痘之为症，婴儿之大劫也。自汉以前无有，元朔中，武帝使使至回鹘，因传染入中国。其气腥秽难近，惟
大贵而贤者，则间出墨痘，此绝无而仅有者也。昆山朱HT 靖公名希周，幼时出痘，颗颗皆黑，若束一带于腰间
者，诸医皆谓不治。有一医能识之，谓朱翁曰∶令嗣之症无妨也，然愿与公约，我有弱女，痘痊后，欲得令嗣
入赘。翁许之，后遂赘焉。医固富，凡膏火之费，悉以资之。后公中弘治丙辰状元，官至礼部尚书，为礼乐名
臣，卒年九十四，谥HT 靖。
张达泉治颜铨部为儿时，中痘已死。达泉视之曰∶未死也，急掘地作坑，置儿其中，取新水数桶，用纸蘸
之，重贴其身上。少顷，有细烟起，儿手微动。达泉喜曰∶生矣。复以水沃之，气蓬蓬上蒸，大啼数声，取起
再进以药，不数日愈。
王敏治千户申志，年二十，忽瞑眩谵语，体热而咳，众医以伤寒治。敏曰∶痘也。与升均汤而疮出。
葛茂林诊汪比部子，年二十五矣。忽患痘，汪故知医，以为无恙也，葛视怫然。迨五日而足，七日而靥，
亦怫然。至十四日而痂落，汪信其无虞。葛曰∶灾其在弥月乎，至期而其子晏然，汪置酒高会，若以诮葛者。
葛视其子之足底有泡，结瘢肤内，曰∶吁！其殆哉。迨是日而暴殁。汪以为神，问其故。葛曰∶夫痘构形之余
秽也。苟有纤芒未尽，亦无生理。是疾初发自肾，而我知其不能畅，是以必死。既而流注于足底焉，以故发之
缓，而必至是日也。汪叹服。
沈好问治沈勤云义女，年十岁。幼子痘，女抱儿出诊。沈曰∶儿无伤，女即出恶痘矣。若呼头及骨痛，宜
服粪清。如其言而愈。
唐守元治园花祝氏儿，患痘症，遍身血迸无罅，唐捣药涂其身，糁药茵蓐上，卷起倒竖床前，合家啼骇。
唐叱曰∶若辈勿惊，此名蛇壳痘，必用逆，乃得脱。已而皮肤解裂，如蛇蜕然，遂愈。
关家女阿观，年八岁，出痘甚多恶。沈曰∶诸医云何？对曰∶死症，不必药矣。沈曰∶儿一身死痘，然有
一生痘，尚可生。令取五年抱雏母鸡，用药入鸡腹，外以糯蒸鸡令食尽。视之，右手关脉痘二粒，明艳如珠，
女果生。
江鲁陶子一岁，痘止三颗，见额上耳后唇旁。沈曰∶儿痘部位，心肾脾三经逆传，土克水，水克火，宜攻
不宜补，攻则毒散，补则脏腑相戕。治至十四日，痘明润将成矣。沈曰∶以石膏治之，恐胃土伤肾水也。俗
医怜儿小，谬投以参。沈见之惊曰∶服参耶，不过二十一矣。儿卒死。
许季明幼子痘，沈曰∶顺症也，不必补。小儿纯阳，阳盛必克阴。许不从，痘愈，讥沈为妄。沈曰∶儿且
死。许益不悦。至十二日，儿熟睡，视之，绝矣。
潘氏云∶一女病，发热腰痛，手足厥逆，目如昏闷，形症极恶，疑是痘候。时暑月，急取屠家猪血，倍用
龙脑（冰片也。）和服，得睡。须臾，一身疮出而安。若非此方，则横夭矣。（《本草纲目》。）
括苍陈坡云，分教三山日，其孙方三岁，发热七日，痘出而倒靥，色黑唇白，冰冷，一士教以用狗蝇七枚
擂细，和醅酒少许调服，移时，红润如常。又其次女，痘后毒上攻，遂成内障，一医者用蛇蜕一具，洗净焙燥，
天花粉等分，细末之，入羊肝内，麻皮缚定，用米泔熟煮切食之，旬日而愈。（《居易录》。狗蝇夏月极多易得，
冬月则藏于耳中。）
扶沟赵神仙传起死回生散，治痘疮至七八日，忽然变色黑，收入腹内，遍身抓破，吭喘，死在须臾，服
此从新另发出，立可回生。方用四物汤加升麻、红花。上陷加白芷，下陷加牛膝，遍身黑陷加麻黄、象粪微炒。
如一岁用二钱，大则用至三五钱。右锉一剂，半水半酒煎服，从新发出。脚下有黑疔，至七八日用针挑去，以
太乙膏贴之，即拔去毒，连进二三服。
朱丹溪治一子七岁，痘将出未出之际，腹泄数行，其泄色黑，不发根窠，三日后痒，抓出即黑水，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。
龚子才治一女，痘出至胀满将贯脓时，忽紫黑抓破流血，此属热毒太盛，乃用皮硝，不拘多少，入花椒一
撮煎水，用青布蘸搭患处，频频良久，即起胀如旧。
孙文垣治郑都谏长君，四岁患痘，稠密烦躁。医皆谓热盛不退，形枯色紫，顶有焦势，症逆不可为。孙至，
细审之，见两太阳圆净，神气苍浓，（可生在此。）谓当急为凉血解毒。用赤芍、生地各三钱，紫草二钱，连
翘、黄芩、贝母、山楂、木通各一钱，蝉蜕、甘草各五分。药成剂而众止之，曰∶麻要清凉痘要温，今乃独主
寒凉，保元之谓何？孙曰∶用药贵对症，保元汤温矣，必血活热清而后可用，今血热毒盛，而用温剂，是火炽
添油也。众曰∶若虑毒未解，吾苕酵法甚佳，用桑虫，鸡血酒调服之，痘即立起。孙曰∶此法亦可用于清解后，
火未退而用，是以毒攻毒，其势愈炽。郑遂命煎服，其减去山楂、贝母，从众议也。次日痘色明润，焦顶尽退，
血亦渐活。惟呕哕抢喉，众谓药所致。孙曰∶此火毒未尽也，宜进竹茹汤，乃大哗。郑弟检《痘疹全书》用竹茹以
证，乃已。药进而哕止。至八日，泄泻发痒，乃以保元汤加白芍、术，大加首乌，一帖泻痒止。至十四日，天
庭两颧皆回浆作靥，惟两颐未回，泄泻不止。逾半日，口开顶软，四肢尽瘪，腹又胀，已成内攻，举家啼泣，
孙亦茫然，不遑为计，太息出门。郑弟把袂相送。揖别顷，闻衣间痘臭，语之曰∶君闻臭乎？曰∶闻。孙曰∶
似有生意，急还起之。因思颐乃肾经部位，独不回浆者，肾元虚也，峻补乃可使活。先以紫河车一钱，用酒调
服，服后即睡。继以人参一两，黄 、菟丝各三钱，作大剂服之，一日夜，服人参一两八钱。再视之，其结靥
之下，复灌一线黄浆，盖赠痘也，遂调理而愈。（此症如不收功，则向之指斥寒凉及戒用竹茹者，皆可借口矣。
此气虚血热而胃气不畅也。于凉血剂中少用葛根以畅胃气，则焦顶立化，更参用参、 以补气，则其痘立长，
此予友赵功甫法也。目睹其用药，辄应手见效。孙君尚未达此旨，故不免多费周折耳。）
喻嘉言诊顾 明子，种痘即请视，其痘苗淡红磊落，中含水色，明润可爱，且颗粒稀疏。他医已先夸为状
