诀云∶虚则痒，实则痛，此大概言之。痘疮之痒，其候不同，有初出时便身痒爬搔不停者，此邪气欲出，皮
肤闭密，其火游移往来，故痒也，与伤寒太阳病身痒汗不出者同论，可发之，使皮肤纵缓，腠理开通，邪气得泄，
疮出而痒去，所谓火郁则发之者是已。有将收较而痒者，其脓已成，其疮将回，邪气散而正气复，荣卫和畅，故痒
也，与痈疖将痊而痒者同论，不须服药，但谨护之，勿令 掐，以致肿灌，所谓美 者是已。有起壮泡浆而痒者，当
血已化水，水未成脓之时，其毒未化，浑身瘙痒，爬搔不宁，此恶候也，与伤寒阳明经病皮中如虫行者同论，所
谓虚风外搏，邪气内强，痒而不止为泄风者是已。此视疮之干湿，以风药佐之，必令痒去，方为佳兆，若痒甚不休，
疮坏皮脱，其毒复陷，谓之痒塌，必不能治矣。大抵出形而皮肉红艳，起发而皮嫩多水者，其后常致痒塌也。凡痘子
瘙痒者，须于形色上详审，如疮一向起发红活，光壮肥满，忽然瘙痒者，此秽气所触也，宜内服十全大
补汤（汗），外用茵陈熏法（起发），其破者以白龙散敷之。如疮本干燥又添瘙痒者，火甚也。如疮原带水，皮肉嫩薄，
又痒
者，此温热也。摆头扭项，手足动作，昏闷者死证。如初出身痒者，可发之，桂枝葛根汤（初热）加制麻黄、牛蒡子、
主之。如起发养浆而痒者，通用十全大补汤（汗）加防风、牛蒡子主之。起发身痒有二证，一则血气不足，其痒为虚，
十
全大补汤主之。一则不能食淡、以致发痒，蝉蜕膏主之（初热）。如疮干而痒者，宜养血润燥，以四物汤（失血）合消
风化毒汤、夺命丹（起发）主之，外用茵陈熏法。如疮湿而痒者，宜养气去湿，以四君子汤（不能食）合消风化毒汤、
夺命丹主之，外用茵陈熏法。凡痘子已熟，忽作瘙痒抓破者，此脾胃虚弱，不能荣养肌肉也，内服四君子汤加黄 、官
桂，外以败草散（溃烂）主之。如因自利脾胃虚，致痒塌者，陈氏木香散（泄利）、异功散（出不快）主之。如疮将
收而作痒，误犯破损，不肯干较者，用白龙散贴敷。丹溪法∶于形色脉上分虚实，实则脉有力气壮，虚则脉无力气馁。
实痒则势 ，虚痒则势怯。虚痒以实表之剂加凉血药，实痒以大黄寒凉之药少许与之，
下其结粪。沧洲翁法∶主血气不足，用十补托里散及木香散加丁香、官桂。胃主肌
肉，尤宜四君子汤加芎、归、木香、紫草煎服。或患者不能忌口，因食毒物而作痒者，二物汤、百花膏，或四君子汤加
解毒药。陈氏法痘疮作痒，抓破成疮，脓水淋漓者，由血气衰，肌肉虚也，宜用木香散（泻）加丁香、肉桂，及败草
散（收靥），切忌用牛粪灰。闻人氏法∶痒有二证，一则气血不足，其痒为虚，活血散（出不快）或四君子汤加黄
、枳壳主之（左中恕用十全大补汤、十宣内托散）。一则不能食淡以致痒，蝉蜕一物汤主之（痘腹痛）。魏氏法以
保元汤倍加黄 ，少加芍药。
或云首尾痒塌，保元加牛蒡子、白芍药、何首乌。何首乌有红白二种，名为雄雌，必须兼下有效。忌铁。王汝言云∶
痘疮虚怯，淡白色，痒塌，此属虚寒，宜用陈氏法。若发热壮盛，齐涌红紫色，燥痒，此属热毒，宜用凉血解毒之剂。
薛氏云∶前证皆因气血虚弱所致，预为调护，使气血和平，庶无此患，又必察其外证，色白者用四君之类，色赤者用
四物之类。
袁氏云∶囊贮半浆而作痒者，可以疗止，必当用参、 、芍药、升麻、附子之属，不宜投寒散之药。若焦贴皮肤作痒
者不治。空壳莲蒲作痒者，不治。
参 内托散 治里虚发痒，疮不溃，倒靥。
人参 黄 （炒） 当归 川芎 浓朴（姜制） 防风（各五分） 桔梗 白芷 官桂（各二分） 木
香甘草（各三分） 紫草（五分）
上入糯米一撮，水煎，量服之。寒战切牙，饮水泻渴，亦宜服。
紫草木香散 治痘疮里虚痒塌，黑陷发热。
紫草 伏苓 甘草 白术 木香 人参（各等分） 糯米
上，每服三钱，水煎。
消风化毒汤
防风 黄 白芍药 荆芥穗 桂枝 牛蒡子 升麻（各等分） 甘草（减半）
上锉碎。加薄荷叶七片，水一盏，煎七分，去滓温服，无时。
〔丹〕治痘疮痒塌不掩。
白术（一钱半） 黄 （炙） 当归 陈皮（各五分） 甘草（炙些）
水煎，温服。
予治一子七岁，痘将出未出之际，腹泄数行，其泄色黑，不发根窠，三日后痒塌，抓即黑色，口渴，
其根窠如水疥状不红泽，不起发，食少，脉浮数有力，按之虚。遂用参、 、归、术、陈皮、肉豆
