里虚之状。或因先病吐泻或因误服寒凉之剂。或痘疮已出未出之间。而为吐泻呕恶。精
神
倦怠。喜热饮食者。宜六君子汤。五君子煎。理中汤。参姜饮之类主之。若少食。或不思食
。
或食亦不化。此脾胃之气虚也。宜五味异功散。四君子汤之类主之。若二便清利。或溏泄不
渴。或气促声微。或神昏多睡。或腹膨嗳气。吞酸。脉见弱而无力者。宜人参理中汤。保元
汤。六气煎之类主之。若痘未出。发热之初。而见吐泻一二次即止者。其痘出必轻。不必治
之。此又不可不知也。要之痘疮全赖里气完固。若里气虚损。则生机息矣。喜用石膏大黄者
。吾诚不知其为何心也。
里实之状。二便秘结。胸膈胀满。作渴喜冷。或唇燥咽干。口疮舌黑。脉见沉数有力。
痘形
未见之时。宜微下之。四顺清凉饮。当归丸之类。少少与之。若肢体热甚。柴胡饮子。若烦
躁惊狂。声高谵语。脉见洪滑者。辰砂六一散。退火丹。导赤散之类主之。若痘已隐隐见
于皮肤之间。此痘已发越在表。若里症果急。宜微通其二便。断不可过用攻里之剂也
。若妄下之。必致里虚而变内陷矣。慎之慎之。要之近日属实之症不多。若妄用之。则大误
矣。且痘疮最喜里气完实。自必能食。虽兼他症。以末治之可也。
里虚的证候表现。可能是因为先前患病出现呕吐腹泻，或者误服了寒凉性质的药物，或者是痘疮已经发出或尚未发出的阶段，出现了呕吐、腹泻、恶心等症状，精神疲倦乏力，喜欢热饮食的人，适宜使用六君子汤、五君子煎、理中汤、参姜饮这类方剂来主治。如果吃得很少，或者不想吃东西，或者吃了食物也不能消化，这是脾胃之气虚弱，适宜使用五味异功散、四君子汤这类方剂来主治。如果大小便清利通畅，或者大便稀溏且不口渴，或者气短声音微弱，或者神志昏沉嗜睡，或者腹部胀大嗳气、吞酸，脉象表现为弱而无力的人，适宜使用人参理中汤、保元汤、六气煎这类方剂来主治。如果痘疮尚未发出，在发热初期，出现一两次呕吐腹泻随即停止的，其痘疹发出后病情必然较轻，不需要专门治疗，这一点也是不可不知道的。总之，痘疮完全依赖体内正气（里气）的完固，如果体内正气虚损，那么生机就会断绝。那些喜欢使用石膏、大黄的人，我实在不知道他们是什么用心。
里实的证候表现。大小便秘结不通，胸膈部位胀满，感到口渴且喜欢冷饮，或者嘴唇干燥咽喉干涩，口腔生疮舌头变黑，脉象表现为沉数且有力。在痘形尚未显现的时候，适宜轻微通下，使用四顺清凉饮、当归丸这类方剂，少量给予。如果肢体发热严重，使用柴胡饮子。如果出现烦躁惊狂，声音高亢说胡话，脉象表现为洪滑的人，适宜使用辰砂六一散、退火丹、导赤散这类方剂来主治。如果痘疹已经在皮肤之间隐约可见，这说明痘毒已经发越于体表，如果里证确实紧急，适宜轻微通利其二便，绝对不可以过度使用攻逐里实的药剂。如果妄自使用泻下法，必定导致里气虚弱而使病邪内陷，务必谨慎再谨慎。总之，近期属于实证的病症并不多见，如果妄用攻下之法，那就是大大的错误了。而且痘疮最喜欢体内正气充实完备，自然能够进食，即使兼有其他症状，也可以从次要方面进行治疗即可。
Manifestations of Interior Deficiency. These may arise from prior illness involving vomiting and diarrhea, or from the mistaken administration of cold-natured medicines, or during the stage when variola (smallpox) has erupted or is yet to erupt, presenting with vomiting, diarrhea, nausea, mental fatigue, and a preference for hot drinks. In such cases, Liu Junzi Tang (Six Gentlemen Decoction), Wu Junzi Jian (Five Gentlemen Decoction), Lizhong Tang (Regulate the Middle Decoction), or Shengjiang Yin (Ginger Drink) should be used. If the patient eats little, lacks appetite, or cannot digest food after eating, this indicates deficiency of Spleen and Stomach Qi. Wuyi Yigong San (Five-Ingredient Efficacy-Enhancing Powder) or Sijunzi Tang (Four Gentlemen Decoction) are appropriate. If urination and defecation are clear and free, or if there is loose stool without thirst, shortness of breath with a faint voice, lethargy and excessive sleep, abdominal distension with belching and acid regurgitation, and a weak and powerless pulse, Ren Shen Lizhong Tang (Ginseng Regulate-the-Middle Decoction), Baoyuan Tang (Protect the Origin Decoction), or Liuqi Jian (Six Qi Decoction) should be employed. If the rash has not yet appeared, and vomiting and diarrhea occur only once or twice at the initial stage of fever before stopping spontaneously, the eruption will likely be mild; no specific treatment is required, a point that must not be overlooked. Essentially, the recovery from variola relies entirely on the integrity of the Interior Qi. If the Interior Qi is deficient, vital energy ceases. I truly do not understand the intent of those who favor the use of Shigao (Gypsum Fibrosum) and Dahuang (Rhei Radix et Rhizoma).
Manifestations of Interior Excess. Constipation of both bowel and bladder, chest and diaphragm fullness and distension, thirst with a preference for cold drinks, dry lips and throat, oral ulcers, black tongue, and a deep, rapid, and forceful pulse. When the rash pattern has not yet manifested, a mild purgative approach is indicated. Sixun Qingliang Yin (Four-Oriented Cooling Decoction) or Danggui Wan (Angelica Pill) should be administered in small amounts. If limb heat is severe, Chaihu Yinzi (Bupleurum Decoction) is suitable. For restlessness,惊狂 (frightened mania), loud voice, and delirious speech with a surging and slippery pulse, Chen Sha Liuyi San (Cinnabar Six-One Powder), Tuihuo Dan (Fire-Removing Pellet), or Daochi San (Directing Red Powder) should be used. If the rash is already faintly visible on the skin, it indicates that the pathogen has been vented to the Exterior. If the Interior syndrome is indeed urgent, mild unblocking of the bowels and bladder is appropriate; however, one must absolutely avoid overusing interior-purging agents. Reckless purgation will inevitably lead to Interior Deficiency and internal collapse of the pathogen. Exercise extreme caution. In recent times, true Excess syndromes are rare; reckless use of purgatives would be a major error. Moreover, variola thrives when the Interior Qi is solid and complete, allowing for normal appetite. Even if other symptoms coexist, they can be treated as secondary concerns.