〔袁〕先哲云∶臭痘不死，以其得化泄阳明之毒瓦斯故耳，若臭而黑烂成窝者，元气亏损，亦死之证也。患
此者，须服定金汤。
定金汤方
绵黄 人参 炒术 当归 白芍药 生地黄 白茯苓 甘草 白芷 防风 荆芥 升麻
入芫荽一握，白银一块，灯心二十茎，同煎服。
予每诊臭痘脓血流溢者生，臭不枭痒者生，臭不延人者生，臭不抓脱者生，臭不黑烂者生，犯此，须以芫荽、艾
叶烧，辟其秽气，随用升麻、紫苏汤揩挹其臭处，净洁其衣服床被，即服前方，无不获全，若顶
胁胸颈气窝处凹烂黑臭，洞见筋骨者，必死之痘也。四明俞氏用寒水丹掺之，亦可。
寒水丹
鸡骨灰（带血肉，烧过） 银朱（各一钱） 冰片 赤石脂（各五分） 棕衣灰（二分）
上研细末。洗净，徐徐掺之。
〔袁〕天地间，有形化者，有气化者，形化者由于胎卵，气化者忽焉成形，痘之有蛆，形化、气化、兼之
也。近有华峰道人，隐吴山治痘，有一小儿患痘，时届十
一月，感发之候，痘经正顺，囊廓鼎竦，忽头项上恶痒难忍，手搔难禁，遂于溃破处将银簪挑之，则见其虫
如丝，细而长有寸，遂以香油取尽，花椒汤洗之，痒即止。愚按∶寒冬蛰令，岂有虫乎，兹乃气化然也。又
有一患痘者，时值炎热之际，头项上如前作痒，予视之，见其虫如米粒，囊中或二三盘据焉，此乃蝇蚋聚
啮脓血，形化然也。先哲云蛆痘不死，以其枭毒尽发于外也。
治痘疮生蛆方
经霜桑叶 野薄荷
煎汤洗之，其蛆自去，或先用艾条熏之，后增紫苏、甘草、煎汤洗之。禁雄黄、矾石、等药。
【验头面】论曰∶轻者头面少。又，胡荽酒法不欲喷头面。以诸阳之会在于头，心之华在于面，痘为阳毒，
而心主之，故痘疮头面稠密者重。头面预肿者凶。头面疮破烂腥臭者凶。欲占疮之轻重吉凶，莫如头面也。
人之一身，内则心为君主，外则头为元首，病有真心痛，真头痛，以见不可轻犯也。经曰∶头者精明之府，头
倾视深，精神弃矣，故占人之生死者亦莫如头，凡疮初出，从他处先见，渐登于头，
起发收靥皆然，他皆有疮，而头独稀，此佳兆也。若于头额之间先出，先戴浆，先干收，先破损，其疮稠密
无缝，肉下浮肿，皮上溅起粗肤者皆凶。惟疮遍身俱收，而头上不收，或熟自破，或脓出结如堆者，不须怪。
盖天地之化，孤阳不生，孤阴不长，阳变阴合，彼此相成，头者诸阳之会，无阴相济，所以难收也。又
病闭目摇头者死，此阳脉不治，谓之心绝也。
经曰∶十二经脉，三百六十五络，其气皆上走于面，而走空窍。又，肝开窍于目，肺开窍于鼻，脾开窍于
口，心、肾开窍于耳。又，修真家云∶面有七窍，内应乎心。又，相术但观人之面，以知祸福，可见面不
可败也。凡疮稠密，七窍闭塞，败面者凶，以脏腑经络之气皆病也。又，诸阳皆聚于面，痘为阳毒，初出
之时，必先于面，然面有部位，其候不同，额属心，离火之位，火性急烈，不可轻犯，凡疮出现、泡浆、干
收，先从额上起者凶。左颊属肝，震木之位，右颊属肺，兑金之位，二处不论先后，但疮欲磊落坚浓，若模糊
成块，浮嫩易破，溃烂灌肿者凶，盖肝藏魂、肺藏魄，肝肺俱败，魂魄以离，故凡病两腮冷或木硬者死。颏属
肾，坎水之位，此处先出、先壮、先靥者吉，盖疮疹出于肾则吉，入于肾则凶也。鼻属脾，坤土
之位，亦不论先后，但不欲模糊，早干收也，若未成浆，鼻头先干黄色凶，此脾土将败，真脏色见也。
〔薛〕闻人氏云∶痘疹属火证，其面色赤者为顺，甚者为热。若肝木克制脾土，致面色青者，是为逆也，
急用四君、升麻、柴胡，调补脾胃，色正才治。窃谓前证若伤食而呕吐搐搦，脾气受伤而泻利搐搦或厥逆，
皆慢脾风之渐也，用人参理中汤（泄利）加柴胡、钓藤钩治之，或有少误，多致不起。若有痘毒内外郁蒸，发
出遇风寒相搏，凝滞于肌肉，遍身皮肤青色者，用透肌散。胃伤则生风呕吐，脾伤则生风厥逆，用
五味异功散加天麻。若疮密热盛便秘，饮冷面赤者，用犀角解毒散。灌浆之后，发热烦躁，作渴面赤者，用
当归补血汤。足热腰痛，目睛赤者地黄丸。皆要法也。一小儿出痘饮冷过多，腹痛面青，手足并冷。此寒邪伤
脾而虚寒也，用附子理中汤一剂而痛止，用人参一两、姜一钱二剂而脓灌，又用人参煎汤代茶与饮，月余而靥。
一小儿出痘面色青，手足冷。此寒水侮土也，非十二味异功散不能救。不信，乃服疏通之药，殁而遍身皆青。
人中为阴阳之分，故赵子昂以泰卦象之，人中而上，分为三部，人中而下，亦
分为三部，发际之上，阳之上也，两眉之间，阳之中也，山根以下，阳之下也。自口至两乳间，阴之上也，
自心蔽骨至阴毛际，阴之中也，自阴而下，阴之下也。凡疮之出现、起发、收靥，自人中而分，上下循序，
阴阳和畅，虽多且密，亦可言吉，若或舛差，虽是稀少，亦可言凶，此有伏也。
发热之时，面色明莹者吉，面赤若涂抹者重，此邪气拂郁于阳明胃与大肠也，阳明经上循于面，故赤也，
宜以清凉解毒之药少通利之。面垢惨黯者凶，疮疹之火，发自少阳，面垢者，少阳候见也，《针经》云∶少
阳病甚则面微壅，宜表里双解，盖少阳从中治也。
