（诸痘中有独大者，或黑、或白，其根结硬，即是痘疔，如疔疮样，直抵筋骨，宜挑破，以四圣散点之。凡
黑陷中有微尖顶如苦楮样者，疔也，无此状者，谓之黑陷，非疔也）
〔万〕痘疔者，热毒蓄积，气血腐坏而成也，状有数种，乃疫毒之气，最为恶候，宜谨察之。有肌肉微肿，状
如堆粟，不分颗粒者，此气滞血凝，毒瓦斯郁结也。有初出红点，渐变黑色，其硬如石者，此肌肉已败，气血中虚，
不能载毒而出，反致陷伏也。有中心黑陷，四畔突起戴浆者，此血随毒走，气不为用也。有中心戴浆，四
畔干陷焦黑者，此气附毒出，血不为使也。有头戴白浆，自破溃烂者，此气血不充，皮肤败坏也。有为水泡溶溶易
破者，此火湿并行，气虚不能敛束也。有为血泡色紫
易破者，此血热妄行，不能自附于气也。有疮头针孔，浆水自出者，此卫气已败，其液外脱也。此数证者，于五六
日间候之，但见一证，即不可治。〔薛〕痘疔，又谓之贼痘，或三五枚，或五七枚，间杂于诸痘之间，其色紫
黯，作痛不宁，以致诸证蜂起，不能灌脓，甚至不救，乃热毒势甚并结也，用仙方活命饮（疮疡）。如二便秘
涩，量加大黄。遍身拘急，加麻黄。外必用线针挑破，出黑血，或吮出毒血，以泄其毒，余痘才得灌脓，否则其
毒无从而解，必致不起。如未应，急用隔蒜灸，若毒瓦斯盛者，或不知痛者，不用蒜隔，就着肉灼艾灸之，若灸后，
疮头红肿发 ，用针挑破出毒血，灼艾尤好，虽此法未出方书，予屡用屡验者，世多用至宝丹之类，亦
不可恃。别见起发证治，宜参考。
凡痘疮起发之时，但见干燥，其根焦黑者，即内服夺命丹（见形），外用四圣散涂之。如原有疮疹，或灌疮未
愈，或疮将较瘢嫩者，至痘出之时，其处痘本攒聚，形色黑溃，急以针刺破之，吮去毒血，外以四圣散涂之，内
服加味四圣汤（见形）调无价散（倒靥）并夺命丹主之。如疮焦黑，浑身皆是者，看大便何如，若大便秘者，内服承气
汤（便闷）调无价散，外用水杨汤浴法（起发）。大便利者，内服十全大补汤（汗）陈氏木香散（泻）调无
价散合夺命丹，外用水杨汤浴法。
四圣散
绿豆（四十九粒） 豌豆（四十九粒。各烧、存性） 珍珠（一分） 油头发（烧过，一分）
上为细末。胭脂水调，先以簪子拨开黑疮，以此涂之。
二圣散 治痘疔，挑破，以此点之。
雄黄（二钱） 紫草（三钱）
上，研末。用油胭脂调。
敷方 痂后痘疔溃烂成坑，内见筋骨，以此敷之。
赤石脂 腻粉 黄柏 杭粉（炒） 血竭 伏龙肝（各一钱） 飞丹（炒，八分） 发灰（五分）
乳香 没药（各三分） 冰片（三厘） 蜜陀僧（飞过，二钱）
有臭气，加阿魏三四分。
上为细末。绵纸筛过敷之，外用膏药贴。内服人参败毒散加穿山甲、蝉蜕、连翘。
拔毒膏 治痘疔。
雄黄（研）
上，用胭脂重浸水，令浓，调雄黄点疔痘上。立时红活，亦神法也，盖雄黄能拔毒，胭脂能活血也。
飞龙夺命丹 治痘疔、痘毒、痘痈，或麻木呕吐，重者昏愦切牙。
真蟾酥（干者，酒化） 轻粉（各一钱） 枯白矾 寒水石 铜绿 乳香 没药 麝香（各二钱）
朱砂（六钱） 蜗牛（四十二个，另研、如无亦可）
上，各为末。入蟾酥、蜗牛，或加酒少许，糊丸绿豆大。每服一丸，温酒或葱汤送下。重者，外用隔蒜
法灸，甚者，多灸或着肉灸。
卷帘疔〔袁〕痘六七朝，舌望上卷，喉锁，烦渴紧痛，饮食难进，不知者妄用刀割舌下青筋，倏时致死，
岂知疔毒结坐于舌根，疔甚者如黑豆，次者似葡萄，犯此证候，要把银钩钩破患处，尽净恶血，随以苦茶漱口，
尽吐其毒血，而以后方投之。歌口∶晡仙妙制龙宫丹，冰片硼砂青黛间，薄荷荆芥僵蚕炒，还觅黄连法制
