（凡一十八首，共一十八方）
发热三朝痘出稀，方为毒浅吉之机。先期痘甚浑无制，过此多因血气微。
凡痘发热三日而出，常期也。出而稀者，不须服药。如发热一二日即出者，此毒瓦斯太甚，冲击荣卫，一齐
涌出，难以制服，大凶之象，必欲治之，不过消毒救里，使无陷伏耳，宜消毒快斑汤。
如过期四五六日始出，此血气本虚，不能载毒使出，当补中托里发表，宜增损八物汤。
痘出迟迟有数般，皮肤闭塞属风寒。里虚吐泻宜分治，痘壅三焦治却难。
凡痘出有常期。若应出不出，或外感风寒，六腑闭塞，不能即出，其证头眩身痛，发热无汗，喜盖覆猥倚怀
中，此恶风寒之象也，当发散之，宜加味参苏饮。若曾经吐泻，里虚不能快出，宜加减调中汤。
如发热烦躁，狂妄大渴，唇燥舌裂，此毒瓦斯壅并，留而不泄。毒火郁于三焦，荣卫不行，上下不通而死矣。
应期不出事如何？发表诸方切忌讹。腹胀便坚烦躁甚，消斑承气理沉 。
凡痘疹应出不出，或外感风寒，内虚吐泻，治各不同。如前参苏饮、调中汤、败毒散、葛根汤之类，皆良
法也。若热甚腹胀气粗，烦躁闷乱，大便秘结，此毒火内蓄，急以消斑承气汤解之。
痘出身凉吉可期，如逢炽热覆明夷。终朝渐密无空隙，怪证丛生必定疑。
痘疮之热，毒火为之。未出之先，毒火在内，故发热于外∶既出之后，其毒发外，热当尽退，毒本轻而痘亦
稀也。若痘既出，热仍不退，是毒积于中，未可为轻，急用解肌化斑升托之。服药后热渐退，方可言吉；更不退，
其痘累累而出，痘空中始虽稀而终朝渐密，最怕生出他证，或狂妄，或泄泻，或腹痛，或搔疮，或失声，或错喉
干呕，或喘促黑陷，皆不可治。
出现先观面部中，其间凶吉最难通。绕唇夹颊方为吉，额上眉心未可逢。
人之面部，五脏精华皆见于此。故左颊属肝木，右颊属肺金，颏属肾水，鼻属脾土；又正额太阳脉之所会，
唇颊阳明脉之所经，两耳旁少阳之所过。痘为阳毒，故随阳位而见于面。但阳明胃与大肠，积陈受污，气血俱
多，先于其部出现者吉；若太阳则水火交战
之位，少阳则木火相并之冲，若于其位出现者凶。不但出形忌于正额眉间，耳之前后，凡起灌收靥，但从此处
先者，皆逆象也。
头为元首称至尊，更有咽喉阖辟门。若使痘疮多出此，蒙头锁项受灾连。
经曰∶头者，精明之府。五脏精华皆现于面，至尊至贵，不可凌犯者也。咽者，胃脘水谷之道路，主纳而不
主出；喉者，肺管呼吸之往来，主息之出入。人非此则水谷绝，呼吸废而死矣，故谓阖辟之门。痘疮最要头项稀
少，如头面多者，谓之蒙头；咽喉多者，谓之锁项。蒙头则视听昏废，神明失居；锁项则内者不出，外者不入。
正所谓神出则机息，气止则化绝，死之兆也。
头面胸前痘欲稀，四肢虽盛毒犹微。浑身碎密多惆怅，疏解当知发散机。
头面诸阳之会，胸前诸阳之聚，脏腑受气之区。陈氏曰∶痘疹轻者，作三四次出，头面稀少胸前无，以清
阳之分不可浊乱也；至于四肢，虽为阳之本，乃身之役使，卒伍卑贱之职，故不畏其多也。若遍身稠密琐碎，
急为解毒，疏通荣卫，令气得其均，血得其活，一齐起发，庶无干枯黑痿之变，用疏毒快斑汤，随证加减而调
之。
痘疮磊落不须防，丛聚相粘定见伤。蚕壳蛇皮生不久，蚤斑蚊迹祸难量。
凡痘疮初出，须看相去远近。若相去三五寸一粒者，轻证也，一二寸者颇密，如二三成丛者，必密而重，
其候多变痒塌。如蚕之壳、蛇之皮者，此气至而血气不随也，当行气补血，宜祛风匀气散；如蚤之斑，蚊之
迹者，此血至而气不随也，当凉血补气，宜参 和气饮。
一出形来艳色娇，定知皮嫩气虚枵。溶溶破损生难久，个个成浆喜气饶。
痘疮出形，如平日正色者吉。痘色带艳而赤，其后多皮嫩易破，痒不可救。但见带艳，即防后日痒塌之变，
