灌脓时根窠红润，脓浆满足，如黄蜡色，二便如常，饮食不减，此为吉证，不
须服药。
灌脓时纯是清水，皮白而薄，与水泡相似，三四日后、抓破而死。
灌脓之时痘中干枯，全无活血，此名空仓，不治。
灌脓时吐利不止，或二便下血，乳食不化，痘烂无脓者死。（或二便不下血，犹可用止泻
健脾之药。）
灌脓时二便闭，目闭声哑，腹中胀满，肌肉变黑者死。
痘疮成脓之后，鲜明肥泽，饱满坚实，以手拭之，疮头微焦硬者，此欲靥也，
大小先后，以渐收靥，不失太急，不失太缓，已靥者痂壳周圆无有突凸陷凹者，干
净无淫湿破溅者，此为正靥，否极泰来之象也。凡痘疮收靥，不可以日数拘也，大
抵痘本稀，元气实者，自然易出易靥，若疮本稠密，元气虚者，难出难靥也，只要
先后有次，疾徐得中，饮食如常，便无他证。如收太急者，毒邪未尽，煎熬津液，
以致速枯，非正收也，必为目病，为痈毒，为诸怪疾，甚则夭亡，微则残废，宜微
利之，以彻其毒，当归丸主之（大便秘）。如收太迟者，中气已虚，脾胃太弱，不能荣养
肌肉，使之完就，以致溃烂，内服十全大补汤（汗），外用败草散（溃烂）衬之。海藏云∶
疹脓而不焦，此本治失清凉之气，有如五谷得阳气而成熟，非凉风至则不能实也，
天地严肃之气一加，则万物秀而实矣，与 疹何异，须察何经而清凉之，或下而成
严肃之气，则疮气必不至于脓而不痂矣。要当知之，余毒不尽而疾作，盖出于此（当
是清凉饮子下之是也。）非阳和则苗不秀，非严肃则秀不实。钱氏云∶五七日痂不焦，是
内发热，蒸于外，故不得焦痂也，宜宣风散（痘发热）导之，用生犀磨汁解之，必着痂矣。
刘洙疮子诀云∶痘发，如脓窠不肯靥者，但调沙糖水与吃。刘提点云∶亦曾试用，
但后来结瘢痕白。
〔薛〕陈文宿先生云∶痘欲靥不靥，其痂欲落不落，若腹胀烦渴，忌食水蜜生冷
之物，若食之，转渴而死，急与木香散救之。如身热烦渴者，宜服人参麦门冬散。
身热大渴，人参白术散。如不愈，仍服木香散。窃谓前证乃脾胃气虚，津液不足所
致，非实热为患也，如身热烦躁，手足发热，脾胃有热也，用人参麦门冬散。身热
作渴，手足微冷者，脾胃气虚也，用人参白术散。腹胀泄泻，或寒战切牙，脾胃虚
寒也，用十一味木香散。泄泻气促，手足并冷，脾气脱陷也，用十二味异功散。凡
疮结痂作靥，皆由元气充实而内融也，若审见虚弱，便与滋补，血气无亏，可保终
吉，若见不靥而投补剂，恐无及矣。一小儿出痘，贯脓不靥，证如实热。余谓血气
虚甚之假热也。用十全大补汤数剂渐愈。忽又恶寒，余又曰，此邪气退，而真气遂
见虚象也，仍用前药，内参、 各五钱，数剂而愈。一小儿痘不结痂，用补中益
气汤、地黄丸料，煎服而愈。次年毕姻后，寒热作渴头运，脉洪数，按之微细。此
脾肾虚火上炎也，以前药各加肉桂五分，引火归经而愈。
治痘日久不靥。歌曰∶防风锉五钱，炒术与茯苓，当归大腹皮，煎服得安宁。
昔古杭俞氏，专以四制白术散治痘疮日久不肯结痂收脓者，亦此方之遗意也。但回
蚤之痘，元气充托者则可，若元气不足，而回速必宜保护，不如痘之随期而迟回，
何必勉强用药，以速其收功也。
回浆散 治痘不收浆结痂。
何首乌 白芍药 黄 人参 甘草 白术 白茯苓
上，姜水煎服。
象牙散 治同上。
人参 黄 白术（各一钱） 甘草（七分） 茯苓（一钱半） 何首乌（二钱）
上，加糯米二钱，枣二枚，水煎，调下象牙末一钱。
〔溃烂〕痘疮过期不收，遍身溃烂者，此与 烂不同，乃熟太过也，其候不同。
或因天寒失于盖覆，使疮受冻而不收者，宜内服五积散（初热），外用乳香烧烟于被内熏
之。或因天热，过求温暖，使疮被蒸而不收者，宜内服人参白虎汤（见形），或五苓散（惊），
外减去衣被，令少清凉，以天水散（即六一散）扑之。或大便秘结，内外极热，毒瓦斯散
漫，无阴气以敛之而不收者，宜内服宣风散（痘发热），或三黄丸（热），四顺清凉饮（热），外用胆
导法（大便秘）以败草散衬之。或泄泻气虚，脾胃弱，津液少，肌肉虚而不收者，宜内服
陈氏木香散（泻），外用败草散。或因渴饮冷水过多，以致水渍脾胃，湿淫肌肉而不收
者，内服五苓散。如因食少气虚而不收者，人参白术散（渴）去葛根、加桂主之。以
上诸证，以法治之，已溃者结薄痂，未溃者结痂，方为佳兆。若痂皮俱不结者，成
倒靥矣。痘已成脓之后，过期不靥，以致溃烂，脓汁淋漓，不可着席，粘惹痛疼者，用败草散或荞麦粉
以绢袋盛，于身体上扑之，更多布席上，衬卧尤佳，面上欲不成瘢 者，用灭瘢散和百花膏敷之。
败草散
多年屋上烂茅草，择净者为末，掺之，墙上烂草亦佳，以多受风露之气，故能解痘疮毒。
荞麦粉
荞麦一味，磨取细面，痘疮破者，以此敷之，溃烂者以此遍扑之，绢袋盛扑，以此衬卧尤佳。
灭瘢救苦散
蜜陀僧 滑石（各二两） 白芷（半两）
上为细末。湿则干掺之，干则好白蜜调敷。
百花膏
石蜜不拘多少，略用汤和，时时以鹅翎刷之，疮痂亦易落无痕。
