热透三朝痘见形，此为常候不须评，过期不及多乘气，论治先分虚实因。
数日蒸蒸出不齐，竟行疏发莫生疑，按方加药观疮势，表里平和痘本稀。
痘出常须令气匀，更宜和暖气如春，气匀出快无壅滞，偏热偏寒气不行。
头面呼为元首尊，咽喉紧隘似关津，莫教苍子多稠密，锁项蒙头总不应。
胸前头面总宜疏，手足虽多不用忧。若是周身都密甚，却愁气血不能周。
初出形来艳色娇，定知皮嫩不坚牢，溶溶损破添愁绪，个个成浆喜气饶。
痘疮初出解咽喉，喉痹咽疮毒火饶，只恐后来封管签，挫喉声哑治徒劳。
若恐斑疮入眼中，古方获目有神功，眼多 泪睛多赤，急泻心肝免毒攻。
夫痘子起发，不可拘以日数，疮出以渐，其发亦以渐，谓之适中。若一齐涌出，
即皮肉虚肿。一齐 发者，此表气虚，毒瓦斯奔溃而出，表虚则不能收敛，必生痒痛溃烂
矣。其治急宜救表为主。若已出尽，当起不起，此里气虚，毒瓦斯留伏，壅而不出，必增
烦燥腹满喘促矣。此又急宜救里为要，然痘疹发于肌肉，阳明胃经主之，脾气一温，胃
气时扬，决无陷伏之患。如 人笼蒸之法，但欲其松耳。
凡痘疮起发之时，磊落分布者，乃表里疏通，上下发泄，毒瓦斯解散，为顺痘也。此
颗粒丛聚，根窠坚硬，似瘤之红而不痛，似核之坚而不动，似痈之肿而不溃者，此气血
凝滞而不流，肌肉败坏而不化，毒瓦斯郁积而不解，为逆痘也。不出四五日，必瘙痒闷乱
而死。更有初出细密模糊，不成窠粒。至于起发，尽成大泡，清水虚痒者，此乃卫气不
敛，为逆痘也，不出二三日，皮脱肉干闷乱而死。此皆恶毒之气所致，须于出现起发之
时候之。若到成脓，则无是病矣。
凡痘之出，以气血和平为主，尖圆坚实者气也。血活明润者血也。红活平陷者，血
至而气不足也。圆实而色淡者，气至而血不足也。平塌灰白者，气血俱不足也。 肿红
绽，气血俱有热也。若痘至起发，则欲透而磊落，尖圆光壮肥泽者，上也。如根脚横
开，皮起水涨者，次也。如顶皮不起，根脚不开，犹是先出之形，不见新生之水者，此
即谓之起发不透。如气本实者，此必曾感风寒，宜用发表。如气本虚者，此必不能饮
食，或兼吐利，宜补中气而兼托表。若对日已多，发犹不透，是以烦躁不安啼叫恶热
者，此毒热在里，宜急松肌表，托而兼解散热毒，导引心火可也。若谵语而妄有见闻，
时发狂叫者，此五脏热毒蕴积而阳气独盛，无阴气以和之，必大便不利，宜微通之，使
里无留滞而外得快利也。甚至昏不知人，腹胀喘呼者，不治。总之，起发之时，不徐不
疾，以渐长大尖圆磊落，光壮坚实，根脚红活，此气充足，载血而行，透彻诸疮，自然
尖圆光壮，不须服药。如虽红活，项平中陷，不成尖圆，色嫩皮薄，不能坚浓，其变
为痒塌，为留伏壅遏，乃气虚也，宜用补气。若疮皮薄色娇，淫淫如湿者，此气不胜
血，宜补气凉血。如浮囊虚起，谷中无水者，此气不液血，血不附气，其变为痒塌，
为痈肿矣，宜十全大补汤加减主之。凡由红斑而水泡，水泡而脓泡而结痂，有自然之序
者吉也。若颠倒失常，尽由气血两虚，邪火冲击，变现为害，及初起发疮，头便带白浆
者，不分何处，并非佳兆，不特口唇也。
三日四日，痘出当齐，点至足心，势言安定。若犹有陆续不出之状，或隐隐于皮肤
之内，不见不起者，非风寒壅遏之因，必内虚不振之故，是以四日以前痘毒方出，身表
宜凉；四日以后，毒出已定，身表宜温。凉则气血和平，痘色必然润泽；温则入里开
通，其毒易以成浆，至此而身若不温，虽未必至于水状，而痘疮断难易长。又若身热不
