自痘疹发热报痘，起胀灌浆，结靥诸证秘法，皆汇于此部中，以便检阅参治。
聂九吾曰∶发热之初，若身热和缓，或热或退，神清气爽，饮食如常，则不必用
药发汗，但或戒晕禁风调护而已。盖痘有顺而不必治者，不轻治，即所以调治之也。
其或憎寒壮热，头痛发热，头痛咳嗽，鼻流清涕者，多因于外感，不可不发散也，
当视儿强弱而用药发汗。儿体气素壮实者，加味升麻葛根汤汗之；（白葛根、升麻、赤芍、甘
草、桔梗、防风、苏叶、小川芎、山楂净肉、牛蒡子煎服，此方即是伤感而非痘疹服之发汗，亦无妨。）体气
素怯弱者，用加味参苏饮汗之。（人参、苏叶、桔梗、前胡、小川芎、山楂肉、粉葛、陈皮、制半夏、牛
蒡子，甘草煎服。）然皆不可出汗太多，恐发虚其表后，难起胀灌浆也。既经发汗而身热
渐缓，儿颇安静者，其痘出必稀少，此为顺候，且勿服药以待之。亦有发热和缓后痘多者，血气虚也。
发汗之后，或身热不退而烦躁者，且勿峻攻。故少待之，其或烦闷躁渴而妄语
者，用败毒和中散清之。（连翘、陈枳壳、防风、升麻、前胡、小川芎、麦门冬、桔梗、蝉蜕、牛蒡子、荆
芥、木通、甘草、紫草茸、酒炒黄连。大便秘涩者加酒炒大黄一钱二分微利之，不秘者勿加入，服此觉烦闷少
解，即止勿服，听其痘出外则中自安也。）或有腹痛、腰痛而烦闷者，此其毒瓦斯诚重，然只当用
败毒和中散主之。大便秘则加酒炒大黄微利之，听其痘毒出外，则内痛自止。
然后看其痘，或稠密，或红紫带黑，又
议解毒可也。切不可纯用寒凉，以阻遏其毒出之势，立致内攻告变。（凉药要制过，则性纯
而有效。）世人不知此理，多纯用寒凉解毒，或用硝黄峻下，因而速毙而卒不悟者多矣。
当时令众姓出痘时，小儿或有发热稍缓，其热或作或止，其红点或未见，或微
见而未明，或者出痘，或非出痘，正在疑似之间，当此之时，不如且勿服药，以待
其自定，但禁风、寒、荤，调护之而已。所谓不轻治之，所以深治之者此也。有等富
贵之家，珍爱太过，见其如此，屡投以清凉解毒之剂。不知若是痘证，则其毒瓦斯发
动于五脏，勃勃欲出外，其势决不可阻遏，屡用清凉阻遏其势，即所以迫之内攻而祸
速矣。故犯此者多有报痘，数日即烦闷惊搐而死，此解毒之剂杀之也。正如寇在宫
墙之内，不逐之外出，反遏其出路，围而攻之，宫中之人有不遭残害者乎！然医曰∶
吾用解毒药何至于杀人，既不自任其咎，病家亦曰彼用解毒药何至于杀吾人，亦不归
咎于医，杀人于冥冥之中，而已不悟也，人不知也。噫！亦可悲也已。予故表而出之，
以戒世之爱而反害者。语曰∶久腊者毒必浓，痘毒禀于胎元，伏于五脏，其轻者无
论已，其重者深藏久蓄，不为不浓矣。一旦触发于倏然忽然之顷，其势猛锐欲出，断
不可御，是以必藉气血载毒出外，成浆结痂，然后毒散而功成，此病机亦化机也。岂
其若诸疮之毒，可以骤然而解散者，故解之于既出之后，是顺其欲散之势，犹为近
理；解之于未出之先，是遏其猛锐欲出之势，其祸甚速。如初决之堤，水势排山而
欲捧土塞之，有是理乎？奈何自古治痘之家，其卑者固不足道，其高者亦未深悟其
理，每每于痘疮发热之初，欲出未出之际，
辄以解毒为主，且日服某药则毒可解而痘必出稀，不知痘之稀，由其初受毒之轻耳，
岂将出之时所能骤解乎！致启后之庸医，讹以承讹，见痘疮欲出未出之间，毒瓦斯炽盛
则多用寒凉以解之，或妄下以解之，彼自以为对证之妙剂，而不知反致内攻之奇祸，
至于杀人而终不悟，前覆而后不鉴，其祸又无穷也。予睹近时庸医，治痘多犯此失，
以致童幼数日而死者甚多，则皆茫然委于证恶难救，而举世莫觉其致死之由，殊可
矜恻也。故不得不再三发明其理，以救将来。
发热之际，有偶感风寒，饮食停滞而腹痛者，用升消平胃散，（小川芎、香附、苍术、
紫苏、陈皮、麦芽、砂仁、炒浓朴、楂肉、白芷、炙草、
藿香、姜引煎服。）一剂其痛立止。（然饮食作腹痛与毒瓦斯作腹痛，其证不同。停食痛者，其痛多急疾而啼叫
必甚，多在脐以上痛，面必青白，唇淡手足冷。毒瓦斯痛者，痛稍延缓而有作有止，多在脐以下，或连腰而痛，面
或红色而唇紫手足不冷，此两者必然分辨明白，方可用药也。）
发热之际，有呕吐者，有泄泻者，有吐泻交作者，全要辨虚实寒热而用药。
如吐泻交作而胸腹痛甚者，此感寒而停食也。（仍用升消平胃散主之，一服立效。）如胃气
弱而有寒，呕吐不思饮食，或食下即吐，其吐多顺快而无声，面青白唇淡，精神倦怠，
宜用参砂和胃散主之。（人参、砂仁、半夏、白术、茯苓、藿香、陈皮、炙草去皮、煨姜三片，煎服。）如脾
气虚弱，饮食不化而泄泻者，其泄滑利而色带白，宜用术苓调脾散主之。（白术、白茯苓、
白芍、神曲、炙草、扁豆、砂仁、香附、浓朴。或加人参、煨姜、大枣同煎服。）如有毒瓦斯作吐泻者，其
吐必酸，刺而有声，神气不甚困倦，其泄必黄色臭秽，虽或吐泄交作，胸腹多不痛，
