血热痘症初发，身体如烙，而热毒弥盛则毒瓦斯无所分消。治宜重用升提发散，使毒
以达表而从外解，引以渗泄疏利，使热得以润下，而从内治，佐以清凉解毒行血凉血之
剂，则痘虽稠密，亦能消散，自易火而易化也。所谓轻其表而凉其内，平其实而清其
热，故痘有安表、和中、解毒三者。如初发热及见点之际，毒瓦斯壮盛，或外为风寒所
抑，或肌肉粗浓，腠理坚闭，肌窍不通。经络阻塞，使清气不得引毒达表，循窍而出，
则热毒壅塞于内。为腹胀，为喘急，为秘结，为狂烦，为惊搐，为失血，皮燥毛直，
喘急眼胀，睡卧不宁，惊啼多哭，此皆热毒拥遏之症，辨认不差，并即以羌活散郁汤投
之，盖用川芎、羌话、白芷、防风，有升提发散之力，桔梗有开提匀气之能，荆芥、连
翘、鼠粘，善解郁热，地骨皮消拥热于筋骨之间，且能整肃脏腑，紫草滑肌通窍，大腹
皮引热下行，甘草和中解毒。如此数味，则既能发散开提，而又得透肌和解，使热毒不
拥而其出自易。若骤用寒凉，如芩、连升麻之类，则热为寒气所抑，不得伸越而必逗遛
经络，退则冰伏陷害，还为痈疽。至于热拥神倦而误用参 ，补益于热毒未浆之前，是
以实助实邪，得补而愈盛也。至成热毒吐泻而误投肉蔻诃子，温里敛涩之剂，是以热助
热毒，得温而愈亢，变症百出，岂其治哉！及至血泡已成，气血定位，头顶白光，势将
充灌，血热之势已清，火毒之郁既解，久宜毋热清凉，另为斟酌可也。
血热型痘症在初发阶段，患者身体感觉像被火烙一样灼热，如果此时热毒过于强盛，体内的毒气就无法通过正常途径分散和消除。治疗应当重用具有升提和发散作用的药物，使毒邪能够透达体表并从外部解除；配合使用具有渗湿泄热、疏通利导作用的药物，使热邪得以向下滋润排泄，从而从内部进行治疗；再辅以清凉解毒、行血凉血的药剂，那么即使痘疹密集稠厚，也能逐渐消散，使病情由危重转为轻浅，由难治转为易愈。这就是所谓的“轻疏表邪而凉清内热，平抑实邪而清除热毒”，因此治疗痘症有安固表里、调和脾胃、解毒祛邪这三个方面。
如果在初起发热以及痘点刚出现的时候，毒气正处壮盛阶段，或者外受风寒邪气压制，或者患者肌肉粗厚致密，腠理（皮肤纹理及汗孔）坚固闭塞，肌窍不通畅，经络阻塞，导致清气无法引导毒邪透达体表、循着孔窍排出，热毒就会壅塞在体内。这会导致腹胀、喘急、便秘、狂躁烦闷、惊厥抽搐、出血、皮肤干燥、毫毛直立、眼胀、睡眠不安、惊哭啼叫等症状。这些都是热毒郁遏阻滞的表现，只要辨认准确，就立即投用羌活散郁汤。该方使用川芎、羌活、白芷、防风，具有升提发散的功效；桔梗具有开提肺气、调匀气机的作用；荆芥、连翘、牛蒡子善于解除郁结之热；地骨皮能消除筋骨间的郁热，并且能调理脏腑；紫草能使肌肤滑润、通利孔窍；大腹皮引导热邪下行；甘草调和脾胃、解毒。这几味药配合使用，既能发散开提，又能透达肌表、和解邪气，使热毒不致郁遏，毒邪排出就容易了。
如果突然使用寒凉药物，如黄芩、黄连、升麻之类，热邪会被寒气所抑制，不能舒展升越，必然滞留于经络之中，一旦退却就会像冰伏一样造成危害，进而转化为痈疽。至于因热毒郁闭导致精神疲倦，却误用人参等补益药物，这是在热毒尚未成熟化脓之前进行补益，是以实证助长实邪，得到补益后邪气反而更加旺盛。等到热毒导致呕吐腹泻时，又误投肉豆蔻、诃子等温里收敛涩肠的药物，这是以温热助长热毒，得到温补后热势更加亢盛，变证百出，这哪里算是正确的治疗呢！
等到血泡已经形成，气血定位，头顶出现白光，病势即将充灌满溢，此时血热的势头已经清除，火毒的郁结已经解开，长久以来不宜再用清凉药物，需要另外斟酌调整治疗方案。
In the initial stage of blood-heat type smallpox (or variola), the patient's body feels as hot as if branded by fire. If the heat-toxin becomes excessively vigorous, the toxic qi fails to disperse and dissipate properly. The treatment should prioritize heavy use of herbs with ascending and dispersing properties to guide the toxin to the exterior for resolution from outside; combined with agents that promote diuresis and unblocking to allow heat to descend and moisten, thereby treating it from within; and assisted by cooling, detoxifying, blood-invigorating, and blood-cooling formulas. Even if the pustules are dense and crowded, they can resolve, transforming a difficult condition into an easy one, and a severe state into a mild one. This is referred to as "lightly releasing the exterior while cooling the interior, pacifying excess while clearing heat." Therefore, treating smallpox involves three aspects: stabilizing the exterior, harmonizing the middle jiao, and detoxifying.
