凡痘出标，以一日为始，六日九日为变，又十二十四日为变，此决生死之定期
也。症有寒热，故死有迟速耳。毒盛而属实热者，火势迅速，不过六七日而已，盖痘毒
自内达外，三日当齐，然毒尚在内矣。至于六日，则当尽发于表，若毒盛不能尽出者，
则至六七日间，毒反内攻，伤害脏腑而死，若窠粒不见者，则其死亦不待六日，人小而
弱者三日，人大则壮者五日而已，此毒瓦斯不能发泄阴阳，二道俱绝，故死尤速也，若毒
少而属虚寒者，此只是血气不足，不能灌脓成就，故必待九日之后变痘气脱而死。或延
十余日者有之，此皆因痘毒之有虚实，寒热之有迥殊，且人之有大小强弱也。
凡实热拥遏之症，只得清凉升提发散，不宜峻用苦寒，清凉则血热自解，发散则痘
点自呈，升提则壅遏自舒，然宜得平乃止若多用寒凉，则内伤脾胃，外冰肌肉，如过
加发散，则肌凑空虚，无气耗散，即成冰硬，则药宜温和，姜桂之热，亦所不忌，既泻之后，
则热气自散，真气自虚，既成气虚，则药宜补益，况气虚必寒，虚寒即明，自宜温补。然泄泻后
而为虚症，治当温补者宜矣。即有未经之泄泻，而在三四日后，身反不热，痘疮不长者，亦焉得不进
以温补之剂，如官桂川芎干姜之类，使内气一暖，而自能充皮毛、温分肉也。其夫泄泻之后者，其
内必虚，虽有腹胀烦渴喘急等症，亦焉得复为寒热，此不过内虚伏陷，毒成内攻而然，故即
实热之症，七八九日曾经泄泻，皆从虚治，有木香异攻之症，便进木香异攻为贵，此非治病之
常法，乃劫病不得已之权宜，故无木硬之证，切勿误投温补，无泄泻之症，切勿误投木香异攻。即有
泄泻之症，而无木香异功之症，亦勿投木香异功，况痘本热毒，务使阴阳得所，气血和平，毒化而
热亦解矣。至于塌陷倒靥干枯，而无冰硬泄泻之患者，是又多因热毒内攻而然，此又当以有百样猪
尾等方治之，然古之治痘者，陈文中乃用木香散异攻峻热之药，丹溪发挥其误，然有用之而获捷
效者，刘河间、张子和则专用黄连解毒，升麻葛根等汤，寒凉之剂，此岂古人之用药迥别，有如斯者，此各
因所值之时，所犯之症，而为之处方耳。后之宗陈氏者，多用热药，宗刘张者，多用凉药，此刻舟
求剑之道也。君子诚能臆度寒暄，推详脉候，而视疾为转移焉，则攻补适宜，宗陈氏可也，宗刘张可也。
凡是痘疹发出，以第一天作为开始，第六天到第九天是变化期，第十天到第十四天也是变化期，这是决定生死的确定期限。病症有寒证和热证的区别，所以死亡有快慢之分。如果毒气旺盛且属于实热证，火势迅猛，不过六七天就会结束；这是因为痘毒从体内向体表透发，三天应当全部发出，但此时毒气尚在体内。到了第六天，痘毒应当完全发散于体表，如果毒气旺盛不能全部透出，那么在第六七天之间，毒气反而向内攻伐，伤害脏腑而导致死亡。如果看不到痘疮的根窠和颗粒，那么死亡甚至不需要等到第六天，身体小且虚弱的人三天就会死，身体大且强壮的人五天就会死，这是因为毒气无法发泄，阴阳二气断绝，所以死亡尤其迅速。如果毒气少且属于虚寒证，这仅仅是因为血气不足，不能灌注脓液使痘疮成熟，所以必须等到第九天之后，因痘气脱失而死亡。有的拖延十余天的也有这种情况，这都是因为痘毒有虚实之分，寒热性质截然不同，加上人体有大小强弱的差异。
凡是实热壅遏的病症，只能使用清凉、升提、发散的方法，不适宜峻烈地使用苦寒药物。使用清凉药则血热自然解除，使用发散药则痘点自然显现，使用升提药则壅遏之气自然舒展，然而应当以平和为度才停止。如果过多使用寒凉药物，则会内伤脾胃，外冻肌肉；如果过度使用发散药物，则肌表空虚，元气耗散，最终形成冰硬之症。因此药物宜温和，姜、桂等热性药物也不忌讳。在腹泻之后，热气自然消散，真气自然虚弱，既然成为气虚证，药物就应当补益。况且气虚必然导致寒象，虚寒证是明显的，自然适宜温补。所以在泄泻后出现的虚证，治疗应当采用温补法，这是适宜的。即使没有发生泄泻，但在三四天后，身体反而不发热，痘疮不长出的，也怎么能不给予温补的药物呢？如官桂、川芎、干姜之类的药物，使体内气息温暖，自然能充实皮毛、温煦分肉。那些在泄泻之后的患者，体内必然虚弱，即使有腹胀、烦躁口渴、喘急等症状，又怎么能再认为是寒热实证呢？这不过是内虚伏陷，毒气内攻所致。所以即使是实热证，如果在七八九天曾经发生过泄泻，都应当按照虚证治疗。如果有木香异攻散对应的症状，就应当进服木香异攻散，这是珍贵的治法。这不是治病的常规方法，而是挽救病情的不得已的权宜之计。所以没有木香异攻散适应证的，切勿误投温补药物；没有泄泻症状的，切勿误投木香异攻散。即使有泄泻症状，而没有木香异攻散适应证的，也不要投用木香异功散。何况痘疹本是热毒，务必使阴阳各得其所，气血和平，毒气化解而热邪也就解除了。至于痘疮塌陷、倒靥（痘顶凹陷）、干枯，而没有冰硬和泄泻症状的患者，这又多是因为热毒内攻所致，这又应当用百样猪尾汤等方剂来治疗。然而古代治疗痘疹的人，陈文中使用木香散及异攻散等峻烈热药，朱丹溪阐发了其中的错误，但是也有使用而获得快速疗效的情况。刘河间、张子和则专门使用黄连解毒汤、升麻葛根汤等寒凉药物，这难道不是古人的用药截然不同吗？像这样的情况，都是各自根据所遇到的时令、所患的病症，从而进行处方的。后世尊崇陈氏的人，多使用热药；尊崇刘河间、张子和的人，多使用凉药，这是刻舟求剑的做法。君子如果能推测气候的寒暖，推详脉象候息，并根据病情灵活变通，那么攻法和补法适宜，尊崇陈氏可以，尊崇刘张也可以。
Whenever smallpox lesions erupt, the first day marks the beginning, the sixth to ninth days constitute the transformation phase, and the tenth to fourteenth days also represent a transformation phase; these are the fixed periods for determining life and death. Since syndromes present with either cold or heat characteristics, death may occur at varying speeds. If the pathogenic toxin is abundant and belongs to excess-heat syndrome, the fire-like progression is rapid, concluding within six or seven days. This is because the smallpox toxin moves from the interior to the exterior, and should fully emerge by the third day, yet the toxin remains within. By the sixth day, the toxin should be entirely dispersed on the surface. If the toxin is too strong to fully emerge, between the sixth and seventh days, the toxin may counter-attack inwardly, damaging the zang-fu organs and causing death. If no lesion bases (ke) or granules are visible, death may occur even before the sixth day: those who are small and weak may die in three days, while those who are large and robust may die in five days. This occurs because the toxic qi cannot be vented, leading to the severance of both yin and yang, resulting in particularly rapid death. Conversely, if the toxin is scant and belongs to deficiency-cold syndrome, it is merely due to insufficient blood and qi, which cannot nourish pus formation to mature the lesions. Thus, death must await until after the ninth day, caused by the exhaustion of smallpox qi. Some cases may extend beyond ten days. These variations arise from the differences in the deficiency or excess of the toxin, the distinct nature of cold versus heat, and the individual's size and strength.
