痘疮大约之数，发热三日，报痘三日，起胀三日，灌脓三日，结靥三日，共十五日，乃大率常
数，此其正也。惟痘密毒甚者，常过其期；痘疏毒微者，常不及期，固有不可一例拘者。但得痘色
明润，根窠红活，饮食二便如常，又无表里杂证，虽迟数日不妨。设有当出不出，当起不起，当脓
不脓，当靥不靥者，须详察其证。或为元气虚弱，不能营运，则补其元气，成为杂证攻剥，不能通
灌，则去其杂证。又六日以前毒发未尽，有杂证者常也；六日以后，毒该尽出，杂证当除而不出者
为逆，须详辨而急治之。
痘疹二证，古人有云∶痘自里而出于脏，其毒深，故久热而难出为重；疹自表而出于腑，其毒
浅，故暴热而易出为轻。余谓此说未必然也。盖痘疹皆出于脏腑，未有表里不相通者，但出于腑者
在痘亦轻，出于脏者在疹亦重。所以凡是疹子，必发热至五六日而后出，不可言易。且疹子多属肺
经，岂肺经非脏耶？
一、心经痘证，心主火，儿红赤烦渴，或上窜切牙者，心脏热也。心热者，导赤散。心虚者，
人参、麦门冬、生地黄、当归之类。烦渴邪盛者，葛根解毒汤。脾经痘证，多有吐泻腹痛者，诀云∶
发热肚中痛，斑疮腹内攻。发多防未透，发少更防痈。可见疮疹腹痛乃为恶候，当察腹痛吐泻各条
治之。肺经痘证，凡发热之时，喘息气逆，喉中涎响，此肺经恶候也。盖毒火内蒸刑肺而然，当察
本条治之。肝经之痘，儿发热之初，多有惊
搐等证。盖痘毒多热，热则生风，风热相搏，故发惊搐。然有当速治者，有不必治者，详见本条。
肾经痘证，初发热时，便觉腰痛。盖肾与膀胱为表里，今毒由太阳传入少阴，所以腰痛。此其毒陷
阴分，最非佳兆，宜察本条治之。
一、毒归五脏，证有不同，当详辨也。毒归于心，则为斑疹，为惊悸，为壮热，为咽干，为痛，
为渴，为汗，为丹瘤，为痈疡溃烂。毒归于肺，则为咳，为喘，为痒，为衄血，为疮，干燥皱揭，
为肩臂痛。毒归于脾，则为吐，为泻，为肿，为胀，为腹痛，为唇疮破裂，为舌本强，为手足痛，
为不食。毒归于肝，则为闷乱，为水 ，为目病。为卵肿，为干呕，为筋急拘挛，为吐蛔，为寒战
切牙。毒归于肾，为腰痛，为黑陷，为失音，为手足逆冷，为咽干痛，为饥不欲食，为多唾。毒归
于肠胃，为泄泻，为痢脓血，为腹鸣矢气，为大便不通。毒归于膀胱，为小腹满痛，为溺血，为遗
溺，为小水不通，为头顶肿痛，为反张，为目上视。以上五脏之证，举其概耳，凡诸证治，俱备杂
证各条之中，宜详究之。
痘疮的大致病程规律是：发热三天，出痘三天，起胀三天，灌脓三天，结痂三天，共计十五天，这是通常的常规情况，属于正常现象。只有痘疹密集且毒邪严重的，常常超过这个期限；痘疹稀疏且毒邪轻微的，常常不到这个期限，这本来就有不能一概而论的情况。只要痘色明亮润泽，痘根红润鲜活，饮食和二便都正常，又没有表里夹杂的其他病证，虽然延迟或提前几天也无妨。假如出现该出不出、该起不起、该化脓不化脓、该结痂不结痂的情况，必须详细诊察其证候。如果是元气虚弱，不能推动气血运行，就补益元气；如果因为夹杂病证攻伐损伤，导致气血不能通达灌注，就去掉夹杂的病证。另外，六天以前毒邪发作未尽，有夹杂病证是常理；六天以后，毒邪应该全部发出，夹杂病证应当消除却未消除的，属于逆证，必须仔细辨别并紧急治疗。
痘和疹两种病证，古人曾说：痘从体内发出而源于脏，毒邪深重，所以持续发热且难以透发为重症；疹从体表发出而源于腑，毒邪浅表，所以突发高热且容易透发为轻症。我认为这种说法不一定正确。大概痘和疹都出于脏腑，没有表里不相通的道理，只是出于腑的在痘中较轻，出于脏的在疹中也较重。所以凡是疹子，必定发热到第五六天才发出，不能说容易。而且疹子多属于肺经，难道肺经不是脏吗？
一、心经痘证：心主火，小儿面色红赤、烦躁口渴，或者眼球上翻、咬牙的，是心脏热盛。心热的，用导赤散。心虚的，用人参、麦门冬、生地黄、当归之类的药物。烦躁口渴且邪气盛的，用葛根解毒汤。
脾经痘证：多有呕吐、腹泻、腹痛的，医诀说：“发热肚中痛，斑疮腹内攻。发多防未透，发少更防痈。”可见疮疹腹痛属于恶候，应当根据腹痛、吐泻各条来治疗。
肺经痘证：凡是在发热的时候，出现喘息气逆，喉中有痰鸣声的，这是肺经的恶候。大概是毒火在内蒸腾刑克肺金所致，应当根据本条来治疗。
肝经痘证：小儿在发热初期，多有惊风抽搐等证候。大概痘毒多热，热极生风，风热相搏结，所以发生惊搐。然而有的需要迅速治疗，有的不必特殊治疗，详见本条。
肾经痘证：初发热时，就觉得腰痛。大概肾与膀胱互为表里，现在毒邪由太阳经传入少阴经，所以腰痛。这是毒邪陷入阴分，最不是好兆头，宜根据本条来治疗。
