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In the initial stage of blood-heat type smallpox (or variola), the patient's body feels as hot as if branded by fire. If the heat-toxin becomes excessively vigorous, the toxic qi fails to disperse and dissipate properly. The treatment should prioritize heavy use of herbs with ascending and dispersing properties to guide the toxin to the exterior for resolution from outside; combined with agents that promote diuresis and unblocking to allow heat to descend and moisten, thereby treating it from within; and assisted by cooling, detoxifying, blood-invigorating, and blood-cooling formulas. Even if the pustules are dense and crowded, they can resolve, transforming a difficult condition into an easy one, and a severe state into a mild one. This is referred to as "lightly releasing the exterior while cooling the interior, pacifying excess while clearing heat." Therefore, treating smallpox involves three aspects: stabilizing the exterior, harmonizing the middle jiao, and detoxifying.

At the onset of fever and when spots first appear, if the toxic qi is vigorous, or if it is suppressed by external wind-cold, or if the muscles are thick and dense with tight pores and obstructed skin apertures, the meridians become blocked. This prevents clear qi from guiding the toxin to the surface and exiting through the apertures, causing heat-toxin to stagnate internally. Symptoms include abdominal distension, panting and urgency, constipation, mania and restlessness, convulsions, hemorrhage, dry skin with erect hair, eye swelling, restless sleep, startled crying, and frequent weeping. These are all signs of heat-toxin obstruction. Once correctly identified, Qianghuo San Yu Tang (Notopterygium Decoction for Dispersing Stagnation) should be administered immediately. It uses Chuanxiong Rhizoma (Chuanxiong), Notopterygii Rhizoma et Radix (Qianghuo), Angelicae Dahuricae Radix (Baizhi), and Saposhnikoviae Radix (Fangfeng) for their ascending and dispersing power; Platycodonis Radix (Jiegeng) to open and regulate qi; Schizonepetae Spica (Jingjie), Forsythiae Fructus (Lianqiao), and Arctii Fructus (Niubangzi) to resolve stagnant heat; Lycii Cortex (Digupi) to clear heat in the bones and vessels and regulate the zang-fu organs; Leonuri Herba (Zicao) to smooth the skin and open apertures; Arecae Pericarpium (Dafupi) to guide heat downward; and Glycyrrhizae Radix et Rhizoma (Gancao) to harmonize the middle and detoxify. With these ingredients, the formula both disperses and ascends, penetrates the muscle layer, and harmonizes, ensuring heat-toxin does not stagnate and exits easily.

If cold-natured herbs such as Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), or Cimicifugae Rhizoma (Shengma) are used abruptly, the heat will be suppressed by the cold, unable to expand and rise, thus lingering in the meridians. When it retreats, it becomes frozen like ice, causing harm and potentially turning into carbuncles and sores. Furthermore, if a patient presents with mental fatigue due to heat-toxin stagnation but is mistakenly given Ginseng Radix et Rhizoma (Renshen) for tonification before the pus has formed, this aids the excess pathogen with tonification, making the evil more vigorous after supplementation. When vomiting and diarrhea occur due to heat-toxin, administering warming and astringent agents like Myristicae Semen (Roudoukou) and Terminaliae Chebulae Fructus (Hezi) further fuels the heat-toxin with warmth, causing the heat to become hyperactive. This leads to myriad complications, which is certainly not proper treatment.

Once blood blisters have formed and the qi and blood have settled in position, with white light appearing on the crown indicating impending fullness, the momentum of blood-heat has cleared, and the depression of fire-toxin has been resolved. At this stage, prolonged use of cooling agents is inappropriate, and the treatment plan requires careful reconsideration.