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Chen stated: Whenever smallpox eruptions are slow to appear, it mostly belongs to deficiency syndromes. If mistakenly considered as excess heat and toxin accumulation, and wrongly administered with purgative or draining medicines, it will cause the internal organs to suffer from cold, leading to stagnation of Ying (Nutritive) and Wei (Defensive) Qi, preventing them from circulating to the skin and muscles. Consequently, the eruptions cannot rise and fill out, nor can they solidify into scabs. Eventually, the patient will die from itching, restlessness, panting, and thirst.

Xue stated: The aforementioned conditions may also arise from excessive heat in various meridians, causing obstruction and slow eruption; or from severe toxins forming pustules that fail to rise; or from residual toxins causing ulceration and itching. One must carefully examine the etiology before prescribing medication.

Jingyue (Zhang Jiebin) stated: Both previous statements are reasonable. However, cases of delayed appearance and failure to rise are most commonly due to internal deficiency of Qi and Blood, which cannot reach the surface quickly. Cases caused by external closure of Wind-Cold, or toxins retained in pustules, do occur but are rare. Cases caused by excessive heat in various meridians obstructing eruption are even rarer. Why? Because when heat is excessive, the toxin must be severe; when the toxin is severe, the disease process tends to be rapid, appearing either densely or early, without delay. Therefore, in treating such cases, one must observe the degree of heat to differentiate between excess and deficiency, and check for the presence of external pathogens to differentiate between exterior and interior. If there are no external pathogens, no pustules, and the fire pathogen is not severe, it entirely belongs to deficiency syndromes, suitable for warming and tonifying methods. One must avoid杂乱 (mixed/disordered) treatments to prevent future complications. Detailed treatment methods are reported in the "Three Days of Smallpox Treatment" section.

In observing smallpox, the goal is for eruptions to appear completely; incomplete appearance is called "Fu" (Lagging/Trapped). The goal is for eruptions to rise thoroughly; incomplete rising is called "Dao Xian" (Inverse Collapse). The goal is for crusting to be clean; unclean crusting is called "Dao Ye" (Inverse Crusting). "Fu" has only one syndrome type, while "Xian" (Collapse) has several types. When toxins are trapped, it occurs before the eruptions become vigorous. Although eruptions appear, the fever does not decrease slightly, accompanied by irritability/thirst or restlessness/distress, indicating trapped toxins have not fully emerged. "Xian" occurs after the eruptions have become vigorous. If the blood dries up and turns black, it is called "Hei Xian" (Black Collapse); if pus fails to form yet itching occurs, or lesions break open, it is called "Dao Xian" (Inverse Collapse); if pus forms but becomes wet and rotting, skin breaks and refuses to crust over, resulting in unclean recovery, it is called "Dao Ye" (Inverse Crusting), which is also a type of collapse. These are all ominous signs. Treating these requires potent and drastic medicines; otherwise, revival is impossible. Contemporary physicians attempting to save such critical illnesses with ordinary medicines is like releasing sparrows to fight or driving sheep against tigers. For mild cases, Du Ming Dan (Life-Rescuing Pill) is appropriate; for severe cases, Shen Ying Duo Ming Dan (Divine Response Life-Rescuing Pill) is appropriate, offering a chance of survival. If black spots increase after taking medicine, it is an untreatable condition.

First, regarding smallpox with retained trapped toxins not fully emerging, syndromes vary and require differentiation. If Yuan Qi (Primal Qi) is insufficient and lacks strength to push toxins out, this indicates innate weakness and poor diet, presenting with no high fever but incomplete eruption, signifying deficiency. Shi Xuan San (Ten-Accumulation Powder) and Chan Tui Gao (Cicada Slough Paste), added with Du Sheng San (Single-Sage Powder), are indicated. If deficiency accompanies heat, Ren Shen Tou Ji San (Ginseng Penetrating-Muscle Powder) is indicated. If toxins are severe and Qi stagnation traps toxins in collaterals, preventing eruption, the patient typically has dense/turbid constitution, high fever, and difficulty sweating, indicating excess. Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Decoction to Overcome Toxins) is indicated. If both exterior and interior are excess, with external high fever and internal constipation/restfulness, Shuang Jie San (Double-Release Powder) is indicated.

