夫痘分逆顺险法。古无有也。愚妄立之。何则。顺者吉之象。逆者凶之象。险者悔吝之象。
治痘而执此三法。以观形色。
验吉凶。将无施而不当也。盖痘发热三日。放标三日。起长二日。灌浆三日。收靥三日。始于见
形。终于结痂。凡十四五日之间而已。是故吉不必治。治则反凶。凶不可治。治之无益。至如险
者治之。则可以转危就安。夫气血盛。斯毒易解。气血损。则毒难愈。惟气血弱者。虽毒不能顿
解。故必加补益扶持。使生意固乎其中。无不平矣。余尝苦心究讨。定立法式。观者幸毋以余为僭。
一二日。初出如粟。血点淡红润色。于口鼻年寿之间。先发两三点。顺之兆也。形如蚕种。
紫黑干枯。于天庭司空印堂方广太阳等处先见者。逆之兆也。虽稠红润泽成个者。亦险也。圆晕
成形。干红少润。险之兆也。险者毒虽犯上。其气未离。候其气血交会。保元汤加桂。
二三日。根窠圆混。气满血附。长发饱满。光洁为顺。根窠无晕。气失血散。枯死不长为逆。
根窠虽圆而顶不满为险。保元汤加芎、桂。
四五日。大圆光泽。大小不一。气和血就为顺。绵密如蚕种。黑陷干红紫泡者为逆。根窠虽
起。色不光洁为险。保元汤加桂、糯米。
五六日。气会血附。红活鲜明为顺。气虽旺而血不归附。灰陷紫陷。或发水泡。痒塌为逆。
气弱血微。光白不荣为险。保元汤加木香、芎、归。
六七日。气化浆行。光洁饱满为顺。浆毒不行。神去色枯为逆气血不足。不能成浆为险。急
以保元汤加桂、米。
七八日。气旺血附。神全色润为顺。毒不化浆。色枯干紫为逆。发痈者可治。外剥者必死。
气血少缓。毒虽化而浆
不满为险。保元汤加桂、米。
八九日。浆足根化。而无他证为顺。浆不足而成外剥者为逆。浆不充满。血附线红气弱者
为险。保元汤加姜、米。
十一二日。血尽毒解。气调浆足而敛为顺。气弱血凝。枯朽剥尽为逆。血尽浆足。湿润不敛。
内虚为险。保元汤加苓、术。
十三四日。气血归本。浆老结痂为顺。毒未解而脱形。诸邪并作。虽结痂为逆。浆老结痂之
际。或有杂证相并。不可峻用大寒大热之剂。保元汤随证加减。
十四五日。气血收功。痂落瘢明为顺。痂未易落寒战切牙。谵语狂烦。疔肿作者为逆。痂落
潮热。唇红口渴。不能食者为险。四君子加黄连、山楂、陈皮。不解。大连翘汤加减。
论曰。保元汤。即东垣所制黄 汤也。不越人参、黄 、甘草。性味甘温。专补中气。而能
补火。故虚火非此不去。人参固内。黄 固表。甘草解毒。借以治痘。令其内固外护。扶阳助气。
使气生血附。藉此载领。有回生起死之功。或云。气血与毒同途。何专理气而不理血。殊不知气
旺自能载领其血也。或曰。桂者辛物。痘出已热。而专用之何也。盖取其辛甘发散。助参、 之
力而成伟功也。今更采入痘科诸方。辅助保元汤以收图治。是以升麻汤、和解汤、四顺清凉饮等。
有开济之功。故用于三日七日保元之前。解毒汤、大连翘汤、参苏饮等。有平治之能。故用于十
四日前后。四君子汤、生脉散、桔梗汤、参苓白术散、四苓散等。故用于保元之间。有赞相之能。
不拘日数。白螺散治痘之不收。金华散治痘后肥疳疥癣。生肌散治痘疳蚀不敛。以上诸方。不过
翊运保元。以济阴阳亏盈之变。治痘用药之要。始出之前。宜开和
解之门。既出之后。当塞走泄之路。痂落以后。清凉渐进。毒去已尽。补益宜疏。其他虽有奇方。
不合中和之道。悉皆不录。
痘疹分为逆、顺、险三种辨证方法。古代并没有这种说法，是我妄自创立的。为什么呢？因为“顺”是吉祥的象征，“逆”是凶险的象征，“险”则是悔恨与艰难的象征。
治疗痘疹时，如果执着于这三种方法来观察痘疹的形色，来验证吉凶，那么就没有不恰当的。大概痘疹发热三天，出标（痘疹初现）三天，起长两天，灌浆三天，收靥（结痂脱落）三天，从开始显现形态到最终结痂，总共不过十四五天的时间。所以，如果是顺证，不需要特别治疗，治疗反而会导致凶险；如果是逆证，不可强行治疗，治疗也没有益处。至于险证，通过治疗，就可以转危为安。气血旺盛，毒邪就容易化解；气血亏损，毒邪就难以痊愈。只有气血虚弱的人，虽然毒邪不能立刻解除，但必须加以补益扶持，使生机稳固在体内，就没有不平复的了。我曾经苦心钻研探讨，确定了这些法式，希望读者不要认为我僭越。
