一痘初出，头焦带黑，或色红紫，惨黯不明，谵语狂乱，大热不退，烦渴饮水者，
此毒在血分，为血热毒盛之症也，宜急凉血解毒表托为主。大便秘结者，宜微利下，清
解升托，如不急治，则黑陷不救。一痘初出，色白皮薄而光，但根窠微带一线红色
者，此毒滞气分，为气虚不足之症也，治宜急以补气调荣为主。如不急治则后痒塌而
死，初出痘疮，惟此血热气虚二证而已，此时急宜治之，必待白转红活，黑转淡红，根
窠明润，疮皮坚实，能食二便如常，则起胀灌脓收靥，一路无余恙矣。一周身匀称，惟
咽喉独密者，名曰缠喉，宜急清肺利咽为主，防至八九日间，水呛不食。一自见点之
后，身热终不退者，是毒瓦斯太盛也。始终宜用清解。一出二三日，身热不退，是以血耗
而根窠无红晕者，宜用当归活血散，内加酒炒苓连。一初出而胸前稠密者，急与消毒清
火。一放标渐多，兼见红斑而痘干紫不起，顶不碍手，身热气粗者，宜急清胃化斑表
托。一初出灰白，顶陷不起，或起不碍手，根窠不红活，身凉而静者，此虚寒症也。如
身凉而痘灰白不进饮食，或呕吐腹胀，寒气上逆，或泄清水而手足厥冷者，此纯阴之症
也，治宜大为温补。一手指头上先见者为肝甲痘，可治。一谷道中先见者为阑门痘，可
治。一沿眼边先见三四点者，为攒眼痘，可治。一小便两边先见者，为囊眼痘，可治。
一头上两角先见者，为日月角痘，可治。有头上先见为数粒，中有一粒极大深烂者，名
尿毒痘，急宜挑破以汕胭脂和珍珠细末封之，必待脓成毒化方可脱去，否则，复聚成
穴，血气为其所夺，诸痘难长矣。一凡起势虽密。如根脚自分太阳稀少，周身无成块之
形，而色不干红者，虽多可治。一根盘已具，如顶未起，肌未松者，急与透托。有一
等白痘似粉，有盘有顶而软肥者，宜大补气血。一痘白肉红者，固系气虚，不能拘血，
亦因火热游行于表，故宜凉血以清肌表之热，切忌归芎升散之剂。一痘内黑外白者，是
毒在里宜解毒汤以清里。如内白外黑者，是毒在表，宜升麻汤以散表。一痘出完而热
甚气滞，其皮肉肿亮者，是毒瓦斯在内也，宜急内托，迟则其毒内攻而死。一因夏月暑气
熏炙，以致烦燥发渴而出不快者，宜用人参白虎汤加减服之。一因各月寒气所侵，以致
肌肤粟起，鼻塞声重，咳嗽而出不快者，宜参苏饮加减服之。一因邪气所触而出不快
者，宜用十宣散加减服之，外用乳香芫荽焚烧，以辟其气。一因劳力在前，元气虚弱而
出不快者，宜补中益气汤主之。一因吐泻，胃虚不食而出不快者，宜理中汤主之。一便
结口渴而出不快者，是内有实热也。若便利口渴而出不快者，是内有虚热也。若便利口
不渴而出不快者，此内有虚寒也，宜细辨之。一见标一二日，喉痛眼红唇肿者，此肝
肺胃火旺也。如痘色气血交会者，宜急清解治之可愈。若色惨暗干红，则气血离散，七
八日内必至鼻孔出血，不可救也。一有色，若灰桃颗粒肥大。若按之硬手者，则红活可
期，尚可救也。
痘疮刚发出时，如果痘头焦枯带黑，或者颜色红紫、黯淡无光，伴有胡言乱语、狂躁混乱，高热不退，心烦口渴想喝水的，这是毒邪在血分，属于血热毒盛的病症，应当紧急以凉血解毒、透表托毒为主。如果大便秘结的，宜轻微通下，采用清解升提托毒的方法，如不紧急治疗，则会出现黑陷症而无法救治。
痘疮刚发出时，如果颜色发白、皮薄而光亮，只有根部周围微微带一线红色的，这是毒邪滞留气分，属于气虚不足的病症，治疗应当紧急以补气调荣为主。如不紧急治疗，后来会因瘙痒塌陷而死。初出的痘疮，只有血热和气虚这两种证候而已，此时必须紧急治疗，一定要等到痘色由白转红活，由黑转淡红，根部明亮润泽，疮皮坚实，能进食且大小便正常，那么后续的起胀、灌脓、收靥过程就会一路顺利，没有余患。
全身匀称，唯独咽喉部位痘疮密集的，名叫“缠喉”，应当紧急以清肺利咽为主，防止到第八九日时出现饮水呛咳、无法进食的情况。自见到痘点之后，身体发热始终不退的，是毒气太盛，始终应当使用清解之法。出痘二三天后，身体发热不退，是因为血耗伤导致根部没有红晕的，宜用当归活血散，内部加入酒炒的黄芩和黄连。
刚发出时胸前痘疮稠密的，紧急给予消毒清火。痘标逐渐增多，兼见红斑而痘体干枯紫暗不起，顶部不碍手（不饱满），身体发热呼吸粗重的，宜紧急清胃化斑、透表托毒。刚发出时呈灰白色，顶部凹陷不起，或者起了但不饱满，根部不红活，身体发凉安静的，这是虚寒症。如果身体发凉且痘色灰白不进饮食，或者呕吐腹胀，寒气上逆，或者泻清水样便且手脚厥冷的，这是纯阴症，治疗应当大力温补。
手指头上先出现的，叫作“肝甲痘”，可以治愈。肛门中先出现的，叫作“阑门痘”，可以治愈。沿眼边先出现三四点的，叫作“攒眼痘”，可以治愈。小便两边先出现的，叫作“囊眼痘”，可以治愈。头上两角先出现的，叫作“日月角痘”，可以治愈。有头上先出现为数粒，其中有一粒极大且深烂的，名叫“尿毒痘”，紧急宜挑破后用胭脂和珍珠细末调和封贴，必须等到脓成毒化方可去掉，否则，又会聚集成坑洞，气血被其掠夺，其他痘疮就难以长好了。
