痘疮收靥，圆净坚浓如螺靥者上也。头穿脓出，堆聚成痂如鸡矢者次也。皮破脓出，痂薄如纸者又其次也。
皮烂脓溃，不成痂皮，脓汁腥臭者斯为下矣。如已过期，譬如瓜果熟久则烂，此造化之常，还作顺看。若未及期，
则为 烂，乃逆候也，变倒靥而死。
结靥时色转苍蜡，一二日从口唇四边结靥，由胸腹收至两腿，然后脚背和额上一齐结靥，落而愈者吉。
结靥时遍身臭烂，如搭饼臭不可近，目中无神者死。
结靥时遍身发痒，抓破无脓，皮卷如豆壳干者死。
结靥时寒战手足颤掉，切牙噤口者死。
落痂后瘢痕雪白，全无血色者死，急宜补气血，养脾胃，庶几可活。
〔袁〕患痘八九日，充灌回谢，宜保全矣，然有回至项颈而死者，有回至胸前而死者，有回至脐上而死者，有回
至阳物而死者，其故何欤。曰消息盈虚，自有定数，若痘证仅取其浆灌则可也，倘元气所禀者本是薄劣，痘
兼多蔓，遂用毒物尽以发之，再投升劫之剂，尽把元气赶上，痘虽充灌，然外囊实而内体耗蠹矣，五经伤而不能
斡补矣。颈上喉突气窝，肺之关辖也，肺气先绝，回至此则蜮绊而死。胸阜，心之关辖也，心脉先绝，回至此则死。
脐乃脾之关辖也，脾脉先绝，回至此则死。眼眶乃肝之关辖也，肝脉先绝，回至此则死。阳物乃肾之关辖，肾脉
先绝，回至此则死。本拔则枝枯，源塞则流涸，自然之道也。若语其变，风寒不知慎护，而致枭邪逼于中，饮食不
知樽节，而致脾胃伤于内，肚腹肿胀，痰喘不息，于是回至各关辖而死者，亦有之也。又有一样嚣痘，视之若似黄
脓灌满，回至胸前则死，此真蜮痘也。
痘疮结痂脱落时，若痂皮圆润、洁净、坚硬且厚实，如同田螺壳一般，属于上等的顺证。若脓液从顶部穿出，堆积形成痂皮，形状像鸡屎一样，属于次一等。若皮肤破损，脓液流出，但形成的痂皮薄如纸张，又更次一等。
若皮肤溃烂，脓液外泄，无法形成完整的痂皮，且脓汁气味腥臭，这属于下等的逆证。如果已经到了预期的结痂时间，就像瓜果成熟过久自然会腐烂一样，这是自然规律，仍应视为顺证处理。如果未到预期时间就出现这种情况，则称为“烂”，属于逆候，会导致痘疹倒靥（塌陷）而死亡。
在结痂过程中，若痘色转为苍老蜡黄，经过一两天后，先从口唇四周开始结痂，然后由胸腹部向双腿收敛，最后脚背和额头同时结痂，脱落后痊愈，这是吉兆。
若在结痂时，全身散发恶臭腐烂的气味，如同烧饼焦糊般令人难以靠近，且眼睛无神，预示死亡。
若在结痂时，全身发痒，抓破后没有脓液，皮肤卷曲干燥如同豆壳，预示死亡。
若在结痂时，出现寒战、手足颤抖、咬牙紧闭口不能言的症状，预示死亡。
若脱痂后留下的瘢痕雪白，完全没有血色，预示死亡；此时急需补益气血，调养脾胃，或许还有一线生机。
〔袁氏〕曾问：患痘疮八九日，痘疹已经充盈灌浆并开始回谢（消退），本应保全性命，然而有的患者痘毒退回至颈部而死，有的退回至胸前而死，有的退回至肚脐以上而死，有的退回至生殖器而死，这是什么原因呢？
回答是：病情的消息盈虚，自有定数。如果治疗痘证仅关注浆液充盈即可，但如果患者先天元气禀赋本就薄弱，痘疹又多蔓延，医生便使用毒性药物强行发散，再投用升提劫夺的药剂，强行将元气催发出来。虽然痘疹看起来充盈灌浆，但实际上外表囊实而内部本体已被耗损蛀空，五脏经脉受损而无法补救。
颈部喉突气窝处，是肺脏的关辖所在，肺气先绝，痘毒退回至此则因阻滞而死。胸部隆起处，是心脏的关辖所在，心脉先绝，痘毒退回至此则死。肚脐是脾脏的关辖所在，脾脉先绝，痘毒退回至此则死。眼眶是肝脏的关辖所在，肝脉先绝，痘毒退回至此则死。生殖器是肾脏的关辖所在，肾脉先绝，痘毒退回至此则死。树根拔除则枝叶枯死，水源堵塞则水流干涸，这是自然的道理。
如果说其中的变证，是因为风寒侵袭时不知谨慎防护，导致邪气逼迫于体内；饮食不知节制，导致脾胃内伤，出现肚腹肿胀、痰喘不止等症状，于是痘毒退回至各脏腑关辖而死的情况，也是存在的。另外有一种嚣张的痘疹，看起来似乎充满了黄色的脓液，但当痘毒退回至胸前时就会死亡，这种痘疹被称为“真蜮痘”（恶毒之痘）。
When the smallpox pustules are scabbing over and falling off, if the scabs are round, clean, firm, and thick like a snail shell, it is considered an excellent favorable condition. If pus oozes from the top of the pustules and piles up to form scabs resembling chicken droppings, it is of secondary quality. If the skin breaks, pus flows out, but the resulting scabs are thin as paper, it is even worse.
