陈文宿先生云∶痘疮痒塌，若脏腑调和，血气充实，外常温暖，内无冷气，必无此症。设服宣利之药所致，宜用异
功散治之。丹溪云∶痘疹痒塌者，于形色脉上分之，实则脉有力，气壮；虚则脉无力，气怯。虚痒则实之，更加凉血药；
实痒则大便秘结，以凉药下之。窃谓前症若色赤而有痒者，属血虚有热，用四物、牡丹皮。色白而兼痒者，属气虚有热，
用四君加芎、归。若发热大便秘结者，用犀角消毒散。发热大便调和者，用麦门冬饮。寒战渴泻，喘嗽声哑气急，先用
十一味木香散，如未应，急用十二味异功散，外用败草散敷之。若寒战切牙，烦热喘渴足冷，灰白内陷，腹胀渴泻者，
皆不治。
一小儿出痘六日，痒塌寒战，钱密 谓血气虚寒。用十一味木香散二剂而浆贯；用参 托里散，而靥脱。后痕作痒，
用大补汤而痊。
一小儿第七日，痒塌少食，手足俱冷，发热恶寒。先君谓阳气虚寒。用十二味异功散，一剂而痒止，又用托里散加
肉桂，四剂而浆贯，用十全大补汤而结靥。后痕赤作痒，此血气虚热，用八珍汤二十余剂而愈。
一妇人出痘，热数日而发见，用紫草快 汤，虽红活而痒塌，询其素勤劳，元气颇不充实，用八珍汤，烦热渐止，
又用托里散而靥。
一小儿十六岁，第九日痘塌口干，发痒手冷腹胀。先君谓脾胃血气虚弱，用五味异功散加归、 、姜、桂，四剂痒
渐止；又用十全大补汤，六剂浆贯；用八珍汤数剂而靥。后遍身不时作痒，或痘痕色赤，用补中益气汤而痊。
一小儿痘浆不满，面赤作痒。余谓血气虚而有热，欲与温补。不信，服清热之药，至十三日，疮痕色赤，烦渴腹胀
不食，手足逆冷而殁。
五味异功散 治痘疮，脾胃气虚痒塌。（方见寒战切牙）
四物汤（方见痘疮出迟）
四君子汤（即六君子汤去陈皮、半夏，方见不靥闷乱）
托里散
犀角消毒散（二方见痘痈）
十全大补汤（方见腹胀）
八珍汤
十一木香散
十二味异功散（三方见顶陷灰白）
紫草快 汤（方见顶陷心烦）
陈文宿先生说：痘疮出现瘙痒和塌陷，如果脏腑功能调和，气血充盈，体表经常温暖，体内没有寒气，就一定不会出现这种症状。如果是服用泻下宣通药物导致的，适宜用异功散治疗。朱丹溪说：痘疹出现瘙痒和塌陷的，要从面色、形态和脉象上来区分，实证则脉象有力，气壮；虚证则脉象无力，气怯。虚证引起的瘙痒要补益它，再加凉血药；实证引起的瘙痒通常伴有便秘，用凉性药物攻下。我认为前症如果颜色红赤且伴有瘙痒，属于血虚有热，用四物汤加牡丹皮。颜色苍白且伴有瘙痒的，属于气虚有热，用四君子汤加川芎、当归。如果有发热且大便秘结的，用犀角消毒散。发热但大便正常的，用麦门冬饮。如果有寒战、口渴、腹泻、气喘咳嗽、声音嘶哑、呼吸急促的，先用十一味木香散，如果无效，急用十二味异功散，外用败草散敷贴。如果出现寒战、咬牙、烦热、气喘、口渴、脚冷、痘色灰白内陷、腹胀、口渴腹泻的，都属于不治之症。
有一个小孩出痘第六天，出现瘙痒塌陷、寒战，钱密认为是血气虚寒。用了两剂十一味木香散后脓浆充满；再用参芪托里散，痂皮脱落。后来痘痕发痒，用大补汤而痊愈。
有一个小孩第七天，出现瘙痒塌陷、食欲减少，手脚都冷，发热恶寒。先父认为是阳气虚寒。用了十二味异功散，一剂后瘙痒停止，又用托里散加肉桂，四剂后脓浆充满，用十全大补汤结痂。后来痘痕发红发痒，这是血气虚热，用八珍汤二十多剂而愈。
有一个妇人出痘，发热几天后发出皮疹，用紫草快斑汤，虽然颜色红活但瘙痒塌陷，询问她平时勤劳，元气颇不充实，用八珍汤，烦热逐渐停止，又用托里散结痂。
有一个十六岁的小孩，第九天痘塌口干，发痒手冷腹胀。先父认为是脾胃血气虚弱，用五味异功散加当归、人参、生姜、肉桂，四剂后瘙痒逐渐停止；又用十全大补汤，六剂后脓浆充满；用八珍汤几剂后结痂。后来全身不时发痒，有的痘痕颜色红赤，用补中益气汤而痊愈。
有一个小孩痘浆不满，面红发痒。我认为是血气虚而有热，想要给予温补。家属不信，服用了清热药物，到了第十三天，疮痕颜色红赤，烦渴腹胀不进食，手脚逆冷而死。
五味异功散 治疗痘疮，脾胃气虚引起的瘙痒塌陷。（方剂见“寒战切牙”条）
四物汤（方剂见“痘疮出迟”条）
四君子汤（即六君子汤去掉陈皮、半夏，方剂见“不靥闷乱”条）
托里散
犀角消毒散（两个方剂见“痘痈”条）
十全大补汤（方剂见“腹胀”条）
八珍汤
十一味木香散
十二味异功散（三个方剂见“顶陷灰白”条）
紫草快斑汤（方剂见“顶陷心烦”条）
Mr. Chen Wensu stated: Regarding the itching and collapse of smallpox lesions, if the zang-fu organs are harmonious, qi and blood are abundant, the exterior is consistently warm, and there is no cold qi in the interior, this condition will certainly not occur. If caused by the administration of purgative or draining medicines, Yigong San (Extraordinary Efficacy Powder) should be used for treatment. Zhu Danxi said: For smallpox and rashes presenting with itching and collapse, differentiation should be made based on complexion, morphology, and pulse. In excess patterns, the pulse is forceful and qi is robust; in deficiency patterns, the pulse is weak and qi is timid. For itching due to deficiency, tonification is required, supplemented by blood-cooling herbs; for itching due to excess, typically accompanied by constipation, cooling purgatives should be used. I believe that if the lesions are red and itchy, it belongs to blood deficiency with heat, treated with Siwu Tang (Four Substances Decoction) plus Mudanpi (Moutan Cortex). If pale and itchy, it belongs to qi deficiency with heat, treated with Sijunzi Tang (Four Gentlemen Decoction) plus Chuanxiong (Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix). If accompanied by fever and constipation, Xijiao Xiaodu San (Rhinoceros Horn Detoxification Powder) is used. If fever is present but bowel movements are normal, Maidong Yin (Ophiopogon Decoction) is used. In cases of chills, thirst, diarrhea, asthma, cough, hoarseness, and dyspnea, Shiyiwei Muxiang San (Eleven-Ingredient Atractylodes Macrocephala Powder) is administered first; if ineffective, Shierwei Yigong San (Twelve-Ingredient Extraordinary Efficacy Powder) should be urgently used, with Baicao San (Decayed Grass Powder) applied externally. If chills, teeth grinding, irritability, heat, asthma, thirst, cold feet, grayish-white retracted lesions, abdominal distension, thirst, and diarrhea occur, these are all incurable.
