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The syndrome of obstruction in smallpox, although presenting with severe symptoms, yields extremely miraculous efficacy if treated correctly. If cold and cooling herbs such as Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), and Cimicifugae Rhizoma (Shengma) are suddenly used, the heat will be suppressed by the cold qi, unable to extend and transcend, lingering in the meridians, leading to carbuncles or boils; cases of water retention causing hard urinary retention also occur. As for warming and tonifying agents like Ginseng Radix (Renshen), Astragali Radix (Huangqi), Atractodis Rhizoma (Baizhu), and Poria (Fuling), if mistakenly used, they will exacerbate the obstructed excess, bringing disaster immediately. Others such as Caryophylli Flos (Dingxiang), Cinnamomi Cortex (Guizhi), Aucklandiae Radix (Muxiang), Zingiberis Rhizoma (Jiang), and Aconiti Lateralis Radix Preparata (Fuzi), which attack heat with heat, can kill instantly, and thus extreme caution is required. Therefore, from the initial fever until after the appearance of spots, it is appropriate to treat with this formula, making modifications according to the methods described later.

Modifications of Qianghuo San Yu Tang:
For initial onset with high fever, red cheeks and face, dry and scorched hair, dry skin, cough, and rapid breathing, add Cimicifugae Rhizoma (Shengma). For irritability and thirst, add Trichosanthis Radix (Tianhuafen) and Puerariae Radix (Gange). For abdominal distension, rapid breathing, nasal congestion, red face resembling anger, upright and withered hair, add Ephedrae Herba (Mahuang). For constipation, add Angelicae Sinensis Radix (Danggui) and Aurantii Fructus (Zhike); for severe cases, add Rheum Radix et Rhizoma (Dahuang). For vomiting, add Polyporus (Zuling), Alismatis Rhizoma (Zexie), and Citri Reticulatae Pericarpium (Chenpi); avoid Zingiberis Rhizoma (Shengjiang), Caryophylli Flos (Dingxiang), Aucklandiae Radix (Muxiang), and Pinelliae Tuber (Banxia). For diarrhea, add Cimicifugae Rhizoma (Shengma); avoid Atractodis Rhizoma (Baizhu), Poria (Fuling), Myristicae Semen (Doukou), and Os Draconis (Longgu). For wheezing, cough, and aversion to wind, add Mori Cortex (Sangbai pi) and Perillae Folium (Zisu). For bleeding, add Rhinocerotis Cornu (Xijiao), Rehmanniae Radix (Shengdihuang), and Coptidis Rhizoma (Huanglian). For eruption of rashes, add Coptidis Rhizoma (Huanglian), Scutellariae Radix (Huangqin), and Gardeniae Fructus (Shanzhi). For dark and astringent urination, add Talcum (Huashi), Gardeniae Fructus (Shanzhi), Rehmanniae Radix (Shengdihuang), and Paeoniae Radix Alba (Shaoyao). For epistaxis, add Scutellariae Radix (Huangqin) and Rhinocerotis Cornu (Xijiao). For palpitations and fright, add Akebiae Caulis (Mutong) and Gardeniae Fructus (Shanzhi). For convulsions, add Tangerine Peel (Qingpi). For loss of appetite, add Crataegi Fructus (Shanzha). For food stagnation, add Crataegi Fructus (Shanzha), Massae Fermentatae Medicinatae (Shenqu), and Hordeum Fructus Germinatus (Maiya). For slow eruption between two to three days after spots appear, add Arctii Fructus (Niubangzi), Crataegi Fructus (Shanzha), and Bombyx Batryticatus (Chantui), named Touji San. For irritability and bright red color, add Rehmanniae Radix (Shengdihuang), Carthami Flos (Honghua), and Moutan Cortex (Mudanpi); remove Angelicae Dahuricae Radix (Baizhi) and Saposhnikoviae Radix (Fangfeng). For tight skin and tense muscles with severe high fever, add Puerariae Radix (Gegen) and Peucedani Radix (Qianhu).

