夫痘有似凶而吉者。似吉而凶者。不可不辨。如诸痘不起。而天庭晓星起灌者吉。诸痘壮起
。而天庭晓星不起者凶。诸痘不起。而太阳独起者吉。诸痘壮起。而太阳不起者凶。 诸痘不起。
而耳边方圆寸许独起者。肾经旺也。吉。诸痘壮起。而耳边方圆寸许不起者。为肾败也。不治。
遍身俱起灌。惟左耳下外面。有两三粒不起灌者。肝肾毒盛。定作唇裂齿干。宜急救之。 凡头
面四肢密者为险。若得地角有数粒如珠者。为顺。诸痘俱好。地角独伏陷干枯。或灰白不起者。
为逆。 痘遍身俱陷。惟尻骨饱满如珠。此肾脏有权。补托灌浆即愈。 面部俱稀。而鼻梁左右
密如蚕种者。毒聚于胃也。危。面部俱稀。而口角有黑痘一粒独大。或两边有两粒者。为 门疔
。初起可救。五六日不治。 痘出遍身稀疏。惟项下稠密一片至颐者。名锁项托颐。不治。若喉
颈太多者。急用山豆根、牛蒡子、黑参、木通、甘、桔、芎、归、生地、
荆芥辈治之。迟则毒结咽喉。不救矣。 初见标时。胸上脐下俱有。中间一截无者。此脾胃虚。
急用参、 、归、芷、浓朴、紫草、木通、防风辈救之。七日之外难矣。痘出遍身斑斑成片。如
打伤痕者。不治。 痘标既完。手足胸背俱多。而头面无者。气血不能上升也。急用升麻、芎、归
、甘、桔、防、芷、苏叶、前胡。加姜服之。五日后不治。曲池生痈而死。若遍身稀者。不在此
例。 初出便如绿豆。两三日大如棋子。其痘根顶全无血色。比众独大。按之虚软。曰贼痘。四
五日出血而死。痘出数十粒成块。肌肉结硬。中有一大者。曰痘母。此血凝毒盛。急须挑破。内
服真人解毒汤。外用绵胭脂煮热熨之。熨之肉不柔和者不治。 头面无空。平塌色白。俗名蛇皮。
此干枯不能作浆。至十一二日必危。若得发臭而不剥裂者。可治。 初标红润。至四五日忽变伏
陷。此为药患。急扶表里。 痘虽肥满。而内实干无血水者死。 痘中有凹。四边特起。明亮坚
硬。浆板不化。形加石臼者。不治。 痘疮生虫。皆湿热所化。毒流皮肤也。虽冬月亦有之。以
柳叶铺下。令儿卧上。则虫自死无柳叶时。预收干者为末。香油调敷亦效。初出血点。其色红紫
。遍身如点朱者。六日死。 血泡协热。而浆肥满。刺泡血红。急以犀角地黄汤加白芍治之。血黑
不治。 痘本稀少。四五日起发。六七日收靥。痂干而赤。九日而痂落。此气血充足毒少。故随
出随痂。不及作脓也。最佳。 疮虽起发。四畔又出小痘。攒簇如粟米。不待长养灌浆。必加搔
痒而死。 疮头有孔。脓水漏出。堆聚干结。或清水自破。水去干黑者不治。痘发浆泡。而人中
平满唇翻。腹胀气急者不治。 痘发燎浆泡。切忌损破。浆臭后犹或可治。破则不治。 其形如
豆壳。灰白全无血色。擦破血出无脓不治。 痘已出齐。紫色不起不浆。如浮萍贴于肉上者不治。
如微微高起。爬出有血。急以凉血解毒之剂救之。 黑痘多属血热。本为恶候。然形状多端。宜
随证解救。紫黑点子隐于皮肤间者。用人牙烧灰、猪尾血。酒酿
调五七分。量人大小与之。初出便见黑点。急用紫草茸三钱酒煎服。或形如痣。或如牵牛子。或
如煤炭。或青紫成块。皆为寒闭热毒。宜化毒凉血。荆、防、蝉蜕、紫草、黑参、木通、连翘辈
救之。热甚加黄连。黑而软大者。气弱毒盛也。保元汤加紫草。以上诸证。竭力图成。或可十全
一二也。 近看如水蓼花。远望如胭脂色。清水不能成浆者不治。 先见标一二点于面部。或口
唇上下。周身俱无。如常起胀灌浆收靥。此为报痘。不知者以为本痘稀少。以火照之。红点隐隐藏
于肌肉之内。急宜托里解毒。其痘齐出。否则颐下发痈毒而成不救。
痘疮有看似凶险实则预后良好者，也有看似良好实则预后凶险者，不可不加以辨别。例如：所有痘疮都不起发，但天庭（额头中央）的“晓星”（指痘疹初起时如星星般的小突起）能够起发灌浆的，为吉兆；所有痘疮都壮盛起发，但天庭的“晓星”不起发的，为凶兆。所有痘疮都不起发，但太阳穴部位单独起发的，为吉兆；所有痘疮都壮盛起发，但太阳穴部位不起发的，为凶兆。所有痘疮都不起发，但耳边方圆一寸左右的地方单独起发的，这是肾经旺盛的表现，为吉兆；所有痘疮都壮盛起发，但耳边方圆一寸左右的地方不起发的，这是肾气败绝的表现，无法治疗。全身痘疮都起发灌浆，唯独左耳下外侧有两三粒不起发灌浆的，这是肝肾毒邪炽盛，必定会出现嘴唇干裂、牙齿干燥的症状，应当紧急救治。凡是头面四肢痘疮密集的为险证；如果在地角（下巴角落）有几粒如珍珠般的痘疮，则为顺证。所有痘疮都好，唯独地角处伏陷干枯，或呈灰白色不起发的，为逆证。痘疮遍布全身都凹陷，唯独尻骨（尾椎骨附近）饱满如珠状，这是肾脏功能尚存，通过补益托毒、促进灌浆即可痊愈。面部痘疮稀疏，而鼻梁左右两侧密集如蚕种状的，这是毒邪聚集于胃，病情危重。面部痘疮稀疏，而口角有一粒黑痘特别大，或两边各有两粒的，称为“门疔”，初期可以救治，若五六天不治疗则死亡。痘疮发出遍身稀疏，唯独颈部下方稠密一片延伸至下颌的，名为“锁项托颐”，无法治疗。如果喉咙颈部痘疮太多的，紧急使用山豆根、牛蒡子、黑参（玄参）、木通、甘草、桔梗、川芎、当归、生地黄、荆芥等药物治疗，拖延则毒邪结聚咽喉，无法救治。刚见到痘标（痘疹初期形态）时，胸部以上、肚脐以下都有，中间一段没有的，这是脾胃虚弱，紧急用人参、白术、当归、白芷、厚朴、紫草、木通、防风等药物救治，过了七天就难治了。痘疮发出遍身斑斑成片，像被打伤留下的伤痕一样的，无法治疗。痘标既已完备，手足胸背都多，而头面没有的，这是气血不能上升，紧急使用升麻、川芎、当归、甘草、桔梗、防风、白芷、苏叶、前胡，加生姜服用，五天后不治。曲池穴生痈疽而死。如果遍身痘疮稀疏的，不在此例。初出时就像绿豆大小，两三天后大如棋子，其痘根和顶部完全没有血色，比其他的独大，按压时虚软，称为“贼痘”，四五天出血而死。痘疮发出数十粒结成一块，肌肉结硬，其中有一颗特别大的，称为“痘母”，这是血凝毒盛，必须紧急挑破，内服真人解毒汤，外用绵胭脂煮热熨烫。熨烫后肌肉不柔和的无法治疗。头面无空隙，平塌色白，俗名“蛇皮”，这是干枯不能化浆，到十一二日必然危险。如果能散发臭味而不剥裂的，可以治疗。初起痘标红润，到四五日忽然变伏陷，这是因用药不当造成的祸患，紧急扶助表里。痘疮虽然肥满，但内部实干无血水的会死亡。痘疮中有凹陷，四周特别隆起，明亮坚硬，浆液板结不化，形状像石臼一样的，无法治疗。痘疮生虫，都是湿热所化，毒邪流注皮肤所致。即使是冬天也有这种情况，用柳叶铺在地上，让孩子睡在上面，虫子自然死亡；没有柳叶时，预先收集干燥的柳叶研成粉末，用香油调敷也有效。初起出血点，颜色红紫，遍身像点了朱砂一样的，六天死亡。血泡伴有热邪，而浆液肥满，刺破水泡流出血红色的液体，紧急用犀角地黄汤加白芍治疗。血液黑色的无法治疗。痘疮本来稀少，四五日起发，六七日收靥，痂皮干枯而赤红，九日痂皮脱落，这是气血充足毒邪少，所以随出随结痂，来不及化脓，这是最好的情况。疮虽然起发，四周又长出小痘，攒簇如粟米状，不待长大灌浆，必定因为搔痒而死。疮头有孔，脓水漏出，堆聚干结，或清水自行破裂，水去后干黑的无法治疗。痘发燎浆泡，而人中平满、嘴唇外翻、腹胀气急的无法治疗。痘发燎浆泡，切忌弄破，浆液发臭后或许还可以治疗，一旦弄破就无法治疗。其形状如豆壳，灰白完全没有血色，擦破出血没有脓液的无法治疗。痘已出齐，紫色不起不发浆，像浮萍贴在肉上的无法治疗。如果微微高起，爬出有血的，紧急用凉血解毒的药物救治。黑痘多属于血热，本为恶候，但形状多种多样，应当根据症状解救。紫黑点子隐于皮肤间的，用人牙烧灰、猪尾血，用酒酿调服五七分，根据病人大小给予剂量。初出便见黑点的，紧急用紫草茸三钱酒煎服用。或者形状像痣，或像牵牛子，或像煤炭，或青紫成块，都属于寒闭热毒，应当化毒凉血，用荆芥、防风、蝉蜕、紫草、黑参、木通、连翘等药物救治。热甚加黄连。黑色而软大的，是气弱毒盛，用保元汤加紫草。以上各种证候，竭力图谋治愈，或许能挽回一二成。近看像水蓼花，远望像胭脂色，清水不能成浆的无法治疗。先见到痘标一两点在面部，或嘴唇上下，周身都没有，如果像平常一样起胀、灌浆、收靥，这称为“报痘”。不知道的人以为本痘稀少，用火照看，红点隐藏于肌肉之内，紧急宜托里解毒。如果痘疮一齐出来，否则下颌会发痈毒而成不救之症。
