痘紫干红，热盛皮燥，二便清溏，饮食短少，表热里寒，此理显耀，能明此理，
药无不效。里热表寒，痘色灰白，粪结尿黄，切牙寒战，辨明施治，功超太皇。表
里俱热，狂言烦躁，痘子干红，干燥又渴，二便不通，早下奇方。表里俱寒，痘色灰
白，陷顶不红，二便清溏，头温足冷，清浆作痒，寒战切牙，温补回祥。（又曰∶无汗表
实，有汗表虚，诸痛为实，诸痒为虚，红则为热，白则为寒，热应足温，白赤寒热。）
初热三日在肾经，热盛而不知用疏散，或遍身痛，或出黑斑，或出之后见此，乃
脏腑臭烂必死，此肾经之变证也。见点三日在心经，若痘焦赤色，狂言烦躁，如不
知用解毒药，以致红黑斑生，或口臭尿血，心经变证也。起壮三日在肺经，以前调治
不清，不知用疏毒药，或痰喘咳嗽，挫喉声哑，或大便泻，此肺经变证也。收敛三
日在肝经，已前失治，而不知疏毒凉血，散邪助气，以致少浆黑陷空收，或寒战切牙，
或目翳，此肝经变证也。收靥三日在脾经，如以前失治，或发痈疽，牙齿脱落，唇焦
眼肿，此脾经变证也。（故重在先散肾毒，二凉心，
三平肺气，三脏既平，然后敛血归肝，调理脾胃，自无变生之患。）
初热三朝，肾经主事，宜发散。（前胡、半夏、苏叶、葛根、桔梗、茯苓、陈皮、枳壳，火盛加知
母、黄柏。）出痘三朝，心经主事，宜清解。（归尾、红花、桔梗。）灌浆三朝，肺经主事，宜温
补。（桔梗、白芷。）收靥三朝，肝经主事，宜敛血。（地黄、白芍、桔梗。）靥毕三朝，脾经主事、
宜固脾。（茯苓、白术、薏仁、莲肉、山药。）
痘初发热三朝治法∶痘疹之发，有类伤寒，憎寒壮热，身体疼痛，鼻流清涕者，
宜参苏饮；若壮热不退，谵语昏迷者，宜人参羌活散；若泄泻寒热，小便黄赤，口
渴，用四苓散加木通；若干呕加姜汁、炒黄连；渴加麦门冬；若水泻小便清，可用理中汤加附子，或人参、官桂可用。
痘见点三朝治法；发热一朝出者，凶也。发热二日出者，次之。发热三四日出
者，皆轻。若热盛急用人参羌活散加紫草、牛蒡子之类，服数剂不妨。若紫红色者，可
与化痰汤加酒炒黄芩、黄连。若吐衄者，可与犀角地黄汤；热极者加黄芩。若痘夹疹
可用麻黄甘葛汤主之，其疹自退。若痘夹斑可与升麻葛根汤，多磨犀角水在内服之，
仍加紫草、蝉蜕煎服。若作渴照前分冷热治之，热用四苓散，冷用理中汤。
灌浆三朝治法∶灌浆三朝务须饱满，如根窠色红是顺，红疔无脓为逆，可用托里
散加黄 、人参、肉桂发之。若内虚泄泻，可与异功散治之。
痘疮起胀三朝治法∶痘疮起胀，（俗名大胖。）三朝肥满光泽，根窠红活，饮食如常，
不须服药必顺。若顶陷白色属气虚，可与四君子汤加黄 、官桂、川芎、山楂、人
参、茯苓。若紫红色者，乃热毒未解，可用四圣汤加紫草、酒炒黄芩、黄连、红花
之类。治热者四苓散，寒者理中汤，送下豆蔻丸。
痘至十日当靥治法∶痘疮十日当回，痒塌寒战切牙，泄泻腹胀者，急用异功散治
之。如饮食不进，水米不化，急与丁香、陈皮、白豆蔻、附子之类，后再解毒，若无脓，声哑气急，即死不治。
以上痘疹治法，谆切明白，时时参悟，要在随证处方，对证用药，加之眼力观看，以决生死，无不验也。
诸经传于肾经，夹热见标而毒极盛，必转寒战而死也。痘当收不收，宜均气收浆
汤，再加人参四物汤治之。痘十余朝不能大便者，用木通白术散治之，不然变寒战
而死。痘痒塌无脓，七真汤加何首乌、麦冬治之。痘后头痛，加川芎、白芷、升麻
在霪羊均气二汤内服。痘后声哑，用七真汤，或升天散、霪羊均气汤内加诃子、桔
梗，其功甚大。痘后灰白泄泻，用升天散加人参、诃子、白豆蔻治之。痘后腹胀，用
霪羊均气二汤，内加茯苓、香附、神曲治之。痘便青粪，用均气汤加白术、附子、川
芎治之。室女出痘行经，用四物汤，仍加炒赤芍治之。痘出完，泄泻发肿，乃毒复
入内，急用托里千金散治之，如不早治，内攻必死。如天庭有地而成者，如绿豆润泽，
其痘必有风寒，略为疏散皮肤，去其风寒助气，乃上吉之痘也。如天庭痘密而黄色，
根窠红者，虽有后变灰色，须扶表里，免成陷伏之证。如天庭痘稀者，各部甚多，不
必服药而自愈也。此痘要气血补足，如大意因循，后必变为痒塌泄泻而亡。（宜用麝灵
丹。小儿天灵盖一具，米泔水洗净，将真麝香少许涂上，炙令黄色，研细姜汤调下。）
聂九吾曰∶大凡调治痘疮，自发热之初，见点之时，即须思及如何起发，如何
灌浆，如何收结，一动手用药，便要顾首顾尾，慎其初以善其后，然后次第调治，可保万全也。
痘有夹斑而出者，有红赤点而无头粒，多随出而随没。又有夹丹而出者，红赤成
片如云头而突起，此皆毒火浮游散漫于皮肤之间也。遇此者不必惊慌，但用元参升
麻汤一二剂，散其游火，其 丹自退。（元参、
升麻、甘草、防风、牛蒡子、荆芥煎温服。）有夹麻疹
而出者，用前方加桔梗、黄芩。令其麻疹先退，痘疮自当起发也。
痘疮初见一二日细小，四五日渐大顶平，至六七日脚渐阔，顶愈平陷，其色金
白，形如豆壳者，名曰倒靥，此气血大虚而浆不行也。宜用参归鹿茸汤加官桂、白
