痘疮既出。全藉脾胃安和。进纳饮食。则易浆易靥。自四五日以至痂落之后。饮食不减。二
便如常。虽不起发不红绽。或陷塌。用药得宜。可保无虞。若乳食减少。兼之泄泻。则元气日衰。
虽无前证。日后必至有变。药亦难效。岂能保其无事哉。若胸前稠密。毒瓦斯伤脾减食者。消毒饮
加黄芩、山楂、紫草、人参。有伤食腹胀不食者。枳术丸。有痘出太多。中气暴虚不食者。四君
子加糯米。有痘已痂起而不能食。身无热者。调补脾胃为主。凡四五日前不食而便秘者。此毒盛
于里。犹为可治。至六七日后。反不能食。则变证百出。纵药何益。有禀受壮实而发于五岁之外
者。又不可一例而论也。又有痘起之后。能食易饥者。此胃大热。不久而变生焉。大便秘者。四
顺饮加连翘、牛蒡微利之。不秘者。芍药汤加茯苓、木通、牛蒡子以和之。又有饥欲食而不能者
。必喉舌有痘。难于吞嚼也。
凡痘疹发热。有呕吐者。有泄泻者。有吐利兼作者。有干呕而哕者。有不食者。皆毒火所致
。不可骤止。吐利中有疏通之义。治宜平和疏透。引毒达表。则吐泻自止。如不止。兼调脾胃。
如干呕而哕。为胃虚火逆最危之兆。宜橘皮茱连散。以安胃气清火毒。有不嗜食者。此脾受热毒
。当升提发散。俾毒得外出。饮食自进。若误认呕吐泄泻不食为里寒而
用丁、桂、姜、附。转增烦剧也。误认呕吐泄泻不食为里虚而用参、 、苓、术。反增壅遏也。
此专为痘疹初出未透者而言。若浆正行时而吐利不食者。乃脾胃虚弱。多有内虚倒 喘胀之患。
凡长发起顶灌浆时。泄泻俱为险候。急用白术、茯苓以渗泄健脾。人参、黄 以助元托里。诃子
肉果以止泻。佐以升提之药。使无壅遏之患。若不升发。难免倒 之虞。如见心烦干呕而哕。此
脏败毒攻。最为凶候。二陈加黄连、木通、灯心、竹叶。夏月。四苓散以利小便。利而不通者危
。至如泄泻而手足热面赤者。热也。弱者。白术散加竹叶、陈皮。强者。泻黄散。若下午泻甚。
上午泻稀。此伤食。平胃散加山楂、麦芽。厥冷。加干姜。或益黄散补之。泻利而呕逆厥冷。理
中汤加木香。上午泻甚。下午不泻者。脾虚也。朝用白术散。夕用豆蔻丸。泻出腥臭秽滞者。肠
胃热也。葛根黄芩黄连汤。泻而失气者。气下泄也。白术散加升麻、防风提之。若受寒邪。或食
冷物。而泄泻清冷。痘色灰白顶陷。或手足厥而寒颤切牙者。陈氏木香散、异功散。疮虽正而吐
泻。或下血。俱为逆候。若但吐不泻。无痰。益黄散。有痰。二陈汤。吐而身热烦渴。腹满气促。
大小便涩而赤者。当利小便。若先吐而后出痘。足蜷不伸。声哑热蒸者。虽有清浆不治。陈文宿
云。痘疮泻水谷。或白色。或淡黄者。陈氏木香散送豆蔻丸。不愈。异功散救之。
痘疮发出之后，完全依赖脾胃功能安和。若能正常进食，则容易化脓结痂。从第四五天直到结痂脱落，如果饮食没有减少，大小便正常，即使痘疹不起发、不红绽，或者出现陷塌的情况，只要用药得当，可以保证平安无事。如果乳食减少，并且伴有泄泻，那么元气就会日渐衰弱，虽然目前没有上述严重症状，日后必然会出现变故，药物也难以见效，怎么能保证不出事呢？如果胸前痘疹稠密，毒气损伤脾胃导致食欲减退的，用消毒饮加黄芩、山楂、紫草、人参。如果有伤食导致腹胀不能进食的，用枳术丸。如果痘出得太多，中气突然虚弱不能进食的，用四君子汤加糯米。如果痘已结痂起发但不能进食，身体无热的，以调补脾胃为主。凡是发病四五天前不能进食且便秘的，这是毒邪盛于体内，还可以治疗；到了第六七天，反而不能进食，那么变证百出，即使用药又有什么益处呢？有先天禀赋壮实而在五岁以后发病的，又不宜一概而论。又有痘发出后，能进食且容易饥饿的，这是胃火大热，不久就会发生变故。大便干结的，用四顺饮加连翘、牛蒡子轻微通利；大便不干结的，用芍药汤加茯苓、木通、牛蒡子来调和。又有感到饥饿想吃东西但无法吞咽的，一定是喉舌部位有痘疹，难以咀嚼吞咽。
凡是痘疹发热，有的呕吐，有的泄泻，有的吐泻兼作，有的干呕并呃逆，有的不能进食，这些都是毒火所致。不可骤然止住，吐利之中蕴含着疏通的意义，治疗应当平和疏透，引导毒邪达于体表，则吐泻自然停止。如果不停止，兼以调理脾胃。如果是干呕并呃逆，这是胃虚火逆，是最危险的征兆，宜用橘皮茱连散，以安胃气、清火毒。如果不喜欢吃东西，这是脾受热毒，应当升提发散，使毒邪得以外出，饮食自然能进。如果误认为呕吐泄泻不食是里寒而使用丁香、肉桂、干姜、附子，反而会加重烦躁剧烈病情。误认为呕吐泄泻不食是里虚而使用人参、白术、茯苓、甘草（注：原文缺字，依语境补全为参苓术等健脾药），反而会增加壅滞阻塞。这是专门针对痘疹初出未透的情况而言。如果浆液正行期间出现吐泻不食，乃是脾胃虚弱，多有内虚倒靥、喘胀的祸患。凡是在长发起顶、灌浆的时候，泄泻都属于险恶征候，急用白术、茯苓来渗湿健脾，人参、黄芪来助元气托毒出里，诃子肉、肉豆蔻来止泻，佐以升提的药物，使其没有壅滞的祸患。如果不升发，难免有倒靥的忧虑。如果见到心烦干呕并呃逆，这是脏腑败坏、毒邪攻心，最为凶险的征候，用二陈汤加黄连、木通、灯心草、竹叶。夏季，用四苓散来利小便。利小便而不通的危重。至于泄泻而手足热、面赤的，是热证。体质弱的，用白术散加竹叶、陈皮；体质强的，用泻黄散。如果下午泄泻严重，上午泄泻稀薄，这是伤食，用平胃散加山楂、麦芽。四肢厥冷，加干姜。或者用益黄散补益。泄泻兼呕吐逆乱、四肢厥冷的，用理中汤加木香。上午泄泻严重，下午不泄泻的，是脾虚。早晨用白术散，晚上用豆蔻丸。泻出物腥臭秽浊黏滞的，是肠胃热证，用葛根黄芩黄连汤。泄泻并放屁的，是气向下泄，用白术散加升麻、防风提举。如果受寒邪，或吃生冷食物，导致泄泻清冷，痘色灰白、顶部凹陷，或者手足厥冷、寒战咬牙的，用陈氏木香散、异功散。疮形虽然正常但出现吐泻，或者下血，都属于逆证。如果只吐不泻，无痰，用益黄散；有痰，用二陈汤。吐而身热烦渴，腹部胀满气促，大小便涩滞且颜色红的，应当利小便。如果先呕吐而后出痘，足部蜷缩不能伸直，声音嘶哑、热气蒸腾的，即使有清浆也不治。陈文宿说：痘疮泻下水谷，或者白色，或者淡黄色的，用陈氏木香散送服豆蔻丸；不愈的，用异功散救治。
