房玄龄，痘惧黑色，如龙眼大。一老僧见之，惊叹曰∶万龙含珠，今得见矣。
邱琼山七岁，痘亦遍身俱黑，父忧哭。一渔父烛之，跃然曰∶紫垣中辅弼宿，落于此田舍翁家。取笔书辅
弼二字于子背上而去。
昔有一儿，痘形俱黑色，在日中视之则黑，以灯照之真红映内。偶遇一僧，不服药，以保元汤浴之，即转
红活，后至台辅。
一黑痘，圆明光泽，至浆时，色如紫葡萄，根围血晕微黄色，名为紫袍金带。
万密斋治王氏子出痘，起发时渐变黑，已蔓延一身矣。或谓痘变黑，归肾不治。曰∶黑痘有二症，一则干
枯变黑者，此名倒陷，乃邪火大炽，真水已竭，故曰归肾不治。一则痘色变黑，不至干塌，此疫毒之气，所谓
火发而熏昧者也。今此正类，乃用当归梢、生地、赤芍、红花以凉血，黄 、人参、甘草以泻火补元气，酒炒
芩、连、牛蒡、连翘、升麻以解毒，荆、防以疏表，每剂入烧人粪一钱，连进十三剂，色转红，脓成而靥。
李氏子痘起发时，变黑而干，自发热至今未大便。曰∶此热甚于内，宜急解之。制一方∶麻黄酒蜜拌炒黑、
红花子、紫草、人中黄、连翘、酒蒸大黄、烧人粪，煎服。外用胆导法，取下燥矢，痘转红活。后以四物汤去
川芎，加紫草、木通、枳壳、生甘草，调理而愈。
黑痘多由疔毒，今入此门者，恐人误认也。
徐氏子十三岁，痘成脓浆，将靥。或谓变黑归肾不可治。视其痘磊落，脓浆饱满，神识清爽，言语清亮，
惟大便五日未通。此里实热蒸，故溃烂，其色苍黑，亦正色也，但解里即靥矣。与四顺清凉饮一帖，下燥矢二
十余枚，随靥而安。
房玄龄，出痘时痘疹颜色发黑，大小如同龙眼。一位老僧看见后，惊叹道：“这是万龙含珠的贵相，如今才见到。”
邱琼山七岁时，身上的痘疹也全部变黑，他的父亲担忧得痛哭。一位渔夫拿着烛光照看后，高兴地说：“这是紫微垣中的辅星和弼星，落到了这户农家。”于是取笔在孩子的背上写下“辅弼”二字后离去。
从前有一个孩子，痘疹形状全部呈黑色，在阳光下看是黑色的，用灯照看则内部透出真实的红色。偶然遇到一位僧人，没有服用内服药，而是用保元汤给他洗澡，痘色随即转为红润鲜活，后来这孩子官至台辅高位。
有一种黑痘，痘形圆整、表面光泽，到了化脓阶段，颜色像紫色的葡萄，痘根周围的血晕微微发黄，这种征象被称为“紫袍金带”。
万密斋治疗王氏之子出痘，痘疹起发时逐渐变黑，已经蔓延全身。有人说道：痘疹变黑，归属于肾，无法治愈。万密斋说：“黑痘有两种证候，一种是干枯变黑的，这叫倒陷，是邪火极度炽盛，真阴已枯竭，所以说是归肾不治。另一种是痘色变黑，但不至于干枯塌陷，这是疫毒之气所致，所谓‘火发而熏昧’（火热熏蒸导致晦暗）。现在这个病例正属于这一类，于是使用当归梢、生地、赤芍、红花来凉血，黄芪、人参、甘草来泻火补元气，酒炒的黄芩、黄连、牛蒡子、连翘、升麻来解毒，荆芥、防风来疏解表邪，每剂药加入烧过的人粪一钱，连续服用十三剂，痘色转红，脓液形成并结痂。
李氏之子出痘起发时，变黑且干燥，从发热到现在一直未大便。万密斋说：“这是体内热势极盛，应当紧急解除。”于是配制一方：麻黄用蜂蜜拌炒至黑、红花子、紫草、人中黄、连翘、酒蒸大黄、烧人粪，煎服。外用胆导法（猪胆汁灌肠），排出燥结粪便后，痘色转为红润鲜活。之后用四物汤去掉川芎，加入紫草、木通、枳壳、生甘草，调理后痊愈。
黑痘多由疔毒引起，现在将此类病例收入此门，是恐怕人们误认病情。
徐氏之子十三岁，痘疹已成脓浆，即将结痂。有人说道：痘疹变黑归属于肾，不可治愈。观察其痘疹磊落分明，脓浆饱满，神志清爽，言语清晰洪亮，只是大便五天未通。这是里实热蒸腾，导致溃烂，其颜色苍黑，也是正常的色泽，只要解除里实热结就会结痂愈合。给予四顺清凉饮一帖，排出燥结粪便二十余枚，随后结痂而安。
Fang Xuanling presented with smallpox lesions that were black in color, the size of a longan fruit. An old monk saw this and exclaimed, "This is the noble appearance of 'ten thousand dragons holding pearls'; I have seen it only now."
