痘疮起发视根窠，红括充肥血气和。若是干枯青紫点，急宜养血莫蹉跎。
四围沸起陷当中，胃气亏虚发未通，外白中心成黑点，是名鬼痘急宜攻。
中心凸起四沿平，外黑里红一例论，此是表邪多壅遏， 邪发表令调匀。
发时磊落最堪夸，三五粘连便不佳。若是糊涂成一块，切防瘙养又来加。
头面斑疮总属阳，升生浮长类相当，微微渐肿疮红润，骤肿疮平可预防。
起发之初未试浆，口唇疮色早焦黄。如斯恶候无人识，待得收时作祸殃。
出形未定先涵水，起发之初便戴浆，脓水未成收靥急，不堪有此命终亡。
起发一齐如锡面，皮肤浮肿形容变，其人能食乃为佳，食减气虚作凶断。
热有大小治不同，古人取譬似蒸笼，不知邪气分深浅，妄治何能得适中。
痘疮起发肿为奇，头面先肿又不宜，五脏精华从此散，枭炎肆虐魄魂离。
六七日之期，顺候浆行半足，虚疮方见分光，毒重而壅遏者，必干枯退缩，气盛而
发者，必饱满光荣，头面行浆而四肢未起，见之切莫惊张，腿 发泡而脸额焦枯，
见之且休欢喜，既已惧其发呛，发呛愁其失音，且又虑其喘急，喘急恐其腹胀，饮食不
多，或致脏虚而内陷，水浆频进，恐未泄泻而复颠，调理失宜，倒或反掌，热盛渴烦，
到此休根据实论，再加溏泻，此时只作虚看，黑紫干枯，急攻发而或生，气虚塌陷，重温
补而幸活，疮或白而少神，根虽红而莫治，皮不起而离窠，脚虽赤而难生，淡白塌涸，
此内必无浆汁，皮薄娇红，有浆亦是清稀，犯此四端，八九日必然发痒。若还壮热燎
人，不痒定行干燥，至紫色干枯，不须着眼，定然凶中凝血迹，或可幸而成浆水，三
日而焦紫者，犹可转斡旋之功，七日而焦紫者，难以施挽回之力。浆既行而半足，时尚
未宜收敛，忽然一齐紫黑，自古名为倒靥，请君莫认谓之结痂，攻发若得其宜，此症犹
堪复活，旁生血点，再行浆，伏毒凭之而解散。至若气急而腹胀，黄泉在迩，失音而呕
哕，阳数无几已。
心痘疮出现三日，则乃起胀，渐乃养脓，继而结靥，初出现时，其形小，其色
红，乃是一点血，至起发其形圆，其色红白，乃血化为水也。养脓则其形大而坚，其
色红而黄，乃水化为脓也。结靥则其形大而软，其色红而黑，谓之苍腊，此脓熟欲靥之
状，如果之熟，自然外皮软而内肉烂，已而结实也。假如十日以后，正当成脓结靥之
时，其形平陷其色红紫，外不胖壮，内无脓水，此名生痘，血至而气不至，乃倒陷也，
不出中三日，腹胀气喘闷乱而死。
或问痘之脓浆，自何经证来，亦何经收去，盖容光所照，日月之真明也。湍润沂
发，河海之渊源也。夫痘起于肾而伏藏于肾，天一生水，肾居之。为肾之所主者，骨
髓，而痘毒所伏也。是以脓浆亦自始于天一之水，然乙癸同源，而用荣助之故，其根本
源于肾。王尊推于心，调畅由于肝，卫养在于肺，收藏伏于脾，水火相济，以成其功，
赖上以成其实，故痘终变而为黄者，是阳明土之正色也。是以毒伏于肾，振于阳明。又
终以生化之土而归藏之，故痘无浆则毒不化，浆不足则毒不尽。毒伏肾，必赖肾以竣
之，上化毒，必赖脾以收之，故脓浆之来，虽出于肝血，实资于真水。真水者，即真阴
也。脓浆之收，虽赖于脾土，实藉于真火真火者，即真阳也。脓浆之理，于此昭然
矣。
痘疮起发时，需观察其根部（根窠）的情况。若痘粒红润饱满、气血调和，则为吉兆；若是干枯无泽或呈青紫色斑点，则急需养血，不可延误时机。
若痘疮四周隆起而中间凹陷，说明胃气亏虚，痘毒未能透发通畅；若痘皮外白中心出现黑点，这被称为“鬼痘”，必须紧急攻邪治疗。
若痘疮中心凸起而四周平坦，无论外表黑还是内里红，都按同一原则处理：这是因为表邪壅滞遏阻所致，应通过解表使邪气发散，令气血调匀。
痘疮发出时颗粒分明、磊落清晰是最值得称赞的；若三五颗粘连在一起便不佳；若糊涂连成一片，务必防止瘙痒症状再次加重。
头面部的斑疮总属阳证，其形态升浮生长与阳气相应。若微微逐渐肿胀且疮色红润，是佳象；若突然剧烈肿胀而疮顶平塌，则需预防变证。
在起发初期尚未见浆液时，若口唇处的疮色早早变得焦黄，这是无人能识别的恶候，等到收靥阶段便会酿成大祸。
痘形未定之前先含有水分，或在起发之初就带有浆液，若脓水未成熟就急于收靥，患者将不堪此症，可能导致死亡。
若痘疮起发时整体如锡箔般光亮平整，皮肤浮肿、面容改变，此时若患者食欲良好则是佳兆；若饮食减少、气虚，则判断为凶险之证。
热势有大有小，治疗方法也不同。古人将其比喻为蒸笼，但不知邪气有深浅之分，若盲目治疗怎能恰到好处？
痘疮起发时肿胀本是奇特之象，但若头面部先肿则又不适宜，因为五脏精华从此散失，毒火肆虐，魂魄离体。
