毒化浆行领载功，脓窠充满根晕红，板黄灰滞紫黯热，地紫形焦毒热凝，
根晕淡红血亏少，顶陷灰白气不盈，皮薄浆清根无晕，气虚血缩甚分明。
[注]
起胀即顺，而按日毒化浆行，乃气领血载之功也，
故发时脓窠充满，根晕红活，皆灌浆顺痘也，
板黄者，谓板硬干黄，乃毒盛凝结气血也，
灰滞者，谓灰白黯滞，乃毒盛郁滞气血也，
紫黯者，痘色紫黯，乃毒盛血不化脓也，
地界色紫，痘形焦黑，乃毒火灼干血液也，
根脚之晕红色浅，乃血不足而亏少也，
顶陷不起，灰白无浆，乃气不足不充盈也，
若痘皮薄浆，清根无红晕，乃气血虚缩，其用峻补无疑也。
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清毒活血汤
板灰紫黯浆不生，清毒活血地归茸，查芍翘蒡芩连桔，木通参耆大酌行。
[注]
痘不如期灌浆，
若板硬干黄，或灰滞紫黯干枯，
此皆毒火伤其气血而浆不行也，俱以清毒活血汤为主，
其方即紫草茸，当归，木通，生地，白芍，连翘，牛蒡子，南山查，
桔梗，黄连，黄芩，人参，黄耆是也，
本方中有人参，黄耆，形气怯弱者宜之，
若形气壮实者，当减去人参，黄耆，
便秘加大黄，临时当酌而行之可也。
(清毒活血汤) 紫草茸 当归 木通 生地黄 白芍酒炒 连翘去心
牛蒡子炒研 南山查桔梗 黄连 黄芩 人参 黄耆生 引加灯心水煎服。
便秘者加大黄。
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加味归宗汤
灌浆地紫形焦黑，毒火炽盛气血凝，归宗汤内加归尾，红紫犀连山甲丁。
[注]
痘当灌浆之时地界红紫，痘形焦黑，而浆不行，
此毒火炽盛，气血锢滞也，急用归宗汤主之，
本方中加归尾，红花，紫草，犀角，黄连，穿山甲，地丁。
(加味归宗汤) 方见发热证治。
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千金内托散
淡红顶陷无浆脓，气血虚失领载功，干金内托散堪服，气充毒化自浆生。
[注]
痘灌浆时，若色淡红，或顶凹陷又无脓浆者，
此气血虚弱，失其领载之功，
宜千金内托散补之，气充毒化而浆自生矣。
(千金内托散) 方见见点证治。
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参归鹿茸汤
皮薄装清根无晕，气虚血缩变须臾，参归鹿茸汤峻补，参归鹿茸草黄耆。
[注]
痘形皮薄浆清，根色无红晕者，此气虚血缩，惟恐变在须臾也，
以参归鹿茸汤峻补气血，浆生毒化，庶得生矣。
(参归鹿茸汤)
人参 鹿茸白酒炙 归身 甘草炙 嫩黄耆蜜炙 加引糯米水煎服。
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The transformation of pathogenic toxins into pus relies on the function of Qi leading and Blood carrying. When pustules are full and the base halo is red and vibrant, this indicates a normal stage of filling with fluid; if the lesions are hard and yellow, dull gray, or purple-dark with heat, it signifies congealed toxic heat; if the base turns purple and the shape scorched, it indicates stagnant toxic heat; if the base halo is pale red, it signifies blood deficiency; if the apex is depressed and gray-white, it signifies Qi insufficiency and lack of fullness; if the skin is thin, the fluid clear, and the base lacks a red halo, it clearly indicates Qi deficiency and Blood contraction.
[Note]
Swelling up marks a favorable condition, followed by the daily transformation of toxins into flowing pus, which is the merit of Qi leading and Blood carrying. Therefore, when erupting, the pustules are full and the base halo is red and lively, all indicating favorable stages of filling with fluid in smallpox. "Hard yellow" refers to lesions that are hard, dry, and yellow, caused by abundant toxins congealing Qi and Blood. "Gray stagnation" refers to gray-white, dull, and stagnant colors, caused by abundant toxins stagnating Qi and Blood. "Purple-dark" refers to purple-dark lesion color, caused by abundant toxins preventing blood from transforming into pus. "Base color purple" refers to purple-dark bases and scorched-black shapes, caused by toxic fire scorching and drying the blood. "Pale red base halo" refers to shallow red halos at the base, caused by insufficient and deficient blood. "Depressed apex" refers to sunken apices, gray-white color, and absence of fluid, caused by Qi insufficiency and lack of fullness. If the lesion skin is thin, the fluid clear, and there is no red halo at the base, this indicates Qi deficiency and Blood contraction, requiring vigorous tonification without doubt.
