（凡二十六首，共五十方）
起发出来无定期，庸常计日强猜疑。不知毒瓦斯分深浅，妄执方书只补脾。
时俗医云∶三日发热，三日出形，三日起发。此鄙论也。盖毒瓦斯有深浅，元气有浓薄，出之先后，壮亦因之，
大抵不出五六日间。彼毒浅气浓者，其起发常易；毒深气薄者，至五六日始壮者有之，未可以常期准也。俗医
见其起发之迟，不认毒之浅深，概谓正气不足，妄用补脾之剂，殊不知曾因吐泻不能食者，补脾以助长可也；若
无吐泻能食，六
根坚固，复用补药，不免党邪为害，非徒无益，而反害之。
起发如期贵适从，过犹不及类皆凶。先期痘出充肤腠，过后斑疮腹里壅。
凡痘疮起发，只在六七日，谓之得中，盖自发热算起，正当六七日也。如未及期而骤发，此毒火太甚，荣卫
气虚，直犯清道而出，谓之邪气太过。法当固表解毒，以防痒塌之变，宜黄 芍药汤。
如过六七日不起发，此脏腑虚弱，毒留于中，壅塞不出，谓之正气不及。法当托里解毒，以防倒陷干黑之
变，宜内托护心散。
出形已定视根窠，红活充肥气象和。倘若青干兼紫黑，急宜解托勿蹉跎。
凡痘出现已尽，时当起发，仅视根窠，以决轻重。如形充满，色红润，此气血和畅，毒瓦斯发越，大吉之兆，
不须服药；若形扁而塌，色枯而黑，此气血多滞，毒瓦斯壅遏不能起，急用解毒托里之药，用十宣散内托之。
痘出稀疏正得宜，如斯平顺不须医。若然稠密休轻易，解毒常常虑险危。
凡痘出稀少，不须服药。若稠密，其毒必盛，防气血不足，起发不透，渐生变易。
当服解毒托里散。服药之后，红活光壮，此气血内实，毒不能留，即止后服；如服后病势淹延，此邪气盛、
正气虚，不能成就，宜屡服之；如服此药当起不起，此必有变，不可治之，反取怨尤也。
乳郭充肥完且坚，色多苍蜡或红鲜。如逢破损多嚣薄，纵有良方恐莫延。
凡痘乳郭充实，皮囊坚浓，以指擦之，坚实不破，其色苍蜡而红活，皆顺证也，不喜干燥，淫湿。若疮虽
红鲜，反干燥而不充肥，此火甚而血不足，宜轻清之剂退火凉血，用四物快斑汤。
如疮充肥而带湿淫，此湿盛而气不足，宜利湿补气兼风药治之，盖风能胜湿故也，四物快斑汤。
如疮红活充肥，以指擦之随破，此名皮
嫩疮，破后必痒塌不合治，宜大补快斑汤。
如当起发，如浮囊空壳，如蚕之壳，麦之麸，皮中无水色者，此血气俱虚，用大补快斑汤治之。用药后，
若转而润泽，中涵水色者可治；否则，痒塌闷乱，叫哭而死矣。
形色须教着意观，紫红实热白虚寒。倘然错认分毫处，咫尺云泥祸害端。
凡痘疮起发，须谛观形色，以定重轻吉凶。如根窠红润，顶苍蜡色者上吉，根窠红，顶灰白色者次之；根
窠赤，顶亦赤而带艳者，此火胜，用解毒泻火汤清之。服药色退者生，不退者凶。
如纯白色者，作寒论，此血寒气虚也。虚则补之，十全大补汤加丁香、鹿茸，回其阳气，四肢冷者，加附
子。
如纯紫色者，作热论，此血热气实也。实者泻之，黄连解毒汤加犀角之类，以平为期，服药疮色回者，十
死一生。
四围起发陷居中，阳气亏衰尚未通。若是中枯成黑子，此名疔痘类非同。
痘疮起发，其形不一。有紧小而充实者，俗呼珍珠痘，此痘易壮易靥；有粗大而饱满者，俗呼天痘，此痘
早壮迟靥；有四围起中心落陷者，俗呼茱萸痘，此痘有吉凶、有轻重。稀者轻而吉，密者重而凶，盖因中气不
足，时日未到，但四围起发而中心尚是好肉，未得起发耳，时日既到，自然充括而成血浆，轻稀者不须治，重
密者用解毒化斑汤。若先有水，忽然干枯黑陷，此名疔痘，不可与中气不足同例论。
中心微起四围干，不久焦枯变一般。毒火熏蒸津液竭，开关启龠治应难。
凡痘有中心微起含水色，四畔干枯者，此毒火熏蒸，津液枯竭，急以疔痘之法治之，否则尽枯。又复烦躁
叫哭喘渴者不治。
痘疔只为火伤阴，济急无如砭与针。解毒透肌兼发散，胭脂四圣效应深。
大抵痘之初出一点血，此一点属正气，觉毒瓦斯冲击，随腠理而出现；其后，毒与血化
为水，水化为脓，脓成毒解。若毒大甚，熬煎阴血，其血干枯而变黑色，不得化水，反闭塞毒出之路，以致毒瓦斯
陷伏不得出，此名倒陷。其人烦躁腹胀，喘满口渴，多不可救。故古方外以针刺破，吮出其血，或用灯火淬之，
无非欲其开关启龠，而使毒瓦斯得出也。宜四圣珍珠散治之，用药后其疮便回者吉，如不回，反添黑陷，死证也，
不可妄治。内服之药，有用穿山甲烧人牙者，药既非解毒发表之药，又无托里快斑之能。愚者执而用之，适足
误事，又不若四圣快斑散，屡多奇效。
密斋曰∶钱氏用百祥丸、牛李膏，必其人大小便秘结，烦躁作渴，故宜服之；若其人大小便自调，身无大
热，则必不可用。今改去百祥丸、牛李膏，以宣风快斑散代之，服此以通为度，通后疮回，以四君子汤徐调之。
若或因泄泻，其疮由灰白而变黑陷，此名倒靥，宜木香快斑散治之。
予按∶痘中坏证，惟黑陷最恶。凡见黑陷者，大便未必自调，身体未必不热，神情未必不扰攘，宣风快斑
散或可治其轻者；若大便秘结，烦躁闷乱，大热口渴，舌上黄黑者，舍百祥无以挽回。盖黑陷凶危之证，非峻
厉之方，不足以制其猖獗。今凡如百祥丸及枣姜百祥丸、无价散、胡荽酒，并外治忍冬汤五方，宜预制，以便临
证酌用。万氏、钱氏两存可也。
黑陷疮为坏证先，此名恶候古今传。若教出现浑身上，卢扁无功莫怨天。
凡黑陷用以前治法，其疮红活，根据期光壮，吉兆也；倘服药如故，则不可治。若痘本稀，其中起发者多，
