痱疮痛痒。
绿豆粉（微炒，四两） 滑石（五钱）
研匀朴之。
又方 雪水洗之，随洗随减。
又方 黄瓜（即王瓜）。切片擦之，即愈。
又方 石粉扑之良。
痱子摩破成疮，生肌止痛。（《集验》）
赤石脂 黄柏（去粗皮） 腊茶（各五钱） 白面（二两） 冰片（五分）
共研细，棉蘸扑之。
申斗垣曰∶脑窝项后生疮，名燕窝疮，
此足太阳膀胱经湿热所生也。（《启玄》）
燕土丹（申斗垣）
烟胶（一两） 燕窝土（三钱） 轻粉（一钱） 枯矾（五分）
共研细，清油调搓患上神效。
钱青抡曰∶凡小儿百日内生疮，名曰蓐疮。由胎毒所致。从身渐延至头，齐眉
癞遍则愈；若从头渐至腹者难治。宜内服犀角丸以化其毒。（《幼科良方》）
犀角丸（钱青抡） 治胎毒蓐疮。
天竺黄 防风 羚羊角 全蝎（酒洗） 白僵蚕 羌活 明天麻 京墨（ 微烟为度）
川黄连 犀角 胆南星 麻黄 犀牛黄（各等分）
为细末。蒸饼打糊为丸芡实大，朱砂金箔为衣，每服一丸，薄荷汤下。
自发热报痘灌浆起胀收靥，以及面耳部位预知顺逆，诸家秘而不传之术、秘法，俱汇于此部中，以便检阅参治。
朱纯嘏曰∶粤稽上古之世，未闻痘疮之说，亦无治痘之书，即《素问》集中并
无只字言及于痘，非黄帝、岐伯以痘为轻易，不详加问难，而无一言以及之耶？盖
三皇五帝之时，天清地宁，民淳俗朴，虚邪苛毒无由而生，及至汉时建武年间，征
边染毒，军中遂生此疾。其说出于万密斋《痘疹心要》，查建武二十五年征武陵蛮，伏
波军次下隽从壶头进兵，会甚暑，士卒疫死大半，援亦中病卒于军，史乃以疫书之
意者。其痘乎？然传之年久，姑存以后之考正。总之，当日不知是何病证，因其生
长收藏，尖圆红润有似于痘，故名之为痘。后此班师，毒瓦斯传入中国，诸家计议调治，
皆据《内经》诸痛痒疮疡皆属心火之一言，为治痘之要领。殊不知痘疮与诸疮相隔天
壤，诸疮之证未成形可解毒、可内消，已成形可攻破，即破可生肌，如痘不可解毒
也，不可内消也，不可攻破也，自发热三日之后，始见痘苗，放苗之后，又三日而
出齐，出齐之后，次第长浆，上由面部，次及身上，再则胀及脚下，务期稠脓充满，徐
徐回水结痂，大约于一十二日之中收其成功。自发热造端，即以热之轻重，报痘之
缓急，便知痘之疏密，看报痘之部位，便知痘之吉凶，看痘粒之形色，便知痘之虚
实。至于起胀灌浆，计时限日，观形察色，分别虚实寒热，用药调治，以为灌浆之计，
失此不治，竟不成浆，虽有妙剂仙丹，不能保其不死。久吾聂氏曰∶痘之生死，判
于浆之有无，有浆毒从外散故生，无浆毒留内攻故死，脓浆既成，结痂又浓，色又
苍蜡，此顺证也。总之，痘疮不与诸疮同治，即属心火之一言，于痘原无干涉也。前
代刘河间、钱仲阳立方，俱以解毒为主，多用寒凉，少用温补，张洁古、王海藏咸宗
之。揆其意，俱本于属心火之一言，而以寒凉泻火也。迨至陈文中力矫其偏，专主
温补，宜于虚寒，未必宜于实热。至朱丹溪立论，又矫陈氏之偏，而取钱氏之长，主
于解毒和中安表，其失亦起于拘泥《内经》属心火之一言也。近如黄西邱着《顺
险逆三图》，顺证不顺用药，险证有药治之。若逆证虽勉强用药，断不得活，曾立逆证
图三十条，余每看痘证，逐年经见实有一十三图果系不可活之证，无再生之望，虽
细心极力变方设法，亦不能出西邱范围之外，其余一十七证，亦曾用药救活，因以
揭逆证一十三条分列于后，以广后学之见闻。他如《保赤全书》舛谬甚多，至于
《证治准绳》系王肯堂先生居高位之暇，念及斯世之男女大小，身染沉 ，不能起死
回生，延各大小方脉，内外全科，校订方书，取名《证治准绳》，以备后学参考，可
谓详悉，大有功于世。独于痘科悖谬之极，或假手于庸医，亦未可定。他如《金镜
录》、《痘科正宗》、《痘疹心要》、《痘疹会编》等书，岂止数十家，非无一节之长，一
论之是，一方之妙，然皆择焉而不精，语焉而不详。兼之各家痘书传流年久，不惟
深山穷谷之中，即各省名邦以及都城辇毂
之下，凡诸名医不肯细心究竟，辨别是非，无不以昔年之痘书为今日之秘诀。不知有
清江久吾聂氏名尚恒者，生于隆庆末年，万历年间以乡进士出知福建汀州府宁化县
事，卓有政声。惜当时以儒宦显，不列名于医林。故其姓字不传于今世岐黄之口，即
着有《活幼心法》一书，亦不传于今世岐黄之家。要知天地气化生聂氏于豫章之清
江，非为此一隅之幼儿女起见，将令普天之下，后世之人，提撕惊觉，救斯世之赤
子而令安全于襁褓中也。今余独知久吾聂氏集痘疹之大成，开幼科之法眼，议论精，
辨证确，用药当，不偏于寒凉，亦不偏于温补，深得中和之理，合宜之用，无过不
及之差。嘏生也晚，不获亲炙门墙，恭承面谕，幸得《活幼心法》而熟读之，沉潜
玩味，裘葛三更，一旦恍然，若有心领神会，顿将前此之旧闻洗涤净尽，心胸之茅
塞剪锄豁开。又恐天下之大，万方之众，不能周知，岁久年深，终成湮没，今特表而
出之。凡业幼科者，必当熟读《活幼心法》，反复究竟，自然得心应手。（痘疹定论。）
又云∶《易》曰∶大哉干元，万物资始。又曰∶至哉坤元，万物资生。夫干为父，资
始者气之始也；坤为母，资生者形之始也。人之有生，受气于父，成形于母，是父精
母血之毒已凝聚于阳施阴受之始，是胎元之初成，即胎毒之蕴蓄，故名之曰胎毒。夫
