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At the initial stage of fever, if one accidentally contracts wind-cold and suffers from abdominal pain due to food stagnation, administering one dose of Jiawei Shengxiao Pingwei San (Modified Ascending, Eliminating, and Stomach-Pacifying Powder) will stop the pain immediately. However, the symptoms of abdominal pain caused by food stagnation differ from those caused by toxic vapors (smallpox toxins). Abdominal pain due to food stagnation is characterized by sudden and severe pain, loud crying, pain located mostly above the umbilicus, a clear-white complexion, pale lips, and cold hands and feet; it is treated with Shengxiao Pingwei San. Abdominal pain due to toxic vapors presents with slightly delayed pain that comes and goes, located mostly below the umbilicus or radiating to the waist, a red face with purple lips, and warm hands and feet; it is treated with Baidu Hezhong San (Toxin-Resolving and Middle-Jiao-Harmonizing Powder).

During the initial stage of fever, symptoms may include vomiting, diarrhea, or both simultaneously. Medication must be prescribed based on a differentiation of deficiency/excess and cold/heat. If vomiting and diarrhea occur together accompanied by severe chest and abdominal pain, this indicates contraction of cold combined with food stagnation. Shengxiao Pingwei San should still be used, yielding immediate results after one dose. If stomach qi is weak and cold pathogenic factors are present, leading to vomiting, loss of appetite, or immediate regurgitation after eating, where the vomit is smooth and silent, the complexion is blue-white, lips are pale, and spirit is fatigued, Jiawei Rensha Hewei San (Modified Ginseng and Amomum Stomach-Harmonizing Powder) is appropriate. If spleen qi is weak, causing indigestion and diarrhea where the stool is slippery and whitish, Shuqin Tiaopi San (Atractylodes and Scutellaria Spleen-Regulating Powder) is indicated. If vomiting and diarrhea are caused by toxic vapors, the vomit will be sour and spicy with sound, the spirit not overly exhausted, and the stool yellow and foul-smelling. Although vomiting and diarrhea may occur together, the chest and abdomen are generally not painful. This represents the venting of toxic vapors through vomiting and diarrhea, which is considered a favorable sign (shun hou) where stopping them is unnecessary; this is the only such case. In contrast, vomiting and diarrhea due to deficiency-cold are vastly different. Zhang Jiegu and others claimed that all cases prior to smallpox eruption involve vomiting and diarrhea, advising against treatment to ensure good outcomes, without distinguishing between deficiency/excess and cold/heat; this is extremely reckless.

When body heat persists for two to three days, and the rash desires to erupt but fails to do so, or if there is irritability, stifling sensation, convulsions, or delirious speech, one must not panic. Treatment requires careful examination of deficiency/excess and cold/heat. Essentially, these conditions arise because toxic vapors are trapped internally and cannot be vented externally. However, the failure of toxic vapors to vent manifests in different symptoms, necessitating differentiation.

If toxic vapors are abundant and stagnant internally, unable to suddenly erupt externally, resulting in convulsions and mania, the rash shadows will be red-purple, the face red and lips purple, voice loud, breath coarse, hands and feet hot, and pulse surging and rapid. This indicates abundant toxic vapors; Qingjie San (Clearing and Resolving Powder) should be used to vent them.

If internal toxins are originally abundant but constrained externally by wind-cold, leading to stagnation and inability to exit, resulting in convulsions and mania, the physical signs are similar to the previous case, but with heavy voice, nasal congestion, or runny nose, and a floating-rapid pulse. This indicates toxic vapors constrained by wind-cold, occurring mostly in cold months or in individuals intolerant to wind-cold. Sujiexuan San (Perilla-Resolving and Venting Powder) should be used to disperse them.

If qi and blood are weak, failing to push toxins out, resulting in convulsions and mania, the rash shadows are faint under the skin, tongue shows no redness, lips are pale, face is white or cyan, and pulse is slow and languid. Even with irritability, convulsions, madness, and delirium, this is due to qi and blood deficiency failing to expel toxins. Wenzhong Yiqi Tuo (Warming the Middle, Tonifying Qi, and Supporting/Ejecting method) is indicated.

These three categories require precise observation: examining form and color, listening to sounds, asking about symptoms, and consulting the pulse. Only then can differentiation be clear, medication accurate, and after one dose, the rash erupts and convulsions cease. Ancients claimed that convulsions before smallpox eruption are a favorable sign requiring no treatment; is this true?

Furthermore, when a child is about to develop smallpox, they may have fever for two to three days with no visible rash points, yet suddenly experience convulsions and mania resembling acute convulsive disease (Ji Jing Feng). This is also due to abundant toxic vapors unable to vent. Qingjie San should be used to vent them; once the rash erupts, convulsions cease. If physicians mistake this for acute convulsive disease and treat accordingly, using cold-cooling herbs or phlegm-dispersing purgatives, the child will surely die. Why? Because it obstructs the toxins, preventing their exit and causing internal attack. Therefore, for children before eruption encountering such symptoms, one should suspect smallpox.

