痘有顺、险、逆三者，治痘之不可不知也。顺者，吉之象也。逆者，凶之象也。
险者，悔吝之象也。吉则不必治，治之反凶，凶不劳治，治则无益，至于险者则宜
治矣。夫痘之不齐，由气血之不均也。凡气血充盛，则毒易解而为顺矣。此不治而
自痊者也。如气血损则毒难愈，而为逆矣，此即虽治而无益者也。惟气血少弱，其毒
不能顿解，而生意不固乎中，故必加以补益扶持之功耳。所谓得助者昌，失助者亡。
且痘疏而毒少者，则邪不胜正，其气自和，其势自顺，不须服药；若痘密而毒多者，则
邪正相持，其气乃病，其势乃险，此宜抑邪扶正，使邪气亟夺而不为正气之贼。若
痘稠密无缝而毒甚者，则正不胜邪，其气自乖，其势自逆，即虽善治者，束手待毙
而已。故顺者勿治，险者贵治，逆者不治，其理于此可见矣。
夫荣行脉中，卫行脉外，内外卫护，互为滋养，得天地生生之道而无咎矣。然荣
卫根于元气，元气固则荣卫于脉之内外，阴阳相济而无间断，自能拘血附位而功成矣。
若气在内而外不及，则血载毒出为外剥，气在外而内不续，则血载毒入为内攻，阳道
虚阴往从之，阴道虚阳往从之义也。是以荣卫者，气血之德也。气血者，痘毒之庐
也。痘毒者，气血之贼也。荣卫德盛，则力战其贼而庐舍全，荣卫德衰，则贼肆其
虐而庐舍剥，血不能载则塌，气不能拘则陷，故痘宜调补气血，血生则内固，气益
则外旺，荣血得以随气之情，培根于内，卫气得以顺血之情，保障于外矣。夫人之一
身，本乎荣卫。卫者，阳气所以开阖橐龠，运动枢机者也。荣者，阴血所以充溢脏腑，
灌溉肢体者也。故气虚则神机息，血虚则化源绝，然二者又不可偏胜也。夫痘疮之
毒，本于五脏之液，各随经络部位，直犯荣卫而出，因即气血从之，故观其里来坚
浓，窠囊充长者，气之足也；根芽红活，形色润泽者，血之足也。气血既足，则痘易
发易靥，不须施治，以蹈实实之戒。如平陷嫩薄者，气之病也，干枯紫黑者，血之
病也，此宜责而治之，不可因循以贻后悔。然脾胃者，气血之父也。心肾者，气血之
母也。肝肺者，气血之舍也。脾纳水谷，其悍气注于肾而为气，肾舍于肺而为卫，以
温肉分，充皮毛，肥腠理，司开阖也。若卫气虚则疮不起发，其毒乘气之虚而入于
肺，肺受之而为陷伏，而归于肾矣。抑脾
纳水谷，其精气注于心而为血，心舍于肝而为荣，以走九窍，注六经，朝百脉也。若
荣血虚则疮不光泽，其毒乘血之虚而入于肝，肝受之则为痒塌，而归于心矣。故凡
治此者，气病治气，血病治血，寒则温之，热则清之，虚则补之，实则泻之，仍以脾
胃为主，而不可犯之。凡寒凉解毒，伤胃泻心之药，不可轻用也。夫血之荣，如
水之溶，周流灌溉，造化潜孚，无时止息。气之卫，如域之坚，范围充固，浩然刚大，
直养无害。痘之一证，始末俱赖于荣卫，淫毒之攻侮，非血气不足以表暴，形色之呈
见，非血气不能以鼎峻，囊廓之布列，非血气不能以充贯，是以气血不可相离，阴
阳不可相犯，而有偏胜也。血阴宜下，气阳宜上，理之然也。若痘以阴犯阳，则气
失其平，而有焦紫疔 之患；以阳凌阴，则血逐于邪，而致灰煤塌陷之危。偏胜于阳，
阳为热，热伤气，气虚则为陷为伏；偏胜于阴，阴为寒，寒则气血凝滞，不能生长
矣。故痘之出，最宜气血调和，是以发热之时，色将放标，欲其热缓气平，二便如
常，两类不甚赤，六脉不甚洪，见点累累，根肥顶尖，色甚红活者，此气血调和之候
也。自一日至二三日，口无秽气，色泽光亮，以手按之，坚累可数，日长一日，身
无斑点，根脚不散者，是虽有咳嗽喷嚏，呵欠惊悸之候，亦气血冲和之证也。自四日
至六日，势如桃朵着露，绽然可爱，肌不甚肿，饮食如常者，此气血充润之候也。自
七日至九、十日，光润如珠，浆充神旺，顶足盘红，身虽热而不烦，口虽渴而不泻者，
此气血安详之侯也。自十日至十二日，根据部结痂，蜡色有神，二便调实者，此气血
坚凝之候也。自十三至十六日，身朗目开，痂毒尽脱，热亦渐退者，此气血还原之候
