疮疹陷伏倒靥，方书称倒靥而已，殊不知内虚不能尽出者为陷伏，外被风寒所迫，或被
恶气冲触，而不得出者名倒靥。然得之有始末轻重不同，若一概用药，因兹夭折者多矣，盖
疮疹已出，斑点为始，以血 为中，以结脓窠痂 为末，三者浅深不同，乌得不论。夫既出
斑点为始者，脏腑蒸蕴，毒瓦斯内外皆热，数日既热甚，蕴斑毒于肌窍，出于皮肤，亦有陷伏
，亦有倒靥，斑点始出，外被风寒所感，使肌窍复开，血凝涩而不行，必身疼。四肢微厥，
气血盛，与风寒相搏于肌肤，必大小便秘。斑点不长，或黑色，或身生青紫瘾疹，此为倒靥
也，当此可温肌，发散风寒，如紫草蝉蜕陈皮葡萄人齿僵蚕荷叶之类，温散寒邪，然后热气
复行，则斑出矣。有胃虚而不能副荣卫者，虽出而复没，故斑运白色，或黑色，此内虚所致
，故出而无血气以应之，其人必不能食乳。或大便自利，小便不赤而清，或倦或呕，四肢微
厥，乃由内胃既虚，自不能出，因为陷伏也，当此宜用温辛之药，令其胃暖，荣卫复温，必
自然出矣，如理中汤活血散人齿散之类以温之，吐利甚者，须姜附硫桂亦可用，此治内自虚
而陷伏者也。若以血 为中者，是红斑出之后，至足有斑为出齐，斑疹毒方出尽也，自斑点
生如豆，起于肌皮之上，所以血 为中者，未结脓血痂 之前证也。血 七日当结脓血痂
，当此或外被风寒所感为倒靥，或胃气虚而吐泻为陷伏者，亦前法治之可也。血 是毒瓦斯正
盛，阳热内外弥满，无阴以收之。血 出至七日，而当结脓窠痂 而愈，今七日而尚如豆大
，血贯之不结脓窠，此由毒瓦斯内外贯注，血热相搏，必复入于心矣，痘至危毙，急以猪尾膏
凉心血，使阴气感之，必随时结痂 而愈，古人以朱砂脑麝猪血等凉心药治疮疹，是治其毒
气已出后，心热毒瓦斯倍常，则用之也，非治里自弱而陷伏者，非肌窍感寒而倒靥者可用也。
陷伏倒靥，皆虚寒证，陷伏胃弱，自不能出，当温之，倒靥是风寒外感于肌窍，当发散，故
非猪尾膏证。猪尾膏是治心热太过，而不能自收敛结痂 者，非为凉脾之药也。盖《素问》
云∶疮疡燥痛，非皆出于心。当血 后紫黑而不结脓窠痂 ，内外贯注毒瓦斯，还复于心则危
矣。以血 结脓窠，脓窠结痂 ，如结浓脓窠痂 ，无外有感冒而生病者，此触冒之过，治
之无异于前斑点时用者也。观小儿数日减食，则胃虚热甚，气耗作斑点，脓窠则血弱在痂
之际，少增滋养，荣卫调适，寒温药以助之为佳，病后服解利药，亦不可缓也 。疮疹未透
，心烦狂燥，气喘妄语，或见鬼者龙脑膏，触犯黑色者夺命膏，黑陷者百祥丸、蓝根散、四
圣散、人齿散，毒盛而黑色者，山栀汤宣毒膏。《良方》治毒瓦斯入脏而不出者脑子猪血酒，
《活人书》黑疮子恶候，无比散、倍金散、朱砂散。疮子反入，抵圣丸、救生散、玳瑁散、
化斑散。疮子靥，花蛇散、麻黄汤、湿生虫散、橄榄核磨水牛蒡散，治黑色名鬼疮子，人齿
猪血散皆是。热盛毒瓦斯倒靥者，非治里虚，吐泻不食而倒靥者，如脾胃虚吐泻，或斑未出，
医人不识，惧用凉药冰却，致令内伏不出，胃爱散主之。服之汗出者，不用控心散，如无汗
，即服控心散，后下羌活散为良。
疮疹出现后，若痘疹内陷或倒靥（痘疹出而复没），医书仅称为“倒靥”罢了，却不知道因体内虚弱不能将毒邪完全透发出来的叫做“陷伏”，因外受风寒逼迫，或被恶气冲撞，导致痘疹不得发出的叫做“倒靥”。然而，这两种情况的发生有起因、过程和轻重的不同，如果一概使用同样的药物治疗，因此夭折的人很多。大概疮疹已经发出，以斑点出现为开始，以血络充盈（指痘疹充血饱满）为中间阶段，以结成脓疱和结痂为结束，这三者深浅不同，怎能不加以区分呢？
既然以斑点出现为开始的，是脏腑蒸腾蕴郁，毒热在内外都炽盛，发热数日后热势更甚，蕴积的斑毒发散于肌窍，出于皮肤。这种情况也有发生陷伏的，也有发生倒靥的。斑点刚发出时，外被风寒所感，使肌窍重新闭合，血液凝涩而不流通，必然身体疼痛，四肢轻微厥冷；如果气血旺盛，与风寒相搏结于肌肤，必然导致大小便不通畅。如果斑点不长，或者颜色变黑，或者身上生出青紫色的瘾疹，这叫做倒靥。此时应当温通肌表，发散风寒，可以使用紫草、蝉蜕、陈皮、葡萄、人齿、僵蚕、荷叶之类的药物，温散寒邪，然后热气重新运行，斑点就能发出了。
如果有胃气虚弱而不能配合荣卫运行的，虽然痘疹发出却又隐没，所以斑点呈现白色，或者黑色，这是由内部虚弱导致的，所以发出后没有血气来应合，这个人必然不能进食乳食。或者大便自利（腹泻），小便不红而清亮，或者疲倦或者呕吐，四肢轻微厥冷，这是由于内部胃气既已虚弱，自然不能将毒邪透出，因此成为陷伏。此时适宜使用温辛的药物，令其胃暖，荣卫恢复温热，必然能自然发出，如理中汤、活血散、人齿散之类的药物来温补。如果呕吐腹泻严重的，姜、附子、硫黄、肉桂也可以使用，这是治疗内部自虚而导致陷伏的方法。
如果以血络充盈为中间阶段的，是指红斑发出之后，直到足部都有斑点才算出齐，斑疹的毒邪方才出尽。从斑点生成如豆粒大小，隆起于肌皮之上，所以所谓“血络充盈为中间阶段”，是指未结成脓血痂之前的证候。血络充盈七日应当结成脓血痂，此时如果外被风寒所感成为倒靥，或者胃气虚弱而吐泻成为陷伏的，也可以用前面提到的方法治疗。
