顺证∶气血冲和，痘毒宣畅，精神素健，饮食如常，不必施治；
险证∶气血不舒，痘毒壅遏，或杂证搅扰，开落失期，速宜施治；
逆证∶痘毒凝结，气血干枯，怪证丛生，病不对药，治之无功；
五善∶一、饮食如常，二、大小便调，三、疮色红活，皮浓坚实，四、脉静身凉，手足温暖，五、声音清
亮，动止安和。五者不能尽得，得一二亦自清吉；
七恶∶一、烦躁闷乱，谵妄恍惚，二、呕吐泻利，饮食不能，三、黑陷焦枯，痒塌破烂，四、头面预肿，鼻
煽肩抬，目张唇裂，五、喉舌溃烂，食入即呕，饮水则呛，六、寒颤切牙，声哑色黯，七、腹胀喘促，四肢厥
冷。七者不必皆有，有一二亦自难为。
七恶之外，又有浑身血泡，心腹刺痛，伏陷不起，便溺皆血，寻衣撮空，是又卒死而不救者。
（凡一十一首，共一十五方）
痘虽火毒肇胚胎，不遇天行不见灾。郡邑若逢疵疠日，预施灵药解将来。
凡痘疹之证，皆由父母胎毒蓄于命门之中。命门者，下极丹田也，为人身生化之源。或遇冬温，阳气暴泄，
人则感之，触动相火，至春夏生长之时即发，传染相似，是谓天行疫疠也。未出痘疹者，但觉冬温，宜先服解
毒之药，如辰砂散、三豆汤、代天宣化丸之类，使毒瓦斯无倾伏留连之患；如脾胃素弱者，更宜调其胃气，间以
四君子汤加陈皮、木香之属与之，使胃气和畅，荣卫流通，使痘易出易靥也。
予按∶代天宣化，即韩氏之五瘟丹也。苦寒克削，损胃败脾，纵能解疫疠之毒，未必能预解先天之毒，即
使能之，亦只可行于藜藿禀实之儿。倘膏粱禀怯，不察妄投，吾恐毒未解而胃先损，痘未至而中已寒，预伐无
辜，暗伤真气，及出痘时，反不能救，夭枉相仍，咎将谁诿！盖藜藿禀实而毒轻，无俟于解；膏粱禀薄而毒重，
势不能解。岂有先天之毒，深藏潜伏于命门之中，毫未发觉，而敢用此沉阴冱寒之品，预伐其生机，诚为危道，
必不可行，即欲解之，又不若三豆汤之为得也。
欲知痘疹吉凶机，察色观形在细微。年寿山根犹紧要，鲜明可喜黯青非。
痘疹未出之先，欲知吉凶轻重，但于面部推之，其色红黄明润者吉，青黑昏暗者凶。相书以山根管命宫，
年寿管疾厄，所以二处犹为紧要也。
汗下虽然谓不宜，刻舟求剑岂通医？能分虚实知权变，可越乾坤造化维。
首尾不可汗下，诚痘科固执之言，然亦自其平证语之耳。若遇风寒外袭，应出不出，则汗剂仍不可少；如大
便连日不通，烦闷狂躁，不与下之，宁不夭人生命，是下剂之在所必用。但能消息虚实，与时权变，斯可谓之通
医。
始终便溺自调嘉，便若艰难事可嗟。腹胀喘呼多壅遏，急行疏导免留邪。
此言可利则利者也。大抵豆疮始终小便清利，而大便滋润者为顺。若小便或秘，急宜利其小便，宜八正散；
若大便秘结，速用通幽汤滋润之。
痘家脉证喜中和，徐疾由来不可过。弦急浮洪为实候，微迟短涩属虚多。
夫人以胃气为主，脉亦当以胃气为主。脉有胃气，则气象中和，所谓弦不弦，石不石者是也。太过为实，不
及为虚，最宜消息。
痘疹伤寒证一般，上工临证贵详端。休将汗下轻相试，解表和中病自安。
痘疹发热与伤寒相似，但伤寒只见一经形证，若痘疹则五脏之证皆见。如呵欠顿闷，肝证也；乍冷乍热，手
足梢冷，好睡，脾证也；面燥腮赤，咳嗽喷嚏，肺证也；惊悸不宁，心证也；尻凉耳凉，肾之平证也。若尻耳俱
热，则邪伏肾经也。
痘疹虽然本属阳，往来微热始相当。倘逢昼夜身如火，解毒须教小便长。
凡痘疹属阳，非热不成，故治痘不可尽除其热；如热太甚，毒未发尽，只宜解毒兼利小便，宜连翘升麻葛根汤。
食饮能多胃气充，自然荣卫两丰隆。休
言食少无他虑，但恐脾虚毒内攻。
痘疹始终能食者，其人脾胃素强，自然气血充实，易壮易靥。若一旦食减，即宜询问。或咽喉肿痛，宜甘桔
汤；伤食者橘皮汤；若非以上二证，因脾胃气弱，不能消食者，宜参苓白术散运用之。
