痘原
上古无痘疹，周末秦初乃有之。（《医学入门》）
痘疮一证，俗曰天疮。原其所由，实由胎毒内蓄，而复因时气外触，其毒乃发，故传染相似，是亦天行
疫疠证也。但考之《内经》，则止言疡疹，即今斑疹之属也。故自越人、仲景、元化、叔和诸公，皆无言及痘，
可见上古本无是证。而今何以有之？愚谓近代之毒，必以醇酒五味造作太过，较古人之恬淡，相去远矣！或者
未信余言，第观藜藿、膏粱之家，即有不同。今之北域亦不出痘，原其所由，实由是耳，岂果彼无胎毒邪？（张景岳）
痘疹之原，有论秽毒者，有论淫火者，有论时行正病者，靡有定论。将谓秽毒淫火耶？则一岁之中，大
而郡县，小而村落，病者相似，而死相继，未必人人若此之甚也。将谓时行正病耶？何以自少至老，但作一度，
厥后再无传染也。盖父母于子，一体而分，精血之毒，已蓄于阳施阴化之始，固不待诞生之顷，咽其血而后有
也。然则待时而发者，胎毒也。或速而危，或徐而顺，或暴而死者，气之微甚所使也。发则其毒泄矣。所以终
身但作一度，后即有其气，不复传染焉。○痘为胎毒昭昭矣！其间或疏而轻，或密而重，或重变轻，或轻变重，
变化叵测。是又有说也，疏而轻者始终如一，密而重者变怪百出。或因父母相传而然，或因疫疠相染而然，或
因鬼疰相着而然。杳冥恍惚，出于闻见思虑之所不及。此与智者道之，痴人前不必说梦也。○按痘疹之发，
显是天行时气。廛市村落，互相传染，轻则俱轻，重则俱重。虽有异于众者，十之一二而已，岂概谓胎毒哉！
然疫疠终身不染者，比比皆是，而痘疹无一人得免；疫疠一染之后，不能保其不再染，而痘疹一发不再发。则
胎毒之说，又何可尽废乎？至谓淫火秽血，古亦有之，而何独无痘疹之患？欲以破胎毒之说，则又不然，天下
之无而忽有者，多矣。草有名虞美人者，虞美人，项王宠姬也，为项王死，世哀之，为之歌。对草倚声凄恸而
草辄摇，草无情识也。方其未有楚，则宠姬亦无，况有草耶？一切众生，妄自颠倒而成三界，如之，又何疑乎
痘疹？（万密斋）
按胎毒之轻重，人皆易明，若外感之气，人莫能晓。夫天地间只有六气，气平则为和，气不平则有胜复。
胜复至极，则为厉气，为疫气、瘴气，更有道途中秽浊气。人若感之，不拘老幼俱病。今出痘所感之气，则异
乎是。此气独与未泄胎毒之儿两相感触，未闻痘证盛行之时，已出过痘之儿亦染患也。考是气，自古迄今，从
未有人申帮助白确为何气，故前贤于痘证一科，因不明其气之源，不无偏执之弊。有喜于寒泻者；有喜于温托
者；有先用寒泻，而后用温补者；有先用温托，而后用清解者；更有不审儿体之虚实寒热，俱宗费建中《救偏
琐言》，每于发热见点时，概用大黄、石膏、黄连、犀角、羚角等，不知费氏之书名为“救偏”，乃救惯用热
药之偏耳。若本不偏，而宗其法，反至偏矣。婴儿之命，其何以堪！（《临证指南》）
痘者，受胎之始，其毒浸浃骨髓，一呼一吸，久随气血营运。然虽随之营运，终非我之族类，其性必异，
一旦其类来召，则摇撼震动，离而去之。其去也，初与气血一家，今与气血各党，邪正不合，彼此欲别，必与
争战。战而气血胜，则毒亡而人存；战而毒胜，则气血败，毒由是外灭肌肤，内戕骨髓，而人死矣。
（《黄帝逸典》）
调护
如天时大寒，盖覆常宜温暖，勿使受寒，恐毒瓦斯为寒所触，而不得出也。如天时大热，不可盖覆，欲宜
清凉，勿使客热与毒相并，致增烦躁，使疮溃烂也。如时有迅雷、烈风、豪雨之变，宜谨帏帐，添盖覆，多烧
辟秽香，以辟一时不正之气。○卧处常要无风，又要通明，切忌幽暗。夜静不断灯火，不离亲人看守，恐要饮食，
一时得具，或有痛痒，与之抚摩。（闻人 ）
布痘如值严冬，房中多置炭火，有回天之能；盛暑多盛冰水，得清心之喜。务须四时和暖如春，令气血
和畅为妙。（《冯氏锦囊》）
凡出痘，须开窗以通天气，居楼下以通地气，宽衣带以通血气。（《橡村痘诀》）
避秽
痘疮宜避一切秽恶气及外人入房。远行劳汗气，腋下狐臭气，房中淫液气，麝香臊膻气，妇人经候诸血
腥臭气，硫黄蚊烟气，厕缸便桶气，误烧头发气，吹灭灯烛气，鸡毛鱼骨气，葱蒜韭薤气，以上皆不可犯。须
要时常烧乳香之类。芬芳之气，使之常闻，则营卫调畅，可无倒 陷伏等患。（李东垣）
木得桂则枯，雌黄遇胡粉则黑，柑得脯则坏，物之相畏如此，疮痘之畏秽恶杂气，其理亦然。（闻人 ）
脉候
凡看痘，一见发热，即当察脉。盖痘疮将出，未见形迹，必先发热，既见发热，脉必滑数。但见滑数有
神，而不失和缓者，其痘必轻；若滑数加倍，而犹带和缓者，其痘必重；若滑数之甚，又兼弦躁，或芤急无神，
而全无和缓者，其痘必危。故余于初热时，便能断其吉凶，人多惊服，而不知所窥在脉耳。此法但全握小儿之
手，单以拇指诊之，亦最易也。（张景岳）
看法
用纸捻饱蘸麻油烘干，临用再蘸其油，于灯上略炙，照时须将门窗尽闭，致令黑暗。欲视其左，火移于右，
欲视其右，火移于左，上下同法。则痘之多少，色之如何，可以预见。疹则浮于皮外，肉内无根；痘则肉内有
根。若以日光观之，则难辨矣。（《冯氏锦囊》）
初热之时，以红纸捻蘸香油燃火照之，验其生意有无。又以手指摩其两颊，如红色随手转白、随白转红，
谓之血活，生意在矣；如揩之不白，举之不红，是为血枯，纵疏不治。又看目睛，神光 然，唇舌红活如常，
而无焦燥之色，乃为吉证。（《证治准绳》）
凡看痘，须见天光，则辨认不瘥；暗室燃纸条，多恐有误。抱儿于亮处为妙。（《橡村痘诀》）
观痘不必启手足，但观头面。头面者，诸阳之会，上应乎天，所谓身半以上，天气主之是也，故以少见为
贵。肢体者，下应乎地，所谓身半以下，地气主之是也，虽多见无伤。（《黄帝逸典》）
凡看痘有三要∶平日间，预知出痘轻重，一也；发热时，知痘出与不出，二也；见点时，辨痘是否，三也。
平日脉洪大匀净者吉，弦紧散数者凶，手足心及脐尻耳叶热者凶，神气清者吉，神气浊者凶。将来出痘之轻重
可知也。发热时有似寒食惊风，医若误认寒食治之，犹无大害，若误认惊风，乱投金石，妄攻其里，泄泻真元，
或不见点而死，或随见随没而死，或成浆后不能收 而死。有等痧疹红活磊落，若有根盘，看者误认逆痘，抑
知痧疹出后，必咳嗽痰壅，或作泻鼻衄，神思自清，身体自凉，与痘迥别。有等水赤痘，有大有小，有浆有瓣，
自顶至足，红活可爱，看者误认正痘，抑知水赤豆，齐起，齐浆，齐 ，不如正痘之三朝齐，五朝浆，七朝 。
其形色明亮如珠，皮薄易绉，神思如常，与正痘有别。（叶杏苑）
恶寒无汗，头痛脊强，伤寒之所有，痘证之所无。两眼含泪，
鼻气出粗，睡中微惊，耳颧纹见，痘证之所有，伤寒之所无。（徐春沂）
部位
诸疮皆属心火。心之华在面，痘疮之候，但以面之部位占之，思过半矣。且痘疹俱属阳毒，诸阳皆聚于面，
吉凶善恶，尤易见也。额属心火，如印堂以上，发际以下，横两日月角位，先见红点，先浆先 者，此恶候也。
盖心为君主，毒发于心，故先见于其位，心危则十二官皆危。左睑属肝，右睑属肺，如两睑先见红点，磊落者
吉；如相聚作块，其肉硬肿者死。盖肝藏魂，肺臧魄，生意既绝，魂魄将离，故不治也。颏属肾，承浆横抵两
颐，先见红点，先发先 者吉。此位虽属肾，然三阴三阳之脉皆聚于此，阴阳和，故可治也。鼻属脾土，若准
头先出先 者凶。盖脾属土，四脏禀命于脾，毒发于脾土，败则四脏相随而败，故延绵日久，而后毙也。肾之
窍在耳，心寄窍于耳，心肾皆少阴君火也。又少阳相火之脉，行于耳之前后，凡耳叶先见红点者凶。盖君、相
二火用事，燔灼之势难以扑灭也。惟口唇四围，先出先起先 者大吉。盖阳明之脉，夹口环唇，胃与大肠主之，
无物不受故也。（翟益都）
顺逆险
痘疹有顺逆者三∶有时之顺逆者，春夏阳气发生，痘疹为顺也；秋冬阳气伏藏，痘疹为逆也。有虚实之顺
逆者，如便闭能食，是为实为顺也；如便泻不食，是为虚为逆也。有出入之顺逆者，出者为顺，倒 陷伏者为
逆也。（钱仲阳）
痘书云∶春夏为顺，秋冬为逆。春时之顺固不待言，秋凉治痘亦多顺手。若时当酷暑，三分痘便抵十分，
刻刻防变，不可不慎。冬时虽似难调，犹愈于夏日也。○顺逆在天，险证在人。顺者十中三、四，逆者十中一、
二，险证居其大半。故于治法，须要随时讲论。（《痘诀余义》）
春夏为顺，秋冬为逆。此亦语其生长收藏之理尔，岂有春夏皆顺而吉，秋冬皆逆而凶者乎？如春失奉生，夏
失奉长，则春夏亦逆也；秋能养收，冬能养藏，则秋冬亦顺也。惟痘出一般疏密得所，不愆其期，证之顺也；
痘出夹杂，带斑带疹，稠密无缝，常失其期，证之逆也。噫！春夏为顺，秋冬为逆，古人之言，岂真拘拘于时
令之说耶？盖春夏，发生之令也；秋冬，杀伐之令也。痘疮之出，起发者，得春夏之令，所以为顺；陷伏者，
得秋冬之令，所以为逆。其斯之谓欤？（万密斋）
痘疮一证，顺者不必治，逆者不能治，所当治者惟险证耳。何为险证？如根窠顺而部位险，部位顺而日期
险，日期顺而多寡险，多寡顺而颜色险，颜色顺而饮食险，饮食顺而杂证险，杂证顺而治疗险，治疗顺而触秽
