肺主气，气不足，则致后三证
自汗声不出。疮顶陷塌。不绽肥。并宜十奇散。（自汗倍黄 ，声不出倍桔梗）
心主血，血不足，则致后三证。
灰白色。根窠不红。不光泽。并宜芎归汤加芍药、紫草、红花，良验。
〔钱〕凡疮疹若出辨视轻重，若一发便出尽者必重也。痘夹疹者半轻半重也。出
稀者轻。里外肥红者轻。外黑里白者微重也。外白里黑者大重也。疮端里黑如针
孔者热剧也。青干黑陷，昏睡汗出不止，烦躁热渴，腹胀啼喘，大小便不通者困也。
凡疮疹，当乳母慎口，不可令饥及受风寒，必归肾变黑，难治。〔海〕或热极反兼
水化者，亦能变黑，当以凉药主之，不可不察，以脉别之可也。或有出色正者，内
素有热，头反陷，色或灰青似黑，中有针眼下陷，当急以清凉药疏之，便结者大黄、
牵牛之类，便软者金花丸之类主之。
〔陈〕轻者作三次出。大小不一等。头面稀少。眼中无。根窠红。肥满光泽。
重者一齐并出。密如蚕种。身热腹胀。疮灰白色。稠密无缝。泻渴不止。头温足冷。
轻变重。犯房室。不忌口。先曾泻。饮冷水。饵凉药。
重变轻。避风寒。常和暖。大便稠。不燥渴。忌生冷。忌外人。
上，饮冷水，饵凉药，若内有实热者不须忌之。
二日三日，痘疮始见，微微才出如粟米大，或如黍米大，或如绿豆大，似水珠
光泽明净者佳，不须服药。
四日五日，痘疮大小不等，根窠红活，光泽明净者轻。如稠密陷顶，灰白色泻
渴者重。
六日七日，痘疮肥红光泽者轻。如身温气促，口干腹胀，足指冷者重。
八日九日，痘疮长足，肥满苍蜡色者轻。如寒战闷乱，腹胀烦渴，气急切牙者，
至重也。
十日十一日，痘疮当靥，疮痂欲落而愈。如身热闷乱，腹胀泄泻，寒战切牙者重。
〔翁〕轻痘歌 热缓神清痘小稀，根窠红活出参差，四肢温暖无寒热，乳食如常
渴泻除，太阳面颊俱光润，手足累累圆似珠，更兼腰项当心少，但宜调护不须医。
重痘歌 初热一日即便出，稠密鲜红减饮食，泄泻烦渴头面多，红 夹疹二便
涩，平阔灰白欠光明，疔毒脓疮水流湿，若此重证须预防，莫待临期有疏失。
〔万〕古人云∶轻变重，重变轻，轻者，指出稀者，里外肥红者，人见其轻，遽生
怠忽之心，不避风寒，不节饮食，不慎禁戒，不择医巫，以致感风寒则生外热，伤
饮食则生内热，热气熏蒸，或翻出疮痘稠密者，或痘后目盲发痈者，或腹胀，或烦
躁，或吐利，犯禁戒则为瘙痒，为溃烂，医之误，则补所不当补，泻所不当泻，巫
之诬，则咒水洒之以伤其表，令之饮水以伤其里，往往变为重疾，归之气数，抑何
愚哉。重者，指出密者，外黑里赤者，外白里黑者，能存忧惧之心，适寒温，慎饮食，
禁戒必守，医巫必择，自然易发易靥，能变为轻，非人能胜天乎。
辨不药而愈
痘脚稀疏 根窠红绽 不泻不渴 乳食不减 四肢温和 身无大热
以上六证，并不须服药，惟宜善加调护，须使房室温盎，屏诸秽气，忌见外人，
毋犯房色，及往来妇人月水并腋臭者，皆不可近。惟宜烧大黄、苍术，以辟恶气，
勿宜烧沉、檀、降真、乳香、脑、麝，帏帐之内，宜悬胡荽，或以胡荽渍酒、喷
床帐，并烧木香为佳。夫痘疮之毒，最怕秽恶之气触犯，切不可信僧道看经解秽，
况无纤毫之力，而返恐被其秽恶之气触犯，亦不可恃其能解而不预防，戒之，
戒之。
辨五不治证
痒塌，寒战切牙，渴不止。痘紫黑色，喘渴不宁。灰白色陷顶，腹胀。头
温足冷，闷乱饮水。气促泄泻渴。
肺主司气，若气不足，则会导致以下三种证候：
自汗、声音不出。疮顶凹陷塌陷、不能饱满生长。均适宜使用十奇散治疗。（若自汗严重则加倍黄芩，若声音不出则加倍桔梗）
心主司血，若血不足，则会导致以下三种证候：
痘色呈灰白色、根部周围不红、缺乏光泽。均适宜使用芎归汤加入芍药、紫草、红花治疗，疗效显著。
〔钱乙〕凡是痘疹，应当仔细辨别以观察轻重。如果一出就全部发出来的，病情必然严重。痘疹夹杂出现的，属于半轻半重。出得稀疏的属轻症。内外都饱满红润的属轻症。外表黑而内部白的属轻微严重。外表白而内部黑的属非常严重。疮头内部黑如针孔的，说明热毒剧烈。出现青干黑陷、昏睡且出汗不止、烦躁热渴、腹胀啼哭喘息、大小便不通的，属于危困之症。
凡是痘疹，应当让乳母谨慎饮食起居，不可让患儿饥饿或受风寒侵袭，否则病邪必归于肾导致变黑，难以治愈。〔海藏〕或者热极反而兼有水化（寒象）的情况，也能导致变黑，应当用凉性药物治疗，不可不仔细考察，可以通过脉象来辨别。或者有痘色正常的，但体内素有热邪，头部反而凹陷，颜色或呈灰青似黑，中间有针眼样下陷，应当紧急用清凉药物疏解，大便结实的用大黄、牵牛子之类，大便稀软的用金花丸之类主治。
〔陈文中〕轻症的痘疹分三次发出。大小不一。头面部稀少。眼睛周围没有。根部周围红润。饱满有光泽。
重症的痘疹一齐并发。密集如蚕种。身体发热腹胀。痘色灰白色。稠密无缝隙。腹泻口渴不止。头部温热脚部寒冷。
轻症转为重症的原因：犯房事禁忌。不忌口。先前曾患腹泻。饮用冷水。服用凉性药物。
重症转为轻症的方法：避开风寒。保持温暖。大便成形。不燥渴。忌食生冷。避免外人接触。
上述情况中，如果是饮用冷水、服用凉性药物，若体内有实热的则不需要忌讳。
