痘当起胀渐尖圆，红润根松体厚坚，平凹嫩白为虚证，赤紫皮塌是毒残，
更有风寒滞热郁，毒不透达起发难，察痘形色分所属，合证虚实寒热参。
[注]
痘出齐之后，当渐渐根据次起胀，
其形顶尖肥圆，其色红活滋润，根脚松绽，体厚皮坚皆起胀，顺痘也，
平者，谓平扁不张，
凹者，谓顶陷不起，
嫩者，谓皮薄娇嫩，
白者，谓色白不红，此皆为气血虚弱，
赤者，深红而艳，
紫者，深赤而黯，
板者，板硬不绽，
塌者，平塌不起，
此皆毒热伤残，更有风寒外束，滞热内郁，使毒不得透出而起发也，
医者当察痘之形色，分其所属，合其病证，虚实寒热，
参详施治，庶无差谬矣。
%
保元化毒汤
平凹灰白皮嫩亮，倦怠气乏不渴烦，保元化毒参耆草，芎归查甲芷香蚕。
[注]
痘不如期起胀，若平扁顶凹，其包灰白，皮薄嫩亮，
更见倦怠气乏，不渴不烦等虚证者，
此气血虚弱，不能起发其毒也，宜用保元化毒汤主之。
(保元化毒汤) 人参 黄耆蜜炙 甘草炙 当归 南山查 穿山甲炒
白芷 木香 僵蚕研炒
川芎 引加煨姜水煎服。
%
必胜汤 归宗汤
艳红紫黯不起胀，板硬平塌不绽松，证见阳热一切证，急服必胜或归宗。
[注]
痘当起胀之时，若色艳红紫，黯而不起胀，板硬平塌，而不绽松，
更见阳热烦躁，便闭闷乱等证者，
此毒火锢滞，气血不能领载其毒也，
急用必胜汤，或归宗汤，庶或逆中求生也。
(必胜汤)方见见点证治
(归宗汤)方见发热证治。
%
苏解散
外因风寒痘不起，浅淡黯滞不润红，发热恶寒无汗表，苏解散发自然松。
[注]
痘当起胀之时，偶为风寒外袭，闭塞痘毒，不能起胀者，
其色则浅淡黯滞不润，
其证则现发热恶寒无汗，宜用苏解散透发其毒，自然松而起矣。
(苏解散) 方见见点证治。
%
宽中快□汤
伤食滞热郁不起，恶食腹热便臭粘，快□透毒加陈木，减葛蒡穗桔前蝉。
[注]
起胀之时，过于饮食，滞热内郁，痘不起胀，
其现证懒食恶食，肚皮发热，大便臭粘，宜用宽中快□汤主之，
其方即宽中透毒饮加入陈皮，木香，减去葛根，牛蒡子，
荆芥穗，桔梗，前胡，蝉蜕。
(宽中快□汤) 青皮醋炒 陈皮 枳壳炒 南山查 麦芽炒 木香 黄连生
连翘去心 厚朴炒 甘草生 引用生姜灯心水煎服。
%
The variola (smallpox) should gradually rise and become round and pointed, with a ruddy color, loose root base, thick body, and firm skin; these are favorable signs. Flatness and tender whiteness indicate deficiency syndromes, while red-purple discoloration and collapsed skin indicate residual toxic heat. Furthermore, if external wind-cold or internal stagnant heat obstructs the pathogenic factors, preventing them from being expressed, the eruption will be difficult to rise. The physician must observe the shape and color of the lesions to categorize them, and combine this with the overall syndrome differentiation regarding excess/deficiency and cold/heat to guide treatment.
[Annotation]
After the variola has fully erupted, it should gradually rise in sequence. If the shape is pointed and plump, the color is ruddy and moist, the root base is loose and spreading, and the body is thick with firm skin, these are all favorable signs of rising. "Flat" refers to lesions that are flat and not raised; "concave" refers to lesions with depressed tops that do not rise; "tender" refers to thin and delicate skin; "white" refers to pale color without redness; these all belong to Qi and Blood deficiency. "Red" refers to deep red and bright; "purple" refers to dark crimson and dull; "board-like" refers to hard and non-spreading; "collapsed" refers to flat and non-rising; these all result from toxic heat damaging the tissues. Additionally, external wind-cold binding or internal stagnant heat may prevent the toxin from being expressed, making it difficult for the eruption to rise. The physician should observe the shape and color of the lesions, distinguish their categories, integrate them with the disease manifestations, and carefully analyze the excess/deficiency and cold/heat patterns before administering treatment, thereby avoiding errors.
Bao Yuan Hua Du Decoction (Tonify Origin and Transform Toxin Decoction)
Indicated for cases where the lesions are flat, grayish-white, with tender and shiny skin, accompanied by fatigue, Qi deficiency, lack of thirst, and lack of irritability—symptoms of deficiency. The formula consists of Renshen (Ginseng Radix), Huangqi (Astragali Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), Nanshan Zha (Crataegi Fructus), Chuanshanjia (Manis Squama), Baizhi (Angelicae Dahuricae Radix), Muxiang (Aucklandiae Radix), and Jiangcan (Bombyx Batryticatus).
