一赵中书郎二十岁痘，朱四日内视之，面部油光，喉凹下至胸下鸠尾，如小儿涎衣状，一片红丹，润至
两腋前，颈上腹上则朗绽。朱曰∶油光症，元阳大泄，胸膛之丹，居华盖之地，此险中带逆症也。药之，至五
日后，面部油光者，有浆势也。胸前丹俱起粟珠，带浆色，独背上紫色未退，舌有微苔，他医定大下。朱曰∶
此症元阳已泄于面，只可重用润药，不可用硝、黄攻之。用当归五七钱，一剂，佐以枳壳诸凉血药。于五六日
小灌之期，一医用人参、黄 、肉桂、鹿胶，下午则神昏谵妄，两齿相斗，声闻彻耳，七八日皆然。仍用大清
凉四剂，九日浆似大行，而斗齿诸症亦少静，觉眼眶稍陷，神稍倦。于清凉中略用人参五分，以助元气，眼不
合而有泪，鼻不封而有涕，面部渐成苍老之色，而胸前丹地，则浆水成袋，两臂两腿亦有浆袋。至十一日夜，
忽大渴，连饮荼十三四碗，此引水自救之意也。微用清补，延至十二朝，症渐平。后即去参，单以养血清火药，
扶至十七八朝而愈。此人新娶，元气未免削薄，故清凉中略带补耳。此症至八九日，阴囊根上忽失血杯许。朱
曰∶此血一出，可当发毒，后果如所言。若坏症，则此血又大泄肾元矣，何以能生？
朱应我治其堂弟，年四十岁患痘，二日，视之面浮，白点如 成片，遍身紫细点如麻成片。朱曰∶此症死
生在定标时，开则生，不开则危。急用犀角饮，并破气血药，大料饮之，每日三剂。至四日，天庭地角，忽开
朗如星散，惟两颧仍不开。启身视之，亦开朗，特紫色太甚，腰下更平塌如痣，生意虽有，尚濒死地，急以大
黄下之，犀角照原料不少减。所下仅溏，尚不大通，以其原有吐红之疾，秉体虚弱，不堪大剂剥削，只得用酒
熟大黄薄涤之。第五日下泄多，且如粟块。六日早视之，两颧忽星散而朗，身痘亦朗绽，面部大有放白起水之
势。七日势充而浆至矣，止大黄、犀角，只用凉血清火之剂。奈胸背两臂仍枯滞紫焦而不动，又急用犀角四五
钱饮之。忽胸前及两臂手腕，痘有起顶放水白之光，根脚如石榴样，红艳可爱。朱曰∶届九日浆水必至矣。仍
用犀角药，下午浆至，十日遍身水浆充满而来。无何，十二朝收靥，遍身无一硬壳，止见破裂浆水，不流者起
泡，已破者见赤肉，病者大惧。朱曰∶浆有七八分，红根尽化，此醒浆收也。延至十六七朝，头额复瘟疤而浆
起，胸前亦起，原破裂者，皆有 壳。头额所瘟于六日出蛆，并卵袋破处亦蛆，浆水臭烂，是微有生气可医。
但脾胃不强，口舌生疮，此余毒尚未清也。十九朝前，全以清凉扶之而已。此症初决为血热异常，到底不可补
益。病者平素虚弱，恐不其然。至后节次用清凉则安，一停犀角等药，即发大热。第三日发狂，用牛黄、琥珀
等而安。六日停犀角，不安。七八日，重用犀角，又安。十七八日，少进 、术，又不安。况腰以下自腿至胫，
十七八日犹然紫黯，而灌浆皮且有皱纹折数。此痘难治，一至于此。夫大险症，未有眼不合，鼻不封，而可
以灌浆者。此症九日前，眼止合一日，鼻则不封。何以能灌八分之浆，毕竟不结靥而醒浆破溃，眼复微合，
鼻反大封。十八夜，因嗔怒，十九日少见鼻血，此不善调摄之过也。昼夜泄六七次，神气不爽，饮食减少，小
水一夕七八次，不得已进补中益气汤，人参用至数钱，以回生意。此清后用补，乃正法也。此乃二十日期，越
一日，稍思食。辰后大便仍条软，午后食略增，急去补中益气中之升、柴，配之以八物料，仍不减黄连，参止
用三四分，为其养血，以令气之不发越而为火，此阴阳调燮之妙理也。又因七八日来，腰背倦卧，而不能伸，
脚膝屈软而不能步，未扶之起，顿觉能坐能移，亦见引导药力之妙。又二十四日夜半，先寒战，随发热，宛如
疟状，如此者四夜，或止或发，此是痘作于六月时，未免夹溽暑之寒热。至五日下午，汗流至腹，朱曰∶暑气
解矣，此夜必不发热。果然。其实数日内小柴胡加人参、天冬、知母、五味，间加香薷，故得愈也。
按∶此痘六月初二日见，至七月半，予南行，嘱曰∶原痘甚危，此时股肉脱，饮食少，元气未复，必保
养年余，方可安枕。别去五十日，九月初至家，一见惊曰∶弟何脱形至此？急离卧内，调药饵，或可延也。
讵予又远行，病者家务不放闲，书史不放手，忽于夜半时竟死矣。大都痘犯大危，后来不善调摄，未有能
保全者。此症痊后，房中过百日，安得不就枕席之事，所以一百二十日之关，不能逃也。（原评。）
朱应我治一郑姓妇，见点面部不甚稠，止颏下有红色一小片，至四日，面部软萎，遍身夹丹，丹中微微细
点。朱曰∶此丹不能退，后必大灌清水，定然外剥。医虽用参、 ，面部不放白，颏下至身，通行皮卷破裂，
九日而逝，此丹症之最酷者也。
一戚室庠友子，三十余岁患痘，一医视标，以为极顺，可勿药。其宗有医，以为险甚。主人信先医，不信
宗医，治五日，延朱决之。至则视其面部根顶不分，痘地不分，淡白一色，且有油光，况口张不阖，唇不盖齿，
此危症也。所取者，面粒疏朗可数，兼之胸前甚少，而颈亦稀耳。启四肢视之，则挨簇中夹丹，两臂阳面之丹，
自曲骨上下约长三四寸，阔寸许。两股阳面之丹，自臀横纹起，直至脚肚下，约长二尺许，且背如通红之毡条。
幸两臂阴面两股阴面，尚有子粒，而不甚稠。论颜色则面淡白，颈胸粒白，而根不红。丹内琐细如堆粟，丹外
紫地一片，即阴面之痘，皆点粒下有紫晕一圈，细看如此形色，即欲谢归。奈主母乃朱同宗女，强留之，为其
