痘出八九日，脓浆充满，颜色苍蜡者，若无他症，勿药可也。痘出稠密，而脓不甚满，
此时饮食多减，痰液甚多，用养胃开痰汤。渴者去法半，加麦冬八分，北味九粒。吐逆者加
藿香、砂仁三分。灌脓时忌用术、苓、半夏，恐其燥干精液，脓浆不行也。至将靥时，则可
用矣。
此时有 逆者，俗呼呃，胃气上越也。取真黄土鼻边闻之即止。此时浆满，或为寒所
剥。一时痘俱紫黑，如紫卜闻色，不必惊恐，急以上好肉桂磨汤或煎汤，服之立效。如旧有
寒战切牙者，此真气外发而内虚寒也，宜建中汤，一服立止。甚者不过二服。收靥时后寒战
切牙者，亦同此调治。或谓寒战切牙，有热有寒，如痘色红紫，一齐涌发，身热，烦躁，作
渴，大便秘，小便涩赤，脉来洪数者热也。盖胃热则切牙，肺热则寒战也。如痘色淡白，皮
薄顶陷，身凉恶寒，大小便利，脉沉迟者寒也。盖胃寒则切牙，肺寒则寒战也。此说当矣。
然此症属寒者十之九，属热者十之一，是于七八日之前，犹有属热者见，于七八日之后，其
属热者寡矣，是以不为热者立方。
九十日间，脓足而色苍者，且必发热熏蒸，此回水之候也。盖真阳运化，其水自消。
其有元气不足，则不能及时回水，而当靥不靥矣，此虚寒症也。必身凉而手足冷，须大
补气血，以助其收结，宜用温表调中汤主之。
其有发热熏蒸，当靥而不靥者，毒瓦斯未解也。退其热则痘自收。宜用清表散毒汤，或用
砂糖半酒杯，百沸汤调作一碗，温服，谓之甘露回天饮，能令热退痘收。但毒盛者，恐未必
效。
痘靥时，有外溃而脓水淋漓者，谓之水靥。用新瓦粉调鸭蛋清敷之，立收而落。
当靥时，有忽然腹痛，着在中脘，此热毒凝滞，瘀血作痛也。宜用消毒散血汤。若结痂
浓实，无他症者，不必服药。
结痂后，发热或烦渴者，当辨其寒、热、虚、实调治。发热壮盛，胸腹手足头面俱热，
大便秘涩，小便赤涩者，余毒盛也。即当解毒，若解毒迟，则痂落后必发痈毒。急用大连翘
饮解之，大便仍秘，加熟军五分。
若其发热稍缓，头热面不热，其手足心热，手脚背不热，精神困倦，大小便利者，虚热
也。宜补中益气汤，渴者加麦冬一钱，五味子九粒。
痂落还元，或痂落一半后，忽然遍身大热，余毒欲发痈也。或手足四肢头顶胸背一二处
更甚者，即痈之所在也。此在脓浆不满，而痂浮薄速收速落者多有之，急用大连翘饮以退其
热。大便秘者，加酒炒大黄微利之。如热不退，须连服数剂，热退身凉，方可内消。
此时又有忽然头顶大痛者，余毒上攻也。或因多服热药所致，若不急治，其毒必注于眼
目，而目病大作矣。宜用大连翘饮，去木通、车前、滑石，加升麻、桔梗六分，川芎、薄荷
四分，服数剂以解散上攻之毒，则目患可免也。
痂落后，有精神困倦，饮食减少，胸腹头项手足心发热而烦渴者，内虚也。仍用补中益
气汤主之。或有虽不发热，而倦怠嗜卧，不思饮食，或手足冷，或津液少而渴，或瘢白不红
，皆内虚之症也。亦宜用补中益气汤主之。不然，恐生他变。
须知出痘多者，收结之时，还无之后，五脏真气发泄已多，一身血气耗散已甚，虽或毒
气未净，而其真气极虚，是以用凉药解毒，必须用酒炒制。其体质弱者，或时加参、 、归
、芍之类，以救血气，切不可因其有热症而遂投以生三黄、生栀子、大黄、石膏之类。此时
正气微弱，用寒凉峻攻，多有一投而辄毙者矣，必须戒之！
治痘之家，既谨其始，又须慎其终。盖痘之危险者有二∶一曰毒盛，一曰体虚。当其未
出之时，或三五日而速毙者，皆毒盛也。及结痂还元之后，或误投一药，误进一饮食而辄毙
者，皆因体虚也。毒盛欲出不出者，能顺其势而导之使出，不妄施解毒以阻遏拂逆之，则未
必致毙，故前论再三告戒，深为谨始者虑也，其体虚者，能察其虚而补养之，又防其虚而不
峻攻之，则可保无虞。惟玩其收结还元，而忽意不加谨者，多致误事。故又深为慎终者警也
痘疹发出后八九天，脓浆充满，颜色呈苍黄色，如果没有其他症状，可以不用药物治疗。如果痘疹出得稠密，但脓液不够充盈，此时饮食大多减少，痰液很多，使用养胃开痰汤。口渴的，去掉法半夏，加入麦冬八分，北五味子九粒。呕吐逆气的，加入藿香、砂仁三分。在灌脓阶段，忌用白术、茯苓、半夏，恐怕它们燥干精液，导致脓浆运行不畅。到了即将结痂的时候，就可以使用了。
此时如果有呃逆的情况，俗称“呃”，是胃气上逆的表现。取真黄土放在鼻边闻其气味，呃逆即可停止。此时痘浆已满，有时被寒气所伤。一时之间痘疹全部变成紫黑色，像紫卜闻色一样，不必惊恐，急忙用上好肉桂磨成汤或煎成汤，服用后立即见效。如果原本就有寒战咬牙的症状，这是真气外发而内部虚寒所致，适宜用建中汤，服一次立即停止。严重的不过两次。在收靥（结痂）之后出现寒战咬牙的，也按此法调治。有人曾说寒战咬牙，有热证也有寒证，如痘色红紫，一齐涌出，身体发热，烦躁，作渴，大便秘结，小便涩赤，脉象洪数，这是热证。因为胃热则咬牙，肺热则寒战。如果痘色淡白，皮薄顶陷，身体凉爽怕冷，大小便通畅，脉象沉迟，这是寒证。因为胃寒则咬牙，肺寒则寒战。这种说法是正确的。然而此症属寒的占十分之九，属热的占十分之一，所以在七八日之前，还有属热的情况出现，到了七八日之后，属热的就很少了，因此不为热证专门立方的原因。
在九十天内，脓足且颜色苍黄的，并且一定会有发热熏蒸的感觉，这是回水（痘浆吸收转化）的征候。因为真阳运化，水分自然消退。那些元气不足的，就不能及时回水，应当结痂而不结痂，这是虚寒症。必然身体凉爽而手脚冰冷，必须大补气血，以助其收结，适宜用温表调中汤为主治疗。