此则毒瓦斯由吐泄而发泄，所谓吐泄为顺候而不必止者，惟此一证耳。若虚寒吐泄与
此迥异者亦多矣。（张洁古等乃一概谓痘前吐泻，慎勿乱治而多吉，并不分虚实寒热，何其孟浪之甚耶。）
身热至二三日后，痘欲出不出，或烦闷惊搐，或狂言谵语，切不可惊惶失措，惟
详审虚实寒热而治之。要知此等证皆由毒瓦斯在内，不得宣发于外而作，然毒瓦斯不得
宣发，证有不同，不可不辨。
如毒瓦斯壅盛于内，不能骤发于外，而惊搐狂躁者，宜用清解散以宣之。（防风、荆芥、
蝉蜕、桔梗、前胡、葛根、升麻、黄芩、黄连、紫草、木
通、牛蒡、连翘、甘草、楂肉、川芎煎服。）如内毒本盛，外为风邪所束，郁滞不得出而惊搐狂
躁，宜苏解散发之。（清解散内去芩连，加紫苏、白芷、羌活乘热服。）又有血气虚弱，送毒瓦斯不出
而惊搐狂躁者，宜用温中益气汤托之。（人参、白术、生 、归身、白茯苓、炙草、川芎、白芷、防风、
南木香、官桂、楂肉、姜、枣引服，中病即止。）
凡辨惊狂诸证，最宜精详，观形察色，审声闻证，又参之以脉，然后可以分别。
察痘影红紫，面赤唇紫，声音亮，口气粗，手足热，脉洪数，此毒瓦斯壅盛者也。
（或形色多同，但声重鼻塞或鼻涕，脉浮数者，此毒盛而为风寒所束者也。然此证多在寒凉之月，
或不谨避风寒者，然后有之。）
察其痘影淡淡在皮下，不见红活，唇淡面白或带青，脉又迟缓，虽烦躁惊狂谵
语，亦是血气虚而送毒瓦斯不出者也。（三者分别用药，当一剂之后，痘出而惊狂定矣。昔人谓痘未出
之前惊搐为顺，岂其然乎。）
幼儿初出痘，有发热二三日，全无痘点形影，而忽然惊搐，状与急惊风一样者，
此亦痘气壅盛不能宣发所致，宜用清解散以宣之，痘出即惊定矣。若医者不知是痘，
而误作急惊施治，或单以寒凉投之，或以驱痰药峻下之，其儿必死。何者？阻遏其
毒使不得出而内攻也。故未痘之儿，若遇此等证，即当经疑，恐是出痘，不可作急
惊治。又有发热稍轻，至三四日而痘仍隐隐不出者，最要详察，不可一概认为毒
轻痘少而漫不加意。若发热和缓，精神清爽，饮食如常，出痘少而点数明，头粒尖，
渐渐长大红活，此为毒轻痘少无疑矣。若身热虽轻，至三四日而倦怠嗜卧，不思饮食，所出
之痘，影影淡白，点粒不明，此非痘毒轻少，亦是血气虚弱，送毒瓦斯不出
也，急宜用温中益气汤以托之。甚者即连服二三剂痘始出齐，其痘必多，若因其安
静，袖手玩视而不急托痘出外，延至五六日后，毒瓦斯内攻，须臾告变，不可救疗，甚
是畏也。昔人热轻则痘轻之说，可尽信乎！而六日之前痘未出齐，勿用温补之说，可
尽拘乎！自有方书治病以来，其时不啻二千年，其人不啻数百家，然皆详于已出之
后，略于未出之前。深言出速而稠密之害，不言留中而不出之祸。不知已出之毒外寇
也，未出之毒内寇也，出速而稠密者外攻也，留中而不出者内攻也，内寇与外寇孰
急，内攻与外攻祸孰烈。故痘已出而死者，多在旬日之外；痘不出而死者，多在六日
之内。徒知御外寇而不知逐内寇，自古以来，诸贤之为计疏也。然其失计安在，惟
在痘未出而急于解毒，缓于逐毒也，不知未出之毒不可解，但当汲汲逐之出外也。予
深悟其理而明鉴其失，故长顾却虑，为未出以前诸证设法，惟明辨其虚实寒热以施
治。实热者，宜发其壅滞，以逐毒出外；虚寒者，补助其气血，以逐毒出外。至于急
用寒凉遏毒内攻等弊，则谆谆致戒，不厌再三。一以救前哲之失，一以开后人之迷，虽岐黄复起，不易吾言矣。
喜泰顺曰∶初发悠悠身热，气息和平，二便如常，面容不改，睡卧安宁，便见痘
来顺候。肌色青而 白，精神少而倦怠，此证断作虚看。痘出决然不振，再见便溏呕
乳，只须补益为先。若还热甚而气粗，烦躁而不宁，谵语妄言，均为内热。如加喘
满膨胀便秘，须知热壅。肌肤燥而毛色焦，口气热而身燔灼，此则蓄热郁遏，内证固
重而外邪尤烈。腹胀口张而喘息，啼声不倦而哑嗄，五窍不通，须防出血；点来隐
隐，只恐复留。吐乳更兼眼倦而青，又见摇跳狂乱不宁，发惊先兆。是故热盛者先
宜清凉发散，不宜骤用苦寒发散，则毒得外出而热自解；苦寒则毒反冰伏而出愈难。
故发散之剂，轻则如升麻葛根以疏其热；而
烦躁壮盛者，非此何以定其标。重则用麻黄以开其壅，而喘急腹胀者，非此何以救
其危。未萌先泻，有热证莫作虚看，无热证便为虚论，止热泻，次清凉，重加发散。
治虚溏以温补，仍用开提。是以内虚误用寒凉，不特助伊芳作泻，实热如投温补，只
恐转增剧烦。安静而能食，勿谓便实而可下，泄泻而烦热，莫言热证以投凉。
又曰∶初发壮热，毛直皮焦，睡卧不宁，腮红睛赤，躁烦热渴，腹胀啼喘，大
小便秘，兼之腰疼膝痛，口中臭气冲人，此毒火郁遏，大为险逆之途。医者当表下之，
俟见之后，再看点粒色泽如何。
邵氏曰∶发热一日，遍身只出红点，犹如蚕种，摸之并不扛手者死。发热时肠肚
