凡一二日初出之象，如于人中，及鼻、腮、颐、年寿之间，先发三两点淡红润色
者，顺之兆也。若于天庭、司空、太阳、印堂、方广之处，先发者，是逆之兆，虽见光
明润泽成个者险也。至如圆润成形，而干红少润者，又其险也。顺者不治，自愈，为气
得其正，血得其形，气尊血分，而毒自不能妄行以肆其虐也。逆者虽治不愈，为气涩血
滞，且毒妄参阳位，无以当其势也。险者可治而愈，盖毒虽犯上，但其气血未离，犹有
辅助之功耳，然忧虑之象，未可加治必俟其气血交会之后，随候施治，其有难出易靥
者，表实里虚也。亦有易出难靥者，表虚里实也。
凡二三日根窠圆润，气至充满，血而光洁者，顺也；若根窠无晕，气离血散，枯死
不荣者，逆也；若根窠虽圆混而光洁有神，但顶陷者，则势必血亦难聚，而为险也。顺
而自愈者，为气血得其道也。逆而不治者，为气血交会不足，致毒乘机犯内也。险而可
治者，为气弱不能拘领其血，若能补气以制阴，血能随气以逐毒，亦可变而为顺矣。
凡四五日，观痘势之形色，则知气血之壮弱，受毒之浅深矣。其形尖圆光泽气满血
荣者，顺也。若绵密如蚕种，及黑陷干红紫泡者逆也，若根窠已起，但色不光洁者，此
生意犹在而为险也。顺而自愈者，为气拘血附，各得其道，而毒自释也。逆而不治者，
气血相离，而纵毒内攻也。险而可治者，为气血稍弱，然得交会分明，故势虽夹毒犯
上，若用保元以助卫制荣，自能化毒成功矣。凡五六日气会血附，红活鲜明者，为
顺。若气虽旺而血不归附，其色灰陷紫陷，或水泡痒塌及干枯绵密，气背血离者，为
逆。若气虽旺而血附不浓，其色 白不荣，或带昏黯红紫者，为险。顺而自愈者，为气
血丰浓，毒受制也，逆而不治者，为气弱血衰，致毒下陷，而外剥也。险而可治者，为
气盈血弱，不及归附，若加助血附血，则自得中和之道矣。
凡六七日，气盈血附，光洁饱满，毒自化而成浆者，顺也。若气陷血衰，不能成
浆，其毒内伏，神去色枯者，逆也。若光润有神，但因气血不足，或荣卫少寒而未成浆
者，险也。顺而自愈者，为气血得中，其毒自解也。逆而不治者，为气血相离，不能制
毒而外解也。险而可治者，为荣卫少虚，或气血少少不能振作，若用四君四物，或保元
汤加桂米之属，以助成浆，则何虑之有哉！
凡至八日毒化成浆，神彩光润气足而血微者，顺也。若气血乖离，毒不化浆，色枯
干紫者，逆也。若气血不旺，毒难化而浆不满，其色光润不枯者，险也。顺而自愈者，
其气旺，拘血而已化毒也。逆而不治者，为气血不及不能振作以制其毒，然有发疔发痈
者，可生，外剥内攻者必死，险而可治者为气血有亏，不能振荡以尽全功，若再用保元
内加桂米而补益之，何虑功亏一篑也！
凡八九日浆若充足，则可见气壮血化而毒解功成，若无他症者顺也，如浆不充足，
气陷不荣，毒成外剥者，气血尽矣，逆也若气平少充，红黄色润，浆不泛溢，血附线
红者，是气弱而险也。易用保元汤内加姜桂以助其气而驾其血，则浆自成可免无虞。
凡十二日血尽毒解气调浆足，此生生自然之理也，顺也。若血淡而浆微，或血凝而
浆滞，以见气亏而毒不解，必至枯朽剥极矣，逆也。若血尽浆足，湿润不敛者，内虚
也，并血淡浆微而血凝浆滞者。若得声清能食，根晕犹存，皆为险也，宜用保元汤，一
加茯苓、白术，以助收敛。结痂，一加芎归熟地，以助成浆收靥可也。
凡十三四日，气血归本，毒既殄减，浆老结痂者，顺也。如痘不脱靥，诸邪并作
者，此其逆也。若毒虽尽解，而浆老结痂之际，或有杂症相仍者，此其险也，治宜从保
元温补之法，随症加减，不可轻用大寒荡涤之剂以致内伤也。
凡十四五六日，气血功收。痂落瘢明而无他症者，顺之征也。若痂未易落，寒战咬
牙，谵语狂烦，疔肿并作，气血两亏者，逆之兆也，如痂落，潮热唇红口渴，而或不食
神倦者，险之势也，此宜随候施治。若有余毒者，即当解毒清凉，无余毒者，盒饭略加
补益，即有余毒者，然在病久之后，补知痛虚，亦不可过于治也。
凡是出痘后一两天，痘疹初现的形态，如果先在鼻人中、鼻子、面颊、下巴、年寿等部位，先发出两三粒颜色淡红且润泽的，这是顺证的征兆。如果在天庭、司空、太阳、印堂、方广这些部位先发出来的，是逆证的征兆；即使看到痘疹光亮润泽、颗粒分明，也是险证。至于痘形圆润成形，但干燥发红而缺少润泽的，又是另一种险证。顺证不需要特别治疗，也能自愈，这是因为气得到了正气，血得到了正常的形态，气尊贵而血分守位，毒邪自然不能妄行肆虐。逆证即使治疗也难以痊愈，因为气机涩滞、血液运行不畅，而且毒邪妄动侵犯阳位，无法抵挡其势头。险证可以治疗并痊愈，大概是因为毒邪虽然侵犯上部，但其气血尚未离散，还有辅助之功，然而这是令人忧虑的征象，不可急于用药，必须等到气血交会之后，根据当时的情况施治。那些难以发出但容易结痂的，是表实里虚。也有容易发出但难以结痂的，是表虚里实。
凡是出痘后两三天，痘根圆润，气机充满，血色光洁的，是顺证；如果痘根没有红晕，气离血散，干枯死板不荣润的，是逆证；如果痘根虽然圆浑光洁有神，但顶部凹陷的，那么势必血液也难以聚集，属于险证。顺证而自愈的，是因为气血得其正道。逆证而不治（指难治）的，是因为气血交会不足，导致毒邪乘机侵犯内部。险证而可治的，是因为气弱不能统摄血液，如果能补气以制约阴邪，血液能随着气机驱逐毒邪，也可以转变为顺证。
凡是出痘后四五天，观察痘势的形色，就知道气血的强弱和受毒的深浅了。痘形尖圆光泽、气满血荣的，是顺证。如果密集如蚕种，以及黑陷、干红、紫泡的，是逆证；如果痘根已经隆起，但颜色不光洁的，这说明生机还在，属于险证。顺证而自愈的，是因为气能拘束血液附着，各得其道，毒邪自然消散。逆证而不治的，是因为气血相离，放纵毒邪内攻。险证而可治的，是因为气血稍弱，但交会分明，所以势头虽然夹杂毒邪侵犯上部，如果使用保元汤来助卫气、制营血，自然能化解毒邪取得成功。
