〔万〕疮疹虽胎毒，必待时令不正之气相传染而发，盖春气温和，夏气暑热，秋气
清凉，冬气冷冽，此四时正气之序，若春应燠而反寒，夏应热而反清，秋应凉而反
热，冬应寒而反温，此非其时而有其气，乃不正之令也，夫人感之，或为寒热，或
为疟痢，或为喉痹，或为肿，或为 疹，谓之天行正病。又云∶疫疠是以一岁之中，
彼此传染，大小相似，又若冬温阳气暴泄，至于来岁必发疮疹，何也？盖小雪以后，
为终之气，太阳寒水主之，水德不彰，使厥阴、少阴木火之气，反来乘之，阳气
早发，奉生者少，故来春民多病也，况疮疹之毒，藏于至阴之下，发于太阳之经，
当其时而动其气，毒乃发矣，此冬温之后，必发疮疹也。凡此不正之气，发之、泄之、
解之、平之，勿犯岁气，是谓良工，故治疫疠者，以解毒为急。
〔钱〕伤寒，男，体重，面黄。女，面赤，喘息急。各憎寒，口中气热，呵欠顿
闷项急。疮疹则腮赤躁，多喷嚏，悸动昏倦，四肢冷。伤寒当发散之。疮疹当
温平之，有大热者宜解毒。昏睡、喜嚏、悸者将发疮疹。
〔垣〕辨 证∶呵欠，喷嚏，睡中急惊，耳尖冷，眼涩。辨伤寒∶口热，口中
醋气，奶瓣不消，腹中疼痛。〔蔡〕或传染，或伤风，或伤食，或痘疹，其证不一。
头与肢节疼痛无时者，为时疫传染热也。面赤汗出而鼻流清涕者，为伤风热也。午
后发热，头与肚热，上额有纹者，为伤食热也。乍寒乍热，呵欠顿闷，惊悸，咳嗽
嚏喷，两腮赤红， 凉耳凉者，为痘疹热也。浑身壮热，妄言鬼神，口鼻衄血，惊
搐不止，几死而复生，为痘疹实热在内也。
〔钱〕疮疹候，面燥腮赤，目胞亦赤，呵欠顿闷，乍凉乍热，咳嗽嚏喷，足稍冷，
夜卧惊悸、多睡，此疮疹症天行之病也。疮疹始出之时，五脏证见，惟肾无候，
但见平证尔，尻凉耳凉是也。尻耳俱属于肾，其居北方，主冷也。
〔张〕痘之始发，有因伤风伤寒而得者，有因时气传染而得者，有因伤食呕吐而
得者，有跌扑惊恐蓄血而得者，或为窜眼惊搐如风之证，或口舌咽喉腹肚疼痛，或
烦躁狂闷昏睡，或自汗，或下利，或发热，或不发热，证候多端，卒未易辨，须以耳
冷、尻冷、足冷、鼻尖冷验之，并视其耳后有红筋赤缕者为真。又，脉洪大而弦数，
诊脉之际，身略战动，是其证也。
歌曰∶五指稍头冷，惊痫不可安，若还中指热，必定是伤寒。中指独自冷，麻
痘正相干，男左女右别，分明仔细看。
秘法，凡入门看痘，未知是否，但见心窝皮肤内有红色，两耳尖冷，耳筋红。
见此，痘征也。看耳筋法，未出之先紫筋者不治，预以凉血解毒之剂治之，亦有
愈者。若二便秘结，宜先通利。大红者可治而愈，水红者不药而愈，桃红者分轻重
治之。分男左女右看。
〔验热时候〕〔钱〕始发潮热三日以上，热晕入皮肤，即发疮疹而不甚多者，热
留皮腠之间，潮热随脏出，如早食潮热不已，为水泡之类也。〔张〕痘疮皆因发热
而出，即其热之有时，可知其自何脏发出，寅卯辰时潮热者属肝，当出水泡。巳午
未时潮热者属心，当出 疮。申酉戌时潮热者属肺，当为脓泡。亥子丑时潮热者属
脾，当出疹子。
〔用药验是否〕〔王〕验 （此所谓 ，即痘也）法，若三日未觉形迹，当以生酒涂身上，
时时看之，状如蚤痕者是也。或曰伤寒、伤食、潮热，与 疹不能辨者，宜以辛凉
之剂调之，五日以里发出即汗，五日以外无者非 也，各随应见而治之。
〔验证施治〕〔阎〕治小儿壮热昏睡，伤风、风热、疮疹、伤食皆相似，未能
辨认间，服升麻葛根汤、惺惺散、小柴胡汤甚验，盖此数药通治之，不致误也。
惟伤食则大便酸臭，不消化，畏食或吐，宜以药下之。海藏云∶宜以药下之者，
当察其所伤何物，生硬寒热不等，不可遽以巴豆之类大毒之药下之。升麻葛根汤太
阴阳明也。惺惺散治风热咽不利，脾不和，少阳渴，小便不利也。小柴胡汤治往来
寒热，胸胁微痛，少阳也。然欲知其经，当以脉别之。小儿耳冷尻冷，手足乍暖
乍凉，面赤，时嗽时嚏，惊悸，此疮疹欲发候也，未能辨认间，服升麻汤、消毒散，
已发未发皆宜服，仍用胡荽酒、黄柏膏。暑月烦躁，食后与白虎汤、玉露散。热盛，
与紫雪。咽喉或生疮，与甘桔汤、甘露散。余根据前说，大人小儿同治法，惟大小不
同耳。海藏云∶消毒散，太阳药也。白虎汤，治身热目疼鼻干不得卧，阳明药也。
甘露散，肺肾药也。甘桔汤，少阳药也，紫雪、天冬、麦冬、黄芩、生地，为血剂。
玉露散，肺肾药也，石膏、寒水石，为气剂。以上五方，皆泻时暑之药。
【万全】疮疹虽然源于胎毒，但必须等待时令不正之气相互传染才会发作。大概春季气候温和，夏季气候暑热，秋季气候清凉，冬季气候冷冽，这是四时正气的正常顺序。如果春天本该温暖却反而寒冷，夏天本该炎热却反而清冷，秋天本该凉爽却反而炎热，冬天本该寒冷却反而温暖，这种非其时而有其气，就是不正的令气。人感受了它，有的表现为寒热往来，有的表现为疟疾痢疾，有的表现为喉痹，有的表现为肿胀，有的表现为疹子，这叫做“天行正病”。又说：疫疠是在一年之中，彼此互相传染，大人小孩症状相似。又比如冬季温热导致阳气暴泄，以至于来年必然发生疮疹，为什么呢？因为小雪以后，是终之气，由太阳寒水主事，若水的德性不彰显，使得厥阴、少阴的木火之气反过来乘袭它，阳气过早发动，奉养生长的力量就少，所以来春百姓多生病。况且疮疹的毒邪，藏于至阴之下，发于太阳之经，当此时节触动其气，毒邪就会发作，这就是冬温之后必然发疮疹的原因。凡是这些不正之气引发的疾病，用发汗、泄下、解表、平调的方法治疗，不要触犯当年的岁气，这就叫良医。所以治疗疫疠，以解毒为急务。
