凡物得其平则静，失其平则动。经曰∶阳气者静则养神，柔则养筋。又曰∶阴
气者静则神藏，躁则消亡。夫患痘者，阴阳俱病，息欲其匀，语欲其少，寐欲其定，
寤欲其宁，饥则索食，渴则少饮，触其疮则吟，拂其欲则鸣，此平人之候，神清气
定，谓之静而吉也。如呻者，身有苦也。自语者，神不清也。喘粗者，内热也。肠
鸣者，泄也。坐卧不定者，心烦也。啼叫不止者，痛也。摇头者，风也。指欲搔者，
痒也。咽物难者，咽痛也。切牙者，心肝热也。若闷乱躁扰，谵妄昏眩，如见鬼状，
摇头扭项，手舞足掷，目睛上翻，寒战切牙，语音不出，则皆死候矣。如病向静，
忽作扰动者异也，以法求之，如疮色变，无他候者，此戾气所触也。如疮色不变，
又无他证，此必有因，但俟自定。其有目瞑息微，四肢僵直，口噤疮坏，昏睡不醒
者，此真气将脱，魂魄欲离之兆。又不可作静诊也。
或云痘疮之候，无以脉诊言，形色可辨也。谓之形者，痘之形也，故尖圆坚浓，
始出之形。发荣滋长，欲壮之形。饱满充足，成浆之形。敛束完固，收靥之形。与
大豆豌豆绿豆相似者，皆正形也。或平或陷，形之变也，如初出时空若蚕种之蜕，
隐如蚊蚤之迹，薄如麸片，密如针头，若热之痱，寒之粟者，不能起发而死。粘聚
模糊，肌肉虚浮，溶软嫩薄，皮肤溃烂者，不能收靥而死。谓之色者，痘之色也，
喜鲜明而恶昏暗，喜润泽而恶干枯，喜苍蜡而恶娇嫩，红不欲焰、焰则易破，白不
欲灰、灰则难靥，由红而白，白而黄，黄而黑者，此出形、起发、成浆、结痂之正
色也。出形而带紫，起发而灰白，此色之变。能辨痘之形色，可知死生之期。
先贤看痘有四，曰根、曰窠、曰脚、曰地，用是以验吉凶，断死生，不易之法
也。何谓窠，中透而起顶者是也。何谓根，外圈而红者是也。即圈之红否，而其中
之虚实，与痘毒之浅深可见矣。即窠之起否，而根之浅深，气血之盈亏可定矣。所
谓脚地，则本乎根窠之丸混，痘子之稀密也，红晕之处谓之脚，彼此颗粒界限分明，
不散不杂者，此痘脚明净也。空隙之处便谓之地，彼此颗粒不相连缀者，此地面明
净也。根欲其活，窠欲其起，脚欲其固，地欲其宽，四者俱顺，痘虽密，无虑矣。
丸者，气之形也，气盛则痘窠必圆满周净。晕者，血之形也，血盛则痘窠必光明红
活。气虚则顶陷，气散则塌阻，或有气虚极而不塌陷者，乃火载之，虽见圆满，实
空壳如泡然也。血虚则晕淡，血惫则晕枯，根必散，或有血虚极面犹红色者，乃火
上浮，虽见圈晕，实枯槁而不润泽也。痘色之明暗，系于血气之虚实，如色之红
者，痘初出也。白者，毒未解也。黄者，毒将解也。干黄者，毒尽解也。灰白者，
气衰而血不附也。紫者，毒盛而血滞也。黑者，热极而兼水化也。焦褐者，气血枯
也。红变白，白变黄者，顺而生。红变紫，紫变黑者，逆而死。
初验之时，以红纸蘸清油，燃火照之，验其生意有无，又以手揩摩面颊，如红
色随手转白，随白转红，谓之血活，生意在矣。如揩之不白，举之不红，是为血枯，
纵疏不治。又看目睛神光了然，口唇尖上红活如常，无燥白之色，乃为吉证，万元
忧也。
凡是事物，得到平衡就安静，失去平衡就躁动。《内经》说：阳气如果安静，就能滋养精神；柔和，就能滋养筋脉。又说：阴气如果安静，神志就能内藏；如果躁动，精气就会消亡。患痘疮的人，阴阳两脏都受病邪侵害，呼吸应当均匀，言语应当稀少，睡眠应当安稳，醒来应当宁静，饿了就索取食物，渴了就少量饮水，触碰痘疮时会呻吟，拂拭其欲望（如瘙痒）时会鸣叫，这些都是平和之人的征候，神气清朗、安定，称为“静”，是吉利的征兆。
如果是呻吟，说明身体有痛苦。自言自语，说明神志不清醒。呼吸粗重急促，说明体内有热。肠鸣，说明腹泻。坐卧不安定，说明心烦意乱。啼哭叫喊不止，说明疼痛。摇头，说明有风邪。手指想要搔抓，说明瘙痒。吞咽困难，说明咽喉疼痛。咬牙，说明心肝有热。如果出现烦闷混乱、躁动扰乱、胡言乱语、昏眩，好像看见鬼怪一样，摇头扭颈，手舞足蹈，眼球上翻，寒战咬牙，发不出声音，这些都是死候。
如果病情趋向安静，忽然出现扰动，这是异常情况，需要用方法去探究。如果痘色发生变化，没有其他征候，这是被乖戾之气所触犯。如果痘色没有变化，又没有其他证候，这一定有原因，只需等待它自行安定。如果有闭目、气息微弱、四肢僵硬挺直、牙关紧闭、痘疮溃坏、昏睡不醒的情况，这是真气即将脱失、魂魄将要离体的征兆，这就不能当作“静”来诊断了。
