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In variola (smallpox), extreme heat generates wind, presenting similarly to stroke (Zhong Feng). Some patients exhibit stiffness and tension in the limbs, waist, and neck; some show eye deviation and traction, open mouth, and stiff tongue. Treatment should uniformly employ formulas such as Rensu Yin (Ginseng and Perilla Decoction). Once the pustules erupt and the heat resolves, the wind syndrome subsides spontaneously. However, if these symptoms appear after the stage of swelling and pus formation, it indicates deficiency of both Qi and Blood with internal stirring of deficient wind, which is a critical condition. Only vigorous tonification of Qi and Blood may offer a chance of rescue.

The Couli (interstices/skin pores) are the gateways of Lung Qi. If obstructed by Wind-Cold, the clear pathways cannot circulate freely, leading to stagnation. Thus, when Fire moves, Heat manifests; when Fire is constrained, Cold manifests; extreme Cold transforms into Heat, and extreme Heat transforms into Cold. However, fever occurring before the eruption of variola is Excess, resulting from robust Qi and Blood resisting invasion by pathogens and contending with toxic fire. Fever appearing after eruption is Deficiency. Fever caused by abundant toxin is "Pathogen Excess"; fever caused by scanty toxin is "Deficiency"; fever appearing after scabbing is "Residual Toxin"; and fever due to excessive use of harsh drugs damaging Yuan Qi is "Great Reversal" (Da Ni). Isolated fever around the seventh day is called "Variola Steaming" (Dou Zheng), indicating both Qi/Blood and Toxin are abundant. Fever persisting after the fourteenth day is also residual toxin, which is easy to treat. Isolated coldness around the seventh day indicates Qi and Blood depletion with internal constraint of toxic fire, which is difficult to treat. For Excess patterns, dispersing methods clear the airways; for Deficiency patterns, tonifying methods secure the True Yuan. Tonification must be precise, and dispersing methods must not be overused. If True Yuan is damaged, recovery is impossible.

Hemorrhage in variola occurs because abundant Qi attacks the toxin, but is blocked by pathogenic factors in the clear pathways. Extreme heat and blazing fire cause Qi and Toxin to contend together, overwhelming the Blood, leading to chaotic vessel flow and uncontrolled bleeding. This is a pathology of Qi exceeding Blood. Abundant toxin causes Blood Heat, and Blood Heat leads to reckless bleeding. Treatment should employ formulas like Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). Hemorrhage may occur from the mouth, from urination/defecation, or from ulcerated sores; all indicate internal involvement and are difficult to treat. Survival is possible only with epistaxis (nosebleed). Why? Because abundant Qi drives the Blood, which carries the toxin throughout the body, transmitting through the Du Mai (Governing Vessel), breaking through barriers to exit externally without invading the interior, thus causing no major harm. Therefore, while Qi should not be weak during variola eruption, it should not be excessively strong, as excess damages Blood. Treatment should stabilize Qi position and nourish Blood to avoid error. Purulent bloody diarrhea resembling dead liver or bean juice indicates rotting of the Stomach, which is incurable. Regarding menstruation, early onset is termed Heat, and late onset is termed Cold, according to general principles. However, prolonged menstrual flow should always be treated as Deficiency using tonifying and supporting agents containing Ginseng, Angelica Sinensis, and Paeonia Lactiflora. In cases of weak pulse and mental fatigue, warming and tonifying measures should be doubled to prevent deterioration into grayish-white lesions (indicating failure of the rash).

The Classic states: Injury to Yang collaterals causes external blood overflow, resulting in epistaxis; injury to Yin collaterals causes internal blood overflow, resulting in hematochezia/melena. Hemorrhage in variola/rash is due to internal burning by rash-fire forcing Blood to move recklessly with the Fire. Thirst for cold drinks with hot hands and feet indicates blazing toxic Qi overflowing upward. Thirst for warm drinks with cool hands and feet indicates Spleen and Lung Qi deficiency failing to control Blood. Epistaxis with a rapid Right Cun pulse indicates Lung Metal受刑 (injured by Fire) with internal Heat. Hematemesis with red rashes, thirst, and fever indicates Stomach Meridian toxic Heat. Both should be treated primarily with resolving/toxic-clearing and cooling-blood methods.

Dry, hard stool causing slight bleeding after defecation is often due to anal injury. If sores have healed but bloody purulent stool appears without external changes, it indicates inverted sores where正气 (Righteous Qi) repels pathogens, and toxins exit via bowels; this is harmless. Conversely, continuous bloody diarrhea with lethargy and anorexia indicates organ failure and reckless Yin Blood loss, a fatal sign.

The Heart governs Blood and nourishes it. Excessive toxic Qi in variola blocks meridians, allowing fire-toxin to invade and stagnate into Blood stasis between the heart and hypochondrium, causing chest/hypochondriac pain, gray-black sores, irritability, panting, thirst, and abdominal distension. Alternatively, downward-pushing Heat forces Blood into the bowels, causing hematochezia. If heat subsides, spirit clears, and rashes improve after bleeding, Heat has resolved with Blood; treat with Xijiao Dihuang Tang. If symptoms worsen after bleeding, Pathogen overwhelms Righteous Qi, which is incurable. Blood preceding stool is "Near Blood" from Large Intestine Heat; blood following stool is "Distant Blood" from Stomach Heat. Both require clearing Heat and securing Ying Blood. Post-prolonged diarrhea/flux bleeding indicates Spleen Qi deficiency-cold failing to control Blood; treat with warming, tonifying, and lifting methods.