口渴者，因毒热攻冲，致胃火上炎，口作大渴也。内溃者，胃脘溃烂，穿出胸背而死，惨伤
莫此为甚。群书皆谓风寒外袭，腠理固密，壅塞不通，阳气挟同毒火，内攻而溃。如无大渴，有
恶寒状，宜升麻葛根汤加羌、防、芎、芷散风寒。如见渴证，即勿专于畏缩，但用麦冬、五味之
类止渴，则杯水之力，岂能救车薪烈火也耶？凡小渴，六一散；大渴，大剂白虎汤。大便秘，兼
凉膈散一剂，必令渴止，方免
大害。安可坐视生灵之毙乎？如痘后渴不甚者，保元汤加麦冬、五味、天粉，或参苓白术散之类
。口舌白色，胸痘灰色，乃内溃预验。
心经有热则烦躁。盖痘毒之热，蕴蓄于心，所以烦躁啼叫、闷乱狂言也。宜解毒汤及辰砂六
一散，使二便清利，火泄自可。有因痛痒烦躁者，随证治之。痘后烦躁，虚而有余毒也，大补气
血为主，兼解余毒。
是证由热毒壅遏而克肺金，或风邪乘虚而入。或解毒，或发散，暂加止嗽清痰之药，桑皮、
杏仁、枳壳、桔梗、前胡、贝母、陈皮、茯苓之类。半夏、南星戒之。有药入口即嗽吐出者，毒
热停积于肺胃也，随证治之。
斑者，血之余也。有点而无头，粒如笔尖点脂，如蚊虫所咬。然痘随脏而出，其势迅速，如
热毒炽盛，痘有太过之血，夹毒上浮，乘痘毒之热而发为斑也。如痘毒起齐，内必虚矣。内虚则
斑从内解，如
不解，当散其火邪。凉血活血解毒之药，宜玄参升麻汤加黄芩、黄连、红花（三味酒炒）、丹皮
、荆芥、当归、川芎、白芍。在初起宜用表散，次宜解利。如得斑退血附，则当补益，犹防损陷
。但痘中夹斑，亦危恶之候，十救一、二。紫斑不过三日，青、黑斑不出周时，斑如锦纹，六日
而毙。
口渴，是因为毒热攻冲，导致胃火上炎，口中出现严重口渴。内溃，是指胃脘部溃烂，穿透胸背而死亡，惨痛没有比这更严重的了。各类医书都认为这是风寒外袭，腠理（皮肤毛孔）致密，壅塞不通，阳气挟带毒火，向内攻冲而导致溃烂。如果没有严重口渴，但有恶寒症状，适宜用升麻葛根汤加羌活、防风、川芎、白芷来疏散风寒。如果见到口渴症状，就不要只因为害怕发散而畏缩不前，仅仅使用麦冬、五味子之类的药物来止渴，那么这点力量就像杯水车薪，怎么能扑灭车薪上的烈火呢？凡是轻微口渴，用六一散；严重口渴，用大剂量的白虎汤。大便秘结，兼用一剂凉膈散，必须让口渴停止，才能免除大祸害。怎么可以坐视百姓死亡呢？如果是痘疹消退后口渴不严重的，用保元汤加麦冬、五味子、天花粉，或者参苓白术散之类的方剂。口舌发白，胸部痘疹呈灰色，这是内溃的先兆验证。
心经有热就会烦躁。大概是因为痘毒的热气蕴蓄在心，所以出现烦躁啼叫、烦闷混乱、胡言乱语的症状。适宜用解毒汤及辰砂六一散，使大小便清利，火气泄出自然就好了。有因为疼痛瘙痒而烦躁的，根据证候治疗。痘疹消退后的烦躁，是正气虚弱而有余毒残留，以大补气血为主，兼以解除余毒。
这个证候是由热毒壅遏克制肺金，或者风邪乘虚而入引起的。或者解毒，或者发散，暂时加入止咳清痰的药物，如桑白皮、杏仁、枳壳、桔梗、前胡、贝母、陈皮、茯苓之类。半夏、天南星要禁忌。有药入口即咳嗽吐出的，是毒热停积在肺胃，根据证候治疗。
斑，是血的残余。有点状而无头，颗粒像笔尖点脂，像蚊虫叮咬的样子。然而痘疹随脏腑而出，其势迅速，如果热毒炽盛，痘疹有过剩的血，夹杂毒气上浮，乘着痘毒的热气而发为斑。如果痘毒起发齐全，内部必然虚弱。内部虚弱则斑从内部解决，如果不解，应当疏散火邪。凉血活血解毒的药物，适宜用玄参升麻汤加黄芩、黄连、红花（这三味药酒炒）、丹皮、荆芥、当归、川芎、白芍。在初起时适宜用表散法，其次适宜解利。如果得到斑退血附（指斑色转红活），则应当补益，还要防止损伤下陷。但是痘中夹斑，也是危险恶劣的征候，十个人救不回一两个。紫斑不超过三天，青、黑斑不出一个时辰，斑如锦纹，六天就会死亡。
Thirst is caused by toxic heat attacking and rushing, leading to stomach fire flaring upward, resulting in severe thirst in the mouth. Internal ulceration refers to the rotting of the epigastrium, piercing through the chest and back leading to death; there is no tragedy more cruel than this. Various medical texts attribute this to external invasion of wind-cold, with tight pores (skin and hair follicles) causing blockage and obstruction. Yang Qi carries the toxic fire inward, attacking and causing ulceration. If there is no severe thirst but symptoms of aversion to cold are present, Shengma Gegen Tang (Ephedra Root and Pueraria Decoction) added with Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Baizhi (Angelicae Dahuricae Radix) should be used to disperse wind-cold. If thirst is observed, one must not shrink back out of fear of dispersing; merely using herbs like Maidong (Ophiopogonis Tuber) and Wuweizi (Schisandrae Fructus) to stop thirst would be like a cup of water trying to extinguish a bonfire on a cartload of firewood—how could it suffice? For mild thirst, Liuyi San (Six-One Powder); for severe thirst, a large dose of Baihu Tang (White Tiger Decoction). If accompanied by constipation, use one dose of Liangge San (Cooling the Diaphragm Powder) to ensure the thirst stops, thereby avoiding major disaster. How can one sit idly by and watch people die? If thirst after the eruption of smallpox is not severe, Baoyuan Tang (Preserve the Origin Decoction) added with Maidong, Wuweizi, and Tianfen (Tianhua Fen/Trichosanthis Radix), or Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) may be used. White tongue and mouth, with gray pustules on the chest, are precursors indicating internal ulceration.
