陈文宿先生云∶痘紫色顶陷，心烦狂躁，气喘妄语，或如见鬼神，内热便秘者，宜用龙脑膏子、猪尾膏。如无内热，
大便不实，不可轻服。窃谓前症多因初起热盛之时，失于解利所致。亦有因痘毒未尽，有因胃经有热，有因肺胃有热，
有因心脾有热。烦躁，痘裂出血，便血衄血，屎黑痕赤，详见各症。大凡作渴发热，手足指冷或大便秘结者，内有热
也，切不可禁其饮水，观张子和述水中儿事，良可验矣。盖热极故得水而生也。
一小儿痘症狂喘，热渴饮冷，痰涎不利，先君用十六味清膈饮、犀角地黄汤而痊。
一小儿痘紫发热，小便不利，手足发热，此肺经有热，用人参清肺饮小便随利，又用犀角地黄汤而靥。
一小儿痘紫作渴，手足并热，余谓胃经有热，用竹叶石膏汤一剂，诸症顿退而愈，用人参白术散而痊。
一小儿痘紫作痛，又顶欲陷，发热饮冷，作渴痰喘，小便秘结。此肺胃有热，用十六味清膈散一剂，诸症顿减，又
用葛根麦门冬散一剂而愈。
一小儿出痘发狂，作渴饮冷，此上焦热炽也，用黄连解毒汤、芹菜汁而止；又用紫草快 汤将靥。因间药饵三日，
色黑倒靥，用紫草散渴止，又用人参白术散而痊。
一小儿出痘喘咳面赤，其脉洪数，右寸脉尤甚，此心火克肺金，用人参平肺散以清心肺，再用地黄丸以壮肾水，喘
嗽顿止。
一小儿痘将愈，喘躁作渴面赤，此禀足三阴虚也，用地黄丸料数剂，诸症稍可，又佐以益气汤，诸症渐愈。后因沐
浴出汗，仍喘咳烦躁面赤，脉洪大，按之如无，此汗多亡阳也，用当归补血汤而愈。毕姻后，喘咳音哑，用地黄丸、益
气汤各百余剂，得远帏幕而生。
一小儿痘愈后，时发狂兼喘，发过面色黄白，手足并冷，此脾胃虚弱也，余用补中、八珍二汤各三十余剂。或云当
先降火邪而后补元气，乃服芩、连、朴硝之类，汗吐不止而殁。
十六味清膈散 治涕唾稠粘，喘嗽痰盛，身热鼻干，大便如常，小便黄赤。
人参 柴胡 当归 芍药 知母 桑白皮 白术 黄 紫菀 地骨皮 茯苓 甘草 桔梗 黄芩（炒，半两） 石
膏（ ） 滑石
上每服三钱，姜水煎，量儿服之。
葛根麦门冬汤 治痘疹胃经热甚，头疼闷烦，或痘后余毒。
麦门冬 干葛 人参 赤芍药 升麻 茯苓（各二分） 石膏末（五分） 甘草（二分）
上水煎服。
犀角地黄汤 治郁热不解，气血涌为衄血，或流入胃脘而吐血，或余血停滞，面色痿黄，大便色黑。
犀角 生地黄 白芍药 牡丹皮（各一钱）
上水煎，乳母同服。
人参平肺散 治心火克肺金，传为痈痿咳嗽喘呕，痰涎壅盛，胸膈痞满，咽嗌不利。
人参 陈皮 甘草 地骨皮 茯苓（各一钱） 知母 五味子（各一钱） 青皮（四分） 天门冬（去心，四分）
桑白皮
上水煎，徐徐服。
竹叶石膏汤 治痘疮胸中烦闷，小便赤涩，口干作渴，兼有赤 。又宜服犀角散（方见泄泻切牙）
龙脑膏子 治时气 痘疮及赤疹子未透，心烦狂躁，气喘妄语，或见鬼神，或已发而陷伏。宜速治，否则毒入
脏必死。
生龙脑
上研细，滴雄猪心血，丸绿豆大，每服一丸。心烦狂躁，紫草汤下。疮陷伏，温酒化下。一方加辰砂五分尤妙。
服后少时，心神清爽，得睡，疮疹发透。
猪尾膏 治痘疮黑陷倒靥。
用小猪尾尖，刺血两三点，入脑子少许，辰砂末一钱，同研膏，以木香汤化下。
紫草快 汤 治痘疹下血不止，不能发出，血气不足，色不红活等症。（即紫草汤）
紫草 人参 白术 茯苓 当归 川芎 芍药 木通 甘草 糯米
上每服二钱，水煎。
人参清肺散（方见痘喘）
八珍汤（方见顶陷灰白泻渴）
黄连解毒汤（方见 症）
地黄丸（即六味地黄丸）
人参白术散（即七味白术散，二方见发热属阴属阳）
补中益气汤
当归补血汤（二方见寒战切牙）
陈文宿先生说：痘疮颜色紫暗、顶部凹陷，伴有心烦意乱、狂躁不安、气喘及胡言乱语，或者出现幻视（如见鬼神），体内有热且大便秘结的，适宜使用龙脑膏子和猪尾膏。如果没有内热，大便稀溏不成形，则不可轻易服用。我认为上述症状多因在发病初期热势炽盛时，未能及时给予解表透疹或清热利导所致。也有因为痘毒未尽、胃经有热、肺胃有热、心脾有热等原因引起的。烦躁不安、痘疮破裂出血、便血、鼻衄（流鼻血）、大便色黑、小便红赤等症状，详见各病症章节。大凡出现口渴发热、手足指端发冷或大便秘结的情况，说明体内有热，切不可禁止患者饮水，参考张子和记载的从水中救起婴儿的案例，足以验证这一道理。这是因为热极之时，得水则能生存。