术、川芎、南木香。大便溏泄者，兼用参术散；痘痒者，表虚也，此为危证，宜参
实表汤。（蜜炙黄 、人参、官桂、炙草、防风、白芷、当归、浓朴、南木香、川芎、桔梗，煎温服。一
方外治痘痒，用荆芥穗为末，纸裹扎紧，糊粘纸头令不散，仍烘干，灯上燃之，却于桌上舂去灰，
指定痒痘，用荆芥火点痒处一下，患者自以为妙，每痒痘悉点之立止。）
痘痒必定属虚，管 乃谓气盛，血热而痒者，此无稽谬说也。又有谓因血上行
气分，血味本咸，腌螫皮肉作痒，似为近理，然灰白之痘，不为气虚，而血虚亦甚
矣。岂能上行而腌皮肉痒塌最甚，则此说亦未必然也。有秽气触犯而痒者，急烧苍
术、红枣，或黄茶叶以辟之，甚者内服平和汤。
表虚之痘，脓浆不满，多有痒者，其在幼儿，或儿虽长而神气困者，必不能禁
其手搔，须令其着就旧软绢衣袖长者，用绢条缚其袖口，令不得爪搔为妙，如无绢
衣，或作软绢袋裹儿手亦可。（有一六岁女孩，其痘不正，脓浆淋漓而痒甚，曾用此法，得不搔破，其后
头面亦无疤痕，若不用此法而抓破已多，纵性命能保，恶疤决难免也。）
痘痛为实，此为吉兆，用生白芍为细末，酒调下一钱五分立止，甚者不过二服。
痘出齐后，有头目肿胀，而痘不胀者，此血虚气弱，不能抱摄毒瓦斯以成脓，故其
毒散漫，妄行肉分也，此为危候。急宜大补气血以收摄其毒，则痘灌脓而肿胀自消
矣。参归大补汤。（人参、当归身、炙黄 、川芎、桔梗、楂肉、炙甘草、防风、白芷、浓朴、紫草茸、木
香同煎温服。）痘疮原多溃烂，收结后或手足等处仍作热臭，烂出脓水不止者，生肌散
掺。（地骨皮、黄连、黄柏、五倍子、生甘草等分，研细
干掺之，即退热结痂而愈。其有仍作热作脓而不即愈者，内毒未净也。仍用大连翘饮解之。）
又有余毒流注各处，出清水者，绵茧散掺。（也蛾茧不拘多少，用生明矾末填在内，烧令汁
尽成灰，为末干掺之。）
痘有鼻中衄血者，毒瓦斯上冲于肺也，此其毒瓦斯外泄，亦非恶候，不必惊惶，只用
发灰散。（用少壮无病患乱发，不拘男女，肥皂洗净油
垢气，又用温汤洗净肥皂气，焙干，量发多少用新瓦罐
一个，将发填入内令满，净瓦片盖口，盐和泥封之，又
全封瓦罐晒干，用炭火围罐一半， 一炷香久，取出候
冷，其灰成块，研令极细末，每用二钱，童便七分，酒
三分，调服立止，轻者用灰吹鼻亦止，此方极妙，不惟
可用于痘疮，凡诸血证皆可用。）或清肺汤治之。（花粉、麦冬、天冬、甘草、桔梗、当归、生白芍、片芩、丹
皮、知母同煎一二服，或入发灰一钱，调服尤妙。）切不可峻用寒凉，如犀角、生地、山栀、生三
黄之类，冰伏其血，必为大害。世人不诸此理，一遇痘疮有衄血咽喉口舌等证，即
认为实热，遽投以寒凉，冰凝血脉，以致痘疮不得成脓，而变为坏证者多矣，是治而未妨其本，昧之甚者也。
痘有水泡无脓者，血少不能化脓也。急宜参归鹿茸汤峻补其血。若脓 与水 相
半者，无大妨害；如十分中有二三分脓 者，犹有生意；惟浑身水 ，全无脓浆则
危矣。然胃气好而饮食如常者，亦可望生。但其毒瓦斯未散，须防发痈耳。其或儿小痘
多，则气血有限，不能尽成脓浆，而水 与脓 相间，此常理也。若无他证不必施治。
痘有口舌生疮者，或者热毒，或者虚火，当以痘色辨之。切不可概认为实热，而
纯用寒凉解毒，如痘色红紫涌盛者，热毒也，用清上饮主之。（薄荷、防风、甘草、葛根、牛
蒡、连翘、桔梗、黄芩、黄连、花粉、麦冬同煎，温服。）
如痘色淡白者，虚火也，用参麦清肺汤主之，外用赴筵散。（薄荷、黄柏各等分、入青苔少许，
和匀搓。）如口舌生疮而肿碍者，痘靥自愈，不必治，治不效。
痘有咽喉肿痛者，首尾俱用利咽解毒
汤，（山豆根、麦冬、元参、桔梗、牛蒡、防风、甘草煎，食后良久分三二起缓服。）外用王锁匙搽。
（硼砂、朴、硝、僵蚕、冰片，研细，竹管吹之。）
痘有音哑者，当细辨痘色，以分顺逆。若痘色红者，行浆而音哑者，此气喉有痘
也。是以外痘行浆时，内痘亦行浆也，窒碍气道而音不亮也，待外痘靥则内痘亦消，
而音自亮矣。此不必别加调治也。若痘色虚陷，灰白而音哑者，乃血气虚弱，送毒
不出，毒留于肺，肺气受伤，以致失音，此则危矣。宜参麦清肺汤主之。兼用千金内托散。
痘有咽喉呛水者，顺逆不同，须当分辨。若痘灌脓浆时呛水者，喉中有痘也，外
痘成浆则内痘亦成浆，壅于会厌门而呛也。盖是门乃饮食所进之处，既有所壅，则饮
水必溢入气喉而发呛，若食物有渣，自能咽下，不犯气道，故不呛也。待外痘靥则
内自痊，不药而愈矣。然此虽呛水，其喉不甚痛也。若痘未行浆，而喉先呛水，此
则毒瓦斯壅塞，其喉必痛，宜用利咽解毒汤。
痘有小便赤涩者，宜导赤汤。（木通、赤茯苓、麦冬、车前子、生地、甘草、人参、灯心同煎，饥
时服之。如不应宜八正汤。赤茯苓、瞿麦、 蓄、车前子、山栀、木通各八分，滑石末二钱，甘草四分，灯心
同煎服。热甚大便亦秘加大黄一钱。）
