初发悠悠身热，尤宜气息和平，二便自调，面容不改，兼之睡卧安宁，见点尖红光
润，饮食如常，便见症来顺候。初热而吐泻腹痛，昏迷而不省人事，闷乱喘急，或连热
齐敷，色不光润，及紫泡黑陷，固已皆为逆症，更如肌色青而 白，精神少而倦怠，
视此当作虚看，痘出决然不振，再见便痛 乳，只须补益为先。若还热盛而气粗。
烦躁而不宁，谵语狂言，均为内热。如加喘满，腹膨HT 便秘，须知热拥，肌肤燥而毛
色焦，口气热而身燔灼，此则蓄热郁遏，内症固重而外症尤烈，腹胀口张而喘急，啼声
不绝而嘎嘎，五窍不通，须防失血。点来隐隐，出恐复颠，吐乳更兼搭眼，面青又见摇
头，狂乱忽生，此乃发惊先兆，然热甚者，只宜清凉发散，不可峻用苦寒，发散则毒得
外出，而热自解。若寒则毒反冰伏而出愈难，其发散之剂轻则如升麻，干葛以疏其
热，则烦燥壮盛者，非此何以定其标！重则有麻黄、桂枝以开其壅，则喘急腹胀者，非
此何以救其危！未萌先泄，有热症莫作虚看，无热症便为虚论。热泻投以清凉，更加
发散，虚溏投以温补，仍佐开提，内虚误用寒凉，不特助伊芳作泻，实热如投补剂，必致
转增烦剧，安静而能食，勿谓便实而可下，泄泻而烦渴，莫言热症以投凉。
痘之为候，必先火热如烙，然后痘暴于外，盖天地化育万物，虽赖土以生患，然土
发育而无火，则偃匿而不克振，故也。人身一小天地，故痘若不壮热熏蒸，焉能振援于
外，发泄其肾窖之枭郁哉！故曰∶五谷不热不秀，实痘疹不热不透彻，彻则肌松窍利，
痘出粗肥，匀净而无细密连片之虚，但太过者，则真元耗烁，以有限之血，抵无涯之
火。鼎沸于内，轻变重，重变危矣。然有当热者。如痘未出之前，宜大热以逐其毒。若
反头温足冷，则毒不能发越在外，反致内溃而死矣。不当热者。如毒既出，则宜表里和
平，以长养气血助毒成浆。如反壮热，则气血煎熬，往来不宁，不能拘收其毒，是以毒
无出路，变为紫黑干枯，失血狂扰，胀满而毙矣。凡发热一日而见点者为鬼箭，此正不
胜邪，痘毒妄行，夺逸肌表，凶之兆也。然鬼箭者，惊厥又为上乘，盖痘从心经火性疾
速，虽见点而亦渐次出齐，粗肥磊落者也。如稠密缩小者，大凶。若热三四日而见点者
为正候，是气血交会，拘毒出于肌表之间，邪正不相抗搏，故乃热退身凉，见点红润，
立成窠穴，吉之兆也。若热六七日而见点者为愆期，是气血凝滞，枭毒烦蒸，凶之兆
也。至若乍凉乍热，嬉笑如常，饮食如故，潮热多日而见点者，此又最为顺候，因毒轻
质浓，邪火难于感动也。出必稀，又不可作愆期论也。
痘之毒非热不能发，痘之出非热不能损，盖痘虽必因热而始出，然热太甚，则血
气虚损而出愈难，故发热之初，宜为表散，见点之后，宜为清解。但痘疹热者，发生之
机也。不然过用寒凉以损阳气，若热甚便秘者，可微利之。如微热者，只当解毒，过发
散则表虚，过寒凉则凝滞，骤补益则助火，是以表后宜补，补中兼表，此通变之术也。
若起胀热甚而无浆者，则宜清火退热，热退而浆自行。若气血虚而作潮热不止者，则宜
十全大补汤主之。更有痘后潮热者，之犹产后气血大虚。所谓火从虚发，必于午后脸赤
发热也，宜保元汤合四物汤加减服之。
凡热之时，外者外治，内者内治，中外皆和，其痘自出。然又当审察天时，如时大
寒，则腠理间密，气血凝涩，防其发涩得迟而有毒瓦斯壅遏之变，治宜以辛热之药发之。
如时太热，则腠理开张，气血淖泽，防其发泄太急而有溃烂之变，治宜以辛凉之药发
之。若在平候，则以温和之剂如治，故宜顺四时之气，勿伐天和。如春肝旺，宜折风木
之胜以补脾之受制。如夏心旺，宜补肺之不足。如秋肺旺，治宜清散肺中之邪。如冬肾
旺，治宜以胜表里之寒，兼有暴寒暴热，久晴久雨，又宜变通。凡热因于痘，治痘为
先，痘困于热，治热为要，热必有本求本治之。然痘在初热，何能预识其轻重乎？凡发
热而乍进乍退，气色明荣，精神如故，大小便调，能食不渴，目清唇润，此毒轻也。痘
必稀疏，即多而必易发易靥。如壮热不减。气色惨暗，精神昏闷，且不能食，二便不
调，目赤唇焦，此毒盛也，痘必稠密。若出疏者，防其有伏，但看身热口渴俱止，精神
爽快，便调能食，更无他苦者，是真疏也。然既识其候，何以解之？夫诸疮皆属于心，
心之华在面，故初发热。如青筋现露，目中泪出，此毒发于肝。夫肝木心生火，是从后
来者，故为实邪，肝火水泡风火相扇，必作瘙痒，其治宜先解脾之毒。如面赤如锦，谵
妄多惊，额上红筋现露者，此毒发于心，夫心火自旺，是为正邪，君主不明，多有限伏
不治。如口干唇焦，面黄而燥者，此毒发于脾，夫心火生脾土，是从前来，故为虚邪，
脾为斑，心为疹，故必夹斑、夹疹，兼胆主肌肉，为火所灼，又必溃烂，治宜先解心脾
之毒。如面色 白，鼻中干燥，或衄出，或清涕者，此毒发于肺，夫心火刑肺经，是
乘其所胜，故为微邪，治宜解肺金之毒。如面色黑气，而如烟浮目中见鬼，头热足冷
