消，中宫阻塞，口中嗳腐酸臭，腹内饱闷，痘出不快者，是为里实，急宜消化，令得
宣畅。放点各证治之大略，由此而推之，其余可概矣。
聂九吾曰∶报痘三日后，痘已出齐，身体温和，精神清爽，颗粒尖圆润泽，根脚
红活，胸背稀疏，饮食如常，二便不涩，此顺候也。不必服药，但节饮食，避风寒，防秽气。
痘出齐后三日内，其时十分紧要，其形色证候，最宜精察。盖好痘全要脓浆灌
满，其次亦要六七分脓浆，方可保无虞。痘一出齐，形色显然，其脓之成与不成，足
与不足，皆可逆睹矣。除以上顺候，自然脓足，不必服药。其有不顺者，后必无脓，
或脓少而清，急于此三日内，察其形色，分别寒热虚实，用药调治，以为灌脓计，犹
可及也。失此不治，多有缓不及事，而竟不成脓者，痘之生死判于脓之有无，有脓
则毒从外散，故生；无脓则毒留内攻，故死。是以脓灌满而痂浓者上也；脓未满而
痂薄者次也；其下者，遍身俱水 ，然水 七八分而间有二三分脓 者，犹可生也；
其最下者，密不成颗，串为一片，而其皮下有脓浆，又或 密而溃脓水湿渍，犹可
望生也；惟干枯无脓浆，或薄浆不满二三分者，必痒塌而死，无生意矣。是以出齐
而调治灌脓，如拯溺救焚不可缓也。气血流畅，则毒化为脓，脓之不成，其病有二∶
毒瓦斯炽盛则血燥而凝，故不能运化而成脓，元气虚弱则血寒而缩，亦不能运化而成脓，
故痘色红紫干枯，或带焦黑者，毒炽而血凝者也，必不成脓，急宜清毒活血汤。（治紫
陷，一二剂其痘立转。灌脓时，六七日不大便，亦此方，起胀时并用当归、紫草茸、前胡、牛蒡子、木通、生地、
生白芍、连翘、桔梗、黄连、黄芩、甘草、楂肉、人参、生黄 煎服。烦渴者去参 、加麦冬、天花粉。）痘色
淡白， 不尖圆，根无红晕者，气虚而血缩者也，必不成脓，急宜用参归鹿茸汤。（治
白陷灰陷，痘不光溜， 虚浆清，行脓二三日尚不充满，皆可服以托痘。鹿茸密炙，嫩绵黄 、归身、炙甘草、人
参、元眼肉三个同煎，入好酒一杯温服；儿有能饮酒者，浓煎药汁，与酒相半和服，亦好。虚弱未甚者，服此一
二剂，其痘即转红活行浆。困倦手足冷，饮食少者，加木香、丁香、官桂；寒战切牙者，再加官桂、附子；泄
泻者，去当归加面炒白术、酒炒白芍、白茯苓、木香、丁香、官桂，另用参术散止泻，托脓之剂莫妙与此方，以
鹿茸补血力峻，与草木诸补药不同，然恐鹿茸未必得，故又录千金内托散，倍用人参、归身、蜜炙黄 、白芍、川
穹、官桂、炙草、山楂肉、南木香、防风、白芷、浓朴、龙眼肉三个同煎，入好酒和服，随证加减法同上。有用
人乳和药服者，虽与灌脓有理，但人乳性凉，脾胃弱而大便滑者忌之，泄泻者尤忌之。）
出齐后当治不治，则浆不行而五陷之证作矣。五陷者∶白陷、灰陷、紫陷、黑陷、血陷也。
痘稠密红紫而顶陷者，紫陷也。甚则转而为黑陷也。此毒热炽盛，蔽其气凝其
血而陷也，仍用清毒活血汤治之，其随证加减法亦如之。然当其紫陷时，不过一二
剂而痘立起，其效如神；及至黑陷则受毒已深，虽用此方救治而不活者，十尝八九矣。
痘虽稠密，其色淡白，根无红晕而顶陷者，白陷也。甚则转而为灰陷也。此气
血虚寒不能运化毒瓦斯以成浆，故陷也。宜参归鹿茸汤，或千金内托散治之，其随证加减法亦如之。
又有一种痘疮，头粒通红成血 而不成浆者，此气虚不能统血，而血溢妄居气
位也，宜用参 汤大补其气。（人参、炙黄 、炙甘草、官桂煎温服，服此 即转白而成浆。）血 失治，
则气愈虚而为血陷。然治之亦不外此方，血陷与紫陷相类，但血陷虽红，然淡而不紫
也。紫陷属热，气粗身热；血陷属虚，气少身凉，不可不辨。（身热身凉，虚实显然。）
何西邱论五陷，说理朦胧不明，管 论之尤舛错可恶。痘出齐二三日后，毒热
