（收靥门参看）
〔万〕痘疮所贵者，坚实不破，圆净成痂也，其有溃烂者，火胜也。经曰∶热胜
则肉腐。火之为用，猛虐峻暴，近之则燥痒不宁，迫之则焦痛难忍，灼之则糜烂成疮，故败物者莫如火也。火生
于空，非虚不燃，乘之以风，其焰益烈，痘疮溃烂，由肌肉素虚，邪风侵袭，风者，善行数变，行诸脉俞，散
于荣卫之间，一旦毒发于里，风应于表，风火相扇，肌肉愤 ，皮肤决裂，而疮坏矣。如脓成而溃，则毒已
化，但粘衣渍席，不能干较，古方以败草散主之，诚良法也。脓浆未成，其毒未化，痒破溃烂者，则卫气暴泄，
津液不荣，譬诸草木剥削其皮，枯萎而死矣。经曰∶根于中者，命曰神机，神去则机息，根于外者，命曰气立，
气止则化绝，此之谓也。
〔薛〕闻人氏云∶痘 烂之证，因当发散而不发散，则毒瓦斯闭塞，以致喘促闷乱。不当发散而误发散，则
毒随阳气暴出于外，遍身皮肤溃烂。治宜调脾胃，进饮食，大便调和，荣卫健旺，毒瓦斯自解，而无目赤咽痛，口疮
吐衄等证。窃谓，前证若发表过甚，大便自利，急用理中丸、豆蔻丸（俱痘泻利）以救其里。亦有痘疹如蚊
所啮而色黑，乃危证也，若大小便秘结烦躁，用山栀子汤（痘夹 ）、 猪尾血调脑子治之，自利不食者
不可用。盖毒发于表而妄汗之，则腠理开泄，荣卫益虚，转增疮烂，由是风邪乘虚
变证者有之。若毒根于里而妄下之，则内气愈虚，毒不能出而反入焉，由是土不胜水，变黑归肾，身体振寒，
两耳尻冷，眼合肚胀，其疮黑陷，十无一生，治者审之。
疮出太盛，脓汁淋漓，不可着席，疼痛者干黄土罗末敷之，甚者白龙散（痒塌）帛裹扑之，或败草散（收靥）
贴之。丹溪云∶疮湿者，用泻湿，乃肌表间湿，宜用风药白芷、防风之类。闻人氏用麦麸衬卧。暑月热，甚
当藉之以芭蕉叶为佳。或疮已出定，大便不通，而脓汁不干者，此热毒合下证也，宜牛黄丹利之。若疮口湿，
及脓血杂流者，百花膏（收靥）、生肌散、金华散、绵茧散（收靥）、魏氏白螺散、乳香韶粉散俱可
用。若靥后复生，乃余毒失于解利，留滞于肌肉之间而然也，宜消毒散（出太密）。或结痂久而不落，亦宜百
花膏。若痘烂无脓，吐利不止，或二便下血，乳食不化者，不治之证也。
牛黄丹 治疮子出定，大便不通，疮中脓水不干。
牛黄 大黄末（生用） 珍珠末 粉霜（各一两）
上研匀，炼蜜丸，如黍米大。每服十粒，人参汤下。量儿大小加减。
生肌散 治疳蚀不敛，并痘后脓血杂流不收等疮。
地骨皮 黄连 五倍子 甘草 黄柏（各等分）
上为细末。干掺疮上。
金华散 治痘证后肥疮、疳疮疥癣，能收水、凉肌、解毒。
黄丹（水飞过，火 红，一两） 黄柏 黄连（各五钱） 黄芩 大黄（各三钱） 轻粉（一钱）
麝香（一分）
上为细末。疮湿，干掺，燥，用腊猪油熬化，调搽。
白螺散 专治疮痘不收。
白螺蛳壳（不拘多少，古墙上取）
上，去土，洗净，火炼红，取出，存性，为极细末。疮口湿处，干掺为妙。
乳香韶粉散
即韶粉散加乳香末三钱。（韶粉散方见落痂证治）
又方
荔枝壳（微烧，存性） 草纸（烧灰，存性） 败茅（多年者）
三味，共为细末。或搽，或掺，自能收水结痂。
又方
黄豆壳烧白灰，为末，掺之。如痘风癣，以痘壳煎汤洗。
秘传茶叶方 痘烂遍身、无皮，脓水流出，粘拈衣被。茶叶，要多拣去粗梗，入滚水一渫，即捞起，
再拣去梗，湿铺床上，用草纸隔一层，令儿睡上，一夜则脓皆干。
荞麦粉法（见收靥证治）
蝉花散 治烂痘生蛆虫，及夏月诸虫咬伤，臭恶不可近者。服之，虫皆化而为水，苍蝇亦不敢近。
蝉蜕（洗净，焙） 青黛（澄去灰土。各五钱） 北细辛（二钱半） 蛇蜕（一两，烧、存性）
上为细末。每服三钱，酒调下。仍以生寒水石细末，掺之。
（参见收靥门）