者，此毒发于肾，夫肾水克心火，故为贼邪，必成黑陷不治矣。
书曰∶疮疹发热，热气微者，其毒必少，痘出自疏，易发易靥。热气甚者，其毒
必多，痘出自密，难发难靥，且多他变，然有热微而痘出反密者，其人则必口燥渴，唇
焦裂，小便赤，大便秘，是毒深而热亦深，故表不大热而里热甚也，或有热甚而痘出反
疏者，其人则必口不渴，唇色润，二便调，是身虽大热毒浅而热亦浅，此表热而里气和
也。若至遍身如火，昼夜不休，此是心火尤甚，脾土益燥，乃失其常。又见口渴目赤唇
焦，二便不利，烦燥咽痛，则尤是表里惧热之症矣。宁可不投以黄连解毒汤之类，消散
于六日之前，否则，热壅不清，后变坏症。若外虽大热，但面清而睛不黄赤，大便不
秘、小便清者，此里无蕴热，不特黄连宜禁，即生地、丹皮、升麻、紫草，亦不可多
与，有伤阳气，以致寒中，譬诸草木，必赖冬月潜藏，而阳春一转，萌芽自生，但阳气
不可过于亢甚耳。
夫初热之际，时时恶寒，其身振振摇动。如疟之状者，其人卫气必虚，荣血亦
弱，不能逼毒快出，乃使毒邪留连于经络之中，欲出不出，与正相争，邪火外射，乃化
为寒。振振者，火之象也，不可误作寒战妄投辛热，以致误人。然痘疮必不免于热
者，盖毒邪在里，煎熬气血，熏蒸脏腑而然。若既现形，则毒泄而热解矣。故凡疮出
而热即退者必疏，疮出而热尚甚者必密、然亦有身热自始至终而不退者，是多得于毒瓦斯
太盛，始末宜兼清解。若内症不退者，当看大小便如何以治之。如虽热而精神不减，饮
食二便如常，痘疮根据期起灌顺美者，此又性禀偏阳所致，亦当顺其自然，但调其气血，
节其饮食，痘既收功而热自退，勿过求全，反致有损，所以有火里苗一种之痘，即此是
也。
冰浓三尺，非一日之寒，痘疮蕴热，非一日之热，其所受最深也。然痘之发藏于内
者，盖有各脏所属之不同，彰于外者，有时日形症之自异，何以言之？假如连二、三日
而在寅卯辰时潮热呵欠顿闷者，是肝旺寅卯，潮热者，毒乃运动也。预知其必多水
泡，其疮之色青而小也。如连三日而在已午未时、潮热时作惊悸者，是心旺已午。预知
其疮有斑，其色赤而小也。如连在申酉戍时潮热，面赤咳嗽喷嚏者，是肺旺在申酉，预
知其必有脓泡，其疮色微白而大也。如连在亥子丑时，乍发乍凉，手足冷而多睡者，是
脾气旺动，所发为疹，其疮色黄赤也。惟肾在腑下，不受秽气，惟内虚归肾变黑者，属
肾症而难治，然有今日潮热在于申酉，来日生于寅卯者，是必脓水二泡相杂而出，其余
可仿类推，更有热势相同，其出则有迟速轻重之别者，此表热里热，深浅之有不同也。
须于初热之时，以手按囟门之下。如轻按略热，重按久而反不热者，则必由迟。如初轻
按略热，重按久而大热者，则必出速，再看眼中神光，清如秋水，洞彻到底，黑白分
明，则必出轻，若瞳人暗晦，则必出重也。
初起时身体微微发热，此时最宜患者气息平和，大小便自然通畅，面色没有改变，并且睡眠安稳，痘疹初现时红活润泽，饮食正常，这就表明病势顺遂。如果初热时就出现呕吐、腹泻、腹痛，神志昏迷不省人事，胸闷烦躁、气喘急促，或者痘点刚出就迅速布满全身，颜色不光泽，甚至变成紫色、起水泡或黑陷，这些都已经属于逆证。更如肌肤颜色发青而苍白，精神萎靡且倦怠，对此应当当作虚证来看待，痘疹发出后必然不能振奋有力。如果再见到吐乳不止，只需以补益为先。如果热势旺盛而呼吸粗重，烦躁不安，胡言乱语，这都是内热的表现。如果加上气喘胸满，腹部膨隆，大便不通，须知是热邪壅滞。肌肤干燥，毛发焦枯，口气热而身体灼热，这是蓄热郁遏，内症固然严重，外症尤为剧烈。腹胀口张而气喘急促，啼哭声不断且嘶哑，五窍不通，须防止失血。痘点隐约难见，担心发出后会颠扑不定，吐乳同时伴有眼睑下垂，面色青又见摇头，突然狂乱，这是惊风的先兆。然而热势严重的，只宜用清凉发散的方法，不可峻猛使用苦寒药物，发散则毒邪得以外出，热自会解除。如果用寒凉药，则毒邪反而冰伏，更难发出。轻的发散剂可用升麻、干葛来疏散热邪，那么对于烦躁壮盛者，不用这些药怎么能平息其标症！重的则有麻黄、桂枝来开通壅滞，那么对于气喘腹胀者，不用这些药怎么能挽救其危局！在病症未萌生前先予疏导，有热症不要看作虚证，无热症便视为虚证论治。热泻投以清凉药，再加发散；虚溏投以温补药，仍佐以开提之法。内虚误用寒凉，不仅助长其泄泻，实热若投补剂，必致病情加重烦躁加剧。安静且能进食的，不要认为大便结实就可以攻下；泄泻且烦渴的，不要说是热症就投凉药。
