读前人之书，当知其立言之意。苟读其书，而不知其意，求通于用，不可得也。痘疮之论，钱氏为详，历
举源流经络，分明表里虚实，开陈其施治之法，而又证以论辨之言，深得着书垂教之体。学人读而用之，如求
方圆于规矩，较平直于准绳，引而伸之，触类而长之，可为无穷之应用也。今人不知致病之因，不求立方之意，
仓猝之际，据症检方，漫尔一试，设有不应，并其书而废之，不思之甚也。近因《局方》之教久行，《素问》
之学不讲，抱疾谈医者，类皆喜热恶寒，喜补而恶解利。忽得陈氏方论，皆燥热补剂，其辞确文简，欢然用之，
翕然信之，遂以为钱氏不及陈氏远矣。或曰∶子以为陈氏方不足欤？曰∶陈氏方诚一偏之论，然亦可谓善求病
情者矣。其意大率归重太阴一经。盖以手太阴属肺，主皮毛，足太阴属脾，主肌肉。肺金恶寒而易于感，脾土
恶湿而无物不受。观其用丁香、官桂，所以治肺之寒也；用附、术、半夏，所以治脾之湿也。使其肺果有寒，脾
果有湿而兼有虚，量而与之，中病即止，何伤之有哉？今也不然，徒见其疮之出迟者，身热者，泄泻者，惊悸
者，气急者，渴而思饮者，不问寒热虚实，率投木香、异功等散，间有偶中，随手获效。设或误投，祸不旋踵。
何者？古人用药制方，有向导，有监制，有辅佐，有因用。钱氏方固未尝废细辛、丁香、白术、参、 ，
率有监制辅佐之药，不专务于温补也。然其用寒冷者多，而于辅助一法，略开端绪，未曾深及。痴人之前，不
可说梦，钱氏之虑至矣。亦将以候达者，扩充广而用之。虽渴者用温药，痒塌者用补药，自陈氏发之，回出前
辈。然其多用桂、附、丁香等燥热，恐未为适中也。何者？桂、附、丁香辈，当有寒而虚者，固是的当。虚而
未必寒者，其为害当何如？陈氏立方之时，必有夹寒而痘疮者，其用燥热补之，固其宜也。今未夹寒而用一偏
之方，宁不过于热乎？予尝会诸家之粹，求其意而用之，实未敢据其成方也。
王节斋曰∶近时小儿痘疮，多用陈文中木香异功散，殊不知彼时立方，时为运气在寒水司天，时令又值严
冬大寒，为因寒郁遏，痘疮不红绽，故用辛热之剂发之。今人不分时令寒热，一概施治，误人多矣。
又曰∶丹溪痘疮治法，最为明备。近世通用陈文中异功等方，乃一偏之术。若痘疮虚怯淡白痒塌，此属虚
寒，宜用陈文中方。若发热壮盛，齐涌紫色燥痒，此属热毒，宜凉血解毒。自陈文中方盛行后，属虚寒者率得
生，属热毒者悉不救。痘是胎毒，古人治法，只是解毒，然气血虚则毒瓦斯不出，反不能成浆，故陈文中之法，
亦千载妙诀，补前人之所未备者。但温补之法既行，而解毒之旨遂隐，故救得一边，又害一边。今必详究丹溪，
二法通用，斯无弊也。
魏直曰∶痘浆数日隔顶，浆滞不行，或风寒所阻者，宜用水杨叶，无叶用枝五斤，流水一大釜，煎汤温浴
之，如冷添汤。良久，照见累起有晕丝者，浆行也。如不满，再浴之。力弱者，只洗头面手足。如屡浴不起者，
气血败矣，不可再浴。始出及痒塌者，皆不可浴。痘不行浆，乃气涩血滞，腠理固密，或风寒外阻而然。浴令
暖气透达和畅，郁蒸气血通彻，浆自贯满，功非浅也。若内服助血气药，藉此发之，其效尤速。直见一妪，用
此有验，即得其方行之，百发百中，慎毋忽也。古无此法，故详注之。（水杨，乃草也，非杨柳之杨。人家有
小儿出痘者，宜先收取，否则一时难觅。）
安庆张氏传种痘法，云已三世。其法∶先收稀痘浆，贮小瓷瓶，遇欲种者，录小儿生辰，焚香致几上，随
将黄豆一粒，敷以药，按方位埋土中，取所贮浆染衣衣小儿。黄豆三日萌芽，小儿头发热，五日豆长，儿痘亦
发，十日而萎，儿病随愈。自言必验。
福山戍卒遇一醉虎，缚献王大将军辕门，将军剖肉分赠郡绅云∶小儿食之，可以稀痘。
李捷用头生鸡子三五枚，浸厕坑内五七日取出，煮熟与食。数日再食一枚，永不出痘。徐都司得于淅人之
方。
朱丹溪治一叟，发热而昏倦，其脉大而似数，与参、 、归、术、陈皮大料，二十剂而痘出，又二十剂而
脓泡成，身无完肤，又六十剂而安。
痘症有二，一曰血热毒盛，一曰气虚毒盛。气虚者，可以徐补。血热毒盛者，势必亟。一发热便口渴面赤，
气喘狂躁，谵语，此其证也。一见点即宜凉血解毒，急磨犀角汁多饮之，十可疗四五，稍迟难救矣。又有血热
兼气虚者，初发先服凉血解毒之剂，五六朝后，可以并力补气助浆。若初时不早凉血，则毒不解，延至六七朝，
势必以参、 助浆，浆必不来，反流毒火。又有血热毒盛似气虚者，初热放点，神思昏乱，足冷，痘色白如水
窠。惟有唇肿口渴，辨其火症，医者反以气虚治之，十无一生。（《广笔记》。）
叶天士曰∶论痘首推钱仲阳、陈文中二家。钱用寒凉，陈用温热，确乎相左。丹溪祖钱非陈，分解毒、和
中、安表为要。以犀角地黄汤为主方，举世宗之，莫敢异议。后之万氏，以脾胃为主，魏氏以保元为主，皆从
二家脱化。费建中救偏，悉以石膏、大黄，（徐灵胎曰∶最不通。）胡氏辄投汗下，松江东地多宗秦镜明，
京口江宁咸推管柽《保赤》，吾苏悉遵翁仲仁《金镜录》，可谓家喻户晓者。其所长在乎看，不在乎治，看法
精确，有可以前知之巧妙。后之翟氏、聂氏，深以气血盈亏，解毒化毒，分晰阐扬钱、陈底蕴，超出诸家。
因分别太多，读者目眩心愦，不若翁仲仁刍荛悦口也。然眼目之功，须宗翁氏，而汇治讲究，参之诸家可矣。
（徐灵胎曰∶痘症因时而变，不但历代不同，隔数十年亦有小变。钱仲阳时，所说痘症痘形，与今大不相同，
其方亦迥别。神而明之，必合历代之言而参观之也。）
大凡发热三日，而后见点是其常，即以热势参详见症，定其吉凶。翁仲仁《金镜录》甚明，兹不复赘。
伤寒邪由外入，痘子热从内起。但时邪引动而出，与伤寒两途。
周岁小儿，初热即现惊搐昏迷之状最多，世俗谓惊痘最好，此言未必尽然。方书云∶先惊后痘者生，先痘
