痘癞者，是热毒拂郁，气血虚弱，而肌肉败坏也。《经》曰∶热胜则肉腐。《正理
论》曰∶脉浮而大，大为气强，浮为气虚，风火相搏，必成瘾疹，身体为痒。痒者，名
为泄风，久久为大癞，故凡气血充实者，则自外无虚风，内无强邪，必无是病。惟气血
素虚者，则不能荣卫于身，而易感天地肃杀之气，是以皮肉之内，虚风居之，兼以痘疹
秽毒疫疠恶气，击搏燔灼，流散四布，随空而出，所以疮本稠密，身无完肤，瘙痒难
任，肌肉溃烂，而痘癞成矣。宜急内用大补气血清热解毒之法，外用减瘢救苦散涂之，
庶可保全。若至败面堕鼻，唇崩目盲，肢体残伤者，纵得苟全，终为废人矣。
夫痘有五不治者何？凡痒塌而寒战切牙及渴不止者，一也。痘紫黑色而喘渴不宁
者，二也。灰白色而顶陷腹胀喘渴者，三也。头温足冷闷乱饮水者，四也。切牙气促
而泄泻烦渴者，五也。是皆不治。
初出项陷连肉红，限至九日一场空。假如血热带紫斑，斯症死在六日中。发斑黑者
在朝夕，斑青顷刻去匆匆。无脓痒弱十二日，不治腰疼及挺胸。势如汤泡及火烧，舌
掷囊缩死之终。紫泡刺破出黑血，饮食挫喉症俱凶。难疗面肿痘不肿，青紫黑陷及无
脓。二便流利下肠垢，更有吐泻与蛔虫。头温足冷好饮水，此皆死症命将终。
痘癞，是由于热毒郁结、气血虚弱，导致肌肉败坏所致。《黄帝内经》说：热邪亢盛则肌肉腐烂。《正理论》说：脉象浮而大，大脉表示气盛，浮脉表示气虚，风火相互搏结，必然形成瘾疹（皮肤上突起的红色小疙瘩），身体感到瘙痒。这种瘙痒称为“泄风”，久而久之会演变成严重的癞病。因此，凡是气血充盛的人，外部没有虚风的侵袭，内部没有强盛的邪气，必定不会得这种病。只有那些原本气血虚弱的人，不能使营卫之气荣养全身，容易感受天地间肃杀之气，使得虚风居于皮肉之间，再加上痘疹的秽毒、疫疠恶气，冲击搏击、焚烧灼烧，流散遍布全身，随着毛孔排出，所以疮疡原本就稠密，身上没有完好的皮肤，瘙痒难以忍受，肌肉溃烂，从而形成了痘癞。应当紧急采用内服大补气血、清热解毒的方法，外用减瘢救苦散涂抹，或许可以保全性命。如果发展到面部败坏、鼻子脱落、嘴唇崩裂、眼睛失明、肢体残伤的地步，即使侥幸保住性命，最终也会成为废人。
为什么说痘疮有五种不治之症呢？凡是出现瘙痒塌陷、寒战咬牙以及口渴不止的，是第一类不治之症。痘色紫黑且伴有气喘、口渴不安的，是第二类。痘色灰白、顶部凹陷、腹部胀满、气喘口渴的，是第三类。头部温热、足部寒冷、神志烦闷混乱、想喝水的，是第四类。咬牙、呼吸急促且伴有腹泻、烦躁口渴的，是第五类。这些都是无法治愈的死症。
痘疮初出时项部凹陷，连及肌肉发红，若到了第九天病情突然恶化如一场空。假如血热并夹杂紫斑，此症在六日内必死。痘发黑斑的，早晚之间就会死亡；痘发青斑的，顷刻间便匆匆离去。没有脓液、瘙痒无力、十二日未愈，或者伴有腰痛及挺胸症状的，属于不治。痘势如同汤泡或火烧，舌体卷缩、阴囊收缩的，是死亡的终局。紫泡刺破后流出黑血，饮食难以下咽、喉部受阻，症状都属凶险。难以治疗的面部肿胀但痘疮不肿，痘色青紫黑陷且无脓液的，二便通畅却排泄肠道污垢，更有呕吐腹泻及蛔虫排出的，头部温热足部寒冷且喜欢喝水的，这些都是死症，生命即将终结。
Doulai (Severe Pox Scarring) is caused by the stagnation of heat-toxin and deficiency of Qi and Blood, leading to the decay of muscles. The *Classic* states: "When heat prevails, flesh rots." The *Zheng Lilun* states: "A pulse that is floating and large indicates strong Qi for the large aspect, but deficient Qi for the floating aspect. When wind and fire contend with each other, urticaria (hives) must form, causing itching in the body. This itching is named 'Xiefeng' (Wind Leakage). Over time, it becomes severe Doulai. Therefore, those whose Qi and Blood are ample will have no external deficiency-wind and no internal strong pathogen, and thus will not suffer from this disease. Only those who are constitutionally deficient in Qi and Blood cannot nourish the body with Ying and Wei Qi, making them susceptible to the killing energy of heaven and earth. Thus, deficiency-wind resides within the skin and flesh. Combined with the filth-toxin of pox, epidemic pestilence, and evil qi, which strike, contend, burn, and scorch, flowing and spreading everywhere, exiting through the pores, the sores were originally dense, leaving no intact skin on the body. The itching is unbearable, muscles ulcerate, and Doulai forms. One should urgently employ internal methods to greatly tonify Qi and Blood and clear heat-toxin, and externally apply Jiancan Jiuku San (Scar-Reducing Bitterness-Saving Powder) to preserve life. If it progresses to facial necrosis, nasal collapse, lip rupture, blindness, and limb injury, even if one survives, they will ultimately become a disabled person.
Why are there five types of pox that are untreatable? First, when there is itching, sinking, chills with teeth-chattering, and unquenchable thirst. Second, when the pox are purple-black accompanied by panting, thirst, and restlessness. Third, when the pox are grayish-white with sunken tops, abdominal distension, panting, and thirst. Fourth, when the head is warm, feet are cold, accompanied by mental confusion and desire to drink water. Fifth, when there is teeth-chattering, rapid breathing, diarrhea, irritability, and thirst. All these are untreatable.
When pox first appear with depression at the neck extending into red flesh, if by the ninth day the condition collapses entirely. If blood-heat accompanies purple macules, death occurs within six days. If black spots appear, death comes within morning or evening; if green spots appear, death follows instantly. Without pus, with itching and weakness, persisting twelve days, or accompanied by lower back pain and chest protrusion, these are untreatable. Conditions resembling hot water blisters or burns, with tongue retraction and scrotal contraction, mark the end of death. If purple blisters are punctured and black blood flows out, and food/drink obstructs the throat, all symptoms are ominous. Difficult to treat: facial swelling without pox swelling, green-purple-black sunken pox without pus. Free urination and defecation yet excreting intestinal sludge, along with vomiting, diarrhea, and roundworm expulsion. Warm head, cold feet, and preference for drinking water—all these are fatal signs indicating imminent death.