痘疹作为病候，必须先有如火烙般的壮热，然后痘疹才能暴发于体表。大概天地化育万物，虽然依赖土气生长，但土气发育若无火气推动，就会偃息隐匿而不能振兴。所以人身也是一小天地，因此痘疹如果不壮热熏蒸，怎么能振奋援救于外，发泄肾中深藏的郁结呢？所以说：五谷不经过火热就不能抽穗结实，实际上痘疹不经过壮热就不能透彻。透彻则肌松窍利，痘出粗大丰满，均匀洁净而没有细密连片的虚象。但是太过壮热，则会耗损真元，以有限的血液去抵挡无穷的火势。体内如鼎沸一般，轻症会变重，重症会变危。然而有的情况应当壮热。如痘未出之前，宜大热以驱逐毒邪。如果反而头温足冷，则毒邪不能发散于外，反而导致内溃而死。不当壮热的情况。如毒邪既已发出，则宜表里和平，以长养气血帮助毒邪成浆。如果反而壮热，则气血被煎熬，往来不安宁，不能收敛毒邪，因此毒邪没有出路，变为紫黑干枯，导致失血狂扰，胀满而死。凡是发热一天就出痘点的称为“鬼箭”，这是正气不胜邪气，痘毒妄行，掠夺逸出于肌表，是凶险的征兆。然而“鬼箭”者，惊厥又为上乘，因为痘从心经火性疾速，虽然见点但也渐次出齐，粗大磊落。如果稠密缩小的，大凶。如果发热三四天而出痘点的为正候，这是气血交会，拘束毒邪出于肌表之间，邪正不相抗搏，所以热退身凉，见点红润，立即形成窠穴，是吉兆。如果发热六七天而出痘点的称为“愆期”，这是气血凝滞，毒邪烦蒸，是凶兆。至于忽冷忽热，嬉笑如常，饮食如故，潮热多日而出痘点的，这又是最为顺候，因为毒轻质浓，邪火难于感动。出痘必然稀疏，也不可以当作愆期论断。
痘毒非热不能发散，痘疹非热不能透发。大概痘虽必因热而始出，但如果热太甚，则气血虚损而出痘更难。所以在发热之初，宜用表散法；见点之后，宜用清解法。但痘疹发热，是发生之机。不然过用寒凉会损伤阳气。如果热甚便秘者，可轻微通利。如微热者，只当解毒，过用发散则表虚，过用寒凉则凝滞，骤用补益则助火。因此在表散后宜补，补中兼表，这是通变之术。如果起胀时热甚而无浆者，则宜清火退热，热退而浆自行。如果气血虚而作潮热不止者，则宜十全大补汤主治。更有痘后潮热者，犹如产后气血大虚。所谓火从虚发，必于午后脸赤发热，宜保元汤合四物汤加减服用。
凡发热之时，外症用外治法，内症用内治法，内外调和，痘疹自然发出。但又应当审察天时，如时值大寒，则腠理密闭，气血凝涩，防其发出不畅而有有毒瓦斯壅遏的变化，治疗宜用辛热药物发散。如时值太热，则腠理开张，气血淖泽，防其发泄太急而有溃烂的变化，治疗宜用辛凉药物发散。如果在平候，则以温和之剂治疗，故宜顺应四时之气，不要破坏天和。如春季肝旺，宜折风木之胜以补脾之受制。如夏季心旺，宜补肺之不足。如秋季肺旺，治疗宜清散肺中之邪。如冬季肾旺，治疗宜以胜表里之寒。兼有暴寒暴热，久晴久雨，又宜变通。凡热因于痘，治痘为先；痘困于热，治热为要。热必有本，求本治之。然而痘在初热阶段，如何预先识别其轻重呢？凡是发热而乍进乍退，气色明荣，精神如故，大小便调，能食不渴，目清唇润，这是毒轻。痘必稀疏，即使多也必易发易靥。如壮热不减，气色惨暗，精神昏闷，且不能食，二便不调，目赤唇焦，这是毒盛，痘必稠密。如果出痘稀疏，防其有伏邪。只看身热口渴俱止，精神爽快，便调能食，更无其他痛苦者，是真疏。既然已经识别了病候，如何解除呢？诸疮皆属于心，心的华彩表现在面部，所以初发热时，如青筋现露，目中泪出，这是毒发于肝。肝木生心火，是从后来者，故为实邪，肝火水泡风火相扇，必作瘙痒，治疗宜先解脾之毒。如面赤如锦，谵妄多惊，额上红筋现露者，这是毒发于心。心火自旺，是为正邪，君主不明，多有局限伏匿不治。如口干唇焦，面黄而燥者，这是毒发于脾。心火生脾土，是从前来，故为虚邪，脾为斑，心为疹，故必夹斑、夹疹，兼胆主肌肉，为火所灼，又必溃烂，治疗宜先解心脾之毒。如面色苍白，鼻中干燥，或衄血，或流清涕者，这是毒发于肺。心火刑肺经，是乘其所胜，故为微邪，治疗宜解肺金之毒。如面色黑气，如烟浮，目中见鬼，头热足冷者，这是毒发于肾。肾水克心火，故为贼邪，必成黑陷不治矣。
书曰：疮疹发热，热气微者，其毒必少，痘出自疏，易发易靥。热气甚者，其毒必多，痘出自密，难发难靥，且多他变。然而有热微而痘出反密者，其人则必口燥渴，唇焦裂，小便赤，大便秘，是毒深而热亦深，故表不大热而里热甚也。或有热甚而痘出反疏者，其人则必口不渴，唇色润，二便调，是身虽大热毒浅而热亦浅，此表热而里气和也。若至遍身如火，昼夜不休，这是心火尤甚，脾土益燥，乃失其常。又见口渴目赤唇焦，二便不利，烦躁咽痛，则更是表里俱热之症了。宁可不服用黄连解毒汤之类，消散于六日之前，否则，热壅不清，后变坏症。若外虽大热，但面清而睛不黄赤，大便不秘、小便清者，此里无蕴热，不仅黄连宜禁，即生地、丹皮、升麻、紫草，也不可多与，有伤阳气，以致寒中。譬诸草木，必赖冬月潜藏，而阳春一转，萌芽自生，但阳气不可过于亢甚耳。
