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Yangwei Kaitan Decoction (Stomach-Nourishing Phlegm-Resolving Decoction): Renshen (Ginseng Radix et Rhizoma) 3 fen, Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil) 3 fen, Zhigancao (Prepared Licorice Root) 3 fen, Yunling (Poria), 3 fen, Jiegeng (Platycodon Root) 3 fen, Zharou (Hawthorn Flesh, stir-fried) 5 fen, Huaiyao (Dioscoreae Rhizoma, stir-fried) 5 fen (preferably 2 qian), Chenpi (Citri Reticulatae Pericarpium) 3 fen, Shengjiang (Fresh Ginger) as a guide.

Jianzhong Decoction (Middle-Building Decoction): Renshen (Ginseng Radix et Rhizoma) 2 qian, Zhigancao (Prepared Licorice Root) 3 qian, Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil) 1.5 qian, Guishen (Angelicae Sinensis Radix, wine-stir-fried) 1.5 qian, Chuanxiong (Ligusticum Chuanxiong Rhizome) 8 fen.

Wenbiao Tiaozhong Decoction (Warm-Surface Regulate-Middle Decoction): Zhigancao (Prepared Licorice Root) 2 qian, Renshen (Ginseng Radix et Rhizoma) 1 qian, Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil) 1 qian, Yunling (Poria) 1 qian, Guangui (Cinnamon Twig) 1 qian, Ganjiang (Dried Ginger) 1 qian.

Qingbiao Sandu Decoction (Clear-Surface Disperse-Toxicity Decoction): Gupi (Moutan Cortex, processed) 8 fen, Maidong (Ophiopogonis Radix, wine-rinsed) 8 fen, Huafen (Trichosanthis Radix, wine-stir-fried) 8 fen, Niuzi (Arctii Fructus, stir-fried) 5 fen, Lianqiao (Forsythiae Fructus) 4 fen, Gancao (Licorice Root) 4 fen.

Da Lianqiao Yin (Great Forsythia Infusion): Lianqiao (Forsythiae Fructus, heart removed) 1 qian, Niuzi (Arctii Fructus, stir-fried) 8 fen, Chaihu (Bupleuri Radix) 8 fen, Guishen (Angelicae Sinensis Radix, wine-rinsed) 8 fen, Chishao (Paeoniae Radix Rubra) 8 fen, Mutong (Akebiae Caulis, purified) 5 fen.

Xiaodu Sanxue Decoction (Dispel-Toxicity Scatter-Blood Decoction): Niuzi (Arctii Fructus, stir-fried) 1 qian, Jiushaoyao (Paeoniae Radix Alba, wine-treated) 1 qian, Taoren (Persicae Semen, skin and tip removed, oil extracted) 1 qian, Shudahuang (Polygoni Multiflori Preparata Radix) 1 qian, Honghua (Carthami Flos) 5 fen.

Buzhong Yiqi Tang (Tonify-Middle Boost-Qi Decoction): Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix) added according to previous instructions. Renshen (Ginseng Radix et Rhizoma) 8 fen, Zhigancao (Prepared Licorice Root) 8 fen, Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil) 8 fen, Guishen (Angelicae Sinensis Radix, wine-rinsed) 8 fen.

In cases where smallpox erupts accompanied by macules (Ban, 斑), there may be red spots without granules, which often appear and disappear quickly. In other cases, it erupts accompanied by scarlet rash (Dan, 丹), appearing as large red patches like cloud patterns with pointed elevations. These are all caused by toxic fire floating and scattering between the skin and muscles. For such conditions, one need not panic; simply disperse the wandering fire, and the macules and rashes will naturally recede. Yuanshen Shengma Tang (Scrophulariae Radix and Cimicifugae Rhizoma Decoction) is appropriate.

When smallpox erupts accompanied by measles sores, continue using Yuanshen Shengma Tang (Scrophulariae Radix and Cimicifugae Rhizoma Decoction), adding Jiegeng (Platycodon Root) and Huangqin (Scutellariae Radix) 6 fen each, to allow the measles to recede first, after which the smallpox will naturally rise and develop.

When smallpox first appears in the first or second day, it is fine and small; by the fourth or fifth day, it becomes larger but flat-topped; by the sixth or seventh day, the base widens and the top sinks further. If the color is entirely white and the shape resembles a bean shell, it is named "Dao Ye" (Reversed Crusting/Inversion). This indicates severe deficiency of Qi and Blood, preventing the formation of pus/fluid. Can Gui Lu Rong Tang (Ginseng, Angelica, and Deer Antler Decoction) should be used, adding Guangui (Cinnamon Twig), Shaoyao (Paeoniae Radix), and Chuanxiong (Ligusticum Chuanxiong Rhizome) 6 fen each, and Nanmuxiang (Aquilariae Lignum Resinatum) 4 fen. If diarrhea occurs, use Can Xiao San (Ginseng-Resolving Powder) concurrently.

