Library

(Comprising fifteen verses and another sixteen prescriptions)

The difficulty of *shouye* (scabbing/healing) of smallpox cannot be restricted by the number of days; it must be distinguished based on the sparsity or density of the lesions and the deficiency or excess of Yuan Qi (Original Qi). Slow, orderly scabbing tends to be firm and stable; if scabbing is too rapid, one must guard against residual toxins steaming internally.

The healing process of smallpox lesions should not be confined to a fixed number of days. Generally speaking, patients with sparse lesions and solid Original Qi find it easy to erupt and heal; those with dense lesions and deficient Original Qi find it difficult to both. As long as the healing proceeds slowly and in order, it is acceptable. If healing occurs too hastily, it indicates that toxic heat is boiling and burning, causing blood and Qi to wither and dry up. This is not normal healing; it will inevitably lead to carbuncles, toxic eruptions, and bizarre syndromes. In severe cases, it may cause death; in mild cases, it may result in disfigurement.

The area above and below the Renzhong (GV26, Philtrum) can distinguish Yin and Yang; observing the healing process at this location is beneficial. If blackening and scabbing occur first on the forehead and skull, the prognosis is mostly ominous with little auspiciousness, requiring early vigilance.

Renzhong (GV26) is the intersection of the Du Mai (Governing Vessel) and Ren Mai (Conception Vessel). If smallpox lesions erupt vigorously and heal first from this area, it indicates harmonious flow of Yin and Yang. If scabbing occurs first on the forehead, skull, palms, or soles, it signifies pathogenic qi attacking the Heart, which is incurable.

Healing is always prized for its neatness; foul odor, restlessness, and ulceration indicate abnormality. One must carefully examine the favorable (Shun) and unfavorable (Ni) patterns and must not hesitate or become confused within the situation.

In smallpox healing, neatness is paramount. Lesions drying into shell-like scabs are superior; those where the apex breaks, pus oozes out, and forms scabs resembling chicken droppings are secondary; those that remain ulcerated without forming scabs are inferior. Whenever such conditions are encountered, one must inquire whether any unfavorable factors were involved. For instance, if the patient's Blood and Qi were originally solid but tonifying herbs were mistakenly administered, the pathogen, aided by the tonification, would instead damage healthy Qi, causing ulceration like fire burning. In such cases, Tianshui San (Sky Water Powder) should be used to resolve it, allowing the pathogenic fire to recede and healing to proceed neatly.

If cold water was consumed initially, causing dampness to infiltrate the Spleen and Stomach and leading to uneven healing, Shishi Tang (Damp-Draining Decoction) should be used to percolate the dampness. This will drain dampness internally and dry the exterior, restoring proper healing.

If the face and head are ulcerated with a foul smell, and the skin peels off all over the body and limbs, one must differentiate between favorable and unfavorable patterns. If pus has formed and toxins have transformed, and the patient eats and drinks normally without other distress, it is a favorable pattern. If pus and fluid have not formed, it is called *daoye* (inverted healing/toxin sinking), and the outcome is unpredictable.

When smallpox reaches the stage of healing, pus naturally dries, sealing and converging into crusts, which is comforting. One must prevent rotting and skin shedding; such conditions should be viewed as *daoxian* (toxin sinking/internal collapse).

Whenever *daoxian* occurs, toxins sink deeply. Re-swelling and regeneration are not to be despised. If the face and head swell down but empty areas are not filled, disaster approaches like "peeling the bed," affecting the skin closely. How can this be tolerated?

All cases of inverted healing stem from insufficiency of Middle Qi. Urgently use Wenzhong Tuoli Tang (Warm the Middle and Support the Interior Decoction) to support and expel toxins. After taking the medicine, broken areas re-swollen and filled, and new eruptions appear in previously clear areas, this is called "filling the void," commonly known as "regenerating smallpox." This indicates healthy Qi is intact and pathogens are retained; although it prolongs the disease, it causes no harm. If the face does not swell and voids are not filled, it corresponds to the I Ching's concept of "peeling the bed," where disaster touches the skin. Such cases are dire!

During healing, sudden onset of diarrhea requires careful examination of favorable versus unfavorable signs. If the stool contains pus, blood, and scab material, it indicates strong Spleen and weak Kidney, which is a favorable sign; the dysentery will cease spontaneously, and forced treatment is unnecessary. If the stool is undigested food and water, it indicates strong Kidney and weak Spleen, an unfavorable sign. Administer Doukou Wan (Cardamom Pill) delivered with fried rice soup. If diarrhea stops, it is auspicious; if not, it is ominous. The formula for Doukou Wan is seen earlier.

Failure to heal past the expected time is anomalous; foul rotting all over the body and uneven scabbing occur. When lesions stick to mats and clothes, how to treat? Bailong San (White Dragon Powder) and Baicao San (Decayed Grass Powder) guide the lost.