有一个小儿患痘疮症，出现狂喘、发热口渴喜饮冷水、痰涎不利，我的父亲使用了十六味清膈饮和犀角地黄汤而痊愈。
有一个小儿痘疮颜色紫暗、发热、小便不利、手足发热，这是肺经有热，使用人参清肺饮后小便随即通畅，又使用犀角地黄汤使痘疮结痂愈合。
有一个小儿痘疮颜色紫暗、口渴、手足均发热，我认为这是胃经有热，使用竹叶石膏汤一剂，各种症状顿时消退而愈，随后用人参白术散调理而康复。
有一个小儿痘疮颜色紫暗、疼痛，且顶部即将凹陷，伴有发热、喜饮冷水、口渴、痰喘、小便秘结。这是肺胃有热，使用十六味清膈散一剂，各种症状顿时减轻，又使用葛根麦门冬散一剂而痊愈。
有一个小儿出痘后发狂、口渴喜饮冷水，这是上焦热势炽盛，使用黄连解毒汤和芹菜汁使症状停止；又使用紫草快痘汤促使痘疮结痂。因间断服药三日，痘色变黑并倒靥（痘疮塌陷不结痂），使用紫草散使口渴停止，又用人参白术散而康复。
有一个小儿出痘后喘咳、面赤，脉象洪数，右寸脉尤为明显，这是心火克制肺金，使用人参平肺散以清心肺之热，再用地黄丸以滋补肾水，喘咳顿时停止。
有一个小儿痘疮即将痊愈时，出现喘促烦躁、口渴面赤，这是禀赋不足导致足三阴经虚损，使用地黄丸料数剂，各种症状稍有好转，又辅以益气汤，各种症状逐渐痊愈。后来因为沐浴出汗，再次出现喘咳烦躁面赤，脉象洪大但重按无力，这是汗出过多导致亡阳，使用当归补血汤而痊愈。结婚后，出现喘咳声音嘶哑，使用地黄丸、益气汤各百余剂，得以远离病榻而存活。
有一个小儿痘疮痊愈后，时常发作狂躁兼带喘促，发作过后面色黄白，手足均冷，这是脾胃虚弱，我使用补中益气汤和八珍汤各三十余剂。有人说是应当先降火邪而后补元气，于是服用黄芩、黄连、朴硝之类的药物，导致汗吐不止而死亡。
十六味清膈散：治疗涕唾稠粘、喘嗽痰盛、身热鼻干、大便正常、小便黄赤。
药材组成：人参、柴胡、当归、芍药、知母、桑白皮、白术、黄芪、紫菀、地骨皮、茯苓、甘草、桔梗、黄芩（炒，半两）、石膏（煅）、滑石。
用法：每次服用三钱，用姜水煎煮，根据患儿情况调整剂量服用。
葛根麦门冬汤：治疗痘疹胃经热甚、头疼闷烦，或痘后余毒。
药材组成：麦门冬、干葛、人参、赤芍药、升麻、茯苓（各二分）、石膏末（五分）、甘草（二分）。
用法：用水煎服。
犀角地黄汤：治疗郁热不解、气血涌溢导致鼻衄，或流入胃脘而吐血，或余血停滞、面色萎黄、大便色黑。
药材组成：犀角、生地黄、白芍药、牡丹皮（各一钱）。
用法：用水煎煮，乳母同服。
人参平肺散：治疗心火克肺金，传变为痈痿咳嗽喘呕，痰涎壅盛，胸膈痞满，咽喉不利。
药材组成：人参、陈皮、甘草、地骨皮、茯苓（各一钱）、知母、五味子（各一钱）、青皮（四分）、天门冬（去心，四分）、桑白皮。
用法：用水煎煮，慢慢服用。
竹叶石膏汤：治疗痘疮胸中烦闷、小便赤涩、口干作渴，兼有赤疹。也宜服用犀角散（方见泄泻切牙）。
龙脑膏子：治疗时气痘疮及赤疹子未透，心烦狂躁、气喘妄语、或见鬼神，或已发出而陷伏。宜速治，否则毒入脏必死。
药材组成：生龙脑。
用法：研细，滴入雄猪心血，制成绿豆大小的丸药，每次服用一丸。若心烦狂躁，用紫草汤送下；若疮陷伏，用温酒化开送下。另一方法加辰砂五分尤其妙。服用后不久，心神清爽，入睡，疮疹发透。
猪尾膏：治疗痘疮黑陷倒靥。
用法：取小猪尾尖，刺血两三点，加入少许脑子（冰片）、辰砂末一钱，同研成膏，用木香汤化开送下。
紫草快痘汤：治疗痘疹下血不止、不能发出、血气不足、颜色不红活等症状。（即紫草汤）
药材组成：紫草、人参、白术、茯苓、当归、川芎、芍药、木通、甘草、糯米。
