痘证初起，用药甚难，难者何？预护之为难也。盖痘之放肥，灌浆，结痂，总从见点之初立根
基，非深思远虑者不能也。且其情势未曾显张，大约辛凉解肌，芳香透络，化浊解毒者，十之七、八；
本身气血虚寒，用温煦保元者，十之二、三。尤必审定艺之壮弱肥瘦，黑白青黄，所偏者何在？所不
足者何在？审视体质明白，再看已未见点，所出何苗？参之春夏秋冬，天气寒热燥湿，所病何时？而后
定方。务于七日前先清其所感之外邪，七日后只有胎毒，便不夹杂矣。
治痘之明家甚多，皆不可偏废者也。若专主于寒、热、温、凉一家之论，希图省事，祸斯亟矣。
痘科首推钱仲阳、陈文中二家，钱主寒凉，陈主温热，在二家不无偏胜，在后学实不可偏废。盖二
家犹水火也，似乎极不同性，宗此则害彼，宗彼则害此。然万物莫不成于水火，使天时有暑而无寒，
万物焦矣，有寒而无暑，万物冰矣，一阴一阳之谓道，二家之学，似乎相背，其实相需，实为万世治痘
立宗旨。宗之若何？大约七日以前，外感用事，痘发由温气之行，用钱之凉者十之八、九，用陈之温
者一、二。七日以后，本身气血用事，纯赖脏真之火，炼毒成浆，此火不外鼓，必致内陷，用陈之温者
多，而用钱之凉者少也。若始终实热者，则始终用钱；始终虚寒者，则始终用陈；痘科无一定之证，故
无一定之方也。丹溪立解毒、和中、安表之说，亦最为扼要。痘本有毒可解，但须解之于七日之前，
有毒郁而不放肥，不上浆者，乌得不解毒哉！如天之亢阳不雨，万物不生矣。痘证必须和中，盖脾胃
最为吃紧，前所谓以中焦作战场也。安表之论，更为妙谛，表不安，虽至将成犹败也，前所谓以皮肤
结痂，为成功之地，而可不安之也哉！安之不暇，而可混发以伤之也哉！至其宗钱而非陈，则其偏
也。万氏以脾胃为主，魏氏以保元为主，亦确有见识，虽皆从二家脱化，而稍偏于陈。费建中
《救偏琐言》，盖救世人不明痘之全体大用，偏用陈
文中之辛热者也；书名救偏，其意可知，若专主其法，悉以大黄、石膏从事，则救偏而反偏矣。胡氏
辄投汗下，下法犹有用处，汗法则不可也。翁仲仁《金镜录》一书，诚为痘科宝筏，其妙处全在于
看，认证真确，治之自效，初学必须先熟读其书，而后历求诸家，方不误事。后此翟氏、聂氏，深
以气血盈亏，解毒化毒，分晰阐扬钱氏、陈氏底蕴，超出诸家之上，然分别太多，恐读者目眩。愚谓看
法必宗翁氏，叶氏有补翁仲仁不及之条；治法兼用钱、陈，以翟氏、聂氏，为钱、陈之注，参考诸家可
也。近日都下盛行《正宗》一书，大抵用费氏、胡氏之法而推展之，恣用大汗大下，名归宗汤，石膏、大
黄始终重用，此在枭毒太过者则可，岂可以概治天下之小儿哉！南方江西江南等省，全恃种痘，一遇
自出之痘，全无治法；医者无论何痘，概禁寒凉，以致有毒火者，轻者重，重者死，此皆偏之为害也。
痘证在初起阶段，用药非常困难，难点在哪里呢？在于预先防护的难度。因为痘疹的舒展饱满、灌浆、结痂，都取决于见点之初确立的基础，不是深思远虑的人不能做到。而且其病情态势尚未完全显露，大约采用辛凉解肌（用辛凉药物解除肌表之邪）、芳香透络（用芳香药物疏通经络）、化浊解毒（化解湿浊、解除毒素）的方法，占十分之七、八；如果是患者本身气血虚寒，使用温煦保元（温补阳气、保护元气）的方法，占十分之二、三。尤其必须审察患儿体质的壮弱、肥瘦，肤色黑白青黄，其偏颇之处在哪里？不足之处在哪里？仔细审视体质情况明确后，再看痘疹是否已出现，发出的痘苗形态如何？结合春夏秋冬四季，天气的寒热燥湿，发病的时间是何时？然后才能确定方剂。务必在七日前先清除所感受的外邪，七日后只有胎毒，就不会夹杂其他病邪了。
治疗痘疹的知名医家很多，他们的学说都不可偏废。如果专门主张寒、热、温、凉其中一家的理论，企图省事，祸患就会很快到来。痘科首推钱仲阳、陈文中两家，钱氏主张寒凉，陈氏主张温热，这两家在学术上虽各有侧重，但对后学者来说实在不可偏废。因为这两家就像水和火一样，似乎性质极不相同，尊崇这一家就会损害那一家，尊崇那一家就会损害这一家。然而万物没有不成于水火的，假使天时只有暑热而没有寒冷，万物就会焦枯；只有寒冷而没有暑热，万物就会冰冻。一阴一阳叫做道，两家的学说，看似相背，其实相互需要，实为万世治疗痘疹确立的宗旨。如何尊崇他们呢？大约七日以前，外感致病为主，痘疹发作由温气运行所致，用钱氏寒凉方法的占十分之八、九，用陈氏温热方法的占一、二。七日以后，患者自身的气血起作用，纯粹依赖脏腑真火，炼化毒素成浆，这火如果不向外鼓动，必然导致内陷，所以多用陈氏温热方法，而少用钱氏寒凉方法。如果始终表现为实热证，则始终用钱氏方法；始终表现为虚寒证，则始终用陈氏方法；痘科没有固定的证候，所以没有固定的方剂。朱丹溪提出解毒、和中（调和脾胃）、安表（固护肌表）的说法，也最为扼要。痘疹本来有毒可以解除，但必须在七日之前解除，如果有毒郁结而不能舒展饱满、不能灌浆的，怎能不解毒呢！就像天空亢阳无雨，万物就不能生长一样。痘疹必须和中，因为脾胃最为关键，前面所说的以中焦作为战场。安表的理论，更是精妙真谛，肌表不安定，即使快要痊愈也会失败，前面所说的以皮肤结痂作为成功之地，怎么能不安定它呢！安定它还来不及，怎么能胡乱发散来伤害它呢！至于他尊崇钱氏而非陈氏，则是他的偏颇。万全以脾胃为主，魏直以保元为主，也确有见识，虽然都是从这两家脱化而来，但稍微偏向陈氏。