〔万〕痘癞者，热毒拂郁，气血虚弱，肌肉败坏。经云∶热胜则肉腐者是也。正理论曰∶脉浮而大，浮为
风虚，大为气强，风气相抟，必成瘾疹，身体为痒，痒者名为泄风，久久为大癞。凡气血充实者，外无虚风，
内无强邪，必无是病，惟气血素虚者，不能荣卫于身，易感天地肃杀之气，皮肉之内，虚风居之，兼以痘疹秽
毒，疫疠恶气，击搏燔灼，流散四布，随空而出，所以疮本稠密，身无完肤，瘙痒
难任，肌肉溃烂，而痘癞成矣。急用大补气血，清热解毒之法，庶可求全，若待败面堕鼻，唇崩目盲，肢体残伤，
不至殒命，亦为废人矣。凡疮破成癞者，用十全大补汤（汗）苦参丸合而服之，外用灭瘢救苦散（收靥）涂之。
苦参丸
苦参（一两） 白蒺藜 胡麻 牛蒡子（各半两） 甘草（二钱半）
共为末。酒调面、为丸。竹叶汤下。
经曰∶热胜则肿。大抵毒之盛者必肿，毒微者不肿。凡疮出尽，应期起发，头面以渐浮肿者，此毒火发越，聚
于三阳之分，欲作脓血，故宜皮肉 肿也。设当起发之时，头面不肿者，必疮本磊落，毒瓦斯轻浅，虽尔作脓，
根不占处，所以不肿，不须治之。如疮本模糊，起发不肿者，此毒伏于内，不即发泄，不可以毒轻论也。
如起发肿大，皮肉如常，疮尖而圆，粒粒分明者，此佳兆也。若皮色鲜红、疮本成串，粘聚平塌者，若疮色灰白
成饼、如锡面者，若疮焦紫无水者，皆凶兆也。有先
起发头面预肿者，此兼疫毒之气，名大头瘟者是也。腮颔预肿者，此名虾蟆瘟也，须兼疫气而治，多凶少吉。
大凡疮肿者，直至干浆结痂之时，毒化而肿消矣，故应肿不肿，应消不消者，谨提防之。
凡疮肿胀，面浮目闭者，急与解毒、护目、救咽喉、相兼治之，内用消毒化斑汤（起发），外用神应膏（见形）
护目。凡疮肿胀，切防瘙痒，正面之中，不可少有破损者，苟生痒破，沙崩之势渐不可为，邪气内陷，真气外
泄，肿消而死矣。但得破者复灌，消者复肿，饮食如常，大小便自调者，变凶为吉，用十全大补汤（汗）、苦参丸（痘
癞）合而治之。如疮色灰白，面肿如锡饼者，但看其人脏腑何如，若能食，大便调，小便长，
无他苦者，多吉。若不能食，吐利并作，或生瘙痒者，多凶。
如头面预肿，或腮颊预肿者，此时行疫毒也，并用羌活救苦汤主之。
羌活救苦汤（见起发）
【万全论述】痘癞（天花遗留的严重瘢痕或麻风样病变），是由于热毒拂郁不畅，气血虚弱，导致肌肉败坏。《内经》说：热邪亢盛则肌肉腐烂，正是这个意思。《正理论》说：脉象浮而大，浮表示风邪与虚证，大表示气分强盛，风邪与正气相互搏结，必然形成瘾疹（皮肤红肿瘙痒的皮疹），身体发痒，这种痒症名为泄风，久而久之就会发展成严重的癞病。凡是气血充实的人，体表没有虚风侵袭，体内没有强盛的邪气，必定不会得这种病；只有那些素来气血虚弱的人，不能使营卫之气荣养全身，容易感受天地间肃杀之气，虚风潜伏在皮肉之间，再加上痘疹的秽浊毒气和疫疠恶气的冲击、焚烧和灼伤，流散遍布全身，随着毛孔排出，所以疮疡原本就稠密，身上没有完好的皮肤，瘙痒难以忍受，肌肉溃烂，从而形成了痘癞。此时必须紧急使用大补气血、清热解毒的方法，才有望保全生命，如果等到面部溃败脱落、鼻子塌陷、嘴唇崩裂、眼睛失明、肢体残损受伤，即使不死，也会成为废人。凡是疮破后形成癞病的，用十全大补汤（用于汗法阶段）配合苦参丸一起服用，外用灭瘢救苦散（用于收靥阶段）涂抹。
苦参丸配方：
苦参（一两）、白蒺藜、胡麻、牛蒡子（各半两）、甘草（二钱半）。
以上药物共研为细末，用酒调和面粉，制成丸药。用竹叶汤送服。
《内经》说：热邪亢盛则肿胀。大致来说，毒气旺盛的必然肿胀，毒气微弱的则不肿胀。凡是痘疮出齐，到了应期起发的阶段，头面部逐渐浮肿的，这是毒火发散，聚集在三阳经的部位，准备化脓成血，所以会出现皮肉肿胀的情况。如果在应当起发的时候，头面部不肿胀，那一定是痘疮本身颗粒磊落分明，毒气轻浅，虽然也会化脓，但根基不占据大面积，所以不肿胀，这种情况不需要治疗。如果痘疮本身模糊不清，起发时也不肿胀，这是毒气伏藏在体内，没有立即发泄出来，不能认为是毒气轻微。如果起发时肿大，皮肉形态正常，疮顶圆锐，颗粒分明，这是吉兆。如果皮色鲜红、疮底连成片、粘连聚拢且平塌，或者疮色灰白像饼状、表面如锡箔光泽，或者疮体焦紫干枯无津液，这些都是凶兆。有在起发前头面部预先肿胀的，这是兼夹了疫毒之气，名叫大头瘟。腮部和下颌预先肿胀的，名叫虾蟆瘟，必须兼治疫气，大多凶险少吉利。大凡疮肿，直到干燥结浆结痂的时候，毒气化解而肿胀消退，所以应该肿胀而不肿胀，应该消退而不消退的，要谨慎提防。
凡是疮疡肿胀，面部浮肿、眼睛闭合的，紧急给予解毒、保护眼睛、救治咽喉的方法综合治疗，内服消毒化斑汤（用于起发阶段），外用神应膏（见于见形阶段）保护眼睛。凡是疮疡肿胀，务必防止瘙痒，面部正中部位，不可稍有破损，如果因为生痒而抓破，沙崩（指痘疮溃烂如沙崩塌）的趋势逐渐发展就无法挽回了，邪气内陷，真气外泄，肿胀消退而死。只要能使破损处重新灌脓，消退处重新肿胀，饮食正常，大小便自然调畅的，就能变凶为吉，用十全大补汤（用于汗法阶段）、苦参丸（用于痘癞）合方治疗。如果疮色灰白，面部肿胀如锡饼，只需看此人的脏腑状况如何，如果能进食，大便调畅，小便通长，没有其他痛苦，大多吉利。如果不能进食，呕吐腹泻并作，或者产生瘙痒的，大多凶险。
