《经》曰∶肺通窍于鼻，故痘初热喷嚏者，是火邪上干于肺，外应于鼻，火灼之而
痒则嚏也。鼻干黑燥者，火刑于金，金体本燥，得愈甚也。鼻衄者，阳明热极，血得热
而妄行，上溢于脑，故衄出于鼻也。鼻流清涕者，疹也。盖疹发于心，心肺相连，以火
的金，热极反化为水也。鼻塞不通者，非风寒壅寒，即火蚀清气而不升也。若一出红点
数粒成块，发于山根之上者，为毒盛气虚，而毒乘虚犯上也。然脾络通鼻为坤土之位，
故不论先后，但忌模糊成片，而早干收也。若正成浆，鼻上先黄者，此脾土将败，真脏
色见也。并诸疮未浆而鼻端先干者，凶。《经》曰∶脏最高于肺，以行荣卫阴阳也。
若邪火弄肺，则肺败不能输精于皮毛，故皮毛焦粘，先见于鼻，渐必荣卫不行，阴阳不
续，必遍身干枯而死。并疮变坏症，鼻中出血者，涕自流出者，鼻孔开张喘急者，皆肺
经也，不治。
《经》曰∶肾通窍于耳。耳者，肾之外候也。肾为水脏，天一生之，受气之初，先
生两肾，而一阴藏焉。又有相火存于命门之中，故发热而耳独凉者，顺。盖疹疮属火，
肾不受邪，存水之德以制阳光也。如耳反热者，则火炎水涸，真阴败绝，水不胜火，将
有归肾之变。然痘出之候，必验耳后红缕者，盖手少阳三焦之脉，从膻中上出缺盆，
系于耳后，直上耳角，红者，是火色也。此疮疹之火发自少阳而自见于其经也。若疮自
耳先出，及未成浆而耳输先靥者，则渐萌归肾之势，君相二火用事，燔灼之势，难加扑
灭必致不可为矣。
夫痘起于相火，耳为肾窍，故纹兆耳
后，直面细，红而润者为上，粗而斜紫而亮者为中，曲而杂紫而黯者为下。若以久近论
之，则红纹直上而不明莹者，一岁之征也。红纹邪掠而隐于重膜之间者，八九月之征
也，红纹横截而映肉分者，半载之征也。青紫纹直上有鱼刺者，两月之征也。青紫纹邪
掠者，四旬之征也。青紫纹横截者，一月之征也。紫纹盘结者，时日之征也。然时日之
间，更有十验焉。如两耳垂珠冷，一也。 冷，二也。手足指尖冷，三也。眼昏花黑，
自不分明，四也。眉绉戚戚不开扬，黄亮，五也。发热而脸赤唇红，六也。或身头痛而
乍热乍凉，七也。气呵欠而不通利，八也。睡中、或时挫声，九也。梦寐，或时闪摄，
十也。十者之中，若犯四五，痘必见矣。
《黄帝内经》说：肺通过鼻窍与外界相通，所以痘疹初期发热时出现打喷嚏，是因为火邪向上侵犯肺脏，在外部反映于鼻部，火热灼烧导致鼻内发痒，从而引发喷嚏。如果鼻孔干燥、颜色发黑且燥裂，这是火邪克制肺金（肺属金），肺金本性干燥，受热后更加严重。流鼻血，是阳明经热势极盛，血液受热而妄行，向上溢出至脑部，所以从鼻腔流出。鼻涕清稀，是疹病的表现。因为疹病发于心，心与肺相连，以火克金，当热势极盛时反而化为水液。鼻塞不通，不是风寒壅塞，就是火邪侵蚀清气导致其不能上升。如果在山根（鼻梁根部）上方长出几粒红点聚集成块，这是毒气旺盛而正气虚弱，毒气乘虚上犯所致。然而脾的络脉通于鼻，对应坤土之位，所以不论痘疹发展的先后阶段，都忌讳鼻部模糊成片，以及过早干燥结痂。如果痘疹正化成脓浆，但鼻部先变黄，这是脾土功能即将败坏，真脏色显露的表现。各种疮疡在未化脓前鼻端先干燥的，预后凶险。《黄帝内经》说：五脏中位置最高的是肺，它负责运行营卫和阴阳之气。如果邪火扰动肺脏，则肺脏衰败，不能将精气输布到皮毛，所以皮毛焦枯粘连，最先表现在鼻部，进而必然导致营卫运行停滞，阴阳之气断绝，最终全身干枯而死。此外，疮疡变坏症中，鼻中出血、鼻涕自行流出、鼻孔开张且呼吸急促的，都属于肺经病变，难以治愈。
《黄帝内经》说：肾通过耳窍与外界相通。耳朵，是肾脏的外在征候。肾是水脏，受天一之水而生，在受孕之初，先生成两肾，其中藏有一阴之气。又有相火存留于命门之中，所以发热时唯独耳朵凉爽，属于顺证。因为疹疮属火，肾不受邪气侵袭，依靠存水的德性来制约阳光（火热）。如果耳朵反而发热，则是火炎上而水枯竭，真阴败绝，水不能胜火，将有病邪归并于肾的变故。然而痘疹发出的征兆，必须观察耳后是否有红色血丝，因为手少阳三焦的经脉，从膻中穴向上出于缺盆，联系于耳后，直上至耳角，发红的是火色的表现。这是疮疹之火发自少阳经而在本经显现出来。如果疮疹先从耳部发出，以及未成脓浆时耳部皮肤先凹陷结痂的，则逐渐萌生病邪归肾的趋势，君火与相火二火主事，焚烧灼热的态势，难以扑灭，必定导致不可救治的局面。
痘疹起于相火，耳为肾之窍，所以耳后的纹路兆象，正面看细直、红润光泽的为上佳；粗斜、紫色光亮的中等；弯曲杂乱、紫色暗滞的为下劣。如果以病程久近来判断，则红色纹路直上但不明莹的，是一岁的征象；红色纹路斜掠并隐没在重膜之间的，是八九个月的征象；红色纹路横截并映现于肌肉纹理间的，是半年的征象；青紫色纹路直上有如鱼刺状的，是两个月的征象；青紫色纹路斜掠的，是四十天的征象；青紫色纹路横截的，是一个月的征象；紫色纹路盘结的，是数日内的征象。然而在数日之间，还有十种验证方法。比如双耳垂珠寒冷，是第一征；（原文此处似有脱漏或重复，依文意推测可能指耳廓冷或其他部位冷，暂按原文“冷”处理，结合上下文可能是指耳轮冷或整体寒象，此处保留原文字面意思，通常此类歌诀中第二验常指耳轮冷或耳背冷，但原文仅写“冷”，故译为冷），第二征；手足指尖寒冷，第三征；眼睛昏花视物不清，第四征；眉头紧皱神情忧郁不舒展，面色黄亮，第五征；发热且脸赤唇红，第六征；或者身体头痛且忽冷忽热，第七征；气息呵欠且不通畅，第八征；睡眠中有时发出呻吟声，第九征；睡梦中有时惊悸闪摄，第十征。这十种征象中，如果出现四五种，痘疹必然发作。
