〔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。
[Wan Quan] The *Huoren Shu* (Book of Living People) states: If Shaoyang disease (Shaoyang syndrome, a stage in Shanghan theory) is treated with purgatives too early, heat qi enters the Stomach due to deficiency, triggering Dan Du (erysipelas, characterized by red, hot, swollen skin). If purgatives are used too late, heat remains in the Stomach, also triggering Dan Du. If the Stomach tissue rots, it similarly triggers Dan Du.
Dan Du arises from heat-toxin stagnation and suppression, which boils and consumes Yin blood. When blood is heated but not resolved, it floats into the muscles, governed by the Foot-Yangming Stomach Meridian. When smallpox lesions first appear, if the skin and flesh are red and swollen, resembling patterns on brocade, this indicates Smallpox complicated by Dan Du. It should be resolved with acrid-cool herbs. As the Dan Du gradually recedes, if the smallpox base is firm, it is an auspicious sign; otherwise, the skin will ulcerate, and the smallpox may become itchy, which refers to the condition where tender skin breaks easily. If red Dan Du forms clumps with swollen and hard flesh, it is called Dan Liu (erysipelas tumor), which has the most severe toxicity. If the smallpox has not yet matured but this area ulcerates first, it is difficult for physicians to treat. For smallpox complicated by Dan Du, Jingfang Baidu San (Astragalus and Saposhnikovia Decoction to Overcome Toxicity) is primarily used. Once the Dan Du subsides, it can be cured.
[Zhang Jingyue] In cases where smallpox appears complicated by Dan Du, the smallpox toxin follows the Zang organs to emerge externally. The momentum of the toxin's eruption is extremely rapid. This may occur when Blood is excessive while Qi is insufficient, causing Wei Qi (Defensive Qi) to be sparse and deficient, unable to tightly protect the meridians and vessels. Consequently, the excess Blood carries toxin upward, erupting as carbuncles along with the toxin's outward movement. This is slightly easier to treat than smallpox complicated by rashes. If the smallpox rises uniformly, the interior must be deficient; the toxin often resolves internally. If it does not resolve, Shengma Tang (Cimicifuga Decoction) added with Dang Gui (Angelica Sinensis) and Bai Shao (White Peony Root) is used. There are also cases where Dan Du erupts after scabbing. Excess residual heat-toxin boils the muscle tissue, causing the skin to ulcerate. Xiaodu San (Toxin-Resolving Powder) [indicated for slow eruption] added with Dang Gui, Bai Shao, and Fang Feng (Saposhnikovia Root) is used. If heat is severe, Lianqiao Tang (Forsythia Decoction) [indicated for constipation] is used. Ulcerated areas are dressed with Shengji San (Flesh-Regenerating Powder) [indicated for ulcers]. If the complicating toxin initially appears bright red like fire, it is due to toxin stagnation preventing dissemination. Sishun Yin (Four Compliance Drink) [indicated for fever] is used to promote drainage. If bowel movements occur once or twice and the Dan Du recedes, the Blood adheres to the Qi level. Immediately, Sijunzi Tang (Four Gentlemen Decoction) [indicated for anorexia] added with Ren Shen (Ginseng), Sheng Jiang (Fresh Ginger), and Da Zao (Jujube) should be administered to prevent Qi collapse. If diarrhea persists, Dou Kou (Nutmeg) will stop it.
[Weng Zhongren] Xuan Shen Sheng Ma Tang (Scrophularia and Cimicifuga Decoction) [indicated for sore throat], Huang Qin (Scutellaria Root), Jing Jie (Schizonepeta), Bai Shao, Dang Gui, and Chuan Xiong (Sichuan Lovage Rhizome) are used. Early stages favor dispersing methods; later stages favor resolving and draining methods. Red Dan Du is easy to resolve; purple Dan Du is slightly difficult; blue Dan Du is incurable.
