乃太过之症，比疹更重，夹毒上浮，从毛窍中出，形如蚊咬之状而色紫赤，宜用石膏、生地、丹参、荷
鼻、大力、黄连、川芎、羌活、山栀、防风、荆芥、连翘、甘草、大黄等味，便有神功。
痘若现形之后，有碎密如芥子者，疹也。皮肉鲜红成块者，斑也。此火毒薰灼于中，急宜解毒，使斑疹
消散，痘得成功。《经》云∶痘疹连呈甚是奇，夹斑夹疹总为非，斑消疹散先解毒，芩母石膏玄参宜。
又云∶疹先痘后小儿哭，退疹方能痘自来，莫道寒凉忧冰伏，时师一见便痴呆。
又云∶治疹不治痘，惟要开其腠，腠开毒自出，毒出为宁候。
又云∶先退其麻疹，痘疮自然发越，宜服生甘草、防风、黄芩、荆芥、黄柏、玄参、大力、石膏，再加升麻。
红紫干滞、黑色焦枯者，表热而实也。大便秘结，小便赤
涩，身热鼻干而燥，气热唇焦烦渴者，里热而实也。表热宜清凉发散分利之，里热宜重解毒兼清凉发散为主。
后现点或疔多者，热毒抑遏皮肤也。《经》云∶急宜清毒始为美，连翘饮下莫磋砣。
又有疹后牙根出血，咽喉肿痛者，《经》云∶甘桔汤中用荆芥、防风、玄参、大力，可扶伤牙根舌上。
若生疮，连翘解毒桔玄当。
发热惊悸，心肝受病，心主火，肝主风木，风火相搏激而发搐，升解主之。又有咳嗽喘怯，肺肝受病。
肺主气，肝主血，是为金木相并，气血两搏，亦要发搐，宜清肺饮主之。《经》云∶治惊之法要平肝，利水
之时势自安。诸风掉眩皆属肝木，心火热盛，肺金受克，不能制水，肝木热则生风，风火相搏，神气不
宁，故发惊搐，治法平肝木、利小便为要。筋抽脉惕动者状似惊也，筋属肝，毒在于肝不得寻窍而出，筋脉受
冲激，以致抽动如惊，而实非惊也，或用苏解散即清解散去芩、连，加羌、苏。
这是病情过重的证候，比出疹更为严重。毒邪夹带热势上浮，从毛孔中透出，形状像被蚊子叮咬一样，颜色呈紫红色。适宜使用石膏、生地、丹参、薄荷（荷鼻）、牛蒡子（大力）、黄连、川芎、羌活、山栀、防风、荆芥、连翘、甘草、大黄等药物，服用后会有显著疗效。
痘疮如果显现形态后，出现细碎密集如芥菜籽大小的，是疹。皮肤肌肉鲜红成片状的，是斑。这是因为火毒在体内熏蒸灼烧，急需解毒，使斑和疹消散，痘疮才能顺利透发。《内经》说：痘和疹同时出现非常奇特，夹杂斑或疹总归是不正常的，应当先让斑消疹散并优先解毒，黄芩、知母、石膏、玄参适宜使用。又说：疹先发而痘后发，小儿会哭闹，只有退去疹毒，痘疮才能自然发出，不要担心寒凉药会导致冰伏（邪气内陷），当时的医生一见这种情况就显得愚钝无知。又说：治疗疹病而不顾痘疮，关键在于开通腠理（毛孔及肌肤纹理），腠理开通则毒邪自然排出，毒邪排出就是安宁的征象。又说：先消退麻疹，痘疮自然会透发旺盛，适宜服用生甘草、防风、黄芩、荆芥、黄柏、玄参、牛蒡子、石膏，再加升麻。
颜色红紫且干燥滞涩、或者黑色焦枯的，属于表热实证。大便秘结，小便赤红涩痛，身体发热、鼻子干燥而燥热，气息热、嘴唇焦裂、烦躁口渴的，属于里热实证。表热适宜用清凉发散兼分利的方法治疗；里热适宜以重剂解毒为主，兼用清凉发散。
后来出现的红点或疔疮多发的，是热毒郁遏在皮肤所致。《内经》说：急需清热解毒才算是好治法，服用连翘饮不要犹豫拖延。又有疹后牙根出血、咽喉肿痛的，《内经》说：在甘桔汤中加入荆芥、防风、玄参、牛蒡子，可以修复受损的牙根和舌头。如果是生疮，应用连翘、解毒药、桔梗、玄参。
发热惊悸，是心和肝受病。心主火，肝主风木，风与火相互搏激而导致抽搐，用升解方主治。又有咳嗽气喘怯弱，是肺和肝受病。肺主气，肝主血，这是金木相并，气血相互搏结，也会发生抽搐，适宜用清肺饮主治。《内经》说：治疗惊风的法则要平抑肝木，利水的时候局势自然安定。各种风病引起的震颤眩晕都归属于肝木，心火亢盛，肺金受到克制，不能制约水液，肝木热则生风，风火相互搏结，神气不宁静，所以发生惊搐，治疗方法以平抑肝木、通利小便为关键。筋脉抽掣、脉搏跳动惊恐的样子类似惊风，但筋属肝，毒邪在于肝却找不到出口排出，筋脉受到冲击激荡，导致抽动如同惊风，但实际上并不是惊风，可以用苏解散（即清解散去掉黄芩、黄连，加入羌活、紫苏）。
This is a syndrome of excess, more severe than macules (maculae). It involves toxin floating upward with heat, emerging from the hair follicles, resembling mosquito bites in shape and appearing purple-red. It is appropriate to use Shigao (Gypsum Fibrosum), Shengdi (Rehmanniae Radix), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Bohe (Menthae Haplocalycis Herba), Niubangzi (Arctii Fructus), Huanglian (Coptidis Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Zhizi (Gardeniae Fructus), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), Lianqiao (Forsythiae Fructus), Gancao (Glycyrrhizae Radix et Rhizoma), and Dahuang (Rhei Radix et Rhizoma), which will yield miraculous effects.
