曰起胀。是点已定。毒瓦斯尽出时也。本乎上者上之。本乎下者下之。气血定位。毒被制
伏成
脓矣。若白不泛顶。红不敛窠。气血毒泯而为一。元气弱也。苟能察形色。验唇舌。如转柁
回流。一持而正。后 如破竹矣。
凡痘三日。先见者先起胀。后见者后起胀。根红顶白。面与目渐浮肿。鼻塞流涕。口角
涎
出。而眼蒙不欲开。顺候也。即不然而两腮间。有一二起胀悦目。顶白根红。亦顺候也。
凡起胀时。色焦紫者。毒甚也。形大皮薄。而起皱纹者。毒甚气虚也。满顶红者。血滞
也。
滞者活之。焦者清之。气虚毒甚。补而兼解散之。但面部有一二悦目可爱。用药当节。则枯
者润。薄者浓。而生意自勃勃矣。
起胀时。诸痘未起。而其中先有起虚大。色如黄金者名曰贼胀痘。痘至五日。而内外症
平。
宜该起发退红。若不起发。不退红。正气虚也。方内倍人参。加黄 。古人以此为唤浆法。
当起胀时。有一等光活可爱。娇嫩艳观。手捺之则破。灯照如琉璃。此假胀。又名空欢
喜。急救表。或可幸治。迟则必痒塌而死。
又四日起大驶。亦非吉兆。何者。表虚毒甚也。七日后肿退。倒靥。皆此之变。遇此须
分虚实预防之。
又有一等。至五日而即带黄色。假浆也。不信请以神彩办之。有神有彩者。为真浆。此
则无也。或补或泻。唯舌是准。
起胀时。痘上有小孔。不黑不白。曰蛀痘。用保元汤。加丁桂服之。其孔一密。其痘自
起。
痘出五六日眼不封鼻不塞而大孔时下气者。逆也。轻痘无妨。
大都痘出五六日。气血不分。颜色焦紫。面红肿如瓜。而痘伏。或犹烟云罩定。或舌白至唇
。湿处者曰内溃。或遍身发紫泡。或闷乱不宁。叫哭不已。腰腹犹痛。皆死症也。虽然亦有
形。色本善。调理失宜而然者。又有误饵汤药而致者。
所谓“起胀”，是指痘疹接种后，毒气完全透发出来的阶段。病势向上者则向上透发，病势向下者则向下透发，气血各归其位，毒邪被制约并化为脓液。如果痘粒白色不泛至顶端，红色不收敛于底部，说明气血与毒邪混杂不分，这是元气虚弱的表现。如果能仔细观察痘疹的形色，查验唇舌状况，就像调转船舵使水流回转一样，一旦持正纠偏，后续的恢复就会像劈开竹子一样顺利了。
凡是痘疹发出三天后，先出现的痘粒先起胀，后出现的痘粒后起胀。痘根红、痘顶白，面部和眼睛逐渐浮肿，鼻塞流涕，口角流出涎水，眼睛朦胧不想睁开，这是顺证（正常的好现象）。即使不是这样，只要两颊间有一两颗起胀悦目，且顶白根红的，也属于顺证。
凡是起胀时，颜色焦紫的，说明毒邪严重。形体大但皮薄，且出现皱纹的，说明毒邪严重而正气虚弱。整个头顶都变红的，是血行滞涩。对于滞涩的要活血通络，对于焦枯的要清热凉血。如果是气虚且毒邪严重，就要在补益的同时兼用解散毒邪的方法。只要面部有一两颗看起来悦目可爱的，用药就要有节制，这样干枯的就能滋润，稀薄的就能浓密，生机自然就会蓬勃旺盛。
在起胀阶段，其他痘粒还未起来，其中先出现虚大、颜色如黄金般的，名叫“贼胀痘”。痘疹到第五天，如果内外症状平稳，应该开始起发并消退红色。如果不起了发，也不退红，说明正气虚弱。方剂中应加倍使用人参，加入黄芪。古人把这称为“唤浆法”（促使化脓结痂的方法）。
在起胀时，有一类痘疹光亮可爱，娇嫩艳丽，用手按压就破，灯光照射下像琉璃一样透明，这叫“假胀”，又名“空欢喜”。必须紧急解表治疗，或许可以侥幸治愈，拖延下去一定会因为瘙痒塌陷而死。
又有一种情况，到第四天痘疹长得非常大且急骤，这也不是吉兆。为什么呢？这是因为表虚而毒邪严重。七天后肿退、倒靥（痘疹凹陷），都是这种情况的变化。遇到这种情况必须分辨虚实进行预防。
还有一种情况，到了第五天痘疹就带上黄色，这是“假浆”（假性脓液）。不相信的话请用神采来辨别。有神采的是真浆，这种就没有神采。治疗或补或泻，以舌象为准绳。
在起胀时，痘面上有小孔，不黑不白的，叫“蛀痘”。用保元汤，加入丁香、肉桂服用。小孔一闭合，痘疹自然就会隆起。
痘疹发出五六天，眼睛没有封闭，鼻子没有堵塞，但大孔时常排气，这是逆证（不好的征兆）。轻症痘疹无妨。
大体上，痘疹发出五六天，气血混乱不分，颜色焦紫，面部红肿像瓜一样，而痘疹潜伏不起，或者像烟云笼罩固定不动，或者舌苔白直到嘴唇边缘，湿润处叫做“内溃”。或者全身发出紫泡，或者烦躁不安，哭叫不停，腰腹部疼痛，这些都是死症。虽然也有形体和颜色本来很好，但因为调理不当而导致这样的；又有误服汤药而导致的。
The term "Qi Zhang" (Swelling and Rising) refers to the stage where, after inoculation or eruption, the pathogenic toxins are fully expressed. Those originating from the upper body rise upward, while those from the lower body descend downward; Qi and Blood return to their proper positions, and the toxins are subdued and transformed into pus. If the white color does not extend to the apex and the redness does not converge at the base, it indicates that Qi, Blood, and toxins are mixed together, signifying a deficiency of Yuan Qi (Primal Qi). By carefully observing the appearance and color of the lesions and examining the lips and tongue, one can steer the course like turning a rudder against the current. Once corrected and stabilized, subsequent recovery will proceed smoothly, like splitting bamboo.
