灌脓时根窠红润，脓浆满足，如黄蜡色，二便如常，饮食不减，此为吉证，不
须服药。
灌脓时纯是清水，皮白而薄，与水泡相似，三四日后、抓破而死。
灌脓之时痘中干枯，全无活血，此名空仓，不治。
灌脓时吐利不止，或二便下血，乳食不化，痘烂无脓者死。（或二便不下血，犹可用止泻
健脾之药。）
灌脓时二便闭，目闭声哑，腹中胀满，肌肉变黑者死。
痘疮成脓之后，鲜明肥泽，饱满坚实，以手拭之，疮头微焦硬者，此欲靥也，
大小先后，以渐收靥，不失太急，不失太缓，已靥者痂壳周圆无有突凸陷凹者，干
净无淫湿破溅者，此为正靥，否极泰来之象也。凡痘疮收靥，不可以日数拘也，大
抵痘本稀，元气实者，自然易出易靥，若疮本稠密，元气虚者，难出难靥也，只要
先后有次，疾徐得中，饮食如常，便无他证。如收太急者，毒邪未尽，煎熬津液，
以致速枯，非正收也，必为目病，为痈毒，为诸怪疾，甚则夭亡，微则残废，宜微
利之，以彻其毒，当归丸主之（大便秘）。如收太迟者，中气已虚，脾胃太弱，不能荣养
肌肉，使之完就，以致溃烂，内服十全大补汤（汗），外用败草散（溃烂）衬之。海藏云∶
疹脓而不焦，此本治失清凉之气，有如五谷得阳气而成熟，非凉风至则不能实也，
天地严肃之气一加，则万物秀而实矣，与 疹何异，须察何经而清凉之，或下而成
严肃之气，则疮气必不至于脓而不痂矣。要当知之，余毒不尽而疾作，盖出于此（当
是清凉饮子下之是也。）非阳和则苗不秀，非严肃则秀不实。钱氏云∶五七日痂不焦，是
内发热，蒸于外，故不得焦痂也，宜宣风散（痘发热）导之，用生犀磨汁解之，必着痂矣。
刘洙疮子诀云∶痘发，如脓窠不肯靥者，但调沙糖水与吃。刘提点云∶亦曾试用，
但后来结瘢痕白。
〔薛〕陈文宿先生云∶痘欲靥不靥，其痂欲落不落，若腹胀烦渴，忌食水蜜生冷
之物，若食之，转渴而死，急与木香散救之。如身热烦渴者，宜服人参麦门冬散。
身热大渴，人参白术散。如不愈，仍服木香散。窃谓前证乃脾胃气虚，津液不足所
致，非实热为患也，如身热烦躁，手足发热，脾胃有热也，用人参麦门冬散。身热
作渴，手足微冷者，脾胃气虚也，用人参白术散。腹胀泄泻，或寒战切牙，脾胃虚
寒也，用十一味木香散。泄泻气促，手足并冷，脾气脱陷也，用十二味异功散。凡
疮结痂作靥，皆由元气充实而内融也，若审见虚弱，便与滋补，血气无亏，可保终
吉，若见不靥而投补剂，恐无及矣。一小儿出痘，贯脓不靥，证如实热。余谓血气
虚甚之假热也。用十全大补汤数剂渐愈。忽又恶寒，余又曰，此邪气退，而真气遂
见虚象也，仍用前药，内参、 各五钱，数剂而愈。一小儿痘不结痂，用补中益
气汤、地黄丸料，煎服而愈。次年毕姻后，寒热作渴头运，脉洪数，按之微细。此
脾肾虚火上炎也，以前药各加肉桂五分，引火归经而愈。
治痘日久不靥。歌曰∶防风锉五钱，炒术与茯苓，当归大腹皮，煎服得安宁。
昔古杭俞氏，专以四制白术散治痘疮日久不肯结痂收脓者，亦此方之遗意也。但回
蚤之痘，元气充托者则可，若元气不足，而回速必宜保护，不如痘之随期而迟回，
何必勉强用药，以速其收功也。
回浆散 治痘不收浆结痂。
何首乌 白芍药 黄 人参 甘草 白术 白茯苓
上，姜水煎服。
象牙散 治同上。
人参 黄 白术（各一钱） 甘草（七分） 茯苓（一钱半） 何首乌（二钱）
上，加糯米二钱，枣二枚，水煎，调下象牙末一钱。
〔溃烂〕痘疮过期不收，遍身溃烂者，此与 烂不同，乃熟太过也，其候不同。
