附痂后。
徐仲光曰∶一痘浆足，结痂忽尔紫黑，此冲冒秽气也，以十全大补加木香，治之而愈。
一痘收痂，浓而干黑，身热咳嗽，乃风寒客肺也，麻黄汤得微汗而愈。
一痘痂如麸薄，粘皮不脱，昏睡内热，乃脾虚少血之故，以调脾养荣汤治之。
一痘收靥干黑，粘皮不脱，身热烦渴，睡卧不宁，有以气血不足大补之，四七日，枯槁而卒。
一痘如前，以犀角地黄汤加翘、蒡治之，火渐减而诸痘悉平，痂 渐脱而愈。此乃毒火弥炽之故，经曰火
盛则水涸，此之谓也。
一痘痂浓而干黑，粘皮不脱，身热烦渴，谵语妄言，睡卧不宁，乃阴虚火甚也，以四物汤，合生脉散加枣仁。
一痘清浆，结 如麸，乃正气不足，不能化毒尽解。以补中益气汤加山药治之，两曲池发痈成脓而愈。
一痘靥淡白如麸，便溏减食，乃中气不足，用参苓白术散加肉果、陈仓米愈。
一儿九岁出痘，匀朗绽突，九日浆足，能食便溏。乃恃其顺而恣与之食，以致肚腹胀痛，停浆色滞。用消
化药而便行安和。痘浆不长，乃食物虽消，正气受伤，当与调脾益气，助浆收敛。竟不从治，延至十四日，渐
内虚倒靥，浆复化为水，而始行补气，不效，喘胀而卒。
一痘至十日十一日，头面将结痂，脓浆尚未充足，只是气虚不能托毒于外，急以木香散加黄 、蝉蜕而愈。
一痘十二三日，上身已结痂，下体尚灰白不充满，头温足冷，以木香散加附子、酒 而愈。
一痘至十四五日，遍身结痂而充，但是足下未焦，寒战切牙，以十全大补汤加附子愈。
一痘至十五六日，脓泡充足，当痂不痂，又作寒战切牙，只是不足，治以温补。
一痘如前，顶突根绽，此是阳火有余，胃气大热也，服白虎汤一剂而愈。
一痘痂脱尽，正额一痘溃而不敛，四九日作痒，破出臭脓，声哑闷乱而死。
一痘痂尽脱，头上一痘不敛，二十八朝，作痒甚，出蛆盏许，亦声哑闷乱而死。
万密斋治胡氏长女，痘甚密，脓成过期不靥。此女平日脾虚食少，性不服汤剂，以钱氏异功散加木香、青
皮，蜜丸，米饮下，调理而安。
胡氏子痘甚密，脓成不靥，渐至溃烂。自起发以来，未得大便。此毒热郁蒸，故不成痂。欲下之，彼谓此
子素弱，不可下。时有术士，符水甚验，乃书一符，焚而服之，少顷，腹中鸣而利下清水，众皆称妙。因思久
未更衣，岂无燥矢？至次日，痘益溃烂，乃用胆导法，下燥矢三十余枚，如弹子大。众又笑曰∶此法更妙。痘
即收靥，至腰又不收，盖大便下后，又未行也。再用胆导法，去燥矢十四枚，后皆溏屎，痘尽收而安。
一小儿因渴，饮水过多，湿伤脾胃，不靥，以四君子汤，人参补中，白术燥湿，茯苓渗水，甘草解毒，加
防风以胜皮毛之湿，白芷以逐肌肉之水，桂以利关节而去寒水之邪，砂仁以温胃止渴，调理而安。
一小儿大便不通，热蒸于内而生湿，致浔淫不能成痂，用当归梢、生地以凉血，麻仁以润燥，酒大黄以泻
热开结，生甘草以和中，得利而安。
一小儿泄泻不止，食少，此里虚不能成痂，用陈氏异功散合肉蔻丸而愈。
蔡氏子痘密脓成，过期不靥，面疮溃肿，起止呻吟，呛水吐食，语音不清。或谓不治。视其面疮肿起，正
在贯脓，遍身皆然，非倒靥也。呛水呕食者，口唇肿硬，吞咽不便，非咽喉溃烂也。语音不清者，鼻中壅塞，
气不得通，非失音也。疮毒尽表病，里和可治也。用苦参、酒芩、牛蒡、白蒺藜、何首乌、荆芥穗，等分为
末，酒糊为丸，淡竹叶煎汤下，调理而安。时邻居一儿症同，谓不可治。或问故，曰∶彼过期宜靥，此未成脓
不宜靥，一也。彼肿胀，犹实脓血，此则面平目开，皮脱肉干，二也。彼喉舌无疮，此则咽舌溃烂，呛水失音，
三也。彼私与蔡氏求药，服之无效，死。（雄按∶吞咽不便，何以用丸？）
