一痘半出，遍身作痛，乃热毒壅滞，未尽外出故也。活命饮加蝉蜕而愈。
一痘浆足而痛不止，此诸痛为实也。用白芷、陈皮、甘草、牛蒡、连翘、山楂而愈。
一痘六七日痛不止，此毒未化，郁而作痛也。非虚非实，不须治之，俟毒从脓化，其痛自止。
徐仲光治一痘，初起作痒，风寒外滞也。升麻葛根汤，焙荆芥穗熨而愈。
一痘起胀淡白，神少，泄泻口渴而痒，此脾胃气虚也。补中益气汤去归，加桂、附、糯米而愈。
一痘成浆痒破，是卫气暴泻，津液不荣。幸能食便润，四君子汤加芎、芍、橘，复肿灌成痂而愈。
一痘成浆，痒破溃烂，乃湿火并至也，调脾渗湿而愈。
一痘九日，浆清作痒，大补气血而愈。
一痘见七日至十三日痒塌，木香散加丁、桂，固表里而愈。
万密斋治郑氏子，痘将见形，作痒不能禁。曰∶起发时作痒者，逆也；贯脓时作痒者，逆也；浆靥时作痒
者，险也。险者可治，逆者不可治。才见便痒，书无此症，因思仲景《伤寒正理》论云∶病身痒，此邪在表，
欲出而不得出也，桂枝麻黄各半汤。阳明经病，皮中如虫行者，此肌肉虚也，建中汤。今此身痒，正是痘欲出
不得出，与太阳症同，非阳明肌肉虚也。乃以各半汤去桂、杏，加升麻、葛根、牛蒡，一服痒止，痘出甚密，
调治半月而安。（雄按∶真善读古人书者。）
屠家子出痘，贯脓时请一巫诵咒 水解厌，后忽加瘙痒，痘形平塌，其色青白而气腥臭。曰∶犯房室秽气
也。急令买胶枣一斤，烧烟熏之，痘转红活，而痒亦止。问其故，老巫他往，而子代之，有房事。
胡氏女七岁，痘初发热，两手如捻物状。曰∶此肝病也，经云其为病也握，宜平其肝。以泻青丸去大黄，
加甘草、柴胡、青皮，一帖而握止。欲再进一帖，不听。曰∶凡肝病者，多水泡而作痒，宜止之未发之前。既
不信，七日后再议。至六日，尽抓破矣，乃用保元汤加防风、白芷，二帖痒止，再服着痂而安。
施季泉治臧玉函幼儿，甫半周，身热一日即见痘。专门云∶树少花多，顶平脚塌，根窠薄，百死一生之症
也。五朝，固辞去。药以保元汤为主，拟六朝多用人参加附子。疑虑间，施至，曰∶此险症。且戒云∶必发痒
异常，须看守严密。药用凉剂，与前治大别。七朝，大发痒作泻，一日夜二十余行，或药水，或乳，或汤饮，
俱倾注不变色。或谓必无幸矣，施怡然自若，因强之用参，必不许，乃加炒黑黄连，渴止。十三朝，复发痒，
口渴唇燥，舌生白苔，又加炒黄连，白苔去，到底不用参，十九朝而别。又戒曰∶慎防痘疔口疳。疔之发也，
必在脑后枕骨间，当以收口膏贴之，禁用渗药，口疳惟君家人中白散为妙。不数日发疳，如其言治之辄效。
（《广笔记》。）
A child with half-erupted smallpox experienced pain all over the body; this was due to heat-toxin stagnation that had not yet fully exteriorized. The patient recovered after taking Huoming Yin (Life-Saving Decoction) added with Chantui (Cicada Slough).
A child whose smallpox pustules were full but continued to hurt suffered from "all pains are excess" syndrome. The patient recovered using Baizhi (Angelicae Dahuricae Radix), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Niubangzi (Arctii Fructus), Lianqiao (Forsythiae Fructus), and Shanzha (Crataegi Fructus).
A child experiencing persistent pain on the sixth or seventh day of eruption had untransformed toxin causing pain through depression. This was neither deficiency nor excess, requiring no specific treatment; once the toxin transformed into pus, the pain ceased spontaneously.
Xu Zhongguang treated a smallpox case where itching appeared at the onset, caused by external stagnation of wind-cold. The patient recovered after administering Shengma Gegen Tang (Ephedra and Kudzu Root Decoction) and applying hot-baked Jingjie Sui (Schizonepeta Spike) as a fumigation/washing therapy.
A child presenting with pale, flat swelling, low spirit, diarrhea, thirst, and itching suffered from Spleen-Stomach Qi deficiency. The patient recovered using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Danggui (Angelicae Sinensis Radix) removed, and Rougui (Cinnamomi Cortex), Fuzi (Aconiti Lateralis Radix Praeparata), and Nuomi (Oryza Sativa Germen) added.