第二日第三日，痘疮才开始显现，刚刚发出像粟米大，或者像黍米大，或者像绿豆大，像水珠一样光泽明净的是佳兆，不需要服药。
第四日第五日，痘疮大小不等，根部周围红活，光泽明净的属轻症。如果稠密顶陷，灰白色且腹泻口渴的属重症。
第六日第七日，痘疮饱满红润有光泽的属轻症。如果身体温和但气促，口干腹胀，脚趾冷的属重症。
第八日第九日，痘疮长足，饱满呈苍蜡色的属轻症。如果出现寒战闷乱，腹胀烦渴，气急咬牙的，属于至重之症。
第十日第十一日，痘疮应当结痂，疮痂欲落而痊愈。如果出现身体发热闷乱，腹胀泄泻，寒战咬牙的属重症。
〔翁氏〕轻痘歌诀：热势缓、神志清、痘小稀疏，根部红活参差不齐，四肢温暖无寒热，吃奶进食如常，无口渴腹泻，太阳穴及面颊都光润，手足圆润累累如珠，腰部项部当心处较少，只需调护即可，不需要医疗干预。
重痘歌诀：初热一天就立即发出，稠密鲜红减少饮食，腹泻烦渴头面部多，红色痘疹夹杂皮疹二便涩滞，平阔灰白缺乏光明，疔毒脓疮流水湿烂，若是这种重症必须预防，不要等到临期出现疏忽失误。
〔万全〕古人说：轻变重，重变轻。轻症，是指出疹稀疏、内外饱满红润的。人们见其轻，就产生怠慢疏忽之心，不避风寒，不节饮食，不慎禁戒，不择医巫，以致感受风寒则生外热，损伤饮食则生内热，热气熏蒸，或者翻出痘疮稠密的，或者痘后目盲发痈的，或者腹胀，或者烦躁，或者吐利，违反禁戒则导致瘙痒、溃烂，医生误治，则补了不该补的，泻了不该泻的，巫师诬妄，则咒水喷洒以伤其表，让人饮水以伤其里，往往变为重疾，归结为气数命运，多么愚蠢啊。重症，是指出疹密集、外黑内赤、外白内黑的。能存有忧惧之心，调节寒温，谨慎饮食，严守禁戒，选择医巫，自然容易发出容易结痂，能转变为轻症，这不是人能胜过天吗？
辨别不药而愈
痘脚稀疏，根部红绽，不腹泻不口渴，吃奶进食不减，四肢温和，身体无大热。
以上六种证候，都不需要服药，只宜善于调护，须使房间温暖，排除各种秽气，忌讳见外人，不要犯房事，以及往来妇女的月经和腋臭者，都不可靠近。只宜烧大黄、苍术，以辟除恶气，不宜烧沉香、檀香、降真香、乳香、冰片、麝香，帷帐之内，宜悬挂胡荽，或者用胡荽浸泡酒、喷洒床帐，并烧木香为佳。痘疮的毒气，最怕秽恶之气触犯，切不可相信僧道看经解秽，况且他们毫无能力，反而恐怕被他们的秽恶之气触犯，也不可依赖他们能解秽而不加预防，切记，切记。
辨别五不治证
瘙痒塌陷，寒战咬牙，口渴不止。痘色紫黑色，喘促口渴不安宁。灰白色顶陷，腹胀。头部温热脚部寒冷，闷乱饮水。气促腹泻口渴。
The Lung governs Qi. If Qi is insufficient, it leads to the following three syndromes: spontaneous sweating (Zi Han) and inability to produce sound. The pustule apex is depressed and collapsed, failing to become plump. All are suitable for treatment with Shiqi San (Ten Wonders Powder). (If spontaneous sweating is severe, double the amount of Huangqin [Scutellariae Radix]; if inability to produce sound occurs, double the amount of Jiegeng [Platycodonis Radix]).
The Heart governs Blood. If Blood is insufficient, it leads to the following three syndromes: ash-white coloration, non-redness at the root base, and lack of luster. All are suitable for treatment with Xionggui Tang (Angelica and Ligusticum Decoction) added with Shaoyao (Paeoniae Radix), Zicao (Arnebiae Radix), and Honghua (Carthami Flos), which yields excellent results.