【钱乙】伤寒症，男孩表现为身体沉重，面色黄；女孩表现为面色红，呼吸急促。两者都憎恶寒冷，口中气息热，打哈欠且突然感到胸闷项强。疮疹则表现为腮部红赤躁动，多打喷嚏，心悸昏倦，四肢冰冷。伤寒应当用发散法治疗。疮疹应当用温平法治疗，若有大热的情况适宜解毒。出现昏睡、喜欢打喷嚏、心悸的症状，是即将发出疮疹的征兆。
【李杲】辨证：打哈欠、打喷嚏、睡眠中急惊、耳尖冷、眼睛干涩。辨别伤寒：口热，口中有一股醋味，奶瓣不消化，腹中疼痛。
【蔡氏】或者是传染，或者是伤风，或者是伤食，或者是痘疹，症状各不相同。头和肢体关节无定时疼痛的，是时疫传染热。面红出汗且流清鼻涕的，是伤风热。午后发热，头和肚子热，上额有纹路的，是伤食热。忽冷忽热，打哈欠胸闷，惊悸，咳嗽喷嚏，两腮红赤，耳朵凉的，是痘疹热。浑身高热，胡言乱语见鬼神，口鼻出血，惊厥抽搐不止，几乎死亡又复活，是痘疹实热在内。
【钱乙】疮疹的候象，面部干燥腮红，眼睑也红，打哈欠胸闷，忽冷忽热，咳嗽喷嚏，脚稍冷，夜间卧睡惊悸、多睡，这是疮疹作为天行病的症状。疮疹刚开始发出的时候，五脏的症状都会显现，只有肾脏没有特定的候象，只见到平证而已，即尻骨凉、耳朵凉。尻和耳都属于肾，位居北方，主冷。
【张琰】痘疮刚开始发作，有因伤风伤寒而得的，有因时气传染而得的，有因伤食呕吐而得的，有因跌扑惊恐蓄血而得的。或者出现窜眼惊搐像风一样的证候，或者口舌咽喉腹肚疼痛，或者烦躁狂闷昏睡，或者自汗，或者下利，或者发热，或者不发热，证候多种多样，仓促之间难以辨别，必须以耳冷、尻冷、足冷、鼻尖冷来验证，并观察其耳后有红筋赤缕的是真痘。另外，脉象洪大而弦数，诊脉时身体略微颤抖，就是这种证候。
歌诀说：五指梢头冷，惊痫不安宁；若是中指热，必定是伤寒。中指独自冷，麻痘正相关，男女分左右，分明仔细看。
秘法：凡入门看痘，不知道是不是痘，只要看见心窝皮肤内有红色，两耳尖冷，耳筋红。见此征象，就是痘征。看耳筋的方法，未出之前紫筋的不治，预先用凉血解毒的药剂治疗，也有痊愈的。如果大小便秘结，宜先通利。大红色的可以治愈，水红色的不吃药也能愈，桃红色的分轻重治疗。分男左女右来看。
【验热的时候】
【钱乙】开始发作潮热三日以上，热晕进入皮肤，随即发出疮疹而不多的，是热留在皮腠之间，潮热随着脏气而出。如果早饭后潮热不停止，是水泡之类的。
【张琰】痘疮都是因为发热而出，根据其发热的时辰，就可以知道是从哪一脏发出的。寅卯辰时潮热的属肝，应当出水泡。巳午未时潮热的属心，应当出疮。申酉戌时潮热的属肺，应当为脓泡。亥子丑时潮热的属脾，应当出疹子。
【用药验是否】
【王肯堂】验证痘（此所谓痘，即痘也）的方法，如果三天还没感觉到形迹，应当用生酒涂在身上，时时观察，状如蚤痕的就是。有人说伤寒、伤食、潮热，与痘疹不能辨别的，宜用辛凉的药剂调理，五日内发出就有汗，五日以外没有的不是痘，各自根据应该见到的症状治疗。
【验证施治】
【阎孝忠】治疗小儿壮热昏睡，伤风、风热、疮疹、伤食都很相似，在未能辨认期间，服用升麻葛根汤、惺惺散、小柴胡汤很有效，因为这些药能通治，不会误治。只有伤食则大便酸臭，不消化，畏食或吐，宜用药物攻下。海藏说：宜用药物攻下的，应当考察所伤的是什么东西，生硬寒热不等，不可立刻用巴豆之类大毒的药物攻下。升麻葛根汤治太阴阳明病。惺惺散治风热咽不利，脾不和，少阳渴，小便不利。小柴胡汤治往来寒热，胸胁微痛，属少阳。然而要知其经络，应当用脉象来辨别。小儿耳冷尻冷，手足乍暖乍凉，面红，时咳时嚏，惊悸，这是疮疹欲发的候象，在未能辨认期间，服用升麻汤、消毒散，已发未发皆适宜服用，仍用胡荽酒、黄柏膏。暑月烦躁，食后给予白虎汤、玉露散。热盛，给予紫雪。咽喉或生疮，给予甘桔汤、甘露散。其余根据前面的说法，大人小孩同治法，只是剂量不同罢了。海藏说：消毒散，是太阳经的药。白虎汤，治身热目疼鼻干不得卧，是阳明经的药。甘露散，是肺肾经的药。甘桔汤，是少阳经的药，紫雪、天冬、麦冬、黄芩、生地，属于血剂。玉露散，是肺肾经的药，石膏、寒水石，属于气剂。以上五方，都是泻时暑的药。
[Wan] Although chancres and rashes (Chuangzhen) originate from fetal toxins, they must wait for the abnormal qi of the seasons to transmit among people before manifesting. Generally, spring climate is mild, summer climate is hot and humid, autumn climate is cool, and winter climate is cold and biting; this is the normal sequence of the four seasons' righteous qi. If spring should be warm but turns cold, summer should be hot but turns clear/cool, autumn