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Cough, expectoration of phlegm, and wheezing (asthma-like breathing), although belonging to Lung heat (Lung heat), also occur due to Qi deficiency causing the Couli (pores and interstices) to be insecure, allowing Wind pathogen to invade the Lung, resulting in cough with expectoration of thin sputum. Can use Shen Su Yin (Ginseng and Perilla Decoction). Headache, fever, nasal congestion, wheezing, and cough are caused by Cold-Wind (Cold-Wind). Can use Xiong Su San (Ligusticum and Perilla Powder). If cough persists without exterior syndrome (exterior syndrome), this is Lung deficiency being attacked by smallpox toxin. Can use Bu Fei Tang (Tonify Lung Decoction). Wheezing, abdominal distension, and constipation indicate Lung heat. Can use Huang Qin Xie Fei Tang (Scutellaria Decoct to Drain the Lung). If fluids cause immediate coughing and vomiting upon entry, it indicates sticky and solidified Phlegm-Heat in the Lung and Stomach. First use Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) added with Cong Bai (Scallion White) and Jie Geng (Platycodon Root) to induce vomiting, then take Ru Sheng Yin (Like Sage Drink). Pale complexion, cold hands and feet, and rapid wheezing indicate Deficient-Cold (Deficient-Cold). Can use Bai Zhu San (Atractylodes Macrocephala Powder). There are also cases where pustules exist in the Lung orifice, causing itching and a sensation of obstruction in the airway leading to cough; this resolves spontaneously when the pustules recede. Cases of wheezing without cough: if sneezing, runny clear nose, and wheezing occur at the initial eruption of pustules, it is Cold-Wind lodging in the Lung. Can use Shen Su Yin. Dry-red pustules accompanied by abdominal distension, constipation, and wheezing indicate excessive toxin and stagnant Qi. Clearing Heat (Clearing Heat) and detoxifying (Detoxification) should be employed. When Qi deficiency fails to expel pathogens outward, toxin lingers internally causing wheezing and abdominal distension, this is Men Dou (Trapped Smallpox Syndrome), which is difficult to treat. Wheezing after diarrhea indicates Spleen Qi sinking, defying Fire rising, and failure of lower Qi to continue. Can use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Wheezing after vomiting indicates Stomach deficiency failing to control Ministerial Fire (Ministerial Fire). Can use Liu Jun Zi Tang (Six Gentlemen Decoction). On the fourth or fifth day of smallpox, if lesions sink inward with wheezing and abdominal distension, they must be re-invigorated for eruption; recovery is possible if they rise again. If pustules are half-filled but invert (invert) with wheezing and abdominal distension, tonification combined with invigoration for eruption is suitable; swelling and suppuration are auspicious signs. Abdominal distension and wheezing caused by erroneous administration of Ginseng (Ren Shen) can be treated with Zhi Ke Tang (Immature Bitter Orange Decoction). Nasal congestion due to dense pustules, with rapid breathing resembling wheezing, is not true wheezing; treating it as such is an error.

Smallpox should present with thick and sticky nasal discharge and saliva, facilitating the evaporation of Heat-Toxin (Heat-Toxin). If discharge is thick and sticky, accompanied by fever, nasal congestion, normal stool, and yellow-red urine, modify Xiong Su San (Ligusticum and Perilla Powder). If there is abundant phlegm, high fever, chest oppression, hard stool, and urgent wheezing when lying down, slightly purge with Qian Hu Zhi Ke Tang (Peucedanum and Immature Bitter Orange Decoction) to preserve Yuan Qi (Primary Qi) and facilitate smallpox eruption.