胡氏女十三岁，痘甚密，或与参、 大补之。二十日后，过期不靥，已溃烂，幸勿倒靥。乃温补过多，里
邪尽出，表毒不解，急宜解表，勿使皮肉腐烂。不信。又逾五日，不收，乃用荆、防、升麻以解表，白芷以蚀
脓逐水，连翘、牛蒡、甘草解郁蒸之毒。肺主皮毛，因黄 之补，肺热已甚，时值夏火正旺之时，用黄芩以泻
肺中之火，解时令之热，调理一月而安。
卢文学妻李氏，痘甚密，未及成脓，面疮自破，皮肿脓聚，气多腥臭，过期不靥，饭食渐少，锁喉呛水。
曰∶形症俱恶，恐不得痊，二十余日殒。
一小儿痘后又出一层小痘，其家惊忧。曰∶佳兆也。痘科云，轻者作三四次出，大小不一等，重者一齐涌
出。此痘最轻，且无余毒，发已尽矣。果然。
吴氏子三岁出痘，毒瓦斯有余，谷气不足，食少，故不靥也。问服何药？曰∶无药可解，能食则生，不能食
则死。次日思食，所食且多。曰∶死急矣。问故。曰∶谓能食矣，久不食而今思食，自少加多，胃气复也。今
忽多食，乃胃败火盛，邪火杀谷，名曰除中，（出《伤寒论》。）犹膏之将灭，必大明而后熄，死在旦夕也。
果然。
一小儿靥后，痂皮不脱，曰∶此脾肺二经不足也。盖肺主皮毛，脾主肌肉，其气不足，故痂难脱。用钱氏
异功散加黄 、桂而愈。
一儿痘后，一身尽靥，痂皮尽脱，惟头与足不靥，曰∶此常候也，不必治。盖诸阳皆聚于头，乃阳中之阳，
谓之孤阳。诸阴皆会于足，乃阴中之阴，谓之寡阴。孤阳不生，寡阴不育，所以头疮不收者，孤阳无阴也。
足疮不收者，寡阴无阳也，久当自痊，但迟迟也。（说欠明允。）
一小儿痂落后，瘢内凸起作痒，此风热也，用人参败毒散加荆、防，一服安。后有患此者，用荆防败毒散
加人参服之，外洗水杨汤，皆效。
一小儿落痂后，瘢肿复成疮，久不愈，此痘毒疮也。由犯手 掐，不得自脱，故皮肉受伤而复作疮，以苦
参丸与服效。
一小儿落痂后，瘢毒不平，曰∶痘家戒食姜，恐靥不齐，瘢不平也。问之果然。
王氏女痂落，遍身尽白，色不红，日夜啼哭，遍身潮热，不思乳食，曰∶此症若不急治，或一二月，或二
三年，必至成疳而死。不信，后果殁。其子亦患此，令服十全大补汤数剂，又与三合汤治之，其热即退，哭亦
止，痂肉色尽红，方止药。又服加减八宝汤全愈。
一小儿已脱痂，初无他苦。一医视其目睛无神带白，曰∶不可为矣。逾日亡。（《广笔记》。）
附：痘疮结痂后的情况。
徐仲光说：有一例痘疮浆液充足后，结痂突然变成紫黑色，这是冲犯了秽浊之气所致，用十全大补汤加木香治疗，痊愈了。
有一例痘疮收靥（结痂），痂皮浓厚而干黑，身体发热咳嗽，这是风寒客居于肺所致，用麻黄汤发微汗而痊愈。
有一例痘疮痂皮像麸皮一样薄，粘在皮肤上不脱落，昏睡且体内发热，这是脾虚血少的缘故，用调脾养荣汤治疗。
有一例痘疮收靥干黑，粘皮不脱，身体发热烦躁口渴，睡卧不安，有人认为是气血不足给予大补，到了第四十七天，因枯槁而死。
有一例痘疮如前所述症状，用犀角地黄汤加连翘、牛蒡子治疗，火势逐渐减退，所有痘疮都平复，痂皮逐渐脱落而痊愈。这是毒火炽盛的缘故，经书说“火盛则水涸”，说的就是这种情况。
有一例痘疮痂皮浓厚而干黑，粘皮不脱，身体发热烦躁口渴，胡言乱语，睡卧不安，这是阴虚火旺所致，用四物汤合生脉散加酸枣仁治疗。
有一例痘疮清稀浆液，结痂如麸皮，这是正气不足，不能化解毒邪完全解除。用补中益气汤加山药治疗，两侧曲池穴处发痈成脓而痊愈。
有一例痘疮收靥淡白如麸皮，大便溏泄食欲减退，这是中气不足，用参苓白术散加肉豆蔻、陈仓米治愈。
