痘疹一证，虽原于有生之初，然必因时气相触，内外挟邪而后作。凡痘之轻重，已兆于发热之
微甚，而吉凶于此亦可判矣。毒轻者易出易靥，固不必治；毒甚者险证百出，故不得不治。凡治此
者，于初热时，急宜用轻扬之剂，汗以散之，但使外感之邪，脏腑之毒，皆作秽汗，尽从毛窍中出
，则毒瓦斯已减其半，而重者可轻，危者可活矣。即如痘中一切变证，亦无非毒瓦斯欲出不能之所为，
一经表散，则毒从汗去，而诸证亦必自退。然又当察表里之轻重，或宜解表，或宜清里，或宜托助
元气，孰者宜急，孰者宜缓，有不可执一也。故胡氏曰∶表热壅盛，非微汗则热不解，里热壅盛，
非微利则里不解。失此不治，则毒瓦斯渐盛，而逆证随见矣。
一、散表之法，当知邪之浅深，毒之微甚。表邪甚者微散之，则表不能解，无益于事；表邪微
者妄汗之，则表气必虚，痘不起发，而反为大害。故惟以得中为贵，亦以微汗为贵，不可过伤卫气
也。其有大热不退，肌肤秘密，或气令寒凝之时，则不得不大为表散，一散未应，或至于再，必令
身热由汗而退，则毒瓦斯自解，可无患矣。此散之微甚，有权宜也。故凡是痘证，最畏内外之寒气，
务使表里温暖，但得毛窍中常见津津润泽，亦犹庖人炊笼之法，但欲其松，则皮肤通畅，气无不达，
痘必易出易收，无不善矣。
一、痘疮发热之候，宜乍热乍凉者为常。若遍身如火，昼夜不休，为失常也。此当察其表里，
酌宜施治。
一、痘疮初见发热，若无虚寒等证，固不得骤用温补，以助火邪，恐致鼓扇痘毒，则反资大害。
若无实火大热等证，切不可因其发热，妄用寒凉，必致败脾泄泻，则为害尤甚。此时医之通弊也，
大宜戒之。
一、既经表散之后，须谨避风寒，若使外邪再感，则皮毛闭塞，热毒必将复炽，汗而再汗，必
不能堪。又须切戒生冷水果，若误犯之，恐寒湿伤脾而为泄泻不食，则无不致害。
一、表散之剂，凡初见发热，状类伤寒，未知是痘非痘，即当先用汗散。此时欲散表邪，即当
兼调营气，宜以柴归饮为第一，惟大便不实者勿用之，以其性多润也，其次则苏葛汤，再次则升麻
葛根汤，或只用加减参苏饮亦佳。若冬月寒胜之时，或气体壮实，表不宜解者，须加麻黄，必要表
出一身臭汗为佳，但使热退身凉，苗则轻矣。若初发热，有恶寒身振如疟之状者，阳气虚也，宜柴
葛桂枝汤加黄 主之，痘出即愈。
一、清解之剂，用治表里而兼清兼散也。凡热之甚者毒必甚，若身常有汗而大热不退，或兼烦
躁热渴者，此其内火熏蒸而表里俱热也，须两解之，宜连翘升麻汤，或如圣汤。若身热烙手而目赤
口干，二便热秘，烦闷不安者，此表里俱实也，宜柴胡饮子，甚者大连翘饮、双解散，或调益元散
以利之。
一、表汗已透者，不得再汗，恐外亡阳而内伤气也。
一、发热之时，有腹痛胀满者，必外邪与毒瓦斯相并，未得外达而然，宜参苏饮加砂仁，温而散
之。
一、初热时，有惊搐谵语者，是为痘搐。微见而随止者不必治。若元气强壮而搐之甚者，宜羌
活散调制过朱砂以表之。若痰涎壅盛，喉内作声者，宜烈生姜汤，调化痰丸服之，或抱龙丸亦可。
一、此时渴欲茶水，只宜少与葱白汤，既可止渴，亦可疏表。
一、痘疮首尾皆畏泄泻，宜检本条速为治之，否则内溃脱陷之祸，不可胜言也。
徐氏曰∶凡解表之药，必在红点未见之前，如热之甚者，邪毒必甚，宜败毒散或参苏饮，调三
酥饼。
张冀之曰∶凡痘疮一见红点，便不可用升麻葛根汤，恐发得表虚也。程晨峰曰∶治痘者不可轻
用升麻，恐提气上冲，引动肺气也。按此二家之说，是皆治痘之大要，甚属有理，但其中亦有宜否之
辨。如阳气下陷，不能透达肌表者，则暂用升麻，固其所宜。又或虽见红点而表有热邪未解者，则
仍宜解散，亦不可缓。些二说者，虽不可坚执，实不可不知也。
吴东园曰∶初热时，只有二事，惟去邪扶正而已。邪热盛则去邪而正气自旺，正气衰则扶正而
邪热自退。正气盛而痘自发，热为痘用，则不为害矣。邪气退而正气不受烁，血脉充裕，则痘自泰
矣。须于此时看明，下手迟则无济于事矣。
痘疹这一病证，虽然根源在于生命初始之时，但必然因为感受时行疫气，内外邪气相合才会发作。凡是痘疮的轻重程度，在发热症状的轻微或严重上就已经显露征兆，而预后的吉凶也可以由此判断。毒邪轻浅者容易发出且容易结痂愈合，本来就不需要特别治疗；毒邪深重者险恶证候百出，所以不得不进行治疗。凡是治疗这类疾病，在初起发热阶段，应当紧急使用性质轻扬升散的药剂，通过发汗来疏散邪气，只要能使外感之邪、脏腑之毒，都化作秽浊之汗，完全从毛孔中排出，那么毒势就会减少一半，重症可转为轻症，危症可转危为安。就像痘疮出现的一切变证，无非是毒邪想要透出体表却受阻所致，一旦经过表散治疗，毒邪随汗液而去，各种证候也必然会自行消退。然而又应当审察表证和里证的轻重，有的适宜解表，有的适宜清里，有的适宜托举扶助元气，哪些情况急需处理，哪些可以缓治，不能固执于一种方法。所以胡氏说：表热壅盛，如果不微微发汗则热势不解；里热壅盛，如果不微微通利大便则里热不解。错过这个时机不治疗，毒势就会逐渐增强，逆证随即出现。