血络充盈之时，是毒热正盛，阳热在内外弥漫充满，没有阴气来收敛它。血络充盈发出至七日，应当结成脓疱结痂而痊愈，现在七日了还像豆粒那么大，刺破出血却不结成脓疱，这是由毒热在内外贯注，血热相互搏结，必然再次侵入心脏，痘疹到了危险致死的地步，急需使用猪尾膏凉心血，使阴气感应它，必然随时结痂而痊愈。古人用朱砂、脑麝、猪血等凉心药治疗疮疹，是治疗毒气发出后，心热毒热加倍寻常时使用，并不是治疗内部自弱而陷伏的，也不是治疗肌窍感受寒冷而倒靥的可以使用的。
陷伏和倒靥，都是虚寒证。陷伏是胃气虚弱，自己不能透出，应当温补；倒靥是风寒外感于肌窍，应当发散，所以不是猪尾膏的适应证。猪尾膏是治疗心热太过，而不能自行收敛结痂的，并不是凉脾的药。大概《素问》说：疮疡燥痛，并不都出于心。当血络充盈后，痘色紫黑而不结成脓疱痂，内外贯注毒热，又返回到心脏，那就危险了。等到血络充盈结成脓疱，脓疱结成痂，就像结成浓稠的脓疱痂一样，如果没有外感感冒而生病的，这是触冒风寒的过错，治疗它与之前斑点时期使用的方法没有不同。
观察小儿几天减少饮食，则是胃虚热甚，气耗损而形成斑点；脓疱形成时则是血弱在结痂之际，稍微增加滋养，使荣卫调适，用寒温药物辅助为佳，病后服用解利药物，也不可迟缓。
疮疹未透发，心烦狂躁，气喘胡言乱语，或者见鬼的，用龙脑膏；触犯黑色毒气的，用夺命膏；黑陷的，用百祥丸、蓝根散、四圣散、人齿散；毒盛而黑色的，用山栀汤、宣毒膏。《良方》治疗毒热入脏而不出用的脑子猪血酒；《活人书》治疗黑疮子恶候的，有用无比散、倍金散、朱砂散。疮子反入（痘疹内陷）的，用抵圣丸、救生散、玳瑁散、化斑散。疮子收靥（痘疹消退）的，用花蛇散、麻黄汤、湿生虫散、橄榄核磨水、牛蒡散，治疗黑色名为鬼疮子的，用人齿猪血散都可以。热盛毒热导致倒靥的，不是治疗里虚；吐泻不食而倒靥的，如脾胃虚吐泻，或者斑点未出，医生不认识，害怕用凉药冰伏，致使内伏不出，用胃爱散主治。服用后出汗的，不用控心散；如无汗，即服控心散，随后服用羌活散为好。
When sores and pox have erupted, if the lesions sink inward or recede (sores/pox erupt and then disappear), medical texts merely call this "receding" (Dao Ye). However, they fail to realize that when internal deficiency prevents the complete expulsion of toxins, it is called "sinking inward" (Xian Fu); whereas when external wind-cold forces the condition, or evil qi assaults it, preventing eruption, it is called "receding" (Dao Ye). Nevertheless, these conditions arise with different origins, processes, and severities. If treated uniformly with medication, many perish as a result. Generally, after sores and pox have begun to appear, the emergence of macules marks the beginning, the filling of blood vessels (indicating congestion and fullness of the lesions) marks the middle stage, and the formation of pustules and scabs marks the end. These three stages differ in depth; how can one fail to distinguish them?
In cases where the eruption begins with macules, the zang-fu organs are steaming and accumulating heat, with toxic heat blazing both internally and externally. After several days of fever, the heat intensifies, and the accumulated macular toxin disperses through the muscle pores and emerges on the skin. In such scenarios, some cases involve sinking inward, while others involve receding. When