一、出痘之时，须面稀少，胸前背上，皆无根窠，红润顶突碍手，如水珠光泽者，上吉也，不须用药而愈。
一、出痘之时，腰腹疼痛不止，口气大臭，其自出紫黑色黯者，决死。
一、出痘之时，白色皮薄，而光根全无红色，或根带一点红，
三五粒如绿豆样，此痘决不能贯脓，久后成泡清水，擦破即死，不可因其好者而妄与下药。
一、出痘之时，全不起，顶如汤泡，及灯草火灰者，十日后，决主痒塌而死。
一、出痘之时，口鼻及耳烊红，血不止者，决死。
一、出痘之时，起红斑如纹者，六七日后，决死。
一、出痘之时，起黑斑如痣状，肌肉有成块黑者，即死。
一、出痘虽稀，根窠全白无血色，三四日便起胀，痘大按之虚软，此名贼痘。血气太虚，至贯脓
时变成水泡，大若葡萄，内是清水，无脓皮薄，白如纸，擦破即死。好痘相间，可治。
凡痘初出，每三五点相连者，必密；单见形者，稀。有小红点
先见，名血痘，不起不退者不治。
凡痘出后见红点，太阳脉门，胸心喉掩无者，可治。若太阳两颊、胸心如蚕种，不治。干涩如 尬者，不
治。舌缩者不治。初出即虚泛，不治。灯照恍惚，见黑荫者，不治。见赤点，如绿豆大，于两腋小腹数点者，不治。
胡荽酒 治痘疹，已发未发，喷之立出。
胡荽三两细切，以酒二钟煎沸，用纸密封，不令气出，候冷去渣，从顶至颐颔微微涂之，更喷背膂胸腹
及两腿皆遍，再用满房门户遍洒之，尤妙。
化毒汤 治痘已出，以此消毒，或出不快，皆宜服之。一云∶痘疮欲出，浑身壮热，不思饮食，若
服此一剂，即内消已；有一两颗出，即解其半；若全出，即当日头焦，只三服愈。
紫草茸（五钱） 川升麻（二钱半） 甘草（炙，二钱半）
上锉，每二钱，糯米五十粒，同煎服。
消毒饮 治痘疮初出，胸前稠密者，急进此药三四服，决透，消毒应手，神效。
鼠粘子（四钱） 荆芥（二钱） 甘草（一钱，生用） 防风（去芦，五分）
本方加山楂、黄芩酒洗、紫草煎服。减食，加人参，细锉一剂，水煎，加生犀角尤妙。
加味四圣散 治痘疮出不快，及变黑陷者。
紫草茸 木通 黄 川芎 南木香（各等分） 甘草（炙，减一半）
上锉，水煎服。如大便闭，加枳壳；大便如常，加糯米百粒解
毒，能酿而发之。杨氏曰∶糯米能解毒发疮。
紫草饮子 治痘出不快，三四日隐隐将出未出。紫草二两，细锉，百沸汤一大碗，沃之盖定，
勿令气出，逐旋温服。紫草能动大便，发出亦轻。大便利者，不可用。
丝瓜散 治痘出不快最妙。
丝瓜不拘几个，连皮、子烧存性为末。每服一抄，时时用米汤
调服，此物发痘最妙。或以紫草、甘草煎汤，调服尤佳。
紫草膏
全蝎（二十个） 僵蚕（八个，炒） 麻黄（五钱） 甘草（五钱） 紫草（五钱） 蟾酥（一
钱） 白附子（五钱）
上为细末，另将紫草一两，锉、煎，去渣，熬成膏，紫草汤化下。又用蜜二两，入好酒半盏，炼过，
同紫草膏搅匀，调前末药，丸如皂角子大，每三四岁儿服一丸。红紫黑陷属热毒者，紫草汤化
下；淡白灰陷属虚寒者，好酒化开，热服。发热之初，煎败毒散化下，表汗亦能稀痘；证似风寒者，参苏
饮化下；发惊者，薄荷、灯心、葱白汤化下。
保元汤
人参（去芦，二钱） 甘草（一钱） 嫩黄 （一钱）
上锉一剂，生姜一片，水煎温服。
一二日初出，圆晕成形，干红少润，毒虽犯上，其气血未离，可治，以俟其气血交会也。然毒尚浅，
急以保元汤加官桂，兼活血匀气之剂；如毒若盛，兼解毒之药活血，加当归五分，白芍一钱；匀气，加陈
皮五分；解毒，加玄参七分，牛蒡子炒七分，水一盏，煎七分，温服。
二三日根窠虽圆，而顶陷者，血亦难聚，为气虚弱，不能领袖其血，以保元汤加川芎、官桂扶阳抑阴，
岂有不痊者哉？
四五日根窠虽起，色不光泽，生意犹存，为气弱血盛，以保元汤加芍药、官桂、糯米助卫制荣，斯
为调燮之妙也。
五六日气盈血弱，色昏红紫，以保元汤加木香、当归、川芎助
血归附气位，以全中和之道也。
五六七日，气交不旺，血虽归附，不能成浆，为气血少，寒不
能制，急投保元汤加官桂、糯米助其成浆，而收济惠之伟功，斯为治矣。
七八日，毒虽化浆而不满，为血气有疑，不能大振，以保元汤加官桂、糯米发阳助浆，斯可以保全生命矣。
（一至此专主贯脓，脓已满，虽有他证，亦不坏事。若痘无脓灰暗，虽无他证，亦死。）
八九日，浆不冲满，血附线红，气弱而危也，以保元汤加糯米，
以助其气而驾其血，斯浆成矣，于此可见施治者之妙道也。
十一二日，气血冲满，血尽浆足。湿润不敛者，内虚也，以保元汤，血亦有力，加白术、茯苓助其收敛而结痂也。