险，然犹有最险者，则在元气与邪气耳。若邪气虽强，元气亦强者无害；若元气一馁，邪气虽微者亦危。设或
犯之而不速治，则顺者不顺，而吉者变为凶矣。凡此数者，皆痘中之要领，所当察辨也。（张景岳）
逆证亦有得生者，未可舍之不治也。险证必无死理，其有死者，医之过，非痘之过也。今有拣顺证治之，
以混俗沽名，而弃其险者，吾是以恶《金镜录》等书分证之言为不仁也。（吴天士）
元气
看痘先看元气。痘儿元气非有非无，惟心领意会而已。如形色初善，而终变恶者，元气内竭也；形色初恶，
而终归善者，元气内强也。元气本也，形色末也，故善治者必求其本。（《慈幼筏》）
人知痘藉气血，不知痘之所藉尤有超于气血者。盖元气盛，则气血流通，而领逐，而负载，并行祛毒，痘
必应期而开落。元气一亏，则在外者内不续，在内者外不固，毒肆妄行，或出或入，而为外剥内攻矣。调养真
元，补益气血，诚治痘完策，不得已而欲攻他证，中病即止。（魏桂岩）
气血
治痘以气血为本，犹治国以仁义为要。盖气居中，君道也；血附外，臣道也。气正道尊，而能圆、能领、
能拘、能含、能光泽、能逐、能黄、能解；血正道顺，而能附、能载、能制、能敛、能红活。此气血各得其职
也。气失其正，则为热、为陷、为痒塌、为颤、为吐、为泻、为狂烦、为灰白；血失其正，则为寒、为肿、为
滞、为谵语、为紫黑。此气血各失其职也。（魏桂岩）
气有生血之功，血无益气之理。故气不可亏，亏则阳会不及，而圆晕之形不成；血不可盈，盈则阴乘阳
位，而倒 之祸立至。是以治虚证当补气为先。盖气有神而无形，补则易充；血有形而无神，补难速效。况气
阳而血阴，阴从阳，血从气，理也。故补气不补血，使气盛而充，血亦随之而盛矣。○气过热则 ，血过热则
斑；气不及，则顶陷不起，血不及则浆毒不附。（翁仲仁）
气居亲上之尊，则痘顶尖圆白润；血安亲下之分，则四围色晕红活。若通顶红色，必不能浆，八、九日
痒塌而死。此非血之过，由气亏而失其尊，故血得妄行，而僭居其位耳。大补其气，犹或可救；误认血热，以
凉治之，毙矣。○夫包血成圆者，气也。气能拘血制毒，则痘晕必光明而红活。顶陷者气之虚，塌陷者气之离。
晕枯者血之虚，根散者血之离。圆也晕也，气血之所为也。而所以成圆成晕者，气血不得专也。○气血有常，
但不能盈于常，而能亏于常。然亦有时而盈者，何也？毒壅于气，火搏于血耳。斑者血有余也， 者气独盛也。
（《慈幼筏》）
毒
痘毒在人身，无处不有，然其发也有次第。自骨髓而达于筋。肾主骨，血气壮盛，毒尽送出于筋，则肾
经毒解。自筋达于肌肉。肝主筋，气血充足，毒尽送出于肌肉，则肝经毒解。自肌肉达于血脉。脾主肌肉，
血气充足，毒尽送出于血脉，则脾经毒解。自血脉达于皮毛。心主血，气血充足，毒尽送出于皮毛，则
心经毒解。自皮毛达于疮窠。肺主皮毛，气血充足，毒尽送出于疮窠，则肺经毒解。五脏毒解，血化为脓，毒
从脓化，痂结 落，而功成矣。若出于筋，而少留于骨髓，则壮热、口干、闷乱；出于肌肉，而少留于筋，则
Origin of Smallpox
In ancient times, there were no smallpox or chickenpox; they only appeared at the end of the Zhou Dynasty and the beginning of the Qin Dynasty. ( *Medical Beginner* )
This condition of smallpox sores is commonly known as "Heaven's Sore." Tracing its origin, it is actually due to fetal toxin accumulating internally, which is then triggered by external seasonal pathogens, causing the toxin to manifest. Therefore, it is contagious and symptoms are similar, belonging to the category of epidemic diseases caused by heavenly qi. However, examining the *Neijing* (Inner Canon), it only mentions ulcers and rashes, i.e., macules and papules. Thus, from Bian Que (Yue Ren), Zhang Zhongjing, Hua Yuanhua, Wang Shuhe, and other masters, none mentioned smallpox, indicating that this condition did not exist in ancient times. So why does it exist now? I believe that toxins in recent times must be caused by excessive consumption of strong wine and rich flavors, which differs greatly from the simple and bland lifestyle of ancients! Perhaps some do not believe my words; just observe the differences between those who eat coarse food and those who eat rich pastries and meats. Even today, people in northern regions may not develop smallpox; tracing the cause, it is indeed due to this reason. Could it really be that they lack fetal toxins? (Zhang Jingyue)
Regarding the origin of smallpox and chickenpox, some argue it is foul toxin, some argue it is excessive fire, and some argue it is a regular epidemic disease, with no fixed conclusion. If one claims it is foul toxin or excessive fire, then within a year, from large commanderies to small villages, patients have similar symptoms and deaths follow one another; it is unlikely that everyone suffers to such an extent. If one claims it is a regular epidemic disease, why does it occur only once from youth to old age, with no further transmission afterwards? Parents and children share one body but are divided; the toxin of essence and blood has accumulated since the beginning of yin-yang interaction during conception, not waiting until birth to swallow blood before existing. Therefore, what waits for the right time to manifest is fetal toxin. Some are rapid and critical, some slow and smooth, some violent leading to death; this is determined by the weakness or strength of qi. Once manifested, the toxin is discharged. Hence, it occurs