元痘，昌未知也。踌躇良久，明告曰∶此痘热尚未遏，头重颈软，神躁心烦，便泄青白，全是一团时气外感，
兼带内虚，若用痘门通套药，必危之道也，必得一二剂先退其外感，则痘不治自痊，若迟二三日，缓无及矣。
彼不听，而以虾鱼、鸡、 发痘之物杂投，误上加误，适所以速其亡耳。才至六日而坏，正应感症坏期。若痘
既美，即有意外变症，亦在一月半月矣。越二日，次男即发热布痘，仍挟时气外感，仍用前医，仍六日而坏。
冯楚瞻治蒋总宪之孙，痘不甚密，但先天甚弱，壮热溃汗不止，四五日来，痘反退缩平陷，昏睡惊惕。冯
曰∶壮热者，阳在外也，溃汗者，阴外泄，阳不敛也，宜滋阴养阳补中，则痘不发而自起矣。以熟地八钱，乳
炒白术三钱，牛膝八钱，麦冬二钱，五味四分，上肉桂六分煎服，不超时，熟睡身凉汗收，神爽痘起，思食而愈。
胡氏子患痘，初起甚危，一老医断其必死，延冯同治，见其方寒凉大甚，所以伏而不出，有喘急腹胀诸症
也。先以酒酿鸡冠血，调下独胜散一服，解其冰伏之势，喘热俱减，痘有出势。其医以必不救为争，冯曰∶毋
若是，以重主人之忧，望为同事。吉则君之功，凶则某之事，彼犹不然。其父惟日夜痛哭，勉留调治，十愈八
九，主人仍不乐。盖渠每日诊视，谆谆断以不起时日，直至结痂全愈，主人乃喜迎于色，悔听蛊惑，几至败
事。
冯楚瞻五儿，禀赋素弱，年四岁出痘，发热一二日便神气困倦，汗出如雨。已见痘，因汗多阳虚，一切疏
解屏不用。三日外，汗出不止，清利甚频，所见之痘，反隐隐退缩，未出者则 如也。以人参、炒白术各三钱，
炙甘草八分，固中为君；天蚕三钱，角刺一钱，炒甲片六分，攻托为臣；以川芎八分，升提而兼辛发，肉桂六
分，温经而兼外达为佐。四日，汗泻小减，出见少长，未出者见形，仍用前方加当归、大枣煎服。五日，起胀
者，少有脓色，后出者，亦有起胀之势。但面上之痘，淡红无光彩，身背之痘，紫陷不润泽，知由气血两虚兼
血滞而然，只以温补气血为主，前方加黄 、山药、粘米、圆肉煎服。六日，痘色红活，但皮薄而亮，脓色清
稀，四肢水泡，知气血弱而脾土更虚也，乃用保元汤加桂。人参五钱，滋补元气为君；生 二钱，充补卫气
为臣；炙甘草六分，缓中补土，粘米一撮，内壮胃气，外酿脓浆为佐；肉桂宣通血脉，补托为使。七日，脓色
大长，以和平养长之剂而痂。
吴孚先治一儿患痘，至出齐后，忽变灰白，七八日毫无浆路，更兼便溏，不思饮食，势极危，用人参、鹿
茸、制附、肉桂、木香、桑虫、人牙、穿山甲、角刺、防风、桔梗、糯米，以黄 二两煎汤煮药，一帖有浆脚，
二帖起胀，三帖浆足矣。
一儿十三岁，痘出稠密，至八九日将贯脓时，粒粒陷入成窠。或以木香异功散，陷伏愈甚。视其痘，色红
紫而体气不弱，曰∶此血气欲行浆，为毒瓦斯壅遏，故痘顶陷伏，宜速清毒，血气自行，缓则有变。用当归、生
地、白芍、紫草、牛蒡、连翘、桔梗、甘草、山楂、黄 ，加酒炒芩、连，人参三分，一剂而陷立起，再剂而
浆充满矣。
一儿年十四，痘出身热，三四日后，出才隐隐数点，忽发谵狂，或以凉药解毒。诊之，六脉缓弱，痘色淡
白，曰∶此至虚似实也。缘气血虚弱，送毒不出，故发谵狂，与实热发狂者迥别。投以温中补气之药，痘出遍
身，谵狂顿止。
王履素曰∶余孙孟溥出痘，起发贯浆俱如法，惟回浆太早，九朝左臂发一痘毒，医通用清热解毒之药，
不四剂而寒战切牙之症作矣，皆泥于痘毒不敢用参、术，止用归、 ，而兼解毒。余谓痘后气血俱虚，复以寒
药败脾，故见斯症，阳气已虚甚，即有归、 ，亦何能济？况尚兼清解乎，必无幸矣。《保婴撮要》寒战切牙
门，用十全大补汤，即痘毒门初发时，只用仙方活命饮一二剂，旋用托里散助其元气，则未成可消，已成可溃。
设使气血不充，则不脓不溃，难以收拾。于是断以己意，服十全汤三剂而寒战止，再数剂而切牙定。及延疡医
妙手，外治其毒，内服参、 、归、芍不辍，凡匝月而愈。当寒战症作，臂肿方 ，用药颇多疑虑，人参且不
敢多用，而况白术？至于桂，更无敢用至三分者。余叹曰∶立斋断不误，遂决用大剂参、术，加桂至五六分，
而诸症皆瘳矣。（立斋之误亦多矣，未可以此为据也。）
周怀第四儿，生四十余日即出痘。其初头上并身上，不过三四点，身不甚热，饮乳如常，医谓痘极少，当
不满百粒，周未然之，即令禁风调理。再二日遂多甚，头上、胸腹、腰背、手足俱稠密，至额上面上，及阴囊
俱一片纯红，不分颗粒，脐内甚多，因肿大突出，舌上亦多，形如白粟，脓浆布满。医又谓儿小痘多，且有不
顺诸症，此必不可为矣。因视其痘色红活，颇能饮乳，宜可调治。第虑其气血不支，以参、 、炙草煎浓汁，
时与乳相间饮之。五六日后，头上多有脓浆，间有水泡，身上及手足则水泡大半，脓泡仅小半耳。谓其气血有
限，理所宜然。所虑额上面上，一片纯红者，忽有一二次变黑，因大惊，以为逆候也。然察儿精神及饮乳，略
无困惫。至三更，阴囊下亦转黑结痂，因悟其非恶候，乃儿小血气易于周浃，七日后即收靥耳。至八日寅卯时，
自上至下俱结痂，至时结完。九日自上至下俱痂落，至晚落完。既而遍身发大热，此毒未尽发，是以速收速落，
将发痈也。急宜解毒，以大连翘饮浓煎汁，每用半酒杯，以茶匙缓缓挑服。一日夜，服三酒杯而热退，可无痈
患矣。其鼻上有痂封固，以蜜密润之，用银耳挖挑开，以出其气。纯红处脓水未干，以黄柏、黄连、甘草、
地骨皮、五倍子为细末糁之。阴囊流清水，用棉茧散糁之皆愈。（此气至而血不至也，欠此养血一着，故毒不
尽解，留为后患。）
周次女六岁出痘，发热甚缓，至二日，面与手微有痘影数点，热至第四日，其点仍旧，且带白色，困倦嗜
卧，不思饮食。医视之，谓痘轻少，不满百粒。周心甚疑，谓痘既少，儿当精神清爽，饮食如常。今困倦嗜卧，
不思饮食，痘影淡白，此必气血虚弱，送痘不出故也。乃以温中益气汤托之，一帖而皮下隐隐欲出者甚多，二