should be cool but turns hot, and winter should be cold but turns warm, having such qi out of season constitutes an abnormal command. When humans contract it, some present with alternating chills and fever, some with malaria and dysentery, some with throat obstruction (Houbi), some with swelling, and some with rashes; this is called "Heavenly Epidemic Righteous Disease" (Tianxing Zhengbing). It is also said: Epidemics (Yili) are those that spread between people within a year, where adults and children show similar symptoms. Furthermore, if winter warmth causes a sudden leakage of yang qi, leading to chancres and rashes erupting in the following year, why is this? Because after Minor Snow, it is the final phase of qi, governed by Taiyang Cold Water. If the virtue of water does not manifest, causing Jueyin and Shaoyin Wood-Fire qi to counter-attack, yang qi emerges prematurely, and the force supporting growth is diminished; thus, people fall ill frequently in the coming spring. Moreover, the toxin of chancres and rashes hides beneath the extreme yin and manifests on the Taiyang meridian. When the time comes and its qi is stirred, the toxin erupts; this is why chancres and rashes inevitably follow winter warmth. For diseases caused by such abnormal qi, treatment involves diaphoresis (Fazhi), purgation (Xiezi), resolution (Jiezi), and pacification (Pingzi), without violating the annual qi; this is called a skilled physician. Therefore, in treating epidemics, detoxification is urgent.
[Qian] In Shanghan (Cold Damage), boys present with heavy body weight and yellow complexion; girls present with red face and rapid breathing. Both groups hate chills, have hot breath, yawning, sudden chest oppression, and neck stiffness. Chancres and rashes present with red and restless cheeks, frequent sneezing, palpitations, drowsiness, and cold limbs. Shanghan should be treated with dispersing methods. Chancres and rashes should be treated with warming and pacifying methods; if there is severe heat, detoxification is appropriate. Drowsiness, preference for sneezing, and palpitations indicate impending eruption of chancres and rashes.