早用疏风固表消毒之药，使血气充实，邪火渐退，正气不亏，光
壮干收，如期不乱可也，宜固阳散火汤，解毒固表。
最怕头焦 色封（ 音陶，青黑色也），又愁皮嫩水溶溶。头焦变黑多归肾，皮嫩须防痒塌攻。
痘疮初出，所喜明润而鲜，坚实而浓。若头焦带黑，此毒在血分，不急治之，则变黑归肾而难救矣。宜凉
血解毒汤，解散血中之邪。若皮嫩嚣薄，此毒在气分，不急治之，则痒塌而死。宜加味固阳散火汤。
痘疮切要解咽喉，喉痹咽疮毒火浮。但恐一朝封管 ，锁喉声哑枉营谋。
凡痘疮未有咽喉不痛者，如烟囱之状，火焚于下，炎升于上，宜乎作痛。宜鼠粘子汤，外用一圣散吹之。
惟恐斑疮入眼中，膏煎黄柏妙无穷。但观眼内多红赤，急泻心肝免损瞳。
痘疮之毒，第一防眼，所以古人用护眼之法，其滤深矣。宜黄柏膏涂之。
若眼内有红筋萦缠，或眼肿闭，多生眵泪，急泻心肝之火，宜蝉花散清解之。
痘疮只出一般奇，斑疹相参最不宜。消疹化疹宜急解，倘仍不解势倾危。
钱氏曰∶痘只一样为善。若已现形，间有碎密如芥子者，此夹斑也，皮内鲜红成块，此夹疹也。皆毒火熏
烁于内，故使斑疮夹出于外，急宜解毒，使斑疮消散，痘得独成。宜荆防解毒汤消散之。
痘标才见两三窠，爬搔浑身瘙痒多。此是火邪留腠理，急清风火证应瘥。
凡痘初出之时，遍身作痒，爬掐不止，此火邪留于肌肉皮肤之间，不能即出故耳。与伤寒不出汗作痒同，
非痒塌之例也，宜泻心肝火邪，其痒自除。宜清风去火化毒汤升散之。
口中腥臭气冲冲，邪毒炎蒸肺作痈。泻火清金须急用，淹延七日祸相从。
凡痘初出，若口中之气腥臭冲人，此肺中邪火熬煎炎燥，故令腥臭出于口，急与清
金泻火汤解之。倘淹延不治，至七日而死矣。经曰∶肺绝者，七日死。此证之变。或失声，或喘，或干呕，皆
其候也。
皮中簇簇如寒粟，肉肿隆隆似热瘤。如此岂能延日月，哀哉不久返瀛州！
凡痘初出，欲期颗粒分明，皮肉柔润。若簇簇生于皮间，似风寒粟子之状，此痘变于反掌，不待起发即隐
而不见，啼叫烦闷而死矣。或有正面、腰背、胸膈、手足肿硬成块，似丹瘤之状，此证俟起发之时，其处疮先
黑陷，破烂不能成浆，干硬而死，皆为不治。
出形未定先涵水，起发之时便戴浆。脓水未成收靥急，休夸妙术有青囊。
凡痘初出一点血，血化为水，水化为脓，脓成而毒解，此自然之序；若初出之时，半为水泡，或将起发，
便戴白浆，或脓水未成，忽然收靥，此毒火太甚，失其自然之序。不应至而至，谓之太过，不久倒陷入里而死，
无有治矣，盖不应至而至，所谓早发还先萎也。比之应至不至者，因其气血不充，尚有补救，所谓人夺天功，
此则不相侔矣。
鼻如灶突面烘烟，皮似涂朱或橘然。唇舌咽喉痘丛聚，任教和缓莫回天。
凡痘疮之证，始终归重于太阴、阳明，手太阴肺、手阳明大肠、足太阴脾、足阳明胃者是也。盖鼻者肺之
窍，贵于滋润，鼻干黑燥如灶突之状，火刑金也；面者阳明经所聚，贵于鲜明，面黑而枯，精华散矣；皮者肺
之合，欲其色红白如常，色若涂朱，火之象也，或如橘柚，火极如土则黄矣。咽喉肺胃之管 ，唇吻脾之窍也，
舌者脾之络也。痘甚于此，其毒极矣，安可治哉？
（共十八首，对应十八个方剂）
发热三天后痘疹才出现且稀疏，这是毒邪浅表、病情吉祥的征兆。如果痘疹在预期时间之前大量发出且无法控制，过了这个时期多是因为患者血气虚弱。
凡是痘疹发热三天后才出齐，属于正常周期。出疹稀疏者，不需要服药。如果发热一两天就出疹，这是毒邪太盛，冲击营卫之气，一齐涌出，难以制服，是大凶之象。一定要治疗的话，不过是消毒救里，防止毒邪内陷伏留罢了，宜用消毒快斑汤。