也。如宜起胀之日，而平陷嫩薄，干枯紫黑，吐泻不时，惊搐烦闷，或 或泡；如
将充灌之日，而浆清顶陷，根脚散漫，饮食少进，热极神昏，灰白无脓，或焦枯肉
肿；如将收靥之日，而不结痂，泻利频作，声哑阳气促，咳嗽不食者，此皆气血为病，
荣卫不周，阴阳失序，致毒内攻而脏腑绝，故气血实关乎痘，岂可忽哉！若以诸疮皆
属心火，而以寒凉泻心为事，致血凝毒滞，心为君主，何能运一身之血以成功耶！
痘疹有顺证、险证、逆证三种情况，治疗痘疹时不可不明了这些道理。顺证是吉祥的征兆。逆证是凶险的征兆。险证则是介于吉凶之间、令人悔恨或吝惜的征兆。如果是吉（顺）证，就不必特意治疗，强行治疗反而会导致凶险；如果是凶（逆）证，也不必劳神治疗，治疗也无济于事。至于险证，则适宜进行治疗。
痘疹出得不整齐，是由于气血分布不均匀造成的。凡是气血充盛的人，毒邪容易化解，表现为顺证，这是不用治疗也能自然痊愈的情况。如果气血受损，毒邪难以治愈，表现为逆证，这就是即使治疗也无益处的情况。只有气血稍微虚弱，毒邪不能立刻解除，且生机在中焦不够稳固，所以必须加以补益扶持的功夫。所谓得到辅助就能昌盛，失去辅助就会灭亡。
况且痘疹稀疏而毒邪少的，邪气不能战胜正气，人体之气自然调和，病势自然顺利，不需要服药；如果痘疹密集而毒邪多的，则邪正双方相持不下，人体之气处于病态，病势属于险证，这时应当抑制邪气、扶助正气，使邪气迅速被剥夺而不成为正气的祸害。如果痘疹稠密无缝且毒邪严重的，则正气不能战胜邪气，人体之气自然乖乱，病势自然逆乱，即使是善于治疗的大夫，也只能束手待毙罢了。所以顺证不要治疗，险证贵在及时治疗，逆证不治疗，其中的道理就在这里可以看到了。
荣气行于脉管之中，卫气行于脉管之外，内外互相卫护，彼此滋养，符合天地生生不息的道理而没有灾祸。然而荣卫根源于元气，元气固摄有力，则荣卫在脉管内外，阴阳相互协调而没有间断，自然能使血液约束并安守其位而功能完成。如果气在内而不能达于外，则血携带毒邪外出导致体表溃破；气在外而不能续接于内，则血携带毒邪内陷导致内部攻冲。这是“阳道虚则阴往从之，阴道虚则阳往从之”的道理。因此，荣卫是气血的德行表现。气血是痘毒的居所。痘毒是气血的贼寇。荣卫德行强盛，就能奋力抗击贼寇而使居所保全；荣卫德行衰弱，则贼寇肆意肆虐而使居所破损。血不能承载则塌陷，气不能约束则下陷。所以痘疹适宜调补气血，血生则内部稳固，气足则外部旺盛，荣血能够随着气的意愿，在内部扎根培本；卫气能够顺着血的意愿，在外部提供保障。
人的身体，根本在于荣卫。卫气是阳气，用来调节开阖（汗孔的开合），运动身体的枢纽机关。荣气是阴血，用来充盈脏腑，灌溉肢体。所以气虚则生命活动的枢机停止，血虚则化生之源断绝，然而这两者又不可以偏胜。痘疮的毒邪，本源于五脏的津液，各自随着经络部位，直接侵犯荣卫而发出，随即气血随之响应。所以观察痘疹内部坚实浓稠，痘窠囊饱满长大的，是气充足的表现；根芽红活，形色润泽的，是血充足的表现。气血既然充足，则痘疹容易发出也容易结痂，不需要施治，以免犯“实实”（使实证更实）的禁忌。如果痘疹平塌凹陷、质地嫩薄，是气的病变；干枯紫黑，是血的病变，这时应当责备其不足而进行治疗，不可因循拖延以致留下后悔。
然而脾胃是气血的父亲。心肾是气血的母亲。肝肺是气血的舍宅。脾接纳水谷，其悍烈之气注入肾中转化为气，肾将此气寄居于肺中以化为卫气，用以温煦肌肉分肉，充实皮毛，肥厚腠理，主管开阖。如果卫气虚弱，则疮疹不起发，毒邪乘气虚而入肺，肺受邪则导致痘疹陷伏，进而归于肾。脾接纳水谷，其精微之气注入心中转化为血，心将此血寄居于肝中以化为荣气，用以流注九窍，灌注六经，朝会百脉。如果荣血虚弱，则疮疹不光泽，毒邪乘血虚而入肝，肝受邪则导致痘疹瘙痒塌陷，进而归于心。所以大凡治疗这类疾病，气病治气，血病治血，寒证用温法，热证用清法，虚证用补法，实证用泻法，仍然以脾胃为主轴，不可违背。凡是寒凉解毒、损伤胃气、泻心火的药物，不可轻易使用。
