报痘二日后，痘已出齐，身体温和，精神清爽，颗粒尖圆润泽，根脚红活，脑背稀疏，
饮食如常，二便不涩，此顺候也。不必服药，但节饮食，避风寒，防秽气而已。
痘出齐三日内，其时日十分紧要，其形色症候，最宜精详。盖好痘全要脓浆浓满，其次
亦要六七分脓浆，方可保全无虞。痘一出齐，形色显然，其脓之成与不成，足与不足，皆可
逆睹。其痘顺者，自然脓足，不必服药。其症之不顺者，后必无脓，或脓少而清。急于此三
日内，察形观色，分别虚、实、寒、热，用药调治，以为灌脓汁，犹可及也。失此不治，多
有缓不及事，而竟不成脓者矣。痘之生死，判于脓之有无，有脓则生，无脓则死。有脓则毒
从外散故生，无脓则毒留内攻故死。是以脓浓满而痂浓者上也，脓未满而痂薄者次也，其下
身遍身俱水泡。然水泡七八分而间有二三分薄脓 ，犹可生也，其最下者，密不成颗，串为
一片。而其皮下有脓浆，又或 密而溃，脓水湿溃，犹可生也，惟干枯无脓浆，或薄浆不满
二三分者，必痒塌而死，无生意也。是以出齐而调治灌脓，如拯溺救焚，不可缓也。
气血流畅，则毒化而为脓，脓之不成，其病有二∶毒瓦斯盛炽，则血燥而凝，不能运化以
成脓，故痘色干枯红紫，或带焦黑者，毒炽而血凝者也，急用清毒活血汤，烦渴者去参、
，加麦冬、花粉八分；元气虚弱，则血寒而缩，亦不能运化而成脓，故痘色淡白， 不尖圆
，根无红晕者，气虚而血缩也，急用参归鹿茸汤，或千金内托散，甚者服此一二剂，其痘即
转红活。行浆困倦、手足冷、饮食少者，加木香、丁香五分，官桂五分。寒点切牙者，再加
官桂三分、制附子八分。泄泻者，去当归，加神曲、白术、酒芍、云苓八分，木香、丁香三
分，另用参术散。止泻托脓之剂，莫妙于此方。以鹿茸补血力峻，与草木诸药不同，然恐鹿
茸未必得，故又录千金内托散，加减法同上。
出齐后，当治不治，则浆不行，而五陷之症作矣。五陷者，白、灰、紫、黑、血陷是也
痘稠密红紫而顶陷者，紫陷也。甚则转而为黑陷也。此热毒盛炽，闭其气、凝其血而陷
也。仍用清毒活血汤，烦渴者去参、 ，加麦冬、花粉八分。然此紫陷时，不过一二剂，而
痘即立起，其效如神。以至黑陷，则受毒已深，虽用此药救治，而不活者十常八、九。
痘虽稠密，其色淡白，根无红晕而顶陷者，白陷也。甚则转而为灰陷也。此气血虚弱，
不能运化毒瓦斯以成浆，故陷也。宜用参归鹿茸汤，或千金内托散，其随症加减法亦如之。
又有一种痘疮，颗粒通红，或血 而不成浆者，此气不能统血，而血溢妄居气位也。详
见前论气血条。宜大补其气，用参 汤主之，服此 即转白而成浆，否则血 不治，则气愈
虚而为血陷，然治之亦不外此方。血陷与紫陷相类，但血陷虽红，然淡而不紫也。紫陷属热
，气粗身热。血陷属虚，气少身凉，不可不辨。何西邱论五陷，说此朦胧不明，管KT 论
之，
犯五陷者，治已见前，其或虽不顶陷而痘不光润，或 虚而浆不过三四分，虽或有浆而
清薄，或行脓至二三日尚不充满，此皆难以收靥。宜用参归鹿茸汤，催足其脓浆，或千金内
托散亦可。若浆不满，鸡冠血酒亦可。用三四年以上大雄鸡，先将好酒一杯炖温，次刺鸡冠
血滴入和匀，仍炖温服之。服后虽燥痛一时，无妨，但其鸡不可杀。
又有一种出痘稠密，毒火既盛，然元气虚，血气弱，精液枯竭，不能制火，以致虚火炎
蒸，或咽喉痛，或鼻时出血，难任温补，痘不能成脓结痂。大凡年长之男女，嗜欲久开，血
气既耗者多有之，最为难治。时医见其多热症，率用清凉，如犀角地黄之类。不知原因血气
不能胜毒瓦斯而有此种症，今又纯用寒凉，则血气愈亏损，而毒瓦斯愈妄行，岂复有可生之理！
是以此等症，治之者十无一生，殊可哀怜！今特制参麦清补汤，须频频服之，方保无虞。
痘出五六日后，至七八日，若脓浆不行，亦当用参归鹿茸汤托之，黄 生用，不必加减
，如脓浆不起，则无生意矣。若有四、五分脓，犹可望生。
灌浆时，有叶泻 ，症各不同。吐有二症，泻有二症。
吐而酸苦有声，吐讫反快者，毒火上腾也，痘色必红紫，用连栀二陈汤，缓缓服之，吐
止勿服。但二陈不可轻用，用伏龙肝、藿香可也。
吐而有物无声，不酸不苦，吐讫困倦，不思饮食，胃气损也，痘色必淡白。用参砂和胃
散主之，方见前发热条。
泄而粪黄臭秽，小便赤涩者，毒瓦斯奔越也，痘色必红紫。用加味四苓散，食前服。
泻而粪滑利清白者，虚寒也，痘色必淡白。用参术散，食前温服，入稀粥内和服亦可。