【倒靥】痘子初出，磊落成个，后来长大作脓，始相连串，外虽相串，皮下犹一个是一个，至于结痂，肿消
脓干，现出初来本形，所以收藏敛束，要完全坚浓，复成个数为贵。或根脚相通，皮肉尽串者，结痂之时，亦要
干净，无有淫湿及溅破者，次也。若未成痂者溃烂，已成痂者只是嫩皮，此倒靥也。痘毒当靥不靥，复入于里者，
谓之倒靥，此死证也，元气素怯，又不食，常自利者，陈氏木香散（泻）、异攻散（出不快），死中求活圣药也。
如原无泄泻，大便久秘，今添腹胀喘呼，此毒盛，薄
蚀元气，复入于里，宜急下之，排毒散。若不急下，则肠胃不通，荣卫不行，益加喘满躁闷而死矣。若毒入里，忽
然自利者，此人脾胃素强，毒瓦斯难留，故自利，须看利下之物，如利痂皮脓血者，毒瓦斯得出为顺，不可止之，待
利尽脓血自愈。如利水谷者，此毒瓦斯反驱水谷，脾虚不能制之，其证为逆，不可治也。
排毒散
大黄（一两） 白芷 木香（各半两） 穿山甲（七片，土炒焦卷）
共为细末。看虚实大小加减，长流水煎沸调服。
如痘疮破损溃烂者复肿灌作疮，不致干枯，原无痘疮处，复出一层如初出之状，亦以渐起发作脓者，此里气充
实，毒不得入，犹在于表，未成倒靥，逆中之顺证也。但疮子重出一番，必其人能食，大便坚，足以胜其再作之毒，
如食少大便润者，用十全大补汤、人参白术散、肉豆蔻丸主之，盖病久气虚，惟利温补，不可再解毒也。
【不靥闷乱哽气腹胀】〔薛〕陈文宿先生云∶痘疮十一日至十二日当靥不靥，身
热闷乱不宁，卧则哽气，腹胀泄泻，寒战切牙，急用异功散加木香、当归、以救阴
阳表里，助其收靥。窃谓前证若手足并冷，属脾胃虚寒，宜用十二味异功散。手足微冷，属脾胃虚弱，宜用五味异功
散加木香。若手足热，大便秘，属脾胃实热，宜用清凉饮救其阴，以抑其阳。一小儿痘不结痂，发热饮汤，哽气腹胀。
此脾气虚弱。用五味异功散、参 四圣散而愈。后噫气下气，欲服枳壳之类，余谓噫气属心火虚，下气属脾气虚，朝
用六君子汤加姜桂，夕用补中益气汤而愈。一小儿哽气喘咳，腹胀下气，手足不冷不热。此脾虚不能摄气而腹胀下气，
肺虚不能摄气而哽气喘咳，用五味异功散加升麻而愈。
【泄泻】 痘子初出以来，表里俱病，收靥之时，表邪已解，里气当和，大便宜润，小便宜清，忽尔洞泄水
谷者，此中气暴虚，不能禁固水谷。或毒瓦斯乘虚入里，欲作倒靥。并宜陈氏木香散（泻）、异攻散（出不快）、肉豆
蔻丸（泻）主之，利止者佳。利不止者，阳脱而死。
【面】 痘疮溃烂先伤于面者，面乃诸阳之会，痘乃纯阳之毒，以类相从，如水就湿，火就燥也。又，心之华在面，
诸疮皆属于心，心火上炎之象。如面疮已破，肿消目开者，此不着痂先已干燥，病为倒靥，死在旦夕。如已破复
灌，满面成饼，
焦裂溅起，脓血淋漓，食谷则呕，饮水则呛，咯唾粘涎，语音哑嗄，口中气臭者，此脏腑败坏，故诸证尽见也，淹
延闷绝而死。如疮溃肿，饮食无阻，大小便调，更无他苦如上证者，此则可治，内用十全大补汤、升阳解毒
汤相间服之，外用灭瘢救苦散、百花膏合而敷之。
升阳解毒汤
当归 升麻 柴胡 桔梗 甘草 牛蒡子 密蒙花 蝉蜕 连翘 防风 荆芥穗（各等分）
上锉细。水一盏，煎七分，去滓，食后温服。
【人中】人中为任督交会之衢，督乃阳脉，自人中而上，任乃阴脉，自人中而下，故自准头至印堂，与颏至鸠
尾相应，印堂至发际，与鸠尾至膝相应，发际以上，与膝以下相应，痘疮收靥，但观面上收到之处，则知身上收
到之处矣。凡痘子自人中上下左右，先出先靥者吉，阴阳变合相济之理也，若自额角先靥者，孤阳不生，足下
先靥者，孤阴不长，皆凶兆也。
【头足】造化之理，生于阳者阴成之，生于阴者阳成之，故痘疮收靥，头自发际
以上，阳气独盛，谓之孤阳，足自膝以下，阴气所聚，谓之寡阴，所以诸疮皆靥之
后，此二处难靥，乃造化自然之理，不可作倒靥论。
【疳蚀】〔陈〕痘已靥未愈之间，忽被风邪搏之，成疳蚀疮，宜雄黄散、绵茧散治之，久不愈，多渍骨、伤筋、
杀人。〔薛〕前证属足阳明胃经，其方解毒杀虫之剂，若毒发于外，元气未伤者，用之多效。若胃气伤损，
邪火上炎者，用芜荑汤、六味丸。若赤痛者，用小柴胡汤加生地黄。肝脾疳证，必用四味肥儿丸及人参白术
散，更佐以九味芦荟丸。〔万〕痘疮结脓窠之先，或曾伤犯破损者，灌烂成疮，至于收靥，此独不靥，脓汁不干，更
多痛楚，若不急治，渐成疳蚀疮，损骨伤筋，以致横夭，宜内服十全大补汤，外用灭瘢散和百花膏敷之。痘子已成疳
蚀疮者，若在肢节及诸虚怯软弱、血气俱少之处，色青紫黑，肿痛溃烂，以渐延开，血自出者难治，若所生之处，
在于阳分，不痛不烂，色不变，血不出者，以绵茧散主之。
雄黄散 治小儿牙龈生疳蚀疮。
雄黄（一钱） 铜绿（二钱）
上二味同研极细。每用，量疮大小，干贴。
绵茧散 治小儿因痘疮，身体及肢节上生疳蚀疮，脓水不绝，用出蛾绵茧，以生白
