〔万〕水火者，阴阳之迹也，坎离者，水火之位也，心肾者，坎离之配也，故水阴也，而生于阳，离中之阴，乃
真水也。火阳也，而生于阴，坎中之阳，乃真火也。阴根于阳，阳根于阴，互为其根，所以能变合而生万物也。孔子赞
易，以坎为血卦、为赤，离为鳖、为蟹、为螺、为蚌、为龟，其义可见。以人身言之，血阴也，气阳
也，心配离而生血，阳中有阴，乃真阴也，肾配坎而生气，阴中有阳，乃真阳也，故心中之血，即肾中之真水也，灌溉
滋濡，水之德也，肾中之气，即心中之真火也， 嘘鼓动，火之象也，然水善而火恶，老子曰∶上善若水，下愚如火。
善恶之分也。况人之两肾，左为水，右为火，经曰∶七节之旁，中有小心，小心者，命门相火也，
以其为君之相，故云小心，行君之令，故云命门也。夫以一水立乎二火之间，其不胜也，明矣，运之于中而使火不赫曦，
水不涸流者，有神以主之也，所谓神者，何物也，太虚之中，神之栖也。然水火不并立，各有所胜，盛衰之变，此其常
也。故盛则薄所不胜而乘所胜也，命曰气淫。衰则所胜妄行而所生受病，所不胜薄之也，
命曰气迫。疮疹之火，起于命门之下，二火相合，所谓得助者强也，相火复挟君火之势，肆其猖獗，销烁燔炳，
无所不至，可恃者心中之真水，尚有以制之，奈何阳道常饶，阴道常乏，赫曦者其气淫，涸流者其气迫，并真水亦亡
而已矣。经曰∶成败倚伏生乎动，动而不已则变作焉。真水既亡，津液暴绝，其气滞，其发燥，槁不
能润乎皮毛，滋乎腠理，而疮中之血亦干而黑矣，是则变黑者，血色本赤，而干则变黑也。谓之归肾者，血本
肾中之阴，血干则肾水亦干矣，此肾虚之证，岂有肾实为邪之理乎。邵子观物篇曰∶东赤，南白，西黄，北黑，
此正色也，验之于晓午暮夜之时，可见之矣，由是推之，婴儿始生而赤，长稍变而白，病则黄，老死而
黑，物生地下而赤，稍长而白，萎落则黄，枯槁而黑，凡物皆资一阳之气以生，此四色者，乃一阳之气色递变者也。
夫痘疮由出现而起发，起发而成浆，成浆而结痂，亦人身中一阳之气之流行也，其出现而赤，起发稍变而白，成
浆则黄，结痂则黑，此亦色之递变自然者，乃证之顺，未可全以变黑为不正之色也。夫以变黑为逆者，
以四时言之，春主生，夏主长，秋主收，冬主藏，此自然之序，递相成功者也，痘
疮之出，犹春之生也，起发犹夏之长也，成浆犹秋之收也，结痂犹冬之藏也，亦自然之序，苟出现而黑色，是春
行冬令矣，起发而黑色，是夏行冬令矣，成浆而黑色，是秋行冬令矣，不循递变之次，故谓之逆。黑者，肾之色也，
为起蛰封藏之本，故以变黑为归肾也。又肺主皮毛，心主血脉，脾主肌肉，肝主筋，肾主骨髓，疮疹之
毒，由内而外为顺，内者不出曰伏，已出复入曰陷，不能成浆谓之倒陷，不能结痂谓之倒靥，曰伏、曰陷、曰倒，
皆由外而内，入于骨髓，故曰归肾为逆也。
按∶钱仲阳为万世幼医之祖，而独以变黑归肾，为肾实之证，其失不小，万氏辟之，最为详明，故备引之。
盖耳 者，肾之部也，诸痛疮疡皆属于火，肾本属水，水不畏火，故疮疹之初，肾独无证，凡五脏之部、之色、之
证、见者皆为恶候，故曰善则不可见，恶则可见也。倘若小儿，肾水本亏，则火毒愈盛，水不足以制之，而火反侮
其所不胜，及其既久，火熬水热，于是肾之所部始病，而恶证见焉，钱氏以百祥丸下之者，大有至理，盖大戟者，
泻小肠之药也，心与小肠为表里，不直泻其心，而泻其合，使心火下降而肾水上升，得阴阳交媾之
道，有起骨加肉之功，然不救者，尚十有九，水火岂易抽添哉！盖非百祥丸则
无治也，毒瓦斯去而真气不绝者犹活，前人谓百祥丸泻膀胱之水，令脾土复旺，是不读《本草》而且大夫仲阳之旨也。
又，导赤散亦仲阳所制，亦泻小肠，但与百祥丸之功效有宽猛耳，四圣散用木通亦妙，世以大戟为猛，而易以其
他淡渗之药，反泻膀胱与肾者，是不刃而杀之矣。万氏以百祥丸下肾中毒瓦斯，是犹以为肾实而泻其子也，毫厘之差，
千里之谬，不可以不辨。
疮痘黑陷，分四证，详见起发证治陷伏条。薛云∶喜热饮食，手足并冷者，
乃脾胃亏损，阳气虚寒之证，宜用辛热之剂补之。喜冷冻饮料食，手足并热，乃阳气实热之证，宜用苦寒之剂泻之。外感
风寒者温散之。毒入腹者分利之。阳气虚者温补之。外寒触犯者熏解之。陈宿州先生用十二味异功散，以预保脾土于
未败之先，实发前人之未发，开万世之聋 也。
〔闻人〕人牙散 治痘疮方出，风寒外袭，或变黑，或青紫，宜温肌发散，使热气复行，而 自出。用人齿、
脱落者不拘多少，瓦罐固济， 过出火毒，研末。出不快而黑陷者， 猪血调下一钱，因服凉药血涩倒陷者，入麝香
温酒服之。
初虞世名回生散，用人牙灰入麝香少许，每服半钱，黄 、白芍药、煎汤调下。
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。一方，用鸡冠血调成膏，好酒半盏，人乳半盏，入葱白一茎，煎汤送下。彭氏云∶只用紫草汤，自
好疮痘，最怕麝香与酒气，触禁，不可用。凡服牙齿，不可过多，每服止三分，多则阳气尽出于表，恐痘斑
烂无血色，阴气内盛，必里寒而濡泄，急以四君子加芎、归服之。
〔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。
〔寇〕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。）
〔万〕凡痘子黑陷，古方用穿山甲者，取其穿肠透膜而善走也，用人牙者，取牙齿乃骨之余，肾主骨，可以入
肾也，此二物者，但借为向导，引解毒之剂以施
治则可，若军用之，何济于事哉，有用烧人屎者，盖屎大解疫毒，痘乃时疫所发，
故宜用之，若加入发表和中解毒汤内尤良。
上方，皆通表发肌之药，首一证感风寒，肌窍闭塞，血凝不行而黑陷者，宜之。
《活人》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）。
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）
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，身黄紫肿。
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，未有他证，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。铁脚葳灵仙为末炒，一钱，脑子一分，用温水调服，取下疮痂，为效。
《活人》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）。
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。
上方，皆里药，第二证所谓毒瓦斯太盛，内外蒸烁，毒复入里，必心烦狂躁，气喘妄言，如见鬼神，大小
便秘，渴而腹胀者所宜，选而用之者也。
〔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）
上，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）
〔魏〕变黑归肾，乃气弱不能蓄血，血亦不荣，故致枯萎而黑，只用保元汤加芎、桂、补提其气，气旺，
则黑者转而为黄矣。
上补虚例。第三证所谓内虚而不能使阳气以副云云者之所宜也。
吴氏云∶痘色初深红者，必变紫，紫必变黑，紫黑必至于干枯，此血热渐变，理势之一定不移者也，故初见
深红，失于解散，至于干枯黑陷，危殆极矣。治法，当以凉血退热为主，看其微甚，或利大便，或利小便，或
用解散之剂，顶虽平陷，
不可专以气虚例之，而惟用参 补剂，补则气愈盛，而血愈干涸矣。翁氏治血热证，七八日间有紫黑干枯，及青