Itching of the smallpox indicates exterior deficiency. This is a critical condition. Urgently use Shen Gu Shi Biao Tang (Ginseng-Firming Exterior Decoction) to tonify. Itching smallpox essentially belongs to deficiency. Guan Zhongyang claimed there could be cases of Qi excess; however, gray-white smallpox indicates not only Qi deficiency but also severe Blood deficiency. How can such a condition ascend to the skin and flesh to cause itching? Thus, this theory is not necessarily correct.

If itching is caused by foul air contact, urgently burn Cangzhu (Atractylodis Rhizoma) and Red Dates (Zao Ren), or yellow tea leaves to ward off the foulness. For severe cases, take Heping Tang (Harmonizing Decoction), see the Fever section for the formula.

Painful smallpox indicates excess, which is an auspicious sign. Use raw Shaoyao (Paeoniae Radix Alba) 2 qian ground into powder, mixed with wine and taken orally to stop pain immediately. Severe cases require no more than two doses.

After the smallpox has fully erupted, if the face and eyes are swollen but the pustules themselves are not, this is due to weakness of Qi and Blood, unable to consolidate the toxic vapors to form pus, causing the toxin to scatter and wander in the muscle layers. This is a critical prognosis. Urgently tonify Qi and Blood greatly to consolidate the toxin. Use Shen Gui Da Bu Tang (Ginseng and Angelica Great Tonifying Decoction); then the pustules will fill with pus and the flesh swelling will subside naturally.

Several days after the smallpox has fully erupted, if there are purple, swollen, hard pustules that are unusually large without a surrounding halo, these are "Dou Ding" (Smallpox Carbuncles). Fill them with Sisheng Gao (Four Saints Ointment), or apply Badu San (Detoxification Powder). First, pierce the carbuncle opening with a silver needle, insert the medicine, and it will turn red and vibrant.

When smallpox toxin manifests on the skin, and Qi and Blood cannot transform it into pus and scabs, stagnant heat remains undissipated, leading to redness, swelling, and abscess formation. This occurs less frequently before the crusting phase and more frequently after. Before crusting, there may be cases with little and thin pus. After crusting, there may be cases with thin, floating scabs that form and fall quickly. However, cases with full pus and thick, solid scabs that form and fall slowly do not exist. This is clear evidence of whether the toxic vapors have been fully excreted or not. Additionally, abscesses caused by taking tonics when not deficient, or hot herbs when not cold, are medical errors. All such cases should be treated primarily with Da Lianqiao Yin (Great Forsythia Infusion). When the swelling first begins, internal and external attacks occur simultaneously, and dispersal is the best approach. Once pus forms, young children often cannot tolerate it well, and locations on the head, chest, back, waist, and abdomen are dangerous. Externally, apply Sansheng Jiang (Three Milks Paste).

Smallpox sores originally tend to ulcerate. After crusting, if the hands, feet, or other areas remain hot, smelly, and weeping continuously, apply Shengji San (Generate-Flesh Powder). The heat will subside, scabs will form, and healing will occur. If heat and pus persist without immediate healing, resolve it with Da Lianqiao Yin (Great Forsythia Infusion). If residual toxins flow to various parts and secrete clear fluid, apply Mianjian San (Silkworm Cocoon Powder).

Epistaxis (nosebleed) during smallpox indicates toxic vapors rushing upward to the Lung. Since the toxin is being excreted externally, this is not a malignant sign, and one need not panic. Treat with Fahui San (Hair-Ash Powder) or Qingfei Tang (Clear-Lung Decoction). Do not harshly use cold-cooling herbs such as Xijiao (Rhinoceros Horn, now substituted), Shengdi (Rehmanniae Radix), Zhizi (Gardeniae Fructus), or Sanhuang (Three Yellows), as this will freeze and stagnate Qi and Blood, causing great harm. People who do not understand this principle often mistake nosebleeds, sore throat, or mouth ulcers associated with smallpox for excess heat, and hastily administer cold-cooling herbs. This freezes the blood vessels, preventing the smallpox from forming pus and turning into complicated diseases. This treats the branch while harming the root, demonstrating extreme ignorance.

Smallpox blisters containing water but no pus indicate insufficient Blood to transform into pus. Urgently use Can Gui Lu Rong Tang (Ginseng, Angelica, and Deer Antler Decoction) to strongly tonify Blood. If the ratio of pus to water blisters is half-and-half, it is not concerning. If three or four out of ten parts are pus-filled, there is still vitality. Only if the entire body consists of water blisters is it critical. However, if the Stomach Qi is good and appetite is normal, survival is possible, but one must guard against abscess formation as the toxic vapors have not yet dissipated.

