浆只不来，或半浆难足，此系尚欠解毒之故，或烧人屎，或粪缸岸 过研末，二味择一，加穿山甲于内，或牛
黄散亦可。书云∶斥补法以防过益，进清凉以助结痂。此言浆足不可再用参、 ，倘不知此，见痘不收，愈补
愈坏。○黄 催浆，只宜生用， 时以蜜炙之。（《仁端录》）
凡虫蚁皆攻，无血者走气，有血者走血，飞者升，地行者降。○火毒归肺，余遵孙真人苇茎汤，间有效
者。（叶天士）
古人谓痘疮但见红点，便不可服升麻葛根汤，恐发得表虚也。此盖为痘疏毒少者言。后人不达立言之旨，
遽谓凡痘见点，俱不可服，殊不知升麻葛根汤四味，乃发表解毒、疏通血气、升降阴阳之剂，痘出太密，正宜
服之，令陷者升之，燥者润之，郁者疏之，过者平之，阴精不衰，而阳毒不亢也。若痘疏毒少者，虽他药亦不
可服，况升麻葛根汤乎？（万密斋）
放痘
古有种痘良法，相传至今，至稳至当。盖正痘因外感时邪而发，种痘则种于无病之时，岂非避危就安之
妙法乎？种法全在好苗。夫苗者，即取他儿种落之痂，谓之种苗，无时行之气。若自出之痂，谓之时苗，有时
行之气，若不辨而用，名虽为种，实与传染时痘无异。然种苗要择痘稀色润，浆浓痂浓，光泽尖圆者，此气血
充足，阴阳合德之上苗也。收贮瓷瓶，紧护其口，置清凉处，勿触秽气。其苗在北方，天气凉，春时一月之内，
冬月四、五十日尚可种。南方气温，夏月四、五日，春月二十日，冬月三十日，久则气薄无力，恐种不出。欲
觅此苗，访有人家种痘，向其恳求数粒，即可源源而种。或平日于同道种师老诚者言明，彼此互借，则苗亦可
不断。近有种师，因种苗已断，权取时苗种之，往往有种出稠密证重者，不知时苗亦必要传种数儿，俱各顺当，
性始平和，方与种苗相等。至于种法，凡种一儿，用痂三、四粒放茶杯内，滴入清水数匙，指尖搅湿，将水倾
去，用柳木小杵，研十数转，如浆糊状，用新棉捏一小团，如枣核大，长短粗细，量儿鼻孔大小，棉团不可太
松，松恐苗气易往外泄，将棉团一头蘸痂糊于上，塞儿鼻中，男左女右，塞勿太进，恐儿不适意，亦勿太出，
恐易于脱落，须宽紧浅深适中为妙。塞后勿任儿手拈出，若嚏打出，仍急塞入。下苗后，以六个时辰为度，
天热早取出数刻，天寒多留数刻，苗气渐次传遍五脏，至七日或八、九日发热，发热三日而见点矣。将发热时，
小儿颈项必发小块，状如痰核，乃毒瓦斯结聚于此，痘发必稀，不必医治，痂后渐消。若用时苗种者，项中无块
可辨。儿之可种与否，须察其体之虚实，及有无宿病。调护之法，当节饮食，适寒温，防惊吓，此皆种师俱
各明悉，兹不重赘。（叶天士）
放苗之七日，应期发热而出者，为活动之苗。放而不出者，苗性不灵，行至半途而止。如自鸣钟之失时，
爆竹之不过线。○
曾记程汉昭先生有五不放之说∶解颅目多白者不放；肉虚软多痰者不放；肤枯发黄有疳积者不放；鼻孔小者不
放；未周岁者不放。痘师能避此五种，自不致失手矣。○予谓五者之外，尤有三不放∶病后未复元者不放；身
生疮疥者不放；时痘出处不放。恐时疫传染，内外交攻，体难任也。（《痘诀余义》）
选案
张圆庵侍御子，年十三岁，六月南归，感受暑热，躁渴狂烦，服天水散不止，改服大顺散，人事昏沉，二
便闭塞五日。予与白虎汤，用石膏煎汁代茶，一昼夜渐觉松快，小便稍长，从新壮热。予曰∶此痘发矣。急与
内托清散，仍用石膏为君，阅二日痘始出，唇舌燥裂，以石膏二十斤、黄连一斤煎汁频进，方获起胀灌脓。前
后二十七日，计用石膏八十五斤，黄连三斤。此种火毒之证，世不常有，非侍御公笃信，安望生全？○黄武功
郎，五岁出痘，下体稠密，上截全无。予曰∶此误下过也。改用升发之剂，始得渐布于上。适予渡江数日，武
功听俗医，恣用芩、连、犀角，八朝无浆，遣人迎予，与以参、 内托立起。○吴皋门郎，十一岁，逆痘变烂，
收功一月后，忽又发痘遍身，一日出齐，三日灌足，第四日一片破烂，全无痘形，脓水淋漓，用松花荞麦粉，
愈扑愈甚。予审视曰∶此原无痘毒，乃脾虚湿胜，究系从前用麻黄发为臭烂，元气耗去，未用参、术调补耳。
内服异功散，外以人参末糁之，随糁随干，内外共享人参一斤五两，至今破处绝无疤痕。○范道生郎，十三岁，
出痘，医用生地、羚羊、芩、连、栀、柏，致淫湿淋漓，不能成浆。予谓∶破烂泄气，又当严冬，再受寒邪，
更变不测。自手至足，俱用皮纸糊密，内服参麦清补汤，加茯苓、山药，逐节调理，回浆后纸渐绉开，痂结
落。（程华仲）
方搏九先生，治徐氏子，三岁出痘，儿质本虚，皮薄娇红，四朝即用参、 ，头面渐肿，五、六分浆，至
七朝，看守不勤，左颊抓破，左眼忽开，声音顿哑。方云，此抓破气虚发痒也。肿
消目开，元气泄也；音哑者气虚，毒欲归肺也。急宜托住元气，清之即死。遂以独参汤频呷，神安片时，续进
大剂参、 ，面复渐肿。方云∶生则生矣，难免发痈。其家尚以音哑为虑，方云∶勿忧，俟其发毒耳。十二朝
至足，右肩井下毒发如杯，五日脓熟，视其毒光而软，银针刺之，脓射如线，而音顿清。○程锦堂孙，五岁，
痘出五朝，予视其天庭两颊模糊，周身稠密，干红紫滞，中有黑点，唇舌焦黑，身热指冷，烦躁，不食不便，
此血热毒壅之证，用十神解毒合犀角地黄，服药依然，以为不可治矣。老医程汉昭视云∶证是实火，在六日前
犹可救治。先用燕巢泥研细，葱汁调敷两太阳及两乳间，以拔其毒；煎剂用麻黄、芩、连、黄柏各一钱，大黄
二钱，紫草三钱，犀角、羚角另研冲服，大便连下数行，色如败酱，唇舌稍退，能食。予曰∶内证虽减，痘已
枯萎，如何灌脓？程云∶火毒既解，不能灌，别有治法。时正严寒，用铜盆盛水置被内，取白石烧红投水中，
热气蒸之。又用芸香熏之。又用雄鸡去毛肠，纳芫荽一握、浓朴三钱于鸡腹，煮浓汁频服，间进清凉活血之剂。
予曰∶此何解也？程云∶水气蒸之令其表透；芸香熏之令其肤裂。（燕巢、白石、芸香等法出《证治准绳》。）；
雄鸡大发、浓朴散结、芫荽透窍，使毒从毛孔透出。肤裂毒出，身必流水，水流毒化，不能灌脓，亦可成功。
如法行之，果被褥皆湿，周身皮脱而愈。予服其治法之妙，始见其善治实证，或不善治虚证。后又治程锦堂次
子，年大体虚，痘重浆灌不起，用羊胎、参、 、枸杞、淫羊藿同煮浓汁服愈，此何等识力也。（《橡村痘诀》）
予儿生四十日，出痘数点，身不甚热，看者谓此痘极轻。越二日，遍身痘出稠密，额面阴囊一片纯红，
不分颗粒，看者又以儿小痘多，必不可为。予见痘色红活，颇能饮乳，尚可调治，以参、 、甘草煎浓，与乳
间服。至六日，头上痘虽有浆，而间发水 ，肢体 多浆少。儿小血气有限，犹不足忧，独额面纯红无
浆，以为必得有脓，毒方可化，仍与前药。至七日，额面红处，忽见一二转黑，惊为变逆，察其精神未惫，是
夜，囊亦转黑，悟非恶候，乃结痂也。缘儿小血气易于周浃，不可拘以常期。九日，痂落，身复大热，此余毒
欲发痈也，以大连翘饮服之，热退，红处痂落，脓水未干，以黄柏、黄连、甘草、地骨皮、五倍子末糁愈。阴
囊流水，用绵茧散糁愈。此极小之儿，极多之痘，极危之证，随证用药，立起回生。世人遇儿小痘多，及纯红
水等证，即弃不治，不亦误乎！○表弟年十五，出痘稠密，八、九日，当灌脓时，痘粒陷入成窝，医用木香、
异功等药，陷伏愈甚。予视其色红紫，体气颇旺。谓曰∶此非虚弱，乃毒盛壅蔽气血，是以陷伏不行浆耳。与
清毒活血汤一剂，陷伏立起，再剂，脓浆充满。（久吾）