难，按合研匀为细末，慢吹喉内卷帘翻。按∶此疔人多不晓，夭杀儿童，若患此者痘，定经于心，急宜清解，
若补助之药，不宜服也，有方用蛤蜊汁和玉露滴者，
亦可。
燕窝疔 痘形五六日，而腋下硬肿，两手坦垂，不能活动转舒，烦躁谵语，眼碧脸赤，恶渴吐沫，不知者以
为结痈而然，岂知痘毒结坐于腋下，名曰燕窝疔，急用银针挑去其根，尽除恶血，随将燕窝打水澄清者
洗净，而以珍珠末和油胭脂涂其患处，内服消毒饮。歌曰∶燕窝疔欲燕窝除，挑破须将澄去泥，洗净尽除其
毒血，油胭脂和米珍珠，涂沫其中时刻候，管教毒尽痘离离。又曰∶消毒饮是鼠粘先，甘草通茯生地全，红
花犀芍连翘合，灯草浓煎毒尽捐。余历详察此痘左腋潜注，则右体之痘沉伏而失色，右腋潜注，则左体之
痘叛逆而无元，是准格也，若曰疔左而左痘坏则误矣，有方以蜒蝣和核桃肉吞者，虽暂获效，终之无济。
火珠疔 痘值六七日而鼻窍中阗塞喷火，气息甚难，恶渴烦躁，面赤眼红，痰紧，饮食不餐，热烙，名曰火
珠疔，外要钩破，随将药点入眼角，再服泻金汤，则愈矣。歌曰∶鼻中阗塞火珠疔，速要钩穿眼上行，黄连
膏和梅花片，点滴其中左右经，再服泻金汤二剂，自然毒尽得安宁。泻金汤歌曰∶乌犀桔梗鼠粘行，芍药
甘稍伏火青，生地红花通紫草，合煎服后自消疔。按∶此痘疔患于小儿们，人昧
以为息肉阗塞，不知挑剔，屡致枉死，惯治者允宜详验眼翻气急，手足乱撒候，则是矣，或以田螺水滴入者，未善。
忘汲疔 痘值六七之期，两眼沿倏然结座，疔毒封蛤肿胀，热极而面色紫，烦渴，则以治鼻疔法治之，挑破
处速以瓦葱捣烂 之，盖此处不可以钩穿者也。歌曰∶眼沿生疔眼必瞎，自有仙家神治法，瓦葱细捣 封牢，莫
待风枭再作恶。昔穆修治此疔，专用山慈菇和蜣螂肉捣烂 上，取疔根，亦捷法也。
豢虎疔 痘期里正要会脓结蜡，而耳孔内结成疔毒，盖肾地宜无痘毒，而疔独辏结于此者，则枭炎炽而癸元已
耗矣，急宜锥破，随用鹅管石、女真子、薄荷共研为极细末，吹于患处，再用马兰根洗净，寸断塞耳。歌曰∶豢虎
由来两耳中，少阳临证制吹筒，鹅管石和女真子，薄荷三味并相攻，再把马兰根洗净，随将寸断
塞其中，不须时刻相回挽，自然疔里见奇功。
按∶此方鹅管石宜改玄精石，以玄精而写鹅管，此亦传易隐射之失也，内还有冰片、女真子，亦是女真，
抄曰子者，亦传讹也。
注命疔痘期里两足掌心，痘毒辏结成疔，硬肿恶痛，或如钱样，或如大黑豆，
或如胡椒粒，紫筋直注透足股盘处，其毒甚矣，速锄取其根，尽净其血，随用田螺水调和冰片点三次，把慎火草、绿豆、
浸胀，捣烂 于患处，内服化毒丹。歌曰∶痘里如生注命疔，花栏决定不为轻，银针挑尽其中毒，寻个田螺
吐水清，调和冰片胭脂点，再觅龙鳞草要真（即慎火草又名火丹草），脱皮绿豆浸渍胀，共捣将来 一层，内把
化毒丹来服，不怕疔生足掌心。俗人多以足下疔不加意，岂知疔虽生于下，而绾
刺于上，竟犯脾心二经，时刻不可挨，故曰注命。
骊含疔 痘值五六朝，身发恶热躁，谵语，两眼翻厥，肚腹膨胀，小便闭塞，恶痛叫号不宁，盖因枭毒澄聚于膀胱，
而于阳茎窍里辏结鸩疔，名骊含疔，语云∶痘疔结此，时刻要死，急用银朱、冰片、蟾酥、牛黄、麝香研匀极细末，将
黄连、细茶浓煎，候冷，取半匙调药，把细软稻心蘸药，通纳其窍中，再用油菜子 捋其茎，内服木通败毒散。歌曰∶
骊含生疔疔如刀，十个疔来九不饶，胡僧仙授攻医法，继后骊含命始逃，牛黄冰片蟾酥麝，和合银朱一样HT ，
茶连数沸
煎浓冷，稻草心将蘸药膏，根据方按法相为用，何畏疔锥日夜号。昔云间一僧，用细银丝通窍内，随以清水漱口净，翕之，
