夫痘有血热气虚二症，血热者人固知为凉血也。气虚者，人固知为补气也。殊不知
疹之为症，先动阳分而后归于阴经，痘之为症，直由阴经而后传于阳分，是以血热之症
初发，虽宜凉血，然即以寒凉之剂一加，则毒冰伏于肾而难出矣。故必先以清凉升提发
散，使毒出于阴经，传于阳分，而后凉血清热之剂治之，至如气虚之症即现，虽宜补
气，亦必俟其毒将解时，而补真正气以制之，是以初见红点而补气之剂固难骤加，即
少变白色亦未可遽用，盖白者毒未解也，若即投之，则得补愈盛而反助干枯燥涸之势
矣。故色少微黄，虽大剂参 用之而见神效，若势方色白，而轻易投之，反阻其行浆
生发之机，惟有气弱而不能出者，当微补其气，气和则出快矣。即补气之药，又当兼以
表托也，盖此气弱，而不能出者，则不过仅是气弱，虽载而难发非毒盛难释，肆其猖獗
而不肯出也。故少一助之，则如久旱之苗，得其甘霖而自长，用以扶正则正受扶，用以
削邪则邪受削，而邪正自判焉。若在虽成白色，未见黄浆，可见血已载毒，气已拘毒，
毒已受血所载，受气所拘，气血与毒同混一处，但气血偏亏，未能释运，毒邪太盛，况
以久缠，气血不能顿化其毒，以出毒于气血之外，毒邪未肯疑释于内，以溶化于窠晕之
中，故色虽见白未得脓黄，此时毒正为锐，如投补益，所谓里粟以资盗粮，扶正则毒受
其奉，削邪则毒避其锋，反足以损真气，是宜渐渐扶持，俟其锐气少挫，邪毒少解，色
化微黄，而峻补之。若因水亏金燥，脓浆无自而成者，尤宜先为养血调荣，盖毒之化假
乎浆，而浆之成由乎血，血虽旺于斯须也。若不究气虚血虚，而概以参 ，则燥槁者，
愈燥槁也。候至血既滋荣，脓浆流动，而参 补托之剂，又直接续，勿间断也。《经》
曰∶方其盛时必毁，因其衰也。事必大昌，此张之管见也。惟按脉无力，及痘多而气血
不足者，最宜预为温补，方能发白行浆，若至虚极，变生诸症而后补之已无及矣。
痘疹有血热和气虚两种证候，对于血热证，人们自然知道应当使用凉血的方法。对于气虚证，人们自然知道应当使用补气的方法。然而殊不知，疹这种病症，是先扰动阳分然后归于阴经；痘这种病症，则是直接由阴经传变到阳分。因此，血热证在初发时，虽然适宜凉血，但如果立即加上寒凉的药剂，就会导致毒邪冰伏于肾而难以透发出来。所以必须先使用清凉、升提、发散的药物，使毒邪从阴经透出，传至阳分，然后再用凉血清热的药剂进行治疗。至于气虚证如果已经显现，虽然适宜补气，但也必须等到毒邪将要解除的时候，再补益正气来制约它。因此在初见红点时，补气药剂固然难以骤然加入；即使颜色稍微变白，也不可以立刻使用，因为白色代表毒邪尚未解除。如果此时就投以补药，那么得到补益后毒势会更盛，反而助长干枯燥涸的趋势。所以颜色稍微微黄时，虽然使用大剂量的参类药材也能见到神效；如果势头正盛且颜色尚白，轻易投以补药，反而会阻碍其行浆生发的机理。只有那种气弱而不能透发出来的情况，才应当轻微地补益其气，气机调和则透发就会迅速。即使是补气药物，也应当兼用表托的方法。大概这种气弱而不能透发的情况，仅仅是气弱而已，并非毒邪盛大难以释放、肆意猖獗而不肯透发。所以稍加辅助，就像久旱的禾苗得到甘霖滋润而自然生长，用来扶助正气则正气受助，用来削减邪气则邪气受削，邪正自然就能分辨清楚。如果在痘色已成白色但未见黄色脓浆时，可见血已承载毒邪，气已拘束毒邪，毒邪已被血所载、被气所拘，气血与毒邪混杂在一起，只是气血偏亏，未能运化释放毒邪，毒邪太盛，况且纠缠日久，气血不能瞬间化解毒邪，将毒邪排出气血之外，毒邪不肯在内部松懈溶解于窠晕之中，所以颜色虽然见白但未得脓黄，此时毒邪正处锐利阶段，如果投以补益之药，正所谓“给敌人粮草以资助盗贼”，扶助正气则毒邪接受供奉，削减邪气则毒邪避开锋芒，反而足以损伤真气。这时应当渐渐扶持，等到毒邪锐气稍挫，邪毒稍解，颜色化为微黄时，再进行峻补。如果是因水亏金燥，导致脓浆无法自然形成的情况，尤其应当先养血调荣。因为毒邪的化解借助于脓浆，而脓浆的形成依赖于血液，血液虽然在短时间内旺盛。如果不探究是气虚还是血虚，而一概使用人参等补药，那么原本干燥枯槁的，会更加干燥枯槁。等到血液既已滋荣，脓浆流动时，再用参类补托药剂，又直接接续，不要间断。《内经》说：“当邪气盛极时治疗必会毁坏正气，顺应其衰退之势治疗事情必定大昌。”这是张景岳的管见。只有脉象无力，以及痘疹多而气血不足者，最适宜预先进行温补，才能发白行浆，如果到了极度虚弱，变生各种症状后再去补益，就已经来不及了。
There are two syndromes in smallpox: blood-heat and Qi-deficiency. For the blood-heat syndrome, people naturally know to use cooling-blood methods. For the Qi-deficiency syndrome, people naturally know to use tonifying-Qi methods. However, it is not well known that rashes (Zhen) first disturb the Yang aspect and then return to the Yin meridians, whereas smallpox (Dou) directly transmits from the Yin meridians to the Yang aspect. Therefore, for the initial stage of the blood-heat syndrome, although cooling-blood treatment is appropriate, if cold-natured agents are applied immediately, the pathogenic toxin will be frozen in the Kidney and become difficult to erupt. Thus, one must first use cooling, ascending, lifting, and dispersing herbs to allow the toxin to emerge from the Yin meridians and transmit to the Yang aspect, before treating with cooling-blood and clearing-heat agents. Regarding the Qi-deficiency syndrome, even if it manifests clearly, although tonifying Qi is indicated, one must wait until the toxin is about to resolve before tonifying the true Qi to control it. Therefore, when red spots first appear, tonifying Qi agents should not be added abruptly; even if the color slightly turns white, they should not be used hastily, because white indicates the toxin has not yet resolved. If tonics are administered at