（凡二十一首，共二十六方）
起发之时渐作脓，毒随脓化语无凶。或成空壳兼清水，毒瓦斯留连虑晚攻。
凡痘疮自起发之后，血化为水，水化为脓，至此脓已成，毒已化矣。饮食如常，不亦吉乎！若当起发，壳中
出清水，此气至而血不随也，治之当益其荣，宜四物化毒汤。
或内含清水，平塌不起，此血至而气不随也，当益其卫，宜保元化毒汤。
或窠囊浮肿，中含清水，如水泡之状，此气血俱虚，不能制毒，反为毒逼，渐变痒塌，治之当托其毒，固其
荣卫，使无痒塌，以十全化毒汤主之。
亦有饮食如常，六脏充实，若见空壳清水之证，虽能收敛，未免发为痈毒，不可不早治之。
脓成毒化笑颜开，犹虑形生变证来。莫谓清安无个事，风云不测霎时灾。
痘疮至成脓 ，此收功之时，手足常要和暖，过热过寒者，变也；人事常要安静，烦躁闷乱者，变也；六腑
常要充实，忽吐利者，变也；声音常要响亮，忽喑哑者，变也；饮食要渐进，忽不食反作渴者，变也；色要苍
蜡，形要饱满，忽灰白平塌者，变也；疮要安和，忽痒痛者，变也。或触风寒，或犯禁忌，或伤食，或误服汤
丸，医者当详察其所因而治之。
四肢温暖始相宜，寒热乘常势渐离。补
泻无偏能谨慎，折肱端的信良医。
凡痘疮手足常要和暖，不宜太热太寒，寒热太甚，则水火偏胜而残矣。假如病患六腑闭结，狂妄烦躁，口
干作渴，其脉洪数沉紧者，实也，手足热，本病也。若手足冷，阳极似阴，谓之阳厥，下之勿疑，宜承气化毒汤。
若曾经吐泻，其脉沉细微弱者，虚也，手足冷，本病也。若手足热，乃阴极似阳，谓之阴躁，宜补之，回
阳化毒汤温之。
养浆安静吉堪夸，战惕鸣牙祸必加。痛痒躁烦双足冷，纵教仙手枉喧哗。
凡痘疮已成浆，或寒战，或切牙，单见一证者可治。盖寒战因疮出太甚，表虚而振振摇动者有之，宜养卫
化毒汤。
若切牙者，必肝火甚，其牙相戛而鸣也，宜清神化毒汤凉解之。
若寒战切牙并作者，此阳脱神丧，不可治矣。若因疮痛由脓血绷急而胀痛者，宜导神化毒汤。
若吐利而手足冷者，宜回阳化毒汤，方见前。更兼寒战切牙，闷乱烦躁痒塌者，不治。
有脓有血毒归疮，端的其人正气强，莫遇中虚生吐泻，功亏一篑费治详。
凡痘疮成浆之时，不宜吐泻。如吐而无物，恶证也。因冲任之火上冲于胃，直犯清道而逆出之，为不治。若
吐而有物者，用养胃化毒汤和之。
凡泄泻，视其所出之物何如∶若色黄而臭，小便黄赤，热也，宜香连化毒汤；若泻出之物清冷不臭，小便清
长，舌上无苔，寒
也，宜理中化毒汤。
如泻久不止，不论冷热，皆宜止之，通用理中化毒汤，吞豆蔻丸。方见前。
若吐泻不止，手足厥冷，此脾胃之气将绝，急宜附子化毒汤。
其有无时溏泄，手足和暖，饮食如常，虽治之不止，亦可言无事也。
身外诸疮脓血成，咽喉自此贵宁清，反加呛水声音哑，咽烂喉穿鬼伴行。
凡痘疮初出，失于调解，以致毒火熏蒸，喉舌生疮，又失于解毒，其疮稠密，然外疮未熟。至于养水之时，
则先熟者又先靥矣。所以咽喉宜渐和平，声音清亮，饮食不难，此吉兆也。若当此时，饮水则呛，食谷则哕，
甚者失声，此内疮糜烂，舌上成坑，咽门腐烂，肺管壅塞，以致呼吸皆废，饮食卒绝而死矣。亦有先本无疮，
因误食辛热之物，或误投辛热之药，其后旋生是证者，可急用甘桔化毒汤。服药后，病退者吉，不退者凶。
或咽门无疮而暴喑者，此少阴之血不荣于舌也，宜养心化毒汤。
若有声而不清，此火毒乘于肺也，宜泻白化毒汤。中病即止，不中勿治。
陷起平尖脚润红，窠囊饱满蜡浆充。自然气色咸如式，略见差池便不同。
凡痘养浆之时，若平日中陷者尽起，顶平者尽尖，根脚红活，窠囊饱满，其色苍蜡，气如蒸豆，自然安吉。
盖灰白虽为脓之正色，亦由气之不足，宜大补化毒汤。若因泄泻而灰白者，宜固本化毒汤。
若其气腥臭，此有湿热，宜解其标，用解肌化毒汤，外以益元散薄敷疮上，勿令至于溃烂可也。
正值成浆忽痒搔，用心调护莫辞劳。不分干湿皆凶候，能食神清福自高。
凡痘至成浆，切防搔痒抓破，以泄其气。俗云抓破出血者吉，不出血者凶。殊不知起发之时，其疮未熟
而内是血，抓破宜出血，若养浆之时，其疮已熟而内是脓，抓破有血无血，
何足以定吉凶？大抵不宜作痒，如作痒而人清爽，自知其误抓破，或言其痒，欲人拊之者吉；若痒而闷乱烦躁，
语之不听，禁之不止，摇头扭项，手足舞乱者，凶也。如其人清爽，搔痒不住者，当视其形体虚实，未曾吐泻者，
宜四圣化毒汤；如元气素弱而有吐泻，宜参归化毒汤。又要看其抓破处，复灌成疮则吉，破而不灌，皮肉焦黑
者，不可治也。
正面将脓早破伤，依然肿灌复成疮。莫嗟败面留残喘，肿若消时愈断肠。
凡视痘疮以正面为主，盖五脏精华，皆聚于面。如他处痘疮破损，正面完全，可言无事；若正面成片破损，
别处虽完全，亦何益哉！若破处复得肿灌成疮，脓血淋漓，却又无事，面虽败，穿鼻破唇，但留残喘耳。岂不愈
