溯源 痘诊之症，不着先秦古书，故溯流穷源，类多未定之见。有谓在母腹中时食秽血
而致者，有谓在交媾时欲火所钟者，盖皆胎毒也。宋元以来，医家之说大抵皆然。而近又有
天行疫厉与伤寒同，则是外感了，与胎毒无干，不知伤寒之病，人有不患之者；而痘则人
人不得而免。伤寒则既病之后，不能保其不再病；而痘疹一出之后，永不复出。如此，则所谓
胎毒者，是也。然食秽之于欲火，自有男女以来即有之，何此不见于汉以前，而特于建武以
后始有之，岂建武以前独无胎毒耶？曰∶痘疹之症，其始也，未有不本于胎毒；而其既也，未
始不成于外感。惟其本于胎毒，故人人不得而免；惟其成于外感，故特见于建武之后，而建
武以前无见也。经云∶不平之温热者疮。盖上古之时，风气未漓，禀受素浓，即有胎毒，自能
内消。寒凉之地，腠理闭秘，疫厉难侵；温热之方，风气平安，疮亦不作，故未闻有患痘者。至
建武时，胡虏极西北之人，到南方温热之地，腠理开通，偶感时行疫厉之气，触动在胎时所
受温热毒，发为此疮，所传染无一得免，而痘症着矣。即如俗所云杨梅疮者，亦起近代，亦
能传染，其一发之后，不复再出，又与痘同。盖人在气交之中，故痘疹由外感而成者，类能传
染，惟莫开其端，则其症不着，要未可以执一论也。惟内染外感，相搏而成，故欲发之初，未
见红点之际，以微汗散之，未有不愈者。失此不汗，至于将出未出之时，其势已成，更欲汗
之，虚者不能成浆，实者必成斑烂矣。可不审哉。
痘疹始于胎毒，继感瘟疫外邪，引动伏毒，势若燎原，危险万分，互相传染，为害闾
阎，所以喻氏为之。痘因温疫而发，按外感六经而治，所以择无疫之时宣泄，可收十全，万
密斋言之最精，管柽亦良，《痘诊定论》补方尤妙。近有引种法，由占拿氏发明原理，百无一
失，仅行于粤东，尚未广布宇内。江浙之人，疑信相半，惜乎不能开通，奈何！能治外感疫厉，
即能疗痘疮，喻氏创之于前，是济世之苦心，奈庸俗不知何！
按∶近牛苗引种之法已普遍。
预防 预防之药，如古方油饮子、辰砂散、龙骨膏之类，人多用之未有效者，痘固不
可以预治耶？然不治已病治未病，亦医所宜知。故凡值天时不正，乡邑痘疮盛发，或遇冬
温阳气暴泄，至春夏之时，疮必大行，宜预以凉血降火之药治之，则多者可少，少者可无，
亦或有此理。今以经验一方附于后∶
代天宣化丸
人中黄（属土，甲已年为君） 黄芩（属金，乙庚年为君） 黄柏（属水，丙辛年为君）
栀子（属木，丁壬年为君） 黄连（属火，戊癸年为君） 苦参（佐） 荆芥穗（佐） 防风
（去芦，佐） 连翘（去心，酒洗，佐） 紫苏叶（佐） 牛旁子（酒淘，炒，佐） 山豆根（佐）
先视其年所属，取其药以为君，其余主岁者为臣。为君者倍之，为臣者半之，为佐者如
臣四分之三。于冬至日修合为末，取雪水煮升麻，和竹沥，调神曲为丸，外用辰砂、雄黄为
衣。竹叶汤送下（按∶此方即无效，亦无损）。
制人中黄法 取甘草大者，不拘多少，用新竹一节，纳入甘草，仍紧塞无节空处，尿缸
中浸七七日，取出晒干，听用。消毒丹、辰砂（飞过）、丝瓜（近蒂者，三寸，烧存性，为末），上各等分。
周岁以下一钱，一岁以上者二钱，蜜调下。或将鸽子及雄者煮熟，以辰砂搽上，令儿服之，亦可。
上二方大抵以凉血为主。余友孙元博又以生地黄、金银花、川山甲主之，亦妙。盖二药
能凉血，而川山甲能水能陵，又可以引二药贯通经络而无阏也。
若人脾胃素弱者，更宜调其胃气，适其寒温，节其乳食，间以六君子汤加枳实、砂仁、木
香之类与之，使胃气和畅，荣卫流通，其疮易出，亦易靥也。如或禀受元虚，则又宜以滋补
化源为主、微兼凉血之药，如生地、金银花之类，气血既旺，虽即毒盛，亦自无妨。不宜过服
凉解之剂，要在融通而已。
当痘疫未起之年，或天时不正、温疫流行之际，预服凉血降火之药，减泄伏毒，自能减
轻伏邪，确有此理。余在京师旅馆，有滇南普耳莫君，亦来会试。谈及该处有神皇豆，能迎
养供奉之，其所过之街，痘疹不作、作者可免夭陨，真神物也，相传系神农手植。并蒙赠一
粒，试之果验。此言世人罕知，今特记之。
论痘起足太阳 痘疹之症，大抵自足太阳经传变中来。盖痘疹虽非外感，却是因外感
而发，故阳经先受病。与伤寒同。钱氏谓五脏各有一证∶呵欠伸闷，肝也；时发惊悸，心也；
乍凉乍寒，手足凉者，脾也；面目腮赤，咳嗽时嚏者，肺也；惟肾独无症，以其位在下，不受秽
也。此说似是而非。夫痘固毒甚，然亦自经络中受病，苟非坏症，岂有径尔入脏之理！至于
肾独无症，耳、尻、足稍加冷之故。则以痘本火毒，而肾为水脏，水能克火，故火不敢侵之，非
以其不受秽也。子在母胎之时，肾实系之，彻始彻终，皆肾用事，设有秽毒，肾当先受矣。然
则缘何而知其自足太阳起也？曰∶《灵枢·口问篇》治欠伸及嚏，俱补足太阳，是知欠、嚏皆
太阳候也。《素问》又曰∶岁水太过，寒气流行，病烦心燥悸。寒水夹脊逆流，上逆丙火，正寒
气流行之谓也。寒水逆丙火于面上，故面腮俱赤。是惊悸、腮赤，又太阳候也。至于咳嗽、寒
热，则伤寒初起之对，亦多有之，未闻其以此遽谓为脏病也。曰∶既与伤寒同，自太阳来，则
何以无头痛、项强、骨节痛之症？曰∶此属温热，受病既殊，辨症亦异也。
