夫痘疮必待三日，不出或出不快，即微发之，如发后不出，仅宜日服二剂，此后而
再不出，方大发之，若见点虽少，倘脉和平，是疮本稀，亦不可乱为发表，发表犹
此，况汗下乎？故痘症虽似伤寒，然治惟有温平之法，而无汗下之理。且伤寒表症未
解，尚不可下，况痘疮必欲起胀，翕浆而后已哉，何世谓初觉即宜利之，宜泄其毒，误
矣。故在初发热足冷，头痛脉数，与伤寒疑似之间，仅宜解肌微表，若有内伤等症，仅
宜微与化食宽膈，若痘而误服麻黄之剂，以汗下之，则阳气尽出于肌表，遂必斑烂而脏
虚，虚则腹疼自利，或作寒战，甚或里无阳气，乃作阴痫，而死者多矣。抑痘而误用大
黄之剂，以下之，则毒乘虚陷伏，或为腹胀。或为喘急，而死者有矣。虽然亦有不得
不汗下以劫病者，如未出时，重感风寒，约束皮肤，而腠理闭密，疮出不快者，此必当
汗之，令其阴阳和，荣卫通，而疮自易出，毒得解散，苟不汗之，则毒无从外出，存伏
于中，未免有闭门留寇之祸也。更如大热不退，转增烦渴，谵妄昏沉，便尿阻塞者，此
毒蓄于肠胃之间，而与谷气并结也，宜急下之，使其陈秽涤去，脏俯流通也，苟不下
之，则藏污蓄毒煎熬于中，宁无养虎遗患之虞乎？《书》曰∶首尾不可下者，或谓首云
上焦，尾云下焦，盖治上宜消，治下宜导，而无下之理。或云，痘未显于表，其脉症有
表而无理，若一下之则邪气不得伸越，故禁首不可下也。痘已显于外而无一切里症，内
无根蒂，大忧不甚实，苟一下之，则毒邪逆陷，并即靥而精滋耗亡，是以大便干结者，
如亦下之，则愈竭荣血。故禁尾不可下也。论虽不同，理则一致，至如顺痘初出，又无
表里感伤者，则当任其自然，惟加安养，自见全功，若有风寒闭塞，惟宜解肌自出矣。
奈何才见痘点，亦罔顾其所蕴轻重，肌热未透，毛窍未松，惟恐不出，用药峻发，毒无
出路，遇发则一倍变为十倍，十疮合为一疮，各曰斑烂。五内七窍，至于皆有，重者
不救，轻者或为喉痛声哑，目疾鼻塞之患也。
痘疮（天花）必须等待三天，如果不出疹或出疹缓慢，就只宜轻微发汗；如果在发汗之后仍然不出疹，仅适宜每天服用两剂药；在此之后如果再不出疹，才宜大力发汗。如果虽然见点很少，但脉象平和，这是痘疮本身稀疏，也不可以胡乱使用发表药物，发表尚且如此，何况是发汗和攻下呢？所以痘症虽然类似伤寒，然而治疗只有温和平稳的方法，而没有发汗和攻下的道理。况且伤寒表证未解，尚且不可攻下，何况痘疮一定要等到起胀、灌浆之后才能结束呢？为什么世人说初觉发热时就宜于利导泄毒，这是错误的。所以在初起发热、足冷、头痛、脉数，与伤寒疑似难辨之间，仅宜解肌微发其汗；如果有内伤等症，仅宜轻微给予消食宽膈的药物。如果痘疮误服麻黄类药剂进行发汗攻下，那么阳气就会全部出于肌表，必然导致痘疮溃烂而脏腑虚弱，虚则腹痛自利，或者出现寒战，甚至体内没有阳气，从而发生阴痫，死亡的人很多。再者，痘疮误用大黄类药剂进行攻下，那么毒邪会乘虚陷入潜伏，或者导致腹胀，或者导致喘急，死亡的案例也有。虽然也有不得不通过发汗或攻下来劫夺病邪的情况，如未出疹时，重感风寒，约束皮肤，使腠理闭密，导致出疹不快者，这必须当用发汗法，使其阴阳调和，营卫通畅，而痘疮自然容易发出，毒邪得以解散，如果不发汗，那么毒邪无从外出，存伏于体内，未免有“闭门留寇”的祸患。又如大热不退，转增烦渴、谵妄昏沉、大小便阻塞者，这是毒邪蓄积在肠胃之间，与谷气并结所致，应当紧急攻下，使其陈腐秽物涤除，脏腑流通，如果不攻下，那么藏污蓄毒在中焦煎熬，难道没有养虎遗患的忧虑吗？《尚书》说：首尾不可攻下，有人解释“首”指上焦，“尾”指下焦，大概治疗上焦宜于消散，治疗下焦宜于导引，而没有攻下的道理。也有人认为，痘疮未显于体表，其脉症有表证而无里证，若一下之则邪气不得伸越，所以禁止初期不可攻下。痘疮已显于外而无一切里证，内无根蒂，大便不甚干实，苟且攻下，则毒邪逆陷，即使结痂也会精血耗亡，因此大便干结者，如果也攻下，则会更加竭尽营血。所以禁止末期不可攻下。论述虽然不同，道理却一致。至于顺症痘疮初出，又没有表里感伤者，则应当任其自然，只需加以安养，自然能见到痊愈的功效；如果有风寒闭塞，只宜解肌让其自然发出。奈何刚见到痘点，也不顾其所蕴毒邪的轻重，肌肤热度未透，毛孔未松，惟恐不出，用药峻猛发汗，毒邪没有出路，遇到发汗则一倍变为十倍，十疮合为一疮，各自称为斑烂。五脏七窍，以至于都有病变，重的无法救治，轻的也可能成为喉痛声哑、眼疾鼻塞的祸患。
Smallpox (Xiaochuan) must wait for three days; if the eruption does not appear or appears slowly, only mild diaphoresis (releasing the exterior through sweating) should be employed. If after diaphoresis the eruption still does not appear, it is appropriate to administer two doses per day. Only if the eruption fails to appear thereafter should vigorous diaphoresis be used. Although few spots may be seen, if the pulse is harmonious and peaceful, this indicates that the smallpox is naturally sparse; one must not recklessly use exterior-releasing methods. Exterior-releasing methods are thus constrained, let alone diaphoresis and purgation. Therefore, although smallpox symptoms resemble Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang channel), treatment should only employ gentle and balanced methods, without the rationale of diaphoresis or purgation. Moreover, even in Taiyang disease, if the exterior syndrome is unresolved, purgation is contraindicated; how much more so for smallpox, which must proceed to swelling and pustulation before resolution? Why do some claim that upon initial onset, purgation and detoxification are indicated? This is erroneous. Thus, during the initial fever with cold feet, headache, and rapid pulse—where differentiation from Taiyang disease is difficult—only mild muscle-relieving and slight exterior-releasing methods should be used. If there are internal injuries such as food stagnation, only mild digestion-promoting