[Lou Quanshan] uses Baihu Tang (White Tiger Decoction).
[Yuan Shi] Smallpox complicated by Dan Du occurs because the Yangming Meridian is overwhelmed by fierce inflammatory toxins. Drugs such as Ding (Tian Ding, i.e., Gleditsia Spine) and Gui (Cinnamon Twig) must absolutely not be used. Zhang Banxian used Huanglian Jiedu Tang (Coptis Decoction to Resolve Toxin) to treat smallpox with Dan Du, which was too cold. Qian Yi used Bing Lang (Areca Nut) and Da Huang (Rhubarb) to treat Dan Du in smallpox, which was too harsh. It is best to use Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) to clear internal Yangming郁毒 (stagnant toxin), and Wulong Huaban Tang (Five Dragons Spot-Resolving Decoction) to eliminate external blood-streaks resembling mosquito bites. By attacking internally and externally, harmonizing the interior and exterior, health can be restored. I have treated many cases of smallpox complicated by Dan Du. Whenever the morphology shows Dan Du without typical smallpox features, the heat-toxin is fierce; only three or four out of ten recover completely. If Dan Du appears within two days, rapid clearing and expulsion are essential. Patients suffer from irritability, delirium, thirst, and restlessness. Chan Shi Liu employed Earthworm Juice mixed with Rhino Horn Water for administration, demonstrating his expertise in treating Dan Du.
Shanzhizi Tang (Gardenia Decoction) treats smallpox and Dan Du presenting like mosquito or flea bites, with severe blackened toxicity.
Shanzhizi Ren (Gardenia Seed), Baixianpi (Dictamnus Bark), Chishaoyao (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, plus a little Zicao (Arnebia Root) and Bohe (Mint Leaf), decoct until 5 fen remains. Strain and take warm.
Yuan Shi Formula
Zicao, Honghua (Safflower), Xijiao (Rhino Horn - *Note: Use synthetic substitute or Anibis Cornu in modern practice*), Mutong (Akebia Stem), Shaoyao (Peony Root), Shengdihuang (Rehmannia Root), Fuling (Poria), Gancao, Chantui (Cicada Slough).
Decoct with Dengcao (Juncus Effusus) and Jinyinhua (Honeysuckle). Additionally, decoct Jingjie, Zisu (Perilla Leaf), Mutong, Lizhi Qiao (Lychee Shell), Fenghuang Tuo, Shengma, and Yangzhi (Willow Branch) in strong soup for bathing.
Yangdu Shengma Tang (Yang-Toxin Cimicifuga Decoction) treats facial redness,狂言 (wild speech), irritability, lower back pain, diarrhea, floating pulse, and sore throat.
Shengma (5 qian), Xijiao, Shegan (Belamcanda Rhizome), Huang Qin, Renshen, Gancao (each 2.5 qian).
Decoct in water and take.
Yindu Shengma Tang (Yin-Toxin Cimicifuga Decoction) treats Yin Toxin (Yin-cold pathogenic factor).
Shengma, Dang Gui, Chuanjiao (Sichuan Pepper), Biejia (Turtle Shell), Xionghuang (Realgar), Gancao.
Decoct in water and take.
