发热三朝始见点，热减身和不渴烦，颗粒稀疏渐次出，色润红活顶尖圆。
【注】发热三朝之后始见点者，此痘如期而出也。热减身和者，毒已宣发透彻也。不
渴不烦者，无里热壅滞也。颗粒稀疏者，不稠密联系也，渐次出者，先自头面渐至周身
而出也。色润红者，痘色红活滋润也。顶尖圆者，痘形顶尖而体圆也。此皆见点顺证。
痘已见形身仍热，稠密联系不润红，稀疏淡隐精神少，痘顺兼杂病险名。
【注】痘已见形，身仍发热者，此毒瓦斯未尽透也。稠密者，痘出稠密不少也。联系者，
颗粒粘连不分也。不润红者，痘色虽红而黯滞也。稀疏淡隐者，痘虽稀疏而色浅淡，隐
于皮肤不透出也。精神少者，精神倦怠也。此皆见点险证。痘顺兼杂病者，谓痘出虽属顺
证，而或兼杂病，亦属险名也。
发热一朝即见形，一齐涌出不分明，密如蚕种平塌隐，紫黑干枯逆证凶。
【注】发热一朝或半朝即见点者，此毒火太迅，不循次第也。一齐涌出者，此毒火太
盛，不受领载也。点不分明者，颗粒不分也。密如蚕种者，密如蚕之种也。平塌者，平塌
不起也。隐者，痘已出复隐也。紫黑者，痘色或紫或黑也。干枯者，痘干枯不润也。此
皆见点逆证。
发热三朝渐见点，热减形疏色润红，应出不出出犹热，已出复隐涌出凶。赤紫黑白
分亮黯，平板稠连辨紧松，当审风寒毒火制，气血虚失领载能。
【注】发热三朝渐渐见点者，谓见点不疾不徐也。热减者，谓痘出齐而热减退也。形
疏者，谓痘稀疏颗粒分明也。色润红者，谓色红而润泽也。皆见点顺痘也。应出不出者，
谓发热三日之后而不见点，此毒伏于内也。出犹热者，谓痘已出齐，而犹身热不退，此毒
热盛也。已出复隐者，谓痘已见点，复隐藏不见，此毒陷内攻也。涌出者，谓发热不待
三日，其痘一齐涌出，此毒火迅烈也。此皆逆而主凶之痘也。赤紫黑白者，谓痘色红为
正，或深红赤色、深赤紫色、紫甚黑色、不红白色，皆非正色也。分亮黯者，谓非正色
之痘，又当分亮黯而取治焉。亮者多虚，黯者多实。赤紫黑色明亮者，尚有活动可治之
机；若滞黯则为毒热凝滞不行也；色白亮者，乃气血因虚不荣也；白而黯者，谓气血为毒
所制也。平板稠连者，谓痘形平塌不起，板硬不绽，或稠密成攒，联系不分，皆非正形
也。辨紧松者，谓非正形之痘，当辨紧松而取治焉。紧松者，根脚之紧松也。紧者毒滞，
松者毒松。平板稠连，根形松绽，尚有活动可治之机；若根形紧束，则为毒盛瘀滞，难
治之痘也。当审风寒毒火制者，谓已上痘之形色，各有所因，当审其为风寒外郁，火毒
内锢也。气血虚失领载能者，谓或因气虚不
能领毒，血虚不能载毒，使毒不能发于肌表，而失领载之能也。
苏解散 归宗汤 保元汤 升麻葛根汤
应出不出表苏解，羌苏升葛桔荆防，川芎前薄楂通草，里热毒伏归宗汤。不足不出
无表里，参 甘草保元汤，毒轻升麻葛根并，毒重攻毒救正良。
【注】痘发热三朝，期应见点而不见点，则为应出不出。若有表邪风寒外郁不出，宜
用苏解散发之，表开自然出也。若无表证而有里热者，此为毒火内伏不出，宜用归宗汤
攻之，里开自然出也。若形气不足，应出不出，无表里证者，是正气虚而不能发出也。若
毒轻热微，宜用保元汤合升麻葛根汤并而用之，补正除邪可也。若有表里证，或毒重热
甚，则不宜补，恐助火毒，宜苏解散或归宗汤，攻邪救正为良法也。
苏解散
川芎 前胡 牛蒡子（炒） 南山楂 木通 生甘草 羌活 苏叶 升麻 葛根 桔梗 荆芥 防风
引加芫荽，水煎服。
保宗汤（方见发热证治）
保元汤
人参 黄 （制） 甘草（炙）
引加生姜，水煎服。
升麻葛根汤（方见发热证治）
凉血攻毒饮 清热解毒汤
已出犹热分表里，在内凉血攻毒佳，红花紫草丹蝉葛，合上归宗减去楂。在外清热
解毒治，归宗大赤不须加，更入前连丹蝉蜕，紫花地丁滑红花。
【注】痘已见形，身热当减，若仍热不退，此属毒火盛也，须分表里施治。若见在内毒
火盛之证，宜用凉血攻毒饮攻之。其方即红花、紫草、丹皮、蝉蜕、葛根，合上归宗汤
药，减去山楂也；若见在外毒火盛之证，宜用清热解毒汤解之。其方即归宗汤减去大黄、
赤芍，更加前胡、黄连、丹皮、蝉蜕、紫花地丁、滑石、红花是也。
凉血攻毒饮
大黄 荆芥穗 木通 牛蒡子（炒） 赤芍 生地 青皮 蝉蜕 红花 紫草 葛根 丹皮
引加灯心，水煎服。
清热解毒汤
荆芥穗 木通 牛蒡子（炒） 生地 青皮 山楂 丹皮 红花 蝉蜕 前胡 紫花地丁 黄连 滑石
引加灯心，水煎服。
苏解散 必胜汤 保元汤 《千金》内托散
已出复隐谓之陷，外邪闭塞苏解良，内毒必胜桃红葛，丁蝉地龙归宗汤。气虚陷入保
元主，无热《千金》内托方，保元加桂归芎芍，白芷楂朴木香防。
【注】痘已见点，复隐藏不见者，谓之毒瓦斯内陷也。外邪闭塞者，有外感风寒邪证，闭
塞其毒，故以苏解散解之也。内毒者，火毒内攻，故以必胜汤攻之也。其方即桃仁、红
花、葛根、紫花地丁、蝉蜕、地龙，合上归宗汤也。若形气不足，中气不能载毒而复陷
入者，宜以保元汤主之也。若不见热证者，虚而兼寒，宜用《千金》内托散补而温之。其
方即保元汤加官桂、当归、川芎、白芍、白芷、山楂、木香、防风也。
苏解散（方见本条证治）
必胜汤
