经曰∶阳络伤则血外溢，阴络伤则血内溢。血外溢则衄血，血内溢则便血。疮疹之火由内而发，
毒不能
达，则燔灼经络而迫血妄行，血随火动，从上而出，则为衄为吐，从下而出，则为便为溺，
阴阳俱伤，则上下俱出。凡痘疹失血，若从鼻出者，则有阳明外达之意，尚可望生，若从他处，
则总属阴分而火毒内陷，乃悉为危证。
一、痘疹发热见血者，多属火证。若衄血者，宜玄参地黄汤，或加茅根汁，或加京墨汁同
饮之。衄止者生，不止者不治。溺血者，大厘清饮，或八正散。大便秘而见血者，宜四顺清凉饮。
一、痘疮已出未出之间，凡诸血证，俱宜用犀角地黄汤三方酌宜治之最佳。血止后，可进调元
汤加木通。
一、痘疮十日之后，忽脓血大作，大便陡出者，此为胃烂不治。
痘疮发泡亦与黑陷相类，虽一以外出，一以外入，形有不同，而邪气留结，毒则一也。或
发水泡，或发血泡，或赤或紫或黑，但见此证，十无一生。然亦有似泡而实非者，不可不辨。或
其人身上原有破伤，或疮疖未痊，或虽痊而瘢痕尚嫩，一旦痘出，则疮瘢四围痘必簇，此
物从其类之理也。因疮作泡，则其腐败皮肉，气色本异，宜与完肤有别，不得即认为紫黑泡也。
至若治泡之法，先以针刺破，吮去恶血，后用胭脂汁涂法，又用百花膏敷之。此疮极易作痒，
起发之后，宜常用茵陈熏法熏之，勿令抓伤。若不慎之，则反复灌烂，淹延不愈，变为疳蚀坏
疮，以致不治者多矣。
《黄帝内经》中说：阳络受损则血液向外溢出，阴络受损则血液向内溢出。血液向外溢出表现为鼻衄（鼻出血），血液向内溢出表现为便血。痘疹的火热之邪由体内发出，若毒邪不能透达外出，就会燔灼经络并迫使血液妄行，血液随着火势上涌，从上部排出，就表现为鼻衄或呕吐；从下部排出，就表现为大便带血或尿血。如果阴阳两方面的络脉都受损，那么上下都会出血。凡是痘疹引起的失血，如果是从鼻子流出的，说明阳明经之气尚能外达，还有希望存活；如果是从其他部位出血，则总属于阴分病变，火毒内陷，全都是危重证候。
一、痘疹发热时出现出血症状的，多属于火证。如果是鼻衄，适宜使用玄参地黄汤，或者加入白茅根汁，或者加入京墨汁一同服用。鼻衄停止的就能存活，不止血的无法救治。尿血的，适宜使用大厘清饮，或者八正散。大便秘结且见血的，适宜使用四顺清凉饮。
一、痘疮处于已出未出之间的阶段，凡是有各种出血症状的，都适宜根据具体情况斟酌选用犀角地黄汤的三个方剂进行治疗，这是最佳方案。血止之后，可以进服调元汤加木通。
一、痘疮发病十天之后，忽然脓血大量产生，大便突然排出脓血，这是胃壁腐烂的表现，属于不治之症。
痘疮发泡的症状与黑陷相似，虽然一个是向外发出，一个是向内陷入，形态有所不同，但邪气留结、毒邪的性质是一样的。有的发水泡，有的发血泡，颜色或红、或紫、或黑，只要出现这种证候，十个人中没有能活下来的。然而也有看似水泡实则不是的情况，不可不加以辨别。有的人身上原本就有破损伤口，或者疖子尚未痊愈，或者虽然痊愈但瘢痕还很娇嫩，一旦痘疮发出，痘疮必定簇拥在疮瘢周围，这是同类相从的道理。因为疮疡而引发的水泡，其腐败皮肉的气色本来不同，应该与完好皮肤有所区别，不能立即认定为紫黑色的水泡。至于治疗水泡的方法，先用针刺破，吸吮去除恶血，然后用胭脂汁涂抹，再用百花膏敷贴。这种疮极易瘙痒，起发之后，宜常用茵陈熏法进行熏蒸，不要让它被抓伤。如果不谨慎护理，就会导致反复溃烂，拖延不愈，变成疳蚀坏疮，以至于导致死亡的情况很多。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the Yang collaterals are injured, blood overflows outward; when the Yin collaterals are injured, blood overflows inward. Blood overflowing outward manifests as epistaxis (nosebleed), while blood overflowing inward manifests as hematochezia (blood in stool). The fire of chickenpox and smallpox erupts from within. If the toxin cannot be vented outward, it will scorch the meridians and collaterals, forcing blood to move recklessly. Blood follows the fire upward and exits from above, manifesting as epistaxis or vomiting; it exits from below, manifesting as blood in stool or urine. If both Yin and Yang are injured, bleeding occurs both above and below. In cases of hemorrhage due to smallpox/chickenpox, if the bleeding is from the nose, it indicates that the Qi of the Yangming channel can still reach the exterior, and survival is still possible. If bleeding occurs from other parts, it generally belongs to the Yin aspect with internal sinking of fire-toxin, representing critical conditions.