用法：每次服用二钱，用水煎煮。
人参清肺散（方见痘喘）
八珍汤（方见顶陷灰白泻渴）
黄连解毒汤（方见惊风症）
地黄丸（即六味地黄丸）
人参白术散（即七味白术散，二方见发热属阴属阳）
补中益气汤
当归补血汤（二方见寒战切牙）
Mr. Chen Wensu stated: When smallpox lesions are purple in color and sunken at the apex, accompanied by mental restlessness, mania, panting, delirious speech, or hallucinations (such as seeing ghosts or deities), internal heat, and constipation, Longnao Gaozi (Borneol Pills) and Zhuwei Gao (Pig Tail Ointment) should be used. If there is no internal heat and the stool is loose, these should not be taken lightly. I believe that the aforementioned symptoms are mostly caused by failing to resolve the exterior or clear heat and promote drainage when the heat was intense at the onset. There are also cases due to incomplete elimination of smallpox toxin, heat in the Stomach meridian, heat in the Lungs and Stomach, or heat in the Heart and Spleen. Symptoms such as irritability, bleeding from ruptured lesions, hematochezia, epistaxis, black stools, and red urine are detailed in their respective sections. Generally, if thirst, fever, coldness of the fingertips, or constipation occur, it indicates internal heat. One must not forbid drinking water; referring to Zhang Zihe's account of rescuing an infant from water serves as a good verification. This is because extreme heat generates a need for water to sustain life.
A child with smallpox presented with mania, panting, fever, thirst for cold drinks, and difficult expectoration. My father treated him with Shiliuwei Qingge Yin (Sixteen-Ingredient Diaphragm-Clearing Decoction) and Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), resulting in recovery.
