〔丹〕炉灰白色，静者怯者作寒看，躁者勇者 发者作热看。凡痘疹白色将靥如豆壳者，盖因初起时饮水
多，其靥不齐，俗呼倒靥，不妨但服实表之剂。如毒瓦斯郁里，消息他大小便，如大便闭，通大便，小
便闭，通小便，无妨。
吴店小儿周岁，痘疮色白甚痒，药中每加参、 半两。
白术（五分） 丁香（两个） 当归（一钱） 官桂（三分） 黄 （一两） 水煎服。
予族侄女，笄年出痘，灰白色，身热喘嗽，渴，脉洪有力，与八物汤加连翘、桔梗、犀角屑、半夏、
木通、紫草、干葛、石膏、杏、枳、连、芩、前胡、栝蒌仁服之，十帖后，色红活，喘嗽缓减渐微，但热未除。
遂于前方减 、杏、胡、枳、连、芩、蒌七味，服三十余帖而安。安后发皆落，月余方起床，虚之盛也。
又一男子二十余岁，出痘已破，未破者灰白色，又杂间以黑陷倒靥者，发热寒战，身痛，脉洪，或时弦，
亦与八物加木通、红花、紫草、陈皮、连翘，服十余帖而安。
〔阎〕紫草散 治疮痘黑陷，曾服此方愈。亢、钱皆云∶有枳壳难服。
紫草 甘草 糯米（亢云∶此味极好，助胃气）黄 （各等分）水煎服。
〔丹〕痘疮黑陷二种，因气虚而毒瓦斯不能尽出者，用黄 、人参、酒炒紫草治之。颜色正者，如上治法。
（参、 之补，佐以紫草之通利也。）
如将出成就之际，却色淡不正者，属血虚。宜用补血药，当归、川芎、白芍酒洗之类，或加红花。
如将成就之际，却色紫不正者，属热。宜用凉药解毒，升麻、芩、连、桔梗、连翘之类，甚者用犀角屑。
（如用后项诸药，色仍不正者，宜兼用二法治之。）
〔世〕回生散 治疮疹倒靥黑陷。
用人牙烧灰存性，入麝香少许研细，每服半钱，用黄 、白芍药煎汤调下，立效。钱氏方中，用温酒
调下。云岐方中，用升麻、紫草煎汤调下。（海藏云∶若平昔油腻肠垢者，通膈丸下之，朱砂为衣，
与宣风散相表里。彭氏云∶只用紫草汤自好，钱氏方用麝香及酒，盖疮痘最怕麝香与酒气，触禁不可用。）
〔汤〕治痘疮黑陷，药不能发者，有验。用穿山甲一味烧存性，为细末，入麝香当门子少许，一岁五分，
三岁一钱，温酒调下，一服取效。虽半身黑陷欲绝者，亦能暂苏而发红色，但有目闭无魂者，不复生矣。
（此方虽验，回生散又佳。今详麝香，恐不宜服。）
〔《衍》〕麻黄汤
用麻黄剪去根节五钱，用蜜一匙，同炒良久，以水半升煎，候沸。去上沫，再煎去三分之一，不用渣。病
疮倒靥黑者，乘热尽服之，避风，俟其疮复出。一法，用无灰酒煎更速。但小儿不能饮酒者难服，以此药
入表也。（世传此法累用有效。）
〔《活》〕疮黑倒陷，猪尾汤、无比散、龙脑膏子，无不验。（海藏云∶若用草药下之，似胜脑麝，必
不得已而后用之可也。）
〔《活》〕猪尾膏 治疮倒靥。
用小猪尾尖刺血两点，入生脑子少许，同研，新汲水调下，食后，立效。
龙脑膏子 治时疫发痘疮，及出疮子未透，心烦狂躁，气喘妄语，或见鬼神，或已发而陷伏，皆
宜速治。不治，其毒入脏决死。
用生龙脑一钱，研细，滴猪心血和丸如豆子大，每服一丸。心烦狂躁者，用紫草汤化下。若疮子陷伏者，
用温酒化下。少时心神便定得睡，疮疹发透，根据常将息取安。（海藏云∶此一法证极而用，故《活人》
云不得已也。）
〔海〕四粪散 治 疮倒靥黑陷。（出《御院药方》）
歌曰∶人猫猪犬腊辰烧，每服三钱蜜水调，选甚倒靥并黑陷，万两黄金也合消。（腊月辰日合此药，
甚验。）
〔子和〕人中黄，腊月者最佳，通风处以火 成煤，水调下三五钱，陷者自出。丹溪云∶子和黑陷甚
者用烧人屎，即此方也。
〔世〕治疹痘不透，干黑危困。用山楂肉一味，为末，每服二钱，紫草酒送下，量儿大小加减，徐徐进三
四服即红活。
〔海〕刘守真凉膈散治小儿 疹黑陷亦妙。然止能治大便结硬，小便赤涩为当。若大便小便已通，
不宜用此。惟以易老去大黄、硝者，最为稳当。
〔钱〕凡痘疹重者，犹十活四五。黑者无问何如，十难救一。其候或寒战切牙，或身黄肿紫，宜急以百祥
丸下之。复恶寒不已，身冷出汗，耳尻反热者死。何以然？肾气大旺，脾虚不能治故也。下后身热气温，
欲饮水者，可治。以脾气生，胜肾，寒去而温热也。治之宜解毒，不可妄下，妄下则内虚，多归于肾。
若能食而痂头焦起，或未焦而喘实者，可下之，宜四顺饮。疮赤陷而耳尻反热者为逆，用百祥丸、牛李膏
各三服，不愈者，死。
百祥丸一名南阳丸。治疮疹黑陷，寒战切牙戛齿，身黄肿紫。
红牙大戟（不以多少，阴干，浆水煮软去骨，日中曝干，复纳汁煮汁尽，焙干为末）
上水丸如黍米大。每服一二十丸，研芝麻汤下，吐利同，无时。此方治戛齿甚妙。
牛李膏
用牛李子不以多少，取汁，石器内熬成膏。牛李子生野道边，至秋结实，黑子成穗。如无生者，
以干者为末，水熬代用，每服皂子大，煎杏胶汤化下，此药须于九月中取之。
睦亲宅一大王病疮疹，始用一李医，又召钱氏，钱留与抱龙丸三服。李以药下之，其疹稠密。钱氏
见，大惊曰∶若非转下，则为逆病。王曰∶李已用药下之。钱曰∶疮疹始出，未有他症，不可下也。但当用平
