顺 颗粒渐长，粗肥圆绽，高耸结实，根窠红润，一圈红晕，紧附痘根；痘顶壮满，光泽明亮，
脚地疏朗，内外平正，渐至根红项白，毒化水色。乃气充血盛，血气归附。
险 痘虽起发，昏滞枯涩；或平塌灰白，而顶不圆绽；或根脚虽红，而晕不紧附。盖痘之形由
气，根之色由血，必赖气血而始终其功，然而解毒尤为急务。痘于六日乃为界限，六日前清尽毒
火，六日后温补助浆。至此失治，欲温补，又助毒邪炽盛，反不化浆；欲清凉，复恐浆滞不行，
遂成掣肘。然临证又不可固执。六日前，毒火已清，即兼补益；六日后，热邪未盛，少兼清解。
如痘不光泽饱满，亦有二焉。如花卉遇阴天，则艳丽华美；逢烈日，则焦萎干枯，诚不系于树力
之强弱耳。痘不绽，看余证。有躁烦热渴，二便秘涩等热候，宜清凉；有体倦热缓，二便清利等
虚候，宜温补。最宜细察，岂可概谓不绽，便行补益，而蹈实实虚虚杀人之罪乎！凡口渴多饮，
急宜清胃火。失治则外虽收敛，胃受火毒，烂溃内攻，致穿胸背而死。轻者遍身赤斑，亦危。
主方 当归 川芎 芍药（酒炒） 蝉蜕 僵蚕 山楂 牛蒡子 白芷 桔梗（等分）
甘草（减半） 上水煎服。
有虚寒证，六日加人参、黄 、肉桂、糯米，少加陈皮。无则七日用。
又方 治虚寒证。川芎 白芷 山楂 陈皮 当归 桔梗 甘草（等分）渐加温补，加枣水
煎。
又方 治实热证。川芎 蝉蜕 山楂 牛蒡子 桔梗 木通 防风 加灯心、大枣，水煎服。
又方 治血热证。归尾 生地 木通 桔梗 连翘 川芎 蝉蜕 僵蚕 水煎服。
夹斑 加黄芩、黄连、红花、丹皮（酒炒、）生地。小便清长去木通。便涩、腹胀加腹皮。不润加
当归；不快加牛蒡。陷塌，黄 。痛加白芷。不匀，防风。细斑难治，大斑令人呼出毒血。口渴
服六一散，甚，白虎汤（方见伤寒。）
逆 痘不起而平塌虚浮，色不泽而根窠无晕，腹胀不食，气促神昏。或痘粒遍体过头，红紫如
胭脂；或头面红肿，而痘反退伏；或痘中陷眼如针孔而黑紫；或如粟粥皮面，或口唇上下肿甚，
俗名判官嘴。皆气涩血凝，或气离血散为逆。逆者，交会不足，致毒乘机而内攻也。又邪视，面
如橘皮，不分肉地，或腰下有痘，腰上无痘，皆不治证。
顺证：痘粒逐渐生长，变得粗大肥硕、圆润绽开，高耸且坚实，痘根周围红润，有一圈红晕，紧紧附着在痘的根部；痘顶饱满壮实，光泽明亮，痘脚疏朗，痘体内外平正，逐渐发展到根部发红、颈部发白，毒气化为水浆。这是气血充盈、血气归附于痘的表现。
险证：痘虽然已经起发，但显得昏滞枯涩；或者痘形平塌、颜色灰白，且顶部不圆不绽；或者痘根虽红，但红晕不紧密附着。大概痘的形状由气决定，痘根的颜色由血决定，必须依赖气血才能完成整个过程，然而解毒更是当务之急。痘疹以第六天为界限，六日之前要清尽毒火，六日之后用温补药物助其化浆。到了这个阶段如果治疗失当，想要温补，又会助长毒邪炽盛，反而不能化浆；想要清凉，又担心导致浆液停滞不行，从而造成两难局面。然而临证时又不可固执己见。如果六日之前毒火已清，就可以兼用补益药；如果六日之后热邪未盛，可以少量兼用清解药。像痘疹缺乏光泽和饱满感，也有两种情况。就像花卉遇到阴天，则艳丽华美；遇到烈日，则焦萎干枯，这确实不在于树木本身力量的强弱。痘疹不绽开，要看其他伴随症状。如果有烦躁、发热、口渴、大小便秘涩等热象，宜用清凉法；如果有身体疲倦、热势缓和、大小便清利等虚象，宜用温补法。最宜仔细察辨，怎么能一概认为痘不绽开就进行补益，而犯下“实实虚虚”（使实证更实、虚证更虚）致人死亡的罪过呢！凡是口渴多饮的，急宜清胃火。如果失治，虽然外表看似收敛，但胃受到火毒侵害，内部烂溃并内攻，导致穿透胸背而死。轻者全身出现赤斑，也很危险。
主方：当归、川芎、芍药（酒炒）、蝉蜕、僵蚕、山楂、牛蒡子、白芷、桔梗（各等分），甘草（减半）。以上药材用水煎服。
如果有虚寒证，第六天加人参、黄芪、肉桂、糯米，少加陈皮。如果没有虚寒证，第七日用主方。
又一方：治疗虚寒证。川芎、白芷、山楂、陈皮、当归、桔梗、甘草（各等分），逐渐增加温补药，加枣汤煎服。
又一方：治疗实热证。川芎、蝉蜕、山楂、牛蒡子、桔梗、木通、防风，加灯心草、大枣，水煎服。
又一方：治疗血热证。归尾、生地黄、木通、桔梗、连翘、川芎、蝉蜕、僵蚕，水煎服。
夹斑证：加黄芩、黄连、红花、丹皮（酒炒）、生地黄。小便清长去掉木通。大便涩滞、腹胀加腹皮（厚朴）。不滋润加当归；不通快加牛蒡子。痘陷塌，加黄芪。疼痛加白芷。痘出不匀，加防风。细斑难治，大斑让人呼出毒血。口渴服六一散，严重者服白虎汤（方剂见《伤寒论》）。
逆证：痘不起发而平塌虚浮，色泽不润泽且痘根无红晕，腹胀不食，气促神昏。或者痘粒遍布全身甚至过头部，红紫如胭脂；或者头面红肿，而痘反而退伏；或者痘中凹陷如针孔且黑紫；或者像粟粥皮面，或者口唇上下肿得很厉害，俗名判官嘴。这些都是气涩血凝，或者气离血散导致的逆证。所谓逆证，是交会不足，致使毒邪乘机内攻。还有斜视，面色如橘皮，不分肌肉纹理，或者腰下有痘、腰上无痘，都是不治之证。
Shun (Favorable) Pattern: The pustules gradually grow, becoming coarse, plump, round, and bursting open. They stand high and are solid. The base is reddish with a ring of red halo tightly attached to the root of the pustule; the top is full and bright with luster. The base is spacious, and the interior and exterior are level. Gradually, the root turns red and the neck turns white, as the toxin transforms into fluid/pus. This indicates abundant Qi and blood, with Qi and blood returning to attach to the pustules.