For syndromes characterized by excess-heat obstruction, only cooling, ascending, and dispersing methods should be employed; harsh bitter-cold medicines are inappropriate. Cooling resolves blood heat, dispersing allows lesions to appear clearly, and ascending relieves obstruction. However, treatment should cease once balance is achieved. Overuse of cold-cooling agents damages the spleen and stomach internally and freezes muscles externally. Excessive dispersing empties the muscle layer, depletes qi, and leads to ice-hardening conditions. Therefore, medicines should be mild; hot herbs like ginger (Shengjiang, 生姜) and cinnamon twig (Guizhi, 桂枝) are not contraindicated. After diarrhea, heat dissipates naturally, and true qi becomes deficient. Once qi deficiency is established, tonification is indicated. Moreover, qi deficiency inevitably leads to cold; deficiency-cold is evident and warrants warming and tonifying. Thus, post-diarrheal deficiency syndromes should indeed be treated with warming and tonifying methods. Even without prior diarrhea, if after three or four days the body feels cool and lesions fail to grow, warming and tonifying agents such as official cinnamon (Guan Gui, 官桂), ligusticum chuanxiong (Chuanxiong Rhizoma, 川芎), and dried ginger (Gan Jiang, 干姜) should be administered to warm internal qi, thereby enriching the skin and warming the muscle layers. Patients following diarrhea necessarily have internal deficiency; even if symptoms like abdominal distension, irritability, thirst, or急促 breathing (chuan ji, 喘急) appear, these cannot be classified as cold-heat excess syndromes. Rather, they result from internal deficiency with sinking toxin attacking inwardly. Therefore, even in excess-heat syndromes, if diarrhea occurred around the seventh to ninth days, treatment should follow deficiency protocols. If symptoms match Mu Xiang Yi Gong San (Aucklandia and Atractylodes Macrocephala Powder), this formula should be prioritized. This is not a standard method but an emergency expedient to rescue the patient. Without indications for Mu Xiang Yi Gong San, do not mistakenly use warming-tonifying drugs; without diarrhea, do not mistakenly use Mu Xiang Yi Gong San. Even with diarrhea, if there are no specific indications for Mu Xiang Yi Gong San, do not administer it. Smallpox is fundamentally a heat-toxin; the goal is to harmonize yin and yang and balance blood and qi, allowing the toxin to resolve and heat to subside. For cases involving collapsed, inverted, or dry lesions without ice-hardening or diarrhea, the cause is often heat-toxin attacking inwardly, requiring formulas such as Bai Yang Zhu Wei Tang (Hundred Pig Tail Decoction). Historically, Chen Wenzhong used hot medicines like Mu Xiang San and Yi Gong San. Zhu Danxi criticized these errors, yet some achieved rapid results. Liu Wansu and Zhang Zihe exclusively used cold-cooling agents like Huang Lian Jie Du Tang (Coptis Decoction for Resolving Toxins) and Sheng Ma Ge Gen Tang (Cimicifuga and Pueraria Decoction). Was this not a stark difference in ancient prescribing? Such variations depended on the season and specific syndrome. Later followers of Chen favored hot medicines, while followers of Liu and Zhang favored cold medicines; this is akin to carving a mark on a moving boat to find the sword. A wise practitioner estimates climatic changes, analyzes pulse signs, and adjusts treatment according to the disease. Then, whether employing attack or tonification, and whether following Chen or Liu/Zhang, will be appropriate.