夫痘痈为阳毒，然痈夹于痘中，不可概以阳毒为论，盖发于七日前看，凡疮也。有
原素积热毒内伏，遇痘毒火感激乃相并而发者。更有素患凡疮未痊，或初结瘢处，肉分
空虚，遇痘热毒瓦斯血攻击，复趋虚处而发，是以阳疮阴毒，混杂一堂，须看其毒湿润
者，则气血俱盛，而痘与毒自易成浆也。若毒枯燥干红，则气血俱弱，必毒与诸疮相
抗，而俱不能成浆矣，治宜大加补托。如枯转润，红变白，其浆自溢者，可愈。惟在七
日后发痈者，阳毒也。此即痘之毒，并聚一处，以假其名也。盖因气血不能拘收乘载其
毒，以致气弱血盛，阳分空虚，而乃血载其毒，传注四肢合处，合者，海也，如曲池、
委中是也。总七日前后见者，宜从之以发，则毒亦从此而出矣。若治其毒，则必随痘而
散，内攻脏腑，焉可救乎！惟于痘毒已解，血气丰盛者，则宜解散其余毒。然痈之成
也，多由气血不和，留结所致，况病久必虚，故解毒汤中，必君以调和荣卫补益气血
为主。即痘始夹痈者，亦须大用芎、归、黄 、生地、僵蚕之类，大补气血，以托解其
毒。否则，气血为毒所遇，而痘必难成功矣。
夫伤寒自表入里，痘疹从里达表，候虽相似，症实天渊。若痘正发而夹伤寒者，是
邪在表可用发散以微汗之，则腠理疏通，而痘出自易矣。若伤寒在痘三四朝，而有烦躁
谚语，腹胀恶渴，睡卧不宁，便闭者，是邪在里，可用微下，次即随以升提，则表里和
平，邪壅自解，经络无滞，荣卫得行，而毒化成浆自易矣。此所谓应犯而犯，似乎无
犯。至如可以不汗不下，尤为顺候，然即汗即下，又宜两安，贵乎急则治标，缓则治
本，而兼以痘之明痘之候并参之。然真伤寒者少，类伤寒者多，况八岁以下无伤寒，切
勿以头痛发热者，便作伤寒例论也。
痘疮和痈肿都属于阳毒，然而痈肿夹杂在痘疮中发生，不能一概按照阳毒来论述。大概在痘发七日前出现的，凡是疮疡都属此类。有的是原本体内就积存有热毒，遇到痘毒的火气激发，两者相互结合而发作的。更有的人平时患有普通疮疡尚未痊愈，或者刚刚结痂的地方，肌肉腠理空虚，遇到痘热的毒气血液攻击，又趋向于虚处而发作，因此阳性的疮疡与阴性的毒邪混杂在一起，必须观察其毒邪湿润与否：如果毒邪湿润，说明气血都旺盛，那么痘疮与毒邪自然容易化脓成浆；如果毒邪干枯、颜色红赤，说明气血都虚弱，必然导致毒邪与各疮疡相互对抗，都不能化脓成浆，治疗应当大力使用补益托毒的方法。如果干枯转为湿润，红色变为白色，脓浆自然溢出，就可以痊愈。只有在痘发七日后出现痈肿的，才属于阳毒。这就是痘毒并聚在一处，借用痈的名称罢了。这是因为气血不能约束承载这些毒邪，导致气弱血盛，阳气分位空虚，于是血载着毒邪，传注到四肢关节合缝之处，“合”指的是海穴，如曲池、委中等穴位。总之，在七日前后出现的，适宜顺从其势以发散，那么毒邪也就从此排出体外了。如果只去治疗毒邪，则毒邪必定随着痘疹散入体内，攻犯脏腑，哪里还能救治呢！只有在痘毒已经解除，血气丰盛的情况下，才适宜解散剩余的毒邪。然而痈肿的形成，多由气血不和、留滞凝结所致，况且病久必然体虚，所以在解毒汤中，必须以调和营卫、补益气血作为君药（主药）。即使是痘疮初期夹杂痈肿的，也必须大量使用川芎、当归、黄芪、生地黄、僵蚕之类的药物，大补气血，以托举并化解毒邪。否则，气血被毒邪遏制，痘疮就难以成功发出。
伤寒的病邪是从体表传入体内的，痘疹的病邪是从体内达于体表的，虽然候象相似，但症状实则天差地别。如果在痘疮正发的时候夹杂了伤寒，这是邪气在表，可以使用发散法使其微微出汗，这样腠理疏通，痘疮自然容易发出。如果伤寒在痘发三四天时，出现烦躁、说胡话、腹胀、厌恶口渴、睡卧不宁、大便闭结等症状，这是邪气在里，可以使用轻微的泻下法，随后立即配合升提之法，这样表里平和，邪气壅滞自然解除，经络没有阻滞，营卫得以运行，毒邪化成脓浆就容易了。这就是所谓的“应该犯险而犯险”，看起来好像没有犯错。至于那些可以不汗下治疗的，更是顺证，但如果必须汗下，又宜使表里两安，关键在于急则治其标，缓则治其本，并结合对痘疮明察秋毫的判断来参考。然而真正的伤寒很少，类似伤寒的情况很多，况且八岁以下儿童不会患伤寒，千万不要因为头痛发热，就当作伤寒来论述。
Varicella (smallpox) and carbuncles are both classified as Yang toxins. However, when a carbuncle occurs concurrently with varicella, it cannot be uniformly diagnosed as a Yang toxin condition. Generally, lesions appearing within the first seven days of eruption are considered ordinary sores. Some cases arise from latent internal heat-toxins that, upon stimulation by the fire of the varicella toxin, combine and erupt together. In other instances, patients may have pre-existing ordinary sores that have not yet healed, or areas where scabs have just formed; these regions have deficient flesh and pores. When attacked by the heat and toxic vapors of the varicella blood, the pathogen tends to settle in these deficient areas. Consequently, Yang sores and Yin toxins become mixed. One must observe whether the lesion is moist: if moist, it indicates abundant Qi and Blood, allowing the varicella and toxin to easily transform into pus. If dry and bright red, it indicates deficient Qi and Blood, leading to resistance between the toxin and the sores, preventing pus formation. Treatment should prioritize strong tonification and expulsion of toxins. If dryness turns to moisture and redness fades to pallor, with spontaneous pus discharge, recovery is possible. Only carbuncles