诀云∶虚则痒，实则痛，此大概言之。痘疮之痒，其候不同，有初出时便身痒爬搔不停者，此邪气欲出，皮
肤闭密，其火游移往来，故痒也，与伤寒太阳病身痒汗不出者同论，可发之，使皮肤纵缓，腠理开通，邪气得泄，
疮出而痒去，所谓火郁则发之者是已。有将收较而痒者，其脓已成，其疮将回，邪气散而正气复，荣卫和畅，故痒
也，与痈疖将痊而痒者同论，不须服药，但谨护之，勿令 掐，以致肿灌，所谓美 者是已。有起壮泡浆而痒者，当
血已化水，水未成脓之时，其毒未化，浑身瘙痒，爬搔不宁，此恶候也，与伤寒阳明经病皮中如虫行者同论，所
谓虚风外搏，邪气内强，痒而不止为泄风者是已。此视疮之干湿，以风药佐之，必令痒去，方为佳兆，若痒甚不休，
疮坏皮脱，其毒复陷，谓之痒塌，必不能治矣。大抵出形而皮肉红艳，起发而皮嫩多水者，其后常致痒塌也。凡痘子
瘙痒者，须于形色上详审，如疮一向起发红活，光壮肥满，忽然瘙痒者，此秽气所触也，宜内服十全大
补汤（汗），外用茵陈熏法（起发），其破者以白龙散敷之。如疮本干燥又添瘙痒者，火甚也。如疮原带水，皮肉嫩薄，
又痒
者，此温热也。摆头扭项，手足动作，昏闷者死证。如初出身痒者，可发之，桂枝葛根汤（初热）加制麻黄、牛蒡子、
主之。如起发养浆而痒者，通用十全大补汤（汗）加防风、牛蒡子主之。起发身痒有二证，一则血气不足，其痒为虚，
十
全大补汤主之。一则不能食淡、以致发痒，蝉蜕膏主之（初热）。如疮干而痒者，宜养血润燥，以四物汤（失血）合消
风化毒汤、夺命丹（起发）主之，外用茵陈熏法。如疮湿而痒者，宜养气去湿，以四君子汤（不能食）合消风化毒汤、
夺命丹主之，外用茵陈熏法。凡痘子已熟，忽作瘙痒抓破者，此脾胃虚弱，不能荣养肌肉也，内服四君子汤加黄 、官
桂，外以败草散（溃烂）主之。如因自利脾胃虚，致痒塌者，陈氏木香散（泄利）、异功散（出不快）主之。如疮将
收而作痒，误犯破损，不肯干较者，用白龙散贴敷。丹溪法∶于形色脉上分虚实，实则脉有力气壮，虚则脉无力气馁。
实痒则势 ，虚痒则势怯。虚痒以实表之剂加凉血药，实痒以大黄寒凉之药少许与之，
下其结粪。沧洲翁法∶主血气不足，用十补托里散及木香散加丁香、官桂。胃主肌
肉，尤宜四君子汤加芎、归、木香、紫草煎服。或患者不能忌口，因食毒物而作痒者，二物汤、百花膏，或四君子汤加
解毒药。陈氏法痘疮作痒，抓破成疮，脓水淋漓者，由血气衰，肌肉虚也，宜用木香散（泻）加丁香、肉桂，及败草
散（收靥），切忌用牛粪灰。闻人氏法∶痒有二证，一则气血不足，其痒为虚，活血散（出不快）或四君子汤加黄
、枳壳主之（左中恕用十全大补汤、十宣内托散）。一则不能食淡以致痒，蝉蜕一物汤主之（痘腹痛）。魏氏法以
保元汤倍加黄 ，少加芍药。
或云首尾痒塌，保元加牛蒡子、白芍药、何首乌。何首乌有红白二种，名为雄雌，必须兼下有效。忌铁。王汝言云∶
痘疮虚怯，淡白色，痒塌，此属虚寒，宜用陈氏法。若发热壮盛，齐涌红紫色，燥痒，此属热毒，宜用凉血解毒之剂。
薛氏云∶前证皆因气血虚弱所致，预为调护，使气血和平，庶无此患，又必察其外证，色白者用四君之类，色赤者用
四物之类。
袁氏云∶囊贮半浆而作痒者，可以疗止，必当用参、 、芍药、升麻、附子之属，不宜投寒散之药。若焦贴皮肤作痒
者不治。空壳莲蒲作痒者，不治。
参 内托散 治里虚发痒，疮不溃，倒靥。
人参 黄 （炒） 当归 川芎 浓朴（姜制） 防风（各五分） 桔梗 白芷 官桂（各二分） 木
香甘草（各三分） 紫草（五分）
上入糯米一撮，水煎，量服之。寒战切牙，饮水泻渴，亦宜服。
紫草木香散 治痘疮里虚痒塌，黑陷发热。
紫草 伏苓 甘草 白术 木香 人参（各等分） 糯米
上，每服三钱，水煎。
消风化毒汤
防风 黄 白芍药 荆芥穗 桂枝 牛蒡子 升麻（各等分） 甘草（减半）
上锉碎。加薄荷叶七片，水一盏，煎七分，去滓温服，无时。
〔丹〕治痘疮痒塌不掩。
白术（一钱半） 黄 （炙） 当归 陈皮（各五分） 甘草（炙些）
水煎，温服。
予治一子七岁，痘将出未出之际，腹泄数行，其泄色黑，不发根窠，三日后痒塌，抓即黑色，口渴，
其根窠如水疥状不红泽，不起发，食少，脉浮数有力，按之虚。遂用参、 、归、术、陈皮、肉豆
蔻为君，炙甘草、诃子、桂为佐，使水煎熟，
好酒些少，咽下痒立止，食立进，根窠红泽而起发，二服全愈。
蝉花散 治痘疹不拘前后始终，遍身作痒抓破，皆治之。
蝉蜕（去头足，洗去土，微炒，一两） 地骨皮（炒黑色，一两）
共为末。每服一茶匙，水酒送下，一二服，神效。
二物汤
蝉蜕（净洗，二十一枚） 甘草（炙，一两）
上为末。水煎，时时服之。
盒脾散 痘至八九日期，倏然身中枭痒，此痘证之最急者，以此治之。