如果痘浆生成不足，或者半浆难以满足需求，这是因为解毒之力尚且不够。可以选择烧制的人屎灰，或者粪缸岸边的过筛细末，两味药中任选其一，加入穿山甲粉末；或者使用牛黄散也可以。古籍记载：采用“斥补法”以防止过度进补导致弊端，通过推进清凉之法以辅助结痂。这句话的意思是，当痘浆充足时，不可再使用人参、黄芪等补气药物；倘若不懂这个道理，看到痘疮不能收敛，反而越补越糟糕。○ 黄芪用于催发痘浆，只适宜生用，在收浆阶段则用蜜炙过的黄芪。（《仁端录》）
凡是虫蚁类药物都具有攻伐作用，无血的走气分，有血的走血分，飞行的药性主升，爬行的药性主降。○ 火毒归并于肺，我遵循孙思邈真人的苇茎汤，偶尔也有见效的。（叶天士）
古人说痘疮只要见到红点，就不可以服用升麻葛根汤，恐怕会导致表虚。这大概是针对痘疹稀疏、毒邪较少的情况而言的。后人不理解立论的本意，就武断地认为凡是痘疮见点，都不可服用此方。殊不知升麻葛根汤这四味药，是发表解毒、疏通气血、升降阴阳的方剂。如果痘疹出得太密，正适宜服用它，使下陷者提升，干燥者滋润，郁滞者疏解，亢盛者平抑，从而使阴精不衰竭，阳毒不亢盛。如果是痘疹稀疏、毒邪少的情况，即使其他药物也不宜服用，何况是升麻葛根汤呢？（万密斋）
【种痘】
古代有种痘的好方法，流传至今，非常稳妥恰当。因为正痘是因为外感时行邪气而发作，种痘则是在无病的时候进行接种，这难道不是避开危险、趋向安全的妙法吗？种痘的关键在于好的“苗”。所谓“苗”，就是取其他孩子种痘后脱落的痂皮，称为“种苗”，没有时行邪气。如果是自然患痘后脱落的痂皮，称为“时苗”，带有当时流行的邪气。如果不加辨别而使用，名义上是种痘，实际上与时行痘的传染无异。然而种苗要选择痘疹稀疏、色泽润泽、浆液浓稠、痂皮厚密、光泽尖圆者，这是气血充足、阴阳调和的上等种苗。将其收藏在瓷瓶中，紧紧封住瓶口，放置在清凉处，不要接触污秽之气。如果在北方，天气凉爽，春季一个月内、冬季四五十天内还可以接种。南方气温较高，夏季四五天、春季二十天、冬季三十天，时间久了气力薄弱无力，恐怕种不出来。想要寻找这种苗，可以探访有人家种痘，向其恳求几粒，就可以源源不断地接种。或者平时与同行中诚实可靠的种痘师说明情况，彼此互相借用，那么种苗也可以不断绝。近来有些种痘师，因为种苗已断，暂时取时苗来接种，往往出现种出后痘疹稠密、证候严重的情况，他们不知道时苗也要经过几次传种，都要顺当，药性才会平和，才能与种苗相等。至于种法，凡是给一个孩子接种，用三、四粒痂皮放入茶杯内，滴入几匙清水，用手指尖搅湿，将水倒掉，用柳木小杵研磨十几转，呈浆糊状，用新棉花捏成一小团，大小如枣核，长短粗细根据孩子的鼻孔大小而定，棉团不可太松，松了恐怕苗气容易向外泄露。将棉团一头蘸上痂糊，塞入孩子的鼻孔中，男左女右，塞入不要太深，恐怕孩子不舒服，也不要太浅，恐怕容易脱落，必须宽紧深浅适中才妙。塞好后不要让孩子的用手抠出来，如果打喷嚏打出来了，仍要急忙塞进去。下苗后，以六个时辰为限度，天气热的话早取出片刻，天气冷多留片刻，苗气逐渐传遍五脏，到第七天或第八、九天发热，发热三天后就见痘点了。将要发热时，小儿颈部一定会发出小块，形状像痰核，这是毒瓦斯结聚在这里，痘发出来后必然稀疏，不必医治，结痂后会逐渐消退。如果使用时苗接种的，颈部就没有这种块状物可辨认。孩子是否可以接种，必须观察其体质的虚实，以及是否有宿疾。调护的方法，应当节制饮食，适应寒温，防止惊吓，这些都是种痘师都明白的，这里不再重复赘述。（叶天士）
接种后的第七天，按时发热并出痘的，称为“活动之苗”。接种后不出痘的，是苗性不灵，行至半途而停止。就像自鸣钟不准时，爆竹不过线一样。○
曾经记得程汉昭先生有“五不放”的说法：囟门未闭、眼睛多白睛者不放；肌肉虚弱柔软、多痰者不放；皮肤干枯发黄、有疳积者不放；鼻孔小者不放；未满周岁者不放。痘医能避开这五种情况，自然不会失手。○我认为在这五种之外，还有“三不放”：病后元气未恢复者不放；身上生疮疥者不放；正值时行痘流行期间不放。恐怕时疫传染，内外交攻，身体难以承受。（《痘诀余义》）
【选案】
张圆庵侍御的儿子，十三岁，六月从南方归来，感受暑热，烦躁口渴，狂乱烦闷，服天水散不止，改服大顺散，人事昏沉，二便闭塞五天。我给他开白虎汤，用石膏煎汁代替茶水，一昼夜后渐渐觉得轻松爽快，小便稍长，随即再次壮热。我说：“这是痘毒发了。”急忙给予内托清散，仍以石膏为主药，过了两天痘才出来，嘴唇舌头干燥开裂，用石膏二十斤、黄连一斤煎汁频频服用，才得以起胀灌脓。前后二十七天，共用石膏八十五斤，黄连三斤。这种火毒炽盛的证候，世间不常有，如果不是侍御公深信不疑，哪里指望能保全性命？○黄武功郎中，五岁出痘，下半身痘疹稠密，上半身完全没有。我说：“这是误用泻下药导致的。”改用升发药剂，才渐渐布于上部。恰好我渡江几天，武功听信庸医，肆意使用黄芩、黄连、犀角，到了第八天还没有浆液，派人来接我，我给予人参、黄芪内托，立刻起效。○吴皋门的儿子，十一岁，逆痘变烂，收功一个月后，忽然又全身发痘，一天出齐，三天灌满，第四天一片破烂，完全没有痘形，脓水淋漓，用松花粉和荞麦粉扑洒，越扑越严重。我仔细审视说：“这原本没有痘毒，而是脾虚湿盛，究其原因是从前用麻黄发汗导致臭烂，元气耗损，没有用人参、白术调补罢了。”内服异功散，外用掺人参与末，随掺随干，内外共用人参一斤五两，直到如今破损处绝无疤痕。○范道生的儿子，十三岁，出痘，医生用地黄、羚羊角、黄芩、黄连、栀子、黄柏，导致湿气淋漓，不能成浆。我说：“破烂泄气，又值严冬，再受寒邪，变化莫测。”从手到脚，全部用皮纸糊严密，内服参麦清补汤，加茯苓、山药，逐节调理，回浆后纸渐渐皱开，结痂脱落。（程华仲）
方搏九先生治疗徐氏的儿子，三岁出痘，孩子体质本虚，皮肤薄嫩娇红，第四天就用参、芪，头面渐渐肿胀，五、六分浆，到了第七天，看护不勤，左脸颊被抓破，左眼忽然睁开，声音顿时嘶哑。方先生说：“这是抓破后气虚发痒。”消肿目开，是元气泄露；声音嘶哑是气虚，毒欲归于肺。急宜托住元气，若用清热药就会死亡。于是用独参汤频频呷服，神志安定片刻，接着进大剂量参、芪，面部又渐渐肿胀。方先生说：“活是活了，难免会发痈疽。”家属还担心声音嘶哑，方先生说：“不要担忧，等它发毒吧。”第十二天毒气至足，右肩井穴下毒发如杯状，五天脓熟，看它的毒光亮而软，用银针刺破，脓液喷射如线，而声音顿时清晰。○程锦堂的孙子，五岁，痘出第五天，我看他天庭两颊模糊，周身稠密，干红紫滞，中有黑点，嘴唇舌头焦黑，身体发热手指冰冷，烦躁，不食不便，这是血热毒壅的证候，用十神解毒合犀角地黄汤，服药后依然如故，认为不可治了。老中医程汉昭看后说：“证属实火，在六日前还可以救治。”先用燕巢泥研细，葱汁调敷在两太阳穴及两乳之间，以拔除毒气；煎剂用麻黄、黄芩、黄连、黄柏各一钱，大黄二钱，紫草三钱，犀角、羚角另研冲服，大便连下数次，颜色像败酱，嘴唇舌头稍微退热，能进食。我说：“内证虽然减轻，但痘已枯萎，如何灌脓？”程先生说：“火毒既解，不能灌脓，另有治法。”当时正值严寒，用铜盆盛水放在被子里，取烧红的白石投入水中，用热气蒸熏。又用芸香熏蒸。又用雄鸡去掉毛肠，纳入一把芫荽、三钱浓朴在鸡腹内，煮浓汁频频服用，间或进服清凉活血的药剂。我问：“这是什么解释？”程先生说：“用水气蒸熏使其表透；用芸香熏蒸使其皮肤裂开。（燕巢、白石、芸香等方法出自《证治准绳》）；雄鸡大发散、浓朴散结、芫荽透窍，使毒气从毛孔透出。皮肤裂开毒气排出，身体必然流水，水流毒化，不能灌脓，也可以成功。”按这种方法施行，果然被褥都湿了，周身皮肤脱落而痊愈。我佩服他治法的奇妙，开始见识到他善于治疗实证，或许不善于治疗虚证。后来又治疗程锦堂的二儿子，年大体虚，痘重浆灌不起，用羊胎、参、芪、枸杞、淫羊藿同煮浓汁服用而愈，这是何等见识和魄力啊！（《橡村痘诀》）
