曰起胀，是点已定，毒瓦斯尽出时也。本乎上者上之，本乎下者下之。血气定位，毒
被制服成脓矣。若白不从顶，红不敛颗，气血毒混而为一，元气弱也。苟能察形色，验
唇舌，如转柁回流，一持而正，后断如破竹势矣。
凡痘三日后，先见者先起胀，后见者后起胀，顶白根红，如一颗明珠，坐于胭脂之
上，面与目渐浮肿，鼻流涕，口角涎出，眼蒙欲开不开，顺症也。即不然，两腮间，有
一二悦目起肿者，顶白根红，亦顺症也。不可妄治。
凡起胀时，色焦紫者，毒盛也。形大皮薄而起皱纹者，毒盛气虚也。顶红满者，血
滞也。滞者活之。焦者清之，气虚毒盛，补而兼解之。但面部有一二悦目可爱，用药当
节，则枯者润，薄者浓，而生意勃然矣。
方鹿村曰∶明此则虚中夹毒，非逆症可知。
痘至五日，而内外症平，宜该起发退红，不尔正气虚也。方中倍加参、 。古人以此为唤浆法也。
起胀时诸痘未起，而有一二似脓非脓，色如黄金者，名曰贼胀痘。又四日起，大快亦
非吉兆。何者？表虚毒盛也。七日后肿退倒靥，皆此之变，遇此须分虚实预防之。
起胀时，有一等光活可爱，娇嫩艳观，手揉之则破，灯照之如琉璃，此假胀也，名曰
空欢喜。急救表，或可幸活，否则痒塌而死。
又有至五日
The term "Qi Zhang" (Swelling and Rising) refers to the stage after inoculation when the pathogenic toxins have fully emerged. Pathogens tending upward will manifest upward, while those tending downward will manifest downward. At this time, Qi and Blood settle into their proper positions, and the toxins are subdued and transformed into pus. If the tops of the pustules do not turn white and the bases do not consolidate, causing Qi, Blood, and toxins to mix indistinguishably, it indicates a deficiency of Yuan Qi (Original Qi). By carefully observing the color and shape of the lesions and examining the lips and tongue, one can steer the course like turning a rudder against the current; once corrected, the 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 that appeared later follow suit. A lesion with a white top and red base, resembling a bright pearl sitting on rouge, accompanied by gradual swelling of the face and eyes, runny nose, salivation at the corners of the mouth, and eyes that are hazy and half-open, constitutes a favorable progression (Shun Zheng). Even if not all symptoms are present, if there are one or two pleasing, swollen lesions between the cheeks with a white top and red base, it is also considered a favorable progression. In such cases, no arbitrary treatment should be administered.
During the swelling phase, if the lesion color is scorched purple, it indicates excessive toxin. If the lesion is large but the skin is thin and wrinkled, it indicates excessive toxin combined with Qi deficiency. If the top is entirely red and full, it indicates blood stasis. For stasis, promote circulation; for scorching, clear heat; for Qi deficiency with excessive toxin, tonify Qi while resolving toxins. However, if only one or two lesions on the face are pleasing and lovely, medication should be used with restraint, so that dry areas become moist and thin areas become thick, thereby revitalizing life force.
Fang Lucun stated: Understanding this reveals that deficiency mixed with toxin is not necessarily an adverse condition (Ni Zheng).
By the fifth day of smallpox, if internal and external symptoms are stable, the lesions should begin to rise and the redness should subside. If this does not occur, it indicates a deficiency of healthy Qi. Therefore, in the prescription, the dosage of Renshen (Ginseng Root) and Huangqi (Astragalus Root) should be doubled. Ancients referred to this method as "Huan Jiang Fa" (Method to Summon Pus).
During the swelling phase, if most lesions have not yet risen, but one or two appear pus-like yet are golden-yellow in color, they are called "Zei Zhang Dou" (Thief Swelling Pustules). Furthermore, rapid crusting and falling off by the fourth day is also not an auspicious sign. Why? Because it indicates exterior deficiency with excessive toxin. If swelling subsides and inversion occurs (Dao Ye) after seven days, these are variations of this condition. In such cases, one must distinguish between deficiency and excess to prevent complications.
During the swelling phase, there is a type of lesion that is bright, lovely, tender, and gorgeous. It ruptures upon touch and appears transparent like glass under lamplight. This is called "Jia Zhang" (False Swelling), known as "Kong Huan Xi" (Empty Joy). Urgent treatment to secure the exterior may allow for survival; otherwise, death will result from itching and collapse.
There are also cases reaching the fifth day...