最宜安静号和平，表里无邪心自清。忽尔躁烦宜审谛，更防神爽欠分明。
痘疮以安静为贵，此表里无邪，不必服药。但有烦躁，必毒瓦斯壅并，表里不宁，宜审谛之。如搔爬不宁，疮
痒也；心神不宁，里热也；呻吟不止，疮痛也。非折肱之手，莫能识其病情。以上治疗见后。
四时分治证须真，暑湿风寒各有因。异气莫教经触犯，灾危反复立缠身。
大凡治病之道，春夏养阳，秋冬养阴。故春病治在肝，夏病治在心，秋病治在肺，冬病治在肾，不可逆也。
治痘之人，切须识此。如天有烈风豪雨，酷暑严寒，常要谨其帷 ，适其寒温，寒则盖覆欲浓，热则居处欲清。
苟伤热则血气淖泽，疮易腐烂；偏寒则血气凝滞，疮难起发。若有触犯，轻则变重，卒生异证，是谓灾怪。如
暴风连日，病见伤风之证，治以桂枝葛根汤；如寒威凛烈，病见伤寒之证，治以正气散；若酷暑熏蒸，病见热
证，治以人参白虎汤；倘值久雨浸淫，有受湿之证，泄泻身重，治以胃苓汤。
治痘皆言在补脾，补中有害少人知。虚虚实实休轻放，审证施方贵合宜。
凡痘疮始终以脾胃为本，若饮食如常，六腑充实，不须服药，若补其脾，反增烦躁，为害非轻；倘不能食，
常多泄泻，此气虚也。宜四君子汤助之可也。
顺证：气血调和，痘毒宣发通畅，精神素来健壮，饮食如常，不需要进行治疗；
险证：气血运行不畅，痘毒壅滞阻塞，或者夹杂其他病症干扰，出痘时机失当，应当迅速进行治疗；
逆证：痘毒凝结，气血干枯，怪异病症丛生，病情与药物不对症，治疗无效；
五善：一、饮食如常，二、大小便正常，三、疮色红活，皮厚坚实，四、脉象平静身体凉爽，手足温暖，五、声音清亮，动作举止安详平和。这五项不能全部具备，能具备一二项也自然吉利；
七恶：一、烦躁闷乱，胡言乱语神志恍惚，二、呕吐腹泻，无法进食，三、痘色黑陷焦枯，瘙痒塌陷破烂，四、头面部预先肿胀，鼻翼煽动抬肩呼吸，眼睛睁大嘴唇裂开，五、咽喉舌头溃烂，食物入口即呕吐，喝水则呛咳，六、寒战咬牙，声音嘶哑面色晦暗，七、腹胀气喘急促，四肢冰冷。这七项不必全部出现，只要有一两项也难以救治。
在七恶之外，又有浑身血泡，心腹部刺痛，痘毒伏陷不起，大小便皆出血，手摸空衣被抓空中，这是突然死亡且无法救治的情况。
（共十一首，十五个方剂）
痘疹虽然是由火毒在胚胎时期肇始，但若不遇到时行疫气就不会发生灾祸。如果郡县遭遇瘟疫流行之日，预先施用灵药解除它。
凡是痘疹的病症，都是由父母的胎毒蓄积在命门之中。命门，就是下极丹田，是人身生化之源。如果遇到冬温，阳气暴泄，人感受了它，触动相火，到了春夏生长之时就发作，具有传染性，这叫做天行疫疠。尚未出痘疹的人，只感觉有冬温症状，应当先服用解毒的药物，如辰砂散、三豆汤、代天宣化丸之类，使毒瓦斯没有倾覆留连的隐患；如果脾胃素来虚弱，更应当调理胃气，偶尔给予四君子汤加陈皮、木香之类的药物，使胃气和畅，营卫流通，使痘疹容易发出容易结痂。
我按语：代天宣化丸，就是韩氏的五瘟丹。苦寒克削，损伤胃败坏脾，纵然能解疫疠之毒，未必能预先解先天之毒，即使能，也只适用于禀赋充实的平民百姓之子。如果是膏粱子弟禀赋怯弱，不察明情况妄自投药，我恐怕毒未解而胃先受损，痘未至而中气已寒，预先伐害无辜，暗中损伤真气，等到出痘时，反而不能救治，夭折枉死相继，过错归咎于谁！大概平民百姓禀赋充实而毒轻，无需解表；膏粱子弟禀赋薄弱而毒重，势态上不能解。哪有先天之毒，深藏潜伏在命门之中，丝毫未发觉，而敢用这种沉阴冱寒的药物，预先伐害其生机，实在是危险之道，必不可行，即使想要解它，也不如三豆汤更为得当。
想知道痘疹吉凶的关键，观察颜色和形态在于细微之处。年寿和山根部位尤其紧要，颜色鲜明可喜为吉，黯青则为凶。
