是证由气血两虚也，阳气虚则阴血乘之。血味咸，腌蜇肌肉，故痒，宜温补兼芍药酸敛。阴
血虚则阳气乘之，气性热犹灼火，故痛，养血兼清凉。灰白者，因气虚，故灰色而不光泽，血虚
，故白色而不红润。
斯证见于七日之前寒战者，乃心火亢盛，上熏肺金，九窍闭塞，火极之故，宜解表诸热；
切牙者，乃阳明热甚，宜清胃火。七日之后，皆属虚寒。寒战者，温补阳气，兼养血；切牙者，
大培阴血兼补气。
是证尤有陷伏倒靥之类，形略似而证不同也。痘色干红变紫，紫变黑，名曰干枯，热极也。
当于干红时，急宜清凉解毒，防风、白芷、连翘、荆芥、牛蒡、升麻、干葛之类，兼利小便。如
胃虚不能纳食，副荣卫不能尽出，虽出而复没，故根晕白色或黑，此内虚所致。手足微冷，或呕
或倦，名曰陷伏。宜辛温之药，如理中汤之类，甚则异功、木香。如被风寒所触，或香臭恶气，
生人、房事，月经冲触，痘色忽变，名曰倒陷。风寒，参、苏之类加羌、防、蚕蜕。冲触，加味
四圣饮。如贯脓七、八日间，气血两虚，不能浆老结靥；或因泄泻不食，忽然痘色干紫，肿消开
眼，名曰倒靥。毒伏内攻，非结痂也，急宜大补气血，倍用人参、黄 （酒炒、）白术、当归、
川芎、肉桂、炙甘草、丁香、木香（二味为末，）加山甲（炒、研一钱、）人牙（火 研，二厘）
攻补。或得头面数粒结靥，或攻溃成外收，或出细痘数粒，或生痈毒，皆生机矣。
这种证候是由于气血两虚引起的。阳气虚弱，阴血就会乘虚侵袭。血味咸，腌制蛰伏于肌肉之中，所以产生瘙痒感，适宜用温补法兼用芍药的酸敛作用。阴血虚弱，阳气就会乘虚侵袭，气的性质热，如同灼烧的火焰，所以产生疼痛感，适宜养血兼用清凉法。痘色灰白，是因为气虚，所以呈现灰色而没有光泽；血虚，所以呈现白色而不红润。
如果在发病七日之前出现寒战，这是心火亢盛，向上熏蒸肺金（肺属金），导致九窍闭塞，是火邪极盛的原因，适宜用解表清热的方法治疗；出现咬牙的症状，这是阳明经热势严重，适宜清泻胃火。如果在发病七日之后，都属于虚寒证。出现寒战，应当温补阳气，兼以养血；出现咬牙，应当大补阴血兼补气。
这种证候还有陷伏、倒靥等类型，形态大致相似但证候不同。痘色干枯红变紫，紫变黑，称为“干枯”，这是热邪极盛的表现。应当在痘色干红时，紧急使用清凉解毒的药物，如防风、白芷、连翘、荆芥、牛蒡子、升麻、干葛等，兼以利小便。如果胃气虚弱不能进食，导致营卫之气不能全部透发，虽然痘疹发出又隐没，所以根部晕圈呈白色或黑色，这是内里虚损所致。手足微冷，或者呕吐或者疲倦，称为“陷伏”。适宜用辛温性质的药物，如理中汤之类，严重的用异功散、木香。如果被风寒触动，或者闻到香臭恶气，或者受到性生活、月经冲撞的影响，痘色突然变化，称为“倒陷”。如果是风寒所致，用人参、苏叶之类的药加上羌活、防风、蝉蜕。如果是冲触所致，加味四圣饮。如果在化脓期第七八天，气血两虚，不能使痘浆老熟结痂；或者因为腹泻不进食，忽然痘色干枯紫暗，肿胀消退睁眼，称为“倒靥”。毒邪潜伏向内攻伐，并不是真正的结痂，急需大补气血，倍量使用人参、黄芪（酒炒）、白术、当归、川芎、肉桂、炙甘草、丁香、木香（后两味研为末），加入穿山甲（炒、研一钱）、人牙（火研，二厘）进行攻补兼施。或者头面部位有几粒结痂，或者溃破后向外收敛，或者生出细密痘疹几粒，或者生痈毒，这些都是生机恢复的表现。
This syndrome arises from the deficiency of both Qi and Blood. When Yang Qi is deficient, Yin Blood takes advantage of it. Since Blood has a salty taste and "pickles" or stagnates in the muscles, itching occurs; treatment should involve warming and tonifying combined with the sour astringent properties of *Paeoniae Radix Alba* (Shaoyao). When Yin Blood is deficient, Yang Qi takes advantage of it. Since the nature of Qi is hot, like burning fire, pain occurs; treatment should involve nourishing Blood combined with cooling methods. The ash-white color of the lesions is due to Qi deficiency, resulting in an ashen hue lacking luster; Blood deficiency results in a white color lacking ruddiness.
