（光绪三年丁丑添加）
痘疮之起，由来远矣。或云自周，或云自汉，然总不越乎氤氲化醇。当构精结胎时，先
天之邪火，伏于脏腑，偶感天时，遂行发泄。故曰天行。
天行之来，父母之心惕然矣。何也？以其夭折之多也。前人出大智能，创为种痘之法。
预贮痘痂之纯洁坚浓者，研而为面，于天行未起、和风甘雨之时，择婴儿之无疾病疮疥疳积
等症者，以纸筒装痂末，吹其鼻内，或用银簪剔取鲜浆，藏于鼻中。令其气息透入于肺，同
类相招，因而泄发。天时既正，身体又健，而且未渴掘井，治之于未然，慎之于将发，刻刻
提防，事事周匝，故十存其九，法至善也。然不能保其万全者。因肺开窍于鼻，肺为华盖，
朝百脉而覆脏腑，气一感之，则五脏六腑之火，一齐并发，毒有浅深，痘有疏密，偶一失调
，故间有不救，非种之之过也。
夫人不生于空桑，自不免乎出痘。然天地之大德曰生，保合太和，默默中常欲胥天下而
尽登仁寿，彼婴儿何罪，天岂忍故生斯疾以夭折之耶！何以天花流行殇者多而寿者寡，此非
天之特降其灾也。同一时行耳，其中或赋质本虚而适逢疠气，或身当疾病而又遇眚灾，故痘
未出而已伏危机，痘一出而即遭夭毙。本实先拨，倾者覆之，固亦事理之常，无足怪者。然
此亦不过十中之一二耳。天心仁爱，断不多也。其不须治而勿药有喜者则恒四五，略治而即
愈者二三，因治而后坏者乃竟四五焉，而婴孩遭劫矣，此非持论之过刻也。试与之平心而论
，旷观乎天花盛行之时，其暗昧无识，贪财射利，装模作样，草菅人命而不知罪孽者无论矣
。即或浅尝辄效，侥幸成功，世所称崭然见头角者，亦不过牛羊过眼，恪守师传，既不能因
人变化，而蠖屈之虫，专泥成书，又不能随地迁移。求其胸罗万卷，镜挂秦台，用法而不羁
于法，治人而不困于人，变通尽利，神而明之者，虽或不乏人，然戛戛乎其难之矣。此所以
全豹未窥，垣方难洞。过于寒，则遏其勃发之机，而毒攻于内；偏于补，则犯乎实实之戒，
而锢蕴于中。甚至以毒攻毒，不善其用而溃烂肌肤，无贼引贼，胡乱而投，而本根克伐，推
其广络原野，坐失机宜，其流弊之祸，不至于不毙而毙，当生不生，烂额焦头，沿街遍巷而
不止也。呜呼劫哉！贾生所谓可为流涕痛哭者，此也。然操治者一误再误，犹复自以为是，
而诿之于天，归之于命。夫天岂任咎耶？命岂任咎耶？苍苍者天，蚩蚩者氓，亦安能禁此无
学
怀
嘉庆十年，西洋KT 咭 船载痘种，并其国医咭拿，自吕宋航海至粤，为人种痘。据
伊芳书所载∶国医咭拿，悯出痘之多灾，见养牲之家独不出痘，审视其牛身起蓝泡，疑其为痘
，挑取其浆，用小刀剔起小儿两臂中央之皮，以牛痘之浆装入于内，旋出一颗。又将其浆轮
流递种，百发百中，永不再出云云。但查伊芳书只图绘种法，而未确指出其源，故于初种之时
，人见其与吹鼻异，多疑以为怪，而不知殊非怪也，彼鬼子特未发明其所以然耳。
夫西洋之法，亦犹吹鼻之法也。而巧则过之，何也？吹鼻之法，由肺引入，挑臂之法，
亦由肺引入。但吹鼻则触动五脏六腑之火，故出痘或多。挑臂则于两臂之中，独取三焦微微
动处之穴，剔起装浆，经络皮毛俱属于肺，而传浆和血又兼入于心。《内经》云∶诸痛疮疡
，俱属于心。痘为先天邪火，伏之于心，彼巧莫巧于单刀直入，独提出先天一点心火，而余
经不动，此种以独出一颗，而奏万全之效也。其用牛痘为种者何？因牛性属土，毒逢土则解
，借牛之土性，以解痘之火毒耳。兹有力之家，各捐果金以留其种，洵菩提甘露遍滴人间也
。能留其种固佳，倘万一失传，千万里远隔重洋，又何能一时飞渡耶？顾思医者意也，牛之
种可以种人，人之种亦可以种牛，当天行之时，择痘痂之纯净坚浓者，研而为面，如人吹鼻
种痘之法，以种无病少壮之牛，得牛之种，则可以转而种人，似亦无不可也。但当种之之时
，须按正两臂中间微微动处，即系三焦之穴，用笔墨点定，然后轻轻用手斜刀挑起纤纤薄皮
，不可挑破肉上之膜至令血出，则是皮毛之下，血肉之上，中隔一膜，《内经》所谓分肉者
此也。若不从微微动处点定下针，偏左偏右，稍远三焦之穴，则不独不能提出先天心火，而
