痘家以看法为要。初见点时。用纸捻蘸清油点照。遍观其色。熟视其形。须以火在内。向外
平照。则隐于肌肉间者。悉皆显现。以手揩摩面颊。如红色随手转白。白随转红。谓之血活。生
意在矣。如揩之不白。举之不红。是为血枯。纵疏难治。又看目睛光彩了然。口唇尖上红活如常。
无燥白紫滞之色。乃为吉兆。又须知灯火之下红。纸窗之下白。不可不审。先哲看痘有四。曰根。
曰窠。曰脚。曰地。根欲其活。窠欲其起。脚欲其固。地欲其宽。四者俱顺。虽密无虑。近世看法。
但言盘顶。盖盘即根也。顶即窠也。所谓脚地。则本乎根窠之圆混。痘点之稀密也。凡见顶起盘
深。红晕透在肉里。方是正痘。若无盘顶。红色浮在皮肤。即是水痘。非正痘也。否则必是气虚
毒盛之故。始虽长发。后必浆清脚阔。十朝十一朝。必变痒塌而死。若根脚阔散。不成红晕。
后必难于收敛。十二三朝必有变也。盖痘疹须辨血气之盛衰。形色之轻重。大抵形属气。色属血。
故形色为气血之根本。最为切要。其起先专看根脚紧束。紧束则热聚。易长易灌。若灌浆
后。专要根脚溶化。溶化则毒解。易收易脱。若发热三四日。身凉而出。初见淡红。
三四日方齐。微觉明亮。磊落如珠。大小不等。颗颗如黍米。摸之碍手。四五日间。明亮光泽。
根窠红活。二三次出。头面胸腹腰背项下稀少。大小便如常者为吉。若一热便出。疮多稠密者。
当详视其根窠分与不分。颜色红润不红润。若其中有先起虚大色黄如金者。名贼痘。大而黑者为
痘疔。若报点青色。箸头大一块不起凸者。此冷疔也。若根窠分。色红润。或一盘三四顶中有黑
疔者。当以银针挑破。口含清水。吸去秽血。用紫草膏、油胭脂。加血余灰。真珠末填入疮内。
或珍珠散并与三仙散。或犀角消毒饮加紫花地丁。以解其毒。挑后痛不止者。隔蒜灸之。若无
根窠。色紫黑疔多。小弱者不治。若头面一片光润。如胭脂涂抹。隐隐于皮肤中者。是血涩不流。
气凝不运。为痰阻滞。不得通贯也。先以升均汤大吐其痰。次以犀角地黄汤去丹皮加木通、紫草、
蝉蜕、连翘。但两颧琐碎成攒。红晕不分颗粒者。急投羚羊解毒汤以分之。若虽分根窠。身热枯
紫者。后必发躁。导赤散以利小便。更用凉血解毒药。入烧人矢一钱。迟则变黑而危矣。若身不
热。只干焦者热也。导赤散。若虽红活。太觉娇嫩。此元气不实。毒入气分。保元汤加连翘、忍
冬。若色淡皮宽者。此元气至虚。参 内托散。若虽高起色红。但干燥口渴。此火盛血少。四物
汤换生地加荆芥、紫草、连翘、木通。最忌参、术。若带淫淫湿气者。此脾
胃气弱。四君子加苍术、荆、防、川芎。切戒黄 。若色虽光润。捺之即破。此气不足。大剂参
内托散。或保元汤。若色如麸壳无水气者。此气血俱虚。急用十全大补加烧人矢治之。能变红
润含水者可治。否则危矣。以上俱有痒塌之变。均险证也。若遍身有细如芥子者。夹疹也。有皮
肉鲜红成片者。夹斑也。皆毒火太盛。故一齐涌出。并宜化斑汤发之。热剧势甚。加石膏。若初
见点。簇簇于皮中。不现不起者。非风寒壅遏。必气虚不振。风寒壅遏。必烦扰色晦。羌活汤加
升、葛。气虚不振。必气微色淡。保元汤加芎、桂。有痘出身凉而口燥渴者。此热毒内盛。其痘
必密而重。急宜内解热毒。禁用升麻。痘初出而肢体作痒。爬搔不宁者。此风寒滞于皮肤也。解
毒饮子加穿山甲。痘出隐隐不起。而发狂便闷溺涩者。此毒火郁结于阳明也。凉膈散下之。痘本
磊落。而变干焦紫黑。厥冷脉伏者。此必饮食所伤。不能运化。致气血凝滞。故形如死状。但按
其胸腹必热。枳实栀子豉汤加大黄。痘出将半。遍身作痛者。此热毒郁滞而未尽外出也。荆防解
毒饮。亦有六淫所滞而作痛者。审时令寒暄而调适之。痘出壮热烦渴。痰喘便秘者。肺胃二经实
热壅遏也。凉膈散加前胡、枳壳。痘未出齐而烦躁壮热色赤。用凉剂转躁热者。此毒得寒而凝滞
也。仍用前药。稍加辛温之味以开发之。凡痘出未尽。毒犹在内。慎不可与大寒大热之剂。寒则
凝滞其毒。热则转助其火。惟宜平和疏透之品。随表里虚实寒热调之。痘未出齐而痢下赤白。此
血热毒盛。兼有积滞也。黄芩汤去枣加楂、 、防风。若痘隐不振。形色淡白者。非保元汤加桂、
附不救。痘出而手足摇动者。由脉不能约束其毒。热甚生风之象也。荆防解毒饮加全蝎。痘出未
齐而头面浮肿者。风热上攻也。解毒饮子。痘出而两目赤肿。色见干红。大小便秘。睡卧不宁者。
此血热毒盛不解。上攻于目也。犀角地黄汤去丹皮加连翘、黑参、牛蒡、荆芥。有未见点时。身
