七日前阳毒，凡疮即黄 、血风、绵花、杨梅疮之类。痘疮未痊及初结瘢处，肉分必虚，毒趋虚处而出，
阳疮阴毒，溷杂一党，反胜诸毒而名之也。其疮湿润者，为气血俱盛，而诸毒易成浆也，宜解毒汤主之；其疮枯
燥干红者，为气血俱弱，毒与诸疮相拒，而俱不成浆也，宜保元汤加芎、桂、糯米，更以水杨汤沃之，则枯转
润，白变红，其浆自溢矣。水杨汤∶杨柳五斤（春冬用枝、秋夏用叶），洗净捣碎，取长流水一大釜，煎六七
沸，去渣。将三分之一注盆中，宜先服汤药，然后乘热洗浴，久许乃以油纸捻点灯照之，累累然有起势，陷处
有圆晕红丝，此浆影也。浆必满足，如不满，又如前浴法。弱者只浴头面手足，勿浴背，灯照如无起势，则气
血败而津液枯。盖痘不成浆，乃气涩血滞，腠理固密，药气力缓，颇难顿尔达其头面手足，惟服药后以此沃之，其
药藉此升提开豁万窍。洗法必添汤久浴，使其缓透肌内，疏通内外，斯毒瓦斯随暖气而发。凡报痘起胀、行浆贯
满，痘疮顶陷、浆滞不行或为风寒久克者，皆效。
坏证头低肢软脆，
初起表证，足冷无害。惟足冷头低，四肢软弱，始终大忌。痘出后，头温足冷者亦死。
面色青肿HT 鼻屎；
痘以心血为主，面赤者顺，面青必生风，虚下利厥逆。报痘误服热药，发而不透，以致身体头面两目
皆肿，风搐身强者，人参羌活散救之。如当胀之时，头额肿如瓜，或面肿，或顺项亦肿而疮不肿者死，宜消肿
毒，补中气以救之，若痘色与皮一般肿，根窠红者无害，或一边面肿，形色顺者吉。鼻燥有黑气，或以手
HT鼻孔者死。
露睛耳焦唇紫崩，
两目闭而露睛无魂，如鱼眼、猫眼者死，或两眼不封而光烁者亦死。耳内焦黄，唇紫燥裂，甚则唇崩溃烂，
乃见标之时，复感风寒，使热毒攻内，不治。
口烂舌卷戛牙齿；
口内臭烂，舌上白苔或黑，舌卷囊缩，身必战动，肚腹急痛不止，痘变紫黑者，谓之内溃胃烂。原因
七日前被风寒所中，腠理周密，壅塞其毒，反攻脏腑之内，宜量与清胃消毒豁痰，解散风寒之剂救之。切牙
作渴身热者，心胃热也，宜甘露饮。如寒战切牙，则为肾毒上攻，内托十宣散，去防风。白芷，加茯苓救之。
声哑饮食便挫喉，
声出肺与心，或感风寒失声，或饮食毒壅，或多啼气噎。不问已出未出，失声身温者，解毒防风汤；便
秘者，甘桔汤加当归、黄连、大黄；身凉者，内托十宣散倍桔梗。如浆满声哑者，肺气绝也，不治；痘出不好，
声哑者亦死。又有呃逆胃寒，冷气上升也，宜盐炒吴萸一钱，丁香五分，水煎服。咽喉有毒，饮食如锯挫喉，
水浆不入，或吐出，或常干呕者，危；若贯脓时见此证，二便闭者，反吉。
腰痛如咬囊缩死；
腰痛如咬，不能起立，胸高足冷者，肾绝。若微痛者，风寒所伤。败毒散解之，外以麻油揉按。囊缩者，
肝绝，不治。
身温为实身凉虚，温补解毒法尽矣。
不问初证、杂证、变证、坏证，俱以身温为顺，身凉为逆。譬之种豆，晴暖则易生。且人无非常之热，
亦无非常之冷，惟身温，温则为气血和也。大概热证身温，俱宜解毒；虚证身凉，俱宜温补。虚证有热者，
温补中兼解毒；热证有虚者，解毒中兼温补。解毒∶初出，消毒饮、连翘散。解毒中略兼温补，解毒防风汤、
鼠粘汤。温补∶血虚，四物汤，或古芎归汤；气虚，四君子汤，或保元汤为主。泄者暂加白术、茯苓；烦渴加麦
门冬、五味子；虚热加黄连∶湿痰加陈皮；气郁不通加山楂；消毒加鼠粘子；退痈肿加荆芥穗；扶胃气加陈
黄米；助阳发表加生姜；色紫血热加连翘。要知连翘、鼠粘、山楂、甘草，始终必用；官桂、川芎、紫草、芍
药，五七日后慎用。气血俱虚者，内托十宣散、托里散，或保元汤加当归、芍药以活血，或合匀气散以和气。
温补中略兼解毒，八物汤加酒炒芩、连或保元汤各一钱，加牛蒡子、黄芩、黄连、玄参、丝瓜灰、连翘、白
芍各五分，姜、葱煎服。七日后势重毒深者，气虚，保元汤加大黄；血虚，古芎归汤加大黄、芒硝下之。又有
虚寒变证，木香散、异功散、古姜附汤、四逆汤，皆救危妙剂。但虚寒常迟十数日方死，热毒者死速。以上
总论初热以致收靥。
初热俨似太阳病，所异腮赤中指冷；
初起发热恶寒，类伤寒太阳表证。但伤寒男面黄，女面赤，麻痘则腮赤也；伤寒中指热，惊风男左女右五
指俱冷，麻痘中指与耳、鼻尖及尻、足俱冷。又察其耳后，有红筋赤缕为真，无筋者非痘。筋红赤易愈，紫者
难治，黑者死。
太阳正病不须医，感伤传变用药整。
初热见太阳表证，乃痘家正病，不必服药。惟内伤外感，挟瘀挟惊，及四脏见证，热轻者，匀气令其自
出；热重者，清肌解毒，甚则渗泄。但误下则伤脾，误温则损目，慎之。外感表郁热盛，痘难出、难作浆，宜表
托以助其欲发之势。兼心证者，惺惺散、消毒饮；兼肝证者，人参羌活散；兼脾证，虚者，惺惺散，或保元汤
加地皮、黄芩、荆芥，热者，升麻葛根汤、如圣汤；兼肺证者，参苏饮加葱白、山楂根。通用∶无汗者，羌活
冲和汤；有汗者，防风冲和汤。邪传半表半里，见胸紧呕吐，烦躁不眠等证。小柴胡加生地；虚者，二参汤。
邪传入里，二便俱秘，或溺中见血者，凉膈散、防风通圣散下之。有不敢下者，蜜导法。轻者，四圣散合败毒
散，或合辰砂六一散，或解毒汤微微渗利，不可尽
去其热，恐痘难发。内伤饮食生冷，见呕泻者，寒月，理中汤、胃苓散、不换金正气散；暑月，六和汤、二陈
汤、胃苓汤。如伤饮食，俱加山楂、麦芽消导之药。挟惊者，加减红绵散。挟瘀见血者，犀角地黄汤合小柴