我的儿子出生四十天，出痘数点，身体不太热，看的人说这是极轻的痘。过了两天，遍身痘出稠密，额面阴囊一片纯红，不分颗粒，看的人又以孩子小痘多，认为必不可救。我看见痘色红活，颇能饮乳，尚可调治，用参、芪、甘草煎浓，在喂奶间隙服用。到了第六天，头上的痘虽有浆，但间有水疱，肢体多浆少。孩子小血气有限，尚不足忧，唯独额面纯红无浆，认为必定要有脓，毒方可化解，仍给前药。到了第七天，额面红处，忽然见一二处转黑，惊以为变逆，察其精神未疲惫，当天晚上，阴囊也转黑，醒悟不是恶候，乃是结痂。因为孩子小血气易于周流贯通，不可拘泥于常规日期。第九天，痂落，身体复大热，这是余毒欲发痈疽，服大连翘饮，热退，红处痂落，脓水未干，用黄柏、黄连、甘草、地骨皮、五倍子末掺敷而愈。阴囊流水，用绵茧散掺敷而愈。这是极小的婴儿，极多的痘疹，极危重的证候，随证用药，立即起死回生。世人遇到孩子小痘多，以及纯红水疱等证候，就放弃不治，不也是错误吗！○表弟十五岁，出痘稠密，八、九天，正当灌脓时，痘粒陷入成窝，医生用木香、异功散等药，陷伏更甚。我看他颜色红紫，体力气颇旺盛。对他说：“这不是虚弱，而是毒盛壅蔽气血，所以陷伏不行浆。”给清毒活血汤一剂，陷伏立刻起来，再剂，脓浆充满。（久吾）
If the pustular fluid is insufficient, or if half-fluid cannot meet the requirements, this is due to a lack of detoxification power. One may choose burnt human feces ash, or fine powder from the bank of a cesspit, selecting one of these two, and adding Pangolin Scales (Chuan Shan Jia) powder; alternatively, Niuhuang San (Calculus Bovis Powder) can also be used. Ancient texts state: "Employ the method of repelling tonification to prevent excessive benefit, and advance cooling methods to assist scabbing." This means that when the pustular fluid is sufficient, Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi) should not be used again. If one does not understand this, seeing that the smallpox lesions do not converge, and tonifying further will only worsen the condition. ○ Huangqi (Astragali Radix) for promoting pustular fluid should only be used raw; during the stage of fluid formation, it should be honey-fried. (From *Ren Duan Lu*)
All insects and ants have attacking properties. Those without blood move in the Qi level, those with blood move in the Blood level. Flying ones ascend, ground-walking ones descend. ○ Fire-toxin returning to the Lung, I follow Sun Simiao's Weijing Tang (Ejunctum Calami Decoction), occasionally there are effective cases. (Ye Tianshi)
The ancients said that once red spots appear in smallpox, Shengma Gegen Tang (Bupleuri and Puerariae Decoction) should not be taken, fearing it might cause exterior deficiency. This was likely stated for cases where the rash is sparse and the toxin is light. Later generations did not understand the intent of this statement and rashly concluded that Shengma Gegen Tang should never be taken once any spots appear. They did not realize that the four ingredients of Shengma Gegen Tang are a formula for releasing the exterior and detoxifying, unblocking Qi and Blood, and regulating Yin and Yang. If the rash is too dense, it is precisely suitable to take this formula, to lift what has sunk, moisten what is dry, disperse what is stagnant, and calm what is excessive, thereby preventing Yin essence from depletion and Yang toxin from hyperactivity. In cases where the rash is sparse and toxin is light, even other medicines should not be taken, let alone Shengma Gegen Tang? (Wan Mizhai)
[Smallpox Vaccination]