蔻为君，炙甘草、诃子、桂为佐，使水煎熟，
好酒些少，咽下痒立止，食立进，根窠红泽而起发，二服全愈。
蝉花散 治痘疹不拘前后始终，遍身作痒抓破，皆治之。
蝉蜕（去头足，洗去土，微炒，一两） 地骨皮（炒黑色，一两）
共为末。每服一茶匙，水酒送下，一二服，神效。
二物汤
蝉蜕（净洗，二十一枚） 甘草（炙，一两）
上为末。水煎，时时服之。
盒脾散 痘至八九日期，倏然身中枭痒，此痘证之最急者，以此治之。
炒术 芍药 生地黄 甘草 升麻 荆芥 防风 陈皮 大腹皮 僵蚕 蝉蜕
水煎服。
震泽汤
人参 黄 芍药 生地黄 防风 甘草
水煎服。
天元二仙丹
浑天汤 人参（乳浸） 黄 生附子（面煨。各一两）
四味，另研细，方和合一处，白蜜调匀。量儿大小加减，十岁以上一钱，十五
岁以上二钱。服后，随以振元汤连进，痒遂止矣。
七星散
黄 芍药（各二钱） 人参 桂心（各一钱） 黑鱼（一个）
上，前四味共研为末，置黑鱼肚内，升麻酒煮熟，与痘痒者连药食之。凡上焦
痒吃头，中焦痒吃身，下焦痒吃尾。亦验方也。
白龙散
用干黄牛粪，在风露中多久者，火 成灰，取中心白者为末，薄绢囊裹，于疮上扑之。
浴法
经霜桑叶（上） 苏梗（中） 升麻（上） 荆芥穗（中） 防风（中）
水煎十数沸，候温，拭体。
痒甚欲搔者，以乌羽轻拂之。以细茶、当归、黄 、玄参、烧烟熏之。或以铁器烧
红，置酽醋中，于室中熏之。
〔丹〕轻者，用淡蜜水调滑石末，以鸡羽润疮上。
〔陈〕痘痒难任，搔之成疮，或脓或血出者，败草散治之，切不可用牛粪灰，贴则臭
秽瘢多矣（方见收靥证治）。
小儿痘疮痒难任，误搔成疮，及疮痂欲落不落，用上好白蜜一味涂于疮上，其痂易落，可无紫黑瘢痕。
世传痘靥落后，痘毒不尽，变成癞癣，其痒难任，用陈年腊脂油敷，神妙。
又方 用羊 骨髓涂疮效（方见落痂证治痂不脱条）。
【爬破】〔万〕凡痘子脓成浆熟，或痒，误犯破者，只复灌烂，不能成痂，若脓浆未成之时，不可犯
破半个，必然痒塌而死。〔袁〕敢问，有爬破囊房脓血淋漓而死者。有爬破囊房干枯脱皮而死者。其故何与？
曰木枯则自折，土燥则自裂，痘之囊房空虚，则枭痒自作，欲其不搔爬也难矣，但爬破于不关轴之处，犹可
以全活，若脸颧气窝，命之要辖也，于兹爬脱，死在旦夕。彼爬破而脓血淋漓，似乎气血交
养，本不宜死也，而有死者，岂痘之不分美恶乎？要知鱼得水而肥，鸟得林而栖，
痘囊既破，脓血淋漓，既竭，则元气耗绝矣，元气既竭，乌得不至死耶。评云∶脓血流来痘可生，只因灌破走黄金，
任教炉火工夫到，弃了黄金恼杀人。喻言极是。
谢冲霄说∶女娲炼五色石以补天，皮脱可药纸以封之，斯言谬矣。
治痘疮抓碎出血，黑虎丹。歌曰∶丝瓜联蒂与囊皮，孔里乌金统用之，慢火置于新瓦炙，烧时存性效真奇，痘
经抓破恶枭攻，须识王真一笑翁，荆芥防风香白芷，绵 芍药建奇功。
按∶古方有用败草散抹者，有用荞麦粉抹者，有用蛤粉掺者，有用文蛤末掺者，总不如黑虎丹之妙也。
歌诀说：虚证表现为瘙痒，实证表现为疼痛，这是大概的说法。痘疮的瘙痒，其表现各不相同。有的在刚发出时就全身瘙痒、抓挠不停，这是因为邪气想要外出，但皮肤腠理密闭，火毒游走往来，所以产生瘙痒，这与伤寒太阳病身痒无汗的情况道理相同，可以采用发汗的方法，使皮肤松弛，腠理开通，邪气得以宣泄，痘疮发出后瘙痒自去，这就是所谓“火郁则发之”的道理。有的快要结痂收靥时出现瘙痒，此时脓液已经形成，痘疮即将消退，邪气消散而正气恢复，营卫气血调和通畅，所以产生瘙痒，这与痈疖即将痊愈时的瘙痒情况相同，不需要服药，只需小心护理，不要让孩子抓挠，以免导致肿胀溃烂，这就是所谓“美疮”（指愈合良好的疮疡）的表现。有的在起胀灌浆过程中出现瘙痒，当血液已化为水液，但水液尚未完全变成脓液之时，毒邪尚未化解，全身瘙痒，抓挠不安，这是恶候，这与伤寒阳明经病中皮肤如虫行般的症状道理相同，所谓虚风外袭，邪气内盛，瘙痒不止称为“泄风”。这种情况需观察痘疮的干湿情况，辅以祛风药物，必须使瘙痒停止，才是佳兆；如果瘙痒剧烈不止，导致痘疮破损、皮肉脱落，毒邪再次陷入体内，称为“痒塌”，这就必然无法治愈了。