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Shun (Favorable) Pattern: When the smallpox pustules first begin to fill with pus, they initially appear watery, gradually turning white and bright, becoming dense and full, changing to a yellow wax color. The base is red and vibrant, tightly attached to the root of the pock. Diet, urination, and defecation remain normal.

Xian (Dangerous) Pattern: Although the smallpox pustules are filling with pus, they are not dense and full; or the skin is thin, tender, and red, pale white, wide, and collapsed. It will inevitably itch and lead to subsequent complications. It is urgent to use Baoyuan Tang (Preserve the Origin Decoction) for warming and tonification, which will naturally become dense and full. If there is still heat toxin, slightly combine with cooling herbs. Or if it resembles the color of white rice, flat and collapsed, with pale white surroundings, dry and rough without redness, this indicates Blood Deficiency; if the apex does not rise, this indicates Qi Deficiency. Add Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), Cinnamomi Cortex (Rougui), and Aucklandiae Radix (Muxiang) to Baoyuan Tang (decocted with human milk and good wine). If various ominous signs appear, such as restlessness and unease, but the color of the smallpox remains unchanged and diet is normal, treatment can proceed without hindrance. Scratching until pus and blood appear is auspicious; empty shells without pus and blood are inauspicious.

Main Formula: Ren Shen (Ginseng Radix et Rhizoma) (1 qian), Huang Qi (Astragali Radix) (1 qian), Gan Cao (Licorice Root) (0.4 qian), Rou Gui (Cinnamon Bark) (0.3 qian), Dang Gui (Angelicae Sinensis Radix) (0.8 qian), Chuan Xiong (Ligusticum Chuanxiong Rhizoma) (0.7 qian), Bai Shao (Paeoniae Radix Alba) (used at the beginning and end, stir-fried with wine), 100 grains of Glacinis Semen (Glutinous Rice). Decoct in water and take orally.

If detoxification is also required, add Bai Zhi (Angelicae Dahuricae Radix), Fang Feng (Saposhnikoviae Radix), Niu Bang Zi (Arctii Fructus), etc. When using Ren Shen, add a small amount of Shan Zha (Crataegi Fructus) to eliminate the cloying nature of Ren Shen and Huang Qi; add Muxiang to promote the circulation of Qi and Blood. To prevent Ren Shen from causing fullness, add a small amount of Chen Pi (Citri Reticulatae Pericarpium) to control it. If too much or repeatedly used Zhi Qiao (Aurantii Fructus Immaturus) or Qing Pi (Citri Reticulatae Pericarpium Viride), then Ren Shen will be ineffective. Distension and pain, although a favorable sign, if persistent, add Muxiang and Shan Zha. Or if the pustules have filled halfway, suddenly becoming dry and purple, with swelling subsiding and the pock eyes opening, this is called Dao Ye (Reversed Crusting) (see separate section later). Or if there is food stagnation or diarrhea, add herbs to digest food and stop diarrhea, treating according to the syndrome. Or if cooling medicines are overused, suppressing the pathogen and preventing progression, with no fever, it becomes Bing Fu Syndrome (Ice-Frozen Syndrome); use large doses of warming and tonifying medicines (such as Yigong San and Muxiang San). Or if the apex is flat, the base is wide, and the pus is clear, use Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) with added Muxiang and Gan Jiang (Zingiberis Rhizoma). For those with heavy smallpox toxin, if the pus is insufficient after ten days, greatly tonify Qi and Blood, slightly combining with detoxifying herbs, fearing subsequent carbuncle/toxin complications. Or if the upper body forms pus and the legs/feet form large blisters, the toxin has been resolved.

Ni (Adverse) Pattern: The smallpox color is scorched, withered, black, and sunken, unable to fill with pus; or red turns purple, purple turns black; or crystal-clear with no redness at all. These indicate that the toxin is not yet exhausted and Qi and Blood are depleted, constituting a death pattern. Or symptoms such as fright, chills, tremors, teeth grinding, and refusal to eat occur. (These are ominous signs; temporarily tonify Qi and Blood.)