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Pus is a transformation of blood. When the smallpox rash first appears, it is merely a spot of blood; as it gradually rises and grows, it transforms from blood into serum (plasma), and then from serum into pus, thereby forming a solid pustule. Therefore, where there is blood, there is pus; where there is no blood, there is no pus. When the smallpox reaches the stage of filling with pus (Guannong), the general condition is already established. At this time, the presence or absence of pus is the primary criterion: life depends on the presence of pus, and death results from its absence; this is an inevitable principle. Thus, before the sixth day, if there is fever, detoxification is appropriate; if there is no fever, regulating Qi and Blood is appropriate, which will naturally lead to filling with pus. If, after the seventh day, the tops of the lesions remain depressed and fail to fill with pus, it must be due to prior improper regulation and treatment. Therefore, treatment cannot be delayed; one must wait for the serum to become sufficient to restore life. If the tops are depressed and grayish-white, with no serum or pus appearing, this indicates that both Qi and Blood have dispersed, and vitality is lost.

1. The process of smallpox filling with pus focuses primarily on the Spleen and Stomach. If the Spleen and Stomach are strong, Qi and Blood will be abundant, resulting in full, firm, and thick pus and serum, requiring no medication; if the Spleen and Stomach are weak, Qi and Blood will be deficient, leading to incomplete systemic filling. Thus, even if serum appears, it will not be full, or it may be clear, grayish-white, and unable to form pus. Even the small amount of accumulated serum remains merely initial blood-water. Serum that is too thin to transform into pus generally belongs to the pattern of severe deficiency of Qi and Blood. If not treated promptly, it will inevitably develop into internal attack and external ulceration syndromes. One should urgently use Liuwu Decoction (Six-Ingredient Decoction), or modify Liuqi Decoction (Six-Qi Decoction). Alternatively, Baoyuan Decoction (Preserve the Origin Decoction) or Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) added with human milk and good wine can be taken, which is also excellent. To distinguish the strength of the Spleen and Stomach, observe diet and bowel movements. Although food intake may be low, if stools are hard, the Qi of the Spleen and Stomach is still acceptable; slight tonification and regulation are needed, prioritizing the ability to eat. If stools are loose or diarrhea occurs, this is most alarming. For once diarrhea starts, serum formation stops; once diarrhea ceases, filling resumes. Urgently use Wenwei Yin (Warm the Stomach Infusion); for severe cases, use Chen's Twelve-Ingredient Yigong San (Extraordinary Efficacy Powder) as the main formula. If at the time when pus should form, the lesion remains an empty shell, this indicates Blood failing to adhere to Qi. Since Blood has not arrived, how can toxins be transformed? Use Wuwu Jian (Five-Material Decoction), or Siwu Tang (Four-Substance Decoction), or Zicao San (Arnebiae Herb Powder) added with Cicada Slough (Chantui). If the tops are depressed with little pus, or if they temporarily rise after taking internal-supporting medicines but then sink again, this is due to severe deficiency of Qi and Blood. Use Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) with increased doses of Ginseng Radix (Renshen), Astragali Radix (Huangqi), Angelicae Sinensis Radix (Danggui), and Glutinous Rice (Nuomi). After decocting, add human milk and good wine for administration; this is a wonderful method to assist filling.

1. Within the three days of filling with pus, if the body is cool and the rash color is grayish-white, or if the patient cannot eat, or if cold Qi rebels upward causing vomiting, or abdominal distension, or diarrhea with cold extremities, these are all patterns of pure Yin without Yang. Urgently use Baoyuan Decoction (Preserve the Origin Decoction) added with Erxian San (Two-Immortal Powder), administered continuously for several doses; for severe cases, Jiawei Yigong Jian (Nine-Ingredient Extraordinary Efficacy Decoction) or Chen's Twelve-Ingredient Yigong San (Extraordinary Efficacy Powder) can be selected. Symptoms such as chills, teeth grinding, and diarrhea are treated similarly.