热和缓。见点后。身反大热不休。烦躁昏
沉便秘。或吐泻者。逆证也。痘报形起胀时身热。四肢冷者。后天脾胃衰弱也。蜷卧不伸者。先
天肾气本亏也。俱不可治。有初出便见水泡。二三日即头戴白浆。不久即干。此火毒盛剧不治。
若丛杂细密如蚕种。平塌如胖蚕如冷粥结面。或大者平塌。小者稠密。皮薄而软。邪视若无。皮
肉眼胞面唇先肿。则五七日出血而危。若皮肤如寒风粟起。如疹如喑。或隐或现。此不待长发。
当啼叫而危。若正面胸背手足肿硬。或成块青紫。或紫如瘤状。当黑陷破烂而危。若红紫黑斑如
蚤啮蚊迹。洒朱点黑泼青。与皮肤一平。头面一片如胭脂者。三五朝即危矣。
痘疹的治疗以观察病情为关键。刚看到痘点初现时，用纸捻蘸取清油点燃照明，全面观察其颜色，仔细审视其形态。必须以火光在内，向外平照，这样隐藏在肌肉间的痘点就能全部显现出来。用手摩擦面颊，如果红色随摩擦转白，白色随摩擦又转红，这叫做“血活”，说明生机已存。如果摩擦后不转白，抬起手后不转红，这叫“血枯”，即使疏于治疗也难以治愈。
又要看眼睛是否有光彩，口唇尖端是否红润如常，没有干燥、发白或紫暗滞涩的颜色，这才是吉兆。另外必须知道在灯火下看是红色，在纸窗下看是白色，这一点不可不仔细审察。先哲观察痘疹有四个方面：根、窠、脚、地。“根”希望它活跃，“窠”希望它隆起，“脚”希望它稳固，“地”希望它宽广。这四方面都顺遂，即使痘点密集也不必担忧。近世观察痘疹的方法，只说盘和顶。所谓“盘”就是“根”，“顶”就是“窠”。至于“脚”和“地”，则取决于根和窠的圆润浑厚程度以及痘点的稀密情况。凡是见到痘顶隆起、盘底深陷，红晕透入肉里的，才是正痘。如果没有盘顶，红色浮在皮肤表面，那就是水痘，不是正痘。否则必定是气虚毒盛的原因，开始虽然长发，后来必然浆液清稀、脚部宽阔，到了第十天或第十一天，必然变痒塌陷而死。如果根脚阔散，不成红晕，后来必然难以收敛，第十二三天必然发生变故。
大抵痘疹需要辨别气血的盛衰和形色的轻重。大体上，形属于气，色属于血，所以形色是气血的根本，最为切要。起初专门看根脚是否紧束，紧束则热聚，容易生长灌浆；如果灌浆之后，专门要看根脚是否溶化，溶化则毒解，容易收靥脱痂。
如果发热三四日，身体凉爽后才出痘，初见淡红色，三四天才能出齐，微微觉得明亮，磊落如珠，大小不等，颗颗如黍米，摸起来碍手，四五日间明亮光泽，根窠红活，分二三次发出，头面胸腹腰背项下稀少，大小便正常，这是吉兆。如果一发热就出痘，疮多且稠密的，应当详细查看其根窠是分开的还是连在一起的，颜色是红润还是不红润。如果其中有先起、虚大、色黄如金的，名叫“贼痘”；大而黑的叫作“痘疔”。如果报点时呈青色，像筷子头大的一块不起凸的，这是“冷疔”。如果根窠分开，颜色红润，或者一个盘中有三四颗顶里有黑疔的，应当用银针挑破，口中含清水，吸去污血，用紫草膏、油胭脂，加入血余灰、真珠末填入疮内。或者使用珍珠散配合三仙散，或者犀角消毒饮加紫花地丁，以解除其毒。挑破后疼痛不止的，隔蒜灸之。如果没有根窠，颜色紫黑且疔多的，瘦弱的无法救治。
如果头面一片光润，像涂抹了胭脂，隐隐在皮肤中，这是血涩不流，气凝不运，被痰阻滞，不得通贯。先用升均汤大吐其痰，其次用犀角地黄汤去掉丹皮，加入木通、紫草、蝉蜕、连翘。但如果两颧琐碎成团，红晕不分颗粒的，急投羚羊解毒汤以分散它。如果虽然分了根窠，但身体发热、干枯紫暗的，后来必然发躁，用导赤散以利小便，更用凉血解毒药，加入烧人矢一钱，迟了就会变黑而危险。如果身体不热，只是干焦的，也是热证，用导赤散。如果虽然红活，但太觉娇嫩，这是元气不实，毒入气分，用保元汤加连翘、金银花。如果色淡皮宽的，这是元气至虚，用参内托散。如果虽然高起色红，但干燥口渴，这是火盛血少，用四物汤换生地，加荆芥、紫草、连翘、木通。最忌讳人参、白术。如果带有淫淫湿气的，这是脾胃气弱，用四君子汤加苍术、荆芥、防风、川芎。切忌黄连。如果色虽光润，捺之即破，这是气不足，用大剂量的参内托散，或者保元汤。如果色如麸壳无水气，这是气血俱虚，急用十全大补汤加烧人矢治疗。能变红润含水者可治，否则危险。以上都有痒塌的变故，都属于险证。
