徐仲光治一庠友，年十八，初热腰痛，点发在额角，红绽光泽，心经顺症，非肾逆候，亦宜滋肾，六味地
黄丸料加杞子、杜仲，与升发之药间服，痛止痘出。至六朝，烦渴谵妄，唇燥舌黑，睡卧不宁，此乃肾水不
足以制火也，保元汤加归、芍、冬、杞、枣仁、龙眼肉，间服八味地黄丸加麦冬、枸杞渐愈。有一痘同，但补
阳而不滋阴，竟枯涸疤粘不脱而死。
一儿痘初热，腰痛如折，此折腰痘也。强以荆防败毒散发出，点如蚤斑，口鼻出血而死。
一儿初热，腰痛连背脊，不能转侧，点见左耳侧，及腰左一点如筋头大，平而紫，又舌中心一点，悚而黑，
此肾毒逆候也。急以四牙散，发出紫黑点，五日死。
一儿孟夏发热，腰痛甚，见点稠密紫黑，幸有神而胃气强，元气实，虽逆而尚有生理。四朝，以四牙散一
服，又化毒散送下地黄丸二服，次日痘起。但色未转，以黄连解毒汤加柴、蒡、归、芍、地黄而愈。
一女年十四，痘正浆足，忽腰痛不能转侧，此经血去多之故。六味地黄丸加归、芍、续断、杜仲，治之而
愈。
一男子年十八，痘后四十日外，忽腰痛极，两手撒撇，目开无光，汗出遗尿，喉声如锯，六脉浮大，此恣
欲房劳，而阴阳离决也。以艾灸气海六十二壮，四肢活动。又以独圣汤频服，及八味地黄丸而愈。
一男子年二十，痘后腰痛，左尺脉微弱，房劳所致也。以八味地黄丸、补中益气汤相间服而愈。
一痘不起而腰痛，缪仲淳用人参芦三两煎服，一吐而痘起痛止。毒在下，吐而升之，吐有发散之义也。
（《广笔记》。）
一好痘，绽朗而色淡红，两腿痛甚。腿亦属肾，此阴虚而毒乘之也。活命饮二剂，痛稍止。十全大补汤、
六味地黄丸，间服而愈。此症不早治，及四肢厥冷，则变黑变紫而死，与腰痛之逆相同，不可轻视之也。
一儿痘后，足胫痛甚，不红肿，气血虚不能荣养筋骨也。归芍四君子汤加牛膝、独活、苡仁、桂枝，连进
数服而愈。
一儿年十四，痘后腰脊痛不能俯仰，午后潮热，此骨髓枯，少水不胜火，肾气热也。灸昆仑穴、申脉穴各
三壮，又以六味地黄丸加独活，及补中益气汤间服而愈。（既是肾热，何以用火攻而愈？其说可疑。）
万密斋治一富家子，年十六，患痘，发热腰痛。问曾婚否？曰∶未也。连进人参败毒散二剂，痛止痘出而
安。若曾有房室者，不可治也。（或以大剂左归与之，必有拿手。 批。）
李季虬曰∶顾叔夏次郎，出痘而先腰痛。予断以不治，果殇。施季泉曰∶凡成婚或破阳后，出痘而腰痛者
可疗，童子而腰痛，是先天之水不足也，不治。（《广笔记》。）
费建中治章继美，年近三旬，季冬忽腰如杖，昏溃如迷，问之不答，身体振振，肉 筋惕，痘之象也。但
腰如被杖，其症必逆。用大黄、山楂各六钱，青皮、羌活、桃仁各二钱，佐以荆芥、干葛、元参，乘初起预攻，
庶望转机于万一。若见痘，则肾已受伤，无及矣。自申至卯，连服二头煎，次早发出如芥如砂，色焦紫，上下
无容针之隙，形色既逆，神情又恶，辞勿治。因苦恳，乃用大黄八钱，石膏一两，黄连二钱，生地两半，佐以
荆芥、羌活、葛根、牛蒡、红花、桃仁、蝉蜕等，加白颈地龙，每剂十条，又以猪尾膏半盏和入，连进二剂。
次日如芥如砂，并焦黑色即退，颗粒分明红活，但密而神昏热炽。前方服之九朝，虽圆绽如珠，浆黄如蜡，而
昏热如故，大便日六七次而不畅，水米不沾。议者谓寒凉太过。曰∶如过荡涤伤胃，则气血乏本，浆何由得？
至十日，正面有回意，仍不思食，乃用大黄、石膏各一两，生地两半，黄连、山楂四钱，佐以牛蒡、荆芥、
甘草。十二日，胃忽开，神爽热和。十五日，诸症悉愈，痂如松皮。彼又口疳，齿牙既落，又服牛黄、朱末，
并黄连解毒汤十余剂，渐愈。月外，又发血风疮，身无完肤，（此肾传脾，故为轻症。）将百日始霍然。是症
当危疑之际，旁议纷纷，幸病家有识，故得收效云。
朱应我治一新娶男子，二十岁痘，腰痛不支。医以面部痘白色挨簇，当此新婚时，必肾虚也，急煎杜仲、
锁阳等补剂。朱视之，面部虽白，而眼则红，腰间微见红斑，决不可补，以犀角、生地、丹皮，加升麻、芍
药，一剂腰痛如失。此见斑则治斑，不可拘于新婚也。后亦清补间施而愈。
徐仲光治疗一位同窗好友，年龄十八岁。起初发热并伴有腰痛，痘疹首发于额角部位，痘点红艳且光泽明亮，属于心经顺症（病情向好的征象），并非肾气逆乱的危候，但也应当滋补肾阴。处方用六味地黄丸的药料，加入枸杞子、杜仲，并与具有升发作用的药物交替服用，结果疼痛停止，痘疹发出。到了第六天，出现烦躁口渴、胡言乱语、嘴唇干燥、舌苔发黑、睡眠不安等症状，这是肾水不足以制约心火的表现。处方用保元汤加入当归、白芍、麦冬、枸杞、酸枣仁、龙眼肉，并间服八味地黄丸（即金匮肾气丸）加麦冬、枸杞，逐渐痊愈。有一个患痘的孩子情况相同，但医生只补阳气而不滋阴液，导致身体干枯涸竭，痘痂粘连不脱落而死亡。
