痘当起胀渐尖圆，红润根松体浓坚，平凹嫩白为虚证，赤紫板塌是毒残。更有风寒
滞热郁，毒不透达起发难，察痘形色分所属，合证虚实寒热参。
【注】痘出齐之后，当渐渐根据次起胀，其形顶尖肥圆，其色红活滋润，根脚松绽，体
浓皮坚皆起胀，顺痘也。平者，谓平扁不胀。凹者，谓顶陷不起。嫩者，谓皮薄娇嫩，白
者谓色白不红，此皆为气血虚弱。赤者，深红而艳。紫者，深赤而黯。板者，板硬不绽。
塌者，平塌不起。此皆毒热伤残，更有风寒外束，滞热内郁，使毒不得透出而起发也。医
者，当察痘之形色，分其所属，合其病证，虚实寒热，参详施治，庶无差谬矣。
保元化毒汤
平凹灰白皮嫩亮，倦怠气乏不渴烦，保元化毒参 草，芎归植甲芷香蚕。
【注】痘不如期起胀，若平扁顶凹，其色灰白，皮薄嫩亮，更现倦怠气乏，不渴不烦
等虚证者，此气血虚弱，不能起发其毒也。宜用保元化毒汤主之。
保元化毒汤
人参 黄 （蜜炙） 甘草（炙） 当归 南山楂 穿山甲（炒） 白芷 木香 僵蚕（炒研） 川芎
引加煨姜，水煎服。
必胜汤 归宗汤
艳红紫黯不起胀，板硬平塌不绽松，证见阳热一切证，急服必胜或归宗。
【注】痘当起胀之时，若色艳红紫，黯而不起胀，板硬平塌，而不绽松，更见阳热烦
躁，便闭闷乱等证者，此毒火锢滞，气血不能领载其毒也。急用必胜汤，或归宗汤，庶
或逆中求生也。
必胜汤（方见见点证治）
归宗汤（方见发热证治）
苏解散
外因风寒痘不起，浅淡黯滞不润红，发热恶寒无汗表，苏解散发自然松。
【注】痘当起胀之时，偶为风寒外袭，闭塞痘毒，不能起胀者，其色则浅淡、黯滞、不
润，其证则现发热、恶寒、无汗，宜用苏解散透发其毒，自然松而起矣。
苏解散（方见见点证治）
宽中快 汤
伤食滞热郁不起，恶食腹热便臭粘，快 透毒加陈木，减葛蒡穗桔前蝉。
【注】起胀之时，过于饮食，滞热内郁，痘不起胀。其现证懒食恶食，肚皮发热，大
便臭粘，宜用宽中快 汤主之。其方即宽中透毒饮加入陈皮、木香，减去葛根、牛蒡子、
荆芥穗、桔梗、前胡、蝉蜕。
宽中快 汤
青皮（醋炒） 陈皮 枳壳（炒） 南山楂 麦芽（炒） 木香 黄连（生） 连翘（去心）
浓朴（炒） 甘草（生）
引用生姜、灯心。水煎服。
痘疹应当逐渐隆起，形态尖圆，色泽红润，根部松绽，质地浓密坚实；若平陷、嫩白则为虚证，若色呈赤紫、板硬塌陷则是毒邪残盛。更有因风寒外束或热邪内郁，导致毒邪不能透达，从而难以起发者。医者需观察痘疹的形色以辨别所属证型，结合整体病证的虚实寒热进行参详施治。
【注】痘疹出齐之后，应当逐渐按次序隆起。其形态顶尖且饱满圆润，色泽红活滋润，根脚松绽，皮厚质坚，这些都是起胀的表现，属于顺证痘疹。所谓“平”，是指平扁而不隆起；所谓“凹”，是指顶端凹陷不起；所谓“嫩”，是指皮肤薄而娇嫩；所谓“白”，是指颜色苍白不红，这些都属于气血虚弱所致。所谓“赤”，是指深红而鲜艳；所谓“紫”，是指深赤而晦暗；所谓“板”，是指坚硬而不松绽；所谓“塌”，是指平塌不起。这些情况都是毒热伤残所致，再加上风寒外束、热邪内郁，使得毒邪无法透出并起发。医者应当观察痘疹的形色，分辨其所属证候，结合病人的具体病情，分析虚实寒热，详细斟酌后进行治疗，这样才能避免差错和谬误。
保元化毒汤
若痘疹平陷、灰白、皮嫩光亮，伴有倦怠乏力、口不渴、心烦等症状，可用保元化毒汤，方含人参、甘草、川芎、当归、穿山甲、白芷、木香、僵蚕。
【注】痘疹未能如期起胀，若呈现平扁、顶端凹陷，颜色灰白，皮肤薄嫩光亮，并出现倦怠、气短乏力、口不渴、不心烦等虚证表现，这是气血虚弱，不能托举毒邪外出的缘故。适宜使用保元化毒汤为主进行治疗。
保元化毒汤
人参、黄芪（蜜炙）、甘草（炙）、当归、南山楂、穿山甲（炒）、白芷、木香、僵蚕（炒研）、川芎。
用法：加煨生姜为引，水煎服。
必胜汤、归宗汤
若痘疹色泽艳红或紫黯，不起胀，板硬平塌，不松绽，同时见到阳热、烦躁、便秘、闷乱等一切阳热证候，应紧急服用必胜汤或归宗汤。
【注】在痘疹应当起胀的时候，如果颜色艳红或紫黯，晦暗而不隆起，板硬平塌，不松绽，并且出现阳热、烦躁、大便闭塞、神志闷乱等证候，这是毒火锢滞，气血不能承载毒邪外出的缘故。应紧急使用必胜汤，或者归宗汤，或许能在逆证中求得生机。
必胜汤（方剂见“见点证治”章节）
归宗汤（方剂见“发热证治”章节）
苏解散
若因风寒外袭导致痘疹不起，颜色浅淡、晦暗滞涩、不润泽红润，伴有发热、恶寒、无汗等表证，宜用苏解散发散透毒，痘疹自然会松起。
【注】在痘疹应当起胀的时候，偶然受到风寒外袭，闭塞痘毒，导致不能起胀。其颜色则表现为浅淡、晦暗滞涩、不润泽，其症状表现为发热、恶寒、无汗，适宜使用苏解散来透发毒邪，痘疹自然就会松起。
苏解散（方剂见“见点证治”章节）
宽中快毒汤
若因伤食导致热邪内郁而不能起胀，伴有厌食、腹部发热、大便臭秽粘腻等症状，应在快毒透毒的基础上加入陈皮、木香，减去葛根、牛蒡子、荆芥穗、桔梗、前胡、蝉蜕。
【注】在起胀的时候，饮食过度，导致热邪内郁，痘疹不起胀。出现的症状有懒食、厌食、肚皮发热、大便臭秽粘腻，适宜使用宽中快毒汤为主进行治疗。该方即宽中透毒饮加入陈皮、木香，减去葛根、牛蒡子、荆芥穗、桔梗、前胡、蝉蜕。
宽中快毒汤
青皮（醋炒）、陈皮、枳壳（炒）、南山楂、麦芽（炒）、木香、黄连（生）、连翘（去心）、厚朴（炒）、甘草（生）。
用法：引用生姜、灯心草。水煎服。