矾捶碎入茧内令满，炭火烧令白矾汁尽，取出研极细，每用，干贴疮口上。
【口疳】〔袁〕痘八九朝之期，虽澄黄结蜡，而口中恶臭喷外，上下牙床溃烂，舌板堆裹黄垢，名曰口疳，
若不早治，则床脱牙落，而成漏矣，速将出白散吹之。歌曰∶痘中疳臭世休轻，脱床落齿漏淹成，出白散
方多不识，细茶薄荷共煎浓，乱发滚汤摩洗净，指缠拭口去膜腥，才将青黛硼砂片，薄荷僵蚕些铜青，按制研
为极细末，吹来顷刻痘疳平。余治痘疳，军用人中白 过，和片脑薄荷吹之，朝夕用细
茶、黄连、薄荷煎汤频频漱口后吹之，极效。
【喉痹】〔袁〕痘至七八朝之际，而喉内锁紧，肿痛难咽，毒峻于阳明而然也，金虚则鸣，当以稀涎散吹之。
歌曰∶喉中锁痛觅稀涎，山豆根真效可言，薄荷熊胆相圭合，再把茶芽总共研，随时吹入喉门里，顷刻之间痛遂
痊。此方甚妙，熊胆、山豆根，须要识得真正者，方可用此获效，否则以为无用之方矣。
【发热】痘疮常宜温暖，有热不可尽去，如一向身温，今反发热者，俗名干浆，
此亦常候。只怕内伤饮食，外感风寒，以致发热，又当别论。然病久气虚，不可轻
用汗下，因外伤者，桂枝葛根汤（初热）加人参，因内伤者，木香大安丸（伤食）主之。
歌曰∶待到浑身脓水干，人情倦怠尽偷安，不知禁忌多翻变，一篑终亏九仞山。盖收靥之时，人心怠
忽，居处饮食，不知禁忌，以致变生异证者，纷纷皆是也，行百里者，半于九十，可不慎哉。
【灌脓期的吉凶判断】
在化脓阶段，如果痘疮根部红润，脓液充足，颜色像黄蜡一样，大小便正常，饮食没有减少，这是吉兆，不需要服药。
如果在化脓阶段全是清水，皮肤苍白而薄，像水泡一样，三四天后抓破就会死亡。
在化脓阶段，痘疮内部干枯，完全没有活血迹象，这叫做“空仓”，无法治愈。
在化脓阶段，呕吐腹泻不止，或者大小便出血，乳食不消化，痘疮溃烂没有脓液的，会死亡。（如果大小便不出血，还可以使用止泻健脾的药物。）
在化脓阶段，大小便闭塞，眼睛闭合，声音嘶哑，腹部胀满，肌肉变黑的，会死亡。
【收靥（结痂）的正常与异常】
痘疮化成脓之后，色泽鲜明肥润，饱满坚实，用手擦拭，疮头微微焦硬，这是将要结痂的迹象。大小不一的痘疮依次逐渐结痂，不过于急促，也不过于缓慢，已经结痂的痂壳周围圆润，没有突起或凹陷，干净没有渗液或溅破，这叫作“正靥”，是坏运过去好运到来的象征。大凡痘疮收靂，不能拘泥于天数。大致来说，痘疮原本稀疏、元气充实的人，自然容易出痘也容易结痂；如果痘疮原本稠密、元气虚弱的人，就难出也难结痂。只要先后有序，快慢适中，饮食如常，就没有其他病症。如果收靂太急，毒邪未尽，煎熬津液，导致迅速干枯，这不是正常的收靂，必然会导致眼病、痈毒以及各种怪病，严重的甚至夭折，轻微的也会残疾，应当轻微通利大便，以清除毒邪，用当归丸主治（适用于大便秘结的情况）。如果收靂太迟，中气已虚，脾胃太弱，不能滋养肌肉，使其愈合，导致溃烂，内服十全大补汤（适用于出汗者），外用败草散（适用于溃烂者）衬垫。海藏说：疹痘化脓但不焦枯，这是因为治疗时失去了清凉之气，就像五谷得到阳气才能成熟，不是凉风到来就不能结实一样，天地肃杀之气一加，万物就能秀美而结实了，这与疹痘有什么关系呢？必须观察是哪条经络的问题而给予清凉，或者通过泻下形成肃杀之气，那么痘气就一定不会停留在化脓而不结痂的阶段了。要知道，余毒不尽而疾病发作，大概就是这个原因（应该是用清凉饮子泻下）。不是阳和之气，禾苗就不能秀美；不是肃杀之气，秀美也不能结实。钱乙说：五到七天痂皮不焦枯，是因为内热发热，蒸腾于外，所以不能形成焦痂，宜用宣风散引导，用生犀牛角磨汁解毒，一定能结痂。刘洙《疮子诀》说：痘疮发出后，像脓窠一样不肯结痂的，只调沙糖水给他喝。刘提点说：也曾试用过，但后来结的瘢痕是白色的。
薛己按：陈文宿先生说：痘疮想结痂却不结痂，痂皮想脱落却不脱落，如果腹胀烦渴，忌食水、蜜、生冷之物，如果吃了，会更加口渴而死，急忙用木香散救治。如果身体发热烦渴的，宜服人参麦门冬散。身体发热大渴的，用人参白术散。如果不好转，仍服木香散。我认为前面的证候是由于脾胃气虚、津液不足导致的，不是实热为患。如果身体发热烦躁，手足发热，是脾胃有热，用人参麦门冬散。身体发热作渴，手足微冷的，是脾胃气虚，用人参白术散。腹胀泄泻，或者寒战咬牙，是脾胃虚寒，用十一味木香散。泄泻气促，手足都冷，是脾气脱陷，用十二味异功散。凡是疮口结痂成靥，都是由元气充实而内部融合所致，如果审察见到虚弱，就给予滋补，血气没有亏损，可以保全最终吉利，如果见到不结痂就投用补剂，恐怕来不及了。有一个小孩出痘，化脓后不结痂，证候像实热。我说这是血气极度虚弱的假热。用了十全大补汤几剂后渐渐痊愈。忽然又恶寒，我又说，这是邪气退去，真气显露出虚象，仍然用前药，加入人参、黄芪各五钱，几剂后痊愈。另一个小孩痘疮不结痂，用补中益气汤、地黄丸料煎服而愈。第二年结婚后，出现寒热、作渴、头晕，脉象洪数，重按微细。这是脾肾虚火上炎，以前药各加肉桂五分，引火归经而愈。
