痘证不过气血毒，
毒乃胎家淫火食秽，停蓄脏腑，生后啼声一发，悉归命门。遇岁火运，时行传染∶或冬暖遇春夏而发；或
因伤寒热病失汗，下而变成∶或因外感风寒，内伤生冷而发；或因跌仆惊恐蓄血而发，发则命门火动，煎熬左
肾，夹脊逆流自头额而下克丙火，不聚于面，令散四肢，所禀气血实则胜毒，为顺；气血虚则毒胜，为逆；气
血与毒相等则险。凡言顺者，不必药治；逆者，治之无效；险者，必用药救。
首尾一十二日间。
除初热三日不算，有热发三五日，或十余日故也。自报痘至收靥，首尾一十二日，中间有不守禁戒，以致
淹缠。又有气血和者，不及一十二日而愈。初不甚拘日数，以后分日，为初学较言耳。
证有初证并杂证，阴阳常变类伤寒；任他坏证并瘥证，无非邪与毒相残。
初热三日，类伤寒初证；自初热至报痘，类伤寒六经三阴三阳证；六日以后，谓之杂证；
报痘次至收靥，常证也；异常，谓之变证；水痘、斑疹，谓之类证；不治，谓之坏证；余毒，谓之瘥证。其间
机轴俨似伤寒，但痘毒自里出表，非若伤寒自表入里，所以治法微异。至于痘中百病，皆外感内伤，邪秽与毒
相搏。大法痘未尽出，见三阳证，宜清肌解毒；痘已出齐，见三阳证，宜温中托里。太阳病恶寒身热，气急尿赤，
出不快者，防风荆芥甘草汤∶三味等分，水煎服。少阳病乍寒乍热，出不快者，连翘防风甘草汤∶三味等分，
水煎服。阳明病身热目赤，便秘，疮遍肌肉，出不快者，升麻葛根汤加紫草；四肢出不快者，防风芍药甘草汤∶
三味等分，水煎服。太阴病腹满自利，四肢厥逆，已出者，附子理中汤、木香散、理中丸。少阴病痘出黑陷，
口舌腐烂，四物汤加紫草、红花。厥阴病舌卷囊缩，粪青目青，时发厥逆，异功散、十全大补汤加附子。凡阳
证见于春夏及天晴则顺，阴证见于秋冬及阴雨则逆。
痘象豆形色豆色，惟有黑陷最惊人；
痘者，豆也，大小不一无妨，惟欲圆满硬实，不宜陷。有皮嫩易破，他如茱萸者险；如麻子、如蚕种、
如浮萍，不分个数者逆。故曰∶顺其形则顺，逆其形则逆。色者，五脏精华，红、黄、绿者为佳。痘乃脾土及
君相二火所主，黄绿乃脾胃正色，毒将出也；红亦深色，桃红三分，红中一分白，毒始出也；鲜红则为血热。
初起紫者，大热；白者，气虚毒未出也。初起白者，大虚；灰白者，血衰而气滞也；黑者，毒滞而血干也；焦
褐者，气血结也。
形属气兮色属血，形贵充顶色润身；
顶形圆满者，天之象也。气，阳也，故形属乎气。晕色红润者，地之象也。血，阴也，故色属乎血。顶
尖圆满而不皴陷，则气体天而常亲乎上；根窠红润而晕外明净，则气体地而常亲乎下，极其顺也。
形色得半要根活，根地圆晕显有神；交会不明形色反，灯影周旋眼法新。
气可盈而血不可盈，苟或形陷伏而不绽凸，则气不足以收毒，而反亲乎下；色泛溢而不凝敛，则血有余而
反亲乎上。又有气多血少者，痘虽凸而四围无色；血多气少者，痘虽陷而四围红紫；毒有余而气血不足者，其痘
不发不红，此气血之辨也。根即圆晕，痘 曰窠， 圈围晕曰根，圈晕外曰地皮，白无红是为交会。明白圆晕
乃气血之会，形色之神也。盖包血而成圆者，气之形，然必气与血会，而后圆形周净；附气而成晕者，血之形，
然必血与气交，而后晕色分明。虽然一元流行而已，自气血凝滞而言，谓之形，自气血光华而言，谓之色。形中
有色，色中有形，运用鼓舞形色而言，谓之神。灯影周旋者，痘形色虽险，若灯光影与痘根圆晕相为周旋，根窠
红活，浆影深浓，虽陷伏灰紫，皆可调治。若根窠不红不起，血死不活，浆无影者，虽轻难治。故虽白日，亦必
用麻油纸捻照之。自始至终，全以根地为主，眼法新巧，全在于此。
证与痘亦恒相因，
痘善而证恶者，必外感寒暑；证善而痘恶者，必外触秽污。痘为主，证为辅，虽无他证，而痘恶者必死。
表实难出虚易出；
证以身热无汗为表实，痘以红突为表实；证以身凉汗多为表虚，痘以灰陷为表虚。盖无汗则肤腠闭密，
所以痘稍难出，出则红活绽突；多汗则腠理空疏，所以痘反易出，出则灰灸顶平。有言表实易出者，必里实
甚也，表虚难出者，必里亦虚也。
里实顺靥虚倒靥，
证以便秘能食为里实，吐泻少食为里虚。里实则正气收毒，自痘顶而下，渐次结痂者顺；里虚则气血不
能收毒，而痘根先靥者逆。
不绽或淡表里坠。
证既吐泻汗多，痘又灰白陷伏，表里俱败。
轻者从头至足稀，能食便调不须治；重者不食二便乖（或秘或溏），脚先头上或齐至；
凡出、靥从头至足为顺，从足至头为逆，头脚齐出、齐靥者险。所以轻者，靥出俱从头至足，痘亦稀少；
重者稠密，头上未出未靥，脚上先出先靥。然痘以脾土为主，自始至终，以能食者顺。胀贯时，宜食老鸡补气；
收靥时，宜食雄鸭收毒，或猪精肉。肥者助痰滞气。始终忌鱼腥。二日一便者为顺，三四日不便者为秘，一日
三四便者为利。
轻变重者非有妖，外感内伤犯污秽。
忌风寒，恐损表；忌暑，恐生烦躁；忌湿，恐脓不干；忌生冷与蜜，恐寒中；忌肥腻，恐泻；忌咸，恐渴；
忌酒、葱、鱼、羊、盐等，恐痒。淡食为佳。忌煮鸡、鹅、鸭卵，病患闻气害目；忌柿、枣、砂糖，恐痘疮入
眼；忌茶、醋。猪肝、猪血，恐瘢黑；忌烧香满室以燥血，只宜常烧苍术、猪甲、乳香以避恶气；忌酒色僧入洒
