痘疹切牙寒颤。有先后之序。痘正出时。为寒邪所袭。则肌腠闭塞。不能宣达。而发寒颤。宜
疏解之。若养浆时寒颤。乃阴凝于阳。阳分虚。则阴入气道而作颤。保元汤加丁、桂以温阳分。
若系表虚风寒所乘。则宜保元汤加羌、防、荆芥、连翘、木香之类。痘未透而切牙者。阳明胃热。
宜清解之。若养浆时切牙。乃阳陷于阴。阴分虚则阳入血道。故切牙也。保元汤加芎、归以益阴
分。若系肝盛木邪乘土。则宜泻青丸合导赤散作汤。二证并作于吐泻后者。邪正交攻。气血俱
虚之候。十全大补汤。单见且凶。况并见乎。若痘色红紫。大小便秘。烦渴欲饮水者。表里俱热之
证。而不寒但颤者。疮痛而摇也。切牙者忍痛也。乍作乍止。四顺清凉饮。若溃烂灰白。泄泻不
止。此脾胃虚寒。纯阴无阳之证。急用陈氏木香、异功。若瘙痒闷乱。腹胀足冷者。倒 也。不治
。若痘焦紫陷伏。闷乱昏睡。或躁扰不宁。声哑气急。而寒颤切牙者。为热毒内攻。法在不治。
急投神授散以救之。若青干紫陷。二便不通。大渴不止者。此纯阳无阴。百祥丸、宣风散。急下
以救阴津。下后身安手足温者。方许可治。若腹胀气喘 语。手足冷者伏陷也。不治。大抵二证
并见最为危候。又当以痘色辨其吉凶。或单寒颤者。当补气之中兼补其血。单切牙者。于补血之
中兼助其气。然此二证。多发于痘后。其人属虚无疑。虽有少热。亦余毒耳。在养浆收靥之时。
最忌见此。故于七日前见者可治。在七日后见者为逆。
痘疹出现咬牙和寒战的症状，有发病先后的顺序。在痘疹正在透发的时候，如果受到寒邪侵袭，会导致肌表腠理闭塞，正气不能宣通发散，从而引发寒战，适宜采用疏风解表的方法治疗。如果在痘疹灌浆阶段出现寒战，这是因为阴气凝滞于阳气之中，阳分虚弱，导致阴气侵入气道而产生颤抖，应当使用保元汤加入丁香、肉桂来温补阳分。如果是由于体表虚弱，风寒之邪乘虚而入，则适宜使用保元汤加入羌活、防风、荆芥、连翘、木香等药物。痘疹尚未透发就出现咬牙的，是阳明胃经有热，适宜采用清热解表的方法治疗。如果在灌浆阶段出现咬牙，这是因为阳气下陷于阴分，阴分虚弱导致阳气进入血道，所以出现咬牙，应当使用保元汤加入川芎、当归以滋补阴分。如果是由于肝气过盛，木邪克制脾土所致，则适宜使用泻青丸合导赤散煎汤服用。这两种症状如果在吐泻之后同时出现，属于邪气与正气相互交争，气血都虚弱的证候，应当使用十全大补汤。单独出现其中一种症状已经凶险，何况两种同时出现呢？如果痘色红紫，大小便不通畅，烦躁口渴想喝水的，这是表里俱热的证候。不感到寒冷只是身体颤抖的，是因为疮疡疼痛导致的肢体摇动。咬牙是因为忍受疼痛。症状时作时止，可以使用四顺清凉饮。如果痘疮溃烂呈灰白色，泄泻不止，这是脾胃虚寒，纯阴无阳的证候，紧急使用陈氏木香散或异功散。如果瘙痒、烦闷扰乱，腹胀且脚冷的，是痘毒内陷（倒靥），无法治愈。如果痘疮焦枯紫暗，凹陷伏匿，烦闷扰乱，昏睡不醒，或者躁动不安，声音嘶哑，呼吸急促，并且伴有寒战和咬牙的，这是热毒内攻，按照法则属于不治之症，紧急投予神授散以挽救。如果痘色青黑干枯紫暗凹陷，二便不通，极度口渴不止的，这是纯阳无阴，应当使用百祥丸、宣风散，紧急攻下以挽救阴津。攻下后如果身体安宁，手足温暖，才可以允许治疗。如果腹胀气喘，胡言乱语，手足冰冷的，是痘毒伏陷，无法治愈。大抵来说，寒战和咬牙两种症状同时出现是最为危重的证候。另外还应当根据痘色的变化来辨别吉凶。如果只有寒战的，应当在补气之中兼补血；如果只有咬牙的，应当在补血之中兼助气。然而这两种症状，大多发生在痘疹后期，患者体质肯定虚弱，即使有少许热象，也是余毒残留。在灌浆收靥的阶段，最忌讳出现这些症状，所以在出痘七日前出现的还可以治疗，在七日后出现的属于逆证。
Teeth grinding and shivering in smallpox/rubella have a sequence of onset. When the lesions are erupting, if attacked by cold pathogenic factors, the muscle pores (muscle-coupling) become closed, preventing the diffusion and dissemination of healthy qi, resulting in shivering; it is appropriate to use dispersing and resolving methods. If shivering occurs during the pus-filling stage, it indicates that yin condenses upon yang; due to deficiency in the yang aspect, yin enters the qi pathway causing tremors. Baoyuan Decoction (Preserve the Origin Decoction) should be added with Dingxiang (Caryophylli Flos) and Rougui (Cinnamomi Cortex) to warm the yang aspect. If caused by wind-cold invading due to exterior deficiency, Baoyuan Decoction should be added with Qianghuo (Notopterygii Rhizoma), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Herba), Lianqiao (Forsythiae Fructus), and Muxiang (Aucklandiae Radix). If teeth grinding occurs before the lesions fully emerge, it is due to heat in the Yangming Stomach; clearing and resolving methods are appropriate. If teeth grinding occurs during the pus-filling stage, it indicates yang sinking into yin; due to deficiency in the yin aspect, yang enters the blood pathway, causing teeth