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(Whenever sores or rashes erupt during autumn and winter, it is considered a "reverse" condition, as this corresponds to the time of pure Yin.)

Coldness in the lower legs and shins, abdominal distension due to deficiency, green-colored stool, pale complexion, vomiting of milk and food, bluish-green eyes, and a deep and faint pulse.
For the above seven signs, cold-natured medicines should not be administered.

When smallpox lesions are erupting vigorously, if there is cold reversal of the four limbs or spontaneous diarrhea, the pathogen is in the Taiyin Spleen Meridian; urgent warming is required. Use Yigong San (for slow eruption), Fuzi Lizhong Tang, or Tiaozhong Wan (for diarrhea). If the smallpox lesions are flat and collapsed with a grayish-white lusterless appearance, this indicates insufficiency of righteous Qi; Shibu Tuoli San should be used, doubling the dosage of Huangqi and adding Shu Fuzi. If there is cold reversal of the four limbs accompanied by occasional convulsions, the pathogen is in the Jueyin; warming is indicated using Yigong San (for slow eruption) added with Fangfeng and Qingpi, or Baizhu San (for thirst) with Gan Ge and Huoxiang removed, and Fuzi and Rougui added.

In smallpox syndromes, there are cases of Yang excess with Yin deficiency, and cases of Yin excess with Yang deficiency. Those with Yang excess drink ice and snow without feeling cold; those with Yin excess drink boiling water without feeling heat. Any case presenting with fever and thirst, cold reversal of the hands and feet, spontaneous diarrhea, and a preference for drinking hot soup belongs to Yin excess with Yang deficiency. Xue uses Da Yigong San (for slow eruption) and Bawei Wan to treat it. If there is fever and thirst, but with constipation, hot hands and feet, and a preference for drinking cold water, this belongs to Yang excess with Yin deficiency. Xue uses Sishun Yin (for heat) and Dihuang Wan (tonifying Kidney) to treat it. If there is vexatious heat and thirst, with a red face and white sclera, this is deficient heat in the Kidney Meridian; Dihuang Wan or similar formulas are also appropriate. Chen Wenzhong treated Yin excess with Yang deficiency using Da Yigong San added with Muxiang and Danggui to tonify Yang, which was correct. However, for Yang excess with Yin deficiency, he used Muxiang San added with Dingxiang and Guanzi Gui to tonify Yin; is this not treating fire with fire? This is why Chen’s prescriptions were regarded as one-sided methods and ridiculed by earlier philosophers. Scholars who fail to examine this carefully and misuse them—how can one count the premature deaths caused?

If voice remains present after sores and rashes have erupted, it means the form is diseased but the Qi is not diseased. For those with warm bodies, Jiedu Fangfeng Tang (general principle) is suitable; for those with constipation, Danggui Wan (for constipation) is suitable. If voice is absent before sores and rashes erupt, it means the form is not diseased but the Qi is diseased; Bufei San (for loss of voice) added with Sheng Huangqi is suitable. If sores and rashes have erupted but voice is absent, this indicates that both form and Qi are diseased. For children with inherently weak congenital endowment, Shiqi San (i.e., Shixuan San, see the section on rising) should be taken in advance, doubling the dosage of Danggui and Xiong, with a small amount of Muxiang, decocted and taken orally. (Some say Shibu San or Da Yigong San is suitable; others state that when both form and Qi are diseased, the Lung should be cleared, using Bafeng Tang or Liangge San with Xiaoshi and Huanglian removed.)