者即充足之象也。总而言之，痘疮之始终，咸赖乎气血，即根脚亦必藉气血以乘载，充足亦必藉气血以营运。
以形色较之，只可形平塌而色红活，不可形尖圆而色晦滞，所谓只教有色无形，休教有形无色也。（《冯氏锦囊》）
痘者豆也，肖其形则生，不肖其形则死，形之不肖，元神竭矣。尖圆而突，周净而松，形之有神者也。如
麸（白色）、如痱（壳空）、如疥（无根窠）、如蚕种（小黑）、如蛇皮（一片）、如蚊迹（血散）、如蚤斑
（散根）、如汤泡（皮肉先烂）、如火刺（血干），形之无神者也。形而无神，可冀生乎？至于色也，欲如春
花之缀露
（红活光润），不欲如秋草之经霜（黑暗干黄）。红白两分，明润光活，色之有彩者也。如腻粉、如枯骨、如
红米饭、如猪肝色，色之无彩者也。形不有神，色不见彩，生意可知矣。呜呼！神彩其生死之门户欤？○凡形
色大恶，气不交，浆不成，似为死矣。若精明爽朗，便食如故，而天庭有一、二悦目者，犹可发毒作臭痘而愈。
何也？毒在外，不在内也。○见点色白不红，未可便作虚治。若白而无神，唇舌淡润，或吐或泻者，真虚也。
若白而起 色，唇舌干红者，非虚也。妄施温补，三日后渐变深紫，其误不浅。（《慈幼筏》）
痘疮之发，身热和缓，达于表者必轻；闷乱烦躁，彰于外者必重。色贵润泽而嫌昏暗，贵光彩而嫌枯涩，
贵淡红而嫌紫滞，贵鲜洁而嫌娇嫩。形贵圆净而嫌琐碎，贵高耸而嫌平塌。皮贵坚实而嫌虚薄。粒贵稀疏而嫌
稠密。根窠贵收紧。痘分阴阳，见点活动，最忌浮肿，出要参差，血宜归附。耳后、颈项、心胸，少于他处为
吉；眉棱、颧额，润而不滞为佳。色之红者，毒始出也；白者，毒未解也；黄者，毒将解也；灰白者，血衰而
气滞也；焦褐者，气滞而血枯也；黑者，毒滞而血干也。如红变白，白变黄者，吉；红变紫，紫变黑者，凶。（翁仲仁）
铺红者，一片如胭脂，如橘皮，此血热太盛，无成功之理。 红者，如以红水着纸，渐渐 开。翟氏加白
芍以收束其根窠，甚妙。圈红者，根窠收紧，上吉之痘也。淡红滋润者吉。干红者，血热也，紫则热之甚也，
夹斑者亦血热也。血热之药，上部用红花，下部用归尾。干红则润之，生地、当归之属；色紫热甚，方用紫草、
茜根，不可纷纷乱用。○凡看色当视儿之皮肤。儿肤本娇，颜色虽艳何碍？儿质苍浊，虽干红不泽，亦自成脓。
○娇红淡而无彩，如雨打桃花，谓之虚中夹毒，八、九日必然发痒，决难成功。○淡白者，血之虚。亦有全无血
色者，只要点粒圆净，白而不灰，参、 、乳酒、熟附、归、芎，亦可酝酿成脓。○色如白饭者，
自是虚能受补。色如炉灰，则虚中有毒，补法中酌兼解毒，所以为难。○色淡紫如茄花者，最恶。五、六朝擦破，
不待九朝而成外剥矣。○焦紫如火刺者，凉血解毒，继以攻发，十中犹有五、六得生。○有痘色之外，别有一
层浮气，如花间之雾，火上之烟者，毒盛也。宜松肌透毒，痘起壮而浮气自退。（《橡村痘诀》）
凡看痘，初起要根盘，则痘易长绽。倘尖瘦不肥，多险。成浆之后，务要根盘即化，一线圈红紧附，顶满
滚圆，是为毒化。若顶陷皮皱，根盘黯僵，毒与气血交凝。实宜攻，虚宜补。○痘顶属气，根盘属血。气领血
载，毒得 炼化浆。凡体实者多火，治以清凉，火解浆成，误补则痈。其气虚血弱，色必淡白，形不雄伟，或
顶陷，或皮皱，内证则恶心、少食、便溏，元气不能胜毒使之外出，多有内陷致变者，治宜保元汤、参归鹿茸
汤、木香异功散。若肠滑不禁者，用豆蔻丸、白术散、理中汤多效。（叶天士）
痘色初见深红，失于解散，渐至干枯黑陷，治当凉血退热。看其微甚，或利小便，或用解毒。顶虽平陷，
不可专责气虚，例用参、 补剂，则气愈盛，而血愈干矣。（吴东园）
痘之黑者，譬之于火，活则为火为红，死则为灰为黑。又气不胜其毒，故为之不充突而陷，不红活而黑耳。
