Library

The application of diaphoresis (sweating method) and purgation are measures taken only when no other options remain. Even a slight error can cause significant harm. For instance, if the variola (smallpox) lesions are originally sparse, with no obstruction, and without symptoms of unrelieved exterior heat, but heavy medicines are recklessly used to induce sweating, it will inevitably lead later to ulcerated lesions, hoarseness, thin and itchy collapsing skin, or even collapse due to deficiency. If the Qi and Blood are originally harmonious, with no constipation, toxic heat, or purple-black discoloration, but heavy medicines are recklessly used to purge, it will inevitably result in the lesions sinking and failing to rise, weak stomach function leading to grayish-white lesions, or transformation into emaciation and abdominal distension. All these are faults of reckless diaphoresis and purgation; how can one not be cautious! However, there are cases where mild diaphoresis or mild purgation is indicated for variola. The term "mild" warns against excess. For example, if exterior heat is intense, before red spots appear, the shadow of the lesions does not emerge, accompanied by irritability, red cheeks, and lesions that do not rise actively, light and ascending agents should be used to slightly open the Couli (skin pores), facilitating the eruption of the lesions. Moreover, since fire stagnation requires ascending methods to reduce its excessive momentum, formulas such as Shengma Gegen Tang (Decoction of Cimicifugae and Puerariae) and Shensu Yin (Ginseng and Perillae Leaf Drink) may be employed. Once red spots have appeared, Puerariae Radix (Gegen) should be avoided, lest excessive dispersion leads to deficiency and easy collapse of the lesion bases; however, if the exterior is solid, its use is permissible. Furthermore, there are conditions requiring purgation; if purgation is neglected, it will later result in purple-black discoloration with stagnant toxic heat accumulation, and blood depletion becomes a consequence of missed purgation. Therefore, before the eruption of variola, if the pulse is rapid and surging, urine is scanty and dark, stool is constipated, breathing is coarse with abdominal distension, lips are dry with irritability and thirst, this indicates abundant toxic heat that cannot vent. Mild purgation is appropriate to resolve internal stagnation, allowing the Ying (Nutritive) and Wei (Defensive) Qi to ascend and descend normally, so that the lesions erupt smoothly. However, if there are no contraindications throughout the course of variola, one must not lightly employ diaphoresis or purgation, lest the Yuan Qi (Original Qi) be depleted, preventing the formation of pus, which will inevitably cause trouble later.

One who does not understand Excess and Deficiency cannot be a physician. The *Classic* states: Do not reinforce an Excess condition, nor deplete a Deficiency condition. Thus, failing to distinguish between Excess and Deficiency is unacceptable. The *Classic* states: One must first assess the fatness or thinness of the body to regulate the Excess or Deficiency of Qi; this distinguishes Excess and Deficiency through physical form. It also states: Abundant food intake correlates with abundant Qi, while deficient food intake correlates with deficient Qi; this distinguishes Excess and Deficiency through diet. It further states: A solid pulse indicates solid Blood, while a deficient pulse indicates deficient Blood; this distinguishes Excess and Deficiency through the pulse. Additionally, it states: When pathogenic factors are abundant, it is Excess; when essential Qi is depleted, it is Deficiency; this distinguishes Excess and Deficiency through the struggle between pathogens and healthy Qi. Generally, Excess refers to the abundance of pathogenic factors, while Deficiency refers to the weakness of healthy Qi. The *Classic* says: Where pathogenic factors gather, healthy Qi must be deficient; if Excess persists without being resolved, the disease manifests as Excess. It is also said that death from "Five Excesses" refers to the Excess of pathogenic factors, while death from Deficiency refers to the Deficiency of healthy Qi. In all cases of sores and variola, if the patient has a robust physique, eats well, has a surging and solid pulse in all six positions, has no prior illnesses, normal bowel movements, and red, lustrous lesions, this indicates that both Exterior and Interior Healthy Qi are solid, and medication is unnecessary. Conversely, if the patient is emaciated, prone to illness, has reduced appetite, a weak and thready pulse in all six positions, frequent vomiting and diarrhea, yet the lesions are red and lustrous, this indicates that both Exterior and Interior Healthy Qi are deficient; treatment should employ warming and tonifying methods. If the sores are too vigorous, with swelling, pain, distension, persistent high fever, irritability, thirst, drowsiness, and constipation of both urine and stool, this indicates that both Exterior and Interior Pathogenic Factors are solid; treatment should employ cooling and purging methods. If the lesions are dense, red, and active, but accompanied by vomiting, diarrhea, and inability to eat, this indicates Exterior Solidity and Interior Deficiency; treatment should tonify the Middle Jiao while adding detoxifying herbs. If the lesions are pale white, fail to erupt fully, accompanied by constipation of urine and stool, and a desire for large amounts of water and substantial food, this indicates Interior Solidity and Exterior Deficiency; treatment should resolve the exterior while adding ascending and dispersing herbs. Generally, pain indicates Excess; thus, sore pain is due to solid pathogenic factors, requiring blood-invigorating methods to relieve stagnation. However, if the pain is like knife-wounding, accompanied by confusion and loud crying, do not treat. Generally, ulcers indicate Deficiency; thus, sore-ulcers are due to deficient healthy Qi, requiring Qi-tonifying methods to dry dampness. However, if there is restless scratching, ulceration, and skin peeling, do not treat. Grayish-white lesions indicate Qi Deficiency, where the efficacy of Ginseng Radix et Rhizoma (Renshen) is paramount; dryness indicates Blood Deficiency, where the power of Angelicae Sinensis Radix (Danggui) and Chuanxiong Rhizoma (Chuanxiong) should be emphasized. Treat Deficiency by tonifying, and Excess by purging; stop when the disease is addressed, avoiding over-treatment; this is the balance of treatment. If a fundamentally Deficient condition is treated with purgation, Healthy Qi becomes further depleted, potentially leading to vomiting, diarrhea, or cold extremities; these are all consequences of excessive purgation. The *Classic* states: Do not exacerbate the pathogen, do not neglect the healthy Qi, thereby cutting short human life—this is what is meant.