数点，颜色惨暗，惊搐不定，面青目窜，人事不省，谓之惊闭；毒伏肝胆，即日死。痘毒本甚，一齐赴胃，胃气
为热所伤，不能送毒出外，必发青紫蓝斑，胃烂而死，多在五、六日间。此四种，常法治之不效，为定新方救
之，死中求活，用药速，十挽一、二。（《橡村痘诀》）
三、四、五朝
上工治痘，一见定吉凶，次则三朝决生死，三朝不能决，不可与言治矣。○虚中夹毒，三、四朝最难用药，
热毒务在必清，而元气又不可罔顾。予尝用黄连、石膏、犀角、地黄、紫草、红花、丹皮、栀子之类，少加人
参监之。譬犹用兵，须择膂力过人者，虑其卤莽，必以老成监其后，俾热毒化而气血不伤，多有成功。此法予
师与方搏九先生得之，时人不悟也。古人发表有参苏饮、人参羌活散，攻里有黄龙汤，和解有小柴胡汤，清胃
有人参白虎汤，治痢有参连饮，皆难于清解，不可用人参而不得不用者，援为治痘比例，何独不可？○真实火
证，必用清凉。清凉之剂不宜早，亦不宜迟，得力在三、四朝，三、四朝不急清，后虽用之，痘必不受。譬如
禾苗浇灌在初种时，若苗既长成，灰粪虽加，已无及矣。○四、五朝，痘色光亮者不好，枯涩者亦不好，不枯
不亮之间，须要理会得。○痘出三日，点至足下为齐。若繁密，点不至足，曰无根，后必生变。足冷不温者，
以葱艾煎汤洗，暖覆片时，点渐透者吉。○痘三朝出齐之后，当清与否，总以唇舌为准，必须舌干唇燥，二便
闭结，方可重用清凉。若唇舌淡润而无里证，痘虽稠密，或干红紫滞，只宜淡剂清解，黄连、石膏、犀角、地
黄之类，不可浪用。若清凉太过，八、九朝多致痒泻内攻而死。○不但清剂不宜太过，一见唇舌淡润，即宜早
进参、 ，合之归、芎、甘、桔、防风、僵蚕，以导其行浆之路，浆成早则毒化易，浆迟滞则毒化难。里无实
火，浪用清凉，脓安得成？脓不成则毒
必不化，欲不生变，其可得乎？（《橡村痘诀》）
翁氏云∶三日、四日，痘出当齐，点至足心，势方安静。若幼小之儿，气血易周，常有未及三日而发齐
者。年长之体，四日已外，犹有增发者，痘稀数不盈百，不必点至足心。辨明形色，身体强壮，痘属上中，方
可许其无虑。倘幼小弱质，或病后，或带别病，而后布痘，未可见痘好浪许。（叶天士）
三、四日，欲其胖，宜用鼠粘子，透发痘标，又能起胖。僵蚕，起胖时妙药，能胖痘，又能助浆。夫痘
已胖，即欲其成浆，此味又能治游红痘，三、四、七、八日皆可用。○三、四日未能发胖，行浆药中可用鸡冠
血酒乳，或恐酒助毒发痒，然亦无妨。○穿山甲大能发痘起胖，再以僵蚕佐之，何虑其不胖乎？（《仁端录》）
痘至五日，内外证平，宜该起发退红。不尔，正气必虚，方中倍加参、 ，为唤浆法。（《慈幼筏》）
起胀
痘不起胀，其亡速也。起胀之科，气至焉，血次焉。起胀之由，火蒸之，水腾之。不此之务，而攻发以
求胀，是揠苗也，是犹敝车羸马，而鞭策以求进也。痘一见点，则毒分于外，气卫其宫，血守其中。今气不至，
不能托毒于外，毒得跨迹门墙之内，故不起耳。间有起者，中空暗薄，气至不盛也，血次不继也，由于火不足
蒸也，水不足腾也，将息之余烟，欲枯之微泽也，不久倒塌而亡。（《黄帝逸典》）
痘毒未发，伏于命门，本与气血不曾交会，及其发而赴胃，胃多气血而主肌肉，毒与气血交会于胃，而
痘乃出。既交矣，毒与气血混而为一，气血之中安肯容毒？于是领载而出，出而长，长而灌，及其成功，毒既
结而为疤，气血返而归于吾体，一有窒碍，则变态百出矣。是以出齐之后，未灌之先，不存地步，何以容受？
是起胀为行浆之要道也。医家于此当求过第二关。○或曰∶痘之起胀，如造蒸饼之上板笼，此喻最确。○血热之痘，火盛毒
壅，气血为其所烁，毒结于中，何能起胀？急宜凉血解毒，毒解则火退，火退则气血分，而痘自起。○痘以元
气为主，起胀者气至也。气虚不能充畅，何能起胀，急用保元，佐以松肌活血，则气血自分矣。（《橡村痘诀》）
凡起胀时色焦紫者，毒盛也；形大皮薄而起绉纹者，毒盛气虚也；顶红满者，血滞也。滞者活之，焦者清
之，气虚毒盛，补而兼解之。但面部有一、二悦目可爱，用药当节，则枯者润，薄者浓，而生意勃然矣。（《慈幼筏》）
六朝
古人云∶痘证生于六日之前者易治，生于六日之后者难疗。则六朝为痘家生死关头。顺痘至此，上部多已
行浆；即险证至此，亦宜顶白根红，有行浆之势方可。若至此时，气血不分，断无成功之理。○痘六朝叫痛者
最吉，痛则不敢粘惹，痘自完全。痒最可嫌，痒之轻者，嘱其把捉，重用鲜鳞攻毒饮，浆行则痒变为痛矣。○
六朝以前，毒未化而正气虚，清为主，补为佐；六日后，毒未化而正气虚，补为主，清为佐。○痘六朝当灌脓，
大粒者光壮，细碎者干焦，当取大者。大粒者顶陷平塌，或枯涩无脓，细粒者内有真浆，渐次充满，当取细者。
总宜极力攻发，方可收功。○六日以前，专看根窠，无根窠则必不灌脓；六日以后，专看脓色，无脓色则必难收
。先贤历练之言，确不可易。复为之解曰∶无根窠要使之收束，无脓色要使之融化。气虚者补其气，则血自
归附；血虚者敛其血，则根不散漫；火甚者清其火，则血不伤。三法治例，各从其是，不用通套方子，便不为
陈言所困矣。○痘五、六朝，元气虚弱，顶陷不起者，古方补中益气汤甚妙。其中参 甘草保元汤也，白术助参
而固脾土，当归和血而生血，升柴能使清者升、陷者起。虚弱痘证，用于起壮行浆之期，胜于僵蚕、角刺多
矣。（《橡村痘诀》）
痘至六日，欲其行浆，加生 、圆眼、当归于抚芎、桔、
橘剂中。芎能调气， 可托里，又与桔、橘并力升发，嗣后渐加人参、山药、莲肉、糯米等，令浆足则毒化功
收矣。此时尚有未解之火，又不可不兼用丹参、僵蚕等。真虚寒证，再加桂、附亦可。（《痘疹元珠》）
浮肿
气属阳，血属阴，宜和而不离。痘未起发，而头面先肿者，此乃阳火亢盛，火性炎上。《经》曰∶热盛则
肿。以见毒火随阳上升，而阴血不能归附，气血相离之象。若痘起发，头面以渐而肿者，此毒瓦斯发越，聚于三
阳，欲作脓血，此宜肿也。设当起发，而头面不肿者，必痘本磊落，毒势轻浅，固虽作浆，根不粘连，所以不
肿，此佳兆也。如痘本稠密，起发宜肿而不肿者，此毒伏于内不能发越，此正气不足，不能胜邪而然也。治法
当助正气为主。如痘稀疏，起发不应肿而肿者，此感疫毒之气，名大头瘟者是也。治法当兼疫气而治之。大凡
疮肿者，直至脓满结痂，毒化而肿消目开者吉；若未充足而肿消目开者，此正气不足，不能化毒成浆，名为倒
，乃凶兆也。故应肿不肿，不应肿而肿，应消不消，不应消而消，皆宜详察。（《痘科类编》）
头面预肿，毒不归窠，非大腹皮不为功。（《橡村痘诀》）
封合
痘至灌浆，则藏伏之毒与精华，皆为逼烁在外，所以空窍眼鼻之所，津液留聚而为封塞也。然必待肿胀灌
脓而然，乃为正候。故三、四朝不宜封塞者，谓毒未外达，邪火上炎也；若五朝之后又宜封塞者，谓气血充灌，
精华不外驰也。其封塞之所，如胶脂光润者吉；如煤干黑者，脏腑燥槁，津液枯竭也；如脓流溢者，毒火内烁，
精华外泄也，并凶。若既封塞，而六、七朝即开者，防毒未消，有内攻之危。惟痘稀少者，不在此例。（冯楚瞻）
回浆时眼肿不能开者，以水湿绢巾，拭去脓眵，略用手指攀开眼皮，透一线缝，则不生翳膜。（《医学入门》）
七、八朝
痘出七日，阴中之阳尽达于外，内则空虚，如釜中甑内之气，阳起一分，阴长一分，故其浆也，宜渐而黄，
根下血晕，宜渐而紧，如腺围定，不铺散，不灰黯，昼夜不痛楚，饮食倍常，大便少，身热微微，吉兆也，反
是者逆。至是决死生，惟视血晕紧散，脓色真伪耳。真者宝色光彩，伪则色如土黄。紧者气能拘血化毒也，散
则气虚散而华，气将绝矣。血晕全无者死。脓者毒所化也。诀曰∶六日以后专看脓色。故有脓则生，无脓则死。
使或有或无，而根脚不红，或连肉灰红，作痒烦躁，目封欲开，作泻干呕，不食少睡，此气虚不能拘血化毒也，
急峻补之。倘此时尚见舌黑有刺，生意绝矣，不惟不容补，即补之何益？（程华仲）
七、八朝，面部浆未灌足，早结干红疤 ，而头顶不收，下部犹灌者，无妨，但宜攻发，不得早用清利。
○七、八朝，面部虽有真浆，下体纯是清水，不切牙，不作泻者，参、 酝酿亦可收功。若切牙泄泻，擦破皮
塌不成疤 者，谓之外剥，不治。○七、八朝，先灌者虽收，后出者方灌，只宜攻发后者，不得早用清利。○痘
至八朝，音咽忽有痰声，虽痘色不变，亦要提防，九朝气急腹胀，恐从此始。（《橡村痘诀》）
痘至七日，当用参、 等助浆，恐于火毒相戾，所以六朝以前，须预着力清解，使火毒净尽为妙。若清
解未净，而清补并用，必致减去参、 之力，所以药不应手。（徐仲光）
行浆
浆之不浆，胀之不先，浆之斯浆，胀之而藏。其浆也，气血齐盈，水火均平，毒孤而熟化其根。夫痘之
浆，毒之化也，毒所由化，气至而水盈焉，水盈而血生焉，使不干焦而成薄脓。气之至焉，水足而火行焉，火
行而毒熟焉，能蒸烂其毒而成稠脓。故火不得水不蒸，水不得火不腾。浆而不浆，不责其毒，不责其血，惟求
其气。浆而不稠，毒不尽化，温而扶之。因泻不稠，气下泄
也，温扶而升之。浆而不浆，恣其补益，幸而毒腐，真元惫极，气机以息，是成板黄，主客俱伤，不免死亡。
浆已成熟，气不能接，犹弓开难满，忽下陷而泄，目为之开，势在危急，但观其痘色犹未变，半日之间数倍补
益，生犹可得。大抵痘之生死，系于浆之有无；浆之有无，系于胀之起伏；胀之起伏，系于身之气血；身之气
血，系于中之水火。水乃后天之形气，火乃先天之元气，此起胀行浆之微妙也。（《黄帝逸典》）
行浆自头面始，头面有洋，自能顺行而下，渐转黄熟。所谓洋者，如玉中之绵，水中之云，光彩活动，
二日过肩，三日过膝。若头面虽灌，而清淡无洋，不过肩者，必成外剥，不过膝者，必有余毒。○予师口授云∶
看浆必要有洋。凡浆起必要浮胰，伞顶看脓，痘必要如豆煮熟，中心一样。其言最形容的当。○浆清多是体虚，
皮浓而不灰者，参、 、乳酒、鸡汁、羊肉之属酿之，自可成脓结 。皮薄者，擦之即成外剥，泄泻切牙，内
攻不能救矣。○灌不起有二证∶一为血热，一为气虚。血热者毒结而不化，急宜凉血解毒；气虚者灰白顶陷，
毒凝不运，急宜补气。其他形状多般，总不离此二者。○灌不起，体虚者十之七，血热者十之三。或清或补，
佐以攻发，多有成功。若体虚而夹毒，血热而伤气者，清中补，补中清，生死关头，端在乎此。○灌脓时要有
腥气，无腥气必无真浆，急宜攻发。○抢浆者，稀痘无之。稠密之痘，未至浆期，先灌数粒，其色黄熟，此火