[Yuan] Differentiation: Yawning, sneezing, acute convulsions during sleep, cold ear tips, dry eyes. Differentiating Shanghan: Hot mouth, sour odor in the mouth, undigested milk curds, abdominal pain.
[Cai] It may be due to infection, wind-cold injury, food stagnation, or smallpox/rashes, with varying symptoms. Pain in the head and joints occurring at irregular times indicates epidemic infectious heat. Red face, sweating, and runny nose indicate wind-heat injury. Fever in the afternoon, heat in the head and abdomen, and lines on the upper forehead indicate food-stagnation heat. Alternating chills and fever, yawning, chest oppression, palpitations, coughing, sneezing, red cheeks, and cold ears indicate smallpox/rash heat. High fever all over the body, delirium seeing ghosts, epistaxis, continuous convulsions, near-death experience followed by revival, indicate excess heat of smallpox/rash internal.
[Qian] Signs of chancres and rashes: Dry face, red cheeks, red eyelids, yawning, chest oppression, alternating chills and fever, coughing, sneezing, slightly cold feet, night-time restlessness/palpitations, and excessive sleep; these are signs of chancres and rashes as heavenly epidemic diseases. At the initial eruption of chancres and rashes, signs of the five zang organs appear, except for the Kidney which shows no specific sign, only flat signs, namely cool sacrum and cool ears. The sacrum and ears belong to the Kidney, located in the North, governing cold.
[Zhang] The initial eruption of smallpox may result from wind-cold/cold damage, seasonal qi infection, food stagnation/vomiting, or falls/fright/blood stasis. Symptoms may include eyes darting and convulsions resembling wind, pain in mouth/tongue/throat/abdomen, irritability, mania, oppression, drowsiness, spontaneous sweating, diarrhea, fever, or absence of fever. The manifestations are manifold and difficult to distinguish hastily. Verification must rely on cool ears, cool sacrum, cool feet, and cool nasal tip, along with observing red veins and threads behind the ears for true diagnosis. Additionally, a pulse that is surging, large, wiry, and rapid, accompanied by slight trembling of the body during pulse taking, confirms the condition.
