痘曰胎毒，由男女交媾时，先有火会而后精聚，此火蕴酿于胚胎之中，为血液之贼。
外有感触。忽然而生，莫可止遏。间有轻重不等者，或父母禀受所致，或天行运气使然。
善治者因其势而利导之，何难皆中理解也。
儿在胞中，如雏在卵，形体未全，口无透窍，赖其母血液灌溉于脐带中，浑浑然太
初之气也。产时母血横流，渗入儿口，容或有之，俗谓口含血饼咽下，寄于命门，蕴蓄
成毒误矣。其有脐矢者，犹瓜果中浆汁，岂食血饼而成。若云腹中赖此滋生，则此乃血
液之宝，焉得成毒哉？
沈旬仲曰∶此益都翟氏之旨也，凤雏渊源翟氏，一番推出一番新。翟氏得未曾有，凤
雏又发明其所以然，开聋 而济夭枉。二先生宁止为斯道之功臣。
痘毒禀自胚胎，或数年而后发，或十数年而后发，或数十年而后发。其未发也，深
藏潜伏，声臭俱泯。正如闾阎无事时，未可执人而诛之曰，尔将为寇也。奈何世有预解
痘毒之说者。
预解痘毒方法，有偶中者，小儿胎毒本轻也。一或不中，当奈之何？尝见富贵之家，
珍爱太过，遍觅方士金丹，及出痘时，反极重不可救药。良由所服损虚脏气，不得使痘毒宣畅故尔。
痘毒在人身中，无处不有。然其发也有次第，自骨髓而达于筋，肾主骨，血气壮盛，
毒尽送出于筋，则肾经毒解，自筋达于肌肉。肝主筋，气血充足，毒尽送出于肌肉，则肝
经毒解，自肌肉达于血脉。脾主肌肉，血气充足，毒尽送出于血脉，则脾经毒解，自血
脉达于皮毛。心主血，气血充足，毒尽送出于皮毛，则心经毒解，自皮毛达于疮窠。肺
主皮毛，气血充足，毒尽送出于疮窠，则肺经毒解。五脏毒解，血化为脓，毒从脓化，痂
结靥落而功成矣。若出于筋而少留于骨髓，则壮热口干闷乱。出于肌肉而少留于筋，则搐
搦牵掣，紫黑潮热。出于血脉而少留于肌肉，则得痈肿于四肢。出于皮毛而少留于血脉，则
痘不圆肥。出于疮窠而少留于皮毛，则痂落迟而多麻 。
痘毒与诸疮毒不同，诸疮毒未成形，可解散内消而愈。既成形而未成脓，犹可逐散
不成脓而愈。痘毒发自先天，应期开落，不可内消，不能逐散，全仗气血送毒归痘。（翟氏
秘奥在此四字）以灌脓结痂，生理沛然。一用寒凉冰伏，变症丛生矣。况有不必解者，又有不
可解者，小儿禀赋强壮，素无疾病，饮食如常，其气血足以运送，变化成功，顺症也，焉
用解。若先天禀赋素虚，后天脾胃复弱，出痘时饮食减少，或泻利腹胀，或手足冷，或
气短促失声，或出不快，或根窠不红活，或色白顶陷，或当脓而不脓，当靥而不靥，此
气血不能运送变化，宜速用温补。若参、 、归、术，力不及者，即丁香、桂、附佐之，亦
不为害，焉可解为？
痘毒蕴结于脏腑骨肉之间，与血气浑成一块，未曾破解，有感之后，渐渐分离。如
胎之将产，此解字乃分形解体也。故痘出一分，毒解一分，痘出二分，毒解二分，痘尽
出，则毒尽解，特在肌肉之间而未化耳。出不齐，胀不起，脓不化，痂不结，气血弱也，
速宜助之。助之者，恐胶结难解也。若曰未出可解之不出，多出可解之少出，将使胎之
在腹者，可使之不产，将产亦可使之有不产乎。
痘之发与杂症不同，杂症只在一经，痘则五脏之症俱见。古云似伤寒者，亦大概言
也。孟春沂曰∶寒出外入（故恶寒），痘由内出（故恶热），故恶寒无汗，头痛脊强，左额青纹，面
色惨而不舒，此伤寒之所有，痘症之所无也。两目含泪珠如水精，鼻气出粗，睡中微惊，耳
纹现（淡红者吉，青紫者凶），恶热不恶寒，此痘症之所有，伤寒之所无也。有云中指独冷，耳尻
冷等说，理亦信焉。
痘者豆也，肖其形则生，不肖其形则死。形之不肖，元神竭矣。尖圆而突，周净而松，
形之有神者也。如麸（色白）如沸（空壳），如疥（无根颗）如蚕种（黑小）如蛇皮（一片），如蚊迹（血，散）
如瘙斑（根散），如汤泡（皮肉，先烂）如火刺（血干），形之无神者也。形而无神，可冀生乎？至于色也，欲
如春花之在露（红活光润），不欲如秋草之经霜（黑暗干黄。）红白两分，明润光活，色之有彩者也。如
腻粉，如枯骨，如红米饭，如猪肝色，色之无彩者也。形不有神，色不现彩，生意可知矣。呜呼，神彩其生死
之门户也。
凡痘之看，先看元气。痘儿元气，非有非无，唯心领意会而已。如形色初善而终变
恶者，元气内竭也。形色初恶而终归善者，元气内强也。元气本也，形色未也，故善治者必求本。
程书焉曰∶昔人用人参、黄 、甘草为保元汤，始终不易，正欲使元气内强耳。
桂岩子曰∶人知痘藉气血，不知痘之所藉，尤有超于气血者，盖元气盛，则气血流
通，而领逐，而负载，并行祛毒，痘必应期而开落。元气一亏，则在外者内不续，在内
者外不固，毒肆妄行，或出或入，而为外剥内攻矣。调养真元，补益气血，诚治痘完策。
不得已而欲攻他症，中病即止。经曰∶常毒治病，十去其八，无毒治病，十去其九。夫
包血成圆者，气也，气能拘血制毒，则痘晕必光明而红活。顶陷者，气之虚，塌陷者，气
之离，晕枯者，血之虚，根散者，血之离。圆也晕也，气血之所为也。而所以成圆成晕者，气血不得专也。
吴东园曰∶根颗者，血之运，脓者，血之腐。六日前专看根颗，无根颗者，必不灌
脓（毒在内也）。六日后专看脓色，无脓色者，必难收靥（元气不足）。此理也势也。
无形者根据有形，有形者附无形，互相根据附，天地之道，亦气血之道也。气之离，不
由血之散乎，故自气血交后，常观根晕为凭准。粗紧红活，生意沛然。若微细而不现不
敛，且黯淡，则气将飞去而必不克制毒矣。是故内攻根散者死，内攻而根血犹附，非毒作
楚，必三因致之（因体虚、因秽触、因误药）。
气血有常，但不能盈于常，而能自亏于常。然亦有盈者，何也？毒壅于气，火搏于
血耳。斑者，血有余也； 者，气独盛也。经曰∶邪气盛则实，真邪夺则虚。
气居亲上之尊，则痘顶尖圆白润；血安亲下之分，则四围色晕红活。若通顶红色，必
不能浆，八九日痒塌而死。此非血之过，由气亏而失其尊，故血得妄行而僭居其位也。大
补其气，犹或可救，误认血热，以凉治之，毙矣（真血热则枯焦紫黑，甚至无痘处亦紫）。
凡形色大恶，气不交，浆不成，似为死矣。若精神爽朗，便食如故，而天庭有一二
悦目者，犹可发毒，作臭痘而愈。何也，毒在外，不在内也，故如此云。
陈氏云∶痘以太阴脾肺二经为主，肺宜温而脾宜燥。万氏云∶痘始终以脾胃为主，胃
当养而脾当补。马氏云∶痘以少阴心经为主