那些有发热熏蒸，应当结痂而不结痂的，是毒瓦斯未解。退去热邪则痘疹自然收敛。适宜用清表散毒汤，或者用砂糖半酒杯，用滚开水调成一碗，温服，称为甘露回天饮，能使热退痘收。但是毒势旺盛的，恐怕未必有效。
痘疹结痂时，有外部溃破而脓水淋漓不断的，称为水靥。用新瓦粉调和鸭蛋清敷在上面，立即收敛脱落。
当结痂时，有忽然腹痛，痛处在中脘穴部位，这是热毒凝滞，瘀血作痛。适宜用消毒散血汤。如果结痂浓实，没有其他症状的，不必服药。
结痂后，发热或烦渴的，应当辨别寒、热、虚、实来调治。发热壮盛，胸腹手足头面都热，大便秘涩，小便赤涩的，是余毒盛。当即解毒，如果解毒迟缓，则痂落后必然发生痈毒。急忙用大连翘饮来解除，大便仍然秘结的，加熟大黄五分。
如果发热稍缓，头热面不热，手脚心热，手脚背不热，精神困倦，大小便通畅的，是虚热。适宜用补中益气汤，口渴的加麦冬一钱，五味子九粒。
痂落还元，或者痂落一半后，忽然遍身大热，余毒欲发为痈肿。或者手足四肢头顶胸背有一两处更严重的，就是痈肿所在的地方。这在脓浆不满，而痂浮薄速收速落的情况下多有发生，急忙用大连翘饮来退热。大便秘结的，加酒炒大黄轻微通便。如果热不退，须连续服用几剂，热退身凉，才可以内消。
此时又有忽然头顶剧烈疼痛的，是余毒上攻。也可能因多服热药所致，如果不急治，毒必注入眼目，而眼病大作。适宜用大连翘饮，去掉木通、车前子、滑石，加入升麻、桔梗六分，川芎、薄荷四分，服用几剂以解散上攻之毒，则眼患可免。
痂落后，有精神困倦，饮食减少，胸腹头项手足心发热而烦渴的，是内虚。仍用补中益气汤为主治疗。或者有虽然不发热，而倦怠嗜卧，不思饮食，或者手脚冷，或者津液少而渴，或者瘢痕白不红，都是内虚的症状。也适宜用补中益气汤为主治疗。不然，恐怕产生其他变故。
须知出痘多的，在收结之时，还元之后，五脏真气发泄已多，一身血气耗散已甚，虽然可能毒气未净，但其真气极虚，所以用凉药解毒，必须用酒炒制。体质弱的，或者时常加入人参、[缺字，推测为黄芪]、当归、芍药之类，以救血气，切不可因其有热症而随即投以生三黄、生栀子、大黄、石膏之类。此时正气微弱，用寒凉峻猛攻伐，多有一服药就死亡的，必须戒除！
治疗痘疹的人家，既然谨慎于开始，又必须谨慎于结束。大概痘疹的危险有两点：一是毒盛，一是体虚。当其未出之时，或三五天就迅速死亡的，都是毒盛。等到结痂还元之后，或误投一药，误进一饮食就死亡的，都是因为体虚。毒盛想出不出的，能顺应其势而引导它出来，不妄加解毒以阻遏拂逆它，则未必致死，所以前论再三告诫，是为谨慎开始者考虑；那些体虚的，能观察其虚而补养它，又防止其虚而不峻猛攻伐它，则可以保证无忧。只有玩弄其收结还元，而疏忽大意不加谨慎的，多导致误事。所以又深深警示谨慎结束的人。
After the smallpox rash has emerged for eight or nine days, if the pustules are full of pus and have a grayish-yellow color, and there are no other symptoms, medication may be omitted. If the rash is dense but the pus is not sufficiently filled, and at this time dietary intake is significantly reduced with excessive phlegm, use Yangwei Kaitan Decoction (Stomach-Nourishing and Phlegm-Resolving Decoction). For thirst, remove Banxia (Pinellia Rhizome) and add Maidong (Ophiopogon Tuber) 8 fen, Beiweizi (Schisandra Berry) 9 grains. For vomiting and reflux, add Huoxiang (Patchouli Herb) and Sharen (Amomum Fruit) 3 fen. During the stage of pus formation, avoid using Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), and Banxia (Pinellia Rhizome), lest they dry up the essence fluids and hinder the flow of pus. When approaching the scabbing stage, these herbs may then be used.
