养胃开痰汤∶人参三分，白术（土炒）三分，炙草三分，云苓三分，桔梗三分，楂肉（炒）
五分，怀药（炒）五分（宜用二钱），陈皮三分，生姜引。
建中汤∶人参二钱，炙 三钱，白术（土炒）一钱五分，归身（酒炒）一钱五分，川芎
八分
温表调中汤∶炙 二钱，人参一钱，白术（土炒）一钱，云苓一钱，官桂一钱，干姜一
钱
生
清表散毒汤∶骨皮（制）八分，麦冬（酒洗）八分，花粉（酒炒）八分，牛子（炒）五
分，连翘
通四分，甘草四
大连翘饮∶连翘（去心）一钱，牛子（炒）八分，柴胡八分，归身（酒洗）八分，赤芍
八分，
飞）五分，
消毒散血汤∶牛子（炒）一钱，酒芍一钱，桃仁（去皮尖油）一钱，熟大黄一钱，红花
五分
补中益气汤∶参、 照前加用。人参八分，炙 八分，白术（土炒）八分，归身（酒洗）
八
痘有夹斑而出者，有红赤点而无颗粒，多随出而随没。又有夹丹而出者，红赤成片，如
云头而尖起。此皆毒火浮游散漫于皮肤之间，遇此症者，不必惊惶，但散其游火，其斑丹自
退，宜用元参升麻汤。
有夹麻疮而出者，仍用玄参升麻汤，加桔梗、黄芩六分，令其麻疮先退，痘疮自然起发
痘初见一二日细小，四五日渐大顶平，至六七日脚渐阔、顶愈平陷，其色全白，形如豆
壳者，名为倒靥。此气血大虚而浆不行也，宜参归鹿茸汤，加官桂、白芍、川芎六分，南木
香四分。若泄泻者兼用参消散。
痘痒者，表虚也。此为危症。急用参 实表汤补之。痒痘毕竟属虚，管KT 乃谓有气
盛
然灰白之痘，不但属气虚，而血虚亦甚矣，岂能上行皮肉， 而作痒乎？则此说亦未必然。
有秽气触犯而痒者，急烧苍术、红枣，或黄茶叶以避之。甚者，内服和平汤，方见发热条。
痘痛者为实，此为吉兆，用生白芍二钱为末，酒调服立止。甚者不过二服。
痘出齐后，有面目肿胀而痘不肿者。此血气虚弱，不能收摄毒瓦斯以成脓，故其毒散漫，
妄行肉分也。此为危候。急宜大补气血以收摄其毒。用参归大补汤，则痘灌脓而肉胀自消矣。
痘出齐数日后，其间有紫胀硬痘，独大而无根晕者，此痘疔也。用四圣膏填入，或拔毒
散点之，先将银针拨开疔口，将药填入，即转红活。
痘毒发于肌肤，而血气不能运化以成脓结痂，则有郁热不散，赤肿而成痈者。其发于未
收以前者少，而发于既收以后者多。未收以前，必脓少而淡者有之。既收以后，必痂浮薄而
速结速落者有之。若脓浆饱满，结痂浓实，缓结缓落者，并无有也。此毒瓦斯发泄、尽与不尽
之明验也。又有不虚而服补剂，不寒而服热剂以致发痈者，医之误也，俱用大连翘饮主之。
但当其初发肿时，内外夹攻，消散之为上。至于成脓，则幼小之儿多难堪，而在头顶胸背腰
腹者皆险也。外治以三豆浆涂之。
痘疮原多溃烂，收结后或手足等处仍作热臭烂，出水不止，用生肌散搽之，热退结痂而
愈。其有仍作热作脓而不即愈者，用大连翘饮解之即愈，又有余毒流注各处出清水者，绵茧
散搽之。
痘有鼻中衄血者，毒瓦斯上冲于肺也。此其毒瓦斯外泄，亦非恶候，不必惊惶，只用发灰散
、或清肺汤治之。切不可峻用寒凉，如犀角、生地、栀子、三黄之类，冰伏其气血，必为大
害。世人不知此理，一遇痘疮有衄血、咽喉、口舌等症，即认为实热，遽投以寒凉，冰伏其
血脉，以致痘不得成浆而变为坏症者多矣。是治末而妨其本，昧之甚者也。
痘有水 而无脓者，血少不能化脓也。急用参归鹿茸汤，峻补其血。若脓 与水 相半
者无妨。如十分中有三四分脓 ，犹有生意，惟遍身水 则危矣。然胃气好而饮食如常者，
亦可望生，但其毒瓦斯未散，须防发痈耳。
其或小儿痘多，则血气有限，不能尽成脓，而水 与脓 相间，此常理也。若无他症，
不必施治。