灰干黑陷者，有夺命大造、谈笑博金、一字金、或百祥、牛李、猪尾等方，然早能凉血解毒，必无此患，患此而后
用此药，得全者少矣。若服凉解之药过多，以致泄泻滑脱，而成黑陷者，仍从陈氏法，以木香、异功
治之，又不得以血热为拘也。
夺命五毒丹 治痘黑陷倒靥，干枯不起者，神验。
月魄（蟾酥。少许） 吐月华（牛黄。二分） 银红（朱砂。一钱） 男王（雄黄。三分） 梅精（冰片。二分）
上五味，用 猪尾血、为丸如麻子大。薄荷汤下一丸，移时活动。
谈笑博金丹 治同上。
取用寅亥戌未四时四灵丹，加脐香下。（俱用天灵盖）
大造保童丸 治同上，兼治痘毒。亦妙。
一蛮子（人胎骨。炙过）二野狼子（狗胎骨。酥炙）三猫子（猫胎骨。炙过）
上，加脐香下。
一字金丹 治同上。
紫花地丁 金线重楼 山慈菇
至宝丹 治同上。
戌腹粮（即将大米、净室与犬食饱，取其粪洗净、炙干、研细，每一两、麝香一、二分）
一粒金丹 治同上，虚证虽死者，可立活。
腽肭脐（二） 鸦片（三） 冰片（二） 麝香（一） 原蚕蛾（二）
[Wan Quan] Water and fire are the external manifestations of Yin and Yang; Kan (Water) and Li (Fire) trigrams represent the positional symbols of water and fire; the Heart and Kidney correspond to the Kan and Li trigrams in organ association. Therefore, water belongs to Yin but is generated from Yang (containing Yang within); the Yin line within the Li trigram constitutes the true Yin water. Fire belongs to Yang but is generated from Yin (containing Yin within); the Yang line within the Kan trigram constitutes the true Yang fire. Yin takes Yang as its root, and Yang takes Yin as its root; they serve as mutual roots, thereby enabling transformation and combination to generate all things. Confucius, in praising the *I Ching* (Book of Changes), stated that the Kan trigram represents the Blood trigram and the color red, while the Li trigram represents turtles, crabs, snails, clams, and tortoises; the underlying principles can be seen here. Regarding the human body, blood is Yin and Qi is Yang. The Heart corresponds to the Li trigram and generates blood; Yang containing Yin constitutes true Yin. The Kidney corresponds to the Kan trigram and generates Qi; Yin containing Yang constitutes true Yang. Thus, the blood in the Heart is the true water in the Kidney, possessing the virtue of irrigation and moistening, which is the nature of water. The Qi in the Kidney is the true fire in the Heart, exhibiting the image of blowing and stirring, which is the nature of fire. However, water is benevolent and fire is fierce. Laozi said: "The highest good is like water; the lowest is like fire." This denotes the distinction between benevolence and fierceness. Moreover, in the two kidneys, the left belongs to water and the right to fire. The medical classics state: "Beside the seventh vertebra, there is a 'Small Heart' (Xiao Xin)." This 'Small Heart' refers to the Ministerial Fire of the Gate of Life (Mingmen). Because it assists the Sovereign Ruler (Heart), it is called 'Small Heart'; because it executes the orders of the Sovereign, it is called the Gate of Life. With one water standing between two fires, it is evident that water cannot overcome fire. What operates in the middle to prevent the fire from becoming excessively blazing and the water from drying up is the 'Spirit' (Shen) that governs it. What is this Spirit? It resides in the Great Void (Tai Xu). However, water and fire cannot coexist stably; each has its dominance. Fluctuations in prosperity and decline are the norm. When one aspect is prosperous, it bullies what it cannot overcome and exploits what it overcomes; this is termed "Qi Indulgence" (Qi Yin). When one aspect is deficient, what it overcomes acts recklessly, and what it generates suffers