有一个九岁儿童出痘，痘形匀朗突起，九天浆液充足，能进食但大便溏泄。家人倚仗病情顺遂而恣意喂食，导致肚腹胀痛，浆液停滞颜色晦暗。用消食药后大便通畅身体安和。但痘浆不长，是因为食物虽然消化了，但正气受伤，应当调理脾胃益气，帮助浆液生成收敛。竟然没有听从这种治法，拖延到第十四天，逐渐出现内虚倒靥（痘疮内陷），浆液重新化为水，这时才开始补气，无效，喘胀而死。
有一例痘疮到第十日或十一日，头面即将结痂，脓浆尚未充足，只是气虚不能托毒外出，急用木香散加黄芪、蝉蜕而痊愈。
有一例痘疮十二三日，上身已结痂，下体尚灰白不充满，头部温热足部寒冷，用木香散加附子、酒煎服而痊愈。
有一例痘疮到十四五日，遍身结痂充实，但是脚底未焦枯，寒战咬牙，用十全大补汤加附子治愈。
有一例痘疮到十五六日，脓泡充足，该结痂时不结痂，又出现寒战咬牙，只是正气不足，治疗用温补法。
有一例痘疮如前所述，痘顶突起根部绽开，这是阳火有余，胃气大热，服用白虎汤一剂而痊愈。
有一例痘疮痂皮脱尽，正额头上一颗痘溃烂而不收敛，过了四个七日（二十八天）作痒，破溃流出臭脓，声音嘶哑神志昏乱而死。
有一例痘疮痂皮脱尽，头顶上一颗痘不收敛，到了第二十八天，瘙痒严重，流出蛆虫约一盏的量，也是声音嘶哑神志昏乱而死。
万密斋治疗胡家的长女，痘疮非常密集，脓成后过期不结痂。这女孩平时脾虚食少，性格不服从汤药治疗，用钱氏异功散加木香、青皮，制成蜜丸，米饮送下，调理而平安。
胡家的儿子痘疮非常密集，脓成后不结痂，逐渐溃烂。自起发出痘以来，没有解过大便。这是毒热郁蒸，所以不成痂。想要用泻下药，家属认为这孩子素来虚弱，不可攻下。当时有术士，符水很灵验，于是写一道符，烧灰服用，不久，腹中鸣响而下利清水，众人都称妙。心想久未排便，难道没有燥屎？到了第二天，痘疮更加溃烂，于是用胆导法（猪胆汁灌肠），排出燥屎三十多枚，如弹子大小。众人又笑着说：这个方法更妙。痘疮随即收靥，到了腰部又不收，因为大便通下后，又没有再行通便。再用胆导法，排出燥屎十四枚，之后都是溏屎，痘疮全部收靥而平安。
一个小孩因为口渴，饮水过多，湿气损伤脾胃，不结痂，用四君子汤，人参补中气，白术燥湿，茯苓渗水利湿，甘草解毒，加防风以胜皮毛之湿，白芷以逐肌肉之水，桂枝以利关节而去寒水之邪，砂仁以温胃止渴，调理而平安。
一个小孩大便不通，热气蒸腾于内而生湿，导致湿热浸淫不能成痂，用当归梢、生地以凉血，麻仁以润燥，酒大黄以泻热开结，生甘草以和中，得利后平安。
一个小孩泄泻不止，食少，这是里虚不能成痂，用陈氏异功散合肉蔻丸而愈。
蔡家的儿子痘密脓成，过期不结痂，面部疮疡溃肿，起止呻吟，呛水吐食，语音不清。有人说无法治疗。观察他的面部疮疡肿起，正在贯脓阶段，遍身皆然，不是倒靥。呛水呕食，是因为口唇肿硬，吞咽不便，不是咽喉溃烂。语音不清，是因为鼻中壅塞，气不得通，不是失音。疮毒尽在于表，里气平和可以治疗。用苦参、酒芩、牛蒡子、白蒺藜、何首乌、荆芥穗，等分为末，酒糊为丸，淡竹叶煎汤送下，调理而平安。当时邻居一孩子症状相同，说不可治。有人问原因，回答说：那孩子过期应该结痂，这个孩子未成脓不应该结痂，这是一点。那孩子肿胀，还是实脓血，这个孩子面平目开，皮脱肉干，这是第二点。那孩子喉舌无疮，这个孩子咽舌溃烂，呛水失音，这是第三点。那孩子私自向蔡家求药，服药无效，死了。（雄按：吞咽不便，为何用丸药？）