一、毒邪归于五脏，证候有所不同，应当详细辨别。毒邪归于心，则表现为斑疹、惊悸、壮热、咽干、疼痛、口渴、出汗、丹瘤、痈疡溃烂。毒邪归于肺，则表现为咳嗽、气喘、瘙痒、鼻出血、疮疡、皮肤干燥皱裂脱屑、肩臂疼痛。毒邪归于脾，则表现为呕吐、腹泻、肿胀、腹胀、腹痛、嘴唇生疮破裂、舌体僵硬、手足疼痛、不想进食。毒邪归于肝，则表现为烦闷混乱、水肿、眼病、睾丸肿胀、干呕、筋脉拘急挛缩、吐蛔虫、寒战咬牙。毒邪归于肾，则表现为腰痛、痘色黑陷、失音、手足逆冷、咽干痛、饥饿但不想进食、多唾。毒邪归于肠胃，则表现为泄泻、痢疾脓血、肠鸣矢气、大便不通。毒邪归于膀胱，则表现为小腹胀满疼痛、尿血、遗尿、小便不通、头顶肿痛、角弓反张、眼睛向上凝视。以上五脏的证候，只是列举大概，所有各种证候的治疗，都备载于杂证各条之中，应当详细探究。
The approximate course of smallpox is generally as follows: fever for three days, eruption for three days, swelling for three days, suppuration for three days, and crusting for three days, totaling fifteen days. This is the usual constant pattern, representing the normal state. However, cases with dense eruptions and severe toxins often exceed this period; those with sparse eruptions and mild toxins often fall short of it. There are indeed situations that cannot be rigidly applied to all cases. As long as the eruption color is bright and lustrous, the base is red and vibrant, diet and bowel/bladder functions are normal, and there are no mixed exterior-interior symptoms, a delay or advance of a few days is not detrimental. If there are instances where eruption should occur but does not, swelling should rise but does not, suppuration should happen but does not, or crusting should form but does not, one must carefully examine the syndrome. If it is due to deficiency of Yuan Qi (Original Qi) failing to circulate and transport, tonify the Yuan Qi. If it is due to mixed syndromes attacking and depleting, preventing proper circulation and infusion, remove the mixed syndromes. Furthermore, before the sixth day, if toxin emission is incomplete and mixed syndromes exist, this is common. After the sixth day, if toxins should have fully emerged and mixed syndromes should have resolved but have not, this constitutes a adverse condition (Ni Zheng), requiring careful differentiation and urgent treatment.