一二日：痘疹刚发出，像粟米一样，血点淡红润泽，先在口鼻、年寿（鼻准）之间出现两三点，这是顺证的征兆。形状像蚕种，紫黑干枯，在天庭、司空、印堂、方广、太阳等处先出现的，是逆证的征兆。虽然稠密红活润泽成片的，也是险证。圆晕成形，干红少润，是险证的征兆。险证虽然毒邪侵犯上部，但其气尚未离散，等待气血交会之时，用保元汤加桂枝。
二三日：根窠（痘疹根部）圆润混整，气满血附，长发饱满，光洁为顺证。根窠没有晕圈，气失血散，枯死不长为逆证。根窠虽然圆整但顶部不满为险证。用保元汤加川芎、桂枝。
四五日：大圆光泽，大小不一，气和血就为顺证。绵密如蚕种，黑陷干红紫泡者为逆证。根窠虽起，色不光洁为险证。用保元汤加桂枝、糯米。
五六日：气会血附，红活鲜明为顺证。气虽旺但血不归附，灰陷紫陷，或发水泡，痒塌为逆证。气弱血微，光白不荣为险证。用保元汤加木香、川芎、当归。
六七日：气化浆行，光洁饱满为顺证。浆毒不行，神去色枯为逆证。气血不足，不能成浆为险证。急用保元汤加桂枝、糯米。
七八日：气旺血附，神全色润为顺证。毒不化浆，色枯干紫为逆证。发痈者可治，外剥者必死。气血稍缓，毒虽化但浆不满为险证。用保元汤加桂枝、糯米。
八九日：浆足根化，而无其他症状为顺证。浆不足而成外剥者为逆证。浆不充满，血附线红气弱者为险证。用保元汤加生姜、糯米。
十一二日：血尽毒解，气调浆足而收敛为顺证。气弱血凝，枯朽剥尽为逆证。血尽浆足，湿润不收敛，内虚为险证。用保元汤加茯苓、白术。
十三四日：气血归本，浆老结痂为顺证。毒未解而脱形，诸邪并作，虽然结痂也为逆证。在浆老结痂之际，或有杂证相并，不可峻用大寒大热的药剂。保元汤随证加减。
十四五日：气血收功，痂落瘢明为顺证。痂未易落，寒战切牙，谵语狂烦，疔肿作者为逆证。痂落潮热，唇红口渴，不能食者为险证。用四君子汤加黄连、山楂、陈皮。不解，用大连翘汤加减。
论述说：保元汤，就是李东垣所制的黄芪汤。不离人参、黄芪、甘草。药性甘温，专门补中气，并能补火。所以虚火非此不去。人参固护内部，黄芪固护体表，甘草解毒。借此治疗痘疹，使其内固外护，扶阳助气，使气生血附，借此承载统领，有回生起死之功。有人说，气血与毒同途，为何专理气而不理血？殊不知气旺自然能承载统领其血。有人说，桂枝是辛味药，痘出已经发热，为何专用它呢？大概是取其辛甘发散，辅助人参、黄芪之力而成就伟大功效。现在更采集入痘科诸方，辅助保元汤以收图治。因此升麻汤、和解汤、四顺清凉饮等，有开济之功，所以用于第三日、第七日保元汤之前。解毒汤、大连翘汤、参苏饮等，有平治之能，所以用于第十四日前后。四君子汤、生脉散、桔梗汤、参苓白术散、四苓散等，故用于保元汤之间，有赞相之功。不拘泥于日数。白螺散治疗痘疹不收口，金华散治疗痘后肥疳疥癣，生肌散治疗痘疳蚀不收敛。以上诸方，不过是辅运保元汤，以救济阴阳盈亏的变化。治疗痘疹用药的要领，始出之前，宜开通和解之门；既出之后，当堵塞走泄之路；痂落以后，清凉渐进；毒去已尽，补益宜疏。其他虽有奇方，不合中和之道，全部都不收录。
The classification of smallpox/variolae into "Ni" (Adverse), "Shun" (Favorable), and "Xian" (Dangerous) methods did not exist in ancient times. I have presumptuously established this framework. Why? Because "Shun" represents an auspicious sign, "Ni" represents an ominous sign, and "Xian" represents a sign of regret and difficulty.
