夫痘症热极生风，亦如中风之状，或手足腰项强急，或目视牵引，口张舌强，治宜
俱用参苏饮之类，痘出热解，而风自己，若在起胀成浆之后而见者，则为气血两虚，虚
风内鼓，危之症也，惟峻补气血，或能救之。
腠理者，肺气之门户也。苟为风寒闭塞，则清道不能流通，而施其合矣。是以火
动则热，火郁则寒，寒极则热，热极则寒，然痘未出，而发者为实，此气血旺，而不受
邪触，乃与毒火相争也。若已出之后而发者，则为虚矣。发于毒盛者为邪胜，发于毒
少者为虚，极发结痂之后者为余毒，发于因用毒药太过，而元气虚损者为大逆。七日前
后独热者为痘蒸，是气血与毒俱盛也。十四日后热者，亦为余毒，易治。七日前后独寒
者，是气血亏损，毒火内郁也，难疗。实则发散以清其气道，虚则补益以固其真元，但
补益必须看明，发散切勿过用，若真元一损，则无复有可回之理矣。
痘疮失血者，乃气盛攻毒，为贼邪阻塞清道，热盛火炽，而气与毒相挟交争，血不
能胜，以致错经妄道，涣散无统，是皆气盛于血之患也。毒盛则血热，血热则妄行，治
宜犀角地黄之类。然有从口而出者；有从大小便出者；有从疮毒出者；是皆有犯于内，
皆难治也。惟从鼻出，而得生者，何也？盖为气盛逐血，血载毒奔行周身，传注督脉，
斩关而出，不犯其内，无大害也。故痘之发，虽云气不可弱，然亦不可太盛，太盛则
伤其血。治者安其气位而补血，斯无误矣。若下泻脓血，如死肝豆汁者，是胃烂也，不
治。至于女人经期，先期而治者谓之热，后期而至者谓之寒，此常论也。然经行至久，
并从虚治，参 归芍，补托之剂，在所宜施。如脉虚神倦者，尤宜倍加温补，庶无灰
白之变。
《经》曰∶阳络伤则血外溢，血外溢，则衄血；阴络伤，则血内溢，血内溢，则后
血。痘疹失血者，因疮疹之火熏灼于里，迫血妄行，血亦随火而动耳。若作渴饮冷，手
足并热者，此毒瓦斯炽盛，而上溢也。若作渴饮汤，手足不热者，此脾肺气虚，不能摄
血，而妄行也。若衄血，而右寸脉数者，此肺金受刑而有火者。如吐血，而痘赤作渴发
热者，此胃经热毒也，并宜透托凉血为主。
有因大便干硬燥结，是以微血从粪后而出者，此或因肛门伤损也。如疮已收，而大
便脓血，外候无变者，此毒邪倒靥，正不受邪，而毒从利出也，并为无害。若非此，而
便血淋漓，昏睡不食者，是脏腑败坏，阴血妄行也，必死之候。
夫心主血，而荣于血，痘疮毒瓦斯太盛，则经络壅塞，火毒侵淫，郁成瘀血，于心胁
之间，是以或为心胁痛，其疮灰黑，而烦躁喘渴腹胀矣。或热邪下迫，血随热注，而便
血矣。便后而热减神清痘转者，此热随血解，用犀角地黄主之。如便后而诸症愈甚
者，此邪乘胜正，为不治也。凡便血，而从粪前来者为近血，是大肠积热所致也。从粪
后来者为远血，是胃间积热所致也，皆宜清热固荣为主。若于久泻久利之后者，是脾气
虚寒不能摄血所致也，宜温补，而兼升提。
痘症中热极生风，其症状表现也如同中风一般，有的出现手足、腰项强直拘急，有的出现眼球牵引偏斜、口张舌强，治疗应当全部使用参苏饮之类的方剂。待痘疹发出、热邪解除后，风证自然平息；如果在起胀成浆阶段之后才出现这些症状，则属于气血两虚，虚风内动，这是危重的病症，只有峻补气血，或许还能挽救。
腠理，是肺气出入的门户。如果因风寒闭塞腠理，那么清肃之道就不能通畅流通，从而使得气机郁滞。因此，火气发动则表现为热，火气郁结则表现为寒，寒极则转化为热，热极则转化为寒。然而，在痘疹未发出之前出现的发热，属于实证，这是因为气血旺盛，不受外邪侵袭，而是与体内的毒火相互抗争所致。若痘疹已发出之后才出现发热，则属于虚证。发热是由于毒邪炽盛引起的，称为邪胜；发热是由于毒邪较少引起的，称为正虚；发热出现在结痂之后的，称为余毒；发热是因为使用了过于猛烈的药物导致元气虚损的，称为大逆之证。痘疹发出前后七天独自发热的，称为“痘蒸”，这是气血与毒邪都旺盛的表现。十四日后仍有发热的，也是余毒作祟，容易治疗。痘疹发出前后七天独自发冷的，这是气血亏损、毒火内郁的表现，难以治疗。对于实证，采用发散的方法来清除气道中的邪气；对于虚证，采用补益的方法来巩固真元。但是，补益必须仔细辨明，发散切勿过度使用，如果真元一旦受损，就没有再能挽回的道理了。
