【顺候】 春夏为顺。先发惊搐而后出痘者顺。先发热、热歇出痘顺。饮食如常顺。二
便如常顺。
【逆候】 秋冬为逆。春脓泡，（金克木）。夏黑陷，（水克火。）秋发斑，（火克金）。
冬发疹，（土克水）。便血或利，乳食不化，（脾虚）。正出吐利，风攻颐颔项睫，或胸高突，
面肿鼻陷，闭目切牙，或鼻有黑气。肌肉黑。面色青黑。或因吐利内虚陷伏。已出妄汗而成
斑烂。或冒风邪成倒靥，不起发也。泄泻不止，疮成饼塌，燥渴小便涩，声哑。饮药
错喉，喘息不休，疮尽爪破，臭烂不可近。目闭黑暗， 昧无魂。头面肿，足冷至膝。不时
努力，（如用大便之状。）疮与肉色不分。已出身热足热不解，已出烦躁闷乱。瘥后惊搐，
痘疮未该靥结，卒然焦黑青紫。
【恶候】 痘出而复不出。忽大泻而渴。已出谵语不止。或黑紫色隐在肌内里，其毒重。
甚者五脏咽喉中有痘。其疮不成粒，如凝血而痛，黑靥不生脓血者死。或见是证以药解之，
而毒反没者死。目开腹胀口中作臭气者不治。大小便秘，肌黑目闭声哑者死。胃热发黄身
如橘色下利者死。
痘疮始出一二日间
【顺候】 初出血点淡红润色，一二日如粟如黍，出于口鼻腮耳、年寿之间。先发三两
点淡红润色者，顺之兆也。顺者不药自愈，为气得其正，血得其行，其毒不甚，不得妄行
肆其虐也。
【逆候】 形如蚕种一片如麻布红，黑疹初出于天庭、司空太阳、印堂、方广之处，逆之
兆也。逆者不
治，此为元气本虚、血气凝滞。毒邪太盛，妄参阳位，无以当其势。
【险候】 圈晕成形，干红少润，痘出虽稠尚红润而成粒者，险也。险者，毒虽盛，
元气尚充，未可为虞，宜用补元气之中少加解毒之药，须防毒盛正气有所伤也。
痘疮圆混二三日间
【顺候】 气溢血附，饱满光洁，三四日间，根窠圆混，元气之充满也。气充则血附，而各
得其道，为顺。顺者不治自愈。
【逆候】 气涩血凝，枯槁不泽，根窠无晕，气离血散，为逆。逆者，气血交会不足，致毒
乘机而犯内也。
【险候】 顶陷不满，光洁有神、根窠尚圆，惟顶有陷，气血难充，为险。以保元汤加芎
桂助脾胃气血，可保无虞。
痘疮形色候四五日间
【顺候】 气满血荣，鲜明光泽，则知血气之旺，受毒之浅。其形光润，大小不一等，此气
和血就，为顺，不治自愈。
【逆候】 四五日来绵密如泡，紫黑干红，或如蚕种，或黑陷紫泡，皆逆也。逆者难治，为
气血乖离，邪毒内攻也。
【险候】 四五日间，根窠虽起，色惨不明，为险。血虽好，气分弱，些交会欠分明。宜用
保元汤加术芎助卫和荣，色自光明矣。
痘疮起发圆满候
【顺候】 五六日间，气盛血荣于内，痘当圆满起发于外，斯为顺也，不须用药而自愈。
【逆候】 五六日，痘尚干枯，绵密不起，陷顶灰白色，或紫黑，或为水泡、痒塌，为逆。此
气血衰弱致毒内陷而外剥也。皆不可治。
【险候】 五六日之间，痘疮虽起，但色白不荣，为险。此气盈血亏。保元汤加芎、归、桂、
芍，则痊愈矣。
痘疮浆满七八日间
【顺候】 七八日痘疮浆足圆满，青黄光泽，则毒消而气血之功成矣。此为顺候，不须用药。
【逆候】 七八日浆不足，此气血衰尽之时，不能用药，为逆。
【险候】 八九日红黄色润，浆略不足，此气弱而为险也。以保元、姜、术充而助之，则老
足矣。
痘疮血尽浆回十一二日间
【顺候】 十二三日，痘疮气调血尽，毒解浆回，光色渐敛，此自然之顺候也。
【逆候】 十二三日，血淡而浆薄、血凝而气滞，则毒不散、浆不回，枯朽剥极，为逆之候，
