发生聚散而彰于外者。阳之德也。灌溉滋润而守于内者。阴之德也。阴不足则阳不长。而枯
萎之变出焉。阳不足则阴不生。而陷伏之变出焉。痘疮正当长发灌浆之时。平塌不起。谓之伏。
出而复没。谓之陷。有紫黑白三者不同。虚实寒热之异。今人乃谓变黑归肾。欲用钱氏宣风散、
百祥丸下之。不知牵牛、大戟。峻利之药。有伤元气。非质坚便实者。不可轻用。大抵血热之证。
初必深红。失于解散。必变紫变黑。甚至干焦。自然之理。治者当于干红之时。急用解毒凉血。
顶虽平陷。断不可以气虚例治。而用参、 补剂。则气盛而血愈涸矣。丹溪曰。疮干宜退火。只
用轻剂。荆、防、牛蒡之类。若其人能食便秘溺赤者。当用解毒防风汤发散其毒。有黑疔。挑出
恶血。内服犀角消毒饮。外以珍珠散涂之。触犯寒邪。肌表固闭。毒瓦斯伏而不发。致黑陷者。神
应夺命丹发之。热毒内攻。神昏闷乱。寒战切牙而黑陷者。神授散救之。便秘气实。四顺清凉饮。
小便不利。导赤散。减食气弱。加味四圣散。兼扶脾以胜肾水自愈。阎孝忠不达钱氏本意。妄言
黑陷为寒。及云斑疮终始不可服凉泻之药。后人因之。反致热甚黑陷而死者多矣。观斑疮之陷者。
无不腹满喘急。小便赤涩不通。岂非热极所致耶。间有胃气虚寒而陷伏不起。则用至宝丹。毒邪
伤胃。无价散。毒邪窜入肾经。
人牙散。毒邪伏于心肾。珍珠人牙散。但人牙发痘最猛。用之不当。则有痘顶迸裂之虞。不可不
慎。若因虚热毒盛而陷。急用桑虫浆、地龙酒、鸡冠血等方选用。盖气虚白陷。用桑虫。血热黑
陷。用地龙。疮干紫陷。用鸡冠血。不可混也。朱济川曰。毒壅心肺二经。用鸡冠血以发之。毒
壅脾经。用桑虫浆以酵之。毒壅肝经。用紫草茸以松之。毒壅肾经。用人牙散以攻之。毒滞经络。
用穿山甲以透之。叶子蕃云。毒壅于肺。则用桑虫。毒壅于肝。则用鸡冠血。毒壅脾胃。则用地
龙。毒壅心肾。无药可治。惟寒闭毒邪于肾。则用人牙。与济川稍异。古方牛李膏、宣风散、枣
变百祥丸、独圣散、周天散。皆治毒盛黑陷之药。咸可取用。如外触秽气。当用胡荽酒喷其衣被。
并烧红枣、乳香辟之。若瘙痒者。茵陈蒿为末。枣膏和。晒干烧烟熏之。在大江以北。则用水杨
汤浴之。凡见灰白陷者。此必不能食乳。或先因吐泻。脾胃虚弱。毒匿不起。而变虚寒白陷者。
白花蛇散最捷。盖气虚则为痒为陷。血热则为痛为燥。痘色白者。必至于灰惨。灰惨者。必至于
痒塌。此皆气虚而不能起胀。血虚而不能华色也。参 内托散加归、芍。使血活气行。白者可变
为红矣。若虚寒甚者。陈氏异功散加养血药救之。若单行补气。则气燥血虚。必致发痒抓破灰惨
倒塌。为不治矣。
阳气发生、聚散并显现于外的，是阳的特性。阴气灌溉、滋润并守持于内的，是阴的特性。阴气不足则阳气无法生长，从而出现枯萎的病变；阳气不足则阴气无法化生，从而出现陷伏的病变。痘疮正处于应当充分生长、灌浆的时候，如果痘形平塌不起，称为“伏”；出痘后又复没入体内，称为“陷”。痘色有紫、白、黑三种不同表现，对应虚实寒热的差异。现在的人却认为变黑是病邪归肾，想要用钱乙的宣风散、百祥丸来攻下。却不知道牵牛子、大戟是峻烈通利的药物，会损伤元气，不是体质坚实、大便燥结者，不可轻易使用。大致血热证候，初期痘色必深红，若失于疏散解表，必然变为紫色或黑色，甚至干枯焦灼，这是自然的道理。治疗者应当在痘色尚呈干红之时，紧急使用解毒凉血的方药。痘顶虽然平陷，绝对不可以按气虚证治疗而用人参等补气药剂，否则会使气盛而血液更加枯竭。丹溪说：痘疮干枯适宜退火，只用轻剂，如荆芥、防风、牛蒡子之类。如果患者能进食但便秘、尿赤，应当使用解毒防风汤发散其毒。若有黑疔，挑出恶血，内服犀角消毒饮，外用珍珠散涂抹。若触犯寒邪，肌表固闭，毒瓦斯潜伏不发，导致痘色黑陷的，用神应夺命丹发散之。若热毒内攻，神志昏闷狂乱，寒战咬牙而痘色黑陷的，用神授散救治。若便秘气实，用四顺清凉饮；小便不利，用导赤散；饮食减少、气弱，用加味四圣散，兼以扶助脾气以制约肾水，即可自愈。阎孝忠不理解钱乙的本意，妄言黑陷为寒证，又说斑痘从头到尾不可服用凉泻药物，后人沿袭此说，反而导致因热甚黑陷而死亡的人很多。观察斑痘陷伏者，无不腹部胀满、气喘急促、小便赤涩不通，这难道不是热极所致吗？间或有胃气虚寒而导致陷伏不起的，则用至宝丹；毒邪伤胃，用无价散；毒邪窜入肾经，用人牙散；毒邪伏于心肾，用珍珠人牙散。但是人牙发痘效力最猛，使用不当，则有痘顶迸裂的危险，不可不谨慎。若是因虚热毒盛而陷，紧急选用桑虫浆、地龙酒、鸡冠血等方剂。大概气虚白陷，用桑虫；血热黑陷，用地龙；疮面干枯紫陷，用鸡冠血，不可混淆。朱济川说：毒邪壅塞心肺二经，用鸡冠血发散之；毒邪壅塞脾经，用桑虫浆发酵之；毒邪壅塞肝经，用紫草茸疏松之；毒邪壅塞肾经，用人牙散攻逐之；毒邪滞留经络，用穿山甲透达之。叶子蕃说：毒邪壅于肺，则用桑虫；毒邪壅于肝，则用鸡冠血；毒邪壅于脾胃，则用地龙；毒邪壅于心肾，无药可治。只有寒邪闭塞毒邪于肾，才用人牙，这与朱济川的说法稍有不同。古方中的牛李膏、宣风散、枣变百祥丸、独圣散、周天散，都是治疗毒盛黑陷的药物，都可以取用。如外触秽气，当用胡荽酒喷洒其衣被，并焚烧红枣、乳香以辟秽。若瘙痒者，将茵陈蒿研为末，用枣膏调和，晒干后烧烟熏之。在大江以北地区，则用水杨汤沐浴。凡是见到灰白色陷伏的，这必定是不能吃奶，或者先前因吐泻导致脾胃虚弱，毒邪隐匿不起，而变为虚寒白陷的，用白花蛇散最为快捷。大概气虚则为痒为陷，血热则为痛为燥。痘色白者，必至于灰惨；灰惨者，必至于痒塌。这都是气虚而不能起胀，血虚而不能华彩的表现。用参芪内托散加当归、芍药，使血活气行，白色的痘疹可以变为红色。若虚寒严重，用陈氏异功散加养血药救治。若单行补气，则气燥血虚，必定导致发痒抓破、灰惨倒塌，成为不治之症。
The occurrence, dispersion, and manifestation of Yang Qi on the exterior is the virtue of Yang. The irrigation, moistening, and retention of Yin within is the virtue of Yin. When Yin is insufficient, Yang cannot grow, leading to changes of withering and drying; when Yang is insufficient, Yin cannot be generated, leading to changes of sinking and hiding (Xianfu). During the stage where smallpox should be vigorously growing and filling with pus, if the lesions are flat and do not rise, it is called "Fu" (Hiding); if they emerge and then disappear again, it is called "Xian" (Sinking). There are three different colors: purple, white, and black, corresponding to differences in deficiency/excess and cold/heat. Nowadays, people claim that turning black indicates