appearing after the seventh day belong to Yang toxins. This represents the aggregation of varicella toxins in one place, borrowing the name of a carbuncle. It occurs because Qi and Blood fail to constrain and carry the toxins, resulting in weak Qi and excessive Blood, with emptiness in the Yang aspect. The Blood carries the toxin to the junctions of the limbs, specifically the "Sea" points such as Quchi (LI11) and Weizhong (BL40). For lesions appearing before or after the seventh day, treatment should follow their natural course to disperse them, allowing the toxin to exit through this route. If one merely treats the toxin without regard to the varicella, the toxin will scatter internally and attack the Zang-Fu organs, making rescue impossible. Only after the varicella toxin has resolved and Qi and Blood are robust should residual toxins be dispersed. Carbuncles often form due to disharmony and stagnation of Qi and Blood. Since prolonged illness leads to deficiency, detoxifying decoctions must use herbs that harmonize Ying and Wei and tonify Qi and Blood as the sovereign agents. Even in early stages where varicella is complicated by carbuncles, large doses of Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), Astragali Radix (Huangqi), Rehmanniae Radix Recens (Shengdihuang), and Bombyx Batryticatus (Jiangcan) should be used to strongly tonify Qi and Blood, thereby supporting the expulsion of toxins. Otherwise, if Qi and Blood are suppressed by the toxin, the varicella eruption will fail.
Shanghan (Cold Damage) pathogens enter from the exterior to the interior, whereas rash diseases like varicella emerge from the interior to the exterior. Although their presentations may seem similar, their symptoms are vastly different. If Shanghan complicates an active varicella eruption, the pathogen is at the exterior; mild diaphoresis can be induced to open the cou li (skin pores), facilitating the eruption of varicella. If Shanghan persists during the third or fourth day of varicella, accompanied by restlessness, delirious speech, abdominal distension, aversion to thirst, restless sleep, and constipation, the pathogen is in the interior. Mild purgation may be used, followed immediately by lifting therapies. This restores harmony between the interior and exterior, resolves pathogenic obstruction, clears meridians, allows Ying and Wei to circulate, and facilitates the transformation of toxins into pus. This is referred to as "acting according to necessity," which appears harmless. Cases requiring neither sweating nor purging are favorable. If sweating or purging is necessary, both interior and exterior must be stabilized. The principle is to treat the acute symptoms first and the root cause later, while carefully observing the specific signs of varicella. True Shanghan is rare; many cases mimic it. Children under eight years old do not contract Shanghan. Therefore, headache and fever should not automatically be diagnosed as Shanghan.