If the smallpox rash is purple, dry, and red, with intense heat causing dry skin, clear and loose stools, and reduced appetite, this indicates exterior heat and interior cold. The principle is obvious; understanding it ensures effective treatment. If there is interior heat and exterior cold, the rash is grayish-white, stools are constipated, urine is yellow, teeth are clenched, and chills occur. Distinguishing these allows for treatment that surpasses ancient masters. If both exterior and interior are hot, with delirium, irritability, dry red rash, dryness, thirst, and blocked urination and defecation, early use of a purgative formula is miraculous. If both exterior and interior are cold, the rash is grayish-white, depressed at the apex without redness, stools and urine are clear and loose, head is warm but feet are cold, fluid exudation causes itching, chills, and teeth clenching; warming and tonifying methods restore auspiciousness (recovery). (It is also said: No sweat indicates exterior excess; sweating indicates exterior deficiency. All pain indicates excess; all itching indicates deficiency. Redness corresponds to heat; whiteness corresponds to cold. Heat should manifest as warm feet; whiteness corresponds to cold.)
During the initial fever phase (first three days), the Kidney Meridian governs. If heat is intense but dispersing methods are not used, or if body pain occurs, black spots appear, or these signs emerge after eruption, it signifies internal organ rotting and certain death—a complication of the Kidney Meridian. During the appearance phase (next three days), the Heart Meridian governs. If the rash becomes scorched and crimson, with delirium and irritability, and detoxifying herbs are not used, leading to red-black spots, bad breath, or blood in urine, it is a complication of the Heart Meridian. During the swelling phase (next three days), the Lung Meridian governs. If previous treatment was unclear and dispersing/detoxifying herbs were not used, leading to phlegm, wheezing, cough, throat