预知疮痘吉凶机，气色都于面部推，年上山根犹紧要，红光可喜黯青疑。
痘疹伤寒疑似间，古人分证可相参，莫将汗剂先轻视，发散惟图表里安。
疮疹为阳待热成，微微发热始和平，假如大热身犹火，解毒当叫小便清。
始终能食最为良，平日其人脾胃强，食少却防中气弱，淹留引日变疮疡。
最宜安静好平和，表里无邪志自宁，烦扰忽来宜察审，最嫌失志转神昏。
陷伏须方实与虚，实须清托大相宜，如逢虚冷宜温补，幽谷春回庆有余。
四时分治候须明，暑湿风寒不可轻，异气莫教相触犯，致令翻变乱其真。
痘疮脉候贵和平，胃气悠长最要清，弦数浮洪为实候，微沉短涩是虚因。
第一犯猿猴跳镇。（凡儿未患痘时，先感冒风邪，身如火烙，头疼自汗，咳嗽不已，或伤寒之后而痘
随出者，则元气嚣清，须急疏风解热，补血滋阴，调元固表。诀曰∶一犯伤寒势欲危，医须斟酌痘无亏，如将
汤药柴胡用，婴魄含花死可悲。）
第二犯观音拂座。（凡儿饮食不克撙节，暑湿不能护养，是以脾胃损伤，频多泄泻，饮食懒飧，肢体
羸瘦，方愈未久而痘随出者，则脾虚津耗，元气衰微，治宜温养脾元，补益中气，则痘可起胀成脓结实矣。诀曰∶
泻后俄然痘证临，脾虚元耗势沉沉，急宜培土将元益，冷药毫厘不可侵。
第三犯马驰剑道。（凡儿饮食寒暑不能撙节，是以疟疾缠身，寒热消灼，肌肉渐瘦，其愈未几而痘随
出者，凡常山、草果断不可用，惟宜参苓、白术以扶正气。诀曰∶婴儿疟后痘相临，元气嚣漓不可闻，草果、柴
胡宜悉去，滋阴补卫效通神。）
第四犯一苇航海。（凡儿元体薄劣，身发火热，干渴恶嗽，疹出未几，其痘随出者，此与寻常先疹后痘
者不同。凡先痘后疹者谓之逆，先疹后痘者谓之顺，然此身弱发热，恶嗽干渴，继又出疹而痘随后，则势颇危，
须急补阴清肺，养胃扶脾，若黄 补肺之剂，切宜禁绝。诀曰∶小儿疹出大阴虚，痘疹随形毒客脾，急宜清金与
培土，黄 若用嗽来催。）
第五犯三仙入洞（凡儿平时患成疳积，肚大青筋，四肢羸瘦，变为丁奚，倏然而痘随出者，且治痘
为主。诀曰∶丁奚疳积肚交关，且把花来发透全，切禁消磨并冷药，槟榔浓朴及川连。）
第六犯倒挂银瓶。（凡儿风热，腠理时发火热，自头达身，丹瘤遍起，其愈未几，或尚未愈而痘随形者，
宜犀角、地黄、丹皮之类以清肝心二经。诀曰∶丹瘤未愈痘形身，又属肝心是二经，最怕枭红根座绕，解炎祛
毒痘方明。）
第七犯霜桥印迹。（凡儿火烙脸赤，眼睛直竖，手足掣搐，惊厥屡次，口燥谵语，其愈不数日而痘随形
者，此与循常先惊后痘者不同。盖因痘而起者，是痘从心经，故不过时微，惊惕即甚，亦不过临痘时也，此则
其惊已甚，治宜且与治痘为主，凡镇心凉脏之剂，皆不可投。诀曰∶惊厥新痊痘证随，朱砂金石莫相追，若还
既见惊无歇，只管升花更与培。）
第八犯藕池渗水。（凡儿身热自汗，口中咯血，或鼻衄溺血，其愈不数日而痘见形者，此心官失守，致
血妄行，治宜清心抑火，切不可妄用寒凉。诀曰∶诸血皆由热犯心，清心抑火自归营，切休轻用寒凉剂，花蒌
花栏悔实深。）
第九犯石鼓阴鸣。（凡儿未痘之前，身发火热，饮食懒飧，肚腹膨胀，眼胞浮肿，睡卧不安，未数日而
痘见者，治宜补脾理气。诀曰∶腹中膨胀不思飧，气阴脾虚痘必难，宜速补脾调气血，更加升表自然安。）
第十犯赤泽栽莲。（凡儿身发恶热，自汗不止，眼睛昏花，呵欠啼叫，其证才愈而痘随形者，治宜敛汗
而用黄 熬人乳，频频饮之。更助以调荣益卫之剂。诀曰∶汗流恶热已亡元，痘犯心肝十不全，急补心肝并敛
汗，痘如鼎灌自然痊。）
第十一犯岩头走马。（凡儿跌扑损伤，不数日而痘即见者，治宜补血活血，兼以扶脾可也。诀曰∶跌
扑惊伤未愈时，个中透出好花枝，安经活血调脾脉，自得群花朵朵奇。）
第十二犯逐鹿亡羊。（凡儿往来潮热，腹生痞块，日积月累，身体羸弱，面黄力弱而痘随出者，不宜