汗法和下法虽然说不宜使用，但刻舟求剑难道算是通晓医理？能够分辨虚实懂得权变，才可以超越乾坤造化的维系。
痘疹的首尾阶段不可轻易使用汗法和下法，这确实是痘科医生固执的说法，但这也是针对平证而言的。如果遇到风寒外袭，应当出痘却出不出来，那么汗剂仍然不可少；如果大便连续几天不通，烦闷狂躁，如果不使用下法，难道不是让人夭折吗，所以下剂是必须使用的。只要能斟酌虚实，与时机权变，这才称得上是通晓医理。
始终大小便调畅是好的，如果排便艰难事情就令人叹息。腹胀喘呼多因壅滞阻塞，紧急进行疏导以免留下邪气。
这是说可以利小便时就利小便。大致痘疮从头到尾小便清利，而大便滋润的为顺证。如果小便闭塞，紧急应当利小便，宜用八正散；如果大便秘结，速用通幽汤滋润它。
痘家脉象和证候喜欢中和，徐缓或急疾由来都不可以过度。弦急浮洪属于实候，微迟短涩属于虚证居多。
人以胃气为主，脉象也应当以胃气为主。脉有胃气，则气象中和，所谓弦不像弦，石不像石的样子。太过为实，不及为虚，最宜仔细斟酌。
痘疹伤寒证候一般相似，高明的医生临证贵在详细审慎。不要将汗法和下法轻率地尝试，解表和中病自然安宁。
痘疹发热与伤寒相似，但伤寒只见一经的形证，若痘疹则五脏的证候都可见到。如呵欠顿闷，是肝证；乍冷乍热，手足梢冷，好睡，是脾证；面燥腮赤，咳嗽喷嚏，是肺证；惊悸不宁，是心证；尻凉耳凉，是肾的平证。如果尻部和耳朵都热，则是邪气伏于肾经。
痘疹虽然本属阳证，往来微热才相当。如果遇到昼夜身体如火烧，解毒必须让小便通长。
凡是痘疹属阳，非热不成，所以治痘不可完全去除其热；如果热太甚，毒未发尽，只宜解毒兼利小便，宜用连翘升麻葛根汤。
食饮能多说明胃气充盛，自然营卫两方丰隆。不要说食少没有其他忧虑，只恐怕脾虚导致毒气内攻。
痘疹从头到尾能进食的人，其人脾胃素来强壮，自然气血充实，容易壮实容易结痂。如果一旦食量减少，就应当询问原因。如果是咽喉肿痛，宜用甘桔汤；伤食的用橘皮汤；如果不是以上两种证候，因为脾胃气弱，不能消食的，宜运用参苓白术散。
最宜安静称为和平，表里无邪心神自然清静。忽然躁烦应当审察谛视，更要防备神志清爽但不分明。
痘疮以安静为贵，这是表里无邪，不必服药。但有烦躁，必定是毒瓦斯壅并，表里不宁，应当审察。如搔爬不宁，是疮痒；心神不宁，是里热；呻吟不止，是疮痛。不是久病成医的手腕，不能识别其病情。以上治疗见后文。
四季分治证候必须真实，暑湿风寒各有成因。异气不要让身体触犯，灾危反复立刻缠绕身体。
大凡治病之道，春夏养阳，秋冬养阴。所以春病治在肝，夏病治在心，秋病治在肺，冬病治在肾，不可违背。
治疗痘疹的人，切须认识这一点。如天有烈风豪雨，酷暑严寒，常常要谨慎帷帐，适应寒温，寒冷则盖覆要浓，炎热则居处要清凉。如果伤热则血气淖泽，疮容易腐烂；偏寒则血气凝滞，疮难起发。如果有触犯，轻则变重，突然产生怪异证候，这叫做灾怪。如暴风连日，病见伤风证候，治以桂枝葛根汤；如寒威凛烈，病见伤寒证候，治以正气散；若酷暑熏蒸，病见热证，治以人参白虎汤；倘若值久雨浸淫，有受湿证候，泄泻身重，治以胃苓汤。
治痘都说在补脾，补中有危害少人知道。虚虚实实不要轻易放过，审察证候施方贵在合适。
凡是痘疮始终以脾胃为本，如果饮食如常，六腑充实，不需要服药，如果补其脾，反而增加烦躁，为害非轻；如果不能进食，常多泄泻，这是气虚。宜用四君子汤帮助它即可。
Smooth Course: Qi and blood are harmonious, the variola toxin is smoothly excreted, the spirit is robust, and diet is normal; no treatment is required.
