搐搦、牵掣、紫黑、潮热；出于血脉，而少留于肌肉，则发痈肿于四肢；出于皮毛，而少留于血脉，则痘不圆
肥；出于疮窠，而少留于皮毛，则痂落迟，而多麻瘢。（翟益都）
痘毒与诸疮毒不同。诸疮毒未成形，可解散内消而愈，既成形，而未成脓，犹可逐散，不成脓而愈。痘毒
发自先天，应期开落，不可内消，不能逐散，全仗气血送毒归痘。○痘毒蕴结于脏腑骨肉之间，与血气浑成一块，
未曾破解，有感之后，渐渐分离，如胎之将产。此“解”字，乃分形解体也。故痘出一分，毒解一分；痘出二
分，毒解二分；痘尽出，则毒尽解。特在肌肉之间而未化耳，出不齐，胀不起，脓不化，痂不结，气血弱也，
速宜助之。助之者，恐胶结难解也。若曰未出，可解之不出；多出，可解之少出；将使胎之在腹者，可使之不
产；将产，亦可使之不产乎！○痘不为害，惟毒为害。毒尽附于痘中不为害，惟不尽附于痘中则为害。故无论随
所因而用何剂，必少加穿山甲末，透其窍而逐之，使毒归于颗粒而后已。又必加白芍敛其血，而收其毒，使无
一分渗漏旁溢，治法其庶几乎！○痘未出前，升发微汗，使毒瓦斯宣通，毒出外，而内自安也；既出后，调气助
血，使浆路充盈，浆始化，而毒无不尽也。○毒停肌肉则发肿，毒滞皮肤则作臭。肌肉。阳明主之属土；皮肤，
太阴主之属金。痈肿土象，腥臭金象，各从其类也。（《慈幼筏》）
人之有痘毒，犹石之有火也。毒感则出，不感则不出，犹石之火，击则见，不击则不见也。人言痘可以稀，
试抱此石浸之江河千百年，取出一击，吾不知果有火否也。（朱一麟）
人身之火，毒也，与天时之火遇，则天时之火亦并而为毒。
毒即火也，火即毒也。有火毒甚而气血不虚者，未有气血虚而无火毒者也。故治痘用补法，要安顿得毒瓦斯住。
○胎毒轻，感时气亦轻，故其痘稀；胎毒重，感时气轻，痘虽密，犹为可救；胎毒轻，感时气重，解去时疫，
痘自然顺；若胎毒本甚，兼逢疫疠之气，其有能治者鲜矣。○吴氏《痘诀》云∶气血之分，犹清浊之本乎上下也；
气血之交，犹阴阳之互为根据附也。当分不分，毒结之；当交不交，毒隔之。知升阳散郁，何不分之患？知清热
解毒，何不交之忧？予师最服此一条，但云“结”字、“隔”字，须要参透。结者，散之，升阳散郁是已；隔
字要钻得通，清热解毒，治法未为尽善，行之既久，始知用太乙保和汤。○痘之生死，在毒归窠与不归窠。用
药之妙，于补泻之外，别有会意。毒归窠则生，不归窠则死。毒归窠，则点粒圆稳而光壮，根盘收紧，人事
清爽，痘虽多无害。毒不归窠，其患有二∶其一，火毒太盛，表剂之中未驭清凉，一发无制，点粒为其所烁，
致成焦萎，或点粒匾阔歪斜，隙地散而成斑，种种恶状，急宜泻火之中领毒归窠；其一，元气本虚，火毒又盛，
弱难制强，不能统摄，毒瓦斯散漫，或头面预肿，或发紫 ，痘点不长，此谓虚中夹毒，清补两难。予前有太乙
保和汤之论，寓补益于清凉活血之中，虽然合法，在四、五朝用之者多，而三朝出齐，根窠不立，另有方法，
名摄毒汤，人参、当归、生地、丹皮、桔梗、甘草、蒡子、连翘、紫草、川芎、防风、栀子、腹皮、贯众合为
一剂，所谓领毒归窠者也。○领毒归窠，即古人松肌透毒之义。虚证欲补，一味闷补，肌何由透？实证欲清，
一味呆清，肌必不松。药之佐使，将之先锋，领毒归窠，则非补泻之力，全仗佐使之功也。防风卒伍之职而无
专司，山楂散结有功而无透力，三、四朝，清凉剂中，领毒归窠。一部本草，舍腹皮、贯众，别无可用之药。（《橡村痘诀》）
火
痘、疹二证，皆言火者是也。然轩岐之火义有三∶曰太过、
曰平气、曰不及。太过之火，是谓赫曦炎烈之气也，其毒甚，治宜清解；平气之火，是谓升明蕃茂之气也，其
毒平，不必治之；不及之火，是谓伏明屈伏之气也，其毒陷，治宜培补。此阴中有阳，阳中有阴之义，亦痘疹
万病之法旨。使不知此，尚敢云医！（张景岳）
痘之为用，全赖火以成功。釜中无火，何由蒸化？但火太盛，则有食气之患，故不得不清。里证既平，
痘点稍开，急宜转手。若寒凉太过，七朝以后，多生变证，皆凉药之误也。（《橡村痘诀》）
热
五谷不热不结，痘疮不热不彻。但热太过者真阴灼，不及者真阳衰。故痘之始终，全顾热之深浅何如耳。（《岐黄书》）
凡病皆发热，痘亦必发热。然热同而所以热则异。盖病自外来，痘从中出；病由中虚，痘为虚中。○见
点前后，毒与血别，动而后定，危而后安，周行故道，乃复招气，如妻之招夫归也。气亦随亲血以卫之，如夫
之归顾妇也。故汗出热退，而身凉矣。○所以热退身凉而见点者，上也。毒微而血不亏也。血不亏，则不盗气，
气血相附，以待毒化。○见点而后热退者，中也。毒伤血也。血被毒伤，必待气充血足，斯返旧日之平和。○
热未几而遽见点者，下也。毒盛伤血也。伤甚，则血枯不能滋润夫气，气乃无家，气既无家，乃罔顾家，反助
表邪，一涌而出，则气不卫表，门墙崩而远见室中之物矣。○点齐之后不复热矣。若仍发热，是毒郁于中，而
欲重出也。至胀浆时又必发热。若应热不热，是气惫而不能蒸毒使之化，久之必亡。○ 时当身凉不热矣。倘
有余热，是气血大虚，须求补益。否则血虚不能招气，气为飞扬，不能尽祛其毒而腐于外，此时毒既为毒，不
得复与血混，气因衰焉，毒乃猖狂侵血而为热。慎哉！热之发也。○发热之初，清毒，则毒伏于内而不出；退火，
则血凝于中而不流；攻发，则气伤于外而不遍。是皆不明于病之为热、痘之为热也。辨哉！热之发也。
（《黄帝逸典》）
痘疹属阳，无热不成，亦无热不散。所以非热不能出见，非热不能起发，非热不能化浆，非热不能干浆。