费建中的《救偏琐言》，大概是救治世人不明白痘疹的整体大用，片面使用陈文中之辛热药物的弊病；书名叫做救偏，其用意可知，如果专门主张这种方法，全部使用大黄、石膏，那么救治偏颇反而又陷入偏颇了。胡氏动辄投用汗法、下法，下法还有用处，汗法则不可以。翁仲仁的《金镜录》一书，确实是痘科的宝贵指南，其妙处全在于诊察，辨证准确，治疗自然有效，初学者必须先熟读这本书，然后遍求各家学说，才不会误事。此后翟氏、聂氏，深刻阐述气血盈亏、解毒化毒的道理，分晰阐扬钱氏、陈氏的底蕴，超出诸家之上，然而区分太多，恐怕读者眼花缭乱。我认为诊察方法必须宗法翁氏，叶天士有补充翁仲仁不足的地方；治疗方法兼用钱氏、陈氏，以翟氏、聂氏作为钱氏、陈氏的注解，参考各家即可。近日北京盛行《正宗》一书，大体上使用费氏、胡氏的方法并加以推展，肆意使用大汗、大下法，名义上归宗汤药，始终重用石膏、大黄，这对于枭毒太过的患者是可以的，难道可以用来普遍治疗天下的小儿吗！南方江西、江南等省，完全依靠种痘，一旦遇到自出之痘，完全没有治疗方法；医生无论什么痘疹，一概禁止寒凉药物，以致导致有毒火的患者，轻者变重，重者死亡，这都是偏颇带来的危害。
In the initial stage of variola (smallpox), the use of medicinal substances is extremely difficult. What is the difficulty? It lies in the challenge of preventive care. The expansion and fullness, filling with pus, and scabbing of variola all depend on establishing a foundation at the very beginning when spots first appear; this requires profound deliberation and foresight. Moreover, since the clinical presentation has not yet fully manifested, approximately seventy to eighty percent of cases are treated with acrid-cool methods to release the muscle layer (using acrid-cool medicinal substances to relieve pathogenic factors in the muscle layer), aromatic methods to penetrate collaterals (using aromatic medicinal substances to unblock collaterals), and methods to transform turbidity and resolve toxins. If the patient's own Qi and Blood are deficient and cold, warming and preserving Yuan Qi (warming Yang Qi and protecting primordial Qi) accounts for twenty to thirty percent. One must specifically examine the strength or weakness, fatness or thinness, and skin color (black, white, green, yellow) of the child, identifying where the bias lies and where there is deficiency. After clearly assessing the constitution, one observes whether the spots have appeared and what form the emerging lesions take. These observations are combined with the seasonal characteristics of spring, summer, autumn, and winter, as well as the climatic conditions of cold, heat, dryness, and dampness, and the timing of the onset. Only then can a prescription be determined. It is essential to clear the external pathogenic factors acquired prior to the seventh day; after the seventh day, only fetal toxin remains, preventing contamination by other pathogens.