痘不出，即出后亦复发。此非种法之差也，特其下手种痘时之谬耳！
余恐日后转相传授，差之毫厘，谬之千里，讹以传讹、必至复出，遂哗然谓种法荒谬而
置之不议，则辜负慈航救世之苦心，为大可惜矣！因不揣固陋，详为揭焉。庶几刍荛一得，
葑菲弗遗，于运针之时手如握虎。点穴之际部在秋毫，则一举手而仰副上天大生广生之心，
一下针而尽遂世间为父为母之愿。弥天花雨，种植无枉折之灾。遍地慈云，龆龀获平安之福
，不伤财，不劳民，至简至易，万举万全，法至善也，术至仁也。惟愿缙绅君子，慈淑仁人
，坚其信焉，远为播焉，则广种福田，同登寿域，岂不乐哉。嘉庆二十年端阳日书于小有清
虚精舍，南海黄安怀书。
（光绪三年丁丑年添加）
天花这种病，起源已经很久了。有人说始于周朝，有人说始于汉朝，但总归离不开天地阴阳氤氲化生万物的道理。在父母精气结合形成胚胎的时候，先天的邪火潜伏在脏腑之中，偶然感应到天时气候的变化，于是便发泄出来。所以称之为“天行”（时行疫病）。
天行疫气的到来，让父母心中感到惊恐不安。为什么呢？因为夭折的孩子太多了。前人出于大智慧，创制了种痘的方法。预先储存纯洁、坚实、浓稠的痘痂，研磨成粉末，在当时行疫病尚未流行、和风甘雨适宜的时候，选择没有疾病、疮疥、疳积等病症的婴儿，用纸筒装盛痘痂粉末，吹入其鼻孔内；或者用银簪挑取新鲜的痘浆，藏于鼻中。让气息透入肺脏，同类相感召，从而引发痘毒发泄。此时天时正当，身体又健康，而且没有等到口渴才去挖井（比喻未雨绸缪），在病发之前进行治理，在将发之时谨慎防范，时刻提防，事事周全，所以十个人能保住九个，这种方法是非常好的。然而不能保证绝对万无一失的原因在于：肺开窍于鼻，肺为五脏六腑之华盖，覆盖并朝会百脉，一旦气机受到感应，五脏六腑的火气就会一齐并发，毒邪有浅深之分，痘疹有疏密之别，偶尔出现一次失调，所以间或有无法救治的，这并不是种痘方法的过错。
人不是生在空桑里，自然免不了出痘。然而天地最大的德行就是赋予生命，保持太和之气，默默中常希望天下人都能尽得仁德长寿，那些婴儿有什么罪过，上天怎么忍心故意生出这种疾病来让他们夭折呢！为什么天花流行时死者多而活者少，这并不是上天特意降下的灾难。同样是时行疫病，其中有的人禀赋本虚恰好遇到疠气，有的人身患疾病又遭遇灾祸，所以在痘未发出时就已经潜伏危机，痘一发出就遭到夭折。根本先已动摇，就像倾倒的房屋一样容易倒塌，这也是事理中的常情，不足为怪。但这也不过是十个人中的一两个罢了。天心仁爱，这种情况断然不会多。不需要治疗而不用药就能痊愈喜人的占四五成，稍微治疗一下就能痊愈的占二三成，因为治疗不当而导致病情恶化的竟然也有四五成，导致婴孩遭受劫难，这并非持论过于苛刻。试着让人平心静气地讨论，纵观天花盛行时期，那些愚昧无知、贪财逐利、装模作样、视人命如草芥而不知罪孽的人且不说。即使有些人浅尝辄止却侥幸成功，被世人称为崭露头角者，也不过像牛羊从眼前经过一样，死守师传，既不能因人制宜变化疗法，又像尺蠖屈伸般拘泥于成书，又不能随地迁移变通。想要找到胸罗万卷、明察秋毫、运用法则而不被法则束缚、治疗病人而不被病人困扰、变通尽利、神妙通达的医生，虽然或许不乏其人，但也确实是很难得的。这就是为什么未能窥见全豹，难以洞悉医方奥妙。用药过于寒凉，则会遏制痘毒勃发的生机，导致毒邪攻陷于内；用药偏于温补，则会触犯“实实”（使实证更实）的禁忌，导致邪气锢结于中。甚至有的以毒攻毒，不善于使用反而导致肌肤溃烂，如同引贼入室，胡乱投药，损伤人体根本，推究其广泛地在原野上盲目行动而坐失良机，这种流弊造成的祸害，不至于不死的不幸死亡，本该生存的不幸夭折，额头溃烂、焦头烂额，遍布街巷不止。唉，真是劫数啊！贾谊所说的可以为此流泪痛哭的情况，正是如此。然而施治者一误再误，还自以为是，把责任推给上天，归结为命运。难道上天要承担责任吗？命运要承担责任吗？苍天茫茫，百姓愚昧，又怎么能禁止这些无学之人……
