痘者，胎中之阴毒也，必赖阳气以成之。小儿出痘大约发热三日，肌肉松透，然后能见
点苗齐，热退乃真阳内伏，交会于阴。复发热三日，是运水到苗，以成清浆，浆足热退，及
至养浆，真阳外出，发热三日，化毒以成脓，脓成热退而阳伏。毒既化脓，又必发热蒸干，
方能结痂。痂落后真阳外出，蒸化斑点，谓之烧斑。倘有黑斑，乃是火衰，并非因吃盐酱之
故，所谓痘禀于阴而成于阳也。如此，治痘之法，始终当以补气血扶阳气为第一义，用药以
温补少加发散为首务。否则，气不足则痘顶不起，火不足则浆不稠，且恐厥逆腹痛，阴寒起
而坏症作矣。
或问曰∶痘宜温补，此理甚明，若兼发散，岂不伤气？不知纯用散药，汗多则伤气，少
加发散药于温补药中，则血脉疏通，痘疮易出，无壅滞之患，受解散之功。所以古方补中益
气汤内有升麻、柴胡，大温中饮内有麻黄，温中补气尚用散药，可见古人用心之妙。痘之初
出，是断不可减去散药者也。
或又问曰∶痘宜温补兼散，此理已明。后开大补元煎、六味回阳饮，此二方重用附、桂
，并无散药，兼用龙骨、粟壳收涩之药，其义何取？不知温补兼散，乃治寻常痘疮之法。更
有一种小儿发热一二日，即遍身出痘，古书无方，时师袖手，此乃阴毒太重，阳气太虚，阴
毒一发，阳气已清，故泻痢不止，泻出之物多作青黑色，肝气所化，胃气将竭之兆。速宜大
补元煎、六味回阳饮，二方大剂连进，可以扶元阳，可以清阴毒，操起死回生之功，有鬼神
莫测之妙。二方合煎名返魂丹，治痘收效，指不胜屈。余治外甥汪陵医案所当细阅。
至于清火解毒凉药，必察明果有实火者方可暂用。若误用于齐苗时，则水不能升而顶陷
。若误用于养浆时，则浆不能稠而痒塌，痒塌者真火衰也明矣。当前速宜参、熟，并用附、
桂同煎，脾肾双补，大剂叠进，尚可挽回。否则，寒战切牙，吐泻交作，不可为矣。至于身
凉而脓不干，痂落而斑不化，及痘后发毒，皆因误服生地、银花、泽泄、连翘等凉药之故，
不可不知。热有邪正，必当体察。正热者，阳气蒸腾，自内达外，苗露头而不恶寒，时热时
止，兼有小汗，手足温和，饮食有味，二便如常，所谓内外无邪，不必服药。邪热者，偶受
风寒，头痛恶寒，四肢冷而无汗，荆防地黄汤内加肉桂一钱，一二剂尽可解散表邪而愈。古
人云∶热不可尽除，真格言也。
痘疮，是胎儿时期形成的阴毒，必须依赖阳气才能发育成熟。小儿出痘大约发热三天，肌肉变得松弛透达，然后才能看到痘点整齐出现；热退后是真阳内伏，与阴气交会。再次发热三天，这是运送水液到痘苗，以形成清亮的浆液；浆液充足后热退；到了养浆阶段，真阳外出，再发热三天，化解毒素形成脓液；脓液形成后热退而阳气内伏。毒素既然化为脓液，又必须通过发热来蒸干，才能结痂。痂皮脱落后真阳外出，蒸发化解斑点，这叫做“烧斑”。如果出现黑斑，那是火衰的表现，并不是因为吃了盐酱的缘故，这就是所说的痘疮禀受于阴而成于阳的道理。像这样，治疗痘疮的方法，自始至终都应当把补气血、扶助阳气作为第一要义，用药以温补为主，稍加发散药物为首要任务。否则，气不足则痘顶起不来，火力不足则浆液不浓稠，而且恐怕会出现四肢厥冷、腹痛等症，阴寒之气兴起而导致坏证发作。
有人问：痘疮宜用温补，这个道理很明白，如果兼用发散药，难道不会伤气吗？不知道单纯使用发散药，出汗多就会伤气；在温补药中少加一点发散药，就能使血脉疏通，痘疮容易发出，没有壅滞的祸患，从而受到解散邪气的功效。所以古方补中益气汤里面有升麻、柴胡，大温中饮里面有麻黄，即使是温中补气也使用发散药，可见古人用心的精妙。痘疮刚出来的时候，是绝对不可以减去发散药的。
又有人问：痘疮宜用温补兼发散，这个道理已经明白了。后来开设的大补元煎、六味回阳饮这两个方子，重用附子、肉桂，并没有发散药，还兼用龙骨、粟壳等收涩的药物，这是什么用意呢？不知道温补兼发散，是治疗寻常痘疮的方法。还有一种情况，有些小儿发热一两天，就遍身出痘，古书没有记载方剂，当时的医生束手无策，这是因为阴毒太重，阳气太虚，阴毒一发出来，阳气就已经耗竭，所以泻痢不止，泻出的东西多呈青黑色，这是肝气所化，胃气即将竭绝的征兆。此时应当迅速使用大补元煎、六味回阳饮，两个方子大剂量连续服用，可以扶助元阳，可以清除阴毒，起到起死回生的功效，有鬼神都难以测度的奇妙之处。两个方子合在一起煎煮名叫返魂丹，治疗痘疮收到疗效的例子，数不胜数。我治疗外甥汪陵的医案，应当仔细查阅。