书谓变黑归肾，可笑也。此证牛黄散可治，或烧人屎与蜜水服之，最妙。（《仁端录》）
疏密
痘欲其疏，疏则毒少；不欲其密，密则毒盛。然疏密之分，尤有喜忌焉。如头面欲疏，是元首不可犯也；
颈项欲疏，是管 不可塞也；胸堂欲疏，是神明之地，心肺之居，不可触也；腹背欲疏，是脏腑俞募之所附也。
若夫手足，则不忌其密矣。谓之疏者，非但稀少也，即铺排磊落，大小匀净，亦可以言疏也。故不论疏密，而
贵论磊落。颗粒分明、尖圆紧实，虽密无妨。谓之密者，非必盛多也，即攒聚粘连，模糊作块，不分点粒，虽
只数处，
亦可以言密也。初出红点才见，而表里热候便退者，此即可言其疏也。苟见点虽少，而大热不解，唇口燥裂，
便秘烦躁，此由毒遏于中不能遽出，一、二日后复出，必然稠密，是即初出虽少，未可言其疏也。○痘有先密
后疏者，此夹疹夹斑也。初出一片红点，难以分辨，至起发后，斑疹退去，惟痘独在，故先似密而后疏也。有
先疏后密者，此有顺逆。轻者三、四次出，大小不等，故先似疏而后渐密，此顺证也；若初出只面上胸前三、
五处，颗粒模糊，根脚肿硬，待至起发，则一齐涌出，故先虽疏而后尤密，此逆证也。陆续出者，正气充足，
毒瓦斯轻松，得以拘束也；一齐出者，表虚毒盛，不能约束，任其奔溃也。（《冯氏锦囊》）
荣枯
夫物湿则润泽，燥则干枯。荣枯之分，血实主之。故血者所以营阴阳、濡皮毛、流关节者也。疮本疏者，
血不在多而易充足。疮本稠密，贵乎血之有余矣。苟血有余，则经脉流行，沦于肌肤，浃于皮毛，灌溉滋润，
肥泽长养，自然形色鲜明，根窠红活也。如血不足，则经脉壅遏，窠囊空虚，黑燥而不鲜明也，枯萎而不肥泽
也，皮肤皱揭而启裂也。《经》曰∶诸涩枯涸，干劲皱揭，皆属于燥。又曰∶燥胜则干。由其人血常不足，加
以毒火熏灼，反兼燥金之化，精血并竭，是以有此证也。治宜活血养液，散热解毒，清金润燥，则干涸可回。
其或湿气太过，疮本浸淫、溃烂、难 者，此又火极而兼水化也。脾强则生，脾弱则死。（《证治准绳》）
老嫩
痘疮喜老而恶嫩。苍蜡、娇红，色之老嫩也；紧实、虚浮，形之老嫩也；浓浊、清淡，浆之老嫩也；坚浓、
软薄，痂之老嫩也。然老嫩之故，卫气主之。《经》曰∶卫气者，所以温分肉、
充皮肤、肥腠理、司开阖者也。是故卫气强，则收敛禁束，制其毒而不得放肆，乃色苍而蜡，形紧而实，浆浓
而浊，痂浓而坚，自然易壮易 ，虽有邪风秽气，不能为害也。如卫气弱，则不胜其毒，而毒得以恣其猖狂之
性，乃色娇而红，形虚而浮，浆清而淡，痂软而薄，必然易破难 ，不待邪风秽气，而先败坏矣。（《证治准绳》）
日数
世俗谓几日发热，几日出形，几日起发，几日作浆，几日收 ，此大略之言耳。痘有疏密，毒有微甚，人
有虚实，岂可一切拘以日数？如疮本疏者其毒微，其人中气实，又能食，自然易出易 ，固不待于旬日者；如
疮本密者其毒盛，其人中气实，又能食，营卫调和，内外无诸伤犯，至十二、三日可以刻期收 也。若其人中
气虚，食少，或内外曾有伤犯，或遇气候乖变，因而难 。岂可必拘以日数哉！（万密斋）
痘之出、胖、灌、 ，各有三日，共十二日为定期。有太过，有不及，或实热，或虚寒，或杂证，各宜随
证调治。○凡痘每粒以十二日为期，有先出者，有后出者，何得限期概论？（《仁端录》）
痘之出，有热一、二日而即出者，有热至五、六日而始出者，则三日见标之说不必拘。有一出便尽者，有
出至五、六日犹未尽者，则三日出齐之说不必拘。有至七、八日而始灌者，有灌至十五、六日而未收者，则三
日灌脓，三日收 之说又不必拘。莫若以出齐为出，以灌足为灌，以收尽为 ，随时应变，至稳至当。（《橡村痘诀》）
饮食