嘉庆十年，西洋荷兰船载着痘种，连同该国医生咭拿，从吕宋航海到达广东，为人种痘。据他们的书籍记载：该国医生咭拿，怜悯出痘之多灾，看到饲养牲畜的家庭唯独不出痘，仔细审视牛身上起的蓝泡，怀疑那是痘症，挑取其浆液，用小刀剔起小儿两臂中央的皮肤，将牛痘的浆液装入其中，随即长出一颗痘。又将其浆液轮流递种，百发百中，永远不再出痘等等。但是查阅他们的书籍只绘制了种法图，而没有确切指出其源头，所以在初次种植的时候，人们见到与吹鼻法不同，大多怀疑以为怪异，而不知道这绝非怪异，只是那些外国人特未阐明其中的原理罢了。
西洋的方法，也如同吹鼻的方法一样。但巧妙程度超过了它，为什么呢？吹鼻法，由肺引入；挑臂法，也是由肺引入。但吹鼻会触动五脏六腑之火，所以出的痘可能较多。挑臂则在两臂中间，单独选取三焦微微动处的穴位，剔起皮肤装入浆液，经络皮毛都归属于肺，而传递浆液调和血液又兼入于心。《内经》说：各种疼痛疮疡，都归属于心。痘是先天邪火，潜伏在心，他们巧妙之处在于单刀直入，单独提出先天一点心火，而其他经脉不动，这种只出一颗痘而奏效万全的方法。为什么要用牛痘作为种子呢？因为牛性属土，毒遇土则化解，借牛的土性，来化解痘的火毒罢了。现在有力的人家，各自捐献金钱以保留这种痘种，确实是菩提甘露遍洒人间。能保留这种痘种固然好，倘若万一失传，千万里远隔重洋，又怎么能一时飞渡过来呢？我想医者重在心意，牛的痘种可以种在人身上，人的痘种也可以种在牛身上，当天行疫病流行时，选择纯净坚实浓稠的痘痂，研磨成粉，像人吹鼻种痘的方法一样，用来种在无病少壮的牛身上，得到牛的痘种，然后就可以转而种在人身上，似乎也没有什么不可以的。但在种的时候，必须按照两臂中间微微动处，即是三焦的穴位，用笔墨点定，然后轻轻用手斜刀挑起纤薄的皮，不可挑破肉上的膜以致出血，这样就是在皮毛之下、血肉之上，中间隔着一层膜，《内经》所说的分肉就是这个意思。如果不从微微动处点定下针，偏左偏右，稍远离三焦的穴位，那么不仅不能提出先天心火，而且痘出不来，即使出来也会复发。这不是种法的差错，只是下手种痘时的错误罢了！
我担心日后转相传授，差之毫厘谬以千里，讹传讹，必然导致再次发病，于是喧哗地说种法荒谬而搁置不议，那就辜负了慈航救世的苦心，太可惜了！因此不顾自己固陋，详细揭示出来。希望哪怕是一点点见解，也不被遗弃，在运针的时候手如握虎般稳重，点穴之际精细如秋毫，那么一举手就能仰副上天大生广生的心意，一下针就能尽遂世间做父亲母亲的愿望。漫天天花雨，种植没有枉然折断的灾害。遍地慈云，儿童获得平安的福分，不伤财，不劳民，极其简单容易，万举万全，方法极好，技术极仁。只希望士绅君子，慈淑仁人，坚定他们的信念，广为传播，那么广种福田，同登寿域，难道不快乐吗？嘉庆二十年端阳日写于小有清虚精舍，南海黄安怀书写。
(Added in the Ding Chou year of Guangxu 3)
The onset of smallpox has a distant origin. Some say it began in the Zhou Dynasty, others in the Han Dynasty, but it ultimately does not transcend the principle of yin and yang mingling to generate essence (Yinyun Huachun). When the father's essence and mother's form combine to create the fetus, the innate pathogenic fire lies dormant within the zang-fu organs. Occasionally, upon sensing changes in the heavenly climate, it is vented forth. Hence, it is called "Tianxing" (Seasonal Epidemic).
