〔万〕《活人书》云∶伤寒下之太早，热气乘虚入胃，发 。下之太迟，热留胃中，发 。胃烂，亦发 。
者，乃热毒郁遏，煎熬阴血，血得热而不解，浮于肌肉为 ，足阳明胃主之。痘疮初出，皮肉红肿，片片如
锦纹者，此夹 也，以辛凉之药解之，其 渐退，疮本坚实者吉，否则皮肤 烂，疮易瘙痒，所谓皮嫩易破者
是也。如赤 成块，其肉浮肿结硬者，又名丹瘤，其毒最酷，疮未成就，此先溃烂，工不能治。夹 痘，
亦用荆防败毒散主之， 退，可治。〔张〕痘出而夹 者，
痘毒随脏而出，其毒发之势最为迅疾，或血太过而气不及，则卫气疏缺，不能密护脉络，而致太过之血，夹毒上浮，
亦乘毒出之势而发为痈也，较前夹疹者稍为易治，如痘起齐，其内必虚， 多从内解，如不解，以升麻汤加归、
芍主之。又有或结痂后而发者，余毒热盛，煎熬肉分，其 必烂，以消毒散（出不快）加归、芍、防风，盛则
用连翘汤（痘大小便秘），烂处以生肌散（溃烂）敷之。若夹毒初出，色赤如火，乃毒滞不能宣发之故，以四顺饮（发
热）利之，如大便利一二次，而 或退，则血附气位，急用四君子汤（不能食）加 、姜、枣、与服，以防其损陷，
如不止，加肉豆蔻必止。〔翁〕用玄参升麻汤（咽喉）、黄芩、荆芥、白芍、归、芎，在初多用表散，在后多用解利，
红易退，紫 稍难，蓝 不可治矣。〔娄〕用白虎汤。〔袁〕痘中夹 ，阳明受枭炎之毒盛而然，丁、桂、之药，纤
毫莫可投也，张半仙用黄连解毒汤以治夹 之痘，则失之太寒。钱氏用槟榔大黄以疗痘中之 ，则失之太峻。总不
如犀角地黄汤以彻内阳明之郁毒，五龙化 汤以消外蚊咬之血纹，内外夹攻，表里调和，斯能复全矣。愚
治痘里夹 者极多，但见形就是 ，不见痘样者热毒峻烈，克全者十止三四，两日而 见者，速清逐为尚，患此
者必烦躁谵语，渴饮不宁，刘禅师用地龙汁和犀角水
投服，亦心得治 之法者矣。
山栀子汤 治痘疮及 毒，状如蚊蚤所啮，毒盛黑色者。
山栀子仁 白藓皮 赤芍药 升麻（各一两） 寒水石 甘草（各五钱）
上为细末。每服一钱，水八分，紫草、薄荷各少许，同煎至五分，去滓，放温服。
袁氏方
紫草 红花 犀角 木通 芍药 生地黄 茯苓 甘草 蝉蜕
灯草、金银煎服。外加荆芥、紫苏、木通、荔枝壳、凤凰脱、升麻、杨枝，浓煎汤，浴之。
阳毒升麻汤 面赤，狂言，烦躁，腰背疼，下利，脉浮，喉痛。
升麻（五钱） 犀角 射干 黄芩 人参 甘草（各二钱半）
上，水煎服。
阴毒升麻汤 治阴 。
升麻 当归 川椒 鳖甲 雄黄 甘草
上，水煎服。
【夹瘿】〔袁〕夹瘿，为痰毒凝结而成也，或结于项颈，或结于耳后，或结于腋下，大者如桃，小者似李，长
者似瓜，短者似枣，身烙烦渴，势若不凶，痘三四日而瘿作，则毒随痘泄，脓随痘灌，自可挽全而无害。倘
瘿红肿将脓，而痘随标焉，吾恐毒脓一溃，元气嚣漓，痘焉能表暴充灌乎。七八之期，痘已黄蜡，而瘿作焉，
保护元气，消毒祛邪，竟获绥全之庆，虽溃无妨。治法在乎审日期之先后，视元气之浓薄，纪男女之大小，范
时令之寒暑，庶几免紊错之愆矣。瘿已红肿而痘标焉，法宜托里，毒盛消其毒，元虚补其元，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，诸药缺一不可也。痘起遂发瘿，治以补托，为芩连之药不可用，耗烁之剂不宜投，消痰解毒为尚。痘标而瘿
破流脓出血，自致元气虚亏，大用黄 卫元汤可也，人参、黄 、川归、红花、桔梗、芍药、甘草、防风、煎服。
痘两三日而瘿毒仍作，急用三消散，半夏、川归、茯苓、甘草、木通、红花、生地、芍药、牛蒡子、天花粉、蝉蜕、灯
草煎服。痘七八日充灌而瘿作，宜服冲和饮子，人参、
