凡痘灰白不红绽。不起发。出不快。昏暗顶陷。皆表寒而虚。二便清。身凉。手足口气俱冷。
不渴少食。唇白涕清。饮食不化。皆里虚而寒。此表里虚寒之证。急宜温脾胃补气血。当用参、 、
归、术、木香、肉桂等药。以助灌脓收靥。夫表虚者。以补气为主。补血次之。里虚者。于补血
之中须兼补气。使胃气条畅。脾气壮实。在后必无陷伏之忧。苟能补气。则血亦周流。送毒出尽。
不致凝滞。在后必无痒塌之患。凡红紫干滞。黑陷焦枯者。皆表热而实。大便秘结。小便赤涩。身
热鼻干。唇燥烦渴者。皆里热而实。此表里实热之证。急宜凉血解毒。当用紫草、红花、连翘、
鼠粘、木通、蝉蜕、荆芥。甚则芩、连之类。如表热者。则宜清凉解表而分利次之。里热者。重
于解毒而兼清凉。如在二三日之前。热毒盛者。以硝、黄微下
之。盖凉血不至于干紫。解毒则免于黑陷。如表虚不补。则成外剥。里虚不补。则成内攻。表实
过补。则不结痂。里实过补。则发痈毒。所以痘证变迁不常。若色一转。又当变通。不可拘于一定也。
夫气有生血之功。血无益气之理。故气不可亏。亏则阳位不及。而痘之圆晕之形不成。血不
可盈。盈则阴乘阳位。而痘之倒 之祸立至。是以治虚证。必当补气为先。盖气有神而无形。补
之则易充。血有形而无神。补养难收速效。况气阳而血阴。阴从阳。血从气。理也。故补气不补
血。使气盛而充。血亦随之而盛矣。何谓气血虚实。且如气过热则泡。血过热则斑。气不及则顶
陷不起。血不及则浆毒不附。凡痘色淡白。顶不坚实。不碍手。不起胀。皆属气虚。宜保元汤倍
黄加肉桂、丁香。人乳与酒酿同服。根窠不红不紧束。或红而散阔。以手摸过即转白。毫毛竖
起。枯槁不活者。皆血虚也。保元汤加芎、归、红花及山楂以行参、 之滞。木香以散滞气。而
血自活也。凡用黄 。当在痘出尽之后。凡用热药。当看毒尽解之时。更察气血之虚实偏胜而治
之。则药无不效矣。凡补血。首尾用地黄。防滞血必用姜制。用芍药恐酸寒伐胃。必用酒炒以抑
其润下之性。借酒力而行之达表也。
凡是痘疹颜色灰白、不红润、不舒展隆起，发出不顺畅，痘顶昏暗凹陷的，都属于表寒且虚证。二便清长，身体凉爽，手足和口气都冰冷，口不渴、食欲减退，嘴唇苍白、鼻涕清稀，饮食不能消化，都属于里虚且寒证。这是表里俱虚寒的证候，应当紧急温补脾胃、补益气血，应当使用人参、黄芪、当归、白术、木香、肉桂等药物，以助痘浆灌注和结痂收靥。对于表虚的，以补气为主，补血为辅；对于里虚的，在补血之中必须兼用补气，使胃气条达通畅，脾气强壮坚实，后期必然没有痘毒内陷的忧虑。如果能够补气，那么血液也能周流全身，将毒邪送尽，不至于凝滞，后期必然没有瘙痒塌陷的祸患。凡是痘色红紫、干燥滞涩，或黑陷焦枯的，都属于表热且实证。大便秘结，小便赤黄涩痛，身体发热，鼻干，嘴唇干燥，烦躁口渴的，都属于里热且实证。这是表里俱实热的证候，应当紧急凉血解毒，应当使用紫草、红花、连翘、牛蒡子、木通、蝉蜕、荆芥，严重时可用黄芩、黄连之类。如果是表热，则宜用清凉解表的方法，分利小便次之；如果是里热，则重在解毒并兼用清凉之法。如果在发病二三日之前，热毒炽盛的，可以用大黄、芒硝轻微攻下。因为凉血可以防止痘色干紫，解毒可以避免痘色黑陷。如果表虚不补，就会形成外剥（痘疮破溃）；里虚不补，就会形成内攻（毒邪内陷脏腑）。表实过补，就不会结痂；里实过补，就会引发痈毒。所以痘证的变迁无常，如果颜色发生转变，又应当灵活变通，不可拘泥于固定的法则。
气有生血的功效，血没有益气的作用。所以气不可亏损，亏损则阳气不能到达体表，导致痘疹圆晕的形状无法形成；血不可过盈，过盈则阴邪乘袭阳位，导致痘疹倒靥（痘疮塌陷）的灾祸立刻到来。因此治疗虚证，必须以补气为先。因为气具有神机但没有固定形态，补益它容易充盈；血具有形体但没有神机，补养它难以迅速见效。况且气属阳而血属阴，阴随阳动，血随气行，这是常理。所以只补气而不补血，使气盛而充盈，血也会随之旺盛。什么是气血虚实呢？例如气过热则出现水泡，血过热则出现斑疹；气不足则痘顶凹陷不起，血不足则浆液和毒邪不能附着。凡是痘色淡白，痘顶不坚实，摸之不碍手，不起胀的，都属于气虚，适宜用保元汤加倍黄芪，加入肉桂、丁香，配合人乳和酒酿一同服用。痘根周围不红且不紧束，或者发红但散漫宽阔，用手抚摸后即转白，毫毛竖立，干枯无生机的，都属于血虚。保元汤中加入川芎、当归、红花以及山楂以行参、芪之滞气，加入木香以疏散滞气，那么血自然流通。凡是使用黄芪，应当在痘疹出尽之后。凡是使用热药，应当看毒邪完全解除之时，再察看病人的气血虚实偏胜情况来治疗，那么药物就没有不生效的。凡是补血，首尾阶段用地黄，防止瘀滞必须用生姜炮制；使用芍药恐怕其酸寒之性损伤胃气，必须用酒炒以抑制其润下的性质，借助酒力使其药势通达体表。
Whenever the smallpox lesions are grayish-white, not red or vibrant, do not elevate or spread out, erupt slowly, appear dull with depressed tops, these all indicate exterior cold and deficiency. Clear urine and stool, cool body temperature, cold hands, feet, and breath, absence of thirst, reduced appetite, white lips, clear nasal discharge, and indigestion all indicate interior deficiency and cold. This is a syndrome of exterior and interior deficiency-cold. It is urgent to warm the spleen and stomach and tonify qi and blood. One should use herbs such as Renshen (Ginseng Radix), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Muxiang (Aucklandiae Radix), and Rougui (Cinnamomi Cortex) to assist in filling the pustules and forming scabs. For exterior deficiency, tonifying qi is primary, while tonifying blood is secondary. For interior deficiency, one must combine qi tonification within blood tonification, ensuring the stomach qi flows smoothly and spleen qi becomes robust, thereby avoiding the worry of toxin collapse later on. If qi is tonified, blood will also circulate freely, expelling toxins completely without stagnation, thus avoiding itching and collapsing lesions later. Whenever the lesions are red-purple, dry and stagnant, or black and depressed with scorched appearance, these all indicate exterior heat and excess. Constipation, dark and scanty urine, fever, dry nose, dry lips, and irritability with thirst all indicate interior heat and excess. This is a syndrome of exterior and interior excess-heat. It is urgent to cool the blood and resolve toxicity. One should use herbs such as Zicao (Arnebiae Radix seu Rhizoma), Honghua (Carthami Flos), Lianqiao (Forsythiae Fructus), Niuniangzi (Arctii Fructus), Mutong (Akebiae Caulis), Chantui (Cicadae Periostracum), and