可惧也。
【险候】 十二三日，血尽浆老、湿润不敛，为内虚，为险。宜用保元加苓、术助其收敛而结
痂也。
痘疮结痂候十三四日间
【顺候】 十三四日，气血归原，毒瓦斯消散，浆老结痂，此为神化十全，为顺。
【逆候】 十三四日，毒未脱，形虽结痂，而诸邪仍作，为逆。
【险候】 十三四日内，浆老结痂之际，尚有杂证相仍，此要临时酌量消息调和，不可轻妄
为妙。
痘疮还原候十四五日间
【顺候】 十四五日，气血十全，痂脱瘢明，神清气爽，此为顺也。
【逆候】 十四五日，痂未易落，谵语狂烦， 于寒战，疔肿杂病并仍，此无生意，为逆。
【险候】 十四五日，痂落而少食，口渴烦热，此余毒也，为险。宜用四君子加黄连、鼠粘子、
连翘解毒汤之属，治之可愈。
【顺候】 春夏季节出现痘疮属于顺证。先出现惊厥抽搐，随后出痘的，为顺证。先发热，热退后出痘的，为顺证。饮食正常的，为顺证。大小便正常的，为顺证。
【逆候】 秋冬季节出现痘疮属于逆证。春季出现脓疱（金克木）。夏季出现黑陷（水克火）。秋季出现发斑（火克金）。冬季出现发疹（土克水）。大便出血或腹泻，乳汁食物不消化（脾虚）。痘疮正当发出时出现呕吐腹泻，风邪侵袭面颊、下颌、颈部、睫毛部位，或者胸部高突，面部肿胀鼻部凹陷，闭目咬牙，或者鼻部有黑色气色。肌肉变黑。面色青黑。或者因为呕吐腹泻导致内部虚弱，痘毒内陷伏匿。痘已发出却妄自出汗，导致痘疮溃烂。或者因冒受风邪导致痘疮倒靥（痘顶凹陷不起），不能起发。泄泻不止，痘疮像饼一样塌陷，口干燥渴，小便涩滞，声音嘶哑。服药时呛入咽喉，喘息不停，痘疮全部被抓破，恶臭腐烂不可靠近。眼睛闭合，眼神黑暗，神志昏迷如失魂。头面部肿胀，脚冷至膝盖。不时用力挣扎（像是要解大便的样子），痘疮与周围肉色不分。痘已发出但身热足热不退，痘已发出但烦躁闷乱。病愈后出现惊厥抽搐，痘疮未到结痂期，突然焦黑青紫。
【恶候】 痘疮发出后又不出。忽然大泻且口渴。痘已发出但胡言乱语不止。或者黑紫色隐伏在肌肉深处，说明毒性严重。严重的，五脏和咽喉中都有痘疮。其痘疮不成颗粒，像凝血一样疼痛，黑痂不生脓血的，主死。或者见到这些症状用药解毒，反而导致毒邪内没的，主死。眼睛睁开但腹胀，口中散发臭气的，不治。大小便闭塞，肌肉发黑，眼睛闭合，声音嘶哑的，主死。胃热发黄，身体像橘子颜色，伴有下利的，主死。
痘疮刚发出一二日间
【顺候】 初起出血点呈淡红润色，一二天后像粟米、黍米一样，出现在口鼻、腮部、耳朵、年寿（鼻准）之间。先发两三颗淡红润色的，是顺证的征兆。顺证者不吃药也能自愈，这是因为正气充足，血液运行通畅，毒性不重，不会妄行肆虐。
【逆候】 形状像蚕种一片，如麻布上的红点，黑疹初出于天庭、司空、太阳、印堂、方广等部位，是逆证的征兆。逆证者难以治疗，这是因为元气本虚，气血凝滞。毒邪太盛，妄犯阳位，无法抵挡其势头。
【险候】 痘疮周围晕圈成形，干燥发红少润泽，痘疮虽然稠密但仍红润并成颗粒的，属险证。险证者，虽然毒盛，但元气尚充，不必过分担忧，宜在补益元气的药物中少量加入解毒药，必须防止毒盛损伤正气。
痘疮圆混二三日间
【顺候】 气溢血附，饱满光洁，三四日间，痘根圆浑，这是元气充满的表现。气充则血附，各得其道，为顺证。顺证者不治自愈。
【逆候】 气涩血凝，枯槁无光泽，痘根无晕，气离血散，为逆证。逆证者，气血交会不足，导致毒邪乘机侵犯内部。