胡汤。抑论痘证，始终必兼四脏，如热冲于心，时作惊悸，甚则狂谵，宜朱砂、参、苓之类；热蒸于肝，呵欠
烦闷，甚则发搐，宜防风、羌活、天麻、全蝎、南星之类；热蒸于脾，乍凉乍热，肢冷多睡，甚则目肿腹胀，便
秘作渴，宜枳壳、陈皮、神曲、山栀、地黄之类；热蒸于肺，面赤喷嚏，甚则喘渴咳嗽，鼻干，宜桑白皮、半
夏、马兜铃之类。惟肾无证，所以尻、耳宜冷。若先如疟，后发渴，其疮色黯，乃肾证，不治。然四脏又以脾
肺为主，盖肺主皮毛，脾主肌肉故也。
初热为根痘为标，根少标多生不永；
痘未出，非大热不能发；痘已出，非微热不能成。如潮三四日后，温温次第出，根多标少者生；潮一二日，即
涌出鲜红，根少标多者，七日后死。若全不发热，痘少而好，又无杂证者，轻。
欲防眼患药宜清，
痘出太盛，恐入眼为患，宜消毒饮，或气血药中，加酒炒芩，连，或桑白皮，或草龙胆、钩藤以清肝肺。
如痘已落眼，听其自然，深治反至损目。
护眼朱砂亦简省。
护眼膏∶黄柏一两，红花二两，绿豆粉一两半，甘草四两，为末。痘疮正发之时，用清油调，涂两眼四畔，则
面上痘亦稀少。或用朱砂为末，水调，涂眼眶，或只用干胭脂末，蜜调，涂眼眶，则痘不入眼。古方用如米细
朱砂为末，蜜调少许，每五分，作三次，量儿大小加减，温水送下。不拘痘疮出未，首尾可服，密者可稀，稀
者可无，黑陷者可起，痘痈 肿可消，兼治壮热烦渴微喘。但性亦微寒，不可多服。
报痘三朝毒居中，忌汗忌下和为上；
报痘，毒居半表半里，寒药伤胃滞毒，热药愈助火邪。忌汗者，痘点在肤，无俟于汗也；忌下者，痘在肌而
反空肠胃，无是理也。纵有余邪，亦但于宜服药中，加以陈皮、生姜之类和之而已。
热未彻者犹有邪，半清表兮半温养。
热彻出痘为安，如热犹未彻者，必感伤邪未尽净，此时热毒内熏，恐后滞为痈毒，宜半清表半温里之剂
调之，四圣散、解毒防风汤、紫草木香汤。如报痘干燥，腹痛腰痛不止者死。
一日母痘初见形，几点淡红间架明；
痘先出者为母，后出者为子孙。母好子孙多，则自然有不如者，亦无害。如红点先见于口鼻上下、腮、颧、
年寿之间，眼中全无，大小形状不一，作三四次出，或单或双，间架明白，淡红色润者顺。
稠密干红宜渐补，
三五相连，圆晕成个，干红少润，未可遽施补药，俟其气血交合，方可保元汤加官桂，助阳令其红润。
但嫌枯黑参天庭。
先见于天庭、方广、印堂、两耳（太阳、太阴）以结咽、心胸之处，或头尚无而脚先有，或心胸稠多，腰密
缠过如蚕种者，急用消毒饮加山楂、黄芩、紫草。虚加人参，或升麻葛根汤加连翘一分，或败毒散，犀角地黄汤
以清内解肌。如初发便见腰痛、疮稠干枯、几点紫黑者，死。或问紫黑归肾，阳位不宜，何也？诸阳聚顶，诸毒
聚顶，顶稠枯黑，毒胜气血明矣！尝考痘毒一发，出于四脏而肾不留邪为吉。如申西戌时发热属肺，发为脓 ，
如涕色白而大；巳午未时发热属心，发为血 ，色赤而小多兼斑；亥子丑时发热属脾，色黄微赤多兼疹；寅卯
辰时发热属肝，发为水 ，如泪色微青而小，此皆初发之状，不同如此。若报痘三日，当悉成血 ，起胀三
日后，血 成脓 ，贯脓三日后，脓 结痂而疮愈矣。盖贯脓脓 色黄充满，与初出色白，淡淡如脓者，名同实
不同也。
二日如粟根圆混，顶满光明碍指佳；
二日红点如粟如黍，如绿豆，如真珠，如
水晶，顶满色光，根脚圆晕，混合不散，以手摸之，觉得碍指者顺。如根窠虽圆而顶陷者，气弱不能领血也，
保元汤加芎、桂助阳，但川芎暂用以为参、 之使，有汗者忌之。若顶陷色枯，或鲜红莲肉亦红，又无根脚者，
必死。
出速且多毒太盛，
出速且密，胸背尤多，身热者，恐毒盛不能收成，必变青干紫陷，宜消毒饮、鼠粘汤、解毒防风汤以防之。
出盛面黄便黑，烦躁腹胀，或见血者，犀角地黄汤。出盛内外热壅血聚，以致能食腹胀，便秘烦渴，喘急狂谵
者，毒瓦斯与心贯注，无阴以敛也，宜猪尾膏；毒盛壅遏，出不快者，亦宜。若出不快，而更被外邪入里，遂
至胃烂便血而死。
出迟内虚必挟邪。
红点数日不出而复陷者逆，惟出迟隐隐在皮肤，似出不出，其证不一，若概用发散，阳气外出，令疮色白，
纵出亦有忽然而毙者矣。有荣卫虚不能出者，必面青，肌软恶寒，宜小活血散、八物汤；中气下陷而不起发者，
保元汤、补中益气汤、人齿散。有脾胃冷，因服凉药损伤，以致吐利者，须益气温中，中温则气不消削，而自
充发于肌肤矣，宜益黄散，理中汤、丸，木香散；甚者，古姜附汤，或大断下丸去姜、附、榴、蛎，加砂仁、
木香。痘出面复不出，或泄或秘，烦渴者，乃痘出误服凉药，逼毒在肺中，痘带白脓者轻，紫黑者重，鼻有黑
气者死。外盛里虚，毒瓦斯发越不透，半成血 ，半是红点，不能乳食，大便如常，小便清白，宜半温里半助表，
四圣散、紫草饮、解毒防风汤、万金散、紫草木香汤、蟾肝丸，或丝瓜连皮烧灰，沸汤调服，或葡萄研酒饮之，
选用。
有气实痰郁滞发不出者，二陈汤、疏气饮。啼吐不已，神不安舍，不能主行荣卫而发不出者，匀气散、
小活血散、大温惊丸。外感羁绊胃气，而出不快者，便清自调，知其在表，方可量体微微发散。因天寒不能出
者，熟料五积散、正气散，或参苏饮、紫草膏。四肢出不快者，防风、芍药、甘草等分，水煎服。痘疮不出，
伤寒不语者，单烧人屎为末，蜜调服。瘟毒既发，痘疮不发者，黑膏。因炎暑烦渴，昏冒，不能发出者，辰砂
