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During the stage when smallpox pustules are filling with pus, the patient exhibits mental fatigue and lassitude, mental confusion and lethargy, loss of consciousness, unresponsiveness to calls, muttering to oneself, resembling a state of possession by evil spirits. This is due to excessive eruption of the smallpox, resulting in emptiness of the Heart, where the Shen (Spirit) lacks a foundation. Ren Shen Suan Zao Tang (Ginseng and Sour Jujube Seed Decoction) should be used. For Qi deficiency, a large dose of Du Shen Tang (Single Ginseng Decoction) or Bao Yuan Tang (Protect the Origin Decoction) added with Suan Zao Ren (Sour Jujube Seed) and Fu Shen (Poria with Hostwood) is indicated. If there is irritability, high fever, vigorous breathing, and profuse phlegm-saliva, Ding Qing Xin Wan (Fixed Clear Heart Pill) should be substituted. If after taking medicine the patient becomes restless and instead experiences increased oppression and chaos, death ensues. If the pus is clear but the patient cannot eat, it is incurable.

Excessive sweating in smallpox leads to the external leakage of Body Fluids. Whether before the pustules form or after they have crusted over, Bao Yuan Tang (Protect the Origin Decoction) added with Blood-nourishing herbs is appropriate. However, if there is facial flushing, thirst, and sweating only reaching below the waist, this indicates Stomach Heat and Kidney Deficiency. Si Jun Zi Tang (Four Gentlemen Decoction) with Bai Zhu (Atractylodis Rhizoma) removed and replaced by Mai Dong (Ophiopogonis Radix), combined with Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill), should be administered. If there is facial flushing, thirst, heat in the palms and soles, and hard stool, this is Excess Heat in the Intestines and Stomach; Xie Huang San (Drain Yellow Powder) is indicated. If spontaneous sweating occurs during the initial fever at the onset of the disease, it is acceptable, as it results from Damp-Heat steaming. One must not hastily use Cang Zhu (Atractylodis Rhizoma) or Bai Zhu (Atractylodis Rhizoma) to consolidate the Cou Li (interstitial spaces), nor recklessly use Sheng Ma (Cimicifugae Rhizoma) or Ge Gen (Puerariae Lobatae Radix) to disperse muscle-layer pathogens. Since spontaneous sweating indicates that the smallpox heat has already subsided, one must fear that excessive sweating will consume internal Body Fluids, causing Yin to dissipate with Yang, making it difficult for the lesions to crust over. Even spontaneous sweating after crusting requires careful examination and treatment. If spontaneous sweating is due to Blood deficiency, there will be night-time irritability and thirst; Dang Gui Bu Xue Tang (Angelica Sinensis and Astragalus Decoction) is indicated. If sweating is due to Qi deficiency failing to secure the exterior, symptoms include panting upon movement, weak strength, body heat, and cold limbs; Si Jun Zi Tang (Four Gentlemen Decoction) added with Dang Gui (Angelicae Sinensis Radix) and Huang Qi (Astragali Radix) is used. If the eruptions are flat, pale, lacking spirit, with a cool body and sweating, Bao Yuan Tang (Protect the Origin Decoction) added with Rou Gui (Cinnamomi Cortex) and Dang Gui (Angelicae Sinensis Radix) is indicated. If a patient sweats excessively despite being in heavy curtains, on a warm kang, wearing thick clothes and heavy quilts, the bedding and clothing should be gradually reduced to achieve comfort and clarity.

Hemorrhage in smallpox/rash diseases is always a critical condition. If hemorrhage occurs due to robust Qi and Blood and intense toxic fire, it signifies that the pathogen is resolving through the blood; hemostatic agents should not be used blindly. Instead, clearing the blood and detoxifying is appropriate. If treatment fails to stop the bleeding, the prognosis is ominous. If hemorrhage occurs due to deficient Qi and Blood combined with intense toxicity, it is incurable. If "stifling smallpox" (internalized eruptions) causes bleeding from the five orifices, it is incurable. If inverted smallpox causes bloody fluid to flow from the nose, it is incurable. If hemorrhage results from misapplying hot formulas to a Heat syndrome, cooling and detoxifying methods should be used. If cold-natured drugs were used while the eruptions had not fully emerged, the toxin was shocked by the cold, damaging the Spleen and Stomach, preventing them from moving the blood. This causes blood to rebel within the Zang-Fu organs, with internal toxins stagnating in the chest and diaphragm, accumulating into foul blood that flows recklessly, causing sudden hematemesis, epistaxis, and syncope. For pale, white, depressed, and sunken eruptions, Li Zhong Tang (Regulate the Middle Decoction) and Du Shen Tang (Single Ginseng Decoction) added with Rou Gui (Cinnamomi Cortex) are used, focusing on warming and tonifying. This illustrates the principle of "tonifying Qi in cases of Blood depletion," where Yang generation promotes Yin growth. If the tips of the eruptions open showing purple stagnation accompanied by epistaxis, this is Toxic Fire punishing Metal (Lung); Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) added with stir-fried black Shan Zhi (Gardeniae Fructus) is indicated. If residual toxins attack the Spleen after crusting, injuring Spleen Qi and impairing its ability to control blood, causing epistaxis, a small dose of Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) added with stir-fried black Lian (Coptidis Rhizome) and Shao Yao (Paeoniae Radix) is used. If there is restlessness, heat, oppression, chaos, severe dry mouth and thirst, epistaxis, and heat in both hands and feet, Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) with Dan Pi (Moutan Cortex) removed, and added with Huang Lian (Coptidis Rhizome), Shan Zhi (Gardeniae Fructus), and Pao Jiang (Zingiberis Rhizoma Preparatum) is indicated. There are also cases of mid-Qi deficiency causing intermittent paroxysmal heat, alternating cold and heat in the extremities, and epistaxis; this indicates that Clear Yang Qi fails to ascend, and rootless fire comes and goes suddenly. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shao Yao (Paeoniae Radix) and Rou Gui (Cinnamomi Cortex) is used. If intense toxicity causes obstruction and stifling, constraining Lung Metal, leading to flow into the Large Intestine and causing hematochezia, Si Wu Tang (Four Substances Decoction) with Shu Di Huang (Rehmanniae Radix Preparata) replaced by Sheng Di Huang (Rehmanniae Radix), and added with Huang Qin (Scutellariae Radix) and Huang Lian (Coptidis Rhizome) is indicated. If lower bleeding continues without stopping and the patient falls into a deep sleep from which they cannot be awakened, the condition is critical. Among all hemorrhages in smallpox, only those originating from the nose are treatable; those from the mouth or both mouth and nose simultaneously are mostly incurable. Some bleed directly from the pusticles, termed "Zou Xie" (leaking pathogen). Severe leaking leads to emptiness in the intermuscular spaces, leaving the toxin without a fixed location. These are all invasions of the interior and are difficult to treat.