后惊者死。频频惊厥，最多闷痘。盖痘由肾至肝，至心脾及肺，自里至外，自深至浅。未发之前，痘热先已内
动，目现水晶光芒，肾热也。水生木而入肝，木生火而入心，火生土而入脾，土生金而入肺。其先天痘毒，从
至阴以达阳，全藉身中元气领载充长，以化毒为浆。（徐灵胎曰∶岂可先用恶药伤元？）浆必脓浓，苍老而始
结痂，毒已外泄，元气内返，斯无变症。周岁以内，身小元弱，常有热一日即止，亦有顺痘。但须看神气静躁，
热势轻重，见点徐徐而出，既出即长，热缓安乳，便是好症。若神气虽安，热亦不盛，痘点虽不多，形呆色钝，
或作头 足弱，脉懈不束筋骨，隐隐叹息，或短气如喘，或呕或泻，（徐灵胎曰∶皆由气血不足，毒瓦斯不能外
发之故。）最多闷症。（徐灵胎曰∶句句真传。）若二三日间，痘苗已长，色亦颇好，竟夜终日烦躁不止，最
妨隐处发疔，及发斑夹疹等症。
一发热烦躁，标点虽见，热躁愈加，细询无忽，再参兼症。为六气郁遏者，从时气治；为内伤停滞者，从
里症治。亦有表里两解者，亦有下夺者。但下法寒凉之中，必须活血理气，防其凝涩冰伏。（徐灵胎曰∶此乃
痘中兼症，非明于内外科者不能。）
初起必三次而出，热止即齐，其增点亦有陆续发出者，须看颜色灵活生气，顷刻转机变化为要。察形辨
症，治法用药，表药活血疏肌，次则凉血解毒。实热便闭者，微下之。虚弱气怯者，忌进疏解寒凉。间有虚寒
弱稚，初发身不大热，四肢皆冷，吐乳泻乳，痘点不长，闻声悠悠欲绝，望色惨淡无形，恰在一二朝间。余见
程氏女，年甫半龄，布痘极多，痘形 ，色淡白，前痘迭见。近地幼科，佥用荆、防、蒡、蝉、红花、楂肉、
木通、胡荽、笋尖之属。方虽写，而示以凶危，延余诊视。余曰∶毒重气虚，法在不治。但身无热，见症虚寒，
不因厉气表邪，焉用表药？考万氏始终以脾胃为主，以理中汤加丁、桂与服，（徐灵胎曰∶前症皆虚寒之体，
此等药其效如神。）一剂肢暖呕止。再服，利缓痘起。再用参、归、鹿茸二服，以钱氏异功散而愈。
凡看痘，先论儿体强弱，辨肌色。如色白多气虚，色苍多血热。形象 羸有宿病，或渴乳。肌柔白嫩者，
痘必鲜明；苍黑皮粗者，色必暗晦。羸瘦病质，色燥形枯，必须辨明，根据期长养，内症安和。
病躯出痘，即平顺无逆，亦难调理。歌诀云∶形体羸瘦骨如柴，肌肉枯焦神思衰；遍体铺排如此痘，纵能
浆足亦堪嗟。
一初见腰痛足 ，不能起立者死，此毒伏于肾。
一初见腰腹胀，胸高，续增喘哕者死。
一初见目睛呆瞪，或暗无光，或黑白高低，皆属紧闷症。
一初见痘，烦躁不止，即防疔斑。疔必现于隐处，多死。
一初见痘，痘不续发，斑色深紫，渐变蓝黑，亦六日内死。
一初见痘，紫斑渐起，痘反隐伏，此名紫斑白闷。
一初见痘，痘斑间杂，若似洒珠点墨，必死。
以上皆论初见看法，以定凶危。发齐热退后，皆无诸恶症。翁仲仁云∶三日四日，痘出当齐，点至足心，
势方安静。若论幼小之儿，气血易周，常有未及三日而发齐者。年长之体，四日以外，犹有增发者。痘子稀少，
数不盈百，不必点至足心。仲仁大意谓发齐安静，无虑变症，然须辨明痘形痘色，是何等呈色。身体强壮，痘
属上中，方可许其无虑。倘幼小弱质，或病后，或带别病，而后布痘，未可见痘好浪许。再以冬夏气候审详，可以百千
无误。今世用方，初见宜解肌疏表通套法。荆芥、（四日不用。）防风、（三日不用。）前胡、（四日不用。）牛蒡子、
（四日不用。）紫草、（二三日便滑，忌。）木通、红花、甘草、赤芍、天蚕、楂肉、川芎、连翘、桔梗、广皮、蝉蜕。
（三四日不宜用。）
方书中未见点用升麻葛根汤，（徐灵胎曰∶此是开宗第一方。）今人不用。伍氏方法，见点忌升麻。后
人谓葛根表疏亦忌。此轻扬升表通套药，若里症急，须两解。
伍氏方，一二日用羌防透肌汤，今人不用，恶其辛温气雄也。一二日壮热气促，烦渴便秘，痘粒不发。仲
仁云∶若非风寒壅遏，定是气虚不振。愚谓近世布痘，每盛发于君相风木燥金司令，盖非火不发也。火郁发之，
升阳散火是已。但前症若里热甚重，煎灼脂液，（徐灵胎曰∶必有此二句，后方方可用。）苟非苦寒下夺，佐
以升表，不能治也。费建中方，颇为中的，石膏、大黄、连翘、赤芍、青皮、（腹痛用。）楂肉、紫草、木通、丹皮、（辛
凉入血。）犀角，（辛凉通血。）发齐后，用黄连。凡寒凉清火解毒，必佐活血疏畅，恐凝滞气血也。实热便秘，通用凉
膈散、防风通圣散、前胡枳壳汤、四顺清凉饮。
痘四日发足，伍氏遵古方用牛蒡子熟末三分，用荸荠汁，酒酿，炖热调匀，临服，刺入生鸡冠血十余滴与
服。毒轻者，即起光润之色。世皆宗之。
发齐已四五日，用凉血解毒汤药，伍氏名四圣饮，非扁鹊原方。（徐灵胎曰∶方极平稳。）生地、连翘、银花、
红花、甘草、天虫、桔梗、紫草，（徐灵胎曰∶纯是凉血之品。）血热加丹皮、犀角；火盛加黄连、石膏、羚
羊角；有斑加金汁、元参；头面不起加川芎、鸡冠血；咽喉痛加射干、玄参、山豆根；狂乱躁扰加地龙汁；毒重
血凝加猪尾血、冰片。近世凉血解毒，多用地丁银花汤煎药。
凡看痘，初起要根盘，其痘易长绽。倘光瘦不肥，多险。成浆之后，务要根盘，即花一线圈红紧附，顶满
滚圆，是为毒化。若顶陷顶皱，根盘黯僵，其毒与气血交凝。实宜攻，虚宜补，实火宜清，攻不宜早。看来火
色大赤，痘形色湿润，方可攻托。否则搔擦，立至干剥，毒陷不治。
虚有气虚血虚之分，血虚为热，气虚为寒。但虚热与实热不同，虚热用滋清方药。痘顶属气，根盘属血，
气领血载，毒得 炼化浆。凡体强质实者多火，以清凉之剂，火解浆成，误补则痈。痈者，壅也。其气虚血弱，
色必淡白，形不雄伟，或顶陷，或皮皱，内症则恶心少食便溏。年少未进谷食者，肠胃薄劣，最多虚症。七日
