上古无痘性淳朴，中古有痘情欲恣，痘禀胎元出不再，毒之深浅重轻识。天疮之名
因天禀，疮形如豆痘名居，塞北不出寒胜热，毒发必自待天时。
【注】上古之人无出痘者，天性淳朴也。中古之人有出痘者，情欲渐炽也。古人谓痘
禀胎毒，此定论也。惟禀于胎元，故一出不再出也，毒有浅深，故出有轻重也。名为天
疮者，因毒禀于先天也。名为痘疮音，因疮形如豆也。其毒伏于形中，而塞北不出者，以
其气多寒凉，鲜邪阳火旺之气以触发其毒，故伏藏于内而不出也。中土之人必出者，以其
气多温热，一触邪阳火旺之气，毒随内发而即出也。此皆医所当识者也。
欲识小儿出痘形，类是伤寒发热惊，气粗眼目中指冷，耳尻不热耳筋红。
【注】痘证初起，见证大抵与伤寒相似。其候身体发热，不时惊悸，口鼻气粗，两眼HT
发HT ，惟中指独冷，耳尻不热，耳后有红筋，皆为出痘之形证也。
痘出五脏主证形，呵欠顿闷是肝经，肺证咳嗽痰嚏涕，心证惊烦面赤红，脾证喜睡
肢热利，耳尻俱凉是肾征，肝泡肺脓心赤小，脾大黄浅肾黑形。
【注】痘疮之毒伏于五脏，故内出何脏，外即应之。如呵欠顿闷，此痘出肝经证也；咳
嗽有痰，喷嚏泣涕，此痘出肺经证也；惊悸烦躁，面色红赤，此痘出心经证也；喜睡自
利，四肢发热，此痘出脾经证也∶惟肾经但见尻耳发凉者，是火不能胜水也。肝痘之形
为水泡，其色青而小，肺痘之形为脓泡，其色白而大；心痘之形，其色赤而小；脾痘之
形，其色黄浅而大。至于肾经，不宜有证，若水不胜火，痘色黑者，非吉兆也。
上古时期，人们天性淳朴，没有出痘的情况；中古时期，人们的欲望放纵，因此出现了痘症。痘症禀受于胎元，所以一生只出一次，通过观察可以识别毒邪的深浅轻重。
“天疮”这个名字是因为痘毒禀受于先天（天禀）而得名；因为疮的形状像豆子，所以称为痘。在塞北地区不出痘，是因为那里寒气胜过了热气，毒邪潜伏，必须等待天时（阳气旺盛时）才会发作。
【注】上古时代的人不出痘，是因为天性淳朴。中古时代的人出痘，是因为情欲逐渐炽盛。古人说痘是禀受胎毒，这是确定的结论。正因为禀受于胎元，所以一出不再出。毒有浅深之分，所以出痘有轻重的区别。命名为“天疮”，是因为毒禀受于先天。命名为“痘疮”，是因为疮形像豆子。其毒邪潜伏在形体之中，而塞北地区不出痘，是因为那里的风气多寒凉，缺少邪阳火旺之气来触发毒邪，所以毒邪伏藏在内而不发出来。中原地区的人一定会出痘，是因为那里风气多温热，一旦触碰到邪阳火旺之气，毒邪就会随着内气发动而立即出痘。这些都是医生应当认识到的。
想要识别小儿出痘的形态，症状类似伤寒，表现为发热、惊悸，呼吸粗重，眼睛发红，中指发冷，耳朵和尾骶部不热，耳后有红筋。
【注】痘证初起，所见症状大体与伤寒相似。其表现为身体发热，不时惊悸，口鼻呼吸粗重，两眼发红，只有中指单独发冷，耳朵和尾骶部不热，耳后有红筋，这些都是出痘的形态和征象。
痘出五脏的主要证候形态如下：呵欠、突然胸闷是肝经的证候；肺经的证候是咳嗽、痰多、打喷嚏、流鼻涕；心经的证候是惊悸、烦躁、面色红赤；脾经的证候是嗜睡、四肢发热、腹泻；耳朵和尾骶部都发凉是肾经的征象。肝痘的形状是水泡，颜色青且小；肺痘的形状是脓泡，颜色白且大；心痘的形状，颜色红且小；脾痘的形状，颜色黄浅且大。至于肾经，本不应有证候表现，如果水不能胜火，痘色变黑，这不是吉兆。
【注】痘疮的毒邪潜伏在五脏，所以内里哪一脏受累，外表就会相应显现。比如呵欠、突然胸闷，这是痘出肝经的证候；咳嗽有痰，打喷嚏流泪流鼻涕，这是痘出肺经的证候；惊悸烦躁，面色红赤，这是痘出心经的证候；嗜睡、自发性腹泻，四肢发热，这是痘出脾经的证候；只有肾经只见耳朵和尾骶部发凉的，这是因为火不能胜水。肝痘的形状为水泡，颜色青而小；肺痘的形状为脓泡，颜色白而大；心痘的形状，颜色红而小；脾痘的形状，颜色黄浅而大。至于肾经，不应该出现证候，如果水不胜火，痘色变黑的，不是吉祥的征兆。
In ancient times, people possessed simple and pure natures and did not suffer from smallpox; in middle antiquity, desires became unrestrained, leading to the emergence of smallpox. Smallpox is endowed by the fetal origin (Taiyuan), thus occurring only once in a lifetime; its severity can be identified by assessing the depth and lightness of the pathogenic toxin.