黄、麦门、柴胡、防风、荆芥、芍药、茯苓、炒白术、桔梗、连翘、当归、栝蒌根，频进四服，自愈矣。歌曰∶
木通生地并黄 ，桔梗当归芍药俱，大力蝉蜕兼甘草，白茯僵蚕效实奇，上焦加味升麻引，贝母门冬不可遗，
下焦牛膝相资助，紧觅山姑倍用之，热多荆芥随多少，疼极还寻白芷医。愚按方治证，须验时日，若
头面尽肿而瘿肿，则诸痘决不能鼎峻，多致损伤。
【夹丹】〔袁〕痘里发丹，内热之极而然也，不宜遽用极寒透里之剂，若标两三日，竟以化 汤徐徐浴之，
内服生地、牛蒡子、芍药、甘草、木通、荆芥穗，其毒自消矣。若用猪胆、京墨、冰片涂之，竟罹其害，慎之！
头面项颈，倘如蛇缠硬肿，火烧疼痛，枭毒辏于上，宜用炒黄连、紫草、车前子、栀子等药。余治痘丹，
准前药加减，单用露桃花二钱，即丹收痘朗，若肿疼，须加柴胡、羌活、生地、芍药倍之。有用凤尾草独煎汤饮，
岂知山蕨即凤尾草名也，性极寒而沉走，恐伤于痘，不可轻用。
【夹疮疡】〔袁〕痘里夹疮，痘迎疮见隙而盘据，愈加多密矣，痘起气虚，风痒自作，宜用紫苏、荆芥汤
浴之，随用芍药、生地、防风、黄 、白术、僵蚕、甘草、
蝉蜕等药服之可也。若男女种患杨梅恶疮，痛不可忍，而痘适标其间，李少阳用蜗牛丹以治，但香油、皂子仁、不
可轻用。若患肥疳疮，如松香、轻粉、飞丹、雄黄，皆不可涂也。歌曰∶黄 芍药直僵蚕，生地防风白术联，甘
草红花牛蒡子，酒煎来服效难言，若是杨梅疮破烂，牛黄土茯倍加焉，痛极乳香些少助，自然疮可
痘安痊。余历验小儿痘种于疮疡中，痘虽美丽，势必枭痒，若不按法制汤以浴，痘蹲聚于疮隙，奚克鼎峻，尹头陀专
以香马兰藤煎汤，浴夹疮疡之痘，允得镇痘之妙，但香马兰有三种，分别青红白，根浮上红者甚佳，采用则可。
治法，升麻、黄 、为君，芍药、生地、为臣，羌活、防风、为佐，甘草、蝉蜕为使，此准格也。
【夹损伤】〔袁〕痘标一两日，或致扑跌，或犯金石所伤，则脾脉亏损而血气走散，痘终受其阻厄，李少
阳用孩骨胡桃酒以治，则失之峻利，况胡桃又作泻之物，用之不宜。王近川用归尾桃仁汤以治，则失之狂妄，
痘中岂宜破败其血者耶。准根据刘半塘拱元散，人参、黄 、当归、红花、伏凤雏、蝉蜕、防风、芍药、甘草以
补托其内，用文蛤、棕灰 于伤处，以收敛其外可也。若损而不破者，用虾蟆皮贴之，徐徐以手摩抚，若是汤泼
火烙者，不宜敷以生冷之药，以凝滞其痘也。歌
曰∶损伤须觅伏凤雏，土鳖参 蝉蜕驰，橘红甘草当归合，再入红花防地俱。昔黄舍人次子十三岁，患痘两朝，上
楼失足，损伤头额，致血淋漓，父母痛哭，以为痘中损伤，必不能生矣，请予视治，即将前方倍下参、 、归、地、
连进四服而痘遂鼎灌，身带不宁，加茯神、桂心，外单用棕灰敷之，不半月而自靥脱全美。但痛甚者少加乳香，若
外伤重、痕阔，弗克收痂，用白芨、白蔹、象皮末掺之，自痊。
[Complicated by Macules (Ban)] Wan Quan stated in the *Huoren Shu* (Book of Living People): If Shaoyang disease is treated with purgatives too early, heat qi enters the stomach while it is deficient, causing macules. If purged too late, heat remains in the stomach, also causing macules. If the stomach tissue rots, macules will also appear.
