一痘半出，遍身作痛，乃热毒壅滞，未尽外出故也。活命饮加蝉蜕而愈。
一痘浆足而痛不止，此诸痛为实也。用白芷、陈皮、甘草、牛蒡、连翘、山楂而愈。
一痘六七日痛不止，此毒未化，郁而作痛也。非虚非实，不须治之，俟毒从脓化，其痛自止。
徐仲光治一痘，初起作痒，风寒外滞也。升麻葛根汤，焙荆芥穗熨而愈。
一痘起胀淡白，神少，泄泻口渴而痒，此脾胃气虚也。补中益气汤去归，加桂、附、糯米而愈。
一痘成浆痒破，是卫气暴泻，津液不荣。幸能食便润，四君子汤加芎、芍、橘，复肿灌成痂而愈。
一痘成浆，痒破溃烂，乃湿火并至也，调脾渗湿而愈。
一痘九日，浆清作痒，大补气血而愈。
一痘见七日至十三日痒塌，木香散加丁、桂，固表里而愈。
万密斋治郑氏子，痘将见形，作痒不能禁。曰∶起发时作痒者，逆也；贯脓时作痒者，逆也；浆靥时作痒
者，险也。险者可治，逆者不可治。才见便痒，书无此症，因思仲景《伤寒正理》论云∶病身痒，此邪在表，
欲出而不得出也，桂枝麻黄各半汤。阳明经病，皮中如虫行者，此肌肉虚也，建中汤。今此身痒，正是痘欲出
不得出，与太阳症同，非阳明肌肉虚也。乃以各半汤去桂、杏，加升麻、葛根、牛蒡，一服痒止，痘出甚密，
调治半月而安。（雄按∶真善读古人书者。）
屠家子出痘，贯脓时请一巫诵咒 水解厌，后忽加瘙痒，痘形平塌，其色青白而气腥臭。曰∶犯房室秽气
也。急令买胶枣一斤，烧烟熏之，痘转红活，而痒亦止。问其故，老巫他往，而子代之，有房事。
胡氏女七岁，痘初发热，两手如捻物状。曰∶此肝病也，经云其为病也握，宜平其肝。以泻青丸去大黄，
加甘草、柴胡、青皮，一帖而握止。欲再进一帖，不听。曰∶凡肝病者，多水泡而作痒，宜止之未发之前。既
不信，七日后再议。至六日，尽抓破矣，乃用保元汤加防风、白芷，二帖痒止，再服着痂而安。
施季泉治臧玉函幼儿，甫半周，身热一日即见痘。专门云∶树少花多，顶平脚塌，根窠薄，百死一生之症
也。五朝，固辞去。药以保元汤为主，拟六朝多用人参加附子。疑虑间，施至，曰∶此险症。且戒云∶必发痒
异常，须看守严密。药用凉剂，与前治大别。七朝，大发痒作泻，一日夜二十余行，或药水，或乳，或汤饮，
俱倾注不变色。或谓必无幸矣，施怡然自若，因强之用参，必不许，乃加炒黑黄连，渴止。十三朝，复发痒，
口渴唇燥，舌生白苔，又加炒黄连，白苔去，到底不用参，十九朝而别。又戒曰∶慎防痘疔口疳。疔之发也，
必在脑后枕骨间，当以收口膏贴之，禁用渗药，口疳惟君家人中白散为妙。不数日发疳，如其言治之辄效。
（《广笔记》。）
一个患儿痘疹刚出一半，全身疼痛，这是热毒壅滞，未能完全透发于外的缘故。使用活命饮加入蝉蜕后痊愈。
一个患儿痘浆已足但疼痛不止，这是因为诸痛属于实证。使用白芷、陈皮、甘草、牛蒡子、连翘、山楂后痊愈。
一个患儿痘出六七日疼痛不止，这是毒邪未化解，郁结而作痛。这既非虚证也非实证，不需要特殊治疗，等待毒邪化为脓液，疼痛自然停止。
徐仲光治疗一个痘疹患儿，初起时瘙痒，这是风寒外束所致。使用升麻葛根汤，并焙干荆芥穗熨烫患处后痊愈。
一个患儿痘疹起胀时颜色淡白，精神萎靡，伴有泄泻、口渴和瘙痒，这是脾胃气虚所致。使用补中益气汤去掉当归，加入肉桂、附子、糯米后痊愈。
一个患儿痘疹成浆期瘙痒抓破，这是卫气突然耗散，津液不能濡养肌肤。幸好患儿能进食且大便润通，使用四君子汤加入川芎、白芍、橘皮，使痘疹重新肿胀灌脓结成痂而痊愈。
一个患儿痘疹成浆期，瘙痒抓破溃烂，这是湿邪与火邪并至所致，通过调理脾胃、渗利湿邪而痊愈。
一个患儿痘疹从第七天到第十三天出现瘙痒塌陷，使用木香散加入丁香、肉桂，固护表里而痊愈。
万密斋治疗郑氏之子，痘疹即将显现形态时，瘙痒难以忍受。他说：在起发阶段瘙痒的，是逆证；在贯脓阶段瘙痒的，是逆证；在收靥阶段瘙痒的，是险证。险证可以治疗，逆证不可治疗。才见到痘形就瘙痒，医书中没有这种病症记载，于是想到张仲景《伤寒正理》论述说：身体瘙痒，这是邪气在表，想要透出却透不出来的缘故，用桂枝麻黄各半汤。如果是阳明经病，皮肤中像虫子爬行一样的感觉，这是肌肉虚损的缘故，用建中汤。现在这个患儿身体瘙痒，正是痘疹想要透出却透不出来，与太阳病症状相同，并非阳明经肌肉虚损。于是用桂枝麻黄各半汤去掉桂枝、杏仁，加入升麻、葛根、牛蒡子，服用一次后瘙痒停止，痘疹出得很密集，经过半个月调治而平安。（按语：真正善于阅读古人书籍的人。）
屠家儿子出痘，在贯脓阶段请一个巫师诵咒水解厌，后来忽然加重瘙痒，痘形平塌，颜色青白且有腥臭味。我说：这是犯了房事后的秽气所致。急忙让人买一斤胶枣，烧烟熏蒸，痘疹转为红活，瘙痒也停止了。询问原因，老巫去别处了，由他的儿子代替回答，承认有房事。