Second, regarding dry blackness, failure to rise, and inverse collapse, five syndromes should be distinguished:
1. Internal deficiency where Yang Qi cannot reach the exterior, causing eruptions to emerge then vanish, or white spots, or gray-black inverse collapse. The patient cannot nurse/eat, has abdominal distension/internal cold, cold hands/feet, vomiting/diarrhea, or chattering teeth. This is internal deficiency. Rapidly warm the middle. Mild cases: Shi Xuan San, Liu Qi Jian (Six-Qi Decoction). Severe cases: Chen's Twelve-Ingredient Yi Gong San (Extraordinary Function Powder) or Jiu Wei Yi Gong Jian (Nine-Ingredient Extraordinary Function Decoction). Externally spray Hu Su Jiu (Coriander Wine) or use Shi Quan Da Bu Tang (Complete Great Tonifying Decoction). If cold becomes warm, collapse rises, and black turns red/lively, it is a good omen. If restlessness/confusion worsens after medication, death ensues.
2. Toxin Qi is too severe, burning internally and externally, unable to reach the surface, thus sinking back inward. This causes heat, restlessness, panting, delirium, difficult urination/defecation, thirst, and abdominal distension. This is toxic inverse collapse. Mild cases: promote urination with Da Lian Qiao Yin (Large Forsythia Drink), Tong Guan San (Opening Pass Powder), or Si Shun Qing Liang Yin (Four-Compliance Cooling Clearing Drink). Severe cases: promote defecation with Cheng Qi Tang (Inherit the Qi Decoction), and externally bathe in Shui Yang Tang (Water Poplar Decoction). Good sign if eruptions appear after bowel movement, followed by Jia Wei Si Sheng San (Modified Four-Sages Powder). Survival depends on preserving Yang Qi, keeping Spleen/Stomach warm, body temperature normal, and desire for water. Death if accompanied by chills, cold body, sweating, and hot ears/buttocks.
3. External contraction of Wind-Cold, closing muscle pores, blocking blood vessels. Symptoms include body pain, slight cold limbs, spots failing to grow, or turning purple-black like hives. This is inverse trapping. Warm muscles and release the exterior using Gui Zhi Ge Gen Tang (Cinnamon Twig and Pueraria Decoction) added with Ma Huang (Ephedrae Herba) and Chan Tui (Cicada Slough), or Zi Cao Yin (Arnebia Drink). Externally spray Hu Su Jiu. Warming and dispersing Cold allows Heat Qi to circulate, and eruptions will grow naturally.
4. Due to erroneous purgation, toxin Qi enters the interior causing black collapse. First use Liu Qi Jian or Wen Wei Yin (Warm Stomach Drink) to nourish Stomach Qi. If exterior symptoms remain unresolved, subsequently use Chai Ge Gui Zhi Tang (Bupleurum, Pueraria, and Cinnamon Twig Decoction) to disperse externally; add Ma Huang for severe cases.
5. Due to unclean living quarters or contact with foul odors causing black collapse. Internally take Zi Cao Yin Zi (Arnebia Decoction), externally spray Hu Su Jiu, or use Yin Chen Moxibustion/Fumigation method, and apply Pi Xie Dan (Evil-Expelling Pill).

Third, during the rising phase, if blisters contain fluid but the color is dark/black, it is most alarming. Urgently use Liu Qi Jian added with Chuan Xiong (Ligusticum Rhizome) to invigorate Blood and Qi. When Blood and Qi are vigorous, toxins disperse and color becomes lively. Alternatively, use Shi Quan Da Bu Tang combined with Wu Jia San (Priceless Powder).

Fourth, regarding inverse crusting, one must observe the stool. If constipated with internal heat, promote drainage with Si Shun Qing Liang Yin or San Huang Wan (Three-Yellow Pill). If loose stools without internal heat, tonify with Liu Qi Jian or Shi Quan Da Bu Tang added with Fang Feng (Saposhnikovia Root) and Bai Zhi (Angelica Dahurica Root). For severe diarrhea, use Chen's Twelve-Ingredient Yi Gong San. For non-diarrheal but severe deficiency-cold, use Jiu Wei Yi Gong Jian and externally apply Bai Cao San (Decayed Grass Powder).

Fifth, there are three verification methods for treating collapse/trapping syndromes:
1. After medication, if collapsed areas swell again and gradually form pus, this is the first verification.
2. If original sores have dried but new layers emerge in empty spaces, rise, form pus, and gradually crust, this is the second verification.
3. If there is no swelling or emergence, but spontaneous diarrhea occurs passing pus and blood, while appetite and spirit remain normal, this is the third verification. Presence of verification signs indicates auspiciousness; absence indicates ominous prognosis.