空谷而附应。形动而影随。夫痘疮之发也。内热和缓。达于外者必轻。便闭烦躁。彰于
外者
必重。有诸中形诸外者。理势之自然也。夫颜色贵润泽而嫌昏暗。贵光彩而嫌枯涩。贵淡
红而嫌黑滞。贵圆净而嫌破损。贵高耸而嫌平塌。贵结实而嫌虚薄。贵稀疏而嫌稠密。根窠
收紧。痘分阴阳。见点动活。更怕脸浮。出要参差。血宜归附。耳后心喉。少于他处为佳。
眉棱两颧额前。光润不泄为妙。如发热便出者重。疮夹疹者半轻半重。里外微红者轻。外黑
里赤者微重。外赤里黑大重。疮内黑点如针孔者。热极。青干紫陷昏睡。汗出烦躁。热渴腹胀
啼喘。大小便闭者。困也。善治者。看其形色而辨之。轻者获安。重能取效矣。
胎毒蓄积。发于痘疮。传染由于外感。轻重起于内伤。初起太阳。壬水克于丙丁。后归
阳明
血水化为脓浆。势若燃眉。变若反掌。若救焚兮徙薪。何如焦额。如落水兮拯溺。不及
褰裳。欲知表里虚实。须明寒热温凉。证候殊形。脏腑易状肝火。激成水泡。肺主涕而脓
浆。心斑红紫。脾疹赤黄。肾经居下。不受污浊。为变黑而可防。观其外症。推乎五内。呵
欠烦闷兮。肝木之因。咳涕喷嚏兮。肺金之象。目带赤兮。心火延于胸膈。手足厥冷而昏
睡兮。脾土困于中央。耳尻属肾。温暖如常。二处烦热。痘疹乖张。先分部位。次察灾祥。
阳明从目落鼻。太阳形于头上。心火炎热。则舌干面赤。肺金郁结。则胸膈先伤。手足属乎
脾胃。肝胆主胁肋之旁颈项三阳交会。腰背统乎膀胱。外症分明。用心想象。泄者。邪盛于
下。吐者邪盛于上。气逆而腹胀隐隐。毒甚而腰痛惶惶。心热甚而惊搐。胃邪实而癫狂。
口燥咽干。肺受火邪而液竭。便闭尿涩。肾因火旺而津亡。欲识痘之轻重。当观热于形状。
毒甚兮心如炎上。毒微兮内外清凉。寒热往来神气爽。定知痘出必祯祥。数番渐出兮春回阳
谷。一齐涌出兮火烈昆冈。蚊虫蚤斑。刻期而死。蛇皮蝉蜕。引日而亡。虽怕红紫。最
嫌灰
白。最宜淡红滋润。切忌黑陷干黄。色要明润兮。犹恐薄嫩之易破。痘贵干结兮。又愁
痒塌之难当。面颊稀而磊落。清安可保。胸膈密而连串。吉凶难量。顶欲尖圆。不宜平陷。
浆宜饱满。切忌空疮。皮喜老而愁嫩。肤爱活而怕光。结实高耸。始终无虑。丹浮皮肉。必
主刑伤。唇面头肿兮。八九如何可过。腰痛胃烂兮。一切定主灾殃。疮堆口舌。毒缠颈项。
咽疮喉肿。饮食难尝。泄痢脓血。毒陷无浆。人力难尽。生命匪长。痘疮焦落。辨别阴阳。
人中上下。先靥为良。足腰先若黑靥。多凶而少吉祥。
如同空旷的山谷中声音会有回响，身体动作时影子必然跟随。痘疮发作时，如果体内热势和缓，反映到体表的病情一定较轻；如果大便闭塞、烦躁不安，显露在外的症状一定较重。内在的病机必然通过外在表现显现出来，这是事物发展的自然规律。
痘疹的颜色以润泽为贵，忌讳昏暗；以光彩为贵，忌讳枯涩；以淡红为贵，忌讳黑滞；以形态圆净为贵，忌讳破损；以高耸饱满为贵，忌讳平塌；以质地结实为贵，忌讳虚薄。根脚收紧，可以区分阴阳属性；见点（出痘初期）灵动活泼，更需警惕面部浮肿。出痘要参差错落，血液宜归附于痘内。耳后、心区、咽喉处的痘疹少于其他部位为佳。眉棱骨、两颧、额前部位，光润不泄气为妙。如果发热不久就出痘的，病情重；痘疮夹杂麻疹的，半轻半重；里外都微红的，病情轻；外面黑里面红的，稍微重一点；外面红里面黑的，非常重。痘疮内部出现如针孔般的黑点，说明热毒极盛。出现青色干枯、紫色下陷、昏睡、出汗、烦躁、热渴、腹胀、啼哭喘息、大小便闭塞等症状，属于危困之象。善于治疗的人，观察其形色来辨别病情，轻症可获得安宁，重症也能取得疗效。