大黄 荆芥穗 赤芍 青皮 生地黄 山楂 木通 牛蒡子（炒） 桃仁 紫花地丁 蝉蜕
葛根 地龙 红花
芦根水煎药服。
保元汤（方见本条证治）
《千金》内托散
人参 黄 （制） 甘草（炙） 官桂 当归 白芍药（炒） 川芎 白芷 南山楂
浓朴（姜炒） 木香 防风
引加生姜，水煎服。
南金散 必胜汤
见点外触诸邪秽，痘陷灰滞黑焦塌，轻虚南金蚕荷叶，重实必胜最为佳。
【注】痘至见点之后，房中最要洁净，一被邪秽所触，则毒即陷于内矣。灰滞者，谓
痘色灰白暗滞也。黑者，谓痘色紫黑也。焦者，谓痘形枯焦也。塌者，谓痘形平塌也。轻
虚者，谓毒轻形气虚也，以南金散主之；重实者，谓毒重形气实也，以必胜汤主之。
南金散
白僵蚕（取直者，炒） 紫背荷叶（取霜后搭水者，各等分）
共为末，每服五分，或一钱，芫荽汁和黄酒少许调下。
必胜汤（方见本条证治）
加味归宗汤
热未三朝齐涌出，毒火内发迅难当，归宗汤内加紫草，石膏犀连归尾良。
【注】热未三朝者，发热或半日或一日也。涌出者，痘涌出不循序也。此由毒火迅烈莫
能约束，以归宗汤加紫草、石膏、犀角、黄连、归尾治之。
归宗汤（方见发热证治）
清热解毒汤 凉血攻毒饮 《千金》内托散 归宗汤
赤紫明泽解毒治，黑暗焦枯攻毒良，灰白亮虚内托散，灰白滞郁归宗汤。
【注】凡痘见点，贵察其色。如赤紫明亮者，此毒盛血热也，以清热解毒汤主之；如
黑暗干枯者，此毒锢血凝也，以凉血攻毒饮主之；如灰白明亮者，此血气虚而不荣也，以
《千金》内托散主之；如灰白暗滞者，此毒瓦斯郁滞而不行也，以归宗汤主之。
清热解毒汤 凉血攻毒饮 《千金》内托散（方俱见本条证治）
归宗汤（方见发热证治）
紫草饮子 归宗汤
平塌板硬根松散，气虚紫草饮木通，紫甲楂蝉参枳壳，根脚紧束主归宗。
【注】凡痘见点，贵观其形。若顶平不起，根脚松散，此气虚不能载毒，而痘难宣发也，
以紫草饮主之；若根脚紧束，此毒盛气滞而内伏也，以归宗汤主之。
紫草饮子
紫草 蝉蜕 人参 穿山甲（炒） 枳壳（麸炒） 山楂 木通
水煎服。
归宗汤（方见发热证治）
归宗汤
痘出稠密或粘连，总是枭毒不必言，惟以归宗攻毒主，根松犹可紧硬难。
【注】痘出之形，贵审疏密。若稠密攒簇，粘连不分，总属枭毒为害，惟以归宗汤攻毒
为主。其痘根脚松动者，犹属可治；若紧束板硬者难治。
归宗汤（方见发热证治）
After three days of fever, the spots begin to appear. The fever subsides, the body feels harmonious, there is no thirst or irritability. The spots are sparse and emerge sequentially. Their color is moist and vibrant red, with pointed yet round tops.
[Note] When spots appear only after three days of fever, this indicates that the smallpox (Xiaozhen) is erupting on schedule. Fever subsiding and body feeling harmonious indicates that the pathogenic toxins have been thoroughly dispersed. Absence of thirst and irritability indicates no internal heat stagnation. Sparse spots indicate they are not dense or adherent; sequential emergence means they first appear on the head and face and gradually spread to the entire body. Moist and red color indicates the spots are vibrant and hydrated. Pointed yet round tops indicate the shape is pointed at the apex and round in body. These are all favorable signs of spot eruption (Jiandian Shunzheng).
If the spots have taken shape but the body remains hot, if they are dense, adherent, and not moist/red, or if they are sparse, pale, hidden, and accompanied by low spirit, these are named "favorable signs complicated by dangerous conditions."