only once in a lifetime; afterwards, even if exposed to the pathogenic qi, one is not infected again. ○ The origin of smallpox as fetal toxin is evident! Among them, some are sparse and mild, some dense and severe, some severe turning mild, some mild turning severe; changes are unpredictable. There is another explanation: sparse and mild cases remain consistent throughout, while dense and severe cases present myriad anomalies. Some result from parental inheritance, some from epidemic contagion, some from ghostly attachment. These are obscure and elusive, beyond the reach of observation and thought. This can be explained to the wise, but there is no need to speak dreams to the foolish. ○ Examining the eruption of smallpox and chickenpox, it clearly appears to be caused by heavenly seasonal qi. Markets and villages transmit it to each other; mild cases are all mild, severe cases are all severe. Although there are exceptions accounting for ten percent or two, how can we generally attribute it solely to fetal toxin? Yet, those who never contract epidemics in their lifetime are common, whereas no one escapes smallpox and chickenpox; after contracting an epidemic, one cannot guarantee against reinfection, but after smallpox erupts, it never recurs. Then, how can the theory of fetal toxin be completely discarded? As for excessive fire and foul blood, these existed in ancient times too, so why was there no smallpox affliction? To use this to break the theory of fetal toxin is incorrect; there are many things in the world that appear suddenly from nothing. There is a grass named "Yu Meiren" (Crown Flower). Yu Meiren was also the name of Xiang Yu's favored concubine, who died for him. People mourned her and sang songs. Singing sorrowful songs to the grass causes it to sway, although the grass has no consciousness. Before the state of Chu existed, the concubine did not exist, let alone the grass. All sentient beings become deluded and form the Three Realms; how could there be doubt regarding smallpox? (Wan Mizhai)
Regarding the severity of fetal toxins, people understand easily, but the nature of external pathogenic qi is unknown to most. Between heaven and earth, there are only six qi. When qi is balanced, it is harmonious; when unbalanced, there is excess and deficiency. When excess and deficiency reach extremes, they become pestilential qi, epidemic qi, miasma, or foul qi on roads. If humans contract these, both young and old fall ill. However, the qi contracted for smallpox is different. This qi interacts specifically with infants whose fetal toxins have not yet been released. It is unheard of that during peak smallpox seasons, children who have already had smallpox get infected. Investigating this qi, from ancient times to now, no one has clarified exactly what kind of qi it is. Therefore, former sages in the field of smallpox, lacking knowledge of its source, inevitably had biases. Some preferred cold purgation; some preferred warm support; some used cold purgation first, then warm tonification; some used warm support first, then clearing and resolving. Moreover, some failed to examine the child's constitution regarding deficiency/excess and cold/heat, blindly following Fe Jianzhong's *Jiu Pian Suo Yan* (Records of Saving Deviations). Whenever fever and spots appear, they indiscriminately use Rhubarb (*Da Huang*), Gypsum (*Shi Gao*), Coptis (*Huang Lian*), Rhinoceros Horn (*Xi Jiao*), and Antelope Horn (*Ling Yang Jiao*). They do not realize that Fe's book is titled "Saving Deviations," meaning it corrects the bias of overusing hot medicines. If one is not biased but follows his method, deviation results. How can an infant's life withstand this! (*Lin Zheng Zhi Nan*)
