（收靥门参看）
〔万〕痘疮所贵者，坚实不破，圆净成痂也，其有溃烂者，火胜也。经曰∶热胜
则肉腐。火之为用，猛虐峻暴，近之则燥痒不宁，迫之则焦痛难忍，灼之则糜烂成疮，故败物者莫如火也。火生
于空，非虚不燃，乘之以风，其焰益烈，痘疮溃烂，由肌肉素虚，邪风侵袭，风者，善行数变，行诸脉俞，散
于荣卫之间，一旦毒发于里，风应于表，风火相扇，肌肉愤 ，皮肤决裂，而疮坏矣。如脓成而溃，则毒已
化，但粘衣渍席，不能干较，古方以败草散主之，诚良法也。脓浆未成，其毒未化，痒破溃烂者，则卫气暴泄，
津液不荣，譬诸草木剥削其皮，枯萎而死矣。经曰∶根于中者，命曰神机，神去则机息，根于外者，命曰气立，
气止则化绝，此之谓也。
〔薛〕闻人氏云∶痘 烂之证，因当发散而不发散，则毒瓦斯闭塞，以致喘促闷乱。不当发散而误发散，则
毒随阳气暴出于外，遍身皮肤溃烂。治宜调脾胃，进饮食，大便调和，荣卫健旺，毒瓦斯自解，而无目赤咽痛，口疮
吐衄等证。窃谓，前证若发表过甚，大便自利，急用理中丸、豆蔻丸（俱痘泻利）以救其里。亦有痘疹如蚊
所啮而色黑，乃危证也，若大小便秘结烦躁，用山栀子汤（痘夹 ）、 猪尾血调脑子治之，自利不食者
不可用。盖毒发于表而妄汗之，则腠理开泄，荣卫益虚，转增疮烂，由是风邪乘虚
变证者有之。若毒根于里而妄下之，则内气愈虚，毒不能出而反入焉，由是土不胜水，变黑归肾，身体振寒，
两耳尻冷，眼合肚胀，其疮黑陷，十无一生，治者审之。
疮出太盛，脓汁淋漓，不可着席，疼痛者干黄土罗末敷之，甚者白龙散（痒塌）帛裹扑之，或败草散（收靥）
贴之。丹溪云∶疮湿者，用泻湿，乃肌表间湿，宜用风药白芷、防风之类。闻人氏用麦麸衬卧。暑月热，甚
当藉之以芭蕉叶为佳。或疮已出定，大便不通，而脓汁不干者，此热毒合下证也，宜牛黄丹利之。若疮口湿，
及脓血杂流者，百花膏（收靥）、生肌散、金华散、绵茧散（收靥）、魏氏白螺散、乳香韶粉散俱可
用。若靥后复生，乃余毒失于解利，留滞于肌肉之间而然也，宜消毒散（出太密）。或结痂久而不落，亦宜百
花膏。若痘烂无脓，吐利不止，或二便下血，乳食不化者，不治之证也。
牛黄丹 治疮子出定，大便不通，疮中脓水不干。
牛黄 大黄末（生用） 珍珠末 粉霜（各一两）
上研匀，炼蜜丸，如黍米大。每服十粒，人参汤下。量儿大小加减。
生肌散 治疳蚀不敛，并痘后脓血杂流不收等疮。
地骨皮 黄连 五倍子 甘草 黄柏（各等分）
上为细末。干掺疮上。
金华散 治痘证后肥疮、疳疮疥癣，能收水、凉肌、解毒。
黄丹（水飞过，火 红，一两） 黄柏 黄连（各五钱） 黄芩 大黄（各三钱） 轻粉（一钱）
麝香（一分）
上为细末。疮湿，干掺，燥，用腊猪油熬化，调搽。
白螺散 专治疮痘不收。
白螺蛳壳（不拘多少，古墙上取）
上，去土，洗净，火炼红，取出，存性，为极细末。疮口湿处，干掺为妙。
乳香韶粉散
即韶粉散加乳香末三钱。（韶粉散方见落痂证治）
又方
荔枝壳（微烧，存性） 草纸（烧灰，存性） 败茅（多年者）
三味，共为细末。或搽，或掺，自能收水结痂。
又方
黄豆壳烧白灰，为末，掺之。如痘风癣，以痘壳煎汤洗。
秘传茶叶方 痘烂遍身、无皮，脓水流出，粘拈衣被。茶叶，要多拣去粗梗，入滚水一渫，即捞起，
再拣去梗，湿铺床上，用草纸隔一层，令儿睡上，一夜则脓皆干。
荞麦粉法（见收靥证治）
蝉花散 治烂痘生蛆虫，及夏月诸虫咬伤，臭恶不可近者。服之，虫皆化而为水，苍蝇亦不敢近。
蝉蜕（洗净，焙） 青黛（澄去灰土。各五钱） 北细辛（二钱半） 蛇蜕（一两，烧、存性）
上为细末。每服三钱，酒调下。仍以生寒水石细末，掺之。
（参见收靥门）
〔万全〕痘疮最可贵的是坚实不破、圆满洁净并结成痂皮。那些出现溃烂的，是因为火邪过盛。医经说：热邪胜则肌肉腐烂。火的作用，猛烈暴虐，靠近它则感到燥痒不安，逼迫它则焦痛难忍，灼烧它则糜烂成疮，所以败坏事物的没有比得上火的了。火产生于空虚之处，没有虚空不能燃烧，乘着风势，火焰更加猛烈。痘疮溃烂，是由于肌肉素来虚弱，邪风侵袭所致。风性善行数变，行走在经脉俞穴之间，散布在荣卫之中。一旦毒发于体内，风应于体表，风火相互煽动，肌肉肿胀，皮肤破裂，从而导致疮疡毁坏。如果脓液形成后破溃，说明毒邪已经化解，只是粘衣服湿席子，难以干燥，古方用败草散主治，确实是良法。如果脓浆未形成，毒邪未化解，因瘙痒抓破而溃烂的，则是卫气突然泄脱，津液不能濡养肌肤，就像草木剥去了树皮，枯萎而死一样。医经说：根于体内的，叫做神机，神去则机能停止；根于体外的，叫做气立，气止则化生绝灭，说的就是这个道理。