the pathogen returning to the Kidney, and wish to use Qian Yi's Xuanfeng San (Promoting Wind Powder) or Baixiang Wan (Hundred Auspicious Pills) to purge. They fail to realize that Niuniu (Pharbitidis Semen, 牵牛) and Daji (Kansui Radix, 大戟) are harsh purgative drugs that damage Yuan Qi (Original Qi), and should not be used lightly unless the constitution is solid and stool is dry and hard. Generally, in blood-heat patterns, the initial color must be deep red. If neglected without dispersing and resolving, it will inevitably turn purple or black, even becoming dry and scorched, which is the natural progression. The practitioner should urgently employ detoxifying and cooling-blood remedies while the lesions are still dry and red. Even if the apex is flat and sunken, one must absolutely not treat it as Qi deficiency by using Ginseng (Renshen, 人参) or other tonifying agents, for this would cause Qi to become excessive and Blood to become further depleted. Danxi stated: For dry sores, it is appropriate to reduce fire, using only mild agents such as Jingjie (Schizonepetae Herba, 荆芥), Fangfeng (Saposhnikoviae Radix, 防风), and Niubangzi (Arctii Fructus, 牛蒡子). If the patient can eat but has constipation and dark urine, one should use Jiedu Fangfeng Tang (Detoxifying Saposhnikovia Decoction) to disperse the toxin. If there is a black carbuncle, puncture to drain the foul blood, administer Xijiao Xiaodu Yin (Rhinoceros Horn Detoxification Infusion) internally, and apply Zhenzhu San (Pearl Powder) externally. If cold pathogen is encountered, causing the muscle surface to close tightly, trapping the toxic qi so it does not erupt, leading to black sinking, use Shenyng Duoming Dan (Divine Response Life-Extending Pill) to induce eruption. If heat-toxin attacks internally, causing mental confusion, restlessness, chills, and teeth grinding with black sinking, use Shenshou San (Heavenly Bestowal Powder) to rescue. If there is constipation and excess Qi, use Sishun Qingliang Yin (Four Compliance Cooling Clearing Infusion); if urination is difficult, use Daochi San (Guiding Out Redness Powder); if appetite is reduced and Qi is weak, use Jiawei Sisheng San (Modified Four Saints Powder), simultaneously supporting Spleen Qi to overcome Kidney Water, leading to self-healing. Yan Xiaozhong did not understand Qian Yi's original intent, recklessly claiming black sinking was due to cold, and stating that measles/smallpox should never be treated with cooling purgatives from start to finish. Later generations followed this, resulting in many deaths due to extreme heat and black sinking. Observing those with sinking lesions, none lack abdominal fullness, panting, urgency, and dark, scanty, or obstructed urination. Is this not caused by extreme heat? Occasionally, there are cases of sinking and hiding due to Stomach Qi deficiency and cold, treated with Zhibao Dan (Precious Treasure Pill); if toxic pathogen damages the Stomach, use Wuji San (Priceless Powder); if toxic pathogen invades the Kidney Meridian, use Renya San (Human Tooth Powder); if toxic pathogen hides in the Heart and Kidney, use Zhenzhu