痘疮收靥，圆净坚浓如螺靥者上也。头穿脓出，堆聚成痂如鸡矢者次也。皮破脓出，痂薄如纸者又其次也。
皮烂脓溃，不成痂皮，脓汁腥臭者斯为下矣。如已过期，譬如瓜果熟久则烂，此造化之常，还作顺看。若未及期，
则为 烂，乃逆候也，变倒靥而死。
结靥时色转苍蜡，一二日从口唇四边结靥，由胸腹收至两腿，然后脚背和额上一齐结靥，落而愈者吉。
结靥时遍身臭烂，如搭饼臭不可近，目中无神者死。
结靥时遍身发痒，抓破无脓，皮卷如豆壳干者死。
结靥时寒战手足颤掉，切牙噤口者死。
落痂后瘢痕雪白，全无血色者死，急宜补气血，养脾胃，庶几可活。
〔袁〕患痘八九日，充灌回谢，宜保全矣，然有回至项颈而死者，有回至胸前而死者，有回至脐上而死者，有回
至阳物而死者，其故何欤。曰消息盈虚，自有定数，若痘证仅取其浆灌则可也，倘元气所禀者本是薄劣，痘
兼多蔓，遂用毒物尽以发之，再投升劫之剂，尽把元气赶上，痘虽充灌，然外囊实而内体耗蠹矣，五经伤而不能
斡补矣。颈上喉突气窝，肺之关辖也，肺气先绝，回至此则蜮绊而死。胸阜，心之关辖也，心脉先绝，回至此则死。
脐乃脾之关辖也，脾脉先绝，回至此则死。眼眶乃肝之关辖也，肝脉先绝，回至此则死。阳物乃肾之关辖，肾脉
先绝，回至此则死。本拔则枝枯，源塞则流涸，自然之道也。若语其变，风寒不知慎护，而致枭邪逼于中，饮食不
知樽节，而致脾胃伤于内，肚腹肿胀，痰喘不息，于是回至各关辖而死者，亦有之也。又有一样嚣痘，视之若似黄
脓灌满，回至胸前则死，此真蜮痘也。
痘疮结痂脱落阶段，若痂皮圆润、洁净、坚实且厚实，如同田螺壳一般，这是上等的表现。若头部脓液穿出，堆积形成痂皮，形状像鸡粪一样，这是次一等的表现。若皮肤破损，脓液流出，形成的痂皮薄如纸张，这又更次一等。
若皮肤腐烂，脓液溃破，无法形成完整的痂皮，且脓汁带有腥臭味，这就是下等的表现。如果已经到了预期的结痂时间，就像瓜果成熟过久就会腐烂一样，这是自然规律，仍应视为顺证（正常病程）。如果未到预期时间就出现这种情况，则属于“烂”症，是逆证（凶险征兆），会导致痘疹倒陷而死亡。
在结痂过程中，如果全身颜色转为苍黄蜡色，从第一天起从口唇四周开始结痂，由胸腹部逐渐收敛至双腿，最后脚背和额头同时结痂，脱落后痊愈，这是吉兆。
在结痂过程中，如果全身散发恶臭腐烂气味，如同烧饼焦糊般令人难以靠近，且眼神无神，这是死证。
在结痂过程中，如果全身发痒，抓破后没有脓液，皮肤卷曲干燥如同豆壳，这是死证。
在结痂过程中，如果出现寒战、手足颤抖、咬牙紧闭口唇的症状，这是死证。
脱痂后留下的瘢痕若雪白一片，完全没有血色，这是死证；此时急需补益气血，调养脾胃，或许还有一线生机。
〔袁氏〕问：患痘疮八九日，痘疹已充盈灌浆并开始回缩谢顶，本应保全性命了，但有的人回缩到颈部就死了，有的人回缩到胸前就死了，有的人回缩到肚脐以上就死了，有的人回缩到生殖器部位就死了，这是什么原因呢？
答：事物的消长盈亏自有定数。如果看痘证，只要取其浆液充盈即可判断预后。但如果患者先天元气禀赋本就薄弱，痘疹又多蔓延，医生又误用毒性药物强行发散，再投用升提劫夺的药剂，强行把元气赶尽，虽然痘疹表面看起来充盈灌浆，但实际上外囊充实而内部精气已经耗损蛀空，五脏经脉受损而无法补救。
颈部上方的喉突气窝，是肺脏的关隘管辖之处，肺气先绝，痘疹回缩至此就会因阻滞而死。胸部隆起处，是心脏的关隘管辖之处，心脉先绝，痘疹回缩至此就会死。肚脐，是脾脏的关隘管辖之处，脾脉先绝，痘疹回缩至此就会死。眼眶，是肝脏的关隘管辖之处，肝脉先绝，痘疹回缩至此就会死。生殖器，是肾脏的关隘管辖之处，肾脉先绝，痘疹回缩至此就会死。树根拔除则枝叶枯死，水源堵塞则水流干涸，这是自然的道理。
如果说变证的情况，是因为风寒侵袭时不知谨慎防护，导致邪气逼迫于体内；饮食不知节制，导致脾胃内伤，出现肚腹肿胀、痰喘不止等症状，于是痘疹回缩至各脏腑关隘而死，这也是有的。还有一种叫“嚣痘”的病，看起来好像黄色脓液灌满，但回缩到胸前就死了，这才是真正的“蜮痘”（恶毒之痘）。
During the scabbing and falling-off stage of smallpox, if the scabs are round, clean, firm, and thick like a snail shell, this is the best outcome. If pus exudes from the head of the pustules and accumulates to form scabs resembling chicken droppings, this is of secondary quality. If the skin breaks, pus flows out, and the resulting scabs are thin as paper, this is even worse.