Smallpox originates at conception; its toxin permeates the bone marrow. With every breath, it circulates long-term with qi and blood. Although it circulates, it is not of our own kind; its nature must be different. Once its kind calls it, it shakes and moves, leaving and departing. Upon departure, initially it was one with qi and blood, now it forms separate factions. Evil and righteousness clash, wanting to separate, leading to battle. If qi and blood win, the toxin dies and the person survives; if the toxin wins, qi and blood fail, the toxin destroys muscles and skin externally and damages bone marrow internally, leading to death. (*Huang Di Yi Dian*)
Care and Protection
If the weather is extremely cold, coverings should be warm to prevent cold exposure, lest the toxin's vapor be constrained by cold and unable to emerge. If the weather is extremely hot, avoid heavy coverings; keep cool to prevent external heat from combining with the toxin, causing increased irritability and ulceration of sores. If sudden thunder, fierce winds, or heavy rain occur, be cautious with curtains, add coverings, and burn incense to dispel foulness to avoid abnormal qi. ○ Sleeping areas should always be windless and bright; darkness is strictly avoided. Keep lights on at night and have relatives watch closely, ready to provide food or massage if pain or itching occurs. (Wen Ren)
When treating smallpox in deep winter, place plenty of charcoal fires in the room, possessing the power to reverse critical conditions; in midsummer, place plenty of ice water, bringing joy to clear the heart. It is essential to maintain a spring-like warmth in all four seasons, allowing qi and blood to flow smoothly. (*Feng Shi Jin Nang*)
Whenever smallpox erupts, open windows to connect with heavenly qi, live on the ground floor to connect with earthly qi, and loosen clothing belts to facilitate blood qi. (*Xiang Cun Dou Jue*)
Avoiding Foulness
Smallpox sores should avoid all foul odors and strangers entering the room. Avoid smells from travel sweat, armpit fox odor, sexual fluids, musk and mutton smell, menstrual blood and fishy odors from women, sulfur mosquito coil smoke, toilet bowl odors, burnt hair smell, extinguished candle wick smell, chicken feather and fish bone smells, and garlic, scallions, leeks, and wild onions. None of these should be encountered. One must frequently burn frankincense or similar fragrant substances. Constant inhalation of fragrant qi ensures smooth Ying and Wei circulation, preventing complications like inversion or sinking. (Li Dongyuan)
Wood withers when encountering Cinnamon Twig (*Gui Zhi*); realgar turns black when meeting lead white powder; citrus rots when meeting dried fruit. Things repel each other thus; sores and smallpox fear foul mixed qi, following the same principle. (Wen Ren)
Pulse Diagnosis
When examining smallpox, upon seeing fever, one must immediately check the pulse. Since smallpox sores will erupt, before visible signs appear, fever must come first. Once fever is seen, the pulse must be slippery and rapid. If the pulse is slippery and rapid with spirit, yet retains harmony and slowness, the smallpox will be mild; if slippery and rapid doubled, yet still carries a hint of harmony, the smallpox will be severe; if extremely slippery and rapid, combined with wiry and restless, or hollow and urgent without spirit, and completely lacking harmony, the smallpox will be critical. Thus, I can predict auspiciousness or inauspiciousness during initial fever, astonishing many, though they do not know the insight lies in the pulse. This method requires holding the child's hand fully and using only the thumb to diagnose, which is easiest. (Zhang Jingyue)
