葡萄疫者。形如青紫葡萄。大小不一。头面身体。随处可生。由感四时不正之气。郁于皮肤。乃腑症也。初
起服羚羊角散。清热凉血。久则牙根出血。邪传入胃也。服胃脾汤。滋益其内。如牙腐烂者。于牙疳门参
考。
羚羊角散
羚羊角 牛蒡子 防风 麦门冬 知母 玄参 黄芩（各八分）
甘草（一分）
水钟半。淡竹叶十片。煎七分服。
胃脾汤
沙参 白术 陈皮 茯神 远志 麦冬（各六分） 五味子 甘草（各五分）
水煎服。有汗去沙参。加人参黄 。
痘里夹瘿 结于颈项。或生耳后腋下。形如桃、李、枣、瓜。身烙烦渴。由痰气凝结所致。治在审日期之先
后。视元气之浓薄。纪男女之大小。范时令之寒暑。庶几免紊乱之愆。
痘初起即发瘿者。治宜托里消痰解毒。如木通、桔梗。解毒而彻关锁。恶实、生地。除枭而祛荣炎。甘草清
理诸邪。蝉蜕祛风辟毒。芍药泄诸经之郁火。荆芥散阳明之风邪。如是之药。缺一不可。若芩、连等药。及
耗烁之剂。俱不宜用。
痘发在三四日而瘿作者。则毒随痘泄。毒随痘灌。自可挽全而无害。宜服三消散。倘斯时红肿将脓。一
溃则元气泄而痘焉能克灌乎。七八日之期。急用黄 卫元汤补之。
痘至七八日克灌时而发瘿者。冲和饮子主之。是痘黄蜡色而作瘿者。服保元兼以消毒。虽溃无妨。
三消散 治痘发至三四日而作瘿者。
半夏 当归 茯苓 甘草 木通 红花 生地 芍药 牛蒡子 天花粉 蝉蜕 灯草
水煎服。
黄 卫元汤 治痘发三四日而瘿溃者。宜此补之。
黄 人参 当归 红花 芍药 桔梗 甘草 防风
水煎服。
冲和饮子 治痘至七八日而发瘿者。
人参 黄 麦门冬 芍药 柴胡 防风 荆芥 白茯苓 白术 桔梗 连翘 当归
天花粉
水煎服。
痘里发丹 由内热之极也。宜生地、牛蒡子、芍药、甘草、木通、荆穗。其毒自消。肿痛加柴胡、
羌活。头顶盛者。毒凑于上焦也。宜炒黄连、柴、甘、车前、栀子等类。外以化斑汤浴之。慎服寒药。
及用猪胆、京墨、冰片等涂抹之类。
痘里夹疮 宜紫苏、荆芥煎汤浴之。随用升麻、黄 为君。芍药、生地、白术为臣。羌活防风、为佐。
甘草、姜
蚕、蝉蜕为使。此准则也。若杨梅疮。如皂角子仁。肥疳疮。如松香、轻粉、黄丹、雄黄。俱不可用。
痘夹损伤 宜拱元散。人参、黄 、伏凤雏、当归、红花、芍药、蝉蜕、防风、甘草。一加橘红、
生地、土鳖。以补其内。用文蛤、棕灰罨之。收敛其外。若损而未破者。虾蟆皮贴之。痕阔弗收者。
白芨、白蔹、象皮末掺之。慎用峻利及败血等药。如汤火伤者。忌敷凉药。
痘疔 俗谓之贼痘。生于五六日之间。或三五枚六七枚。杂于诸痘之间。其色紫黯。甚则黑硬于右。有
此。以致诸症蜂起。不能灌脓。甚至不救。由热毒势甚并结之也。有中心黑陷四畔突起戴浆者。有中心
戴浆四畔干陷焦黑者。有头戴白浆自破溃烂者。有水泡溶溶易破者。有血泡色紫易破者。有疮头针
孔浆水自出者。以上数症。生于四肢。身温音清。浮高而润者轻。生于腰腹。身热音哑。深陷而焦者重。
看疔秘法 天庭承浆黑陷。男应阴囊。女应阴户。两颧两颐有黑陷。应在腰下。人中有黑陷。应在脐下。
太阳有黑陷。应在腿足。耳上有黑陷。应在手足。轻则黑陷。重则疔也。
卷帘疔 生于舌根。小如黑豆。大似葡萄。令儿舌卷喉痛。急用银钩钩破。尽净恶血。随以苦茶漱口。搽
龙宫丹。冰片、硼砂、青黛、黄连、薄荷、荆芥、炒僵蚕。为细末。吹用。
火珠疔 生鼻孔内。阗塞喷火。面赤眼红。用钩钩破。用黄连膏加冰片滴鼻内。服泻金散。犀角、牛蒡子、
桔梗、芍药、生地、红花、紫苏、甘草。煎服。
忘汲疔 生于眼沿。封蛤肿胀。烦热面紫。治宜挑破。用瓦葱捣烂罨之。
豢虎疔 生于耳内。于会脓之时。宜挑破。搽拔疔散。
燕窝疔 生于腋下。肿硬。面赤谵语。如在左腋潜注。则右体之痘沉伏失色。右则反之。宜银针挑破去