剂而痘出大半。一日夜尽四剂，而遍身出齐，稠密特甚。缘数日前曾患发热呕吐，稍伤胃气，故必待温中托里
而痘方出故也。若不察其虚，不逐毒出外，必致内攻之患矣。
痘疹这种病症，是婴儿成长过程中的一场大劫难。在汉代以前并没有这种病，到了汉武帝元朔年间，武帝派遣使者出使回鹘，因此从那里传染进入中国。这种病气气味腥臭秽浊，令人难以靠近。只有那些地位尊贵且贤德的人家，偶尔会出现黑色的痘疹，这是绝无仅有、极其罕见的情况。
昆山朱希周（号靖公）小时候出痘，每一颗都是黑色的，像系在腰间的一束带子一样，众位医生都说无法医治。有一位医生能够识别这种病情，对朱希周说：“令郎的病症没有妨碍，但我希望与您约定，我有个弱女，待他痘疹痊愈后，我想让令郎入赘我家。”朱希周答应了，后来朱希周便入赘了。这位医生原本就富有，凡是需要膏火等费用，都资助给他。后来朱希周考中了弘治丙辰年的状元，官至礼部尚书，成为礼乐方面的名臣，享年九十四岁，谥号为靖。
张达泉治疗颜铨部之子时，孩子因患痘疹已经死亡。张达泉诊察后说：“还没有死。”急忙让人在地上挖个坑，把孩子放在里面，取来几桶新水，用纸张蘸水，重重地贴在孩子身上。过了一会儿，有细烟升起，孩子的手微微动弹。张达泉高兴地说：“活过来了。”又用水浇灌孩子，热气蓬勃向上蒸腾，孩子大声啼哭了几声，抱出来再喂药，没过几天就好了。
王敏治疗千户申志，二十岁，突然头晕目眩、胡言乱语，身体发热并咳嗽，众位医生按伤寒症治疗。王敏说：“这是痘疹。”给予升均汤服用，随后痘疹发出。
葛茂林诊视汪比部的儿子，二十五岁了。突然患上痘疹，汪某本来懂医术，认为没什么大碍。葛茂林看后神情严肃。等到第五天痘疹透发，第七天结痂，葛茂林依然神情严肃。到了第十四天痂皮脱落，汪某相信孩子没有危险了。葛茂林说：“灾难恐怕会在满月时发生。”到了那个日期，他的儿子安然无恙，汪某摆酒高会，好像在嘲笑葛茂林多虑。葛茂林观察他儿子的脚底有水泡，疤痕结在皮肤内部，感叹道：“唉！这孩子恐怕要死了。”到了这一天，孩子突然暴毙。汪某认为葛茂林神机妙算，询问原因。葛茂林说：“痘疹是构建形体后残留的秽浊之气。如果有一丝一毫的毒邪未尽，就没有生存的道理。这种病最初发自肾脏，我知道它不能畅达排出，所以必然致死。后来流注到脚底，因此发作缓慢，但必然导致这一天的死亡。”汪某叹息佩服。
沈好问治疗沈勤云的义女，十岁。幼小的弟弟出痘，姐姐抱着弟弟去请医生诊治。沈好问说：“弟弟没有受伤，姐姐却会发出恶性的痘疹。如果出现头痛及骨痛的症状，应该服用粪清（人尿的上层清液）。”按照他的话做，果然痊愈。
唐守元治疗园花祝氏的儿子，患痘疹，全身血斑迸裂，没有缝隙。唐守元捣碎药物涂在他身上，将药粉撒在褥子上，卷起孩子倒竖在床前，全家惊恐啼哭。唐守元呵斥道：“你们不要惊慌，这名叫蛇壳痘，必须用逆治法，才能脱险。”不久皮肤解裂，像蛇蜕皮一样，于是痊愈。
关家的女儿阿观，八岁，出的痘疹很多且恶劣。沈姓医生说：“其他医生怎么说？”回答说：“是死症，不必用药了。”沈医生说：“孩子一身都是死痘，但还有一颗活痘，还可以救活。”让人取来下过蛋五年的母鸡，用药填入鸡腹，外面用糯米蒸熟让鸡吃尽。查看发现，孩子右手关脉处有两粒痘疹，明亮鲜艳如珍珠，女孩果然存活。
江鲁陶的儿子一岁，痘疹只出了三颗，出现在额头、耳后和嘴唇旁边。沈医生说：“孩子的痘疹部位，属于心、肾、脾三经逆传，土克水，水克火，应该攻伐而不宜补益，攻伐则毒邪消散，补益则脏腑相互伤害。”治疗到第十四天，痘疹明润即将成熟。沈医生说：“如果用石膏治疗，恐怕会损伤胃土和肾水。”俗医怜悯孩子小，错误地投以人参。沈医生看见后惊讶地说：“服用人参了吗？不超过二十一岁就会死。”孩子最终死去。
许季明的幼子出痘，沈医生说：“这是顺症，不必补益。小儿纯阳之体，阳气盛必然会克制阴气。”许季明不听从，痘疹痊愈后，讥笑沈医生胡说。沈医生说：“孩子快要死了。”许季明更加不高兴。到了第十二天，孩子熟睡中，一看，已经断气了。
潘氏记载：一个女孩生病，发热腰痛，手足厥冷，眼睛昏闷，形症极差，怀疑是痘疹的前兆。当时正值暑月，急忙取屠户家的猪血，加倍使用龙脑（即冰片）调和服用，孩子睡着了。一会儿，全身疮疹发出而平安。如果不是这个方子，就会横死。（出自《本草纲目》。）
括苍陈坡说，他在分教三山时，孙子刚三岁，发热七天，痘疹发出后倒靥（痘疹内陷），颜色黑，嘴唇白，手脚冰冷。一位士人教他用七枚狗蝇研细，加少许醋酒调服，过了一会儿，面色红润如常。其次女，痘疹后毒气上攻，形成内障。一位医生用蛇蜕一具，洗净焙干，与天花粉等分，研成细末，放入羊肝内，用麻皮绑紧，用米泔水煮熟切食，十天痊愈。（出自《居易录》。狗蝇夏季极多易得，冬季则藏在耳朵里。）
扶沟赵神仙传授起死回生散，治疗痘疮到七八天，突然变色变黑，收入腹内，全身抓破，气喘，随时可能死亡，服用此药重新发出，立刻可以回生。方剂用四物汤加升麻、红花。上部凹陷加白芷，下部凹陷加牛膝，全身黑陷加麻黄、象粪微炒。如一岁用二钱，大的用到三五钱。以上锉成一剂，半水半酒煎服，重新发出。脚下有黑疔，到七八天用针挑去，以太乙膏贴敷，即可拔去毒邪，连续进二三服。
朱丹溪治疗一个七岁儿子，痘疹将要发出未发出之际，腹泻数次，排泄物颜色黑，不发根窠，三天后发痒，抓破流出黑水，口渴，其根窠像水疱状，不红泽，不起发，食少，脉浮数有力，重按则虚。于是用人参、茯苓、当归、白术、陈皮、肉豆蔻为君药，炙甘草、诃子、桂枝为使药，水煎熟，加少量好酒送服，瘙痒立即停止，食欲立即恢复，根窠红泽而起发，两服药全愈。
龚子才治疗一个女孩，痘疹发出到胀满即将化脓时，突然变紫黑，抓破流血，这属于热毒太盛，于是用皮硝，不拘多少，加入一撮花椒煎水，用青布蘸水搭在患处，频繁敷贴良久，随即起胀如旧。