此痘疮之终始不能无热，亦不可无热也。但热贵其微，不宜其甚。盖热甚者毒必甚，而痘出必重；热微者毒亦
微，而痘出必轻；无热则不成、不化。此热固痘之常也。凡治痘者，不可尽除其热，若必欲尽去之，则未有不
成阴证而败者矣。（《景岳全书》）
痘证，凡出胖贯 ，各欲其身热一番，是其正候。（《仁端录》）
痘始终藉热成功。先三日热而后出，出齐则退；浆行又热，浆足则退；回浆又热，浆回则退；结痂、收
、落痂又热，名曰烧瘢。此皆不宜凉解，凉解则气血凝滞，痘毒留中而祸作矣。（《慈幼筏》）
虚实
凡痘灰白，不红绽，不起发，出不快，昏暗顶陷，皆表寒而虚；二便清利，身凉，手足口气俱冷，不渴
少食，唇白涕清，饮食不化，皆里寒而虚。夫表虚者，以补气为主，而补血次之；里虚者，于补血之中，而兼
补气。苟能补气，则脾胃自壮，胃气随畅，在后必无陷伏之忧；既能补血，则气血周流，送毒出尽，不致凝滞，
在后必无痒塌之患。凡红紫、干滞、黑陷、焦枯者，皆表热而实；大便秘结，小便赤涩，身热鼻干，唇燥烦渴
者，皆里热而实。如表热者，则宜清凉解表，而分利次之；里热者，则重于解毒，而兼清凉，或在二、三日之
前热毒盛者，微下之。盖凉血不至红紫，解毒则免黑陷。故表虚不补，则成外剥；里虚不补，则成内攻。表实
过补，则不结痂；里实过补，则发痈毒。○身发壮热，毛直皮燥，睡卧不安，腮红睛赤，气粗烦渴，腹胀便秘，
喘急，皆实证也。又见呕吐之证，似虚也。然不知热毒在内不得伸越，则上逆攻冲而吐。《经》云诸逆冲上，
皆属于火者是也。治从升阳发散。又有泄泻之证兼见者，似虚也。然因热毒郁盛，
熏炙脾胃，不得外达，则毒从下陷，寻窍而出。《经》谓暴注下迫者是也。古云∶未出而泻者生，既出而泻者
死。治以升提发散，引毒外达，毒得外解，则内泄自止。又有不思饮食，书云不思饮食皆属内虚者是矣。然不
知郁热之证，毒瓦斯在内，不得升达肌表，二便秘结，腠理阻塞，热毒壅盛，腹胀喘急，不思饮食者，必然之势
也。治以升提发散，引毒达表，则热气有所伸越，而脏腑和平，饮食自进矣。若误用丁、桂、半夏等热药于呕
泻不食之证，是以热攻热而转增烦剧；用参、 、苓、术等补剂于腹胀不食之证，则邪得补而愈盛。医之过也。（翁仲仁）
问∶痘以气血为主，气血实，气血虚，皆有死证。何也？予曰∶实证之死，血凝气结；虚证之死，气离血散。（许宣治）
凡所言实热、虚寒，即一日之间，俄而实热，俄而虚寒，须时刻审谛，前后的确，不可概拘。（《仁端录》）
轻重
一发便出尽者，重；疮夹疹者，半轻半重也；出稀者，轻；里外微红者，轻；外赤里黑者，微重；外白
里黑者，大重也；疮端里黑点如针孔者，势剧也；青干黑陷，昏睡汗出，烦躁热渴，腹胀啼喘，二便不通者，
困也。（钱仲阳）
标本
病有标本，治有先后。有从标者，有从本者，有先标后本者，有先本后标者，有标本兼治者。视其急缓，
不可胶柱而鼓瑟也。痘疮之候，自人身而言，则气血为本，痘疮为标；自痘疮而言，则痘疮为本，别证为标。
如疮稠密，在标之病也，视其气之不匀，血之不周，以匀气活血为主，兼行解毒。此则标本兼治也。若疮起发，
气或虚者补其气，血或虚者补其血。此缓则治其本也。气血充实，疮或壅遏者，单行托里解毒之剂。此急则治
其标也。疮势太甚，咽喉肿痛者，以治咽喉为主。此急则治其标也。疮势太甚，自利不止者，以治利为主。此
急则治其标也。利久不止，渐
成坏证，救里发表，兼而行之。此亦标本兼治也。先救其里，后攻其表。此则先标后本也。大小便秘，烦躁喘
呼者，急利之。此急则治其标也。疮势太甚，烦渴不止，以解毒为主，兼治其渴。此先本而后标也。凡此之类，
扩而充之，以尽其余，则治不紊矣。（《证治准绳》）
始终
治痘贵乎慎之于始，而虑其所终。发热之初，烦渴便秘，腹痛腰疼，鼻干唇燥，惊悸谵妄者，此毒郁于内，
防其伏而不出。若吐利不止者，防其中气虚弱，不能助痘成浆。故热则解之，秘则利之，惊则平之，吐利则止
之。且如初出一点血，此春生之令也；至于起发，此夏长之令也；水化为浆，此秋成之令也；脓干结 ，此冬
藏之令也。若初出而便含水，将发而便戴浆，脓未成而便收 者，此未至而至，谓之太过，须防陷伏倒 ，宜
发表托里，兼与解毒。若应出不出，应起不起，应灌不灌，应收不收者，此至而不至，谓之不及。此血衰气弱，
须防无浆斑烂，宜补托生浆，兼与匀气活血。又如初出而色艳者，则必皮嫩，嫩则易破，须防痒塌；相聚成块
者，不可谓之疏，防有内伏；浆水清稀者，虽见成痂，防后发痈；头面预肿者，防其易消而内攻；咽痛者，须
急解之，防其失音而挫喉；频更衣者，防其倒 ；多水 者，防其自利；目涩泪出者，防其肤翳。杜渐防微，
治未病之良法也。（《冯氏锦囊》）
形色
尝观万物之生，雨甚则烂，旱甚则焦；生则鲜泽，死则枯暗；鲜泽则耸拔，枯暗则低垂。人情物理，何
以异哉！（《黄帝逸典》）
夫痘贵乎形色。谓之形者，始出尖圆坚浓，起壮发荣，滋长成浆，饱满充足，收 敛束完固，与水珠光
泽者，皆正形也。或平或陷者，形之变也。是以初出之时，隐如蚊蚤之迹，空若蚕种之蜕，薄如麸片，密似针
头，如热之痱、寒之粟者，必不能起发
而死；若粘聚模糊，肌肉虚浮，溶软嫩薄，皮肤溃烂者，必不能收 而死。谓之色者，喜鲜明而恶昏暗，喜润
泽而恶干枯，喜苍蜡而恶娇嫩。红不欲艳，艳则易破；白不欲灰，灰则难 。由红而白，白而黄，黄而黑者，
此色之正也；若初出而紫滞，起发而灰白者，此色之变也。更有根、窠、脚、地四者，名虽各殊，总不离乎形、
色二字。何谓窠？中透而起顶者是也。何谓根？外圈而红者是也。然圈之红否，则其中之虚实，与痘毒之浅深