大痛，腰如被杖，临起痘时，痘又干燥，肠肚痛又不能止，更兼红点并不坚硬者，三
日者后死。（先肠肚痛后止者，宜用助血药救之。）发热时身无大热，腹无疼痛，三日后缓缓现
出红点，坚硬扛手者吉。发热时头面通红，俨如涂胭脂于满面者，五日后死。发热时
声音忽变喉肿者，（清凉饮消之可生。）发热时用红纸捻蘸麻油点着，照顶心皮肉里如一块
红，身上成红块者，八九日后死。发热时饮食不吃，并大小便不通者，二日后死。发
热时口出乱语，身现红紫者，四日后死。发热时或从风寒停食起，风寒不散，惊悸不
散，食滞不消，结成一块者，一昼夜必死。发热遍身缓缓外现，不时惊搐者，必是心
经痘出也，用药治之可愈。发热时父母不可乱求医生看，听彼胡言，有损性命。发
热时举家男妇不祥言语，均宜禁忌。发热时与家上下人等，淫欲之事须戒半月，以
及孝服尼僧，行经妇女，不可触恶，好痘变成坏痘，烂浆枯陷。发热时或吐泻而神
气不减者，无妨。（虽有大热内解，但不宜久，久则恐神气耗散耳。）发热之始，声音遂变者重。（可
用清肺饮、甘桔汤加元参治之。）出痘之初，凡里有热，当利小便，虽不用凉药，然里热必令
从小便泄去，小便乃导引热邪之道，可用
导赤散治之。若里有小热，则不可渗利小便，只宜内解其毒。若渗利小便，恐损其
真气，宜用犀角地黄汤、解毒散。凡发热或头温足冷，昏闷如痴，渴饮者凶。
痘疹发热、报痘（发出红点）、起胀（痘粒隆起）、灌浆（痘内充满脓液）、结靥（结痂）等各种证候的秘法，都汇集在这一部分中，以便查阅参考和治疗。
聂九吾说：在发热的初期，如果身体发热和缓，时热时退，精神清爽，饮食正常，那么就不必用药发汗，只需注意避免受风着凉、细心调护即可。因为痘病有顺症而不需要特别治疗的，不轻易治疗，就是对其最好的调治。如果有憎寒（怕冷）壮热（高热）、头痛发热、咳嗽、流清鼻涕等症状，多是因为外感邪气，不可不发散解表，应当根据孩子的体质强弱来用药发汗。如果孩子平时体质强壮，用加味升麻葛根汤发汗；（方药组成：白葛根、升麻、赤芍、甘草、桔梗、防风、苏叶、小川芎、山楂净肉、牛蒡子煎服，此方本是治疗伤风感冒而非专门针对痘疹，但服用后发汗也无妨。）如果孩子平时体质虚弱，用加味参苏饮发汗。（方药组成：人参、苏叶、桔梗、前胡、小川芎、山楂肉、粉葛、陈皮、制半夏、牛蒡子、甘草煎服。）但是都不可以出汗过多，恐怕发散过度导致表虚，之后难以起胀灌浆。既然已经发汗且身热逐渐缓解，孩子比较安静，那么痘出必然稀少，这是顺症，暂且不要服药，等待其自然发展。也有发热和缓后痘多的，这是因为血气虚弱。发汗之后，如果身热不退且烦躁，暂且不要用峻猛的药物攻下。稍作等待，如果出现烦闷躁渴、胡言乱语的情况，用败毒和中散清热。（方药组成：连翘、陈枳壳、防风、升麻、前胡、小川芎、麦门冬、桔梗、蝉蜕、牛蒡子、荆芥、木通、甘草、紫草茸、酒炒黄连。大便秘结者加酒炒大黄一钱二分以轻微通便，不大便者勿加入，服用此药后觉得烦闷稍减，就停止服用，听任痘毒向外透发，体内自然安宁。）如果有腹痛、腰痛且烦闷的，这是毒瓦斯确实沉重，但也只应当用败毒和中散为主治疗。大便秘结则加酒炒大黄轻微通便，听任痘毒向外透出，内部疼痛自然停止。然后观察其痘，如果稠密，或红紫带黑，再商议解毒即可。切不可纯用寒凉药物，以阻遏痘毒外出的势头，否则立即会导致毒气内攻发生变故。（凉药要经过炮制，性质纯正才能有效。）世人不懂这个道理，大多纯用寒凉解毒，或用硝石、大黄峻猛攻下，因而加速死亡而始终不明白原因的人很多了。当时令众多姓氏的孩子出痘时，小儿或有发热稍缓，热势时作时止，红点或未见到，或微见而未明显，或者出痘，或非出痘，正处于疑似之间，在这个时候，不如暂且不要服药，等待其自行定局，只需禁止风吹、寒冷、荤腥食物，细心调护即可。所谓不轻易治疗，正是为了深入治疗，就是这个道理。有一类富贵人家，珍爱太过，看到这种情况，屡次投予清凉解毒之剂。不知道如果是这种痘证，其毒瓦斯发动于五脏，蓬勃欲向外透发，其势头决不可阻遏，屡次用清凉药阻遏其势头，就是逼迫毒气内攻，灾祸迅速到来。所以犯此错误的人多有报痘后，数日即因烦闷惊搐而死，这是被解毒药杀死的。正如寇贼在宫墙之内，不驱逐其外出，反而遏制其出路，围困攻击它，宫中的人有不遭受残害的吗！然而医生说：我用解毒药怎么会杀人？既不承担自己的罪责，病人家属也说：他用解毒药怎么会杀死我的人？也不归咎于医生，在冥冥之中杀人，而自己却不醒悟，别人也不知道。唉！也可悲啊。我特意表彰并揭示这一道理，以告诫世上那些因爱护反而伤害孩子的人。俗话说：陈年的腊肉毒性必然浓厚，痘毒禀受于胎元，潜伏在五脏，轻的不用说，重的深藏久蓄，不能说毒性不浓厚。一旦在忽然之间触发，其势头猛烈锐利想要外出，绝对不可抵御，因此必须借助气血载毒外出，成浆结痂，然后毒散而功效完成，这也是病情机理也是造化机理。