治痞。诀曰∶病痞花开宜补元，扶脾益胃莫迟延，尤须治痘培根本，何怕花儿命不全。）
第十三犯推车陷雪。（凡儿禀父母胎毒，身患杨梅广疮，不时寒热，其证未愈而痘随形者，将何所治？
诀曰∶恶疮未愈出天花，当用升麻药不差，莫假连翘诸败毒，误将熏点浪涂搓。）
第十四犯霜逐梧桐。（凡儿身如火烙，不时呕吐，不能饮食，投诸理气而痘随见者，将何所治？诀曰∶
呕吐惊惶胃不和，忽看花痘又相磨，应须安胃兼升表，自得成功患可无。）
第十五犯倦龙行雨。（凡儿饮食不节，致伤脾胃，四肢不收，发热恶寒而痘随见者，将何所治？诀曰∶
儿伤饮食正逢灾，痘又阳明胃里来，宜略内消兼补胃，更加升表自花开。）
第十六犯秋蝉泣露。（凡儿未痘之前，因感湿热之气，乃患赤白痢疾，其证未愈，而痘随见者，将何
所治？诀曰∶痢痘治宜清湿热，更加培土和气血，还须表痘复滋花，根本调维灾自灭。）
第十七犯冻鳞出谷。（凡儿因误持刀刃致伤手足，是以寒热往来而痘随形者，将何所治？诀曰∶金
疮未愈痘来呈，活血还兼开滞凝，更要升花期表暴，扶持鼎峻自安宁。）
第十八犯浪里鱼舟。（凡儿每发惊厥，或患风痫未久而见痘者，将何以治？诀曰∶风痫复苦痘来催，只
把花栏着意培，灌得浆来花朵朵，不愁风雨更颠危。
各书所载名目不同，总痘前十八犯，专意培花为主，若痘后犯十八条，则又以专补元气为要耳。）
预知疮痘吉凶的机理，气色都要从面部来推断，年寿宫和山根部位尤其紧要，面色红润可喜，晦暗发青则令人怀疑。
在痘疹与伤寒症状相似难以区分时，可以参考古人的分证方法，千万不要轻视使用汗法，发散邪气只有表里安和才能治愈。
疮疹属于阳证，要等待热势形成，微微发热才是和平之象，假如身体大热如火，应当用解毒之法使小便清利。
始终能够进食是最好的，说明平日此人的脾胃强健，如果吃得少却要防备中气虚弱，拖延时日会转变为严重的疮疡。
最适宜安静平和的状态，表里没有邪气志意自然安宁，突然烦躁扰乱应当仔细审察，最忌讳意志消沉转为神志昏乱。
痘疮陷伏有实证和虚证之分，实证适合用清托法最为适宜，如果遇到虚寒证宜用温补法，如同幽谷春回值得庆幸有余。
四季分别治疗必须明了，暑湿风寒不可轻视，异气不要让它们相互触犯，导致病情翻变乱了真机。
痘疮的脉象贵在平和，胃气悠长最为重要且清晰，弦、数、浮、洪属于实证的脉候，微、沉、短、涩是虚证的成因。
第一犯：猿猴跳镇。（凡是小儿在未患痘之前，先感冒风邪，身体像火烙一样烫，头疼自汗，咳嗽不停，或者在伤寒之后痘随之而出，此时元气耗散清虚，必须紧急疏风解热，补血滋阴，调元固表。口诀说：一旦犯伤寒形势危急，医生须斟酌不让痘亏损，如果用汤药柴胡，婴儿含花而死可悲。）
第二犯：观音拂座。（凡是小儿饮食不能节制，暑湿不能护养，因此脾胃损伤，频繁腹泻，懒于进食，肢体瘦弱，病刚愈不久痘随之而出，这是脾虚津液耗损，元气衰微，治疗宜温养脾元，补益中气，那么痘就可以起胀成脓结实了。口诀说：泻后忽然痘证来临，脾虚元耗形势沉重，急宜培土将元气补益，冷药丝毫不可侵犯。）
第三犯：马驰剑道。（凡是小儿饮食寒暑不能节制，因此疟疾缠身，寒热消灼肌肉，逐渐消瘦，病愈没几天痘随之而出，凡常山、草果绝对不可用，只宜用人参、茯苓、白术来扶助正气。口诀说：婴儿疟疾后痘相临，元气耗漓不可听闻，草果、柴胡应该全部去除，滋阴补卫效果通神。）
第四犯：一苇航海。（凡是小儿原本体质薄弱，身体发热，口干渴恶咳，疹出没多久痘随之而出，这与寻常先疹后痘不同。凡是先痘后疹叫做逆，先疹后痘叫做顺，然而这里身体弱发热，恶咳干渴，接着又出疹而痘随后，则形势颇危，必须紧急补阴清肺，养胃扶脾，如果是黄芪补肺之剂，切切记禁绝。口诀说：小儿疹出大阴虚，痘疹随形毒客脾，急宜清金与培土，黄芪若用嗽来催。）
