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The first condition is diarrhea due to internal deficiency; the second is external contraction of wind and cold; the third is the eruption turning black and returning to the Kidney. Regarding diarrhea due to internal deficiency, it arises from weak Zang-Fu organs, indicating a reversal of the disease pattern. From the onset, diarrhea occurs naturally, or it results from mistakenly administering cooling medicines before the eruption appears. In such cases, the eruptions fail to emerge, presenting only as small red spots that are white or slightly yellow, resembling blisters. Treatment should employ Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder), administered with Nan Mu Xiang (Southern Cyperus) decoction to stop the diarrhea first, followed by mild agents to vent the pathogen.

Regarding external contraction of wind and cold, it occurs when the child is restless and aversive to cold, exposing their head and face while the papules are just emerging, suddenly being attacked by wind and cold; or when the eruptions appear like beads, and for the sake of cooling comfort, clothing is loosened, allowing wind and cold to invade. In mild cases, the lesions are red but do not fully erupt; in severe cases, they sink like the bottom of a stone mortar, appearing white and soft. Treatment requires warming the blood and dispersing cold pathogens using Bu Huan Jin Zheng Qi San (Golden Exchange Harmonizing the Upright Qi Decoction) plus Chuan Xiong (Ligusticum). If aversion to cold is severe, add Guan Gui (Cinnamon Bark) and Zi Su (Perilla Leaf), then administer venting agents. Whether due to internal deficiency diarrhea or external wind-cold contraction, if prolonged, the Stomach Qi becomes damaged, leading to deterioration. The ears may become hot, cyanotic, and black, clearly indicating a Kidney syndrome. Since the Kidney belongs to Water in the North, its color is black, and the prognosis is adverse. The treatment method is to first drain the Bladder Fu organ, then urgently warm the Spleen. If the eruptions are not black, it is definitely not a Kidney syndrome; caution against purgation is essential. To drain the Bladder: first, use equal parts of Gui Zhi (Cinnamon Twig), Shao Yao (White Peony Root), and Da Ji (Euphorbia Lathyris) powdered, taking one qian per dose with Jujube decoction; subsequently, take Xuan Feng San (Promoting Wind Powder) one qian with Qing Pi (Tangerine Peel) decocted. If foul matter is discharged, follow immediately with Wen Pi Tang (Warming the Spleen Decoction). Eruptions damaged by Yin pathogens and turbid qi can also deteriorate; vinegar-charred fumes and Su He Xiang Wan (Styrax Pill) can be used to resolve toxicity.

For pediatric smallpox/chickenpox that has already erupted, Zi Cao Yin (Arnebiae Decoction) is generally given. If fever is present with symptoms resembling Taiyang disease (Exterior Syndrome), but eruptions are not yet visible and diagnosis is uncertain, initially administer Xing Xing San (Wonderful Powder), Shen Su Yin (Ginseng and Perilla Decoction), or Ren Shen (Ginseng) and Qiang Huo (Notopterygium). If heat is intense, use Sheng Ma Tang (Ephedra Decoction), fearing exterior deficiency. If at the initial stage there is fever, a cold nose tip, yawning, coughing, and facial redness, these are signs of eruption; Sheng Ma Ge Gen Tang (Ephedra and Kudzu Decoction) added with Shan Zha (Hawthorn) and Niu Bang Zi (Arctii Fructus) is appropriate. Sparse eruptions heal easily. At the initial or pre-eruption stage, take three cun of Si Gua (Luffa Fruit) near the stem, including seeds, burn to ash preserving nature, powder it, and mix with honey water, or mix with sugar and Cinnabar powder. For numerous eruptions, reduce dosage; for few, omit. Protect the chest during initial eruption. If dense, urgently use Xiao Du Yin (Detoxification Decoction) added with Shan Zha, Huang Qin (Scutellaria root washed with wine), Zi Cao, reduce diet, and add Ren Shen. At the onset of fever, apply Orealis seed powder mixed with honey to the anterior fontanelle to prevent eye complications. Spontaneous sweating at the onset is acceptable, caused by damp-heat steaming.

Treatment of eruptions must distinguish between Exterior/Interior and Deficiency/Excess. Vomiting, diarrhea, and poor appetite indicate Interior Deficiency; no vomiting/diarrhea and desire to eat indicate Interior Excess. Tonifying Interior Excess leads to carbuncles and inverted crusts (inverted scabbing). Ash-white color indicates Exterior Deficiency; red, vibrant, and convex color indicates Exterior Excess. Tonifying Exterior Excess leads to ulceration without scabbing. Itching and collapsing require differentiation by form and color. Excess presents with strong, robust pulse; Deficiency with weak pulse. Deficient itching is treated with exterior-firming agents plus blood-cooling herbs; excess itching with constipation is treated with minor doses of Da Huang (Rhubarb) and other cooling purgatives to unblock stool.