一、发散表邪的方法，应当知道邪气的深浅和毒邪的微甚。表邪严重者如果只轻微发散，则表邪不能解除，对病情无益；表邪轻微者如果妄用大汗法，则卫表之气必虚，痘疮不能起发，反而造成大害。所以只有掌握适度最为珍贵，也以微微出汗为贵，不可过度损伤卫气。如果有高热不退、肌肤腠理密闭，或者正值气候寒冷凝滞之时，则不得不大力发散表邪，一次发散未见效，甚至进行两次，务必使身体热度随汗出而退去，那么毒邪自然解散，就没有祸患了。这种散法的微甚程度，需要根据情况权宜变通。所以凡是痘疮病症，最畏惧内外的寒气，务必使表里温暖，只要能让毛孔中经常保持微微湿润润泽的状态，也就像厨师蒸笼的方法一样，只希望其疏松透气，那么皮肤通畅，气机无不通达，痘疮必然容易发出也容易收靛，没有不好的结果。
一、痘疮发热的时期，适宜忽冷忽热作为常态。如果全身像火一样烧灼，昼夜不停，属于失常现象。此时应当审察表里状况，酌情施治。
一、痘疮刚见发热时，如果没有虚寒等证候，固然不能骤然使用温补药物，以免助长火邪，恐怕导致鼓动煽惑痘毒，反而造成大害。如果没有实火大热等证候，切不可因为其发热，就妄用寒凉药物，必定会导致脾胃败坏、腹泻，这样危害尤其严重。这是当时医生常见的弊病，非常应该戒除。
二、经过表散治疗后，必须谨慎避免风寒，如果让外邪再次侵袭，则皮毛闭塞，热毒必将重新炽盛，反复发汗，身体必定无法承受。又必须严格戒除生冷水果，如果误食，恐怕寒湿损伤脾胃而导致腹泻、食欲不振，那就无不致害了。
一、解表散邪的药剂，凡是刚见发热，症状类似伤寒，不知道是痘疮还是其他疾病时，就应当先用发汗散邪之法。此时想要疏散表邪，就应当兼调营气，以柴归饮为首选，只有大便不成形者不要使用，因为其药性多滋润。其次则是苏葛汤，再次是升麻葛根汤，或者只用加减参苏饮也很好。如果在冬季寒气胜出的时候，或者患者体质壮实，不宜单纯解表的情况，须加入麻黄，必要时要发出一身臭汗为佳，只要使热度退去、身体凉爽，痘势就会减轻。如果初起发热时，有怕冷、身体颤抖像疟疾一样的症状，这是阳气虚弱，宜用柴葛桂枝汤加黄芪主治，痘疮发出后痊愈。
一、清解类药剂，用于同时治疗表里，兼具清热和发散作用。凡是热势严重的毒邪必然严重，如果身体经常出汗但大热不退，或者兼有烦躁、口渴，这是内火熏蒸导致表里俱热，需要表里两解，宜用连翘升麻汤，或者如圣汤。如果身体热得烫手，眼睛发红，口干，大小便热秘，烦闷不安，这是表里俱实证，宜用柴胡饮子，严重的用大连翘饮、双解散，或者调服益元散以利下。
一、表汗已经透发出来的，不得再发汗，恐怕导致阳气外亡而内伤正气。
一、发热的时候，如果有腹痛胀满的症状，一定是外邪与毒邪相并，未能向外透达所致，宜用参苏饮加砂仁，温散之。
一、初起发热时，如果出现惊厥抽搐、胡言乱语，这称为痘搐。如果只是轻微出现随即停止的不必治疗。如果元气强壮而抽搐严重的，宜用羌活散调制过朱砂来发表。如果痰涎壅盛，喉咙里有声音的，宜用烈生姜汤，调服化痰丸，或者抱龙丸也可以。
一、这个时候想喝茶水，只适宜少量给予葱白汤，既可以止渴，也可以疏解表邪。
一、痘疮从头到尾都害怕发生泄泻，应当查阅本条内容迅速治疗，否则会有内部溃烂、塌陷的危险，后果不堪设想。
徐氏说：凡是解表的药物，必须在红点尚未出现之前使用，如果热势严重，邪毒必然严重，宜用败毒散或参苏饮，调服三酥饼。
张冀之说：凡是痘疮一见红点，就不能再用升麻葛根汤，恐怕导致表虚。程晨峰说：治疗痘疮不可轻易使用升麻，恐怕提升气机上冲，引动肺气。按这两家的说法，都是治疗痘疮的要领，很有道理，但其中也有适宜与否的辨别。比如阳气下陷，不能透达肌表的情况，则暂时使用升麻，固然是适宜的。又或者虽然见到红点但表有热邪未解的情况，则仍然适宜解散，也不可迟缓。这两种说法，虽然不可固执坚持，但实际上不可不知道。
吴东园说：初起发热时，只有两件事，只是去除邪气和扶助正气而已。邪热盛则去除邪气而正气自然旺盛，正气衰则扶助正气而邪热自然消退。正气盛而痘疮自然发出，热被痘疮所用，就不会造成伤害了。邪气退而正气不被灼伤，血脉充裕，则痘疮自然安稳。必须在这个时候看清楚，下手迟了就无济于事了。
The disease of smallpox and measles (Douzhen), although originating from the beginning of life, must occur due to contact with seasonal pathogens (Shiqi) and the combination of internal and external pathogenic factors. The severity of smallpox is already indicated by the mildness or severity of fever, and prognosis can be judged accordingly. When the toxin is light, eruption and crusting are easy, so treatment is not strictly necessary; when the toxin is severe, various dangerous syndromes emerge, necessitating treatment. In treating