痘疮之出，固赖元气以发之，而元气之壮，必资乳食以养之。自四、五日以至落痂，饮食不减，二便如常，
虽不起发，不红绽或陷塌，用药得宜，可保无虞。使乳食减少，兼以泄泻，则元气自此而日衰，虽无前证，日
后必至药亦难效，去生远矣。故四、
五日前不食者，此毒盛于里，犹可治也。六、七日后而不能食者，杂证百出，行浆不实，虽药之，亦何益哉！
有禀受壮实，又发于五岁之外者，又不可以例论也。（翁仲仁）
痘子不怕稠密，只要能食，无不全者。人以胃气为本，用药不可犯胃气。（万密斋）
四、五朝不食，有因唇口肿硬，动则裂血畏痛，故不食，此胃热甚也。药用十神解毒汤，加黄连、石膏，
外用甘草石膏水，羊毛笔不时扫洗，唇口和软，自能食矣。（《橡村痘诀》）
痘证禁绝荤腥是矣。然亦有富贵之子，脾胃赖此以养，一旦使之不食，则生生之气将何以熏蒸长育乎？是
又不可以常法论也。（《慈幼筏》）
这就是气血充足的表现。总而言之，痘疮的整个过程，都依赖于气血，即使是痘疮的根部（根脚），也必须依靠气血来承载；气血的充盈，也必然依靠气血的运行和滋养。
从形态和色泽来比较，只允许形态平塌而色泽红活，不允许形态尖圆而色泽晦暗滞涩，这就是所谓的“只要有气色而没有明显的突起形状，不要有突起形状而没有气色”。（出自《冯氏锦囊》）
“痘”字通“豆”，是模拟其形状，如果形状像豆子则能生，不像豆子则会死。形状不像豆子，说明元神已经枯竭。形状尖圆且突出，周围干净且疏松，这是形状有神的表现。如果像麸皮（白色）、像痱子（壳空）、像疥疮（没有根基的巢穴）、像蚕种（小黑点）、像蛇皮（连成一片）、像蚊子叮咬的痕迹（血液散乱）、像跳蚤斑（根部散开）、像汤水泡过的皮肤（皮肉先腐烂）、像火刺伤（血液干枯），这些都是形状无神的表现。形状而无神，还能指望存活吗？至于色泽，希望像春天带露水的鲜花（红活光润），不希望像秋天经霜的野草（黑暗干黄）。红白分明，明亮润泽光活，这是色泽有光彩的表现。如果像腻粉、像枯骨、像红米饭、像猪肝的颜色，这是色泽无光彩的表现。形状没有神，色泽没有光彩，生机就可以知道了。唉！神采和光泽难道是决定生死的关键吗？○凡是形态和色泽非常恶劣，气血不交合，浆液不能形成，看似死亡了。但如果患者眼神精明爽朗，饮食如常，而且天庭（额头）有一两处令人愉悦的红点，还可以发毒变成臭痘而痊愈。为什么呢？因为毒邪在体表，不在体内。○看到痘点颜色发白，不要立刻当作虚证治疗。如果白色而没有神气，嘴唇舌头淡而湿润，或者有呕吐或腹泻症状，这才是真正的虚证。如果白色而泛起红色，嘴唇舌头干燥发红，就不是虚证。胡乱使用温补药物，三天后逐渐变成深紫色，这个错误就不小了。（出自《慈幼筏》）
痘疮发作时，身体发热和缓，热势达于体表的病情一定轻；闷乱烦躁，表现于外部的病情一定重。色泽贵在润泽而忌讳昏暗，贵在光彩而忌讳枯涩，贵在淡红而忌讳紫滞，贵在鲜洁而忌讳娇嫩。形态贵在圆净而忌讳琐碎，贵在高耸而忌讳平塌。皮肤贵在坚实而忌讳虚薄。颗粒贵在稀疏而忌讳稠密。根部巢穴贵在收紧。痘疮分阴阳，见点时活动，最忌讳浮肿，出疹要参差错落，血液宜归附于根部。耳后、颈项、心胸部位，比其他处少为吉利；眉棱、颧骨、额头，润泽而不滞涩为佳。红色的，是毒邪刚开始外出；白色的，是毒邪未解；黄色的，是毒邪将要解除；灰白色的，是血衰而气滞；焦褐色的，是气滞而血枯；黑色的，是毒滞而血干。如果由红变白，由白变黄，是吉兆；由红变紫，由紫变黑，是凶兆。（出自翁仲仁）
