初出涌壮者不治。出如蚕种者不治。
随出随没者不治。如蚊虫咬者不治。
气血相失者不治。倒出者不治。
饮水如促鼻者不治。以肺气不能疏理也。
轻者热轻痘亦稀。大小后先出不齐。根窠红活疮肥满。饮食如常勿药宜。重者热中疮并
出。密如蚕种若胭脂。根白顶红并紫黑。若逢血活尚堪医。
保元汤
人参（去芦二钱） 嫩黄 （三钱） 甘草（一钱）
上锉一剂。生姜一片。水煎。温服。
一当起胀而不起。用穿山甲炒成珠。研为末二钱。酒调服。
一血弱不起。根底淡薄。以保元汤加丁香三粒。肉桂一钱。当归二钱。川芎一钱。水煎
温服。
一二日初出。圆晕成形。干红少润。毒虽犯上。其气血未离。以俟其气血交会也。然
毒尚
浅。急以保元汤加官桂。活血匀气之剂。如毒太盛。兼解毒之药。活血。加当归五分。白芍
一钱。匀气。加陈皮五分。解毒。加元参七分。牛蒡子炒七分。水一盏。煎七分。温服。
二三日根窠虽圆。而顶陷者。血亦难聚。为气虚弱。不能领袖其血也。以保元汤加川芎
、官
桂。扶阳抑阴。岂有不痊者哉。四五日根窠虽起。色不光泽。生意犹存。为气弱血盛。以保
元汤加芍药、官桂、糯米。助卫制荣。斯为调变之妙也。
五六日气盈血弱。色昏红紫。以保元汤加木香、当归、川芎。助血归附气位。以全中和
之道也。
六七日气交不旺。血虽归附。不能成浆。为气血少。寒不能制。急投保元汤加官桂、糯
米。助其成浆。而收济惠之伟功。斯为治矣。
七八日毒虽化而浆不满。为气血有凝。不能大振。以保元汤加官桂、糯米。发阳助浆。
可以保全生命矣。
一痘至此。专主贯脓。脓已满。虽有他症。不致坏事。若痘无脓。灰暗。虽无他症。亦
死矣。
一痘疮至八九日。视痘顶心上有点如水珠。见出此痘漏。无药可医。乃死症也。
八九日浆不充满。血附线红。气弱而险也。以保元汤加糯米。以助其气而驾其血。斯浆
成矣。
十一二日气血充满。血尽浆足。湿润不敛者。内虚也。以保元汤。血亦有力。加白术、
茯苓。助其收敛而结痂也。
十三四日。毒虽尽解。浆老结痂之际。或有杂症相仍。以保元汤随症加减。不可峻用寒
凉大热之剂。恐致内损之患故也。
十四五六日。痂落。潮热唇红。口渴不食。以四君子汤加陈皮、山楂、黄连。如渴甚。
用参
苓白术散。如热不解。以大连翘饮去黄芩主之。症去之后。多有内损。或余毒未解。此则尤
为难治也。
凡痘疮发渴者。为虚弱而津液枯竭也。保元汤加麦门冬、五味子即止。如不止。以参苓
白术散。一二剂即止。
凡痘疮不起发。脓浆不浓。保元汤加川芎五分。丁香四分。（夏月二分）糯米二百粒。煎
熟。好酒人乳各半盏。加入同服。
若头额不起胀。加川芎六分为引。若面部不起胀。加升麻四分为引。若胸膈不起胀。加
桔梗四分为引。若两膝不起胀。加牛膝四分为引。若两手不起胀。加桂枝二分为引。
一论痘疮。胃虚不进饮食。或口干发渴。或吐泻等症。
参苓白术散
人参 白术（去芦炒） 白茯苓（去皮） 甘草（炙） 白扁豆（炒） 莲肉（去心） 山药（炒
各一钱五分） 桔梗（八分） 薏苡仁（八分） 砂仁（七分）
上为细末。每服五六分。或一钱。红枣煎汤调下。或姜汤亦可。
初出即呈现壮盛形态的痘疮，属于不治之症。痘点像蚕种一样细小的，属于不治之症。
刚冒出来随即消退隐没的，属于不治之症。痘形像蚊虫叮咬痕迹的，属于不治之症。
气血相互离失的，属于不治之症。痘毒倒陷内收的，属于不治之症。
饮水时气息急促、如同鼻塞不通畅的，属于不治之症。这是因为肺气不能疏理通畅的缘故。
病情轻浅的，发热轻微，痘疹稀疏。痘疹大小不一，先后出出不齐整。痘根红活，疮体丰满。饮食正常，无需用药即可痊愈。病情严重的，发热较重，痘疹密集并发。稠密如蚕种，颜色红艳如胭脂。痘根发白，顶部呈红色或紫黑色。如果遇到血行通畅的情况，尚可医治。
保元汤（Bao Yuan Tang, Preserved Origin Decoction）
人参（去除芦头，二钱） 嫩黄芪（三钱） 甘草（一钱）
以上药材锉碎为一剂。加入生姜一片，加水煎煮。温服。
第一种情况：痘疮应当起胀却不起胀。用穿山甲炒至成珠状，研为细末，每次二钱，用酒调服。