痘疮出现失血的情况，是因为气盛攻伐毒邪，被贼邪阻塞了清道，导致热盛火炽，气与毒相互挟持交争，血液不能胜任，以致血脉错乱妄行，涣散无统摄，这都是气盛于血的祸患。毒邪炽盛则血热，血热则血液妄行，治疗宜用犀角地黄汤之类的方剂。然而，出血有的从口中吐出，有的从小便或大便排出，有的从疮疡溃破处流出，这些都是病邪侵犯内脏的表现，都属于难治之症。唯有从鼻出血而能够生存的，为什么呢？这是因为气盛推动血液，血液携带毒邪奔行于周身，传导注入督脉，冲破关隘而出，没有侵犯内脏，所以没有大的危害。因此，痘疹发作时，虽然常说气不可虚弱，但也不可太过亢盛，太过亢盛会损伤血液。治疗者安定气的位置并补充血液，就不会有误诊误治。如果出现下泻脓血，状如死肝豆汁，这是胃腑腐烂的表现，无法治疗。至于女性经期，提前来潮的称为热证，推后而至的称为寒证，这是一般的常论。然而月经行经时间过长，都应当从虚证论治，使用人参、当归、白芍等组成的补托方剂，是在所应当施用的。如果脉象虚弱、精神疲倦的，尤其应当加倍使用温补之法，这样才能避免病情恶化转为灰白（指痘色转败）的变化。
《黄帝内经》说：阳络受伤则血液外溢，血液外溢，则发生鼻衄（鼻出血）；阴络受伤，则血液内溢，血液内溢，则发生便血（后血）。痘疹失血的原因，是因为疮疹的火毒熏灼于体内，逼迫血液妄行，血液也随之火性而动。如果口渴想喝冷水，手足都发热，这是毒瓦斯炽盛，向上溢出所致。如果口渴想喝热水，手足不发热，这是脾肺气虚，不能固摄血液，导致血液妄行所致。如果发生鼻衄，且右寸脉数，这是肺金受刑而有火邪。如果出现吐血，且痘色红赤、口渴发热，这是胃经的热毒所致，都应当以透托解毒、凉血止血为主。
有因为大便干硬燥结，导致少量血液在大便之后排出的，这可能是因为肛门损伤所致。如果疮疡已经收敛，却出现大便脓血，而外部征候没有变化的，这是毒邪内陷（倒靥），正气不受邪侵，而毒邪从利下排出，这并无大害。如果不是这种情况，而是便血淋漓不止，伴有昏睡、不思饮食的，这是脏腑败坏，阴血妄行，是必死的征候。
心主司血液，并滋养血液。痘疮毒瓦斯太盛，会导致经络壅塞，火毒浸淫，郁结形成瘀血，停留在心胁之间，因此有时会出现心胁疼痛，疮色灰黑，并伴有烦躁、气喘、口渴、腹胀等症状。或者热邪向下逼迫，血液随热下行，从而导致便血。便血之后热势减退、神志清醒、痘疹好转的，这是热随血解，应用犀角地黄汤为主进行治疗。如果便血之后各种症状反而加重，这是邪气乘胜正气衰弱，属于不治之症。凡是便血，血液混在大便前面的称为近血，是大肠积热所致；血液混在大便后面的称为远血，是胃间积热所致，都应当以清热固护营血为主。如果在久泻久痢之后出现便血，这是脾气虚寒不能固摄血液所致，应当使用温补兼升提的方法。
In variola (smallpox), extreme heat generates wind, presenting similarly to stroke (Zhong Feng). Some patients exhibit stiffness and tension in the limbs, waist, and neck; some show eye deviation and traction, open mouth, and stiff tongue. Treatment should uniformly employ formulas such as Rensu Yin (Ginseng and Perilla Decoction). Once the pustules erupt and the heat resolves, the wind syndrome subsides spontaneously. However, if these symptoms appear after the stage of swelling and pus formation, it indicates deficiency of both Qi and Blood with internal stirring of deficient wind, which is a critical condition. Only vigorous tonification of Qi and Blood may offer a chance of rescue.
