夫痘由中以达外。用药因期而变通。以常言之。发热三日而后见标。出齐三日而后起胀。蒸
长三日而后灌脓。浆满三日而后收靥。故发热三日。当托里解毒。使其易出。亦有气弱而不能出
者。当微补其气。气和则出快。切不可轻用黄 。恐腠理一密。则痘难出也。四五六日起发之时。
宜清热解毒。清热则无血热枯燥之患。解毒则无壅滞黑陷之虞。七八九日灌脓之时。宜温补气血。
气血流行。而成浆自易也。十日至十一二日收靥之时。宜调和气血。补脾利水。自然结靥矣。此
特语其常也。盖常者可必。而变幻无期。当随候参详。见红点之时。如痘轻少。不可过表。在后
恐成斑烂。如干红紫色。急宜疏利。不然。在后必成黑陷。四五日之内。痘出足下为齐。苟未尽
出。于解毒中宜兼发散。若专于清凉。则痘反凝滞。不能起发也。七八日之间。毒未尽解。于温
补之中。宜兼解毒。若偏于温燥。则毒反蕴蓄。不能化浆也。十一二日之间。浆未满足。虽当大
补气血。然须兼解余毒。不然。恐有痈毒 疤之患也。夫痘疮之发也。身热和缓。达于外者必轻。
闷乱烦躁。彰于外者必重。其颜色贵润泽而嫌昏暗。贵光彩而嫌枯涩。贵淡红而嫌黑滞。贵鲜洁
而嫌娇嫩。贵圆净而嫌琐碎。贵高耸而嫌平塌。其皮肤贵坚实而嫌虚薄。贵匀净而嫌冗杂。其根
窠贵收紧而嫌散润。痘根阴阳见点。最忌浮肿。出要参差。血宜归附。耳后头项心胸。少于他处
为吉。眉棱两颧额前先后润而不滞为
佳。夫色之红者。毒始出也。白者。毒未解也。黄者。毒将解也。干黄者。毒尽解也。灰白者。
血衰而气滞也。焦褐者。气滞而血枯也。黑者。毒滞而血干也。如红变白。白变黄者吉。红变紫。
紫变黑者。死之兆也。
Smallpox pathogens emerge from the interior to the exterior. Medication must be adjusted flexibly according to the stages of the disease course. Generally speaking, after three days of fever, the rash begins to appear (Jianbiao); three days after full eruption, it begins to swell and rise (Qizhang); three days of steaming and growth lead to suppuration (Guannong); and three days after the pustules are full, scabbing occurs (Shouye). Therefore, during the three-day fever stage, one should employ methods to support the interior and resolve toxicity (Tuoli Jiedu) to facilitate easy eruption. In cases where Qi deficiency prevents eruption, slight tonification of Qi is necessary; when Qi harmonizes, eruption proceeds rapidly. One must not lightly use bitter-cold herbs like Huangqin (Scutellariae Radix), lest they cause the pores (Couli) to close tightly, thereby hindering eruption. During the fourth to sixth days, when the rash is rising, clearing heat and resolving toxicity (Qingre Jiedu) is appropriate. Clearing heat avoids the hazard of blood-heat dryness, while resolving toxicity prevents the risk of stagnation and black depression (Heixian). During the seventh to ninth days, when suppuration occurs, warming and tonifying Qi and Blood (Wenbu Qixue) is indicated; with smooth circulation of Qi and Blood, pus formation becomes easier. From the tenth to eleventh-twelfth days, during the scabbing phase, harmonizing Qi and Blood, tonifying the Spleen, and promoting water metabolism (Bupi Lishui) naturally leads to scabbing. This describes only the regular pattern. Regular patterns are predictable, but changes are unpredictable; thus, one must analyze based on specific manifestations. When red spots appear, if the rash is mild and sparse, excessive dispersing and releasing the exterior (Guobiao) should be avoided, as it may lead to ulceration later. If the color is dry red or purple, urgent疏导 and purgation (Shuli) is required; otherwise, black depression will inevitably occur. Within four to five days, if the rash has not fully covered the body, dispersing methods should be combined with toxicity resolution. If purely cooling agents are used, the rash may become stagnant and fail to rise. Between seven and eight days, if toxins are not fully resolved, detoxification should be combined with warming and tonification. If overly warm and drying agents are used, toxins may accumulate and fail to transform into pus. Between eleven and twelve days, if the pustules are not full, although substantial tonification of Qi and Blood is needed, residual toxins must also be cleared; otherwise, there is a risk of abscesses and scarring. Regarding the eruption of smallpox: mild fever that manifests externally indicates a light condition; mental restlessness and irritability manifesting externally indicate a severe condition. The color should be moist and lustrous, avoiding dullness; bright and radiant, avoiding withered and rough textures; pale red, avoiding black stagnation; fresh and clean, avoiding delicate and tender appearances; round and pure, avoiding fragmented and messy shapes; high and protruding, avoiding flat and collapsed forms. The skin should be firm and solid, avoiding thin and weak qualities; even and clean, avoiding mixed and chaotic patterns. The base of the lesion (Genke) should be tight and contracted, avoiding loose and moist characteristics. Initial appearance of Yin-Yang points in the rash most strongly contraindicates edema. Eruption should be uneven, and blood should adhere properly. Scarcity of lesions behind the ears, on the head/neck, chest, and heart is auspicious. Moisture without stagnation in the brow ridge, cheeks, and forehead, appearing sequentially, is ideal. Red color indicates initial toxin emergence; white indicates unresolved toxins; yellow indicates impending toxin resolution; dry yellow indicates complete toxin resolution; gray-white indicates blood deficiency and Qi stagnation; scorched brown indicates Qi stagnation and blood exhaustion; black indicates toxin stagnation and blood dryness. Transformation from red to white, or white to yellow, is auspicious. Transformation from red to purple, or purple to black, is an omen of death.