痘至灌浆，则藏伏之毒与精华皆为逼灼在外，所以空窍眼鼻之所，津液留聚而为封
塞也。然必待肿胀灌脓而然，为正候也，故三四朝，不宜封塞者，谓毒未外达，邪火上
炎也。若五朝之后，又宜封与塞者，谓气血充灌，精不外驰也。其封塞之所。如胶如脂
光润者，吉。如煤之干黑者，脏腑燥槁，津液枯竭也。如脓之流溢者，毒火内灼，精华
外泄也，并为凶候。若既已封塞而六七朝即开者，须防其毒未消而有内攻之势，则属再
危更甚矣。惟痘稀少者，不在此例。
肩背者，五脏之所系，最宜疏朗红活，切忌繁密焦紫。但小儿多喜仰卧，故肩膊臀
背之疮，展转摩擦。若痘子好者，自然坚浓耐久，其次则收靥稍迟，即穿破溃烂矣。最
可嫌者。如汤火之炮，水去皮脱，或疮自破纯出清水，黑 干焦，目红散漫者。更有浆
水全无，平塌焦紫者，并皆不治。
夫初起时肌肤干燥者，是腠理闭密，津液阻滞也，治宜发散表痘为主。有见点而痘
燥涩不荣者，是荣血本虚，又为风胜火灼而益燥矣，治宜凉血养血为主。如痘既起胀，
或将成就之时而疮干者，此荣血不足，复为脓浆耗损，无以灌溉皮毛，通调百脉也，治
惟有补而已。
《经》曰∶热胜则肉腐，故臭痘未有不因火迫所致，然多不死者，以其得化泄阳明
之毒也。若臭而黑烂成窝，兼之目中无神者，则元气亏竭，亦死之症也。故臭而红
活，脓血流溢者；臭而不燥不痒者；臭而不延人毒痛者；臭而囊不尽脱者；臭而皮肉不
黑烂者；臭而口内无恶臭者，臭而不指烂入筋者，臭而身热气蒸，声清能食者；皆生症
也，然须以芫荽、艾叶烧之，以辟秽气，兼用升麻、紫苏煎汤，揩挹臭处，更宜洁净衣
服床被之类，内用升托补养之药为要。若至顶、胁、胸、颈、气窝等处，四烂臭黑，深
见筋骨者，必死之症也。并在脓浆未成，其毒未化之日而臭者，是邪火用事，卫气早
泄，必至阳绝阴竭而后已。
当痘疹发展到灌浆阶段时，潜伏在体内的毒邪与人体精华都被逼迫灼烧于体表，因此在空窍、眼鼻等部位，津液停留积聚而形成封塞。但这必须等到肿胀灌脓之后才出现，才是正常的征候。所以，如果在第三四天的时候就出现封塞，是不适宜的，这是因为毒邪尚未向外透达，邪火向上炎升所致。若在第五天之后，又适宜出现封塞，这是因为气血充盈灌注，精微物质不致外泄。封塞处的形态如果像胶脂一样光润，是吉兆；如果像干黑的煤炭一样，说明脏腑干燥枯槁，津液枯竭；如果像脓液一样流溢出来，说明毒火在内灼烧，精华向外泄漏，这些都属于凶险的征候。如果已经封塞，但在第六七天就开裂，必须防止毒邪未消而有向内攻冲的趋势，这就属于更加危重的情况。只有痘疹稀少者，不在此例。
肩背部是五脏经络所系之处，最宜疏朗红活，切忌繁密焦紫。但小儿多喜欢仰卧，所以肩膊臀背部位的痘疮容易因辗转摩擦而受损。如果痘子长得好，自然会坚实浓稠耐久；其次则收靥（结痂脱落）稍迟，就会穿破溃烂。最令人厌恶的是，痘疮像被汤火烫过一样，表皮脱落，或者痘疮自行破裂流出纯清水，干枯焦黑，眼睛发红散漫无神。更有浆水全无，平塌焦紫的，都属于无法救治的情况。
在痘疹初起时，如果肌肤干燥，这是腠理闭密，津液阻滞所致，治疗应以发散表痘为主。见到痘点出现但痘体燥涩不荣润的，这是营血本虚，又被风邪胜复、火邪灼烧而更加干燥，治疗应以凉血养血为主。如果痘疹既已起胀，或将要成熟之时痘疮却干燥的，这是营血不足，再加上脓浆耗损，无法灌溉皮毛，通调百脉，治疗唯有补益而已。
《内经》说：热邪胜复则肌肉腐烂，所以臭痘没有不是因火邪逼迫所致，然而大多不死，是因为毒邪得以从阳明经化泄。如果痘疮臭秽且黑烂成窝，兼有目中无神的，则是元气亏竭，也是死症。所以，痘疮臭秽但红活，脓血流溢的；臭秽但不干燥不瘙痒的；臭秽但不蔓延侵入毒痛部位的；臭秽但囊袋不尽脱落的；臭秽但皮肉不黑烂的；臭秽但口内无恶臭气的；臭秽但不指烂入筋骨的；臭秽但身体热气蒸腾、声音清亮能进食的，这些都是生症（可治愈），但需用芫荽、艾叶焚烧以辟除秽气，兼用升麻、紫苏煎汤擦拭臭秽处，更应保持衣物床被洁净，内服升托补养的药剂是关键。如果到顶、胁、胸、颈、气窝等处，四处腐烂臭黑，深见筋骨，必然是死症。如果在脓浆未成、毒邪未化的日子就出现臭秽，这是邪火用事，卫气早泄，必然导致阳绝阴竭而后止。
When the smallpox (or variola) reaches the stage of pustule formation, the latent toxins and the body's essence are forced to the exterior by heat. Therefore, at orifices such as the eyes and nose, body fluids accumulate, leading to "sealing and blocking" (Fengsai, accumulation of fluid causing obstruction). However, this must occur after swelling and pus formation; this is the normal presentation. Thus, if sealing occurs on the third or fourth day, it is unfavorable, indicating that the toxin has not yet reached the exterior and pathogenic fire is flaring upward. If sealing occurs after the fifth day, it is favorable, indicating that Qi and blood are充盈 (full) and essence is not leaking out. If the sealed area is smooth and lustrous like glue or fat, it is auspicious. If it appears dry and black like coal, it indicates dryness and withering of the Zang-Fu organs and depletion of body fluids. If it flows like pus, it indicates internal burning by toxic heat and leakage of essence, which are ominous signs. If sealing occurs but opens up on the sixth or seventh day, one must guard against the possibility that the toxin remains uneliminated and attacks inwardly, which would be even more critical. This exception does not apply to cases with sparse lesions.