The *Classic* states: The Lung opens into the nose. Therefore, when pox (smallpox) initially presents with fever and sneezing, it is because Fire pathogenic factors invade the Lung from above, manifesting externally on the nose. The heat burns and causes itching, leading to sneezing. If the nostrils are dry, black, and cracked, this indicates Fire punishing Metal (Lung). Since Metal inherently possesses dryness, the condition worsens upon receiving heat. Epistaxis (nosebleed) occurs due to extreme heat in the Yangming channel; blood moves recklessly under the influence of heat and overflows upward into the brain, thus exiting through the nose. Clear nasal discharge indicates measles (rash diseases). This is because rashes originate in the Heart; the Heart and Lung are connected. Fire controls Metal, but when heat reaches its extreme, it transforms into water. Nasal congestion without passage is not caused by Wind-Cold obstruction, but rather by Fire damaging clear Qi, preventing it from ascending. If a few red spots appear and cluster on the Shangen (root of the nose), it signifies excessive toxin and deficient Qi, where the toxin attacks upward taking advantage of the deficiency. However, the collaterals of the Spleen connect to the nose, corresponding to the position of Kun Earth. Therefore, regardless of the stage, one must avoid the nose becoming blurred into patches or drying and crusting too early. If the pustules are forming pus but the nose turns yellow first, this indicates the impending failure of Spleen Earth and the appearance of the True Zang color. If the tips of the nose become dry before any sores have formed pus, the prognosis is ominous. The *Classic* states: Among the Zang organs, the Lung is the highest, responsible for circulating Ying and Wei Qi and Yin and Yang. If evil Fire disturbs the Lung, the Lung fails to transmit essence to the skin and hair, causing the skin and hair to become scorched and sticky, first appearing at the nose. Gradually, Ying and Wei circulation will cease, and Yin and Yang will disconnect, leading to death from total body dryness. Furthermore, in deteriorating conditions of sores, epistaxis, spontaneous nasal discharge, open nostrils with rapid breathing, all belong to Lung channel pathology and are incurable.