[Qian Yi] Regarding variola and rubeola, one must carefully distinguish their severity. If they erupt all at once upon onset, the condition is necessarily severe. Variola mixed with rubeola indicates a moderate severity. Sparse eruption indicates mildness. Plump and red both inside and out indicates mildness. Black outside and white inside indicates slightly severe. White outside and black inside indicates very severe. Pustules with black centers like needle holes indicate intense heat toxin. Cyanosis, dryness, black depression, lethargy with incessant sweating, irritability, heat, thirst, abdominal distension, crying, wheezing, and obstruction of urination and defecation indicate a critical and difficult state.
For all variola and rubeola, the wet nurse must be cautious with diet and lifestyle; the infant must not be allowed to go hungry or be exposed to wind-cold. Otherwise, the pathogen will return to the Kidney, turning black, and will be difficult to treat. [Hai Zang] Alternatively, extreme heat may paradoxically generate water transformation (cold signs), also leading to blackening. One should use cooling medicines. This must not be overlooked; pulse diagnosis can differentiate it. There may be cases where the eruption color is normal, but internal heat exists chronically, causing the head to depress, with colors appearing grayish-blue or black, and central needle-like depressions. One should urgently use cooling medicines to disperse them. For constipation, use Da Huang (Rhei Radix et Rhizoma) and Qianniu (Pharbitidis Semen); for loose stools, use Jinhua Wan (Golden Flower Pill).
[Chen Zhongwen] Mild cases erupt in three stages. Sizes vary. Scarce on the head and face. Absent around the eyes. Root bases are red. Plump and lustrous.
Severe cases erupt simultaneously. Dense as silkworm eggs. Fever and abdominal distension. Ash-white color. Dense without gaps. Incessant diarrhea and thirst. Warm head and cold feet.
Causes of mild becoming severe: Sexual activity. Failure to observe dietary taboos. Previous diarrhea. Drinking cold water. Taking cooling medicines.
Causes of severe becoming mild: Avoiding wind-cold. Maintaining warmth. Formed stools. No dryness or thirst. Avoiding raw and cold foods. Avoiding outsiders.