和药，频与乳食，不受风冷可也。疮痂若起能食者，大黄丸泻一二行即止。令先下之，疮疹未能出尽
而稠密，甚则难治，此误也。纵得安，其病有三，一者疥，二者痈，三者目赤。李氏不能治，经三日黑
陷后，复召钱。曰∶幸不发寒，病未困也。遂用百祥丸为主，牛李膏为助，各二大服。至五日间，疮复红活，
七日而愈。盖黑者，归肾水也。肾旺胜脾，土不克水，故脾虚寒战则难治。所用百祥丸者，以泻膀胱之腑。
腑若不实，脏自不盛也。何以不泻肾？由肾主虚，不受泻，如二服不效，即加寒而死矣。
〔子和〕治疮疹黑陷。铁脚威灵仙为末，炒一钱，脑子一分，用温水调服，取下疮痂，为效。
〔《活》〕无比散 治小儿疮疹恶候。
朱砂（先研，一两） 牛黄 麝香 樟脑 腻粉（细研。各一钱）
上同研细，如有患者，小儿一字，大人五分，入水银少许，用小猪尾上血三两点，新水同调服。
宁稳得睡者，然后取转下如烂鱼肠葡萄穗之类涎臭恶物便安。小儿用乳汁调，妙。（海藏云∶此泻内热之极，
不能开发于外，则宜此，内虽过泄，外亦开发，即透肌肤之药，与至宝丹同。）
〔云〕小儿 疹黑陷方。
干胭脂（三钱） 胡桃（一个，烧存性）
上为细末，煎胡荽酒调下药一钱，立效。
上治死血黑陷，凡前方用穿山甲及麝香等药治黑陷，皆为气滞者设也。
〔云〕治 疹黑陷。用腊月秃枭脑子一个或二个，以好酒调服。若干者，以好酒浸少时化开，根据上条服
立效。（秃枭，百劳鸟也。）
〔无〕箬叶散 治倒靥。
用箬叶一味，烧灰为末，麝香酒下。
〔钱〕疮黑而忽泻，便脓血并痂皮者顺，水谷不消者逆。何以然？且疮黑属肾，脾气本强，或旧服补脾药，
脾气得实，肾虽用事，脾可制之，令疮入腹为脓血，及连痂皮得出，是脾强肾退，即病出而安也。泻米
谷及泻乳不化者，是脾虚不能制肾，故自泄也，此必难治。（海藏云∶泻出痂皮，根在内也，表里俱病，
是为火郁，水谷化者顺，水谷不化者逆。）
未绽一齐黑者为陷，已绽而不齐黑者为将靥。
[Background Information]
Book: Medical Outline (Yixue Gangmu)
Author: Lou Ying
Dynasty: Ming
Chapter: Grey and White Pox / Black Sunken and Inverted Pox
Category: Medical Theory
[Dan] Pox with a grey-white color resembling furnace ash: those with a quiet constitution and weakness are viewed as cold syndromes; those with an agitated constitution and robustness are viewed as heat syndromes. Whenever pox/rash lesions are white in color and resemble bean shells as they are about to scab over, this is because the patient drank too much water at the beginning, resulting in uneven scabbing. This is commonly called "inverted scab" (Dao Ye). It does not hinder treatment; one may simply administer formulas that consolidate the exterior and strengthen Wei Qi. If toxic factors are stagnant inside, observe their large and small bowel movements: if stool is obstructed, unblock the bowels; if urine is obstructed, promote urination. This poses no hindrance.
A one-year-old child in Wudian had pox lesions that were very white and extremely itchy. The prescription added Ren Shen (Ginseng Root) half liang per dose.
Formula: Bai Zhu (Atractylodes Rhizome) 5 fen, Ding Xiang (Clove) 2 pieces, Dang Gui (Angelica Sinensis Root) 1 qian, Guan Gui (Cinnamon Twig) 3 fen, Huang Qi (Astragalus Root) 1 liang. Decoct in water and take orally.
