夫凡痘之未出。必先发热三日为透为吉。如发一日热者。即现标为凶。如一日半不及二日者为险。
此是发
热三日之吉凶可见也。次则见标。三日内陆续出。稀朗圆尖至足有。方为出齐。无他症。能食。此为
吉为顺。如发出稠密蚕种蚊蚤斑而不碍手者。再兼恶症必死。此为凶为逆。不可治之。如圆晕虽成。
干红少润。此气血初交之际。得失未定。当补托。气血和而痘自化成。此是出三日已见标之吉凶也。
如五六日痘当贯浆。皮浓光圆苍蜡色。乃气化浆行。毒自解也。为吉为顺。如浆不行毒不解则干枯而
密。痒 灰陷者。此是血不能归附于气也。为凶为逆。必死。如气血虽交。其浆不克。其色半润。此
痘为险。为半吉凶。宜保元汤加桂术以生其浆。有浆则生。无则死。此为贯浆三日之吉凶也。如痘靥
之时。从头面及背。先灰者为吉为顺。如从足从阴股者。为逆为凶。此九日至十日十一日靥痘之吉凶
也。如十二日至十四日十五日痘毒已回。其疮当落痂。是气血克实。毒已化净。为吉为顺。亦有当落
而不落。或又有脓臭结痂。俗称外回痘也。非也。乃气血不足。而痘毒未尽也。必待气血和平。毒解
自愈也。
大抵小儿有禀受虚实不等。贫富之家。调摄不同。儿形壮怯。护养失宜。亦有实实虚虚之过也。
皆父母爱子之心。无所不至也。岂知有反复之患乎。致令子发热三五日而成 。八九日而方生。但足
上有痘方为齐。齐后成血 。或八九日结脓窠中夹出红 或天时暄暖。则痘易出。若天令凛冽则痘出
少迟。岂可以日期一例而论哉。必待荣卫调和无诸症。如期而愈矣。
凡是痘疮在发出之前，必须先发热三天，这样痘毒才能透发出来，属于吉兆。如果只发热一天就出现痘疹标志，这是凶兆。如果发热一天半，不足两天的，属于险证。
这就是通过发热三天的情况来判断吉凶。接下来是见标（出痘初期），在三日内陆续发出，稀疏、圆润、尖挺，一直长到脚部才算出齐，没有其他症状，能够进食，这属于吉证和顺证。如果发出的痘疹稠密如蚕种、蚊蚤斑一样，但不碍手（不坚硬），再兼有恶症，必然死亡，这属于凶证和逆证，不可治疗。如果痘疹的圆晕虽然形成，但干燥发红而缺少润泽，这是气血刚开始交接的时候，得失尚未确定，应当采用补托法。气血调和，痘疮自然化成脓浆，这是在出痘三天后见到痘标的吉凶判断。
到了五六天，痘疮应当贯浆（化脓）。痘皮浓密、光滑、圆润、呈苍蜡色，这是气化推动浆行，毒邪自然解除的表现，属于吉证和顺证。如果浆液不行，毒邪不解，则变得干枯且密集，瘙痒、灰色下陷，这是血不能依附于气的表现，属于凶证和逆证，必然死亡。如果气血虽然已经交接，但浆液生成能力不足，颜色半润半干，这种痘疮属于险证，属于半吉半凶，适宜使用保元汤加桂枝、白术来促进浆液的生成。有浆液就能存活，没有浆液就会死亡，这是在贯浆三天后的吉凶判断。
当痘疮结痂脱落时，从头面及背部开始，先变灰暗的是吉证和顺证。如果从足部和大腿内侧开始，则是逆证和凶证，这是第九日至第十日、第十一日结痂时的吉凶判断。如果第十二日至第十四日、第十五日，痘毒已经消退，疮口应当结痂脱落，这是气血充实，毒邪已化净的表现，属于吉证和顺证。也有该脱落而不脱落的，或者又有脓臭结成痂皮的，俗称“外回痘”，其实不对，这是因为气血不足，而痘毒未尽的缘故。必须等待气血平和，毒邪解除，自然会痊愈。
大抵小儿先天禀赋虚实不等，贫富家庭调摄护理不同，孩子形体强壮或怯弱，护养失宜，也有导致实证更实、虚证更虚的过错。这都是父母爱子之心无所不至造成的，哪里知道会有反复的祸患呢？致使孩子发热三五天才成痘，八九天才才生出。只有脚上长出痘疮才算出齐，出齐后结成血痂。或者八九日结脓窠中夹杂红色痘点，或者天时温暖，则痘疮容易发出；如果天气寒冷凛冽，则痘疮发出稍迟。怎么可以一概而论日期呢？必须等到营卫调和，没有各种病症，如期痊愈罢了。
In general, before the smallpox lesions erupt, there must be a fever for three days to allow the pathogenic factors to vent outwards, which is an auspicious sign. If fever lasts only one day before the initial signs of eruption appear, it is an inauspicious sign. If the fever lasts one and a half days, less than two days, it is a perilous condition.