【验耳目鼻】经曰∶肾通窍于耳。耳者，肾之外候也，肾之为脏，水脏也，天一生水，受气之初，先生
两肾，而一阴藏焉，又有相火存乎命门之中，疮疹发热耳独凉者，疮疹为火，肾不受邪，存水之主以制阳光也。
如耳反热，则水不胜火，将有归肾之变。痘疮之候，先观耳后有红缕者，盖手少阳三焦之脉，从膻中上出缺盆，
系耳后，直上出耳角。红者火色也，此疮疹之火，发自少阳，自见于其经也。凡疮自耳先出，未及成浆，耳
轮先靥者，渐萌归肾之势矣。
目别见
经曰∶肺通窍于鼻，疮疹发热之初喷嚏者，火邪上干于肺，外应于鼻，而痒则嚏。鼻干黑燥者，火刑于金，金
体本燥，得火反甚，急宜清金泻火，以解其毒。鼻衄者，血得热而妄行，故衄出于鼻，急与凉血泻火，以解其毒。
鼻流清涕者疹也，疹发于心，心肺相连，以火炼金，热极而反化为水也。疮出之后，鼻塞不通者热也，火主 胀。疮
已成浆收靥之时，鼻塞不得息者，此鼻内有疮，脓涕粘结，可用金银小簪子以通之。如疮未成浆，鼻端先干
者凶，经曰∶脏真高于肺，以行荣卫阴阳也，邪火刑肺，肺败不能输精于皮毛，故皮毛焦枯，先见于鼻，荣卫不行，
阴阳不续，以渐遍身皆干枯而死矣。凡疮变坏，鼻中血出者，涕自流出者，鼻孔开张喘急者，肺绝之候，皆死证也。
【验唇口牙齿】脾之窍，通于口，其华在唇四白。《脉诀》曰∶应唇通口气。疮疹发热之初，口中和，唇色红
润者吉。如口燥唇裂，其毒必甚，急解之。疮出稠密，唇口疮子相粘，诸疮未发，此疮先已戴浆，诸疮未收，此疮先
已焦黑者凶。面疮肿灌，唇上疮裂，成块干溅者重。如疮出太密，口中臭气者，脏腑败坏，故臭出于口
也。疮欲变坏，唇上缩者，脾绝也。唇下自呷者，鱼口也。口中涎如胶粘者，脾津竭也。皆不可治。疹家唇
口生疮声哑者，狐惑证也。不急治之，杀人。
上片牙隶于坤土，乃足阳明胃脉之贯络也，下片牙隶于干金，乃手阳明大肠脉之贯络也。疮疹发热之初，
口开，前板齿燥者里热也，宜以清凉之剂微解之。切牙者，牙乃骨之余，肾主骨，寒战切牙，毒归于肾，必死。
如发热切牙者，有欠则为肝热，有上窜，则为心热，此欲作搐也。疮已收靥，牙龈溃烂者，此肉疮未得平复
也，勿作走马疳疮治之，疹后牙龈溃烂，血出肉黑气臭者，此方是走马疳也。
【验喉舌】咽喉别见
舌者，心之候。《脉诀》曰∶外应舌，将荥。又，脾之脉，络于舌，舌之在人，延纳饮食，主持声音，
其用亦大矣，疮疹发热，其舌红润者吉。舌燥如芒刺者，里热甚也，急解之。《针经》曰∶热病口干舌黑者死。
吐舌者，脾有热也，脾脏微热，则舌络微紧，时时舒舌，勿用冷药及下之，或饮水者，医疑为热而下之，误也，
饮水者，脾胃虚，津液少故耳。疮出之后，舌上稠密，出如堆粟，破如蜂窠者危，更加饮水则呛，食物则哕，
声哑不出者，必死之证。疮出太甚，弄舌者凶。
【验颈项】经曰∶东风生于春，病在肝，俞在颈项。颈项者，生气之本也。又曰∶天气通于肺，地气通于嗌。天
食人以五气，喉者气之所由也，故喉主天气，地食人以五味，咽者味之所由也，故咽主地气。颈项者，咽喉之管
束也。又，三阳之脉自颈而上，三阴之脉自颈而还，颈项者阴阳之道路也。痘疮之候，颈项欲疏，若
缠项而出，稠密太甚者，谓之锁项，废其管束，阻其道路，上不得降，下不得升，内者不出，外者不入，经曰∶出
入废则神机化灭，升降息则气立孤危。此死之征也。凡病深项软者死，骨败也。
【验胸腹】经曰∶凡刺胸腹者，必避五脏。胸腹者，脏腑之郭也。又曰∶鬲肓之上，中有父母。盖言心肺也，
故痘疮轻者胸前无，胸腹出太甚者必重也。其中于脏，各有期日，凡病深喘急，胸骨扇动者，肺焦胀也，左乳下
动脉突出者，宗脉绝也，皆不可治。疮疹腹痛者，毒未尽也，更宜详审。
【验手足】四肢者，诸阳之本，疮出欲疏，其发欲透，其靥欲齐。如应出不出，应发不发，应收不收，此脾
胃气虚不能旁达四肢也。发热，手寻衣领、乱捻物者，肝热也。手掐眉目鼻口者，肺热也。手足搐搦者，心肝风
火相搏也。各随其脏而泻
之。足凉者，此常候也，疮疹肾不受邪，肾主足，故足宜凉。手足冷者，脾脏怯也，四肢皆禀气于胃而不得至经，
必因于脾，乃得禀也，脾怯，不能为胃行其津液，故冷耳，宜温之。疮已出现，手足多水泡者，此肝胜脾衰，
为鬼贼，宜急治之，不久便生痒塌也。如遍身皆发，手足不透，是空壳者，此脾胃虚弱，津液耗竭，荣卫凝
涩，故其毒亦郁而不发也，不能食者死，能食者必发痈疽。疮势太甚，手足冷者不治。疮未成浆，手足皮脱者必
死。疮已正靥，惟足不收者，足为纯阴，无阳相济，所以收迟，《玉函经》曰∶孤阳寡阴即不中，譬取鳏夫及寡
妇。如疮始成浆，他处未收，手足心先靥者，其后必生怪疾也。疮靥之后，手足关节肿痛者，必发痈也。疮
痒，手足搔乱者凶。
【验寝卧】夫卫气者，昼则行阳，夜则行阴，行阳则寤，行阴则寐，人之常也。疮疹发热便昏睡者，心主热，
脾主困，心受气于脾，故发热昏睡，此常候也。起卧不时者，内有热也，必多陷伏之变。合面卧者，里热也。