至于清热泻火解毒的凉性药物，必须查明确实有实火的情况下才可以暂时使用。如果在痘点刚齐的时候误用，则水液不能上升导致痘顶凹陷。如果在养浆的时候误用，则浆液不能浓稠导致瘙痒塌陷，瘙痒塌陷说明真火衰弱是很明显的了。此时应当迅速用人参、熟地黄，并用附子、肉桂同煎，脾肾双补，大剂量接连进服，还可以挽回局面。否则，就会出现寒战咬牙、呕吐腹泻交替发作，就无法救治了。至于身体发凉而脓液不干，痂皮脱落而斑点不化，以及痘后发毒，都是因为误服生地、金银花、泽泻、连翘等凉性药物的缘故，不可不知道。热有邪热和正热之分，必须仔细体察。正热，是阳气蒸腾，从内部达于外部，痘苗露头而不恶寒，时热时止，兼有小汗，手足温和，饮食有味，大小便正常，这就是所谓的内外无邪，不必服药。邪热，是偶然受风寒侵袭，头痛恶寒，四肢冰冷而无汗，在荆防地黄汤中加入一钱肉桂，一二剂就可以解散表邪而痊愈。古人说：热不可尽除，真是至理名言啊。
Smallpox (Dòuzhěn) is the Yin toxin (Yīn dú) formed in the fetus, which must rely on Yang Qi (Yáng qì) to mature. Children with smallpox typically experience fever for about three days; once the muscles become loose and permeable, the pustules (dòu diǎn) appear uniformly. When the fever subsides, it indicates that True Yang (Zhēn yáng) is hidden internally and interacting with Yin. Fever recurs for another three days, representing the transport of fluids to the pustules to form clear serum (qīng jiāng). Once the serum is sufficient, the fever subsides. During the stage of nourishing the serum (yǎng jiāng), True Yang emerges externally, causing fever for three more days to transform toxins into pus (nóng). After the pus forms, the fever subsides again as Yang becomes hidden. Since the toxin has turned to pus, further fever is required to evaporate the moisture before scabs can form. After the scabs fall off, True Yang emerges externally to evaporate and resolve the spots, a process called "burning spots" (shāo bān). If black spots appear, it signifies Fire deficiency (huǒ shuāi), not due to consuming salt or soy sauce. This illustrates that smallpox originates from Yin but matures through Yang. Therefore, the treatment principle for smallpox should always prioritize tonifying Qi and Blood (qì xuè) and supporting Yang Qi. Medication should primarily use warming and tonifying herbs, with a minor addition of dispersing agents. Otherwise, insufficient Qi will prevent the pustule tops from rising, and insufficient Fire will result in thin serum, potentially leading to cold limbs (jué nì), abdominal pain, and the onset of severe complications due to rising Yin Cold.