化为脓浆，渐渐充满，起顶光滑时润，身体温和，饮食能进，小便清利，大便二三
日一次，此顺侯也。不必服药，但节饮食，护风寒，避秽气而已。
犯五陷者，治之见前，其或虽不陷顶，而痘不光润，或 虚而浆不过三四分，或
虽有浆而清薄，或行脓至二三日尚不充满，皆难以收靥，宜用参归鹿茸汤催足其浆。（无
根窠不能灌浆，浆不足不能结靥，此时看浆为主。）
邵氏曰∶痘出三日，应当逐渐起胀，根窠红绽，顶红光润泽者生。起胀遍身头皮
俱陷下，其中有眼如针孔紫黑者死。起胀时如腰腹或痛或止，根窠如蚊蚤所咬，全
无起色者死。起胀顶陷者，可用助血气药救之。起胀如渴不止者，用退火回生丹救
之。起胀痘复陷黑，闷躁不宁，神昏气促而死。起胀小便下血，顶尖紫色而干燥，全
然不起发者死。起胀大小便俱下血，泻久气泄痘枯者死。起胀腹肚膨胀，饮食不下
者死。（如略进饮食，速以消膨胀药治之。）如痘初出一小点，渐大如绿豆饱满者，是起胀之后
灌脓，起胀是将灌未灌之时也。如起胀灌
浆之时，乃痘发大，其气道窄狭，以致喉痛，不治自愈。起胀时色如白饮者死。（若遇
此证，断不可作虚寒治之，乃毒盛气滞之故耳。）起胀时先有六七粒细而成块，于中有一粒扁阔
歪斜者死。起胀时痘上有一孔，不黑不白，名曰蛀痘。此乃腠理不密而有是痘，泄丧
元气，失治则凶。（用保元汤加丁香、肉桂，其孔自密，而痘自起矣。）
喜泰顺曰∶五六日来血包以成痘，当肥大而粗，顶宜放光而白，故根红而顶白
者，已俱行浆之势。若还赤色过头，虽见娇红可爱，延绵六日，依然空壳，虚花皮
薄而光亮如灯，内含是水，顶尖而根脚不红，行浆弗实。是以热毒未解，则为紫为
黑；痘壅不起则为陷为塌；色滞而不荣，则为干为枯，为青为灰；形怯而不振，则为
不快，为停浆。或有肉先肿胀而痘反不起者，浆则滞而不行，面已虚浮而痘反退伏
者，毒则遏而不进。是以辨明用剂，分虚实寒热之证，表里轻重之形，补泻温凉使
气血交会，气充于上则顶尖圆，血附于下则根红固，顶尖根固，庶可全功。至于气
血交会之期，头尖皮薄光亮如灯，根无红晕，至后来必成皮薄浆清之患；八九日必
然发痒，切牙抓破无脓，临期十二，命厄归泉。若见顶陷不起，头有火刺之形，其
根必紫而散塌，此气血为毒火凝滞，故不光润。内证参详，必渴欲饮水，谵语妄言，
切牙寒战，诸等实热，显著于外。治法当清凉解毒，斟酌下之，大用凉心破血之剂，
连连进之，气血分明，方有活路。又有灰白形怯不振之证，书曰灰白是虚，务必兼
详外证，如面青 白，肌体瘦弱，便溏呕乳，只须补益为先，大用参、 、木香、丁、
桂之剂，庶可挽回于十一。以上诸证，俱要分明虚实寒热，方可投药，不然则鱼目可以混珠，美石可以同玉矣。
（痘疹）消退，中焦脾胃阻塞，口中嗳气带有腐败酸臭味，腹部饱胀闷痛，痘疹发出迟缓不畅的，这是里实证，急需使用消食导滞的方法，使气机宣通畅达。以上列举了各种证候治疗的大致原则，由此类推，其余情况就可以概略知道了。
聂九吾说：报痘（出痘初期）三天后，痘疹已经出齐，身体温和，精神清爽，痘粒尖圆润泽，根部红润鲜活，胸背部稀疏，饮食如常，大小便通畅不涩滞，这是顺证。不需要服药，只需节制饮食，避风寒，防秽气。痘疹出齐后的三天内，时机十分紧要，痘疹的形色和证候，最需仔细察辨。因为好的痘疹全要靠脓浆灌满，其次也要有六七分的脓浆，才可以保证没有危险。痘疹一出齐，形色明显，其脓浆形成与否、充足与否，都可以预先推测。除了上述顺证自然脓足外，不必服药。那些不顺的，后来必然无脓，或者脓少而清稀，必须在这三天内，察辨其形色，分别寒热虚实，用药调治，以促使脓浆生成，还来得及。