所谓胎毒者，不论富贵贫贱俱皆有之，岂待成胎之后，归咎于欲火妄动，饮食不节，
降生之顷咽其血而后有是毒耶！虽然天地有非常之气，即有非常之令，或于春而不
温和，或于夏而不炎热，或于秋而不清凉，或于冬而不凛冽，四时之正气失序，两间
之杂气交攻，夫然后五脏之邪气内侵，命门之胎毒外透，痘疹从此而发矣。（痘疹原于胎毒论。）
又曰∶痘出五脏，疹出六腑，前哲言之不究其本，后学传之不穷其源，以致以
讹传讹，千有余年，习为成语，谁知辨其
非者，今特表而出之，非无征而敢云然也。人之有生，受气于父，成形于母，当阳施
阴受之始，二五之精妙会而凝，干道成男，坤道成女，在胎之内，先有命门，犹混沌
未分，先有太极，命门人身之太极也。自其凝而成形言之，先有命门则父精母血之
毒藏于命门，真且确矣。外形则先长鼻，故今人称始祖为鼻祖，内如五脏六腑，外如
百骸九窍，俱从此逐日逐月，渐次生长，故胎有十月之期而始生育，惟命门凝成于有
形之初，则胎毒亦蓄蕴于有形之始。命门即太极也，两肾两仪也，天一生水，地六
成之，坎中之一阳，命门也，坎上下之两阴列于两旁两肾也，今人以右肾为命门，不
能致知格物也，两肾列于命门之两旁，是太极生两仪也。地二生火生心也，天三生
木生肝也，地四生金生肺也，天五生土生脾也，然止能成物，不能生物，今曰地二
生火，地四生金，似与坤作成物说不去矣。然河图一、二、三、四、五者，五行之生
数也，六、七、八、九、十者，五行之成数也。生数五行之发端，成数五行之结果，
故人生以十月为期，得天地之成数也，间有七个月、八个月、九个月而生者，间亦
养育成人，婚配生育，是六、七、八、九、十者五行之成数也明矣。然地二生火，地
四生金，天包罗于地之外，其气常行乎地之中，非地之孤阴能生火与金也，得天之
气贯于其中而生火、生金，实由天地 ，阴阳配合而生，此水火木金土也。或问之
曰∶子言胎毒藏于命门，固言之有理，而心、肝、脾、肺、肾可不必复言矣。即应
之曰∶是何言也！命门体也，五脏用也，相须而生成也。鼻之气通乎肺，如遇痘疹之
气，鼻闻其气则传于肺金，肺金传肾水，肾水传肝木，肝木传心火，心火传脾土，一
昼一夜随天运转一周天；次日早脾土复传肺金，肺再传于肾，肾再传于肝，肝再传
于心，心再传于脾，一昼一夜随天运又一周天；次早又复传于肺，五日五夜将五脏
传遍，痘疹之时气自外而达内，命门之胎毒，从内而发外，至六日而微热，至七日
而身热大作矣。或又问曰∶子何知之详且悉也？答曰∶以种痘而得造化之机缄也。自
出之痘，无形之气传染也，种出之痘，有形之痂引导也。若夫自出之疹，亦无形之
气传染也，胎毒蕴于命门，其中有阴阳之辨别焉。命门也，人身之太极也，太极所
以动而阳、静而阴之本体也，阴阳互藏于太极之中，阳变阴合而生水、火、木、金、
土；胎毒蕴蓄于命门之中，亦有所以动而阳、静而阴之本体也，阴阳互藏于命门之
内，感痘之气化而出痘，感疹之气化而出疹，何也？是阴为痘而阳为疹也。统言之
则为胎毒，分言之胎毒之中又有阴阳之各别也，当其阳施阴受之始，成胎凝结先有
命门，莫可端倪，无可想像，命门也，胎毒始藏之密处也，体也，五脏者迎接时气
之传递也，用也，胎毒发出而为痘，则胎毒之静而阴者尽矣，一发不复再发矣。若
出正痘之后，隔三五月或隔半年一载，或隔七八年之久，如感时气出疹，胎毒发出
而为疹，则胎毒之动而阳者亦尽矣，所以一出亦不复再出矣。或又问曰∶命门在何
处？答曰∶脊骨自上大椎数下二十一椎，自尾闾尻骨望上数七椎之上，上从下数一十
四椎之下，上下相接之界，命门之所居也，命门居脊骨之前，两肾列于两旁，脂膜护
之，为一身之主宰，且出痘与疹而腰不痛者顺也，痘疹初发，即云腰痛，命门伤也，
未可以言吉也，故曰一身之主宰也。
聂九吾曰∶痘疹之源？有谓儿在胎时食母血秽而致也，有谓父母欲火所致也，欲
火之说出于臆测，固无明据。然尝见孕妇饮食清淡者，生子出痘多稀少而平顺，恣
食浓味者，生子出痘多稠密而险危，则其病源受毒于母胎血秽，似有明验。盖饮食
淡则血气清而胎毒轻，饮食浓则气血浊而胎毒重，受毒轻故出痘少，受毒重故出痘
多，若因诸痛痒疮疡皆属心火，谓火由欲
生，致毒因火结，故其为害独胜于诸疮，此其说亦未为全非，而总之痘毒一胎毒耳。惟
其为胎毒，则潜伏五脏，有触则发，无触则不发，故其发有迟速，当其未发时，形
气俱泯，无可端倪，若未燧之火何处寻觅，又何可解释？古立预解痘毒诸方，若无故
而逐寇于通都，不近理也，及其触而发则勃然不可御，盖其毒瓦斯发自五脏，实动五
脏真气，全赖血气送毒瓦斯而出之于外，运化之而成浆，收结之而成痂，而后脏腑可安。
若血气送毒瓦斯不出，则毒瓦斯反攻脏腑，如寇作于都城中，主者不能操谋夺武逐之
于外，致令操戈内攻，安得不危，故用药犹如用兵，不可不透此理也。（论受病之源。）
又曰∶治痘之家多矣。刘河间悉用寒凉，偏害不小，至于钱仲阳立方，亦以解
毒为主，而多用寒凉，少用温补，张洁古、王海藏咸宗之，此其意俱本于《内经》诸
疮疡属心火之一言，故以寒凉泻火也。厥后陈文中立方力矫其偏，专主温补，凡痘
疮已出未出之间诸证，悉用十一味木香散，（南木香、大腹皮、赤茯苓、诃子肉、人参、青皮、半夏、
