夫痘疹之原，乃胎毒所致。婴儿在胎之时，必资胎养以长其形焉，缘母失于节慎，纵欲恣食，感其秽
毒之气，藏于肺腑之中，近自孩提，远走童年，若值寒暄不常之候，痘疹由是而发，因其所受浅
深，而为稀稠焉。大抵初HT 之时，孩儿口内亦有余秽之毒，急用棉裹指头，拭去口中污汁，免咽入腹。事倘
不及，宜以拭秽等法，并预解胎毒诸方，择便用之，亦能免痘疹诸症，真良法。然痘疹虽是素禀胎毒；未必
不由诸病相传而成，其始发之时，有因伤寒伤风而得者，有因时气传染而得者，有因伤食发热，有因跌扑
惊恐蓄血而得者。或为目 口噤，惊搐如风之证，或口舌、咽喉、腹肚疼痛，或烦躁狂闷，昏睡谵语，或
自汗，或下利，或发热，或不发热，证候多端，卒未易辨，必须以耳冷、 冷，足冷验之。盖疮疹属阳，肾
脏无证，耳与 、足俱属于肾，故肾之部独冷，然疑似之间，或中
或否，不若视其耳后有红脉、赤缕为真，于此可以稽验矣。治疗之法，痘疹未出之先，预解胎毒；发热未出
之际，急须微汗；已出未收之时，当用温和之剂。又曰∶始出之前，宜开和解之门；既出之后，当塞走泄
之路；痂落以后，清凉渐进；毒已去尽，补益宜疏。大凡初起，未见红点，证与伤寒相类，发热烦躁，脸
赤唇红，身热头痛，乍寒乍热，喷嚏呵欠，喘嗽痰涎等证，身热未明，疑似之间，急须表汗发散，可服升麻
葛根汤、参苏饮之类。其或气实烦躁热炽，大便闭结，则与犀角地黄汤、败毒散之类，或多服紫草饮，亦能利
之。如小便赤涩者，分利小便，宜以四苓散、导赤散之类，则热气有所渗而出。凡热不可骤遏，但轻解之。若
无热，则疮又不起发也。盖发热之初，红点未见之前，非微汗则表不解，乃痘疮未出，表热壅实之时也；非
微下则里不解，在红点未见，里热壅盛之际也。若正出未收之时，妄汗则成斑烂，妄下则成陷伏。痘疮一
发，出于心肝脾肺四脏，而肾无留邪者为吉，若初发便作腰痛，见点则紫黑色者，多死，乃毒瓦斯留于肾间，
而不发越故耳。向者疮随五脏，有证未发，则五脏之证悉具。已发则归于一脏，受毒多者见之。故肝脏发为水
泡，色青而小；肺脏发为脓泡，色白而大；心脏发为斑色，赤血泡；脾脏发为疹色，黄小斑疮；惟归肾则变
黑，青紫干陷。故疮疹属阳，本无肾证，肾在下不受秽气，阳取火也，阴取水也，以火为水所制，岂不气殆
哉？大抵痘疮之法，多归重于脾肺二经，盖脾主肌肉，而肺主皮毛，故遍身为之斑烂也。其为证也，
宜发越不宜郁滞；宜红活凸绽，不宜紫黑陷伏，疮出之后，医者当察色详证，以辨表里虚实用药，其吐泻不
能食，为里虚；灰白色，陷顶多汗，为表虚；红活凸绽为表实。又诸痛为实，诸痒为虚。外快内痛为内实
外虚，外痛内快为内虚外实。内实而补，则结壅毒∶表实而复用实表之药，则溃烂而不结痂矣。如表虚者，
疮易出而难靥；表实者，疮难出而易收。里实则出快而轻，里虚则发迟而重。
表实里虚，则发慢收迟。调养之法，切不可妄用硝黄巴豆大寒大热之药。解表不致于冷，调养不致于热，
小儿难任非常之热，亦不堪非常之冷，稍有偏焉，病从此生。故热药之助热者，以火济火，而热势太盛，荣
卫壅遏，轻为咽喉目疾，吐衄痈疮，重则热极生风，斑烂不出；冷药之乘寒者，以水滋水，使脾胃虚寒，气
血凝滞，轻为吐利腹胀，重则陷伏倒靥。又宜谨避风寒，严戒房事，禁止杂人月妇，清除秽气触忤，调节
乳食，勿食过饱失饥，忌餐冷热，毋使伤脾损胃。大法活血调气，安表和中，轻清消毒，温凉之剂，二者
得兼而已。又曰∶首尾宜以保元汤增损为主治焉。医斯疾者，当看时令寒热，审儿之虚实，辨痘之荣枯，
参考各门方法，庶无执泥之弊。故曰∶虚者益之，实者损之，冷者温之，热者清之，是为随机应变。
若胶柱鼓瑟，则何足以妙圆神，不滞之机乎？
痘疹的根源，是由于胎毒引起的。婴儿在母体胎儿时期，必须依靠胎养来生长发育形体，如果母亲失于节制谨慎，放纵欲望、恣意饮食，感受了秽毒之气，藏匿在肺腑之中，近则影响幼儿，远则波及童年，如果遇到寒暑不定的时候，痘疹就会由此发作，根据所受毒气的深浅，而表现为稀疏或稠密。大概初起的时候，孩子口腔内也有残留的秽毒，急忙用棉絮包裹手指，擦拭去口中的污浊汁液，避免咽入腹中。事情如果来不及处理，适宜用拭秽等方法，以及预先准备解胎毒的各种方剂，选择方便的使用，也能免除痘疹的各种症状，真是好方法。然而痘疹虽然是素来禀受的胎毒；未必不是由其他疾病传染而成的，其刚开始发作的时候，有因为伤寒伤风而得的，有因为时气传染而得的，有因为伤食发热而得的，有因为跌打惊恐蓄血而得的。