A child whose smallpox reached the pustule stage experienced itching and rupture due to sudden dispersion of Wei-Qi (Defensive Qi) and failure of Jin-Ye (Body Fluids) to nourish. Fortunately, the patient could eat and had moist stools. The patient recovered using Sijunzi Tang (Four Gentlemen Decoction) added with Xiong (Chuanxiong Rhizoma), Shaoyao (Paeoniae Radix Alba), and Jupi (Citri Reticulatae Pericarpium), leading to re-swelling, pustulation, and scabbing.
A child whose smallpox reached the pustule stage experienced itching, rupture, and ulceration due to simultaneous arrival of Dampness and Fire. Recovery was achieved by regulating the Spleen and promoting dampness drainage.
A child on the ninth day presented with clear pustules and itching, recovering after substantial tonification of Qi and Blood.
A child between the seventh and thirteenth days exhibited itching and collapse of eruptions, recovering after administration of Muxiang San (Costus Powder) added with Dingxiang (Caryophylli Flos) and Guizhi (Cinnamomi Ramulus) to secure the Exterior and Interior.
Wan Mizhai treated the son of the Zheng family, who suffered unbearable itching just as smallpox lesions were about to appear. He stated: Itching during the rising phase is a adverse sign (Ni); itching during the suppuration phase is an adverse sign; itching during the crusting phase is a dangerous sign (Xian). Dangerous signs are treatable; adverse signs are untreatable. Since itching appeared immediately upon sighting the rash—a symptom not recorded in books—he recalled Zhang Zhongjing's *Shanghan Zhengli* stating: "Body itching indicates pathogen in the Exterior, attempting to exit but unable to do so," treated with Guizhi Mahuang Gehan Tang (Half-Half Decoction of Cinnamon Twig and Ephedra). If it were Yangming channel disease with skin sensation like insects crawling, it would indicate muscle deficiency, treated with Jianzhong Tang (Establish the Middle Decoction). Here, the itching indicated smallpox attempting to erupt but failing, similar to Taiyang syndrome, not Yangming muscle deficiency. Thus, he used Guizhi Mahuang Gehan Tang removing Guizhi and Xingren, adding Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), and Niubangzi. One dose stopped the itching, eruptions became dense, and peace was restored after half a month of care. (Commentary: Truly one who reads ancient texts well.)
The son of the Tu family, during the suppuration phase of smallpox, consulted a shaman for incantations and water purification, after which severe itching suddenly worsened, eruptions flattened, color turned bluish-white, and odor became fishy. I diagnosed this as contamination by filth from sexual intercourse. Urgently, I ordered one jin (approx. 500g) of Jiaozao (Jujube processed with Gelatin) to be burned for fumigation. The eruptions turned red and vibrant, and itching ceased. Upon inquiry, the old shaman was absent, replaced by the son, who admitted to recent sexual activity.
Hu's seven-year-old daughter, upon initial fever of smallpox, held her hands in a grasping posture. I diagnosed Liver disease, citing the classic: "Its manifestation is grasping," and prescribed calming the Liver. Using Xieqing Wan (Drain the Green Pill) removing Dahuang (Rhei Radix et Rhizoma), and adding Gancao, Chaihu (Bupleuri Radix), and Qingpi (Citri Reticulatae Pericarpium Viride), the grasping stopped after one dose. The family refused a second dose. I warned: Liver diseases often present with vesicles and itching, which should be prevented beforehand. Ignoring this, seven days later, all lesions were scratched open. I then used Baoyuan Tang (Preserve the Origin Decoction) added with Fangfeng (Saposhnikoviae Radix) and Baizhi, stopping itching after two doses, followed by scabbing and recovery.
Shi Jiquan treated Zang Yuhan's infant, aged one year, who showed smallpox after one day of fever. A specialist declared it a critical case ("few trees, many flowers," flat tops, collapsed bases, shallow roots), predicting death in ten cases out of nine. On the fifth day, the family dismissed the previous doctor. Treatment focused on Baoyuan Tang, planning to add Renshen (Ginseng Radix et Rhizoma) and Fuzi on the sixth day. While hesitating, Shi arrived, diagnosing a dangerous case and warning of extreme itching requiring strict monitoring. He prescribed cooling agents, distinct from previous treatments. On the seventh day, severe itching and diarrhea occurred (>20 times/day); fluids poured in remained unchanged. Despair set in, but Shi remained calm. He insisted on Renshen, which was refused, so he added Chao Huanglian (Stir-fried Coptidis Rhizoma), stopping thirst. On the thirteenth day, recurring itching, thirst, dry lips, and white tongue coating prompted more stir-fried Huanglian, clearing the coating, while still avoiding Renshen. He departed on the nineteenth day, warning to prevent Dou Ding (Smallpox Carbuncle) and Kou Gan (Oral Ulcer). He specified that carbuncles appear at the occiput, treated with Shoukou Gao (Closing Wound Plaster), avoiding damp-draining herbs; oral ulcers respond best to Zhongbai San (Middle White Powder) used by the family. Days later, ulcers appeared, and treatment per his advice was effective. (*Guang Biji*).