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The secret methods for various syndromes of smallpox and chickenpox, including fever onset (Fe Re), reporting of rash (Bao Dou - appearance of red spots), swelling and rising (Qi Zhang - elevation of pustules), filling with pus (Jiang Guang - accumulation of purulent material), and scabbing (Jie Ye - formation of crusts), are all compiled in this section for easy reference and treatment.

Nie Jiuwu said: At the initial stage of fever, if the body heat is mild and moderate, fluctuating between hot and normal, with a clear spirit and normal diet, there is no need to use medicine to induce sweating; one only needs to avoid wind exposure and provide careful nursing. This is because some cases of smallpox/chickenpox follow a favorable course without requiring specific treatment; refraining from light intervention is itself a form of regulation and treatment. However, if there is aversion to cold with high fever, headache, coughing, and runny nose, these are mostly due to external pathogenic invasion, which must be dispersed through diaphoresis. Medication for inducing sweating should be administered based on the child's physical strength. If the child is constitutionally robust, Jiawei Shengma Gegen Tang (Modified Cinnamon Twig and Kudzu Root Decoction) should be used to induce sweating. (Ingredients: Radix Puerariae Albae [Baigegen], Rhizoma Cimicifugae [Shengma], Radix Paeoniae Rubra [Chishao], Radix Glycyrrhizae [Gancao], Fructus Platycodi [Jiegeng], Radix Saposhnikoviae [Fangfeng], Folium Perillae [Suye], Rhizoma Chuanxiong [Xiaochuanxiong], Sanguis Ziziphus Spinosae [Shanzha Jingrou], Semen Arctii [Niubangzi] decocted and taken orally. This formula is originally for treating common cold rather than smallpox/chickenpox, but inducing sweat with it causes no harm.) If the child is constitutionally weak, Jiawei Renshen Suyu Yin (Modified Ginseng and Perilla Leaf Decoction) should be used to induce sweating. (Ingredients: Radix Ginseng [Renshen], Folium Perillae [Suye], Fructus Platycodi [Jiegeng], Radix Peucedani [Qianhu], Rhizoma Chuanxiong [Xiaochuanxiong], Sanguis Ziziphus Spinosae [Shanzha Rou], Radix Puerariae [Fenge], Pericarpium Citri Reticulatae [Chenpi], Rhizoma Pinelliae Preparatum [Zhibanxia], Semen Arctii [Niubangzi], Radix Glycyrrhizae [Gancao] decocted and taken orally.) However, excessive sweating must be avoided, as it may lead to deficiency of the exterior, making it difficult for the lesions to swell and fill with pus later. Once sweating has been induced and the fever gradually subsides, and the child becomes quiet, the eruption will likely be sparse, indicating a favorable prognosis. In such cases, medication should be withheld to allow natural progression. There are also cases where fever is mild but the eruption is dense, which indicates deficiency of blood and qi. After sweating, if fever persists accompanied by irritability, do not use harsh purgatives immediately. Wait for a while; if restlessness, thirst, and delirious speech occur, use Baidu Hezhong San (Poison-Resolving and Middle-Regulating Powder) to clear heat. (Ingredients: Fructus Forsythiae [Lianqiao], Pericarpium Aurantii [Chenzhiqiao], Radix Saposhnikoviae [Fangfeng], Rhizoma Cimicifugae [Shengma], Radix Peucedani [Qianhu], Rhizoma Chuanxiong [Xiaochuanxiong], Radix Ophiopogonis [Maimendong], Fructus Platycodi [Jiegeng], Periostracum Cicadae [Chantui], Semen Arctii [Niubangzi], Herba Schizonepetae [Jingjie], Caulis Akebiae [Mutong], Radix Glycyrrhizae [Gancao], Flos Lonicerae Japonicae cum Calyce [Zicao Rong], Rhizoma Coptidis Wine-fried [Jiuchao Huanglian]. For constipation, add 1 qian 2 fen of Rhizoma Rhei Wine-fried [Jiuchao Dahuang] for mild purgation; do not add if stool is not dry. Stop taking this medicine once restlessness alleviates slightly, allowing the poison to exit outward so the interior may settle. If abdominal or lower back pain accompanies restlessness, the toxin load is heavy, yet Baidu Hezhong San remains the primary treatment. Add wine-fried Rhizoma Rhei [Jiuchao Dahuang] for constipation to mildly purge, allowing the toxin to exit outward, which will stop internal pain. Then observe the lesions; if dense, red-purple, or blackish, consider detoxification. Do not use purely cold-natured medicines to obstruct the outward movement of toxins, as this will immediately cause internal attack and complications. (Cold medicines should be processed to ensure pure efficacy.) People who do not understand this principle often use purely cold-natured detoxifiers or harsh purgatives like Nux Vomica [Xiaoshi] and Rhizoma Rhei [Dahuang], leading to rapid death without realizing the cause. During outbreaks, when children have mild fever that comes and goes, with faint or unclear red spots, or uncertain eruption status, it is best to withhold medication and wait for clarity, focusing only on avoiding wind, cold, and rich foods. This "non-treatment" is actually deep treatment. Wealthy families, overly protective, often repeatedly administer cold-natured detoxifiers. They fail to realize that in such conditions, toxins surge from the five zang organs, vigorously attempting to exit outward; this momentum cannot be blocked. Repeated use of cold medicines blocks this momentum, forcing toxins inward and accelerating disaster. Many die within days of fever onset due to restlessness and convulsions caused by these detoxifiers. It is like having bandits inside a palace: blocking their exit and attacking them internally ensures destruction. Doctors claim, "How could my detoxifiers kill?" refusing responsibility, while families ask, "How could his detoxifiers kill my child?" failing to blame the doctor. Death occurs in obscurity, unnoticed. Alas, how tragic! I reveal this to warn those whose love causes harm. As the saying goes, aged cured meats hold strong toxins; smallpox/chickenpox toxins originate from fetal essence, hidden in the five zang organs. Light cases are negligible, but severe cases involve deep, long-standing accumulation of potent toxins. When triggered suddenly, the momentum is fierce and unstoppable, relying on blood and qi to carry toxins outward to form pus and scabs, completing the disease process. This is both pathology and physiological transformation. Unlike other sores whose toxins can be rapidly dispersed, detoxifying after eruption follows the natural dispersal trend and is reasonable; detoxifying before eruption opposes the fierce outward momentum and causes rapid disaster. It is like trying to stop a bursting dam with handfuls of soil. Since ancient times, even skilled practitioners have failed to grasp this, prioritizing detoxification over expulsion during the early fever phase. They wrongly believe daily medication reduces toxin load and spares density, ignoring that sparse eruption results from initial light toxin exposure, not sudden resolution at eruption. This error propagates among mediocre doctors, who use cold medicines or purgatives for perceived excess toxins, causing internal attacks and death. I have seen many children die rapidly due to these mistakes, dismissed as "incurable severe syndromes," leaving the true cause unknown and pitiable. Thus, I clarify this principle to save future patients.

