之冷热，大便如常，是亦疮疹之一顺也。如起发之时忽然泄泻，此宜急止之，恐肠
胃虚，真气脱也，须辨冷热虚实，如泻而手足冷，面色青白，疮不红（绽）者，冷证也，
理中汤丸、豆蔻丸（俱泄利）、益黄散（脾）、甚则陈氏木香散（泄利）、异功散（出不快）皆
可用也。泻下之物黄又酸臭，渴，手足心热，面赤，疮红绽 发者，热证也，黄芩汤、
（泄利）五苓散（惊搐）主之。脾胃怯弱，精神慢而不食者为虚，当温养之，益黄散。身热中满，渴
而不食者为实，当清利之，五苓散。其人或脏气自脱，或因服寒药，致令疮毒
陷入大肠，泻下如豆汁，或便脓血，或便黑汁，口内臭气，唇焦目闭，加腹胀者必死之
证。方论详泄泻本门。
不二散 治痘当起胀灌浆时泄泻不止，以此止之，只一服愈，如服此不已，是元气
已脱，不可为矣。
莲肉（炒，去心，一两） 真鸦片（二钱，另研）
上，各取净末，和匀。每服三四分，米饮调下。此方不但止泻，亦治烦、痒、
二证。夫固大肠之滑脱、易知也，敛心火之浮游、难知也。
〔手足〕痘疮起发欲透，惟四肢稍远，难得均齐，必脾胃素强能食多者，不须
虑此，若脾胃素弱又食少者，手足上疮常发不透，盖脾主四肢，脾虚则不能行其津
液溉灌四肢，所以发迟，以补脾为主快 越婢汤，如不令透，其后手足必作痈毒。
又手足疮痘，多发水泡者，此肝乘脾也，先泻肝，羌活汤（发热）加柴胡。后补脾，人参
白术散（渴）去葛根加桂。如见而复隐，起而复塌，色紫黑者，此肾乘脾，不可治。
快 越婢汤
黄 （炙） 白芍药 桂枝 防风 甘草（炙）
上锉细。加生姜一片，枣一枚，水煎，温服，不拘时。
〔头面〕头面属阳，疮疹亦属阳，以类相从，故出现、起发、收靥自头面始，
升生浮长，阳之性也，痘疮起发，头面以渐肿大，升生浮长之性，不须忧恐，只要
疮子磊落红活，光壮肥泽，待至成脓之后，毒化结痂，而肿亦渐消矣。如疮粘连通
串，模糊成饼者，又要红活润泽，以快 汤、消毒饮（并见形）合而饮之，或消毒化 汤
以解其毒，更以甘桔汤（咽喉）加牛蒡子相间与之，以利咽喉，宽胸膈，令饮食无阻也。
又以神应膏护目（见形）。若灰白青黄干燥，疮面肤起者，皆死证也。其头面肿，有不闭
目者，毒浅而轻，有闭目者，毒深而重，亦待疮熟肿消而目自开，若疮未成，肿消
目开者，此陷也，勿治。
消毒化 汤
升麻 柴胡 桔梗 甘草 龙胆草 牛蒡子 连翘 防风 蝉蜕 密蒙花
上锉细。加淡竹叶十片，水一盏半，煎一盏，去滓，食后服。
凡将起发，头面预肿者，此时行疫疠之气，名大头瘟，其毒最酷，急用羌活救
苦汤解之。
羌活救苦汤
羌活 白芷 川芎 蔓荆子 防风 桔梗 黄芩 大力子 连翘 升麻 人中
黄（各等）
上锉碎。加薄荷叶七片，水一盏，煎七分，去滓，食后温服。
〔痘疔〕痘疹之毒，自内而出，冲突气血，发散腠理，初出一点血，乃身中气
血被毒驱逐，现于皮肤之外，其成形者气也，成色者血也，毒火太甚，煎熬气血，
先至之气则削矣，血则枯矣，气削血枯，腠理反闭，毒不得出，未免复入于里，遂
成陷伏，时人以黑疮子为痘疔，又曰鬼痘者，深恶而畏之词也。此乃毒瓦斯郁遏，非
外感风寒，内虚吐利，杂气触犯者可比，古人立方，如大小便秘，腹胀烦躁者则下
之，但大小便秘者，则利小便解毒，自利者以泻脓血为顺，水谷为逆，却不立方，
以毒虽入腹，皆泻出也，攻之则无所攻，补之则不可补，昏闷不醒者，用龙脑膏（黑陷）
以去心中之邪。枯黑不起者，或内用无价散（倒靥）以解在里之邪，或外用水杨汤（见前）、四圣
散（痘疔），胭脂涂法（见形）以解其表，使邪气得出，皆良法也。为工者，合下即下，合利即
利，合发即发，或解其里，或解其表，应变出奇，勿泥常法可也。
〔发 〕痘疮发 ，亦与黑陷相类，外出内入虽不同，而毒瓦斯壅郁则一也。或
发水 ，或发血 ，或赤、或紫、或黑，但见此证，十无一生。然亦有似是而非者
不可不辨，其人身上原有灌疮或破伤，疮未痊，或虽痊瘢痕尚嫩，一旦痘出，则疮
瘢四围，痘必簇者，物从其类之理也，发生之后，必然作 者腐败，皮肉气色先
变，宜与完肤有别也，治此者先以针刺破，吮去恶血，后以胭脂涂法（见形）合百花膏（收
靥）敷之。此疮又易作痒，起发之后，常宜以茵陈熏法（见前）熏之，勿令爪伤，若被爬搔，
则反复灌烂，淹延不愈，变为疳蚀坏疮。以致不治者多矣。〔袁〕痘起六七朝，脓
浆未曾充裕，头面身背或手足关轴遽起水 ，或似葡萄样，或似鹳子大，或如被单
联盖，因肝荣不能以资 ，而肺金窃势以凌侮，准服三化丹。歌曰∶七朝泡起势相
凌，三化丹中二味金，白术茯苓俱二两，四般法制用工深，一两要同归酒浸，一两
和却乳参蒸，一两再和雄附煮，一两分与炒米停，为末必须甜醴服，自然泡里注黄
金。痘里起泡，多患乎脓浆不能充灌，若虚泡结轴，十中八九泡内微有脓浆。滋养
元气，振援两仪，寒剥之剂，毫不可投，或单用浑天汤和人参酒服。但恐痒作而泡
溃，死在旦夕耳。
〔起发不透〕痘疹起发欲透，磊落尖圆，光壮肥泽者上也。根脚横开，皮起水
涨者次也。顶皮不起，根脚不开，犹是先出之形，不见新生之水，此谓起发不透。
