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In cases where wind-cold obstructs the *Couli* (pores of the skin), preventing the release of heat-toxin, resulting in pain throughout the body, head, and back, clear nasal discharge, alternating chills and fever accompanied by manic convulsions, dry throat, dry nose, and even blue-black patches all over the body, sweating methods should be employed. If the lesions are purple-black with extreme heat, purgation should be considered cautiously. If the blue-black discoloration persists after treatment, the prognosis is fatal.

In cases where summer-heat qi is congested and blocking, causing toxins to have no outlet and instead attacking inward, leading to chest oppression, restlessness, irritability, thirst, asthma, abdominal fullness, and stupor resembling mania, the treatment should focus on clearing summer-heat, benefiting Qi, and supporting the eruption of pox, as summer-heat often damages Qi. If there is an accompanying exterior contraction, acrid-cool exterior-releasing agents should be used as the primary treatment.

(Suijin Section)

If a child has firm and thick skin, is lean and dark with luster, this indicates strong bones relative to flesh. If accompanied by clear spirit in the eyes, like autumn water, and red, moist lips and tongue, it is an auspicious sign. This indicates abundant Qi and Blood, meaning the smallpox will be mild. If the muscles are flaccid, fragile, and fat-white, this indicates excessive flesh relative to bones. If accompanied by floating and unclear vision in the eyes, along with excessive phlegm and fire, it is an ominous sign. This indicates deficiency of both Qi and Blood, meaning the smallpox will be severe.

If the body is warm during fever, or the fever fluctuates, with clear spirit, normal diet, urination, and defecation, and no history of miscellaneous diseases, it is auspicious. If convulsions occur at the onset of initial heat, it is auspicious, as the toxin emerges from the Heart Meridian. If vomiting or diarrhea occurs during the initial heat phase, and stops once the rash appears, it is auspicious. This is because the heat-toxin is resolved internally, and the pathogenic factors are expelled through the upper and lower pathways without prolonged duration, preserving the Healthy Qi.

If after three days of fever, there is no high fever, no pain in the waist and abdomen, only just appearing spots that are hard to the touch, it is auspicious. If vomiting and diarrhea occur but spirit remains unimpaired, breathing is not coarse, mouth odor is absent, and the rash erupts naturally, even if frequent, it is still considered auspicious.

If vomiting and diarrhea persist during fever with body heat and thirst, *Siling San* (Four-Ling Powder) modified should be used. Warm and astringent medicines must not be administered, as they would hinder the release of heat-toxin, akin to adding fuel to fire. In the initial heat stage, if vomiting is severe, accompanied by pain in the head, body, waist, and abdomen, and simultaneous vomiting, diarrhea, and cough, the exterior contraction is significant, and the internal toxin is also heavy. *Jingfang Da Bantu* (Major Dispersion with Schizonepeta and Saposhnikovia Decoction) should be urgently administered for dispersion.

If wind-cold is congested, preventing the emergence of red-purple macules, urgent sweating to penetrate the muscle layer is required. If foul sweat covers the whole body, the toxic vapors will naturally dissipate. If fever is accompanied by excessive phlegm, delirium, coma, and convulsions, this indicates exterior wind-cold combined with interior stirring of Heart-heat. Urgent dispersal of wind and elimination of phlegm, along with promoting diuresis, are required. The Heart-heat will subside, and convulsions will cease.

If toxin is excessive and heat is congested during fever, accompanied by any bleeding symptoms, blood-cooling and toxin-resolving methods combined with specific eruption support should be used. Generally, miscellaneous diseases in the early stage of smallpox are due to trapped toxic vapors; thus, exterior-releasing herbs should be used extensively. Otherwise, without an exit for the toxin, minor toxins accumulate into major toxins. If the voice changes during the initial heat stage, the condition is serious; urgent clearing of the Lungs and benefitting the throat is required. If fever is accompanied by abdominal pain and dry, reporting (early stage) pox, blood-nourishing herbs should be used to rescue the condition. During smallpox epidemics, even before fever onset, if there is lower back pain or toxic sores on the waist, it indicates impending smallpox. Since the toxin is heavy, the eruption will be severe; therefore, preemptive clearing and resolving treatments are necessary.