obstruction, hoarseness, or diarrhea, it is a complication of the Lung Meridian. During the contraction phase (next three days), the Liver Meridian governs. If previous treatment failed and dispersing/detoxifying, cooling-blood, and qi-boosting methods were not used, leading to insufficient pus, black depression, empty contraction, chills, teeth clenching, or eye opacity, it is a complication of the Liver Meridian. During the crusting phase (next three days), the Spleen Meridian governs. If previous treatment failed, leading to carbuncles, tooth loss, cracked lips, or swollen eyes, it is a complication of the Spleen Meridian. (Therefore, priority is given to dispersing Kidney toxin, cooling the Heart, and balancing Lung Qi. Once these three organs are balanced, then consolidate blood into the Liver and regulate the Spleen and Stomach, avoiding complications.)
Initial fever (three days): Governed by the Kidney Meridian; disperse externally. (Qianhu, Banxia, Ziye, Gegen, Jiegeng, Fuling, Chenpi, Zhike. Add Zhi Mu and Huangbo if fire is intense.) Eruption (three days): Governed by the Heart Meridian; clear and resolve internally. (Guiwei, Honghua, Jiegeng.) Pus formation (three days): Governed by the Lung Meridian; warm and tonify. (Jiegeng, Baizhi.) Crusting (three days): Governed by the Liver Meridian; consolidate blood. (Dihuang, Baishao, Jiegeng.) Post-crusting (three days): Governed by the Spleen Meridian; strengthen the Spleen. (Fuling, Baizhu, Yiren, Lianrou, Shanyao.)
Treatment during initial fever (three days): Smallpox resembles Taiyang disease, with aversion to cold, high fever, body pain, and runny nose; use Shen Su Yin. If high fever persists with delirium and coma; use Renshen Qiang Huo San. If diarrhea with alternating cold/heat, yellow-red urine, and thirst; use Si Ling San plus Mutong. If retching; add Ginger Juice and Chao Huanglian. If thirsty; add Maidong. If watery diarrhea with clear urine; use Lizhong Tang plus Fuzi, or Renshen and Guigui.