痘有口舌生疮，或者热毒，或者虚火，当以痘色辨之，切不可概认实热，而纯用寒凉解
毒之药。如痘色红紫涌盛者，热毒也，用上清饮散主之。如痘色淡白者，虚火也，用前参麦
清补汤主之，外用赴筵散搽之即愈。或口舌有痘而肿痛者，痘收自愈。不必治，治亦不效。
痘有咽喉肿硬者，首尾俱用利咽解毒汤，外用玉锁匙吹之。
痘有咽哑者，当辨痘色以分顺逆。若痘色红紫，当行浆而音哑者，此气喉有痘也。是以
外痘行浆时，内痘亦行浆，窒碍气道而音不亮也。待外痘收则内痘亦消而音自亮矣。此不必
别加调治也。若痘色灰白而音哑者，乃血气虚弱，送毒不出，毒留于肺，肺气受伤，以致失
音，此则危矣！宜参麦清补汤，兼千金内托散。
又，痘有咽喉呛水者，顺逆不同，须为分辨。若痘灌脓时呛水者，喉中有痘也。外痘成
脓，则内痘亦成脓，壅于食门而呛也。盖是门乃饮食所进之门，既有所壅，则饮食必溢于气
喉而发呛，若食物无渣，自能咽下，不犯气道，故不呛也。待外痘收，则内痘自收，可不药
而愈矣。然此虽呛水，其喉不甚痛也。若痘未行浆而喉先呛水，此则毒瓦斯壅塞，其喉必痛，
宜用前治咽喉方治之。
痘有小便赤色者，用导赤散主之，有血淋者，用当归一两，怀牛膝三钱，亦效。
痘毒入眼，有赤肿而痛不能开者，有翳膜遮蔽而不能视者，自古方书所载，皆以为痘疮
入眼，而不知此非有形之痘，乃无形之痘也。其遮睛之翳，有似痘疮而实非也。盖有形之痘
，发于咽喉口舌者有之，然皆外痘胀时，内痘亦盛，外收靥时，而内亦消。惟入眼之毒，必
作之收靥之时，还元之后，与咽喉口舌之痘迥异，此以知其非有形之痘也。盖眼者，五脏血
气之精华也。痘毒之郁滞于肌肤者为痛为疖，而其留于精华则发为眼患矣。其受病也深，治
之者，切不可鲁莽躁率，责效于数剂之间，当从容调治，收功于数十剂之后，又不可骤用寒
凉，峻攻其里，而疏利其下。何则？痘后之人，元气虚弱，而其毒发露在表，又在至高之分
，若峻用寒凉，则既伤其元气，又拂逆其病势，未有不至丧明者，且生他病，而为患不小。
又忌用寒凉药点洗，止可用清毒拨翳汤，缓缓调之。
痘后 白，口作渴者，脾火也。用黄土滚水泡，澄清温服。即愈。
痘后发毒者，用三黄为末，有水干滟，无水麻油调搽。
养胃开痰汤：人参三分，白术（土炒）三分，炙甘草三分，云茯苓三分，桔梗三分，山楂肉（炒）五分，怀山药（炒）五分（宜用二钱），陈皮三分，生姜为引。
建中汤：人参二钱，炙甘草三钱，白术（土炒）一钱五分，当归身（酒炒）一钱五分，川芎八分。
温表调中汤：炙甘草二钱，人参一钱，白术（土炒）一钱，云茯苓一钱，官桂一钱，干姜一钱。
清表散毒汤：地骨皮（制）八分，麦冬（酒洗）八分，天花粉（酒炒）八分，牛蒡子（炒）五分，连翘通四分，甘草四分。
大连翘饮：连翘（去心）一钱，牛蒡子（炒）八分，柴胡八分，当归身（酒洗）八分，赤芍八分，木通（飞）五分。
消毒散血汤：牛蒡子（炒）一钱，酒白芍一钱，桃仁（去皮尖油）一钱，熟大黄一钱，红花五分。
补中益气汤：人参、黄芪照前法加用。人参八分，炙甘草八分，白术（土炒）八分，当归身（酒洗）八分。
痘疹伴有斑疹而出者，有红赤点而无颗粒，多随出随没。又有伴有丹痧而出者，红赤成片，如云头状而尖端突起。这都是毒火浮游散漫于皮肤之间，遇到此症者，不必惊慌，只需疏散其游走的火邪，其斑疹丹痧自然消退，适宜使用玄参升麻汤。
伴有麻疹疮疡而出者，仍用玄参升麻汤，加桔梗、黄芩六分，令其麻疹先退，痘疹自然起发。
痘疹初见时一二日细小，四五日渐大且顶部平塌，至六七日脚部渐宽、顶部愈平陷下，其色全白，形状如豆壳者，名为倒靥（痘疹塌陷）。这是气血大虚而浆液不行也，适宜用人参归鹿茸汤，加官桂、白芍、川芎六分，南木香四分。若伴有泄泻者，兼用参消散。