The variola (smallpox) lesions should gradually swell, becoming pointed and round, with a ruddy color, loose roots, and dense, firm texture. Flatness and tender whiteness indicate deficiency syndromes, while red-purple discoloration and board-like collapse indicate residual toxic pathogens. Furthermore, external constraints by wind-cold or internal stagnation of heat may prevent the toxic pathogens from penetrating outward, making eruption difficult. The physician must observe the shape and color of the lesions to distinguish their corresponding patterns, and combine this with the overall syndrome's deficiency/excess and cold/heat characteristics for comprehensive treatment.
[Note] After the variola lesions have fully erupted, they should gradually swell in sequence. Their shape should be pointed at the apex and plump and round, with ruddy, vibrant, and moist color, loose root margins, thick skin, and firm body; these are signs of swelling and represent favorable (shun) smallpox. "Flat" refers to being flat without swelling. "Depressed" refers to the apex sinking down without rising. "Tender" refers to thin and delicate skin. "White" refers to pale color lacking redness; all these belong to Qi and Blood deficiency. "Red" refers to deep red and bright. "Purple" refers to deep crimson and dull. "Board-like" refers to hardness without loosening. "Collapsed" refers to being flat and sunken without rising. These are all caused by damage from toxic heat, compounded by external wind-cold constraint and internal stagnation of heat, which prevents the toxic pathogens from emerging and erupting. Physicians should observe the shape and color of the lesions, differentiate their associated patterns, integrate them with the patient's specific symptoms, analyze the deficiency/excess and cold/heat, and deliberate on the treatment accordingly, thereby avoiding errors and mistakes.
Baoyuan Huadu Decoction (Preserve Origin and Transform Toxin Decoction)
If the lesions are flat, depressed, grayish-white, with tender and shiny skin, accompanied by fatigue, Qi deficiency, lack of thirst, and irritability, use Baoyuan Huadu Decoction, containing Renshen (Ginseng Radix), Gancao (Licorice Root), Chuanxiong (Szechwan Lovage Rhizome), Danggui (Angelica Sinensis), Nanshan Zha (Crataegus Fruit), Chuanshan Jia (Pangolin Scales), Baizhi (Angelica Dahurica), Muxiang (Aucklandiae Radix), and Jiangcan (Bombyx Batryticatus).