错过这三天不治疗，多有因延误而不及救治，最终不能成脓的。痘疹的生死取决于脓浆的有无，有脓则毒邪从外部散发，所以生；无脓则毒邪留在内部攻伐脏腑，所以死。因此，脓浆灌满且痂皮厚实的为上等；脓浆未满但痂皮薄的为次等；下等的，遍身都是水疱，但如果水疱占七八分，间或有二三分脓疱的，还可以生存；最差的是，痘粒密集不成颗粒，连成一片，虽然皮下有脓浆，或者痘粒密集而溃破流脓水湿浸渍，还有一线生机；只有干枯无脓浆，或者脓浆薄且不满二三成的，必然因瘙痒塌陷而死，没有生机了。因此，痘疹出齐后调治促脓，如同拯救溺水、扑救火灾一样不可迟缓。气血流畅，则毒邪化为脓浆；脓浆不能形成，病因有二：毒火炽盛则血液干燥凝滞，所以不能运化而成脓；元气虚弱则血液寒凝收缩，也不能运化而成脓。所以痘色红紫干枯，或带焦黑色的，是毒火炽盛而血凝所致，必然不能成脓，急需使用清毒活血汤。（治疗紫陷症，服一两剂痘疹立刻转变。在灌脓期，若六七日不大便，也用此方。在起胀期，同时加入当归、紫草茸、前胡、牛蒡子、木通、生地、生白芍、连翘、桔梗、黄连、黄芩、甘草、山楂肉、人参、生黄芪煎服。若烦渴者，去掉人参，加麦冬、天花粉。）痘色淡白，痘粒不尖圆，根部无红晕的，是气虚而血缩所致，必然不能成脓，急需使用参归鹿茸汤。（治疗白陷、灰陷症，痘疹不光溜，气虚浆清稀，行脓二三日尚不充满，都可以服用以托举痘疹。鹿茸密炙，嫩绵黄芪、当归身、炙甘草、人参、桂圆肉三个同煎，加入好酒一杯温服；小儿能饮酒的，将药汁浓煎，与酒各半混合服用，也很好。虚弱不严重的，服用一两剂，痘疹即转为红活行浆。困倦手足冷，饮食少的，加木香、丁香、官桂；寒战咬牙的，再加官桂、附子；泄泻的，去掉当归加面炒白术、酒炒白芍、白茯苓、木香、丁香、官桂，另外用参术散止泻，托脓之剂没有比这个方子更妙的了，因为鹿茸补血力量峻猛，与草木类补药不同，然而恐怕鹿茸难以得到，所以又收录千金内托散，倍用人参、当归身、蜜炙黄芪、白芍、川芎、官桂、炙甘草、山楂肉、南木香、防风、白芷、厚朴、桂圆肉三个同煎，加入好酒和服，随证加减法同上。有用的人乳和药服的，虽然符合灌脓的道理，但人乳性凉，脾胃弱而大便滑者忌用，泄泻者尤其忌用。）痘疹出齐后应当治疗而不治疗，则浆液不行而五陷证发作。五陷是指：白陷、灰陷、紫陷、黑陷、血陷。痘疹稠密红紫而顶部凹陷的，叫紫陷。严重时转变为黑陷。这是毒热炽盛，遮蔽气机凝结血液而导致凹陷，仍用清毒活血汤治疗，其随证加减法也是如此。然而在紫陷时，不过一两剂痘疹立刻升起，效如神验；等到黑陷时，受毒已深，即使使用此方救治而不活的，十有八九了。痘疹虽稠密，但色淡白，根部无红晕而顶部凹陷的，叫白陷。严重时转变为灰陷。这是气血虚寒不能运化毒邪以成浆液，所以凹陷。宜用参归鹿茸汤，或千金内托散治疗，其随证加减法也是如此。又有一种痘疮，头粒通红成血疱而不能成浆液的，这是气虚不能统摄血液，而血液溢出妄居气位，宜用参芪汤大补其气。（人参、炙黄芪、炙甘草、官桂煎温服，服用此方即转白而成浆液。）血陷失治，则气愈虚而为血陷。然而治疗也不外乎此方，血陷与紫陷相似，但血陷虽红，却淡而不紫。紫陷属热，气粗身热；血陷属虚，气少身凉，不可不辨别。（身热身凉，虚实显然。）何西邱论述五陷，说理朦胧不明，管庠论之更是错谬可恶。痘疹出齐二三天后，毒热化为脓浆，渐渐充满，起顶光滑湿润，身体温和，饮食能进，小便清利，大便二三日一次，这是顺证。不需要服药，只需节制饮食，护风寒，避秽气而已。
