岁乙丑季秋，检阅所刻《验方新编》，校正讹字，本邑少海陈君， 以《痘症慈航》一
卷。余以为《新编·小儿科》论治痘详矣，似不必赘。旋为翻阅其书，着自明季欧阳公调律
先生，经郭昆山先生删润成集，所论辩症用方，理悉与《新编》相合。第自发热以至齐苗、
灌浆、收结，现何症候，从形色、声气、脉息之间，辨其顺逆，审其寒热虚实，何症宜用何
方，即以方药附后，一览朗然。虽不知医者，亦可按卷辩症，对症用方，诚仓卒时救急之慈
航也。因附录《补遗》卷内，以为广渡众生之一助云。同治四年乙丑岁仲冬月资阳李洞书识。
治痘之家多矣。刘河间悉用寒凉，偏害非小，至于钱仲阳，立方亦以解毒为主，而多用
寒凉，少用温补。张洁古、王海藏咸宗之。此其意俱本于《内经》诸疡疮皆属心火之一言，
故以寒凉泻心火也。厥后，陈文中立方，力矫其偏，专主温补。凡痘已出未出之间，悉用十
二味异功散，其意归重于太阴之一经。盖以手太阴肺主皮毛，足太阴脾主肌肉，肺经恶寒，
脾土恶湿，故用丁香、官桂以治肺之寒，术、附、半夏以治脾之湿。此方用之得当，其效固
大。然不分寒、热、虚、实而一概用之，则宜于虚寒，不宜于实热，其偏害又可知也。朱丹
溪解之是矣。至丹溪立论，矫陈氏之偏，而取钱氏之长，主于解毒、和中、安表，以为的当
，举世用之，数百年无有议其失者。余则以治他症，丹溪多妙论，至于治痘，则孟浪而未尽
其妙，倘亦千虑一失乎。盖其矫偏于陈氏，而不敢轻用木香、桂、附等药，似乎因噎而废食
。其取长于钱氏，而必用芩、连、牛子之类，以监制参、 、术、附补剂，似乎任将而中制
，因兵而外监也，其失亦泥于《内经》诸疡属心火之一言而未透其理也。不知痘疹虽属心火
，却与诸疡不同。诸疮之毒，当其初发而未成形，可用药解散而愈。及至已形而未成脓，又
可用药逐散而愈。痘毒发自五脏，必借血气送出于皮肤，运化之而成脓，收结之而成痂，而
后收全功也，可解散而愈乎？可未脓而愈乎？故诸疮以解毒为主，能解毒于早则轻，不能解
毒
解毒之药多损胃气，罔顾血气之亏损而急于解毒，是犹不虑我兵之强弱而急于杀敌也。
盖毒有必解者，又有不可解者，若小儿禀赋壮实，胃气好饮食如常者，其血气自旺，自
能送毒瓦斯以成功，其痘自始至终多顺症，此不必解毒也，若其禀赋素弱，脾胃又弱，出痘之
时，饮食又少，或渴或泻，或腹胀，或手足冷，或气短促，或失声，或痘出不快，或根窠不
红活，或色白而顶陷，或当灌脓而不灌脓，当结痂而不结痂，皆由血气不能送毒瓦斯，此不可
解毒者也。当速用温补，以扶胃气而助血气，若用参、 、归、术等而力不及，即加入木香
、丁香、桂、附佐之，亦不为过，又何可参入牛子、芩、连等凉品，以监制温补之力而损气
血乎？所以丹溪未尽其妙者也。丹溪又教人用犀角地黄汤以解痘毒，后人沿其说，失其初意
，因习而用之，以为奇妙而不知其害。盖心者血为主，心之所以能主血者，以其属火也。痘
属心火，正借心火以运用一身之气血而成功，岂其可泻而去乎。盖人身之血，温则流行，寒
则凝滞，犀角地黄汤凉心经而泻心火，心经既凉，心火既泻，则一身之血俱凝滞不行，何以
运化毒瓦斯成脓结痂乎？故内攻之患作，而竟以告毙者，泻心火之药实杀之，而人不知也，医
者亦竟不悟也。可慨也夫！余谓痘已出之后，未结痂之前，凡一切凉心之药，如犀角、地黄
之类，姑禁绝不用，待痘结痂后用之解余毒可也。或曰∶若然，则未收结之前，毒俱不可解
乎？曰∶奚为不可。若其血气与毒瓦斯俱盛者，脉必洪数。或初出即带紫黑，或既出而稠密红
紫，内则烦闷燥渴，小便赤涩，大便秘结，此则属实热，宜速用清凉之剂以解毒。如大便久
秘者，量入酒炒大黄微利之可也。若其毒瓦斯虽盛，而血气未旺者，则以解毒为主而兼活血养
气，参、 、归、芍之类亦未可离也。临症时，须细心审之。
近世痘方，多宗黄西邱，其书自始至终，俱分顺、逆、险而立说。其谓顺者，不必服药
。谓险者，宜以保元汤调治，犹近理也。至谓逆者俱不可治，治之徒劳无功，是教人袖手待
毙也。其言不仁之甚。此为俗医图利计则甚便，而于救济生成之术则甚乖也。盖医者仁术，
圣人以之赞助造化之所不及，所贵扶危救困，起死回生耳。若治其易治，而弃其难治，何以
医为？惟俗医意在图利，又恐坏名，见有不顺者，辄诿弃之，彼诚恐利未必得而徒冒不识症
之名。若是仁人君子，当为死里求生，岂忍坐视其死而不治乎。故曰∶西邱之言，便于俗医
，而非所以救世也。且其所指逆症多端，稠密者多有之。如发热而惊悸、吐泻，报痘而先发
于司空、印堂、天庭等处。初出而根窠无晕，既出而色白灰陷，或发水泡，或痒塌，或当行
浆而不行浆，或痂未落而寒战切牙，皆其所谓逆而不治者也。余每治之而得生者多矣，奈何
悉谓治之无益而戒人勿治乎。惟初出而形如蚕种，既出而紫黑干枯者，难以灌浆，多不可救
耳。然明知救之而不活，不忍坐视而不救也。
同治四年乙丑年深秋，我检阅并校对了所刻印的《验方新编》，纠正了其中的错别字。本邑陈少海先生，将《痘症慈航》一卷书送给我。起初我认为《新编·小儿科》中关于治疗天花（痘症）的论述已经非常详尽，似乎不必再添加此书。随后我翻阅了那本书，发现它由明代欧阳调律先生撰写，后经郭昆山先生删减润色而成集。书中对于辨证施治和选用方剂的论述，道理与《新编》完全吻合。只是从发热到出齐痘苗、灌浆、收结的各个阶段，根据出现的症状，通过观察神色形态、听声音气息、诊察脉象，来辨别病情的顺逆，审察寒热虚实，何种症状适宜使用何种方剂，并在方药后附上说明，一目了然。即使是非医学专业人士，也可以按卷查阅以辨析病症，对症选用方剂，这确实是仓促之间急救的指南。因此将其附录在《补遗》卷内，希望能成为广泛渡化众生的一份助力。同治四年乙丑年仲冬月，资阳李洞记识。