胡家女儿十三岁，痘疮非常密集，有人给予人参、黄芪大补。二十日后，过期不结痂，已经溃烂，幸好没有倒靥。这是因为温补过多，里邪尽出，表毒不解，急宜解表，勿使皮肉腐烂。家属不信。又过五日，不收靥，于是用荆芥、防风、升麻以解表，白芷以蚀脓逐水，连翘、牛蒡子、甘草解郁蒸之毒。肺主皮毛，因为黄芪的补益，肺热已甚，时值夏火正旺之时，用黄芩以泻肺中之火，解时令之热，调理一月而平安。
卢文学的妻子李氏，痘疮非常密集，未及成脓，面部疮疡自行破溃，皮肿脓聚，气味多腥臭，过期不结痂，饭食渐少，锁喉呛水。医生说：形症俱恶，恐怕不能痊愈，二十多天会死亡。
一个小儿痘后又出一层小痘，其家人惊恐忧虑。医生说：这是佳兆。痘科书上说，轻症分三四次出，大小不一；重症一齐涌出。此痘最轻，且无余毒，发已尽矣。果然如此。
吴家儿子三岁出痘，毒瓦斯有余，谷气不足，食少，所以不结痂。问服什么药？医生说：无药可解，能食则生，不能食则死。次日想吃东西，吃得还很多。医生说：死期近了。问原因。回答说：说是能吃了，很久没吃而现在想吃，由少加多，是胃气恢复。现在忽然多吃，乃是胃败火盛，邪火杀谷，名叫除中（出自《伤寒论》），就像蜡烛将灭，必然大亮然后熄灭，死在旦夕之间。果然。
一个小儿结痂后，痂皮不脱落，医生说：这是脾肺二经不足。肺主皮毛，脾主肌肉，其气不足，所以痂难脱。用钱氏异功散加黄芪、桂枝而愈。
一个小孩痘后，一身尽结痂，痂皮尽脱，只有头和脚不结痂，医生说：这是常候，不必治疗。盖诸阳皆聚于头，乃阳中之阳，谓之孤阳。诸阴皆会于足，乃阴中之阴，谓之寡阴。孤阳不生，寡阴不育，所以头疮不收者，孤阳无阴也。足疮不收者，寡阴无阳也，久当自痊，但时间较长罢了。（说法不够明允。）
一个小儿痂落后，瘢痕内凸起作痒，这是风热所致，用人参败毒散加荆芥、防风，一服即安。后来有患此病者，用荆防败毒散加人参服用，外洗水杨汤，都有效。
一个小儿落痂后，瘢痕肿复成疮，久不愈，这是痘毒疮。由于用手抓挠掐捏，不得自脱，故皮肉受伤而复作疮，用苦参丸内服有效。
一个小儿落痂后，瘢痕毒不平，医生说：痘家戒食姜，恐怕结痂不齐，瘢痕不平。询问果然如此。
王氏女孩痂落，遍身尽白，色不红，日夜啼哭，遍身潮热，不思乳食，医生说：此症若不急治，或一两个月，或两三年，必至成疳而死。家属不信，后果然死亡。她的儿子也患此病，令服用十全大补汤数剂，又与三合汤治疗，其热即退，哭亦止，痂肉色尽红，才停止用药。又服加减八宝汤全愈。
一个小儿已脱痂，初无其他痛苦。一位医生看他的眼睛无神带白，说：不可为矣。逾日亡。（《广笔记》。）
Appendix: Conditions after the scabbing of smallpox.
Xu Zhongguang stated: In one case, after the pustules were full of fluid, the scabs suddenly turned purple-black. This was caused by exposure to foul and turbid qi. It was treated with Shiquan Dabu Tang (Decoction for Ten-Absentee Tonification) plus Muxiang (Aucklandiae Radix), resulting in a cure.