第五犯：三仙入洞（凡是小儿平时患有疳积，肚子大青筋暴露，四肢瘦弱，变为丁奚病，突然痘随之而出，暂且以治痘为主。口诀说：丁奚疳积肚交关，暂且把花发透全，切禁消磨并冷药，槟榔浓朴及川连。）
第六犯：倒挂银瓶。（凡是小儿风热，腠理时常发热，从头到身，丹瘤遍起，病愈没几天，或尚未痊愈痘随之出现，宜用犀角、地黄、丹皮之类来清肝心二经。口诀说：丹瘤未愈痘形身，又属肝心是二经，最怕枭红根座绕，解炎祛毒痘方明。）
第七犯：霜桥印迹。（凡是小儿脸赤如火烙，眼睛直竖，手足抽搐，惊厥屡次，口燥谵语，病愈不几天痘随之出现，这与循常规先惊后痘不同。因为痘而起的是痘从心经，所以不过时轻微，惊惕即甚也不过临痘时也，这则是其惊已甚，治疗宜暂且以治痘为主，凡是镇心凉脏之剂，都不可投用。口诀说：惊厥新痊痘证随，朱砂金石莫相追，若还既见惊无歇，只管升花更与培。）
第八犯：藕池渗水。（凡是小儿身热自汗，口中咯血，或鼻衄溺血，病愈不几天痘见形者，这是心官失守，导致血妄行，治疗宜清心抑火，切不可妄用寒凉。口诀说：诸血皆由热犯心，清心抑火自归营，切休轻用寒凉剂，花蒌花栏悔实深。）
第九犯：石鼓阴鸣。（凡是小儿未痘之前，身体发热，饮食懒食，肚腹膨胀，眼胞浮肿，睡卧不安，没几天痘见者，治疗宜补脾理气。口诀说：腹中膨胀不思飧，气阴脾虚痘必难，宜速补脾调气血，更加升表自然安。）
第十犯：赤泽栽莲。（凡是小儿身发恶热，自汗不止，眼睛昏花，呵欠啼叫，其证才愈而痘随之出现，治疗宜敛汗而用黄芪熬人乳，频频饮之。更助以调荣益卫之剂。口诀说：汗流恶热已亡元，痘犯心肝十不全，急补心肝并敛汗，痘如鼎灌自然痊。）
第十一犯：岩头走马。（凡是小儿跌扑损伤，没几天痘即见者，治疗宜补血活血，兼以扶脾即可。口诀说：跌扑惊伤未愈时，个中透出好花枝，安经活血调脾脉，自得群花朵朵奇。）
第十二犯：逐鹿亡羊。（凡是小儿往来潮热，腹生痞块，日积月累，身体羸弱，面黄力弱而痘随之而出，不宜治痞。口诀说：病痞花开宜补元，扶脾益胃莫迟延，尤须治痘培根本，何怕花儿命不全。）
第十三犯：推车陷雪。（凡是小儿禀受父母胎毒，身体患杨梅广疮，不时寒热，其证未愈而痘随之出现，将如何治疗？口诀说：恶疮未愈出天花，当用升麻药不差，莫假连翘诸败毒，误将熏点浪涂搓。）
第十四犯：霜逐梧桐。（凡是小儿身如火烙，不时呕吐，不能饮食，投诸理气而痘随之见者，将如何治疗？口诀说：呕吐惊惶胃不和，忽看花痘又相磨，应须安胃兼升表，自得成功患可无。）
第十五犯：倦龙行雨。（凡是小儿饮食不节，致伤脾胃，四肢不收，发热恶寒而痘随之见者，将如何治疗？口诀说：儿伤饮食正逢灾，痘又阳明胃里来，宜略内消兼补胃，更加升表自花开。）
第十六犯：秋蝉泣露。（凡是小儿未痘之前，因感湿热之气，乃患赤白痢疾，其证未愈，而痘随之见者，将如何治疗？口诀说：痢痘治宜清湿热，更加培土和气血，还须表痘复滋花，根本调维灾自灭。）
第十七犯：冻鳞出谷。（凡是小儿因误持刀刃致伤手足，是以寒热往来而痘随之形者，将如何治疗？口诀说：金疮未愈痘来呈，活血还兼开滞凝，更要升花期表暴，扶持鼎峻自安宁。）
第十八犯：浪里鱼舟。（凡是小儿每发惊厥，或患风痫未久而见痘者，将何以治疗？口诀说：风痫复苦痘来催，只把花栏着意培，灌得浆来花朵朵，不愁风雨更颠危。
各书所载名目不同，总称痘前十八犯，专意以培花为主，如果痘后犯十八条，则又以专补元气为要耳。）