Observation Method
Soak a paper twist in sesame oil, dry it, dip it again before use, and slightly roast it over a lamp. When observing, close all doors and windows to create darkness. To view the left side, move the light to the right; to view the right, move the light to the left; apply similarly up and down. Then, the number of sores and their color can be predicted. Rashes float on the skin surface with no root in the flesh; smallpox has roots in the flesh. Observing under sunlight makes differentiation difficult. (*Feng Shi Jin Nang*)
During initial fever, use a red paper twist dipped in sesame oil, ignite it, and shine it to verify the presence of vitality. Rub the cheeks with fingers; if redness turns white and white turns red with the touch, it is called "living blood," indicating vitality exists; if rubbing does not whiten it and lifting does not redden it, it is "withered blood," which is untreatable even if sparse. Also observe the eyes: if spiritual light is bright, lips and tongue are red and lively as usual, without scorched or dry appearance, it is an auspicious sign. (*Zheng Zhi Zhun Sheng*)
When examining smallpox, natural daylight is required for accurate identification; burning paper strips in dark rooms often leads to errors. Holding the child in a bright place is best. (*Xiang Cun Dou Jue*)
Observing smallpox need not involve uncovering hands and feet, only the head and face are needed. The head and face are the gathering point of all yang meridians, corresponding to heaven above. It is said that the upper half of the body is governed by heavenly qi, so fewer sores here are precious. Limbs correspond to earth below; it is said the lower half is governed by earthly qi, so more sores here do no harm. (*Huang Di Yi Dian*)
There are three essentials for examining smallpox: 1. In daily life, predict severity beforehand; 2. During fever, determine if sores will erupt; 3. When spots appear, verify if they are true smallpox. A pulse that is surging, large, uniform, and clean is auspicious; wiry, tight, scattered, or rapid is inauspicious. Heat in palms, soles, umbilicus, buttocks, and earlobes is inauspicious; clear spirit is auspicious; turbid spirit is inauspicious. The future severity can be known. During fever, symptoms may resemble cold-food stagnation or convulsions. If misdiagnosed as cold-food and treated accordingly, little harm ensues; if misdiagnosed as convulsions and treated recklessly with metallic minerals, attacking the interior wrongly, causing diarrhea and depleting true yuan, death may occur before spots appear, shortly after appearance, or after pustule formation fails to crust. Some measles are red, lively, and distinct, appearing rooted; observers mistake them for adverse smallpox. Do they know that after measles erupt, cough and phlegm obstruction, diarrhea, or epistaxis occur, spirit clears, and body cools, distinctly different from smallpox? Some "water-red smallpox" varies in size, has pus and petals, red and lively from head to toe; observers mistake them for standard smallpox. Do they know "water-red beans" erupt, fill with pus, and crust simultaneously, unlike standard smallpox which aligns on day three, fills with pus on day five, and crusted on day seven. Their color is bright like pearls, skin thin and wrinkled, spirit normal, distinct from standard smallpox. (Ye Xingyuan)
