夫气虚痘症初发，则必身热悠悠，乍热乍凉，懒言神倦，面青 白，饮食减少，
手足时冷时热，呕吐便溏，痘点即见，隐隐不振，淡红皮薄，至三四日陆续不齐，不易
长大，至五六日不易成浆，少食气馁，伤食易泄，至七八日，塌陷灰白，自汗泄泻，腹
胀喘渴，塌痒闷乱，寒战切牙，头温足冷，势所必至，故治虚症初发之际，不宜投升麻
葛根，紫草三豆汤类，而宜从参 饮，温补之法为要。若气粗皮燥，无润色者，亦忌
之，只以四君子减人参，加桔梗，川芎腹皮于补益之中，略佐以升提之法为妙。若点之
出齐，又当重用参 ，及至八九日间，无他凶症，治法如常。如有顶陷灰白不起，或浆
清自汗微渴者，则用大补汤加姜桂主之。若塌陷灰白腹胀泄泻者，则投以木香散，若至
塌痒闷乱，腹胀渴泄喘急头温足冷，寒战切牙者，急进异功散，以救之。然此气虚痘
症，若父母能守禁忌及用药不误，则元气复充，腠理坚固，脾胃强健，饮食如常，而虚
症可以变实矣。亦有因补益太过，反增沉剧者，如浆足之后，而犹重用参 乃有喘急腹
胀之患者，更有误用五苓木香散多，乃有大便秘结之患者，更有过用丁桂辛热之剂，乃
有咽喉肿痛烦燥闭渴之患者，凡此喘急腹胀，大便坚秘，烦燥咽痛等症，虽为实症，
然实是病浅，而用药过深之失也。岂真实哉！亦不宜疏通重施，否则将生之气复虚，
而至脱症又至矣。
气虚型痘症（天花）在初发阶段，必然出现身体持续低热、忽冷忽热、懒言少语、精神疲倦、面色青白、饮食减少、手足时而发冷时而发热、呕吐、大便稀溏等症状。此时痘点虽然显现，但隐隐约约、气势不振，颜色淡红且皮薄。到了第三四天，痘疹陆续出齐但仍参差不齐，难以长大；到了第五六天，难以化脓成浆。若进食过少则元气不足，若饮食不节则容易腹泻。到了第七八天，痘顶塌陷、颜色灰白，伴有自汗、泄泻、腹胀、气喘、口渴、痘痒、胸闷烦乱、寒战咬牙、头部温热而足部寒冷等表现，这些都是病情发展的必然结果。因此，在治疗气虚型痘症的初期，不宜使用升麻葛根汤、紫草三豆汤这类方剂，而应当采用人参饮等温补的方法作为关键。如果患者呼吸粗重、皮肤干燥、缺乏润泽之色，也忌讳使用温补法，只应在四君子汤中减去人参，加入桔梗、川芎和大腹皮，在补益的基础上略微配合升提之法才为巧妙。如果痘点已经出齐，又应当重用参类药材。到了第八九天，如果没有其他凶险症状，治疗方法就按常规进行。如果出现痘顶塌陷、颜色灰白不起，或者脓浆清稀、自汗、轻微口渴的情况，则使用大补汤加生姜、肉桂来主治。如果出现痘顶塌陷、颜色灰白、腹胀、泄泻的情况，则投用木香散。如果发展到痘顶瘙痒、胸闷烦乱、腹胀、口渴、泄泻、气喘急促、头部温热足部寒冷、寒战咬牙的情况，则急需进服异功散以挽救病情。然而，这种气虚型痘症，如果父母能遵守禁忌并用药无误，那么元气就会恢复充盈，腠理坚固，脾胃强健，饮食恢复正常，气虚证就可以转化为实证。也有因为补益过度，反而导致病情加重沉郁的，比如在脓浆充足之后，仍然重用参类药材，从而导致气喘急促、腹胀的患者；更有误用五苓散和木香散过多，导致大便秘结的患者；还有过度使用丁香、肉桂等辛热药物，导致咽喉肿痛、烦躁、闭闷、口渴的患者。凡是这些气喘急促、腹胀、大便坚硬秘结、烦躁咽痛等症状，虽然表现为实证，但实际上是病位浅表而用药过深造成的失误，难道这是真正的实证吗！也不宜再施用强烈的疏通方法，否则会使刚刚恢复的元气再次虚弱，甚至导致脱证的发生。
In the initial stage of Qi deficiency variola (smallpox), symptoms necessarily include a lingering low-grade fever, alternating hot and cold sensations, reluctance to speak, mental fatigue, cyanotic or pale complexion, reduced appetite, intermittent coldness and warmth in the hands and feet, vomiting, and loose stools. Although the variolae spots appear, they are faint, lacking vigor, with a pale red color and thin skin. By the third or fourth day, the eruptions emerge successively but irregularly, failing to enlarge; by the fifth or sixth day, they fail to fill with pus. Insufficient food intake leads to Qi deficiency, while dietary indiscretion easily causes diarrhea. By the seventh or eighth day, the pustules collapse and turn grayish-white, accompanied by spontaneous sweating, diarrhea, abdominal distension, asthma, thirst, pruritus at the eruption site, chest oppression, restlessness, chills, teeth grinding, warmth of the head, and coldness of the feet. These manifestations are inevitable consequences of the disease progression. Therefore, in treating the initial stage of Qi deficiency variola, formulas such as Shengma Gegen Tang (Cimicifugae et Puerariae Decoction) and Zicao Sandou Tang (Arnebiae et Three Beans Decoction) should not be administered. Instead, the key lies in employing