气血虚寒不振扬，灰白陷顶少脓浆，速用参归鹿茸剂，鸡冠血酒更堪尝。
【注】痘至灌浆时，其色淡白，根无红晕而顶陷者，是谓白陷。虚极则转为灰陷。由
气虚委而不振，血虚浆不能充，故一陷而不可遏也。治宜大补气血为主，宜参归鹿茸汤。
临服入鸡冠血酒，日进二三服，但得顶起浆行，方免无恙。
\r灰陷白陷图\p03-b24a40.bmp\r
参归鹿茸汤（方见灌浆证治）
鸡冠血酒
用大雄鸡一只，先将白酒一杯炖温，次刺鸡冠血数点，滴入杯中和匀，仍炖温调煎
药内服。
紫陷黑陷皆毒盛，平塌昏黯根不松，此属气血被火郁，解毒急宜用归宗。
【注】痘出稠密，颗粒碎小，根紧昏黯，顶凹下而紫者，谓之紫陷。甚而转为黑色，则
为黑陷。皆由毒火郁闭，气不宣通故也。治宜清热解毒，以归宗汤主之。
\r紫陷黑陷图\p03-b24a41.bmp\r
归宗汤（方见发热证治）
浆未充足痘板黄，顶塌成片皮硬僵，气滞血凝难灌溉，皆缘毒热侵脾乡，速服清毒
活血剂，毒化痘起转安康。
【注】板黄者，谓灌脓时浆未得半，忽然黄色突起，干燥坚硬。盖因枭毒肆害脾乡，故
气滞血凝，难以灌溉也，须用清毒活血汤治之。倘得痘起，尚可望生，若头面、颈项、眼
眶、唇上及周身黄者，则不治也。
\r板黄图\p03-b24a42.bmp\r
清毒活血汤
当归 白芍药（酒炒） 生地黄 紫草茸（酒洗） 黄芩 黄连（酒炒） 牛蒡子（炒）
南山楂 连翘（去心） 人参 黄 （生） 桔梗 木通
引用灯心，水煎服。
【方歌】清毒活血汤最灵，归芍生地紫草茸，芩连牛蒡山楂翘，参 桔梗合木通。
气血虚弱寒凉，导致阳气不能振奋升发，痘疹呈现灰白色，痘顶凹陷且缺乏脓浆，应迅速使用人参、当归、鹿茸组成的方剂，并配合鸡冠血酒服用效果更佳。
【注】痘疹发展到灌浆阶段时，如果颜色淡白，根部没有红晕且顶部凹陷，这被称为“白陷”。如果虚损极度严重，就会转变为“灰陷”。这是因为气虚导致精神萎靡不振，血虚导致脓浆无法充盈，所以一旦凹陷就无法遏制。治疗应当以大补气血为主，适宜使用参归鹿茸汤。在服药时加入鸡冠血酒，每天服用两到三次，只要能使痘顶隆起、脓浆运行，才能免除危险，恢复健康。
参归鹿茸汤（该方剂见“灌浆证治”章节）
鸡冠血酒
取一只大公鸡，先将一杯白酒炖温，然后刺取鸡冠上的几滴血，滴入杯中搅拌均匀，再次炖温后调入煎好的药液中内服。
紫陷和黑陷都是因为毒邪炽盛，痘疹平塌、色泽昏黯、根部紧实不松软，这是由于气血被火邪郁闭所致，急需解毒，应当使用归宗汤。
【注】痘疹出得稠密，颗粒细碎微小，根部紧绷、色泽昏黯，顶部凹陷且呈紫色，这叫做“紫陷”。严重时转为黑色，则称为“黑陷”。这都是因为毒火郁结闭塞，气机不能宣通所致。治疗应当清热解毒，以归宗汤为主方。
归宗汤（该方剂见“发热证治”章节）
脓浆尚未充足，痘板呈现黄色，痘顶塌陷成片，皮肤僵硬，这是气滞血凝难以灌溉滋养的表现，都源于毒热侵袭脾脏区域，应迅速服用清毒活血的方剂，待毒邪化解、痘疹隆起，即可转危为安。
【注】所谓“板黄”，是指在灌脓时脓浆未达到一半，突然突起黄色，干燥坚硬。这是因为凶险的毒邪肆意侵害脾脏区域，导致气滞血凝，难以灌溉滋养，必须使用清毒活血汤治疗。倘若痘疹能够隆起，还有希望存活；如果头面、颈项、眼眶、嘴唇周围及全身都出现黄色，则是不可治愈的死症。
清毒活血汤
当归、白芍药（用酒炒）、生地黄、紫草茸（用酒洗）、黄芩、黄连（用酒炒）、牛蒡子（炒制）、南山楂、连翘（去心）、人参、黄芪（生用）、桔梗、木通。
引用灯心草作为药引，用水煎煮后服用。
【方歌】清毒活血汤最为灵验，包含当归、白芍、生地黄、紫草茸，加上黄芩、黄连、牛蒡子、山楂、连翘，再合用人参、黄芪、桔梗和木通。
When Qi and Blood are deficient and cold, failing to uplift and promote vitality, the smallpox lesions appear grayish-white with depressed tops and scanty pus. One should promptly administer a decoction containing Ginseng Radix (Renshen), Angelicae Sinensis Radix (Danggui), and Antler Cornu Cervi Pantotrichum (Lurong), and taking it with Cock Comb Blood Wine (Jiguanxue Jiu) yields even better results.
