疮痘本因热而出，热势甚则其出愈难，故 点未见之时，惟当用平和药如升麻
葛根汤、参苏饮（俱初热）、东垣鼠粘子汤（出太密）、惺惺散（初热）等解利之。或有不问虚
实，便以辛热之剂大发之，施之虚者，犹庶几焉，若盛实之人，热毒弥漫，荣卫闭
塞。里毒甚者，大便不通，小便如血，是谓郁毒不散，毒瓦斯无所从出，反攻脏腑。表毒盛
者，疮凹而不起，遂成倒陷，或为溃烂，或为痈疮。当此之际，不能解利，至于毙
者多矣，是阳盛热炽，无阴气以感之也，用消毒饮（咽喉）、七物升麻丸（初热），得毒瓦斯解散，
荣卫流通，疮子将自起矣。
凡小儿发热三日之间，热退身凉，凉而复热，热而复凉，然后报痘，从口角颧
骨上两两三三，成对报点，至三四五日出齐者，顺之兆也。其或发热只一日或二日
即见红点，或吐泻腹痛，或战栗身温，不食昏卧，三四日痘不起发，不光泽，惨暗
不明，根窠色白，皆虚寒之候也，所谓险也，可治而愈。苟发热太甚，烦躁闷乱，
喘急不食，及热而复凉，连热一齐突出，红紫黑色不起涣，不光润，为表中实
热。或自太阳天庭方广出起，皆凶之兆，难治。
报痘时头面稀少，胸前背后皆无，根窠红润，顶尖碍手，如水珠光泽者，上吉
也，不必服药。
报痘时烦躁不宁，腰腹痛不止，口气大臭，出紫点者死。亦有出青 如蓝靛
色者，皆死证也。
报痘时色白皮薄而光，根窠全无红色，或根带一点红，三五日即长如绿豆大，
此痘决不能灌浆，久后成一包清水，擦破即死，不可因其好看，妄与下药。
报痘全不起顶，又顶如汤泡及灯草火烧之状，十日后痒塌而死。
报痘时起红 如锦纹者，六日死，遍身如蛇皮者死。
报痘时黑 如痣状，肌肉成块黑者，即日死。
痘身发热未透，而即报点现标，已而复没不见，又出又没者，谓之弄标痘。盖
痘疮全凭热透，则肌肤通畅，自然易出，今热不透，则地皮未熟，出而复没，隐而
又出，气血衰弱之甚，无力发泄故也，难治。
痘色红紫焦枯，贴肉不起，皮浓黑如铁，挑之不破，无浆血者，谓之铁甲痘。
乃气涩而不营，血枯而不润，磅因礴皮肉，八九日内死。
凡疮子已出，头面要稀疏磊落，颈项上宜少不宜多，胸前要少而疏，如此者其
毒则轻。如面上模糊一片，未发先肿，缠项稠蜜，胸前亦密，此毒甚也，勿治。
凡痘子出尽，正将起发，其中有发血 者，此毒伏于心，即死。有发水 者，
此毒伏于肝，旋见痒塌而死。
痘疮原本是因为热邪外发而出，热势越盛，痘点就越难透发。因此，在痘点尚未显现的时候，只应当使用平和的药物，如升麻葛根汤、参苏饮（均用于初起发热阶段）、东垣鼠粘子汤（用于出痘过密的情况）、惺惺散（用于初起发热）等来解表透毒。如果不论患者虚实，就使用辛热药物大发其汗，施用于虚证患者，或许还有一线生机；但若用于实证之人，会导致热毒弥漫，营卫之气闭塞。若体内毒邪严重，出现大便不通、小便带血，这叫做郁毒不能消散，毒气无处宣泄，反而攻冲脏腑。若体表毒邪炽盛，痘点凹陷而不能隆起，遂形成倒陷，或者溃烂，或者变成痈疮。到了这种地步，如果不能及时解表透毒，导致死亡的人很多，这是因为阳气亢盛、热势炽烈，缺乏阴气来感应调和所致。此时应使用消毒饮（用于咽喉肿痛）、七物升麻丸（用于初起发热），使毒气解散，营卫流通，痘点自然就会隆起。
凡是小儿发热三天之内，热度退去身体变凉，凉后又发热，热后又变凉，然后才发出痘点，从口角和颧骨上方两三个、两三个地成对出现，到第三、四、五天全部出齐的，是顺证的征兆。如果发热仅一天或两天就见到红点，或者伴有呕吐腹泻、腹痛，或者战栗但身体温暖，不进食且昏睡，到了第三四天痘点不起发、没有光泽、颜色惨暗不明、痘根周围色白，这些都是虚寒的表现，称为险证，虽然危险但可以治愈。假如发热过于剧烈，烦躁不安、胸闷混乱，气喘急促、无法进食，以及热退后又发热，痘点一齐突然发出，颜色红紫黑且不起发、不涣散、不光润，这是表里实热之证。或者痘点从太阳穴、天庭部位广泛地发出，都是凶险的征兆，难以治疗。
发出痘点时，头面部稀少，胸前背后都没有，痘根红润，痘尖顶手，像水珠一样有光泽的，是上吉之兆，不需要服药。
发出痘点时烦躁不安，腰腹部疼痛不止，口气恶臭，发出紫色痘点的，主死。也有发出青色如蓝靛色的，都属于死证。
发出痘点时颜色白、皮薄而有光泽，痘根完全没有红色，或者根部带一点红，三到五天后长到绿豆大小，这种痘决不能灌浆，时间久了变成一个充满清水的包，擦破即死，不要因为看起来好看就胡乱用药。
发出痘点时完全不起顶，或者痘顶像水泡及灯草火烧过的样子，十日后因瘙痒塌陷而死。
发出痘点时起红色斑纹如锦缎花纹的，六日死；全身像蛇皮一样的，死。
发出痘点时黑色如痣状，肌肉结成块状黑色的，当日死。