略有数个黑陷，此则可治；假如稠密，又不起发，或灰白、或紫赤、或青干，又加黑陷者，治之无功。
灰白迟延顶复平，紫红 肿候须明。且将气血分虚实，莫弃圆机执一行。
凡痘疮喜红活充实，若不红活充实虚也，红肿太过实也。假如灰白色，当起不起，而顶平陷者，此气虚也。
必问其人初起证候，如
初因吐泻不能饮食，其后泻止而灰白顶平者，此正气虚弱，宜大补快斑汤以补之。
如泄泻一向不止，用异功快斑汤兼豆蔻丸；如服以上之药，泄泻仍甚，用附子理中汤以温其中。
若其人素日虚怯，而吐泻不止，此元气不足，用补元快斑汤；如误服解毒寒凉，及误饮冷水者，用调中快
斑汤。
若灰白色又加痒塌、顶陷、腹胀，此不治之证；假如红 紫肿，血热也，宜凉血快斑汤。
若其人素实，初起误服热药，以致红 紫肿，宜三黄解毒汤清解之；若紫赤变黑，喘渴不宁者，不治。
起发犹如锡饼铺，皮肤光若水精壶。其人能食方无虑，不食将为鲍肆枯。
凡痘疮稠密，要根据次起发，红活尖者吉。一齐起发，遍身白色如锡饼形，头目浮肿，此恶候也。但看其人之
食饮何如∶若能食，大便坚，小便清，无他证，往往延至日久，浑身皮脱而愈；若不能食，后加吐泻热渴瘙痒，
必死之证。能食者，宜服解毒之药，用助脾快斑汤扶其中气。
起发之时未试浆，口唇疮色早焦黄。如斯恶候无人识，慢自矜夸强立方。
口唇，脾之候也。脾司运化以养血气，所以痘疮不宜脾胃受伤。如初出起发之时，浆水未试，口唇疮色内带
黄浆，此恶候也。时人不识，喜其成浆，便呼为吉，不知六七日间，其疮先靥，剥落一层而死矣。
疮头起发浆先白，不问何经皆是贼。慢夸妙手有仙方，七日应为泉下客。
凡痘由红点而水泡，由水泡而脓泡而结痂，有自然之序。初起发时，头带白浆，此疫疠也，不可治。
发时磊落最堪夸，相串牵连事可嗟，若又四围添小粟，定然瘙痒证来加。
凡痘起发，颗粒分明，尖圆磊落者吉；若彼此牵连成一片者凶。如上分气血虚实，用
解毒快斑治之。或本痘起发，或于根窠四畔又旋出小者，攒簇本疮，成丛似粟者，不待养浆，即加瘙痒而死矣。
起发时常验四肢，发而不透成凶危。此缘脾胃多虚弱，发散还须当补脾。
凡痘疮宜视手足何如∶若手足循序起发，此脾胃素强，毒瓦斯得越，不必忧虑；若遍身俱起，手足起不透，
此脾胃本弱也。盖脾胃主灌溉四肢，今既虚弱，不能行其津液，使毒得越，所以手足起发不齐，宜补脾快斑汤
助长可也。
起发之时贵谨扶，调和何必问医巫！暑寒食饮须当慎，后悔噬脐莫可图。
痘疮有轻变重者，犯禁，或误医药，或犯风寒，有重变轻者，反是。然轻者吉凶之变，存乎起发之时，调
护不可纵弛也。或遇暴风骤雨、迅雷闪电，即当以密布帏 ，紧饰房户，以防客风怪气之侵。如失调护，为
寒凉所郁，不能起发，宜正气快斑汤。
凡痘起发之时，遇久阴雨不能起发，宜平胃快斑汤以燥其湿。
凡痘当起发，遇天气暄热，俗人不知，谓痘欲温暖，盖覆太浓，以致毒火郁遏，不得发越。此壮火食气，反
虚其气，宜白虎快斑汤。
凡痘当起发，误伤生冷，以致脾虚不能起发者，用理中快斑汤。
凡痘疮起发，内伤饮食，腹中饱闷或痛，以致中气郁遏，不能起透者，宜宽中快斑汤。
自此常宜大便坚，如常调理保安然。若逢泄泻无休歇，寒热须教仔细研。
痘疮自起发之后，大便要坚，虽三四日一次亦无事；小便常要清利，若见小便赤少，宜四苓新加汤。
或有忽然泄泻，宜分寒热治之。视其所泄之物，或焦黄酸臭，此内热也，或伤饮食，宜胃苓和中汤。
若泄出之物，清白澄冷，里寒也。用附子理中汤方见前。如久泄不止，用理中汤吞
送豆蔻丸方见前。
其人能食素脾强，大便虽溏也不妨。但用补中消导药，六君加味信良方。
其人能食，虽有泄泻不能为害，当用补中之药，宜六君子汤固其中气。
起发预防头面肿，大头时气可兼医。疮宜磊落色宜润，反此倾危命必随。
凡痘疮起发，有头面由渐而肿，此毒瓦斯发越，聚于三阳，欲作脓血，故皮肉 肿。此虽正病，亦当解毒、
护目、救咽喉而兼治之，宜清毒化斑汤。
若头面不肿，必疮本稀疏磊落，痘根轻浅，虽作脓血，却不占处，故且不肿，不必治之。
若痘稠密，应肿不肿，此毒郁于内，不能起发，急服托里快斑汤。服药后，疮起者吉，不起者凶。
至于肿时，又要观其皮色何如，磊落红活者吉；模糊黑黯灰色者，多不可治。
亦有痘将起发，便头目先肿。此天行疫疠之气，名大头瘟者是也。急解其毒，宜苦参散。
面肿头浮眼不开，如斯恶候实堪哀。未应开处偏开早，搔痒频加凶祸来。
痘疮起发，头面浮肿，有不闭目者，但观其痘之轻重疏密。若疏轻者，目虽不闭亦不妨，重密者，其目要
闭，宜闭不闭者凶。盖眼封鼻塞，神气内固而不外驰，吉兆也。但遇封眼之时，必待其收靥之时而后渐开可也；
若未及收靥，渐生瘙痒，而肿消目开者，大凶！
痛痒原来有实虚，痒虚痛实载于书。都来痛者终为吉，诸痒难言吉自如。
大凡诸痛为实，痒为虚。谓之实者，邪气实也；谓之虚者，正气虚也。盖痘疮始终气以载之，血以养之，
气血充实，则禁固其毒，不得横行，所以紧实而为痛也。痛乃美事，不须服药，苟欲治之，宜凉血芍药汤。
疮痘作痒，邪气横行，泛滥皮肉，不任
条约，侵螫是为痒也。盖痘疮惟回头作痒，容或有之，此否极泰来之兆。若发热及养浆时作痒，皆危证也，内