The *Classic* states: The Kidney opens into the ears. The ears are the external manifestation of the Kidney. The Kidney is a Water organ, generated by Tian Yi (Heaven One), and during conception, the two kidneys form first, harboring a Yin essence. Additionally, Ministerial Fire resides within the Mingmen gate. Therefore, if fever occurs but the ears remain cool, it is a favorable sign. This is because rash diseases belong to Fire, and the Kidney does not accept the pathogen, relying on its Water nature to control the Solar fire. If the ears become hot instead, it indicates Fire blazing and Water drying up, true Yin failing, and Water being unable to overcome Fire, suggesting a shift of the disease to the Kidney. Regarding the eruption of smallpox, one must examine the ear area for red threads. The Sanjiao (Triple Burner) meridian of Hand-Shaoyang ascends from the Danzhong point, emerges above the Keyan (Clavicle), connects behind the ear, and goes straight to the ear apex. Redness here represents the color of Fire. This shows that the fire of the sores originates from the Shaoyang meridian and manifests in its own channel. If sores appear first from the ear, or if the ear skin collapses before pus forms, it gradually indicates a trend of the disease returning to the Kidney. With both Sovereign and Ministerial Fires in action, their burning intensity is hard to extinguish, inevitably leading to an untreatable state.
Smallpox arises from Ministerial Fire, and the ear is the aperture of the Kidney. Thus, the patterns behind the ear serve as omens: fine, straight, red, and moist lines are superior; coarse, slanted, purple, and bright lines are medium; curved, mixed, purple, and dark lines are inferior. Judging by duration: red lines going straight up but not bright indicate one year of age; red lines slanting and hidden between membranes indicate eight to nine months; red lines crossing horizontally and reflecting in muscle layers indicate half a year; straight blue-purple lines with fish-bone-like projections indicate two months; slanting blue-purple lines indicate forty days; horizontal blue-purple lines indicate one month; knotted purple lines indicate a few days. Within these few days, there are ten further signs: 1. Cold earlobes; 2. Cold [ears/limbs]; 3. Cold fingertips; 4. Blurred vision and darkness; 5. Frowning brows with a sullen expression and yellow-bright complexion; 6. Fever with red face and lips; 7. Body pain alternating with hot and cold sensations; 8. Yawning and difficult breathing; 9. Moaning during sleep; 10. Startling or jerking in dreams. If four or five of these ten signs appear, smallpox will certainly erupt.