During fever, if abdominal pain arises from accidental wind-cold or food stagnation, Shengxiao Pingwei San (Ascending and Eliminating Stomach-Regulating Powder) is used. (Ingredients: Rhizoma Chuanxiong [Xiaochuanxiong], Rhizoma Cyperi [Xiangfu], Rhizoma Atractylodis Macrocephalae [Cangzhu], Folium Perillae [Zisu], Pericarpium Citri Reticulatae [Chenpi], Fructus Hordei Germinatus [Maiya], Fructus Amomi [Sharen], Cortex Magnoliae Officinalis Stir-fried [Chao Nongpuo], Sanguis Ziziphus Spinosae [Zharou], Radix Angelicae Dahuricae [Baizhi], Radix Glycyrrhizae Honey-fried [Zhigancao], Herba Agastaches [Huoxiang], with Fresh Ginger [Jiang] as guide, decocted). One dose stops pain immediately. (Note: Food-stagnation pain differs from toxin pain. Food pain is acute, with loud crying, located above the umbilicus, with blue-white face, pale lips, and cold extremities. Toxin pain is slower, intermittent, below the umbilicus or radiating to the waist, with reddish face, purple lips, and warm extremities. These must be distinguished clearly before medicating.)

During fever, vomiting, diarrhea, or both require differentiation of deficiency/excess and cold/heat. If vomiting and diarrhea accompany severe chest/abdominal pain, it is wind-cold with food stagnation. (Use Shengxiao Pingwei San; one dose brings immediate relief.) If weak stomach qi with cold causes vomiting, loss of appetite, or immediate regurgitation, with smooth, soundless vomiting, blue-white face, pale lips, and fatigue, use Renshen Shahe Wei San (Ginseng and Amomi Stomach-Regulating Powder). (Ingredients: Radix Ginseng [Renshen], Fructus Amomi [Sharen], Rhizoma Pinelliae [Banxia], Radix Atractylodis Macrocephalae [Baizhu], Poria [Fuling], Herba Agastaches [Huoxiang], Pericarpium Citri Reticulatae [Chenpi], Radix Glycyrrhizae Honey-fried [Zhigancao], Peeled; three slices of Ginger [Wenjiang], decocted.) If spleen qi deficiency causes indigestion and diarrhea with slippery, white-colored stools, use Shuling Tiaopi San (Atractylodes and Poria Spleen-Regulating Powder). (Ingredients: Radix Atractylodis Macrocephalae [Baizhu], Poria [Baifuling], Radix Paeoniae Alba [Baishao], Massa Medicata Fermentata [Shenqu], Radix Glycyrrhizae Honey-fried [Zhigancao], Dolichos Lablab [Biandou], Fructus Amomi [Sharen], Rhizoma Cyperi [Xiangfu], Cortex Magnoliae Officinalis [Nongpuo]. Optionally add Radix Ginseng [Renshen], Ginger [Wenjiang], and Jujube [Dazao] for decoction.) If toxins cause vomiting/diarrhea, vomit is sour and forceful, spirit is not very tired, stool is yellow and foul-smelling, though vomiting/diarrhea occur, chest/abdomen usually does not hurt. This represents toxin release via vomiting/diarrhea, considered a favorable sign where stopping is unnecessary. (Zhang Jiegu and others indiscriminately advised against treating pre-eruption vomiting/diarrhea, ignoring deficiency/excess and cold/heat distinctions, which is reckless.)

