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When the complexion turns cyan, the skin is flaccid and slow to react, and clear saliva is vomited, this is also a sign of variola (smallpox) or rubeola (measles). This is all caused by physicians mistakenly administering too many cold and purgative medicines, leading to difficulty in the eruption of sores. Generally, when the pathogenic factors of sores are harmonious with Qi and Blood, and the Spleen is warm, eruption is easy; however, if too many cold medicines are taken, it leads to stagnant Blood, weak Qi, and a cold Spleen, making it difficult for the toxic heat of sores to be discharged, thereby transforming into a malignant condition. For such conditions, Bohe San (Mint Powder) and Tuochi San (Tooth-Exfoliating Powder) may also be administered. If the face is cyan, breathing is coarse, and both urination and defecation are obstructed, with sores not yet erupted, Huashi San (Talcum Powder) should be advanced (formula see "Sore Eruption Difficulty" section). If urination and defecation are not smooth, Tuochi San should be taken, followed by observation of color and symptoms for further treatment. Some patients have a red complexion, which is also a sign of sores. If the complexion changes from red to cyan, it indicates an adverse prognosis. Or, after several days of illness, if the face is cyan or sallow, limbs are slightly cold, there is upward panting without phlegm, and hands and feet twitch and contract, this is due to congestion of Qi in the Triple Burner, stagnation of blood vessels, and failure of Qi to nourish each other. Mint Powder should be used to vent and discharge the sore toxins.

In infants, upon initial onset, there may be惊狂 (convulsions and mania), fever, and sweating. Upon inquiry, the body does not feel cold, nor is there aversion to wind, and the pulse is洪数 (surging and rapid); in such cases, purgation is indicated. Recognizing these symptoms, before the rash erupts, Danggui San (Angelica Sinensis Powder) should be taken (formula see "Purgation Before Rash Appearance" section). If there is initial headache, hot air exhaled from mouth and nose, aversion to cold with high fever, chest and diaphragm fullness and oppression, salivation, rebellious Heart Qi, incessant thirst, cold toes, foul breath, wiry or weak pulses in both hands, and a wiry-rapid pulse in the Spleen position, this is due to injury from hunger and pathogenic heat, requiring the eruption of red rashes. There are also cases of headache, slight fever, hot air from mouth and nose, dry and painful throat, sores on cheeks, eyes burning like fire, slightly cold ear tips and extremities, surging-large pulses in both hands, followed by thirst and red face after two or three days, intermittent aversion to cold, rebellious Heart Qi, foul breath, and eyes suddenly appearing vermilion; this is also a sign of latent variola/rubella. The pathogenic toxins must first be removed using Dahuang Tang (Rhubarb Decoction) to purge. Baidu (Croton Seed), Shuiyin (Mercury), and Qingfen (Calomel) must not be used, as they lack the ability to clear heat toxins and instead damage the Zang organs.

If it feels as though toxins have gathered between the skin and hair follicles and are slightly emerging, purgation must strictly be avoided. Mistaken purgation causes the toxin to sink back, accumulating in the Heart, entering the Lungs, causing internal destruction of sores and death. If sores erupt excessively and suppurate with pus and water, mild purgation with Dahuang-containing medicines should be used to remove toxins. If purgation was already performed before the eruption, Dahuang medicines should not be used; instead, heat-clearing medicines should be used to eliminate residual toxins. Many ignorant laypeople forbid medication, relying only on witchcraft and prayers, failing to use medicines to purge sores, leading to obstruction of urination and defecation, retention of heat toxins in the Zang-Fu, attacking eyes and nose, swelling and blockage of throat, rotting of mouth and tongue, resulting in helpless death.

Others treat rash symptoms with cold or Qi-regulating medicines arbitrarily. After the rash has erupted, if harsh medicines are used again due to error, the disease becomes incurable even by Bian Que, causing premature death. According to Bian Que's method for treating variola: upon sensing symptoms, first use Youma Ji (Sesame Oil Preparation) (formula see "Initial Eruption" section) to relieve extreme heat in the four limbs. After taking the medicine, rest for a while, then take 3-5 doses until urination and defecation are smooth, limb heat subsides, and pathogenic toxins gradually resolve, resulting in milder eruption. If Dahuang San (Rhubarb Powder) was previously taken, this medicine is unnecessary. It is beneficial for infants. If toxins have erupted without prior resolution/purgation, Jiedu Bisheng San (Certain Miracle Detoxifying Powder) or Shengma San (Cimicifuga Powder) should be taken (two formulas see "Erupted or Not" section, same as *Boji* and *Yangsheng Biyong*). If toxins are in the skin and muscles but do not emerge clearly after 3-4 days, Zicao Yinzi (Arnebia Decoction) should be urgently used (formula see "Initial Eruption", same as *Shenghui*), and after several doses, sores will erupt. Before eruption, Huangbai Gao (Phellodendron Ointment) (see "Protecting Face and Eyes" section, same as *Shenghui*) should be applied to the cheeks and eyes, and Huisu Jiu (Coriander Wine) (formula see "Initial Eruption") sprayed on the back and limbs to promote rapid eruption.

