样痘者，如一家兄弟姊妹数人，或兄患痘疮，沿及于弟，而身出数颗，此非已
之正证，即所谓样痘也。若痘有先标者，此乃自己经位传出，又非可与沿得者同视，世
作样痘者谬矣。然凡兄样于弟，叔样于侄，姊样于妹，男样于女，则其起样者，正而
不戾，反是则逆，样痘者，可不辨耶。
凡疮疹只出一般者，纵有并形，尤宜详焉，如先发脓泡，后发疹者，是脾肺相
生也，顺也。先疹后 者，是心脾相生也，顺也。先发水泡，后发疹者，是肝克脾也，
逆也。先发脓泡，后发 子者，是心克肺也，逆也。先发脓泡，后发水泡少者，是
金木两得而难杀也；顺者，多也。金来克木，或木乘金衰矣，逆也。先发水泡，后
发子者，多是火乘木衰矣，逆也。少者，子衰母旺也，顺也。且春脓泡，夏黑隐，秋
子，冬疹子，是皆逆也。然疮疹既出，而有逆顺者三。有时之顺逆也，春夏阳气生
发，疮疹为顺；秋冬阳气伏藏，疮疹为逆。有虚实之顺逆者，如大便闭而能食者，是
为实为顺也；如二便利而不能食者，是为虚为逆也。有出入之顺逆者，疮疹出者为
顺；倒靥伏陷者为逆，此其略也。然凡先
见疹子，而夹出如水痘者，定是痘证，因疹子耗去荣血，故白如水痘，但与发散，疹
子继养荣血，则疹散而痘自成。不可认为水痘，盖疹子从不夹水痘者耳。
所谓“样痘”，就像一家中的兄弟姐妹几人，如果哥哥患了痘疮，传染给弟弟，导致弟弟身上只长出几颗痘疹，这并非弟弟自身的典型证候，这就是所谓的“样痘”。如果痘疹是先从患者自身的经络部位传发出来的，这就不是通过接触传染获得的，不能将其与“样痘”混为一谈，世人将这种情况也称作“样痘”是错误的。然而，凡是哥哥传给弟弟、叔叔传给侄子、姐姐传给妹妹、男性传给女性的，这种被传染而起的痘疹，属于正气所感而不违背常理；反之则属逆乱，对于“样痘”，难道可以不加以辨别吗？
凡是疮疹只出一类形态的，即使有并发的情况，尤其需要详细辨析。例如：先发脓泡（化脓性疱疹），后发疹子（红色斑丘疹）的，这是脾土生肺金的关系，属于顺证。先出疹子，后出痘子的，这是心火生脾土的关系，属于顺证。先发水泡（透明水疱），后发疹子的，这是肝木克脾土的关系，属于逆证。先发脓泡，后出痘子（含浆液的小疱）的，这是心火克肺金的关系，属于逆证。先发脓泡，后出水泡较少的，这是金（肺）与木（肝）两相得势而难以被克制；若水泡多者，为顺证。若是金来克木，或者木气乘虚侵犯衰弱的金气，则为逆证。先发水泡，后出痘子较多的，多是火气乘虚侵犯衰弱的木气，属于逆证；若痘子较少，则是子气衰弱而母气旺盛，属于顺证。此外，春季出脓泡，夏季出黑陷隐伏之痘，秋季出痘子，冬季出疹子，这些都是逆证。然而，疮疹发出之后，其逆顺表现主要有三个方面。一是时令的逆顺：春夏季节阳气生发，疮疹随之发出为顺；秋冬季节阳气伏藏，疮疹发出则为逆。二是虚实的逆顺：如大便闭塞但能进食的，是为实证，属于顺证；如二便通畅但不能进食的，是为虚证，属于逆证。三是出入的逆顺：疮疹顺利发出为顺；痘疹倒靥（痘顶凹陷不灌浆）、伏陷（隐没不出）的为逆证，这仅仅是大略的情况。然而，凡是先见到疹子，随后夹杂发出像水痘一样的皮疹的，必定是痘证。因为疹子耗伤了营血，所以颜色白得像水痘一样，此时只需使用发散的方法治疗，待疹子消退后，身体重新滋养营血，则疹散而痘自然形成。不可误认为是水痘，因为疹子从不夹杂水痘的。
"Yang Dou" (imitation smallpox) refers to a situation similar to several siblings in one family: if the elder brother suffers from smallpox and it spreads to the younger brother, resulting in only a few spots appearing on the younger brother's body, this is not the typical manifestation of the younger brother's own condition, but rather what is termed "Yang Dou." If the pustules originate from the patient's own meridian positions, they are transmitted internally and cannot be viewed identically to those acquired through contact; it is erroneous for people to label such cases as "Yang Dou." However, when an elder brother infects a younger brother, an uncle infects a nephew, an elder sister infects a younger sister, or a male infects a female, the onset of these imitated cases follows the normal flow of transmission and is considered regular (Zheng); conversely, deviations from this pattern are considered irregular (Ni). Therefore, must one not distinguish carefully between true and imitated smallpox?
When sores and rashes appear in only one type of morphology, even if there are concurrent forms, detailed differentiation is essential. For instance, if pustules (purulent blisters) appear first, followed by maculopapular rashes (Zhenzi), this indicates that Spleen Earth generates Lung Metal, which is a favorable progression (Shun). If rashes appear first, followed by vesicles/pustules (Douzi), this indicates that Heart Fire generates Spleen Earth, which is also favorable. If clear fluid-filled blisters (Shuipao) appear first, followed by rashes, this indicates Liver Wood overcoming Spleen Earth, which is unfavorable (Ni). If pustules appear first, followed by vesicles/pustules, this indicates Heart Fire overcoming Lung Metal, which is unfavorable. If pustules appear first, followed by fewer blisters, this suggests that Metal and Wood are both strong and difficult to overcome; if the number of blisters is large, it is favorable. If Metal overcomes Wood, or if Wood attacks weakened Metal, it is unfavorable. If blisters appear first, followed by many vesicles/pustules, this usually indicates Fire attacking weakened Wood, which is unfavorable; however, if the number of vesicles/pustules is small, it indicates that the "child" element is weak while the "mother" element is prosperous, which is favorable. Furthermore, the appearance of pustules in spring, dark and sunken lesions in summer, vesicles in autumn, and rashes in winter are all considered unfavorable patterns. However, after the eruption of sores and rashes, there are three aspects of favorable and unfavorable indications. First, seasonal favorable/unfavorable: In spring and summer, when Yang Qi is generating and ascending, the eruption of sores and rashes is favorable; in autumn and winter, when Yang Qi is hidden and stored, their eruption is unfavorable. Second, deficiency-excess favorable/unfavorable: Constipation with the ability to eat indicates an Excess pattern, which is favorable; free defecation and urination with inability to eat indicates a Deficiency pattern, which is unfavorable. Third, exit/entry favorable/unfavorable: The outward emergence of sores and rashes is favorable; retroverted crusting (Dao Ye) or sunken/hidden lesions are unfavorable. This is a brief overview. Moreover, if rashes appear first, followed by eruptions resembling chickenpox (Shuipao), it is definitely a case of smallpox. Because the rash consumes Ying Blood (Nutritive Blood), the color appears white like chickenpox. Treatment should focus on dispersing the pathogen; once the rash dissipates and the body regenerates Ying Blood, the rash will clear and the smallpox will form naturally. One must not mistake this for chickenpox, as rashes never accompany chickenpox.