于死耶，若破处不灌不肿，或肿而又消，烦躁闷乱，此毒瓦斯倒陷，决不可治矣。
眉心鼻准耳叶边，唇口诸疮贵活鲜。但有焦枯兼黑靥，慢求医卜命难全。
凡痘欲成脓之时，眉心鼻准耳叶两颊，若先有焦枯黑靥，此名倒陷，医之不能，祷之无效，凶矣哉！
正待行浆浆濯濯，惟愁干塌成空壳。倒陷由来证本乖，劳君着意毋偏驳。
凡痘自出现而起发，自起发而至养浆之时，便要成浆。如当养浆而反不成浆，依旧平塌，与未起发相似，
或起发内有空虚，干枯无水者，名倒伏。谓之倒者，脓根在里也；谓之伏者，毒伏而不出也；谓之陷者，毒出
而复入也。此等之时，人事清爽，饮食如常，别而治之。小便大便秘结，壮热烦渴，宜下之以承气化斑汤。
（方见前。）若吐泻频数，六脉虚弱，宜温之以回阳化毒汤。（方见前。）若人事昏闷，寒战切牙，足冷腹胀喘促者死。
额上浑如沸水浇，溶溶破烂气残凋。渐延两颊多亏损，泄尽元阳魂魄飘。
凡痘起发养浆，额上似沸汤所浇之象，皮溶易破，不成颗粒，大片损烂，此因失下之过。毒火熏蒸，渐延两
颊，破损水出而干，似靥非靥，则阳脱阴留，徒增烦闷，呻吟而死矣。
疮头有孔出脓腥，结聚成堆雉屎形。此个未闻人救得，徒教医祷恐无灵。
凡痘最要皮囊坚浓，包裹完全。若苍头有孔，脓水淋漓漏出，堆聚干结，其色灰白如天泡疮及癞疮之形，
或清水非脓，无事自破，水出干黑，未有能治者矣。
虽然痘密着床久，疮好皮坚无败朽，如逢擦破更焦枯，任彼天人应费手。
凡痘稠密，最难为肘膊、腰臀之间，其外久着床席，辗转挨磨，若非坚浓，鲜有不破者，但破须要肿灌。
若焦干黧黑，如火烧汤泼之状，必死；又见其人手足破烂，成片而不灌者，亦死。
略见浆脓起发时，休教人物往来驰。邪风秽气相侵触，变乱无常悔却迟。
凡痘疮起发之后，渐渐养浆，即当谨饰房户，禁止人物，内者休出，外者休入，谨防秽厌触犯其疮，轻者
作痛作痒，变而为重；重者痒塌抓破，烦闷而死矣。故房户内外，常须烧苍术、大黄，以避不正之气。但二味
气味恶劣，不可使痘儿闻之，更不可焚烧诸香。盖香能助火透入关节，所以禁之。其诸秽厌，房事最毒，酒次
之，五辛又次之，死尸之气，烈于粪秽，狐狸之气，甚于犬羊。烈风豪雨，亦能为害。饮食之偏寒偏热者，勿
恣于口；天气太热，则薄其衣裳，常令凉爽；太寒则温其盖覆，常令温暖。皆调理切要之法，不可不知。凡用
僧道洒水涤秽与医家用药，必用老诚之人，既能清心寡欲，而且经验复多，自能司人之命。凡被房事、生产、
月经所厌，以大枣烧烟解之；被酒所厌，以葛根、茵陈烧烟解之；五辛所厌，烧生姜烟解之；被死尸、疫疠厌，
以苍术、大黄烧烟解之；狐狸犬羊所厌，烧枫树球烟解之。凡遇风雨，须烧枫树球以避湿气。
脓血淋漓心脏虚，舍空神乱若邪居。睡中妄语难苏省，养血安神病自除。
凡痘稠密，成浆之时，或昏昏而睡，呼
之不醒，口中喃喃妄语，如被邪祟之状。时人不知，多生惊怪，殊不知此由脓血出多，心脏空虚，神无所根据而
然，当养血安神，病当自退，宜宁神化毒汤与安神丸相间服之。
疮成腹痛果何因？便秘肠中火烁津。又恐误伤生冷食，消详补泻贵情真。
痘出之初腹痛，乃为毒瓦斯；疮成无脓而腹痛，未可以为毒也，当审其人便解饮食何如耳？倘若未得大便，此
燥屎在里而痛，宜大黄化毒汤微利之，不可拘于首尾不可下之说，坐以待变也。若因误伤生冷，或饮冷而痛，宜
温中化毒汤暖之，效。
疮毒无邪证适中，忽然腹胀气庞鸿。此因食饮多生变，消导天然不用攻。
凡痘顺正，表里无邪，脓血已成，可无苦矣。忽然腹胀气喘，色变而烦闷者，必伤食得之也。何以知之？以
其疮正故也。宜消导之，用助脾化毒汤。
脓成尽说毒将升，谁料其间未足凭，饱满坚牢诚可爱，塌平淫湿最堪憎。
世俗之见，但知痘疮已过一七，发起作脓，便言无事。不知脓成之时，尚未可凭信，若郛郭坚浓，脓浆饱
满，言其无事信矣；若平塌不饱满。湿淫不坚浓，莫言无事。至于十二三日之后，尚有变异，延绵日久，而有
死者矣。
险逆诸疮且勿云，聊将顺证语诸君。缘何业已成浆日，尚有凶危不可垠？
凡痘分三等∶有顺、有险、有逆。顺者不须治，险者治之吉，逆者无可治。今除险逆不必论，然顺者亦有
成浆之日，反变为险逆者，此何故也？盖有失调理，触犯禁忌，误服汤丸，恃其轻少而不调护，故令轻者变重。
此人事之害也。又有只出一二粒而殒命者，疠气使然也，岂人能逆料者哉！
（共二十一首歌诀，涉及二十六个方剂）
痘疮在起发阶段逐渐化脓，毒邪随脓液排出则言语无凶险之兆。若痘疮形成空壳并伴有清水流出，说明毒气滞留，需担忧攻伐时机过晚。
凡是痘疮从起发之后，血液转化为水液，水液再转化为脓液，至此脓液已成，毒邪已化解。此时饮食正常，不是吉兆吗？如果正当起发之时，痘壳中流出清水，这是气机到达而血液未随之运行的表现，治疗应当补益营血，适宜使用四物化毒汤。