如果过期四五天甚至更久才出疹，这是因为血气本虚，不能载送毒邪外出，应当补益中气、托毒外出并发表，宜用增损八物汤。
痘疹出得迟缓有多种原因，皮肤闭塞属于风寒束表。里气虚弱导致吐泻的应当分别治疗，痘毒壅塞三焦则治疗困难。
凡是痘疹出疹有固定周期。如果到了该出疹的时候不出，或者外感风寒，六腑闭塞，不能立即出疹，症状表现为头晕身痛，发热无汗，喜欢盖被子蜷缩在怀中，这是恶风寒的表现，应当发散解表，宜用加味参苏饮。如果曾经吐泻，里气虚弱不能使痘疹顺利透出，宜用加减调中汤。
如果发热烦躁，狂妄口渴，嘴唇干燥舌头裂开，这是毒邪壅滞，停留而不能排泄。毒火郁结在三焦，营卫运行不畅，上下不通就会死亡。
应期不出该怎么办？发表的各种方剂切忌误用。如果腹胀大便干结烦躁严重，需用消斑承气汤来调理沉疴。
凡是痘疹应出而未出，或因外感风寒，或因内虚吐泻，治疗方法各不相同。如前所述的参苏饮、调中汤、败毒散、葛根汤等，都是良法。如果热势很盛，腹胀气粗，烦躁闷乱，大便秘结，这是毒火内蓄，急需以消斑承气汤解除。
痘疹发出后身体转凉是吉祥可期的表现；如果遇到高热不退，则是凶兆。整天逐渐变密没有空隙，怪异病症丛生必定令人怀疑。
痘疮的热象，是由毒火引起的。未出疹之前，毒火在内，所以体外发热；既出疹之后，毒邪发于体表，热应当完全消退，毒邪轻而痘疹也稀疏。如果痘疹已出，热仍不退，说明毒邪积聚在体内，不可视为轻症，急用解肌化斑升托之法。服药后热渐退，才可以说是吉兆；如果热仍不退，痘疹累累而出，虽然开始时稀疏但整天逐渐变密，最怕生出其他证候，或狂妄，或泄泻，或腹痛，或搔抓疮口，或失声，或咽喉干呕，或喘促黑陷，都不可治。
观察痘疹先观面部中间，其中的吉凶最难通晓。环绕嘴唇和脸颊为吉，出现在额头和眉心则不可逢（不吉）。
人的面部，五脏精华都显现于此。所以左颊属肝木，右颊属肺金，下巴属肾水，鼻子属脾土；又正额是太阳脉汇聚之处，唇颊是阳明脉经过之处，两耳旁是少阳脉经过之处。痘疹为阳毒，所以随阳位而见于面部。但是阳明胃与大肠，积陈受污，气血俱多，先在这些部位出现者为吉；若太阳则是水火交战之位，少阳则是木火相并之冲，如果在这些位置出现则为凶。不但出形忌讳在正额眉间、耳朵前后，凡是在起胀、灌浆、收靥过程中，从此处先出现的，都是逆象。
头为元首称为至尊，还有咽喉是呼吸饮食的门户。如果痘疮多出在此处，蒙头锁项将遭受连累灾祸。
经说：头是精明之府。五脏精华都现于面部，至尊至贵，不可凌犯。咽是胃脘水谷的道路，主纳而不主出；喉是肺管呼吸的往来，主气息出入。人没有这些则水谷断绝，呼吸停止而死，所以称为阖辟之门。痘疮最要紧的是头项稀少，如果头面多者，称为蒙头；咽喉多者，称为锁项。蒙头则视听昏废，神明失居；锁项则内者不出，外者不入。正所谓神出则机息，气止则化绝，是死亡的征兆。
头面胸前痘疹欲稀，四肢虽多毒邪犹微。浑身碎密多惆怅，疏解当知发散之机。
头面是诸阳之会，胸前是诸阳之聚，是脏腑受气之区。陈氏说：痘疹轻者，分三四次出，头面稀少胸前无，因为清阳之分不可浊乱；至于四肢，虽为阳之本，却是身体的役使，如同卒伍卑贱之职，所以不畏其多。如果遍身稠密琐碎，急为解毒，疏通营卫，令气得其均，血得其活，一齐起发，才没有干枯黑痿的变化，用疏毒快斑汤，随证加减而调之。
痘疮磊落不须防备，丛聚相粘定见损伤。像蚕壳蛇皮生不久，像蚤斑蚊迹祸难量。
凡是痘疮初出，须看相距远近。如果相距三五寸一粒者，是轻证；一二寸者颇密；如二三成丛者，必密而重，其候多变痒塌。如蚕之壳、蛇之皮者，这是气至而血气不随之，当行气补血，宜用祛风匀气散；如蚤之斑，蚊之迹者，这是血至而气不随之，当凉血补气，宜用参和气饮。