disease, while what it cannot overcome bullies it; this is termed "Qi Compulsion" (Qi Po). The fire of smallpox and measles originates below the Gate of Life. When the two fires combine, strength is gained through assistance. The Ministerial Fire, carrying the momentum of the Sovereign Fire, runs rampant, consuming and burning without limit. One can rely on the true water in the Heart to restrain it. Alas, Yang is often abundant, while Yin is often deficient. Blazing fire leads to Qi Indulgence; dried-up water leads to Qi Compulsion. Eventually, even the true water perishes. The classics say: "Success and failure lie hidden in movement; ceaseless movement gives rise to transformation." Once the true water perishes, body fluids suddenly cease. Qi stagnates, dryness develops, and the skin and hair lose moisture and nourishment. Consequently, the blood within the lesions dries and turns black. This explains why lesions turn black: blood is originally red, but turns black when dried. This is termed "Returning to the Kidney" because blood originates from Kidney Yin; when blood dries, Kidney water also dries. This is a pattern of Kidney Deficiency, not Kidney Excess with pathogenic factors. Shao Yong in his *Guanwu Pian* states: East is red, West is white, South is yellow, North is black; these are the primary colors. This can be verified by observing morning, noon, dusk, and night. By extension, infants are born with a reddish complexion, which gradually turns white as they grow, yellow when ill, and black upon death. Plants growing underground are red, turn white as they grow, yellow when withering, and black when dead. All things rely on the Qi of Yang for growth; these four colors represent the sequential changes in the color of Yang Qi. Smallpox progresses from eruption to development, from development to pustule formation, and from pustules to scabbing. This is also the circulation of Yang Qi in the body. Eruption is red, development slightly whitens, pustules are yellow, and scabs are black. This is the natural sequential change of colors, representing a favorable prognosis (Shun). One cannot simply regard turning black as an unfavorable color. If turning black is considered adverse, consider the seasons: Spring governs growth, Summer governs flourishing, Autumn governs harvesting, and Winter governs storing. This is the natural order of successive achievement. The eruption of smallpox is like Spring's growth; development is like Summer's flourishing; pustule formation is like Autumn's harvesting; scabbing is like Winter's storing. This is also the natural order. If lesions appear black upon eruption, it is like Spring executing Winter's command; if black upon development, it is like Summer executing Winter's command; if black during pustule formation, it is like Autumn executing Winter's command. Failing to follow the sequential order is termed "Adverse" (Ni). Black is the color of the Kidney, the root of hibernation and storage; thus, turning black is termed "Returning to the Kidney." Furthermore, the Lungs govern skin and hair, the Heart governs blood vessels, the Spleen governs muscles, the Liver governs sinews, and the Kidneys