痘因外感引动伏毒而发。太阳，通体之经，故阳经先受，其始必由太阳，亦自然之理
也。西士占拿氏发明引种法，以泄手少阳之毒，引种后永不复出，是良法也。
论汗下 痘疮未出，疑似之间，不可妄用汗、下之药。盖妄汗则虚其表而难成，妄下则
虚其里而易倒陷也。然亦语其平，示人精审耳。若语风寒外袭，应出不出，则汗剂亦可用
也。如大便连日不行，烦闷狂躁，不与下之，宁不夭人生命哉！是下剂亦可用也。况有不止
于此者（明表里，别虚实。在表宜汗，在里宜下，补偏救弊，转危而安，亦治法之权衡，虚实
之妙用也），《体仁汇编》云∶痘疮逆者，宜以保元汤加牛旁子、芩、连、玄参、丝瓜灰、芎、归、
连翘各五分，陈皮桂三分，白芍药一钱，防风、羌活、荆芥、前胡各三分，姜、葱煎服取汗，以
泄其毒，开其滞涩。若七八日内，病势沉重，色白毒深，又用保元汤兼大黄、芒硝、枳实、朴、
芎、归水煎，大下之，则里虚而毒反内攻；在里而汗之，则表虚而毒益难出。气血既实，毒虽
盛而不足以胜其气血，则汗、下以泄其毒，而病自去矣。若气血虚而毒反胜之，则不惟虚人
禁汗，即毒尽泄去亦决不能存活，徒负杀人之谤耳，要当精审也。
辨虚实 不食，气促，腹胀，吐利，为里
虚，四君子汤加减，甚者木香散。反此则实，不必服药。若脏腑热甚，大便秘，小便赤，腹满而
喘，掌心并腋下汗出，诞言妄语，渴饮水浆，能食，而不结痂，宜以承气汤下之。身凉，痘疮根
窠不红，顶陷，为表虚，黄 建中汤加减，甚者异功汤。反此则实，不必服药矣。
吐利，气促，腹胀，为里虚；腹满而喘，二便秘，谵狂，口渴为里实。细心讨论，虚实判然矣。
验轻重 发热轻则毒瓦斯轻，故报痘亦轻；发热重则毒瓦斯重，故报痘亦重。轻者不必言
治，重者宜先解表，凉血解毒次之，及痘既出，盒饭温补气血，以助其成浆收靥。失此不治。
六日之后，无能为矣，审之，慎之！又有两耳后红筋起，明润者，其痘必轻；若紫红筋起而晦
暗者，其痘必重；若大红虽微带紫，而色明润者，痘虽重无事，二者急用解毒凉血之药投之，亦重而变轻矣。
察验耳后红筋以辨轻重，最为明显易从。
溯源：痘疹的症状，没有记载在先秦的古书中，因此追溯其源头，大多是没有定论的看法。有人说是在母腹中时吃了污秽的血而导致的，有人说是在性交时欲望之火积聚所致，这大概都是胎毒。自宋元以来，医家的说法大体上都是这样。但近来又有认为天行疫厉（流行性传染病）与伤寒相同，这就属于外感了，与胎毒无关，却不知道患伤寒的人，并不是每个人都得病；而出痘疹则是人人无法避免的。患伤寒之后，不能保证不再次患病；而痘疹发过一次之后，就永远不再复发。像这样，那么所谓的胎毒，就是这个道理。然而吃污秽之物或欲火积聚，自从有男人女人以来就存在了，为什么这在汉代以前没有见到，而偏偏在建武年以后才开始出现？难道建武以前唯独没有胎毒吗？回答说：痘疹的症状，起初没有不基于胎毒的；而其形成，也没有不是由外感完成的。正因为基于胎毒，所以人人无法避免；正因为由外感促成，所以特别见于建武以后，而建武以前没有见到。经典说：“不平之温热者疮。”大概上古之时，风气淳朴，禀赋浓厚，即使有胎毒，也能自然在内消除。寒冷之地，腠理致密，疫病难以侵入；温暖之地，风气平和，疮疡也不发生，所以没听说过有人患痘。到了建武时期，胡虏极西北之人来到南方温热之地，腠理开通，偶然感受时行疫厉之气，触动在胎时所受的温热毒，发作成这种疮，所传染的人无一幸免，于是痘症就确立了。就像俗话说的杨梅疮，也是起于近代，也能传染，它发过一次之后，就不再复发，又与痘疹相同。大概人在气交之中，所以痘疹由外感而成的，大都能传染，只要不开这个头，那么症状就不会显现，不可以固执地用一种观点来论述。只有内染胎毒与外感邪气相互搏结而成，所以在欲发之初，未见红点之际，用微汗法发散它，没有不痊愈的。错过这个机会不发汗，等到将出未出之时，病势已经形成，再想发汗，虚的人不能化脓成浆，实的人一定会变成斑烂。能不审慎吗？
痘疹始于胎毒，继而感受瘟疫外邪，引动伏毒，势如燎原，危险万分，互相传染，危害百姓，所以喻氏为此著书。痘因温疫而发，按照外感六经来治疗，所以选择无疫之时宣泄，可以收到十全的效果，万密斋说得最精辟，管柽也很好，《痘疹定论》补充的方子尤其奇妙。近来有引种法（种痘），由占拿氏（琴纳）发明原理，百无一失，仅在粤东地区施行，尚未广泛传播到全世界。江浙一带的人，半信半疑，可惜不能开通思想，无奈啊！能治外感疫厉，就能治疗痘疮，喻氏在前面开创，这是济世救人的苦心，无奈庸俗之人不知道这是什么！
按语：近来牛苗引种之法已经普遍。
预防：预防的药物，如古方油饮子、辰砂散、龙骨膏之类，很多人用了没有效果，痘疹真的不可以预先治疗吗？然而“不治已病治未病”，也是医生应该知道的。所以凡是遇到天时不正，乡间痘疮盛发，或者遇到冬温阳气暴泄，到了春夏之时，疮疹必定大规模流行，应当预先用凉血降火的药物治疗，那么多的可以减少，少的可以没有，也许有这个道理。现在附上一个经验方在后面：
代天宣化丸
人中黄（属土，甲己年为君药） 黄芩（属金，乙庚年为君药） 黄柏（属水，丙辛年为君药）