〔薛己〕闻人氏说：痘疮溃烂的证候，是因为应当发散表邪而没有发散，导致毒瓦斯闭塞，以致气喘急促、胸闷烦乱。不应当发散而误用发散，则毒随阳气暴出于体表，遍身皮肤溃烂。治疗应当调理脾胃，增进饮食，使大便调和，荣卫健旺，毒瓦斯自然解除，就不会出现目赤咽痛、口疮吐衄等证候。我认为，前述证候如果发表过度，导致大便自利（腹泻），急用理中丸、豆蔻丸（均用于痘泻利）来救里。也有痘疹像被蚊子叮咬且颜色发黑的，这是危重证候，如果大小便秘结烦躁，用山栀子汤（用于痘夹斑）、猪尾血调脑子治疗，如果是自利不食的则不可用。因为毒发于体表而妄用发汗，则腠理开泄，荣卫更加虚弱，反而增加疮烂，由此风邪乘虚而入产生变证的有这种情况。如果毒根深于体内而妄用攻下，则内气更加虚弱，毒邪不能排出反而内陷，由此土不胜水，变黑归肾，身体战栗恶寒，两耳和尾骶部冰冷，眼睛闭合腹部胀大，疮色黑陷，十无一生，医者务必审慎。
疮出得太盛，脓汁淋漓，不能接触席子，疼痛的用干黄土研末外敷，严重的用白龙散（用于痒塌）用帛包裹扑撒，或者用败草散（用于收靥）贴敷。丹溪说：疮面潮湿的，用祛湿法，这是肌表间的湿气，宜用风药如白芷、防风之类。闻人氏用麦麸衬垫卧具。暑天炎热，更应当借助芭蕉叶为佳。或者疮已出定，大便不通，而脓汁不干者，这是热毒兼有可下之证，宜用牛黄丹通利。如果疮口潮湿，以及脓血混杂流出者，百花膏（用于收靥）、生肌散、金华散、绵茧散（用于收靥）、魏氏白螺散、乳香韶粉散均可使用。如果结痂后复发，是余毒未能解利，留滞于肌肉之间所致，宜用消毒散（出自太密证治）。或者结痂久而不落，也宜用百花膏。如果痘疮溃烂无脓，吐利不止，或二便下血，乳食不化的，是不治之证。
牛黄丹 治疗疮痘出定后，大便不通，疮中脓水不干。
牛黄 大黄末（生用） 珍珠末 粉霜（各一两）
以上研匀，炼蜜为丸，如黍米大。每次服十粒，人参汤送下。根据患儿年龄大小加减剂量。
生肌散 治疗疳蚀不收敛，以及痘后脓血混杂流出不收等疮疡。
地骨皮 黄连 五倍子 甘草 黄柏（各等分）
以上为细末。干掺于疮上。
金华散 治疗痘证后肥疮、疳疮疥癣，能收水、凉肌、解毒。
黄丹（水飞过，火煅红，一两） 黄柏 黄连（各五钱） 黄芩 大黄（各三钱） 轻粉（一钱）
麝香（一分）
以上为细末。疮面潮湿，干掺；干燥的，用腊猪油熬化，调匀搽涂。
白螺散 专治疮痘不收口。
白螺蛳壳（不拘多少，从古墙上取）
以上，去掉泥土，洗净，火煅至红，取出，存性，研为极细末。疮口潮湿处，干掺为妙。
又方
荔枝壳（微烧，存性） 草纸（烧灰，存性） 败茅（多年的）
三味，共为细末。或搽，或掺，自能收水结痂。
又方
黄豆壳烧成白灰，为末，掺之。如患痘风癣，以痘壳煎汤清洗。
秘传茶叶方 痘烂遍身、无皮，脓水流出，粘着衣被。茶叶，要多拣去粗梗，放入滚水中烫一下，立即捞起，再拣去梗，湿铺在床上，用草纸隔一层，让患儿睡在上面，一夜则脓水皆干。
荞麦粉法（见收靥证治）
蝉花散 治疗烂痘生蛆虫，以及夏季各种虫咬伤，臭恶不可近者。服用后，虫皆化为水，苍蝇也不敢靠近。
蝉蜕（洗净，焙干） 青黛（澄去灰土。各五钱） 北细辛（二钱半） 蛇蜕（一两，烧、存性）
以上为细末。每次服三钱，酒调下。仍以生寒水石细末，掺于患处。
(See also the section on Scab Formation)