二三日前，舌有小血泡，吮之始平。询大便数日不行，遍身皆紫色，权以大黄下二三度，继以犀角地黄汤，兼
芩、连投之，随手辄效。九日面部颈胸浆皆至，背及四肢亦见浆色，而丹处有似水白。主人益信为顺症。十一
日，丹处浆水成袋，忽忽破流，而皮脱去矣，面部及胸结浓壳可观，是日粥入而呕痰与水，不多食，且艰阻，
朱与宗医商扶脾方进之。痘者自计饮乳，雇乳母及内人，似小儿吮法，主人以为妙术。日落时忽谵语一二句，
夜半更甚，小便尿血数点。十二日早视之，昏谵，尚知人事，叩之则应，但精神疲弱不支。因数日便闭，冀便
通或可止谵，用蜜导法不应，于补脾药内重用当归，仅少溏泄，而大便亦有血，主人始惧。时朱有他行，然不
知小便之血胡为而来。细询之，知痘者平日极好色，此时原有契友伴卧，言未吮乳先，痘者言∶好却好，恐泄
精。又主母来看，令婢坐榻前服事，友另坐，从壁隙窥之，见主母偶离，痘者 问何人，婢者应，即推去被，
而以两手搂婢。如是，则前少妇吮乳时，未必不动念，精变血而来，固如是乎。细思粥入而呕逆，食入几何，
蜜导而不通，药润而无益，此痘中关格之症，气血已不流通，安望成功？夫血热故成丹，丹艳故成剥，此丹甚
剥甚之不多见者也。又面肿退而眼开者，其常也。此痘洗眼以令其开，犹然上胞不支而紧合，视其黑珠，则
似明似昧，此亦神将脱之症也。又痘者每日饮雨前细茶不已，禁之不听，后竟粥入而呕逆，未必非茶饮之过。
别后闻舌短者已两日，危甚。后忽渐转能饮食，宗医仍调以清剂，延至十八日而食大进，可渐生矣。细思此痘，
面颈胸点少可数，即臂内股内，皆有子粒，至背如红毡，臂外股外皆夹丹无缝，从未有阴阳分界有如此稀密之
不同者也。内症则呕逆在上，阻滞失血在下，神昏舌短，外剥甚酷，此死多生少之症，得生可为万幸。又细思
此症之生，毕竟面部稀疏有浆，即四肢及背，如此酷烈，犹有保全于濒死之时。古云痘全以正面为主，信哉。
至十九日，闻其左眼流脓，珠子凸出，右眼障满则坏矣。从来外剥不至内攻，内攻者甚罕，此症得生，亦千百
之一二云。
朱应我治一人，二十三岁，痘出六日，延朱视之，舌上黑色罩满，黑疔在舌尖之里，如圆眼核大，面部有
子粒而朗，身亦布匀，而脚色尚不紫黯，急磨生犀角二三钱，入黄连解毒汤内，加石膏、竹叶、灯心，日大料
三剂，舌黑色尽退，疔尽消平，红润如常，饮食亦进。至第八日，正面浆五六分，而胸背浆亦来，朱以戚痘促
归，遂付之他医。至十二朝夜，烦躁呢喃。延至十三朝，而失尿遗屎之症顿生。十四朝，始复迎朱。至视之，
则已倒靥，碎铺似炉灰色，挺卧如尸，口自言，手自撒，胸背浆水清，两手腕至臂皆软鳖无神，痘粒比前似加
稠密。盖肿腿臂瘦，而痘落下，故见密也。朱辞不治，后闻他医见其遗屎，即进人参三钱，又见其谵妄，即进
犀角三钱。此医者手忙脚乱，而主人不知也，延至十六朝而逝。此虽医者之无法，然实疔之痘，从来未有如此
之酷烈者。故伏毒甚深，医治一错，岂不关人性命哉。
朱丹溪治一叟，发热而昏倦，其脉大而似数，与参、 、归、术、陈皮，大料二十剂而痘出。又二十剂而
脓泡成，身无完肤。又六十剂而安。
赵中书郎二十岁时患痘疹，朱丹溪在第四天诊视。见其面部皮肤油亮光泽，咽喉凹陷处一直延伸到胸部下方的鸠尾穴区域，如同小儿唾液形成的薄膜状，呈现出一片红色的痘斑，湿润光亮延伸至两侧腋下前方，而颈部和腹部则痘疹舒展明亮。朱丹溪说：“这是‘油光症’，表明元阳之气大量外泄。胸前的红色痘斑位于华盖（肺）所在之地，这是险症中带有逆证的表现。”用药治疗后，到了第五天，面部油光消退，痘疹有了灌浆的趋势。胸前所有的红色痘斑都隆起如粟米珠状，带有浆液的颜色，唯独背部的紫色痘斑没有消退，舌头上有轻微的苔垢，其他医生判定应当使用大黄、芒硝等猛烈攻下的药物。朱丹溪说：“此症元阳已在面部外泄，只能重用滋润的药物，不可用硝石、大黄来攻伐。”于是使用当归五到七钱，一剂药，辅以枳壳等凉血药物。在五六天小灌期时，另一位医生使用了人参、黄芪、肉桂、鹿角胶等温补药物，下午患者出现神志昏迷、胡言乱语，两齿相击打架，声音大到耳朵都能听见，七八天都是这样。朱丹溪仍然使用大清凉方剂四剂，到了第九天，浆液似乎大量生成，而咬牙等症状也稍微安静下来，患者感觉眼眶稍显凹陷，精神稍显疲倦。于是在清凉药中略微加入五分人参，以辅助元气，此时眼睛不再完全闭合且有泪水流出，鼻孔不再闭塞且有鼻涕流出，面部逐渐呈现出苍老之色，而胸前的红色痘地，浆水形成袋状，双臂和双腿也有浆袋形成。到了第十一夜，突然极度口渴，连续喝茶十三四碗，这是身体引水自救的意思。轻微使用清补之法，延续到第十二天，症状逐渐平稳。之后去掉人参，单用养血清火药物，扶持到第十七八天痊愈。此人刚娶妻，元气难免削弱单薄，所以在清凉药中略带补益。此症到了第八九日，阴囊根部突然失血约一杯许。朱丹溪说：“这一出血，可以代替发散毒邪，后果正如所言。”如果是坏症，这血会再次大量泄漏肾元，怎么能存活呢？
