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When smallpox erupts concurrently with ordinary sores (ordinary skin eruptions), the flesh and pores become empty, causing the smallpox lesions to inevitably cluster densely. Furthermore, as Qi and Blood are depleted by the sores, the lesions will inevitably dry up, turn black, and sink inward. The smallpox often fails to rise and fill with pus, or heat-toxin may aggregate to form carbuncles (ding). It is necessary to urgently administer internal support formulas continuously, vigorously cooling blood and nourishing blood to assist, while applying fine pearl powder mixed with rouge to the sore areas to prevent the sores from turning black and spreading, which would cause the smallpox to also turn black.

When smallpox first begins to emerge, the abdomen should generally be comfortable and loose, indicating that there is no pathogenic factor in the interior. If abdominal distension occurs, it signifies that toxic vapors have gathered in the intestines and stomach, preventing eruption, or allowing only a slight emergence before retreating inward. In severe cases, wheezing and syncope occur, the lesions lack color, or they turn purple-black, often leading to untreatable conditions. The treatment method should involve ascending and releasing to resolve obstruction, allowing toxic vapors to dissipate through the upper, lower, middle, and exterior aspects. If constipation accompanies spleen-heat-induced distension, purgation via urine is indicated; if scanty red urine accompanies stomach-heat-induced distension, diuresis is indicated. If abdominal distension is accompanied by diarrhea, thirst, shortness of breath, fatigue, cold hands and feet, hiccups, spontaneous diarrhea, and distension, this indicates Spleen and Stomach deficiency-cold, requiring warming and tonification. If fever, rapid pulse, constipation, irritability, wheezing, extreme thirst, red face, delirium, restlessness, and abdominal distension occur, this indicates heat-toxin congestion, requiring urgent purgation combined with dispersing the exterior. If heat-toxin, while actively erupting, is suppressed by cold, leading to disharmony of Yin and Yang, clashing of cold and heat, and failure of toxin to vent, resulting in abdominal borborygmus, spontaneous urination and defecation, faint pulse, cold extremities, and loss of appetite, warming agents should be added to attack and support. If abdominal distension is caused by food stagnation, digestive-resolving agents and treatments specific to the ingested substance should be added to ascending and releasing formulas, after assessing the cold or heat nature for treatment. If excessive eruption leads to a yellowish complexion, black stool, irritability, wheezing, thirst, and abdominal distension, this indicates blood stasis in the interior; peach kernels and red-colored substances should be added to heat-clearing and blood-cooling formulas to resolve it. As for closed eyes, unconsciousness, and severely foul breath, these indicate that Qi and Blood have separated from the toxin and collapsed internally, rendering the condition untreatable.