孙文垣治疗郑都谏的长子，四岁患痘，稠密烦躁。医生都说热盛不退，形体枯瘦，颜色紫暗，顶部有焦枯之势，症候逆乱不可为。孙文垣到来，仔细审察，见两太阳穴圆净，神气苍浓（生机在此），说应当紧急凉血解毒。用赤芍、生地各三钱，紫草二钱，连翘、黄芩、贝母、山楂、木通各一钱，蝉蜕、甘草各五分。药成后众人阻止，说：“麻疹要清凉，痘疹要温补，现在唯独主用寒凉，保元汤算什么？”孙文垣说：“用药贵在对症，保元汤虽然温补，但必须血活热清之后才可用，现在血热毒盛，如果用温剂，是火上浇油。”众人说：“如果担心毒未解，我们苕酵法很好，用桑虫，鸡血酒调服，痘疹立刻起来。”孙文垣说：“这个方法也可以在清解后用，如果在火未退时用，是以毒攻毒，火势更炽。”郑都谏于是命煎服，减去山楂、贝母，顺从众人的意见。第二天痘色明润，焦顶全部消退，血液也逐渐流通。只是呕吐呃逆抢喉，众人认为是药所致。孙文垣说：“这是火毒未尽，应该进竹茹汤”，众人哗然。郑都谏的弟弟检查《痘疹全书》用竹茹来证明，才作罢。药进后呃逆停止。到第八天，泄泻发痒，于是用保元汤加白芍、白术，大量加首乌，一帖后泻痒止。到第十四天，天庭两颧都回浆结痂，只有两腮未回，泄泻不止。过了半天，口开顶软，四肢尽瘪，腹部又胀，已成内攻之症，全家啼哭，孙文垣也茫然无策，来不及想办法，叹息出门。郑都谏拉着袖子送别。揖别片刻，听到衣服间有痘臭味，对他说：“您闻到臭味了吗？”说：“闻到了。”孙文垣说：“似乎还有生机，赶快回去救他。”因为想到腮部是肾经部位，唯独不回浆，是肾元虚损，峻补才能使生命复活。先用紫河车一钱，用酒调服，服后即睡。继用人参一两，黄芪、菟丝子各三钱，做大剂服用，一天一夜，服人参一两八钱。再看，结痂之下，又灌一线黄浆，这是赠送的痘浆，于是调理而愈。（此症如果不收功，那么之前指责寒凉及戒用竹茹的人，都可以借口了。这是气虚血热而胃气不畅。在凉血剂中少用葛根以畅胃气，则焦顶立化，更参用人参、黄芪以补气，则痘立长，这是我朋友赵功甫的方法。目睹其用药，往往应手见效。孙先生尚未达到这个旨意，所以不免多费周折罢了。）
喻嘉言诊视顾明之子，种痘后立即请视，其痘苗淡红磊落，中含水色，明润可爱，且颗粒稀疏。其他医生已先夸赞为状元痘，喻嘉言却不知道。犹豫良久，顾明告诉他说：“此痘热势尚未遏制，头重颈软，神躁心烦，大便泄青白色，全是一团时气外感，兼带内虚，如果用痘门通用的套药，必是危险之道，必须得一两剂先退其外感，则痘不治自痊，如果迟两三天，就来不及了。”他们不听，而以虾、鱼、鸡、发痘之物杂投，误上加误，正好加速其死亡。才到第六天就败坏，正应验感症坏期。如果痘既美，即使有意外变症，也应该在一月半月后才出现。过了两天，次男即发热布痘，仍挟时气外感，仍用前医，也是第六天败坏。
冯楚瞻治疗蒋总宪之孙，痘疹不甚密，但先天甚弱，壮热溃汗不止，四五日来，痘反退缩平陷，昏睡惊惕。冯楚瞻说：“壮热者，阳气在外；溃汗者，阴气外泄，阳气不收敛。宜滋阴养阳补中，则痘不发而自起矣。”用熟地八钱，乳炒白术三钱，牛膝八钱，麦冬二钱，五味子四分，上肉桂六分煎服，不到一小时，熟睡身凉汗收，神爽痘起，思食而愈。
胡氏子患痘，初起很危重，一位老医断定必死，延请冯楚瞻同治，见其方寒凉大甚，所以伏而不出，有喘急腹胀诸症。先用酒酿鸡冠血，调下独胜散一服，解其冰伏之势，喘热俱减，痘有出势。其医以必不救相争，冯楚瞻说：“不要这样，加重主人的忧愁，希望作为同事合作。吉则是您的功劳，凶则是我的事。”那人还是不同意。孩子的父亲日夜痛哭，勉强留下调治，十愈八九，主人仍然不快乐。大概因为他每天诊视，谆谆断定不起时日，直到结痂全愈，主人才喜形于色，后悔听信蛊惑，几乎败事。
冯楚瞻的第五个儿子，禀赋素弱，四岁出痘，发热一二日便神气困倦，汗出如雨。已见痘，因汗多阳虚，一切疏解药屏不用。三日外，汗出不止，清利甚频，所见之痘，反隐隐退缩，未出者则隐没不见。用人参、炒白术各三钱，炙甘草八分，固中为君；天蚕三钱，角刺一钱，炒甲片六分，攻托为臣；以川芎八分，升提而兼辛发，肉桂六分，温经而兼外达为佐。第四天，汗泻小减，出见少长，未出者见形，仍用前方加当归、大枣煎服。第五天，起胀者，少有脓色，后出者，亦有起胀之势。但面上之痘，淡红无光彩，身背之痘，紫陷不润泽，知由气血两虚兼血滞而然，只以温补气血为主，前方加黄芪、山药、粘米、圆肉煎服。第六天，痘色红活，但皮薄而亮，脓色清稀，四肢水泡，知气血弱而脾土更虚也，乃用保元汤加桂。人参五钱，滋补元气为君；生黄芪二钱，充补卫气为臣；炙甘草六分，缓中补土，粘米一撮，内壮胃气，外酿脓浆为佐；肉桂宣通血脉，补托为使。第七天，脓色大长，以和平养长之剂而结痂。
吴孚先治疗一个儿子患痘，至出齐后，忽然变灰白，七八日毫无浆路，更兼便溏，不思饮食，势极危，用人参、鹿茸、制附子、肉桂、木香、桑虫、人牙、穿山甲、角刺、防风、桔梗、糯米，以黄芪二两煎汤煮药，一帖有浆脚，二帖起胀，三帖浆足矣。
一个儿子十三岁，痘出稠密，至八九日将贯脓时，粒粒陷入成窠。有人用木香异功散，陷伏愈甚。视其痘，色红紫而体气不弱，说：“这是血气欲行浆，为毒瓦斯壅遏，故痘顶陷伏，宜速清毒，血气自行，缓则有变。”用当归、生地、白芍、紫草、牛蒡、连翘、桔梗、甘草、山楂、黄芪，加酒炒黄芩、黄连，人参三分，一剂而陷立起，再剂而浆充满矣。
一个儿子年十四，痘出身热，三四日后，出才隐隐数点，忽然发谵狂，有人用凉药解毒。诊之，六脉缓弱，痘色淡白，说：“这是至虚似实。”缘气血虚弱，送毒不出，故发谵狂，与实热发狂者迥别。投以温中补气之药，痘出遍身，谵狂顿止。