【险候】 痘顶凹陷不满，但光洁有神，痘根尚圆，只有顶部凹陷，气血难以充盈，为险证。用保元汤加川芎、桂枝助脾胃气血，可保证无虞。
痘疮形色候四五日间
【顺候】 气满血荣，鲜明光泽，可知气血旺盛，受毒较浅。其形光润，大小不一，这是气和血就，为顺证，不治自愈。
【逆候】 四五天来绵密如泡，紫黑干红，或者像蚕种，或者黑陷紫泡，都是逆证。逆证者难治，因为气血乖离，邪毒内攻。
【险候】 四五天间，痘根虽起，但色泽惨淡不明，为险证。血虽好，但气分弱，气血交会欠分明。宜用保元汤加白术、川芎助卫气和荣血，色泽自然会光明。
痘疮起发圆满候
【顺候】 五六日间，气盛血荣于内，痘疮应当圆满起发于外，这才是顺证，不需要用药而自愈。
【逆候】 五六日，痘疮依然干枯，绵密不起，痘顶灰白色，或者紫黑，或者成为水泡、瘙痒塌陷，为逆证。这是气血衰弱导致毒邪内陷而外部剥落。都不可治。
【险候】 五六日之间，痘疮虽然起发，但颜色白而不荣润，为险证。这是气盈血亏。用保元汤加川芎、当归、桂枝、芍药，则可痊愈。
痘疮浆满七八日间
【顺候】 七八日痘疮浆液充足圆满，青黄光泽，则毒消而气血之功已成。此为顺证，不需要用药。
【逆候】 七八日浆液不足，这是气血衰尽之时，不能用药，为逆证。
【险候】 八九日红黄色润，浆液略不足，这是气弱而为险证。用保元汤加生姜、白术充养辅助，则浆液老足。
痘疮血尽浆回十一二日间
【顺候】 十二三日，痘疮气调血尽，毒解浆回，光色渐敛，这是自然的顺证。
【逆候】 十二三日，血淡而浆薄，血凝而气滞，则毒不散，浆不回，枯朽剥落至极，为逆证，值得恐惧。
【险候】 十二三日，血尽浆老，湿润不收敛，为内虚，为险证。宜用保元汤加茯苓、白术帮助收敛结痂。
痘疮结痂候十三四日间
【顺候】 十三四日，气血归原，毒瓦斯消散，浆老结痂，这是神化十全，为顺证。
【逆候】 十三四日，毒未脱，形体虽结痂，但各种邪气仍发作，为逆证。
【险候】 十三四日内，浆老结痂之际，还有杂证相继出现，这需要临时斟酌调和，不可轻举妄动为妙。
痘疮还原候十四五日间
【顺候】 十四五日，气血十全，痂脱落瘢痕明显，神清气爽，此为顺证。
【逆候】 十四五日，痂未脱落，胡言乱语狂躁烦闷，寒战，疔肿杂病并存，此无生机，为逆证。
【险候】 十四五日，痂落而少食，口渴烦热，这是余毒，为险证。宜用四君子汤加黄连、鼠粘子（牛蒡子）、连翘解毒汤之类治疗，可以痊愈。
[Shun Hou (Favorable Prognosis)] The occurrence of smallpox in spring and summer is favorable. It is favorable if convulsions and twitching occur first, followed by the eruption of pustules. It is favorable if fever occurs first, subsides, and then pustules erupt. It is favorable if dietary intake remains normal. It is favorable if urination and defecation remain normal.
