闻人氏云∶痘 烂之症，因当发散而不发散，则毒瓦斯闭塞，以致喘促闷乱。不当发散而误发散，则毒随阳气暴出于
外，遍身皮肤溃烂。治宜调脾胃进饮食，大便调和，荣卫健旺，毒瓦斯自解，而无目赤咽痛，口疮吐衄等症。窃谓前症若
发表过甚，大便自利，急用理中丸、豆蔻丸，以救其里。亦有痘疹，如蚊所啮而色黑，乃危症也。若大小便秘结烦躁，
用山栀子汤， 猪尾血调脑子治之，自利不食者不可用。盖
毒发于表而妄汗之，则腠理开泄，荣卫益虚，转增疮烂，由是风邪乘虚变症者有之。若毒根于里而妄下之，则内气愈
虚，毒不能出，而反入焉。由是土不胜水，变黑归肾，身体振寒，两耳尻冷，眼合肚胀，其疮黑陷，十无一生，治者审
之。
一小儿患此，发热作渴，手足并冷，此脾经热毒，先用泻黄散五分，又用七味白术散而愈。
一小儿患此，但恶寒发热、体倦头痛，人迎脉大于寸口二三倍，此风邪外伤，用补中益气汤加川芎、蔓荆子，愈而
自靥。
一小儿患此，口舌生疮，手足并冷，余谓此中气虚而内热耳，用五味异功散，议论不一，犹豫未服。翌日，腹痛口
噤，余用前药，更加干姜，一剂诸症稍缓，再剂而愈。
一小儿患此，或痒或痛，发热口渴，先用白术散，次用补中汤而愈。后因作课劳心，发热头痛，痘痕 赤。用补中
汤加蔓荆子，及八珍汤而愈。
一小儿患此作痛，喜饮热汤，发热恶寒，手足并冷，余谓此中气虚而外假热也，用补中汤加参、 ，各三剂四剂而
愈。
一小儿患之，多在两胁，时发寒热，此肝经之症，用加味逍遥散而寒热退，又二剂而胁痛止，及立效散而痊。
一小儿患之，作渴发热，额间为甚。此心经有热，先用导赤散，母服渐愈；又用柴胡栀子散，敷三黄散而痊。
一小儿患之，发热作渴，面目多白，尺脉数而无力，此禀足三阴虚也，用地黄丸、补中汤寻愈。毕姻后，患瘵症，
服黄柏、知母等药几危，余仍用前药而痊。
一小儿患此，体倦恶寒，此脾胃气虚也，用补中益气
汤，数剂而愈。后因饮食停滞，发热而痘痕复赤，先用陈皮、参、术、神曲、山楂消食，仍用补中益气汤，调补脾胃而
愈。若误用败毒之剂，决不起矣。
一小儿痘愈后因劳，痘痕作痒，搔破脓水淋漓，面色皎白，脉浮大按之如无，余用补中益气汤渐愈。或云∶先攻其
邪，而后补之。乃用消风散，变 ，汗退场门噤而死。惜哉！
山栀子汤 治痘疹及 毒状如蚊蚤啮毒盛黑色者。
栀子仁（一两） 白藓皮 赤芍药 升麻（各一两） 寒水石 甘草（炙。各五钱）
上为末，每服一钱，水八分，入柴草。
三黄散 治疳热生疮，脓水浸淫，脓流处便湿烂。
松香 五倍子 黄连 黄丹 海螵蛸（各一钱） 轻粉 雄黄
上为末，用莹肌散煎洗，渗之干者，香油敷。
豆蔻丸（方见泄泻切牙）
柴胡栀子散（即柴胡清肝散）
五味异功散
补中益气汤（二方见寒战切牙）
加味逍遥散（方见欲靥不靥）
地黄丸（即六味地黄丸）
七味白术散（二方见发热属阴阳）
泻黄散（方见靥后发咽痛）
导赤散
立效散（二方见风邪搏于肌肤）
闻人氏说：痘疮溃烂的病症，是因为应当使用发散法治疗却未发散，导致毒气闭塞，从而引起气喘急促、胸闷烦乱。不应当使用发散法却误用发散，则毒气随着阳气突然暴出于体表，导致全身皮肤溃烂。治疗应当调理脾胃，促进饮食摄入，使大便调和，营卫之气健旺，毒气自然解除，就不会出现眼睛发红、咽喉疼痛、口舌生疮、吐血衄血等症状。我认为前述病症如果发表（发散表邪）过度，导致大便自利（腹泻），应立即使用理中丸、豆蔻丸，以救治里虚寒证。也有痘疹，像被蚊子叮咬一样且颜色发黑，这是危重病症。如果大小便便秘结、烦躁不安，使用山栀子汤，用猪尾血调拌脑子（脑髓）来治疗；如果是自利（腹泻）且不进食者，不可使用。因为毒气发于体表而妄用发汗法，则腠理开泄，营卫更加虚弱，反而增加疮疡溃烂，由此风邪乘虚而入产生变证的有这种情况。如果毒根深结于体内而妄用攻下法，则内气更加虚弱，毒气不能排出，反而陷入体内。由此土不胜水，毒气变黑归并于肾，身体战栗恶寒，两耳和尾闾部寒冷，眼睛闭合、腹部胀满，痘疮黑陷，十人中无一生还，医者务必审慎对待。
有一个小孩患此病，发热口渴，手足均冷，这是脾经热毒，先用泻黄散五分，又用七味白术散而痊愈。
有一个小孩患此病，只是恶寒发热、身体疲倦头痛，人迎脉比寸口脉大二三倍，这是风邪外感伤及体表，用补中益气汤加川芎、蔓荆子，痊愈后痘疮自然结痂脱落。
有一个小孩患此病，口舌生疮，手足均冷，我认为这是中气虚弱导致的内热，用五味异功散，当时议论不一，犹豫未服用。第二天，腹痛、牙关紧闭，我使用前面的药，再加干姜，一剂后诸症稍缓，再服一剂而痊愈。
有一个小孩患此病，有时痒有时痛，发热口渴，先用白术散，后用补中汤而痊愈。后来因为读书劳心，再次发热头痛，痘痕发红。用补中汤加蔓荆子，以及八珍汤而痊愈。
有一个小孩患此病感到疼痛，喜欢喝热汤，发热恶寒，手足均冷，我认为这是中气虚弱而外现假热，用补中汤加人参、[原文缺字，推测为黄芪]，各服三至四剂而痊愈。
有一个小孩患此病，多在两胁部位发作，时常发冷发热，这是肝经的病症，用加味逍遥散而寒热退去，又服二剂而胁痛停止，再用立效散而痊愈。
有一个小孩患此病，口渴发热，额头部位尤为严重。这是心经有热，先用导赤散，母亲未服逐渐好转；又用柴胡栀子散，外敷三黄散而痊愈。
