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Whenever smallpox lesions erupt, the first day marks the beginning, the sixth to ninth days constitute the transformation phase, and the tenth to fourteenth days also represent a transformation phase; these are the fixed periods for determining life and death. Since syndromes present with either cold or heat characteristics, death may occur at varying speeds. If the pathogenic toxin is abundant and belongs to excess-heat syndrome, the fire-like progression is rapid, concluding within six or seven days. This is because the smallpox toxin moves from the interior to the exterior, and should fully emerge by the third day, yet the toxin remains within. By the sixth day, the toxin should be entirely dispersed on the surface. If the toxin is too strong to fully emerge, between the sixth and seventh days, the toxin may counter-attack inwardly, damaging the zang-fu organs and causing death. If no lesion bases (ke) or granules are visible, death may occur even before the sixth day: those who are small and weak may die in three days, while those who are large and robust may die in five days. This occurs because the toxic qi cannot be vented, leading to the severance of both yin and yang, resulting in particularly rapid death. Conversely, if the toxin is scant and belongs to deficiency-cold syndrome, it is merely due to insufficient blood and qi, which cannot nourish pus formation to mature the lesions. Thus, death must await until after the ninth day, caused by the exhaustion of smallpox qi. Some cases may extend beyond ten days. These variations arise from the differences in the deficiency or excess of the toxin, the distinct nature of cold versus heat, and the individual's size and strength.

For syndromes characterized by excess-heat obstruction, only cooling, ascending, and dispersing methods should be employed; harsh bitter-cold medicines are inappropriate. Cooling resolves blood heat, dispersing allows lesions to appear clearly, and ascending relieves obstruction. However, treatment should cease once balance is achieved. Overuse of cold-cooling agents damages the spleen and stomach internally and freezes muscles externally. Excessive dispersing empties the muscle layer, depletes qi, and leads to ice-hardening conditions. Therefore, medicines should be mild; hot herbs like ginger (Shengjiang, 生姜) and cinnamon twig (Guizhi, 桂枝) are not contraindicated. After diarrhea, heat dissipates naturally, and true qi becomes deficient. Once qi deficiency is established, tonification is indicated. Moreover, qi deficiency inevitably leads to cold; deficiency-cold is evident and warrants warming and tonifying. Thus, post-diarrheal deficiency syndromes should indeed be treated with warming and tonifying methods. Even without prior diarrhea, if after three or four days the body feels cool and lesions fail to grow, warming and tonifying agents such as official cinnamon (Guan Gui, 官桂), ligusticum chuanxiong (Chuanxiong Rhizoma, 川芎), and dried ginger (Gan Jiang, 干姜) should be administered to warm internal qi, thereby enriching the skin and warming the muscle layers. Patients following diarrhea necessarily have internal deficiency; even if symptoms like abdominal distension, irritability, thirst, or急促 breathing (chuan ji, 喘急) appear, these cannot be classified as cold-heat excess syndromes. Rather, they result from internal deficiency with sinking toxin attacking inwardly. Therefore, even in excess-heat syndromes, if diarrhea occurred around the seventh to ninth days, treatment should follow deficiency protocols. If symptoms match Mu Xiang Yi Gong San (Aucklandia and Atractylodes Macrocephala Powder), this formula should be prioritized. This is not a standard method but an emergency expedient to rescue the patient. Without indications for Mu Xiang Yi Gong San, do not mistakenly use warming-tonifying drugs; without diarrhea, do not mistakenly use Mu Xiang Yi Gong San. Even with diarrhea, if there are no specific indications for Mu Xiang Yi Gong San, do not administer it. Smallpox is fundamentally a heat-toxin; the goal is to harmonize yin and yang and balance blood and qi, allowing the toxin to resolve and heat to subside. For cases involving collapsed, inverted, or dry lesions without ice-hardening or diarrhea, the cause is often heat-toxin attacking inwardly, requiring formulas such as Bai Yang Zhu Wei Tang (Hundred Pig Tail Decoction). Historically, Chen Wenzhong used hot medicines like Mu Xiang San and Yi Gong San. Zhu Danxi criticized these errors, yet some achieved rapid results. Liu Wansu and Zhang Zihe exclusively used cold-cooling agents like Huang Lian Jie Du Tang (Coptis Decoction for Resolving Toxins) and Sheng Ma Ge Gen Tang (Cimicifuga and Pueraria Decoction). Was this not a stark difference in ancient prescribing? Such variations depended on the season and specific syndrome. Later followers of Chen favored hot medicines, while followers of Liu and Zhang favored cold medicines; this is akin to carving a mark on a moving boat to find the sword. A wise practitioner estimates climatic changes, analyzes pulse signs, and adjusts treatment according to the disease. Then, whether employing attack or tonification, and whether following Chen or Liu/Zhang, will be appropriate.