凡是出痘后五到六天，气会血附，颜色红活鲜明的，为顺证。如果气虽旺盛但血液不归附，颜色灰暗凹陷或紫色凹陷，或者出现水泡、瘙痒塌陷及干枯密集，气背血离的，为逆证。如果气虽旺盛但血液附着不浓，颜色苍白不荣润，或者带有昏黯红紫色的，为险证。顺证而自愈的，是因为气血丰浓，毒邪被制约。逆证而不治的，是因为气弱血衰，导致毒邪下陷，而外部剥落。险证而可治的，是因为气盈血弱，不及归附，如果加以助血附血的方法，就能自然得到中和之道。
凡是出痘后六七天，气盈血附，光洁饱满，毒邪自然化而为浆的，是顺证。如果气陷血衰，不能成浆，毒邪内伏，神气离去、颜色枯槁的，是逆证。如果光润有神，但因为气血不足，或者营卫稍有寒邪而未成浆的，是险证。顺证而自愈的，是因为气血得中，毒邪自然解除。逆证而不治的，是因为气血相离，不能制约毒邪而在外解除。险证而可治的，是因为营卫稍虚，或者气血稍微不足不能振作，如果使用四君子汤、四物汤，或者保元汤加桂枝、米仁之类，来协助成浆，有什么可忧虑的呢！
凡是到了第八天，毒化成浆，神采光润、气足而血微的，是顺证。如果气血乖离，毒不化浆，颜色枯干紫色的，是逆证。如果气血不旺，毒难化而浆不满，但颜色光润不枯的，是险证。顺证而自愈的，是气旺盛，拘束血液而已化解毒邪。逆证而不治的，是因为气血不及，不能振作以制约毒邪，然而如果有发疔、发痈的，还可以生存，如果是外部剥落、内部攻陷的必定死亡。险证而可治的是因为气血有亏，不能振荡以完成全部功效，如果再使用保元汤内加桂枝、米仁来补益它，何必担心功亏一篑呢！
凡是八九天，浆液如果充足，就可以见到气壮血化而毒解功成，如果没有其他症状就是顺证；如果浆液不充足，气陷不荣，毒成外剥的，说明气血已尽，是逆证。如果气平少充，红黄色润泽，浆液不泛溢，血液附着呈线红色的，是气弱而险。容易使用保元汤内加生姜、桂枝来助其气而驾驭其血，那么浆液自然形成，可以避免危险。
凡是十二天，血尽毒解、气调浆足，这是生生自然的道理，属于顺证。如果血淡而浆微，或者血凝而浆滞，表现出气亏而毒不解，必定至枯朽剥落至极，这是逆证。如果血尽浆足，湿润但不收敛的，是内虚；以及血淡浆微而血凝浆滞的。如果声音清亮、能进食，痘根红晕犹存的，都属于险证，适宜使用保元汤，一加茯苓、白术，以协助收敛结痂；二加川芎、当归、熟地黄，以协助成浆收靥即可。
凡是十三四天，气血归本，毒邪既已消灭减少，浆老结痂的，是顺证。如果痘不脱靥，各种邪气并作的，这是逆证。如果毒邪虽然完全解除，但在浆老结痂之际，或有杂症相继出现的，这是险证，治疗适宜遵循保元汤温补的方法，随症状加减，不可轻易使用大寒荡涤的药物以致造成内伤。
凡是十四五六天，气血功能收敛。痂落瘢痕明显而没有其他症状的，是顺证的征象。如果痂未脱落，寒战咬牙，谵语狂烦，疔肿并作，气血两亏的，是逆证的征兆。如果痂落，潮热唇红口渴，或者不食神倦的，是险证的态势，这应当随候施治。如果有残余毒邪的，就应当解毒清凉；没有余毒的，应当略微加以补益。即使有余毒的，然而在病久之后，知道痛虚，也不可过于治疗。
For the initial appearance of smallpox lesions on the first or second day, if two or three spots with a pale red and lustrous color appear first in areas such as the philtrum (Ren Zhong), nose, cheeks, chin, or Nian Shou region, this is an omen of a favorable course (Shun). If they appear first in the Tian Ting, Si Kong, Tai Yang, Yin Tang, or Fang Guang regions, it is an omen of an unfavorable course (Ni); even if the lesions are bright, lustrous, and distinct, it remains a critical condition (Xian). Furthermore, if the lesions are round and formed but dry, red, and lacking moisture, this is another form of critical condition. A favorable course requires no specific treatment and heals spontaneously, as Qi obtains its righteousness and Blood obtains its proper form; Qi is respected and Blood stays within its domain, so the pathogenic toxin cannot act recklessly to wreak havoc. An unfavorable course may not be cured even with treatment, because Qi is stagnant and Blood flow is sluggish, and the toxin recklessly invades Yang regions, making it impossible to withstand