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Accumulation of fetal toxin (fetal toxicity) manifests as smallpox (smallpox). Transmission is due to external contraction, while severity depends on internal injury. Initially affecting the Taiyang channel (Taiyang meridian), Ren water controls Bing fire; later returning to the Yangming channel (Yangming meridian), blood and water transform into pus and serum. The momentum is like burning eyebrows, changes are like flipping a palm. To know the exterior-interior and deficiency-excess, one must clarify cold-heat and warm-cool. Symptoms differ in form, organs present different states: The Liver governs tears and thus water blisters; the Lung governs nasal discharge and thus pus and serum; Heart spots are red and purple; Spleen rashes are red and yellow; Only the Kidney meridian has no disease manifestation, but turning black can be prevented. Therefore, observing external symptoms allows inferring the five internal organs: yawning and sudden stuffiness is due to Liver wood; coughing and sneezing is the image of Lung metal; face and eyes red with palpitations indicates Heart fire blazing in the chest and diaphragm; cold extremities and drowsiness indicates Spleen earth trapped in the center; ears and sacrum warm as usual shows Kidney water is unharmed. If these two areas are scorching hot, one must recognize the abnormality of smallpox. Thus, one should first distinguish locations, then examine details carefully. Yangming descends from eyes to nose, Taiyang appears on the head. Heart fire heat causes dry nose and red face, Lung metal stagnation injures chest and diaphragm first. Spleen and Stomach belong to hands and feet parts, Liver and Gallbladder govern sides of ribs. Neck and nape are intersection of three Yang channels, waist and back are unified by Bladder channel. Diarrhea means evil is excessive below, vomiting means evil is excessive above. Qi rebellion causes hidden abdominal pain, severe toxin causes fearful lower back pain. Excessive Heart heat causes convulsions, Stomach evil excess causes mania. Dry mouth and throat indicate Lung receiving fire evil and fluid exhaustion, constipation and difficult urination indicate Kidney due to fire excess and fluid loss. To identify severity of smallpox, observe the shape of the condition. Severe toxin makes body like fire, mild condition makes interior and exterior cool. Alternating chills and fever with clear spirit predicts auspicious eruption; gradual emergence over several times is like spring returning with lingering cold, simultaneous eruption is like fierce fire on Kunlun Mountain. Mosquito bites and flea marks predict death within period, snake skin and silkworm seeds prolong life until return to underworld. One must fear purple-red and dislike gray-white; pale red and moist is best; black sinking into red is strictly forbidden. Color should be bright and moist, yet fear thinness and fragility; pustules prefer drying and crusting, itching and collapsing is unbearable. Sparse and distinct on cheeks ensures safety; dense and connected on chest/diaphragm makes fortune uncertain. Pustules should be pointed and round, not flat or sunken; full of serum is good, empty sores are bad. Skin prefers old and rough, fears tender and smooth. Firm and high projection brings no worry; floating carbuncle on flesh implies punishment/injury. Swollen lips and face, how to pass 8-9 days? Lower back pain and rotten stomach, disaster strikes at 7 days. Sores piled on tongue, toxin winding neck, sore throat and swelling make eating difficult. Bloody diarrhea with pus/toxin excess and no serum are cases beyond human power, knowing fate is short.

When scabs fall, distinguish Yin and Yang. Crusting first on upper/lower Renmai is good; black crusting first on four sides is mostly ominous, beware. Initial fever mild, waist/abdomen painless, Shangen and Nianshang bright red/yellow, constitution surplus. Face not withered, pulse floating large and rapid, lips/tongue red/moist, appearing first on cheeks, zygoma, nose, chin, with red rings and thick skin, distinct from flesh. Pointed tips touching hand, pleasing color/moisture, unique stacked bases, normal feeding, normal excretion, five peaks elegant, timely inflation/filling, no internal symptoms. This is most favorable, why worry about daily changes? If initial fever like fire, constipation, extreme thirst/restlessness, cyan/black on Shangen, dry/dark on Nianshang, headache like breaking, screaming delirium, cursing/coma seeing ghosts, breath like fire/dry, body hot with severe chills, pulse weak/deep/thin/slow, waist/abdomen stabbing/cramping pain, violent restlessness, panting/thirst/vomiting/diarrhea/coma, body very hot with cracked lips/mouth, voice lost before spots appear, many dense sores, continuous eating, back pain when