凡痘疮溃烂，先伤于面者，盖面乃诸阳之会，痘乃诸阳之毒，以类相从。如水就湿
火就燥也。况心之华在面，诸疮皆属于心，是又心火上炎之象。然若面疮已破而肿消日
开者，此不着痂，元已干燥，病为倒靥而死，在旦夕者也。如已破复灌，满面成供焦
裂溅起，脓血淋漓，食谷则呕，饮水则呛，咯唾粘涎，语音哑嗄，口中气臭者，此脏腑
败坏，故诸症尽见也，必淹延闷绝而死。如疮肿溃而饮食无阻，大小便调，更无他苦，
加上症者，此则可治，宜内用十全大补汤，升阳解毒汤，相须兼服，外用灭瘢散，合百
花膏投之。
凡痘结脓窠之先，或经伤寒，是以虽至收靥，独不结痂，脓汁淋漓痛苦者，须急治
之。否则，成为疳蚀。溃烂时痛，出而损骨伤筋，以致横夭，宜内服十全大补汤，加金
银花、连翘，外用灭瘢散和百花膏敷之。然亦有因气血虚弱，热毒未尽，外被风寒所搏
以致腠理固郁，津液涩滞而成者，治宜观其颜色，及患在何处。若在肢节，及诸虚怯软
弱，气血俱少之处，其色青紫而黑，溃烂延开血出者，难治。若所生之处，在于阳分
不痛不烂，色鲜红润者，以绵尔散主之。
夫有当靥不靥，身热闷乱不宁，卧则硬气，腹胀泄泻，寒战切牙，手足并冷者，此
脾胃虚寒，急用异攻，以救阴阳，助其收靥。若大便秘结，手足皆热者，此脾胃实
热，宜清凉饮，以扶阴抑阳。更有哽气喘咳，腹胀下气，手足微温者、此脾虚不能收
摄而腹胀下气，肺虚不能输降而哽气喘唆耳。
凡是痘疮溃烂，先从面部开始的，这是因为面部是诸阳经汇聚之处，痘毒也是诸阳之毒，同类事物相互吸引。就像水趋向湿润处、火趋向干燥处一样。况且心的荣华表现于面部，各种疮疡都归属于心，这又是心火上炎的表现。然而，如果面部的痘疮已经破溃且肿胀消退、疮口日渐开阔的，这是不能结痂，元气已经干枯，属于“倒靥”（痘疮内陷不结痂），患者将在早晚之间死亡。如果痘疮破溃后再次流脓，满面如同被烧焦般干裂溅起，脓血淋漓，进食则呕吐，饮水则呛咳，咯吐粘涎，声音嘶哑，口中散发臭气的，这是脏腑败坏，所以各种症状全部出现，必然拖延时日，因郁闷窒息而死。如果痘疮肿胀溃破但饮食没有阻碍，大小便正常，更没有其他痛苦，并加上这些症状的，这是可以治疗的，适宜内服十全大补汤和升阳解毒汤，两方配合服用；外用灭瘢散，配合百花膏涂抹。
凡是痘疮结成脓窠之前，或者曾经患过伤寒，因此即使到了收靥阶段，唯独不结痂，脓汁淋漓且痛苦的，必须紧急治疗。否则，会演变成疳蚀疮。在溃烂时感到疼痛，脓液流出损伤骨骼和筋脉，导致横死早夭，适宜内服十全大补汤，加入金银花、连翘；外用灭瘢散调和百花膏敷贴。然而也有因为气血虚弱，热毒未尽，外部受到风寒侵袭，导致腠理闭塞郁滞，津液涩滞而形成的，治疗应当观察其颜色，以及患病部位。如果在肢节，以及诸虚怯软弱、气血俱少的地方，颜色青紫发黑，溃烂蔓延出血的，难以治疗。如果生长的部位，在于阳分，不痛不烂，颜色鲜红润泽的，以绵尔散为主治方。
那些到了该结痂的时候却不结痂，身体发热、胸闷烦乱不安，躺下时呼吸急促僵硬，腹胀腹泻，寒战咬牙，手足冰冷的，这是脾胃虚寒，急需使用异攻散，来救助阴阳，帮助其收靥结痂。如果大便秘结，手足都发热的，这是脾胃实热，适宜用清凉饮，来扶持阴气抑制阳气。更有咽喉哽塞、气喘咳嗽，腹胀排气，手足微微温热的，这是脾虚不能收摄而导致腹胀排气，肺虚不能输降而导致咽喉哽塞、气喘咳嗽罢了。
Whenever smallpox sores ulcerate, starting first on the face, it is because the face is the convergence point of all Yang meridians, and smallpox toxin is also a toxin of all Yang; like attracts like. Just as water flows to wet places and fire moves toward dryness. Moreover, the flourishing aspect of the Heart manifests in the face, and all sores belong to the Heart; this is another sign of Heart Fire flaming upward. However, if the facial sores have already ruptured, swelling has subsided, and the lesions are opening wider day by day, this indicates failure to form scabs, with the Yuan Qi (Original Qi) already dried up. This is "Dao Ye" (inverted healing where sores fail to crust over), and death will occur within a day or two. If after rupture, pus continues to flow, the entire face becomes scorched and cracked, with dripping pus and blood, vomiting upon eating, choking upon drinking, expectorating sticky saliva, hoarse voice, and foul breath from the mouth, this indicates the deterioration of the Zang-Fu organs, hence all symptoms appear; death by lingering illness and suffocation is inevitable. If the sores swell and ulcerate but digestion is unimpeded, urination and defecation are regular, and there are no other distressing symptoms, this case is treatable. Internally, one should administer Shiquan Dabu Tang (Complete Great Tonifying Decoction) and Shengyang Jiedu Tang (Yang-Raising and Toxin-Resolving Decoction) concurrently. Externally, Miecan San (Scar-Extingling Powder) combined with Baihua Gao (Hundred Flowers Ointment) should be applied.