其根。用拔疔散。服消毒饮子。牛蒡子、犀角、芍药、生地、红花、甘草、木通。茯苓、连翘、灯心。
水煎服。
注命疔 生两足心。于痘期里肿硬如钱如豆如椒。有紫筋直透足股。挑之去血净。用田螺水调冰片
点之。次用慎火草、浸胀绿豆。捣烂敷之。
透肠疔 生肛门旁。在六七朝肿痛如锥。挑之。煎金银花防风汤冷洗之。次用轻粉、珍珠、冰片、白蔹末
涂之。内服黄连解毒汤。
骊龙疔 生尿孔内。于五六朝。身热谵语。眼翻肢厥。腹胀小便闭是也。急用蟾酥、牛黄、银珠、冰片、麝香。
研末。次用黄连、细茶浓煎候冷。取半匙调药。用细软稻心蘸药。送于孔内。内服木通败毒散。
痂后痘疔。溃见筋骨者。
密陀僧（二钱） 赤石脂 腻粉 黄柏 杭粉（炒） 伏龙肝 血竭（各一钱） 飞丹（八分）
发灰（五分） 乳香 没药（各三分） 冰片（半分） 有臭气。加阿魏（三四分）
为极细末掺之。外用膏药盖之。内服人参败毒散。加穿山甲、蝉蜕、连翘。
痘烂身无完肤。脓水浸淫。粘拈衣被者。用茶叶拣去梗。入滚水一 。即捞起。再拣去梗。湿铺床上。上铺
草纸一层。令儿卧之。一夜则脓干。此秘诀也。
痘烂生蛆。及夏月诸虫咬伤。臭秽不堪者。用蛇蜕一两烧存性。蝉蜕用水洗净焙之。青黛飞。各五钱。细
辛二钱半。为末。每服三钱。酒下。仍以生寒水石细末掺之。则虫化为水。蝇亦不敢近。
蛆痘。形化气化兼之也。先哲云。蛆痘不死。以其枭毒尽化于外也。用经霜艾叶、野薄荷煎汤洗之。或紫
苏、甘草煎汤洗之。或用艾熏之。其蛆自去。禁用雄黄、矾石等药。
痘痂不脱。久之必成瘢陷。用生蜜、苏合油二味。调匀敷痂沿处。其痛立止。其痂速脱。无苏合油以线鸡
油代之。
痘痂落后。其面瘢或赤或黑。用四白灭瘢散。临卧搽之。至晓洗去。自然白莹。更不得早见风日。经年不
灭。如疮瘢凸者。热毒未尽也。解毒防风汤。外用蚬子肉水涂之。如疮瘢凹者。脾胃虚也。人参白术散加
黄主之。四白灭瘢散。搽面 效。用白芷、白附子、白僵蚕、鹰屎白、密陀僧。等分为末。清蜜水调搽。灭
瘢散。治瘢黯或凸或凹者。韶粉一两轻粉一钱为末。猪骨髓熬熟调敷。
Grape Plague (Putao Yi) presents with lesions resembling purple grapes, varying in size, and can appear anywhere on the head, face, and body. It is caused by contracting abnormal Qi of the four seasons, which stagnates in the skin; this belongs to Fu-organ syndromes. In the initial stage, Lingyang Jiao San (Antelope Horn Decoction) should be taken to clear heat and cool blood. If the condition persists for a long time leading to bleeding from the gums, it indicates that pathogenic factors have transmitted to the Stomach meridian; Weitai Tang (Stomach and Spleen Decoction) should be taken to nourish and tonify the interior. If the gums rot, refer to the section on Gangrene of the Gums (Yagan).