或去白术，加赤石脂、骨碎补亦可止泻。如虚滑不止，服前药不效者，兼用七味豆蔻丸。此
等丸散，治痘之家，必须预制，以防虚滑泄泻。若痘起胀收结时，骤然泄泻不止，危在旦夕
矣。然止泻有用汤药不效，服至异功散而不止者，惟此丸散可以止之。若热毒作泻者，加味
四苓散一二剂即可止。
起胀灌脓时，或有六、七日不大便而烦闷作痛者，毒盛而秘也。用前清毒和血汤，去参
、，加淮牛膝二钱，入生蜜半杯，紫草、当归倍用；如又不通，加酒炒大黄微利之。若仍
不通，用猪胆汁滴入谷道中即通。切不可用硝、黄下之，恐下后变他症则危矣。
灌浆时有身凉而汗不止者，用归 主之，有痰用白附子，热水磨服。切不可用二陈，恐
燥阳明，孤阳无阴，不能化也。至收结时，用之不妨。
【背景信息】
书名：验方新编 作者：鲍相璈 朝代：清 章节：痘出齐后起发灌脓数日内调治法 类别：方剂
【待处理原文翻译】
痘疹发出两天后，痘点已经出齐，身体温度温和，精神清爽，痘粒尖圆、光泽润泽，根部红润鲜活，头部和背部稀疏，饮食正常，大小便通畅不涩滞，这是顺证（病情顺利）。不需要服药，只需节制饮食，避免风寒，防止秽浊之气即可。
痘疹出齐后的三天内，时间十分紧要，痘的形态颜色及症状候象，最需要精细详察。因为好的痘疹全赖脓浆浓密饱满，其次也要有六七分的脓浆，才能保全性命无虞。痘一出齐，形态颜色明显，其脓液的形成与否、充足与否，都可以预先推断。那些顺证的痘疹，自然脓液充足，不需要服药。那些症状不顺的，后来必然没有脓液，或者脓液少而清稀。必须在这三天内，观察形态颜色，分别虚、实、寒、热，用药调治，以便促进灌脓，还来得及。如果错过这个时机不治疗，多有因迟缓而误事，最终不能成脓的情况。痘疹的生死，取决于脓液的有无，有脓则生，无脓则死。有脓则毒邪从外部散发所以生，无脓则毒邪留在内部攻冲所以死。因此，脓液浓满且结痂厚实的为上等，脓液未满且结痂薄的为次等，最差的是全身遍布水泡。然而水泡占七八分而间或有二三分薄脓的，还可以存活，最下等的，密集不成颗粒，连成一片。而其皮下有脓浆，或者密集溃烂，脓水湿溃的，还可以存活，只有干枯无脓浆，或者薄浆不足二三分的，必然瘙痒塌陷而死，没有生机。因此，痘出齐后调治以促灌脓，如同拯救溺水、扑救火灾，不可迟缓。
气血流畅，则毒邪化为脓液；脓液不能形成，病因有二：一是毒火旺盛炽烈，导致血燥而凝结，不能运化而成脓，所以痘色干枯红紫，或带焦黑色的，是毒炽盛而血凝滞，急用清毒活血汤，伴有烦躁口渴的去人参、甘草，加麦冬、天花粉八分；二是元气虚弱，导致血寒而收缩，也不能运化而成脓，所以痘色淡白，不尖圆，根部无红晕的，是气虚而血缩，急用参归鹿茸汤，或千金内托散，严重的服用此方一二剂，痘疹即转红润鲜活。出现行浆期困倦、手足冷、饮食少的，加木香、丁香五分，官桂五分。出现寒战咬牙的，再加官桂三分、制附子八分。出现泄泻的，去当归，加神曲、白术、酒白芍、茯苓八分，木香、丁香三分，另服参术散。止泻托脓的药物，没有比这个方子更妙的了。因为鹿茸补血力量峻猛，与草木类药物不同，但恐怕鹿茸未必能得到，所以又收录千金内托散，加减方法同上。
痘出齐后，应当治疗而不治疗，则浆液不行，五陷的症状就会发作。五陷是指白陷、灰陷、紫陷、黑陷、血陷。痘疹稠密红紫而顶部凹陷的，是紫陷。严重时转为黑陷。这是热毒盛炽，闭塞气机、凝滞血液而导致凹陷。仍用清毒活血汤，伴有烦躁口渴的去人参、甘草，加麦冬、天花粉八分。然而在此紫陷阶段，不过服用一二剂，痘疹立即隆起，效果如神。至于黑陷，则受毒已深，虽然用此药救治，但不活的十有八九。
痘疹虽稠密，但颜色淡白，根部无红晕而顶部凹陷的，是白陷。严重时转为灰陷。这是气血虚弱，不能运化毒邪以成浆液，所以凹陷。宜用参归鹿茸汤，或千金内托散，其随症加减方法也与此相同。
又有一种痘疮，颗粒通红，或出血而不能成浆的，这是气不能统摄血液，而血液溢出妄居气的位置。详见前文论气血条。宜大补其气，用参芪汤主之，服用此方后即转白而成浆，否则出血不止，则气愈虚而为血陷，然而治疗也不外乎此方。血陷与紫陷相似，但血陷虽然红，却是淡而不紫。紫陷属热，气粗身热。血陷属虚，气少身凉，不可不辨别。何西邱论述五陷，说得朦胧不明，管仲京论述它，
