夫人身由气血而生，火毒亦由气血而中而发而解，故痘者，假气血以成形者也，然
气卫于脉外，血荣于脉内，而元气者，又为荣卫之主，故元气盛，则气血营运，五内百
骸，周流不息，诸疾无自而作，虽痘毒感发，而气有领逐之能，血有负载之力，气拘
血附，并行祛毒，痘疮必应期而开落，以其毛皮充，肉分温，而毒营运自快也。苟使元
气一亏，则气血交会不足，气在内而外不固，血即载毒以出，而为外剥。气在外而内
不续，血即载毒以入，而为内攻，诸症变作危亡，立至矣。譬如，元气者主帅也，气血
者卒徒也，痘毒者敌人也，主将得人，则卒徒用命。而敌为之自破，不然鲜有不肆害于
吾之土地者，观于气血之盛衰，而痘有圆陷荣枯，信可验矣。故智者必补益真元，调理
荣卫，而治痘也，然气血盛，固能逐毒，而火毒盛亦能损其气血，故急则治其标，（是清
火解毒矣。）缓则治其本，（是补气血矣。）尤不可不知也。且气有生血之功，血
无益气之理，必先益气为主，而补血为助，气盈则能引血以逐其毒，如水必得风而后舟楫
之行自顺，苟或过于益血，则必载毒泛滥，久为大逆矣。此扶阳抑阴之大道也。
人之有生，赖乎气血。然血为荣者，融也，如水之融，周流灌溉，而无所阻滞，气
为卫者，围也，如城之围，范护充固于身，而无所屈挠，即痘之一症，始末俱赖乎荣
卫，淫毒之攻侮，非血气不能以表暴也。形色之呈见，非血气不能充灌也。虽曰痘伏于
肾，发于脾，然所以建功成实者，则血气也。气阳也。故轻清而自浮，血阴也，故重
浊而自沉，是以气阳从于表，血阴从于里，气以成痘之形，气充则顶起圆润，血以华痘
之色，血盛则根窠红活，然气为之主，血为之附，必气血相和于内，则虚其发扬于外，
是为气血交会者也，若气虽盛，而血失所宜，不相归附，则又有变态存焉，气过盛则
发为泡，气虚则为顶陷，为痒塌，为自汗，为皮薄而软，为寒战，为吐泻，为灰白，血
过盛则为斑丹，血失职则为滞，为紫黑，为倒靥，或紫赤浮于肌表，而不藏入于 内，
血虚则为淡白，为根窠无晕，以手摸过而红色不见者是皆交会不足也，若根焦紫黑者血
热也，顶陷而紫黑者，血热而气滞也。此皆不可以气虚而误用补剂，但宜活血凉荣，解
毒为主，血活则气行也。
夫气体大而常亲乎上。血体地而常亲于下。然气有生血之功，血无益气之理，故气
不可以亏，亏则阳会不及，而痘之圆晕之形不成，血不可以盈，盈则阴乘阳位，而痘之
倒陷之祸立至，是以痘有气血虚实之殊，然血之有盈，乃气之不足也。大抵寒为虚，虚
者正气虚也，内症必多，热为实，实者邪气实也，外症必重，气虚寒则宜温补，气实热
则宜清凉，血虚则宜补血，血热则宜解毒，必致气血和平，无过不及可也。然何谓气血
虚实之殊？且如气过则泡，血过则斑，气不及则顶陷不起，血不及则浆毒不附，更如痘
色淡白，顶不坚实，不碍手，不起胀，或痒塌吐利，寒战切牙，手足冷，是皆属气虚，
大宜保元，倍加酒炒黄 ，肉桂川芎，丁香人乳，好酒同服，若根窠不红，或红而散
乱，以手抹过，色即转白，痘上如寒毛竖起，枯涩不活，及疮干脓水少者，皆血虚
也，亦宜保元内加川芎当归，酒洗红花，及下山楂，以消参 之滞，再下木香数分，而
血自活，是经所云∶形不足者温之以气，精不足者补之以味也。然用黄 当在痘尽出之
后，投热药须看毒尽解之时，用地黄防滞血，烦将姜制，用芍药恐酸寒，尤宜酒炒
耳。
人之所以能够生存，是由气血化生而成的；火毒也是通过气血的作用而侵入、发作并最终解除的。因此，痘疮（天花）是借助气血来形成形态的。然而，气护卫在脉管之外，血滋养在脉管之内，而元气则是营卫之气的主宰。所以，如果元气旺盛，那么气血就能正常运行，五脏六腑和全身骨骼肌肉周流不息，各种疾病就没有机会产生。即使痘毒被感发，气也有统领驱逐的能力，血有承载毒素的力量，气约束血并依附于血，两者并行以祛除毒素，痘疮必然能按时期开放和结痂脱落，因为皮毛充实，肌肉温暖，毒素的运行排泄自然顺畅。
假如元气一旦亏损，那么气血的交会就会不足。气在内而体表不固，血就会携带毒素向外发散，导致痘疮外剥（溃烂）。气在外而内部接续不上，血就会携带毒素向内攻陷，导致内攻（毒邪内陷），各种变症发作，危及生命，立刻到来。这就好比，元气是主帅，气血是士兵，痘毒是敌人。主将得人（元气充足），则士兵听从命令，敌人自然破败；否则，很少有不肆意侵害我们身体这片土地的。观察气血的盛衰，就可以验证痘疮是圆润饱满还是凹陷枯萎，这确实是可信的。
所以，明智的人一定会补益真元，调理营卫之气来治疗痘疮。然而，气血旺盛固然能驱逐毒素，但火毒旺盛也能损伤气血。所以在紧急情况下要治其标（这是清除火毒解毒），在缓和情况下要治其本（这是补益气血），这一点尤其不可不知道。而且，气有生化的功能来帮助生成血，但血没有益气（补气）的道理。因此，必须以益气为主，补血为辅。气充足才能引导血去驱逐毒素，就像水必须依靠风的力量，船只航行才会顺遂。如果过于侧重补血，就一定会载着毒素泛滥，长久以来成为极大的逆乱。这是扶持阳气、抑制阴气的根本大道。
人的生存，依赖于气血。但是，血作为“荣”（营养），意思是融合，像水一样融合，周流灌溉，没有任何阻滞；气作为“卫”（保卫），意思是包围，像城墙的围墙，环绕护卫身体，坚固而没有屈挠。即使是痘疮这一病症，从头到尾都依赖营卫之气。淫毒的攻击侮辱，不是血气就不能使其显露于体表。形色状的呈现，不是血气就不能充盈灌注。虽然常说痘毒潜伏于肾，发源于脾，但之所以能建功立业、成熟结实，靠的是血气。气属阳，所以轻清而自然上浮；血属阴，所以重浊而自然下沉。因此，气之阳从属于表，血之阴从属于里。气用来构成痘疮的形状，气充盛则痘顶隆起圆润；血用来美化痘疮的颜色，血旺盛则痘根红活润泽。然而，气是主导，血是依附。必须在内部气血调和，才能在外部发扬光大，这就是所谓的“气血交会”。
