痘出七日。阴中之阳。尽付于外。内则空虚。如釜中甑内之气。妙不可言。阳起一分阴
亦长
一分。故其浆也。则宜渐而黄。根下血晕。亦宜渐而紧。如线围定。不铺散。不灰黯。昼夜
痛楚。饮食倍常。大便少。身微热。吉症也。反是者逆。至是欲决生死。唯视血晕聚散。脓
色真伪耳。真者宝色烨烨。手捏粘丝。伪则土黄也。聚者气拘血而化毒也。散则气虚散。而
真气将竭。血晕全无者死。脓者。毒所化也。诀曰。六日以后专看脓色。故脓有者生。无脓
者死。使或有或无而脚根不红。或连肉灰红。作痒烦燥。目闭后开。作泻干呕。不食少睡。
气虚不能拘血化毒也急峻补之。倘此时尚见黑苔有刺。生意绝矣。不唯不容补。即补之何益
。浆行七日肿要过颈。浆要过胸。肿者。毒外出也言过胸者从上下也。至阳物亦要贯。乃
宗筋之会也。两脚不贯不妨。又两臂亦宜满。不然临收时必不食而生他变。手臂脾所主也。
痘出七日或大泻者。气陷也。急补涩之。若浆色正而根血一线。紧紧绕定。虽泻无妨。
浆色不正。血不敛。毒在内也。七日毒尚在。如命何。
若正痘依然根晕红活。精神饮食清健而泻。此阳症也。不妨。但看舌。用兼止之药而愈
至八九日。浆行似足。忽眼开而陷。毒内攻也。内攻者必闷乱烦燥。根晕飞散。若无是
而唇舌洁净。方内加桂附治之。唇燥舌赤。内加连芩解毒治之。
有一等。至八日充灌饱满。扑摸不破。而剔破无脓。毒陷伏也。不可作顺痘误人。服赛
春
雷。是正法也。若数服而犹硬无脓。根晕不活。生意可知矣然此必神不内宁。若神宁痘少不
必药治。
贯脓时作痒。十常六七。并准以唇舌药之。但爬破成坑者。或干而无水者皆不治。
痘行浆作痛。火热也。亦吉兆也。丹溪曰。诸痛为实。是气滞作痛。方内加
枳壳山楂治之。血热作痛。方内加
芍药。生地治之。
八九日寒战切牙。虚极也。唯峻补而已。此外无法。若头摇。牙颤。目闭。无魂者不治
又八九日。有等土黄而硬者。往往作正浆目之。不知此为阴阳失政。致浆注于中。板腻
死塞
之正。土黄者。黄而无彩者也。又有贯脓充足。至九日大便忽欲去不去。阳明血燥也。
方内倍加当归以润之。不治则靥落之后。非滞下必干热而死。
灌脓发泡。气过甚也本方加白术。茯苓。渗利之。擦破水出而不能包者。败草散掩之。
八九
日最忌皮薄浆清。皮薄则嫩而易破。浆清则水而不脓。书曰。浆假毒成。毒从浆化。若此而
幸成者。未之有也。凡皮薄浆清。至九日而躁乱不宁。生死可隔壁断矣。周岁半岁者。又不
必至九日。若七日便蹬打不定。揩破不干。万不救一。何者。痘以七日为界七日以前气血外
行七日以后气血内入。外行时。尚不欲留毒。矧内入时乎。故七日后躁乱者。毒攻也。毒攻
内者。必死。
凡灌脓时。额上如汤泡。皮肉尽赤而干者死诸痘才贯。而两唇先黄硬者死。
擦破无脓血者死。擦破而疮痕隐然有生意者。秽触也不当作死症论。
痘疹发出后第七天，属于阴中之阳的阶段。体内的正气全部外达于体表，内部则显得空虚，就像蒸笼里升腾的热气一样，其妙处难以言表。阳气每升起一分，阴液也就随之增长一分。因此，痘疮内的浆液应当逐渐变黄，痘根下的血晕也应当逐渐收紧，像线围住一样，不扩散、不灰暗。此时患者昼夜感到疼痛，饮食量加倍，大便次数减少，身体微热，这是吉利的征象。反之则为逆证。到了这个阶段，决定生死的关键，只在于观察血晕的聚散以及脓色的真假。真正的脓色光彩夺目，用手捏时有粘丝感；假的则是土黄色。血晕聚集，说明气能约束血液从而化毒；血晕散开，说明气虚散乱，真气即将衰竭。如果完全没有血晕，就会死亡。脓液是毒素转化而成的产物。诀法说：六日以后专门看脓色。所以有脓的就能存活，没有脓的就会死亡。如果出现脓液时有时无，且痘根不发红，或者连肉带皮呈现灰红色，伴有瘙痒、烦躁，眼睛闭合后又睁开，腹泻，干呕，不吃东西，睡眠少，这是气虚不能约束血液化毒的表现，必须紧急使用峻补之法。如果此时舌苔还是黑色且有刺，生机就断绝了，不仅不能用补法，即使用了补法又有什么益处呢？浆液运行七天，肿胀要超过颈部，浆液要充满胸部。肿胀意味着毒素向外排出。所谓“过胸”，是指从上往下充盈。直到生殖器部位也要灌满，因为这里是宗筋汇聚之处。两脚不灌满没关系，但两手臂也应该饱满，否则在收靥时必然因不吃东西而生出其他变故，因为手臂由脾所主。痘疹发出七天后如果发生大泻，是气陷的表现，必须紧急补气固涩。如果浆色正常，且根部有一线血紧紧环绕固定，即使腹泻也无妨。如果浆色不正常，血液不能收敛，说明毒素仍在体内。七天时毒素还在体内，性命堪忧。
如果是正痘，依然根部血晕红润鲜活，精神清爽，饮食健旺而腹泻，这属于阳症，不妨碍病情。只需观察舌象，使用兼有止泻作用的药物即可痊愈。到了第八九天，浆液似乎已经充足，突然眼睛睁开（或指神志清醒）但痘疮凹陷，这是毒素内攻的表现。内攻的患者必定会出现胸闷烦乱、烦躁不安，根部血晕飞散。如果没有这些症状，而是嘴唇舌头洁净，可以在方剂中加入桂枝、附子来治疗。如果嘴唇干燥、舌头赤红，则在方剂中加入黄连、黄芩来解毒治疗。
