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Xu Zhongguang treated a child who, after smallpox, suffered from loose stools, leg swelling, and restless sleep. This was due to deficiency of the three Yin meridians of the foot (Liver, Spleen, Kidney). He prescribed Si Jun Zi Tang (Four Gentlemen Decoction) with added Chen Pi (Tangerine Peel), Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root), Gou Qi Zi (Goji Berry), Ze Xie (Alisma), Shi Hu (Dendrobium), and Chuan Niu Xi (Cyathula Root). Subsequently, Ba Wei Wan (Eight-Ingredient Pill, i.e., Jin Gui Shen Qi Wan) was administered, leading to recovery.

Another child, after smallpox, contracted dysentery due to overexertion. Although the dysentery resolved, tubercles formed in the shins and knees, developing into He Xi Feng (Crane Knee Wind, characterized by swollen knee joints). This resulted from deficiency of the three Yin meridians of the foot combined with pathogenic invasion. Feng Qu San (Wind-Expelling Powder) and Ba Wei Wan were alternated, with added Yi Yi Ren (Coix Seed), Niu Xi (Achyranthes Root), Tu Si Zi (Cuscuta Seed), and Dang Gui (Angelica Sinensis).

A third child’s smallpox rash started from the soles of the feet, moved upward to the head and face, then retreated to the epigastrium, attacking the interior organs and causing death. If treated early, once the rash on the head and face had fully erupted, strong ascending and lifting herbs should be used. Bao Yuan Tang (Preserve the Origin Decoction) with Chuan Xiong (Ligusticum Chuanxiong) should be administered, along with protecting the Heart using one dose of Huang Lian Jie Du Tang (Coptis Decoction for Resolving Toxicity) to ensure proper pustule formation and scabbing, allowing the rash to recede from top to bottom, thereby saving the life.

Zhu Yingwo treated his great-nephew, aged seven months. After three days of visible rash, the pustules were distinct, but the red and white colors were indistinct, appearing muddy and dull, lacking vitality. He used herbs that both tonify and release the exterior to harmonize Yin and Yang. By the seventh day, the eruption remained inactive. He quickly administered Ren Shen (Ginseng) and Huang Qi (Astragalus) via Bao Yuan Tang (Preserve the Origin Decoction) with blood-invigorating herbs. By the eleventh or twelfth day, the pus was still thin, and the complexion was sallow and dark. He rapidly increased the dosage of Ren Shen (Ginseng). By the seventeenth to nineteenth day, it was reported that the child slept tiredly during the day, lacked spirit, and showed no signs of playfulness. Careful examination revealed that the scars on the right side were white and dull, and the right hand and foot were atrophic, stiff, and immobile. In contrast, the left-side scars were red, and the left hand and foot moved normally; the child also used the left hand for rubbing the face. Without early treatment, this might develop into flaccid paralysis. Two doses of Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) were given, with the dosage of Chai Hu (Bupleurum Root) being double that of Sheng Ma (Cimicifuga Rhizome), plus Huang Bo (Phellodendron Bark). Although the child did not show joy, the edema in the right hand and foot gradually subsided. The original formula uses Sheng Ma (Cimicifuga Rhizome) to ascend clear Qi to the left and Chai Hu (Bupleurum Root) to ascend clear Qi to the right; thus, more Chai Hu (Bupleurum Root) than Sheng Ma (Cimicifuga Rhizome) was used to treat the right side. Huang Bo (Phellodendron Bark) was added to stimulate strength in the legs. With appropriate prescription, the condition gradually improved.

Initially, the right hand and foot were swollen but not red, suspected as damp-phlegm flowing into the collaterals without forming a toxic swelling, so Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was deemed suitable for resolution. On the twenty-third day, upon re-examination, the spirit was still diminished, and the right hand and foot remained immobile. Therefore, Gui Zhi (Cinnamon Twig) was added. After two or three days, the condition remained unstable, and the prescription was changed to Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction). Seeing that the right hand could grasp objects, but a boil appeared on the dorsum of the right foot, exuding pus, medication was paused to observe recuperation methods, which proved effective. It was calculated that 6–7 qian of Ren Shen (Ginseng) had been consumed. Fortunately, the primordial Qi slowly recovered slightly, allowing for further mild tonification until recovery. For an infant under one year old, taking over thirty doses is unconventional.

