凡三日痘渐出齐，然毒瓦斯尚在内，忌用大寒大热之剂。寒药滞毒不散，难出；热药愈炽火邪。故
热毒盛者，盒饭解毒，毒解之后，略与温补，否则反变虚寒之证矣；虚寒甚者，先当温补，补后略与解毒，
否则反生热毒之证矣。善治者，调适中和而已。
夫发热一日即出痘者，太重；二日即出者，亦重；微微发热，三日后乃出痘者，为轻；四五日身凉，
乃见痘者，尤轻。自出痘一日至二三日方齐，大小不等，红润圆顶，光泽明净如珠者，吉，不须服药。若
有他证，照后所论，加减调治。
凡小儿发热一日，遍身红点，如蚊蚤咬者，决非痘疮，乃热毒为风寒所遏，不能发越故也。宜
照发热门内，煎败毒散热服表之，汗后身凉，红点自退，再越二日，出痘返稀矣。
凡发热一日，遍身出痘稠密如蚕种，根虽红润，然顶白平软不得指，中有清水者，此由热毒熏蒸皮肤
而生痱疮，亦名疹子，俗曰麻子，其始发热，亦类伤寒之状，但麻证始终可表，宜照发热门内，煎败毒
散表之，退肌肤之热，则麻子自没矣。夫发热门内云∶既见红点，切戒再表者，谓痘疮也。此复云∶表
退者，谓麻疹痱疮，非正痘也，宜慎辨之。然痘疹初出，与麻疹痱疮略相似，若根窠红，顶圆突，
坚实碍手者，痘也；若根或不红，顶虚软，略有清水，摸
过不碍指者，麻疹痱疮也。疑似之间，可以辨明，而用药得无误乎！
凡发热一日，即见红点，根红顶圆，坚实碍指者，正痘疮也，此由毒瓦斯太盛，故出速，宜败毒散，
或化毒汤加紫草、红花、蝉蜕之类，凉血解毒可也；若一日出齐，稠密红赤成片，此毒盛太过，
不久，紫黑发斑而死。
凡壮热惊搐，烦渴谵语，如见鬼神者，宜辰砂六一散；痰盛者，宜抱龙丸。
凡痘出不快者，加味四圣散、紫草饮、丝瓜汤之类。
凡痘出灰白不红绽，或灰黑陷顶，表寒而虚，二便清，身凉，口气冷，不渴不食，食不化，里寒而虚，此
表里虚寒也，急宜温脾胃，补血气，以助贯脓收靥，保元汤加白术、川芎、当归、木香之类，盖脾土一温，
则胃气随畅，而无内虚陷伏之忧；气血既成，则送毒得出，无痒塌之患。失此不治，必不能贯脓收靥，
过十一二日后，发痒抓破而死矣。若温补之后，痘肥满红润，能食，二便如常，此表里皆平矣，再勿温补，
恐变热毒；若痘红紫，又当解毒以调血气，否则变成黑陷，譬又伤寒变证不常，非杂病可径直而取效也。
凡痘色红紫，根窠成片近黑，黑如乌羽，色润者为血活，尚可医；若黑如炭者血死，不可治。凡看色仿
此推之。焦陷，表热而实；大便闭结，小便赤涩，身热，口气热，口干引饮，里热而实，此表里皆热盛也，
急宜凉血解毒，祛出化毒汤加红花、黄芩、地骨皮，或紫草汤调四圣散。盖凉血不致红紫，解毒则免黑陷，
失此不治。过六日后，毒盛不能尽出，反攻脏腑，变黑归肾，死矣。悔何及哉？若解毒之后，痘顶不红，
根窠红润，小便清利，大便如常，能食不渴，此表里皆清矣，再勿解毒。若色转白，证变虚寒，又当
温补气血，以助贯脓收靥，否则反成痒塌，犹伤寒过服凉药，阳证变阴，又当服保元汤加干姜、白
术之类，不可拘泥。
凡痘疮初出之际，须看胸前，若稠密，急煎消毒饮，加山楂、黄芩（酒洗）、紫草，减食加人参。
凡痘色淡白，顶不坚实，不碍指者，气虚也；根窠不红，或略
红，手摸过处转白者，血虚也。盒饭大补气血，以保元汤加川芎、当归。
凡痘热盛，发红斑，如锦纹在皮肉者，化毒汤加红花、黄芩、升麻。喉痛加玄参，磨犀角和服，此伤寒
阳毒发斑，用玄参升麻汤加减之法。若见黑斑，不终日而死矣。
凡出痘时，或有红丹，如云头突起者，败毒散加紫草、红花、黄芩解之。
凡出痘后，或发麻疹稠密如蚕种者，化毒汤加柴胡、红花解之。若色好，不可过用凉药伤脾，以致陷伏。
凡出痘时，或泄泻，大便黄，小便赤，口气热如渴，此为热泻，宜去桂五苓散加木通、车前、灯
草；如溏泄清利，口气冷不渴，此为寒泻，宜五苓散加肉豆蔻，甚者保元汤加白术、干姜。
凡痘正出，或因吐泻陷伏，宜胃苓汤；寒甚吐泻不止，宜理中汤加丁香、肉豆蔻，附子。
凡因食积生冷，膨胀疼痛者，平胃散加山楂、麦芽、香附、砂仁之类。
凡痘疮初起发时，自汗不妨，盖湿热熏蒸故也，甚者，保元汤实表，以防其难靥也。
凡痘出红赤，掀摸过皮软不碍指者，此贼痘也，过三日变成水泡，此危证也。急少下保元汤，
大加紫草、蝉蜕、红花解之；或煎灯草木通汤调六一散，利出心经蕴热而红自退；如已成水泡，则保
元汤中倍加四苓散利之，此千金秘方也。不然则遍身抓破赤烂而
死。（愚见贼痘者，是诸痘未浆，此痘先以成熟者，亦是贼痘也，又名假虚。泛发太阳脉
门、喉掩、心等处，三日见者，六日死；四日见者，七日亡；五六日见者，十一二日必死也。）
凡痘一出即变黑者，乃肾证也，此为恶候，如有起兴，少用保元汤，大下紫草、红花服下，外用四
圣散点之。然早能凉血解毒，必无此患，亦多因脾胃衰弱，土不能制水故也。经曰∶红变白，白
变黄者，生；红变紫，紫变黑者，死。
自出痘三日内，毒瓦斯半于表里，此时妄汗，则成斑烂，妄下则成陷伏。峻塞之药伤胃，峻热之
药助火。虚寒不补，则陷伏痒塌；盛热不解，则变黑归肾，然则医者，可不审证？