〔万全〕痘疮最可贵的是坚实不破、圆满洁净并结成痂皮。那些出现溃烂的，是因为火邪过盛所致。医经说：热邪胜则肌肉腐烂。火的功用，猛烈暴虐，靠近它便感到燥热瘙痒不安，逼迫它便焦痛难忍，灼烧它便糜烂成疮，所以败坏事物的没有比火更厉害的了。火产生于空虚之处，没有空隙不能燃烧，乘着风势，火焰更加猛烈。痘疮溃烂，是由于肌肉原本虚弱，邪风侵袭所致。风邪的特点是善行数变，行走在经脉腧穴之间，散布在荣卫之中。一旦毒气发于体内，风邪应于体表，风火相互煽动，肌肉肿胀破裂，皮肤开裂，从而导致疮疡败坏。如果脓液形成后溃破，说明毒气已经化解，只是粘衣服湿席子，难以干燥，古方用败草散为主治，确实是良法。如果脓浆未形成，毒气未化解，因痒而抓破溃烂的，则是卫气突然泄失，津液不能濡养肌肤，就像草木剥去了外皮，枯萎而死一样。医经说：根源于体内的，叫做神机，神气离去则机能停止；根源于体外的，叫做气立，气机停止则化生绝灭，说的就是这个道理。
〔薛己〕闻人氏说：痘疮溃烂的证候，是因为应当发散毒邪而没有发散，导致毒气闭塞，以致气喘急促、胸闷烦乱。不应当发散而误用了发散法，则毒气随着阳气突然暴发于体表，遍身皮肤溃烂。治疗应当调理脾胃，增进饮食，使大便调和，荣卫健旺，毒气自然解除，就不会出现目赤咽痛、口疮吐衄等证候。我认为，前述证候如果发表过度，导致大便自利，急需用理中丸、豆蔻丸（均用于痘泻利）来救里。也有痘疹像被蚊子咬过且颜色发黑的，这是危重证候。如果大小便秘结烦躁，用山栀子汤（用于痘夹斑）、猪尾血调脑子治疗；如果是自利不食的，不可使用。因为毒气发于体表而妄用汗法，则腠理开泄，荣卫更加虚弱，反而增加疮烂，由此风邪乘虚而入产生变证的有这种情况。如果毒根深植于体内而妄用下法，则内气更加虚弱，毒气不能排出反而内陷，由此土不胜水，变黑归肾，身体战栗恶寒，两耳和尻部发冷，眼睛闭合肚子胀大，疮色黑陷，十无一活，医者务必审慎。
疮发出太多，脓汁淋漓，不能接触席子，疼痛的用干黄土研末外敷；严重的用白龙散（用于痒塌）包裹扑撒，或用败草散（用于收靥）贴敷。丹溪说：疮面潮湿的，用祛湿法，这是肌表间的湿气，宜用防风药如白芷、防风之类。闻人氏用麦麸衬垫卧具。暑天炎热，很应当借助芭蕉叶铺衬为佳。或者疮已出定，大便不通，而脓汁不干涸的，这是热毒兼有可下之证，宜用牛黄丹通利。如果疮口潮湿，以及脓血混杂流出的，百花膏（用于收靥）、生肌散、金华散、绵茧散（用于收靥）、魏氏白螺散、乳香韶粉散都可以使用。如果结痂后复发，是余毒未能解利，留滞于肌肉之间所致，宜用消毒散（用于出得太密）。或者结痂很久不脱落，也宜用百花膏。如果痘疮溃烂无脓，吐利不止，或二便下血，乳食不消化的，是不治之证。
牛黄丹 治疗痘疮出定后，大便不通，疮中脓水不干涸。
牛黄 大黄末（生用） 珍珠末 粉霜（各一两）
以上研匀，炼蜜为丸，如黍米大小。每次服十粒，用人参汤送下。根据患儿年龄大小加减剂量。
生肌散 治疗疳蚀不收敛，以及痘后脓血混杂流出不收口的各种疮疡。
地骨皮 黄连 五倍子 甘草 黄柏（各等分）
以上研为细末。干掺于疮面上。
金华散 治疗痘证后肥疮、疳疮疥癣，能收水、凉肌、解毒。
黄丹（水飞，火煅至红，一两） 黄柏 黄连（各五钱） 黄芩 大黄（各三钱） 轻粉（一钱）
麝香（一分）
以上研为细末。疮面潮湿时干掺，干燥时用腊猪油熬化，调和涂抹。
白螺散 专治疮痘不收口。
白螺蛳壳（不拘多少，从古墙上取）
以上去土，洗净，火煅至红，取出，存性，研为极细末。疮口潮湿处，干掺效果最好。
又方
荔枝壳（微烧，存性） 草纸（烧灰，存性） 败茅（多年的）
三味，共为细末。或搽或掺，自然能收水结痂。
又方
黄豆壳烧成白灰，研末，掺之。如患痘风癣，用痘壳煎汤清洗。
秘传茶叶方 痘疮溃烂遍身、无皮，脓水流岀，粘着衣被。茶叶，要多拣去粗梗，放入滚水中烫一下，立即捞起，再拣去梗，湿铺在床上，用草纸隔一层，让患儿睡在上面，一夜之后脓水皆干。
荞麦粉法（见收靥证治）
蝉花散 治疗烂痘生蛆虫，以及夏季各种虫咬伤，臭恶不可近者。服用后，虫子都化为水，苍蝇也不敢靠近。
蝉蜕（洗净，焙干） 青黛（澄去灰土。各五钱） 北细辛（二钱半） 蛇蜕（一两，烧，存性）
以上研为细末。每次服三钱，酒调下。仍以生寒水石细末，掺于患处。
(See also the section on Scab Formation)
