胎毒蓄积，发为痘疮，传染由于外感，轻重过于内伤，初起太阳，壬水克乎丙火，后归
阳明，血水化为脓浆，势若燃眉，变如反掌。欲知表里虚实，须明寒热温凉。症候殊形，脏
腑异状，肝主泪而水泡，肺主涕而脓浆，心斑红紫，脾疹赤黄，独有肾经之无病，惟变黑而
可防，所以观乎外症，因而推何五内，呵欠顿闷兮，肝木之因，咳嗽喷嚏兮，肺金之象，面目
带赤而惊悸兮，心火炎于胸膈，手足厥冷而昏睡兮，脾土困于中央，耳尻温暖如常兮，可见
肾水之无咎。二处若还灼热兮，须识痘症之乖张，故宜先分部位，次察灾详。阳明从目落
鼻，太阳形于头上，心火炎热则鼻干面赤，肺金郁结则胸膈先伤。脾胃属手足之部，肝胆
主胁肋之旁，颈项三阳交会，腰背统乎膀胱，泄泻者邪甚于下，呕吐者邪甚于上，气逆则腹
痛隐隐，毒甚则腰痛惶惶，心热甚则惊搐，胃邪实则癫狂，口燥咽干，肺受火邪而液竭，便
秘尿涩，肾因火旺而津亡。欲识痘症之轻重，又当观势之形状。毒甚兮必身如炎火，势微
兮则内外清凉，寒热往来神气爽，定知痘出必祯详，数番渐出兮，春回寒在，一齐涌出兮火
烈昆岗。蚊迹蚤斑，刻期而归阴府，蛇皮蚕种，引日而返泉乡，须怕紫红更嫌灰白，最宜
淡红滋润，切忌黑陷于红，色要明润兮，犹恐薄嫩之易破，痘贵干结兮，切忌痒塌之难当，
面颊稀而磊落，清安可保，胸膈密而连串，吉凶难量，欲要尖圆不宜平陷，浆宜饱满，切忌
空疮，皮喜老而愁嫩，肤爱糙而怕光，结实高耸，始终无虑，丹浮皮肉，必主刑伤，唇面欲肿
兮，八九如何可过，腰痛胃烂兮，一七定受灾殃，疮堆口舌毒缠颈项，咽疮喉肿，饮食难尝，
泻利脓血毒甚无浆，此皆人力难挽，须知天命匪长。若至痘疮焦落，又宜辨别阴阳，人中上
下先靥为良，若是四旁先黑靥，多凶少吉要提防。
初热温和，腰腹不痛，山根年上，光彩红黄，禀质有余。面无枯滞，脉息浮大而数，唇
舌红润而鲜，先出腮颐颧鼻地阁之处，圈红皮浓，顿殊肉色之分。顶尖碍手，更喜色姿多润
泽，根窠垒列尤奇，乳食又能餐，二便如常，五嵩拱秀，根据期起灌，内症全无。此乃最为顺
候，何愁日至变迁，若初发热如火，便闭烦渴非常，青黑见于山根，燥暗乘于年上，头痛似
破，狂叫谵癫，詈骂昏沉而见鬼，口气如火而焦干，身壮热而恶寒复甚，脉无力而沉细兼
迟，腰围肚腹，刺痛绞痛不已，暴烈烦燥，喘渴吐泻昏沉，身大热而唇口焦裂，未见点而遂哑
声音，痘密既多，饮食不已，方发热而腰痛难伸，未见点而面目预肿，热未透而先知蚕种，
或未热而先出如麸，肉色连红，根窠不立。或带紫色，惨黯不明，及见紫黑，青 如痣。天
庭司空太阳心胸，先出成片，方广印堂唇上结喉，首见如灰，顶不起而软薄，根不紧而铺红，
满面红赤无缝，遍身紫黑干枯，颧骨胭脂，五俞蚕种，皮薄成浆如水，色黯昏黑无光，此等
最为逆候，华佗应愧青囊，故色若鲜明，根窠红活，虽平塌而可救，色不润泽，根不紧附，纵
起发而终凶，身热不退而烦燥，且手足无花，虽四日还防添痘，身体既凉而宁静。又四肢
俱至，即三朝可许为齐，六日以前，内症虽多，痘疮表暴而自愈。六期以后，内症不痊，表里
俱病而为凶。靥后脉宜和缓，如见洪数者，余毒留而未尽，黑疔挑见黑血，或无血水者，气
血竭而难生，初热唇舌如聚黑点，或紫黑燥裂，预知症已多凶浆脓，口唇痘先黄熟，是热
毒内攻，尤为不治之症，痘逢擦破，脓血淋漓，有溃烂之势者是吉，颧脸爬穿，目开肿退，如
痘壳之干者为凶。起胀时多鼻涕，固为祯兆，成浆口涎眼泪，总属佳征。初出昏惨色紫，茱
根窠微细，宜堤御以防后变，痂落赤紫形突，及睡卧不稳，即清解以免毒生，故曰一看口唇
舌尖而无枯涸燥涩；二自痘点圆活红润，肉痘之色分明；三看心窝腮口背项颧额脐间稀少∶
四看顶硬根附，气爽神清，而绝疔 焦紫及内症；五看儿禀壮浓，饮食素能，尚无疾病气围
血溶。全此数者，则虽无三窟，亦可高枕无忧矣。
肿毒恶疮方愈，麻疹诸疾才痊。气血尚虚，重痘又见，标后壮热而不退，将脓厥冷而
难温，恶痈夹于极痘，发热喘粗不已，一便秘兼目闭，声哑肌黑唇青，痘出昏沉，憎寒逆冷
而不食，脓时胎堕，血来大热而神昏烦燥，腹疼不止，而痘臭异常。头温足冷如痴，而闷渴
殊甚，皮肤赤色不退，上下失血不痊，青回口角，云掩天痘，腹胀喘粗，且虚鸣而出秽气于
口中，痘无根窠，纵微圈而夹沉重之内症，因热经来久不止，以药治之全不效，吐利不住食
不化，或二便之血交流，痰喘心烦，头汗如珠，兼下尿不止，是阴阳相离于上下。大渴血死
痘色黑黯。或锡片干呆，是荣卫咸竭于表里，痘方盛时而发惊不止，及至虚弱而痫症相缠，
胃热发黄，状如橘色而下利，脓浆未足，毒邪尚盛而眼开，不时努气，如大便之坚涩，口中
无食，若嚼物之空然，困倦殆极而饮食不进，囊缩舌卷，而治之不痊，足冷至膝，啮齿目闭
而无魂，吐泻不止，寒战切牙而气冷，肚腹漫胀，气粗殊甚，大喘烦渴，汗出如油，痘黑面
焦，唇项肿硬。或胸高突起，吐泻不瘳，狂闷不食。或手足如水，大头瘟见于初起之际，黑
靥成于六日之期，并一七而浆空寒战。或三八而溃损斑烂，闷乱烦谵，见鬼指怪，元神
亏乏，目失精明，泄泻烦渴，汤水入喉声汨汨，真亡毒伏，腹胀脐陷气悠悠，自报痘后，便得
非常恶梦，从敷花际，时闻怪兆妖征，行举异常，悉变向时模样，半粟不食，忽思顿胜野狼餐。
痘毒即繁，杂症又极，卢医扁鹊，也应酸鼻，仓公韦氏，勿浪扬眉。
胎毒蓄积，引发痘疮（天花），其传染源于外感邪气，病情的轻重取决于内伤的程度。初期病变在太阳经，壬水克制丙火；后期归入阳明经，血水转化为脓浆。病情发展迅速，势如燃眉之急，变化快如反掌之间。想要了解表里、虚实的状况，必须辨明寒热、温凉的性质。症状表现各异，脏腑反应不同：肝主泪，故见水泡；肺主涕，故见脓浆；心对应的斑疹呈红紫色；脾对应的疹子呈赤黄色；唯独肾经若无病变则无特殊表现，但若变黑则尚可预防。因此通过观察外部症状，可以推断内部五脏的情况：呵欠且突然感到烦闷，是肝木受邪所致；咳嗽且打喷嚏，是肺金受邪之象；面目发红并伴有惊悸，是心火炎上于胸膈；手足厥冷并昏睡，是脾土被困于中焦；耳部和尾骶部温暖如常，可见肾水无恙。若这两处灼热，须识别痘症的反常。所以应当先分辨部位，再详细考察灾祥。