If the skin rots and pus溃 (ulcerates/leaks), failing to form proper scabs, and the pus has a fishy, foul odor, this is considered a poor unfavorable condition. However, if this occurs after the expected time for scabbing, it is like fruits rotting after being ripe for too long; this is a natural process and should still be viewed as a favorable progression. If it occurs before the expected time, it is termed "rotting" (Lan), which is an unfavorable sign leading to inverted scabbing (Dao Ye) and death.
During the scabbing phase, if the color of the lesions turns dark and waxy, and after one or two days, scabbing begins around the mouth and lips, then recedes from the chest and abdomen down to the legs, finally scabbing simultaneously on the dorsum of the feet and forehead before falling off with recovery, this is auspicious.
If during scabbing, the whole body emits a foul, rotting odor, like burnt cakes that is unbearable to approach, and the eyes lack spirit, death is imminent.
If during scabbing, the whole body itches intensely, and scratching reveals no pus, with the skin curling and drying like bean shells, death is imminent.
If during scabbing, there are chills, trembling of the hands and feet, teeth grinding, and lockjaw (Jin Kou), death is imminent.
If after the scabs fall off, the resulting scars are snow-white with absolutely no blood color, death is imminent; urgent supplementation of Qi and Blood and nourishment of the Spleen and Stomach may offer a chance of survival.
[Yuan] asked: On the eighth or ninth day of smallpox, when the pustules have filled with pus and begun to resolve, life should be preserved. Yet some patients die when the resolution retreats to the neck, some to the chest, some above the umbilicus, and some to the genitalia. What is the reason?
The answer is: The waxing and waning of the disease follows its own fixed destiny. If treating smallpox only focuses on the filling of pus, but the patient's congenital Yuan Qi (Original Vital Energy) was inherently weak, and the smallpox spread extensively, using toxic herbs to forcibly disperse the pathogen, followed by ascending and劫夺 (rob/capture) agents to force the Yuan Qi upward, although the pustules appear full, the exterior is solid while the interior essence is consumed and hollowed out. The Five Meridians (Wu Jing) are damaged and cannot be rescued.
The area of the neck and throat protrusion is the gatekeeper of the Lung; if Lung Qi fails first, retreat to this point leads to death due to obstruction. The chest mound is the gatekeeper of the Heart; if Heart pulse fails first, retreat to this point leads to death. The umbilicus is the gatekeeper of the Spleen; if Spleen pulse fails first, retreat to this point leads to death. The eye sockets are the gatekeepers of the Liver; if Liver pulse fails first, retreat to this point leads to death. The genitalia are the gatekeepers of the Kidney; if Kidney pulse fails first, retreat to this point leads to death. When the root is pulled, the branches wither; when the source is blocked, the stream dries up; this is the natural way.
Regarding variable conditions: if one fails to guard against Wind-Cold, allowing evil pathogens to press inward; or if one fails to regulate diet, damaging the Spleen and Stomach internally, leading to abdominal swelling and incessant phlegm-wheezing, then death occurring as the pathogen retreats to these various gatekeepers does happen. Furthermore, there is a type of aggressive smallpox that appears full of yellow pus, but causes death when retreating to the chest; this is called "Zhen Hu Dou" (True Evil Smallpox).