有一类情况，到了第八天痘疮充灌饱满，触摸不破，但挑破后却没有脓液，这是毒素陷入潜伏的状态。不可误认为是顺症而延误治疗，应服用赛春雷丸，这是正确的治法。如果服用几剂后仍然坚硬无脓，根部血晕不鲜活，生机就可以知道了。然而这种情况必定是因为心神不宁。如果心神安宁，痘疮数量少，就不必用药治疗。
在贯脓期间出现瘙痒，十次中有六七次是正常的，并参照唇舌的情况用药。但如果抓破形成坑洞，或者干燥没有水分的，都属不治之症。
痘疹行浆时出现疼痛，是火热所致，这也是吉兆。朱丹溪说：各种疼痛属于实证，是气滞导致的疼痛，方剂中加入枳壳、山楂来治疗。血热导致的疼痛，方剂中加入芍药、生地来治疗。
第八九天出现寒战咬牙，是极度虚弱的表现，只有峻补一法，此外没有别的办法。如果出现头摇、牙颤、眼睛闭合、无魂的症状，属于不治之症。
又过了八九天，有一些痘疮呈土黄色且坚硬，往往被当作正常的浆液看待。不知道这是因为阴阳失调，导致浆液注于其中，板结腻塞而死。所谓的土黄色，是指黄色而没有光泽。还有贯脓充足，到了第九天大便忽然想拉拉不出来的，这是阳明经血燥所致。方剂中加倍加入当归以滋润肠道。如果不治疗，那么在结痂脱落之后，不是患痢疾就是因干热而死。
灌脓发泡，是气过盛的表现，本方中加入白术、茯苓以利水渗湿。擦破后水流出来而不能包裹疮面的，用败草散覆盖。
第八九天最忌讳皮肤薄、浆液清稀。皮肤薄则娇嫩容易破裂，浆液清稀则如水而非脓。医书说：浆液借毒素而成形，毒素从浆液中化解。像这样还能侥幸成功的，从未有过。凡是皮肤薄、浆液清稀，到了第九天还躁动混乱不安的，生死可以隔着墙壁判断了。周岁或半岁的婴儿，又不必等到第九天，如果第七天就蹬打不定，擦破后不干涸，万中无一能救活。为什么呢？痘疹以七天为界限，七天以前气血向外运行，七天以后气血向内回归。在外行时，尚且不想留毒在内，何况在内入的时候呢？所以七天以后出现躁乱的，是毒素内攻。毒素内攻内部的，必定死亡。
凡是在灌脓时，额头像汤泡一样，皮肉全部发红且干燥的，会死亡。所有痘疮刚开始贯脓，而两嘴唇先变黄硬的，会死亡。
擦破后没有脓血的，会死亡。擦破后疮痕隐约可见生机的，是被秽物触碰所致，不应当当作死症来讨论。
On the seventh day after the eruption of smallpox, it is a stage of "Yang within Yin." The body's righteous Qi (vital energy) is entirely directed outward to the surface, leaving the interior empty, much like the steam rising within a steamer basket; its subtlety is beyond words. For every unit of Yang that rises, a corresponding unit of Yin also grows. Therefore, the fluid within the pustules should gradually turn yellow, and the blood晕 (halo/redness at the base) under the root should gradually tighten, resembling a line encircling it, without spreading out or becoming grayish-dark. During this time, the patient experiences pain day and night, consumes double the usual amount of food, has fewer bowel movements, and exhibits a slight fever; these are auspicious signs. The opposite indicates an adverse condition. At this stage, life and death depend solely on observing the aggregation or dispersion of the blood晕 and the authenticity of the