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Generally speaking, in the regulation and treatment of smallpox (or variola), from the initial stage of fever to the time when spots appear, one must consider how to promote eruption, how to fill with pus, and how to scab over. Once medication is administered, one must attend to both the beginning and the end, being cautious in the initial phase to ensure a good outcome, and then proceeding with step-by-step regulation and treatment to guarantee safety.

At the initial stage of fever, if the body heat is mild and moderate, fluctuating or subsiding, and the spirit is clear and refreshing, there is no need to use medicine to induce sweating; one should merely avoid greasy food and wind exposure, without taking any medicine. This is because some cases of smallpox follow a smooth course without specific treatment; not treating lightly is itself a form of treatment. However, if there are symptoms such as aversion to cold with high fever, headache, cough, and runny nose, these are mostly due to external contraction of pathogenic factors and cannot fail to be treated with dispersing methods. One should observe the patient's constitution: for those with strong constitutions, Jiawei Shengma Gegen Tang (Modified Ligusticum and Pueraria Decoction) can be used to induce slight sweating; for those with weak constitutions, Jiawei Shen Su Yin (Modified Ginseng and Perilla Drink) should be used to induce sweating. In all cases, excessive sweating must be avoided, lest it weaken the exterior and make subsequent swelling and pus-filling difficult. Nevertheless, these two formulas can also be taken for external contractions unrelated to smallpox without adverse effects.

If fever persists after sweating has been induced, do not resort to harsh purgatives immediately; wait for a while. If there is restlessness, dryness, thirst, and delirious speech, Bai Du He Zhong San (Poison-Dispersing and Middle-Regulating Powder) should be used to clear the heat. If constipation is present, add Jiu Chao Da Huang (Wine-fried Rheum Rhizome) to mildly promote bowel movement; if not constipated, do not add it. After taking the medicine, if irritability subsides slightly, stop administration immediately and allow the rash to erupt outward while the interior settles naturally. One must absolutely avoid lightly using Qingjie (clearing and resolving) herbs like Chai Hu (Bupleurum Root), Huang Qin (Scutellaria Root), and Hua Fen (Trichosanthes Root) typically used for Shanghan (Cold Damage) syndromes. If these medicines are misused, even by one dose, they will weaken the exterior. By the seventh or eighth day, the pus will certainly fail to form. Even with vigorous tonification, rescue will be impossible, leading to many deaths due to scorched, dried, itchy, and collapsed lesions. Smallpox relies on the interior as its root and the exterior as its foundation; weakening the exterior is like building a house but destroying its foundation. Thus, treating smallpox differs from treating Shanghan. In recent times, Guan [Zhongyang] wrote books... [Text fragment implies discussion on abdominal/lower back pain]. Or if there is abdominal pain, lower back pain accompanied by restlessness, this indicates heavy toxic qi, which should also be primarily treated with Bai Du He Zhong San. For constipation, add wine-fried Da Huang to mildly promote evacuation. Allow the toxin to exit outward so internal pain stops naturally. Then, observe whether the rash is dense, red-purple, or black, and only then discuss detoxification. One must absolutely not use purely cold-natured herbs to block the trend of toxin expulsion, as this will immediately cause internal attack and transformation into critical conditions. People who do not understand this principle often use purely cold-natured detoxifiers or harsh purgatives like Xiao (Mirabilite) and Da Huang, causing rapid death without realizing the cause, which is lamentable.

During the season when smallpox breaks out, children may have slightly milder fever, with heat appearing and disappearing, or having red spots, or no red spots visible, or faintly visible but unclear, or possibly having smallpox or not, remaining in a state of doubt. At this time, it is better not to administer medicine but to wait for clarity, merely avoiding wind and greasy food. This is what is meant by "not treating lightly is precisely deep treatment." Some wealthy families, overly cherishing their children, seeing such symptoms, repeatedly administer cooling and detoxifying agents. They do not realize that if it is indeed smallpox, the toxic qi originates from the five zang organs and vigorously seeks to emerge outward; this momentum cannot be blocked. If cooling agents are used to block this momentum, it forces the toxin inward, accelerating disaster. Consequently, many who commit this error die from restlessness and convulsions a few days after eruption, harmed by detoxifying medicines. It is like bandits within palace walls: instead of driving them out, one blocks their exit, surrounds, and attacks them; surely the people inside will suffer harm. Yet physicians say, "I used detoxifying medicine; how could it kill?" refusing to accept blame. Families say, "He used detoxifying medicine; how could it kill?" failing to attribute fault to the doctor. Killing in the dark without self-awareness or public understanding is truly tragic. Therefore, I highlight this to warn those whose love becomes harmful.

The saying goes: "Those aged long possess concentrated toxins." Smallpox toxin is inherited from prenatal essence and lies hidden in the five zang organs. The mild cases need not be discussed; the severe cases are deeply stored and accumulated, certainly not lacking concentration. Once triggered suddenly, the momentum is fierce and unstoppable. Therefore, one must rely on blood and qi to carry the toxin outward, forming pus and scabs, so that the toxin dissipates and the cure is achieved. This is both the disease mechanism and the transformative process. How can this be compared to other sores where toxins can be dispersed abruptly? Thus, detoxifying after eruption follows the natural trend of dispersion and is reasonable. Detoxifying before eruption blocks the fierce momentum of emergence, causing rapid disaster, like trying to stop a mountain-rushing flood with handfuls of soil—is this logical? Since ancient times, practitioners of smallpox treatment, whether low-level or high-level, have not deeply grasped this principle. Often at the initial fever stage, just before eruption, they prioritize detoxification, claiming that taking such medicine resolves the toxin and ensures sparse rash. They do not know that sparse rash results from light initial infection, not from sudden resolution at the moment of eruption. This has led later quacks to perpetuate errors: seeing intense toxic qi during impending eruption, they heavily use cold herbs to detoxify or wrongly purge. Believing these to be miraculous对症 (symptom-matching) remedies, they unknowingly cause internal attack disasters, killing patients without realization. Past failures serve no warning for future ones, leading to endless calamities! I observe that modern quacks frequently make this mistake, causing many children to die within days. They茫然ly attribute it to severe, incurable symptoms, while the world remains ignorant of the cause, which is pitiable. Hence, I must elucidate this principle to save future generations.