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Smallpox (or variola) is characterized by "form" (shape) being full and plump, and "color" being red and vibrant. A depressed and non-elevated pustule head indicates Qi deficiency (deficiency of vital energy), while a lack of brightness in color indicates Blood deficiency (deficiency of nutritive blood). Treatment should primarily focus on nourishing and tonifying Qi and Blood. In cases of true Yang deficiency, there is no red halo, and the entire body may appear white, with the body feeling cold and not warm. The Da Bu Yuan Jian (Great Tonification Decoction for the Source) should be used; once Yang returns and the body warms up, the color will turn from white to red.

There is another condition where the entire body is covered with blood blisters. This is not due to excess Blood, but rather insufficient Qi failing to control the Blood, causing it to flow recklessly. One must urgently use Da Bu Yuan Jian. Once Qi and Yang are filled, the blood blisters will turn white (suppurate) and the patient will recover. Quack doctors, misunderstanding this principle, erroneously claim it is Blood Heat and mistakenly use cold and cooling herbs, leading to an increase in complications day by day.

Form and color are external manifestations. If the patient has an appetite for food and bowel and urinary functions are normal, one can ascertain that there is no internal disease, and medication may be withheld. However, if bowel and urinary functions are irregular, food cannot be taken, and the patient experiences irritability, confusion, and restlessness at night, even if the form and color appear good, it is a matter of great concern. One must carefully examine the condition and administer medication cautiously to save life.

Poor form and color are mostly due to Qi deficiency and Cold, accompanied by cold extremities, heavy head, mental fatigue, clear stools, and diarrhea. Da Bu Yuan Jian must be used, combined with Fuzi (Prepared Aconite Root) and Guizhi (Cinnamon Twig). If diarrhea persists, Longgu (Fossilized Bones) and Susuke (Poppy Shell) should be added to astringe and stop the discharge, which can then restore life.

Redness is prized in smallpox, categorized into Quan Hong (Ring Red), Xun Hong (Scattered Red), and Pu Hong (Spread Red). Quan Hong refers to a distinct ring of redness tightly adhering to the base of the pustule, which is the most auspicious sign. Xun Hong refers to the blood color at the base appearing faint and scattered, also due to Qi's inability to consolidate; rapid tonification of Qi and Blood is required. Pu Hong refers to a flat spread of redness extending to areas without pustules, indicating indistinct boundaries. If accompanied by aversion to cold, thirst with desire to drink, foul-smelling and scanty urine, and dry, constipated stool, it indicates internal heat. Bai Hu Di Huang Tang (White Tiger and Rehmannia Decoction) should be used to clear heat and promote urination. Once heat subsides and the body cools, mild tonification should be adopted, avoiding excessive doses.

Another type is Xi Guang Dou (Tin-Light Pustules), where the body is cold and not warm, and the color is white without redness. This is Yang deficiency, representing Yin manifestation. It requires massive tonification of Qi and Blood, using Fuzi and Guizhi together. When Qi is sufficient and Yang returns, the pustule base turns red, and the pus becomes thick, forming scabs. Another type features a base without a red disk and a top containing black fluid. This indicates severe Yang deficiency and congealing of Yin. Da Bu Yuan Jian combined with Fuzi and Guizhi is appropriate, transforming the black fluid into pus.

There are five types of blisters: Water Blister, Pus Blister, Ash Blister, Blood Blister, and Purple Blister. There are five types of depressions/collapses: White Collapse, Ash Collapse, Blood Collapse, Purple Collapse, and Black Collapse. Water blisters have thin, transparent skins. The Classics state that Qi heat generates water, knowing that clear serum is water. Why does it not become pus? Because Fire (Yang) is insufficient. Large doses of Jiang (Ginger), Gui (Cinnamon), and Fuzi (Aconite) must be administered abruptly; the water will then transform into pus. If cooling herbs are mistakenly used, causing diarrhea, it transforms into White Collapse. Neglecting Pus Blisters leads to rupture and discharge of pus. Neglecting Ash Blisters leads to Ash Collapse. Both conditions require large doses of Renshen (Ginseng), Shudi (Prepared Rehmannia Root), Fuzi, and Guizhi. If small granules emerge, it is called "the child saving the mother," indicating that vitality remains.

Blood blisters result from Qi deficiency, not Blood Heat. They also require massive tonification of Yuan Yang (Original Yang); otherwise, they transform into White Collapse. Purple blisters present two syndromes: Those with purple mixed with cyan are due to Qi deficiency failing to control Blood, causing Yin Blood to congeal. The patient必定 exhibits fatigue, aversion to cold, white tongue coating, poor appetite, and clear urine and stool. Rapid tonification of Yuan Yang is necessary, or it transforms into Purple Collapse. Another type is purple-black and scorched/dry, representing a syndrome of pure Yang without Yin. The patient必定 exhibits dry mouth, aversion to heat, scanty urine, and constipation. This is Excess Fire. Cooling and detoxification methods are indicated; Bai Hu Di Huang Tang with added Dahuang (Rhubarb) to promote purgation is suitable. As long as suppuration occurs, survival is possible; neglect leads to Black Collapse.

Furthermore, some children, after taking cooling herbs, experience abdominal pain, vomiting, and diarrhea, progressing toward slow convulsions. They exhibit high fever on the head and face, cracked lips, and a black tongue, resembling Excess Fire. This is actually Fire failing to return to its source (Mingmen). Excess Fire is characterized by foul, obstructed urine and stool. Deficient Fire is characterized by incessant diarrhea. Careful observation is essential to discern the truth. The Classics say: "For existing symptoms, seek their cause; for absent symptoms, seek their mechanism. For Excess, blame the pathogen; for Deficiency, blame the constitution." This means all diseases must be examined regarding Cold, Heat, Excess, and Deficiency. Can treatment of smallpox simply assume Excess Fire and indiscriminately use bitter-cold, draining herbs, thereby costing lives?