万密斋治张氏子，痘靥时，面疮溃肿，脓水浸淫，泄下脓血，后重不食。或作噤口痢治，不效。视其症乃
倒靥，非痢也。在痘科中，痢下脓血痂皮者生，水谷不化者死。在伤寒，太阴经病论则曰∶热蓄于内，当便脓
血，勿治，利尽脓血自愈。因思此疾不可急治，乃故制药延缓以待之。数日后，度其脓血将尽，乃用四君子汤
加白芍、枳壳、黄连、木香，一服后重除，利稍止，再服能食，三四服痘靥。
一痘后，初秋利下白积，身热腹痛，呕哕不食，此湿热瘀积，兼受寒邪。理中汤加防风，一剂哕止。平胃
散加香、连、青、葛、麦愈。
一痘后，利下赤白，能食而不化。此胃热而脾虚也，乃恣食而不知节慎，遂致莫救。
一痘后，噤口痢，用人参一两，陈皮、黄连、石莲肉各五钱，桔梗三钱，胃风汤调服愈。
一痘后，利久不止，积未尽而中气不足，用人参、白术、白芍、甘草、升麻、陈米，大固中气而愈。
一痘后，毒入大肠而便脓血者，牛黄散、三黄散、犀角地黄汤、黄连解毒汤而愈。
（徐仲光治。）
一痘，十九岁，标点时，便秘至十二朝不行，口渴狂躁，左尺脉浮大，此阴不足而津液竭也，用参、冬、
归、地、知、杞、枳壳、菟丝子而便利。
一痘后，食粽便结，痛不可按，手足搐搦，大柴胡汤加酒曲二钱而行。
一痘后，身热便秘，此余毒结大肠也，以解毒汤治之而愈。
一痘后，身热便燥，此辛热耗液，润燥汤愈。
一十五岁，血热毒重，痘十八朝，忽小便不利，欲解不能，起倒竟夕，闻其大便已阻而不行者四日矣。此
有燥屎结于幽门，后窍不通，故前窍亦闭。进以汤药，则小便益急而不能出，痛苦极矣。且药力未能达于至阴
之下，因用胆导法，须臾二便皆通。
一痘正出而小便秘，此气为火食也，导赤散加疏解药而愈。
一痘泄泻溺涩，此阴阳不分，五苓散加车、通而愈。
一痘，阴阳分而小便少，此脾肺虚也，补中益气汤加麦冬、五味而愈。
一痘溺涩，为阴虚火炎烁肺，六味地黄丸加冬、味而愈。
一痘后小便赤色，知热在膀胱，导赤散加栀、苓、车前、竹叶、灯心而愈。
一痘后小便不利，用五苓而愈甚，阴囊渐肿。此阴虚而渗利之，复损其阴也。六味地黄丸加肉桂、车前，
又补中益气调理愈。（六味丸最为此症的对之药，既系阴虚，何取乎补中益气？）
一老医有孙，痘既脱痂，少腹胀，小便不通。众谓痘后余毒，用利水解毒，愈胀。老医忽悟曰∶此脾虚下
陷也，痘后无实症，土坚则水清。人参一两，大枣五枚，生姜五片，煎服愈。（《广笔记》。）
万密斋治庠生余光庭，年十九岁，染痘发热，五日不出，三日未更衣，脉细而数，虽有下症，元气怯弱，
不可下也。以胆导之不得通，病者烦躁，因思发热日久，毒流其中，燥粪闭塞肛门，大肠干枯，气不得行，血
不得润，胆导力小，故不能通也。自立一法，取猪尿脬一枚，以猪胆汁半杯，清油半杯，蜜半杯，三物和匀
入脬中，如作胆导法，取下燥屎二十余枚，气通热解，神清痘出。此法外意也。（虞天民亦有此法。）
胡氏子出痘，乍热乍退，足冷，数日不大便，先出者犹是红点，亦不起发，此逆症也。或曰∶热微毒亦微，
热甚毒亦甚，今热不甚，顺症也。曰∶不然，痘本火毒，待热而发，如发热而不烦不渴，大小便如常，精神清
爽者，此热在表，无邪毒，火发越而痘易出易靥也。若烦躁不安，大小便艰，昏昏喜睡，此毒火内蕴，不得发
越，表热虽微，内热则甚。今乍热乍退者，毒火来往也；大便不通者，毒火郁遏也；见红点而不起发者，毒火
陷伏也；足冷者，火极兼水化，谓之逆冷也。彼不以为然，次日红点俱没，烦躁转甚，犹谓此内收也。翌日死。
万密斋治疗张氏之子，在痘疹结痂脱落时，面部疮口溃烂肿胀，脓水浸淫蔓延，排泄物中有脓血，伴有里急后重且无法进食。有人将其当作噤口痢来治疗，但无效。万密斋诊察其症状，发现这是“倒靥”（痘疹未正常结痂而内陷），并非痢疾。在痘科中，若痘疹后出现下痢脓血及痂皮者预后良好，若水谷不化者则预后不良。在伤寒论中，太阴经病论述道：热邪蓄积于体内，应当排出脓血，无需特殊治疗，待脓血排尽后疾病自愈。因此想到此病不可急于治疗，于是故意延缓用药以等待时机。数日后，估测其脓血即将排尽，便使用四君子汤加入白芍、枳壳、黄连、木香，服用一次后里急后重消除，腹泻稍止，再次服用后能够进食，三四次服药后痘疹顺利结痂。