Treatment during appearance (three days): Fever lasting one day before eruption is ominous. Two days is moderate. Three to four days is mild. If heat is intense, urgently use Renshen Qiang Huo San plus Zicao and Niubangzi. If purple-red color; use Huatan Tang plus Jiuhuangqin and Jiuhuanglian. If vomiting blood; use Xijiao Dihuang Tang. If extreme heat; add Huangqin. If smallpox accompanied by measles; use Mahuang Gange Tang. If accompanied by macules; use Shengma Gegen Tang with ground Xijiao water, plus Zicao and Chantui. If thirsty, treat according to cold/heat: heat uses Si Ling San; cold uses Lizhong Tang.
Treatment during pus formation (three days): Pus must be full. Red base indicates favorable prognosis; red pustule without pus indicates unfavorable. Use Tuoli San plus Huangqi, Renshen, and Rougui. If internal deficiency with diarrhea; use Yigong San.
Treatment during swelling (three days): Swelling (colloquially "Da Pang") should be plump and glossy with red, vibrant bases within three days; no medication needed for favorable outcome. If apex is depressed and white, indicating Qi deficiency; use Sijunzi Tang plus Huangqi, Guigui, Chuanxiong, Shanzha, Renshen, and Fuling. If purple-red, indicating unresolved heat-toxin; use Sisheng Tang plus Zicao, Jiuhuangqin, Jiuhuanglian, and Honghua. For heat, use Si Ling San; for cold, use Lizhong Tang delivered with Doukou Wan.
Treatment when crusting begins (tenth day): Crusting should occur around the tenth day. Itching, collapse, chills, teeth clenching, diarrhea, and abdominal distension require urgent Yigong San. If unable to eat/digest; use Dingxiang, Chenpi, Baidoukou, and Fuzi, followed by detoxification. If no pus, hoarseness, and shortness of breath, death is inevitable.
The above treatments are clear and precise. Apply them flexibly based on symptoms. Observation determines life or death; efficacy is assured.
Transmission to the Kidney Meridian with extreme heat-toxin leads to chills and death. If crusting fails, use Junqi Shuangjiang Tang plus Renshen Siwu Tang. Constipation after ten days: use Mutong Baizhu San, otherwise chills and death ensue. Itching/collapse without pus: use Shizhen Tang plus Heshouwu and Maidong. Post-smallpox headache: add Chuanxiong, Baizhi, and Shengma to Yinyang Junqi Er Tang. Post-smallpox hoarseness: use Shizhen Tang, or Shengtian San/Yinyang Junqi Tang plus Hezi and Jiegeng. Post-smallpox gray/white diarrhea: use Shengtian San plus Renshen, Hezi, and Baidoukou. Post-smallpox abdominal distension: use Yinyang Junqi Er Tang plus Fuling, Xiangfu, and Shenqu. Green stool: use Junqi Tang plus Baizhu, Fuzi, and Chuanxiong. Menstruating girls with smallpox: use Siwu Tang plus Chao Chishao. After eruption, diarrhea and swelling indicate toxin re-entering; use Tuoli Qianjin San urgently, or internal attack causes death. Forehead spots resembling green beans indicate wind-cold; slight dispersion aids recovery (auspicious). Dense yellow forehead spots with red bases may turn gray; support exterior/interior to prevent collapse. Sparse forehead spots with many elsewhere heal spontaneously. Blood/Qi must be sufficient; negligence leads to itching/collapse/diarrhea and death. (Use Sheling Dan: Child's skull cleaned with rice water, coated with real Musk, roasted yellow, powdered, taken with Ginger Decoction.)
Nie Jiuwu stated: Treating smallpox requires foresight from fever onset through crusting. Medication must consider the beginning and end, ensuring safety throughout sequential treatment.
Smallpox accompanied by macules (red spots without heads) or erysipelas (red patches like clouds) indicates floating heat-toxin in the skin. Do not panic; use Yuanshen Shengma Tang for one to two doses to scatter wandering fire. Accompanied by measles: add Jiegeng and Huangqin to the above formula to clear measles first, allowing smallpox to develop.