朱应我治疗他的堂弟，四十岁患痘疹，第二天诊视，见面部浮肿，白点成片，遍身紫细点如麻子成片。朱丹溪说：“此症的生死取决于标色是否开启，开启则生，不开启则危险。”急忙使用犀角饮，并配合破气血的药物，大量服用，每天三剂。到了第四天，天庭和地角部位，突然开朗如星散开，只有两颧仍未开启。掀开身体查看，也开朗了，只是紫色太严重，腰部以下更平坦塌陷如痣，生机虽有，但仍濒临死亡边缘，急忙使用大黄攻下，犀角照原剂量不少减。所下的粪便仅稀溏，尚不通畅，因为他原有吐血之疾，体质虚弱，不堪受大剂量药物的剥削，只得用酒制熟的大黄轻轻涤荡。第五天下泄较多，且像粟米块状。第六天早上诊视，两颧突然星散而开朗，身上痘疹也舒展明亮，面部大有放白起水的趋势。第七天势态充盈，浆液就到了，停止使用大黄、犀角，只用凉血清火的方剂。无奈胸背和双臂仍然枯滞紫焦而不活动，又急忙使用犀角四五钱服用。突然胸前及双臂手腕处，痘疹起顶放水呈白色光泽，根脚像石榴样，红艳可爱。朱丹溪说：“到了第九天浆液一定会到来。”仍用犀角药，下午浆液至，第十天遍身水浆充满而来。不久，第十二天收靥，遍身没有硬壳，只见破裂的浆水，未流的起泡，已破的见赤肉，病人非常恐惧。朱丹溪说：“浆液已有七八分，红根全部化解，这是醒浆收靥。”延续到第十六七天，头额又长瘟疤而浆液再起，胸前也起，原来破裂的，都有结痂。头额所长的瘟疤在第六天出蛆，阴囊袋破处也有蛆，浆水臭烂，这是微有生气可医。但脾胃不强，口舌生疮，这是余毒尚未清除。第十九天前，全用清凉药扶持而已。此症初判为血热异常，到底不可补益。病人平素虚弱，恐怕不是这样。后来节次使用清凉药则安适，一停犀角等药，就发大热。第三天发狂，用牛黄、琥珀等药而安。第六天停犀角，不安。七八天，重用犀角，又安。十七八天，少量进服白术、茯苓，又不安。况且腰部以下自腿至小腿，十七八天仍然紫暗，而灌浆的皮肤甚至有皱纹折叠。此痘难治，到了这种地步。大险症，从来没有眼睛不闭合，鼻子不封闭，就可以灌浆的。此症九天前，眼睛只闭合了一天，鼻子则不封闭。怎么能灌八分的浆，毕竟不结靥而醒浆破溃，眼睛重新微合，鼻子反而大封。十八日夜，因愤怒，十九日少量流鼻血，这是不善调摄的过错。昼夜腹泻六七次，神气不爽，饮食减少，小便一夜七八次，不得已进服补中益气汤，人参用到数钱，以挽回生机。这是清解后用补益，是正法。此症过了二十天期限，过了一天，稍微想吃东西。辰时后大便仍条软，午后食物略增，急忙去掉补中益气汤中的升麻、柴胡，配伍八珍汤物料，仍不减黄连，人参只用三四分，为了养血，使气不浮越而为火，这是阴阳调和的妙理。又因为七八日来，腰背倦卧，不能伸展，脚膝屈软不能行走，未扶起之前，顿觉能坐能移，也见到引导药力的奇妙。又二十四日夜半，先寒战，随后发热，宛如疟疾状，如此四天，或止或发，这是痘疹发作在六月时，未免夹杂暑湿的寒热。到了第五天下午，汗流至腹部，朱丹溪说：“暑气解除了，此夜必不发热。”果然。其实数日内用小柴胡加人参、天冬、知母、五味子，间加香薷，所以得以痊愈。
按语：此痘六月初二日显现，到七月半，我要往南行，嘱咐说：“原痘很危险，此时大腿肌肉消瘦，饮食少，元气未恢复，必须保养一年余，方可安心。”分别五十天后，九月初到家，一见惊叫：“弟弟怎么瘦脱形到这种地步？”急忙离开卧室，调药喂食，或许可以延长寿命。岂料我又远行，病人家务不放闲，书史不放手，忽然于半夜时竟死去了。大都痘疹犯大危，后来不善调摄，没有能保全的。此症痊愈后，房事中过了一百日，怎能不就枕席之事，所以一百二十日的关卡，不能逃脱。（原评。）
朱应我治疗一位郑姓妇女，见痘点面部不甚稠密，只有下巴下有红色一小片，到了第四天，面部软萎，遍身夹杂丹毒，丹毒中微微细点。朱丹溪说：“此丹不能退，后来必然大量灌注清水，定然外部剥落。医生虽然用人参、黄芪，面部不放白，下巴到全身，通行皮卷破裂，第九天去世，这是丹症中最残酷的。”
一位同乡学友的儿子，三十多岁患痘疹，一位医生看标色，认为极顺，可以不用药。他的家族中有医生，认为很危险。主人相信先前的医生，不相信家族医生，治疗五天，请朱丹溪决断。到了那里，看其面部根顶不分，痘地不分，淡白一色，且有油光，况且口张不闭，唇不盖齿，这是危症。所取的依据是，面粒疏朗可数，兼之胸前甚少，而颈部也稀疏。掀开四肢查看，则在挨簇中夹杂丹毒，两臂阳面的丹毒，从曲骨上下约长三四寸，宽一寸许。两股阳面的丹毒，从臀部横纹起，直到脚肚下，约长二尺许，且背部如通红的毡条。幸好两臂阴面两股阴面，尚有子粒，而不甚稠。论颜色则面淡白，颈部胸部粒白，而根不红。丹内琐细如堆粟米，丹外紫地一片，即阴面的痘，皆点粒下有紫晕一圈，细看如此形色，就想谢世归去。无奈主母是朱丹溪同宗女，强留之，为其二三日前，舌有小血泡，吮之才平。询问大便数日不行，遍身皆紫色，权且用大黄攻下二三度，继以犀角地黄汤，兼黄芩、黄连投服，随手辄效。第九天面部颈部胸部浆液皆至，背部及四肢也见浆色，而丹处有似水白。主人更加相信为顺症。第十一天，丹处浆水成袋，忽忽破流，而皮脱去矣，面部及胸部结浓壳可观，当日粥入而呕痰与水，不多食，且艰阻，朱丹溪与家族医生商量扶脾方进之。痘者自己打算饮乳，雇乳母及内人，似小儿吮吸法，主人以为妙术。日落时忽谵语一二句，夜半更甚，小便尿血数点。第十二天早上诊视，昏谵，尚知人事，叩之则应，但精神疲弱不支。因为数日便闭，希望便通或许可止谵语，用蜜导法不应，于补脾药内重用当归，仅少溏泄，而大便亦有血，主人始惧。