六脉为脏腑虚实之据，气血强弱之征，水火盛衰之验，故治百病必凭脉用药而无
误，痘疮尤为据脉施治而有功。盖痘疮之出，全赖正气以充托达表也。痘疮之脓，全
赖气以煦之，血以濡之者，不独气血为用，更有真水真火，以为血之根而后煦濡有力，
克成气血之德也。痘疮之收，既赖土德化毒之功，复寓归藏之理，故气血尚为标，而
水火土乃其本也。且诸疮肿毒，非气血不和所致，即暴受客热而成，并无传经定限，
故可迁延岁月，或调和气血而形肿内消，或解毒清凉而脓血勿溃，至于痘疮得于生身
之始，根于肾，发于心，传于肝肺脾，克期定限，十四日之中，自头面以渐而下，见
点起胀。贯浆收靥而后已，宁有内消者乎！宁有不成脓者乎！故必调理气血，送毒出
表，充托成脓，则毒化于外，还元于中，虽有客邪外犯，无足虑也。是以治痘者，须
于七日以前，如花之始蕾而发，其势日盛，气高于上之时，则助气血以令头面贯浆，气
交于中之时，则助气血以令胸背贯浆，气交于下之时，则助气血以令腿足贯浆，借
毒火之营运，而充贯成浆自易矣。有此药力，以代气血充贯之用，则脓成之后，气
血无伤，精神如故也，若不调补气血，妄行解毒清凉，延缓时日，一至七日之后，如
花之气敛而欲谢矣。其气日衰而降，复欲升提气血以达头面行浆，不亦晚乎！况气
血日衰而充贯自难，毒火无从消化，重则内攻脏腑，轻则变生诸证，上古婴儿，天
禀有余，故古方惟为疏表清理，以图易出
易解，盖因气血充足，不必为之瞻顾也。奈近世婴孩，受质浇漓，虽名纯阳之子，熟
知阴既不足，而禀阳亦虚，当此行天之证发露，而阴阳两亏者甚多，难出难脓。若
始也徒从疏表为事，则表虚者不能约束，任其一涌而出，则气血充贯不周，定有难浆
难靥之患。里虚者中气愈馁，无力载毒成形，昧者重用毒药迅攻，实同无米炊饭之
象，非转虚而成内溃，即奔溃而如蚕种蛇皮。至于脓也，而惟图清解为事，则阳虚
者冰伏于中，阴虚者枯涸于表，水火不行，无形之化，气血难成有质之功。况禀薄之
芽儿，不耐疾病，一经发热，数日元气已伤于中，再加疏表故托，气血辗转潜耗。痘
之少者，虽虚而无伤乎性命，痘之密者，愈损而绝其生机。故张痛求至理，凡遇六脉
洪大有力者，则从古法以解肌；若六脉沉微无力者，则微温中以托里，使中气不馁，
而气血鼓舞，则逐毒而有力，起胀灌浆不谋而至也。若六脉弦数无力者，则惟于壮
水之中，仍佐补火之药，使嘘濡有力，而自出也。盖可见痘疮为标，气血为本，书
曰∶认中标，只取本，治千人无一损，此之谓也。
六脉是判断脏腑虚实、气血强弱以及水火盛衰的依据，因此治疗各种疾病必须依据脉象来用药才能无误，痘疮的治疗更是依据脉象施治才能见效。大概痘疮的发出，完全依赖正气来充实并托举毒邪达于体表。痘疮化脓，完全依赖气来温煦它，血来濡润它，这不仅仅是气血的作用，更有真水真火作为血的根基，之后温煦和濡润的力量才充足，从而成就气血的功效。痘疮的收靥（结痂），既依赖脾土化解毒邪的功能，又蕴含归藏的道理，所以气血尚且属于标，而水火土才是其根本。况且各种疮肿毒邪，不是由气血不和导致，就是突然感受客热而成，并没有固定的传经期限，所以可以拖延很长时间，或者通过调和气血使肿胀在体内消散，或者通过解毒清凉使脓血不溃破。至于痘疮，从出生之初就已获得，根源于肾，发源于心，传变于肝、肺、脾，有固定的期限，在十四天之中，从头部面部逐渐向下发展，出现斑点、起胀、贯浆、收靥而后结束，哪里有在体内消散的呢！哪里有不成脓的呢！所以必须调理气血，送毒邪出表，充实托举以成脓，这样毒邪就在外部化解，元气在内部恢复，即使有外来的邪气侵犯，也不必担忧。因此治疗痘疮的人，必须在七日以前，像花蕾刚开始绽放，气势日益旺盛，气机高于上部的时候，就辅助气血让头面部贯浆；当气机交合于中部的时候，就辅助气血让胸背部贯浆；当气机交合于下部的时候，就辅助气血让腿足部贯浆，借助毒火的运行营运，充实贯通成浆就容易了。有了这种药力，代替气血充实贯通的作用，那么在脓成之后，气血就不会受伤，精神依然如故。如果不调补气血，妄行解毒清凉之法，拖延时日，到了七日之后，就像花朵之气收敛将要凋谢一样。其气日渐衰弱而降，此时再想升提气血以到达头部面部行浆，不是太晚了吗！何况气血日渐衰弱，充实贯通自然困难，毒火无法消化，严重的会内攻脏腑，轻则会变生各种证候。上古时期的婴儿，先天禀赋有余，所以古方只用于疏解表邪、清理内热，以求容易出痘、容易化解，这是因为气血充足，不必有所顾虑。无奈近世的婴孩，禀受的气质浇薄，虽然名为纯阳之子，但深知阴既不足，禀受的阳也虚弱，正当这种行天之证发作显露时，阴阳两亏的情况很多，难以出痘、难以成脓。如果起初只致力于疏解表邪，那么表虚者不能约束，任由痘毒一涌而出，那么气血充实贯通就不周全，必定会有难成浆、难结痂的祸患。里虚者中气更加疲惫，无力载毒成形，愚昧之人重用毒药猛烈攻伐，实在如同无米之炊的景象，不是转为虚损而导致内溃，就是奔溃破裂如同蚕种蜕皮或蛇皮脱落。至于成脓阶段，如果只图清解，那么阳虚者会被寒凉冰伏于中，阴虚者会在体表枯涸，水火不行，无形的化生功能受阻，气血难以成就有形的功效。何况禀赋单薄的幼儿，不耐受疾病，一经发热，几天之内元气已在内部受损，再加上疏表固托，气血辗转暗中消耗。痘疹稀疏的，虽然虚弱但不会伤及性命；痘疹密集的，越损伤越断绝生机。所以张痛求探究至理，凡是遇到六脉洪大有力的，就遵循古法以解肌发表；如果六脉沉微无力的，就用微温中的方法以托里，使中气不疲惫，而气血受到鼓舞，那么驱逐毒邪就有力量，起胀灌浆不期而至。如果六脉弦数无力的，就只在壮水（滋阴）之中，仍辅以补火（助阳）的药物，使嘘濡有力，痘毒自然发出。由此可见，痘疮是标，气血是本，书上说：认清标与本，只取本进行治理，治疗千人无一受损，说的就是这个道理。
The six pulses are the basis for determining the deficiency and excess of the Zang-Fu organs, the signs of the strength and weakness of Qi and Blood, and the verification of the flourishing and declining of Water and Fire. Therefore, treating all diseases must rely on pulse diagnosis to prescribe medication without error; treating smallpox is particularly effective when treatment is administered based on pulse diagnosis. Generally, the