Generally, three days after the eruption of smallpox, lesions that appeared first begin to swell and rise first, while those appearing later follow suit. A lesion with a red base and white apex, accompanied by gradual swelling of the face and eyes, nasal congestion, runny nose, salivation from the corners of the mouth, and eyes that are hazy and reluctant to open, constitutes a favorable prognosis (Shun Hou). Even if this is not the case, if there are one or two lesions on the cheeks that look pleasing, with a white apex and red base, it is also considered a favorable prognosis.
If the color is scorched purple during the swelling phase, it indicates severe toxicity. If the lesions are large but thin-skinned and wrinkled, it indicates severe toxicity combined with Qi deficiency. Redness covering the entire crown indicates blood stasis. For stasis, promote circulation; for scorched/dry conditions, clear heat. In cases of Qi deficiency with severe toxicity, tonify while simultaneously dispersing the pathogens. As long as there are one or two pleasing-looking lesions on the face, medication should be administered with restraint. This way, dry lesions will become moist, and thin ones will become dense, allowing vitality to flourish naturally.
During the swelling phase, if other lesions have not yet emerged, but one appears prematurely, large and empty, with a golden-yellow color, it is called "Zei Zhang Dou" (Thief Swelling Pox). By the fifth day, if internal and external symptoms are stable, the lesions should begin to rise and the redness should recede. If they fail to rise and the redness persists, it indicates deficiency of righteous Qi. In the prescription, double the dosage of Renshen (Ginseng Root) and add Huangqi (Astragalus Root). Ancients referred to this method as "Huan Jiang Fa" (Method to Summon Pus).
During the swelling phase, some lesions may appear bright, lovely, tender, and glamorous, bursting upon touch and looking transparent like glass under a lamp. This is called "Jia Zhang" (False Swelling), also known as "Kong Huan Xi" (Empty Joy). Emergency treatment to release the exterior is required; otherwise, delay will inevitably lead to death due to itching and collapse.
Another condition is when, by the fourth day, the lesions grow excessively large and rapid, which is not an auspicious sign. This occurs due to exterior deficiency and severe toxicity. Swelling subsiding and inversion (Dao Ye) after seven days are variations of this pattern. In such cases, one must distinguish between deficiency and excess to prevent complications.
Another scenario involves lesions turning yellow by the fifth day, indicating "Jia Jiang" (False Pus). One can verify this by observing the spirit and luster. Lesions with spirit and luster contain true pus; those without do not. Treatment, whether tonifying or purging, should be guided by the tongue diagnosis.
During the swelling phase, if small holes appear on the lesions, neither black nor white, it is called "Zhu Dou" (Moth-eaten Pox). Treat with Baoyuan Tang (Protect the Origin Decoction) supplemented with Dingxiang (Clove) and Rougui (Cinnamon Bark). Once the holes close, the lesions will naturally rise.
If, five to six days after eruption, the eyes remain unsealed, the nose unblocked, but air frequently escapes through large pores, it is a counter-prognosis (Ni Zheng). This is acceptable in mild cases of smallpox.
Generally, five to six days after eruption, if Qi and Blood are disordered and indistinguishable, the color is scorched purple, the face is swollen and red like a melon, and the lesions remain flat or obscured like smoke clouds, or if the tongue coating extends white to the lips, and the moist areas indicate "Nei Kui" (Internal Ulceration); or if purple blisters erupt all over the body, accompanied by restlessness, incessant crying, and pain in the waist and abdomen, these are fatal signs. However, there are cases where the original form and color were good, but deterioration occurred due to improper care, or due to the administration of incorrect herbal decoctions.