净冷水，闭其皮肤，大忌父母房室、月水、乳母腋气、人畜粪污、房内炙爆、对梳扫地、生人往来、一切恶秽，
以致气滞。盖气闻香则行，闻臭则止故也。自报痘至收靥，一有感伤秽污，便令当出不出，当靥不靥，或变黑
陷作痛发痒，一切杂证。大概外感，冬时，五积散去麻黄，加桂心、紫草；春时，不换金正气散，加芎、芷、
防风，或为风邪所袭者，消风散加紫草∶暑月，六一散、清暑益气汤，体薄清贵者，只用保元汤，随证加减。内
伤乳食，气壅遏者，二陈汤加山楂、升麻、白术，四君子汤加砂仁、木香、川芎、紫草，或枳术丸。宿食重者，
感应丸。伤生冷、凉药者，益黄散、治中汤。内伤兼外感者，调解散、加味四圣散。秽污触者，避秽丹∶苍术、
细辛、甘松、川芎、乳香、降真香各等分为末，烈火焚之。将出者，用胡荽泡酒喷帐帏，及悬胡荽于帐中，甚
者，以胡荽泡汤，化下苏合香丸。但胡荽能通心窍，利大肠，惟便滑者忌之。秽毒入内黑陷者，再苏丹∶白矾、
生地龙炒各等分为末。每五分，用小猪尾血调新汲水下，不拘时服。如体薄者，四物汤去地黄，加人参、黄
梢、连翘、白芷、甘草梢、木香。
类证水痘热三日，出靥俱易眼光华；
水痘似正痘，仍身热二三日而出，初出即如赤小豆大，皮薄痂结，中空圆晕更少，易出易靥，被湿则难
结痂，亦不为害。外证两眼如水，宜小麦汤∶滑石、甘草、地骨皮各一分，人参、麻黄、大黄、知母、羌活、
葶苈各二分，小麦七粒，水煎服。如斑疮水痘，烦热溺涩，口舌生疮者，八正散。
斗热发斑或丹毒，
斑红痕如锦纹，或如蚊迹，与伤寒阳毒发斑同，热极则发，宜败毒散表之，汗后身凉，红痕自退。再越
二日，或报痘反少。又有报痘时，热盛发斑者，透肌散加红花、黄芩、升麻。咽痛，加玄参、磨犀角和服，或
玄参升麻汤加减。热盛者，解毒汤加芎、归、白芍、防风。若见黑斑即死，水 、脓 后发斑者亦死，斑少者可
救。报痘时有红丹如云头尖者，败毒散加紫草、红花、黄芩解之；如肿高红紫痕者，透肌散加黄芩、地骨皮、
蝉蜕。
顶平有水是疹麻。
疹如粟米，微红，隐隐皮肤不出，作痒，全无肿痛；麻即如麻，顶平软，不碍指，即有清水。痘多夹疹
同出，麻亦多夹疹同出，故曰痘疹、麻疹。但痘成脓 后，出疹者反顺，水 后出者逆。又有先发疹而后发斑
者，亦无害。治疹宜消风热，用败毒散加葛根、升麻、白芷，表退肌热，则疹自无矣。又有报痘后，麻疹稠密
如蚕种者，透肌散加柴胡、红花解之。若色好，不可过用凉药，必伤脾胃，易致陷伏也。
麻有夹痘同出者，麻没痘存色愈加；
麻夹痘出者，治痘为主，麻必先没而痘独存。盖痘属五脏为阴，难出难靥；麻属六腑为阳，易出易没。
麻没后痘必起发，形色愈加者顺，如形色已亏者，四君子汤加芎、归、黄 ；黑陷者，
去茯苓，更加紫草、木香、糯米，入酒煎服。
麻急理麻痘急（理）痘，麻痘源头共一家。
杂证热毒头亦痛，
凡杂证，皆因荣卫不和，以致毒不泄于肌肤，而反内攻脏腑，或上攻咽、膈、头面，多挟内外邪秽。
头痛初起为风，以后多热毒上攻，毒甚则肿。
眼红舌苔唇吒 ；
眼角流红，或目黄，肝热；舌上白苔，心热；口唇吒啧欲怒，肺热。
口疮咽痛郁多啼，
口疮痛不能食，脾热，五福化毒丹，或蜜渍黄柏汁饮之。咽干涩痛，口烂齿肿，心胃热也，甘露饮，
或甘桔汤加牛蒡子、麦门冬、竹叶煎服；水浆不入者，紫雪抱龙丸、消毒饮。如能食便溏者，又当清上温下，
不可纯用凉药。多啼，当察外证、郁毒在表在里，调之。如果因心热、痰热者，辰砂六一散，痘未出，葱白煎
汤下；痘出盛，灯心煎汤下；黑陷者，加龙脑半厘，紫草煎汤下。
贯胀极忌咳与喘。
初热咳嗽气促，风寒在表故也。痘出时咳嗽胁痛，吐食不下者，半表里邪也，小柴胡汤加五味子、枳壳、
桔梗；小便赤者，加山栀、赤茯苓。如服冷药太过，咳嗽、肢冷、呕吐者，甘草干姜汤。胀贯时，呵欠、喷嚏、
打屁亦忌。如咳嗽气喘，乃毒攻肺胀，胸高声哑而死，果系外感者，亦必痘好乃吉。初起烦躁喘急者，麻黄
汤加桑白皮及麝一厘，或黄芩汤加麻黄、桂枝；便秘者，前胡枳壳汤。凡无痰喘急，不能卧者，死。
大渴不止恐阴虚，
口渴，毒火炎上者，用甘草、栝蒌根等分，水煎服，或黑豆、绿豆各二合，乌梅二个，水煎澄清服；饮水
小便少者，恐湿渍脾土，后难收靥，宜六一散渗之；内虚津乏者，保元汤加麦门冬、五味子，或参苓白术散、
黄六一汤。如虚阳偏盛好饮冷者，木香散，倍丁香、官桂；阴寒偏盛好饮热者，异功散加木香、当归。惟血
虚痘黑，火动发渴者难治。凡虚证见渴者皆死。
胸紧烦躁安眠少；
胸膈紧满者，枳梗汤，或二陈汤加枳壳。烦躁动止不宁，初起报痘时躁者，表未解也，宜清内解肌，黄芩芍
药汤和之；起胀时躁者，毒欲散未散也，或生黑豆一味煎汤，徐徐冷冻饮料，解毒散热，召复阴气，或抱龙丸、生
犀角磨汁、单甘草煎汤，俱能解毒；贯脓时躁者，毒冲心膈也，宜利小便，大便不通者，宜润之；结痂后躁者，
解其余毒可也。痘出及余毒烦躁，小便不利者，用灯心一把，鳖甲二两煎服。烦躁不得眠者，酸枣仁汤。
腹痛有块或坚硬，
初热时腹痛甚，手足稍冷，尻、阴冷，为痘毒作痛无疑。外感，宜藿香正气散、升麻葛根汤、参苏饮，俱
加山楂；内伤生冷冻饮料食，腹痛自利者，理中汤加陈皮、砂仁、木香。如痘出腹痛，便调者，无妨；便秘鼻热，