Lingyang Jiao San (Antelope Horn Decoction)
Ingredients: Antelope Horn (Lingyang Jiao), Arctostaphylis Seed (Niubangzi), Saposhnikovia Root (Fangfeng), Ophiopogon Tuber (Maimendong), Anemarrhena Rhizome (Zhimu), Scrophularia Root (Xuanshen) (each 8 fen); Licorice Root (Gancao) (1 fen).
Preparation: Use half a zhong of water and ten slices of light bamboo leaf. Decoct until reduced to seven-tenths volume, then take orally.
Weitai Tang (Stomach and Spleen Decoction)
Ingredients: Glehnia Root (Shashen), Atractylodes Macrocephala Rhizome (Baizhu), Tangerine Peel (Chenpi), Poria (Fushen), Polygala Root (Yuanzhi), Ophiopogon Tuber (Maidong) (each 6 fen); Schisandra Berry (Wuweizi), Licorice Root (Gancao) (each 5 fen).
Preparation: Decoct in water and take orally. If sweating is present, remove Glehnia Root (Shashen) and add Ginseng Root (Renshen) and Astragalus Root (Huangqi).
Erysipelas-like nodules (Ying) occurring within smallpox are clustered in the neck or behind the ears and in the axillae, resembling peaches, plums, dates, or melons. The patient suffers from burning fever, irritability, and thirst. This is caused by the coagulation of phlegm and Qi. Treatment requires assessing the timing of onset, observing the strength of Yuan Qi (Primordial Qi), considering the age and gender of the patient, and adapting to seasonal cold and heat changes to avoid therapeutic errors.
If erysipelas-like nodules appear at the very beginning of smallpox, treatment should focus on supporting the interior, resolving phlegm, and detoxifying. Use Tong Cao (Akebia Stem) and Platycodon Root (Jiegeng) to resolve toxicity and open blockages; use Arctostaphylis Seed (Niubangzi) and Rehmannia Root (Shengdi) to eliminate toxins and dispel Ying-level inflammation. Licorice Root (Gancao) clears various pathogens; Cicada Slough (Chantui) dispels wind and eliminates toxicity; Peony Root (Shaoyao) drains stagnant fire from all meridians; Schizonepeta Spike (Jingjie) disperses Wind-Evil in the Yangming meridian. Such herbs are indispensable. Herbs like Scutellaria Root (Huangqin) and Coptis Rhizome (Huanglian), as well as agents that consume Yin, are not suitable.
If erysipelas-like nodules appear on the third or fourth day of smallpox, the toxin is discharged along with the pustules and pus, allowing for recovery without harm. Sanxiaosan (Three Dissolving Powder) should be taken. However, if redness and swelling are about to suppurate at this time, rupture would leak Yuan Qi, preventing proper filling of the pustules. By the seventh or eighth day, Huangqi Weiyuan Tang (Astragalus Guardian Origin Decoction) should be urgently used to tonify.
If erysipelas-like nodules appear during the seventh or eighth day when pustules are filling, Chonghe Yinzi (Harmonizing Infusion) is the primary formula. If the pustules are yellow-wax colored and accompanied by nodules, Baoyuan Tang (Protect Origin Decoction) combined with detoxification should be taken. Even if they rupture, there is no danger.