[Note] If the spots have taken shape but the body still has fever, this indicates the toxic qi has not fully penetrated. Dense means many spots erupt densely. Adherent means the particles stick together without distinction. Not moist/red means although red, the color is dull and stagnant. Sparse, pale, and hidden means although sparse, the color is light and shallow, hidden under the skin without emerging clearly. Low spirit refers to mental fatigue and listlessness. These are all dangerous signs of spot eruption (Jiandian Xianzheng). "Favorable signs complicated by other diseases" means that although the eruption belongs to favorable signs, if it is complicated by other diseases, it is also considered dangerous.
If spots appear as soon as one day of fever, erupting all at once indistinctly, dense like silkworm eggs, flat and hidden, purple-black and dry/withered, these are adverse signs indicating a ominous prognosis.
[Note] Spots appearing after one day or half a day of fever indicates the toxic fire is too rapid, not following the proper sequence. Erupting all at once indicates the toxic fire is too excessive, unable to be contained or carried. Indistinct spots mean the particles are not clearly defined. Dense like silkworm eggs means as dense as silkworm seeds. Flat means flat and rising not. Hidden means the spots appeared and then disappeared. Purple-black means the color is either purple or black. Dry/withered means the spots are dry and lack moisture. These are all adverse signs of spot eruption (Jiandian Nizheng).
Fever for three days with gradual appearance of spots, fever subsiding, sparse shape, moist red color: should emerge but does not, emerges yet remains hot, already emerged but re-hidden or erupting all at once—these are ominous. Distinguishing brightness/darkness of red, purple, white, black colors; distinguishing tight/loose nature of flat/dense connections; one must examine whether it is constrained by wind-cold or toxic fire, and whether Qi and Blood deficiency has lost the ability to carry the toxin.