如果遍身有细如芥子的，是夹疹。有皮肤鲜红成片的，是夹斑。都是毒火太盛，所以一齐涌出，都宜用化斑汤发散。热势剧烈严重的，加石膏。如果初见痘点，簇簇在皮中，不现不出的，如果不是风寒壅遏，必定是气虚不振。风寒壅遏，必定烦扰、面色晦暗，用羌活汤加升麻、葛根。气虚不振，必定气微、面色淡白，用保元汤加川芎、桂枝。有痘出身凉而口燥渴的，这是热毒内盛，其痘必密而重，急宜内解热毒，禁用升麻。痘初出而肢体作痒，爬搔不宁的，这是风寒滞于皮肤，用解毒饮子加穿山甲。痘出隐隐不起，而发狂、便闷、溺涩的，这是毒火郁结于阳明经，用凉膈散攻下。痘本磊落，而变干焦紫黑，四肢厥冷、脉伏的，这必定是饮食所伤，不能运化，致气血凝滞，故形如死状。但按其胸腹必热，用枳实栀子豉汤加大黄。痘出将半，遍身作痛的，这是热毒郁滞而未尽外出，用荆防解毒饮。也有因六淫所滞而作痛的，审时令寒暖而调适之。痘出壮热烦渴、痰喘便秘的，是肺胃二经实热壅遏，用凉膈散加前胡、枳壳。痘未出齐而烦躁壮热色赤，用凉剂反而转躁热的，这是毒得寒而凝滞，仍用前药，稍加辛温之味以开发之。凡痘出未尽，毒犹在内，慎不可与大寒大热之剂，寒则凝滞其毒，热则转助其火，惟宜平和疏透之品，随表里虚实寒热调之。
痘未出齐而痢下赤白的，这是血热毒盛，兼有积滞，用黄芩汤去掉枣，加山楂、薤白、防风。如果痘隐不振，形色淡白的，非保元汤加桂枝、附子不能救。痘出而手足摇动的，由脉不能约束其毒，是热甚生风的象，用荆防解毒饮加全蝎。痘出未齐而头面浮肿的，是风热上攻，用解毒饮子。痘出而两目赤肿，色见干红，大小便秘，睡卧不宁的，这是血热毒盛不解，上攻于目，用犀角地黄汤去掉丹皮，加连翘、黑参、牛蒡、荆芥。有未见点时，身热和缓，见点后，身反大热不休，烦躁昏沉便秘，或吐泻的，是逆证。痘报形起胀时身热，四肢冷的，是后天脾胃衰弱。蜷卧不伸的，是先天肾气本亏，都不可治。
有初出便见水泡，二三日即头戴白浆，不久即干的，这是火毒盛剧，不治。如果丛杂细密如蚕种，平塌如胖蚕如冷粥结面，或者大的平塌，小的稠密，皮薄而软，斜视若无，眼皮面部嘴唇先肿，则五七日出血而危。如果皮肤如寒风粟起，如疹如喑，或隐或现，这不待长发，当啼叫而危。如果正面胸背手足肿硬，或成块青紫，或紫如瘤状，当黑陷破烂而危。如果红紫黑斑如蚤啮蚊迹，洒朱点黑泼青，与皮肤一平，头面一片如胭脂的，三五朝即危矣。
In the treatment of smallpox and measles, observation is paramount. When the spots first appear, use a paper wick dipped in clear oil for illumination to observe their color comprehensively and examine their shape carefully. The light should be held inward and shone outward horizontally so that spots hidden within the muscles are fully revealed. Rubbing the cheeks: if the redness turns white upon rubbing and returns to red when released, this is called "active blood" (Xue Huo), indicating vitality. If it does not turn white upon rubbing nor red upon release, this is called "withered blood" (Xue Ku); even with skilled treatment, it is difficult to cure.