血的荣润，像水的流动，周流灌溉，潜移默化地孕育造化，没有时刻停止。气的卫护，像疆域的坚固，范围充实巩固，浩然刚大，直养而无危害。痘疹这一病症，从头到尾都依赖荣卫。淫毒的攻伐侮辱，不是血气不足以使其表露；形色的呈现，不是血气不足以使其高耸；痘囊廓形的布列，不是血气不足以使其充满贯通。因此气血不可分离，阴阳不可相犯而有偏胜。血属阴宜下行，气属阳宜上行，这是理所当然的。如果痘疹以阴犯阳，则气失去平衡，而有焦紫疔疮的祸患；以阳凌阴，则血被邪气驱逐，而导致灰白煤色塌陷的危险。偏胜于阳，阳即为热，热伤气，气虚则为陷为伏；偏胜于阴，阴即为寒，寒则气血凝滞，不能生长了。
所以痘疹发出，最宜气血调和。因此在发热之时，色泽将要放散标显，希望其热势缓和、气息平稳，大小便如常，两类（指二便或上下焦）不甚赤红，六脉不甚洪大，见点累累，根部肥大顶尖，颜色非常红活的，这是气血调和的征候。从第一日到第二三日，口中无秽气，色泽光亮，用手按压，坚实可数，日渐长大，身上无斑点，根脚不散的，是虽然有咳嗽喷嚏、呵欠惊悸等征候，也属于气血冲和的证候。从第四日到第六日，势态如同桃花带着露水，绽放可爱，肌肤不甚肿胀，饮食如常的，这是气血充润的征候。从第七日到第九、十日，光润如珠，浆液充满精神旺盛，顶部和底部盘绕红润，身体虽然发热但不烦躁，口虽然渴但不腹泻的，这是气血安详的征候。从第十日到第十二日，根据部结痂，呈蜡色有神，二便调实正常的，这是气血坚凝的征候。从第十三日到第十六日，身体明朗眼睛睁开，痂毒全部脱落，热势也逐渐退去的，这是气血还原的征候。
如果在应该起胀的日子，却出现平陷嫩薄、干枯紫黑、吐泻不时、惊搐烦闷，或者出现斑疹或水泡；如果在即将充灌脓浆的日子，却出现浆液清稀、顶部凹陷、根脚散漫、饮食减少、热极神昏、灰白无脓，或者焦枯肉肿；如果在即将收靥结痂的日子，却不结痂、泻利频繁、声音嘶哑阳气急促、咳嗽不食的，这些都是气血生病，荣卫不周全，阴阳失序，导致毒邪内攻而脏腑衰竭，所以气血确实关乎痘疹生死，怎么可以忽视呢！如果认为所有疮疡都属于心火，而以寒凉泻心为主要手段，导致血液凝滞、毒邪停滞，心作为君主之官，怎么能运化一身之血来取得成功呢！
There are three types of smallpox/rubella progression: favorable (Shun), precarious (Xian), and unfavorable (Ni). It is essential to understand these when treating the disease. Favorable signs indicate auspiciousness. Unfavorous signs indicate peril. Precarious signs indicate a state between fortune and misfortune, evoking regret or caution. If the condition is auspicious (favorable), no specific treatment is needed; forcing treatment may lead to adverse outcomes. If the condition is inauspicious (unfavorable), treatment is futile and unnecessary. However, precarious conditions require intervention.