栀子（属木，丁壬年为君药） 黄连（属火，戊癸年为君药） 苦参（佐药） 荆芥穗（佐药） 防风
（去芦头，佐药） 连翘（去心，酒洗，佐药） 紫苏叶（佐药） 牛蒡子（酒淘，炒，佐药） 山豆根（佐药）
先查看该年所属五行，取对应的药物作为君药，其余主岁者为臣药。为君药的用量加倍，为臣药的减半，为佐药的用量是臣药的四分之三。在冬至日制作成粉末，取雪水煮升麻，和入竹沥，调和神曲做成丸药，外用辰砂、雄黄做外衣。用竹叶汤送服（按：此方即使无效，也没有损害）。
制人中黄法：取大的甘草，不拘多少，用新竹子的一节，纳入甘草，仍然紧密塞住没有节的空处，放入尿缸中浸泡七十七天，取出晒干，听候使用。消毒丹、辰砂（飞过）、丝瓜（靠近蒂部的，三寸长，烧至存性，研为末），以上各等分。
周岁以下一钱，一岁以上者二钱，蜜调下服。或者将鸽子及雄鸡煮熟，用辰砂涂抹在上面，让孩子服用，也可以。
上述两个方子大致以凉血为主。我的朋友孙元博又用生地黄、金银花、穿山甲为主药，也很妙。大概这两味药能凉血，而穿山甲能走水又能走陆，又可以引导这两味药贯通经络而没有阻滞。
如果人脾胃素来虚弱，更应该调理胃气，适应寒温，节制乳食，偶尔用六君子汤加枳实、砂仁、木香之类的药给他服用，使胃气和畅，营卫流通，那么疮疹容易发出，也容易结痂愈合。如果禀受元气虚弱，则又应该以滋补化源为主，微微兼用凉血的药，如生地、金银花之类，气血既旺盛，虽然毒素强盛，也自然无妨。不宜过服凉解之剂，关键在于融通而已。
当痘疫未起的年份，或者天时不正、温疫流行的时候，预先服用凉血降火的药，减少泄发伏毒，自然能减轻伏邪，确实有这个道理。我在京师旅馆时，有滇南普洱莫君，也来会试。谈及当地有神皇豆，能够迎接供养供奉它，它所经过的街道，痘疹不发生，发生的可以避免夭折，真是神物啊，相传是神农亲手种植的。并赠送我一粒，试用果然灵验。这话世人很少知道，现在特意记录下来。
论痘起足太阳：痘疹的症状，大体上是从足太阳经传变而来的。大概痘疹虽然不是外感，却是因外感而发作，所以阳经先受病。这与伤寒相同。钱氏说五脏各有一个证候：呵欠伸腰闷倦，是肝的证候；时常惊悸，是心的证候；乍冷乍热，手足凉的，是脾的证候；面目腮部发红，咳嗽打喷嚏的，是肺的证候；唯独肾没有症状，因为它的位置在下，不受秽浊之气。这种说法似是而非。痘疹固然毒素很盛，但也从经络中受病，如果不是坏症，哪有直接入脏的道理！至于肾唯独没有症状，是因为耳、尻、脚稍微加冷的缘故。因为痘本是火毒，而肾是水脏，水能克火，所以火不敢侵犯它，不是因为不受秽浊。孩子在母胎之时，肾实际上系连着胎儿，彻始彻终，都是肾在起作用，如果有秽毒，肾应当先受到。既然这样，那么凭什么知道它从足太阳开始呢？回答说：《灵枢·口问篇》治疗呵欠伸腰及打喷嚏，都补足太阳经，由此可知呵欠、打喷嚏都是太阳经的候象。《素问》又说：岁水太过，寒气流行，病烦心燥悸。寒水夹脊逆流而上，上逆丙火，正是寒气流行的意思。寒水逆冲丙火于面部，所以面腮都发红。这样看来，惊悸、腮赤，又是太阳经的候象。至于咳嗽、寒热，则是伤寒初起时的对证，也有很多这种情况，没听说据此就立刻说是脏病。回答说：既然与伤寒相同，自太阳而来，那么为什么没有头痛、项强、骨节痛的症状？回答说：这属于温热病，受病的性质不同，辨证也就不同。
痘因外感引动伏毒而发作。太阳经，是通体之经，所以阳经先受病，其起始必然由太阳经开始，这也是自然的道理。西方人士占拿氏发明引种法，以泄手少阳之毒，引种后永不复发，这是良法。
论汗下：痘疮未出，处于疑似之间，不可妄用汗、下之药。大概妄用汗法则会虚其表而难成浆，妄用下法则会虚其里而易倒陷。然而这也是针对平常情况而言，示人以精细审慎罢了。如果说风寒外袭，应出不出，那么汗剂也可以使用。如果大便连续几天不行，烦闷狂躁，如果不给之下药，难道不害人性命吗！所以下剂也可以使用。何况还有不止于此的情况（明辨表里，辨别虚实。在表宜汗，在里宜下，补偏救弊，转危为安，也是治法的权衡，虚实的妙用啊），《体仁汇编》说：痘疮逆证的，宜用保元汤加牛蒡子、黄芩、黄连、玄参、丝瓜灰、川芎、当归、连翘各五分，陈皮、桂枝三分，白芍药一钱，防风、羌活、荆芥、前胡各三分，姜、葱煎服取汗，以泄其毒，开其滞涩。如果七八日内，病势沉重，色白毒深，又用保元汤兼大黄、芒硝、枳实、厚朴、川芎、当归水煎，大下之，则里虚而毒反而内攻；在里而用汗法，则表虚而毒更难外出。气血既实，毒虽盛但不足以战胜气血，则用汗、下来泄其毒，病自然去除。如果气血虚而毒反而胜过它，那么不仅虚人禁汗，即使毒尽泄去也绝对不能存活，徒负杀人的骂名罢了，一定要精细审慎。
辨虚实：不进食，气促，腹胀，吐利，为里虚，用四君子汤加减，严重的用木香散。与此相反则为实，不必服药。如果脏腑热甚，大便秘结，小便赤黄，腹部胀满而喘，掌心并腋下出汗，胡言乱语，渴喜饮水浆，能进食，但不结痂，宜用承气汤下之。身凉，痘疮根窠不红，顶陷，为表虚，用小建中汤加减，严重的用异功汤。与此相反则为实，不必服药了。
