大凡调治痘疮，自发热之初、见点之时，即当思及如何起发，如何灌浆，如何收结，一
动手用药，便顾首顾尾，慎其初以善其后，然后次第调治，可保万全也。发热之初，若身热
和缓，或热或退，神清气爽，则不必用药发汗，但戒荤禁风而已，不必服药。盖痘有顺而不
治者，不轻治即所以治之也，其或憎寒壮热，头痛咳嗽，鼻流清涕者，多因外感，不可不发
散也。当视其强弱，用药发散，见体质壮实者，用加味升麻葛根汤微汗之，体质怯弱者，宜
用加味参苏饮汗之。然皆不可出汗太多，恐虚其表，后难起胀、灌浆也。然此二方，即外感
而非痘，服之亦无妨。
或发汗之后，身热不退者，且勿峻攻，姑少待之。其或烦闷燥渴而妄语者，用败毒和中
散清之，大便秘者，加酒炒大黄微利之，不秘不加。服之后，觉烦躁少解，即止勿服，听其
痘出外而中自安。切不可轻用伤寒症柴胡、黄芩、花粉等清解之，此药若用差一剂，则解虚
其表，至七八日，浆必不行，虽极力补助，莫能救疗，至焦枯痒塌而死者多矣。盖痘以里为
根，以表为基，一虚其表，是犹筑室而圮其基也，是以治痘与治伤寒异也。近世管KT 着
书，
一，
或有腹痛、腰痛而烦闷者，此其毒瓦斯沉重，亦当用败毒和中散主之，大便秘加酒炒大黄
微利之，听其毒出外而内痛自止，然后视其痘或稠密，或红紫，或带黑，方议解毒可也。切
不可纯用寒凉，以阻遏其毒出之势，立致内攻告变，世人不知此理，纯用寒凉解毒，或用硝
、黄峻下，因而速毙，而卒不悟，可慨也夫。
当时令出痘时，小儿或有发热稍缓，其热或作或止，或红点，或未见红点，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，以待其定，但禁风、
戒荤而已，所谓不轻治正所以深治之也。有等富贵之家，爱惜太重，见其如此，屡投以清凉
解毒之剂，不知若是痘症，则其毒瓦斯发于五脏，勃勃欲出于外，其势决不可阻遏。倘用清凉
阻遏其势，即所以迫之内攻而速祸矣。故犯此者，多有出痘数日，烦躁惊搐而死，此解毒之
药害之也。正如寇在宫墙之中，不逐之出外，反阻其出路，围而攻之，室中之人？有不遭其
残害其乎？然医者曰∶吾用解毒之药，何至于杀人，既不自任其咎。病家曰∶彼用解毒之药
，何至于杀人，亦不归咎于医。杀人于冥冥之中而己不悟也，人不知也，噫！良可悲也。余
故表而出之，以戒夫世之爱而反害者。
语曰∶久腊者毒必浓。痘毒禀于胎元，伏于五脏，其轻者无论，其重者深藏久蓄，不为
不浓矣。一旦触发于倏然之顷，其势猛锐，断不可御。是以必借血气载毒出外，成浆结痂
，然后毒散而功成，此病机亦化机也。此岂若诸疮之毒，可以骤然而解散者乎。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，
如水势排山，而欲捧土塞之，有是理乎？自古治痘之家，其卑者固不足道，其高者亦未深悟
其理。每于发热之初，欲出未出之际，辄以解毒为主，且曰服其药则毒可解，而痘必稀。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
将出之时，毒瓦斯盛炽，则多用凉药以解之，或妄下以解之。彼自以为对症之妙药，而不知反
致内攻之奇祸，至于杀人而终不悟，前覆而后不戒，其祸又无穷也！余观近世庸医，多犯此
失，以致童幼数日而毙者甚多，则皆茫然委于症恶难救，而举世莫知其致此之由，殊可矜也
。故不得不发明其理，以救将来。
大凡调理治疗痘疮，从发热初期、疹点显现之时起，就应当考虑到如何使痘疹起发、如何灌浆、如何收结。一旦动手用药，就要兼顾首尾，谨慎地处理好初始阶段以善后，然后按次序进行调理治疗，才能确保万无一失。
在发热初期，如果身体热度温和缓和，或热或退，精神清爽，那么就不必用药发汗，只需禁止荤腥食物和避免受风即可，不必服药。因为痘疮有顺应自然而不需治疗就能痊愈的情况，不轻易治疗正是对它的治疗。如果出现憎寒（怕冷）壮热（高热）、头痛咳嗽、鼻流清涕等症状，多因外感邪气所致，不可不进行发散治疗。此时应观察患者体质的强弱：体质壮实者，使用加味升麻葛根汤使其微微出汗；体质怯弱者，宜用加味参苏饮使其出汗。然而这些方法都不可使出汗过多，恐怕会导致体表虚弱，后续难以起胀、灌浆。但这两个方子，即使是针对外感而非痘疮病症服用，也没有妨碍。