Irregular eruption of lesions results from uneven distribution of Qi and Blood. When Qi and Blood are abundant, toxins are easily resolved, manifesting as a favorable course, which heals spontaneously without treatment. If Qi and Blood are deficient, toxins are difficult to resolve, manifesting as an unfavorable course, where treatment yields little benefit. Only when Qi and Blood are slightly weak, preventing immediate toxin resolution and lacking stability in the middle Jiao, must supportive and tonifying measures be applied. As stated, "Those who receive assistance prosper; those who lose assistance perish."
When lesions are sparse and toxin load is low, pathogenic factors cannot overcome healthy Qi. The body's Qi harmonizes naturally, and the disease course proceeds smoothly without medication. Conversely, when lesions are dense and toxin load is high, pathogens and healthy Qi contend. The body's Qi becomes pathological, and the course becomes precarious. In such cases, one should suppress pathogens and support healthy Qi, rapidly depriving pathogens of their power so they do not harm healthy Qi. If lesions are densely packed without gaps and toxins are severe, healthy Qi fails to overcome pathogens. The body's Qi becomes disordered, and the course turns unfavorable. Even skilled physicians may find themselves helpless. Thus, favorable courses require no treatment, precarious courses benefit greatly from timely treatment, and unfavorable courses are generally untreatable. This principle is evident here.
Ying (Nutritive) Qi circulates within the vessels, while Wei (Defensive) Qi circulates outside the vessels. They protect each other internally and externally, nourishing one another, aligning with the generative way of Heaven and Earth without fault. Ying and Wei are rooted in Yuan (Original) Qi. When Yuan Qi is solid, Ying and Wei maintain yin-yang harmony inside and outside the vessels without interruption, allowing blood to remain contained and functional. If Qi remains internal without reaching the exterior, blood carries toxins outward causing external ulceration. If Qi remains external without connecting inward, blood carries toxins inward causing internal attack. This illustrates the principle that "when Yang is deficient, Yin follows; when Yin is deficient, Yang follows." Therefore, Ying and Wei represent the virtue/function of Qi and Blood. Qi and Blood serve as the dwelling for smallpox toxins. Smallpox toxins act as thieves against Qi and Blood. When Ying and Wei are strong, they battle the "thieves," preserving the "dwelling." When Ying and Wei weaken, the "thieves" wreak havoc, damaging the "dwelling." If blood cannot carry, lesions collapse; if Qi cannot constrain, lesions sink. Hence, smallpox requires regulating and tonifying Qi and Blood. Generating blood stabilizes the interior; strengthening Qi enhances the exterior. Ying Blood follows the direction of Qi, rooting internally; Wei Qi follows the direction of Blood, protecting externally.
The human body relies fundamentally on Ying and Wei. Wei Qi, a form of Yang Qi, regulates opening and closing (pore function) and moves the physiological pivot. Ying Qi, a form of Yin Blood, fills the Zang-Fu organs and irrigates the limbs. Thus, Qi deficiency halts vital mechanisms; Blood deficiency cuts off the source of transformation. Neither should dominate excessively.
Smallpox toxins originate from the fluids of the Five Zang organs, traveling along meridians to directly invade Ying and Wei before erupting. Qi and Blood respond accordingly. Observing firm, thick interiors and full, long pustule sacs indicates sufficient Qi. Red, vibrant roots and moist, lustrous colors indicate sufficient Blood. With adequate Qi and Blood, eruptions appear and crust over easily, requiring no treatment to avoid the error of "treating excess with excess" (adding to an already full condition). Flat, sunken, tender, and thin lesions indicate Qi pathology. Dry, purple-black lesions indicate Blood pathology. These require prompt treatment to avoid regretful delays.