and chest-widening herbs should be given. If smallpox is mistakenly treated with Ephedrae Herba (Mahuang, 麻黄) preparations to induce sweating and purgation, Yang Qi will all exit to the muscular surface, inevitably leading to ulcerated lesions and visceral deficiency. Deficiency results in abdominal pain and spontaneous diarrhea, or chills and shivering. In severe cases, the interior lacks Yang Qi, leading to Yin epilepsy (Yin Xian), with many deaths. Furthermore, if large doses of Rhizoma et Radix Rhei (Dahuang, 大黄) are mistakenly used for purgation, toxic pathogens will sink into the deficiency and become latent, causing abdominal distension or panting and urgency, resulting in death. However, there are situations where diaphoresis or purgation is necessary to seize the disease. For example, before eruption, if heavy exposure to wind-cold constricts the skin and closes the pores (Couli, interstices), hindering eruption, diaphoresis is mandatory to harmonize Ying and Wei (Nutritive and Defensive Qi), allowing the eruption to emerge easily and toxins to dissipate. Without diaphoresis, toxins cannot exit outward but remain latent inside, creating the disaster of "locking the door and leaving the thief inside." Similarly, if high fever persists, worsening with irritability, thirst, delirium, coma, and urinary/fecal obstruction, toxins are accumulated in the intestines and stomach, binding with grain qi. Urgent purgation is required to cleanse waste and unblock the Zang-Fu organs. Without purgation, filth and toxins simmer within, posing the risk of "nurturing a tiger and leaving trouble behind." The *Book* states: "The head and tail [beginning and end] stages should not be purged." Some interpret "head" as the Upper Jiao and "tail" as the Lower Jiao, suggesting treatment of the upper should focus on dissipation and the lower on guidance, without purgation. Others argue that when smallpox has not yet manifested on the surface, the pulse and symptoms show exterior signs but lack interior pathology; purgation would prevent the evil from extending outward, hence the prohibition against purging at the beginning. When smallpox has manifested externally without any interior symptoms, lacking an internal root, and the stool is not severely dry, purgation causes toxic pathogens to counterflow and sink, deplete essence and blood even after crusting, hence the prohibition against purging at the end. Although theories differ, the principle is consistent. For favorable smallpox initially erupting without exterior-interior pathogenic invasion, nature should be allowed to take its course, with only supportive care needed for full recovery. If wind-cold blocks the exterior, only muscle-relieving methods should be used to allow natural eruption. Alas, seeing just a few spots, disregarding the severity of the latent toxin, while skin heat is not fully penetrated and pores are not loose, fearing non-eruption, practitioners use harsh diaphoretic drugs. With no outlet for toxins, the effect multiplies tenfold; ten lesions merge into one, termed "ban lan" (maculopapular rash). Viscera and seven orifices are affected; severe cases are incurable, while mild cases may suffer from sore throat, hoarseness, eye diseases, or nasal congestion.