Sanxiaosan (Three Dissolving Powder) treats erysipelas-like nodules appearing on the third or fourth day of smallpox.
Ingredients: Pinellia Tuber (Banxia), Angelica Sinensis Root (Danggui), Poria (Fuling), Licorice Root (Gancao), Tong Cao (Akebia Stem), Safflower (Honghua), Rehmannia Root (Shengdi), Peony Root (Shaoyao), Arctostaphylis Seed (Niubangzi), Trichosanthes Root (Tianhuafen), Cicada Slough (Chantui), Juncus Effusus (Dengcao).
Preparation: Decoct in water and take orally.
Huangqi Weiyuan Tang (Astragalus Guardian Origin Decoction) treats erysipelas-like nodules that rupture on the third or fourth day of smallpox; use this to tonify.
Ingredients: Astragalus Root (Huangqi), Ginseng Root (Renshen), Angelica Sinensis Root (Danggui), Safflower (Honghua), Peony Root (Shaoyao), Platycodon Root (Jiegeng), Licorice Root (Gancao), Saposhnikovia Root (Fangfeng).
Preparation: Decoct in water and take orally.
Chonghe Yinzi (Harmonizing Infusion) treats erysipelas-like nodules appearing on the seventh or eighth day of smallpox.
Ingredients: Ginseng Root (Renshen), Astragalus Root (Huangqi), Ophiopogon Tuber (Maimendong), Peony Root (Shaoyao), Bupleurum Root (Chaihu), Saposhnikovia Root (Fangfeng), Schizonepeta Spike (Jingjie), White Poria (Baifuling), Atractylodes Macrocephala Rhizome (Baizhu), Platycodon Root (Jiegeng), Forsythia Fruit (Lianqiao), Angelica Sinensis Root (Danggui), Trichosanthes Root (Tianhuafen).
Preparation: Decoct in water and take orally.
Erysipelas (Dan) occurring within smallpox is due to extreme internal heat. Use Rehmannia Root (Shengdi), Arctostaphylis Seed (Niubangzi), Peony Root (Shaoyao), Licorice Root (Gancao), Tong Cao (Akebia Stem), and Schizonepeta Spike (Jingsui). The toxin will naturally dissipate. For severe swelling and pain, add Bupleurum Root (Chaihu) and Notopterygium Root (Qianghuo). If symptoms are concentrated on the top of the head, the toxin has gathered in the Upper Jiao; use stir-fried Coptis Rhizome (Huanglian), Bupleurum Root (Chaihu), Licorice Root (Gancao), Plantago Seed (Cheqian), and Gardenia Fruit (Zhizi). Bathe externally with Huaban Tang (Spot-Dissolving Decoction). Be cautious about using cold-natured medicines, or applying pig bile, Beijing ink, or borneol.
Ulcers (Chuang) accompanying smallpox should be bathed with decoctions of Perilla Leaf (Zisu) and Schizonepeta Spike (Jingjie). Subsequently, use Primula Root (Shengma) and Astragalus Root (Huangqi) as sovereign herbs; Peony Root (Shaoyao), Rehmannia Root (Shengdi), and Atractylodes Macrocephala Rhizome (Baizhu) as minister herbs; Notopterygium Root (Qianghuo) and Saposhnikovia Root (Fangfeng) as assistant herbs; Licorice Root (Gancao), Ginger Silkworm (Jiangcan), and Cicada Slough (Chantui) as envoy herbs. This is the standard principle. For Yaws (Yangmei Chuang), use soap pod kernels; for Fegany Ulcers, use rosin, calomel, lead tetroxide, and realgar. These are strictly prohibited.
