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The eruption of smallpox (Douzhen) is the result of pathogenic heat steaming and diffusing from within to outside. If, while the heat-toxin is in motion, it is abruptly constrained by violent cold, the external cold and internal heat repel each other, preventing the toxin from entering inward or exiting outward due to the obstruction by external cold. Consequently, toxic vapors become congested in the muscle and interstitial spaces, causing the pustules to appear like mole spots, either blue or purple, commonly known as "Ghost Pinching Blue" (Guinianning Qing). The treatment should focus on dispersing cold pathogens, warming the muscles, and harmonizing Qi, so that toxic vapors can resume their circulation and the pustules can erupt properly. This condition occurs not only in young individuals with weak constitutions but also frequently in robust adults with thick flesh.

The face is the convergence point of all Yang meridians. Therefore, regardless of the disease or stage, a complexion that is white with hints of red and yellow indicates the transformation of Yang Qi. Since smallpox belongs to the Fire element, a reddish facial color is a favorable sign (Shun). Conversely, a bluish-green complexion indicates a mismatch between color and disease, carrying an Yin, cold, and desolate Qi, which is an unfavorable sign (Ni). However, this may arise from Liver Wood overacting on Spleen Earth; from vomiting and diarrhea injuring the Spleen and Stomach; from cold pathogens clashing during eruption causing stagnation and generalized cyanosis; or from persistent fever and restlessness leading to wind-stirring. Generally, excess heat generates wind, while deficiency leads to diarrhea. Treatment depends on the cause, but fundamentally, it usually stems from insufficient congenital Yang Qi and deficient postnatal Spleen Yuan, resulting in more misfortune than fortune.

If a patient presents with swelling and pain in the scrotum resembling a gourd, it indicates excessive heat in the Bladder and toxic vapors flowing into the Small Intestine. The treatment should prioritize detoxification, clearing heat, and promoting diuresis. If this occurs after the resolution of pustules, it is due to residual heat and toxins causing damp-heat to flow downward. It should also be treated with detoxification and clearing/drainage of damp-heat. Externally, apply a thick paste made from grinding Shiyan (Swallow Stone) in vinegar.

The eyes are directed by the Heart Spirit and house the Shen (Spirit). However, the eyes require blood nourishment to see, and the essence-Qi of all meridians and Zang-Fu organs flows upward into them. Thus, the harmonious interaction of Yin and Yang forms the essence of vision. When smallpox toxins affect the Zang-Fu organs, severe heat-toxins tend to travel through hollow orifices; thus, those with Liver and Kidney deficiency will inevitably suffer eye involvement. During the initial fever, if the eyes appear weary and reluctant to open, it indicates smallpox; if they appear watery, it indicates measles (Zhen). Since all sores belong to the Heart, signs manifest in the eyes. Pustules growing on the eyes typically do not occur at the onset but rather during the crusting phase (Shouye), when the face is ulcerated, repeatedly filling with pus and blood. Heat-toxins steam and attack inwardly. Alternatively, excessive use of acrid-warm herbs due to slow progression of severe toxins may cause this. Lesions on the Bai Zhu Zi (white part of the eye/sclera) need no treatment and will resolve spontaneously; however, lesions on the Hei Lun (black part/cornea/pupil area) require urgent treatment using methods to invigorate blood and detoxify. Blood-invigorating agents should not be too hot, and detoxifying agents should not be too cold. With appropriate medication, symptoms will gradually subside. For weak patients, cold-natured formulas are strictly contraindicated to avoid inducing various complications, which would be futile and harmful. Only after regulating the Zang-Fu to harmony, if the condition persists, should specific eye treatment be pursued. For instance, after crusting, if eyes are dry and cannot open regardless of light, it indicates Liver Heat. If eyes close in bright light but open in darkness, it is called photophobia (Xiuming), caused by residual heat in the Heart and Liver or Kidney deficiency. Dim vision with frequent hot tears indicates Liver Excess Heat. Other presentations include redness, swelling, and bleeding from attacking Wind-Heat; unbearable redness and pain from blood-heat stagnation due to sore toxins entering the eyes; or the formation of nebulae (Yi Mo). Nebulae spreading at the periphery are easy to treat; sudden obscuration of the black pupil often leads to blindness. Damage to the pupil, protrusion, or sinking of the eyeball are incurable. Crucially, avoid using eye drops or washes, which may cause greater harm. Prevention is best: before eruption, applying water-infused rouge around the eyes or using other eye-protection formulas are effective methods. After recovery, avoid chicken, duck, and eggs, as egg whites are cold and cloying; stagnation prevents toxin resolution, allowing toxins to enter the Liver and cause eye diseases.