发热恶热硬痛里，便秘为实下利虚，实则板实根紧硬，虚则倒陷靥收迟。
【注】痘出发热恶寒者，表证也；不恶寒恶热者，里证也。硬者，不大便而硬也。痛
者，肚腹作痛也。此皆属里热之证。若便秘，则为里实；下利，则为里虚。板实者，痘囊
板实不活动也。根紧硬者，根脚紧束，坚硬不松，皆里实证也。倒陷者，痘已出，复陷
入于内也。倒靥者，痘正灌浆即收靥也。收迟者，痘已灌浆，日久不靥，皆里虚证也。此
辨里之虚实也。
阳热壮热面唇赤，舌干饮冷爪尿红，烦躁昏狂谵失血，紫黑焦枯不润通。
【注】凡痘属阳热者，身必壮热，面唇皆赤，舌上干燥，好饮冷水，爪甲、尿尿，皆
现红色，烦躁不宁，神气昏愦，发狂谵语。失血者，吐血、衄血也。紫黑焦枯者，痘色紫
黑焦枯也。不润通者，九窍不润通也。此皆属阳热之证也。
阴寒无热口鼻冷，面唇尿爪色白青，厥冷难回利不臭，水泡灰白无晕红。
【注】凡痘属阴寒者，身肢不热，口鼻皆冷，面唇、尿尿、爪甲色现青白也。厥冷难
回者，谓四肢厥冷，不能即温也。利不臭者，谓下利无臭秽也。水泡，湿盛也。灰白无晕
者，谓痘色灰白，根脚无红晕也。此皆属阴寒之证也。
温补过则痘溃烂，毒攻咽龈目肿痈，清泻过则痘白陷，呕吐不渴厥利清。
【注】痘有虚实，治有补泻，要在审当而施也。如虚者当补，亦须酌量施治。若温补
过甚，则反助毒热而痘溃烂也，以致毒热上攻，或咽喉肿痛，或牙龈发疳，或眼目赤肿
生翳，甚而攻于荣卫，发为痈疽也。如实者当泻，亦须中病即止。若清泻过甚，则损伤
正气，而痘白陷，或呕吐不渴，或厥逆下利。此皆发明温补、清泻之过当也。
Fever, aversion to heat, hardness and pain in the interior, with constipation indicates a Excess pattern; diarrhea indicates a Deficiency pattern. In an Excess pattern, the pustule base is board-like and firm, and the root is tight and hard. In a Deficiency pattern, the eruption collapses inward or scabs formation is delayed.
[Note] When fever and aversion to cold occur upon the emergence of smallpox/variolous eruptions, it is an Exterior syndrome; when there is no aversion to cold but only aversion to heat, it is an Interior syndrome. "Hardness" refers to constipation with hard stool. "Pain" refers to abdominal pain. These all belong to Heat syndromes of the Interior. If there is constipation, it is an Interior Excess; if there is diarrhea, it is an Interior Deficiency. "Board-like firmness" means the pustule sac is rigid and immobile. "Tight and hard root" means the base of the eruption is tightly bound and hard without looseness; these are all signs of Interior Excess patterns. "Collapse inward" (Dao Xian) means the eruptions, having emerged, sink back inside. "Premature scabbing" (Dao Ye) means the pustules begin to scab while still filling with pus. "Delayed scabbing" means the pustules have filled with pus but take a long time to scab; these are all signs of Interior Deficiency patterns. This section distinguishes between Excess and Deficiency in the Interior.
Yang-Heat patterns manifest as high fever, redness of the face and lips, dry tongue, desire for cold drinks, red nails and urine, restlessness, mental confusion, mania, delirium, bleeding, and eruptions that are purple-black, scorched, dry, and lack moisture and free flow.
[Note] For eruptions belonging to Yang-Heat, the body must have high fever, the face and lips are red, the tongue surface is dry, and the patient desires cold water. The nails and urine both appear red. There is restlessness, mental confusion, mania, and delirious speech. Bleeding refers to hematemesis (vomiting blood) and epistaxis (nosebleed). Purple-black and scorched refers to eruptions that are purple-black and dry. Lack of moisture and free flow refers to the obstruction of the nine orifices. These all belong to Yang-Heat syndromes.
Yin-Cold patterns manifest as absence of fever, cold mouth and nose, white or bluish-white color of the face, lips, urine, and nails, cold limbs that are difficult to warm, diarrhea without foul odor, vesicular eruptions, and eruptions that are grayish-white without a red halo.
[Note] For eruptions belonging to Yin-Cold, the limbs are not hot, and the mouth and nose are cold. The face, lips, urine, and nails appear blue or white. "Cold limbs difficult to warm" refers to cold extremities that cannot be quickly warmed. "Diarrhea without odor" refers to diarrhea lacking a foul smell. Vesicles indicate excessive Dampness. Grayish-white without a halo refers to eruptions that are grayish-white with no red halo at the base. These all belong to Yin-Cold syndromes.
Overuse of warming and tonifying methods leads to ulceration of the eruptions, with toxic heat attacking the throat and gums, causing eye swelling and sores. Overuse of clearing and purging methods leads to whitening and sinking of the eruptions, vomiting without thirst, cold limbs, and clear diarrhea.
[Note] Eruptions have Excess and Deficiency patterns, and treatments involve tonification and purging; the key lies in careful and appropriate application. If it is a Deficiency pattern, tonification is indicated, but dosage must be carefully considered. If warming and tonifying are excessive, they will inadvertently assist toxic heat, leading to ulceration of the eruptions. Toxic heat may attack upward, causing sore throat, gum disease (gan), or red swollen eyes with nebulae, and in severe cases, attack the Ying and Wei levels, causing carbuncles and sores. If it is an Excess pattern, purging is indicated, but treatment should stop once the pathogen is addressed. If clearing and purging are excessive, they will damage healthy Qi, leading to whitening and sinking of eruptions, vomiting without thirst, cold limbs, and clear diarrhea. These points elucidate the dangers of improper overuse of warming-tonifying and clearing-purging methods.