痘出妄汗妄下，误服升麻汤、大黄等药，不忌口，过饱失饥，食生冷，饮酒多，信巫
不信医，犯房室，触秽气，冒风寒。
不食多渴，（渴饮不食，益黄散、白术散。）戛齿噤牙，（有虚有实，能令陷伏。）憎
寒困倦，令疮陷入，是脾虚也。）烦躁体热，（摇头
者，欲生风。）吐逆泄泻，（食不化而出，并痘后大便脓血。）疮作黑陷，（内无脓血，或作黑泡，
或先疮迹，作黑孔死。）大小便涩，（三黄丸。）痈块壅肿，（痘毒变疮，口臭、蚀唇口鼻、
牙落者，死。）喘急痰盛，声哑气噎，（或正出或痘后有此证者，多死。）咽药食，肠中鸣
者死。
以上俱是危证，首尾可畏也。除此之外皆不妨。内犯二者∶若饮食如旧，虽困重，医治
可生。如饮食减平日之半者死。饮食如旧，内犯三四件者亦死。
痘疮有蜡、红、白、黑四色，为吉凶晦吝之主，甚不可不辨也。何则？蜡色即苍而黄，为
中央之正色。痘见蜡色者，斯为吉兆也。红色者，南方火心之象也。火盛则色红，晦之道也。
则当解乎心热，如凉血犀角地黄汤之类是也。白色者，西方金肺之象也。肺气虚则色白，虚甚
则兼陷伏，痘见白色而陷中，吝之道也。则当大补气血，如保元汤加姜桂附子之类是也。黑
色者，北方水肾之象也。肾水不足以制火邪，火极变黑而似水也。俗调变黑归肾。痘见黑而陷，
凶之道也。则当解毒。如久闭者，用百祥丸、小承气汤下之。有虚之甚者，保元汤加桂芎，从
其热而用之之类也。
汪氏《理辨》曰∶五色者，五行之精华也。正则光而明，衰则惨而暗，五脏荣枯于此可
见矣。故痘毒之出于脏，惟利乎明，不利乎暗。光明者，气血旺也。惨暗者，气血衰也。气位
旺而血得其令，气位衰而血被其囚。血非气则毒不收，气非血则毒不化，信乎痘毒必气血而后
可以终始成功。且夫色之红者，毒始出也。白者，毒未散也。黄者，毒将解也。干黄者，毒尽
解也。灰白者，血衰而气滞也。黑者，毒滞而血干也。焦竭者，血气枯也。如红变白，白变黄
者吉，红变紫，紫变黑者，凶之兆也。且毒出乎五脏而非独一脏。前人言五脏各主色，固有之，
又不载各脏治法。钱氏陈氏所论变黑归肾，此皆过于理也。
春甫调五色合五脏，此至当之理。然《辨》云毒出五脏非独一脏，正所以五脏之中而一脏
之病甚，则其一脏之象着见也。又云钱氏、陈氏变黑归肾之论，皆过于理，是《辨》之未详
辨也。凡变黑者，乃火之剧，而肾
水浸衰不能制火，故色黑也。其责安得不归于肾乎？调其未载五脏之方则可矣，谓其谬论，《辨》
亦未知思也。予每参合五脏立方，罔不应验，故录其方法于四色辨中，以备全论，医者审之。
痘疮发出后，如果错误地发汗或攻下，误服升麻汤、大黄等药物，不忌口，饮食过饱或饥饿不定，食用生冷食物，饮酒过多，迷信巫术而不相信医生，进行房事，接触污秽之气，遭受风寒侵袭。
患儿不吃东西且多口渴（口渴饮水但不进食，可用益黄散、白术散治疗），咬牙紧闭（有虚证也有实证，会导致痘毒内陷伏留），怕冷困倦，导致痘疮内陷，这是脾虚的表现。烦躁身体发热（摇头的，是想生风），呕吐腹泻（食物未消化就排出，以及痘后大便脓血）。痘疮变成黑色并内陷（内部没有脓血，或者形成黑泡，或者先出现疮迹，变成黑孔而死），大小便不通畅（可用三黄丸治疗）。痈肿壅塞肿胀（痘毒变为疮疡，口臭、腐蚀嘴唇口鼻、牙齿脱落的，会死），气喘急促痰多，声音嘶哑气机阻塞（或在痘疹刚发出时或痘后有此症状的，大多死亡）。吞咽药食时，肠中鸣响的会死。
以上都是危重证候，从头到尾都令人畏惧。除此之外都不妨碍预后。如果内伤因素触犯两条：如果饮食如常，虽然病情严重，经过医治可以存活。如果饮食减少到平时的一半，就会死亡。饮食如常，但内伤因素触犯三四种的也会死亡。
痘疮有蜡色、红色、白色、黑色四种颜色，是判断吉凶祸福的主要依据，非常不可不辨别。为什么呢？蜡色即青中带黄，是中央土的正色。痘疮呈现蜡色的，这是吉兆。红色，是南方火心的象征。火盛则颜色红，是不好的征兆。那么应当清解心热，如凉血犀角地黄汤之类的方剂。白色，是西方金肺的象征。肺气虚则颜色白，虚甚则兼有内陷伏留，痘疮呈现白色且内陷的，是不好的征兆。那么应当大补气血，如保元汤加生姜、肉桂、附子之类的方剂。黑色，是北方水肾的象征。肾水不足以制约火邪，火极盛变黑而似水。俗话叫“变黑归肾”。痘疮呈现黑色且内陷的，是凶兆。那么应当解毒。如久闭的，用百祥丸、小承气汤攻下。有虚损严重的，保元汤加桂枝、川芎，顺从其热性来使用之类的方剂。
汪氏在《理辨》中说：五色，是五行精华的体现。正气旺盛则光亮明亮，正气衰弱则惨淡昏暗，五脏的荣枯可以从这里看出来。所以痘毒出于五脏，只利于明亮，不利于昏暗。光明的，是气血旺盛。惨淡昏暗的，是气血衰弱。气位旺盛而血得其令，气位衰弱而血被其囚困。血没有气则毒不能收敛，气没有血则毒不能化解，确实痘毒必须依靠气血才能最终成功。况且红色的，是毒刚开始发出。白色的，是毒未消散。黄色的，是毒将要解除。干燥黄色的，是毒完全解除。灰白色的，是血衰而气滞。黑色的，是毒滞而血干。焦枯竭绝的，是血气枯竭。如红变白，白变黄的为吉，红变紫，紫变黑的，是凶兆。而且毒出于五脏而非仅一脏。前人说五脏各主一种颜色，固然有道理，但没有记载各脏的治疗方法。钱乙和陈文中所说的“变黑归肾”，这都是过于理论化的说法。