以尽其毒血，外用珍珠片脑，调服亦验。
透肠疔 痘六七朝之内，腹中饱闷，绞痛难忍，大便闭结，烦渴，遂于粪门旁
阖辏坐疔毒，肿硬紫锥，名曰透肠疔，毒彻于阳明故耳，速针锥其毒，大用金银花、防风、煎汤，候冷洗净，
随将轻粉、珍珠、片脑、白蔹末，灯心蘸涂于上，内服黄连解毒汤。歌曰∶透肠疔毒命随倾，治得全时漏必成，
此方奇效人谁得，惟是晡仙用自珍，片脑珍珠与轻粉，分两般般无重轻，要将白蔹先为末，澄过干时后并行，
毒收还黄时干结，溃烂来时极可憎。此疔，有剔后用苎根捣烂、 者，有用桑杪捣烂和麝敷者，俱有明效，
总不如野绿豆末和红花末、干掺，甚美。
（在各类痘疹中，若出现单独较大的痘粒，颜色或黑或白，根部坚硬结聚，这就是痘疔，形态类似疔疮，病势深重直抵筋骨。应当挑破痘疔，用四圣散点涂患处。凡是黑陷型痘疹中，有微小尖顶形状像苦楮树果实那样的，就是疔；没有这种形状的，称为黑陷，不是疔。）
〔万全论述〕痘疔，是由于热毒蓄积，导致气血腐坏而形成的。其症状有多种表现，属于疫毒之气，是最为凶险的证候，应当仔细诊察。有的肌肉轻微肿胀，形状如堆积的粟米，分不清颗粒，这是气滞血凝，毒瓦斯郁结所致。有的初起为红点，逐渐变为黑色，质地坚硬如石头，这是肌肉已经败坏，气血中虚，不能托毒外出，反而导致毒邪内陷伏留。有的中心黑陷，四周突起并带有脓浆，这是血随毒走，气机失于统摄所致。有的中心带浆，四周干枯下陷且焦黑，这是气依附毒邪外泄，血液失于濡养所致。有的痘头带有白色脓浆，自行破裂溃烂，这是气血不充盛，皮肤败坏所致。有的形成水泡，溶溶易破，这是火湿并行，气虚不能收敛固束所致。有的形成血泡，颜色紫暗易破，这是血热妄行，血液不能依附于气机所致。有的疮头呈针孔状，浆水自行流出，这是卫气已败，津液外脱所致。这几种证候，要在出痘后的第五六天观察，只要见到其中一种症状，就难以治愈。
〔薛己论述〕痘疔，又被称为贼痘，数量少则三五枚，多则五七枚，夹杂在普通痘疹之间。颜色紫暗，疼痛不止，导致其他证候蜂拥而起，无法灌脓化浆，甚至危及生命，这是因为热毒势盛且结聚所致。使用仙方活命饮治疗。如果大小便不通畅涩滞，酌情加大黄。如果遍身拘急痉挛，加入麻黄。外部必须用线针挑破，放出黑血，或者吮吸出毒血，以泄解毒邪，其余的痘疹才能得以灌脓化浆，否则毒邪无处可解，必然导致死亡。如果上述方法无效，急忙使用隔蒜灸法。如果毒瓦斯炽盛，或者患者不知疼痛，可以不隔蒜，直接在肉上施灸。如果灸后，疮头红肿发热，再用针挑破放出毒血，此时施灸效果更好。虽然此法未见于方书，但我屡用屡验。世人多依赖至宝丹之类的药物，也不可过分倚仗。其他关于起发阶段的诊治，请参考相关章节。
凡痘疮处于起发阶段时，只要见到干燥，根部焦黑的，立即内服夺命丹，外用四圣散涂抹。如果原有疮疹，或者灌脓疮未愈，或者疮口即将愈合但皮肤娇嫩者，到出痘时，该处的痘本聚集，形色黑溃，急忙用针刺破，吮去毒血，外用四圣散涂抹，内服加味四圣汤配合无价散和夺命丹主治。如果疮面焦黑，浑身皆是，要看大便情况如何。如果大便秘结，内服承气汤配合无价散，外用水杨汤浴法。如果大便通畅，内服十全大补汤配合陈氏木香散调和无价散合夺命丹，外用水杨汤浴法。
四圣散
绿豆（四十九粒） 豌豆（四十九粒。各烧存性） 珍珠（一分） 油头发（烧过，一分）
以上研为细末。用胭脂水调和，先用簪子拨开黑疮，以此药粉涂之。
二圣散 治疗痘疔，挑破后，以此药点涂。
雄黄（二钱） 紫草（三钱）