Before smallpox pustules form their honeycomb-like structures, or if the patient has previously suffered from Shanghan (Cold Damage), even when reaching the stage of healing, they may fail to form scabs, with continuous pus discharge and pain; this requires urgent treatment. Otherwise, it will develop into Gan Shi Chuang (Gangrenous Ulcer). When ulcerating, pain occurs, and discharge damages bones and tendons, leading to premature death. Internally, Shiquan Dabu Tang (Complete Great Tonifying Decoction) should be taken, added with Yinyinhua (Lonicerae Japonicae Flos) and Lianqiao (Forsythiae Fructus). Externally, Miecan San (Scar-Extingling Powder) mixed with Baihua Gao (Hundred Flowers Ointment) should be applied. However, some cases arise due to deficiency of Qi and Blood, incomplete resolution of heat-toxin, and external contraction of Wind-Cold, causing obstruction and stagnation in the Couli (pores/skin interstices) and sluggish body fluids. Treatment should observe the color and location of the lesions. If located on the limbs and joints, areas characterized by deficiency, weakness, and scarcity of Qi and Blood, where the color is bluish-purple and black, with spreading ulcers and bleeding, it is difficult to treat. If the lesion is located in the Yang aspects, without pain or ulceration, and the color is fresh red and moist, Mian'er San should be the primary prescription.
In cases where scabbing should occur but does not, accompanied by fever, chest oppression, restlessness, stiff breathing when lying down, abdominal distension, diarrhea, severe chills with teeth grinding, and cold hands and feet, this indicates Spleen-Stomach Deficiency-Cold. One must urgently use Yigong San to rescue Yin and Yang and assist in scabbing. If constipation is present and both hands and feet are hot, this indicates Spleen-Stomach Excess-Heat; Qingliang Yin (Cooling Drink) should be used to support Yin and suppress Yang. Furthermore, in cases with throat obstruction, wheezing, and coughing, abdominal distension with flatus, and slightly warm hands and feet, this is due to Spleen Deficiency failing to control and hold, causing abdominal distension and flatus, and Lung Deficiency failing to descend and distribute, causing throat obstruction, wheezing, and coughing.