五苓散，用生地、麦门冬煎汤下；身热甚者，小柴胡汤加生地；烦渴，便实者，白虎加参汤；轻者，竹叶石
膏汤加生地。外感邪入里不散，大小便秘，气滞壅遏而出不快者，紫草木通汤；痘发出者，紫草饮。如痘出干
黑，身不大热，大小便秘者，毒滞于内也，宜宣风散，用大黄煎汤下；若表大热者，不可妄下。或已出稠密，
喘渴者，当归丸、黑膏；轻者，消毒饮加大黄、山栀。
已出复被风寒拒，青紫如痣遍身遮；
痘出被风复入者，加味四圣散，或快斑散去木通，加穿山甲；或痘已出，外被风寒与内热相拒，不能发
出，以致发热狂搐，遍身或青、或紫，如痣 ，如瘾疹，俗云鬼捻青，年壮皮浓者多有之，宜却寒温肌透里之
剂。危甚者，用经霜紫背荷叶（旧者亦好），入僵蚕等分为末，胡荽煎酒调服；或丝瓜连皮烧灰为末，沸汤调
服，发痘最妙。见风寒表证者，惺惺散、古牛蚕散；见热毒证多者，透肌散。
出不匀遍色不润，
痘已出未能匀遍，色不红润者，乃毒盛以致气血壅塞故也，宜紫草饮。外用芥子为末，白汤调如膏，涂
儿脚心，干即再涂，其毒渐渐复出，痘疮根据前红活。
但要照原不减些。
凡痘出不快，而先出之痘，形色照原者，乃毒未发也；如形色渐退者，乃内虚，毒入必死。若痘出喜笑
如常，饮食进，精神爽，无诸杂证，则痘本火也，不可再发。
壮年皮浓多劳役，
Seven days prior, Yang Toxin (Yang Du) appeared. This refers to various sores such as Huangshui Chuang (Yellow Water Blister), Xuefeng Chuang (Blood Wind Sore), Mianhua Chuang (Cotton Sore), and Meiyang Chuang (Syphilitic Sore). Where the smallpox lesions have not yet fully healed or where scabs have just formed, the flesh and pores are necessarily deficient. The toxin tends toward these deficient areas to emerge. When Yang sores and Yin toxins mix together, they may overpower other toxins and derive their name from this interaction. For sores that are moist, it indicates that both Qi and Blood are abundant, allowing the toxins to easily form pus. Jiedu Tang (Detoxification Decoction) should be used as the primary treatment. For sores that are dry, withered, and dark red, it indicates that both Qi and Blood are weak, causing the toxin to repel other sores, resulting in a failure to form pus. Baoyuan Tang (Preserve Origin Decoction) added with Chuanxiong Rhizome (Chuanxiong), Cinnamon Twig (Guizhi), and glutinous rice should be used. Additionally, washing with Shuiyang Tang (Water Willow Decoction) will transform dryness into moisture and white into red, allowing pus to naturally overflow. Shuiyang Tang: Take five jin of willow branches or leaves (branches in spring/winter, leaves in autumn/summer), wash clean, crush, and decoct in a large pot of running water for six or seven boils. Strain the dregs. Pour one-third of the liquid into a basin. One should first take oral herbal medicine, then bathe while the water is hot. After some time, use an oil-paper wick lamp to illuminate the