有一个小孩患此病，发热口渴，面目颜色多白，尺脉数而无力，这是先天禀赋足三阴经虚损所致，用地黄丸、补中汤寻得痊愈。结婚后，患痨瘵症，服用黄柏、知母等药几乎危及生命，我仍然使用前面的药物而痊愈。
有一个小孩患此病，身体疲倦恶寒，这是脾胃气虚，用补中益气汤，数剂而痊愈。后来因饮食停滞，发热且痘痕复红，先用陈皮、人参、白术、神曲、山楂消食，仍用补中益气汤，调理补益脾胃而痊愈。如果误用败毒之剂，必定无法挽救。
有一个小孩痘疮痊愈后因劳累，痘痕作痒，抓破后脓水淋漓，面色苍白，脉象浮大但按之如无，我用补中益气汤逐渐治愈。有人说：先攻除邪气，然后再补益。于是用消风散，结果变为[原文缺字，推测为坏证或脱证]，汗出如雨，肛门紧闭而死。可惜啊！
山栀子汤 治疗痘疹及痘毒症状像蚊蚤叮咬、毒盛色黑者。
栀子仁（一两） 白鲜皮 赤芍药 升麻（各一两） 寒水石 甘草（炙。各五钱）
以上研为末，每次服用一钱，用水八分，加入柴草（原文“柴草”疑为“葱白”或特定草药，此处直译）。
三黄散 治疗疳积热毒生疮，脓水浸淫，流脓处潮湿溃烂。
松香 五倍子 黄连 黄丹 海螵蛸（各一钱） 轻粉 雄黄
以上研为末，用莹肌散煎水洗患处，渗干后，用香油涂抹。
豆蔻丸（方见泄泻切牙章节）
柴胡栀子散（即柴胡清肝散）
五味异功散
补中益气汤（二方见寒战切牙章节）
加味逍遥散（方见欲靥不靥章节）
地黄丸（即六味地黄丸）
七味白术散（二方见发热属阴阳章节）
泻黄散（方见靥后发咽痛章节）
导赤散
立效散（二方见风邪搏于肌肤章节）
Wenren stated: The condition of ulcerated smallpox (痘烂) arises when dispersing methods should have been used but were not, causing toxic qi to become blocked, leading to panting, shortness of breath, chest oppression, and confusion. If dispersing methods are mistakenly used when they are contraindicated, the toxin follows the Yang qi and violently erupts to the exterior, causing widespread skin ulceration throughout the body. Treatment should focus on regulating the Spleen and Stomach, promoting dietary intake, harmonizing bowel movements, and strengthening Ying and Wei Qi, so that the toxin resolves naturally, preventing symptoms such as red eyes, sore throat, mouth ulcers, vomiting blood, and epistaxis. I believe that if the aforementioned condition is treated with excessive surface-releasing methods, resulting in spontaneous diarrhea, one should urgently use Lizhong Wan (Regulate the Middle Pill) and Doukou Wan (Cardamom Pill) to rescue the interior deficiency-cold. There are also cases of smallpox where lesions resemble mosquito bites and turn black; this is a critical condition. If there is constipation of both stool and urine accompanied by irritability, Shanzhizi Tang (Gardenia Decoction), mixed with pig tail blood and brain matter, should be used. However, it must not be used for patients with spontaneous diarrhea and anorexia. This is because releasing toxins from the exterior through reckless sweating opens the interstices (Couli), further depleting Ying and Wei Qi, thereby exacerbating ulceration. Consequently, Wind