可见矣。窠之起否，则根之浅深，与气血之盈亏可定矣。所谓脚、地者，亦本乎根窠之圆晕，颗粒之稀密也。
夫红晕之处谓之脚，凡颗粒界限分明，不散不杂者，此痘脚之明净也。空隙之处谓之地，凡颗粒不相连缀者，
此地面之明净也。总之，根欲其活，窠欲其起，脚欲其固，地欲其宽。四者俱顺，痘虽重而无虑矣。然圆者气
之形也，气盛则必痘窠圆满而周净；晕者血之形也，血盛则必痘窠光明而红活。故气虚则顶陷，气散则窠塌。
然有气虚极而不塌陷者，乃火载之，是虽圆满，实空壳而如 也。血虚则晕淡，血惫则晕枯。然有血虚极而犹
红活者，乃火上浮，是虽圆晕，实枯槁而不泽也。形色者，乃气血之标；气血者，乃形色之本。诀曰∶有盘有
顶终须贵，有顶无盘却不宜。观此二语，则盘顶固俱属痘家之紧要，而盘更重于顶也。盘者即根脚之义也，顶
Convulsions, limb traction and spasms, purplish-black color of the lesions, tidal fever; if the *douxu* (smallpox toxin) originates from the blood vessels but lingers slightly in the muscles, carbuncles and swellings will erupt on the four limbs; if it originates from the skin and hair follicles but lingers slightly in the blood vessels, the pustules will not be round and plump; if it originates from the *ke* (the base/depression of the lesion) but lingers slightly in the skin, scabs will fall off late, leaving many pockmarks. (Zhai Yidu)
The *douxu* (smallpox toxin) is different from the toxins of other sores. For other sore toxins, when they have not yet formed a shape, they can be resolved internally and eliminated to achieve cure; even after forming but before suppuration, they can still be dispersed to heal without suppuration. The *douxu* (smallpox toxin) arises from congenital sources and follows its scheduled cycle of opening and closing; it cannot be eliminated internally nor forcibly dispersed. It relies entirely on Qi and Blood to transport the toxin into the pustules for expulsion. ○ The *douxu* (smallpox toxin) accumulates between the Zang-Fu organs, bones, and flesh, mixing with Qi and Blood into a single mass that has not been broken apart. After external pathogenic factors trigger it, it gradually separates, similar to a fetus about to be born. This character "jie" (resolve/loosen) refers to the separation of form and structure. Thus, for every portion of the rash that emerges, one portion of the toxin is resolved; for two portions, two portions are resolved; when all rashes emerge, all toxin is resolved. At this stage, the toxin remains in the muscles and has not yet fully transformed. If the eruption is uneven, swelling does not rise, pus does not form, and scabs do not bind, it indicates deficient Qi and Blood, which requires rapid assistance. The method of