哪里像其他疮疡的毒，可以骤然解散呢？所以在痘出之后解毒，是顺应其欲散之势，还算近于情理；在未出之前解毒，是遏制其猛烈欲出之势，其祸害非常迅速。就像刚决口的堤坝，水势排山倒海而来，想用捧土去堵塞，有这样的道理吗？奈何自古以来治疗痘疹的人，低劣的不必说，高明的也未深刻领悟此理，每每在痘疮发热之初，欲出未出之际，就以解毒为主，并且说每天服用某药则毒可解而痘必出得稀少，不知道痘出稀少，是因为初受毒邪较轻罢了，难道将要出之时能骤然解毒吗！这导致后来的庸医，以讹传讹，见痘疮欲出未出之间，毒瓦斯炽盛则多用寒凉以解之，或妄用攻下以解之，他们自以为是对证的妙剂，却不知道反而导致毒气内攻的奇祸，至于杀人而始终不醒悟，前人跌倒后人却不借鉴，其祸害又无穷无尽。我目睹近时庸医，治疗痘疹多犯此失误，以致儿童幼童数日死亡的很多，他们都茫然地归结为证候恶劣难救，而举世没有人察觉致死的原因，实在令人怜悯痛惜。所以我不得不再三阐明此理，以救治将来的人。
发热之际，有偶然感受风寒，饮食停滞而导致腹痛的，用升消平胃散，（方药组成：小川芎、香附、苍术、紫苏、陈皮、麦芽、砂仁、炒浓朴、楂肉、白芷、炙甘草、藿香，生姜引煎服。）一剂其痛立止。（然而饮食引起的腹痛与毒瓦斯引起的腹痛，证候不同。停食痛者，其痛多急疾而啼叫必甚，多在脐以上痛，面色必青白，唇淡手足冷。毒瓦斯痛者，痛稍延缓而有作有止，多在脐以下，或连腰而痛，面色或红色而唇紫手足不冷，这两者必然分辨明白，方可用药。）
发热之际，有呕吐的，有泄泻的，有吐泻交作的，全都要辨别虚实寒热而用药。如吐泻交作而胸腹痛甚的，这是感寒而停食。（仍用升消平胃散主治，一服立效。）如胃气弱而有寒，呕吐不思饮食，或食下即吐，其吐多顺快而无声，面青白唇淡，精神倦怠，宜用参砂和胃散主治。（方药组成：人参、砂仁、半夏、白术、茯苓、藿香、陈皮、炙甘草去皮、煨姜三片，煎服。）如脾气虚弱，饮食不化而泄泻的，其泄滑利而色带白，宜用术苓调脾散主治。（方药组成：白术、白茯苓、白芍、神曲、炙甘草、扁豆、砂仁、香附、浓朴。或加人参、煨姜、大枣同煎服。）如有毒瓦斯引起吐泻的，其吐必酸，刺而有声，神气不甚困倦，其泄必黄色臭秽，虽或吐泄交作，胸腹多不痛，这是毒瓦斯通过吐泄而发泄，所谓吐泄为顺症而不必止住的，只有这一个证候罢了。若虚寒吐泻与此截然不同也很多了。（张洁古等人一概认为痘前吐泻，千万不要乱治而多吉，并不分虚实寒热，何其鲁莽之极啊。）
身热至二三日后，痘欲出不出，或烦闷惊搐，或狂言谵语，切不可惊慌失措，只有详细审察虚实寒热而治疗。要知道这些证候皆由毒瓦斯在内，不得宣发于外而发作，然而毒瓦斯不得宣发，证候有不同，不可不辨。
如毒瓦斯壅盛于内，不能骤然发于外，而惊搐狂躁的，宜用清解散以宣发。（方药组成：防风、荆芥、蝉蜕、桔梗、前胡、葛根、升麻、黄芩、黄连、紫草、木通、牛蒡、连翘、甘草、楂肉、川芎煎服。）如内毒本盛，外为风邪所束，郁滞不得出而惊搐狂躁，宜苏解散发之。（清解散内去掉黄芩、黄连，加紫苏、白芷、羌活乘热服。）又有血气虚弱，送毒瓦斯不出而惊搐狂躁的，宜用温中益气汤托举。（方药组成：人参、白术、生黄芪、当归身、白茯苓、炙甘草、川芎、白芷、防风、南木香、官桂、楂肉，生姜、大枣引服，中病即止。）
凡辨惊狂诸证，最宜精详，观形察色，审声闻证，又参之以脉，然后可以分别。观察痘影红紫，面赤唇紫，声音亮，口气粗，手足热，脉洪数，这是毒瓦斯壅盛的。（或形色多同，但声重鼻塞或流鼻涕，脉浮数的，这是毒盛而为风寒所束的。然而此证多在寒冷的月份，或不谨慎避风寒的人，然后才有。）
观察其痘影淡淡在皮下，不见红活，唇淡面白或带青，脉又迟缓，虽然烦躁惊狂谵语，也是血气虚而送毒瓦斯出不出的。（三者分别用药，当一剂之后，痘出而惊狂定矣。古人说痘未出之前惊搐为顺，难道是这样吗？）
幼儿初出痘，有发热二三日，全无痘点形影，而忽然惊搐，状与急惊风一样的，这也是痘气壅盛不能宣发所致，宜用清解散以宣发，痘出即惊定矣。如果医者不知道是痘，而误作急惊风施治，或单以寒凉投之，或以驱痰药峻下之，其儿必死。为什么？阻遏其毒使不得出而内攻也。所以未出痘的孩子，如果遇到这等证候，就应当怀疑，恐是出痘，不可作急惊风治。又有发热稍轻，至三四日而痘仍隐隐不出者，最要详察，不可一概认为是毒轻痘少而漫不加意。若发热和缓，精神清爽，饮食如常，出痘少而点数明，头粒尖，渐渐长大红活，这是毒轻痘少无疑了。若身热虽轻，至三四日而倦怠嗜卧，不思饮食，所出之痘，影影淡白，点粒不明，这不是痘毒轻少，也是血气虚弱，送毒瓦斯不出也，急宜用温中益气汤以托举。