痘疮能根据期灌浆结痂如螺靥为吉。若脓未满足。忽然干靥。或脓成之后。不痂破烂。或收靥
之时。泄泻脓血。或空泡干枯。或发热昏愦。或切牙寒战。或手足并冷。饮沸汤而不知热。是名
倒。由中气不足。毒从内入之故。宜参 内托散、补中益气汤、保元汤选用。使破者重复灌浆。
无处更出赠痘。则正气得补。复祛出毒邪也。若服补药不出赠痘。破
处不复肿灌。更下脓血者不治。若将靥之时忽然黑 。或浆未充而忽然收靥。或浆虽充而一齐结
干紫。此气虚血热。因火迫而收之太速也。犀角地黄汤加紫草茸。或四圣散加人参、当归。然
其形证。又当推辨。如身痛四肢微厥。疮色青紫者。此则外感寒邪。腠理闭拒而倒 。人参败毒
散。并用胡荽酒喷之。忽然倒 而心神不宁者。猪尾膏。若心烦狂躁。谵语便秘。口渴饮水能食
者。此则外触秽气而倒 。内服夺命丹。外烧熏秽散辟之。尸气所触而 。辟秽香解之。有浆未
满足。忽然目眶深陷。乃气脱倒陷。若作昏沉痰喘者死。丹溪云。痘疮倒 。因真阳虚而毒瓦斯不
能出者。保元汤加紫草之类。若将成就之际。却淡色者属血虚。芎、归之类。或加红花、紫草。
属热。升麻、芩、连、桔梗之类。甚者用犀角。薛氏云。若热毒方出。忽被风寒闭塞肌窍。血脉
不行。身体作痛。或四肢微厥。斑点不长。或变青紫黑色者。此为倒 。若胃气虚弱。不能补接
营卫。出而复没者。谓之陷伏。误用解毒之药。必致陷塌。若喜热饮食。手足并冷者。乃脾胃虚
弱之证。宜用辛热之剂补之。喜冷冻饮料食。手足并热。乃阳气壮热之证。宜用苦寒之剂泻之。外感
风寒者温散之。毒瓦斯入腹者分利之。阳气虚者温补之。外寒触犯者熏解之陈文宿用异功散。以预
保脾胃于未败之先。实发前人之未发。开万世之蒙 也。
痘疮若能按照病程阶段正常灌浆、结痂，形态如螺靥（一种类似蜗牛壳的圆形隆起），属于吉兆。如果脓液尚未充盈，突然干燥结痂；或者脓液形成后，不结痂反而破烂；或者在收靥（结痂脱落）的时候，出现泄泻脓血的症状；或者痘疹变成空泡并干枯；或者出现发热、神志昏乱；或者咬牙寒战；或者手足同时冰冷，即使饮用滚烫的水也感觉不到热，这被称为“倒靥”。这是由于中气不足，毒邪从内部侵入的缘故。适宜选用参内托散、补中益气汤、保元汤进行治疗，使已经破损的痘疹重新灌浆，不再长出额外的赠痘（指在主痘之外额外长出的痘疹），这样正气得到补充，就能再次驱除毒邪。如果服用补药后仍然没有长出赠痘，破损处不再肿胀灌浆，反而继续下泄脓血的，属于不治之症。如果在即将结痂时突然变黑，或者浆液未充盈就突然收靥，或者浆液虽然充盈但一齐结成干紫的颜色，这是气虚血热，因为火邪逼迫导致收敛太快。可用犀角地黄汤加紫草茸，或者四圣散加人参、当归。然而其形证表现，又应当进一步推究辨析。例如身体疼痛、四肢轻微厥冷、疮色青紫的，这是外感寒邪，腠理闭塞拒邪而导致倒靥，用人参败毒散治疗，并用胡荽酒喷洒患处。如果突然倒靥且心神不宁的，用猪尾膏。如果心烦狂躁、说胡话、便秘、口渴能喝水且能进食的，这是外触秽浊之气而导致的倒靥，内服夺命丹，外用烧熏秽散以辟除秽气。如果是被尸气所触而倒靥的，用辟秽香解之。如果有浆液未充盈，突然眼眶深陷的，这是气脱导致的倒陷，如果出现昏沉痰喘症状的会死亡。朱丹溪说：痘疮倒靥，是因为真阳虚弱，毒瓦斯不能透发出来的原因，用保元汤加紫草之类。如果在即将成熟之际，颜色却淡白的，属于血虚，用川芎、当归之类。或者加红花、紫草。属于热证的，用升麻、黄芩、黄连、桔梗之类。严重的用犀角。薛己说：如果热毒刚刚发出，忽然被风寒闭塞肌窍，血脉运行不畅，身体疼痛，或者四肢轻微厥冷，斑点不长，或者变成青紫黑色的，这叫倒靥。如果胃气虚弱，不能补接营卫之气，痘疹发出后又隐没下去的，叫做陷伏。误用解毒的药物，必然导致塌陷。如果喜欢热饮食，手足冰冷的，是脾胃虚弱的证候，适宜用辛热的药剂来补益。喜欢冷冻饮料食物，手足发热的，是阳气壮热的证候，适宜用苦寒的药剂来泻热。外感风寒的用温散法治疗。毒瓦斯入腹的用分利法治疗。阳气虚的用温补法治疗。外寒触犯的用熏解法治疗。陈文宿使用异功散，以便在未败坏之前预先保护脾胃，这确实发挥了前人的未发之论，开启了万世的蒙昧啊。
If smallpox lesions can follow the disease stage to properly fill with pus and form scabs, appearing round and raised like a snail shell (luoye), it is an auspicious sign. If the pus has not yet fully accumulated but suddenly dries and forms scabs; or if after pus formation, no scabs form and the lesions instead become broken; or if during the scabbing-off stage, diarrhea with pus and blood occurs; or if the vesicles become empty and dry up; or if fever and delirium occur; or if teeth are chattered and shivering happens; or if both hands and feet become cold, such that even drinking boiling water feels no heat, this is called "reversed scabbing" (daoye). This is due to insufficient middle qi, causing the pathogenic toxin to enter from within. It is appropriate to select Shennei Tuosan (Ginseng Internal Support Powder), Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), or Baoyuan Tang (Preserve the Origin Decoction) for treatment, so that broken lesions may refill with pus again, and no additional accessory pustules (zengdou) will emerge. In this way, the healthy qi is replenished, enabling the expulsion of pathogenic toxins once more. If, after taking tonifying medicines, no accessory pustules appear, the broken areas do not swell and refill with pus, but instead continue to discharge pus and blood, the condition is incurable. If, just as scabbing is about to complete, the lesions suddenly turn black; or if the scabs form prematurely before the pus is full; or if although the pus is full, they all dry up and turn purple, this indicates qi deficiency and blood heat, caused by fire pathogen forcing premature contraction. Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) added with Zicao Rong (Saussurea Root) or Sisheng San (Four Holy Powders) added with Renshen (Ginseng) and Danggui (Angelica Sinensis) may be used. However, the specific manifestations must be further deduced and differentiated. For instance, if there is body pain, slight coldness in the four limbs, and green-purple lesion color, this is due to external cold pathogen invading, closing the interstices and rejecting the pathogen, leading to reversed scabbing. Ren Shen Bai Du San (Ginseng and Detoxification Powder) should be used, along with spraying Huixie Jiu (Coriander Wine) on the affected areas. If reversed scabbing occurs suddenly accompanied by mental restlessness, Zhuwei Gao (Pig Tail Ointment) is indicated. If there is mental agitation, mania, delirious speech, constipation, thirst with desire to drink, and ability to eat, this is due to external contact with foul turbid qi causing reversed scabbing. Neifu Deming Dan (Internal Administration of Life-Snatching Pill) should be taken, while Wai Shao Xunhui San (External Burning of Foul-Expelling Powder) should be burned externally to ward off the foul qi. If reversed scabbing is triggered by corpse qi, Bihui Xiangjie (Foul-Qi Warding Incantation/Powder) should be used. If the pus is not yet full but the eye sockets suddenly sink deeply, this is qi collapse causing involution; if accompanied by lethargy and phlegm-wheezing, death ensues. Zhu Danxi stated: Smallpox reversed scabbing occurs because true yang is deficient, preventing the toxic vapors from being expelled. Baoyuan Tang (Preserve the Origin Decoction) added with Zicao (Saussurea) and similar herbs is suitable. If at the stage of nearing maturity, the color remains pale, this belongs to blood deficiency, treated with Xiong (Ligusticum Chuanxiong) and Gui (Angelica Sinensis). Red Flower (Honghua) and Zicao (Saussurea) may be added. If it belongs to heat, Shengma (Cimicifuga), Qin (Scutellaria), Lian (Coptis), and Jiegeng (Platycodon) are used. Severe cases require Xijiao (Rhinoceros Horn). Xue Ji stated: If heat-toxin is just emerging but is suddenly blocked by wind-cold closing the muscle pores, causing blood vessels to stagnate, resulting in body pain, slight coldness in the four limbs, failure of spots to grow, or turning green-purple-black, this is called reversed scabbing. If stomach qi is weak and unable to nourish Ying and Wei, causing the rash to emerge and then vanish, it is called "sunken and hidden" (xianfu). Misusing detoxifying drugs will inevitably lead to collapse. If the patient prefers hot food and drinks and has cold hands and feet, this is a syndrome of spleen-stomach weakness, treated with acrid-hot agents to tonify. If the patient prefers cold food and drinks and has hot hands and feet, this is a syndrome of strong yang-heat, treated with bitter-cold agents to drain. External wind-cold is treated with warming and dispersing methods. Toxic vapors entering the abdomen are treated with draining and separating methods. Yang qi deficiency is treated with warming and tonifying methods. External cold invasion is treated with fumigation and resolving methods. Chen Wensu used Yigong San (Extraordinary Support Powder) to protect the spleen and stomach before they deteriorated, truly expounding upon what predecessors had not yet revealed, and enlightening generations to come.