痘疮手足和暖为贵。如养浆之时，手足发热而且手足有汗者，此毒热郁于中，必二
便不通而脉沉滑疾数也，治宜利之。若手足厥逆者，此阳气欲脱，脾胃虚弱也，必自吐
利不止而脉沉细微弱也，宜急温之。服药后手足和暖者，生。厥者，死。若大小便闭，
烦燥狂妄，腹胀喘急而渴，脉沉滑数，疮不起者，此有陷伏为阳厥也，宜大泄其毒以主
之。
痘疮每至作脓之时，咳唾痰涎，或有脓血夹杂，咽喉不利，饮食亦少者，此肺受火
邪，津液不足，故多粘痰，喉舌牙齿之间，且兼疮溃于内，故脓血夹杂也，治宜清肺化
痰利咽为主，其收靥之后，则自然平和，不可妄用大凉之剂。
夫痘内之脓，皆身中之血熏蒸而成，故痘疮稠密而脓血周遍者，则津液消耗矣。盖
心主血，血虚则舍空，是以心热而虚烦不得眠也，宜枣仁汤主之。若心虚甚而喜睡，梦
中呢喃，如与人言，其语多怪异之事，唤之不醒者，宜安神丸主之。至如毒攻闷乱，神
亡失志，谵妄不已者，坏症也。
痘有灰白痒塌者、乃气血亏弱而变为虚寒也。盖阳分者，气居之地也。阴分者，血
居之地也。如阳气弱，则陷于阴，阴血盛，则乘于阳，气虚则血进，血虚则气凌，此自
然之理也。其所以痒塌者，盖因血乘气分，血味本盐，淹螫皮肉，是以爬破血流而致
也。然气愈虚，则其痒愈甚，势必气陷而倒塌矣。治此当以保元汤，倍加黄 而助表，
少加芍药以制血，再或随时加减其痒自止矣。更有过食毒物，发动中气，以致津液外
行，发为水泡血泡，气势虚甚无以约制，是以水遗肉分，涩滞难行，不能进退，乃作痒
不止，爬穿皮肉。如汤火泡者有之，此乃不治之症也。然气虚，则为麻为痒为陷，血热
则为干为燥为痛。白者必至于灰，灰者，必至于平伏痒塌，此皆气虚而不起胀，血虚而
不华色，故其治法以大补气血为主。如内热者，少佐清利解毒，使血活气行，则白可变
而为红，苟单补气不补血，则气愈燥热而痒塌益甚矣。故有气失其卫痘自作痒者；有血
不能滋灌，痘痒难释者；有初发而为火痒者；有毒瓦斯暴烈而为恶痒者；有痂落之后，
新血生而为虚痒者，但气血虚寒而作痒者，固自不少气实血热而作痒者，间亦有之。
凡疮一向起发，红活光壮肥满，忽然瘙痒者，此必秽气所触也，宜内服十全大补
汤，外用茵陈熏法。如疮本干枯，又添瘙立痒者，此火甚也。如疮原带水，皮肉嫩薄又
痒者，此经热也。如当起发养浆，因血气不足而肉分空虚者，其痒为虚，通用十全大补
汤加减主之。然症有数端，治有异法。如因不能食淡而致发痒者，则用蝉蜕膏以主之，
疮干而痒者，宜养血润燥，疮湿而痒者，宜养气去湿。实则脉有力而气壮；虚则脉无力
而气馁。实痒则壮热势 ，红紫色燥；虚痒则淡白，势怯身凉。气弱治虚，养以实表、
补中治实，痒以清里解毒。然有痘子成熟，忽作瘙痒抓破者，比脾胃虚弱，不能荣养肌
肉也，宜用四君，内加黄 官桂。如因自利而脾胃虚，以至痒塌者，急进木香异攻散以
救之。因过食毒物而作痒者，则以四君，加解毒之药。凡囊贮半浆而作痒者，犹可参
疗治。若焦贴皮肤者，及空壳莲蒲者，并摆头扭项，手足动作昏闷者，并为死症也。
夫瘙痒而作于灌脓时者，凶者吉少之症也。必须视其所发，观其所因，察其情状，
以施治法，以决生死可也。视其所发者，或发于手足，或发于肩背，拂之则止，禁之则
听者，言若发于正面，瘙痒不止，皮脱肉干者，凶。观其所因者，或因吐泻少食，脾胃
既弱，气血不荣者，虚痒也。可用温补之法，或因秽恶之气，触动邪火者，暴痒也
可用熏解之法，或因痘疮已熟，邪气尽解，正气渐生，气血调和，火微欲退，乃溶溶而
痒者，此美疾也，不须服药。若无所因，自生瘙痒者，原是恶痘，不得善成，察其情状
者。如瘙痒之，时乍作乍止，精神清爽，不自抓搔，欲人抚摩者，生。若抓搔无时，神
志昏沉，胡抓乱舞，摇头扭项者，决死勿治。
痘疮患者手足温暖是吉兆。如果在化脓阶段，手足发热且出汗，这是毒热郁结在体内，必然出现大小便不通、脉象沉滑疾数，治疗应当采用通利的方法。如果手足厥冷（四肢逆冷），这是阳气即将脱失、脾胃虚弱的表现，必然伴有呕吐腹泻不止、脉象沉细微弱，应当紧急使用温补法。服药后手足恢复温暖，预示生机；若持续厥冷，则预后不良。如果大小便闭塞，烦躁狂妄，腹胀喘急且口渴，脉象沉滑数，痘疹不起发，这是毒邪内陷导致的阳厥证，应当大力泄解毒邪来主治。
痘疮每到化脓的时候，咳嗽吐痰涎，或者脓血夹杂，咽喉不利，饮食减少，这是肺受火邪侵袭，津液不足，所以多粘痰，喉舌牙齿之间，兼有痘疮在内溃破，所以脓血夹杂，治疗应当以清肺化痰利咽为主，待痘疮收靥之后，自然平和，不可妄用大寒凉的药物。
