(13) The color of variola (smallpox/rubella-like rash) is auspicious when it is bright red. If the color is pale white, it indicates insufficiency of Heart Blood (Xin Xue). If the color is excessively red or dark purple, it indicates heat in the Blood level (Xue Re); if it turns black, it signifies a fatal prognosis. In such cases, Xi Jiao Da Qing Tang (Rhino Horn and Indigo Decoction) may be administered to hope for a chance of recovery.
(14) When the patient with variola has spontaneous sweating, this is favorable as it indicates the natural resolution of the pathogen from the exterior (Biao). When the patient experiences spontaneous epistaxis (nosebleed) or gingival bleeding, this is also favorable as it provides a pathway for the pathogen to exit. Neither condition should be forcibly stopped.
However, while sweating is beneficial, excessive sweating leads to the collapse of Yang Qi (Wang Yang); therefore, individuals with weak constitutions should not undergo overly aggressive diaphoretic treatment. Although epistaxis need not be forcibly stopped, excessive bleeding consumes Blood; thus, it should be controlled if severe.
(15) Coughing that is continuous and unceasing during variola indicates that the pathogen is being excreted through the Lung. Therefore, when the rash is just emerging, severe coughing is considered an optimal sign. However, if after the rash has fully erupted and begins to fade, the patient continues to cough incessantly accompanied by rebellious Qi and wheezing (Shang Qi Chan Xi), Qing Yan Zi Fei Tang (Throat-Clearing and Lung-Nourishing Decoction) should be used to clear Lung Heat. For those with copious phlegm due to cough, remove Ophiopogonis Radix (Mai Dong) and add Citri Reticulatae Pericarpium (Ju Pi) and Poria (Fu Ling).