痘疮一证。由先天伏毒。触后天时行之气而后发。在上古民物贞淳。并无所谓痘疮之说
。至
于后世。乃至人人不免。为婴儿生死一大关头。虽曰天地之气运使然。要亦人事之不古耳。
其候有三。曰顺险逆。辨之有四。曰寒热虚实。盖顺症可不必治自愈。逆症难治难愈。
所宜治者
。惟险症而已。所谓险症者。或由天时不正。或因禀赋素虚。或兼外感。或挟内伤。或将护
失宜。或服药谬妄。率皆人事之不齐。非痘疮之自为险逆也。尝见近日幼科。动称火毒。大
黄
石膏之属。率意轻投。致使脾肾生气大伤。势必毒瓦斯乘虚内陷。冤乎冤乎。此非医为之乎。
且夫痘疮见点之后。毒瓦斯悉已发越在表。最忌攻里。前人戒妄汗妄下。已不胜谆切详尽。何
后人之懵懵也。主治之法。辨列于后。宜详观之。然欲无险逆而求万全。莫如种痘附种痘说
。
表虚之状。初发热时。其热必微。或恶寒。身振振摇动。如疟之状。宜柴葛桂枝汤。加
黄
主之。或寒热往来。四肢厥冷。面色青白。或多汗恶风。或怠惰嗜卧。脉必浮细而弱。宜温
中益气汤。参 内托散。或十宣散之类主之。若初见点便作痒者。宜六气煎。加川芎白芷防
风荆芥。或十宣散之类主之。若表虚不能约束毒瓦斯。以致一齐涌出。颗粒细碎者。实表解毒
汤主之。若表虚无力托送。以致痘出不快者。实表解毒汤。十宣散。保元汤之类主之。若已
见齐。而痘色灰白。顶陷。或伏陷。或不起发。不光泽。或色嫩皮薄。或痒 。或如水泡。
或摸不碍手。或根窠不红。或倒靥。或不能结痂者。脉必细数无力。悉是表虚之候。宜保元
汤。十全大补汤。六气煎之类主之。若已成浆。不因吐泻。而忽见寒战者。表虚甚也。养卫
化毒汤主之。
痘疮这一病症，源于先天潜伏的毒邪，受到后天时行疫气的触发而发病。在上古时代，民风质朴纯真，并没有所谓痘疮的说法。到了后世，以至于人人难免感染，成为决定婴儿生死的关键关头。虽然说是天地气运使然，但也因为人事不如古代（谨慎）罢了。
痘疮的证候分为三类：顺、险、逆。辨别要点有四个方面：寒、热、虚、实。大概顺症可以不必治疗而自愈，逆症难治且难愈。适宜治疗的，只有险症而已。所谓的险症，有的是因为天时不正，有的是因为禀赋素来虚弱，有的兼有外感，有的夹杂内伤，有的是护理不当，有的是用药错误，这些都是人事不齐造成的，并不是痘疮自己变得险恶逆乱。我曾看见近来的儿科医生，动不动就称是火毒，随意轻率地投用大黄、石膏之类的药物，致使脾肾的生气大受损伤，势必导致毒瓦斯乘虚内陷。冤啊冤啊！这难道不是医生造成的吗？
况且痘疮见点之后，毒瓦斯已经完全发散在体表，最忌讳攻里。前人告诫不要妄用发汗和攻下之法，已经不胜恳切详尽，为什么后人还如此懵懂无知呢？主治的方法，辨别列述如下，应当详细观察。然而想要没有险逆而求得万全，不如种痘。（附《种痘说》）。
表虚的症状表现：在刚开始发热时，热度必然轻微，或者怕冷，身体震颤摇动，像疟疾一样的症状。适宜用柴葛桂枝汤加黄芪主之。或者寒热往来，四肢厥冷，面色青白，或者多汗怕风，或者倦怠嗜睡，脉象必然浮细而弱。适宜用温中益气汤、参内托散、或十宣散之类主之。如果初见痘点就开始瘙痒的，适宜用六气煎加川芎、白芷、防风、荆芥，或十宣散之类主之。如果表虚不能约束毒瓦斯，导致一齐涌出，颗粒细碎的，用实表解毒汤主之。如果表虚无力托送，导致痘出不快的，用实表解毒汤、十宣散、保元汤之类主之。如果痘已出齐，但痘色灰白，顶端凹陷，或伏陷，或不隆起，不光泽，或颜色嫩皮薄，或瘙痒，或像水泡，或摸起来不碍手，或根脚不红，或倒靥，或不能结痂的，脉象必然细数无力，全都是表虚的证候。适宜用保元汤、十全大补汤、六气煎之类主之。如果已经成浆，不因吐泻，却忽然出现寒战的，这是表虚非常严重了。用养卫化毒汤主之。
The condition of smallpox arises from latent pathogenic toxins inherent in the congenital constitution, triggered by epidemic qi of the postnatal environment. In ancient times, when people were simple and pure, there was no such concept as smallpox. By later generations, it became unavoidable for everyone, representing a critical juncture between life and death for infants. Although this is attributed to the movement of heaven and earth's qi, it is also due to human affairs not being as prudent as in antiquity.