My clan's niece, after coming of age (Ji Nian), developed pox with a grey-white color. She had fever, asthma/cough, thirst, and a surging and forceful pulse. I administered Ba Wu Tang (Eight-Ingredient Decoction, a formula for tonifying Qi and Blood) plus Lian Qiao (Forsythia Fruit), Jie Geng (Platycodon Root), Xi Jiao Xie (Rhinoceros Horn Shavings - note: substitute with Buffalo Horn in modern practice), Ban Xia (Pinellia Tuber), Mu Tong (Akebia Stem), Zi Cao (Arnebia Root), Gan Ge (Pueraria Root), Shi Gao (Gypsum), Xing Ren (Apricot Seed), Zhi Shi (Immature Bitter Orange), Lian Qiao (Forsythia Fruit), Huang Qin (Scutellaria Root), Qian Hu (Peucedanum Root), and Gua Lou Ren (Trichosanthes Seed). After ten doses, the color became red and vibrant, asthma and cough gradually eased, but the heat was not yet eliminated. Subsequently, I removed seven herbs from the previous formula: Huang Qi, Xing Ren, Qian Hu, Zhi Shi, Lian Qiao, Huang Qin, and Gua Lou Ren. After taking more than thirty doses, she recovered. After recovery, all scabs fell off, and it took over a month before she could get out of bed, indicating extreme deficiency of Zheng Qi (Upright Qi).
Another man in his twenties had pox that had already broken. The unbroken parts were grey-white, interspersed with black sunken and inverted lesions. He had fever, chills, body pain, a surging pulse, or occasionally a wiry pulse. I also administered Ba Wu Tang plus Mu Tong, Hong Hua (Safflower), Zi Cao, Chen Pi (Tangerine Peel), and Lian Qiao. After more than ten doses, he recovered.
[Yan] Zi Cao San (Arnebia Powder) treats black sunken pox/rash. Someone was cured by this formula. Kang and Qian both stated: Zhi Ke (Bitter Orange) is difficult to administer.
Formula: Zi Cao (Arnebia Root), Gan Cao (Licorice Root), Nu Mi (Glutinous Rice) [Kang said: This ingredient is excellent, it assists Stomach Qi], Huang Qi (Astragalus Root) [equal parts]. Decoct in water and take orally.