Within three days after spots appear, all modifications should be based on this formula. After three days, when the pustules are fully erupted, blood vessels are formed, and previous symptoms have subsided, this formula should not be reused, lest excessive dispersion makes it difficult for pus to form; other formulas are provided later. Prohibited medications should be managed according to the treatment principles for blood-heat smallpox syndromes; hence, no specific contraindications are listed for this formula.

Taiyi Baohe Tang (also known as Zicao Touji Tang)
Specifically treats blood-heat smallpox syndromes after taking Shishen Jiedu Tang, where heat symptoms have completely disappeared, and internal and external conditions are peaceful. If pustules do not grow well three days after appearance, especially in those with coarse skin, this formula protects and harmonizes Yuan Qi, invigorates blood and resolves toxicity, assists in pus formation, and facilitates scabbing and falling off.
Platycodonis Radix (Jiegeng), Lithospermi Radix et Rhizoma (Zicao), Chuanxiong Rhizoma (Chuanxiong), Crataegi Fructus (Shanzha), Akebiae Caulis (Mutong), Ginseng Radix (Renshen), Carthami Flos (Honghua), Rehmanniae Radix (Shengdihuang), Glycyrrhizae Radix et Rhizoma (Gancao), Glinis Oryzae Semen (Nuomi - 50 grains).
Take the above ingredients, add seven strands of Juncus effusus (Dengxincao), one slice of Zingiberis Rhizoma (Shengjiang), and one cup of water; decoct to six-tenths volume; take warm.
For astringent urination and abdominal distension, add Arecae Pericarpium (Dafupi). For overly red and unmoistened appearance, add Angelicae Sinensis Radix (Danggui) and Bombyx Batryticatus (Chantui). For slow eruption, add Arctii Fructus (Niubangzi). For sunken lesions, add Astragali Radix (Huangqi). For pain, add Angelicae Dahuricae Radix (Baizhi). For uneven distribution, add Saposhnikoviae Radix (Fangfeng). For blisters, add Atractodis Rhizoma (Baizhu) and Paeoniae Radix Alba (Shaoyao). For cough, add Schisandrae Fructus (Wuweizi) and Ophiopogonis Tuber (Mendong). For thirst, add Ophiopogonis Tuber (Mendong). For itching, add Atractodis Rhizoma (Baizhu) and Paeoniae Radix Alba (Shaoyao).
After seven to eight days, when pus is sufficient, but body temperature rises again, with constipation, irritability, thirst, abdominal distension, and rapid breathing, use Qianhu Zhike Tang. Do not use this formula once pus is sufficient; another decoction is provided later.

Yiyuan Touji San
Specifically treats obstructive heat smallpox syndromes. After taking Qianghuo San Yu Tang, if obstruction symptoms open up and qi and blood become peaceful, but pustules do not enlarge or form pus after three to four days, using this formula harmonizes qi, resolves toxicity, penetrates the muscle layer to reach the surface, leads out Yuan Yang, assists in pus formation, and facilitates the formation of pus pits. Modifications are discussed similarly to Baohe Tang; after pus is sufficient, Baoying Baibu Tang is provided later.
This is Taiyi Baohe Tang minus Rehmanniae Radix (Shengdihuang) and Carthami Flos (Honghua), plus Bombyx Batryticatus (Chantui), Arctii Fructus (Niubangzi), and Citri Reticulatae Pericarpium (Chenpi).
Take the above ingredients, add one cup of water, fourteen strands of Juncus effusus (Dengxincao), and two dates; decoct to six-tenths volume; take warm.