胎毒蓄积，发作为痘疮；传染是由于外感邪气；病情的轻重取决于内伤的程度。初起时病在太阳经，壬水（肾水）克制丙丁火（心火）。后期归于阳明经，血水化为脓浆。病情发展迅速，犹如眉毛着火般紧急，变化快如翻手之间。就像救火不如预先移开柴薪以防患未然，又如同落水救人，不如提前提起衣裳以免湿身。想要知道表里虚实，必须明白寒热温凉的辨证。证候形态各异，脏腑状态也会改变。肝火旺盛，激惹形成水泡；肺主涕唾并化生脓浆；心经斑疹呈红紫色；脾经疹色赤黄；肾经位于下部，不受污浊之气侵扰，若变为黑色尚可预防。观察外在症状，推断内在五脏。呵欠烦闷，是肝木受邪的原因；咳嗽流涕打喷嚏，是肺金受邪的现象；眼睛发红，是心火蔓延至胸膈；手足厥冷且昏睡，是脾土被困于中焦；耳朵和尾骶部属肾，温暖如常为好，这两处烦热，说明痘疹异常。先分辨部位，再观察吉凶。阳明经病变从眼睛落到鼻子，太阳经病变显现在头上。心火炎热，则舌干面赤；肺金郁结，则胸膈先受伤。手足归属于脾胃，肝胆主管胁肋旁边，颈项是三阳经交会之处，腰背统属于膀胱。外在症状分明，用心推想。腹泻，是邪气盛于下部；呕吐，是邪气盛于上部。气逆导致腹部隐隐作痛，毒甚导致腰部疼痛惶惶不安。心热严重会导致惊厥抽搐，胃邪实盛会导致癫狂。口燥咽干，是肺受火邪灼烧而津液枯竭；大便闭塞小便涩痛，是肾因火旺而津液亡失。想要识别痘疮的轻重，应当观察热势与形状。毒气严重时，心如炎上般躁动；毒气轻微时，内外清凉。寒热往来但神气清爽，定知痘出必为吉祥。分几次逐渐出痘，如同春天回到阳谷般生机渐复；一齐涌出，则如火烈昆冈般猛烈。蚊虫蚤斑样者，限期而死；蛇皮蝉蜕样者，拖延时日而亡。虽然害怕红紫，最忌讳灰白。最适宜淡红滋润，切忌黑陷干黄。颜色要明润，但又担心过于薄嫩容易破裂；痘疮贵在干燥结实，却又愁痒塌难以忍受。面颊稀疏而磊落，可保清安；胸膈密集而连串，吉凶难料。痘顶欲尖圆，不宜平陷；浆液宜饱满，切忌空疮。皮肤喜欢老练而愁嫩弱，肌肤爱活络而怕光滑。结实高耸，始终无忧；丹浮皮肉，必然主刑伤。唇面头肿，八九成难以度过；腰痛胃烂，一切定主灾殃。疮堆口舌，毒缠颈项，咽疮喉肿，饮食难以下咽。泄痢脓血，毒陷无浆，人力难尽，生命不长。痘疮焦落，辨别阴阳。人中上下，先结痂者为良。足腰先若黑痂，多凶少吉。
Just as an echo responds in a valley and a shadow follows movement, the eruption of smallpox (Xiaochuang) reflects internal conditions externally. If the internal heat is mild, the external manifestation will be light; if constipation and irritability are present, the external signs will be severe. What exists internally manifests externally; this is the natural course of things.