甚者即连服二三剂痘始出齐，其痘必多，若因其安静，袖手旁观而不急于托痘出外，延至五六日后，毒瓦斯内攻，须臾告变，不可救疗，甚是可怕。古人说热轻则痘轻的说法，可以尽信吗！而在六日之前痘未出齐，不用温补的说法，可以尽拘泥吗！自有方书治病以来，时间不止二千年，人数不止数百家，然而都详于已出之后，略于未出之前。深言出速而稠密的危害，不言留中而不出的祸患。不知道已出的毒是外寇，未出的毒是内寇，出速而稠密者是外攻，留中而不出者是内攻，内寇与外寇哪个紧急，内攻与外攻祸害哪个猛烈。所以痘已出而死的，多在旬日之外；痘不出而死的，多在六日之内。只知道御外寇而不知道逐内寇，自古以来，各位贤人的计谋疏漏啊。然而他们的失计在哪里，只在痘未出而急于解毒，缓于逐毒也，不知道未出的毒不可解，只应当急切地驱逐其外出。我深刻领悟此理而明鉴其失误，所以长顾却虑，为未出以前诸证设法，只有明辨其虚实寒热以施治。实热者，宜发其壅滞，以逐毒出外；虚寒者，补助其气血，以逐毒出外。至于急用寒凉遏毒内攻等弊病，则谆谆告诫，不厌其烦。一来救治前哲的失误，二来开启后人的迷津，即使岐伯、黄帝复活，也不会改变我的话。
喜泰顺说：初发悠悠身热，气息和平，二便如常，面容不改，睡卧安宁，便见痘来顺候。肌色青而苍白，精神少而倦怠，此证断作虚看。痘出决然不振，再见便溏呕乳，只须补益为先。若还热甚而气粗，烦躁而不宁，谵语妄言，均为内热。如加喘满膨胀便秘，须知热壅。肌肤燥而毛色焦，口气热而身燔灼，此则蓄热郁遏，内证固重而外邪尤烈。腹胀口张而喘息，啼声不倦而哑嗄，五窍不通，须防出血；点来隐隐，只恐复留。吐乳更兼眼倦而青，又见摇跳狂乱不宁，发惊先兆。是故热盛者先宜清凉发散，不宜骤用苦寒发散，则毒得外出而热自解；苦寒则毒反冰伏而出愈难。故发散之剂，轻则如升麻葛根以疏其热；而烦躁壮盛者，非此何以定其标。重则用麻黄以开其壅，而喘急腹胀者，非此何以救其危。未萌先泻，有热证莫作虚看，无热证便为虚论，止热泻，次清凉，重加发散。治虚溏以温补，仍用开提。是以内虚误用寒凉，不特助其作泻，实热如投温补，只恐转增剧烦。安静而能食，勿谓便实而可下，泄泻而烦热，莫言热证以投凉。
又说：初发壮热，毛直皮焦，睡卧不宁，腮红睛赤，躁烦热渴，腹胀啼喘，大小便秘，兼之腰疼膝痛，口中臭气冲人，此毒火郁遏，大为险逆之途。医者当表下之，俟见之后，再看点粒色泽如何。
邵氏说：发热一日，遍身只出红点，犹如蚕种，摸之并不扛手（按之不起）者死。发热时肠肚大痛，腰如被杖，临起痘时，痘又干燥，肠肚痛又不能止，更兼红点并不坚硬者，三日者后死。（先肠肚痛后止者，宜用助血药救之。）发热时身无大热，腹无疼痛，三日后缓缓现出红点，坚硬扛手者吉。发热时头面通红，俨如涂胭脂于满面者，五日后死。发热时声音忽变喉肿者，（清凉饮消之可生。）发热时用红纸捻蘸麻油点着，照顶心皮肉里如一块红，身上成红块者，八九日后死。发热时饮食不吃，并大小便不通者，二日后死。发热时口出乱语，身现红紫者，四日后死。发热时或从风寒停食起，风寒不散，惊悸不散，食滞不消，结成一块者，一昼夜必死。发热遍身缓缓外现，不时惊搐者，必是心经痘出也，用药治之可愈。发热时父母不可乱求医生看，听彼胡言，有损性命。发热时举家男妇不祥言语，均宜禁忌。发热时与家上下人等，淫欲之事须戒半月，以及孝服尼僧，行经妇女，不可触恶，好痘变成坏痘，烂浆枯陷。发热时或吐泻而神气不减者，无妨。（虽有大热内解，但不宜久，久则恐神气耗散耳。）发热之始，声音遂变者重。（可用清肺饮、甘桔汤加元参治之。）出痘之初，凡里有热，当利小便，虽不用凉药，然里热必令从小便泄去，小便乃导引热邪之道，可用导赤散治之。若里有小热，则不可渗利小便，只宜内解其毒。若渗利小便，恐损其真气，宜用犀角地黄汤、解毒散。凡发热或头温足冷，昏闷如痴，渴饮者凶。
The secret methods for various syndromes of smallpox and chickenpox, including fever onset (Fe Re), reporting of rash (Bao Dou - appearance of red spots), swelling and rising (Qi Zhang - elevation of pustules), filling with pus (Jiang Guang - accumulation of purulent material), and scabbing (Jie Ye - formation of crusts), are all compiled in this section for easy reference and treatment.
