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In the treatment of smallpox and measles, observation is paramount. When the spots first appear, use a paper wick dipped in clear oil for illumination to observe their color comprehensively and examine their shape carefully. The light should be held inward and shone outward horizontally so that spots hidden within the muscles are fully revealed. Rubbing the cheeks: if the redness turns white upon rubbing and returns to red when released, this is called "active blood" (Xue Huo), indicating vitality. If it does not turn white upon rubbing nor red upon release, this is called "withered blood" (Xue Ku); even with skilled treatment, it is difficult to cure.

Furthermore, observe whether the eyes have luster and whether the tip of the lips is ruddy as usual, without signs of dryness, pallor, or purple stagnation; these are auspicious omens. One must also note that under lamplight, the appearance is reddish, while under paper windows, it appears whitish; this distinction requires careful scrutiny. Ancient physicians assessed smallpox by four aspects: Root (Gen), Nest (Ke), Foot (Jiao), and Ground (Di). The Root should be active, the Nest raised, the Foot firm, and the Ground broad. If all four are favorable, there is no cause for worry even if the spots are dense. Modern methods often only mention the Plate (Pan) and Top (Ding). The Plate corresponds to the Root, and the Top to the Nest. The Foot and Ground depend on the roundness and fullness of the Root and Nest, as well as the density of the spots. When the top rises and the plate sinks deeply, with red halos penetrating into the flesh, it is considered true smallpox (Zheng Dou). If there is no plate or top, and the redness floats on the skin surface, it is water pox (Shui Dou), not true smallpox. Otherwise, it is likely due to Qi deficiency and intense toxin. Although it may grow initially, later the pus will be thin and the base wide; by the 10th or 11th day, itching and collapse will occur, leading to death. If the root and foot are scattered without a red halo, convergence will be difficult, and changes will likely occur by the 12th or 13th day.

Generally, one must distinguish the abundance or deficiency of Qi and Blood, and the severity of form and color. Form belongs to Qi, and color belongs to Blood; thus, form and color are the foundation of Qi and Blood and are most critical. Initially, focus on whether the root and foot are tight; tightness concentrates heat, facilitating growth and filling. After filling, focus on whether the root and foot soften; softening resolves toxins, facilitating scabbing and shedding.

If fever lasts three to four days, followed by cooling before eruption, with initial pale red spots that align over three to four days, appearing bright, distinct like pearls, varying in size like millet grains, and rough to touch, becoming glossy by the fourth or fifth day with ruddy roots and nests, erupting in two or three waves, sparse on the head, face, chest, abdomen, back, and neck, with normal urination and defecation, this is auspicious. If eruption occurs immediately upon fever with dense spots, carefully inspect whether the roots/nests are separated or confluent, and whether the color is ruddy or dull. If some spots appear early, large, empty, and yellow like gold, they are named "Thief Pox" (Ze Dou); large black ones are "Pox Carbuncles" (Dou Ding). If the initial spots are cyan, stick-head sized, and non-elevated, this is "Cold Carbuncle" (Leng Ding). If roots/nests are separated and ruddy, but some tops within a plate contain black carbuncles, puncture them with a silver needle, rinse with fresh water, suck out foul blood, and fill the wound with Zicao Gao (Arnebia Ointment), You Yanzhi (Oil Carmine), Xueyu Hui (Burnt Hair Ash), and Zhenzhu Mo (Pearl Powder). Alternatively, use Zhenzhu San (Pearl Powder) combined with Sanxian San (Three Immortals Powder), or Xijiao Xiaodu Yin (Rhinoceros Horn Detoxification Decoction) plus Zihua Diding (Viola Yedoensis) to resolve toxins. If pain persists after puncture, apply moxibustion through garlic. If there are no roots/nests, the color is purple-black, and there are many carbuncles, especially in weak patients, it is untreatable.

If the face is uniformly glossy, resembling applied rouge, faintly visible under the skin, this indicates stagnant blood flow, congealed Qi movement, and obstruction by phlegm. First, induce severe vomiting using Shengjun Tang (Ascend Equal Decoction) to expel phlegm, then use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) removing Danpi (Moutan Cortex), adding Mutong (Akebia Caulis), Zicao (Arnebiae Radix et Rhizoma), Chantui (Cicada Slough), and Lianqiao (Forsythiae Fructus). However, if the malar areas are clustered with indistinct red halos, urgently administer Lingyang Jiedu Tang (Antelope Horn Detoxification Decoction) to disperse it. If roots/nests are separated but the body is hot, dry, and purple, restlessness will follow; use Daochi San (Guide Out Red Powder) to promote urination, along with cooling-blood and detoxifying herbs, adding Shao Renshi (Burnt Human Feces) 1 qian. Delay leads to blackening and danger. If the body is not hot but dry and scorched, it is still heat; use Daochi San. If ruddy but too tender, Qi Yuan is insufficient, and toxin has entered the Qi level; use Baoyuan Tang (Preserve Origin Decoction) plus Lianqiao and Rendongying (Honeysuckle Flower). If pale and loose-skinned, Qi Yuan is severely deficient; use Shen Neituo San (Ginseng Internal Support Powder). If elevated and red but dry and thirsty, Fire is excessive and Blood is scant; use Siwu Tang (Four Substances Decoction) replacing Shudi with Shengdi, plus Jingjie, Zicao, Lianqiao, and Mutong. Strictly avoid Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala Rhizome). If accompanied by dampness, Spleen/Stomach Qi is weak; use Sijunzi Tang (Four Gentlemen Decoction) plus Cangzhu, Jingjie, Fangfeng, and Chuanxiong. Avoid Huanglian (Coptidis Rhizoma). If glossy but collapses upon pressure, Qi is insufficient; use large doses of Shen Neituo San or Baoyuan Tang. If color resembles bran with no moisture, both Qi and Blood are deficient; urgently use Shiquan Dabu Tang (Ten Complete Tonifying Decoction) plus Shao Renshi. Recovery is possible if it becomes ruddy and moist; otherwise, it is critical. All the above involve itching and collapse, representing dangerous conditions.