Furthermore, observe whether the eyes have luster and whether the tip of the lips is ruddy as usual, without signs of dryness, pallor, or purple stagnation; these are auspicious omens. One must also note that under lamplight, the appearance is reddish, while under paper windows, it appears whitish; this distinction requires careful scrutiny. Ancient physicians assessed smallpox by four aspects: Root (Gen), Nest (Ke), Foot (Jiao), and Ground (Di). The Root should be active, the Nest raised, the Foot firm, and the Ground broad. If all four are favorable, there is no cause for worry even if the spots are dense. Modern methods often only mention the Plate (Pan) and Top (Ding). The Plate corresponds to the Root, and the Top to the Nest. The Foot and Ground depend on the roundness and fullness of the Root and Nest, as well as the density of the spots. When the top rises and the plate sinks deeply, with red halos penetrating into the flesh, it is considered true smallpox (Zheng Dou). If there is no plate or top, and the redness floats on the skin surface, it is water pox (Shui Dou), not true smallpox. Otherwise, it is likely due to Qi deficiency and intense toxin. Although it may grow initially, later the pus will be thin and the base wide; by the 10th or 11th day, itching and collapse will occur, leading to death. If the root and foot are scattered without a red halo, convergence will be difficult, and changes will likely occur by the 12th or 13th day.
Generally, one must distinguish the abundance or deficiency of Qi and Blood, and the severity of form and color. Form belongs to Qi, and color belongs to Blood; thus, form and color are the foundation of Qi and Blood and are most critical. Initially, focus on whether the root and foot are tight; tightness concentrates heat, facilitating growth and filling. After filling, focus on whether the root and foot soften; softening resolves toxins, facilitating scabbing and shedding.
