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After the eruption signs of smallpox appear, it gradually rises and swells. Every bit of rising corresponds to the expulsion of a bit of fetal toxin; when fully risen, all fetal toxins are expelled. If some lesions fail to rise, it may be due to weak Yuan Qi (primordial energy) unable to drive out the toxin, or due to other complicating conditions blocking the ascent and eruption. These are all results of improper regulation before the eruption. At this stage, prompt treatment is necessary; otherwise, the consequences will be difficult to manage.

One: It is auspicious for smallpox to erupt gradually. If they erupt all at once with flaccid swelling of the skin and flesh, this indicates exterior deficiency failing to consolidate, causing the toxin to burst forth. Later, itching, suppuration, or ulceration will inevitably occur. Urgently use Renshen Guji Tang (Ginseng Muscle-Firming Decoction) or Xionggui Tang (Ligusticum and Angelica Decoction). If there is blood heat, use Liangxue Yangying Jian (Cool Blood and Nourish Ying Decoction). For severe deficiency, use Liuwu Jian (Six-Ingredient Decoction). For abundant toxin, use Liuwei Xiaodu Yin (Six-Ingredient Toxin-Clearing Infusion), or Siwei Xiaodu Yin (Four-Ingredient Toxin-Clearing Infusion) with modifications.

One: Smallpox that fails to rise or does not rise thoroughly is mostly caused by internal deficiency of Yuan Qi, which cannot support and expel the toxin, leaving the toxic qi latent. If the toxin is not completely expelled, unpredictable complications may arise. Upon seeing this, one must quickly treat the interior to support the expulsion of the toxin. However, one must distinguish whether the issue lies in the Qi level or the Blood level and treat accordingly. Generally, the robustness and protrusion of smallpox depend on Qi, while its luster and moisture depend on Blood. Qi provides warmth, and Blood provides nourishment. If the form is robust but the color is withered, this means Qi has arrived but Blood is not nourishing; use Siwu Tang (Four-Substance Decoction) added with Renshen (Ginseng) and Maidong (Ophiopogon Tuber). If the color is ruddy but the shape is flat and depressed, this means Blood has arrived but Qi is insufficient; use Baoyuan Tang (Preserve Origin Decoction) or Liuqi Jian (Six-Qi Decoction) added with Chuanxiong (Sichuan Lovage Rhizome). If both color and form are weak and fail to rise, this indicates insufficiency of both Qi and Blood; use Liuwu Jian with modifications, or Baoyuan Tang, Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction), administered with Wuji San (Priceless Powder) or Dusheng San (Single-Saint Powder). If during winter or spring, cold qi suppresses the eruption, use Mahuang Gancao Tang (Ephedra and Licorice Decoction) added with Danggui (Angelica Sinensis) and [missing character], or Shixuan San (Ten-Accumulations Powder). If during summer or autumn, excessive fire prevents eruption accompanied by irritability, thirst, constipation, and internal heat, use Renshen Baihu Tang (Ginseng White Tiger Decoction). If the eruption is delayed and lacks ruddiness and luster, use Baoyuan Tang or Liuwu Jian added with Dingxiang (Clove), Shanzha (Hawthorn Fruit), Nuomi (Glutinous Rice), Renru (Human Milk), and good wine. Alternatively, use Wuji San, adjusted according to the child's age and mixed with good wine. In general, whole-body eruption should be thorough, though the limbs, being distant, may lag behind. If the Spleen and Stomach are inherently strong and appetite is good, do not worry. Only if the Spleen and Stomach are inherently weak with poor appetite might the limbs fail to erupt thoroughly, because the Spleen governs the four limbs and fluids cannot irrigate them. Treatment should focus on tonifying the Spleen, using Kuaiban Yebipi Tang (Rapid-Eruption Yi Yi and Ma Huang Decoction) added with Danggui, or Huangqi Jianzhong Tang (Astragalus Middle-Conserving Decoction) added with Renshen and Fangfeng (Saposhnikovia Root). If white, non-rising lesions result from mistakenly administering cooling medicines, use Lizhong Tang (Regulate the Middle Decoction) or Weiai San (Stomach-Loving Powder).