犯五陷证的，治疗方法见前文。那些虽然不陷顶，但痘疹不光润，或气虚而浆液不过三四分，或虽有浆液但清薄，或行脓至二三日尚不充满的，都难以收靥，宜用参归鹿茸汤催足其浆液。（无根窠不能灌浆，浆不足不能结靥，此时以观察浆液为主。）
邵氏说：痘疹出三天，应当逐渐起胀，根窠红绽，顶部红光润泽的为生证。起胀时遍身头皮都陷下，其中有眼如针孔紫黑的为死证。起胀时如果腰腹或痛或止，根窠如蚊蚤所咬，全无起色的为死证。起胀时顶部凹陷的，可以用助血气药救之。起胀时如口渴不止的，用退火回生丹救之。起胀时痘疹复陷黑，闷躁不宁，神昏气促的死证。起胀时小便下血，顶尖紫色而干燥，全然不起发的为死证。起胀时大小便俱下血，泻久气泄痘枯的为死证。起胀时腹肚膨胀，饮食不下的为死证。（如果能略微进食饮食，速以消膨胀药治疗。）如果痘初出一小点，渐大如绿豆饱满的，是起胀之后灌脓，起胀是将灌未灌之时。如起胀灌浆之时，乃痘发大，其气道窄狭，以致喉痛，不治自愈。起胀时色如白饮的为死证。（若遇此证，断不可作虚寒治之，乃毒盛气滞的缘故。）起胀时先有六七粒细而成块，于中有一粒扁阔歪斜的为死证。起胀时痘上有一孔，不黑不白，名叫蛀痘。这是腠理不密而有此痘，泄丧元气，失治则凶险。（用保元汤加丁香、肉桂，其孔自密，而痘自起了。）
喜泰顺说：五六日来血包以成痘，应当肥大而粗，顶部宜放光而白，所以根红而顶白的，已是行浆之势。如果红色过头，虽见娇红可爱，延绵六日，依然空壳，虚花皮薄而光亮如灯，内含是水，顶尖而根脚不红，行浆不实。因此热毒未解，则为紫为黑；痘壅不起则为陷为塌；色滞而不荣，则为干为枯，为青为灰；形怯而不振，则为不快，为停浆。或者有肉先肿胀而痘反不起的，浆则滞而不行；面已虚浮而痘反退伏的，毒则遏而不进。因此辨明用药，分虚实寒热之证，表里轻重之形，补泻温凉使气血交会，气充于上则顶尖圆，血附于下则根红固，顶尖根固，才可以全功。至于气血交会之期，头尖皮薄光亮如灯，根无红晕，到后来必成皮薄浆清的祸患；八九日必然发痒，切牙抓破无脓，临期十二天，命厄归泉。若见顶陷不起，头有火刺之形，其根必紫而散塌，这是气血为毒火凝滞，所以不光润。内证参详，必渴欲饮水，谵语妄言，切牙寒战，诸等实热，显著于外。治法当清凉解毒，斟酌下之，大用凉心破血之剂，连连进之，气血分明，方有活路。又有灰白形怯不振之证，书曰灰白是虚，务必兼详外证，如面青苍白，肌体瘦弱，便溏呕乳，只须补益为先，大用参、芪、木香、丁、桂之剂，才可以挽回于十一。以上诸证，都要分明虚实寒热，方可投药，不然则鱼目可以混珠，美石可以同玉矣。
(When the pustules) subside, if there is obstruction in the Middle Jiao (Middle Burner), belching with a sour and putrid odor, abdominal fullness and distension, and slow or unsmooth eruption of the pox, this is an Excess condition in the Interior. It is urgent to employ methods of digestion and promotion to allow the Qi mechanism to be open and smooth. The general principles for treating various syndromes listed above can be extrapolated to cover other situations.