毒所迫，气血不能主持，与伤科未老先白头同病，急宜泻火。○血浆者，火甚也。痘之为用，全赖火以成功，
火固不可尽泻，然亦不宜太盛，温温养之，则浆成矣。浆者血之变也。火甚则血不及变而即行，故成血浆，不
急泻火。有色紫烦闷而告变者，泻火则色淡而浆渐浓，亦自成疤而愈。○血浆与紫 不同∶间发者为紫 ，擦
碎则纯是清水；胸背腰腹一片红者为血浆，碎之则是未变脓之血也。○停浆者，浆半行而忽止，非气血之虚，
亦毒之结也。由于营卫不和，或寒
暑之气逆之。速宜斟酌用药，不尔，轻则鬼肿发，重则内攻矣。（《橡村痘诀》）
浆行七日，肿要过项，浆要过胸。肿者，毒外出也；言过胸者，从上下也。至阳物亦要灌，乃宗筋之会也。
两脚不灌不妨。○两臂亦宜满，不然，临收时必不食而生他变。手臂，脾所主也。○珠不在大，在乎体之明；浆
不在足，在乎色之正。土黄者，黄而无彩也。○灌脓时，额上形如汤泡，皮肉尽赤而干，此气自尽不能拘血，血
亦不能附气而制毒，必死。诸痘才灌，而两唇先黄硬，此毒先入脾，失次序矣，必死。擦破而疮痕隐隐有生意，
此秽触也，勿作死证治。（程华仲）
看脓之法，火照之内外光润，手按之皮薄软陷者，无脓也。火照之而内暗，手按之而如鼓者，有脓也。○
凡灌浆时，必认得毒已解尽，方可一心温补。若遇寒证，加姜、桂亦可。但毒未解尽者，须带丹参辈以清火；
僵蚕之妙，以其助浆兼解毒也。○痘浆已足，即宜清凉解毒，兼利小水，则毒不留于内，从小便泄去，而湿润
之气，转而为燥，庶 收而余毒得免。（《仁端录》）
漏浆
几点，颜色惨暗，惊厥抽搐不定，面色青紫，眼球上翻或斜视，人事不省，称为惊闭；毒邪潜伏于肝胆，当日即死。痘毒本已深重，一齐攻向胃腑，胃气被热邪所伤，不能将毒邪排出体外，必然出现青、紫、蓝、黑色的斑疹，胃烂而死，多在发病后的第五、六天。这四种情况，用常规方法治疗无效，需制定新方来救治，在死亡中寻找生机，用药要迅速，十人中可挽救一、二人。（《橡村痘诀》）
第三、四、五天
高明的医生治痘，一见初起就能断定吉凶，其次是在第三天决定生死，如果到了第三天还不能决断，就谈不上谈论治疗了。○虚证中夹杂毒邪，在三、四朝最难用药，热毒务必彻底清除，但元气又不可不顾及。我曾经使用黄连、石膏、犀角、地黄、紫草、红花、丹皮、栀子这类药物，少量加入人参来监制（防止寒凉伤正）。这就好比用兵打仗，必须选择体力过人者冲锋，又担心其鲁莽，一定要以老成持重者在后监督，使热毒化解而气血不受损伤，这样往往能成功。这种方法是我的老师与方搏九先生悟得的，当时的人并不理解。古人发表（解表）有用参苏饮、人参羌活散，攻里有黄龙汤，和解用小柴胡汤，清胃用人参白虎汤，治痢疾有人参连饮，这些都是难以单纯清解，不可不用人参而又不得不用人参的情况，援引这些作为治痘的类比，为什么唯独治痘不可以呢？○真实火证，必须使用清凉药物。清凉之剂不宜过早，也不宜过晚，得力之处在于三、四朝，如果在三、四朝不及时清除，后来虽然再用，痘疮也一定无法承受。譬如禾苗浇灌要在初种时进行，如果苗已经长成，即使加上灰粪，也已经来不及了。○第四、五朝，痘色光亮的不太好，枯涩的也不好，在不枯不亮之间，需要仔细体会把握。○痘出三天，点到足下为齐整。如果分布繁密，点不到足部，叫做无根，后来必然发生变故。足冷不温的，用葱白和艾叶煎汤清洗，保暖覆盖片刻，如果痘点逐渐透发出来则是吉兆。○痘出三朝出齐之后，是否应当清热，总以嘴唇和舌头为准，必须舌干唇燥，大小便闭结，才可以重用清凉药物。如果唇舌淡润而没有里证，痘虽稠密，或干红紫滞，只宜用清淡的药物清解，黄连、石膏、犀角、地黄之类，不可滥用。如果清凉太过，到八、九朝多会导致瘙痒腹泻、毒邪内攻而死。○不但清热药不宜太过，一见唇舌淡润，就应尽早进服人参、黄芪，合用当归、川芎、甘草、桔梗、防风、僵蚕，以引导行浆的道路，浆成得早则毒易化，浆迟滞则毒难化。里没有实火，滥用清凉，脓怎么能形成？脓不成则毒必不化，想要不发生变故，可能吗？（《橡村痘诀》）
翁氏说：三日、四日，痘出应当齐整，点到足心，病势才安静。如果是年幼的孩子，气血容易周流，常有不到三天就发齐的。年长体质的人，四日以后，还有继续增发的，痘稀疏数量不足一百颗，不必点到足心。辨明形色，身体强壮，痘属上中等级，才可以允许其无忧虑。如果是幼小弱质，或者病后，或者带有其他疾病，而后布痘，不可轻易地说痘好而无顾虑。（叶天士）
三、四日，希望痘粒饱满，宜用牛蒡子，透发痘标，又能使痘粒饱满。僵蚕，是使痘粒饱满时的妙药，能使痘饱满，又能助长浆液。既然痘已经饱满，就想让它成浆，这个药又能治疗游红痘，三、四、七、八日都可以使用。○三、四日未能发胖，行浆药中可用鸡冠血酒乳，或者恐怕酒助毒发痒，然而也无妨。○穿山甲大能发痘起胀，再以僵蚕辅助它，何必担心它不饱满呢？（《仁端录》）
痘至五日，内外证候平稳，应当开始起发退红。不然，正气必然虚弱，方中加倍加入人参、黄芪，这是唤浆的方法。（《慈幼筏》）
起胀
痘不起胀，死亡很快。起胀这一关，气到达是关键，血次之。起胀的原因，是火蒸腾，水升腾。不致力于此，反而通过攻发来求取起胀，这是拔苗助长，就像破车瘦马，却鞭打驱策以求前进一样。痘一见点，则毒分散于外，气护卫其宫，血守在其中。现在气不到，不能托毒于外，毒得以跨越门槛留在里面，所以不起胀。间或有起的，中空暗薄，是因为气至而不盛，血次不继，由于火不足蒸腾，水不足升腾，像将息的余烟，想枯竭的微泽，不久倒塌而亡。（《黄帝逸典》）
痘毒未发时，潜伏于命门，本来与气血不曾交会，等到发作而奔赴胃腑，胃多气血而主肌肉，毒与气血在胃中交会，痘才发出。既已交会，毒与气血混而为一，气血之中怎肯容留毒邪？于是领载而出，出而生长，生长而灌注，等到成功，毒既结成而为疤痕，气血返回归于人体，一旦有阻滞，则变态百出。所以在出齐之后，未灌注之前，如果不存留余地，何以容纳？因此起胀是行浆的重要通道。医家在此应当寻求度过第二关。○有人说：痘的起胀，如同制作蒸饼的上笼屉，这个比喻最确切。○血热之痘，火盛毒壅，气血被其灼烧，毒结于中，怎能起胀？急宜凉血解毒，毒解则火退，火退则气血分离，而痘自然起胀。○痘以元气为主，起胀就是气至。气虚不能充畅，怎能起胀，急用保元汤，佐以松肌活血，则气血自然分开。（《橡村痘诀》）
凡起胀时颜色焦紫的，是毒盛；形体大皮薄而起皱纹的，是毒盛气虚；顶部红满的，是血滞。滞者用活血法，焦者用清热法，气虚毒盛，用补益兼解毒法。只要面部有一、二处悦目可爱，用药当节制，则枯者润，薄者浓，而生机勃然。（《慈幼筏》）
第六天
古人说：痘证生于六日之前者易治，生于六日之后者难疗。那么六朝是痘家的生死关头。顺症痘至此，上部大多已经行浆；即使是险证至此，也应当顶白根红，有行浆之势才可以。如果到此时，气血不分，绝对没有成功的道理。○痘六朝叫痛的最好，痛则不敢粘惹，痘自完全。痒最可嫌，痒之轻者，嘱咐其把捉，重用鲜鳞攻毒饮，浆行则痒变为痛了。○六朝以前，毒未化而正气虚，以清为主，补为佐；六日后，毒未化而正气虚，以补为主，清为佐。○痘六朝应当灌脓，大粒者光壮，细碎者干焦，应当选取大者。大粒者顶陷平塌，或枯涩无脓，细粒者内有真浆，渐次充满，应当选取细者。总宜极力攻发，方可收功。○六日以前，专看根窠，无根窠则必不灌脓；六日以后，专看脓色，无脓色则必难收功。先贤历练之言，确不可改。再解释一下：无根窠要使之收束，无脓色要使之融化。气虚者补其气，则血自归附；血虚者敛其血，则根不散漫；火甚者清其火，则血不伤。这三种治法条例，各从其是，不用通套方子，便不为陈言所困。○痘五、六朝，元气虚弱，顶陷不起的，古方补中益气汤甚妙。其中参、甘草是保元汤，白术助参而固脾土，当归和血而生血，升麻、柴胡能使清者升、陷者起。虚弱痘证，用于起壮行浆之期，胜于僵蚕、皂角刺多了。（《橡村痘诀》）
痘至六日，欲其行浆，加生黄芪、圆眼肉、当归配伍抚芎、桔梗、陈皮剂中。川芎能调气，黄芪可托里，又与桔梗、陈皮并力升发，嗣后渐加人参、山药、莲肉、糯米等，令浆足则毒化功收矣。此时尚有未解之火，又不可不兼用丹参、僵蚕等。真是虚寒证，再加肉桂、附子也可以。（《痘疹元珠》）
浮肿
气属阳，血属阴，宜调和而不分离。痘未起发，而头面先肿的，这是阳火亢盛，火性炎上。《内经》说：热盛则肿。可见毒火随阳气上升，而阴血不能归附，是气血相离的现象。如果痘起发，头面逐渐肿胀的，这是毒瓦斯发越，聚于三阳经，欲作脓血，这是应该肿的。假如应当起发，而头面不肿的，必定痘本磊落，毒势轻浅，固然虽作浆，根不粘连，所以不肿，这是佳兆。如痘本稠密，起发应当肿而不肿的，这是毒伏于内不能发越，这是正气不足，不能胜邪所致。治法应当以助正气为主。如痘稀疏，起发不应肿而肿的，这是感疫毒之气，名叫大头瘟的是这种情况。治法应当兼治疫气。大凡疮肿者，直至脓满结痂，毒化而肿消目开者为吉；若未充足而肿消目开的，这是正气不足，不能化毒成浆，名为倒靥，乃凶兆也。所以应肿不肿，不应肿而肿，应消不消，不应消而消，都应当详细察验。（《痘科类编》）
封合
痘至灌浆，则藏伏之毒与精华，都被逼烁在外，所以空窍眼鼻之处，津液留聚而为封塞。然而必须待肿胀灌脓而然，才是正候。所以三、四朝不宜封塞的，是说毒未外达，邪火上炎；如果五朝之后又宜封塞的，是说气血充灌，精华不外驰。其封塞之所，如胶脂光润者为吉；如煤干黑者，是脏腑燥槁，津液枯竭；如脓流溢的，是毒火内烁，精华外泄，都是凶兆。如果既封塞，而六、七朝即开的，防毒未消，有内攻的危险。只有痘稀少的，不在此例。（冯楚瞻）
回浆时眼肿不能开的，用水湿绢巾，拭去脓眵，略用手指攀开眼皮，透一线缝，则不生翳膜。（《医学入门》）
第七、八天
痘出七日，阴中之阳尽达于外，内则空虚，如釜中甑内之气，阳起一分，阴长一分，所以其浆，宜渐而黄，根下血晕，宜渐而紧，如腺围定，不铺散，不灰黯，昼夜不痛楚，饮食倍常，大便少，身热微微，是吉兆，反之者是逆证。至此决定死生，只看血晕紧散，脓色真伪罢了。真的宝色光彩，伪则色如土黄。紧者气能拘血化毒，散则气虚散而华，气将绝矣。血晕全无者死。脓是毒所化。诀曰：六日以后专看脓色。故有脓则生，无脓则死。假使或有或无，而根脚不红，或连肉灰红，作痒烦躁，目封欲开，作泻干呕，不食少睡，这是气虚不能拘血化毒，急峻补之。倘若此时尚见舌黑有刺，生意绝矣，不仅不容补，即补之何益？（程华仲）