宜托里解毒之药，外用熏洗之法，令无致于痒塌破陷可矣。仍要分虚实治之，若能食而大便秘者，此邪气内实，
正气外虚，宜加味四圣解毒汤，外用洗法；若有泄泻而作痒者，乃正气里虚，邪气外实，宜调元托里汤，外用
熏法。
起发之时渴又临，火邪内迫热偏深。急宜解毒生津液，休得俄延向外寻。
凡痘疮起发，身上作热，不可除其热。若不热则痘不发，如热太过，甚于常时，唇焦口燥，小便短少，不
可不治，宜导赤解毒汤微解之。
若痘疮作渴，此是常事。盖由胃中津液不能滋养本元，内则炽于毒火，外则灌润于疮，故宜渴耳。凡一切
瓜果生冷之物，不可与食，惟炒米汤饮之为宜。若渴太甚，看其人虚实而治。
若饮食如常，大便坚实而渴者，此内热也，宜生津地黄汤润之。
若泄泻而渴，此内虚津液不足，不能上潮于口，宜七味白术散滋之。
声哑无音更切牙，憎寒躁扰乱纷哗。错喉干呕多昏闷，形气俱伤最可嗟。
痘疮始终要声音清朗，人事安静，五脏坚实，饮食如常。若起发之时，忽然失声切牙，寒战烦躁，昏迷呛
水，错喉干呕，痰气喘急，泄泻不止，腹痛闷乱，俱皆凶证。古人云∶痘出而声不变者，形病也；痘未出而
声变者，气病也；痘出而声不出者，形气俱病，将欲治之，诚难为力。咳嗽而失声者，非此论。
痘儿呕哕不堪闻，不是寒邪是火焚。妄进汤丸如拙匠，内伤脏腑非妖氛。
凡痘疮干呕无物，或时常哕逆，此脏腑内伤，冲任之火上犯清道，故为呕哕之恶声。经曰∶弦败者，声必
(There are twenty-six poems in total, comprising fifty prescriptions.)
The eruption of smallpox has no fixed schedule; ordinary people often guess and suspect by counting days. They do not know that the depth and severity of the pathogenic factors vary, yet they blindly adhere to medical texts and only prescribe spleen-tonifying agents.
Contemporary physicians claim: "Fever appears on the third day, lesions emerge on the third day, and eruption occurs on the third day." This is a superficial view. The pathogenic factors have depths, and the primordial Qi (vital energy) has density and thinness; thus, their emergence varies in timing, and their flourishing also depends on this, generally occurring within five to six days. Those with shallow pathogenic factors and dense Qi usually erupt easily; those with deep pathogenic factors and thin Qi may not flourish until the fifth or sixth day, so one cannot judge solely by a standard timeline. When common physicians see delayed eruption, failing to recognize the depth of the pathogenic factors, they generally attribute it to insufficient righteous Qi (vital resistance) and recklessly use spleen-tonifying formulas. Little do they know that if the patient previously suffered from vomiting and diarrhea and could not eat, tonifying the spleen to aid growth is acceptable; however, if there was no vomiting or diarrhea, the patient can eat, and the six roots (sensory orifices and organs) are solid, using tonifying medicines again will inevitably support the evil and cause harm, doing no good but rather causing damage.