治疗痘疮日久不结痂。歌诀说：防风切五钱，炒白术与茯苓，当归和大腹皮，煎服得安宁。
从前杭州俞氏，专门用四制白术散治疗痘疮日久不肯结痂收脓的，也是这个方子的遗意。但是回蚤（早期消退）的痘疮，元气充托的可以这样，如果元气不足，而消退迅速，必定应该保护，不如痘疮随期限而迟缓消退，何必勉强用药来加速其收功呢？
回浆散：治疗痘疮不收浆结痂。
何首乌、白芍药、黄芪、人参、甘草、白术、白茯苓。
以上药材，用姜水煎服。
象牙散：治疗同上。
人参、黄芪、白术（各一钱）、甘草（七分）、茯苓（一钱半）、何首乌（二钱）。
以上药材，加糯米二钱，大枣二枚，水煎，调入象牙末一钱服用。
【溃烂】痘疮过期不收口，遍身溃烂的，这与烂喉不同，乃是熟透太过所致，其征候不同。
或者因为天寒失于覆盖，使疮受冻而不收敛的，宜内服五积散（初热期），外用乳香烧烟在被子里熏之。或者因为天热，过分求温暖，使疮被蒸烤而不收敛的，宜内服人参白虎汤（见形期），或五苓散（惊风期），外减去衣被，令其稍清凉，用天水散（即六一散）扑洒。或者大便秘结，内外极热，毒瓦斯散漫，无阴气以收敛它而不收敛的，宜内服宣风散（痘发热），或三黄丸（热证），四顺清凉饮（热证），外用胆导法（大便秘结）并用败草散衬垫。或者泄泻气虚，脾胃弱，津液少，肌肉虚而不收敛的，宜内服陈氏木香散（泄泻），外用败草散。或者因为口渴饮冷水过多，以致水渍脾胃，湿淫肌肉而不收敛的，内服五苓散。如果因为食少气虚而不收敛的，用人参白术散（口渴）去掉葛根、加桂枝主治。以上各种证候，依法治疗，已溃烂的结成薄痂，未溃烂的结成痂，才是佳兆。如果痂皮都不结成的，就成了倒靥。痘疮已成脓之后，过期不结痂，以致溃烂，脓汁淋漓，不可着席，粘惹疼痛的，用败草散或荞麦粉装在绢袋里，在身上扑洒，更多铺在席子上，衬着睡更好，脸上想要不成瘢痕的，用灭瘢散和百花膏敷之。
败草散：多年屋顶上的烂茅草，择净的研为粉末，掺在患处，墙上的烂草也很好，因为它多受风露之气，所以能解痘疮毒。
荞麦粉：荞麦一味，磨取细面，痘疮破了的，以此敷之，溃烂的以此遍扑之，装在绢袋里扑洒，以此衬着睡更好。
灭瘢救苦散：蜜陀僧、滑石（各二两）、白芷（半两）。
以上研为细末。湿了则干掺，干了则用好白蜜调敷。
百花膏：石蜜不拘多少，略用热水调和，时时用鹅毛刷涂，疮痂也易落且无痕。
【倒靥】痘子初出时，磊落成一个个，后来长大化脓，开始相连串，外面虽然相连串，皮下还是一个是一个，直到结痂，肿消脓干，现出初来的本形，所以收藏敛束，要完全坚厚浓密，复成个数为贵。或者根脚相通，皮肉尽相连串的，结痂之时，也要干净，没有渗液及溅破的，次一等。如果未成痂者溃烂，已成痂者只是嫩皮，这叫倒靥。痘毒当结痂时不结痂，反而入里的，叫倒靥，这是死证。元气素来怯弱，又不吃东西，经常自利的，陈氏木香散（泄泻）、异攻散（出不快），是死中求活的圣药。如果原来没有泄泻，大便久秘，现在增添腹胀喘呼，这是毒盛，侵蚀元气，复入于里，宜急下之，用排毒散。如果不急下，则肠胃不通，营卫不行，更加喘满躁闷而死。如果毒入里，忽然自利的，这是人脾胃素强，毒瓦斯难留，故自利，须看拉下的东西，如果拉的是痂皮脓血，毒瓦斯得出为顺，不可止住，待拉尽脓血自愈。如果拉的是水谷，这是毒瓦斯反驱水谷，脾虚不能制约它，其证为逆，不可治。
排毒散：大黄（一两）、白芷、木香（各半两）、穿山甲（七片，土炒焦卷）。
共为细末。看虚实大小加减，长流水煎沸调服。
如果痘疮破损溃烂后又肿起化脓作疮，不致干枯，原无痘疮处，又出一层如初出的状貌，也渐渐起发作脓的，这是里气充实，毒不得入，犹在于表，未成倒靥，是逆中的顺证。但疮子重出一番，必其人能食，大便坚，足以胜其再作的毒，如果食少大便润的，用十全大补汤、人参白术散、肉豆蔻丸主治，盖病久气虚，惟利温补，不可再解毒。
【不靥闷乱哽气腹胀】〔薛〕陈文宿先生说：痘疮十一日至十二日应当结痂却不结痂，身体发热闷乱不宁，卧则哽气，腹胀泄泻，寒战咬牙，急忙用异功散加木香、当归，以救阴阳表里，助其收靥。我认为前面的证候如果手足都冷，属脾胃虚寒，宜用十二味异功散。手足微冷，属脾胃虚弱，宜用五味异功散加木香。如果手足热，大便秘，属脾胃实热，宜用清凉饮救其阴，以抑其阳。一个小孩痘不结痂，发热饮汤，哽气腹胀。这是脾气虚弱。用五味异功散、参四圣散而愈。后来噫气下气，想服枳壳之类，我说噫气属心火虚，下气属脾气虚，早晨用六君子汤加姜桂，晚上用补中益气汤而愈。一个小孩哽气喘咳，腹胀下气，手足不冷不热。这是脾虚不能摄气而腹胀下气，肺虚不能摄气而哽气喘咳，用五味异功散加升麻而愈。