以上研末。用油胭脂调和。
敷方 痂后痘疔溃烂成坑，内部可见筋骨，以此药敷贴。
赤石脂 腻粉 黄柏 杭粉（炒） 血竭 伏龙肝（各一钱） 飞丹（炒，八分） 发灰（五分）
乳香 没药（各三分） 冰片（三厘） 蜜陀僧（飞过，二钱）
如果有臭气，加入阿魏三四分。
以上研为细末。用绵纸筛过后敷贴，外用膏药贴敷。内服人参败毒散加穿山甲、蝉蜕、连翘。
拔毒膏 治疗痘疔。
雄黄（研细）
以上用胭脂重浸水，使其浓稠，调和雄黄点涂在疔痘上。立时变红活，也是神效之法，因为雄黄能拔毒，胭脂能活血。
飞龙夺命丹 治疗痘疔、痘毒、痘痈，或者麻木呕吐，重者昏愦咬牙。
真蟾酥（干者，酒化开） 轻粉（各一钱） 枯白矾 寒水石 铜绿 乳香 没药 麝香（各二钱）
朱砂（六钱） 蜗牛（四十二个，另研，如无也可不用）
以上各研为末。加入蟾酥、蜗牛，或加少许酒，糊丸如绿豆大。每服一丸，温酒或葱汤送下。重者，外用隔蒜灸法，甚者，多灸或直接着肉灸。
卷帘疔〔袁氏论述〕痘出六七天后，舌头向上卷曲，喉部锁紧，烦渴剧烈疼痛，饮食难进。不知情的人妄用刀割舌下青筋，瞬间致死。哪里知道疔毒结聚在舌根，重的像黑豆，次一点的像葡萄。遇到这种证候，要用银钩钩破患处，排尽恶血，随即用苦茶漱口，吐尽毒血，然后投以下方。歌诀曰：晡仙妙制龙宫丹，冰片硼砂青黛间，薄荷荆芥僵蚕炒，还觅黄连法制难，按合研匀为细末，慢吹喉内卷帘翻。按语：此疔人多不晓，害死儿童。如果患此痘，定经于心，急需清解，补助类药物不宜服用。有方用蛤蜊汁和玉露滴入，也可以。
燕窝疔 痘形五六日时，腋下硬肿，两手坦垂，不能活动舒展，烦躁谵语，眼碧脸赤，恶渴吐沫。不知情的人以为结成痈疽，哪里知道痘毒结聚在腋下，名叫燕窝疔。急忙用银针挑去其根，尽除恶血，随后将燕窝加水打澄清洗净，用珍珠末和油胭脂涂患处，内服消毒饮。歌诀曰：燕窝疔欲燕窝除，挑破须将澄去泥，洗净尽除其毒血，油胭脂和米珍珠，涂沫其中时刻候，管教毒尽痘离离。又说：消毒饮是鼠粘子为先，甘草通草茯苓生地全，红花犀角芍药连翘合，灯草浓煎毒尽捐。我详细考察此痘，左腋潜注，则右体之痘沉伏而失色；右腋潜注，则左体之痘叛逆而无元气，这是规律。如果说疔在左边左边痘坏那就错了。有方用蜒蚰和核桃肉吞服，虽然暂时获效，最终无济于事。
火珠疔 痘值六七日时，鼻窍中堵塞喷火，气息非常困难，恶渴烦躁，面赤眼红，痰紧，饮食不进，热烙，名叫火珠疔。外部要钩破，随即用药点入眼角，再服用泻金汤，即可痊愈。歌诀曰：鼻中阗塞火珠疔，速要钩穿眼上行，黄连膏和梅花片，点滴其中左右经，再服泻金汤二剂，自然毒尽得安宁。泻金汤歌诀曰：乌犀桔梗鼠粘行，芍药甘稍伏火青，生地红花通紫草，合煎服后自消疔。按语：此痘疔患于小儿身上，人昧然以为是息肉堵塞，不知挑剔，屡次导致枉死。惯治者应当详验眼翻气急、手足乱撒的症状，这才是正确的。有人用田螺水滴入，并不妥善。
忘汲疔 痘值六七天的时候，两眼眼睑突然结座，疔毒封蛤肿胀，热极而面色紫暗，烦渴，则以治疗鼻疔的方法处理，挑破处速以瓦葱捣烂敷之，因为此处不可以用钩穿透。歌诀曰：眼沿生疔眼必瞎，自有仙家神治法，瓦葱细捣封牢，莫待风枭再作恶。昔日穆修治疗此疔，专用山慈菇和蜣螂肉捣烂敷上，取疔根，也是快捷之法。
豢虎疔 痘期里正要会脓结蜡，而耳孔内结成疔毒。盖肾地适宜无痘毒，而疔独辏结于此，则枭炎炽盛而癸元已耗损。急忙宜锥破，随即用鹅管石、女真子、薄荷共研为极细末，吹于患处，再用马兰根洗净，寸断塞耳。歌诀曰：豢虎由来两耳中，少阳临证制吹筒，鹅管石和女真子，薄荷三味并相攻，再把马兰根洗净，随将寸断塞其中，不须时刻相回挽，自然疔里见奇功。
