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Human beings rely on the Qi of Heaven and Earth to sustain life, and inherit the Qi of parents to form their physical structure. However, why is it inevitable to suffer from smallpox (痘疹)? This is because excessive ministerial fire (Yin Huo) lies latent within the body before the physical form is established, and erupts after life begins. When encountering years where the Fire element is overly abundant and heat-toxins are prevalent, the smallpox toxin is triggered to manifest. This condition must rely on the sufficiency of Qi and Blood to erupt, and only through the movement of Qi and Blood can it be resolved.

The initial symptoms resemble those of Cold Damage (Shanghan). However, in Cold Damage, pathogens enter from the exterior into the interior, thus presenting symptoms of a single meridian. In contrast, smallpox emerges from the interior to the exterior, so symptoms of all five Zang organs may appear. If symptoms of a specific Zang organ are particularly prominent and frequent, it indicates that the toxin in that organ is especially severe, and treatment should target that organ.

Therefore, fever, irritability, redness of the cheeks and lips, and dry complexion indicate the wandering of Fire. Body heat, headache, and stiffness of the waist and spine belong to the Taiyang Meridian. Alternating chills and fever indicate the mutual suppression of Yin and Yang. Sneezing belongs to the Lung. Yawning belongs to the Spleen. Cough, asthma, profuse phlegm and saliva, or irritability with palpitations and coarse nasal breathing indicate Heat in the Lung and Heart. Swelling and pain in the eyes occur because the Bladder Meridian originates at the inner canthus. Convulsions and tremors occur because the Liver governs the sinews, and body heat invades the Liver, resulting in symptoms resembling Wind. Pain in the mouth and tongue indicates Heat in the Spleen and Heart. Throat pain indicates Heat in the Lung. Abdominal pain involves the Spleen and Liver. Mania and oppression also stem from Heat in the Spleen and Stomach. Lethargy and sleepiness result from excessive Heat causing spiritual fatigue. Spontaneous sweating occurs due to exterior deficiency leading to open pores, or due to steaming by Damp-Heat. Diarrhea results from Heat-Toxin sinking downward, or from food stagnation. Vomiting is caused by Fire-Toxin forcing its way upward. Fever indicates excess Heat in the exterior. Absence of fever indicates robust Zheng Qi (Upright Qi).

However, initially, there are cases caused by external wind invasion, seasonal epidemic transmission, internal food injury with vomiting, or blood stasis accumulation due to falls, trauma, or fright. The manifestations are diverse and difficult to distinguish quickly. One must also verify by checking if the ears, nose tip, buttock tip, and feet are cold. Generally, smallpox belongs to Yang; when erupting, the Kidney shows no specific symptoms. Since the ears, buttock tips, and feet all belong to the Kidney, the areas governed by the Kidney alone become cold. Additionally, one must observe for red threads or protruding red vessels behind the ears, whether the pulse is surging, wiry, and rapid, if there are red spots in the epigastrium, if the eyes are tired with clear color like autumn water, if the earlobes, buttock tips, and middle fingers are all cold, if patterns appear between the cheekbones, if the sclerae are yellow, eyelids red, extremities and nose cold, urine scanty and dark, stool constipated, or if there is diarrhea, lethargy, hypersomnia, aversion to heat rather than cold, slight fever with frequent startles—these are the most reliable indicators for verification.

However, the method for treating smallpox lies solely in examining the exterior/interior, cold/heat, and deficiency/excess. If the exterior syndrome is heavy, treat the exterior as the root; if the interior syndrome is heavy, treat the interior as the priority. For Cold, use warming methods; for Heat, use cooling/pacifying methods; for Deficiency, use tonification; for Excess, use reduction/draining. Resolve stagnant Qi, nourish the source of transformation, and aim for balance. This is the general principle. If an interior Excess pattern is treated with harsh draining herbs, abscesses and toxins will surely form; if an exterior Excess pattern is treated with harsh dispersing herbs, ulceration without scabbing will surely occur. Therefore, on days 1-2, release the exterior to facilitate eruption; on days 3-4, clear heat and detoxify to facilitate growth; on days 6-7-8-9, warm and tonify Qi and Blood to facilitate pustule formation; on days 10-11-12, clear and astringe to facilitate drying/scabbing. These are the standard methods for treating smallpox. However, smallpox may erupt early and rapidly, or late and slowly. How can one rigidly adhere to a single method? If cooling herbs are used before the rash has fully erupted, the rash will stagnate due to cold; if warming tonics are used before the heat-toxin is fully resolved, the toxin will accumulate and fail to transform into pus. After the rash has crusted over, one need only avoid wind-cold and regulate diet. The critical period for cautious treatment is before the sixth day; careful medication selection then allows mild cases to rest easy and severe cases to recover from danger.