eruption of smallpox relies entirely on Righteous Qi (Zheng Qi) to fill and support the toxin to reach the exterior. The suppuration of smallpox relies entirely on Qi to warm it and Blood to moisten it. This is not merely a function of Qi and Blood, but also requires True Water and True Fire as the root of Blood, so that the power of warming and moistening is sufficient to accomplish the virtue of Qi and Blood. The crusting (shou ye) of smallpox relies both on the function of Earth (Spleen/Stomach) to transform toxins and embodies the principle of storage and return. Thus, Qi and Blood are considered the branch (biao), while Water, Fire, and Earth are the root (ben). Moreover, various sores, swellings, and toxic lesions are caused either by disharmony of Qi and Blood or by sudden contraction of external heat, without fixed limits of transmission through meridians. Therefore, they can linger for years, resolving internally through harmonizing Qi and Blood, or preventing pus and blood formation through detoxification and cooling. In contrast, smallpox is acquired from birth, rooted in the Kidney, originating in the Heart, and transmitting to the Liver, Lungs, and Spleen. It follows fixed timelines: within fourteen days, it progresses gradually from the head and face downward, showing spots, swelling, filling with fluid, and crusting before ending. How could there be internal resolution? How could there be failure to form pus? Therefore, one must regulate Qi and Blood, send the toxin out to the exterior, and fill/support to form pus. Thus, the toxin is transformed externally, and Yuan Qi (Original Qi) is restored internally. Even if external pathogens invade, there is little to worry about. Hence, those treating smallpox must, before the seventh day, when the condition is like a flower bud beginning to bloom and its momentum daily increasing with Qi rising above, assist Qi and Blood to fill the head and face with fluid. When Qi intersects in the middle, assist Qi and Blood to fill the chest and back. When Qi intersects below, assist Qi and Blood to fill the legs and feet. By borrowing the operation of toxic fire, filling and forming fluid becomes easy. With this medicinal power substituting for the function of Qi and Blood filling, after pus forms, Qi and Blood remain uninjured, and spirit remains unchanged. If one does not tonify Qi and Blood but recklessly uses detoxifying and cooling methods, delaying time, after the seventh day, the Qi of the "flower" will contract and fade. As Qi declines and descends daily, attempting to raise and lift Qi and Blood to reach the head and face for fluid formation is too late! Furthermore, as Qi and Blood decline daily, filling becomes difficult, toxic fire cannot be digested, severe cases attack the Zang-Fu internally, and mild