凡痘初发热之时未明是否不是否。宜用升麻汤薄苏汤或白酒姜汁苏叶煎服。令少暖时。是痘则标
现矣。即将红绵纸作拈子蘸麻油点灯照儿浑身上下。皮肤里有大小枝蒂根苗花蕊等意。色红活者吉。
勿妄用药。如耳眼鼻窄狭如针尾。不泽无枝朵者。凶亦勿药。非丹也无效。凡见痘已出。必先几日次
问饮食多少。便利调匀。再看痘之稀密颜色圆晕如何。如发热六七日。精气清爽。其痘必稀尖圆活润。
如发两三日热者不妨。如发一二日热者。神浊气粗。痘必密。其色润。虽分个数亦有尖突。过十四日
安。如密而色暗。平塌不分缝孔者。不须用药。难过五日必死。更有一样痘窠不圆。色暗不光。不食。
热甚口内疮白烂臭。名曰内溃。七日难过。大抵不食为之气郁闷结不通。保元汤加山楂木香。如色紫
乃血滞气虚。本方加黄 川
芎。不尖者是气弱。倍参 。如痘浆清。顶不足者必生痘毒。七日前有此者。乃毒发于表。七日后有
此者。乃毒发于里。发于里者乃保元汤加姜糯桂枝。向里焦黑。必用黄连荆芥牛蒡子。七日复发热。
名曰蒸浆。十日后复热。名曰余毒不尽。用连翘败毒散。十四日复热。名曰表虚。八珍汤。七日前痢。
本方加木香黄连豆蔻。七日后痢。如浆不足保元汤。腹痛是伤食。保元汤加山楂陈皮。如痘七分。杂
症三分。痘一解。余症即无。余毒疔痘发于四肢者轻。头面胸腹者重。急用金银簪刺破。入珍珠末血
竭油胭脂于疮外。以棉纸卦固。内服保元汤加当归红花牛蒡连翘。如目有病。必待痘疮回毕。方可治
之。治眼用蔓荆密蒙花类。如生痈疽。专以解毒为主。无脓加官桂二分。寒战切牙保元汤加木香。大
抵十四日内用保元汤治之加减。万不失一是也。
凡是痘疮刚开始发热的时候，还无法明确判断病情吉凶。适宜使用升麻汤、薄苏汤，或者用白酒、姜汁和紫苏叶煎煮后服用。待药液稍暖时服下。如果是真正的痘疮，其征兆就会显现出来。随即用红绵纸搓成捻子，蘸取麻油点燃灯火，照射患儿全身上下。观察皮肤内部是否有大小不一的枝蒂、根苗、花蕊等形态。颜色红润鲜活者为吉兆。不要胡乱用药。如果耳、眼、鼻部位狭窄如针尾，色泽不润泽且没有枝朵形态的，为凶兆，也不要用药，这不是丹毒，用药也无效。
凡是见到痘疮已经发出，必须先询问几天来饮食量的多少，以及大小便是否调和均匀。然后再看痘疮的稀疏密集程度、颜色和周围晕圈的情况。如果发热六七天，精气神清爽，那么痘疮必然稀疏、尖圆、鲜活、润泽。如果只发热两三天，情况尚可；如果发热一两天，就出现神情浑浊、气息粗重，痘疮必然密集，虽然颜色润泽，但即使分出个数，也有尖突之象。若能度过十四天安稳无事，则预后较好。如果痘疮密集而颜色晦暗，平塌不起、不分缝隙孔窍的，不需要用药，难以度过五天，必定死亡。
另外还有一种痘窠不圆润，颜色晦暗无光泽，不能进食，高热且口腔内疮面白烂发臭的，称为“内溃”，七日之内难以度过。大抵不能进食是因为气机郁闷结滞不通，可用保元汤加山楂、木香。如果颜色紫暗，是血滞气虚，本方加黄芪、川芎。痘形不尖的，是气弱，加倍人参用量。如果痘浆清稀，顶部不足的，必然产生痘毒。七日前出现这种情况，是毒邪发于体表；七日后出现这种情况，是毒邪发于体内。毒邪发于体内的，用保元汤加生姜、糯米、桂枝。如果痘色向里焦黑，必须用黄连、荆芥、牛蒡子。七日后再次发热，称为“蒸浆”。十日后再次发热，称为余毒未尽，用连翘败毒散。十四日后再次发热，称为表虚，用八珍汤。七日前出现痢疾，本方加木香、黄连、豆蔻。七日后出现痢疾，如果痘浆不足，用保元汤。腹痛是伤食所致，用保元汤加山楂、陈皮。如果痘疮占七分病势，杂症占三分，痘疮一旦消退，其余症状自然消失。余毒引发的疔痘发于四肢的较轻，发于头面胸腹的较重，急用金银簪刺破，外敷珍珠末、血竭油、胭脂，用棉纸固定。内服保元汤加当归、红花、牛蒡子、连翘。如果眼睛有病，必须等到痘疮回缩完毕之后，才可以治疗。治疗眼病用蔓荆子、密蒙花之类。如果生痈疽，专门以解毒为主，如果没有脓液，加官桂二分。寒战咬牙，用保元汤加木香。大抵在十四日内用保元汤加减治疗，万无一失。
When the smallpox rash first begins to manifest with fever, it is not yet clear whether the prognosis is favorable or unfavorable. It is appropriate to administer Shengma Tang (Cimicifugae Decoction), Bosu Tang (Perilla Decoction), or a decoction of Baijiu (White Wine), Jiangzhi (Ginger Juice), and Ziye (Perilla Leaf). The medicine should be taken when slightly warm. If it is indeed smallpox, its characteristics will become apparent. Subsequently, use red cotton paper rolled into a wick, dipped in sesame oil, lit as a lamp, and used to illuminate the child's entire body. Observe the skin for internal structures resembling branches, roots, sprouts, or flower stamens of varying sizes. A reddish and vibrant color indicates a good prognosis; do not administer medication indiscriminately. If the ears, eyes, and nose are narrow like needle tips, lacking luster and branch-like formations, it indicates a poor prognosis; again, do not administer medication, as this is not erysipelas (Dan Du), and medication would be ineffective.