govern bone marrow. Pathogenic toxins of rashes and smallpox emerging from inside to outside is favorable. Toxin remaining inside without emerging is called "Trapped" (Fu); emerging and then sinking back in is called "Sunken" (Xian); inability to form pustules is called "Reverse Sunken" (Dao Xian); inability to scab is called "Reverse Scabbing" (Dao Ye). Fu, Xian, and Dao all indicate movement from outside to inside, penetrating into the bone marrow; hence, returning to the Kidney is adverse.
Commentary: Qian Yi (courtesy name Zhongyang) is revered as the ancestor of pediatric medicine for all generations, yet he uniquely attributed blackening of smallpox to Kidney Excess, a significant error. Wan Quan refutes this most clearly and comprehensively, so I quote him in full. The ear region is the external manifestation of the Kidney. All pain, ulcers, and sores belong to Fire. The Kidney inherently belongs to Water; Water does not fear Fire. Therefore, in the early stages of smallpox, the Kidney alone shows no symptoms. Whenever the manifestations, colors, or symptoms of any Zang organ appear, they are ominous signs. Thus, it is said that auspicious signs should not appear, while ominous ones do. If a child has inherent Kidney Water deficiency, Fire toxicity becomes even more vigorous. Water is insufficient to restrain Fire, and Fire counter-rebels against what it cannot overcome. After a long time, Fire boils the Water, causing pathology in the Kidney's domain and manifesting evil signs. Qian Yi used Baixiang Pill (Hundred-Immortality Pill) to purge, which holds profound rationale. Dajie (Euphorbiae Pekinensis Radix) purges the Small Intestine. The Heart and Small Intestine are exterior-interior pairs. Rather than directly purging the Heart, one purges its paired organ, allowing Heart Fire to descend and Kidney Water to ascend, achieving the Tao of Yin-Yang interaction, with the power to restore life from death. However, nine out of ten cases remain untreatable. Can Water and Fire be easily added or subtracted! Without Baixiang Pill, there is no treatment. If toxin is removed and True Qi remains unextinguished, survival is possible. Predecessors claimed Baixiang Pill purges Bladder Water to strengthen Spleen Earth; this indicates a failure to read the *Bencao* (Materia Medica) and misunderstand Qian Yi's intent. Daoye San (Guide Out the Red Powder), also created by Qian Yi, also purges the Small Intestine, but differs from Baixiang Pill in being milder versus stronger. Six-Sheng San uses Mutong (Akebiae Caulis), which is also clever. People consider Dajie too harsh and substitute other bland-draining herbs, which inadvertently harms the Bladder and Kidney, effectively killing without a blade. Wan Quan uses Baixiang Pill to purge Kidney toxin, still viewing it as Kidney Excess and purging its "Son" (Water generates Wood, but here referring to the Five Elements generation cycle where Kidney Water generates Liver Wood, or potentially referring to purging the bladder/earth relation depending on context, but strictly following text "purge its son"). A difference of a hair's breadth leads to a thousand-mile error; this must be distinguished.