或因天寒失于盖覆，使疮受冻而不收者，宜内服五积散（初热），外用乳香烧烟于被内熏
之。或因天热，过求温暖，使疮被蒸而不收者，宜内服人参白虎汤（见形），或五苓散（惊），
外减去衣被，令少清凉，以天水散（即六一散）扑之。或大便秘结，内外极热，毒瓦斯散
漫，无阴气以敛之而不收者，宜内服宣风散（痘发热），或三黄丸（热），四顺清凉饮（热），外用胆
导法（大便秘）以败草散衬之。或泄泻气虚，脾胃弱，津液少，肌肉虚而不收者，宜内服
陈氏木香散（泻），外用败草散。或因渴饮冷水过多，以致水渍脾胃，湿淫肌肉而不收
者，内服五苓散。如因食少气虚而不收者，人参白术散（渴）去葛根、加桂主之。以
上诸证，以法治之，已溃者结薄痂，未溃者结痂，方为佳兆。若痂皮俱不结者，成
倒靥矣。痘已成脓之后，过期不靥，以致溃烂，脓汁淋漓，不可着席，粘惹痛疼者，用败草散或荞麦粉
以绢袋盛，于身体上扑之，更多布席上，衬卧尤佳，面上欲不成瘢 者，用灭瘢散和百花膏敷之。
败草散
多年屋上烂茅草，择净者为末，掺之，墙上烂草亦佳，以多受风露之气，故能解痘疮毒。
荞麦粉
荞麦一味，磨取细面，痘疮破者，以此敷之，溃烂者以此遍扑之，绢袋盛扑，以此衬卧尤佳。
灭瘢救苦散
蜜陀僧 滑石（各二两） 白芷（半两）
上为细末。湿则干掺之，干则好白蜜调敷。
百花膏
石蜜不拘多少，略用汤和，时时以鹅翎刷之，疮痂亦易落无痕。
【倒靥】痘子初出，磊落成个，后来长大作脓，始相连串，外虽相串，皮下犹一个是一个，至于结痂，肿消
脓干，现出初来本形，所以收藏敛束，要完全坚浓，复成个数为贵。或根脚相通，皮肉尽串者，结痂之时，亦要
干净，无有淫湿及溅破者，次也。若未成痂者溃烂，已成痂者只是嫩皮，此倒靥也。痘毒当靥不靥，复入于里者，
谓之倒靥，此死证也，元气素怯，又不食，常自利者，陈氏木香散（泻）、异攻散（出不快），死中求活圣药也。
如原无泄泻，大便久秘，今添腹胀喘呼，此毒盛，薄
蚀元气，复入于里，宜急下之，排毒散。若不急下，则肠胃不通，荣卫不行，益加喘满躁闷而死矣。若毒入里，忽
然自利者，此人脾胃素强，毒瓦斯难留，故自利，须看利下之物，如利痂皮脓血者，毒瓦斯得出为顺，不可止之，待
利尽脓血自愈。如利水谷者，此毒瓦斯反驱水谷，脾虚不能制之，其证为逆，不可治也。
排毒散
大黄（一两） 白芷 木香（各半两） 穿山甲（七片，土炒焦卷）
共为细末。看虚实大小加减，长流水煎沸调服。
如痘疮破损溃烂者复肿灌作疮，不致干枯，原无痘疮处，复出一层如初出之状，亦以渐起发作脓者，此里气充
实，毒不得入，犹在于表，未成倒靥，逆中之顺证也。但疮子重出一番，必其人能食，大便坚，足以胜其再作之毒，
如食少大便润者，用十全大补汤、人参白术散、肉豆蔻丸主之，盖病久气虚，惟利温补，不可再解毒也。
【不靥闷乱哽气腹胀】〔薛〕陈文宿先生云∶痘疮十一日至十二日当靥不靥，身
热闷乱不宁，卧则哽气，腹胀泄泻，寒战切牙，急用异功散加木香、当归、以救阴
阳表里，助其收靥。窃谓前证若手足并冷，属脾胃虚寒，宜用十二味异功散。手足微冷，属脾胃虚弱，宜用五味异功
散加木香。若手足热，大便秘，属脾胃实热，宜用清凉饮救其阴，以抑其阳。一小儿痘不结痂，发热饮汤，哽气腹胀。
此脾气虚弱。用五味异功散、参 四圣散而愈。后噫气下气，欲服枳壳之类，余谓噫气属心火虚，下气属脾气虚，朝
用六君子汤加姜桂，夕用补中益气汤而愈。一小儿哽气喘咳，腹胀下气，手足不冷不热。此脾虚不能摄气而腹胀下气，