铺红者，是一片如胭脂，如橘皮，这是血热太盛，没有成功的道理。晕红者，像用红水沾纸，渐渐散开。翟氏加入白芍以收敛其根部巢穴，非常巧妙。圈红者，根部收紧，是最上等的痘疮。淡红滋润的是吉兆。干红的，是血热；紫色的则是热得厉害；夹杂斑点的也是血热。治疗血热的药物，上部用红花，下部用当归尾。干红则滋润它，用生地、当归之类；色紫热甚，才用紫草、茜根，不可纷纷乱用。○凡看色泽应当观察孩子的皮肤。孩子皮肤本来娇嫩，颜色虽然艳丽有什么关系？孩子体质苍老浑浊，虽然干红不泽，也能自然化脓。○娇红淡而无彩，像雨打桃花，称为虚中夹毒，八、九日必然发痒，很难成功。○淡白的，是血虚。也有完全没有血色的，只要点粒圆净，白而不灰，用人参、黄芪、乳酒、熟附子、当归、川芎，也可以酝酿成脓。○色如白饭的，自然是虚证能受补。色如炉灰的，则是虚中有毒，在补法中酌情兼用解毒药，所以为难。○色淡紫如茄子花的，最恶。五、六天擦破，不用等到九天就变成外剥了。○焦紫如火刺的，凉血解毒，继以攻发，十个人中还有五、六个能活。○有痘色之外，另有一层浮气，像花间的雾，火上的烟，这是毒盛。宜松肌透毒，痘起壮实而浮气自然消退。（出自《橡村痘诀》）
凡看痘疮，初起要有根盘，则痘容易长绽。如果尖瘦不肥厚，多危险。成浆之后，务必根盘即化，一线圈红紧附，顶部满滚圆，这是毒已化解。如果顶陷皮皱，根盘黯僵，毒与气血交凝。实证宜攻，虚证宜补。○痘顶属气，根盘属血。气领血载，毒得以炼化浆。凡是体质实的多有火，治疗用清凉药，火解浆成，误用补药则成痈。如果气虚血弱，颜色必淡白，形态不雄伟，或者顶陷，或者皮皱，内部症状则有恶心、少食、便溏，元气不能胜任毒邪使其外出，多有内陷导致变证的，治疗宜用保元汤、参归鹿茸汤、木香异功散。如果肠滑不禁的，用豆蔻丸、白术散、理中汤多有效。（出自叶天士）
痘色初见深红，失于解散，渐至干枯黑陷，治疗应当凉血退热。看其轻重，或者利小便，或者用解毒药。顶部虽然平陷，不可专门责怪气虚，按例用人参、黄芪等补剂，则气愈盛，而血愈干了。（出自吴东园）
痘疮发黑的，比作火，活的则为火为红，死的则为灰为黑。又是气不胜其毒，所以使之不充突而陷下，不红活而黑。书上说变黑归肾，可笑。此证牛黄散可治，或者烧人屎加蜜水服用，最妙。（出自《仁端录》）
疏密
痘疮希望它稀疏，稀疏则毒少；不希望它稠密，稠密则毒盛。然而疏密之分，尤其有喜忌。比如头面希望稀疏，是因为头部元首不可侵犯；颈项希望稀疏，是因为管窍不可堵塞；胸堂希望稀疏，是因为神明之地，心肺居所，不可触碰；腹背希望稀疏，是因为脏腑俞募之所依附。至于手足，则不忌讳其稠密。所说的疏，不仅仅是稀少，即使铺排磊落，大小匀净，也可以称为疏。所以不论疏密，而贵在论磊落。颗粒分明、尖圆紧实，虽然稠密也无妨。所说的密，不一定是盛多，即使攒聚粘连，模糊作块，不分点粒，虽然只有几处，也可以称为密。初出的红点刚见到，而表里热候就退了，这就可以称为疏。如果见点虽少，而大热不解，唇口燥裂，便秘烦躁，这是毒遏于中不能立即外出，一、二日后复出，必然稠密，这就是初出虽少，不能称为疏。○痘有先密后疏的，这是夹疹夹斑。初出一片红点，难以分辨，到起发后，斑疹退去，惟独痘还在，所以先似密而后疏。有先疏后密的，这有顺逆。轻者三、四次出，大小不等，所以先似疏而后渐密，这是顺证；如果初出只在面上胸前三、五处，颗粒模糊，根脚肿硬，等到起发，则一齐涌出，所以先虽疏而后尤密，这是逆证。陆续出的，正气充足，毒瓦斯轻松，得以约束；一齐出的，表虚毒盛，不能约束，任其奔溃。（出自《冯氏锦囊》）
荣枯
