毒化浆行领载功，脓窠充满根晕红，板黄灰滞紫黯热，地紫形焦毒热凝。根晕淡红
血亏少，顶陷灰白气不盈，皮薄浆清根无晕，气虚血缩甚分明。
【注】起胀既顺，而按日毒化浆行，乃气领血载之功也。故发时脓窠充满，根晕红活，
皆灌浆顺痘也。板黄者，谓板硬干黄，乃毒盛凝结气血也。灰滞者，谓灰白黯滞，乃毒
盛郁滞气血也。紫黯者，痘色紫黯，乃毒盛血不化脓也。地界色紫，痘形焦黑，乃毒火
灼干血液也。根脚之晕红色浅淡，乃血不足而亏少也。顶陷不起，灰白无浆，乃气不足
不充盈也。若痘皮薄、浆清、根无红晕，乃气血虚缩，其用峻补无疑也。
清毒活血汤
板灰紫黯浆不生，清毒活血地归茸，楂芍翘蒡芩连桔，木通参 大酌行。
【注】痘不如期灌浆，若板硬干黄，或灰滞紫黯干枯，此皆毒火伤其气血而浆不行也，
俱以清毒活血汤为主。其方即紫草茸、当归、木通、生地、白芍、连翘、牛蒡子、
南山楂、桔梗、黄连、黄芩、人参、黄 是也。本方中有人参、黄 ，形气怯弱者宜之；
若形气壮实者，当减去人参、黄 。便秘加大黄，临时当酌而行之可也。
清毒活血汤
紫草茸 当归 木通 生地黄 白芍（酒炒） 连翘（去心） 牛蒡子（炒研）
南山楂 桔梗 黄连 黄芩 人参 黄 （生）
引加灯心，水煎服。便秘者，加大黄。
加味归宗汤
灌浆地紫形焦黑，毒火炽盛气血凝，归宗汤内加归尾，红紫犀连山甲丁。
【注】痘当灌浆之时，地界红紫，痘形焦黑，而浆不行，此毒火炽盛，气血锢滞也。急
用归宗汤主之，本方中加归尾、红花、紫草、犀角、黄连、穿山甲、地丁。
加味归宗汤（方见发热证治）
《千金》内托散
淡红顶陷无浆脓，气血虚失领载功，《千金》内托散堪服，气充毒化自浆生。
【注】痘灌浆时，若色淡红，或顶凹陷又无脓浆者，此气血虚弱，失其领载之功，宜
《千金》内托散补之。气充毒化，而浆自生矣。
《千金》内托散（方见见点证治）
参归鹿茸汤
皮薄浆清根无晕，气虚血缩变须臾，参归鹿茸汤峻补，参归鹿茸草黄 。
【注】痘形皮薄、浆清、根色无红晕者，此气虚血缩，惟恐变在须臾也。以参归鹿茸
汤峻补气血，浆生毒化，庶得生矣。
参归鹿茸汤
人参 鹿茸（白酒炙） 归身 甘草（炙） 嫩黄 （蜜炙）
引加糯米，水煎服。
The transformation of toxic heat into pus relies on the function of Qi guiding and Blood carrying. When pustules are full and the base shows a vibrant red halo, this indicates a favorable progression of pus formation. Conversely, if the lesions appear board-like, yellow, grayish, stagnant, purple-dark, or accompanied by heat, it signifies the coagulation of toxic heat. A pale red base indicates blood deficiency; a depressed apex with grayish-white color indicates Qi insufficiency; thin skin, clear fluid, and absence of a basal halo clearly indicate severe Qi and Blood contraction.
[Note] After the swelling phase proceeds smoothly, the daily transformation of toxins into pus demonstrates the efficacy of Qi guiding and Blood carrying. Therefore, when pustules are full and the base is vibrant red during eruption, these are signs of favorable pus formation. "Board-like yellow" refers to hard, dry, yellow lesions, indicating toxin excess causing Qi and Blood coagulation. "Grayish stagnation" refers to grayish-white, dull, and stagnant appearances, indicating toxin excess causing Qi and Blood郁stagnation. "Purple-dark" refers to purple-dark lesion colors, indicating toxin excess preventing blood from transforming into pus. A purple base and scorched-black lesion shape indicate toxic fire scorching and drying the blood. A pale red halo at the base indicates insufficient and deficient blood. A depressed apex that does not rise, appearing grayish-white without pus, indicates insufficient and non-abundant Qi. If the skin is thin, the fluid is clear, and there is no red halo at the base, this represents Qi and Blood contraction, necessitating vigorous tonification without doubt.
Qingdu Huoxue Decoction (Clear Toxins and Invigorate Blood Decoction)
For lesions that are board-like, gray, purple-dark, and failing to produce pus, use Qingdu Huoxue Decoction. Ingredients include Shengdi Huang (Rehmanniae Radix), Dang Gui (Angelicae Sinensis Radix), Luzhishuang (Cornu Cervi Pantotrichum Preparatum), Shan Zha (Crataegi Fructus), Bai Shao (Paeoniae Radix Alba), Lian Qiao (Forsythiae Fructus), Niu Bang Zi (Arctii Fructus), Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Jie Geng (Platycodonis Radix), Mu Tong (Akebiae Caulis), Ren Shen (Ginseng Radix et Rhizoma), Huang Qi (Astragali Radix), and Da Huang (Rhei Radix et Rhizoma) as appropriate.