area. If nodules appear densely with a rising trend, and concave areas show circular red halos, this indicates the shadow of forming pus. The pus must be full; if not, repeat the bathing method. For weak patients, only bathe the head, face, hands, and feet, avoiding the back. If illumination shows no rising trend, it signifies the collapse of Qi and Blood and the drying up of body fluids. Generally, the failure of smallpox to form pus is due to stagnant Qi and blood, tight pores, and slow-acting medication that cannot quickly reach the head, face, hands, and feet. Only after taking internal medicine can this external wash help lift and open all orifices. The bathing method requires adding hot water and long-duration bathing to allow slow penetration into the muscles, unblocking the interior and exterior, so that toxic vapors dissipate with the warm qi. This is effective for cases of initial swelling, pus filling, depressed lesion tops, stagnant pus, or lesions suppressed by wind-cold for a long time.
Bad signs include a low head and soft, brittle limbs. Initial exterior signs with cold feet are harmless. However, cold feet combined with a low head and weak limbs throughout are strictly contraindicated. Death occurs if the head is warm but feet are cold after eruption.
Blue-purple swollen face with nasal discharge: Smallpox is governed by Heart Blood. A red face is auspicious; a blue face indicates wind generation, deficiency, diarrhea, and cold extremities. If hot herbs were mistakenly taken during the reporting stage, causing incomplete eruption, leading to swelling of the body, head, face, and eyes, with wind-induced spasms and rigidity, Renshen Qianghuo San (Ginseng and Notopterygium Powder) should be used for rescue. If during the swelling phase, the forehead swells like a melon, or the face or neck swells while the sores do not, death ensues. Use methods to reduce swelling and tonify Middle Qi. If the sore color matches the skin's swelling and the root is red, there is no harm. Unilateral facial swelling with favorable characteristics is auspicious. Dry nose with black gas, or picking at the nostrils, indicates death.