Xu Zhongguang stated: In cases where smallpox fails to form pus internally, resulting in dryness and emptiness, this indicates Qi deficiency and sinking. If the patient is alert and eating normally, with no damage to the pustules, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) or Gui Rong Tang (Deer Antler and Angelica Decoction) should be used. However, if symptoms include wheezing, distension, vomiting, diarrhea, restlessness, and outward peeling, it is incurable.

In another case, although the smallpox was full of pus, the root color was pale red, with excessive phlegm-saliva and afternoon tidal fever, indicating Qi deficiency. Treatment with Bao Yuan Tang (Preserve the Origin Decoction) plus Chuan Xiong (Ligusticum Chuanxiong), Dang Gui (Angelica Sinensis), Bei Mu (Fritillaria Bulb), and Chen Pi (Tangerine Peel) failed. This was actually Yin deficiency with hyperactive fire generating phlegm. Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) ingredients were used, supplemented with Ren Shen (Ginseng), Fu Zi (Aconite Root), and Rou Gui (Cinnamon Bark) to warm and tonify. Once the phlegm ceased and fever subsided, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was administered, leading to recovery.

In a case with abundant pus and phlegm, reduced appetite, and loose stools, this was due to Spleen-Stomach weakness failing to transform and transport essence, causing fluid stagnation. Liu Jun Zi Tang (Six Gentlemen Decoction) with Pao Jiang (Processed Ginger) was used.

In a case where pus was sufficient but sudden diarrhea, cold body, and spontaneous sweating occurred, this stemmed from Spleen-Stomach Qi deficiency. Bao Yuan Tang (Preserve the Origin Decoction) combined with Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) cured it, optionally adding Rou Dou Kou (Nutmeg).

In a case where pus was difficult to fill and the color was pale white, this was also Spleen-Stomach Qi deficiency. Da Bao Yuan Tang (Great Preserve the Origin Decoction) was used, assisted by Gui Rong Tang (Deer Antler and Angelica Decoction).

In a case where pus was sufficient but the color did not turn dark yellow, this was due to weak Spleen, which governs scabbing. Bao Yuan Tang (Preserve the Origin Decoction) with Bai Zhu (Atractylodes Macrocephala), Bai Shao (White Peony Root), Chen Pi (Tangerine Peel), Guan Gui (Cinnamon Bark), and Lian Rou (Lotus Seed Flesh) was used to thicken the scabs and cure the condition. If scabs were thin like bran, Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Magnifica Powder) alone was sufficient.

In a case on the seventh day where there was no pus and premature scabbing occurred, only the roots contracting, Bao Yuan Tang (Preserve the Origin Decoction) with Shan Jia (Pangolin Scales) and Guan Gui (Cinnamon Bark) was used. Additionally, bathing the head, face, hands, and feet in Shui Yang Tang (Water Willow Decoction) caused the lesions to rise again after some time, forming pus and curing the disease.

In a case on the ninth day with flat, pus-less lesions, redness below the mouth, ability to eat, but loose stools, this indicated insufficient Yuan Qi unable to ascend to the face. Bao Yuan Tang (Preserve the Origin Decoction) with Bai Zhu (Atractylodes Macrocephala), Bai Shao (White Peony Root), Guan Gui (Cinnamon Bark), Rou Dou Kou (Nutmeg), and Sheng Ma (Cimicifuga Rhizome) was used. By the eleventh day, new pustules filled the empty spaces and formed pus. Yi Gong San (Extraordinary Efficacy Powder) was then administered for recovery.

In a case where the front face had sufficient pus and scabs, but the limbs lacked pus, with ability to eat, loose stools, and undigested food in feces, this indicated Spleen Yin deficiency failing to nourish. Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Magnifica Powder) with Fu Zi (Aconite Root), Tu Si Zi (Cuscuta Seed), and Rou Dou Kou (Nutmeg) was used, followed by He Che San (Placenta Powder) for recovery.

In a case on the eighth day with empty shells and no pus due to Qi and Blood deficiency failing to control toxins, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was used. Four or five ding (hard nodules) emerged, leading to recovery. The Classics state: "Emergence of carbuncles or ding indicates survival."

In a case on the eighth day with inverted scabbing, gray-white color, diarrhea, thirst, teeth grinding, and chills, this was Qi and Blood deficiency-cold. Yi Gong San (Extraordinary Efficacy Powder) cured it. If treatment failed and drowsiness worsened, death would ensue.