This illustrates how to judge auspiciousness or inauspiciousness based on the three-day fever period. Next comes the appearance of the initial marks (early stage of eruption). If they emerge successively within three days, are sparse, round, and pointed, extending down to the feet, this constitutes complete eruption without other symptoms and with normal appetite, which is an auspicious and favorable condition. If the erupted lesions are dense like silkworm eggs or mosquito bites but not hard to the touch, yet accompanied by malignant symptoms, death is inevitable; this is an inauspicious and adverse condition, untreatable. If the circular halos of the lesions have formed but appear dry, red, and lacking moisture, this indicates the initial interaction between Qi and Blood, where the outcome is undetermined. One should employ tonification and support methods. When Qi and Blood harmonize, the lesions will naturally suppurate. This describes the judgment of auspiciousness or inauspiciousness three days after eruption begins.
By the fifth or sixth day, the lesions should fill with pus (suppuration). The skin of the lesions should be thick, smooth, round, and waxy-white in color, indicating that Qi transformation promotes fluid movement and toxins resolve spontaneously; this is auspicious and favorable. If pus fails to form and toxins do not resolve, the lesions become dry, dense, itchy, gray, and sunken; this signifies that Blood cannot adhere to Qi, representing an inauspicious and adverse condition leading inevitably to death. If Qi and Blood have interacted but pus formation is insufficient, with colors being partially moist, the condition is perilous, representing a mixed prognosis of partial auspiciousness and partial inauspiciousness. It is appropriate to use Baoyuan Tang (Preserve the Origin Decoction) added with Guizhi (Cinnamon Twig) and Baizhu (Atractylodes Macrocephala Rhizome) to promote pus generation. Survival depends on the presence of pus; absence leads to death. This describes the prognosis three days into the suppuration phase.
During the scabbing phase, if the lesions turn gray starting from the head, face, and back, it is auspicious and favorable. If they turn gray starting from the feet and inner thighs, it is adverse and inauspicious. This refers to the prognosis on the ninth, tenth, or eleventh day during scabbing. By the twelfth to fourteenth or fifteenth day, if the toxin has receded and the sores should shed their scabs, this indicates that Qi and Blood are substantial and toxins are completely resolved, which is auspicious and favorable. There are cases where scabs do not fall off as expected, or where purulent odor forms crusts, commonly called "external return smallpox"; this is incorrect. It actually results from deficiency of Qi and Blood and incomplete resolution of toxins. Healing occurs only when Qi and Blood reach harmony and toxins dissipate.
Generally, children vary in innate constitution (deficiency or excess), and care differs between wealthy and poor families. Children may be strong or frail, and improper nursing can lead to exacerbation of excess conditions or worsening of deficiency conditions. This stems from parents' excessive love and intervention, unaware of the risks of relapse. Consequently, fever may last three to five days before lesions form, and eruption may take eight to nine days. Complete eruption is confirmed only when lesions appear on the feet. After completion, blood scabs form. Alternatively, around the eighth or ninth day, pus-filled pits may contain red spots. If the weather is warm, eruptions occur easily; if cold, eruptions are delayed. Therefore, one cannot judge strictly by days alone. Recovery occurs only when Ying and Wei (Defensive and Nutritive Qi) are harmonized and no other symptoms persist, allowing healing to proceed as scheduled.