审查证候，如气本实者，必曾感风寒，以桂枝葛根汤（初热）合夺命丹（见形）发之。如气本
虚，必不能食或吐利，以人参白术散（渴）合夺命丹以补中气，而发表邪。如欲成陷伏
者，根据前四法治之。若时日已多，发犹不透，或烦躁不安者，此毒热在里，心恶热，
以导赤散（心）送服牛黄清心丸（痘烦躁）以解散热毒，导引心火也。或啼哭者，凡人五脏平
和，则神宇安静，今五脏蕴毒，内外蒸郁，神不安舍，以导赤散送服安神丸（痘谵妄）使
郁热解散，神宇清快也。若谵言妄有见闻，时狂叫者，此五脏热毒蕴积，阳气独盛，
无阴气以和之，大便必不利，以当归丸（便闷）微利之，再行胆导法（便闷），使无留滞，易
快利也，甚则三乙承气汤主之（便闷）。若昏不知人，腹胀喘呼，死证也。
鸡鸣散 男女发热三四五日，或痘未形，或痘形隐隐，或才形于外而不能快利，或
烦躁谵语，或腹疼呕吐，或痰喘恶渴，急服此药，则毒自表出矣。
炒术 当归 川芎 甘草 大力子 茯苓 木通 桔梗 蝉蜕 升麻 橘红 山楂 红花
灯草生姜煎，临服，入雄鸡血并酒，妙。
震蛰丹 小儿热三四朝，痘或隐隐伏于皮肤，或形于头面一二颗，或标于身体四五
颗，上不宜补，下不宜泻，当服震蛰丹。穿山甲四钱，酒洗净，和砂仁、陈米炒，
卷去砂仁米，用白芍酒浆煮焙四钱，红曲三钱，蟾酥三钱，和匀，共研细为末。
每用酒浆量儿大小增减，大者一分，小者半分，若逾十二三岁者斟酌加之，用升
麻煎酒调服，其效立见。
天元接髓丹 男子十七八岁，或二三十岁，破阳亏元，倏一时患痘，稀少者虽年大
无妨，倘多密连布，欲其鼎峻充灌，势必难矣，急服天元接髓丹。
歌曰∶男儿阳破痘来临，不遇奇方坐视沉，天元接髓丹功捷，世上医家尽不明，
真正酒浆澄十碗，一毫酸苦莫相侵，人参黄 各二两，橘蝉归地半加赢，鹿茸乳
炙一两半，附桂半两要调停，慢火瓮中煨熟后，去滓出火莫胡斟，每钟人乳三杯
和，薄薄生姜二片存，再匀一沸仍温服，立建奇功若有神。此方，屡获明效，但
制法要详明，当归去头尾，怀地拣粗软，人参觅清河，黄 选绵白，橘红连本蒂，
蝉蜕要身全，附子连皮脐，官桂削外皮，煨时度候，只以米熟验之，人乳取来就
不宜过夜入尘。辛酉年杭城邵语溪子年二十六岁，平素寡弱，患痘，痘势沉匿不
起，单以此方倍加人参服之，竟后保全。
内托散 痘不起发，根窠不红，或灰白色，切牙寒战等证。
人参 黄 甘草 川芎 当归 防风 白芷 桔梗 白芍 浓扑 木香 肉桂
上，姜一片，枣一枚，水煎服。色红紫者，去肉桂、木香，加紫草、蝉蜕。
浆不满，水酒各半煎服。色淡白者，去防风、白芷，加糯米。大便燥，加人乳。
治孩儿百日里痘。歌曰∶全蝎要身全，五个蜜焙干，蝉蜕不可脱，完身又完足，五
个酒浆洗，和炒研细末，再加酒芍药，砂糖调来服，自然痘森森，那怕月不足。
月里患痘，稀美者多，密恶者少，变蒸未逾，猛浪之剂不宜妄投，是方斟酌，百
投百效。
痘至五六朝，忽然手脚牵缩一团，不知者以为惊使然耳，岂知阳明受枭毒之熬铄，
而筋络不能荣血以滋养故也，谓之一把缚，须服羚羊散。歌曰∶
白玉羚羊一两霜，木通紫草生地黄，芍药僵蚕全蝎桔，橘红甘草荆芥防，按法
服来随妥贴，误看惊治即多伤。此痘多起于四五六朝则为是，若起于两三朝则为
惊缩，若起于八九朝则作寒战，治之可也，羚羊角必取其锐尖处用之。
〔阳毒〕七日前阳毒者，凡疮也，以儿未出痘之先，或生疥疮，有形窠而成脓，
因而发热出痘者。或凡疮未痊，因而出痘者。或凡疮方结成瘢，因而出痘者。盖凡
疮未痊，及初结瘢处，肉分必虚，毒趋虚处而出，故阳疮阳毒，杂为一党，气血俱
盛，则易成浆，气血衰弱，则枯燥干红，与诸疮俱不成浆，治法与顶陷同。
起发最忌泄泻，故特着之，其他证候如发热、痛痒、腹胀、烦躁、谵妄等，各有本门，宜就彼中查之，兹不赘叙。
〔起发吉凶〕痘疮放标以后，渐渐起胀，先出者先起，后出者后起，微红光泽，
根窠明润，面目渐肿，能食无杂证者吉。大抵痘胀一分，则毒出一分，至六七日不
尽胀，又黑色者死。鼻有涕，口有涎，眼有泪者，可治，俱无者，大凶。凡痘子
已出，自放标之日算起，如当起发，不应有浆先有戴浆者。如当作浆，不应收靥便
有干收者。此皆恶候，治之无功。口唇者，脾之外候，人以脾胃为本，不宜受伤，
如初发热，唇焦裂者，此毒发于脾，便宜用泻黄散解之，不知早治，痘子之出，簇
于唇，及至起发之初，诸痘尚未试浆，此痘已熟，内带黄浆者，此恶候也，待诸痘
成浆，此疮已靥，唇皮捣脱，渐变呕食呛水，昏睡而死矣。大抵起发之初，疮头便
戴白浆者，不分何处，并非佳兆，不特口唇为然，盖痘疮初出一点血，血化为水，
水化为脓，脓成而毒解，此自然之序也。若初出之时半是水 ，或才起发，便有带
浆者，或未成脓，即干收者，火性躁急，失其自然之序，不应至而至，所谓早发还
先萎也，此毒火所为，倏忽之间，焰息气尽而死矣。痘疮最要以渐起发，磊落红
活，如一发都起，无复颗粒，模糊串连，不红活，带灰白色，面上浮肿如锡饼形，
此恶候也，其人能食，大小便如常，无它证候者吉，若食顿减，或原不能食者凶。
凡起发之时，痘疮稠密，又见陷伏、烦躁、狂叫之证，或口中出臭气者，此毒火熏煎，