当时朱丹溪有其他行程，然而不知小便的血为何而来。细问之，知痘者平日极好色，此时原有契友伴卧，言未吮乳前，痘者言：“好却好，恐泄精。”又主母来看，令婢女坐榻前服事，友另坐，从壁隙窥之，见主母偶离，痘者问何人，婢女应，即推去被，而以两手搂抱婢女。如是，则前少妇吮乳时，未必不动念，精变血而来，固然是这样。细思粥入而呕逆，食入几何，蜜导而不通，药润而无益，此痘中关格之症，气血已不流通，怎望成功？夫血热故成丹，丹艳故成剥，此丹甚剥甚之不多见者也。又面肿退而眼开者，其常也。此痘洗眼以令其开，犹然上胞不支而紧合，视其黑珠，则似明似昧，此亦神将脱之症也。又痘者每日饮雨前细茶不已，禁之不听，后竟粥入而呕逆，未必非茶饮之过。别后闻舌短者已两日，危甚。后忽渐转能饮食，家族医生仍调以清剂，延续到第十八日而食大进，可渐生矣。细思此痘，面颈胸点少可数，即臂内股内，皆有子粒，至背如红毡，臂外股外皆夹丹无缝，从未有阴阳分界有如此稀密之不同者也。内症则呕逆在上，阻滞失血在下，神昏舌短，外剥甚酷，此死多生少之症，得生可为万幸。又细思此症之生，毕竟面部稀疏有浆，即四肢及背，如此酷烈，犹有保全于濒死之时。古云痘全以正面为主，信哉。至第十九日，闻其左眼流脓，珠子凸出，右眼障满则坏矣。从来外剥不至内攻，内攻者甚罕，此症得生，亦千百之一二云。
朱丹溪治疗一人，二十三岁，痘出六天，请朱丹溪诊视，舌上黑色罩满，黑疔在舌尖之里，如圆眼核大，面部有子粒而朗，身亦布匀，而脚色尚不紫黯，急忙磨生犀角二三钱，入黄连解毒汤内，加石膏、竹叶、灯心草，日大料三剂，舌黑色尽退，疔尽消平，红润如常，饮食亦进。到了第八天，正面浆液五六分，而胸背浆液也来，朱丹溪因亲戚痘疹急促而归，遂托付给其他医生。到了第十二朝夜，烦躁呢喃。延续到第十三朝，而失尿遗屎之症顿生。第十四朝，才复迎朱丹溪。到了诊视时，则已倒靥，碎铺似炉灰色，挺卧如尸，口自言，手自撒，胸背浆水清，两手腕至臂皆软鳖无神，痘粒比前似加稠密。盖肿腿臂瘦，而痘落下，故见密也。朱丹溪辞不治，后闻其他医生见其遗屎，即进人参三钱，又见其谵妄，即进犀角三钱。此医者手忙脚乱，而主人不知也，延续到第十六朝而逝。此虽医者之无法，然实疔之痘，从来未有如此之酷烈者。故伏毒甚深，医治一错，岂不关人性命哉。
朱丹溪治疗一位老人，发热而昏倦，其脉大而似数，给予人参、黄芪、当归、白术、陈皮，大料二十剂而痘出。又二十剂而脓泡成，身无完肤。又六十剂而安。
Zhao Zhongshulang, aged twenty, contracted smallpox. Zhu [Danxi] examined him on the fourth day. The facial skin was oily and glossy; from the depression of the throat down to Jiwei (CV15) below the chest, it resembled a layer of saliva membrane in infants, presenting as a sheet of red mottling, moist and shiny extending to the front of both axillae, while the neck and abdomen showed distinct, spreading lesions. Zhu said: "This is 'Oily Light Syndrome', indicating a massive leakage of Primordial Yang. The red mottling on the chest resides in the area of Huagai (the Lung), which is a dangerous condition with adverse signs." After medication, by the fifth day, the oily gloss on the face had subsided, and the lesions showed signs of filling with pus. The red mottling on the chest all rose like millet grains, taking on a pus-like color, except for the purple patches on the back which remained. There was a slight coating on the tongue. Other physicians decided to use strong purgatives such as Xiaoshi (Mirabilite) and Dahuang (Rhubarb). Zhu said: "Since the Primordial Yang has already leaked out through