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When a child suffers from smallpox, by the eighth or ninth day, during the stage of filling and pustulation or resolution, life should be preserved. However, some children die when the eruption recedes to the neck; some die when it recedes to the chest; some die when it recedes above the umbilicus; some die when it recedes to the scrotum. What is the reason for this? It is due to deficient and weak Yuan Qi (Vital Energy), dense eruptions with heavy toxicity, and the harsh use of toxic substances to induce eruption, combined with the administration of ascending and activating agents. This forces all the Yuan Qi upward, exhausting it completely. Thus, although the eruptions appear full, the exterior "sac" (pustule shape) may seem solid while the interior is depleted. The five meridians are injured and cannot be supplemented. Therefore, the neck and throat are the gatekeepers of Lung Qi (Lung Vital Energy); if Lung Qi fails first, the eruption is blocked here, leading to death. The chest is governed by Heart Qi (Heart Vital Energy); if Heart Qi fails first, the eruption is blocked here, leading to death. The umbilicus is the gatekeeper of Spleen Qi (Spleen Vital Energy); if Spleen Qi fails first, the eruption is blocked here, leading to death. The eye sockets are governed by Liver Qi (Liver Vital Energy); if Liver Qi fails first, the eruption is blocked here, leading to death. The scrotum is the gatekeeper of Kidney Qi (Kidney Vital Energy); if Kidney Qi fails first, the eruption is blocked here, leading to death. This is like pulling up the roots causing trees to wither, or blocking the source causing streams to dry up—a natural law. If one can pre-adjust the Qi so that the smallpox toxin resolves naturally, then Yuan Qi will not be damaged, and there will be no worry of "blooming without fruiting" (failure to mature).

(For details not covered herein, please refer to the General Discussion section on "Essentials of Smallpox".)

Since the initial appearance of smallpox, both the exterior and interior are diseased. By the time of crusting and resolution (Shou Ye), the exterior pathogenic factors should have been resolved, and the interior Qi should be harmonious. Stool should be moistened, and urine should be clear. If sudden watery diarrhea of undigested food occurs instead, this is because the Middle Qi (Middle Jiao Energy) has suddenly become deficient and unable to secure retention. The toxic vapors enter the interior in the absence of resistance, attempting to halt the crusting process but instead obstructing the transformation of grain and water. In such cases, Yigong San (Heterogeneous Attack Powder) should be used as the primary formula. If the diarrhea stops, the condition transforms favorably. Otherwise, Yang collapse (Yang Tuo) will occur, leading to death. As for those who pass pus-tinged crusts, this indicates that the Righteous Qi (Zheng Qi) is not invaded by pathogens, but rather the passive expulsion of toxins outward. Once the toxins are exhausted, recovery will follow naturally. One should regulate Qi and Blood to resolve residual toxins and assist Ying (Nutritive) and Wei (Defensive) circulation, following the trend of toxin expulsion, and must not use astringent methods to stop it.

After the smallpox crusts fall off, if proper care is neglected, or if diet is improper, or if Wind-Dampness is contracted, the Spleen may be injured. When Spleen deficiency occurs, it cannot transport water, causing water to overflow and rise, resulting in edema (Swelling). If caused by dietary injury, employ methods to strengthen the Spleen and promote diuresis. If caused by Wind-Dampness, employ sweating methods to release the exterior. However, after prolonged illness, the five Zang organs are all deficient. The Spleen cannot transport, leading to Qi stagnation; the Lung cannot distribute, leading to descending failure of Qi; the Kidney cannot grasp Qi, leading to failing to store Qi. Consequently, rootless and unanchored Qi rises and falls aimlessly. It is common for the face to swell when lying down and the feet to swell when standing. Simply regulating the five Zang organs will allow the edema to heal itself. Abandoning the root to treat only the swelling is ultimately of no benefit.