如果气虽然旺盛，但血失去了适宜的状态，不相归附，那么又会有变态存在。气过盛则发为水泡；气虚则表现为痘顶凹陷、瘙痒塌陷、自汗、皮肤薄而软、寒战、呕吐腹泻、颜色灰白。血过盛则发为斑丹；血失职则表现为瘀滞、紫黑色、倒靥（痘疮逆向发展或内陷），或者紫红色浮于肌表，而不藏入体内。血虚则表现为颜色淡白、痘根无红晕，用手抚摸后红色消失。这些都是气血交会不足的表现。如果痘根焦黑紫暗，是血热；痘顶凹陷且紫黑，是血热而气机阻滞。这些情况都不可以因为认为是气虚而误用补剂，只宜以活血凉营、解毒为主，血活了气也就行了。
气的形体大而常亲近于上；血的形体地广而常亲近于下。然而，气有生血之功，血无益气之理。所以气不可以亏损，亏损则阳气会合不及，痘疮的圆晕形状就无法形成；血不可以过盈，过盈则阴气乘袭阳气之位，痘疮倒陷的祸患立刻到来。因此，痘疮有气血虚实之分。但是，血的过盈，其实是气的不足。大体来说，寒证属于虚，虚是指正气虚弱，内症必然多；热证属于实，实是指邪气亢盛，外症必然重。气虚寒则适宜温补，气实热则适宜清凉；血虚则适宜补血，血热则适宜解毒。必须达到气血平和，不过分也不欠缺，才可以。
那么，什么是气血虚实的具体区别呢？比如，气过盛则生水泡，血过盛则现红斑；气不及则痘顶凹陷不起，血不及则浆液毒素不附着。再如痘色淡白，痘顶不坚实，不碍手，不起胀，或者瘙痒塌陷、呕吐泄利、寒战咬牙、手足冰冷，这些都归属于气虚，非常适宜使用保元汤，加倍加入酒炒黄芪、肉桂、川芎、丁香，用人乳和好酒同服。如果痘根不红，或者红而散乱，用手抹过后颜色立即转白，痘上像寒毛竖起，枯涩不鲜活，以及疮口干燥脓水少的，都是血虚，也适宜在保元汤中加入川芎、当归、酒洗红花，以及下山楂以消除人参的滞腻，再添加木香数分，血自然就会流通。这正是经典所说：“形体不足的，用气药来温养它；精髓不足的，用味厚的药物来滋补它。”
然而，使用黄芪应当在痘疹完全发出之后，投用热药须看毒素完全解除之时，用地黄防止血液停滞，烦闷时将生姜炮制，使用芍药恐怕性味酸寒，尤其适宜用酒炒制罢了。
Human life is generated by Qi and Blood; fire-toxins also enter, manifest, and resolve through the medium of Qi and Blood. Therefore, smallpox (dòuchuāng) takes shape by borrowing Qi and Blood. However, Wei-Qi (Defensive Qi) guards outside the vessels, while Ying-Blood (Nutritive Blood) nourishes inside the vessels, and Yuan-Qi (Primal Qi) serves as the master of Ying and Wei. Thus, when Yuan-Qi is robust, Qi and Blood circulate smoothly, flowing endlessly throughout the five zang organs and the hundred bones. Various diseases have no opportunity to arise. Even if smallpox toxins are triggered, Qi has the ability to lead and expel, and Blood has the power to carry and transport. Qi constrains and attaches to Blood, moving together to dispel toxins. Consequently, the smallpox lesions will open and scab off according to schedule, because the skin and hair are filled, the flesh is warm, and the circulation and excretion of toxins are smooth.
If Yuan-Qi is deficient, the intersection of Qi and Blood will be insufficient. If Qi remains internal while the exterior is not secured, Blood will carry toxins outward, leading to external ulceration (wàibāo). If Qi stays on the exterior while the interior lacks continuity, Blood will carry toxins inward, leading to internal attack (nèigōng). Various complications will arise, bringing immediate danger to life. It is like this: Yuan-Qi is the commander, Qi and Blood are the soldiers, and smallpox toxins are the enemy. If the main general is capable (Yuan-Qi is sufficient), the soldiers follow orders, and the enemy breaks itself. Otherwise, few do not suffer rampant harm within one's own territory. By observing the flourishing or declining state of Qi and Blood, one can verify whether the smallpox lesions are round and full or sunken and withered; this is indeed verifiable.
