发泡为气盛血虚之候。盖肺火动而皮毛伤。前聚而为泡。小者如水珠。大者如葡萄。色白而
空。或有清水者。气虚有火也。治之当补脾肺。顺水道而虚自实矣。钱氏异功散加车前、泽泻之
类。紫而空者。血虚有热也。清肺汤加当归、芍药、茯苓、车前。使小便下行。则气平血和。其
泡自敛。若薄如竹膜燎浆泡者。必待浆臭而后可治。泡碎则亡矣。
气虚则陷伏。血虚则痒塌。痘初出而遍身作痒者。此邪欲出。因风寒闭其腠理。其火游移往
来故痒。宜疏散而泻肝
木。邪气得泄。痘出而痒自止。痘收敛而作痒者。脓成毒解。火气渐微。本无毒蕴也。芍药汤。
若大便秘结。犀角消毒饮。痘养浆时。淡白平塌。少食便溏。浆清而痒。爬搔不宁者。此脾胃虚
弱。气血俱虚虚。火扰攘所致。参 内托散。甚则陈氏木香散佐之。药不应者凶。痘色红紫干滞。
二便秘。口渴烦躁。浆充而痒。抓破血流者。此气盛血热也。四物汤加连翘、赤芍、白芷、蝉蜕。
甚则四顺饮下之。如作痒人事清爽。自知其误抓破。或言其痒。欲人拊之吉。如痒而闷乱烦躁。语
禁不止。摇头手足舞乱。破损无血。眼札目开凶也。若他处破损虽多。脓血稠粘。正面不破者。
其脏府精华不散。正气未亏。尽可收功。有面痘虽痒甚。擦破即痂。能食神清者。可治。昏乱者
死。若破无脓血。不结靥。如无肤之状。寒颤切牙。便泄哕呛者。不治。
发泡是气盛血虚的征候。这是因为肺火亢动损伤了皮毛，气血前聚而形成水泡。小的像水珠，大的像葡萄，颜色白且中空，有的含有清水，这是气虚而有火的表现。治疗应当补益脾肺，通利水道，正气自然充实。可用钱乙的异功散加入车前子、泽泻等药物。如果水泡紫而中空，这是血虚有热的表现。用清肺汤加入当归、芍药、茯苓、车前子，使小便下行，则气平血和，水泡自然收敛。如果是薄如竹膜般的燎浆泡，必须等到脓液变臭之后才可治疗，若水泡破裂则会导致死亡。
气虚则痘疹陷伏，血虚则痘疹瘙痒塌陷。痘疹初出时遍身瘙痒，这是邪气欲出，因风寒闭塞腠理，火热之气游移往来所致，适宜疏散并泻肝木。邪气得泄，痘疹发出后瘙痒自止。痘疹收敛时出现瘙痒，是因为脓成毒解，火气逐渐微弱，本无毒邪蕴结，可用芍药汤。如果大便秘结，用犀角消毒饮。在痘疹养浆阶段，若痘色淡白平塌，饮食减少且大便溏稀，浆液清稀且瘙痒，抓挠不安，这是脾胃虚弱，气血俱虚，虚火扰攘所致，用参内托散。严重时辅以陈氏木香散。服药无效者预后凶险。如果痘色红紫干枯滞涩，二便不通，口渴烦躁，浆液充盈且瘙痒，抓破后流血，这是气盛血热的表现，用四物汤加入连翘、赤芍、白芷、蝉蜕。严重时用四顺饮攻下。如果瘙痒但神志清爽，自知误抓破，或告知他人其痒，希望被人抚摸安抚，这是吉兆。如果瘙痒且闷乱烦躁，言语禁止不住，摇头晃脑，手足舞动混乱，破损处无血，眼睛紧扎或睁开，这是凶兆。如果在其他部位破损虽多，但脓血稠粘，面部未破损的，脏腑精华不散，正气未亏，完全可以治愈。有面部痘疹虽然瘙痒严重，擦破即结痂，能进食且神志清醒的，可治。昏乱者死。如果破损处无脓血，不结痂，如同没有皮肤一样，伴有寒战咬牙，腹泻呃逆呛咳的，不可治。
Blisters are a sign of excess Qi and deficient Blood. This is because Lung Fire moves and damages the skin and hair, causing Qi and Blood to gather anteriorly to form blisters. Small ones resemble water droplets, large ones resemble grapes; they are white and hollow, or contain clear fluid, indicating Qi deficiency with Fire. Treatment should tonify the Spleen and Lung, and facilitate the water passages so that the Qi becomes solid naturally. Qian Yi's Yigong San (Modified Extraordinary Efficacy Powder) can be used with additions such as Plantaginis Semen (Cheqianzi, 车前子) and Alismatis Rhizoma (Zexie, 泽泻). If the blisters are purple and hollow, it indicates Blood deficiency with Heat. Qingfei Tang (Lung-Clearing Decoction) with additions of Angelicae Sinensis Radix (Danggui, 当归), Paeoniae Radix (Shaoyao, 芍药), Poria (Fuling, 茯苓), and Plantaginis Semen (Cheqianzi, 车前子) should be used to promote urination downward; thus Qi will calm and Blood will harmonize, and the blisters will naturally retract. If they are thin like bamboo membrane and are blistered by fire (Liaojiang Pao), treatment is only possible after the pus becomes foul; if the blisters rupture, death ensues.
