言方）加瓜霜紫雪丹为主。险症多闷痘症，紫闷最急，症多毒盛火闭，首用瓜霜紫雪丹钱许，大剂芳透，继用局
方妙香丸三五粒，峻剂开达，次用费氏必胜汤，大剂清凉攻毒，外以针刺少商、曲池、委中、三穴，以泄血毒，
庶可十救一二。但闷多夹症，夹食为食闭，夹痰为痰闭，夹瘀为血闭，因夹而闭，因闭而闷者甚多，急进飞马金
丹（沈樾亭验方传信方），使上吐下泻，开通气道血路，得夹邪一解，然后察其病势之轻重，对症发药。势轻
者但须活血解毒，如聂氏清毒活血汤、伍氏凉血解毒汤、小剂清瘟败毒饮之类。势重者必须凉血攻毒，如清凉攻
毒散（王晋三古方选注方）、费氏必胜汤、清火解毒汤（救偏琐言方）之类。惟温毒挟虫而闷者，宜先与椒梅丸
诱入虫口，继以紫草承气汤（张氏医通方）下之。更有真元大虚而闷者，宜急以参归鹿茸汤（痘门方旨方）、参
茸升汤（张氏医通方）二方挽救之，然温热病中百不一见。若闷而缓者名曰轻性闷痘，火毒内壅，聂氏清解
散凉透之；风冷外束，聂氏苏解散疏达之。谨述发痘症列下∶
顺症之候∶一二日初出如粟痘，色淡红而润，口鼻年寿间先发两三点，二三日根窠圆混长发饱满，四五日
大圆光泽大小不一，五六日红活鲜明，六七日光洁饱满，七八日神全色润，八九日浆足根化而无他症，十一二
日浆足而敛，十三四日浆老结痂，十四五日痂落瘢明。
逆险症之候∶鼻煤衄血，咽痛声哑，烦躁癫狂，弄舌黑刺，唇裂肌燥，目胞红肿，消渴饮冷，口秽喷人，
泪热出血，暴泻如注 溺膏溲血 痘则洒墨涂朱 迸裂泡涌
紫陷、黑陷之候∶痘稠密，晕红紫，顶陷下，甚则晕脚干枯，中有黑脐而陷，气粗身热，神昏躁乱，甚或
血厥如尸，闷乱搐搦。
轻性闷痘之候∶身热三日，痘欲出不出，痘影红紫，声亮气粗，手足心热，惊搐烦躁，或声重鼻塞流涕。
重性闷痘，毒盛火闭之候∶一发热即报点如丹，身热如烙，痘渐干焦紫黑，烦躁闷乱唇焦口臭，或唇口肿满。
闷痘夹食之候∶初发时便大热神昏，腹痛谵语，舌刺如芒，气粗便闭，狂叫闷乱。
闷痘夹痰之候∶发热时便头项不举，痰嗽气急，目闭神昏，眩晕颠仆，闷乱搐搦。
闷痘夹瘀之候∶一发热见点即谵语神昏，喘胀衄血，烦闷躁扰，胸痹作痛，舌色紫暗。
闷痘夹虫之候∶一发热即烦闷呕吐，舌下常流清水，或时沉默喜唾，或时躁扰不宁，或腹痛狐疑，或频频
叫喊，舌下筋青，或下唇有黑白细点。
重性闷痘，真元亏极之候∶身热二三日，痘欲出未出，一见点细白如 ，身无大热，气怯无力，目闭无神，
面唇反鲜泽娇艳、光彩倍常。
（关于方药的应用）以加瓜霜紫雪丹为主。险症中多见闷痘症，其中紫闷最为急重，症状多表现为毒盛火闭，首选服用一钱许的瓜霜紫雪丹，用大剂量的芳香透达之品；继服局方妙香丸三五粒，用峻猛之剂开通达邪；再服费氏必胜汤，用大剂量清凉攻毒之品；外用针刺少商、曲池、委中三穴，以泄出血中毒邪，这样或许能十中救一二。但闷痘多夹杂其他病证，夹食滞的为食闭，夹痰浊的为痰闭，夹瘀血的为血闭，因夹杂而导致闭塞，因闭塞而导致闷痘的情况很多，此时应紧急进服飞马金丹（沈樾亭验方传信方），使患者上吐下泻，开通气道和血路，待夹杂之邪解除后，再观察病势的轻重，对症用药。病势轻者只需活血解毒，如聂氏清毒活血汤、伍氏凉血解毒汤、小剂量的清瘟败毒饮之类。病势重者必须凉血攻毒，如清凉攻毒散（王晋三古方选注方）、费氏必胜汤、清火解毒汤（救偏琐言方）之类。唯有温毒挟带虫积而致闷痘的，宜先用椒梅丸诱引药物进入虫口，继以紫草承气汤（张氏医通方）攻下。更有真元极度虚弱而致闷痘的，宜急用参归鹿茸汤（痘门方旨方）、参茸升汤（张氏医通方）两方来挽救，然而在温热病中百中难见一例。若闷痘发作较缓的，称为轻性闷痘，火毒内壅的，用聂氏清解散凉透；风冷外束的，用聂氏苏解散疏达。谨述发痘症候如下：
顺症的表现：初起一二日，痘疹如粟米状发出，颜色淡红而润泽，先在口、鼻、年寿部位出现两三点，二三日时根部圆浑饱满，四五日时痘体大圆光泽、大小不一，五六时红润鲜活鲜明，六七时日色光洁饱满，七八日时神气充足、色泽润泽，八九日时浆液充满、根部化脓而无其他病症，十一二日时浆足而收敛，十三四日时浆老结痂，十四五日时痂落瘢痕明显。
逆险症的表现：鼻孔黑煤、衄血，咽喉疼痛、声音嘶哑，烦躁不安、癫狂，弄舌生黑刺，嘴唇干裂、肌肤干燥，眼睑红肿，消渴喜饮冷水，口气秽臭喷人，流泪且热、出血，暴泻如水注，尿膏混血，痘疹如洒墨涂朱般迸裂泡涌。
紫陷、黑陷的表现：痘疹稠密，周围红紫色，顶部凹陷，甚至周围脚部干枯，中间有黑色脐窝而凹陷，呼吸粗重、身体发热，神志昏迷、躁动混乱，甚至出现血厥如同尸体，闷乱抽搐。
轻性闷痘的表现：身体发热三日，痘疹欲出未出，痘影红紫，声音响亮、气息粗重，手足心发热，惊悸抽搐、烦躁，或声音沉重、鼻塞流涕。
重性闷痘，毒盛火闭的表现：一发热即报点如丹砂，身体热如烙铁，痘疹逐渐干枯焦紫黑，烦躁闷乱、嘴唇焦枯、口臭，或嘴唇口部肿满。
闷痘夹食的表现：初发时大便热、神志昏迷，腹痛谵语，舌苔生刺如芒，气息粗重、大便闭塞，狂叫闷乱。
闷痘夹痰的表现：发热时头项不能抬起，痰嗽气急，眼睛闭合、神志昏迷，眩晕跌倒，闷乱抽搐。
闷痘夹瘀的表现：一发热见点即谵语神昏，喘胀衄血，烦闷躁扰，胸痹作痛，舌色紫暗。
闷痘夹虫的表现：一发热即烦闷呕吐，舌下常流清水，有时沉默喜唾，有时躁扰不宁，有时腹痛狐疑不定，有时频频叫喊，舌下筋脉青紫，或下唇有黑白细点。
重性闷痘，真元亏极的表现：身体发热二三日，痘疹欲出未出，一见点细小白色如粟米，身体无大热，气怯无力，眼睛闭合无神，面唇反而鲜泽娇艳、光彩倍于平常。
(Regarding the application of formulas) The primary treatment is Guashuang Zixue Dan (Melon Frost Purple Snow Pill) with added ingredients. In critical cases, particularly "Men Dou" (stifled smallpox), "Zi Men" (purple stifled type) is the most urgent. The symptoms typically manifest as excessive toxin and fire closure. Initially, administer approximately one qian of Guashuang Zixue Dan, using a large dose of aromatic penetrating agents. Subsequently, administer three to five pills of Ju Fang Miaoxiang Wan (Wonderful Fragrance Pill from the Bureau Formulary) as a potent agent to open and unblock. Next, administer Fei Shi Bisheng Tang (Fei's Invincible Decoction) in a large dose for cooling and detoxifying attack. Externally, needle the Shaoshang (LU11), Quchi (LI11), and