【泄泻】痘子初出以来，表里俱病，收靥之时，表邪已解，里气当和，大便宜润，小便宜清，忽然洞泄水谷的，这是中气暴虚，不能禁固水谷。或者毒瓦斯乘虚入里，欲作倒靥。并宜陈氏木香散（泄泻）、异攻散（出不快）、肉豆蔻丸（泄泻）主治，利止者佳。利不止者，阳脱而死。
【面】痘疮溃烂先伤于面的，面乃诸阳之会，痘乃纯阳之毒，以类相从，如水就湿，火就燥也。又，心之华在面，诸疮皆属于心，心火上炎之象。如果面疮已破，肿消目开的，这是不着痂先已干燥，病为倒靥，死在旦夕。如果已破复灌，满面成饼，焦裂溅起，脓血淋漓，食谷则呕，饮水则呛，咯唾粘涎，语音哑嗄，口中气臭的，这是脏腑败坏，故诸证尽见也，淹延闷绝而死。如果疮溃肿，饮食无阻，大小便调，更无他苦如上证的，这则可治，内用十全大补汤、升阳解毒汤相间服之，外用灭瘢救苦散、百花膏合而敷之。
升阳解毒汤：当归、升麻、柴胡、桔梗、甘草、牛蒡子、密蒙花、蝉蜕、连翘、防风、荆芥穗（各等分）。
以上锉细。水一盏，煎七分，去滓，食后温服。
【人中】人中为任督交会之衢，督乃阳脉，自人中而上，任乃阴脉，自人中而下，故自准头至印堂，与颏至鸠尾相应，印堂至发际，与鸠尾至膝相应，发际以上，与膝以下相应，痘疮收靥，但观面上收到之处，则知身上收到之处矣。凡痘子自人中上下左右，先出先靥者吉，阴阳变合相济之理也，若自额角先靥者，孤阳不生，足下先靥者，孤阴不长，皆凶兆也。
【头足】造化之理，生于阳者阴成之，生于阴者阳成之，故痘疮收靥，头自发际以上，阳气独盛，谓之孤阳，足自膝以下，阴气所聚，谓之寡阴，所以诸疮皆靥之后，此二处难靥，乃造化自然之理，不可作倒靥论。
【疳蚀】〔陈〕痘已靥未愈之间，忽被风邪搏之，成疳蚀疮，宜雄黄散、绵茧散治之，久不愈，多渍骨、伤筋、杀人。〔薛〕前证属足阳明胃经，其方解毒杀虫之剂，若毒发于外，元气未伤者，用之多效。若胃气伤损，邪火上炎者，用芜荑汤、六味丸。若赤痛者，用小柴胡汤加生地黄。肝脾疳证，必用四味肥儿丸及人参白术散，更佐以九味芦荟丸。〔万〕痘疮结脓窠之先，或曾伤犯破损者，灌烂成疮，至于收靥，此独不靥，脓汁不干，更多痛楚，若不急治，渐成疳蚀疮，损骨伤筋，以致横夭，宜内服十全大补汤，外用灭瘢散和百花膏敷之。痘子已成疳蚀疮者，若在肢节及诸虚怯软弱、血气俱少之处，色青紫黑，肿痛溃烂，以渐延开，血自出者难治，若所生之处，在于阳分，不痛不烂，色不变，血不出者，以绵茧散主之。
雄黄散：治疗小儿牙龈生疳蚀疮。
雄黄（一钱）、铜绿（二钱）。
以上两味同研极细。每用，量疮大小，干贴。
绵茧散：治疗小儿因痘疮，身体及肢节上生疳蚀疮，脓水不绝，用出蛾绵茧，以生白矾捶碎入茧内令满，炭火烧令白矾汁尽，取出研极细，每用，干贴疮口上。
【口疳】〔袁〕痘八九朝之期，虽澄黄结蜡，而口中恶臭喷外，上下牙床溃烂，舌板堆裹黄垢，名曰口疳，若不早治，则床脱牙落，而成漏矣，速将出白散吹之。歌曰：痘中疳臭世休轻，脱床落齿漏淹成，出白散方多不识，细茶薄荷共煎浓，乱发滚汤摩洗净，指缠拭口去膜腥，才将青黛硼砂片，薄荷僵蚕些铜青，按制研为极细末，吹来顷刻痘疳平。我治疗痘疳，军用人中白煅过，和片脑薄荷吹之，朝夕用细茶、黄连、薄荷煎汤频频漱口后吹之，极效。
【喉痹】〔袁〕痘至七八朝之际，而喉内锁紧，肿痛难咽，毒峻于阳明而然也，金虚则鸣，当以稀涎散吹之。歌曰：喉中锁痛觅稀涎，山豆根真效可言，薄荷熊胆相圭合，再把茶芽总共研，随时吹入喉门里，顷刻之间痛遂痊。此方甚妙，熊胆、山豆根，须要识得真正者，方可用此获效，否则以为无用之方矣。
【发热】痘疮常宜温暖，有热不可尽去，如一向身温，今反发热者，俗名干浆，此亦常候。只怕内伤饮食，外感风寒，以致发热，又当别论。然病久气虚，不可轻用汗下，因外伤者，桂枝葛根汤（初热期）加人参，因内伤者，木香大安丸（伤食）主治。
歌曰：待到浑身脓水干，人情倦怠尽偷安，不知禁忌多翻变，一篑终亏九仞山。盖收靥之时，人心怠忽，居处饮食，不知禁忌，以致变生异证者，纷纷皆是也，行百里者，半于九十，可不慎哉。
[Prosperity and Adversity during the Suppuration Stage]
During the suppuration stage, if the base of the pock is ruddy, the pus is abundant, the color resembles yellow wax, bowel and bladder movements are normal, and food intake has not decreased, this is a favorable sign (Ji Zheng), and no medication is required.