炒术 芍药 生地黄 甘草 升麻 荆芥 防风 陈皮 大腹皮 僵蚕 蝉蜕
水煎服。
震泽汤
人参 黄 芍药 生地黄 防风 甘草
水煎服。
天元二仙丹
浑天汤 人参（乳浸） 黄 生附子（面煨。各一两）
四味，另研细，方和合一处，白蜜调匀。量儿大小加减，十岁以上一钱，十五
岁以上二钱。服后，随以振元汤连进，痒遂止矣。
七星散
黄 芍药（各二钱） 人参 桂心（各一钱） 黑鱼（一个）
上，前四味共研为末，置黑鱼肚内，升麻酒煮熟，与痘痒者连药食之。凡上焦
痒吃头，中焦痒吃身，下焦痒吃尾。亦验方也。
白龙散
用干黄牛粪，在风露中多久者，火 成灰，取中心白者为末，薄绢囊裹，于疮上扑之。
浴法
经霜桑叶（上） 苏梗（中） 升麻（上） 荆芥穗（中） 防风（中）
水煎十数沸，候温，拭体。
痒甚欲搔者，以乌羽轻拂之。以细茶、当归、黄 、玄参、烧烟熏之。或以铁器烧
红，置酽醋中，于室中熏之。
〔丹〕轻者，用淡蜜水调滑石末，以鸡羽润疮上。
〔陈〕痘痒难任，搔之成疮，或脓或血出者，败草散治之，切不可用牛粪灰，贴则臭
秽瘢多矣（方见收靥证治）。
小儿痘疮痒难任，误搔成疮，及疮痂欲落不落，用上好白蜜一味涂于疮上，其痂易落，可无紫黑瘢痕。
世传痘靥落后，痘毒不尽，变成癞癣，其痒难任，用陈年腊脂油敷，神妙。
又方 用羊 骨髓涂疮效（方见落痂证治痂不脱条）。
【爬破】〔万〕凡痘子脓成浆熟，或痒，误犯破者，只复灌烂，不能成痂，若脓浆未成之时，不可犯
破半个，必然痒塌而死。〔袁〕敢问，有爬破囊房脓血淋漓而死者。有爬破囊房干枯脱皮而死者。其故何与？
曰木枯则自折，土燥则自裂，痘之囊房空虚，则枭痒自作，欲其不搔爬也难矣，但爬破于不关轴之处，犹可
以全活，若脸颧气窝，命之要辖也，于兹爬脱，死在旦夕。彼爬破而脓血淋漓，似乎气血交
养，本不宜死也，而有死者，岂痘之不分美恶乎？要知鱼得水而肥，鸟得林而栖，
痘囊既破，脓血淋漓，既竭，则元气耗绝矣，元气既竭，乌得不至死耶。评云∶脓血流来痘可生，只因灌破走黄金，
任教炉火工夫到，弃了黄金恼杀人。喻言极是。
谢冲霄说∶女娲炼五色石以补天，皮脱可药纸以封之，斯言谬矣。
治痘疮抓碎出血，黑虎丹。歌曰∶丝瓜联蒂与囊皮，孔里乌金统用之，慢火置于新瓦炙，烧时存性效真奇，痘
经抓破恶枭攻，须识王真一笑翁，荆芥防风香白芷，绵 芍药建奇功。
按∶古方有用败草散抹者，有用荞麦粉抹者，有用蛤粉掺者，有用文蛤末掺者，总不如黑虎丹之妙也。
歌诀说：虚证表现为瘙痒，实证表现为疼痛，这是大概的说法。痘疮的瘙痒，其表现各不相同。有的在刚发出时就全身瘙痒、抓挠不停，这是因为邪气想要外出，但皮肤腠理闭塞致密，火邪游移往来，所以产生瘙痒。这与伤寒太阳病中身体瘙痒且无汗的情况属于同一类机理，可以采用发汗的方法，使皮肤松弛，腠理开通，邪气得以宣泄，痘疮发出后瘙痒自然消除，这就是所谓“火郁则发之”的道理。
有的痘疮在即将收靥（结痂脱落）时出现瘙痒，此时脓液已经形成，痘疮即将消退，邪气消散而正气恢复，营卫之气调和通畅，所以产生瘙痒。这与痈疖即将痊愈时的瘙痒属于同一类机理，不需要服药，只需谨慎护理，不要让孩子抓挠，以免导致肿胀溃烂流脓，这就是所谓“美疮”（指愈合良好的疮疡）的表现。
有的在起胀、起泡、灌浆过程中出现瘙痒，当血液已化为水液，但水液尚未完全化为脓液之时，毒邪尚未化解，导致浑身瘙痒，抓挠不安，这是不良的征候。这与伤寒阳明经病中皮肤感觉像虫子爬行一样的情况属于同一类机理，所谓虚风外袭，邪气内盛，瘙痒不止称为“泄风”。这种情况需要观察痘疮的干湿状况，辅以祛风药物，务必使瘙痒停止，这才是佳兆；如果瘙痒剧烈不止，导致痘疮败坏、皮肉脱落，毒邪再次陷入体内，这就叫做“痒塌”，必定无法治愈了。大致来说，痘疹发出时皮肉红艳光亮，起发时皮嫩多水者，其后常会导致痒塌。
凡是痘子瘙痒的，必须详细审察其形色。如果痘疮一直起发红活、光泽壮实饱满，忽然出现瘙痒，这是被秽气所触犯所致，适宜内服十全大补汤，外用茵陈熏法；对于破损的痘疮，用白龙散敷贴。如果痘疮本来干燥又增添瘙痒，这是火毒炽盛。如果痘疮原本带有水湿，皮肉嫩薄，又出现瘙痒，这是温热之邪所致。如果出现摇头扭颈、手足躁动、神志昏闷的症状，属于死证。
如果是初出时身痒，可以用发汗法，以桂枝葛根汤加制麻黄、牛蒡子为主方治疗。如果是起发养浆时瘙痒，通用十全大补汤加防风、牛蒡子为主方治疗。起发时身痒有两种证型：一是血气不足，其痒属虚，用十全大补汤主治；二是因不能忌口吃淡食而导致发痒，用蝉蜕膏主治。如果痘疮干燥而痒，宜养血润燥，以四物汤合消风化毒汤、夺命丹为主方治疗，外用茵陈熏法。如果痘疮湿润而痒，宜补气去湿，以四君子汤合消风化毒汤、夺命丹为主方治疗，外用茵陈熏法。