Regarding smallpox and measles, ancients stated: Smallpox emerges from the interior originating in the Zang organs, with deep-seated toxins; thus, prolonged fever and difficulty in eruption indicate severity. Measles emerges from the exterior originating in the Fu organs, with superficial toxins; thus, sudden high fever and ease of eruption indicate mildness. I believe this view is not necessarily correct. Both smallpox and measles originate from the Zang and Fu organs; there is no case where interior and exterior are disconnected. Merely, when emerging from Fu organs, smallpox is mild; when emerging from Zang organs, measles is severe. Therefore, for all measles cases, fever must persist for five to six days before eruption occurs; it cannot be said to be easy. Moreover, measles mostly belongs to the Lung Meridian; can the Lung Meridian be considered not a Zang organ?
1. Heart Meridian Smallpox Syndrome: The Heart governs Fire. If the child has a red face, irritability, thirst, upward staring of eyes, or grinding of teeth, this indicates Heat in the Heart. For Heart Heat, use Dao Chi San (Guide Out the Red Powder Decoction). For Heart Deficiency, use herbs such as Renshen (Ginseng Root), Maidong (Ophiopogon Tuber), Shengdihuang (Rehmannia Root), and Danggui (Angelica Sinensis Root). For irritability, thirst, and excess pathogenic factors, use Gegen Jiedu Tang (Kudzu Root Detoxification Decoction).
Spleen Meridian Smallpox Syndrome: Often accompanied by vomiting, diarrhea, and abdominal pain. The medical maxim states: "Fever with abdominal pain implies internal attack by macules and papules. Abundant eruptions require caution for incomplete penetration; scarce eruptions require caution for abscess formation." Thus, abdominal pain in sores and rashes is an ominous sign. Treatment should follow the specific guidelines for abdominal pain, vomiting, and diarrhea.
Lung Meridian Smallpox Syndrome: During fever, if wheezing, counterflow of Qi, and phlegm rattling in the throat occur, this is an ominous sign of the Lung Meridian. This is likely caused by toxic fire steaming internally and punishing the Lung. Treatment should follow the specific guidelines for this category.
Liver Meridian Smallpox Syndrome: At the initial stage of fever, children often present with convulsions and tremors. Generally, smallpox toxins are hot; heat generates Wind, and Wind-Heat clash, causing convulsions. Some cases require rapid treatment, while others do not; see the specific section for details.
Kidney Meridian Smallpox Syndrome: At the onset of fever, lower back pain is felt. Since the Kidney and Bladder are exterior-interior paired organs, the toxin transmitting from the Taiyang (Greater Yang) meridian to the Shaoyin (Lesser Yin) meridian causes lower back pain. This indicates the toxin sinking into the Yin aspect, which is a very poor omen. Treatment should follow the specific guidelines for this category.
1. Toxin Residing in the Five Zang Organs: Syndromes vary and must be carefully differentiated. Toxin residing in the Heart manifests as macules and papules, palpitations, high fever, dry throat, pain, thirst, sweating, erysipelas-like swellings, and ulceration of carbuncles. Toxin residing in the Lung manifests as cough, asthma, itching, epistaxis, sores, dry and peeling skin, and shoulder/arm pain. Toxin residing in the Spleen manifests as vomiting, diarrhea, edema, distension, abdominal pain, cracked lips, stiff tongue, limb pain, and anorexia. Toxin residing in the Liver manifests as restlessness, edema, eye diseases, testicular swelling, dry retching, tendon spasm and contracture, expulsion of roundworms, chills, and teeth grinding. Toxin residing in the Kidney manifests as lower back pain, black sunken lesions, aphonia, cold extremities, dry and painful throat, hunger without desire to eat, and excessive salivation. Toxin residing in the Intestines and Stomach manifests as diarrhea, dysentery with pus and blood, borborygmus and flatus, and constipation. Toxin residing in the Bladder manifests as lower abdominal fullness and pain, hematuria, enuresis, urinary retention, headache and swelling at the vertex, opisthotonos, and upward deviation of the eyes. The above syndromes of the Five Zang organs are merely general examples. Treatments for all various syndromes are detailed in the sections on miscellaneous syndromes; these should be studied thoroughly.