〔万〕疮疹虽胎毒，必待时令不正之气相传染而发，盖春气温和，夏气暑热，秋气
清凉，冬气冷冽，此四时正气之序，若春应燠而反寒，夏应热而反清，秋应凉而反
热，冬应寒而反温，此非其时而有其气，乃不正之令也，夫人感之，或为寒热，或
为疟痢，或为喉痹，或为肿，或为 疹，谓之天行正病。又云∶疫疠是以一岁之中，
彼此传染，大小相似，又若冬温阳气暴泄，至于来岁必发疮疹，何也？盖小雪以后，
为终之气，太阳寒水主之，水德不彰，使厥阴、少阴木火之气，反来乘之，阳气
早发，奉生者少，故来春民多病也，况疮疹之毒，藏于至阴之下，发于太阳之经，
当其时而动其气，毒乃发矣，此冬温之后，必发疮疹也。凡此不正之气，发之、泄之、
解之、平之，勿犯岁气，是谓良工，故治疫疠者，以解毒为急。
〔钱〕伤寒，男，体重，面黄。女，面赤，喘息急。各憎寒，口中气热，呵欠顿
闷项急。疮疹则腮赤躁，多喷嚏，悸动昏倦，四肢冷。伤寒当发散之。疮疹当
温平之，有大热者宜解毒。昏睡、喜嚏、悸者将发疮疹。
〔垣〕辨 证∶呵欠，喷嚏，睡中急惊，耳尖冷，眼涩。辨伤寒∶口热，口中
醋气，奶瓣不消，腹中疼痛。〔蔡〕或传染，或伤风，或伤食，或痘疹，其证不一。
头与肢节疼痛无时者，为时疫传染热也。面赤汗出而鼻流清涕者，为伤风热也。午
后发热，头与肚热，上额有纹者，为伤食热也。乍寒乍热，呵欠顿闷，惊悸，咳嗽
嚏喷，两腮赤红， 凉耳凉者，为痘疹热也。浑身壮热，妄言鬼神，口鼻衄血，惊
搐不止，几死而复生，为痘疹实热在内也。
〔钱〕疮疹候，面燥腮赤，目胞亦赤，呵欠顿闷，乍凉乍热，咳嗽嚏喷，足稍冷，
夜卧惊悸、多睡，此疮疹症天行之病也。疮疹始出之时，五脏证见，惟肾无候，
但见平证尔，尻凉耳凉是也。尻耳俱属于肾，其居北方，主冷也。
〔张〕痘之始发，有因伤风伤寒而得者，有因时气传染而得者，有因伤食呕吐而
得者，有跌扑惊恐蓄血而得者，或为窜眼惊搐如风之证，或口舌咽喉腹肚疼痛，或
烦躁狂闷昏睡，或自汗，或下利，或发热，或不发热，证候多端，卒未易辨，须以耳
冷、尻冷、足冷、鼻尖冷验之，并视其耳后有红筋赤缕者为真。又，脉洪大而弦数，
诊脉之际，身略战动，是其证也。
歌曰∶五指稍头冷，惊痫不可安，若还中指热，必定是伤寒。中指独自冷，麻
痘正相干，男左女右别，分明仔细看。
秘法，凡入门看痘，未知是否，但见心窝皮肤内有红色，两耳尖冷，耳筋红。
见此，痘征也。看耳筋法，未出之先紫筋者不治，预以凉血解毒之剂治之，亦有
愈者。若二便秘结，宜先通利。大红者可治而愈，水红者不药而愈，桃红者分轻重
治之。分男左女右看。
〔验热时候〕〔钱〕始发潮热三日以上，热晕入皮肤，即发疮疹而不甚多者，热
留皮腠之间，潮热随脏出，如早食潮热不已，为水泡之类也。〔张〕痘疮皆因发热
而出，即其热之有时，可知其自何脏发出，寅卯辰时潮热者属肝，当出水泡。巳午
未时潮热者属心，当出 疮。申酉戌时潮热者属肺，当为脓泡。亥子丑时潮热者属
脾，当出疹子。
〔用药验是否〕〔王〕验 （此所谓 ，即痘也）法，若三日未觉形迹，当以生酒涂身上，
时时看之，状如蚤痕者是也。或曰伤寒、伤食、潮热，与 疹不能辨者，宜以辛凉
之剂调之，五日以里发出即汗，五日以外无者非 也，各随应见而治之。
〔验证施治〕〔阎〕治小儿壮热昏睡，伤风、风热、疮疹、伤食皆相似，未能
辨认间，服升麻葛根汤、惺惺散、小柴胡汤甚验，盖此数药通治之，不致误也。
惟伤食则大便酸臭，不消化，畏食或吐，宜以药下之。海藏云∶宜以药下之者，
当察其所伤何物，生硬寒热不等，不可遽以巴豆之类大毒之药下之。升麻葛根汤太
阴阳明也。惺惺散治风热咽不利，脾不和，少阳渴，小便不利也。小柴胡汤治往来
寒热，胸胁微痛，少阳也。然欲知其经，当以脉别之。小儿耳冷尻冷，手足乍暖
乍凉，面赤，时嗽时嚏，惊悸，此疮疹欲发候也，未能辨认间，服升麻汤、消毒散，
已发未发皆宜服，仍用胡荽酒、黄柏膏。暑月烦躁，食后与白虎汤、玉露散。热盛，
与紫雪。咽喉或生疮，与甘桔汤、甘露散。余根据前说，大人小儿同治法，惟大小不
同耳。海藏云∶消毒散，太阳药也。白虎汤，治身热目疼鼻干不得卧，阳明药也。
甘露散，肺肾药也。甘桔汤，少阳药也，紫雪、天冬、麦冬、黄芩、生地，为血剂。
玉露散，肺肾药也，石膏、寒水石，为气剂。以上五方，皆泻时暑之药。
【万全】疮疹虽然源于胎毒，但必须等待时令不正之气相互传染才会发作。大概春季气温温和，夏季气候暑热，秋季空气清凉，冬季天气冷冽，这是四时正气的正常顺序。如果春天应当温暖却反而寒冷，夏天应当炎热却反而清冷，秋天应当凉爽却反而炎热，冬天应当寒冷却反而温暖，这种非其时而有其气，就是不正的时令之气。人感受了这种邪气，有的表现为寒热往来，有的表现为疟疾或痢疾，有的表现为喉痹，有的表现为肿胀，有的表现为斑疹，这称为“天行正病”。又说：疫疠是在一年之中，彼此相互传染，症状大小相似。又比如冬温导致阳气暴泄，以至于来年必定会爆发疮疹，为什么呢？因为小雪节气以后，是终之气阶段，由太阳寒水主令。如果水的德性不能彰显，使得厥阴、少阴的木火之气反过来乘袭它，阳气过早发动，奉养生长的力量就少，所以来年的百姓多会生病。况且疮疹之毒，藏于至阴之下，发于太阳之经，当此时节触动其气，毒邪就会发作，这就是为什么冬温之后，必定会爆发疮疹的原因。凡是这些不正之气引发的疾病，治疗时要采用发汗、泄下、解表、平调的方法，不要触犯当年的岁气，这才叫高明的医生。所以治疗疫疠，以解毒为急务。