[Ni Hou (Unfavorable Prognosis)] The occurrence of smallpox in autumn and winter is unfavorable. In spring, the appearance of purulent blisters indicates Metal overcoming Wood. In summer, black sunken lesions indicate Water overcoming Fire. In autumn, the appearance of macules indicates Fire overcoming Metal. In winter, the appearance of papules indicates Earth overcoming Water. Hematochezia or diarrhea, and indigestion of milk and food indicate Spleen deficiency. During the active eruption phase, vomiting and diarrhea occur; wind pathogen attacks the cheeks, mandible, neck, and eyelids; or the chest protrudes high, the face swells with a sunken nose, eyes are closed, and teeth are clenched; or there is black qi at the nostrils. Muscles turn black. The complexion becomes cyanotic and black. Or, due to vomiting and diarrhea causing internal deficiency, the toxin sinks inward. After eruption, spontaneous sweating leads to ulceration. Or, exposure to wind pathogen causes inverted crusts (sunken pustule tops) that fail to rise. Diarrhea persists, pustules flatten like cakes, dry thirst and dysuria occur, voice becomes hoarse. Medication is aspirated into the throat, wheezing does not cease, pustules are all scratched open, emitting an unbearable foul odor. Eyes are closed, gaze is dark, spirit seems lost. Head and face swell, feet are cold up to the knees. Frequent straining (resembling the effort of defecation), with no distinction between pustule color and surrounding skin. After eruption, fever and heat in the feet do not subside; after eruption, restlessness and confusion persist. Post-recovery convulsions occur; before the expected crusting stage, sudden blackening, darkening, or purplish discoloration appears.
[E Hou (Malignant Prognosis)] Pustules erupt but then disappear. Sudden severe diarrhea accompanied by thirst. After eruption, continuous delirium. Or, black-purple discoloration hidden deep within the muscles, indicating severe toxicity. In severe cases, pustules appear in the five Zang organs and the throat. The lesions do not form granules, resemble coagulated blood, cause pain, and black crusts produce no pus or blood; this indicates death. Or, if these signs are seen and medication is used to resolve the toxin, but the toxin instead sinks inward, this indicates death. Eyes open but abdomen distended, with foul breath from the mouth; this is incurable. Constipation of both stool and urine, blackened skin, closed eyes, and hoarseness indicate death. Stomach heat causing jaundice, body color like orange peel, accompanied by diarrhea; this indicates death.
Smallpox Eruption: First to Second Day
[Favorable] Initially, bleeding points appear as pale red and lustrous. By the second day, they resemble millet grains, appearing around the mouth, nose, cheeks, ears, and the tip of the nose. The initial emergence of two or three pale red and lustrous spots is a sign of favorability. Favorable cases heal spontaneously without medication, as Qi is upright, Blood flows smoothly, and the toxin is mild, preventing it from wreaking havoc.
[Unfavorable] The shape resembles a patch of silkworm eggs or red dots on hemp cloth. Black papules initially appearing on the Tian Ting, Si Kong, Tai Yang, Yin Tang, and Fang Guang areas are signs of unfavorability. Unfavorable cases are difficult to treat, indicating original Qi deficiency and Qi-Blood stagnation. The pathogenic toxin is too excessive, invading Yang regions, overwhelming the body's resistance.
[Critical] Areoles take shape, dry and red with little moisture. Although dense, the pustules are still red, lustrous, and granular; this is critical. In critical cases, although the toxin is strong, original Qi is still sufficient, so alarm is unnecessary. One should use formulas to tonify original Qi with a slight addition of detoxifying herbs, ensuring the strong toxin does not damage righteous Qi.
Smallpox Roundness: Second to Third Day
[Favorable] Qi overflows and adheres to Blood; the lesions are full and smooth. By the third or fourth day, the bases are round and complete, indicating abundant original Qi. When Qi is abundant, Blood adheres, and both follow their proper paths; this is favorable. Favorable cases heal spontaneously.
[Unfavorable] Qi is stagnant, Blood coagulates; the lesions are withered and lack luster, bases have no areole, Qi separates from Blood; this is unfavorable. This indicates insufficient intersection of Qi and Blood, allowing toxins to invade internally opportunistically.
[Critical] The apex is sunken and not full, yet smooth and spirited; the base is still round, but only the apex is sunken, indicating difficulty in Qi-Blood filling; this is critical. Use Bao Yuan Tang (Preserve the Origin Decoction) plus Chuanxiong Rhizoma (Chuanxiong) and Cinnamomi Ramulus (Guizhi) to assist Spleen and Stomach Qi and Blood, ensuring safety.
Smallpox Color and Shape: Fourth to Fifth Day
[Favorable] Qi is full, Blood is nourished, bright and lustrous, indicating vigorous Qi and Blood and shallow toxin penetration. The shape is smooth, varying in size; this indicates harmony of Qi and integration of Blood, which is favorable and heals spontaneously.
[Unfavorable] By the fourth or fifth day, lesions are dense like blisters, purple-black and dry-red, resembling silkworm eggs, or black-sunken purple blisters; all are unfavorable. Unfavorable cases are hard to treat due to separation of Qi and Blood and internal attack by pathogenic toxins.