一出形来颜色娇艳，定知皮嫩气虚。溶溶破损生难久，个个成浆喜气饶。
痘疮出形，如平日正色者为吉。痘色带艳而赤，其后多皮嫩易破，痒不可救。但见带艳，即防后日痒塌之变，早用疏风固表消毒之药，使血气充实，邪火渐退，正气不亏，光壮干收，如期不乱可也，宜用固阳散火汤，解毒固表。
最怕头焦黑色封（音陶，青黑色也），又愁皮嫩水溶溶。头焦变黑多归肾，皮嫩须防痒塌攻。
痘疮初出，所喜明润而鲜，坚实而浓。若头焦带黑，这是毒在血分，不急治之，则变黑归肾而难救矣。宜用凉血解毒汤，解散血中之邪。若皮嫩嚣薄，这是毒在气分，不急治之，则痒塌而死。宜用加味固阳散火汤。
痘疮切要解咽喉，喉痹咽疮毒火浮。但恐一朝封管窍，锁喉声哑枉营谋。
凡是痘疮未有咽喉不痛的，如烟囱之状，火焚于下，炎升于上，宜乎作痛。宜用鼠粘子汤，外用一圣散吹之。
惟恐斑疮入眼中，膏煎黄柏妙无穷。但观眼内多红赤，急泻心肝免损瞳。
痘疮之毒，第一防眼，所以古人用护眼之法，其虑深矣。宜用黄柏膏涂之。
若眼内有红筋萦缠，或眼肿闭，多生眵泪，急泻心肝之火，宜用蝉花散清解之。
痘疮只出一般奇，斑疹相参最不宜。消疹化疹宜急解，倘仍不解势倾危。
钱氏说：痘只一样为善。若已现形，间有碎密如芥子者，此夹斑也，皮内鲜红成块，此夹疹也。皆毒火熏烁于内，故使斑疮夹出于外，急宜解毒，使斑疮消散，痘得独成。宜用荆防解毒汤消散之。
痘标才见两三窠，爬搔浑身瘙痒多。此是火邪留腠理，急清风火证应瘥。
凡是痘初出之时，遍身作痒，爬掐不止，这是火邪留于肌肉皮肤之间，不能即出故耳。与伤寒不出汗作痒同，非痒塌之例也，宜泻心肝火邪，其痒自除。宜用清风去火化毒汤升散之。
口中腥臭气冲冲，邪毒炎蒸肺作痈。泻火清金须急用，淹延七日祸相从。
凡是痘初出，若口中之气腥臭冲人，这是肺中邪火熬煎炎燥，故令腥臭出于口，急与清金泻火汤解之。倘淹延不治，至七日而死矣。经说：肺绝者，七日死。此证之变。或失声，或喘，或干呕，皆是其候。
皮中簇簇如寒粟，肉肿隆隆似热瘤。如此岂能延日月，哀哉不久返瀛州！
凡是痘初出，欲期颗粒分明，皮肉柔润。若簇簇生于皮间，似风寒粟子之状，此痘变于反掌，不待起发即隐而不见，啼叫烦闷而死矣。或有正面、腰背、胸膈、手足肿硬成块，似丹瘤之状，此证俟起发之时，其处疮先黑陷，破烂不能成浆，干硬而死，皆为不治。
出形未定先涵水，起发之时便戴浆。脓水未成收靥急，休夸妙术有青囊。
凡是痘初出一点血，血化为水，水化为脓，脓成而毒解，这是自然之序；若初出之时，半为水泡，或将起发，便戴白浆，或脓水未成，忽然收靥，这是毒火太甚，失其自然之序。不应至而至，谓之太过，不久倒陷入里而死，无有治矣，盖不应至而至，所谓早发还先萎也。比之应至不至者，因其气血不充，尚有补救，所谓人夺天功，此则不相侔矣。
鼻如灶突面烘烟，皮似涂朱或橘然。唇舌咽喉痘丛聚，任教和缓莫回天。
凡是痘疮之证，始终归重于太阴、阳明，手太阴肺、手阳明大肠、足太阴脾、足阳明胃者是也。盖鼻者肺之窍，贵于滋润，鼻干黑燥如灶突之状，火刑金也；面者阳明经所聚，贵于鲜明，面黑而枯，精华散矣；皮者肺之合，欲其色红白如常，色若涂朱，火之象也，或如橘柚，火极如土则黄矣。咽喉肺胃之管窍，唇吻脾之窍也，舌者脾之络也。痘甚于此，其毒极矣，安可治哉？
(There are eighteen verses in total, corresponding to eighteen formulas.)
If fever persists for three days before the smallpox rash appears and is sparse, this indicates that the pathogenic toxin is superficial, which is a auspicious sign. If the rash erupts excessively before the expected time and cannot be controlled, it is mostly due to deficiency of blood and qi after this period.
Generally, if smallpox fever lasts for three days before eruption, it is within the normal cycle. If the eruption is sparse, no medication is needed. If eruption occurs after only one or two days of fever, this indicates excessive pathogenic toxin attacking the Ying (Nutrient) and Wei (Defensive) levels, erupting all at once, difficult to control, representing a dire prognosis. Treatment should focus on clearing heat and detoxifying while protecting the interior to prevent the toxin from sinking inward. The appropriate formula is Xiaodu Kuaiban Tang (Detoxification and Rapid Rash-Expelling Decoction).
If eruption is delayed until four or five days or later, it is because the original blood and qi are deficient and unable to transport the toxin outward. Treatment should tonify the middle jiao, support the interior, and release the exterior. The appropriate formula is Zengsun Bawu Tang (Modified Eight-Ingredient Decoction).
Delayed eruption can arise from several causes: skin closure belongs to wind-cold constraint; internal deficiency with vomiting and diarrhea requires separate treatment; toxin congestion in the Triple Burner makes treatment difficult.