痛甚，痘出不快，体冷甚发厥者，独圣散，或四磨汤，服之则毒瓦斯泄而四肢温，腹痛自止。已出，厥痛者亦宜。
腹胀初起尚可表。
初热腹肛，毒与邪搏，升麻葛根汤加山楂、牛蒡子，微汗即散。一切异证，随证加减由人。但此汤乃初起
及结痂后，解毒凉肌之药，惟内虚胃弱，及红点见后无表证者忌之，如大小便难者，四圣散、紫草饮。
失血肺胃被热侵，毒并大肠便瘀了；
痘出阴分，极忌动血。口鼻失血，肺胃热甚，宜解毒汤加生地、大黄；轻者，黄芩汤；虚热者，单人中白
为末，蜜水调服。便血粪黑，毒并大肠，犀角地黄汤，或小柴胡汤加生地。痘出下利黄赤脓血，身热作渴者，
薤白汤、三黄熟艾汤，解其毒而痘自出。便血神昏不醒者，抱龙丸救之。盖痘虽内毒，运之者血，心主血藏
神，今便血神昏，宜乎危矣。如大小便血及七孔流血者，即死。有因服凉药以致毒陷，泻血有如豆汁黑者，
急用理中汤、胃风汤，得便闭、
疮红活者生。若胀贯时便血而疮坏无脓者，胃烂必死。痘愈后便血，或下肠垢身热者，升麻葛根汤加黄连、生
地；身热烦渴者，解毒汤；热势盛者，小承气汤；下利者，黄连阿胶丸，小驻车丸。
内外毒蕴便不通，烦胀汗渴言谵杳。
《活人》谓首尾不可下者，盖痘未出，有表无里；痘既出，表盛里虚，所以首尾忌下。奈其间有因外感里
热，及内伤热食、热药、以致热毒蕴结，便秘烦躁，腹胀，手掌心并腋下有汗，作渴，谵语，实热里证悉俱，
肠胃壅塞，脉络凝滞，壅遏痘毒，不出不起不靥，必用下药，通其荣卫，而后毒得起发，从权以下利药中，
The pathogenesis of smallpox (Dou Zheng) is nothing more than the pathology of Qi and Blood combined with toxic pathogens.
The toxin arises from excessive fire in the prenatal constitution and unclean diet, stagnating and accumulating in the Zang-Fu organs. Upon the first cry after birth, all toxins return to the Mingmen (Gate of Life).
When encountering annual fire cycles or contagious epidemics; or when winter warmth leads to eruption in spring and summer; or due to neglecting sweating in cold damage or febrile diseases followed by inappropriate purgation; or due to external contraction of wind-cold and internal injury from raw/cold foods; or due to trauma, fright, and blood stasis, the condition erupts.
Upon eruption, the fire of Mingmen moves violently, roasting the left Kidney, flowing counter-current along the spine, descending from the head and forehead to suppress Bing Fire (Small Intestine/San Jiao Fire). If it does not gather on the face but scatters to the limbs, those with substantial innate Qi and Blood can overcome the toxin, which is a favorable prognosis (Shun); if Qi and Blood are deficient, the toxin prevails, which is an unfavorable prognosis (Ni); if Qi, Blood, and toxin are equal in strength, the condition is dangerous (Xian).
For favorable prognoses, medication is not strictly necessary; for unfavorable ones, treatment is often ineffective; for dangerous ones, urgent medication is required.
The entire course lasts about twelve days.
