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The approximate course of smallpox is generally as follows: fever for three days, eruption for three days, swelling for three days, suppuration for three days, and crusting for three days, totaling fifteen days. This is the usual constant pattern, representing the normal state. However, cases with dense eruptions and severe toxins often exceed this period; those with sparse eruptions and mild toxins often fall short of it. There are indeed situations that cannot be rigidly applied to all cases. As long as the eruption color is bright and lustrous, the base is red and vibrant, diet and bowel/bladder functions are normal, and there are no mixed exterior-interior symptoms, a delay or advance of a few days is not detrimental. If there are instances where eruption should occur but does not, swelling should rise but does not, suppuration should happen but does not, or crusting should form but does not, one must carefully examine the syndrome. If it is due to deficiency of Yuan Qi (Original Qi) failing to circulate and transport, tonify the Yuan Qi. If it is due to mixed syndromes attacking and depleting, preventing proper circulation and infusion, remove the mixed syndromes. Furthermore, before the sixth day, if toxin emission is incomplete and mixed syndromes exist, this is common. After the sixth day, if toxins should have fully emerged and mixed syndromes should have resolved but have not, this constitutes a adverse condition (Ni Zheng), requiring careful differentiation and urgent treatment.

Regarding smallpox and measles, ancients stated: Smallpox emerges from the interior originating in the Zang organs, with deep-seated toxins; thus, prolonged fever and difficulty in eruption indicate severity. Measles emerges from the exterior originating in the Fu organs, with superficial toxins; thus, sudden high fever and ease of eruption indicate mildness. I believe this view is not necessarily correct. Both smallpox and measles originate from the Zang and Fu organs; there is no case where interior and exterior are disconnected. Merely, when emerging from Fu organs, smallpox is mild; when emerging from Zang organs, measles is severe. Therefore, for all measles cases, fever must persist for five to six days before eruption occurs; it cannot be said to be easy. Moreover, measles mostly belongs to the Lung Meridian; can the Lung Meridian be considered not a Zang organ?

1. Heart Meridian Smallpox Syndrome: The Heart governs Fire. If the child has a red face, irritability, thirst, upward staring of eyes, or grinding of teeth, this indicates Heat in the Heart. For Heart Heat, use Dao Chi San (Guide Out the Red Powder Decoction). For Heart Deficiency, use herbs such as Renshen (Ginseng Root), Maidong (Ophiopogon Tuber), Shengdihuang (Rehmannia Root), and Danggui (Angelica Sinensis Root). For irritability, thirst, and excess pathogenic factors, use Gegen Jiedu Tang (Kudzu Root Detoxification Decoction).

Spleen Meridian Smallpox Syndrome: Often accompanied by vomiting, diarrhea, and abdominal pain. The medical maxim states: "Fever with abdominal pain implies internal attack by macules and papules. Abundant eruptions require caution for incomplete penetration; scarce eruptions require caution for abscess formation." Thus, abdominal pain in sores and rashes is an ominous sign. Treatment should follow the specific guidelines for abdominal pain, vomiting, and diarrhea.

Lung Meridian Smallpox Syndrome: During fever, if wheezing, counterflow of Qi, and phlegm rattling in the throat occur, this is an ominous sign of the Lung Meridian. This is likely caused by toxic fire steaming internally and punishing the Lung. Treatment should follow the specific guidelines for this category.

Liver Meridian Smallpox Syndrome: At the initial stage of fever, children often present with convulsions and tremors. Generally, smallpox toxins are hot; heat generates Wind, and Wind-Heat clash, causing convulsions. Some cases require rapid treatment, while others do not; see the specific section for details.

Kidney Meridian Smallpox Syndrome: At the onset of fever, lower back pain is felt. Since the Kidney and Bladder are exterior-interior paired organs, the toxin transmitting from the Taiyang (Greater Yang) meridian to the Shaoyin (Lesser Yin) meridian causes lower back pain. This indicates the toxin sinking into the Yin aspect, which is a very poor omen. Treatment should follow the specific guidelines for this category.

1. Toxin Residing in the Five Zang Organs: Syndromes vary and must be carefully differentiated. Toxin residing in the Heart manifests as macules and papules, palpitations, high fever, dry throat, pain, thirst, sweating, erysipelas-like swellings, and ulceration of carbuncles. Toxin residing in the Lung manifests as cough, asthma, itching, epistaxis, sores, dry and peeling skin, and shoulder/arm pain. Toxin residing in the Spleen manifests as vomiting, diarrhea, edema, distension, abdominal pain, cracked lips, stiff tongue, limb pain, and anorexia. Toxin residing in the Liver manifests as restlessness, edema, eye diseases, testicular swelling, dry retching, tendon spasm and contracture, expulsion of roundworms, chills, and teeth grinding. Toxin residing in the Kidney manifests as lower back pain, black sunken lesions, aphonia, cold extremities, dry and painful throat, hunger without desire to eat, and excessive salivation. Toxin residing in the Intestines and Stomach manifests as diarrhea, dysentery with pus and blood, borborygmus and flatus, and constipation. Toxin residing in the Bladder manifests as lower abdominal fullness and pain, hematuria, enuresis, urinary retention, headache and swelling at the vertex, opisthotonos, and upward deviation of the eyes. The above syndromes of the Five Zang organs are merely general examples. Treatments for all various syndromes are detailed in the sections on miscellaneous syndromes; these should be studied thoroughly.