顺 痘初贯脓，先作水色，渐转白亮，浓浓饱满，变黄蜡色，根圈红活，紧附痘脚，饮食、二
便如常。
险 痘虽行浆，不浓浓满足；或皮薄娇红，淡白阔塌，必然发痒而有后患。急宜保元汤温补，
自然
浓浓。犹有热毒，略兼清凉。或如白饭色，平塌不起，四围淡白，干涩不红活，血虚；顶不起，
气虚。保元汤加川芎、当归、肉桂、木香（人乳、好酒）。或见诸恶候，烦躁不安，但得痘色不变，
饮食如前，不妨。痒塌（后另有条）抓破有脓血吉，空壳、无脓血凶。
主方 人参（一钱） 黄 （一钱） 甘草（四分） 肉桂（三分） 当归（八分） 川
芎（七分） 白芍（首尾，酒炒）糯米百粒，水煎服。
如兼解毒，加白芷、防风、牛蒡之类。用人参，少加山楂，以消参、 之腻；加木香，行气
血之滞。恐参作饱，少加陈皮以制之。如多用或再用枳壳、青皮之类，则人参无功矣。胀痛虽为
顺候，不止，加木香、山楂。或行浆半足，忽然干紫，肿消眼开，名为倒靥（后另有条）。或停食、
泄泻等，加消食止泻，随证治之。或过用凉药，遏而不进，身不热，遂成冰伏之证，大剂温补（异
功散、木香散之类。）或顶平脚阔浆清，十全大补加木香、干姜。痘毒盛者，十日外浆未足，大
补气血，略兼解毒，恐后有痈毒之患。或上身成脓，腿足成大水泡，毒亦解矣。
逆 痘色焦枯黑陷，不得贯脓，或红色变紫，紫变黑，或如水晶，全无红色，皆毒未尽，气血
已竭，死证。或发惊寒战，切牙不食等证。（恶候，姑补气血。）
顺证：痘疮刚开始灌浆时，先呈现水色，逐渐转为白亮，浓密饱满，变成黄蜡色，根部红活，紧贴痘根，饮食和二便都正常。
险证：痘疮虽然开始行浆，但不浓密饱满；或者皮薄娇嫩发红，淡白色且宽阔塌陷，必然发痒并留下后患。此时急需使用保元汤进行温补，自然就会变得浓密饱满。如果还有热毒，稍微兼用清凉药物。或者像白饭的颜色，平塌不起，四周淡白，干涩不红活，这是血虚；痘顶起不来，是气虚。在保元汤中加入川芎、当归、肉桂、木香（用人乳、好酒煎服）。如果出现各种恶候，烦躁不安，但只要痘色没有改变，饮食如常，不妨碍治疗。抓破后出脓血为吉，空壳、无脓血为凶。
主方：人参（一钱），黄芪（一钱），甘草（四分），肉桂（三分），当归（八分），川芎（七分），白芍（初用和末用，酒炒），糯米一百粒，水煎服。
如果兼有解毒需求，加入白芷、防风、牛蒡子之类。使用人参时，少加山楂，以消除人参、黄芪的腻滞；加木香，以行气血之滞。担心人参导致饱胀，少加陈皮来制约它。如果使用过多或再次使用枳壳、青皮之类，那么人参就无效了。胀痛虽然是顺证的表现，但如果不止痛，加木香、山楂。或者行浆过半，突然干枯紫暗，肿胀消退、痘眼睁开，这叫做倒靥（后面另有专条论述）。或者停食、泄泻等症，加入消食止泻药，随证治疗。或者过用凉药，遏制正气而不进，身体不发热，遂成冰伏之证，需用大剂量的温补药（异功散、木香散之类）。或者痘顶平、脚阔、浆清，用十全大补汤加木香、干姜。痘毒盛者，十天后浆未充足，大补气血，稍微兼用解毒药，恐怕日后会有痈毒之患。或者上身成脓，腿足成大水泡，毒邪也就解除了。
逆证：痘色焦枯黑陷，不能灌浆，或者红色变紫，紫变黑，或者像水晶一样，全无红色，都是毒邪未尽，气血已竭，属于死证。或者出现发惊、寒战、咬牙不食等症状。（这是恶候，暂且补益气血。）
Shun (Favorable) Pattern: When the smallpox pustules first begin to fill with pus, they initially appear watery, gradually turning white and bright, becoming dense and full, changing to a yellow wax color. The base is red and vibrant, tightly attached to the root of the pock. Diet, urination, and defecation remain normal.