肺虚不能摄气而哽气喘咳，用五味异功散加升麻而愈。
【泄泻】 痘子初出以来，表里俱病，收靥之时，表邪已解，里气当和，大便宜润，小便宜清，忽尔洞泄水
谷者，此中气暴虚，不能禁固水谷。或毒瓦斯乘虚入里，欲作倒靥。并宜陈氏木香散（泻）、异攻散（出不快）、肉豆
蔻丸（泻）主之，利止者佳。利不止者，阳脱而死。
【面】 痘疮溃烂先伤于面者，面乃诸阳之会，痘乃纯阳之毒，以类相从，如水就湿，火就燥也。又，心之华在面，
诸疮皆属于心，心火上炎之象。如面疮已破，肿消目开者，此不着痂先已干燥，病为倒靥，死在旦夕。如已破复
灌，满面成饼，
焦裂溅起，脓血淋漓，食谷则呕，饮水则呛，咯唾粘涎，语音哑嗄，口中气臭者，此脏腑败坏，故诸证尽见也，淹
延闷绝而死。如疮溃肿，饮食无阻，大小便调，更无他苦如上证者，此则可治，内用十全大补汤、升阳解毒
汤相间服之，外用灭瘢救苦散、百花膏合而敷之。
升阳解毒汤
当归 升麻 柴胡 桔梗 甘草 牛蒡子 密蒙花 蝉蜕 连翘 防风 荆芥穗（各等分）
上锉细。水一盏，煎七分，去滓，食后温服。
【人中】人中为任督交会之衢，督乃阳脉，自人中而上，任乃阴脉，自人中而下，故自准头至印堂，与颏至鸠
尾相应，印堂至发际，与鸠尾至膝相应，发际以上，与膝以下相应，痘疮收靥，但观面上收到之处，则知身上收
到之处矣。凡痘子自人中上下左右，先出先靥者吉，阴阳变合相济之理也，若自额角先靥者，孤阳不生，足下
先靥者，孤阴不长，皆凶兆也。
【头足】造化之理，生于阳者阴成之，生于阴者阳成之，故痘疮收靥，头自发际
以上，阳气独盛，谓之孤阳，足自膝以下，阴气所聚，谓之寡阴，所以诸疮皆靥之
后，此二处难靥，乃造化自然之理，不可作倒靥论。
【疳蚀】〔陈〕痘已靥未愈之间，忽被风邪搏之，成疳蚀疮，宜雄黄散、绵茧散治之，久不愈，多渍骨、伤筋、
杀人。〔薛〕前证属足阳明胃经，其方解毒杀虫之剂，若毒发于外，元气未伤者，用之多效。若胃气伤损，
邪火上炎者，用芜荑汤、六味丸。若赤痛者，用小柴胡汤加生地黄。肝脾疳证，必用四味肥儿丸及人参白术
散，更佐以九味芦荟丸。〔万〕痘疮结脓窠之先，或曾伤犯破损者，灌烂成疮，至于收靥，此独不靥，脓汁不干，更
多痛楚，若不急治，渐成疳蚀疮，损骨伤筋，以致横夭，宜内服十全大补汤，外用灭瘢散和百花膏敷之。痘子已成疳
蚀疮者，若在肢节及诸虚怯软弱、血气俱少之处，色青紫黑，肿痛溃烂，以渐延开，血自出者难治，若所生之处，
在于阳分，不痛不烂，色不变，血不出者，以绵茧散主之。
雄黄散 治小儿牙龈生疳蚀疮。
雄黄（一钱） 铜绿（二钱）
上二味同研极细。每用，量疮大小，干贴。
绵茧散 治小儿因痘疮，身体及肢节上生疳蚀疮，脓水不绝，用出蛾绵茧，以生白
矾捶碎入茧内令满，炭火烧令白矾汁尽，取出研极细，每用，干贴疮口上。
【口疳】〔袁〕痘八九朝之期，虽澄黄结蜡，而口中恶臭喷外，上下牙床溃烂，舌板堆裹黄垢，名曰口疳，
若不早治，则床脱牙落，而成漏矣，速将出白散吹之。歌曰∶痘中疳臭世休轻，脱床落齿漏淹成，出白散
方多不识，细茶薄荷共煎浓，乱发滚汤摩洗净，指缠拭口去膜腥，才将青黛硼砂片，薄荷僵蚕些铜青，按制研
为极细末，吹来顷刻痘疳平。余治痘疳，军用人中白 过，和片脑薄荷吹之，朝夕用细
茶、黄连、薄荷煎汤频频漱口后吹之，极效。
【喉痹】〔袁〕痘至七八朝之际，而喉内锁紧，肿痛难咽，毒峻于阳明而然也，金虚则鸣，当以稀涎散吹之。