痘疹瘙痒者，是表虚所致。此为危重之症。急用人参固实表汤来补益。痒痘毕竟属于虚证，管仲阳却认为有气盛的情况，然而灰白色的痘疹，不但属于气虚，而且血虚也很严重，岂能上行至皮肉而作痒呢？所以这种说法也未必正确。
有秽气触犯而致痒者，急烧苍术、红枣，或黄茶叶以避除秽气。严重者，内服和平汤，方剂见发热条。
痘疹疼痛者为实证，此为吉兆，用生白芍二钱研为末，酒调服立即停止。严重者不过两服即可。
痘疹出齐后，有面目肿胀而痘疹不肿者。这是血气虚弱，不能收摄毒瓦斯以成脓，故其毒散漫，妄行于肌肉之间。此为危候。急宜大补气血以收摄其毒。使用参归大补汤，则痘疹灌满脓液而肌肉肿胀自然消除。
痘疹出齐数日后，其间有紫胀硬痘，独大而无根晕者，此痘疔也。用四圣膏填入，或用拔毒散点涂，先将银针拨开疔口，将药填入，即转为红活。
痘毒发于肌肤，而血气不能运化以成脓结痂，则有郁热不散，赤肿而成痈者。其发于未收口以前者少，而发于既收口以后者多。未收口以前，必脓少而淡者有之。既收口以后，必痂浮薄而速结速落者有之。若脓浆饱满，结痂浓实，缓结缓落者，并无这种情况。这是毒瓦斯发泄尽与不尽的明显验证啊。又有不虚而服用补剂，不寒而服用热剂以致发痈者，是医生的误治，都用大连翘饮主治。但当其初发肿时，内外夹攻，以消散为上策。至于成脓，则幼小之儿多难承受，而在头顶胸背腰腹者皆属险症。外治以三豆浆涂之。
痘疮原本多溃烂，收结后或手足等处仍作热臭烂，出水不止，用生肌散搽之，热退结痂而痊愈。其有仍作热作脓而不即愈者，用大连翘饮解之即愈，又有余毒流注各处出清水者，用绵茧散搽之。
痘疹有鼻中衄血者，是毒瓦斯上冲于肺也。这是其毒瓦斯外泄，亦非恶候，不必惊慌，只用发灰散、或清肺汤治之。切不可峻用寒凉药，如犀角、生地、栀子、三黄之类，以免冰伏其气血，必为大害。世人不知此理，一遇痘疮有衄血、咽喉、口舌等症，即认为实热，遽投以寒凉药，冰伏其血脉，以致痘不得成浆而变为坏症者多矣。这是治末而妨其本，愚昧得很啊。
痘疹有水疱而无脓者，是血少不能化脓也。急用人参归鹿茸汤，峻补其血。若脓与水疱相半者无妨。如十分中有三四分脓水，犹有生机，惟遍身水疱则危矣。然胃气好而饮食如常者，亦可望生还，但其毒瓦斯未散，须防发痈耳。
其或小儿痘多，则血气有限，不能尽成脓，而水疱与脓疱相间，此常理也。若无他症，不必施治。
痘疹有口舌生疮者，或者是热毒，或者是虚火，当以痘色辨之，切不可概认实热，而纯用寒凉解毒之药。如痘色红紫涌盛者，热毒也，用上清饮散主之。如痘色淡白者，虚火也，用前参麦清补汤主之，外用赴筵散搽之即愈。或口舌有痘而肿痛者，痘收自愈。不必治，治亦不效。
痘疹有咽哑者，当辨痘色以分顺逆。若痘色红紫，当行浆而音哑者，此气喉有痘也。是以外痘行浆时，内痘亦行浆，窒碍气道而音不亮也。待外痘收口则内痘亦消而音自亮矣。此不必别加调治也。若痘色灰白而音哑者，乃血气虚弱，送毒不出，毒留于肺，肺气受伤，以致失音，此则危矣！宜参麦清补汤，兼千金内托散。
又，痘疹有咽喉呛水者，顺逆不同，须为分辨。若痘灌脓时呛水者，喉中有痘也。外痘成脓，则内痘亦成脓，壅于食门而呛也。盖是门乃饮食所进之门，既有所壅，则饮食必溢于气喉而发呛，若食物无渣，自能咽下，不犯气道，故不呛也。待外痘收口，则内痘自收，可不药而愈矣。然此虽呛水，其喉不甚痛也。若痘未行浆而喉先呛水，此则毒瓦斯壅塞，其喉必痛，宜用前治咽喉方治之。
痘疹有小便赤色者，用导赤散主之，有血淋者，用当归一两，怀牛膝三钱，亦有效。