The Couli (interstices/skin pores) are the gateways of Lung Qi. If obstructed by Wind-Cold, the clear pathways cannot circulate freely, leading to stagnation. Thus, when Fire moves, Heat manifests; when Fire is constrained, Cold manifests; extreme Cold transforms into Heat, and extreme Heat transforms into Cold. However, fever occurring before the eruption of variola is Excess, resulting from robust Qi and Blood resisting invasion by pathogens and contending with toxic fire. Fever appearing after eruption is Deficiency. Fever caused by abundant toxin is "Pathogen Excess"; fever caused by scanty toxin is "Deficiency"; fever appearing after scabbing is "Residual Toxin"; and fever due to excessive use of harsh drugs damaging Yuan Qi is "Great Reversal" (Da Ni). Isolated fever around the seventh day is called "Variola Steaming" (Dou Zheng), indicating both Qi/Blood and Toxin are abundant. Fever persisting after the fourteenth day is also residual toxin, which is easy to treat. Isolated coldness around the seventh day indicates Qi and Blood depletion with internal constraint of toxic fire, which is difficult to treat. For Excess patterns, dispersing methods clear the airways; for Deficiency patterns, tonifying methods secure the True Yuan. Tonification must be precise, and dispersing methods must not be overused. If True Yuan is damaged, recovery is impossible.
Hemorrhage in variola occurs because abundant Qi attacks the toxin, but is blocked by pathogenic factors in the clear pathways. Extreme heat and blazing fire cause Qi and Toxin to contend together, overwhelming the Blood, leading to chaotic vessel flow and uncontrolled bleeding. This is a pathology of Qi exceeding Blood. Abundant toxin causes Blood Heat, and Blood Heat leads to reckless bleeding. Treatment should employ formulas like Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). Hemorrhage may occur from the mouth, from urination/defecation, or from ulcerated sores; all indicate internal involvement and are difficult to treat. Survival is possible only with epistaxis (nosebleed). Why? Because abundant Qi drives the Blood, which carries the toxin throughout the body, transmitting through the Du Mai (Governing Vessel), breaking through barriers to exit externally without invading the interior, thus causing no major harm. Therefore, while Qi should not be weak during variola eruption, it should not be excessively strong, as excess damages Blood. Treatment should stabilize Qi position and nourish Blood to avoid error. Purulent bloody diarrhea resembling dead liver or bean juice indicates rotting of the Stomach, which is incurable. Regarding menstruation, early onset is termed Heat, and late onset is termed Cold, according to general principles. However, prolonged menstrual flow should always be treated as Deficiency using tonifying and supporting agents containing Ginseng, Angelica Sinensis, and Paeonia Lactiflora. In cases of weak pulse and mental fatigue, warming and tonifying measures should be doubled to prevent deterioration into grayish-white lesions (indicating failure of the rash).
The Classic states: Injury to Yang collaterals causes external blood overflow, resulting in epistaxis; injury to Yin collaterals causes internal blood overflow, resulting in hematochezia/melena. Hemorrhage in variola/rash is due to internal burning by rash-fire forcing Blood to move recklessly with the Fire. Thirst for cold drinks with hot hands and feet indicates blazing toxic Qi overflowing upward. Thirst for warm drinks with cool hands and feet indicates Spleen and Lung Qi deficiency failing to control Blood. Epistaxis with a rapid Right Cun pulse indicates Lung Metal受刑 (injured by Fire) with internal Heat. Hematemesis with red rashes, thirst, and fever indicates Stomach Meridian toxic Heat. Both should be treated primarily with resolving/toxic-clearing and cooling-blood methods.
Dry, hard stool causing slight bleeding after defecation is often due to anal injury. If sores have healed but bloody purulent stool appears without external changes, it indicates inverted sores where正气 (Righteous Qi) repels pathogens, and toxins exit via bowels; this is harmless. Conversely, continuous bloody diarrhea with lethargy and anorexia indicates organ failure and reckless Yin Blood loss, a fatal sign.
The Heart governs Blood and nourishes it. Excessive toxic Qi in variola blocks meridians, allowing fire-toxin to invade and stagnate into Blood stasis between the heart and hypochondrium, causing chest/hypochondriac pain, gray-black sores, irritability, panting, thirst, and abdominal distension. Alternatively, downward-pushing Heat forces Blood into the bowels, causing hematochezia. If heat subsides, spirit clears, and rashes improve after bleeding, Heat has resolved with Blood; treat with Xijiao Dihuang Tang. If symptoms worsen after bleeding, Pathogen overwhelms Righteous Qi, which is incurable. Blood preceding stool is "Near Blood" from Large Intestine Heat; blood following stool is "Distant Blood" from Stomach Heat. Both require clearing Heat and securing Ying Blood. Post-prolonged diarrhea/flux bleeding indicates Spleen Qi deficiency-cold failing to control Blood; treat with warming, tonifying, and lifting methods.