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Before the smallpox toxin has erupted, one should open the gate of harmonization (He Jie); after it has erupted, one must block the path of leakage and depletion. If there is high fever and red cheeks, Gan Ge (Puerariae Radix) should be taken; if the complexion is blueish and spirit is sluggish, Shen Su Yin (Ginseng and Perilla Decoction) should be urgently administered. If breathing is coarse, heat is congested in the heart causing irritability, and constipation occurs, harmonization methods should be used; if there is wheezing, abdominal distension, swollen eyelids, and dry/tight skin, dispersing and venting methods should be urgently applied. Once the pathway for the eruption of sores is opened, the steaming heat will naturally resolve.

Before spots appear, only this method applies; after sores have spread, there are other miraculous formulas. If the sores are sparse and Qi and Blood are peaceful, one must understand the principle of harmonizing the exterior and centering the middle. If the sores are dense and overwhelming, one must recognize the subtlety of resolving toxins from both interior and exterior. If the sores are red and appear scorched/dry, cooling herbs to clear heat and detoxify should be used; if red spots are crimson-purple, Huang Qin (Scutellariae Radix), Lian Lian (Coptidis Rhizoma), Xi Jiao (Rhinocerotis Cornu - note: modern substitutes usually used), and Bai Ye (Platycladi Cacumen) should be combined. If body heat is blazing like fire, Gan Ge (Puerariae Radix) and Qian Hu (Peucedani Radix) should be used together. If breathing is coarse and abdomen is distended, Chan Tui (Cicadae Periostracum), Zhi Ke (Aurantii Fructus), and Mu Tong (Akebiae Caulis) should be used. If blood stasis causes paroxysmal abdominal pain, Yuan Hu (Corydalis Rhizoma), Zha Shi (Crataegi Fructus), Shao Yao (Paeoniae Radix Alba), and Mu Xiang (Aucklandiae Radix) should be used. If the color is ruddy and moist, Lian Qiao (Forsythiae Fructum) should be removed; if urination and defecation are clear and smooth, Sheng Di Huang (Rehmanniae Radix) and Tu Si Zi (Cuscutae Semen) [Note: 'Ju Tu' interpreted contextually] along with Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Fu Ling (Poria) should be added. This has been called "Ping Ze Zhi" since ancient times.

If spirit is fatigued and intake is low, Ren Shen (Ginseng Radix et Rhizoma) should be advanced; if eruption is slow but without vomiting, Shan Zha (Crataegi Fructus) should be added. If initially the redness is dense and thick, Zi Cao (Arnebiae Radix seu Lithospermi Radix) should be used without doubt; if the momentum is severe, toxins are heavy, and the color is arrogant/bright, using Yin Lv [Note: specific herb reference] what harm is there? However, before the third day, only these methods are permitted; following this path, one cannot apply them casually.

Suppose the sore tips turn white, indicating the stage of pus formation; one must then examine the differences between internal deficiency and external pathogens, and decide on appropriate warming, level-balancing, exterior-releasing, and tonifying methods. If spirit is vigorous, Qi is abundant, food intake is normal, and stools are solid, even if sores are dense, only a neutral formula to release the exterior should be used, such as Fang Feng (Saposhnikoviae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Dang Gui (Angelicae Sinensis Radix), Jie Geng (Platycodonis Radix), Xiong Qiong (Ligustici Chuanxiong Rhizoma), and Zha Shi (Crataegi Fructus), merely to promote pus formation. If essence is exhausted, spirit is weak, appetite is reduced, sores are depressed, and toxins are numerous, heavy tonifying agents should be used, such as Ren Shen (Ginseng Radix et Rhizoma), Gui Zhi (Cinnamomi Ramulus), Jie Geng (Platycodonis Radix), Xiong Qiong (Ligustici Chuanxiong Rhizoma), Dang Gui (Angelicae Sinensis Radix), and Gan Cao (Glycyrrhizae Radix et Rhizoma) as priority. These two formulas are established as tools for nourishing pus. If pustules are not yet full, do not change the formula lightly.

However, smallpox changes vary; one must use wisdom according to circumstances. When the pus is abundant and toxins are fully resolved/constrained, the method should gradually shift to cooling. If Qi and Blood return to their original strength, one must not excessively advocate exterior-releasing and tonifying; Ren Shen (Ginseng Radix et Rhizoma) should not be taken in large amounts, as excessive fullness may be difficult to manage. If stools are solid, food intake is good, and high fever persists, purgative and draining methods should be prioritized, using Sheng Ma (Cimicifugae Rhizoma), Gan Ge (Puerariae Radix), and Si Shun Qing Liang Yin (Four-Smooth Cooling Decoction). If stools are loose, appetite is reduced, and high fever exists without thirst, strengthening the Spleen is paramount, using Mu Tong (Akebiae Caulis), Fu Ling (Poria), Tong Cao (Tetrapanacis Medulla), Dang Gui (Angelicae Sinensis Radix), Fang Feng (Saposhnikoviae Radix), and Chi Shao (Paeoniae Radix Rubra). If internal and external symptoms are balanced, cold medicines need not be overused. After scabbing forms, observe whether residual toxins remain; if so, drain and purge; if not, tonify and regulate. If there is fever, irritability, thirst, and dark urine, Da Lian Qiao Yin (Large Forsythia Decoction) is used. If Qi is coarse, heat is strong, and constipation exists, Si Shun Qing Liang Yin (Four-Smooth Cooling Decoction) is used. If diarrhea occurs, Li Zhong Tang (Regulate the Middle Decoction) is suitable. If sores persist, Sheng Ma (Cimicifugae Rhizoma) and Gan Ge (Puerariae Radix) are used. If truly no residual toxins exist, simply nourish and rest Qi and Blood.