夏禹铸曰∶痘出于脏， 出于腑， 乃大肠主之，毒瓦斯蒸肺故发咳嗽。先辈书未尝齿及
症，盖以其轻而忽之也，却不知表症虽轻，毒侵肺腑，亦多性命攸关。余经历甚众，费手
居多，因不惜笔力详着于篇，以杜婴儿 症之患流行。 症其候烧热，必发咳嗽，声必稍哑
，面皮微有肿样，两腮颜色微红，此吉兆也。如发出不快及不透发，或红点见面，偶挟风邪
而隐，或医人不知，误除烧热，隐而不见，腹内作痛，治之神莫神于天保采薇汤，圣莫圣于
天保采薇汤，只须一服即发出，或有不尽发者再加一服，从未有不效者。如肺脏先虚又加大
肠毒瓦斯攻肺，面皮像浇薄的式子惨白浮浮，光光溜溜便是肺气已绝，在精威二穴对拿，其声不
出必是死症，药之无济。
有 方见点随即收入，或泻青水，审非风寒为害，唇色惨白，口气微微，此乃内虚不能
送毒，不可分利止泻，惟用八珍汤以托之。外用葱半斤许，白酒煎，遍身擦之。如再不透发
，只额上稍见些微，惟用六君子汤循循调治，自愈。
有 初发热时，心火盛极刑克肺金致 不出，必先用黄连、木通等分服之，再用防风、
荆芥、葛根、升麻、南星、枳壳、赤芍、桑皮、柴胡、桔梗、甘草煎服之即发。
有痢疾兼 症，若 见点急用香薷、桔梗、枳壳、黄连、浓朴、木通、升麻、赤芍、车
前煎服， 疮透发而治痢疾，此弃轻从重之说，不可不知。
本邑陶一公涯玉之子， 症发热方两日，医人误为除热， 伏不出，形状似惊，差役请
余治。面色花杂，喘急不嗽，必有内毒。于太阳穴以口涎擦之，皮内隐有红点，知是 毒内
攻，无烧不出，用天保采薇汤倍加升麻、干葛，一服额上见点，色不红起，面色唇口惨淡无
泽，知为内虚，即用固真汤一服，通身发热，陶公惊怖，余曰∶ 非带热不出。仍服天保采
薇汤一剂，通体透发，愈。此见面色花杂便知内毒之一验也。
培继楼同学庠友方恒绥一子 症，隐而不出，形症甚凶，邀余治。见其面色惨白，口气
微冷，唇舌淡白，大便泄泻，即用八珍汤。一服额稍见点，恒绥因侄前 症殒于泄泻力迫
止泻。余曰∶分利更虚。不允。见口吻间觉以泻关性命，勉强用五苓散，果止而额上红点即
隐，又用十全大补汤内托，外用葱酒蒸引，卒不透发。余值事往郡蹑后札示；皮上每发一泡
，破即成黑窟，附他医攻毒方单。余札复曰∶肌肉脾属，破即成窟，乃脾虚之极，何可攻毒
，惟用六君子汤顾脾为主。果效。此望色审窍万无一失，分利虚脾即此可见之一验也。
思诚堂同学友措大方薪衍第五郎患 症，初医者不知 候用六一散以除烧热。邀余过治
，见其舌纯紫，两唇燥裂，大小二便皆秘，声鼾不已，即用黄连八分，木通、黄柏各一钱，
服下大便刮白如冷痢，然在座者口吻觉为凉剂所致，余亦踌躇满志，岂脏腑苗窍此症独不相
符，毫不首鼠，问前医退热所用何剂，薪衍曰∶六一散，余便恍觉下元为六一寒冷所滞，致
火不降灼，无疑矣。随以炒盐久熨脐下，仍用前味黄连倍加，服之方下大便燥结与黑枣无异
，可见苗窍辨真治定不爽之一验也。
夏禹铸说：痘疹（天花）源于内脏，发于腑，主要由大肠主管。毒气熏蒸肺部，因此引发咳嗽。前辈医书中未曾提及此症，大概是因为认为它病情轻微而忽略了它，却不知道表证虽然看似轻浅，但若毒邪侵入肺腑，也往往关乎性命。我经历此类病例很多，治疗起来颇为棘手，因此不惜笔墨详细记载于此篇中，以杜绝婴儿患此痘疹的流行。
痘疹的症状表现为发热、必发咳嗽，声音稍显嘶哑，面部皮肤微有肿胀感，两腮颜色微红，这是吉兆。如果痘疹发出缓慢且不透彻，或者脸上出现红点，偶尔夹杂风邪导致痘疹隐没不见；或者是医生不知晓此症，误用清热药去除热象，导致痘疹隐没不见，腹部作痛。治疗上，没有比天保采薇汤更神妙的方剂了，也没有比天保采薇汤更圣明的方剂了，只需服用一服即可使痘疹发出，如果有未完全发出的，再加服一服，从未有不奏效的。如果肺脏先已虚弱，又加大肠毒气攻肺，面部皮肤像浇了薄浆一样惨白浮肿，光光溜溜的，这便是肺气已绝的表现，在精威二穴进行对拿针灸，如果声音不出，必定是死症，用药已无济于事。
有的痘疹刚见点随即收入体内，或者泻出青色水样便，仔细审察并非风寒为害，唇色惨白，气息微弱，这是内虚不能托送毒邪外出，不可使用分利止泻的方法，只能用八珍汤来托毒外出。外用葱半斤左右，加白酒煎煮，遍身擦拭。如果再不透发，只在额头稍见些微红点，只用六君子汤循序渐进地调理，自然痊愈。
有的痘疹在初发热时，心火极盛克制肺金，导致痘疹出不出来，必须先用黄连、木通各等分煎服，再用防风、荆芥、葛根、升麻、南星、枳壳、赤芍、桑白皮、柴胡、桔梗、甘草煎服，痘疹即可发出。
有的痢疾兼患痘疹症，如果痘疹见点，急用香薷、桔梗、枳壳、黄连、厚朴、木通、升麻、赤芍、车前子煎服，待痘疮透发后再治痢疾，这是“弃轻从重”的说法，不可不知道。
本邑陶一公（名涯玉）的儿子，患痘疹症发热才两天，医生误以为是一般发热而用清热法，导致痘疹伏匿不出，形状类似惊风，差役请我去治疗。面色花杂，喘急但不咳嗽，必有内毒。我在他的太阳穴用口涎擦拭，发现皮内隐有红点，知道是痘毒内攻，没有热象则痘疹不出，于是用天保采薇汤倍加升麻、干葛，服用一服后额头上见到痘点，但颜色不红且不起隆，面色唇口惨淡无光泽，知道是内虚，立即用固真汤服用一服，全身发热，陶公惊恐害怕，我说：“这不是带热不出。”继续服用天保采薇汤一剂，全身痘疹透发，痊愈。这是见面色花杂便知有内毒的一个验证。
