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In cases of *Yong* (obstruction/stagnation) in smallpox, although the symptoms are severe, the therapeutic effect can be extremely profound if treated correctly. If cold and cooling herbs such as Huangqin (Scutellariae Radix), Lianlian (Coptidis Rhizoma), and Shengma (Cimicifugae Rhizoma) are used abruptly, the heat will be suppressed by the cold qi, unable to extend and emerge, lingering in the meridians, leading to carbuncles or boils; or causing water retention and hard constipation. As for warming and tonifying agents like Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Fuling (Poria), if misused, they will exacerbate the stagnation and abundance, bringing disaster immediately. Others such as Dingxiang (Caryophylli Flos), Rougui (Cinnamomi Cortex), Muxiang (Aucklandiae Radix), Jiang (Zingiberis Rhizoma), and Fuzi (Aconiti Lateralis Radix Praeparata), using heat to attack heat, can cause death instantly, and extreme caution is required. Therefore, from the initial fever until after the eruption of spots, it is appropriate to treat with this formula (referring to Qianghuo San Yu Tang mentioned previously), adding or subtracting ingredients according to the methods described later.

Additions and Subtractions to Qianghuo San Yu Tang:
If at the onset there is high fever, red cheeks, flushed face, dry and brittle hair, dry skin, cough, and rapid breathing, add Shengma (Cimicifugae Rhizoma). For irritability and thirst, add Tianhuafen (Trichosanthis Radix) and Gange (Puerariae Radix). For abdominal distension, rapid breathing, nasal congestion, flushed face resembling anger, and straight, withered hair, add Mahuang (Ephedrae Herba). For constipation, add Danggui (Angelicae Sinensis Radix) and Zhike (Aurantii Fructus), and in severe cases, Dahuang (Rhei Radix et Rhizoma). For vomiting, add Zhuling (Polyporus), Zexie (Alismatis Rhizoma), and Chenpi (Citri Reticulatae Pericarpium); ginger, dingxiang, muxiang, and Banxia (Pinelliae Rhizoma) are forbidden. For diarrhea, add Shengma; Baizhu, Fuling, Doukou (Cardamomi Fructus), and Longgu (Fossilia Ossis Mastodi) are forbidden. For wheezing, cough, and aversion to wind, add Sangbaipi (Mori Cortex) and Zisu (Perillae Folium). For bleeding, add Xijiao (Rhinocerotis Cornu), Shengdihuang (Rehmanniae Radix), and Huanglian (Coptidis Rhizoma). For the appearance of rashes, add Huanglian, Huangqin (Scutellariae Radix), and Shanzhi (Gardeniae Fructus). For dark and scanty urination, add Huashi (Talcum), Shanzhi, Shengdihuang, and Shaoyao (Paeoniae Radix Alba). For epistaxis, add Huangqin and Xijiao. For palpitations and fright, add Mutong (Akebiae Caulis) and Shanzhi. For convulsions, add Qingpi (Citri Reticulatae Pericarpium Viride). For loss of appetite, add Shanzha (Crataegi Fructus). For food stagnation, add Shanzha, Shenqu (Massa Medicata Fermentata), and Maiya (Hordei Fructus Germinatus). Between two and three days after spotting, if eruption is not smooth, add Niubangzi (Arctii Fructus), Shanzha, and Chantui (Cicadae Periostracum), named Touji San (Muscle-Penetrating Powder). For facial irritation and redness, add Shengdihuang, Honghua (Carthami Flos), and Mudanpi (Moutan Cortex); remove Baizhi (Angelicae Dahuricae Radix) and Fangfeng (Saposhnikoviae Radix). For tight skin and tense muscles with high fever, add Gegen (Puerariae Radix) and Qianhu (Peucedani Radix).

Within three days after spotting, additions and subtractions should follow this formula. After three days, when the smallpox lesions are fully erupted, blood vessels have formed, and previous symptoms have subsided, this formula must not be reused, lest excessive dispersion hinder the formation of pustules and scabs; other formulas are provided later. Prohibited medications should be managed according to the principles for treating bloody-heat smallpox syndromes, so no specific contraindications are listed for this formula.