在初热之际，时时恶寒，其身振振摇动，如疟之状者，其人卫气必虚，营血亦弱，不能逼毒快出，乃使毒邪留连于经络之中，欲出不出，与正气相争，邪火外射，乃化为寒。振振者，火之象也，不可误作寒战妄投辛热，以致误人。然而痘疮必不免于热者，盖毒邪在里，煎熬气血，熏蒸脏腑而然。若既现形，则毒泄而热解矣。所以凡疮出而热即退者必疏，疮出而热尚甚者必密。然而亦有身热自始至终而不退者，是多得于毒瓦斯太盛，始末宜兼清解。若内症不退者，当看大小便如何以治之。如虽热而精神不减，饮食二便如常，痘疮根据期起灌顺美者，此又性禀偏阳所致，亦当顺其自然，但调其气血，节其饮食，痘既收功而热自退，勿过求全，反致有损，所以有火里苗一种之痘，即此是也。
冰浓三尺，非一日之寒，痘疮蕴热，非一日之热，其所受最深也。然而痘之发藏于内者，盖有各脏所属之不同，彰于外者，有时日形症之自异，何以言之？假如连续二、三天而在寅卯辰时潮热呵欠顿闷者，是肝旺于寅卯，潮热者，毒乃运动也。预知其必多水泡，其疮之色青而小也。如连续三日而在巳午未时、潮热时作惊悸者，是心旺于巳午。预知其疮有斑，其色赤而小也。如连续在申酉戌时潮热，面赤咳嗽喷嚏者，是肺旺在申酉，预知其必有脓泡，其疮色微白而大也。如连续在亥子丑时，乍发乍凉，手足冷而多睡者，是脾气旺动，所发为疹，其疮色黄赤也。惟肾在腑下，不受秽气，惟内虚归肾变黑者，属肾症而难治。然而有今日潮热在于申酉，来日生于寅卯者，是必脓水二泡相杂而出，其余可仿类推。更有热势相同，其出则有迟速轻重之别者，此表热里热，深浅之有不同也。须于初热之时，以手按囟门之下。如轻按略热，重按久而反不热者，则必由迟。如初轻按略热，重按久而大热者，则必出速。再看眼中神光，清如秋水，洞彻到底，黑白分明，则必出轻，若瞳人暗晦，则必出重也。
At the initial stage, when the body temperature rises slightly, it is most appropriate for the patient to have a calm breath, natural and unobstructed bowel movements, unchanged facial complexion, and peaceful sleep. When the pox first appears, if it is red, vibrant, and moist, and the patient eats normally, this indicates a favorable progression of the disease. If vomiting, diarrhea, abdominal pain occur at the onset of fever, accompanied by coma and loss of consciousness, chest tightness, restlessness, rapid breathing, or if the spots spread rapidly over the whole body with dull color, turning purple, forming blisters, or sinking into blackness, these are all adverse signs. Furthermore, if the skin color is cyanotic and pale, with mental fatigue and lethargy, this should be regarded as a deficiency syndrome; the pox will inevitably fail to emerge vigorously. If milk regurgitation persists, tonification should be prioritized. If the heat is intense with coarse breathing, restlessness, and delirious speech, this indicates internal heat. If accompanied by wheezing and chest fullness, abdominal distension, and constipation, it signifies heat accumulation and stagnation. Dry skin, scorched hair, hot breath, and burning body heat indicate trapped heat; the internal condition is severe, and the external symptoms are particularly fierce. Abdominal distension, open