若痘疮内部含有清水，形态平塌不起，这是血液到达而气机未随之运行的表现，应当补益卫气，适宜使用保元化毒汤。
若痘窠囊袋浮肿，内含清水，状如水泡，这是气血俱虚，不能制约毒邪，反而被毒邪逼迫，逐渐变为瘙痒塌陷，治疗应当托举毒邪，巩固营卫，防止瘙痒塌陷，以十全化毒汤为主治。
也有饮食正常，六腑充实，但出现空壳清水症状的，虽然能收敛，难免会引发痈毒，不可不早期治疗。
脓成毒化时笑颜开，但仍要忧虑形体产生变证。不要以为清静平安就没事，风云变幻往往在瞬间带来灾祸。
痘疮到了成脓阶段，这是收功的时候。手足常要保持和暖，过热或过寒都是变证；人事常要保持安静，烦躁闷乱是变证；六腑常要保持充实，忽然呕吐腹泻是变证；声音常要保持响亮，忽然失音嘶哑是变证；饮食要逐渐增加，忽然不吃反而口渴是变证；面色要呈苍蜡色，形体要饱满，忽然灰白平塌是变证；疮疡要安和，忽然瘙痒疼痛是变证。或因触犯风寒，或违反禁忌，或伤食，或误服汤药丸剂，医者应当详细察明病因进行治疗。
四肢温暖才适宜，寒热偏离常态之势逐渐远离。补泻无偏颇且能谨慎，折肱多年的确是良医。
凡是痘疮手足常要保持和暖，不宜太热太寒。寒热太过，则水火偏胜而导致残废。假如病患六腑闭结，狂妄烦躁，口干作渴，脉象洪数沉紧，这是实证，手足热是本病。如果手足冷，是阳极似阴，称为阳厥，攻下不要犹豫，适宜承气化毒汤。
如果曾经吐泻，脉象沉细微弱，这是虚证，手足冷是本病。如果手足热，是阴极似阳，称为阴躁，应当补益，用回阳化毒汤温养。
浆液养成安静吉祥值得夸耀，战栗咬牙祸患必然增加。疼痛瘙痒烦躁双足冷，即使有神仙之手也枉然喧哗。
凡是痘疮已成浆液，如果出现寒战，或者咬牙，仅见其中一种症状的可以治疗。因为寒战是因为痘疮发出太多，表虚而振颤摇动，适宜养卫化毒汤。
如果咬牙，一定是肝火很盛，牙齿相互摩擦作响，适宜清神化毒汤凉解。
如果寒战和咬牙同时出现，这是阳气脱失、神志丧失，不可治疗了。如果是因为疮痛由脓血绷急而胀痛，适宜导神化毒汤。
如果吐泻且手足冷，适宜回阳化毒汤，方剂见前文。更兼有寒战咬牙、闷乱烦躁瘙痒塌陷的，不可治疗。
有脓有血毒归入疮口，的确是人体正气强盛。不要遇到中焦虚弱产生吐泻，功亏一篑费尽治疗详查。
凡是痘疮成浆的时候，不宜吐泻。如果呕吐而无物吐出，是恶证。因为冲任之火上冲于胃，直犯清道而逆出，为不治之症。如果呕吐而有物吐出，用养胃化毒汤调和。
凡是泄泻，观察所出之物如何：如果颜色黄而臭，小便黄赤，是热证，适宜香连化毒汤；如果泻出之物清冷不臭，小便清长，舌上无苔，是寒证，适宜理中化毒汤。
如果泻久不止，不论冷热，都应当止泻，通用理中化毒汤，吞服豆蔻丸。方剂见前文。
如果有时无溏泄，手足和暖，饮食正常，虽然治疗不止泻，也可以说没事。
身体其他部位疮疡脓血已成，咽喉从此贵在宁静清澈，反而加上呛水声音嘶哑，咽喉烂穿如鬼伴行。
凡是痘疮初出，失于调解，导致毒火熏蒸，喉舌生疮，又失于解毒，其疮稠密，然而外部疮疡未熟。到了养浆的时候，先熟的又先结痂了。所以咽喉应该逐渐和平，声音清亮，饮食不难，这是吉兆。如果在这个时候，饮水则呛咳，进食则干呕，严重的失声，这是内部疮疡糜烂，舌上成坑，咽门腐烂，肺管壅塞，导致呼吸停止，饮食突然断绝而死。也有原本没有疮疡，因误食辛热之物，或误投辛热药物，随后旋生此证的，可紧急使用甘桔化毒汤。服药后病退者吉，不退者凶。
如果咽门无疮而突然失音，这是少阴之血不能荣养舌头，适宜养心化毒汤。
如果有声但不清晰，这是火毒乘袭肺部，适宜泻白化毒汤。中病即止，不中勿治。
陷起平尖脚润红，窠囊饱满蜡浆充溢。自然气色都符合法式，略微见到差错便不同。
凡是痘疮养浆的时候，如果平日中间凹陷的全部隆起，顶部平坦的全部变尖，根脚红活，窠囊饱满，颜色苍蜡，气息如蒸豆，自然安吉。灰色白色虽然是脓的正色，但也由于气不足，适宜大补化毒汤。如果因为泄泻而灰白的，适宜固本化毒汤。
如果气味腥臭，这是有湿热，适宜解其标，用解肌化毒汤，外用益元散薄敷疮上，不要让它们溃烂即可。
正值成浆忽然瘙痒抓挠，用心调护不辞辛劳。不分干湿都是凶候，能吃神清福气自高。
凡是痘至成浆，切防搔痒抓破，以泄其气。俗语说抓破出血者吉，不出血者凶。殊不知起发之时，其疮未熟而内是血，抓破宜出血，若养浆之时，其疮已熟而内是脓，抓破有血无血，何足以定吉凶？大体上不宜作痒，如果作痒而人清爽，自知误抓破，或者说痒欲让人抚摸的是吉兆；如果痒而闷乱烦躁，说话不听，禁止不住，摇头扭颈，手足舞乱，是凶兆。如果其人清爽，搔痒不止，应当视其形体虚实，未曾吐泻的，适宜四圣化毒汤；如元气素弱而有吐泻的，适宜参归化毒汤。又要看其抓破处，重新灌脓成疮则吉，破而不灌，皮肉焦黑的，不可治疗。
正面将脓早破受伤，依然肿灌复成疮。不要感叹败面留残喘，肿胀消退时更断肠。