吐利，气促，腹胀，为里虚；腹满而喘，二便不通，谵语狂躁，口渴为里实。细心讨论，虚实判断清楚了。
验轻重：发热轻则毒瓦斯轻，所以报痘（出痘初期表现）也轻；发热重则毒瓦斯重，所以报痘也重。轻的不用说治疗，重的宜先解表，凉血解毒其次，等到痘既出，应当温补气血，以助其成浆收靥。错过这个时机不治疗，六日之后，就无能为力了，审慎啊，谨慎啊！又有两耳后红筋起，明亮润泽的，其痘必轻；如果紫红筋起而晦暗的，其痘必重；如果大红虽微带紫，而色明润的，痘虽重也无事，这两种情况急用解毒凉血的药投之，也能重而变轻。
察验耳后红筋以辨轻重，最为明显易从。
Tracing the Source: The symptoms of smallpox are not recorded in pre-Qin ancient books. Therefore, tracing its origin and source results in many undecided views. Some claim it is caused by ingesting foul blood while in the womb; others attribute it to the accumulation of desire fire during intercourse. These are generally considered "fetal toxins" (Tai Du, toxins inherited from the fetus). Since the Song and Yuan dynasties, most physicians have held similar views. Recently, however, some have argued that epidemic febrile diseases (Tian Xing Yi Li) are identical to cold damage (Shang Han), implying they are external contractions unrelated to fetal toxins. This is incorrect. Not everyone contracts cold damage, whereas smallpox is unavoidable for everyone. After contracting cold damage, one cannot guarantee against reinfection; but after smallpox erupts once, it never recurs. Thus, the concept of "fetal toxin" holds true. However, ingesting foul substances or desire fire has existed since the beginning of humanity. Why was this not seen before the Han Dynasty, but only appeared after the Jianwu era? Was there truly no fetal toxin before Jianwu? The answer is: initially, all cases of smallpox are rooted in fetal toxins; ultimately, all cases are formed through external contractions. Because they are rooted in fetal toxins, everyone is susceptible; because they are formed by external contractions, they specifically appeared after the Jianwu era and were absent before. The Classics state: "Uneven warmth and heat produce sores." In ancient times, when customs were pure and constitution strong, even if fetal toxins existed, they could be internally resolved. In cold regions, where pores are closed and tight, epidemics struggle to invade; in warm regions with peaceful climates, sores do not form. Hence, smallpox was unheard of. By