If during the suppuration stage there is only clear water, the skin is pale and thin, resembling a blister, and it dies after being scratched open three or four days later.
During the suppuration stage, if the pock is dry inside with no signs of vital blood circulation, this is named "Empty Granary" (Kong Cang) and is incurable.
During the suppuration stage, if vomiting and diarrhea persist, or if there is bleeding in the stool and urine, milk and food are not digested, and the pocks are ulcerated without pus, death will occur. (If there is no bleeding in the stool and urine, anti-diarrheal and spleen-strengthening medicines may still be used.)
During the suppuration stage, if there is constipation and urinary retention, eyes are closed, voice is hoarse, abdomen is distended, and muscles turn black, death will occur.
[Normal and Abnormal Scabbing (Shou Ye)]
After the pox have formed pus, if they are bright, plump, firm, and slightly scaly/hard to the touch, this indicates that scabbing is about to occur. The larger and smaller poxes should scab gradually in order, neither too hastily nor too slowly. If the already scabbed areas have round, even scabs without protrusions or depressions, and are clean without exudate or rupture, this is called "Correct Scabbing" (Zheng Ye), which signifies the transition from bad luck to good fortune. Generally, the timing of scabbing for smallpox should not be rigidly fixed by days. Roughly speaking, those with sparse poxes and solid primordial qi naturally recover easily; conversely, those with dense poxes and deficient primordial qi find it difficult to erupt and scab. As long as the sequence is orderly, the pace is moderate, and diet remains normal, no other complications will arise. If scabbing occurs too quickly, the pathogenic toxins are not fully cleared, leading to the consumption of body fluids and rapid drying, which is not proper scabbing. This inevitably leads to eye diseases, carbuncles, and various strange ailments, potentially causing premature death or disability. Mild purgation should be employed to eliminate toxins, primarily using Danggui Wan (for cases with constipation). If scabbing is delayed, the middle qi is deficient, and the spleen and stomach are too weak to nourish the muscles for healing, resulting in ulceration. Internally administer Shiquan Dabu Tang (for cases with sweating), and externally apply Baicao San (for ulcerations) as a dressing. Haizang stated: Rashes/poxes that suppurate but do not scab result from a lack of cooling energy in treatment, similar to grains requiring yang energy to mature and cool wind to fill out. When the austere energy of heaven and earth acts, all things become beautiful and solid. One must observe which meridian is affected and provide cooling, or induce an austere state through purgation, so that the pox does not remain in a state of suppuration without scabbing. It must be understood that disease recurrence due to residual toxins stems from this principle. Without harmonious yang energy, shoots cannot flourish; without austere energy, flourishing cannot bear fruit. Qian Yi stated: If scabs do not scorch between the fifth and seventh days, it is due to internal heat steaming outward, preventing scab formation. Xuanfeng San should be used to guide the heat, and fresh rhinoceros horn juice applied to resolve toxicity, ensuring scab formation. Liu Zhu's *Czai Jue* states: For poxes forming pustules that refuse to scab, simply administering sand sugar water helps. Point Inspector Liu noted: He also tried this, but the resulting scars were white.
Xue Ji commented: Mr. Chen Wensu said: When poxes want to scab but do not, and scabs want to fall but do not, accompanied by abdominal distension, irritability, and thirst, one must avoid water, honey, and raw/cold foods. Ingestion can lead to increased thirst and death; urgently treat with Muxiang San. For fever and irritability, Ren Shen Maidong San is suitable. For high fever and extreme thirst, Renshen Baizhu San is indicated. If ineffective, revert to Muxiang San. I believe these symptoms stem from spleen-stomach qi deficiency and insufficient body fluids, not excess heat. If accompanied by fever, irritability, and hot extremities, it indicates spleen-stomach heat, treated with Ren Shen Maidong San. If fever and thirst are present with slightly cold extremities, it indicates spleen-stomach qi deficiency, treated with Renshen Baizhu San. For abdominal distension, diarrhea, chills, and teeth grinding, it indicates spleen-stomach deficiency-cold, treated with Shi Yi Wei Muxiang San. For diarrhea, shortness of breath, and cold extremities, it indicates sinking of spleen qi, treated with Shi Er Wei Yigong San. Scabbing results from the consolidation of primordial qi. If weakness is identified, tonification should be provided immediately to preserve blood and qi for a favorable outcome; delaying tonification until scabbing fails may render it futile. A child with poxes that failed to scab after suppuration presented with symptoms resembling excess heat. I diagnosed this as false heat due to severe blood and qi deficiency. Several doses of Shiquan Dabu Tang led to gradual recovery. Subsequently, aversion to cold appeared. I explained this as the retreat of pathogens revealing underlying qi deficiency, continuing the previous prescription with added Ren Shen and Huang Qi (each 5 qian), resulting in cure. Another child with non-scabbing poxes was cured with Buzhong Yiqi Tang and Dihuang Wan decoction. After marriage the following year, he developed alternating chills and fever, thirst, dizziness, and a surging, rapid pulse that felt fine upon deep pressure. This indicated empty fire flaming upward from spleen-kidney deficiency. Adding Rou Gui (0.5 qian) to the previous prescriptions guided the fire back to its source, effecting a cure.
For prolonged failure to scab: A verse states: Cut Fang Feng (5 qian), stir-fried Bai Zhu and Fu Ling, Dang Gui and Da Fu Pi; decoct and take for peace.