一例痘疹之后，初秋时节下痢白色黏液，身体发热腹痛，呕吐呃逆无法进食，此为湿热瘀积，兼受寒邪。使用理中汤加入防风，一剂药后呃逆停止。随后使用平胃散加入香附、黄连、青皮、葛根、麦冬痊愈。
一例痘疹之后，下痢赤白相间，能进食但消化不良。这是胃热而脾虚所致，因患者恣意饮食而不知节制谨慎，最终导致无法救治。
一例痘疹之后，患噤口痢，使用人参一两，陈皮、黄连、石莲肉各五钱，桔梗三钱，用胃风汤调服而痊愈。
一例痘疹之后，腹泻日久不止，积滞未尽而中气不足，使用人参、白术、白芍、甘草、升麻、陈米，大补中气而痊愈。
一例痘疹之后，毒邪进入大肠导致便脓血，使用牛黄散、三黄散、犀角地黄汤、黄连解毒汤而痊愈。
（徐仲光治疗。）
一例痘疹患者，十九岁，在痘疹出齐时，便秘长达十二天未解，口渴狂躁，左尺脉浮大，此为阴液不足而津液枯竭，使用人参、麦冬、当归、地黄、知母、枸杞、枳壳、菟丝子而大便通畅。
一例痘疹之后，食用粽子导致便秘，疼痛不可触碰，手足抽搐，使用大柴胡汤加入酒曲二钱而大便通行。
一例痘疹之后，身体发热便秘，此为余毒结聚于大肠，以解毒汤治疗而痊愈。
一例痘疹之后，身体发热大便干燥，此为辛热药物耗伤津液，使用润燥汤痊愈。
一名十五岁患者，血热毒重，痘疹十八天，突然小便不利，想解却解不出，整夜辗转反侧痛苦不堪，听说其大便已阻塞四天未行。此为燥屎结聚于幽门（此处指肠道深处或肛门附近，意指下窍不通），后窍不通，故前窍亦闭。服用汤药，则小便更加紧急却无法排出，痛苦至极。且药力未能到达至阴之下，因此采用胆导法（猪胆汁灌肠），片刻之后大小便皆通。
一例痘疹正发出时小便闭塞，此为气被火邪所遏，使用导赤散加入疏解药物而痊愈。
一例痘疹后泄泻且小便涩滞，此为阴阳不分，使用五苓散加入车前子、通草而痊愈。
一例痘疹后，阴阳虽分但小便量少，此为脾肺虚损，使用补中益气汤加入麦冬、五味子而痊愈。
一例痘疹后小便涩滞，为阴虚火炎灼伤肺金，使用六味地黄丸加入麦冬、五味子而痊愈。
一例痘疹后小便颜色红赤，知道热邪在膀胱，使用导赤散加入栀子、茯苓、车前子、竹叶、灯心草而痊愈。
一例痘疹后小便不利，使用五苓散治疗后病情加重，阴囊逐渐肿胀。此为阴虚却使用渗利药物，进一步损伤了阴液。使用六味地黄丸加入肉桂、车前子，又用补中益气汤调理而痊愈。（六味地黄丸最为对症之药，既然已是阴虚，为何还要取用补中益气汤？）
一位老医生的孙子，痘疹脱痂后，小腹胀满，小便不通。众人认为是痘后余毒，使用利水解毒药物，结果胀满更甚。老医生忽然醒悟道：这是脾虚下陷所致，痘后无实证，土气坚固则水液清澈。使用人参一两，大枣五枚，生姜五片，煎服而痊愈。（出自《广笔记》）
万密斋治疗庠生余光庭，年龄十九岁，感染痘疹发热，五天未出痘，三天未排便，脉象细而数，虽有可下的症状，但元气怯弱，不可攻下。使用胆导法仍不得通，病人烦躁，因而思考发热日久，毒邪流注其中，燥粪闭塞肛门，大肠干枯，气机不得运行，血液不得滋润，胆导法力小，所以不能通便。于是自立一法，取猪尿脬一个，装入猪胆汁半杯，清油半杯，蜂蜜半杯，三种药物混合均匀放入尿脬中，如同做胆导法一样，取下燥屎二十多枚，气机通畅热邪解除，神志清醒痘疹发出。此法为意外之法。（虞天民也有此法。）
胡氏之子出痘，忽冷忽热，脚冷，几天不大便，先出的痘点仍是红点，也未起发，此为逆症。有人说：热微毒亦微，热甚毒亦甚，现在热势不盛，是顺症。我说：不对，痘本属火毒，依赖发热而发出，如果发热但不烦躁口渴，大小便如常，精神清爽，这是热在表，无邪毒，火毒发散则痘易出易结痂。如果烦躁不安，大小便艰难，昏昏欲睡，这是毒火内蕴，不得发散，虽然表热轻微，但内热严重。现在忽冷忽热，是毒火往来；大便不通，是毒火郁遏；见到红点而不起来发，是毒火陷伏；脚冷，是火极兼水化，称为逆冷。他不以为然，第二天红点全部隐没，烦躁更加严重，还说是内收。次日死亡。