If the skin rots and pus ulcerates without forming complete scabs, accompanied by a fishy and foul odor in the pus, this is the worst outcome. If this occurs after the expected time for scabbing, it is akin to fruits rotting after being ripe for too long; this follows the natural order and should still be viewed as a favorable progression (Shun). However, if this occurs before the expected time, it constitutes "rotting" (Lan), which is an adverse prognosis (Ni) and leads to death due to inverted scabbing (Dao Ye).
During the scabbing process, if the body color turns pale yellow like wax, starting from the first day with scabs forming around the mouth and lips, then gradually receding from the chest and abdomen to the legs, and finally scabbing simultaneously on the dorsum of the feet and forehead, followed by healing after the scabs fall off, this is auspicious.
During the scabbing process, if the entire body emits a foul, rotting odor, unbearable like burnt flatbread, and the eyes lack spirit, this indicates death.
During the scabbing process, if the whole body itches intensely, scratching reveals no pus, and the skin curls and dries like bean shells, this indicates death.
During the scabbing process, if chills occur, hands and feet tremble, teeth are clenched, and the mouth is locked shut, this indicates death.
After the scabs fall off, if the resulting scars are snow-white with absolutely no blood color, this indicates death; urgent supplementation of Qi and Blood and nourishment of the Spleen and Stomach are required, upon which survival might be possible.
[Yuan] asked: On the eighth or ninth day of smallpox, the lesions have filled with pus and begun to recede, implying preservation of life. Yet some patients die when the recession reaches the neck, some at the chest, some above the navel, and some at the genitalia. What is the reason?
The answer is that growth and decline follow fixed laws. In assessing smallpox, one primarily looks at whether the pustules fill with pus. However, if the patient's congenital Yuan Qi (Original Vital Energy) was inherently weak, and the smallpox spread extensively, the physician mistakenly used toxic herbs to force dispersion, followed by ascending and purgative agents that exhausted the Yuan Qi. Although the pustules appear externally full, the internal essence is hollowed out and damaged, injuring the Five Meridians beyond repair.
The area above the neck near the laryngeal prominence is the gatekeeper of the Lung; if Lung Qi fails first, recession to this point causes death by obstruction. The chest mound is the gatekeeper of the Heart; if Heart vessels fail first, recession to this point causes death. The navel is the gatekeeper of the Spleen; if Spleen vessels fail first, recession to this point causes death. The eye sockets are the gatekeepers of the Liver; if Liver vessels fail first, recession to this point causes death. The genitalia are the gatekeepers of the Kidney; if Kidney vessels fail first, recession to this point causes death. When the root is pulled up, branches wither; when the source is blocked, the stream dries up—this is the natural way.
Regarding variable conditions: if wind-cold is not carefully guarded against, pathogenic factors may invade internally; if diet is not regulated, the Spleen and Stomach may be injured internally, leading to abdominal distension and incessant phlegm-wheezing. In such cases, death may occur as the lesions recede to these respective gatekeepers. There is also a type called "Xiao Dou" (Noisy Pustules), which appears to be filled with yellow pus but causes death upon recession to the chest; this is truly "Yu Dou" (Evil Pustules).