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Whenever the smallpox lesions are grayish-white, not red or vibrant, do not elevate or spread out, erupt slowly, appear dull with depressed tops, these all indicate exterior cold and deficiency. Clear urine and stool, cool body temperature, cold hands, feet, and breath, absence of thirst, reduced appetite, white lips, clear nasal discharge, and indigestion all indicate interior deficiency and cold. This is a syndrome of exterior and interior deficiency-cold. It is urgent to warm the spleen and stomach and tonify qi and blood. One should use herbs such as Renshen (Ginseng Radix), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Muxiang (Aucklandiae Radix), and Rougui (Cinnamomi Cortex) to assist in filling the pustules and forming scabs. For exterior deficiency, tonifying qi is primary, while tonifying blood is secondary. For interior deficiency, one must combine qi tonification within blood tonification, ensuring the stomach qi flows smoothly and spleen qi becomes robust, thereby avoiding the worry of toxin collapse later on. If qi is tonified, blood will also circulate freely, expelling toxins completely without stagnation, thus avoiding itching and collapsing lesions later. Whenever the lesions are red-purple, dry and stagnant, or black and depressed with scorched appearance, these all indicate exterior heat and excess. Constipation, dark and scanty urine, fever, dry nose, dry lips, and irritability with thirst all indicate interior heat and excess. This is a syndrome of exterior and interior excess-heat. It is urgent to cool the blood and resolve toxicity. One should use herbs such as Zicao (Arnebiae Radix seu Rhizoma), Honghua (Carthami Flos), Lianqiao (Forsythiae Fructus), Niuniangzi (Arctii Fructus), Mutong (Akebiae Caulis), Chantui (Cicadae Periostracum), and Jingjie (Schizonepetae Herba). In severe cases, herbs like Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) may be used. If it is exterior heat, cooling and resolving the exterior is appropriate, followed by promoting urination. If it is interior heat, the focus is on resolving toxicity combined with cooling. If before the second or third day, heat-toxin is vigorous, mild purgation using Dahuang (Rhei Radix et Rhizoma) and Mangxiao (Natrii Sulfas) can be applied. Cooling blood prevents dryness and purple discoloration; resolving toxicity prevents black depression. If exterior deficiency is not tonified, external ulceration occurs; if interior deficiency is not tonified, internal attack by toxins occurs. Over-tonification in exterior excess leads to failure to form scabs; over-tonification in interior excess leads to carbuncles and sores. Therefore, the changes in smallpox are unpredictable. If the color changes, treatment must be adjusted accordingly; one cannot adhere rigidly to fixed rules.

Qi has the function of generating blood, but blood does not have the function of benefiting qi. Therefore, qi must not be deficient; if deficient, yang fails to reach the surface, and the round halo shape of the lesion cannot form. Blood must not be excessive; if excessive, yin invades yang positions, leading immediately to the disaster of inverted lesions (collapsing pustules). Thus, when treating deficiency syndromes, tonifying qi must come first. Qi possesses spirit but no fixed form, making it easy to fill through tonification. Blood has form but lacks spirit, making rapid effects difficult to achieve through nourishment. Moreover, qi is yang and blood is yin; yin follows yang, and blood follows qi, which is the principle. Therefore, tonifying qi without tonifying blood allows qi to become vigorous and full, and blood will follow suit and become abundant. What constitutes qi and blood deficiency and excess? For instance, if qi is too hot, blisters form; if blood is too hot, macules appear. If qi is insufficient, the top of the lesion is depressed and does not rise; if blood is insufficient, pus and toxins do not adhere. Whenever the lesion color is pale white, the top is not firm, feels smooth to touch, and does not swell, these belong to qi deficiency. Baoyuan Tang (Preserve Origin Decoction) with doubled Huangqi (Astragali Radix), added with Rougui (Cinnamomi Cortex) and Dingxiang (Eugeniae Flos), taken with human milk and fermented rice wine, is suitable. If the base of the lesion is not red or tightly bound, or is red but scattered and broad, turning white upon touch, with erect hairs, appearing withered and lifeless, these belong to blood deficiency. Baoyuan Tang added with Xiong (Chuanxiong Rhizome), Danggui (Angelicae Sinensis Radix), Honghua (Carthami Flos), and Shanzha (Crataegi Fructus) to move the stagnation caused by Renshen and Huangqi, along with Muxiang (Aucklandiae Radix) to disperse stagnant qi, will make the blood flow naturally. Whenever using Huangqi (Astragali Radix), it should be after the smallpox has fully erupted. Whenever using hot-natured medicines, one should wait until the toxins are completely resolved, then examine the deficiency and excess of qi and blood to treat accordingly; then the medicine will be effective. Whenever tonifying blood, Dihuang (Rehmanniae Radix) should be used at the beginning and end. To prevent blood stasis, Jiangzhi (Ginger-processed) forms are necessary. Using Shaoyao (Paeoniae Radix) is feared for its sour-cold nature damaging the stomach; therefore, Jiuchao (Wine-fried) Shaoyao must be used to suppress its moistening and downward-draining properties, borrowing the power of wine to direct the action to the exterior.