If a child has many smallpox lesions, their Qi and Blood are limited and cannot all transform into pus, resulting in alternating water blisters and pus blisters. This is normal physiology. If there are no other symptoms, no treatment is necessary.

Mouth and tongue ulcers during smallpox may be due to heat-toxin or deficiency-fire. Differentiate based on the color of the smallpox. Do not universally assume excess heat and use purely cold-cooling detoxifying herbs. If the smallpox color is red-purple and vigorous, it is heat-toxin; treat with Shangqing Yin San (Upper-Clearing Infusion Powder). If the smallpox color is pale white, it is deficiency-fire; treat with Shen Mai Qing Bu Tang (Ginseng-Ophiopogon Clear-Tonifying Decoction) previously mentioned, and apply Fuyan San (Feast-Gathering Powder) externally for cure. If there are smallpox lesions on the mouth and tongue with swelling and pain, they will heal naturally upon crusting. No treatment is needed, and treatment would be ineffective.

For swollen and hard throat during smallpox, use Liyan Jiedu Tang (Throat-Relieving Detoxification Decoction) throughout the course, and apply Yusuo Chi (Jade Lock Spoon) powder externally via insufflation.

Hoarseness during smallpox requires differentiation of favorable vs. unfavorable prognosis based on smallpox color. If the smallpox is red-purple and hoarseness occurs during the pus-forming stage, this is because smallpox has formed in the Qi-Throat. When external smallpox forms pus, internal smallpox also forms pus, obstructing the airway and causing hoarseness. Wait for the external smallpox to crust; the internal smallpox will subside, and voice will return naturally. No additional treatment is needed. If the smallpox is gray-white and hoarse, it indicates weak Qi and Blood failing to expel the toxin, leaving toxin in the Lung and injuring Lung Qi, leading to loss of voice. This is critical! Use Shen Mai Qing Bu Tang (Ginseng-Ophiopogon Clear-Tonifying Decoction) combined with Qianjin Neituo San (Thousand-Gold Internal-Supporting Powder).

Furthermore, choking on water during smallpox varies in prognosis and must be differentiated. If choking occurs during the pus-forming stage, there is smallpox in the throat. External smallpox forming pus means internal smallpox also forms pus, blocking the food passage and causing choking. This passage is the gate for food intake; once blocked, food/drink overflows into the airway causing choking. If food is smooth without residue, it can be swallowed without touching the airway, so no choking occurs. Wait for external smallpox to crust; internal smallpox will self-resolve, and recovery will occur without medication. Although water causes choking here, the throat does not hurt severely. If choking occurs before the pus-forming stage, the toxic vapors are obstructed, and the throat will definitely hurt. Treat with the previously mentioned throat formulas.

Red urine during smallpox: Treat primarily with Daochi San (Guide-Out Red Powder). For hematuria, Danggui (Angelicae Sinensis Radix) 1 liang and Huainiuxi (Cyathulae Radix) 3 qian are also effective.

Smallpox toxin entering the eye: Cases include redness, swelling, pain preventing opening, or membranes obscuring vision and preventing sight. Ancient texts attribute this to smallpox entering the eye, but do not realize this is not a tangible smallpox lesion, but an intangible one. The membrane obscuring the pupil resembles smallpox but is not actually so. Tangible smallpox may occur in the throat and mouth/tongue, but when external smallpox swells, internal smallpox is also vigorous; when external smallpox crusts, internal smallpox subsides. However, toxin entering the eye manifests at the time of crusting and restoration of Yuan Qi, distinct from throat/mouth smallpox, proving it is not a tangible lesion. The eye is the essence of Qi and Blood of the five Zang organs. Toxin stagnating in the skin and muscles causes pain or boils, but remaining in the essence causes eye disease. The pathology is deep. Treatment must not be reckless or hasty, expecting results in a few doses. Manage calmly, achieving results after dozens of doses. Do not suddenly use cold-cooling herbs to attack internally or drain downward. Why? Post-smallpox patients have weak Yuan Qi, and their toxin is exposed on the surface and at the highest part of the body. Harshly using cold-cooling herbs injures Yuan Qi and opposes the disease trend, inevitably leading to blindness and other illnesses, causing significant harm. Also avoid washing with cold-cooling herbs. Only use Qingdu Boyi Tang (Toxin-Clearing Membrane-Removing Decoction) to regulate slowly.

White sclera and thirst after smallpox indicate Spleen Fire. Brew Loess (Huangtu) in boiling water, clarify, and drink warm. Cure follows.

Post-smallpox toxicity: Use Sanhuang (Three Yellows) ground into powder. Apply dry if there is moisture, or mix with sesame oil if dry.