If sores have not erupted, or have erupted with irritability and thirst, Gancao San (Licorice Powder) (see "Excessive Eruption" section) should be taken to mildly purge, stopping heat toxins. If eruption is delayed, Zicao Yinzi should also be taken. For adults, acupuncture at the radial styloid process of both wrists, or one moxa cone, also assists in erupting rash toxins. If already erupted, this is unnecessary. If sores have not suppurated, with irritability in the chest/diaphragm and restless sleep, Qingdai San (Indigo Powder) and Heidou Zhi (Black Soybean Juice) should be taken (two formulas see "Purgation Before Appearance" section). After toxins are fully expelled, Huangqin San (Scutellaria Powder) should be taken to resolve residual toxins. If vomiting occurs, this stops it. If there are sores in the mouth and lower body with diarrhea, Huanglian San (Coptis Powder) is indicated. If irritability, panting, and difficult urination occur after eruption, Dengxin Tang (Juncus Decoction) should be advanced (both formulas see "Resolving Residual Toxins After Eruption" section). If panting is severe, Mahuang Tang (Ephedra Decoction) should be used (see "Excessive Eruption" section). If there is sore throat and cough, add Shexiang (Musk). If excessive cold medicines were taken, leading to cough, cold hands/feet, and slow pulse, Pao Ganjiang (Prepared Ginger) and Zhi Gancao (Honey-fried Licorice), 4 qian each, decocted in 1.2 sheng of water to yield 4 he, should be taken. For dysentery with yellow-red stool, pus/blood, and whole-body fever, Xiebai Tang (Allium Macrostemon Decoction) (see "Dysentery with Pus/Blood" section) should be given to resolve evil accumulation and improve bowel movements.

If variola stabilizes but moves downward, causing eye nebulae and swelling, this is due to lingering敗热 (defeated heat) in the Liver. Eye drops must be strictly avoided; instead, benefit the Spleen and Lungs, resolve Liver heat toxins, apply medicines around the eyes to disperse toxins, and administer Ruiren San (Buckthorn Seed Powder). For severe nebulae, combine with Mimenghua San (Descurainia Flower Powder), dosing according to strength (two formulas see "Sores Entering Eyes" section); stop when nebulae recede. For epidemic variola, urgently pre-administer Dou Tang (Bean Decoction) to prevent eruption (formula see Black Soybean Juice above). If eruption occurs due to epidemic heat, with painful sores and high fever, use Guizhi (Cinnamon Twig), Qujie Mahuang (De-stemmed Ephedra), and Huangqin (Scutellaria), 0.5 liang each, powdered, mixed with warm water (1-2 qian based on age), covered to induce sweat, followed by Gegen San (Kudzu Powder) to release the muscle layer (formula see "Erupted or Not" section). For body pain, high fever, and headache, if minor sweating is not induced, pathogens cannot be dispersed from the exterior; if constipation persists, toxins remain hidden; if abdominal distension exists, mild purgation is needed to release pathogens; careful consideration is required. If sores have erupted, exterior-releasing methods must not be used, lest they worsen ulceration. If suppuration and pain are severe, apply finely sifted clean yellow earth powder and consume honey frequently. If sores are mild, apply Chuan Mangxiao (Niter) mixed with pig bile to the sores, avoiding disturbance, until scabs fall off. For severe eruptions preventing lying on mats, lie on a wheat-bran mat. If pustules form white pus, toxicity is light; if purple-black and hidden in muscles, toxicity is heavy; in severe cases, sores exist in five Zang organs and throat. With constipation and bleeding, black scabs without pus indicate death. Black tongue and black qi from nostrils indicate death.

