夫痘由中以达外。用药因期而变通。以常言之。发热三日而后见标。出齐三日而后起胀。蒸
长三日而后灌脓。浆满三日而后收靥。故发热三日。当托里解毒。使其易出。亦有气弱而不能出
者。当微补其气。气和则出快。切不可轻用黄 。恐腠理一密。则痘难出也。四五六日起发之时。
宜清热解毒。清热则无血热枯燥之患。解毒则无壅滞黑陷之虞。七八九日灌脓之时。宜温补气血。
气血流行。而成浆自易也。十日至十一二日收靥之时。宜调和气血。补脾利水。自然结靥矣。此
特语其常也。盖常者可必。而变幻无期。当随候参详。见红点之时。如痘轻少。不可过表。在后
恐成斑烂。如干红紫色。急宜疏利。不然。在后必成黑陷。四五日之内。痘出足下为齐。苟未尽
出。于解毒中宜兼发散。若专于清凉。则痘反凝滞。不能起发也。七八日之间。毒未尽解。于温
补之中。宜兼解毒。若偏于温燥。则毒反蕴蓄。不能化浆也。十一二日之间。浆未满足。虽当大
补气血。然须兼解余毒。不然。恐有痈毒 疤之患也。夫痘疮之发也。身热和缓。达于外者必轻。
闷乱烦躁。彰于外者必重。其颜色贵润泽而嫌昏暗。贵光彩而嫌枯涩。贵淡红而嫌黑滞。贵鲜洁
而嫌娇嫩。贵圆净而嫌琐碎。贵高耸而嫌平塌。其皮肤贵坚实而嫌虚薄。贵匀净而嫌冗杂。其根
窠贵收紧而嫌散润。痘根阴阳见点。最忌浮肿。出要参差。血宜归附。耳后头项心胸。少于他处
为吉。眉棱两颧额前先后润而不滞为
佳。夫色之红者。毒始出也。白者。毒未解也。黄者。毒将解也。干黄者。毒尽解也。灰白者。
血衰而气滞也。焦褐者。气滞而血枯也。黑者。毒滞而血干也。如红变白。白变黄者吉。红变紫。
紫变黑者。死之兆也。
痘疮的病邪由体内向体表透发。用药需根据病程阶段灵活变通。按常规情况而言，发热三天后痘疹开始显现（见标），出齐三天后开始隆起（起胀），蒸长三天后开始化脓（灌脓），浆液充满三天后开始结痂（收靥）。因此，在发热三天阶段，应当采用托里解毒法，促使痘疹容易透出。也有因正气虚弱而不能透发的，应当轻微补益其气，气机调和则透发迅速。切不可轻易使用黄芩等苦寒药物，恐怕导致腠理闭塞，反而使痘疹难以透出。第四、五、六天是痘疹起发之时，宜用清热解毒之法。清热则可避免血热枯燥的祸患，解毒则可避免毒邪壅滞、黑陷的危险。第七、八、九天是化脓之时，宜温补气血，气血运行通畅，则成浆自然容易。第十天至十一二天是收靥之时，宜调和气血，补脾利水，自然就能结痂了。这仅仅是讲述常规情况。常规是可以预料的，但病情变幻无常，应当随证候详细参详。见到红点时，如果痘疹轻少，不可过度发散解表，否则后期恐形成斑烂。如果是干枯的红紫色，急宜疏泄通利，不然，后期必成黑陷。在四五日之内，痘疹发出遍及全身为齐，如果未尽发出，在解毒中宜兼用发散之法。若专于清凉，则痘疹反而凝滞，不能起发。在七八日之间，毒邪未尽解除，在温补之中，宜兼用解毒之法。若偏于温燥，则毒邪反而蕴蓄，不能化浆。在十一二日之间，浆液未满足，虽然应当大补气血，然而须兼解余毒，不然，恐怕有痈毒留疤的祸患。痘疮发作时，身体热度温和缓和，透达于体表的必然病轻；闷乱烦躁，表现于体外的必然病重。痘疹的颜色以润泽为贵，以昏暗为忌；以光彩为贵，以枯涩为忌；以淡红为贵，以黑滞为忌；以鲜洁为贵，以娇嫩为忌；以圆净为贵，以琐碎为忌；以高耸为贵，以平塌为忌。皮肤以坚实为贵，以虚薄为忌；以匀净为贵，以冗杂为忌。痘根（根窠）以收紧为贵，以散润为忌。痘疹初现阴阳之点，最忌讳浮肿。出痘要参差不齐，血液宜归附于痘形。耳后、头项、心胸部位，比别处稀少为吉。眉棱、两颧、额前，先后润泽而不滞涩为佳。红色的痘疹，表示毒邪刚开始透出；白色的，表示毒邪未解；黄色的，表示毒邪即将解除；干燥黄色的，表示毒邪完全解除；灰白色的，表示血衰而气滞；焦褐色的，表示气滞而血枯；黑色的，表示毒邪停滞而血液干涸。如红色变为白色，白色变为黄色的为吉兆；红色变为紫色，紫色变为黑色的，是死亡的征兆。
Smallpox pathogens emerge from the interior to the exterior. Medication must be adjusted flexibly according to the stages of the disease course. Generally speaking, after three days of fever, the rash begins to appear (Jianbiao); three days after full eruption, it begins to swell and rise (Qizhang); three days of steaming and growth lead to suppuration (Guannong); and three days after the pustules are full, scabbing occurs (Shouye). Therefore, during the three-day fever stage, one should employ methods to support the interior and resolve toxicity (Tuoli Jiedu) to facilitate easy eruption. In cases where Qi deficiency prevents eruption, slight tonification of Qi is necessary; when Qi harmonizes, eruption proceeds rapidly. One must not lightly use bitter-cold herbs like Huangqin (Scutellariae Radix), lest they cause the pores (Couli) to close tightly, thereby hindering eruption. During the fourth to sixth days, when the rash is rising, clearing heat and resolving toxicity (Qingre Jiedu) is appropriate. Clearing heat avoids the hazard of blood-heat dryness, while resolving toxicity prevents the risk of stagnation and black depression (Heixian). During the seventh to ninth days, when suppuration occurs, warming and tonifying Qi and Blood (Wenbu Qixue) is indicated; with smooth circulation of