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Shun (Favorable) Pattern: The pustules gradually grow, becoming coarse, plump, round, and bursting open. They stand high and are solid. The base is reddish with a ring of red halo tightly attached to the root of the pustule; the top is full and bright with luster. The base is spacious, and the interior and exterior are level. Gradually, the root turns red and the neck turns white, as the toxin transforms into fluid/pus. This indicates abundant Qi and blood, with Qi and blood returning to attach to the pustules.

Xian (Dangerous) Pattern: Although the pustules have erupted, they appear dull, stagnant, withered, and dry; or they are flat, collapsed, grayish-white, with tops that are not round or bursting; or although the roots are red, the halo is not tightly attached. Generally, the shape of the pustules depends on Qi, and the color of the roots depends on Blood. It relies on Qi and Blood to complete the process throughout, yet resolving toxins is the urgent priority. The sixth day serves as a boundary for smallpox. Before the sixth day, clear away toxic fire; after the sixth day, use warming tonification to assist in forming pus. If treatment fails at this stage, attempting warming tonification may further intensify the toxic pathogen, preventing pus formation; attempting cooling may cause stagnation of the pus, leading to a dilemma. However, clinical practice requires flexibility. If toxic fire has been cleared before the sixth day, tonifying herbs can be added; if heat pathogens are not severe after the sixth day, mild clearing and resolving herbs can be used. Regarding the lack of luster and fullness in pustules, there are two scenarios. Like flowers, on cloudy days they remain vibrant and beautiful, but under scorching sun they wither and dry out; this indeed does not depend solely on the strength of the tree. If pustules do not burst, observe other symptoms. If there are heat signs such as restlessness, fever, thirst, and constipation of both bowels and bladder, use cooling methods. If there are deficiency signs such as fatigue, mild fever, and clear/unobstructed urination and defecation, use warming tonification. Careful observation is essential. One cannot simply assume that non-bursting pustules require tonification, thereby committing the error of "reinforcing excess and depleting deficiency" which leads to death. For cases with excessive thirst and drinking, urgently clear Stomach Fire. If untreated, although the exterior may seem to converge, the Stomach suffers from fire-toxin, leading to internal ulceration and attack, causing perforation of the chest and back and death. Mild cases may present with widespread red macules, which is also critical.

Main Formula: Danggui Radix Angelicae Sinensis, Chuanxiong Rhizoma Ligustici Chuanxiong, Shaoyao Radix Paeoniae Alba (stir-fried with wine), Chanui Periostracum Cicadae, Jiangcan Bombyx Batryticatus, Shanzhao Fructus Crataegi, Niubangzi Fructus Arctii, Baizhi Radix Angelicae Dahuricae, Jiegeng Radix Platycodonis (equal parts); Gancao Radix Glycyrrhizae Uralensis (half dose). Decoct in water and take orally.
For Xuhan (Deficiency-Cold) patterns, add Renshen Radix Ginseng, Huangqi Radix Astragali, Rougui Cortex Cinnamomi, Nuomi Oryza Sativa Glutinosa on the sixth day, with a small amount of Chenpi Pericarpium Citri Reticulatae. If no Xuhan pattern exists, use the main formula on the seventh day.
Another Formula: Treats Xuhan (Deficiency-Cold) patterns. Chuanxiong Rhizoma Ligustici Chuanxiong, Baizhi Radix Angelicae Dahuricae, Shanzhao Fructus Crataegi, Chenpi Pericarpium Citri Reticulatae, Danggui Radix Angelicae Sinensis, Jiegeng Radix Platycodonis, Gancao Radix Glycyrrhizae Uralensis (equal parts). Gradually add warming tonics, decoct with Jujube water.
Another Formula: Treats Shi Re (Excess-Heat) patterns. Chuanxiong Rhizoma Ligustici Chuanxiong, Chanui Periostracum Cicadae, Shanzhao Fructus Crataegi, Niubangzi Fructus Arctii, Jiegeng Radix Platycodonis, Mutong Herba Akebiae, Fangfeng Radix Saposhnikoviae. Add Dengxin Cao Medulla Junci and Dazao Fructus Ziziphi Jujubae, decoct in water and take orally.
Another Formula: Treats Xue Re (Blood-Heat) patterns. Guiwei Radix Angelicae Sinensis Tail, Shengdihuang Rhizoma Rehmanniae Recens, Mutong Herba Akebiae, Jiegeng Radix Platycodonis, Lianqiao Fructus Forsythiae, Chuanxiong Rhizoma Ligustici Chuanxiong, Chanui Periostracum Cicadae, Jiangcan Bombyx Batryticatus. Decoct in water and take orally.
Jia Ban (Accompanied by Macules): Add Huangqin Radix Scutellariae, Huanglian Rhizoma Coptidis, Honghua Flos Carthami, Danmu Pi Cortex Moutan (stir-fried with wine), Shengdihuang Rhizoma Rehmanniae Recens. If urine is clear and profuse, remove Mutong Herba Akebiae. If stool is difficult and abdomen is distended, add Fupi Pericarpium Tugitrichi. If not moist, add Danggui Radix Angelicae Sinensis; if not moving smoothly, add Niubangzi Fructus Arctii. If collapsed, add Huangqi Radix Astragali. If painful, add Baizhi Radix Angelicae Dahuricae. If uneven, add Fangfeng Radix Saposhnikoviae. Fine macules are difficult to treat; large macules allow expelling toxic blood via respiration. For thirst,服用 Liuyi San (Six-One Powder); if severe, use Baihu Tang (White Tiger Decoction) (see Shanghan Lun).

Ni (Adverse/Rebellious) Pattern: Pustules do not erupt, appearing flat, collapsed, and floating; color lacks luster and roots have no halo; abdominal distension, anorexia, shortness of breath, and coma. Or pustules cover the whole body extending over the head, red-purple like rouge; or the face and head are swollen and red, while pustules recede; or pustules sink into pits like needle holes and turn black-purple; or resemble millet porridge skin; or lips and mouth area swell severely, commonly known as "Judge's Mouth". These indicate Qi stagnation and Blood coagulation, or Qi separation and Blood scattering, constituting adverse patterns. Adverse patterns result from insufficient intersection, allowing toxins to penetrate inward opportunisticaly. Additionally, strabismus, skin resembling orange peel without distinct muscle texture, or pustules only below the waist but none above, are all untreatable conditions.