另一个孩子初起发热时，腰痛剧烈如折断一般，这称为“折腰痘”。医生强行使用荆防败毒散来发散痘毒，结果痘点像跳蚤咬的斑点一样细碎密集，口鼻出血而死。
另一个孩子初起发热时，腰痛牵连背部脊柱，不能转身侧卧，痘点出现在左耳侧面，以及腰部左侧一点如筋头大小，平坦且呈紫色，舌中心也有一点，高耸且发黑，这是肾毒逆乱的危候。紧急使用四牙散，使紫黑色的痘点发出，五天后死亡。
另一个孩子在孟夏时节发热，腰痛严重，痘点稠密且呈紫黑色，幸好患者神志尚清且胃气强盛，元气充实，虽然属于逆症但还有生机。第四天，服用一剂四牙散，又送服两剂化毒散配合地黄丸，第二天痘疹发出。但颜色未转红润，于是用黄连解毒汤加入柴胡、牛蒡子、当归、白芍、地黄而痊愈。
一个十四岁的女孩，痘疹正处在灌浆充足阶段，突然腰痛不能转身侧卧，这是因为经血流失过多所致。用六味地黄丸加入当归、白芍、续断、杜仲治疗，痊愈。
一个十八岁的男子，出痘后四十多天，突然腰痛极其剧烈，两手撒开抽搐，眼睛睁开无神，出汗且遗尿，喉间痰声如锯响，六脉浮大，这是由于纵欲房劳过度，导致阴阳离决（生命基础崩溃）。用艾灸气海穴六十壮，四肢恢复活动。又频繁服用独圣汤，并配合八味地黄丸而痊愈。
一个二十岁的男子，出痘后腰痛，左尺脉微弱，这是房劳过度所致。用八味地黄丸、补中益气汤交替服用而痊愈。
有一个痘疹不起发而腰痛的患者，缪仲淳用人参芦三两煎服，通过催吐使痘疹发出，疼痛停止。病邪在下焦，通过呕吐使其上升发散，吐法具有发散的含义。（出自《广笔记》。）
还有一个痘疹形态良好，绽开明朗且颜色淡红，但双腿疼痛剧烈。腿部也归属于肾，这是阴虚而毒邪乘虚侵袭所致。服用两剂活命饮，疼痛稍止。再用十全大补汤、六味地黄丸交替服用而痊愈。此症如果不早治疗，等到四肢厥冷，就会变为黑紫色而死，与腰痛逆症相同，不可轻视。
一个孩子出痘后，小腿胫骨疼痛剧烈，但不红肿，这是气血虚弱不能荣养筋骨所致。用归芍四君子汤加入牛膝、独活、薏苡仁、桂枝，连续服用数剂而痊愈。
一个十四岁的孩子，出痘后腰脊疼痛不能俯仰，午后潮热，这是骨髓枯竭，少水不胜多火，肾气有热的表现。灸昆仑穴、申脉穴各三壮，又用六味地黄丸加入独活，及补中益气汤交替服用而痊愈。（既然说是肾热，为什么用火攻疗法却痊愈了？这种说法值得怀疑。）
万密斋治疗一个富家子弟，十六岁，患痘，发热腰痛。询问是否结婚？回答说：没有。连续服用两剂人参败毒散，疼痛停止，痘疹发出而安。如果曾经有过性生活，则无法治愈。（或者可以用大剂量的左归丸给予治疗，那必定是高手的做法。批注。）
李季虬说：顾叔夏的次子，出痘前先腰痛。我判断为不治之症，果然夭折。施季泉说：凡是成婚或破阳之后，出痘而腰痛的是可以治疗的；童子若腰痛，则是先天肾水不足，无法治愈。（出自《广笔记》。）
费建中治疗章继美，年龄近三十岁，季冬时节突然腰部像被棍棒打击般疼痛，昏沉溃乱如同昏迷，问他不回答，身体震颤，肌肉跳动，这是痘疹的征象。但腰部剧痛，说明病情必然逆乱。用大黄、山楂各六钱，青皮、羌活、桃仁各二钱，佐以荆芥、干葛、玄参，趁痘疹初起预先攻下，希望能有一线转机。如果见到痘疹发出，则肾已受伤，就来不及了。从申时到卯时，连续服用两个头煎药，次日早晨痘点发出如芥菜籽如砂粒，颜色焦紫，上下紧密无隙，形色既已逆乱，神情又恶劣，拒绝治疗。因患者苦苦恳求，于是用大黄八钱，石膏一两，黄连二钱，生地一两半，佐以荆芥、羌活、葛根、牛蒡子、红花、桃仁、蝉蜕等，每剂药加入十条白颈地龙，又以猪尾膏半盏调和入药，连续服用两剂。第二天如芥如砂的焦黑色痘点消退，颗粒分明红活，但密度大且神志昏沉、热势炽盛。前方药服用了九天，虽然痘顶绽开如珠，浆液黄如蜡，但昏热依旧，每天大便六七次且不顺畅，不吃水米。议论者认为寒凉药太过。我说：如果因为过用荡涤伤及胃气，则气血缺乏根本，浆液从何而来？到了第十天，面部有回生之意，但仍不思饮食，于是用大黄、石膏各一两，生地一两半，黄连、山楂四钱，佐以牛蒡子、荆芥、甘草。第十二天，胃口忽然打开，神志清爽，热势平和。第十五天，诸症悉愈，结痂如松皮。他又出现口疮，牙齿脱落，又服用牛黄、朱砂末，并黄连解毒汤十余剂，逐渐痊愈。一个月后，又发作血风疮，身上没有完好的皮肤，（这是肾病传脾，所以算作轻症。）将近一百天才完全康复。这个病症在危急疑惧之际，旁议纷纷，幸亏病人家属有见识，所以得以收效。
朱应我治疗一个新娶的男子，二十岁出痘，腰痛支撑不住。医生见面部痘疹白色挨挤簇拥，考虑到此时正值新婚，必定是肾虚，急忙煎煮杜仲、锁阳等补益药剂。朱应我看诊后认为，面部虽然白，但眼睛红，腰间微见红斑，决不可进补，用犀角、生地、丹皮，加入升麻、芍药，一剂药后腰痛消失。这是见到斑疹就治疗斑疹，不可拘泥于新婚这一因素。后来也是清热与补益交替施用而痊愈。
