肺主气，气不足，则致后三证
自汗声不出。疮顶陷塌。不绽肥。并宜十奇散。（自汗倍黄 ，声不出倍桔梗）
心主血，血不足，则致后三证。
灰白色。根窠不红。不光泽。并宜芎归汤加芍药、紫草、红花，良验。
〔钱〕凡疮疹若出辨视轻重，若一发便出尽者必重也。痘夹疹者半轻半重也。出
稀者轻。里外肥红者轻。外黑里白者微重也。外白里黑者大重也。疮端里黑如针
孔者热剧也。青干黑陷，昏睡汗出不止，烦躁热渴，腹胀啼喘，大小便不通者困也。
凡疮疹，当乳母慎口，不可令饥及受风寒，必归肾变黑，难治。〔海〕或热极反兼
水化者，亦能变黑，当以凉药主之，不可不察，以脉别之可也。或有出色正者，内
素有热，头反陷，色或灰青似黑，中有针眼下陷，当急以清凉药疏之，便结者大黄、
牵牛之类，便软者金花丸之类主之。
〔陈〕轻者作三次出。大小不一等。头面稀少。眼中无。根窠红。肥满光泽。
重者一齐并出。密如蚕种。身热腹胀。疮灰白色。稠密无缝。泻渴不止。头温足冷。
轻变重。犯房室。不忌口。先曾泻。饮冷水。饵凉药。
重变轻。避风寒。常和暖。大便稠。不燥渴。忌生冷。忌外人。
上，饮冷水，饵凉药，若内有实热者不须忌之。
二日三日，痘疮始见，微微才出如粟米大，或如黍米大，或如绿豆大，似水珠
光泽明净者佳，不须服药。
四日五日，痘疮大小不等，根窠红活，光泽明净者轻。如稠密陷顶，灰白色泻
渴者重。
六日七日，痘疮肥红光泽者轻。如身温气促，口干腹胀，足指冷者重。
八日九日，痘疮长足，肥满苍蜡色者轻。如寒战闷乱，腹胀烦渴，气急切牙者，
至重也。
十日十一日，痘疮当靥，疮痂欲落而愈。如身热闷乱，腹胀泄泻，寒战切牙者重。
〔翁〕轻痘歌 热缓神清痘小稀，根窠红活出参差，四肢温暖无寒热，乳食如常
渴泻除，太阳面颊俱光润，手足累累圆似珠，更兼腰项当心少，但宜调护不须医。
重痘歌 初热一日即便出，稠密鲜红减饮食，泄泻烦渴头面多，红 夹疹二便
涩，平阔灰白欠光明，疔毒脓疮水流湿，若此重证须预防，莫待临期有疏失。
〔万〕古人云∶轻变重，重变轻，轻者，指出稀者，里外肥红者，人见其轻，遽生
怠忽之心，不避风寒，不节饮食，不慎禁戒，不择医巫，以致感风寒则生外热，伤
饮食则生内热，热气熏蒸，或翻出疮痘稠密者，或痘后目盲发痈者，或腹胀，或烦
躁，或吐利，犯禁戒则为瘙痒，为溃烂，医之误，则补所不当补，泻所不当泻，巫
之诬，则咒水洒之以伤其表，令之饮水以伤其里，往往变为重疾，归之气数，抑何
愚哉。重者，指出密者，外黑里赤者，外白里黑者，能存忧惧之心，适寒温，慎饮食，
禁戒必守，医巫必择，自然易发易靥，能变为轻，非人能胜天乎。
辨不药而愈
痘脚稀疏 根窠红绽 不泻不渴 乳食不减 四肢温和 身无大热
以上六证，并不须服药，惟宜善加调护，须使房室温盎，屏诸秽气，忌见外人，
毋犯房色，及往来妇人月水并腋臭者，皆不可近。惟宜烧大黄、苍术，以辟恶气，
勿宜烧沉、檀、降真、乳香、脑、麝，帏帐之内，宜悬胡荽，或以胡荽渍酒、喷
床帐，并烧木香为佳。夫痘疮之毒，最怕秽恶之气触犯，切不可信僧道看经解秽，
况无纤毫之力，而返恐被其秽恶之气触犯，亦不可恃其能解而不预防，戒之，
戒之。
辨五不治证
痒塌，寒战切牙，渴不止。痘紫黑色，喘渴不宁。灰白色陷顶，腹胀。头
温足冷，闷乱饮水。气促泄泻渴。
肺主司气，若气不足，则会导致以下三种证候：自汗、声音不出、疮顶塌陷。这些情况都适宜使用十奇散治疗。（若自汗严重，加倍黄芩；若声音不出，加倍桔梗。）
心主司血，若血不足，则会导致以下三种证候：痘色灰白、根脚不红、缺乏光泽。这些情况都适宜使用芎归汤加入芍药、紫草、红花治疗，疗效显著。
〔钱乙〕凡是痘疹，应当仔细辨别其轻重。如果一出就全部发出，病情必然严重。痘中夹杂疹子的，属于半轻半重。出得稀疏的，病情较轻。内外都肥润红润的，病情较轻。外表黑而内部白的，稍微严重。外表白而内部黑的，非常严重。疮头内部黑如针孔的，说明热邪剧烈。出现青干黑陷、昏睡且汗出不止、烦躁口渴、腹胀啼哭喘息、大小便不通的，属于危困之证。
凡是痘疹期间，乳母应当注意饮食禁忌，不可让患儿饥饿或受风寒侵袭，否则病邪必归于肾，导致痘色变黑，难以治愈。〔海藏〕有的因为热极反而兼有水化（寒象），也能导致变黑，应当用凉性药物主治，不可不仔细察辨，可以通过脉象来辨别。有的虽然痘色正常，但体内素有热邪，痘头反而凹陷，颜色或呈灰青似黑，中间有针眼状下陷，应当紧急用清凉药物疏解。大便结硬的，用大黄、牵牛子之类的药物；大便稀软的，用金花丸之类的药物主治。
〔陈文中〕轻症的痘疹分三次发出。大小不一。头面部稀少。眼睛周围没有。根脚红润。饱满有光泽。
重症的痘疹一齐并发。密集如蚕种。身体发热腹胀。痘色灰白。稠密无缝隙。腹泻口渴不止。头部温热足部冰冷。
轻症转为重症的原因：犯房事。不注意饮食禁忌。先前曾患腹泻。饮用冷水。服用凉性药物。
重症转为轻症的方法：躲避风寒。保持温暖。大便成形。不干燥口渴。忌食生冷。避免外人接触。
上文提到的“饮冷水，服凉药”，如果体内有实热的情况，不需要忌讳。
发病后二三日，痘疮才开始显现，刚刚发出时像粟米大，或者像黍米大，或者像绿豆大，形状像水珠一样光泽明净的，是佳兆，不需要服药。