There are cases of smallpox that appear ominous but are actually auspicious, and cases that appear auspicious but are actually ominous; these must not fail to be distinguished. For instance: if all pustules do not rise, but the "Dawn Star" (small initial protrusions on the forehead) in the Tian Ting (center of the forehead) rises and fills with pus, this is auspicious. If all pustules rise vigorously, but the "Dawn Star" in the Tian Ting does not rise, this is ominous. If all pustules do not rise, but those at the Tai Yang (temporal region) alone rise, this is auspicious. If all pustules rise vigorously, but those at the Tai Yang do not rise, this is ominous. If all pustules do not rise, but those within an inch square around the ear alone rise, this indicates the flourishing of the Kidney Meridian (Kidney channel), which is auspicious. If all pustules rise vigorously, but those within an inch square around the ear do not rise, this indicates the failure of the Kidney Qi, which is incurable. If pustules fill and rise over the whole body, except for two or three grains at the lower outer side of the left ear that do not rise or fill, this indicates excessive toxin in the Liver and Kidney, inevitably leading to cracked lips and dry teeth; urgent rescue is required. Generally, dense pustules on the head, face, and limbs indicate a dangerous condition. However, if there are a few pearl-like pustules at the Di Jiao (corner of the chin), it indicates a favorable course. If all other pustules are good, but those at the Di Jiao are sunken, dry, and withered, or grayish-white and non-rising, it indicates an adverse condition. If pustules are sunken all over the body, but the Kao Gu (sacral/coccygeal area) is full and round like a bead, this shows the Kidney organ still has authority; supplementation and support to promote pus formation will lead to recovery. If facial pustules are sparse, but those on both sides of the nasal bridge are dense like silkworm eggs, toxin is gathered in the Stomach, indicating critical danger. If facial pustules are sparse, but there is one unusually large black pustule at the corner of the mouth, or two on each side, this is called Men Ding (Gate Carbuncle); it can be saved initially, but death ensues if untreated after five or six days. If pustules are sparse all over the body, but densely clustered from below the neck to the jaw, named Suo Xiang Tuo Yi (Locking Neck Supporting Chin), it is incurable. If there are too many pustules in the throat and neck, urgently treat with Radix Dolichandrone (Shan Dou Gen), Fructus Arctii (Niu Bang Zi), Radix