火不可太清，而血不可太寒。夫脾为孤脏，主肌肉，化水谷而生津液，灌溉诸经，而熏蒸
发育。肺主气，心主血，气血充盈。 濡流贯，而痘有不得其天者乎。
心主血而属火，痘藉之以运用一身，温则流行，寒则凝滞，世以犀角凉之，此不知
阴阳之属也，恶能使之运化痘毒而成功乎？故予只于痂后余毒用之。若天行疠气，与气血
争盛者，脉洪数，痘初出即带紫色，既出而稠密红紫，内症烦闷躁渴，小便赤涩，大便
秘结，量入清凉之味解之，或酒炒大黄微利之，甚有口鼻出血者，犀角暂用之。若毒盛
而气血不盛者，虽曰解毒，必兼活血补气，参、 、归、芍，安可缺耶？
黄连、犀角皆泻心之品，时下恃为治痘神良，不论虚实寒热，一切用之，更益以石
膏、明粉、生地汁、羚羊角之属，冰伏其生生之气，噫异哉。
痘始终藉热成功，先三日热而后出，出齐则退，浆将行又热，浆足则退。回浆前又
热，浆回则退，结痂收靥落痂又热，名曰烧瘢。凡此皆不宜凉解，凉解则气血凝滞不行，
痘毒留中而祸作矣。（初热未退，痘即出日火苗，宜辛凉托表。）
痘不为害，惟毒为害，毒尽附于痘中不为害，惟不尽附于痘中则为害（秘奥法门）。故无
论随所因而用何剂，必少加穿山甲末，透其窍而逐之，使毒归于颗粒而后已。又必加白
芍，敛其血而收其毒，使无一分渗漏傍溢。治痘之法，其庶几乎？
痘未出前，升发微汗，使毒瓦斯宣通，毒出外而内自安也。既出后，调气助血，使浆
路充盈，浆始化而毒无不尽也。
毒停肌肉则发肿，毒滞皮肤则作臭，肌肉阳明主之，属土，皮肤太阴主之，属金，痈
肿土象，腥臭金象，亦各从其类也。
书谓红 者生，紫 者死，黑 蓝 ，百不救一。虽然，亦有红 死，而紫 蓝 得
生者，夫 、血热也，失于解利则发 ，恶
痘出，势所必然，无论颜色， 与不 皆死。但天庭疏朗，形色善而斑出，又当别论。
昔一 症，诸医莫治，召予视之，已七日矣。斑分上中下，上斑红，中斑紫，下斑青，视
其痘，则绽突疏朗，内含清水，色黑黯而精神爽健。视唇舌，则多苔燥。予曰∶失解故
也，进以清凉自愈。后果然。由是书不可拘也，察形色，验唇舌是准。
痘前后有衄血者，毒瓦斯外泄，冲于肺也，此非恶候，只宜发灰散、清肺汤调之，不可用犀角等峻剂。
疔之结也，亦热毒壅盛，失于解和，内不能入，而结隧道空隙之处，恶痘疔结，逆
转为顺矣。但结前后心必死，结耳门喉下者死。辨疔有法，慎无以黑痘作疔，黑痘犹痘也。疔则陷入肉中，
形如螺盖，捏之则有核，割之不知痛，其根白或长寸许，医多误认，靥后疔烂，七日前后者，四圣丹主之。
痘起胀，或收结时，骤然泄泻不止，危在旦夕。有用异功散仍不效者，豆蔻丸、白术散止之（热毒作泻
用加味四苓散）。起胀灌脓时，有六七日不大便而烦闷作痛者，毒盛而秘也，清毒活血汤去参、 。加牛膝，
倍紫草、当归，服时入生蜜半杯，甚者加酒炒大黄三钱利之。若仍不通，用猪胆汁滴入谷道中，即通，切
不可用硝黄大下，使生变症，禁绝荤腥是矣。然亦有富贵之子，其脾胃赖此以养成者，一
旦使之不食，则生生之气，将何赖以熏蒸长育乎？是又不可以常法论者。
痘之所恃者，血为养而气为充也，故眼鼻必欲封塞，眼封则神不外驰，鼻塞则气不
外逐，神气内荣，而毒不为之制伏者鲜矣。然又有鼻塞而有涕，美之征也。鼻塞而窍外干
黑者死，眼封而有泪，生之兆也。封而沿眶涂煤者死，封眼五六日间未肿，过封后必眼
疾，痘少者不封，或封而才靥，即退。
气血之分，犹清浊之本于上下也。气血之交，犹阴阳之互为根据附也当分不分毒结之，
当交不交毒隔之。知阴阳散郁，何不分之有
知清热解毒，何不交之忧。
痘之形症有四∶曰毒壅，曰血热，曰气虚，曰血虚。又虚实有四∶表里虚实是也。见
点稠密，形不尖松，色惨黯而皮肤间欲出不出，此毒壅也。见点深红，而渐变紫黑，夹
疔夹 ，此血热也。顶陷皮薄，平塌不振者，此气虚也。色淡根散，或痘色与肉色无异者，
此血虚也。身微热而有汗曰表虚。壮热无汗，喘促，脉浮皮毛焦，肌肉痛，表实也。精神
疲倦，唇舌淡白，曰里虚。狂乱气盛，渴饮善食，唇燥而舌见黄白苔者，里实也。毒壅
血热，同表里之实。气虚血虚，同表里之虚。此一而二，二而一者也。壅者疏之，热者凉
之，虚者补之，实者泻之，不虚不实，平剂以调之。明此数者，思过半矣。虽然，辨寒
热虚实，尤须用舌作纲维。
三等∶顺、险、逆。顺者，血气充和，痘毒宣畅，不必施治。险者，气血不舒，痘毒
壅遏，或杂症搅扰，当急施治。逆者，痘毒凝结，气血干枯，治之无功。五要∶一、出
欲尽。二、起发透。三、脓稠满。四、收靥齐。五、结痂浓。五善∶一、饮食如常。二、
大小便调。三、疮红活坚实。四、脉静身凉，手足温暖。五、声音清亮，动止安和。（五者不
能全得，得一二亦自清吉。）七恶∶一、烦躁闷乱，谵妄恍惚。二、呕 泄利，饮食不能。三、黑
陷焦枯，痒塌破烂。四、头面预肿，鼻煽肩抬，目张唇裂。五、喉舌溃烂，食入即 ，水
入即呛。六、寒战切牙，声哑色黯。七、腹胀喘促，四肢逆冷。（七者不必皆有有一二亦自难为）七
恶之外，又有浑身血 ，心腹刺痛，陷伏不出，便溺皆血，寻衣撮空，是又卒死而不可救者。
叶天士曰∶逆症亦有得生者，未可舍之不治也。险症必无死理，死者医之过，非痘
之过也。今且有拣顺症治之，以混俗沾名，而舍弃其险者，吾是以恶金镜录等书分症之言，为不仁也。
痘有至佳者，随出随长，随长随灌，顶
尖圆而色红润，稍见浆而即靥。又有至奇者，随出随长，随长即靥，通不见脓汁，名为旱
痘。二者俱不宜施治，庸妄者每至杀人。先出疹，疹靥而痘始出，曰垫疹。疹与痘并出，
疹靥而痘始长，曰夹疹。痘出即有小小颗粒堆于痘之上，曰罩痘痧。痘出时，皮肉间隐
痘疮被称为胎毒，源于男女交媾之时，先有相火交会而后精气凝聚，这股火气蕴酿在胚胎之中，成为血液的贼害。
此外还有外感邪气的触动，突然发生，无法遏制。其中病情轻重不一，有的是父母先天禀赋所致，有的是天时运气使然。
善于治疗的人顺应病势加以引导，有什么困难不能理解并解决呢？
婴儿在母体胞宫之中，如同雏鸟在蛋内，形体尚未完全，口鼻等窍穴未通，依赖母亲的血液通过脐带灌溉滋养，这是浑然一体的太初之气。分娩时母亲血液横流，渗入婴儿口中，或许会有这种情况，世俗所谓“口含血饼咽下，寄存在命门，蕴蓄成毒”的说法是错误的。那些有脐带残留物的，就像瓜果中的浆汁，难道是吃了血饼形成的吗？如果说腹部依靠这个来滋生发育，那么这应该是血液的宝物，怎么会变成毒呢？