前胡、肉桂、丁香、甘草。）已出之间诸证，悉用十二味异功散，（人参、制半夏、白术、茯苓、当归、
陈皮、浓朴、制附子、木香、丁香、肉果、官桂。）其意归重于太阴一经，盖以手太阴肺主皮毛，足
太阴脾主肌肉，肺金恶寒，脾土恶湿，故用木香、官桂以治肺之寒，用术、附、半
夏以治脾之湿，二方用之得其当，其效固大，然不分寒热虚实而一概用之，则宜于
虚寒，不宜于实热，其偏害又可知也。朱丹溪辨之是矣。至丹溪立论矫陈氏之偏，而
取钱氏之长，主于解毒和中安表，似为的当，举世宗之，数百年来无敢议其失者。余
则以为丹溪治他病多妙论，独于治痘则孟浪而未尽其妙，倘亦千虑之失乎！盖其矫
偏于陈氏，而不敢轻用木香、丁香、桂、附等热剂，似乎因噎而废食，惩羹而吹 ，其
取长于钱氏，而必用芩、连、牛蒡、连翘之类，以监制参 归术等补剂，似乎任将
而中制用兵而外监也，其失亦起于泥《内经》疮疡属心火之言，而未透其理也。不
知痘疮虽属心火，却与诸疮不同，诸疮之毒，当其初发而未成形，可用药解散内消
而愈，及其已形而未成脓，又可用药逐散，未成脓而愈，痘毒发自五脏，必藉血气送
出于皮肤，运化之而成脓，收结之而成痂，而后收全功也，可内消而愈乎？可未成脓
而愈乎？故诸疮以解毒为主，能解毒于早则轻，不能解毒于早则重，痘疮以血气为
主，血气能送毒以灌脓结痂则生，血气不能送毒以灌脓结痂则死，解毒之药多损气
痱子是由于暑气伤热而形成的。
痱疮表现为疼痛和瘙痒。
绿豆粉（微炒，四两） 滑石（五钱）
研匀后扑撒患处。
又一方：用雪水洗患处，随洗随减。
又一方：黄瓜（即王瓜），切片擦拭患处，即可痊愈。
又一方：用石粉扑撒患处效果良好。
痱子摩擦破损形成疮疡，可生肌止痛。（《集验》）
赤石脂 黄柏（去除粗皮） 腊茶（各五钱） 白面（二两） 冰片（五分）
共同研成细末，用棉蘸取后扑撒患处。
申斗垣说：在脑窝、项后生疮，名为燕窝疮，
这是足太阳膀胱经湿热所导致的。（《启玄》）
燕土丹（申斗垣方）
烟胶（一两） 燕窝土（三钱） 轻粉（一钱） 枯矾（五分）
共同研成细末，用清油调和搓涂患处，神效。
钱青抡说：凡是小儿百日内生疮，名为蓐疮。由胎毒所致。从身体逐渐蔓延至头部，若遍布眉毛则愈；若从头逐渐蔓延至腹部则难治。宜内服犀角丸以化解其毒。（《幼科良方》）
犀角丸（钱青抡方） 治疗胎毒蓐疮。
天竺黄 防风 羚羊角 全蝎（酒洗） 白僵蚕 羌活 明天麻 京墨（微烟为度）
川黄连 犀角 胆南星 麻黄 犀牛黄（各等分）
研为细末。用蒸饼打糊制成如芡实大小的丸药，用朱砂金箔做衣，每次服用一丸，薄荷汤送下。
自发热报痘、灌浆、起胀、收靥，以及面耳部位预知顺逆，各家秘而不传之术、秘法，都汇集在此部中，以便检阅参考治疗。
朱纯嘏说：考察上古时代，未曾听闻痘疮的说法，也没有治疗痘疮的书籍，即使《素问》集中也无只字提及痘疮，难道黄帝、岐伯认为痘疮轻微而不详细询问探讨，所以一言未提吗？大概在三皇五帝时期，天清地宁，民风淳朴，虚邪苛毒无从产生，到了汉代建武年间，征讨边疆感染毒气，军中遂生此疾。这种说法出自万密斋《痘疹心要》，查建武二十五年征武陵蛮，伏波军驻扎在下隽，从壶头进兵，正值酷暑，士卒疫病死亡大半，援军也患病卒于军中，史书将其记载为疫病的意图。那可能是痘疮吧？然而流传年代久远，姑且存留以供后人考证纠正。总之，当时不知道是什么病证，因其生长收藏，尖圆红润类似痘疮，所以命名为痘。后来班师回朝，毒瓦斯传入中国，诸家商议调治，都依据《内经》“诸痛痒疮疡皆属心火”这一句话，作为治疗痘疮的要领。殊不知痘疮与各种疮疡相差甚远，各种疮疡的症状在未成形时可解毒、可内消，已成形时可攻破，即使破溃也可生肌，但痘疮不可解毒，不可内消，不可攻破。自发热三日之后，才见痘苗，放苗之后，又三日而出齐，出齐之后，次第长浆，上由面部，次及身上，再则胀及脚下，务必期求稠脓充满，徐徐回水结痂，大约在一十二日之中完成其功效。自发热造端，即以热的轻重，判断报痘的缓急，便知痘的疏密，看报痘的部位，便知痘的吉凶，看痘粒的形色，便知痘的虚实。至于起胀灌浆，计时限日，观形察色，分别虚实寒热，用药调治，作为灌浆之计，错过此时不治疗，竟不成浆，虽有妙剂仙丹，也不能保全不死。久吾聂氏说：痘的生死，判断于浆的有无，有浆则毒从外散故生，无浆则毒留内攻故死，脓浆既成，结痂又浓，色又苍蜡，这是顺证。总之，痘疮不与各种疮同治，即使是“属心火”这一句话，对于痘原无干涉。前代刘河间、钱仲阳立方，都以解毒为主，多用寒凉，少用温补，张洁古、王海藏都尊崇他们。推究他们的意思，都基于“属心火”这一句话，而以寒凉泻火。等到陈文中极力纠正其偏颇，专主温补，适宜于虚寒，未必适宜于实热。到朱丹溪立论，又纠正陈氏的偏颇，而取钱氏之长，主于解毒和中安表，其失误也起因于拘泥《内经》“属心火”这一句话。近来如黄西邱著《顺险逆三图》，顺证不顺用药，险证有药治之。若逆证虽勉强用药，断不得活，曾立逆证图三十条，我每次看痘证，逐年经见实有一十三图果系不可活之证，无再生之望，虽细心极力变方设法，也不能超出西邱范围之外，其余一十七证，也曾用药救活，因此将逆证一十三条分列于后，以广后学之见闻。