[Complicated by Goiter/Ying] [Yuan Shi] Complicating Ying (goiter-like swelling) is formed by phlegm-toxin coagulation. It may knot at the neck, behind the ears, or in the axillae. 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 Ying appears on the 3rd or 4th day of smallpox, the toxin drains with the smallpox, and pus fills with the smallpox, allowing recovery without harm. However, if Ying becomes red, swollen, and suppurative while the smallpox marks fade, I fear that once the toxic pus ruptures, Yuan Qi (Original Qi) will be exhausted, and how can the smallpox then fill and erupt? If Ying appears during the 7th or 8th day when smallpox has turned yellow-wax colored, protecting Yuan Qi and resolving toxin/dispelling evil can still ensure safety, even if it ruptures. Treatment depends on assessing the sequence of days, the thickness of Yuan Qi, gender/age, and seasonal climate. Ying that is red/swollen with fading smallpox requires interior-supporting methods: resolve toxin if severe, tonify Yuan if deficient. Mutong and Jiegeng (Platycodon Root) resolve toxin and open locks; Niuxiangzi (Burdock Fruit) and Shengdi (Rehmannia) remove fierce toxins and clear Ying-fire; Gancao clears various evils; Chantui dispels wind and detoxifies; Shaoyao drains depression-fire in meridians; Jingjie disperses Wind-Evil in Yangming. All herbs are indispensable. If Ying erupts immediately upon smallpox rising, treatment focuses on tonifying and supporting; Huang Qin (Scutellaria) and Lian Huan (Coptis) are contraindicated, as are draining/consumptive agents; resolving phlegm and detoxifying is preferred. If smallpox fades and Ying ruptures leaking pus/blood, causing Yuan Qi deficiency, large doses of Huangqi Weiyuan Tang (Astragalus Supporting Original Qi Decoction) are suitable: Renshen, Huangqi, Chuan Gui, Honghua, Jiegeng, Shaoyao, Gancao, Fangfeng, decocted and taken. If Ying-toxin recurs on days 2-3, urgently use Sansan Xiao (Three Dissolutions Powder): Banxia (Pinellia), Chuan Gui, Fuling, Gancao, Mutong, Honghua, Shengdi, Shaoyao, Niubangzi (Burdock Fruit), Tianhuafen (Trichosanthes Root), Chantui, Dengcao, decocted and taken. If Ying appears on days 7-8 when smallpox is filling, drink Chonghe Yinzi (Harmonizing Drink): Renshen, Huangqi, Maidong (Ophiopogon), Chaihu (Bupleurum), Fangfeng, Jingjie, Shaoyao, Fuling, Chao Baizhu (Fried Atractylodes), Jiegeng, Lianqiao (Forsythia), Dang Gui, Gualougen (Trichosanthes Root). Take four doses frequently for self-healing. Song says: Mutong, Shengdi, and Huangqi; Jiegeng, Dang Gui, Shaoyao all present; Niuxiangzi, Chantui, and Gancao; Bai Fu, Jiangcan show true wonder; Add Shengma for Upper Jiao guidance; Beimu, Maidong must not be omitted; Nixi assists Lower Jiao; Shan Cigu used doubly; More Jingjie for Heat; White芷 (Angelica Dahurica) for extreme pain. My analysis: Verify timing against symptoms. If head/face are fully swollen with Ying, smallpox cannot rise vigorously, leading to damage.
[Complicated by Erysipelas/Dan] [Yuan Shi] Dan erupting within smallpox results from extreme internal heat. Do not abruptly use extremely cold interior-penetrating agents. If smallpox marks appear for 2-3 days, bathe slowly with Huaban Tang (Spot-Resolving Decoction). Internally, take Shengdi, Niubangzi, Shaoyao, Gancao, Mutong, Jingjie Sui (Schizonepeta Tip); the toxin will naturally dissipate. Using Pig Gall, Jing Mo (Beijing Ink), or Bingpian (Borneol) topically causes harm; beware! If the head, face, neck, and nape are hard-swollen like snake-bites and burning painful, with fierce toxin gathering above, use fried Huanglian, Zicao, Cheqianzi (Plantago Seed), Zhizi (Gardenia), etc. My treatment of smallpox-Dan adjusts previous formulas. Using only Lu Tao Hua (Wild Peach Blossom) 2 qian resolves Dan and clarifies smallpox. If swollen/painful, add Chaihu, Qianghuo (Notopterygium), Shengdi, and double Shaoyao. Some use Fengweicao (Pteris Multifida) alone decocted and drunk; however, Shan Jue is Fengweicao, which is extremely cold and sinking, likely harming smallpox; do not use lightly.
