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At the initial stage of fever in variola (smallpox-like rash), before the spots appear, if there is coughing, sore throat, rapid breathing with asthma, swelling of the face and eyes, restlessness alternating between lying down and getting up, irritability, and dry mouth, this is due to toxic fire steaming internally causing the lung lobes to become scorched and elevated. It is appropriate to use Ganjie Tang (Licorice and Platycodon Decoction) combined with Renshen Baizhu Tang (Ginseng and White Tiger Decoction) with modifications as the main treatment. If vomiting and diarrhea occur at the onset of fever, this is because pathogenic fire forces upward affecting the Upper Jiao causing vomiting, downward affecting the Lower Jiao causing diarrhea, or centrally affecting the Middle Jiao causing both. The treatment should focus on resolving toxicity, releasing the exterior, and clearing heat; astringents for stopping vomiting and diarrhea should not be used. If there is tenesmus and dysentery-like stool (Zhi Xia), slightly add Radix Rheei Preparata (Dahuang, 大黄) to mildly promote bowel movement. This is a pure heat syndrome and should not be treated as cold; one should seek the cause within the context of rash-related vomiting and diarrhea, rather than treating it merely as common vomiting/diarrhea or dysentery. If there is severe sore throat and swelling preventing eating, Ganjie Tang (Licoric and Platycodon Decoction) added with seeds of Fructus Armeniacae Amarum (Niu Bang Zi, 牛蒡子) is suitable. If there is thirst and desire to drink water, this indicates pathogenic fire entering from outside and Heart Fire flaring internally, resulting in scorched lungs and dry stomach. For thirst occurring at the onset of fever, Shengma Gegen Tang (Cimicifugae Rhizoma and Puerariae Radix Decoction) should be used to release the exterior and expel pathogens. After the rash appears and heat-toxin naturally resolves, if thirst persists, use Radix Polygoni Multiflori Preparata (Heshouwu, though here likely referring to Radix Scrophulariae/Xuan Shen or similar cooling herbs, but text says Huafen which is Trichosanthis Radix/Tian Hua Fen) Tian Hua Fen (Radix Trichosanthis), Radix Ophiopogonis (Maidong, 麦冬) combined with Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity). The appropriate beverage is a decoction of Mung Bean, Herba Centipedae (Deng Xin Cao, 灯心草), and roasted rice, to generate fluids and resolve heat. Indiscriminate consumption of cold water can lead to severe cases where toxic vapors attack internally leading to death, or mild cases transforming into water retention syndromes: water entering the Lung causes asthma and cough; entering the Spleen causes edema, distension, and spontaneous diarrhea; entering the Stomach causes vomiting and hiccups; entering the Heart causes palpitations, fright, or oppression; entering the Liver causes hypochondriac pain; entering the Kidney and Bladder causes difficulty in urination and scrotal swelling, while residual toxins remain unclear manifesting various symptoms.

It is well known that smallpox prefers warmth while rash prefers coolness. However, one must not ignore that smallpox requires substantial formation, and excessive warmth leads to ulceration. For early-stage rash, excessive coolness prevents eruption. Practitioners must observe seasonal climate changes and adapt accordingly. In severe cold, use Guizhi Gegen Tang (Cinnamon Twig and Pueraria Decoction) to release; in severe heat, use Shengma Gegen Tang (Cimicifugae Rhizoma and Puerariae Radix Decoction) combined with Renshen Baizhu Tang (Ginseng and White Tiger Decoction); in moderate conditions, use Fangjing San Du Fa (Prevention and荆 Herb Detoxification Powder) to vent. If epidemic qi is present, use Renshen Baidu San (Ginseng and Toxin-Resolving Powder). Ensuring proper warmth and coolness allows Yin and Yang to harmonize, allowing the rash to fully erupt and resolve, unlike smallpox which must suppurate and crust over. There are also distinctions between red and white rashes: red rashes require coolness to resolve, while white rashes require warmth to dissipate. If a patient has had fever for six or seven days without visible rash, it may be due to thick skin, closed pores, wind-cold invasion, or prior vomiting/diarrhea causing Qi deficiency and latent pathogens. Treatment urgently requires formulas that support the interior and release the exterior, externally spraying with wine boiled with Coriander (Hu Su Zi/Hu Sui, here Hu Su likely refers to Coriandrum sativum/Xiang Cai). If constipation persists due to deep internal toxin retention, use Liangge San (Cooling the Diaphragm Powder) added with Niu Bang Zi (Fructus Arctii). If still no eruption, accompanied by abdominal distension/pain, wheezing, confusion, and delirium, it is a fatal case. The Classic states: "Excess of pathogenic qi constitutes excess syndrome." Since pathogenic qi is abundant, only sweating and dispersing can remove it. Exterior-releasing methods often involve heat; without acrid-warm herbs, how can it be resolved? Rash belongs to Yang, and initially consumes Yin, so acrid-hot drugs are contraindicated. Yet, people indiscriminately use cold-cooling remedies. Early use causes blood stasis and toxin stagnation, suppressing fire makes heat-toxin hard to exit; late use damages Stomach Qi, and freezing residual toxins traps pathogens in meridians, leading to eye diseases and dysentery. It is said: "Rash needs coolness, Smallpox needs warmth." Does "coolness" mean cold-cooling? One must always assess the strength of pathogens and seasonal temperature. In winter, not only avoid cold-cooling formulas, but also apply fermented Coriander externally. In summer, when pores are open, acrid-hot items are forbidden; although Coriander is slightly acrid and important for rash, it should also be avoided.