王履素说：“我的孙子孟溥出痘，起发贯浆俱如法，惟回浆太早，第九天左臂发一痘毒，医生通用清热解毒之药，不四剂而寒战切牙之症作矣，皆泥于痘毒不敢用参、术，只用归、芪，而兼解毒。我认为痘后气血俱虚，复以寒药败脾，故见斯症，阳气已虚甚，即有归、芪，亦何能济？况尚兼清解乎，必无幸矣。《保婴撮要》寒战切牙门，用十全大补汤，即痘毒门初发时，只用仙方活命饮一二剂，旋用托里散助其元气，则未成可消，已成可溃。设使气血不充，则不脓不溃，难以收拾。于是断以己意，服十全汤三剂而寒战止，再数剂而切牙定。及延疡医妙手，外治其毒，内服参、芪、归、芍不辍，凡匝月而愈。当寒战症作，臂肿方剧，用药颇多疑虑，人参尚不敢多用，而况白术？至于桂，更无敢用至三分者。我叹曰：立斋断不误，遂决用大剂参、术，加桂至五六分，而诸症皆瘳矣。（立斋的错误也很多，不可以此为据。）”
周怀的第四个儿子，出生四十余日即出痘。起初头上并身上，不过三四点，身不甚热，饮乳如常，医生谓痘极少，当不满百粒，周怀不以为然，即令禁风调理。再二日遂多甚，头上、胸腹、腰背、手足俱稠密，至额上面上，及阴囊俱一片纯红，不分颗粒，脐内甚多，因肿大突出，舌上亦多，形如白粟，脓浆布满。医生又谓儿小痘多，且有不顺诸症，此必不可为矣。因视其痘色红活，颇能饮乳，宜可调治。第虑其气血不支，以人参、黄芪、炙草煎浓汁，时与乳相间饮之。五六日后，头上多有脓浆，间有水泡，身上及手足则水泡大半，脓泡仅小半耳。谓其气血有限，理所宜然。所虑额上面上，一片纯红者，忽有一二次变黑，因大惊，以为逆候也。然察儿精神及饮乳，略无困惫。至三更，阴囊下亦转黑结痂，因悟其非恶候，乃儿小血气易于周浃，七日后即收靥耳。至八日寅卯时，自上至下俱结痂，至时结完。九日自上至下俱痂落，至晚落完。既而遍身发大热，此毒未尽发，是以速收速落，将发痈也。急宜解毒，以大连翘饮浓煎汁，每用半酒杯，以茶匙缓缓挑服。一日夜，服三酒杯而热退，可无痈患矣。其鼻上有痂封固，以蜜密润之，用银耳挖挑开，以出其气。纯红处脓水未干，以黄柏、黄连、甘草、地骨皮、五倍子为细末糁之。阴囊流清水，用棉茧散糁之皆愈。（此气至而血不至也，欠此养血一着，故毒不尽解，留为后患。）
周怀的次女六岁出痘，发热甚缓，至二日，面与手微有痘影数点，热至第四日，其点仍旧，且带白色，困倦嗜卧，不思饮食。医生视之，谓痘轻少，不满百粒。周怀心甚疑，谓痘既少，儿当精神清爽，饮食如常。今困倦嗜卧，不思饮食，痘影淡白，此必气血虚弱，送痘不出故也。乃以温中益气汤托之，一帖而皮下隐隐欲出者甚多，二剂而痘出大半。一日夜尽四剂，而遍身出齐，稠密特甚。缘数日前曾患发热呕吐，稍伤胃气，故必待温中托里而痘方出故也。若不察其虚，不逐毒出外，必致内攻之患矣。
The eruption of smallpox is a great tribulation for infants. Before the Han Dynasty, this disease did not exist. During the Yuanshuo era of Emperor Wu of Han, envoys were sent to the Uyghurs, and the disease was transmitted from there into China. The pathogenic qi has a foul and turbid odor that is difficult to approach. Only among those of high status and virtue do black smallpox eruptions occasionally appear; this is extremely rare.
Zhu Xizhou (courtesy name Jinggong) of Kunshan had smallpox in his childhood. Every pustule was black, resembling a bundle of strips tied around his waist. All physicians declared it incurable. One physician, however, recognized the condition and said to Zhu's father, "Your son's condition poses no threat. However, I wish to make an agreement with you: I have a daughter, and after his recovery, I would like your son to marry into my family." Zhu agreed, and he subsequently became a live-in son-in-law. This physician was already wealthy and provided all necessary expenses. Later, Zhu passed the imperial examination as the top scholar (Zhuangyuan) in the Bingchen year of the Hongzhi reign, rose to the position of Minister of Rites, and became a renowned official in ritual and music. He lived to be ninety-four years old and was posthumously titled "Jing".