At the onset of fever and when spots first appear, if the toxic qi is vigorous, or if it is suppressed by external wind-cold, or if the muscles are thick and dense with tight pores and obstructed skin apertures, the meridians become blocked. This prevents clear qi from guiding the toxin to the surface and exiting through the apertures, causing heat-toxin to stagnate internally. Symptoms include abdominal distension, panting and urgency, constipation, mania and restlessness, convulsions, hemorrhage, dry skin with erect hair, eye swelling, restless sleep, startled crying, and frequent weeping. These are all signs of heat-toxin obstruction. Once correctly identified, Qianghuo San Yu Tang (Notopterygium Decoction for Dispersing Stagnation) should be administered immediately. It uses Chuanxiong Rhizoma (Chuanxiong), Notopterygii Rhizoma et Radix (Qianghuo), Angelicae Dahuricae Radix (Baizhi), and Saposhnikoviae Radix (Fangfeng) for their ascending and dispersing power; Platycodonis Radix (Jiegeng) to open and regulate qi; Schizonepetae Spica (Jingjie), Forsythiae Fructus (Lianqiao), and Arctii Fructus (Niubangzi) to resolve stagnant heat; Lycii Cortex (Digupi) to clear heat in the bones and vessels and regulate the zang-fu organs; Leonuri Herba (Zicao) to smooth the skin and open apertures; Arecae Pericarpium (Dafupi) to guide heat downward; and Glycyrrhizae Radix et Rhizoma (Gancao) to harmonize the middle and detoxify. With these ingredients, the formula both disperses and ascends, penetrates the muscle layer, and harmonizes, ensuring heat-toxin does not stagnate and exits easily.
If cold-natured herbs such as Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), or Cimicifugae Rhizoma (Shengma) are used abruptly, the heat will be suppressed by the cold, unable to expand and rise, thus lingering in the meridians. When it retreats, it becomes frozen like ice, causing harm and potentially turning into carbuncles and sores. Furthermore, if a patient presents with mental fatigue due to heat-toxin stagnation but is mistakenly given Ginseng Radix et Rhizoma (Renshen) for tonification before the pus has formed, this aids the excess pathogen with tonification, making the evil more vigorous after supplementation. When vomiting and diarrhea occur due to heat-toxin, administering warming and astringent agents like Myristicae Semen (Roudoukou) and Terminaliae Chebulae Fructus (Hezi) further fuels the heat-toxin with warmth, causing the heat to become hyperactive. This leads to myriad complications, which is certainly not proper treatment.
Once blood blisters have formed and the qi and blood have settled in position, with white light appearing on the crown indicating impending fullness, the momentum of blood-heat has cleared, and the depression of fire-toxin has been resolved. At this stage, prolonged use of cooling agents is inappropriate, and the treatment plan requires careful reconsideration.