After the eruption of smallpox, the body relies entirely on the harmonious function of the Spleen and Stomach. If food intake is normal, pus formation and scabbing will occur easily. From the fourth or fifth day until the scabs fall off, if dietary intake does not decrease and urination and defecation remain normal, even if the pustules do not rise or turn red, or if they collapse (inversion), as long as the medication is appropriate, safety can be ensured. If milk and food intake decrease accompanied by diarrhea, the primordial Qi will decline daily. Although there are no prior severe symptoms, changes will inevitably occur later, and medications will be difficult to take effect; how can one ensure safety? If the chest area has dense eruptions and toxic heat damages the Spleen reducing appetite, use Xiaodu Yin (Detoxification Decoction) added with Huangqin (Scutellariae Radix), Shanzha (Crataegi Fructus), Zicao (Arnebiae Radix seu Lithospermi Radix), and Renshen (Ginseng Radix et Rhizoma). For cases of food stagnation causing abdominal distension and anorexia, use Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill). For cases where excessive eruption causes sudden deficiency of Middle Qi leading to anorexia, use Sizijunzi Tang (Four Gentlemen Decoction) added with Nuomi (Oryza Sativa Var. Glutinosa Semen). For cases where scabs have formed but the patient cannot eat and has no fever, focus on regulating and tonifying the Spleen and Stomach. For those who cannot eat and have constipation in the first four or five days, this indicates abundant toxin in the interior, which is still treatable. However, if after six or seven days the patient suddenly cannot eat, myriad complications will arise, and what benefit would medication bring? Individuals with robust constitution developing smallpox after age five should not be treated uniformly. Additionally, for those who can eat and feel hungry easily after eruption, this indicates excessive Stomach heat, which will lead to complications soon. For constipation, use Sishun Yin (Four Smoothness Decoction) added with Lianqiao (Forsythiae Fructus) and Niubangzi (Arctii Fructus) to mildly promote bowel movement. For non-constipation, use Shaoyao Tang (Peony Decoction) added with Fuling (Poria), Mutong (Akebiae Caulis), and Niubangzi to harmonize. For those feeling hunger but unable to swallow, it is likely due to lesions in the throat and tongue making chewing and swallowing difficult.