[Complicated by Sores/Ulcers] [Yuan Shi] Smallpox complicating sores means smallpox occupies gaps between sores, becoming denser. Smallpox rising with Qi deficiency causes wind-itch. Bathe with Zisu (Perilla Leaf) and Jingjie soup. Then take Shaoyao, Shengdi, Fangfeng, Huangqi, Baizhu, Jiangcan (Silkworm), Gancao, Chantui. If suffering from Yangmei Chuang (Syphilis-like sore) with unbearable pain, and smallpox grows in the sores, Li Shaoyang used Woniu Dan (Snail Pill), but Xiangyou (Sesame Oil) and Zaoren (Soap Nut Kernel) must not be used lightly. If suffering from Feigan Chuang (Obesity-related sores), avoid applying Songxiang (Rosin), Qingfen (Calomel), Feidan (Red Lead), or Xionghuang (Realgar). Song says: Huangqi, Shaoyao, straight Jiangcan; Shengdi, Fangfeng, Baizhu linked; Gancao, Honghua, Niubangzi; Decocted in wine, efficacy hard to describe; If Yangmei Chuang is broken, double Niuhuang, Tushen, Fuling; For extreme pain, add a little Rushiang (Frankincense); Naturally sores heal, smallpox recovers. I have verified children's smallpox growing among sores; although beautiful, they itch fiercely. Without proper herbal baths, smallpox clusters in sores and cannot rise vigorously. Yin Toutuo specifically decocts Xiang Malan Teng (Aromatic Malan Vine) to bathe smallpox complicating sores, truly achieving the miracle of calming smallpox. Note: Xiang Malan has three types (green, red, white); the one with red roots floating upwards is best. Treatment principle: Shengma and Huangqi as Sovereign; Shaoyao and Shengdi as Ministers; Qianghuo and Fangfeng as Assistants; Gancao and Chantui as Envoys. This is the standard pattern.
[Complicated by Injury] [Yuan Shi] One or two days after smallpox marks appear, falls or metal injuries may occur, damaging the Spleen pulse and scattering Qi/Blood, obstructing smallpox. Li Shaoyang used Haigu Hutao Jiu (Child Bone Walnut Wine), which is too harsh; moreover, Hutao (Walnut) is purgative, making it unsuitable. Wang Jinchuan used Guiwei Taoren Tang (Tao Ren Decoction with Angelica Tail), which is reckless; breaking blood is inappropriate for smallpox. Based on Liu Bantang's Gongyuan San, use Renshen, Huangqi, Dang Gui, Honghua, Fufengchu (Eupolyphaga/Slat Beetle), Chantui, Fangfeng, Shaoyao, Gancao to tonify/support internally. Apply Wen Ge (Clam Shell) and Zonghui (Palm Ash) externally to the wound to astringe. If injured but unbroken, apply Xama Pi (Toad Skin) and gently massage. For scalds/burns, do not apply cold/raw drugs to avoid stagnating smallpox. Song says: For injury seek Fufengchu; Tubie, Renshen, Huangqi, Chantui gallop; Juhong, Gancao, Dang Gui combine; Add Honghua, Fangfeng, Dihu together. Formerly, Huang She Ren's second son, aged 13, had smallpox for two days, fell upstairs injuring forehead, bleeding profusely. Parents wept, believing survival impossible. I treated him, doubling Renshen, Huangqi, Dang Gui, Dihu in the formula. After four doses, smallpox rose vigorously. Body restless, added Fushen (Poria with Hostwood) and Guixin (Cinnamon Heart). Externally applied Zonghui alone. Within half a month, scabs fell off perfectly. For severe pain, add little Rushiang. For heavy external trauma/wide scars failing to crust, apply Baiji (Bletilla), Bailian (Lilium Bulb), Xiangpi (Elephant Skin) powder; natural recovery ensues.