七、八朝，面部浆未灌足，早结干红疤，而头顶不收，下部犹灌的，无妨，但宜攻发，不得早用清利。○七、八朝，面部虽有真浆，下体纯是清水，不切牙，不作泻的，人参、黄芪酝酿亦可收功。若切牙泄泻，擦破皮塌不成疤的，谓之外剥，不治。○七、八朝，先灌者虽收，后出者方灌，只宜攻发后者，不得早用清利。○痘至八朝，音咽忽有痰声，虽痘色不变，也要提防，九朝气急腹胀，恐从此始。（《橡村痘诀》）
痘至七日，当用人参、黄芪等助浆，恐于火毒相戾，所以六朝以前，须预着力清解，使火毒净尽为妙。若清解未净，而清补并用，必致减去人参、黄芪之力，所以药不应手。（徐仲光）
行浆
浆之不浆，胀之不先，浆之斯浆，胀之而藏。其浆也，气血齐盈，水火均平，毒孤而熟化其根。夫痘之浆，毒之化也，毒所由化，气至而水盈焉，水盈而血生焉，使不干焦而成薄脓。气之至焉，水足而火行焉，火行而毒熟焉，能蒸烂其毒而成稠脓。故火不得水不蒸，水不得火不腾。浆而不浆，不责其毒，不责其血，惟求其气。浆而不稠，毒不尽化，温而扶之。因泻不稠，气下泄也，温扶而升之。浆而不浆，恣其补益，幸而毒腐，真元惫极，气机以息，是成板黄，主客俱伤，不免死亡。浆已成熟，气不能接，犹弓开难满，忽下陷而泄，目为之开，势在危急，但观其痘色犹未变，半日之间数倍补益，生犹可得。大抵痘之生死，系于浆之有无；浆之有无，系于胀之起伏；胀之起伏，系于身之气血；身之气血，系于中之水火。水乃后天之形气，火乃先天之元气，此起胀行浆之微妙也。（《黄帝逸典》）
行浆自头面始，头面有洋，自能顺行而下，渐转黄熟。所谓洋者，如玉中之绵，水中之云，光彩活动，二日过肩，三日过膝。若头面虽灌，而清淡无洋，不过肩的，必成外剥，不过膝的，必有余毒。○予师口授云：看浆必要有洋。凡浆起必要浮胰，伞顶看脓，痘必要如豆煮熟，中心一样。其言最形容的当。○浆清多是体虚，皮浓而不灰的，人参、黄芪、乳酒、鸡汁、羊肉之属酿之，自可成脓结痂。皮薄者，擦之即成外剥，泄泻切牙，内攻不能救矣。○灌不起有二证：一为血热，一为气虚。血热者毒结而不化，急宜凉血解毒；气虚者灰白顶陷，毒凝不运，急宜补气。其他形状多般，总不离此二者。○灌不起，体虚者十之七，血热者十之三。或清或补，佐以攻发，多有成功。若体虚而夹毒，血热而伤气的，清中补，补中清，生死关头，端在乎此。○灌脓时要有腥气，无腥气必无真浆，急宜攻发。○抢浆者，稀痘无之。稠密之痘，未至浆期，先灌数粒，其色黄熟，此火毒所迫，气血不能主持，与伤科未老先白头同病，急宜泻火。○血浆者，火甚也。痘之为用，全赖火以成功，火固不可尽泻，然亦不宜太盛，温温养之，则浆成矣。浆者血之变也。火甚则血不及变而即行，故成血浆，不急泻火，有色紫烦闷而告变者，泻火则色淡而浆渐浓，亦自成疤而愈。○血浆与紫痘不同：间发者为紫痘，擦碎则纯是清水；胸背腰腹一片红者为血浆，碎之则是未变脓之血也。○停浆者，浆半行而忽止，非气血之虚，亦毒之结也。由于营卫不和，或寒暑之气逆之。速宜斟酌用药，不尔，轻则鬼肿发，重则内攻矣。（《橡村痘诀》）
浆行七日，肿要过项，浆要过胸。肿者，毒外出也；言过胸者，从上下也。至阳物亦要灌，乃宗筋之会也。两脚不灌不妨。○两臂亦宜满，不然，临收时必不食而生他变。手臂，脾所主也。○珠不在大，在乎体之明；浆不在足，在乎色之正。土黄者，黄而无彩也。○灌脓时，额上形如汤泡，皮肉尽赤而干，此气自尽不能拘血，血亦不能附气而制毒，必死。诸痘才灌，而两唇先黄硬，此毒先入脾，失次序矣，必死。擦破而疮痕隐隐有生意，此秽触也，勿作死证治。（程华仲）
看脓之法，火照之内外光润，手按之皮薄软陷的，无脓也。火照之而内暗，手按之而如鼓的，有脓也。○凡灌浆时，必认得毒已解尽，方可一心温补。若遇寒证，加姜、桂亦可。但毒未解尽的，须带丹参辈以清火；僵蚕之妙，以其助浆兼解毒也。○痘浆已足，即宜清凉解毒，兼利小水，则毒不留于内，从小便泄去，而湿润之气，转而为燥，庶几收而余毒得免。（《仁端录》）
漏浆
A few spots, with a dull and dark color, restless convulsions and tremors, cyanotic complexion, upward deviation or strabismus of the eyes, and loss of consciousness, is called "Jing Bi" (Shock Closure); the toxin is latent in the Liver and Gallbladder, leading to death on the same day. The Varicella toxin is originally severe, attacking the Stomach all at once; the Stomach Qi is injured by Heat, unable to expel the toxin outward, inevitably resulting in Cyan, Purple, Blue, or Black macules, rotting of the Stomach, and death, mostly occurring between the fifth and sixth days. These four conditions are ineffective with conventional treatments; new prescriptions must be formulated to save them, seeking life amidst death, requiring rapid medication, where one or two out of ten may be saved. (*Racun Doujue*)
On the third, fourth, and fifth days:
An expert physician treating smallpox can determine auspiciousness or inauspiciousness upon first sight, and next, decide life or death on the third day. If unable to decide on the third day, one cannot speak of treatment. ○ In cases of Deficiency mixed with Toxin, the third and fourth days are the most difficult for medication. Heat-Toxin must be thoroughly cleared, yet Yuan Qi (Primal Qi) must not be neglected. I have used herbs such as Huanglian (Coptis Rhizome), Shigao (Gypsum Fibrosum), Xijiao (Rhinoceros Horn - *Note: Substitute with Buffalo Horn in modern practice*), Dihuang (Rehmannia Root), Zicao (Arnebia Root), Honghua (Carthamus Flower), Danpi (Moutan Cortex), and Zhizi (Gardenia Fruit), adding a small amount of Renshen (Ginseng Root) to supervise (prevent cold-natured herbs from damaging the healthy Qi). This is like using troops; one must select those with extraordinary strength to charge, but fearing their rashness, one must employ an experienced veteran to supervise from behind, ensuring the Heat-Toxin is transformed without injuring Qi and Blood, often achieving success. This method was discovered by my teacher and Mr. Fang Bojiu, which people at the time did not understand. Ancients used Renshen Su Yin (Ginseng and Perilla Decoction) and Renshen Qianghuo San (Ginseng and Notopterygium Powder) for releasing the exterior; Huanglong Tang (Yellow Dragon Decoction) for purging the interior; Xiaochaihu Tang (Minor Bupleurum Decoction) for harmonizing; Renshen Baibu Tang (Ginseng and White Tiger Decoction) for clearing the Stomach; and Renshen Lian Yin (Ginseng and Coptis Drink) for treating dysentery. All these