夫痘疮已长，而脓浆欲成之时，专以脾胃为主。盖脾胃强，则气血充实， 自然脓浆易成，饮满坚浓，不须服药。
若脾胃弱，则气血衰少，不能周灌于身而使之作浆，是以虚软轻淡，虽有微浆，亦水而已，然脾胃之强弱，则
于食之多少得之，便之坚泻验之，食少而大便坚者，是脾胃之气犹足也。人良少而便泄泻者，是则脾胃之气
益虚也。至若大便已坚秘多日而有狂躁之机者，宜用胆导之，使气道疏通，禁卫和鬯。庶可不生他症，痘不斑
粒也。
（内有未备者悉具总论痘要门参看）
凡痘疮太密者，喉中亦有之。至成浆时，喉疮早熟，肉虚皮薄，易致破损，疮瘢
新嫩，触之即痛，痂皮粘滞，痰涎缠里，所以堵塞其间、饮食难入，勉强吞咽，则为疼
痛。是以水入则呛，谷入则呕也。如语言清亮者，可治。若声哑嗄，语言不出，咽喉溃
烂者，不可治矣。惟痘本轻疏，因伤令腹痛而呕者，宜平胃散加减主之。如因食生冷，
冷伤脾胃，是以疮变灰白而呕者，宜异攻散加减主之。如果痘出太密，喉舌皆是，以靥
时呛水吐食，且夹杂脓血痂皮疾涎而出者，宜甘桔汤加减时时饮之。如疮不透甚，脓不
满顶，忽而将靥之时，虽即不饮不食，常自呕哕者，此逆痘也。即所谓木陈叶落，弦绝
声嘶，必致失声闷乱而死。
痘疮已经长出，且脓浆即将形成的时候，治疗应专门以调理脾胃为主。因为脾胃功能强健，则气血充盈，自然容易形成脓浆，使脓液饱满、质地浓稠坚实，此时不需要服药。
如果脾胃虚弱，则气血衰少，不能周全地灌注全身从而促使脓浆生成，因此痘疮显得虚软、颜色浅淡，即使有少量的浆液，也仅仅是水而已。然而，判断脾胃的强弱，可以通过饮食量的多少和大便的干稀来验证：进食少而大便干结的，说明脾胃之气尚且充足；进食极少而大便泄泻的，说明脾胃之气更加虚弱。至于如果大便已经干结秘滞多日，并出现狂躁迹象的，适宜使用胆导法（一种通便方法），使气机通道疏通，卫气和顺畅达。这样才可以不产生其他病症，痘疮也不会变成斑疹。
（内部有不详尽之处，请参见总论痘要门参考）
凡是痘疮过于密集的，咽喉中也有痘疮。到了成浆阶段，咽喉处的痘疮早熟，肉质虚浮、表皮薄嫩，容易导致破损。疮面新嫩，触碰即痛，痂皮粘滞，痰涎缠绕其中，所以堵塞在咽喉之间，导致饮食难以进入，勉强吞咽时就会引起疼痛。因此，喝水时会呛咳，吃食物时会呕吐。如果患者语言清晰洪亮，尚可治疗。如果声音嘶哑，言语不出，咽喉溃烂的，则不可治疗。只有那些痘疮原本轻疏，因受寒邪导致腹痛而呕吐的，适宜用平胃散加减来主治。如果是因食用生冷食物，寒气损伤脾胃，导致痘疮变为灰白色并呕吐的，适宜用异攻散加减来主治。如果确实痘出得太密，咽喉舌头全是痘疮，在结痂时呛水吐食，并且夹杂脓血、痂皮和疾涎排出的，适宜用甘桔汤加减，时时饮用。如果痘疮透发不透，脓液不满顶，忽然将要结痂的时候，虽然不饮不食，却经常自发性地干呕呃逆，这是逆证痘疮。也就是所谓的“树老叶落，弦断声嘶”，必然会导致失声、神志昏乱而死。
When the smallpox lesions have emerged and the pus is about to form, treatment should focus primarily on the Spleen and Stomach. This is because if the Spleen and Stomach are strong, Qi and Blood will be abundant, allowing pus to form naturally; the pus will be full and thick, requiring no medication.
If the Spleen and Stomach are weak, Qi and Blood will be deficient, unable to circulate fully throughout the body to generate pus. Consequently, the lesions appear flaccid and pale; even if there is a slight amount of fluid, it is merely water. However, the strength or weakness of the Spleen and Stomach can be determined by the quantity of food intake and the consistency of stool: those who eat little but have hard stools possess sufficient Spleen-Stomach Qi. Those who eat very little and suffer from diarrhea have increasingly deficient Spleen-Stomach Qi. As for cases where stool has been dry and constipated for many days accompanied by signs of mania and restlessness, the Dan Dao method (a bowel-clearing technique) should be used to unblock the Qi mechanism and harmonize the Defensive Qi. This way, other complications can be prevented, and the smallpox will not transform into macules and papules.
(For details not covered here, please refer to the General Discussion on Key Points of Smallpox.)
In cases where smallpox lesions are too dense, they also appear in the throat. When reaching the stage of pus formation, the throat lesions mature early; the tissue is flaccid and the skin thin, making them prone to rupture. The fresh, tender sores are painful upon touch, with crusts that are sticky and phlegm-saliva entangled within, causing blockage in the throat. This makes swallowing difficult; forcing food down causes pain. Therefore, drinking water leads to choking, and eating food induces vomiting. If the patient’s speech is clear and resonant, the condition is treatable. If the voice is hoarse, speech is lost, and the throat is ulcerated, it is untreatable. For cases where the smallpox was originally light and sparse, but cold pathogenic factors caused abdominal pain and vomiting, Ping Wei San (Calm the Stomach Powder) with modifications should be used as the primary treatment. If the cause is consumption of raw and cold foods, injuring the Spleen and Stomach with cold, leading to the lesions turning grayish-white and vomiting, Yi Gong San (Extraordinary Attack Powder) with modifications should be used. If the smallpox is indeed extremely dense, covering the throat and tongue, and during the crusting stage, the patient chokes on water, vomits food, and expels pus, blood, crusts, and phlegm, Gan Jie Tang (Licorice and Platycodon Decoction) with modifications should be administered frequently. If the lesions fail to fully erupt, the pus does not fill the tops, and suddenly, just as crusting begins, the patient spontaneously retches and hiccups despite not drinking or eating, this is an adverse smallpox case. This is what is referred to as "old trees shed leaves, broken strings lose their sound," inevitably leading to loss of voice, mental confusion, and death.