其他如《保赤全书》舛谬甚多，至于《证治准绳》系王肯堂先生居高位之暇，念及斯世之男女大小，身染沉疴，不能起死回生，延请各大小方脉，内外全科，校订方书，取名《证治准绳》，以备后学参考，可谓详悉，大有功于世。独于痘科悖谬之极，或假手于庸医，也未可知。其他如《金镜录》、《痘科正宗》、《痘疹心要》、《痘疹会编》等书，岂止数十家，非无一节之长，一论之是，一方之妙，然皆择焉而不精，语焉而不详。加之各家痘书流传年久，不仅深山穷谷之中，即各省名邦以及都城辇毂之下，凡诸名医不肯细心究竟，辨别是非，无不以昔年之痘书为今日之秘诀。不知有清江久吾聂氏名尚恒者，生于隆庆末年，万历年间以乡进士出知福建汀州府宁化县事，卓有政声。可惜当时以儒宦显，不列名于医林。故其姓字不传于今世岐黄之口，即著有《活幼心法》一书，亦不传于今世岐黄之家。要知道天地气化生聂氏于豫章之清江，非为此一隅之幼儿女起见，将令普天之下，后世之人，提撕惊觉，救斯世之赤子而令安全于襁褓中也。如今我唯独知道久吾聂氏集痘疹之大成，开幼科之法眼，议论精，辨证确，用药当，不偏于寒凉，亦不偏于温补，深得中和之理，合宜之用，无过不及之差。我朱纯嘏生得晚，未能亲炙门墙，恭承面谕，幸得《活幼心法》而熟读之，沉潜玩味，裘葛三更，一旦恍然，若有心领神会，顿将前此之旧闻洗涤净尽，心胸之茅塞剪锄豁开。又恐天下之大，万方之众，不能周知，岁久年深，终成湮没，如今特表而出之。凡业幼科者，必当熟读《活幼心法》，反复究竟，自然得心应手。（痘疹定论。）
又说：《易》曰：大哉干元，万物资始。又说：至哉坤元，万物资生。夫干为父，资始者气之始也；坤为母，资生者形之始也。人之有生，受气于父，成形于母，是父精母血之毒已凝聚于阳施阴受之始，是胎元之初成，即胎毒之蕴蓄，所以命名为胎毒。所谓胎毒，不论富贵贫贱俱皆有之，岂待成胎之后，归咎于欲火妄动，饮食不节，降生之顷咽其血而后有是毒耶！虽然天地有非常之气，即有非常之令，或于春而不温和，或于夏而不炎热，或于秋而不清凉，或于冬而不凛冽，四时之正气失序，两间之杂气交攻，然后五脏之邪气内侵，命门之胎毒外透，痘疹从此而发矣。（痘疹原于胎毒论。）
又说：痘出五脏，疹出六腑，前哲言之不究其本，后学传之不穷其源，以致以讹传讹，千有余年，习为成语，谁知辨其非者，如今特表而出之，非无征而敢云然也。人之有生，受气于父，成形于母，当阳施阴受之始，二五之精妙会而凝，干道成男，坤道成女，在胎之内，先有命门，犹混沌未分，先有太极，命门人身之太极也。自其凝而成形言之，先有命门则父精母血之毒藏于命门，真且确矣。外形则先长鼻，故今人称始祖为鼻祖，内如五脏六腑，外如百骸九窍，俱从此逐日逐月，渐次生长，故胎有十月之期而始生育，惟命门凝成于有形之初，则胎毒亦蓄蕴于有形之始。命门即太极也，两肾两仪也，天一生水，地六成之，坎中之一阳，命门也，坎上下之两阴列于两旁两肾也，今人以右肾为命门，不能致知格物也，两肾列于命门之两旁，是太极生两仪也。地二生火生心也，天三生木生肝也，地四生金生肺也，天五生土生脾也，然止能成物，不能生物，今曰地二生火，地四生金，似与坤作成物说不去矣。然河图一、二、三、四、五者，五行之生数也，六、七、八、九、十者，五行之成数也。生数五行之发端，成数五行之结果，故人生以十月为期，得天地之成数也，间有七个月、八个月、九个月而生者，间亦养育成人，婚配生育，是六、七、八、九、十者五行之成数也明矣。然地二生火，地四生金，天包罗于地之外，其气常行乎地之中，非地之孤阴能生火与金也，得天之气贯于其中而生火、生金，实由天地阴阳配合而生，此水火木金土也。或问之曰：子言胎毒藏于命门，固言之有理，而心、肝、脾、肺、肾可不必复言矣。即应之曰：是何言也！命门体也，五脏用也，相须而生成也。鼻之气通乎肺，如遇痘疹之气，鼻闻其气则传于肺金，肺金传肾水，肾水传肝木，肝木传心火，心火传脾土，一昼一夜随天运转一周天；次日早脾土复传肺金，肺再传于肾，肾再传于肝，肝再传于心，心再传于脾，一昼一夜随天运又一周天；次早又复传于肺，五日五夜将五脏传遍，痘疹之时气自外而达内，命门之胎毒，从内而发外，至六日而微热，至七日而身热大作矣。或又问曰：子何知之详且悉也？答曰：以种痘而得造化之机缄也。自出之痘，无形之气传染也，种出之痘，有形之痂引导也。若夫自出之疹，亦无形之气传染也，胎毒蕴于命门，其中有阴阳之辨别焉。命门也，人身之太极也，太极所以动而阳、静而阴之本体也，阴阳互藏于太极之中，阳变阴合而生水、火、木、金、土；胎毒蕴蓄于命门之中，亦有所以动而阳、静而阴之本体也，阴阳互藏于命门之内，感痘之气化而出痘，感疹之气化而出疹，何也？是阴为痘而阳为疹也。统言之则为胎毒，分言之胎毒之中又有阴阳之各别也，当其阳施阴受之始，成胎凝结先有命门，莫可端倪，无可想像，命门也，胎毒始藏之密处也，体也，五脏者迎接时气之传递也，用也，胎毒发出而为痘，则胎毒之静而阴者尽矣，一发不复再发矣。若出正痘之后，隔三五月或隔半年一载，或隔七八年之久，如感时气出疹，胎毒发出而为疹，则胎毒之动而阳者亦尽矣，所以一出亦不复再出矣。或又问曰：命门在何处？答曰：脊骨自上大椎数下二十一椎，自尾闾尻骨望上数七椎之上，上从下数十四椎之下，上下相接之界，命门之所居也，命门居脊骨之前，两肾列于两旁，脂膜护之，为一身之主宰，且出痘与疹而腰不痛者顺也，痘疹初发，即云腰痛，命门伤也，未可以言吉也，故曰一身之主宰也。