assistance aims to prevent the toxin from becoming stubbornly adherent and difficult to resolve. One might ask: if the toxin has not emerged, can resolution methods prevent its emergence? If too much emerges, can resolution methods reduce it? Could one make a fetus in the womb not be born, or prevent a fetus ready to be born from being born! ○ The smallpox itself is not harmful; only the toxin is harmful. If the toxin completely attaches to the pustules, it is harmless; harm occurs only when it does not completely attach. Therefore, regardless of the formula used based on the etiology, a small amount of powder from *Chuan Shan Jia* (Pangolin Scales) must be added to penetrate the pores and drive out the toxin, ensuring the toxin returns to the granular lesions before stopping. Additionally, *Bai Shao* (Radix Paeoniae Alba) must be added to astringe the blood and collect the toxin, preventing any leakage or overflow. With this approach, the treatment method is likely to be successful! ○ Before the eruption, inducing slight sweating helps disperse the toxic vapors, allowing the toxin to exit externally while keeping the interior peaceful; after the eruption, regulating Qi and assisting Blood ensures the channels for pus formation are full, allowing pus to transform and the toxin to be completely expelled. ○ When toxin stagnates in the muscles, swelling occurs; when it stagnates in the skin, foul odor develops. Muscles are governed by the Yangming channel and belong to Earth; skin is governed by the Taiyin channel and belongs to Metal. Carbuncles represent the image of Earth, and fishy/foul odors represent the image of Metal, each following their respective categories. (*Ci You Fa*)
Humans possessing *douxu* (smallpox toxin) are like stones containing fire. When triggered by the toxin, it emerges; when not triggered, it does not emerge, just as fire in a stone appears only when struck and remains hidden otherwise. People say smallpox can be made sparse; try immersing such a stone in rivers for thousands of years, take it out, and strike it—I wonder if there will indeed be fire. (Zhu Yilin)
The fire within the human body is the toxin. When it encounters the fire of the seasonal climate, the seasonal fire also merges to become toxin.