如果是头面部预先肿胀，或者腮颊部预先肿胀的，这是时行疫毒所致，都用羌活救苦汤主治。
羌活救苦汤（参见起发章节）
[Discussion by Wan Quan] Doulai (severe sequelae of smallpox resembling leprosy or deep scarring) arises from the stagnation and depression of heat-toxin, deficiency of Qi and Blood, and deterioration of muscles. The Classics state: "When heat prevails, flesh rots," which is precisely this condition. *Zheng Lilun* states: "A pulse that is floating and large; floating indicates wind and deficiency, while large indicates strong Qi. When wind and Qi contend with each other, urticaria (skin rashes with redness, swelling, and itching) must form, causing body itching. This itching is named 'Xiefeng' (draining wind), and over time it develops into severe Lai disease. Those whose Qi and Blood are abundant have no external deficient wind and no internal strong pathogen, so they certainly will not suffer from this disease. Only those who are constitutionally deficient in Qi and Blood cannot nourish the body with Ying and Wei Qi, making them susceptible to the killing energy of heaven and earth. Deficient wind resides within the skin and flesh, compounded by the filth and toxin of smallpox/rash and the malignant qi of epidemics. These factors strike, burn, and scorch, flowing and spreading throughout, exiting through the pores. Consequently, the sores are originally dense, leaving no intact skin on the body; the itching is unbearable, muscles ulcerate, and thus Doulai forms. Urgently employ methods to greatly tonify Qi and Blood and clear heat-toxin, so that preservation may be sought. If one waits until the face decays and falls off, the nose collapses, lips rupture, eyes go blind, and limbs are maimed, even if death does not occur, the person becomes disabled. For cases where sores break and become Lai, administer Shiquan Dabu Decoction (for the sweating stage) combined with Kushen Pill externally applied Miecan Jiuku San (for the crusting stage).
