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When the smallpox lesions have emerged and the pus is about to form, treatment should focus primarily on the Spleen and Stomach. This is because if the Spleen and Stomach are strong, Qi and Blood will be abundant, allowing pus to form naturally; the pus will be full and thick, requiring no medication.

If the Spleen and Stomach are weak, Qi and Blood will be deficient, unable to circulate fully throughout the body to generate pus. Consequently, the lesions appear flaccid and pale; even if there is a slight amount of fluid, it is merely water. However, the strength or weakness of the Spleen and Stomach can be determined by the quantity of food intake and the consistency of stool: those who eat little but have hard stools possess sufficient Spleen-Stomach Qi. Those who eat very little and suffer from diarrhea have increasingly deficient Spleen-Stomach Qi. As for cases where stool has been dry and constipated for many days accompanied by signs of mania and restlessness, the Dan Dao method (a bowel-clearing technique) should be used to unblock the Qi mechanism and harmonize the Defensive Qi. This way, other complications can be prevented, and the smallpox will not transform into macules and papules.

(For details not covered here, please refer to the General Discussion on Key Points of Smallpox.)

In cases where smallpox lesions are too dense, they also appear in the throat. When reaching the stage of pus formation, the throat lesions mature early; the tissue is flaccid and the skin thin, making them prone to rupture. The fresh, tender sores are painful upon touch, with crusts that are sticky and phlegm-saliva entangled within, causing blockage in the throat. This makes swallowing difficult; forcing food down causes pain. Therefore, drinking water leads to choking, and eating food induces vomiting. If the patient’s speech is clear and resonant, the condition is treatable. If the voice is hoarse, speech is lost, and the throat is ulcerated, it is untreatable. For cases where the smallpox was originally light and sparse, but cold pathogenic factors caused abdominal pain and vomiting, Ping Wei San (Calm the Stomach Powder) with modifications should be used as the primary treatment. If the cause is consumption of raw and cold foods, injuring the Spleen and Stomach with cold, leading to the lesions turning grayish-white and vomiting, Yi Gong San (Extraordinary Attack Powder) with modifications should be used. If the smallpox is indeed extremely dense, covering the throat and tongue, and during the crusting stage, the patient chokes on water, vomits food, and expels pus, blood, crusts, and phlegm, Gan Jie Tang (Licorice and Platycodon Decoction) with modifications should be administered frequently. If the lesions fail to fully erupt, the pus does not fill the tops, and suddenly, just as crusting begins, the patient spontaneously retches and hiccups despite not drinking or eating, this is an adverse smallpox case. This is what is referred to as "old trees shed leaves, broken strings lose their sound," inevitably leading to loss of voice, mental confusion, and death.