歌曰∶喉中锁痛觅稀涎，山豆根真效可言，薄荷熊胆相圭合，再把茶芽总共研，随时吹入喉门里，顷刻之间痛遂
痊。此方甚妙，熊胆、山豆根，须要识得真正者，方可用此获效，否则以为无用之方矣。
【发热】痘疮常宜温暖，有热不可尽去，如一向身温，今反发热者，俗名干浆，
此亦常候。只怕内伤饮食，外感风寒，以致发热，又当别论。然病久气虚，不可轻
用汗下，因外伤者，桂枝葛根汤（初热）加人参，因内伤者，木香大安丸（伤食）主之。
歌曰∶待到浑身脓水干，人情倦怠尽偷安，不知禁忌多翻变，一篑终亏九仞山。盖收靥之时，人心怠
忽，居处饮食，不知禁忌，以致变生异证者，纷纷皆是也，行百里者，半于九十，可不慎哉。
[Judgment of Auspicious and Inauspicious Signs during the Suppuration Stage]
During the suppuration stage, if the base of the pustules is ruddy, the pus is abundant, the color resembles yellow wax, bowel and bladder movements are normal, and appetite remains unchanged, this is an auspicious sign; no medication is required.
If during the suppuration stage there is only clear fluid, the skin is pale and thin, resembling a blister, and it dies after being scratched open three or four days later.
If during the suppuration stage the pustules are dry inside with no signs of vital blood circulation, this is called "Empty Granary" (Kong Cang), which is incurable.
If during the suppuration stage there is incessant vomiting and diarrhea, or blood in stool and urine, undigested milk and food, and the pustules rot without forming pus, death will occur. (If there is no blood in stool and urine, antidiarrheal and spleen-strengthening medicines may still be used.)
If during the suppuration stage there is constipation of bowels and bladder, closed eyes, hoarse voice, abdominal distension, and blackening of the muscles, death will occur.