Nie Jiwu stated: Three days after the initial appearance of smallpox, when the lesions have fully erupted, if the body temperature is moderate, the spirit is clear, the individual pustules are pointed, round, lustrous, with red and vibrant roots, sparse distribution on the chest and back, normal appetite, and unobstructed urination and defecation, this is a favorable prognosis (Shun Hou). Medication is not necessary; one should merely regulate diet, avoid wind and cold, and prevent foul odors. The three days following the complete eruption of the pox are critically important, and the color, shape, and symptoms require careful observation. Good pox rely entirely on being filled with pus; at minimum, they must have 60-70% pus content to ensure safety. Once the pox have fully erupted, their color and shape are obvious, and whether pus will form and whether it will be sufficient can be predicted. Except for the aforementioned favorable cases where pus naturally fills adequately—requiring no medication—if the course is unfavorable, there will likely be no pus later, or the pus will be scanty and thin. Within these three days, one must observe the color and shape, differentiate between Cold, Heat, Excess, and Deficiency, and administer medication to promote pus formation; this is still timely. If treatment is delayed beyond this period, many cases become untreatable and fail to form pus. The life or death of the pox depends on the presence or absence of pus: with pus, the toxin disperses outward, leading to survival; without pus, the toxin remains internal and attacks the organs, leading to death. Therefore, cases where pus is fully formed and the scab is thick are superior; those where pus is incomplete but the scab is thin are secondary. Inferior cases present with water-filled vesicles all over the body; however, if 70-80% are water-filled and 20-30% contain pus, survival is still possible. The worst cases are those where lesions are dense and merge into a single mass; even if there is pus under the skin or the dense lesions ulcerate with wet discharge, there is a slight hope for survival. Only cases that are dry, devoid of pus, or have very thin pus (less than 20-30%) will inevitably die from itching and collapse, with no hope of recovery. Thus, treating and promoting pus formation after complete eruption is as urgent as rescuing someone from drowning or putting out a fire. When Qi and Blood flow smoothly, toxins transform into pus. Failure to form pus has two causes: excessive Fire-Toxin causes blood to dry and coagulate, preventing transformation into pus; weak Yuan Qi causes blood to become cold and contract, also preventing transformation into pus. Therefore, pox that are red-purple, dry, or scorched-black indicate excessive Fire-Toxin and blood coagulation, which will not form pus. It is urgent to use Qing Du Huo Xue Tang (Clear Toxin and Invigorate Blood Decoction). (Treats Zi Xian/Purple Depression; the pox will turn around after one or two doses. During the pus-filling stage, if there is constipation for six to seven days, this formula is also used. During the swelling stage, add Dang Gui (Angelicae Sinensis Radix), Zicao Rong (Arnebiae Radix et Rhizoma), Qian Hu (Peucedani Radix), Niubangzi (Arctii Fructus), Mutong (Akebiae Caulis), Sheng Di Huang (Rehmanniae Radix), Sheng Bai Shao (Paeoniae Radix Alba), Lian Qiao (Forsythiae Fructus), Jie Geng (Platycodonis Radix), Huang Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Zha Rou (Crataegi Fructus), Ren Shen (Ginseng Radix et Rhizoma), and Sheng Huang Qi (Astragali Radix); decoct and take. For patients with irritability and thirst, remove Ren Shen and add Mai Dong (Ophiopogonis Radix) and Tian Hua Fen (Trichosanthis Radix).) Pox that are pale white, not pointed or round, and lack red halos at the roots indicate Qi deficiency and blood contraction, which will not form pus. It is urgent to use Shen Gui Lu Rong Tang (Ginseng, Angelica, and Deer Antler Decoction). (Treats Bai Xian/White Depression and Hui Xian/Grey Depression; for pox that are not smooth, with Qi deficiency and thin pus, or where pus formation takes two to three days without filling, this formula can be used to support the pox. Use Lu Rong (Cervi Cornu Pantotrichum) prepared with honey, Nen