凡是出痘三天后，痘疹逐渐出齐，但毒气仍然在体内，忌讳使用大寒或大热的药方。寒性药物会使毒气凝滞不散，难以透出；热性药物会加剧火邪。所以，热毒旺盛的人，应当先解毒，毒解之后，稍微给予温补，否则反而会变成虚寒证候；虚寒严重的人，应当先进行温补，补益之后稍微给予解毒，否则反而会产生热毒证候。善于治疗的人，只是调节使身体达到中和状态罢了。
那些发热一天就出痘的，病情太重；发热两天就出的，也属于重症；微微发热，三天后才出痘的，为轻症；四五天后身体凉爽，才见到痘疹的，尤其轻微。从出痘第一天到二三天才出齐，大小不等，红润圆顶，光泽明净像珍珠一样的，是吉兆，不需要服药。如果有其他证候，按照后面所论述的，加减调治。
凡是小儿发热一天，遍身出现红点，像被蚊子、跳蚤咬的一样，这决不是痘疮，而是热毒被风寒所遏制，不能发散出来的缘故。应该参照发热门内的方法，煎煮败毒散服用以解表散热，出汗后身体变凉，红点自然消退，再过两天，真正的痘疹才会出来且稀疏。
凡是发热一天，遍身出痘稠密得像蚕种一样，根部虽然红润，但顶部白色平坦柔软，按之无阻力，中间有清水的，这是由于热毒熏蒸皮肤而生出的痱疮，也叫疹子，俗称麻子。其开始发热时，也像伤寒的症状，但麻疹从头到尾都可以用发汗解表法，应该参照发热门内，煎煮败毒散解表，退去肌肤的热，那么麻子自然会消退。发热门内说：“既然已经见到红点，切忌再次发汗解表”，这是指痘疮而言。这里又说“解表消退”，是指麻疹、痱疮，不是正痘，应当谨慎辨别。然而痘疹初出，与麻疹、痱疮略微相似，如果根部红，顶部圆突，坚实碍手的，是痘疮；如果根部不红，顶部虚软，略有清水，摸过去不碍手的，是麻疹、痱疮。在疑似之间，可以辨别清楚，而用药就不会有误了！
凡是发热一天，就见红点，根红顶圆，坚实碍手的，是正痘疮，这是由于毒气太盛，所以出得快，宜用败毒散，或者化毒汤加紫草、红花、蝉蜕之类，凉血解毒即可；如果一天就出齐，稠密红赤成片，这是毒气盛得太过，不久就会变成紫黑色斑而死。
凡是高热惊厥抽搐，烦躁口渴胡言乱语，好像看见鬼神一样的，宜用辰砂六一散；痰多者，宜用抱龙丸。
凡是痘色灰白不红绽，或者灰黑陷顶，体表寒冷而虚，二便清长，身体凉，口气冷，不渴不想吃东西，吃了不消化，里寒而虚，这是表里虚寒证，急需温补脾胃，补血气，以帮助贯脓收靥（结痂），用保元汤加白术、川芎、当归、木香之类。因为脾土一温暖，胃气随之通畅，就没有内虚陷伏的忧虑；气血既已生成，就能送毒外出，没有瘙痒塌陷的祸患。错过这个时机不治疗，一定不能贯脓收靥，过了十一二天后，因瘙痒抓破而死。如果温补之后，痘肥满红润，能进食，二便正常，这是表里都平和了，不要再温补，恐怕变成热毒；如果痘色红紫，又应当解毒以调和血气，否则变成黑陷，譬如伤寒变证无常，不像杂病可以直接取效。
凡是痘色红紫，根部成片近黑，黑得像乌鸦羽毛，色泽润泽的是血活，还可以医治；如果黑得像炭一样是血死，不可医治。凡看颜色仿照此理推论。焦陷，是表热而实；大便闭结，小便赤涩，身体热，口气热，口干想喝水，里热而实，这是表里皆热盛，急需凉血解毒，祛出化毒汤加红花、黄芩、地骨皮，或者紫草汤调服四圣散。因为凉血不会导致红紫，解毒则避免黑陷，错过这个时机不治疗，过了六日后，毒气盛不能完全透出，反而攻伐脏腑，变黑归肾，就死了。后悔有什么用呢？如果解毒之后，痘顶不红，根部红润，小便清利，大便正常，能进食不渴，这是表里都清净了，不要再解毒。如果颜色转白，证候变为虚寒，又应当温补气血，以帮助贯脓收靥，否则反而成为瘙痒塌陷，如同伤寒过服凉药，阳证变成阴证，又应当服用保元汤加干姜、白术之类，不可拘泥固执。
凡是痘疮刚出之际，必须看胸前，如果稠密，急忙煎消毒饮，加山楂、黄芩（酒洗）、紫草，减少饮食并加入人参。
凡是痘色淡白，顶部不坚实，不碍手的，是气虚；根部不红，或者略红，手摸过后转白的，是血虚。应当大补气血，用保元汤加川芎、当归。
凡是痘热盛，发红斑，像锦纹在皮肉间的，用化毒汤加红花、黄芩、升麻。喉痛加玄参，磨犀角和服，这是伤寒阳毒发斑，用玄参升麻汤加减的方法。如果见到黑斑，不到一天就会死。
凡是出痘时，或者有红丹，像云头突起一样的，用败毒散加紫草、红花、黄芩来化解它。
凡是出痘后，或者发麻疹稠密像蚕种一样的，用化毒汤加柴胡、红花来化解它。如果颜色好，不可过度使用凉药伤脾，以致陷伏。
凡是出痘时，或者泄泻，大便黄，小便赤，口气热像口渴一样，这是热泻，宜用去桂五苓散加木通、车前子、灯心草；如果是溏泄清利，口气冷不渴，这是寒泻，宜用五苓散加肉豆蔻，严重的用保元汤加白术、干姜。
凡是痘正在出，或者因为吐泻导致陷伏，宜用胃苓汤；寒甚吐泻不止，宜用理中汤加丁香、肉豆蔻、附子。
凡是因食积生冷，腹胀疼痛的，用平胃散加山楂、麦芽、香附、砂仁之类。
凡是痘疮刚起发时，自汗不妨碍，因为是湿热熏蒸的缘故，严重的，用保元汤实表，以防其难结痂。
凡是痘出红赤，掀开摸过去皮软不碍手的，这是贼痘，过三天变成水泡，这是危重证候。急忙少量给予保元汤，大量加紫草、蝉蜕、红花来化解它；或者煎灯草木通汤调服六一散，利出心经蕴热而红色自然消退；如果已成水泡，则在保元汤中加倍加入四苓散来利水，这是千金秘方。不然则遍身抓破赤烂而死。（我的见解：贼痘，是指诸痘还未成浆，此痘先以成熟的，也是贼痘，又名假虚。泛发于太阳脉门、喉掩、心等处，三日见到的，六日死；四日见到的，七日亡；五六日见到的，十一二日必死。）