There was an excellent ancient method for variolation, passed down to this day, which is very safe and appropriate. Because natural smallpox arises from external contraction of seasonal pathogens, variolation is performed when the child is free of disease. Is this not a wonderful method of avoiding danger and seeking safety? The key to variolation lies in good "seed" (variola material). The "seed" refers to taking the scabs from children who have undergone variolation, called "seedling scabs," which lack seasonal pathogenic qi. If one uses scabs from naturally occurring smallpox, called "seasonal scabs," they carry the prevailing epidemic qi. If used without discrimination, although nominally variolation, it is practically no different from transmitting seasonal smallpox. However, seedling scabs must be selected from cases where the rash is sparse, color is lustrous, fluid is thick, scabs are dense, and they are shiny, pointed, and round. These are superior seeds where Qi and Blood are abundant, and Yin and Yang are harmoniously integrated. Store them in porcelain bottles, tightly seal the mouth, place in a cool location, and avoid contact with foul odors. In the North, where the weather is cool, within one month in spring, or forty to fifty days in winter, they can still be used. In the South, where the temperature is warmer, within four to five days in summer, twenty days in spring, or thirty days in winter; if kept too long, the qi becomes weak and ineffective, and vaccination may fail. To obtain such seeds, visit families performing variolation and request a few grains, allowing for continuous supply. Or, clarify matters beforehand with honest and reliable variolators among colleagues, borrowing from each other, so the supply of seeds remains uninterrupted. Recently, some variolators, having run out of seedling scabs, temporarily use seasonal scabs. This often results in dense rashes and severe conditions. They do not know that seasonal scabs must also be transmitted through several generations of successful vaccinations to become mild and equal to seedling scabs. As for the method: for each child, take three or four grains of scab, place them in a teacup, add a few spoons of clear water, wet with fingertips, pour out the water, and grind with a small willow wood pestle for over ten turns until it forms a paste-like consistency. Pinch a small ball of new cotton, size like a jujube pit, length and thickness adjusted to the child's nostril size. The cotton ball should not be too loose, lest the seed qi escape easily. Dip one end of the cotton ball into the scab paste and insert it into the child's nostril, left for males, right for females. Do not insert too deeply, lest the child feel uncomfortable; nor too shallow, lest it fall out easily. It must be moderate in tightness and depth. After insertion, prevent the child from picking it out with their hands. If sneezed out, immediately reinsert. The duration for retaining the seed is six shichen (twelve hours). In hot weather, remove it earlier by a short while; in cold weather, leave it longer. The seed qi gradually spreads through the five Zang organs. On the seventh, eighth, or ninth