Taiyi Baohe Tang (also known as Zicao Touji Tang)
Specifically treats bloody-heat smallpox syndromes. After taking Shishen Jiedu Tang, if heat symptoms have completely resolved and the interior and exterior are harmonious, but after three days of spotting the lesions do not grow well or the skin is rough, use this formula. It protects and harmonizes Yuan Qi (Original Qi), invigorates blood and resolves toxicity, assists in pustule formation, and facilitates scabbing and shedding.
Jiegeng (Platycodonis Radix), Zicao (Arnebiae Radix seu Lithospermi Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Shanzha, Mutong, Renshen, Honghua, Shengdihuang, Gancao (Glycyrrhizae Radix et Rhizoma), Nuomi (Oryzae Sativae Semen Glutinosis) (50 grains).
Take the above herbs, add seven stalks of Dengxincao (Junci Medulla), one slice of Shengjiang (Zingiberis Rhizoma Recens), and one cup of water. Decoct until six-tenths remain, and take warm.
For difficult urination and abdominal distension, add Dafupi (Arecae Pericarpium). For overly red and unmoistened lesions, add Danggui and Chantui. For slow eruption, add Niubangzi. For sunken lesions, add Huangqi. For pain, add Baizhi. For uneven color, add Fangfeng. For vesicles, add Baizhu and Shaoyao. For cough, add Wuweizi (Schisandrae Fructus) and Maidong (Ophiopogonis Radix). For thirst, add Maidong. For itching, add Baizhu and Shaoyao.
After seven or eight days, when pus is sufficient, if the body becomes hot again, with constipation, irritability, thirst, abdominal distension, and rapid breathing, use Qianhu Zhike Tang. Once pus is sufficient, this formula is prohibited; a different decoction is provided later.

Yiyuan Touji San
Specifically treats obstructive-heat smallpox syndromes. After taking Qianghuo San Yu Tang, if obstruction symptoms have cleared and qi and blood are harmonious, but after three or four days of spotting the lesions are not plump or fail to form pus, use this formula. It regulates qi and resolves toxicity, penetrates the muscle layer to reach the surface, guides out Yuan Yang (Original Yang), assists in pustule formation, and facilitates the formation of pustular cavities. Additions and subtractions are discussed similarly to Baohe Tang. After pus is sufficient, Baoying Baibu Tang is provided later.
This is Taiyi Baohe Tang minus Shengdihuang and Honghua, plus Chantui, Niubangzi, and Chenpi.
Take the above herbs, add one cup of water, fourteen stalks of Dengxincao, and two dates. Decoct until six-tenths remain, and take warm.

Baoying Baibu Tang
Specifically treats smallpox after nine or ten days when pus is sufficient and there are no other symptoms. Use this formula to regulate qi and blood, nourish the spleen and stomach. It can be taken regardless of excess or heat types of smallpox. Only for qi-deficiency syndromes after nine or ten days, add Huangqi (Astragali Radix) two qian and Guigui (Cinnamomi Cortex) a little to this formula. If there are other symptoms, adjust according to deficiency and excess.
Danggui, Shaoyao, Dihuang, Baizhu, Renshen, Fuling, Shanyao (Dioscoreae Rhizoma), Gancao.
Take the above herbs, add one cup of water and two dates. Decoct until six-tenths remain, and take warm.