Black sunken smallpox/measles is divided into four patterns; see details under "Development Pattern Treatment for Sunken Patterns." Xue Ji stated: Those who prefer hot drinks/food and have cold hands and feet suffer from Spleen-Stomach deficiency and Yang Qi deficiency-cold; treat with acrid-hot tonics. Those who prefer cold drinks/food and have hot hands and feet suffer from Yang Qi excess-heat; treat with bitter-cold purgatives. For exterior Wind-Cold invasion, use warm dispersal. For toxin entering the abdomen, use separating and draining methods. For Yang Qi deficiency, use warming tonification. For exterior Cold contact, use fumigation and resolution. Mr. Chen Suzhou used Twelve-Ingredient Yigong San to protect Spleen Earth before collapse, truly elucidating prior theories and awakening future generations.
[Wen Ren Shi] Renya San (Human Tooth Powder): Treats smallpox just erupted, attacked by exterior Wind-Cold, turning black or cyan-purple. Use warm muscle-dispersing methods to restore heat flow so eruptions emerge naturally. Use human teeth (fallen teeth, quantity unrestricted). Seal in a clay pot, calcine to remove fire toxicity, and grind to powder. For slow emergence with black sinking, mix with pig blood and take 1 qian. For reverse sinking due to cooling herbs causing blood stasis, add Moschus (Shexiang) and take with warm wine.
Chu Yushi's Huisheng San (Life-Restoring Powder): Uses calcined human tooth ash with a little Moschus. Take 0.5 qian per dose, mixed with decoction of Huangqi (Astragali Radix) and Baishao (Paeoniae Radix Alba).
Qian Yi's formula uses warm wine. Yunqi's formula uses Shengma (Cimicifugae Rhizoma) and Zicao (Arnebiae Radix et Rhizoma) decoction. Haizang stated: For those with chronic greasy stool, use Tongge Wan coated with Cinnabar (Zhusha), acting in concert with Xuanfeng San. Another formula uses cockcomb blood made into a paste, taken with half a cup of fine wine and half a cup of human milk, plus one stem of Congbai (Allii Fistulosi Bulbus) decocted in water. Peng Shi stated: Using only Zicao decoction allows natural recovery. Moschus and alcohol aroma are strictly contraindicated. When using tooth preparations, do not exceed 3 fen per dose. Excessive amounts cause Yang Qi to escape to the surface, risking ulcerated lesions without blood color, internal Yin excess, interior cold, and diarrhea. Immediately administer Sizijun Zi Tang (Four Gentlemen Decoction) plus Chuanxiong (Ligustici Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix).
[Tang] Treating black-sunken smallpox where medicines fail to erupt: Effective. Use Chanshunjia (Manis Pentadactyla scales), calcined to retain property, ground to fine powder. Add a little Moschus. Dosage: 5 fen for 1-year-old, 1 qian for 3-year-old. Mix with warm wine. One dose brings effect; even half-body black sinking near death may temporarily revive and turn red. However, if eyes are closed and spirit is lost, death is certain.