Excluding the initial three days of fever, fever may last three to five days or even ten-plus days.
From the appearance of pustules to the formation of crusts, the total duration is twelve days. Interference with dietary and behavioral restrictions can prolong the illness. Those with harmonious Qi and Blood may recover in less than twelve days. Initially, the number of days was not strictly observed; later distinctions were made for the benefit of beginners.
Symptoms include initial signs and mixed conditions, with Yin-Yang variations resembling Cold Damage (Shang Han).
Regardless of deteriorated or convalescent states, it is essentially the mutual destruction between pathogenic factors and toxins.
The initial three days of fever resemble the initial stage of Cold Damage.
From initial fever to the appearance of pustules resembles the Six Channels (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin) of Cold Damage.
After the sixth day, they are called mixed symptoms.
From the appearance of pustules to crusting is the normal presentation. Abnormal changes are called variable presentations. Water pox and maculopapular rashes are called similar presentations. Incurable cases are called deteriorated presentations. Residual toxins are called convalescent presentations.
The underlying mechanism resembles Cold Damage, but smallpox toxins emerge from the interior to the exterior, unlike Cold Damage which penetrates from exterior to interior, hence treatment methods differ slightly.
Various diseases within smallpox stem from external contractions and internal injuries, where pathogenic filth battles with toxins.
General principles: If toxins have not fully erupted and Three Yang channel signs appear, clear the muscle layer and resolve toxicity. If toxins have fully erupted and Three Yang signs appear, warm the middle and support the interior to expel toxins.
Taiyang disease with aversion to cold, fever, rapid breathing, red urine, and slow eruption: Fangfeng Jingjie Gancao Decoction (Equal parts of Saposhnikovia Root, Schizonepeta Herb, and Licorice Root, decocted in water).