Regarding color, glossiness is preferred over dullness; radiance is preferred withered dryness; pale red is preferred over black stagnation; round and clean shape is preferred over damage; high elevation is preferred over flatness; firm texture is preferred over emptiness and thinness. Tight roots help distinguish Yin and Yang types. The appearance of spots should be lively, but facial edema must be feared. Eruption should be uneven, and blood should remain within the lesions. Fewer eruptions behind the ears, at the heart area, and in the throat are auspicious. The brow ridge, zygomatic arches, and forehead should be lustrous without leakage. Early eruption during fever indicates severity; eruptions mixed with measles indicate moderate severity. Mild redness inside and out indicates light disease; black outside and red inside indicates slightly severe; red outside and black inside indicates very severe. Black dots like needle holes inside the lesions indicate extreme heat. Cyanosis, drying, purple depression, lethargy, sweating, irritability, thirst, abdominal distension, crying and wheezing, and closure of bowels and urine indicate critical distress. A skilled practitioner distinguishes severity by observing form and color; light cases recover, and severe cases can be treated effectively.
Fetal toxin accumulates and erupts as smallpox; transmission occurs via external pathogens; severity depends on internal injury. Initially affecting the Taiyang channel, Ren Water (Kidney Water) controls Bing-Ding Fire (Heart Fire). Later it returns to the Yangming channel, where blood and water transform into pus and plasma. The situation is urgent like burning eyebrows, changing rapidly like flipping a hand. It is better to remove firewood before a fire starts than to scorch one's forehead after ignition; it is better to lift one's clothes when entering water than to save someone already drowning. To understand exterior-interior and deficiency-excess, one must clarify cold-heat-warm-cool patterns. Symptoms vary, and organ states change. Liver fire agitation causes blisters; the Lung governs mucus and generates pus; Heart macules are red-purple; Spleen rashes are red-yellow; the Kidney channel is lower and resists turbidity, so blackening can be prevented. Observing external symptoms allows inference of the five Zang organs. Yawning and stuffiness stem from Liver Wood pathology; coughing, runny nose, and sneezing are signs of Lung Metal involvement; red eyes indicate Heart Fire spreading to the chest and diaphragm; cold extremities and lethargy indicate Spleen Earth trapped in the center. The ears and sacrum belong to the Kidney; warmth there is normal, while heat indicates abnormal rash progression. First distinguish locations, then observe omens. Yangming issues descend from eyes to nose; Taiyang issues appear on the head. Intense Heart Heat causes dry tongue and red face; Lung Metal stagnation injures the chest and diaphragm first. Hands and feet belong to the Spleen and Stomach; Liver and Gallbladder govern the flanks; the neck is the intersection of three Yang channels; the waist and back are governed by the Bladder. External symptoms are clear; careful imagination aids diagnosis. Diarrhea indicates pathogenic excess below; vomiting indicates pathogenic excess above. Qi rebellion causes hidden abdominal pain; severe toxicity causes alarming lower back pain. Extreme Heart Heat causes convulsions; Stomach pathogenic excess causes mania. Dry mouth and throat indicate Lung fluid depletion due to Fire evil; constipation and dysuria indicate Kidney fluid loss due to hyperactive Fire. To identify severity, observe heat and morphology. Severe toxicity makes the mind restless like rising flame; mild toxicity leaves the interior and exterior cool. Alternating chills and fever with clear spirit predict auspicious eruption. Gradual emergence over several days is like spring returning to the Yang Valley; sudden simultaneous eruption is like fierce fire on Kun Gang. Mosquito-bite-like spots lead to death within a set time; snake-skin-like shedding leads to death after prolonged suffering. While red-purple is feared, gray-white is most detested. Pale red and moist is best; black depression and dry yellow must be avoided. Color should be bright and moist, yet too thin/tender risks rupture; lesions should be dry and firm, yet itching/collapse is hard to bear. Sparse cheeks ensure safety; dense chest lesions make prognosis uncertain. Peaks should be pointed/round, not flat/depressed; plasma should be full, not empty. Skin prefers toughness over tenderness; flesh prefers mobility over smoothness. Firm and elevated lesions cause no worry; floating Dan (erythema) on skin predicts trauma/swelling. Swelling of lips, face, and head is often fatal; lower back pain and stomach rot guarantee disaster. Lesions on tongue/lips and neck entanglement, pharyngitis, and throat swelling make eating difficult. Dysentery with pus/blood and toxic collapse without plasma mean human effort is futile and life is short. Scabbing distinguishes Yin/Yang. Crusting first in the upper/lower philtrum is good; black crusting first on feet/waist indicates bad omens.