大抵痘疹发出时皮肉红艳，起发时皮嫩多水者，其后常会导致痒塌。凡是痘子瘙痒，必须在形色上详细审察。如果痘疮一直起发红活、光泽壮实肥满，突然发生瘙痒，这是被秽气所触犯，宜内服十全大补汤，外用茵陈熏法；已经破溃的用白龙散敷贴。如果痘疮本来干燥又增添瘙痒，这是火毒炽盛。如果痘疮原本带水，皮肉嫩薄，又出现瘙痒，这是温热所致。伴有摇头扭项、手足躁动、神志昏闷的，是死证。如果是初出时身痒，可用发汗法，以桂枝葛根汤加制麻黄、牛蒡子主治。如果是起发养浆时瘙痒，通用十全大补汤加防风、牛蒦子主治。起发时身痒有两种证型：一是血气不足，其痒属虚，用十全大补汤主治；二是不能食淡味食物以致发痒，用蝉蜕膏主治。如果痘疮干燥而痒，宜养血润燥，以四物汤合消风化毒汤、夺命丹主治，外用茵陈熏法。如果痘疮湿烂而痒，宜补气去湿，以四君子汤合消风化毒汤、夺命丹主治，外用茵陈熏法。凡是痘子已经成熟，忽然因瘙痒抓破的，这是脾胃虚弱，不能荣养肌肉，内服四君子汤加黄芪、官桂，外用败草散主治。如果是因腹泻导致脾胃虚弱，进而引起痒塌的，用陈氏木香散、异功散主治。如果痘疮将要收靥时作痒，误犯破损，不肯干燥结痂的，用白龙散贴敷。
丹溪的法则是：在形色脉象上分辨虚实，实证则脉有力、气壮，虚证则脉无力、气馁。实痒则势急，虚痒则势弱。虚痒用固表剂加凉血药，实痒用大黄等寒凉药物少许给予，以通下结粪。沧洲翁的法则是：主张血气不足，用十补托里散及木香散加丁香、官桂。胃主肌肉，尤其适宜用四君子汤加川芎、当归、木香、紫草煎服。或者患者不能忌口，因食用毒物而发痒的，用二物汤、百花膏，或四君子汤加解毒药。陈氏的法则是：痘疮作痒，抓破成疮，脓水淋漓，这是由于血气衰败，肌肉虚弱，宜用木香散加丁香、肉桂，及败草散，切忌使用牛粪灰。
闻人氏的法则是：痒有两种证型，一是气血不足，其痒为虚，用活血散或四君子汤加黄芪、枳壳主治（左中恕用十全大补汤、十宣内托散）。二是不能食淡以致发痒，用蝉蜕一物汤主治。魏氏的法则是：用保元汤倍加黄芪，少加芍药。有人说首尾痒塌，保元汤加牛蒡子、白芍药、何首乌。何首乌有红白两种，名为雄雌，必须兼用才有效。忌铁器。王汝言说：痘疮虚怯，色淡白，痒塌，这属于虚寒，宜用陈氏法。若发热壮盛，痘色齐涌红紫色，燥痒，这属于热毒，宜用凉血解毒之剂。薛氏说：上述诸证皆因气血虚弱所致，预先调护，使气血平和，才可避免此患，又必须观察外证，色白的用四君子汤之类，色赤的用四物汤之类。
袁氏说：囊中贮有半浆而作痒的，可以治疗止住，必当用人参、黄芪、芍药、升麻、附子之类，不宜投用寒凉发散的药物。如果焦枯紧贴皮肤作痒的，无法治愈。空壳莲蒲状作痒的，也无法治愈。
参芪内托散：治疗里虚发痒，疮不溃烂，倒靥。
人参、黄芪（炒）、当归、川芎、厚朴（姜制）、防风（各五分）、桔梗、白芷、官桂（各二分）、木香、甘草（各三分）、紫草（五分）。
以上加入糯米一撮，水煎，适量服用。若有寒战咬牙、饮水口渴腹泻，也适宜服用。
紫草木香散：治疗痘疮里虚痒塌，黑陷发热。
紫草、茯苓、甘草、白术、木香、人参（各等分）、糯米。
以上研末，每服三钱，水煎。
消风化毒汤：
防风、黄芪、白芍药、荆芥穗、桂枝、牛蒡子、升麻（各等分）、甘草（减半）。
以上锉碎。加薄荷叶七片，水一盏，煎至七分，去渣温服，不拘时候。
〔丹〕治痘疮痒塌不掩。
白术（一钱半）、黄芪（炙）、当归、陈皮（各五分）、甘草（炙些）。
水煎，温服。
我治疗一个七岁孩子，在痘将出未出之际，腹泻数次，泄下黑色粪便，不发根窠，三日后痒塌，抓后即变黑色，口渴，其根窠如水泡状但不红泽，不起发，食少，脉浮数有力，按之虚。于是用人参、黄芪、当归、白术、陈皮、肉豆蔻为君药，炙甘草、诃子、桂枝为佐药，用水煎熟，加少量好酒送下，瘙痒立即停止，食欲立刻恢复，根窠红泽而起发，服两剂全愈。
蝉花散：治疗痘疹不拘前后始终，遍身作痒抓破，皆可治疗。
蝉蜕（去头足，洗去土，微炒，一两）、地骨皮（炒黑色，一两）。
共为末。每服一茶匙，水酒送下，一二服，神效。
二物汤：
蝉蜕（净洗，二十一枚）、甘草（炙，一两）。
以上为末。水煎，时时服之。