肺烂胃败之气也。或不饮食失声者，此咽喉肿烂也。寒战切牙者，邪传肾也。或闷
乱者，神已丧也。或体寒者，阳脱也。或呕或泻者，肠胃俱败也。经云∶五脏气绝
于内者利不止，六腑气绝于外者手足厥。凡见以上诸证者，皆不可治。
（痘疹）的冷热情况，如果大便正常，这也是痘疹顺证的一种表现。如果在起发阶段突然发生泄泻，此时应当紧急止泻，因为恐怕是肠胃虚弱、真气脱失所致。必须辨别是冷证还是热证，是虚证还是实证：如果腹泻且手足冰冷，面色青白，痘疮不红（绽开），这是冷证，理中汤丸、豆蔻丸（均用于泄利）、益黄散（调理脾脏）、严重时可用陈氏木香散（用于泄利）、异功散（用于痘出不快）等方剂均可使用。如果泻下物色黄且酸臭，口渴，手足心发热，面赤，痘疮红活绽发，这是热证，以黄芩汤、五苓散（用于惊搐）为主治方。脾胃怯弱，精神萎靡且不能进食的是虚证，应当温养，用益黄散。身体发热、腹部胀满、口渴但不能进食的是实证，应当清利，用五苓散。如果患者脏腑之气自行脱失，或者因服用寒凉药物，导致痘毒陷入大肠，泻下物如豆汁，或便脓血，或便黑汁，口中有臭气，嘴唇焦裂，眼睛闭合，加上腹部胀满，这是必死的证候。方论详见泄泻本门。
不二散 治疗痘疮在起胀灌浆时泄泻不止，用此方止泻，只需服一次即可痊愈；如果服后仍不止泻，说明元气已经脱失，无法救治了。
莲肉（炒，去心，一两） 真鸦片（二钱，另研）
以上各取净末，混合均匀。每次服用三四分，用米饮调服。此方不仅能止泻，也能治疗烦、痒两种症状。固涩大肠滑脱容易理解，但收敛浮游的心火则难以知晓。
〔手足〕痘疮起发欲透达全身，只有四肢稍远，难得均匀整齐。必定是脾胃素来强壮、能食量多的人，才不需要担忧这种情况；如果脾胃素来虚弱又吃得少，手足上的痘疮常发不透，这是因为脾主四肢，脾虚则不能输送津液灌溉四肢，所以发痘迟缓，治疗应以补脾为主，用快越婢汤。如果不令其透发，后来手足必然发生痈毒。
另外，手足上的痘疮多发水泡的，这是肝木乘克脾土，先泻肝，用羌活汤（用于发热）加柴胡。后补脾，用人参白术散（用于口渴）去葛根加桂枝。如果痘疮见而复隐，起而复塌，颜色紫黑的，这是肾水乘克脾土，不可治愈。
快越婢汤
黄芪（炙） 白芍药 桂枝 防风 甘草（炙）
以上锉细。加生姜一片，大枣一枚，水煎，温服，不拘时间。
〔头面〕头面部属阳，痘疹也属阳，同类相从，所以出现、起发、收靥都从头面部开始，这是升生浮长，属于阳的性质。痘疮起发时，头面部逐渐肿大，这是升生浮长的本性，不必忧虑恐惧，只要痘粒磊落红活，光泽壮实肥润，等到成脓之后，毒化解结痂，肿胀也会逐渐消退。如果痘疮粘连通串，模糊成片，又要保持红活润泽，用快越汤、消毒饮（均在见形期出现）合而饮之，或用消毒化毒汤以解其毒，再用甘桔汤（用于咽喉）加牛蒡子交替服用，以利咽喉，宽胸膈，使饮食无阻。又用神应膏保护眼睛（见于见形期）。如果痘色灰白青黄干燥，疮面皮肤隆起的，都是死证。头面部肿胀，有的不闭眼，说明毒浅病轻；有的闭眼，说明毒深病重，也要等到疮熟肿消后眼睛自然睁开；如果疮未成脓，肿胀已消且眼睛睁开，这是毒邪内陷，不要治疗。
消毒化毒汤
升麻 柴胡 桔梗 甘草 龙胆草 牛蒡子 连翘 防风 蝉蜕 密蒙花
以上锉细。加淡竹叶十片，水一盏半，煎至一盏，去渣，饭后服用。
凡是即将起发，头面部预先肿胀的，这是时行疫疠之气，名为大头瘟，其毒性最烈，急用羌活救苦汤解之。
羌活救苦汤
羌活 白芷 川芎 蔓荆子 防风 桔梗 黄芩 大力子 连翘 升麻 人中黄（各等分）
以上锉碎。加薄荷叶七片，水一盏，煎至七分，去渣，饭后温服。
〔痘疔〕痘疹的毒气，从体内发出，冲击气血，发散腠理，初出的一点血，是身中气血被毒驱逐，现于皮肤之外，其成形的是气，成色的是血。毒火太盛，煎熬气血，先到之气被削弱，血则枯竭，气削血枯，腠理反而闭塞，毒不得外出，难免复入于里，遂成陷伏。时人将黑疮子称为痘疔，又叫鬼痘，这是深恶而畏惧的说法。这乃是毒瓦斯郁遏所致，不是外感风寒、内虚吐利、杂气触犯可以相比的。古人立方的原则是：如果大小便秘、腹胀烦躁的则攻下它；但如果只是大小便秘的，则通利小便解毒；如果是自利的，以泻出脓血为顺，泻出水谷为逆，却不立攻下之方，因为毒虽入腹，皆随泻而出，攻之则无所攻，补之则不可补。昏闷不醒的，用龙脑膏（用于黑陷）以去除心中之邪。枯黑不起的，或内服无价散（用于倒靥）以解在里之邪，或外用水杨汤（见前文）、四圣散（用于痘疔）、胭脂涂法（见于见形期）以解其表，使邪气得出，都是良法。作为医生，该下的就下，该利的就利，该发的就发，或解其里，或解其表，应变出奇，不要拘泥于常法。