四至五日，痘疮大小不等，根脚红活，光泽明净的，病情较轻。如果稠密、痘顶凹陷、色灰白、伴有腹泻口渴的，病情较重。
六至七日，痘疮肥润红润、有光泽的，病情较轻。如果身体温和但气促、口干腹胀、脚趾冰冷的，病情较重。
八至九日，痘疮长足，饱满呈苍蜡色的，病情较轻。如果出现寒战、神志昏乱、腹胀烦渴、气息急促咬牙的，属于至重之证。
十至十一日，痘疮应当结痂，疮痂欲落而痊愈。如果出现身体发热、神志昏乱、腹胀泄泻、寒战咬牙的，病情较重。
〔翁氏〕轻痘歌诀：热势缓和神志清醒，痘粒小且稀疏，根脚红活参差不齐，四肢温暖无寒热症状，吃奶进食如常，无口渴腹泻，太阳穴和面颊都光润，手足累累圆润似珍珠，腰部和项部及心口部位较少，只需调理护理，不需要医疗干预。
重痘歌诀：初起发热一天就立即发出，稠密鲜红，减少饮食，腹泻烦渴，头面部多，红色痘夹带疹子，大小便涩滞，平阔灰白缺乏光明，疔毒脓疮流水湿烂，如果是这种重症必须预防，不要等到临期出现疏忽失误。
〔万全〕古人说：轻症可转为重症，重症可转为轻症。所谓轻症，是指痘粒稀疏、内外肥润红润的情况。人们看到它轻，就迅速产生怠慢疏忽之心，不躲避风寒，不节制饮食，不谨慎禁戒，不选择医生或巫师，以致感受风寒而生外热，损伤饮食而生内热，热气熏蒸，导致痘疮翻出变得稠密，或者痘后目盲发痈，或者腹胀，或者烦躁，或者吐利。违反禁戒则导致瘙痒、溃烂。医生的误治，则是补了不该补的，泻了不该泻的；巫师的欺骗，则是咒水喷洒以伤其体表，让人饮水以伤其体内。往往因此变为重疾，却归结为气数命运，多么愚昧啊。所谓重症，是指痘粒密集、外黑内赤、外白内黑的情况。若能存有忧虑恐惧之心，调节寒温，谨慎饮食，严守禁戒，选择医生或巫师，自然容易发出和结痂，能转变为轻症，这不是人力胜过天命吗？
辨别不药而愈的证候：
痘脚稀疏，根脚红绽，不腹泻不口渴，吃奶进食不减，四肢温和，身体没有大热。
以上六种证候，都不需要服药，只宜妥善调理护理，须使房间温暖，屏除各种秽气，忌讳见外人，不要犯房事，以及往来妇女的月经期和腋臭者，都不可靠近。只宜烧大黄、苍术，以辟除恶气，不宜烧沉香、檀香、降真香、乳香、冰片、麝香，帷帐之内，宜悬挂胡荽，或者用胡荽浸泡酒、喷洒床帐，并烧木香为佳。痘疮的毒气，最怕秽恶之气触犯，切不可相信僧道看经解秽，况且他们没有丝毫力量，反而恐怕被他们的秽恶之气触犯，也不可依赖他们能解秽而不加预防，切记，切记。
辨别五种不治之证：
瘙痒塌陷，寒战咬牙，口渴不止。痘色紫黑，喘促口渴不安宁。色灰白且痘顶凹陷，腹胀。头部温热足部冰冷，神志昏乱想喝水。气息急促，腹泻口渴。
The Lung governs Qi. If Qi is insufficient, it leads to the following three syndromes: spontaneous sweating (Zihan), inability to vocalize (Shengbuchu), and sunken crust tops (Chuangding xianta). All these are suitable for treatment with Shiqi San (Ten Miracles Powder). (If spontaneous sweating is severe, double the amount of Huangqin [Scutellariae Radix]; if unable to vocalize, double the amount of Jiegeng [Platycodonis Radix].)
The Heart governs Blood. If Blood is insufficient, it leads to the following three syndromes: ash-gray or white color (Huibaise), non-red roots (Genge buhong), and lack of luster (Bu guangze). All these are suitable for treatment with Xionggui Tang (Peony and Angelica Decoction) added with Shaoyao (Paeoniae Radix), Zicao (Arnebiae Radix et Rhizoma), and Honghua (Carthami Flos), which yields excellent results.