有人说，痘疮的征候，无法用脉诊来说明，可以通过形色来辨别。所说的“形”，是指痘疮的形状，所以有刚发出时的形状，如尖圆坚实浓密；有发育繁荣滋长的形状，如壮实的样子；有饱满充足、形成脓浆的形状；有收敛束固、结痂脱落的样子。与大豆、豌豆、绿豆相似的，都是正常的形态。或者平坦或者凹陷，是形态的变化。比如刚发出时空虚像蚕种蜕皮，隐约像蚊子跳蚤的痕迹，薄如麸片，密如针头，像热邪引起的痱子，或寒邪引起的粟粒疹，这些都不能起发而死亡。粘聚模糊，肌肉虚浮松软嫩薄，皮肤溃烂的，不能收靂而死亡。
所说的“色”，是指痘疮的颜色，喜欢鲜明而厌恶昏暗，喜欢润泽而厌恶干枯，喜欢苍老蜡质般的光泽而厌恶娇嫩。红色不希望像火焰一样炽烈，炽烈就容易破裂；白色不希望像灰色一样晦暗，晦暗就很难结痂。由红变白，由白变黄，由黄变黑的，这是出形、起发、成浆、结痂的正常颜色。出形时带紫色，起发时呈灰白色，这是颜色的变异。能够辨别痘疮的形色，就可以知道生死的时间。
先贤观察痘疮有四个方面，叫做根、窠、脚、地，用这些来验证吉凶，判断生死，是不变的法则。什么是窠？中间通透且顶起的是窠。什么是根？外圈发红的是根。通过看圈是否红，就可以看出其中气血的虚实，以及痘毒的浅深。通过看窠是否起发，就可以确定根的浅深，以及气血的盈亏。所谓的脚和地，则取决于根和窠的圆润混杂程度，以及痘子的稀密。红晕的地方叫做脚，彼此颗粒界限分明，不散乱不混杂的，这叫痘脚明净。空隙的地方叫做地，彼此颗粒不相连缀的，这叫地面明净。根希望它活络，窠希望它起发，脚希望它坚固，地希望它宽阔。这四者都顺遂，痘疮虽然密集，也不必担忧。
丸（圆润），是气的形态，气盛则痘窠必然圆满周正洁净。晕（红晕），是血的形态，血盛则痘窠必然光明红润活络。气虚则顶部凹陷，气散则塌陷阻滞，或者有气虚极严重却不塌陷的，那是火邪承载所致，虽然看起来圆满，实际上空壳如泡一样。血虚则红晕淡，血疲惫则红晕枯槁，根部必然散开，或者有血虚极严重却仍然红色的，那是火邪上浮所致，虽然看到圈晕，实际上枯槁而不润泽。痘色的明暗，取决于气血的虚实。比如红色的，是痘初出；白色的，是毒邪未解；黄色的，是毒邪将解；干黄的，是毒邪尽解；灰白的，是气衰而血不依附；紫色的，是毒盛而血滞；黑色的，是热极兼有水化；焦褐色的，是气血枯竭。红变白，白变黄，是顺证而生；红变紫，紫变黑，是逆证而死。
初验的时候，用红纸蘸清油，点燃火照看，验证其生机有无；又用手摩擦面颊，如果红色随手转白，随即又转红，叫做血活，说明生机存在。如果摩擦后不白，举起后不红，这是血枯，即使稀疏也无法治疗。再看眼睛的神光清晰明亮，口唇尖端红润如常，没有燥白之色，这才是吉证，无需担忧。
Whatever things attain balance remain quiet; losing balance leads to movement. The Classics state: "When Yang Qi is quiet, it nourishes the Shen (Spirit); when soft, it nourishes the Jin (Tendons)." It also states: "When Yin Qi is quiet, the Shen is stored within; when restless, it dissipates and perishes." In patients suffering from smallpox (Dou Chuang), both Yin and Yang are diseased. Respiration should be even, speech should be minimal, sleep should be stable, and waking consciousness should be peaceful. When hungry, they seek food; when thirsty, they drink sparingly. They groan when touching their sores and cry out when their desires (such as itching) are disturbed. These are signs of a balanced person with clear and calm Shen, termed "quiet," which indicates a favorable prognosis.