〔发疱〕痘疮发疱，也与黑陷相似，虽然外出内入不同，但毒瓦斯壅郁是一样的。或发水疱，或发血疱，或赤、或紫、或黑，只要见到这种证候，十无一活。然而也有似是而非的情况，不可不辨。如果患者身上原有灌脓疮或破伤，疮未痊愈，或虽愈瘢痕尚嫩，一旦痘出，则疮瘢四周，痘必簇集，这是物从其类的道理，发生之后，必然作腐溃烂，皮肉气色先变，宜与完肤有别。治疗此症先用针刺破，吮去恶血，后用胭脂涂法（见于见形期）合百花膏（用于收靥）敷之。此疮又易作痒，起发之后，常宜用茵陈熏法（见前文）熏之，勿令抓伤，如果被爬搔，则反复灌烂，拖延不愈，变为疳蚀坏疮。以致不治者很多。〔袁〕痘起六七朝，脓浆未曾充裕，头面身背或手足关节处突然起水疱，或似葡萄样，或似鹳子大，或如被单联盖，这是因为肝荣不能资助，而肺金窃势以凌侮，应当服用三化丹。歌曰：七朝泡起势相凌，三化丹中二味金，白术茯苓俱二两，四般法制用工深，一两要同归酒浸，一两和却乳参蒸，一两再和雄附煮，一两分与炒米停，为末必须甜醴服，自然泡里注黄金。痘里起泡，多患乎脓浆不能充灌，若虚泡结轴，十中八九泡内微有脓浆。滋养元气，振援两仪，寒剥之剂，毫不可投，或单用浑天汤和人参酒服。但恐痒作而泡溃，死在旦夕耳。
〔起发不透〕痘疹起发欲透达，磊落尖圆，光壮肥泽的是上佳。根脚横开，皮起水涨的是次之。顶皮不起，根脚不开，还是先出的形状，不见新生之水，这叫起发不透。审查证候，如果气本实的，必定曾感风寒，用桂枝葛根汤（用于初热）合夺命丹（见于见形期）发之。如果气本虚，必定不能食或吐利，用人参白术散（用于口渴）合夺命丹以补中气，而发表邪。如果欲成陷伏的，根据前四种方法治疗。如果时日已多，发犹不透，或烦躁不安的，这是毒热在里，心恶热，用导赤散（用于心）送服牛黄清心丸（用于痘烦躁）以解散热毒，导引心火。或啼哭的，凡人五脏平和，则神宇安静，今五脏蕴毒，内外蒸郁，神不安舍，用导赤散送服安神丸（用于痘谵妄）使郁热解散，神宇清快。如果谵言妄有见闻，时狂叫的，这是五脏热毒蕴积，阳气独盛，无阴气以和之，大便必不利，用当归丸（用于便闷）微利之，再行胆导法（用于便闷），使无留滞，易快利，甚则用三乙承气汤主之（用于便闷）。如果昏不知人，腹胀喘呼，是死证。
鸡鸣散 男女发热三四五日，或痘未形，或痘形隐隐，或才形于外而不能快利，或烦躁谵语，或腹疼呕吐，或痰喘恶渴，急服此药，则毒自表出矣。
炒术 当归 川芎 甘草 大力子 茯苓 木通 桔梗 蝉蜕 升麻 橘红 山楂 红花
灯草生姜煎，临服，入雄鸡血并酒，妙。
震蛰丹 小儿热三四朝，痘或隐隐伏于皮肤，或形于头面一二颗，或标于身体四五颗，上不宜补，下不宜泻，当服震蛰丹。穿山甲四钱，酒洗净，和砂仁、陈米炒，卷去砂仁米，用白芍酒浆煮焙四钱，红曲三钱，蟾酥三钱，和匀，共研细为末。每用酒浆量儿大小增减，大者一分，小者半分，若逾十二三岁者斟酌加之，用升麻煎酒调服，其效立见。
天元接髓丹 男子十七八岁，或二三十岁，破阳亏元，倏一时患痘，稀少者虽年大无妨，倘多密连布，欲其鼎峻充灌，势必难矣，急服天元接髓丹。
歌曰：男儿阳破痘来临，不遇奇方坐视沉，天元接髓丹功捷，世上医家尽不明，真正酒浆澄十碗，一毫酸苦莫相侵，人参黄芪各二两，橘蝉归地半加赢，鹿茸乳炙一两半，附桂半两要调停，慢火瓮中煨熟后，去滓出火莫胡斟，每钟人乳三杯和，薄薄生姜二片存，再匀一沸仍温服，立建奇功若有神。此方，屡获明效，但制法要详明，当归去头尾，怀地拣粗软，人参觅清河，黄芪选绵白，橘红连本蒂，蝉蜕要身全，附子连皮脐，官桂削外皮，煨时度候，只以米熟验之，人乳取来就不宜过夜入尘。辛酉年杭城邵语溪子年二十六岁，平素寡弱，患痘，痘势沉匿不起，单以此方倍加人参服之，竟后保全。
内托散 痘不起发，根窠不红，或灰白色，切牙寒战等证。
人参 黄芪 甘草 川芎 当归 防风 白芷 桔梗 白芍 浓朴 木香 肉桂
以上，姜一片，枣一枚，水煎服。色红紫者，去肉桂、木香，加紫草、蝉蜕。
浆不满，水酒各半煎服。色淡白者，去防风、白芷，加糯米。大便燥，加人乳。
治孩儿百日里痘。歌曰：全蝎要身全，五个蜜焙干，蝉蜕不可脱，完身又完足，五个酒浆洗，和炒研细末，再加酒芍药，砂糖调来服，自然痘森森，那怕月不足。
月里患痘，稀美者多，密恶者少，变蒸未逾，猛浪之剂不宜妄投，是方斟酌，百投百效。
痘至五六朝，忽然手脚牵缩一团，不知者以为惊使然耳，岂知阳明受枭毒之熬铄，而筋络不能荣血以滋养故也，谓之一把缚，须服羚羊散。歌曰：
白玉羚羊一两霜，木通紫草生地黄，芍药僵蚕全蝎桔，橘红甘草荆芥防，按法服来随妥贴，误看惊治即多伤。此痘多起于四五六朝则为是，若起于两三朝则为惊缩，若起于八九朝则作寒战，治之可也，羚羊角必取其锐尖处用之。
〔阳毒〕七日前阳毒者，凡疮也，以儿未出痘之先，或生疥疮，有形窠而成脓，因而发热出痘者。或凡疮未痊，因而出痘者。或凡疮方结成瘢，因而出痘者。盖凡疮未痊，及初结瘢处，肉分必虚，毒趋虚处而出，故阳疮阳毒，杂为一党，气血俱盛，则易成浆，气血衰弱，则枯燥干红，与诸疮俱不成浆，治法与顶陷同。
起发最忌泄泻，故特着之，其他证候如发热、痛痒、腹胀、烦躁、谵妄等，各有本门，宜就彼中查之，兹不赘叙。