[Qian Yi] Regarding variola and rubeola, one must carefully distinguish their severity. If they erupt all at once upon onset, the condition is necessarily severe. Variola mixed with rubeola indicates a moderate severity. Sparse eruption indicates mildness. Plump, red, and lustrous both inside and out indicates mildness. Black outside and white inside indicates slightly severe. White outside and black inside indicates very severe. Crust heads that are black inside like needle holes indicate intense heat. Cyan, dry, black, and sunken crusts, accompanied by drowsiness with incessant sweating, restlessness, thirst, abdominal distension, crying and wheezing, and obstruction of urination and defecation, indicate a critical and difficult condition.
During variola and rubeola, the nursing mother must observe dietary restrictions. The infant must not be allowed to become hungry or exposed to wind-cold; otherwise, the pathogen will return to the Kidney, turning the crusts black, making them difficult to treat. [Hai Zang] In cases where extreme heat reversely combines with water transformation (Hanxiang), it can also lead to blackening. One should primarily use cooling herbs. This must not be overlooked; pulse diagnosis can differentiate it. In cases where the eruption color appears normal but there is pre-existing internal heat, the head may reverse into depression, with colors appearing grayish-blue or black-like, featuring needle-hole depressions in the center. One should urgently use cooling herbs to disperse it. For constipation, use substances like Dahuang (Rhei Radix et Rhizoma) and Qianniu (Pharbitidis Semen); for loose stools, use Jinhuawan (Golden Flower Pill).
[Chen Zhongwen] Mild cases erupt in three stages. Sizes vary. They are sparse on the face and head. None appear around the eyes. Roots are red. Plump and lustrous.
Severe cases erupt simultaneously. Dense as silkworm eggs. Fever and abdominal distension. Ash-gray or white crusts. Dense without gaps. Incessant diarrhea and thirst. Warm head and cold feet.
Causes of mild turning severe: Sexual intercourse. Failure to observe dietary taboos. Previous diarrhea. Drinking cold water. Taking cooling medicines.
Methods for severe turning mild: Avoid wind and cold. Maintain warmth. Formed stools. No dryness or thirst. Avoid raw and cold foods. Avoid contact with outsiders.