are difficult to clear and resolve alone, situations where Renshen cannot be omitted despite difficulties. Drawing parallels for treating smallpox, why should it not apply? ○ For true Fire syndromes, cooling agents must be used. Cooling agents should not be used too early nor too late; they are most effective on the third and fourth days. If not cleared urgently during these days, later use will be ineffective as the pustules will not tolerate it. It is like watering seedlings at the time of planting; if the seedlings have grown tall, adding ash and manure afterwards is futile. ○ On the fourth and fifth days, pustules that are bright and lustrous are not good, nor are those that are dry and rough. One must grasp the balance between neither dry nor bright. ○ After three days, when spots reach the soles of the feet, it is considered complete. If dense but spots do not reach the feet, it is called "Wugen" (Rootless), and changes will surely occur later. If the feet are cold and not warm, wash with a decoction of Congbai (Scallion Stem) and Aiyi (Mugwort Leaf), cover warmly for a while; if spots gradually emerge, it is auspicious. ○ After the third day when spots are complete, whether to clear heat depends entirely on the lips and tongue. Only when the tongue is dry and lips parched, with constipation of stool and urine, can heavy cooling medications be used. If lips and tongue are pale and moist without interior signs, even if pustules are dense, dry, red, purple, or stagnant, only mild clearing agents should be used. Huanglian, Shigao, Xijiao, and Dihuang should not be used recklessly. If cooling is excessive, by the eighth and ninth days, itching, diarrhea, and internal attack of toxin often lead to death. ○ Not only should clearing agents not be excessive; upon seeing pale and moist lips and tongue, Renshen (Ginseng Root) and Huangqi (Astragalus Root) should be advanced early, combined with Danggui (Angelica Sinensis Root), Chuanxiong (Ligusticum Rhizome), Gancao (Licorice Root), Jiegeng (Platycodon Root), Fangfeng (Saposhnikovia Root), and Jiangcan (Bombyx Batryticatus) to guide the path of pus formation. Early pus formation facilitates toxin transformation; delayed pus makes toxin transformation difficult. Without excess Fire in the interior, reckless cooling prevents pus formation. Without pus, toxin cannot transform; how can one avoid complications? (*Racun Doujue*)
Mr. Weng said: On the third and fourth days, pustules should be complete, reaching the sole of the foot, and the condition should stabilize. In young children, whose Qi and Blood circulate easily, completion often occurs before three days. In older individuals, eruptions may continue beyond four days; if pustules are sparse and fewer than one hundred, reaching the sole is unnecessary. Distinguishing form and color, if the body is strong and the pustules are upper-middle grade, one can be reassured. However, in frail children, or those post-illness, or with concurrent diseases, one should not rashly declare the prognosis favorable. (Ye Tianshi)
On the third and fourth days, to promote fullness, use Niubangzi (Arctii Fructus) to vent the pustule tips and promote fullness. Jiangcan (Bombyx Batryticatus) is an excellent herb for promoting fullness; it plumps the pustules and assists pus formation. Once pustules are full, the goal is pus formation; this herb also treats "Youhong Dou" (Roaming Red Pustules) and can be used on the third, fourth, seventh, and eighth days. ○ If fullness is not achieved on the third and fourth days, Ji Guan Xue Jiu Ru (Chicken Comb Blood Wine Milk) can be added to the pus-promoting formula. Although wine might aggravate toxin and cause itching, it is generally acceptable. ○ Chanshanjia (Pangolin Scales) strongly promotes eruption and fullness; assisting with Jiangcan ensures fullness. (*Ren Duan Lu*)
By the fifth day, when external and internal signs are stable, promotion of eruption and reduction of redness should occur. Otherwise, Zheng Qi (Upright Qi) will become deficient; double the dosage of Renshen (Ginseng Root) and Huangqi (Astragalus Root) in the formula as a method to summon pus. (*Ci You Fa*)
Promotion of Swelling (Qi Zhang)
