痘疮放标之后，渐渐起胀，但肥胖一分，是胎毒发出一分，胖尽而毒出尽也。有不起者，或因
元气之弱，不能送毒，或有杂证阻滞，不能升发，皆痘前之失调理也。此时当速治之，否则后难为
矣。
一、痘宜渐发者吉，若一齐涌出，皮肉虚肿者，此表虚不能收摄，故奔溃而出，后必痒疡或成
溃烂，急宜人参固肌汤，或芎归汤。若血热者，宜凉血养营煎。虚甚者，宜六物煎。毒盛者，宜六
味消毒饮，或四味消毒饮出入用之。
一、痘不起发，或起而不透者，多由元气内虚，不能托送，故毒瓦斯留伏不出也。毒不尽出，则
变证莫测。凡见此者，速当救里以托其毒，然当察其气分血分，辨而治之。盖痘之壮突由乎气，肥
泽由乎血，气主 之，血主濡之也。若形虽壮而色见枯者，此气至而血不荣也，宜四物汤加人参、
麦门冬之类主之。若痘色红润而形平陷者，此血至而气不充也，宜保元汤，或六气煎加川芎主之。
若形色俱弱而不起发者，此气血俱不足也，宜六物煎加减主之，或保元汤、十全大补汤，调无价散
或独圣散与之。若冬春之间，为寒气所抑不能起发者，宜麻黄甘草汤加归、 ，或十宣散主之。若
夏秋火盛不起而烦渴秘结内热者，宜人参白虎汤。若痘疮起胀迟延不红活者，宜保元汤，或六物煎
加丁香、山楂、糯米、人乳、好酒主之，或用无价散，量儿大小以好酒调服。凡痘疮起发，通身皆
欲其透，惟四肢稍远难齐。若脾胃素强能食者勿虑，惟脾胃素弱食少者，四肢多有不透，以脾主四
肢，津液不能灌溉故也，宜以补脾为主，用快斑越婢汤加当归，或黄 建中汤加人参、防风。若因
误服凉药而致白 不起者，宜理中汤，或胃爱散。
一、痘虽起发，若灰白色或顶陷者，气虚也，切不可用寒凉之药，须六气煎加丁香、川芎、人
乳、好酒主
之，或保元汤倍加酒炒黄 、当归亦佳。
一、痘虽起发红活，若顶平色嫩，皮薄不能坚浓者，此气虚也，必恐变为痒 ，宜六气煎，或
六物煎加减主之，或十全大补汤、十宣散俱可择用。
一、地红血散不附者，保元汤加芍药、当归稍以收敛，归附气位。
一、根窠淡红，线晕枯燥者，血虚也，宜保元汤加当归、川芎、酒洗红花，再加山楂以行参、
之滞，少加木香以行气而血自活也。
一、痘虽起发而干枯无水，或青紫黯色，不久必变黑陷，乃血虚之甚也，宜四物汤加人参、麦
门冬、紫草、红花或调服无价散，外用水杨汤浴之，兼用胭脂涂法。
一、痘疮红甚而引饮渴不止者，名曰燥痘，宜犀角地黄汤之属。
一、痘色红紫满顶或 肿者，血热毒盛也，宜凉血养营煎加丹皮、木通、牛蒡子之属主之。然
痘出六日以后，有此证者多死。
一、痘已出齐而热尚不退，或烦躁发渴引饮，或二火司气之令，可少与冷水数口无妨。盖水性
下流，不滞上膈，亦能使毒从小便而出。但不可用生果之类，恐伤脾气也。
痘疮贵颗粒分明，如彼此相串，皮肿肉浮，或于本痘四旁旋出小痘攒聚，胖长渐成一块，此候
最险，宜用快斑汤合六味消毒饮以解其毒。
一、出齐后，痘有小孔，自顶宣下至脚，不白不黑，与痘色相同者，名为蛀痘。此因表虚腠理
不密而为此证，失之不治，则大泄元气，不起不发，速人之祸也，宜保元汤，或六气煎，大加糯米
、川芎、丁香，提气灌脓，内补其孔，甚为快捷方式。连进二、三服，必孔满而痘自起，若至黑色，则
为疔矣。
一、口唇为脾之外候，人以脾胃为本，不宜受伤，如初发热即见口唇焦裂，此毒瓦斯攻脾，乃恶
侯也，宜用泻黄散之类以速解之。若不早治，则毒聚于唇，及众痘起发，而唇疮必已先熟，内带黄
浆，及诸痘成浆，而此
疮已靥，唇皮揭脱，渐变呕恶呛水昏沉，不可为矣。
痘疮在发出标志之后，逐渐隆起发胀。每隆起一分，就是胎毒排出一分；完全隆起，则胎毒全部排出。如果有的痘疹不能隆起，可能是因为元气虚弱，无法推动毒邪外出；或者有其他杂证阻滞，导致毒邪不能升发，这都是出痘前调理不当造成的。此时应当迅速治疗，否则后果难以挽回。
一、痘疹适宜逐渐发出的为吉兆。如果一齐涌出，且皮肉虚肿的，这是表虚不能固摄，所以毒邪奔溃而出，后期必然出现瘙痒化脓或形成溃烂。急用人参固肌汤，或者芎归汤。如果是血热的，宜用凉血养营煎。虚损严重的，宜用六物煎。毒邪旺盛的，宜用六味消毒饮，或者四味消毒饮加减使用。
一、痘疹不起发，或者起发但不透达的，多由元气内部虚弱，不能托举送毒，导致毒气留伏不出。毒邪不能完全排出，就会发生不可预测的变证。凡是见到这种情况，应当迅速救里以托举毒邪。但应当辨别是气分还是血分的问题，辨证治疗。大概痘疹的壮实突起取决于气，光泽润泽取决于血。气主煦之（温煦），血主濡之（滋润）。如果形体虽然壮实但颜色枯槁的，这是气到了但血不荣养，宜用四物汤加人参、麦门冬等为主治方。如果痘色红润但形状平陷的，这是血到了但气不充盛，宜用保元汤，或者六气煎加川芎主治。如果颜色和形态都虚弱而不能起发的，这是气血都不足，宜用六物煎加减主治，或者保元汤、十全大补汤，调服无价散或独圣散给予服用。如果在冬春之间，被寒气抑制而不能起发的，宜用麻黄甘草汤加当归、[此处原文缺字，推测为芍药或类似药]，或者十宣散主治。如果在夏秋火气旺盛而不起发，伴有烦躁口渴、便秘内热的，宜用人参白虎汤。如果痘疮起发迟缓且不红活润泽的，宜用保元汤，或者六物煎加丁香、山楂、糯米、人乳、好酒主治，或者用无价散，根据患儿大小用好酒调服。凡是痘疮起发，全身都希望能透发，只有四肢稍远难以齐备。如果脾胃素来强健能进食的不要忧虑，只有脾胃素来虚弱食量少的，四肢多有不能透发的，因为脾主四肢，津液不能灌溉的缘故，宜以补脾为主，用快斑越婢汤加当归，或者黄芪建中汤加人参、防风。如果因误服凉药而导致痘色白而不起的，宜用理中汤，或者胃爱散。
一、痘疹虽然起发，但如果呈灰白色或者顶部凹陷的，是气虚，切不可用寒凉药物，须用六气煎加丁香、川芎、人乳、好酒主治，或者保元汤加倍加入酒炒黄芪、当归也很好。
一、痘疹虽然起发红活，但如果顶部平坦、颜色娇嫩、皮薄不能坚厚浓实的，这是气虚，必定恐怕变为瘙痒化脓，宜用六气煎，或者六物煎加减主治，或者十全大补汤、十宣散都可以择用。