Xian (Dangerous) Pattern: Although the smallpox pustules are filling with pus, they are not dense and full; or the skin is thin, tender, and red, pale white, wide, and collapsed. It will inevitably itch and lead to subsequent complications. It is urgent to use Baoyuan Tang (Preserve the Origin Decoction) for warming and tonification, which will naturally become dense and full. If there is still heat toxin, slightly combine with cooling herbs. Or if it resembles the color of white rice, flat and collapsed, with pale white surroundings, dry and rough without redness, this indicates Blood Deficiency; if the apex does not rise, this indicates Qi Deficiency. Add Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), Cinnamomi Cortex (Rougui), and Aucklandiae Radix (Muxiang) to Baoyuan Tang (decocted with human milk and good wine). If various ominous signs appear, such as restlessness and unease, but the color of the smallpox remains unchanged and diet is normal, treatment can proceed without hindrance. Scratching until pus and blood appear is auspicious; empty shells without pus and blood are inauspicious.
Main Formula: Ren Shen (Ginseng Radix et Rhizoma) (1 qian), Huang Qi (Astragali Radix) (1 qian), Gan Cao (Licorice Root) (0.4 qian), Rou Gui (Cinnamon Bark) (0.3 qian), Dang Gui (Angelicae Sinensis Radix) (0.8 qian), Chuan Xiong (Ligusticum Chuanxiong Rhizoma) (0.7 qian), Bai Shao (Paeoniae Radix Alba) (used at the beginning and end, stir-fried with wine), 100 grains of Glacinis Semen (Glutinous Rice). Decoct in water and take orally.
If detoxification is also required, add Bai Zhi (Angelicae Dahuricae Radix), Fang Feng (Saposhnikoviae Radix), Niu Bang Zi (Arctii Fructus), etc. When using Ren Shen, add a small amount of Shan Zha (Crataegi Fructus) to eliminate the cloying nature of Ren Shen and Huang Qi; add Muxiang to promote the circulation of Qi and Blood. To prevent Ren Shen from causing fullness, add a small amount of Chen Pi (Citri Reticulatae Pericarpium) to control it. If too much or repeatedly used Zhi Qiao (Aurantii Fructus Immaturus) or Qing Pi (Citri Reticulatae Pericarpium Viride), then Ren Shen will be ineffective. Distension and pain, although a favorable sign, if persistent, add Muxiang and Shan Zha. Or if the pustules have filled halfway, suddenly becoming dry and purple, with swelling subsiding and the pock eyes opening, this is called Dao Ye (Reversed Crusting) (see separate section later). Or if there is food stagnation or diarrhea, add herbs to digest food and stop diarrhea, treating according to the syndrome. Or if cooling medicines are overused, suppressing the pathogen and preventing progression, with no fever, it becomes Bing Fu Syndrome (Ice-Frozen Syndrome); use large doses of warming and tonifying medicines (such as Yigong San and Muxiang San). Or if the apex is flat, the base is wide, and the pus is clear, use Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) with added Muxiang and Gan Jiang (Zingiberis Rhizoma). For those with heavy smallpox toxin, if the pus is insufficient after ten days, greatly tonify Qi and Blood, slightly combining with detoxifying herbs, fearing subsequent carbuncle/toxin complications. Or if the upper body forms pus and the legs/feet form large blisters, the toxin has been resolved.
Ni (Adverse) Pattern: The smallpox color is scorched, withered, black, and sunken, unable to fill with pus; or red turns purple, purple turns black; or crystal-clear with no redness at all. These indicate that the toxin is not yet exhausted and Qi and Blood are depleted, constituting a death pattern. Or symptoms such as fright, chills, tremors, teeth grinding, and refusal to eat occur. (These are ominous signs; temporarily tonify Qi and Blood.)