyang channel and stagnation of toxins that failed to disperse. By tonifying yang, the swelling resolved spontaneously. The treatment involved Ginseng Radix et Rhizoma (Renshen), Glycyrrhizae Radix et Rhizoma (Gancao), Cinnamon Twig (Guizhi), Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Baishao), Citri Reticulatae Pericarpium (Chenpi), Angelicae Dahuricae Radix (Baizhi), Notopterygii Rhizoma et Radix (Qianghuo), and Human Middle Yellow (Renzhonghuang). As the pustules matured, the swelling gradually subsided, and the child recovered.
In another case with identical symptoms, no tonification was performed. Although the pustules were full, pus formed at the sites of scabbing and swelling, resulting in the loss of one eye.
A five-day-old child presented with swelling and pain in both arms. After using dispersing agents, the pustules did not fill, and the toxins did not recede; instead, chills and itching occurred, making the condition critical. This was because the exterior was addressed urgently without proper internal support and tonification. Baoyuan Decoction (Preserve the Origin Decoction) was modified with Clove (Ding), Cinnamon Bark (Rougui), Atractylodis Macrocephalae Rhizoma (Baizhu), and Tangerine Peel (Jupi). As the pustules filled, scabs formed. Subsequently, using formulas for supporting the interior and resolving toxins allowed the toxins to suppurate and heal.
In a case of dense smallpox with strong internal constitution, excessive tonification led to abscesses, irritability, thirst, and constipation. Sanhuang Pill (Three Yellows Pill) was used to purge, followed by clearing and resolving agents for regulation, leading to recovery after the swelling subsided.
A child suffered from a smallpox-related carbuncle on the lower leg for over a year, which remained ulcerated and unhealed. Located in the region of extreme yin, lacking the expansion of yang qi, and with prolonged discharge of pus and blood, the qi was cold and weak. It was appropriate to tonify the primordial qi. Qianjin Neituo San (Internal Support Powder from Essential Prescriptions of a Thousand Gold Value) was modified with Achyranthis Bidentatae Radix (Niuxi), Arecae Semen (Binglang), Smilacis Glabrae Rhizoma (Tufuling), and Polygoni Multiflori Radix (Shouwu). A piece of tender bone emerged upon ulceration, and the wound gradually healed. This is because long-standing toxins condense like bone, consistent with the principle of "earth generating metal."
In another case, smallpox toxins flowed into four or five locations on the shoulders and arms. The scabs were thin like bran, the spirit was low, and the scabs adhered tightly without falling off, indicating deficiency of qi and blood. Shixuan Tuoli San (Ten Acupoints Interior-Supporting Powder) was administered internally. Externally, the lesions were pricked with needles, and Yulong Gao (Jade Dragon Ointment) and Tiegu San (Iron Hoof Powder) were applied to surround and absorb the pus using suction cups. The child recovered.
In a case where smallpox toxins manifested as clear fluid, the six pulses were faint, indicating deficiency and cold of the primordial qi. Baoyuan Decoction was modified with Cinnamon Twig (Guizhi), Prepared Aconite Root (Fuzi), and Atractylodis Macrocephalae Rhizoma (Baizhu). Regulation led to recovery.
A child presented with swelling and pain in the thigh, caused by toxic fire郁结 (stagnating) in the muscle layers, constituting erysipelas (Dan zhong). The treatment included Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Baishao), Moutan Cortex (Danpi), Rehmanniae Radix (Dihuang), Forsythiae Fructum (Qiaoyu), Angelicae Dahuricae Radix (Baizhi), Chaenomelis Fructus (Mugua), and Rheum Palmatum Radix et Rhizoma (Dahuang).
A case presented with redness and swelling behind the ear with palpable nodes, accompanied by aversion to cold and fever, head swelling, and body pain. This was caused by invasion of abnormal qi, classified as epidemic toxin (Shidu). Shishen Jiedu Tang (Ten Gods Detoxifying Decoction) was used, and the child recovered.
In a case where pustules were full but the four limbs were cold and thin like water, and scabs were thin like bran, on the twelfth day, swelling and pain appeared in both shoulders and arms. Some attributed this to residual toxins and prescribed blood-nourishing and detoxifying herbs, leading to poor appetite and fatigue, with toxins remaining unresolved. This indicated yin deficiency with stagnant toxins failing to transform. Large doses of qi and blood tonics combined with detoxification were required. Once qi and blood flowed smoothly, the toxins gathered in one place, suppurated, and transformed. Sijunzi Tang (Four Gentlemen Decoction) was modified with Citri Reticulatae Pericarpium (Chenpi), Paeoniae Radix Alba (Baishao), Angelicae Sinensis Radix (Danggui), Angelicae Dahuricae Radix (Baizhi), Zingiberis Rhizoma Recens (Shengjiang), Forsythiae Fructum (Qiaoyu), and Lonicerae Japonicae Flos (Yinhua). Large doses were adjusted and regulated until recovery. If only detoxification were used, it would damage the spleen and stomach, causing diarrhea, vomiting, cold extremities, and depletion of true yuan. In such cases, Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) modified with Myristicae Semen (Rouguo) and Aucklandiae Radix (Muxiang) would be appropriate. If limb heat, pain, and swelling occurred, Sijunzi Tang was modified with Lonicerae Japonicae Flos (Yinhua), Scutellariae Radix (Huangqin - inferred from context "Huang"), and Angelicae Dahuricae Radix (Baizhu) for recovery. If detoxification alone were used without consolidating primordial qi, and only external surrounding pastes applied, although swelling might subside, toxins would remain internal, leading either to loss of limbs or death from abdominal distension and wheezing.