[Kou] Mahuang Tang (Ephedra Decoction): Use 5 qian of Mahuang (Ephedrae Herba) with root nodes removed. Stir-fry with 1 spoon of honey for a long time. Decoct in half sheng of water. Boil, skim foam, boil further until one-third evaporates. Do not discard dregs. For inverted/black scabbed lesions, drink hot immediately. Avoid wind. Wait for eruptions to reappear. Alternative: Decoct in non-grain alcohol for faster action, but difficult for children who cannot drink alcohol, as this is an exterior-releasing formula. (This method is widely circulated and effective.)
[Wan Quan] For black-sunken smallpox, ancient formulas use Chanshunjia for its penetrating and moving properties, or Renya (Human Teeth) because teeth are surplus of bone, and Kidneys govern bone, allowing entry into Kidneys. These two substances merely act as guides to lead detoxifying agents. Using them militarily yields no benefit. Some use calcined human feces because feces resolves epidemic toxins; smallpox arises from epidemics, so this is appropriate. Adding to exterior-releasing, middle-nourishing, and detoxifying decoctions is especially good.
The above formulas are all exterior-penetrating and muscle-releasing drugs. They suit the first pattern: Exterior Wind-Cold blocking skin pores, causing blood stasis and black sinking.
*Huoren* (Book of Living People) treats black inverted lesions with Zhuwei Tang (Pig Tail Decoction), Wubi San (Peerless Powder), and Longnao Gao (Borneol Ointment), all effective. (Haizang stated: Herbal purgatives seem superior to Borneol and Moschus; use only when absolutely necessary.)
Zhuwei Gao (Pig Tail Ointment): Treats inverted scabs. Prick tip of young pig tail for two drops of blood. Grind with a little raw Longnao (Borneolum Syntheticum). Mix with fresh well water. Take after meals. Immediate effect.
Longnao Gao Zi (Borneol Pills): Treats epidemic smallpox, incomplete eruption, mental restlessness, mania, panting, delirium, hallucinations, or eruption followed by sinking. Urgent treatment is required; otherwise, toxin enters viscera leading to death. Use 1 qian raw Longnao, finely ground. Mix with pig heart blood to make pills the size of beans. Take one pill per dose. For mental restlessness/manic behavior, dissolve in Zicao decoction. For sunk lesions, dissolve in warm wine. Calm mind, sleep ensues, eruptions penetrate thoroughly. Rest normally to recover. (Haizang noted: This method is for extreme conditions, hence *Huoren* says "use only when necessary.")
Sifen San (Four Feces Powder): Treats inverted black-sunken lesions. (From *Yu Yuan Yao Fang*). Verse: Human, cat, pig, dog feces burned on Chen day in December. Take 3 qian mixed with honey water. Regardless of inversion or black sinking, ten thousand gold pieces are worth it. (Prepared on Chen day in December; very effective.)
[Zhang Zihe] Renzhonghuang (Human Urine Cake): Best from December. Burn in ventilated area to coal. Mix with water, take 3-5 qian. Sunk lesions will emerge. Danxi stated: Zihe used calcined human feces for severe black sinking; this is the same formula.
[Shi] Treating incomplete rash/smallpox, dry black and critical. Use Shan Zha Rou (Crataegi Fructus flesh) ground to powder. Take 2 qian, washed down with Zicao wine. Adjust dosage by age. Slowly take 3-4 doses. Lesions become red and vibrant.
[Haizang] Liu Shouzhen's Liangge San (Cooling Chest Powder) is also excellent for pediatric black-sunken rashes, but only suitable for hard stools and dark/scanty urine. If bowels/bladder are already open, do not use. Removing Dahuang (Rhei Radix et Rhizoma) and Xiaocuo (Natrii Sulfas) is safest.