Shaoyang disease with alternating chills and fever, slow eruption: Lianqiao Fangfeng Gancao Decoction (Equal parts of Forsythia Fruit, Saposhnikovia Root, and Licorice Root, decocted in water).
Yangming disease with fever, red eyes, constipation, widespread skin lesions, and slow eruption: Shengma Gegen Decoction plus Zi Cao (Arnebia Root/Lithospermum Root); for slow eruption in limbs: Fangfeng Shaoyao Gancao Decoction (Equal parts of Saposhnikovia Root, Peony Root, and Licorice Root, decocted in water).
Taiyin disease with abdominal fullness, spontaneous diarrhea, cold limbs, and already erupted pustules: Fuzi Lizhong Tang, Muxiang San, or Lizhong Wan.
Shaoyin disease with black, sunken pustules, and oral/tongue ulcers: Siwu Tang plus Zi Cao and Honghua (Safflower).
Jueyin disease with curled tongue, retracted testicles, green stool, green eyes, and frequent syncope: Yigong San or Shiquan Dabu Tang plus Fuzi (Aconite Root).
Yang signs appearing in spring/summer or sunny weather are favorable; Yin signs appearing in autumn/winter or rainy weather are unfavorable.
The shape of smallpox resembles beans, and its color resembles bean hues; only black, sunken lesions are most alarming.
"Smallpox" means bean. Variations in size are acceptable, provided they are round, firm, and not sunken. Tender skins prone to rupture or shapes resembling cornels are dangerous. Shapes like hemp seeds, silkworm eggs, or duckweed without distinct boundaries indicate an unfavorable prognosis. Thus, favorable shape implies favorable prognosis, and vice versa.
Color reflects the essence of the Five Zang organs. Red, yellow, and green are auspicious. Smallpox is governed by Spleen Earth and the Ministerial/Fire energies. Yellow-green is the proper color of Spleen/Stomach, indicating impending toxin release. Dark red indicates toxin emergence (peach-red with 30% red and 10% white). Bright red indicates blood heat.
Purple at onset indicates extreme heat. White indicates Qi deficiency and retained toxin. Pale white indicates severe deficiency. Gray-white indicates blood decline and Qi stagnation. Black indicates toxin stagnation and dried blood. Scorched brown indicates Qi-Blood coagulation.
Shape belongs to Qi, Color belongs to Blood. Shape should be full at the apex; Color should moisten the body.
Round apices reflect Heaven's image. Qi is Yang, so shape relates to Qi.
Reddish halos reflect Earth's image. Blood is Yin, so color relates to Blood.
A round, non-wrinkled apex ensures Qi connects with Heaven (upper). A red, clean halo base ensures Qi connects with Earth (lower), representing maximum favorability.
Half-form/half-color requires active roots; roots and halos must show spirit.
Unclear intersections reverse form and color; observing under lamp light reveals new diagnostic insights.
Qi can be abundant, but Blood should not overflow. Sunken, non-protruding forms indicate insufficient Qi failing to contain toxins, pulling them downward. Overflowing colors indicate excess Blood pulling upwards.
Excess Qi/deficient Blood: Pustules protrude but lack surrounding color.
Excess Blood/deficient Qi: Pustules are sunken but surrounded by red-purple.
Excess Toxin/deficient Qi-Blood: Pustules do not erupt or turn red. This distinguishes Qi-Blood status.
The root is the halo; the pit is the "ke"; the ring around the pit is the "gen"; the area outside the ring is the "di". White without red is "jiaohui" (intersection).
Clear halos represent the meeting of Qi and Blood, the spirit of form and color. Circles formed by Blood wrapped in Qi require Qi-Blood harmony for purity. Halos formed by Qi attached to Blood require Blood-Qi interaction for clarity.
Though one continuous flow, stagnation is "Form," brilliance is "Color." Form contains Color, Color contains Form. The dynamic interplay is "Spirit."
Under lamp light, even dangerous lesions can be treated if the root is red/vibrant and fluid shadows are deep, despite gray-purple sunkenness. If roots are pale/non-rising and blood is dead/no shadow, even mild cases are hard to treat. Daylight observation is supplemented by oil-paper wicks. Diagnosis focuses entirely on roots and ground.
Symptoms and smallpox are inherently linked.
Good smallpox/bad symptoms: External Wind-Cold/Heat.
Bad smallpox/good symptoms: External contact with filth.
Smallpox is primary; symptoms secondary. Bad smallpox is fatal regardless of other symptoms.
Exterior Excess makes eruption difficult; Exterior Deficiency makes it easy.
Symptomatically, fever without sweat is Exterior Excess; coolness with profuse sweat is Exterior Deficiency.
Dermatologically, red protrusion is Exterior Excess; gray sinking is Exterior Deficiency.
