痘至开盘，头面腮颊亦肿，谓之起胀。至脓成浆足，痘回而胀消，谓之收胀。盖缘毒瓦斯
由内达外，此时尚在肌肤之间，故腮颊亦随之而肿。迨至脓成浆足，毒瓦斯尽化为脓而胀自消
。亦必脾胃强健，方能如此。若当起胀而不起胀，乃由元气内虚，不能送毒外出之故，宜用
大补气血之药，少加发散，大补元煎、大温中饮相间服之，盘自开而胀自起。若痘未开盘而
头面先肿，乃元气大虚，此乃虚肿、非起胀也。其痘必不能起胀，亦宜大补元气，肿自消而
胀自起。又有痘已回而肿不消，乃元气大虚不能摄毒，余毒留于肌肉之间，不能尽化为脓所
致，亦宜大补元煎，大温中饮相间服之，余毒尽化而脓消矣。《痘书》云∶痘出稠密封眼者
有救，不封眼者无救，此言不确。起胀者有救，不起胀者无救，此言甚确。封眼者眼弦多痘
，胭脂水涂之仍可以不封眼。不起眼者乃元气大虚，何以送毒外出？必当大补元煎、附子、
肉桂大剂多进，胀起而毒化，一定之理也。
痘之紧要，全在养浆。浆成则毒化，浆不成，痘斯坏矣。自发热、见点、齐苗、灌浆，
无非为养浆而设。若颗粒稀蔬，根盘红润，精神爽健，二便如常，乃上等痘也，可以不药。
倘形色平常，全凭用药、助其气血，以养其浆。最怕者无热。全仗真阳充足出而用事，方能
化毒成脓，设阳气不足，何以蒸化其毒，宜在补阳气，实为上策。紧防泄泻，泻则中虚，阳
气一亏，毒必内陷，定当预为提防，补其阳气，助其脾胃，浆干痂结而成功矣。煎药方无非
补中益气汤、大补元煎之类，相兼服之，万不失一。而世之面麻者，皆因不明是理，养浆时
被庸医误用消伐之药，中气下亏所致。若于养浆时，大剂温补，气血充足，落痂后断无面麻
之患。又有一种小儿痘后满头溃烂，名曰虚阳贯顶，又曰发疽。经所不愈，此乃出痘时误服
凉药，胃中受寒，阳无所根据，上冲头顶，譬之火炉中以水泼之，则热气必上冲，此理无二。
速用大补元煎、大温中饮相间服之，引火归元，旬日可愈。
痘疹发展到开盘阶段，头面及腮颊部位也会肿胀，这称为“起胀”。等到脓液形成、浆液充足，痘疹回退且肿胀消退时，称为“收胀”。这是因为毒邪之气由体内达于体表，此时毒邪尚停留在肌肤之间，所以腮颊也随之肿胀。待到脓成浆足，毒邪完全化为脓液，肿胀自然消退。这也必须依靠脾胃功能强健，才能做到这一点。如果在应当起胀的时候不起胀，这是由于元气内部虚弱，不能将毒邪送出体外的缘故，适宜使用大补气血的药物，并少量加入发散药，交替服用大补元煎和大温中饮，痘盘自然会打开，肿胀自然会起来。如果痘疹尚未开盘而头面部先出现肿胀，这是元气极度虚弱的表现，属于虚肿，而不是正常的起胀。这种痘疹必然无法起胀，也应当大补元气，肿胀自会消退，肿胀消退后痘疹自然能起胀。又有痘疹已经回退但肿胀不消的情况，这是由于元气极度虚弱不能统摄毒邪，余毒留存在肌肉之间，不能完全化为脓液所致，也适宜交替服用大补元煎和大温中饮，待余毒完全化解，脓液就会消退。《痘书》中说：痘疹出得稠密且封住眼睛的有救，没有封住眼睛的无救，这种说法不准确。起胀的有救，不起胀的无救，这种说法非常准确。封住眼睛是因为眼睑周围痘疹多，用胭脂水涂抹仍然可以不封眼。不起胀是由于元气极度虚弱，怎么能将毒邪送出体外呢？必定应当大量服用大补元煎，并加入附子、肉桂等大剂量药物，使肿胀起来而毒邪化解，这是一定的道理。
痘疹的关键之处，全在于养浆。浆液形成则毒邪化解，浆液不能形成，痘疹就会败坏。从发热、见点（出现皮疹）、齐苗（出齐）、灌浆，无非都是为了养浆而设立的。如果颗粒稀疏，根盘红润，精神爽快健壮，大小便正常，这是上等痘疹，可以不用服药。倘若形色平常，全凭用药，辅助其气血，以滋养其浆液。最害怕的是没有热度。完全依赖真阳充足出来发挥作用，才能化解毒邪成为脓液，假如阳气不足，怎么能蒸腾化解毒邪呢？应当在补益阳气上下功夫，这才是上策。要紧紧防止泄泻，泄泻会导致中焦虚弱，阳气一旦亏损，毒邪必定内陷，一定要预先提防，补益阳气，助益脾胃，待浆液干燥结痂就能成功。煎煮的药方无非是补中益气汤、大补元煎之类，交替服用，万无一失。然而世上脸上留疤的人，都是因为不明白这个道理，在养浆时被庸医误用了消散攻伐的药物，导致中气下陷亏虚所致。如果在养浆时，使用大剂量的温补药物，使气血充足，落痂后绝对不会有面部留疤的祸患。又有一种小儿在痘疹之后满头溃烂，名叫“虚阳贯顶”，又叫“发疽”。经书中说难以治愈，这是因为出痘时误服了凉药，胃中受寒，阳气无所依附，向上冲撞头顶，好比在火炉中泼水，热气必然向上冲，这个原理没有两样。迅速交替服用大补元煎和大温中饮，引火归元，十天即可痊愈。
When the smallpox lesions reach the stage of opening (expanding), swelling also occurs on the head, face, and cheeks, which is called "Qi Zhang" (Rising Swelling). When pus is formed and the fluid is sufficient, the lesions recede and the swelling subsides, which is called "Shou Zhang" (Receding Swelling). This is because the pathogenic toxins travel from the interior to the exterior; at this time, they are still between the skin and muscles, so the cheeks swell accordingly. Once the pus is formed and the fluid is full, the toxins are completely transformed into pus, and the swelling naturally subsides. This also requires strong Spleen and Stomach functions to achieve. If swelling does not rise when it should, it is due to internal deficiency of Yuan Qi (Original Qi), which fails to send the toxins outwards. It is appropriate to use herbs that greatly tonify Qi and Blood, with a small amount of dispersing herbs, alternating the administration of Da Bu Yuan Jian (Great Tonification Decoction) and Da Wen Zhong Yin (Great Warming Middle Drink). The lesion base will naturally open, and the swelling will naturally rise. If the head and face swell before the lesions have opened, it indicates severe deficiency of Yuan Qi; this is false swelling, not true rising swelling. Such lesions certainly cannot rise in swelling. One should also greatly tonify Yuan Qi; the swelling will subside, and the lesions will naturally rise. In cases where the lesions have receded but the swelling does not disappear, it is due to severe deficiency of Yuan Qi failing to control the toxins, leaving residual