沈旬仲说：这是益都翟氏的观点，凤雏（程云鹏）渊源出自翟氏，每一次推演都有新的发现。翟氏得到了前人未曾有的见解，凤雏又阐发了其中的原理，开启了聋聩，救济了夭折的生命。这两位先生不仅是这一领域的功臣。
痘毒禀受于胚胎，有的几年后发作，有的十几年后发作，有的几十年后发作。在它未发作时，深藏潜伏，声音气味都消失不见。正像乡里平安无事时，不能抓过一个人就杀他说：“你将成为盗贼。”为什么世上会有预先解除痘毒的说法呢？
预先解除痘毒的方法，有偶尔奏效的，是因为小儿胎毒本来轻微。一旦不奏效，该怎么办呢？我曾见过富贵人家，过分珍爱孩子，到处寻找方士的金丹，等到出痘时，反而极其严重不可救药。大概是因为所服用的药物损伤了虚弱的脏腑之气，使得痘毒不能宣畅发散的缘故。
痘毒在人体中无处没有。然而它的发作是有次序的，从骨髓到达筋脉，肾主骨，气血壮盛，将毒全部送出到筋脉，则肾经的毒解除；从筋脉到达肌肉，肝主筋，气血充足，将毒全部送出到肌肉，则肝经的毒解除；从肌肉到达血脉，脾主肌肉，气血充足，将毒全部送出到血脉，则脾经的毒解除；从血脉到达皮毛，心主血，气血充足，将毒全部送出到皮毛，则心经的毒解除；从皮毛到达痘窠（痘疹根部凹陷处），肺主皮毛，气血充足，将毒全部送出到痘窠，则肺经的毒解除。五脏的毒解除后，血液化为脓液，毒随脓液转化，结痂脱落后功效完成。如果毒出于筋脉而少留于骨髓，就会出现高热、口干、烦闷扰乱。出于肌肉而少留于筋脉，就会出现抽搐牵引掣动、紫黑色潮热。出于血脉而少留于肌肉，就会在四肢出现痈肿。出于皮毛而少留于血脉，痘就不圆润肥满。出于痘窠而少留于皮毛，就会结痂脱落迟缓且多留有麻痕。
痘毒与各种疮毒不同，各种疮毒未成形时，可以解散内消而痊愈；既已成形但未成脓时，还可以驱逐消散使其不成脓而痊愈。痘毒发自先天，应期开落，不能内消，也不能逐散，全赖气血送毒归入痘中。（翟氏的秘密奥妙就在这四个字上）依靠灌脓结痂，生理机能充沛。一旦使用寒凉药物冰伏，变证就会丛生。况且有不必解的，又有不可解的。小儿禀赋强壮，平素无疾病，饮食如常，其气血足以运送变化，成功顺症，哪里用得着解？如果先天禀赋素来虚弱，后天脾胃又弱，出痘时饮食减少，或者腹泻腹胀，或者手脚冰冷，或者气短促失声，或者痘出不快，或者根窠不红活，或者色白顶陷，或者该化脓时不化脓，该结痂时不结痂，这是气血不能运送变化，应当迅速使用温补法。如果人参、黄芪、当归、白术力量不够的，就用丁香、肉桂、附子辅助它们，也不为害，怎么能说是需要解毒呢？
痘毒蕴结在脏腑骨肉之间，与气血浑合成一块，未曾破解，有感邪之后，渐渐分离。如同胎儿即将分娩，这个“解”字乃是分形解体。所以痘出一分，毒解一分；痘出二分，毒解二分；痘尽出，则毒尽解，只是在肌肉之间尚未化脓罢了。如果痘出不齐，胀不起，脓不化，痂不结，是气血虚弱，应当迅速帮助它。帮助它，是担心胶结难解。如果说未出的可以解得不出，多出的可以解得少出，那将使腹中的胎儿可以不出生，即将出生的也可以使之不出生吗？
痘的发作与杂症不同，杂症只涉及一经，痘则五脏的症状都会见到。古话说类似伤寒，也是大概而言。孟春沂说：寒邪由外向内侵入（所以恶寒），痘毒由内向外发出（所以恶热）。因此恶寒无汗、头痛脊背强直、左额青纹、面色惨白不舒展，这是伤寒所具有而痘症所没有的。两眼含泪珠如水精，鼻息粗重，睡中微微惊悸，耳后纹现（淡红色为吉，青紫色为凶），恶热不恶寒，这是痘症所具有而伤寒所没有的。有人说中指独冷、耳尻冷等说法，道理也是可信的。
痘就是豆，形状像豆子就能生，不像豆子就会死。形状不像，元神就竭尽了。尖圆而突起，周围干净而疏松，是有神的形状。如麸皮（色白）、如空壳（中空）、如疥疮（无根颗粒）、如蚕种（黑小）、如蛇皮（一片）、如蚊迹（血点散在）、如瘙斑（根散）、如汤泡（皮肉先烂）、如火刺（血干），这些都是无神的形状。有形而无神，能希望生存吗？至于颜色，想要像春花带露（红活光润），不想要像秋草经霜（黑暗干黄）。红白分明，明润光活，是有光彩的颜色。如腻粉、如枯骨、如红米饭、如猪肝色，都是无光彩的颜色。形不有神，色不现彩，生机可知了。唉，神采是生死的门户啊。
凡是看痘，先看元气。痘儿的元气，非有非无，只能用心领意会。如果形色起初好而最终变坏，是元气在内枯竭。如果形色起初坏而最终归于好，是元气在内强盛。元气是本，形色是末，所以善于治疗的人一定求本。
程书焉说：古人用人参、黄芪、甘草组成保元汤，始终不变，正是为了让元气在内强盛。
桂岩子说：人们知道痘依赖于气血，不知道痘所依赖的，更有超越气血的东西，那就是元气。元气旺盛，则气血流通，统领驱逐，负载并行祛毒，痘必然应期开落。元气一亏损，则在外的不能向内接续，在内的不能向外固守，毒肆意妄行，或出或入，造成外剥内攻。调养真元，补益气血，确实是治疗痘疮的完美策略。不得已而要攻治其他病症，中病即止。经书说：用有毒的药治病，病去八分即可；用无毒的药治病，病去九分即可。包裹血液形成圆形的，是气的作用，气能拘束血液制约毒，则痘晕必定光明而红活。顶陷的，是气虚；塌陷的，是气离；晕枯的，是血虚；根散的，是血离。圆形和晕圈，是气血所为。而之所以形成圆形和晕圈，气血不能完全专断。
吴东园说：根颗，是血的运行；脓，是血的腐败。六日前专门看根颗，无根颗的，必然不灌脓（毒在内）。六日后专门看脓色，无脓色的，必然难收靥（元气不足）。这是理也是势。无形者依据有形，有形者依附无形，互相根据依附，这是天地的道理，也是气血的道理。气的离散，难道不是由于血的散乱吗？所以自气血交合后，常以根晕为准绳。粗紧红活，生意充沛。如果微细而不显现不收敛，且黯淡，则气将飞去而不能克制毒了。因此内攻而根散的必死，内攻而根血犹附的，如果不是毒作祟，一定是三因所致（因体虚、因秽触、因误药）。
气血有常态，但不能盈满于常态，却能自亏于常态。然而也有盈满的时候，为什么呢？毒壅于气，火搏于血罢了。斑，是血有余；疹，是气独盛。经书说：邪气盛则实，真气夺则虚。