盒脾散：痘至八九日期，突然身中枭痒，这是痘证中最急重的，以此方治疗。
炒白术、芍药、生地黄、甘草、升麻、荆芥、防风、陈皮、大腹皮、僵蚕、蝉蜕。
水煎服。
天元二仙丹：
浑天汤：人参（乳浸）、黄芪、生附子（面煨，各一两）。
这四味药另研细，再混合一处，用白蜜调匀。根据儿童年龄大小加减，十岁以上一钱，十五岁以上二钱。服后，随即连进振元汤，瘙痒便停止了。
七星散：
黄芪、芍药（各二钱）、人参、桂心（各一钱）、黑鱼（一个）。
以上前四味共研为末，置于黑鱼肚内，用升麻酒煮熟，让患痘痒的孩子连同药一起吃。凡上焦痒吃头部，中焦痒吃身体，下焦痒吃尾部。也是验方。
白龙散：
用干黄牛粪，在风露中放置久远的，烧成灰，取中心白色的部分为末，用薄绢囊包裹，在疮上扑撒。
浴法：
经霜桑叶（上等）、苏梗（中等）、升麻（上等）、荆芥穗（中等）、防风（中等）。
水煎十余沸，候温，擦拭身体。
瘙痒严重想抓挠的，用鸟羽轻轻拂拭。用细茶、当归、黄芪、玄参烧烟熏之。或用铁器烧红，置入浓醋中，在室内熏蒸。
〔丹〕轻症，用淡蜜水调滑石末，用鸡羽润泽疮上。
〔陈〕痘痒难忍，搔之成疮，或脓或血出者，用败草散治疗，切不可用牛粪灰，贴敷则会臭秽且留下很多瘢痕（方见收靥证治）。
小儿痘疮痒难忍，误搔成疮，及疮痂欲落不落，用上好白蜜一味涂于疮上，其痂易落，可无紫黑瘢痕。
世传痘靥落后，痘毒不尽，变成癞癣，其痒难忍，用陈年腊脂油敷，神妙。
又方：用羊骨髓涂疮有效（方见落痂证治痂不脱条）。
【爬破】〔万〕凡是痘子脓成浆熟，或因痒误犯抓破的，只会反复溃烂，不能成痂；若脓浆未成之时，不可犯破半个，必然痒塌而死。〔袁〕敢问，有爬破囊房脓血淋漓而死的。有爬破囊房干枯脱皮而死的。原因何在？
回答说：树木干枯则自然折断，土壤干燥则自然开裂，痘的囊房空虚，则枭痒自作，想要它不抓挠也难了。但如果爬破在不关紧要之处，还可以保全性命；如果在脸颧气窝这些生命要害之处爬破脱落，死在旦夕之间。那些爬破而脓血淋漓，看似气血交养，本不应死，但有死者，难道痘疮不分好坏吗？要知道鱼得水而肥，鸟得林而栖，痘囊既然破了，脓血淋漓，元气既竭，则元气耗绝矣，元气既竭，怎能不死呢？评注说：脓血流来痘可生，只因灌破走黄金，任教炉火工夫到，弃了黄金恼杀人。比喻非常恰当。
谢冲霄说：女娲炼五色石以补天，皮脱可用药纸封之，这话是错误的。
治疗痘疮抓碎出血，用黑虎丹。歌曰：丝瓜联蒂与囊皮，孔里乌金统用之，慢火置于新瓦炙，烧时存性效真奇，痘经抓破恶枭攻，须识王真一笑翁，荆芥防风香白芷，绵黄芪芍药建奇功。
按：古方有用败草散抹的，有用荞麦粉抹的，有用蛤粉掺的，有用文蛤末掺的，总不如黑虎丹之妙也。
The aphorism states: Deficiency manifests as itching, excess manifests as pain; this is a general statement. The itching associated with smallpox varies in presentation. Some patients experience whole-body itching and incessant scratching immediately upon eruption. This occurs because the pathogenic factor desires to exit, but the skin and pores are closed and dense, causing the fire-toxin to wander back and forth, resulting in itching. This is analogous to the body itching without sweating seen in Taiyang disease (disease of the Taiyang channel) in Shanghan (Cold Damage), and can be treated by promoting sweating