Macules are caused by heat-toxin stagnation and obstruction, which boils and consumes yin-blood. When blood is heated but cannot dissipate, it floats into the muscles. The Foot-Yangming Stomach meridian governs this condition. When smallpox lesions first emerge, if the skin and flesh are red and swollen, appearing in patches like brocade patterns, this is "smallpox complicated by macules." It should be resolved with acrid-cool herbs. As the macules gradually recede, if the smallpox base is firm and solid, it is an auspicious sign; otherwise, the skin may rot, and the lesions may become easily pruritic, which is referred to as "delicate skin prone to rupture." If red macules form clumps, with flesh that is edematous and hard, it is called "Danliu" (Red Tumor). This toxicity is extremely fierce. If ulceration occurs before the smallpox matures, it is difficult for physicians to treat. For smallpox complicated by macules, Jingfang Baidu San (Astragalus and Saposhnikovia Decoction to Overcome Toxins) is primarily used. Once the macules recede, the condition becomes manageable. Zhang Jingyue argued that when smallpox emerges accompanied by macules, it is because the smallpox toxin follows the viscera's qi to exit externally. The momentum of the toxin's eruption is most rapid. If blood is excessive while qi is insufficient, Wei Qi (Defensive Qi) becomes sparse and fails to tightly protect the collaterals. Consequently, excess blood carries toxins upward, erupting along with the toxin's outward momentum to form carbuncles. This is slightly easier to treat than smallpox complicated by rashes. If the smallpox eruption is uniform, the interior must be deficient. The macule toxin usually resolves from within; if it does not resolve, Shengma Tang (Cimicifuga Decoction) added with Dang Gui (Angelica Sinensis) and Bai Shao (White Peony Root) should be used. In some cases, symptoms appear after scabbing has formed due to residual heat-toxin being vigorous, boiling the muscle tissue, causing inevitable skin ulceration. Xiaodu San (Toxin-Resolving Powder) added with Dang Gui, Bai Shao, and Fang Feng (Saposhnikovia Root) can be used for slow eruption. If the toxin is vigorous, Lianqiao Tang (Forsythia Decoction) is used for constipation or urinary difficulty. Ulcerated areas should be dressed with Shengji San (Tissue-Regenerating Powder). If the complicating toxin appears initially with a color red as fire, it is due to toxin stagnation preventing dissemination. Sishun Yin (Four Compliance Drink) should be used to promote bowel movement. If bowel movements occur once or twice and the macules recede, blood returns to its proper position following qi. At this point, Sijunzi Tang (Four Gentlemen Decoction) added with Ren Shen (Ginseng), Sheng Jiang (Fresh Ginger), and Da Zao (Jujube) should be urgently administered to prevent damage and sinking of Zheng Qi (Upright Qi). If diarrhea persists, Dou Kou (Nutmeg) will stop it. Weng Zhongren advocated using Xuanshen Shengma Tang (Scrophularia and Cimicifuga Decoction) for sore throat, along with Huang Qin (Scutellaria Root), Jing Jie (Schizonepeta Spike), Bai Shao, Dang Gui, and Chuan Xiong (Ligusticum Rhizome). Early stages favor