[Note] Gradual appearance of spots after three days of fever means the eruption is neither too fast nor too slow. Fever subsiding means the heat decreases after the spots fully emerge. Sparse shape means the spots are sparse and particles are distinct. Moist red color means red and lustrous. These are all favorable smallpox. "Should emerge but does not" means after three days of fever, no spots appear, indicating the toxin is latent internally. "Emerges yet remains hot" means although the spots have fully emerged, the body heat does not subside, indicating excessive toxic heat. "Already emerged but re-hidden" means the spots appeared but then hid again, indicating the toxin has sunk inward and attacked internally. "Erupting all at once" means before three days of fever, the spots erupt simultaneously, indicating rapid and fierce toxic fire. These are all adverse and ominous smallpox. Red, purple, white, black: red is the correct color. Deep red, deep purple, very dark purple/black, or non-red white are incorrect colors. Distinguishing brightness/darkness: for incorrect colored spots, one must distinguish between bright/lustrous and dark/dull to determine treatment. Bright usually indicates deficiency; dark usually indicates excess. Red/purple/black that is bright still has a chance for activity and treatment; if dull/stagnant, it indicates toxic heat coagulation and stagnation. White and bright indicates Qi and Blood deficiency failing to nourish. White and dark indicates Qi and Blood being constrained by the toxin. Flat, hard, dense, and connected: flat and rising not, hard and unopened, or dense clusters adhering together, are all incorrect shapes. Distinguishing tight/loose: for incorrect shaped spots, one must distinguish the tightness/looseness of the base to determine treatment. Tight/loose refers to the base. Tight indicates toxin stagnation; loose indicates toxin dispersion. Flat, hard, dense, connected, but with a loose/open base still has a chance for treatment; if the base is tight and bound, it indicates excessive toxin and blood stasis, making it difficult to treat. One must examine the constraint of wind-cold and toxic fire: the aforementioned shapes and colors have specific causes; one must examine if it is external constraint by wind-cold or internal imprisonment by fire-toxin. Qi and Blood deficiency losing carrying capacity: due to Qi deficiency failing to lead the toxin, or Blood deficiency failing to carry the toxin, preventing the toxin from reaching the muscle surface, thus losing the capacity to carry it.
Sujie San (Perilla Decoction), Guizong Tang (Return to Origin Decoction), Baoyuan Tang (Preserve Origin Decoction), Shengma Gegen Tang (Ephedra and Pueraria Decoction).
For "should emerge but does not," use Sujie San to resolve the exterior; Qianghuo, Su Ye, Shengma, Gegen, Jiegeng, Jingjie, Fangfeng, Chuanxiong, Qianhu, Bohe, Shanzha, Tongcao. For interior heat and latent toxin, use Guizong Tang. For insufficiency causing non-emergence without exterior-interior signs, use Renshen and Gancao in Baoyuan Tang. For mild toxin, combine Shengma Gegen Tang; for severe toxin, using attacking and saving Zheng methods is good.
[Note] After three days of fever, if spots should appear but do not, it is called "should emerge but does not." If there are exterior pathogens (wind-cold) constraining externally preventing emergence, use Sujie San to disperse; once the exterior opens, emergence will naturally occur. If there are no exterior signs but interior heat exists, this is toxic fire latent internally preventing emergence; use Guizong Tang to attack it; once the interior opens, emergence will naturally occur. If physical constitution and Qi are insufficient, leading to non-emergence without exterior-interior signs, it is due to deficient Zheng Qi failing to emit. If the toxin is mild and heat slight, combine Baoyuan Tang and Shengma Gegen Tang to tonify Zheng and eliminate evil. If there are exterior-interior signs, or toxin is heavy and heat severe, tonification is contraindicated as it may aid fire-toxin; using Sujie San or Guizong Tang to attack evil and save Zheng is the best method.
Sujie San
Chuanxiong, Qianhu, Niubangzi (stir-fried), Nanshan Zha, Mutong, Sheng Gancao, Qianghuo, Su Ye, Shengma, Gegen, Jiegeng, Jingjie, Fangfeng.