[Wan Quan] The most desirable outcome for smallpox lesions is that they remain firm, unbroken, round, and clean until scabs form. Lesions that ulcerate are due to an excess of Fire pathogen. The classics state: "When heat prevails, flesh rots." The function of fire is fierce and violent; proximity causes dryness, itching, and restlessness; pressure causes burning pain that is unbearable; scorching leads to erosion and sore formation. Thus, nothing destroys matter more than fire. Fire arises from emptiness and cannot burn without a void; when driven by wind, its flames intensify. Smallpox ulceration occurs because the muscles are inherently deficient, allowing evil wind pathogens to invade. Wind is characterized by rapid movement and change, traveling through the meridians and acupoints, and dispersing between the Ying (Nutritive) and Wei (Defensive) levels. Once the toxin erupts internally, the wind responds externally. Wind and fire fan each other, causing muscle swelling and skin rupture, leading to the destruction of the sores. If pus forms and then ruptures, it indicates that the toxin has transformed; however, the discharge may still stick to clothes and bedding, making it difficult to dry. The ancient formula Baicao San (Decoction of Decayed Grass) is the primary treatment, which is indeed an excellent method. If the pus has not yet formed, and the toxin has not transformed, itching and scratching lead to ulceration. This represents a sudden leakage of Wei Qi and a failure of body fluids to nourish the skin, akin to trees losing their bark and withering to death. The classics state: "Those rooted within are called Shen Ji (Spirit Mechanism); when the spirit departs, the mechanism ceases. Those rooted outside are called Qi Li (Qi Establishment); when the qi stops, transformation ends." This refers to the aforementioned situation.