At this time, if there is hiccups (e ni), commonly known as "e," which indicates stomach qi rebelling upward, take Zhen Huangtu (True Yellow Earth) and smell it near the nose to stop it immediately. At this stage, when the pustules are full, they may sometimes be affected by cold. Suddenly, all pustules turn purple-black, resembling the color of "Zi Bu Wen." There is no need for panic; urgently grind or decoct high-quality Rougui (Cinnamon Bark) in water and administer it for immediate effect. If the patient previously experienced chills and teeth grinding, this is due to true qi emerging externally while internal deficiency-cold exists; Jianzhong Tang (Middle-Building Decoction) is appropriate, stopping the symptoms after one dose. Severe cases may require no more than two doses. Chills and teeth grinding occurring after the scabbing phase should be treated similarly. Some argue that chills and teeth grinding can be either heat or cold patterns: if the rash is red-purple, erupts simultaneously, accompanied by fever, restlessness, thirst, constipation, dark scanty urine, and a surging-rapid pulse, it is a heat pattern. This is because stomach heat causes teeth grinding, and lung heat causes chills. If the rash is pale white, with thin skin and depressed centers, cool body temperature, aversion to cold, normal bowel and bladder movements, and a deep-slow pulse, it is a cold pattern. This is because stomach cold causes teeth grinding, and lung cold causes chills. This explanation is correct. However, nine out of ten such cases belong to cold, and only one out of ten to heat. Before the seventh or eighth day, heat patterns may still appear, but after the seventh or eighth day, heat patterns become rare; hence, no specific formula is provided for heat patterns.
Within ninety days, if the pustules are full and grayish-yellow, accompanied by steaming fever, this indicates the "returning water" phase (absorption and transformation of pus). True yang facilitates metabolism, causing the fluid to dissipate naturally. Those with insufficient yuan qi cannot complete this process on time, resulting in failure to scab when expected; this is a deficiency-cold syndrome. Symptoms include a cool body and cold extremities. One must greatly tonify qi and blood to assist consolidation, using Wenbiao Tiaozhong Decoction (Warm Exterior and Regulate Middle Decoction) as the primary treatment.
