夫痘不热不发。犹五谷之不热不结。身有热也。乃毒与时气相触而动内传百脉外注皮肤
。痘
未见而先兆。此乃必至者。但热有轻重。毒轻则热轻。毒重则热重。又有热五六日出者。有
热一日即出者。太过则正不胜邪。愆期则气血凝滞。唯三四日身凉痘出为正。凡发热肌肤温
平潮润。唇舌滋洁无苔。声音清亮。睡中微惊。便食如故。或少食贪睡。皆吉兆也。重则反
是。一发热。即唇裂。舌坑。烦燥。狂乱。口渴。恶寒。两耳灼热。两睛红。二便结方内加
玄明粉。或千□马下之。恶热者单下。以苔为增减。不可拘在初热当发之说。此亦百中一二
。又毋执以为常。如唇舌滋润。虽见恶症。切不可妄下损人。
发热时。腹疼腰痛。四肢酸痛。皆重症。若表过痛止者吉痛加甚者凶。
发热吐泻。切不可行止法。惟吐泻酸臭。可加消导药佐之。是伤食也。惊发痘前者吉。
何也
。由惊阳症。痘属阴。阳被阴冲。则壅遏之。患息。故吉。照前加减治之。母服惊药。误服
而冰其毒。酿害匪浅。亦有惊即死。此必中恶。
发热时。谵语颠狂。见神见鬼。躁乱不宁。是热甚失表。外邪内毒。两相搏激也。重发
之则愈。舌见黄苔。非下不可。
凡脏腑郁毒。非微汗则不解。故一发热。必用汗药也。身热四五日不退者。知毒犹在内
。务要热退为佳。
身热四五日不退。痘影焦紫。郁郁不出。此必寒气外郁。闭塞鬼门也。令服惊蛰丸。发
出臭汗。则热自退。痘自出也。
一发热。头面中有大痘数点。余不出。复不除热。此名曰报痘。急用银针剔破。不去则
领败正气。为留连之祸。
初发热。即头温足冷。不渴。大便溏。面 白。或泻痢清谷呕食不化。虚症也。
凡热时灯照。肉内有隐隐紫红块者重面红唇白亦重。再加形色不善。死必矣。九窍流血
者死。目闭无魂。舌墨声嗄。胸高而凸。掌文出血。皆死症不治。
痘疹必须依靠发热才能发出。这就像五谷不经过加热就无法成熟结实一样。身体出现发热，是体内的毒邪与时令之气相互触碰，从而在体内发动并传入百脉、外注于皮肤的表现。痘疹尚未显现，但先有征兆，这是必然的规律。但是，发热的程度有轻有重。毒邪轻则发热轻，毒邪重则发热重。又有的是发热五六天出痘的，也有的是发热一天就出痘的。如果发热太过，正气就不能战胜邪气；如果延期不出，气血就会凝滞。只有发热三四天后体温恢复正常（身凉）再出痘，才是正常的表现。凡是发热时肌肤温度温和湿润，嘴唇和舌头滋润洁净没有舌苔，声音清脆响亮，睡眠中偶尔轻微惊跳，饮食如常，或者稍微吃得少一点、贪睡，这些都是吉利的征兆。病情重的则相反。一旦发热，就出现嘴唇干裂，舌面凹陷，烦躁不安，狂乱，口渴，怕冷，两耳灼热，两眼发红，大小便干结，这时可以在方剂中加入玄明粉，或者使用具有泻下作用的药物（此处原文缺字，推测为“承气”类或类似峻下药）来攻下。对于恶热者单独使用泻下法，根据舌苔的变化增减药量，不可拘泥于“初起发热应当发散”的说法。这种情况也是百中无一二的，也不要将其视为常规治法。如果嘴唇和舌头滋润，即使见到严重的症状，也绝不可以妄用泻下法损伤人体。
发热时，如果出现腹痛、腰痛、四肢酸痛，都属于重症。如果表证解除后疼痛停止，则是吉兆；如果疼痛加重，则是凶兆。
发热伴有呕吐腹泻，切不可使用止吐止泻的方法。只有当呕吐物和大便酸臭时，才可以加入消食导滞的药物辅助治疗，这是伤食所致。因受惊吓而诱发痘疹的先兆，属于吉兆。为什么呢？因为惊属阳症，痘属阴，阳气被阴气冲撞，导致壅遏郁结，病势平息，所以吉利。按照前面的方法加减治疗即可，不要服用镇惊药物。误服镇惊药会使毒邪冰伏，酿成的危害不小。也有因惊吓立即死亡的，这必定是中恶邪。
发热时，如果出现胡言乱语、癫狂、看见鬼神、躁动混乱不得安宁，这是因为热势太盛而未能及时发散，外邪与内毒相互搏激所致。加重发汗力度就可以痊愈。如果舌头上出现黄苔，非用泻下法不可。
凡是脏腑郁积的毒邪，如果不通过微微出汗的方式，就无法解除。所以一旦发热，必须使用发汗的药物。身体发热四五天不退，说明毒邪还在体内。务必以热退为佳。
身体发热四五天不退，痘疹的影子焦黑紫色，郁郁葱葱地出不来，这一定是寒气在外部郁结，闭塞了毛孔（鬼门）。此时令患者服用惊蛰丸，发出带有臭味的汗液，那么热自然消退，痘疹自然发出。
一发热，头面部就有几颗大痘出来，其余的不出来，也不退热，这叫做“报痘”。急需用银针挑破，如果不除去，就会败坏正气，留下连绵不断的祸患。
刚开始发热，就出现头部温热、脚部寒冷，不口渴，大便稀溏，面色苍白，或者腹泻痢疾、完谷不化、呕吐食物不消化，这是虚证。
凡是发热时用灯照射，发现肌肉里面有隐隐约约的紫红色块，病情严重；面色红而嘴唇白，病情也严重。再加上形色不好，必死无疑。九窍流血的，死。眼睛闭合无神，舌色黑如墨，声音嘶哑，胸部高耸且凸起，手掌纹路出血，都是死症，无法治疗。
Dermatological eruptions (痘疹) must rely on fever (发热) to emerge. This is analogous to grains which cannot mature and bear fruit without heat. The presence of fever in the body indicates that pathogenic toxins (毒邪) are interacting with seasonal qi (时令之气), thereby activating internally, transmitting through the hundred vessels (百脉), and externalizing into the skin. Before the eruption becomes visible, there are prodromal signs; this is an inevitable process. However, the intensity of fever varies. Mild toxin results in mild fever, while severe toxin results in severe fever. Some cases present with eruptions after five or six days of fever, while others erupt after just one day. If the fever is excessive, the healthy qi (正气) cannot overcome the pathogenic factors (邪气). If the eruption is delayed, the qi and blood (气血) will become stagnant. Only when the fever subsides after three or four days and the body temperature returns to normal before the eruption appears is it considered a normal presentation.
If during the fever, the skin feels warm and moist, the lips and tongue are moist and clean without coating, the voice is clear and bright, there is slight startle during sleep, appetite remains normal, or there is slightly reduced intake with increased sleepiness, these are all auspicious omens. Severe cases present oppositely. Upon onset of fever, if lip cracking, sunken tongue surface, restlessness, mania, thirst, aversion to cold, burning sensation in both ears, red eyes, and constipation of stool and urine occur, Xuanming Fen (Natrii Sulfas) should be added to the prescription, or purgative methods (such as Chengqi Decoction) should be employed. For those with aversion to heat, purgation alone is used, adjusting dosage based on changes in the tongue coating. One must not rigidly adhere to the theory that "initial fever requires dispersing." Such cases are rare (one in a hundred) and should not be treated as routine. If the lips and tongue remain moist, even if severe symptoms appear, one must absolutely avoid reckless purgation that damages the body.
