凡痘初出，磊落成个而后来长大作脓，始相连串，然外虽串通而皮下犹个个分明，
及至结痂肿消而脓干现出，复成个数完全坚浓者上也。即或根脚相通而皮肉尽串，若已
结痂之时，亦得干净，无有淫湿及溅破者，次也。如未成痂者，溃烂，已成痂者，只是
嫩皮，此亦倒靥也。然凡倒靥而如面疮肿起，尚在灌脓，身虽半靥而脓肿犹存者，此
痘已熟，乃为可治之症。如痘犹生而未成脓，即乃结靥，目开而乎肉干，及有失音喘
促烦躁等候者，此决不可治也。
凡痘疮收靥，其色苍蜡，圆净坚浓而如螺靥痂瘢高矣，如珠者。是正靥也。如浓满
而色灰黑，兼之干塌，平在皮肤者，或头穿脓出堆众成痂如鸡矢者，次也。若皮破脓
出，痂薄如纸者，又其次也。若皮烂脓溃，不成痂皮而脓汁腥臭者，此为外靥，斯为下
矣。如过期而然者，则譬诸瓜果熟久则烂，此亦造化之常，还作顺看，未及期者，则为
斑烂，乃逆候也，必变倒靥而死。然有因过服参 托表之剂而致里邪虽已尽出，其表毒
不能自解，是以过期而腐烂不收者，治宜解表以胜其湿淫之气，解里以行其郁蒸之毒。
则自然易于结痂矣。更有内外热极，毒瓦斯散漫，无阴气以敛之者，惟宜清凉解毒而已。
凡痘疮破损者，复肿灌作浆，不致干枯，及或原痘处复出一层，起发作脓者，此
里气充实，毒不得入，犹在于表，未成倒靥，是逆中之顺症也。若疮子重出一番，其
人能食便坚，气充血足，足以胜其再出之毒者，尤为顺也。如食少而便润，则用人参白
术散，或十全大补汤，相兼服之。若自利者，则以肉豆寇丸主之，盖病久气虚，惟宜
温补，不可纯用解毒及托也。然有素不欲食而忽思食，渐渐加多，此胃正气复也，为
吉。若素不思食而多食异常者，此乃胃败，邪火内攻，杀谷也者，曰除中凶之候也。
凡是痘疹刚刚发出，颗粒分明且随后长大化脓，开始连接成片，虽然外表看起来连通，但皮下仍然个个界限分明，等到结痂肿胀消退、脓液干燥显现出来，又恢复成个数完整、坚实浓厚的，这是上等的情况。即使根部相通而皮肉完全连串，如果在结痂的时候，也能保持干净，没有渗液过多及溅破的情况，属于次一等。如果尚未形成痂皮的，发生溃烂；已经形成痂皮的，只是嫩皮，这也属于倒靥（痘疹逆证）。然而凡是倒靥而像面疮一样肿起，还在化脓，身体虽然有一半已结靥但脓肿仍然存在，这说明痘毒已熟，是可以治疗的病症。如果痘疹还处在生发阶段而未化成脓，却强行结靥，出现眼睛睁开但肌肉干枯，以及失音、气喘急促、烦躁等症状，这绝对是不治之症。
凡是痘疮收靥（结痂），颜色呈苍蜡色，圆润洁净、坚实浓厚且像螺靥痂瘢一样高起，如珠子般的，这是正靥（顺证）。如果脓液充满但颜色灰黑，兼有干枯塌陷，平贴在皮肤上，或者头部穿破脓出堆积成痂像鸡屎样的，属于次一等。如果皮肤破损脓液流出，痂皮薄如纸张的，又是更次一等。如果皮肤腐烂脓液溃散，不能形成痂皮且脓汁腥臭的，这叫外靥，是最下等的情况。如果是过了期限才变成这样，那就好比瓜果成熟久了就会腐烂，这也是自然规律，还可以当作顺证来看待；如果未到期限就变成这样，就是斑烂，属于逆证候，必然转变为倒靥而死。然而有因为过服人参等托表药物而导致里邪虽然已全部透出，但表毒不能自行解除，因此过期而腐烂无法收敛的，治疗应当解表以战胜湿淫之气，清里以行散郁蒸之毒，那么自然容易结痂了。更有内外热极，毒气散漫，没有阴气来收敛它的，只宜用清凉解毒的方法罢了。
凡是痘疮破损后，又重新肿胀化浆，不至于干枯，或者在原痘处重新长出一层，起发作脓的，这是因为里气充实，毒邪不得内入，仍然停留在体表，未形成倒靥，这是逆证中的顺证。如果痘疮重发出一番，病人能进食、大便坚硬，气充血足，足以抵御再次发出的毒邪，这尤为顺证。如果吃得少而大便稀软，则用人参白术散，或十全大补汤，配合服用。如果出现自发性腹泻的，则以肉豆蔻丸为主治，因为病久气虚，只宜温补，不可单纯使用解毒及托毒透发的药物。然而有平时不想吃东西却忽然想吃，逐渐增多，这是胃中正气恢复的表现，为吉兆。如果平时不想吃东西却异常多食，这是胃气败坏，邪火内攻，消谷善饥，称为“除中”，是凶险的征候。
Whenever the smallpox rash first appears, the pustules are distinct and separate, then later enlarge and suppurate, beginning to connect in chains. Although they appear connected externally, beneath the skin each remains clearly distinct. When scabs form, swelling subsides, and pus dries up to reveal the scabs again, restoring a complete number of firm and thick scabs, this is the best outcome. Even if the bases are connected and the skin and flesh are entirely fused, as long as at the time of scabbing it remains clean without excessive exudation or rupture, it is second best. If no scab has formed and ulceration occurs, or if only tender skin remains where a scab should be, this is also considered "Dao Ye" (inverted smallpox/reverse progression). However, if inverted smallpox presents like a facial carbuncle with swelling and ongoing suppuration, and although half the body has scabbed, abscesses remain, this indicates the disease toxins have matured, making it a treatable condition. Conversely, if the smallpox lesions are still in the eruptive stage without forming pus, yet prematurely scab over, accompanied by symptoms such as open eyes but dry flesh, loss of voice, panting, rapid breathing, and restlessness, this is absolutely incurable.