犯五陷症的，治疗已见前文，那些虽然顶部不凹陷但痘疹不光润，或者气虚而浆液不超过三四分，虽然有浆液但清稀淡薄，或者行脓至二三日尚不充满的，这些都难以收靥（结痂愈合）。宜用参归鹿茸汤，催足其脓浆，或千金内托散也可以。若浆液不满，鸡冠血酒也可以。选用三四年以上的大公鸡，先将好酒一杯炖温，然后刺取鸡冠血滴入调和均匀，再炖温服下。服后虽然有一时燥痛，无妨，但那只鸡不可杀。
又有一种出痘稠密，毒火既盛，但元气虚，血气弱，精液枯竭，不能制约火邪，以致虚火炎蒸，或咽喉痛，或鼻衄（流鼻血），难以耐受温补，痘疹不能成脓结痂。大凡年长的男女，嗜欲久开，血气既已耗损的，多有这种情况，最为难治。当时的医生见到多是热症，一律使用清凉药，如犀角地黄汤之类。不知道原因是血气不能胜解毒邪而有此种症状，现在又纯用寒凉，则血气愈亏损，而毒邪愈妄行，哪里还有可生的道理！因此这类病症，治疗的十无一活，实在可怜！现在特别配制参麦清补汤，须频频服用，才能保证安全。
痘出五六日后，至七八日，若脓浆不行，也当用参归鹿茸汤托举，黄芪生用，不必加减，如果脓浆不起，则无生机了。若有四、五分脓，还可望生。
灌浆时，有呕吐、泄泻，症状各不相同。呕吐有两种症状，泄泻有两种症状。
呕吐酸苦有声，吐完后反而舒服的，是毒火上腾，痘色必红紫，用连栀二陈汤，缓缓服用，吐止后勿服。但二陈汤不可轻用，用伏龙肝、藿香可以。
呕吐有物无声，不酸不苦，吐完后困倦，不思饮食，是胃气受损，痘色必淡白。用参砂和胃散主之，方见前发热条。
泄泻粪便黄臭秽，小便赤涩的，是毒邪奔越，痘色必红紫。用加味四苓散，食前服用。
泄泻粪便滑利清白，是虚寒，痘色必淡白。用参术散，食前温服，加入稀粥内和服也可以。或者去掉白术，加赤石脂、骨碎补也可以止泻。如果虚滑不止，服用前面的药物无效的，兼用七味豆蔻丸。这类丸散，治痘的家庭，必须预先制备，以防虚滑泄泻。如果在痘起胀收结时，骤然泄泻不止，危在旦夕了。然而止泻有用汤药无效，服用至异功散而仍不止的，只有这种丸散可以止住。如果是热毒作泻，加味四苓散一二剂即可止住。
起胀灌脓时，或有六、七天不大便而烦闷作痛的，是毒盛而便秘。用前清毒和血汤，去人参、甘草，加淮牛膝二钱，入生蜜半杯，紫草、当归加倍使用；如果仍不通，加酒炒大黄轻微通利。如果仍不通，用猪胆汁滴入肛门中即通。切不可用芒硝、大黄攻下，恐怕下后变生他症则危险了。
灌浆时有身凉而汗不止的，用归芪汤主之，有痰用白附子，热水磨服。切不可用二陈汤，恐怕燥伤阳明，孤阳无阴，不能化生。到了收结时，使用不妨。
[Background Information]
Book: Yanfang Xinbian (New Collection of Verified Prescriptions)
Author: Bao Xiang'ao
Dynasty: Qing
Chapter: Methods for Regulation and Treatment within a Few Days After Pox Eruption is Complete, During the Swelling and Suppuration Phase
Category: Formula
After two days of pox eruption, when the lesions are fully erupted, the body temperature is mild, spirit is clear, lesions are pointed, round, lustrous, with red and vibrant roots, sparse on the head and back, diet is normal, and urination and defecation are unobstructed, this is a favorable prognosis (Shun Hou). Medication is not necessary; simply regulate diet, avoid wind and cold, and prevent foul odors.