If pustules do not swell, death comes quickly. In the stage of swelling, Qi arrival is primary, Blood secondary. The mechanism of swelling involves Fire steaming and Water rising. Neglecting this and seeking swelling through aggressive expulsion is like pulling up seedlings to help them grow, akin to whipping a broken cart and weak horse to make it advance. Upon spotting, toxin disperses outward, Qi guards the palace, and Blood stays within. Now, if Qi does not arrive, it cannot push toxin outward, allowing toxin to linger inside the threshold, hence no swelling. Occasionally, swelling occurs but is hollow, dark, and thin because Qi arrival is weak and Blood succession is lacking, due to insufficient Fire steaming and Water rising. Like dying embers trying to dry up slight moisture, collapse and death follow soon. (*Huangdi Yidian*)
Before eruption, toxin lies dormant in Mingmen (Gate of Life), not interacting with Qi and Blood. When it erupts and rushes to the Stomach, which is rich in Qi and Blood and governs muscles, toxin interacts with Qi and Blood in the Stomach, causing pustules to appear. Having interacted, toxin and Qi/Blood mix into one; how can Qi and Blood tolerate toxin? Thus, they carry it out, where it grows, fills, and succeeds. When toxin solidifies into a scar, Qi and Blood return to the body. Any obstruction leads to myriad abnormalities. Therefore, after completion but before filling, if there is no room reserved, how can it accommodate? Thus, swelling is the crucial pathway for pus formation. Physicians must seek to pass this second barrier. ○ Some say: Swelling is like placing dough in a steamer basket; this analogy is precise. ○ For Blood-Heat pustules, with excessive Fire and blocked Toxin, Qi and Blood are scorched, and toxin knots internally, preventing swelling. Urgently cool Blood and resolve Toxin; as toxin resolves, Fire retreats, Qi and Blood separate, and pustules naturally swell. ○ Smallpox relies on Yuan Qi; swelling indicates Qi arrival. If Qi is deficient and cannot flow freely, swelling is impossible. Urgently use Baoyuan Tang (Preserve the Origin Decoction), assisted by herbs that loosen muscle and invigorate Blood, so Qi and Blood separate naturally. (*Racun Doujue*)
When swelling begins, if color is scorched purple, Toxin is excessive; if large, thin-skinned, and wrinkled, Toxin is excessive and Qi is deficient; if the apex is fully red, Blood is stagnant. Treat stagnation with blood-invigorating methods, scorching with clearing methods, and Qi-deficient/Toxin-excessive cases with tonification combined with detoxification. As long as one or two spots on the face are pleasing and lovely, regulate medication carefully; then dry spots become moist, thin spots become thick, and vitality flourishes. (*Ci You Fa*)
Sixth Day
Ancients said: Smallpox appearing before the sixth day is easy to treat; appearing after is difficult. Thus, the sixth day is the critical juncture of life and death. In favorable cases, the upper body has mostly progressed to pus formation by now; even in dangerous cases, the apex should be white and the base red, showing momentum toward pus formation. If Qi and Blood are indistinguishable at this point, success is impossible. ○ Pain on the sixth day is most auspicious; pain prevents adhesion, keeping pustules intact. Itching is detestable; for mild itching, instruct restraint and use Xian Lin Gong Du Yin (Fresh Scale Toxin-Attacking Drink); as pus forms, itching turns to pain. ○ Before the sixth day, if Toxin is untransformed and Zheng Qi is deficient, prioritize clearing with tonification as adjunct; after the sixth day, if Toxin is untransformed and Zheng Qi is deficient, prioritize tonification with clearing as adjunct. ○ On the sixth day, pus should fill. Large pustules should be bright and robust; fine ones may be dry and scorched, so prioritize large ones. If large pustules have depressed/apex-flat tops or are dry/scorched without pus, but fine ones contain true pus filling gradually, prioritize fine ones. Overall, vigorous promotion is necessary for success. ○ Before the sixth day, focus on the root base; without a root base, pus will not fill. After the sixth day, focus on