If fever lasts three to four days, followed by cooling before eruption, with initial pale red spots that align over three to four days, appearing bright, distinct like pearls, varying in size like millet grains, and rough to touch, becoming glossy by the fourth or fifth day with ruddy roots and nests, erupting in two or three waves, sparse on the head, face, chest, abdomen, back, and neck, with normal urination and defecation, this is auspicious. If eruption occurs immediately upon fever with dense spots, carefully inspect whether the roots/nests are separated or confluent, and whether the color is ruddy or dull. If some spots appear early, large, empty, and yellow like gold, they are named "Thief Pox" (Ze Dou); large black ones are "Pox Carbuncles" (Dou Ding). If the initial spots are cyan, stick-head sized, and non-elevated, this is "Cold Carbuncle" (Leng Ding). If roots/nests are separated and ruddy, but some tops within a plate contain black carbuncles, puncture them with a silver needle, rinse with fresh water, suck out foul blood, and fill the wound with Zicao Gao (Arnebia Ointment), You Yanzhi (Oil Carmine), Xueyu Hui (Burnt Hair Ash), and Zhenzhu Mo (Pearl Powder). Alternatively, use Zhenzhu San (Pearl Powder) combined with Sanxian San (Three Immortals Powder), or Xijiao Xiaodu Yin (Rhinoceros Horn Detoxification Decoction) plus Zihua Diding (Viola Yedoensis) to resolve toxins. If pain persists after puncture, apply moxibustion through garlic. If there are no roots/nests, the color is purple-black, and there are many carbuncles, especially in weak patients, it is untreatable.
If the face is uniformly glossy, resembling applied rouge, faintly visible under the skin, this indicates stagnant blood flow, congealed Qi movement, and obstruction by phlegm. First, induce severe vomiting using Shengjun Tang (Ascend Equal Decoction) to expel phlegm, then use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) removing Danpi (Moutan Cortex), adding Mutong (Akebia Caulis), Zicao (Arnebiae Radix et Rhizoma), Chantui (Cicada Slough), and Lianqiao (Forsythiae Fructus). However, if the malar areas are clustered with indistinct red halos, urgently administer Lingyang Jiedu Tang (Antelope Horn Detoxification Decoction) to disperse it. If roots/nests are separated but the body is hot, dry, and purple, restlessness will follow; use Daochi San (Guide Out Red Powder) to promote urination, along with cooling-blood and detoxifying herbs, adding Shao Renshi (Burnt Human Feces) 1 qian. Delay leads to blackening and danger. If the body is not hot but dry and scorched, it is still heat; use Daochi San. If ruddy but too tender, Qi Yuan is insufficient, and toxin has entered the Qi level; use Baoyuan Tang (Preserve Origin Decoction) plus Lianqiao and Rendongying (Honeysuckle Flower). If pale and loose-skinned, Qi Yuan is severely deficient; use Shen Neituo San (Ginseng Internal Support Powder). If elevated and red but dry and thirsty, Fire is excessive and Blood is scant; use Siwu Tang (Four Substances Decoction) replacing Shudi with Shengdi, plus Jingjie, Zicao, Lianqiao, and Mutong. Strictly avoid Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala Rhizome). If accompanied by dampness, Spleen/Stomach Qi is weak; use Sijunzi Tang (Four Gentlemen Decoction) plus Cangzhu, Jingjie, Fangfeng, and Chuanxiong. Avoid Huanglian (Coptidis Rhizoma). If glossy but collapses upon pressure, Qi is insufficient; use large doses of Shen Neituo San or Baoyuan Tang. If color resembles bran with no moisture, both Qi and Blood are deficient; urgently use Shiquan Dabu Tang (Ten Complete Tonifying Decoction) plus Shao Renshi. Recovery is possible if it becomes ruddy and moist; otherwise, it is critical. All the above involve itching and collapse, representing dangerous conditions.