聂九吾说：痘疹之源？有谓儿在胎时食母血秽而致也，有谓父母欲火所致也，欲火之说出于臆测，固无明据。然尝见孕妇饮食清淡者，生子出痘多稀少而平顺，恣食浓味者，生子出痘多稠密而险危，则其病源受毒于母胎血秽，似有明验。盖饮食淡则血气清而胎毒轻，饮食浓则气血浊而胎毒重，受毒轻故出痘少，受毒重故出痘多，若因诸痛痒疮疡皆属心火，谓火由欲生，致毒因火结，故其为害独胜于诸疮，此其说亦未为全非，而总之痘毒一胎毒耳。惟其为胎毒，则潜伏五脏，有触则发，无触则不发，故其发有迟速，当其未发时，形气俱泯，无可端倪，若未燧之火何处寻觅，又何可解释？古立预解痘毒诸方，若无故而逐寇于通都，不近理也，及其触而发则勃然不可御，盖其毒瓦斯发自五脏，实动五脏真气，全赖血气送毒瓦斯而出之于外，运化之而成浆，收结之而成痂，而后脏腑可安。若血气送毒瓦斯不出，则毒瓦斯反攻脏腑，如寇作于都城中，主者不能操谋夺武逐之于外，致令操戈内攻，安得不危，故用药犹如用兵，不可不透此理也。（论受病之源。）
又说：治痘之家多矣。刘河间悉用寒凉，偏害不小，至于钱仲阳立方，亦以解毒为主，而多用寒凉，少用温补，张洁古、王海藏咸宗之，此其意俱本于《内经》诸疮疡属心火之一言，故以寒凉泻火也。厥后陈文中立方力矫其偏，专主温补，凡痘疮已出未出之间诸证，悉用十一味木香散，（南木香、大腹皮、赤茯苓、诃子肉、人参、青皮、半夏、前胡、肉桂、丁香、甘草。）已出之间诸证，悉用十二味异功散，（人参、制半夏、白术、茯苓、当归、陈皮、浓朴、制附子、木香、丁香、肉果、官桂。）其意归重于太阴一经，盖以手太阴肺主皮毛，足太阴脾主肌肉，肺金恶寒，脾土恶湿，故用木香、官桂以治肺之寒，用术、附、半夏以治脾之湿，二方用之得其当，其效固大，然不分寒热虚实而一概用之，则宜于虚寒，不宜于实热，其偏害又可知也。朱丹溪辨之是矣。至丹溪立论矫陈氏之偏，而取钱氏之长，主于解毒和中安表，似为的当，举世宗之，数百年来无敢议其失者。余则以为丹溪治他病多妙论，独于治痘则孟浪而未尽其妙，倘亦千虑之失乎！盖其矫偏于陈氏，而不敢轻用木香、丁香、桂、附等热剂，似乎因噎而废食，惩羹而吹虀，其取长于钱氏，而必用芩、连、牛蒡、连翘之类，以监制参 归术等补剂，似乎任将而中制用兵而外监也，其失亦起于泥《内经》疮疡属心火之言，而未透其理也。不知痘疮虽属心火，却与诸疮不同，诸疮之毒，当其初发而未成形，可用药解散内消而愈，及其已形而未成脓，又可用药逐散，未成脓而愈，痘毒发自五脏，必藉血气送出于皮肤，运化之而成脓，收结之而成痂，而后收全功也，可内消而愈乎？可未成脓而愈乎？故诸疮以解毒为主，能解毒于早则轻，不能解毒于早则重，痘疮以血气为主，血气能送毒以灌脓结痂则生，血气不能送毒以灌脓结痂则死，解毒之药多损气
Miliaria is generated by the injury of summer-heat and pathogenic heat.
Miliaria presents with pain and itching.
Prepared Mung Bean Powder (lightly stir-fried, 4 liang) Talcum (5 qian)
Grind evenly and dust on the affected area.
Another prescription: Wash with snow water; symptoms decrease as washing proceeds.
Another prescription: Slice Cucumber (i.e., Trichosanthes cucumerina), rub on the affected area, and it will heal immediately.
Another prescription: Dusting with stone powder is effective.
When miliaria is rubbed broken into sores, it promotes tissue regeneration and relieves pain. (Ji Yan)
Red Halloysite Cinnabar Barium Sulfate Phosphate Yellow Bark (remove coarse bark) Aged Tea (each 5 qian) White Flour (2 liang) Borneol (5 fen)
Grind together into fine powder, dip in cotton and dust on the affected area.