the Jianwu period, people from the extreme northwest (Hu tribes) moved to the warm southern regions. Their pores opened, and they accidentally contracted the qi of seasonal epidemics, which stirred up the warm-heat toxins received in the womb, causing these sores. Those infected could not escape, and thus smallpox became established. Similarly, the common "yangmei chuang" (syphilis-like sore) also arose in modern times, is contagious, and does not recur after eruption, just like smallpox. Humans exist within the intersection of qi; therefore, smallpox caused by external contractions is generally contagious. If the initial trigger is prevented, the disease does not manifest. One cannot adhere to a single theory. Only when internal fetal toxins and external pathogens clash does the disease form. At the very beginning, before red spots appear, applying mild sweating methods to disperse the pathogen invariably leads to recovery. Missing this opportunity to induce sweating, until the stage of impending eruption, the momentum is already set. Attempting sweating at this point will cause deficiency types to fail to form pus, and excess types to develop into severe macules. How can one not be prudent?
Smallpox begins with fetal toxins, followed by contraction of epidemic external pathogens, which stir up latent toxins. The situation spreads like a prairie fire, extremely dangerous, contagious, and harmful to the common people. Therefore, Yu Shi wrote about it. Smallpox erupts due to warm epidemics; treating it according to the six meridians of external contraction allows for treatment during non-epidemic periods to achieve perfect results. Wan Muzhai expressed this most precisely, Guan Cheng also did well, and the supplementary formulas in *Dou Zhen Ding Lun* are particularly excellent. Recently, inoculation methods (Yin Zhong Fa), pioneered by Jenner (Zhan Na Shi), have proven nearly infallible. They are practiced only in Guangdong and have not yet spread globally. People in Jiangsu and Zhejiang are half-believing and half-doubting; it is a pity that minds are not open. Alas! If one can treat external epidemic contractions, one can treat smallpox. Yu Shi pioneered this approach out of sincere compassion for saving lives, but ignorant vulgarities fail to understand.