Timely eruption should be appropriate; both excess and deficiency are generally ominous. Eruption appearing early fills the skin and pores; eruption appearing late causes blockage in the abdomen.
Generally, the eruption of smallpox occurs within six to seven days, which is considered "balanced," calculated from the onset of fever. If it erupts suddenly before the expected time, this indicates excessive fire-toxin and deficiency of Ying (Nutritive) and Wei (Defensive) Qi, allowing the pathogen to directly invade the clear pathways and emerge, termed "excessive pathogenic Qi." The treatment method should be to consolidate the exterior and resolve toxicity to prevent changes such as itching and collapse, preferably using Huang Shao Yao Tang (Yellow Peony Decoction).
If eruption does not occur after six to seven days, this indicates weakness of the Zang-Fu organs, with toxins remaining inside and blocking emergence, termed "insufficient righteous Qi." The treatment method should be to support the interior and resolve toxicity to prevent inversion and drying/blackening changes, preferably using Nei Tuo Hu Xin San (Interior-Supporting Heart-Protecting Powder).
Once the shape is determined, observe the base; red, vibrant, full, and plump indicates harmonious Qi and Blood. If green, dry, purple, or black appears, urgently apply resolution and support without delay.
When all smallpox lesions have appeared and it is time for eruption, one should only observe the base (root) to determine severity. If the shape is full and color is ruddy, this indicates smooth flow of Qi and Blood, with toxins venting outward, an auspicious sign requiring no medication. If the shape is flat and collapsed, and color is withered and black, this indicates stagnation of Qi and Blood, with toxins blocked and unable to rise; urgently use detoxifying and interior-supporting medicines, such as Shi Xuan San (Ten-Acupoint Powder) for internal support.
Sparse eruption is appropriate; such smooth cases need no medical intervention. If dense, do not treat lightly; always consider the danger of toxicity and resolve it frequently.