to relax the skin, open the pores, allow the pathogen to escape, and resolve the itching once the lesions erupt. This aligns with the principle that "stagnant fire should be dispersed." Others experience itching just before scabbing. At this stage, pus has formed, the lesions are about to recede, the pathogen dissipates, and healthy qi recovers; the Ying and Wei (nutritive and defensive qi) flow harmoniously, causing itching. This is similar to the itching seen when abscesses and furuncles are nearly healed. Medication is unnecessary; careful nursing is required to prevent scratching, which could lead to swelling and suppuration. This represents a favorable healing process ("beautiful sores"). Some experience itching during the rising and pustule-filling stages. When blood has transformed into fluid, but the fluid has not yet fully become pus, and the toxin has not yet resolved, the patient suffers from whole-body itching and restless scratching. This is an ominous sign, analogous to the sensation of insects crawling under the skin seen in Yangming channel disease in Shanghan. This is described as external assault by deficient wind and internal strength of the pathogen, where persistent itching is called "leaking wind." In such cases, one must observe whether the lesions are dry or wet and administer wind-dispersing herbs accordingly. Itching must cease for it to be considered a good omen. If itching is severe and unceasing, leading to lesion rupture and skin shedding, with the toxin sinking back inward, it is called "itch-collapse" (Yang Ta), which is incurable. Generally, if the lesions appear with red and bright flesh, or rise with tender, watery skin, itch-collapse often follows.