Formerly, Doctor Yu of Hangzhou specialized in using Sizhi Baizhu San for poxes failing to scab or absorb pus over time, deriving intent from this formula. However, for poxes that recede early ("Hui Zao"), if primordial qi is robust, this method applies. If primordial qi is insufficient and recession is rapid, protection is essential rather than forcing recovery with medication, unlike the natural, slower progression of typical poxes.
Hujiang San: Treats poxes failing to absorb pus and form scabs.
He Shou Wu, Bai Shao Yao, Huang Qi, Ren Shen, Gan Cao, Bai Zhu, Bai Fu Ling.
Decoct with ginger water.
Xiangya San: Treats the above condition.
Ren Shen, Huang Qi, Bai Zhu (1 qian each), Gan Cao (0.7 qian), Fu Ling (1.5 qian), He Shou Wu (2 qian).
Add Nuomi (2 qian) and two dates, decoct in water, and mix in 1 qian of Xiangya powder.
[Ulceration] Poxes failing to close past the expected time, with widespread ulceration, differ from throat rot; this is due to excessive "ripening." Etiologies vary:
If caused by cold exposure due to inadequate covering, internally administer Wuji San (early heat stage) and externally fumigate the bedding with burning Ru Xiang.
If caused by excessive warmth in hot weather steaming the poxes, internally administer Ren Shen Baitu Tang (eruption stage) or Wuling San (convulsion stage); externally remove clothing/bedding to cool slightly and dust with Tianshui San (Liuyi San).
If constipation exists with extreme internal/external heat and dispersed toxins lacking yin to consolidate them, internally administer Xuanfeng San (fever), Sanhuang Wan (heat), or Sishun Qingliang Yin (heat); externally use Dan Dao Fa (for constipation) with Baicao San dressing.
If diarrhea and qi deficiency cause weak spleen/stomach, scant fluids, and flaccid muscles failing to close, internally administer Chen's Muxiang San (diarrhea) and externally apply Baicao San.
If excessive cold water intake damages spleen/stomach with dampness invading muscles, internally administer Wuling San.
If poor appetite and qi deficiency prevent closure, use Renshen Baizhu San (thirst) removing Ge Gen and adding Gui Zhi.
Proper treatment of these conditions results in thin scabs for ulcers and full scabs for intact lesions, a good omen. Failure to form any scabs constitutes "Dao Ye" (Reverse Scabbing). For poxes that have suppurated but fail to scab, leading to dripping pus and painful adhesion to bedding, apply Baicao San or Buckwheat Flour in silk bags, dusting the body and lining the bed. To prevent facial scarring, apply Mieban San mixed with Baihua Gao.
Baicao San: Use rotten thatch grass from old roofs, cleaned and powdered. Grass from walls is also effective due to exposure to wind and dew, aiding in resolving pox toxins.
Buckwheat Flour: Grind buckwheat into fine flour. Apply to broken poxes or dust over ulcers. Using silk bags for application and bed lining is optimal.
Mieban Jiuku San: Miduo Seng and Hua Shi (2 liang each), Bai Zhi (0.5 liang).
Grind to fine powder. Apply dry if wet; mix with white honey if dry.
Baihua Gao: Shi Mi (rock sugar) in any amount, warmed with water. Brush on frequently with a goose feather; scabs will fall off without traces.
[Reverse Scabbing (Dao Ye)] Initially distinct poxes grow, suppurate, and connect externally while remaining separate subcutaneously. Upon scabbing, swelling subsides, pus dries, and original forms reappear. Proper scabbing requires complete, firm, thick scabs retaining individual identity. Connected roots/skin with clean, non-exudative scabs are secondary. Ulceration before scabbing or tender skin on existing scabs defines Reverse Scabbing. When toxins fail to scab and re-enter the interior, it is called Reverse Scabbing, a fatal sign. For patients with inherent weakness, anorexia, and chronic diarrhea, Chen's Muxiang San (diarrhea) and Yigong San (slow eruption) are holy medicines for survival. If no prior diarrhea exists but constipation is present, now accompanied by abdominal distension and wheezing, this indicates overwhelming toxins eroding qi and re-entering the interior; urgent purgation with Pai Du San is required. Delay leads to intestinal blockage, failure of Ying-Wei circulation, and death from suffocation/restlessness. If sudden diarrhea occurs after toxin entry, it indicates strong spleen/stomach expelling toxins; observe the discharge. Passing scab/pus/blood is favorable (smooth); do not stop it until toxins are exhausted. Passing undigested food indicates reverse expulsion due to spleen deficiency; this is adverse and untreatable.
Pai Du San: Da Huang (1 liang), Bai Zhi, Mu Xiang (0.5 liang each), Chuan Shan Jia (7 slices, soil-fried).
Grind to powder. Adjust dosage by age/condition; decoct in flowing water and take.
If broken/ulcerated poxes swell and suppurate again without drying, and new eruptions appear like initial stages, gradually forming pus, this indicates robust interior qi repelling toxins to the exterior, constituting a "favorable within unfavorable" pattern, not yet Reverse Scabbing. Recurrence requires robust digestion and firm stools to withstand renewed toxicity. For poor appetite and loose stools, use Shiquan Dabu Tang, Renshen Baizhu San, or Roudou Kou Wan. Long-standing illness causes qi deficiency, favoring warm tonification over further detoxification.
[Failure to Scab, Distress, Gasping, Abdominal Distension] [Xue] Mr. Chen Wensu stated: On days 11-12, if poxes fail to scab, accompanied by fever, distress, restlessness, gasping when lying down, abdominal distension, diarrhea, chills, and teeth grinding, urgently use Yigong San plus Mu Xiang and Dang Gui to rescue yin/yang and exterior/interior, assisting scabbing. I add: If extremities are cold, it is spleen-stomach deficiency-cold; use Shi Er Wei Yigong San. If slightly cold, it is spleen-stomach weakness; use Wu Wei Yigong San plus Mu Xiang. If extremities are hot with constipation, it is spleen-stomach excess heat; use Qingliang Yin to nourish yin and suppress yang. A child with non-scabbing poxes, fever, drinking preference, gasping, and distension had spleen qi deficiency, cured with Wu Wei Yigong San and Can Si Sheng San. Later belching and lower qi issues suggested heart fire deficiency and spleen qi deficiency; morning Liu Jun Zi Tang with Jiang/Gui and evening Buzhong Yiqi Tang cured him. A child with gasping, cough, distension, and lower qi issues with neutral extremities had spleen/lung qi deficiency failing to control qi; Wu Wei Yigong San plus Sheng Ma cured him.
