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The toxic fire scalds and damages Yin-blood, causing the pustules to become dry and withered, lacking moisture. In such cases, Jiawei Danggui Huoxue Tang (Modified Angelica Sinensis Blood-Invigorating Decoction) should be used for treatment; if treatment is delayed even slightly, the progression of the disease becomes unpredictable.

[Note] Color is the outward manifestation of blood. When blood is harmonious, the skin appears moist and lustrous; when blood is depleted, it becomes dry and withered. The toxic fire of smallpox enters the blood level: mild cases present with redness, while severe cases present with scorched purple discoloration. Treatment must prioritize saving the blood, and Danggui Huoxue Tang (Angelica Sinensis Blood-Invigorating Decoction) is indicated as the primary formula.

Danggui Huoxue Tang (Angelica Sinensis Blood-Invigorating Decoction)
Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Chi Shao (Paeoniae Rubra Radix), Sheng Di (Rehmanniae Radix), Hong Hua (Carthami Flos), Zi Cao (Arnebiae Radix or Lithospermi Radix), Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Da Huang (Rhei Radix et Rhizoma).
Decoct in water and take orally.

[Folk Song] Jiawei Danggui Huoxue Tang is most effective for pustules that are dry and withered. It combines Siwu Tang (Four Substance Decoction) with Hong Hua (Carthami Flos) and Zi Cao (Arnebiae Radix or Lithospermi Radix), adding Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), and raw Da Huang (Rhei Radix et Rhizoma).

Pu Hong (Spreading Redness) often occurs due to weak Yuan Qi (Original Qi), causing blood to fail to adhere to the pustules and allowing toxic pathogens to spread diffusely. The entire skin surface turns red, and the base of the pustules is bright red; this indicates a loss of Qi's controlling function, and the prognosis for the pustules is generally ominous. For Qi deficiency, Jiuwei Shengong San (Nine-Ingredient Divine Merit Powder) is used to tonify; for excessive toxicity, Liangxue Jiedu Tang (Blood-Cooling and Toxin-Resolving Decoction) is used to clear heat and resolve toxins.

[Note] During the inflation stage, blood fully adheres to the pustules, with a tight red line binding the base underneath; this is the normal form. If Yuan Qi (Original Qi) is weak and blood fails to adhere, toxic vapors scatter diffusely, resulting in bright purple-red coloration at the base on the skin surface. This signifies the loss of Qi's controlling power and often leads to untreatable conditions. If there is Qi deficiency with slight redness of the pustules, Jiuwei Shengong San (Nine-Ingredient Divine Merit Powder) is the primary formula; if toxicity is excessive with bright red bases, Liangxue Jiedu Tang (Blood-Cooling and Toxin-Resolving Decoction) is the primary formula.

Jiuwei Shengong San (Nine-Ingredient Divine Merit Powder)
Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix, raw), Zicao Rong (Arnebiae Radix or Lithospermi Radix, fine hairs), Hong Hua (Carthami Flos), Qianhu (Peucedani Radix), Niubangzi (Arctii Fructus, stir-baked and ground), Gancao (Glycyrrhizae Radix et Rhizoma, raw), Baishao Yao (Paeoniae Radix Alba, wine-fried), Sheng Dihuang (Rehmanniae Radix Preparata).
Use large dates (Zao Ren) as a guide, decoct in water, and take orally.

[Folk Song] Jiuwei Shengong San treats Pu Hong (Spreading Redness), containing Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), and Zicao Rong (Arnebiae Radix or Lithospermi Radix, fine hairs), along with Hong Hua (Carthami Flos), Qianhu (Peucedani Radix), Niubangzi (Arctii Fructus), and Gancao (Glycyrrhizae Radix et Rhizoma), accompanied by Baishao (Paeoniae Radix Alba), Sheng Dihuang (Rehmanniae Radix Preparata), and dates.

Liangxue Jiedu Tang (Blood-Cooling and Toxin-Resolving Decoction) (See the section on Crusting and Scab Falling for the formula details.)