its momentum. A critical condition is treatable and curable, generally because although the toxin attacks the upper body, Qi and Blood have not yet dispersed and still retain their supportive function. However, this is a worrying sign; one should not rush to administer treatment but must wait until Qi and Blood intersect, then treat according to the specific situation. Those who find it difficult to erupt but easy to crust over indicate Excess at the Exterior and Deficiency at the Interior. Conversely, those who erupt easily but have difficulty crusting over indicate Deficiency at the Exterior and Excess at the Interior.
On the second or third day, if the lesion base is round, Qi is full, and the Blood color is bright and clean, it is favorable. If the base lacks a halo, Qi separates from Blood, appearing withered, dead, and un-nourished, it is unfavorable. If the base is round and clear with spirit, but the apex is depressed, Blood will likely fail to gather, constituting a critical condition. Favorable cases heal spontaneously due to Qi and Blood following their proper pathways. Unfavorable cases are difficult to treat because insufficient intersection of Qi and Blood allows the toxin to invade internally during opportunities. Critical cases are treatable because weak Qi fails to control Blood; by tonifying Qi to restrain Yin, Blood can follow Qi to expel the toxin, potentially transforming into a favorable course.
By the fourth or fifth day, observing the shape and color of the lesions reveals the strength of Qi and Blood and the depth of toxin invasion. Lesions that are pointed, round, glossy, full of Qi, and rich in Blood are favorable. Those dense like silkworm eggs, or black, depressed, dry, red, purple, or blistered are unfavorable. If the base has risen but the color is not bright, the vital energy remains, classifying it as critical. Favorable cases heal spontaneously as Qi constrains and attaches Blood, each following its path, allowing the toxin to dissipate naturally. Unfavorable cases involve separation of Qi and Blood, allowing the toxin to attack internally unchecked. Critical cases involve slightly weak Qi and Blood but clear intersection; although the toxin attacks upward, using Baoyuan Decoction (Preserve the Origin Decoction) to support Wei Qi and regulate Ying Blood can successfully resolve the toxin.