Chills without sweat, headache, and stiff spine are present in Cold Damage (*Shang Han*) but absent in smallpox. Eyes full of tears, coarse nasal breathing, slight startle during sleep, and patterns on ears and cheekbones are present in smallpox but absent in Cold Damage. (Xu Chunyi)
Location
All sores belong to Heart Fire. The splendor of the Heart manifests in the face; prognosis for smallpox relies on facial locations, covering half the understanding. Smallpox and chickenpox belong to Yang Toxin; all yang gathers in the face, making auspicious/inauspicious and good/bad signs easy to see. The forehead belongs to Heart Fire. Red spots appearing first in the area above Yintang below the hairline, horizontally between the Sun and Moon angles, with early pus and crusting, is a bad omen. The Heart is the monarch; toxin erupts from the Heart, hence appearing first in its location. If the Heart is endangered, the twelve organs are all endangered. The left eyelid belongs to Liver, the right to Lung. Red spots appearing first on eyelids, distinct and separate, are auspicious; clumped together with hard, swollen flesh indicates death. The Liver stores Hun (Ethereal Soul), the Lung stores Po (Corporeal Soul); when vitality ends, souls depart, hence untreatable. The chin belongs to Kidney. Chengjiang extends horizontally to both jaws. Red spots appearing first, with early eruption and crusting, are auspicious. Though belonging to Kidney, all three Yin and three Yang meridians gather here; yin and yang harmonize, hence treatable. The nose belongs to Spleen Earth. Red spots appearing first on the tip of the nose with early pus/crusting are inauspicious. The Spleen belongs to Earth; the four zang organs receive orders from the Spleen. Toxin erupting from Spleen Earth, if failing, causes the four zang to fail sequentially, leading to prolonged illness and eventual death. The opening of the Kidney is in the ears; the Heart also opens into the ears. Heart and Kidney are both Shaoyin Sovereign Fire. Additionally, Shaoyang Minister Fire meridians run before and behind the ears. Red spots appearing first on earlobes are inauspicious. Sovereign and Minister fires are active; the blazing intensity is hard to extinguish. Only the area around the mouth, erupting, rising, and crusting first, is highly auspicious. The Yangming meridian surrounds the mouth and lips, governed by Stomach and Large Intestine, accepting all things. (Zhai Yidu)
Smooth, Adverse, and Critical
There are three types of smooth and adverse smallpox: Temporal smooth/adverse—Spring and Summer, when yang qi generates, smallpox is smooth; Autumn and Winter, when yang qi hides, smallpox is adverse. Deficiency/Excess smooth/adverse—Constipation with appetite is Excess/Smooth; Diarrhea with anorexia is Deficiency/Adverse. Eruption/Retraction smooth/adverse—Eruption is Smooth; Inversion, sinking, or伏 (hidden) is Adverse. (Qian Zhongyang)
Smallpox texts say: Spring and Summer are smooth, Autumn and Winter are adverse. Spring smoothness needs no mention; autumn coolness also aids treatment. But during intense summer heat, three parts smallpox equals ten parts danger; vigilance against changes is crucial, caution is necessary. Winter seems hard to manage, yet is better than summer. ○ Smooth/Adverse depends on Heaven; Critical depends on Human effort. Of smooth cases, 30-40% survive; of adverse, 10-20%; critical cases constitute the majority. Therefore, treatment methods must be discussed according to circumstances. (*Dou Jue Yu Yi*)
