凡物得其平则静，失其平则动。经曰∶阳气者静则养神，柔则养筋。又曰∶阴
气者静则神藏，躁则消亡。夫患痘者，阴阳俱病，息欲其匀，语欲其少，寐欲其定，
寤欲其宁，饥则索食，渴则少饮，触其疮则吟，拂其欲则鸣，此平人之候，神清气
定，谓之静而吉也。如呻者，身有苦也。自语者，神不清也。喘粗者，内热也。肠
鸣者，泄也。坐卧不定者，心烦也。啼叫不止者，痛也。摇头者，风也。指欲搔者，
痒也。咽物难者，咽痛也。切牙者，心肝热也。若闷乱躁扰，谵妄昏眩，如见鬼状，
摇头扭项，手舞足掷，目睛上翻，寒战切牙，语音不出，则皆死候矣。如病向静，
忽作扰动者异也，以法求之，如疮色变，无他候者，此戾气所触也。如疮色不变，
又无他证，此必有因，但俟自定。其有目瞑息微，四肢僵直，口噤疮坏，昏睡不醒
者，此真气将脱，魂魄欲离之兆。又不可作静诊也。
或云痘疮之候，无以脉诊言，形色可辨也。谓之形者，痘之形也，故尖圆坚浓，
始出之形。发荣滋长，欲壮之形。饱满充足，成浆之形。敛束完固，收靥之形。与
大豆豌豆绿豆相似者，皆正形也。或平或陷，形之变也，如初出时空若蚕种之蜕，
隐如蚊蚤之迹，薄如麸片，密如针头，若热之痱，寒之粟者，不能起发而死。粘聚
模糊，肌肉虚浮，溶软嫩薄，皮肤溃烂者，不能收靥而死。谓之色者，痘之色也，
喜鲜明而恶昏暗，喜润泽而恶干枯，喜苍蜡而恶娇嫩，红不欲焰、焰则易破，白不
欲灰、灰则难靥，由红而白，白而黄，黄而黑者，此出形、起发、成浆、结痂之正
色也。出形而带紫，起发而灰白，此色之变。能辨痘之形色，可知死生之期。
先贤看痘有四，曰根、曰窠、曰脚、曰地，用是以验吉凶，断死生，不易之法
也。何谓窠，中透而起顶者是也。何谓根，外圈而红者是也。即圈之红否，而其中
之虚实，与痘毒之浅深可见矣。即窠之起否，而根之浅深，气血之盈亏可定矣。所
谓脚地，则本乎根窠之丸混，痘子之稀密也，红晕之处谓之脚，彼此颗粒界限分明，
不散不杂者，此痘脚明净也。空隙之处便谓之地，彼此颗粒不相连缀者，此地面明
净也。根欲其活，窠欲其起，脚欲其固，地欲其宽，四者俱顺，痘虽密，无虑矣。
丸者，气之形也，气盛则痘窠必圆满周净。晕者，血之形也，血盛则痘窠必光明红
活。气虚则顶陷，气散则塌阻，或有气虚极而不塌陷者，乃火载之，虽见圆满，实
空壳如泡然也。血虚则晕淡，血惫则晕枯，根必散，或有血虚极面犹红色者，乃火
上浮，虽见圈晕，实枯槁而不润泽也。痘色之明暗，系于血气之虚实，如色之红
者，痘初出也。白者，毒未解也。黄者，毒将解也。干黄者，毒尽解也。灰白者，
气衰而血不附也。紫者，毒盛而血滞也。黑者，热极而兼水化也。焦褐者，气血枯
也。红变白，白变黄者，顺而生。红变紫，紫变黑者，逆而死。
初验之时，以红纸蘸清油，燃火照之，验其生意有无，又以手揩摩面颊，如红
色随手转白，随白转红，谓之血活，生意在矣。如揩之不白，举之不红，是为血枯，
纵疏不治。又看目睛神光了然，口唇尖上红活如常，无燥白之色，乃为吉证，万元
忧也。
凡是事物，得到平衡就安静，失去平衡就躁动。《内经》说：阳气，安静就能滋养精神，柔和就能滋养筋脉。又说：阴气，安静则神志内守，躁动则精气消亡。患痘疮的人，阴阳两脏都受病邪侵害，呼吸应当均匀，言语应当稀少，睡眠应当安稳，醒来应当宁静，饿了就索要食物，渴了就少量饮水，触碰疮口就会呻吟，违背其意愿就会啼哭，这是平和之人的征候，神气清朗安定，称为“静”，是吉兆。如果呻吟，说明身体有痛苦。自言自语，说明神志不清。喘促气粗，说明体内有热。肠鸣，说明腹泻。坐卧不安，说明心烦意乱。啼叫不止，说明疼痛。摇头，说明有风邪。手指想要抓挠，说明瘙痒。吞咽困难，说明咽喉疼痛。咬牙，说明心肝有热。如果出现烦闷混乱、躁动扰乱、胡言乱语、昏眩、好像看见鬼怪的样子，摇头扭颈，手舞足蹈，眼球上翻，寒战咬牙，发不出声音，这些都是死证。如果病情趋向安静，忽然出现扰动，这是异常现象，需要用方法去探究，比如疮色发生变化，没有其他征候的，这是被乖戾之气所触动。如果疮色没有变化，又没有其他症状，这一定有其缘由，只需等待其自行平定。如果有闭目、气息微弱、四肢僵硬挺直、牙关紧闭、疮疡溃坏、昏睡不醒的，这是真气即将脱失、魂魄将要离体的征兆，这也不能当作“静”来诊断了。
有人说，痘疮的征候，无法用脉诊来说明，可以通过观察形色来辨别。所说的“形”，是指痘疮的形状，所以尖圆坚实浓密，是初出时的形状；发荣滋长，是欲壮盛的形状；饱满充足，是成浆时的形状；收敛束固，是收靥时的形状。与大豆、豌豆、绿豆相似的，都是正常的形态。或者平坦或者凹陷，是形态的变化，如初出时空虚像蚕种蜕皮一样，隐约像蚊虫跳蚤的痕迹，薄如麸片，密如针头，像受热出的痱子，像受寒出的粟粒，这些都不能起发而死亡。粘连聚集、模糊不清，肌肉虚浮，松软嫩薄，皮肤溃烂的，不能收靥而死亡。所说的“色”，是指痘疮的颜色，喜欢鲜明而厌恶昏暗，喜欢润泽而厌恶干枯，喜欢苍蜡色而厌恶娇嫩，红色不希望像火焰一样红，红了就容易破溃，白色不希望像灰色一样白，灰了就很难结痂，由红变白，由白变黄，由黄变黑的，这是出形、起发、成浆、结痂的正常颜色。出形时带紫色，起发时呈灰白色，这是颜色的变异。能辨别痘疮的形色，就可以知道死生的期限。
先贤看痘疮有四个方面，叫做根、窠、脚、地，用这些来验证吉凶，判断死生，是不变的法则。什么是窠？中间通透而起顶的就是。什么是根？外圈发红的是。从外圈是否发红，就可以看出其中气血的虚实，以及痘毒的浅深。从窠是否起发，就可以确定根的浅深，以及气血的盈亏。所谓的脚和地，则取决于根和窠的圆润混杂程度，以及痘子的稀密。红晕的地方叫做脚，彼此颗粒界限分明，不散乱不混杂的，这叫痘脚明净。空隙的地方叫做地，彼此颗粒不相连缀的，这叫地面明净。根希望它活络，窠希望它起发，脚希望它坚固，地希望它宽阔，这四者都顺遂，痘疮虽然密集，也不必担忧。丸（圆润），是气的形态，气盛则痘窠必然圆满周正洁净。晕（红晕），是血的形态，血盛则痘窠必然光明红润活络。气虚则顶部凹陷，气散则塌陷阻碍，或者有气虚极而不塌陷的，那是火邪承载所致，虽然看起来圆满，实际上是空壳像水泡一样。血虚则红晕淡薄，血衰竭则红晕枯槁，根部必然散漫，或者有血虚极却仍然红色的，那是火邪上浮，虽然看到圈晕，实际上是枯槁而不润泽的。痘疮颜色的明暗，取决于气血的虚实，比如红色的，是痘疮初出。白色的，是毒邪未解。黄色的，是毒邪将解。干燥黄色的，是毒邪尽解。灰白色的，是气衰而血不依附。紫色的，是毒盛而血行滞涩。黑色的，是热极兼有水化。焦褐色的，是气血枯竭。红色变白色，白色变黄色，是顺证而生；红色变紫色，紫色变黑色，是逆证而死。