[Note] If the lesions fail to swell as expected, presenting as flat, depressed at the apex, grayish-white in color, with thin, tender, and shiny skin, along with symptoms such as fatigue, shortness of breath, lack of thirst, and absence of irritability, this indicates Qi and Blood deficiency unable to push out the toxins. It is appropriate to primarily use Baoyuan Huadu Decoction for treatment.
Baoyuan Huadu Decoction
Renshen (Ginseng Radix), Huangqi (Astragali Radix, honey-fried), Gancao (Licorice Root, fried), Danggui (Angelicae Sinensis Radix), Nanshan Zha (Crataegi Fructus), Chuanshan Jia (Pangolini Squama, fried), Baizhi (Angelicae Dahuricae Radix), Muxiang (Aucklandiae Radix), Jiangcan (Bombyx Batryticatus, fried and ground), Chuanxiong (Ligustici Chuanxiong Rhizoma).
Usage: Add Wei Jiang (Roasted Ginger) as a guide, decoct in water and take orally.
Bisheng Tang (Decoction for Certain Victory), Guizong Tang (Decoction Returning to the Source)
If the lesions are brightly red or purple-dull, failing to swell, board-like and collapsed, not loosening, and accompanied by Yang-heat symptoms such as irritability, constipation, and mental confusion, urgently administer Bisheng Tang or Guizong Tang.
[Note] During the stage when lesions should swell, if the color is brightly red or purple-dull, dark and non-elevated, board-like and collapsed without loosening, and accompanied by Yang-heat, irritability, fecal impaction, and mental restlessness, this indicates toxic fire entrapment where Qi and Blood cannot carry the toxins outward. Urgently use Bisheng Tang or Guizong Tang, perhaps allowing survival amidst adverse conditions.
Bisheng Tang (See formula in "Jiandian Zhengzhi" chapter)
Guizong Tang (See formula in "Fare Re Zhengzhi" chapter)
Sujie San (Perilla Decoction for Release)
If external wind-cold prevents the lesions from swelling, appearing pale, dull, stagnant, and lacking ruddy luster, accompanied by fever, aversion to cold, and anhidrosis (absence of sweating) indicating exterior syndrome, use Sujie San to disperse and vent the toxins, allowing natural loosening and elevation.
[Note] During the swelling stage, if accidentally attacked by external wind-cold, blocking the toxin and preventing swelling, the color will appear pale, dull, stagnant, and unmoistened. Symptoms include fever, aversion to cold, and anhidrosis. It is appropriate to use Sujie San to vent the toxins, after which the lesions will naturally loosen and rise.
Sujie San (See formula in "Jiandian Zhengzhi" chapter)
Kuanzhong Kaidu Tang (Stomach-Widening Toxin-Venting Decoction)
If food stagnation leads to internal heat stagnation preventing swelling, accompanied by anorexia, abdominal heat, and foul, sticky stools, add Chenpi (Citrus Peel) and Muxiang (Aucklandiae Radix) to the Kaidu formula, and remove Gegen (Puerariae Lobatae Radix), Niubangzi (Arctii Fructus), Jingjie Sui (Schizonepetae Spica), Jiegeng (Platycodonis Radix), Qianhu (Peucedani Radix), and Chantui (Cicadae Periostracum).
[Note] During the swelling stage, excessive eating causes internal heat stagnation, preventing lesion swelling. Presenting symptoms include reluctance to eat, anorexia, abdominal heat, and foul, sticky stools. It is appropriate to primarily use Kuanzhong Kaidu Tang for treatment. This formula is Kuanzhong Toudou Yin plus Chenpi (Citri Reticulatae Pericarpium) and Muxiang (Aucklandiae Radix), minus Gegen (Puerariae Lobatae Radix), Niubangzi (Arctii Fructus), Jingjie Sui (Schizonepetae Spica), Jiegeng (Platycodonis Radix), Qianhu (Peucedani Radix), and Chantui (Cicadae Periostracum).
Kuanzhong Kaidu Tang
Qingpi (Exocarpium Citri Reticulatae Viride, vinegar-fried), Chenpi (Pericarpium Citri Reticulatae), Zhike (Aurantii Fructus, fried), Nanshan Zha (Crataegi Fructus), Maiya (Hordei Fructus Germinatus, fried), Muxiang (Aucklandiae Radix), Huanglian (Coptidis Rhizoma, raw), Lianqiao (Forsythiae Fructus, heart removed), Houpo (Magnoliae Officinalis Cortex, fried), Gancao (Licorice Root, raw).
Usage: Use Shengjiang (Zingiberis Rhizoma Recens) and Dengxin Cao (Junci Medulla) as guides. Decoct in water and take orally.