this time, the received tonification will intensify the pathogenic force, thereby exacerbating the trend of dryness and withering. Hence, when the color is slightly yellowish, large doses of Ginseng Radix et Rhizoma (Renshen, 人参) can yield miraculous effects. However, if the condition is vigorous and the color remains white, administering tonics lightly will hinder the mechanism of pus formation and eruption. Only in cases where Qi weakness prevents eruption should the Qi be mildly supplemented; once the Qi harmonizes, eruption will occur rapidly. Even when using Qi-tonifying herbs, surface-expelling and supporting methods should be combined. Generally, in cases of Qi weakness preventing eruption, it is merely a lack of Qi, not an excessive toxin that is difficult to release or rampant and unwilling to erupt. A slight assistance is like rain nourishing seedlings after a long drought; it supports the righteous Qi so that righteousness benefits, and assists in eliminating evil so that evil is subdued, allowing righteous and evil forces to distinguish themselves. If the rash has turned white but no yellow pus is visible, it indicates that Blood has carried the toxin and Qi has constrained it; the toxin is mixed with Qi and Blood, but due to their deficiency, they cannot transform and transport the toxin out. The pathogenic toxin is too strong and has lingered for a long time, so Qi and Blood cannot instantly dissolve the toxin within the lesion. Although the color is white without yellow pus, the toxin is currently at its peak. Administering tonics at this stage is akin to "providing grain to thieves"; supporting righteousness allows the toxin to receive sustenance, while attacking evil allows the toxin to avoid the sharp edge, ultimately damaging the true Qi. In such cases, gradual support is required until the toxin's锐气 (sharp energy) is slightly dampened, the pathogenic toxin slightly resolves, and the color turns slightly yellow, before administering strong tonification. In cases where fluid deficiency and Metal-dryness prevent natural pus formation, it is especially important to first nourish Blood and regulate Ying (Nutritive Qi). Since toxin resolution relies on pus, and pus formation depends on Blood, even if Blood becomes abundant momentarily, failing to investigate whether the deficiency is of Qi or Blood and indiscriminately using Ginseng Radix et Rhizoma (Renshen, 人参) will make dry and withered conditions even drier. Once Blood has nourished and promoted circulation, and pus flows freely, Ginseng Radix et Rhizoma (Renshen, 人参) and other supporting tonics should be continued directly without interruption. The *Classic of Internal Medicine* states: "Treating during the peak of excess will inevitably damage; treating according to decline ensures great success." This is Zhang Jingyue's humble opinion. Only when the pulse is weak, or when there are many pustules indicating Qi and Blood insufficiency, is preemptive warming and tonification most suitable to facilitate whitening and pus formation. If one waits until extreme deficiency and various complications arise before attempting tonification, it will be too late.