十三四日，毒虽尽解，浆老结痂之际，或有杂证相仍，以保元
汤随证加减，不可峻用寒凉大热之剂，恐致内损之患故也。
十四五六日，痂落，潮热唇红，口渴不食，以使君子汤加陈皮、山楂、黄连。如渴甚，以参苓白
术散；如热不解，以大连翘饮去黄芩主之。证去之后，多有内损，或余毒未解，此则尤为难治也。
凡痘疹发渴者，为气弱而津液枯竭也，以保元汤加麦门冬、五味子即止；如不止，以参苓白术术散
一二剂即止。
凡痘疮不起发，脓浆不浓，以保元汤加川芎五分，丁香四分，夏月二分，
糯米二百粒，煎熟，加好酒、人乳各半盏同服。
若头额不起胀，加川芎六分为引。若面部不起胀，加桔梗四
分为引。若腰膝不起胀，加牛膝四分为引。若两手不起胀，加桂枝二分为引。
1. During the eruption of smallpox, if the face is sparse, and there are no roots on the chest and back, with a ruddy color and protruding tops that feel rough to the touch, shining like water droplets, this is an auspicious sign of the highest order; it will heal without medication.
2. During the eruption of smallpox, if there is unceasing pain in the waist and abdomen, foul breath, and the eruptions naturally turn purple-black and dull, death is certain.
3. During the eruption of smallpox, if the eruptions are white with thin skin, completely lacking redness at the base, or having only a trace of red at the base, appearing in clusters of three to five grains the size of mung beans, these eruptions will certainly not suppurate. Later they become blisters filled with clear fluid; if broken, death ensues. Do not recklessly administer purgative medicines just because some eruptions appear favorable.
4. During the eruption of smallpox, if the eruptions fail to rise entirely, with tops resembling hot-water blisters or ash from rush lights, after ten days, death by itching and collapse is certain.
5. During the eruption of smallpox, if the mouth, nose, and ears become red and swollen with unceasing bleeding, death is certain.
6. During the eruption of smallpox, if red spots resembling patterns appear, death is certain after six or seven days.
7. During the eruption of smallpox, if black spots resembling moles appear, or if patches of muscle turn black, death follows immediately.