Toxin is fire; fire is toxin. There are cases where fire-toxin is severe but Qi and Blood are not deficient; there are no cases where Qi and Blood are deficient without fire-toxin. Therefore, when treating smallpox using tonification methods, the key is to settle the toxic vapors. ○ If fetal toxin is mild, the seasonal qi contracted is also mild, so the rash is sparse; if fetal toxin is heavy but seasonal qi is mild, although the rash is dense, it is still salvageable; if fetal toxin is mild but seasonal qi is heavy, once the epidemic qi is resolved, the rash naturally proceeds smoothly; however, if fetal toxin is inherently severe and compounded by epidemic pestilence qi, few can be cured. ○ Wu's *Dou Jue* states: The distinction between Qi and Blood is like the fundamental difference between clear and turbid elements located above and below; the interaction of Qi and Blood is like Yin and Yang relying on each other for support. When differentiation should occur but does not, toxin becomes knotted; when interaction should occur but does not, toxin becomes blocked. Understanding how to raise Yang and scatter depression, why worry about knotting? Understanding how to clear heat and detoxify, why worry about blocking? I most admire this passage, but believe the characters "jie" (knot) and "ge" (block) must be thoroughly comprehended. For knotting, one must scatter it; raising Yang and scattering depression suffices. For "blocking," one must drill through it; clearing heat and detoxifying is not yet perfect; upon long-term practice, one realizes the use of *Tai Yi Bao He Tang* (Great One Harmonizing Decoction). ○ The life or death of smallpox depends on whether the toxin returns to the *ke* (base/depression). The subtlety of medication lies beyond simple tonification and purgation, requiring deeper insight. Toxin returning to the base means survival; failure to return means death. When toxin returns to the base, the spots are round, stable, lustrous, and robust, with tight roots, clear mental state, and no harm despite abundance. When toxin fails to return, two dangers arise: First, excessive fire-toxin not controlled by cooling agents in exterior-releasing formulas leads to uncontrolled eruption, burning the spots until they become scorched and withered, or flat, wide, and slanted, scattering into patches—various malignant signs requiring urgent purging of fire while guiding toxin to the base. Second, inherent Yuan Qi deficiency combined with strong fire-toxin creates a situation where weakness cannot control strength, failing to contain the toxin, leading to scattered toxic vapors, pre-swelling of the head and face, purple discoloration, and stunted growth—this is deficiency mixed with toxin, making clearing and tonifying equally difficult. My previous discussion on *Tai Yi Bao He Tang* (Great One Harmonizing Decoction) embeds tonification within clearing heat and invigorating blood; while lawful, it is mostly used on days 4-5. For eruptions completing by day 3 with unstable bases, another method exists named *She Du Tang* (Toxin-Capturing Decoction), composed of *Ren Shen* (Radix Ginseng), *Dang Gui* (Radix Angelicae Sinensis), *Sheng Di Huang* (Radix Rehmanniae Preparata), *Dan Pi* (Cortex Moutan), *Jie Geng* (Radix Platycodi), *Gan Cao* (Radix Glycyrrhizae), *Niu Bang Zi* (Fructus Arctii), *Lian Qiao* (Fructus Forsythiae), *Zi Cao* (Radix Arnebiae/Lithospermi), *Chuan Xiong* (Rhizoma Chuanxiong), *Fang Feng* (Radix Saposhnikoviae), *Zhi Zi* (Fructus Gardeniae), *Fu Pi* (Cortex Magnoliae Officinalis), and *Guan Zhong* (Rhizoma Dryopteridis Crassirhizomatis) in one dose. This is what is meant by guiding toxin to the base. ○ Guiding toxin to the base is equivalent to the ancient concept of loosening the muscle layer to transmit toxin. For deficiency patterns seeking tonification, blind tonification prevents muscle relaxation; for excess patterns seeking clearing, rigid clearing prevents muscle loosening. The assistants and guides in herbal formulas act as vanguard troops; guiding toxin to the base relies not on tonification or purgation alone, but on the efficacy of these assistants. *Fang Feng* (Radix Saposhnikoviae) serves as infantry without specific command, and *Shan Zha* (Fructus Crataegi) resolves knots but lacks penetrating power. On days 3-4, within cooling formulas, guiding toxin to the base is achieved. Among all materia medica, except for *Fu Pi* (Cortex Magnoliae Officinalis) and *Guan Zhong* (Rhizoma Dryopteridis Crassirhizomatis), there are no other suitable drugs. (*Xiang Cun Dou Jue*)
Smallpox and measles both involve fire, which is correct. However, the meaning of fire in Huangdi and Qibo's teachings has three aspects: Excess, Normal, and Deficient. Excess fire is called "He Xi Yan Lie" (blazing and fierce energy); its toxicity is severe, requiring clearing and resolving. Normal fire is called "Sheng Ming Fan Mao" (ascending, bright, and flourishing energy); its toxicity is balanced, requiring no treatment. Deficient fire is called "Fu Ming Qu Fu" (hidden light and subdued energy); its toxicity sinks, requiring tonification and cultivation. This embodies the principle of Yin containing Yang and Yang containing Yin, and is the fundamental principle for all diseases related to smallpox and measles. Without understanding this, how can one dare claim to be a physician! (Zhang Jingyue)