事物湿则润泽，燥则干枯。荣枯之分，由血主导。所以血是用来营阴阳、濡皮毛、流关节的。疮本稀疏的，血不在多而易充足。疮本稠密的，贵在血有余。如果血有余，则经脉流行，沦于肌肤，浃于皮毛，灌溉滋润，肥泽长养，自然形色鲜明，根部红活。如果血不足，则经脉壅遏，巢穴空虚，黑燥而不鲜明，枯萎而不肥泽，皮肤皱揭而启裂。《内经》说：诸涩枯涸，干劲皱揭，皆属于燥。又说：燥胜则干。由于此人血常不足，加上毒火熏灼，反兼燥金之化，精血并竭，所以有此证。治疗宜活血养液，散热解毒，清金润燥，则干涸可回。或者湿气太过，疮本浸淫、溃烂、难敛的，这是火极而兼水化。脾强则生，脾弱则死。（出自《证治准绳》）
老嫩
痘疮喜欢老而厌恶嫩。苍蜡、娇红，是颜色的老嫩；紧实、虚浮，是形态的老嫩；浓浊、清淡，是浆液的老嫩；坚浓、软薄，是结痂的老嫩。然而老嫩的原因，由卫气主导。《内经》说：卫气，是用来温分肉、充皮肤、肥腠理、司开阖的。所以卫气强，则收敛禁束，制其毒而不得放肆，乃色苍而蜡，形紧而实，浆浓而浊，痂浓而坚，自然易壮易收，虽有邪风秽气，不能为害。如果卫气弱，则不胜其毒，而毒得以恣其猖狂之性，乃色娇而红，形虚而浮，浆清而淡，痂软而薄，必然易破难收，不用待邪风秽气，而先败坏了。（出自《证治准绳》）
日数
世俗说几日发热，几日出形，几日起发，几日作浆，几日收痂，这是大概的说法。痘有疏密，毒有微甚，人有虚实，岂可一概拘泥于日数？比如疮本稀疏的其毒微，其人中气实，又能进食，自然易出易收，固不待旬日；比如疮本稠密的其毒盛，其人中气实，又能进食，营卫调和，内外无诸伤犯，至十二、三日可以按期收痂。如果其人中气虚，食少，或内外曾有伤犯，或遇气候乖变，因而难收。岂可必拘泥于日数呢！（出自万密斋）
痘的出、胖、灌、收，各有三日，共十二日为定期。有太过，有不及，或实热，或虚寒，或杂证，各宜随证调治。○凡痘每粒以十二日为期限，有先出的，有后出的，何得限期概论？（出自《仁端录》）
痘的出，有热一、二日而即出的，有热至五、六日而始出的，则三日见标之说不必拘泥。有一出便尽的，有出至五、六日而未尽的，则三日出齐之说不必拘泥。有至七、八日而始灌的，有灌至十五、六日而未收的，则三日灌脓，三日收痂之说又不必拘泥。不如以出齐为出，以灌足为灌，以收尽为收，随时应变，至稳至当。（出自《橡村痘诀》）
饮食
痘疮的发出，固然依赖元气来发动，而元气的壮实，必须依靠乳食来滋养。自四、五日以至落痂，饮食不减，二便如常，虽然不起发，不红绽或陷塌，用药得宜，可保无虞。如果乳食减少，兼以泄泻，则元气自此而日衰，虽无前证，日后必至药亦难效，离生远矣。所以四、五日前不食的，这是毒盛于里，犹可治。六、七日后而不能食的，杂证百出，行浆不实，虽用药，亦何益哉！有禀受壮实，又发于五岁之外的，又不可以常例论。（出自翁仲仁）
痘子不怕稠密，只要能食，无不全者。人以胃气为本，用药不可犯胃气。（出自万密斋）
四、五朝不食，有因唇口肿硬，动则裂血畏痛，故不食，这是胃热甚。药用十神解毒汤，加黄连、石膏，外用甘草石膏水，羊毛笔不时扫洗，唇口和软，自能食。（出自《橡村痘诀》）
痘证禁绝荤腥是对的。然而也有富贵之子，脾胃赖此以养，一旦使之不食，则生生之气将何以熏蒸长育乎？这又不可以常法论。（出自《慈幼筏》）
This is the manifestation of sufficient Qi and Blood. In summary, the entire process of smallpox relies on Qi and Blood; even the base (root) must be supported by Qi and Blood to carry it, and the sufficiency of Qi and Blood must rely on their circulation and nourishment.