Xu Zhongguang treated a fellow student, aged eighteen. Initially, he suffered from fever accompanied by lower back pain. The smallpox lesions first appeared on the corner of the forehead; the spots were bright red and lustrous, indicating a favorable course (Shun Zheng) related to the Heart channel, rather than a critical reversal pattern (Ni Hou) involving the Kidney. Nevertheless, nourishing the Kidney Yin was indicated. A prescription based on Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) was used, supplemented with Gouqi Zi (Lycium Fruit) and Duzhong (Eucommia Bark), administered alternately with herbs promoting eruption. Consequently, the pain ceased, and the smallpox erupted. By the sixth day, symptoms included irritability, thirst, delirium, dry lips, black tongue coating, and restless sleep. This indicated that Kidney Water was insufficient to control Fire. Baoyuan Tang (Preserve the Origin Decoction) was prescribed with Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root), Dong Gua Ren (not Winter Melon Seed here likely refers to Maidong/Ophiopogon or similar cooling herb in context, but strictly "Dong" usually implies Maidong in this specific formula variation or is a typo for Maidong/Dongchongxiacao, however standard interpretation of "Dong" in Qing texts often points to Maidong Ophiopogonis Radix), Gouqi, Suanzaoren (Ziziphus Seed), and Longyan Rou (Longan Aril). Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill, also known as Jin Gui Shenqi Wan) supplemented with Maidong (Ophiopogon Radix) and Gouqi was taken intermittently, leading to gradual recovery. Another child presented with identical initial symptoms but was treated only with Yang-tonifying herbs without Yin-nourishing agents. The body became desiccated, the scabs adhered and did not detach, resulting in death.