痘疮内的脓，都是身体中的血液熏蒸而成，所以痘疮稠密而脓血遍布的，津液就消耗了。心主血，血虚则心舍空虚，因此心热而虚烦不得睡眠，宜用枣仁汤主治。如果心虚严重而嗜睡，梦中胡言乱语，像与人说话，话语多为怪异之事，呼唤不醒的，宜用安神丸主治。至于毒邪攻冲导致闷乱，神志丧失，谵妄不止的，属于坏症。
痘疮出现灰白、瘙痒塌陷的，是气血亏弱变为虚寒所致。阳分，是气居住的地方；阴分，是血居住的地方。如果阳气虚弱，则陷入阴分，阴血盛则乘袭阳分，气虚则血进，血虚则气凌，这是自然的道理。之所以瘙痒塌陷，是因为血乘袭气分，血味本咸，浸渍皮肉，所以抓破流血而导致。然而气越虚，瘙痒越严重，势必气陷而倒塌。治疗此症当用保元汤，加倍加入黄芪以助表气，少加芍药以制约血分，再或随时加减，其痒自止。更有因过食毒物，发动中气，致使津液外行，发为水泡血泡，气势虚弱至极无法约束，所以水湿遗留在肌肉之间，涩滞难行，不能进退，于是作痒不止，抓穿皮肉。如有如汤火烫伤起泡者，这是不治之症。然而气虚，则表现为麻、痒、陷；血热，则表现为干、燥、痛。白色必然发展到灰色，灰色必然发展到平伏瘙痒塌陷，这都是气虚而不能起胀，血虚而不能华色，所以治疗方法以大补气血为主。如果有内热的，稍佐清利解毒，使血活气行，则白色可变为红色，如果只补气不补血，则气更燥热而瘙痒塌陷更严重。所以有气失去卫护功能而痘自作痒的；有血不能滋润灌溉，痘痒难以缓解的；有初发时为火痒的；有毒瓦斯暴烈而为恶痒的；有痂落之后，新血生成而为虚痒的，但气血虚寒而作痒的，固然不少；气实血热而作痒的，间或有之。凡是疮一向起发，红活光壮肥满，忽然瘙痒的，这一定是秽气所触，宜内服十全大补汤，外用茵陈熏法。如果疮本来干枯，又添剧烈瘙痒的，这是火甚。如果疮原带水，皮肉嫩薄又痒的，这是经热。如果正当起发养浆，因血气不足而肌肉空虚的，其痒为虚，通用十全大补汤加减主治。然而病症有多种，治法各异。如因不能食淡而致发痒的，则用蝉蜕膏主治；疮干而痒的，宜养血润燥；疮湿而痒的，宜养气去湿。实证则脉有力而气壮；虚证则脉无力而气馁。实痒则壮热势盛，红紫色燥；虚痒则淡白，势怯身凉。气弱治虚，养以实表；补中治实，痒以清里解毒。然而有痘子成熟，忽然作瘙痒抓破的，比于脾胃虚弱，不能荣养肌肉，宜用四君子汤，内加黄芪、官桂。如因自利而脾胃虚，以至痒塌的，急进木香异功散来救治。因过食毒物而作痒的，则以四君子汤，加解毒之药。凡是囊贮半浆而作痒的，还可以参酌治疗。如果焦贴皮肤者，及空壳莲蒲者，并摆头扭项，手足动作昏闷的，均为死症。夫瘙痒而发生于灌脓时者，凶多吉少的病症。必须视其所发，观其所因，察其情状，以施治法，以决生死即可。视其所发者，或发于手足，或发于肩背，拂之则止，禁之则听者，言若发于正面，瘙痒不止，皮脱肉干者，凶。观其所因者，或因吐泻少食，脾胃既弱，气血不荣者，虚痒也。可用温补之法，或因秽恶之气，触动邪火者，暴痒也，可用熏解之法，或因痘疮已熟，邪气尽解，正气渐生，气血调和，火微欲退，乃溶溶而痒者，此美疾也，不须服药。若无所因，自生瘙痒者，原是恶痘，不得善成，察其情状者。如瘙痒之时乍作乍止，精神清爽，不自抓搔，欲人抚摩者，生。若抓搔无时，神志昏沉，胡抓乱舞，摇头扭项者，决死勿治。
Warm hands and feet are a favorable sign in smallpox. If during the pustule formation stage, the hands and feet are hot and sweating, this indicates toxic heat stagnating internally, inevitably leading to obstruction of urination and defecation, with a deep, slippery, rapid, and frequent pulse. The treatment should focus on promoting the unblocking of these two passages. If there is cold extremities (coldness of the four limbs), this signifies impending