the face, we can only heavily use moistening herbs; we must not use Xiaoshi or Dahuang to attack." He prescribed Danggui (Angelica Sinensis Root) five to seven qian, one dose, assisted by Zhiqiao (Aurantii Fructus) and other blood-cooling herbs. During the period of minor filling on days five or six, another physician used Renshen (Ginseng), Huangqi (Astragalus), Rougui (Cinnamon Bark), and Lujiao Jiao (Deer Antler Glue). In the afternoon, the patient became comatose and delirious, his teeth chattering so loudly that it could be heard through the ears, persisting through days seven and eight. Zhu continued using four doses of Da Qingliang (Great Cooling) formula. By the ninth day, the pus seemed to be abundantly formed, and the teeth-chattering symptoms subsided slightly. The patient felt his eye sockets were slightly sunken and his spirit somewhat fatigued. A small amount of Renshen (five fen) was added to the cooling formula to support Yuan Qi (Primordial Qi). His eyes no longer closed completely and tears flowed; his nostrils were no longer blocked and nasal discharge appeared. The face gradually took on an aged appearance, while the red base on the chest formed bags of pus, and similar bags formed on both arms and legs. On the night of the eleventh day, he suddenly experienced extreme thirst, drinking thirteen or fourteen bowls of tea continuously; this was the body's attempt to draw water to save itself. Mild clearing and tonifying methods were used, and by the twelfth day, the symptoms gradually stabilized. Renshen was then removed, and solely blood-nourishing and fire-clearing herbs were used to support him until recovery on the seventeenth or eighteenth day. This person had recently married, so his Yuan Qi was inevitably depleted; thus, slight tonification was included in the cooling formula. On the eighth or ninth day, sudden bleeding occurred at the root of the scrotum, about one cup. Zhu said: "This bleeding can substitute for venting the toxin," and indeed it happened as predicted. If it were a deteriorating case, this blood loss would further deplete Kidney Yuan, making survival impossible.