Zhang Daquan treated the son of Y Quanbu when he was a child. The boy had died from smallpox. Zhang examined him and said, "He is not dead." He urgently ordered a pit to be dug in the ground, placed the child inside, and took several buckets of fresh water. Using paper soaked in water, he applied it heavily to the child's body. After a short while, fine smoke rose, and the child's hand moved slightly. Zhang rejoiced, saying, "He is alive." He poured more water on the child, causing steam to rise vigorously, and the child cried loudly several times. Upon taking him out and administering medicine, he recovered within a few days.
Wang Min treated Shen Zhi, a Qianhu (military officer), who was twenty years old. Shen suddenly experienced dizziness, vertigo, and delirious speech, accompanied by fever and cough. Other physicians treated him for cold damage (Shanghan). Wang said, "This is smallpox." He prescribed Shengjun Tang, after which the eruptions appeared.
Ge Maolin diagnosed the son of Wang Bibu, who was twenty-five years old. He suddenly contracted smallpox. Wang, being knowledgeable about medicine, believed there was no danger. Ge looked grave. By the fifth day, the eruptions had fully emerged; by the seventh day, they had crusted over. Ge remained grave. On the fourteenth day, the scabs fell off, and Wang believed his son was safe. Ge said, "Disaster will likely occur at one month." When that time arrived, his son was perfectly fine. Wang hosted a grand banquet, seemingly mocking Ge's prediction. Ge observed blisters on the soles of the boy's feet, with scars forming within the skin, and sighed, "Alas! He is doomed." On that very day, the boy died suddenly. Wang considered Ge divine and asked for the reason. Ge explained, "Smallpox represents the residual filth left after the formation of the body. If even a tiny trace of toxin remains, there is no hope for life. This disease originates from the Kidney, and I knew it could not discharge smoothly, hence death was certain. Later, it flowed to the soles of the feet, which caused the slow onset but inevitable outcome on this day." Wang sighed in admiration.
Shen Haowen treated the adopted daughter of Shen Qinyun, aged ten. Her younger brother had smallpox, and she carried him to seek medical treatment. Shen said, "The brother is unharmed, but the sister will develop malignant smallpox. If she experiences headache and bone pain, she should drink clear urine (Fenqing)." Following this advice, she recovered.
Tang Shouyuan treated the son of Lady Zhu of Yuanhua. The boy suffered from smallpox with blood eruptions covering his entire body without any gap. Tang crushed herbs and applied them to the boy's body, sprinkled herbal powder on the bedding, rolled the boy up, and held him upside down before the bed. The whole family wept in horror. Tang shouted, "Do not be alarmed. This is called 'Snake Skin Smallpox.' It must be treated inversely to escape danger." Soon, the skin cracked and separated like a snake shedding its skin, and he recovered.
Guan's daughter, Aguan, was eight years old and had many severe smallpox eruptions. Dr. Shen asked, "What do other doctors say?" They replied, "It is a fatal case; no medicine is needed." Shen said, "Although the child has many dead eruptions, there is one living eruption, which can still save her." He ordered a hen that had been brooding chicks for five years to be taken. Medicine was inserted into the hen's abdomen, and the hen was steamed with glutinous rice until consumed. Upon examination, two eruptions were found on the Guan pulse of the right hand, bright and vivid like pearls. The girl survived.
Jiang Lutao's son was one year old, with only three smallpox eruptions appearing on the forehead, behind the ears, and beside the lips. Shen said, "The location of the eruptions indicates a reverse transmission through the Heart, Kidney, and Spleen meridians. Earth overcomes Water, and Water overcomes Fire. Treatment should focus on purging rather than tonifying. Purging disperses the toxin, while tonifying harms the zang-fu organs." By the fourteenth day, the eruptions were bright and moist, nearing maturity. Shen said, "Using Gypsum (Shigao) might injure Stomach Earth and Kidney Water." Unorthodox physicians, pitying the young child, mistakenly administered Ginseng (Renshen). Shen exclaimed in shock upon seeing this, "Ginseng? He will not survive past twenty-one." The child eventually died.
Xu Jiming's youngest son had smallpox. Shen said, "This is a favorable course; no tonification is needed. Children possess pure Yang energy; excessive Yang inevitably suppresses Yin." Xu did not comply. The smallpox healed, and Xu mocked Shen as reckless. Shen predicted, "The child will soon die." Xu was displeased. On the twelfth day, while the child was sleeping soundly, he was found deceased.
Pan recorded a case: A girl suffered from fever, lower back pain, cold extremities, and dull eyes. The symptoms were extremely severe, suggesting impending smallpox. It was summer, so pig blood from a butcher was urgently obtained. Dragon Brain (Bingpian/Borneol) was added in double dosage, mixed, and ingested. The girl fell asleep. Shortly after, eruptions appeared all over her body, and she stabilized. Without this prescription, she would have died prematurely. (From *Bencao Gangmu*).
Chen Po from Kuocang recounted that when he was teaching in Sanshan, his grandson, aged three, had a seven-day fever. Smallpox erupted but inverted (daoye), with black coloration, white lips, and icy coldness. A scholar advised using seven houseflies (Gouying) ground finely, mixed with a little vinegar wine. After a while, the complexion returned to normal redness. His second daughter developed internal cataracts due to toxin attacking upwards after smallpox. A physician used one snake skin, washed and dried, mixed equally with Trichosanthes Root (Tianhuafen), ground into powder, stuffed into a sheep liver, bound with hemp rope, boiled in rice wash water, and eaten in slices. She recovered in ten days. (From *Yiju Lu*. Houseflies are abundant in summer; in winter, they hide in ears.)
Zhao Shenxian from Fugou transmitted the "Revive the Dead Powder" (Qisi Huisheng San) for treating smallpox on the seventh or eighth day when eruptions suddenly turned black and receded into the abdomen, with scratching wounds all over, gasping, and imminent death. Taking this powder causes new eruptions to emerge, restoring life immediately. The formula uses Siwu Tang plus Cimicifuga (Shengma) and Safflower (Honghua). For upper inversions, add Angelica Dahurica (Baizhi); for lower inversions, add Achyranthes (Niuxi); for full-body black inversions, add Ephedra (Mahuang) and roasted elephant dung. Dosage: 2 qian for a one-year-old, up to 3-5 qian for older children. Decoct one dose in half water and half wine. For black boils on the feet, puncture on the seventh/eighth day, apply Taiyi Plaster to draw out toxin, continuing 2-3 doses.