【钱乙】伤寒症，男孩表现为身体沉重，面色黄；女孩表现为面色红，呼吸急促。两者都憎恶寒冷，口中气息热，呵欠且突然感到胸闷，项部僵硬。疮疹则表现为腮部红赤烦躁，经常打喷嚏，心悸躁动，昏沉疲倦，四肢冰冷。伤寒应当用发散法治疗。疮疹应当用温和平调法治疗，如果有大热的情况，适宜用解毒法。出现昏睡、喜欢打喷嚏、心悸等症状，是即将爆发疮疹的征兆。
【李杲】辨证要点：呵欠、打喷嚏、睡眠中发生急惊风、耳尖发冷、眼睛干涩。辨别伤寒：口热，口中有一股醋味，奶瓣不消化，腹部疼痛。
【蔡松汀】或者是传染病，或者是伤风，或者是伤食，或者是痘疹，症状各不相同。头和肢体关节随时疼痛的，是时疫传染的热证。面红出汗且流清鼻涕的，是伤风热证。午后发热，头和肚子热，上额有纹路的，是伤食热证。忽冷忽热，呵欠胸闷，惊悸，咳嗽打喷嚏，两腮红赤，耳朵和手脚发凉的，是痘疹热证。浑身高热，胡言乱语见鬼神，口鼻出血，惊厥抽搐不止，几乎死亡又复活，这是痘疹实热在体内的表现。
【钱乙】疮疹的先兆症状：面部干燥腮红，眼睑也红，呵欠胸闷，忽冷忽热，咳嗽打喷嚏，脚稍冷，夜间睡觉惊悸、嗜睡，这是疮疹作为天行病的症状。疮疹刚开始发出时，五脏的症状都会显现，只有肾脏没有特定的征候，只看到平和的症状，即臀部凉、耳朵凉。臀部和耳朵都属于肾，位于北方，主冷。
【张琰】痘疮刚开始发作，有的是因伤风伤寒而得的，有的是因时气传染而得的，有的是因伤食呕吐而得的，有的是因跌打惊恐蓄血而得的。或者出现窜眼、惊厥抽搐像中风一样的症状，或者口舌咽喉腹部疼痛，或者烦躁狂闷昏睡，或者自汗，或者腹泻，或者发热，或者不发热，证候多种多样，仓促之间难以辨认。必须以耳冷、臀部冷、脚冷、鼻尖冷来验证，并观察其耳后是否有红筋赤缕，这才是真的痘疮。另外，脉象洪大而弦数，诊脉时身体略微颤抖，也是这个证候的表现。
歌诀说：五指梢头冷，惊痫不安宁；若还中指热，必定是伤寒。中指独自冷，麻痘正相关；男女分左右，分明仔细看。
秘法：凡入门看痘，不知道是不是痘疮，只要看见心窝皮肤内有红色，两耳尖冷，耳筋发红，见此现象，就是痘征。看耳筋的方法：未出痘之前，如果是紫筋者不治，预先用凉血解毒的药剂治疗，也有痊愈的。如果二便便秘结，宜先通利大便。大红色的可以治愈，水红色的不吃药也能自愈，桃红色的根据轻重分别治疗。分男左女右来看。
【验热的时候】
【钱乙】开始发作潮热三天以上，热晕进入皮肤，随即发出疮疹而且不多的，是热留在皮腠之间，潮热随着脏腑而出。如果早饭后潮热不停止，是水泡之类的症状。
【张琰】痘疮都是因为发热而出，根据其发热的时辰，就可以知道是从哪个脏腑发出的。寅卯辰时潮热的属于肝，应当出水泡。巳午未时潮热的属于心，应当出疮。申酉戌时潮热的属于肺，应当为脓泡。亥子丑时潮热的属于脾，应当出疹子。
【用药验是否】
【王肯堂】验证痘疮（此所谓“疹”，即痘也）的方法：如果三天还没有感觉到形迹，应当用生酒涂在身上，时时观察，形状像蚤咬痕迹的就是痘疮。有人说伤寒、伤食、潮热，与痘疹不能辨别的，适宜用辛凉的药剂调理，五日内发出就有汗，五日以外没有的不是痘疮，各自根据应该见到的症状来治疗。
【验证施治】
【阎孝忠】治疗小儿壮热昏睡，伤风、风热、疮疹、伤食的症状都很相似，在未能辨认清楚期间，服用升麻葛根汤、惺惺散、小柴胡汤非常有效，因为这些药物能通治这些病症，不会误治。只有伤食会导致大便酸臭、不消化、畏食或呕吐，适宜用下药攻下。海藏（张元素）说：适宜用下药攻下的，应当考察所伤的是什么食物，生冷硬热不等，不可立刻用巴豆之类大毒的药物攻下。升麻葛根汤治理太阴阳明经的病。惺惺散治疗风热咽不利、脾不和、少阳渴、小便不利。小柴胡汤治疗往来寒热、胸胁微痛，属于少阳经。然而想要知道是哪一经，应当通过脉象来辨别。小儿耳冷、臀部冷、手足忽暖忽凉、面红、时而咳嗽时而打喷嚏、惊悸，这是疮疹将要发作的征兆。在未能辨认清楚期间，服用升麻汤、消毒散，无论已发未发都适宜服用，同时使用胡荽酒、黄柏膏。暑月烦躁，食后给予白虎汤、玉露散。热盛，给予紫雪。咽喉生疮，给予甘桔汤、甘露散。其余按照前面的说法，大人小孩治疗方法相同，只是剂量不同罢了。海藏说：消毒散，是太阳经的药。白虎汤，治疗身热目疼鼻干不得卧，是阳明经的药。甘露散，是肺肾经的药。甘桔汤，是少阳经的药。紫雪、天冬、麦冬、黄芩、生地，属于血剂。玉露散，是肺肾经的药，石膏、寒水石，属于气剂。以上五个方子，都是泻除时暑的药。
[Wan Quan] Although variola (smallpox) and exanthems originate from fetal toxins, they must wait for the abnormal qi of the seasons to transmit among people before erupting. Generally, spring qi is mild, summer qi is hot and humid, autumn qi is cool and dry, and winter qi is cold and biting; this is the normal sequence of the four seasons' righteous qi. If spring should be warm but turns cold, summer should be hot but turns clear and cool, autumn should be cool but turns hot, and winter should be cold but turns warm, this