张洁古先生云∶一发稠密，如针头者，情势重也。轻其表而凉其内，连翘升麻汤主之。然稠密之处，各有经络部分
所属，额主心，面主胃，腹与四肢主脾，胁主肝，雨腋主肺，下部主肾，肩背主膀胱，当随见症治之。若面色黄，大便
黑，烦躁喘渴，或腹胀者，瘀血在内也，用犀角地黄汤、或抱龙丸、生犀角汁，但根窠分明肥满者，无妨。窃谓前症若
属心经，用导赤散之类。胃经用犀角散之类。肝经用柴胡汤之类。大凡稠密者，热毒炽盛也，若密而不痛，用东垣消毒
散。若密而作痛，用仙方活命饮。若密而小便不通，用八正散。若密而大便不通，用承气汤。若密而恶寒发热，用麻黄
甘草汤。
一小儿十三岁，痘疮稠密而痛，脉洪数而有力，先君用仙方活命饮二剂，先出者痛顿止，后出者隐于肉里，用东垣
消毒散二剂，隐者悉消，又用活命饮一剂，脉静身安而痊。
一小儿出痘稠密，身侧尤甚， 赤呻吟，饮乳不彻，先君谓肝胆之火助邪为患，故身侧尤多，乃乳母肝火传变也，
用柴胡栀子散治其母，子饮数滴而靥。
一小儿痘疮甚密，身侧尤甚，贯脓不满，不红活。或云∶当殁于十二日。余以为气血虚弱，用八珍汤加糯米百粒
数剂，至十五日而愈。
一小儿痘密而灰白色，始末悉用补托之药，安后饮食过
多，呕吐面青白，唇目牵动，先君以为慢脾风症之渐。不信，翌日手足时搐，用五味异功散加木香、干姜而愈。
一小儿痘稠密色赤，先君以为热毒，用东垣消毒散一剂，初出者顿起，后出者悉没，再剂如期而靥。
一小儿稠密色黑，烦躁喜冷，手足并热，先君谓火极似水。令恣饮芹汁，烦热顿止，先用犀角地黄汤，次用地黄丸
料，服之而愈。
一小儿稠密出迟，用四圣散而起发，用参 内托散而靥，后发热恶寒，用八珍汤而愈。
一小儿痘密而痛，用东垣救苦汤一剂，痛顿止，用紫草木通汤而愈。
一小儿痘密，身痛如刺，用活命饮一剂，其痛即止，又用犀角消毒散而愈。
一小儿痘初出密痛。用东垣救苦汤，痛顿止；又用四圣散而发，用犀角消毒而愈。
麻黄甘草汤 治表实痘毒， 盛稠密。
麻黄 生甘草
上水煎服。
柴胡栀子散（方见作痒抓破）
柴胡甘草枳壳汤（方见痘喘）
甘桔防风汤（方见痘咳嗽）
东垣消毒散（一名救苦汤，方见痘身痛）
紫草木通汤（方见小便不利）
仙方活命饮（方见痘痈）
六味地黄丸（方见痘疮发热属阴阳）
四圣散（方见痘腹胀气促）
小柴胡汤（方见 症）
柴胡清肝散（即柴胡栀子散，一方见痘潮热）
紫草散（方见顶陷心烦）
抱龙丸（方见痘痫搐）
犀角消毒散（方见痘疔）
Mr. Zhang Jiegu once said: If the smallpox eruptions appear dense, resembling needle heads, the condition is severe. One should lightly release the exterior pathogen and cool the interior heat; the primary formula is Lianqiao Shengma Tang (Forsythia and Cimicifuga Decoction). However, the areas where the eruptions are dense correspond to specific meridian regions: the forehead corresponds to the Heart, the face to the Stomach, the abdomen and four limbs to the Spleen, the hypochondrium to the Liver, the axillae to the Lung, the lower part (genital area) to the Kidney, and the shoulders and back to the Bladder. Treatment should be based on the symptoms observed in these respective locations. If the complexion is yellow, stool is black, there is restlessness, panting, thirst, or abdominal distension, this indicates blood stasis within the interior. In such cases, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction), Baolong Wan (Dragon-Embracing Pill), or fresh rhino horn juice may be used. However, if the bases of the eruptions are distinct and plump, there is no cause for concern.
I believe that if the aforementioned symptoms belong to the Heart Meridian, formulas such as Daochi San (Mint and Gardenia Powder) should be used; for the Stomach Meridian, Xijiao San (Rhino Horn Powder); and for the Liver Meridian, Chaihu Tang (Bupleurum Decoction). Generally, dense eruptions indicate blazing heat-toxin. If the eruptions are dense but painless, use Dongyuan Xiaodu San (Dongyuan’s Toxin-Resolving Powder); if dense and painful, use Xianfang Huoming Yin (Immortal Formula for Preserving Life); if dense with urinary retention, use Bazheng San (Eight-Ingredient Corrective Powder); if dense with constipation, use Chengqi Tang (Purgative Decoction); if dense with aversion to cold and fever, use Mahuang Gancao Tang (Ephedra and Licorice Decoction).
A thirteen-year-old boy presented with dense, painful smallpox eruptions and a surging, rapid, and forceful pulse. My father administered two doses of Xianfang Huoming Yin (Immortal Formula for Preserving Life), which immediately stopped the pain of the initially erupted lesions. The subsequently erupted lesions receded into the flesh. Two doses of Dongyuan Xiaodu San (Dongyuan’s Toxin-Resolving Powder) were then given, causing the receded lesions to disappear completely. Finally, one dose of Huoming Yin was administered, resulting in a calm pulse, physical peace, and recovery.