第二种情况：血气虚弱导致不起胀，痘根底部淡薄。在保元汤中加入丁香三粒，肉桂一钱，当归二钱，川芎一钱，加水煎煮后温服。
第三种情况：发病一二日，痘疮初出，圆晕成形，干燥红润但缺乏润泽。虽然毒邪侵犯上部，但气血尚未离散。应等待其气血交会。此时毒邪尚浅，急需用保元汤加入官桂，作为活血匀气的方剂。如果毒邪太盛，兼用解毒药物。活血方面，加当归五分，白芍一钱；匀气方面，加陈皮五分；解毒方面，加玄参七分，牛蒡子炒制七分。用水一盏，煎至七分，温服。
第四种情况：发病二三日后，痘根虽圆，但顶部凹陷，血液也难以聚集。这是由于气虚弱，不能统领血液所致。使用保元汤加入川芎、官桂，以扶助阳气、抑制阴寒，哪有不能痊愈的道理呢？
第五种情况：发病四五日，痘根虽已隆起，但色泽不光泽，生机尚存。这是气弱血盛的缘故。使用保元汤加入芍药、官桂、糯米，以助卫气、制约营血。这便是调理变化的妙法。
第六种情况：发病五六日，气盛血弱，颜色昏红紫暗。使用保元汤加入木香、当归、川芎，帮助血液归附于气的位置，以保全中和之道。
第七种情况：发病六七日，气机交接不旺盛，血液虽已归附，但不能化脓成浆。这是因为气血不足，寒气不能制约。急需服用保元汤加入官桂、糯米，帮助其成浆，从而发挥救济的巨大功效。这才是治疗的方法。
第八种情况：发病七八日，毒邪虽已化解但脓浆不满，是因为气血有凝滞，不能大振。使用保元汤加入官桂、糯米，发散阳气、帮助成浆，可以保全生命了。
第九种情况：痘疮发展至此阶段，主要任务是贯脓。如果脓液已满，即使有其他症状，也不会导致坏事。如果痘疮无脓，颜色灰暗，即使没有其他症状，也会导致死亡。
第十种情况：痘疮发展到八九日，观察痘顶心上有如水珠般的斑点，出现这种情况说明痘疮漏泄，无药可医，属于死症。
第十一种情况：八九日时浆液不充满，血附线呈红色，这是气弱而危险的征象。使用保元汤加入糯米，以助其气而驾驭其血，这样浆液就能形成了。
第十二种情况：十一二日时，气血充满，血尽浆足，湿润而不收敛，这是内部虚弱的表现。使用保元汤，若血亦有力，则加入白术、茯苓，帮助其收敛并结痂。
第十三种情况：十三四日时，毒邪虽已完全解除，处于浆老结痂之际，或有杂症相继出现。使用保元汤随症加减，不可峻烈地使用大寒大热的药剂，恐怕会导致内部损伤的祸患。
第十四种情况：十四五六日时，痂皮脱落，出现潮热、嘴唇红、口渴、不想进食的症状。使用四君子汤加入陈皮、山楂、黄连。如果口渴严重，使用参苓白术散。如果热势不退，使用大连翘饮去掉黄芩为主方。症状消除之后，多有内部损伤，或余毒未解，这尤其难以治疗。
第十五种情况：凡是痘疮发作口渴的，是因为虚弱而津液枯竭。保元汤加入麦门冬、五味子即可止渴。如果不止，使用参苓白术散，一两剂即可停止。
第十六种情况：凡是痘疮不起发，脓浆不浓稠。保元汤加入川芎五分，丁香四分（夏季二分），糯米二百粒，煎熟后，加入好酒和人乳各半盏，混合同服。
第十七种情况：如果额头不起胀，加川芎六分作为引经药。如果面部不起胀，加升麻四分作为引经药。如果胸膈不起胀，加桔梗四分作为引经药。如果两膝不起胀，加牛膝四分作为引经药。如果两手不起胀，加桂枝二分作为引经药。
第十八种情况：论述痘疮因胃虚而不进饮食，或口干发渴，或呕吐腹泻等症状。
参苓白术散 (Shen Ling Bai Zhu San, Ginseng, Poria and Atractylodes Macrocephala Powder)
人参 白术（去除芦头炒制） 白茯苓（去皮） 甘草（炙烤） 白扁豆（炒制） 莲肉（去心） 山药（炒制，各一钱五分） 桔梗（八分） 薏苡仁（八分） 砂仁（七分）
以上药材研为细末。每次服用五六分或一钱，用红枣煎汤送服，或用姜汤送服亦可。
Those whose pustules appear initially in a vigorous and robust manner are incurable. Those whose pustules appear as small as silkworm eggs are incurable.