[Normal and Abnormal Crusting (Shou Ye)]
After the smallpox lesions have formed pus, if they are bright, plump, moist, full, and firm, and the tops of the sores feel slightly scorched and hard when wiped by hand, this indicates that crusting is about to occur. The larger and smaller lesions should crust gradually in sequence, neither too fast nor too slow. For those already crusted, the scabs should be round and uniform without protrusions or depressions, clean without excessive moisture or rupture/splashing. This is called "Regular Crusting" (Zheng Ye), symbolizing the transition from extreme misfortune to good fortune. Generally, the timing of crusting should not be rigidly fixed by days. Roughly speaking, if the lesions are sparse and the primordial qi is substantial, eruption and crusting will naturally be easy; if the lesions are dense and the primordial qi is deficient, both eruption and crusting will be difficult. As long as the sequence is orderly, the pace is moderate, and diet is normal, no other complications will arise. If crusting occurs too quickly, the pathogenic toxins are not fully cleared, leading to the boiling away of body fluids and rapid drying; this is not regular crusting and will inevitably lead to eye diseases, carbuncles, and various strange ailments, resulting in premature death in severe cases or disability in mild cases. Mild purgation should be employed to eliminate toxins, using Danggui Wan (Angelica Pill) as the primary formula (for constipation). If crusting is delayed, the middle qi is deficient, and the spleen and stomach are too weak to nourish the muscles for proper healing, leading to ulceration. Internally administer Shiquan Dabu Tang (Complete Great Tonifying Decoction) (for sweating), and externally apply Baicao San (Decayed Grass Powder) as a dressing (for ulceration). Haizang stated: Rashes/pustules that suppurate but do not scorch indicate a loss of cooling energy in treatment, similar to grains maturing due to yang energy but failing to solidify without the arrival of cool winds. When the solemn and austere energy of heaven and earth acts upon all things, they become beautiful and solid. How is this different from rashes? One must observe which meridian is affected and provide cooling therapy, or induce an austere energy through purgation, so that the qi of the sores does not remain in a state of suppuration without crusting. It must be understood that disease recurrence due to residual toxins stems from this principle (likely referring to purging with Qingliang Yinzi/Cooling Drink). Without yang harmony, seedlings cannot flourish; without austere energy, flourishing cannot result in fruitfulness. Qian Yi stated: Scabs that do not scorch between the fifth and seventh days indicate internal heat steaming outward, preventing scab formation. Xuanfeng San (Promote Wind Powder) should be used to guide the heat, and fresh rhinoceros horn juice applied to resolve toxicity, ensuring scab formation. Liu Zhu's *Czai Jue* states: If pustules fail to crust, administering sand sugar water is effective. Director Liu noted that while tested, it resulted in white scars later.
Xue Ji commented: Mr. Chen Wensu stated: If smallpox fails to crust and scabs fail to fall off, accompanied by abdominal distension, irritability, and thirst, avoid water, honey, and cold/raw foods. Consumption leads to increased thirst and death; urgently treat with Muxiang San (Aucklandia Powder). For fever and thirst, Ren Shen Maidong San (Ginseng and Ophiopogon Powder) is suitable. For high fever and extreme thirst, Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Powder) is indicated. If ineffective, revert to Muxiang San. I consider these symptoms caused by deficiency of spleen-stomach qi and insufficient body fluids, not excess heat. For fever with irritability and hot hands/feet, indicating spleen-stomach heat, use Ren Shen Maidong San. For fever with thirst and slightly cold hands/feet, indicating spleen-stomach qi deficiency, use Renshen Baizhu San. For abdominal distension, diarrhea, chills, and teeth grinding, indicating spleen-stomach deficiency-cold, use Shiyiwei Muxiang San (Eleven-Ingredient Aucklandia Powder). For diarrhea with shortness of breath and cold hands/feet, indicating sinking of spleen qi, use Shiwei Yigong San (Twelve-Ingredient Yigong Powder). Crusting results from substantial primordial qi integrating internally. If weakness is observed, tonification should be provided immediately to preserve blood and qi for a favorable outcome; delaying tonification until crusting fails may be too late. A child with smallpox failed to crust despite suppuration, presenting with symptoms resembling excess heat. I diagnosed this as false heat due to severe blood and qi deficiency. Several doses of Shiquan Dabu Tang led to gradual recovery. Sudden aversion to cold occurred; I explained this as the retreat of pathogenic factors revealing true qi deficiency, continuing the previous prescription with added Ginseng and Astragalus (5 qian each), resulting in cure after several doses. Another child with unclosed scabs was cured by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Dihuang Wan (Rehmannia Pill). After marriage the following year, he developed alternating chills and fever, thirst, and dizziness with a surging, rapid pulse that felt faint on deep pressure. This was kidney fire flaming upward due to spleen-kidney deficiency; adding Cinnamon Bark (5 fen) to the previous formulas guided the fire back to its source, effecting a cure.
