病有轻重，药有浅深。病深药浅，不能去病，病浅药深，真气受弊。观疮疹分轻重而治
之，其疮痘出稀者轻，里外肥红者轻，外黑里白者轻，疮夹疹者半轻半重也，一发而出尽者
重也，外黑而里赤者微重，外白而里黑太重也。青干势陷，昏睡汗出不止，烦躁热渴，腹胀
啼喘，大小便不通者，困也。疮中端黑，点如针孔，绀紫剧也。论轻重为用药之法，轻者宜
匀气，令其自出也；半轻半重宜解毒，毒散则自轻也，毒瓦斯重者宜利小便；太重而势剧者，
当随证渗泄。热气冲于心，则谵言妄语，则朱砂参苓之类可用也；蒸于肝则搐搦，状若惊痫
，则防风羌活天麻全蝎南星之类可用也，蒸于脾则腹胀渴水，大便秘，目肿则枳壳散橘曲山
栀地黄之类可用也；蒸于肺则喘急渴水，咳嗽鼻干，则桑白皮马兜铃半夏之类皆可用；毒瓦斯
归肾而黑靥倒入者，宜猪尾膏活血散皆可急而用之也。又有风邪客搏于皮肤，热不得泄，疮
变为瘾疹之状，皮肤瘙痒者则轻。又有内先蕴热，外被风邪相连，搏于血则赤斑，其毒亦深
。伤寒变疮痘者，其伤寒热毒甚而发 疮。其疮色白或赤，发于皮肤，头作瘭浆，戴白脓者
轻；有紫黑作根，隐隐在肌肉里者，其毒必甚，重者五内七窍皆有疮，其形发如豆，故以名
焉。大抵正疮痘，是母腹中时受积秽，良由内实而斑毒生。其感风感寒，为瘾疹，为斑毒，
为痘疮，皆外邪乘内虚而伏于脏腑，内外皆热，热蓄血聚，壅遏不行，蕴结而成也。所遇之
初不同，可不辨乎？正疮子内实而生者，五脏各有一证，前篇备论之矣。且伤寒伤风，何以
别之？面青四肢微厥，无汗而恶寒，耳与阴皆热者，伤寒也；伤风者，面赤，四肢烦，鼻流
涕，有汗恶风。此二者宜审而早治之，不尔必为疮疹也。若在母腹中蕴毒瓦斯者，《千金方》
云∶儿初生以生地黄汁一蚬壳与服，便黑粪为解。又疮多临发未出之间，以升麻汤解之，冬
温以三豆饮子解之。时气发疮疹，恐相传染，以茜草根煎汁解之。此皆疮痘当用者。惟伤寒
伤风变为疮痘，是汗下失时之过。
疾病有轻有重，用药也有深浅之分。病邪深重而药力浅薄，无法祛除病邪；病邪轻微而药力过猛，反而会损伤人体的真气。观察疮疹的轻重并据此治疗：痘疮稀疏的属轻症，内外颜色均呈鲜红的属轻症，外黑内白的属轻症，痘疮夹杂麻疹的属于半轻半重；一旦发出即全部出齐的属重症，外黑内赤的属稍重，外白内黑的属太重。若出现痘顶青紫干枯、塌陷不起，神志昏睡、汗出不止，烦躁不安、发热口渴，腹部胀满、啼哭喘息，大小便不通畅的情况，这属于危困之证。若痘疮顶端发黑，点状如针孔，颜色呈青紫色，这是病情剧烈的表现。根据轻重来制定用药法则：轻症宜调和气机，使其自然透出；半轻半重宜解毒，毒散则病情自缓；毒瓦斯重的宜通利小便；病情过重且势头急迫的，应当随证施以渗泄之法。热气上冲于心，导致胡言乱语，可用朱砂、人参、茯苓等药物；热气蒸灼于肝，导致抽搐痉挛，状似惊痫，可用防风、羌活、天麻、全蝎、南星等药物；热气蒸灼于脾，导致腹部胀满、渴欲饮水、大便秘结、眼睑肿胀，可用枳壳散、橘曲、山栀、地黄等药物；热气蒸灼于肺，导致气喘急促、渴欲饮水、咳嗽、鼻干，可用桑白皮、马兜铃、半夏等药物；毒瓦斯归并于肾，导致痘疮黑陷倒靥的，宜急用猪尾膏或活血散。又有风邪客居搏结于皮肤，热邪不得宣泄，疮疹变为瘾疹（荨麻疹）的样子，皮肤瘙痒的，病情较轻。又有体内先蕴积热邪，外部被风邪相连，搏结于血分则出现赤斑，其毒邪也较深。由伤寒变生为疮痘的，是因为伤寒热毒炽盛而引发疮疡。其疮色白或红，发于皮肤，头部形成脓疱，顶部带有白色脓液的属轻症；若有紫黑色根脚，隐隐在肌肉深处的，其毒邪必定很盛，属重症；重症者五脏七窍都会生出疮疡，形状像豆子，所以以此命名。大抵真正的痘疮，是胎儿在母腹中时受到积滞秽浊之气的影响，多因体内实热而导致斑毒产生。感受风邪或寒邪，表现为瘾疹、斑毒、痘疮，都是外邪乘人体内部虚弱而潜伏于脏腑，导致内外皆热，热邪蓄积、血液聚结，壅滞不通，蕴结而成。所遭遇的初始病因不同，怎能不加以辨别呢？真正的痘疮由体内实热而生，五脏各有一种证候，前文已详细论述。那么伤寒与伤风如何区别呢？面色青，四肢微冷，无汗且恶寒，耳朵和阴部都热的，是伤寒；伤风者，面色红，四肢烦扰不适，流鼻涕，有汗且恶风。这两种情况应当仔细审察并尽早治疗，否则必然发展为疮疹。若在母腹中蕴积了毒瓦斯，《千金方》说：婴儿刚出生时用一蚬壳的生地黄汁给其服用，直到排出黑色粪便为止。另外，疮疹多在临发未出之间，用升麻汤来解表；冬温季节用三豆饮子来解表。时行疫气引发的疮疹，担心相互传染，用茜草根煎汁来解毒。这些都是疮痘应当使用的疗法。只有伤寒、伤风转变为疮痘，是由于发汗或攻下时机不当造成的过失。
Diseases vary in severity, and the depth of medication must correspond accordingly. If the disease is deep but the medication is shallow, it cannot eliminate the pathogen; if the disease is shallow but the medication is too deep, it will damage the Zhenqi (True Qi). When observing sores and rashes to determine their severity for treatment: sparse smallpox lesions indicate a mild condition; lesions that are bright red both internally and externally indicate a mild condition; lesions that are black externally and white internally indicate a mild condition; smallpox mixed with measles indicates a condition of half-mild and half-severe nature; lesions that erupt all at once indicate a severe condition; lesions that are black externally and red internally indicate slightly severe; lesions that are white externally and black internally indicate very severe. If the tops of the lesions appear cyanotic, dry, and sunken, accompanied by drowsiness, profuse sweating, restlessness, fever, thirst, abdominal distension, crying and wheezing, and obstruction of urination and defecation, this constitutes a critical and distressed state. If the tips of the lesions turn black, appearing like needle holes with a purplish-cyan color, this indicates a severe manifestation. The method of medication should be determined based on severity: for mild cases, regulate Qi to allow natural eruption; for half-mild/half-severe cases, resolve toxicity, which will naturally lighten the condition; for heavy toxicity, promote diuresis; for extremely severe and acute cases, apply permeating and draining methods according to the