凡因风寒闭塞腠理，而热毒不得发泄，是以身体头背俱痛，鼻流清涕，寒热往来而
狂搐，咽干鼻燥，甚至遍身有青块者，俱宜发汗。若有紫黑而热极者，斟酌下之。如治
而青黑不退者，死。有因正值暑热壅蔽，是以毒无逐载之官，反乃内攻闷乱，烦渴喘满
昏愦如狂者，治宜清暑益气托痘，盖暑多伤气也。若有外感者，亦宜辛凉表之主之。
（碎锦）
凡小儿皮肤坚浓，瘦黑光彩，此骨胜肉也。再见眼中神光。如秋水澄清，及唇舌红
润者，吉。此气血两盛，其痘决轻。若肌肉浮脆而肥白，此肉胜骨也。再见目中光浮而
不明，兼之多痰多火者，凶。此气血两虚，其痘必重。一身热和暖，或热或退，神气清
爽，饮食二便如常，向无杂症者，吉。一邪热先发惊搐者，吉。以痘从心经而出也。一
初热时，或吐，或泻，痘出随止者，吉。盖热毒内解，邪气上下得泄，且不久见，则正
气不耗，故为吉耳。一发热三日，即无大热，腰腹不痛才见点者，坚硬碍手者，吉。
一凡吐泻而精神不减，气不粗，口不秽，痘自出者，虽次数略频，亦为吉论。
一发热时吐泻不止，身热口渴者，宜以四苓散加减主之，不可投温热止涩之药，致
遏热毒不出，犹以火助火矣。一初热吐盛，头体腰腹俱痛，吐泻咳嗽兼作者，其外感固
不轻，而内毒亦必重。宜急与荆防大为疏散。一风寒壅盛，以致红紫斑影不起者，宜
急透肌表汗，令其遍身皆出臭汗则毒瓦斯自散。一发热痰甚谵语，昏迷惊搐者，是外感
风寒而内动心热也，宜急散风去痰，兼利小便。则心热自减而惊搐自愈矣。一发热时毒
盛热壅，有一切失血之症者，并宜凉血解毒而专表痘。总之痘初杂症，多由毒瓦斯未出，
故宜多用表药，否则，毒无出路，小毒积成大毒。一初热而声遂变者重，宜急清肺利咽
为主。一发热腹痛，报痘干燥者，可用助血药以救之。一痘时行之际，虽未发热。如有
腰痛，或腰毒之类者，亦主出痘，但毒甚而痘出必重，故预宜清解调治。
凡是因风寒闭塞腠理（皮肤毛孔），导致热毒无法发散，从而出现身体、头部和背部都疼痛，流清鼻涕，忽冷忽热并伴有狂躁抽搐，咽喉干燥、鼻孔燥热，甚至全身出现青色斑块的情况，都应当采用发汗的方法治疗。如果痘疹颜色呈紫黑色且热势极盛，则需斟酌使用泻下法。如果经过治疗后青黑色仍不消退，预后不良，会导致死亡。
如果是正值暑热之气壅塞遮蔽，导致毒素没有途径排出，反而向内攻冲，引起胸闷烦乱、烦躁口渴、气喘腹胀、神志昏乱如同发狂的症状，治疗应当采用清解暑热、益气托毒的方法，因为暑邪多会损伤元气。如果有外感表证的情况，也应当以辛凉解表为主进行治疗。
（碎锦篇）
凡是小儿皮肤坚实厚实，身形瘦黑而有光泽，这是骨骼强健而肌肉相对不足的表现。如果再见到眼中神光清澈，如秋水般明净，以及嘴唇和舌头红润，这是吉兆。这说明气血两盛，其痘疹病情必然轻微。如果肌肉浮肿脆弱且肥白，这是肌肉过盛而骨骼相对不足的表现。如果再见到眼中目光浮散而不明亮，兼有多痰多火的症状，这是凶兆。这说明气血两虚，其痘疹病情必然严重。
全身发热但感觉温和，或热或退，精神清爽，饮食和二便正常，向来没有杂症的人，是吉兆。在初热阶段，如果出现惊厥抽搐，也是吉兆。这是因为痘毒从心经发出。在初热阶段，如果出现呕吐或腹泻，痘疹一出症状随即停止的，是吉兆。这是因为热毒在内得到解除，邪气通过上下途径得以宣泄，且持续时间不长，正气没有耗损，所以称为吉兆。
发热三天后，如果没有大热，腰腹部不痛，刚见到痘点，且痘粒坚硬碍手的，是吉兆。凡是出现吐泻但精神不减，呼吸不粗重，口无秽臭，痘疹自然发出的，虽然次数略频繁，也属于吉利的判断。
如果在发热时吐泻不止，身体发热且口渴，应当用四苓散加减来主治，不可投用温热的止涩药物，以免遏制热毒不得外出，这就像是用火去助长火势一样。初热阶段呕吐剧烈，头、体、腰、腹都疼痛，呕吐、腹泻、咳嗽同时发作的，说明外感邪气固然不轻，内毒也必然严重。应当紧急给予荆防败毒散进行疏散治疗。
如果风寒壅盛，导致红紫色的斑影不能透发出来，应当紧急透达肌表发汗，让全身都出臭汗，那么毒瓦斯自然会消散。发热时痰多、说胡话、昏迷、惊厥抽搐的，这是外感风寒而内动心热的表现，应当紧急疏散风邪、去除痰浊，兼以利小便。这样心热自会减轻，惊厥抽搐也会自愈。
发热时毒盛热壅，出现一切失血症状的，都应当采用凉血解毒并专门透发痘疹的方法。总之，痘疹初期的杂症，大多由毒瓦斯未能透出所致，因此宜多用解表药，否则，毒邪没有出路，小毒积聚就会变成大毒。初热阶段声音随即发生变化的，病情较重，应当紧急以清肺利咽为主进行治疗。发热腹痛，痘疹报形干燥的，可以用补血药来救治。在痘疹流行期间，即使尚未发热，如果有腰痛，或者腰部有毒疮之类的症状，也主病为出痘，但毒邪甚重，痘疹发出后必然严重，所以预先应当进行清解调治。
In cases where wind-cold obstructs the *Couli* (pores of the skin), preventing the release of heat-toxin, resulting in pain throughout the body, head, and back, clear nasal discharge, alternating chills and fever accompanied by manic convulsions, dry throat, dry nose, and even blue-black patches all over the body, sweating methods should be employed. If the lesions are purple-black with extreme heat, purgation should be considered cautiously. If the blue-black discoloration persists after treatment, the prognosis is fatal.