In a case on the eighth day with depressed tops, stagnant pus, and scorched-purple color, this was due to Wind-Cold blocking the interstices, causing Qi stagnation and Blood coagulation. Ascending and dispersing agents were needed. Zi Su Yin (Perilla Infusion) was taken internally, and Shui Yang Tang (Water Willow Decoction) used externally to help medicinal qi ascend with the steam, expelling toxins through warmth. For weak children, only the head, face, hands, and feet should be bathed, after which the lesions become smooth, followed by Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) for regulation. This bath is only suitable if Qi and Blood are sufficient and clearly blocked by Wind-Cold. If no rise occurs after bathing and confusion worsens, death results.

In a case during pus formation with lethargy, loose stools, but ability to eat, this indicated Spleen fatigue due to looseness causing deficiency and drowsiness. Gui Pi Tang (Restore the Spleen Decoction) with Bai Shao (White Peony Root), Shan Yao (Chinese Yam), Yi Yi Ren (Coix Seed), and Lian Rou (Lotus Seed Flesh) cured it.

In a case where sufficient pus suddenly scabbed dry and purple, with normal eating and bowel movements, this was rapid scabbing due to Fire forcing closure, known as inverted scabbing. Tonifying and resolving agents were administered. By the fourteenth day, limbs swelled and scabbed, forming pus and resolving toxicity. If the child refused food, had loose stools, hiccups, and choking, it indicated internal deficiency inverted scabbing, toxin returning inward, leading to death from wheezing and distension.

In a case where pus was hard to fill, with red roots, thirst, scanty urine, dry tongue, and constipation, often attributed to Qi deficiency and fluid lack, treating with Bao Yuan Tang (Preserve the Origin Decoction) plus Mai Dong (Ophiopogon Tuber) worsened the condition. Stagnant pus indicated unresolved Blood Heat; warming tonics aided the pathogen, reflecting Fire excess and Water depletion. Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) was switched to, followed by Si Shun Qing Re Yin (Four Smooth Cooling Decoction) to promote urination. All prior symptoms resolved, pus filled, and recovery occurred. The Classics state: "If toxins are not cleared and warming tonics are used, toxins accumulate and fail to form pus."

In a case on the ninth day, a child died and was abandoned on a beach. Limbs twitched, color was scorched-purple, but shape remained protruded. This was toxin-fire causing coma and sudden death. Contact with water cooled the fire, leading to revival. Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) cured him. Some recover through contact with earth.

In a case on the seventh day with red painful roots, constipation, scanty urine, irritability, and thirst, if clearing agents failed, this indicated internal郁 Heat-Toxin. Da Huang (Rhubarb), Dang Gui (Angelica Sinensis), Chi Shao (Red Peony Root), and Gan Cao (Licorice) were given for one dose, followed by Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) for recovery.

In a case during pus formation with bloody stool, hematuria, coma, or excessive sleep, this was because the Heart governs Blood, and deficient pathogens entered the Heart, disturbing the Spirit. Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) and An Shen Wan (Spirit-Calming Pill) were indicated. If treatment failed, death occurred by the twentieth day. If toxins exited completely, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Mai Dong (Ophiopogon Tuber) and Zao Ren (Ziziphus Seed) should be used.

In a case with sufficient pus, black-purple suppuration, severe heat, and constipation, this was Blood Heat and Toxin congestion. Huang Lian Jie Du Tang (Coptis Decoction for Resolving Toxicity) plus Lian Qiao (Forsythia) and Niu Bang Zi (Arctium Fruit) cured it.

A girl suffering from smallpox in late spring spoke deliriously, stood up constantly, and could not sleep for seven days. Her appearance and color were compliant, but the delirious standing indicated Hyperactive Fire of the Heart and Gallbladder. Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) with Chai Hu (Bupleurum Root) and Long Dan Cao (Gentian Root) cured her.

Wan Mizhai treated Wang’s son. When smallpox reached the pus stage, the head, face, abdomen, and back were full, but the hands and feet from elbows/knees to palms/fingers had not erupted. He said: The Spleen governs the four limbs; this child’s Spleen-Stomach must be very weak. Due to loss of milk at birth, Jian Zhong Tang (Establish the Middle Decoction) with Huang Qi (Astragalus) and Fang Feng (Saposhnikovia Root) was given. One dose caused all lesions to swell and form pus. The family worshipped the Black God of Lu Lake. The child was named after the god. Before eruption, the god descended saying he would protect against few smallpox spots. Since many spots erupted, they used a trick to drive the god away.