[Dan] There are two types of black sunken pox. When caused by Qi deficiency preventing toxins from fully emerging, treat with Huang Qi, Ren Shen, and Zi Cao fried in wine. For normal colors, use the above treatment method. (The tonifying effect of Ren Shen and Huang Qi is assisted by the draining/unblocking effect of Zi Cao.)
If at the stage when pox is about to emerge and form, the color is pale and abnormal, it belongs to Blood deficiency. Use blood-tonifying medicines such as Dang Gui, Chuan Xiong (Ligusticum Rhizome), Bai Shao (White Peony Root washed in wine), or add Hong Hua.
If at the stage when pox is about to mature, the color is purple and abnormal, it belongs to Heat. Use cooling medicines to resolve toxicity, such as Sheng Ma (Cimicifuga Rhizome), Huang Qin, Lian Qiao (Forsythia Fruit), Jie Geng, and Lian Qiao. For severe cases, use Xi Jiao Xie. (If using the aforementioned medicines and the color remains abnormal, it is appropriate to combine both treatment methods.)
[Shi] Hui Sheng San (Revive Life Powder) treats inverted scabs and black sunken pox/rash.
Burn human teeth until carbonized but retaining their nature (Cun Xing), add a small amount of She Xiang (Musk), grind finely. Take half qian each time, mixed with decoction of Huang Qi and Bai Shao. Immediate effect. In Qian's formula, mix with warm wine. In Yunqi's formula, mix with decoction of Sheng Ma and Zi Cao. (Hai Zang said: If the patient usually consumes greasy food and has intestinal impurities, first use Tong Ge Wan [coated with Cinnabar] to purge, which acts as the interior-exterior counterpart to Xuan Feng San. Peng said: Using only Zi Cao decoction works well on its own. Qian's formula uses Musk and wine, but pox/rash fears Musk and alcohol aroma most; touching these taboos makes them unusable.)
[Tang] Treats black sunken pox where medicines fail to induce eruption; effective. Use Shan Zha Jia (Pangolin Scales) alone, burn until carbonized, grind into fine powder. Add a small amount of Dang Men Zi She Xiang (Musk). Dosage: 5 li for one year old, 1 qian for three years old. Mix with warm wine and take orally. One dose yields results. Even for half-body black sunken conditions nearing death, it can temporarily revive and turn red. However, if eyes are closed and spirit is absent, there is no hope of survival. (This formula is effective, but Hui Sheng San is better. Upon detailed analysis, Musk might be unsuitable for use.)
[From "Yan"] Ma Huang Tang (Ephedra Decoction)
Use Ma Huang (Ephedra Herb) cut to remove roots and joints, 5 qian. Stir-fry with one spoonful of honey for a long time. Decoct in half sheng of water. Wait for boiling. Remove surface foam. Decoct again until reduced by one-third. Do not discard dregs. For patients with inverted scabs and black pox, drink all while hot. Avoid wind. Wait for the pox to re-emerge. Another method: decoct with non-grain alcohol for faster results. However, children who cannot drink alcohol find it difficult to take. This is because the medicine enters the exterior layer. (This method is widely circulated and has proven effective repeatedly.)
[From "Huo"] For black inverted sunken pox, Zhu Wei Tang (Pig Tail Decoction), Wu Bi San (Incomparable Powder), and Long Nao Gao Zi (Borneol Paste) are all effective. (Hai Zang said: Using herbal purgatives seems superior to Borneol and Musk, but should only be used when absolutely necessary.)
[From "Huo"] Zhu Wei Gao (Pig Tail Ointment) treats inverted scabs.
Prick the tip of a small pig's tail to extract two drops of blood. Add a little raw Long Nao (Borneol). Grind together. Mix with fresh well water and take orally after meals. Immediate effect.
Long Nao Gao Zi (Borneol Paste) treats epidemic-induced pox, or eruptions that have not penetrated fully, causing mental restlessness, mania, asthma, delirium, hallucinations (seeing ghosts/gods), or eruptions that have emerged but sunk/hidden. All require rapid treatment. Untreated, toxins entering the Zang organs lead to certain death.
Take 1 qian of raw Long Nao, grind finely. Mix with pig heart blood to form pills the size of beans. Take one pill each time. For mental restlessness and mania, dissolve in Zi Cao decoction. For sunk/hidden eruptions, dissolve in warm wine. Soon the mind calms, sleep occurs, eruptions penetrate fully, and peace is restored through regular care. (Hai Zang said: This method is used only for extreme syndromes, hence "Ren Min Shu" says it is a last resort.)