Wan Mizhai treated the son of Mr. Zhang. During the stage when the smallpox pustules were crusting over, facial sores ulcerated and swelled, with pus and fluid oozing and spreading. The patient passed pus and blood in stool, experienced tenesmus (a feeling of incomplete defecation), and was unable to eat. Others treated it as "Jinkou Li" (Throat-Closing Dysentery), but it was ineffective. Upon examining the symptoms, Wan Mizhai determined this was "Dao Ye" (inverted crusting/retraction of smallpox crusts), not dysentery. In smallpox management, if pus and blood mixed with crusts are passed after eruption, the prognosis is good; if food and water are not digested, the prognosis is fatal. In the Treatise on Cold Damage, the discussion on Taiyin Meridian disease states: "Heat accumulated internally should result in passing pus and blood; do not treat specifically, and the disease will heal itself once the pus and blood are exhausted." Therefore, he considered that this illness should not be treated hastily. He deliberately delayed medication to wait for the right timing. Several days later, estimating that the pus and blood were nearly exhausted, he prescribed Sijunzi Tang (Four Gentlemen Decoction) added with Baishao (White Peony Root), Zhike (Aurantium Fruit), Huanglian (Coptis Rhizome), and Muxiang (Aucklandia Root). After one dose, tenesmus was relieved, and diarrhea slightly stopped. After a second dose, the patient could eat. After three or four doses, the smallpox crusts formed properly.