按语：此方鹅管石宜改为玄精石，以玄精而写鹅管，这也是传易隐射之失。内还有冰片、女真子，亦是女真，抄曰子者，也是传讹。
注命疔 痘期里两足掌心，痘毒辏结成疔，硬肿恶痛，或者如钱币样，或者如大黑豆，或者如胡椒粒，紫筋直注透足股盘处，其毒甚矣。速锄取其根，尽净其血，随即用田螺水调和冰片点三次，把慎火草、绿豆浸胀，捣烂敷于患处，内服化毒丹。歌诀曰：痘里如生注命疔，花栏决定不为轻，银针挑尽其中毒，寻个田螺吐水清，调和冰片胭脂点，再觅龙鳞草要真（即慎火草又名火丹草），脱皮绿豆浸渍胀，共捣将来一层，内把化毒丹来服，不怕疔生足掌心。俗人多以足下疔不加意，哪里知道疔虽生于下，而绾刺于上，竟犯脾心二经，时刻不可挨，故曰注命。
骊含疔 痘值五六朝，身体发恶热躁动，谵语，两眼翻厥，肚腹膨胀，小便闭塞，恶痛叫号不宁。盖因枭毒澄聚于膀胱，而在阳茎窍里辏结鸩疔，名叫骊含疔。俗语说：痘疔结在此处，时刻要死。急忙用银朱、冰片、蟾酥、牛黄、麝香研匀极细末，将黄连、细茶浓煎，候冷，取半匙调药，用细软稻心蘸药，通纳其窍中，再用油菜子捋其茎，内服木通败毒散。歌诀曰：骊含生疔疔如刀，十个疔来九不饶，胡僧仙授攻医法，继后骊含命始逃，牛黄冰片蟾酥麝，和合银朱一样HT ，茶连数沸煎浓冷，稻草心将蘸药膏，根据方按法相为用，何畏疔锥日夜号。昔日云间一僧，用细银丝通窍内，随即用清水漱口净，翕之，以尽其毒血，外用珍珠片脑，调服亦验。
透肠疔 痘六七朝之内，腹中饱闷，绞痛难忍，大便闭结，烦渴，遂于粪门旁阖辏坐疔毒，肿硬紫锥，名叫透肠疔，毒彻于阳明故耳。速针锥其毒，大用金银花、防风，煎汤，候冷洗净，随即用轻粉、珍珠、片脑、白蔹末，灯心蘸涂于上，内服黄连解毒汤。歌诀曰：透肠疔毒命随倾，治得全时漏必成，此方奇效人谁得，惟是晡仙用自珍，片脑珍珠与轻粉，分两般般无重轻，要将白蔹先为末，澄过干时后并行，毒收还黄时干结，溃烂来时极可憎。此疔，有剔后用苎根捣烂敷者，有用桑杪捣烂和麝敷者，俱有明效，总不如野绿豆末和红花末、干掺，甚美。
(In various types of smallpox, if a single large pustule appears, either black or white, with a hard and knotted root, this is called *Dou Ding* (Smallpox Carbuncle), resembling a carbuncle, with the pathogenic factor penetrating deeply to the muscles and bones. It should be pricked open and treated with *Sisheng San* (Four Sages Powder). Among all black sunken cases, those with a tiny pointed apex resembling the fruit of the Chinese Toon tree are Ding; those without this appearance are simply called black sunken smallpox, not Ding.)