[Hai] Si Fen San (Four Feces Powder) treats inverted scabs and black sunken pox/rash. (From "Imperial Hospital Formulas")
Rhyme: Human, cat, pig, dog feces burned on the Chen day of the twelfth lunar month. Take 3 qian each time, mixed with honey water. Regardless of inverted scabs or black sunken lesions, ten thousand taels of gold are worth it. (Prepare this medicine on the Chen day of the twelfth lunar month; highly effective.)
[Zi He] Ren Zhong Huang (Human Yellow), preferably from the twelfth lunar month. Calcine into coal in a ventilated place. Mix with water and take 3-5 qian. Sunken lesions will naturally emerge. Dan Xi said: Zi He used burnt human excrement for severe black sunken cases; this is the same formula.
[Shi] Treats rash/pox that fails to penetrate, dry and black, critical condition. Use Shan Zha Rou (Hawthorn Flesh) alone, grind into powder. Take 2 qian each time, delivered with Zi Cao wine. Adjust dosage according to the child's size. Slowly advance 3-4 doses until color becomes red and vibrant.
[Hai] Liu Shou Zhen's Liang Ge San (Cooling Diaphragm Powder) is also excellent for treating pediatric rash/pox black sunken cases. However, it is most appropriate only for cases with hard constipation and dark, scanty urine. If bowel movements and urination are already clear, do not use this. Replacing Da Huang (Rhubarb Root) and Xiao (Niter) with Yi Lao (aged versions) is the safest approach.
[Qian] For severe pox/rash cases, four or five out of ten survive. For black cases, regardless of symptoms, fewer than one out of ten can be saved. Symptoms include chills and grinding teeth, or yellow/swollen/purple body. Urgently use Bai Xiang Wan (Hundred Auspicious Pills) to purge. If chills persist, body becomes cold with sweating, and ears/tailbone become hot, death ensues. Why? Kidney Qi is excessively strong, and Spleen deficiency fails to control it. After purging, if body temperature rises and the patient desires water, it is treatable. Spleen Qi generates, overcoming Kidney, eliminating cold and restoring warmth. Treatment should focus on resolving toxicity; do not recklessly purge. Reckless purging causes internal deficiency, often leading to Kidney involvement. If the patient can eat and scabs are dry and raised, or if not dry but with asthma/excess syndrome, purging is indicated. Use Si Shun Yin (Four Smooths Decoction). Red sunken eruptions with hot ears/tailbones indicate adverse prognosis. Use Bai Xiang Wan and Niu Li Gao (Ox Plum Ointment), three doses each. If not cured, death ensues.
Bai Xiang Wan, also known as Nan Yang Wan. Treats black sunken pox/rash, chills, teeth grinding, yellow/swollen/purple body.
Hong Ya Da Ji (Red-toothed Euphorbia Root) [any amount, dried in shade, boiled in rice water until soft, remove woody core, dry in sun, boil again in juice until dry, dry and grind].
Make water pills the size of millet seeds. Take 10-20 pills each time, delivered with crushed sesame seed decoction. Vomiting and diarrhea occur simultaneously. No specific timing. This formula is excellent for teeth grinding.
Niu Li Gao (Ox Plum Ointment)
Take Niu Li Zi (Ox Plum Seeds) [any amount], extract juice. Boil in a stone vessel until ointment forms. Niu Li Zi grows by wild roads, bears fruit in autumn, black seeds in spikes. If fresh ones are unavailable, use dried ones ground into powder, decocted in water as a substitute. Take a size equivalent to a soapberry, dissolved in Apricot Gum decoction. Collect this medicine in the ninth lunar month.