治疗天花的医家很多。刘河间全部使用寒凉药物，偏颇之害不小；至于钱仲阳，创立方剂也以解毒为主，但多用寒凉药，少用温补药。张洁古、王海藏都尊崇这一观点。他们的意图都基于《内经》中“诸疡疮皆属心火”的一句话，所以用寒凉药来泻心火。此后，陈文中创立方剂，极力纠正这种偏颇，专门主张温补。凡是痘疹已出未出之间，全部使用十二味异功散，其用意侧重于太阴经。因为手太阴肺主皮毛，足太阴脾主肌肉，肺经厌恶寒冷，脾土厌恶湿气，所以用丁香、官桂来治疗肺的寒邪，用白术、附子、半夏来治疗脾的湿邪。这个方子如果运用得当，疗效确实很大。然而如果不分寒、热、虚、实而一概使用，那么它只适合虚寒证，不适合实热证，其偏颇之害也就显而易见了。朱丹溪对此解释得很正确。到了丹溪立论时，他纠正陈氏的偏颇，而取钱氏的长处，主张解毒、和中、安表，认为这是恰当的，举世之人都在使用，几百年来没有人议论过它的失误。但我认为，在治疗其他病症时，丹溪有很多精妙的论述，但在治疗天花方面，则显得轻率且未尽其妙，或许是千虑一失吧。因为他纠正陈氏的偏颇，不敢轻易使用木香、肉桂、附子等药物，这似乎是因噎废食。他取钱氏的长处，却一定要用黄芩、黄连、牛蒡子之类的药物，来监制人参、白术、附子等补剂的力量，这似乎是任用将领却在中间制约，依靠军队却在外部监视一样，他的失误也在于拘泥于《内经》“诸疡属心火”的一句话而没有透彻理解其道理。不知道天花虽然属于心火，却与其他疮疡不同。各种疮毒，在其初发而未成形时，可用药物解散而痊愈。等到已经成形但未成脓时，又可用药物逐散而痊愈。痘毒发自五脏，必须借助血气输送到皮肤，运化而成脓，收结而成痂，然后才能完成治疗。这能靠解散而痊愈吗？能在未成脓时就痊愈吗？所以治疗各种疮疡以解毒为主，能早期解毒则病情轻，不能解毒……解毒的药物大多损伤胃气，不顾血气的亏损而急于解毒，这就像不考虑我方军队的强弱而急于杀敌一样。
大概毒邪有必须解的，又有不可解的。如果小儿禀赋壮实，胃气好，饮食如常，其血气自然旺盛，自然能运送毒邪以成功，其痘自始至终多为顺症，这种情况不必解毒。如果其禀赋素来虚弱，脾胃又弱，出痘时饮食减少，或口渴或腹泻，或腹胀，或手足冷，或气短促，或失声，或痘出不快，或根窠不红活，或色白而顶陷，或当灌脓而不灌脓，当结痂而不结痂，这都是由于血气不能运送毒邪，这种情况是不可解毒的。应当迅速使用温补药，以扶持胃气而助益血气，如果使用人参、[缺字]、当归、白术等力量不够，就加入木香、丁香、肉桂、附子作为佐使，也不算过分，又何必掺入牛蒡子、黄芩、黄连等凉性药物，来监制温补之力而损耗气血呢？这就是丹溪未尽其妙的地方。丹溪又教人使用犀角地黄汤来解痘毒，后人沿袭他的说法，失去了最初的本意，因习惯而使用，认为奇妙却不知道其危害。大概心是以血为主的，心之所以能主血，是因为它属火。痘属心火，正借用心火来运用一身的气血以成功，怎么能把它泻去呢？大概人身之血，温暖则流行，寒冷则凝滞。犀角地黄汤凉心经而泻心火，心经既凉，心火既泻，则一身之血都会凝滞不行，凭什么来运化毒邪成脓结痂呢？所以内攻的祸患发作，竟然导致死亡的，是泻心火的药物实际上杀死了病人，而人们却不知道，医者也没有醒悟。真是令人感慨啊！我认为痘已出之后，未结痂之前，凡是一切凉心的药物，如犀角、地黄之类，暂时禁止不用，等痘结痂后再用来解除余毒是可以的。有人问：如果这样，那么在未收结之前，毒都不可解吗？我说：为什么不可解？如果其血气与毒邪都旺盛的，脉象必定洪数。或者刚出来就带紫黑色，或者出来后稠密红紫，内部则烦闷燥渴，小便赤涩，大便秘结，这属于实热证，应当迅速使用清凉药剂来解毒。如果大便长期秘结的，酌情加入酒炒大黄轻微通便即可。如果毒邪虽盛，但血气未旺的，则以解毒为主兼活血养气，人参、[缺字]、当归、白芍之类也不可离开。临症时，必须细心审察。
近世治疗天花的方子，多宗法黄西邱，他的书自始至终，都分顺症、逆症、险症来立论。他认为顺症，不必服药。认为险症，宜以保元汤调治，这还接近事理。至于说逆症都不可治，治了也是徒劳无功，这是教人袖手旁观等待死亡，言辞极其不仁。这对于俗医图谋利益来说很方便，但对于救济生命的技术来说则很违背。大概医生是仁爱之术，圣人用它来赞助造化所不及的地方，可贵之处在于扶持危难、救助困苦、起死回生罢了。如果只治疗容易治的病，而抛弃难治的病，还要医生做什么呢？只有俗医意在图利，又怕坏了名声，见到不顺症的，就推卸责任抛弃他们，他们实在担心未必能得到利益，反而白白冒上不识病症的名声。如果是仁人君子，应当在死里求生，怎么忍心坐视其死亡而不治疗呢？所以说：黄西邱的话，对俗医有利，而不是用来救世的。而且他所指的逆症多种多样，稠密者多有之。如发热而惊悸、吐泻，报痘而先发于司空、印堂、天庭等处。初出而根窠无晕，既出而色白灰陷，或发水泡，或痒塌，或当行浆而不行浆，或痂未落而寒战切牙，都是他所谓的逆症而不治的情况。我每次治疗这些而得生的很多，为什么都说治疗没有益处而告诫人们不要治疗呢？只有初出而形如蚕种，既出而紫黑干枯的，难以灌浆，大多不可救治罢了。然而明知救不活，也不忍心坐视而不救。
In the late autumn of Yichou year (1865), I reviewed and proofread the printed edition of *Yanfang Xinbian* (New Compilation of Verified Prescriptions), correcting erroneous characters. Mr. Chen Shaohai from our county presented me with a volume titled *Douzheng Cihang* (Compassionate Navigation for Smallpox). Initially, I thought that the discussion on treating smallpox in *Xinbian · Pediatrics* was already quite detailed, so it seemed unnecessary to add more. Subsequently, I flipped through that book and found that it was written by Mr. Ouyang Tiaolv from the Ming Dynasty and later edited and polished by Mr. Guo Kunshan. The discussions on syndrome differentiation and prescription selection were consistent with the principles in *Xinbian*. From fever to the appearance of pustules, filling with pus, and scabbing, based on the symptoms presented, one can