一、痘底红赤、血散不依附的，用保元汤加芍药、当归稍作收敛，使归附于气位。
一、痘根淡红，周围晕圈枯燥的，是血虚，宜用保元汤加当归、川芎、酒洗红花，再加山楂以行滞人参、[此处原文缺字，推测为黄芪或补气药]的壅滞，少加木香以行气，则血自然流通。
一、痘疹虽然起发但干枯无水，或者呈青紫暗色的，不久必然变为黑陷，这是血虚至极的表现，宜用四物汤加人参、麦门冬、紫草、红花，或者调服无价散，外用杨汤洗浴，兼用胭脂涂法。
一、痘疮红甚而且引水渴不止的，名叫燥痘，宜用犀角地黄汤之类的方剂。
一、痘色红紫满顶或者肿胀的，是血热毒盛，宜用凉血养营煎加丹皮、木通、牛蒡子之类的方剂主治。然而痘出六日以后，有此证的多数死亡。
一、痘已出齐而热还不退，或者烦躁发渴引水饮用，或者是二火司气的时令，可以少量给几口冷水无妨。因为水性下流，不滞留上膈，也能使毒邪从小便排出。但是不可用生果之类，恐怕损伤脾气。
痘疮贵在颗粒分明，如果彼此相连串，皮肿肉浮，或者在本痘四周旋转长出小痘攒聚，胖长渐渐成一块，这种候象最危险，宜用快斑汤合六味消毒饮以解其毒。
一、出齐后，痘有小孔，从顶部向下延伸至脚部，不白不黑，与痘色相同的，名叫蛀痘。这是因为表虚腠理不紧密而导致的证候，失治不治疗，就会大泄元气，导致不起不发，加速人的祸患，宜用保元汤，或者六气煎，大量加入糯米、川芎、丁香，提气灌脓，内补其孔，非常快捷有效。连续进服二、三剂，必然孔满而痘自起，如果变成黑色，就成为疔疮了。
一、口唇是脾的外候，人以脾胃为本，不宜受伤。如果初发热就见到口唇焦裂，这是毒气攻脾，乃是恶候，宜用泻黄散之类的方剂迅速解除它。如果不早治疗，则毒聚于唇，等到众痘起发，而唇疮必然已经先熟，内部带有黄浆，等到诸痘成浆时，此疮已经结痂，唇皮揭脱，逐渐变为呕吐恶心、呛水昏沉，就无法救治了。
After the eruption signs of smallpox appear, it gradually rises and swells. Every bit of rising corresponds to the expulsion of a bit of fetal toxin; when fully risen, all fetal toxins are expelled. If some lesions fail to rise, it may be due to weak Yuan Qi (primordial energy) unable to drive out the toxin, or due to other complicating conditions blocking the ascent and eruption. These are all results of improper regulation before the eruption. At this stage, prompt treatment is necessary; otherwise, the consequences will be difficult to manage.
One: It is auspicious for smallpox to erupt gradually. If they erupt all at once with flaccid swelling of the skin and flesh, this indicates exterior deficiency failing to consolidate, causing the toxin to burst forth. Later, itching, suppuration, or ulceration will inevitably occur. Urgently use Renshen Guji Tang (Ginseng Muscle-Firming Decoction) or Xionggui Tang (Ligusticum and Angelica Decoction). If there is blood heat, use Liangxue Yangying Jian (Cool Blood and Nourish Ying Decoction). For severe deficiency, use Liuwu Jian (Six-Ingredient Decoction). For abundant toxin, use Liuwei Xiaodu Yin (Six-Ingredient Toxin-Clearing Infusion), or Siwei Xiaodu Yin (Four-Ingredient Toxin-Clearing Infusion) with modifications.
One: Smallpox that fails to rise or does not rise thoroughly is mostly caused by internal deficiency of Yuan Qi, which cannot support and expel the toxin, leaving the toxic qi latent. If the toxin is not completely expelled, unpredictable complications may arise. Upon seeing this, one must quickly treat the interior to support the expulsion of the toxin. However, one must distinguish whether the issue lies in the Qi level or