Zhu Danxi treated a seven-year-old boy. At the stage just before smallpox eruption, he had diarrhea several times with black stool. The eruptions lacked distinct bases. After three days, itching occurred; scratching released black fluid. The child was thirsty, and the bases resembled vesicles, non-red, non-shiny, and undeveloped. Appetite was poor. The pulse was floating, rapid, and forceful, but empty upon deep pressure. Zhu used Ginseng (Renshen), Poria (Fuling), Angelica Sinensis (Danggui), Atractylodes (Baizhu), Tangerine Peel (Chenpi), and Myristica (Roudoukou) as sovereign herbs; Roasted Licorice (Zhi Gancao), Chebula (Hezi), and Cinnamon Twig (Guizhi) as minister/herald herbs. Decocted in water with a little good wine. Itching stopped immediately, appetite returned, bases became red and shiny, and eruptions developed. Two doses resulted in full recovery.
Gong Zicai treated a girl whose smallpox had swollen and was about to suppurate when it suddenly turned purple-black and bled upon scratching. This indicated excessive heat toxin. He used Mirabilite (Pinxiao) in unspecified amounts, boiled with a pinch of Sichuan Pepper (Huajiao). Green cloth soaked in the solution was frequently applied to the affected area for a long time, restoring swelling and appearance.
Sun Wen yuan treated the eldest son of Zheng Duojian, aged four, with dense, irritable smallpox. Physicians claimed excessive heat persisted, wasting physique, purple color, and scorched tops, indicating a hopeless adverse condition. Sun examined closely, noting round temples and vigorous spirit (indicating potential for life). He prescribed urgent cooling of blood and detoxification: Red Peony Root (Chishao) and Rehmannia (Shengdi) 3 qian each, Arnebia/Lithospermum (Zicao) 2 qian, Forsythia (Lianqiao), Scutellaria (Huangqin), Fritillaria (Beimu), Hawthorn (Shanzha), and Akebia (Mutong) 1 qian each, Cicada Slough (Chantui) and Licorice (Gancao) 0.5 qian each. Others objected, stating "Measles require cooling, smallpox require warming." Sun argued, "Medicine must match the syndrome. Baoyuan Tang is warm, but suitable only after blood circulation improves and heat clears. With current blood heat and toxin, warming agents are adding oil to fire." Others suggested using Silkworm (Sangchong) with chicken blood wine to "attack toxin with toxin." Sun warned this would intensify fire if used before clearing heat. Zheng complied with Sun's initial formula (minus Shanzha and Beimu per others' advice). Next day, eruptions became bright, scorched tops receded, and blood flow improved. Vomiting and hiccups ensued, blamed on the medicine by others. Sun attributed it to residual fire toxin and prescribed Bamboo Shavings Decoction (Zhuru Tang), causing uproar. Zheng's brother verified Zhuru usage in *Douzhen Quanshu*, silencing critics. Hiccups ceased. On day eight, diarrhea and itching appeared; Baoyuan Tang plus White Peony (Baishao), Atractylodes (Baizhu), and large amounts of Polygonatum (Shouwu) stopped diarrhea and itching. By day fourteen, Tian Ting and cheeks crusted, but cheeks remained unclosed with persistent diarrhea. Half a day later, mouth opened, crown soft, limbs collapsed, abdomen distended—internal attack. Family wept; Sun was at a loss and left. Zheng's brother escorted him. Hearing a smallpox odor on Sun's clothes, Zheng asked if he smelled it. Sun said yes, noted signs of life, and urged return. He reasoned the unclosed cheeks indicated Kidney deficiency. He first gave Human Placenta (Ziheche) 1 qian with wine, inducing sleep. Then, a large dose of Ginseng (Renshen) 1 liang, Astragalus (Huangqi) and Dodder Seed (Tusizi) 3 qian each, administered over 24 hours (totaling 1.8 liang Ginseng). Yellow serum reappeared under crusts ("gifted pus"), and he recovered. (Note: This case highlights Qi deficiency with Blood heat and stagnant Stomach Qi. Adding Radix Puerariae (Gegen) to cooling formulas aids Stomach Qi; adding Ginseng and Astragalus boosts Qi. This method belongs to Zhao Gongfu. Sun initially lacked this insight, causing delays.)
Yu Jiayan diagnosed Gu Ming's son immediately after variolation. The vaccine material was pale red, distinct, containing moisture, bright, and sparse. Other doctors praised it as a "Top Scholar Smallpox," unaware of underlying issues. After hesitation, Gu Ming reported: Heat not yet suppressed, heavy head, weak neck, restlessness, irritability, green-white diarrhea. This is seasonal external contraction combined with internal deficiency. Standard smallpox formulas would be dangerous. One or two doses to resolve external contraction would allow spontaneous cure. Delaying two or three days would be fatal. They ignored this, feeding shrimp, fish, chicken, and eruptive foods, worsening the condition. The child deteriorated by day six, confirming the prognosis. Two days later, the second son also developed fever and smallpox with seasonal invasion, treated by the same doctor, and failed by day six.
Feng Chuzhan treated the grandson of Jiang Zongxian. Smallpox was not dense, but congenital weakness was severe. High fever, profuse sweating, and retreating flat eruptions over four days, with lethargy and fright. Feng stated: High fever indicates Yang outside; sweating indicates Yin leaking and Yang failing to consolidate. Tonify Yin, nourish Yang, and strengthen the Middle. Formula: Rehmannia (Shudi) 8 qian, Atractylodes (Baizhu) stir-fried in milk 3 qian, Achyranthes (Niuxi) 8 qian, Ophiopogon (Maidong) 2 qian, Schisandra (Wuweizi) 0.4 qian, Cinnamon Bark (Rougui) 0.6 fen. Decocted. Within an hour, deep sleep, cool body, sweat stopped, spirit refreshed, eruptions rose, appetite returned, and he recovered.
A Hu family child had critical smallpox initially. An old doctor predicted death. Feng Chuzhan was invited. The previous prescription was excessively cooling, causing stagnation and eruption failure, with wheezing and abdominal distension. Feng first used fermented rice wine and rooster comb blood with Dusheng San to break the ice-like stagnation. Wheezing and heat decreased, and eruptions showed signs of emerging. The opposing doctor argued for inevitability of death. Feng insisted on collaboration. The father wept daily but allowed treatment. Eight or nine out of ten recovered, but the father remained unhappy, having been told repeatedly that death was imminent. Only upon complete scabbing did the father show joy, regretting his earlier doubts.