阳明经的脉象从眼睛下行至鼻子，太阳经的征象显现于头部。心火炎热则鼻干面赤，肺金郁结则胸膈先受损。脾胃对应手足部位，肝胆主管胁肋旁边。颈项是三阳经交会之处，腰背统属于膀胱经。泄泻说明邪气盛于下部，呕吐说明邪气盛于上部。气逆则腹部隐隐作痛，毒盛则腰部疼痛惶恐不安。心热甚则惊厥抽搐，胃邪实则癫狂。口燥咽干，是肺受火邪而津液枯竭；便秘尿涩，是肾因火旺而津液亡失。想要识别痘症的轻重，又应当观察势态的形状。毒盛则身体如火烧一般，势微则内外清凉。寒热往来且神气清爽，可断定痘出必为吉祥；数番逐渐发出，如同春回大地寒气未尽；一齐涌出，则如火烈昆冈山。若像蚊迹蚤斑，限期死亡归于阴府；若像蛇皮蚕种，拖延时日返回泉乡。必须害怕紫红色，更嫌弃灰白色，最宜淡红滋润，切忌黑色下陷于红色之中。颜色要明润，但又恐怕薄嫩易破；痘粒贵在干燥结痂，切忌瘙痒塌陷难以忍受。面颊稀疏而磊落，可保清安；胸膈密集而连串，吉凶难料。痘形欲要尖圆不宜平陷，浆液宜饱满，切忌空疮。皮肤喜欢老练而愁苦嫩薄，肌肤喜爱粗糙而怕光亮。结实高耸，始终无忧；丹毒浮于皮肉，必然主刑伤。唇面肿胀，八九日如何能过？腰痛胃烂，一七日定受灾殃。疮堆聚于口舌，毒缠绕于颈项，咽疮喉肿，饮食难以下咽。泻利脓血，毒盛无浆，这些都是人力难以挽回的，须知天命不长。
若至痘疮焦落，又宜辨别阴阳。人中上下先结痂者为良，若是四周先出现黑色结痂，多凶少吉，要提防。初起发热温和，腰腹不痛，山根和年上部位光彩红黄，禀赋体质有余。面色无枯滞，脉息浮大而数，唇舌红润鲜亮，先出于腮颐、颧骨、鼻子、地阁之处，圈红皮厚，顿然区别于肌肉颜色。顶尖碍手，更喜色泽姿态多润泽，根窠垒列尤其奇特，乳食又能正常进食，二便如常，五官端正秀丽，按期起胀灌浆，内症全无。这是最为顺候，何必担心每日变迁？若初起发热如火，便秘烦躁口渴非常，青黑色见于山根，燥暗乘于年上，头痛似破碎，狂叫谵妄，骂人昏沉见鬼，口气如火而焦干，身壮热而恶寒更甚，脉无力而沉细兼迟，腰围肚腹刺痛绞痛不已，暴烈烦躁，喘渴吐泻昏沉，身大热而唇口焦裂，未见痘点却声音嘶哑，痘密既多，饮食不止，刚发热而腰痛难伸，未见痘点而面目预先肿胀，热未透而先知蚕种状，或未发热而先出如麸皮样，肉色连红，根窠不立。或带紫色，惨黯不明，及至见到紫黑，青色如痣。天庭、司空、太阳、心胸部位，先出成片，方广、印堂、唇上、结喉，首见如灰色，顶不起而软薄，根不紧而铺红，满面红赤无缝，遍身紫黑干枯，颧骨如胭脂，五俞穴处如蚕种，皮薄成浆如水，色黯昏黑无光，这些最为逆候，华佗也应愧对青囊医书。所以颜色若鲜明，根窠红活，虽平塌而可救；颜色不润泽，根不紧附，纵起发而终凶。身热不退而烦躁，且手足无痘花，虽四日还防添痘；身体既凉而宁静，且四肢俱至，即三朝可许为齐。六日以前，内症虽多，痘疮表暴而自愈。六期以后，内症不痊，表里俱病而为凶。结痂后脉宜和缓，如见洪数者，余毒留而未尽。黑疔挑见黑血，或无血水者，气血竭而难生。初热时唇舌如聚黑点，或紫黑燥裂，预知症已多凶。浆脓时，口唇痘先黄熟，是热毒内攻，尤为不治之症。痘逢擦破，脓血淋漓，有溃烂之势者是吉；颧脸爬穿，目开肿退，如痘壳之干者为凶。起胀时多鼻涕，固为吉祥征兆；成浆时口涎眼泪，总属佳征。初出昏惨色紫，痘根窠微细，宜堤御以防后变；痂落赤紫形突，及睡卧不稳，即清解以免毒生。所以说：一看口唇舌尖而无枯涸燥涩；二看痘点圆活红润，肉痘之色分明；三看心窝、腮口、背项、颧额、脐间稀少；四看顶硬根附，气爽神清，而绝疔、焦紫及内症；五看儿禀壮浓，饮食素能，尚无疾病气围血溶。全此数者，则虽无三窟，亦可高枕无忧矣。
肿毒恶疮方愈，麻疹诸疾才痊。气血尚虚，重痘又见。标后壮热而不退，将脓时厥冷而难温。恶痈夹于极痘，发热喘粗不已。一便秘兼目闭，声哑肌黑唇青。痘出昏沉，憎寒逆冷而不食。脓时胎堕，血来大热而神昏烦躁。腹疼不止，而痘臭异常。头温足冷如痴，而闷渴殊甚。皮肤赤色不退，上下失血不痊。青回口角，云掩天痘，腹胀喘粗，且虚鸣而出秽气于口中。痘无根窠，纵微圈而夹沉重之内症。因热经来久不止，以药治之全不效。吐利不住食不化，或二便之血交流。痰喘心烦，头汗如珠，兼下尿不止，是阴阳相离于上下。大渴血死，痘色黑黯。或锡片干呆，是荣卫咸竭于表里。痘方盛时而发惊不止，及至虚弱而痫症相缠。胃热发黄，状如橘色而下利。脓浆未足，毒邪尚盛而眼开，不时努气，如大便之坚涩。口中无食，若嚼物之空然。困倦殆极而饮食不进，囊缩舌卷，而治之不痊。足冷至膝，啮齿目闭而无魂。吐泻不止，寒战切牙而气冷。肚腹漫胀，气粗殊甚。大喘烦渴，汗出如油。痘黑面焦，唇项肿硬。或胸高突起，吐泻不瘳，狂闷不食。或手足如水，大头瘟见于初起之际，黑靥成于六日之期，并一七而浆空寒战。或三八而溃损斑烂，闷乱烦谵，见鬼指怪。元神亏乏，目失精明。泄泻烦渴，汤水入喉声汨汨，真亡毒伏。腹胀脐陷气悠悠，自报痘后，便得非常恶梦。从敷花际，时闻怪兆妖征。行举异常，悉变向时模样。半粟不食，忽思顿胜野狼餐。痘毒即繁，杂症又极，卢医扁鹊，也应酸鼻，仓公韦氏，勿浪扬眉。