Once the smallpox rash has emerged, one must first inquire about the quantity of food and drink consumed over the preceding days and whether bowel movements and urination are regular. Then, observe the density, color, and surrounding halo of the pustules. If fever persists for six to seven days while the patient's spirit and essence remain clear, the pustules will likely be sparse, pointed, round, vibrant, and moist. If fever lasts only two to three days, the condition is manageable. However, if fever occurs within one to two days accompanied by turbid spirit and coarse breathing, the pustules will be dense. Although they may appear distinct and moist, even if countable, they may exhibit sharp protrusions. Survival beyond fourteen days indicates stability. If the pustules are dense, dark in color, flat, sunken, and lack defined pores, medication is unnecessary; the patient will likely not survive beyond five days.
Additionally, there is a type of pustule that is not round, appears dark and dull, prevents eating, involves high fever, and presents with white, rotting, foul-smelling sores in the mouth, termed "internal collapse" (Nei Kui). This condition is difficult to survive past seven days. Generally, anorexia results from Qi stagnation and obstruction. Baoyuan Tang (Preserve the Origin Decoction) can be modified with Shan Zha (Crataegus) and Mu Xiang (Aucklandia). If the color is purple, it indicates blood stasis and Qi deficiency; add Huang Qi (Astragalus) and Chuan Xiong (Ligusticum) to the base formula. Pustules that are not pointed indicate weak Qi; double the dosage of Ren Shen (Ginseng). If the pustule fluid is clear and the apex is insufficient, toxin accumulation is inevitable. If this occurs before the seventh day, the toxin is manifesting on the exterior; if after the seventh day, it is manifesting in the interior. For interior manifestation, modify Baoyuan Tang with Sheng Jiang (Fresh Ginger), Nuo Mi (Glutinous Rice), and Guizhi (Cinnamon Twig). If the pustules turn black towards the interior, use Huang Lian (Coptis), Jing Jie (Schizonepeta), and Niu Bang Zi (Arctium Seed). Fever recurring on the seventh day is termed "steaming pulp" (Zheng Jiang). Fever recurring on the tenth day indicates residual toxins; use Lianqiao Baidu San (Forsythia Detoxification Powder). Fever recurring on the fourteenth day indicates exterior deficiency; use Bazhen Tang (Eight Treasures Decoction). Diarrhea occurring before the seventh day requires modifying the base formula with Mu Xiang, Huang Lian, and Dou Kou (Cardamom). Diarrhea occurring after the seventh day with insufficient pustule fluid requires Baoyuan Tang. Abdominal pain due to food stagnation is treated with Baoyuan Tang modified with Shan Zha and Chen Pi (Tangerine Peel). If the disease burden is seventy percent smallpox and thirty percent miscellaneous symptoms, once the smallpox resolves, the remaining symptoms will disappear. Carbuncles caused by residual toxins appearing on the limbs are mild; those on the head, face, chest, and abdomen are severe. Urgently puncture with a silver hairpin, apply external powder of Zhen Zhu Mo (Pearl Powder), Xue Jie You (Dragon's Blood Oil), and Yan Zhi (Rouge), and secure with cotton paper. Internally, administer Baoyuan Tang modified with Dang Gui (Angelica Sinensis), Hong Hua (Safflower), Niu Bang Zi, and Lian Qiao (Forsythia). If eye pathology exists, treatment must wait until the smallpox lesions have fully receded. Eye treatments involve Man Jing Zi (Vitex Fruit) and Mi Meng Hua (Blindania Seed). For carbuncles and sores, prioritize detoxification; if no pus forms, add Guan Gui (Cinnamon Bark). Chills and teeth grinding are treated with Baoyuan Tang modified with Mu Xiang. Generally, treating within the first fourteen days using modified Baoyuan Tang ensures success without failure.