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When smallpox (Douzhen) and malaria occur simultaneously, yet life is difficult to preserve, why is this? Malaria is called "Spleen Cold" (Pi Han), indicating that the Spleen is first injured and becomes deficient. Smallpox, like beans/plants, relies on Earth (Soil/Spleen) to grow; if the Earth is first destroyed, how can it nourish and transform? Moreover, cases resembling malaria but not being true malaria are common. Yang deficiency leads to aversion to cold, Yin deficiency leads to aversion to heat; when both Yin and Yang are deficient, cold and heat alternate. If one does not perform substantial tonification but instead administers Qinghao Tang (Artemisia Annua Decoction) or Chaihu (Bupleurum Root) for antipyretic purposes, it would be perilous.

Some patients present with steaming fever, thirst, emaciated muscles, sallow complexion, and develop smallpox, yet remain largely unharmed. Why? Those discussing Qi do not judge fatness or thinness based on muscles; those discussing Blood and Qi do not determine deficiency or excess based on physical form. Furthermore, the toxin transforms from external invasion, and the skin loosens due to tidal fever. Children who are fat and white have floating flesh and fragile bones, with generally deficient Kidney Qi. They may tolerate various ailments but find smallpox particularly difficult. Children who are yellow and thin have strong bones and sinews, with generally solid Kidney Yuan (Original Qi). Although they may suffer from many diseases, they rarely suffer from smallpox.

Injuries from falls or blows cause loss of Blood and Qi; one should not indiscriminately use herbs like Danggui Wei (Angelica Sinensis Tail) and Taoren (Prunus Persica Seed) to break blood stasis. Injury has already consumed Ying Blood (Nutritive Blood); how can it bear further destruction? How can smallpox succeed by breaking and damaging blood? Therefore, it is appropriate to use Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), Chuanxiong (Ligusticum Chuanxiong Rhizome), Danggui (Angelica Sinensis Root), Honghua (Carthamus Tinctorius Flower), Shudi (Rehmannia Glutinosa Root Prepared), and Chantui (Cicada Slough) to circulate stagnation and directly tonify internally. Add Fushen (Poria with Hostwood) and Yuanzhi (Polygala Tenuifolia Root) to calm and stabilize the Heart. Externally, apply Wen Ge (Clam Shell) and Zonghui (Changal Palm Fiber Ash) to the injury site to consolidate the exterior. If pain is severe, add Rushi (Frankincense). If the external wound is wide and cannot scab over, apply Baiji (Bletilla Striata Tuber), Bailian (Veratrum Nigrum Bulb), and Xiangpi (Elephant Skin Powder) as a dusting powder. If injured but not broken, apply Hamagui (Toad Ash) paste and gently massage to disperse stagnant blood. For burns from hot water or fire, treat with cooling agents; do not apply cold formulas, lest they congeal and stagnate the smallpox eruption and allow internal attack by heat qi.

Vomiting (Ou) involves both sound and matter; spitting up (Tu) involves only matter; dry heaving (Gan Ou) involves only sound. Both dry heaving and hiccups (Yue) involve only sound, but dry heaving is low-pitched and short, whereas hiccups are heavy and long. Vomiting at the onset indicates Fire flaming upward. However, vomiting and hiccups signify internal attack by toxin. In cases of sudden, continuous severe vomiting and diarrhea, with spirit fading and nearly departing, pulse faint and nearly vanishing, face blue, limbs cold, and all evil signs manifesting, yet feeling temporary chest relief and mental clarity: this occurs because although Zheng Qi (Upright Qi) is departing, the internal Heat is just leaving. Heat causes mental confusion; Cold allows mental clarity, hence the temporary relief. But with massive Zheng Qi deficiency, Evil Qi inevitably prevails, leading soon to sudden panting, sweating, coma, and death, like a lamp refiring before extinction. Vomiting and hiccups in deep disease are especially ominous prognoses. Humans rely on Stomach Qi as their root; the Stomach belongs to Earth. When Earth fails, Wood insults it. Wood, carrying the force of Ministerial Fire, attacks the Stomach from above. The qi rises directly from below the navel, invading the clear pathways, and exits via the贲门 (Cardia). Mildly, it causes dry heaving; severely, it causes hiccups. All are signs of Earth's failure. The Classic states: "When wood is exhausted, leaves must fall; when the string breaks, the sound must hoarse; when disease is deep, the sound must be hiccup."

Initial vomiting and diarrhea during smallpox should not be abruptly stopped, as vomiting expels Heat and diarrhea expels Toxin. Smallpox toxin resides inside; stopping it makes it worse. Heat-toxin congested at the stomach opening is a sign of Fire flaming upward. There is no case where treating only the vomiting stops it without treating the smallpox. One should only promote the eruption of smallpox; once erupted, vomiting stops naturally. Treating vomiting without addressing the root leads to self-healing of vomiting. Using ordinary anti-emetic methods increases irritability and regurgitation. Do not use acrid-warm-drying drugs, which prevent Blood from nourishing the complexion. Although it may seem like Stomach Cold, do not use hot medicines, for acute illness is not necessarily Yin-cold, especially since smallpox is inherently Heat-Toxin. If accompanied by nausea and incessant dry heaving, this indicates Deficient Fire of the Chong and Ren meridians rushing upward, invading clear pathways. This usually signifies organ failure and toxic attack, an untreatable ominous sign. Urgently differentiate Yin and Yang and promote urination. The method for treating dry heaving primarily involves promoting urination. If urination remains blocked after treatment, the condition is critical.