Weizhong (BL40) acupoints to drain blood toxins. This approach may save one or two out of ten patients. However, stifled smallpox often involves complicated conditions: food stagnation causing "Shi Bi" (food closure), phlegm turbidity causing "Tan Bi" (phlegm closure), and blood stasis causing "Xue Bi" (blood closure). Many cases involve closure due to complications, leading to stifling. In such emergencies, rapidly administer Feima Jindan (Flying Horse Golden Pill, Shen Yueting's verified prescription from Chuanxin Fang) to induce vomiting and diarrhea, thereby opening the qi channels and blood pathways. Once the complicating pathogen is resolved, assess the severity of the disease and prescribe medication accordingly. For mild cases, only blood-invigorating and detoxifying methods are needed, such as Nie Shi Qingdu Huoxue Tang (Nie's Toxin-Clearing Blood-Invigorating Decoction), Wu Shi Liangxue Jiedu Tang (Wu's Cooling-Blood Detoxifying Decoction), or a small dose of Qingwen Baidu Yin (Clear Plague and Eliminate Toxin Decoction). For severe cases, cooling-blood and attacking-toxin methods are essential, such as Qingliang Gongdu San (Cooling Attack-Toxin Powder, Wang Jinshan's Ancient Formula Selection), Fei Shi Bisheng Tang, or Qinghuo Jiedu Tang (Fire-Clearing Detoxifying Decoction, from Jiupian Suoyan). Only when warm toxin is complicated by parasites causing stifling should one first use Jiaomei Wan (Pepper and Plum Pill) to lure the medicine into the parasite's mouth, followed by Zicao Chengqi Tang (Lithospermum Da-Huang Decoction, from Zhang Shi Yitong) to purge downwards. Furthermore, in cases where true yuan (vital energy) is extremely deficient causing stifling, urgently rescue with Shenguilu Rong Tang (Ginseng, Angelica, and Deer Antler Decoction, from Doumen Fangzhi) or Shenrong Sheng Tang (Ginseng and Deer Antler Ascending Decoction, from Zhang Shi Yitong); however, this is seen in less than one in a hundred warm-heat diseases. If the stifling is slow, it is called "Qingxing Mendou" (mild-type stifled smallpox). If caused by internal obstruction of fire toxin, use Nie Shi Qingjie San (Nie's Clearing-Unblocking Powder) for cooling and penetrating; if constrained externally by wind-cold, use Nie Shi Sujie San (Nie's Eucalyptus Unblocking Powder) for dispersing and unblocking. The manifestations of eruptive smallpox syndromes are listed below:
Manifestations of favorable syndrome: On the first or second day, eruptions appear like millet grains, pale red and moist. Two or three spots initially appear around the mouth, nose, and Nianshou area. By the second or third day, the bases are round, full, and long. By the fourth or fifth day, they are large, round, glossy, and vary in size. By the sixth or seventh day, they are red, vibrant, bright, clean, and full. By the seventh or eighth day, spirit is complete and color is moist. By the ninth or tenth day, the pus is full, the base resolves, and there are no other symptoms. By the eleventh or twelfth day, the pus is full and begins to dry/converge. By the thirteenth or fourteenth day, the pus matures and forms scabs. By the fifteenth or sixteenth day, the scabs fall off, leaving clear marks.