[Treatment for Delayed Crusting]
A verse states: Cinnabar-wrapped Fangfeng (5 qian), stir-fried Baizhu and Fuling, Danggui and Dafupi, decoct and take for peace.
Formerly, Yu of Hangzhou specialized in Sizhi Baizhu San (Four-Processed Atractylodes Macrocephala Powder) for smallpox failing to crust or drain pus over time, deriving from this formula's intent. However, for early-draining lesions with substantial primordial qi, this is acceptable. If primordial qi is insufficient and drainage is rapid, protection is necessary rather than forcing closure with medication, unlike lesions that drain slowly according to schedule.
[Huijiang San] Treats smallpox failing to drain pus and form scabs.
He Shouwu, Baishaoyao, Huangqi, Renshen, Gancao, Baizhu, Baifuling.
Decoct with ginger water and take.
[Yaxiao San] Treats the above.
Renshen, Huangqi, Baizhu (1 qian each), Gancao (0.7 qian), Fuling (1.5 qian), He Shouwu (2 qian).
Add glutinous rice (2 qian) and jujubes (2 pieces), decoct with water, and take mixed with 1 qian of Ivory Powder.
[Ulceration] Smallpox failing to close past the expected time with widespread ulceration differs from throat rot; it results from excessive "ripening." Etiologies vary:
Cold exposure due to inadequate covering causes freezing of sores; internally use Wuji San (Five Accumulations Decoction) (early heat stage), externally fumigate bedding with burning Frankincense.
Excessive warmth in hot weather causes steaming of sores; internally use Renshen Baihu Tang (Ginseng White Tiger Decoction) (eruption stage) or Wuling San (Five-Ling Powder) (convulsion stage), externally remove clothing/bedding for coolness, and dust with Tianshui San (Heavenly Water Powder, i.e., Liuyi San).
Constipation with extreme internal/external heat and diffuse toxins lacking yin to consolidate requires Xuanfeng San (promoting wind for fever), Sanhuang Wan (Three-Yellow Pill), or Sishun Qingliang Yin (Four-Compliant Cooling Drink) internally, and Dan Dao Fa (Gallbladder Enema Method) with Baicao San externally.
Diarrhea with qi deficiency, weak spleen/stomach, scant fluids, and muscle weakness requires Chenshi Muxiang San (Chen's Aucklandia Powder) internally and Baicao San externally.
Excessive cold water intake damaging spleen/stomach with dampness invading muscles requires Wuling San.
Poor appetite and qi deficiency require Renshen Baizhu San (thirst type) minus Gegen, plus Guizhi.
Successful treatment results in thin scabs for ulcers and regular scabs for non-ulcerated areas. Failure to form scabs indicates "Reverse Crusting" (Dao Ye). Post-suppurative failure to crust leading to ulceration with dripping pus causing pain upon contact with bedding can be managed with Baicao San or Buckwheat Flour in silk bags, dusted on the body and bedding. To prevent facial scarring, Mieban San (Scar-Extinguishing Powder) mixed with Baihua Gao (Hundred Flowers Ointment) should be applied.
[Baicao San]
Old rotten thatch from roofs, cleaned and powdered. Roof thatch is best as it absorbs wind and dew, resolving smallpox toxins.
[Buckwheat Flour]
Finely ground buckwheat. Apply to broken sores, dust over ulcers, or use in silk bags for bedding.
[Mieban Jiuku San]
Miduoseng (Lead Monoxide), Huashi (Talcum) (2 liang each), Baizhi (0.5 liang).
Grind to fine powder. Apply dry if wet; mix with honey if dry.
[Baihua Gao]
Rock sugar (Shimi) as needed, warmed with water. Brush onto sores with goose feathers to facilitate scab removal without scarring.