In another case following smallpox, during early autumn, the patient had dysentery with white mucus, fever, abdominal pain, vomiting, hiccups, and inability to eat. This was due to damp-heat stagnation combined with cold pathogen invasion. Lizhong Tang (Regulate the Middle Decoction) added with Fangfeng (Saposhnikovia Root) stopped the hiccups after one dose. Then, Pingwei San (Powder to Level the Stomach) added with Xiangfu (Cyperi Rhizome), Huanglian, Qingpi (Aged Tangerine Peel), Gegen (Pueraria Root), and Maidong (Ophiopogon Tuber) cured the condition.
In another case following smallpox, the patient passed red and white dysenteric stools, could eat but suffered from indigestion. This was caused by stomach heat and spleen deficiency, resulting from excessive eating without moderation, leading to an incurable state.
In another case following smallpox, the patient suffered from Jinkou Li (Throat-Closing Dysentery). Ren Shen (Ginseng Root) 1 liang, Chenpi (Tangerine Peel), Huanglian, and Shilian Rou (Lotus Seed Embryo) each 5 qian, and Jiegeng (Platycodon Root) 3 qian were administered, mixed with Weifeng Tang (Stomach Wind Decoction), which cured the illness.
In another case following smallpox, chronic diarrhea persisted, with residual accumulation and insufficient middle qi. Ren Shen, Baizhu (Atractylodes Macrocephala Rhizome), Baishao, Gancao (Licorice Root), Shengma (Cimicifuga Rhizome), and Chen Mi (Old Rice) were used to strongly tonify the middle qi, resulting in recovery.
In another case following smallpox, toxins entered the large intestine causing pus and blood in stool. Niuhuang San (Calculus Bovis Powder), Sanhuang San (Three Yellows Powder), Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), and Huanglian Jiedu Tang (Coptis Detoxification Decoction) were used to cure the condition.
(Treated by Xu Zhongguang.)
A nineteen-year-old patient with smallpox experienced constipation lasting twelve days at the time of eruption completion, accompanied by thirst, mania, and a floating-large pulse at the left Chi position. This indicated yin insufficiency and exhaustion of body fluids. Renshen, Donggui (Ophiopogon Tuber - likely Maidong here based on context), Danggui (Angelica Sinensis Root), Dihuang (Rehmannia Root), Zhimu (Anemarrhena Rhizome), Gouqi (Goji Berry), Zhike, and Tusizi (Dodder Seed) were used to restore bowel movement.
Following smallpox, consumption of zongzi (sticky rice dumplings) led to constipation, severe tenderness upon pressure, and convulsions of hands and feet. Daxiehu Tang (Major Bupleurum Decoction) added with 2 qian of wine qu cured the condition by promoting bowel movement.
Following smallpox, fever and constipation occurred due to residual toxins knotting in the large intestine. Jiedu Tang (Detoxification Decoction) cured it.
Following smallpox, fever and dry stool resulted from acrid-hot medicines consuming fluids. Rundao Tang (Moistening Dryness Decoction) cured it.
A fifteen-year-old patient with severe blood heat and heavy toxins, on the eighteenth day of smallpox, suddenly experienced difficulty urinating, unable to void despite the urge, tossing and turning all night. It was known that bowel obstruction had existed for four days. This was due to dry feces knotting in the lower orifice (Houqiao), blocking the posterior opening, thereby closing the anterior opening (urinary meatus). Administering herbal decoctions made urinary urgency worse without relief, causing extreme suffering. Since the medicinal power could not reach the deepest yin levels, Dan Dao Fa (Gallbladder Enema Method) was employed. Within moments, both urine and stool flowed freely.