〔起发吉凶〕痘疮放标以后，渐渐起胀，先出者先起，后出者后起，微红光泽，根窠明润，面目渐肿，能食无杂证者吉。大抵痘胀一分，则毒出一分，至六七日不尽胀，又黑色者死。鼻有涕，口有涎，眼有泪者，可治，俱无者，大凶。凡痘子已出，自放标之日算起，如当起发，不应有浆先有戴浆者。如当作浆，不应收靥便有干收者。此皆恶候，治之无功。口唇者，脾之外候，人以脾胃为本，不宜受伤，如初发热，唇焦裂者，此毒发于脾，便宜用泻黄散解之，不知早治，痘子之出，簇于唇，及至起发之初，诸痘尚未试浆，此痘已熟，内带黄浆者，此恶候也，待诸痘成浆，此疮已靥，唇皮捣脱，渐变呕食呛水，昏睡而死矣。大抵起发之初，疮头便戴白浆者，不分何处，并非佳兆，不特口唇为然，盖痘疮初出一点血，血化为水，水化为脓，脓成而毒解，此自然之序也。若初出之时半是水疱，或才起发，便有带浆者，或未成脓，即干收者，火性躁急，失其自然之序，不应至而至，所谓早发还先萎也，此毒火所为，倏忽之间，焰息气尽而死矣。痘疮最要以渐起发，磊落红活，如一发都起，无复颗粒，模糊串连，不红活，带灰白色，面上浮肿如锡饼形，此恶候也，其人能食，大小便如常，无它证候者吉，若食顿减，或原不能食者凶。
凡起发之时，痘疮稠密，又见陷伏、烦躁、狂叫之证，或口中出臭气者，此毒火熏煎，肺烂胃败之气也。或不饮食失声者，此咽喉肿烂也。寒战切牙者，邪传肾也。或闷乱者，神已丧也。或体寒者，阳脱也。或呕或泻者，肠胃俱败也。经云：五脏气绝于内者利不止，六腑气绝于外者手足厥。凡见以上诸证者，皆不可治。
(The cold and heat of) the eruption, if the stool is normal, is also a favorable progression of variola. If sudden diarrhea occurs during the eruptive stage, it should be stopped urgently, as this may indicate deficiency of the stomach and intestines and loss of true qi. One must differentiate between cold and heat, deficiency and excess: if there is diarrhea with cold hands and feet, cyanotic and pale complexion, and pustules that are not red (blooming), it is a cold syndrome; Lizhong Tang Wan, Doukou Wan (both for diarrhea), Yihuang San (for spleen), and in severe cases, Chen's Muxiang San (for diarrhea) or Yigong San (for slow eruption) can be used. If the discharged material is yellow and sour-smelling, accompanied by thirst, hot palms and soles, red face, and red, blooming pustules, it is a heat syndrome; Huangqin Tang and Wuling San (for convulsions) are the main treatments. Weakness of the spleen and stomach, with lethargy and anorexia, indicates deficiency, which should be treated with warming and nourishing methods using Yihuang San. Fever, abdominal fullness, thirst, and anorexia indicate excess, which should be treated with clearing and draining methods using Wuling San. If the patient's organ qi spontaneously collapses, or due to the administration of cold medicines causing toxin to sink into the large intestine, resulting in stools like bean curd dregs, pus and blood in stool, black fluid in stool, foul breath, cracked lips, closed eyes, and abdominal distension, it is a fatal syndrome. For detailed formulas and discussions, see the section on Diarrhea.