春甫调和五色与五脏的关系，这是最恰当的道理。然而《理辨》说毒出五脏非独一脏，正是因为在五脏之中某一脏的病很重，那么这一脏的征象就会明显显现。又说钱乙、陈文中关于“变黑归肾”的论述，都是过于理论化，《理辨》也没有详细辨析。凡是变黑的，乃是火邪剧烈，而肾水浸渍衰弱不能制火，所以颜色黑。这责任怎么能不归咎于肾呢？说它没有记载五脏的方剂是可以的，说它是谬论，《理辨》也是不知思考。我每次结合五脏来立方，无不灵验，所以记录其方法于四色辨中，以完备全论，医者请审慎对待。
After the eruption of smallpox, if sweating or purging is incorrectly induced, and medicines such as Shengma Tang (Cimicifugae Decoction) and Dahuang (Rhei Radix et Rhizoma) are mistakenly taken, dietary restrictions are ignored, leading to overeating or starvation, consumption of raw and cold foods, excessive alcohol intake, reliance on witchcraft rather than medicine, sexual activity, exposure to foul odors, and contraction of wind-cold.
The patient refuses food and experiences excessive thirst (thirst with drinking but refusal to eat can be treated with Yihuang San [Yi Huang Powder] and Baizhu San [Atractylodis Macrocephalae Powder]). Teeth gnashing and jaw clenching occur (indicating either deficiency or excess, which can cause the lesions to sink inward). Aversion to cold, fatigue, and lethargy lead to the sinking of lesions, indicating Spleen deficiency. Restlessness and body heat (head shaking suggests impending wind-stroke). Vomiting and diarrhea (undigested food expulsion, and pus-blood in stool after smallpox). Lesions turn black and sink inward (absence of pus and blood inside, formation of black blisters, or initial lesions turning into black holes indicate death). Difficulty in urination and defecation (can be treated with Sanhuang Wan [Three Yellows Pill]). Abscesses and swelling blockages (smallpox toxin transforming into sores, bad breath, erosion of lips, mouth, nose, and tooth loss indicate death). Panting, urgency, profuse phlegm, hoarseness, and Qi obstruction (symptoms occurring during eruption or after smallpox usually indicate death). Swallowing medicine or food accompanied by borborygmus indicates death.