凡是观察痘疮以正面为主，因为五脏精华，都聚集于面部。如果其他部位痘疮破损，正面完全，可以说没事；如果正面成片破损，别处虽完全，又有什么益处呢！如果破处重新肿灌成疮，脓血淋漓，却又没事，面虽败，穿鼻破唇，但留残喘而已。难道不如死吗？如果破处不灌不肿，或肿而又消，烦躁闷乱，这是毒瓦斯倒陷，决不可治疗了。
眉心鼻准耳叶边，唇口诸疮贵在鲜活。只要有焦枯兼黑靥，慢慢求医卜命难全。
凡是痘欲成脓的时候，眉心鼻准耳叶两颊，如果先有焦枯黑靥，这名叫倒陷，医治不能，祈祷无效，凶啊！
正待行浆浆液濯濯，只愁干塌成空壳。倒陷由来证候本乖违，劳君着意毋偏驳。
凡是痘自出现而起发，自起发而至养浆的时候，便要成浆。如当养浆而反不成浆，依旧平塌，与未起发相似，或起发内有空虚，干枯无水者，名叫倒伏。叫作倒的，脓根在里；叫作伏的，毒伏而不出；叫作陷的，毒出而复入。这个时候，人事清爽，饮食正常，另外治疗。小便大便秘结，壮热烦渴，适宜攻下用承气化斑汤。（方剂见前。）如果吐泻频数，六脉虚弱，适宜温养用回阳化毒汤。（方剂见前。）如果人事昏闷，寒战咬牙，足冷腹胀喘促的死。
额上浑如沸水浇，溶溶破烂气残凋。渐延两颊多亏损，泄尽元阳魂魄飘。
凡是痘起发养浆，额上似沸汤所浇之象，皮溶易破，不成颗粒，大片损烂，这是因为失于攻下的过错。毒火熏蒸，渐延两颊，破损水出而干，似靥非靥，则阳脱阴留，徒增烦闷，呻吟而死。
疮头有孔出脓腥，结聚成堆雉屎形。这个未曾听说有人救得，徒教医祷恐怕无灵。
凡是痘最要皮囊坚浓，包裹完全。如果苍头有孔，脓水淋漓漏出，堆聚干结，其色灰白如天泡疮及癞疮之形，或清水非脓，无事自破，水出干黑，未有能治者矣。
虽然痘密着床久，疮好皮坚无败朽，如逢擦破更焦枯，任彼天人应费手。
凡是痘稠密，最难为肘膊、腰臀之间，其外久着床席，辗转挨磨，如果不是坚浓，鲜有不破者，但破须要肿灌。如果焦干黧黑，如火烧汤泼之状，必死；又见其人手足破烂，成片而不灌的，亦死。
略见浆脓起发时，休教人物往来驰。邪风秽气相侵触，变乱无常悔却迟。
凡是痘疮起发之后，渐渐养浆，即当谨饰房户，禁止人物，内者休出，外者休入，谨防秽厌触犯其疮，轻者作痛作痒，变而为重；重者痒塌抓破，烦闷而死。故房户内外，常须烧苍术、大黄，以避不正之气。但二味气味恶劣，不可使痘儿闻之，更不可焚烧诸香。盖香能助火透入关节，所以禁之。其诸秽厌，房事最毒，酒次之，五辛又次之，死尸之气，烈于粪秽，狐狸之气，甚于犬羊。烈风豪雨，亦能为害。饮食之偏寒偏热者，勿恣于口；天气太热，则薄其衣裳，常令凉爽；太寒则温其盖覆，常令温暖。皆调理切要之法，不可不知。凡用僧道洒水涤秽与医家用药，必用老诚之人，既能清心寡欲，而且经验复多，自能司人之命。凡被房事、生产、月经所厌，以大枣烧烟解之；被酒所厌，以葛根、茵陈烧烟解之；五辛所厌，烧生姜烟解之；被死尸、疫疠厌，以苍术、大黄烧烟解之；狐狸犬羊所厌，烧枫树球烟解之。凡遇风雨，须烧枫树球以避湿气。
脓血淋漓心脏虚，舍空神乱若邪居。睡中妄语难苏省，养血安神病自除。
凡是痘稠密，成浆的时候，或昏昏而睡，呼之不醒，口中喃喃妄语，如被邪祟之状。时人不知，多生惊怪，殊不知此由脓血出多，心脏空虚，神无所根据而然，当养血安神，病当自退，宜宁神化毒汤与安神丸相间服之。
疮成腹痛果何因？便秘肠中火烁津。又恐误伤生冷食，消详补泻贵情真。
痘出之初腹痛，是为毒瓦斯；疮成无脓而腹痛，未可以为毒也，当审其人便解饮食何如耳？倘若未得大便，此燥屎在里而痛，适宜大黄化毒汤微利之，不可拘于首尾不可下之说，坐以待变也。如果因误伤生冷，或饮冷而痛，适宜温中化毒汤暖之，效。
疮毒无邪证适中，忽然腹胀气庞鸿。此因食饮多生变，消导天然不用攻。
凡是痘顺正，表里无邪，脓血已成，可无苦矣。忽然腹胀气喘，色变而烦闷者，必伤食得之也。何以知之？以其疮正故也。适宜消导之，用助脾化毒汤。
脓成尽说毒将升，谁料其间未足凭，饱满坚牢诚可爱，塌平淫湿最堪憎。
世俗之见，但知痘疮已过一七，发起作脓，便言无事。不知脓成之时，尚未可凭信，如果郛郭坚浓，脓浆饱满，言其无事信矣；如果平塌不饱满，湿淫不坚浓，莫言无事。至于十二三日之后，尚有变异，延绵日久，而有死者矣。
险逆诸疮且勿云，聊将顺证语诸君。缘何业已成浆日，尚有凶危不可垠？
凡是痘分三等：有顺、有险、有逆。顺者不须治，险者治之吉，逆者无可治。今除险逆不必论，然顺者亦有成浆之日，反变为险逆者，此何故也？盖有失调理，触犯禁忌，误服汤丸，恃其轻少而不调护，故令轻者变重。此人事之害也。又有只出一二粒而殒命者，疠气使然也，岂人能逆料者哉！
(Comprising twenty-one songs, involving twenty-six formulas)