Comparing morphology and color, one should only accept a flat morphology with ruddy and lively color, not a pointed and round morphology with dull and stagnant color. This is what is meant by "only have color without distinct shape, do not have shape without color." (From *Feng Shi Jin Nang*)
The character "Dou" (smallpox/pox) is homophonous with "Bean," imitating its shape. If it resembles a bean, life ensues; if not, death follows. A shape that does not resemble a bean indicates the exhaustion of the Primordial Spirit (Yuan Shen). A shape that is pointed, round, protruding, clean around the edges, and loose is considered to have spirit (Shen). Conversely, shapes resembling bran (white), prickly heat (hollow shell), scabies (no root nest), silkworm eggs (small black dots), snake skin (continuous patch), mosquito bites (scattered blood), flea marks (scattered roots), soup blisters (skin and flesh rotting first), or fire thorns (dried blood) are considered to lack spirit. Can one hope for survival when there is shape but no spirit? As for color, one desires it like spring flowers adorned with dew (ruddy, lively, bright, and moist), not like autumn grass after frost (dark, dry, and yellow). Distinct red and white, bright, moist, and lively, this is color with luster. Colors resembling talcum powder, dry bones, red rice, or pig liver are colors lacking luster. When shape lacks spirit and color lacks luster, vitality can be known. Alas! Are spirit and luster the gateway to life and death? ○ When morphology and color are extremely poor, Qi and Blood do not interact, and pus fails to form, appearing as death. However, if the eyes are bright and clear, appetite remains normal, and there are one or two pleasing spots on the forehead (Tian Ting), recovery is still possible through the emergence of toxic pustules. Why? Because the pathogenic toxin is in the exterior, not the interior. ○ When spots appear white and not red, do not immediately treat as deficiency. If white without spirit, with pale and moist lips and tongue, accompanied by vomiting or diarrhea, this is true deficiency. If white but turning red, with dry and red lips and tongue, it is not deficiency. Recklessly applying warming and tonifying herbs may cause the color to gradually turn deep purple after three days, a significant error. (From *Ci You Fa*)
When smallpox erupts, mild fever reaching the exterior indicates a light condition; stifling confusion and restlessness manifesting externally indicate a severe condition. Color should be moist and glossy rather than dim; bright and lustrous rather than withered and rough; pale red rather than purple and stagnant; fresh and clean rather than delicate. Morphology should be round and clean rather than fragmented; high and prominent rather than flat and collapsed. Skin should be firm rather than thin and weak. Granules should be sparse rather than dense. The root nest should be tight. Smallpox is divided into Yin and Yang; active appearance of spots is best, while edema is most feared. Eruption should be staggered, and blood should adhere to the roots. Spots behind the ears, on the neck, chest, and heart being fewer than elsewhere is auspicious; smoothness without stagnation on the brow ridge, cheekbones, and forehead is excellent. Red indicates the initial exit of toxins; white indicates unresolved toxins; yellow indicates toxins about to resolve; grayish-white indicates blood deficiency and Qi stagnation; brownish-black indicates Qi stagnation and blood exhaustion; black indicates toxin stagnation and blood drying. Change from red to white, or white to yellow, is auspicious; change from red to purple, or purple to black, is ominous. (Weng Zhongren)
"Pu Hong" (spreading red) appears as a patch like rouge or orange peel, indicating excessive blood heat with no prospect of success. "Yun Hong" (halo red) spreads like red water on paper. Adding White Peony Root (*Bai Shao*) to tighten the root nest is ingenious. "Quan Hong" (ring red) with a tight root nest is the best type of smallpox. Pale red and moist is auspicious. Dry red indicates blood heat; purple indicates severe heat; spots with macules also indicate blood heat. For treating blood heat, use Safflower (*Hong Hua*) for the upper body and Angelica Sinica Tail (*Dang Gui Wei*) for the lower body. For dry red, moisten with Rehmannia (*Sheng Di*) and Angelica Sinica (*Dang Gui*); for purple and severe heat, use Arnebia (*Zi Cao*) and Rubia (*Qian Cao*), avoiding indiscriminate use. ○ When observing color, examine the child's skin. Children's skin is naturally tender; even if the color is bright, it is not a hindrance. If the child's constitution is coarse and turbid, even if dry and red