If chills occur before the seventh day of onset, this indicates hyperactivity of Heart Fire steaming upward to affect Lung Metal, causing blockage of the nine orifices due to extreme Fire; treatment should employ various exterior-releasing heat-clearing methods. If teeth grinding occurs, this indicates severe Heat in the Yangming channel; treatment should clear Stomach Fire. After the seventh day, all cases belong to deficiency-cold. For chills, warm and tonify Yang Qi while nourishing Blood; for teeth grinding, greatly nourish Yin Blood while supplementing Qi.
This syndrome also includes types such as sinking/obscuring (Xianfu) and turning inward/retracting (Daojie), which are similar in appearance but different in syndrome. When the lesion color becomes dry red then purple, and purple turns black, it is named "Dry Withered" (Gan Ku), indicating extreme Heat. At the stage of dry redness, urgent cooling and detoxification are required using herbs such as *Saposhnikoviae Radix* (Fangfeng), *Angelicae Dahuricae Radix* (Baizhi), *Forsythiae Fructus* (Lianqiao), *Schizonepetae Herba* (Jingjie), *Aucubae Semen* (Niuxi/Bangzi - note: text says Niuxi but context implies Niu Bang Zi usually, sticking to literal translation of herb name provided or standard equivalent if obvious typo, here assuming Niu Bang Zi/Akebia fruit? Text says Niu Bang, likely Niu Bang Zi), *Cimicifugae Rhizoma* (Shengma), and *Puerariae Radix* (Gegen), combined with promoting urination. If Spleen/Stomach deficiency prevents food intake, leading to Ying and Wei Qi failing to fully emerge, although lesions appear they retract, leaving the base halo white or black, this is caused by internal deficiency. With slightly cold hands and feet, vomiting, or fatigue, it is named "Sinking/Obstructed" (Xianfu). Treatment requires acrid-warm medicines such as *Lizhong Tang* (Regulate the Middle Decoction); in severe cases, *Yigong San* (Extraordinary Efficacy Powder) or *Muxiang*. If triggered by Wind-Cold exposure, foul odors, sexual activity, or menstrual interference, causing sudden changes in lesion color, it is named "Turning Inward/Retracting" (Daojie). For Wind-Cold, use *Renshen* and *Suye* (Perilla Leaf) added with *Qianghuo*, *Fangfeng*, and *Chantui* (Cicada Slough). For interference, use *Jiawei Sisheng Yin* (Modified Four Saints Drink). During the suppuration phase on days seven or eight, if Qi and Blood are deficient and cannot mature the pus and form scabs, or if diarrhea and anorexia cause sudden dry purple discoloration, reduction of swelling, and opening of the lesions, it is named "Inverted Scabbing" (Daojie). This represents toxins lurking and attacking internally rather than true scabbing; urgent massive tonification of Qi and Blood is needed, doubling the dosage of *Ren Shen* (Ginseng), *Huang Qi* (Astragalus, wine-fried), *Baizhu* (Atractylodes Macrocephala), *Dang Gui* (Angelica Sinensis), *Chuanxiong* (Ligusticum), *Rougui* (Cinnamon Bark), *Zhi Gancao* (Prepared Licorice), *Dingxiang* (Clove), and *Muxiang* (Vladimiria Root, powdered); add *Shanjia* (Pangolin Scales, fried and powdered, 1 qian) and *Ren Ya* (Human Tooth, fire-processed and powdered, 2 li) for simultaneous attack and tonification. If a few scabs form on the head and face, or if ulceration leads to external contraction, or if a few fine lesions appear, or if abscesses/toxins arise, these are all signs of vital energy recovery.