凡是痘一出即变黑的，是肾证，这是恶候，如果有起兴的迹象，少量用保元汤，大量下紫草、红花服用，外用四圣散点涂。然而早能凉血解毒，必定没有这种祸患，也多因脾胃衰弱，土不能制水的原因。经书说：“红变白，白变黄的，生；红变紫，紫变黑的，死。”
从出痘三天内，毒气一半在表一半在里，此时妄用发汗，则变成斑烂，妄用泻下则变成陷伏。峻猛的塞药伤胃，峻猛的热药助火。虚寒不补，则陷伏瘙痒塌陷；盛热不解，则变黑归肾，既然如此，医生怎能不审慎辨证？
When the smallpox rash gradually appears completely after three days, the toxic qi remains within the body. It is contraindicated to use formulas that are excessively cold or excessively hot. Cold medicines cause the toxin to stagnate and fail to disperse, making it difficult to erupt; hot medicines intensify the fire pathogen. Therefore, in cases where heat-toxin is abundant, detoxification should be performed first; after the toxin is resolved, a slight warming and tonifying treatment should be given. Otherwise, it may transform into a deficiency-cold syndrome. In cases of severe deficiency-cold, warming and tonifying should be done first; after tonification, slight detoxification should be administered. Otherwise, it may generate heat-toxin syndromes. A skilled practitioner merely adjusts the body to achieve a state of harmony (Zhonghe).
Those whose fever lasts only one day before the eruption of smallpox have a very severe condition; those with eruption on the second day also have a severe condition. Those with mild fever who show eruptions after three days have a mild condition; those whose body temperature returns to normal after four or five days before the appearance of pustules have an especially mild condition. If the eruptions appear evenly between the first and third days, varying in size, with a ruddy color, round tops, and a lustrous, clear appearance like pearls, this is auspicious, and no medicine is required. If other symptoms are present, adjust the treatment according to the discussions below.
If a child has a fever for one day and red spots appear all over the body, resembling mosquito or flea bites, this is definitely not smallpox. It is caused by heat-toxin being constrained by wind-cold, preventing its release. One should refer to the "Fever" chapter and decoct Baidu San (Toxin-Resolving Powder) to relieve the exterior and dissipate heat. After sweating, when the body cools down, the red spots will naturally recede. Two days later, the actual smallpox will emerge sparsely.