The success of smallpox treatment relies entirely on fire. Without fire in the pot, how can steaming and transformation occur? But if fire is too strong, it risks consuming Qi, so clearing is necessary. Once interior symptoms stabilize and spots begin to open, the treatment strategy must shift urgently. Overuse of cold-cooling herbs often leads to complications after the seventh day, errors caused by cooling medications. (*Xiang Cun Dou Jue*)
Grains do not mature without heat; smallpox does not fully develop without heat. However, excessive heat burns True Yin, while insufficient heat weakens True Yang. Thus, the entire course of smallpox depends on the depth of heat. (*Qi Huang Shu*)
All diseases involve fever, and smallpox necessarily involves fever. Yet, although the symptom (fever) is the same, the cause differs. External diseases come from outside; smallpox arises from within; external diseases stem from internal deficiency; smallpox is a condition of deficiency within. ○ Before and after the appearance of spots, toxin separates from blood, moving then settling, dangerous then safe, returning to normal pathways, thereby re-attracting Qi, like a wife summoning her husband home. Qi follows the blood to protect it, like a husband returning to care for his wife. Thus, sweating leads to fever reduction and coolness. ○ Fever subsiding with coolness prior to spot appearance is the best outcome, indicating mild toxin and non-deficient blood. Non-deficient blood does not steal Qi; Qi and Blood adhere, awaiting toxin transformation. ○ Fever subsiding after spot appearance is intermediate, indicating toxin damaging blood. Damaged blood requires Qi and Blood to replenish before returning to equilibrium. ○ Fever quickly followed by immediate spot appearance is inferior, indicating severe toxin damaging blood. Severe damage causes blood depletion, failing to nourish Qi; Qi loses its home, neglects its duty, and aids external pathogens, rushing out together. Qi fails to guard the exterior, walls collapse, revealing internal organs. ○ After spots are complete, fever should cease. Persistent fever indicates toxin stagnating internally, attempting to re-emerge. Fever returns during the swelling/pus-filling stage. Absence of expected fever indicates exhausted Qi unable to steam toxin for transformation, leading to death over time. ○ By the recovery stage, the body should be cool. Residual heat indicates severe Qi and Blood deficiency, requiring tonification. Otherwise, deficient blood fails to attract Qi; Qi floats upward, unable to expel toxin externally, leading to putrefaction. Here, toxin, now distinct, mixes no longer with blood; Qi declines, and toxin rampantly invades blood causing heat. Caution is needed regarding the onset of heat! ○ At the initial stage of fever, clearing toxin traps it internally; reducing fire coagulates blood internally; forcing eruption damages Qi externally. All result from misunderstanding the nature of fever in general disease versus smallpox. Discernment is crucial! (*Huang Di Yi Dian*)
Smallpox and measles belong to Yang; without heat, they cannot form, nor can they dissipate. Heat is required for emergence, rising, pus formation, and drying. Thus, heat is indispensable throughout the course of smallpox, yet must be moderate. Severe heat implies severe toxin and heavy eruption; mild heat implies mild toxin and light eruption; absence of heat prevents formation and transformation. This moderation is the norm for smallpox heat. Treating physicians must not eliminate all heat; attempting to remove it completely invariably leads to Yin-cold patterns and failure. (*Jing Quan Quan Shu*)
In smallpox cases, whenever lesions appear plump and connected, the body should experience a period of fever; this is the normal sign. (*Ren Duan Lu*)
Smallpox relies on heat for its entire course. Three days of fever precedes eruption, subsiding when complete; fever returns during pus formation, subsiding when sufficient; fever returns during regression, subsiding when regressed; fever returns during scabbing, crust removal, and scab falling, termed "burning scars." Cooling and resolving are inappropriate here; doing so causes Qi and Blood stagnation, trapping toxin internally and triggering disaster. (*Ci You Fa*)
Deficiency and Excess