Nie Jiuwu said: At the initial stage of fever, if the body heat is mild and moderate, fluctuating between hot and normal, with a clear spirit and normal diet, there is no need to use medicine to induce sweating; one only needs to avoid wind exposure and provide careful nursing. This is because some cases of smallpox/chickenpox follow a favorable course without requiring specific treatment; refraining from light intervention is itself a form of regulation and treatment. However, if there is aversion to cold with high fever, headache, coughing, and runny nose, these are mostly due to external pathogenic invasion, which must be dispersed through diaphoresis. Medication for inducing sweating should be administered based on the child's physical strength. If the child is constitutionally robust, Jiawei Shengma Gegen Tang (Modified Cinnamon Twig and Kudzu Root Decoction) should be used to induce sweating. (Ingredients: Radix Puerariae Albae [Baigegen], Rhizoma Cimicifugae [Shengma], Radix Paeoniae Rubra [Chishao], Radix Glycyrrhizae [Gancao], Fructus Platycodi [Jiegeng], Radix Saposhnikoviae [Fangfeng], Folium Perillae [Suye], Rhizoma Chuanxiong [Xiaochuanxiong], Sanguis Ziziphus Spinosae [Shanzha Jingrou], Semen Arctii [Niubangzi] decocted and taken orally. This formula is originally for treating common cold rather than smallpox/chickenpox, but inducing sweat with it causes no harm.) If the child is constitutionally weak, Jiawei Renshen Suyu Yin (Modified Ginseng and Perilla Leaf Decoction) should be used to induce sweating. (Ingredients: Radix Ginseng [Renshen], Folium Perillae [Suye], Fructus Platycodi [Jiegeng], Radix Peucedani [Qianhu], Rhizoma Chuanxiong [Xiaochuanxiong], Sanguis Ziziphus Spinosae [Shanzha Rou], Radix Puerariae [Fenge], Pericarpium Citri Reticulatae [Chenpi], Rhizoma Pinelliae Preparatum [Zhibanxia], Semen Arctii [Niubangzi], Radix Glycyrrhizae [Gancao] decocted and taken orally.) However, excessive sweating must be avoided, as it may lead to deficiency of the exterior, making it difficult for the lesions to swell and fill with pus later. Once sweating has been induced and the fever gradually subsides, and the child becomes quiet, the eruption will likely be sparse, indicating a favorable prognosis. In such cases, medication should be withheld to allow natural progression. There are also cases where fever is mild but the eruption is dense, which indicates deficiency of blood and qi. After sweating, if fever persists accompanied by irritability, do not use harsh purgatives immediately. Wait for a while; if restlessness, thirst, and delirious speech occur, use Baidu Hezhong San (Poison-Resolving and Middle-Regulating Powder) to clear heat. (Ingredients: Fructus Forsythiae [Lianqiao], Pericarpium Aurantii [Chenzhiqiao], Radix Saposhnikoviae [Fangfeng], Rhizoma Cimicifugae [Shengma], Radix Peucedani [Qianhu], Rhizoma Chuanxiong [Xiaochuanxiong], Radix Ophiopogonis [Maimendong], Fructus Platycodi [Jiegeng], Periostracum Cicadae [Chantui], Semen Arctii [Niubangzi], Herba Schizonepetae [Jingjie], Caulis Akebiae [Mutong], Radix Glycyrrhizae [Gancao], Flos Lonicerae Japonicae cum Calyce [Zicao Rong], Rhizoma Coptidis Wine-fried [Jiuchao Huanglian]. For constipation, add 1 qian 2 fen of Rhizoma Rhei Wine-fried [Jiuchao Dahuang] for mild purgation; do not add if stool is not dry. Stop taking this medicine once restlessness alleviates slightly, allowing the poison to exit outward so the interior may settle. If abdominal or lower back pain accompanies restlessness, the toxin load is heavy, yet Baidu Hezhong San remains the primary treatment. Add wine-fried Rhizoma Rhei [Jiuchao Dahuang] for constipation to mildly purge, allowing the toxin to exit outward, which will stop internal pain. Then observe the lesions; if dense, red-purple, or blackish, consider detoxification. Do not use purely cold-natured medicines to obstruct the outward movement of toxins, as this will immediately cause internal attack and complications. (Cold medicines should be processed to ensure pure efficacy.) People who do not understand this principle often use purely cold-natured detoxifiers or harsh purgatives like Nux Vomica [Xiaoshi] and Rhizoma Rhei [Dahuang], leading to rapid death without realizing the cause. During outbreaks, when children have mild fever that comes and goes, with faint or unclear red spots, or uncertain eruption status, it is best to withhold medication and wait for clarity, focusing only on avoiding wind, cold, and rich foods. This "non-treatment" is actually deep treatment. Wealthy families, overly protective, often repeatedly administer cold-natured detoxifiers. They fail to realize that in such conditions, toxins surge from the five zang organs, vigorously attempting to exit outward; this momentum cannot be blocked. Repeated use of cold medicines blocks this momentum, forcing toxins inward and accelerating disaster. Many die within days of fever onset due to restlessness and convulsions caused by these detoxifiers. It is like having bandits inside a palace: blocking their exit and attacking them internally ensures destruction. Doctors claim, "How could my detoxifiers kill?" refusing responsibility, while families ask, "How could his detoxifiers kill my child?" failing to blame the doctor. Death occurs in obscurity, unnoticed. Alas, how tragic! I reveal this to warn those whose love causes harm. As the saying goes, aged cured meats hold strong toxins; smallpox/chickenpox toxins originate from fetal essence, hidden in the five zang organs. Light cases are negligible, but severe cases involve deep, long-standing accumulation of potent toxins. When triggered suddenly, the momentum is fierce and unstoppable, relying on blood and qi to carry toxins outward to form pus and scabs, completing the disease process. This is both pathology and physiological transformation. Unlike other sores whose toxins can be rapidly dispersed, detoxifying after eruption follows the natural dispersal trend and is reasonable; detoxifying before eruption opposes the fierce outward momentum and causes rapid disaster. It is like trying to stop a bursting dam with handfuls of soil. Since ancient times, even skilled practitioners have failed to grasp this, prioritizing detoxification over expulsion during the early fever phase. They wrongly believe daily medication reduces toxin load and spares density, ignoring that sparse eruption results from initial light toxin exposure, not sudden resolution at eruption. This error propagates among mediocre doctors, who use cold medicines or purgatives for perceived excess toxins, causing internal attacks and death. I have seen many children die rapidly due to these mistakes, dismissed as "incurable severe syndromes," leaving the true cause unknown and pitiable. Thus, I clarify this principle to save future patients.
