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Blisters are a sign of excess Qi and deficient Blood. This is because Lung Fire moves and damages the skin and hair, causing Qi and Blood to gather anteriorly to form blisters. Small ones resemble water droplets, large ones resemble grapes; they are white and hollow, or contain clear fluid, indicating Qi deficiency with Fire. Treatment should tonify the Spleen and Lung, and facilitate the water passages so that the Qi becomes solid naturally. Qian Yi's Yigong San (Modified Extraordinary Efficacy Powder) can be used with additions such as Plantaginis Semen (Cheqianzi, 车前子) and Alismatis Rhizoma (Zexie, 泽泻). If the blisters are purple and hollow, it indicates Blood deficiency with Heat. Qingfei Tang (Lung-Clearing Decoction) with additions of Angelicae Sinensis Radix (Danggui, 当归), Paeoniae Radix (Shaoyao, 芍药), Poria (Fuling, 茯苓), and Plantaginis Semen (Cheqianzi, 车前子) should be used to promote urination downward; thus Qi will calm and Blood will harmonize, and the blisters will naturally retract. If they are thin like bamboo membrane and are blistered by fire (Liaojiang Pao), treatment is only possible after the pus becomes foul; if the blisters rupture, death ensues.

Qi deficiency leads to sinking and collapsing; Blood deficiency leads to itching and collapse. When pustules first appear and the whole body itches, this is because the pathogenic factor desires to exit, but Wind-Cold closes the Couli (pores), causing Fire Qi to wander back and forth, resulting in itching. It is appropriate to disperse and drain Liver Wood. Once the pathogen is released and pustules emerge, the itching stops naturally. When pustules are converging and itching occurs, it is because pus has formed and toxins resolved, and Fire Qi is gradually weakening, with no inherent toxin accumulation; Shaoyao Tang (Peony Decoction) can be used. If there is constipation, Xijiao Xiaodu Yin (Rhinoceros Horn Detoxification Decoction) is indicated. During the stage of nourishing the pus, if the pustules are pale, flat, and collapsed, with reduced appetite and loose stools, clear pus and itching, and restless scratching, this is due to Spleen-Stomach weakness, dual deficiency of Qi and Blood, and disturbance by Deficient Fire; Shennai Tuo San (Ginseng Internal-Supporting Powder) is used. In severe cases, Chen Shi Muxiang San (Chen’s Costus Powder) is added as an assistant. If medication is ineffective, the prognosis is ominous. If the pustules are red-purple, dry, and stagnant, with obstruction of both bowels and bladder, thirst, irritability, full pus, and itching where scratching causes bleeding, this indicates Qi excess and Blood Heat; Siwu Tang (Four Substances Decoction) with additions of Forsythiae Fructus (Lianqiao, 连翘), Red Paeonia Root (Chishao, 赤芍), Angelicae Dahuricae Radix (Baizhi, 白芷), and Bombyx Batryticatus (Chantui, 蝉蜕) is used. In severe cases, Sixun Yin (Six-Flow Decoction) is administered to purge. If itching occurs but the patient remains mentally clear, aware of accidental scratching, or asks others to soothe the itch, this is auspicious. If itching is accompanied by mental confusion, irritability, uncontrollable speech, head shaking, chaotic limb movements, ruptured areas without blood, tightly closed or staring eyes, this is ominous. Although extensive rupture elsewhere may occur, if the pus and blood are thick and sticky, and the face remains unruptured, the essence of the Zang-Fu organs is not scattered, and Righteous Qi is not depleted, recovery is fully achievable. If facial pustules itch severely, scab immediately upon rubbing, and the patient can eat and remains mentally clear, it is treatable. Confusion indicates death. If ruptured areas have no pus or blood, do not form scabs, and appear as if lacking skin, accompanied by chills, teeth grinding, diarrhea, hiccups, and choking, it is untreatable.