Smallpox eruption follows a regular schedule. If eruption does not occur when expected, or if external wind-cold causes closure of the six fu organs preventing immediate eruption, symptoms include dizziness, body pain, fever without sweat, and a preference for covering up and curling into someone's embrace, indicating aversion to wind and cold. Treatment should involve releasing the exterior. The appropriate formula is Jiawei Rensu Yin (Modified Ginseng and Perilla Leaf Decoction). If there was prior vomiting and diarrhea causing internal deficiency preventing smooth eruption, use Jiajian Tiaozhong Tang (Modified Middle-Regulating Decoction).
If accompanied by fever, irritability, delirium, extreme thirst, dry lips, and cracked tongue, this indicates toxin congestion stagnating without excretion. Toxic fire郁 (stagnates) in the Triple Burner, blocking Ying and Wei circulation, leading to death due to blockage between upper and lower jiao.
What to do if eruption is delayed? One must avoid errors in using exterior-releasing formulas. If accompanied by abdominal distension, hard stool, and severe irritability, Xiaoban Chengqi Tang (Rash-Clearing and Bowel-Purging Decoction) should be used to treat deep-seated conditions.
For smallpox that should erupt but does not, whether due to external wind-cold or internal deficiency with vomiting/diarrhea, treatments differ. As mentioned, Rensu Yin, Tiaozhong Tang, Baidu San (Toxin-Resolving Powder), Gegen Tang (Kudzu Decoction), etc., are effective methods. If heat is intense with abdominal distension, coarse breathing, irritability, restlessness, and constipation, this indicates internal accumulation of toxic fire, requiring urgent resolution with Xiaoban Chengqi Tang.
After eruption, if the body cools down, recovery is auspicious; if high fever persists, it is an ominous sign. If the rash becomes dense throughout the day with no gaps, and strange symptoms arise, suspicion is warranted.
The heat of smallpox is caused by toxic fire. Before eruption, toxic fire is internal, causing external fever; after eruption, the toxin manifests externally, so heat should subside completely, indicating light toxin and sparse rash. If fever persists after eruption, it means toxin accumulates internally and cannot be considered mild. Urgently apply methods to resolve muscle layer, transform rash, and lift/support. If heat subsides after medication, it is auspicious; if not, and the rash becomes dense despite initial sparseness, fear other complications such as delirium, diarrhea, abdominal pain, scratching wounds, loss of voice, throat dryness/vomiting, panting, or black depression, all of which are untreatable.
Observe the face first when assessing eruption patterns; determining auspiciousness is difficult. Eruption around the lips and cheeks is auspicious; eruption on the forehead and between eyebrows is inauspicious.
The face reflects the essence of the five zang organs. The left cheek corresponds to Liver Wood, the right cheek to Lung Metal, the chin to Kidney Water, and the nose to Spleen Earth. The forehead is where the Taiyang (Greater Yang) meridian converges; the lips and cheeks are traversed by the Yangming (Bright Yang) meridians; the sides of the ears are traversed by Shaoyang (Lesser Yang) meridians. Smallpox is a yang toxin, appearing on yang areas of the face. However, the Yangming Stomach and Large Intestine accumulate turbid matter and have abundant qi and blood; eruption here first is auspicious. The Taiyang position is where water and fire clash, and Shaoyang is where wood and fire merge; eruption here is inauspicious. Not only is eruption on the forehead, eyebrows, and ears inauspicious, but any progression (swelling, filling, scabbing) starting from these areas is a reverse/inauspicious sign.
The head is the supreme leader. The throat is the gate for opening and closing (respiration and digestion). If smallpox eruptions are concentrated here, "covering the head" and "locking the neck" will bring disaster.
The Classics state: The head is the residence of clarity and spirit. Since the essence of the five zang organs manifests on the face, it is supreme and sacred, not to be violated. The pharynx (Yan) is the pathway for food and drink in the stomach, governing intake but not output; the larynx (Hou) is the lung tube for respiration, governing breath entry and exit. Without these, food and breath cease, leading to death; thus they are called the gates of opening and closing. It is crucial that smallpox eruptions are sparse on the head and neck. Excessive eruptions on the head/face are called "Meng Tou" (Covering Head); excessive eruptions in the throat are called "Suo Xiang" (Locking Neck). Meng Tou leads to blurred vision/hearing and loss of spirit; Suo Xiang prevents internal expulsion and external entry. This signifies the cessation of spirit and transformation, a sign of death.