Regarding fever during smallpox, some present with vomiting, some with diarrhea, some with both, some with dry heaving and hiccuping, and some with anorexia. All are caused by toxic fire. Do not abruptly stop these symptoms, as vomiting and diarrhea contain the principle of unblocking. Treatment should be mild and dispersing, guiding toxins to the surface, after which vomiting and diarrhea will cease naturally. If they persist, regulate the Spleen and Stomach concurrently. Dry heaving with hiccups indicates deficient Stomach Qi with rebellious fire, a critical sign; use Jupi Zhulian San (Tangerine Peel, Evodia, and Coptis Powder) to calm Stomach Qi and clear toxic fire. Anorexia due to heat-toxin in the Spleen requires lifting and dispersing methods to allow toxins to exit outward, restoring appetite. Misinterpreting vomiting, diarrhea, and anorexia as interior cold and using Dingxiang (Caryophylli Flos), Rougui (Cinnamomi Cortex), Ganjiang (Zingiberis Rhizoma), and Fuzi (Aconiti Lateralis Radix Praeparata) will worsen irritability and severity. Misinterpreting them as interior deficiency and using Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), and Gancao (Glycyrrhizae Radix et Rhizoma) will increase stagnation. This advice applies specifically to early-stage smallpox that has not yet fully erupted. If vomiting, diarrhea, and anorexia occur during the pus-filling stage, it indicates Spleen-Stomach weakness, often leading to internal inversion (dao die), wheezing, and distension. During the rising and pus-filling stages, diarrhea is a dangerous sign; urgently use Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuling (Poria) to leach out dampness and strengthen the Spleen, Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix) to assist Yuan Qi and support the interior, Heziren (Terminalia Chebulae Fructus) and Roudoukou (Myristicae Semen) to stop diarrhea, assisted by lifting herbs to prevent stagnation. Without lifting, there is a risk of inversion. Restlessness, dry heaving, and hiccups indicate organ failure and attacking toxins, a most ominous sign; use Erchen Tang (Two-Cured Decoction) added with Huanglian (Coptidis Rhizoma), Mutong (Akebiae Caulis), Dengxincao (Junci Medulla), and Zhuyeqing (Bambusa Leaves). In summer, use Siling San (Four Porias Powder) to promote urination. Failure to urinate after promotion is critical. Diarrhea with hot extremities and red face indicates heat syndrome. For weak patients, use Baizhu San (Atractylodes Powder) added with Zhuye (Bamboo Leaves) and Chenpi (Citri Reticulatae Pericarpium); for strong patients, use Xiehuang San (Drain Yellow Powder). Diarrhea worse in the afternoon and loose in the morning indicates food stagnation; use Pingwei San (Peace the Stomach Powder) added with Shanzha (Crataegi Fructus) and Maiya (Hordei Fructus Germinatus). Add Ganjiang (Zingiberis Rhizoma) for cold limbs. Alternatively, use Yihuang San (Benefit the Spleen Powder) to tonify. Diarrhea with vomiting, reversal, and cold limbs requires Lizhong Tang (Regulate the Middle Decoction) added with Muxiang (Aucklandiae Radix). Diarrhea worse in the morning and absent in the afternoon indicates Spleen deficiency; use Baizhu San (Atractylodes Powder) in the morning and Doukou Wan (Cardamom Pill) in the evening. Foul-smelling, turbid diarrhea indicates Heat in the Intestines and Stomach; use Gegen Qinlian Tang (Kudzu and Coptis Decoction). Diarrhea with flatus indicates Qi sinking downward; use Baizhu San (Atractylodes Powder) added with Shengma (Cimicifugae Rhizoma) and Fangfeng (Saposhnikoviae Radix) to lift. Diarrhea with clear, cold stools due to cold pathogen or cold food consumption, accompanied by gray-white, inverted pustules, cold limbs, chills, and teeth grinding, requires Chen's Muxiang San (Chen's Aucklandia Powder) or Yigong San (Extraordinary Assistance Powder). Normal lesions with vomiting/diarrhea or hematochezia are adverse signs. Vomiting without diarrhea and phlegm uses Yihuang San (Benefit the Spleen Powder); with phlegm, use Erchen Tang (Two-Cured Decoction). Vomiting with fever, thirst, abdominal fullness, shortness of breath, and scanty red urine requires promoting urination. Vomiting preceding eruption, curling legs, hoarseness, and steaming heat indicate incurability despite pus formation. Chen Wensu stated: Smallpox diarrhea with watery stool, white or pale yellow color, is treated with Chen's Muxiang San (Chen's Aucklandia Powder) delivered with Doukou Wan (Cardamom Pill); if ineffective, Yigong San (Extraordinary Assistance Powder) is used for rescue.