Zhu Yingwo treated his cousin, aged forty, who suffered from smallpox. On the second day, examination revealed facial edema, white spots forming sheets, and the entire body covered with fine purple spots resembling measles. Zhu said: "The life or death of this case depends on whether the 'biao' (surface indicators) open up. If they open, there is life; if not, it is critical." He urgently prescribed Xijiao Yin (Rhino Horn Drink) combined with blood-breaking and qi-moving herbs, administered in large doses, three times daily. By the fourth day, the Tian Ting (Forehead) and Di Jiao (Chin/Jaw corners) suddenly cleared up like scattered stars, except for the two zygomatic areas which remained unopened. Upon lifting the body to inspect, the areas were also clear, but the purple discoloration was too severe, and the area below the waist was flat and collapsed like moles. Although there was some vitality, the patient was still on the brink of death. Zhu urgently used Dahuang (Rhubarb) to purge, keeping the dosage of Xijiao (Rhino Horn) unchanged from the original prescription. The stool passed was merely loose and not fully cleared. Because the patient had a history of hemoptysis and was constitutionally weak, he could not withstand heavy depletion; therefore, Jiu Shu Dahuang (Wine-processed Rhubarb) was used gently to cleanse. On the fifth day, the purgation was more profuse, resembling millet grains. On the sixth morning, the zygomatic areas suddenly cleared like scattered stars, and the body lesions spread openly. The face showed signs of turning white and producing fluid. By the seventh day, the momentum was full, and pus arrived. Dahuang and Xijiao were stopped, and only blood-cooling and fire-clearing agents were used. However, the chest, back, and arms remained dry, stagnant, purple, and scorched without movement. Zhu urgently administered Xijiao (four to five qian). Suddenly, the lesions on the chest and wrists raised their peaks and released white fluid, with roots resembling pomegranates, bright red and lovely. Zhu said: "By the ninth day, pus will surely arrive." He continued using Xijiao. In the afternoon, pus arrived, and by the tenth day, the entire body was filled with fluid. Soon, on the twelfth day, the crusts formed. There were no hard scabs on the body; instead, ruptured pus was seen. Unruptured ones formed blisters, and ruptured ones exposed red flesh, causing great fear in the patient. Zhu said: "The pus is about seventy to eighty percent complete, and the red roots have all transformed; this is 'waking the pus' for crusting." By the sixteenth or seventeenth day, the forehead developed pox-like scars with renewed pus formation, and the chest also showed this. The originally ruptured areas formed crusts. Pox on the forehead produced maggots on the sixth day, and the broken scrotal sacs also had maggots; the pus was foul-smelling and rotting, indicating slight vitality that could be treated. However, the Spleen and Stomach were weak, and mouth/tongue ulcers indicated residual toxins not yet cleared. Until the nineteenth day, only cooling herbs were used to support the patient. Initially, this case was judged as abnormal blood heat, and tonification was contraindicated. However, the patient was usually weak, suggesting otherwise. Subsequent use of cooling herbs brought peace, but stopping Xijiao caused high fever. On the third day, he went mad; Niuhuang (Calculus Bovis) and Hupo (Amber) calmed him. Stopping Xijiao on the sixth day caused unrest. Reusing Xijiao heavily on the seventh/eighth day restored calm. Taking Shaoyao (Peony) and Baizhu (Atractylodes) lightly on the seventeenth/eighteenth day caused unrest again. Moreover, from the waist down to the shins, the color remained purple-dark on days seventeen/eighteen, and the skin of the filled pustules had wrinkles and folds. This smallpox was difficult to treat to this extent. In major dangerous cases, it is unheard of to fill with pus when the eyes do not close and the nose does not seal. Before the ninth day, the eyes were closed for only one day, and the nose did not seal. How could he fill with eighty percent pus? Ultimately, he did not form crusts but woke the pus which ruptured; the eyes re-closed slightly, and the nose sealed significantly. On the night of the eighteenth day, due to anger, he had slight epistaxis on the nineteenth day; this was negligence in care. He defecated six or seven times day and night, spirit was unrefreshed, food intake decreased, and urination occurred seven or eight times per night. Reluctantly, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was given, with Renshen (Ginseng) up to several qian, to restore vitality. Using tonification after clearing is the correct method. After passing the twenty-day mark, he desired food slightly. After Chen hour (7-9 AM), stool was soft strips; after Wu hour (1-3 PM), food intake increased slightly. Zhu urgently removed Shengma (Cimicifuga) and