cases generate various syndromes. Infants in ancient times had abundant innate endowment, so ancient formulas only focused on releasing the exterior and clearing heat, aiming for easy eruption and resolution, because Qi and Blood were sufficient, requiring no hesitation. Unfortunately, infants in recent times have thin constitutions. Although called "children of pure Yang," it is well known that Yin is insufficient and the endowed Yang is also weak. During the manifestation of this heavenly disease, many suffer from dual deficiency of Yin and Yang, making eruption and suppuration difficult. If initially one only focuses on releasing the exterior, those with deficient exterior cannot constrain the eruption, allowing toxins to surge out uncontrollably. Consequently, Qi and Blood filling will be incomplete, leading to difficulties in forming fluid and crusting. Those with interior deficiency will have further weakened Middle Qi, lacking the strength to carry toxins into shape. Ignorant practitioners use heavy toxic drugs for rapid attack, which is akin to cooking rice without grain; this leads either to transformation into deficiency causing internal collapse, or to bursting rupture resembling silkworm molting or snake skin shedding. Regarding suppuration, if one only seeks clearing and resolving, those with Yang deficiency will have their interior frozen by cold, and those with Yin deficiency will become dry at the exterior. Water and Fire fail to circulate, hindering无形 transformation, making it difficult for Qi and Blood to achieve tangible results. Moreover, children with thin constitutions cannot tolerate illness. Once fever occurs, Yuan Qi is damaged internally within a few days. Adding exterior-releasing and supporting measures causes Qi and Blood to be secretly consumed. For sparse smallpox, although deficient, life is not endangered; for dense smallpox, further damage cuts off vitality. Therefore, Zhang Tongqiu sought the ultimate truth: whenever the six pulses are surging (hong) and forceful, follow ancient methods to release the muscle layer (jie ji); if the six pulses are deep (chen) and faint (wei) with no force, use mild warming of the Middle Jiao to support the interior, ensuring Middle Qi is not exhausted, thereby inspiring Qi and Blood to forcefully expel toxins, causing swelling and fluid formation to arrive spontaneously. If the six pulses are wiry (xian) and rapid (shu) with no force, focus on strengthening Water (nourishing Yin) while assisting Fire (aiding Yang), ensuring sufficient moistening power, allowing natural eruption. Thus, it is evident that smallpox is the branch, and Qi and Blood are the root. The book states: Recognize the branch and root, treat only the root, and treating thousands will result in no harm. This is what is meant.