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The disease of smallpox and measles (Douzhen), although originating from the beginning of life, must occur due to contact with seasonal pathogens (Shiqi) and the combination of internal and external pathogenic factors. The severity of smallpox is already indicated by the mildness or severity of fever, and prognosis can be judged accordingly. When the toxin is light, eruption and crusting are easy, so treatment is not strictly necessary; when the toxin is severe, various dangerous syndromes emerge, necessitating treatment. In treating this condition, during the initial fever stage, it is urgent to use light and ascending/dispersing agents to induce sweating and disperse the pathogen. If external pathogens and internal organ toxins can all be excreted as foul sweat through the hair follicles, the toxin load will be reduced by half, turning severe cases into mild ones and critical cases into survivable ones. All complications in smallpox are essentially caused by the toxin's inability to erupt. Once dispersed via the surface, the toxin leaves with sweat, and symptoms subside. However, one must assess the severity of exterior versus interior conditions: some require exterior resolution, some interior clearing, and some support of Yuan Qi (Primal Qi). One cannot adhere rigidly to a single method. As Hu stated: "When exterior heat is congested and excessive, only slight sweating resolves it; when interior heat is congested and excessive, only slight purgation resolves it." Missing this window allows the toxin to intensify, leading to adverse syndromes.

1. Methods for dispersing the exterior must consider the depth of the pathogen and the intensity of the toxin. If the exterior pathogen is severe but treated with mild dispersion, the exterior will not resolve, yielding no benefit. If the exterior pathogen is mild but treated with profuse sweating, Wei Qi (Defensive Qi) will be depleted, preventing eruption and causing great harm. Therefore, moderation is key, aiming for slight sweating without excessively damaging Wei Qi. In cases of persistent high fever, closed pores, or cold weather, vigorous dispersion may be necessary. If one attempt fails, repeat until fever subsides with sweat, resolving the toxin. This requires flexibility. Smallpox fears cold internally and externally; maintaining warmth ensures pores remain slightly moist and open, similar to a steamer, allowing Qi to reach the skin, facilitating easy eruption and recovery.

2. During the fever phase of smallpox, alternating hot and cold sensations are normal. Continuous burning heat day and night is abnormal and requires assessment of exterior/interior status for appropriate treatment.

3. At the onset of fever, if there are no deficiency-cold signs, warm-tonifying herbs should not be used abruptly to avoid aiding fire and stirring up toxin. Conversely, if there are no excess-fire or high-heat signs, cold-cooling herbs should not be used merely because of fever, as this damages the Spleen, causing diarrhea, which is even more harmful. This is a common medical error that must be avoided.

4. After dispersing the exterior, one must strictly avoid wind and cold. Re-infection closes the pores, reigniting heat-toxin, making repeated sweating unbearable. Raw/cold foods and fruits must also be avoided to prevent Cold-Dampness from injuring the Spleen, leading to diarrhea and anorexia.

5. For initial fever resembling Taiyang disease (Cold Damage) where smallpox is uncertain, use diaphoretic methods first. To disperse exterior pathogens while regulating Ying Qi (Nutritive Qi), Chai Gui Yin (Bupleurum and Angelica Decoction) is preferred, except for those with loose stools due to its lubricating nature. Alternatives include Su Ge Tang (Perilla and Kudzu Decoction) or Shengma Gegen Tang (Cimicifugae Rhizoma and Puerariae Radix Decoction), or Jiachen Rensu Yin (Modified Ginseng and Perilla Decoction). In winter or for robust constitutions requiring stronger dispersion, add Ephedrae Herba (Mahuang) to induce a heavy sweat, cooling the body and reducing severity. If initial fever presents with aversion to cold and tremors resembling malaria, indicating Yang Qi deficiency, use Chaige Guizhi Tang (Bupleurum, Kudzu, and Cinnamon Twig Decoction) plus Astragali Radix (Huangqi). Recovery follows eruption.

6. Clearing and resolving agents treat both exterior and interior simultaneously. Severe heat implies severe toxin. If fever persists despite sweating, accompanied by irritability and thirst, it indicates internal fire steaming both interior and exterior; use Qiaoshao Shengma Tang (Forsythiae Fructus and Cimicifugae Rhizoma Decoction) or Rusheng Tang. If the body is hot to the touch, eyes are red, mouth dry, and bowels/bladder are obstructed with heat, indicating fullness in both exterior and interior, use Chaihu Yinzi (Bupleuri Decoction). For severe cases, Da Lianqiao Yin (Large Forsythia Decoction) or Shuangjie San (Double Resolution Powder), or Yi Yuan San (Benefit Primordial Powder) mixed for purgation.

7. Once exterior sweat has been achieved, do not sweat again, to prevent loss of Yang Qi and injury to interior Zheng Qi (Upright Qi).

8. Abdominal pain and distension during fever indicate exterior pathogen combined with toxin failing to exit. Use Rensu Yin (Ginseng and Perilla Decoction) plus Amomi Fructus (Sharen) to warm and disperse.

9. Initial fever with convulsions and delirium is called "Dou Chu" (Smallpox Convulsion). Mild, self-limiting cases need no treatment. For strong constitution with severe convulsions, use Qianghuo San (Notopterygii Rhizoma Decoction) processed with Cinnabaris (Zhusha) to release the exterior. For copious phlegm-saliva and throat sounds, use Lie Shengjiang Tang (Strong Ginger Decoction) with Huatan Wan (Phlegm-Resolving Pill) or Baolong Wan.

10. Thirst for tea/water at this stage should be satisfied sparingly with Congbai Tang (Scallion White Decoction), which quenches thirst and disperses the exterior.

11. Diarrhea is feared throughout the course of smallpox. Treat promptly to avoid internal collapse and sinking, which are catastrophic.

Xu stated: Exterior-resolving medicines must be used before red spots appear. For severe heat/toxin, use Baidu San (Toxin-Overcoming Powder) or Rensu Yin, taken with Sansu Bing (Three-Su Biscuit).

Zhang Jizhi stated: Once red spots appear, Shengma Gegen Tang should not be used, fearing it causes exterior deficiency. Cheng Chenfeng stated: Do not lightly use Cimicifugae Rhizoma (Shengma) in smallpox treatment, fearing it lifts Qi upward and disturbs Lung Qi. These views are important principles, though nuances exist. If Yang Qi is sunken and cannot reach the skin, temporary use of Shengma is appropriate. If red spots appear but exterior heat remains unresolved, dispersion is still necessary. These theories should be understood, not rigidly applied.

Wu Dongyuan stated: Initial fever involves only two tasks: removing pathogen and supporting Zheng Qi. If pathogen-heat is strong, remove it so Zheng Qi flourishes; if Zheng Qi is weak, support it so pathogen-heat recedes. Strong Zheng Qi leads to natural eruption, utilizing heat for the rash without harm. Retreated pathogen preserves blood vessels, ensuring stability. Timely action is crucial; delay renders treatment futile.