Within three days after the pox is fully erupted, the time is critical, and the morphology, color, and symptoms require careful observation. Good pox rely entirely on thick and full pus; at least six or seven parts pus are needed to ensure safety. Once the pox is fully erupted, the morphology and color are evident, and whether pus will form and be sufficient can be predicted in advance. Favorable cases naturally have sufficient pus and require no medication. Unfavorable cases will likely lack pus or have scanty, thin pus. It is urgent to observe morphology and color within these three days, differentiate deficiency, excess, cold, and heat, and use medication to regulate treatment to promote suppuration; there is still time. If this opportunity is missed, many cases become untreatable due to delay and fail to suppurate. The life or death of pox depends on the presence or absence of pus: presence means survival, absence means death. Pus allows toxins to dissipate externally, leading to survival; lack of pus causes toxins to attack internally, leading to death. Therefore, thick pus with thick scabs is superior; insufficient pus with thin scabs is secondary; the worst is generalized vesicles. However, if vesicles account for seven or eight parts with two or three parts of thin pus interspersed, survival is possible. The worst case is dense, confluent lesions without distinct grains. If there is pus under the skin, or if they are dense and ulcerating with wet pus discharge, survival is still possible. Only dry, pus-less lesions, or those with thin pus less than two or three parts, will inevitably die from itching and collapse, with no hope of recovery. Thus, regulating and promoting suppuration after complete eruption is as urgent as saving someone from drowning or extinguishing a fire; it cannot be delayed.