Its manifestations are categorized into three types: favorable (Shun), dangerous (Xian), and adverse (Ni). Differentiation involves four aspects: cold, heat, deficiency, and excess. Generally, favorable cases may heal without treatment, while adverse cases are difficult to treat and cure. The cases that require treatment are primarily the dangerous ones. Dangerous cases arise either from improper seasonal conditions, innate constitutional deficiency, concurrent external contraction, internal injury, improper nursing care, or erroneous medication. These are all due to inconsistencies in human management, not because smallpox itself becomes inherently dangerous or adverse. I have observed that recent pediatric practitioners often attribute symptoms to "fire toxin," recklessly administering herbs like Radix Rheae Palmatae (Dahuang) and Gypsum Fibrosum (Shigao). This severely damages the vital qi of the Spleen and Kidney, inevitably causing toxic vapors to sink inward through the deficiency. How unjust! Is this not caused by the physician?
Moreover, after the appearance of smallpox spots, the toxic vapors have fully emerged at the exterior; attacking the interior is strictly contraindicated. Predecessors warned against reckless sweating and purging methods with utmost earnestness and detail. Why are later generations so ignorant? The main treatment principles are differentiated and listed below; please observe them carefully. However, to avoid danger and adverse outcomes and seek absolute safety, vaccination is recommended. (See "Discussion on Vaccination").
Manifestations of Exterior Deficiency: At the initial stage of fever, the heat is likely mild, accompanied by aversion to cold, trembling and shaking of the body resembling malaria. Chai Ge Gui Zhi Tang (Bupleurum, Kudzu, and Cinnamon Twig Decoction) added with Radix Astragali Membranacei (Huangqi) is indicated. Alternatively, if there is alternating chills and fever, cold limbs, cyanotic and pale complexion, excessive sweating with aversion to wind, lethargy, and drowsiness, with a pulse that is floating, fine, and weak, Wen Zhong Yi Qi Tang (Warm the Middle and Augment Qi Decoction), Shen Nei Tuo San (Astragalus Interior-Expelling Powder), or Shi Xuan San (Ten Acupoints Powder) are indicated. If itching occurs immediately upon the appearance of spots, Liu Qi Jian (Six Qi Decoction) added with Rhizoma Chuanxiong (Chuanxiong), Radix Angelicae Dahuricae (Baizhi), Radix Saposhnikoviae (Fengfeng), and Herba Schizonepetae (Jingjie), or Shi Xuan San is indicated. If exterior deficiency fails to constrain toxic vapors, causing them to surge out all at once in fragmented granules, Shi Biao Jie Du Tang (Solidify the Exterior and Resolve Toxicity Decoction) is indicated. If exterior deficiency lacks the strength to push forth the eruption, resulting in slow emergence, Shi Biao Jie Du Tang, Shi Xuan San, or Bao Yuan Tang (Protect the Origin Decoction) are indicated. If the eruption is complete but the lesions are grayish-white, depressed at the apex, sunken, non-elevated, lusterless, tender with thin skin, itchy, vesicular, flat to touch, lacking redness at the base, inverted, or unable to form scabs, with a fine, rapid, and forceless pulse, these are all signs of exterior deficiency. Bao Yuan Tang, Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction), or Liu Qi Jian are indicated. If pus has formed, yet sudden rigors occur without vomiting or diarrhea, this indicates severe exterior deficiency. Yang Wei Hua Du Tang (Nourish the Defensive and Transform Toxicity Decoction) is indicated.