When treating variolae, if one adheres to these three methods to observe the shape and color, thereby verifying auspiciousness or ominousness, there will be no inappropriate application. Generally, fever lasts for three days, the emergence of marks (initial appearance of lesions) takes three days, elevation and growth take two days, pus filling takes three days, and scabbing and falling take three days. From the initial manifestation of form to the final formation of scabs, it is completed within about fourteen or fifteen days. Therefore, in cases of Shun (Favorable), treatment is unnecessary; treating them may lead to adverse outcomes. In cases of Ni (Adverse), forced treatment is ineffective and futile. However, for Xian (Dangerous) cases, treatment can turn danger into safety. When Qi and Blood are abundant, pathogens are easily resolved; when Qi and Blood are depleted, pathogens are difficult to heal. Only in cases of weak Qi and Blood, where pathogens cannot be instantly resolved, must tonification and support be added to stabilize vitality within, ensuring recovery without complication. I have painstakingly studied and determined these principles; readers are urged not to consider my work presumptuous.
Days 1-2: Lesions initially appear like millet grains, with pale red, moist blood spots, first emerging at two or three points between the mouth, nose, and Nianshou (tip of the nose). This is a sign of Shun (Favorable). If they resemble silkworm eggs, appearing purple-black and dry, and emerge first at Tianting, Sikong, Yintang, Fangguang, or Taiyang areas, this is a sign of Ni (Adverse). Even if dense, red, and moist, forming distinct patches, it is still considered Xian (Dangerous). If circular halos form but the color is dry red with little moisture, it is a sign of Xian (Dangerous). Although pathogens affect the upper body, the vital Qi has not yet dispersed. Wait for the intersection of Qi and Blood, then use Baoyuan Tang (Preserve Origin Decoction) with Guizhi (Cinnamon Twig).
Days 2-3: The base of the lesion (Genke) is round and integrated, with full Qi and attached Blood, growing long and plump, appearing clean and bright—this is Shun (Favorable). If the base lacks a halo, Qi is lost, Blood is scattered, and it appears withered, dead, and does not grow—this is Ni (Adverse). If the base is round but the apex is not full—this is Xian (Dangerous). Use Baoyuan Tang (Preserve Origin Decoction) with Xiong (Ligusticum Chuanxiong Rhizome) and Gui (Guizhi/Cinnamon Twig).
Days 4-5: Large, round, and glossy, varying in size, with harmonious Qi and settled Blood—this is Shun (Favorable). Dense like silkworm eggs, black and sunken, dry red, or purple blisters—this is Ni (Adverse). The base rises but the color is not clean and bright—this is Xian (Dangerous). Use Baoyuan Tang (Preserve Origin Decoction) with Gui (Guizhi/Cinnamon Twig) and Nuomi (Glutinous Rice).
Days 5-6: Qi meets and Blood attaches, appearing red, vibrant, and distinct—this is Shun (Favorable). Qi is vigorous but Blood does not attach; gray or purple sinking, or development of water blisters, itching, and collapse—this is Ni (Adverse). Qi is weak, Blood is minute, appearing pale white and lacking luster—this is Xian (Dangerous). Use Baoyuan Tang (Preserve Origin Decoction) with Muxiang (Aucklandiae Radix), Xiong (Ligusticum Chuanxiong Rhizome), and Gui (Angelicae Sinensis Radix).
Days 6-7: Qi transforms and Pus flows, appearing clean, bright, and plump—this is Shun (Favorable). Pus toxins do not flow, Spirit fades, and color becomes withered—this is Ni (Adverse). Insufficient Qi and Blood, unable to form pus—this is Xian (Dangerous). Urgently use Baoyuan Tang (Preserve Origin Decoction) with Gui (Guizhi/Cinnamon Twig) and Mi (Rice).
Days 7-8: Qi is vigorous, Blood attaches, Spirit is complete, and color is moist—this is Shun (Favorable). Toxins do not transform into pus, color becomes withered, dry, and purple—this is Ni (Adverse). Development of carbuncles is treatable; external peeling leads to death. Qi and Blood are slightly slow; although toxins transform, pus is insufficient—this is Xian (Dangerous). Use Baoyuan Tang (Preserve Origin Decoction) with Gui (Guizhi/Cinnamon Twig) and Mi (Rice).