Song says: Cold finger and toe tips indicate unsettled fright and epilepsy; if the middle finger is hot, it is surely Shanghan. If only the middle finger is cold, it relates directly to measles or smallpox; distinguish by male left and female right, look carefully.
Secret method: When initially examining for smallpox, if unsure, check for redness under the skin at the heart pit, cool ear tips, and red ear veins. These indicate smallpox signs. Regarding ear veins: purple veins before eruption indicate untreatable cases; treat preemptively with blood-cooling and detoxifying agents, which may lead to recovery. If both bowels are constipated, first promote unblocking. Bright red cases are treatable and curable; water-red cases heal without medicine; peach-red cases require treatment based on severity. Examine male left and female right.
[Verifying Heat Timing]
[Qian] Initial tidal fever lasting more than three days, with heat mist entering the skin, leads to eruption of few chancres and rashes; this is heat remaining in the skin and interstices, with tidal fever emerging with the zang qi. If tidal fever persists after early meals, it indicates vesicles.
[Zhang] Smallpox eruptions occur due to fever; by observing the timing of the fever, one can determine which zang organ it originates from. Tidal fever during Yin-Mao-Chen hours belongs to Liver, indicating vesicle eruption. Tidal fever during Si-Wu-Wei hours belongs to Heart, indicating ulcer eruption. Tidal fever during Shen-You-Xu hours belongs to Lung, indicating pustule formation. Tidal fever during Hai-Zi-Chou hours belongs to Spleen, indicating rash eruption.
[Verifying with Medication]
[Wang] To verify smallpox (referred to here as Dou), if no traces are felt after three days, apply raw wine to the body and observe frequently; marks resembling flea bites confirm the diagnosis. Some say that Shanghan, food stagnation, and tidal fever cannot be distinguished from smallpox/rashes; in such cases, use acrid-cool agents to regulate. If eruption occurs within five days with sweating, it is confirmed; if not after five days, it is not smallpox. Treat according to corresponding signs.
[Verification and Treatment]
[Yan] Treating pediatric high fever and drowsiness: Wind-cold, wind-heat, chancres/rashes, and food stagnation present similarly. During periods of uncertainty, Shengma Gegen Tang, Xingxing San, and Xiao Chaihu Tang are effective because these formulas provide general treatment without error. Only in cases of food stagnation, characterized by sour-smelling stool, indigestion, aversion to eating, or vomiting, should purgative drugs be used. Haizang states: When using purgatives, one must investigate what was ingested, as raw, hard, cold, or hot foods vary; do not hastily use highly toxic purgatives like Radix Crotonis (Badou). Shengma Gegen Tang treats Taiyang and Yangming conditions. Xingxing San treats wind-heat with sore throat, spleen disharmony, Shaoyang thirst, and difficult urination. Xiao Chaihu Tang treats alternating chills and fever, slight chest/hypochondriac pain, belonging to Shaoyang. To know the meridian, differentiate by pulse. Cool ears and sacrum, alternating warm/cool hands and feet, red face, intermittent cough/sneezing, and palpitations in children indicate impending chancres/rashes. Before differentiation, Shengma Tang and Xiaodu San are suitable regardless of eruption status; additionally use Huqi Wine and Huangbai Ointment. In summer months with irritability, give Baihu Tang or Yulu San after meals. With intense heat, give Zixue. If sores form in the throat, give Ganjie Tang or Ganlu San. Rest follows previous explanations; adult and pediatric treatments are the same, differing only in dosage. Haizang states: Xiaodu San is a Taiyang formula. Baihu Tang treats body heat, eye pain, nasal dryness, and insomnia, and is a Yangming formula. Ganlu San is a Lung-Kidney formula. Ganjie Tang is a Shaoyang formula; Zixue, Tian Dong, Mai Dong, Huang Qin, and Sheng Di constitute blood agents. Yulu San is a Lung-Kidney formula; Shi Gao and Hanshui Shi constitute qi agents. The above five formulas are all herbs for draining seasonal summer heat.