气居于亲上的尊贵地位，则痘顶尖圆白润；血安于亲下的位置，则四围色晕红活。如果通顶红色，必然不能化浆，八九日痒塌而死。这不是血的过错，是由于气亏而失去了尊贵，所以血得以妄行而僭居其位。大补其气，或许还可救，误认血热，用凉药治疗，就会致死（真正的血热则枯焦紫黑，甚至无痘处也紫）。
凡是形色极坏，气不交，浆不成，看似死了。如果精神爽朗，饮食如故，而天庭有一两处悦目的，还可以发毒，化作臭痘而愈。为什么呢？毒在外，不在内，所以这样说。
陈氏说：痘以手太阴肺经和足太阴脾经为主，肺宜温而脾宜燥。万氏说：痘始终以脾胃为主，胃当养而脾当补。马氏说：痘以足少阴心经为主。
火不可太清，而血不可太寒。脾为孤脏，主肌肉，化水谷而生津液，灌溉诸经，而熏蒸发育。肺主气，心主血，气血充盈，濡润流贯，而痘有不得天年者吗？
心主血而属火，痘藉之以运用一身，温则流行，寒则凝滞，世人用犀角来凉之，这是不懂阴阳的属性，怎么能使之运化痘毒而成功呢？所以我只在痂后余毒时用之。如果是天行疠气，与气血争盛，脉洪数，痘初出即带紫色，既出而稠密红紫，内症烦闷躁渴，小便赤涩，大便秘结，酌情加入清凉之味解之，或用酒炒大黄微利之，甚有口鼻出血的，暂用犀角。如果毒盛而气血不盛，虽然说是解毒，必须兼活血补气，人参、黄芪、当归、芍药，怎么可缺呢？
黄连、犀角都是泻心的药物，时下人倚仗它们为治痘神良，不论虚实寒热，一切用之，更加上石膏、滑石、生地汁、羚羊角之类，冰伏其生生之气，唉，奇怪啊。
痘始终依靠热来成功，先三日热而后出，出齐则退，浆将行又热，浆足则退，回浆前又热，浆回则退，结痂收靥落痂又热，名叫烧瘢。凡此都不宜凉解，凉解则气血凝滞不行，痘毒留中而祸患产生。（初热未退，痘即出曰火苗，宜辛凉托表。）
痘不为害，惟毒为害，毒尽附于痘中不为害，惟不尽附于痘中则为害（秘密法门）。所以无论随什么因而用什么剂，必须少加穿山甲末，透其窍而驱逐它，使毒归于颗粒而后停止。又必须加白芍，敛其血而收其毒，使无一分渗漏旁溢。治痘的方法，差不多就是这样吧？
痘未出前，升发微汗，使毒瓦斯宣通，毒出外而内自安。既出后，调气助血，使浆路充盈，浆始化而毒无不尽也。
毒停肌肉则发肿，毒滞皮肤则作臭，肌肉阳明主之，属土，皮肤太阴主之，属金，痈肿是土象，腥臭是金象，也是各从其类。
书中说红疹者生，紫疹者死，黑疹蓝疹，百不救一。虽然，也有红疹死，而紫疹蓝疹得生的，夫疹，是血热，失于解利则发疹，恶痘出，势所必然，无论颜色，疹与不疹皆死。但天庭疏朗，形色善而斑出，又当别论。
昔日有一个疹症，众医不能治，召我去看，已经七天了。斑分上中下，上斑红，中斑紫，下斑青，看他的痘，则绽突疏朗，内含清水，色黑黯而精神爽健。看唇舌，则多苔燥。我说：失于解利故也，进以清凉自愈。后果然。由此书不可拘泥，察形色，验唇舌是准绳。
痘前后有衄血（鼻出血）的，毒瓦斯外泄，冲于肺也，这不是恶候，只宜用发灰散、清肺汤调理，不可用犀角等峻剂。
疔的结聚，也是热毒壅盛，失于解和，内不能入，而结隧道空隙之处，恶痘疔结，逆转为顺了。但结在前心后心必死，结耳门喉下者死。辨疔有方法，慎勿以黑痘作疔，黑痘还是痘。疔则陷入肉中，形如螺盖，捏之则有核，割之不知痛，其根白或长寸许，医多误认，靥后疔烂，七日前后的，用四圣丹主治。
痘起胀，或收结时，骤然泄泻不止，危在旦夕。有用异功散仍不效的，用豆蔻丸、白术散止之（热毒作泻用加味四苓散）。起胀灌脓时，有六七日不大便而烦闷作痛的，毒盛而秘也，用清毒活血汤去人参、黄芪。加牛膝，倍紫草、当归，服时入生蜜半杯，甚的用酒炒大黄三钱利之。如果仍不通，用猪胆汁滴入肛门中，即通，切不可用硝黄大下，使生变症，禁绝荤腥是对的。然而也有富贵之子，其脾胃赖此以养成，一旦使之不食，则生生之气，将何赖以熏蒸长育乎？这又不可以常法论。
痘所依赖的，血为养而气为充，所以眼鼻必欲封塞，眼封则神不外驰，鼻塞则气不外逐，神气内荣，而毒不为之制伏者很少。然而又有鼻塞而有涕，是美之征。鼻塞而窍外干黑者死，眼封而有泪，是生之兆。封而沿眶涂煤者死，封眼五六日间未肿，过封后必眼疾，痘少者不封，或封而才靥，即退。
气血之分，犹清浊之本于上下。气血之交，犹阴阳之互为根据附。当分不分毒结之，当交不交毒隔之。知阴阳散郁，何不分之？知清热解毒，何不交之忧？
痘的形症有四：曰毒壅，曰血热，曰气虚，曰血虚。又虚实有四：表里虚实是也。见点稠密，形不尖松，色惨黯而皮肤间欲出不出，此毒壅也。见点深红，而渐变紫黑，夹疔夹疹，此血热也。顶陷皮薄，平塌不振者，此气虚也。色淡根散，或痘色与肉色无异者，此血虚也。身微热而有汗曰表虚。壮热无汗，喘促，脉浮皮毛焦，肌肉痛，表实也。精神疲倦，唇舌淡白，曰里虚。狂乱气盛，渴饮善食，唇燥而舌见黄白苔者，里实也。毒壅血热，同表里之实。气虚血虚，同表里之虚。此一而二，二而一者也。壅者疏之，热者凉之，虚者补之，实者泻之，不虚不实，平剂以调之。明此数者，思过半矣。虽然，辨寒热虚实，尤须用舌作纲维。
三等：顺、险、逆。顺者，血气充和，痘毒宣畅，不必施治。险者，气血不舒，痘毒壅遏，或杂症搅扰，当急施治。逆者，痘毒凝结，气血干枯，治之无功。五要：一、出欲尽。二、起发透。三、脓稠满。四、收靥齐。五、结痂浓。五善：一、饮食如常。二、大小便调。三、疮红活坚实。四、脉静身凉，手足温暖。五、声音清亮，动止安和。（五者不能全得，得一二亦自清吉。）七恶：一、烦躁闷乱，谵妄恍惚。二、呕吐泄利，饮食不能。三、黑陷焦枯，痒塌破烂。四、头面预肿，鼻煽肩抬，目张唇裂。五、喉舌溃烂，食入即呕，水入即呛。六、寒战切牙，声哑色黯。七、腹胀喘促，四肢逆冷。（七者不必皆有，有一二亦自难为）七恶之外，又有浑身血斑，心腹刺痛，陷伏不出，便溺皆血，寻衣撮空，是又卒死而不可救者。
叶天士说：逆症亦有得生者，未可舍之不治也。险症必无死理，死者医之过，非痘之过也。今且有拣顺症治之，以混俗沾名，而舍弃其险者，吾是以恶金镜录等书分症之言，为不仁也。
痘有至佳的，随出随长，随长随灌，顶尖圆而色红润，稍见浆而即靥。又有至奇的，随出随长，随长即靥，通不见脓汁，名为旱痘。二者俱不宜施治，庸妄者每至杀人。先出疹，疹靥而痘始出，曰垫疹。疹与痘并出，疹靥而痘始长，曰夹疹。痘出即有小小颗粒堆于痘之上，曰罩痘痧。痘出时，皮肉间隐
