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Smallpox originates from fetal toxin, commonly known as "Heavenly Sore" (Tian Chuang). Although it is contagious via pestilential qi (Li Qi), it is essentially the manifestation of a killing mechanism. Its changes are unpredictable, and its cruelty and severity are hard to bear. Muscles ulcerate and shed, like snakes shedding skin or dragons shedding bones; spirit and energy are exhausted, like earthworms in ash or eels in boiling water. The sores have sparse and dense distributions: sparse indicates mildness, while dense indicates severity. Toxins vary in degree: mild toxins bring auspiciousness, while severe toxins bring disaster. It is laughable to those who stick to the number of days, failing to understand the variations of speed; it is pitiable to those confused by ghosts and gods, who do not seek good medicine.

The wonderful union of Heaven and Earth, with Zhen and Xun energies expanding, receives qi from the father, condensing through yang essence. It takes form from the mother, relying on yin blood for nourishment. People indulge in desires, causing their qi to lose its purity and simplicity. Lustful fire blazes in the bedroom, and filth accumulates in rich foods. The essence and blood inherit toxic vapors, worse than She Wang (a type of poison); the body bears killing energy, more dangerous than sharp blades.

The Five Movements (Wu Yun) govern North and South, having Tai and Shao aspects. The Six Qi (Liu Qi) divide into Host and Guest, Yin and Yang. Changes each attain correctness, victory and defeat are constant. When order is maintained, qi is regulated, and there are no epidemics in the state; when order is lost, qi is chaotic, and people suffer from rashes and ulcers. Qi that should arrive but does not arrives slowly; one should anticipate and seize its momentum. Qi that should not arrive but does arrives violently; one should hold back to avoid its strength. Not knowing this and acting rashly leads to failure against time; understanding this and acting cautiously leads to prosperity following Heaven.

Spring is warm and promotes growth; Summer is hot and promotes floating and lengthening; Autumn is cool and promotes descending and gathering; Winter is cold and promotes sinking and storing. This follows the correct pattern of the four seasons and does not harm all things. If Winter is unexpectedly warm, buds sprout early; if Spring is unexpectedly cold, hibernating insects remain hidden; if Summer is unexpectedly crisp, cool winds strike the flesh; if Autumn is unexpectedly steaming, summer sweat wets clothes. Such contrary qi causes infection leading to epidemics. There is also empty wind; those struck by it inevitably suffer premature death or injury. Receiving parents' filth and toxins, they hide in dark places; touching heaven and earth's pestilential qi, they trigger latent storage. Emitted from within, they spread to the four limbs; dissipated from outside, their root lies in the five zang organs. What is pleasant is budding and fruiting, like birds shedding spurs; what is loathsome is withering and collapsing, like tigers lying in wait.

East is red, South is white, West is yellow, North is black, each distributed with certainty. Spring generates, Summer lengthens, Autumn gathers, Winter stores, flowing naturally without boundaries. Initially appearing as blood spots, red and fresh, obtaining the qi of life. Next transforming into fluid, white and bright, showing the state of gradual growth. Pus forms and turns yellow, indicating the desire to gather; scabs form and turn black, indicating the image of closing storage. Saying the Kidney has no symptoms is like saying Winter cannot complete the year; saying black is adverse is like asking how waste-white can regulate Yang.

During its emergence, Spring and Summer are favorable, Autumn and Winter are not auspicious. During its convergence, Autumn and Winter are favorable, while Spring and Summer failing to store are adverse. Emergence turning to convergence is called "Sunken and Hidden"; Convergence turning to emergence is called "Rotting Ulcer". Treatment not deviating from the method turns danger into smoothness, like spring returning to a secluded valley; Medicine not matching the disease turns danger into adversity, like fire raging on a ridge.

Disease seeming smooth but actually adverse requires accurate recognition; Disease seeming adverse but actually smooth requires careful observation. Accumulating like millet piles and obstructing is inferior to being open and dense; Bright red like cinnabar and tender is inferior to pale white and aged. Initial appearance containing water, rising with浆 (plasma/serum). Pus not yet formed but dry and black, sac not full but withered yellow, emerging early like garden flower buds growing rapidly; suddenly disappearing like floodwater in ditches, this is called a "Life-Stealing Syndrome", do not boast of the skill of breaking an arm three times.

Mild cases may become severe due to taking wrong medicine and violating taboos; Severe cases may become mild due to meeting a good doctor and proper care. Mosquito bites and flea marks change instantly; Snake skins and silkworm shells only bind waiting for death. Accompanied by macules and papules, their disappearance is joyful; Flat or sunken tops, their rising is not alarming. Disease has root and branch, establishing methods based on urgency. Medicine has tonification and purgation, prescribing formulas based on deficiency and excess.

