钱氏曰凡疮疹一发便出尽者必重也疮夹疹者半轻半重也出稀者轻里外肥红者轻外黑里赤
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重也外白里黑者大重也疮端里黑点如针孔者势剧也青干紫陷睡昏汁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味凡饥及风寒归肾变黑难治也有大热当利小便有小热宜
解毒若黑紫干陷者百祥丸下之不黑者慎勿下看时月轻重大抵疮疹属阳出则春夏为顺秋冬逆冬
月肾旺又盛寒病多归肾变黑又当辨春脓 夏黑陷秋 冬疹亦不顺也黑者无问何时十难救一其
候
寒战噤牙或身黄肿紫宜急以百祥丸下之复恶寒不已身冷出汗耳 反热者死肾气大旺也下后身
热饮水可治脾旺胜肾寒去而温热也 先发脓胞后发疹子者顺后发 子者逆 先发水 后发疹
子者逆 先发脓 后发水泡多者顺少者逆 先水泡后 子多者逆少者顺 先疹子后 子者
顺凡疮疹只出一般者善
洁古曰一发便密如针头情势重者合轻其表而凉其内连翘升麻汤若 已发密重微喘饮水者
有热
证则去风药微下之若出不快清便自调知其在表不在里当微发散用升麻葛根汤若青干黑陷身不
大热大小便涩则是热在内煎大黄汤下宣风散若身表大热表证未罢不可下若 疹已出见小热
小便
不利当利之已发后有余毒未散复有身热疮肿之类当用茶粉下解毒丸疮疹已出后有声音者乃形
病气不病也疮疹未出先声音不出者乃形不病而气病也若疮疹出而声音不出者是形气俱病也当
清其肺气当用八风汤并凉膈散去硝黄亦可
钱乙说：凡是痘疮疹子一发出就全部出齐的，病情必然严重。疮与疹夹杂出现的，属于半轻半重。出得稀疏的，病情较轻。疮体外部肥润、内部红润的，病情较轻；外部发黑、内部赤红的，属于轻微的重症；外部发白、内部发黑的，属于非常严重的重症。疮头内部有像针孔一样的黑点的，病势剧烈。出现青色、干枯、紫暗凹陷、嗜睡昏迷、汁液流出不止、烦躁、发热口渴、腹胀、啼哭喘息、大小便不通的，属于危困之证。
凡是痘疮疹子发作期间，乳母应当谨慎饮食口味。如果因饥饿及感受风寒导致邪气归并于肾，痘疮变黑，则难以治疗。如果有大热，应当通利小便；如果有小热，适宜解毒。如果痘疮呈现黑紫色、干枯凹陷，应用百祥丸攻下；如果不黑，千万不要攻下。观察时节轻重，大体上痘疮属阳，春夏季发出为顺证，秋冬季发出为逆证。冬季肾气旺盛，又加上寒气盛，病多归于肾而变黑。另外还要辨别：春季出脓疱、夏季黑陷、秋季出疹、冬季出痘，都不算顺证。黑色痘疮无论发生在什么季节，十难救一。其症状表现为寒战、咬牙，或者身体发黄肿胀、紫暗，应当紧急用百祥丸攻下。如果攻下后仍然恶寒不止、身体冰冷出汗、耳朵反而发热，这是死证，因为肾气太旺了。攻下之后身体发热、想喝水，是可以治疗的，这是因为脾土旺盛克制了肾水，寒气去除而转为温热。
先发脓疱后发疹子的，是顺证；后发疹子的，是逆证。先发水疱后发疹子的，是逆证；先发脓疱后发水泡多的，是顺证，少的，是逆证。先水泡后疹子多的，是逆证，少的，是顺证。先疹子后脓疱的，是顺证。凡是痘疮疹子只出一类形态的，预后良好。
张元素（洁古）说：痘疮一发就密集如针头状，情势严重的，应当轻解其表邪并清凉其内热，用连翘升麻汤。如果已经发出且密集严重，伴有轻微气喘、想喝水的，有热证表现，则去掉祛风药，稍微攻下它。如果出得不畅快，但大便小便正常调和，知道病邪在表不在里，应当轻微发散，用升麻葛根汤。如果痘疮青黑干枯凹陷，身体不是特别热，大小便涩滞，则是热邪在内煎熬，用大黄汤攻下宣风散。如果身体表面大热，表证未罢，不可攻下。如果疹子已经发出，见轻微发热，小便不利，应当通利小便。痘疮发出后，有余毒未散，再次出现身体发热、疮肿等情况的，应当用茶粉送服解毒丸。痘疮发出后声音正常的，是形体有病而气机无病；痘疮未发出前声音就不出的，是形体无病而气机有病；如果痘疮发出了声音却不出，是形和气都有病，应当清肃肺气，当用八风汤，也可以使用凉膈散去硝石和黄连（注：原文为去硝黄，通常凉膈散含硝黄，此处依原文翻译为去掉硝黄，或指使用去除了硝黄的凉膈散加减，按字面意译）。
Qian Yi stated: Whenever the pox and rashes erupt completely all at once upon their first appearance, the condition must be severe. When sores and rashes appear together, it is a case of half-light and half-severe. When they appear sparsely, the condition is mild. When the sores are plump and red externally and internally, the condition is mild; when black externally and red internally, it is a slightly severe condition; when white externally and black internally, it is a very severe condition. When there are black spots like needle holes inside the tips of the sores, the disease momentum is violent. Cases presenting with cyanosis, dryness, purple depression, lethargy/coma, unceasing discharge of fluid, restlessness, fever, thirst, abdominal distension, crying and wheezing, and obstruction of both large and small bowel movements, are critical and distressed conditions.