When Qi and Blood flow smoothly, toxins transform into pus. Failure to form pus has two causes: First, excessive toxin-fire causes blood dryness and coagulation, preventing transformation into pus. Lesions appear dry, red-purple, or scorched-black, indicating intense toxin and blood stasis. Urgently use Qingdu Huoxue Tang (Clear Toxin and Invigorate Blood Decoction); if accompanied by irritability and thirst, remove Renshen (Ginseng Radix) and Gancao (Licorice Root), and add Maidong (Ophiopogon Tuber) and Huafen (Trichosanthes Root) 8 fen. Second, Yuanqi (Primal Qi) deficiency causes blood coldness and contraction, also preventing pus formation. Lesions appear pale white, not pointed or round, with no red halo at the root, indicating Qi deficiency and blood retraction. Urgently use Shenguilurong Tang (Ginseng, Angelica, and Deer Antler Decoction) or Qianjin Neituo San (Thousand-Gold Internal Support Powder). Severe cases may see lesions turn red and vibrant after one or two doses. For lethargy during the pus-forming stage, cold extremities, and poor appetite, add Muxiang (Aucklandia Root) and Dingxiang (Clove) 5 fen, Guanzi Gui (Cinnamon Bark) 5 fen. For chills and teeth grinding, add Guanzi Gui 3 fen and Zhifuzi (Prepared Aconite Root) 8 fen. For diarrhea, remove Danggui (Angelica Sinensis), add Shenqu (Massa Medicata Fermentata), Baizhu (Atractylodes Macrocephala Rhizome), Jiubaishao (Wine-processed White Peony Root), and Fuling (Poria) 8 fen, Muxiang 3 fen, Dingxiang 3 fen, and separately administer Shenshu San (Ginseng and Atractylodes Powder). No formula is more excellent for stopping diarrhea and supporting pus formation. Deer antler (Lurong) has potent blood-nourishing effects, differing from herbal medicines. Since Lurong may be unavailable, Qianjin Neituo San is recorded as an alternative, with the same modification rules.
Failure to treat after complete eruption leads to stagnant pus and the onset of "Five Collapses" (Wu Xian): White Collapse, Gray Collapse, Purple Collapse, Black Collapse, and Blood Collapse. Dense, red-purple lesions with depressed tops indicate Purple Collapse. If severe, it turns into Black Collapse. This is caused by intense heat-toxin closing Qi mechanism and congealing Blood. Use Qingdu Huoxue Tang; if accompanied by irritability and thirst, remove Renshen and Gancao, add Maidong and Huafen 8 fen. At the Purple Collapse stage, one or two doses usually cause immediate elevation of lesions with miraculous effect. By the time it becomes Black Collapse, toxin penetration is deep; even with treatment, eight or nine out of ten cases die.
Dense lesions that are pale white, with no red halo at the root and depressed tops indicate White Collapse. If severe, it turns into Gray Collapse. This is caused by Qi and Blood deficiency, failing to transform toxins into pus. Use Shenguilurong Tang or Qianjin Neituo San, with modifications as described above.
Another type presents with bright red lesions or bleeding without pus formation. This indicates Qi failing to control Blood, causing Blood to overflow and occupy Qi's position. See the previous discussion on Qi and Blood. Greatly tonify Qi using Shenqi Tang (Ginseng and Astragalus Decoction). After administration, lesions turn white and form pus. Otherwise, persistent bleeding leads to Qi deficiency and Blood Collapse. Treatment remains the same. Blood Collapse resembles Purple Collapse but is pale rather than purple. Purple Collapse is Heat-type, with coarse breathing and fever. Blood Collapse is Deficiency-type, with weak breath and cool body; differentiation is crucial. He Xiqiu’s discussion on Five Collapses was vague; Guan Tongjing clarified it.