Accumulation of fetal toxin (fetal toxicity) manifests as smallpox (smallpox). Transmission is due to external contraction, while severity depends on internal injury. Initially affecting the Taiyang channel (Taiyang meridian), Ren water controls Bing fire; later returning to the Yangming channel (Yangming meridian), blood and water transform into pus and serum. The momentum is like burning eyebrows, changes are like flipping a palm. To know the exterior-interior and deficiency-excess, one must clarify cold-heat and warm-cool. Symptoms differ in form, organs present different states: The Liver governs tears and thus water blisters; the Lung governs nasal discharge and thus pus and serum; Heart spots are red and purple; Spleen rashes are red and yellow; Only the Kidney meridian has no disease manifestation, but turning black can be prevented. Therefore, observing external symptoms allows inferring the five internal organs: yawning and sudden stuffiness is due to Liver wood; coughing and sneezing is the image of Lung metal; face and eyes red with palpitations indicates Heart fire blazing in the chest and diaphragm; cold extremities and drowsiness indicates Spleen earth trapped in the center; ears and sacrum warm as usual shows Kidney water is unharmed. If these two areas are scorching hot, one must recognize the abnormality of smallpox. Thus, one should first distinguish locations, then examine details carefully. Yangming descends from eyes to nose, Taiyang appears on the head. Heart fire heat causes dry nose and red face, Lung metal stagnation injures chest and diaphragm first. Spleen and Stomach belong to hands and feet parts, Liver and Gallbladder govern sides of ribs. Neck and nape are intersection of three Yang channels, waist and back are unified by Bladder channel. Diarrhea means evil is excessive below, vomiting means evil is excessive above. Qi rebellion causes hidden abdominal pain, severe toxin causes fearful lower back pain. Excessive Heart heat causes convulsions, Stomach evil excess causes mania. Dry mouth and throat indicate Lung receiving fire evil and fluid exhaustion, constipation and difficult urination indicate Kidney due to fire excess and fluid loss. To identify severity of smallpox, observe the shape of the condition. Severe toxin makes body like fire, mild condition makes interior and exterior cool. Alternating chills and fever with clear spirit predicts auspicious eruption; gradual emergence over several times is like spring returning with lingering cold, simultaneous