Note: The cowpox inoculation method is now widespread.
Prevention: Preventive medicines, such as the ancient formulas You Yin Zi, Chen Sha San, and Long Gu Gao, are often used without effect. Is it really impossible to prevent smallpox beforehand? However, "treating disease before it arises" is knowledge physicians should possess. Therefore, whenever weather is abnormal, local smallpox outbreaks occur, or winter warmth causes sudden leakage of yang qi, leading to large-scale eruptions in spring and summer, one should preemptively use blood-cooling and fire-descending medicines. This may reduce severe cases to mild ones, or mild ones to none. Perhaps this principle holds. I hereby attach an experienced formula below:
Dai Tian Xuan Hua Wan (Pill to Announce Heaven's Will)
Ren Zhong Huang (Earth element, Sovereign herb in Jia/Ji years) Huang Qin (Metal element, Sovereign herb in Yi/Geng years) Huang Bo (Water element, Sovereign herb in Bing/Xin years)
Zhi Zi (Wood element, Sovereign herb in Ding/Ren years) Huang Lian (Fire element, Sovereign herb in Wu/Gui years) Ku Shen (Assistant) Jing Jie Sui (Assistant) Fang Feng
(removed rhizome, Assistant) Lian Qiao (removed heart, wine-washed, Assistant) Zi Su Ye (Assistant) Niu Bang Zi (wine-rinsed, fried, Assistant) Shan Dou Gen (Assistant)
First, determine the elemental year, selecting the corresponding herb as the Sovereign. The remaining annual rulers serve as Ministers. The Sovereign herb dosage is doubled; the Minister herb dosage is halved; the Assistant herb dosage is three-quarters of the Minister. Process on the Winter Solstice day into powder. Use snow water to decoct Sheng Ma, mix with Zhu Li (bamboo sap), and blend with Shen Qu to form pills. Coat externally with Chen Sha (Cinnabar) and Xiong Huang (Realgar). Administer with Zhu Ye Tang (Bamboo Leaf Decoction). (Note: Even if ineffective, this formula causes no harm.)