凡是痘子已经成熟，忽然发生瘙痒被抓破的，这是脾胃虚弱，不能荣养肌肉所致，内服四君子汤加黄芪、官桂，外用败草散主治。如果是因自利（腹泻）导致脾胃虚弱，进而引起痒塌的，用陈氏木香散、异功散主治。如果痘疮将要收靥却作痒，误犯破损，不肯干燥结痂，用白龙散贴敷。
丹溪的法则是：从形色脉象上分辨虚实。实证则脉有力、气壮；虚证则脉无力、气馁。实性瘙痒则势头急迫，虚性瘙痒则势头怯弱。虚性瘙痒用固表剂加入凉血药；实性瘙痒用少量大黄等寒凉药物，以通下结粪。沧洲翁的法则是：主张血气不足，用十补托里散及木香散加丁香、官桂。胃主肌肉，尤其适宜用四君子汤加川芎、当归、木香、紫草煎服。或者患者不能忌口，因食用毒物而作痒的，用二物汤、百花膏，或四君子汤加解毒药。
陈氏的法则是：痘疮作痒，抓破成疮，脓水淋漓，这是由于血气衰败，肌肉虚弱所致，宜用木香散加丁香、肉桂，以及败草散，切忌使用牛粪灰。
闻人氏的法则是：瘙痒有两种证型，一是气血不足，其痒为虚，用活血散或四君子汤加黄芪、枳壳主治（左中恕用十全大补汤、十宣内托散）。二是不能食淡以致痒，用蝉蜕一物汤主治。
魏氏的法则是：以保元汤倍加黄芪，少加芍药。有人说首尾痒塌，保元汤加牛蒡子、白芍药、何首乌。何首乌有红白两种，名为雄雌，必须兼用才有效。忌铁器。王汝言说：痘疮虚怯，色淡白，痒塌，这属于虚寒，宜用陈氏法。若发热壮盛，痘疹齐涌呈红紫色，燥痒，这属于热毒，宜用凉血解毒之剂。
薛氏说：上述诸证皆因气血虚弱所致，预先调护，使气血平和，才可避免此患，又必须察验外证，色白的用四君子汤之类，色赤的用四物汤之类。
袁氏说：囊中贮有半浆而作痒的，可以疗止，必当用人参、黄芪、芍药、升麻、附子之类的药物，不宜投用寒凉发散之药。若痘疮焦枯贴于皮肤作痒的，无法治疗。空壳莲蒲状痘疮作痒的，也无法治疗。
参苓内托散：治疗里虚发痒，痘疮不溃破，倒靥。
组成：人参、黄芪（炒）、当归、川芎、厚朴（姜制）、防风（各五分）、桔梗、白芷、官桂（各二分）、木香、甘草（各三分）、紫草（五分）。
用法：上药入糯米一撮，水煎，适量服用。若有寒战咬牙、饮水口渴腹泻等症状，也适宜服用。
紫草木香散：治疗痘疮里虚痒塌，黑陷发热。
组成：紫草、茯苓、甘草、白术、木香、人参（各等分）、糯米。
用法：上药研粗末，每服三钱，水煎。
消风化毒汤：
组成：防风、黄芪、白芍药、荆芥穗、桂枝、牛蒡子、升麻（各等分）、甘草（减半）。
用法：上药锉碎。加薄荷叶七片，水一盏，煎至七分，去渣温服，不拘时候。
〔丹〕治痘疮痒塌不掩（指痘疮塌陷不能覆盖）。
组成：白术（一钱半）、黄芪（炙）、当归、陈皮（各五分）、甘草（炙少许）。
用法：水煎，温服。
我治疗一个七岁男孩，在痘疹将出未出之际，腹泻数次，泻下物色黑，痘根不起，三日后出现痒塌，抓挠后即变黑色，口渴，其痘根如水泡状而不红泽，不起发，食欲少，脉浮数有力，重按则虚。于是用人参、黄芪、当归、白术、陈皮、肉豆蔻为君药，炙甘草、诃子、肉桂为佐药，用水煎熟，加少许好酒送下，咽下后瘙痒立即停止，食欲立即恢复，痘根红泽而起发，服两剂全愈。
蝉花散：治疗痘疹不论前后始终，遍身作痒抓破，均可治疗。
组成：蝉蜕（去头足，洗去土，微炒，一两）、地骨皮（炒黑色，一两）。
用法：共为细末。每服一茶匙，水酒送下，一二服，神效。
二物汤：
组成：蝉蜕（净洗，二十一枚）、甘草（炙，一两）。
用法：上为细末。水煎，时时服之。
盒脾散：痘至八九日期，突然全身剧烈瘙痒，这是痘证中最紧急的情况，以此方治疗。
组成：炒白术、芍药、生地黄、甘草、升麻、荆芥、防风、陈皮、大腹皮、僵蚕、蝉蜕。
用法：水煎服。
震泽汤：
组成：人参、黄芪、芍药、生地黄、防风、甘草。
用法：水煎服。
天元二仙丹：
浑天汤组成：人参（乳浸）、黄芪、生附子（面煨，各一两）。
用法：以上四味（注：此处原文似缺一味，通常指前文提到的药物组合，依原文记录），另研细，方和合一处，白蜜调匀。根据患儿年龄大小加减，十岁以上一钱，十五岁以上二钱。服后，随即连进振元汤，瘙痒便停止了。
七星散：
组成：黄芪、芍药（各二钱）、人参、桂心（各一钱）、黑鱼（一个）。
用法：前四味共研为末，置入黑鱼肚内，用升麻酒煮熟，让患痘痒的孩子连同药一起食用。凡上焦痒吃头部，中焦痒吃躯干，下焦痒吃尾部。这也是验方。
白龙散：
用法：用久在风露中的干黄牛粪，烧成灰，取中心白色的部分为细末，用薄绢囊包裹，扑在疮上。
浴法：
组成：经霜桑叶（上等）、苏梗（中等）、升麻（上等）、荆芥穗（中等）、防风（中等）。
用法：水煎十余沸，候温，擦拭身体。