eruption is like fierce fire on Kunlun Mountain. Mosquito bites and flea marks predict death within period, snake skin and silkworm seeds prolong life until return to underworld. One must fear purple-red and dislike gray-white; pale red and moist is best; black sinking into red is strictly forbidden. Color should be bright and moist, yet fear thinness and fragility; pustules prefer drying and crusting, itching and collapsing is unbearable. Sparse and distinct on cheeks ensures safety; dense and connected on chest/diaphragm makes fortune uncertain. Pustules should be pointed and round, not flat or sunken; full of serum is good, empty sores are bad. Skin prefers old and rough, fears tender and smooth. Firm and high projection brings no worry; floating carbuncle on flesh implies punishment/injury. Swollen lips and face, how to pass 8-9 days? Lower back pain and rotten stomach, disaster strikes at 7 days. Sores piled on tongue, toxin winding neck, sore throat and swelling make eating difficult. Bloody diarrhea with pus/toxin excess and no serum are cases beyond human power, knowing fate is short.
When scabs fall, distinguish Yin and Yang. Crusting first on upper/lower Renmai is good; black crusting first on four sides is mostly ominous, beware. Initial fever mild, waist/abdomen painless, Shangen and Nianshang bright red/yellow, constitution surplus. Face not withered, pulse floating large and rapid, lips/tongue red/moist, appearing first on cheeks, zygoma, nose, chin, with red rings and thick skin, distinct from flesh. Pointed tips touching hand, pleasing color/moisture, unique stacked bases, normal feeding, normal excretion, five peaks elegant, timely inflation/filling, no internal symptoms. This is most favorable, why worry about daily changes? If initial fever like fire, constipation, extreme thirst/restlessness, cyan/black on Shangen, dry/dark on Nianshang, headache like breaking, screaming delirium, cursing/coma seeing ghosts, breath like fire/dry, body hot with severe chills, pulse weak/deep/thin/slow, waist/abdomen stabbing/cramping pain, violent restlessness, panting/thirst/vomiting/diarrhea/coma, body very hot with cracked lips/mouth, voice lost before spots appear, many dense sores, continuous eating, back pain when just febrile, facial swelling before spots, silkworm appearance before heat penetrates, bran-like appearance