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Pediatric smallpox (Xiaoe Douchuang) is caused by excessive sexual fire during the conception of parents. This is referred to as congenital toxin (Xiantian Zhi Du), acquired at the very beginning of life. Generally, smallpox is essentially a congenital sexual toxin, hidden within the Liver and Kidneys. When triggered by abnormal Qi of the four seasons, it erupts. Qi leads and Blood carries, delivering the toxin to the exterior of the skin. This is because Wei Qi (Defensive Qi) circulates outside the vessels, while Ying Blood (Nutritive Blood) circulates inside the vessels; Qi can expel toxins outward, and Blood can carry toxins upward. For those with strong Yuan Qi (Primal Qi), scabbing occurs within ten days, leading to recovery. If Yuan Qi is weak, with deficiency in Qi and Blood, or excess of Cold/Heat, the toxin cannot fully reach the skin surface. The remaining toxin rises and reverses upward, causing smallpox lesions in the eyes and damaging the pupil (Tongshen). Alternatively, after the pustule stage, although the toxin has erupted on the skin, the internal Yuan Qi of the Five Viscera is already deficient, and medicinal tonification is insufficient. The residual toxin fails to exit externally and instead penetrates deeply inward, resulting in star-like opacities and obscuration in the eyes, with various complications. By examining the color of the scabs: white indicates Qi deficiency; pale red indicates Blood deficiency; purple indicates residual toxin not yet cleared. If scabs do not fall off after the expected period, it signifies severe depletion of Qi and Blood. Regulating cold, heat, warmth, and coolness, and supplementing deficient Qi and Blood will restore clear vision and eliminate opacities.

Rash (Zhen) is a minor disease following smallpox, originating from the Spleen and Lung meridians, internally corresponding to the Hand and Foot Taiyin meridians. It is caused by pathogenic Li Qi (Malignant Qi) from heaven and earth, hence named Rash. However, names vary: in Suzhou and Songjiang, it is called Sha Zi (Sand Children); in Zhejiang, it is called [missing character] Zi; in Huguang, Ma Zi (Hemp Children); in Zhili, Zhen Zi (Rash Children); in Shanxi and Shaanxi, Fu Chuang (Skin Sores), also known as Kang Chuang (Bran Sores) or Chi Chuang (Red Sores). Although names differ, symptoms are identical. It is generally due to the blazing of Ministerial Fire (Xiang Huo) and Sovereign Fire (Jun Huo), affecting the Taiyin Spleen and Lung. Thus, symptoms necessarily include sneezing, coughing, facial swelling, red cheeks, swollen eyelids, and watery eyes. Cases where Qi is robust and pathogen is shallow are easy to treat. If pathogen is strong and Zheng Qi (Upright Qi) is weak, unable to withstand the toxin, crisis ensues immediately. Furthermore, after recovery, if residual heat remains unclarified and ascends to the orifices, suppressing Wood of the Liver, it causes star-like obstructions on the black pearl (cornea/lens area), blurred vision, photophobia, and tearing. One must strictly avoid sour and cold herbs that damage the Stomach; instead, one should clear and nourish Lung Yin, and supplement Qi and Blood. Mistaking this for Wind and using dispersing/superficial-releasing methods is like adding fuel to the fire.