the Blood level and treat accordingly. Generally, the robustness and protrusion of smallpox depend on Qi, while its luster and moisture depend on Blood. Qi provides warmth, and Blood provides nourishment. If the form is robust but the color is withered, this means Qi has arrived but Blood is not nourishing; use Siwu Tang (Four-Substance Decoction) added with Renshen (Ginseng) and Maidong (Ophiopogon Tuber). If the color is ruddy but the shape is flat and depressed, this means Blood has arrived but Qi is insufficient; use Baoyuan Tang (Preserve Origin Decoction) or Liuqi Jian (Six-Qi Decoction) added with Chuanxiong (Sichuan Lovage Rhizome). If both color and form are weak and fail to rise, this indicates insufficiency of both Qi and Blood; use Liuwu Jian with modifications, or Baoyuan Tang, Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction), administered with Wuji San (Priceless Powder) or Dusheng San (Single-Saint Powder). If during winter or spring, cold qi suppresses the eruption, use Mahuang Gancao Tang (Ephedra and Licorice Decoction) added with Danggui (Angelica Sinensis) and [missing character], or Shixuan San (Ten-Accumulations Powder). If during summer or autumn, excessive fire prevents eruption accompanied by irritability, thirst, constipation, and internal heat, use Renshen Baihu Tang (Ginseng White Tiger Decoction). If the eruption is delayed and lacks ruddiness and luster, use Baoyuan Tang or Liuwu Jian added with Dingxiang (Clove), Shanzha (Hawthorn Fruit), Nuomi (Glutinous Rice), Renru (Human Milk), and good wine. Alternatively, use Wuji San, adjusted according to the child's age and mixed with good wine. In general, whole-body eruption should be thorough, though the limbs, being distant, may lag behind. If the Spleen and Stomach are inherently strong and appetite is good, do not worry. Only if the Spleen and Stomach are inherently weak with poor appetite might the limbs fail to erupt thoroughly, because the Spleen governs the four limbs and fluids cannot irrigate them. Treatment should focus on tonifying the Spleen, using Kuaiban Yebipi Tang (Rapid-Eruption Yi Yi and Ma Huang Decoction) added with Danggui, or Huangqi Jianzhong Tang (Astragalus Middle-Conserving Decoction) added with Renshen and Fangfeng (Saposhnikovia Root). If white, non-rising lesions result from mistakenly administering cooling medicines, use Lizhong Tang (Regulate the Middle Decoction) or Weiai San (Stomach-Loving Powder).