培继楼的同学庠友方恒绥的儿子患痘疹症，痘疹隐没不出，形症非常凶险，邀请我去治疗。见其面色惨白，口气微冷，唇舌淡白，大便泄泻，立即用八珍汤。服用一服后额头稍见痘点，恒绥因为侄子之前因痘疹症因泄泻逼迫而死，极力要求止泻。我说：“分利小便会更伤正气致虚。”他不听。见口吻间觉得泄泻关乎性命，勉强用了五苓散，果然止泻，但额头上的红点随即隐没，又用十全大补汤内托，外用葱酒蒸引，最终未能透发。我当时正忙于公务去郡城，后来写信指示：皮上每发一个水泡，破了就变成黑窟窿，附上其他医生攻毒的方单。我回信说：“肌肉属脾，破了就成窟窿，乃是脾虚到了极点，怎么能攻毒呢？只用六君子汤顾护脾胃为主。”果然有效。这是望色审窍万无一失，分利之法损伤脾气的例子，由此可见一斑。
思诚堂的同学友措大方薪衍的第五个儿子患痘疹症，起初医生不知痘疹候脉，用六一散来除烧热。邀我去治疗，见其舌纯紫，两唇燥裂，大小二便皆秘结不通，打鼾声不停，立即用黄连八分，木通、黄柏各一钱，服下后大便排出白色如冷痢样的东西，然而在座的人口吻间觉得这是凉药所致，我也犹豫不决，难道脏腑苗窍在此症上唯独不相符吗？毫不迟疑，问前医退热所用的是什么药剂，薪衍说是六一散，我便恍然大悟，认为是下元被六一散的寒凉所阻滞，导致火气不降反灼，毫无疑问了。随即用炒盐长时间熨烫脐下，仍然用前面的药味，黄连加倍，服用之后才排出干燥结块的大便，与黑枣无异，可见通过苗窍辨别真伪，治疗决定无误，这是一个验证。
Xia Yuzhu said: Smallpox (Tianhua) originates from the Zang organs and manifests in the Fu organs, primarily governed by the Large Intestine. The toxic vapors steaming the Lungs cause coughing. Predecessor medical texts did not mention this syndrome, likely because they considered it mild and ignored it. However, one should not know that although the exterior syndrome appears mild, if the toxin invades the Lung and Heart, it can often be life-threatening. I have encountered many such cases, which were mostly difficult to treat. Therefore, I do not spare my efforts to record them in detail in this chapter, to prevent the epidemic of infant smallpox.
The symptoms of smallpox include fever, inevitable coughing, slightly hoarse voice, slight swelling of the facial skin, and slightly red color on both cheeks; this is an auspicious sign. If the eruption is slow and incomplete, or if red spots appear on the face but are occasionally hidden due to wind-pathogen invasion, or if doctors, unaware of this syndrome, mistakenly use heat-clearing methods to remove the fever, causing the eruption to hide and abdominal pain to occur, there is no formula more miraculous than Tianbao Caiwei Tang (Heavenly Protection Mulberry Leaf Decoction), nor any more sagacious. A single dose will cause the eruption to appear; if some remain un-erupted, a second dose may be added. It has never failed. If the Lung organ is first deficient, and then attacked by Large Intestine toxins, the facial skin becomes pale white and floating like thin slurry, smooth and shiny; this indicates that Lung Qi has exhausted. Needling the Jing and Wei acupoints with opposite manipulation, if the voice does not come out, it is certainly a fatal case, and medicine is of no help.