A question arises: It is clear that smallpox requires warming and tonification; if dispersing agents are added, will they not damage Qi? The answer is that purely using dispersing herbs causes excessive sweating, which damages Qi. However, adding a small amount of dispersing herbs to warming and tonifying formulas unblocks the blood vessels, facilitates the eruption of smallpox, prevents stagnation, and allows the body to benefit from the dispersal of pathogens. Thus, ancient formulas like Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) contain Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix), and Dawenzhong Yin (Greatly Warm the Middle Decoction) contains Mahuang (Ephedrae Herba). Even when warming and tonifying Qi, dispersing herbs are used, demonstrating the profound wisdom of ancient physicians. At the initial stage of smallpox eruption, dispersing herbs must absolutely not be omitted.
Another question: It is now clear that smallpox treatment involves warming, tonifying, and dispersing. However, the later formulas Dabu Yuanyuan Jian (Greatly Tonify the Origin Decoction) and Liuwei Huiyang Yin (Six-Ingredient Return Yang Decoction) heavily use Fuzi (Aconiti Lateralis Radix Praeparata) and Rougui (Cinnamomi Cortex), without any dispersing herbs, and instead include astringents like Longgu (Fossilia Ossis Mastodi) and Suke (Papaveris Pericarpium). What is the rationale? Warming, tonifying, and dispersing is the method for ordinary smallpox cases. In some children, fever lasts only one or two days before the body erupts with smallpox. Ancient texts lack prescriptions for this, and contemporary doctors are at a loss. This condition results from severe Yin toxicity and extreme Yang deficiency. When the Yin toxicity erupts, the Yang Qi is already exhausted, leading to incessant diarrhea and dysentery. The excrement is often dark green or black, indicating transformation by Liver Qi and the impending exhaustion of Stomach Qi. In such urgent cases, Dabu Yuanyuan Jian and Liuwei Huiyang Yin should be administered in large doses continuously. These formulas support Yuan Yang (Primordial Yang) and clear Yin toxicity, achieving the miraculous effect of restoring life from death. When decocted together, they are named Fanshun Dan (Return Soul Pill), which has yielded numerous successful cases in treating smallpox. Readers should carefully study my medical case record of treating my nephew Wang Ling.
Regarding cooling herbs for clearing fire and detoxifying, they may only be used temporarily after confirming the presence of Excess Fire (Shí huǒ). If mistakenly used when the pustules are uniform, fluids cannot ascend, causing the pustule tops to sink. If mistakenly used during the serum-nourishing stage, the serum will fail to thicken, leading to itching and collapse, which clearly indicates True Fire deficiency. In such cases, immediately administer Renshen (Ginseng Radix) and Shudihuang (Rehmanniae Radix Praeparata), decocted with Fuzi and Rougui, to simultaneously tonify the Spleen and Kidney. Large doses administered continuously can still reverse the situation. Otherwise, chills, teeth grinding, vomiting, and diarrhea will occur, rendering the condition incurable. Conditions such as cool body temperature with non-drying pus, spots failing to resolve after scab detachment, and post-smallpox toxicity are all caused by the mistaken use of cooling herbs like Shengdi Huang (Rehmanniae Radix), Jinyinhua (Lonicerae Japonicae Flos), Zexie (Alismatis Rhizoma), and Lianqiao (Forsythiae Fructus). One must understand this. Heat is categorized as either Pathogenic Heat (Xié rè) or Physiological Heat (Zhèng rè), requiring careful differentiation. Physiological heat is the steaming of Yang Qi from inside out; the pustules emerge without aversion to cold, the fever comes and goes, accompanied by slight sweating, warm hands and feet, normal appetite, and regular urination and defecation. This indicates no pathogenic factors inside or outside, and no medication is needed. Pathogenic heat results from accidental exposure to Wind-Cold, presenting with headache, aversion to cold, cold limbs, and anhidrosis. Adding Qian jin (5 grams) of Rougui to Jingfang Dihuang Tang (Schizonepeta, Saposhnikovia, and Rehmannia Decoction) can resolve the exterior pathogen within one or two doses. As the ancients said, "Heat should not be completely eradicated," which is indeed a true maxim.