Spring/Summer smooth, Autumn/Winter adverse. This refers to the principles of growth, flourishing, harvesting, and storing. Are all springs/summers smooth/auspicious and autumns/winters adverse/inauspicious? If spring fails to nourish generation, or summer fails to nourish flourishing, then spring/summer become adverse. If autumn nourishes harvesting, and winter nourishes storing, then autumn/winter become smooth. Only when smallpox erupts with appropriate sparsity/density, not missing its timing, is it smooth; when erupting mixed with macules/rashes, densely packed without seams, often missing timing, it is adverse. Alas! "Spring/Summer smooth, Autumn/Winter adverse"—did ancients truly拘拘 (rigidly adhere) to seasonal theories? Spring/Summer are commands of generation; Autumn/Winter are commands of killing/harvesting. Smallpox eruption, if rising and developing, receives the command of Spring/Summer, hence smooth; if sinking and hidden, receives the command of Autumn/Winter, hence adverse. Is this what is meant? (Wan Mizhai)
For smallpox, smooth cases need not be treated; adverse cases cannot be treated; only critical cases deserve treatment. What are critical cases? If the base is smooth but location is critical; location smooth but timing critical; timing smooth but quantity critical; quantity smooth but color critical; color smooth but diet critical; diet smooth but mixed symptoms critical; mixed symptoms smooth but treatment critical; treatment smooth but exposure to foulness critical. Yet the most critical lies in Yuan Qi (Original Qi) vs. Pathogenic Qi. If pathogenic qi is strong but Yuan Qi is also strong, there is no harm; if Yuan Qi weakens, even slight pathogenic qi becomes critical. If violated and not treated quickly, smooth becomes unsmooth, and auspicious turns inauspicious. All these are key points in smallpox requiring careful discrimination. (Zhang Jingyue)
Adverse cases can also survive; do not abandon them untreated. Critical cases have no inherent death logic; those who die bear medical error, not smallpox's fault. Now, some select only smooth cases to treat, mixing with customs to gain fame, abandoning critical ones. I therefore detest the classification arguments in books like *Jin Jing Lu* as inhumane. (Wu Tianshi)
Yuan Qi (Original Qi)
Examine Yuan Qi first when looking at smallpox. The child's Yuan Qi is neither existent nor non-existent; it is grasped through mental intuition. If appearance/color is initially good but turns bad, Yuan Qi is internally exhausted; if initially bad but turns good, Yuan Qi is internally strengthened. Yuan Qi is the root; appearance/color is the branch. Good practitioners seek the root. (*Ci You Fa*)
People know smallpox relies on qi and blood, but do not know it relies on something surpassing qi and blood. When Yuan Qi is abundant, qi and blood flow smoothly, leading, chasing, carrying, and expelling toxin together; smallpox will open and fall according to schedule. Once Yuan Qi is deficient, external factors lack internal continuity, internal factors lack external stability, toxin acts wildly, emerging or entering, causing external erosion and internal attack. Nourishing true yuan and tonifying qi and blood is indeed the complete strategy for treating smallpox. If forced to treat other conditions, stop once the disease is addressed. (Wei Guiyan)
Qi and Blood
Treating smallpox takes qi and blood as the root, just as governing a country takes benevolence and righteousness as essential. Qi resides in the center, embodying the ruler's way; Blood attaches to the exterior, embodying the minister's way. Qi follows the correct path, honored, capable of rounding, leading, restraining, containing, shining, chasing, yellowing, and resolving; Blood follows the correct path, smooth, capable of attaching, carrying, controlling,收敛 (astringing), and being red/lively. This is qi and blood performing their duties. Qi losing correctness leads to heat, sinking, itching/collapse, trembling, vomiting, diarrhea, mania/irritability, gray/white; Blood losing correctness leads to cold, swelling, stagnation, delirium, purple/black. This is qi and blood losing their duties. (Wei Guiyan)