collapse of Yang Qi and spleen-stomach deficiency, inevitably accompanied by incessant vomiting and diarrhea, with a deep, fine, minute, and weak pulse; urgent warming therapy is required. If the hands and feet become warm after taking medicine, it indicates survival; if they remain cold, it indicates death. If there is obstruction of urination and defecation, restlessness, delirium, abdominal distension, panting, thirst, a deep, slippery, and rapid pulse, and non-elevated lesions, this is "Yang Jue" caused by toxin sinking inward; heavy purgation to drain toxins is indicated.
During the pus-forming stage of smallpox, if there is coughing with sputum, or sputum mixed with pus and blood, throat discomfort, and reduced appetite, this is due to lung invasion by fire pathogen and insufficiency of body fluids, resulting in sticky phlegm. Since internal ulcers are also present, pus and blood mix. Treatment should primarily focus on clearing the lungs, resolving phlegm, and benefiting the throat. After scabbing falls off, the condition will naturally stabilize; do not recklessly use strong cooling agents.
The pus within smallpox lesions is formed by the steaming of blood in the body. Therefore, when lesions are dense and pus/blood are widespread, body fluids are consumed. The Heart governs blood; blood deficiency leads to an empty Heart residence, causing heart heat, emptiness, irritability, and insomnia. Zao Ren Tang (Semen Ziziphi Jujubae Decoction) is indicated. If Heart deficiency is severe, leading to excessive sleepiness, muttering in dreams as if speaking to others about strange matters, and being unrousable, An Shen Wan (Calming Spirit Pill) is indicated. However, if toxins attack causing mental confusion, loss of spirit and will, and incessant delirium, it is a critical condition (bad syndrome).