After two to three days of fever, if eruptions are delayed, or accompanied by restlessness, convulsions, or delirium, remain calm and carefully differentiate deficiency/excess and cold/heat. These symptoms arise from internal toxins unable to vent outward. Differentiation is crucial.

If toxins are abundant internally and cannot erupt, causing convulsions and mania, use Qingjie San (Clear and Disperse Powder) to vent. (Ingredients: Radix Saposhnikoviae [Fangfeng], Herba Schizonepetae [Jingjie], Periostracum Cicadae [Chantui], Fructus Platycodi [Jiegeng], Radix Peucedani [Qianhu], Radix Puerariae [Gegen], Rhizoma Cimicifugae [Shengma], Radix Scutellariae [Huangqin], Rhizoma Coptidis [Huanglian], Flos Lonicerae Japonicae cum Calyce [Zicao], Caulis Akebiae [Mutong], Semen Arctii [Niubang], Fructus Forsythiae [Lianqiao], Radix Glycyrrhizae [Gancao], Sanguis Ziziphus Spinosae [Zharou], Rhizoma Chuanxiong [Chuanxiong] decocted.) If internal toxins are abundant but constrained by external wind-cold, causing stagnation and convulsions, use Sujie San (Perilla Dispersing Powder). (Modify Qingjie San by removing Huangqin and Huanglian, adding Folium Perillae [Zisu], Radix Angelicae Dahuricae [Baizhi], and Radix Notopterygii [Qianghuo]; take hot.) If blood/qi deficiency prevents toxin transport, causing convulsions and mania, use Wenzhong Yiqi Tang (Warm Middle and Boost Qi Decoction) to support. (Ingredients: Radix Ginseng [Renshen], Radix Atractylodis Macrocephalae [Baizhu], Radix Astragali [Sheng Huangqi], Radix Angelicae Sinensis [Guishen], Poria [Baifuling], Radix Glycyrrhizae Honey-fried [Zhigancao], Rhizoma Chuanxiong [Chuanxiong], Radix Angelicae Dahuricae [Baizhi], Radix Saposhnikoviae [Fangfeng], Radix Aucklandiae [Nanmuxiang], Ramulus Cinnamomi [Guangui], Sanguis Ziziphus Spinosae [Zharou], Fresh Ginger [Jiang] and Jujube [Dazao] as guides; stop when effective.)

Differentiating convulsive syndromes requires precision: observe shape/color, listen to voice/symptoms, and check pulse. Red-purple lesions, red face, purple lips, loud voice, coarse breath, hot extremities, and surging-rapid pulse indicate abundant toxins. (Similar signs with heavy voice, nasal congestion/runny nose, and floating-rapid pulse indicate toxin abundance constrained by wind-cold, common in cold months or poor protection.) Pale subcutaneous lesions, lack of vitality, pale/blueish face, slow-decelerated pulse, despite restlessness/delirium, indicate blood/qi deficiency failing to transport toxins. (Medicate accordingly; after one dose, eruptions appear and convulsions cease. Ancient claims that pre-eruption convulsions are favorable are incorrect.)