Between the fifth and sixth days, when Qi meets and attaches to Blood, resulting in bright red and vivid coloration, it is favorable. If Qi is strong but Blood does not attach, presenting as gray/depressed, purple/depressed, or with blisters, itching, collapse, or dryness/density where Qi backs away and Blood separates, it is unfavorable. If Qi is strong but Blood attachment is thin, with pale/un-nourished colors or dull red/purple hues, it is critical. Favorable cases heal due to abundant Qi and Blood restraining the toxin. Unfavorable cases result from weak Qi and deficient Blood, causing toxin sinking and external peeling. Critical cases feature abundant Qi but weak Blood failing to attach; assisting Blood to attach restores balance.
On the sixth or seventh day, when Qi is full and attaches to Blood, appearing bright, smooth, and plump, with toxins naturally transforming into pus, it is favorable. If Qi sinks and Blood is weak, unable to form pus, with toxins lying dormant internally, spirit departing, and color withering, it is unfavorable. If bright and lustrous with spirit, but due to insufficient Qi and Blood, or slight Cold in Ying and Wei preventing pus formation, it is critical. Favorable cases heal as Qi and Blood are balanced, resolving the toxin. Unfavorable cases involve separated Qi and Blood unable to restrain the toxin for external resolution. Critical cases involve slight deficiency in Ying and Wei or insufficient Qi and Blood to振奋 (invigorate); using Sijunzi Decoction (Four Gentlemen Decoction), Siwu Decoction (Four Substances Decoction), or Baoyuan Decoction plus Cinnamon Twig (Guizhi) and Coix Seed (Yiyiren) to assist pus formation removes worry.
By the eighth day, if toxins transform into pus, with radiant spirit, sufficient Qi, and slight Blood, it is favorable. If Qi and Blood are discordant, toxins do not transform into pus, and color is withered, dry, and purple, it is unfavorable. If Qi and Blood are not vigorous, toxins are hard to transform, and pus is incomplete, but color is bright and not withered, it is critical. Favorable cases heal due to strong Qi constraining Blood and transforming toxins. Unfavorable cases occur when Qi and Blood are insufficient to invigorate and restrain toxins; however, development of carbuncles (Ding) or abscesses (Yong) suggests survival, whereas external peeling with internal attack indicates death. Critical cases involve Qi and Blood deficiency failing to complete the process; using Baoyuan Decoction with Cinnamon Twig and Coix Seed for tonification prevents failure at the last step.
By the ninth or tenth day, if pus is sufficient, indicating strong Qi, transformed Blood, and resolved toxins without other symptoms, it is favorable. If pus is insufficient, Qi sinks and is un-nourished, and toxins cause external peeling, Qi and Blood are exhausted, indicating an unfavorable course. If Qi is calm and slightly full, with red-yellow moist color, pus does not overflow, and Blood attachment shows red lines, it is weak Qi and critical. Using Baoyuan Decoction with Ginger and Cinnamon to boost Qi and guide Blood allows natural pus formation and safety.
By the twelfth day, with exhausted Blood, resolved toxins, balanced Qi, and sufficient pus, this follows the natural law of life generation, indicating a favorable course. If Blood is pale and pus scant, or Blood coagulates and pus stagnates, showing Qi deficiency and unresolved toxins leading to extreme withering and peeling, it is unfavorable. If Blood is exhausted and pus sufficient, but moist and not contracting, it indicates Internal Deficiency; this also applies to pale Blood/scant pus and coagulated Blood/stagnant pus. If voice is clear, appetite exists, and the lesion halo remains, these are critical signs. Use Baoyuan Decoction: add Poria (Fuling) and Atractylodes Macrocephala (Baizhu) to aid contraction and scabbing; or add Ligusticum Chuanxiong (Chuanxiong), Angelica Sinensis (Danggui), and Rehmannia Glutinosa (Shudihuang) to aid pus formation and scabbing.
By the thirteenth or fourteenth day, with Qi and Blood returning to their roots, toxins largely eliminated, and old pus forming scabs, it is favorable. If scabs do not fall off and various pathogens arise simultaneously, it is unfavorable. If toxins are fully resolved but miscellaneous symptoms persist during the scabbing phase, it is critical. Treatment should follow the warming and tonifying method of Baoyuan Decoction, modified by symptoms; avoid harsh cold purgatives to prevent internal injury.
By the fifteenth to sixteenth day, Qi and Blood functions conclude. Falling scabs with clear scars and no other symptoms are signs of a favorable course. If scabs have not fallen, accompanied by chills, teeth grinding, delirium, mania, simultaneous carbuncles, and dual deficiency of Qi and Blood, it is an omen of an unfavorable course. If scabs have fallen, accompanied by tidal fever, red lips, thirst, anorexia, and mental fatigue, it is a trend toward a critical condition, requiring treatment based on the current state. For residual toxins, use detoxifying and cooling methods; for no residual toxins, use mild tonification. Even with residual toxins, after prolonged illness, knowing the pain and deficiency, one must not over-treat.