[Reverse Crusting (Dao Ye)]
Initial smallpox appears distinct, then enlarges into connected pustules. Under the skin, they remain individual. Upon crusting, swelling subsides, pus dries, and original forms reappear. Complete, thick, and distinct scabs are preferred. Connected roots/skin are secondary if clean. Ulceration before scabbing or tender skin on existing scabs constitutes Reverse Crusting. Toxin returning inward instead of crusting is Reverse Crusting, a fatal sign. For patients with inherent weakness, anorexia, and chronic diarrhea, Chenshi Muxiang San and Yigong San are holy medicines for survival. If no prior diarrhea but current constipation, abdominal distension, and wheezing indicate toxin excess eroding qi and returning inward; urgent purgation with Pai Du San (Detoxification Powder) is required. Without purgation, intestinal blockage and failure of Ying/Wei circulation lead to death. Spontaneous diarrhea after toxin entry indicates strong spleen/stomach expelling toxins; if scabs/pus/blood pass, it is favorable and should not be stopped. If grain/water passes, it indicates spleen deficiency failing to control digestion, an adverse and untreatable sign.
[Pai Du San]
Dahuang (1 liang), Baizhi, Muxiang (0.5 liang each), Chuanshanjia (7 scales, soil-fried).
Grind to powder. Adjust dosage by age/condition, decoct in running water, and take.
If ulcerated lesions swell and suppurate again without drying, and new eruptions appear like initial stages, this indicates substantial interior qi preventing toxin invasion, keeping pathogens superficial. This is a favorable turn within an adverse condition. If the patient eats well and has firm stools, they can withstand the second wave. If appetite is poor and stools loose, use Shiquan Dabu Tang, Renshen Baizhu San, or Roudoukou Wan. Prolonged illness causes qi deficiency, requiring warm tonification, not further detoxification.
[Uncrusted, Confusion, Choking, Abdominal Distension]
Mr. Chen Wensu stated: On days 11-12, if smallpox fails to crust, accompanied by fever, restlessness, choking sensation when lying down, abdominal distension, diarrhea, chills, and teeth grinding, urgently use Yigong San with Muxiang and Danggui to rescue yin/yang and exterior/interior, aiding crusting. If hands/feet are cold, it is spleen-stomach deficiency-cold; use Shiwei Yigong San. If slightly cold, spleen-stomach weakness; use Wuwei Yigong San with Muxiang. If hands/feet are hot with constipation, spleen-stomach excess heat; use Qingliang Yin to nourish yin and suppress yang. A child with unclosed scabs, fever, drinking desire, choking, and distension had spleen qi deficiency; cured with Wuwei Yigong San and Shensi San. Later belching and lower gas indicated heart fire deficiency and spleen qi deficiency; treated with Liujunzi Tang with Ginger/Cinnamon in the morning and Buzhong Yiqi Tang in the evening. Another child with choking, wheezing, cough, distension, and lower gas but neutral hands/feet had spleen/lung qi deficiency; cured with Wuwei Yigong San plus Shengma.
[Diarrhea]
From eruption to crusting, exterior and interior are diseased. At crusting, exterior pathogens resolve, interior harmonizes, stools should be moist, urine clear. Sudden watery diarrhea indicates sudden middle qi deficiency failing to secure fluids/grain, or toxin entering inward threatening Reverse Crusting. Treat with Chenshi Muxiang San, Yigong San, or Roudoukou Wan. Cessation of diarrhea is good; persistence leads to yang collapse and death.
[Facial Sores]
The face is the meeting point of all yang meridians; smallpox is pure yang toxin. Like seeks like. Heart manifests in the face; all sores relate to heart, indicating flaming heart fire. If facial sores break, swelling subsides, eyes open, but scabs don't form and dry out, it is Reverse Crusting, death imminent. If breaking leads to refilling, face becomes cake-like, cracked, splashing pus/blood, vomiting food, choking on water, sticky saliva, hoarse voice, foul breath indicates organ failure and death. If sores ulcerate/swell but eating/bowel/bladder functions are normal without other symptoms, it is treatable. Internally alternate Shiquan Dabu Tang and Shengyang Jiedu Tang. Externally apply Mieban Jiuku San and Baihua Gao.