胡家女儿七岁，痘疹初发热时，双手呈现如捻弄东西状。我说：这是肝病，经书说肝病的表现是握拳，应当平抑肝气。使用泻青丸去掉大黄，加入甘草、柴胡、青皮，服用一帖后握拳停止。想要再进服一帖，家属不听。我说：凡是肝病，多会出现水泡并伴随瘙痒，应当在瘙痒发生之前止住。既然不信，七天后再议。到了第六天，痘疹全被抓破了，于是使用保元汤加入防风、白芷，两帖后瘙痒停止，再服药结痂而平安。
施季泉治疗臧玉函的幼儿，刚满周岁，身热一天后就见痘疹。专门看痘的医生说：树少花多（指根基弱而痘点多），顶部平坦脚部塌陷，根部浅薄，是百死一生的重症。第五天，家属坚决辞退。用药以保元汤为主，计划第六天多加用人参和附子。正在疑虑之间，施季泉来到，说：这是险症。并且告诫说：必定会异常剧烈地瘙痒，必须严密看护。用药要用凉剂，与前法截然不同。第七天，大发瘙痒并腹泻，一天一夜二十多次，无论是药水、乳汁还是汤饮，倒进去都不变色。有人说必定没救了，施季泉怡然自若，因此强行要求用人参，家属一定不允许，于是加入炒黑的黄连，口渴停止。第十三天，再次发作瘙痒，口渴唇燥，舌生白苔，又加入炒黄连，白苔退去，始终不用人参，第十九天告别。又告诫说：小心预防痘疔和口疳。痘疔发作时，必定在后脑枕骨之间，应当用收口膏贴敷，禁用渗湿药，口疳只有您家人用的中白散最妙。没过几天发了疳，按照他的话治疗立即见效。（《广笔记》。）
A child with half-erupted smallpox experienced pain all over the body; this was due to heat-toxin stagnation that had not yet fully exteriorized. The patient recovered after taking Huoming Yin (Life-Saving Decoction) added with Chantui (Cicada Slough).
A child whose smallpox pustules were full but continued to hurt suffered from "all pains are excess" syndrome. The patient recovered using Baizhi (Angelicae Dahuricae Radix), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Niubangzi (Arctii Fructus), Lianqiao (Forsythiae Fructus), and Shanzha (Crataegi Fructus).
A child experiencing persistent pain on the sixth or seventh day of eruption had untransformed toxin causing pain through depression. This was neither deficiency nor excess, requiring no specific treatment; once the toxin transformed into pus, the pain ceased spontaneously.
Xu Zhongguang treated a smallpox case where itching appeared at the onset, caused by external stagnation of wind-cold. The patient recovered after administering Shengma Gegen Tang (Ephedra and Kudzu Root Decoction) and applying hot-baked Jingjie Sui (Schizonepeta Spike) as a fumigation/washing therapy.
A child presenting with pale, flat swelling, low spirit, diarrhea, thirst, and itching suffered from Spleen-Stomach Qi deficiency. The patient recovered using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Danggui (Angelicae Sinensis Radix) removed, and Rougui (Cinnamomi Cortex), Fuzi (Aconiti Lateralis Radix Praeparata), and Nuomi (Oryza Sativa Germen) added.