以来，元气用事，不能胜毒，使之外出，多有内陷致变者。余最究心是症，调之应手取效，魏氏保元汤，聂氏
参归鹿茸汤，陈氏木香异功散。肠滑不禁，用七味豆蔻丸、白术散、理中汤，多获奇效，甚者必用三服。（徐灵胎
曰∶用补之方，尽于此矣。）
大凡儿肌白嫩者，多虚症，苍黑者，多实火，虽为大概，亦属至要。白嫩发痘，色必鲜艳，勿谓便是善症；
苍黑发痘，色必暗晦，勿便许为凶。总以神气安静，颜色日换，形象渐长便吉。六七日，伍氏内托散∶生黄 、
甘草、陈皮、川芎、当归、防风、白糯米、天虫、角刺、银花。血热者不用 、芎、归。表虚者，去天虫、角
Reading the medical books of predecessors, one must understand their intent in establishing theories. If one reads the books without understanding their intent, it is impossible to achieve proficiency in practical application. Regarding the discussion on smallpox (Dou Chuang), Qian Yi (Qian Shi) is the most detailed. He systematically outlines the origin, meridians, and collaterals, clearly distinguishing between exterior and interior, deficiency and excess, expounding treatment methods, and supporting them with dialectical arguments, thereby deeply embodying the spirit of writing for instruction. Scholars who read and apply these works will find that, like seeking squares and circles using compasses and set-squares, or measuring straightness with a plumb line, they can extend and generalize these principles to infinite applications.
Today's practitioners often fail to understand the causes of disease and the rationale behind prescriptions. In moments of urgency, they consult prescriptions based merely on symptoms and try them indiscriminately. If ineffective, they discard the book, which is extremely thoughtless. Recently, due to the long-standing popularity of the *Tai Ping Hui Min He Ji Ju Fang* (Ju Fang) and the neglect of studies from the *Su Wen* (Yellow Emperor's Inner Canon: Basic Questions), those discussing medicine while ill tend to prefer warmth over cold, and tonification over dispersing and purging. Upon encountering the formulas and theories of Chen Wenzhong (Chen Shi), which consist entirely of drying, warming, and tonifying agents with concise and precise language, they gladly use and widely believe them, concluding that Qian Shi is far inferior to Chen Shi.