[Shengyang Jiedu Tang]
Danggui, Shengma, Chaihu, Jiegeng, Gancao, Niubangzi, Mimenghua, Chantui, Lianqiao, Fangfeng, Jingjisui (equal parts).
Cut finely. Decoct 1 cup water to 0.7 cup, strain, take warm after meals.
[Ren Zhong]
Ren Zhong is the intersection of Ren and Du meridians. Du is yang (ascending from Ren Zhong); Ren is yin (descending from Ren Zhong). Correspondences exist between facial and body regions. Observing facial crusting indicates body crusting status. Early eruption/crusting around Ren Zhong is auspicious (yin-yang harmony). Early crusting at forehead corners indicates solitary yang (inauspicious); early crusting at feet indicates solitary yin (inauspicious).
[Head and Feet]
Creation's principle: yang born, yin completes; yin born, yang completes. Head above hairline has excessive yang (Solitary Yang); feet below knees gather yin (Solitary Yin). These areas crust last naturally; do not diagnose as Reverse Crusting.
[Gan Shi (Erosive Sores)]
Between crusting and healing, wind-pathogen invasion causes Gan Shi Sores. Treat with Xionghuang San and Mianjian San. Untreated, they erode bone/tendon, killing the patient. Xue Ji noted this belongs to Foot Yangming Stomach Meridian. Detoxifying/insect-killing formulas work if external toxin and intact primordial qi. If stomach qi damaged with evil fire flaming up, use Wuyi Tang and Liuwei Wan. For redness/pain, Xiaochaihu Tang with Shengdihuang. Liver/Spleen Gan syndrome requires Siwei Fei'er Wan, Renshen Baizhu San, and Jiawei Lujian Wan. Wan noted: Pre-crusting injury leading to rotting, failure to crust, weeping pus, and pain progressing to Gan Shi Sores requires Shiquan Dabu Tang internally and Mieban San/Baihua Gao externally. For established Gan Shi Sores on limbs/weak areas with purple/black discoloration, swelling, ulceration, and bleeding, prognosis is poor. For Yang aspect locations without pain/ulceration/color change/bleeding, use Mianjian San.
[Xionghuang San] Treats pediatric gingival Gan Shi Sores.
Xionghuang (1 qian), Tonglv (2 qian).
Grind extremely fine. Apply dry according to sore size.
[Mianjian San] Treats pediatric Gan Shi Sores on body/limbs with continuous pus from smallpox. Use silkworm cocoons, fill with raw Baifan, bake until ash, grind fine. Apply dry to sores.
[Kou Gan (Oral Gangrene)]
Around day 8-9, despite yellow/waxy appearance, foul breath, gum ulceration, and coated tongue indicate Kou Gan. Untreated, gums recede, teeth fall, forming fistulas. Apply Chubai San. Verse: Do not轻视 smallpox halitosis... Chubai San recipe involves tea, mint, hair cleaning, Qingdai, Borax, Mint, Jiangcan, Tongqing. I treat with calcined Renzhongbai and Borneo Mint. Rinse mouth with tea/Coptis/Mint decoction before application.
[Throat Bi]
Around day 7-8, tight throat, swelling, difficulty swallowing due to severe Yangming toxin. Metal deficiency causes ringing; apply Xixian San. Verse: Seek Xixian for throat pain... Sandougen, Mint, Bear Gallbladder, Tea leaves. Authentic ingredients are crucial.
[Fever]
Smallpox prefers warmth; some heat is necessary. Normal warmth turning to fever is "Dry Pus," a common occurrence. Beware of dietary injury or wind-cold. Prolonged illness causes qi deficiency; avoid harsh sweating/purging. External injury: Guizhi Gegen Tang + Renshen. Internal injury: Muxiang Da'an Wan.
Verse: Wait until pus dries... People relax, forgetting taboos... One basket lost ruins nine ren's mountain. Caution is needed at the end.