Alas, doctors have no fixed methods; In confusion, medicines have no fixed formulas. Generally, attacking is despised and tonifying is valued, so warmth is preferred and coolness is disliked. If the disease encounters deficiency-cold, warming and tonifying are effective. If the syndrome presents as excess-heat, pungent aromatics are dared to be tasted. Pungent-hot substances entering the throat will distress those with excessive Yang; Bitter-cold substances entering the stomach will injure those with excessive Yin. Avoid sweating and purging at the beginning and end, detesting the theory of attack; Tonify Spleen Earth to control Kidney Water, favoring the norm of tonification. Without knowing the shortcomings of tonification, how can one discuss the strengths of attack?

Sharp and round shapes with luster indicate abundant Qi; Bright and moist colors indicate nourished Blood. No medicine is needed, this is called "No Illness". Gray-white and flat/sunken indicate deficient Qi and Blood, treated with warmth; Red-bright and swollen indicate Heat in Qi and Blood, treated with cooling. Qi arriving but Blood insufficient results in unfat roots even after eruption; Blood arriving but Qi insufficient results in unexpanded borders even if bright and moist. Clinging to text to infer one corner, guarding the stump cannot catch the rabbit; Arguing while holding two extremes, many paths inevitably lose the sheep.

Spleen is the root of water and grain, certainly cannot be neglected for tonification; Kidney is the source of fluids, especially cannot be neglected for maintenance. Earth although prevents Water, Water can restrain Fire's hyperactivity. Kidney governs bone marrow, involution into bone marrow is incurable; Kidney governs closure and storage, turning black until closure can be prevented. These are harms attributed to the Kidney, how can one say the Kidney is strong? Toxic fire blazing, Kidney Water dries up; Ying Qi ruined, Spleen Earth also injured. Thus, tonifying Spleen is不如 saving Kidney, and nourishing Yin thus nourishes Yang.

Heat makes Qi and Blood slippery and unconvergent; Cold makes Qi and Blood stagnant and unmanifest. Qi and Blood losing nourishment,痘疹 (smallpox/rubella) injured. Or injured by heat, manifesting as irritability, redness, pain; Or injured by cold, manifesting as palpitations, whiteness, itching. Follow seasonal cold and warmth, prohibit human and animal movement, avoid latrine odors, avoid burning sandalwood and musk, fearing entry through deficiency, assisting toxin to cause disaster. Smallpox although auspicious, violating taboos brings much misfortune, experiencing strange changes; Syndrome although evil, regulating well brings goodness, finally seeing health.

Regarding the heat of sores and rashes, similar to internal and external injuries. Evil fire blazing, jade and stone burn together; True Water calm and smooth, waves do not rise. Sneezing and coughing, Lung Metal flows with burning; Neck stiffness and sudden oppression, Liver Wood is wounded; Yawning and palpitations, Heart although Monarch is unsettled; Vomiting, diarrhea, and drowsiness, Spleen granary does not store. Each organ has symptoms, only Kidney has no image, not receiving filth-toxin fire, uniquely showing cold ears. Mild heat means little toxin, severe heat means strong fire; Great heat with calmness means toxin exits with heat without worry; Mild heat with irritability means toxin stays with heat and can be prevented. Unpredictable disaster, both heat and thirst; Mild and loose allows, alternating heat and cool. Vomiting and diarrhea not stopping, allowing toxin to escape without obstruction; Palpitations unsettled, fearing toxin deepening and hiding. Blood leaking randomly from orifices, death faster than snapping fingers; Delirious speech involving ghosts, changes easier than flipping a hand.

Form and symptoms determined by density, location determines survival or death. Like smallpox spreading, particles sparse already determined; Like measles piling up, blurred dense is hurtful. Cheeks and mouth encircled, Geng-Wu Yangming position; Cheekbones and forehead, Ren-Bing Taiyang region. Head is the respected chief, most feared covering head; Neck is the key pass, still dislikes locking neck. Nose tip initially appears, lustful toxin attacks Tian Gen; Ear leaf first shows, evil fire invades Yu Tang.

Gradual emergence is auspicious, simultaneous surge is ominous. Smallpox about to emerge with reduced heat, do not take medicine rashly; Smallpox just emerging with intense heat, doctor should prevent early. Resolve fire toxin, fearing stagnation and drying; Nourish Qi and Blood, desiring flow and smoothness. Avoid cold and heat invasion, reduce or increase, must make peaceful; Assist Spring and Summer commands, reach and emit, must make flourishing. Treat before chaos, repair mulberry roots before rain; Know preventing gradual onset, truly solid ice on walking frost.

Emerge wanting completion without leaving, erupt wanting penetration and uniform growth. Buds gradually forming nests, where Qi arrives; Flesh turning to pus, where Blood nourishes. Sparse means less toxin, head and face not swollen, do not fear; Dense means more toxin, Qi and Blood not sufficient, should panic. Time sufficient, naturally rising mixed; Exterior and Interior free of evil, do not rush to make decoction. So-called good general using troops, good attack不如 good storage. Throat urgent pain, do not delay treating; Head and face pre-swollen, merely extending days leads to death. Urine wants clear, stool wants firm; Light taste edible, heavy taste cannot eat. Tasting light preserves Stomach Qi; Nourishing heavy increases Fire Evil. Or seeing black spots, dot with rouge; Or encountering dryness, bathe with water poplar. Itching suddenly arises, take Artemisia capillaris to fumigate; Scratching restless, even Bian Que hesitates.