After smallpox pustules form, failure to heal past the deadline with whole-body ulceration sticking to bedding is best treated by lining the bed with Bailong San and Baicao San.

Delayed healing requires urgent treatment; observe the syndrome carefully without rigidity. Ignoring teachings harms oneself; rescue at the critical moment is often too late.

When smallpox should heal but does not, detailed examination is required, never neglectful. In winter cold, if thin coverings allow wind-cold to constrain eruption and healing, Guizhi Jiedu Tang (Cinnamon Twig Detoxification Decoction) should be used to release and resolve. In summer, if thick clothing causes heat steaming preventing healing, remove layers to cool slightly, then use Ganlu Jiedu Tang (Sweet Dew Detoxification Decoction) to clear heat.

If constipation persists with excessive interior heat preventing healing, Danggui Jiedu Tang (Angelica Detoxification Decoction) should be used for mild purgation; anal suppositories are particularly effective.

If diarrhea and Qi deficiency prevent healing, resulting only in uneven scabbing and desire for "sitting paste" (a specific remedy/state), do not treat recklessly. If original Qi is chronically weak causing delayed healing, Shen Gui Huadu Tang (Ginseng and Angelica Toxin-Resolving Decoction) should be used.

When pus dries and scabs form, do not let ignorance undermine support. Ignoring taboos leads to changes; this is like abandoning a mountain project at the last basket.

Secular practices during smallpox healing involve killing chickens or eating ginger and pepper, believing them warming. However, chicken belongs to Xun (Wind), stirring Wind; pungency aids Fire. Those with strong Spleen/Stomach suffer no harm, but the weak see Fire exacerbated, leading to carbuncles, stomach injury, and mouth ulcers, causing ruin. Whether overheating when warmth is indicated or overcooling when cooling is indicated violates taboos and causes complications. Be extremely cautious!

Usually the body is cool and harmonious; why sudden fever during healing? Slight fever dries pus adequately; excessive fever causes withering and more diseases.

Smallpox should maintain slight heat throughout; it should not disappear completely. If during healing there is high fever, thirst, and irritability, toxins are internal, risking sinking. Urgently use Gegen Tang (Kudzu Decoction) with properties to generate fluids and cool blood to clear heat.

Broken sores refilling with pus remain ulcerated; healing becomes slower. Profuse pus and blood are hard to bear; do not fear using Dabu Tang/Wan (Great Tonification Decoction/Pill).

Smallpox lesions with tender skin prone to breaking are inherently difficult to treat. However, if they break and then re-swollen, it indicates strong Healthy Qi expelling toxins outward. Healing should still proceed according to schedule. If healing fails, it means Healthy Qi is depleted by pathogens; although pathogens are pushed out, they cannot be forced into scabs. Urgently use Dabu Tang to warm and tonify; do not delay, lest disasters arise.

Stubborn sores refusing to heal bleed fresh blood upon touch. Do not treat lightly; membrane and tendon damage implies fatal consequences.

Damaged smallpox lesions swelling and painful, unable to dry, are called Ganshi Chuang (Corrosive Ulcer) or Yang Chuang (Yang Ulcer). Touching them causes uncontrolled bleeding, a difficult-to-treat condition. Internally administer Dabu Tang (formula seen earlier); externally apply Mianjian San (Silkworm Cocoon Powder). Delaying treatment leads to tendon and bone damage, perforation of membranes, and many deaths.

Pustular sores covering the face with much blood and pus; ruined face and damaged eyes—what to do? Only skilled physicians can harmonize interior and exterior to save critical cases.

For facial sores that are ulcerated, repeatedly swelling and weeping pus and blood, guarding against eye damage and disfigurement, use Shengma Jiedu Tang (Cimicifuga Detoxification Decoction) to clear heat.

Scratched smallpox presents various states: bleeding into pits with dry fluid. Itching and burning pain seem minor, but tendon damage and flesh erosion cause deformity.

Scratched smallpox manifests differently:
1. Breaking with bleeding is Yang Chuang (Yang Ulcer); treat with Danggui Liangxue San (Angelica Cooling Blood Powder).
2. Breaking without fluid, becoming dry, indicates sinking; favorable if sores refill and flesh swells again; internally use Tuoli Huisheng San (Support Interior Revive Life Powder).
3. Breaking into pits indicates internal sinking; internally use Tuoli Huisheng San; externally apply Bailong San (formula seen earlier).
Failure to examine and treat these three symptoms carefully results in deformity or death.

Healing proceeds on schedule with scab formation; occasional tremors or delirious speech occur. The Three Primordial Qi (Yuan Qi) is recovering; there is no need to summon a doctor or sigh.

When smallpox is about to heal, scabs are round and quiet. Occasional tremors and delirious speech indicate recovering Healthy Qi struggling to maintain control. There is no need to worry; it will settle spontaneously shortly.