Exposed eyes, scorched ears, purple lips, and collapse: Eyes closed but exposing the pupils without spirit, resembling fish or cat eyes, indicate death. Eyes unsealed with flashing light also indicate death. Scorched yellow ears, purple dry/cracked lips, or collapsing rotten lips, occurring when marks appear and wind-cold is re-contracted, causing heat-toxin to attack internally, is untreatable.
Mouth rot, curled tongue, and grinding teeth: Foul-smelling mouth rot, white or black coating on the tongue, curled tongue, retracted scrotum, body tremors, and unceasing abdominal pain with purple-black sores indicate internal ulceration and stomach rot. Caused by wind-cold contracting seven days prior, tightening pores and blocking toxins, which then attack the organs internally. Administer Qingwei Xiaodu Huotan (Clear Stomach, Detoxify, Resolve Phlegm) and formulas to resolve wind-cold according to condition. Grinding teeth with thirst and fever indicates Heart/Stomach heat; Ganlu Yin (Sweet Dew Decoction) is suitable. Chills with grinding teeth indicate Kidney toxin attacking upward; Neituo Shixuan San (Internal Support Ten Acupoints Powder) with Fangfeng and Baizhi removed, and Fuling added, is suitable.
Hoarse voice, difficulty eating/drinking, throat obstruction: Voice originates from Lung and Heart. Hoarseness can result from wind-cold, dietary toxin stagnation, or excessive crying causing Qi blockage. Regardless of eruption status, hoarseness with warm body temperature calls for Jiedu Fangfeng Tang (Detoxification and Saposhnikovia Decoction). Constipation calls for Ganjie Tang (Licorice and Platycodon Decoction) added with Danggui, Huanglian, and Dahuang. Cool body temperature calls for Neituo Shixuan San with doubled Jiegeng. Hoarseness with full pus indicates Lung Qi exhaustion and is untreatable. Hoarseness with poor eruption indicates death. Hiccups due to Stomach cold and rising cold Qi call for Yanwu Yu (Salt-fried Evodia) 1 qian and Dingxiang (Clove) 0.5 qian, decocted in water. Toxic throat causing saw-like pain, inability to swallow, vomiting, or dry heaving is critical; however, if seen during pus formation with blocked bowels/bladder, it is auspicious.
Waist pain like biting and retracted scrotum indicate death: Waist pain like biting, inability to stand, high chest, and cold feet indicate Kidney exhaustion. Mild pain indicates wind-cold injury; Baidu San (Eliminate Poison Powder) resolves it, with external massage using Sesame Oil. Retracted scrotum indicates Liver exhaustion and is untreatable.
Warm body indicates excess, cool body indicates deficiency; warming, tonifying, and detoxifying methods are exhausted. Regardless of initial, mixed, changed, or bad signs, a warm body is favorable, and a cool body is unfavorable. Like planting beans, warmth aids growth. Humans rarely experience extreme heat or cold; warmth indicates harmonious Qi and Blood. Heat patterns with warm bodies require detoxification; deficiency patterns with cool bodies require warming and tonification. Deficiency with heat requires warming/tonifying with detoxification; heat with deficiency requires detoxification with warming/tonification. Detoxification: At eruption, Xiaodu Yin (Detoxification Decoction) or Liaoqiao San (Forsythia Powder). Detoxification with slight warming: Jiedu Fangfeng Tang or Niubangzi Tang (Arctium Decoction). Warming: Blood deficiency uses Siwu Tang (Four Substances Decoction) or Gu Xionggui Tang (Ancient Cyperi and Angelica Decoction); Qi deficiency uses Sijunzi Tang (Four Gentlemen Decoction) or Baoyuan Tang (Preserve Origin Decoction) as main formulas. Diarrhea adds Baizhu and Fuling; thirst adds Maidong and Wuweizi; deficiency heat adds Huanglian; damp-phlegm adds Chenpi; Qi stagnation adds Shanzha; detoxification adds Niubangzi; reduces abscesses adds Jingjiesui; supports Stomach Qi adds aged glutinous rice; assists Yang and releases exterior adds Shengjiang; purple color/blood heat adds Liaoqiao. Liaoqiao, Niubangzi, Shanzha, and Gancao must be used throughout; Guigui, Chuanxiong, Zicao, and Shaoyao should be used cautiously after day five or seven. Combined Qi and Blood deficiency uses Neituo Shixuan San, Tuoli San, or Baoyuan Tang added with Danggui and Shaoyao to invigorate blood, or He Yunqi San to harmonize Qi. Warming with slight detoxification: Bawu Tang added with Jiuhuang Qin/Lian or Baoyuan Tang (1 qian each), plus Niubangzi, Huangqin, Huanglian, Xuanshen, Sigua Hui, Liaoqiao, and Baishao (0.5 fen each), decocted with Jiang and Cong. After day seven, severe/deep toxin with Qi deficiency uses Baoyuan Tang plus Dahuang; Blood deficiency uses Gu Xionggai Tang plus Dahuang and Mangxiao to purge. Cold-deficiency changes use Muxiang San, Yigong San, Gu Jiangfu Tang, or Sini Tang as critical rescue agents. Cold-deficiency deaths are delayed by ten days; heat-toxin deaths are rapid. This summarizes from initial heat to scabbing.