痘毒入眼，有赤肿而痛不能开者，有翳膜遮蔽而不能视者，自古方书所载，皆以为痘疮入眼，而不知此非有形之痘，乃无形之痘也。其遮睛之翳，有似痘疮而实非也。盖有形之痘，发于咽喉口舌者有之，然皆外痘胀时，内痘亦盛，外收靥时，而内亦消。惟入眼之毒，必作之收靥之时，还元之后，与咽喉口舌之痘迥异，此以知其非有形之痘也。盖眼者，五脏血气之精华也。痘毒之郁滞于肌肤者为痛为疖，而其留于精华则发为眼患矣。其受病也深，治之者，切不可鲁莽躁率，责效于数剂之间，当从容调治，收功于数十剂之后，又不可骤用寒凉，峻攻其里，而疏利其下。何则？痘后之人，元气虚弱，而其毒发露在表，又在至高之分，若峻用寒凉，则既伤其元气，又拂逆其病势，未有不至丧明者，且生他病，而为患不小。又忌用寒凉药点洗，止可用清毒拨翳汤，缓缓调之。
痘后目白（巩膜）色白，口作渴者，脾火也。用黄土滚水泡，澄清温服。即愈。
痘后发毒者，用三黄为末，有水干搽，无水麻油调搽。
Yangwei Kaitan Decoction (Stomach-Nourishing Phlegm-Resolving Decoction): Renshen (Ginseng Radix et Rhizoma) 3 fen, Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil) 3 fen, Zhigancao (Prepared Licorice Root) 3 fen, Yunling (Poria), 3 fen, Jiegeng (Platycodon Root) 3 fen, Zharou (Hawthorn Flesh, stir-fried) 5 fen, Huaiyao (Dioscoreae Rhizoma, stir-fried) 5 fen (preferably 2 qian), Chenpi (Citri Reticulatae Pericarpium) 3 fen, Shengjiang (Fresh Ginger) as a guide.
Jianzhong Decoction (Middle-Building Decoction): Renshen (Ginseng Radix et Rhizoma) 2 qian, Zhigancao (Prepared Licorice Root) 3 qian, Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil) 1.5 qian, Guishen (Angelicae Sinensis Radix, wine-stir-fried) 1.5 qian, Chuanxiong (Ligusticum Chuanxiong Rhizome) 8 fen.
Wenbiao Tiaozhong Decoction (Warm-Surface Regulate-Middle Decoction): Zhigancao (Prepared Licorice Root) 2 qian, Renshen (Ginseng Radix et Rhizoma) 1 qian, Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil) 1 qian, Yunling (Poria) 1 qian, Guangui (Cinnamon Twig) 1 qian, Ganjiang (Dried Ginger) 1 qian.