Qi deficiency leads to sinking and collapsing; Blood deficiency leads to itching and collapse. When pustules first appear and the whole body itches, this is because the pathogenic factor desires to exit, but Wind-Cold closes the Couli (pores), causing Fire Qi to wander back and forth, resulting in itching. It is appropriate to disperse and drain Liver Wood. Once the pathogen is released and pustules emerge, the itching stops naturally. When pustules are converging and itching occurs, it is because pus has formed and toxins resolved, and Fire Qi is gradually weakening, with no inherent toxin accumulation; Shaoyao Tang (Peony Decoction) can be used. If there is constipation, Xijiao Xiaodu Yin (Rhinoceros Horn Detoxification Decoction) is indicated. During the stage of nourishing the pus, if the pustules are pale, flat, and collapsed, with reduced appetite and loose stools, clear pus and itching, and restless scratching, this is due to Spleen-Stomach weakness, dual deficiency of Qi and Blood, and disturbance by Deficient Fire; Shennai Tuo San (Ginseng Internal-Supporting Powder) is used. In severe cases, Chen Shi Muxiang San (Chen’s Costus Powder) is added as an assistant. If medication is ineffective, the prognosis is ominous. If the pustules are red-purple, dry, and stagnant, with obstruction of both bowels and bladder, thirst, irritability, full pus, and itching where scratching causes bleeding, this indicates Qi excess and Blood Heat; Siwu Tang (Four Substances Decoction) with additions of Forsythiae Fructus (Lianqiao, 连翘), Red Paeonia Root (Chishao, 赤芍), Angelicae Dahuricae Radix (Baizhi, 白芷), and Bombyx Batryticatus (Chantui, 蝉蜕) is used. In severe cases, Sixun Yin (Six-Flow Decoction) is administered to purge. If itching occurs but the patient remains mentally clear, aware of accidental scratching, or asks others to soothe the itch, this is auspicious. If itching is accompanied by mental confusion, irritability, uncontrollable speech, head shaking, chaotic limb movements, ruptured areas without blood, tightly closed or staring eyes, this is ominous. Although extensive rupture elsewhere may occur, if the pus and blood are thick and sticky, and the face remains unruptured, the essence of the Zang-Fu organs is not scattered, and Righteous Qi is not depleted, recovery is fully achievable. If facial pustules itch severely, scab immediately upon rubbing, and the patient can eat and remains mentally clear, it is treatable. Confusion indicates death. If ruptured areas have no pus or blood, do not form scabs, and appear as if lacking skin, accompanied by chills, teeth grinding, diarrhea, hiccups, and choking, it is untreatable.