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The morphology of the variola (smallpox) has appeared. At this time, careful nursing is required; one must avoid overfeeding or starving the child, and the five flavors (sour, bitter, sweet, pungent, salty) should not be excessively favored. Parents love their children with utmost care, but if they feed arbitrarily or allow excessive sucking/eating, causing various symptoms to arise simultaneously, would it not harm the child? This is not merely my trivial words.

If the variola suddenly becomes extremely painful and itchy, observe whether there are maggots inside or if the pustules have turned scorched/black. If the variola erupts from the abdomen, or if blisters suddenly appear while the variola is developing, preventing the eruption of the toxic matter, one must examine the color of the blisters and differentiate according to the Zang organs: Green corresponds to the Liver, Red to the Heart, Yellow to the Spleen, White to the Lung, and Black to the Kidney. Adjust the prescription based on the affected organ, using Baoyuan Tang (Preserve the Origin Decoction) as a base, adding Niubangzi (Arctii Fructus), Danggui (Angelicae Sinensis Radix), Jingjie (Schizonepetae Herba), and Lianqiao (Forsythiae Fructus). If green (Liver), add Chaihu (Bupleuri Radix); if red (Heart), add Huanglian (Coptidis Rhizoma); if yellow (Spleen), add Shu Dahuang (Rhei Radix et Rhizoma Praeparated); if white (Lung), add Jiegeng (Platycodonis Radix); if black (Kidney), add Renchi (Human Teeth) or Wuji San (Priceless Powder) mixed for administration. If the initial onset of variola was due to Wind-Cold, and although the variola has erupted, there are internal symptoms of Cold in the Gate (Hanmen), the methods of exterior resolution, interior purgation, sweating, and downward draining can be detailed accordingly.

The term "variola" refers to pus-filled pustules, which are generated because fetal toxin invades the Lung organ. During the sixth to seventh day after fever begins, when the pustules are flourishing, if sand-rash (Sha) also appears, it is called "Sha". Essentially, variola is a form of Sha. This occurs because fetal toxin first invades the Lung, producing pustules, and then invades the Liver, producing sand-rash. This indicates that both Lung Metal and Liver Wood are being insulted by the heat of fetal toxin (the element that does not overcome them is overcoming them). Treatment should focus on clearing Lung Metal to drain fire, and nourishing Liver Wood to moisten water. Using Baoyuan Tang (Preserve the Origin Decoction) added with Maidong (Ophiopogonis Tuber), Zhimu (Anemarrhenae Rhizoma), and Huangqin (Scutellariae Radix) will bring stability. If the sand-rash is not severe, it is not ominous.

Once the pustules have formed, during the sixth to seventh day when they are at their peak, if pustules reappear, consider that these pustules are generated by the blazing of Heart Fire and Ministerial Fire, and the Lung is again subjected to the constraint of Fire. If the quantity is small, it is auspicious; if large, accompanied by wheezing and coughing, life cannot be preserved.

When variola erupts, the fetal toxin is revealed, which is considered auspicious. However, if it is accompanied by water-variola (shui dou), which is caused by external contraction of seasonal epidemic qi, a small quantity is favorable (Shun), while a large quantity is unfavorable (Ni). Treatment should involve clearing the Lung, protecting the Spleen, and resolving heat to achieve peace, without the need for heavy doses.

Regarding the disease of variola, even favorable cases may undergo variations; how much more so if Ding poison (carbuncle/furuncle toxin) and Yongju (abscesses) are present? The toxicity would be even more severe. Careful regulation and nursing are essential; slight attention may lead to recovery. A slight error could result in a miss of a thousand li. However, details regarding Ding poison and Yongju have been discussed previously; treatment should use modified Baoyuan Tang (Preserve the Origin Decoction), as seen in the subsequent sections.