1. Full filling of pus in the hands and feet indicates strong Spleen and Stomach and sufficient Qi and Blood. If the color is grayish-white, the serum is clear and thin, or the lesions are sunken and do not rise, this is due to weak Spleen and Stomach. Or, if filling is complete but some limbs remain unfilled, fear that it may eventually turn into an itching and crusting syndrome. Use Kuaiban Yu Pi Tang (Rapid Rash Dispersing Cough Suppression Decoction), or Liuqi Decoction (Six-Qi Decoction) added with Saposhnikoviae Radix (Fangfeng) and Angelicae Dahuricae Radix (Baizhi) to vent the pathogen, thus avoiding the risk of pathogen sinking inward. If toxins are not fully expelled, fear that abscesses may form at the joints after crusting.

1. Persistent itching, although attributed to deficiency of both Qi and Blood, is also due to insufficient Fire/Heat energy, hence causing itching rather than pain. Use Liuqi Decoction (Six-Qi Decoction), or Wuwu Jian (Five-Material Decoction) added with Saposhnikoviae Radix (Fangfeng), Angelicae Dahuricae Radix (Baizhi), Aucklandiae Radix (Muxiang), and Cicada Slough (Chantui) as the main formula. *Xinjian* states: "The more deficient the Qi, the more intense the itching." Use Baoyuan Decoction (Preserve the Origin Decoction) with doubled Astragali Radix (Huangqi) to support the exterior, and add a small amount of Paeoniae Radix Alba (Shaoyao) to regulate Blood; the itching will cease naturally. If itching occurs just before crusting, this is because toxins are receding, Blood is active, and new flesh is growing smoothly; this is a natural phenomenon and requires no treatment.

1. Unceasing pain during filling indicates Qi stagnation. Administer Baoyuan Decoction (Preserve the Origin Decoction) with Hawthorn Fruit (Shanzha) and Aucklandiae Radix (Muxiang) to move stagnant Qi. If the pus is abundant and full, administer Sizheng San (Four-Zheng Powder) in large doses to promote urination, and the pain will cease.

1. After the eruption of smallpox, failure to form pus presents four patterns:
- Internal deficiency preventing filling: Primarily suitable for supporting and tonifying Qi and Blood, using methods as described above.
- Wind-Cold invasion, with pathogens residing in the skin and interstices preventing filling: Suitable for warming and dispersing, using Chai Ge Gui Zhi Tang (Bupleuri and Kudzu and Cinnamon Twig Decoction) added with Astragali Radix (Huangqi) and Angelicae Dahuricae Radix (Baizhi).
- Excessive Heat-Toxin causing high fever, dry fluids, red hot urine, and preventing filling: Suitable for supporting the interior, clearing toxins, and promoting urination, using Zicao Yinzi (Arnebiae Drink) or Chen Sha Liu Yi San (Cinnabar Six-to-One Powder) to resolve it. Only after the heat subsides should Baoyuan Decoction (Preserve the Origin Decoction) be used. For severe heat, use Da Lian Qiao Yin (Large Forsythia Drink).
- Hard, hot stools, unpassed for several days, preventing filling: Suitable for using Pig Gallbladder (Zhudan) for enema to unblock Qi flow, so that Ying and Wei Qi harmonize and flow smoothly; otherwise, black depression syndrome may result.
- Contact with foul miasma preventing filling: External fumigation with Hu Su Jiu (Coriander Wine) or Pixie Dan (Evil-Dispelling Pill); internally take Zicao Muxiang Tang (Arnebiae and Aucklandia Decoction) or Zicao Kuaiban Tang (Arnebiae Rapid Rash Dispersing Decoction).