warming and tonifying methods, such as Renshen Yin (Ginseng Drink). If the patient exhibits coarse breathing, dry skin, and a lack of luster, warming tonification is also contraindicated. In such cases, it is advisable to modify Sijunzi Tang (Four Gentlemen Decoction) by removing Renshen (Radix Ginseng), adding Jiegeng (Platycodonis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Fupi (Tangerinae Pericarpium Viride), combining slight lifting methods within the framework of tonification for optimal effect. Once the eruptions have fully appeared, heavy use of Ginseng preparations is warranted. By the eighth or ninth day, if no other ominous symptoms arise, treatment proceeds according to routine. If the pustule tops collapse and remain grayish-white, or if the pus is clear, accompanied by spontaneous sweating and mild thirst, Dabu Tang (Great Tonifying Decoction) added with Shengjiang (Zingiberis Rhizoma Recens) and Rougui (Cinnamomi Cortex) should be used. If the pustules collapse, turn grayish-white, and are accompanied by abdominal distension and diarrhea, Muxiang San (Aucklandia Powder) should be administered. If the condition progresses to pruritus at the eruption site, chest oppression, restlessness, abdominal distension, thirst, diarrhea, rapid asthma, warm head with cold feet, chills, and teeth grinding, Yigong San (Yi Gong Powder) must be urgently given to rescue the patient. However, in cases of Qi deficiency variola, if parents observe dietary and lifestyle taboos and ensure correct medication, the Yuanqi (Original Qi) will recover and become abundant, the Couli (interstices) will become firm, the Spleen and Stomach will strengthen, and normal diet will resume, allowing the deficiency syndrome to transform into an excess syndrome. Conversely, excessive tonification may aggravate the condition. For instance, after the pus has sufficiently formed, continued heavy use of Ginseng may lead to rapid asthma and abdominal distension. Overuse of Wuling San (Poria Powder) and Muxiang San may cause constipation. Excessive use of Dinggui (Syzygii Aromatisati Fructus and Cinnamomi Cortex) and other acrid-warm agents may result in sore throat, swelling, irritability, oppression, and thirst. Although symptoms such as rapid asthma, abdominal distension, hard and constipated stool, irritability, and sore throat present as excess syndromes, they are actually due to shallow pathology treated with overly deep or aggressive medication, rather than true excess syndromes. Therefore, strong purgative or draining methods should not be applied; otherwise, the newly recovered Qi will become deficient again, potentially leading to Collapse Syndrome (Tuozheng).