Manifestations of adverse and critical syndromes: Black soot-like discoloration of the nostrils, epistaxis, sore throat, hoarseness, restlessness, mania, tongue protrusion with black prickles, cracked lips, dry skin, swollen eyelids, thirst with preference for cold drinks, foul breath, hot tears with bleeding, profuse watery diarrhea, purulent urine mixed with blood. Smallpox lesions resemble ink sprinkled on vermilion, bursting and bubbling up.
Manifestations of purple depression and black depression: Dense eruptions with red-purple halos, depressed tops, and even dry, withered edges. There may be black umbilici with central depression. Symptoms include coarse breathing, fever, coma, restlessness, and confusion. In severe cases, blood syncope resembling death, mental confusion, and convulsions occur.
Manifestations of mild-type stifled smallpox: Fever for three days, eruptions desire to emerge but do not, eruption shadows are red-purple, voice is loud, breathing is coarse, palms and soles are hot,惊悸 (startle/convulsion), restlessness, or heavy voice, nasal congestion, and runny nose.
Manifestations of severe-type stifled smallpox with excessive toxin and fire closure: Upon fever onset, points appear like cinnabar. Body heat feels like burning iron. Eruptions gradually become dry, scorched, purple, and black. Restlessness, mental confusion, cracked lips, and foul odor occur, or swelling of lips and mouth.
Manifestations of stifled smallpox complicated by food stagnation: At initial onset, high fever, coma, abdominal pain, delirium, tongue prickles like thorns, coarse breathing, constipation, screaming, and mental confusion.
Manifestations of stifled smallpox complicated by phlegm: During fever, inability to lift head and neck, coughing with phlegm, rapid breathing, closed eyes, coma, dizziness, falling, mental confusion, and convulsions.
Manifestations of stifled smallpox complicated by blood stasis: Upon fever and appearance of spots, delirium and coma occur immediately. Symptoms include wheezing, distension, epistaxis,烦闷 (restlessness/oppression), agitation, chest bi (pain/blockage), and purple-dark tongue color.
Manifestations of stifled smallpox complicated by parasites: Upon fever, immediate restlessness and vomiting. Saliva flows constantly under the tongue, or sometimes silence with preference for spitting, or agitation and unrest, or abdominal pain with uncertainty, or frequent screaming. Blue-green veins under the tongue, or black-and-white fine dots on the lower lip.
Manifestations of severe-type stifled smallpox with extreme deficiency of true yuan: Fever for two or three days, eruptions desire to emerge but have not. When spots first appear, they are small and white like millet. No significant body heat. Weak qi and lack of strength. Closed eyes without spirit. Face and lips appear unusually fresh, moist, delicate, and radiant beyond normal.