Scrophulariae (Hei Shen/Xuan Shen), Radix Akebiae (Mu Tong), Radix Glycyrrhizae (Gan Cao), Radix Bupleuri (Jie Geng), Rhizoma Chuanxiong (Xiong Gui), Radix Angelicae Sinensis (Gui), Radix Rehmanniae Preparata (Sheng Di), and Herba Schizonepetae (Jing Jie). Delay allows toxin to knot in the throat, becoming incurable. When the initial marks (Biao) first appear, present above the chest and below the navel, but absent in the middle section, this indicates Spleen and Stomach deficiency; urgently save with Radix Ginseng (Ren Shen), Rhizoma Atractylodis Macrocephalae (Zhu Ru/Bai Zhu context implies Bai Zhu here usually, text says empty space likely implying Bai Zhu or similar, sticking to text entities: Ren Shen, Gui, Zhi, Hou Po, Zi Cao, Mu Tong, Fang Feng). After seven days, it is difficult to treat. If pustules appear all over the body in patches like bruise marks, it is incurable. Once the initial marks are complete, if there are many on hands, feet, chest, and back, but none on the head, this indicates Qi and Blood cannot ascend; urgently use Radix Cimicifugae (Sheng Ma), Rhizoma Chuanxiong (Xiong), Radix Angelicae Sinensis (Gui), Radix Glycyrrhizae (Gan Cao), Radix Bupleuri (Jie Geng), Radix Saposhnikoviae (Fang Feng), Rhizoma Aucklandiae (Zhi), Folium Perillae (Su Ye), Radix Peucedani (Qian Hu), add Ginger, and administer. After five days, it is incurable. Abscesses at Qu Chi (LI11) cause death. If pustules are sparse all over, this case does not apply. Initially emerging like mung beans, growing to the size of chess pieces in two or three days, with roots and tops completely lacking blood color, larger than others, and soft upon pressure, this is called Zei Dou (Thief Pox); death occurs from bleeding after four or five days. Dozens of pustules cluster into a mass, muscles become hard, with one particularly large one in the center, called Dou Mu (Pox Mother); this is blood coagulation and excessive toxin; it must be punctured urgently, internally administered with Zhen Ren Jie Du Tang (True Person's Detoxification Decoction), and externally applied with warm-soaked Mian Yan Zhi (Cotton Carmine). If the flesh remains unsoftened after application, it is incurable. The head and face have no gaps, flat and white, commonly known as She Pi (Snake Skin); this is dry and cannot form pus, becoming critical by the 11th or 12th day. If it emits a foul odor without cracking, it can be treated. If initial marks are red and moist, but suddenly sink and flatten by the 4th or 5th day, this is a drug-induced complication; urgently support the exterior and interior. Although pustules are plump, if the inside is dry and lacks blood/fluid, death ensues. If a pustule has a depression, with sharply raised, bright, hard edges, and the pus plate does not liquefy, resembling a stone mortar, it is incurable. Insects in pox sores are transformed from damp-heat and toxin flowing into the skin; this occurs even in winter. Lay willow leaves for the child to