8. Although the eruptions may be sparse, if the bases are entirely pale and bloodless, and swelling begins within three to four days, with large eruptions that feel soft upon pressure, this is called "Thief Pox" (Ze Dou). Due to extreme deficiency of blood and qi, when the time for suppuration arrives, they transform into blisters the size of grapes, containing clear fluid without pus, thin-skinned, white as paper; if broken, death ensues. If good eruptions are interspersed, treatment is possible.
Generally, when smallpox first appears, eruptions appearing in clusters of three to five points indicate density; those appearing singly indicate sparsity. The early appearance of small red dots is named "Blood Pox" (Xue Dou); if they neither rise nor recede, the condition is incurable.
After smallpox has erupted, if red dots are seen but the Taiyang pulse gate, chest, heart area, and throat are free of eruptions, the condition is treatable. However, if eruptions resemble silkworm eggs densely distributed on both cheeks of the Taiyang region and the chest/heart area, the condition is incurable. Dry and rough eruptions resembling bumps are incurable. A retracted tongue is incurable. Eruptions that appear initially flat and diffuse are incurable. Hazy vision under lamplight revealing black shadows is incurable. Red spots the size of mung beans appearing in several locations in both armpits and the lower abdomen are incurable.
Hu Sui Jiu (Coriander Wine): Treats smallpox-rash, whether erupted or not yet erupted; spraying induces immediate eruption.
Three liang of finely chopped Hu Sui (Coriandri Fructus) are boiled in two zhong of wine until boiling. Seal tightly with paper to prevent vapor loss. After cooling, remove dregs. Apply gently from the crown to the chin. Spray thoroughly over the back, spine, chest, abdomen, and legs. Sprinkle around all doors and windows in the house for optimal effect.
Hua Du Tang (Detoxification Decoction): Treats erupted smallpox to eliminate toxins, or slow eruption. It is suitable for both cases. Some say: When smallpox is about to erupt, causing high fever and loss of appetite, one dose eliminates internal toxicity; if one or two spots emerge, half the toxicity is resolved; if fully erupted, scabbing occurs that day, cured in three doses.
Zi Cao Rong (Arnebiae Radix et Rhizoma, 5 qian), Chuan Sheng Ma (Bupleuri Radix, 2.5 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, roasted, 2.5 qian).
Chop coarsely. Take 2 qian per dose with 50 grains of Nuomi (Oryzae Sativa Semen glutinosum), decoct in water, and take orally.
Xiao Du Yin (Toxin-Resolving Drink): Treats early-stage smallpox with dense eruptions on the chest. Administer urgently, three to four doses, to ensure full eruption and rapid toxin resolution with miraculous efficacy.
Shu Niu Zi (Araliae Japonicae Fructus, 4 qian), Jing Jie (Schizonepetae Herba, 2 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, raw, 1 qian), Fang Feng (Saposhnikoviae Radix, de-rhizome, 0.5 qian).
Add Shan Zha (Crataegi Fructus), Huang Qin (Scutellariae Radix washed with wine), and Zi Cao (Arnebiae Radix et Rhizoma) to the decoction. If appetite is poor, add Ren Shen (Ginseng Radix). Chop finely, decoct one dose in water; adding Sheng Xi Jiao (Rhinocerotis Cornu, raw) is especially excellent.
Jia Wei Si Sheng San (Modified Four Sages Powder): Treats slow eruption of smallpox and blackening/collapse.
Zi Cao Rong (Arnebiae Radix et Rhizoma), Mu Tong (Akebiae Caulis), Huang Qi (Astragali Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Nan Mu Xiang (Aucklandiae Radix) in equal parts. Gan Cao (Glycyrrhizae Radix et Rhizoma, roasted, halved).
Chop coarsely, decoct in water, and take orally. If constipation exists, add Zhi Ke (Aurantii Fructus Immaturus). If bowel movements are normal, add 100 grains of Nuomi (Oryzae Sativa Semen glutinosum) to resolve toxins and promote eruption. Yang Shi stated: Nuomi resolves toxins and promotes eruption.
Zi Cao Yin Zi (Arnebiae Drink): Treats slow eruption where eruptions are faintly visible but not fully out after three to four days. Two liang of Zi Cao (Arnebiae Radix et Rhizoma), finely chopped, steeped in one large bowl of boiling water. Cover tightly to retain vapor. Take warm gradually. Zi Cao promotes bowel movement and causes mild eruption. Contraindicated in patients with loose stools.