When smallpox is sparse, no medication is needed. If dense, the toxin must be abundant; guard against insufficient Qi and Blood leading to incomplete eruption and gradual complications. One should take Jie Du Tuo Li San (Detoxifying and Interior-Supporting Powder). After taking the medicine, if the lesions become red, vibrant, and strong, this indicates substantial internal Qi and Blood, preventing toxin retention; stop subsequent doses. If the disease lingers after taking the medicine, this indicates abundant pathogenic Qi and deficient righteous Qi, unable to complete the process; continue administering the medicine. If the medicine fails to promote eruption when it should, complications are certain, and it cannot be treated; attempting so would only invite blame.
The pustule base should be full, complete, and firm; colors are often grayish-yellow or bright red. If damaged and thin, even good prescriptions may fail to prolong life.
When the pustule base is solid, the sac is thick and firm, resisting pressure without breaking, and the color is grayish-yellow and vibrant, these are favorable signs, disliking dryness or excessive dampness. If the lesion is bright red but dry and not full, this indicates excessive fire and insufficient blood; use light and clearing agents to reduce fire and cool blood, such as Si Wu Kuai Ban Tang (Four Substances Rapid-Eruption Decoction).
If the lesion is full but damp, this indicates excessive dampness and insufficient Qi; treat with damp-draining, Qi-tonifying, and wind-dispersing herbs, as wind can overcome dampness, using Si Wu Kuai Ban Tang.
If the lesion is red, vibrant, and full, but breaks easily upon touch, this is called "tender-skin lesion"; after breaking, it will likely itch, collapse, and fail to heal; use Da Bu Kuai Ban Tang (Great Tonification Rapid-Eruption Decoction).
If at the time of eruption, the lesion resembles a floating empty shell, like a silkworm cocoon or wheat bran, lacking fluid color in the skin, this indicates dual deficiency of Qi and Blood; treat with Da Bu Kuai Ban Tang. After medication, if it becomes moist and contains fluid color, it is treatable; otherwise, itching, collapse, confusion, crying, and death will follow.
Colors and shapes require careful observation; purple-red indicates excess heat, white indicates deficiency cold. Mistaking them by even a fraction leads to disaster as vast as the difference between clouds and mud.
During smallpox eruption, carefully observe colors and shapes to determine severity and fortune. If the base is ruddy and the top is grayish-yellow, it is highly auspicious; if the base is red and the top is grayish-white, it is secondary. If the base is crimson and the top is crimson with brightness, this indicates excessive fire; clear it with Jie Du Xie Huo Tang (Detoxifying and Fire-Draining Decoction). If the color fades after medication, survival is likely; if not, it is ominous.
If purely white, treat as cold, indicating cold blood and deficient Qi. Tonify deficiency with Shi Quan Da Bu Tang (Ten Complete Great Tonifying Decoction) plus Ding Xiang (Clove) and Lu Rong (Deer Antler); for cold limbs, add Fu Zi (Aconite).
If purely purple, treat as heat, indicating hot blood and excess Qi. Drain excess with Huang Lian Jie Du Tang (Coptis Detoxifying Decoction) plus Xi Jiao (Rhinoceros Horn); aim for balance. If the lesion color returns after medication, one in ten survives; if not, death is likely.
Eruption around the perimeter with central depression indicates declining Yang Qi not yet unblocked. If the center dries into a black spot, this is called Ding Smallpox (Carbuncle-like Smallpox), distinct from others.
Smallpox eruption forms vary. Tight and small yet solid ones are commonly called Pearl Smallpox, which flourish and crust easily. Coarse and full ones are called Heavenly Smallpox, which flourish early but crust late. Those rising around the perimeter with a central depression are called Dogwood Smallpox, having varying degrees of fortune and severity. Sparse cases are mild and auspicious; dense cases are severe and ominous, due to insufficient Middle Qi and untimely arrival. Only the perimeter erupts while the center remains healthy flesh, awaiting the proper time to naturally fill and form plasma. Mild, sparse cases need no treatment; severe, dense cases use Jie Du Hua Ban Tang (Detoxifying and Spot-Resolving Decoction). If fluid appears then suddenly dries and sinks blackly, this is Ding Smallpox, not to be discussed alongside Middle Qi deficiency.
Slight elevation in the center with dry surroundings soon turns scorched and uniform. Toxin-fire steams and depletes fluids; opening the gates is difficult to treat.
When smallpox has slight elevation with fluid in the center but dry surroundings, this indicates toxin-fire steaming and fluid depletion; urgently treat with methods for Ding Smallpox, otherwise it will completely dry up. If accompanied by irritability, crying, panting, and thirst, it is untreatable.
Ding Smallpox arises from fire injuring Yin; urgent relief requires cupping and acupuncture. Resolving toxicity, penetrating muscle, and dispersing externally, Yan Zhi Si Sheng (Red Rose Four Sages) yields profound effects.