Someone might ask: Do you consider Chen Shi's formulas inadequate? I reply: Chen Shi's formulas are indeed a one-sided perspective, yet they can be said to skillfully address the condition. His approach largely emphasizes the Taiyin Meridian. The Hand Taiyin Lung Meridian belongs to the Lung, which governs the skin and hair; the Foot Taiyin Spleen Meridian belongs to the Spleen, which governs the muscles. Metal of the Lung dislikes cold and is easily affected by pathogens; Earth of the Spleen dislikes dampness and accepts all influences. His use of Ding Xiang (Clove) and Guan Gui (Cinnamon Twig) treats Lung cold; his use of Fu Zi (Aconite Root), Bai Zhu (Atractylodes Rhizome), and Ban Xia (Pinellia Tuber) treats Spleen dampness. If the Lung truly has cold, the Spleen truly has dampness accompanied by deficiency, and one doses appropriately, stopping when the illness is cured, what harm would there be? However, this is not the current practice. Practitioners simply observe delayed eruption, fever, diarrhea, palpitations, shortness of breath, and thirst, regardless of whether the pattern is cold or heat, deficiency or excess, and indiscriminately administer Mu Xiang Yi Gong San (Costus Powder for Transforming Function). Occasionally, there are coincidental successes. If misapplied, disaster follows immediately. Why? Ancient physicians used guiding, restraining, assisting, and situational drugs. Although Qian Shi's formulas did not exclude Xi Xin (Asarum), Ding Xiang, Bai Zhu, Ren Shen (Ginseng), and Gan Cao (Licorice), they always included restraining and assisting herbs, not solely focusing on warming and tonifying. However, he used more cooling herbs, and his method of assistance was only briefly introduced, not deeply explored. One cannot speak dreams to fools; Qian Shi's considerations were thorough, awaiting those who could expand and apply them. Although the use of warming herbs for thirst and tonifying herbs for itching/collapse originated with Chen Shi, surpassing predecessors, his frequent use of Gui Zhi (Cinnamon Twig), Fu Zi, and Ding Xiang may not be perfectly balanced. These warming herbs are appropriate for patterns of both cold and deficiency, but for deficiency without cold, the harm could be significant. When Chen Shi formulated his prescriptions, he likely treated smallpox cases complicated by cold, making warming and tonifying appropriate. Today, using this one-sided formula for cases without cold complication leads to excessive heat. I have synthesized the essence of various schools, sought their intent, and applied them, daring not to rely rigidly on established formulas.