No sweat closes pores, making eruption harder but resulting in vibrant redness once out. Profuse sweat opens pores, making eruption easier but resulting in flat, ash-colored lesions.
Some say Excess is easy to erupt because Interior Excess is severe; Deficiency is hard because Interior Deficiency exists.
Interior Excess leads to normal crusting; Interior Deficiency leads to inverted crusting.
Symptomatically, constipation/appetite is Interior Excess; vomiting/diarrhea/poor appetite is Interior Deficiency.
Interior Excess allows righteous Qi to draw toxins down from the apex for normal crusting. Interior Deficiency fails to contain toxins, causing roots to crust prematurely (unfavorable).
Non-protrusion or pale color indicates collapse of both Exterior and Interior.
If symptoms show vomiting/diarrhea/profuse sweat AND pustules are gray/white/sunken, both systems have failed.
Mild cases: Sparse eruption from head to foot, normal appetite/stool, no treatment needed.
Severe cases: Anorexia, bowel dysfunction (constipation or diarrhea), feet erupt before head or simultaneously.
Eruption/crusting Head-to-Foot is favorable; Foot-to-Head is unfavorable; Simultaneous is dangerous.
Mild cases: Crusting proceeds Head-to-Foot, sparse lesions.
Severe cases: Dense lesions, head lags behind feet in eruption/crusting.
Smallpox relies on Spleen Earth. Appetite throughout is favorable.
During swelling phase: Eat old chicken to tonify Qi.
During crusting phase: Eat male duck or lean pork to resolve toxins. Avoid fatty foods (phlegm/Qi stagnation).
Avoid fish/fowl smells always.
Bowel movements: Once every two days is favorable; every 3-4 days is constipation; 3-4 times daily is diarrhea.
Mild turning severe is not demonic, but due to external/internal injuries and filth.
Taboos: Wind/Cold (damages exterior), Summerheat (causes irritability), Dampness (prevents pus drying), Raw/Cold/Honey (cold in middle), Greasy (diarrhea), Salty (thirst), Alcohol/Green Onion/Fish/Mutton/Salt (itching). Light diet is best.
Avoid cooked chicken/goose/duck eggs (smell harms eyes). Avoid persimmons/jujubes/sugar (risk of eye involvement). Avoid tea/vinegar. Avoid pig liver/blood (black scars). Avoid incense smoke (dries blood); burn Cang Zhu, pig hooves, Frankincense to ward off evil qi. Avoid alcohol, sex, monks, cold water sprinkling (closes pores). Avoid parents' bedroom, menstruation, wet nurse's axillary odor, human/animal waste, cooking fumes, combing near bed, strangers, and all filth causing Qi stagnation. Qi moves with fragrance, stops with stench.
Any exposure to filth during the 12-day period causes delayed eruption, delayed crusting, blackening, pain, itching, and mixed symptoms.
Treatment for External Contraction:
Winter: Wuji San minus Mahuang, add Guixin, Zi Cao.
Spring: Buhuanjin Zhengqi San plus Xiong, Zhi, Fangfeng; or Xiaofeng San plus Zi Cao if wind strikes.
Summer: Liuyi San or Qingshu Yiqi Tang. For delicate constitutions: Baoyuan Tang modified.
Treatment for Internal Injury (Food/Milk):
Qi stagnation: Erchen Tang plus Shan Zha, Shengma, Baizhu; or Sijunzi Tang plus Sharen, Muxiang, Chuanxiong, Zi Cao; or Zhizhu Wan.
Heavy food retention: Yinggan Wan.
Cold/Raw injury: Yihuang San or Zhizhong Tang.
Internal injury + External contraction: Jie Du San or Jiawei Sisheng San.
Filth contact: Bi Hui Dan (Cang Zhu, Xixin, Gansong, Chuanxiong, Ruxiang, Jiangzhenxiang burned).
Pre-eruption: Huixu (Coriander) wine spray/hanging. Severe: Huixu decoction with Suhexiang Wan. Note: Huixu opens orifices/promotes bowels; avoid in diarrhea.
Toxin entering interior/blackening: Su Dan (Bai Fan, Di Long fried). 5 fen mixed with pig tail blood and fresh water.
Delicate constitution: Siwu Tang minus Dihuang, add Renshen, Huangshao, Lianqiao, Baizhi, Gancao Shao, Muxiang.
Similar Presentation: Water Pox. Fever for 3 days, easy eruption/crusting, bright eyes.
Resembles true smallpox, erupts after 2-3 days of fever. Starts like adzuki beans, thin skin, hollow center, less halo. Easy to erupt/crust. Dampness hinders crusting but is generally harmless.