Qingbiao Sandu Decoction (Clear-Surface Disperse-Toxicity Decoction): Gupi (Moutan Cortex, processed) 8 fen, Maidong (Ophiopogonis Radix, wine-rinsed) 8 fen, Huafen (Trichosanthis Radix, wine-stir-fried) 8 fen, Niuzi (Arctii Fructus, stir-fried) 5 fen, Lianqiao (Forsythiae Fructus) 4 fen, Gancao (Licorice Root) 4 fen.
Da Lianqiao Yin (Great Forsythia Infusion): Lianqiao (Forsythiae Fructus, heart removed) 1 qian, Niuzi (Arctii Fructus, stir-fried) 8 fen, Chaihu (Bupleuri Radix) 8 fen, Guishen (Angelicae Sinensis Radix, wine-rinsed) 8 fen, Chishao (Paeoniae Radix Rubra) 8 fen, Mutong (Akebiae Caulis, purified) 5 fen.
Xiaodu Sanxue Decoction (Dispel-Toxicity Scatter-Blood Decoction): Niuzi (Arctii Fructus, stir-fried) 1 qian, Jiushaoyao (Paeoniae Radix Alba, wine-treated) 1 qian, Taoren (Persicae Semen, skin and tip removed, oil extracted) 1 qian, Shudahuang (Polygoni Multiflori Preparata Radix) 1 qian, Honghua (Carthami Flos) 5 fen.
Buzhong Yiqi Tang (Tonify-Middle Boost-Qi Decoction): Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix) added according to previous instructions. Renshen (Ginseng Radix et Rhizoma) 8 fen, Zhigancao (Prepared Licorice Root) 8 fen, Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil) 8 fen, Guishen (Angelicae Sinensis Radix, wine-rinsed) 8 fen.
In cases where smallpox erupts accompanied by macules (Ban, 斑), there may be red spots without granules, which often appear and disappear quickly. In other cases, it erupts accompanied by scarlet rash (Dan, 丹), appearing as large red patches like cloud patterns with pointed elevations. These are all caused by toxic fire floating and scattering between the skin and muscles. For such conditions, one need not panic; simply disperse the wandering fire, and the macules and rashes will naturally recede. Yuanshen Shengma Tang (Scrophulariae Radix and Cimicifugae Rhizoma Decoction) is appropriate.
When smallpox erupts accompanied by measles sores, continue using Yuanshen Shengma Tang (Scrophulariae Radix and Cimicifugae Rhizoma Decoction), adding Jiegeng (Platycodon Root) and Huangqin (Scutellariae Radix) 6 fen each, to allow the measles to recede first, after which the smallpox will naturally rise and develop.
When smallpox first appears in the first or second day, it is fine and small; by the fourth or fifth day, it becomes larger but flat-topped; by the sixth or seventh day, the base widens and the top sinks further. If the color is entirely white and the shape resembles a bean shell, it is named "Dao Ye" (Reversed Crusting/Inversion). This indicates severe deficiency of Qi and Blood, preventing the formation of pus/fluid. Can Gui Lu Rong Tang (Ginseng, Angelica, and Deer Antler Decoction) should be used, adding Guangui (Cinnamon Twig), Shaoyao (Paeoniae Radix), and Chuanxiong (Ligusticum Chuanxiong Rhizome) 6 fen each, and Nanmuxiang (Aquilariae Lignum Resinatum) 4 fen. If diarrhea occurs, use Can Xiao San (Ginseng-Resolving Powder) concurrently.
Itching of the smallpox indicates exterior deficiency. This is a critical condition. Urgently use Shen Gu Shi Biao Tang (Ginseng-Firming Exterior Decoction) to tonify. Itching smallpox essentially belongs to deficiency. Guan Zhongyang claimed there could be cases of Qi excess; however, gray-white smallpox indicates not only Qi deficiency but also severe Blood deficiency. How can such a condition ascend to the skin and flesh to cause itching? Thus, this theory is not necessarily correct.
If itching is caused by foul air contact, urgently burn Cangzhu (Atractylodis Rhizoma) and Red Dates (Zao Ren), or yellow tea leaves to ward off the foulness. For severe cases, take Heping Tang (Harmonizing Decoction), see the Fever section for the formula.