大抵疮疹始终安寝者吉，盖气血强盛，荣卫流行，邪出于表而不在里则神安，神安则志定，是以得安寝也。
若气血衰弱，荣卫滞涩，邪在于里而热，心恶热，则神不安，神不安则志不宁，是
以烦躁、闷乱、谵妄、而不得眠也。亦有毒伏于中，神丧气脱，僵卧如尸，呼之不应，饮食不知者，不可以
嗜卧论，乃死证也。
【验饮食】经曰；人以水谷为本。故人绝水谷则死，仲景曰∶水入于经，其血乃成，谷入于胃，脉道乃行，
可见水谷之悍气为卫，精气为荣，水去则荣散，谷消则卫亡矣。凡痘疮能食者，虽重亦吉，不能食者，虽轻亦
危也，然有不能食而生，能食而死者何也？盖不能饮食者，脏腑内实，大便不行，有平日之谷气以为之主，
疮成之后，自消谷气、而思食矣。其能饮食者，邪热杀谷，即叔和所谓口干饶饮水，多食亦肌虚者也，将不久
而变生焉。惟疹家多不能食，以口中不和，不思食也。余详不能食门。
【袁氏按语】先哲曾说：患臭痘而不死者，是因为其得以化解并排泄阳明经的毒邪之气；但如果痘疮发臭且黑烂成坑者，则是元气亏损的表现，属于死证。患有此症者，必须服用定金汤。
定金汤方剂组成：
绵黄芪、人参、炒白术、当归、白芍药、生地黄、白茯苓、甘草、白芷、防风、荆芥、升麻。
加入芫荽一握、白银一块、灯心草二十茎，一同煎煮后服用。
我每次诊治臭痘患者，发现脓血流溢者能生，发臭但不剧烈瘙痒者能生，臭味不传染他人者能生，抓破后不脱落者能生，不发黑腐烂者能生。若出现上述不良情况，需用芫荽和艾叶焚烧以驱除秽气，随后用升麻、紫苏汤擦拭清洗患处，保持衣物床铺洁净，然后服用前方，没有不能痊愈的。如果痘疮在头顶、胁肋、胸部、颈部及气窝处凹陷腐烂、发黑发臭，甚至洞见筋骨者，必然是死证。四明俞氏使用寒水丹外敷，也可以。
寒水丹方剂组成：
鸡骨灰（带血肉，烧过）、银朱（各一钱）、冰片、赤石脂（各五分）、棕衣灰（二分）。
以上药物研成细末。洗净患处后，徐徐撒布药粉。
【袁氏按语】天地间，有形质化生的事物，有气化而生成的事物。形化者源于胎卵，气化者忽然形成形体。痘疮中生蛆，是形化与气化兼有的结果。近来有位华峰道人，隐居吴山治疗痘疮，有一个小儿患痘，时值十一月，正值痘疹发作之际，痘疹发展正常，囊廓高耸，忽然头项部恶痒难忍，手搔难以控制，于是用银簪挑破溃破处，看见虫如丝线，细长有一寸长，随即用香油取出干净，用花椒汤清洗，瘙痒立即停止。我认为：寒冬蛰伏之时，哪里有虫子呢？这乃是气化所致。又有一位患痘者，时值炎热季节，头项部像前面那样作痒，我看他，看见虫如米粒大小，囊中或有二三只盘踞在那里，这是苍蝇蚊子聚集啃食脓血，属于形化所致。先哲说：患蛆痘不死，是因为其枭毒全部发散于体外。
治疗痘疮生蛆的方子：
经霜桑叶、野薄荷。
煎汤清洗，蛆虫自然去除；或者先用艾条熏蒸，然后增加紫苏、甘草，煎汤清洗。禁止使用雄黄、矾石等药物。
【验头面】论曰：病情轻者，头面部痘疮较少。另外，胡荽酒法不建议喷洒头面部。因为诸阳之会在于头部，心的荣华表现在面部，痘疮属于阳毒，由心所主，所以痘疮在头面部稠密者病情重。头面部预先肿胀者凶险。头面部痘疮破烂腥臭者凶险。想要判断痘疮的轻重吉凶，没有比观察头面部更好的了。人的身体，内部心脏为君主，外部头部为元首，疾病有真心痛、真头痛，以此可见头部不可轻易侵犯。《内经》说：头是精明之府，头倾视深，精神就弃绝了，所以判断人的生死也没有比观察头部更好的了。凡是痘疮初出，从其他部位先出现，逐渐发展到头部，起发、收靥都是如此，其他部位都有痘疮，而头部唯独稀疏，这是佳兆。如果在额头之间先出痘，先戴浆，先干燥收靥，先破损，痘疮稠密无缝，皮下浮肿，皮上溅起粗肤者皆属凶险。只有痘疮遍身都收靥，而头上不收靥，或者熟透自破，或者脓出结如堆状者，不必奇怪。因为天地化育，孤阳不生，孤阴不长，阳变阴合，彼此相成。头是诸阳之会，若无阴气相济，所以难以收靥。另外，病中闭目摇头者死，这是阳脉不治，称为心绝。
《内经》说：十二经脉，三百六十五络，其气都上行于面部，而运行于空窍。另外，肝开窍于目，肺开窍于鼻，脾开窍于口，心、肾开窍于耳。另外，修真家说：面部有七窍，内应乎心。另外，相术只看人的面部，就能知道祸福，可见面部不可败坏。凡是痘疮稠密，七窍闭塞，面部败坏者凶险，因为脏腑经络之气都已患病。另外，诸阳都聚于面部，痘疮为阳毒，初出之时，必定先在面部，然而面部有部位不同，其征候也不同。额属心，离火之位，火性急烈，不可轻犯，凡是痘疮出现、泡浆、干收，先从额上起者凶险。左颊属肝，震木之位，右颊属肺，兑金之位，这两处不论先后，只要痘疮欲磊落坚浓，若模糊成块，浮嫩易破，溃烂灌肿者凶险，因为肝藏魂、肺藏魄，肝肺俱败，魂魄离散，所以凡是病两腮冷或木硬者死。颏属肾，坎水之位，此处先出、先壮、先靥者吉，因为疮疹出于肾则吉，入于肾则凶也。鼻属脾，坤土之位，也不论先后，只是不希望模糊，早干收，如果未成浆，鼻头先干黄色凶险，这是脾土将败，真脏色现。