Abdominal pain, lower back pain, and soreness of the four limbs during fever indicate severe conditions. If the pain ceases after the exterior syndrome resolves, it is auspicious; if the pain worsens, it is ominous.
Fever accompanied by vomiting and diarrhea should never be treated with anti-emetic or anti-diarrheal methods. Only if the vomitus and stool are sour and foul-smelling can digestive-promoting and stagnation-resolving herbs be added as adjuvants, indicating food injury (伤食). Eruption triggered by fright is auspicious. Why? Because fright belongs to Yang syndromes (阳症), while dermatological eruptions belong to Yin. When Yang is clashed by Yin, it causes obstruction and stagnation, leading to the resolution of the illness, hence it is auspicious. Treat according to previous modifications; do not administer anti-fright medicines. Misuse of such medicines may freeze the toxin, causing significant harm. There are also cases of immediate death following fright, which are due to sudden evil invasion (中恶).
During fever, if delirium, mania, hallucinations of spirits and ghosts, and restless agitation occur, it is because the heat is too intense and has not been properly dispersed, causing external pathogens and internal toxins to clash violently. Increasing the sweating method will lead to recovery. If a yellow coating appears on the tongue, purgation is mandatory.
Toxins stagnated in the zang-fu organs (脏腑) cannot be resolved without mild sweating. Therefore, once fever begins, diaphoretic medicines must be used. If fever persists for four or five days, it indicates the toxin remains inside; it is essential for the fever to subside.
If fever persists for four or five days, and the shadow of the eruption is dark purple and scorched, appearing suppressed and unable to emerge, it is due to external cold stagnation blocking the pores (鬼门). Instruct the patient to take Jingzhe Wan (Jingzhe Pill) to induce profuse, foul-smelling sweat; then the fever will naturally subside, and the eruption will emerge.
If upon initial fever, several large pustules appear on the head and face while the rest do not appear and the fever does not abate, this is called "Bao Dou" (报痘 - Reporting Eruption). It is urgent to pierce them with silver needles. If not removed, they will damage the healthy qi and cause lingering disasters.
At the initial stage of fever, if the head is warm but the feet are cold, there is no thirst, stool is loose, complexion is pale, or there is dysentery, undigested food in stool, and vomiting of undigested food, this is a deficiency syndrome (虚症).
When inspecting during fever with a lamp, if faint purple-red patches are visible within the flesh, the condition is severe. A red face with white lips also indicates severity. If combined with unfavorable appearance and form, death is certain. Bleeding from the nine orifices (九窍) indicates death. Closed eyes without spirit, black tongue like ink, hoarse voice, protruding and convex chest, and bleeding from palm lines are all terminal syndromes (死症) that cannot be treated.