Painful smallpox indicates excess, which is an auspicious sign. Use raw Shaoyao (Paeoniae Radix Alba) 2 qian ground into powder, mixed with wine and taken orally to stop pain immediately. Severe cases require no more than two doses.
After the smallpox has fully erupted, if the face and eyes are swollen but the pustules themselves are not, this is due to weakness of Qi and Blood, unable to consolidate the toxic vapors to form pus, causing the toxin to scatter and wander in the muscle layers. This is a critical prognosis. Urgently tonify Qi and Blood greatly to consolidate the toxin. Use Shen Gui Da Bu Tang (Ginseng and Angelica Great Tonifying Decoction); then the pustules will fill with pus and the flesh swelling will subside naturally.
Several days after the smallpox has fully erupted, if there are purple, swollen, hard pustules that are unusually large without a surrounding halo, these are "Dou Ding" (Smallpox Carbuncles). Fill them with Sisheng Gao (Four Saints Ointment), or apply Badu San (Detoxification Powder). First, pierce the carbuncle opening with a silver needle, insert the medicine, and it will turn red and vibrant.
When smallpox toxin manifests on the skin, and Qi and Blood cannot transform it into pus and scabs, stagnant heat remains undissipated, leading to redness, swelling, and abscess formation. This occurs less frequently before the crusting phase and more frequently after. Before crusting, there may be cases with little and thin pus. After crusting, there may be cases with thin, floating scabs that form and fall quickly. However, cases with full pus and thick, solid scabs that form and fall slowly do not exist. This is clear evidence of whether the toxic vapors have been fully excreted or not. Additionally, abscesses caused by taking tonics when not deficient, or hot herbs when not cold, are medical errors. All such cases should be treated primarily with Da Lianqiao Yin (Great Forsythia Infusion). When the swelling first begins, internal and external attacks occur simultaneously, and dispersal is the best approach. Once pus forms, young children often cannot tolerate it well, and locations on the head, chest, back, waist, and abdomen are dangerous. Externally, apply Sansheng Jiang (Three Milks Paste).
Smallpox sores originally tend to ulcerate. After crusting, if the hands, feet, or other areas remain hot, smelly, and weeping continuously, apply Shengji San (Generate-Flesh Powder). The heat will subside, scabs will form, and healing will occur. If heat and pus persist without immediate healing, resolve it with Da Lianqiao Yin (Great Forsythia Infusion). If residual toxins flow to various parts and secrete clear fluid, apply Mianjian San (Silkworm Cocoon Powder).
Epistaxis (nosebleed) during smallpox indicates toxic vapors rushing upward to the Lung. Since the toxin is being excreted externally, this is not a malignant sign, and one need not panic. Treat with Fahui San (Hair-Ash Powder) or Qingfei Tang (Clear-Lung Decoction). Do not harshly use cold-cooling herbs such as Xijiao (Rhinoceros Horn, now substituted), Shengdi (Rehmanniae Radix), Zhizi (Gardeniae Fructus), or Sanhuang (Three Yellows), as this will freeze and stagnate Qi and Blood, causing great harm. People who do not understand this principle often mistake nosebleeds, sore throat, or mouth ulcers associated with smallpox for excess heat, and hastily administer cold-cooling herbs. This freezes the blood vessels, preventing the smallpox from forming pus and turning into complicated diseases. This treats the branch while harming the root, demonstrating extreme ignorance.
Smallpox blisters containing water but no pus indicate insufficient Blood to transform into pus. Urgently use Can Gui Lu Rong Tang (Ginseng, Angelica, and Deer Antler Decoction) to strongly tonify Blood. If the ratio of pus to water blisters is half-and-half, it is not concerning. If three or four out of ten parts are pus-filled, there is still vitality. Only if the entire body consists of water blisters is it critical. However, if the Stomach Qi is good and appetite is normal, survival is possible, but one must guard against abscess formation as the toxic vapors have not yet dissipated.
If a child has many smallpox lesions, their Qi and Blood are limited and cannot all transform into pus, resulting in alternating water blisters and pus blisters. This is normal physiology. If there are no other symptoms, no treatment is necessary.