pus color. Authentic pus shines with a radiant luster and feels sticky when pinched; inauthentic pus appears earthy-yellow. Aggregation of the blood晕 indicates that Qi can constrain Blood to transform toxins; dispersion indicates Qi deficiency and scattering, with True Qi nearing exhaustion. If there is no blood晕 at all, death ensues. Pus is the transformation of toxins. The aphorism states: After the sixth day, focus exclusively on the pus color. Thus, those with pus survive, while those without pus die. If pus is present intermittently, the root is not red, or the flesh and skin appear grayish-red, accompanied by itching, restlessness, eyes closing then opening, diarrhea, dry heaving, anorexia, and insomnia, this indicates Qi deficiency failing to constrain Blood for toxin transformation. Urgent and vigorous tonification is required. If a black, prickly tongue coating is still present at this time, the vital potential is extinguished; not only is tonification contraindicated, but even if applied, it would be of no benefit. By the seventh day of fluid progression, swelling should extend over the neck, and fluid should fill the chest. Swelling signifies the outward expulsion of toxins. "Filling the chest" implies filling from top to bottom. Even the genitalia should be filled, as this is the convergence of the Zongjin (tendons). Filling of the legs is not essential, but both arms should be full; otherwise, during the crusting phase, anorexia and other complications will likely arise, as the arms are governed by the Spleen. If severe diarrhea occurs on the seventh day post-eruption, it indicates sinking of Qi, requiring urgent tonification and astringency. If the fluid color is normal and a line of blood tightly encircles the root, diarrhea is not problematic. However, if the fluid color is abnormal and Blood fails to consolidate, toxins remain internal. With toxins still present on the seventh day, life is precarious.