In some cases, when the smallpox spots appear, they immediately recede inward, or green watery diarrhea occurs. Carefully examining, if it is not caused by Wind-Cold, and the lip color is pale white with weak breath, this is internal deficiency unable to send the toxin outward. One must not use draining and stopping-diarrhea methods, but only use Bazhen Tang (Eight Treasures Decoction) to support and push the toxin out. Externally, use about half a jin (approx. 500g) of Scallion Stems (Cong Bai), decocted with white wine, and wipe all over the body. If it still does not erupt, showing only slight spots on the forehead, use Liujunzi Tang (Six Gentlemen Decoction) for gradual regulation, and it will heal naturally.
In some cases, during initial fever, excessive Heart Fire severely restricts Lung Metal, causing the smallpox to fail to erupt. One must first administer equal parts of Coptis Rhizome (Huanglian) and Awlhead Pipestem Climber Stem (Mutong). Then, decoct and administer Saposhnikovia Root (Fangfeng), Schizonepeta Spike (Jingjie), Kudzu Root (Gegen), Bupleurum Root (Chaihu), Pinellia Tuber (Nanxing), Aurantium Fruit (Zhike), Red Peony Root (Chishao), Mulberry Bark (Sangbai Pi), Platycodon Root (Jiegeng), and Licorice Root (Gancao). The eruption will then appear.
In cases where Dysentery (Liji) coexists with smallpox, if smallpox spots appear, urgently decoct and administer Mosla Herb (Xiangru), Platycodon Root (Jiegeng), Aurantium Fruit (Zhike), Coptis Rhizome (Huanglian), Magnolia Bark (Houpo), Awlhead Pipestem Climber Stem (Mutong), Bupleurum Root (Shengma), Red Peony Root (Chishao), and Plantago Seed (Cheqian). Treat the dysentery only after the smallpox sores have fully erupted. This is the principle of "abandoning the light to address the heavy," which must not be ignored.