Qi has the function of generating blood; blood has no principle of benefiting qi. Thus, qi must not be deficient; deficiency means yang convergence is insufficient, and the round halo shape fails to form. Blood must not be excessive; excess means yin invades yang positions, and inversion disaster strikes immediately. Therefore, treating deficiency syndromes prioritizes tonifying qi. Qi has spirit but no form; tonifying it is easy to fill. Blood has form but no spirit; tonifying it yields slow effects. Moreover, qi is yang and blood is yin; yin follows yang, blood follows qi, which is the principle. Thus, tonifying qi without tonifying blood allows qi to become abundant and filled, and blood will follow and become abundant. ○ If qi overheats, acne/boils occur; if blood overheats, macules occur. If qi is insufficient, the summit sinks and does not rise; if blood is insufficient, pus/toxin does not attach. (Weng Zhongren)
When qi occupies the superior position, the smallpox summit is round, white, and moist; when blood rests in the inferior position, the surrounding halo is red and lively. If the entire summit is red, it certainly cannot form pus, leading to itching/collapse and death on days 8-9. This is not blood's fault, but due to qi deficiency losing its honor, allowing blood to act recklessly and usurp its position. Greatly tonifying qi might still save; mistaking it for blood heat and treating with cooling agents leads to death. ○ That which encloses blood into a circle is qi. Qi can restrain blood and control toxin, so the smallpox halo must be bright and red/lively. Summit sinking is qi deficiency; collapse is qi separation. Halo withering is blood deficiency; root scattering is blood separation. Roundness and halo are actions of qi and blood. But the reason for forming roundness and halo is that qi and blood do not act exclusively. ○ Qi and blood have constants, but they cannot exceed constants in abundance, only in deficiency. Yet sometimes they are abundant. Why? Toxin obstructs qi, fire wrestles with blood. Macules indicate blood excess; acne/boils indicate qi alone is abundant. (*Ci You Fa*)
Toxin
Toxin in the body is everywhere, but its eruption has a sequence. From bone marrow to sinews. Kidney governs bones; if qi and blood are robust, toxin is fully sent out to sinews, then Kidney Meridian toxin resolves. From sinews to muscles. Liver governs sinews; if qi and blood are sufficient, toxin is fully sent out to muscles, then Liver Meridian toxin resolves. From muscles to blood vessels. Spleen governs muscles; if qi and blood are sufficient, toxin is fully sent out to blood vessels, then Spleen Meridian toxin resolves. From blood vessels to skin/hair. Heart governs blood; if qi and blood are sufficient, toxin is fully sent out to skin/hair, then Heart Meridian toxin resolves. From skin/hair to sore bases. Lung governs skin/hair; if qi and blood are sufficient, toxin is fully sent out to sore bases, then Lung Meridian toxin resolves. When toxins of the five zang resolve, blood transforms into pus, toxin transforms from pus, scabs form, crusts fall, and the task is completed. If erupting from sinews but remaining slightly in bone marrow, then high fever, dry mouth, restlessness; if erupting from muscles but remaining slightly in sinews, then