Chaihu (Bupleurum) from Buzhong Yiqi Tang, combined it with Bazhen (Eight Treasures) ingredients, kept Huanglian (Coptis) unchanged, and reduced Renshen to three or four fen to nourish blood, preventing Qi from floating and transforming into fire; this is the subtle principle of balancing Yin and Yang. Due to fatigue lying down from the seventh/eighth day, unable to extend, and knees/feet too weak to walk, before being helped up, he suddenly felt able to sit and move, demonstrating the efficacy of guiding herbs. On the night of the twenty-fourth day, he first had chills, then fever, resembling malaria, for four nights, intermittent. Since the smallpox erupted in June, it inevitably involved damp-heat from summer heat. On the afternoon of the fifth day, sweat flowed to the abdomen. Zhu said: "Summer heat is resolved; there will be no fever tonight." Indeed. Actually, over these few days, Xiaochaihu Tang (Minor Bupleurum Decoction) plus Renshen, Tiandong (Asparagus Root), Zhimu (Anemarrhena), Wuweizi (Schisandra), occasionally Xiangru (Elsholtzia), allowed him to recover.
Commentary: This smallpox appeared on the second day of the sixth lunar month. By mid-July, I traveled south, instructing: "The original smallpox was very critical. At this time, thigh muscles are wasted, food intake is low, and Yuan Qi has not recovered. One must rest and nourish for over a year to sleep peacefully." After fifty days apart, returning home in early September, I exclaimed in shock: "Why has my brother wasted away to this state?" I urgently left the bedroom to prepare medicine and food, hoping to prolong life. Alas, I traveled far again. The patient did not relax household duties nor put down books. Suddenly, he died in the middle of the night. Generally, when smallpox reaches a critical danger, poor care afterwards leads to failure to survive. After recovery, having sexual intercourse within one hundred days—how could one avoid bedchamber matters? Thus, the hurdle of one hundred and twenty days could not be escaped. (Original commentary.)
Zhu Yingwo treated a woman surnamed Zheng. The initial spots on the face were not dense, with only a small red patch under the chin. By the fourth day, the face was soft and flaccid, the body covered with Dan (erysipelas/mottling) containing tiny points. Zhu said: "This Dan cannot recede; later it will pour out clear fluid, and definitely peel externally. Although doctors used Renshen and Huangqi, the face did not turn white. From the chin to the body, the skin rolled and ruptured throughout. She died on the ninth day. This was the most cruel type of Dan syndrome."
A son of a fellow student, aged thirty-something, had smallpox. One physician examined the surface indicators and deemed it extremely smooth, requiring no medication. A family physician considered it very dangerous. The master believed the first physician and not the family doctor. After five days of treatment, Zhu was consulted. Examination showed no distinction between root and peak on the face, no distinction between lesion bases, a pale white color, and oily gloss. Furthermore, the mouth was open and unclosable, lips did not cover teeth; this was a critical condition. The basis for judgment was that facial spots were sparse and countable, few on the chest, and sparse on the neck. Inspecting limbs, amidst clusters were Dan patches. Dan on the anterior aspect of both arms extended from Qugu (SP12) up and down, about 3-4 cun long, 1 cun wide. Dan on the anterior aspect of both thighs started from the gluteal crease down to the calf, about 2 chi long. The back resembled a thoroughly red felt strip. Fortunately, the posterior aspects of arms and thighs still had spots, though not dense. Regarding color: face pale white, neck/chest spots white, roots not red. Inside the Dan, fine points piled like millet; outside the Dan, a sheet of purple ground. Even spots on the posterior aspect had a purple halo around each point. Carefully observing this shape and color, one might wish to die. However, the mistress was a relative of Zhu, and strongly detained him. Two or three days prior, the patient had small blood blisters on the tongue, which flattened after sucking. Inquiry revealed constipation for several days, and the whole body was purple. Temporarily using Dahuang to purge two or three times, followed by Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) combined with Huangqin (Scutellaria) and Huanglian (Coptis), yielded immediate results. By the ninth day, pus arrived on the face, neck, and chest, and was visible on the back and limbs, with Dan areas looking like white water. The master became even more convinced it was a smooth case. On the eleventh day, pus in Dan areas formed bags, suddenly ruptured and flowed, shedding the skin. The face and chest formed thick crusts. That day, porridge induced vomiting of phlegm and water; food intake was low and difficult. Zhu and the family doctor discussed a