Shen Douyuan said: Sores appearing in the nape of the neck and behind the head are named "Swallow's Nest Sores" (Yanwo Chuang).
This is caused by damp-heat in the Foot-Taiyang Bladder Meridian. (Qi Xuan)
Swallow's Nest Earth Dan (Shen Douyuan Prescription)
Tobacco Gum (1 liang) Swallow's Nest Earth (3 qian) Calomel (1 qian) Calcined Alum (5 fen)
Grind together into fine powder, mix with clear sesame oil, and rub onto the affected area for miraculous effect.
Qian Qinglun said: Any sore appearing in infants within one hundred days after birth is named "Postpartum Sore" (Ruchuang). It is caused by fetal toxin. If it spreads from the body gradually to the head and covers the eyebrows, it heals; if it spreads from the head gradually to the abdomen, it is difficult to treat. Internal administration of Rhinoceros Horn Pill is suitable to resolve its toxicity. (You Ke Liang Fang)
Rhinoceros Horn Pill (Qian Qinglun Prescription) Treats fetal toxin postpartum sores.
Bambusae Fructus Scutellatae Radix Saposhnikoviae Antelope Cornu Whole Scorpion (washed in wine) Whitish Silkworm Qianghuo Gastrodia Elata Beijing Inkstick (until slight smoke appears)
Coptis Rhizome Rhinoceros Horn Arisaema Cum Bile Ephedrae Herba Rhinoceros Calculus (equal parts)
Grind into fine powder. Make pills using steamed bread paste, sized like Euryale Seed, coated with Cinnabar and Gold Leaf. Take one pill per dose, washed down with Mint Decoction.
From fever onset, rash reporting, pus filling, swelling, and scabbing, to predicting favorable or unfavorable outcomes based on facial and ear locations, various secret techniques and methods not previously transmitted are compiled here for reference and treatment.
Zhu Chongu said: Examining ancient times, there was no mention of smallpox, nor books on treating it. Even in Su Wen, there is not a single word about smallpox. Did Huangdi and Qibo consider smallpox trivial and not ask about it? Probably during the time of the Three Sovereigns and Five Emperors, the sky was clear, the earth peaceful, people were simple and honest, and empty evils and harsh toxins had no way to arise. It was only during the Jianwu era of the Han Dynasty, when campaigning at the borders and contracting toxins, that this disease arose in the army. This theory comes from Wan Mizhai's Dou Zhen Xin Yao. Checking history, in the 25th year of Jianwu, campaigns against the Wuling Man occurred. Fubo Army stationed at Xiajun advanced from Hutou. Severe heat prevailed, and most soldiers died of epidemic diseases. Reinforcements also fell ill and died in camp. The historical records labeled it an epidemic, likely meaning it was smallpox. However, given the long passage of time, we retain it for future correction. In short, they did not know what disease it was then; because its growth, flourishing, harvesting, and storage resembled smallpox with sharp, round, red, and lustrous features, it was named smallpox. Later, returning troops brought the toxic miasma into China. Various physicians discussed treatments, relying on the statement in Nei Jing: "All pain, itching, sores, and ulcers belong to Heart Fire," as the key principle for treating smallpox. Little did they know that smallpox differs vastly from other sores. For other sores, when unformed, they can be resolved by detoxification or internal dissipation; when formed, they can be broken open, and even after breaking, tissue can regenerate. But smallpox cannot be detoxified, cannot be internally dissolved, and cannot be broken open. After three days of fever, smallpox seeds appear. Three days after erupting, they fully emerge. Then, pus fills sequentially: starting from the face, spreading to the body, and finally reaching the feet. The goal is full, thick pus, slowly drying and forming scabs, completing success within twelve days. From the onset of fever, the severity of heat indicates the speed of eruption, revealing density. Observing eruption sites predicts auspiciousness or ominous signs. Observing the shape and color of pustules reveals deficiency or excess. Regarding swelling and pus filling, timing limits, observing form and color, distinguishing deficiency/excess and cold/heat, and medicating accordingly are crucial for pus formation. Missing this window leads to failure to form pus; even with miraculous remedies, death is inevitable. Jiowu Nie Shuo: Life or death in smallpox depends on the presence of pus. Pus allows toxins to dissipate outward, leading to survival; lack of pus causes toxins to attack inward, leading to death. Once pus forms and scabs thicken with a dark yellow color, it is a favorable syndrome. In short, smallpox is not treated like other sores. The statement "belongs to Heart Fire" has no relevance to smallpox origin. Earlier, Liu Hejian and Qian Zhongyang prescribed mainly for detoxification, using mostly cooling herbs and few warming tonics. Zhang Jiegu and Wang Haicang followed them. Their intent was based on "Heart Fire," using cooling herbs to drain fire. Later, Chen Wenzhong strongly corrected this bias, focusing solely on warming tonics, suitable for deficiency-cold but not necessarily for excess-heat. Zhu Danxi later criticized Chen's bias, adopting Qian's strengths, focusing on detoxification, harmonizing the middle, and stabilizing the exterior. His error also stemmed from rigid adherence to "Heart Fire." Recently, Huang Xiqiu wrote "Three Diagrams of Favorable, Dangerous, and Adverse Cases." Favorable cases do not require specific medication; dangerous cases have treatments. Adverse cases, even with forced medication, cannot survive. He established thirty adverse case diagrams. I observe thirteen diagrams annually that are truly incurable with no hope of recovery. Even with careful formula adjustments, one cannot escape Xiqiu's scope. The remaining seventeen cases have been saved with medication. Thus, I list thirteen adverse cases below to broaden students' knowledge. Other books like Bao Chi Quan Shu have many errors. Zheng Zhi Zhun Sheng, by Wang Kentang, written during his leisure from high office, considering people of all ages suffering from severe illnesses unable to revive the dead, invited various physicians to collate prescriptions, naming it Zheng Zhi Zhun Sheng for student reference. It is detailed and beneficial. However, regarding smallpox, it is extremely erroneous, possibly delegated to mediocre doctors. Other books like Jin Jing Lu, Dou Ke Zheng Zong, Dou Zhen Xin Yao, Dou Zhen Hui Bian, etc., number dozens. None lacks some merit, correct theory, or excellent formula, but they are selected imprecisely and described vaguely. Plus, these books have circulated for years. Not only in remote valleys but also in major provinces and capitals, famous physicians do not carefully investigate or distinguish right from wrong, treating old smallpox books as today's secrets. They do not know of Nie Shangheng (Jiowu) from Qingjiang, Yuzhang, born in late Longqing, serving as Magistrate of Ninghua County, Tingzhou Prefecture, Fujian, in the Wanli era, known for good governance. Regrettably, he was prominent as a Confucian official, not listed among medical masters. Thus, his name did not pass among traditional medicine practitioners. His book Huo You Xin Fa also did not circulate. One must know that Heaven and Earth generated Nie in Qingjiang not just for local children, but to awaken all under heaven and save infants safely in swaddling clothes. Now I alone know Jiowu Nie synthesized smallpox knowledge, opened pediatric insights, with precise discussions, accurate differentiation, appropriate medication, neither biased toward cooling nor warming, deeply understanding the principle of harmony and appropriateness, without excess or deficiency. I, Zhu Chongu, was born late, unable to study directly under him, but fortunately obtained Huo You Xin Fa, read it diligently, pondered deeply through seasons, and suddenly understood, clearing old misconceptions and opening blocked mind. Fearing that such vast knowledge might be lost over time, I now publish it. All pediatricians must study Huo You Xin Fa repeatedly to achieve mastery. (Dou Zhen Ding Lun.)