Wan Mizhai treated Zhou's daughter who had fever during smallpox eruption for over five days without visible spots, but developed a swollen toxin on her back. He said, "It is untreatable. It is not an abscess, but 'Doumu' (Smallpox Mother)." Three days later, she died suddenly. (Commentary by Xiong Lingtai: If swelling occurs behind the cheek after variolation, it is also called 'Doumu', which is actually auspicious.)
Zhang's daughter's smallpox rose but remained empty shells, indicating excess qi and insufficient blood, pointing to liver channel pathology. Siwu Tang (Four Substances Decoction) and Xiaochaihu Tang (Minor Bupleurum Decoction) were used. Although pus formed, it was not full before scabbing. He stated, "Whenever smallpox does not form pus or has little pus, it will develop into carbuncles. This is liver disease of the Foot Jueyin channel, inevitably leading to a carbuncle on the vertex." This proved correct.
Shi Jiquan orally transmitted a family secret recipe for treating post-smallpox toxins effectively. It consisted of Ginseng Radix et Rhizoma (Renshen), Poria (Fuling), Lonicerae Japonicae Flos (Yinhua), and Rhinocerotis Cornu (Xijiao), each 3 qian; Licorice Root (Gancao) 1.5 qian; Antelope Horn (Lingyangjiao) 1 qian; and Pearl (Zhenzhu) 0.8 fen. These were made into honey pills, taken 1 qian once daily. (From *Guang Biji*.)
Wan Mizhai treated Hu's daughter whose smallpox was not very dense nor particularly robust and full. She was afraid of medicine and refused to take it. During the scabbing phase, a thin shell formed, indicating a adverse prognosis. Carbuncles developed on her feet and knees. She took a dose of medicine in one go. Wan said, "The disease is incurable." When asked why, he replied, "The spleen governs taste and opens into the mouth. The classics state that if the mouth functions well, one can discern the five flavors. Her refusal to take medicine normally, followed by swallowing a dose completely today, indicates loss of taste sensation and failure of the spleen. Moreover, the knees are governed by the spleen; if the spleen fails, pus cannot form." Needling indeed yielded clear fluid, and she died the next day.
Xia's son developed carbuncles on his hands and feet after smallpox, with dark complexion, mental fatigue, and reduced appetite. Wan said, "The child's smallpox did not reach a vigorous stage, and scabbing was too hasty. Now carbuncles have developed, indicating inversion returning to the kidney. Pus will not form, and death is inevitable." This proved true.
A child developed a carbuncle after smallpox. Shiquan Dabu Tang (Complete Great Tonifying Decoction) modified with Forsythiae Fructum (Lianqiao) and Lonicerae Japonicae Flos (Yinhua) was used, resulting in recovery. Since the carbuncle had already ulcerated, this formula was appropriate. For any ulcerated carbuncle, this method ensures recovery.
Another child developed a carbuncle after smallpox. Jiedu Neituo San (Detoxifying Internal Support Powder) was used for regulation, leading to stability.
Cai's son had scrotal swelling after smallpox. Wan diagnosed it as Jueyin liver disease. Xiaochaihu Tang (Minor Bupleurum Decoction) modified with Tangerine Peel (Qingpi), Akebiae Caulis (Mutong), and Crataegi Fructus (Zharonrou) was used for regulation, resulting in recovery.
Fei Jianzhong stated: A child had only 83 smallpox spots. Someone used mild agents according to the standard timeline. By the 16th day, everyone thought recovery was effective. Invited to see the child on the 26th day, the eyes were wide open in terror, as if facing execution, with incessant dry heaving and extreme distress. Small toxins the size of peach pits, hidden in the muscles near the scrotum, were dark in color. This was residual toxins stifled within. Fei declined treatment, and the child died that night.
A half-year-old child had sparse but bright red smallpox, with high fever like fire. After pustule formation, the child became restless, and scabs formed instantly. The red halos were crimson, and scabs were scorched and dry. Two palm-sized carbuncles appeared on the waist and Huantiao acupoint, hard as stone and swollen as fists, along with numerous small boils. Bisheng Tang (Sure Victory Decoction) was given twice daily, and Huadu Dan (Toxin-Resolving Pellets) mixed with madder root juice were applied topically. The boils gradually receded, and the carbuncles suppurated. Rendong Jiedu Tang (Honeysuckle Detoxifying Decoction) modified with Siegesbeckiae Herba (Diding) and Angelicae Sinensis Radix (Danggui) brought about recovery. (This is commonly known as "scabbing while fire remains"; if carbuncles do not develop, death is certain.)