without luster, pus will form naturally. ○ Delicate red, pale and lacking luster, like peach blossoms struck by rain, is called "deficiency with embedded toxin," causing itching on the 8th or 9th day, making success difficult. ○ Pale white indicates blood deficiency. Even if completely devoid of blood color, as long as the granules are round and clean, white but not gray, Ginseng (*Ren Shen*), Astragalus (*Huang Qi*), Milk Wine, Prepared Aconite (*Shu Fu Zi*), Angelica Sinica (*Dang Gui*), and Ligusticum (*Chuan Xiong*) can nurture the formation of pus. ○ Color like white rice indicates deficiency capable of receiving tonification. Color like furnace ash indicates deficiency with embedded toxin; adding detoxification to tonification makes treatment difficult. ○ Pale purple like eggplant flowers is most malignant. Rupture on the 5th or 6th day leads to external peeling before the 9th day. ○ Scorched purple like fire thorns requires cooling blood and detoxifying, followed by promoting eruption; five or six out of ten may survive. ○ Beyond the smallpox color, a layer of floating qi exists, like mist among flowers or smoke over fire, indicating abundant toxin. Relieve muscle tension and vent the toxin; as the pox becomes robust, the floating qi recedes. (From *Xiang Cun Dou Jue*)
In examining smallpox, the initial stage requires a strong root base for easy expansion. If pointed and thin without plumpness, danger is likely. After pus formation, the root base should dissolve, with a tight red ring attached, and the top full and round, indicating toxin resolution. If the top is sunken and skin wrinkled, and the root base is dark and stiff, toxin and Qi/Blood are congealed. Excess patterns require attack; deficiency patterns require tonification. ○ The smallpox top belongs to Qi; the root base belongs to Blood. Qi leads and Blood carries, allowing toxin transformation into pus. Robust constitutions often have Fire; treat with cooling herbs. Once Fire resolves and pus forms, mistaken tonification causes carbuncles. Qi deficiency and Blood weakness present with pale color, unimpressive morphology, sunken tops, or wrinkled skin. Internal symptoms include nausea, poor appetite, and loose stools. Yuan Qi cannot overcome toxin expulsion, leading to internal collapse. Treat with Bao Yuan Tang, Shen Gui Lu Rong Tang, or Mu Xiang Yi Gong San. For intestinal sliding/incontinence, Dou Kou Wan, Bai Zhu San, or Li Zhong Tang are effective. (Ye Tianshi)
Deep red at initial onset, if not dispersed, gradually becomes dry, black, and sunken. Treatment should cool blood and reduce heat. Assess severity: promote urination or use detoxifying herbs. Do not attribute sunken tops solely to Qi deficiency and blindly use Ginseng (*Ren Shen*) and Astragalus (*Huang Qi*) tonics, which exacerbate Qi excess and blood dryness. (Wu Dongyuan)
Black smallpox is likened to fire: alive it is fire/red, dead it is ash/black. Qi fails to overcome toxin, causing sinking rather than protrusion, darkness rather than liveliness. The theory that "black transforms to Kidney" is absurd. Niuhuang San treats this, or burnt human feces with honey water is excellent. (From *Ren Duan Lu*)
Sparse vs. Dense
Smallpox should be sparse to reduce toxin; dense implies abundant toxin. However, preferences vary by location. Head/face should be sparse (head is paramount); neck should be sparse (orifices must not block); chest should be sparse (seat of Spirit, Heart/Lung residence); abdomen/back should be sparse (attachment of Zang-Fu Shu-Mu points). Hands/feet need not fear density. "Sparse" means not just few, but well-spaced, uniform, and clean. Thus, regardless of density, prominence is key. Distinct, round, tight granules are acceptable even if dense. "Dense" means clustering, adhesion, blurring into masses, indistinct granules, even if few. If red spots appear and heat subsides internally/externally, it is sparse. If few spots but high fever persists, dry cracked lips, constipation, restlessness, toxin is trapped inside, emerging later as dense. This is not sparse initially. ○ Dense then sparse indicates concurrent measles/macules. Initial red spots blur; after eruption, measles/macules fade, leaving only smallpox. Sparse then dense has favorable/unfavorable implications. Mild cases erupt in 3-4 waves, varying sizes, appearing sparse then dense (favorable). Severe cases start with few blurred spots on face/chest with swollen/hard bases, erupting all at once later (unfavorable). Gradual eruption indicates sufficient Zheng Qi and manageable toxin. Simultaneous eruption indicates exterior deficiency and abundant toxin, unable to contain, leading to chaotic spread. (From *Feng Shi Jin Nang*)