Eruptions on the head, face, and chest should be sparse; even if limbs are numerous, the toxin is slight. Whole-body dense fragmentation is distressing; understanding dispersal mechanisms is key to resolution.
The head and face are the convergence of all yang meridians; the chest is the gathering point of yang and the area where zang-fu receive qi. Chen states: Mild smallpox erupts in three or four waves, being sparse on the head/face and absent on the chest, because the clear yang regions must not be turbid. Limbs, though root of yang, serve the body like low-ranking soldiers, so abundance there is tolerated. If the whole body is densely fragmented, urgently detoxify, unblock Ying and Wei, balance qi, activate blood, and promote uniform eruption to avoid drying, blackening, or withering. Use Shudu Kuaiban Tang (Detoxification and Rash-Expelling Decoction), modified according to symptoms.
Standalone, distinct smallpox lesions need no worry; clustered, adherent lesions indicate injury. Lesions resembling silkworm cocoons or snake skins will not last long; those resembling flea bites or mosquito marks portend immeasurable disaster.
When smallpox first appears, observe the distance between lesions. Spacing of 3-5 cun per lesion indicates mild condition; 1-2 cun is quite dense; clustering of 2-3 indicates density and severity, often changing to itching and collapse. Resembling silkworm cocoons/snake skins indicates qi arrival without blood/qi following; treat by moving qi and tonifying blood with Qufeng Yunqi San (Wind-Dispersing and Qi-Balancing Powder). Resembling flea bites/mosquito marks indicates blood arrival without qi following; treat by cooling blood and tonifying qi with Shenhe Qiyin (Ginseng-Harmonizing Qi Decoction).
If the eruption shape appears overly delicate and bright, it indicates thin skin and deficient qi. Melting/breaking easily suggests short survival; forming pus uniformly brings joy.
Normal coloration upon eruption is auspicious. Reddish-bright colors indicate thin skin prone to rupture and uncontrollable itching. Upon seeing brightness, prevent future itching/collapse by early use of wind-dispersing, surface-consolidating, and detoxifying herbs to充实 (fill/strengthen) blood and qi, gradually retreat evil fire, preserve righteous qi, ensure robust drying/scabbing, and avoid irregularities. Use Guyang Sanhuo Tang (Solidify Yang and Disperse Fire Decoction) to detoxify and consolidate the surface.
Fear most the blackened, scorched top (Tao, dark blue-black color); worry about thin skin with melting fluid. Scorched black tops often revert to Kidney; thin skin fears itching/collapse attacks.
Initial smallpox should be bright, moist, fresh, firm, and thick. Scorched black tops indicate toxin in the blood level; urgent treatment is needed to prevent reverting to Kidney (blackening) which is incurable. Use Liangxue Jiedu Tang (Cool Blood and Detoxify Decoction) to disperse blood-level pathogens. Thin, fragile skin indicates toxin in the qi level; urgent treatment is needed to prevent itching/collapse death. Use Jiawei Guyang Sanhuo Tang (Modified Solidify Yang and Disperse Fire Decoction).
Resolving the throat is critical in smallpox; throat obstruction and ulcers indicate floating toxic fire. Fear sudden sealing of the airway, locking the throat, hoarseness, rendering efforts futile.
All smallpox cases involve sore throats, like a chimney with fire burning below and flames rising above, naturally causing pain. Use Niubangzi Tang (Arctium Seed Decoction) externally apply Yisheng San (One-Saint Powder) insufflation.
Beware most of rashes entering the eyes; Huangbai paste (Phellodendron Paste) is infinitely effective. Observe redness inside the eyes; urgently drain Heart and Liver fire to protect the pupil.
The toxicity of smallpox primarily threatens the eyes; ancient masters used eye-protection methods with deep foresight. Apply Huangbai Gao (Phellodendron Ointment).