Mouth and tongue ulcers during smallpox may be due to heat-toxin or deficiency-fire. Differentiate based on the color of the smallpox. Do not universally assume excess heat and use purely cold-cooling detoxifying herbs. If the smallpox color is red-purple and vigorous, it is heat-toxin; treat with Shangqing Yin San (Upper-Clearing Infusion Powder). If the smallpox color is pale white, it is deficiency-fire; treat with Shen Mai Qing Bu Tang (Ginseng-Ophiopogon Clear-Tonifying Decoction) previously mentioned, and apply Fuyan San (Feast-Gathering Powder) externally for cure. If there are smallpox lesions on the mouth and tongue with swelling and pain, they will heal naturally upon crusting. No treatment is needed, and treatment would be ineffective.
For swollen and hard throat during smallpox, use Liyan Jiedu Tang (Throat-Relieving Detoxification Decoction) throughout the course, and apply Yusuo Chi (Jade Lock Spoon) powder externally via insufflation.
Hoarseness during smallpox requires differentiation of favorable vs. unfavorable prognosis based on smallpox color. If the smallpox is red-purple and hoarseness occurs during the pus-forming stage, this is because smallpox has formed in the Qi-Throat. When external smallpox forms pus, internal smallpox also forms pus, obstructing the airway and causing hoarseness. Wait for the external smallpox to crust; the internal smallpox will subside, and voice will return naturally. No additional treatment is needed. If the smallpox is gray-white and hoarse, it indicates weak Qi and Blood failing to expel the toxin, leaving toxin in the Lung and injuring Lung Qi, leading to loss of voice. This is critical! Use Shen Mai Qing Bu Tang (Ginseng-Ophiopogon Clear-Tonifying Decoction) combined with Qianjin Neituo San (Thousand-Gold Internal-Supporting Powder).
Furthermore, choking on water during smallpox varies in prognosis and must be differentiated. If choking occurs during the pus-forming stage, there is smallpox in the throat. External smallpox forming pus means internal smallpox also forms pus, blocking the food passage and causing choking. This passage is the gate for food intake; once blocked, food/drink overflows into the airway causing choking. If food is smooth without residue, it can be swallowed without touching the airway, so no choking occurs. Wait for external smallpox to crust; internal smallpox will self-resolve, and recovery will occur without medication. Although water causes choking here, the throat does not hurt severely. If choking occurs before the pus-forming stage, the toxic vapors are obstructed, and the throat will definitely hurt. Treat with the previously mentioned throat formulas.
Red urine during smallpox: Treat primarily with Daochi San (Guide-Out Red Powder). For hematuria, Danggui (Angelicae Sinensis Radix) 1 liang and Huainiuxi (Cyathulae Radix) 3 qian are also effective.
Smallpox toxin entering the eye: Cases include redness, swelling, pain preventing opening, or membranes obscuring vision and preventing sight. Ancient texts attribute this to smallpox entering the eye, but do not realize this is not a tangible smallpox lesion, but an intangible one. The membrane obscuring the pupil resembles smallpox but is not actually so. Tangible smallpox may occur in the throat and mouth/tongue, but when external smallpox swells, internal smallpox is also vigorous; when external smallpox crusts, internal smallpox subsides. However, toxin entering the eye manifests at the time of crusting and restoration of Yuan Qi, distinct from throat/mouth smallpox, proving it is not a tangible lesion. The eye is the essence of Qi and Blood of the five Zang organs. Toxin stagnating in the skin and muscles causes pain or boils, but remaining in the essence causes eye disease. The pathology is deep. Treatment must not be reckless or hasty, expecting results in a few doses. Manage calmly, achieving results after dozens of doses. Do not suddenly use cold-cooling herbs to attack internally or drain downward. Why? Post-smallpox patients have weak Yuan Qi, and their toxin is exposed on the surface and at the highest part of the body. Harshly using cold-cooling herbs injures Yuan Qi and opposes the disease trend, inevitably leading to blindness and other illnesses, causing significant harm. Also avoid washing with cold-cooling herbs. Only use Qingdu Boyi Tang (Toxin-Clearing Membrane-Removing Decoction) to regulate slowly.
White sclera and thirst after smallpox indicate Spleen Fire. Brew Loess (Huangtu) in boiling water, clarify, and drink warm. Cure follows.
Post-smallpox toxicity: Use Sanhuang (Three Yellows) ground into powder. Apply dry if there is moisture, or mix with sesame oil if dry.