瘙痒严重想抓挠的，用鸟羽轻轻拂拭。用细茶、当归、黄芪、玄参烧烟熏之。或用铁器烧红，置于浓醋中，在室内熏蒸。
〔丹〕轻症者，用淡蜜水调滑石末，以鸡羽润擦疮上。
〔陈〕痘痒难忍，搔之成疮，或出脓或出血者，用败草散治疗，切不可用牛粪灰，贴敷则会产生臭秽瘢痕（方见收靥证治）。
小儿痘疮痒难忍，误搔成疮，及疮痂欲落不落，用上好白蜜一味涂于疮上，其痂易落，可无紫黑瘢痕。
世传痘靥落后，痘毒不尽，变成癞癣，其痒难忍，用陈年腊脂油敷，神妙。
又一方：用羊骨髓涂疮有效（方见落痂证治痂不脱条）。
【爬破】〔万〕凡是痘子脓成浆熟，或因痒误犯抓破的，只会复灌溃烂，不能成痂；若脓浆未成之时，不可犯破半个，必然痒塌而死。〔袁〕敢问，有爬破囊房脓血淋漓而死者，有爬破囊房干枯脱皮而死者。其原因是什么？
回答说：树木枯槁则自行折断，土壤干燥则自行龟裂，痘的囊房空虚，则剧烈瘙痒自作，想要它不抓挠是很难的。但如果抓破在不关紧要之处，还可以保全性命；若在脸颧气窝等生命要害之处抓破脱落，死亡就在旦夕之间。那些爬破后脓血淋漓，看似气血交养，本不应死，但有死者，难道痘疮不分好坏吗？要知道鱼得水而肥，鸟得林而栖，痘囊既然破裂，脓血淋漓，元气既竭，则元气耗绝矣，元气既竭，怎能不死呢？评注说：脓血流来痘可生，只因抓破走黄金，任凭炉火工夫到，弃了黄金恼杀人。比喻非常恰当。
谢冲霄说：女娲炼五色石以补天，皮脱可用药纸封之，这种说法是错误的。
治疗痘疮抓碎出血，用黑虎丹。歌诀曰：丝瓜联蒂与囊皮，孔里乌金统用之，慢火置于新瓦炙，烧时存性效真奇，痘经抓破恶枭攻，须识王真一笑翁，荆芥防风香白芷，绵芪芍药建奇功。
The aphorism states: Deficiency manifests as itching, excess manifests as pain; this is a general statement. The itching of smallpox varies in presentation. Some patients experience whole-body itching and incessant scratching immediately upon eruption. This occurs because the pathogenic factor desires to exit, but the skin pores are closed and dense, causing the fire pathogen to wander back and forth, resulting in itching. This is analogous to the body itching without sweat seen in Taiyang disease (disease of the Taiyang channel) in Shanghan (Cold Damage) syndrome. It can be treated with diaphoresis (sweating method) to relax the skin, open the pores, allow the pathogen to escape, and resolve the itching once the pustules erupt. This aligns with the principle "when fire is constrained, release it."
Some patients experience itching when the lesions are about to crust over. At this stage, pus has formed, the lesions are subsiding, the pathogen is dispersing, and the healthy qi is recovering. The Ying and Wei (nutritive and defensive) qi are harmonious and flowing smoothly, causing itching. This is analogous to the itching seen when carbuncles and furuncles are nearing cure. Medication is unnecessary; careful nursing is required to prevent scratching, which could lead to swelling and suppuration. This represents a favorable healing process ("beautiful sores").