Those that emerge and then immediately disappear are incurable. Those resembling mosquito bites are incurable.
Those where Qi and Blood have lost their mutual connection are incurable. Those with inverted eruption (Dao Chu) are incurable.
Those who experience rapid breathing when drinking water, as if nasal congestion is obstructing them, are incurable. This is because the Lung Qi cannot disperse and regulate properly.
In mild cases, fever is slight and pustules are sparse. They vary in size and erupt irregularly in sequence. The roots are red and vibrant, and the sores are plump. Diet remains normal, and medication is unnecessary for recovery. In severe cases, fever is moderate to high, and sores erupt densely together. They are crowded like silkworm eggs and red like rouge. The roots are white, while the tops are red or purple-black. If blood circulation is active, they can still be treated.
Bao Yuan Tang (Preserved Origin Decoction)
Ren Shen (Ginseng Radix, rhizome removed, 2 qian)
Nen Huang Qi (Young Astragali Radix, 3 qian)
Gan Cao (Licorice Root, 1 qian)
Crush these ingredients into one dose. Add one slice of fresh ginger, decoct with water, and take warm.
First scenario: When pustules should swell but do not. Use Pang Shan Jia (Pangolin Scales) fried until pearl-like, ground into powder, 2 qian per dose, taken with wine.
Second scenario: Weakness of Blood and Qi prevents swelling, with pale and thin roots. Add Ding Xiang (Clove Bud, 3 grains), Rou Gui (Cinnamon Bark, 1 qian), Dang Gui (Angelicae Sinensis Radix, 2 qian), and Chuan Xiong (Ligusticum Chuanxiong Rhizome, 1 qian) to Bao Yuan Tang. Decoct with water and take warm.
Third scenario: On the first or second day, pustules emerge with defined circular halos, dry and red but lacking moisture. Although toxins affect the upper body, Qi and Blood have not yet separated. Wait for their intersection. Since the toxin is still shallow, urgently use Bao Yuan Tang with Guan Gui (Cinnamon Twig) as a formula to invigorate blood and harmonize Qi. If the toxin is too strong, add detoxifying herbs. For invigorating blood, add Dang Gui (0.5 qian) and Bai Shao (White Peony Root, 1 qian). For harmonizing Qi, add Chen Pi (Tangerine Peel, 0.5 qian). For detoxification, add Yuan Shen (Scrophulariae Radix, 0.7 qian) and Niu Bang Zi (Arctii Fructus, fried, 0.7 qian). Decoct one cup of water to seven-tenths, and take warm.
Fourth scenario: On the second or third day, although the root is round, the top is depressed, making it difficult for blood to gather. This is due to weak Qi failing to lead the blood. Use Bao Yuan Tang with Chuan Xiong and Guan Gui to support Yang and suppress Yin. How could such a case fail to recover?
Fifth scenario: On the fourth or fifth day, the root has risen, but the color lacks luster, though vitality remains. This indicates weak Qi and abundant Blood. Use Bao Yuan Tang with Shao Yao (Peony Root), Guan Gui, and Nuomi (Glutinous Rice) to assist Wei Qi (Defensive Qi) and control Ying Blood (Nutritive Blood). This is the subtle art of regulation.
Sixth scenario: On the fifth or sixth day, Qi is abundant while Blood is weak, resulting in a dull red-purple color. Use Bao Yuan Tang with Mu Xiang (Aucklandiae Radix), Dang Gui, and Chuan Xiong to help blood return to its proper position under Qi, thereby preserving the Way of Harmony.