macules first appear, if affected by external wind-cold, the muscle pores close again, causing blood to coagulate and stagnate without flowing freely. This inevitably leads to body pain and slight coldness in the four limbs. If the vital energy and blood are abundant and contend with wind-cold at the muscle-skin level, it will inevitably cause constipation and difficulty in urination. If the macules do not grow, turn black, or if green-purple wheals appear on the body, this is termed "receding" (Dao Ye). At this stage, one should warm the muscles and disperse wind-cold, using herbs such as *Lithospermi Radix* (Zicao), *Bombyx Batryticatus* (Chantui), *Citri Reticulatae Pericarpium* (Chenpi), *Vitis Vinifera* (Putao), human teeth (Renchì), *Bombyx Batryticatus* (Jiangcan), and *Nelumbinis Nelumbo* (Heye) to warm and disperse cold pathogens. Once the cold is dispersed, the heat will circulate again, allowing the macules to emerge properly.
If there is stomach deficiency failing to support the Ying and Wei (nutritive and defensive energies), the eruptions may appear and then vanish. Consequently, the macules may appear white or black. This is caused by internal deficiency, meaning there is no blood and qi to respond to the eruption. Such patients typically cannot eat or drink milk. They may experience spontaneous diarrhea, clear urine (not red), fatigue, vomiting, and slight coldness in the four limbs. This occurs because the internal stomach qi is deficient and cannot naturally expel the pathogen, resulting in "sinking inward" (Xian Fu). In this case, warm and acrid medicines should be used to warm the stomach and restore the warmth of Ying and Wei, allowing natural eruption. Formulas such as *Lizhong Tang* (Regulate the Middle Decoction), *Huoxue San* (Invigorate Blood Powder), and *Renchì San* (Human Teeth Powder) can be used for warming. In cases of severe vomiting and diarrhea, *Ginger* (Shengjiang), *Aconiti Lateralis Radix Praeparata* (Fuzi), *Sulfur* (Liuhuang), and *Cinnamomi Cortex* (Rougui) may also be employed. This treats sinking inward caused by internal self-deficiency.