Qiu Qiongshan, at seven years old, also had smallpox lesions covering his entire body that turned black. His father was worried and wept bitterly. A fisherman examined him by candlelight and joyfully said, "The stars Fu (Assistant) and Bi (Minister) from the Purple Forbidden Enclosure have fallen into this humble farmer's family." He took a brush, wrote the characters "Fu" and "Bi" on the child's back, and then left.
In the past, there was a child whose smallpox lesions were all black in shape. When viewed in sunlight, they appeared black; but when illuminated by a lamp, a true red color could be seen shining from within. He accidentally met a monk who did not administer internal medicine but instead bathed him with Baoyuan Tang (Preserve the Origin Decoction). The lesions immediately turned red and vibrant. Later, this child attained the high official position of Taifu (Grand Tutor/Chancellor).
There is a type of black smallpox where the lesions are round, complete, and glossy. By the time pus forms, the color resembles purple grapes, and the blood halo around the base of the lesion is slightly yellow. This manifestation is named "Purple Robe with Golden Belt."
Wan Mizhai treated the son of the Wang family for smallpox. During the eruption stage, the lesions gradually turned black and spread over the entire body. Someone remarked, "When smallpox turns black, it indicates involvement of the Kidney and is incurable." Wan Mizhai said, "There are two types of black smallpox syndromes. One is dry and shriveled turning black, known as 'inverted collapse' (Dao Xian), caused by extreme blazing of pathogenic fire and exhaustion of true yin fluids; thus, it is said to involve the Kidney and be incurable. The other is where the lesion color turns black but does not become dry or collapsed; this is due to epidemic toxic qi, described as 'fire erupting and causing obscuration.' This case precisely belongs to the latter category. Therefore, he used Danggui Shao (Radix Angelicae Sinensis Cauda), Shengdi (Radix Rehmanniae Preparata), Chishao (Radix Paeoniae Rubra), and Honghua (Flos Carthami) to cool the blood; Huangqi (Radix Astragali), Renshen (Radix Ginseng), and Gancao (Radix Glycyrrhizae) to clear fire and tonify primordial qi; Jiu Chao Huangqin (Scutellariae Radix fried with wine), Jiu Chao Huanglian (Coptidis Rhizoma fried with wine), Niubangzi (Fructus Arctii), Lianqiao (Fructus Forsythiae), and Shengma (Rhizoma Cimicifugae) to resolve toxicity; Jingjie (Herba Schizonepetae) and Fangfeng (Radix Saposhnikoviae) to disperse the exterior. To each dose, one qian of burned human feces was added. After administering thirteen doses continuously, the color turned red, pus formed, and scabs developed.
The son of the Li family presented with smallpox lesions that turned black and dry during the eruption stage, accompanied by fever and no bowel movement since the onset of fever. Wan Mizhai said, "The heat is severe internally; it must be resolved urgently." He prepared a formula: Mahuang (Ephedrae Herba) stir-fried black with honey, Honghuazi (Semen Carthami), Zicao (Radix Lithospermi), Renzhonghuang (Nitrified Human Excrement), Lianqiao (Fructus Forsythiae), Jiuzheng Dahuang (Rhei Radix et Rhizoma steamed with wine), and burned human feces, decocted and administered orally. Externally, he employed the Dan Dao method (pig bile enema) to expel dry stool. After the dry stool was passed, the lesions turned red and vibrant. Subsequently, Siwu Tang (Four Substance Decoction) without Chuanxiong (Rhizoma Chuanxiong) was modified with the addition of Zicao (Radix Lithospermi), Mutong (Caulis Akebiae), Zhike (Fructus Aurantii), and Sheng Gancao (Raw Radix Glycyrrhizae) for regulation, leading to recovery.
Black smallpox is mostly caused by Ding Du (carbuncle toxin). Including these cases in this section is to prevent people from misidentifying the condition.
The son of the Xu family, aged thirteen, had smallpox lesions that had formed pus and were about to scab. Someone remarked, "If the lesions turn black, it involves the Kidney and is incurable." Upon examination, the lesions were distinct and prominent, the pus was full, the spirit was clear, and speech was crisp and loud. Only the bowel movement had been absent for five days. This indicated excess heat steaming internally, causing ulceration; the dark black color was actually the normal color in this context. Resolving the internal excess would lead to scabbing. One dose of Sishun Qingliang Yin (Four-Compliant Cooling and Clearing Decoction) was given, resulting in the passage of more than twenty pieces of dry stool. He subsequently scabbed and recovered safely.