is having the qi out of season, which constitutes an abnormal seasonal command. When humans are affected by this, some manifest as alternating chills and fever, some as malaria or dysentery, some as throat obstruction (Hou Bi), some as swelling, and some as macules and papules (Zhen). This is called "Heavenly Epidemic Righteous Disease." It is also said: Epidemic diseases (Yi Li) involve mutual transmission within a year, with symptoms similar in severity across all ages. Furthermore, if winter warmth causes a sudden leakage of yang qi, it will inevitably lead to the eruption of variola/exanthems in the following year. Why? Because after the Solar Term of Light Snow, it is the final phase of the year, governed by Taiyang Cold Water. If the virtue of water fails to manifest, allowing Jueyin and Shaoyin Wood-Fire qi to counter-attack, yang qi emerges prematurely, resulting in insufficient nourishment for growth. Thus, the people will fall ill frequently in the coming spring. Moreover, the toxin of variola/exanthems hides beneath the extreme yin and erupts via the Taiyang meridian. When the appropriate time arrives and stirs its qi, the toxin erupts. This explains why variola/exanthems inevitably follow winter warmth. For diseases caused by such abnormal qi, treatment should employ sweating (Fa Han), purging (Xie), resolving (Jie), and balancing methods, without violating the annual qi. This is termed the work of a skilled physician. Therefore, in treating epidemic diseases, detoxification is the priority.
[Qian Yi] In Shanghan (Cold Damage), boys present with heavy body weight and sallow complexion; girls present with red face and rapid breathing. Both groups exhibit aversion to cold, hot breath, yawning with sudden chest oppression, and neck stiffness. In contrast, exanthems present with red and restless cheeks, frequent sneezing, palpitations, drowsiness, lethargy, and cold limbs. Shanghan should be treated with dispersing methods. Exanthems should be treated with warming and balancing methods; if there is intense heat, detoxification is indicated. Drowsiness, preference for sneezing, and palpitations are signs that exanthems are about to erupt.