before heat, red flesh without standing base, purple/dull color, cyan/black like moles. Tian Ting, Si Kong, Tai Yang, Xin Xiong areas erupt成片, Fang Guang, Yin Tang, lips, Jie Hou appear gray first, soft/thin top, loose/red base, whole face red seamless, whole body purple/black dry, zygoma rouge, Wu Shu acupoints like seeds, thin skin watery serum, dark/black dull color. These are most adverse, Hua Tuo would feel ashamed of his medical skills. So if color bright, base red/lively, even flat/sunken can be saved; if color not moist, base not tight, even raised will ultimately be fatal. Unremitting fever with restlessness, no flower on limbs, even day 4 may add sores; body cool/calm, limbs reached, day 3 may be complete. Before day 6, despite many internal symptoms, surface eruption heals itself. After day 6, if internal symptoms persist, interior/exterior both diseased is ominous. Pulse after crusting should be harmonious/slack; if洪数 (surging-rapid), residual toxin remains. Black thorn picking black blood or no blood/water indicates Qi/Blood exhaustion and difficulty surviving. Initial fever lips/tongue like clustered black dots or purple-black dry cracks predict many ominous signs. During serum stage, lip sores ripening yellow first indicates internal attacking heat toxin, especially incurable. Sores rubbed open with dripping pus/blood showing ulceration tendency is auspicious; cheek penetration, eye opening/swelling reduction, dry scab is ominous. Mucus during inflation is auspicious; saliva/tears during filling is good omen. Initial dim purple with fine roots requires defense against later changes; falling crusts red/purple protruding with restless sleep require clearing/resolving to avoid toxin generation. Thus: 1. Check lips/tongue tip for no dryness/astringency; 2. Check spots round/lively/red/moist, flesh color distinct; 3. Check heart pit, cheeks, mouth, back, nape, zygoma, forehead, umbilicus for sparsity; 4. Check hard tops, attached bases, clear Qi/spirit, absence of thorns/blackened spots/internal symptoms; 5. Check strong constitution, normal appetite, no disease/Qi blockage/Blood dissolution. Fulfilling these ensures peace of mind even without multiple escapes.