Initial heat resembles Taiyang Disease, differing in red cheeks and cold middle finger: Initial fever and aversion to cold resemble Taiyang exterior syndrome of Cold Damage. However, in Cold Damage, men have yellow faces and women have red faces, whereas in measles/smallpox, cheeks are red. In Cold Damage, the middle finger is warm; in convulsions, men's left and women's right fingers are cold, whereas in measles/smallpox, the middle finger, ears, nose tip, sacrum, and feet are all cold. Observe behind the ears: red veins indicate true smallpox; absence indicates non-smallpox. Red veins heal easily; purple is difficult; black indicates death.
True Taiyang disease needs no treatment; changes from contraction/injury require regulated medication: Initial heat showing Taiyang exterior signs is the standard presentation for smallpox, requiring no medication. Only with internal injury, external contraction, blood stasis, fright, or Four Viscera signs, mild heat uses Yunqi San to allow natural eruption; heavy heat uses Qingji Jiedu (Clear Muscle and Detoxify), severe cases use Shenxie (Percolating and Draining). Mistaken purging injures Spleen; mistaken warming damages eyes—be cautious. Exterior constraint with heavy heat hinders eruption/pus formation; use Biaotuo (Exterior Support) to aid emergence. Heart signs: Xingxing San, Xiaodu Yin. Liver signs: Renshen Qianghuo San. Spleen signs: Deficient uses Xingxing San or Baoyuan Tang added with Digupi, Huangqin, Jingjie; Heat uses Shengma Gegen Tang or Rusheng Tang. Lung signs: Renshen Su Yin added with Congbai, Shanzhagen. General: Anhidrosis uses Qianghuo Chonghe Tang; Hyperhidrosis uses Fangfeng Chonghe Tang. Pathogen transmitting to Half-Exterior/Half-Interior presents with chest tightness, vomiting, irritability, insomnia: Xiao Chaihu Tang added with Shengdi; Deficient uses Ershen Tang. Pathogen entering Interior with constipation/hematuria: Liangge San or Fangfeng Tongsheng San to purge. Those afraid of purging use Midao Fa (Honey Suppository). Mild cases: Sisheng San combined with Baidu San, or Chen sha Liuyi San, or Jiedu Tang for mild percolation. Do not completely remove heat, lest eruption fail. Internal injury from cold/raw food with vomiting/diarrhea: Cold month uses Lizhong Tang, Weiling San, Buhuanjin Zhengqi San; Hot month uses Liuhe Tang, Erchen Tang, Weiling Tang. Dietary injury adds Shanzha and Maiya for digestion. Fright adds Jiajian Hongmian San. Blood stasis with bleeding: Xijiao Dihuang Tang combined with Xiao Chaihu Tang. Discussing smallpox, the Four Viscera are always involved: Heat rushing Heart causes palpitations/frenzy; use Zhusha, Renshen, Fuling. Heat steaming Liver causes yawning/restlessness/spasms; use Fangfeng, Qianghuo, Tianma, Quanxie, Nanxing. Heat steaming Spleen causes alternating chills/fever, cold limbs/sleepiness, eye swelling/abdominal distension/constipation/thirst; use Zhike, Chenpi, Shenqu, Shanzhi, Dihuang. Heat steaming Lung causes red face/sneezing, panting/thirst/cough, dry nose; use Sangbaipi, Banxia, Madouling. Kidney has no signs, hence sacrum/ears should be cold. If initially like malaria then thirst with dark sores, it is a Kidney sign and untreatable. Spleen and Lung are primary because Lung governs skin/hair and Spleen governs muscles.
Initial heat is the root, sores are the branch; few roots many branches mean short life: Before eruption, great heat is needed to trigger it; after eruption, mild heat is needed for maturation. Eruption gradually over 3-4 days with many roots/few branches is viable; sudden bright red eruption over 1-2 days with few roots/many branches leads to death by day seven. No fever with few good sores and no mixed signs is mild.