Also says: Yi Jing states: Great is the Creative Power, the source of all things. Also: Supreme is the Receptive Power, the source of life. The Creative represents the Father, the source of Qi; the Receptive represents the Mother, the source of Form. Human life receives Qi from the Father and Form from the Mother. The toxicity of Father's Essence and Mother's Blood condenses at the beginning of Yang giving and Yin receiving. The initial formation of the fetal origin is the accumulation of fetal toxin, hence named fetal toxin. This fetal toxin exists regardless of wealth or status. Is it attributed to lustful desires, irregular diet, or swallowing blood at birth? Although Heaven and Earth have extraordinary Qi and commands, causing irregular seasons (spring not mild, summer not hot, autumn not cool, winter not cold), leading to disorder of upright Qi and conflict of mixed Qi, then evil Qi invades the five Zang organs, and fetal toxin in the Mingmen penetrates outward, causing smallpox and rashes. (Dou Zhen Yuan Yu Tai Du Lun.)
Also says: Smallpox emerges from the five Zang organs, rashes from the six Fu organs. Ancients spoke without investigating the root, descendants transmitted without tracing the source, leading to errors for over a thousand years. Who knows to辨 their falsehood? I now publish this, not without evidence. Human life receives Qi from Father, Form from Mother. At the start of Yang giving and Yin receiving, the essence of Heaven and Earth condenses. Creative Path makes male, Receptive Path makes female. Inside the fetus, Mingmen exists first, like chaos undivided, like Taiji before division. Mingmen is the Taiji of the human body. Speaking of condensation into form, Mingmen exists first, so the toxicity of Father's Essence and Mother's Blood hides in Mingmen, which is true and certain. Externally, the nose grows first, hence ancestors are called "Nose Ancestors." Internally, five Zang and six Fu organs, externally, hundred bones and nine orifices, all grow day by day, month by month from here. Hence, gestation lasts ten months before birth. Only when Mingmen condenses at the beginning of form does fetal toxin accumulate at the beginning of form. Mingmen is Taiji; two kidneys are Liangyi. Heaven generates Water, Earth completes it. The single Yang in Kan is Mingmen; the two Yins above and below Kan are the two kidneys. Today, people consider the right kidney as Mingmen, failing to acquire knowledge and investigate things. Two kidneys flank Mingmen, representing Taiji generating Liangyi. Earth generates Fire, creating Heart. Heaven generates Wood, creating Liver. Earth generates Metal, creating Lung. Heaven generates Earth, creating Spleen. However, these only complete things, not generate them. Saying Earth generates Fire and Metal seems inconsistent with Receptive Path completing things. Yet, numbers one to five in Hetu are generating numbers of Five Elements; six to ten are completing numbers. Generating numbers are the start; completing numbers are the result. Human gestation is ten months, obtaining Heaven and Earth's completing numbers. Some are born at seven, eight, or nine months, raised to adulthood, marry, and reproduce. Thus, six to ten are clearly completing numbers. However, Earth generates Fire and Metal, but Heaven envelops Earth, its Qi circulating within Earth. Earth's isolated Yin cannot generate Fire and Metal alone; it requires Heaven's Qi penetrating to generate Fire and Metal, actually resulting from Heaven and Earth, Yin and Yang cooperation, producing Water, Fire, Wood, Metal, Earth. Someone asks: You say fetal toxin hides in Mingmen, which is reasonable, why mention Heart, Liver, Spleen, Lung, Kidney again? Reply: What words are these! Mingmen is Substance; five Zang are Function. They assist each other to generate. Nose Qi connects to Lung. Encountering smallpox/rash Qi, nose smells it, transmitting to Lung Metal. Lung Metal transmits to Kidney Water. Kidney Water transmits to Liver Wood. Liver Wood transmits to Heart Fire. Heart Fire transmits to Spleen Earth. In one day and night, it rotates once around the heavens. Next morning, Spleen Earth transmits to Lung Metal again, then Kidney, Liver, Heart, back to Spleen. One day and night, another rotation. Next morning, again to Lung. Five days and nights transmit through all five Zang. Smallpox/rash seasonal Qi enters from outside to inside; Mingmen fetal toxin emits from inside to outside. By sixth day, slight fever; by seventh day, high fever. Another asks: How do you know so precisely? Reply: By seed vaccination gaining insight into creation's mechanism. Naturally erupted smallpox is infectious via invisible Qi; seeded smallpox is guided by visible scabs. Naturally erupted rashes are also infectious via invisible Qi. Fetal toxin accumulates in Mingmen, containing Yin-Yang distinction. Mingmen is Taiji of the body, the substance moving to Yang and stillness to Yin. Yin and Yang hide within Taiji; Yang changes and Yin combines to generate Water, Fire, Wood, Metal, Earth. Fetal toxin accumulates in Mingmen, having substance moving to Yang and stillness to Yin. Yin and Yang hide within Mingmen. Sensing smallpox Qi produces smallpox; sensing rash Qi produces rash. Why? Yin is smallpox, Yang is rash. Generally called fetal toxin; specifically, fetal toxin contains distinct Yin and Yang. At the start of Yang giving and Yin receiving, conception condenses, Mingmen exists first, indescribable, unimaginable. Mingmen is the secret hiding place of fetal toxin, the Substance. Five Zang are the transmission of seasonal Qi, the Function. When fetal toxin emits as smallpox, the stillness and Yin aspect of fetal toxin is exhausted; it never erupts again. After natural smallpox, after three to five months, half a year, one year, or seven to eight years, if sensing seasonal Qi to produce rash, fetal toxin emits as rash, the movement and Yang aspect of fetal toxin is exhausted; thus, it never erupts again. Another asks: Where is Mingmen? Reply: Counting down twenty-one vertebrae from Dachui on the spine, up from Weilu coccyx seven vertebrae, below fourteen vertebrae counted up from below, the boundary where upper and lower connect is the residence of Mingmen. Mingmen resides before the spine, two kidneys flank it, protected by fat membrane, governing the whole body. Moreover, if smallpox/rash erupts without waist pain, it is favorable. If waist pain occurs at initial eruption, Mingmen is injured, not auspicious. Hence, it is the master of the body.