After swelling/toxins/healing, measles/recovering. Qi/Blood still deficient, severe smallpox reappears. Post-mark high fever unsubsiding, pre-pus cold limbs hard to warm. Malignant abscesses mixed with extreme smallpox, fever/panting unceasing. Constipation plus closed eyes, hoarse voice/black skin/blue lips. Smallpox eruption with coma, aversion to cold/reversal cold/not eating. Pus stage fetal expulsion, bleeding with high fever/coma/restlessness. Abdominal pain unceasing, abnormal smallpox odor. Head warm/feet cold like idiot, severe stifling/thirst. Red skin unsubsiding, upper/lower bleeding unhealed. Cyan corners of mouth, clouds covering heavenly smallpox, abdominal distension/panting, hollow rumbling foul breath from mouth. Smallpox without bases, even slight rings with heavy internal symptoms. Heat menstruation long uncontrolled, medicine ineffective. Vomiting/diarrhea unceasing undigested food, or blood flowing from bowels/bladder. Phlegm/panting/heart vexation, head sweat like pearls, continuous urine leakage, Yin/Yang separation above/below. Extreme thirst/blood death, black/dull smallpox color. Tin-sheet dry/stiff, Ying/Wei exhausted inside/outside. Smallpox flourishing with constant fright, weakness entangled with epilepsy. Stomach heat jaundice orange-colored with diarrhea. Serum insufficient, toxin still盛 (excessive) with open eyes, frequent straining like hard stool. Mouth empty chewing nothing. Extreme fatigue not eating, scrotum shrinkage/tongue curling, treatment fails. Feet cold to knees, grinding teeth/closed eyes/no soul. Vomiting/diarrhea unceasing, chattering teeth/cold qi. Abdominal distension, coarse breathing. Great panting/thirst, sweat like oil. Black smallpox/scorched face, swollen/hard lips/neck. High chest protrusion, vomiting/diarrhea unhealed, manic/stifling/not eating. Hands/feet like water, big head plague at onset, black crusting at day 6, day 7 empty serum/chills. Day 8-9 ulcerated/rotten, confused/manic/delirious, seeing ghosts/pointing weirdly. Yuan Shen deficient, eyes losing clarity. Diarrhea/thirst, gurgling soup entering throat, true depletion/toxin lurking. Abdominal distension/umbilical depression/breath leisurely, reporting post-smallpox terrible dreams. From Huaji area, hearing strange omens. Abnormal movements changing past appearance. Not eating half grain, suddenly craving wolf-like meals. Smallpox toxin abundant, miscellaneous diseases extreme. Lu Yi Bian Que would also cry bitter tears, Cang Gong Wei Shi should not raise eyebrows lightly.