[Qian Yi] Severe smallpox/rashes: 4-5 out of 10 survive. Black lesions: hardly 1 out of 10 survives. Symptoms include chills, grinding teeth, yellow/swollen/purple body. Urgently purge with Baixiang Pill. If aversion to cold persists, cold body with sweating, but ears and sacrum become hot, death occurs. Why? Kidney Qi is overly vigorous, Spleen deficiency fails to control. Post-purge warmth and thirst indicate treatability (Spleen Qi generating, overcoming Kidney, cold departing, warmth returning). Treat with detoxification; do not blindly purge. Blind purging causes internal deficiency accumulating in Kidneys. If eating well and scabs are dry/rising, or not dry but with strong panting, purging is allowed using Sishun Yin. Red-sunken lesions with hot ears/sacrum are adverse; use Baixiang Pill and Niuli Gao, 3 doses each. If ineffective, death.
Baixiang Pill (also Nanyang Pill): Treats rash black-sinking with chills and teeth grinding, yellow/purple swelling.
Hongya Dajie (Red-stemmed Euphorbia): Quantity unrestricted. Dry in shade. Soften in bean juice, remove woody core. Sun-dry. Re-boil in juice until dry. Roast dry. Grind.
Make water pills the size of millet seeds. Take 10-20 pills per dose, washed down with sesame seed decoction. Same for vomiting/diarrhea. Anytime. Excellent for teeth grinding.
Niuli Gao (Cow Plum Ointment): Juice of Niuzi (Cow Plums), quantity unrestricted. Boil in stone mortar to ointment. Grows by wild roads, fruits black in autumn. If fresh unavailable, use dried powder boiled in water. Take size of soap bean, dissolved in Apricot Gum decoction. Harvest in mid-9th lunar month.
Prince Muqin's First Prince suffered rash. Initially treated by Dr. Li, then Qian Yi was summoned. Qian left Bao Long Wan (Three doses). Dr. Li purged, causing dense rash. Qian was shocked: "If not reversed [by proper management], it becomes adverse." Prince said Li already purged. Qian said: "Rash just emerged, no other symptoms, cannot purge. Use mild meds, frequent feeding, avoid cold/wind. If scabs form and eating, purge once/twice with Dahuang Wan, then stop. Purging now prevents full eruption and causes density; hard to treat. This is error. Even if recovered, three sequelae: scabies, abscesses, red eyes." Dr. Li could not treat. Three days later, black sinking returned. Qian said: "Fortunately no chills, condition not exhausted." Used Baixiang Pill as main, Niuli Gao as assistant, two large doses each. Day 5: lesions red/vibrant. Day 7: cured. Black returns to Kidney Water; Kidney overcomes Spleen; Earth fails to control Water; Spleen deficiency/chills = hard to treat. Baixiang Pill purges Bladder Fu; if Fu not full, Zang not excessive. Why not purge Kidney? Kidney governs deficiency, cannot tolerate purging. Two doses ineffective = cold/death.
[Zhang Zihe] Treats rash black sinking. Tie Jiao Weiling Xian (Smilax glabra rhizome) roasted powder, 1 qian. Naozhi (Camphor/Borneol), 1 fen. Mix with warm water. Effective when scabs fall off.
*Huoren* Wubi San (Peerless Powder): Treats pediatric rash evil signs.
Zhusha (Cinnabaris, pre-ground, 1 liang) Niuhuang (Calculus Bovis) Shexiang (Moschus) Zhangnao (Camphora) Nifen (Calomelas) (fine ground, 1 qian each).
Grind together. Pediatric dose: 1 zi; Adult: 5 fen. Add little Mercury. Mix with 2-3 drops pig tail blood and fresh water. Administer. Prefer stable sleep, then expectoration of foul slime/feces-like material. Pediatric dose mixed with breast milk is excellent. (Haizang: Purges extreme internal heat unable to vent externally; penetrates skin; similar to Zhibao Dan.)
Pediatric Rash Black-Sunken Formula:
Gan Yanzhi (Dry Carmine, 3 qian) Hetao (Walnut, 1 piece, calcined)
Grind to powder. Wash down 1 qian with Coriander Wine decoction. Immediate effect.
Above treats Blood Stasis black sinking. Previous formulas using Chanshunjia/Moschus target Qi Stagnation.
Above formulas are Interior drugs. Suitable for Pattern 2: Excessive toxin steaming internally/externally, toxin re-entering interior. Symptoms: restlessness, mania, panting, delirium, hallucinations, constipation, thirst, abdominal distension. Select and use accordingly.