如果在发汗之后，身体热度仍不退去，暂且不要使用猛烈攻下的药物，姑且等待一段时间。如果出现烦闷燥渴甚至胡言乱语的症状，使用败毒和中散来清解；如果大便秘结，加入酒炒大黄使其轻微通利，如果不秘结则不加。服药后，如果觉得烦躁稍微缓解，就立即停药不再服用，听任痘疹向外透发而体内自然安宁。切不可轻易使用治疗伤寒症的柴胡、黄芩、天花粉等清热解表药物，这些药如果使用不当，哪怕只是一剂，也会导致体表虚弱。到了七八天，痘浆必然无法形成，即使极力给予补益资助，也无法救治，最终导致痘疮焦枯、瘙痒塌陷而死的人很多。因为痘疮以里为根本，以表为基础，一旦使体表虚弱，就像建造房屋却破坏了地基一样，所以治疗痘疮与治疗伤寒是不同的。近代管仲阳著书立说，（此处原文可能有误或省略，意指其观点或相关论述），或者出现腹痛、腰痛并伴有烦闷的情况，这是因为毒瓦斯沉重，也应当以败毒和中散为主治，大便秘结的加入酒炒大黄轻微通利，听任毒素向外排出而内部疼痛自然停止，然后再观察痘疹是稠密、红紫还是带黑色，再商议解毒的方法。切不可纯用寒凉药物，以阻遏毒素外出的势头，否则立刻会导致内攻变证。世人不懂这个道理，纯用寒凉解毒，或用芒硝、大黄猛烈攻下，因而加速死亡，却始终不明白原因，真是令人感慨啊。
当时令出痘的时候，小儿如果有发热稍缓，热度时作时止，或有红点，或未见红点，或微见而未明显，或者是出痘，或非出痘，正处于疑似之间。在这个时候，不如暂且不服药，以等待病情确定，只需禁风、戒荤而已，这就是所谓的不轻治正是为了更深层次的治疗。有一类富贵人家，过于爱惜孩子，看到上述情况，屡次投予清凉解毒的药物，不知道如果是痘症，其毒瓦斯发于五脏，蓬勃欲向外透出，这种势头决不可阻遏。倘若用清凉药物阻遏其势头，就是迫使毒素内攻而加速灾祸。因此犯此错误的人，多有在出痘数日后，因烦躁惊搐而死，这是解毒药物害了他们。正如寇贼在宫墙之中，不将其驱逐到外面，反而阻挡其出路，围困并攻击它，屋内的人能不遭受残害吗？然而医生说：“我使用的是解毒药物，怎么会至于杀人？”既不自认其过。病人家属说：“他使用的是解毒药物，怎么会至于杀人？”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！实在可悲啊。所以我特意揭示出来，以告诫那些因爱反而害了孩子的世人。
俗话说：“久腊者毒必浓。”痘毒禀受于胎元，潜伏于五脏，轻的不用说，重的深藏久蓄，不能说是不浓烈。一旦在突然之间被触发，其势头猛锐，断不可抵御。因此必须借助血气载着毒素向外排出，形成痘浆结成痂皮，然后毒素消散而功效达成，这也是病机也是化生之机。这哪里像其他疮疡的毒，可以骤然解散的呢？所以在痘疹发出之后进行解毒，是顺应其想要散发的势头，还算合乎情理。在痘疹未发出之前进行解毒，是遏制其猛锐欲出的势头，其祸患非常迅速，就像水势排山倒海，却想用双手捧土去堵塞，有这样的道理吗？自古以来治疗痘疮的人家，低劣的自然不用提，高明的也未深刻领悟其中的道理。往往在发热初期，欲出未出之际，就以解毒为主，并且说服用这种药则毒可解，而痘疹必然稀少。不知道痘疹稀少，是因为初受毒邪较轻罢了，难道在将要发出的时候，能够骤然解毒吗？这导致了后世庸医以讹传讹，见到痘疹将出之时，毒瓦斯盛炽，就多用凉药来解毒，或妄用泻下药来解毒。他们自以为是对症的妙药，却不知道反而导致内攻的奇祸，以至于杀人而始终不醒悟，前车之鉴而后车不改，其祸患又无穷无尽啊！我观察近世庸医，多犯此失误，以致儿童幼童数日内死亡者甚多，他们都茫然地归结为症状恶劣难以救治，而举世无人知道导致这种情况的原因，实在值得同情。所以不得不阐明其中的道理，以拯救将来之人。