dispersing methods, later stages favor resolving and purging methods. Red macules are easy to resolve; purple ones are slightly difficult; blue ones are incurable. Lou Quanshan advocated using Baihu Tang (White Tiger Decoction). Yuan Shi believed that smallpox complicated by macules results from intense Xiao Yan (fierce inflammation) toxin in the Yangming channel. Drugs associated with Ding and Gui (likely referring to warming/hot natured drugs like Aconite or Cinnamon) should absolutely not be used. Zhang Banxian used Huanglian Jiedu Tang (Coptis Decoction to Resolve Toxins) for macule-complicated smallpox, which was too cold. Qian Yi used Bing Lang (Areca Seed) and Da Huang (Rhubarb Root) to treat macules in smallpox, which was too harsh. Overall, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) is best to thoroughly clear internal Yangming郁毒 (stagnant toxin), and Wulong Huaban Tang (Five Dragons Macule-Resolving Decoction) to eliminate external blood-patterns resembling mosquito bites. Internal and external attacks combined, harmonizing interior and exterior, allows for full recovery. I have treated many cases of smallpox complicated by macules. Whenever the morphology appears as macules without typical smallpox features, the heat-toxin is severe. Only three or four out of ten recover completely. If macules appear after two days, rapid clearing and expulsion is essential. Patients suffer from restlessness, delirium, thirst, and agitation. Chan Shi Liu used Earthworm Juice mixed with Rhino Horn Water, demonstrating insightful treatment methods for macules.
Shanzhizi Tang (Gardenia Decoction) treats smallpox and macule toxin presenting like mosquito or flea bites, with vigorous black toxicity.
Shanzhizi Ren (Gardenia Seed), Baixianpi (Dixonia Root Bark), Chishao Yao (Red Peony Root), Shengma (Cimicifuga Rhizome) (each 1 liang), Hanshuishi (Calcitum), Gancao (Licorice Root) (each 5 qian).
Grind into fine powder. Take 1 qian per dose, boil with 8 fen of water, adding a little Zicao (Arnebia Root) and Bohe (Mint Leaf). Decoct until 5 fen remains, strain, and take warm.
Yuan Shi Formula
Zicao (Arnebia Root), Honghua (Safflower), Xijiao (Rhino Horn - *Note: Use substitutes in modern practice*), Mutong (Akebia Stem), Shaoyao (Peony Root), Sheng Dihuang (Rehmannia Root), Fuling (Poria), Gancao (Licorice Root), Chantui (Cicada Slough).
Decoct Dengcao (Juncus Effusus) and Jinyinhua (Honeysuckle Flower) for drinking. Additionally, decoct Jingjie, Zisu (Perilla Leaf), Mutong, Lizhi Qiao (Lychee Shell), Fenghuang Tuo (likely a local herb name), Shengma, and Yangzhi (Willow Branch) in strong decoction for bathing.
Yangdu Shengma Tang (Yang-Toxin Cimicifuga Decoction) Indications: Red face,狂言 (mad speech), irritability, lower back pain, diarrhea, floating pulse, sore throat.
Shengma (5 qian), Xijiao (Rhino Horn), Shegan (Belamcanda Rhizome), Huang Qin (Scutellaria Root), Renshen (Ginseng), Gancao (Licorice Root) (each 2.5 qian).
Boil in water and take.
Yindu Shengma Tang (Yin-Toxin Cimicifuga Decoction) Treats Yin-macules.
Shengma, Dang Gui (Angelica Sinensis), Chuanjiao (Sichuan Pepper), Biejia (Turtle Shell), Xionghuang (Realgar), Gancao.
Boil in water and take.