Master Cheng said: "Any case with depressed tops and no pus is a reverse syndrome. However, if the root base is ruddy and Blood has not scattered, urgently use Baoyuan Decoction (Preserve the Origin Decoction) combined with Chuanxiong Rhizome (Chuanxiong), Angelicae Sinensis Radix (Danggui), White Peony Root (Baishao), Clove Flower (Dingxiang), and Glutinous Rice (Nuomi). Decoct until ripe, add human milk and good wine, and take warm. If the color is white like crystal with no internal pus, the treatment is the same. As long as there are mixed pus-filled and non-pus lesions, it is treatable; if purely crystal-colored, death is certain. If the base is red with scattered Blood and heat, remove Dingxiang (Clove), add Baishao (White Peony Root) and Cortex Lycii (Digupi) to astringe Blood and reduce heat. If chills and teeth grinding occur, select Muxiang San (Aucklandia Powder) or Yigong San (Efficacy Powder)."

Master Cheng said: "During the vigorous stage, if smallpox erupts vigorously but the skin lacks strength, and pressing causes serum to exude, although the flesh color is not dark, this is called 'False Vigor'. By the 11th or 12th day, it will definitely fail to return serum and crust, leading to death from internal attack. Urgently use Baoyuan Decoction (Preserve the Origin Decoction) added with Dingxiang (Clove), Chuanxiong Rhizome (Chuanxiong), and Nuomi (Glutinous Rice) to raise Qi and fill with pus, leading to self-healing. This is called the 'Internal Support' method. The method of Internal Support is simply Baoyuan Decoction (Preserve the Origin Decoction) added with Chuanxiong Rhizome (Chuanxiong) and Dingxiang (Clove); there is no need to use the Internal Support formula from *Qianjin Fang*, but rather use it as an adjuvant to the base formula."

1. Just as smallpox is about to fill with pus, if dry crusts suddenly appear on the face, this is the "Reverse Depression" syndrome. Urgently use Bazhen Tang (Eight-Treasure Decoction) or Liuwu Jian (Six-Material Decoction) added with Honeysuckle Flower (Jinyinhua), Burdock Fruit (Niubangzi), Forsythia Fruit (Lianqiao), and Ephedra Stem (Mahuang). Decoct in water, and take with Dusheng San (Single-Sage Powder). After medication, if dry areas rise again to form pus, and non-dry areas become vigorous and full, or if supplementary small pox appear in empty spaces to fill them, this is the best outcome. If smallpox fails to form pus, and abscesses develop in empty spaces, this is a secondary outcome. If after three doses, dry areas do not swell, non-dry areas do not become full, and few supplementary pox appear, this is the most critical syndrome. Use Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) added with Jinyinhua (Honeysuckle Flower) for treatment.

1. If bubble-like white blisters the size of a bullet appear during filling, puncture them with a jujube thorn to drain the fluid, apply Talcum Powder (Huashi Mo) externally, and internally take Baoyuan Decoction (Preserve the Origin Decoction) added with Pomegranate Rind (Shiliupi) and Poria (Fuling) to drain fluid from the skin. If purple blisters appear, this indicates toxins overflowing onto the skin surface; this syndrome is critical.

1. For ulcers rotting in patches with non-drying pus/water, apply Talcum Powder (Huashi Mo) or Shoucao San (Gathering Grass Powder); adding Pearl Powder (Zhenzhu) is especially excellent.

1. Regarding recurrent smallpox: In areas where smallpox has broken down and ulcerated, if they swell again and refill with pus without drying out, or if a new layer erupts in originally unaffected areas, resembling the initial eruption and filling stages, this is due to residual toxins not yet exhausted. Relying on substantial interior Qi, the toxins cannot enter inwardly, so they remain on the exterior without causing reverse depression. These are favorable developments within adverse conditions. However, for smallpox to recur, the patient must be able to eat and have hard stools to withstand the renewed toxin attack, eliminating concern. If appetite is poor and stools are moist, use Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) etc. to tonify and regulate. If spontaneous diarrhea occurs, use Chen's Twelve-Ingredient Yigong San (Extraordinary Efficacy Powder) or Rou Doukou Wan (Nutmeg Pill) as the main formula. Because prolonged illness leads to Qi deficiency, only warming and tonifying are beneficial; detoxification should not be used again.