【薛氏按语】闻人氏说：痘疹属于火证，面色赤者为顺，甚者为热。如果肝木克制脾土，导致面色青者，是为逆证，急用四君子汤、升麻、柴胡，调补脾胃，颜色正常才进行治疗。我认为前证如果是伤食而呕吐搐搦，脾气受伤而泻利搐搦或厥逆，都是慢脾风的征兆，用人参理中汤（用于泄利）加柴胡、钩藤治疗，如果有少许误治，多导致不起。如果有痘毒内外郁蒸，发出遇风寒相搏，凝滞于肌肉，遍身皮肤青色者，用透肌散。胃伤则生风呕吐，脾伤则生风厥逆，用五味异功散加天麻。如果疮密热盛便秘，饮冷面赤者，用犀角解毒散。灌浆之后，发热烦躁，作渴面赤者，用当归补血汤。足热腰痛，目睛赤者用地黄丸。这些都是要法。一个小儿出痘饮冷过多，腹痛面青，手足并冷。这是寒邪伤脾而虚寒，用附子理中汤一剂而痛止，用人参一两、姜一钱二剂而脓灌，又用人参煎汤代茶饮用，月余而收靥。一个小儿出痘面色青，手足冷。这是寒水侮土，非十二味异功散不能救。不信，乃服疏通之药，殁而遍身皆青。
人中为阴阳之分界，所以赵子昂以泰卦象之，人中而上，分为三部，人中而下，亦分为三部，发际之上，阳之上也，两眉之间，阳之中也，山根以下，阳之下也。自口至两乳间，阴之上也，自心蔽骨至阴毛际，阴之中也，自阴而下，阴之下也。凡是痘疮的出现、起发、收靥，自人中而分，上下循序，阴阳和畅，虽多且密，亦可言吉，若或舛差，虽是稀少，亦可言凶，此中有伏机。
发热之时，面色明莹者吉，面赤若涂抹者重，这是邪气拂郁于阳明胃与大肠也，阳明经上循于面，故赤也，宜以清凉解毒之药少通利之。面垢惨黯者凶，疮疹之火，发自少阳，面垢者，少阳候见也，《针经》云：少阳病甚则面微壅，宜表里双解，盖少阳从中治也。
【验耳目鼻】《内经》说：肾通窍于耳。耳是肾之外候。肾作为脏，是水脏，天一生水，受气之初，先生两肾，而一阴藏焉，又有相火存乎命门之中。疮疹发热耳独凉者，疮疹为火，肾不受邪，存水之主以制阳光也。如耳反热，则水不胜火，将有归肾之变。痘疮之候，先观耳后有红缕者，盖手少阳三焦之脉，从膻中上出缺盆，系耳后，直上出耳角。红者火色也，此疮疹之火，发自少阳，自见于其经也。凡疮自耳先出，未及成浆，耳轮先靥者，渐萌归肾之势矣。
目别见
《内经》说：肺通窍于鼻，疮疹发热之初喷嚏者，火邪上干于肺，外应于鼻，而痒则嚏。鼻干黑燥者，火刑于金，金体本燥，得火反甚，急宜清金泻火，以解其毒。鼻衄者，血得热而妄行，故衄出于鼻，急与凉血泻火，以解其毒。鼻流清涕者疹也，疹发于心，心肺相连，以火炼金，热极而反化为水也。疮出之后，鼻塞不通者热也，火主胀。疮已成浆收靥之时，鼻塞不得息者，此鼻内有疮，脓涕粘结，可用金银小簪子以通之。如疮未成浆，鼻端先干者凶，《内经》曰：脏真高于肺，以行荣卫阴阳也，邪火刑肺，肺败不能输精于皮毛，故皮毛焦枯，先见于鼻，荣卫不行，阴阳不续，以渐遍身皆干枯而死矣。凡疮变坏，鼻中血出者，涕自流出者，鼻孔开张喘急者，肺绝之候，皆死证也。
【验唇口牙齿】脾之窍，通于口，其华在唇四白。《脉诀》曰：应唇通口气。疮疹发热之初，口中和，唇色红润者吉。如口燥唇裂，其毒必甚，急解之。疮出稠密，唇口疮子相粘，诸疮未发，此疮先已戴浆，诸疮未收，此疮先已焦黑者凶。面疮肿灌，唇上疮裂，成块干溅者重。如疮出太密，口中臭气者，脏腑败坏，故臭出于口也。疮欲变坏，唇上缩者，脾绝也。唇下自呷者，鱼口也。口中涎如胶粘者，脾津竭也。皆不可治。疹家唇口生疮声哑者，狐惑证也。不急治之，杀人。
上片牙隶于坤土，乃足阳明胃脉之贯络也，下片牙隶于干金，乃手阳明大肠脉之贯络也。疮疹发热之初，口开，前板齿燥者里热也，宜以清凉之剂微解之。切牙者，牙乃骨之余，肾主骨，寒战切牙，毒归于肾，必死。如发热切牙者，有欠则为肝热，有上窜，则为心热，此欲作搐也。疮已收靥，牙龈溃烂者，此肉疮未得平复也，勿作走马疳疮治之，疹后牙龈溃烂，血出肉黑气臭者，此方是走马疳也。
【验喉舌】咽喉别见
舌是心的征候。《脉诀》曰：外应舌，将荥。另外，脾之脉，络于舌，舌之在人，延纳饮食，主持声音，其用亦大矣，疮疹发热，其舌红润者吉。舌燥如芒刺者，里热甚也，急解之。《针经》曰：热病口干舌黑者死。吐舌者，脾有热也，脾脏微热，则舌络微紧，时时舒舌，勿用冷药及下之，或饮水者，医疑为热而下之，误也，饮水者，脾胃虚，津液少故耳。疮出之后，舌上稠密，出如堆粟，破如蜂窠者危，更加饮水则呛，食物则哕，声哑不出者，必死之证。疮出太甚，弄舌者凶。
【验颈项】《内经》说：东风生于春，病在肝，俞在颈项。颈项者是生气之本也。又说：天气通于肺，地气通于嗌。天食人以五气，喉者气之所由也，故喉主天气，地食人以五味，咽者味之所由也，故咽主地气。颈项者，咽喉之管束也。另外，三阳之脉自颈而上，三阴之脉自颈而还，颈项者阴阳之道路也。痘疮之候，颈项欲疏，若缠项而出，稠密太甚者，谓之锁项，废其管束，阻其道路，上不得降，下不得升，内者不出，外者不入，《内经》曰：出入废则神机化灭，升降息则气立孤危。此死之征也。凡病深项软者死，骨败也。
