夫痘由中而达外，用药因期而变通，以常而言之，则发热三日，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，其发热三日当托里解表，使其易出，亦有气弱而不能出者，
当微补其气，气和则出快矣。但初不可用 ，恐腠理一密，其痘难出也。四五六日以清凉解毒为主，清
凉则无血热枯肠之患，解毒则无壅滞黑陷之危，惟有气虚症候者，当清凉解毒，又所当忌，以杜泻泄
毒伏之虞，七八九日以灌脓为主，治法当温补气血，气血流行而成浆自易，若有不能行浆者，是必气
弱血枯，或气涩血滞，腠理固密，故即精气虽盛，不易疏通，所以有是患也，宜外用水杨汤法，而内
以宣血补血行气补气之药可也。然凡灌脓，固宜温补，以助其浆，惟症原由血热脚地，势虽稍得清解，
苟遽大用参 温补之法，则又恐依然血热，而非所治矣。此仅可于催浆之品剂中略与清凉解毒之味，
则血热之势自清，囊房之脓且可得而灌也。但太凉则冰血而毒凝滞，故曰中病即止，无过其制。则于
十一二日以收敛为主，大和气血，补脾利水，则自然结靥矣。此特语其常也。然长者可必，当随候参
详。安可执一应无穷之变哉！如见红点之时，痘势轻少、不可过表在后，恐成斑烂，倘遇干红紫色，
宜急疏利，不然在后必成黑陷，四五日内，痘出至足下为齐，苟未尽出，则于解毒药中，宜兼发
表，若专于寒凉，则痘迟滞不出，七八日之间，毒未尽解，则于温补之中，又兼解毒，
若偏于温益，则毒愈盛，不能化浆，十一二日之间，浆未满足，必大补气血，略兼解余
毒，否则恐有痈毒疤痕之患，然凡用寒宜远寒，用热宜远热，毋太过毋不及，此治之
要，理之常也。但发表不远热，攻里不远寒。盖热则行而寒则凝，苦则泻而甘则缓，
此治之权，理之变也，变通之妙，要在随时制宜，如《经》曰∶“春夏养阳，秋冬养
阴”，此皆因时寒暖也。又有曰∶时在春夏，天气主之。治在心肺，心肺之药宜多芩连荆
防之属；时在秋冬，地气主之，治在肝肾，肝肾之药，宜多丁桂姜附之属，是虽不可尽
准，实亦弗犯天和之意也。
痘疮是由体内毒邪向外透发的过程，用药需根据病程阶段灵活变通。按常规情况而言，发热三天后，痘疹应全部透出；再经三天，痘粒开始隆起充胀；再经三天，脓浆灌满；再经三天，痘痂收敛脱落。在发热的三天里，治疗应以托里解表为主，促使痘疹容易透出。也有因气虚而不能透出的，应当轻微补益其气，气机调和则痘疹出得迅速。但初期不可过度使用收敛固涩之药，恐怕腠理一旦密闭，痘疹就难以透出了。第四、五、六天以清凉解毒为主，清凉则可避免血热导致肠道干枯的祸患，解毒则可避免毒邪壅滞、痘色黑陷的危险。只有出现气虚症状的患者，在使用清凉解毒法时应当忌讳，以防发生泄泻和毒邪内伏的忧虑。第七、八、九天以灌脓为主，治法应当温补气血，气血流通则化生脓浆自然容易。如果有不能行浆的情况，这必然是气弱血枯，或者气涩血滞，腠理固密，所以即使精气旺盛，也不易疏通，因此会出现这种病患。适宜外用“水杨汤”法，内服宣血补血、行气补气药物。然而凡是灌脓阶段，固然适宜温补以助成脓浆，但若病症原本源于血热，病情虽然稍得清解，如果骤然大量使用人参等温补之法，又恐怕依然导致血热，这就不是正确的治疗方法了。这种情况仅可在催浆的药剂中略微加入清凉解毒的药物，则血热的势头自然清除，痘囊中的脓浆便可灌满。但如果过于寒凉，则会冰伏血液使毒邪凝滞，所以说中病即止，不要超过限度。到了第十一、十二天，以收敛为主，大调气血，补脾利水，则自然结痂脱落。以上只是讲述常法。然而长幼体质不同，应当随证候详细参详分析。怎么可以拘执一种方法去应对无穷的变化呢！如见到红点之时，若痘势轻少，不可过度发表在后，恐怕形成斑烂；倘若遇到干红紫色的痘疹，应当紧急疏利通便，不然到后来必然变成黑陷。四五天之内，痘疹出至足下才算齐备，假如未尽出，则在解毒药中，应当兼用发表药，若专于寒凉，则痘疹迟滞不出。七八日之间，毒邪未尽解除，则在温补之中，又当兼用解毒药，若偏于温补益气，则毒邪更盛，不能化生脓浆。十一二日之间，脓浆未满足，必须大补气血，略微兼解余毒，否则恐怕有痈毒疤痕的隐患。然而凡是用寒凉药宜远离极寒，用温热药宜远离极热，不要太过也不要不及，这是治疗的要点，是常理。但发表不宜远离温热，攻里不宜远离寒凉。因为温热则气血运行而寒凉则凝滞，苦味则泻下而甘味则缓急，这是治疗的权变，是理的变化。变通的奥妙，关键在于随时制宜。如《内经》所说：“春夏养阳，秋冬养阴”，这都是顺应时节寒暖的道理。又有说法：时在春夏，天气主导，治疗在心肺，心肺的药宜多用黄芩、黄连、荆芥、防风之类；时在秋冬，地气主导，治疗在肝肾，肝肾的药宜多用丁香、肉桂、干姜、附子之类，这虽然不能完全照搬，实则也不违背天和之意。
Smallpox erupts from the interior to the exterior, and medication must be adjusted according to the stage of the disease. Generally speaking, after three days of fever, the rash should fully emerge; after another three days, the pustules begin to swell and rise; after another three days, the pus fills completely; and after another three days, the scabs contract and fall off. During the initial three days of fever, treatment should focus on supporting the interior and releasing the exterior (Tuo Li Jie Biao) to facilitate eruption. There are cases where Qi deficiency prevents eruption; in such instances, slight tonification of Qi is required, so that harmonized Qi leads to rapid eruption. However, astringent agents should not be used excessively in the early stage, lest the interstices (Cou Li) become closed, making eruption difficult. From the fourth to sixth day, the primary approach is cooling and detoxifying (Qing Liang Jie Du). Cooling prevents complications such as intestinal dryness due to blood heat, while detoxifying avoids dangers like toxin stagnation and black depression (Hei Xian). For patients presenting with Qi deficiency symptoms, cooling and detoxifying methods should be avoided to prevent diarrhea and internal retention of toxins. From the seventh to ninth day, the focus is on filling the pustules with pus. The treatment method should involve warming and tonifying Qi and Blood. When Qi and Blood circulate freely, the formation of pus becomes easy. If pus fails to form, it is necessarily due to weak Qi and depleted Blood, or stagnant Qi and sluggish Blood, combined with tight interstices. Thus, even