或者出现眼睛和嘴巴紧闭，惊厥抽搐像风证一样的表现，或者口舌、咽喉、腹部疼痛，或者烦躁狂闷，昏睡说胡话，或者自汗，或者腹泻，或者发热，或者不发热，证候多种多样，仓促之间不容易辨别，必须以耳朵冷、颈部冷、脚冷来验证。因为疮疹属于阳证，肾脏没有证候，耳朵、颈部和脚都归属于肾，所以肾的部位唯独发冷，然而在疑似之间，有时对有时不对，不如观察耳后有红脉、赤丝为真实，在这里可以稽查验证了。治疗的方法，痘疹未出之前，预先解除胎毒；发热但未出的时候，急需微微发汗；已经发出但未收敛的时候，应当使用温和的药剂。又说：开始发出之前，适宜打开和解的门路；既已发出之后，应当堵塞走泄的路径；痂皮脱落以后，清凉药物逐渐进用；毒气已经去除干净，补益药物适宜疏缓。大凡初起，未见红点，证候与伤寒相似，发热烦躁，脸红唇红，身体发热头痛，忽冷忽热，打喷嚏呵欠，气喘咳嗽痰涎等证候，身体发热尚未明确，在疑似之间，急需表汗发散，可以服用升麻葛根汤、参苏饮之类的药物。那些气实烦躁热势炽盛，大便闭结的，则给予犀角地黄汤、败毒散之类的药物，或者多服用紫草饮，也能通利。如果小便赤涩的，分利小便，适宜用四苓散、导赤散之类的药物，那么热气就有渗透而出的途径。凡是热邪不可骤然遏制，只要轻微地解除它。如果没有热，那么疮又不会起发。大概发热之初，红点未见之前，如果不微微发汗则表证不解，这是痘疮未出，表热壅实的时候；如果不微微攻下则里证不解，这是在红点未见，里热壅盛的时候。如果正当发出未收敛的时候，妄用发汗则变成斑烂，妄用攻下则变成陷伏。痘疮一发，出于心肝脾肺四脏，而肾脏没有留邪的是吉兆，如果初发就出现腰痛，见点呈紫黑色的，大多死亡，这是毒瓦斯留在肾间，而不能发散出去的缘故。先前疮随五脏，有证候未发，则五脏的证候全部具备。已发则归于一脏，受毒多的显现出来。所以肝脏发出水泡，颜色青而小；肺脏发出脓泡，颜色白而大；心脏发出斑色，赤血泡；脾脏发出疹色，黄小斑疮；只有归于肾则变黑，青紫干陷。所以疮疹属阳，本来没有肾证，肾在下部不受秽气，阳取火，阴取水，以火被水所制约，难道不危险吗？大抵痘疮的方法，多归结重于脾肺二经，因为脾主肌肉，而肺主皮毛，所以遍身为之斑烂。它的证候，适宜发散不宜郁滞；适宜红活凸绽，不宜紫黑陷伏，疮出之后，医生应当观察颜色详细辨证，以辨别表里虚实用药，那些呕吐腹泻不能进食的，是里虚；灰白色，顶陷多汗的，是表虚；红活凸绽的是表实。另外各种疼痛为实，各种瘙痒为虚。外表舒适内部疼痛为内实外虚，外表疼痛内部舒适为内虚外实。内实而补益，则结聚壅滞毒气；表实而复用实表的药物，则溃烂而不结痂了。如表虚的，疮容易发出但难愈合；表实的，疮难发出但易收敛。里实则发出快而轻，里虚则发迟而重。表实里虚，则发慢收迟。调养的方法，切不可妄用硝石、大黄、巴豆等大寒大热的药物。解表不至于冷，调养不至于热，小儿难以承受非常的热，也不堪受非常的冷，稍有偏颇，病就从此产生。所以热药助长热邪的，是以火济火，而热势太盛，营卫壅遏，轻则为咽喉目疾，吐衄痈疮，重则热极生风，斑烂不出；冷药乘袭寒邪的，是以水滋水，使脾胃虚寒，气血凝滞，轻为吐利腹胀，重则陷伏倒靥。又宜谨慎避开风寒，严格戒除房事，禁止杂人和月经妇女，清除秽气触怒，调节乳食，不要吃得过饱或挨饿，忌吃冷热食物，不要让脾胃受损。大法在于活血调气，安表和中，轻清消毒，温凉药剂，二者兼得而已。又说：从头到尾适宜以保元汤增减为主治法。医治这种疾病的医生，应当看时令寒热，审察孩子的虚实，辨别痘疮的荣枯，参考各门方法，才没有固执泥板的弊病。所以说：虚的补益它，实的损耗它，冷的温煦它，热的清解它，这是随机应变。如果拘泥固执不知变通，怎么足以达到圆融神妙、不滞碍的机巧呢？
The origin of smallpox and measles is caused by fetal toxin (Tai Du, 胎毒). During the fetal stage in the womb, the infant must rely on fetal nourishment to grow its form. If the mother fails to maintain moderation and caution, indulging in desires and excessive eating, she may contract foul toxic qi (Hui Du