One: Although the smallpox has erupted, if it appears grayish-white or the apex is depressed, this is Qi deficiency. Cold-cooling medicines must absolutely be avoided. Use Liuqi Jian added with Dingxiang, Chuanxiong, Renru, and good wine. Alternatively, Baoyuan Tang with doubled Jiuhuangqi (Wine-fried Astragalus Root) and Danggui is also excellent.

One: Although the smallpox has erupted with ruddy color, if the apex is flat, the color tender, and the skin thin without firmness, this is Qi deficiency. There is a fear of transformation into itching and suppuration. Use Liuqi Jian or Liuwu Jian with modifications. Shiquan Dabu Tang or Shixuan San can also be selected.

One: For red bases with scattered blood not adhering, use Baoyuan Tang added with Shaoyao (Peony Root) and Danggui to slightly astringe, allowing the blood to return to its proper Qi position.

One: For pale red bases with dry and withered halos, this is Blood deficiency. Use Baoyuan Tang added with Danggui, Chuanxiong, and Jiu Honghua (Wine-washed Safflower), plus Shanzha to move the stagnation of Renshen and [missing character]. Add a small amount of Muxiang (Aucklandia Root) to move Qi, so that Blood flows naturally.

One: Although the smallpox has erupted, if it is dry, waterless, or dark blue-purple, it will soon turn black and sink, indicating extreme Blood deficiency. Use Siwu Tang added with Renshen, Maidong, Zicao (Arnebia Root), and Honghua, or administer Wuji San. Bathe externally with Yangshui Tang (Poplar Water Decoction) and apply Yanzi Tu Fa (Carmine Application Method).

One: Smallpox that is very red and causes unquenchable thirst is called "Dry Smallpox." Use formulas similar to Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction).

One: Smallpox that is red-purple, full at the apex, or swollen indicates Blood heat and abundant toxin. Use Liangxue Yangying Jian added with Danpi (Moutan Bark), Mutong (Akebia Stem), and Niubangzi (Arctium Fruit). However, if these symptoms appear after the sixth day of eruption, death is likely.

One: After the smallpox has fully erupted, if fever persists, or there is irritability, thirst, and desire to drink, or if it is the season governed by the "Two Fires," giving a few mouthfuls of cold water is harmless. Water flows downward and does not stagnate in the upper diaphragm, helping to expel toxin via urination. However, raw fruits should be avoided as they may damage Spleen Qi.

Smallpox should ideally have distinct, separate grains. If they merge together, with swollen skin and floating flesh, or if small pustules rotate and gather around the original lesion, eventually forming a single mass, this condition is most dangerous. Use Kuaiban Tang (Rapid-Eruption Decoction) combined with Liuwei Xiaodu Yin to clear the toxin.

One: After full eruption, if there are small holes extending from the apex to the base, neither white nor black, matching the lesion color, it is called "Moth-eaten Smallpox." This is caused by exterior deficiency and loose interstices. Failure to treat promptly leads to massive loss of Yuan Qi, preventing eruption, and accelerating demise. Use Baoyuan Tang or Liuqi Jian, heavily adding Nuomi, Chuanxiong, and Dingxiang to lift Qi, fill the pus, and internally repair the holes, which is very effective. Administer two or three doses consecutively; the holes will fill and the lesions will rise. If it turns black, it becomes a Ding (carbuncle).

One: The lips are the external manifestation of the Spleen. Humans rely on the Spleen and Stomach as their foundation, which should not be injured. If chapped and cracked lips appear upon initial fever, this indicates toxic Qi attacking the Spleen, a malignant sign. Use formulas like Xiehuang San (Drain Yellow Powder) to resolve it quickly. If not treated early, toxin accumulates in the lips. When the main lesions erupt, the lip sores will mature first, containing yellow pus. By the time the main lesions form pus, the lip sores will have crusted over, the lip skin will peel off, and vomiting, choking on water, and lethargy will develop, becoming incurable.