lie on, and the insects will die. Without fresh willow leaves, dried powder mixed with sesame oil applied topically is also effective. Initial bleeding points that are red-purple, covering the body like cinnabar dots, result in death on the sixth day. Blood blisters with heat, where pus is plump, but piercing releases red blood, requires urgent treatment with Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) plus Radix Paeoniae Alba (Bai Shao). Black blood is incurable. If pustules are originally sparse, rising on the 4th-5th day, scabbing on the 6th-7th day, with dry red scabs falling off on the 9th day, this indicates sufficient Qi and Blood and little toxin; thus, they scab immediately upon emergence without forming pus, which is optimal. If sores rise, but small pustules cluster like millet seeds around the periphery, without waiting to grow and fill with pus, death ensues from itching. If sore heads have holes leaking pus, accumulating and drying, or clear fluid breaks out leaving dry blackness, it is incurable. If pustules erupt with blistering, accompanied by a flat Ren Zhong (philtrum), everted lips, abdominal distension, and rapid breathing, it is incurable. Blistering pustules must absolutely not be broken; if pus smells foul, it might still be treatable, but once broken, it is incurable. If shaped like bean shells, grayish-white with no blood color, and bleeding without pus upon abrasion, it is incurable. If pustules are fully erupted, purple, non-rising, non-filling, and floating on the skin like duckweed, it is incurable. If slightly elevated with blood oozing out, urgently rescue with cooling blood and detoxifying agents. Black pustules mostly belong to blood heat, inherently a bad omen, but shapes vary; rescue should follow symptoms. Purple-black spots hidden in the skin: use burnt human tooth ash and pig tail blood, mixed with fermented rice wine, administered according to age/size. Black spots appearing immediately upon eruption: urgently decoct 3 qian of Zi Cao Rong (Purple Grass Flos) in wine. Or shaped like moles, bindweed seeds, coal, or blue-purple clumps: all indicate cold closing heat toxin; resolve toxin and cool blood using Jing Jie, Fang Feng, Chan Tui, Zi Cao, Hei Shen, Mu Tong, Lian Qiao. Add Huang Lian if heat is severe. Black and soft/large indicates weak Qi and strong toxin; use Bao Yuan Tang plus Zi Cao. For all above conditions, striving for cure may save one or two percent. Looking close like Polygonum hydropiper flowers, distant like rouge color, unable to form pus with clear fluid: incurable. Seeing one or two initial marks on the face or lips, absent elsewhere, yet rising, filling, and scabbing normally, this is called Bao Dou (Reporting Pox). Uninformed people think the primary pox is sparse; shining a light reveals red dots hidden in the muscle; urgently tonify interior and detoxify. If the pox erupts all at once, otherwise abscesses and toxins will form under the jaw, becoming incurable.