如才发一二日间，痘便一齐涌出者，须问其曾数日前有热否，如曾数日前乍热
乍凉，以过期论。惟原未发热，至今才热便斑现，此表气虚，毒瓦斯盛，荣热卫弱，
腠理不密，肌肉不坚，不能约束于外，使毒瓦斯冲击，故出太骤也。宜用实表之剂，可
以无痒塌，无溃烂。实表解毒汤主之。一方，用羌活散调紫草膏，或保婴丹加紫
草、牛蒡子、蝉蜕与服。热盛不退，以羌活散调退火丹进之，另用灯草、木通、
蝉蜕、地骨皮煎汤候冷服。此用发表之剂，与表虚卫弱之说背驰，盖亦有初发热
时见表证失于解散，实热壅遏而怒发者，此法犹可施也，然得全者，鲜矣。
实表解毒汤
黄 人参 当归稍 生地黄 白芍药 地骨皮 甘草 酒片芩 柴胡 玄参 升麻
上锉细。加薄荷叶少许，淡竹叶十片，水煎温服，无时。
消毒快 汤
桔梗 甘草节 荆芥穗 牛蒡子 防风 当归尾 赤芍药 天花粉 黄 玄参 连翘 前胡 木通
水煎服。
清地退火汤 治痘带热而出，名为火里苗，急用此方以退其热，则后无青黑变陷之候。
地骨皮 地肤子（各一钱） 牛蒡子 紫草 葛根（各八分） 连翘（六分） 当归（五分）
木通（三分） 蝉蜕（二分）
上，加姜一片，水煎服。如热不退，再服一剂，或为末，灯心汤服。
羌活散（本门初热） 保婴丹（本门预防） 退火丹（即六一散加牛黄缠豆藤见初热）
If the smallpox lesions erupt all at once within one or two days of onset, it is necessary to inquire whether the patient had a fever several days prior. If there was indeed intermittent fever (alternating hot and cold) several days ago, the condition should be evaluated as having passed its expected timeline. However, if the patient originally had no fever, and only developed a fever today with the simultaneous appearance of macules/papules, this indicates deficiency of Wei Qi (Defensive Qi) at the exterior, excessive pathogenic toxins, heat in Ying Qi (Nutritive Qi), weakness of Wei Qi, loose interstices (skin pores and tissue spaces), and flaccid muscles that fail to constrain the exterior. This allows the toxins to surge outward, causing the eruption to be too rapid. It is appropriate to use formulas that consolidate the exterior; this can prevent itching, sinking, and ulceration. The primary prescription is Shibiao Jiedu Tang (Consolidate-Exterior and Detoxify Decoction). Another regimen involves using Qianghuo San (Notopterygium Powder) mixed with Zicao Gao (Arnebia Ointment), or Baoying Dan (Infant Protection Pill) supplemented with Zicao (Arnebiae Radix seu Cortex), Niubangzi (Arctii Fructus), and Chantui (Cicadae Periostracum). If the heat remains severe and unsubsided, Qianghuo San is used to mix and administer Tuohuo Dan (Clear-Fire Pill); additionally, Dengcao (Junci Medulla), Mutong (Akebiae Caulis), Chantui (Cicadae Periostracum), and Digupi (Lycii Cortex) are decocted in water, cooled, and administered. The use of diaphoretic (exterior-releasing) formulas here contradicts the theory of "exterior deficiency and weak Wei Qi." This approach is likely applicable when, during the initial fever stage, exterior signs were present but not properly resolved, leading to an accumulation of excess heat that erupted violently. In such cases, this method may still be applied, though few patients recover fully.
Shibiao Jiedu Tang (Consolidate-Exterior and Detoxify Decoction)
Huangqi (Astragali Radix), Renshen (Ginseng Radix), Danggui Shao (Angelicae Sinensis Radix tip), Sheng Dihuang (Rehmanniae Radix Recens), Baishao Yao (Paeoniae Radix Alba), Digupi (Lycii Cortex), Gancao (Glycyrrhizae Radix et Rhizoma), Jiuhuangqin (Scutellariae Radix processed with wine), Chaihu (Bupleuri Radix), Xuanshen (Scrophulariae Radix), Shengma (Cimicifugae Rhizoma).
Crush these ingredients into fine pieces. Add a small amount of Bohe Ye (Menthae Haplocalycis Folium) and ten slices of Danzhuye (Lophatheri Herba). Decoct in water and take warm, at any time.
Xiaodu Kuai Tang (Rapid-Toxin-Clearing Decoction)
Jiegeng (Platycodonis Radix), Gancao Jie (Glycyrrhizae Radix et Rhizoma node), Jingjie Sui (Schizonepetae Spica), Niubangzi (Arctii Fructus), Fangfeng (Saposhnikoviae Radix), Danggui Wei (Angelicae Sinensis Radix tail), Chishao Yao (Paeoniae Radix Rubra), Tianhuafen (Trichosanthis Radix), Huangqi (Astragali Radix), Xuanshen (Scrophulariae Radix), Lianqiao (Forsythiae Fructus), Qianhu (Peucedani Radix), Mutong (Akebiae Caulis).
Decoct in water and take orally.
Qingdi Tuohuo Tang (Clear-Earth and Clear-Fire Decoction)
Indicated for smallpox erupting with heat, termed "Fire Seedling" (Huoli Miao). Use this formula urgently to clear the heat, thereby preventing subsequent cyanosis, blackening, or sinking manifestations.
Digupi (Lycii Cortex), Difuzi (Kochiae Spina), Niubangzi (Arctii Fructus), Zicao (Arnebiae Radix seu Cortex), Gegen (Puerariae Radix) [each 1 qian], Lianqiao (Forsythiae Fructus) [0.6 fen], Danggui (Angelicae Sinensis Radix) [0.5 fen], Mutong (Akebiae Caulis) [0.3 fen], Chantui (Cicadae Periostracum) [0.2 fen].
Add one slice of Shengjiang (Zingiberis Rhizoma Recens). Decoct in water and take orally. If the heat does not subside, take another dose. Alternatively, grind into powder and take with Dengxin Tang (Junci Medulla Decoction).
Qianghuo San (Notopterygium Powder) (See Initial Fever section in this chapter), Baoying Dan (Infant Protection Pill) (See Prevention section in this chapter), Tuohuo Dan (Clear-Fire Pill) (i.e., Liuyi San plus Niuhuang, see Entangled Bean Vine in Initial Fever section).