Si Gua San (Loofah Powder): Most effective for treating slow eruption of smallpox.
Si Gua (Luffae Fructus Retinervus), any quantity, including peel and seeds, burned until carbonized (preserving nature), ground into powder. Take one scoop per dose, mixed with rice gruel frequently. This herb is excellent for promoting eruption. Alternatively, decoct Zi Cao (Arnebiae Radix et Rhizoma) and Gan Cao (Glycyrrhizae Radix et Rhizoma) in water to mix with the powder; this is even better.
Zi Cao Gao (Arnebiae Ointment/Pill Base)
Quan Xie (Scorpio, 20 pieces), Jiang Can (Bombyx Batryticatus, fried, 8 pieces), Ma Huang (Ephedrae Herba, 5 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, 5 qian), Zi Cao (Arnebiae Radix et Rhizoma, 5 qian), Chan Su (Toad Venom, 1 qian), Bai Fu Zi (Typhonii Rhizoma, 5 qian).
Grind into fine powder. Separately, take one liang of Zi Cao (Arnebiae Radix et Rhizoma), chop, decoct, remove dregs, and boil down into an ointment. Dissolve pills in Zi Cao decoction. Also, refine two liang of honey with half a zhan of good wine. Mix evenly with the Zi Cao ointment and the powdered herbs. Form pills the size of soap pods. Children aged three to four years take one pill. For red, purple, or black collapsed eruptions due to heat-toxin, dissolve in Zi Cao decoction. For pale, white, or gray collapsed eruptions due to deficiency-cold, dissolve in good wine and take warm. At the onset of fever, dissolve in Bai Du San (Detoxifying Decoction) to induce sweating and lighten the eruption. For symptoms resembling wind-cold, dissolve in Shen Su Yin (Ginseng and Perilla Drink). For convulsions, dissolve in a decoction of Bo He (Menthae Haplocalycis Herba), Deng Xin Cao (Junci Medulla), and Cong Bai (Allii Fistulosi Bulbus).
Bao Yuan Tang (Preserve Origin Decoction)
Ren Shen (Ginseng Radix, de-rhizome, 2 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, 1 qian), Nen Huang Qi (Young Astragali Radix, 1 qian).
Chop one dose. Add one slice of Sheng Jiang (Zingiberis Rhizoma Recens). Decoct in water and take warm.
On days one and two, when eruptions first appear, forming round halos, dry and red with little moisture, although the toxin affects the upper body, the blood and qi have not yet dispersed; this is treatable, awaiting the intersection of blood and qi. Since the toxin is still shallow, urgently use Bao Yuan Tang (Preserve Origin Decoction) with Guan Gui (Cinnamomi Cortex) combined with formulas that invigorate blood and harmonize qi. If the toxin is severe, combine with detoxifying herbs to invigorate blood; add Dang Gui (Angelicae Sinensis Radix, 0.5 qian) and Bai Shao (Paeoniae Radix Alba, 1 qian). To harmonize qi, add Chen Pi (Citri Reticulatae Pericarpium, 0.5 qian). To resolve toxins, add Xuan Shen (Scrophulariae Radix, 0.7 qian) and Niu Bang Zi (Arnebiae Japonicae Fructus, fried, 0.7 qian). Decoct in one sheng of water until reduced to 0.7 sheng, take warm.
On days two and three, if the bases are round but the tops are depressed, blood is difficult to gather due to weak qi failing to lead the blood. Use Bao Yuan Tang (Preserve Origin Decoction) with Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Guan Gui (Cinnamomi Cortex) to support yang and suppress yin. Recovery is assured.
On days four and five, if the bases have risen but lack luster, though vitality remains, this indicates weak qi and abundant blood. Use Bao Yuan Tang (Preserve Origin Decoction) with Shao Yao (Paeoniae Radix), Guan Gui (Cinnamomi Cortex), and Nuomi (Oryzae Sativa Semen glutinosum) to assist Wei Qi (Defensive Qi) and control Ying Blood (Nutritive Blood). This represents the subtlety of regulation.
