痘疮关系生死，非精于《内经》、《伤寒论》者不能疗，一有专门，则局量不阔，识见不广，沿流而昧其源，此道遂
绝，即如建中滥觞，酿成今日之倒悬。究其变本加厉之故，因见痘初起，血有热，骇为毒火，峻用苦寒逆折，在尔时火
势勃勃欲出，虽经冰伏，尚相持不下，不致入口即毙，医者遂信为用熟无碍，于是气机郁遏，红晕转深，倍增烦热，益
共信为血热毒重，恣用寒凉，以误传误，其弊一也。遇真险症，即作危言，断以不治，而按日处方，尤害在手口相应，
到得送终，病家不咎其手法之辣，转赞其眼力之高；医者益 自负，无复变计，断决愈精，声名鹊起，其弊二也。病
家乐闻清解之说，妇妪嘈嘈，总以泻食积，降火毒为第一着，苟不迎合其意，即使收功后稍有咳嗽及痤 ，尚认为未曾
解毒所致，归咎前医；其或过十余朝，诸法并穷，不得已加人参入清攻药中，为江心补漏，徒见气喘胸高，死后心头犹
热，无识者益悔用补之误，视同鸩砒，时医深于世故，务求不失人情，其弊三也。刻板方治，通国皆然，稍有异同，便
无声援，入附出污，显成时局，彼此互荐，方同一律，成固可以居功，败亦可告无罪，医道之行，惟此为嚆矢矣，彼惟
急
于道之行，宁复知其术之谬，况箕裘如是，衣钵如是，数页方书，锦囊具在，眼光本不盈尺咫，更无从参悟灵机，其弊
四也。具此诸弊，种种相因，襁褓何知，遭此巨劫，谨披肝胆，吐心腹而告诸为人父母者，曰顺痘，本无不生之症，而
误药转有致死之因；险痘，极有可生之路，而误药必无不死之幸；逆痘，尚有求生之法，而误药反为速死之方，与其误
药，毋宁不药。年来痘疹甚行，比户哭声，顺而死者犹十之三，险而死者已十之七，幸而获愈者，非痘出极稀，即贫家
无力延医，或儿性倔强，滴药不肯沾唇，否则药虽下咽，立即呕出，如有神助，求其因药而愈者，百不获一也。曾有一
幼医之女痘殇，哭甚哀，余笑谓之曰∶君当取《左传》语自为告解，因朗诵“余杀人子多矣，能无及此乎”。嗟嗟！余岂
好为垢病哉，亦思稍挽狂澜，为婴儿开一线生路耳，苟能明“不服药为中医”之训，则全活已过半矣，况由《内经》、《伤
寒论》而精之者哉？
痘疮（天花）关系到人的生死，不是精通《黄帝内经》和《伤寒论》的人不能治疗。一旦有了专门的流派，则见识狭隘，认知不广，沿着流弊而迷失了本源，这门医术于是断绝。就像建中汤（温中补虚的方剂）滥觞于前，酿成了今日倒悬（病情危重、难以救治）的局面。
追究其变本加厉的原因，是因为看到痘疮初起时，血分有热，被惊骇地认为是毒火，于是峻烈地使用苦寒药物强行压制。在当时火势勃勃欲出的时候，虽然经过冰伏般的寒凉遏制，尚且相持不下，不至于入口即死，医生便相信使用熟药没有妨碍。于是气机郁遏，红晕转深，倍增烦热，大家更加相信是血热毒重，肆意使用寒凉药物，以误传误，这是弊端之一。
遇到真正的险症，就危言耸听，断定无法治愈，却按日开处方。尤其害处在于手法与口舌相应（指言语刻薄或操作粗暴），等到送终时，病人家属不责怪其手法之辣，反而称赞其眼力之高；医生更加自负，不再改变策略，决断越发精准，声名鹊起，这是弊端之二。
病人家属喜欢听清热解说的说法，妇女们嘈杂议论，总以为泻除食积、降灭火毒是第一要务。如果不迎合他们的心意，即使痊愈后稍有咳嗽及痤疮（此处指痘疹余毒未清之象），也认为是未曾解毒所致，归咎于前医；或者过了十余天，各种方法都用尽了，不得已加入人参进入清热攻邪的药中，如同在江心修补漏洞，只见到气喘胸高，死后心头犹热，无识者更加后悔用补药的错误，视同鸩砒（毒药）。当时的医生深于世故，务必求得不失人情，这是弊端之三。
刻板地套用方治，全国都是如此，稍有不同，就没有声援支持，入附出污，显成时局，彼此互相推荐，方子都同一律，成功固然可以居功，失败也可以告无罪，医道的流行，以此为开端。那些急于让道术流行的人，哪里还知道他们的技术是错误的？况且家传技艺如此，衣钵传承如此，几页方书，锦囊具在，眼光本来就不盈尺咫（极短浅），更无从参悟灵机，这是弊端之四。
具备这些弊端，种种相互因果，婴儿何知，遭受此巨劫。我谨披肝胆，吐露心腹之言告诉为人父母者说：顺痘（轻症），本无不生的症候，而误药反而有致死的原因；险痘（重症），极有可生之路，而误药必然无不死之幸；逆痘（危症），尚有求生之法，而误药反为速死之方。与其误药，不如不药。
近年来痘疹盛行，家家户户哭声不断，顺痘而死的还有十分之三，险痘而死的已有十分之七，侥幸获得痊愈的，不是痘出极稀，就是贫家无力延医，或者是孩子性格倔强，滴药不肯沾唇，否则药虽下咽，立即呕出，如有神助，求其因药而愈的，百不获一也。
曾有一位年轻医生的女儿痘殇（死于天花），哭得很悲哀，我笑着对他说：“你应该取《左传》中的话自我辩解，于是朗诵‘我杀别人的孩子很多了，难道能避免这种报应吗’。”唉！我难道是喜欢诋毁疾病吗？也是想着稍微挽回狂澜，为婴儿开一线生路罢了。如果能明白“不服药为中医”（不吃药算是中等水平的治疗/明智之举）的训诫，那么保全性命的人已经过半了，何况是由《内经》、《伤寒论》进而精通的人呢？
Smallpox (Variola) concerns life and death; it cannot be treated by those who are not proficient in the *Huangdi Neijing* (Yellow Emperor's Inner Canon) and the *Shanghan Lun* (Treatise on Cold Damage). Once a specialized school emerges, the scope of vision becomes narrow, and understanding is limited. Following the stream while losing sight of the source, this medical art eventually perishes. For instance, the initial use of Jianzhong Tang (Cinnamon Twig and Reishi Decoction for warming the middle and tonifying deficiency) led to the current situation of "inverted suspension" (a state of critical and difficult-to-treat illness).
Investigating the reasons for its exacerbation: seeing that at the onset of smallpox, there is heat in the blood, physicians are startled into regarding it as toxic fire. They then severely employ bitter-cold herbs to forcibly suppress it. At that time, when the fire is vigorous and eager to emerge, although suppressed by ice-like coldness, it remains in a stalemate, preventing immediate death upon ingestion. Physicians then believe that using these familiar drugs causes no harm. Consequently, the mechanism of Qi becomes depressed, the red halo deepens, irritability and heat increase, and everyone further believes it is due to severe blood heat and toxicity. They recklessly use cold-natured herbs, passing errors from one to another. This is the first drawback.