During the eruption stage, pustules gradually suppurate; when toxins are resolved along with pus, speech remains unimpeded and auspicious. If pustules form empty shells accompanied by clear fluid, it indicates lingering toxic qi, warranting concern over delayed intervention.
Generally, after the eruption of smallpox lesions, blood transforms into water, and water transforms into pus. Once pus is formed, toxins are resolved. At this stage, normal appetite is a propitious sign! However, if during the eruption phase, clear fluid emerges from within the pustule crusts, it signifies that Qi has arrived but Blood has not followed. Treatment should tonify Ying (Nutritive) Blood, using Siwu Huadu Decoction (Four Substances Toxin-Resolving Decoction).
If the interior of the pustule contains clear fluid and appears flat without elevation, it signifies that Blood has arrived but Qi has not followed. Treatment should tonify Wei (Defensive) Qi, using Baoyuan Huadu Decoction (Preserve Origin Toxin-Resolving Decoction).
If the pustule sacs are edematous and contain clear fluid, resembling water blisters, it indicates deficiency of both Qi and Blood, failing to control toxins, which instead oppress the body. This may gradually transform into itching and collapse. Treatment should support the expulsion of toxins and consolidate Ying and Wei, preventing itching and collapse, primarily using Shiquan Huadu Decoction (Ten Complete Toxin-Resolving Decoction).
There are cases where diet is normal and the Six Fu Organs are full, yet symptoms of empty shells and clear fluid appear. Although contraction may occur, carbuncles and sores may inevitably develop; early treatment is essential.
When pus forms and toxins resolve, smiles return, yet one must still worry about morphological changes manifesting as complications. Do not assume peace implies safety, as sudden disasters can arise unpredictably.
