疮痘出大盛，为血 在肌肤之上，至三日或五六日，当结脓血痂 而愈。今疮痘六七
日不结脓血痂 者，此由毒瓦斯盛而里外贯注，若不速解之，毒瓦斯复入为倒靥，宜猪尾膏。
看脉与外证审谛，方可下之。其血 至五七日不结痂，能食而喘，发渴腹胀，昏睡谵语不大
便者，用承气汤川黄散下之。如作渴发热，面赤闷乱，大小便涩，或大吐者，当利其小便，
宜通关散主之。又疮疹已出定，大便不通，疮出脓汁不干者，牛黄丹。又有疮疹证而未出，
胃热发温状，气粗腹胀满，大小便赤涩，睡中惊悸，烦渴口干，脉沉大滑数，此是毒盛而不
能泄，当用利毒丸下之。里无滞气，荣卫升降，疮疹自出矣，此皆合下证也，又有疮黑陷，
大便自利腹胀者，乃虚寒证也，当温之，不可下。
夫痘子出而复不出，或大泻而渴，或有此候，皆因疮痘出而服外药，逼热毒在肺中也。
故烦躁迷闷不食，或大小便难，皆恶候也。疮痘带白脓者，其毒轻，或紫黑色隐，又在于肌
肉里者，其毒重。甚者五脏咽喉内皆有疮，其不大小便，兼便涩出血而痛，黑靥不生脓者死
，鼻有黑气者死。或痘疹未出，毒瓦斯内通，目瞪上窜惊叫，有如惊风者，此乃疮欲出之候也
。若误认为惊痫调治，必使毒瓦斯内蓄，邪热不泄，亦乃死候。或有疮痘既出，谵语不止，此
亦恶候。或见是疮，以药解利，见疮疹反没者乃死，宜急温之，复出乃愈。或疮作白 ，忽
然伏入脏腑，渐作紫黑无脓，日夜烦闷啼哭，其证尤恶，服化毒散，其毒从手足心出乃瘥，
此是五死一生之候。若便血疮陷无脓者死。其有瘟毒痘疮不出者，一法以地黄雄黄令饮，不
可太多，多则反有所损。前证皆恶候。
痘疮出得盛大，是因为血热郁滞在肌肤表层。到了第三日或第五六日，应当结成脓血痂而痊愈。如今痘疮过了六七日用不结脓血痂的，这是由于毒气旺盛，从里到外贯穿注散，如果不迅速解除它，毒气会再次内陷导致痘疮倒靥（痘顶凹陷不起），适宜使用猪尾膏。诊察脉象与外部证候仔细审慎后，方可使用泻下法。如果血热到了第五七日还不结痂，患者能进食但气喘、口渴、腹胀、昏睡且说胡话、不大便的，用承气汤加川黄散来泻下。如果出现口渴发热、面红心烦意乱、大小便涩滞不通，或者剧烈呕吐的，应当通利小便，适宜以通关散为主治疗。另外，痘疹已经发出定型，但大便不通，痘疮流出的脓汁不干涸的，使用牛黄丹。又有痘疹证候出现但尚未发出，胃中有热表现为低热状，呼吸粗重、腹部胀满，大小便色赤涩痛，睡眠中惊悸不安，烦躁口渴口干，脉象沉大滑数，这是毒气旺盛而不能宣泄，应当使用利毒丸来泻下。体内没有积滞之气，营卫之气升降正常，痘疹自然就会发出，这些都是应当使用泻下法的证候。又有痘疮颜色黑陷，大便自利（腹泻）且腹胀的，属于虚寒证，应当温补，不可使用泻下法。
痘子发出后又隐没不出，或者发生严重腹泻并口渴，或有这些症状，都是因为痘疮发出后服用了外用药物，逼迫热毒滞留于肺中。所以出现烦躁闷乱、昏迷不食，或者大小便困难，都是不良的预后征象。痘疮带有白色脓液的，说明毒气较轻；如果是紫黑色隐伏在肌肉深处的，说明毒气较重。严重的甚至五脏和咽喉内部都生疮，大小便不通，兼有排尿涩痛出血，痘疮呈黑色焦痂且不化脓的，主死；鼻孔周围出现黑气的，主死。或者痘疹尚未发出，毒气内通，眼睛瞪视向上窜动、惊叫，类似惊风的样子，这是痘疮将要发出的征兆。如果误认为是惊痫进行治疗，必然导致毒气内蓄，邪热无法宣泄，也是死证。或者有痘疮已经发出，但胡言乱语不止，这也是不良的预后征象。或者见到这种疮症，用药解表透发，结果痘疹反而隐没下去的，主死，应当紧急温补，使痘疹重新发出才能痊愈。或者痘疮变成白色，忽然伏入脏腑，逐渐变为紫黑色且无脓，日夜烦躁闷乱啼哭，这种证候尤其恶劣，服用化毒散，毒气从手足心透出才能病愈，这是“五死一生”的危重征象。如果出现便血、疮陷无脓的，主死。那些有瘟毒痘疮发不出来的，有一种方法是用生地黄和雄黄煮水令其饮用，剂量不可太多，多了反而会受损。上述证候都属于不良的预后征象。
When the smallpox/rash erupts vigorously, it is due to blood heat stagnating on the surface of the skin. By the third day or fifth to sixth day, pus and blood scabs should form, leading to recovery. If the rash does not form pus and blood scabs after six or seven days, this is because the pathogenic toxins (Du Wei) are abundant and penetrate from the interior to the exterior. If not resolved promptly, the toxins may re-enter, causing the lesions to collapse (Dao Ye), for which Zhuwei Gao (Pig Tail Ointment) is indicated. After carefully examining the pulse and external manifestations, purgative methods may be applied. If the blood heat persists for five to seven days without forming scabs, accompanied by the ability to eat but with panting, thirst, abdominal distension, lethargy, delirium, and constipation, Chengqi Tang (Cassia Decoction) combined with Chuanhuang San (Chuanhuang Powder) should be used to purge. If there is thirst, fever, red face, mental restlessness, difficulty in urination and defecation, or severe vomiting, diuresis should be promoted, and Tongguan San (Passing the Barrier Powder) is appropriate. Furthermore, if the rash has erupted and stabilized but defecation remains blocked, and the pus from the lesions does not dry up, Niuhuang Dan (Calculus Bovis Pill) is indicated. In cases where the rash