For those suffering from Five Collapses, treatments are listed above. Cases where lesions are not depressed but lack luster, or where Qi deficiency results in less than three or four parts of pus, or where pus is clear and thin, or where pus fails to fill even after two to three days, are difficult to heal. Use Shenguilurong Tang to promote sufficient pus, or Qianjin Neituo San. If pus is insufficient, Chicken Comb Blood Wine may be used. Take a large rooster aged three to four years, warm one cup of good wine, prick the comb to let blood drip into the wine, mix well, warm again, and drink. Temporary dryness and pain after ingestion are acceptable; do not kill the chicken.
Another scenario involves dense pox with intense toxin-fire, yet deficient Yuanqi, weak Qi and Blood, and depleted essence, failing to control fire. This leads to deficient fire steaming upward, causing sore throat or epistaxis. Warm tonification is poorly tolerated, preventing pus and scab formation. This is common in older individuals with long-term indulgence and depleted Qi and Blood, making it very difficult to treat. Contemporary physicians often see heat signs and indiscriminately use cooling formulas like Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). They fail to realize that these symptoms arise because Qi and Blood cannot overcome toxins. Using pure cold herbs further depletes Qi and Blood and allows toxins to run rampant, leaving no hope for survival. Such cases are rarely curable and pitiable. We now specially formulate Shenmai Qingbu Tang (Ginseng and Ophiopogon Clearing and Tonifying Decoction); frequent administration ensures safety.
Between five to six days and seven to eight days after eruption, if pus does not form, use Shenguilurong Tang to support. Use raw Huangqi (Astragalus Root) without modifications. If pus does not rise, there is no hope. If four or five parts of pus exist, survival is possible.
During the suppuration phase, vomiting and diarrhea occur with varying symptoms. There are two types of vomiting and two types of diarrhea.
Vomiting sour/bitter sounds with relief afterward indicates toxin-fire rising. Lesions are red-purple. Use Lianzhi Erchen Tang (Scutellaria, Gardenia, and Two-Chen Decoction) slowly; stop after vomiting ceases. Do not use Erchen Tang lightly; Longgu (Dragon Bone) or Huoxiang (Patchouli) may be used instead.
Vomiting without sound, non-acid/non-bitter, followed by fatigue and loss of appetite indicates damaged Stomach Qi. Lesions are pale white. Use Shensha Hewei San (Ginseng and Amomum Harmonizing Stomach Powder), see previous Fever section.
Diarrhea with yellow, foul stool and dark, scanty urine indicates toxin dispersion. Lesions are red-purple. Use Jiawei Siling San (Modified Four-Poria Powder), taken before meals.
Diarrhea with slippery, clear, white stool indicates deficiency-cold. Lesions are pale white. Use Shenshu San, taken warm before meals, or mixed with rice gruel. Alternatively, remove Baizhu and add Chishizhi (Halloysitum Rubrum) and Gusuibu (Drynaria Rhizome) to stop diarrhea. For persistent deficiency-slippage unresponsive to previous remedies, combine with Qiwei Doukou Wan (Seven-Ingredient Cardamom Pill). These pills/powders should be prepared in advance by families treating pox to prevent deficiency-slippage. Sudden persistent diarrhea during swelling/scabbing stages is critical. If decoctions and Yigong San (Yi Gong Powder) fail, only these pills/powders work. For heat-toxin diarrhea, Jiawei Siling San stops it in one or two doses.
During swelling/suppuration, constipation for six to seven days with irritability and pain indicates intense toxin and blockage. Use previous Qingdu Hexue Tang, remove Renshen and Gancao, add Huainiu Xi (Achyranthes Root) 2 qian, raw honey half cup, Zicao (Arnebia Root) and Danggui doubled. If still blocked, add Jiu Da Huang (Wine-processed Rhubarb) for mild purgation. If still blocked, insert pig bile into the anus. Never use Xiaoyan (Mirabilite) or Da Huang for purgation, as post-purgation complications are dangerous.
During suppuration, cool body with continuous sweating requires Guiqi Tang (Angelica and Astragalus Decoction). If phlegm is present, use Baifuzi (Typhonii Rhizoma), ground in hot water. Do not use Erchen Tang, as it dries Yangming, leaving isolated Yang without Yin, preventing transformation. It is safe to use during the scabbing stage.