One: Although the smallpox has erupted, if it appears grayish-white or the apex is depressed, this is Qi deficiency. Cold-cooling medicines must absolutely be avoided. Use Liuqi Jian added with Dingxiang, Chuanxiong, Renru, and good wine. Alternatively, Baoyuan Tang with doubled Jiuhuangqi (Wine-fried Astragalus Root) and Danggui is also excellent.
One: Although the smallpox has erupted with ruddy color, if the apex is flat, the color tender, and the skin thin without firmness, this is Qi deficiency. There is a fear of transformation into itching and suppuration. Use Liuqi Jian or Liuwu Jian with modifications. Shiquan Dabu Tang or Shixuan San can also be selected.
One: For red bases with scattered blood not adhering, use Baoyuan Tang added with Shaoyao (Peony Root) and Danggui to slightly astringe, allowing the blood to return to its proper Qi position.
One: For pale red bases with dry and withered halos, this is Blood deficiency. Use Baoyuan Tang added with Danggui, Chuanxiong, and Jiu Honghua (Wine-washed Safflower), plus Shanzha to move the stagnation of Renshen and [missing character]. Add a small amount of Muxiang (Aucklandia Root) to move Qi, so that Blood flows naturally.
One: Although the smallpox has erupted, if it is dry, waterless, or dark blue-purple, it will soon turn black and sink, indicating extreme Blood deficiency. Use Siwu Tang added with Renshen, Maidong, Zicao (Arnebia Root), and Honghua, or administer Wuji San. Bathe externally with Yangshui Tang (Poplar Water Decoction) and apply Yanzi Tu Fa (Carmine Application Method).
One: Smallpox that is very red and causes unquenchable thirst is called "Dry Smallpox." Use formulas similar to Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction).
One: Smallpox that is red-purple, full at the apex, or swollen indicates Blood heat and abundant toxin. Use Liangxue Yangying Jian added with Danpi (Moutan Bark), Mutong (Akebia Stem), and Niubangzi (Arctium Fruit). However, if these symptoms appear after the sixth day of eruption, death is likely.
One: After the smallpox has fully erupted, if fever persists, or there is irritability, thirst, and desire to drink, or if it is the season governed by the "Two Fires," giving a few mouthfuls of cold water is harmless. Water flows downward and does not stagnate in the upper diaphragm, helping to expel toxin via urination. However, raw fruits should be avoided as they may damage Spleen Qi.
Smallpox should ideally have distinct, separate grains. If they merge together, with swollen skin and floating flesh, or if small pustules rotate and gather around the original lesion, eventually forming a single mass, this condition is most dangerous. Use Kuaiban Tang (Rapid-Eruption Decoction) combined with Liuwei Xiaodu Yin to clear the toxin.
One: After full eruption, if there are small holes extending from the apex to the base, neither white nor black, matching the lesion color, it is called "Moth-eaten Smallpox." This is caused by exterior deficiency and loose interstices. Failure to treat promptly leads to massive loss of Yuan Qi, preventing eruption, and accelerating demise. Use Baoyuan Tang or Liuqi Jian, heavily adding Nuomi, Chuanxiong, and Dingxiang to lift Qi, fill the pus, and internally repair the holes, which is very effective. Administer two or three doses consecutively; the holes will fill and the lesions will rise. If it turns black, it becomes a Ding (carbuncle).
One: The lips are the external manifestation of the Spleen. Humans rely on the Spleen and Stomach as their foundation, which should not be injured. If chapped and cracked lips appear upon initial fever, this indicates toxic Qi attacking the Spleen, a malignant sign. Use formulas like Xiehuang San (Drain Yellow Powder) to resolve it quickly. If not treated early, toxin accumulates in the lips. When the main lesions erupt, the lip sores will mature first, containing yellow pus. By the time the main lesions form pus, the lip sores will have crusted over, the lip skin will peel off, and vomiting, choking on water, and lethargy will develop, becoming incurable.