阳热壮热面唇赤，舌干饮冷爪尿红，烦躁昏狂谵失血，紫黑焦枯不润通。
[注]
凡痘属阳热者，身必壮热，面唇皆赤，舌上干燥，好饮冷水，
爪甲尿溺，皆现红色，烦燥不宁，神气昏愦，发狂谵语，
失血者，吐血衄血也，
紫黑焦枯者，痘色紫黑焦枯也，
不润通者，九窍不润通也，此皆属阳热之证也。
%
阴寒无热口鼻冷，面唇尿爪色自青，厥冷难回利不臭，水泡灰白无晕红。
[注]
凡痘属阴寒者，身肢不热，口鼻皆冷，面唇尿溺爪甲，色现青白也，
厥冷难回者，谓四肢厥冷不能即温也，
利不臭者，谓下利无臭秽也，
水泡湿盛也，
灰白即无晕者，谓痘色灰白，根脚无红晕也，此皆属阴寒之证也。
%
温补过则痘溃烂，毒攻咽龈日肿痈，清泻过则痘白陷，呕吐不渴厥利清。
[注]
痘有虚实，治有补泻，要在审当而施也，
如虚者当补，亦须酌量施治，
若温补过甚，则反助毒热而痘溃烂也，
以致毒热上攻，或咽喉肿痛，或牙龈发疳，或眼目赤肿生翳，
甚而攻于荣卫，发为痈疽也，
如实者当泻，亦须中病即止，
若清泻过甚，则损伤正气，而痘白陷，或呕吐不渴，或厥逆下利，
此发明温补清泻之过当也。
%
毒微气血实则顺，毒甚而虚逆自明，毒微若虚恐化险，毒甚逢实变险能。
[注]
痘由禀赋毒气，轻者固顺，然必儿之气血不虚，则始为顺也，
重者固逆，亦必儿之气血虚，则始为逆也，
毒微者顺也，若儿之气血虚弱，虽顺恐化险也，
毒甚者逆也，若儿之气血不虚，虽逆能变险也，
此以儿之胎毒重轻，气血虚实，定痘之顺逆险也。
%
阳热证表现为身体高热，面部和嘴唇发红，舌头干燥且想喝冷水，指甲和小便颜色红赤，烦躁不安、神志昏迷狂乱、说胡话或出血，痘疹颜色紫黑、焦枯且不滋润通畅。
[注]
凡是属于阳热的痘症，身体必然高热，面部和嘴唇都发红，舌面干燥，喜欢喝冷水，
指甲和小便都呈现红色，烦躁不宁，神志昏沉糊涂，发狂说胡话，
出血的，是指吐血和鼻出血，
紫黑焦枯的，是指痘疹颜色紫黑、焦枯，
不润通的，是指九窍（眼、耳、口、鼻、前后二阴）不滋润通畅，这些都属于阳热的证候。
阴寒证表现为没有发热，口鼻寒冷，面部、嘴唇、小便和指甲颜色发青，四肢厥冷难以回暖，腹泻气味不臭，痘疹呈水泡状、灰白色且没有红晕。
[注]
凡是属于阴寒的痘症，身体和肢体不热，口鼻都冷，面部、嘴唇、小便和指甲的颜色呈现青白色，
四肢厥冷难以回暖的，是指四肢冰冷不能立即变暖，
腹泻气味不臭的，是指下利没有腥臭秽浊的气味，
水泡是湿邪盛的表现，
灰白即无晕的，是指痘疹颜色灰白，根部周围没有红晕，这些都属于阴寒的证候。
温补过度会导致痘疮溃烂，毒气攻冲咽喉牙龈导致每日肿胀生痈；清泻过度会导致痘色苍白下陷，呕吐但不口渴，四肢厥冷且下利清谷。
[注]
痘症有虚证和实证之分，治疗有补法和泻法之别，关键在于审慎判断后施治，
如果是虚证应当用补法，但也必须斟酌衡量后进行治疗，
如果温补过度，反而会助长毒热而导致痘疮溃烂，
以致毒热向上攻冲，出现咽喉肿痛，或者牙龈发生疳疮，或者眼睛红肿生翳，
严重时毒气攻冲营卫，引发痈疽，
如果是实证应当用泻法，也必须中病即止（见效就停止），
如果清泻过度，就会损伤正气，导致痘色苍白下陷，或者呕吐但不口渴，或者四肢厥逆下利清稀，
这是为了阐明温补和清泻使用过度的弊端。
毒气轻微而气血充实为顺证，毒气严重而气血虚弱为逆证自明；毒气轻微若遇气血虚弱恐怕转化为险证，毒气严重若遇气血充实可能转变为险证。
[注]
痘症由禀赋的毒气引起，毒气轻者固然为顺证，但必须孩子的气血不虚，才算是顺证，
毒气重者固然为逆证，也必须是孩子的气血虚弱，才算是逆证，
毒气轻微的是顺证，但如果孩子的气血虚弱，虽然是顺证也恐怕转化为险证，
毒气严重的是逆证，如果孩子的气血不虚，虽然是逆证也能转变为险证（此处原文逻辑似有歧义，通常指逆证若气血不虚尚可挽回，或指变证之复杂，依文意直译：虽属逆证，因气血不虚，故能变化出险恶之象/或指病情复杂化，结合上下文“变险能”应理解为逆证若处理不当或体质特殊可转为险证，此处按字面意思翻译：虽为逆证，因气血不虚，反而能发生变化成为险证——注：中医古籍中此句常有争议，通常解释为：毒微气血实为顺；毒甚气血虚为逆。若毒微而气血虚，则顺转险；若毒甚而气血实，则逆转顺或难治。此处依原文“变险能”直译）。
这是根据孩子的胎毒轻重、气血虚实，来判定痘症的顺、逆、险。
Yang-heat syndrome is characterized by high fever, redness of the face and lips, dry tongue with a desire to drink cold water, red nails and urine, restlessness, delirium, coma, mania, hemorrhage, and pustules that are purple-black, scorched, dry, and unmoistened.