During fever, if abdominal pain arises from accidental wind-cold or food stagnation, Shengxiao Pingwei San (Ascending and Eliminating Stomach-Regulating Powder) is used. (Ingredients: Rhizoma Chuanxiong [Xiaochuanxiong], Rhizoma Cyperi [Xiangfu], Rhizoma Atractylodis Macrocephalae [Cangzhu], Folium Perillae [Zisu], Pericarpium Citri Reticulatae [Chenpi], Fructus Hordei Germinatus [Maiya], Fructus Amomi [Sharen], Cortex Magnoliae Officinalis Stir-fried [Chao Nongpuo], Sanguis Ziziphus Spinosae [Zharou], Radix Angelicae Dahuricae [Baizhi], Radix Glycyrrhizae Honey-fried [Zhigancao], Herba Agastaches [Huoxiang], with Fresh Ginger [Jiang] as guide, decocted). One dose stops pain immediately. (Note: Food-stagnation pain differs from toxin pain. Food pain is acute, with loud crying, located above the umbilicus, with blue-white face, pale lips, and cold extremities. Toxin pain is slower, intermittent, below the umbilicus or radiating to the waist, with reddish face, purple lips, and warm extremities. These must be distinguished clearly before medicating.)
During fever, vomiting, diarrhea, or both require differentiation of deficiency/excess and cold/heat. If vomiting and diarrhea accompany severe chest/abdominal pain, it is wind-cold with food stagnation. (Use Shengxiao Pingwei San; one dose brings immediate relief.) If weak stomach qi with cold causes vomiting, loss of appetite, or immediate regurgitation, with smooth, soundless vomiting, blue-white face, pale lips, and fatigue, use Renshen Shahe Wei San (Ginseng and Amomi Stomach-Regulating Powder). (Ingredients: Radix Ginseng [Renshen], Fructus Amomi [Sharen], Rhizoma Pinelliae [Banxia], Radix Atractylodis Macrocephalae [Baizhu], Poria [Fuling], Herba Agastaches [Huoxiang], Pericarpium Citri Reticulatae [Chenpi], Radix Glycyrrhizae Honey-fried [Zhigancao], Peeled; three slices of Ginger [Wenjiang], decocted.) If spleen qi deficiency causes indigestion and diarrhea with slippery, white-colored stools, use Shuling Tiaopi San (Atractylodes and Poria Spleen-Regulating Powder). (Ingredients: Radix Atractylodis Macrocephalae [Baizhu], Poria [Baifuling], Radix Paeoniae Alba [Baishao], Massa Medicata Fermentata [Shenqu], Radix Glycyrrhizae Honey-fried [Zhigancao], Dolichos Lablab [Biandou], Fructus Amomi [Sharen], Rhizoma Cyperi [Xiangfu], Cortex Magnoliae Officinalis [Nongpuo]. Optionally add Radix Ginseng [Renshen], Ginger [Wenjiang], and Jujube [Dazao] for decoction.) If toxins cause vomiting/diarrhea, vomit is sour and forceful, spirit is not very tired, stool is yellow and foul-smelling, though vomiting/diarrhea occur, chest/abdomen usually does not hurt. This represents toxin release via vomiting/diarrhea, considered a favorable sign where stopping is unnecessary. (Zhang Jiegu and others indiscriminately advised against treating pre-eruption vomiting/diarrhea, ignoring deficiency/excess and cold/heat distinctions, which is reckless.)
After two to three days of fever, if eruptions are delayed, or accompanied by restlessness, convulsions, or delirium, remain calm and carefully differentiate deficiency/excess and cold/heat. These symptoms arise from internal toxins unable to vent outward. Differentiation is crucial.
If toxins are abundant internally and cannot erupt, causing convulsions and mania, use Qingjie San (Clear and Disperse Powder) to vent. (Ingredients: Radix Saposhnikoviae [Fangfeng], Herba Schizonepetae [Jingjie], Periostracum Cicadae [Chantui], Fructus Platycodi [Jiegeng], Radix Peucedani [Qianhu], Radix Puerariae [Gegen], Rhizoma Cimicifugae [Shengma], Radix Scutellariae [Huangqin], Rhizoma Coptidis [Huanglian], Flos Lonicerae Japonicae cum Calyce [Zicao], Caulis Akebiae [Mutong], Semen Arctii [Niubang], Fructus Forsythiae [Lianqiao], Radix Glycyrrhizae [Gancao], Sanguis Ziziphus Spinosae [Zharou], Rhizoma Chuanxiong [Chuanxiong] decocted.) If internal toxins are abundant but constrained by external wind-cold, causing stagnation and convulsions, use Sujie San (Perilla Dispersing Powder). (Modify Qingjie San by removing Huangqin and Huanglian, adding Folium Perillae [Zisu], Radix Angelicae Dahuricae [Baizhi], and Radix Notopterygii [Qianghuo]; take hot.) If blood/qi deficiency prevents toxin transport, causing convulsions and mania, use Wenzhong Yiqi Tang (Warm Middle and Boost Qi Decoction) to support. (Ingredients: Radix Ginseng [Renshen], Radix Atractylodis Macrocephalae [Baizhu], Radix Astragali [Sheng Huangqi], Radix Angelicae Sinensis [Guishen], Poria [Baifuling], Radix Glycyrrhizae Honey-fried [Zhigancao], Rhizoma Chuanxiong [Chuanxiong], Radix Angelicae Dahuricae [Baizhi], Radix Saposhnikoviae [Fangfeng], Radix Aucklandiae [Nanmuxiang], Ramulus Cinnamomi [Guangui], Sanguis Ziziphus Spinosae [Zharou], Fresh Ginger [Jiang] and Jujube [Dazao] as guides; stop when effective.)