Xian (Dangerous) Pattern: Although the pustules have erupted, they appear dull, stagnant, withered, and dry; or they are flat, collapsed, grayish-white, with tops that are not round or bursting; or although the roots are red, the halo is not tightly attached. Generally, the shape of the pustules depends on Qi, and the color of the roots depends on Blood. It relies on Qi and Blood to complete the process throughout, yet resolving toxins is the urgent priority. The sixth day serves as a boundary for smallpox. Before the sixth day, clear away toxic fire; after the sixth day, use warming tonification to assist in forming pus. If treatment fails at this stage, attempting warming tonification may further intensify the toxic pathogen, preventing pus formation; attempting cooling may cause stagnation of the pus, leading to a dilemma. However, clinical practice requires flexibility. If toxic fire has been cleared before the sixth day, tonifying herbs can be added; if heat pathogens are not severe after the sixth day, mild clearing and resolving herbs can be used. Regarding the lack of luster and fullness in pustules, there are two scenarios. Like flowers, on cloudy days they remain vibrant and beautiful, but under scorching sun they wither and dry out; this indeed does not depend solely on the strength of the tree. If pustules do not burst, observe other symptoms. If there are heat signs such as restlessness, fever, thirst, and constipation of both bowels and bladder, use cooling methods. If there are deficiency signs such as fatigue, mild fever, and clear/unobstructed urination and defecation, use warming tonification. Careful observation is essential. One cannot simply assume that non-bursting pustules require tonification, thereby committing the error of "reinforcing excess and depleting deficiency" which leads to death. For cases with excessive thirst and drinking, urgently clear Stomach Fire. If untreated, although the exterior may seem to converge, the Stomach suffers from fire-toxin, leading to internal ulceration and attack, causing perforation of the chest and back and death. Mild cases may present with widespread red macules, which is also critical.