Some patients experience itching during the rising, blistering, and suppurating stages. When blood has transformed into fluid, but the fluid has not yet fully become pus, and the toxin has not yet resolved, the whole body itches, and the patient scratches restlessly. This is an ominous sign. It is analogous to the sensation of insects crawling under the skin seen in Yangming channel disease in Shanghan syndrome. This is described as external attack by deficient wind and internal strength of the pathogen, where incessant itching is called "leaking wind." In such cases, one must observe whether the lesions are dry or moist and administer wind-dispelling herbs accordingly. Itching must cease for this to be considered a good omen. If itching is severe and unceasing, leading to lesion destruction, skin peeling, and re-depression of the toxin, it is called "itch-collapse" (Yang Ta), which is incurable. Generally, if lesions appear bright red and shiny upon eruption, or tender and watery upon rising, they are prone to subsequent itch-collapse.
In all cases of smallpox itching, one must carefully examine the color and shape. If lesions have been rising red and vibrant, lustrous, plump, and full, and suddenly become itchy, this is due to contact with foul qi. Internal administration of Shiquan Dabu Tang (Complete Excellent Tonifying Decoction) and external application of Yinchen fumigation method are indicated. For broken lesions, Bailong San (White Dragon Powder) should be applied. If lesions that were originally dry develop additional itching, this indicates excessive fire/toxin. If lesions originally contained water, had tender/thin skin, and now itch, this indicates warm-heat pathogen. Symptoms such as head shaking, neck twisting, limb movements, and mental confusion indicate a death prognosis.