During active smallpox eruption, urinary retention occurred because qi was obstructed by fire. Daochi San (Guide Out Redness Powder) added with dispersing and resolving herbs cured it.
Following smallpox, diarrhea and scanty, painful urination occurred due to failure of yin-yang differentiation. Wuling San (Five-Ingredient Powder with Poria) added with Cheqianzi (Plantago Seed) and Tongcao (Tetrapanax Pith) cured it.
Following smallpox, although yin and yang differentiated, urine volume was low due to spleen and lung deficiency. Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) added with Maidong and Wuweizi (Schisandra Berry) cured it.
Following smallpox, painful urination was caused by yin deficiency with flaming fire scorching the lungs. Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) added with Maidong and Wuweizi cured it.
Following smallpox, dark red urine indicated heat in the bladder. Daochi San added with Zhizi (Gardenia Fruit), Fuling (Poria), Cheqianzi, Zhuye (Bamboo Leaf), and Dengxin Cao (Juncus Effusus Pith) cured it.
Following smallpox, urinary difficulty worsened with gradual scrotal swelling after using Wuling San. This was yin deficiency exacerbated by diuretic treatment, further damaging yin. Liuwei Dihuang Wan added with Rougui (Cinnamon Bark) and Cheqianzi, followed by Buzhong Yiqi Tang for regulation, cured the condition. (Note: Liuwei Dihuang Wan is the most appropriate remedy for this condition; since it is yin deficiency, why use Buzhong Yiqi Tang?)
The grandson of an old physician, after smallpox scabs fell off, developed lower abdominal distension and urinary retention. Many attributed it to residual toxins post-smallpox and used diuretic and detoxifying herbs, worsening the distension. The old physician suddenly realized: "This is spleen qi sinking due to deficiency. Post-smallpox, there are no excess syndromes; when earth (spleen) is firm, water is clear." Renshen 1 liang, Dazao (Jujube Fruit) 5 pieces, and Shengjiang (Fresh Ginger) 5 slices were decocted and taken, curing the condition. (From *Guang Biji*.)
Wan Mizhai treated Yu Guangting, a student, aged nineteen, who contracted smallpox with fever. After five days, no rash appeared; after three days, no bowel movement occurred. The pulse was fine and rapid. Although there were signs indicating purgation, the primordial qi was weak, so purgation was contraindicated. Dan Dao Fa failed to produce passage. The patient was irritable. Wan considered that prolonged fever allowed toxins to flow inward, drying feces blocked the anus, the large intestine was dry, qi could not move, and blood lacked moisture. The mild force of the gallbladder enema was insufficient. He devised a new method: taking one pig bladder, filling it with half a cup of pig bile, half a cup of clear oil, and half a cup of honey, mixing them evenly, and inserting it like an enema. This expelled over twenty pieces of dry feces. Qi circulation resumed, heat resolved, consciousness cleared, and smallpox erupted. This was an unconventional method. (Yu Tianmin also used this method.)
The son of the Hu family had smallpox with alternating fever and chills, cold feet, and no bowel movement for several days. The initial spots were red dots that did not erupt or rise. This was a counter-productive syndrome. Someone argued: "Mild heat means mild toxin; severe heat means severe toxin. Current heat is not severe, so it is a favorable syndrome." I replied: "Incorrect. Smallpox originates from fire-toxin, relying on fever to erupt. If fever occurs without irritability or thirst, with normal bowel/urinary function and clear spirit, the heat is superficial, without evil toxin, allowing fire to vent outward, making eruption and crusting easy. If there is irritability, difficult bowel/urinary function, drowsiness, the fire-toxin is internalized and cannot vent; although superficial heat is mild, internal heat is severe. Alternating heat indicates wandering fire-toxin; constipation indicates stifled fire-toxin; red spots failing to rise indicates sunken fire-toxin; cold feet indicate extreme fire transforming into water, called 'counter-cold'." He disagreed. The next day, all red spots disappeared, irritability intensified, yet he claimed it was internal retraction. The patient died the following day.