toxins in the muscles that cannot be fully transformed into pus. Alternating administration of Da Bu Yuan Jian and Da Wen Zhong Yin is also appropriate here; once the residual toxins are fully transformed, the pus will subside. The *Dou Shu* (Book on Smallpox) states: "Smallpox that erupts densely and seals the eyes can be saved; those that do not seal the eyes cannot be saved." This statement is inaccurate. The correct statement is: "Those that undergo rising swelling can be saved; those that do not cannot." This is very accurate. Sealing the eyes occurs because there are many lesions on the eyelids; applying Yanzhi Shui (Carmine Water) can prevent sealing. Failure to rise in swelling is due to severe deficiency of Yuan Qi, making it impossible to expel toxins outward. One must administer large doses of Da Bu Yuan Jian along with Fuzi (Aconiti Lateralis Radix Praeparata) and Rougui (Cinnamomi Cortex) to induce rising swelling and transform toxins; this is an immutable principle.
The critical aspect of smallpox lies entirely in nourishing the fluid (Yang Jiang). When the fluid forms, the toxins are transformed; if the fluid does not form, the smallpox deteriorates. From fever, appearance of spots, uniform eruption, to filling with fluid, all stages are established for the purpose of nourishing the fluid. If the lesions are sparse, the bases are red and lustrous, the spirit is bright and robust, and urination and defecation are normal, it is considered superior smallpox, and medication may not be necessary. If the color and shape are ordinary, one must rely on medication to assist Qi and Blood to nourish the fluid. The greatest fear is the absence of heat. It relies entirely on sufficient True Yang (Zhen Yang) to function effectively, thereby transforming toxins into pus. If Yang Qi is insufficient, how can it steam and transform the toxins? Therefore, tonifying Yang Qi is the best strategy. One must strictly guard against diarrhea, as diarrhea leads to deficiency in the Middle Jiao; once Yang Qi is depleted, toxins will inevitably sink inward. Precautions must be taken to tonify Yang Qi and assist the Spleen and Stomach; success is achieved when the fluid dries and scabs form. Decoctions used are mainly Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Da Bu Yuan Jian, administered alternately, ensuring no failure. However, people who suffer from pockmarks on their faces today do so because they did not understand this principle; during the fluid-nourishing stage, quacks mistakenly used draining and reducing herbs, causing downward collapse of Middle Qi. If, during the fluid-nourishing stage, large doses of warming and tonifying herbs were used to ensure sufficiency of Qi and Blood, there would undoubtedly be no risk of facial pockmarks after scabbing falls off. There is another condition in children where the entire head becomes ulcerated after smallpox, known as "Xu Yang Guan Ding" (Deficient Yang Piercing the Crown) or "Fa Ju" (Eruptive Abscess). Classical texts state this is difficult to cure; this results from mistakenly taking cooling herbs during smallpox, causing cold in the Stomach. With Yang having no foundation, it rushes upward to the crown. This is like pouring water on a hot stove; the heat must rush upward. The principle is identical. Rapidly alternating the administration of Da Bu Yuan Jian and Da Wen Zhong Yin will guide the fire back to its source, and recovery can be expected within ten days.