[Wan Quan's Discussion] *Dou Ding* (Smallpox Carbuncle) is formed by the accumulation of heat-toxin, leading to the corruption of Qi and Blood. Its manifestations vary, representing epidemic toxic Qi, which is the most malignant prognosis. It requires careful observation. Some present with slight muscle swelling, resembling piled millet grains without distinct particles; this indicates Qi stagnation and Blood coagulation, with toxic vapors constrained. Some begin as red spots that gradually turn black and become hard as stone; this signifies tissue decay, deficiency of middle Qi and Blood, inability to expel toxin outward, resulting in internal sinking and entrapment. Some show central black depression with surrounding elevation and pus formation; this indicates Blood following the toxin while Qi fails to control it. Some have central pus with surrounding dry, sunken, and scorched-black edges; this indicates Qi attaching to the toxin for expulsion while Blood fails to nourish. Some have heads with white pus that rupture spontaneously; this indicates insufficiency of Qi and Blood and deterioration of the skin. Some form blisters that are soft and easily broken; this indicates concurrent Fire and Dampness, with Qi deficiency failing to consolidate. Some form purple blood blisters that break easily; this indicates reckless movement of Heat in the Blood, unable to adhere to Qi. Some have puncture-like sores with spontaneous discharge of serum; this indicates failure of Defensive Qi and leakage of fluids. These several syndromes should be monitored on the fifth or sixth day after eruption. If any one symptom is observed, the condition is considered incurable.
[Xue Ji's Discussion] *Dou Ding* (Smallpox Carbuncle), also known as "Thief Pustules," may number three to five or five to seven, interspersed among other pustules. They are purple-dark in color, painful and restless, causing other symptoms to arise simultaneously, preventing suppuration, and potentially leading to death due to severe and aggregated heat-toxin. Treat with *Xianfang Huoming Yin* (Immortal Life-Preserving Decoction). If constipation and urinary difficulty occur, add *Dahuang* (Rhubarb Root) according to need. If general stiffness and spasms occur, add *Mahuang* (Ephedra Stem). Externally, the pustules must be pricked with a thread needle to release black blood, or suctioned to remove toxic blood, thereby venting the toxin, allowing other pustules to suppurate. Otherwise, the toxin cannot resolve, leading to certain death. If ineffective, urgently apply *Gesu Jiu* (Garlic-Separated Moxibustion). If toxic vapors are intense or the patient feels no pain, moxa may be applied directly to the flesh without garlic separation. If after moxibustion the sore becomes red, swollen, and hot, prick it again to release toxic blood before applying moxa, which is particularly effective. Although this method is not found in standard formularies, I have used it repeatedly with success. Relying solely on pills like *Zhibao Dan* (Precious Treasure Pill) is inadvisable. Refer to other sections on eruption management.
During the eruption phase of smallpox, if dryness and scorched-black roots are observed, immediately administer *Duoming Dan* (Life-Seizing Pill) internally and apply *Sisheng San* (Four Sages Powder) externally. If pre-existing rashes or unsuppurated sores exist, or if the skin is tender near healing, and upon eruption the local pustules cluster with black, decaying features, prick them urgently with a needle, suction out toxic blood, apply *Sisheng San* externally, and treat internally with *Jiawei Sisheng Tang* (Modified Four Sages Decoction) combined with *Wujia San* (Priceless Powder) and *Duoming Dan*. If the whole body is covered with scorched-black sores, examine the stool. If constipated, administer *Chengqi Tang* (Purgative Decoction) mixed with *Wujia San*, and use *Shuiyang Tang* (Water-Willow Decoction) bath externally. If bowel movements are normal, administer *Shiquan Dabu Tang* (Ten Ingredients Great Tonifying Decoction) mixed with *Chen's Muxiang San* (Chen's Costus Powder) combined with *Wujia San* and *Duoming Dan*, and use *Shuiyang Tang* bath externally.
**Sisheng San (Four Sages Powder)**
*Mung Bean* (49 seeds), *Pea* (49 seeds): each burnt to retain its properties. *Zhenzhu* (Pearl, 1 fen). *You Toufa* (Oily Hair: burnt, 1 fen).
Grind into fine powder. Mix with *Yanzhi Shui* (Alkermes Water). First, use an hairpin to part the black sore, then apply this powder.
**Ersheng San (Two Sages Powder)**
For treating *Dou Ding*: after pricking, apply this powder.
*Xionghuang* (Realgar, 2 qian). *Zicao* (Arnebia Root, 3 qian).
Grind into powder. Mix with oil-based Alkermes.
**Application Formula**
For post-scab *Dou Ding* ulcerations exposing bone/tendon:
*Chishizhi* (Red Halloysite), *Nifen* (Calomel), *Huangbai* (Phellodendron Bark), *Hangfen* (Starch: stir-fried), *Xuexie* (Dragon's Blood), *Fulonggan* (Yellow Dragon Earth: each 1 qian). *Feidan* (Lead Monoxide: stir-fried, 8 fen). *Fahui* (Hair Ash, 5 fen).
*Ruxiang* (Frankincense), *Moyao* (Myrrh: each 3 fen). *Bingpian* (Borneol, 3 li). *Mituoseng* (Litharge: purified, 2 qian).
If foul odor exists, add *Awei* (Asafoetida, 3-4 fen).
Grind into fine powder, sieve through silk paper, and apply. Cover with plaster. Internally, take *Renshen Baidu San* (Ginseng Detoxification Powder) added with *Chuanshanjia* (Pangolin Scale), *Chantui* (Cicada Slough), and *Lianqiao* (Forsythia Fruit).