[Xue Ji] Wenren Shi stated: In cases of smallpox ulceration, if dispersing the exterior was indicated but neglected, the toxic vapors become blocked, leading to panting, shortness of breath, chest oppression, and confusion. If dispersing was not indicated but mistakenly used, the toxins follow the Yang Qi and erupt violently to the exterior, causing widespread skin ulceration. Treatment should focus on regulating the Spleen and Stomach, promoting appetite, ensuring smooth bowel movements, and strengthening Ying and Wei, so that the toxic vapors resolve naturally, preventing symptoms such as red eyes, sore throat, mouth ulcers, vomiting, and epistaxis. I believe that if the aforementioned condition results from excessive exterior-releasing measures leading to spontaneous diarrhea, one should urgently use Lizhong Wan (Regulate the Middle Pill) or Doukou Wan (Cardamom Pill) [both indicated for smallpox with diarrhea] to rescue the interior. There are also cases where smallpox lesions resemble mosquito bites and appear black, which is a critical condition. If accompanied by constipation of both stool and urine, irritability, and restlessness, Shanzhizi Tang (Gardenia Decoction) [for smallpox with macules] mixed with pig tail blood and brain can be used. However, it is contraindicated in patients with spontaneous diarrhea and inability to eat. This is because releasing the exterior via sweating when the toxin is at the surface opens the pores, further depleting Ying and Wei, exacerbating the ulceration, and allowing wind pathogens to enter due to deficiency, causing complications. Conversely, if the toxin is rooted internally and purgatives are wrongly used, the internal Qi becomes even weaker, the toxin cannot exit and instead sinks inward. Consequently, Earth fails to control Water, the color turns black, and the disease returns to the Kidney. Symptoms include tremors and aversion to cold, cold ears and coccyx, closed eyes, abdominal distension, and black, depressed lesions. Few survive; physicians must exercise caution.
If lesions are too numerous, with dripping pus, preventing contact with mats, and causing pain, apply fine powder of dry yellow earth. For severe cases, apply Bailong San (White Dragon Powder) [indicated for itchy collapse] wrapped in cloth, or Baicao San [indicated for scab formation]. Danxi stated: For moist sores, use damp-draining methods. This refers to dampness on the skin surface, suitable for aromatic wind-dispersing herbs like Bai Zhi (Angelicae Dahuricae Radix) and Fang Feng (Saposhnikoviae Radix). Wenren Shi recommended using wheat bran as a mattress liner. During hot summer months, using banana leaves is particularly beneficial. If lesions have erupted but defecation is obstructed and pus does not dry, this indicates heat-toxin combined with a downward-indicating syndrome; Niuhuang Dan (Calculus Bovis Pill) should be used to promote evacuation. For moist sore openings and mixed pus-blood discharge, Baihua Gao (Hundred Flowers Ointment), Shengji San (Generate Flesh Powder), Jinhua San (Golden Splendor Powder), Mianjian San (Silkworm Cocoon Powder), Wei's Bailuo San (White Snail Shell Powder), and Ruxiang Shaofen San (Frankincense and Kaolin Powder) are all applicable. Recurrence after scabbing is due to residual toxins failing to clear, lingering in the muscles; Xiaodu San (Detoxification Powder) [from the section on dense eruptions] is appropriate. If scabs persist for a long time without falling off, Baihua Gao is also suitable. Smallpox ulceration without pus, accompanied by persistent vomiting and diarrhea, hematochezia/melena, and undigested food in vomit/stool, constitutes an untreatable condition.