Seventh scenario: On the sixth or seventh day, Qi transition is not vigorous. Although blood has returned, it cannot form pus. This is due to deficiency of Qi and Blood, allowing cold to prevail uncontrollably. Urgently take Bao Yuan Tang with Guan Gui and Nuomi to assist in forming pus, achieving great remedial effects. This constitutes proper treatment.
Eighth scenario: On the seventh or eighth day, although toxins have transformed, pus is incomplete due to stagnation of Qi and Blood, preventing vigorous recovery. Use Bao Yuan Tang with Guan Gui and Nuomi to disperse Yang and assist pus formation, thereby preserving life.
Ninth scenario: At this stage, the focus is on pus formation. If pus is full, other symptoms will not cause harm. If there is no pus and the color is gray and dark, death will occur even without other symptoms.
Tenth scenario: By the eighth or ninth day, if a water-drop-like spot appears at the center of the pustule head, indicating leakage, it is incurable and constitutes a fatal syndrome.
Eleventh scenario: On the eighth or ninth day, if pus is not full and the blood attachment line is red, it indicates weak Qi and danger. Use Bao Yuan Tang with Nuomi to assist Qi and manage Blood, so that pus can form.
Twelfth scenario: On the eleventh or twelfth day, Qi and Blood are abundant, blood is exhausted, and pus is sufficient. If moist but not converging, it indicates internal deficiency. Use Bao Yuan Tang; if blood strength is adequate, add Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Fu Ling (Poria), to aid convergence and scabbing.
Thirteenth scenario: On the thirteenth or fourteenth day, although toxins are fully resolved and pus is maturing into scabs, miscellaneous symptoms may persist. Modify Bao Yuan Tang according to symptoms. Do not harshly use extreme cold or hot formulas, lest they cause internal damage.
Fourteenth scenario: On the fifteenth to sixteenth days, after scabs fall off, tidal fever, red lips, thirst, and anorexia may occur. Use Si Jun Zi Tang (Four Gentlemen Decoction) with Chen Pi, Shan Zha (Hawthorn Fruit), and Huang Lian (Coptidis Rhizoma). If thirst is severe, use Shen Ling Bai Zhu San. If fever persists, use Da Lian Qiao Yin (Great Forsythia Decoction) without Huang Qin (Scutellariae Radix). After symptoms resolve, internal damage often remains, or residual toxins persist, making treatment particularly difficult.
Fifteenth scenario: Thirst during chickenpox/smallpox eruption is caused by weakness and depletion of body fluids. Bao Yuan Tang with Mai Men Dong (Ophiopogonis Tuber) and Wu Wei Zi (Schisandrae Fructus) will stop it. If it does not stop, Shen Ling Bai Zhu San for one or two doses will suffice.
Sixteenth scenario: For eruptions that fail to rise and produce thick pus, add Chuan Xiong (0.5 qian), Ding Xiang (0.4 qian; 0.2 qian in summer), and 200 glutinous rice grains to Bao Yuan Tang. Decoct well, then mix with half a cup of good wine and half a cup of human milk, and take together.
Seventeenth scenario: If the forehead fails to swell, add Chuan Xiong (0.6 qian) as a guiding herb. If the face fails to swell, add Sheng Ma (Cimicifugae Rhizoma, 0.4 qian) as a guide. If the chest and diaphragm fail to swell, add Jie Geng (Platycodonis Radix, 0.4 qian) as a guide. If both knees fail to swell, add Niu Xi (Achyranthis Bidentatae Radix, 0.4 qian) as a guide. If both hands fail to swell, add Gui Zhi (Cinnamomi Ramulus, 0.2 qian) as a guide.
Eighteenth scenario: Discussion on gastric deficiency leading to loss of appetite, dry mouth, thirst, vomiting, or diarrhea during eruption.
Shen Ling Bai Zhu San (Ginseng, Poria and Atractylodes Macrocephala Powder)
Ren Shen (Ginseng Radix)
Bai Zhu (Atractylodis Macrocephalae Rhizoma, rhizome removed and stir-fried)
Bai Fu Ling (Poria, peeled)
Gan Cao (Licorice Root, honey-fried)
Bai Bian Dou (Dolichoris Semen, stir-fried)
Lian Rou (Lotus Seed, heart removed)
Shan Yao (Dioscoreae Rhizoma, stir-fried; each 1.5 qian)
Jie Geng (Platycodonis Radix, 0.8 qian)
Yi Yi Ren (Coicis Semen, 0.8 qian)
Sha Ren (Amomi Fructus Rotundus, 0.7 qian)
Grind all into fine powder. Take 0.5–1 qian per dose, mixed with decoction of red dates or ginger tea.