pus color; without pus color, healing is difficult. Words of experience from sages are immutable. Further explanation: For absent root bases, promote consolidation; for absent pus color, promote resolution. Tonify Qi in Qi deficiency so Blood adheres; astringe Blood in Blood deficiency so roots do not scatter; clear Fire in Fire excess so Blood is not damaged. These three methods follow their respective principles; avoiding generic formulas prevents being trapped by stale theories. ○ For Qi deficiency with depressed apices on the fifth/sixth day, Buyi Zhongyiqi Tang (Tonify the Middle and Augment the Qi Decoction) is excellent. It contains Renshen and Gancao (Preserve Origin aspect), Baizhu (Assists Ginseng to strengthen Spleen Earth), Danggui (Harmonizes and generates Blood), and Shengma/Chaihu (Raises clear Yang and lifts depression). Used during the swelling/pus phase for deficiency cases, it surpasses Jiangcan and Zaoci Ci (Gleditsia Spine). (*Racun Doujue*)
By the sixth day, to promote pus, add Sheng Huangqi (Raw Astragalus Root), Yuanyan (Longan Aril), and Danggui paired with Fuxiong (Nourishing Chuanxiong), Jiegeng (Platycodon Root), and Chenpi (Tangerine Peel). Chuanxiong regulates Qi; Huangqi supports the interior; together with Jiegeng and Chenpi, they jointly promote ascent. Subsequently, gradually add Renshen (Ginseng Root), Shanyao (Dioscorea Rhizome), Lianrou (Lotus Seed Endosperm), and Nuomi (Glutinous Rice) until sufficient pus transforms toxin and achieves success. At this time, unresolved Fire remains, so Danshen (Salvia Miltiorrhiza Root) and Jiangcan (Bombyx Batryticatus) should be included. For true Cold-Deficiency, add Rougui (Cinnamon Bark) and Fuzi (Aconite Root). (*Douzhen Yuanzhu*)
Edema
Qi belongs to Yang, Blood to Yin; they should harmonize without separating. If edema appears on the head and face before eruption, this is Hyperactive Yang Fire, as Fire nature flares upward. The Classics state: Excess Heat causes swelling. This shows Toxin-Fire rising with Yang, while Yin Blood fails to adhere, indicating separation of Qi and Blood. If edema develops gradually on the head and face after eruption, this is Toxin-Vapor expanding and gathering in the Three Yang meridians, intending to form pus and blood; this is appropriate swelling. If eruption should occur but no edema appears, the pustules are likely distinct and toxin light; although pus may form, roots do not adhere, hence no swelling—this is a good omen. If pustules are dense and should swell but do not, toxin is latent internally and cannot expand; this is due to insufficient Zheng Qi failing to overcome Pathogen. Treatment should primarily support Zheng Qi. If pustules are sparse and should not swell but do, this is contracting Epidemic Toxin, known as Datou Wen (Great Head Plague). Treatment should address the epidemic Qi. Generally, for swelling, if it persists until pus is full and scabs form, toxin transforms, swelling subsides, and eyes open, it is auspicious. If swelling subsides and eyes open before pus is sufficient, this is insufficient Zheng Qi failing to transform toxin into pus, named "Dao Ye" (Inverted Scab), which is ominous. Therefore, swelling when it shouldn't, no swelling when it should, subsiding when it shouldn't, or persisting when it should, all require careful observation. (*Douke Bian*)
Pre-edema of head and face, with toxin failing to settle into its cavity, requires Dafupi (Magnolia Officinalis Bark) to be effective. (*Racun Doujue*)
Sealing (Feng He)
Upon pus formation, latent toxin and essence are forced outward, causing fluids to accumulate in orifices (eyes, nose, etc.), leading to sealing. However, this must await swelling and pus filling to be normal. Thus, sealing on the third/fourth days is inappropriate as toxin has not reached the exterior and Evil Fire flares upward; sealing after the fifth day is appropriate as Qi and Blood are充盈 (full) and essence does not leak. If sealed areas are glossy like gelatin, it is auspicious; if dry black like coal, organs are dry and fluids exhausted (inauspicious); if pus flows out, internal Toxin-Fire scorches and essence leaks (inauspicious). If sealed but opens on the sixth/seventh days, fear uneliminated toxin causing internal attack. Sparse pustules are exempt. (Feng Chuzhan)