For initial itching upon eruption, use a releasing method with Guizhi Gegen Tang (Cinnamon Twig and Pueraria Decoction) plus processed Mahuang (Ephedrae Herba) and Niubangzi (Arctii Fructus). For itching during the rising and suppurating stages, generally use Shiquan Dabu Tang (Complete Excellent Tonifying Decoction) plus Fangfeng (Saposhnikoviae Radix) and Niubangzi (Arctii Fructus). There are two patterns of itching during the rising stage: 1) Blood and qi deficiency, where itching is due to deficiency, treated with Shiquan Dabu Tang (Complete Excellent Tonifying Decoction); 2) Itching caused by failure to maintain a bland diet, treated with Chantui Gao (Cicada Slough Ointment).
If lesions are dry and itchy, nourish blood and moisten dryness using Siwu Tang (Four Substances Decoction) combined with Xiaofeng Huadu Tang (Wind-Dispersing and Toxin-Resolving Decoction) and Duoming Dan (Life-Snatching Pill), with external Yinchen fumigation. If lesions are moist and itchy, tonify qi and remove dampness using Sijunzi Tang (Four Gentlemen Decoction) combined with Xiaofeng Huadu Tang (Wind-Dispersing and Toxin-Resolving Decoction) and Duoming Dan (Life-Snatching Pill), with external Yinchen fumigation.
If mature lesions suddenly itch and are scratched open, this is due to Spleen and Stomach weakness failing to nourish muscles. Internal treatment: Sijunzi Tang (Four Gentlemen Decoction) plus Huangqi (Astragali Radix) and Guigui (Cinnamomi Cortex). External treatment: Baicao San (Decayed Grass Powder). If diarrhea causes Spleen/Stomach weakness leading to itch-collapse, use Chen's Muxiang San (Costus Powder) or Yigong San (Extraordinary Power Powder). If lesions are crusting but itch due to accidental breaking and fail to dry, apply Bailong San (White Dragon Powder).
Danxi's method: Differentiate deficiency and excess based on appearance and pulse. Excess presents with strong pulse and robust qi; deficiency presents with weak pulse and depleted qi. Excess itching has an urgent intensity; deficiency itching has a timid intensity. Treat deficiency itching with exterior-strengthening agents plus blood-cooling herbs; treat excess itching with small doses of Da Huang (Rhei Radix et Rhizoma) and other cold/cool herbs to purge accumulated feces. Cangzhou Weng's method: Focus on blood/qi deficiency, using Shibu Tuoli San (Ten-Ingredient Interior-Tonifying and Supporting Powder) and Muxiang San (Costus Powder) plus Dingxiang (Caryophylli Flos) and Guigui (Cinnamomi Cortex). Since the Stomach governs muscles, Sijunzi Tang (Four Gentlemen Decoction) plus Xiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), Muxiang (Aucklandiae Radix), and Zicao (Leonuri Herba) is particularly suitable. If the patient fails to keep dietary restrictions and eats toxic foods causing itching, use Erwu Tang (Two-Substance Decoction), Baihua Gao (Hundred Flowers Ointment), or Sijunzi Tang (Four Gentlemen Decoction) plus detoxifying herbs.
Chen's method: Itching with scratched lesions weeping pus/blood is due to blood/qi decline and muscle weakness. Use Muxiang San (Costus Powder) plus Dingxiang (Caryophylli Flos) and Rougui (Cinnamomi Cortex), and Baicao San (Decayed Grass Powder). Strictly avoid cow dung ash, as it causes foul-smelling scars.
Wenrenshi's method: Two patterns of itching: 1) Blood/qi deficiency (deficiency type), treated with Huoxue San (Invigorate Blood Powder) or Sijunzi Tang (Four Gentlemen Decoction) plus Huangqi (Astragali Radix) and Zhike (Aurantii Fructus). (Zuo Zhongshu uses Shiquan Dabu Tang [Complete Excellent Tonifying Decoction] and Shixuan Naituo San [Ten-Acupoint Interior-Supporting Powder]). 2) Itching from failure to eat bland food, treated with Chantui Yiwu Tang (Cicada Slough Single-Substance Decoction).
Wei's method: Use Baoyuan Tang (Protect Origin Decoction) with doubled Huangqi (Astragali Radix) and added Shaoyao (Paeoniae Radix). Some say for head/tail itch-collapse, add Niubangzi (Arctii Fructus), Baishaoyao (White Peony Root), and Heshouwu (Polygoni Multiflori Radix) to Baoyuan Tang. Heshouwu has red and white varieties (male/female); both should be used together for efficacy. Avoid iron. Wang Ruyan states: Pale, weak smallpox with itch-collapse indicates deficiency-cold; use Chen's method. Fever with vigorous eruption of red/purple lesions and dry itching indicates heat-toxin; use blood-cooling and detoxifying agents.
Xue's statement: All preceding conditions result from blood/qi weakness. Preventative care to harmonize blood/qi avoids these issues. Observe external signs: pale colors require Sijunzi-type formulas; red colors require Siwu-type formulas.