If there is a fever for one day and the body is covered with dense eruptions resembling silkworm eggs, with ruddy roots but white, flat, soft tops that do not offer resistance upon palpation, containing clear fluid inside, this is miliaria (heat rash) generated by heat-toxin steaming the skin, also known as zhenzi (rash), commonly called mazizi (chickenpox/measles-like rash). The initial fever resembles typhoid fever (Shanghan). However, measles/miliaria can be treated with diaphoresis from start to finish. One should refer to the "Fever" chapter and decoct Baidu San to release the exterior and dissipate cutaneous heat, causing the rash to disappear. The "Fever" chapter states: "Once red spots are seen, strictly avoid further diaphoresis," referring specifically to true smallpox. Here, "relieving via diaphoresis" refers to measles or miliaria, not true smallpox. Caution must be exercised in differentiation. Although early smallpox and measles/miliaria may look slightly similar, if the base is red, the top is round and protruding, and firm/hard to the touch, it is smallpox; if the base is not red, the top is flaccid/soft, contains some clear fluid, and feels smooth/non-resistant to the touch, it is measles or miliaria. Between these suspected conditions, differentiation can clarify the diagnosis, ensuring correct medication.
If red spots appear on the first day of fever, with red bases, round tops, and firmness against the finger, it is true smallpox. This results from excessive toxic qi, leading to rapid eruption. Baidu San (Toxin-Resolving Powder) or Huadu Tang (Toxin-Transforming Decoction) added with Zicao (Arnebiae Radix seu Rhizoma), Honghua (Carthami Flos), and Chantui (Cicadae Periostracum) should be used to cool the blood and resolve toxicity. If the eruption becomes complete in one day, dense, red, and forming patches, the toxin is excessively abundant. Without intervention, the patient will soon develop purple-black macules and die.