A child whose smallpox reached the pustule stage experienced itching and rupture due to sudden dispersion of Wei-Qi (Defensive Qi) and failure of Jin-Ye (Body Fluids) to nourish. Fortunately, the patient could eat and had moist stools. The patient recovered using Sijunzi Tang (Four Gentlemen Decoction) added with Xiong (Chuanxiong Rhizoma), Shaoyao (Paeoniae Radix Alba), and Jupi (Citri Reticulatae Pericarpium), leading to re-swelling, pustulation, and scabbing.
A child whose smallpox reached the pustule stage experienced itching, rupture, and ulceration due to simultaneous arrival of Dampness and Fire. Recovery was achieved by regulating the Spleen and promoting dampness drainage.
A child on the ninth day presented with clear pustules and itching, recovering after substantial tonification of Qi and Blood.
A child between the seventh and thirteenth days exhibited itching and collapse of eruptions, recovering after administration of Muxiang San (Costus Powder) added with Dingxiang (Caryophylli Flos) and Guizhi (Cinnamomi Ramulus) to secure the Exterior and Interior.
Wan Mizhai treated the son of the Zheng family, who suffered unbearable itching just as smallpox lesions were about to appear. He stated: Itching during the rising phase is a adverse sign (Ni); itching during the suppuration phase is an adverse sign; itching during the crusting phase is a dangerous sign (Xian). Dangerous signs are treatable; adverse signs are untreatable. Since itching appeared immediately upon sighting the rash—a symptom not recorded in books—he recalled Zhang Zhongjing's *Shanghan Zhengli* stating: "Body itching indicates pathogen in the Exterior, attempting to exit but unable to do so," treated with Guizhi Mahuang Gehan Tang (Half-Half Decoction of Cinnamon Twig and Ephedra). If it were Yangming channel disease with skin sensation like insects crawling, it would indicate muscle deficiency, treated with Jianzhong Tang (Establish the Middle Decoction). Here, the itching indicated smallpox attempting to erupt but failing, similar to Taiyang syndrome, not Yangming muscle deficiency. Thus, he used Guizhi Mahuang Gehan Tang removing Guizhi and Xingren, adding Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), and Niubangzi. One dose stopped the itching, eruptions became dense, and peace was restored after half a month of care. (Commentary: Truly one who reads ancient texts well.)
The son of the Tu family, during the suppuration phase of smallpox, consulted a shaman for incantations and water purification, after which severe itching suddenly worsened, eruptions flattened, color turned bluish-white, and odor became fishy. I diagnosed this as contamination by filth from sexual intercourse. Urgently, I ordered one jin (approx. 500g) of Jiaozao (Jujube processed with Gelatin) to be burned for fumigation. The eruptions turned red and vibrant, and itching ceased. Upon inquiry, the old shaman was absent, replaced by the son, who admitted to recent sexual activity.
Hu's seven-year-old daughter, upon initial fever of smallpox, held her hands in a grasping posture. I diagnosed Liver disease, citing the classic: "Its manifestation is grasping," and prescribed calming the Liver. Using Xieqing Wan (Drain the Green Pill) removing Dahuang (Rhei Radix et Rhizoma), and adding Gancao, Chaihu (Bupleuri Radix), and Qingpi (Citri Reticulatae Pericarpium Viride), the grasping stopped after one dose. The family refused a second dose. I warned: Liver diseases often present with vesicles and itching, which should be prevented beforehand. Ignoring this, seven days later, all lesions were scratched open. I then used Baoyuan Tang (Preserve the Origin Decoction) added with Fangfeng (Saposhnikoviae Radix) and Baizhi, stopping itching after two doses, followed by scabbing and recovery.
Shi Jiquan treated Zang Yuhan's infant, aged one year, who showed smallpox after one day of fever. A specialist declared it a critical case ("few trees, many flowers," flat tops, collapsed bases, shallow roots), predicting death in ten cases out of nine. On the fifth day, the family dismissed the previous doctor. Treatment focused on Baoyuan Tang, planning to add Renshen (Ginseng Radix et Rhizoma) and Fuzi on the sixth day. While hesitating, Shi arrived, diagnosing a dangerous case and warning of extreme itching requiring strict monitoring. He prescribed cooling agents, distinct from previous treatments. On the seventh day, severe itching and diarrhea occurred (>20 times/day); fluids poured in remained unchanged. Despair set in, but Shi remained calm. He insisted on Renshen, which was refused, so he added Chao Huanglian (Stir-fried Coptidis Rhizoma), stopping thirst. On the thirteenth day, recurring itching, thirst, dry lips, and white tongue coating prompted more stir-fried Huanglian, clearing the coating, while still avoiding Renshen. He departed on the nineteenth day, warning to prevent Dou Ding (Smallpox Carbuncle) and Kou Gan (Oral Ulcer). He specified that carbuncles appear at the occiput, treated with Shoukou Gao (Closing Wound Plaster), avoiding damp-draining herbs; oral ulcers respond best to Zhongbai San (Middle White Powder) used by the family. Days later, ulcers appeared, and treatment per his advice was effective. (*Guang Biji*).