In another case, during the scabbing phase, the scabs were thick, dry, and black, accompanied by fever and cough. This was due to wind-cold invading the lungs. It was cured with Mahuang Tang (Ephedra Decoction) inducing slight sweating.
In a third case, the scabs were thin like bran, adhering to the skin without falling off, accompanied by lethargy and internal heat. This was due to spleen deficiency and blood insufficiency. It was treated with Tiaopi Yangrong Tang (Spleen-Regulating and Nutritive-Vessel-Nourishing Decoction).
In a fourth case, the scabs were dry, black, and adhering to the skin, with fever, irritability, thirst, and restless sleep. Someone treated it as Qi and Blood deficiency with heavy tonification. On the forty-seventh day, the patient died in a state of emaciation.
In a fifth case, presenting similarly, treatment with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) plus Lianqiao (Forsythiae Fructus) and Niubangzi (Arctii Fructus) gradually reduced the fire, causing all pustules to flatten, scabs to fall off, and recovery to ensue. This was due to excessive toxic fire. As the classics state, "When fire is excessive, water dries up," which applies here.
In a sixth case, the scabs were thick, dry, black, and adhering, with fever, irritability, thirst, delirium, and restless sleep. This was Yin deficiency with hyperactive fire. It was treated with Siwu Tang (Four Substances Decoction) combined with Shengmai San (Generate the Pulse Powder) plus Suanzaoren (Ziziphi Spinosae Semen).