Smallpox appearing small initially, flattening by days 4-5, widening by days 6-7 with golden-white color and bean-shell shape is called "Dao Ye" (reverse crusting), indicating severe Blood/Qi deficiency and lack of pus. Use Shenguilurong Tang plus Guigui, Baizhu, Chuanxiong, and Nanmuxiang. Loose stools: add Shenzhu San. Itching indicates exterior deficiency (critical); use Shenshibiao Tang. (External remedy for itching: Bind Schizonepeta spikelets in paper, burn, remove ash, apply fire to itchy spot.)
Itching is always deficiency. Claims of Qi excess or Blood heat causing itching are erroneous. Claims of salty blood irritating skin are plausible but unlikely for gray/white rashes due to severe Blood deficiency. Itching from foul air: burn Cangzhu, red dates, or tea leaves. Severe cases: use Pinghe Tang.
Exterior deficiency smallpox with insufficient pus often itches. Infants or weak children cannot resist scratching. Dress them in old soft silk sleeves tied at cuffs, or wrap hands in soft silk bags. (Case: A six-year-old girl treated this way avoided scarring despite severe itching.)
Pain indicates excess (auspicious). Use raw Baishao powder mixed with wine (1.5 qian) to stop pain immediately; severe cases may need two doses.
After complete eruption, head/eye swelling without pimple swelling indicates Blood/Qi deficiency failing to contain toxin. Urgently tonify Blood/Qi to absorb toxin; pus will form and swelling subside. Use Shengui Dabu Tang.
Post-crusting ulcers with heat/foul smell/pus: apply Shengji San (Goubipi, Huanglian, Huangbai, Wubeizi, Gancao). Persistent heat/pus indicates residual internal toxin; use Dalianqiao Yin.
Residual toxin flowing to various parts with clear fluid: apply Mianjian San (Silkworm cocoon filled with alum, burned to ash, applied dry).
Nosebleeds indicate toxin rushing to the Lung. This external release is not ominous. Use Fa Hui San (Burn human hair in a sealed jar until ash, mix with child's urine and wine). Or Qingfei Tang (Sharen, Maidong, Tiandong, Gancao, Jiegeng, Danggui, Baishao, Pianqin, Danpi, Zhimu). Avoid harsh cold herbs like Xijiao, Shengdi, Shanzhi, or Sanhuang, which freeze blood and cause harm. Misinterpreting nosebleeds as excess heat and using cold herbs often ruins the case.
Blisters without pus indicate Blood deficiency failing to transform into pus. Urgently tonify Blood with Shenguilurong Tang. Half pus/half water is manageable; mostly water is critical. Good stomach function offers hope. Prevent carbuncles as toxin remains. Many blisters in small children with limited Blood/Qi is normal; treat only if other symptoms exist.
Mouth/tongue sores: distinguish heat-toxin vs. deficient fire by rash color. Red/purple vigorous rash = heat-toxin; use Qing Shang Yin. Pale/white rash = deficient fire; use Shenmai Qingfei Tang externally with Fuyan San. Sores obstructing eating/swallowing: let crust heal naturally; treatment is ineffective.
Sore throat/swelling: use Liyan Jiedu Tang internally and Wangsuochi paste externally (Pengsha, Xiaosha, Jiangcan, Bingpian blown into throat).
Hoarseness: Red rash with hoarseness during pus formation indicates internal rash blocking airways; resolves when external rash crusts. Gray/white depressed rash with hoarseness indicates weak Blood/Qi, toxin retained in Lung; critical. Use Shenmai Qingfei Tang plus Qianjin Neituo San.
Choking on water: During pus formation, choking indicates internal rash blocking the epiglottis; resolves when external rash crusts. Before pus formation, choking indicates toxin blockage and throat pain; use Liyan Jiedu Tang.
Red/scanty urination: Use Daochi Tang (Mutong, Chifuling, Maidong, Cheqianzi, Shengdi, Gancao, Renshen, Dengxin). If ineffective, use Bazheng Tang. Severe heat with constipation: add Dahuang.