this condition, during the initial fever stage, it is urgent to use light and ascending/dispersing agents to induce sweating and disperse the pathogen. If external pathogens and internal organ toxins can all be excreted as foul sweat through the hair follicles, the toxin load will be reduced by half, turning severe cases into mild ones and critical cases into survivable ones. All complications in smallpox are essentially caused by the toxin's inability to erupt. Once dispersed via the surface, the toxin leaves with sweat, and symptoms subside. However, one must assess the severity of exterior versus interior conditions: some require exterior resolution, some interior clearing, and some support of Yuan Qi (Primal Qi). One cannot adhere rigidly to a single method. As Hu stated: "When exterior heat is congested and excessive, only slight sweating resolves it; when interior heat is congested and excessive, only slight purgation resolves it." Missing this window allows the toxin to intensify, leading to adverse syndromes.
1. Methods for dispersing the exterior must consider the depth of the pathogen and the intensity of the toxin. If the exterior pathogen is severe but treated with mild dispersion, the exterior will not resolve, yielding no benefit. If the exterior pathogen is mild but treated with profuse sweating, Wei Qi (Defensive Qi) will be depleted, preventing eruption and causing great harm. Therefore, moderation is key, aiming for slight sweating without excessively damaging Wei Qi. In cases of persistent high fever, closed pores, or cold weather, vigorous dispersion may be necessary. If one attempt fails, repeat until fever subsides with sweat, resolving the toxin. This requires flexibility. Smallpox fears cold internally and externally; maintaining warmth ensures pores remain slightly moist and open, similar to a steamer, allowing Qi to reach the skin, facilitating easy eruption and recovery.
2. During the fever phase of smallpox, alternating hot and cold sensations are normal. Continuous burning heat day and night is abnormal and requires assessment of exterior/interior status for appropriate treatment.