Bu'er San treats persistent diarrhea when variola is swelling and filling with pus; one dose cures it. If it does not stop after taking this, the primordial qi has collapsed, and it is incurable.
Lotus Plumule (stir-fried, heart removed, 1 liang) Real Opium (2 qian, ground separately)
Grind each into fine powder and mix evenly. Take 3-4 fen each time, mixed with rice water. This formula not only stops diarrhea but also treats irritability and itching. It is easy to understand how it secures intestinal sliding and prolapse, but difficult to know how it敛 (astringes) floating heart fire.
[Hands and Feet] When variola erupts and seeks to penetrate the whole body, the limbs are farther away and harder to achieve uniformity. Only those with strong spleen and stomach who eat well need not worry about this. If spleen and stomach are weak and appetite poor, eruptions on hands and feet often fail to fully emerge because the spleen governs the four limbs; spleen deficiency prevents the transportation of fluids to irrigate the limbs, causing delayed eruption. Treatment should focus on tonifying the spleen using Kuai Yuebi Shui Tang. If not allowed to emerge, abscesses will likely form on the hands and feet later.
Additionally, when vesicles appear on hands and feet, it indicates Liver overacting on Spleen. First drain the Liver using Qianghuo Tang (for fever) added with Chaihu. Then tonify the Spleen using Renshen Baizhu San (for thirst) removing Gegen and adding Guizhi. If eruptions appear then disappear, rise then collapse, turning purple-black, it indicates Kidney overacting on Spleen, which is incurable.
Kuai Yuebi Shui Tang
Huangqi (honey-fried) Baishao Guizhi Fangfeng Gancao (honey-fried)
Cut into small pieces. Add one slice of fresh ginger and one jujube, decoct in water, take warm at any time.
[Head and Face] The head and face belong to Yang, and variola also belongs to Yang; like attracts like, so appearance, eruption, and scabbing all begin at the head and face. Rising and floating growth is the nature of Yang. During eruption, the head and face gradually swell; this rising nature need not cause fear. As long as the pustules are distinct, red, vibrant, glossy, plump, and lustrous, after pus formation, the toxin resolves and scabs form, and swelling will gradually subside. If pustules adhere and merge into a blurry mass, maintaining redness and moisture is key. Use Kuai Yue Tang and Xiaodu Yin (both seen in the visible stage) together, or Xiaodu Huadu Tang to resolve toxicity. Alternate with Ganjie Tang (for throat) added with Niubangzi to benefit the throat, widen the chest, and ensure unobstructed eating and drinking. Also apply Shenying Gao to protect the eyes (seen in the visible stage). Gray-white, green-yellow, dry pustules with raised skin surface are all fatal signs. Head and face swelling without eye closure indicates shallow and mild toxin; eye closure indicates deep and heavy toxin. Eyes will naturally open after maturation and swelling subsides. If swelling subsides and eyes open before pus forms, it indicates sinking toxin; do not treat.
Xiaodu Huadu Tang
Shengma Chaihu Jiegeng Gancao Longdancao Niubangzi Lianqiao Fangfeng Chantui Mimenghua
Cut into small pieces. Add ten slices of Danzhuye, decoct 1.5 cups of water to 1 cup, strain, take after meals.
When pre-swelling of the head and face occurs just before eruption, it is caused by epidemic pestilence qi, named Datou Wen (Big Head Plague). Its toxicity is most severe; urgently use Qianghuo Jiuku Tang to resolve it.
Qianghuo Jiuku Tang
Qianghuo Baizhi Chuanxiong Manjingzi Fangfeng Jiegeng Huangqin Dali Zi Lianqiao Shengma Renzhonghuang (equal parts)
Cut into fragments. Add seven mint leaves, decoct 1 cup of water to 0.7 cup, strain, take warm after meals.