If fine spots like mustard seeds appear all over, it is Measles Complication (Jia Zhen). If bright red patches appear on the skin, it is Purpura Complication (Jia Ban). Both result from excessive toxin-fire erupting together; treat with Huaban Tang (Transform Purpura Decoction). Add Shigao (Gypsum Fibrosum) if heat is severe. If initial spots cluster under the skin without emerging, it is either Wind-Cold obstruction or Qi deficiency failing to rise. Wind-Cold obstruction presents with agitation and dull complexion; use Qianghuo Tang (Notopterygii Rhizoma Decoction) plus Shengma and Gegen. Qi deficiency presents with weak pulse and pale complexion; use Baoyuan Tang plus Chuanxiong and Guizhi. If eruption occurs with cool body but dry mouth/thirst, internal Heat-Toxin is strong; spots will be dense and heavy. Urgently resolve internal heat-toxin; avoid Shengma (Cimicifugae Rhizoma). Itching during early eruption indicates Wind-Cold stagnating in the skin; use Jiedu Yinzi (Detoxification Infusion) plus Chuanshanjia (Manis Squama). Eruption that is faint, non-elevated, accompanied by mania, abdominal distension, and dysuria indicates Toxin-Fire郁结 (stagnating) in the Yangming Meridian; use Liangge San (Cool Diaphragm Powder) to purge. If originally distinct spots become dry, scorched, purple-black, with cold limbs and hidden pulse, it is due to dietary injury causing failure to transform, leading to Qi/Blood stagnation; palpate the chest/abdomen for heat. Use Zhishi Zhizi Chi Tang (Immature Bitter Orange, Gardenia, and Fermented Soybean Decoction) plus Dahuang (Rhei Radix et Rhizoma). Pain throughout the body when half-erupted indicates lingering Heat-Toxin stagnation; use Jingfang Jiedu Yin (Jingjie and Fangfeng Detoxification Infusion). Pain caused by Six Excesses should be adjusted according to seasonal climate. High fever, thirst, phlegm, wheezing, and constipation indicate excess heat in Lung/Stommer meridians; use Liangge San plus Qianhu and Zhike. Restlessness and high fever with red color during incomplete eruption, worsening with cooling agents, indicates toxin coagulation due to cold; continue previous formula with slight addition of acrid-warm herbs to open. While eruption is incomplete and toxin remains inside, avoid extreme cold or hot formulas; cold coagulates toxin, heat aids fire. Use mild, dispersing, and penetrating herbs, adjusting for exterior/interior, deficiency/excess, cold/heat.
Dysentery with red and white stool during incomplete eruption indicates Blood-Heat-Toxin excess with food stagnation; use Huangqin Tang (Scutellaria Decoction) removing Zao (Jujubae Fructus), adding Zhaxiao (Crataegi Fructus), Xiebai (Allii Macrostemonis Bulbus), and Fangfeng. If spots are faint, pale, and white, only Baoyuan Tang plus Guizhi and Fuzi can save. Trembling of hands and feet during eruption indicates Pulse failing to constrain toxin, a sign of Heat generating Wind; use Jingfang Jiedu Yin plus Quanxie (Scorpio). Head and facial swelling during incomplete eruption indicates Wind-Heat attacking upward; use Jiedu Yinzi. Red, swollen, dry-red eyes with constipation and restless sleep during eruption indicate unresolved Blood-Heat-Toxin attacking the eyes; use Xijiao Dihuang Tang removing Danpi, adding Lianqiao, Heishen (Polygonati Odorati Rhizoma), Niubangzi (Arctii Fructus), and Jingjie. If fever was mild before spotting but becomes unceasingly high after, with agitation, drowsiness, constipation, or vomiting/diarrhea, it is a reverse syndrome (Ni Zheng). Fever with cold limbs during the swelling phase indicates postnatal Spleen/Stomach weakness; curling up without extending indicates prenatal Kidney Qi deficiency; both are untreatable.
Early blisters drying up within two to three days with white pus caps indicate severe Fire-Toxin; untreatable. Dense, flat spots resembling silkworm eggs, fat silkworms, or congealed porridge, or large flat/small dense spots with thin soft skin, looking invisible obliquely, with eyelid/facial/lip swelling, lead to hemorrhage and death by day 5-7. Skin resembling goosebumps from cold wind, rash-like, intermittent, leads to crying and death before full growth. Swelling/hardness of face/chest/back/extremities, purple-black lumps, or dark sunken ulcers are critical. Red/purple/black spots like flea bites or mosquito marks, flat with skin, uniform rouge-like face, lead to death within 3-5 days.