[Wan Quan] The most desirable outcome for smallpox is that it remains firm, unbroken, round, and clean, eventually forming a scab. Cases involving ulceration are caused by excessive Fire pathogen. The classics state: "When Heat prevails, flesh rots." The function of Fire is fierce and violent; proximity causes dryness, itching, and restlessness; pressure causes burning pain that is unbearable; scorching leads to erosion and sore formation. Thus, nothing destroys matter more effectively than Fire. Fire arises from emptiness and cannot burn without void space; when driven by Wind, its flames intensify. Smallpox ulceration occurs due to pre-existing deficiency in muscle tissue, allowing Evil Wind to invade. Wind is characterized by rapid movement and change, traveling through meridians and acupoints, dispersing between Ying (Nutritive) and Wei (Defensive) levels. Once toxins erupt internally and Wind responds externally, Wind and Fire fan each other, causing muscles to swell and rupture, skin to crack, and sores to deteriorate. If pus forms and then ruptures, the toxin has transformed; the issue is merely that it sticks to clothes and mats, making drying difficult. Ancient formulas use Baicao San (Decoction of Decayed Grass) as the primary treatment, which is indeed an excellent method. If pus has not formed and the toxin has not transformed, scratching due to itching leads to ulceration; this represents a sudden leakage of Wei Qi and failure of body fluids to nourish the skin, akin to plants stripped of their bark, withering and dying. The classics state: "Those rooted within are called Shen Ji (Spirit Mechanism); if Spirit departs, mechanisms cease. Those rooted externally are called Qi Li (Qi Establishment); if Qi stops, transformation ends." This refers to such cases.