Trauma accompanying smallpox should be treated with Gongyuan San (Support Origin Powder). Ingredients: Ginseng Root (Renshen), Astragalus Root (Huangqi), Fusouchu (Fufengchu), Angelica Sinensis Root (Danggui), Safflower (Honghua), Peony Root (Shaoyao), Cicada Slough (Chantui), Saposhnikovia Root (Fangfeng), Licorice Root (Gancao). Add Tangerine Peel (Juhong) and Rehmannia Root (Shengdi) to tonify the interior. Externally apply Clam Shell (Wenge) and palm ash to astringe the exterior. If the injury is unbroken, apply Toad Skin (Xiamapi). If scars are wide and do not contract, sprinkle powder of Bletilla Rhizome (Baiji), Ampelopsis Rhizome (Bailian), and Elephant Skin (Xiangpi). Avoid harsh purgatives and blood-breaking drugs. For burns, avoid cooling applications.
Smallpox Ding (Dou Ding), commonly called "Thief Smallpox," appears between the fifth and sixth days, with three to six lesions mixed among other pustules. They are purple-dark, becoming black and hard. Their presence causes numerous complications, prevents pus formation, and can even lead to death, due to intense heat-toxin accumulation. Variants include: center black and depressed with raised edges and pus on top; center with pus and dry, black, depressed edges; top with white pus that ruptures and ulcerates; blisters that easily break; purple blood blisters that easily break; and lesions with needle-hole openings leaking serum. Lesions on limbs with warm body, clear voice, elevated and moist appearance are mild. Lesions on waist/abdomen with fever, hoarse voice, deep depression, and blackening are severe.
Secret Method for Examining Ding: Black depression at Tinghong and Chengjiang corresponds to scrotum in males and vagina in females. Black depression at zygomatic arches and cheeks corresponds to lower waist. Black depression at Renzhong corresponds to below navel. Black depression at Taiyang corresponds to legs and feet. Black depression at ears corresponds to hands and feet. Mild cases show black depression; severe cases indicate Ding.
Juanlian Ding (Curtain-Rolling Ding) arises at the tongue root, small as a black bean, large as a grape, causing tongue curling and throat pain. Urgently hook open with a silver hook, drain all bad blood, rinse with bitter tea, and apply Longgong Dan (Dragon Palace Pill). Longgong Dan consists of borneol, borax, indigo naturalis, Coptis Rhizome, mint, Schizonepeta, and stir-fried silkworm, ground into fine powder, insufflated.
Huozhu Ding (Fire Pearl Ding) arises inside nostrils, causing blockage and hot breath, red face, and red eyes. Hook open, instill Huanglian膏 (Coptis Ointment) with borneol into nose, and take Xiejinsan (Drain Metal Powder): rhinoceros horn, Arctostaphylis Seed, Platycodon Root, Peony Root, Rehmannia Root, Safflower, Perilla Leaf, Licorice Root, decocted and taken orally.
Wangji Ding (Forget-Sucking Ding) arises on eyelids, swollen like a frog, with irritability and purple face. Treat by puncturing and applying mashed tile onion.
Huanhu Ding (Taming-Tiger Ding) arises inside ears. When suppuration occurs, puncture and apply Badingsan (Ding-Pulling Powder).
Yanwo Ding (Swallow's Nest Ding) arises in axillae, swollen and hard, with red face and delirium. If latent in left axilla, right-sided smallpox becomes sunken and discolored; vice versa for right side. Puncture root with silver needle, apply Badingsan (Ding-Pulling Powder), and take Xiaodu Yinzi (Detoxifying Infusion): Arctostaphylis Seed, rhinoceros horn, Peony Root, Rehmannia Root, Safflower, Licorice Root, Tong Cao, Poria, Forsythia Fruit, Juncus Effusus, decocted and taken orally.
Zhuming Ding (Life-Destiny Ding) arises on soles of feet. During smallpox period, swollen and hard like coins, beans, or peppers, with purple veins penetrating to thighs. Puncture to drain blood, apply borneol mixed with water snail juice. Then apply crushed Shenhuocao (Caesalpinia Crista) and soaked mung beans.