Another child with smallpox had purple lesions, fever, difficulty in urination, and hot extremities. This indicated heat in the Lung meridian. After administering Ren Shen Qingfei Yin (Ginseng Lung-Clearing Decoction), urination improved immediately. Subsequently, Xijiao Dihuang Tang was used to facilitate scabbing.
A child with purple smallpox lesions, thirst, and hot hands and feet was diagnosed with heat in the Stomach meridian. One dose of Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) rapidly alleviated all symptoms, followed by Ren Shen Baizhu San (Ginseng and Atractylodes Macrocephala Powder) for complete recovery.
A child with purple, painful smallpox lesions that were about to sink, accompanied by fever, preference for cold drinks, thirst, phlegmic panting, and urinary retention, suffered from heat in the Lungs and Stomach. One dose of Shiliuwei Qingge San (Sixteen-Ingredient Diaphragm-Clearing Powder) significantly reduced symptoms, and one dose of Gegen Maimendong San (Kudzu and Ophiopogon Powder) led to recovery.
A child who developed smallpox became manic, thirsty, and desired cold drinks, indicating blazing heat in the Upper Jiao. Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxins) and celery juice stopped the symptoms. Zicao Kuai Dou Tang (Arnebia Rapid Smallpox-Decoupling Decoction) was then used to promote scabbing. Due to a three-day interruption in medication, the lesions turned black and inverted (reversed scabbing). Zicao San (Arnebia Powder) stopped the thirst, and Ren Shen Baizhu San ensured recovery.
A child with smallpox experienced panting, coughing, and facial flushing, with a surging and rapid pulse, especially prominent at the right Cun position. This indicated Heart Fire overcoming Lung Metal. Ren Shen Pingfei San (Ginseng Lung-Calming Powder) cleared Heat from the Heart and Lungs, followed by Dihuang Wan (Rehmannia Pill) to nourish Kidney Water, which instantly stopped the panting and coughing.
As a child's smallpox was nearing resolution, he exhibited panting, irritability, thirst, and facial flushing, indicating deficiency of the Three Yin meridians of the foot. Several doses of Dihuang Wan material relieved symptoms slightly, supplemented by Yiqi Tang (Qi-Nourishing Decoction) for gradual improvement. Later, after bathing and sweating, he again presented with panting, coughing, irritability, facial flushing, and a surging-large pulse that felt empty upon deep pressure, indicating Yang collapse due to excessive sweating. Danggui Buxue Tang (Angelica Sinensis Blood-Nourishing Decoction) cured him. After marriage, he suffered from panting, coughing, and hoarseness. Over a hundred doses each of Dihuang Wan and Yiqi Tang allowed him to recover and leave his bedridden state.
After recovering from smallpox, a child frequently experienced mania combined with panting. Between episodes, his complexion was sallow and white, and his hands and feet were cold, indicating Spleen and Stomach weakness. I prescribed Buzhong Yiqi Tang (Middle-Boosting Qi-Nourishing Decoction) and Bazhen Tang (Eight-Treasure Decoction), more than thirty doses of each. Some suggested clearing Fire Evil first before tonifying Original Qi, so they administered herbs like Huang Qin, Huang Lian, and Poxiao. The child died from incessant sweating and vomiting.
Shiliuwei Qingge San treats sticky sputum and saliva, profuse phlegmic coughing, body heat, dry nose, normal bowel movements, and yellow-red urine.
Ingredients: Ren Shen (Ginseng), Chai Hu (Bupleurum), Dang Gui (Angelica Sinensis), Shaoyao (Peony), Zhimu (Anemarrhena), Sangbaipi (Mulberry Root Bark), Baizhu (Atractylodes Macrocephala), Huangqi (Astragalus), Ziwan (Asterae Radix), Digupi (Lycium Bark), Fuling (Poria), Gancao (Licorice), Jiegeng (Platycodon), Huangqin (Scutellaria, stir-fried, 0.5 liang), Shigao (Gypsum, calcined), Huashi (Talc).
Usage: Take 3 qian per dose, decoct with ginger water, and adjust dosage according to the child's condition.
Gegen Maimendong Tang treats severe heat in the Stomach meridian during rash diseases, headache, stuffiness, irritability, or residual toxins after smallpox.