Grayish-white, itchy, and collapsed smallpox lesions indicate deficiency and weakness of Qi and Blood transforming into deficiency-cold. The Yang aspect is where Qi resides; the Yin aspect is where Blood resides. When Yang Qi is weak, it sinks into Yin; when Yin Blood is abundant, it invades Yang. Qi deficiency allows Blood to advance; Blood deficiency allows Qi to encroach. This is natural law. The itching and collapsing occur because Blood invades the Qi aspect. Blood has a salty taste, which irritates the skin and flesh, causing scratching, bleeding, and damage. The more deficient the Qi, the more severe the itching, inevitably leading to Qi collapse and lesion flattening. Treatment should use Bao Yuan Tang (Protect the Origin Decoction), doubling the dosage of Huangqi (Astragali Radix) to support the exterior, adding a small amount of Shaoyao (Paeoniae Radix Alba) to restrain Blood, and adjusting according to circumstances to stop itching. Furthermore, overconsumption of toxic foods may stir up Middle Qi, causing body fluids to move outward, forming vesicles or bullae. With extreme Qi deficiency failing to contain them, fluid leaks into muscle layers, becoming stagnant and unable to move forward or backward, causing incessant itching and skin penetration. Some resemble burns/blistering from boiling water, which is an untreatable condition. Generally, Qi deficiency manifests as numbness, itching, and sinking; Blood heat manifests as dryness, roughness, and pain. White lesions must turn gray; gray lesions must flatten, itch, and collapse. These result from Qi deficiency failing to cause elevation and Blood deficiency failing to provide luster. Thus, treatment focuses on greatly tonifying Qi and Blood. If there is internal heat, slightly add clearing, draining, and detoxifying herbs to activate Blood and move Qi, so white can turn red. If only Qi is tonified without nourishing Blood, Qi becomes drier and hotter, worsening itching and collapse. Therefore, some cases involve itching due to Qi losing its protective function; some due to Blood failing to nourish; some initial itching due to fire pathogens; some severe itching due to violent toxic vapors; some post-scab itching due to new Blood generation. Deficiency-cold itching is common, while excess-heat itching is occasional. If lesions that were previously red, vibrant, and full suddenly itch, it is likely triggered by foul air. Internal Shiquan Dabu Tang (Complete Great Tonifying Decoction) and external Artemisiae Scopariae fumigation are indicated. If lesions are originally dry and intensely itchy, Fire is severe. If lesions are watery, thin-skinned, and itchy, it is meridian heat. During elevation and pus formation, if itching is due to Qi/Blood deficiency and empty muscle layers, it is deficiency itching; Shiquan Dabu Tang modified is generally used. Symptoms vary, so treatments differ. Itching due to inability to eat bland food: use Chantui Gao (Cicada Slough Paste). Dry itching: nourish Blood and moisten dryness. Wet itching: nourish Qi and remove dampness. Excess patterns have forceful pulses and robust Qi; deficiency patterns have weak pulses and depleted Qi. Excess itching presents with high fever, red-purple dryness; deficiency itching presents with pale color, weak posture, and cool body. Treat Qi weakness/deficiency by nourishing and solidifying the exterior; treat Spleen/Stomach excess by clearing interior and detoxifying to stop itching. If mature lesions itch and are scratched open due to spleen-stomach weakness failing to nourish muscles, use Sijunzi Tang (Four Gentlemen Decoction) added with Huangqi and Guigui (Cinnamomi Cortex). If diarrhea causes spleen-stomach deficiency leading to itching/collapse, urgently administer Muxiang Yigong San (Costus Root and Mutual Attack Powder). If itching is due to toxic food, use Sijunzi Tang with detoxifying herbs. Lesions half-filled with pus that itch can still be treated. Lesions adhered to skin, empty shells like lotus pods, head shaking, neck twisting, limb movements, and coma are all fatal signs. Itching during pus formation is mostly ominous. One must observe the onset site, etiology, and clinical state to determine treatment and prognosis. Observing onset: If itching stops upon stroking and obeys commands, but facial itching is incessant with skin peeling and flesh drying, it is ominous. Observing etiology: If due to vomiting/diarrhea/poor appetite causing weak spleen/stomach and un-nourished Qi/Blood, it is deficiency itching; use warming tonification. If due to foul air stirring evil fire, it is sudden itching; use fumigation and resolution. If lesions are mature, pathogens cleared, Zheng Qi growing, Qi/Blood harmonious, and mild fire retreating causing gentle itching, it is a good sign requiring no medicine. Spontaneous itching without cause indicates bad smallpox destined for poor outcome. Observing state: If itching comes and goes, spirit is clear, patient does not scratch but desires touch, there is hope. If scratching is constant, spirit is dull, thrashing wildly, head shaking and neck twisting, death is certain; do not treat.