凡是起势虽然密集，但根脚自然分布稀疏，周身没有成块形状，且颜色不干红的，虽然多也可以治愈。如果根盘已经具备，但顶部未起，肌肉未松的，紧急给予透托之法。有一种白痘像粉一样，有盘有顶但软肥的，宜大补气血。痘白肉红的，固然属于气虚，不能固摄血液，也是因为火热游行于体表，所以宜凉血以清除肌表之热，切忌使用当归、川芎等升散的药物。痘内黑外白的，是毒在里，宜用解毒汤以清里热。如内白外黑的，是毒在表，宜用升麻汤以散表邪。
痘出完后而热甚气滞，皮肤肌肉肿胀明亮的，是毒气在内，宜紧急内托，迟了则毒气内攻致死。因为夏季暑气熏蒸，导致烦躁发渴而出痘不畅的，宜用人参白虎汤加减服用。因为各月寒气侵袭，导致肌肤粟起，鼻塞声重，咳嗽而出痘不畅的，宜用参苏饮加减服用。因为邪气所触而出痘不畅的，宜用十宣散加减服用，外用乳香、芫荽焚烧，以辟除邪气。因为劳力在前，元气虚弱而出痘不畅的，宜用补中益气汤主治。因为吐泻，胃虚不食而出痘不畅的，宜用理中汤主治。
大便干结口渴而出痘不畅的，是内有实热。如果大便通畅口渴而出痘不畅的，是内有虚热。如果大便通畅口不渴而出痘不畅的，这是内有虚寒，应当仔细辨别。见到痘标一两天后，喉咙痛、眼睛红、嘴唇肿的，这是肝肺胃火旺。如果痘色气血交会的，宜紧急清解治疗即可痊愈。如果颜色惨淡暗黑干红，则气血离散，七八日内必定鼻孔出血，不可救治。有的痘色若灰桃颗粒肥大，如果按之硬手（手感坚硬）的，则有望转为红活，还可以救治。
When the smallpox lesions first appear, if the heads are scorched and blackish, or red-purple, dull and obscure, accompanied by delirium, mania, persistent high fever, irritability, thirst, and desire to drink water, this indicates that the toxin is in the Blood level, constituting a syndrome of excessive blood heat and toxicity. The treatment should urgently focus on cooling the blood, resolving toxicity, and expelling pathogens from the exterior while supporting the interior (Tuo). If there is constipation, mild purgation should be employed to clear and resolve, lifting and supporting the toxins. If not treated urgently, it will progress to black sinking (Hei Xian), which is incurable.
If the lesions first appear white with thin, shiny skin, and only the root area shows a faint line of redness, this indicates that the toxin is stagnant in the Qi level, constituting a syndrome of Qi deficiency and insufficiency. Treatment should urgently focus on tonifying Qi and regulating the Ying (Nutritive) level. If not treated urgently, it will later lead to itching and collapse, resulting in death. Among newly appearing smallpox lesions, there are only these two syndromes: blood heat and Qi deficiency. At this stage, urgent treatment is essential. One must wait until the color turns from white to vibrant red, from black to pale red, the roots become bright and moist, the crusts become firm, appetite returns, and bowel and bladder functions normalize. Then, the stages of swelling, suppuration, and scabbing will proceed smoothly without further complications.