Baoying Baibu Tang
Specifically treats smallpox after nine to ten days when pus is sufficient and there are no other symptoms. It regulates qi and blood, nourishes spleen and stomach, and can be taken regardless of excess or heat syndromes. For qi deficiency syndromes after nine to ten days, add two qian of Astragali Radix (Huangqi) and a little Guigui (Cinnamon Twig). If other symptoms exist, modify according to deficiency or excess.
Angelicae Sinensis Radix (Danggui), Paeoniae Radix (Shaoyao), Rehmanniae Radix (Dihuang), Atractodis Rhizoma (Baizhu), Ginseng Radix (Renshen), Poria (Fuling), Dioscoreae Rhizoma (Shanyao), Glycyrrhizae Radix et Rhizoma (Gancao).
Take the above ingredients, add one cup of water and two dates; decoct to six-tenths volume; take warm.

[Chen's School Advocates Warming and Tonifying] [Chen] Between the time before and after smallpox eruption, if there is diarrhea and thirst, abdominal distension, or shortness of breath, it is called Interior Deficiency; quickly treat with Shi Yi Wei Muxiang San. If after eruption, the sores lack luster, do not rise, and roots are not red, it is called Exterior Deficiency; quickly treat with Shi Er Wei Yigong San. If after eruption, sores lack luster, do not rise, roots are not red, accompanied by diarrhea/thirst, abdominal distension, or shortness of breath, it is Exterior and Interior Deficiency; quickly treat with Shi Er Wei Yigong San administered with Qi Wei Roudoukou Wan. (Danxi said: Muxiang San and Yigong San are appropriate for cold syndromes; for deficiency without cold, disaster follows immediately.) If from one to ten days after eruption, the whole body has high fever and stool is yellow, it is Exterior and Interior Excess. The sores must be lustrous, rising, full, and easily scabbing, without damage. If no other illness exists, medication is unnecessary. Exterior/Interior Excess heals easily; Exterior/Interior Deficiency is easy to erupt but hard to heal. Exterior deficiency makes eruption difficult; Interior deficiency makes healing difficult. Treat according to syndrome. Zhang Xuanzhi's "Key Methods for Treating Smallpox" states that vomiting/diarrhea and poor appetite indicate Interior Deficiency; sinking/inverted scabs and gray-white color indicate Exterior Deficiency. Both present indicate Exterior/Interior Deficiency; save with Yigong San entirely, even Ginger, Aconite, and Lingsha can be used. If only Interior Deficiency, reduce Guigui; if only Exterior Deficiency, reduce Roudoukou, but do not reduce Guigui or Dingxiang. If able to eat but constipated with sinking/inverted scabs, it is Interior Excess; use Qian's and Danxi's purgative methods. If no vomiting/diarrhea but able to eat, it is Interior Excess; tonifying Interior Excess leads to carbuncles. Red, lively, protruding indicates Exterior Excess; using exterior-releasing drugs for Exterior Excess leads to ulceration without scabbing. For any smallpox, once spots appear, avoid Gegen Tang, lest dispersion causes Exterior/Interior Deficiency.

