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Xi Taishun said: Acne named "thief" (Zei Dou) mostly occurs during the stage of pus formation, or at the period of four to five days, or six to seven days after onset. At this time, Qi and Blood have not yet intersected and merged, the root of the acne has not differentiated Yin and Yang, and various acne lesions have not yet filled with fluid. Sometimes it appears on the head and face, sometimes between the waist and back, in small numbers such as three, five, or six grains, or one, two, or three grains, but individually full and plump, with a yellow and bright color; this is called thief acne. Once thief acne emerges, other acne cannot fill with fluid. It is urgent to puncture them with a silver needle. Although the pathogenic toxin may be discharged through the puncture, the toxin remains within the body. Therefore, treatment should focus on penetrating the muscle and dispersing pathogens, with particular emphasis on detoxification, which is the best approach.

Xi Taishun said: Secretive and stifled acne (Mi Men Zhi Dou) often relates to the Kidney. During fever, lower back pain and abdominal pain occur immediately, or there is soreness and numbness in both legs, making it impossible to stand upright. The eyes are open but the patient speaks deliriously, and bad breath assaults others. They drink boiling water without feeling heat, and drink ice water without feeling cold. Their spirit and qi are confused and昏沉 (dull). The acne spots resemble mosquito bites, red with a purple tint, lacking an erythematous halo, and faintly visible under the skin. By the second or third day, macules appear all over the body, either red or purple; in severe cases, large blue-green macules emerge. The Classics state: "Stomach rot causes macules; if internal organs are depleted, how can toxins exit? Even if they do, their shape resembles silkworm eggs, bran, miliaria, needles, or mustard seeds." Regardless of whether the skin and flesh are uniformly red, this is called stifled acne (Men Dou), which is absolutely incurable.

Xi Taishun said: Sha (here referring to specific morphological changes in acne/rash) is the surplus of blood. There are dot-like formations without heads, resembling mosquito bites, similar to cinnabar marks, interspersed among the lesions, forming patterns like brocade. This mostly occurs in syndromes of blood heat. Books state: "Red sha is easy to resolve; purple sha is difficult to dissipate." If large, blocky blue-green patches form, resembling snake venom entering the yin regions, it is incurable. If fine red sha dots are seen, administer frequent doses of formulas containing Coptis Rhizoma (Huanglian), Arnebiae Radix seu Lithospermi Radix (Zicao), Rhinoceros Horn (Xijiao), and Gypsum Fibrosum (Shigao). Only then might one save one in ten lives. Otherwise, turning from red to purple, the acne will inevitably dry up and invert, with frequent adverse transformations, rendering it untreatable.

Xi Taishun said: Blisters (Pao) are the surplus of Qi. Books say: "Excess Qi leads to blisters; excess Blood leads to sha." These are mostly seen during the eruptive phase, or in conditions with thin skin. If the upper acne fails to erupt, but blisters appear all over the body, large and bright, resembling the appearance of being scalded by hot water or burned by fire, colored purple or black. Upon pricking, clear fluid or purple blood may discharge. Seeing these signs indicates non-survival. Generally, this belongs to the Liver Wood system. Heavy Liver Fire stimulates the formation of blisters. Medication should employ formulas that purges Liver fire and promotes Qi circulation. When blisters subside and acne rises, the patient's condition stabilizes, and diet gradually returns, survival is possible. However, if shortness of breath and abdominal distension are seen, death is imminent, voice is lost in despair, and Yang Qi is nearly exhausted.