[Xue Ji] Wenren Shi stated: In cases of smallpox ulceration, if dispersion should have been employed but was not, toxic vapors become blocked, leading to panting, distress, and confusion. If dispersion is mistakenly used when inappropriate, toxic vapors surge outward with Yang Qi, causing widespread skin ulceration. Treatment should focus on regulating the Spleen and Stomach, promoting appetite, harmonizing bowel movements, and strengthening Ying and Wei, allowing toxic vapors to resolve naturally, thereby preventing symptoms like red eyes, sore throat, mouth ulcers, vomiting, or epistaxis. I believe that if the aforementioned condition results from excessive exterior-releasing methods leading to spontaneous diarrhea, one must urgently use Lizhong Wan (Regulate the Middle Pill) or Doukou Wan (Cardamom Pill) [both indicated for post-smallpox diarrhea] to rescue the interior. There are also cases where smallpox lesions resemble mosquito bites and turn black, indicating a critical condition. If accompanied by constipation of both stool and urine, irritability, and restlessness, Shanzhizi Tang (Gardenia Decoction) [for smallpox with macules] mixed with pig tail blood and brain can be used; however, it is contraindicated in cases of spontaneous diarrhea and anorexia. Releasing the exterior with sweating when toxins are at the surface opens the pores, further depleting Ying and Wei, exacerbating ulceration, and allowing Wind-Evil to enter due to deficiency, causing complications. Conversely, purging when toxins are rooted internally further depletes internal Qi, trapping toxins inside rather than expelling them. This leads to Earth failing to control Water, turning black and returning to the Kidney, manifesting as shivering chills, cold ears and buttocks, closed eyes, abdominal distension, and blackened, depressed sores. Such cases are almost invariably fatal; physicians must exercise caution.
If sores are excessively numerous with dripping pus, unable to touch the mat, and painful, apply fine powder of dry yellow earth. For severe cases, apply Bailong San (White Dragon Powder) [indicated for itchy collapse] wrapped in cloth, or Baicao San [indicated for scab formation]. Danxi stated: For moist sores, use damp-draining methods, as this is dampness on the muscle-surface, suitable for aromatic wind-dispersing herbs like Bai Zhi (Angelicae Dahuricae Radix) and Fang Feng (Saposhnikoviae Radix). Wenren Shi recommended using wheat bran as bedding. During hot summer months, using banana leaves as a lining is highly advisable. If sores have erupted but defecation is obstructed and pus does not dry, this indicates heat-toxin combined with a downward-indicating syndrome; Niuhuang Dan (Calculus Bovis Pill) should be used to promote evacuation. For moist sore openings and mixed discharge of pus and blood, Baihua Gao (Hundred Flowers Ointment), Shengji San (Generate Flesh Powder), Jinhua San (Golden Splendor Powder), Mianjian San (Silkworm Cocoon Powder), Wei's Bailuo San (White Snail Shell Powder), and Ruxiang Shaofen San (Frankincense and Kaolin Powder) are all applicable. Recurrence after scabbing is due to residual toxins failing to be cleared, lingering in the muscle layer; Xiaodu San (Detoxification Powder) [for overly dense eruptions] is appropriate. If scabs persist for a long time without falling off, Baihua Gao is also suitable. However, if smallpox ulceration presents with no pus, continuous vomiting and diarrhea, bleeding from bowels or urethra, and inability to digest milk/food, it is an untreatable condition.