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Qingdu Huoxue Decoction (Clear Toxins and Invigorate Blood Decoction)
When lesions are hard, gray-white, purple-dark, and fail to produce fluid, use Qingdu Huoxue Decoction, containing Zicao Rong (Arnebiae Radix seu Rhizoma), Danggui (Angelicae Sinensis Radix), Zhake (Crataegi Fructus), Baishao (Paeoniae Radix Alba), Lianqiao (Forsythiae Fructus), Niubangzi (Arctii Fructus), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Jiegeng (Platycodonis Radix), Mutong (Akebiae Caulis), Renshen (Ginseng Radix et Rhizoma), and Huangqi (Astragali Radix), to be used as appropriate.
[Note]
If smallpox fails to fill with fluid on schedule,
and the lesions are hard and dry-yellow, or gray-white, dull, purple-dark, and dry,
these are all cases where toxic fire has damaged Qi and Blood, causing fluid failure. All should be treated primarily with Qingdu Huoxue Decoction.
This formula consists of Zicao Rong, Danggui, Mutong, Shengdihuang (Rehmanniae Radix), Baishao, Lianqiao, Niubangzi, Nanshan Zha (Crataegi Fructus),
Jiegeng, Huanglian, Huangqin, Renshen, and Huangqi.
Since this formula contains Renshen and Huangqi, it is suitable for patients with weak constitution and Qi.
For patients with strong constitution and robust Qi, Renshen and Huangqi should be removed.
In cases of constipation, Dahuang (Rhei Radix et Rhizoma) should be added, to be adjusted according to circumstances.
(Qingdu Huoxue Decoction) Zicao Rong, Danggui, Mutong, Shengdihuang, Baishao (stir-fried with wine), Lianqiao (heart removed),
Niubangzi (stir-fried and ground), Nanshan Zha, Jiegeng, Huanglian, Huangqin, Renshen, Huangqi (raw). Use Dengxincao (Junci Medulla) as an guide, decoct in water and take orally.
Add Dahuang for constipation.
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Jiawei Guizong Decoction (Modified Guizong Decoction)
During the filling stage, if the base is purple-dark and the shape scorched-black due to rampant toxic fire causing Qi and Blood stagnation, add Dangguiwei (Angelicae Sinensis Radix), Honghua (Carthami Flos), Zicao (Arnebiae Radix seu Rhizoma), Xijiao (Rhinocerotis Cornu), Huanglian (Coptidis Rhizoma), Chanshanjia (Manis Squama), and Dingxiang (Syzygii Flos) to Guizong Decoction.
[Note]
When smallpox is in the filling stage, if the base is red-purple and the shape scorched-black, yet fluid does not form,
this indicates rampant toxic fire causing Qi and Blood to be bound and stagnant. Urgently use Guizong Decoction as the main treatment.
Add Dangguiwei, Honghua, Zicao, Xijiao, Huanglian, Chanshanjia, and Dingding (Violaris Herba) to this formula.
(Jiawei Guizong Decoction) See the section on Fever Syndrome Treatment for the formula.
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Qianjin Neituo San (Thousand-Gold Internal Support Powder)
If the color is pale-red, the apex is depressed, and there is no pus or fluid, due to Qi and Blood deficiency losing their leading and carrying function, take Qianjin Neituo San. When Qi is sufficient, toxins transform, and fluid generates naturally.
[Note]
During the filling stage of smallpox, if the color is pale-red, or the apex is depressed and devoid of pus/fluid,
this indicates Qi and Blood weakness, losing their function of leading and carrying.
It is appropriate to use Qianjin Neituo San to tonify. When Qi is filled and toxins transform, fluid will generate naturally.
(Qianjin Neituo San) See the section on Appearance Stage Syndrome Treatment for the formula.
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Shengui Lurong Decoction (Ginseng, Angelica, and Deer Antler Decoction)
If the skin is thin, fluid clear, and the base lacks a red halo, with Qi deficiency and Blood contraction changing rapidly, use Shengui Lurong Decoction for vigorous tonification, containing Renshen, Danggui, Lurong (Cervi Cornu Degelatinatum), Gancao (Glycyrrhizae Radix et Rhizoma), and Huangqi.
[Note]
If the lesion shape has thin skin and clear fluid, and the base color lacks a red halo, this indicates Qi deficiency and Blood contraction, fearing rapid changes in condition.
Use Shengui Lurong Decoction to vigorously tonify Qi and Blood, so that fluid generates and toxins transform, thereby ensuring survival.
(Shengui Lurong Decoction)
Renshen, Lurong (stir-fried with white wine), Dangguishen (Angelicae Sinensis Radix), Gancao (roasted), Nen Huangqi (Astragali Radix, honey-roasted). Use Nuomi (Oryza Sativa Glutinosa Semen) as a guide, decoct in water and take orally.
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