Library

Varicella (smallpox) and carbuncles are both classified as Yang toxins. However, when a carbuncle occurs concurrently with varicella, it cannot be uniformly diagnosed as a Yang toxin condition. Generally, lesions appearing within the first seven days of eruption are considered ordinary sores. Some cases arise from latent internal heat-toxins that, upon stimulation by the fire of the varicella toxin, combine and erupt together. In other instances, patients may have pre-existing ordinary sores that have not yet healed, or areas where scabs have just formed; these regions have deficient flesh and pores. When attacked by the heat and toxic vapors of the varicella blood, the pathogen tends to settle in these deficient areas. Consequently, Yang sores and Yin toxins become mixed. One must observe whether the lesion is moist: if moist, it indicates abundant Qi and Blood, allowing the varicella and toxin to easily transform into pus. If dry and bright red, it indicates deficient Qi and Blood, leading to resistance between the toxin and the sores, preventing pus formation. Treatment should prioritize strong tonification and expulsion of toxins. If dryness turns to moisture and redness fades to pallor, with spontaneous pus discharge, recovery is possible. Only carbuncles appearing after the seventh day belong to Yang toxins. This represents the aggregation of varicella toxins in one place, borrowing the name of a carbuncle. It occurs because Qi and Blood fail to constrain and carry the toxins, resulting in weak Qi and excessive Blood, with emptiness in the Yang aspect. The Blood carries the toxin to the junctions of the limbs, specifically the "Sea" points such as Quchi (LI11) and Weizhong (BL40). For lesions appearing before or after the seventh day, treatment should follow their natural course to disperse them, allowing the toxin to exit through this route. If one merely treats the toxin without regard to the varicella, the toxin will scatter internally and attack the Zang-Fu organs, making rescue impossible. Only after the varicella toxin has resolved and Qi and Blood are robust should residual toxins be dispersed. Carbuncles often form due to disharmony and stagnation of Qi and Blood. Since prolonged illness leads to deficiency, detoxifying decoctions must use herbs that harmonize Ying and Wei and tonify Qi and Blood as the sovereign agents. Even in early stages where varicella is complicated by carbuncles, large doses of Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), Astragali Radix (Huangqi), Rehmanniae Radix Recens (Shengdihuang), and Bombyx Batryticatus (Jiangcan) should be used to strongly tonify Qi and Blood, thereby supporting the expulsion of toxins. Otherwise, if Qi and Blood are suppressed by the toxin, the varicella eruption will fail.

Shanghan (Cold Damage) pathogens enter from the exterior to the interior, whereas rash diseases like varicella emerge from the interior to the exterior. Although their presentations may seem similar, their symptoms are vastly different. If Shanghan complicates an active varicella eruption, the pathogen is at the exterior; mild diaphoresis can be induced to open the cou li (skin pores), facilitating the eruption of varicella. If Shanghan persists during the third or fourth day of varicella, accompanied by restlessness, delirious speech, abdominal distension, aversion to thirst, restless sleep, and constipation, the pathogen is in the interior. Mild purgation may be used, followed immediately by lifting therapies. This restores harmony between the interior and exterior, resolves pathogenic obstruction, clears meridians, allows Ying and Wei to circulate, and facilitates the transformation of toxins into pus. This is referred to as "acting according to necessity," which appears harmless. Cases requiring neither sweating nor purging are favorable. If sweating or purging is necessary, both interior and exterior must be stabilized. The principle is to treat the acute symptoms first and the root cause later, while carefully observing the specific signs of varicella. True Shanghan is rare; many cases mimic it. Children under eight years old do not contract Shanghan. Therefore, headache and fever should not automatically be diagnosed as Shanghan.