distinguish between favorable and unfavorable courses by observing complexion and form, listening to voice and breath, and palpating pulses, while assessing cold, heat, deficiency, and excess. For each symptom, the appropriate prescription is listed immediately after, making it clear at a glance. Even those unfamiliar with medicine can consult the volume to differentiate syndromes and select prescriptions accordingly; it is indeed a compassionate guide for emergency rescue in hasty situations. Therefore, I appended it to the "Supplement" volume, hoping it would serve as an aid to widely benefit sentient beings. Recorded by Li Dong of Ziyang in mid-winter of Yichou year, Tongzhi 4th Year.
There have been many physicians treating smallpox. Liu Hejian used exclusively cooling and purgative herbs, causing significant harm due to this bias. As for Qian Zhongyang, his prescriptions also focused mainly on detoxification but relied heavily on cooling herbs and rarely on warming and tonifying ones. Zhang Jiegu and Wang Haicang both revered this approach. Their intent was based on the statement in *Neijing* (The Inner Canon) that "all sores and ulcers belong to Heart Fire," thus using cooling herbs to drain Heart Fire. Later, Chen Wenzhong created prescriptions to vigorously correct this bias, specifically advocating warming and tonifying. Whenever smallpox was about to appear or had just appeared, he exclusively used Twelve-Ingredient Yigong San (Twelve-Ingredient Extraordinary Efficacy Powder), focusing his intent on the Taiyin channel. Since Hand-Taiyin Lung governs skin and hair, and Foot-Taiyin Spleen governs muscles, the Lung channel dislikes cold, and Spleen earth dislikes dampness. Therefore, he used Dingxiang (Caryophylli Flos, Clove) and Guigui (Cinnamomi Ramulus, Cinnamon Twig) to treat Lung cold, and Baizhu (Atractylodis Rhizoma, Atractylodes), Fuzi (Aconiti Lateralis Radix Praeparata, Prepared Aconite Root), and Banxia (Pinelliae Rhizoma, Pinellia) to treat Spleen dampness. If this prescription is used appropriately, its efficacy is indeed great. However, if used indiscriminately without distinguishing cold, heat, deficiency, or excess, it suits deficiency-cold but not excess-heat, revealing its biased harm. Zhu Danxi explained this correctly. When Danxi formulated his theories, he corrected Chen's bias while adopting Qian's strengths, emphasizing detoxification, harmonizing the middle, and stabilizing the exterior, considering this appropriate. The world adopted it, and for centuries no one questioned its errors. However, I believe that while Danxi offered many brilliant insights for other diseases, his