Library

The manifestation of smallpox (Xiaochuan) is similar to Shanghan (Cold Damage), with the pathogen entering from the exterior into the interior, affecting only one meridian. In contrast, the morphology and symptoms of smallpox emerge from the interior to the exterior, presenting symptoms of all five Zang organs. The sequence of transmission is Kidney, Heart, Spleen, Liver, and Lung. On the first or second day, the eruption originates from the bone marrow of the Kidney and transmits to the blood vessels of the Heart; if Qi and Blood are sufficient, it fully transmits to the blood vessels without any residue in the bone marrow. On the second or third day, it fully transmits to the muscles of the Stomach without any residue in the blood vessels. On the third or fourth day, it fully transmits to the sinews of the Liver without any residue in the muscles. On the fourth or fifth day, it fully transmits to the skin and hair without any residue in the sinews. On the fifth or sixth day, it fully emerges as pustules/rash without any residue on the skin. In this manner, by the seventh or eighth day, pus and fluid gradually dry up; by the tenth or eleventh day, scabs form; by the twelfth or thirteenth day, scabs fall off, and the body regains luster.

If the eruption initially arises from the Heart but leaves slight residue in the bone marrow, there will be high fever throughout the body, dry mouth, restlessness, and confusion. Even if it emerges from the muscles, if slight residue remains in the blood vessels, there will be convulsions, irritability, delirium, and the pustules will not be round and plump. If it emerges from the sinews of the Liver but slight residue remains in the muscles, carbuncles and sores will frequently occur on the four limbs. If it emerges from the skin but slight residue remains in the sinews, there will be spasms and twitching, purple-black discoloration, and tidal fever. If it emerges as pustules but slight residue remains on the skin, the scabs will fall off late and leave many pockmarks. Therefore, if the smallpox transmits through the four meridians (Heart, Spleen, Liver, Lung) and there is no residual pathogen in the Kidney meridian, it is auspicious. However, if lower back pain appears at the onset of fever and the spots are purple-black, death is likely, because the toxic qi is deeply entrenched in the Kidney meridian and cannot vent outward.

Smallpox originates in the meridians; mild cases remain mild, and severe cases remain severe. How can a mild case become severe or a severe case become mild? When we say "mild becomes severe," it does not mean the nature of the mild disease transforms into severity, but rather that people treat the mild disease lightly, causing it to worsen. When we say "severe becomes mild," it does not mean the nature of the severe disease transforms into mildness, but rather that people take the severe disease seriously, causing it to improve. For instance, when the smallpox toxin is about to erupt, inflammation is blazing and burning, and pores are all open, which is precisely the time when cold and heat pathogens are easily invaded. After the eruption has occurred, both the interior and exterior are deficient, making it especially a time when diet easily injures the body and external pathogens are easily contracted. Even if the smallpox develops smoothly and beautifully, if one relies on the mild symptoms and fails to avoid wind and cold, fails to regulate diet, engages in sexual activity improperly, fails to avoid filth, overuses cold-natured medicines, disregards dietary taboos regarding raw or cooked food, and manages care improperly, then wind pathogens will gather externally, and the Spleen and Stomach will be injured internally, resulting in a complicated and adverse condition. Conversely, if the eruption is dense, but one treats it with utmost seriousness, carefully manages care, moderates desires, observes taboos, and harmonizes the Spleen and Stomach, then Yin and Yang will be balanced, and Qi and Blood will be harmonious. Adverse conditions may hardly be expected to survive, but dangerous conditions can be ensured to have no calamity.