Generally speaking, in the regulation and treatment of smallpox (or variola), from the initial stage of fever to the time when spots appear, one must consider how to promote eruption, how to fill with pus, and how to scab over. Once medication is administered, one must attend to both the beginning and the end, being cautious in the initial phase to ensure a good outcome, and then proceeding with step-by-step regulation and treatment to guarantee safety.
At the initial stage of fever, if the body heat is mild and moderate, fluctuating or subsiding, and the spirit is clear and refreshing, there is no need to use medicine to induce sweating; one should merely avoid greasy food and wind exposure, without taking any medicine. This is because some cases of smallpox follow a smooth course without specific treatment; not treating lightly is itself a form of treatment. However, if there are symptoms such as aversion to cold with high fever, headache, cough, and runny nose, these are mostly due to external contraction of pathogenic factors and cannot fail to be treated with dispersing methods. One should observe the patient's constitution: for those with strong constitutions, Jiawei Shengma Gegen Tang (Modified Ligusticum and Pueraria Decoction) can be used to induce slight sweating; for those with weak constitutions, Jiawei Shen Su Yin (Modified Ginseng and Perilla Drink) should be used to induce sweating. In all cases, excessive sweating must be avoided, lest it weaken the exterior and make subsequent swelling and pus-filling difficult. Nevertheless, these two formulas can also be taken for external contractions unrelated to smallpox without adverse effects.