In a seventh case, the pustular fluid was clear, and the scabs were thin like bran. This indicated insufficient righteous Qi failing to resolve the toxin completely. It was treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Shanyao (Dioscoreae Rhizoma). The patient recovered when abscesses formed and suppurated at both Quchi (LI11) acupoints.
In an eighth case, the scabs were pale white like bran, with loose stools and poor appetite. This was deficiency of Middle Qi. It was cured with Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) plus Roudoukou (Myristicae Semen) and Chencangmi (aged rice).
A nine-year-old child presented with uniform, protruding smallpox. By the ninth day, the pustules were full, but the child could eat yet had loose stools. Relying on the favorable course, the family overfed the child, leading to abdominal distension and pain, stagnation of pustular fluid, and dull color. After using digestive herbs, bowel movements normalized, and the child felt comfortable. However, the pustules did not mature because although the food was digested, the righteous Qi was injured. Treatment should have been to regulate the spleen and tonify Qi to assist in fluid generation and scab formation. Ignoring this advice, by the fourteenth day, the condition deteriorated into inverted scabbing (reversion), with fluid turning back to water. Only then was Qi-tonifying therapy attempted, but it was ineffective; the child died of wheezing and distension.
In a case where, on the tenth or eleventh day, the head and face were about to scab but the pus/fluid was insufficient, it was due to Qi deficiency failing to push the toxin outward. Urgent treatment with Muxiang San (Aucklandia Powder) plus Huangqi (Astragali Radix) and Chantui (Cicadae Perioaterium) resulted in a cure.
In a case on the twelfth or thirteenth day, the upper body had scabbed, but the lower body remained grayish-white and unfull, with a warm head and cold feet. Treatment with Muxiang San plus Fuzi (Aconiti Lateralis Radix Praeparata) decocted with wine led to recovery.
In a case on the fourteenth or fifteenth day, the whole body had scabbed fully, except the soles of the feet which were not scorched, accompanied by chills and teeth grinding. Treatment with Shiquan Dabu Tang plus Fuzi resulted in a cure.
In a case on the fifteenth or sixteenth day, despite sufficient pustules, scabbing failed to occur, accompanied by chills and teeth grinding. This indicated insufficiency, treated with warming and tonifying methods.
In a case where the pustule tops were prominent and bases spread, indicating excess Yang-fire and intense stomach heat, one dose of Baihu Tang (White Tiger Decoction) resulted in a cure.
In a case where all scabs had fallen off, a single pustule on the forehead ulcerated and failed to heal. After twenty-eight days (four cycles of seven days), it became itchy, ruptured with foul pus, and the patient died with hoarseness and mental confusion.
In another case where all scabs had fallen off, a single pustule on the head failed to heal. On the twenty-eighth day, severe itching occurred, discharging maggots amounting to a cupful. The patient also died with hoarseness and mental confusion.
Wan Mizhai treated the eldest daughter of the Hu family, who had dense smallpox that failed to scab after the pus stage. She usually had spleen deficiency and poor appetite, and refused decoctions. Wan prescribed Yigong San (Yi-Gong's Powder) from Qian's school plus Muxiang and Qingpi (Citri Reticulatae Pericarpium), made into honey pills, taken with rice water. She recovered through regulation.
The son of the Hu family had dense smallpox that failed to scab after pus formation, gradually ulcerating. Since onset, he had not had a bowel movement. This was due to stagnant toxic heat preventing scab formation. The family wanted purgatives, but since the child was constitutionally weak, they feared purging. At that time, a sorcerer offered effective talisman water. The talisman was burned and ingested. Soon, abdominal borborygmus occurred, followed by watery diarrhea, which everyone praised. Thinking that long-term constipation must imply dry feces, the next day the ulcers worsened. A gallbladder enema method was used, expelling over thirty hard fecal pellets, size of bullet seeds. Everyone laughed, saying this method was even better. The scabs then retracted, but stopped at the waist because no further bowel movement occurred. Another gallbladder enema expelled fourteen more hard pellets. Thereafter, stools were loose, all scabs retracted, and the child recovered.