[Liu Wansu/Danxi School context - Note: Yuan Hao is Li Gao's contemporary/student, often grouped here] Differentiation of Symptoms: Yawning, sneezing, acute convulsions during sleep, cold ear tips, and dry eyes. Differentiating Shanghan: Hot mouth, sour odor in the mouth, undigested milk curds, and abdominal pain.
[Cai Songting] The condition may stem from contagion, wind-cold/wind-heat injury, food stagnation, or variola/exanthems, presenting variously. Pain in the head and joints occurring at irregular intervals indicates febrile disease from epidemic contagion. Red face with sweating and clear nasal discharge indicates wind-heat injury. Fever in the afternoon, heat in the head and abdomen, and lines on the upper forehead indicate food-stagnation heat. Alternating chills and fever, yawning with chest oppression, palpitations, coughing, sneezing, bright red cheeks, and cold ears/hands/feet indicate variola/exanthem heat. Generalized high fever, delirium seeing spirits, epistaxis, unceasing convulsions, near-death experience followed by revival, indicates excess heat of variola/exanthems trapped internally.
[Qian Yi] Prodromal signs of exanthems: Dry face with red cheeks, red eyelids, yawning with chest oppression, alternating chills and fever, coughing and sneezing, slightly cold feet, nighttime startle/palpitations, and excessive sleep. These are signs of exanthems as a heavenly epidemic disease. At the initial eruption of exanthems, signs of the five zang organs appear, except for the Kidney, which shows only peaceful signs, specifically coolness of the buttocks and ears. The buttocks and ears belong to the Kidney, located in the North, governing cold.
[Zhang Yan] The onset of variola may result from wind-cold/shanghan, epidemic contagion, food stagnation/vomiting, or trauma/fright/blood stasis. Manifestations may include eye involvement, convulsions resembling wind-stroke, pain in the mouth, tongue, throat, or abdomen, restlessness, mania, deep sleep, spontaneous sweating, diarrhea, fever, or absence of fever. The patterns are diverse and difficult to distinguish hastily. Verification must rely on coldness of the ears, buttocks, feet, and nose tip. Additionally, observing red veins or threads behind the ears confirms true variola. Furthermore, a pulse that is surging, large, wiry, and rapid, accompanied by slight tremors of the body during pulse diagnosis, indicates this condition.