Spleen-supporting formula. The patient planned to drink milk, hiring a wet nurse and a female attendant, mimicking infant sucking. The master thought this a wonderful technique. At sunset, he muttered deliriously for a sentence or two; worse at midnight. Urine contained blood drops. On the twelfth morning, he was comatose and delirious but responsive to questioning, though spirit was exhausted. Due to constipation, hoping bowel movement might stop delirium, honey suppositories failed. Heavy Danggui was added to the Spleen-tonifying formula, resulting in slight loose stool and bloody stool, frightening the master. Zhu was away, unaware why urine contained blood. Detailed inquiry revealed the patient loved lust. A friend slept with him. Before sucking milk, the patient said, "It feels good, but I fear semen loss." When the mistress visited, she ordered a maid to serve at the foot of the bed. The friend sat separately, peeking through a wall gap. Seeing the mistress leave, the patient asked who it was. The maid answered. He pushed aside the covers and embraced the maid with both hands. Thus, during the young woman's milk-sucking, he likely had thoughts, and essence transformed into blood, hence the situation. Thinking carefully: porridge induced vomiting, little food entered, honey suppositories failed, moistening herbs were useless. This is Guan Ge (Obstruction and Regurgitation) in smallpox; Qi and Blood circulation has ceased, how can success be expected? Blood heat causes Dan; Dan beauty causes peeling. This severe peeling is rare. Usually, as facial swelling recedes, eyes open. Here, washing eyes opened them, but upper eyelids drooped and tightly closed. Looking at the black pupil, it seemed bright yet dim; this is also a sign of Spirit departing. The patient drank pre-rain fine tea incessantly, ignoring prohibitions. Later vomiting porridge was likely due to tea. After parting, I heard his tongue was short for two days, critically ill. Then he gradually resumed eating. The family doctor continued cooling agents. By the eighteenth day, appetite increased greatly, suggesting gradual recovery. Reflecting on this case: few spots on face, neck, chest; even inside arms/thighs, there were spots. Back like red felt; outside arms/thighs, seamless Dan. Never have I seen such disparity in density between Yin and Yang aspects. Internal symptoms: vomiting/regurgitation above, obstruction/blood loss below, coma, short tongue. External peeling was severe. This is a case where death outweighs life; survival is a miracle. Reflecting on survival: finally, the face was sparse with pus. Even with limbs and back so severely affected, preservation occurred near death. Ancients said smallpox relies entirely on the front; truly so. By the nineteenth day, I heard his left eye flowed with pus, eyeball protruding. If the right eye was blocked, it would fail. Generally, external peeling does not lead to internal attack; internal attack is rare. Survival in this case was one in a thousand or two.
Zhu Danxi treated a man, aged twenty-three. Smallpox had erupted for six days. Tongue was covered in black; a black ding (carbuncle) was inside the tip of the tongue, size of a round eye kernel. Facial spots were clear, body distribution even, foot color not yet purple-dark. Zhu urgently ground 2-3 qian of raw Xijiao (Rhino Horn), added to Huanglian Jiedu Tang (Coptis Detoxification Decoction), plus Shigao (Gypsum), Zhuye (Bamboo Leaf), Dengxincao (Juncus Effusus). Large doses, three times daily. Blackness on tongue completely receded, ding disappeared and flattened, tongue became red and moist as normal, diet improved. By the eighth day, front face pus was 50-60%, chest/back pus arrived. Zhu returned due to a relative's urgent smallpox case, leaving the patient to another doctor. On the night of the twelfth day, restlessness and muttering began. By the thirteenth day, urinary and fecal incontinence suddenly appeared. On the fourteenth day, Zhu was summoned again. Examination showed inverted crusts, fragmented like furnace ash gray, lying stiffly like a corpse, speaking to himself, hands scattering, chest/back pus clear, wrists to arms soft and spiritless, lesions denser than before. Swollen legs and thin arms made lesions appear dense because they fell. Zhu refused to treat. Later, I heard the other doctor, seeing incontinence, gave 3 qian of Renshen; seeing delirium, gave 3 qian of Xijiao. This doctor was frantic, unknown to the master. The patient died on the sixteenth day. Although this was medical incompetence, it was actually a Ding-type smallpox, never so cruel before. Thus, deep latent poison, one medical error, can cost a life.
Zhu Danxi treated an old man, feverish and drowsy, pulse large and seemingly rapid. He prescribed Renshen, Huangqi, Danggui, Baizhu, Chenpi. Large doses for twenty doses, then smallpox erupted. Another twenty doses, pustules formed, no intact skin on body. Another sixty doses, he recovered.