Zhi Qi, 秽毒之气), which lodges in the lungs and heart. This can affect the child from early infancy through childhood. When exposed to irregular changes in cold and warmth, smallpox and measles erupt as a result, with their sparsity or density depending on the depth of the toxin acquired. Generally, at the initial stage, there is residual foul toxin in the infant's mouth; it is urgent to wrap cotton around a finger to wipe away the dirty fluid, preventing it from being swallowed into the abdomen. If this cannot be done immediately, methods such as wiping away foulness should be used, along with various formulas for pre-emptively resolving fetal toxin, chosen for convenience. This can also prevent various symptoms of smallpox and measles, truly an excellent method. However, although smallpox and measles are due to inherent fetal toxin, they are not necessarily formed solely through transmission from other diseases. At the onset, some cases arise from Cold Damage (Shang Han, 伤寒) or Wind Strike (Shang Feng, 伤风); some from epidemic qi transmission; some from food injury leading to fever; and some from falls, fright, and blood stasis. Symptoms may include locked eyes and mouth, convulsions resembling wind syndrome, pain in the tongue, throat, abdomen, or stomach, restlessness, mania, drowsiness, and delirium, spontaneous sweating, diarrhea, fever, or absence of fever. The manifestations are diverse and difficult to distinguish hastily. One must verify using cold ears, cold neck, and cold feet. Since sores and rashes belong to Yang, and the Kidney shows no specific signs, while ears, neck, and feet all belong to the Kidney, the area of the Kidney alone becomes cold. However, between doubt and certainty, this is not as reliable as observing red veins and crimson threads behind the ears, which confirms the diagnosis.