Mian Huang Qi (Astragali Radix), Dang Gui Shen (Angelicae Sinensis Radix), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), Ren Shen (Ginseng Radix et Rhizoma), and three Long Yan Rou (Longan Aril); decoct together and take warm with a cup of good wine. For children who can drink alcohol, decoct the medicine strongly and mix half with wine. For mild weakness, one or two doses will turn the pox red and active. For fatigue, cold extremities, and poor appetite, add Mu Xiang (Aucklandiae Radix), Ding Xiang (Caryophylli Flos), and Guan Gui (Cinnamomi Cortex). For chills and teeth grinding, further add Guan Gui and Fu Zi (Aconiti Lateralis Radix Praeparata). For diarrhea, remove Dang Gui and add flour-fried Bai Zhu (Atractylodis Macrocephalae Rhizoma), wine-fried Bai Shao (Paeoniae Radix Alba), Bai Fu Ling (Poria), Mu Xiang, Ding Xiang, and Guan Gui; additionally use Shen Zhu San (Ginseng and Atractylodes Powder) to stop diarrhea. This is the best formula for supporting pus formation because Lu Rong has strong blood-nourishing power, different from herbal tonics. However, since Lu Rong may be unavailable, Qian Jin Nei Tuo San (Thousand Gold Internal Support Powder) is recorded as an alternative: double the dose of Ren Shen, Dang Gui Shen, Mi Zhi Huang Qi, Bai Shao, Chuan Xiong (Chuanxiong Rhizoma), Guan Gui, Zhi Cao (Prepared Licorice), Shan Zha Rou (Crataegi Fructus), Nan Mu Xiang (Costi Radix), Fang Feng (Saposhnikoviae Radix), Bai Zhi (Angelicae Dahuricae Radix), Hou Po (Magnoliae Officinalis Cortex), and three Long Yan Rou; decoct together and take with good wine. Dosage adjustments follow the same method as above. Some use human milk to mix with the medicine; while this aligns with the principle of promoting pus, human milk is cooling in nature and is contraindicated for those with weak Spleen-Stomach and loose stools, especially those with diarrhea.) If treatment is neglected after complete eruption, the fluid will not circulate, leading to the Five Depressions (Wu Xian). The Five Depressions are: White Depression, Grey Depression, Purple Depression, Black Depression, and Blood Depression. Dense, red-purple pox with depressed tops are called Purple Depression. Severe cases turn into Black Depression. This is caused by excessive Heat-Toxin obstructing Qi and coagulating Blood, leading to depression. Treat with Qing Du Huo Xue Tang, using the same modification principles. At the stage of Purple Depression, one or two doses will rapidly raise the pox with miraculous effect; however, once it becomes Black Depression, the toxin has penetrated deeply, and even with this formula, eight or nine out of ten cases will not survive. Dense pox that are pale white, lack red halos at the roots, and have depressed tops are called White Depression. Severe cases turn into Grey Depression. This is due to Qi and Blood deficiency and Cold, failing to transform toxins into fluid, causing depression. Treat with Shen Gui Lu Rong Tang or Qian Jin Nei Tuo San, with similar modifications. Another type of pox presents with red heads turning into blood blisters without forming fluid; this is Qi deficiency failing to control Blood, causing Blood to overflow and occupy the Qi position. Treat with Shen Qi Tang (Ginseng and Astragalus Decoction) to greatly tonify Qi. (Ren Shen, Zhi Huang Qi, Zhi Gan Cao, Guan Gui decocted and taken warm; taking this will turn the pox white and form fluid.) If Blood Depression is untreated, Qi becomes increasingly deficient. Treatment remains the same. Blood Depression resembles Purple Depression but is pale rather than purple. Purple Depression belongs to Heat, with coarse breathing and fever; Blood Depression belongs to Deficiency, with shortness of breath and cool body. These must be distinguished clearly. He Xiqiu’s discussion on the Five Depressions is vague and unclear; Guan Xiang’s commentary is particularly erroneous and detestable. Two to three days after complete eruption, if Heat-Toxin transforms into pus, gradually filling the lesions, with smooth, moist tops, moderate body temperature, ability to eat, clear urine, and bowel movements every two to three days, this is a favorable prognosis. No medication is needed; simply regulate diet, protect against wind and cold, and avoid foul odors.