Method for Preparing Ren Zhong Huang: Take large Gan Cao (Licorice Root), any amount. Insert into a section of fresh bamboo, tightly sealing empty spaces without nodes. Soak in a urine vat for 77 days. Remove, dry, and store for use. Xiao Du Dan, Chen Sha (washed), Si Gua (near the stem, 3 cun, burned until charred but retaining nature, powdered). Mix equal parts.
For infants under one year: 1 qian; over one year: 2 qian. Mix with honey and administer. Alternatively, boil pigeon or rooster, apply Chen Sha to the meat, and let the child eat it. This is also acceptable.
The above two formulas mainly focus on cooling blood. My friend Sun Yuanbo uses Sheng Di Huang (Rehmannia Root), Jin Yin Hua (Honeysuckle Flower), and Chuan Shan Jia (Pangolin Scale) as main herbs, which is also excellent. These two herbs cool blood, while Pangolin Scale traverses both water and land, guiding the other herbs through the collaterals without obstruction.
If the spleen and stomach are inherently weak, it is better to regulate stomach qi, adapt to cold and heat, and control milk and food intake. Occasionally administer Liu Jun Zi Tang (Six Gentlemen Decoction) added with Zhi Shi (Immature Bitter Orange), Sha Ren (Amomum Fruit), and Mu Xiang (Aucklandia Root) to harmonize stomach qi and promote circulation of Ying and Wei qi. This facilitates eruption and scabbing. If constitutional yuan qi is deficient, prioritize tonifying the source of transformation, slightly adding blood-cooling herbs like Sheng Di Huang and Jin Yin Hua. Once qi and blood are robust, even strong toxins pose no threat. Avoid excessive use of cooling and resolving agents; the key lies in flexibility.
In years before smallpox epidemics, or during abnormal weather and epidemic propagation, preemptively taking blood-cooling and fire-descending medicines reduces the release of latent toxins, thereby alleviating latent pathogens. This is indeed effective. While staying in a capital inn, I met Mr. Mo Pu'er from Yunnan, who came to take the imperial examination. He mentioned a "Divine Emperor Bean" in his region. Worshipping and offering it prevents smallpox in streets it passes through, or spares those infected from death. It is truly a divine object, said to be planted by Shennong. He gifted me one bean; testing proved it effective. This information is rarely known by the public; I record it here.
On Smallpox Originating from Foot Taiyang: Smallpox symptoms generally evolve from the Foot Taiyang Meridian. Although smallpox is not strictly an external contraction, it erupts due to external factors, so Yang meridians are affected first, similar to cold damage. Qian’s school states each organ has a specific sign: yawning and stretching indicate Liver; frequent palpitations indicate Heart; alternating cold and heat with cold limbs indicate Spleen; red cheeks, coughing, and sneezing indicate Lung. Kidney alone shows no signs because it is located inferiorly and does not accept filth. This view is plausible but flawed. Smallpox toxins are severe, but they enter via meridians. Unless it is a critical condition, how could toxins directly enter the organs? As for Kidney showing no signs, it is because the ears, sacrum, and feet tend to feel cold. Smallpox is fire toxin, while Kidney is a Water organ; Water controls Fire, so Fire does not invade. It is not because Kidney rejects filth. During fetal development, Kidney connects to the fetus throughout, governing life from start to finish. If filth/toxin exists, Kidney should receive it first. Then, how do we know it starts from Foot Taiyang? Answer: *Ling Shu · Kou Wen Pian* treats yawning, stretching, and sneezing by supplementing Foot Taiyang, indicating these are Taiyang signs. *Su Wen* states: Excessive water qi leads to cold pathogen prevalence, causing vexation, irritability, and palpitations. Cold water reverses up the spine, counteracting Bing Fire (Heart/Small Intestine), representing cold pathogen prevalence. Cold water reversing onto the face causes red cheeks. Thus, palpitations and red cheeks are also Taiyang signs. Cough and fever/chills correspond to early cold damage and are common; no one immediately diagnoses them as organ disease based solely on this. Question: If it is like cold damage and comes from Taiyang, why are there no headache, stiff neck, or joint pain symptoms? Answer: This belongs to warm-heat diseases. The nature of infection differs, so syndrome differentiation differs.
