初发身热悠悠。乍热乍凉。肌松神倦。面青 白。饮食减少。手足时冷时热。呕吐便溏。痘
点方见。隐隐不振。淡红皮薄。
三四日陆续不齐。不易长发。五六日不易成浆。少食气馁。伤食易泄。七八日塌陷。灰白不起。
自汗微渴。或腹胀喘渴。泄泻塌痒闷乱。切牙寒战。头温足冷。势所必致。皆缘气虚之故。故治
虚痘。初发不宜轻投透表之剂。即参苏饮、人参败毒散等亦不宜用。况升麻汤等纯行升发之药乎。
至于黄连、紫草。皆为切禁。惟宜保元汤为主。若气粗皮燥无润色者亦当忌之。只以四君子少加
桔梗、川芎。补益之中略佐升提之法。俟点子出齐。重用参、 峻补其气。助其成浆。至八九日
间无他凶证。十全大补汤倍桂。塌陷灰白。腹胀泄泻。木香散。塌痒闷乱。腹胀渴泻喘嗽。头温
足冷。寒战切牙者。急进异功散。迟则不救。
气虚痘疹。调理得宜。使元气充实。腠理坚固。脾胃强健。二便调适。仍可转祸为祥。若补
益太过。浆足之后。重用参、 。多有腹胀喘急之患。用枳壳汤。误用五苓、木香散。多有大便
秘结之患。用宽中散。便实而渴。用麦门冬汤。过用丁、桂辛热之剂。则有咽喉肿痛。烦躁闭渴
之患。用润燥汤。盖喘急腹胀。大便秘坚。烦渴咽痛。皆类实证。然而气虚变实。非真实也。是
病浅而用药过深之失也。只宜斟酌。不宜疏通。若误行疏利。则方生之气复虚。而脱证将至矣。
初起时身体发热，热度起伏不定。肌肉松弛，精神疲倦。面色青白。食欲减退。手足有时发冷，有时发热。痘疹刚刚显现，隐约不振，颜色淡红，皮薄。
三四天内痘点陆续出现但不整齐，难以顺利长出。五到六天难以化脓成浆。饮食减少导致元气不足，伤食容易腹泻。七到八天痘顶塌陷，颜色灰白，不起发。自汗，轻微口渴。或者出现腹胀、气喘、口渴、泄泻、痘疮瘙痒、胸闷烦乱。咬牙寒战。头部温热而足部寒冷。这些情况是必然导致的后果，都是因为气虚的缘故。所以治疗虚证痘疹，初起阶段不宜轻易使用透表发散的药物。即使是参苏饮、人参败毒散等也不宜使用。何况是升麻汤等纯粹具有升发作用的药物呢。至于黄连、紫草，都是绝对禁忌的。只适宜以保元汤为主方。如果患者呼吸粗重、皮肤干燥缺乏润泽色泽的，也应当忌用保元汤。只用四君子汤少量加入桔梗、川芎，在补益之中略微辅助升提的方法。等到痘点出齐后，重用人参、黄芪峻补其气，帮助痘疹成浆。到了八九日之间如果没有其他凶险症状，使用十全大补汤加倍桂枝。对于痘顶塌陷、颜色灰白、腹胀泄泻的情况，使用木香散。对于痘疮瘙痒、胸闷烦乱、腹胀口渴、泄泻气喘咳嗽、头部温热足部寒冷、寒战咬牙的情况，紧急使用异功散，延误时机则无法救治。
气虚型的痘疹，如果调理得当，使元气充实，腠理坚固，脾胃强健，大小便调适，仍然可以转危为安。如果补益太过，在浆液充足之后，重用人参、黄芪，多有腹胀气喘急迫的祸患。此时应使用枳壳汤。误用五苓散、木香散，多有大便秘结的祸患。此时应使用宽中散。大便通畅但口渴，使用麦门冬汤。过度使用丁香、肉桂等辛热药物，则有咽喉肿痛、烦躁闭闷口渴的祸患。此时应使用润燥汤。大概气喘急迫、腹胀、大便秘结坚硬、烦渴咽痛，都类似实证的表现。然而这是气虚转变为假实，并非真正的实证。这是由于病位浅表而用药过深的失误。只应当斟酌病情，不应当使用疏通攻下的方法。如果误用疏利攻下之法，那么刚刚生成的正气会再次虚弱，脱证（元气耗竭）就要发生了。
At the onset, the body experiences a lingering fever with alternating hot and cold sensations. The muscles are relaxed, and the spirit is fatigued. The complexion is cyanotic and pale. Food intake decreases. The hands and feet alternate between cold and hot. The smallpox spots have just appeared, faint and unenergetic, light red in color with thin skin.