In cases with slightly milder fever where the rash remains hidden for three to four days, careful examination is crucial; one must not assume light toxin and few spots. If fever is mild, spirit is clear, diet is normal, and the few erupted spots are distinct, pointed, gradually enlarging, red, and vibrant, this is indeed light toxin and few spots. However, if body heat lessens but by day three or four the child is fatigued, lethargic, anorexic, and the erupted rash is pale, indistinct, and shapeless, this is not light toxin but qi and blood deficiency failing to send toxins out. Urgently use Wenzhong Yiqi Tang (Warming Middle and Tonifying Qi Decoction) to support expulsion; severe cases may require two to three doses until the rash fully erupts, often resulting in numerous spots. If one ignores the quiet state and delays supporting the eruption, waiting until day five or six allows toxic vapors to attack internally, leading to sudden changes, which is terrifying. Thus, can the ancient saying "light heat means few spots" be fully trusted? Can the rule "do not use warming tonics before day six while the rash is incomplete" be rigidly adhered to? Since the existence of medical texts, spanning over two millennia and hundreds of authors, most detail post-eruption conditions while neglecting pre-eruption phases, warning of the dangers of rapid, dense eruptions but ignoring the disaster of retained toxins. The erupted toxin is an external invader; the un-erupted toxin is an internal invader. Which threat is more urgent? Internal attack or external attack, which is more severe? Deaths from erupted smallpox usually occur within ten days. For real-heat cases where external rash has not emerged, vent stagnation to drive toxins out; for deficiency-cold cases, tonify qi and blood to drive toxins out. Regarding the evils of urgently using cold-cooling agents to suppress toxins internally, warnings are repeated earnestly to correct past errors and enlighten future generations. Even if Qibo and Huangdi returned, my words would not change.

Reporting the rash at three to four days of fever, shaped like millet grains, appearing first in points around the mouth, nose, cheeks, ears, and nose tip (Nianshou), with a pale-red and moist appearance, is most auspicious. If the rash appears after one or two days of fever, starting at Tian Ting, Si Kong, Yin Tang, etc., or erupting densely all at once, or appearing dry, withered, purple-black, or confluent without distinct grains, this indicates blood-qii stagnation and rampant toxic vapors, which is most worrying. Urgently employ methods to invigorate blood, nourish qi, and resolve toxins, primarily using Yuanyuan Huadu Tang (Restoring Origin and Transforming Toxin Decoction). For abdominal pain, remove Ren Shen (Ginseng Root) and [missing character], add Zhi Ke (Aurantium Fruit) 8 fen. For chronic constipation, omit Ren Shen and [missing character], add Shu Jun (Prepared Rhubarb) 1 qian 5 fen. If both qi-blood and toxic vapors are vigorous with a surging-rapid pulse, reduce Gui (Angelica Sinensis Root) and Shao Yao (Peony Root) by one-third, and omit Ren Shen and [missing character].

If the rash erupts slowly, symptoms vary and must be distinguished. If the rash is red-purple, dry, dense like silkworm eggs, or confluent, accompanied by fever and constipation, this indicates toxic vapor stagnation and blocked qi-blood. Use Yuanyuan Huadu Tang, removing Ren Shen and [missing character], adding Xiao Chuan Xiong (Sichuan Lovage Rhizome) to clear.

If the rash is pale-white, with reduced diet, cool body, cold hands and feet, clear urine, and loose stools with slow eruption, this indicates deficient qi-blood unable to carry toxins out. Use Wenzhong Yiqi Tang to support expulsion.

If nasal congestion, heavy voice, cough, and aversion to cold accompany slow eruption, this is closure by wind-cold. Use Jiajian Rensu Yin (Modified Ginseng and Perilla Drink) to disperse, but avoid inducing sweating.

If triggered by foul pathogens causing latent sinking and slow eruption, the rash will itch. Use Pinghe Tang (Harmonizing Peaceful Decoction) to resolve. Externally, burn Cang Zhu (Atractylodes Rhizome), Red Dates, Chen Xiang (Aquilaria Wood), and Tan Xiang (Sandalwood) to ward off the odor.

During active eruption, sudden onset of wind-eye (staring eyes) and lockjaw indicates careless nursing and invasion by wind-cold. Do not lightly use harsh wind-dispelling drugs; use Jiang Fu Tang (Ginger and Aconite Decoction). Bai Fu Zi (Typhonii Rhizoma) 2 qian; this drug is highly toxic and should not be used lightly; processed Fu Pian (Aconite Lateralis Radix Preparata) or Rou Gui (Cinnamon Bark) may substitute. Lao Jiang (Old Ginger) 2 qian, decocted thick and taken warm; slight sweating leads to recovery.

During active eruption, a slightly warm body without heat or cold is ideal; mild, harmonious heat is also acceptable. Severe heat is worrisome; especially if high fever persists after the rash fully erupts. The rash will be dense, red-purple, and dry. Use Yuanyuan Huadu Tang, removing Ren Shen and [missing character]. To judge if the rash is complete, check the soles of the feet; presence of rash on the soles indicates completion. This rule does not apply to sparse rashes.

Meat should not be consumed too early; wait until the rash is complete and fever has completely subsided before eating pork. Eating meat while fever persists aids fire-pathogens and causes great harm. Chicken should be avoided entirely; only during the swelling phase can weak patients consume it to aid pus formation. Robust patients should avoid it. All fish are fishy, beef and mutton are gamey; these are taboo for smallpox patients and must be strictly prohibited.