Smallpox erupts when external contractions stir latent toxins. Taiyang is the meridian connecting the whole body; thus, Yang meridians are affected first, starting inevitably from Taiyang, which is natural logic. Western scientist Jenner invented inoculation to drain toxicity from Hand Shaoyang. Post-inoculation, recurrence never happens, making it an excellent method.
On Sweating and Purging: When smallpox has not erupted and diagnosis is uncertain, do not recklessly use sweating or purging medicines. Reckless sweating empties the exterior, making eruption difficult; reckless purging empties the interior, leading to collapse. However, this advice applies to standard cases, emphasizing precision. If wind-cold attacks externally, preventing eruption, sweating agents are applicable. If constipation persists for days accompanied by restlessness and mania, failing to purge would endanger life; thus, purgatives are applicable. Furthermore, situations extend beyond this (Clarify exterior/interior, distinguish deficiency/excess. Exterior requires sweating, interior requires purging. Correct imbalances, turn danger to safety. This is the balance of treatment methods and the subtlety of deficiency/excess). *Ti Ren Hui Bian* states: For adverse smallpox, use Bao Yuan Tang added with Niu Bang Zi, Huang Qin, Huang Lian, Xuan Shen, Si Gua Hui, Xiong Duan, Dang Gui, Lian Qiao (each 5 fen), Chen Pi, Gui Zhi (3 fen), Bai Shao Yao (1 qian), Fang Feng, Qiang Huo, Jing Jie, Qian Hu (each 3 fen). Decoct with Ginger and Scallion to induce sweating, draining toxin and opening stagnation. If after 7-8 days, the condition is severe with white color and deep toxin, use Bao Yuan Tang combined with Da Huang, Mang Xiao, Zhi Shi, Hou Po, Xiong Duan, Dang Gui decocted in water for strong purging. Otherwise, interior deficiency causes toxin to attack inward; sweating an interior condition causes exterior deficiency, making toxin harder to exit. If qi and blood are sufficient, even strong toxins cannot overcome them; sweating and purging drain toxins, and the disease resolves. If qi and blood are deficient and toxins prevail, sweating is forbidden for the deficient. Even if toxins are drained, survival is impossible, resulting only in accusations of murder. Precision is essential.
Differentiating Deficiency and Excess: Anorexia, shortness of breath, abdominal distension, vomiting and diarrhea indicate Interior Deficiency. Modify Si Jun Zi Tang; for severe cases, use Mu Xiang San. The opposite indicates Excess; no medicine needed. If organ heat is severe, with constipation, dark urine, abdominal fullness and wheezing, sweating palms and axillae, delirium, thirst for fluids, appetite but failure to scab, use Cheng Qi Tang to purge. Cool body, non-red pustule bases, and depressed tops indicate Exterior Deficiency. Modify Xiao Jian Zhong Tang; for severe cases, use Yi Gong Tang. The opposite indicates Excess; no medicine needed.
Vomiting/diarrhea, shortness of breath, abdominal distension = Interior Deficiency. Abdominal fullness/wheezing, constipation/urinary retention, delirium/thirst = Interior Excess. Careful discussion clearly distinguishes deficiency and excess.
Assessing Severity: Mild fever implies light toxin, resulting in mild initial eruption signs; heavy fever implies heavy toxin, resulting in severe signs. Mild cases need no special treatment. Severe cases require initial exterior resolution, followed by blood cooling and toxin detoxification. Once erupted, warm-tonify qi and blood to assist pus formation and scabbing. Failure to treat at this stage renders treatment useless after six days. Be prudent and cautious! Red veins appearing behind both ears, bright and lustrous, indicate mild smallpox. Purple-red veins appearing dull and dark indicate severe smallpox. Bright red veins with slight purple tint but lustrous appearance indicate severe smallpox that will resolve safely. For the latter two, urgently administer detoxifying and blood-cooling medicines to transform severity into mildness.
Observing red veins behind the ears to distinguish severity is the most obvious and accessible method.