There are many renowned experts in treating variola, and their theories should not be disregarded individually. If one exclusively adheres to a single theory of cold, heat, warm, or cool to save trouble, disaster will ensue rapidly. In the field of variola, Qian Zhongyang and Chen Wenzhong are highly recommended. Qian advocated cooling methods, while Chen advocated warming methods. Although these two schools have their respective emphases, they are indispensable for later learners. The two schools are like water and fire; although their natures seem extremely different, favoring one harms the other, and favoring the other harms the one. However, all things are formed through water and fire. If heaven had only heat without cold, all things would wither; if it had only cold without heat, all things would freeze. Yin and Yang constitute the Dao. The learning of these two schools seems contradictory but is actually mutually dependent, serving as the guiding principle for treating variola for all generations. How should one apply them? Generally, before the seventh day, external infections dominate, and the eruption of variola is driven by warm Qi; thus, Qian’s cooling methods are used in eighty to ninety percent of cases, while Chen’s warming methods are used in ten to twenty percent. After the seventh day, the patient’s own Qi and Blood become active, relying entirely on the true fire of the Zang organs to refine toxin into pus. If this fire does not vent outward, it will collapse inward; therefore, Chen’s warming methods are used more frequently, and Qian’s cooling methods less so. If the case consistently presents as excess-heat, Qian’s methods are used throughout; if it consistently presents as deficiency-cold, Chen’s methods are used throughout. Since variola presents with no fixed syndrome, there is no fixed prescription. Zhu Danxi proposed the theories of resolving toxins, harmonizing the middle (regulating the Spleen and Stomach), and stabilizing the exterior (protecting the body surface). This is also most pertinent. Variola inherently contains toxins that can be resolved, but resolution must occur before the seventh day. If toxins are stagnant, preventing expansion and pus formation, how can one fail to resolve the toxins? It is akin to extreme yang without rain, resulting in the failure of all things to grow. Harmonizing the middle is essential for variola because the Spleen and Stomach are critical, as previously described as the battlefield of the Middle Jiao. The theory of stabilizing the exterior is even more profound; if the exterior is unstable, failure occurs even near recovery. As previously stated, skin scabbing is the site of success; how can one fail to stabilize it? Stabilization is urgent enough; how could one recklessly induce sweating to cause harm? His preference for Qian over Chen was his bias. Wan Quan focused on the Spleen and Stomach, and Wei Zhi focused on preserving Yuan Qi; both had genuine insight. Although they derived from the two main schools, they leaned slightly toward Chen. Fei Jianzhong’s *Jiu Pian Suo Yan* (Trivial Words on Correcting Bias) aimed to correct the widespread misuse of Chen Wenzhong’s acrid-hot methods due to a lack of understanding of the comprehensive utility of variola. The title implies correcting bias; however, if one strictly applies this method using Rhubarb (*Rhei Radix et Rhizoma*) and Gypsum (*Gypsum Fibrosum*) exclusively, correcting one bias creates another. Hu Shi often employed diaphoresis (sweating therapy) and purgation (draining therapy); purgation has its uses, but diaphoresis is inappropriate. Weng Zhongren’s *Jin Jing Lu* (Golden Mirror Record) is indeed a treasure guide for variola. Its brilliance lies in diagnosis: accurate pattern differentiation ensures effective treatment. Beginners must memorize this book thoroughly before exploring other schools to avoid errors. Later, Zhi Shi and Nie Shi deeply elaborated on the principles of Qi and Blood balance and toxin resolution, clarifying the foundations of Qian and Chen, surpassing other schools. However, their distinctions were too numerous, potentially confusing readers. I believe diagnostic methods should follow Weng Shi, with Ye Tianshi providing supplements to Weng’s omissions. Therapeutic methods should combine Qian and Chen, using Zhi and Nie as commentaries on them, referencing various schools. Recently, the book *Zheng Zong* (Orthodox Standard) has been popular in Beijing. It largely expands upon the methods of Fei and Hu, recklessly employing heavy diaphoresis and purgation, claiming allegiance to decoctions, and consistently using high doses of Gypsum and Rhubarb. This may be suitable for cases with excessive virulent toxins, but it cannot be universally applied to all children. In southern provinces such as Jiangxi and Jiangnan, vaccination is relied upon entirely; spontaneous variola cases receive no treatment. Physicians prohibit cooling medicinal substances regardless of the type of variola, causing patients with toxic heat to deteriorate from mild to severe, or from severe to fatal. These are all harms caused by bias.