pathogen may exploit the deficiency to cause complications. If the toxin is rooted internally and purgative methods are recklessly applied, the internal Qi becomes even more deficient, the toxin cannot exit, and instead sinks inward. Thus, Earth fails to control Water, the toxin turns black and returns to the Kidney, manifesting as tremors and aversion to cold, cold ears and coccyx, closed eyes, abdominal distension, and blackened, sunken lesions; ten out of ten cases result in death. Physicians must exercise extreme caution.
A child suffered from this condition with fever, thirst, and cold extremities. This was identified as Heat-Toxin in the Spleen Meridian. Initially, Xiehuang San (Drain Yellow Powder) was administered at a dosage of five fen, followed by Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder), resulting in recovery.
Another child presented with only aversion to cold, fever, fatigue, and headache. The Renying pulse was two to three times larger than the Cunkou pulse, indicating external Wind pathogen invasion. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) supplemented with Chuanxiong Rhizome (Chuanxiong) and Vitex Fruit (Manjingzi) was used, leading to recovery and natural scabbing of the lesions.
A third child had mouth and tongue ulcers with cold extremities. I diagnosed this as Deficiency of Middle Qi with internal Heat. Wuyi Yigong San (Five-Ingredient Extraordinary Efficacy Powder) was prescribed, but due to differing opinions, the family hesitated and did not administer it. The next day, the child developed abdominal pain and trismus (lockjaw). I used the previous prescription with added Ganjiang (Dried Ginger). After one dose, symptoms alleviated slightly; after another dose, full recovery occurred.
A fourth child experienced itching and pain, fever, and thirst. Baizhu San (Atractylodes Powder) was used first, followed by Bu Zhong Tang (Middle-Tonifying Decoction), resulting in recovery. Later, due to mental exertion from studying, the child developed fever, headache, and reddened scar marks. Bu Zhong Tang with Manjingizi, along with Bazhen Tang (Eight-Treasure Decoction), led to recovery.