Upon reaching the suppuration stage, smallpox enters its concluding phase. The extremities should remain warm; excessive heat or cold indicates complications. Mental state should be calm; restlessness and confusion indicate complications. The Six Fu Organs should be充盈 (full); sudden vomiting or diarrhea indicates complications. Voice should be resonant; sudden hoarseness indicates complications. Diet should gradually increase; sudden anorexia with thirst indicates complications. Complexion should be dark yellowish-white, and physique plump; sudden grayish-white flattening indicates complications. Lesions should be peaceful; sudden itching or pain indicates complications. Etiologies may include wind-cold invasion, violation of taboos, food stagnation, or erroneous administration of decoctions/pills. Physicians must carefully investigate the cause and treat accordingly.
Warm extremities are appropriate; deviations in cold/heat patterns gradually subside. Balanced supplementation and purgation, practiced with caution, characterize a skilled physician.
Extremities should generally be warm, neither too hot nor too cold. Extreme cold or heat leads to imbalance of Water and Fire, resulting in disability. For instance, if a patient presents with constipation of the Six Fu Organs, delirium, restlessness, dry mouth, and thirst, with a surging, rapid, deep, and tight pulse, this is an Excess pattern. Warm extremities here reflect the primary disease. If extremities are cold, it represents "Extreme Yang mimicking Yin," known as Yang Jue (Yang Collapse). Purging should be applied without hesitation, using Chengqi Huadu Decoction (Chengqi Toxin-Resolving Decoction).
If there was prior vomiting/diarrhea, with a deep, fine, weak, and slow pulse, this is a Deficiency pattern. Cold extremities reflect the primary disease. If extremities are hot, it represents "Extreme Yin mimicking Yang," known as Yin Zao (Yine Restlessness). Tonification is indicated, warming with Huiyang Huadu Decoction (Restore Yang Toxin-Resolving Decoction).