All the above are critical conditions, fearful from beginning to end. Apart from these, there are no hindrances. If internal factors violate two rules: if diet remains normal, even if the condition is severe, medical treatment can lead to survival. If diet decreases to half of the usual amount, death ensues. If diet remains normal but internal factors violate three or four rules, death also ensues.
Smallpox lesions exhibit four colors: wax-yellow, red, white, and black, which are primary indicators of auspiciousness or inauspiciousness, requiring careful differentiation. Why? Wax-yellow is greenish-yellow, the correct color of the Central Earth. Smallpox presenting a wax-yellow color is an auspicious omen. Red represents the image of Southern Fire and the Heart. Excessive Fire results in redness, an inauspicious path. One should resolve Heart heat, using formulas like Liangxue Xijiao Dihuang Tang (Cool Blood, Rhinoceros Horn, and Rehmannia Decoction). White represents the image of Western Metal and the Lung. Lung Qi deficiency results in whiteness; severe deficiency leads to sinking and hiding. Smallpox presenting white and sinking is an inauspicious path. One should greatly tonify Qi and Blood, using formulas like Baoyuan Tang (Protect the Origin Decoction) added with Shengjiang (Fresh Ginger), Rougui (Cinnamon Bark), and Fuzi (Prepared Aconite Root). Black represents the image of Northern Water and the Kidney. Kidney Water is insufficient to control Fire evil; extreme Fire transforms into black resembling Water. Commonly said as "black transformation returns to the Kidney." Smallpox presenting black and sinking is an inauspicious omen. One should resolve toxicity. For prolonged constipation, Baixiang Wan (Baixiang Pill) or Xiao Chengqi Tang (Minor Order the Qi Decoction) should be used to purge. For severe deficiency, Baoyuan Tang added with Guizhi (Cinnamon Twig) and Chuanxiong (Ligusticum Rhizome), following the heat to treat it, are examples.
Wang's *Libian* states: The five colors are the essence of the Five Elements. When regular, they are bright and clear; when declining, they are dim and dark. The prosperity or withering of the Zang organs can be seen here. Therefore, for smallpox toxin emerging from the Zang organs, brightness is favorable, while darkness is unfavorable. Brightness indicates robust Qi and Blood. Dimness indicates deficient Qi and Blood. When Qi position is robust, Blood follows its command; when Qi position declines, Blood is imprisoned. Without Qi, Blood cannot收 (collect/resolve) the toxin; without Blood, Qi cannot transform the toxin. Indeed, smallpox toxin requires Qi and Blood to achieve success from start to finish. Moreover, red indicates the toxin is just emerging. White indicates the toxin has not dispersed. Yellow indicates the toxin is about to resolve. Dry yellow indicates the toxin is completely resolved. Gray-white indicates Blood deficiency and Qi stagnation. Black indicates toxin stagnation and Blood dryness. Scorched and exhausted indicates depletion of Qi and Blood. Changes from red to white, or white to yellow, are auspicious. Changes from red to purple, or purple to black, are inauspicious omens. Furthermore, the toxin emerges from the Five Zang organs, not just one. Predecessors stated that each Zang organ governs a specific color, which is true, but they did not record treatment methods for each Zang. Qian Yi and Chen Zhongwen's discussion on "black transformation returning to the Kidney" is overly theoretical.
Chunfu harmonizes the five colors with the five Zang organs, which is the most appropriate principle. However, *Libian* states that the toxin emerges from the Five Zang organs, not just one; precisely because if the disease in one of the Zang organs is severe, the manifestation of that specific Zang will appear prominently. It also states that Qian Yi and Chen Zhongwen's theory of "black transformation returning to the Kidney" is overly theoretical, implying *Libian* lacks detailed differentiation. In fact, any blackening is due to extreme Fire, causing Kidney Water to weaken and fail to control Fire, hence the black color. How can the responsibility not fall on the Kidney? It is acceptable to say it does not record formulas for the five Zang, but calling it a fallacy shows *Libian* fails to think deeply. I have always combined the five Zang to formulate prescriptions, with no failure in efficacy. Therefore, I record these methods in the differentiation of the four colors to complete the full discussion. Physicians should examine this carefully.