mouth, rapid breathing, incessant crying with hoarseness, and obstruction of the five orifices require vigilance against hemorrhage. If the spots are faint and indistinct, there is fear they may become disordered upon emergence. Milk regurgitation combined with drooping eyelids, cyanotic face, and head shaking, along with sudden mania, are precursors to convulsions. However, in cases of severe heat, only cool and dispersing methods should be used; harsh bitter-cold medicines must not be employed vigorously. Dispersal allows the toxin to exit outward, resolving the heat. If cold medicines are used, the toxin becomes frozen and difficult to expel. Light dispersing agents like *Shengma* (Cimicifugae Rhizoma) and *Gan Ge* (Puerariae Radix) can dissipate heat; without them, how can the agitation and excess heat be controlled? Heavier cases may use *Mahuang* (Ephedrae Herba) and *Guizhi* (Cinnamomi Ramulus) to open blockages; without them, how can wheezing and abdominal distension be saved? Before symptoms manifest, guide the pathogen; do not mistake heat syndromes for deficiency, nor deficiency for heat. For heat-induced diarrhea, use cooling agents with dispersants; for deficiency-induced loose stools, use warming tonics with lifting agents. Misusing cold medicines for internal deficiency exacerbates diarrhea; using tonics for excess heat worsens agitation. If the patient is quiet and eating well, do not assume constipation requires purgation; if there is diarrhea with irritability and thirst, do not assume it is a heat syndrome requiring cooling.
The manifestation of smallpox requires initial intense heat, like iron branding, before the rash erupts externally. Just as heaven and earth nurture all things relying on Earth element, but Earth cannot develop without Fire, causing stagnation, so too is the human body a microcosm. Without vigorous heat steaming internally, how can the kidney's deep-seated depression be vented? Thus, grains do not