[Complicated by Goiter/Ying] Yuan Shi said: "Jia Ying" (Complicated Goiter) is formed by phlegm-toxin coagulation. It may knot in the neck, behind the ears, or in the armpits. Large ones resemble peaches, small ones plums, long ones melons, short ones dates. The body feels burning with irritability and thirst. Although the situation seems not fierce, if the goiter appears on the 3rd or 4th day of smallpox, the toxin drains with the smallpox, and pus fills with the smallpox, allowing for natural recovery without harm. However, if the goiter is red, swollen, and suppurating while the smallpox marks are sparse, I fear that once the toxic pus ruptures, the Yuan Qi (Primary Qi) will be exhausted, and how can the smallpox erupt fully? By the 7th or 8th day, if the smallpox has turned yellow-wax colored and the goiter appears, one should protect Yuan Qi, resolve toxin, and dispel evil. Even if it ruptures, there is no harm. Treatment depends on examining the sequence of dates, observing the thickness of Yuan Qi, noting gender and age, and regulating for seasonal cold/heat, thereby avoiding errors. If the goiter is red/swollen but smallpox is sparse, the method should support the interior. If toxin is vigorous, resolve it; if Yuan Qi is deficient, tonify it. Mutong and Jiegeng (Platycodon Root) resolve toxin and open locks; Niuxiangzi (Burdock Fruit) and Shengdi (Rehmannia Root) remove fierce toxins and clear Ying-heat; Gancao clears various evils; Chantui dispels wind and辟毒 (resolves toxins); Shaoyao drains郁火 (stagnant fire) from all meridians; Jingjie disperses Wind-Evil from Yangming. None of these herbs are dispensable. If smallpox eruption is immediately followed by goiter, use tonification and support. Huang Qin (Scutellaria) and Lian (Coptis) should not be used; draining/depleting agents are unsuitable. Focus on resolving phlegm and toxin. If smallpox is sparse and goiter ruptures leaking pus/blood, Yuan Qi is naturally deficient. Use large doses of Huangqi Weiyuan Tang (Astragalus Protecting Primary Qi Decoction): Renshen, Huangqi, Chuan Gui, Honghua, Jiegeng, Shaoyao, Gancao, Fang Feng, decocted and taken. If goiter toxin reappears on days 2-3 of smallpox, urgently use Sansan Xiao (Three Dissolutions Powder): Banxia (Pinellia), Chuan Gui, Fuling, Gancao, Mutong, Honghua, Shengdi, Shaoyao, Niuxiangzi, Tianhuafen (Trichosanthes Root), Chantui, Dengcao, decocted. If goiter appears on days 7-8 during filling stage, drink Chonghe Yinzi (Harmonizing Drink): Renshen, Huangqi, Maimen (Ophiopogon), Chaihu (Bupleurum), Fang Feng, Jingjie, Shaoyao, Fuling, Chao Baizhu (Fried Atractylodes), Jiegeng, Lianqiao (Forsythia), Dang Gui, Gualou Gen (Trichosanthes Root). Take frequently, four doses, and it will heal itself. Song says: Mutong, Shengdi, and Huangqi; Jiegeng, Dang Gui, Shaoyao together; Daliju (Burdock), Chantui, and Gancao; Baifu (Poria) and Jiangcan (Silkworm) show miraculous efficacy. Add Shengma for upper jiao guidance; Beimu (Fritillaria) and Maidong (Ophiopogon) must not be omitted. Assist with Niuxi (Achyranthes) for lower jiao; seek Shangu (Cornus) and double the dose. For more heat, adjust Jingjie quantity; for extreme pain, seek Baizhi (Angelica Dahurica). My analysis of formulas and syndromes requires verifying timing. If the head and face are entirely swollen with goiter, the smallpox certainly cannot erupt vigorously, leading to much damage.
[Complicated by Erysipelas/Dan] Yuan Shi said: Dan (Erysipelas) in smallpox results from extreme internal heat. Do not hastily use extremely cold penetrating agents. If smallpox marks are sparse for two to three days, slowly bathe with Huaban Tang (Macule-Resolving Decoction). Internally take Shengdi, Niuxiangzi, Shaoyao, Gancao, Mutong, Jingjie Sui (Schizonepeta Tip). The toxin will naturally dissipate. Using pig bile, Beijing ink, or Borneol for topical application causes harm; beware! If the head, face, neck, and collarbone present like snake-like hard swelling with burning pain, indicating fierce toxin gathering above, use fried Huanglian (Coptis), Zicao, Cheqianzi (Plantago Seed), Zhizi (Gardenia Fruit), etc. I treat Dan in smallpox by modifying previous formulas. Using only 2 qian of Lu Tao Hua (Dew-soaked Peach Blossom) resolves Dan and clarifies smallpox. If swollen/painful, add Chaihu, Qianghuo (Notopterygium Root), Shengdi, and double Shaoyao. Some use single decoction of Fengwei Cao (Pteris Multifida). Note that Shan Jue is Fengwei Cao, which is extremely cold and sinking, likely harming smallpox; do not use lightly.