[Annotation]
If the variola fails to rise on schedule, presenting as flat with depressed tops, grayish-white sacs, and thin, tender, shiny skin, along with symptoms such as fatigue, Qi deficiency, absence of thirst, and absence of irritability, this indicates Qi and Blood deficiency failing to push out the toxin. Bao Yuan Hua Du Decoction should be administered.
Composition: Renshen (Ginseng Radix), Huangqi (Astragali Radix, honey-fried), Gancao (Glycyrrhizae Radix et Rhizoma, fried), Danggui (Angelicae Sinensis Radix), Nanshan Zha (Crataegi Fructus), Chuanshanjia (Manis Squama, fried), Baizhi (Angelicae Dahuricae Radix), Muxiang (Aucklandiae Radix), Jiangcan (Bombyx Batryticatus, ground and fried), Chuanxiong (Ligustici Chuanxiong Rhizoma). Administration: Add roasted ginger as a guiding herb, decoct in water, and take orally.
Bi Sheng Tang (Sure Victory Decoction) and Gui Zong Tang (Return to Origin Decoction)
Indicated when the lesions are brightly red or purple-dark, fail to rise, are board-like and flat without spreading, and are accompanied by Yang-heat symptoms such as irritability, constipation, and mental confusion. In such urgent cases, Bi Sheng Tang or Gui Zong Tang should be taken immediately.
[Annotation]
When the variola should be rising, if the color is brightly red or purple-dark, the texture is board-like and flat without spreading, and there are accompanying Yang-heat symptoms such as irritability, constipation, and mental confusion, this indicates toxic fire stagnating and blocking the Qi and Blood from carrying the toxin out. Urgently administer Bi Sheng Tang or Gui Zong Tang to seek survival amidst adverse conditions.
(Bi Sheng Tang) See "Treatment of Spots Appearance Syndrome" for the formula.
(Gui Zong Tang) See "Treatment of Fever Syndrome" for the formula.
Su Jie San (Perilla Resolving Powder)
Indicated for cases where external wind-cold prevents the variola from rising, presenting with pale, dark, stagnant, and non-ruddy colors, accompanied by exterior symptoms such as fever, aversion to cold, and anhidrosis. Su Jie San should be used to disperse and express the toxin, allowing the lesions to naturally loosen and rise.
[Annotation]
When the variola should be rising, if it is occasionally attacked by external wind-cold, causing the toxin to be blocked and unable to rise, the color will be pale, dark, stagnant, and non-ruddy. The symptoms will present as fever, aversion to cold, and anhidrosis. Su Jie San should be used to express the toxin, after which the lesions will naturally loosen and rise.
(Su Jie San) See "Treatment of Spots Appearance Syndrome" for the formula.
Kuan Zhong Kuai [?] Tang (Broad Middle Rapid [?] Decoction)
Indicated for cases caused by food injury leading to internal stagnant heat and failure of the variola to rise, presenting with aversion to eating, abdominal heat, and foul, sticky stools. The formula is Kuan Zhong Tou Du Yin modified by adding Chenpi (Citri Reticulatae Pericarpium) and Muxiang (Aucklandiae Radix), and removing Gegen (Puerariae Lobatae Radix), Niubangzi (Arctii Fructus), Jingjie Sui (Schizonepetae Spica), Jiegeng (Platycodonis Radix), Qianhu (Peucedani Radix), and Chantui (Cicadae Periostracum).
[Annotation]
During the rising phase, excessive diet can lead to internal stagnant heat, preventing the variola from rising. Presenting symptoms include anorexia, abdominal heat, and foul, sticky stools. Kuan Zhong Kuai [?] Tang should be administered. This formula is Kuan Zhong Tou Du Yin (Broad Middle and Express Toxin Decoction) with added Chenpi (Citri Reticulatae Pericarpium) and Muxiang (Aucklandiae Radix), and removed Gegen (Puerariae Lobatae Radix), Niubangzi (Arctii Fructus), Jingjie Sui (Schizonepetae Spica), Jiegeng (Platycodonis Radix), Qianhu (Peucedani Radix), and Chantui (Cicadae Periostracum).
Composition: Qingpi (Citri Reticulatae Pericarpium Viride, vinegar-fried), Chenpi (Citri Reticulatae Pericarpium), Zhike (Aurantii Fructus Immaturus, fried), Nanshan Zha (Crataegi Fructus), Maiya (Hordei Fructus Germinatus, fried), Muxiang (Aucklandiae Radix), Huanglian (Coptidis Rhizoma, raw), Lianqiao (Forsythiae Fructus, heart removed), Houpo (Magnoliae Officinalis Cortex, fried), Gancao (Glycyrrhizae Radix et Rhizoma, raw). Administration: Add fresh ginger and Dengxincao (Junci Medulla) as guiding herbs, decoct in water, and take orally.