Kushen Pill Formula:
Sophora Root (one tael), Tribulus Fruit (half tael), Sesame Seed (half tael), Burdock Fruit (half tael), Licorice Root (two qian half).
Grind all into powder. Mix with wine and flour to make pills. Take with Bamboo Leaf Decoction.
The Classics state: "Heat prevailing causes swelling." Generally, when toxin is vigorous, swelling occurs; when toxin is slight, there is no swelling. When all sores have erupted and reach the expected stage of rising, if the head and face gradually swell, this indicates heat-fire dispersing and gathering in the three Yang meridians, preparing to suppurate and bleed, hence the swelling of skin and flesh. If at the time of rising, the head and face do not swell, it must be that the sores are distinct and磊落 (clear/separate), the toxic gas is light and superficial; although suppuration occurs, the root does not occupy a large area, hence no swelling. This requires no treatment. If the sores are originally indistinct and do not swell upon rising, this indicates toxin hidden internally without immediate release; it cannot be judged as slight toxin. If rising involves swelling, with normal skin and flesh texture, sharp and round sore tips, and distinct grains, this is a favorable omen. If the skin color is bright red, the sore bases are clustered in strings, adherent and flat, or if the sore color is gray-white like a cake or tin surface, or if the sores are scorched purple and dry without fluid, these are all ominous omens. If the head and face swell prematurely before rising, this involves epidemic toxic qi, known as Datou Wen (Big Head Plague). If the cheeks and jaw swell prematurely, it is named Xiamu Wen (Toad Plague); it must be treated concurrently with epidemic qi, and prognosis is mostly poor with little hope. Generally, for swollen sores, until they dry, form pus, and crust, the toxin transforms and swelling subsides. Therefore, cases that should swell but do not, or should subside but do not, require careful vigilance.
For sores with swelling, facial edema, and closed eyes, urgently treat with detoxification, eye protection, and throat rescue simultaneously. Internally use Xiaodu Huaban Decoction (for the rising stage); externally apply Shenying Ointment (see Manifestation stage) to protect the eyes. For swollen sores, strictly prevent itching. The center of the face must not suffer any damage. If itching leads to breaking, the trend of 'sand collapse' (ulceration spreading like collapsing sand) becomes irreversible; pathogenic qi sinks inward, true Qi leaks outward, swelling subsides, and death ensues. However, if broken areas refill with pus, subsided areas swell again, diet remains normal, and bowel/bladder functions regulate themselves, misfortune turns to fortune. Use Shiquan Dabu Decoction (sweating stage) and Kushen Pill (Doulai stage) combined for treatment. If sore color is gray-white and face swells like a tin cake, observe the patient's Zang-Fu organs. If they can eat, stool is regular, urine is long/profuse, and there are no other complaints, prognosis is mostly good. If they cannot eat, vomiting and diarrhea occur together, or itching arises, prognosis is mostly bad.
If head/face or cheeks/jaws swell prematurely, this is due to seasonal epidemic toxicity; treat primarily with Qianghuo Jiuku Decoction.
Qianghuo Jiuku Decoction (See Rising Stage)