External sign: Eyes watery. Use Xiaomai Tang: Huashi, Gancao, Digupi (1 fen each); Renshen, Mahuang, Dahuang, Zhimu, Qianghuo, Tingli (2 fen each); 7 Wheat grains. Decoct.
Maculopapular/Water Pox with irritability, dysuria, oral ulcers: Bazheng San.
Fever-induced Macules or Erysipelas.
Red marks like brocade patterns or mosquito bites, similar to Yang-Toxic Macules in Cold Damage. Erupts at peak heat. Use Baidu San to vent. After sweating, coolness returns, marks fade.
Two days later, smallpox may appear less.
If high fever causes macules during eruption: Touji San plus Honghua, Huangqin, Shengma.
Sore throat: Add Xuanshen, Rhinoceros Horn (ground) or Xuanshen Shengma Tang modified.
High heat: Jiedu Tang plus Chuanxiong, Danggui, Baishao, Fangfeng.
Black macules = death. Macules after vesicle/pus stage = death. Few macules = salvageable.
Red erysipema like cloud tips: Baidu San plus Zi Cao, Honghua, Huangqin.
Swollen/high red-purple marks: Touji San plus Huangqin, Digupi, Chantui.
Flat-topped with fluid indicates Rash (Zhen) or Measles (Ma).
Rash: Like millet, faint red, hidden in skin, itchy, no swelling/pain.
Measles: Like hemp seeds, flat/soft, non-obstructive, clear fluid present.
Smallpox often accompanies Rash; Measles often accompanies Rash. Hence "Dou Zhen" and "Ma Zhen."
Post-pus Rash is favorable; Post-vesicle Rash is unfavorable.
Rash then Macule is harmless.
Treat Rash: Clear wind-heat. Baidu San plus Gegen, Shengma, Baizhi. Once exterior clears, rash resolves.
Dense measles post-smallpox: Touji San plus Chaihu, Honghua.
If color is good, avoid excessive cooling herbs to prevent Spleen/Stomach damage and sinking.
Measles accompanying Smallpox: Measles disappear, Smallpox remains, color improves.
Treat Smallpox primarily. Measles vanish first.
Smallpox (Zang/Yin) is hard to erupt/crust. Measles (Fu/Yang) are easy.
After measles vanish, smallpox must rise. Improving color/form is favorable. Declining form: Sijunzi Tang plus Chuanxiong, Danggui, Huangqi. Blackening: Remove Fuling, add Zi Cao, Muxiang, Nuomi, decocted in wine.
Urgent Measles treat Measles; Urgent Smallpox treats Smallpox; they share origins.
Mixed Symptoms: Heat-Toxin also causes headache.
All mixed symptoms stem from Ying-Wei disharmony, preventing toxin release from skin, leading to internal attack on Zang-Fu or upward attack on throat/chest/head, often mixed with external/internal filth.
Headache at onset is Wind; later is Heat-Toxin attacking up; severe toxicity causes swelling.
Red eyes, tongue coating, lip twitching.
Red corners/yellow eyes: Liver Heat.
White tongue coating: Heart Heat.
Lip twitching/anger: Lung Heat.
Mouth ulcers, sore throat, depression, crying.
Painful ulcers/anorexia: Spleen Heat. Wufu Huadu Dan or Honey-soaked Huangbai juice.
Dry/painful throat, oral ulcers, swollen teeth: Heart/Stomach Heat. Ganlu Yin or Ganjie Tang plus Niubangzi, Maidong, Zhuye. Inability to swallow: Zixue Baolong Wan or Xiaodu Yin.
If eating but loose stools: Clear upper, warm lower. Do not use purely cooling herbs.
Excessive crying: Check external signs/depressed toxin (exterior vs interior).
Heart/Phlegm Heat: Chen_sha Liuyi San. Pre-eruption: Scallion white decoction. Peak eruption: Centella decoction. Blackening: Add Borneol, Arnebia decoction.
Distension/Pus stage strictly forbids Cough/Asthma.
Initial fever cough/rapid breathing: Wind-Cold on exterior.
Cough/costal pain/vomiting during eruption: Half-exterior/half-interior pathogen. Xiao Chaihu Tang plus Wuweizi, Zhike, Jiegeng. Red urine: Add Zhizi, Chifuling.
Overuse of cold meds causing cough/cold limbs/vomiting: Gancao Ganjiang Tang.
Distension stage: Yawning, sneezing, flatulence also forbidden.
Cough/Asthma indicates Toxin attacking Lung distension, chest fullness, hoarseness, death. If external, recovery depends on smallpox healing.
Initial irritability/asthma: Mahuang Tang plus Sangbaipi, Musk. Or Huangqin Tang plus Mahuang, Guizhi. Constipation: Qianhu Zhike Tang.
Asthma without phlegm, unable to lie down = Death.
Unceasing thirst fears Yin Deficiency.