[Dou Ding] The toxin of variola emerges from within, impacting Qi and Blood, and dispersing through the interstices. The initial drop of blood is Qi and Blood driven out by toxin to the skin surface. Form comes from Qi, color from Blood. Excessive toxic fire boils Qi and Blood; the arriving Qi is depleted, and Blood becomes dry. Depleted Qi and dry Blood cause the interstices to close, preventing toxin exit, forcing it back inward, leading to sinking and伏 (latent) states. People call black pustules "Dou Ding" or "Ghost Pox," terms expressing deep aversion and fear. This is due to entrapment of toxic vapors, unlike external wind-cold, internal deficiency with vomiting/diarrhea, or miscellaneous qi invasion. Ancient prescriptions state: if constipation, abdominal fullness, and irritability exist, purge them. However, if only constipated, promote urination to detoxify. If spontaneous diarrhea, passing pus/blood is favorable, passing food/water is unfavorable; no purgative formula is set because although toxin enters the abdomen, it exits via diarrhea. Attacking finds nothing to attack; tonifying is contraindicated. For coma and unconsciousness, use Longnao Gao (for black sinking) to remove pathogenic factors from the heart. For dry, black, non-rising lesions, internally use Wuji San (for inverted scabbing) to resolve internal pathogens, or externally use Shuiyang Tang (see previous), Six Saints Powder (for Dou Ding), and Rouge Application Method (see visible stage) to resolve exterior pathogens, allowing evil to exit. These are good methods. Physicians should purge when appropriate, drain when appropriate, release when appropriate, resolve interior or exterior, adapting creatively without rigid adherence to standard methods.
[Fa Pao] Eruption of blisters resembles black sinking. Although outward vs inward differs, toxic vapor congestion is the same. Whether water blisters, blood blisters, red, purple, or black, seeing these signs means nine out of ten die. However, similarities must be distinguished. If the patient had suppurating wounds or injuries before, even if healed, scars are tender. When pox appears, clusters around old scars follow the principle of like attracting like. After emergence, they inevitably rot and decay, changing skin color differently from intact skin. Treat by pricking with needles, sucking out bad blood, then applying Rouge Method (see visible stage) combined with Baihua Gao (for scabbing). These lesions easily itch. After eruption, fumigate with Yinchen Fumigation Method (see previous) frequently, avoiding scratching. Scratching causes repeated suppuration, delaying healing, turning into gan erosion and坏疮 (bad sores), often leading to untreatable conditions. [Yuan] On the 6th-7th day, if pus is insufficient, sudden water blisters appear on head, face, back, or joints, resembling grapes, storks, or connected sheets. This is because Liver Essence fails to nourish, while Lung Metal usurps power to oppress. Administer Sanhua Dan. Verse: Blisters rise on the seventh day, overpowering each other; In Sanhua Dan, two metals reside; A liang each of Baizhu and Fuling, Four processes require deep skill; One liang soaked in Guijiu, One liang steamed with Renshen and milk; One liang boiled with Xiongfuzi, One liang mixed with fried rice; Powder taken with sweet wine, Naturally fills blisters with gold. Blisters in pox often occur when pus fails to fill. If blistering at joints, 8-9 out of 10 have slight pus inside. Nourish Yuanqi, support Yin and Yang; cold-draining agents must not be used. Or simply use Hundun Tang with Renshen wine. Fear itching leads to rupture, death imminent.
[Incomplete Eruption] Ideal eruption is distinct, pointed, round, glossy, plump, and lustrous. Spreading roots, raised skin, and swelling are secondary. Raised top but flat root, showing original shape without new fluid, is called incomplete eruption. Review symptoms: if Qi is solid, likely caught wind-cold; use Guizhi Gegen Tang (for initial fever) combined with Duoming Dan (see visible stage) to release. If Qi is deficient, unable to eat or with vomiting/diarrhea, use Renshen Baizhu San (for thirst) combined with Duoming Dan to tonify middle Qi and release exterior evil. If sinking/latent is desired, follow the previous four methods. If many days pass and eruption remains incomplete, or with irritability, this is heat-toxin in the interior; Heart dislikes heat; use Daochi San (for Heart) to deliver Niuhuang Qingxin Wan (for pox irritability) to clear heat-toxin and guide Heart fire. If crying, peaceful Five Zang brings quiet spirit; now Five Zang harbors toxin, steaming internally and externally, disturbing the spirit; use Daochi San to deliver Anshen Wan (for pox delirium) to dissipate constrained heat and clarify spirit. If delirious, hallucinating, screaming, this is accumulated heat-toxin in Five Zang, excessive Yang without Yin harmony; stool likely obstructed; use Danggui Wan (for abdominal stuffiness) to mildly purge, then perform Gallbladder Guiding Method (for abdominal stuffiness) to prevent stagnation and facilitate rapid evacuation; in severe cases, use San Yi Chengqi Tang (for abdominal stuffiness). Coma, abdominal distension, panting are fatal.
Jiming San For men and women with fever for 3-5 days, or pox not yet formed, faintly formed, or just emerged but not smoothly released, or with irritability, delirium, abdominal pain, vomiting, phlegm-panting, or extreme thirst; urgent intake expels toxin from the exterior.
Chao Zhu Danggui Chuanxiong Gancao Dali Zi Fuling Mutong Jiegeng Chantui Shengma Juhong Shanzha Honghua
Decoct with Dengcao and Shengjiang. Before taking, add rooster blood and wine. Excellent.
Zhenzhe Dan For children with fever for 3-4 days, pox faintly hidden in skin, or 1-2 spots on head/face, or 4-5 spots on body; upper body not suitable for tonification, lower body not suitable for purging; administer Zhenzhe Dan. Shanjiapia 4 qian, washed in wine, stir-fried with Sharen and aged rice, discard Sharen and rice. Baishao boiled in wine浆 and baked 4 qian, Hongqu 3 qian, Chansu 3 qian. Mix and grind fine. Dosage varies by age with wine浆: larger children 1 fen, smaller 0.5 fen; over 12-13 years adjust accordingly. Take with Shengma decocted wine; effect is immediate.
Tianyuan Jiesui Dan Men aged 17-18 or 20-30, having damaged Yang and depleted Yuan, suddenly contracting pox. Sparse cases are fine even at older age, but dense, confluent cases requiring robust filling are difficult; urgently administer Tianyuan Jiesui Dan.