Feng Chuzhan's fifth son, constitutionally weak, developed smallpox at age four. Fever for one to two days led to fatigue and profuse sweating. Eruptions appeared, but due to excessive sweating and Yang deficiency, dispersing agents were withheld. Beyond day three, sweating continued, frequent urination/defecation occurred, visible eruptions retreated, and unseen ones vanished. Formula: Ginseng (Renshen) and stir-fried Atractylodes (Baizhu) 3 qian each, Roasted Licorice (Zhi Gancao) 0.8 fen as sovereign (to secure Middle); Heavenly Silkworm (Tiancan) 3 qian, Thorny Acacia Spine (Jiaoci) 1 qian, Stir-fried Turtle Shell (Jiapian) 0.6 fen as ministers (to attack and support); Ligusticum (Chuanxiong) 0.8 fen to lift and disperse, Cinnamon Bark (Rougui) 0.6 fen to warm channels and reach exterior as assistants. Day four: Sweating/diarrhea reduced, some eruptions grew, hidden ones appeared. Added Angelica (Danggui) and Jujube (Dazao). Day five: Swelling began, slight pus formation in later eruptions. Facial eruptions were pale red without luster; back eruptions were purple, depressed, and dry, indicating Qi/Blood deficiency with stasis. Added Astragalus (Huangqi), Yam (Shanyao), Glutinous Rice (Nimi), and Longan (Yuanrou). Day six: Eruptions red and vibrant, but thin-skinned, shiny, with thin pus and limb blisters, indicating weak Qi/Blood and deficient Spleen Earth. Used Baoyuan Tang plus Cinnamon. Ginseng 5 qian (sovereign, tonifies primal Qi); Raw Astragalus 2 qian (minister, supplements Wei Qi); Roasted Licorice 0.6 fen, Glutinous Rice 1 zhua (assistants, soothe Middle, strengthen Stomach, brew pus); Cinnamon (envoy, unites vessels, supports). Day seven: Pus greatly increased; healed with a mild nurturing formula.
Wu Fuxian treated a boy whose smallpox turned gray-white after full eruption, with no pus formation for 7-8 days, loose stools, and anorexia. Critical condition. Formula: Ginseng, Deer Antler (Lurong), Processed Aconite (Zhi Fu), Cinnamon, Aucklandia (Muxiang), Silkworm (Sangchong), Human Tooth (Renya), Pangolin Scales (Shanjiapia), Thorny Acacia Spine, Saposhnikovia (Fangfeng), Platycodon (Jiegeng), Glutinous Rice. Decocted in decoction of Astragalus (Huangqi) 2 liang. First dose: pus base formed. Second dose: swelling rose. Third dose: sufficient pus.
A thirteen-year-old boy had dense smallpox. By days 8-9, approaching suppuration, every pustule was depressed into a pit. Muxiang Yigong San worsened the depression. Eruptions were red-purple, constitution strong. Diagnosis: Qi/Blood attempting to form pus, blocked by toxic vapors. Urgent detoxification required. Formula: Angelica (Danggui), Rehmannia (Shengdi), White Peony (Baishao), Arnebia (Zicao), Burdock (Niubang), Forsythia (Lianqiao), Platycodon (Jiegeng), Licorice (Gancao), Hawthorn (Shanzha), Astragalus (Huangqi), plus Wine-fried Scutellaria (Huangqin) and Coptis (Huanglian), Ginseng 0.3 fen. One dose raised depressions; two doses filled with pus.
A fourteen-year-old boy had fever after eruption. After 3-4 days, only faint spots appeared. Suddenly developed delirium. Cooling detoxifiers were tried. Pulse: slow and weak throughout. Eruptions: pale white. Diagnosis: Extreme deficiency mimicking excess. Weak Qi/Blood failed to expel toxin, causing delirium (distinct from excess heat mania). Administered warming and Qi-tonifying herbs. Eruptions spread, delirium stopped.
Wang Lusu stated: His grandson Mengpu had standard smallpox development and suppuration, but early resolution of pus. On day nine, a boil appeared on the left arm. Doctors used cooling detoxifiers. Within four doses, chills and teeth-grinding occurred. Doctors feared using Ginseng/Atractylodes due to toxin, relying only on Angelica/Astragalus with detoxifiers. Wang argued post-smallpox Qi/Blood deficiency, exacerbated by cold herbs damaging Spleen. Yang was severely deficient; Angelica/Astragalus alone insufficient, especially with cooling agents. He cited *Baoying Cuoyao* recommending Shiquan Dabu Tang for chills/teeth-grinding, or Xianfang Huoming Yin followed by Tuoli San for early boil stages. Insufficient Qi/Blood prevents suppuration/drainage. Wang prescribed Shiquan Tang for three doses to stop chills, then more to stop teeth-grinding. External treatment by a surgeon, internal use of Ginseng, Astragalus, Angelica, and White Peony continuously. Recovered in a month. During chills, arm swelling was severe; hesitation to use Ginseng/Atractylodes/Cinnamon was common. Wang concluded Lizhai's advice was correct, using large doses of Ginseng/Atractylodes and Cinnamon (5-6 fen), curing all symptoms. (Note: Lizhai has errors; do not rely solely on this.)
Zhou Huai's fourth son developed smallpox at 40+ days. Initially 3-4 spots on head/body, mild fever, normal nursing. Doctors predicted <100 spots. Zhou restricted wind and regulated diet. Two days later, density increased significantly on head, chest, abdomen, back, limbs, forehead, face, and scrotum (solid red, indistinct particles). Umbilicus had many protruding spots. Tongue had many white millet-like spots filled with pus. Doctors deemed it hopeless due to small size and many spots/adverse signs. Zhou observed red/vibrant color and good nursing ability, deeming it treatable. Worried about Qi/Blood exhaustion, he gave concentrated decoction of Ginseng, Astragalus, and Licorice, alternating with milk. Days 5-6: Head had much pus/blisters; body/limbs mostly blisters, few pus-pockets. Forehead/face solid red turned black once or twice, alarming Zhou as adverse. However, spirit and nursing remained intact. By midnight, scrotal scabs turned black. Zhou realized this was not evil due to young age allowing rapid Qi/Blood circulation; scabbing completed by day seven. By day eight (Yin/Mao hours), full body crusted. Day nine: Scabs fell off completely. Subsequently, high fever appeared due to incomplete toxin expulsion, leading to rapid scabbing/falling and impending carbuncle. Urgent detoxification with Dalianqiao Yin (half wine cup, slowly spoon-fed). Three cups overnight cleared fever. Nose scabs softened with honey, picked open with silver ear to release gas. Solid red areas with wet pus dusted with Phellodendron (Huangbai), Coptis (Huanglian), Licorice, Dogwood Root Bark (Digupi), and Chinese Gall (Wubeizi). Scrotal clear fluid treated with Cotton Cocoon Powder. All healed. (Note: Qi reached but Blood did not; lack of Blood-nourishing step left residual toxin.)
Zhou Huai's second daughter developed smallpox at age six. Fever was slow. By day two, faint spots on face/hands. By day four, spots remained, whitish, with fatigue, somnolence, and anorexia. Doctors saw few spots (<100). Zhou suspected otherwise: Few spots should mean clear spirit and normal appetite. Fatigue/anorexia/pale spots indicated Qi/Blood deficiency failing to expel toxin. Prescribed Wenzhong Yiqi Tang to support and expel. One dose: many hidden eruptions appeared. Two doses: majority erupted. Four doses in 24 hours: full body eruption, very dense. Cause: Previous fever/vomiting damaged Stomach Qi, requiring warming/support to erupt. Failure to recognize deficiency and expel toxin would lead to internal attack.