Regarding the healing phase (scabbing) of smallpox: if the color is pale waxy, round and clean, firm and thick, raised like snail-shell scars or beads, this is "Zheng Ye" (normal/smallpox progressing smoothly). If the pus is full but the color is grayish-black, accompanied by dryness and collapse, lying flat on the skin, or if the head bursts with pus oozing out and piling up into scabs resembling chicken droppings, this is second best. If the skin breaks and pus flows out, with scabs thin as paper, this is even worse. If the skin rots and pus溃散 (discharges), failing to form scabs, with foul-smelling pus, this is called "Wai Ye" (external inversion), which is the worst grade. If this state occurs after the expected period, it is akin to fruits rotting after being ripe for too long; this follows natural laws and can still be viewed as a favorable course. If it occurs before the expected period, it is termed "Ban Lan" (mottled decay), an adverse sign that will inevitably turn into inverted smallpox leading to death. However, some cases result from excessive use of tonifying agents like Ginseng to push toxins outward; although internal pathogens have been expelled, external toxins cannot resolve spontaneously, causing prolonged rotting and failure to heal. Treatment should focus on releasing the exterior to overcome dampness and clearing the interior to dissipate stagnant heat toxins, allowing natural scabbing. In cases of extreme internal and external heat with scattered toxic qi and lack of Yin to consolidate it, only cooling and detoxifying methods are appropriate.
When damaged smallpox lesions swell again and fill with fluid without drying up, or when a new layer erupts at the original sites and suppurates, this indicates sufficient internal Qi preventing toxin invasion, keeping it superficial without becoming inverted smallpox; this is a favorable pattern within an adverse context. If the lesions re-erupt and the patient can eat and has hard stools, with abundant Qi and blood sufficient to withstand the renewed toxin, this is particularly favorable. If appetite is poor and stools are loose, Ren Shen Bai Zhu San (Ginseng and Atractylodes Macrocephala Powder) or Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) should be administered together. If spontaneous diarrhea occurs, Rou Dou Kou Wan (Nutmeg Pill) is the primary treatment, as chronic illness leads to Qi deficiency requiring warming and tonification, rather than pure detoxification or pushing-out therapies. However, if a patient who previously lacked appetite suddenly desires food and gradually increases intake, this indicates the recovery of Stomach Zheng Qi (Upright Qi) and is auspicious. If a patient who usually lacks appetite suddenly eats excessively abnormally, this indicates Stomach Qi failure, with evil fire attacking internally and consuming grain rapidly, known as "Chu Zhong" (Elimination of the Middle), which is a ominous sign.