Verse: When Yang breaks and pox arrives, Without miraculous formula, one sits helpless; Tianyuan Jiesui Dan works swiftly, Yet physicians worldwide ignore it. Ten bowls of pure wine浆, No sour or bitter allowed; Renshen and Huangqi each 2 liang, Juhong, Chantui, Danggui, Dihuang half plus extra; Deer Antler with milk-baked 1.5 liang, Fuzi and Guizhi half liang balanced; Simmer slowly in earthenware until cooked, Strain and cool, pour carefully; Mix three cups of human milk per cup, Keep two thin slices of ginger; Boil once more and take warm, Miraculous功效 as if divine. This formula yields frequent success, but preparation must be precise: Danggui remove head/tail, Huai Dihuang select coarse/soft, Renshen seek Heqing origin, Huangqi choose soft/white, Juhong keep stem/pedicel, Chantui require complete body, Fuzi keep skin/navel, Guizhi scrape outer bark. Simmer timing verified by rice doneness; Human milk taken fresh, never overnight exposed to dust. In Xin You year, Shao Yuxi's son, age 26, in Hangzhou, usually frail, contracted pox with sunken/non-rising态势. Taking this formula with doubled Renshen saved him completely.
Neituo San For pox failing to erupt, roots not red, or gray-white, teeth-chattering, chills.
Renshen Huangqi Gancao Chuanxiong Danggui Fangfeng Baizhi Jiegeng Baishao Nongpu Muxiang Rougui
Add one ginger slice, one jujube, decoct in water. For red-purple color, remove Rougui and Muxiang, add Zicao and Chantui. For insufficient pus, decoct with half water half wine. For pale-white color, remove Fangfeng and Baizhi, add glutinous rice. For dry stool, add human milk.
Treats infantile hundred-day pox. Verse: Quanxie must be whole, five roasted with honey; Chantui must not lose shell, complete body and feet; Five washed in wine浆, Stir-fried and ground fine; Add Jiu Baishao, mix with sugar powder; Naturally pox grows dense, Fear not lunar month insufficient.
Pox in the first month is mostly sparse/favorable, rarely dense/bad. Before Bianzheng completes, harsh agents should not be thrown blindly; this formula, when weighed, is effective in every attempt.
On the 5th-6th day, sudden contraction of hands and feet into a ball is mistaken by laymen for convulsion. Actually, it is Yangming suffering from fierce toxin boiling, causing meridians unable to nourish blood. Called "One Hand Bind," must take Lingyang San. Verse: White Jade Lingyang one liang frost, Mutong Zicao Shengdi Huang, Shaoyang Jiangcan Quanxie Jie, Juhong Gancao Jingjie Fang; Follow method for proper fit, Mistaking for convulsion causes much harm. This arises correctly on days 4-6; if days 2-3, it is convulsive contraction; if days 8-9, it is chills, treatable. Lingyangjiao must use the sharp tip.
[Yang Du] Yang Du before the 7th day refers to ordinary sores. Before pox eruption, if child had impetigo forming pustules, then fever and pox erupted. Or ordinary sores unhealed, then pox erupted. Or sores just scabbed, then pox erupted. Since unhealed sores and fresh scars represent deficient flesh, toxin flows to deficiency and emerges. Thus Yang sores and Yang Du mix into one faction. If Qi and Blood are strong, pus forms easily; if weak, dry and red, failing to form pus with other sores. Treatment is same as inverted depression.
Eruption most fears diarrhea, hence specially noted. Other symptoms like fever, pain/itch, abdominal distension, irritability, delirium have their own sections; consult there, not repeated here.
[Eruption Auspiciousness/Misfortune] After marking, pox gradually swells. Early ones rise first, late ones later. Slight redness, glossiness, bright/moist roots, gradual facial swelling, able to eat without miscellany are auspicious. Generally, one part swelling equals one part toxin exit. If by day 6-7 not fully swollen, and black, death ensues. Nasal mucus, oral saliva, eye tears are treatable; absence of all is highly inauspicious. From marking day, if expecting eruption, shouldn't have pus-bearing before expected. If expecting pus, shouldn't have dry scabbing early. These are bad omens, treatment futile. Lips are exterior sign of Spleen; humans rely on Spleen/Stomach base, injury undesirable. Initial fever with cracked lips indicates toxin emerging from Spleen; should use Xiexiang San to resolve. Ignoring early treatment, pox clusters on lips. At early eruption, while others haven't tested pus, this one is ripe with yellow pus inside—bad omen. Wait for others to pus, this one scabs, lip skin peels off, gradually vomiting/choking, sleeping coma, then death. Generally, white pus at crater head at early eruption, anywhere, is not good omen, not just lips. Initial pox drop of blood turns to water, water to pus, pus formed toxin resolves—natural order. If initially half-water blister, or just erupting with pus, or no pus yet dry scabbing, Fire nature is impatient, losing natural order, arriving prematurely. Called "early emergence leads to premature withering." Caused by toxic fire, in moments flame dies, Qi exhausts, death ensues. Pox most requires gradual eruption, distinct red/vibrant. If all erupt at once, no granules, blurry connected, not red/vibrant, gray-white, face swollen like tin cake, this is bad omen. Able to eat, normal stool/urine, no other symptoms is auspicious. Sudden decrease in food or inability to eat originally is inauspicious.
At eruption, if dense pox with sinking, irritability, screaming, or foul breath, this is toxic fire frying, Qi of rotten lung and failed stomach. Not eating/losing voice indicates throat swelling/rotting. Chills/teeth-chattering indicates evil transmitting to Kidney. Confusion indicates spirit lost. Cold body indicates Yang collapse. Vomiting/diarrhea indicates Stomach/Intestines failure. Classic says: Five Zang Qi absolute internally leads to endless diarrhea; Six Fu Qi absolute externally leads to cold extremities. Seeing above signs, all are untreatable.