[Note] When smallpox reaches the stage of pustule formation, if the color is pale white, the base lacks a red halo, and the top is depressed, this is termed "White Depression" (Bai Xian). If deficiency becomes extreme, it transforms into "Gray Depression" (Hui Xian). This occurs because Qi deficiency leads to lethargy and lack of vigor, while Blood deficiency fails to fill the pustules; thus, once depression sets in, it cannot be halted. Treatment should focus on greatly tonifying Qi and Blood, preferably using Shen Gui Lu Rong Tang (Ginseng, Angelica, and Deer Horn Decoction). Upon administration, add Cock Comb Blood Wine. Take two to three doses daily. As long as the pustule tops rise and pus flows, danger can be avoided, and health restored.
Shen Gui Lu Rong Tang (See "Treatment of Pustule Formation Symptoms" for formula details)
Cock Comb Blood Wine
Take one large rooster. First, warm a cup of white wine. Then, prick the cock's comb to obtain several drops of blood, drip them into the cup, and mix well. Warm again and mix into the decocted medicine for oral administration.
Purple Depression and Black Depression both result from excessive pathogenic toxin. The lesions are flat, dull, and dark, with tight bases that do not loosen. This indicates that Qi and Blood are constrained by Fire-toxin. Urgent detoxification is required, and Gui Zong Tang (Return to Ancestral Decoction) should be used.
[Note] When smallpox eruptions are dense, with small, fragmented particles, tight roots, dull and dark colors, and depressed purple tops, this is called "Purple Depression." If it worsens and turns black, it is termed "Black Depression." Both conditions arise from the constraint and closure of Toxic-Fire, preventing the free circulation of Qi. Treatment should employ clearing heat and detoxifying methods, primarily using Gui Zong Tang.
Gui Zong Tang (See "Treatment of Fever Symptoms" for formula details)
When the pus is insufficient and the smallpox plate appears yellow, with collapsed tops forming patches and stiff skin, this signifies Qi stagnation and Blood coagulation, making nourishment difficult. This is entirely due to Toxic-Heat invading the Spleen region. One must quickly take a detoxifying and blood-invigorating agent. Once the toxin resolves and the smallpox rises, health will return.
[Note] "Plate Yellow" refers to the condition where, during pustule formation, the pus has not reached half volume, yet sudden yellow protrusions appear, which are dry and hard. This is because fierce toxins肆虐 (run rampant) in the Spleen region, causing Qi stagnation and Blood coagulation, hindering irrigation. Qing Du Huo Xue Tang (Clear Toxin and Invigorate Blood Decoction) must be used. If the smallpox rises, survival is still possible. However, if yellowing appears on the face, neck, eye sockets, lips, and the entire body, the condition is incurable.
Qing Du Huo Xue Tang
Angelicae Sinensis Radix (Danggui), White Peony Root (Baishaoyao - stir-fried with wine), Rehmanniae Radix Recens (Shengdihuang), Arnebiae Radix seu Lithospermi Radix (Zicaorong - washed with wine), Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian - stir-fried with wine), Arctii Fructus (Niubangzi - stir-fried), Crataegi Fructus (Nanshan zha), Forsythiae Fructus (Lianqiao - remove heart), Ginseng Radix (Renshen), Astragali Radix (Huangqi - raw), Platycodonis Radix (Jiegeng), Akebiae Caulis (Mutong).
Use Juncus effusus (Dengxincao) as an adjuvant. Decoct in water and take orally.
[Formula Song]
Qing Du Huo Xue Tang is most effective,
Containing Danggui, Baishao, Shengdi, and Zicaorong.
Huangqin, Huanglian, Niubang, Shan zha, and Lianqiao join,
With Renshen, Huangqi, Jiegeng, and Mutong combined.