初出一点血，形色未分纯，阴之象也。盖血初载毒犯上，循窍而出，未受阳制，然
其体立矣。次变而阳始会，阴气能定位制下，是以气形于中，血周于外，其中稍有徽
白而外则淡红如故，然血盛之势未降而属徽阳之象也。更变而气尊于内，拘血化毒，气
和血就，尊卑道正而乃根窠圆混，其中之白渐大，外之淡红渐细而属微阴之象也。再受
而为血收气足，毒化成脓，其中之血既充，遂乃圆满结实，白转为黄，红晕俱化血，毒
两降而属纯阳之象也。然是毒也，虽有巨细稀密之殊，而百千形状皆类乎一者性也。惟
其变态不一者情也。性出于阴阳，情可化也。性岂人力为哉！故其加治。凡阴始交阳
之际，阳交阴会之初，夏肤之象未分。若非圣于医而知虚实寒热者，不可轻易下剂，恐
其药性紊乱，气血交会之机。若气始定位，血初归附，各能顺识，亦何药焉，惟苟失其
正，则宜治矣。调其血气之紫，便得交会之妙，自能逐毒成功而无咎矣。
（内有未备者悉具总论痘要门参看）
夫疹由心热，斑由胃热，斑乃血之余，有色点而无头粒者也。盖痘自脏而出，其势
迅速，血热毒盛之痘，则血太过而气不及卫气疏缺，不能密集脉络而致太过之血，任其
三焦浮游之火而发为斑，是以夹毒上浮矣。然至痘毒出齐，则内必虚，内虚则斑从内
解，不解当以轻剂散其火邪，兼活血解毒之药。凡在初多用表散，在后宜用解利，伺其
斑退血附，即用补药，以防其损陷之患。然有色赤如火者，乃毒滞不能宣发也。更有或
结痂而发者，是余毒热盛，煎熬肉分，其斑必烂，当用解毒，烂处以生肌散传之。凡红
斑易退，紫斑稍难，蓝斑黑斑热毒亢害已极，不可治也。夫疮出而斑退者，吉。或斑
退而疮出坚实者，亦吉。否则，皮肤斑烂，疮易瘙痒。如赤斑成槐，其肉浮肿结硬者，
又名丹瘤，其毒最酷每有疮未成，就此先溃烂，多不可治。总之，斑疹必须令退，使痘
独成为妙，否则，气血重耗，脏腑俱病矣。
刚出现一点血点时，色泽形态尚未分明，这是阴的征象。因为血液初次携带毒邪向上侵犯，顺着孔窍而出，尚未受到阳气的制约，但它的形体已经确立。随后变化，阳气开始交会，阴气能够定位并制约下方，因此气显现于内部，血周流于外部，其中稍微呈现微白色而外部则保持淡红色，然而血盛的趋势并未下降，这属于微阳的征象。再次变化，气在内部占据尊贵地位，拘束血液以化解毒邪，气和顺而血依附，尊卑秩序端正，根基圆融浑厚，其中的白色逐渐扩大，外部的淡红色逐渐变细，这属于微阴的征象。再进一步演变，血液收敛而气充足，毒邪化为脓液，其中的血液既已充盈，于是变得圆满结实，白色转为黄色，红晕全部化为血，毒邪与血势两相下降，这属于纯阳的征象。然而这种毒邪，虽然有大、小、稀、密的区别，但千百种形状都类似一种本性。之所以形态变化不一，是情态的表现。本性出于阴阳，情态是可以转化的。本性难道是人能强行改变的吗！所以治疗要顺应其加临的变化。凡是阴气刚开始与阳气交合之际，阳气初交阴气交会之时，如同夏季肌肤之象尚未分明。如果不是精通医术且知晓虚实寒热的人，不可轻易使用攻下剂，恐怕药性紊乱，破坏气血交会的机理。如果气刚开始定位，血初归附，各自都能顺应识别，又需要什么药物呢？只有如果失去了正道，才适宜治疗。调和其紫滞的血气，便能得到交会的妙用，自然能驱逐毒邪取得成功而没有过失。
（书中未详尽之处，请参见总论痘要门参考）
疹子源于心热，斑疹源于胃热，斑是血的余绪，是有颜色斑点但没有头粒的。大概痘疮从脏腑发出，其势头迅速，血热毒盛的痘疮，则血太过而气不足以卫护，气疏缺，不能密集脉络而导致过多的血，任由三焦浮游之火而发为斑，因此夹带毒邪上浮了。然而等到痘毒出齐，体内必然虚弱，内虚则斑从内部解除，不解散时应当用轻剂疏散火邪，兼用活血解毒的药物。凡是在初期多用表散法，后期宜用解利法，等待斑退血附后，立即使用补药，以防损伤下陷的祸患。然而有颜色赤红如火的，是毒邪停滞不能宣发所致。更有结痂后又发作的，这是余毒热盛，煎熬肌肉部分，其斑必定溃烂，应当使用解毒药，溃烂处涂抹生肌散。凡是红斑容易消退，紫斑稍难消退，蓝斑黑斑热毒亢盛危害已到极点，无法治疗了。疮发出而斑消退的，吉利。或者斑消退而疮发出且坚实的，也是吉利。否则，皮肤斑烂，疮容易瘙痒。如果赤斑结成槐树状，其肉浮肿结硬的，又名丹瘤，其毒最猛烈，常有疮未形成，就在此处先溃烂，大多不可治。总之，斑疹必须令其消退，使痘疮单独成为好现象，否则，气血双重耗损，脏腑都会生病。
When the first blood spot appears, its color and form are not yet distinct; this is a manifestation of Yin. Blood initially carries the pathogenic toxin upward, exiting through orifices, without yet being constrained by Yang, yet its physical structure is established. Subsequently, changes occur as Yang begins to intersect; Yin Qi can position itself and control the lower aspect. Thus, Qi manifests internally, while Blood circulates externally. Internally, there is a slight whitish hue, while externally it remains pale red. However, since the momentum of abundant Blood has not subsided, this belongs to the phenomenon of slight Yang. Further transformation occurs as Qi becomes dominant internally, restraining Blood to transform toxins. When Qi is harmonious and Blood adheres, the hierarchy is correct, and the root becomes round and integrated. The whiteness inside gradually enlarges, while the pale red outside gradually thins, representing the phenomenon of slight Yin. In further evolution, Blood retracts and Qi becomes sufficient; toxins transform into pus. With Blood fully充盈 (filled) inside, it becomes round and firm. White turns yellow, and the red halo transforms into Blood. Both toxin and Blood momentum descend, representing the phenomenon of Pure Yang. Nevertheless, this toxin, despite differences in size, sparsity, and density, shares a common nature