【验胸腹】《内经》说：凡刺胸腹者，必避五脏。胸腹者，脏腑之郭也。又说：鬲肓之上，中有父母。盖言心肺也，故痘疮轻者胸前无，胸腹出太甚者必重也。其中于脏，各有期日，凡病深喘急，胸骨扇动者，肺焦胀也，左乳下动脉突出者，宗脉绝也，皆不可治。疮疹腹痛者，毒未尽也，更宜详审。
【验手足】四肢者，诸阳之本，疮出欲疏，其发欲透，其靥欲齐。如应出不出，应发不发，应收不收，此脾胃气虚不能旁达四肢也。发热，手寻衣领、乱捻物者，肝热也。手掐眉目鼻口者，肺热也。手足搐搦者，心肝风火相搏也。各随其脏而泻之。足凉者，此常候也，疮疹肾不受邪，肾主足，故足宜凉。手足冷者，脾脏怯也，四肢皆禀气于胃而不得至经，必因于脾，乃得禀也，脾怯，不能为胃行其津液，故冷耳，宜温之。疮已出现，手足多水泡者，此肝胜脾衰，为鬼贼，宜急治之，不久便生痒塌也。如遍身皆发，手足不透，是空壳者，此脾胃虚弱，津液耗竭，荣卫凝涩，故其毒亦郁而不发也，不能食者死，能食者必发痈疽。疮势太甚，手足冷者不治。疮未成浆，手足皮脱者必死。疮已正靥，惟足不收者，足为纯阴，无阳相济，所以收迟，《玉函经》曰：孤阳寡阴即不中，譬取鳏夫及寡妇。如疮始成浆，他处未收，手足心先靥者，其后必生怪疾也。疮靥之后，手足关节肿痛者，必发痈也。疮痒，手足搔乱者凶。
【验寝卧】夫卫气者，昼则行阳，夜则行阴，行阳则寤，行阴则寐，人之常也。疮疹发热便昏睡者，心主热，脾主困，心受气于脾，故发热昏睡，此常候也。起卧不时者，内有热也，必多陷伏之变。合面卧者，里热也。大抵疮疹始终安寝者吉，盖气血强盛，荣卫流行，邪出于表而不在里则神安，神安则志定，是以得安寝也。若气血衰弱，荣卫滞涩，邪在于里而热，心恶热，则神不安，神不安则志不宁，是以烦躁、闷乱、谵妄、而不得眠也。亦有毒伏于中，神丧气脱，僵卧如尸，呼之不应，饮食不知者，不可以嗜卧论，乃死证也。
【验饮食】《内经》说：人以水谷为本。故人绝水谷则死，仲景曰：水入于经，其血乃成，谷入于胃，脉道乃行，可见水谷之悍气为卫，精气为荣，水去则荣散，谷消则卫亡矣。凡痘疮能食者，虽重亦吉，不能食者，虽轻亦危也，然有不能食而生，能食而死者何也？盖不能饮食者，脏腑内实，大便不行，有平日之谷气以为之主，疮成之后，自消谷气、而思食矣。其能饮食者，邪热杀谷，即叔和所谓口干饶饮水，多食亦肌虚者也，将不久而变生焉。惟疹家多不能食，以口中不和，不思食也。余详不能食门。
[Note by Yuan] The sages of old said: Those who suffer from foul pox (Chou Dou) and do not die do so because they are able to resolve and excrete the toxic qi of the Yangming channel. However, if the pox is foul-smelling and turns black and rotten into pits, it indicates a deficiency of primordial Qi (Yuan Qi) and is a sign of death. Patients with this condition must take Dingjin Decoction (Stabilizing Gold Decoction).
Formula for Dingjin Decoction:
Mian Huangqi (Astragali Radix), Renshen (Ginseng Radix), Chao Baizhu (Fried Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), Baishao Yao (Paeoniae Radix Alba), Sheng Dihuang (Rehmanniae Radix), Bai Fuling (Poria), Gancao (Glycyrrhizae Radix et Rhizoma), Baizhi (Angelicae Dahuricae Radix), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), Shengma (Cimicifugae Rhizoma).
Add one handful of Yuansu (Coriandri Fructus), one piece of silver, and twenty stems of Dengxincao (Junci Medulla), decoct together and take orally.