Wang Jiezhai stated: Recently, pediatric smallpox cases often use Chen Wenzhong's Mu Xiang Yi Gong San. Little do they know that when he formulated it, the cosmic influence was "Cold Water Ruling Heaven," and the season was severe winter cold. Due to cold oppression preventing redness and eruption, he used acrid-warming herbs to disperse. Today's practitioners ignore seasonal cold and heat, treating all cases uniformly, causing much harm.
He further stated: Danxi's treatment of smallpox is the most clear and comprehensive. Modern practitioners generally use Chen Wenzhong's Yi Gong San, which is a one-sided method. If smallpox presents as weak, pale, itchy, and collapsed, belonging to deficiency-cold, Chen's formulas are suitable. If fever is intense, eruptions surge together, appearing purple, dry, and itchy, belonging to heat-toxin, cooling blood and resolving toxin is suitable. Since Chen's formulas became prevalent, deficiency-cold cases mostly survived, while heat-toxin cases perished. Smallpox is fetal toxin; ancient treatments focused on resolving toxin. However, if Qi and Blood are deficient, toxins cannot exit, and pustules fail to form. Thus, Chen's method is a millennium-old secret, supplementing previous shortcomings. Yet, as warming-tonifying methods spread, the principle of resolving toxin faded, saving one side while harming the other. One must thoroughly study Danxi's methods and use both approaches to avoid flaws.
Wei Zhi stated: If smallpox pus stagnates days after eruption, or is blocked by wind-cold, bathing with water willow leaves (Shui Yang Ye) is suitable. If leaves are unavailable, use five jin of branches, decocted in a large pot of flowing water for warm bathing, adding hot water as needed. After some time, if halos appear around raised papules, pus circulation has resumed. If not full, bathe again. For weak patients, wash only head, face, hands, and feet. If repeated bathing fails to raise lesions, Qi and Blood are exhausted, and bathing should cease. Bathing is contraindicated during initial eruption and itching/collapse. Stagnant pus results from Qi stagnation and Blood stasis, tight pores, or external wind-cold obstruction. Bathing allows warm energy to penetrate smoothly, unblocking stagnant Qi and Blood, allowing pus to fill naturally, achieving significant effect. Internal administration of Qi- and Blood-nourishing herbs combined with this method yields even faster results. I witnessed an old woman successfully using this method; I obtained the prescription and applied it with 100% efficacy. Do not neglect it. This method is ancient but undocumented, hence recorded here. (Note: Shui Yang is a herb, not willow. Families with children having smallpox should collect it beforehand, as it is hard to find later.)
The Zhang family of Anqing passed down a variolation method for three generations. The method: Collect mild smallpox matter, store in a small porcelain bottle. For inoculation, record the child's birth date, burn incense on a table, place a soybean coated with medicine buried according to direction. Dip clothing in stored matter and dress the child. Soybean sprouts in three days; child develops fever. Bean grows in five days; child's smallpox erupts. Bean withers in ten days; child recovers. Claimed to be effective.
A soldier in Fushan captured a drunk tiger and presented it to General Wang. The general distributed the meat to local gentry, stating that eating it prevents smallpox.
Li Jie used three to five first-laid chicken eggs, soaked in a latrine pit for five to seven days, then cooked and fed to children. Eating one egg every few days ensures lifelong immunity. This formula was obtained by Commander Xu from people in Xi.
Zhu Danxi treated an elderly man with fever, drowsiness, and a large, rapid pulse. He prescribed large doses of Ren Shen (Ginseng), Gan Cao (Licorice), Dang Gui (Angelica Sinensis), Bai Zhu (Atractylodes), and Chen Pi (Tangerine Peel). After twenty doses, smallpox erupted; after another twenty, pustules formed, leaving no intact skin. After sixty more doses, he recovered.