Regarding the middle stage characterized by filled blood vessels: after red macules have emerged, the presence of spots all the way to the feet indicates complete eruption, meaning the toxin of the macules and papules has been fully expelled. From the initial appearance of macules like bean-sized bumps rising above the skin surface, the state of "filled blood vessels" refers to the condition before the formation of pus-filled pustules and scabs. Seven days after the blood vessel filling stage, pus-filled pustules and scabs should form. At this time, if affected by external wind-cold leading to receding, or if stomach qi deficiency causes vomiting and diarrhea leading to sinking inward, the previously mentioned methods can be applied.
During the blood vessel filling stage, the toxic heat is at its peak, with yang-heat filling the interior and exterior, lacking yin to restrain it. By the seventh day of eruption, pus-filled pustules and scabs should form, leading to recovery. If, after seven days, the lesions remain only bean-sized and do not form pustules upon pricking, it is due to toxic heat penetrating internally and externally, with blood-heat contending. This likely means the pathogen has re-entered the Heart. The pox condition becomes critical and life-threatening. Urgently use *Zhutai Gao* (Pig Tail Ointment) to cool heart-blood and induce yin energy, which will facilitate immediate scabbing and recovery. Ancients used cooling-heart medicines like *Cinnabar* (Zhusha), *Borneolum Syntheticum* (Nao), *Moschus* (She), and *Sanguis Porcinus* (Zhuxue) to treat sores and pox. This was intended for cases where, after toxin release, heart-heat and toxic heat were exceptionally high. It is not for treating internal weakness causing sinking inward, nor for receding caused by cold invading the muscle pores.
Both sinking inward and receding are deficiency-cold syndromes. Sinking inward results from weak stomach qi unable to expel the pathogen, requiring warming treatment. Receding results from external wind-cold invading the muscle pores, requiring dispersal treatment. Therefore, *Zhutai Gao* is not indicated for receding. *Zhutai Gao* treats excessive heart-heat preventing natural contraction and scabbing; it is not a spleen-cooling medicine. As stated in *Su Wen*: Sores and ulcers with dryness and pain do not all originate from the Heart. If, after the blood vessel filling stage, the color turns purple-black without forming pustules or scabs, and toxic heat penetrates internally and externally returning to the Heart, the condition is critical. Once the blood vessel filling stage forms pustules, and pustules form scabs—like thick, dense scabs—if illness arises without external cold invasion, it is due to exposure negligence. Treatment is no different from that used during the macule stage.
Observe that if a child reduces food intake for several days, it indicates stomach deficiency with intense heat and qi consumption, leading to macule formation. During pustule formation, blood is weak at the scabbing stage. Slightly increasing nourishment to regulate Ying and Wei, and assisting with appropriate cold or warm medicines, is ideal. Post-illness administration of resolving and purgative medicines should not be delayed.
For sores and pox that have not fully penetrated, presenting with mental restlessness, mania, agitation, panting, delirious speech, or hallucinations (seeing ghosts), use *Longnao Gao* (Camphor Ointment). For cases involving black toxic qi, use *Duoming Gao* (Life-Seizing Ointment). For black sinking, use *Baixiang Wan* (Hundred Auspicious Pills), *Langen San* (Blue Root Powder), *Sisheng San* (Four Sages Powder), and *Renchì San*. For severe toxicity with black discoloration, use *Shanzhi Tang* (Gardenia Decoction) and *Xuandu Gao* (Toxin-Releasing Ointment). *Liang Fang* uses *Naobao Zhuxue Jiu* (Brain and Pig Blood Wine) for toxic heat entering the zang-organs without exiting. *Huo Ren Shu* addresses malignant signs of black pox using *Wubi San*, *Beijin San*, and *Zhusha San*. For pox reversing inward, use *Disheng Wan*, *Jiusheng San*, *Daimao San*, and *Huaban San*. For pox receding, use *Huashe San*, *Mahuang Tang*, *Shishengchong San*, water ground from *Canarii Fructus* (Ganlan He), and *Niubang San*. For black pox named "Ghost Pox," *Renchì Zhuxue San* is applicable. For receding caused by intense heat and toxic qi, this is not an internal deficiency treatment. For receding accompanied by vomiting, diarrhea, and anorexia due to spleen-stomach deficiency, or if doctors misidentify pre-eruption macules and fear using cooling medicines, causing internal suppression, use *Wei'ai San* as the primary treatment. If sweating occurs after administration, do not use *Kongxin San*; if no sweat occurs, administer *Kongxin San*, followed by *Qianghuo San* for optimal results.