退，或身痛不止，或因风寒所迫，或因暑气所并，而无二便秘塞烦喘之症者，是症在表
而不在里，宜葛根透肌之药以发之，待其表和而痘出自顺，但不可过汗，以丧其津液。
至四五日时，血泡已成。理当起胀。如果肥大而粗，根红而顶光色白者，已具行浆之
势。若还赤色过头，虽见娇红可受，然延棉六日，必依然到头空壳，虚花皮薄而光亮如
灯，内舍是水，顶尖而根脚不红，行浆弗实，热毒盛而不解，则为紫为黑。雍而不
起，则为陷为塌；滞而不荣，则为干为枯，为青为灰；怯而不振，则为不快，或为停
浆。肉先肿胀而痘反不起，浆则滞而不行，面已虚浮而痘反退缩，毒则遏而不进。身不
热而痘不起，已成冰硬之形，赤色若还不变，温之可兴，气血弱而不振，遂成不快之
状，红润依然如故，补之可生。紫色干枯，只宜活血松肌，切忌温中带补，为壅为滞，
烈药虽然可发透肌，尤是良方溏泻，惟宜温补为先，久泻佐以升提为要，此验痘之常经
而用药之大概也。
热毒透发经过三天，痘疹开始显现形态，这是正常的征象，无需多言。如果超过期限而痘出不齐，往往是因为气机受阻，治疗时首先要分辨是虚证还是实证。
几天来痘疹蒸腾而出但参差不齐，应当果断使用疏风发汗的方法，不要犹豫。按照方剂加减药物并观察疮势，若表里平和，痘疹原本稀疏。
痘疹发出后通常要求气机均匀，更宜保持温和如春的气息。气机均匀则出得快且无壅滞，若偏热或偏寒则气机运行不畅。
头面部称为元首之尊位，咽喉紧隘如同关津要道。不要让痘疹在头部和颈部过于稠密，若锁项蒙头则预后不良。
胸前和头面部的痘疹总宜稀疏，手足部位虽然多也不必担忧。若是周身都极其稠密，就担心气血不能周流全身。
初出时的痘形色泽娇艳，必定知道皮嫩不坚固。若溶化破损增添愁绪，个个化成脓浆则是喜气洋洋的好兆头。
痘疮初出时解除咽喉症状，若有喉痹咽疮因毒火炽盛，只恐后来封管签（指咽喉肿胀闭塞），导致咽喉声音嘶哑则治疗徒劳无功。
若担心斑疮侵入眼中，古方中有明目的神效之功。眼睛多流泪、眼珠多发红，需急泻心肝之火以免毒邪攻目。
痘子起发阶段，不可拘泥于日数，痘疹逐渐出，其起发也应当逐渐进行，这叫做适中。若一齐涌出，会导致皮肉虚肿。若一齐发出来，这是因为表气虚弱，毒邪奔溃而出，表虚则不能收敛，必然产生痒痛溃烂。此时治疗急需以救表为主。若痘已出尽，当起发却不起发，这是里气虚弱，毒邪留伏，壅塞而不能出，必然增加烦躁、腹满、喘促等症状。这又急需以救里为关键。然而痘疹发于肌肉，由阳明胃经主管，脾气一温暖，胃气时时扬升，决不会有陷伏的祸患。就像人在笼中蒸桑拿一样，只希望疏松而已。
凡是痘疮起发之时，颗粒磊落分布的，是表里疏通，上下发泄，毒邪解散，属于顺痘。那些颗粒丛聚，根脚坚硬，像瘤一样红而不痛，像核一样坚而不动，像痈一样肿而不溃的，这是气血凝滞而不流动，肌肉败坏而不化解，毒邪郁积而不解，属于逆痘。不出四五日，必然因瘙痒闷乱而死。更有初出细密模糊，不成颗粒形状的。到了起发阶段，全变成大泡，清水虚痒的，这是卫气不收敛，属于逆痘，不出二三日，皮脱肉干闷乱而死。这些都是恶毒之气所致，必须在出现和起发的时刻审察。若到了成脓阶段，就没有这些病症了。
