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Qi is Yang. Blood is Yin. In the disease of smallpox (or variola), without Yang, it cannot erupt; without Yin, its toxin cannot be transformed. Therefore, there must be an intersection of Yin and Yang, where Qi is harmonious and Blood nourishes. When Yang meets Yin, and Qi arrives causing Blood to attach, once the root base (gen ke) is established, if a sudden central depression occurs, this is due to insufficient Yuan Qi (Original Qi), which fails to sustain subsequent efforts. Thus, although Yin Blood has the function of attaching to Qi, Yang Qi lacks the power to control the toxin, resulting in depression that is neither full nor raised, severing the path of life generation. There are five types of depression: one is Black Depression, two is Blood Depression, three is Purple Depression, four is White Depression, and five is Ashen Depression.

Black Depression refers to when pustules initially appear sparse and few, but later become dense. During the phase of Yang meeting Yin, because Yang Qi is weak and cannot continue the initial efficacy, Blood lacks Qi nourishment, leading withering and black depression.

Blood Depression occurs when Blood is abundant relative to Qi, and weak Qi cannot restrain or lead the toxin; over time, it transforms into Purple Depression.

Purple Depression happens when Qi becomes increasingly deficient and Blood lacks Qi to accumulate it; thus, the overwhelming toxin burdens the system, hindering forward movement, causing Blood to detach.

White Depression is caused by insufficient Qi and concomitant weakness of Blood; over time, it transforms into Ashen Depression.

Ashen Depression signifies the decline and failure of both Qi and Blood, failing to provide nourishment. All these depressions are caused by defects in Qi, similar to breaking a rare flower; within moments, vital energy ceases, leading to withering and lack of luster. Hence, early treatment is necessary.

Whenever the rash appears flat, fails to rise, feels soft upon touch, accompanied by skin wrinkling or even central depression, along with symptoms such as vomiting, diarrhea, inability to eat, and incomplete speech, this indicates Qi Deficiency (Qi Xu). One should immediately use Bao Yuan Tang (Preserve the Origin Decoction).

If the rash is plump, with full contours, hard sores, or presents with high fever, wheezing, phlegm obstruction, and coughing, this indicates Qi Excess (Qi Shi). Treatment should focus on Clearing Lung Heat (Qing Fei) and Harmonizing (He Jie).

If clear nasal discharge, cough, aversion to wind, body tremors, spontaneous sweating, and pale rash color occur, this indicates Cold of Qi (Qi Han). Treatment should aim for Neutralization (Zhong He).

If dry nostrils, withered skin and hair, cough with blood-streaked sputum or epistaxis, and scorched-purple rash color appear, this indicates Heat of Qi (Qi Re). Treatment should involve Draining Lung Heat (Xie Fei).

If the rash is not red and vibrant, appearing pale white and itchy, unable to fill with pus (guan jiang), and turning white immediately upon touch, this indicates Blood Deficiency (Xue Xu).

If persistent body heat, alternating chills and fever, scorched-purple rash, bitter taste, dry tongue, cyanotic lips, flushed face, and pain in the hypochondrium and abdomen occur, this indicates Blood Excess (Xue Shi).

If the rash is dull and grayish-white, blood stagnation without vitality, cyanotic face, contracted tendons, vomiting of clear fluid, or watery diarrhea resembling vegetable juice, this indicates Cold of Blood (Xue Han).

If the rash is dim, itchy, eyes are red, stool is hard and dry, body heat is present, and irritability occurs, this indicates Heat of Blood (Xue Re).

For deficiency, tonify; for heat, clear; for cold, warm; for excess, suppress. By ensuring Qi and Blood are neither excessive nor deficient, Bao Yuan Tang, possessing a balanced and harmonious Qi, will naturally have the function of steaming pus formation and resolving toxins. Why then worry about the perils of the five depressions?