In cases where summer-heat qi is congested and blocking, causing toxins to have no outlet and instead attacking inward, leading to chest oppression, restlessness, irritability, thirst, asthma, abdominal fullness, and stupor resembling mania, the treatment should focus on clearing summer-heat, benefiting Qi, and supporting the eruption of pox, as summer-heat often damages Qi. If there is an accompanying exterior contraction, acrid-cool exterior-releasing agents should be used as the primary treatment.
(Suijin Section)
If a child has firm and thick skin, is lean and dark with luster, this indicates strong bones relative to flesh. If accompanied by clear spirit in the eyes, like autumn water, and red, moist lips and tongue, it is an auspicious sign. This indicates abundant Qi and Blood, meaning the smallpox will be mild. If the muscles are flaccid, fragile, and fat-white, this indicates excessive flesh relative to bones. If accompanied by floating and unclear vision in the eyes, along with excessive phlegm and fire, it is an ominous sign. This indicates deficiency of both Qi and Blood, meaning the smallpox will be severe.
If the body is warm during fever, or the fever fluctuates, with clear spirit, normal diet, urination, and defecation, and no history of miscellaneous diseases, it is auspicious. If convulsions occur at the onset of initial heat, it is auspicious, as the toxin emerges from the Heart Meridian. If vomiting or diarrhea occurs during the initial heat phase, and stops once the rash appears, it is auspicious. This is because the heat-toxin is resolved internally, and the pathogenic factors are expelled through the upper and lower pathways without prolonged duration, preserving the Healthy Qi.
If after three days of fever, there is no high fever, no pain in the waist and abdomen, only just appearing spots that are hard to the touch, it is auspicious. If vomiting and diarrhea occur but spirit remains unimpaired, breathing is not coarse, mouth odor is absent, and the rash erupts naturally, even if frequent, it is still considered auspicious.
If vomiting and diarrhea persist during fever with body heat and thirst, *Siling San* (Four-Ling Powder) modified should be used. Warm and astringent medicines must not be administered, as they would hinder the release of heat-toxin, akin to adding fuel to fire. In the initial heat stage, if vomiting is severe, accompanied by pain in the head, body, waist, and abdomen, and simultaneous vomiting, diarrhea, and cough, the exterior contraction is significant, and the internal toxin is also heavy. *Jingfang Da Bantu* (Major Dispersion with Schizonepeta and Saposhnikovia Decoction) should be urgently administered for dispersion.
If wind-cold is congested, preventing the emergence of red-purple macules, urgent sweating to penetrate the muscle layer is required. If foul sweat covers the whole body, the toxic vapors will naturally dissipate. If fever is accompanied by excessive phlegm, delirium, coma, and convulsions, this indicates exterior wind-cold combined with interior stirring of Heart-heat. Urgent dispersal of wind and elimination of phlegm, along with promoting diuresis, are required. The Heart-heat will subside, and convulsions will cease.
If toxin is excessive and heat is congested during fever, accompanied by any bleeding symptoms, blood-cooling and toxin-resolving methods combined with specific eruption support should be used. Generally, miscellaneous diseases in the early stage of smallpox are due to trapped toxic vapors; thus, exterior-releasing herbs should be used extensively. Otherwise, without an exit for the toxin, minor toxins accumulate into major toxins. If the voice changes during the initial heat stage, the condition is serious; urgent clearing of the Lungs and benefitting the throat is required. If fever is accompanied by abdominal pain and dry, reporting (early stage) pox, blood-nourishing herbs should be used to rescue the condition. During smallpox epidemics, even before fever onset, if there is lower back pain or toxic sores on the waist, it indicates impending smallpox. Since the toxin is heavy, the eruption will be severe; therefore, preemptive clearing and resolving treatments are necessary.