[Chen Shi Wei Zhu Wen Bu] [Chen Wenzhong] Between the time before and after smallpox eruption, if there is diarrhea and thirst, abdominal distension, or shortness of breath, this is called Interior Deficiency. Treat it rapidly with Shiyiwei Muxiang San (Eleven-Ingredient Aucklandia Powder). If the rash has erupted but lacks luster, does not rise, and the base is not red, this is called Exterior Deficiency. Treat it rapidly with Shiweiyi Gong San (Twelve-Ingredient Yi Gong Powder). If the rash has erupted, lacks luster, does not rise, the base is not red, accompanied by diarrhea/thirst, abdominal distension, or shortness of breath, this is Exterior and Interior Deficiency. Treat it rapidly with Shiweiyi Gong San administered with Qiwei Roudouwan (Seven-Ingredient Nutmeg Pills). (Danxi said: Muxiang San and Yi Gong San are appropriate for cold syndromes; if deficiency exists without cold, disaster will follow immediately.) If between one and ten days after eruption, the whole body is hot, and stool is yellow, this is Exterior and Interior Excess. The lesions will be lustrous, raised, full, and easily scabbed, without damage. If there are no other diseases, medication is unnecessary. Exterior and Interior Excess leads to easy eruption and scabbing; Exterior and Interior Deficiency leads to easy eruption but difficult scabbing; Exterior Deficiency makes eruption difficult, Interior Deficiency makes scabbing difficult. Treat according to the syndrome. Zhang Xunzhi's "Essential Methods for Treating Smallpox" states that vomiting, diarrhea, and poor appetite indicate Interior Deficiency; sinking, inverted scabs, and gray-white color indicate Exterior Deficiency. Both present together indicate Exterior and Interior Deficiency, treat entirely with Yi Gong San. Even Ginger, Aconite, and Lingsha may be used. If only Interior Deficiency, reduce Guigui; if only Exterior Deficiency, reduce Roudoukou, but do not reduce Guigui or Dingxiang. If able to eat but constipated with sinking/inverted scabs, it is Interior Excess, use Qian's and Danxi's purgative methods. If no vomiting/diarrhea and able to eat, it is Interior Excess; tonifying Interior Excess will lead to carbuncle-toxins. Red, lively, protruding lesions indicate Exterior Excess; using exterior-releasing drugs for Exterior Excess will lead to ulceration and failure to scab. For all smallpox, once spots appear, Gegen Tang is contraindicated, lest dispersion cause Exterior and Interior Deficiency.

[Zhu Danxi] When reading predecessors' works, one must understand their intent. If one reads without understanding the intent, seeking applicability is impossible. Regarding smallpox discussions, Qian Yi was the most detailed, tracing origins, clarifying meridians, distinguishing exterior/interior and deficiency/excess, stating treatment methods, and verifying with discursive arguments, deeply embodying the spirit of teaching through writing. Students who read and apply it find it as reliable as using compasses for circles and squares, or levels for straightness. Extending this, applying it to various cases allows for infinite application. Modern people do not know the causes of disease nor the intent behind prescriptions. In haste, they check formulas based on symptoms and try them casually. If ineffective, they discard the books, which is extremely thoughtless. Recently, due to the long-standing popularity of Ju Fang (Prescriptions of the Bureau of Taiyi), and neglect of Suwen studies, those discussing medicine while ill tend to prefer warming and tonifying over cooling and releasing. Suddenly encountering Chen's formulas, which use drying, hot, and tonifying agents, with precise words and simple text, they happily use and believe them, concluding that Qian is far inferior to Chen. Someone asks: Do you think Chen's formulas are inadequate? I say Chen's formulas are indeed a one-sided theory. However, he can be considered good at investigating disease conditions. His intent largely focuses on the Taiyin channel. Hand Taiyin belongs to the Lung, governing skin and hair; Foot Taiyin belongs to the Spleen, governing muscles. Lung Metal dislikes cold and is easily affected; Spleen Earth dislikes dampness and accepts everything. Using Dingxiang and Guigui treats Lung cold; using Aconite, Baizhu, and Banxia treats Spleen dampness. If Spleen and Lung truly have cold and dampness combined with deficiency, giving measured amounts that hit the mark causes no harm. Now, however, whenever one sees delayed eruption, fever, diarrhea, palpitations, rapid breathing, or thirst, regardless of cold/heat or deficiency/excess, Muxiang San and Yi Gong San are indiscriminately administered. Occasionally effective, but if misused, disaster follows immediately. Why? Ancient prescription-making included guiding agents, restraining agents, counter-assisting agents, and conditional usage. Qian's formulas did not abandon Xixin (Asari Radix), Dingxiang, Baizhu, Renshen, and Huangqi, but always included restraining and assisting agents, not solely focusing on warming and tonifying. He used more cooling agents, hinting at tonification but not delving deep. One cannot speak dreams to the foolish; Qian's considerations were thorough! He waited for enlightened individuals to expand upon them. Although Chen introduced using warming drugs for thirst and tonics for itching/pruritus, surpassing predecessors, his frequent use of Guigui, Aconite, and Dingxiang, which are pungent, aromatic, drying, and hot, may not be perfectly balanced. These drugs are appropriate for cold-deficiency, but what about deficiency without cold? At the time Chen formulated these, he likely addressed cold with a one-sided approach, perhaps leaning towards heat. I have synthesized the essence of various schools and applied their intents, daring not rely solely on his fixed formulas. In the Jiashen year of Zhizheng, yang qi moved early. In January, smallpox in the county was rare. Everyone used Chen's formulas, resulting in over a hundred child deaths. While partly due to fate, I fear human effort was also insufficient.