treatment of smallpox was rash and incomplete, perhaps a rare oversight. Correcting Chen's bias, he dared not lightly use Muxiang (Aucklandiae Radix, Aucklandia), Guizhi (Cinnamomi Ramulus, Cinnamon Twig), and Fuzi (Aconiti Lateralis Radix Praeparata, Prepared Aconite Root), seemingly giving up eating because of choking. Adopting Qian's strengths, he insisted on using Huangqin (Scutellariae Radix, Scutellaria), Lianzi (Coptidis Rhizoma, Coptis - *Note: Text says 'Lianzi' but context implies Huanglian/Coptis or similar bitter cold herb, likely typo for Huanglian or referring to seeds, but standard term for detox is Huanglian. Given context 'Qin, Lian', it refers to Huangqin and Huanglian*), and Niuzi (Arctii Fructus, Arctium) to control the strength of tonics like Renshen (Ginseng Radix, Ginseng), Baizhu (Atractylodis Rhizoma, Atractylodes), and Fuzi (Aconiti Lateralis Radix Praeparata, Prepared Aconite Root). This is like appointing generals but restraining them from within, or relying on troops but monitoring them from outside. His error also lay in rigidly adhering to the *Neijing* saying "all sores belong to Heart Fire" without fully penetrating its logic. One should not know that although smallpox belongs to Heart Fire, it differs from other sores. The toxin of various sores, when initially erupting and not yet formed, can be resolved with medication to heal. Once formed but not yet suppurated, it can also be dispersed with medication to heal. Smallpox toxin originates from the five zang organs and must rely on blood and qi to transport it to the skin, transform it into pus, and consolidate it into scabs to complete the cure. Can it heal merely by dispersion? Can it heal before suppuration? Thus, treating various sores focuses on detoxification; early detoxification leads to mild disease. If detoxification fails... Detoxifying herbs often damage Stomach Qi. Ignoring the depletion of blood and qi to rush towards detoxification is like rushing to kill enemies without considering the strength of one's own troops.
Generally, toxins have some that must be resolved and some that cannot be. If a child has strong constitution, good Stomach Qi, and normal appetite, their blood and qi are naturally vigorous, naturally transporting toxins to succeed; such smallpox cases are mostly favorable throughout, requiring no detoxification. If their constitution is inherently weak, Spleen and Stomach are weak, appetite is poor during eruption, accompanied by thirst or diarrhea, abdominal distension, cold hands and feet, shortness of breath, loss of voice, slow eruption, non-vibrant roots, white color with depressed tops, failure to