Dangerous Course: Qi and blood are stagnant, the variola toxin is obstructed, or complicated by other disorders with mistimed eruption; prompt treatment is necessary.
Adverse Course: The variola toxin is condensed, Qi and blood are dry and exhausted, strange symptoms arise, the disease does not respond to medication, and treatment is ineffective.
Five Auspicious Signs: 1. Diet remains normal; 2. Urination and defecation are regular; 3. Lesions are red and vibrant, with thick skin and firm texture; 4. Pulse is calm, body temperature is cool, and hands and feet are warm; 5. Voice is clear and bright, movements are peaceful and harmonious. If all five cannot be fully present, having one or two is still auspicious.
Seven Inauspicious Signs: 1. Restlessness, confusion, delirium, and mental haze; 2. Vomiting and diarrhea, inability to eat; 3. Lesions turn black, sink, become scorched and dry, itch, collapse, and ulcerate; 4. Premature swelling of the head and face, nasal flaring, shoulder lifting in respiration, eyes wide open, lips cracked; 5. Ulceration of the throat and tongue, immediate vomiting upon eating, choking when drinking water; 6. Chills, teeth grinding, hoarse voice, and dark complexion; 7. Abdominal distension, panting, and cold limbs. Not all seven need to appear; even one or two indicate a difficult prognosis.
Beyond the Seven Inauspicious Signs, there are cases of hemoblisters all over the body, stabbing pain in the heart and abdomen, lesions failing to erupt, blood in urine and feces, and picking at empty air (picking at bedclothes). These indicate sudden death that cannot be saved.
(Comprising eleven poems and fifteen formulas)
Although variola originates from fire-toxin during embryonic development, disaster does not occur without the influence of epidemic qi. If an epidemic breaks out in a region, administer spiritual medicine in advance to resolve it.
All variola and rashes stem from fetal toxin accumulated in the Mingmen Gate (Life Gate). The Mingmen Gate, located at the lower extreme of the Dantian (Elixir Field), is the source of life generation in the human body. If one encounters winter warmth causing a sudden leakage of Yang Qi, and contracts this pathogen, it stirs up the Ministerial Fire. It erupts during the spring and summer growth seasons, spreading contagiously, known as epidemic pestilence. For those who have not yet erupted, if they feel winter warmth, they should first take detoxifying medicines such as Chen Sha San (Cinnabar Powder), San Dou Tang (Three Beans Decoction), or Dai Tian Xuan Hua Wan (Heavenly Mandate Dissemination Pill) to prevent the toxin from lingering. If the Spleen and Stomach are weak, regulate the Stomach Qi, occasionally administering Si Jun Zi Tang (Four Gentlemen Decoction) with Chen Pi (Tangerine Peel) and Mu Xiang (Aucklandia Root) to harmonize Stomach Qi, circulate Ying and Wei (Nutritive and Defensive Qi), and facilitate easy eruption and crusting.
My Commentary: Dai Tian Xuan Hua Wan is identical to Han Shi’s Wu Wen Dan (Five Plague Pills). Bitter and cold, it depletes and cuts down, damaging the Stomach and Spleen. Although it may resolve epidemic toxins, it likely cannot preemptively resolve congenital toxins. Even if it could, it is only suitable for children with strong constitutions from humble backgrounds. If administered recklessly to children of wealthy families with weak constitutions, I fear the toxin will remain while the Stomach is damaged first, and the Middle Jiao becomes cold before the eruptions appear. This pre-emptive attack on the innocent secretly harms True Qi. When eruptions finally occur, rescue may be impossible, leading to premature death. Those with strong constitutions have light toxins requiring no resolution; those with weak constitutions have heavy toxins that cannot be resolved by such means. How can congenital toxins, deeply hidden in the Mingmen Gate without manifesting, be treated with such sinking, yin, and freezing substances to preemptively destroy vitality? This is a dangerous path and must not be followed. If resolution is desired, San Dou Tang is more appropriate.