到了第六七日，顺证的痘疮浆液运行已过半足，虚弱的痘疮才显现出分光的现象。毒重而壅滞者，必然干枯退缩；气盛而发者，必然饱满光荣。头面部行浆而四肢尚未起发，见到此景切勿惊慌；腿部发泡而脸额焦枯，见到此景暂且不要欢喜。既然已经担心痘毒上冲呛咳，又忧愁痘毒导致失音，还要忧虑气喘急促，气喘急促又恐引起腹胀。饮食不多，可能导致脏腑虚弱而内陷；水浆频进，恐怕未止泻反而导致神志昏乱。调理失当，病情逆转只在反掌之间。热盛口渴烦躁，到此阶段不要再根据实证论治；若再加溏泻，此时只当作虚证看待。黑紫干枯，急用攻发之法或许能生还；气虚塌陷，重温补之法或许能存活。痘疮若白色而少神气，虽根部红也难以治愈；痘皮不起而脱离根部，虽脚底赤也难再生；淡白塌陷干涸，体内必然没有浆汁；痘皮薄嫩娇红，虽有浆液也是清稀。犯此四种情况，八九日必然发痒。若还有壮热灼人，不痒定会干燥；至紫色干枯，不必细看，定然凶险中有凝血痕迹，或许侥幸能化成浆水。三日而焦紫的，还可施展扭转局势之功；七日而焦紫的，难以施加挽回之力。浆液既行且半足，时尚未宜收敛，忽然一齐变成紫黑，自古称为“倒靥”，请君不要误认为是结痂。若攻发得当，此症犹可复活；旁生血点，再行浆液，伏毒凭此而解散。至于气喘而腹胀，死亡临近；失音而呕哕，阳气数尽不久矣。
心痘疮出现三天，便开始起胀，逐渐滋养脓液，继而结痂。初出现时，形状小，颜色红，是一点血；到起发时，形状圆，颜色红白，这是血化为水。滋养脓液时，形状大而坚，颜色红而黄，这是水化为脓。结痂时，形状大而软，颜色红而黑，称为“苍腊”，这是脓熟欲结痂的状态，如同果实成熟，自然外皮软而内肉烂，随后结实。假如十日以后，正当成脓结痂之时，形状平陷，颜色红紫，外不胖壮，内无脓水，这名为“生痘”，血至而气不至，属于倒陷，不出中三日，因腹胀气喘闷乱而死。
有人问痘疮的脓浆，从哪条经络产生，又从哪条经络回收？这就像容光所照，是日月真正的光明；湍润沂发，是河海的渊源。痘起源于肾而伏藏于肾，天一生水，肾居其位。肾所主的是骨髓，也是痘毒潜伏之处。因此脓浆也始于天一之水。然而乙癸同源，依靠肝血荣助，其根本源于肾。王尊推于心，调畅由于肝，卫养在于肺，收藏伏于脾，水火相济以成其功，赖土以成其实，所以痘最终变为黄色，这是阳明土的正色。因此毒伏于肾，振于阳明，最终由生化之土而归藏之。所以痘无浆则毒不化，浆不足则毒不尽。毒伏于肾，必赖肾以竣之（完成/终结），上化毒，必赖脾以收之。故脓浆之来，虽出于肝血，实资于真水（真阴）。脓浆之收，虽赖于脾土，实藉于真火（真阳）。脓浆的道理，于此昭然若揭。
When the smallpox pustules begin to rise, one must observe their roots (gen ke). If the pustules are red, plump, and the blood and qi are harmonious, it is an auspicious sign; if they are dry, withered, or present as cyanotic-purple spots, nourishing the blood is urgently required, and time must not be wasted.
If the sides of the pustules are raised while the center is depressed, it indicates deficiency of stomach qi and failure of the toxin to vent smoothly; if the skin is white externally but has a black spot in the center, this is named "Ghost Pox" (Gui Dou), and urgent attack therapy is required.
If the center of the pustule is convex and the margins are flat, whether the exterior is black or the interior is red, treat them under the same principle: this is due to excess pathogenic factors obstructing the exterior; resolve the exterior to allow the pathogen to disperse and regulate the qi and blood.