If there is steaming fever yet failure to scab when expected, it indicates unresolved toxic vapors. Clearing the heat will allow the rash to resolve naturally. Use Qingbiao Sandu Decoction (Clear Exterior and Disperse Toxicity Decoction), or mix half a wine cup of sugar with boiling water to make one bowl, drink warm. This is called Ganlu Huitian Yin (Sweet Dew Heaven-Returning Drink), which can reduce heat and promote scabbing. However, in cases of severe toxicity, efficacy may be limited.
During scabbing, if external ulceration occurs with continuous dripping of pus, it is called "Shui Ye" (Water Scab). Apply a paste of Xin Wa Fen (New Tile Powder) mixed with duck egg white to the area for immediate drying and shedding.
When scabbing begins, sudden abdominal pain localized at Zhongwan (CV12) indicates stagnation of heat-toxin and blood stasis causing pain. Use Xiaodu Sanxue Decoction (Detoxify and Dispel Blood Stasis Decoction). If the scabs are thick and solid without other symptoms, medication is unnecessary.
After scabbing, if fever or irritability/thirst occurs, differentiate between cold, heat, deficiency, and excess to treat. High fever with heat in the chest, abdomen, hands, feet, head, and face, constipation, and dark scanty urine indicates abundant residual toxin. Immediate detoxification is required; delay may lead to carbuncles after scab shedding. Urgently use Da Lianqiao Yin (Large Forsythia Decoction). If constipation persists, add Shu Jun (Prepared Rhubarb) 5 fen.
If fever is slightly milder, with heat in the head but not the face, heat in the palms and soles but not the backs of hands and feet, mental fatigue, and normal bowel/bladder movements, it is deficiency heat. Use Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction). For thirst, add Maidong (Ophiopogon Tuber) 1 qian and Wuweizi (Schisandra Berry) 9 grains.
After scab shedding and restoration, or halfway through shedding, sudden generalized high fever suggests residual toxin attempting to manifest as carbuncles. More severe heat in the limbs, head, chest, or back indicates the location of the carbuncle. This often occurs when pus was insufficient and scabs were thin, falling quickly. Urgently use Da Lianqiao Yin to reduce heat. For constipation, add Jiu Chao Dahuang (Wine-fried Rhubarb) to induce mild purgation. If fever persists, continue administration until heat subsides and the body cools, allowing internal resolution.
Sudden severe headache at the vertex indicates residual toxin attacking upward, possibly due to excessive consumption of hot medicines. Without urgent treatment, the toxin may invade the eyes, causing severe eye disease. Use Da Lianqiao Yin, removing Mutong (Akebia Stem), Cheqiancao (Plantago Seed), and Huashi (Talcum), and add Shengma (Cimicifuga Rhizome), Jiegeng (Platycodon Root) 6 fen, Chuanxiong (Ligusticum Rhizome), and Bohe (Mint Leaf) 4 fen. Administer several doses to disperse the upward-attacking toxin and prevent eye complications.
After scab shedding, mental fatigue, reduced appetite, heat in the chest, abdomen, head, neck, palms, and soles with irritability and thirst indicate internal deficiency. Continue using Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction). Even without fever, lethargy, desire to lie down, anorexia, cold extremities, dry mouth/thirst, or pale non-red scars indicate internal deficiency. Also treat with Buzhong Yiqi Tang. Otherwise, further complications may arise.
Note that patients with extensive eruptions have depleted the true qi of the five zang organs and severely exhausted their blood and qi during consolidation and recovery. Although residual toxin may remain, the true qi is extremely deficient. Therefore, when using cooling herbs for detoxification, they must be processed with wine. For weak constitutions, occasionally add Renshen (Ginseng Root), [missing character, likely Huangqi], Danggui (Angelica Sinensis Root), and Shaoyao (Peony Root) to rescue blood and qi. Do not blindly administer raw Sanhuang (Three Yellows: Rhubarb, Coptis, Scutellaria), raw Zhizi (Gardenia Fruit), Dahuang (Rhubarb), or Shigao (Gypsum) simply because heat symptoms exist. At this stage, with weak righteous qi, harsh cold-cooling attacks often result in death after a single dose; this must be strictly avoided!
Those treating smallpox must be cautious at both the beginning and the end. There are two main dangers: excessive toxicity and physical weakness. Death within three to five days before eruption is due to excessive toxicity. Death after scabbing and recovery due to erroneous medication or diet is due to physical weakness. For excessive toxicity hindering eruption, guide the pathogen outward by following its momentum rather than obstructing it with indiscriminate detoxifying herbs, preventing death. Previous discussions warned against this to protect those careful at the start. For weakness, observe the deficiency and tonify, avoiding harsh attacks to ensure safety. Neglecting caution during the consolidation and recovery phases often leads to errors. Thus, this serves as a warning for those careful at the end.