痘之一症，先贤立论甚详。但近时气候变迁，竟有不同于向日者，莫甚于伏毒，而为时疠壅遏。初起寒热悠悠，腰
腹并无痛楚，两潮而见点，亦色润而形单。并非要害之处，身热未解，得嚏便通。根窠虽立，不易掀发。一到三朝，神
蒙气喘，斑点全无，唇不肿而口不渴，火伏内攻，迅如反掌，痘未退缩，即已喘闭告竭。虽多识者，进以芳香双解，大
剂劫夺，一无奏绩，亦未如之何也已矣。
《内经·气交变大论》详言岁运，《六元正纪大论》详言司天在泉，而今似有不验者，何欤？盖岁运已分太少，而一
岁之中，再分为五运，五运之中，又分主客，主客之中，又分太少司天在泉，再与间气分而为六，六气之中，又分主客，
是每候中必有岁运与司天、在泉，及主运、客运、主气、客气六者矣。角、征、宫、商、羽，与风、火、湿、燥、寒，
杂合于一时，变化靡穷。无怪执岁运之说者，司天在泉不验，执司天在泉之说者，岁运不验，执五运六气之说者，岁运
与司天在泉皆不验，几疑古圣贤书为不可尽信矣。不知五运六气，《经》文虽逐一分言，而未及合参之理；然《天元纪》、
《六微旨》二篇，论至天符岁会，则参合而言。如天符乃岁运，与司天相会，奉天行令而主半年，譬之相辅也，故曰执
法也。故中其病者，危而速也。岁会乃岁运与年辰相会，犹为平气，而主一年，譬之方伯也，故曰行令也。故中其病者，
徐而持也。至于太乙天符，则司天、岁运、年辰三者会合，偏盛极焉。故中其病者，暴而死也。吾侪在医喻医，如一方
中纯寒纯热，其性自偏，服之未有不验者。其非天符、岁会之年，五行错杂，犹之一方中苦辛相制，寒热杂陈，则气味
皆轻，自不觉其利害耳。天符、岁会如此，可知五运六气亦须参合以类推矣。《内经》未言及此者，提其纲而略其目也。
然余更有说者，《经》言中执法者，其病速而危；中行令者，其病徐而持；中贵人者，其病暴而死。曰中、曰其，乃指偏
胜之时，即中此偏胜之邪，于是其病如斯，非泛言其年得病，无论风、寒、暑、湿、燥、火，一概如此断也。况偏胜之
时，虽必有其邪，亦非举世之人而尽中之也。或起居不慎，或寒暖失宜，凡属外感皆然。再壮者气行则散，怯者着而为
病，则是中其邪者，本非常有，何谓《经》文之不验耶？愚意以为运气之说如此。抑更有释天符太乙之说者，谓非一年
之病皆然，当以得病之一日为言，如戊子日亦称天符，戊午日即为太乙，似乎近理，而与中、其二字，究隔一层，仍当
作值其日而中其邪，或合以其年其日而中其邪，如此推之，窃谓断无不验者。
痘疮这一病症，先贤们的论述非常详尽。但是近来的气候发生了变化，竟然有不同于从前的情况，其中最严重的就是伏毒，导致时行疠气壅滞遏阻。发病初期，寒热往来不定，腰部和腹部都没有疼痛感，经过两个周期（或指两潮）后出现痘点，痘点颜色润泽且形态孤立稀疏。痘点并非长在要害部位，身体发热仍未解除，打个喷嚏后气机便通畅。痘根虽然形成，但难以隆起透发。到了第三天，患者神志昏蒙、气喘吁吁，斑点完全隐没不见，嘴唇不肿胀、口不渴，这是火毒潜伏在内攻冲，变化迅速如翻手掌之间，痘疹尚未消退，就已经出现喘促闭塞、正气衰竭的危象。即使是很多有经验的高明医生，使用芳香开窍、表里双解的方法，或者用大剂量的峻猛药物强行攻逐，也毫无疗效，对此也无能为力了。
《黄帝内经·气交变大论》详细阐述了岁运，《六元正纪大论》详细阐述了司天和在泉的理论，但现在似乎有些不应验了，为什么呢？大概是因为岁运已经分为了太乙和少阴（太少），而在一年之中，又再分为五运；在五运之中，又分为主运和客运；在主运和客运之中，又分为主气和客气以及司天在泉的太少之分，再与间气配合分为六气；在六气之中，又分为主气和客气。这样，每一个节气（候）中必然包含岁运、司天、在泉、主运、客运、主气、客气这六种因素。角、徵、宫、商、羽五音，与风、火、湿、燥、寒五行之气，混杂融合于同一时期，变化无穷无尽。难怪那些执着于岁运说法的人，觉得司天在泉理论不应验；执着于司天在泉说法的人，觉得岁运不应验；执着于五运六气整体说法的人，觉得岁运和司天在泉都不应验，几乎让人怀疑古代圣贤的书籍不能完全相信了。不知道五运六气，《内经》原文虽然逐一分别论述，但没有提到综合参详的道理；然而《天元纪大论》、《六微旨大论》两篇，论述到“天符”、“岁会”时，则是综合而言的。比如“天符”是岁运与司天相会合，奉承天的命令而主宰半年，好比辅佐之臣，所以称为“执法”。因此，遇到这种运气致病的人，病情危急且发展迅速。“岁会”是岁运与年支相会合，还算作平气，主宰一年，好比一方长官，所以称为“行令”。因此，遇到这种运气致病的人，病情进展缓慢且持久。至于“太乙天符”，则是司天、岁运、年支三者会合，偏盛达到极点。因此，遇到这种运气致病的人，病情暴烈且致死。我们作为医生来理解医学，就像一方药中纯寒或纯热，其药性自然偏颇，服用后没有不应验的。