Nie Jiuwu said: Origin of smallpox/rash? Some say fetus eats maternal blood impurities; some say parents' lustful fire causes it. Lustful fire theory is speculative, lacking evidence. However, I have seen pregnant women eating light food give birth to children with sparse, smooth smallpox; those eating rich food give birth to children with dense, dangerous smallpox. Thus, the disease source being toxicity from maternal blood impurities seems evident. Light diet means clear Qi and Blood, light fetal toxin; rich diet means turbid Qi and Blood, heavy fetal toxin. Light toxicity yields few smallpox; heavy toxicity yields many. If attributing all sores to Heart Fire, saying fire arises from desire, causing toxin to knot by fire, thus harming more than other sores, this theory is not entirely wrong. Ultimately, smallpox toxin is fetal toxin. Being fetal toxin, it lies dormant in five Zang, erupting upon contact, not erupting without contact. Hence, eruption has early or late timing. Before eruption, form and Qi vanish, indescribable, like unlit fire, where to find? Ancient prescriptions pre-resolve smallpox toxin. Pursuing enemies in a metropolis without cause is unreasonable. Upon contact, eruption is sudden and uncontrollable. Its toxic miasma originates from five Zang, truly moving five Zang True Qi. It relies entirely on Qi and Blood sending toxic miasma outward, transforming it into pus, consolidating it into scabs, then organs can rest. If Qi and Blood fail to send toxic miasma out, toxic miasma counter-attacks organs. Like bandits in the capital, if the ruler cannot strategize and drive them out, causing internal rebellion, how can it not be dangerous? Thus, using medicine is like using troops; one must understand this principle. (Lun Shou Bing Zhi Yuan.)
Also says: Many treat smallpox. Liu Hejian used only cooling herbs, causing significant bias harm. Qian Zhongyang also focused on detoxification, using mostly cooling, few warming tonics. Zhang Jiegu and Wang Haicang followed them. Their intent based on Nei Jing "sores belong to Heart Fire," using cooling to drain fire. Later, Chen Wenzhong strongly corrected this bias, focusing on warming tonics. For smallpsores between erupted and unerupted stages, he used Eleven-Ingredient Aucklandia Powder (Aucklandia Root, Areca Peel, Red Poria, Chebula Fruit, Ginseng, Green Tangerine Peel, Pinellia, Peucedanum, Cinnamon Twig, Clove, Licorice). For erupted stages, Twelve-Ingredient Extraordinary Efficacy Powder (Ginseng, Processed Pinellia, Atractylodes Macrocephala, Poria, Angelica Sinensis, Tangerine Peel, Magnolia Bark, Processed Aconite, Aucklandia, Clove, Myristica, Cinnamon Bark). His intent focused on the Taiyin Meridian. Hand-Taiyin Lung governs skin and hair; Foot-Taiyin Spleen governs muscles. Lung Metal dislikes cold; Spleen Earth dislikes dampness. Thus, using Aucklandia and Cinnamon to treat Lung cold; Atractylodes, Aconite, Pinellia to treat Spleen dampness. Using these two formulas appropriately yields great effect. However, using them indiscriminately for cold/heat and deficiency/excess suits deficiency-cold but not excess-heat, revealing further bias harm. Zhu Danxi correctly identified this. Danxi criticized Chen's bias, adopted Qian's strengths, focusing on detoxification, harmonizing middle, stabilizing exterior, seemingly appropriate. The world followed him for centuries without criticizing his errors. I believe Danxi had many brilliant theories for other diseases, but was rash and incomplete regarding smallpox, perhaps a thousand-thought error! Correcting Chen's bias, he dared not lightly use warm agents like Aucklandia, Clove, Cinnamon, Aconite, seeming to stop eating due to choking, blowing on hot soup. Adopting Qian's strengths, he insisted on using Scutellaria, Coptis, Burdock, Forsythia to control tonics like Ginseng, Angelica, Atractylodes, seeming to appoint generals while restricting military command internally and monitoring externally. His error also stemmed from rigid adherence to Nei Jing "sores belong to Heart Fire," failing to penetrate the principle. Not knowing that although smallpox belongs to Heart Fire, it differs from other sores. Other sore toxins, when initially erupting and unformed, can be dispersed and internally dissolved to heal. When formed but not suppurated, they can be driven away to heal. Smallpox toxin originates from five Zang, must rely on Qi and Blood sending it to skin, transforming into pus, consolidating into scabs to complete success. Can it be internally dissolved? Can it heal before suppuration? Thus, other sores focus on detoxification; early detoxification is mild, late is severe. Smallpox focuses on Qi and Blood; if Qi and Blood send toxin to fill pus and form scabs, life; if not, death. Detoxifying herbs often damage Qi