When encountering truly critical cases, they use alarmist language, declaring them incurable, yet continue to prescribe daily. The particular harm lies in the correspondence between their harsh methods and words. When delivering the final rites, families do not blame the physician's harsh technique but instead praise their diagnostic acumen. Physicians become even more arrogant, abandoning alternative strategies, making decisions with increasing precision, and gaining fame. This is the second drawback.
Families prefer theories of clearing heat and resolving toxicity. Women chatter, believing that purging food stagnation and descending toxic fire is the primary step. If one does not cater to their wishes, even if slight coughing or acne-like lesions remain after recovery, it is attributed to insufficient detoxification, blaming the previous physician. Or, after more than ten days, when all other methods are exhausted, Ginseng Radix et Rhizoma (Renshen, 人参) is reluctantly added to heat-clearing and attacking formulas, like patching a leak in the middle of a river. Only wheezing and chest distension are seen, and the heart remains warm after death. Ignorant people regret the error of using tonics, viewing them as poison. Contemporary physicians, deeply versed in worldly ways, strive to maintain social harmony. This is the third drawback.
Rigidly applying standard prescriptions is common throughout the country. Any deviation lacks support. Formulas become standardized through mutual recommendation; success claims credit, while failure avoids blame. This uniformity marks the beginning of the current medical practice. Those eager to propagate this "Way" do not realize their techniques are erroneous. Moreover, with hereditary traditions and lineages preserved in just a few pages of prescription books, their insight is short-sighted, unable to grasp spiritual flexibility. This is the fourth drawback.
With these drawbacks interlinked, infants, innocent and unaware, suffer this great calamity. With utmost sincerity, I reveal my heart to parents: In mild smallpox (Shun Dou), there are essentially no fatal cases, yet mismedication can cause death. In critical smallpox (Xian Dou), there is a path to survival, yet mismedication ensures death. In adverse smallpox (Ni Dou), there are still methods to seek life, yet mismedication accelerates death. Rather than mismedicate, it is better not to medicate.
In recent years, smallpox has been prevalent, with wailing heard in every household. Among mild cases, three out of ten die; among critical cases, seven out of ten die. Those who fortunately recover either have very sparse eruptions, belong to poor families unable to afford doctors, or have stubborn children who refuse to swallow medicine, vomiting it up immediately if forced. It seems as if divine help is required. Finding a case cured by medication is less than one in a hundred.
Once, a young physician's daughter died of smallpox. He wept bitterly. I smiled and said to him, "You should quote the *Zuo Zhuan* to justify yourself," and recited, "I have killed many of your sons; how could I avoid such retribution?" Alas! Do I enjoy slandering diseases? I merely wish to turn the tide slightly and open a ray of hope for infants. If one understands the teaching that "not taking medicine constitutes medium-level treatment" (Bu Fu Yao Wei Zhong Yi), more than half would survive. How much more so for those who are proficient in the *Neijing* and *Shanghan Lun*?