Wang Ruyan said: If smallpox is weak, pale white, itchy, and sunken, this belongs to deficiency-cold, suitable for Chen Wenzhong's formulas. If fever is high, lesions are bright red/purple, dry, and itchy, this belongs to heat-toxin, requiring rapid blood-cooling and toxin-resolving. Since Chen Wenzhong's formulas became popular, deficiency-cold cases mostly survived, while heat-toxin cases were incurable. Smallpox is fetal toxin; ancient methods focused only on resolving toxins. However, if qi and blood are deficient, toxins cannot be expelled or matured. Thus, Chen's method is a millennium-old secret, supplementing predecessors' omissions. But since warming-tonifying methods prevailed, the principle of toxin-resolution faded, saving one side while harming the other.

When treating smallpox, one must recognize syndromes. If lesion bases are sparse, roots are red and lustrous, no diarrhea/thirst, milk/food intake unchanged, limbs warm, no high fever, no medication is needed; simply care well and wait for maturation. If itchy/sunken, chills, teeth-grinding, incessant thirst, purple-black lesions, wheezing/thirst/restlessness, gray-white sunken tops, abdominal distension, warm head/cold feet, confusion, drinking, shortness of breath, diarrhea/thirst—such syndromes require no medication; even forced treatment is futile.

In treating smallpox, skillful defense is better than skillful attack. If exterior and interior are free of pathogens, do not treat recklessly. Some greedy practitioners, ignoring deficiency/excess, blindly administer decoctions and pills, claiming credit for cures, causing deficiency-to-excess and excess-to-deficiency errors, leading to mutations and death. This is the physician's sin.