For swollen eyes unable to open during pus regression, wipe away discharge with a water-moistened silk cloth, gently pull eyelids apart with fingers to create a slit, preventing membrane formation. (*Yixue Rumen*)
Seventh and Eighth Days
On the seventh day, Yin containing Yang reaches the exterior completely, leaving the interior empty. Like steam in a steamer, for every unit of Yang rising, Yin grows; thus, pus should gradually turn yellow, and the blood halo at the base should tighten, forming defined glandular rings without spreading or graying, without day/night pain, with doubled appetite, reduced stool, and slight fever—all auspicious. The reverse is adverse. At this stage, life or death depends on the tightness/dispersion of the blood halo and the authenticity of pus color. Authentic pus has precious luster; fake resembles earthy yellow. Tightness indicates Qi restraining Blood to transform toxin; dispersion indicates Qi deficiency scattering brilliance, approaching exhaustion. Absence of blood halo means death. Pus is transformed toxin. The maxim states: After the sixth day, focus solely on pus color. Hence, presence of pus means life, absence means death. If pus is intermittent, roots are not red, or flesh is gray-red, with itching, restlessness, sealed eyes wanting to open, diarrhea, dry retching, poor appetite, and little sleep, this is Qi deficiency failing to restrain Blood and transform toxin; urgent strong tonification is required. If black tongue with prickles appears, vitality is extinct; tonification is useless. (Cheng Huazhong)
On the seventh/eighth days, if facial pus is insufficient, drying into red scabs early, while the crown remains unfilled and lower body still filling, it is acceptable, but promote eruption and avoid early clearing/draining. ○ If facial pus is true but lower body is clear fluid, without teeth-grinding or diarrhea, Renshen and Huangqi fermentation can achieve success. If teeth-grinding and diarrhea occur, or skin breaks down failing to form scabs, it is "Waibo" (External Peeling), untreatable. ○ If earlier spots are resolving while later spots are just filling, only promote the later spots; avoid early clearing. ○ By the eighth day, sudden phlegm sounds in voice/throat, even if pustule color hasn't changed, requires vigilance; ninth-day shortness of breath and abdominal distension may begin here. (*Racun Doujue*)
By the seventh day, use Renshen and Huangqi to assist pus. Fear conflict with Fire-Toxin, so prior to the sixth day, effort must be made to clear, ensuring Fire-Toxin is completely eliminated. If clearing is incomplete and clearing/tonifying are combined, the power of Renshen/Huangqi is diminished, rendering medication ineffective. (Xu Zhongguang)
Pus Formation (Xing Jiang)
Failure to form pus stems from failure to swell; successful pus formation follows successful swelling. Pus requires equal abundance of Qi and Blood, balance of Water and Fire, isolating Toxin to ripen its root. Pus is toxin transformation. Transformation occurs when Qi arrives and Water fills; Water fills then Blood generates, preventing dryness and forming thin pus. Qi arrival ensures Water sufficiency and Fire movement; Fire movement ripens toxin, steaming it into thick pus. Fire needs Water to steam; Water needs Fire to rise. Failure to form pus blames neither Toxin nor Blood, but seeks Qi. Thickness failure implies incomplete toxin transformation; warm and support. Diarrhea-induced thinness implies Qi sinking; warm, support, and lift. Unchecked tonification in failure to form pus may luckily rot toxin, but exhausts True Yuan, halts Qi mechanism, resulting in "Banhuang" (Board Yellow), injuring both host and guest, leading to death. If mature pus fails to connect due to Qi inability, like a drawn bow hard to hold, sudden collapse and leakage occur, eyes open, crisis imminent. If pustule color hasn't changed, massive tonification within half a day may save life. Generally, life/death depends on pus presence; pus presence depends on swelling起伏 (rise/fall); swelling depends on Body Qi/Blood; Body Qi/Blood depends on Internal Water/Fire. Water is Postnatal Form-Qi; Fire is Prenatal Yuan Qi—the subtlety of swelling and pus formation. (*Huangdi Yidian*)