if Essence and Qi are abundant, they cannot circulate smoothly, leading to this condition. External application of "Shuiyang Decoction" (Water Willow Soup) is appropriate, along with internal administration of herbs that promote blood circulation, nourish blood, move Qi, and tonify Qi. However, although warming and tonifying are suitable during the pus-filling stage to assist pus formation, if the underlying pathology originates from blood heat, and although the condition may have slightly improved with clearing and resolving, sudden heavy use of warming tonics like Ginseng (Renshen) may exacerbate blood heat, which is incorrect therapy. In such cases, only slight additions of cooling and detoxifying herbs to the pus-promoting formula can clear the blood heat trend, allowing the pustule sacs to fill with pus. However, excessive coldness will freeze the blood and cause toxin stagnation; therefore, one must stop when the disease is addressed and not exceed the proper limits. By the eleventh and twelfth days, the focus shifts to contraction and healing. Harmonizing Qi and Blood, tonifying the Spleen, and promoting water metabolism will naturally lead to scabbing. This describes the general rule. However, variations exist based on age and constitution, requiring detailed analysis of specific signs. One cannot rigidly apply a single method to infinite variations! When red spots appear, if the smallpox severity is mild, excessive external-releasing measures later should be avoided to prevent ulceration. If dry, red-purple rashes are encountered, urgent purgation and unblocking are necessary; otherwise, black depression will occur later. Within four to five days, eruption reaching the soles indicates completion. If not fully erupted, external-releasing herbs should be added to detoxifying formulas. Relying solely on cold-natured herbs causes delayed eruption. Between the seventh and eighth days, if toxins are not fully resolved, detoxifying herbs should be added to warming tonics. Bias towards warming tonics may intensify toxins, preventing pus formation. Between the eleventh and twelfth days, if pus is insufficient, strong tonification of Qi and Blood with slight residual detoxification is required; otherwise, abscesses and scars may result. Generally, when using cold herbs, avoid extreme cold; when using hot herbs, avoid extreme heat. Neither excess nor deficiency is desired. This is the essential principle and constant law. However, for releasing the exterior, warmth should not be far removed; for attacking the interior, coldness should not be far removed. Heat promotes circulation while cold causes stagnation; bitter flavors purge while sweet flavors moderate. These represent therapeutic flexibility and variable principles. The subtlety of adaptation lies in adjusting to circumstances. As stated in the *Classic* (*Jing*): "Nourish Yang in Spring and Summer, Nourish Yin in Autumn and Winter," adapting to seasonal temperature changes. It is also said: In Spring and Summer, Heaven's Qi dominates; treatment targets the Heart and Lungs, utilizing herbs like Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Schizonepetae Herba (Jingjie), and Saposhnikoviae Radix (Fangfeng). In Autumn and Winter, Earth's Qi dominates; treatment targets the Liver and Kidneys, utilizing herbs like Caryophylli Flos (Dingxiang), Cinnamomi Cortex (Guirou), Zingiberis Rhizoma (Shengjiang), and Aconiti Lateralis Radix Praeparata (Fuzi). While these guidelines are not absolute, they align with the intent of preserving Heavenly Harmony.