[Dan] When reading predecessors' works, one must understand their intent. Reading without understanding intent makes practical application impossible. Regarding smallpox, Qian's discussion is most detailed, tracing origins, clarifying meridians, distinguishing Exterior/Interior and Deficiency/Excess, stating treatment methods, and verifying with dialectical discussions, embodying the spirit of teaching through writing. Students who read and apply it find it as reliable as compasses and squares for circles and squares, or levels and plumb lines for straightness; extending it allows infinite application. Modern people do not know the cause of disease nor the intent of prescriptions. In haste, they check formulas against symptoms and try them randomly. If ineffective, they discard the books, showing extreme thoughtlessness. Recently, due to the long-standing influence of "Ju Fang" and neglect of "Su Wen," patients and doctors prefer warming over cooling, and tonifying over releasing. Suddenly encountering Chen's formulas, which use drying, hot, and tonifying agents, with precise words and simple text, they happily use and believe them, thinking Qian is far inferior to Chen. Some ask: Do you think Chen's formulas are inadequate? I say Chen's formulas are indeed one-sided. However, he was good at seeking the nature of the disease. His intent largely focuses on the Taiyin channels. Hand-Taiyin belongs to Lung, governing skin and hair; Foot-Taiyin belongs to Spleen, governing muscles. Lung metal dislikes cold and is easily affected; Spleen earth dislikes dampness and accepts everything. Using Dingxiang and Guigui treats Lung cold; using Fuzi, Baizhu, and Banxia treats Spleen dampness. If Spleen and Lung truly had cold and damp with deficiency, measuring the dose and stopping when effective would cause no harm. Now, however, seeing slow eruption, fever, diarrhea, palpitations, rapid breathing, or thirst, they indiscriminately use Muxiang San and Yigong San regardless of cold/heat or deficiency/excess. Occasionally successful, but mistaken use brings immediate disaster. Why? Ancient prescriptions had guides, controllers, counter-agents, and specific uses. Qian's formulas did not abandon Xixin, Dingxiang, Baizhu, Renshen, etc., but included controlling and assisting herbs, not solely focusing on warming and tonifying. He used more cooling herbs and only hinted at tonification, not going deep. One cannot speak dreams to fools; Qian's caution was profound, waiting for experts to expand upon it. Although Chen introduced using warming drugs for thirst and tonics for itching/sunken lesions, surpassing predecessors, his frequent use of Guizhi, Fuzi, and Dingxiang (acrid, aromatic, drying, and hot) may not be perfectly balanced. These are suitable for cold-deficiency, but what about deficiency without cold? When Chen formulated, he likely addressed cold-complicated cases, leaning towards heat. I have synthesized the essence of various schools and applied their intent, daring not rely solely on their fixed formulas. In Jiashen year of Zhizheng, yang qi moved early. In January, smallpox in the county rarely exceeded one family. All were treated with Chen's formulas, resulting in over a hundred child deaths. Though partly due to fate, I fear human effort was not fully exerted.

Wang Ruyan said: If smallpox is deficient and weak, pale white, itchy, and sunken, it belongs to Deficient Cold; use Chen Zhongwen's formulas. If fever is high, uniform, red-purple, dry, and itchy, it belongs to Heat Toxicity; urgently cool blood and resolve toxicity. Since Chen Zhongwen's formulas became popular, Deficient Cold cases mostly survived, while Heat Toxicity cases all died. Smallpox is fetal toxin; ancients only resolved toxicity. However, if qi and blood are deficient, toxins cannot be expelled or mature. Thus, Chen's method is a millennium secret, supplementing predecessors. But since warming-tonifying methods prevailed, the principle of resolving toxicity faded, saving one side while harming the other.

In treating smallpox, one must recognize syndromes. If base is sparse, roots are red-lustrous, no diarrhea/thirst, milk/food intake unchanged, limbs warm, no high fever, no medication is needed; just care well and wait for maturation. If itchy/sunken, chills, teeth-grinding, incessant thirst, purple-black sores, wheezing/thirst/restlessness, gray-white sunken tops, abdominal distension, warm head/cold feet, confusion, drinking, shortness of breath, diarrhea/thirst, these are hopeless; even forced treatment is useless.

In treating smallpox, skillful defense is better than skillful attack. If no pathogen in Exterior/Interior, do not treat rashly. Greedy doctors,不分虚实 (not distinguishing deficiency/excess), rashly prescribe pills/decoctions, claiming credit for cures, causing deficiency to become more deficient and excess to become more excess, leading to complications and death. This is the doctor's sin.