In infants, fever for 2-3 days with no visible spots followed by sudden convulsions resembling acute convulsive disorder is due to congested toxin qi unable to vent. Use Qingjie San to vent; eruptions resolve convulsions. Misdiagnosing as acute convulsive disorder and using cold medicines or phlegm-resolving purgatives will kill the child by blocking toxin exit. Suspect smallpox/chickenpox in such cases, do not treat as convulsive disorder. Mild fever persisting 3-4 days with hidden eruptions requires careful observation; do not assume light toxin/few spots. Mild fever, clear spirit, normal diet, sparse bright spots, pointed heads, growing red/vital lesions indicate light toxin. Mild fever with fatigue, anorexia, pale/unclear spots after 3-4 days indicates blood/qi deficiency failing to transport toxins; urgently use Wenzhong Yiqi Tang to support. Severe cases may need 2-3 doses for full eruption; if neglected due to apparent calmness, toxins may attack internally within 5-6 days, causing untreatable changes. The theory "mild fever means mild eruption" is unreliable; the rule "no tonics before day 6" is too rigid. Historical texts detail post-eruption care but neglect pre-eruption risks. Rapid/dense eruption is external attack; retained/non-erupting toxin is internal attack. Internal threats are more urgent than external ones. Deaths from erupted toxins occur after 10 days; deaths from non-erupted toxins occur within 6 days. Prioritizing external defense over internal expulsion is a historical oversight. The error lies in rushing detoxification while delaying toxin expulsion. Un-erupted toxins cannot be resolved but must be expelled urgently. I clarify this to prevent past errors and guide future practice, distinguishing deficiency/excess and cold/heat. Excess-heat requires resolving stagnation to expel toxins; deficiency-cold requires boosting blood/qi to expel toxins. I strictly warn against using cold medicines to block toxins internally. This aims to correct past mistakes and enlighten future generations; even if Qibo and Huangdi returned, they would not change my words.

Xi Taishun said: Initial gentle fever, peaceful breathing, normal urination/defecation, unchanged complexion, peaceful sleep indicates favorable smallpox/chickenpox onset. Blue-white skin, low spirit, fatigue indicates deficiency. Eruptions will be weak; if loose stools and milk vomiting occur, tonification is priority. High fever, coarse breath, irritability, delirium indicate internal heat. Wheezing, distension, constipation indicate heat congestion. Dry skin, scorched hair, hot breath, burning body indicate trapped heat with severe internal syndrome and strong external pathogen. Abdominal distension, open mouth, panting, hoarse crying, blocked orifices risk hemorrhage; faint spots risk retention. Milk vomiting with tired/blue eyes, jumping/restlessness indicates impending convulsions. For excess heat, use cool dispersants, not bitter-cold, to allow toxin exit and heat resolution; bitter-cold traps toxins. Light dispersants like Shengma Gegen Tang relieve heat; for severe irritability, they stabilize symptoms. Heavy cases use Ephedra [Mahuang] to open congestion; for wheezing/distension, it saves critical cases. Pre-emptive purgation: treat heat patterns as excess, non-heat as deficiency. Stop heat-diarrhea, then cool, then disperse. Treat deficiency-loose stools with warmth and lifting. Internal deficiency misused with cold aids diarrhea; excess heat misused with warmth worsens irritability. Quiet/eating well does not mean purgation is needed; diarrhea/fever does not mean cold medicines are appropriate.

Also: Initial high fever, straight hair, scorched skin, restless sleep, red cheeks/red eyes, irritability/thirst, abdominal distension/crying/panting, constipation, back/knee pain, foul breath indicate trapped toxin-fire, a dangerous reversal. Physicians should use exterior-releasing and purgative methods, then assess spot color/appearance.

Shao Shi said: Fever day 1, whole-body red spots like silkworm eggs, soft to touch indicates death. Fever with severe intestinal pain, back pain like beating, dry eruptions, unceasing pain, soft red spots indicates death after day 3. (Intestinal pain stopping first suggests rescue with blood-tonifying herbs.) Fever with mild body heat, no abdominal pain, red spots appearing slowly on day 3, hard to touch indicates auspiciousness. Fever with red face/head like rouge applied indicates death after day 5. Fever with sudden voice change and throat swelling can be saved with Qingliang Yin (Cooling Drink). Fever illuminated by red-paper-wrapped sesame oil showing red patch on scalp and red patches on body indicates death after 8-9 days. Fever with no eating/drinking and urinary/fecal obstruction indicates death after 2 days. Fever with delirium and red-purple body indicates death after 4 days. Fever starting from wind-cold/food stagnation, unresolved wind-cold, persistent palpitations, undigested food forming a mass indicates death within 24 hours. Fever with slow whole-body eruption and intermittent convulsions indicates heart-meridian smallpox/chickenpox; treatable with medicine. Parents should not seek random doctors during fever, listening to nonsense harms life. Avoid inauspicious talk in the household. Abstain from sexual activity for half a month, and avoid contact with mourners, nuns, and menstruating women to prevent contamination turning good eruptions into bad ones (rotting pus, sunken scars). Fever with vomiting/diarrhea but preserved spirit is harmless. (Internal heat resolution is good, but prolonged heat dissipates spirit.) Fever starting with voice change is serious. (Treat with Qingfei Yin, Ganjie Tang plus Radix Scrophulariae [Yuanshen].) Early eruption with internal heat requires promoting urination; even without cold medicines, internal heat exits via urine. Urine guides heat out; use Daochi San (Guide Out Red Powder). Mild internal heat should not be drained via urination but resolved internally; draining harms true qi. Use Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) or Jiedu San (Detoxifying Powder). Fever with warm head/cold feet, stupor like dementia, thirst indicates ominous prognosis.