day, fever occurs. After three days of fever, the rash appears. Just before fever, small lumps resembling phlegm nodules will appear on the child's neck. This is where the toxic qi gathers; once the rash emerges, it will be sparse. No treatment is needed; it will gradually subside after scabbing. If seasonal scabs are used, no such lumps will be identifiable in the neck. Whether a child is suitable for variolation depends on observing their constitution (deficiency or excess) and the presence of chronic diseases. Nursing methods include dietary moderation, adapting to temperature changes, and preventing fright. These are all well-known to variolators, so I will not repeat them here. (Ye Tianshi)
Those who develop fever and rash on schedule seven days after inoculation are considered to have "active seeds." Those who do not develop rash after inoculation have seeds that are not agile, stopping halfway. Like a clock losing time or a firecracker failing to ignite. ○
I recall Mr. Cheng Hanzhao's "Five Conditions for Not Variolating": Do not variolate if the fontanelle is open and eyes show excessive white sclera; do not variolate if muscles are soft and flaccid with much phlegm; do not variolate if skin is dry, yellow, and伴有 rickets/accumulation; do not variolate if nostrils are small; do not variolate if under one year old. If variolators can avoid these five situations, they will not make mistakes. ○ I believe that besides these five, there are "Three Conditions for Not Variolating": Do not variolate if recovery from illness is incomplete; do not variolate if sores and scabies are present on the body; do not variolate during an epidemic of seasonal smallpox. Fear of epidemic transmission, internal and external attack, makes the body unable to bear it. (From *Dou Jue Yu Yi*)
[Selected Cases]
The son of Censor Zhang Yuan'an, aged thirteen, returned from the south in June, contracting summer-heat. He suffered from restlessness, thirst, mania, and irritability. After taking Tianshui San (Talcum and Bupleuri Powder) without cessation, he switched to Dashun San (Great Harmony Powder), resulting in lethargy and obstruction of urination and defecation for five days. I prescribed Baihu Tang (White Tiger Decoction), using Gypsum Fibrosum (Shigao) decocted as tea. Within one day and night, he gradually felt relieved, urination increased slightly, but then high fever returned. I said, "This is the eruption of smallpox." Urgently administered Neituo Qingsan (Internal Support and Clearing Powder), still using Gypsum Fibrosum as the chief ingredient. Two days later, the rash appeared. Lips and tongue were dry and cracked. Using eighty-five jin (approx. 51 kg) of Gypsum Fibrosum and three jin (approx. 1.8 kg) of Coptidis Rhizoma (Huanglian) decocted and frequently administered, he finally achieved swelling and suppuration. Over twenty-seven days, total usage was eighty-five jin of Gypsum Fibrosum and three jin of Coptidis Rhizoma. Such a case of intense fire-toxin is rare in the world. Without the Censor's firm trust, how could survival be expected? ○ Huang Wugong Langzhong, aged five, had smallpox. The lower body was dense, the upper body completely devoid of rash. I said, "This is due to erroneous purgation." Changed to ascending and diffusing agents, allowing the rash to gradually spread upwards.