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The term "Qi Zhang" (Swelling and Rising) refers to the stage where, after inoculation or eruption, the pathogenic toxins are fully expressed. Those originating from the upper body rise upward, while those from the lower body descend downward; Qi and Blood return to their proper positions, and the toxins are subdued and transformed into pus. If the white color does not extend to the apex and the redness does not converge at the base, it indicates that Qi, Blood, and toxins are mixed together, signifying a deficiency of Yuan Qi (Primal Qi). By carefully observing the appearance and color of the lesions and examining the lips and tongue, one can steer the course like turning a rudder against the current. Once corrected and stabilized, subsequent recovery will proceed smoothly, like splitting bamboo.

Generally, three days after the eruption of smallpox, lesions that appeared first begin to swell and rise first, while those appearing later follow suit. A lesion with a red base and white apex, accompanied by gradual swelling of the face and eyes, nasal congestion, runny nose, salivation from the corners of the mouth, and eyes that are hazy and reluctant to open, constitutes a favorable prognosis (Shun Hou). Even if this is not the case, if there are one or two lesions on the cheeks that look pleasing, with a white apex and red base, it is also considered a favorable prognosis.

If the color is scorched purple during the swelling phase, it indicates severe toxicity. If the lesions are large but thin-skinned and wrinkled, it indicates severe toxicity combined with Qi deficiency. Redness covering the entire crown indicates blood stasis. For stasis, promote circulation; for scorched/dry conditions, clear heat. In cases of Qi deficiency with severe toxicity, tonify while simultaneously dispersing the pathogens. As long as there are one or two pleasing-looking lesions on the face, medication should be administered with restraint. This way, dry lesions will become moist, and thin ones will become dense, allowing vitality to flourish naturally.

During the swelling phase, if other lesions have not yet emerged, but one appears prematurely, large and empty, with a golden-yellow color, it is called "Zei Zhang Dou" (Thief Swelling Pox). By the fifth day, if internal and external symptoms are stable, the lesions should begin to rise and the redness should recede. If they fail to rise and the redness persists, it indicates deficiency of righteous Qi. In the prescription, double the dosage of Renshen (Ginseng Root) and add Huangqi (Astragalus Root). Ancients referred to this method as "Huan Jiang Fa" (Method to Summon Pus).

During the swelling phase, some lesions may appear bright, lovely, tender, and glamorous, bursting upon touch and looking transparent like glass under a lamp. This is called "Jia Zhang" (False Swelling), also known as "Kong Huan Xi" (Empty Joy). Emergency treatment to release the exterior is required; otherwise, delay will inevitably lead to death due to itching and collapse.

Another condition is when, by the fourth day, the lesions grow excessively large and rapid, which is not an auspicious sign. This occurs due to exterior deficiency and severe toxicity. Swelling subsiding and inversion (Dao Ye) after seven days are variations of this pattern. In such cases, one must distinguish between deficiency and excess to prevent complications.

Another scenario involves lesions turning yellow by the fifth day, indicating "Jia Jiang" (False Pus). One can verify this by observing the spirit and luster. Lesions with spirit and luster contain true pus; those without do not. Treatment, whether tonifying or purging, should be guided by the tongue diagnosis.

During the swelling phase, if small holes appear on the lesions, neither black nor white, it is called "Zhu Dou" (Moth-eaten Pox). Treat with Baoyuan Tang (Protect the Origin Decoction) supplemented with Dingxiang (Clove) and Rougui (Cinnamon Bark). Once the holes close, the lesions will naturally rise.

If, five to six days after eruption, the eyes remain unsealed, the nose unblocked, but air frequently escapes through large pores, it is a counter-prognosis (Ni Zheng). This is acceptable in mild cases of smallpox.

Generally, five to six days after eruption, if Qi and Blood are disordered and indistinguishable, the color is scorched purple, the face is swollen and red like a melon, and the lesions remain flat or obscured like smoke clouds, or if the tongue coating extends white to the lips, and the moist areas indicate "Nei Kui" (Internal Ulceration); or if purple blisters erupt all over the body, accompanied by restlessness, incessant crying, and pain in the waist and abdomen, these are fatal signs. However, there are cases where the original form and color were good, but deterioration occurred due to improper care, or due to the administration of incorrect herbal decoctions.