Grayish-white, non-red, non-protruding, non-rising, slow-erupting, dim, and sunken-top lesions indicate Exterior Cold and Deficiency. Clear urination and stool, cool body, cold extremities and breath, lack of thirst, poor appetite, white lips, clear nasal discharge, undigested food indicate Interior Cold and Deficiency. For Exterior Deficiency, tonifying Qi is primary, tonifying Blood secondary; for Interior Deficiency, tonifying Blood is primary, with concurrent Qi tonification. Tonifying Qi strengthens the Spleen and Stomach, ensuring smooth Stomach Qi and preventing sinking/collapse later. Tonifying Blood promotes circulation, expelling toxin completely and preventing stagnation, itching, and collapse later. Red-purple, dry/stagnant, black-sunken, scorched-dry lesions indicate Exterior Heat and Excess. Constipation, dark/scanty urine, fever, dry nose, dry lips, irritability/thirst indicate Interior Heat and Excess. For Exterior Heat, cooling and releasing the exterior is primary, promoting urination secondary; for Interior Heat, detoxification is primary, with concurrent cooling. If heat-toxin is severe in the first two to three days, mild purgation may be used. Cooling blood prevents red-purple discoloration; detoxification prevents black-sunken lesions. Failure to tonify Exterior Deficiency leads to external peeling; failure to tonify Interior Deficiency leads to internal attack. Over-tonifying Exterior Excess prevents scabbing; over-tonifying Interior Excess triggers carbuncles/toxins. ○ High fever, erect hair, dry skin, restless sleep, red cheeks/red eyes, rough breathing, irritability/thirst, abdominal distension, constipation, and wheezing indicate Excess patterns. Vomiting may seem like Deficiency, but actually results from heat-toxin trapped internally unable to vent, reversing upward. As the Classic states, all rebellious upward movements belong to Fire. Treatment involves raising Yang and dispersing. Diarrhea may also seem like Deficiency, but results from heat-toxin stagnation roasting the Spleen/Stomach, preventing external release, causing toxin to sink downward and exit via orifices. The Classic describes this as sudden violent diarrhea with tenesmus. Ancients said: Diarrhea before eruption indicates life; diarrhea after eruption indicates death. Treatment involves lifting and dispersing to guide toxin outward; once toxin is resolved externally, internal leakage stops. Loss of appetite is often attributed to Internal Deficiency, but in cases of stagnant heat, internal toxic vapors fail to reach the surface, causing constipation, blocked pores, severe heat-toxin, abdominal distension, wheezing, and anorexia. Treatment involves lifting and dispersing to guide toxin to the surface, allowing heat to vent, harmonizing Zang-Fu, and restoring appetite. Misusing hot herbs like Ding Xiang (Caryophylli Flos), Gui Rou (Cortex Cinnamomi), and Ban Xia (Rhizoma Pinelliae) for vomiting/diarrhea/anorexia uses heat to attack heat, worsening agitation. Using tonics like Ren Shen (Radix Ginseng), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Fu Ling (Poria), and Bai Zhu (Rhizoma Atractylodis Macrocephalae) for abdominal distension/anoreasia allows evil to thrive with tonification. These are medical errors. (Weng Zhongren)
Q: Smallpox relies on Qi and Blood; both Excess and Deficiency of Qi/Blood have fatal outcomes. Why?
A: Death from Excess patterns is due to blood coagulation and Qi knotting; death from Deficiency patterns is due to Qi separation and blood scattering. (Xu Xuanzhi)
Regarding Excess-Heat and Deficiency-Cold, within a single day, conditions may shift rapidly from Excess-Heat to Deficiency-Cold. Physicians must examine closely at all times, verifying前后 (before and after), and not apply rigid rules. (*Ren Duan Lu*)
Severity
Erupting completely at once is severe; lesions accompanied by measles-like rash are moderately severe; sparse eruption is mild; slightly red inside and out is mild; red outside/black inside is mildly severe; white outside/black inside is very severe; black dots like needle holes at the tip indicate critical condition; cyanotic/dry/black-sunken, lethargy/sweating, irritability/fever/thirst, abdominal distension/wheezing, urinary/fecal retention indicate exhaustion. (Qian Zhongyang)
Root and Branch
Diseases have Root (Ben) and Branch (Biao); treatments have sequence. Some treat Branch, some Root, some Branch then Root, some Root then Branch, some both simultaneously. One must assess urgency and not play rigidly fixed strings on a zither. Regarding smallpox: relative to the human body, Qi and Blood are Root, smallpox is Branch; relative to smallpox, smallpox is Root, other symptoms are Branch. Dense lesions are a Branch issue; assessing uneven Qi and incomplete Blood circulation, prioritize harmonizing Qi and invigorating Blood, with concurrent detoxification. This treats Root and Branch simultaneously. If lesions rise but Qi/Blood are deficient, tonify them. This is treating Root in缓 (slow/mild) cases. If Qi/Blood are sufficient but lesions are obstructed, use sole formulas for supporting interior and detoxifying. This is treating Branch in急 (urgent/severe) cases. Severe lesions with sore throat/swelling require treating the throat primarily. This is treating Branch urgently. Severe lesions with persistent diarrhea require treating diarrhea primarily. This is treating Branch urgently. Chronic diarrhea leading to complicated patterns requires rescuing Interior and releasing Exterior simultaneously. This treats Root and Branch. Rescue Interior first, then attack Exterior. This is Branch then Root. Constipation/restlessness/wheezing requires urgent purgation. This is treating Branch urgently. Severe lesions with persistent thirst/irritability require detoxification primarily, with concurrent thirst relief. This is Root then Branch. Expanding upon these principles ensures orderly treatment. (*Zheng Zhi Zhun Sheng*)