In all cases of smallpox itching, one must carefully examine the color and form. If the lesions have been rising with red vitality, luster, fullness, and plumpness, but suddenly become itchy, this indicates contact with foul qi. Internal administration of Shiquan Dabu Tang (Complete Excellent Tonifying Decoction) and external application of Yinchen fumigation method are indicated. For ruptured lesions, Bailong San (White Dragon Powder) should be applied. If dry lesions develop additional itching, this indicates intense fire-toxin. If lesions originally contain fluid, with tender and thin skin, and then itch, this indicates warm-heat. Symptoms accompanied by head shaking, neck twisting, limb movements, and mental confusion indicate a fatal prognosis. For initial itching upon eruption, promote sweating using Guizhi Gegen Tang (Cinnamon Twig and Pueraria Decoction) supplemented with processed Mahuang (Ephedrae Herba) and Niubangzi (Arctii Fructus). For itching during the rising and filling stages, use Shiquan Dabu Tang supplemented with Fangfeng (Saposhnikoviae Radix) and Niubangzi. There are two patterns of itching during the rising stage: first, deficiency of blood and qi causes deficiency-type itching, treated with Shiquan Dabu Tang; second, inability to eat bland food causes itching, treated with Chantui Gao (Cicada Slough Paste). For dry and itchy lesions, nourish blood and moisten dryness using Siwu Tang (Four Substances Decoction) combined with Xiaofeng Huadu Tang (Wind-Dispersing and Toxin-Resolving Decoction) and Duoming Dan (Life-Snatching Pill), with external Yinchen fumigation. For wet and itchy lesions, tonify qi and eliminate dampness using Sijunzi Tang (Four Gentlemen Decoction) combined with Xiaofeng Huadu Tang and Duoming Dan, with external Yinchen fumigation. If mature lesions suddenly itch and are scratched open due to spleen and stomach weakness failing to nourish muscles, internally administer Sijunzi Tang supplemented with Huangqi (Astragali Radix) and Guigui (Cinnamomi Cortex), and externally apply Baicao San (Decayed Grass Powder). If diarrhea causes spleen-stomach weakness leading to itch-collapse, use Chen's Muxiang San (Aucklandia Powder) and Yigong San (Extraordinary Power Powder). If lesions itch before scabbing and are mistakenly broken, refusing to dry, apply Bailong San.
Danxi's method distinguishes deficiency and excess based on color, form, and pulse: excess presents with strong pulse and robust qi, while deficiency presents with weak pulse and depleted qi. Excess itching is urgent; deficiency itching is timid. Treat deficiency itching with exterior-consolidating agents plus blood-cooling herbs; treat excess itching with a small amount of cold-purgative herbs like Dahuang (Rhei Radix et Rhizoma) to purge accumulated feces. Cangzhou Weng's method addresses blood and qi deficiency using Shibu Tuoli San (Ten-Ingredient Interior-Supporting Powder) and Muxiang San supplemented with Dingxiang (Caryophylli Flos) and Guigui. Since the Stomach governs muscles, Sijunzi Tang supplemented with Xiong (Chuanxiong Rhizome), Gui (Angelicae Sinensis Radix), Muxiang (Aucklandiae Radix), and Zicao (Lithospermi Radix) is particularly suitable. If the patient fails to keep dietary restrictions and eats toxic foods causing itching, use Erwu Tang (Two-Substance Decoction), Baihua Gao (Hundred Flowers Paste), or Sijunzi Tang plus detoxifying herbs. Chen's method states that itching with scratched-open sores and dripping pus/blood results from declining blood/qi and weak muscles; use Muxiang San supplemented with Dingxiang and Rougui (Cinnamomi Ramulus), plus Baicao San. Cow dung ash must be strictly avoided.
