痘壳圆融浆不行，有虚有实要分明，根色淡白血虚弱，紫紧由于血热凝。《千金》内
托同四物，因证施治莫迟停。
【注】痘至行浆时，头面周身，外虽胀而内实无浆，名曰空壳。当别虚实治之∶如根
色淡白者，此血虚不能化毒成浆也，宜《千金》内托散；根紧而紫者，此气行血滞，毒
热伏于血分，而不能成浆也，宜加味四物汤治之。
\r空壳无浆图\p03-b24a38.bmp\r
《千金》内托散（方见见点证治）
加味四物汤
生地（酒洗） 川芎 白芍（酒炒） 当归（酒洗） 连翘（去心） 紫草茸（酒洗）
水煎服。
【方歌】加味四物汤，当归生地黄，川芎白芍药，紫茸连翘良。
痘根虽红顶塌陷，此证多缘气虚见，面白肢冷食懒尝，虚烦便溏身怠倦。急用补中
益气汤，气充顶升浆充贯。
【注】陷顶者，由中气微弱，不能振扬，故灌浆时，根虽红润，顶却微塌。现证面白
肢冷，不思饮食，虚烦便溏，身体怠倦也。治宜补气为主，用补中益气汤，则气足浆升，而顶自起矣。
\r痘顶塌陷图\p03-b24a39.bmp\r
补中益气汤
黄 （蜜炙） 白术（土炒） 人参 升麻（炒） 柴胡（炒） 陈皮 甘草（炙） 当归身
引用煨姜，大枣，水煎服。
【方歌】补中益气效如神，黄 白术共人参，升麻柴胡陈皮草，煨姜大枣及归身。
The pustule shell is round and smooth, yet the pus fails to circulate; one must clearly distinguish between deficiency (Xu) and excess (Shi). A pale root color indicates blood deficiency, while a purple and tight appearance results from heat in the blood causing coagulation. Refer to Neituo San (Internal Support Powder) from *Qianjin Fang* combined with Siwu Tang (Four Substances Decoction), and treat according to the specific syndrome without delay.
[Note] When the pustules reach the stage of filling with pus, the head and entire body may appear swollen externally, but internally there is actually no pus. This condition is named "Empty Shell" (Kongke). One must differentiate between deficiency and excess to treat it: If the root color is pale white, this is due to blood deficiency failing to transform toxins into pus; *Qianjin Neituo San* is appropriate. If the root is tight and purple, this is due to qi stagnation leading to blood stasis, with toxic heat lurking in the blood level, preventing pus formation; Jiawei Siwu Tang (Modified Four Substances Decoction) is appropriate.
Neituo San from *Qianjin Fang* (Formula see section on Treatment of Spot Appearance Syndrome)
Jiawei Siwu Tang (Modified Four Substances Decoction)
Shengdi Huang (Rehmanniae Radix Praeparata, washed with wine) Chuanxiong (Ligustici Chuanxiong Rhizoma) Baishao (Paeoniae Radix Alba, fried with wine) Danggui (Angelicae Sinensis Radix, washed with wine) Lianqiao (Forsythiae Fructus, heart removed) Zicao Rong (Arnebiae Radix seu Rhizoma, washed with wine)
Decoct with water and take orally.
[Fangge - Formula Song] Jiawei Siwu Tang consists of Danggui and Shengdi Huang, Chuanxiong and Baishao, supplemented with Zirong and Lianqiao for good effect.
Although the pustule root is red, the apex collapses; this syndrome often arises from qi deficiency. Symptoms include a pale face, cold limbs, poor appetite, mental restlessness (deficiency-type vexation), loose stools, and physical fatigue. Urgently use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); once qi is replenished, the apex will rise and the pus will fill completely.
[Note] "Collapsed Apex" occurs because the middle qi is weak and cannot uplift, so during the pus-filling stage, although the root is ruddy, the apex slightly collapses. Presenting symptoms are pale face, cold limbs, lack of desire to eat, deficiency-type vexation, loose stools, and bodily fatigue. Treatment should focus on tonifying qi using Buzhong Yiqi Tang; thus, when qi is sufficient, pus rises, and the apex naturally lifts.
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction)
Huangqi (Astragali Membranacei Radix, honey-fried) Baizhu (Atractylodis Macrocephalae Rhizoma, soil-fried) Renshen (Ginseng Radix) Shengma (Cimicifugae Rhizoma, stir-fried) Chaihu (Bupleuri Radix, stir-fried) Chenpi (Citri Reticulatae Pericarpium) Gancao (Glycyrrhizae Radix et Rhizoma, roasted) Dangguishen (Angelicae Sinensis Radix, the root body)
Use Wei Jiang (Gingerum Zingiberis Preparatum) and Dazao (Ziziphi Jujubae Fructus) as guides; decoct with water and take orally.
[Fangge - Formula Song] Buzhong Yiqi Tang works like a spirit; Huangqi, Baizhu, and Renshen together; add Shengma, Chaihu, Chenpi, and Gancao; along with Wei Jiang, Dazao, and Dangguishen.