To predict the auspicious or inauspicious outcome of sores and smallpox, one must deduce from the Qi and color on the face; the area of Nianshou (Age Palace) and Shanggen (Root of Nose) is particularly critical. A ruddy complexion is auspicious, while a dark or bluish hue raises suspicion.
When differentiating between variola (smallpox), exanthema, and cold damage where symptoms are similar, one may refer to the syndrome differentiation methods of the ancients. Do not lightly dismiss the use of diaphoretic agents; dispersing pathogens ensures peace only when both exterior and interior are harmonized.
Exanthema belongs to Yang and requires heat to mature; slight fever indicates a peaceful state. If the body is excessively hot like fire, detoxification should be employed to clear the urine.
The ability to eat throughout the illness is the best sign, indicating strong Spleen and Stomach function. Poor appetite suggests weak Middle Qi; if prolonged, it may transform into severe sores.
Quietness and peace are most desirable; with no pathogens in the exterior or interior, the spirit remains calm. Sudden restlessness requires careful examination; the worst scenario is loss of will leading to mental confusion.
For collapsed or hidden lesions, distinguish between excess and deficiency syndromes. Excess syndromes suit clearing and supporting therapies, while deficiency-cold syndromes require warming and tonifying, bringing joy like spring returning to a secluded valley.
Treatment varies by season; summer-heat, dampness, wind, and cold must not be neglected. Prevent conflicting pathogenic factors from interfering, which could cause chaotic transformations of the disease.