The arrival of Tianxing epidemics causes parents' hearts to tremble with fear. Why? Because of the high number of premature deaths. Our predecessors, endowed with great wisdom, invented the method of variolation. They would store pure, firm, and thick scabs from smallpox pustules, grind them into powder, and during times when the epidemic had not yet started, amidst gentle winds and sweet rains, select infants free from diseases such as sores, scabies, or malnutrition. Using a paper tube to hold the scab powder, they would blow it into the infant's nostrils, or use a silver hairpin to extract fresh pus and place it inside the nose. This allowed the qi to penetrate into the lungs, where similar elements attract each other, thereby inducing the eruption of the disease. Since the heavenly climate was favorable and the body healthy, and because this approach avoided digging a well only after one was thirsty (metaphor for acting before the crisis), treating the condition before it arose, and being cautious before symptoms appeared, constantly vigilant and thorough in every detail, nine out of ten children survived. The method was excellent. However, it could not guarantee absolute perfection. This is because the lungs open into the nose; the lungs are the canopy of the five zang and six fu organs, covering them and receiving all vessels. Once the qi is stimulated, the fire of all five zang and six fu organs erupts simultaneously. The depth of toxicity varies, and the density of pustules differs. Occasional imbalance leads to occasional untreatable cases; this is not the fault of the variolation method itself.
Humans do not grow from empty mulberry pods; thus, contracting smallpox is inevitable. Yet, the greatest virtue of Heaven and Earth is life. By maintaining Taihe (Great Harmony), Heaven silently wishes for all people under heaven to attain benevolence and longevity. What sin have these infants committed that Heaven should deliberately inflict such a disease to cause their death? Why are there many deaths and few survivors during smallpox epidemics? This is not a special disaster sent by Heaven. It is the same seasonal epidemic, but some individuals have inherent constitutional deficiency and encounter pestilential qi, while others suffer from illness and meet with calamity. Thus, crises lie hidden before the rash appears, and death follows immediately upon eruption. When the root is first undermined, collapse follows naturally; this is a common principle of affairs, nothing strange about it. But this accounts for only one or two out of ten. Heaven's benevolence ensures this is not frequent. Four or five out of ten recover without treatment or medication; two or three out of ten recover with slight treatment; yet four or five out of ten deteriorate due to improper treatment, causing infants to suffer劫 (calamity). This is not an overly harsh argument. Let us discuss this calmly: observing the peak of smallpox epidemics, those who are ignorant, greedy for profit, pretentious, treat human lives as grass, and remain unaware of their sins—let us not speak of them. Even those who achieve superficial success through trial and error, gaining fame as emerging talents, merely follow tradition like cattle passing before eyes. They rigidly adhere to transmitted teachings, unable to adapt to individual patients, nor flexible enough to change according to circumstances. Finding someone who reads thousands of volumes, sees clearly like the Qin mirror, uses methods without being bound by them, treats people without being trapped by them, and achieves maximum benefit through flexibility and divine understanding—is rare, though not non-existent. It is indeed difficult. This is why one cannot see the whole leopard, nor fully comprehend the secret formulas. Overuse of cold herbs suppresses the vigorous eruption mechanism, driving toxicity inward; overuse of tonics violates the prohibition against reinforcing excess (Shi Shi), trapping pathogens internally. Even using toxicity to combat toxicity, if misused, causes skin ulceration, akin to inviting thieves into the house. Reckless prescribing damages the fundamental root. Wandering aimlessly across fields and losing strategic opportunities, the consequences of such abuses lead to unnecessary deaths, missed chances for survival, disfigured faces, and suffering filling streets and alleys. Alas, what a calamity! This is what Jia Yi referred to as worthy of tears and bitter weeping. Yet, practitioners make mistakes repeatedly, still believing themselves correct, blaming Heaven, and attributing outcomes to fate. Does Heaven bear responsibility? Does Fate bear responsibility? The vast Heaven and the ignorant masses, how can they stop this ignorance...