Quiet formation of pus is auspicious; tremors and teeth-grinding portend disaster. Pain, itching, restlessness, and cold feet render even divine hands ineffective.
When smallpox reaches the pus-forming stage, chills or teeth-grinding may occur. If only one symptom appears, prognosis is favorable. Chills result from excessive eruption causing exterior deficiency and trembling; Yangwei Huadu Decoction (Nourish Defense Toxin-Resolving Decoction) is suitable. Teeth-grinding indicates severe Liver Fire causing friction; Qingshen Huadu Decoction (Calm Spirit Toxin-Resolving Decoction) cools and resolves. Simultaneous chills and teeth-grinding indicate Yang collapse and loss of Shen (Spirit), which is untreatable. Pain due to tension from pus/blood requires Daoshen Huadu Decoction (Guide Spirit Toxin-Resolving Decoction). Vomiting/diarrhea with cold feet requires Huiyang Huadu Decoction (see above). Combined with chills, teeth-grinding, confusion, restlessness, itching, and collapse, it is untreatable.
Presence of pus and blood indicates toxins have localized to the lesions, reflecting strong Zheng Qi (Upright Qi). Avoid middle-jiao deficiency leading to vomiting/diarrhea, lest treatment fail at the final stage.
During pus formation, vomiting/diarrhea is contraindicated. Vomiting without material expulsion is a malignant sign, caused by Chong and Ren fire rushing upward to the Stomach, violating clear pathways. It is untreatable. Vomiting with material expulsion is treated with Yangwei Huadu Decoction (Nourish Stomach Toxin-Resolving Decoction) to harmonize.
For diarrhea, observe the excrement: Yellow and foul-smelling with yellow-red urine indicates Heat; Xianglian Huadu Decoction (Atractylodes and Coptis Toxin-Resolving Decoction) is suitable. Clear, cold, odorless excrement with clear/profuse urine and a tongue lacking coating indicates Cold; Lizhong Huadu Decoction (Regulate Middle Toxin-Resolving Decoction) is suitable.
Persistent diarrhea, regardless of cold/heat nature, requires stopping it. Generally use Lizhong Huadu Decoction with Doukou Wan (Cardamom Pill). See above for formulas.
Unstoppable vomiting/diarrhea with cold limbs indicates impending failure of Spleen/Stomach Qi; Fuzi Huadu Decoction (Aconite Toxin-Resolving Decoction) is urgently required.
Intermittent loose stools with warm extremities and normal diet may resolve spontaneously despite treatment.
External sores forming pus/blood require clear throat and voice. Choking on water and hoarseness indicate throat erosion, akin to demonic possession.
Initial smallpox eruption neglected allows toxic fire to scorch throat/tongue. Dense lesions with immature external sores lead to premature crusting of mature ones during pus formation. Auspicious signs include gradual throat peace, clear voice, and easy swallowing. Conversely, choking on water, retching upon eating, or aphonia indicates internal erosion, tongue pits, throat rot, and lung obstruction, leading to respiratory/dietary failure and death. Misuse of acrid-hot substances/drugs may also cause this; Ganjie Huadu Decoction (Licorice and Platycodon Toxin-Resolving Decoction) is urgent. Improvement is auspicious; lack thereof is ominous.
Sudden aphonia without throat lesions indicates Shaoyin Blood failing to nourish the tongue; Yangxin Huadu Decoction (Nourish Heart Toxin-Resolving Decoction) is suitable.
Hoarse but audible voice indicates Fire-Toxin attacking the Lung; Xiebai Huadu Decoction (Drain White Toxin-Resolving Decoction) is used. Stop upon effect; do not treat if ineffective.
Elevated centers, flat peaks, red roots, and full sacs filled with waxy pus indicate natural health. Grayish-white pus, though normal, may signal Qi deficiency; Dabu Huadu Decoction (Great Tonify Toxin-Resolving Decoction) is suitable. Grayish-white due to diarrhea requires Guben Huadu Decoction (Solidify Root Toxin-Resolving Decoction). Foul odor indicates Damp-Heat; Jiemo Huadu Decoction (Release Muscle Toxin-Resolving Decoction) treats the branch, with Yiyuan San (Benefit Primordial Powder) applied externally to prevent ulceration.