fill with pus when expected, or failure to scab when expected, these are all due to blood and qi's inability to transport toxins; in these cases, detoxification is contraindicated. One should rapidly use warming and tonifying herbs to support Stomach Qi and assist blood and qi. If Renshen (Ginseng Radix, Ginseng), [Missing Character], Danggui (Angelicae Sinensis Radix, Angelica), and Baizhu (Atractylodis Rhizoma, Atractylodes) are insufficient, adding Muxiang (Aucklandiae Radix, Aucklandia), Dingxiang (Caryophylli Flos, Clove), Guizhi (Cinnamomi Ramulus, Cinnamon Twig), and Fuzi (Aconiti Lateralis Radix Praeparata, Prepared Aconite Root) as assistants is not excessive. Why mix in Niuzi (Arctii Fructus, Arctium), Huangqin (Scutellariae Radix, Scutellaria), and Huanglian (Coptidis Rhizoma, Coptis) to inhibit the power of warming tonics and damage blood and qi? This is where Danxi failed to fully grasp the subtleties. Danxi also taught using Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) to resolve smallpox toxins. Later generations followed this, losing the original intent, using it out of habit, thinking it miraculous without knowing its harm. The Heart primarily governs blood; the reason the Heart can govern blood is because it belongs to Fire. Smallpox belongs to Heart Fire, which precisely utilizes Heart Fire to circulate the body's qi and blood to achieve success. How can it be drained away? Blood in the human body flows when warm and stagnates when cold. Xijiao Dihuang Tang cools the Heart channel and drains Heart Fire. Once the Heart channel is cooled and Heart Fire drained, the blood in the entire body will stagnate and fail to flow. How can it then transform toxins into pus and scabs? Thus, internal attack complications arise, leading to death; drugs that drain Heart Fire actually kill the patient, though people do not realize it, and physicians remain unaware. Truly lamentable! I propose that after smallpox appears and before scabs form, all cooling-heart drugs like Xijiao (Rhinocerotis Cornu, Rhino Horn - *Note: Modern practice uses substitutes, but text specifies Xijiao*) and Dihuang (Rehmanniae Radix, Rehmannia) should be strictly prohibited. They may be used after scabbing to resolve residual toxins. Someone asked: If so, can toxins never be resolved before consolidation? I said: Why not? If both blood/qi and toxins are vigorous, the pulse will be surging and rapid. Or if purple-black upon initial appearance, or dense red-purple after eruption, accompanied by internal restlessness, dry mouth/thirst, red scanty urine, and constipation, this belongs to excess-heat. One should rapidly use cooling