For high fever accompanied by convulsions, irritability, thirst, delirium, and hallucinations (seeing spirits), Chen Sha Liuyi San (Cinnabar Six-One Powder) is indicated. For excessive phlegm, Baolong Wan (Dragon-Holding Pill) is indicated.
For slow or delayed eruption of smallpox, Jiawei Sisheng San (Modified Four-Saints Powder), Zicao Yin (Arnebia Decoction), or Sigua Tang (Luffa Decoction) may be used.
If the pustules are grayish-white, non-erupted, or grayish-black with sunken tops, accompanied by exterior cold and deficiency, clear urine and stool, cool body, cold breath, lack of thirst, anorexia, indigestion, interior cold and deficiency, this indicates exterior-interior deficiency-cold. Urgent warming of the spleen and stomach and tonification of blood and qi are required to assist in suppuration and scabbing. Baoyuan Tang (Preserve-Yuan Decoction) added with Baizhu (Atractylodis Macrocephalae Rhizoma), Chuanxiong (Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), and Muxiang (Aucklandiae Radix) should be used. Once the spleen-earth is warmed, stomach qi flows smoothly, avoiding internal collapse and sinking. Once blood and qi are formed, toxins are expelled outward, preventing itching and collapsing. Failure to treat at this stage will result in failure to suppurate and scab; after eleven or twelve days, death will occur due to scratching and breaking the lesions. If, after warming and tonifying, the pustules become plump, ruddy, the patient eats well, and excretion is normal, the exterior and interior are balanced. Do not continue warming and tonifying, lest heat-toxin arise. If the pustules are red-purple, detoxification and blood regulation are needed; otherwise, black sinking may occur. Smallpox transformations are unpredictable, unlike miscellaneous diseases which respond more directly.
If the pustule color is red-purple, the base is patchy and near-black, looking like crow feathers but moist/lustrous, the blood is active, and the condition is treatable. If black like charcoal, the blood is dead, and the condition is untreatable. Observe colors based on this principle. "Jiao xian" (scorched sinking) indicates exterior heat-excess. Constipation, dark/scanty urine, fever, hot breath, dry mouth with desire to drink indicate interior heat-excess. This represents excess heat in both exterior and interior. Urgently cool the blood and resolve toxicity using Quchu Huadu Tang (Remove-Toxin Transform-Decoction) added with Honghua (Carthami Flos), Huangqin (Scutellariae Radix), and Digupi (Lycii Cortex); or use Zicao Tang (Arnebia Decoction) to mix with Sisheng San (Four-Saints Powder). Cooling blood prevents red-purple discoloration; resolving toxicity prevents black sinking. Neglect leads to death after six days as the abundant toxin attacks the zang-fu organs, turning black and returning to the kidney. Regret will be useless! If, after detoxification, the pustule tops are not red, the bases are ruddy, urination is clear/profuse, defecation is normal, and the patient eats without thirst, the exterior and interior are clear. Do not continue detoxification. If the color turns white and the syndrome becomes deficiency-cold, warm and tonify blood and qi to aid suppuration and scabbing; otherwise, itching and collapsing will occur. This is akin to Yang syndromes transforming into Yin syndromes due to excessive cooling medicines in Shanghan. In such cases, Baoyuan Tang added with Ganjiang (Zingiberis Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) should be taken. Do not adhere rigidly to protocols.
At the initial eruption of smallpox, inspect the chest. If dense, urgently decoct Xiaodu Yin (Detoxifying Decoction) added with Shanzha (Crataegi Fructus), Huangqin (Scutellariae Radix - wine-fried), and Zicao (Arnebiae Radix seu Rhizoma). Reduce food intake and add Renshen (Ginseng Radix et Rhizoma).
If the pustule color is pale white, the top is not firm, and it does not resist the finger, this indicates Qi deficiency. If the base is not red, or slightly red, and turns white upon rubbing, this indicates Blood deficiency. Profoundly tonify Qi and Blood using Baoyuan Tang (Preserve-Yuan Decoction) added with Chuanxiong (Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix).
If smallpox heat is abundant, causing red macules resembling brocade patterns on the skin and flesh, use Huadu Tang (Toxin-Transforming Decoction) added with Honghua (Carthami Flos), Huangqin (Scutellariae Radix), and Shengma (Cimicifugae Rhizoma). For sore throat, add Xuanshen (Scrophulariae Radix) and ground Xijiao (Rhinocerotis Cornu) for oral administration. This follows the method of modifying Xuanshen Shengma Tang (Scrophularia and Cimicifuga Decoction) for Yang-toxin macules in Shanghan. If black macules appear, death will occur within half a day.