A child drank too much water due to thirst, damaging the spleen and stomach with dampness, preventing scabbing. Treatment with Sijunzi Tang (Four Gentlemen Decoction): Renshen (Ginseng Radix et Rhizoma) tonified the center, Baizhu (Atractylodis Macrocephalae Rhizoma) dried dampness, Fuling (Poria) leached out water, Gancao (Glycyrrhizae Radix et Rhizoma) resolved toxicity, Fangfeng (Saposhnikoviae Radix) overcame dampness in the skin/hair, Baizhi (Angelicae Dahuricae Radix) drove out water in muscles, Guizhi (Cinnamomi Ramulus) benefited joints and dispelled cold-water pathogen, and Sharen (Amomi Fructus) warmed the stomach and stopped thirst. Regulation led to safety.
A child with constipation had internal heat steaming and generating dampness, causing moist exudation preventing scab formation. Treatment with Danggui Shao (Radix Angelicae Sinensis caulis) and Shengdi (Rehmanniae Radix) to cool blood, Huren (Semen Persicae? Note: Text says Mahren likely Hemp Seed/Renziren contextually but text says Mahren/Ma Ren - Sesame/Hemp seed for moistening), Jiuhuang (Rhizoma Coptidis? No, text says Jiu Dahuang - Wine-processed Rheum Rhizome) to purge heat and open knots, and Sheng Gancao to harmonize the middle. Recovery followed successful defecation.
A child with incessant diarrhea and poor appetite suffered from interior deficiency failing to form scabs. Treatment with Chen's Yigong San combined with Roukou Wan (Nutmeg Pill) resulted in a cure.
The Cai family's son had dense smallpox with pus, failing to scab past the due date, with facial ulcers swelling and ulcerating, groaning constantly, choking on water, vomiting food, and unclear speech. Some said it was incurable. Observation showed facial ulcers swelling, entering the suppuration stage, throughout the body—not inverted scabbing. Choking/vomiting was due to swollen/hard lips impeding swallowing, not throat ulceration. Unclear speech was due to nasal congestion obstructing airflow, not aphonia. With toxins expressed externally and interior harmony restored, it was treatable. Treatment with Kushen (Sophorae Flavescentis Radix), Jiu Qin (Scutellariae Radix processed with wine), Niubangzi, Bajieli (Tribuli Fructus), Heshouwu (Polygoni Multiflori Radix), and Jingjie Sui (Schizonepetae Spica) ground into powder, bound with wine paste into pills, taken with Dan Zhuye (Lophatheri Herba) decoction. Regulation led to safety. A neighbor's child had identical symptoms and was deemed incurable. When asked why, the explanation was: 1. That child was overdue for scabbing; this child had not yet formed pus, so scabbing was inappropriate. 2. That child was swollen with solid pus/blood; this child had flat face, open eyes, peeling skin, and dry flesh. 3. That child had no ulcers in throat/tongue; this child had ulcerated throat/tongue, choking, and aphonia. That child secretly sought medicine from the Cai family, took it ineffectively, and died. (Xiong notes: How can pills be used if swallowing is difficult?)
The Hu family's thirteen-year-old daughter had dense smallpox. She was given heavy tonification with Renshen and Huangqi. After twenty days, she failed to scab past the due date and had already ulcerated, though inversion was avoided. Excessive warming/tonification had expelled interior pathogens but left exterior toxins unresolved. Immediate exterior-resolving treatment was needed to prevent skin/muscle rot. The family disagreed. Five days later, still no retraction. Treatment with Jingjie, Fangfeng, and Shengma (Cimicifugae Rhizoma) to resolve the exterior, Baizhi to erode pus and drain water, Lianqiao, Niubangzi, and Gancao to resolve stagnant heat-toxin. The lung governs skin/hair; due to Huangqi tonification, lung heat was severe. Given the summer fire season, Huangqin (Scutellariae Radix) was used to purge lung fire and seasonal heat. Regulation over one month led to safety.
