痘有五善七恶，治者宜熟谙也。何谓五善？一饮食如常，二大小便调，三色泽
红活坚实，四脉静身凉，手足和暖，五声音响亮，动止安宁，五者不能华具，若得
二三，自然清吉。其七恶者何？躁烦闷乱，谵妄恍惚，一也；呕哕泄泻，不能饮食，二
也；青干黑陷，痒塌破烂，三也；头面预肿，鼻塞目闭，唇裂四也；寒战切牙，声
哑色黯，五也；喉舌溃烂，食入则呕，饮水则呛，六也；腹胀喘促，四肢逆冷，七
也；七恶之中，但见一证，即势不可为，七恶之外，复有浑身血泡，心腹刺痛，伏陷
不出， 疔肉硬，便溺皆血，寻衣捏空，是又速亡之侯矣。
夫汗下二举，乃不得已于之所投也，如少误焉，贻毒不浅。如痘证本稀，原无闭
塞表热不快之证，而妄用重药以发之，则在后必成斑烂音哑，皮薄痒塌，或为虚脱
者有矣。如气血本和，原无便闭热毒紫黑之证，而妄用重药以下之，则在后必成陷
伏不起，胃弱灰白，或变虚羸腹胀者有矣。此皆妄汗妄下之过也，可不慎欤！然痘亦
有当微汗微下者，言微者，恐其过也。如方热方炽，红点未见之先，影色不出，烦
躁腮红，起不活动者，则用轻扬之剂微开腠理，使痘易出，况火郁则升之，以减其
盛势也。其剂如升麻葛根汤、参苏饮之类。若既见红点，则忌葛根，恐疏表太过，遂
致成虚，根窠易塌，表实者用亦无妨。更有当下之证而不下，则在后必成紫黑而壅
毒热结血枯者，又为失下之患矣。是以痘未出时，脉数洪大，小便赤涩，大便闭结，
气粗腹胀，唇燥烦渴者，此是热毒壅盛而不得泄，宜微下之，使内无阻滞，荣卫升
降，则痘自顺矣。然痘疮首尾无急证，慎勿轻为汗下，恐元气一耗，则浆无自而成，后必为患矣。
痘疹有“五善”和“七恶”的预后判断，治疗者应当熟悉掌握。什么是“五善”？第一是饮食如常，第二是大便和小便正常，第三是痘疹色泽红活、坚实，第四是脉象平静、身体凉爽、手足温暖，第五是声音响亮、动静安宁。这五种情况如果不能全部具备，如果能出现其中两三种，自然就会平安吉利。那“七恶”是什么呢？烦躁闷乱、胡言乱语、神志恍惚，这是第一种；呕吐呃逆、腹泻、不能进食，这是第二种；痘色青紫干枯、黑陷、瘙痒塌陷、破溃糜烂，这是第三种；头面部预先肿胀、鼻塞、眼睛闭合、嘴唇干裂，这是第四种；寒战咬牙、声音嘶哑、面色晦暗，这是第五种；咽喉舌头溃烂、吃东西就呕吐、喝水就呛咳，这是第六种；腹部胀满、呼吸急促、四肢冰冷，这是第七种。在“七恶”之中，只要见到一种症状，病情就难以挽救了。在“七恶”之外，如果还有全身血泡、心腹剧烈刺痛、痘疹伏陷不出、疔肉坚硬、大小便出血、摸衣被或虚空抓握（循衣摸床），这是又一种迅速死亡的征兆。
发汗和下法这两种治疗方法，是在不得已的情况下才使用的，如果稍微有误，遗留的毒害就不浅了。比如痘证本来稀疏，原本没有表热郁闭导致身体不适的症状，却胡乱使用重药来发汗，那么后来必然会出现痘疹腐烂、声音嘶哑、皮肤薄而瘙痒塌陷，或者导致虚脱的情况。如果气血本来调和，原本没有大便闭塞、热毒深重导致的痘色紫黑的症状，却胡乱使用重药来泻下，那么后来必然会导致痘疹陷伏不起、胃气虚弱导致痘色灰白，或者变成身体消瘦、腹部胀满的情况。这都是胡乱发汗和胡乱泻下的过错，能不谨慎吗！然而痘疹也有需要轻微发汗和轻微泻下的情况，说“微”，是担心过度。比如在发热正盛、火势炽烈、红色痘点尚未出现之前，痘影颜色出不来，伴有烦躁、腮部发红、痘起后不活动的情况，就用轻扬升散的药剂轻微开通腠理（皮肤毛孔），使痘疹容易发出，况且火邪郁结应当用升散的方法，以减弱其旺盛的势头。这类药剂如升麻葛根汤、参苏饮之类。如果已经出现了红色痘点，就要忌用葛根，恐怕疏解表邪太过，从而导致正气虚弱，痘根容易塌陷，如果是表实证的体质，使用也没有妨碍。更有应当使用下法而不用的情况，那么后来必然会导致痘色紫黑、壅滞毒热结聚、血液枯竭，这也是失于使用下法的祸患了。因此，在痘疹未发出时，如果脉象数且洪大，小便赤黄涩痛，大便闭结不通，气粗腹胀，嘴唇干燥烦渴，这是热毒壅盛而不能宣泄，应当轻微泻下，使体内没有阻滞，营卫之气升降通畅，那么痘疹自然就会顺遂了。然而痘疮从头到尾如果没有急重的证候，千万不要轻易使用发汗或泻下法，恐怕元气一旦耗损，痘浆就无法自然生成，后来必然会产生祸患。
Varicella (smallpox) prognosis is categorized into "Five Auspicious Signs" and "Seven Inauspicious Signs," which practitioners must be thoroughly familiar with. What are the "Five Auspicious Signs"? First, normal appetite and intake; second, regular bowel movements and urination; third, lesions that are red, vibrant, and firm; fourth, a calm pulse, cool body temperature, and warm hands and feet; fifth, clear voice and calm behavior. If all five cannot be present simultaneously, the presence of two or three naturally indicates a favorable outcome. What are the "Seven Inauspicious Signs"? First: restlessness, irritability, delirium, and mental confusion; second: vomiting, hiccups, diarrhea, and inability to eat; third: lesions turning cyanotic, dry, black, depressed, itchy, collapsed, ulcerated, or eroded; fourth: premature swelling of the head and face, nasal congestion, closed eyes, and cracked lips; fifth: chills, teeth grinding, hoarse voice, and dark complexion; sixth: ulceration of the throat and tongue, vomiting upon eating, and choking upon drinking; seventh: abdominal distension, rapid breathing, and cold limbs. The appearance of any single sign among the Seven Inauspicious Signs indicates an untreatable condition. Beyond these seven, if there are also blood blisters over the entire body, severe stabbing pain in the heart and abdomen, lesions that are depressed and fail to erupt, hard nodules, hematuria and melena, and unconscious fumbling at clothes or air (Groping for clothes), these are signs of imminent death.