Thirst from Fire flaring up: Gancao, Gualougen equal parts, decoct. Or Dou黑豆, Dou绿豆, Wumei, decoct.
Drinking but low urine: Dampness soaking Spleen, hindering crusting. Use Liuyi San to leach dampness.
Internal deficiency/fluid lack: Baoyuan Tang plus Maidong, Wuweizi; or Shenling Baizhu San, Huang Liuyi Tang.
Deficient Yang preferring cold drinks: Muxiang San, double Dingxiang, Guirou.
Yin Cold preferring hot drinks: Yigong San plus Muxiang, Danggui.
Blood deficiency with black smallpox and fire-driven thirst is hard to treat.
Thirst in deficiency syndromes is fatal.
Chest tightness, irritability, poor sleep.
Chest fullness: Zhigeng Tang or Erchen Tang plus Zhike.
Irritability/restlessness:
Onset/Eruption: Exterior unresolved. Qingnei Jieji. Huangqin Shaoyao Tang harmonizes.
Swelling stage: Toxin trying to scatter. Boiled raw black soybean cold drink to resolve toxin/heat, restore Yin. Or Baolong Wan, Rhinoceros Horn juice, single Gancao decoction.
Pus stage: Toxin rushing Heart/Diaphragm. Promote urination. Constipation: Moisten intestines.
Crusting stage: Resolve residual toxin.
Post-eruption/residual toxin irritability with low urine: Dengxin (Juncus), Biejia decoct.
Insomnia due to irritability: Suanzaoren Tang.
Abdominal pain with masses or hardness.
Initial fever severe pain, cold extremities, cold buttocks/genitals: Smallpox toxin pain.
External contraction: Huoxiang Zhengqi San, Shengma Gegen Tang, Renshen Su Yin, all plus Shan Zha.
Internal injury (raw/cold food) with pain/diarrhea: Lizhong Tang plus Chenpi, Sharen, Muxiang.
Post-eruption pain with normal stool: Harmless.
Constipation, nasal heat, severe pain, slow eruption, cold limbs/syncope: Dusheng San or Simo Tang. Relieves toxin gas, warms limbs, stops pain. Applicable to post-eruption syncope/pain.
Abdominal distension at onset can still be vented.
Initial fever abdominal pain: Toxin battling pathogen. Shengma Gegen Tang plus Shan Zha, Niubangzi. Mild sweating disperses it.
Modify for other symptoms.
This decoction is for initial/crusting stages to clear toxin/cool muscle. Contraindicated in Interior Deficiency/Weak Stomach or after red spots appear without exterior signs. Urinary/Bowel difficulty: Sisheng San, Zicao Yin.
Hemorrhage: Lung/Stomach invaded by Heat; Toxin merges with Large Intestine causing bloody stool.
Smallpox emerging from Yin levels strictly forbids moving Blood.
Nasal/Mouth bleeding (Lung/Stomach Heat): Jiedu Tang plus Shengdi, Dahuang. Mild: Huangqin Tang. Deficient Heat: Renzhongbai powder with honey water.
Bloody stool/Dark feces (Large Intestine Toxin): Xijiao Dihuang Tang or Xiao Chaihu Tang plus Shengdi.
Yellow/red pus-blood diarrhea with fever/thirst: Xiebai Tang or Sanhuang Shuai Ai Tang. Resolves toxin, allows eruption.
Bloody stool with coma: Baolong Wan.
Heart governs Blood/Spirit. Bloody stool/coma is critical.
Simultaneous urinary/fecal/seven-orifice bleeding = Death.
Cooling meds causing toxin sinking/black bean-juice stool: Urgent Lizhong Tang, Weifeng Tang. Recovery indicated by closed bowels and red/vibrant lesions.
Bleeding during distension with necrotic/pus-less lesions: Stomach rot, fatal.
Post-recovery bleeding/intestinal mucus/fever: Shengma Gegen Tang plus Huanglian, Shengdi. Irritable/thirsty: Jiedu Tang. Severe heat: Xiao Chengqi Tang. Diarrhea: Huanglian Ejiao Wan, Xiao Zhuche Wan.
Internal/External Toxin Stagnation causing constipation, irritability, distension, sweating, thirst, delirium.
"Huo Ren" states purgatives are forbidden at start/end.
Start: Exterior present, Interior absent.
End: Exterior excess, Interior deficiency. Hence purgatives forbidden.
However, External contraction/Internal Heat, or Internal injury from Hot Food/Meds, can cause Heat-Toxin accumulation, constipation, irritability, distension, palm/armpit sweating, thirst, delirium. Real Heat Interior signs present. Intestinal blockage, meridian stagnation, suppressing toxin eruption/crusting.
Must use purgatives to open Ying-Wei, allowing toxin to rise. Temporarily use laxatives...