just febrile, facial swelling before spots, silkworm appearance before heat penetrates, bran-like appearance before heat, red flesh without standing base, purple/dull color, cyan/black like moles. Tian Ting, Si Kong, Tai Yang, Xin Xiong areas erupt成片, Fang Guang, Yin Tang, lips, Jie Hou appear gray first, soft/thin top, loose/red base, whole face red seamless, whole body purple/black dry, zygoma rouge, Wu Shu acupoints like seeds, thin skin watery serum, dark/black dull color. These are most adverse, Hua Tuo would feel ashamed of his medical skills. So if color bright, base red/lively, even flat/sunken can be saved; if color not moist, base not tight, even raised will ultimately be fatal. Unremitting fever with restlessness, no flower on limbs, even day 4 may add sores; body cool/calm, limbs reached, day 3 may be complete. Before day 6, despite many internal symptoms, surface eruption heals itself. After day 6, if internal symptoms persist, interior/exterior both diseased is ominous. Pulse after crusting should be harmonious/slack; if洪数 (surging-rapid), residual toxin remains. Black thorn picking black blood or no blood/water indicates Qi/Blood exhaustion and difficulty surviving. Initial fever lips/tongue like clustered black dots or purple-black dry cracks predict many ominous signs. During serum stage, lip sores ripening yellow first indicates internal attacking heat toxin, especially incurable. Sores rubbed open with dripping pus/blood showing ulceration tendency is auspicious; cheek penetration, eye opening/swelling reduction, dry scab is ominous. Mucus during inflation is auspicious; saliva/tears during filling is good omen. Initial dim purple with fine roots requires defense against later changes; falling crusts red/purple protruding with restless sleep require clearing/resolving to avoid toxin generation. Thus: 1. Check lips/tongue tip for no dryness/astringency; 2. Check spots round/lively/red/moist, flesh color distinct; 3. Check heart pit, cheeks, mouth, back, nape, zygoma, forehead, umbilicus for sparsity; 4. Check hard tops, attached bases, clear Qi/spirit, absence of thorns/blackened spots/internal symptoms; 5. Check strong constitution, normal appetite, no disease/Qi blockage/Blood dissolution. Fulfilling these ensures peace of mind even without multiple escapes.

After swelling/toxins/healing, measles/recovering. Qi/Blood still deficient, severe smallpox reappears. Post-mark high fever unsubsiding, pre-pus cold limbs hard to warm. Malignant abscesses mixed with extreme smallpox, fever/panting unceasing. Constipation plus closed eyes, hoarse voice/black skin/blue lips. Smallpox eruption with coma, aversion to cold/reversal cold/not eating. Pus stage fetal expulsion, bleeding with high fever/coma/restlessness. Abdominal pain unceasing, abnormal smallpox odor. Head warm/feet cold like idiot, severe stifling/thirst. Red skin unsubsiding, upper/lower bleeding unhealed. Cyan corners of mouth, clouds covering heavenly smallpox, abdominal distension/panting, hollow rumbling foul breath from mouth. Smallpox without bases, even slight rings with heavy internal symptoms. Heat menstruation long uncontrolled, medicine ineffective. Vomiting/diarrhea unceasing undigested food, or blood flowing from bowels/bladder. Phlegm/panting/heart vexation, head sweat like pearls, continuous urine leakage, Yin/Yang separation above/below. Extreme thirst/blood death, black/dull smallpox color. Tin-sheet dry/stiff, Ying/Wei exhausted inside/outside. Smallpox flourishing with constant fright, weakness entangled with epilepsy. Stomach heat jaundice orange-colored with diarrhea. Serum insufficient, toxin still盛 (excessive) with open eyes, frequent straining like hard stool. Mouth empty chewing nothing. Extreme fatigue not eating, scrotum shrinkage/tongue curling, treatment fails. Feet cold to knees, grinding teeth/closed eyes/no soul. Vomiting/diarrhea unceasing, chattering teeth/cold qi. Abdominal distension, coarse breathing. Great panting/thirst, sweat like oil. Black smallpox/scorched face, swollen/hard lips/neck. High chest protrusion, vomiting/diarrhea unhealed, manic/stifling/not eating. Hands/feet like water, big head plague at onset, black crusting at day 6, day 7 empty serum/chills. Day 8-9 ulcerated/rotten, confused/manic/delirious, seeing ghosts/pointing weirdly. Yuan Shen deficient, eyes losing clarity. Diarrhea/thirst, gurgling soup entering throat, true depletion/toxin lurking. Abdominal distension/umbilical depression/breath leisurely, reporting post-smallpox terrible dreams. From Huaji area, hearing strange omens. Abnormal movements changing past appearance. Not eating half grain, suddenly craving wolf-like meals. Smallpox toxin abundant, miscellaneous diseases extreme. Lu Yi Bian Que would also cry bitter tears, Cang Gong Wei Shi should not raise eyebrows lightly.