Sweating (Diaphoresis) and purging (Purgation) are treatments of last resort; even slight errors can lead to significant residual toxicity. For instance, if the varicella case is originally sparse and lacks symptoms of exterior heat stagnation causing discomfort, but heavy sweating agents are rashly used, it will later result in lesion erosion, hoarseness, thin and itchy/collapsed skin, or even collapse due to deficiency. Conversely, if Qi and Blood are originally harmonious and lack symptoms of constipation or deep-seated heat toxin manifesting as purple-black lesions, but heavy purgatives are rashly used, it will later cause lesions to sink and fail to rise, weak Stomach Qi leading to grayish-white lesions, or transformation into emaciation and abdominal distension. These are all consequences of rash sweating and purging; how can one not be cautious? However, there are cases where mild sweating and mild purging are indicated. The term "mild" warns against excess. For example, when fever is intense and raging, before red spots appear, if the lesion shadow does not emerge, accompanied by restlessness, red cheeks, and non-mobile eruption, light and ascending formulas should be used to mildly open the Cou Li (skin pores) to facilitate eruption. Furthermore, fire stagnation should be treated with ascending methods to reduce its excessive force. Such formulas include Shengma Gegen Tang (Cimicifugae Radix and Puerariae Radix Decoction) and Shen Su Yin (Ginseng and Perilla Infusion). Once red spots have appeared, Gegen (Puerariae Radix) should be avoided to prevent excessive dispersal of the exterior, which could lead to deficiency and easy collapse of the lesion roots; however, for patients with Excess exterior patterns, its use may still be acceptable. Additionally, failing to purge when indicated leads to purple-black lesions, stagnant heat toxin accumulation, and blood depletion, constituting a failure to purge. Therefore, before eruptions occur, if the pulse is rapid and surging, urine is red and scanty, stool is constipated, breathing is coarse with abdominal distension, and lips are dry with thirst and irritability, this indicates excessive heat toxin stagnation that cannot vent. Mild purging should be employed to remove internal obstruction, allowing Ying (Nutritive Qi) and Wei (Defensive Qi) to ascend and descend freely, ensuring smooth progression of the disease. Nevertheless, if there are no urgent conditions throughout the course of varicella, one must strictly avoid rash sweating or purging. Otherwise, once Yuan Qi (Original Qi) is depleted, the pus/serum cannot form naturally, leading to subsequent complications.