Library

The *Classic* (Huangdi Neijing) states: "All pains are caused by cold." It also states: "Pain indicates excess." Therefore, comfort internally and pain externally indicate external excess and internal deficiency; comfort externally and pain internally indicate internal excess and external deficiency. However, body pain caused by smallpox may arise from several causes: either the skin is dense and flesh firm, causing conflict with external cold; or heat-toxin arises internally; or blood deficiency fails to nourish the tissues. Generally, when heat-toxin is not yet exhausted, pain results from stagnation of Qi and blood and obstruction of toxin. When heat-toxin has been exhausted, pain results from blood deficiency and dryness-heat. If the whole body feels as if bitten by insects and the lesions turn black, this indicates dangerous stagnation of toxic qi and coagulation of blood. If spontaneous diarrhea occurs accompanied by anorexia, it is incurable.

Dysentery is formed by damp-heat郁结 (stagnating) in the intestines and stomach, damaging Qi and blood. Smallpox relies primarily on Qi and blood; if both are damaged, what can support the smallpox? The treatment principle is: for red lesions, use Siwu Tang (Four Substances Decoction) as the main formula; for white lesions, use Sijunzi Tang (Four Gentlemen Decoction) as the main formula; for mixed red and white, combine both formulas. If abdominal pain is present, double the dosage of Danggui (Angelicae Sinensis Radix) and Shaoyao (Paeoniae Radix); if tenesmus is present, add Muxiang (Aucklandiae Radix) within the formula to regulate Qi; if red dysentery persists for a long time, add Ejiao (Colla Corii Asini) and Hei Ganjiang (Scorched Ginger); if the condition persists for a long time, add Huangqi (Astragali Radix) and Zhi Ganjiang (Honey-fried Ginger); if there is an external contraction, add Xiaochaihu Tang (Minor Bupleurum Decoction) to disperse the exterior; if urination is difficult and painful, add Mutong (Akebiae Caulis) and Zexie (Alismatis Rhizoma). This is the general approach for treating smallpox complicated by dysentery. However, dysentery is the most difficult to cure quickly, as it does not have a fixed cycle like smallpox. Moreover, with pus forming externally and dysentery occurring internally, both the exterior and interior are deficient, and Yuanqi (Original Qi) is prone to sinking. Therefore, treatment should focus on smallpox, using large doses of Renshen (Ginseng Radix et Rhizoma) to tonify and support, combined with lifting methods, to prevent Yuanqi from sinking and toxin from attacking inward. If one solely uses ordinary methods for treating dysentery, moving Qi and harmonizing Blood, the toxin will instead borrow the momentum of the herbs to sink into the Yin level, making it impossible to reach the surface and succeed! Furthermore, if visible diseases are not removed while invisible Yuanqi is exhausted first, death will occur before the dysentery heals. Also, many conditions resemble dysentery but are not true dysentery; deaths caused by the misuse of Qingpi (Citri Reticulatae Pericarpium Viride) and Binglang (Arecae Semen) are countless.

Heat in the Heart Meridian flowing and unresolved, leading to extreme heat generating wind, produces these convulsive symptoms. However, if convulsions occur before the rash appears, the heat lies in the sores, not in the Heart. If convulsions persist after the rash has appeared, the heat lies in the Heart, not in the sores, which is critical. Thus it is said: convulsions preceding the rash indicate survival; rash preceding convulsions indicates death. The treatment method is: for those who experience convulsions just before the rash emerges, use Shengma Tang (Cimicifugae Decoction) to disperse, as the convulsions will cease once the rash appears. For severe convulsions, Quanxie (Scorpio) and Tianma (Gastrodiae Rhizoma) are appropriate. If the rash has appeared but convulsions do not stop, use Wuling San (Five-Ingredient Powder with Poria) to guide Heart Fire downward, and the convulsions will stop naturally; otherwise, excessive steaming heat will cause the sores to dry up, preventing plasma formation and making crusting difficult. For convulsions before the rash emerges, it is due to internal accumulation of toxic heat. For convulsions when the rash is red and blooming, it is due to pain from heat-toxin. For convulsions during the suppuration stage, it is due to Qi and blood deficiency. For convulsions after crusting, Qi and blood deficiency is even more severe. If eyes are fixed or deviated with convulsions, it is due to wind-fire battling. If saliva flows from the corners of the mouth with convulsions, it is due to Liver Wood overacting on Spleen Earth. If the face is red with tears and convulsions, it is due to Liver Blood deficiency generating wind. Opisthotonos indicates Water failing to generate Wood. All these are diseases arising from internal Qi and blood disturbances; do not mistakenly administer wind-dispelling herbs.

During the fever phase of smallpox, when Heart Fire is acting recklessly, one must strictly avoid agitation and sudden noises, otherwise, they can induce convulsions. During the suppuration stage, when Yuanqi floats upward and Ying-Yin (Nutritive Yin) dissipates, quiet rest is especially necessary; otherwise, Shen (Spirit) will not reside in its house, and Blood will not follow its vessels, leading to stopped plasma in mild cases or fatal complications in severe cases. Convulsions due to severe deficiency after crusting are difficult to cure and require utmost caution. Regarding the notion that "convulsive smallpox is auspicious," this refers to smallpox originating from the Heart Meridian, where fearful convulsions are signs of the Shaoyin meridian manifesting from within to the outside. How could it be considered auspicious simply because external fright damages Heart Qi?