The pulse in smallpox should be peaceful; a long and clear Stomach Qi is paramount. Stringy, rapid, floating, and full pulses indicate excess conditions, while minute, deep, short, and choppy pulses indicate deficiency causes.
First Violation: Monkey Jumping Guard. Before contracting smallpox, if a child catches wind-pathogens, presenting with burning fever, headache, spontaneous sweating, and persistent cough, or if smallpox erupts after cold damage, the Yuan Qi is depleted. Urgent treatment should dispel wind and clear heat, nourish blood and Yin, and consolidate the exterior. Verse: When cold damage threatens danger, physicians must deliberate to protect the smallpox; using Chaihu decoction may lead to tragic death in infants.
Second Violation: Guanyin Brushing the Seat. If a child’s diet is unregulated and protection against summer-heat and dampness fails, Spleen and Stomach damage occurs, leading to frequent diarrhea, anorexia, and emaciation. If smallpox erupts shortly after recovery, Spleen deficiency and fluid depletion have weakened Yuan Qi. Treatment should warm and nourish the Spleen and tonify Middle Qi to allow the lesions to swell and suppurate. Verse: After diarrhea, sudden onset of smallpox indicates heavy Spleen deficiency; urgently cultivate Earth to benefit Yuan Qi, avoiding cold medicines entirely.
Third Violation: Horse Galloping on Sword Path. If dietary regulation regarding cold and heat fails, malaria ensues, consuming muscles through alternating chills and fever. If smallpox erupts shortly after recovery, Changshan and Caoguo are strictly contraindicated; instead, use Renshen, Fuling, and Baizhu to support righteous Qi. Verse: After infantile malaria, smallpox appears; depleted Yuan Qi is alarming. Remove Caoguo and Chaihu; nourishing Yin and supplementing Wei yields miraculous effects.
Fourth Violation: Single Reed Crossing the Sea. If a child has inherent frailty, presenting with fever, dry mouth/thirst, and aversion to cough, followed quickly by rash and then smallpox, this differs from the usual sequence. Smallpox before rash is "reverse"; rash before smallpox is "smooth." However, weakness with fever, thirst, and subsequent rash/smallpox eruption is dangerous. Urgently nourish Yin, clear Lung, nourish Stomach, and support Spleen. Huangqi (Astragalus) for tonifying Lung is strictly forbidden. Verse: Rash emergence indicates severe Yin deficiency; toxins invade Spleen with smallpox. Clear Metal and cultivate Earth immediately; using Huangqi will exacerbate cough.
Fifth Violation: Three Immortals Entering the Cave. If a child suffers from chronic malnutrition (Gan accumulation) with abdominal distension, visible veins, and emaciated limbs, transforming into Dingxi disease, treat smallpox as the priority. Verse: In Dingxi and Gan accumulation, focus on fully erupting the flowers. Strictly avoid draining and cold medicines like Binglang, Houpo, and Chuanlian.
Sixth Violation: Upside-down Silver Vase. If a child has wind-heat causing intermittent fever from head to body, with widespread Danliu (erysipelas-like swelling), and smallpox erupts before full recovery, use Xijiao, Dihuang, and Danpi to clear the Liver and Heart meridians. Verse: Danliu unresolved with smallpox appearance involves Liver and Heart. Beware of red roots encircling; resolve inflammation and remove toxins for clear lesions.
Seventh Violation: Frost Bridge Impressions. If a child has a burning red face, staring eyes, limb convulsions, frequent惊厥 (convulsions), dry mouth, and delirium, with smallpox appearing days after recovery, this differs from the normal sequence of惊 before smallpox. Here, the惊 is severe due to Heart involvement. Treat smallpox primarily; sedating Heart and cooling Zang organs is contraindicated. Verse: After convulsions subside, smallpox follows. Avoid Zhusha and Jinshi. If惊 persists, promote eruption and further tonify.
Eighth Violation: Lotus Pond Seeping Water. If a child has fever, spontaneous sweating, hemoptysis, epistaxis, or hematuria, with smallpox appearing days later, this indicates Heart organ failure causing reckless blood movement. Clear Heart and suppress Fire; do not recklessly use cold/cooling medicines. Verse: All bleeding stems from Heat invading Heart; clearing Heart and suppressing Fire returns blood to Ying. Do not lightly use cold formulas, lest regret be deep.