Wenrenshi's method identifies two patterns: first, blood/qi deficiency causing deficiency itching, treated with Huoxue San (Invigorate Blood Powder) or Sijunzi Tang supplemented with Huangqi and Zhike (Aurantii Fructus); second, itching from inability to eat bland food, treated with Chantui Yiwu Tang (Cicada Slough Single-Substance Decoction). Wei's method uses Baoyuan Tang (Preserve Origin Decoction) with doubled Huangqi and added Shaoyao (Paeoniae Radix). Some suggest adding Niubangzi, Baishaoyao (White Peony Root), and Heshouwu (Polygoni Multiflori Radix) to Baoyuan Tang for head/tail itch-collapse. Heshouwu has red and white varieties (male and female); both should be used together for efficacy. Iron must be avoided. Wang Ruyan states that pale, weak smallpox with itch-collapse belongs to deficiency-cold, treated per Chen's method. Fever with vigorous red-purple eruptions and dry itching belongs to heat-toxin, treated with blood-cooling and detoxifying agents. Xue's view holds that these conditions result from blood/qi weakness; preventive care ensures harmony. Observe external signs: pale colors require Sijunzi-type formulas, red colors require Siwu-type formulas.
Yuan's view states that half-filled pustules itching can be treated with Renshen (Ginseng Radix), Huangqi, Shaoyao, Shengma (Cimicifugae Rhizoma), and Fuzi (Aconiti Lateralis Radix Praeparata); cold-dispersing drugs are contraindicated. Lesions scorched tight to the skin or empty-shell-like lesions itching are incurable.
Shenqi Naituo San treats interior deficiency itching, non-suppurating lesions, and inverted scabbing. Ingredients: Renshen, Huangqi (fried), Danggui (Angelicae Sinensis Radix), Chuanxiong, Houpo (Magnoliae Officinalis Cortex, ginger-processed), Fangfeng (each 5 fen), Jiegeng (Platycodonis Radix), Baizhi (Angelicae Dahuricae Radix), Guigui (each 2 fen), Muxiang, Gancao (Licorice Root, each 3 fen), Zicao (each 5 fen). Add a pinch of Nuomi (Glutinous Rice), decoct in water, and take appropriate amounts. Also suitable for chills, teeth grinding, thirst, and diarrhea.
Zicao Muxiang San treats interior deficiency itch-collapse with black depression and fever. Ingredients: Zicao, Fuling (Poria), Gancao, Baizhu (Atractylodis Macrocephalae Rhizoma), Muxiang, Renshen (equal parts), Nuomi. Powder form; take 3 qian per dose, decoct in water.
Xiaofeng Huadu Tang: Fangfeng, Huangqi, Baishaoyao, Jingjiesui (Schizonepetae Spica), Guizhi (Cinnamomi Ramulus), Niubangzi, Shengma (equal parts), Gancao (half dose). Crush. Add 7 leaves of Bohe (Menthae Haplocalycis Herba), 1 cup of water, decoct to 0.7 cups, strain, and take warm at any time.
[Dan] treats itch-collapse not covering. Ingredients: Baizhu (1.5 qian), Huangqi (roasted), Danggui, Chenpi (Citri Reticulatae Pericarpium, each 5 fen), Gancao (lightly roasted). Decoct in water, take warm.
Case Study: I treated a seven-year-old child. During the pre-eruption phase, he had several episodes of black diarrhea, no root formation, and after three days developed itch-collapse turning black upon scratching. He was thirsty. Roots resembled water blisters, lacked redness/luster, did not rise, and appetite was poor. Pulse was floating, rapid, and forceful superficially, but deficient deeply. I used Renshen, Huangqi, Danggui, Baizhu, Chenpi, and Roudoukou (Myristicae Semen) as sovereign herbs, with Zhi Gancao (honey-fried Licorice), Hezi (Terminalia Chebulae Fructus), and Guizhi as minister herbs. Decocted in water, taken with a little fine wine. Itching stopped immediately, appetite returned, roots became red/lustrous and rose. Two doses resulted in complete recovery.