A child presented with dense smallpox eruptions, particularly severe on the sides of the body, accompanied by groaning due to pain and insufficient breastfeeding. My father attributed this to fire from the Liver and Gallbladder assisting the pathogenic factor, causing the abundance of eruptions on the sides, which he believed was transmitted from the mother’s Liver fire via breast milk. He treated the mother with Chaihu Zhizi San (Bupleurum and Gardenia Powder). The child drank a few drops of breast milk and the eruptions crusted over and healed.
Another child had very dense smallpox eruptions, especially on the sides of the body, with incomplete suppuration and lack of vibrant red color. Some predicted death on the twelfth day. I diagnosed Qi and Blood deficiency and prescribed Bazhen Tang (Eight-Treasure Decoction) with one hundred grains of glutinous rice. After several doses, the child recovered on the fifteenth day.
A child had dense, grayish-white smallpox eruptions. From onset to resolution, tonifying and pushing-out herbs were used continuously. After recovery, excessive food intake led to vomiting, a cyanotic and pale complexion, and twitching of the lips and eyes. My father identified this as the onset of Manpi Feng (Slow Spleen Wind). The family did not believe him. The next day, the child’s hands and feet began to convulse intermittently. Treatment with Wuwei Yigong San (Five-Ingredient Extraordinary Skill Powder) augmented with Muxiang (Aucklandia Root) and Ganjiang (Dried Ginger) resulted in recovery.
A child had dense, red smallpox eruptions. My father diagnosed heat-toxin and prescribed one dose of Dongyuan Xiaodu San (Dongyuan’s Toxin-Resolving Powder). The initially erupted lesions rose immediately, and the subsequent ones disappeared. After a second dose, they crusted over as expected.
A child had dense, black smallpox eruptions, with restlessness, preference for cold drinks, and hot extremities. My father stated this was "extreme fire resembling water" (true cold, false heat syndrome). He allowed the child to drink celery juice freely, which immediately relieved the restlessness and heat. First, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) was used, followed by the ingredients of Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), leading to recovery.
A child had dense eruptions that appeared late. Four Holy Powder (Sisheng San) was used to promote eruption, and Shenqi Neituo San (Ginseng Internal-Supporting Powder) was used to facilitate crusting. Later, fever and aversion to cold occurred, which were cured with Bazhen Tang (Eight-Treasure Decoction).
A child had dense, painful smallpox eruptions. One dose of Dongyuan Jiuku Tang (Dongyuan’s Pain-Relieving Decoction) stopped the pain immediately. Zicao Mutong Tang (Arnebia and Akebia Decoction) led to recovery.
A child had dense smallpox eruptions and body pain like needle pricks. One dose of Huoming Yin (Immortal Formula for Preserving Life) stopped the pain immediately. Xijiao Xiaodu San (Rhino Horn Toxin-Resolving Powder) led to recovery.
A child had dense, painful smallpox eruptions at onset. Dongyuan Jiuku Tang (Dongyuan’s Pain-Relieving Decoction) stopped the pain immediately. Sisheng San (Four Holy Powder) promoted eruption, and Xijiao Xiaodu San (Rhino Horn Toxin-Resolving Powder) led to recovery.
Mahuang Gancao Tang (Ephedra and Licorice Decoction): Treats exterior-excess smallpox toxin with vigorous, dense eruptions.
Ingredients: Ephedrae Herba (Mahuang, 麻黄), Raw Glycyrrhizae Radix et Rhizoma (Sheng Gancao, 生甘草).
Preparation: Decoct in water and take orally.
Chaihu Zhizi San (Bupleurum and Gardenia Powder) (See formula under "Itching and Scratching").
Chaihu Gancao Zhike Tang (Bupleurum, Licorice, and Aurantium Decoction) (See formula under "Smallpox Asthma").
Ganjie Fangfeng Tang (Licorice, Platycodon, and Saposhnikovia Decoction) (See formula under "Smallpox Cough").
Dongyuan Xiaodu San (Dongyuan’s Toxin-Resolving Powder), also known as Jiuku Tang (Pain-Relieving Decoction) (See formula under "Smallpox Body Pain").
Zicao Mutong Tang (Arnebia and Akebia Decoction) (See formula under "Urinary Difficulty").
Xianfang Huoming Yin (Immortal Formula for Preserving Life) (See formula under "Smallpox Carbuncle").
Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) (See formula under "Smallpox Fever Belonging to Yin and Yang").
Sisheng San (Four Holy Powder) (See formula under "Smallpox Abdominal Distension and Shortness of Breath").
Xiao Chaihu Tang (Minor Bupleurum Decoction) (See formula under "Malaria Syndrome").
Chaihu Qinggan San (Bupleurum Liver-Clearing Powder), i.e., Chaihu Zhizi San (Bupleurum and Gardenia Powder) (See formula under "Smallpox Tidal Fever").
Zicao San (Arnebia Powder) (See formula under "Sunken Crown and Restless Heart").
Baolong Wan (Dragon-Embracing Pill) (See formula under "Smallpox Epileptic Convulsions").
Xijiao Xiaodu San (Rhino Horn Toxin-Resolving Powder) (See formula under "Smallpox Boil").