Smallpox fills with water, toxin transforms to paste. Love dense, dislike light; Take satisfaction, discard false itch. Want to know penetration or not, examine hands and feet carefully; Want to know sufficiency or not, observe cheeks properly. If extremities not penetrated, take Spleen and Stomach to take medicine; If one area not sufficient, view meridians to seek formula.

Cheeks most dislike damage, shoulders and back especially fear. Scab suddenly disappears, Qi escapes; Speech suddenly delirious, Spirit perishes; Eating grains causes vomiting, Stomach rots; Drinking water causes choking, Pharynx injured. Grinding teeth, Liver Fire blazing and Kidney failing; Chills, Yang Qi weak and Yin strong. Pus reverses to dry, involution; Pus not forming, hidden storage. Crying non-stop, toxin attacks intestines and stomach; Confusion unrest, fire fierce in diaphragm and huang. Granary not storing, soul and魄 return to darkness; Water springs not stopping, relatives weep on Beimang.

Pus and blood transformed, failed scabs appropriate. Scab from lips, plasma exudes knotting like pearls and jade; Scab from Ren Zhong, parts divide Yin and Yang. Commands execute Autumn and Winter, follow sequence without disorder; Qi responds to storage, prepare upper and lower with regularity. Cheekbones flat and dry, worry about inverted scabs; Forehead receding first, called inauspicious. Scab not adhering and swelling, due to Ying Blood overflowing; Sores fully cracking and peeling, this Wei Qi residual injury. When scabbing not scabbing, when storing not storing. Constipation not passing, interior heat guided by cooling; Loose stool not solid, middle Qi deficient warmed and nourished. Heat injuring skin and hair, blame Lung Metal not collecting remaining Qi; Dampness injuring muscle, blame Spleen Earth not drying residual paste. Head sores piling pus uneven, solitary Yang like widower not generating; Foot sores wrapping water not drying, pure Yin like widow not growing. Diet decreasing, gradually leading to death; Irritability and heat increasing, suddenly ending life.

If intermittent scab skin not shedding, pathogenic qi interfering therein. Smallpox if ruined, tonify empty sores without doubting sequence; Sores if ulcerated, do not dislike pus of formed ulcers. Whole body oozing, sticking to bed mat most bitter; Frontal swelling pouring, avoid fishy smell hindering again. Frequent watery discharge, this is water-storage disease, water gone stops itself; Frequent pus and blood in stool, this is inverted scab syndrome, pus gone becomes auspicious. Scars flourishing everywhere, sunken is deficiency and protruding is excess; Scab skin tender and thin, inside distressed and outside ulcerated. Head and face dry and painful, hundred-flower ointment foam; Whole body ulcerated, rotten grass spreading bed.

Evil qi exhausted and Zheng returns, scab skin sheds and body healthy. If young body often ill, surely residual toxin has storage. Erupting or not complete, no empty sores, must prevent sudden violence; Erupting or not penetrated, no ulcerated pus, must develop carbuncles and ulcers. Not timely early gathering, toxic fire sinking worrying; Or overdue not scabbing, evil qi staying regrettable. Body heat examining deficiency and emaciation, hoarse voice observing vomiting and choking. Suddenly shivering and muscle heat, know Wind-Cold external contraction; Sudden vomiting/diarrhea and abdominal pain, surely Food-Stagnation internal injury. Disease suffering with dizziness, omen of much misfortune little luck; Body free of evil but dazed, bad departing good coming image. Voice not issuing, seek Lung and Kidney meridians; Macules/rashes reappearing, blame Heart and Spleen organs. Gan erosion bleeding, difficult to treat; Hole diarrhea undigested grain, inauspicious. Do not say smallpox gathered so relax, do not say toxin gone so delay. Zheng Qi gradually growing but not recovered, Evil Qi just dissipating but not ended. Specifically violating taboos, now immediately generates change; Indulging in rich/greasy food, later surely has disaster.

Scabies and leprosy rotting, one side tattooed spots like ghost; Carbuncle and abscess flowing, four limbs disabled like blind. Eye swelling red and painful, cold smallpox entering forming opacity; Teeth protruding black and rotten, heat toxin infiltrating destroying gums. Although said residual toxin causing harm, all are regulation abnormalities. Appearance suddenly changed, making people startled; Treatment regret late, vainly sighing. Say humans cannot conquer Heaven, how establish medicine? Say doctor不如 using witch, how reach Heaven?

But encountering years of smallpox, mostly seeking detoxifying formulas. Examine year qi disaster/auspiciousness, must resolve depression; View unique qi bravery/cowardice, each balance organs. Want to avoid pestilential contagion, must first select good land; Want to rely on medicine power protection, especially must recognize good doctor. Generally doctor must recognize syndrome, medicine not执方 (stick to formula). Specializing in warming/tonifying, follows Wenzhong; Preferring cooling/purging, models after Zhongyang. Not understanding books, like blind walking in creek paths; Not mastering spirit, know dwarf looking up at palace walls.