痘疮全凭气血以成功，而气血之盈虚消长，其理甚微，不可不透也。盖气体天而亲上，
血体地而亲下。痘之出也，其高处之泡，气之位也，上也，气宜尤焉。其四晕根脚，血之位
也，下也，血宜附焉。 尖而色白润，是气尊而居其亲上之位也。四围有晕而色红活，是血
附而安其亲下之分也。气居其尊而血安其分，气血和顺而载毒出外，此最吉之症，可勿药而
愈也。顶陷而气反亲下，此气亏而不能充也，法当补气。四围根脚无红晕，此血亏而不能附
也，法当补血，此其理尤易明也。其有通顶红色成血 者，血反亲上也，此症最险，必不能
成浆，至八九日，则痒塌而死。然此非独血盈，乃由气亏而失其居尊之常，故血得以妄行而
僭
见其 红，则谬认为血热，而用凉血行血之剂，致令气愈亏而毙愈速也，不亦悲乎！故气血
盈亏之理，微妙而难识也。至于调理气血，其气独虚者，因宜专补其气而不宜补血，盖阳不
能从阴，阴愈长则阳愈消也。其有血虚者，多由胃气损伤、元气不足所致，则补血宜兼补气
，盖阴必从阳，阳生则阴长也。黄汝言《明医杂着》乃谓血虚而用参、 以补气，则阳旺而
阴血愈消，甚矣！其不明于阴阳消长之理而立此言，为世大害也。余每治妇人产后，去血过
多而发大热，妇人血虚，崩漏而下血不止，以及便血之虚滑者，俱用参、 、姜、附而佐以
血药与升提药，皆获奇效，安得谓血虚不可补气乎！若小儿痘疮，以胃气为主，则补血必先
补气，故气血消长之理，不可不深明也。
痘疮的痊愈完全依赖气血的作用，而气血的充盈与亏虚、增长与消退，其中的道理非常微妙，必须透彻理解。一般来说，气属阳，性质轻清而上行；血属阴，性质重浊而下行。痘疹发出时，位于高处的脓疱，是气所居的位置，属于上部，气应当在此处发挥作用。痘疹四周的红晕和根部，是血所居的位置，属于下部，血应当依附于此。如果痘顶尖锐且颜色白润，说明气尊贵并居于其宜上的位置。如果四周有红晕且颜色红润鲜活，说明血依附并安守于其宜下的位置。气居于尊位而血安守本分，气血调和顺畅，共同托毒外出，这是最吉祥的证候，甚至可以不用药而自愈。如果痘顶凹陷且气反而下沉，这是气亏虚不能充盛的表现，治法应当补气。如果四周根部没有红晕，这是血亏虚不能依附的表现，治法应当补血，这个道理尤其容易明白。如果有通体红色形成血泡的情况，说明血反而上行，这种证候最为危险，必然不能化脓成浆，到了第八九天，就会因瘙痒塌陷而死。然而这不仅仅是血盈，而是由于气亏虚失去了居尊位的常态，所以血得以妄行而显现出红色。此时若错误地认为是血热，而使用凉血行血的药剂，会导致气更加亏虚，死亡速度加快，这不是很可悲吗！所以气血盈亏的道理，微妙而难以识别。至于调理气血，如果是气单独亏虚，应当专门补气而不宜补血，因为阳气不能从属于阴血，阴血越长则阳气越消。如果是血虚，多由胃气损伤、元气不足所致，那么补血应当兼补气，因为阴必从属于阳，阳气生发则阴血生长。黄汝言在《明医杂着》中却说血虚时使用人参、黄芪来补气，会导致阳气旺盛而阴血更加消亡，这太荒谬了！他不明阴阳消长的道理而立此言论，对世人造成了巨大的危害。我每次治疗妇人产后失血过多导致的大热，妇人血虚崩漏下血不止，以及便血导致的虚滑症状，都用人参、黄芪、干姜、附子配合养血药和升提药，都获得了奇效，怎么能说血虚不可补气呢！如果是小儿痘疮，以胃气为主，那么补血必须先补气，所以气血消长的道理，不可不深刻明了。
The recovery of smallpox (痘疮) relies entirely on Qi and Blood. The principles governing the fullness or deficiency, growth or decline of Qi and Blood are subtle and must be thoroughly understood. Generally speaking, Qi is Yang in nature, light and clear, tending to ascend; Blood is Yin in nature, heavy and turbid, tending to descend. When the rash erupts, the pustules at the higher positions represent the domain of Qi, located superiorly, where Qi should exert its influence. The erythematous halo and base surrounding the lesions represent the domain of Blood, located inferiorly, where Blood should adhere. If the apex is pointed and the color is white and moist, it indicates that Qi is respected and resides in its appropriate ascending position. If the periphery has a halo and the color is red and vibrant, it indicates that Blood adheres and remains secure in its appropriate descending position. When Qi occupies its respected position and Blood stays within its proper bounds, Qi and Blood harmonize and smoothly transport the pathogenic toxins outward. This is the most auspicious presentation, which may heal spontaneously without medication. If the apex is depressed and Qi sinks instead of ascending, this indicates Qi deficiency failing to fill and support; the treatment method should be to tonify Qi. If there is no red halo around the base, this indicates Blood deficiency failing to adhere; the treatment method should be to nourish Blood. This principle is particularly easy to understand. However, if the entire lesion turns red forming blood blisters, it indicates Blood abnormally ascending. This condition is extremely dangerous; pus formation will inevitably fail. By the eighth or ninth day, the patient will die from itching and collapse. Yet, this is not merely due to Blood excess, but rather because Qi deficiency causes the loss of its normal role as the ruler, allowing Blood to act recklessly and manifest redness. If one mistakenly diagnoses this as Blood Heat and uses formulas to cool Blood and invigorate Blood circulation, it will further deplete Qi and accelerate death, which is truly tragic! Therefore, the principles of Qi and Blood fullness and deficiency are subtle and difficult to discern. Regarding the regulation of Qi and Blood: if only Qi is deficient, one should exclusively tonify Qi and avoid nourishing Blood, because Yang cannot follow Yin; if Yin grows excessively, Yang declines. If Blood is deficient, it is often caused by damage to Stomach Qi and insufficiency of Yuan Qi (Primary Qi). In such cases, nourishing Blood should be combined with tonifying Qi, because Yin follows Yang; when Yang generates, Yin grows. Huang Ruyan, in *Ming Yi Za Zhuo* (Miscellaneous Writings of Famous Physicians), claimed that using Ren Shen (Ginseng Root) and Huang Qi (Astragalus Root) to tonify Qi in cases of Blood deficiency would cause Yang to flourish and Yin/Blood to decline further. This is profoundly erroneous! His failure to understand the principles of Yin-Yang growth and decline led to harmful advice for the world. Whenever I treat postpartum women with high fever due to excessive blood loss, women with Blood deficiency suffering from metrorrhagia (崩漏) with continuous bleeding, or those with hematochezia (便血) leading to defecation incontinence due to deficiency, I use Ren Shen (Ginseng Root), Huang Qi (Astragalus Root), Gan Jiang (Dried Ginger), and Fu Zi (Prepared Aconite Root), assisted by Blood-nourishing herbs and lifting agents. All achieve remarkable effects. How can one claim that Qi should not be tonified in Blood deficiency? For pediatric smallpox, which relies primarily on Stomach Qi, nourishing Blood must begin with tonifying Qi. Thus, the principles of Qi and Blood growth and decline must be deeply understood.