across thousands of shapes. Its varied manifestations constitute its "emotion" (dynamic state). Nature arises from Yin and Yang, while emotion can be transformed. Can nature be altered by human effort? Therefore, treatment must adapt to these changes. At the initial stage of Yin-Yang intersection, when Yang meets Yin and the summer-skin-like appearance is indistinct, unless one is a sage physician who understands deficiency, excess, cold, and heat, one should not lightly administer purgatives, lest drug properties cause chaos and disrupt the mechanism of Qi-Blood intersection. If Qi positions itself and Blood returns to its place, each following its natural course, what medication is needed? Only if deviation occurs is treatment appropriate. Harmonizing the purple stagnation of Qi and Blood achieves the wonder of intersection, naturally expelling toxins successfully without fault.
(For details not covered herein, please refer to the General Discussion on Key Points of Smallpox.)
Rashes originate from Heart Heat, while macules arise from Stomach Heat. Macules are the surplus of Blood, characterized by colored spots without granular heads. Generally, variola (smallpox) erupts from the Zang-Fu organs with rapid momentum. In cases of severe Blood Heat and toxin abundance, Blood exceeds while Qi fails to defend; Qi is sparse and deficient, unable to densely network the vessels. This excessive Blood allows the floating fire of the San Jiao (Triple Burner) to erupt as macules, thus carrying toxins upward. However, once the variola toxin is fully expressed, internal deficiency inevitably follows. Internal deficiency causes macules to resolve from within. If they do not resolve, light agents should be used to disperse Fire pathogens, combined with herbs that invigorate Blood and detoxify. Initially, exterior-releasing methods are mostly used; later, resolving and promoting methods are suitable. Once macules recede and Blood adheres, tonifying medicines should be immediately administered to prevent damage and sinking complications. However, macules that are crimson like fire indicate stagnant toxins unable to diffuse. Cases where scabs form and then re-erupt indicate residual toxins with intense heat, boiling the flesh, causing macules to ulcerate. Antidotal measures are required, and ulcerated areas should be treated with Shengji San (Flesh-Regenerating Powder). Red macules are easy to resolve; purple macules are slightly difficult. Blue and black macules indicate extreme toxicity and heat, which are incurable. If sores appear and macules recede, it is auspicious. If macules recede and sores appear firm, it is also auspicious. Otherwise, skin maceration and itching of sores may occur. If red macules form knots resembling locust trees, with swollen and hard flesh, it is called Danliu (Red Tumor). Its toxicity is most fierce; often, sores have not yet formed, but ulceration occurs here first, making it largely incurable. In summary, macules and rashes must be made to recede, allowing variola to manifest alone for the best outcome. Otherwise, both Qi and Blood will be doubly depleted, and all Zang-Fu organs will become diseased.