The name "Tian Chuang" (Heavenly Sore) derives from the toxin being endowed by the pre-heavenly constitution (Tianbing). It is called "Dou" (Pox) because the sore resembles a bean. In the northern regions beyond the Great Wall, smallpox does not manifest because cold dominates over heat; the toxin remains latent and must await favorable climatic conditions (Heavenly Time) to erupt.
[Note] People in ancient times did not contract smallpox due to their simple and pure nature. Those in middle antiquity contracted it as desires gradually intensified. The ancients stated that smallpox stems from fetal toxin, which is a definitive conclusion. Because it is endowed by the fetal origin, it occurs only once. Since toxins vary in depth, the manifestation varies in severity. Named "Tian Chuang" because the toxin is endowed by the pre-heavenly source. Named "Dou Chuang" because the sore shape resembles a bean. The toxin lies latent within the body; in the north, where the climate is predominantly cold and lacks the qi of evil yang and excessive fire to trigger the toxin, it remains hidden internally without erupting. In the central plains, people inevitably develop smallpox because the climate is warm and hot; upon contact with the qi of evil yang and excessive fire, the toxin erupts immediately along with the internal qi. These are matters physicians must recognize.
To identify the morphology of pediatric smallpox eruption, symptoms resemble Taiyang disease (Shanghan), presenting with fever,惊悸 (palpitations/fright), coarse breathing, red eyes, coldness of the middle finger alone, non-heat in the ears and sacrum, and red veins behind the ears.
[Note] At the onset of smallpox, observed symptoms largely resemble those of Taiyang disease. Manifestations include bodily fever, intermittent palpitations and fright, coarse respiration through mouth and nose, redness of both eyes, isolated coldness of the middle finger, lack of heat in the ears and sacrum, and red veins behind the ears; all these constitute the morphological signs of smallpox eruption.
The primary syndromes and morphologies associated with smallpox affecting the Five Zang Organs are as follows: yawning and sudden chest oppression indicate the Liver Meridian; coughing with phlegm, sneezing, tearing, and runny nose indicate the Lung Meridian; palpitations, irritability, and reddish complexion indicate the Heart Meridian; drowsiness, spontaneous diarrhea, and limb heat indicate the Spleen Meridian; coolness of both ears and sacrum indicates the Kidney Meridian. The shape of Liver smallpox is a water blister, green and small; the shape of Lung smallpox is a pus blister, white and large; the shape of Heart smallpox is red and small; the shape of Spleen smallpox is yellowish and large. Regarding the Kidney Meridian, no specific signs should ideally appear; if Water fails to overcome Fire and the pox turns black, this is an inauspicious omen.
[Note] The toxin of smallpox lies latent within the Five Zang Organs; thus, whichever internal organ is affected, corresponding external signs appear. For instance, yawning and sudden chest oppression signify smallpox involving the Liver Meridian; coughing with phlegm, sneezing, tearing, and rhinorrhea signify involvement of the Lung Meridian; palpitations, irritability, and flushed face signify involvement of the Heart Meridian; drowsiness, spontaneous diarrhea, and limb heat signify involvement of the Spleen Meridian. Only when the Kidney Meridian presents with coolness of the ears and sacrum does it indicate that Fire cannot overcome Water. The morphology of Liver smallpox is a water blister, green and small; Lung smallpox is a pus blister, white and large; Heart smallpox is red and small; Spleen smallpox is yellowish and large. As for the Kidney Meridian, signs should not typically manifest; if Water fails to control Fire resulting in black-colored pox, it is not a auspicious sign.