庄在田曰∶痘科一症，顺者不必治，逆者不能治，可治者惟险症耳。险症治之得法则生
，不得法则不生，是治法之不可不精也。《内经》未尝言及，今行世诸书，皆本之于“诸疮
痛痒、皆属于热”八字。所以立意先言解毒，开方定用寒凉，在其父母闻之。解毒最为入耳
，寒凉似亦应然。殊不知痘疮全以发透为吉，起发必赖气血滋培，方能自内达外，齐苗、灌
浆、结痂，无非阳气为之主也。寒凉则血滞，克削刚气破，血滞气破，毒瓦斯乘虚深入，此痘
症陷塌之所由来也。譬之猪脬（即尿脬），若欲其胀满，必须以气充之，散其气立即陷矣。
此
症
血
谓
陋
哲
四
饮食减少，或不甚消化等症。知腹中火少，出痘时必难灌浆，亦难结痂，气血不足之故，是
名虚寒。速宜培补元阳，以防变症也。何者为实热？或小儿气体壮实，饮食易消，出痘时大
便结而燥，小便赤而臊，口鼻中出气如火，恶热喜凉等症，是名实热。察明果是内热，方可
暂行清解，荆防地黄汤用生地加大黄，一二剂而火退矣。然不可以虚火误认为实火。察虚火
实火之法，全凭大小便为主，小便清白，大便不燥，身虽大热，乃是中宫有寒，火无所根据，
浮而在外。误服寒凉亦有此症。不得以身热便认为实火。虚火者十中八九，实火者十中之一
二耳。
庄在田说：痘科这一病症，顺症不需要治疗，逆症无法治疗，可以治疗的只有险症罢了。险症如果治疗方法得当就能存活，不得法就不能存活，所以治疗方法不可不精妙。《内经》未曾提及此病，现在流传于世的各种书籍，都依据“各种疮疡疼痛瘙痒，都属于热”这八个字。因此立意先讲解毒，开方必定使用寒凉药物，这是因为父母们听到后容易接受。解毒的说法最让人听得进去，寒凉似乎也是理所当然的。却不知道痘疮全以透发为吉利，起发必须依赖气血的滋养培育，才能从内达外，齐苗、灌浆、结痂，无非是阳气在其中起主导作用。寒凉药物会导致血液凝滞，削弱刚健之气，血滞气破，毒邪乘虚深入，这就是痘症出现陷塌症状的原因所在。这就好比猪脬（即尿脬），如果想要它胀满，必须用气体充满它，散掉气体它就会立即塌陷。
这种病症中，有一种情况是饮食减少，或者食物不太容易消化等症状。知道腹中火力不足，出痘时必然难以灌浆，也难以结痂，这是气血不足的缘故，这就叫做虚寒。应当迅速培补元阳，以防止发生变症。什么是实热？或者是小儿体质壮实，饮食容易消化，出痘时大便干结燥硬，小便颜色红赤且有臊味，口鼻中呼出的气息像火一样，厌恶炎热喜欢凉爽等症状，这就叫做实热。仔细查明果真是内热，才可以暂时使用清解的方法，荆防地黄汤中使用生地黄加大黄，服用一两个疗程火气就消退了。然而不可以把虚火误认为实火。辨别虚火和实火的方法，完全凭借大小便作为主要依据，小便清白，大便不干结，身体虽然大热，这是中宫（脾胃）有寒，火气没有根基，浮越在外。误服寒凉药物也会出现这种情况。不能因为身体发热就认为是实火。虚火的情况占十之八九，实火的情况只占十之一二罢了。
Zhuang Zaitian said: Regarding the disease of smallpox (Dou Zheng), smooth cases do not require treatment, and adverse cases cannot be treated; only dangerous cases (Xian Zheng) are treatable. If dangerous cases are treated with correct methods, the patient survives; if not, they die. Therefore, treatment methods must be precise. The *Neijing* (Inner Canon) does not mention this disease. Modern books circulating today all base their theories on the eight characters from the classic text: "All sores and ulcers with pain and itching belong to heat." Consequently, the initial approach emphasizes detoxification, and prescriptions invariably use cold and cool herbs, as this is what parents find acceptable. The concept of detoxification is most readily accepted, and the use of cold/cool properties seems logical. However, it is unknown that for smallpox, successful eruption is auspicious. Eruption relies entirely on the nourishment and cultivation of Qi and Blood to move from the interior to the exterior. The stages of even distribution of pustules (Qi Miao), filling with pus (Jiang Huang), and scabbing (Jie Jia) are all dominated by Yang Qi. Cold and cool herbs cause blood stasis and weaken robust Qi. When blood stagnates and Qi is broken, pathogenic toxins penetrate deeply into the deficiency. This is the origin of sinking and collapsing lesions in smallpox. It is like a pig bladder (Zhou Pao); if one wishes it to be inflated, it must be filled with air; if the air dissipates, it immediately collapses.
In such cases, symptoms include reduced appetite or poor digestion. Knowing that there is insufficient fire in the abdomen, during the eruption phase, it will be difficult to fill with pus or form scabs. This is due to insufficiency of Qi and Blood, which is named Deficient-Cold (Xu Han). One should quickly tonify Original Yang (Yuan Yang) to prevent complications. What constitutes Excess-Heat (Shi Re)? It refers to children with robust constitutions whose food digests easily. During eruption, their stools are dry and hard, urine is red and pungent, breath exhaled from the mouth and nose feels hot like fire, and they dislike heat while preferring coolness. This is named Excess-Heat. Only after carefully confirming internal heat can one temporarily employ clearing and resolving methods. Using Jingfang Dihuang Tang (Astragalus and Saposhnikovia Decoction with Rehmannia) with Shengdi Huang (Rehmanniae Radix) added with Da Huang (Rhei Radix et Rhizoma), the heat subsides after one or two doses. However, one must not mistake Deficient-Fire (Xu Huo) for Excess-Fire. The method to distinguish between Deficient-Fire and Excess-Fire relies primarily on urination and defecation. If urine is clear and white, and stools are not dry, despite high fever, this indicates Cold in the Middle Palace (Zhong Gong, referring to the Spleen and Stomach). The Fire has no foundation and floats outward. Misusing cold/cool herbs can also produce these symptoms. One must not assume Excess-Fire simply because of body heat. Deficient-Fire accounts for eight or nine out of ten cases, while Excess-Fire accounts for only one or two out of ten.