Main Formula: Danggui Radix Angelicae Sinensis, Chuanxiong Rhizoma Ligustici Chuanxiong, Shaoyao Radix Paeoniae Alba (stir-fried with wine), Chanui Periostracum Cicadae, Jiangcan Bombyx Batryticatus, Shanzhao Fructus Crataegi, Niubangzi Fructus Arctii, Baizhi Radix Angelicae Dahuricae, Jiegeng Radix Platycodonis (equal parts); Gancao Radix Glycyrrhizae Uralensis (half dose). Decoct in water and take orally.
For Xuhan (Deficiency-Cold) patterns, add Renshen Radix Ginseng, Huangqi Radix Astragali, Rougui Cortex Cinnamomi, Nuomi Oryza Sativa Glutinosa on the sixth day, with a small amount of Chenpi Pericarpium Citri Reticulatae. If no Xuhan pattern exists, use the main formula on the seventh day.
Another Formula: Treats Xuhan (Deficiency-Cold) patterns. Chuanxiong Rhizoma Ligustici Chuanxiong, Baizhi Radix Angelicae Dahuricae, Shanzhao Fructus Crataegi, Chenpi Pericarpium Citri Reticulatae, Danggui Radix Angelicae Sinensis, Jiegeng Radix Platycodonis, Gancao Radix Glycyrrhizae Uralensis (equal parts). Gradually add warming tonics, decoct with Jujube water.
Another Formula: Treats Shi Re (Excess-Heat) patterns. Chuanxiong Rhizoma Ligustici Chuanxiong, Chanui Periostracum Cicadae, Shanzhao Fructus Crataegi, Niubangzi Fructus Arctii, Jiegeng Radix Platycodonis, Mutong Herba Akebiae, Fangfeng Radix Saposhnikoviae. Add Dengxin Cao Medulla Junci and Dazao Fructus Ziziphi Jujubae, decoct in water and take orally.
Another Formula: Treats Xue Re (Blood-Heat) patterns. Guiwei Radix Angelicae Sinensis Tail, Shengdihuang Rhizoma Rehmanniae Recens, Mutong Herba Akebiae, Jiegeng Radix Platycodonis, Lianqiao Fructus Forsythiae, Chuanxiong Rhizoma Ligustici Chuanxiong, Chanui Periostracum Cicadae, Jiangcan Bombyx Batryticatus. Decoct in water and take orally.
Jia Ban (Accompanied by Macules): Add Huangqin Radix Scutellariae, Huanglian Rhizoma Coptidis, Honghua Flos Carthami, Danmu Pi Cortex Moutan (stir-fried with wine), Shengdihuang Rhizoma Rehmanniae Recens. If urine is clear and profuse, remove Mutong Herba Akebiae. If stool is difficult and abdomen is distended, add Fupi Pericarpium Tugitrichi. If not moist, add Danggui Radix Angelicae Sinensis; if not moving smoothly, add Niubangzi Fructus Arctii. If collapsed, add Huangqi Radix Astragali. If painful, add Baizhi Radix Angelicae Dahuricae. If uneven, add Fangfeng Radix Saposhnikoviae. Fine macules are difficult to treat; large macules allow expelling toxic blood via respiration. For thirst,服用 Liuyi San (Six-One Powder); if severe, use Baihu Tang (White Tiger Decoction) (see Shanghan Lun).
Ni (Adverse/Rebellious) Pattern: Pustules do not erupt, appearing flat, collapsed, and floating; color lacks luster and roots have no halo; abdominal distension, anorexia, shortness of breath, and coma. Or pustules cover the whole body extending over the head, red-purple like rouge; or the face and head are swollen and red, while pustules recede; or pustules sink into pits like needle holes and turn black-purple; or resemble millet porridge skin; or lips and mouth area swell severely, commonly known as "Judge's Mouth". These indicate Qi stagnation and Blood coagulation, or Qi separation and Blood scattering, constituting adverse patterns. Adverse patterns result from insufficient intersection, allowing toxins to penetrate inward opportunisticaly. Additionally, strabismus, skin resembling orange peel without distinct muscle texture, or pustules only below the waist but none above, are all untreatable conditions.