syndrome appears but has not yet erupted, with stomach heat manifesting as mild fever, coarse breathing, abdominal fullness, reddish and difficult urination and defecation, palpitations during sleep, irritability, thirst, dry mouth, and a deep, large, slippery, and rapid pulse, this indicates abundant toxins that cannot be vented; Lidu Wan (Toxin-Expelling Pill) should be used to purge. When there is no internal stagnation and the Ying (Nutritive) and Wei (Defensive) Qi circulate normally, the rash will erupt naturally. These are all indications for purgation. Conversely, if the lesions are black and depressed, with spontaneous diarrhea and abdominal distension, this is a deficiency-cold syndrome requiring warming treatment, and purgatives must not be used.
If the smallpox eruptions appear and then disappear, or if there is severe diarrhea with thirst, these conditions arise because external medications were taken after the eruption, forcing heat toxins into the Lung. Consequently, irritability, confusion, loss of appetite, or difficulty in urination and defecation occur, all of which are ominous signs. Rash lesions containing white pus indicate light toxicity; whereas purple-black lesions hidden deep within the muscles indicate heavy toxicity. In severe cases, sores may form in the five Zang organs and the throat. If there is obstruction of urination and defecation, accompanied by painful and bloody urine, black eschars without pus formation, death is certain. Similarly, black qi emanating from the nostrils indicates death. If the rash has not yet erupted, but toxins have penetrated internally, causing staring eyes, upward gaze, convulsions, and screaming resembling wind-stroke (Jing Feng), this is actually a sign that the rash is about to erupt. Misdiagnosing this as epilepsy (Jing Xian) and treating accordingly will cause toxins to accumulate internally and evil heat to remain unvented, also leading to death. If the rash has erupted but delirium persists, this is also an ominous sign. If, upon seeing such lesions, one uses resolving and promoting herbs, causing the rash to retract, death ensues; urgent warming treatment is required to bring the rash back out for recovery. If the lesions turn white and suddenly retreat into the Zang-Fu organs, gradually becoming purple-black without pus, accompanied by day-and-night irritability and crying, the condition is extremely dire. Taking Huadu San (Toxin-Transforming Powder) allows the toxin to exit through the palms and soles, leading to recovery; this is a "five deaths, one life" critical prognosis. Hematochezia with depressed, pus-less lesions indicates death. For those with plague-toxin smallpox that fail to erupt, one method involves administering a decoction of Sheng Dihuang (Rehmanniae Radix Recens) and Xionghuang (Realgar). The dosage must not be excessive, as too much may cause harm. All the aforementioned conditions are ominous prognoses.