If the distribution is even over the body but dense specifically in the throat, it is named "Chanting Throat" (Chan Hou). Urgent treatment should focus on clearing the Lungs and benefiting the throat to prevent choking on fluids and inability to eat around the eighth or ninth day. If fever persists from the initial appearance of spots until the end, it indicates excessive toxic qi. Clearing and resolving methods should be used throughout. If fever persists after two or three days of eruption due to blood depletion causing a lack of red halo at the roots, use Dang Gui Huo Xue San (Angelica Sinensis Blood-Activating Powder) with added Jiu Chao Huang Qin and Huang Lian (Alcohol-fried Scutellariae Radix and Coptidis Rhizoma).
If lesions are dense on the chest upon initial eruption, urgently apply detoxification and fire-clearing methods. As the raised marks increase, accompanied by macules, dry purple lesions that do not rise, feel flat to the touch, with fever and coarse breathing, urgently clear the Stomach, transform macules, and support the exterior. If lesions initially appear gray-white, depressed and non-rising, or rising but flat, with non-vibrant roots, cool body, and quiet demeanor, this is a Deficient-Cold syndrome. If the body is cool, lesions are gray-white, appetite is lost, or there is vomiting, abdominal distension, counterflow of cold qi, watery diarrhea, and cold extremities, this is a Pure Yin syndrome; treatment requires significant warming and tonification.
Lesions appearing first on the fingertips are called "Gan Jia Dou" (Liver Nail Smallpox) and are treatable. Lesions appearing first in the anus are called "Lan Men Dou" (Gate of Intestines Smallpox) and are treatable. Lesions appearing first along the eye margins are called "Cuan Yan Dou" (Gathering Eyes Smallpox) and are treatable. Lesions appearing first on both sides of the genitals are called "Nang Yan Dou" (Sac Eye Smallpox) and are treatable. Lesions appearing first at the two corners of the head are called "Ri Yue Jiao Dou" (Sun-Moon Corner Smallpox) and are treatable. If a few appear on the head, with one being extremely large and deeply ulcerated, it is named "Niao Du Dou" (Urine Toxin Smallpox). It should be urgently punctured and sealed with a mixture of Hong Zhi (Vermilion/Red Lac) and fine Zhen Zhu powder. The seal must remain until pus forms and toxins resolve; otherwise, it will re-aggregate into a cavity, draining Qi and Blood, making other lesions difficult to grow.
If the eruption is dense but the roots are naturally sparse, without clumping, and the color is not dry red, it is treatable despite the quantity. If the base is established but the top has not risen and the skin is not loose, urgently apply permeating and supporting methods. If there are white lesions resembling flour, with bases and tops but soft and plump, strongly tonify Qi and Blood. If lesions are white with red flesh, it is indeed Qi deficiency failing to constrain Blood, but also due to Heat wandering on the exterior; thus, cooling the blood to clear exterior heat is appropriate. Avoid formulas containing Dang Gui (Angelicae Sinensis Radix) and Chuan Xiong (Ligustici Chuanxiong Rhizoma) that ascend and disperse. If lesions are black inside and white outside, the toxin is internal; use Jie Du Tang (Detoxification Decoction) to clear the interior. If white inside and black outside, the toxin is external; use Sheng Ma Tang (Cimicifugae Decoction) to scatter the exterior.
After complete eruption, if fever is severe, Qi is stagnant, and skin/muscles are swollen and bright, the toxin is internal; urgently apply internal support. Delay leads to internal attack and death. If caused by summer heat steaming, leading to irritability, thirst, and poor eruption, use Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) modified. If invaded by cold qi in various months, causing gooseflesh, nasal congestion, heavy voice, cough, and poor eruption, use Shen Su Yin (Ginseng Perilla Drink) modified. If triggered by pathogenic contact causing poor eruption, use Shi Xuan San (Ten Acupoints Powder) modified, externally burning Ru Xiang (Frankincense) and Yuan Su (Coriander) to repel the pathogen. If caused by prior labor and weak Yuan Qi leading to poor eruption, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) as the main formula. If caused by vomiting/diarrhea, stomach deficiency, and anorexia leading to poor eruption, use Li Zhong Tang (Regulate the Middle Decoction) as the main formula.
Constipation with thirst and poor eruption indicates internal Excess Heat. Normal stool with thirst and poor eruption indicates internal Deficient Heat. Normal stool without thirst and poor eruption indicates internal Deficient Cold; distinguish carefully. One to two days after seeing the raised marks, if there is sore throat, red eyes, and swollen lips, it indicates hyperactive Fire in the Liver, Lungs, and Stomach. If the lesion color shows intersection of Qi and Blood, urgent clearing and resolving will cure it. If the color is dull, dark, and dry red, Qi and Blood have separated; nosebleeds will occur within seven to eight days, and it is incurable. Some lesions resemble gray peach kernels, large and plump. If hard to the touch, they may turn vibrant and red, indicating they are still treatable.