agents to detoxify. If constipation persists,适量 (moderate amount) of Jiuhuang (Rhhei Radix et Rhizoma, Rhubarb fried with wine) can be added to mildly promote bowel movement. If toxins are abundant but blood/qi are not yet vigorous, focus on detoxification while simultaneously invigorating blood and nourishing qi; Renshen (Ginseng Radix, Ginseng), [Missing Character], Danggui (Angelicae Sinensis Radix, Angelica), and Baishao (Paeoniae Radix Alba, White Peony Root) should not be abandoned. During clinical practice, careful examination is required.
Recent prescriptions for smallpox mostly follow Huang Xiqiu. His book consistently distinguishes between favorable, unfavorable, and dangerous syndromes. He stated that favorable syndromes require no medication. Dangerous syndromes should be treated with Baoyuan Tang (Preserve Origin Decoction), which is still reasonable. However, stating that unfavorable syndromes are untreatable and treatment is futile teaches people to stand by and wait for death, which is extremely unkind. This is convenient for vulgar physicians seeking profit but contrary to the art of saving lives. Medicine is a benevolent art; sages use it to assist what creation cannot achieve, valuing the ability to support the perilous, rescue the distressed, and revive the dead. If one treats only easy cases and abandons difficult ones, what is the purpose of being a physician? Only vulgar physicians seek profit and fear damaging their reputation; seeing unfavorable cases, they shirk responsibility and abandon patients, fearing they might gain nothing but incur the name of misdiagnosis. If one is a benevolent gentleman, one should strive for life amidst death; how could one bear to watch them die without treatment? Thus, Huang Xiqiu's words benefit vulgar physicians but do not save the world. Moreover, the unfavorable syndromes he points out are numerous, especially in dense cases. Examples include fever with palpitations, vomiting, and diarrhea; eruption starting first at Sikong, Yintang, or Tianting areas; no halo around roots upon initial appearance; white/gray depressed color after eruption; blister formation; itching and collapse; failure to progress to pus stage when expected; or chattering teeth and chills before scabs fall off. These are all what he calls unfavorable and untreatable. I have treated many such cases successfully. Why claim treatment is useless and warn against it? Only cases appearing like silkworm eggs, turning purple-black and dry after eruption, failing to fill with pus, are mostly incurable. Yet, even knowing they may not survive, I cannot bear to sit idly by without treating them.