The shoulder and back are areas connected to the Five Zang Organs. They should ideally be sparse, red, and vibrant, and must avoid being dense, scorched, and purplish. Since infants often lie supine, the lesions on the shoulders, buttocks, and back are prone to friction from turning over. If the lesions are healthy, they will naturally be firm, thick, and durable; otherwise, scabbing (Shouye) may be delayed, leading to rupture and ulceration. The most undesirable presentation is when lesions resemble burns from hot water or fire, with skin peeling off, or when lesions spontaneously rupture and discharge clear fluid, becoming dry, black, and scorched, accompanied by red, scattered, and spiritless eyes. Cases where there is no pus, with flat, scorched, and purplish lesions, are incurable.
At the initial stage, if the skin is dry, it indicates closed pores (Couli) and blocked body fluids; treatment should focus on dispersing the exterior to promote eruption. If lesions appear dry, rough, and lacking luster upon emergence, it indicates deficiency of Ying-Blood, exacerbated by wind dominance and fire burning, leading to further dryness; treatment should focus on cooling the blood and nourishing blood. If lesions become dry during the swelling phase or just before maturation, it indicates insufficient Ying-Blood and further loss due to pus formation, failing to irrigate the skin and hair follicles and regulate the meridians; treatment relies solely on tonification.
The *Classic* states: "Excessive heat causes flesh to rot." Therefore, foul-smelling lesions are invariably caused by fire forcing toxins outward. However, many patients survive because the toxin is transformed and discharged via the Yangming channel. If the lesions are foul-smelling, black, rotten, and pitted, accompanied by a lack of spirit in the eyes, it indicates exhaustion of Yuan-Qi and is a fatal sign. Conversely, if lesions are foul-smelling but red and vibrant, with flowing pus and blood; foul-smelling but not dry or itchy; foul-smelling but not spreading into painful toxic areas; foul-smelling but the sac does not completely detach; foul-smelling but skin and flesh are not black and rotten; foul-smelling but without bad breath in the mouth; foul-smelling but not rotting down to the tendons; foul-smelling but with steaming body heat, clear voice, and ability to eat—these are all signs of survival. Treatment requires burning mugwort (Aiye) and shepherd's purse (Yuansui) to dispel foul odors, wiping the affected areas with decoctions of Cimicifugae Rhizoma (Shengma) and Perillae Folium (Zisu), maintaining cleanliness of clothes and bedding, and internally administering herbs that lift and tonify. If lesions on the crown, hypochondrium, chest, neck, and axilla are four-sided rotten, foul, black, and deep enough to expose bone and tendon, it is inevitably fatal. If foul odor appears before pus formation and toxin transformation, it indicates pathogenic fire acting unchecked and premature leakage of Wei-Qi, leading inevitably to Yang exhaustion and Yin depletion.