For cases involving the Five Depressions, see treatments above. For cases where the top is not depressed but the pox are not smooth, or Qi deficiency results in less than 30-40% fluid, or fluid is thin and clear, or pus formation takes two to three days without filling, it will be difficult to form scabs. Use Shen Gui Lu Rong Tang to promote adequate fluid formation. (Without proper roots, fluid cannot fill; insufficient fluid prevents scabbing; focus on observing fluid at this stage.)
Shao Shi stated: Three days after eruption, the pox should gradually swell. Red, expanded roots and bright, lustrous tops indicate survival. If, during swelling, the entire body and scalp depress, with eyes like needle holes that are purple-black, it indicates death. If, during swelling, the waist and abdomen hurt intermittently, roots resemble mosquito bites with no improvement, it indicates death. If the top is depressed during swelling, tonifying Qi and Blood medicines can save the patient. If thirst persists during swelling, Tui Huo Hui Sheng Dan (Fire-Reducing Life-Restoring Pill) can save the patient. If the pox turn black and depressed during swelling, accompanied by stifling restlessness, coma, and rapid breathing, it indicates death. If hematuria occurs during swelling, with purple, dry, and non-elevating tops, it indicates death. If both hematochezia and hematuria occur during swelling, with prolonged diarrhea, Qi exhaustion, and withered pox, it indicates death. If abdominal distension and inability to eat occur during swelling, it indicates death. (If food intake is slightly maintained, quickly treat with anti-distension medicines.) If a pox starts as a small dot and grows to the size of a mung bean, it indicates the stage after swelling, preparing for pus formation; "swelling" is the time just before pus filling. When swelling and pus filling occur, the pox enlarge, narrowing the airway, causing sore throat, which heals spontaneously. If the color is like white liquid during swelling, it indicates death. (Do not treat this as Cold-Deficiency; it is due to excessive Toxin and Qi stagnation.) If, during swelling, six or seven fine grains form clumps, with one flat, wide, and tilted grain among them, it indicates death. If a pore appears on the pox during swelling, neither black nor white, called "Moth-Eaten Pox," it is due to loose interstices leaking Yuan Qi; neglect leads to凶险 (danger). (Use Bao Yuan Tang plus Ding Xiang and Rou Gui; the pore will close, and the pox will rise.)
Xi Taishun stated: After five or six days, blood packets form the pox, which should be large and coarse. The top should be bright and white, so red roots and white tops indicate the trend of fluid circulation. If the redness is excessive, appearing charming but remaining empty shells after six days, with thin, shiny skin like a lamp containing water, and a pointed top with non-red roots, fluid circulation is insubstantial. Thus, unresolved Heat-Toxin leads to Purple or Black colors; blocked pox lead to Depression or Collapse; dull luster leads to Dryness or Withering, Green or Grey colors; weak form leads to slow progression or stagnant fluid. If flesh swells first but pox do not rise, fluid stagnates; if the face is puffy but pox recede, Toxin is blocked. Therefore, distinguish medications based on Excess/Deficiency and Cold/Heat, Exterior/Interior and Severity. Tonification and Purging, Warming and Cooling should facilitate Qi-Blood intersection. Abundant Qi makes the top round; adherent Blood secures the root. With a round top and secure root, success is achieved. During the Qi-Blood intersection phase, if the head is pointed, skin thin and shiny like a lamp, with no red halo, it will later result in thin skin and clear fluid. By day eight or nine, itching will occur; teeth grinding and scratching without pus will lead to death by day twelve. If the top is depressed and does not rise, with a prickly heat appearance and purple, scattered, collapsed roots, Qi and Blood are stagnated by Fire-Toxin, lacking luster. Internal signs include thirst, delirium, teeth grinding, chills, and obvious external Excess-Heat. Treatment requires cooling and detoxifying,酌情 (judiciously) purging, using strong Heart-cooling and Blood-breaking agents continuously to clarify Qi and Blood, providing a path to life. For cases with grey-white, weak forms, texts state grey-white indicates Deficiency. One must carefully examine external signs: blue-pale face, emaciation, loose stools, vomiting milk. Tonification is primary, using large doses of Ren Shen, Huang Qi, Mu Xiang, Ding Xiang, and Rou Gui to salvage one in ten. All above conditions must clearly distinguish Excess/Deficiency and Cold/Heat before administering medicine; otherwise, fake pearls may pass for real ones, and inferior stones may be mistaken for jade.