初诊时，用红纸蘸清油，点燃火照看，检验其生机有无，又用手摩擦面颊，如果红色随手转白，随即又转红，这叫血活，生机就在里面了。如果摩擦后不转白，举起后不转红，这叫血枯，即使稀疏也无法治疗。再看眼睛的神光清晰明亮，口唇尖端红润活络如常，没有燥白的颜色，这才是吉证，无需担忧。
For all things, when they attain equilibrium, they are still; when they lose equilibrium, they move. The Classics state: "When Yang Qi (vital energy) is still, it nourishes the Shen (spirit); when it is soft, it nourishes the Jin (tendons)." It also states: "When Yin Qi (nutritive energy) is still, the Shen is stored within; when it is restless, it dissipates and perishes." In patients suffering from smallpox (variola), both Yin and Yang are diseased. Respiration should be even, speech should be minimal, sleep should be stable, and waking should be peaceful. When hungry, they seek food; when thirsty, they drink sparingly. If touched at the sores, they groan; if their desires are thwarted, they cry out. These are signs of a balanced person, with clear Shen and stable spirit, termed "stillness," which indicates a favorable prognosis. Moaning indicates bodily pain. Mutters to oneself indicate unclear Shen. Rapid and coarse breathing indicates internal heat. Borborygmus (bowel sounds) indicates diarrhea. Restlessness in sitting or lying down indicates mental agitation. Unceasing crying indicates pain. Shaking the head indicates wind pathogen. Desire to scratch fingers indicates pruritus. Difficulty swallowing indicates sore throat. Grinding teeth indicates Heat in the Heart and Liver. However, if there is confusion, restlessness, delirium, dizziness, hallucinations (seeing ghosts), shaking head and twisting neck, flailing hands and kicking feet, upward deviation of the eyes, rigors with teeth grinding, and inability to speak, these are all signs of impending death. If the condition tends toward stillness but suddenly becomes agitated, this is abnormal; one must investigate using appropriate methods. For instance, if the color of the lesions changes without other symptoms, this is caused by contact with aberrant Qi (pathogenic factors). If the lesion color remains unchanged and there are no other signs, there must be a specific cause; one should simply wait for it to stabilize on its own. If there is closed eyes, faint respiration, stiff and straight limbs, trismus (lockjaw), necrotic sores, and deep sleep without awakening, these are signs that True Qi is about to collapse and Hun and Po (ethereal and corporeal souls) are about to depart. This cannot be diagnosed as "stillness."
