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。
痘疹的外壳虽然圆润饱满，但内部脓浆却无法生成，这种情况有虚证和实证之分，必须分辨清楚。如果痘根颜色淡白，是由于血液虚弱所致；如果痘顶紫暗且紧绷，则是由于血热导致血液凝滞。治疗时应参考《千金方》中的内托散配合四物汤，根据具体证候施治，不可延误。
【注释】当痘疹进入灌浆阶段时，头面和全身表面虽然看起来肿胀，但内部实际上没有脓浆，这种情况被称为“空壳”。此时应当辨别虚实进行治疗：如果痘根颜色淡白，这是血虚不能将毒素转化为脓浆，适宜使用《千金方》中的内托散；如果痘根紧绷且呈紫色，这是气行不畅导致血瘀，毒热潜伏在血分中，因而无法形成脓浆，适宜使用加味四物汤进行治疗。
《千金方》内托散（方剂见“见点证治”章节）
加味四物汤
生地黄（用酒清洗） 川芎 白芍（用酒炒制） 当归（用酒清洗） 连翘（去除心部） 紫草茸（用酒清洗）
用水煎煮后服用。
【方歌】加味四物汤，由当归、生地黄、川芎、白芍药组成，再加入紫草茸和连翘疗效良好。
痘疹的根部虽然红润，但顶部却出现塌陷，这种病症多因气虚引起。患者表现为面色苍白、四肢冰冷、食欲不振、心中虚烦、大便稀溏、身体倦怠乏力。此时急需使用补中益气汤，待正气充足后，痘顶便会升起，脓浆也会充盈贯通。
【注释】所谓陷顶，是因为中气微弱，无法振奋上扬，所以在灌浆时，虽然痘根红润，但顶部却微微塌陷。伴随的症状有面色苍白、四肢发冷、不想吃东西、心中虚烦、大便稀溏、身体疲倦无力。治疗应以补气为主，使用补中益气汤，这样气足则脓浆上升，顶部自然就会隆起。
补中益气汤
黄芪（用蜂蜜炙烤） 白术（用土炒制） 人参 升麻（炒制） 柴胡（炒制） 陈皮 甘草（炙烤） 当归身
引用煨姜、大枣为引，用水煎煮后服用。
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.