Within three to four days, the spots appear successively but irregularly, making it difficult for them to grow properly. By five to six days, they fail to fill with pus. Reduced food intake leads to Qi deficiency; food stagnation easily causes diarrhea. By seven to eight days, the pustules collapse, turning grayish-white and failing to rise. There is spontaneous sweating and slight thirst. Alternatively, there may be abdominal distension, asthma (wheezing), thirst, diarrhea, pruritus of the lesions, chest tightness, and mental confusion. Teeth chattering and shivering occur. The head feels warm while the feet are cold. These outcomes are inevitable due to Qi deficiency. Therefore, when treating deficient-type smallpox, one should not lightly administer exterior-releasing agents at the onset. Even formulas such as Shensu Yin (Ginseng and Perilla Decoction) and Renshen Baidu San (Ginseng Detoxification Powder) are unsuitable. How much more so are pure ascending and dispersing formulas like Shengma Tang (Cimicifuga Decoction)? As for Huanglian (Coptidis Rhizoma) and Zicao (Arnebiae Radix seu Lithospermi Radix), they are strictly contraindicated. One should primarily rely on Baoyuan Tang (Protect the Origin Decoction). However, if the patient has coarse breathing and dry skin lacking luster, Baoyuan Tang should also be avoided. Instead, use Sijunzi Tang (Four Gentlemen Decoction) with minor additions of Jiegeng (Platycodonis Radix) and Chuanxiong (Ligustici Chuanxiong Rhizoma), employing a slight lifting method within the tonification strategy. Once the spots have fully emerged, heavily use Ren Shen (Ginseng Radix et Rhizoma) and Huang Qi (Astragali Radix) to vigorously tonify Qi and assist in filling the pustules. If no other ominous signs appear by the eighth or ninth day, use Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) with doubled Gui Zhi (Cinnamomi Ramulus). For collapsed, grayish-white lesions accompanied by abdominal distension and diarrhea, use Muxiang San (Costus Powder). For pruritic lesions, chest tightness, mental confusion, abdominal distension, thirst, diarrhea, wheezing, cough, warm head, cold feet, shivering, and teeth chattering, urgently administer Yigong San (Extraordinary Skill Powder); delay will result in untreatable conditions.
For Qi-deficient smallpox, if managed appropriately, allowing the Yuan Qi (Primary Qi) to become substantial, the Cou Li (interstices/skin texture) to become firm, the Spleen and Stomach to become strong, and the bowel and bladder movements to be regulated, disaster can still turn into auspiciousness. However, excessive tonification, particularly the heavy use of Ren Shen (Ginseng Radix et Rhizoma) and Huang Qi (Astragali Radix) after the pustules are full, often leads to abdominal distension and urgent wheezing. In such cases, Zhike Tang (Immature Bitter Orange Decoction) should be used. Misuse of Wuling San (Five-Ingredient Powder with Poria) or Muxiang San (Costus Powder) often leads to constipation. In such cases, Kuanzhong San (Broaden the Middle Powder) should be used. If the stool is solid but thirst persists, use Maidong Tang (Ophiopogon Decoction). Overuse of acrid-warm agents such as Ding Xiang (Caryophylli Flos) and Rou Gui (Cinnamomi Cortex) leads to sore throat, swelling, restlessness, and closed-off thirst. In such cases, Rundao Tang (Moisten Dryness Decoction) should be used. Generally, urgent wheezing, abdominal distension, hard constipation, vexing thirst, and sore throat resemble excess patterns. However, this transformation from Qi deficiency to "excess" is false excess, not true excess. It is an error of using overly deep-acting drugs for a superficial disease. One should only exercise discretion and avoid purgative or draining methods. If mistaken purgatives or draining methods are applied, the newly generated Qi will become deficient again, and the syndrome of collapse (Tuo Zheng) will approach.