[Complicated by Sores/Ulcers] Yuan Shi said: Sores complicating smallpox occupy gaps between lesions, making them denser. Smallpox onset involves Qi deficiency and spontaneous wind-itch. Bathe with Zisu (Perilla Leaf) and Jingjie decoction. Then take Shaoyao, Shengdi, Fang Feng, Huangqi, Baizhu, Jiangcan (Silkworm), Gancao, Chantui, etc. If patients contract Yangmei E Chuang (Syphilitic Ulcer), unbearable pain, with smallpox emerging among them, Li Shaoyang used Woniu Dan (Snail Pill), but Xiangyou (Sesame Oil) and Zaoren (Soapberry Kernel) should not be used lightly. If suffering from Feigan Chuang (Obesity-related Sores), avoid applying Songxiang (Rosin), Qingfen (Calomel), Feidan (Lead Monoxide), or Xionghuang (Realgar). Song says: Huangqi, Shaoyao, and Jiangcan; Shengdi, Fang Feng, Baizhu linked; Gancao, Honghua, Niuxiangzi; Decocted with wine, efficacy is hard to describe. If Yangmei Chuang is broken, double Niuhuang (Calculus Bovis), Tuhu (Earthworm), and Fuling. For extreme pain, add a little Ru Xiang (Frankincense), naturally sores heal and smallpox recovers. I have verified many pediatric smallpox cases complicated by sores. Even if beautiful, they inevitably itch fiercely. Without proper bath decoctions, smallpox clusters in sores and cannot erupt vigorously. Yin Toutuo specifically used Xiang Malan Teng (Aromatic Malan Vine) decoction for bathing smallpox complicated by sores, achieving excellent sedative effects. Note Xiang Malan has three types: green, red, white. Roots floating up with red color are best. Treatment principle: Shengma and Huangqi as Sovereign; Shaoyao and Shengdi as Ministers; Qianghuo and Fang Feng as Assistants; Gancao and Chantui as Envoys. This is the standard pattern.
[Complicated by Injury] Yuan Shi said: On days 1-2 of sparse smallpox, falls or injuries from metal/stone may occur. Spleen pulse is damaged, blood/qi scatters, obstructing smallpox eruption. Li Shaoyang used Haigu Hetao Jiu (Child Bone Walnut Wine), which is too harsh. Walnuts cause diarrhea, so it is unsuitable. Wang Jinchuan used Guiwei Taoren Tang (Torus and Peach Kernel Decoction), which is reckless. One should not break blood in smallpox cases. Following Liu Bantang's Gongyuan San, use Renshen, Huangqi, Dang Gui, Honghua, Fufengchu (likely a specific herb or typo for Tu Bie Chong/Earth Beetle), Chantui, Fang Feng, Shaoyao, Gancao to tonify/support internally. Apply Wen Ge (Clam Shell) and Zonghui (Palm Ash) externally to the wound to astringe. If injured but not broken, apply Toad Skin and gently massage. If scalded or burned, do not apply cold/raw medicines to stagnate smallpox. Song says: For injury, seek Fufengchu; Tubie (Earth Beetle) and Renshen, Chantui gallop; Ju Hong (Tangerine Peel), Gancao, Dang Gui combine; add Honghua, Fang Feng, Di Gu Pi (Lycium Bark). Formerly, Secretary Huang's second son, aged 13, had smallpox for two mornings. Falling upstairs injured his forehead, causing bleeding. Parents wept, believing death was certain. I treated him, doubling Renshen, Huangqi, Dang Gui, Shengdi in the previous formula. After four doses, smallpox erupted vigorously. Restlessness continued, so Fushen (Poria with Wood) and Guixin (Cinnamon Heart) were added. Externally, only Zonghui was applied. Within half a month, scabs fell off naturally, achieving full recovery. For severe pain, add a little Ru Xiang. For heavy external trauma/wide scars unable to scab, use Baiji (Bletilla), Bailian (Ampelopsis), and Elephant Skin powder sprinkled on, resulting in self-healing.