[Yan] Zicao San (Arnebia Powder): Treats rash black sinking. Cured previously. Kang/Qian noted Zhiqiao (Aurantii Fructus) is hard to take.
Zicao (Arnebiae Radix et Rhizoma) Gancao (Glycyrrhizae Radix et Rhizoma) Nuomi (Oryzae Semen Glutinosum) Huangqi (Astragali Radix) (Equal parts).
Decoct in water and drink.
[Danxi] Two types of black-sunken smallpox due to Qi deficiency preventing toxin expulsion: Use Huangqi, Renshen (Ginseng Radix et Rhizoma), Jiu Chao Zicao (Wine-fried Arnebia).
Normal color: Treat as above. (Tonify with Ginseng/Astragalus, assist with Arnebia's promoting/dredging action.)
[Wei] Blackening returning to Kidney is due to weak Qi failing to hold blood, blood failing to nourish, leading to withering/blackening. Use Baoyuan Tang (Preserve Origin Decoction) plus Chuanxiong, Guizhi (Cinnamomi Ramulus) to tonify and lift Qi. When Qi is vigorous, black turns yellow.
Above: Tonifying Deficiency example. Suitable for Pattern 3: Internal deficiency failing to support Yang Qi.
Wu Shi stated: Deep red initial color turns purple, then black, then dry/shriveled. This is inevitable progression of Heat in Blood. If deep red initially fails to disperse, it becomes dry/black-sunken, extremely critical. Treatment: Cool Blood and clear Heat primarily. Assess severity: purge bowels, drain urine, or use dispersing agents. Even if flat/sunken, do not assume solely Qi deficiency and use only Ginseng/Astragalus tonics. Tonification increases Qi, drying Blood further. Weng Shi treated Heat in Blood (days 7-8, purple/black dry, cyan-black sinking) using Duoming Dazao, Tanxiao Bojin, Yizi Jin, Baixiang, Niuli, Zhuwei etc. Early cooling/detoxification prevents this. Late use results in few recoveries. If cooling herbs cause diarrhea/slippage leading to black sinking, follow Chen Shi's method: Muxiang (Aucklandiae Radix), Yigong San. Do not be rigid about Heat in Blood.
Duoming Wudu Dan (Life-Rescuing Five-Toxin Pill): Treats black-sunken inverted dry smallpox. Divine efficacy.
Yuepo (Chan Su / Toad Venom, little) Tui Yuehua (Niu Huang / Calculus Bovis, 2 fen) Yinghong (Zhusha / Cinnabaris, 1 qian) Nanwang (Xionghuang / Realgar, 3 fen) Meijing (Bingpian / Borneolum Syntheticum, 2 fen).
Mix five ingredients with pig tail blood, make pills size of hemp seeds. Take one pill with Mint decoction. Activity resumes shortly.
Tanxiao Bojin Dan: Treats same.
Use Si Ling Dan (Four Spiritual Pills) from Yin/Hai/Xu/Wei hours, add Navel Fragrance (Tianlinggai / Human Skull Cap). All use Tianlinggai.
Dazao Baotong Wan: Treats same, also smallpox toxin. Excellent.
Yiman Zi (Ren Tai Gu / Human Fetal Bone, roasted) Er Yelang Zi (Gou Tai Gu / Dog Fetal Bone, butter-roasted) San Mao Zi (Mao Tai Gu / Cat Fetal Bone, roasted).
Add Navel Fragrance.
Yizi Jin Dan: Treats same.
Zihua Diding (Violaris Herba) Jinxian Chonglou (Paris Polyphyllae Rhizoma) Shancigu (Fritillariae Thunbergii Bulbus).
Zhibao Dan: Treats same.
Xu Fuliang (Rice fed to dog in clean room, feces washed, roasted, ground. 1 liang + 1-2 fen Moschus).
Yili Jin Dan: Treats same. Even dead deficiency cases revive instantly.
Wana Qi (Viverrina Penis) Yapian (Papaveris Cortex) Bingpian (Borneolum Syntheticum) Shexiang (Moschus) Yuancang E (Bombyx Batryticatus).