1. Hemorrhage occurring during fever in smallpox/chickenpox mostly belongs to Fire syndromes. For epistaxis, Xuan Shen Di Huang Tang (Scrophulariae Radix and Rehmanniae Radix Decoction) is appropriate, or one may add juice of Imperatae Rhizoma (Mao Gen) or Jing Mo Zhi (Beijing Ink Stick Juice) to drink together. If the epistaxis stops, the patient lives; if it does not stop, the condition is untreatable. For hematuria (blood in urine), Da Li Qing Yin (Great Clearance Decoction) or Ba Zheng San (Eight-Ingredient Powder for Rectification) is appropriate. For constipation accompanied by bleeding, Si Shun Qing Liang Yin (Four-Obedience Cooling and Clearing Decoction) is appropriate.
1. During the stage where smallpox lesions are emerging but not fully erupted, for any hemorrhagic symptoms, it is best to carefully select among the three variations of Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmanniae Radix Decoction) for treatment. After bleeding stops, Tiao Yuan Tang (Regulating Origin Decoction) with Tong Cao (Akebia Caulis) can be administered.
1. Ten days after the onset of smallpox, if pus and blood suddenly appear in large quantities and are passed via the stool, this indicates rotting of the stomach and is an untreatable condition.
The blistering of smallpox is similar to black depression (Hei Xian). Although one manifests outwardly and the other inwardly, and their forms differ, the pathogenic factors remain lodged and the nature of the toxin is the same. Some develop water blisters, some develop blood blisters, which may be red, purple, or black. Whenever such a syndrome appears, ten out of ten patients die. However, there are cases that resemble blisters but are not true blisters, which must be distinguished. If a person originally has broken skin wounds, or boils that have not healed, or scars that are still tender even after healing, once smallpox erupts, the lesions will cluster around the scars. This follows the principle of "things follow their kind." Blisters caused by sores involve corrupt flesh with different coloration, distinct from intact skin, and should not be immediately identified as purple-black blisters. As for treating blisters, first puncture them with a needle, suck out the bad blood, then apply juice of Carthami Flos (Hong Hua/Zhi Zi derivative often referred to as Yan Zhi in historical contexts, here translated as Rouge Juice/Carthamus juice) followed by applying Bai Hua Gao (Hundred Flowers Ointment). These sores easily cause itching. After eruption, it is advisable to frequently use Chen Yin Moxibustion/Fumigation (Artemisiae Scopariae Fumigation) and prevent scratching. If care is neglected, repeated ulceration and suppuration will occur, leading to prolonged non-healing, transforming into gan erosion necrotic sores, resulting in death in many cases.