Ninth Violation: Stone Drum Yawning. Before smallpox, if a child has fever, anorexia, abdominal distension, eyelid edema, and restless sleep, with smallpox appearing soon, treat by tonifying Spleen and regulating Qi. Verse: Abdominal distension and lack of appetite indicate difficult Spleen Qi/Yin deficiency. Quickly tonify Spleen and regulate Qi/Blood; promoting release brings natural peace.
Tenth Violation: Red Marsh Planting Lotus. If a child has aversion to heat, continuous sweating, blurred vision, yawning, and crying, with smallpox appearing as symptoms resolve, treat by arresting sweating using Huangqi boiled in human milk, administered frequently. Assist with formulas regulating Ying and supplementing Wei. Verse: Sweating and heat loss deplete Yuan Qi; smallpox affecting Heart/Liver is ten parts fatal. Urgently tonify Heart/Liver and arrest sweating; smallpox will heal naturally like boiling cauldrons.
Eleventh Violation: Rock Head Running Horse. If a child suffers trauma/falls, with smallpox appearing within days, treat by nourishing and invigorating blood, combined with supporting Spleen. Verse: During unresolved trauma/shock, good flowers emerge. Calm meridians, invigorate blood, regulate Spleen pulse, and enjoy unique blossoms.
Twelfth Violation: Hunting Deer Losing Sheep. If a child has tidal fever, abdominal masses accumulating over time, weakness, sallow complexion, and smallpox eruption, do not treat the masses directly. Verse: When disease-masses bloom, tonify Yuan Qi. Support Spleen/Stomech without delay. Prioritize treating smallpox to root the foundation; fear not incomplete life of the flower.
Thirteenth Violation: Pushing Cart Trapped in Snow. If a child inherits maternal fetal toxin, suffering from Yangmei Guangchuang (syphilis-like sore) with intermittent chills/fever, and smallpox erupts before resolution, how to treat? Verse: Erupting smallpox while evil sores persist; use Shengma without error. Do not rely on Lianqiao or other detoxifiers; mistaken fumigation/rubbing causes harm.
Fourteenth Violation: Frost Chasing Wutong Tree. If a child has burning fever, frequent vomiting, inability to eat, and smallpox appears despite Qi-regulating attempts, how to treat? Verse: Vomiting and panic indicate Stomach disharmony; suddenly flowers/smallpox grind together. Must soothe Stomach and promote release; success ensures no harm.
Fifteenth Violation: Tired Dragon Bringing Rain. If improper diet damages Spleen/Stomach, causing flaccid limbs, fever, aversion to cold, and smallpox eruption, how to treat? Verse: Child injured by diet meets disaster; smallpox comes from Yangming Stomach. Slightly digest internally and tonify Stomach; promoting release allows flowers to bloom.
Sixteenth Violation: Autumn Cicada Weeping Dew. Before smallpox, if damp-heat causes red-white dysentery, and smallpox erupts before resolution, how to treat? Verse: Dysentery/smallpox treatment clears damp-heat, cultivates Earth, harmonizes Qi/Blood. Promote smallpox eruption to nourish flowers; regulating foundation extinguishes disaster.
Seventeenth Violation: Frozen Scales Emerging from Valley. If hand/foot injury from blades causes alternating chills/fever and smallpox eruption, how to treat? Verse: Unhealed metal wounds present with smallpox. Invigorate blood and open stagnation. Promote eruption for surface exposure; supporting the tripod ensures peace.
Eighteenth Violation: Fish Boat in Waves. If a child suffers frequent convulsions or wind-phlegm epilepsy, and smallpox appears early, how to treat? Verse: Wind-phlegm suffers smallpox催促. Focus on cultivating the flower fence. Fill with pus, blossom by blossom; fear not wind/rain instability.
Different books list various names, collectively termed the Eighteen Violations Before Smallpox, focusing primarily on nurturing the eruption. If these violations occur after smallpox, the priority shifts exclusively to tonifying Yuan Qi.