syndrome. If heat qi rushes to the Heart, causing delirious speech, Zhusha (Cinnabar), Renshen (Ginseng), and Fuling (Poria) may be used; if heat steams the Liver, causing convulsions resembling epilepsy, Fangfeng (Saposhnikovia Root), Qianghuo (Notopterygium Rhizome), Tianma (Gastrodia Tuber), Quanxie (Scorpion), and Nanting (Arisaema Rhizome) may be used; if heat steams the Spleen, causing abdominal distension, thirst for water, constipation, and eyelid swelling, Zhike San (Bitter Orange Powder), Juqu (Citri Reticulatae Fermentum), Shanzhi (Gardeniae Fructus), and Dihuang (Rehmanniae Radix) may be used; if heat steams the Lung, causing rapid breathing, thirst, cough, and nasal dryness, Sangbaipi (Morus Alba Bark), Madouling (Aristolochiae Manshuriensis Radix), and Banxia (Pinelliae Rhizoma) may be used; if toxic qi returns to the Kidney, causing lesions to turn black and invert, Zhuiwei Gao (Pig Tail Paste) or Huoxue San (Blood-Invigorating Powder) should be urgently administered. Additionally, if Wind-Evil lodges and combats in the skin, preventing heat from venting, and the rash transforms into Urticaria (Nettle Rash) with itchy skin, the condition is mild. If internal heat is first accumulated and then connected with external Wind-Evil, combusting the Blood level results in red macules, indicating deep toxicity. Smallpox transformed from Shanghan (Cold Damage) occurs because the Cold Damage heat-toxin is intense, triggering sores. These sores are white or red, erupt on the skin, form pustules at the head, and those with white pus on top are mild; those with purple-black roots hidden deep within the muscles indicate very severe toxicity. In severe cases, sores appear in the five viscera and seven orifices, shaped like beans, hence the name. Generally, true smallpox arises from accumulation of filth received in the maternal womb, primarily due to internal excess leading to macular toxins. Contracting Wind or Cold manifests as Urticaria, macular toxins, or smallpox; these are all external pathogens taking advantage of internal deficiency to lie dormant in the Zang-Fu organs, resulting in internal and external heat, heat accumulation, blood stasis, obstruction, and conglomeration. Since the initial causes differ, how can they not be distinguished? True smallpox arising from internal excess has specific syndromes for each Zang organ, discussed in detail in previous chapters. How then to distinguish Shanghan from Shangfeng (Wind Strike)? Cyan face, slight coldness of limbs, absence of sweat with aversion to cold, and heat in ears and genitals indicate Shanghan; Shangfeng presents with a red face, restless limbs, runny nose, presence of sweat with aversion to wind. Both conditions require careful examination and early treatment, otherwise they will inevitably develop into sores and rashes. For infants harboring toxic qi in the womb, the *Qianjin Fang* states: upon birth, administer one shell's worth of raw Shengdihuang juice until black stool is passed. Furthermore, when sores are about to erupt but have not yet appeared, Shengma Tang ( Cimicifuga Decoction) is used to resolve the exterior; in winter warmth, Sandou Yinzi (Three Bean Drink) is used. For epidemic rashes where contagion is feared, Qiancaogen (Rubia Cordifolia Root) decoction is used to resolve toxicity. These are all appropriate treatments for sores and smallpox. Only when Shanghan or Shangfeng transforms into sores and smallpox is it due to the error of mistimed sweating or purging therapies.