In my clinical practice, I have observed that patients with foul pox survive if there is pus and blood flowing out, if the odor is present but without severe itching, if the odor does not spread to others, if scratching does not cause the scabs to fall off, and if the lesions do not turn black and rot. If these adverse conditions occur, burn Yuansu and Aiye (Artemisiae Argyi Folium) to dispel the foul odor, then wipe the affected area with a decoction of Shengma and Zisu (Perillae Folium), keep clothes and bedding clean, and subsequently take the aforementioned formula. There will be no case that fails to recover. However, if the pox on the crown, hypochondrium, chest, neck, and acupoints becomes sunken, rotten, black, and foul-smelling, exposing bone and tendon, it is inevitably a fatal case. Yu Shi from Siming used Hanshui Dan (Cold Water Powder) externally, which is also effective.
Formula for Hanshui Dan:
Jigu Hui (Ash of Chicken Bone, burned with flesh and blood), Yinzhu (Cinnabar), each 1 qian; Bingpian (Borneolum Syntheticum), Chishizhi (Halloysit Rubra), each 5 fen; Zongyi Hui (Ash of Palm Fiber), 2 fen.
Grind all ingredients into a fine powder. Clean the affected area and sprinkle the powder gently.
[Note by Yuan] In the world, there are beings formed through material transformation (Xinghua) and those formed through Qi transformation (Qihua). Material transformation arises from eggs or wombs, while Qi transformation occurs suddenly. The presence of maggots in pox involves both material and Qi transformation. Recently, a Daoist named Huafeng, practicing in Wushan, treated a child with pox in November, during the season of manifestation. The pox developed normally, with raised vesicles. Suddenly, the head and neck became intolerably itchy, and the child scratched uncontrollably. Using a silver hairpin to pick at the ruptured areas, silk-like worms, thin and long, about one cun, were seen. They were removed using sesame oil, and the area was washed with Sichuan pepper water, stopping the itch immediately. I reason that in the cold winter hibernation period, how could there be worms? This is due to Qi transformation. Another patient with pox, during a hot summer, had similar itching on the head and neck. Upon examination, worms the size of rice grains were found, two or three coiled in the vesicles. This is due to flies and mosquitoes gathering to feed on the pus and blood, representing material transformation. The sages said: Those with maggot pox do not die because their toxic evil is fully expelled outward.
Formula for treating maggots in pox:
Shuang Sangye (Mulberry Leaf frosted by frost), Ye Bohe (Wild Mentha).
Decoct and wash; the maggots will naturally disappear. Alternatively, fumigate first with moxa sticks, then add Zisu and Gancao, decoct, and wash. Prohibit the use of Xionghuang (Realgar) and Fanshi (Alumen).
[Examination of Head and Face] It is said: In mild cases, there are few pox on the head and face. Furthermore, the method of Huisu wine should not be sprayed on the head and face. Because the meeting point of all Yang channels is in the head, and the flourishing of the Heart manifests in the face, and pox belongs to Yang toxic heat governed by the Heart, dense pox on the head and face indicates severe disease. Premature swelling of the head and face is ominous. Broken, smelly pox on the head and face is ominous. To judge the severity and prognosis of pox, nothing is better than observing the head and face. In the human body, the Heart is the monarch internally, and the head is the chief externally. Diseases such as True Heart Pain and True Headache show that the head must not be lightly offended. The Classics state: "The head is the mansion of clarity." If the head tilts and eyes are sunken, spirit is abandoned. Thus, to judge life and death, nothing is better than observing the head. Generally, when pox first appears from other parts and gradually ascends to the head, in its rising, maturing, and crusting phases, if other parts have pox but the head remains sparse, this is a good omen. If pox first appears between the forehead, crusts first, dries first, breaks first, is dense without gaps, has subcutaneous swelling, and rough skin elevation, it is ominous. Only if pox on the whole body crusts over but the head does not, or ruptures spontaneously, or forms pus piles, need one not worry. Heaven and Earth's transformation requires neither pure Yang nor pure Yin alone; Yang changes and Yin combines. The head is the meeting of all Yang; without Yin to assist, it is difficult to crust. Additionally, patients who close their eyes and shake their heads die; this is failure of Yang channels, called Heart Exhaustion.
The Classics state: The twelve meridians and 365 collaterals all ascend to the face and run through the orifices. The Liver opens into the eyes, the Lung into the nose, the Spleen into the mouth, and the Heart and Kidney into the ears. Cultivators say: The seven orifices on the face correspond internally to the Heart. Physiognomy judges fortune by the face, showing the face must not fail. Dense pox with blocked seven orifices and facial decay is ominous, as Qi of organs and meridians is diseased. All Yang gathers in the face; pox is Yang toxic heat, appearing first on the face. However, different areas have different signs. The forehead belongs to the Heart, position of Li Fire; fire is fierce and easily offended. Pox appearing, blistering, and crusting starting from the forehead is ominous. The left cheek belongs to the Liver, position of Zhen Wood; the right cheek belongs to the Lung, position of Dui Metal. Regardless of order, if pox is rugged and thick, but becomes blurred into clumps, tender and easily broken, ulcerated and swollen, it is ominous. The Liver stores Hun, the Lung stores Po; failure of Liver and Lung means separation of Hun and Po. Thus, coldness or numbness/hardness of both cheeks indicates death. The chin belongs to the Kidney, position of Kan Water; appearance, strength, and crusting here first is auspicious. Pox exiting the Kidney is auspicious; entering the Kidney is ominous. The nose belongs to the Spleen, position of Kun Earth. Regardless of order, it should not be blurred and should dry/crust early. If unblistered, the nose tip turning yellow and dry first is ominous, indicating Spleen Earth failing and true organ color appearing.