Niuhuang Dan (Calculus Bovis Pill): Treats smallpox lesions that have erupted, with obstructed defecation and non-drying pus/water in sores.
Calculus Bovis (Niu Huang), Rhubarb Powder (Da Huang Mo, raw), Pearl Powder (Zhen Zhu Mo), Frost Powder (Fen Shuang) (each 1 liang).
Grind uniformly, mix with refined honey, and pill to the size of millet seeds. Take 10 pills per dose, washed down with Ginseng decoction. Adjust dosage according to the child's age and size.
Shengji San (Generate Flesh Powder): Treats gan erosion that fails to heal, and post-smallpox sores with mixed pus-blood discharge that do not close.
Groundcherry Root Bark (Di Gu Pi), Coptis Rhizome (Huang Lian), Chinese Gall (Wu Bei Zi), Licorice Root (Gan Cao), Phellodendron Bark (Huang Bo) (equal parts).
Grind into fine powder. Apply dry powder directly to the sores.
Jinhua San (Golden Splendor Powder): Treats post-smallpox impetigo, gan sores, tinea, and scabies; drains dampness, cools the skin, and detoxifies.
Lead Monoxide (Huang Dan, water-washed, calcined until red, 1 liang), Phellodendron Bark (Huang Bo), Coptis Rhizome (Huang Lian) (each 5 qian), Scutellaria Root (Huang Qin), Rhubarb (Da Huang) (each 3 qian), Calomel (Qing Fen, 1 qian), Musk (She Xiang, 1 fen).
Grind into fine powder. For moist sores, apply dry powder; for dry sores, melt rendered pork lard and mix with the powder for application.
Bailuo San (White Snail Shell Powder): Specifically treats sores and smallpox that fail to close.
White River Snail Shells (Bai Luo Si Ke) (any amount, taken from old walls).
Remove dirt, wash clean, calcine until red, remove from fire, preserve the nature/properties, and grind into extremely fine powder. Apply dry powder to moist sore openings for best results.
Ruxiang Shaofen San (Frankincense and Kaolin Powder)
This is Shaofen San plus 3 qian of Frankincense Powder (Ru Xiang Mo). (Shaofen San formula is found in the section on Scab Falling).
Another Prescription:
Lychee Shell (Li Zhi Qiao, slightly burned, preserved properties), Paper Straw (Cao Zhi, burned to ash, preserved properties), Old Imperata Rhizome (Bai Mao Gen, aged) (three ingredients).
Grind together into fine powder. Apply or sprinkle; it naturally dries exudate and promotes scabbing.
Another Prescription:
Burn soybean shells to white ash, grind into powder, and sprinkle. For smallpox wind-tinea, wash with decoction of smallpox shells.
Secretly Transmitted Tea Leaf Method: For widespread smallpox ulceration without skin, with oozing pus sticking to clothes and bedding. Select tea leaves, removing coarse stems. Blanch in boiling water once, immediately remove, pick out remaining stems, spread wet on the bed, place a layer of paper straw over it, and let the child sleep on it overnight. The pus will dry completely.
Buckwheat Flour Method (see section on Scab Formation).
Chan Hua San (Cicada Flower Powder): Treats maggots in ulcerated smallpox and insect bites in summer that are foul-smelling and repulsive. Upon ingestion, maggots dissolve into water, and flies dare not approach.
Cicada Slough (Chan Tui, washed and dried), Indigo Naturalis (Qing Dai, settled to remove dust) (each 5 qian), Asarum (Xi Xin, 2.5 qian), Snake Slough (She Tui, 1 liang, burned, preserved properties).
Grind into fine powder. Take 3 qian per dose, mixed with wine. Additionally, apply fine powder of Calcitum (Han Shui Shi) topically.