Jingjie (Schizonepetae Herba). In severe cases, herbs like Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) may be used. If it is exterior heat, cooling and resolving the exterior is appropriate, followed by promoting urination. If it is interior heat, the focus is on resolving toxicity combined with cooling. If before the second or third day, heat-toxin is vigorous, mild purgation using Dahuang (Rhei Radix et Rhizoma) and Mangxiao (Natrii Sulfas) can be applied. Cooling blood prevents dryness and purple discoloration; resolving toxicity prevents black depression. If exterior deficiency is not tonified, external ulceration occurs; if interior deficiency is not tonified, internal attack by toxins occurs. Over-tonification in exterior excess leads to failure to form scabs; over-tonification in interior excess leads to carbuncles and sores. Therefore, the changes in smallpox are unpredictable. If the color changes, treatment must be adjusted accordingly; one cannot adhere rigidly to fixed rules.
Qi has the function of generating blood, but blood does not have the function of benefiting qi. Therefore, qi must not be deficient; if deficient, yang fails to reach the surface, and the round halo shape of the lesion cannot form. Blood must not be excessive; if excessive, yin invades yang positions, leading immediately to the disaster of inverted lesions (collapsing pustules). Thus, when treating deficiency syndromes, tonifying qi must come first. Qi possesses spirit but no fixed form, making it easy to fill through tonification. Blood has form but lacks spirit, making rapid effects difficult to achieve through nourishment. Moreover, qi is yang and blood is yin; yin follows yang, and blood follows qi, which is the principle. Therefore, tonifying qi without tonifying blood allows qi to become vigorous and full, and blood will follow suit and become abundant. What constitutes qi and blood deficiency and excess? For instance, if qi is too hot, blisters form; if blood is too hot, macules appear. If qi is insufficient, the top of the lesion is depressed and does not rise; if blood is insufficient, pus and toxins do not adhere. Whenever the lesion color is pale white, the top is not firm, feels smooth to touch, and does not swell, these belong to qi deficiency. Baoyuan Tang (Preserve Origin Decoction) with doubled Huangqi (Astragali Radix), added with Rougui (Cinnamomi Cortex) and Dingxiang (Eugeniae Flos), taken with human milk and fermented rice wine, is suitable. If the base of the lesion is not red or tightly bound, or is red but scattered and broad, turning white upon touch, with erect hairs, appearing withered and lifeless, these belong to blood deficiency. Baoyuan Tang added with Xiong (Chuanxiong Rhizome), Danggui (Angelicae Sinensis Radix), Honghua (Carthami Flos), and Shanzha (Crataegi Fructus) to move the stagnation caused by Renshen and Huangqi, along with Muxiang (Aucklandiae Radix) to disperse stagnant qi, will make the blood flow naturally. Whenever using Huangqi (Astragali Radix), it should be after the smallpox has fully erupted. Whenever using hot-natured medicines, one should wait until the toxins are completely resolved, then examine the deficiency and excess of qi and blood to treat accordingly; then the medicine will be effective. Whenever tonifying blood, Dihuang (Rehmanniae Radix) should be used at the beginning and end. To prevent blood stasis, Jiangzhi (Ginger-processed) forms are necessary. Using Shaoyao (Paeoniae Radix) is feared for its sour-cold nature damaging the stomach; therefore, Jiuchao (Wine-fried) Shaoyao must be used to suppress its moistening and downward-draining properties, borrowing the power of wine to direct the action to the exterior.