The First Prince of Mumin Residence suffered from pox/rash. Initially treated by Doctor Li, then Qian Yi was summoned. Qian left three doses of Bao Long Wan. Doctor Li used purgative medicines, resulting in dense rash. Qian saw this and was greatly alarmed, saying: "If not purged, it becomes an adverse disease." The Prince said: "Doctor Li has already used purgatives." Qian said: "Pox/rash just emerged, without other symptoms, purging is contraindicated. Only mild medicines should be used, frequent breastfeeding, avoiding wind and cold. If scabs rise and the patient can eat, Da Huang Wan should cause one or two bowel movements then stop. Purging prematurely prevents full eruption and leads to density, making it difficult to treat later. This is a mistake. Even if stabilized, three diseases may follow: scabies, carbuncles, and red eyes. Doctor Li could not treat them. After three days of black sunken lesions, Qian was recalled. Qian said: 'Fortunately, no chills; the disease is not yet critical.' Then used Bai Xiang Wan as the main formula and Niu Li Gao as assistance, two large doses each. By the fifth day, eruptions turned red and vibrant. Cured in seven days. Black color returns to Kidney Water. Kidney excess overcomes Spleen. Earth fails to control Water, thus Spleen deficiency with chills is hard to treat. Bai Xiang Wan is used to drain the Bladder Fu organ. If the Fu organ is not full, the Zang organ will not be excessive. Why not drain the Kidney? Because the Kidney governs deficiency and cannot withstand purging. If two doses are ineffective, adding cold [purgatives] leads to death."
[Zi He] Treats black sunken pox/rash. Tie Jiao Wei Ling Xian (Iron-footed Snowbell Root) ground into powder. Stir-fry 1 qian. Add 1 fen of Nao Zi (Borneol). Mix with warm water and take orally. Effect achieved when scabs are discharged.
[From "Huo"] Wu Bi San (Incomparable Powder) treats malignant pediatric pox/rash syndromes.
Zhu Sha (Cinnabar, pre-ground, 1 liang), Niu Huang (Calculus Bovis), She Xiang (Musk), Zhang Nao (Camphor), Ni Fen (Calomel, finely ground) [each 1 qian].
Grind all together finely. For patients: infants take one character weight (approx. 0.5-1 g), adults take 5 fen. Add a little Mercury. Mix with 2-3 drops of blood from a small pig's tail and fresh water. Take orally.
Once the patient sleeps steadily, then induce purging to discharge foul-smelling phlegm-like substances resembling rotten fish intestines or grape clusters. Peace follows. For infants, mix with breast milk; excellent. (Hai Zang said: This drains extreme internal heat that cannot vent externally. Although internally over-drained, externally it promotes penetration. It is a medicine that penetrates the skin, similar to Zhi Bao Dan.)
[Yun] Formula for pediatric rash/pox black sunken cases.
Gan Yan Zhi (Dry Rouge, 3 qian), Hu Tao (Walnut, 1 piece, burned to retain nature).
Grind into fine powder. Decoct Hu Sui Jing (Coriander) wine. Mix with 1 qian of medicine and take orally. Immediate effect.
The above treats black sunken due to dead blood. All previous formulas using Pangolin scales and Musk for black sunken cases are designed for Qi stagnation.
[Yun] Treats rash/pox black sunken. Use one or two brains of Tu Xiao (Bai Lao Bird) from the twelfth lunar month. Mix with good wine and take orally. If dry, soak in good wine for a short time to dissolve. Follow the above instructions for immediate effect. (Tu Xiao is also known as Bai Lao bird.)
[Wu] Ruo Ye San (Bamboo Leaf Powder) treats inverted scabs.
Use Ruo Ye (Bamboo Leaf) alone, burn to ash, grind into powder. Take with Musk wine.
[Qian] If black pox suddenly causes diarrhea with pus/blood and scabs, it is favorable (Shun). If food/water is undigested, it is unfavorable (Ni). Why? Black pox belongs to Kidney. Spleen Qi is originally strong. Or, if previously taking Spleen-tonifying medicines, Spleen Qi becomes solid. Although Kidney is active, Spleen can control it, causing pox to enter the abdomen and become pus/blood, and expel scabs. This indicates Spleen strength and Kidney retreat, meaning the disease exits and peace is restored. Diarrhea of undigested grain/milk indicates Spleen deficiency failing to control Kidney, hence spontaneous diarrhea. This is definitely hard to treat. (Hai Zang said: Discharging scabs means the root is internal. Exterior and Interior are both diseased, termed Fire Depression. Digestion of food/water is favorable; indigestion is unfavorable.)
Blackness appearing all at once before bursting is "Sunken" (Xian). Blackness appearing unevenly after bursting is "About to Scab" (Jiang Ye).