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Qian Yi discussed the treatment of smallpox, stating that both diaphoresis (inducing sweating to release the exterior) and purgation (draining downward to clear the interior) should not be used recklessly. He further stated: "If there is no slight sweating, the exterior pathogen cannot be resolved; if there is no slight purgation, the interior pathogen cannot be resolved." This refers to the situation where the exterior heat is intense before the smallpox spots appear. If the patient has contracted cold pathogenic factors externally, constricting the cou li (skin pores and interstices), the smallpox will fail to emerge quickly. In this case, one should employ slight diaphoresis to harmonize Ying and Wei (nutritive and defensive qi), allowing the smallpox to emerge easily and the toxin to resolve. However, if there was no exterior obstruction or difficulty in emergence, and one recklessly induces sweating, it will lead to complications such as deficiency of the exterior, itching, collapse of lesions, and ulceration.

When the smallpox is emerging, if symptoms such as irritability, fever, delirium, wheezing, abdominal distension, and constipation occur, this indicates that the toxin is accumulated between the zang-fu organs, specifically the intestines and stomach. One should employ slight purgation. As long as the zang-fu organs are unobstructed, old stagnation is cleared away, and qi and blood return to harmony, the toxin can easily rise and manifest through the eruption. Conversely, if there is no interior excess or heat accumulation, and one recklessly uses purgation, it will cause the Yuan Qi (original qi) to sink, leading to critical conditions characterized by grayish-white lesions and deficiency collapse. Zhang Hangao stated: "In treating conditions of blood heat, toxin congestion, and constipation, I always use Liang Ge San (Cool the Diaphragm Powder) for purgation, with a success rate of nearly 100%."

Someone asked: "What is the relationship between the prevalence of seasonal epidemic qi and the severity of smallpox?" Generally, the emergence of smallpox relies on Tian Xing Shi Qi (seasonal epidemic climate factors) to develop. Seasonal epidemic qi varies in its intensity (prosperous vs. declining), and human congenital endowment varies in strength (strong vs. weak). When epidemic qi is prevalent, even mild cases can become severe; if a person with weak endowment encounters this, it will inevitably lead to danger. When malignant qi declines, even severe cases can become mild; if a person with strong endowment encounters this, the condition appears even lighter. Therefore, children from poor families, who endure hardships and exposure to wind and cold, and do not consume rich foods that damage the spleen, can withstand even severe conditions. In contrast, children from wealthy families, who wear warm clothes, consume rich diets, lack exposure to wind and sunlight, have fragile spleens and stomachs, and are unused to labor, may turn minor illnesses into major diseases. This is like plants growing in shady places; how can they withstand frost and scorching sun? Thus, in clinical practice, must one not distinguish the strength and social status of the patient, and consider the prevalence of seasonal qi, to determine the treatment strategy?

There are cases of smallpox patients dying and then reviving. This is not due to the separation of qi and blood, but rather because the toxin-fire is excessively intense, causing qi and blood to stagnate and cease flowing, resulting in cold limbs and apparent cessation of breath. However, this is not true death; although breath seems absent, life force remains connected. When the toxin-fire temporarily subsides slightly, the righteous qi gradually recovers, leading to revival. I have seen children with smallpox who appeared dead, lying on the ground, only to revive after a long while. This is attributed to receiving the energy of the earth (contact with the ground) to transform toxin-heat, thereby restoring righteous qi. However, even in cases of apparent death due to qi cessation, the chest and heart region must remain warm. There has never been a case of revival where the chest was cold upon apparent death.