[Medication] [Wan] For smallpox, distinguish qi/blood and deficiency/excess, and mild/severe toxicity. Gray-white, non-rising, itchy/sunken, vomiting/diarrhea, chills/teeth-grinding, cold hands/feet indicate Qi Deficiency; use Qi-tonifying agents. Dry sores, non-lively, scant pus indicate Blood Deficiency; use Blood-tonifying agents. Dense, swollen, red-purple indicate Severe Toxicity; use Detoxifying agents. Sunken cases require combined Qi/Blood detoxification. For Qi tonification, use Sijunzi Tang; suitable if sores are moist or spontaneous diarrhea occurs. If sores are dry, Baizhu dries fluids, Fuling leaches fluids; unsuitable for constipation/excess. For Blood tonification, use Siwu Tang; suitable if sores are dry or color is too delicate. If unable to eat, Shengdihuang blocks the chest, Shaoyao astringes intestines; unsuitable. For detoxification, use Huanglian, Huangqin, Huangbai, Zhizi, Lianqiao, Niubangzi, Shengma, etc., all wine-processed to prevent cold-cooling damaging spleen/stomach. To release exterior, add a little Guizhi. Zicao, Shandougen, Gegen need not be wine-processed. When using detoxifiers, differentiate organs and yin/yang. Huanglian clears Heart fire; Huangqin clears Lung fire; Zhizi clears Liver fire; Huangbai clears Kidney and Sanjiao fire; Shigao clears Spleen/Stomach fire; Mutong clears Small Intestine fire; Huangqin also clears Large Intestine fire; Lianqiao/Niubangzi clear sore toxicity fire; Shandougen/Zicao clear smallpox toxicity fire; Shengma clears epidemic toxicity fire. Each has specific indications. Above mid-year, Yang dominates, Heart/Lung govern; use more Huangqin/Huanglian. Below mid-year, Yin dominates, Kidney/Liver govern; use more Huangbai/Zhizi.

Secret Eight-Ingredient Two-Flower Powder
Peach Blossom Stamen (5 qian), Plum Blossom Stamen (amount unspecified, dried in shade, total 1 liang 6 qian 2 fen), Pangolin Scales (four-footed, wine-fried, 1 liang), Cinnabar (water-washed, 1 liang), Placenta Humana (washed free of red veins, baked dry, powdered, 1 unit), Tianlinggai (1 unit, washed with Gleditsia sinensis decoction, prepared with butter, powdered, total 1 qian 7 fen), Deer Antler (hair removed, butter-prepared, total 1 liang 2 qian), Ginseng (selected official grade, 1 liang).
Powder each separately. Before eruption, use Cinnabar (1 liang) as chief, Plum Blossom (2 qian), Peach Blossom (3 qian), mix evenly. Take 5 fen, 3 fen, or 2.5 fen per dose. Feed with rooster meat and two cups of wine. Prick blood into the cup upside down. Mix medicine with hot wine and take together. For initial failure to rise, use Plum Blossom (1 liang) as chief, add Peach Blossom (1 qian), Tianlinggai (5 fen). For Qi/Blood deficiency, gray-white, use Placenta Humana (1 liang) as chief, add Tianlinggai (1 qian), Deer Antler (1.5 qian), Plum Blossom (1 qian), Peach Blossom (1 qian or 8 fen). For black sunken non-rising, use Pangolin Scales (1 liang) as chief, add Peach Blossom (1 qian), Plum Blossom (8 fen), Tianlinggai (7 fen), Moschus (5 fen). For Qi/Blood deficiency failing to fill with pus, use Deer Antler (1 liang) as chief, add Placenta Humana (2 qian), Peach Blossom (1 qian), Plum Blossom (8 fen), Tianlinggai (7 fen), Moschus (5 fen), Ginseng (1 qian). For Qi/Blood deficiency failing to scab, use Deer Antler (1 liang) as chief, Tianlinggai (5 fen), Peach Blossom (7 fen), Plum Blossom (9 fen). After scab falling, white scars, Qi/Blood deficiency, use Ginseng (1 liang) as chief, add Placenta Humana (2 qian), Deer Antler (1 qian), Plum Blossom (1.5 qian). Follow the first dosage method for all.

Baosheng San
Placenta Humana (prepared as above), Tortoise Plastron (butter-fried, 1 fen), Deer Antler (butter-fried, 1 liang each).
Powder. Dose according to child's size. For Blood deficiency, take with Angelicae Sinensis, Poria, Lithospermi decoction. For Qi deficiency, take with Ginseng, Astragali, Glycyrrhizae decoction.