恰逢 I crossed the river for a few days. Wugong listened to vulgar doctors and recklessly used Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), and Rhinocerotis Cornu (Xijiao). By the eighth day, there was no pus/fluid. They sent for me. I administered Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi) for internal support, and the condition improved immediately. ○ Wu Gaomen's son, aged eleven, had inverted smallpox turning rotten. One month after recovery, suddenly developed widespread smallpox again. All erupted in one day, filled with fluid in three days. On the fourth day, the area became a mass of rotting flesh, lacking distinct pock marks, with dripping pus and water. Used pine pollen and buckwheat flour, but the more applied, the worse it became. Upon careful examination, I said, "Originally there was no smallpox toxin, but spleen deficiency with dampness predominance. Ultimately, it was caused by previous use of Ephedrae Herba (Mahuang) for sweating leading to putrefaction, consuming Yuan Qi, and failure to use Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu) for regulation and tonification." Internally administered Yigong San (Extraordinary Skill Powder), externally applied Ginseng Radix et Rhizoma (Renshen) powder. With each application, it dried instantly. Internally and externally, a total of one jin five liang (approx. 600g) of Ginseng Radix et Rhizoma (Renshen) was shared. To this day, the broken areas have absolutely no scars. ○ Fan Daosheng's son, aged thirteen, had smallpox. Doctors used Rehmanniae Radix (Disheng), Antelopis Cornu (Lingyangjiao), Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Gardeniae Fructus (Zhizi), and Phellodendri Cortex (Huangbai), causing excessive dampness and inability to form fluid. I said, "Rotting leaks Qi, and it is deep winter; suffering cold evil again will lead to unpredictable changes." From hand to foot, covered tightly with paper. Internally administered Shenmai Qingbu Tang (Ginseng and Ophiopogon Clearing and Tonifying Decoction), added Poria (Fuling) and Dioscoreae Rhizoma (Shanyao), regulating step by step. After fluid returned, the paper gradually wrinkled and opened, and scabs formed and fell off. (Cheng Huazhong)
Mr. Fang Bojiu treated the son of the Xu family, aged three, with smallpox. The child's constitution was originally deficient, with thin, delicate, pink skin. On the fourth day, Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi) were used. The head and face gradually swelled, reaching five to six parts fluid. On the seventh day, due to negligent care, the left cheek was scratched, the left eye suddenly opened, and the voice became hoarse. Fang said, "This is itching due to Qi deficiency after scratching." Swelling subsiding and eyes opening