On days five and six, if qi is abundant but blood is weak, with a dull red-purple color, use Bao Yuan Tang (Preserve Origin Decoction) with Mu Xiang (Aucklandiae Radix), Dang Gui (Angelicae Sinensis Radix), and Chuan Xiong (Ligustici Chuanxiong Rhizoma) to help blood return to its qi position, preserving the Way of Harmony.
On days five, six, and seven, if qi interaction is not vigorous, and although blood returns, it cannot form pus due to deficiency of blood and qi and inability to counteract cold, urgently preserve Bao Yuan Tang (Preserve Origin Decoction) with Guan Gui (Cinnamomi Cortex) and Nuomi (Oryzae Sativa Semen glutinosum) to assist pus formation, achieving great remedial effects. This constitutes proper treatment.
On days seven and eight, although the toxin transforms into pus, it is not full due to doubt in blood and qi preventing vigorous action. Use Bao Yuan Tang (Preserve Origin Decoction) with Guan Gui (Cinnamomi Cortex) and Nuomi (Oryzae Sativa Semen glutinosum) to stimulate yang and assist pus formation, thereby preserving life.
(Until this stage, the focus is on suppuration. Once pus is full, other symptoms do not ruin the outcome. If eruptions lack pus and are gray/dull, death occurs even without other symptoms.)
On days eight and nine, if pus does not fill completely, with blood adhering in red lines, indicating weak qi and danger, use Bao Yuan Tang (Preserve Origin Decoction) with Nuomi (Oryzae Sativa Semen glutinosum) to assist qi and manage blood, thus forming pus. Herein lies the brilliance of the practitioner.
On days eleven and twelve, blood and qi are full, blood exhausted, and pus sufficient. If moist and not drying/converging, it indicates internal deficiency. Use Bao Yuan Tang (Preserve Origin Decoction); since blood is strong, add Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Fu Ling (Poria) to aid convergence and scabbing.
On days thirteen and fourteen, although toxins are resolved and pus matures into scabs, miscellaneous symptoms may persist. Modify Bao Yuan Tang (Preserve Origin Decoction) according to symptoms. Do not harshly use cold or hot remedies, lest internal damage occur.
On days fourteen, fifteen, and sixteen, as scabs fall, tidal fever, red lips, thirst, and anorexia may occur. Use Shi Jun Zi (Quisqualis Fructus) with Chen Pi (Citri Reticulatae Pericarpium), Shan Zha (Crataegi Fructus), and Huang Lian (Coptidis Rhizoma). If thirst is severe, use Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder). If fever persists, use Da Lian Qiao Yin (Large Forsythia Drink) removing Huang Qin (Scutellariae Radix). After symptoms resolve, internal damage often remains, or residual toxins linger, making treatment particularly difficult.
For smallpox-rash accompanied by thirst, caused by weak qi and depletion of body fluids, use Bao Yuan Tang (Preserve Origin Decoction) with Mai Men Dong (Ophiopogonis Tuber) and Wu Wei Zi (Schisandrae Fructus) to stop thirst. If ineffective, use Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) for one to two doses.
For smallpox eruptions that fail to rise and produce thin pus, use Bao Yuan Tang (Preserve Origin Decoction) with Chuan Xiong (Ligustici Chuanxiong Rhizoma, 0.5 qian), Ding Xiang (Caryophylli Flos, 0.4 qian, 0.2 qian in summer), and Nuomi (Oryzae Sativa Semen glutinosum, 200 grains). Decoct well, then add half a zhan of good wine and half a zhan of human milk, taken together.
If the forehead fails to swell, add Chuan Xiong (Ligustici Chuanxiong Rhizoma, 0.6 qian) as a guiding herb. If the face fails to swell, add Jie Geng (Platycodonis Radix, 0.4 qian) as a guiding herb. If the waist and knees fail to swell, add Niu Xi (Achyranthis Bidentatae Radix, 0.4 qian) as a guiding herb. If the hands fail to swell, add Gui Zhi (Cinnamomi Ramulus, 0.2 qian) as a guiding herb.