Days 8-9: Pus is sufficient, bases resolve, with no other symptoms—this is Shun (Favorable). Insufficient pus leading to external peeling—this is Ni (Adverse). Pus is not full, blood attachment lines are red, and Qi is weak—this is Xian (Dangerous). Use Baoyuan Tang (Preserve Origin Decoction) with Jiang (Zingiberis Rhizoma) and Mi (Rice).
Days 11-12: Blood is exhausted, toxins are resolved, Qi is regulated, pus is sufficient, and lesions contract—this is Shun (Favorable). Qi is weak, Blood coagulates, becoming withered and fully peeled—this is Ni (Adverse). Blood is exhausted, pus is sufficient, but remains moist and does not contract due to internal deficiency—this is Xian (Dangerous). Use Baoyuan Tang (Preserve Origin Decoction) with Ling (Poria) and Zhu (Atractylodis Macrocephalae Rhizoma).
Days 13-14: Qi and Blood return to their roots, old pus forms scabs—this is Shun (Favorable). Toxins are not resolved, body emaciates, various evils act together; even if scabs form, it is Ni (Adverse). During the stage of old pus and scabbing, if mixed symptoms occur, harsh cold or hot agents should not be used severely. Modify Baoyuan Tang (Preserve Origin Decoction) according to symptoms.
Days 14-15: Qi and Blood conclude their work, scabs fall revealing clear skin—this is Shun (Favorable). Scabs have not fallen, accompanied by chills, teeth grinding, delirium, mania, and carbuncle formation—this is Ni (Adverse). Scabs fall with tidal fever, red lips, thirst, and inability to eat—this is Xian (Dangerous). Use Sijunzi Tang (Four Gentlemen Decoction) with Huanglian (Coptidis Rhizoma), Shanzha (Crataegi Fructus), and Chenpi (Citri Reticulatae Pericarpium). If unresolved, use Dalianqiao Tang (Great Lonicera Decoction) modified.
Discussion: Baoyuan Tang (Preserve Origin Decoction) is the Huangqi Tang (Astragalus Decoction) created by Li Dongyuan. It consists of Ren Shen (Ginseng Radix), Huang Qi (Astragali Membranacei Radix), and Gan Cao (Licorice Root). Its nature is sweet and warm, specifically tonifying Middle Qi and supplementing Fire. Thus, deficient fire cannot be dispelled without it. Ren Shen (Ginseng Radix) secures the interior, Huang Qi (Astragali Membranacei Radix) secures the exterior, and Gan Cao (Licorice Root) resolves toxicity. Using this to treat variolae ensures internal security and external protection, supporting Yang and assisting Qi, generating Blood through Qi, and carrying it along, possessing the power to revive the dead. Some say, Qi and Blood share the same path as toxins; why manage Qi exclusively and not Blood? It is unknown that when Qi is vigorous, it naturally carries and manages Blood. Others ask, Guizhi (Cinnamon Twig) is pungent; since heat arises after lesions appear, why use it exclusively? It is taken for its pungent-sweet dispersing action, assisting the power of Ren Shen (Ginseng Radix) and Huang Qi (Astragali Membranacei Radix) to achieve great merit. Now, various formulas from the variolae specialty are incorporated to assist Baoyuan Tang (Preserve Origin Decoction) for comprehensive treatment. Therefore, Shengma Tang (Ephedra Decoction), Hejie Tang (Harmonizing Decoction), and Sishun Qingliang Yin (Four-Smooth Cooling Drink) have opening and aiding functions, so they are used before the third and seventh days prior to Baoyuan Tang (Preserve Origin Decoction). Jiedu Tang (Detoxification Decoction), Dalianqiao Tang (Great Lonicera Decoction), and Rensu Yin (Ginseng and Perilla Drink) have pacifying and governing abilities, so they are used around the fourteenth day. Sijunzi Tang (Four Gentlemen Decoction), Shengmai San (Generate Pulse Powder), Jiegeng Tang (Platycodon Decoction), Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder), and Siling San (Four-Poria Powder) are used between applications of Baoyuan Tang (Preserve Origin Decoction), having a supportive function. Regardless of the day count. Bailuo San (White Snail Powder) treats non-healing variolae; Jinhua San (Jinhua Powder) treats post-variolae obesity, phthisis, scabies, and tinea; Shengji San (Generate Flesh Powder) treats variolae phthisis erosion and non-healing. The above formulas merely assist and transport Baoyuan Tang (Preserve Origin Decoction) to remedy changes in Yin-Yang deficiency and excess. The key to medication for treating variolae: before emergence, open the gate of harmonization and resolution; after emergence, block the path of leakage; after scabbing, gradually apply cooling; when toxins are completely gone, tonification should be gentle. Other miraculous formulas, though existing, do not conform to the Way of Harmony and Neutrality, and are all excluded.