Qi and Blood, pus formation becomes easier. From the tenth to eleventh-twelfth days, during the scabbing phase, harmonizing Qi and Blood, tonifying the Spleen, and promoting water metabolism (Bupi Lishui) naturally leads to scabbing. This describes only the regular pattern. Regular patterns are predictable, but changes are unpredictable; thus, one must analyze based on specific manifestations. When red spots appear, if the rash is mild and sparse, excessive dispersing and releasing the exterior (Guobiao) should be avoided, as it may lead to ulceration later. If the color is dry red or purple, urgent疏导 and purgation (Shuli) is required; otherwise, black depression will inevitably occur. Within four to five days, if the rash has not fully covered the body, dispersing methods should be combined with toxicity resolution. If purely cooling agents are used, the rash may become stagnant and fail to rise. Between seven and eight days, if toxins are not fully resolved, detoxification should be combined with warming and tonification. If overly warm and drying agents are used, toxins may accumulate and fail to transform into pus. Between eleven and twelve days, if the pustules are not full, although substantial tonification of Qi and Blood is needed, residual toxins must also be cleared; otherwise, there is a risk of abscesses and scarring. Regarding the eruption of smallpox: mild fever that manifests externally indicates a light condition; mental restlessness and irritability manifesting externally indicate a severe condition. The color should be moist and lustrous, avoiding dullness; bright and radiant, avoiding withered and rough textures; pale red, avoiding black stagnation; fresh and clean, avoiding delicate and tender appearances; round and pure, avoiding fragmented and messy shapes; high and protruding, avoiding flat and collapsed forms. The skin should be firm and solid, avoiding thin and weak qualities; even and clean, avoiding mixed and chaotic patterns. The base of the lesion (Genke) should be tight and contracted, avoiding loose and moist characteristics. Initial appearance of Yin-Yang points in the rash most strongly contraindicates edema. Eruption should be uneven, and blood should adhere properly. Scarcity of lesions behind the ears, on the head/neck, chest, and heart is auspicious. Moisture without stagnation in the brow ridge, cheeks, and forehead, appearing sequentially, is ideal. Red color indicates initial toxin emergence; white indicates unresolved toxins; yellow indicates impending toxin resolution; dry yellow indicates complete toxin resolution; gray-white indicates blood deficiency and Qi stagnation; scorched brown indicates Qi stagnation and blood exhaustion; black indicates toxin stagnation and blood dryness. Transformation from red to white, or white to yellow, is auspicious. Transformation from red to purple, or purple to black, is an omen of death.