Guiding herb: Yuanxu. Decoct in water and take.
Baozong Tang (Formula see Fever Treatment)
Baoyuan Tang
Renshen, Huangqi (processed), Gancao (honey-roasted).
Guiding herb: Shengjiang. Decoct in water and take.
Shengma Gegen Tang (Formula see Fever Treatment)
Liangxue Gongdu Yin (Cool Blood and Attack Toxin Drink), Qingre Jiedu Tang (Clear Heat and Resolve Toxin Decoction).
If spots have emerged but fever persists, differentiate exterior-interior. Internal toxic heat is best treated with Liangxue Gongdu Yin. Honghua, Zicao, Danpi, Chantui, Gegen, combined with the above Guizong Tang minus Shanzha. External toxic heat is treated with Qingre Jiedu Tang: Guizong Tang minus Dahuang, Chishao, plus Qianhu, Huanglian, Danpi, Chantui, Zihuadiding, Huashi, Honghua.
[Note] Once spots have taken shape, fever should subside. If it remains high, this indicates excessive toxic fire; treatment must differentiate exterior-interior. If signs of excessive toxic fire inside are seen, use Liangxue Gongdu Yin to attack. This formula consists of Honghua, Zicao, Danpi, Chantui, Gegen, combined with Guizong Tang minus Shanzha. If signs of excessive toxic fire outside are seen, use Qingre Jiedu Tang to resolve. This formula is Guizong Tang minus Dahuang and Chishao, plus Qianhu, Huanglian, Danpi, Chantui, Zihuadiding, Huashi, and Honghua.
Liangxue Gongdu Yin
Dahuang, Jingjiesui, Mutong, Niubangzi (stir-fried), Chishao, Shengdi, Qingpi, Chantui, Honghua, Zicao, Gegen, Danpi.
Guiding herb: Dengxincao. Decoct in water and take.
Qingre Jiedu Tang
Jingjiesui, Mutong, Niubangzi (stir-fried), Shengdi, Qingpi, Shanzha, Danpi, Honghua, Chantui, Qianhu, Zihuadiding, Huanglian, Huashi.
Guiding herb: Dengxincao. Decoct in water and take.
Sujie San, Bisheng Tang (Victory Decoction), Baoyuan Tang, Qianjin Neituo San (Thousand Gold Interior Support Powder).
"Emerged then re-hidden" is called sinking. Exterior pathogen closure is well treated with Sujie San. Internal toxin is treated with Bisheng Tang adding Taoren, Honghua, Gegen, plus Zihuadiding, Chantui, Dilong, and Guizong Tang. Qi deficiency sinking is primarily treated with Baoyuan Tang. Without heat signs, use Qianjin Neituo San to tonify and warm. This formula is Baoyuan Tang adding Guan Gui, Danggui, Chuanxiong, Baishao, plus Baizhi, Shanzha, Houpo, Muxiang, Fangfeng.
[Note] If spots appear and then hide again, it is called toxin sinking internally. Exterior pathogen closure involves external wind-cold pathogens blocking the toxin; thus, use Sujie San to resolve it. Internal toxin involves fire-toxin attacking inward; thus, use Bisheng Tang to attack. This formula is Taoren, Honghua, Gegen, Zihuadiding, Chantui, Dilong, combined with Guizong Tang. If physical constitution and Qi are insufficient, and Middle Qi cannot carry the toxin causing it to sink again, use Baoyuan Tang as primary treatment. If no heat signs are present, indicating deficiency with cold, use Qianjin Neituo San to tonify and warm. This formula is Baoyuan Tang plus Guan Gui, Danggui, Chuanxiong, Baishao, Baizhi, Shanzha, Muxiang, Fangfeng.
Sujie San (Formula see this section's treatment)
Bisheng Tang
Dahuang, Jingjiesui, Chishao, Qingpi, Shengdihuang, Shanzha, Mutong, Niubangzi (stir-fried), Taoren, Zihuadiding, Chantui, Gegen, Dilong, Honghua.
Decoct in Luzhen water and take.