[Diarrhea] Since eruption, both exterior and interior are diseased. At scabbing, exterior pathogens should be resolved, and interior qi harmonized; stool should be moist, urine clear. Sudden watery diarrhea indicates acute middle qi deficiency failing to secure food/water, or toxins entering the interior threatening Reverse Scabbing. Treat with Chen's Muxiang San, Yigong San, or Roudou Kou Wan. Cessation of diarrhea is good; persistence leads to yang collapse and death.
[Face] Facial ulceration occurs first because the face is the meeting point of all yang meridians, and pox toxins are pure yang, attracting like to like (water to moisture, fire to dryness). The face reflects the heart's splendor; all sores relate to the heart, indicating flaming heart fire. If facial sores break, swelling subsides, and eyes open, but scabs do not form and dry prematurely, it is Reverse Scabbing, fatal within days. If broken sores re-suppurate, forming a crusty, cracked, weeping mass with bloody pus, vomiting food, choking on water, sticky saliva, hoarseness, and foul breath, this indicates organ failure and impending death from suffocation. If sores ulcerate/swell but eating, urination, and defecation are normal without other severe symptoms, it is treatable. Internally alternate Shiquan Dabu Tang and Shengyang Jiedu Tang; externally apply Mieban Jiuku San and Baihua Gao.
Shengyang Jiedu Tang: Dang Gui, Sheng Ma, Chai Hu, Jie Geng, Gan Cao, Niu Bang Zi, Mi Meng Hua, Chan Tui, Lian Qiao, Fang Feng, Jing Jie Sui (equal parts).
Cut finely. Decoct 1 cup water to 0.7 cup, strain, and take warm after meals.
[Glabella/Renzhong] Renzhong is the intersection of Ren and Du meridians. Du is yang (ascending from Renzhong); Ren is yin (descending from Renzhong). Correspondences exist: Nose tip to Yintang matches chin to Jiwei; Yintang to hairline matches Jiwei to knees; above hairline matches below knees. Observing facial scabbing extent reveals body scabbing extent. Eruption/scabbing starting around Renzhong is auspicious (yin-yang harmony). Starting at forehead corners indicates solitary yang (inauspicious); starting at feet indicates solitary yin (inauspicious).
[Head and Feet] Creation's principle: Yang born items are completed by yin, yin born by yang. During scabbing, the head (above hairline) has dominant yang (Solitary Yang), and feet (below knees) gather yin (Lonely Yin). Thus, these areas scab last naturally; do not diagnose as Reverse Scabbing.
[Cancreous Sores] [Chen] Between scabbing and healing, wind-pathogen invasion causes Cancreous Sores. Treat with Xiong Huang San and Mian Jian San. Untreated, they erode bone/tendon and kill. [Xue] These belong to Foot-Yangming Stomach Meridian. Detoxifying/insect-killing formulas work if toxins are external and primordial qi is intact. If stomach qi is damaged with evil fire flaming up, use Wuyi Tang and Liuwei Wan. For redness/pain, use Xiaochai Hu Tang plus Sheng Di Huang. Liver-spleen cancreous conditions require Siwei Fei'er Wan and Renshen Baizhu San, assisted by Jiwei Lujian Wan. [Wan] Before scabbing, if poxes were damaged and became ulcerated, failing to scab with persistent pus and pain, urgent treatment prevents bone/tendon damage and premature death. Internally use Shiquan Dabu Tang; externally Mieban San and Baihua Gao. For established cancreous sores: If on limbs/joints (weak, blood/qi deficient areas) with purple/black discoloration, swelling, pain, ulceration, and bleeding, prognosis is poor. If on yang aspects, painless, non-ulcerated, unchanged color, no bleeding, use Mian Jian San.
Xiong Huang San: Treats pediatric gingival cancreous sores.
Xiong Huang (1 qian), Tong Lv (2 qian).
Grind extremely fine. Apply dry according to sore size.
Mian Jian San: Treats pediatric cancreous sores on body/limbs from poxes with continuous pus. Use silkworm cocoons, fill with raw Bai Fan, burn until ash remains, grind fine. Apply dry to sores.
[Mouth Cancreous Sores] [Yuan] Around days 8-9, despite yellow/waxy scabs, foul breath emanates, gums ulcerate, tongue coated with yellow debris. Named Mouth Cancreous Sores. Untreated, gums recede, teeth fall, forming fistulas. Quickly apply Chu Bai San. Verse: Do not轻视 (underestimate) pox mouth odor... Chu Bai San recipe often unknown... Grind fine and insufflate. I treat pox mouth cancreous sores using calcined Ren Zhong Bai mixed with Bo He and Bing Pian. Rinse mouth frequently with tea, Huang Lian, Bo He decoction before insufflation; highly effective.
[Throat Bi] [Yuan] Around days 7-8, throat tightens, swells, painful swallowing due to severe Yangming toxins. Metal deficiency causes ringing; insufflate Xi Xian San. Verse: Seek Xi Xian for throat lock pain... Sand Dou Gen and Xiong Dan are key... Insufflate into throat for instant relief. Bear bile and Sand Dou Gen must be authentic for efficacy.
[Fever] Poxes generally require warmth; some heat is normal. If previously warm but now febrile, commonly called "Dry Pus," this is a common symptom. Caution against dietary injury or wind-cold causing fever. Due to long-term qi deficiency, avoid harsh sweating/purgation. For external injury, Guizhi Gegen Tang (early heat) plus Ren Shen. For internal injury, Muxiang Da'an Wan (food stagnation).
Verse: Wait until pus dries... People relax... Ignoring taboos ruins progress... One basket fails where nine were built. During scabbing, negligence in diet/environment causes complications. He who travels a hundred miles is only half done at ninety; how can one be careless?