A child presented on the sixth day of smallpox eruption with itching, collapse, and chills. Qian Mi attributed this to deficiency-cold of qi and blood. After two doses of Shiyiwei Muxiang San, the pustules filled; subsequently, Shenqi Tuoli San (Ginseng and Astragalus Interior-Supporting Powder) was used, leading to scab detachment. Later, when the scars itched, Dabu Tang (Great Tonifying Decoction) was administered, resulting in recovery.
Another child presented on the seventh day with itching, collapse, reduced appetite, cold hands and feet, fever, and aversion to cold. The author's father attributed this to deficiency-cold of yang qi. Twelvewei Yigong San was given for one dose, stopping the itching; then Tuoli San was added with Rougui (Cinnamon Bark), and after four doses, the pustules filled. Shiquan Dabu Tang (Perfect Great Tonifying Decoction) was used for scabbing. Later, the scars turned red and itched, indicating deficiency-heat of qi and blood; Bazhen Tang (Eight Treasures Decoction) was administered for over twenty doses, leading to recovery.
A woman presented with smallpox after several days of fever. Zicao Kuaban Tang (Arnebia Rapid-Eruption Decoction) was used. Although the lesions were red and vibrant, they itched and collapsed. Upon inquiry, she was found to be industrious with insufficient primordial qi. Bazhen Tang was administered, gradually stopping irritability and heat, followed by Tuoli San for scabbing.
A sixteen-year-old child presented on the ninth day with collapsed lesions, dry mouth, itching, cold hands, and abdominal distension. The author's father attributed this to weakness of spleen-stomach qi and blood. Wuwei Yigong San (Five-Ingredient Extraordinary Efficacy Powder) was added with Danggui, Renshen (Ginseng Radix), Shengjiang (Zingiberis Rhizoma Recens), and Rougui, for four doses, gradually stopping itching. Shiquan Dabu Tang was then used for six doses until the pustules filled, followed by several doses of Bazhen Tang for scabbing. Later, intermittent whole-body itching and reddish scars occurred; Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) led to recovery.
A child presented with incomplete pus formation in the lesions and facial redness with itching. The author attributed this to deficiency of qi and blood with heat, intending to provide warming tonification. The family disagreed and administered heat-clearing medicines. By the thirteenth day, the scars were red, accompanied by irritability, thirst, abdominal distension, anorexia, and cold extremities, leading to death.
Wuwei Yigong San treats smallpox with itching and collapse due to spleen-stomach qi deficiency. (Formula see "Chills and Teeth Grinding")
Siwu Tang (Formula see "Delayed Smallpox Eruption")
Sijunzi Tang (Is Liujunzi Tang without Chenpi and Banxia, Formula see "Failure to Scab and Restlessness")
Tuoli San
Xijiao Xiaodu San (Two formulas see "Smallpox Abscess")
Shiquan Dabu Tang (Formula see "Abdominal Distension")
Bazhen Tang
Shiyiwei Muxiang San
Shierwei Yigong San (Three formulas see "Apex Collapse and Grayish-White Color")
Zicao Kuaban Tang (Formula see "Apex Collapse and Heart Irritability")