Baoyuan Tang (Formula see this section's treatment)
Qianjin Neituo San
Renshen, Huangqi (processed), Gancao (honey-roasted), Guan Gui, Danggui, Baishaoyao (stir-fried), Chuanxiong, Baizhi, Nanshan Zha, Houpo (ginger-stir-fried), Muxiang, Fangfeng.
Guiding herb: Shengjiang. Decoct in water and take.
Nanjin San, Bisheng Tang.
External contact with various filth during spot eruption causes sinking, gray-dull, black, scorched, or flat spots. Mild deficiency uses Nanjin San with Can'e and Heye; severe excess uses Bisheng Tang as best.
[Note] After spots appear, cleanliness in the room is paramount. Contact with filth causes toxin to sink internally. Gray-dull means gray-white and dark/dull. Black means purple-black. Scorched means withered/dry. Flat means flat. Mild deficiency means light toxin and deficient physical form/Qi, treated with Nanjin San. Severe excess means heavy toxin and robust physical form/Qi, treated with Bisheng Tang.
Nanjin San
Bai Jiangcan (straight ones, stir-fried), Zi Bei Heye (harvested after frost with dew, equal parts).
Pulverize together. Take 0.5 qian or 1 qian per dose, mixed with Yuanxu juice and a little yellow wine.
Bisheng Tang (Formula see this section's treatment)
Jiawei Guizong Tang (Modified Return to Origin Decoction).
Erupting all at once before three days of fever, internal toxic fire is rapid and unbearable. Add Zicao, Shigao, Xijiao, Huanglian, Guiwei to Guizong Tang for good effect.
[Note] "Before three days of fever" means fever lasting half a day or one day. "Erupting all at once" means erupting out of order. This is due to rapid and fierce toxic fire that cannot be restrained; treat with Guizong Tang plus Zicao, Shigao, Xijiao, Huanglian, and Guiwei.
Guizong Tang (Formula see Fever Treatment)
Qingre Jiedu Tang, Liangxue Gongdu Yin, Qianjin Neituo San, Guizong Tang.
Red-purple bright: treat with detoxifying decoction. Dark-black scorched-withered: treat with attacking toxin drink. Gray-white bright deficiency: treat with Neituo San. Gray-white dull stagnation: treat with Guizong Tang.
[Note] In observing spot eruption, color is crucial. Red-purple and bright indicates excessive toxin and blood heat; treat with Qingre Jiedu Tang. Dark-black and dry/withered indicates toxin imprisonment and blood coagulation; treat with Liangxue Gongdu Yin. Gray-white and bright indicates Qi and Blood deficiency failing to nourish; treat with Qianjin Neituo San. Gray-white and dull/stagnant indicates toxin qi stagnation and non-flow; treat with Guizong Tang.
Qingre Jiedu Tang, Liangxue Gongdu Yin, Qianjin Neituo San (Formulas see this section's treatment)
Guizong Tang (Formula see Fever Treatment)
Zicao Yinzi (Arnebia Infusion), Guizong Tang.
Flat, hard, loose base: Qi deficiency uses Zicao Yinzi plus Mutong. Zicao, Chuanshanjia, Shanzha, Chantui, Renshen, Zhike. Tight base primarily uses Guizong Tang.
[Note] In observing spot eruption, shape is crucial. If the top is flat and rising not, and the base is loose, this is Qi deficiency failing to carry the toxin, making eruption difficult; treat with Zicao Yinzi. If the base is tight and bound, this is excessive toxin and Qi stagnation latent internally; treat with Guizong Tang.
Zicao Yinzi
Zicao, Chantui, Renshen, Chuanshanjia (stir-fried), Zhike (bran-stir-fried), Shanzha, Mutong.
Decoct in water and take.
Guizong Tang (Formula see Fever Treatment)
Guizong Tang.
Dense or adherent spots are always Xiao Du (Ominous Toxin); no need to elaborate. Primarily use Guizong Tang to attack toxin. Loose base is still treatable; tight/hard base is difficult.
[Note] The shape of eruption requires examining density. Dense clusters and adhesion indicate harm by Xiao Du; primarily use Guizong Tang to attack toxin. If the base is loose, it is still treatable; if tight and hard, it is difficult to treat.
Guizong Tang (Formula see Fever Treatment)