Song says: Cold fingertips indicate unsettled fright and epilepsy; warmth in the middle finger indicates definite Shanghan. Isolated coldness in the middle finger relates directly to measles or smallpox; distinguish between males (left) and females (right) carefully.
Secret method: When initially examining for variola, if uncertain, look for redness under the skin of the heart pit, cold ear tips, and red ear veins. Seeing these indicates variola signs. Regarding ear veins: purple veins before eruption are untreatable; treat preemptively with blood-cooling and detoxifying formulas, though some may recover. If constipation occurs, first promote bowel movement. Bright red cases are treatable and curable; pale red cases heal without medicine; peach-red cases require treatment based on severity. Observe left for males and right for females.
[Verifying Heat Timing]
[Qian Yi] If tidal fever lasts more than three days upon onset, and the heat晕 (yun/miasma) enters the skin, exanthems will erupt but not excessively. This indicates heat remaining in the skin and interstices, emerging with the tidal fever according to the affected zang organ. If tidal fever persists after early meals, it indicates vesicles.
[Zhang Yan] Variola always erupts due to fever. By observing the timing of the fever, one can determine the originating zang organ. Tidal fever during Yin-Mao-Chen hours belongs to the Liver, indicating vesicle eruption. Tidal fever during Si-Wu-Wei hours belongs to the Heart, indicating pustule/ulcer eruption. Tidal fever during Shen-You-Xu hours belongs to the Lungs, indicating pus-filled blisters. Tidal fever during Hai-Zi-Chou hours belongs to the Spleen, indicating rash eruption.
[Using Medication to Verify]
[Wang Kentang] To verify variola (referred to here as Zhen, meaning smallpox): If no visible traces appear after three days, apply raw wine to the body and observe frequently. If the marks resemble flea bites, it is variola. Some argue that Shanghan, food stagnation, and tidal fever cannot be distinguished from variola/rash. In such cases, use acrid-cool formulas to regulate. If eruption occurs with sweating within five days, it is confirmed; if not after five days, it is not variola. Treat according to the specific manifestations.
[Verification and Treatment]
[Yan Xiaozhong] Treating pediatric high fever and drowsiness: Wind-cold, wind-heat, exanthems, and food stagnation present similarly. During the period of uncertainty, administering Shengma Gegen Tang (Cimicifugae and Puerariae Decoction), Xingxing San (Awakening Powder), or Xiao Chaihu Tang (Minor Bupleurum Decoction) is highly effective, as these formulas broadly address these conditions without error. However, food stagnation presents with sour-smelling, undigested stool, anorexia, or vomiting, requiring purgative treatment. Haizang (Zhang Yuansu) stated: When using purgatives, one must identify the ingested substance, as foods vary in nature (raw, hard, cold, hot). Do not hastily use highly toxic purgatives like Radix Crotonis (Badou). Shengma Gegen Tang addresses Taiyang and Yangming channels. Xingxing San treats wind-heat causing throat obstruction, spleen dysfunction, Shaoyang thirst, and dysuria. Xiao Chaihu Tang treats alternating chills and fever and slight hypochondriac pain, addressing the Shaoyang channel. To identify the channel, differentiate by pulse. Pediatric signs of impending exanthems include cold ears/buttocks, fluctuating hand/foot temperature, red face, intermittent cough/sneezing, and palpitations. While differentiation is unclear, Shengma Tang and Xiaodu San are suitable regardless of eruption status. Also apply Hu Su Jiu (Coriander Wine) and Huang Bo Gao (Phellodendron Ointment). For irritability in summer months, administer Baihu Tang (White Tiger Decoction) or Yulu San (Jade Dew Powder) after meals. For intense heat, administer Zixue (Purple Frost). For throat ulcers, administer Ganjie Tang (Licorice and Platycodon Decoction) or Ganlu San (Sweet Dew Powder). Other treatments follow previous descriptions; adult and pediatric therapies are identical, differing only in dosage. Haizang stated: Xiaodu San is a Taiyang channel formula. Baihu Tang treats body heat, eye pain, nasal dryness, and insomnia; it is a Yangming channel formula. Ganlu San targets Lung and Kidney. Ganjie Tang targets Shaoyang. Zixue, Tian Dong (Asparagi Radix), Mai Dong (Ophiopogonis Radix), Huang Qin (Scutellariae Radix), and Sheng Di Huang (Rehmanniae Radix) are blood-level agents. Yulu San targets Lung and Kidney; Shi Gao (Gypsum Fibrosum) and Hanshui Shi (Lapis Aquamarina) are qi-level agents. The above five formulas are all used to drain summer-heat.