It is most praiseworthy when the erupted pustules are distinct and clear; if three or five adhere together, it is unfavorable; if they blur into a single mass, one must guard against the recurrence of itching.
Rashes on the head and face generally belong to Yang patterns; their ascending and floating growth corresponds to Yang qi. Slight, gradual swelling with red and lustrous pustules is a good sign; sudden severe swelling with flat-topped pustules requires prevention of complications.
At the initial stage of rising, before serum appears, if the color of the sores on the lips turns scorched yellow early, this is a malignant symptom unrecognized by many; waiting until the crusting stage will bring disaster.
If water content appears before the shape is fixed, or if serum is present at the very beginning of rising, rushing to crust before pus is formed will make the patient unable to withstand the condition, potentially leading to death.
If the rising pustules are uniformly smooth like tin foil, accompanied by edema and altered facial features, good appetite is a favorable sign; reduced diet and qi deficiency indicate a ominous prognosis.
Heat intensity varies, requiring different treatments. Ancients compared it to a steamer, but failing to recognize the depth of the pathogen leads to inappropriate treatment.
Swelling during the rising phase is unusual; however, swelling first appearing on the head and face is unfavorable, as it signifies the dispersion of essence from the five zang organs, with toxic fire raging and soul departing.
By the sixth or seventh day, in favorable cases, the serum flow is more than half complete, while weak pustules only then show separation of light. Those with heavy toxins and obstruction will inevitably become dry and retracted; those with vigorous qi will be full and glorious. If the head and face have serum while the limbs have not yet risen, do not panic; if legs blister while the face and forehead are scorched and dry, do not rejoice prematurely. One should fear upward choking of the toxin, worry about loss of voice, and dread rapid breathing; rapid breathing may lead to abdominal distension. Insufficient food intake may cause visceral deficiency and internal collapse; excessive fluid intake may lead to diarrhea and confusion. Improper management can reverse the situation instantly. With intense heat, thirst, and irritability, one must no longer diagnose based on excess syndromes; if loose stools occur, treat as deficiency. Black, purple, and dry conditions require urgent attacking methods for potential survival; qi deficiency and collapse require warming tonification for potential recovery. White pustules lacking spirit are difficult to cure even if the base is red; skin that does not rise and detaches from the root is hard to regenerate even if the feet are red; pale, collapsed, and dried-out conditions imply no internal serum; thin, tender, and bright-red skin implies thin serum even if present. Violating these four principles leads to itching by the eighth or ninth day. If accompanied by high fever burning the body, lack of itching ensures dryness; purple dryness indicates imminent fatality with coagulated blood traces, though rare recovery into serum is possible. Crusting purple within three days allows for reversal; crusting purple after seven days makes rescue difficult. Once serum flows and is more than half complete, it is too early to converge; sudden uniform darkening is anciently called "Reverse Crusting" (Dao Ye); do not mistake it for normal scabbing. Proper attacking therapy may still revive the patient; lateral blood spots and subsequent serum formation allow latent toxins to dissipate. Rapid breathing with abdominal distension indicates approaching death; loss of voice with vomiting and hiccupping indicates exhaustion of yang qi.
For heart-related smallpox, three days after appearance, the pustules begin to swell, gradually nourish pus, and finally crust. Initially, they are small, red, and appear as a dot of blood. Upon rising, they become round, red and white, indicating blood transforming into water. During pus nourishment, they become large and firm, red and yellow, indicating water transforming into pus. During crusting, they become large and soft, red and black, termed "Cang La," representing ripe pus ready to crust, like a ripe fruit where the outer skin softens and inner flesh rots before solidifying. If after ten days, during the expected pus and crusting stage, the shape is flat and depressed, color red-purple, exterior not plump, and interior lacking pus, this is named "Raw Pox" (Sheng Dou), where blood arrives but qi does not, constituting a reverse collapse; death from abdominal distension, panting, and confusion occurs within three days.
One asks: From which meridian does the smallpox serum originate, and through which is it collected? This is like the illumination of the sun and moon, or the source of rivers and seas. Smallpox originates in the Kidney and hides in the Kidney; Heaven generates Water, and the Kidney resides there. The Kidney governs bone marrow, which is where the smallpox toxin hides. Thus, serum begins from the Water of Heaven One. Since Liver (Yi) and Kidney (Gui) share the same source, supported by Ying blood, the root lies in the Kidney. Heart governs respect, Liver ensures smooth flow, Lung protects and nourishes, and Spleen stores and hides. Water and Fire assist each other to achieve success, relying on Earth to form substance. Therefore, smallpox eventually turns yellow, the true color of Yangming Earth. Thus, toxin hides in Kidney, vibrates in Yangming, and finally returns to storage via transforming Earth. Without serum, toxin does not transform; insufficient serum means toxin is not exhausted. Toxin hiding in Kidney relies on Kidney to complete it; upper transformation of toxin relies on Spleen to collect it. Thus, although serum comes from Liver blood, it truly depends on True Water (True Yin). Although serum collection relies on Spleen Earth, it truly borrows from True Fire (True Yang). The logic of serum is thus clear.