Therefore, wise practitioners must tonify True Yuan and regulate Ying and Wei to treat smallpox. However, while abundant Qi and Blood can drive out toxins, excessive fire-toxin can also damage Qi and Blood. Hence, in acute cases, treat the branch (this involves clearing fire and resolving toxins); in chronic or mild cases, treat the root (this involves tonifying Qi and Blood). This principle must not be ignored. Furthermore, Qi has the function of generating Blood, but Blood does not have the principle of benefiting Qi. Therefore, one must prioritize benefiting Qi, with tonifying Blood as an aid. When Qi is sufficient, it can guide Blood to expel toxins, just as water requires wind for boats to navigate smoothly. If one overemphasizes tonifying Blood, it will inevitably carry toxins into chaos, causing great disorder over time. This is the great principle of supporting Yang and suppressing Yin.
Human existence relies on Qi and Blood. "Ying" (Blood/Nutrition) implies fusion, like water merging, circulating and irrigating without obstruction. "Wei" (Qi/Defense) implies encirclement, like a city wall surrounding and protecting the body firmly without yielding. Even in the case of smallpox, from beginning to end, it relies on Ying and Wei. The assault of pathogenic toxins cannot be manifested on the surface without Qi and Blood. The presentation of colors and forms cannot be filled and infused without Qi and Blood. Although it is said that smallpox lies hidden in the Kidney and emerges from the Spleen, the achievement of maturation and solidification depends on Qi and Blood. Qi is Yang, thus light and clear, naturally floating upward. Blood is Yin, thus heavy and turbid, naturally sinking downward. Therefore, Yang-Qi follows the Exterior, and Yin-Blood follows the Interior. Qi forms the shape of the smallpox lesion; when Qi is abundant, the apex rises and becomes round. Blood beautifies the color of the smallpox lesion; when Blood is prosperous, the base is red and vibrant. However, Qi is the master, and Blood is the follower. Only when Qi and Blood harmonize internally can they flourish externally; this is called the "intersection of Qi and Blood."