Before eruption, if heat toxins force inward, causing wide-open staring eyes, upward rolling, screaming, resembling convulsions, this is a sign of impending eruption. Mistaking this for convulsions and treating accordingly causes toxin accumulation, failure to vent pathogenic heat, and death. If malignant sores erupt with incessant delirium, this is a malignant sign; treating with cold medicines causes aphonia, sinking of sores, and death. Overuse of drying medicines causes sore throat/swelling, sudden epistaxis, panting/cough, and death. If sores turn white, suddenly sink into Zang-Fu, become purple-black, lack pus, and cause day/night irritability, Huadu San (Detoxifying Powder) (see "Inverse Sores" section) should be taken; toxins should exit via palms and soles for recovery; this is a "five deaths, one life" prognosis. Hematochezia and necrotic sores without pus indicate ten deaths, no cure. For smooth eruption of major heat toxins, regulate according to symptoms. For epidemic bean pox not erupting, one method uses Dihuang (Rehmannia) and Xionghuang (Realgar) drink, but not in excess, lest it cause harm. If hot milk accumulates in Zang-Fu due to drinking/eating, the lactating mother should also be treated. Infants and children have Yang abundance and Yin deficiency; slight imbalance of Zang-Fu Yin-Yang Qi leads to irregular urination/defecation. Since Bian Que and Taichanggong discussed pediatric medicines, they prioritized solar terms and Yin-Yang regulation to benefit Zang-Fu and resolve disease.

Zhang Zhongjing stated: Upon birth, Dihuang juice should be instilled in the infant's mouth to expel black stool, preventing variola in adulthood. For infants under 100 days, during warm weather without evil winds, expose them to sunlight to tighten skin and acclimatize to wind/sun. Keeping them indoors or in warmth, then suddenly exposing them to wind/sun, causes cold pathogens to accumulate in Zang-Fu; with climate irregularity, this often leads to variola. Only when sores erupt does cold pathogen dissipate and toxins消 (disappear). Parents must abstain from intercourse if the child has sores; violation causes non-eruption, toxin entry into Heart, confusion, and death. If already erupted, violation causes black, rotten, excruciatingly painful sores; if healed, scars remain black for years. Zhongjing advised burning Chizhu (Atractylodes) and Zhu Jia (Pig Nails) in the room before sores appear to repel evil qi. Parents should curb lust, guard doors against outsiders to prevent violation and hindered eruption. Wheezing and cyan-yellow face are still good signs. Deaths from violation are countless. After recovery, if scabs fall but scars remain uneven/muscles depressed, and sores recur, this is due to failure to resolve toxins post-recovery, leaving defeated heat in muscles.

I have studied ancient and modern formularies; pre-Han/Wei texts did not record variola formulas, except for Bian Que's oil preparation and Zhongjing's few formulas, which I have recorded. Qin Chengzu of Song and Wang [Name Missing] of Jin each had one formula, also recorded later. Later, Chao Yuanfang discussed rash/variolous symptoms, and *Taiping Shenghui* compiled some formulas, though rarely cited elsewhere. Current popular formulas are those proven effective by skilled practitioners, kept secret.不忍 (cannot bear) to watch people die, I narrate the transmission, pulse/symptoms, and medicines to spread knowledge, sparing patients premature suffering.

*Huoren Shu* states: Pediatric sores resemble Taiyang syndrome (exogenous febrile disease), with headache, fever, cold feet, and rapid pulse. In doubtful cases, only Shengma Tang (Cimicifuga Decoction) should be given (see "Taiyang Macula" section). Shengma Tang releases the muscle layer and treats sores, usable whether erupted or not. However, purgation (Shuzhuan) is strictly forbidden. Taiyang fever should not be purged; sores with exterior heat especially must not be purged. Ignorant people claim early purgation vents toxins, which is wrong. Others say post-eruption purgation is fine if pus/blood are excessive, which is also wrong. Generally, sores must never be purged at start or end. Purging in children with fever, cold ears/buttocks, and cough sends toxins inward, causing death. Instead, use Huadu Tang (Detoxifying Decoction), Zicao Mutong Tang (Arnebia and Akebia Decoction) (see "Erupted or Not"), Niuzibang Tang (Arctium Decoction) (see "Throat Pain"), and if excessive, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) (see "Excessive Eruption"). For slow eruption with irritability/insomnia, Shuijie San (Water-Relieving Powder) (see "Seasonal Disease"), Mahuang Huangqin Tang (Ephedra and Scutellaria Decoction), Shengma Huangqin Tang (Cimicifuga and Scutellaria Decoction) (both see "Taiyang"), and Huoxue San (Blood-Invigorating Powder) (see "Slow Eruption") are indicated. For black inverse sores, Zhuwei Wubi San (Pig Tail Peerless Powder), Longnao Gaozi (Borneol Paste) are effective (see "Inverse Sores"). For heat toxins attacking throat, Rusheng Tang (Like-Saint Decoction) (see "Throat Pain"). For eyes entering sores, Jueming San (Cassia Seed Powder), Boyun San (Cloud-Piercing Powder), Mimenghua San, Tongsheng San, Ha Fen San (Clam Shell Powder) are indicated (all see "Eye Entry"). These are the ultimate methods.