Some say that the signs of smallpox cannot be determined by pulse diagnosis alone, but can be distinguished by observing Xing (form) and Se (color). By "Xing," we mean the shape of the pustules. Thus, pointed, round, firm, and dense shapes represent the initial eruption. Lush growth represents the stage of vigorous development. Full and plump shapes represent the stage of pus formation. Contracted and solid shapes represent the stage of scabbing. Shapes resembling soybeans, peas, or mung beans are all normal forms. Flat or depressed shapes are variations of form. For example, initially empty like shed silkworm skins, faint like mosquito or flea bites, thin like bran flakes, or dense like needle heads, resembling miliaria (heat rash) or hordeolum (cold grain), these will fail to erupt and result in death. Clumped, blurred, with vacuous and floating flesh, soft and tender skin, and ulcerated epidermis will fail to scab and result in death. By "Se," we mean the color of the pustules. Brightness is preferred over dullness; moisture is preferred over dryness; a waxy hue is preferred over delicate tenderness. Red should not be fiery red, as it breaks easily; white should not be grayish, as it fails to scab. The progression from red to white, white to yellow, and yellow to black represents the normal colors of eruption, development, suppuration, and crusting. Purple tint during eruption and grayish-white during development are color abnormalities. By distinguishing the Xing and Se of smallpox, one can predict the timing of life or death.
Ancient experts examined smallpox based on four aspects: Gen (root), Ke (nest), Jiao (foot), and Di (ground). These are unchanging methods to verify auspiciousness or inauspiciousness and determine life or death. What is Ke? It refers to the center being transparent and rising to a peak. What is Gen? It refers to the outer ring being red. From whether the ring is red, one can see the deficiency or excess within, and the depth of the toxin. From whether the Ke rises, one can determine the depth of the Gen and the fullness or emptiness of Qi and Blood. "Jiao" and "Di" depend on the roundness and mixing of the Gen and Ke, and the density of the pustules. The area with red halo is called Jiao; if particles are distinct, not scattered or mixed, this is "clear Jiao." The empty space is called Di; if particles do not connect, this is "clear Di." The Gen should be active, the Ke should rise, the Jiao should be solid, and the Di should be broad. If all four are harmonious, even dense smallpox need not be feared. "Wan" (roundness) is the form of Qi; abundant Qi ensures the Ke is complete, circular, and clean. "Yun" (halo) is the form of Blood; abundant Blood ensures the Ke is bright, red, and vital. Qi deficiency leads to sunken peaks; Qi dispersion leads to collapse. Even if Qi is extremely deficient without sinking, it may be carried by Fire; although appearing round, it is actually an empty shell like a blister. Blood deficiency leads to pale halos; Blood exhaustion leads to withered halos, causing the root to scatter. Even if Blood is extremely deficient yet appears red, it is due to Fire floating upward; although a halo is seen, it is actually withered and lacks moisture. The brightness or dimness of smallpox color depends on the deficiency or excess of Qi and Blood. Red indicates initial eruption. White indicates unresolved toxin. Yellow indicates resolving toxin. Dry yellow indicates resolved toxin. Grayish-white indicates Qi decline and Blood detachment. Purple indicates excessive toxin and Blood stasis. Black indicates extreme Heat combined with Water transformation. Scorched brown indicates exhaustion of Qi and Blood. Red turning to white, white turning to yellow, indicates a smooth course leading to survival. Red turning to purple, purple turning to black, indicates a reverse course leading to death.
During initial examination, dip red paper in clarified oil, ignite it, and use the flame to illuminate the lesions to check for vitality. Rub the cheeks with hand; if the redness turns white upon rubbing and returns to red immediately, this is "active Blood," indicating vitality exists. If rubbing does not turn it white, and lifting does not make it red, this is "exhausted Blood"; even if sparse, it is untreatable. Also observe that the eyes have clear and bright Shen (spirit), and the tips of the lips are red, vital, and normal, without dry whiteness. This constitutes a favorable sign, requiring no worry.