如果不是天符、岁会的年份，五行之气错杂混合，就像一方药中苦味和辛味相互制约，寒性和热性杂乱陈列，那么气味都变得轻微，自然不觉察到它的利害罢了。天符、岁会的情况如此，可知五运六气也必须综合参详以类推其他情况。《内经》没有提及这一点，是因为它提纲挈领地提出了纲领而略去了细节。然而我还有进一步的解释，《内经》说遇到“执法”之气，病势急骤而危险；遇到“行令”之气，病势缓慢而持久；遇到“贵人”之气，病势暴烈而致死。“中”、“其”这两个字，是指偏胜之时，即中了这种偏胜的邪气，于是病情就是这样，并不是泛泛地说这一年得病，无论风、寒、暑、湿、燥、火，一概如此判断。况且偏胜之时，虽然必定有其邪气，但也并非世上所有人都被击中。或者起居不慎，或者冷暖失调，凡是属于外感病都是这样。再者，体质强壮的人，气机运行则邪气消散；体质虚弱的人，邪气留着而成为疾病。那么中了这种邪气的人，本来就不是经常有的事，为什么说《内经》的记载不应验呢？我的意思是运气学说应当如此理解。另外还有一种解释“天符”、“太乙”的说法，认为不是一年的病都这样，应当以得病的那一天来说，比如戊子日也称为天符，戊午日即为太乙，这似乎合乎情理，但与“中”、“其”二字相比，终究隔了一层，仍然应当理解为值遇那一天而中了邪气，或者结合那一年那一天的运气而中了邪气，这样推演下去，我认为断然没有不应验的。
The disease of smallpox has been discussed in detail by ancient sages. However, due to recent changes in climate, there are cases that differ significantly from the past, most notably those involving latent toxins (latent pathogenic factors) obstructed by epidemic pestilence (epidemic pathogenic qi). At the onset, there is alternating chills and fever without pain in the waist or abdomen. After two cycles (or tidal phases), spots appear; they are moist in color and sparse in form. They do not occur in critical areas. The body heat remains unresolved, but clears up after sneezing. Although the base of the pustule forms, it is difficult to raise and erupt. By the third day, the patient suffers from mental confusion and asthma (wheezing with shortness of breath), while the macules and papules completely disappear. The lips are not swollen, and there is no thirst. This indicates fire toxin (heat pathogen) lurking internally and attacking inwardly, changing as swiftly as flipping a hand. Before the smallpox lesions can recede, the patient already presents with asthmatic closure (severe wheezing and airway obstruction) and exhaustion of vital energy. Even experienced physicians, using aromatic dual-resolving methods (aromatic herbs to open orifices and resolve exterior-interior pathogens) or large doses of drastic purgatives, achieve no effect and are helpless.