Varicella (smallpox) is called "fetal toxin" (Tai Du), originating from the time of sexual intercourse between man and woman, where the ministerial fire meets first and then essence gathers. This fire brews within the embryo, becoming a thief of blood.
Externally, there are influences of pathogenic factors. It arises suddenly and cannot be stopped. Among them, severity varies; some are caused by parental congenital endowment, others by heavenly luck and qi transformation.
A skilled practitioner guides according to the trend, so what difficulty is there in understanding and resolving it?
The fetus in the womb is like a chick in an egg; its form is not yet complete, and orifices are not open. It relies on maternal blood irrigating through the umbilical cord, which is the primordial qi (Tai Chu Zhi Qi). During birth, maternal blood flows excessively and may seep into the infant's mouth. The folk belief that the infant swallows a "blood cake" which lodges in the Gate of Life (Ming Men) and accumulates into toxin is erroneous. Those with residual umbilical matter are like the juice in fruits and melons; how could this be formed by eating a blood cake? If one claims the abdomen relies on this for nourishment, then this should be the treasure of blood, how could it become toxin?
Shen Xunzhong said: This is the viewpoint of Zhai Shi from Yidu. Fengchu (Cheng Yunpeng) traces his origin to Zhai Shi, pushing forward with each generation to reveal new insights. Zhai Shi obtained what was previously unheard of, and Fengchu further elucidated the reasons, opening the deaf and saving those who would otherwise die young. These two gentlemen are not only meritorious officials in this field.
Fetal toxin for smallpox is inherited from the embryo. It may manifest after several years, ten-plus years, or even decades. Before manifestation, it hides deeply and潜伏ly, with no sound or smell. Just as when a village is peaceful, one cannot grab a person and execute him saying, "You will become a bandit." Why then does the world have theories about preemptively resolving fetal toxin?
Methods for preemptively resolving fetal toxin occasionally work because the child's fetal toxin is originally mild. But if they do not work, what then? I have seen wealthy families, being overly protective, seeking alchemical pills from Daoist practitioners. When smallpox appears, it becomes extremely severe and incurable. This is likely due to the ingested medicines damaging the qi of deficient organs, preventing the smallpox toxin from being disseminated and unblocked.