[Note] If pus formation fails to occur on schedule, presenting as hard, dry, and yellow, or grayish, stagnant, purple-dark, and dry, these conditions result from toxic fire damaging Qi and Blood, thereby obstructing pus formation. The primary formula is Qingdu Huoxue Decoction. This formula consists of Zicao Rong (Lithospermi Herba cum Cornu Cervi Pantotricho), Dang Gui, Mu Tong, Sheng Di Huang, Bai Shao, Lian Qiao, Niu Bang Zi, Nan Shan Zha, Jie Geng, Huang Lian, Huang Qin, Ren Shen, and Huang Qi. The presence of Ren Shen and Huang Qi makes this formula suitable for patients with weak constitution and Qi; for those with robust constitution, Ren Shen and Huang Qi should be omitted. If constipation is present, add Da Huang, adjusting dosage according to clinical judgment.
Qingdu Huoxue Decoction (Clear Toxins and Invigorate Blood Decoction)
Zicao Rong (Lithospermi Herba cum Cornu Cervi Pantotricho) Dang Gui (Angelicae Sinensis Radix) Mu Tong (Akebiae Caulis) Sheng Di Huang (Rehmanniae Radix) Bai Shao (Paeoniae Radix Alba) (stir-fried with wine) Lian Qiao (Forsythiae Fructus) (heart removed) Niu Bang Zi (Arctii Fructus) (stir-fried and ground) Nan Shan Zha (Crataegi Fructus) Jie Geng (Platycodonis Radix) Huang Lian (Coptidis Rhizoma) Huang Qin (Scutellariae Radix) Ren Shen (Ginseng Radix et Rhizoma) Huang Qi (Astragali Radix) (raw)
Add Deng Xin Cao (Junci Medulla) as an adjuvant, decoct in water and take orally. For constipation, add Da Huang (Rhei Radix et Rhizoma).
Jiawei Guizong Decoction (Modified Guizong Decoction)
During pus formation, if the base is purple-red and the lesion shape is scorched-black, indicating intense toxic fire causing Qi and Blood coagulation, add Dang Gui Wei (Angelicae Sinensis Radix caudex), Hong Hua (Carthami Flos), Zicao (Lithospermi Herba), Xi Jiao (Rhino Ceratoss), Huang Lian (Coptidis Rhizoma), Chuan Shan Jia (Manis Squama), and Ding Xiang (Eugeniae Flos) to Guizong Tang.
[Note] During the pus formation stage, if the base is red-purple, the lesion shape is scorched-black, and pus does not form, this indicates intense toxic fire causing Qi and Blood entrapment and stagnation. Urgently use Guizong Tang as the main treatment, adding Dang Gui Wei, Hong Hua, Zicao, Xi Jiao, Huang Lian, Chuan Shan Jia, and Di Ding (Violaris Herba) to the original formula.
Jiawei Guizong Decoction (See Heat Syndrome Treatment section for formula)
Qianjin Neituo San (Thousand-Gold Internal-Supporting Powder)
If the color is pale red, the apex is depressed, and there is no pus, it indicates Qi and Blood deficiency losing their guiding and carrying functions. Qianjin Neituo San is suitable for administration. Once Qi is abundant and toxins transform, pus will naturally generate.
[Note] During pus formation, if the color is pale red or the apex is depressed without pus, this indicates Qi and Blood weakness, resulting in the loss of guiding and carrying functions. It is advisable to administer Qianjin Neituo San for tonification. With abundant Qi and transformed toxins, pus will naturally arise.
Qianjin Neituo San (See Eruption Point Syndrome Treatment section for formula)
Shen Gui Lu Rong Decoction (Ginseng, Angelica, and Deer Antler Decoction)
Thin skin, clear fluid, and absence of a basal halo indicate Qi deficiency and Blood contraction, with changes occurring rapidly. Use Shen Gui Lu Rong Decoction for vigorous tonification. Ingredients include Ren Shen, Dang Gui, Lu Rong, Gan Cao, and Huang Qi.
[Note] Lesions with thin skin, clear fluid, and no red halo at the base indicate Qi deficiency and Blood contraction, with fear of sudden deterioration. Use Shen Gui Lu Rong Decoction to vigorously tonify Qi and Blood, allowing pus to form and toxins to transform, thereby ensuring survival.
Shen Gui Lu Rong Decoction (Ginseng, Angelica, and Deer Antler Decoction)
Ren Shen (Ginseng Radix et Rhizoma) Lu Rong (Cornu Cervi Pantotrichum) (prepared with white wine) Gui Shen (Angelicae Sinensis Radix caudex) Gan Cao (Glycyrrhizae Radix et Rhizoma) (roasted) Nen Huang Qi (Astragali Radix) (prepared with honey)
Add Mi Nan (Glutinose Oryzae Semen) as an adjuvant, decoct in water and take orally.