Regarding the above, if drinking cold water or taking cooling medicines, there is no need to avoid them if there is excess heat internally.
On the second and third days, variola begins to appear, just emerging like millet seeds, or like broomcorn millet seeds, or like mung beans. Those resembling water droplets, bright and clear, are auspicious and require no medicine.
On the fourth and fifth days, variola varies in size. Red and vibrant root bases with bright clarity indicate mildness. Dense, depressed apices, ash-white color, diarrhea, and thirst indicate severity.
On the sixth and seventh days, plump, red, and lustrous variola indicates mildness. Warm body but rapid breathing, dry mouth, abdominal distension, and cold toes indicate severity.
On the eighth and ninth days, fully grown, plump, and waxy-yellow variola indicates mildness. Chills, confusion, abdominal distension, irritability, thirst, rapid breathing, and teeth grinding indicate the most severe condition.
On the tenth and eleventh days, variola should crust over, scabs fall off, and healing occurs. Fever, confusion, abdominal distension, diarrhea, chills, and teeth grinding indicate severity.
[Weng Shi] Song for Mild Variola: Heat is mild, spirit is clear, pustules are small and sparse, root bases are red and vibrant with irregular distribution, limbs are warm without chills or fever, nursing and eating are normal, no thirst or diarrhea, Taiyang area and cheeks are smooth and moist, hands and feet are round and piled like pearls, fewer lesions on waist and neck. Only care is needed, no medical intervention required.
Song for Severe Variola: Erupts immediately after one day of initial heat, dense and fresh red, reduced appetite, diarrhea, irritability, thirst, abundant on head and face, red pustules mixed with rubeola, obstructed urination and defecation, flat and wide ash-white lacking luster, carbuncles and pus sores weeping moisture. Such severe conditions require prevention; do not wait until the crisis for negligence.
[Wan Quan] The ancients said: Mild becomes severe, severe becomes mild. "Mild" refers to sparse eruptions, plump and red inside and out. People see its mildness and become negligent, failing to avoid wind-cold, regulate diet, observe taboos, or choose proper healers. Thus, contracting wind-cold generates external heat; damaging diet generates internal heat. Heat steams upward, causing either dense eruption of pustules, blindness or carbuncles post-variola, abdominal distension, irritability, vomiting, or diarrhea. Violating taboos causes itching and ulceration. Medical error involves tonifying what should not be tonified or purging what should not be purged. Shamanistic deception involves sprinkling cursed water, damaging the exterior, or forcing water intake, damaging the interior. Often this turns into serious disease, attributed to fate, how foolish! "Severe" refers to dense eruptions, black outside/red inside, or white outside/black inside. By maintaining caution, regulating temperature, being careful with diet, strictly observing taboos, and choosing proper healers, it naturally erupts and crusted easily, transforming into mildness. Is this not humans overcoming heaven?
Differentiating Self-Healing Without Medicine
Sparse pustule bases, red and spreading root bases, no diarrhea or thirst, normal nursing and eating, warm limbs, no high fever.
For the above six syndromes, no medicine is needed. Only proper care is suitable. Keep the room warm, exclude foul odors, avoid seeing outsiders, abstain from sexual activity, and keep away from menstruating women and those with axillary odor. Burning Da Huang (Rhei Radix et Rhizoma) and Cangzhu (Atractylodis Rhizoma) is recommended to dispel evil qi. Burning Chenxiang (Aquilariae Lignum Resinatum), Tanxiang (Santalum Album Lignum), Jiangzhengxiang (Daemonorops Draconis Resina), Ruxiang (Olibanum), Bingpian (Borneolum Syntheticum), and Shexiang (Moschus) should be avoided. Inside the curtains, hanging Huyu (Coriandri Fructus) is suitable, or soaking Huyu in wine and spraying beds/curtains, along with burning Muxiang (Aucklandiae Radix), is excellent. The toxin of variola fears foul odors most. Do not believe monks or Daoists who claim to cleanse impurity through scriptures; they have no power and may themselves introduce foul odors. Do not rely on them for cleansing without prevention. Beware, beware.
Differentiating Five Incurable Syndromes
Itching and collapse, chills and teeth grinding, incessant thirst. Purple-black variola, panting, thirst, and restlessness. Ash-white depressed apices, abdominal distension. Warm head and cold feet, confusion and drinking water. Rapid breathing, diarrhea, and thirst.