Another child developed severe lower back pain resembling a fracture during the initial fever stage, a condition termed "Broken Waist Smallpox." Forced eruption using Jingfang Baidu San (Schizonepeta and Saposhnikovia Decoction to Overcome Toxicity) resulted in pinpoint spots like flea bites and hemorrhage from the mouth and nose, leading to death.
A third child presented with fever, lower back pain radiating to the spine, and inability to turn sideways. Lesions appeared on the left side of the ear and one spot on the left waist, flat and purple, sized like a sinew knot. A spot on the center of the tongue was elevated and black. This signified a critical reversal pattern of Kidney toxicity. Siya San (Four-Tooth Powder) was urgently administered to erupt the purple-black spots; the patient died five days later.
A fourth child developed fever and severe lower back pain in early summer. The smallpox spots were dense, purple, and black. Fortunately, the spirit was clear, stomach Qi was strong, and Yuan Qi (Original Qi) was substantial. Although it was a reversal pattern, there was still hope for life. On the fourth day, one dose of Siya San was given, followed by two doses of Huadu San (Toxin-Transforming Powder) with Dihuang Wan (Rehmannia Pill). The next day, the smallpox erupted. As the color had not turned red, Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity) was modified with Chaihu (Bupleurum Root), Niubangzi (Arctii Fructus), Dang Gui, Bai Shao, and Dihuang, leading to recovery.
A fourteen-year-old girl, whose smallpox was fully filled with pus, suddenly experienced severe lower back pain preventing her from turning. This was attributed to excessive loss of menstrual blood. Liuwei Dihuang Wan supplemented with Dang Gui, Bai Shao, Xuduan (Dipsacus Root), and Duzhong cured the condition.
An eighteen-year-old man suffered extreme lower back pain forty days after smallpox onset, accompanied by flaccid limbs, open eyes with no luster, sweating, urinary incontinence, saw-like phlegm rattle in the throat, and floating-large pulses. This was diagnosed as Yin-Yang separation due to excessive sexual indulgence. Moxibustion at Qihai (CV6) for sixty moxa cones restored limb movement. Dusheng Tang (Single-Superior Decoction) was frequently administered along with Bawei Dihuang Wan, resulting in recovery.
A twenty-year-old man suffered lower back pain after smallpox, with a weak and fine pulse at the left Chi position. This was caused by sexual fatigue. Bawei Dihuang Wan and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) were taken alternately, leading to recovery.
In a case where smallpox failed to erupt accompanied by lower back pain, Miao Zhongchun prescribed three taels of Renshen Lu (Ginseng Rhizome) decoction. Induced vomiting caused the smallpox to erupt and the pain to cease. Since the toxin was located below, vomiting served to raise and disperse it; the method of vomiting embodies dispersal. (From *Guang Biji*).
In another case, the smallpox appeared well-defined with pale red color, but the legs were severely painful. The legs are associated with the Kidney; this indicated Yin deficiency allowing toxin invasion. Two doses of Huoming Yin (Life-Preserving Drink) alleviated the pain slightly. Shiquan Dabu Tang (Ten-Agent Great Tonifying Decoction) and Liuwei Dihuang Wan were taken intermittently, curing the patient. If not treated early, leading to cold extremities, the spots would turn black/purple, causing death, similar to critical lower back pain patterns; thus, it must not be neglected.
A child suffered severe pain in the shins after smallpox, without redness or swelling. This was due to Qi and Blood deficiency failing to nourish the sinews and bones. Guishao Sijunzi Tang (Angelica, White Peony, and Four Gentlemen Decoction) supplemented with Niuxi (Achyranthes Root), Duhuo (Angelica Pubescens), Yiyiren (Coix Seed), and Guizhi (Cinnamon Twig) cured the condition after several doses.
A fourteen-year-old child suffered lower back and spine pain preventing flexion/extension after smallpox, with afternoon tidal fever. This indicated exhaustion of bone marrow, insufficient water failing to overcome fire, and Heat in the Kidney Qi. Moxibustion was applied to Kunlun (BL60) and Shenmai (BL62) for three cones each. Liuwei Dihuang Wan supplemented with Duhuo, and Buzhong Yiqi Tang were taken intermittently, leading to recovery. (Note: If it is Kidney Heat, why did heat therapy (moxibustion) cure it? This explanation is questionable.)