To prevent eye complications, clear medications are suitable: Excessive eruption risks eye involvement; use Xiaodu Yin, or add Jiuhuang Qin/Lian, Sangbaipi, Cao Longdan, or Gouteng to Blood/Qi formulas to clear Liver/Lung. If sores fall into eyes, let nature take its course; deep treatment damages eyes.
Eye protection with Zhusha is simple: Eye protection ointment: Huangbai 1 liang, Honghua 2 liang, Lvdou Fen 1.5 liang, Gancao 4 liang, powdered. During active eruption, mix with clear oil and apply around eyes to reduce facial sores. Or use Zhusha powder mixed with water around orbits, or dry rouge powder mixed with honey around orbits to prevent sores entering eyes. Ancient formula: Fine Zhusha powder mixed with honey, 0.5 qian three times daily, adjusted by age, taken with warm water. Usable before/after eruption; dense becomes sparse, sparse disappears, black/depressed rise, abscesses resolve; treats high fever/thirst/mild wheezing. Nature is slightly cold; do not overdose.
Reporting stage (Day 3), toxin centers, avoid sweating/purging, harmony is best: Reporting stage places toxin in Half-Exterior/Half-Interior. Cold herbs injure Stomend and stagnate toxin; hot herbs fuel fire. Avoid sweating because sores are on skin and do not require sweat; avoid purging because sores are in muscle and emptying intestines is illogical. Even with residual pathogen, simply add Chenpi/Shengjiang to appropriate formulas to harmonize.
Incomplete heat implies remaining pathogen; half-clear exterior, half-warm nourishment: Complete heat with eruption is safe. Incomplete heat implies unresolved pathogen; internal heat-toxin steaming risks later abscesses. Use half-clear exterior/half-warm interior formulas: Sisheng San, Jiedu Fangfeng Tang, Zicao Muxiang Tang. Dry reporting stage with unceasing abdominal/waist pain indicates death.
Day 1: Mother sores appear, pale red with clear structure: Sores appearing first are "Mother," subsequent are "Descendants." Good mothers yield many descendants; inferior ones are harmless. Pale red spots appearing around mouth/nose/cheeks/nose bridge, absent in eyes, varying sizes/shapes, erupting in 3-4 waves (single/double), with clear structure and moist color, are favorable.
Dense/dry-red requires gradual tonification: Clusters of 3-5, circular halos, dry/red with little moisture. Do not rush tonics. Wait for Qi/Blood integration, then use Baoyuan Tang with Guigui to assist Yang and promote redness/moisture. Beware of withered/black reaching Tianting. Appearance at Tianting, Fangguang, Yintang, ears (Taiyang/Taiyin), throat/chest, or feet before head, or dense chest/waist like silkworm eggs, requires urgent Xiaodu Tang with Shanzha, Huangqin, Zicao. Deficiency adds Renshen; or Shengma Gegen Tang with Liaoqiao; or Baidu San, Xijiao Dihuang Tang to clear interior/resolve muscle. Initial waist pain, dense/dry/black sores indicate death. Question: Why does black return to Kidney if Yang positions are unsuitable? All Yang gather at the top; all toxins gather at the top. Dense/withered/black at the top clearly shows toxin overcoming Qi/Blood. Examining smallpox toxin, emerging from Four Viscera without lingering in Kidney is auspicious. Fever at Shen/You/Xu hours belongs to Lung, producing white/large pus blisters like mucus; Si/Wu/Wei hours belong to Heart, producing red/small blood blisters with macules; Hai/Zi/Chou hours belong to Spleen, producing yellow/light red papules; Yin/Mao/Chen hours belong to Liver, producing green/small vesicles like tears. These are initial states, different from the above. By Day 3 reporting, all become blood blisters; 3 days after swelling, blood blisters become pus blisters; 3 days after pus filling, scabs form and healing occurs. Pus-filled blisters are yellow/full, distinct from initial white/dilute pus despite similar names.
Day 2: Like millet roots, round and mixed, full top and bright light, obstructing finger is good: Day 2 red spots like millet/millet seeds/mung beans/pearls/crystal, full top, bright color, round roots, mixed but不散, feeling obstructing to touch is favorable. Round roots but depressed top indicates weak Qi failing to lead Blood; Baoyuan Tang with Chuanxiong/Guizhi assists Yang. Chuanxiong is temporarily used as an assistant to Renshen/Qi; contraindicated with sweating. Depressed top with dry color, or fresh red flesh/red without roots, indicates death.
Fast/profuse eruption means toxin too strong: Fast/dense eruption, especially on chest/back, with fever, risks toxin overwhelming capacity to mature, turning cyanotic/dry/purple/depressed. Prevent with Xiaodu Yin, Niubang Tang, Jiedu Fangfeng Tang. Profuse eruption with yellow face/black stool, irritability/abdominal distension/bleeding uses Xijiao Dihuang Tang. Profuse eruption with internal/external heat congestion/blood accumulation, leading to hunger/distension/constipation/thirst/panting/frenzy, indicates toxin connecting with Heart without Yin to restrain; use Zhuwei Gao. Toxic stagnation hindering eruption also benefits from it. Slow eruption with external pathogen entering interior leads to stomach rot/bloody stool death.
