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Whenever a child initially falls ill with cold ears, alternating cold and warm hands and feet, fever, red face, intermittent coughing and sneezing, palpitations, and the appearance of red vascular patterns behind the ears, this is definitely a sign of smallpox (Xiaochuan). At this time, it is urgent to use exterior-releasing medications to allow the fetal toxins within the zang-fu organs and the pathogenic qi from external infections to dissipate entirely through sweating, thereby resulting in fewer eruptions. However, exterior-releasing medicines must be administered before the red macules appear. If body heat persists after sweating, cooling medicines should not be used immediately, lest the toxin fail to erupt.

(Eruptions) that emerge in two waves, varying in size, sparse on the head and face, absent in the eyes, with red and plump roots, full and glossy appearance, and sparse distribution on the anterior and posterior chest.

(Eruptions) that erupt simultaneously, resembling silkworm eggs, appearing crimson-red and dry, or grayish-white; accompanied by warmth in the head and coldness in the feet, warmth in the body but abdominal distension, dense eruptions with diarrhea and thirst.

If eruptions appear one day after the onset of fever, the condition is severe; if they appear two days after fever, the condition is also severe; if there is slight fever and eruptions appear after three days, the condition is mild; if the body cools down after four or five days and eruptions then appear, the condition is particularly mild, as the heat dissipates along with the toxin.

If a child suddenly experiences convulsions at the onset of fever but recovers quickly, eruptions will inevitably follow. This is called "Jing Dou" (Startled Smallpox), indicating a very stable prognosis.

Measles (Mazhen) fever resembles rash symptoms. Measles involves the fu organs and belongs to yang; it is easy to manage and can heal spontaneously even without medication, though one must guard against complications due to toxic ingestion or wind-cold exposure.

Initial eruptions may resemble measles or miliaria. If the root is red, the apex is round and pointed, and the eruption is firm and palpable, it is true smallpox (Zheng Dou). If the root is not red and the apex is soft and slightly depressed...

If a child has fever and develops red spots on the body that turn into bright vesicles within one or two days, this is chickenpox (Shuidou), also caused by fetal toxin but milder than true smallpox. If there are no other symptoms, treatment is unnecessary.

If a child has fever and develops red spots all over the body resembling mosquito bites one day after onset, this is definitely not smallpox, but rather heat toxin suppressed by wind-cold, preventing eruption. Treatment should focus on resolving the fever; once the fever subsides, the spots will dissipate.

When examining smallpox, first observe the base of the eruption. If the base is raised with red and smooth blood flow, there is vitality; even if involution occurs, it can be treated. If the base is flat, non-red, non-raised, and dark/dead in color, there is no vitality; even mild cases are difficult to treat. This is like planting beans: fertile soil and living roots allow weak seedlings to recover with irrigation; scorched soil and dead roots render irrigation useless.

When smallpox first appears, if there are tiny red spots inside resembling insect bites, it is called "Blood Smallpox" (Xue Dou). If eruptions do not progress or rise, the case is untreatable.

Although eruptions are sparse, if the roots and leaves are completely white without blood color, and after three to four days they swell and become large and soft upon pressure, this is called "Thief Smallpox" (Ze Dou), indicating severe deficiency of qi and blood. By the suppuration stage, they become blisters the size of grapes containing clear fluid without pus; the skin is thin and white as paper, and rupture leads to death.

In all cases of smallpox, one must distinguish severity, exterior/interior, deficiency/excess, and cold/heat.

Eruptions emerging evenly between one to two days, varying in size, red, round, and pointed, indicate a mild pattern requiring no specific treatment.

Eruptions erupting simultaneously, forming red-purple patches, dense as silkworm eggs, with irritability, thirst, and desiccation, indicate a severe pattern where treatment is futile.

Exterior Excess pattern: Eruptions are red, body is moist, apex is round and shiny, firm and palpable.

Interior Excess pattern: Stool is dry, urine is yellow and copious, appetite is normal, mouth is slightly dry.
These two patterns require no medication.

Exterior Deficiency pattern: Eruptions are white, itchy, fail to form pustules, apex is depressed, accompanied by chills and cold body.

Interior Deficiency pattern: Diarrhea, thirst, abdominal distension, panting, teeth grinding.
These two patterns urgently require tonification of both exterior and interior.

Exterior Heat pattern: Eruptions are red-purple, roots are patchy and scorched, body is hot, apex is crimson-purple-black.

Interior Heat pattern: Constipation, red urine, body heat, thirst with desire to drink, delirium, and fright.
These two patterns urgently require clearing heat and detoxifying.

Exterior Cold pattern: Body is cool, eruptions fail to rise, roots are pale white and non-red.

Interior Cold pattern: Vomiting and diarrhea, abdominal distension, cold qi, undigested food, clear urination and defecation, eruptions are gray with depressed apices.
These two patterns urgently require warming the middle and replenishing primal qi.

Red and plump roots, clear urination, normal stool, ability to eat without thirst, peaceful sleep, and clear spirit indicate clarity in both exterior and interior.