Smallpox patterns fall into two categories: Blood Heat with Excess Toxin, and Qi Deficiency with Excess Toxin. Qi deficiency allows gradual tonification. Blood heat with excess toxin requires urgent intervention. Symptoms include immediate thirst, red face, asthma, mania, and delirium upon fever onset. Upon first spotting, cool blood and resolve toxin immediately by drinking fresh Rhinoceros Horn Juice (Xi Jiao Zhi). Four out of ten may survive; delay makes rescue difficult. For Blood Heat with Qi Deficiency, initially cool blood and resolve toxin; after five to six days, simultaneously tonify Qi to support pus formation. If blood is not cooled early, toxin persists. By day six or seven, attempting to tonify Qi with Ren Shen and Gan Cao will fail to produce pus and instead scatter toxic fire. For Blood Heat resembling Qi Deficiency (initial fever, spots, confusion, cold feet, white pockmarks like water wells, swollen lips, thirst), if diagnosed as Qi Deficiency by mistake, mortality is total. (*Guang Biji*)
Ye Tianshi stated: Discussions on smallpox prioritize Qian Zhongyang and Chen Wenzhong. Qian used cooling, Chen used warming, directly opposing each other. Danxi followed Qian, rejecting Chen, emphasizing detoxification, harmonizing middle jiao, and stabilizing the exterior, using Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) as the main formula, universally respected. Later, Wan Shi emphasized the Spleen and Stomach; Wei Shi emphasized Bao Yuan Tang (Preserve Origin Decoction), both evolving from these two masters. Fei Jianzhong corrected biases using Shi Gao (Gypsum) and Da Huang (Rhubarb) – (Xu Lingtai comments: Most illogical.) Hu Shi frequently used sweating and purging methods. In Songdong, many followed Qin Jingming; in Jingkou and Jiangning, Guan Cheng's *Bao Chi* was revered; in our region, Weng Zhongren's *Jin Jing Lu* (Golden Mirror Record) was strictly followed, becoming household knowledge. Their strength lay in diagnosis, not treatment; their diagnostic precision allowed prediction. Later, Zhai Shi and Nie Shi elaborated on Qi/Blood balance and toxin resolution, surpassing others. However, their distinctions were too complex, confusing readers, whereas Weng Zhongren's views were more accessible. Nevertheless, for diagnostic skill, follow Weng, while integrating treatment strategies from various schools. (Xu Lingtai comments: Smallpox changes with time, differing across dynasties and even decades. Qian's descriptions differed greatly from modern ones; his formulas were also distinct. Divine understanding requires comparing historical texts.)
Generally, fever for three days followed by spotting is normal. Assess prognosis based on fever intensity and detailed symptoms. Weng Zhongren's *Jin Jing Lu* clarifies this well; repetition is unnecessary.
Shanghan (Cold Damage) pathogens enter from outside; smallpox heat arises from within. Seasonal pathogens trigger eruption, distinct from Shanghan pathways.
Infants under one year often present with convulsions and coma during initial fever. Folk say "convulsive smallpox" is best, but this is not entirely true. Medical texts state: Convulsion before eruption indicates survival; eruption before convulsion indicates death. Frequent convulsions often lead to suppressed smallpox. Smallpox moves from Kidney to Liver, Heart/Spleen, and Lung, from interior to exterior, deep to shallow. Before eruption, internal heat activates, manifesting as crystal-like eye glow (Kidney heat). Water generates Wood entering Liver; Wood generates Fire entering Heart; Fire generates Earth entering Spleen; Earth generates Metal entering Lung. Congenital toxin moves from Yin to Yang, relying on Yuan Qi (Primal Qi) to transform toxin into pus. (Xu Lingtai comments: How can harmful herbs be used first to damage Yuan Qi?) Pus becomes thick and mature before scabbing; toxin exits externally, Yuan Qi returns internally, preventing complications. Infants have weak Yuan Qi; sometimes fever stops in one day, indicating smooth course. Observe mental quietness/restlessness, fever severity, slow eruption, rapid growth, calm feeding after fever subsides—these indicate good prognosis. If mental state is calm, fever mild, few spots, but dull appearance, heavy head/weak limbs, loose pulse, sighing, shortness of breath, vomiting, or diarrhea, (Xu Lingtai comments: All due to insufficient Qi/Blood failing to expel toxin,) suppression is likely. (Xu Lingtai comments: Every sentence is a true transmission.) If by day two or three, seedlings grow well, color is good, but night-long restlessness occurs, watch for hidden carbuncles, macules, or rashes.
For fever with restlessness, even if spots appear, increasing heat/restlessness requires careful inquiry and analysis of concurrent symptoms. If caused by Six Qi oppression, treat as seasonal qi; if due to internal injury/stagnation, treat as interior syndrome. Some require simultaneous exterior-interior resolution; some require purging. Purging methods must include blood-invigorating and Qi-regulating herbs amidst cooling agents to prevent stagnation. (Xu Lingtai comments: These are concurrent smallpox syndromes, understandable only to experts in internal and surgical medicine.)