Slow eruption indicates internal deficiency with pathogen: Red spots failing to erupt for days then sinking is unfavorable. Slow eruption hidden in skin, seemingly erupting/not, varies in signs. General dispersal expels Yang Qi, whitening sores, potentially causing sudden death. Wei/Blood deficiency failing to erupt presents with blue face, soft muscle, aversion to cold; use Xiaohuoxue San, Bawu Tang. Middle Qi sinking failing to rise uses Baoyuan Tang, Buzhong Yiqi Tang, Renci San. Cold Spleen/Stomach injured by cold meds causing vomiting/diarrhea requires Yi Qi Wen Zhong (Benefit Qi Warm Middle); warmth prevents Qi consumption, allowing natural eruption. Use Yihuang San, Lizhong Tang/Pills, Muxiang San. Severe cases use Gu Jiangfu Tang or Daduanxia Wan removing Jiang/Fu/Liu/Li, adding Sharen/Muxiang. Sores appearing then disappearing, or diarrhea/constipation, thirst, due to cold meds forcing toxin into Lung: White pus sores are mild; purple/black are severe; black nose gas is fatal. Exterior excess/Interior deficiency, toxin unable to vent, half blood blisters/half red spots, inability to nurse, normal stool, clear urine: Use half-warm interior/half-assist exterior: Sisheng San, Zicao Yin, Jiedu Fangfeng Tang, Wanjing San, Zicao Muxiang Tang, Chan Gan Wan, or Sigua ash with boiling water, or grape wine. Select appropriately. Qi excess/Phlegm stagnation hindering eruption uses Erchen Tang, Shuqi Yin. Crying/vomiting, unsettled spirit, failing to govern Wei/Ying uses Yunqi San, Xiaohuoxue San, Dawenjing Wan. Exterior constraint binding Stomach Qi slowing eruption: If stool/urine normal, knowing exterior location, use mild dispersal. Cold weather hindering eruption uses Shuliao Wuji San, Zhengqi San, Renshen Su Yin, Zicao Gao. Limbs slow eruption uses Fangfeng, Shaoyao, Gancao equal parts, decocted. Smallpox not erupting, Cold Damage mutism uses burnt human feces powder mixed with honey. Plague toxin erupted, smallpox not erupting uses Hei Gao. Summer heat/thirst/coma hindering eruption uses Chen sha Wuling San with Shengdi/Maidong decoction; severe fever uses Xiao Chaihu Tang + Shengdi; thirst/constipation uses Baihu Jiaren Tang; mild uses Zhuye Shigao Tang + Shengdi. Exterior pathogen entering interior, constipation, Qi stagnation hindering eruption uses Zicao Mutong Tang; erupted uses Zicao Yin. Dry/black sores, mild fever, constipation indicates internal toxin stagnation; use Xuanfeng San with Dahuang decoction. Surface heavy heat contraindicates purging. Dense erupted sores with panting/thirst uses Danggui Wan, Hei Gao; mild uses Xiaodu Yin + Dahuang/Shanzhi.
Erupted then rejected by wind-cold, cyanotic/purple like moles covering body: Sores erupted then wind-driven back in use Jiawei Sisheng San, or Kuaiban San removing Mutong, adding Chuanshanjia. Or erupted sores rejected by exterior wind-cold and interior heat, failing to erupt, causing fever/spasms, cyanotic/purple like moles/rash (Ghost Pinch Cyan), common in robust thick-skinned youth. Use Hanque Wenji Touli (Expel Cold Warm Muscle Penetrate Interior) formulas. Critical cases use Frost-ridden Purple Back Lotus Leaf (old is fine) + Jiangcan equal parts powder, mixed with Huisu wine. Or Sigua ash with boiling water, best for eruption. Wind-cold exterior signs use Xingxing San, Gu Niucan San. Heat-toxin signs use Touji San.
Uneven eruption, dull color: Uneven eruption, lack of redness, indicates toxin strength causing Qi/Blood congestion. Use Zicao Yin. External application: Mustard seed powder mixed with hot water into paste, applied to soles, reapplying when dry, gradually releasing toxin, restoring redness/vitality.
But ensure original shape is not reduced: Slow eruption with original appearance/color in early sores indicates toxin not yet emitted; fading appearance/color indicates interior deficiency and toxin invasion leading to death. Smiling/eating normally, energetic, no mixed signs indicates smallpox is Fire-based and should not be re-stimulated.
Robust adults with thick skin and labor,