If fine spots like mustard seeds appear all over, it is Measles Complication (Jia Zhen). If bright red patches appear on the skin, it is Purpura Complication (Jia Ban). Both result from excessive toxin-fire erupting together; treat with Huaban Tang (Transform Purpura Decoction). Add Shigao (Gypsum Fibrosum) if heat is severe. If initial spots cluster under the skin without emerging, it is either Wind-Cold obstruction or Qi deficiency failing to rise. Wind-Cold obstruction presents with agitation and dull complexion; use Qianghuo Tang (Notopterygii Rhizoma Decoction) plus Shengma and Gegen. Qi deficiency presents with weak pulse and pale complexion; use Baoyuan Tang plus Chuanxiong and Guizhi. If eruption occurs with cool body but dry mouth/thirst, internal Heat-Toxin is strong; spots will be dense and heavy. Urgently resolve internal heat-toxin; avoid Shengma (Cimicifugae Rhizoma). Itching during early eruption indicates Wind-Cold stagnating in the skin; use Jiedu Yinzi (Detoxification Infusion) plus Chuanshanjia (Manis Squama). Eruption that is faint, non-elevated, accompanied by mania, abdominal distension, and dysuria indicates Toxin-Fire郁结 (stagnating) in the Yangming Meridian; use Liangge San (Cool Diaphragm Powder) to purge. If originally distinct spots become dry, scorched, purple-black, with cold limbs and hidden pulse, it is due to dietary injury causing failure to transform, leading to Qi/Blood stagnation; palpate the chest/abdomen for heat. Use Zhishi Zhizi Chi Tang (Immature Bitter Orange, Gardenia, and Fermented Soybean Decoction) plus Dahuang (Rhei Radix et Rhizoma). Pain throughout the body when half-erupted indicates lingering Heat-Toxin stagnation; use Jingfang Jiedu Yin (Jingjie and Fangfeng Detoxification Infusion). Pain caused by Six Excesses should be adjusted according to seasonal climate. High fever, thirst, phlegm, wheezing, and constipation indicate excess heat in Lung/Stommer meridians; use Liangge San plus Qianhu and Zhike. Restlessness and high fever with red color during incomplete eruption, worsening with cooling agents, indicates toxin coagulation due to cold; continue previous formula with slight addition of acrid-warm herbs to open. While eruption is incomplete and toxin remains inside, avoid extreme cold or hot formulas; cold coagulates toxin, heat aids fire. Use mild, dispersing, and penetrating herbs, adjusting for exterior/interior, deficiency/excess, cold/heat.

Dysentery with red and white stool during incomplete eruption indicates Blood-Heat-Toxin excess with food stagnation; use Huangqin Tang (Scutellaria Decoction) removing Zao (Jujubae Fructus), adding Zhaxiao (Crataegi Fructus), Xiebai (Allii Macrostemonis Bulbus), and Fangfeng. If spots are faint, pale, and white, only Baoyuan Tang plus Guizhi and Fuzi can save. Trembling of hands and feet during eruption indicates Pulse failing to constrain toxin, a sign of Heat generating Wind; use Jingfang Jiedu Yin plus Quanxie (Scorpio). Head and facial swelling during incomplete eruption indicates Wind-Heat attacking upward; use Jiedu Yinzi. Red, swollen, dry-red eyes with constipation and restless sleep during eruption indicate unresolved Blood-Heat-Toxin attacking the eyes; use Xijiao Dihuang Tang removing Danpi, adding Lianqiao, Heishen (Polygonati Odorati Rhizoma), Niubangzi (Arctii Fructus), and Jingjie. If fever was mild before spotting but becomes unceasingly high after, with agitation, drowsiness, constipation, or vomiting/diarrhea, it is a reverse syndrome (Ni Zheng). Fever with cold limbs during the swelling phase indicates postnatal Spleen/Stomach weakness; curling up without extending indicates prenatal Kidney Qi deficiency; both are untreatable.

Early blisters drying up within two to three days with white pus caps indicate severe Fire-Toxin; untreatable. Dense, flat spots resembling silkworm eggs, fat silkworms, or congealed porridge, or large flat/small dense spots with thin soft skin, looking invisible obliquely, with eyelid/facial/lip swelling, lead to hemorrhage and death by day 5-7. Skin resembling goosebumps from cold wind, rash-like, intermittent, leads to crying and death before full growth. Swelling/hardness of face/chest/back/extremities, purple-black lumps, or dark sunken ulcers are critical. Red/purple/black spots like flea bites or mosquito marks, flat with skin, uniform rouge-like face, lead to death within 3-5 days.