Heat in the Heart Meridian causes irritability. This is because the heat of the smallpox toxin accumulates in the heart, leading to irritability, crying out, mental confusion, and delirious speech. Jiedu Tang (Detoxification Decoction) and Chencha Liuyi San (Cinnabar Six-One Powder) should be used to promote clear urination and defecation, allowing the fire to dissipate naturally. For irritability caused by pain and itching, treat according to the syndrome. Irritability after the resolution of smallpox indicates deficiency with residual toxins; the primary treatment is to greatly tonify Qi and Blood, while simultaneously resolving residual toxins.
This syndrome arises from heat-toxin blockage impairing Metal (Lungs), or wind-pathogen entering due to deficiency. Treatment involves detoxification or dispersion, temporarily adding herbs to stop coughing and clear phlegm, such as Sangbai Pi (Morus Alba Bark), Xingren (Prunus Armeniaca Seed), Zhike (Aurantii Fructus Immaturus), Jiegeng (Platycodon Root), Qianhu (Peucedani Radix), Beimu (Fritillariae Bulbus), Chenpi (Citri Reticulatae Pericarpium), and Fuling (Poria). Banxia (Pinelliae Rhizoma) and Nanting (Arisaematis Rhizoma Preparatum) are contraindicated. If medication induces immediate coughing and vomiting upon entry, it indicates heat-toxin stagnating in the Lungs and Stomach; treat according to the syndrome.
Maculae (spots) are the remnants of blood. They appear as dots without heads, granular like ink drops or insect bites. However, pustules emerge following the organs, moving rapidly. If heat-toxin is excessive, surplus blood in the pustules mixes with toxin floating upward, erupting as maculae driven by the heat of the smallpox toxin. Once the pustules have fully risen, the interior must be deficient. Interior deficiency allows maculae to resolve internally; if they do not resolve, the fire-pathogen should be dispersed. Herbs for cooling blood, invigorating blood, and detoxifying include Xuanshen Shengma Tang (Scrophularia and Cimicifugae Decoction) added with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Honghua (Carthami Flos - stir-fried with wine), Danpi (Moutan Cortex), Jingjie (Schizonepetae Spica), Danggui (Angelicae Sinensis Radix), Chuanxiong, and Baishao (Paeoniae Radix Alba). In the early stage, exterior dispersion is appropriate; subsequently, resolution and benefit are needed. If the maculae recede and blood returns to normal, tonification should be applied, while guarding against collapse and sinking. However, smallpox complicated by maculae is a critical and ominous sign; only one or two out of ten may survive. Purple maculae lead to death within three days; green or black maculae within an hour; maculae resembling brocade patterns lead to death in six days.