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The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the Yang collaterals are injured, blood overflows outward; when the Yin collaterals are injured, blood overflows inward. Blood overflowing outward manifests as epistaxis (nosebleed), while blood overflowing inward manifests as hematochezia (blood in stool). The fire of chickenpox and smallpox erupts from within. If the toxin cannot be vented outward, it will scorch the meridians and collaterals, forcing blood to move recklessly. Blood follows the fire upward and exits from above, manifesting as epistaxis or vomiting; it exits from below, manifesting as blood in stool or urine. If both Yin and Yang are injured, bleeding occurs both above and below. In cases of hemorrhage due to smallpox/chickenpox, if the bleeding is from the nose, it indicates that the Qi of the Yangming channel can still reach the exterior, and survival is still possible. If bleeding occurs from other parts, it generally belongs to the Yin aspect with internal sinking of fire-toxin, representing critical conditions.

1. Hemorrhage occurring during fever in smallpox/chickenpox mostly belongs to Fire syndromes. For epistaxis, Xuan Shen Di Huang Tang (Scrophulariae Radix and Rehmanniae Radix Decoction) is appropriate, or one may add juice of Imperatae Rhizoma (Mao Gen) or Jing Mo Zhi (Beijing Ink Stick Juice) to drink together. If the epistaxis stops, the patient lives; if it does not stop, the condition is untreatable. For hematuria (blood in urine), Da Li Qing Yin (Great Clearance Decoction) or Ba Zheng San (Eight-Ingredient Powder for Rectification) is appropriate. For constipation accompanied by bleeding, Si Shun Qing Liang Yin (Four-Obedience Cooling and Clearing Decoction) is appropriate.

1. During the stage where smallpox lesions are emerging but not fully erupted, for any hemorrhagic symptoms, it is best to carefully select among the three variations of Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmanniae Radix Decoction) for treatment. After bleeding stops, Tiao Yuan Tang (Regulating Origin Decoction) with Tong Cao (Akebia Caulis) can be administered.

1. Ten days after the onset of smallpox, if pus and blood suddenly appear in large quantities and are passed via the stool, this indicates rotting of the stomach and is an untreatable condition.

The blistering of smallpox is similar to black depression (Hei Xian). Although one manifests outwardly and the other inwardly, and their forms differ, the pathogenic factors remain lodged and the nature of the toxin is the same. Some develop water blisters, some develop blood blisters, which may be red, purple, or black. Whenever such a syndrome appears, ten out of ten patients die. However, there are cases that resemble blisters but are not true blisters, which must be distinguished. If a person originally has broken skin wounds, or boils that have not healed, or scars that are still tender even after healing, once smallpox erupts, the lesions will cluster around the scars. This follows the principle of "things follow their kind." Blisters caused by sores involve corrupt flesh with different coloration, distinct from intact skin, and should not be immediately identified as purple-black blisters. As for treating blisters, first puncture them with a needle, suck out the bad blood, then apply juice of Carthami Flos (Hong Hua/Zhi Zi derivative often referred to as Yan Zhi in historical contexts, here translated as Rouge Juice/Carthamus juice) followed by applying Bai Hua Gao (Hundred Flowers Ointment). These sores easily cause itching. After eruption, it is advisable to frequently use Chen Yin Moxibustion/Fumigation (Artemisiae Scopariae Fumigation) and prevent scratching. If care is neglected, repeated ulceration and suppuration will occur, leading to prolonged non-healing, transforming into gan erosion necrotic sores, resulting in death in many cases.