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Whenever smallpox sores ulcerate, starting first on the face, it is because the face is the convergence point of all Yang meridians, and smallpox toxin is also a toxin of all Yang; like attracts like. Just as water flows to wet places and fire moves toward dryness. Moreover, the flourishing aspect of the Heart manifests in the face, and all sores belong to the Heart; this is another sign of Heart Fire flaming upward. However, if the facial sores have already ruptured, swelling has subsided, and the lesions are opening wider day by day, this indicates failure to form scabs, with the Yuan Qi (Original Qi) already dried up. This is "Dao Ye" (inverted healing where sores fail to crust over), and death will occur within a day or two. If after rupture, pus continues to flow, the entire face becomes scorched and cracked, with dripping pus and blood, vomiting upon eating, choking upon drinking, expectorating sticky saliva, hoarse voice, and foul breath from the mouth, this indicates the deterioration of the Zang-Fu organs, hence all symptoms appear; death by lingering illness and suffocation is inevitable. If the sores swell and ulcerate but digestion is unimpeded, urination and defecation are regular, and there are no other distressing symptoms, this case is treatable. Internally, one should administer Shiquan Dabu Tang (Complete Great Tonifying Decoction) and Shengyang Jiedu Tang (Yang-Raising and Toxin-Resolving Decoction) concurrently. Externally, Miecan San (Scar-Extingling Powder) combined with Baihua Gao (Hundred Flowers Ointment) should be applied.

Before smallpox pustules form their honeycomb-like structures, or if the patient has previously suffered from Shanghan (Cold Damage), even when reaching the stage of healing, they may fail to form scabs, with continuous pus discharge and pain; this requires urgent treatment. Otherwise, it will develop into Gan Shi Chuang (Gangrenous Ulcer). When ulcerating, pain occurs, and discharge damages bones and tendons, leading to premature death. Internally, Shiquan Dabu Tang (Complete Great Tonifying Decoction) should be taken, added with Yinyinhua (Lonicerae Japonicae Flos) and Lianqiao (Forsythiae Fructus). Externally, Miecan San (Scar-Extingling Powder) mixed with Baihua Gao (Hundred Flowers Ointment) should be applied. However, some cases arise due to deficiency of Qi and Blood, incomplete resolution of heat-toxin, and external contraction of Wind-Cold, causing obstruction and stagnation in the Couli (pores/skin interstices) and sluggish body fluids. Treatment should observe the color and location of the lesions. If located on the limbs and joints, areas characterized by deficiency, weakness, and scarcity of Qi and Blood, where the color is bluish-purple and black, with spreading ulcers and bleeding, it is difficult to treat. If the lesion is located in the Yang aspects, without pain or ulceration, and the color is fresh red and moist, Mian'er San should be the primary prescription.

In cases where scabbing should occur but does not, accompanied by fever, chest oppression, restlessness, stiff breathing when lying down, abdominal distension, diarrhea, severe chills with teeth grinding, and cold hands and feet, this indicates Spleen-Stomach Deficiency-Cold. One must urgently use Yigong San to rescue Yin and Yang and assist in scabbing. If constipation is present and both hands and feet are hot, this indicates Spleen-Stomach Excess-Heat; Qingliang Yin (Cooling Drink) should be used to support Yin and suppress Yang. Furthermore, in cases with throat obstruction, wheezing, and coughing, abdominal distension with flatus, and slightly warm hands and feet, this is due to Spleen Deficiency failing to control and hold, causing abdominal distension and flatus, and Lung Deficiency failing to descend and distribute, causing throat obstruction, wheezing, and coughing.