To know the fortune or misfortune of variola, observe colors and forms in detail. The Nian Shou (Year Longevity area on nose) and Shan Gen (Mountain Root area between eyes) are critical; bright and pleasant colors are auspicious, while dark and blue-green are ominous.
Although sweating and purging methods are generally contraindicated, rigid adherence is not true medical wisdom. One who can distinguish deficiency and excess and adapt accordingly masters the principles of creation.
Consistent regulation of urination and defecation is auspicious; difficulty indicates trouble. Abdominal distension and panting suggest obstruction; urgent dredging is needed to avoid lingering pathogens.
This refers to promoting urination when indicated. Generally, clear urination and moist stool throughout the course denote a smooth progression. If urination is blocked, urgently promote diuresis with Ba Zheng San (Eight Upright Powder); if constipation occurs, quickly use Tong You Tang (Unblocking the Abyss Decoction) to moisten.
Pulse and symptoms in variola favor moderation; neither too rapid nor too slow is ideal. Wiry, rapid, floating, and full pulses indicate excess; thready, slow, short, and choppy pulses indicate deficiency.
The human body relies on Stomach Qi, and so does the pulse. A pulse with Stomach Qi appears moderate, neither distinctly wiry nor stone-like. Excess arises from overabundance, deficiency from insufficiency; careful assessment is crucial.
Variola and Shanghan (Cold Damage) share similar presentations, but skilled physicians must examine details carefully. Do not lightly experiment with sweating or purging; resolving the exterior and harmonizing the interior ensures peace.
Fever in variola resembles Shanghan, but Shanghan presents with symptoms of a single meridian, whereas variola shows signs of all five Zang organs. Yawning and drowsiness indicate Liver involvement; alternating chills and fever, cold extremities, and lethargy indicate Spleen involvement; dry face, red cheeks, cough, and sneezing indicate Lung involvement; palpitations and restlessness indicate Heart involvement; coolness of the sacrum and ears indicates normal Kidney status. Heat in both sacrum and ears indicates pathogen latent in the Kidney meridian.
Although variola belongs to Yang and requires heat to mature, excessive heat is problematic. If heat is severe and toxins are not fully expressed, resolve toxicity and promote urination using Lian Qiao Sheng Ma Ge Gen Tang (Forsythia, Cimicifuga, and Pueraria Decoction).
Abundant appetite indicates sufficient Stomach Qi, leading to robust Ying and Wei Qi. Do not dismiss reduced appetite as harmless; fear Spleen deficiency allowing toxin invasion.
Continuous ability to eat indicates strong Spleen and Stomach, ensuring abundant Qi and Blood for easy maturation and crusting. A sudden decrease in appetite warrants inquiry. Sore throat suggests Gan Jie Tang (Licorice and Platycodon Decoction); food stagnation suggests Ju Pi Tang (Tangerine Peel Decoction); otherwise, if due to weak Spleen Qi and poor digestion, employ Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder).
Tranquility is prized as peace, indicating no exterior-interior pathogens and clear mind. Sudden restlessness requires scrutiny; watch for mental clarity lacking focus. Tranquility implies no pathogens; restlessness implies toxin accumulation and interior disturbance. Scratching indicates itching; mental unrest indicates interior heat; groaning indicates pain. Only experienced practitioners can discern these conditions. See treatments below.
Seasonal treatments must be accurate, addressing summer-heat, dampness, wind, and cold separately. Avoid exposure to abnormal qi to prevent recurring disasters.
In treating diseases, nourish Yang in spring and summer, Yin in autumn and winter. Spring diseases treat the Liver, Summer the Heart, Autumn the Lungs, Winter the Kidneys. Do not violate this. Physicians must understand this. Protect against extreme weather; adjust bedding and environment for warmth or coolness. Heat causes blood and Qi to become loose, leading to rotting sores; cold causes stagnation, hindering eruption. Exposure leads to worsening or strange symptoms, termed "disaster anomalies." Wind injury treated with Gui Zhi Ge Gen Tang (Cinnamon Twig and Pueraria Decoction); Cold damage treated with Zheng Qi San (Righteous Qi Powder); Summer heat treated with Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction); Dampness with diarrhea and heaviness treated with Wei Ling Tang (Stomach and Pinellia Decoction).
Treating variola emphasizes tonifying the Spleen, but harm can result from improper tonification. Do not neglect distinguishing deficiency and excess; prescribe based on accurate diagnosis.
Variola fundamentally relies on the Spleen and Stomach. If diet is normal and Six Fu Organs are full, no medicine is needed; tonifying the Spleen may cause irritability. If unable to eat with frequent diarrhea, it is Qi deficiency; assist with Si Jun Zi Tang (Four Gentlemen Decoction).