Pus formation starts at head/face. If "Yang" (luminosity/fluidity) exists, it flows downward, turning yellow/ripe. "Yang" is like cotton in jade, clouds in water, lively and bright. By day two, it passes shoulders; day three, knees. If head/face fills but lacks Yang, not passing shoulders leads to External Peeling; not passing knees leaves residual toxin. ○ My teacher orally instructed: Look for Yang in pus. Pus must float like fat; check pus at umbrella-top; pustules must resemble cooked beans, uniform in center. This description is apt. ○ Clear pus often indicates Body Deficiency. If skin is thick and not gray, ferment with Renshen, Huangqi, Milk-Wine, Chicken Juice, Lamb Meat to form pus and scabs. Thin skin, if rubbed, becomes External Peeling; diarrhea, teeth-grinding, internal attack are incurable. ○ Failure to fill has two patterns: Blood-Heat and Qi-Deficiency. Blood-Heat: toxin knots untransformed; urgently cool Blood/resolve Toxin. Qi-Deficiency: gray/white, depressed apex, toxin coagulated/unmoving; urgently tonify Qi. Other shapes fall into these two. ○ 70% of filling failures are Body Deficiency; 30% Blood-Heat. Clear or tonify, assisted by promotion, often succeed. For Deficiency with Toxin, or Heat injuring Qi, balance clearing/tonifying; life/death hinges here. ○ Pus filling should have a fishy smell; absence means no true pus; urgently promote. ○ "Snatching Pus": rare in sparse smallpox. In dense cases, before pus phase, a few grains fill yellow/ripe; this is Fire-Toxin forcing Qi/Blood to lose control, similar to premature graying in trauma; urgently purge Fire. ○ "Blood Pus": excessive Fire. Smallpox relies on Fire for success; Fire cannot be fully purged, nor should it be too strong. Warmly nourish, and pus forms. Pus is transformed Blood. Excessive Fire prevents Blood transformation, flowing immediately as Blood Pus. Do not urgently purge Fire; if purple/restless changes occur, purging Fire lightens color and thickens pus, leading to natural scabbing/healing. ○ Blood Pus differs from Purple Pustules: Intermittent purple spots crush to clear water; widespread redness on chest/back/waist/abdomen is Blood Pus, crushing reveals untransformed Blood pus. ○ "Stopped Pus": pus stops halfway. Not Qi/Blood deficiency, nor Toxin knotting, but Ying-Wei disharmony or reversal of Cold/Summerheat Qi. Adjust medication promptly; otherwise, mild cases develop "Ghost Swelling," severe cases internal attack. (*Racun Doujue*)
Seven days of pus flow: swelling should pass the neck, pus should pass the chest. Swelling indicates toxin exiting externally; passing chest indicates descending from top/bottom. Genitals should also fill, as they are the convergence of Zongjin (Convergent Tendons). Empty legs are acceptable. ○ Arms should also be full; otherwise, upon closure, refusal to eat and other changes occur. Arms are governed by Spleen. ○ Pearls need not be large, but clarity of body matters; pus need not be abundant, but correct color matters. Earthy yellow is yellow without luster. ○ During filling, if forehead resembles boil, skin/flesh red and dry, Qi is exhausted, unable to restrain Blood; Blood cannot attach to Qi to control Toxin; death is certain. If lips turn yellow/hard before other pustules fill, Toxin entered Spleen first, losing order; death is certain. Rubbed lesions with faint vitality indicate filth contact; do not treat as fatal. (Cheng Huazhong)
Method to inspect pus: Illuminate with fire; if内外光润 (internally/externally glossy) and soft/depressed on touch, no pus. If dark internally and drum-like on touch, pus exists. ○ During filling, ensure Toxin is fully resolved before focusing on warming/tonifying. For Cold patterns, add Ginger/Cinnamon. If Toxin unresolved, include Danshen to clear Fire; Jiangcan is wonderful for assisting pus and resolving Toxin. ○ When pus is sufficient, use cooling/detoxifying and diuretic methods to prevent internal toxin retention, excreting via urine, transforming dampness to dryness, aiding closure and sparing residual toxin. (*Ren Duan Lu*)
Leaking Pus