Flourishing vs. Withered
Moist things are lustrous; dry things are withered. Flourishing/withered distinction is governed by Blood. Blood nourishes Yin/Yang, moistens skin/hair, flows through joints. Sparse sores need little blood to suffice. Dense sores require abundant blood. Abundant blood allows meridian flow, permeating skin/hair, irrigating and nourishing, resulting in bright color and red roots. Insufficient blood causes meridian obstruction, empty nests, black/dry/withered appearance, and skin cracking. *Jing* states: "All astringency, withering, dryness, and cracking belong to Dryness." Also: "Excess Dryness causes dryness." Due to inherent blood deficiency plus toxin-fire scorching, transforming into Metal/Dryness, essence and blood exhaust, causing these signs. Treat by invigorating blood, nourishing fluids, clearing heat, detoxifying, purifying Metal, and moistening dryness. If dampness is excessive, causing oozing/ulceration, this is extreme Fire combining with Water transformation. Strong Spleen brings life; weak Spleen brings death. (From *Zheng Zhi Zhun Sheng*)
Mature vs. Tender
Smallpox prefers mature over tender. Grayish-wax vs. delicate-red is color maturity; tight/firm vs. void/fluid is morphological maturity; thick/turbid vs. clear/light is pus maturity; hard/thick vs. soft/thin is scab maturity. Maturity is governed by Defensive Qi (Wei Qi). *Jing* states: Wei Qi warms muscles, fills skin, thickens pores, controls opening/closing. Strong Wei Qi restricts toxin, preventing rampant behavior, resulting in gray-wax color, tight/firm shape, thick/turbid pus, hard/thick scabs, easy maturation/recovery, resisting evil winds. Weak Wei Qi cannot control toxin, allowing rampant behavior, resulting in delicate-red color, void/fluid shape, clear/light pus, soft/thin scabs, easy rupture, failure to recover, and premature decay. (From *Zheng Zhi Zhun Sheng*)
Days
Common belief cites specific days for fever, eruption, maturation, pus formation, and scabbing. This is approximate. Smallpox varies in sparsity/density, toxin severity, and patient constitution (excess/deficiency). One cannot rigidly adhere to days. Sparse sores with mild toxin, strong middle Qi, and good appetite erupt/resolve easily, not needing ten days. Dense sores with severe toxin, strong middle Qi, good appetite, harmonious Ying/Wei, and no external/internal injury may resolve by days 12-13. If middle Qi is weak, poor appetite, prior injuries, or climate changes occur, resolution is difficult. Rigid adherence to days is unjustified. (Wan Mizhai)
Eruption, swelling, pus, and scabbing each take three days, totaling twelve days as a standard. There are excesses and deficiencies, excess-heat or deficiency-cold, or mixed syndromes, requiring syndrome-specific treatment. ○ Each smallpox grain has a twelve-day cycle; early or late eruptions make fixed timelines inappropriate. (From *Ren Duan Lu*)
Eruption occurs after 1-2 days of fever or 5-6 days; thus, the "spot visible on day 3" rule is not absolute. Some erupt fully at once; others take 5-6 days; thus, "fully erupted by day 3" is not absolute. Pus forms on days 7-8 or lasts until 15-16 days; thus, "pus on day 3, scab on day 3" is not absolute. Better to define eruption by completion, pus by sufficiency, and scabbing by total coverage, adapting to circumstances. (From *Xiang Cun Dou Jue*)
Diet
Smallpox eruption relies on Yuan Qi, which depends on milk/food for nourishment. From days 4-5 to scab falling, if diet remains unchanged and excretion normal, even if eruption/maturation is delayed or sunken, proper medication ensures safety. If diet decreases with diarrhea, Yuan Qi declines daily; even without prior signs, medication becomes ineffective, distancing from recovery. Non-eating before days 4-5 indicates toxin excess in interior, still treatable. Non-eating after days 6-7 indicates myriad mixed syndromes, incomplete pus formation; medication is futile. Robust constitutions or those over age five are exceptions. (Weng Zhongren)
Smallpox patients need not fear density if they can eat; all can recover. Stomach Qi is fundamental; medications must not harm Stomach Qi. (Wan Mizhai)
Non-eating on days 4-5 due to swollen/hard lips/mouth, pain upon movement causing bleeding, indicates severe Stomach Heat. Use Shishen Jiedu Tang plus Coptis (*Huang Lian*) and Gypsum (*Shi Gao*). Externally, wash with Licorice (*Gan Cao*) and Gypsum water using a goat-hair brush; lips/mouth soften, eating resumes. (From *Xiang Cun Dou Jue*)
Prohibiting meat/fish in smallpox is correct. However, wealthy children rely on this for Spleen/Stomach nourishment; denying it hinders vital energy growth. This exception applies to special cases. (From *Ci You Fa*)