During the eruption of pox and rashes, the nursing mother must be cautious about her diet. If due to hunger and exposure to wind-cold, the pathogenic qi returns to the Kidney causing the pox to turn black, it is difficult to treat. If there is high fever, one should promote urination; if there is slight fever, detoxification is appropriate. If the pox presents as black-purple, dry, and depressed, Baixiang Wan (Hundred-Prosperity Pill) should be used to purge. If not black, purging must strictly be avoided. Generally speaking regarding the severity according to seasons: Pox and rashes belong to Yang. Eruption in spring and summer is favorable (Shun), while in autumn and winter it is unfavorable (Ni). In winter, Kidney Qi is prosperous, and combined with strong cold, diseases often return to the Kidney turning black. Additionally, one must distinguish: pus blisters in spring, black depression in summer, rashes in autumn, and pox in winter are all unfavorable. Black pox is hardly curable regardless of the season, with only one in ten surviving. The symptoms include chills, teeth grinding, or yellowish swelling of the body, and purple discoloration. In such cases, Baixiang Wan should be urgently administered to purge. If after purging, aversion to cold persists, the body becomes cold with sweating, and the ears become hot instead, this is a death sign due to excessive Kidney Qi. After purging, if the body becomes hot and the patient desires water, it is treatable; this indicates Spleen Earth overcoming Kidney Water, cold dissipating, and transforming into warmth.
Erupting pus blisters first and then rashes is favorable; erupting rashes later is unfavorable. Erupting water blisters first and then rashes is unfavorable. Erupting pus blisters first and then many water blisters is favorable, few is unfavorable. Many water blisters first and then rashes is unfavorable, few is favorable. Rashes first and then pus blisters is favorable. Whenever pox and rashes present in only one type of morphology, the prognosis is good.
Zhang Yuansu (Jiegu) stated: If pox and rashes erupt densely like needle heads immediately, indicating a severe situation, one should lightly release the exterior and cool the interior using Lianqiao Shengma Tang (Forsythia and Cimicifuga Decoction). If already erupted, dense and severe, with slight wheezing and desire for water, indicating heat signs, remove wind-dispelling herbs and slightly purge. If eruption is slow but stool and urine are normal, knowing the pathogen is in the exterior not the interior, use mild diaphoresis with Shengma Gegen Tang (Cimicifuga and Kudzu Root Decoction). If the pox is cyanotic, dry, black, and depressed, without significant body heat, and with astringent stool and urine, the heat is internal and boiling; purge using Dahuang Tang (Rhubarb Decoction) combined with Xuanfeng San (Wind-Releasing Powder). If the body surface has high heat and exterior signs have not resolved, do not purge. If rashes have erupted showing slight heat and difficulty in urination, promote urination. After eruption, if residual toxins remain undissipated and recurrent fever and sores occur, use Cha Fen (Tea Powder) to administer Jiedu Wan (Detoxification Pill). If the voice remains normal after pox eruption, it means the form is diseased but the Qi is not. If the voice is absent before pox eruption, it means the form is not diseased but the Qi is. If pox erupts but the voice is absent, both form and Qi are diseased; one should clear Lung Qi, using Bafeng Tang (Eight-Winds Decoction), or Liangge San (Cool the Epigastrium Powder) with Nuxi (Mirabilite) and Huanglian (Coptis Rhizome) removed.