[Medication] [Wan Quan] For smallpox, medication must distinguish qi/blood and deficiency/excess, and the severity of toxins. Gray-white, non-raised, itchy/sunken, vomiting/diarrhea, chills/teeth-grinding, cold hands/feet—all indicate qi deficiency, suitable for qi-tonifying agents. Dry lesions, non-lively color, scant pus—all indicate blood deficiency, suitable for blood-tonifying agents. Dense, swollen, red-purple lesions—all indicate severe toxin, suitable for toxin-resolving agents. Sunken lesions require combined qi/blood and toxin resolution. For qi tonification, Si Jun Zi Tang (Four Gentlemen Decoction) is suitable; if lesions are moist or spontaneous diarrhea occurs, it can be used. If lesions are dry, Baizhu dries fluids, Fuling leaches fluids; if constipated and excess, it is unsuitable. For blood tonification, Si Wu Tang (Four Substance Decoction) is suitable; if lesions are dry or color is too delicate, it can be used. If unable to eat, Shengdihuang clogs the chest, Shaoyao contracts intestines/stomach; it is unsuitable. For toxin resolution, agents include Huanglian, Huangqin, Huangbai (Phellodendri Cortex), Zhizi (Gardeniae Fructus), Lianqiao (Forsythiae Fructus), Niubangzi, Shengma, etc., all wine-processed to prevent cold-cooling from damaging spleen/stomach. To release the exterior, add a little Guizhi (Cinnamomi Ramulus). Others like Zicao, Shandougen (Sophorae Tonkinensis Radix), Gegen need not be wine-processed. When using toxin-resolving drugs, distinguish organs and yin/yang. Huanglian clears Heart fire, Huangqin clears Lung fire, Zhizi clears Liver fire, Huangbai clears Kidney and Sanjiao fire, Shigao (Gypsum Fibrosum) clears Spleen/Stomach fire, Mutong clears Small Intestine fire, Huangqin also clears Large Intestine fire, Lianqiao/Niubangzi clear sores/toxins fire, Shandougen/Zicao clear smallpox toxin fire, Shengma clears epidemic toxin fire. Each has specific indications. Above half-year age, belonging to Yang, Heart/Lung dominate; use more Huangqin/Huanglian. Below half-year age, belonging to Yin, Kidney/Liver dominate; use more Huangbai/Zhizi.

Secretly Transmitted Eight-Ingredient Two-Flower Powder
Taohua Rui (Peach Blossom Stamen) (5 qian), Meihua Rui (Plum Blossom Stamen) (unlimited amount, dried in shade, total 1 liang 6 qian 2 fen), Chuanshanjia (Manis Squama) (take four-footed ones, wine-fried, 1 liang), Zhusha (Cinnabar) (water-washed, 1 liang), Ziheche (Human Placenta) (wash off red veins, bake dry, powder, one placenta), Tianlinggai (Skull Cap of Human Skull) (one piece, wash with Sophora decoction, prepare with butter, powder, total 1 qian 7 fen), Lurong (Cervi Cornu Pantotrichum) (remove hair, prepare with butter, total 1 liang 2 qian), Renshen (selected official grade, 1 liang).
Grind each into powder. Before smallpox/rash eruption, use 1 liang Zhusha as the chief ingredient, mixed with 2 qian Meihua and 3 qian Taohua. Take 5 fen, 3 fen, or 2.5 fen per dose. Feed a rooster with two cups of wine, collect its blood into the cup by hanging it upside down and pricking it. Mix the medicine with hot wine and administer together. For initial failure to rise, use 1 liang Meihua as chief, add 1 qian Taohua and 5 fen Tianlinggai. For qi/blood deficiency, gray-white color, use 1 liang Ziheche as chief, add 1 qian Tianlinggai, 1.5 qian Lurong, 1 qian Meihua, and 1 qian or 8 fen Taohua. For black sinking/non-rising, use 1 liang Chuanshanjia as chief, add 1 qian Taohua, 8 fen Meihua, 7 fen Tianlinggai, and 5 fen Shexiang (Moschus). For qi/blood deficiency failing to fill pustules, use 1 liang Lurong as chief, add 2 qian Ziheche, 1 qian Taohua, 8 fen Meihua, 7 fen Tianlinggai, 5 fen Shexiang, and 1 qian Renshen. For qi/blood deficiency failing to scab, use 1 liang Lurong as chief, 5 fen Tianlinggai, 7 fen Taohua, 9 fen Meihua. After scab falling, if scar is white and qi/blood deficient, use 1 liang Renshen as chief, add 2 qian Ziheche, 1 qian Lurong, 1.5 qian Meihua. All above follow the first administration method.

Baosheng San
Ziheche (prepared as above), Guiban (Testudinis Carapax et Plastrum) (butter-fried, 1 fen), Lurong (butter-fried, 1 liang each).
Grind into powder. Dosage depends on child's size. For blood deficiency, take with Danggui, Fuling, Zicao decoction. For qi deficiency, take with Renshen, Huangqi, Gancao decoction.