fruit without heat, and pox does not penetrate thoroughly without heat. Thorough penetration means relaxed muscles and open pores, resulting in plump, uniform, clean pox without fine, confluent patches of deficiency. However, excessive heat consumes true Yuan Qi, pitting limited blood against boundless fire, boiling internally, turning mild cases severe and severe cases critical. Some situations require intense heat; before eruption, great heat drives out toxins. If instead the head is warm and feet cold, toxins cannot vent outward, leading to internal collapse and death. Inappropriate heat occurs after toxins have emerged; then surface and interior should be harmonious to nourish Qi and Blood, aiding toxin maturation into pus. If intense heat persists, Qi and Blood are fried, causing unrest, failing to contain toxins, leading to purple-black dryness, hemorrhage, mania, distension, and death. Eruption within one day of fever is called "Ghost Arrow," indicating righteous Qi failing to overcome pathogens, toxins wandering recklessly, emerging violently—a sign of凶险 (ominous prognosis). However, "Ghost Arrow" implies convulsions are superior because Heart Fire moves quickly; though spots appear, they emerge sequentially, large and distinct. Dense and small spots indicate extreme danger. Eruption after three to four days of fever is the normal pattern, where Qi and Blood intersect, confining toxins to the surface, with no struggle between pathogen and righteous Qi, leading to reduced fever, cool body, red-radiant spots forming distinct pits—a auspicious sign. Eruption after six to seven days is called "Missed Period," indicating stagnant Qi and Blood, vexatious toxin steaming—an ominous sign. Intermittent fever and chills, normal laughter and diet, tidal fever for many days before eruption is the most favorable pattern, due to light toxin and dense quality, making pathogenic fire hard to stir. Eruption will be sparse, not considered a missed period.