indicates leakage of Yuan Qi; hoarseness indicates Qi deficiency and toxin wanting to return to the Lung. Urgently support Yuan Qi; clearing heat would cause death. Thus, Dushen Tang (Single Ginseng Decoction) was given frequently to sip. Spirit calmed for a moment, then large doses of Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi) were continued. Face swelled again. Fang said, "Life is saved, but abscess formation is inevitable." The family still worried about hoarseness. Fang said, "Do not worry, wait for the toxin to erupt." On the twelfth day, the toxin reached the feet. An abscess like a cup erupted below the right Jianjing point. Five days later, pus matured. Observing the toxin was bright and soft, pricked with a silver needle, pus sprayed like a thread, and the voice cleared instantly. ○ Grandson of Cheng Jintang, aged five. On the fifth day of eruption, I saw his forehead and cheeks blurred, body densely covered, dry red-purple stagnation with black spots, lips and tongue scorched black, body heat with cold fingers, irritability, no eating or bowel movement. This is a syndrome of Blood heat and toxin congestion. Used Shishen Jiedu He Xijiao Dihuang Tang (Ten Divine Detoxification combined with Rhinoceros Horn and Rehmannia Decoction). Medication had no effect, deemed incurable. Old doctor Cheng Hanzhao examined and said, "The syndrome is excess fire, treatable within six days." First, apply finely ground swallow nest mud mixed with green onion juice to both temples and between breasts to draw out toxin; decoction uses Ephedrae Herba (Mahuang), Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), and Phellodendri Cortex (Huangbo) one qian each, Rheum Palmatum Radix et Rhizoma (Dahuang) two qian, Lithospermi Radix (Zicao) three qian, with Rhinocerotis Cornu (Xijiao) and Antelopis Cornu (Lingyangjiao) separately ground and taken with the decoction. Bowel movements occurred several times, color like spoiled sauce, lips and tongue slightly cooled, able to eat. I said, "Internal symptoms reduced, but rash has withered, how to generate pus?" Cheng said, "Fire-toxin resolved, cannot generate pus, there is another method." It was severe cold. Placed copper basin with water inside blankets, threw red-hot white stones into water, steaming with hot air. Also fumigated with Rutae Fructus (Yunxiang). Also removed feathers and entrails of a rooster, placed a handful of Coriandri Fructus (Yansui) and three qian of Magnoliae Officinalis Cortex (Houpo) inside the chicken belly, boiled to make strong decoction, frequently administered, interspersed with cooling and blood-invigorating agents. I asked, "What is the explanation?" Cheng said, "Water vapor steams to penetrate the exterior; Yunxiang fumigation causes skin cracking. (Methods using swallow nests, white stones, Yunxiang etc. come from *Zhengzhi Zhunsheng*); Rooster strongly disperses, Houpo resolves accumulation, Yansui opens orifices, allowing toxin to emerge from hair follicles. Skin cracks, toxin exits, body flows with water, water flow transforms