Beginning and End
Treating smallpox requires caution at the start and consideration of the end. Initial fever with irritability/thirst, constipation, abdominal/lower back pain, dry nose/lips, palpitations/confusion indicates toxin stagnating internally, risking suppression/non-emergence. Persistent vomiting/diarrhea risks Middle Qi deficiency failing to assist pus formation. Thus, fever requires resolving, constipation requires purging, fright requires calming, vomiting/diarrhea requires stopping. Early blood spots represent Spring generation; rising represents Summer growth; water transforming to pus represents Autumn harvest; pus drying/scabbing represents Winter storage. If early spots contain fluid prematurely, or rise with pus before full development, or scab before pus forms, this is "arriving before due time" (Excess), risking collapse/inversion; release exterior, support interior, and detoxify. If eruption/rising/filling/scabbing fails to occur as expected, this is "arriving late" (Deficiency), indicating weak Blood/Qi, risking lack of pus/ulceration; tonify/support to generate pus, harmonize Qi/Blood. Bright colors indicate tender skin prone to rupture; watch for itching/collapse. Clumped lesions are not sparse; watch for internal stagnation. Thin pus warns of later carbuncles even if scabs form. Pre-swelling of head/face warns of easy dissolution/internal attack. Sore throat requires urgent resolution to prevent loss of voice/throat damage. Frequent bowel movements warn of inversion. Excessive fluid-filled blisters warn of spontaneous diarrhea. Dry eyes/tearing warn of corneal opacity. Preventing gradual decline is the best method for treating disease before it arises. (*Feng Shi Jin Nang*)
Form and Color
Observing all things: heavy rain causes rot, drought causes scorching; living things are fresh/lustrous, dead things are withered/dark; lustrous things stand tall, dark things droop. How are human affairs and natural principles different! (*Huang Di Yi Dian*)
Smallpox values Form and Color. "Form" refers to initial sharp/round/firm/dense appearance, rising robustly, nourishing into pus, full/plump, secure scabbing, and luster like water drops—all correct forms. Flat or sunken forms are variations. Initially appearing like mosquito bites, empty like silkworm skins, thin like bran, dense like needle heads, or like heat-miliaria/cold-goosebumps will fail to rise and die; sticky/blurred, flabby muscles, soft/thin skin, ulcerated skin will fail to scab and die. "Color" prefers brightness over darkness, moisture over dryness, sturdy waxiness over tenderness. Red should not be overly bright (prone to rupture); white should not be grayish (hard to scab). Transition from Red → White → Yellow → Black is correct color variation; Purple-stagnant at start, Gray-white at rising is incorrect variation. Roots, Bases, Feet, and Grounds are four terms differing in name but united in Form/Color. What is Base? Transparent center with raised top. What is Root? Outer circle red. Whether the circle is red reveals internal deficiency/excess and toxin depth. Whether the Base rises reveals root depth and Qi/Blood status. "Feet" and "Grounds" depend on the circular halo of roots/bases and density of particles. Red halos are Feet; distinct boundaries without scattering indicate clear Feet. Empty spaces are Grounds; non-connected particles indicate clear Grounds. In summary: Roots should be active, Bases should rise, Feet should be solid, Grounds should be wide. If all four are favorable, severity is manageable. Roundness is the form of Qi; abundant Qi ensures round, clean bases. Halos are the form of Blood; abundant Blood ensures bright, red-active bases. Qi deficiency causes sunken tops and collapsed bases. Extreme Qi deficiency without collapse is carried by Fire; though round, it is an empty shell. Blood deficiency causes faint halos; exhausted Blood causes withered halos. Extreme Blood deficiency remaining red-active is due to floating Fire; though round, it is withered and dull. Form/Color are the Branch of Qi/Blood; Qi/Blood are the Root of Form/Color. Formula says: Having both plate (root) and top is noble; having top without plate is unsuitable. Observing this, the plate/root is more critical than the top. Plate refers to the root/foot meaning, Top...