凡是痘的发出，以气血和平为主。尖圆坚实的是气足；血活明润的是血足。红活平陷的，是血至而气不足；圆实而色淡的，是气至而血不足；平塌灰白的，是气血俱不足；肿红绽裂的，是气血俱有热。若痘到起发阶段，则欲透而磊落，尖圆光壮肥泽的，为上等。如根脚横开，皮起水涨的，为次等。如顶皮不起，根脚不开，还是先出的形状，不见新生之水的，这就叫做起发不透。如气本实的，这必定曾感风寒，宜用发表药。如气本虚的，这必定不能饮食，或兼吐利，宜补中气而兼托表。若对着太阳已多天，发犹不透，是以烦躁不安啼叫恶热的，这是毒热在里，宜急松肌表，托里兼解散热毒，导引心火下行即可。若谵语而妄有见闻，时常发狂叫的，这是五脏热毒蕴积而阳气独盛，无阴气以调和它，必然大便不利，宜微通大便，使里没有留滞而外面得快利。甚至昏不知人，腹胀喘呼的，属不治之症。总之，起发之时，不徐不疾，逐渐长大尖圆磊落，光壮坚实，根脚红活，这是气充足，载血而行，透彻诸疮，自然尖圆光壮，不需要服药。如虽红活，项平中陷，不成尖圆，色嫩皮薄，不能坚浓，其变为痒塌，为留伏壅遏，乃气虚也，宜用补气。若疮皮薄色娇，淫淫如湿者，此气不胜血，宜补气凉血。如浮囊虚起，谷中无水者，此气不液血，血不附气，其变为痒塌，为痈肿矣，宜十全大补汤加减主之。凡由红斑而水泡，水泡而脓泡而结痂，有自然之序者吉也。若颠倒失常，尽由气血两虚，邪火冲击，变现为害，及初起发疮，头便带白浆者，不分何处，并非佳兆，不特口唇也。
第三四天，痘出应当整齐，直至足心，态势说安定。若还有陆续不出的样子，或隐隐在皮肤之内，不见不起的，不是风寒壅遏的原因，一定是内虚不振的缘故，所以四日以前痘毒刚出，身体表面宜凉；四日以后，毒出已定，身体表面宜温。凉则气血和平，痘色必然润泽；温则入里开通，其毒容易成浆，至此而身若不温，虽未必至于水状，而痘疮断难易长。又若身热不退，或身痛不止，或因风寒所迫，或因暑气所并，而无二便秘塞烦喘之症的，是症在表而不在里，宜葛根透肌之药以发之，待其表和而痘出自顺，但不可过汗，以丧其津液。
至第四五天时，血泡已成。理当起胀。如果肥大而粗，根红而顶光色白者，已具行浆之势。若还赤色过头，虽见娇红可受，然延绵六日，必依然到头空壳，虚花皮薄而光亮如灯，内舍是水，顶尖而根脚不红，行浆弗实，热毒盛而不解，则为紫为黑。雍而不起，则为陷为塌；滞而不荣，则为干为枯，为青为灰；怯而不振，则为不快，或为停浆。肉先肿胀而痘反不起，浆则滞而不行，面已虚浮而痘反退缩，毒则遏而不进。身不热而痘不起，已成冰硬之形，赤色若还不变，温之可兴，气血弱而不振，遂成不快之状，红润依然如故，补之可生。紫色干枯，只宜活血松肌，切忌温中带补，为壅为滞，烈药虽然可发透肌，尤是良方溏泻，惟宜温补为先，久泻佐以升提为要，此验痘之常经而用药之大概也。
After the heat toxin has penetrated for three days and the smallpox lesions begin to show their form, this is a normal occurrence and requires no comment. If the eruption exceeds the expected time limit without being complete, it is often due to qi obstruction; treatment must first distinguish between deficiency (Xu) and excess (Shi).