Toxin cannot vent without heat; pox cannot emerge without heat. Although pox begins with heat, excessive heat damages Qi and Blood, making emergence harder. Thus, early fever requires dispersal; after spotting, clearing and resolving. Fever in pox is the mechanism of generation. Otherwise, overuse of cold damages Yang Qi. If heat is severe with constipation, mild purgation is allowed. For slight heat, only detoxification is needed. Over-dispersal causes surface deficiency; over-cooling causes stagnation; sudden tonification aids fire. Hence, tonify after dispersal, combining tonification with dispersal—this is adaptive technique. If swelling is severe without pus, clear fire and reduce heat; pus forms naturally when heat subsides. If Qi and Blood deficiency causes persistent tidal fever, *Shiquan Dabu Tang* (Decoction for Complete Great Tonification) is indicated. Post-pox tidal fever resembles postpartum Qi and Blood deficiency; fire arising from deficiency causes afternoon facial flushing and fever, treated with *Baoyuan Tang* (Decoction for Protecting Origin) combined with *Sini Tang* (Four Substance Decoction) modified.
During fever, treat exterior externally and interior internally; when both harmonize, pox emerges naturally. Observe seasonal weather: in severe cold, pores close, Qi and Blood stagnate, risking delayed eruption and toxic congestion; treat with acrid-hot dispersants. In extreme heat, pores open, Qi and Blood are fluid, risking rapid eruption and ulceration; treat with acrid-cool dispersants. In neutral conditions, use mild agents. Follow the Four Seasons, preserving Heavenly Harmony. In Spring, Liver is strong; curb Wind-Wood excess to support Spleen. In Summer, Heart is strong; supplement Lung deficiency. In Autumn, Lung is strong; clear Lung pathogens. In Winter, Kidney is strong; resolve interior-exterior cold. Sudden changes in weather require flexibility. If heat stems from pox, treat pox first; if pox is hindered by heat, treat heat primarily. Seek the root. How to predict severity during initial fever? If fever fluctuates, complexion is bright, spirit normal, bowels regular, appetite good, eyes clear, lips moist—this is light toxin. Pox will be sparse, easy to erupt and crust. If high fever persists, complexion dark, spirit dull, anorexia, irregular bowels, red eyes, scorched lips—this is heavy toxin. Pox will be dense. Sparse pox may hide latent pathogens. If fever/thirst cease, spirit refreshes, bowels regular, eating well—this is truly sparse. How to resolve based on patterns? All sores belong to Heart; its brilliance shows on the face. Initial fever with visible blue veins, tearing eyes—toxin in Liver. Liver Wood generates Heart Fire (later generator), constituting Excess Pathogen. Liver fire, water blisters, wind-fire interaction cause itching; treat by resolving Spleen toxin first. Red face like brocade, delirium, frequent fright, red veins on forehead—toxin in Heart. Heart Fire self-proliferating is Correct Pathogen. Ruler unclear, often leads to hidden untreatable conditions. Dry mouth, scorched lips, yellow dry face—toxin in Spleen. Heart Fire generates Spleen Earth (earlier generator), constituting Deficiency Pathogen. Spleen manifests as macules, Heart as papules; thus mixed macules and papules. Gallbladder governs muscle, burned by fire, leading to ulceration; treat by resolving Heart and Spleen toxins. Pale white face, dry nose, epistaxis, or clear rhinorrhea—toxin in Lung. Heart Fire punishes Lung Metal (overcoming conquered), constituting Minor Pathogen; treat by resolving Lung Metal toxin. Blackish complexion, smoke-like haze, hallucinations, hot head, cold feet—toxin in Kidney. Kidney Water overcomes Heart Fire (robber pathogen), leading to black sinking, untreatable.