Differentiating convulsive syndromes requires precision: observe shape/color, listen to voice/symptoms, and check pulse. Red-purple lesions, red face, purple lips, loud voice, coarse breath, hot extremities, and surging-rapid pulse indicate abundant toxins. (Similar signs with heavy voice, nasal congestion/runny nose, and floating-rapid pulse indicate toxin abundance constrained by wind-cold, common in cold months or poor protection.) Pale subcutaneous lesions, lack of vitality, pale/blueish face, slow-decelerated pulse, despite restlessness/delirium, indicate blood/qi deficiency failing to transport toxins. (Medicate accordingly; after one dose, eruptions appear and convulsions cease. Ancient claims that pre-eruption convulsions are favorable are incorrect.)
In infants, fever for 2-3 days with no visible spots followed by sudden convulsions resembling acute convulsive disorder is due to congested toxin qi unable to vent. Use Qingjie San to vent; eruptions resolve convulsions. Misdiagnosing as acute convulsive disorder and using cold medicines or phlegm-resolving purgatives will kill the child by blocking toxin exit. Suspect smallpox/chickenpox in such cases, do not treat as convulsive disorder. Mild fever persisting 3-4 days with hidden eruptions requires careful observation; do not assume light toxin/few spots. Mild fever, clear spirit, normal diet, sparse bright spots, pointed heads, growing red/vital lesions indicate light toxin. Mild fever with fatigue, anorexia, pale/unclear spots after 3-4 days indicates blood/qi deficiency failing to transport toxins; urgently use Wenzhong Yiqi Tang to support. Severe cases may need 2-3 doses for full eruption; if neglected due to apparent calmness, toxins may attack internally within 5-6 days, causing untreatable changes. The theory "mild fever means mild eruption" is unreliable; the rule "no tonics before day 6" is too rigid. Historical texts detail post-eruption care but neglect pre-eruption risks. Rapid/dense eruption is external attack; retained/non-erupting toxin is internal attack. Internal threats are more urgent than external ones. Deaths from erupted toxins occur after 10 days; deaths from non-erupted toxins occur within 6 days. Prioritizing external defense over internal expulsion is a historical oversight. The error lies in rushing detoxification while delaying toxin expulsion. Un-erupted toxins cannot be resolved but must be expelled urgently. I clarify this to prevent past errors and guide future practice, distinguishing deficiency/excess and cold/heat. Excess-heat requires resolving stagnation to expel toxins; deficiency-cold requires boosting blood/qi to expel toxins. I strictly warn against using cold medicines to block toxins internally. This aims to correct past mistakes and enlighten future generations; even if Qibo and Huangdi returned, they would not change my words.
Xi Taishun said: Initial gentle fever, peaceful breathing, normal urination/defecation, unchanged complexion, peaceful sleep indicates favorable smallpox/chickenpox onset. Blue-white skin, low spirit, fatigue indicates deficiency. Eruptions will be weak; if loose stools and milk vomiting occur, tonification is priority. High fever, coarse breath, irritability, delirium indicate internal heat. Wheezing, distension, constipation indicate heat congestion. Dry skin, scorched hair, hot breath, burning body indicate trapped heat with severe internal syndrome and strong external pathogen. Abdominal distension, open mouth, panting, hoarse crying, blocked orifices risk hemorrhage; faint spots risk retention. Milk vomiting with tired/blue eyes, jumping/restlessness indicates impending convulsions. For excess heat, use cool dispersants, not bitter-cold, to allow toxin exit and heat resolution; bitter-cold traps toxins. Light dispersants like Shengma Gegen Tang relieve heat; for severe irritability, they stabilize symptoms. Heavy cases use Ephedra [Mahuang] to open congestion; for wheezing/distension, it saves critical cases. Pre-emptive purgation: treat heat patterns as excess, non-heat as deficiency. Stop heat-diarrhea, then cool, then disperse. Treat deficiency-loose stools with warmth and lifting. Internal deficiency misused with cold aids diarrhea; excess heat misused with warmth worsens irritability. Quiet/eating well does not mean purgation is needed; diarrhea/fever does not mean cold medicines are appropriate.
Also: Initial high fever, straight hair, scorched skin, restless sleep, red cheeks/red eyes, irritability/thirst, abdominal distension/crying/panting, constipation, back/knee pain, foul breath indicate trapped toxin-fire, a dangerous reversal. Physicians should use exterior-releasing and purgative methods, then assess spot color/appearance.
Shao Shi said: Fever day 1, whole-body red spots like silkworm eggs, soft to touch indicates death. Fever with severe intestinal pain, back pain like beating, dry eruptions, unceasing pain, soft red spots indicates death after day 3. (Intestinal pain stopping first suggests rescue with blood-tonifying herbs.) Fever with mild body heat, no abdominal pain, red spots appearing slowly on day 3, hard to touch indicates auspiciousness. Fever with red face/head like rouge applied indicates death after day 5. Fever with sudden voice change and throat swelling can be saved with Qingliang Yin (Cooling Drink). Fever illuminated by red-paper-wrapped sesame oil showing red patch on scalp and red patches on body indicates death after 8-9 days. Fever with no eating/drinking and urinary/fecal obstruction indicates death after 2 days. Fever with delirium and red-purple body indicates death after 4 days. Fever starting from wind-cold/food stagnation, unresolved wind-cold, persistent palpitations, undigested food forming a mass indicates death within 24 hours. Fever with slow whole-body eruption and intermittent convulsions indicates heart-meridian smallpox/chickenpox; treatable with medicine. Parents should not seek random doctors during fever, listening to nonsense harms life. Avoid inauspicious talk in the household. Abstain from sexual activity for half a month, and avoid contact with mourners, nuns, and menstruating women to prevent contamination turning good eruptions into bad ones (rotting pus, sunken scars). Fever with vomiting/diarrhea but preserved spirit is harmless. (Internal heat resolution is good, but prolonged heat dissipates spirit.) Fever starting with voice change is serious. (Treat with Qingfei Yin, Ganjie Tang plus Radix Scrophulariae [Yuanshen].) Early eruption with internal heat requires promoting urination; even without cold medicines, internal heat exits via urine. Urine guides heat out; use Daochi San (Guide Out Red Powder). Mild internal heat should not be drained via urination but resolved internally; draining harms true qi. Use Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) or Jiedu San (Detoxifying Powder). Fever with warm head/cold feet, stupor like dementia, thirst indicates ominous prognosis.