The fifth son of Tao Yigong (Yayu) in our county suffered from smallpox fever for only two days. The doctor mistakenly treated it as general fever using heat-clearing methods, causing the smallpox to lie dormant and not erupt. The condition resembled convulsions. An officer invited me to treat him. His complexion was mottled, he panted urgently without coughing, indicating internal toxin. I rubbed saliva on his Taiyang acupoint, revealing hidden red spots under the skin, knowing it was smallpox toxin attacking internally. Without heat, the eruption cannot emerge. I used Tianbao Caiwei Tang with increased doses of Bupleurum Root (Shengma) and Kudzu Root (Gan Ge). After one dose, spots appeared on the forehead, but the color was not red and did not rise. The complexion and lips were pale and lusterless, indicating internal deficiency. I immediately administered Guzhen Tang (Solidify True Decoction) for one dose. The whole body became hot. Mr. Tao was terrified. I said, "This is not failing to erupt due to heat." He continued taking Tianbao Caiwei Tang for another dose, and the eruption penetrated the whole body, leading to recovery. This is a verification that a mottled complexion indicates internal toxin.
A student friend of Peijilou, Fang Hengsui, had a son with smallpox. The eruption was hidden and did not appear, with severe symptoms. He invited me to treat. I saw his face was pale white, breath slightly cold, lips and tongue pale white, with loose stools. I immediately prescribed Bazhen Tang (Eight Treasures Decoction). After one dose, slight spots appeared on the forehead. Hengsui, because his nephew previously died from smallpox complicated by forced diarrhea, strongly demanded stopping the diarrhea. I said, "Draining fluids will further weaken the Spleen." He refused. Seeing that the family felt diarrhea threatened life, he reluctantly used Wuling San (Five-Ingredient Powder with Poria). Indeed, the diarrhea stopped, but the red spots on the forehead immediately hid. I then used Shiquan Dabu Tang (Ten Great Tonifying Decoction) for internal support and externally applied steamed scallion-wine extraction. Ultimately, it did not erupt. I was busy with official duties and went to the prefecture, later sending a letter instructing: Each blister on the skin, once broken, becomes a black cavity. Attached is a list of other doctors' formulas for attacking toxins. I replied: Flesh belongs to the Spleen. Breaking into cavities indicates extreme Spleen deficiency. How can one attack toxins? Only use Liujunzi Tang (Six Gentlemen Decoction) to protect the Spleen as the primary goal. It was indeed effective. This demonstrates that observing complexion and orifices is infallible; draining fluids damages the Spleen, as seen here.
Wu Dayan's fifth son from Sichengtang, a classmate friend, suffered from smallpox. The initial doctor, unaware of the smallpox pulse/syndrome, used Liu Yi San (Six-to-One Powder) to clear heat. He invited me to treat. I saw his tongue was purely purple, lips dry and cracked, urination and defecation both obstructed, and snoring continuously. I immediately prescribed Coptis Rhizome (Huanglian) 8 fen, Awlhead Pipestem Climber Stem (Mutong) and Phellodendron Bark (Huangbo) 1 qian each. After ingestion, white stool resembling cold dysentery was passed. Those present whispered that this was caused by cooling herbs, and I also hesitated. Could the viscera and orifices be inconsistent with this syndrome? Without hesitation, I asked what the previous doctor used for heat-clearing. Dayan said, "Liu Yi San." I suddenly realized that the lower origin was stagnated by the coldness of Liu Yi San, causing fire to fail to descend and instead scorching. There was no doubt. I then used fried salt to moxa/iron the area below the navel for a long time, and still used the previous herbs with doubled Coptis Rhizome. After ingestion, dry, hard stool resembling black dates was finally passed. This shows that distinguishing truth through orifices leads to accurate treatment, a verification of this principle.