Generally, the initial appearance of a smallpox spot involves a drop of blood, belonging to righteous Qi. Feeling the impact of toxins, it emerges through the pores. Later, toxin and blood transform into water, water into pus, and pus formation resolves the toxin. If the toxin is too strong, it boils Yin blood, turning it dry and black, preventing transformation into water and blocking the exit path, causing toxin entrapment, termed "Inverted Depression." The patient suffers irritability, abdominal distension, panting, and thirst, often incurable. Ancient methods used needle puncture to suck out blood or moxa cauterization to open the gates and release toxins. Use Si Sheng Zhen Zhu San (Four Sages Pearl Powder). If the lesion improves after medication, it is auspicious; if not, adding black depression indicates death, and reckless treatment is forbidden. Internal medicines using burned Pangolin scales (Chuan Shan Jia) and human teeth are neither detoxifying/dispersing nor supporting/resolving; foolish adherence to them causes errors. Si Sheng Kuai Ban San (Four Sages Rapid-Eruption Powder) is superior and effective.
Mi Zhai said: Qian's use of Bai Xiang Wan (Hundred Auspicious Pills) and Niu Li Gao (Ox Plum Paste) is suitable only when the patient has constipation, irritability, and thirst. If bowel movements are normal and body heat is not high, they must not be used. Now, remove Bai Xiang Wan and Niu Li Gao, replacing them with Xuan Feng Kuai Ban San (Ventilation Rapid-Eruption Powder). Administer until unblocking is achieved; after unblocking and lesion improvement, slowly regulate with Si Jun Zi Tang (Four Gentlemen Decoction). If diarrhea causes lesions to turn gray-white and sink blackly, this is called "Inverted Crusting," treat with Mu Xiang Kuai Ban San (Costus Rapid-Eruption Powder).
I note: Among bad smallpox syndromes, black depression is the worst. Seeing black depression, bowels may not be normal, body may be hot, and spirit may be disturbed; Xuan Feng Kuai Ban San might treat mild cases. If constipation, irritability, severe heat, thirst, and yellow-black tongue coating exist, only Bai Xiang can reverse it. Black depression is a critical syndrome requiring potent formulas to control its rampant nature. Prescriptions like Bai Xiang Wan, Zao Jiang Bai Xiang Wan, Wu Jia San, Hu Sui Jiu, and external Ren Dong Tang (Honeysuckle Decoction) should be prepared in advance for clinical use. Both Wan's and Qian's approaches can be retained.
Black depression lesions are precursors to bad syndromes, known as ominous signs passed down since ancient times. If appearing all over the body, even Lu Bin (Lu Guoqing and Bian Que) would fail; do not blame heaven.
For black depression, use previous treatments; if lesions become red, vibrant, and strong according to schedule, it is auspicious. If unchanged after medication, it is untreatable. If originally sparse with many erupting lesions and only a few black depressions, it is treatable. If dense, non-erupting, or gray-white, purple-red, green-dry, plus black depression, treatment is futile.
Gray-white delay with flat tops; purple-red swelling signs must be clarified. Distinguish Qi and Blood deficiency/excess; do not stick rigidly to one method.
Smallpox prefers red, vibrant, and full; lack thereof indicates deficiency, while excessive redness/swelling indicates excess. Gray-white color, failure to erupt, and flat/collapsed tops indicate Qi deficiency. Ask about initial symptoms: if caused by vomiting/diarrhea leading to inability to eat, followed by cessation of diarrhea but gray-white flat tops, this is righteous Qi deficiency; use Da Bu Kuai Ban Tang to tonify.
If diarrhea persists, use Yi Gong Kuai Ban Tang (Yi Gong Rapid-Eruption Powder) combined with Dou Kou Wan (Cardamom Pills); if still severe after these, use Fu Zi Li Zhong Tang (Aconite Regulate the Center Decoction) to warm the middle.
If the person is constitutionally weak with persistent vomiting/diarrhea, this is Yuan Qi (Primordial Qi) deficiency; use Bu Yuan Kuai Ban Tang (Tonify Primordial Qi Rapid-Eruption Decoction). If mistakenly taken cooling detoxifiers or cold water, use Tiao Zhong Kuai Ban Tang (Regulate Center Rapid-Eruption Decoction).
If gray-white is accompanied by itching, collapse, flat tops, and abdominal distension, it is untreatable. If red/purple/swollen, this is blood heat; use Liang Xue Kuai Ban Tang (Cool Blood Rapid-Eruption Decoction).
If the person is constitutionally strong but mistakenly took hot medicines initially, causing red/purple swelling, use San Huang Jie Du Tang (Three Yellows Detoxifying Decoction) to clear and resolve. If purple-red turns black with panting/thirst/restlessness, it is untreatable.
Eruption spreads like tin plates; skin shines like crystal pots. Only if the patient can eat is there no worry; inability to eat leads to desiccation like a fish market.