3. At the onset of fever, if there are no deficiency-cold signs, warm-tonifying herbs should not be used abruptly to avoid aiding fire and stirring up toxin. Conversely, if there are no excess-fire or high-heat signs, cold-cooling herbs should not be used merely because of fever, as this damages the Spleen, causing diarrhea, which is even more harmful. This is a common medical error that must be avoided.
4. After dispersing the exterior, one must strictly avoid wind and cold. Re-infection closes the pores, reigniting heat-toxin, making repeated sweating unbearable. Raw/cold foods and fruits must also be avoided to prevent Cold-Dampness from injuring the Spleen, leading to diarrhea and anorexia.
5. For initial fever resembling Taiyang disease (Cold Damage) where smallpox is uncertain, use diaphoretic methods first. To disperse exterior pathogens while regulating Ying Qi (Nutritive Qi), Chai Gui Yin (Bupleurum and Angelica Decoction) is preferred, except for those with loose stools due to its lubricating nature. Alternatives include Su Ge Tang (Perilla and Kudzu Decoction) or Shengma Gegen Tang (Cimicifugae Rhizoma and Puerariae Radix Decoction), or Jiachen Rensu Yin (Modified Ginseng and Perilla Decoction). In winter or for robust constitutions requiring stronger dispersion, add Ephedrae Herba (Mahuang) to induce a heavy sweat, cooling the body and reducing severity. If initial fever presents with aversion to cold and tremors resembling malaria, indicating Yang Qi deficiency, use Chaige Guizhi Tang (Bupleurum, Kudzu, and Cinnamon Twig Decoction) plus Astragali Radix (Huangqi). Recovery follows eruption.
6. Clearing and resolving agents treat both exterior and interior simultaneously. Severe heat implies severe toxin. If fever persists despite sweating, accompanied by irritability and thirst, it indicates internal fire steaming both interior and exterior; use Qiaoshao Shengma Tang (Forsythiae Fructus and Cimicifugae Rhizoma Decoction) or Rusheng Tang. If the body is hot to the touch, eyes are red, mouth dry, and bowels/bladder are obstructed with heat, indicating fullness in both exterior and interior, use Chaihu Yinzi (Bupleuri Decoction). For severe cases, Da Lianqiao Yin (Large Forsythia Decoction) or Shuangjie San (Double Resolution Powder), or Yi Yuan San (Benefit Primordial Powder) mixed for purgation.
7. Once exterior sweat has been achieved, do not sweat again, to prevent loss of Yang Qi and injury to interior Zheng Qi (Upright Qi).
8. Abdominal pain and distension during fever indicate exterior pathogen combined with toxin failing to exit. Use Rensu Yin (Ginseng and Perilla Decoction) plus Amomi Fructus (Sharen) to warm and disperse.
9. Initial fever with convulsions and delirium is called "Dou Chu" (Smallpox Convulsion). Mild, self-limiting cases need no treatment. For strong constitution with severe convulsions, use Qianghuo San (Notopterygii Rhizoma Decoction) processed with Cinnabaris (Zhusha) to release the exterior. For copious phlegm-saliva and throat sounds, use Lie Shengjiang Tang (Strong Ginger Decoction) with Huatan Wan (Phlegm-Resolving Pill) or Baolong Wan.
10. Thirst for tea/water at this stage should be satisfied sparingly with Congbai Tang (Scallion White Decoction), which quenches thirst and disperses the exterior.
11. Diarrhea is feared throughout the course of smallpox. Treat promptly to avoid internal collapse and sinking, which are catastrophic.
Xu stated: Exterior-resolving medicines must be used before red spots appear. For severe heat/toxin, use Baidu San (Toxin-Overcoming Powder) or Rensu Yin, taken with Sansu Bing (Three-Su Biscuit).
Zhang Jizhi stated: Once red spots appear, Shengma Gegen Tang should not be used, fearing it causes exterior deficiency. Cheng Chenfeng stated: Do not lightly use Cimicifugae Rhizoma (Shengma) in smallpox treatment, fearing it lifts Qi upward and disturbs Lung Qi. These views are important principles, though nuances exist. If Yang Qi is sunken and cannot reach the skin, temporary use of Shengma is appropriate. If red spots appear but exterior heat remains unresolved, dispersion is still necessary. These theories should be understood, not rigidly applied.
Wu Dongyuan stated: Initial fever involves only two tasks: removing pathogen and supporting Zheng Qi. If pathogen-heat is strong, remove it so Zheng Qi flourishes; if Zheng Qi is weak, support it so pathogen-heat recedes. Strong Zheng Qi leads to natural eruption, utilizing heat for the rash without harm. Retreated pathogen preserves blood vessels, ensuring stability. Timely action is crucial; delay renders treatment futile.