Groaning indicates physical pain. Muttersing in one's sleep indicates unclear Shen. Rapid and coarse breathing indicates internal Heat. Bowel sounds indicate diarrhea. Restlessness in sitting or lying down indicates mental restlessness (Xin Fan). Unceasing crying and shouting indicate pain. Shaking the head indicates Wind. Wanting to scratch with fingers indicates itching. Difficulty swallowing indicates sore throat. Clenching teeth indicates Heart and Liver Heat. If there is confusion, agitation, delirium, dizziness, hallucinations (seeing ghosts), shaking of the head and neck, flailing of limbs, upward deviation of the eyes, chills with teeth clenching, and inability to speak, these are all signs of impending death.
If the condition tends toward quietness but suddenly becomes agitated, this is abnormal. One must investigate using appropriate methods. If the color of the lesions changes without other symptoms, this is due to contact with aberrant pathogenic factors (Li Qi). If the lesion color remains unchanged and there are no other symptoms, there must be a specific cause; one should simply wait for it to stabilize on its own. If there is closed eyes, faint respiration, rigid limbs, locked jaw, necrotic lesions, deep coma, these are signs that True Qi is about to collapse and Hun and Po are about to depart. This cannot be diagnosed as "quiet" (favorable).
Some say that the signs of smallpox cannot be determined by pulse diagnosis alone but can be distinguished by Xing (Form) and Se (Color). "Xing" refers to the shape of the pustules. Thus, there is the initial form (sharp, round, firm, dense); the form of flourishing growth (robust); the form of fullness and sufficiency (formation of pus); and the form of contraction and consolidation (scabbing and falling off). Shapes resembling soybeans, mung beans, or peas are considered normal forms. Flatness or depression represent variations in form. For example, if initially appearing empty like shed silkworm skins, faint like mosquito bites, thin like bran flakes, or dense like needleheads—resembling heat-induced miliaria or cold-induced millet-like papules—they will fail to erupt and lead to death. Adhesion, blurriness, floating and loose flesh, soft and tender skin, or ulcerated skin will fail to scab and lead to death.
"Se" refers to the color of the lesions. Brightness is preferred over dimness; moisture is preferred over dryness; a mature, waxy luster is preferred over delicate tenderness. Red should not be fiery; if fiery, it breaks easily. White should not be grayish; if grayish, it fails to scab. The progression from red to white, white to yellow, and yellow to black represents the normal colors corresponding to eruption, development, pus formation, and scabbing. Purple hue at eruption and grayish-white at development are color abnormalities. By distinguishing the form and color of smallpox, one can predict the time of life or death.
Ancient experts observed four aspects of smallpox: Gen (Root), Ke (Nest), Jiao (Foot), and Di (Ground). These are unchanging methods to verify auspiciousness and determine life or death. What is Ke? It is where the center is transparent and the top rises. What is Gen? It is the outer ring that is red. By observing whether the ring is red, one can see the deficiency or excess within and the depth of the toxin. By observing whether the Ke rises, one can determine the depth of the Gen and the sufficiency or deficiency of Qi and Blood.
What are Jiao and Di? They depend on the roundness and mixing of the Gen and Ke, and the density of the pustules. The area of red halo is called Jiao. If particles are distinct, not scattered or mixed, the Jiao is clear. The empty space between particles is called Di. If particles do not connect, the Di is clear. The Gen should be active; the Ke should rise; the Jiao should be solid; the Di should be broad. If all four are harmonious, even dense eruptions need not be feared.
"Wan" (roundness) is the form of Qi. Abundant Qi ensures the Ke is complete, neat, and clean. "Yun" (halo) is the form of Blood. Abundant Blood ensures the Ke is bright, red, and lively. Qi deficiency causes the top to sink; Qi dispersion causes collapse and obstruction. Even if extremely Qi-deficient lesions do not collapse, it may be due to Fire carrying them up; although appearing round, they are actually empty shells like blisters. Blood deficiency makes the halo pale; Blood exhaustion makes the halo withered, causing the root to scatter. Even if extremely Blood-deficient lesions appear red, it may be due to Fire floating upward; although a halo appears, it is actually withered and lacks moisture. The brightness or dimness of the lesion color depends on the deficiency or excess of Qi and Blood. Red indicates initial eruption; white indicates unresolved toxin; yellow indicates resolving toxin; dry yellow indicates resolved toxin; grayish-white indicates Qi decline and Blood detachment; purple indicates abundant toxin and Blood stasis; black indicates extreme Heat combined with Water transformation; brown/blackened indicates Qi and Blood exhaustion. Red turning to white, white to yellow, is a smooth progression leading to life. Red turning to purple, purple to black, is a reverse progression leading to death.
During initial examination, dip red paper in pure oil, ignite it, and use the light to check for vitality. Rub the cheeks with the hand; if the redness turns white upon rubbing and returns to red immediately, it is called "active Blood," indicating vitality exists. If rubbing does not turn it white and lifting does not make it red, it is "exhausted Blood," which is untreatable even if sparse. Also observe that the eyes have clear spirit, the tip of the lips is red and lively as usual, without dry whiteness. This is an auspicious sign, requiring no worry.