Yuan's statement: Itching with half-filled blisters can be stopped using Renshen (Ginseng Radix), Huangqi (Astragali Radix), Shaoyao (Paeoniae Radix), Shengma (Cimicifugae Rhizoma), and Fuzi (Aconiti Lateralis Radix Preparata). Avoid cold/dispersing herbs. Burning lesions adhering to skin are incurable. Empty-shell lotus-pod-like lesions with itching are incurable.
Shenling Naituo San (Ginseng and Atractylodes Interior-Supporting Powder): Treats interior deficiency itching, non-ulcerating lesions, and inverted crusting.
Ingredients: Renshen (Ginseng Radix), Huangqi (Astragali Radix, stir-fried), Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Houpo (Magnoliae Officinalis Cortex, ginger-processed), Fangfeng (Saposhnikoviae Radix) [each 5 fen], Jiegeng (Platycodonis Radix), Baizhi (Angelicae Dahuricae Radix), Guigui (Cinnamomi Cortex) [each 2 fen], Muxiang (Aucklandiae Radix), Gancao (Glycyrrhizae Radix et Rhizoma) [each 3 fen], Zicao (Leonuri Herba) [5 fen].
Preparation: Add a pinch of glutinous rice, decoct in water, and take appropriate amounts. Also suitable for chills, teeth grinding, thirst, and diarrhea.
Zicao Muxiang San (Leonurus and Costus Powder): Treats interior deficiency itch-collapse, black depression, and fever in smallpox.
Ingredients: Zicao (Leonuri Herba), Fuling (Poria), Gancao (Glycyrrhizae Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Muxiang (Aucklandiae Radix), Renshen (Ginseng Radix) [equal parts], Glutinous Rice.
Preparation: Coarsely powder. Take 3 qian per dose, decoct in water.
Xiaofeng Huadu Tang (Wind-Dispersing and Toxin-Resolving Decoction):
Ingredients: Fangfeng (Saposhnikoviae Radix), Huangqi (Astragali Radix), Baishaoyao (Paeoniae Radix Alba), Jingjie Sui (Schizonepetae Spica), Guizhi (Cinnamomi Ramulus), Niubangzi (Arctii Fructus), Shengma (Cimicifugae Rhizoma) [equal parts], Gancao (Glycyrrhizae Radix et Rhizoma) [half amount].
Preparation: Coarsely chop. Add 7 leaves of Bohe (Menthae Haplocalycis Herba), 1 cup of water, decoct to 0.7 cup, strain, and take warm at any time.
[Dan] treats itch-collapse where lesions do not cover.
Ingredients: Baizhu (Atractylodis Macrocephalae Rhizoma) [1.5 qian], Huangqi (Astragali Radix, honey-fried), Danggui (Angelicae Sinensis Radix), Chenpi (Citri Reticulatae Pericarpium) [each 5 fen], Gancao (Glycyrrhizae Radix et Rhizoma, lightly fried).
Preparation: Decoct in water, take warm.
Case Study: I treated a seven-year-old boy. During the pre-eruption phase, he had several episodes of dark-colored diarrhea. Lesions failed to rise from their bases. Three days later, itch-collapse occurred; scratching turned them black. He was thirsty. Bases resembled water blisters, lacked redness/luster, and did not rise. Appetite was poor. Pulse was floating, rapid, and forceful, but empty upon deep pressure. I used Renshen (Ginseng Radix), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), and Roudoukou (Myristicae Semen) as sovereign herbs; Zhi Gancao (Prepared Licorice), Hezi (Terminalia Chebulae Fructus), and Rougui (Cinnamomi Cortex) as minister herbs. Decocted in water, taken with a little fine wine. Itching stopped immediately, appetite returned, bases became red/lustrous and rose. Cured after two doses.
Chan Hua San (Cicada Flower Powder): Treats whole-body itching and scratching in smallpox/rubeola, regardless of stage.
Ingredients: Chantui (Cicada Slough, heads/feet removed, washed, lightly fried) [1 liang], Digupi (Lygodii Radix, fried until black) [1 liang].
Preparation: Powder. Take 1 tea spoon with water/wine. Effective after 1-2 doses.
Erwu Tang (Two-Substance Decoction):
Ingredients: Chantui (Cicada Slough, clean) [21 pieces], Gancao (Glycyrrhizae Radix et Rhizoma, fried) [1 liang].
Preparation: Powder. Decoct in water, take frequently.
Hepi San (Box Spleen Powder): Used for sudden severe whole-body itching on days 8-9 of smallpox, the most urgent condition.
Ingredients: Chao Baizhu (Stir-fried Atractylodis Macrocephalae Rhizoma), Shaoyao (Paeoniae Radix), Sheng Dihuang (Rehmanniae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Shengma (Cimicifugae Rhizoma), Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix), Chenpi (Citri Reticulatae Pericarpium), Dafupi (Arecae Pericarpium), Jiangcan (Bombyx Batryticatus), Chantui (Cicada Slough).