For several days, the lesions erupt with a steaming sensation but are uneven in distribution. One should decisively employ dispersing and releasing methods without hesitation. By adjusting herbs according to the formula and observing the lesion's progression, if the exterior and interior are harmonious, the original density of the lesions was sparse.
The eruption of smallpox generally requires uniform qi flow, and it is further advisable to maintain a gentle warmth like spring. Uniform qi leads to rapid eruption without stagnation; deviation towards heat or cold impedes qi movement.
The head and face are called the "noble head," and the throat is tight and narrow like a strategic pass. One must prevent the lesions from becoming too dense on the head and neck; if they lock the neck and cover the head, the prognosis is poor.
Lesions on the chest and face should ideally be sparse. Even if there are many on the hands and feet, there is no need to worry. However, if the entire body is extremely dense, one must fear that qi and blood cannot circulate throughout the whole body.
The initial appearance of the lesions is delicate and colorful, indicating tender and unfirm skin. If they melt and break, causing distress, but eventually fill with pus, it is a joyful omen.
When smallpox initially erupts, symptoms in the throat should be resolved. If there is throat bi (obstruction) or ulcers due to fierce toxic fire, one must fear later closure of the glottis, leading to hoarseness where treatment becomes futile.
If one fears the rash entering the eyes, ancient formulas have miraculous effects for vision. For eyes with excessive tearing and redness, urgently draining Heart and Liver heat prevents toxic attack on the eyes.
During the stage of smallpox development, one should not rigidly adhere to the number of days. The eruption should be gradual, and its development should also be gradual; this is called "moderate." If they all surge out at once, it causes flaccid swelling of the skin and flesh. If they all erupt simultaneously, this indicates deficiency of Exterior Qi, with toxins rushing out violently. Due to Exterior deficiency, they cannot consolidate, inevitably leading to itching, pain, and ulceration. Treatment urgently prioritizes rescuing the Exterior. If the lesions have fully erupted but fail to develop, this indicates Interior Qi deficiency, with toxins lingering and stagnating, unable to emerge, inevitably increasing irritability, abdominal fullness, and panting. This situation urgently prioritizes rescuing the Interior. However, smallpox develops in the muscles, governed by the Yangming Stomach Meridian. When Spleen Qi warms and Stomach Qi rises timely, there will be no risk of sinking or stagnation. It is like steaming in a basket; the goal is simply looseness.
Whenever smallpox develops, if the lesions are distinct and well-distributed, it signifies smooth Exterior and Interior, upward and downward discharge, and dissolution of toxins; this is a favorable (Shun) case. If lesions cluster together, with hard bases, resembling tumors that are red but not painful, nodules that are hard and immobile, or carbuncles that swell but do not suppurate, this indicates stagnant qi and blood that do not flow, ruined muscle tissue that does not transform, and accumulated toxins that do not resolve; this is an unfavorable (Ni) case. Within four to five days, death will occur due to itching and restlessness. Furthermore, if initially fine and dense, indistinct, and lacking defined granules, and upon development turning into large blisters filled with clear fluid and feeling empty/itchy, this indicates defensive qi failing to consolidate; this is an unfavorable case. Within two to three days, skin peels off, flesh dries, and death occurs from restlessness. All these are caused by malignant toxic qi and must be assessed during the emergence and development stages. Once suppuration is reached, these pathologies cease.