toxin, inability to generate pus, yet success can be achieved." Following this method, indeed bedding became wet, whole body skin shed, and recovered. I admired the brilliance of his treatment, beginning to see his skill in treating excess syndromes, perhaps less so in deficiency syndromes. Later treated Cheng Jintang's second son, young but constitutionally weak, heavy smallpox with poor fluid generation. Used sheep placenta, Ginseng Radix et Rhizoma (Renshen), Astragali Radix (Huangqi), Lycii Fructus (Gouqi), and Epimedii Folium (Yinyanghuo) boiled together in strong decoction, cured. What insight and courage! (From *Xiangcun Dou Jue*)
My son, forty days old, had a few smallpox spots, body not very hot. Observers said this was very mild. Two days later, body became densely covered with rash, forehead, face, and scrotum pure red, indistinguishable particles. Observers again said because the child was small and rash numerous, it was hopeless. Seeing the rash color was lively and red, and the child could suck milk, I thought it could still be treated. Used Ginseng Radix et Rhizoma (Renshen), Astragali Radix (Huangqi), and Glycyrrhizae Radix et Rhizoma (Gancao) decocted strongly, given between feeds. By the sixth day, head rash had fluid, but intermittent vesicles, limbs mostly fluid-poor. Child is small, Qi and Blood limited, not yet worrying. Only forehead and face pure red without fluid, believed must have pus for toxin to transform, still gave previous medicine. By the seventh day, one or two spots on the red forehead turned black. Frightened thinking it was a reversal, observed spirit was not exhausted. That night, scrotum also turned black. Realized it was not a bad omen, but scabbing. Because the child is small, Qi and Blood circulate easily, cannot stick to normal timelines. Ninth day, scabs fell off, body had high fever again. This is residual toxin wanting to erupt as an abscess. Took Dalianqiao Yin (Great Lonicaria Decoction), fever subsided, scabs fell off red areas, pus water not dry, used Phellodendri Cortex (Huangbai), Coptidis Rhizoma (Huanglian), Glycyrrhizae Radix et Rhizoma (Gancao), Lycii Cortex Radicis (Digupi), and Myrobalani Fructus (Wubeizi) powder applied, cured. Scrotum flowing water, cured with Mianjian San (Cocoons Powder). This was a very small infant, very numerous smallpox, very critical condition. Treating according to symptoms, immediately revived. People encountering small infants with numerous smallpox, and pure red vesicle syndromes, give up treatment, is this not a mistake! ○ Cousin, fifteen years old, dense smallpox. Eighth and ninth days, when supposed to fill with pus, pocks sank into pits. Doctors used Costi Radix (Muxiang) and Yigong San, sinking became worse. I saw color red-purple, vitality quite robust. Said, "This is not weakness, but toxin excess blocking Qi and Blood, hence sinking and failing to form fluid." Gave Qingdu Huoxue Tang (Toxin-Clearing and Blood-Invigorating Decoction) one dose, sinking immediately rose. Second dose, pus and fluid full. (Jiuwu)