痘身发热未透，却立即报点现标，随后又消失不见，出了又没、没了又出的，叫做弄标痘。大概痘疮全凭热透，则肌肤通畅，自然容易发出，现在热不透，就像土地未熟，痘点出来又消失，隐没又出现，这是气血衰弱至极，无力发泄的缘故，难以治疗。
痘色红紫焦枯，紧贴皮肤不起，皮色浓黑如铁，挑不破，无浆无血的，叫做铁甲痘。这是气滞涩而不营养，血枯竭而不滋润，毒气迫注于皮肉之间，八九日内死亡。
凡是痘疮已经发出，头面部要稀疏磊落，颈项部宜少不宜多，胸部要少而疏，这样的毒邪较轻。如果脸上模糊一片，未发先肿，颈部缠绕稠密，胸部也密集，这是毒邪极盛，不可救治。
凡是痘点出尽，正要起发的时候，其中有发出血疱的，这是毒邪伏于心，即刻死亡。有发出水疱的，这是毒邪伏于肝，随即出现瘙痒塌陷而死。
The smallpox rash originally erupts due to heat pathogen. When the heat intensity is severe, eruption becomes more difficult. Therefore, before the spots appear, one should only use mild medications such as Shengma Gegen Tang (Cimicifugae Rhizoma and Puerariae Radix Decoction), Shen Su Yin (Ginseng and Perilla Leaf Drink) (both for initial fever stage), Dongyuan Niuzangzi Tang (Echinopsiae Fructus Decoction by Li Dongyuan) (for overly dense eruption), Xingxing San (Xingxing Powder) (for initial fever) to resolve the exterior and promote eruption. If one disregards deficiency or excess and uses pungent-warm agents to induce heavy sweating, applying this to deficient patients might still offer a slim chance; however, if applied to individuals with excess conditions, it leads to rampant heat-toxin and closure of Ying (Nutrient) and Wei (Defensive) Qi. If internal toxin is severe, presenting as constipation and hematuria, this is termed "stagnant toxin not dispersing," where toxic qi has no outlet and counter-attacks the Zang-Fu organs. If external toxin is excessive, causing lesions to be depressed and unable to rise, resulting in inversion collapse, ulceration, or carbuncles, death is common at this stage if exterior resolution fails. This occurs because Yang is hyperactive and heat is blazing, lacking Yin Qi to harmonize. At this juncture, use Xiaodu Yin (Detoxification Drink) (for throat issues) or Qiwu Shengma Wan (Seven-Ingredient Cimicifuga Pill) (for initial fever) to disperse toxin, circulate Ying and Wei Qi, allowing the lesions to naturally rise.