[Note by Xue] Wenren Shi said: Pox belongs to Fire syndrome; red face is favorable, extreme red indicates heat. If Liver Wood overacts on Spleen Earth causing a green face, it is unfavorable. Urgently use Sijunzi Decoction (Four Gentlemen Decoction), Shengma, and Chaihu to regulate and tonify Spleen and Stomach; treat only after color normalizes. I believe if the previous symptoms involve food stagnation with vomiting and convulsions, or Spleen Qi injury with diarrhea, convulsions, or cold limbs, these are gradual stages of Slow Spleen Wind. Use Renshen Lizhong Decoction (Ginseng and Ginger Decoction for Cold Deficiency) [for diarrhea] plus Chaihu and Gouteng (Uncariae Ramulus cum Uncis) to treat. Minor errors often lead to fatality. If internal and external郁蒸 (stagnant steaming) of pox toxin meets wind-cold, stagnating in muscles causing cyanosis of the whole body skin, use Touji San (Muscle-Penetrating Powder). Stomach injury causes wind and vomiting; Spleen injury causes wind and cold limbs; use Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder) plus Tianma (Gastrodiae Rhizoma). If pox is dense, heat is severe, constipation, drinking cold fluids, and red face, use Xijiao Jiedu San (Rhinoceros Horn Detoxifying Powder). After blistering stage, fever, irritability, thirst, and red face, use Danggui Buxue Tang (Danggui Tonifying Blood Decoction). Hot feet, lower back pain, red eyes, use Dihuang Wan (Rehmannia Pill). These are essential methods. A child drank too much cold fluid during pox eruption, having abdominal pain, green face, and cold hands/feet. This is cold pathogen injuring Spleen causing deficiency-cold. One dose of Fuzi Lizhong Decoction stopped pain; one liang of Renshen and 1 qian of Jiang (Fresh Ginger) over two doses promoted pus filling; decocting Renshen as tea for over a month led to crusting. A child with pox had green face and cold hands/feet. This is Cold Water insulting Earth; only Twelve-Ingredient Yigong San can save him. Disbelieving, he took dispersing drugs, died with whole body cyanosis.
The Renzhong (philtrum) is the division of Yin and Yang. Zhao Zi'ang used Tai Gua to symbolize it. Above Renzhong, divided into three parts: above hairline is Upper Yang; between eyebrows is Middle Yang; below Shangen (root of nose) is Lower Yang. From mouth to nipples is Upper Yin; from xiphoid process to pubic hair is Middle Yin; below pubis is Lower Yin. For pox appearance, rising, and crusting, if proceeding sequentially from Renzhong up and down with harmonious Yin and Yang, even if dense, it can be auspicious. If chaotic, even if sparse, it is ominous; there is a hidden mechanism.
During fever, bright and clear complexion is auspicious; red face like painted makeup is severe, indicating pathogenic Qi stagnating in Yangming Stomach and Large Intestine. Yangming channel ascends to face, hence redness; use cooling detoxifying herbs with mild purgation. Dull, dark, dirty face is ominous. Pox fire originates from Shaoyang; dull face indicates Shaoyang syndrome. *Zhenjing* states: Severe Shaoyang disease causes slight facial swelling; use simultaneous release of exterior and interior, as Shaoyang is treated from the middle.
[Examination of Ears, Eyes, Nose] The Classics state: Kidney opens into the ears. Ears are external manifestations of Kidney. Kidney is Water organ; Heaven generates One Water. At conception, two Kidneys form first, containing one Yin, with Ministerial Fire in Mingmen. If pox fever makes ears cool, it means Kidney resists pathogen, preserving Water master to control Sunlight. If ears become hot, Water cannot overcome Fire, leading to return to Kidney change. In pox, observe red threads behind ears first. Hand-Shaoyang Sanjiao channel goes from Danzhong up to clavicle, connects behind ear, goes up to ear angle. Red is Fire color; pox fire originates from Shaoyang, visible in its channel. If pox starts from ear, before blistering, ear helix crusts first, it shows trend of returning to Kidney.
Eyes see separately.
The Classics state: Lung opens into nose. Sneezing at initial fever of pox is Fire pathogen affecting Lung externally manifesting in nose; itching causes sneezing. Dry, black, cracked nose indicates Fire punishing Metal; Metal is naturally dry, Fire makes it worse; urgently clear Metal and purge Fire to resolve toxin. Epistaxis is blood moving recklessly due to heat; urgently cool blood and purge Fire. Clear nasal discharge indicates rash; rashes originate from Heart, Heart-Lung connected, Fire melts Metal, extreme heat transforms to Water. Nasal congestion after eruption is Heat; Fire causes distension. During blistering/crusting, nasal blockage due to internal pox and sticky pus/mucus can be cleared with small gold/silver pins. If unblistered, nose tip drying first is ominous. Classics state: Organ Truth is higher than Lung to circulate Ying and Wei Qi and Yin-Yang. Evil Fire damages Lung; Lung fails to transport essence to skin/hair, causing dryness/withering, seen first in nose. Ying/Wei stop, Yin/Yang disconnect, whole body dries and dies. Bad changes with nosebleed, dripping mucus, open nostrils with panting are signs of Lung Exhaustion, all fatal.
[Examination of Lips, Mouth, Teeth] Spleen opens into mouth, flourishing in lips. *Maijue* says: Corresponds to lips, communicating Qi. At initial fever, neutral mouth and red moist lips are auspicious. Dry mouth and cracked lips indicate severe toxin; urgently resolve. Dense pox with sticky lip/mouth sores, or pox crusting/blistering before others, or turning black before others, is ominous. Swollen face sores with cracked lips forming dry clumps is severe. Too dense pox with bad breath indicates organ failure, stench coming from mouth. Retracting lips indicates Spleen Exhaustion. Lower lip twitching is Fish Mouth. Sticky saliva indicates Spleen Fluid exhaustion. All incurable. Rash patients with lip/mouth sores and hoarse voice have Huhuo Syndrome; urgent treatment needed or death.
Upper teeth belong to Kun Earth, connecting Foot-Yangming Stomach channel. Lower teeth belong to Qian Metal, connecting Hand-Yangming Large Intestine channel. At initial fever, open mouth and dry front teeth indicate Interior Heat; use mild cooling agents. Grinding teeth: Teeth are surplus of bone, Kidney governs bone. Cold shivering with grinding indicates toxin returning to Kidney, fatal. Fever with grinding: yawning indicates Liver Heat; upward staring indicates Heart Heat; impending convulsion. Post-crusting gum ulceration is unresolved flesh sore, do not treat as Walking Gangrene. Post-rash gum ulceration with black blood/flesh and foul smell is Walking Gangrene.