The treatment principle is: before eruption, pre-emptively resolve fetal toxin; during fever but before eruption, urgently induce slight sweating; after eruption but before crusting, use mild and warm agents. It is said: Before initial eruption, open the gate of harmonization; after eruption, block the path of leakage; after scabs fall, gradually introduce cooling agents; once toxins are fully expelled, tonification should be gentle. Generally, at the beginning, when red spots are not yet visible, the presentation resembles Cold Damage: fever, restlessness, flushed face and lips, body heat, headache, alternating chills and fever, sneezing, yawning, wheezing, coughing, and phlegm. When body heat is unclear and the condition is doubtful, urgent superficial sweating and dispersal are required. Formulas such as Shengma Gegen Tang (Cimicifugae et Puerariae Decoction) or Shen Su Yin (Ginseng and Perilla Drink) may be taken. For those with excess qi, restlessness, intense heat, and constipation, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) or Baidu San (Detoxifying Powder) may be given, or Zijiao Yin (Arnebiae Drink) consumed frequently to promote purgation. For dark, scanty urine, diuresis is indicated using Siling San (Four Porias Powder) or Daochi San (Guiding Out Redness Powder), allowing heat to渗 out. Heat should not be abruptly suppressed but lightly resolved. Without heat, the sores will not erupt. Initially, when fever begins and red spots are absent, without slight sweating the exterior remains unresolved, as this is the time when smallpox has not erupted and exterior heat is congested and solid; without slight purgation, the interior remains unresolved, as this is the time when red spots are absent and interior heat is abundant and flourishing. If, during active eruption before crusting, one recklessly induces sweating, it leads to ulceration; reckless purgation leads to sinking and collapse. Smallpox erupts from the Heart, Liver, Spleen, and Lung; if the Kidney retains no evil, it is auspicious. If lower back pain occurs at onset, or spots appear purple-black, death is likely, as the toxic gas remains in the Kidney and fails to vent. Previously, sores followed the Five Viscera; before eruption, signs of all five viscera were present. After eruption, they converge on one viscera, revealing the one that received the most toxin. Thus, Liver eruptions manifest as water blisters, small and green; Lung eruptions as pus blisters, large and white; Heart eruptions as macules and bloody blisters, red; Spleen eruptions as rashes, small yellow spots. Only when converging on the Kidney do they turn black, becoming cyanotic, dry, and sunken. Therefore, sores and rashes belong to Yang and inherently lack Kidney signs; the Kidney, located inferiorly, does not accept foul qi. Yang takes Fire, Yin takes Water; if Fire is controlled by Water, is it not perilous? Generally, smallpox treatment emphasizes the Spleen and Lung meridians, as the Spleen governs muscles and the Lung governs skin and hair, hence the whole body suffers ulceration. The syndrome requires dispersion rather than stagnation; it should be rosy, vibrant, and convex, not purple-black and sunken. After eruption, physicians must observe color and detail symptoms to differentiate exterior/interior and deficiency/excess for medication. Vomiting, diarrhea, and inability to eat indicate Interior Deficiency; grayish-white color, sunken tops, and profuse sweating indicate Exterior Deficiency; rosy, vibrant, and convex indicate Exterior Excess. Pain indicates Excess; itching indicates Deficiency. Comfort outside with pain inside indicates Interior Excess and Exterior Deficiency; pain outside with comfort inside indicates Interior Deficiency and Exterior Excess. Tonifying Interior Excess causes toxic congestion; treating Exterior Excess with exterior-solidifying drugs causes ulceration without crusting. Exterior Deficiency makes sores easy to erupt but hard to heal; Exterior Excess makes them hard to erupt but easy to resolve. Interior Excess leads to fast, mild eruption; Interior Deficiency leads to slow, severe eruption. Exterior Excess with Interior Deficiency results in slow eruption and late resolution.
In nursing care, one must never recklessly use drastic cold or hot drugs like Nux (Nitrums), Dahuang (Rhei Radix et Rhizoma), or Badou (Crotonis Fructus). Exterior-resolving agents should not be too cold; nourishing agents should not be too hot. Children cannot tolerate extreme heat or cold; any deviation breeds disease. Hot drugs aiding heat are like adding fire to fire, causing excessive heat, blocking Ying and Wei (Nutritive and Defensive Qi), leading to mild cases of throat/eye diseases, vomiting, epistaxis, and abscesses, or severe cases of wind generated by extreme heat, where sores fail to erupt. Cold drugs exploiting cold are like adding water to water, causing Spleen/Stomach deficiency-cold and qi/blood stasis, leading to mild cases of vomiting, diarrhea, and abdominal distension, or severe cases of sinking and inverted crusting. One must carefully avoid wind and cold, strictly abstain from sexual activity, prohibit visitors and menstruating women, clear foul odors, regulate milk and food intake, avoid overeating or hunger, and忌 cold/hot foods to protect the Spleen and Stomach. The general method involves invigorating blood, regulating qi, stabilizing the exterior, harmonizing the middle, lightly clearing detoxification, using mild-warm or cool agents, balancing both aspects. It is said: Throughout the illness, Baoyuan Tang (Preserve the Origin Decoction) should be the primary treatment with modifications. Physicians treating this disease must consider seasonal cold/heat, assess the child’s deficiency/excess, distinguish the prosperity/withering of the pox, and refer to methods from various sections to avoid rigid adherence. Thus: Tonify deficiency, drain excess, warm cold, clear heat. This is adapting to circumstances. If one is inflexible like a fixed peg, how can one achieve the profound, unobstructed efficacy?