grinding. Baoyuan Decoction should be added with Chuanxiong (Ligustici Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix) to benefit the yin aspect. If caused by excessive liver qi where wood pathogen overacts on earth (spleen/stomach), Xieqing Wan (Drain Green Pill) combined with Daochi San (Direct Red Powder) decocted as a soup is appropriate. If both conditions occur after vomiting and diarrhea, it signifies an attack between evil and righteous qi, with both qi and blood deficient; Shiquan Dabu Tang (Ten Complete Tonifying Decoction) is indicated. Even appearing alone is ominous, let alone appearing together. If the lesion color is red-purple, with constipation of stool and urine, irritability, thirst, and desire to drink water, this is a syndrome of heat in both interior and exterior. Trembling without cold sensation is due to pain from sores causing shaking. Teeth grinding is enduring pain. Intermittent occurrence can be treated with Sishun Qingliang Yin (Four Smooth Cooling Clearing Drink). If ulcers are grayish-white with unceasing diarrhea, this is spleen-stomach deficiency-cold, a pure-yin no-yang syndrome; urgently use Chen's Muxiang Powder or Yigong San. If accompanied by itching, mental restlessness, abdominal distension, and cold feet, it is inversion (Dao Dian); it is incurable. If lesions are scorched, purple, sunken, and hidden, with restlessness, lethargy, or agitation, hoarseness, rapid breathing, along with shivering and teeth grinding, it is internal attack by heat-toxin; according to principles, it is incurable, but Shenhou San (Divinely Bestowed Powder) should be urgently administered to save it. If lesions are dark-green, dry, purple, sunken, with obstruction of urination and defecation, and unceasing extreme thirst, this is pure-yang no-yin; Baixiang Wan (Hundred Auspicious Pills) and Xuanfeng San (Dispel Wind Powder) should be used to urgently purge to save yin fluids. If the body becomes calm and hands/feet warm after purging, treatment may proceed. If abdominal distension, panting, delirious speech, and cold hands/feet occur, it is deep-seated sinking; it is incurable. Generally, the simultaneous appearance of these two conditions is the most critical prognosis. Furthermore, auspiciousness or inauspiciousness should be distinguished by lesion color. If only shivering occurs, tonify qi while simultaneously tonifying blood. If only teeth grinding occurs, tonify blood while assisting qi. However, these two conditions mostly occur post-smallpox, indicating definite deficiency in the person. Even slight heat is merely residual toxin. During the pus-filling and scabbing stages, seeing these signs is most taboo. Therefore, appearance within seven days is treatable; appearance after seven days is adverse.