Smallpox toxin exists nowhere in the human body but does not appear everywhere at once. However, its eruption follows a sequence: from bone marrow to sinews. The Kidney governs bones; when qi and blood are robust, the toxin is sent out to the sinews, resolving the Kidney channel's toxin. From sinews to muscles. The Liver governs sinews; when qi and blood are sufficient, the toxin is sent out to the muscles, resolving the Liver channel's toxin. From muscles to blood vessels. The Spleen governs muscles; when qi and blood are sufficient, the toxin is sent out to the blood vessels, resolving the Spleen channel's toxin. From blood vessels to skin and hair. The Heart governs blood; when qi and blood are sufficient, the toxin is sent out to the skin, resolving the Heart channel's toxin. From skin to pustule bases. The Lung governs skin and hair; when qi and blood are sufficient, the toxin is sent out to the pustule bases, resolving the Lung channel's toxin. Once the toxins of the Five Zang organs are resolved, blood transforms into pus, toxin transforms with the pus, scabs form and fall off, completing the process. If toxin remains slightly in the bone marrow after emerging from sinews, it causes high fever, dry mouth, and restlessness. If it remains slightly in the sinews after emerging from muscles, it causes spasms, convulsions, purple-black tidal fever. If it remains slightly in muscles after emerging from blood vessels, it causes abscesses on the limbs. If it remains slightly in blood vessels after emerging from skin, the pustules are not round and plump. If it remains slightly in skin after emerging from pustule bases, scabbing and falling off are delayed, leaving many pockmarks.
Smallpox toxin differs from other sore toxins. Other sore toxins, before taking shape, can be dispersed and internally resolved to heal. After taking shape but before forming pus, they can still be driven away to prevent pus formation and heal. Smallpox toxin originates from the congenital state, opens and falls according to its cycle; it cannot be internally resolved nor driven away. It entirely relies on qi and blood to send the toxin back into the smallpox lesions. (The secret of Zhai Shi lies in these four characters.) Relying on filling with pus and forming scabs, physiological vitality is abundant. Using cold-cooling herbs to freeze the condition leads to numerous complications. Moreover, there are cases that need no resolution and cases that cannot be resolved. If a child has strong congenital endowment, is usually healthy, eats normally, and their qi and blood are sufficient to transport and transform, resulting in a smooth course, why use resolution? If congenital endowment is weak and postnatal Spleen and Stomach are also weak, with reduced appetite during eruption, diarrhea, abdominal distension, cold hands and feet, shortness of breath, hoarseness, slow eruption, non-vibrant bases, white color with depressed tops, failure to suppurate or scab, this indicates qi and blood cannot transport and transform. Rapid warm-tonification is needed. If Ren Shen (Ginseng Root), Huang Qi (Astragalus Root), Dang Gui (Angelica Sinensis), Bai Zhu (Atractylodes Macrocephala Rhizome) are insufficient, add Ding Xiang (Clove), Gui Zhi (Cinnamon Twig), Fu Zi (Aconite Lateral Root Preparata); this is harmless. How can one say it needs resolution?
Smallpox toxin knots in the internal organs and flesh/bone, merging with qi and blood into one block. Before breaking apart, upon pathogenic influence, it gradually separates. Like a fetus about to be born, this "resolution" means separating form and dissolving structure. Thus, for every part of smallpox that emerges, one part of toxin is resolved; when all smallpox emerges, all toxin is resolved, though it remains untransformed in the muscles. If eruption is uneven, swelling does not rise, pus does not form, scabs do not knot, it is due to weak qi and blood; assist them quickly. Assisting them prevents difficult-to-resolve adhesion. To say that un-erupted ones can be made not to erupt, or excessive ones can be made to erupt less, is like saying a fetus in the belly can be prevented from being born, or one about to be born can be prevented from being born.
Smallpox eruption differs from miscellaneous diseases. Miscellaneous diseases involve only one channel; smallpox shows symptoms of all five Zang organs. Ancient texts say it resembles Taiyang disease (Cold Damage), but this is a generalization. Meng Chunyi said: Cold enters from outside (hence aversion to cold); smallpox emerges from inside (hence aversion to heat). Therefore, aversion to cold, no sweat, headache, stiff spine, blue veins on the left forehead, pale and uncomfortable complexion—these are present in Taiyang disease but absent in smallpox. Eyes holding tears like water pearls, coarse nasal breathing, slight startle during sleep, appearance of ear ridges (light red is auspicious, blue-purple is ominous), aversion to heat without aversion to cold—these are present in smallpox but absent in Taiyang disease. Some say only the middle finger is cold, or ears and buttocks are cold; the reasoning is credible.
"Smallpox" (Dou) sounds like "bean" (Dou). If it resembles a bean, life ensues; if not, death ensues. Lack of resemblance means exhaustion of Yuan Shen (Primordial Spirit). Pointed, round, protruding, clean surroundings, and loose texture indicate spirit presence. Like bran (white), like hollow shells, like scabies (rootless granules), like silkworm seeds (black and small), like snake skin (in patches), like mosquito bites (scattered blood spots), like itch macules (scattered roots), like soup blisters (skin/flesh rotting first), like fire thorns (dried blood)—these lack spirit. Can one hope for life if form lacks spirit? Regarding color: desire it like spring flowers with dew (red, vibrant, glossy); do not desire it like autumn grass after frost (dark, dry, yellow). Distinct red and white, bright and moist, indicates colorful vitality. Like face powder, like dead bones, like red rice grains, like pig liver color—these lack color. Form lacking spirit, color lacking vibrancy, vitality is known. Alas, spirit and color are the gates of life and death!
When examining smallpox, first examine Yuan Qi (Primordial Qi). A smallpox patient's Yuan Qi is neither existent nor nonexistent; it must be perceived intuitively. If appearance/color starts good but ends bad, Yuan Qi is exhausted internally. If appearance/color starts bad but ends good, Yuan Qi is strong internally. Yuan Qi is the root; appearance/color is the branch. Thus, skilled practitioners seek the root.
Cheng Shuyan said: Ancients used Ren Shen (Ginseng Root), Huang Qi (Astragalus Root), Gan Cao (Licorice Root) to form Bao Yuan Tang (Protect Primordial Decoction), unchanged throughout, precisely to strengthen internal Yuan Qi.
Gui Yanzi said: People know smallpox relies on qi and blood, but do not know what smallpox relies on is superior to qi and blood, namely Yuan Qi. When Yuan Qi is vigorous, qi and blood flow smoothly, leading expulsion, carrying and transporting, jointly dispelling toxin, ensuring smallpox opens and falls on schedule. If Yuan Qi is deficient, external cannot connect internally, internal cannot secure externally, toxin acts recklessly, emerging or entering, causing external peeling and internal attacking. Nourishing True Yuan and tonifying qi and blood is indeed the perfect strategy for treating smallpox. If forced to treat other conditions, stop when the disease is addressed. The Classics say: For toxic drugs, remove 80% of the disease; for non-toxic drugs, remove 90%. Encircling blood to form circles is the function of Qi. Qi can constrain blood and control toxin, making the smallpox halo bright and red/vibrant. Depressed tops indicate Qi deficiency; collapsed tops indicate Qi separation; withered halos indicate Blood deficiency; scattered bases indicate Blood separation. Circles and halos are the work of qi and blood. Yet, qi and blood do not act exclusively to form circles and halos.