Renya San (Pearl Human Tooth Powder). However, Renya (Human Tooth) is most potent for erupting smallpox; if used improperly, there is a risk of the lesion apex bursting, so caution is essential. If sinking is due to deficiency-heat and abundant toxin, urgently select Sangchong Jiang (Mulberry Insect Slurry), Dilong Jiu (Earthworm Wine), or Jiguanxue (Rooster Comb Blood). Generally, Qi-deficiency white sinking uses Sangchong; Blood-heat black sinking uses Dilong; Dry-purple sinking uses Jiguanxue; these must not be confused. Zhu Jichuan said: If toxin obstructs the Heart and Lung meridians, use Jiguanxue to erupt it; if toxin obstructs the Spleen meridian, use Sangchong Jiang to ferment it; if toxin obstructs the Liver meridian, use Zicao Rong (Lithospermi Radix et Rhizoma) to loosen it; if toxin obstructs the Kidney meridian, use Renya San to attack it; if toxin stagnates in the collaterals, use Chuanshanjia (Manis Squama, 穿山甲) to penetrate it. Ye Zifan said: If toxin obstructs the Lung, use Sangchong; if toxin obstructs the Liver, use Jiguanxue; if toxin obstructs the Spleen and Stomach, use Dilong; if toxin obstructs the Heart and Kidney, there is no medicine to treat it. Only if cold closes toxic pathogen in the Kidney is Renya used, which differs slightly from Jichuan's view. Ancient formulas such as Niuli Gao (Cow Plum Paste), Xuanfeng San, Zaobian Baixiang Wan (Date-Transformed Hundred Auspicious Pills), Dusheng San (Single Saint Powder), and Zhoutian San (Celestial Circuit Powder) are all medicines for treating abundant toxin and black sinking, and may all be employed. If exposed to foul odors externally, Huixie Jiu (Coriander Wine) should be sprayed on clothes and bedding, and Hongzao (Jujubae Fructus, 红枣) and Ruxiang (Olibanum, 乳香) burned to repel them. If itching occurs, Yinchenshao (Artemisiae Scopariae Herba, 茵陈蒿) powder mixed with Zao Gao (Jujube Paste), dried, and smoked is used. North of the Great River, Shuiyang Tang (Willow Bark Bath) is used. Whenever gray-white sinking is seen, this is certainly due to inability to feed, or prior vomiting/diarrhea causing Spleen-Stomach weakness, allowing toxin to hide and not rise, transforming into deficiency-cold white sinking. Baihua She San (White-Banded Snake Powder) is most effective. Generally, Qi deficiency causes itching and sinking; Blood heat causes pain and dryness. White lesions inevitably become gray and miserable; gray-miserable lesions inevitably become itchy and collapsed. These are all due to Qi deficiency failing to cause swelling and Blood deficiency failing to provide luster. Use Shenqi Neituo San (Ginseng-Astragalus Internal Support Powder) plus Danggui (Angelicae Sinensis Radix, 当归) and Shaoyao (Paeoniae Radix, 芍药) to activate Blood and move Qi, so white lesions can turn red. If deficiency-cold is severe, use Chen Shi Yigong San (Chen's Extraordinary Work Powder) added with Blood-nourishing herbs to rescue. If only Qi-tonifying herbs are used alone, Qi becomes dry and Blood deficient, inevitably leading to itching, scratching, breaking, gray collapse, and total failure, becoming incurable.