**Badu Gao (Toxin-Extracting Ointment)**
For *Dou Ding*.
*Xionghuang* (Realgar: ground).
Soak in concentrated Alkermes water, mix with *Xionghuang*, and apply to the pustule. It turns red and active immediately. This is a divine method because Realgar extracts toxins and Alkermes invigorates Blood.
**Feilong Duoming Dan (Flying Dragon Life-Seizing Pill)**
For *Dou Ding*, smallpox toxin, and carbuncles, or numbness/vomiting; in severe cases, coma and teeth-grinding.
*Zhen Chansu* (Toad Venom: dried, dissolved in wine), *Qingfen* (Calomel: each 1 qian). *Kubai Fan* (Calcined Alum), *Han Shuishi* (Halloysite), *Tonglü* (Malachite), *Ruxiang* (Frankincense), *Moyao* (Myrrh), *Shexiang* (Musk: each 2 qian).
*Zhusha* (Cinnabar, 6 qian). *Wo Niu* (Snail, 42 pieces, ground separately; optional).
Grind each into powder. Add Toad Venom and Snail, or a little wine, to make pills the size of mung beans. Take one pill per dose with warm wine or Scallion Decoction. For severe cases, use Garlic-Separated Moxibustion externally; for extreme cases, direct moxibustion.
**Juanlian Ding (Rolling-Curtain Carbuncle) [Yuan's Discussion]**
On the sixth or seventh day of smallpox, the tongue rolls upward, throat locks, with severe thirst and pain, making eating difficult. Ignorant practitioners may cut the blue veins under the tongue, causing sudden death. One must realize the toxin is rooted at the base of the tongue; severe cases resemble black beans, mild ones grapes. Use a silver hook to pierce the affected area, drain all evil blood, rinse mouth with bitter tea to spit out toxic blood, then administer the following formula. Verse: *Buxian*’s miraculous Long Palace Pill, mixed with Borneol, Borax, and Indigo; Stir-fry Mint, Schizonepeta, and Silkworm; Seek processed Coptis, grind finely, blow slowly into the throat to unroll the curtain. Note: This carbuncle is unknown to many, killing children. Since it affects the Heart, clear and resolve urgently; tonics are contraindicated. Using Clam Juice and Yulu Drop is also acceptable.
**Yanwo Ding (Swallow’s Nest Carbuncle)**
On days five or six, hardness and swelling appear in the armpit, arms hang limp and immobile, with restlessness, delirium, greenish eyes, red face, extreme thirst, and foaming. Ignorant people mistake this for an abscess. In fact, smallpox toxin gathers in the armpit, named Yanwo Ding. Urgently pierce the root with a silver needle, drain evil blood, wash with clarified Swallow’s Nest water, apply Pearl Powder mixed with Oil Alkermes externally, and take *Xiaodu Yin* (Detoxification Decoction) internally. Verse: To cure Yanwo Ding, use Swallow’s Nest; pierce and clarify mud; wash away toxic blood; mix Oil Alkermes with Rice Pearl; apply constantly until toxin leaves. Also: *Xiaodu Yin* starts with Burdock, Licorice, Akebia, Poria, Rehmannia complete; add Safflower, Rhinoceros Horn, Peony, Forsythia; boil Rush grass strongly to eliminate toxin. Detailed observation shows: left armpit involvement causes right-sided pustules to sink and lose color; right armpit involvement causes left-sided pustules to rebel and lose vitality. This is the rule. Saying left Ding ruins left pustules is wrong. Using Slug and Walnut meat orally gives temporary relief but ultimately fails.
**Huozhu Ding (Fire Pearl Carbuncle)**
On days six or seven, nasal passages are blocked with fire-like sensation, breathing is difficult, with extreme thirst, restlessness, red face/eyes, tight phlegm, anorexia, and burning heat. Named Huozhu Ding. Externally, hook/pierce it, apply medicine to the eye corners, then take *Xiejing Tang* (Draining Metal Decoction) for cure. Verse: Nasal blockage with Fire Pearl Ding; quickly hook up towards the eye; Apply Coptis Ointment and Plum Blossom Borneol; drip into both sides; take two doses of Draining Metal Decoction, toxin clears naturally. *Xiejing Tang* Verse: Black Rhinoceros, Platycodon, Burdock move; Peony, Licorice, Licorice Root, Cooling Green settle fire; Rehmannia, Safflower, Akebia, Arnebia combine; decoct together, toxin dissolves. Note: This occurs in children; mistaken for polyps, lack of piercing leads to death. Practitioners should check for eye rolling, rapid breathing, and limb flailing. Using Snail water is not ideal.