For dense smallpox, sequential eruption with red, vibrant, pointed tips is auspicious. Simultaneous eruption with whole-body whiteness like tin plates, head/eye swelling, is an ominous sign. Observe eating/drinking: if able to eat, hard stool, clear urine, no other symptoms, recovery may come after prolonged shedding of skin. If unable to eat, followed by vomiting/diarrhea, heat/thirst, itching, it is fatal. Those who can eat should take detoxifying medicines, using Zhu Pi Kuai Ban Tang (Support Spleen Rapid-Eruption Decoction) to support Middle Qi.
At eruption time, before testing for pus, if lip lesion color turns scorched yellow early, this ominous sign is unrecognized; do not boast of prescribing forcibly.
Lips reflect the Spleen. The Spleen governs transportation/transformation to nourish Qi and Blood, so smallpox should not injure Spleen/Stomach. At initial eruption, before pus forms, if lip lesion color contains yellow pus internally, this is ominous. Contemporaries do not recognize this, praising pus formation as auspicious, unaware that within five to six days, lesions will crust prematurely, peel off, and cause death.
Lesion heads erupting with white pus first, regardless of meridian, are thieves. Do not boast of miraculous prescriptions; the patient will be a guest under the springs in seven days.
Smallpox progresses naturally from red spots to blisters, to pustules, to scabs. At initial eruption, if heads carry white pus, this is epidemic pestilence, untreatable.
Distinct eruption is praiseworthy; connected strands are lamentable. Adding small millet grains around further adds itching symptoms.
Smallpox eruption with distinct, round, sharp grains is auspicious; connected成片 (forming a sheet) is ominous. Differentiate Qi/Blood deficiency/excess as above, treating with Jie Du Kuai Ban Tang. Or, if new small grains cluster around the base of existing lesions, forming millet-like clusters, itching will add to symptoms before pus maturation, leading to death.
Check limbs frequently during eruption; incomplete eruption leads to danger. This stems from Spleen/Stomach weakness; dispersing requires tonifying the Spleen.
Observe hands and feet: if they erupt sequentially, Spleen/Stomach is strong, toxins vent, no worry. If whole body erupts but limbs do not fully erupt, Spleen/Stomach is weak. Spleen/Stomach irrigates limbs; weakness prevents fluid transport and toxin venting, causing uneven limb eruption. Use Bu Pi Kuai Ban Tang (Tonify Spleen Rapid-Eruption Decoction) to assist.
Careful nursing is precious during eruption; why ask doctors or shamans? Be cautious with heat/cold and diet; regretting later is useless.
Smallpox can worsen due to taboos, wrong medicine, or wind-cold; it can improve conversely. Changes in mild cases depend on eruption time; nursing must not be lax. During storms/lightning, cover windows tightly to prevent pathogenic winds. If neglected and suppressed by cold, failing to erupt, use Zheng Qi Kuai Ban Tang (Righteous Qi Rapid-Eruption Decoction).
During prolonged rainy weather preventing eruption, use Ping Wei Kuai Ban Tang (Peace Stomach Rapid-Eruption Decoction) to dry dampness.
During hot weather, laypeople wrongly cover heavily for warmth, trapping toxin-fire and preventing venting. Excessive fire consumes Qi, causing deficiency; use Bai Hu Kuai Ban Tang (White Tiger Rapid-Eruption Decoction).
If raw/cold food injures Spleen, preventing eruption, use Li Zhong Kuai Ban Tang (Regulate Center Rapid-Eruption Decoction).
If dietary injury causes abdominal fullness/pain, blocking Middle Qi and eruption, use Kuan Zhong Kuai Ban Tang (Widen Middle Rapid-Eruption Decoction).
Stool should be firm henceforth; normal regulation ensures safety. If diarrhea persists, carefully study cold/heat.
After eruption, stool should be firm (even once every 3-4 days is fine); urine should be clear. If red/scanty urine, use Si Ling Xin Jia Tang (Four Ling New Additions Decoction).
Sudden diarrhea requires differentiating cold/heat. Scorched yellow/sour foul smell indicates internal heat or food injury; use Wei Ling He Zhong Tang (Stomach-Ling Harmonize Center Decoction).
Clear/cold watery stool indicates interior cold; use Fu Zi Li Zhong Tang (see above). For chronic diarrhea, use Li Zhong Tang with Dou Kou Wan (see above).
If the patient eats well and has strong Spleen, loose stool is harmless. Use middle-tonifying and digestion-promoting medicines; Liu Jun Zi Jia Wei (Six Gentlemen Modified) is a good prescription.
Those who eat well are unaffected by diarrhea; use middle-tonifying medicines, specifically Liu Jun Zi Tang (Six Gentlemen Decoction) to secure Middle Qi.