A fifth child suffered from pain, preference for hot drinks, fever, aversion to cold, and cold extremities. I diagnosed this as Deficiency of Middle Qi presenting with false Heat externally. Bu Zhong Tang supplemented with Renshen (Ginseng Root) and [missing character, likely Huangqi/Astragalus] was administered for three to four doses, resulting in recovery.
A sixth child had lesions primarily on the hypochondrium, with intermittent chills and fever. This was identified as a Liver Meridian disorder. Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) resolved the chills and fever. After two additional doses, hypochondriac pain ceased, and Lixiao San (Rapid Efficacy Powder) ensured complete recovery.
A seventh child presented with thirst, fever, and severe involvement of the forehead. This indicated Heat in the Heart Meridian. Daochi San (Guide Out Redness Powder) was used initially; although the mother did not take it, the condition gradually improved. Subsequently, Chaihu Zhizi San (Bupleurum and Gardenia Powder) was administered, and Sanhuang San (Three-Yellows Powder) was applied topically, leading to recovery.
An eighth child exhibited fever, thirst, pale complexion, and a rapid yet forceless Chi pulse. This was diagnosed as congenital deficiency of the Foot Three Yin Meridians. Dihuang Wan (Rehmannia Pill) and Bu Zhong Tang were used, leading to recovery. After marriage, the child contracted tuberculosis (Zhai syndrome) and nearly died after taking drugs such as Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome). I continued using the previous medications, resulting in recovery.
A ninth child presented with fatigue, aversion to cold, and Spleen-Stomach Qi deficiency. Bu Zhong Yi Qi Tang was administered for several doses, resulting in recovery. Later, due to food stagnation, fever returned, and the scars reddened. Chenpi (Tangerine Peel), Renshen, Baizhu, Shenqu (Medicated Leaven), and Shanzha (Hawthorn Fruit) were used to digest the food, followed by Bu Zhong Yi Qi Tang to regulate and tonify the Spleen and Stomach, leading to recovery. Had toxic-clearing agents been mistakenly used, recovery would have been impossible.
A tenth child, after recovering from smallpox, suffered from itchy scars due to overexertion. Scratching caused oozing pus, pale complexion, and a floating, large pulse that felt empty upon pressure. Bu Zhong Yi Qi Tang was used for gradual improvement. Some suggested attacking the pathogen first before tonifying. They used Xiaofeng San (Eliminate Wind Powder), which resulted in [missing character, likely deterioration], profuse sweating, anal closure, and death. What a pity!
Shanzhizi Tang treats smallpox and toxin conditions resembling mosquito or flea bites, with intense toxicity and black coloration.
Zhizi Ren (Gardenia Seed) (1 liang), Baixianpi (Dense Barberry Bark), Chi Shaoyao (Red Peony Root), Shengma (Cimicifuga Rhizome) (each 1 liang), Hanshuishi (Calcitum), Gancao (Licorice Root, honey-fried) (each 5 qian).
Grind into powder. Take 1 qian per dose, decocted with 8 fen of water and Chaicao (Herb).
Sanhuang San treats malnutrition heat-induced ulcers with oozing pus and moist, ulcerated areas.
Songxiang (Pine Rosin), Wubeizi (Chinese Gall), Huanglian (Coptis Rhizome), Huangdan (Lead Tetroxide), Haipiaoxiao (Cuttlefish Bone) (each 1 qian), Qingfen (Calomel), Xionghuang (Realgar).
Grind into powder. Wash the lesion with Yingji San decoction. Once dried, apply sesame oil.
Doukou Wan (See Diarrhea and Trismus section for formula)
Chaihu Zhizi San (Same as Chaihu Qinggan San)
Wuyi Yigong San
Bu Zhong Yi Qi Tang (See Chills and Trismus section for formula)
Jiawei Xiaoyao San (See Non-healing Scabs section for formula)
Dihuang Wan (Same as Liuwei Dihuang Wan)
Qiwei Baizhu San (See Fever Belonging to Yin/Yang section for formula)
Xiehuang San (See Post-scab Sore Throat section for formula)
Daochi San
Lixiao San (See Wind Pathogen Combating Skin section for formula)