Spleen and Stomach are the "parents" of Qi and Blood. Heart and Kidney are the "mothers." Liver and Lung are the "residences." Spleen processes food and water; its vigorous Qi enters the Kidney to transform into Qi. This Qi resides in the Lung to become Wei Qi, warming muscles, filling skin/hair, thickening interstices, and controlling opening/closing. If Wei Qi is deficient, lesions fail to rise; toxins enter the Lung due to Qi deficiency, causing sinking/obscuration, eventually affecting the Kidney. Spleen processes food/water; its essence enters the Heart to transform into Blood. This Blood resides in the Liver to become Ying Qi, flowing through the nine orifices, saturating the six Fu organs, and meeting all vessels. If Ying Blood is deficient, lesions lack luster; toxins enter the Liver due to Blood deficiency, causing itching/collapse, eventually affecting the Heart.
Therefore, treat Qi diseases by addressing Qi, and Blood diseases by addressing Blood. Cold is treated with warmth; Heat with clearing. Deficiency with tonification; Excess with purging. The Spleen and Stomach remain central and must not be violated. Cold-cooling detoxifying herbs that damage Stomach Qi or drain Heart Fire should not be used lightly.
Blood’s nourishment is like flowing water, circulating and irrigating, subtly fostering creation without rest. Qi’s defense is like a fortified border, solid and vast, nurtured straightly without harm. Smallpox depends entirely on Ying and Wei from start to finish. Without Qi and Blood, toxic attacks cannot be manifested; without them, physical features cannot stand tall; without them, pustule structures cannot fill. Thus, Qi and Blood must not separate, nor should Yin and Yang conflict or dominate exclusively. Blood (Yin) tends downward; Qi (Yang) tends upward—this is natural law. If Yin invades Yang, Qi loses balance, risking dark-purple nodular lesions. If Yang overwhelms Yin, Blood is driven by pathogens, risking gray/black collapsed lesions. Excess Yang implies Heat, which damages Qi, leading to sinking/obscuration due to Qi deficiency. Excess Yin implies Cold, causing Qi/Blood stagnation and inhibiting growth.
Thus, harmonious Qi and Blood are crucial during eruption. During fever, as color emerges, heat should be mild, Qi calm, urination/stool normal, lower/upper aspects not overly red, and pulses not overly surging. Numerous spots with broad bases and sharp tips, vividly red, indicate harmonious Qi and Blood. From day 1 to 2-3, absence of foul breath, bright luster, firm palpable bumps, daily growth, no spreading macules, even with cough/sneeze/yawning/startle, indicates harmonious Qi and Blood. From day 4 to 6, resembling dew-kissed peach blossoms, pleasing appearance, mild swelling, normal diet, indicates abundant/moistened Qi and Blood. From day 7 to 9-10, lustrous as pearls, full pus, vigorous spirit, red base/top, fever without irritability, thirst without diarrhea, indicates tranquil Qi and Blood. From day 10 to 12, crusting at bases, waxy luster, regulated stool/urine, indicates solidified Qi and Blood. From day 13 to 16, clear eyes, fallen scabs, fading fever, indicates restored Qi and Blood.
If, during the rising phase, lesions are flat/thin/dry/purple-black, with vomiting/diarrhea, convulsions, or blisters; if, during the filling phase, pus is clear, tops sunken, bases diffuse, appetite poor, fever causes coma, pus is gray/white or dry/swollen; if, during the crusting phase, no scabs form, frequent diarrhea, hoarse voice, rapid shallow breathing, cough, and anorexia occur—all indicate Qi/Blood pathology, incomplete Ying/Wei circulation, disordered Yin/Yang, internal toxin attack, and organ failure. Qi and Blood are critical to smallpox; how can they be ignored? Assuming all sores belong to Heart Fire and using cold-draining Heart methods causes blood coagulation and toxin stasis. As the Monarch, how can the Heart circulate blood to achieve success under such conditions?