Touchang Ding (Intestine-Penetrating Ding) arises beside anus. On days 6-7, painful swelling like awl pricks. Puncture, wash cold with Honeysuckle and Saposhnikovia decoction. Then apply calomel, pearl, borneol, and Ampelopsis powder. Internally take Huanglian Jiedu Tang (Coptis Detoxification Decoction).
Lilong Ding (Black Dragon Ding) arises in urethral opening. On days 5-6, fever, delirium, eye rolling, limb coldness, abdominal distension, and urinary retention. Urgently grind toad venom, buffalo gallstone, cinnabar, borneol, and musk into powder. Boil Coptis and strong tea, cool, mix half spoon of liquid with powder. Dip soft rice stem in medicine and insert into opening. Internally take Mutong Baidu San (Akebia Detoxification Powder).
Scab-stage Smallpox Ding, ulcerated exposing bone/tendon: Metocong (2 qian), Red Halloysite (Chishizhi), Calomel (Nifen), Phellodendron Bark (Huangbai), Stir-fried Hangfen (Hangfen), Dragon Liver (Fulonggan), Blood Dragon Resin (Xuejie) (each 1 qian), Flying Cinnabar (Feidan) (8 fen), Hair Ash (Fahui) (5 fen), Frankincense (Ruxiang), Myrrh (Moyao) (each 3 fen), Borneol (0.5 fen). If foul odor, add Asafoetida (Aswei) (3-4 fen). Grind to ultra-fine powder and sprinkle. Cover externally with plaster. Internally take Renshen Baidu San (Ginseng Detoxification Powder) with Pangolin Scales, Cicada Slough, and Forsythia Fruit.
Smallpox erosion with no intact skin, oozing pus sticking to clothes/bedding: Pick stems out of tea leaves, dip in boiling water once, remove stems again, lay wet on bed, cover with one layer of straw paper, let child lie on it. Pus dries overnight. This is a secret method.
Smallpox erosion with maggots, or insect bites in summer, unbearable stench: Burn 1 liang of snake slough to preserve nature, wash and bake cicada slough, process Qingdai (Indigo Naturalis), each 5 qian, Xixin (Asarum) 2.5 qian. Grind to powder. Take 3 qian per dose with wine. Sprinkle fine powder of Sheng Hanshui Shi (Raw Gypsum) externally; insects turn to water, flies stay away.
Maggot Smallpox results from both form and Qi transformation. Ancients say maggot smallpox does not kill because toxins are transformed outward. Wash with decoction of frost-experienced Mugwort and wild mint, or Perilla and Licorice. Or fumigate with Mugwort. Maggots will disappear. Strictly prohibit Realgar and Alum.
Smallpox scabs not falling off will eventually cause scar pits. Apply raw honey and Suhe Oil evenly around scab edges. Pain stops immediately, scabs fall quickly. If no Suhe Oil, substitute with chicken oil from thread.
After scab falls, facial scars may be red or black. Apply Sibai Mieban San (Four Whites Scar-Removing Powder) before sleep, wash off at dawn. Face becomes naturally white and bright. Avoid wind and sun exposure early. Scars persisting for a year: if convex, heat-toxin remains; use Jiedu Fangfeng Tang (Detoxification Saposhnikovia Decoction). Externally apply clam meat water. If concave, Spleen/Stomach deficiency; treat with Renshen Baizhu San (Ginseng Atractylodes Powder) plus Astragalus Root.
Sibai Mieban San (Four Whites Scar-Removing Powder) is effective for facial application. Equal parts of Angelica Dahurica Root (Baizhi), Bletilla Rhizome (Baifu Zi - *Note: Text says Bai Fuzi, likely Aconitum or similar, but context implies whitening agent*), White Silkworm (Bai Jiangcan), Eagle Droppings White (Yingshi Bai), and Metocong. Mix with clear honey water for application.
Mieban San (Scar-Removing Powder) treats dark, convex, or concave scars. Shaofen (1 liang) and Qinfen (1 qian) ground to powder, mixed with boiled pig marrow for application.