Chanhua San treats generalized itching and scratching in smallpox/rubeola at any stage. Ingredients: Chantui (Cicada Slough, head/feet removed, washed, lightly fried, 1 liang), Digupi (Lycii Cortex, fried until black, 1 liang). Powder. Take one tea spoon, swallowed with water and wine. One to two doses yield miraculous effects.
Erwu Tang: Chantui (cleaned, 21 pieces), Gancao (roasted, 1 liang). Powder. Decoct in water, take frequently.
Hepi San: For sudden severe itching on day 8-9 of smallpox, the most critical condition. Ingredients: Fried Baizhu, Shaoyao, Shengdihuang (Rehmanniae Radix), Gancao, Shengma, Jingjie (Schizonepetae Herba), Fangfeng, Chenpi, Dafupi (Arecae Pericarpium), Jiangcan (Bombyx Batryticatus), Chantui. Decoct in water.
Zhenze Tang: Renshen, Huangqi, Shaoyao, Shengdihuang, Fangfeng, Gancao. Decoct in water.
Tianyuan Erxian Dan: Hundun Tang ingredients: Renshen (milk-soaked), Huangqi, Sheng Fuzi (raw Aconite, flour-roasted, each 1 liang). Grind these four finely separately, mix, and blend with white honey. Dosage depends on age: 1 qian for over 10 years, 2 qian for over 15 years. Follow with Zhenyuan Tang continuously to stop itching.
Qixing San: Huangqi, Shaoyao (each 2 qian), Renshen, Guixin (Cinnamomi Ramulus, each 1 qian), Black Carp (one fish). Grind the first four into powder, place inside the black carp, cook熟 in Shengma wine. Feed the medicine and fish to the patient. Eat head for upper jiao itch, body for middle jiao itch, tail for lower jiao itch. An effective empirical formula.
Bailong San: Use old dried yellow cow dung exposed to wind and dew. Burn to ash, take the white center, grind to powder. Wrap in thin silk bag and dust onto sores.
Bathing Method: Frost-exposed Sangye (Mulberry Leaf), Sugeng (Perilla Stem), Shengma, Jingjiesui, Fangfeng. Decoct boiling vigorously, cool slightly, and wipe the body. For severe itching, gently brush with bird feathers. Smoke incense made of Xiacha (Fine Tea), Danggui, Huangqi, Xuanshen (Scrophulariae Radix). Alternatively, heat an iron vessel red-hot, dip in strong vinegar, and fumigate the room.
[Dan] For mild cases, mix Tuhua Shi (Calcitum) powder with light honey water, apply with chicken feather.
[Chen] For unbearable itching leading to sores with pus/blood, use Baicao San. Strictly avoid cow dung ash, as it causes foul odor and scarring. (Formula see Scabbing Treatment). For children with unbearable itching, scratched sores, or stubborn scabs, apply high-quality white honey to the sores to facilitate scab removal without purple-black scars. For post-scabbing leprosy-like rashes caused by residual toxin, apply aged tallow fat. Another method: apply sheep bone marrow to sores.
[Crawling/Breaking] [Wan] If mature pustules are scratched open due to itching, they will repeatedly ulcerate and fail to scab. If scratched before pus formation, itch-collapse and death are inevitable. [Yuan] Why do some die from dripping pus/blood after scratching, while others die from dry peeling? Answer: Dry wood breaks naturally; dry soil cracks naturally. Empty pustules cause uncontrollable itching. Scratching in non-vital areas may allow survival; scratching vital areas (cheeks/nasolabial folds) leads to imminent death. Although dripping pus seems to nourish blood/qi, death occurs because the "water" (fluid source) is exhausted, leading to collapse of Yuan Qi (Original Qi). Commentary: Pus flow suggests life, but breaking the "golden" structure destroys it. Even with skilled treatment, losing the essence is fatal.
Xie Chongxiao claimed that skin loss could be patched with medicinal paper like Nüwa mending the sky; this is erroneous.
For scratched bleeding sores, use Heihu Dan (Black Tiger Pill). Verse: Silk gourd stem and sac skin, black gold from within, slow roast on new tile preserving nature... Jingjie, Fangfeng, Baizhi, Huangqi, Shaoyao perform miracles. Note: Ancient methods used Baicao San, Buckwheat flour, or Clam powder, none as effective as Heihu Dan.