The *Neijing* (Classic of Internal Medicine) · Chapter on Changes in the Interaction of Qi (*Qi Jiao Bian Da Lun*) details the Annual Motion (Sui Yun), and the Chapter on the Correct Principles of the Six Origins (*Liu Yuan Zheng Ji Da Lun*) details the Sovereign Heaven (Si Tian) and Nether Heaven (Zai Quan). Yet now, these theories seem inapplicable in some respects. Why? It is because the Annual Motion is divided into Taiyi (Great Yang/Excess) and Shaoyin (Lesser Yin/Deficiency). Within a year, it is further divided into Five Motions (Wu Yun); within the Five Motions, there are Host Motion (Zhu Yun) and Guest Motion (Ke Yun); within Host and Guest motions, there are distinctions based on Taiyi/Shaoyin for Sovereign Heaven and Nether Heaven, which are then combined with Intercalary Qi (Jian Qi) to form the Six Qi (Liu Qi). Within the Six Qi, there are again Host Qi and Guest Qi. Thus, each period (Hou) necessarily contains six factors: Annual Motion, Sovereign Heaven, Nether Heaven, Host Motion, Guest Motion, Host Qi, and Guest Qi. The five tones (Jue, Zhi, Gong, Shang, Yu) and the five elements (Wind, Fire, Dampness, Dryness, Cold) mix together at any given time, resulting in endless variations. No wonder those who adhere strictly to the theory of Annual Motion find Sovereign Heaven and Nether Heaven inapplicable; those adhering strictly to Sovereign Heaven and Nether Heaven find Annual Motion inapplicable; and those adhering to the comprehensive theory of Five Motions and Six Qi find both Annual Motion and Sovereign Heaven/Nether Heaven inapplicable. This leads one to suspect that the books of ancient sages cannot be entirely trusted. However, although the *Neijing* discusses Five Motions and Six Qi separately, it does not explicitly state the principle of comprehensive reference. In the chapters *Tian Yuan Ji Da Lun* and *Liu Wei Zhi Da Lun*, when discussing "Tian Fu" (Heavenly符/Synergy) and "Sui Hui" (Annual Meeting), they are discussed in conjunction. For instance, "Tian Fu" occurs when the Annual Motion meets with Sovereign Heaven, executing the Heavenly mandate for half a year, akin to an assisting minister; thus it is called "Executing Law" (Zhi Fa). Therefore, those affected by this pattern suffer from critical and rapid illness. "Sui Hui" occurs when the Annual Motion meets with the Earthly Branch of the year, representing a Balanced Qi (Ping Qi) governing the whole year, akin to a regional governor; thus it is called "Executing Order" (Xing Ling). Therefore, those affected suffer from slow and persistent illness. "Tai Yi Tian Fu" occurs when Sovereign Heaven, Annual Motion, and the Earthly Branch converge, leading to extreme excess. Therefore, those affected suffer from sudden and fatal illness. We doctors should understand this medically: just as a prescription containing purely cold or purely hot herbs has a biased nature and will inevitably show effects, so too do these energetic patterns. In years that are not Tian Fu or Sui Hui, the Five Elements are mixed, similar to a prescription where bitter and acrid flavors counteract each other, and cold and hot properties are intermingled; the medicinal qualities become mild, and their harmful or beneficial effects are not readily perceived. Since this applies to Tian Fu and Sui Hui, it follows that Five Motions and Six Qi must also be comprehensively referenced for deduction. The *Neijing* omitted this detail by providing the outline while omitting the specifics. Furthermore, I have another explanation: The *Neijing* states that meeting "Executing Law" results in rapid and critical illness; meeting "Executing Order" results in slow and persistent illness; meeting "Noble Person" (Gui Ren) results in sudden death. The characters "Zhong" (to strike/meet) and "Qi" (its/her) refer to the time of excessive dominance, meaning contracting this dominant pathogen causes such illness. It does not mean that everyone getting sick in that year, regardless of whether the pathogen is Wind, Cold, Summer-heat, Dampness, Dryness, or Fire, will follow this rule uniformly. Moreover, during times of dominance, although the pathogen exists, it does not affect everyone. Whether due to careless living habits or improper temperature regulation, all external contractions are subject to individual constitution. Those with strong Qi disperse the pathogen through circulation; those with weak Qi retain it and fall ill. Thus, contracting such specific pathogenic influences is not common. Why claim the *Neijing* is inapplicable? My view is that the theory of Luck (Yun Qi) should be understood this way. Additionally, some interpret "Tian Fu" and "Tai Yi" not as applying to the whole year's illnesses, but specifically to the day of onset—for example, Wu Zi days are called Tian Fu, and Wu Wu days are Tai Yi. While this seems reasonable, it still differs slightly from the nuance of "Zhong" and "Qi." It is better interpreted as encountering the specific day and contracting the corresponding pathogen, or combining the year and day's energies to contract the pathogen. By deducing in this manner, I believe there will be no instances of inapplicability.