Li Shi, wife of Lu Wenxue, had dense smallpox. Before pus formation, facial ulcers ruptured spontaneously, with swollen skin and accumulated pus emitting a foul odor. Overdue for scabbing, food intake decreased, and she choked on water with locked throat. The doctor said: The signs and symptoms are malignant; recovery is unlikely. Death within twenty-plus days.
A child developed a second layer of smallpox after the initial eruption, alarming the family. The doctor said: This is a good omen. Smallpox texts state mild cases erupt in three or four waves of varying sizes; severe cases erupt all at once. This was the mildest type, with no residual toxin, and the eruption was complete. It proved true.
The Wu family's three-year-old son had smallpox with excess toxin Qi but insufficient grain Qi (digestive energy), leading to poor appetite and failure to scab. Asked what medicine to take, the doctor said: No medicine can solve this. If he eats, he lives; if not, he dies. The next day, he desired food and ate a lot. The doctor said: Death is imminent. Explaining: Previously, desire to eat increased gradually, indicating recovery of stomach Qi. Now, sudden excessive eating indicates stomach failure and hyperactive fire, where evil fire destroys grain, known as "Chu Zhong" (Elimination of the Middle), from Shanghan Lun. Like a candle about to extinguish, it flares brightly before dying. Death is imminent. It proved true.
After a child's scabs fell off, the scabs did not detach. The doctor said: This is deficiency of the Spleen and Lung meridians. The lung governs skin/hair, the spleen governs muscles. Insufficient Qi makes scab detachment difficult. Treatment with Qian's Yigong San plus Huangqi and Guizhi resulted in a cure.
A child's entire body scabbed and shed, except the head and feet. The doctor said: This is a normal pattern, requiring no treatment. All Yang meridians converge at the head, making it Yang within Yang, called "Gu Yang" (Solitary Yang). All Yin meridians converge at the feet, making it Yin within Yin, called "Gua Yin" (Lonely Yin). Solitary Yang cannot generate; Lonely Yin cannot nurture. Thus, head wounds fail to close due to Solitary Yang lacking Yin. Foot wounds fail to close due to Lonely Yin lacking Yang. They will eventually heal naturally, though slowly. (This explanation is considered insufficiently accurate.)
After a child's scabs fell off, bumps appeared inside the scars causing itching. This was Wind-Heat. Treatment with Renshen Baidu San (Ginseng and Detoxification Powder) plus Jingjie and Fangfeng resulted in relief after one dose. Later patients with this condition were treated with Jingfang Baidu San plus Renshen orally, and washed externally with Shuiyang Tang (Water-Yang Decoction), all effective.
After a child's scabs fell off, scar swelling recurred as sores, lingering without healing. This was a smallpox toxin sore. Caused by scratching/picking, preventing natural shedding, injuring skin/muscle. Treatment with Kushen Wan (Sophora Pill) orally was effective.
After a child's scabs fell off, the scarred area was uneven. The doctor said: Smallpox patients must avoid ginger, lest scabbing be irregular and scars uneven. Inquiry confirmed this.
A Wang family girl's scabs fell off, leaving her body entirely white, lacking redness, crying day and night, with tidal fever, and refusal of milk/food. The doctor said: If not urgently treated, within one to two months or two to three years, she will develop malnutrition syndrome (Gan) and die. The family disagreed; she indeed died. Her son suffered similarly. He was given several doses of Shiquan Dabu Tang, then Sanhe Tang. Fever subsided, crying stopped, scar tissue turned red, and medication ceased. He was fully cured with Jiajian Babao Tang (Modified Eight-Treasures Decoction).
A child had shed scabs with no other complaints. A physician observed his eyes lacked spirit and had white opacity, stating: It is hopeless. The child died the next day. (From Guang Biji.)