If the primary smallpox lesions retain a vibrant, red, and active blood晕 at the root, with clear spirit and robust appetite despite diarrhea, this is a Yang syndrome and is not detrimental. One must observe the tongue and administer herbs that simultaneously stop diarrhea for recovery. By the eighth or ninth day, if fluid seems sufficient but the eyes suddenly open and the lesions collapse, this indicates internal attack by toxins. Internal attack manifests as chest oppression, confusion, and restlessness, with the blood晕 scattering. If these symptoms are absent and the lips and tongue are clean, add Cinnamon Twig (Guizhi) and Prepared Aconite Root (Fuzi) to the formula. If the lips are dry and the tongue is crimson, add Coptis Rhizome (Huanglian) and Scutellaria Root (Huangqin) to detoxify.
In some cases, by the eighth day, the lesions are fully inflated and firm to the touch, yet yield no pus when pricked; this indicates toxins have sunk and become latent. This must not be mistaken for a favorable course, which would endanger the patient. The correct treatment is to administer Saichunlei Wan. If several doses fail to produce softening and pus, and the root blood晕 remains inactive, the prognosis is poor. However, this condition often stems from inner unrest of the Shen (Spirit). If the Shen is calm and the number of lesions is small, medication may not be necessary.
Itching during the pus-filling stage occurs in six or seven out of ten cases and is generally normal; treatment should be guided by the state of the lips and tongue. However, if scratching leads to pitted sores or if the lesions are dry without moisture, they are incurable. Pain during the fluid-forming stage is due to Fire-Heat and is considered an auspicious sign. Zhu Danxi stated: "All pain belongs to Excess," indicating pain caused by Qi stagnation. Add Bitter Orange Fruit (Zhike) and Hawthorn Fruit (Shanzha) to the formula. For pain caused by Blood-Heat, add White Peony Root (Baishao) and Rehmannia Root (Shengdi).
Chills and teeth-grinding on the eighth or ninth day indicate extreme deficiency, requiring vigorous tonification; no other method suffices. Head shaking, jaw trembling, closed eyes, and absence of Shen indicate an incurable condition.
Later, around the eighth or ninth day, some lesions appear earthy-yellow and hard, often mistakenly regarded as normal pus. This is actually due to dysfunction of Yin and Yang, causing fluid accumulation that becomes board-like and obstructed. Earthy-yellow refers to yellow without luster. In another scenario, where pus filling is adequate, sudden retention of stool on the ninth day indicates dryness of Blood in the Yangming channel. Double the dosage of Angelica Sinensis Root (Danggui) in the formula to moisten. Without treatment, after the scabs fall off, the patient will either suffer from dysentery or die from dry heat.
Excessive Qi causes puffiness and blistering during pus formation; add Atractylodes Macrocephala Rhizome (Baizhu) and Poria (Fuling) to the formula to promote diuresis and leaching out dampness. If lesions are broken, leaking fluid without encapsulation, cover them with Baicao San.
The most taboo signs on the eighth or ninth day are thin skin and clear fluid. Thin skin is tender and prone to rupture; clear fluid is watery rather than purulent. The classics state: "Fluid forms through toxins; toxins are transformed via fluid." Cases like this rarely recover successfully. If skin is thin and fluid is clear, and the patient becomes restless and agitated by the ninth day, the outcome regarding life and death is evident. For infants aged one year or six months, one need not wait until the ninth day; if they are restless and kicking by the seventh day, and lesions do not dry after being broken, less than one in ten thousand will survive. Why? The seventh day marks a boundary: before the seventh day, Qi and Blood move outward; after the seventh day, they move inward. When moving outward, toxins are expelled; when moving inward, retaining toxins is dangerous. Therefore, restlessness after the seventh day indicates internal attack by toxins. Internal attack invariably leads to death.
During pus formation, if the forehead resembles a boil from hot water, with red, dry skin and flesh, death ensues. If, upon initial pus formation, the lips turn yellow and hard first, death ensues.
Lesions that break without yielding pus or blood result in death. However, if broken lesions show subtle signs of vitality, it is due to contact with filth and should not be classified as a fatal case.