[Critical] By the fourth or fifth day, bases have risen, but the color is dull and unclear; this is critical. Blood is good, but Qi is weak, and their intersection is indistinct. Use Bao Yuan Tang plus Atractylodis Macrocephalae Rhizoma (Baizhu) and Chuanxiong Rhizoma (Chuanxiong) to support Defensive Qi and Nutritive Blood; the color will naturally become bright.
Smallpox Rising and Fulfillment Phase
[Favorable] By the fifth or sixth day, Qi is abundant and Blood is nourished internally; pustules should be full and rising externally. This is favorable and heals spontaneously without medication.
[Unfavorable] By the fifth or sixth day, pustules remain dry, dense, and non-rising; apices are gray-white, purple-black, or water-filled, itchy, and collapsed; this is unfavorable. This indicates Qi and Blood weakness leading to internal sinking of toxins and external peeling. All such cases are untreatable.
[Critical] Between the fifth and sixth days, pustules have risen but are white and lacking luster; this is critical. This indicates excess Qi and deficient Blood. Use Bao Yuan Tang plus Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), Cinnamomi Ramulus (Guizhi), and Paeoniae Radix Alba (Baishao) for recovery.
Smallpox Pus Fullness: Seventh to Eighth Day
[Favorable] By the seventh or eighth day, pustules are full of pus and complete, with green-yellow luster; the toxin is eliminated, and the work of Qi and Blood is accomplished. This is favorable and requires no medication.
[Unfavorable] By the seventh or eighth day, pus is insufficient; this is the time of Qi and Blood exhaustion, making medication ineffective; this is unfavorable.
[Critical] By the ninth or tenth day, color is red-yellow and moist, but pus is slightly insufficient; this indicates weak Qi and a critical state. Use Bao Yuan Tang plus Zingiberis Recens Rhizoma (Shengjiang) and Atractylodis Macrocephalae Rhizoma (Baizhu) to tonify and assist, ensuring the pus matures fully.
Smallpox Blood Exhaustion and Pus Return: Eleventh to Twelfth Day
[Favorable] By the twelfth or thirteenth day, Qi is regulated, Blood is exhausted (consumed by the process), toxin is resolved, pus returns, and luster gradually收敛 (converges); this is a natural favorable prognosis.
[Unfavorable] By the twelfth or thirteenth day, Blood is pale and pus thin, Blood coagulates and Qi stagnates; thus, toxin does not disperse, pus does not return, leading to extreme withering and peeling; this is an unfavorable prognosis, worthy of fear.
[Critical] By the twelfth or thirteenth day, Blood is exhausted, pus is mature, but moisture does not converge; this indicates internal deficiency and a critical state. Use Bao Yuan Tang plus Poria (Fuling) and Atractylodis Macrocephalae Rhizoma (Baizhu) to aid convergence and crusting.
Smallpox Crusting: Thirteenth to Fourteenth Day
[Favorable] By the thirteenth or fourteenth day, Qi and Blood return to their origins, toxic vapors dissipate, mature pus forms crusts; this represents perfect transformation and healing, which is favorable.
[Unfavorable] By the thirteenth or fourteenth day, toxin has not expelled; although crusts form, various pathogens still manifest; this is unfavorable.
[Critical] Within the thirteenth to fourteenth days, during the formation of mature crusts, miscellaneous symptoms persist; this requires temporary adjustment and harmonization. Do not act lightly; this is the essence of management.
Smallpox Restoration: Fourteenth to Fifteenth Day
[Favorable] By the fourteenth or fifteenth day, Qi and Blood are perfect, crusts fall off, scars are clear, spirit is refreshed; this is favorable.
[Unfavorable] By the fourteenth or fifteenth day, crusts have not fallen, delirium and mania persist, chills occur, carbuncles and miscellaneous diseases remain; this indicates loss of vitality and is unfavorable.
[Critical] By the fourteenth or fifteenth day, crusts fall but appetite is low, thirst and irritability persist; this is residual toxin and is critical. Use Si Jun Zi Tang (Four Gentlemen Decoction) plus Coptidis Rhizoma (Huanglian), Arctii Fructus (Niubangzi), and Forsythiae Fructus (Lianqiao) Detoxification Decoction type formulas to treat; recovery is possible.