如才发一二日间，痘便一齐涌出者，须问其曾数日前有热否，如曾数日前乍热
乍凉，以过期论。惟原未发热，至今才热便斑现，此表气虚，毒瓦斯盛，荣热卫弱，
腠理不密，肌肉不坚，不能约束于外，使毒瓦斯冲击，故出太骤也。宜用实表之剂，可
以无痒塌，无溃烂。实表解毒汤主之。一方，用羌活散调紫草膏，或保婴丹加紫
草、牛蒡子、蝉蜕与服。热盛不退，以羌活散调退火丹进之，另用灯草、木通、
蝉蜕、地骨皮煎汤候冷服。此用发表之剂，与表虚卫弱之说背驰，盖亦有初发热
时见表证失于解散，实热壅遏而怒发者，此法犹可施也，然得全者，鲜矣。
实表解毒汤
黄 人参 当归稍 生地黄 白芍药 地骨皮 甘草 酒片芩 柴胡 玄参 升麻
上锉细。加薄荷叶少许，淡竹叶十片，水煎温服，无时。
消毒快 汤
桔梗 甘草节 荆芥穗 牛蒡子 防风 当归尾 赤芍药 天花粉 黄 玄参 连翘 前胡 木通
水煎服。
清地退火汤 治痘带热而出，名为火里苗，急用此方以退其热，则后无青黑变陷之候。
地骨皮 地肤子（各一钱） 牛蒡子 紫草 葛根（各八分） 连翘（六分） 当归（五分）
木通（三分） 蝉蜕（二分）
上，加姜一片，水煎服。如热不退，再服一剂，或为末，灯心汤服。
羌活散（本门初热） 保婴丹（本门预防） 退火丹（即六一散加牛黄缠豆藤见初热）
如果痘疹在刚发出的一两天内就一齐涌出，必须询问患者在几天前是否有过发热。如果之前曾有过忽冷忽热的症状，应按病程已过期的情况论治。只有那些原本没有发热，直到今天才发热并随即出现斑疹的，属于表气虚弱、毒邪炽盛，营血热而卫气弱，腠理（皮肤纹理及汗孔）不致密，肌肉不坚实，不能固摄于外，导致毒邪冲击，所以出得太急促。适宜使用充实表气的方剂，可以避免瘙痒塌陷和溃烂。以实表解毒汤为主治方。另一方案，用羌活散调服紫草膏，或者保婴丹加入紫草、牛蒡子、蝉蜕一起服用。如果热势亢盛不退，用羌活散调服退火丹进服，另外用灯心草、木通、蝉蜕、地骨皮煎汤，待冷却后服用。这种方法使用的是发表（发散表邪）的方剂，与表虚卫弱的理论相违背，大概是因为在初发热时见到表证却未能及时解散，导致实热壅滞而猛烈爆发，这种情况下此法还可以施行，然而能痊愈的人很少了。
实表解毒汤
人参 当归梢 生地黄 白芍药 地骨皮 甘草 酒炒黄芩 柴胡 玄参 升麻
以上药材切碎成细末。加入少许薄荷叶，淡竹叶十片，加水煎煮，温服，不拘时候。
消毒快汤
桔梗 甘草节 荆芥穗 牛蒡子 防风 当归尾 赤芍药 天花粉 黄芪 玄参 连翘 前胡 木通
加水煎煮服用。
清地退火汤 治疗痘疹带着热邪而出，名为“火里苗”，急需使用此方以退去其热，那么之后就不会出现青黑变色或内陷的症状。
地骨皮 地肤子（各一钱） 牛蒡子 紫草 葛根（各八分） 连翘（六分） 当归（五分）
木通（三分） 蝉蜕（二分）
以上药材，加生姜一片，加水煎煮服用。如果热势不退，再服用一剂，或者将药研为粉末，用灯心草汤送服。
If the smallpox lesions erupt all at once within one or two days of onset, it is necessary to inquire whether the patient had a fever several days prior. If there was intermittent fever (alternating hot and cold) several days ago, it should be treated as having passed the critical period. However, if the patient originally had no fever and only developed a fever today, followed immediately by the appearance of macules/rashes, this indicates deficiency of Wei Qi (Defensive Qi) at the exterior, excessive pathogenic toxins, heat in Ying Blood (Nutritive Blood) with weakness of Wei Qi, loose interstices (skin pores and tissue spaces), and unfirm muscles, which fail to constrain the exterior, allowing toxins to surge outward; thus, the eruption is too rapid. It is appropriate to use formulas that tonify the exterior, which can prevent itching, collapse, and ulceration. Shibiao Jiedu Tang (Solidify Exterior and Detoxify Decoction) is the primary prescription. Another method involves using Qianghuo San (Notopterygium Powder) mixed with Zicao Gao (Arnebia Ointment), or Baoying Dan (Infant Protection Pill) added with Zicao (Arnebiae Radix seu Rhizoma), Niubangzi (Arctii Fructus), and Chantui (Cicadae Periostracum). If the heat remains intense and does not subside, Tuihuo Dan (Eliminate Fire Pill) mixed with Qianghuo San is administered; additionally, Dengcao (Junci Medulla), Mutong (Akebiae Caulis), Chantui (Cicadae Periostracum), and Digupi (Lycii Cortex) are decocted in water, cooled, and taken orally. This approach uses exterior-releasing formulas, which contradicts the theory of exterior deficiency and weak Wei Qi. This situation likely arises because the exterior syndrome during initial fever was neglected and not resolved, leading to stagnation of excess heat and violent eruption. Although this method may still be applied, few patients recover fully.
Shibiao Jiedu Tang (Solidify Exterior and Detoxify Decoction)
Renshen (Ginseng Radix et Rhizoma), Danggui Shao (Angelicae Sinensis Radix tip), Sheng Dihuang (Rehmanniae Radix), Baishao Yao (Paeoniae Radix Alba), Digupi (Lycii Cortex), Gancao (Glycyrrhizae Radix et Rhizoma), Jiuhuangqin (Scutellariae Radix fried with wine), Chaihu (Bupleuri Radix), Xuanshen (Scrophulariae Radix), Shengma ( Cimicifugae Rhizoma).
Crush these ingredients finely. Add a small amount of Bohe Ye (Menthae Haplocalycis Folium) and ten slices of Danzhuye (Lophatheri Herba). Decoct in water and take warm, at any time.
Xiaodu Kuaitang (Rapidly Dispel Toxics Decoction)
Jiegeng (Platycodonis Radix), Gancao Jie (Glycyrrhizae Radix et Rhizoma node section), Jingjie Sui (Schizonepetae Spica), Niubangzi (Arctii Fructus), Fangfeng (Saposhnikoviae Radix), Danggui Wei (Angelicae Sinensis Radix tail), Chishao Yao (Paeoniae Radix Rubra), Tianhuafen (Trichosanthis Radix), Huangqi (Astragali Radix), Xuanshen (Scrophulariae Radix), Lianqiao (Forsythiae Fructus), Qianhu (Peucedani Radix), Mutong (Akebiae Caulis).
Decoct in water and take orally.
Qingdi Tuihuo Tang (Clear Earth and Eliminate Fire Decoction)
Indicated for smallpox erupting with heat, termed "Fire-born Sprouts." Use this formula urgently to reduce heat, thereby preventing subsequent cyanosis, blackening, or sinking lesions.
Digupi (Lycii Cortex), Difuzi (Kochiae Spina): each 1 qian.
Niubangzi (Arctii Fructus), Zicao (Arnebiae Radix seu Rhizoma), Gegen (Puerariae Lobatae Radix): each 8 fen.
Lianqiao (Forsythiae Fructus): 6 fen.
Danggui (Angelicae Sinensis Radix): 5 fen.
Mutong (Akebiae Caulis): 3 fen.
Chantui (Cicadae Periostracum): 2 fen.
Add one slice of Jiang (Zingiberis Rhizoma Recens). Decoct in water and take orally. If heat persists, administer another dose, or grind into powder and take with Dengxin Tang (Junci Medulla Decoction).
Qianghuo San (Notopterygium Powder) (Used in the initial fever stage of this section)
Baoying Dan (Infant Protection Pill) (Used for prevention in this section)
Tuihuo Dan (Eliminate Fire Pill) (Consists of Liuyi San plus Niuhuang, see "Initial Fever" chapter for Tiandouteng)