[Note]
In all cases where pox (smallpox) belongs to Yang-heat, the body must have high fever, the face and lips are both red, the tongue surface is dry, and there is a preference for drinking cold water.
The nails and urine both appear red; restlessness without peace; spirit is confused and dull; mania and delirious speech occur.
Hemorrhage refers to hematemesis (vomiting blood) and epistaxis (nosebleed).
Purple-black and scorched refers to the color of the pustules being purple-black and scorched.
Unmoistened and unpatent refers to the nine orifices (eyes, ears, mouth, nose, and anterior/posterior orifices) lacking moisture and patency. These all belong to Yang-heat syndromes.
Yin-cold syndrome is characterized by absence of fever, coldness of the mouth and nose, bluish-green color of the face, lips, urine, and nails, cold extremities that are difficult to warm, diarrhea without foul odor, and pustules presenting as blisters, grayish-white in color, and lacking a red halo.
[Note]
In all cases where pox belongs to Yin-cold, the body and limbs are not hot, the mouth and nose are both cold, and the color of the face, lips, urine, and nails appears blue-green and white.
Cold extremities that are difficult to warm means the four limbs are cold and cannot be warmed immediately.
Diarrhea without foul odor means the downward discharge lacks a foul smell.
Blisters indicate an abundance of dampness.
Grayish-white without a halo means the pustule color is grayish-white, and the base has no red halo. These all belong to Yin-cold syndromes.
Excessive warming and tonification leads to ulceration of the pustules; pathogenic toxins attacking the throat and gums cause daily swelling and carbuncles. Excessive clearing and purging leads to pale, sunken pustules, vomiting without thirst, cold extremities, and clear diarrhea.
[Note]
Pox has deficiency (Xu) and excess (Shi) patterns; treatment involves tonification and purging methods. The key lies in careful assessment before applying treatment.
If it is a deficiency pattern, tonification should be used, but dosage must be carefully considered.
If warming and tonification are excessive, they will inadvertently assist pathogenic heat, leading to ulceration of the pustules.
This may cause pathogenic heat to attack upward, resulting in sore throat and swelling, gum disease (gan), or red, swollen eyes with nebulae.
In severe cases, toxins attack Ying and Wei (Nutritive and Defensive levels), causing carbuncles and sores.
If it is an excess pattern, purging should be used, but one must stop once the disease is addressed (Zhong Bing Ji Zhi).
If clearing and purging are excessive, healthy Qi (Zheng Qi) is damaged, leading to pale, sunken pustules, vomiting without thirst, cold extremities, and clear diarrhea.
This section elucidates the dangers of excessive warming/tonification and excessive clearing/purging.
When pathogenic toxin is mild and Qi and Blood are substantial, the course is favorable (Shun); when the toxin is severe and Qi and Blood are deficient, the course is unfavorable (Ni), which is self-evident. If the toxin is mild but Qi and Blood are deficient, it may transform into a dangerous (Xian) state; if the toxin is severe but Qi and Blood are substantial, it may also transform into a dangerous state.
[Note]
Pox arises from congenital toxic Qi. Mild toxicity is naturally favorable, but it requires the child's Qi and Blood to be non-deficient to truly be considered favorable.
Severe toxicity is naturally unfavorable, but it requires the child's Qi and Blood to be deficient to truly be considered unfavorable.
Mild toxicity indicates a favorable course; however, if the child's Qi and Blood are weak, even a favorable course may transform into danger.
Severe toxicity indicates an unfavorable course; if the child's Qi and Blood are not deficient, even an unfavorable course can transform into danger (Note: This interpretation follows the literal text "bian xian neng", implying complexity or potential for critical transformation despite substantial constitution, though clinically often implies reversibility or specific complication risks depending on context).
This determines the favorable, unfavorable, and dangerous courses of pox based on the severity of the child's fetal toxin and the substance/deficiency of their Qi and Blood.