Itching during pus formation requires careful care. Scratching leaks Qi. Folk belief claims bleeding upon scratching is auspicious; this is incorrect. During eruption, lesions contain blood; bleeding is expected. During pus formation, lesions contain pus; bleeding status is irrelevant. Generally, itching is unfavorable. If the patient is clear-headed and acknowledges accidental scratching or seeks relief via touch, it is auspicious. If itching causes confusion, restlessness, disobedience, head-shaking, and limb thrashing, it is ominous. For clear-headed patients with persistent itching and no vomiting/diarrhea, Sisheng Huadu Decoction (Four Sages Toxin-Resolving Decoction) is suitable. For those with weak Yuan Qi and prior vomiting/diarrhea, Shenguī Huadu Decoction (Ginseng and Angelica Toxin-Resolving Decoction) is suitable. Re-suppuration of scratched areas is auspicious; blackened/necrotic tissue is untreatable.
Early rupture of facial pustules causes damage. Re-swelling and re-suppuration allow survival despite facial disfigurement. Lack of swelling/resolution, combined with restlessness, indicates toxin reversal/collapse, which is untreatable.
Facial features (glabella, nose tip, ear lobes, cheeks, lips) should appear fresh/vibrant during suppuration. Scorched/black eschars indicate "Dao Xian" (Reverse Collapse), which is untreatable and inauspicious.
Pus should flow freely; fear of drying/collapse into empty shells. "Dao" (Reverse) means pus root remains internal; "Fu" (Hidden) means toxin hides internally; "Xian" (Collapse) means toxin returns inward. In these stages, if mental state is clear and diet normal, treat separately. Constipation, high fever, and thirst require purging with Chengqi Huaban Decoction (Chengqi Spot-Resolving Decoction). Frequent vomiting/diarrhea with weak pulses requires warming with Huiyang Huadu Decoction. Coma, chills, teeth-grinding, cold feet, abdominal distension, and wheezing indicate death.
Forehead resembling boiling water, melting skin, large erosions, indicate failure to purge earlier. Toxic fire spreads to cheeks, causing dry, crust-like lesions. Yang collapses, Yin remains, leading to groaning death.
Pustule heads with holes leaking foul pus, accumulating like pheasant droppings, resemble Tianshuang Chuang (Sky Blister Sores) or Leprosy. Clear fluid rather than pus, spontaneous rupture, and black drying indicate untreatability.
Dense smallpox is hardest to manage on elbows, arms, waist, and buttocks due to bed friction. Without thick skins, rupture is likely. Rupture must be followed by swelling/suppuration. Blackened/necrotic tissue resembling burns indicates death. Extremity erosion without suppuration also indicates death.
During eruption/pus formation, restrict visitors to prevent pathogenic winds and filth. Light cases become painful/itchy; heavy cases become collapsed/scratched, leading to fatal restlessness. Burning Cangzhu (Atractylodis Rhizoma) and Dahuang (Rhei Radix et Rhizoma) inside/outside rooms repels evil Qi. Their strong odor should not reach the patient. Incense is forbidden as it aids fire penetration into joints. Taboos: Sexual intercourse is most toxic; alcohol next; Five Pungents next; Corpse odor worse than feces; Fox/Dog/Sheep odors vary. Storms also harm. Diet should avoid extreme cold/heat. Clothing should adjust to temperature. These are critical management principles. Use honest, experienced monks/doctors for purification rituals. Specific smoke remedies exist for various contaminations (e.g., Jujube for sexual/reproductive contamination; Kudzu and Artemisia capillaris for alcohol; Ginger for pungents; Atractylodes and Rhubarb for corpses/plagues; Maple balls for animals/rain).
Profuse pus/blood depletes Heart Qi, causing Shen (Spirit) disorder resembling possession. Sleepiness, unresponsiveness, and muttering indicate Heart emptiness. Tonify Blood and calm Shen using Ningshen Huadu Decoction (Calm Spirit Toxin-Resolving Decoction) alternating with Anshen Wan (Calm Spirit Pill).
Abdominal pain during suppuration: If constipated, intestinal fire scorches fluids; Dahuang Huadu Decoction (Rhubarb Toxin-Resolving Decoction) gently purges. Do not adhere strictly to "no purgation" rules. If caused by raw/cold food intake, Wenzhong Huadu Decoction (Warm Middle Toxin-Resolving Decoction) warms and heals.
Smooth progression with no pathogens, but sudden abdominal distension and dyspnea indicate Food Stagnation. Since lesions are regular, use Zhipai Huadu Decoction (Assist Spleen Toxin-Resolving Decoction) to guide out stagnation.
Pus formation suggests toxin ascent, but fullness and firmness are reassuring. Flaccidity and dampness are abhorrent. Laypeople assume safety after seven days of suppuration, but reliance is premature. Firm, full pus is safe; flat, damp, unfilled pus is dangerous. Complications may arise after 12-13 days, potentially fatal.
Ignoring perilous/reverse cases, we discuss smooth cases. Why do smooth cases turn perilous/reverse during pus formation? Neglect of regulation, taboo violations, erroneous medication, or complacency in mild cases cause light conditions to worsen (human error). Rarely, death occurs from only one or two lesions due to epidemic Qi, unpredictable by humans.