Text states: Mild heat in sores/pox means little toxin, sparse eruption, easy crusting. Severe heat means much toxin, dense eruption, difficult crusting, more complications. However, mild heat with dense pox indicates deep toxin and deep heat; surface not very hot but interior heat severe, with dry mouth, cracked lips, red urine, constipation. Severe heat with sparse pox indicates shallow toxin and shallow heat; no thirst, moist lips, regular bowels; surface hot but interior Qi harmonious. Whole-body burning day and night indicates extreme Heart Fire and dry Spleen Earth, losing normalcy. With thirst, red eyes, scorched lips, irregular bowels, irritability, sore throat—this is extreme interior-exterior heat. Better to administer *Huanglian Jiedu Tang* (Coptis Decoction for Resolving Toxins) before the sixth day to dissipate heat; otherwise, heat congestion leads to deterioration. If exterior is very hot but face clear, eyes not yellow/red, stool not constipated, urine clear—no interior heat retention. Avoid *Huanglian*, *Shengdi* (Rehmanniae Radix), *Danpi* (Moutan Cortex), *Shengma*, *Zicao* (Arnebiae Radix et Rhizoma); overuse harms Yang Qi, causing cold injury. Like plants relying on winter storage for spring sprouting, Yang Qi must not be excessively hyperactive.
At initial fever, aversion to cold with trembling/shaking like malaria indicates deficient Wei Qi and weak Ying Blood, unable to force toxin out quickly. Toxin lingers in meridians, struggling with righteous Qi, transforming into cold via external projection of evil fire. Trembling is a sign of fire, not cold shivering; do not mistakenly use acrid-hot medicines. Pox inevitably involves heat because internal toxin fries Qi/Blood and steams Zang-Fu. Once formed, toxin vents and heat resolves. So, pox erupting with immediate fever reduction is sparse; persistent severe heat is dense. Persistent fever throughout indicates excessive toxic vapor; clear and resolve from start to finish. If internal symptoms persist, treat based on bowels/bladder. If fever continues but spirit/diet/bowels normal, pox follows schedule smoothly—this is Yang constitution bias; follow nature, regulate Qi/Blood and diet. Heat subsides after recovery; do not over-treat. This explains "Fire-in-Seed" type pox.
Three-foot ice is not formed in one day's cold; pox heat accumulation is not one day's fever, deeply rooted. Internal manifestation varies by organ; external signs vary by time/symptoms. Two-three days of tidal fever, yawning, drowsiness in Yin-Mao-Chen hours (Liver time): Liver strong, toxin moving. Predict many water blisters, green-small pox. Three days of tidal fever with palpitations in Si-Wu-Wei hours (Heart time): Heart strong. Predict macules, red-small pox. Tidal fever with red face, cough, sneezing in Shen-You-Xu hours (Lung time): Lung strong. Predict pus blisters, pale-white-large pox. Alternating cold/heat, cold limbs, sleepiness in Hai-Zi-Chou hours (Spleen time): Spleen Qi active. Manifests as rashes, yellow-red pox. Kidney is lowest, rejects turbidity; only internal deficiency turning black belongs to Kidney syndrome, difficult to treat. Tidal fever shifting from Shen-You to Yin-Mao indicates mixed pus/water blisters. Others follow analogy. Similar heat intensity but varying eruption speed/severity indicates differences in surface/interior heat depth. At initial fever, press below fontanelle. Light pressure warm, heavy pressure long-term cool—delayed eruption. Light pressure warm, heavy pressure long-term hot—rapid eruption. Check eye spirit: clear as autumn water, distinct black/white—light eruption. Dark pupils—heavy eruption.