The emergence of smallpox relies primarily on the harmony of qi and blood. Sharp, round, and firm lesions indicate sufficient qi. Active and lustrous blood indicates sufficient blood. Red, active, yet flat and sunken lesions indicate blood has arrived but qi is insufficient. Round and solid but pale lesions indicate qi has arrived but blood is insufficient. Flat, collapsed, and gray-white lesions indicate both qi and blood are insufficient. Swollen, red, and bursting lesions indicate heat in both qi and blood. Upon reaching the development stage, lesions should be transparent and distinct, sharp, round, bright, strong, plump, and lustrous; this is superior. If the base spreads horizontally and the skin rises with water accumulation, this is secondary. If the apex does not rise and the base does not open, retaining the initial shape without new fluid generation, this is called incomplete development. If the constitution is originally robust, it likely involved wind-cold invasion, requiring exterior-releasing herbs. If the constitution is originally deficient, involving inability to eat or vomiting/diarrhea, tonifying Middle Qi while supporting the Exterior is appropriate. If after many days facing the sun, development remains incomplete, accompanied by irritability, crying, and aversion to heat, this indicates toxic heat in the Interior; urgently loosening the muscle layer, supporting internally while resolving external heat toxins, and guiding Heart fire downward is suitable. If delirium, hallucinations, and frequent manic shouting occur, this indicates accumulation of heat toxins in the Five Zang organs with exclusive dominance of Yang Qi and lack of Yin Qi to harmonize it; bowel movements will likely be difficult, requiring mild purgation to clear internal stagnation and facilitate external relief. If unconsciousness, abdominal distension, and panting occur, it is untreatable. In summary, during development, without haste or slowness, gradually growing sharp, round, distinct, bright, strong, firm, with red and active bases, indicates sufficient qi carrying blood through all lesions, naturally resulting in sharp, round, bright, and firm forms without needing medication. If red and active but flat with central depression, not sharp or round, tender color, thin skin, unable to become firm and thick, transforming into itching/collapse or stagnation/suppression, this is qi deficiency, requiring qi tonification. If lesion skin is thin and delicate, moist like dampness, this indicates qi cannot control blood, requiring qi tonification and blood cooling. If floating blisters rise emptily without fluid in the center, this indicates qi fails to transform blood and blood fails to attach to qi, transforming into itching/collapse or carbuncles; Shiquan Dabu Decoction (Ten Great Tonifying Decoction) modified is indicated. Progression from erythema to vesicles, to pustules, to scabs follows a natural order, which is auspicious. Reversal of this order, entirely due to dual deficiency of qi and blood and assault by evil fire, manifesting harm, or initial development showing white pus on the head regardless of location, is not a good omen, not limited to the lips.
On the third and fourth days, eruptions should be uniform down to the soles of the feet, indicating stability. If there is still a pattern of delayed eruption or hidden within the skin without appearing or developing, it is not due to wind-cold stagnation but rather internal deficiency and weakness. Therefore, before the fourth day, as toxins are just emerging, the body surface should be cool; after the fourth day, as toxins have stabilized, the body surface should be warm. Coolness harmonizes qi and blood, ensuring lustrous lesion color; warmth opens the interior, facilitating toxin transformation into pus. If the body is not warm at this stage, although not necessarily leading to watery lesions, smallpox growth will definitely be difficult. If fever persists or body pain continues, whether due to wind-cold pressure or summer-heat combination, without constipation, vexation, or panting, the pathology is in the Exterior, not the Interior. Ge Gen Tang (Kudzu Root Decoction) or similar muscle-loosening herbs should be used to release the exterior. Wait for exterior harmony so eruptions proceed smoothly, but avoid excessive sweating to preserve fluids.
By the fourth and fifth days, blood blisters should have formed, and development/swelling should logically follow. If large and coarse, with red bases and bright white apices, the potential for pus formation is established. If the redness is excessive, though appearing delicate and acceptable, if it persists for six days, it will inevitably end up as empty shells, with thin, flower-like skin bright as a lamp, containing only water inside. If the apex is sharp but the base is not red, pus formation will be insubstantial. Fierce heat toxins unresolved lead to purple or black colors. Obstructed and non-rising leads to sinking and collapse; stagnant and un-nourished leads to dryness, withering, green, or gray colors; weak and un-stirring leads to sluggishness or stopped pus formation. Flesh swells first while lesions do not rise, pus stagnates and does not flow; face becomes puffy while lesions recede, toxins are blocked and do not advance. If the body is not hot and lesions do not rise, forming ice-hard shapes, if redness does not change, warming can revive them. If qi and blood are weak and un-stirring, leading to sluggishness, if redness remains unchanged, tonification can generate life. Purple and dry/withered lesions require only blood-invigorating and muscle-loosening methods; strictly avoid warming with tonification to prevent stagnation. Although potent drugs can release and penetrate the muscle layer and are good prescriptions, for loose stools, warming and tonification should come first; for chronic diarrhea, assisting with lifting is key. This is the standard method for evaluating smallpox and the general principles of medication.