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If the smallpox lesions erupt all at once within one or two days of onset, it is necessary to inquire whether the patient had a fever several days prior. If there was intermittent fever (alternating hot and cold) several days ago, it should be treated as having passed the critical period. However, if the patient originally had no fever and only developed a fever today, followed immediately by the appearance of macules/rashes, this indicates deficiency of Wei Qi (Defensive Qi) at the exterior, excessive pathogenic toxins, heat in Ying Blood (Nutritive Blood) with weakness of Wei Qi, loose interstices (skin pores and tissue spaces), and unfirm muscles, which fail to constrain the exterior, allowing toxins to surge outward; thus, the eruption is too rapid. It is appropriate to use formulas that tonify the exterior, which can prevent itching, collapse, and ulceration. Shibiao Jiedu Tang (Solidify Exterior and Detoxify Decoction) is the primary prescription. Another method involves using Qianghuo San (Notopterygium Powder) mixed with Zicao Gao (Arnebia Ointment), or Baoying Dan (Infant Protection Pill) added with Zicao (Arnebiae Radix seu Rhizoma), Niubangzi (Arctii Fructus), and Chantui (Cicadae Periostracum). If the heat remains intense and does not subside, Tuihuo Dan (Eliminate Fire Pill) mixed with Qianghuo San is administered; additionally, Dengcao (Junci Medulla), Mutong (Akebiae Caulis), Chantui (Cicadae Periostracum), and Digupi (Lycii Cortex) are decocted in water, cooled, and taken orally. This approach uses exterior-releasing formulas, which contradicts the theory of exterior deficiency and weak Wei Qi. This situation likely arises because the exterior syndrome during initial fever was neglected and not resolved, leading to stagnation of excess heat and violent eruption. Although this method may still be applied, few patients recover fully.

Shibiao Jiedu Tang (Solidify Exterior and Detoxify Decoction)
Renshen (Ginseng Radix et Rhizoma), Danggui Shao (Angelicae Sinensis Radix tip), Sheng Dihuang (Rehmanniae Radix), Baishao Yao (Paeoniae Radix Alba), Digupi (Lycii Cortex), Gancao (Glycyrrhizae Radix et Rhizoma), Jiuhuangqin (Scutellariae Radix fried with wine), Chaihu (Bupleuri Radix), Xuanshen (Scrophulariae Radix), Shengma ( Cimicifugae Rhizoma).
Crush these ingredients finely. Add a small amount of Bohe Ye (Menthae Haplocalycis Folium) and ten slices of Danzhuye (Lophatheri Herba). Decoct in water and take warm, at any time.

Xiaodu Kuaitang (Rapidly Dispel Toxics Decoction)
Jiegeng (Platycodonis Radix), Gancao Jie (Glycyrrhizae Radix et Rhizoma node section), Jingjie Sui (Schizonepetae Spica), Niubangzi (Arctii Fructus), Fangfeng (Saposhnikoviae Radix), Danggui Wei (Angelicae Sinensis Radix tail), Chishao Yao (Paeoniae Radix Rubra), Tianhuafen (Trichosanthis Radix), Huangqi (Astragali Radix), Xuanshen (Scrophulariae Radix), Lianqiao (Forsythiae Fructus), Qianhu (Peucedani Radix), Mutong (Akebiae Caulis).
Decoct in water and take orally.

Qingdi Tuihuo Tang (Clear Earth and Eliminate Fire Decoction)
Indicated for smallpox erupting with heat, termed "Fire-born Sprouts." Use this formula urgently to reduce heat, thereby preventing subsequent cyanosis, blackening, or sinking lesions.
Digupi (Lycii Cortex), Difuzi (Kochiae Spina): each 1 qian.
Niubangzi (Arctii Fructus), Zicao (Arnebiae Radix seu Rhizoma), Gegen (Puerariae Lobatae Radix): each 8 fen.
Lianqiao (Forsythiae Fructus): 6 fen.
Danggui (Angelicae Sinensis Radix): 5 fen.
Mutong (Akebiae Caulis): 3 fen.
Chantui (Cicadae Periostracum): 2 fen.
Add one slice of Jiang (Zingiberis Rhizoma Recens). Decoct in water and take orally. If heat persists, administer another dose, or grind into powder and take with Dengxin Tang (Junci Medulla Decoction).

Qianghuo San (Notopterygium Powder) (Used in the initial fever stage of this section)
Baoying Dan (Infant Protection Pill) (Used for prevention in this section)
Tuihuo Dan (Eliminate Fire Pill) (Consists of Liuyi San plus Niuhuang, see "Initial Fever" chapter for Tiandouteng)