If fever persists after sweating has been induced, do not resort to harsh purgatives immediately; wait for a while. If there is restlessness, dryness, thirst, and delirious speech, Bai Du He Zhong San (Poison-Dispersing and Middle-Regulating Powder) should be used to clear the heat. If constipation is present, add Jiu Chao Da Huang (Wine-fried Rheum Rhizome) to mildly promote bowel movement; if not constipated, do not add it. After taking the medicine, if irritability subsides slightly, stop administration immediately and allow the rash to erupt outward while the interior settles naturally. One must absolutely avoid lightly using Qingjie (clearing and resolving) herbs like Chai Hu (Bupleurum Root), Huang Qin (Scutellaria Root), and Hua Fen (Trichosanthes Root) typically used for Shanghan (Cold Damage) syndromes. If these medicines are misused, even by one dose, they will weaken the exterior. By the seventh or eighth day, the pus will certainly fail to form. Even with vigorous tonification, rescue will be impossible, leading to many deaths due to scorched, dried, itchy, and collapsed lesions. Smallpox relies on the interior as its root and the exterior as its foundation; weakening the exterior is like building a house but destroying its foundation. Thus, treating smallpox differs from treating Shanghan. In recent times, Guan [Zhongyang] wrote books... [Text fragment implies discussion on abdominal/lower back pain]. Or if there is abdominal pain, lower back pain accompanied by restlessness, this indicates heavy toxic qi, which should also be primarily treated with Bai Du He Zhong San. For constipation, add wine-fried Da Huang to mildly promote evacuation. Allow the toxin to exit outward so internal pain stops naturally. Then, observe whether the rash is dense, red-purple, or black, and only then discuss detoxification. One must absolutely not use purely cold-natured herbs to block the trend of toxin expulsion, as this will immediately cause internal attack and transformation into critical conditions. People who do not understand this principle often use purely cold-natured detoxifiers or harsh purgatives like Xiao (Mirabilite) and Da Huang, causing rapid death without realizing the cause, which is lamentable.
During the season when smallpox breaks out, children may have slightly milder fever, with heat appearing and disappearing, or having red spots, or no red spots visible, or faintly visible but unclear, or possibly having smallpox or not, remaining in a state of doubt. At this time, it is better not to administer medicine but to wait for clarity, merely avoiding wind and greasy food. This is what is meant by "not treating lightly is precisely deep treatment." Some wealthy families, overly cherishing their children, seeing such symptoms, repeatedly administer cooling and detoxifying agents. They do not realize that if it is indeed smallpox, the toxic qi originates from the five zang organs and vigorously seeks to emerge outward; this momentum cannot be blocked. If cooling agents are used to block this momentum, it forces the toxin inward, accelerating disaster. Consequently, many who commit this error die from restlessness and convulsions a few days after eruption, harmed by detoxifying medicines. It is like bandits within palace walls: instead of driving them out, one blocks their exit, surrounds, and attacks them; surely the people inside will suffer harm. Yet physicians say, "I used detoxifying medicine; how could it kill?" refusing to accept blame. Families say, "He used detoxifying medicine; how could it kill?" failing to attribute fault to the doctor. Killing in the dark without self-awareness or public understanding is truly tragic. Therefore, I highlight this to warn those whose love becomes harmful.
The saying goes: "Those aged long possess concentrated toxins." Smallpox toxin is inherited from prenatal essence and lies hidden in the five zang organs. The mild cases need not be discussed; the severe cases are deeply stored and accumulated, certainly not lacking concentration. Once triggered suddenly, the momentum is fierce and unstoppable. Therefore, one must rely on blood and qi to carry the toxin outward, forming pus and scabs, so that the toxin dissipates and the cure is achieved. This is both the disease mechanism and the transformative process. How can this be compared to other sores where toxins can be dispersed abruptly? Thus, detoxifying after eruption follows the natural trend of dispersion and is reasonable. Detoxifying before eruption blocks the fierce momentum of emergence, causing rapid disaster, like trying to stop a mountain-rushing flood with handfuls of soil—is this logical? Since ancient times, practitioners of smallpox treatment, whether low-level or high-level, have not deeply grasped this principle. Often at the initial fever stage, just before eruption, they prioritize detoxification, claiming that taking such medicine resolves the toxin and ensures sparse rash. They do not know that sparse rash results from light initial infection, not from sudden resolution at the moment of eruption. This has led later quacks to perpetuate errors: seeing intense toxic qi during impending eruption, they heavily use cold herbs to detoxify or wrongly purge. Believing these to be miraculous对症 (symptom-matching) remedies, they unknowingly cause internal attack disasters, killing patients without realization. Past failures serve no warning for future ones, leading to endless calamities! I observe that modern quacks frequently make this mistake, causing many children to die within days. They茫然ly attribute it to severe, incurable symptoms, while the world remains ignorant of the cause, which is pitiable. Hence, I must elucidate this principle to save future generations.