Wan Mizhai treated a wealthy sixteen-year-old boy with smallpox, fever, and lower back pain. Upon asking if he was married, the answer was no. Two doses of Renshen Baidu San (Ginseng Decoction to Overcome Toxicity) were administered consecutively; the pain stopped, the smallpox erupted, and the patient stabilized. If he had engaged in sexual activity, the condition would have been incurable. (Commentary: Using a large dose of Zuogui Wan (Left-Restoring Pill) might have been effective; that would require a master physician.)
Li Jiqiu stated: Gu Shuxia's second son developed lower back pain before the smallpox eruption. I judged it as incurable, and indeed, he died young. Shi Jiquan stated: For those who have married or lost their virginity, smallpox with lower back pain is treatable. For boys (virgins) with lower back pain, it indicates insufficiency of congenital Kidney Water and is incurable. (From *Guang Biji*).
Fei Jianzhong treated Zhang Jimei, nearly thirty years old. In late winter, he suddenly suffered severe lower back pain as if beaten, confusion akin to coma, unresponsiveness, body tremors, and muscle twitching—signs of smallpox. However, the severe back pain indicated a critical reversal. Da Huang (Rhubarb Root and Rhizome) and Shan Zha (Hawthorn Fruit) 6 qian each, Qingpi (Citrus Peel), Qianghuo (Notopterygium Rhizome), and Taoren (Peach Kernel) 2 qian each, assisted by Jingjie (Schizonepeta Spike), Gegen (Kudzu Root), and Xuanshen (Scrophularia Root), were used to attack the pathogen preemptively at the onset, hoping for a slight turnaround. Once the smallpox appears, the Kidney is already injured, and it is too late. From Shen hour to Mao hour, two head-decoctions were consumed. The next morning, spots emerged like mustard seeds or sand, dark purple, densely packed. The appearance was critical, and the mental state was poor; treatment was refused. Due to persistent pleading, Da Huang 8 qian, Shigao (Gypsum) 1 liang, Huanglian (Coptis Rhizome) 2 qian, Shengdi (Rehmannia Root) 1.5 liang, assisted by Jingjie, Qianghuo, Gegen, Niubangzi, Honghua (Safflower), Taoren, Chan Tui (Cicada Slough), plus ten earthworms (Di Long) per dose, and half a cup of Zhuwei Gao (Pig Tail Paste) mixed in, were administered for two doses. The next day, the dark spots receded, revealing distinct, red, and vibrant granules, though the density remained high with confusion and intense heat. The previous formula was taken for nine days. Although the pustules opened like pearls with yellow wax-like fluid, confusion and heat persisted. Bowel movements occurred six to seven times daily but were obstructed; no food or water was taken. Critics argued the cold-cooling herbs were excessive. Fei replied: If purging damages the Stomach Qi, Qi and Blood lack a root, how can fluid form? On the tenth day, the face showed signs of recovery, but appetite remained absent. Da Huang and Shigao 1 liang each, Shengdi 1.5 liang, Huanglian and Shan Zha 4 qian each, assisted by Niubangzi, Jingjie, and Gancao (Licorice Root), were prescribed. On the twelfth day, the stomach opened, spirit cleared, and heat subsided. On the fifteenth day, all symptoms resolved, forming pine-bark-like scabs. He then developed oral ulcers and tooth loss. Niuhuang (Calculus Bovis), Zhuma (Cinnabar), and Huanglian Jiedu Tang were taken for over ten doses, leading to gradual improvement. After a month, wind-blood sores erupted, leaving no intact skin (Kidney transmitting to Spleen, hence considered a milder complication). Full recovery took nearly one hundred days. Amidst crisis and conflicting opinions, the family's discernment allowed for success.
Zhu Yingwo treated a newlywed twenty-year-old man with smallpox and unbearable lower back pain. The physician observed white, clustered facial spots and assumed Kidney deficiency due to recent marriage, prescribing rapid decoctions of Duzhong and Suoyang (Cynomorium) tonics. Zhu observed that although the face was white, the eyes were red, and faint red spots appeared on the waist. He determined supplementation was contraindicated. Xijiao (Rhinoceros Horn - now substituted with Shuiniu Jiaojiao or similar), Shengdi, Mudan Pi (Moutan Cortex), Shengma (Cimicifuga Rhizome), and Shaoyao were prescribed. One dose eliminated the lower back pain. This illustrates treating the rash upon its appearance, without being bound by the factor of recent marriage. Subsequent alternating clearing and tonifying therapies led to recovery.