*Quansheng Zhimi* states: Sores are recorded in *Chao Shi Bing Yuan* and *Qianjin Yaofang*, often following epidemic heat, without specific definitive theory. Treatments often rely on folk sayings. Initially, Huisu Jiu, wine, and warm/hot medicines are used to hasten eruption. If stuck in skin, fire-needle teeth with wine is used. Cold medicines are forbidden to avoid stomach cold hindering eruption, favoring warmth. I have seen many deaths (nearly 30) from adherents causing flat features, blocked throat, constipation, and hematuria. Inverse sores (black, sunken) result from initial mismanagement adding warm medicines, leading to isolated Yang, trapped toxins, internal attack, and death. Further warming accelerates death. I study this as part of seasonal diseases. Types include urticaria-like flakes, red maculae-like spots, pea-like bumps, or varying sizes with pus (pustules). Depth of toxins varies eruption appearance. Wind-pathogens on skin with trapped heat cause urticaria (itchy, mild). Internal heat combined with wind invading blood causes red maculae. Deep visceral entrapment, meridian closure, heat/blood stagnation causing pus results in pustules. Picking scabs to bleed prevents scarring; natural drying leaves scars. (Liu Zhu has no unique formulas, citing common ones).

Dong Ji's *Ban Zhen Zonglun* states: Life grows from small to large. Infants have weak Qi; *Duanju Fang* notes children under six are hard to treat due to lack of textual basis. Pediatric macular/rash conditions are hard to pulse-diagnose and critical. Initial symptoms resemble Taiyang syndrome or Yin epilepsy. Famous doctors in capitals can distinguish them; remote areas often misdiagnose as wind-cold, using heavy Ma Huang (Ephedra) sweating, causing exterior deficiency and interior excess. Treating as Yin epilepsy with warm/convulsion medicines increases heat. By days 3-4, diagnosis is set, but much time is lost. Secular doctors use hot medicines to erupt sores, causing extreme stomach heat. Early subcutaneous maculae turn black and sink. Continued heating makes eruption harder to reverse. Use Shao Xingxing San (Minor Awakening Powder) for moderate heat. Wait 1-2 days. No red spots = wind-cold (wait 5-6 days for self-resolution). Food-stagnation heat resolves in 1-2 days. Red spots + constipation (2-3 days) = mild purgation needed. Normal stool = no medicine (fear of freezing eruption). Days 4-6 diarrhea = Lizhong Wan (Regulate Middle Pill) and warm medicines. Days 4-5 constipation + severe sores + panting/distension/red urine = Sishun San (Four Compliance Powder: Licorice, Rhubarb, Peony, Angelica) to unblock. Once breathing/abdomen normalize, stop medicine for gradual recovery. Initial red spots + normal stool + red urine = use medicine to move bowels for faster eruption. Red/fast eruption = no purgation needed. People say no purgation post-eruption. But if half-erupted/half-hidden, or excessive with constipation/red urine/panting/distension/grinding teeth/dry lips/thirst/delirium, urgent purgation is required. If half-erupted with diarrhea/cold limbs/vomiting/distension, urgently use Lizhong, Sini, Jiangfu Tang (Ginger-Aconite Decoction). Tested effective. For pustule-like sores not crusting, give sugar water. As sores dry, expect headache/fever/chills/cold extremities/irritation/itching/delirium/surging pulse (6-7 beats per breath). Do not panic or treat differently.

Previous cases serve as warning. Recent verified methods listed below: Initial headache/fever/chill/irritability/sore throat = Siwei Shengma Tang (Four-Ingredient Cimicifuga Decoction) (see "Erupted or Not", same as *Yangsheng Biyong*). Itching/urticaria = Jingjie Tang (Schizonepeta Decoction). Vomiting = Xiao Chaihu Tang (Minor Bupleurum Decoction). No chill, only irritability/red urine/thirst/red spots = Zhuye Tang (Bamboo Leaf Decoction), Xijiao Yinzi (Rhino Horn Drink) (four formulas see "Erupted or Not"). Constipation = Sishun Yinzi (Four Compliance Drink) (same as Ge Shi Siwei Yin, see "Warm Fever"). Severe delirium/constipation = Da Chengqi Tang (Major Order the Qi Decoction) (see "Urination/Defecation Obstruction"). Spontaneous black-yellow stool = toxins exiting; avoid extensive decoctions to prevent new illnesses. Post-purgation, do not use warm medicines, lest sores become sparse and self-resolve. Shengma Tang and Jingjie Tang are best.

Liu Zhu's Pediatric Sores Formula: If infant has fever/sores pain, fearing wind-cold or food stagnation, and constipation, do not use Baidu (Croton) to purge accumulation, causing interior deficiency, persistent heat, deepening pathogens, wheezing/fullness, hematochezia, carbuncles, body splitting, and premature death.