Ingredients: Maimendong (Ophiopogon), Gan Ge (Kudzu Root), Ren Shen (Ginseng), Chi Shaoyao (Red Peony), Shengma (Cimicifuga), Fuling (Poria, 2 fen each), Shigao Mo (Gypsum Powder, 5 fen), Gancao (Licorice, 2 fen).
Usage: Decoct in water and take orally.
Xijiao Dihuang Tang treats unresolved stagnant heat causing blood to surge and cause epistaxis, or flow into the stomach cavity causing hematemesis, or residual blood stagnation leading to sallow complexion and black stools.
Ingredients: Xijiao (Rhinoceros Horn), Sheng Dihuang (Raw Rehmannia), Bai Shaoyao (White Peony), Mudanpi (Moutan Cortex, 1 qian each).
Usage: Decoct in water; the nursing mother takes it concurrently.
Ren Shen Pingfei San treats Heart Fire overcoming Lung Metal, transmitting as abscesses, wasting-thirst, coughing, panting, vomiting, profuse phlegm, chest and diaphragm fullness, and throat obstruction.
Ingredients: Ren Shen (Ginseng), Chenpi (Citrus Peel), Gancao (Licorice), Digupi (Lycium Bark), Fuling (Poria, 1 qian each), Zhimu (Anemarrhena), Wuweizi (Schisandra, 1 qian each), Qingpi (Green Citrus Peel, 4 fen), Tianmendong (Asparagus Tuber, heart removed, 4 fen), Sangbaipi (Mulberry Root Bark).
Usage: Decoct in water and take slowly.
Zhuye Shigao Tang treats chest oppression and stuffiness from smallpox, red and scanty urination, dry mouth, and thirst, accompanied by red rashes. It is also suitable to take Xijiao San (see "Diarrhea and Teeth Grinding" for formula).
Longnao Gaozi treats epidemic smallpox and red rashes that have not fully erupted, mental restlessness, mania, panting, delirious speech, hallucinations, or eruptions that have sunk and collapsed. Immediate treatment is required; otherwise, toxin entering the Zang organs will be fatal.
Ingredients: Sheng Longnao (Raw Borneol).
Usage: Grind finely, add fresh pig heart blood drop by drop, and form pills the size of mung beans. Take one pill per dose. For mental restlessness and mania, take with Zicao Tang (Arnebia Decoction). For collapsed lesions, dissolve with warm wine. Another method adds 5 fen of Chen Sha (Cinnabar), which is excellent. Shortly after taking, the mind becomes clear, sleep occurs, and rashes erupt fully.
Zhuwei Gao treats black, sunken, and inverted smallpox lesions.
Usage: Prick the tip of a young pig's tail to extract two or three drops of blood, add a small amount of Naozi (Camphor/Borneol), 1 qian of Chen Sha Mo (Cinnabar Powder), grind together into an ointment, and dissolve with Muxiang Tang (Costus Root Decoction) for oral administration.
Zicao Kuai Dou Tang treats continuous bleeding from smallpox/rash, failure to erupt, insufficient blood and Qi, and dull color without vitality. (This is Zicao Tang).
Ingredients: Zicao (Arnebia), Ren Shen (Ginseng), Baizhu (Atractylodes Macrocephala), Fuling (Poria), Dang Gui (Angelica Sinensis), Chuanxiong (Ligusticum), Shaoyao (Peony), Mutong (Akebia), Gancao (Licorice), Nuomi (Glutinous Rice).
Usage: Take 2 qian per dose, decoct in water.
Ren Shen Qingfei San (See "Smallpox Panting" for formula)
Bazhen Tang (See "Sunken Lesions, Ashy White Color, Diarrhea, Thirst" for formula)
Huanglian Jiedu Tang (See "Convulsion" for formula)
Dihuang Wan (i.e., Liuwei Dihuang Wan / Six-Ingredient Rehmannia Pill)
Ren Shen Baizhu San (i.e., Qiwei Baizhu San / Seven-Ingredient Atractylodes Powder; see "Fever: Yin vs. Yang" for both formulas)
Buzhong Yiqi Tang
Danggui Buxue Tang (See "Chills and Teeth Grinding" for both formulas)