[Examination of Throat and Tongue] Throat see separately.
Tongue is Heart indicator. *Maijue* says: Externally corresponds to tongue, managing Ying. Spleen channel connects to tongue. Tongue receives food and controls voice, usage is great. Red moist tongue during fever is auspicious. Dry tongue like thorns indicates severe Interior Heat; urgently resolve. *Zhenjing* states: Heat disease with dry black tongue is fatal. Protruding tongue indicates Spleen Heat; slight Spleen heat makes tongue meridians tight, tongue extends frequently. Do not use cold drugs or purgatives, or give water. Doctors mistaking this for Heat and purging is error; giving water is wrong because Spleen/Stomach deficiency leads to low fluids. Dense pox on tongue like millet piles, breaking like bee combs is critical. Drinking causes choking, eating causes hiccups, hoarse voice unable to speak is fatal. Excessive pox with tongue playing is ominous.
[Examination of Neck and Occiput] Classics state: East wind born in Spring, disease in Liver, Shu point in neck/occiput. Neck/occiput is root of vital Qi. Heaven Qi connects to Lung, Earth Qi connects to throat. Heaven feeds Five Qi, throat governs Qi transmission (Heaven Qi). Earth feeds Five Flavors, pharynx governs flavor transmission (Earth Qi). Neck/occiput binds throat/pharynx. Three Yang channels ascend from neck, Three Yin channels return from neck; neck/occiput is road of Yin/Yang. In pox, neck/occiput should be sparse. If entangled and dense, called Lock Neck, blocking passage, preventing descent/ascent, internal/external exchange. Classics state: Abandonment of entry/exit destroys Spirit Mechanism; cessation of ascent/descent leaves Qi standing in peril. This is sign of death. Deep disease with soft neck indicates bone failure, death.
[Examination of Chest and Abdomen] Classics state: Needling chest/abdomen must avoid five Zang organs. Chest/abdomen are walls of organs. Above diaphragm/huang contains Parents (Heart/Lung). Mild pox has none on chest; excessive chest/abdominal pox is severe. Invasion of organs has specific timelines. Deep disease with panting and flapping sternum indicates Lung scorched/distended. Prominent artery below left breast indicates Zong Mai exhaustion, incurable. Abdominal pain in pox indicates incomplete toxin resolution; examine carefully.
[Examination of Hands and Feet] Four limbs are roots of all Yang. Pox should be sparse, rise clearly, crust evenly. Failure to erupt, rise, or crust indicates Spleen/Stomach Qi deficiency failing to reach limbs. Fever with hand seeking collar/touching objects randomly indicates Liver Heat. Pinching brows/eyes/nose/mouth indicates Lung Heat. Convulsions of hands/feet indicate Heart/Liver Wind-Fire conflict. Purge according to organ. Cool feet is normal; Kidney governs feet, pox Fire does not invade Kidney, so feet should be cool. Cold hands/feet indicate Spleen weakness. Limbs receive Qi from Stomach but must pass through Spleen. Spleen weakness fails to transport fluids, hence cold; warm them. Post-eruption blisters on hands/feet indicate Liver overcoming Spleen (Ghost Thief); treat urgently, soon will have itchy collapse. Whole body eruption but hands/feet not transparent, empty shells, indicate Spleen/Stomach weakness, fluid exhaustion, Ying/Wei stagnation, toxin郁 not erupting. Unable to eat is death; able to eat will develop abscess. Extreme pox with cold hands/feet is incurable. Pre-blistering skin shedding on hands/feet is fatal. Proper crusting but feet not crusting: feet are pure Yin, lacking Yang assistance, hence slow crusting. *Yuhan Jing* states: Solitary Yang and scant Yin do not fit, like widower and widow. If blistering starts elsewhere but palms/soles crust first, strange diseases will follow post-crusting. Joint swelling/pain post-crusting indicates abscess. Itchy pox with chaotic scratching of hands/feet is ominous.
[Examination of Sleep and Wake] Wei Qi moves in Yang by day, Yin by night. Moving in Yang is wakefulness, in Yin is sleep, normal human pattern. Pox fever with lethargy/sleep: Heart governs Heat, Spleen governs fatigue; Heart receives Qi from Spleen, hence fever with sleep is normal. Restless lying/sitting indicates Internal Heat, likely sinking/submerged changes. Prone sleeping indicates Internal Heat. Generally, peaceful sleep throughout pox is auspicious, indicating strong Qi/Blood, smooth Ying/Wei, pathogen on exterior, spirit calm, will settled. Weak Qi/Blood, stagnant Ying/Wei, pathogen in interior with Heat, Heart dislikes Heat, spirit uneasy, will unsettled, leads to irritability, confusion, delirium, insomnia. Also, toxin hidden inside, spirit lost, Qi escaped, stiff lying like corpse, unresponsive, unaware of food/drink, is not嗜卧 (love of sleep), but fatal sign.
[Examination of Diet] Classics state: Humans rely on Water and Grain. Deprivation leads to death. Zhongjing said: Water enters meridians, blood forms; Grain enters Stomach, pulse channels move. Vigor of Water/Grain is Wei, Essence is Ying. Water gone, Ying scatters; Grain consumed, Wei perishes. Able to eat in pox, even if severe, is auspicious; unable to eat, even if mild, is dangerous. Why some unable to eat survive, some able to eat die? Those unable to eat have full internal organs, no bowel movement, relying on daily grain Qi as master; after pox formation, self-consumes grain Qi, craving food. Those able to eat have pathogenic Heat killing grain (digestion), as Shuhe said: dry mouth craving water, eating much but muscle empty, changes will arise soon. Rash patients mostly cannot eat due to mouth discomfort and lack of appetite. See detailed section on inability to eat.