Wu Dongyuan said: Bases/granules represent Blood transport; pus represents Blood corruption. In the first six days, focus on bases; without bases, pus will not fill (toxin is internal). After six days, focus on pus color; without pus color, scabbing will be difficult (Yuan Qi insufficient). This is principle and trend. Formless relies on formed; formed attaches to formless. They rely on and attach to each other; this is the Way of Heaven and Earth, and also the Way of Qi and Blood. Qi separation does not stem from Blood scattering? Thus, after qi and blood interact, always observe bases and halos as standards. Thick, tight, red, vibrant, full of vitality. If fine, invisible, non-converging, and dull, Qi will flee and fail to control toxin. Therefore, internal attack with scattered bases results in death. Internal attack with attached bases and blood—if not caused by toxin acting violently, it must be due to Three Causes (due to body weakness, due to filth contact, due to mistaken medication).
Qi and Blood have constants, but cannot exceed constants, yet can self-deplete within constants. However, there are times of excess. Why? Toxin obstructs Qi, Fire clashes with Blood. Macules (Ban) indicate Blood excess; Papules (Zhen) indicate Qi excess. The Classics say: Excess of pathogenic qi constitutes Excess syndrome; depletion of true qi constitutes Deficiency syndrome.
Qi resides in the superior position, making smallpox tops round, white, and moist. Blood rests in the inferior position, making surrounding halos red and vibrant. If the entire top is red, it will not suppurate; by day 8-9, itching and collapse lead to death. This is not Blood's fault, but Qi deficiency losing its superiority, allowing Blood to act recklessly and usurp its position. Greatly tonifying Qi might save it; mistaking it for Blood Heat and treating with cooling herbs leads to death (True Blood Heat presents as withered, scorched, purple-black, even areas without smallpox turn purple).
If appearance/color is extremely bad, Qi does not intersect, pus does not form, it seems like death. If spirit is clear, appetite normal, and Tian Ting (Forehead) has one or two pleasing spots, toxin can still erupt, turning into foul-smelling smallpox and healing. Why? Because toxin is external, not internal, hence this statement.
Chen Shi said: Smallpox focuses on Hand-Taiyin Lung and Foot-Taiyin Spleen channels. Lung prefers warmth; Spleen prefers dryness. Wan Shi said: Smallpox always focuses on Spleen and Stomach. Stomach should be nourished; Spleen should be tonified. Ma Shi said: Smallpox focuses on Foot-Shaoyin Heart channel.
Fire should not be cleared too much, and Blood should not be cooled too much. Spleen is the solitary organ, governing muscles, transforming food/water into fluids, irrigating all channels, and steaming/developing. Lung governs Qi, Heart governs Blood. When Qi and Blood are abundant, moistening and flowing continuously, can smallpox fail to reach its natural lifespan?
Heart governs Blood and belongs to Fire. Smallpox relies on it to operate the whole body. Warmth allows flow; cold causes stagnation. The world uses Xi Jiao (Rhinoceros Horn - *Note: Now banned/substituted*) to cool it; this ignores Yin-Yang attributes. How can it transform smallpox toxin and succeed? Thus, I only use it for residual toxin after scabbing. If Heavenly Pestilence Qi contends fiercely with Qi and Blood, pulse is surging and rapid, smallpox emerges purple initially, becomes dense red-purple later, with internal symptoms of irritability, restlessness, thirst, red/scanty urine, constipation,酌情 add cooling flavors to resolve, or use Jiu Chao Da Huang (Wine-fried Rhubarb) to mildly purge. If nose/mouth bleeding occurs, temporarily use Xi Jiao. If toxin is盛 (excessive) but Qi/Blood are not, although termed "resolving toxin," one must combine activating Blood and tonifying Qi. Ren Shen (Ginseng Root), Huang Qi (Astragalus Root), Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root)—how can these be omitted?
Huang Lian (Coptis Rhizome) and Xi Jiao (Rhinoceros Horn) are Heart-draining agents. Currently, people rely on them as divine remedies for smallpox, using them indiscriminately regardless of Excess/Deficiency or Cold/Heat, adding Shi Gao (Gypsum), Ming Fen (Calcined Shell/Slippery Stone), Sheng Di Zhi (Rehmannia Root Preparata), Ling Yang Jiao (Antelope Horn), freezing the vitalizing Qi. Alas, how strange!
Smallpox ultimately relies on Heat to succeed. First three days: heat precedes eruption. After full eruption: heat subsides. Before pus formation: heat returns. After full pus: heat subsides. Before pus regression: heat returns. After pus regression: heat subsides. During scabbing/falling: heat returns, named "Burning Scar." All these should not be treated with cooling/resolving methods. Cooling causes Qi/Blood stagnation, leaving toxin internally and causing disaster. (Initial heat not subsided, smallpox erupts immediately: "Fire Flame," use Acrid-Cool to support exterior.)
Smallpox itself does not harm; only the toxin harms. If toxin fully attaches to smallpox, it does not harm. If not fully attached, it harms (Secret Method). Therefore, regardless of cause or formula, add a little Shan Zha Jia (Pangolin Scale) powder to penetrate orifices and drive it out, until toxin returns to the granules. Also add Bai Shao (White Peony Root) to astringe Blood and collect toxin, preventing any leakage. Is this not the method for treating smallpox?
Before smallpox erupts, induce slight sweating to disperse toxin vapors, sending toxin outward so interior becomes safe. After eruption, regulate Qi and assist Blood to fill the pus pathways. Only then does pus form and toxin exhaust.
Toxin stopping in muscles causes swelling; toxin stagnating in skin causes foul odor. Muscles are governed by Yangming, belonging to Earth. Skin is governed by Taiyin, belonging to Metal. Abscesses reflect Earth image; foul odor reflects Metal image. Each follows its kind.
Books state: Red papules indicate life; purple papules indicate death; black/blue papules, one in a hundred survives. Although, there are cases of red papules dying and purple/blue papules surviving. Papules indicate Blood Heat. Failure to resolve/purge leads to papules and malignant smallpox, which is inevitable. Regardless of color, with or without papules, death ensues. Unless Tian Ting (Forehead) is clear, appearance/color is good, and macules appear—this requires separate discussion.
Once, a papule case, physicians could not treat. Summoned me, it had been seven days. Papules divided upper/middle/lower: upper red, middle purple, lower blue. Examining smallpox: protruding, sparse, containing clear fluid, dark/black color, but spirit vigorous. Examining lips/tongue: dry coating. I said: Due to failure to resolve/purge. Administer cooling, and it healed spontaneously. Indeed so. Thus, books should not be rigidly followed. Observing appearance/color and verifying lips/tongue is the standard.