**Wangji Ding (Forgotten Drawing Carbuncle)**
On days six or seven, eyelids suddenly swell and knot; toxin seals like a clam, causing extreme heat, purple face, thirst. Treat like nasal Ding: prick and apply mashed Tile Onion (*Wacong*) immediately, as hooks cannot penetrate here. Verse: Ding on eyelid blinds the eye; use immortal method; mash Tile Onion firmly, do not wait for Wind Owl to cause evil. Formerly, Mu Xiu treated this with Mountain Garlic (*Shancigu*) and Dung Beetle meat mashed and applied to extract the root; also effective.
**Huanhu Ding (Taming Tiger Carbuncle)**
During the suppuration/crusting phase, toxin forms in the ear canal. The Kidney region should be free of smallpox toxin; its presence here indicates fierce inflammation and depletion of Kidney Essence. Urgently pierce with an awl, then blow extremely fine powder of *EGuanguan Shi* (Tube Stone), *Nüzhenzi* (Eucommia Seed), and *Bohe* (Mint) into the site. Wash *Malan Gen* (Kalimeris Root), cut into inches, and insert into the ear. Verse: Taming Tiger originates in both ears; Shaoyang syndrome managed with blowing tube; Tube Stone, Eucommia Seed, Mint attack together; Wash Kalimeris Root, cut and insert; no need to hesitate, miracle works within the Ding. Note: *EGuanguan Shi* should be changed to *Xuanjing Shi* (Mysterious Essence Stone); copying errors exist regarding *Nüzhenzi*.
**Zhuming Ding (Life-Directing Carbuncle)**
On the soles of the feet during the disease period, toxin gathers into a Ding, hard, swollen, painful, resembling a coin, large black bean, or peppercorn. Purple veins extend to the thigh/knee. Toxicity is severe. Quickly dig out the root, drain all blood, apply Ice Borneol mixed with Snail water three times, mash soaked Caulophyllum (*Shenhuaocao*) and Mung Beans, apply locally, and take *Huadu Dan* (Toxin-Resolving Pill) internally. Verse: If Zhuming Ding arises in smallpox, the flower fence is not light; silver needle drains toxin; find snail spitting clear water; mix Borneol and Alkermes; seek true Dragon Scale Grass (aka Fire Dan Grass); soak peeled Mung Beans, mash together, apply layer; take Huadu Dan internally, fear not the sole Ding. Laypeople ignore foot Ding, not knowing it connects upwards to Spleen and Heart meridians; it cannot be delayed, hence "Life-Directing."
**Lihan Ding (Black Snake Containing Carbuncle)**
On days five or six, body feverish and restless, delirious, eyes rolling, abdomen distended, urine blocked, painful crying. Toxin gathers in Bladder, forming poison in the urethral orifice. Named Lihan Ding. Saying: Ding here means death soon. Urgently mix *Yinzhu* (Silver Cinnabar), Borneol, Toad Venom, Cow Bezoar, Musk into fine powder. Boil Coptis and strong Tea, cool, take half spoon to mix medicine. Dip soft Rice Straw Heart in medicine, insert into orifice, massage shaft with Rapeseed Oil, take *Mutong Baidu San* (Akebia Detoxification Powder) internally. Verse: Lihan Ding like a knife; nine out of ten do not survive; Monk’s divine method saves life later; Cow Bezoar, Borneol, Toad Venom, Musk, mixed with Silver Cinnabar; boil Tea/Coptis strong, cool; dip Rice Straw Heart in paste; follow method, fear not night/day cries. Formerly, a monk from Yunjian used thin silver wire to clear orifice, rinsed with water, sucked out toxic blood; externally using Pearl and Borneol was also effective.
**Touchang Ding (Penetrating Intestine Carbuncle)**
Within days six or seven, abdominal fullness, unbearable colic, constipation, thirst. Toxin gathers beside the anus, hard, purple, conical. Named Touchang Ding, toxin penetrates Yangming. Quickly needle/pierce toxin. Boil large amounts of *Jinyinhua* (Honeysuckle Flower) and *Fangfeng* (Saposhnikovia Root), cool, clean, then apply Calomel, Pearl, Borneol, *Bailian* (White Tulip Bulb) powder dipped on Rush Grass. Take *Huanglian Jiedu Tang* (Coptis Detoxification Decoction) internally. Verse: Touchang Ding toxin threatens life; if cured, fistula may form; who knows this miracle? Only *Buxian* treasures it; Borneol, Pearl, Calomel, equal weights; first grind Bailian, sift dry, then mix; when toxin recovers and yellows, it dries; when ulcerating, it is repulsive. After picking, mashed Ramie Root or Mulberry Twig with Musk is effective, but wild Mung Bean powder mixed with Safflower powder, dry-applied, is best.