Initial eruption occurs in three waves; cessation of fever means completion. Additional spots may emerge sequentially. Observe vibrant color changes. Diagnosis guides treatment: Exterior herbs invigorate blood and loosen muscle; subsequently, cool blood and resolve toxin. For excess heat with constipation, mild purgation is indicated. For weakness and timidity, avoid dispersing and cooling herbs. Rarely, weak infants with deficiency-cold present with mild fever, cold limbs, vomiting/diarrhea of milk, non-growing spots, faint voice, pale complexion, occurring on day one or two. I observed a half-year-old girl, Cheng Shi, with numerous flat, pale white spots. Local pediatricians used Jing Jie (Schizonepeta), Fang Feng (Saposhnikovia), Niu Bang Zi (Arctium Seed), Chan Tui (Cicada Slough), Hong Hua (Safflower), Shan Zha (Hawthorn), Mu Tong (Akebia), Hu Sui (Coriander), and bamboo shoots. Although prescribed, signs indicated danger. I examined her and stated: Heavy toxin with Qi deficiency suggests untreatability. However, absence of fever and presence of deficiency-cold signs mean no exterior pathogen exists; why use exterior herbs? Wan Shi prioritized Spleen/Stomach; I prescribed Li Zhong Tang (Regulate the Middle Decoction) plus Ding Xiang and Gui Zhi. (Xu Lingtai comments: Previous symptoms were deficiency-cold; these herbs work miraculously.) One dose warmed limbs and stopped vomiting. Second dose slowed diarrhea and raised spots. Third dose used Ren Shen, Dang Gui, and Lu Rong (Deer Antler); cured with Qian Shi's Yi Gong San.
When examining smallpox, first assess body strength and skin color. Pale skin indicates Qi deficiency; dark/coarse skin indicates Blood heat. Emaciated bodies with chronic illness or thirst require attention. Soft, white, tender skin predicts bright eruptions; dark, coarse skin predicts dull eruptions. Emaciated, dry, withered constitutions must be distinguished; nourish internally until symptoms stabilize.
Even smooth smallpox in sick bodies is hard to manage. A rhyme states: Emaciated frame, bones like firewood, withered muscles, depleted spirit; widespread such eruptions, even with full pus, is lamentable.
Immediate lower back pain, leg weakness, inability to stand indicates death; toxin hides in Kidney.
Immediate waist/abdominal distension, high chest, followed by wheezing/vomiting indicates death.
Immediate staring eyes, dimness, or unequal black/white pupils indicate tight suppression.
Immediate persistent restlessness after eruption warns of carbuncles/macules. Carbuncles appear in hidden areas, usually fatal.
Non-sequential eruption, deep purple macules turning blue-black indicates death within six days.
Rising purple macules with hidden smallpox is named "Purple Macule White Suppression."
Interspersed smallpox and macules resembling scattered pearls and ink drops indicate death.
These describe initial diagnostic criteria for prognosis. After complete eruption and fever reduction, malignant signs disappear. Weng Zhongren stated: By days three or four, eruptions should be complete, reaching soles, with calm progression. Young children with agile Qi/Blood may complete eruption in less than three days. Older children may continue erupting beyond day four. Sparse eruptions (<100) need not reach soles. Weng's main point: Complete eruption with calmness implies no complications, provided morphology and color are favorable. Only robust bodies with upper/middle grade eruptions guarantee safety. Weak infants, post-illness, or those with concurrent diseases require caution. Consider winter/summer climates for accuracy. Modern initial treatment uses standard exterior-dispersing formulas: Jing Jie (avoid on day 4), Fang Feng (avoid on day 3), Qian Hu (avoid on day 4), Niu Bang Zi (avoid on day 4), Zi Cao (contraindicated if loose stools on days 2-3), Mu Tong, Hong Hua, Gan Cao, Chi Shao, Tian Can, Shan Zha, Chuan Xiong, Lian Qiao, Jie Geng, Guang Pi, Chan Tui (avoid on days 3-4).
Medical texts prescribe Sheng Ma Ge Gen Tang (Ephedra and Pueraria Decoction) before spotting appears, (Xu Lingtai comments: This is the foundational first formula.) but modern practitioners omit it. Wu Shi's method avoids Sheng Ma upon spotting. Later scholars also avoid Ge Gen for its dispersing nature. These light, ascending herbs are standard; if interior syndrome is urgent, dual resolution is needed.