Niuhuang Dan (Calculus Bovis Pill): Treats smallpox after eruption with constipation and non-drying pus/water in sores.
Calculus Bovis (Niuhuang), Rhubarb Powder (Dahuang Mo, raw), Pearl Powder (Zhenzhu Mo), Frost Powder (Fenshuang) (each 1 liang).
Grind uniformly, mix with refined honey to form pills the size of millet seeds. Take 10 pills per dose, washed down with Ginseng decoction. Adjust dosage according to the child's age and size.
Shengji San (Generate Flesh Powder): Treats gan erosion that fails to heal, and various sores after smallpox where pus and blood flow mixedly without closing.
Groundsel Root Bark (Digupi), Coptis Rhizome (Huanglian), Chinese Gall (Wubeizi), Licorice Root (Gancao), Phellodendron Bark (Huangbai) (equal parts).
Grind into fine powder. Apply dry powder directly onto the sore.
Jinhua San (Golden Splendor Powder): Treats post-smallpox fatty sores, gan sores, and tinea, capable of absorbing moisture, cooling the skin, and resolving toxicity.
Lead Oxide (Huandan, water-washed, calcined until red, 1 liang), Phellodendron Bark (Huangbai), Coptis Rhizome (Huanglian) (each 5 qian), Scutellaria Root (Huangqin), Rhubarb (Dahuang) (each 3 qian), Calomel (Qingfen, 1 qian), Musk (Shexiang, 1 fen).
Grind into fine powder. For moist sores, apply dry powder; for dry sores, melt lard (La Zhuyou) and mix for topical application.
Bailuo San (White Snail Shell Powder): Specifically treats sores and smallpox that fail to close.
White River Snail Shell (Bailuosi Ke) (quantity unrestricted, taken from ancient walls).
Remove dirt, wash clean, calcine until red, remove from fire, preserve nature, grind into extremely fine powder. Best applied as dry powder to moist sore openings.
Ruxiang Shaofen San (Frankincense and Kaolin Powder)
This is Shaofen San plus 3 qian of Frankincense Powder (Ruxiang Mo). (Shaofen San formula see Treatment of Falling Scabs).
Another Formula
Lychee Shell (Lizhi Qiao, lightly burned, preserve nature), Paper Straw (Caozhi, burned to ash, preserve nature), Old Imperata Rhizome (Baimao, multi-year old).
Grind three ingredients into fine powder. Apply or sprinkle; naturally absorbs moisture and forms scabs.
Another Formula
Burn soybean shells to white ash, grind into powder, and sprinkle. For smallpox wind-tinea, wash with decoction of smallpox shells.
Secretly Transmitted Tea Leaf Method: For widespread smallpox ulceration without skin, with flowing pus sticking to clothes and bedding. Select tea leaves, removing coarse stems thoroughly. Blanch in boiling water once, immediately remove, pick out remaining stems. Spread wetly on the bed, place a layer of paper straw over it, let the child sleep on top. After one night, the pus will dry completely.
Buckwheat Flour Method (see Treatment of Scab Formation).
Chanhua San (Cicada Flower Powder): Treats maggots in ulcerated smallpox, and insect bites in summer causing foul odor intolerable to others. Upon ingestion, maggots dissolve into water, and flies dare not approach.
Cicada Slough (Chantui, washed and dried), Indigo Naturalis (Qingdai, settled to remove dust) (each 5 qian), Asarum (Beixixin, 2.5 qian), Snake Slough (Shetui, 1 liang, burned, preserve nature).
Grind into fine powder. Take 3 qian per dose, mixed with wine. Also sprinkle fine powder of Calcitum (Sheng Hanshuishi) on the affected area.