Epistaxis (nosebleed) before or after smallpox indicates toxin vapor leaking outward, rushing to the Lung. This is not an ominous sign. Use Fa Hui San (Ash Powder) or Qing Fei Tang (Clear Lung Decoction) to regulate. Do not use harsh agents like Xi Jiao.
Ding (carbuncle) formation is due to excessive Heat-Toxin, failure to resolve/harmonize, unable to enter internally, knotting in tunnel voids. Malignant smallpox Ding transforms from adverse to favorable. But knotting at front/back heart leads to death; knotting at ear gate/throat leads to death. Differentiating Ding has methods. Beware mistaking black smallpox for Ding. Black smallpox is still smallpox. Ding sinks into flesh, shaped like a snail shell, nodular upon pinching, painless upon cutting, root white or inch-long. Physicians often mistake this. Post-scab Ding ulceration, within seven days before/after, treat with Si Sheng Dan (Four Saints Pill).
During smallpox swelling or scabbing, sudden persistent diarrhea is critical. Yi Gong San (Beneficial Work Powder) may fail. Use Dou Kou Wan (Cardamom Pill) or Bai Zhu San (Atractylodes Powder) to stop. (For Heat-Toxin diarrhea, use Jia Wei Si Ling San). During swelling/suppurating, if no bowel movement for 6-7 days with irritability/pain, it is toxin excess and constipation. Use Qing Du Huo Xue Tang (Clear Toxin Activate Blood Decoction), remove Ren Shen, Huang Qi. Add Niu Xi (Achyranthes Root), double Zi Cao (Arnebia Root), Dang Gui (Angelica Sinensis). Take with half cup raw honey. Severe cases add 3 qian Jiu Chao Da Huang (Wine-fried Rhubarb) to purge. If still blocked, insert Pig Gallbladder juice into anus to通便. Do NOT use Xiao (Mirabilite) and Huang (Rhubarb) for drastic purgation, causing complications. Abstaining from meat/fish is correct. However, children of wealth rely on this diet for Spleen/Stomach development. Depriving them of food deprives vitalizing Qi of steam/nourishment. This cannot be judged by common rules.
Smallpox relies on Blood for nourishment and Qi for filling. Thus, eyes and nose must seal. Eye sealing prevents Spirit from wandering; Nose sealing prevents Qi from escaping. Spirit/Qi nourishes internally, making it rare for toxin not to be controlled. However, nasal congestion with mucus is a good sign. Nasal congestion with dry/black orifice edges indicates death. Eye sealing with tears indicates life. Eye sealing with coal smeared around orbits indicates death. If eyes sealed for 5-6 days without swelling, eye disease will follow sealing. Few smallpox lesions do not require sealing, or seal briefly until scabbing then release.
Differentiation of Qi/Blood is like clarity/turbidity rooted in upper/lower. Intersection of Qi/Blood is like Yin/Yang relying on each other. When differentiation is needed but not done, toxin knots. When intersection is needed but not done, toxin isolates. Knowing Yin-Yang disperses depression, why not differentiate? Knowing Clear Heat Resolves Toxin, why not worry about intersection?
Smallpox forms/symptoms have four: Toxin Obstruction, Blood Heat, Qi Deficiency, Blood Deficiency. Excess/Deficiency have four: Exterior/Interior Excess/Deficiency. Dense eruption points, non-pointed/loose shape, pale/dark color,欲出不出 (wanting to emerge but not) in skin—this is Toxin Obstruction. Deep red points turning purple/black, accompanied by Ding/Papules—this is Blood Heat. Depressed top, thin skin, flat/collapsed—this is Qi Deficiency. Pale color, scattered bases, or smallpox color indistinguishable from flesh—this is Blood Deficiency. Slight fever with sweat is Exterior Deficiency. High fever without sweat, panting, floating pulse, scorched skin/hair, muscle pain—Exterior Excess. Mental fatigue, pale lips/tongue—Interior Deficiency. Mania, excessive Qi, thirst, good appetite, dry lips, yellow/white tongue coating—Interior Excess. Toxin Obstruction and Blood Heat correspond to Exterior/Interior Excess. Qi Deficiency and Blood Deficiency correspond to Exterior/Interior Deficiency. One becomes two, two becomes one. Obstruction: disperse. Heat: cool. Deficiency: tonify. Excess: purge. Neither excess nor deficiency: use neutral formulas to regulate. Understanding these means more than half the thinking is done. Although, differentiating Cold/Heat/Excess/Deficiency especially requires using the tongue as the guideline.
Three Grades: Smooth (Shun), Dangerous (Xian), Adverse (Ni). Smooth: Qi/Blood harmonious, toxin disseminated, no treatment needed. Dangerous: Qi/Blood stagnant, toxin obstructed, or miscellaneous diseases interfering, urgent treatment needed. Adverse: Toxin knotted, Qi/Blood dried up, treatment futile. Five Essentials: 1. Eruption should be complete. 2. Swelling should be thorough. 3. Pus should be thick/full. 4. Scabbing should be uniform. 5. Scabs should be thick. Five Goods: 1. Appetite normal. 2. Bowel/bladder regular. 3. Sores red/vibrant/firm. 4. Pulse calm, body cool, hands/feet warm. 5. Voice clear, movements peaceful. (Cannot get all five; getting one or two is also auspicious.) Seven Evils: 1. Irritability/restlessness, delirium/confusion. 2. Vomiting/diarrhea, inability to eat. 3. Black/depressed/scorched, itchy/collapsed/ruptured. 4. Pre-swelling of head/face, nasal flaring/shrug lifting, staring eyes/cracked lips. 5. Throat/tongue ulceration, vomiting upon eating, choking upon drinking. 6. Chills/tooth-grinding, hoarse voice/dark color. 7. Abdominal distension/panting, cold extremities. (Not all seven need be present; having one or two is already difficult.) Beyond Seven Evils, there are whole-body blood macules, stabbing heart/abdominal pain, sunken/non-emerging, bloody urine/stool, grasping at air/clothes—these are sudden death and incurable.
Ye Tianshi said: Adverse cases can also survive; do not abandon them untreated. Dangerous cases definitely do not have a death sentence; death is the physician's fault, not smallpox's. Now, some select Smooth cases to treat to blend in and gain fame, abandoning Dangerous ones. Therefore, I detest the symptom classification in books like Jin Jing Lu as inhumane.
Best smallpox: Emerges, grows, fills with pus sequentially. Tops round/red/vibrant; slight pus appearance leads immediately to scabbing. Most unique: Emerges, grows, immediately scabs, never seeing pus fluid, named "Dry Smallpox." Both should not be treated; incompetent/arrogant practitioners often kill patients. Rash erupts first, rash scabs then smallpox emerges: "Padding Rash." Rash and smallpox erupt together, rash scabs then smallpox grows: "Clasped Rash." Smallpox emerges with tiny granules piled on top: "Covered Smallpox Rash." When smallpox emerges, hidden in skin/flesh...