Wu Shi's formula uses Qiang Huo Fang Feng Tou Ji Tang (Notopterygium and Saposhnikovia Muscle-Penetrating Decoction) on days one and two, now avoided due to its strong acrid-warm nature. On days one and two, intense fever, rapid breathing, irritability, thirst, constipation, and non-eruption occur. Zhongren stated: If not wind-cold oppression, it must be Qi deficiency. I believe modern eruptions often peak during dominant Wind-Joint/Dry-Metal seasons, requiring Fire activation. Suppressing Fire requires ascending and scattering. However, if interior heat is severe, burning fluids, (Xu Lingtai comments: These two sentences are essential before using subsequent formulas,) bitter-cold purging with ascending assistance is necessary. Fei Jianzhong's formula is accurate: Shi Gao, Da Huang, Lian Qiao, Chi Shao, Qing Pi (for abdominal pain), Shan Zha, Zi Cao, Mu Tong, Dan Pi (acrid-cool entering blood), Xi Jiao (acrid-cool unblocking blood). After complete eruption, use Huang Lian. All cooling/fire-resolving/toxin-resolving methods must assist blood circulation to prevent stagnation. For excess heat constipation, commonly use Liang Ge San, Fang Feng Tong Sheng San, Qian Hu Zhi Ke Tang, or Si Shun Qing Liang Yin.
On day four, when eruptions reach extremities, Wu Shi followed ancient methods using three fen of finely ground Niu Bang Zi, mixed with water chestnut juice and fermented rice wine, heated, and administered with ten drops of raw rooster comb blood. Mild toxin cases show immediate luster. Universally respected.
Four to five days after complete eruption, use cooling blood and resolving toxin decoctions. Wu Shi called this Si Sheng Yin (Four Sages Drink), not Bian Que's original formula. (Xu Lingtai comments: Formula is very stable.) Sheng Di, Lian Qiao, Yin Hua, Hong Hua, Gan Cao, Tian Chong, Jie Geng, Zi Cao. (Xu Lingtai comments: Purely cooling blood ingredients.) Add Dan Pi and Xi Jiao for Blood Heat; Huang Lian, Shi Gao, Ling Yang Jiao for Excess Fire; Jin Zhi and Xuan Shen for Macules; Chuan Xiong and Rooster Comb Blood for facial non-eruption; She Gan, Xuan Shen, Shan Dou Gen for sore throat; Di Long Zhi for mania/agitation; Pig Tail Blood and Bing Pian for heavy toxin/blood coagulation. Modern cooling/resolving methods often use Di Ding Yin Hua Tang (Viola and Honeysuckle Decoction).
When examining smallpox, initial base (root disk) determines ease of growth. Thin bases indicate danger. After pus formation, a tight red ring at the base and round, full apex indicate toxin transformation. Depressed/wrinkled apex and dark/stiff base indicate toxin-Qi-Blood congealment. Excess requires attack; deficiency requires tonification; excess fire requires clearing. Attack should not be early. Only when fire color is bright red and texture moist is attack/support appropriate. Otherwise, scratching leads to dry peeling and untreatable toxin collapse.
Deficiency divides into Qi and Blood types; Blood deficiency manifests as heat, Qi deficiency as cold. Deficiency heat differs from excess heat; treat deficiency heat with nourishing-clearing formulas. Apex relates to Qi; base relates to Blood. Qi leads, Blood carries, transforming toxin into pus. Robust constitutions often have Fire; cooling resolves Fire and forms pus. Incorrect tonification causes abscesses (Yong), meaning obstruction. Qi deficiency and Blood weakness present with pale color, lack of vigor, depressed apex, wrinkled skin, nausea, poor appetite, loose stools. Youth without solid food intake have thin intestines/stomachs, prone to deficiency. From day seven, Yuan Qi dominates; inability to overcome toxin leads to internal collapse. I focus intensely on this syndrome, achieving success with Wei Shi's Bao Yuan Tang, Nie Shi's Shen Gui Lu Rong Tang, and Chen Shi's Mu Xiang Yi Gong San. For slippery bowels, use Qi Wei Dou Kou Wan, Bai Zhu San, or Li Zhong Tang, often with miraculous results. Severe cases require three doses. (Xu Lingtai comments: Tonifying formulas end here.)
Generally, white/tender skin indicates deficiency; dark/coarse skin indicates excess fire. While general, this is crucial. White/tender eruptions are bright; do not assume good prognosis. Dark/coarse eruptions are dull; do not assume bad prognosis. Ultimately, calm spirit, changing colors, and growing appearance indicate auspiciousness. Days six-seven: Wu Shi's Nei Tuo San: Sheng Huang Qi, Gan Cao, Chen Pi, Chuan Xiong, Dang Gui, Fang Feng, Bai Nuo Mi, Tian Chong, Jiao Ci, Yin Hua. Avoid Huang Qi, Chuan Xiong, Dang Gui for Blood Heat. For exterior deficiency, remove Tian Chong and Jiao Ci.