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When the smallpox lesions are grayish-white, not red and spreading, failing to erupt, with a dim and depressed apex, this indicates exterior cold and deficiency. Use Ginseng Radix (Renshen) to tonify Qi, combined with Siwu Decoction (Four Substances Decoction) to nourish Blood. When urination and defecation are clear and free, the body is cool, breath is cold, appetite is poor, lips are white, and nasal discharge is clear, this indicates interior cold and deficiency. Use Siwu Decoction to nourish Blood, combined with Ginseng Radix to tonify Qi. In all these cases, it is appropriate to warm the Spleen and Stomach, tonify Qi and Blood, adding such herbs as Aucklandiae Radix (Muxiang) and Cinnamomi Cortex (Rougui) to assist in the formation of pus and scabbing. When the lesions are red-purple, dry and stagnant, black and depressed, scorched and withered, this belongs to exterior heat and excess. Use cooling methods combined with detoxification. Secondly, promote diuresis (such as Daochi San). When both urination and defecation are difficult and obstructed, the body is hot with vigorous qi, the nose is dry with thirst, this belongs to interior heat and excess. Use detoxification combined with cooling, and slightly promote bowel movement (such as Sishun Yin). All these cases are suitable for using Huadu Decoction, Liuyi San, and herbs such as Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Moutan Cortex (Danpi), Carthami Flos (Honghua), Cicadae Periostracum (Chantui), and Schizonepetae Herba (Jingjie).

Cold patterns tend to be deficient, while excess patterns tend to be hot. Deficient cold is treated with warming and tonification; excess heat is treated with clearing and draining. Qi deficiency is treated by tonifying Qi; Blood deficiency is treated by nourishing Blood. Heat in Qi is treated with cooling; Heat in Blood is treated with detoxification. When the lesion apex is depressed and does not rise, is not firm, does not hinder the hand, does not swell, and does not produce pus, it is due to Qi deficiency. Use Baoyuan Decoction with doubled amount of Astragali Radix (Huangqi) stir-fried with wine, plus Chuanxiong Rhizoma (Chuanxiong), Cinnamomi Cortex (Rougui), and Aucklandiae Radix (Muxiang), taken together with human milk and good wine prepared as a decoction. When the base of the lesion is not red, or the redness does not tightly encircle the root but spreads out, turns white upon touch, and the lesion surface stands up like goosebumps, being dry, astringent, and lacking luster, it is due to Blood deficiency. Use Baoyuan Decoction added with Angelicae Sinensis Radix (Danggui), Chuanxiong Rhizoma (Chuanxiong), and Carthami Flos (Honghua) washed with wine; add Hawthorn Fruit (Shanzha) to eliminate the stagnation caused by Ginseng Radix and Astragali Radix; add a small amount of Aucklandiae Radix (Muxiang) to move Qi and invigorate Blood. Ginseng Radix and Astragali Radix should be used only after the smallpox has completely erupted. Zingiberis Rhizoma Recens (Dingxiang), Aucklandiae Radix (Muxiang), and Cinnamomi Cortex (Rougui) should be used only when the pathogenic toxin has been completely resolved. Shu Dihuang (Prepared Rehmanniae Radix processed with ginger), Shaoyao (Paeoniae Radix stir-fried with wine), and Danggui (Angelicae Sinensis Radix washed with wine; if diarrhea occurs, stir-fried with earth) should be used cautiously. Overuse of Rhei Radix et Rhizoma (Dahuang), Plantaginis Semen (Cheqian), Talcum (Huashi), Shengdihuang (Raw Rehmanniae Radix), Arctii Fructus (Niubang), and Aurantii Fructus (Zhike) will cause Qi sinking and internal attack. Overuse of Ephedrae Herba (Mahuang), Puerariae Radix (Gange), Cimicifugae Rhizoma (Shengma), Notopterygii Rhizoma et Radix (Qianghuo), Saposhnikoviae Radix (Fangfeng), Schizonepetae Herba (Jingjie), Cicadae Periostracum (Chantui), Manis Squama (Chuanshanjia), and Human Tooth (Renya, calcined, 1-2 li) will cause exterior deficiency, itching, and collapse.