In the tenth year of Jiaqing, Dutch ships carrying smallpox seeds and their physician Kina arrived from Luzon to Guangdong via sea route to perform variolation on humans. According to their records: Dr. Kina, pitying the high mortality of smallpox, noticed that families raising livestock did not contract the disease. Upon examining blue blisters on cows, he suspected they were related to smallpox. He extracted the fluid, used a small knife to lift the skin between the arms of children, inserted the cowpox fluid, and subsequently developed a single pock. By circulating this fluid through successive inoculations, he achieved 100% success with permanent immunity. However, reviewing their books reveals only illustrations of the technique, lacking explanation of its origin. Initially, people found it different from nasal insufflation and deemed it strange, not realizing it was not strange at all, but rather that the foreigners had not yet elucidated the underlying rationale.
The Western method is similar to nasal insufflation but more ingenious. Why? Nasal insufflation introduces the agent via the Lungs; arm inoculation also introduces it via the Lungs. However, nasal insufflation stirs up fire in all five zang and six fu organs, potentially resulting in numerous pustules. Arm inoculation targets a specific point in the middle of the arms, associated with the Sanjiao (Triple Burner), where there is slight movement. The skin and hair belong to the Lungs, while the transmission of fluid and harmonization of blood involve the Heart. As stated in the *Neijing*: "All pain and sores belong to the Heart." Smallpox is innate pathogenic fire residing in the Heart. Their ingenuity lies in direct access, isolating this single point of heart fire without disturbing other meridians. Producing only one pock ensures complete efficacy. Why use cowpox? Cows belong to the Earth element; toxicity dissolves upon contact with Earth. Borrowing the Earth nature of cows neutralizes the Fire toxicity of smallpox. Wealthy families now donate funds to preserve this strain, truly spreading nectar of Bodhi throughout the world. Preserving the strain is good, but if lost, separated by oceans, how can it be transported instantly? I believe medicine relies on intent. Cowpox can infect humans; human smallpox can infect cows. During an epidemic, selecting pure, firm scabs, grinding them into powder, and inoculating healthy young cows mirrors human nasal variolation. Obtaining cowpox from cows allows subsequent human inoculation, which seems feasible. However, during inoculation, one must mark the slightly moving spot between the arms, corresponding to the Sanjiao acupoint. Gently lift the thin epidermis with a slanted blade without breaking the membrane beneath to avoid bleeding. This layer between skin and flesh is what the *Neijing* calls "fenrou" (divided flesh). If the needle is not placed precisely at this moving spot, but deviates left or right, away from the Sanjiao point, it fails to extract the innate heart fire. Pustules may not appear, or if they do, they recur. This is not a flaw in the method, but an error in execution.
Fearing that future generations might transmit errors, compounding minor deviations into major failures, leading to recurrence, and then dismissing the method as absurd, thereby betraying the compassionate intention of saving lives, I deem it a great pity. Therefore, disregarding my own limitations, I detail this method here. May even humble insights be considered. With steady hands like holding a tiger during acupuncture, and precise acupoint selection down to the finest hairs, every movement honors Heaven's generative will, and every needle fulfills the hopes of parents. May天花 (smallpox) rain fall gently, ensuring no plants are broken in vain. May clouds of compassion cover the earth, granting safety to children. Without wasting wealth or labor, simple and easy, achieving perfection in every attempt, the method is supreme, the art most benevolent. I pray that gentlemen and virtuous people strengthen their faith and spread this widely, cultivating merit and attaining longevity together. Is this not joyful? Written on the Duanwu Festival of the 20th year of Jiaqing at Xiao You Qing Xu Jing She, Huang Anhuai of Nanhai.