During smallpox eruption, if red dan (erythema) appears, protruding like cloud heads, use Baidu San (Toxin-Resolving Powder) added with Zicao (Arnebiae Radix seu Rhizoma), Honghua (Carthami Flos), and Huangqin (Scutellariae Radix) to resolve it.
After smallpox eruption, if measles appear densely like silkworm eggs, use Huadu Tang (Toxin-Transforming Decoction) added with Chaihu (Bupleuri Radix) and Honghua (Carthami Flos). If the color is good, avoid excessive use of cold medicines to prevent spleen injury and toxin sinking.
During smallpox eruption, if diarrhea occurs with yellow stool, red urine, hot breath, and thirst, this is heat-diarrhea. Use Wu Ling San (Five-Ingredient Powder with Poria) minus Guizhi (Cinnamon Twig), added with Mutong (Akebiae Caulis), Cheqian (Plantaginis Semen), and Dengcao (Junci Medulla). If loose/watery stool is clear, breath is cold, and there is no thirst, this is cold-diarrhea. Use Wu Ling San (Five-Ingredient Powder with Poria) added with Roudoukou (Myristicae Semen). For severe cases, use Baoyuan Tang (Preserve-Yuan Decoction) added with Baizhu (Atractylodis Macrocephalae Rhizoma) and Ganjiang (Zingiberis Rhizoma).
If smallpox is erupting but collapses due to vomiting/diarrhea, use Weiling Tang (Stomach-Linus Decoction). For severe cold with incessant vomiting/diarrhea, use Lizhong Tang (Regulate-the-Middle Decoction) added with Dingxiang (Caryophylli Flos), Roudoukou (Myristicae Semen), and Fuzi (Aconiti Lateralis Radix Praeparata).
For abdominal distension and pain due to food stagnation from raw/cold foods, use Pingwei San (Peace-the-Stomach Powder) added with Shanzha (Crataegi Fructus), Maiya (Hordei Fructus Germinatus), Xiangfu (Cyperi Rhizoma), and Sharen (Amomi Fructus).
During the initial onset of smallpox, spontaneous sweating is acceptable due to damp-heat steaming. For severe cases, use Baoyuan Tang (Preserve-Yuan Decoction) to consolidate the exterior and prevent difficulty in scabbing.
If smallpox is red and hot, but the skin is soft and does not resist the finger upon touching, this is "Thief Smallpox" (Zeidou). After three days, it transforms into blisters, which is a critical condition. Urgently administer a small dose of Baoyuan Tang (Preserve-Yuan Decoction) with large amounts of Zicao (Arnebiae Radix seu Rhizoma), Chantui (Cicadae Periostracum), and Honghua (Carthami Flos) to resolve it. Alternatively, decoct Dengcao Mutong Tang (Juncus and Akebia Decoction) to mix with Liuyi San (Six-One Powder) to drain heart-heat, causing redness to subside. If blisters have already formed, double the amount of Siling San (Four-Poria Powder) in Baoyuan Tang to promote diuresis. This is a thousand-gold secret recipe. Otherwise, the body will be scratched until raw and bloody, leading to death. (My opinion: Thief smallpox refers to pustules maturing prematurely before others have turned to pus, also called false deficiency. When appearing on Taiyang pulse gates, throat closures, or heart areas: if seen on day 3, death on day 6; day 4, death on day 7; day 5-6, death on day 11-12.)
If smallpox turns black immediately upon eruption, it is a Kidney syndrome, a malignant sign. If there is any sign of recovery, use a small amount of Baoyuan Tang (Preserve-Yuan Decoction) with large doses of Zicao (Arnebiae Radix seu Rhizoma) and Honghua (Carthami Flos) orally, and apply Sisheng San (Four-Saints Powder) externally. Early cooling of blood and detoxification would have prevented this. This often occurs due to spleen-stomach weakness, where Earth fails to control Water. The Classics state: "Red turning to white, white turning to yellow indicates life; red turning to purple, purple turning to black indicates death."
Within the first three days of eruption, the toxin is half in the exterior and half in the interior. Reckless diaphoresis causes maceration and ulceration; reckless purgation causes sinking and collapse. Harsh obstructive medicines damage the stomach; harsh hot medicines assist fire. Deficiency-cold untonified leads to sinking, itching, and collapsing; abundant heat unresoved leads to black sinking into the kidney. Thus, how can physicians fail to examine the syndrome carefully?