If after the eruption of smallpox lesions appear fine and dense like mustard seeds, these are macules (maculae). If the skin and flesh are bright red and form patches, these are maculae (maculae/patches - note: in TCM context here distinguishing 斑 ban as larger patches vs 疹 zhen as smaller spots). This is caused by fire-toxin steaming and scorching internally; it is urgent to resolve toxicity so that the maculae and rashes dissipate, allowing the smallpox to complete its course. The Classics state: "Smallpox and rash appearing together is very rare; mixed with maculae or rashes is generally unfavorable. First dissipate maculae and rashes, then resolve toxicity; Huangqin (Scutellariae Radix), Zhimu (Anemarrhenae Rhizoma), Shigao (Gypsum Fibrosum), and Xuanshen (Scrophulariae Radix) are suitable." It also states: "When rash appears first and smallpox later, the child cries; only after the rash recedes can the smallpox emerge naturally. Do not worry that cold-natured drugs will cause 'ice-fusion' (internal stagnation); contemporary physicians often act foolishly upon seeing this." It further states: "In treating rashes without attending to smallpox, one must open the couli (skin pores and interstices). Once the couli are open, toxins exit naturally, which indicates a peaceful prognosis." It also states: "First subside the measles/rash, and the smallpox will naturally erupt vigorously. It is suitable to take Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma), Fangfeng (Saposhnikoviae Radix), Huangqin (Scutellariae Radix), Jingjie (Schizonepetae Spica), Huangbai (Phellodendri Cortex), Xuanshen (Scrophulariae Radix), Niubangzi (Arctii Fructus), Shigao (Gypsum Fibrosum), plus Shengma (Cimicifugae Rhizoma)."
Red-purple and dry/stagnant, or black and scorched/dry, indicate exterior heat and excess. Constipation, dark and painful urination, fever, dry nose, hot breath, cracked lips, irritability, and thirst indicate interior heat and excess. Exterior heat should be treated with cooling, dispersing, and draining methods. Interior heat should be primarily treated with heavy detoxification, combined with cooling and dispersing.
The appearance of numerous red spots or carbuncles later indicates heat-toxin suppressed in the skin. The Classics state: "It is best to clear toxicity urgently; do not hesitate to administer Lianqiao Yin (Forsythia Decoction)." There are also cases of bleeding gums and sore throat after the rash. The Classics state: "In Ganjie Tang (Licorice and Licorice Root Decoction), add Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Xuanshen (Scrophulariae Radix), and Niubangzi (Arctii Fructus) to support healing of the damaged gums and tongue." If sores arise, use Lianqiao (Forsythiae Fructus), detoxifying herbs, Jiegeng (Platycodonis Radix), and Xuanshen (Scrophulariae Radix).
Fever with palpitations and fright indicates disease in the Heart and Liver. The Heart governs Fire, and the Liver governs Wind-Wood. When wind and fire clash and excite each other, convulsions occur; they are treated with Shengjie Tang (Ascending and Resolving Decoction). There are also cases of cough, wheezing, and weakness, indicating disease in the Lung and Liver. The Lung governs Qi, and the Liver governs Blood; this represents Metal and Wood combining, with Qi and Blood clashing, which also leads to convulsions; they are treated with Qingfei Yin (Clear Lung Decoction). The Classics state: "The method for treating fright requires soothing the Liver; when water metabolism is promoted, the situation naturally stabilizes." All wind syndromes involving tremors and dizziness belong to Liver-Wood. Excessive Heart-Fire attacks Lung-Metal, preventing it from controlling Water. When Liver-Wood becomes hot, it generates Wind; Wind and Fire clash, disturbing the Shen (Spirit), causing fright and convulsions. The treatment principle is to soothe Liver-Wood and promote urination. Twitching of tendons and trembling of pulses resemble fright. Tendons belong to the Liver. If toxin resides in the Liver but cannot find an outlet to exit, the tendons and vessels are impacted, causing twitching similar to fright, though it is not actually fright. In such cases, use Sujie San (Perilla Resolving Powder), which is Qingjie San (Clearing and Resolving Powder) minus Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma), plus Qianghuo (Notopterygii Rhizoma et Radix) and Zisu (Perillae Folium).