Prevent head/face swelling during eruption; treat Big Head Epidemic concurrently. Lesions should be distinct and moist; reversal brings peril.
Gradual head/face swelling indicates toxin venting and gathering in Three Yang meridians, preparing for pus/blood, causing flesh swelling. Though part of the disease, treat with detoxification, eye protection, and throat rescue using Qing Du Hua Ban Tang (Clear Toxin Resolve Spot Decoction).
If no head/face swelling, lesions are likely sparse/shallow; though pus forms, it doesn't occupy much space, so no swelling; no treatment needed.
If dense lesions should swell but don't, toxin is trapped internally, failing to erupt; urgently take Tuo Li Kuai Ban Tang (Support Interior Rapid-Eruption Decoction). Improvement after medication is auspicious; no change is ominous.
During swelling, observe skin color: distinct/red/vibrant is auspicious; blurry/black/dull gray is mostly untreatable.
If head/eyes swell before eruption, this is Tian Xing Yi Li (Heavenly Flow Epidemic) called Big Head Wen (Plague); urgently resolve toxin with Ku Shen San (Sophora Powder).
Face swollen, head floating, eyes won't open; this ominous sign is pitiable. Opening too early where it shouldn't, frequent itching brings disaster.
With head/face swelling, some don't close eyes. Observe severity/density: sparse/mild cases, open eyes are fine; dense/severe cases, eyes should close. Failure to close in severe cases is ominous. Eye closure and nasal congestion fix spirit internally, auspicious. Eyes should open gradually only after crusting; if itching starts and swelling subsides before crusting, it is highly ominous!
Pain/itchiness stem from excess/deficiency; books record itch as deficiency, pain as excess. Pain throughout is ultimately auspicious; itching makes fortune hard to predict.
Generally, pain is excess (pathogenic abundance); itch is deficiency (righteous deficiency). Qi carries, Blood nourishes; sufficient Qi/Blood confines toxins, causing tightness/pain. Pain is good, needs no medicine; if treating, use Liang Xue Shao Yao Tang (Cool Blood Peony Decoction).
Itching means pathogens spreading in flesh, unable to be contained, stinging causes itch. Itch only at the "turning back" stage is possibly auspicious (extreme yin yielding to yang). Itch during fever or pus-maturation is critical. Internally use interior-supporting detoxifiers; externally use fumigation/washing to prevent collapse. Differentiate excess/deficiency: if eating well with constipation, pathogenic excess/internal, righteous deficiency/external; use Jia Wei Si Sheng Jie Du Tang (Modified Four Sages Detoxifying Decoction) externally wash. If diarrhea with itch, righteous deficiency/internal, pathogenic excess/external; use Diao Yuan Tuo Li Tang (Regulate Primordial Support Interior Decoction) externally fumigate.
Thirst arrives during eruption; fire-pathogen presses internally, heat is deep. Urgently resolve toxicity and generate fluids; do not delay seeking external solutions.
During eruption, fever should not be removed; without heat, smallpox won't erupt. If heat is excessive, with scorched lips, dry mouth, scanty urine, treatment is needed; use Dao Chi Jie Du Tang (Guide Outward Detoxifying Decoction) to mildly resolve.
Thirst is common due to Stomach fluids failing to nourish the source, burning internally with toxin-fire, and irrigating lesions externally. Avoid raw fruits/vegetables; fried rice soup is best. If thirst is severe, treat based on deficiency/excess.
If eating normally, hard stool, and thirsty, this is internal heat; use Sheng Jin Di Huang Tang (Generate Fluids Rehmannia Decoction) to moisten.
If diarrhea with thirst, this is internal deficiency/fluid insufficiency failing to ascend; use Qi Wei Bai Zhu San (Seven Ingredients Atractylodes Powder) to nourish.
Hoarse voice, grinding teeth, aversion to cold, irritability, chaos. Throat obstruction, dry retching, coma, Qi/Form injury is lamentable.
Smallpox requires clear voice, quiet demeanor, solid Zang-Fu, normal eating. At eruption, sudden loss of voice, teeth grinding, chills, irritability, choking on water, dry retching, phlegm/panting, persistent diarrhea, abdominal pain/confusion are all ominous signs. Ancients said: Voice unchanged after eruption is Form disease; voice changed before eruption is Qi disease; voice absent after eruption is dual Qi/Form disease, hard to treat. Cough with voice loss is not this theory.
Infant vomiting/hiccuping is unbearable; not cold pathogen but fire burning. Reckless pills/potions are like clumsy craftsmen; internal organ injury is not demonic.
Dry retching without substance or frequent hiccups indicate internal organ injury, Chong/Ren fire invading clear pathways, causing bad sounds. Classics say: String-like pulse failure, voice must...