Preparation: Decoct in water.
Zhenze Tang (Zhenze Decoction):
Ingredients: Renshen (Ginseng Radix), Huangqi (Astragali Radix), Shaoyao (Paeoniae Radix), Sheng Dihuang (Rehmanniae Radix), Fangfeng (Saposhnikoviae Radix), Gancao (Glycyrrhizae Radix et Rhizoma).
Preparation: Decoct in water.
Tianyuan Erxian Dan (Heavenly Origin Two Immortals Pill):
Huntian Tang Ingredients: Renshen (Ginseng Radix, milk-soaked), Huangqi (Astragali Radix), Sheng Fuzi (Prepared Aconiti Lateralis Radix, flour-baked) [each 1 liang].
Preparation: Grind the four ingredients separately to fine powder, mix, and blend with white honey. Dosage by age: >10 years old = 1 qian; >15 years old = 2 qian. Follow with Zhenyuan Tang (Restore Origin Decoction) consecutively to stop itching.
Qixing San (Seven Star Powder):
Ingredients: Huangqi (Astragali Radix), Shaoyao (Paeoniae Radix) [each 2 qian], Renshen (Ginseng Radix), Guixin (Cinnamomi Ramulus) [each 1 qian], Black Carp (1 fish).
Preparation: Powder the first four ingredients, place inside the black carp, cook in Shengma (Cimicifugae Rhizoma) wine until done. Eat the fish and medicine with the itchy child. Upper jiao itch: eat head; Middle jiao itch: eat body; Lower jiao itch: eat tail. An empirical formula.
Bailong San (White Dragon Powder):
Preparation: Use dried yellow cow manure aged long in wind/dew. Burn to ash. Take the white center, powder it, wrap in thin silk, and dust onto lesions.
Bathing Method:
Ingredients: Frost-exposed Sangye (Mori Folium) [top grade], Sugeng (Perillae Caulis) [medium], Shengma (Cimicifugae Rhizoma) [top grade], Jingjie Sui (Schizonepetae Spica) [medium], Fangfeng (Saposhnikoviae Radix) [medium].
Preparation: Decoct vigorously, cool, and wipe the body.
For severe itching wanting to scratch: Lightly brush with bird feathers. Smoke with Xiacha (Fine Tea), Danggui (Angelicae Sinensis Radix), Huangqi (Astragali Radix), Xuanshen (Scrophulariae Radix). Or heat an iron tool, dip in strong vinegar, and smoke the room.
[Dan]: Mild cases: Mix Tuhua Shi (Calcitum) powder with light honey water, apply with chicken feather.
[Chen]: Unbearable itching leading to sores/weeping pus/blood: Use Baicao San (Decayed Grass Powder). Strictly avoid cow dung ash, as it causes foul scars (see Crusting Treatment).
For children with unbearable itching causing sores, or stubborn scabs: Apply high-quality white honey to lesions. Scabs fall easily, preventing purple/black scars.
Popular belief: After crusting, unresolved toxins cause scabies/lichen. Apply aged tallow for miraculous effect.
Another Formula: Sheep marrow applied to lesions is effective (see Scab Removal Section).
[Scratching Open] [Wan]: If mature pus-filled lesions are scratched open due to itching, they will only ulcerate further and fail to crust. If scratched before pus formation, itch-collapse and death are inevitable. [Yuan]: Why do some die from weeping pus after scratching, while others die from dry peeling?
Answer: Dry wood breaks naturally; dry soil cracks naturally. Empty smallpox blisters cause intense itching, making scratching difficult to resist. Scratching non-vital areas may allow survival; scratching vital areas (cheeks/nose bridge) leads to imminent death. Weeping pus seems to nourish blood/qi, yet death occurs. Fish thrive in water; birds nest in forests. Once the blister breaks and pus leaks, Yuan Qi (Original Qi) is exhausted. Exhausted Yuan Qi leads to death. Commentary: "Pus flow suggests life, but scratching wastes the 'gold' (vital essence). No matter how skilled the treatment, losing the 'gold' is heartbreaking." This analogy is apt.
Xie Chongxiao said: Nuwa mended the sky with five-colored stones; skin loss can be patched with medicinal paper. This statement is erroneous.
Treatment for scratched bleeding lesions: Heihu Dan (Black Tiger Pill). Verse: Silk gourd stem and sac skin, black gold from within, slow-roasted on new tile preserving nature, efficacy truly miraculous. When scratching brings evil wind, know the laughter of Master Wang Zhen. Schizonepeta, Saposhnikovia, Angelica dahurica, Astragalus, and Peony perform wondrous feats.
Note: Ancient methods used Baicao San, Buckwheat flour, Gege (Clam shell powder), or Wen Ge (Clam shell powder). None compare to the excellence of Heihu Dan.