Regarding "drinking cold water and taking cooling medicines" mentioned above, if there is excess-heat internally, no need to avoid them.
On the second or third day, variola begins to appear. Newly erupted ones resemble millet grains, or broomcorn millet grains, or mung beans. Those resembling water beads, bright and clear, are auspicious and require no medication.
On the fourth or fifth day, variola varies in size. Red and vibrant roots with bright clarity indicate mildness. Dense, sunken tops, ash-gray or white color, with diarrhea and thirst indicate severity.
On the sixth or seventh day, plump, red, and lustrous variola indicates mildness. Warm body but rapid breathing, dry mouth, abdominal distension, and cold toes indicate severity.
On the eighth or ninth day, fully grown, plump, waxy-colored variola indicates mildness. Chills, confusion, abdominal distension, vexation and thirst, rapid breathing, and teeth grinding indicate the most severe condition.
On the tenth or eleventh day, variola should scab over, with crusts falling off indicating recovery. Fever, confusion, abdominal distension, diarrhea, chills, and teeth grinding indicate severity.
[Weng Shi] Song for Mild Variola: Heat is mild, spirit is clear, pustules are small and sparse; roots are red and vibrant, unevenly distributed; limbs are warm without chills or fever; milk and food intake are normal; thirst and diarrhea are absent; Taiyang area and cheeks are smooth; hands and feet are piled up, round like pearls; fewer lesions on waist, neck, and heart region; only requires care, no medicine needed.
Song for Severe Variola: Onset of heat with eruption on the first day; dense and bright red, reduced appetite; diarrhea, vexation, thirst, abundant on head and face; red pustules mixed with rashes, obstructed urination and defecation; flat and broad, ash-gray lacking brightness; carbuncles and sores weeping fluid; such severe conditions require prevention; do not wait until the moment arises to make mistakes.
[Wan Quan] The ancients said: Mild can turn severe, severe can turn mild. "Mild" refers to sparse eruptions, plump and red inside and out. People see its mildness and quickly develop an attitude of negligence, failing to avoid wind-cold, failing to regulate diet, failing to observe precautions, and failing to select appropriate doctors or shamans. Consequently, contracting wind-cold generates external heat; damaging diet generates internal heat. Heat steams and steeps, causing pustules to flip out densely, or leading to blindness after variola, abscesses, abdominal distension, vexation, vomiting, and diarrhea. Violating taboos causes itching and ulceration. Medical error involves tonifying what should not be toned or purging what should not be purged; shamanic deception involves sprinkling cursed water to damage the exterior and forcing drinking to damage the interior. Often this turns into serious illness, yet it is attributed to fate, how foolish! "Severe" refers to dense eruptions, black outside and red inside, white outside and black inside. If one maintains a sense of caution, regulates temperature, observes diet strictly, adheres to taboos, and selects proper medical help, natural healing becomes easy, transforming into mildness. Is this not human effort surpassing destiny?
Differentiating Recovery Without Medication:
Sparse pustule bases, red and spreading roots, no diarrhea or thirst, normal milk/food intake, warm limbs, no high fever.
For the above six signs, medication is unnecessary. Only proper care is required. Keep the room warm, exclude foul odors, avoid seeing outsiders, abstain from sexual activity, and keep away from menstruating women and those with axillary odor. Burning Dahuang (Rhei Radix et Rhizoma) and Cangzhu (Atractylodis Rhizoma) is recommended to repel evil qi. Do not burn Chenxiang (Aquilariae Lignum Resinatum), Tanxiang (Santalum Album Lignum), Jiangzhenxiang (Dipterocarpus Turbinatus Resina), Ruxiang (Olibanum), Bingpian (Borneolum Syntheticum), or Shexiang (Moschus). Hanging Huisu (Coriandri Fructus) inside curtains, soaking it in wine to spray beds and curtains, or burning Muxiang (Aucklandiae Radix) is excellent. The toxin of variola fears foul odors most. Do not believe monks or Daoists who claim to cleanse impurity through scriptures; they have no power and may introduce foul odors themselves. Do not rely on them for cleansing without prevention. Beware, beware.
Differentiating Five Incurable Syndromes:
Itching and collapse, chills with teeth grinding, incessant thirst. Purple-black pustules, panting and restless thirst. Ash-gray or white sunken tops, abdominal distension. Warm head and cold feet, confused and desiring water. Rapid breathing, diarrhea, and thirst.