If Qi is abundant but Blood loses its proper state and does not attach, abnormalities occur. Excessive Qi leads to vesicles (pào). Qi deficiency leads to sunken apices, itching and collapse, spontaneous sweating, thin and soft skin, chills, vomiting and diarrhea, and grayish-white color. Excessive Blood leads to macules (bāndān). Blood dysfunction leads to stasis, purple-black discoloration, and inverted crusting (dǎoyè), or purple-red hues floating on the skin surface without receding inward. Blood deficiency leads to pale white color and bases lacking a red halo; the redness disappears upon touch. These are all signs of insufficient intersection. If the base is scorched purple-black, it indicates Blood Heat. If the apex is sunken and purple-black, it indicates Blood Heat with Qi stagnation. In such cases, one must not mistakenly use tonifying formulas due to perceived Qi deficiency. Instead, one should prioritize activating Blood, cooling Ying, and resolving toxins. Once Blood activates, Qi flows.
The nature of Qi is large and tends toward the upper; the nature of Blood is earth-like and tends toward the lower. However, Qi generates Blood, while Blood does not benefit Qi. Therefore, Qi must not be deficient; if deficient, Yang convergence will be inadequate, and the round halo shape of the smallpox lesion will fail to form. Blood must not be excessive; if excessive, Yin will usurp the position of Yang, and the disaster of inverted smallpox will occur immediately. Thus, smallpox presents differences in Qi and Blood deficiency and excess. Generally, Blood excess is actually a sign of Qi insufficiency. Broadly speaking, Cold patterns belong to Deficiency, meaning Zheng-Qi (Upright Qi) is weak, and internal symptoms are numerous. Heat patterns belong to Excess, meaning Xie-Qi (Pathogenic Qi) is strong, and external symptoms are severe. For Qi deficiency with Cold, warming and tonifying are appropriate; for Qi excess with Heat, cooling is appropriate. For Blood deficiency, tonifying Blood is appropriate; for Blood heat, resolving toxins is appropriate. One must achieve balance in Qi and Blood, neither excessive nor insufficient.
What specifically distinguishes Qi and Blood deficiency and excess? For instance, Qi excess produces vesicles; Blood excess produces macules. Qi insufficiency results in a sunken, non-rising apex; Blood insufficiency results in pus/toxin failing to adhere. Furthermore, pale white smallpox color, non-firm apices that do not feel raised or distended, or itching/collapse, vomiting/diarrhea, chills, teeth grinding, and cold hands and feet all belong to Qi deficiency. It is highly suitable to use Baoyuan Decoction (Preserve the Origin Decoction), doubling the dosage of wine-fried Huangqi (Astragali Radix), Rougui (Cinnamon Bark), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Dingxiang (Caryophylli Flos), taken with Renru (Human Milk) and good wine. If the base is not red, or is red but scattered, turning white immediately upon wiping, with hair-like projections on the sores, dryness, lack of vitality, and little pus/fluid, these indicate Blood deficiency. It is also suitable to add Chuanxiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), and Honghua (Carthami Flos) washed in wine to Baoyuan Decoction, along with Xiashanzha (Crataegi Fructus) to eliminate the stagnating effect of Renshen (Ginseng Radix et Rhizoma), and add Muxiang (Aucklandiae Radix) in small amounts to activate Blood. This aligns with the classic saying: "For deficiencies of form, warm with Qi-tonics; for deficiencies of essence, nourish with flavor-rich substances."
However, Huangqi (Astragali Radix) should be used only after the smallpox has fully erupted. Hot medicines should be administered only when the toxin is completely resolved. Dihuang (Rehmanniae Radix) is used to prevent blood stasis; Fanjiang (Zingiberis Rhizoma Recens) is processed for irritability. Shaoyao (Paeoniae Radix) is avoided due to its sour-cold nature, especially if not wine-fried.