When a child has fever for three days, then fever subsides and body cools, cooling then heats up again, heating then cools down, before the rash appears, emerging two or three at a time from the corners of the mouth and cheekbones, forming pairs, and fully erupting by the third, fourth, or fifth day, this is an omen of favorable progression. If red spots appear after only one or two days of fever, accompanied by vomiting, diarrhea, abdominal pain, tremors with warm body, anorexia, and lethargy, and by the third or fourth day the lesions fail to rise, lack luster, appear dull and dark, with white areolas, these are signs of deficiency-cold, termed "dangerous" but treatable and curable. However, if fever is too intense, with restlessness, chest oppression, confusion, rapid breathing, anorexia, and alternating fever patterns where lesions suddenly erupt all at once in red-purple-black colors without rising or spreading smoothly, lacking luster, this indicates interior-exterior excess-heat. If lesions emerge extensively from the Taiyang region or Tianning area, it is an ominous sign, difficult to treat.
When lesions emerge sparsely on the head and face, absent on the chest and back, with reddish-pink areolas, pointed tops that feel rough to touch, and glistening like water droplets, this is the highest auspicious sign, requiring no medication.
If, upon emergence, there is restlessness, unceasing lower back and abdominal pain, foul breath, and purple spots, death ensues. Emergence of blue-green spots resembling indigo dye also indicates fatal prognosis.
If lesions are white, thin-skinned, and glossy, with areolas completely lacking redness or showing only a slight red tint, growing to mung bean size within three to five days, these lesions will definitely not fill with pus. Later, they become sacs filled with clear fluid; rupture leads to death. Do not administer drugs merely because they look aesthetically pleasing.
If lesions completely fail to form a peak, or if peaks resemble blisters or charred rush stems, death occurs ten days later due to itching and collapse.
Red streaks appearing like brocade patterns upon emergence indicate death within six days; skin resembling snake scales indicates death.
Black spots appearing like moles, with muscle tissue turning black in clumps, indicate death on the same day.
If the body fever does not penetrate thoroughly, yet spots appear and disappear repeatedly ("playing with the tip"), it is called "Nongbiao Rash." Smallpox relies on thorough heat penetration for smooth skin circulation and easy eruption. Lack of heat penetration means the "ground is unripe," causing lesions to emerge and vanish, hide and re-emerge. This signifies extreme deficiency of Qi and Blood, lacking strength to vent, making it difficult to treat.
Lesions that are red-purple, scorched, dry, adherent to the skin without rising, thick and black like iron, unbreakable upon pricking, and devoid of pus or blood, are called "Iron Armor Rash." This results from stagnant Qi failing to nourish and枯竭 Blood failing to moisten, with toxin pressing into skin and flesh, leading to death within eight to nine days.
Once lesions have erupted, those sparse and distinct on the head and face, few on the neck, and sparse on the chest indicate light toxicity. Conversely, if the face is blurred, swollen before eruption, neck densely covered, and chest crowded, toxicity is severe and untreatable.
When lesions have fully erupted and are about to rise, if blood blisters appear, toxin is hidden in the Heart, leading to immediate death. If water blisters appear, toxin is hidden in the Liver, leading to death shortly after itching and collapse.