If red veins entangle inside the eyes, or eyes swell/shut with excessive discharge/tears, urgently drain Heart and Liver fire with Chanhua San (Cicada Flower Powder) to clear and resolve.
It is strange if smallpox presents alone; mixing with macules (ban) and papules/rashes (zhen) is highly inadvisable. Clearing rashes requires urgent resolution; failure leads to critical danger.
Qian states: Smallpox presenting uniformly is good. If shapes appear, occasionally dense like mustard seeds, this is mixed Ban (macules), bright red patches under skin; this is mixed Zhen (rashes). Both result from internal toxic fire scorching, causing mixed eruption externally. Urgently detoxify to dissipate ban/zhen so smallpox can form independently. Use Jingfang Jiedu Tang (Aristolochia and Saposhnikovia Detoxifying Decoction) to dissipate.
Seeing only two or three clusters of smallpox marks, with widespread scratching and itching. This is fire-pathogen remaining in the couli (interstices); urgently clear wind-fire, and the condition should improve.
When smallpox first appears, whole-body itching and incessant scratching indicate fire-pathogen trapped in muscle/skin layers, unable to erupt immediately. Similar to cold damage without sweat causing itching, not the itching-collapse type. Drain Heart/Liver fire-pathogens, and itching will remove itself. Use Qingfeng Quhuo Huadu Tang (Clear Wind, Remove Fire, Transform Toxin Decoction) to ascend and disperse.
Foul, fishy odor in the mouth indicates evil toxin steaming and forming lung abscesses. Urgently use fire-draining and metal-clearing methods; delay of seven days brings disaster.
When smallpox first appears, foul breath indicates lung evil fire roasting and desiccating, causing odor. Urgently use Qingjin Xiehuo Tang (Clear Metal and Drain Fire Decoction). If untreated and prolonged, death occurs by the seventh day. The Classics state: Lung exhaustion leads to death in seven days. This is a variation of the condition. Symptoms include loss of voice, panting, dry heaving.
Clusters in skin like cold goosebumps; swollen flesh like hot tumors. How can such cases survive long days? Alas, they will soon return to the Isles of the Blessed!
Initial smallpox should have distinct granules and soft/moist skin/flesh. Clusters in skin like cold gooseberries indicate rapid reversal; without waiting for eruption, they vanish, causing crying/distress and death. Swelling/hardening on face, back, chest, limbs like erysipelas tumors: during eruption phase, lesions turn black/depressed, break open, fail to form pus, become dry/hard, and cause death. All are untreatable.
If eruption shape is unstable and initially contains water, but fills with pus upon rising. If pus/water has not formed but scabbing rushes in, do not boast of medical skill (Qing Nang).
Initial smallpox starts as a drop of blood, transforming to water, then pus; pus formation resolves toxin—this is the natural order. If initially half-water blisters, or filling with white pus prematurely, or scabbing before pus forms, this indicates excessive toxic fire disrupting natural order. "Arriving when not expected" is excess; inversion sinking inward leads to death without cure. This premature eruption is like early wilting. Compared to "not arriving when expected" (due to qi/blood deficiency, allowing remediation via human effort usurping heaven's work), this excess scenario is incomparable.
Nose like stove flue with smoke-scorched face; skin like vermilion paint or orange peel. Dense eruptions in lips, tongue, throat; even with He Huan's skill, heaven cannot be reversed.
Smallpox pathology ultimately focuses on Taiyin and Yangming meridians: Hand-Taiyin Lung, Hand-Yangming Large Intestine, Foot-Taiyin Spleen, Foot-Yangming Stomach. The nose is the orifice of the Lung, valued for moisture; dry/black/nose like stove flue indicates fire punishing metal. The face gathers Yangming meridians, valued for brightness; black/withered face indicates scattered essence. Skin is the exterior of the Lung, desired red-white normal; vermilion color indicates fire; orange-yellow indicates extreme fire turning to earth. Throat/lungs/stomach tubes, lips/orifices of Spleen, tongue collateral of Spleen. Severe eruptions here indicate extreme toxin; how can it be treated?