Medication must distinguish Qi Deficiency and Blood Deficiency. Qi Deficiency uses Ren Shen and Bai Zhu with detoxifying herbs; Blood Deficiency uses Si Wu Tang (Four Substances Decoction) with detoxifying herbs. Most eruptions involve Qi and Blood insufficiency; deficiency is aided by blood-generating and activating agents with slight wind-dispersing herbs. Excess uses Bai Shao (White Peony Root) as the sovereign herb, Huang Qin as minister, assisted by Bai Zhi (Angelica Dahurica), Lian Qiao (Forsythia), and Xu Duan (Dipsacus). Black color indicates Blood Heat, prioritizing blood cooling; white color indicates Qi Deficiency, prioritizing Qi tonification. Initial white color warrants major Qi and Blood tonification: Ren Shen, Bai Zhu, Chuan Xiong, Sheng Ma, Gan Jiang, Gan Cao, Mu Xiang, Ding Xiang (wine-washed), Dang Gui, Bai Shao. Add He Zi Rou (Terminalia Chebula pulp) and Dou Kou (Cardamom) for diarrhea. Two types of black sinking due to Qi deficiency preventing toxin expulsion are treated with wine-fried Huang Qi (Astragalus), Zi Cao, and Ren Shen. Severe over-emergence uses Ren Shen Bai Du San (Ginseng Detoxification Powder) and Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction). Sparse eruptions lack toxicity; dense ones have toxicity, requiring cooling resolution; multiple doses are safe. Gray-white and quiet eruptions indicate Cold; bright and uniform eruptions indicate Heat. All-white eruptions resembling bean shells during crusting result from excessive water intake early on, causing uneven scabbing (inverted scabbing). Treat with exterior-firming agents. For bowel/bladder issues: constipation requires promoting bowel movement; urinary retention requires promoting urination; red, scanty urine uses Da Lian Qiao Tang (Large Forsythia Decoction) or Gan Lu Yin (Sweet Dew Decoction). Constipation with internal restlessness and external heat uses Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Zhi Ke (Bitter Orange), or Si Shun Qing Liang Yin (Four Compliance Cooling Drink).

Normal color requires no medicine. Pale color nearing completion requires blood-assisting herbs: Dang Gui, Chuan Xiong (wine-washed), Bai Shao, possibly Hong Hua (Safflower). Purple color nearing completion indicates Heat, resolved with cooling herbs: Sheng Ma, Ge Gen, wine-fried Huang Qin, Huang Lian, Lian Qiao. Severe cases use Xi Jiao (Rhinoceros Horn) for major detoxification. Dry eruptions require fire-clearing with light agents: Jing Jie (Schizonepeta), Sheng Ma, Ge Gen. Wet eruptions require damp-draining using wind herbs like Bai Zhi and Fang Feng (Saposhnikovia) for surface dampness. Sore throat uses Da Ru Sheng San and Niu Bang Zi Tang (Arctii Decoction). Wheezing and distension use Ma Huang Huang Qin Tang (Ephedra and Scutellaria Decoction). Restlessness and thirst use Gan Cao San (Licorice Powder) taken with Wu Mei Tang (Mume Decoction). Dysentery and vomiting use Mu Xiang Tang and Li Zhong Tang (Regulate the Middle Decoction).

Qian Yi stated: Black sinking with cyanosis is treated with Baixiang Wan (Hundred Perfected Pills) for purgation; non-black cases must not be purged. I understand this purges Bladder pathogens. The Child's Kidney is inherently deficient and should not be purged directly; instead, draining the Bladder empties the Fu organ, removing Kidney pathogens. Post-purgation fever, warmth, and thirst indicate water accumulation or indigestion; chills indicate reversal. This implies strong Spleen Earth controls Water. Post-purgation Wen Pi Tang uses equal parts Ren Shen, Fu Ling, Bai Zhu, plus fried Hou Po, Mu Xiang, and Gan Cao. Eruptions manifest in muscles governed by Yangming; warming Spleen Earth smooths Stomach Qi, eliminating leaked Kidney Water. This is Qian’s profound insight.

Urination and defecation must remain unobstructed. If stools are normal and yellow/black, toxins are reduced; minimal Hua Du Tang (Toxin Resolution Decoction) suffices. Closure of bowels/bladders causes intestinal congestion, meridian stagnation, and toxin retention, leading to closed eyes, hoarseness, dark skin, and rapid deterioration.

Cold-deficiency eruptions may persist ten days before death; toxin-excess purple eruptions die within seven to eight days. Fetal toxins emerge outwardly over one to three days; toxins remain internal until day six when they fully manifest externally, suppurating and scabbing by days seven to nine. If toxins are excessive and cannot exit, entering organs after day six necessitates urgent blood-cooling and detoxifying drugs before day six. After day six, treatment fails, causing rapid death. Weakness with low toxins results in delayed death due to insufficient Qi/Blood for suppuration. This distinguishes deficiency/excess severity. Numerous eruptions imply high toxins, requiring initial detoxification, followed by tonics to support pus formation due to potential Qi/Blood insufficiency.

Post-eruption voice indicates body pathology without Qi pathology; pre-eruption voice loss indicates Qi pathology without body pathology. Voice loss post-eruption indicates both body and Qi pathology, requiring Lung clearing with Ba Feng Tang (Eight Winds Decoction) and Liang Ge San (Cooling Diaphragm Powder) minus Xiao Shi and Da Huang.