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Smooth Course: Qi and blood are harmonious, the variola toxin is smoothly excreted, the spirit is robust, and diet is normal; no treatment is required.
Dangerous Course: Qi and blood are stagnant, the variola toxin is obstructed, or complicated by other disorders with mistimed eruption; prompt treatment is necessary.
Adverse Course: The variola toxin is condensed, Qi and blood are dry and exhausted, strange symptoms arise, the disease does not respond to medication, and treatment is ineffective.
Five Auspicious Signs: 1. Diet remains normal; 2. Urination and defecation are regular; 3. Lesions are red and vibrant, with thick skin and firm texture; 4. Pulse is calm, body temperature is cool, and hands and feet are warm; 5. Voice is clear and bright, movements are peaceful and harmonious. If all five cannot be fully present, having one or two is still auspicious.
Seven Inauspicious Signs: 1. Restlessness, confusion, delirium, and mental haze; 2. Vomiting and diarrhea, inability to eat; 3. Lesions turn black, sink, become scorched and dry, itch, collapse, and ulcerate; 4. Premature swelling of the head and face, nasal flaring, shoulder lifting in respiration, eyes wide open, lips cracked; 5. Ulceration of the throat and tongue, immediate vomiting upon eating, choking when drinking water; 6. Chills, teeth grinding, hoarse voice, and dark complexion; 7. Abdominal distension, panting, and cold limbs. Not all seven need to appear; even one or two indicate a difficult prognosis.
Beyond the Seven Inauspicious Signs, there are cases of hemoblisters all over the body, stabbing pain in the heart and abdomen, lesions failing to erupt, blood in urine and feces, and picking at empty air (picking at bedclothes). These indicate sudden death that cannot be saved.

(Comprising eleven poems and fifteen formulas)
Although variola originates from fire-toxin during embryonic development, disaster does not occur without the influence of epidemic qi. If an epidemic breaks out in a region, administer spiritual medicine in advance to resolve it.
All variola and rashes stem from fetal toxin accumulated in the Mingmen Gate (Life Gate). The Mingmen Gate, located at the lower extreme of the Dantian (Elixir Field), is the source of life generation in the human body. If one encounters winter warmth causing a sudden leakage of Yang Qi, and contracts this pathogen, it stirs up the Ministerial Fire. It erupts during the spring and summer growth seasons, spreading contagiously, known as epidemic pestilence. For those who have not yet erupted, if they feel winter warmth, they should first take detoxifying medicines such as Chen Sha San (Cinnabar Powder), San Dou Tang (Three Beans Decoction), or Dai Tian Xuan Hua Wan (Heavenly Mandate Dissemination Pill) to prevent the toxin from lingering. If the Spleen and Stomach are weak, regulate the Stomach Qi, occasionally administering Si Jun Zi Tang (Four Gentlemen Decoction) with Chen Pi (Tangerine Peel) and Mu Xiang (Aucklandia Root) to harmonize Stomach Qi, circulate Ying and Wei (Nutritive and Defensive Qi), and facilitate easy eruption and crusting.
My Commentary: Dai Tian Xuan Hua Wan is identical to Han Shi’s Wu Wen Dan (Five Plague Pills). Bitter and cold, it depletes and cuts down, damaging the Stomach and Spleen. Although it may resolve epidemic toxins, it likely cannot preemptively resolve congenital toxins. Even if it could, it is only suitable for children with strong constitutions from humble backgrounds. If administered recklessly to children of wealthy families with weak constitutions, I fear the toxin will remain while the Stomach is damaged first, and the Middle Jiao becomes cold before the eruptions appear. This pre-emptive attack on the innocent secretly harms True Qi. When eruptions finally occur, rescue may be impossible, leading to premature death. Those with strong constitutions have light toxins requiring no resolution; those with weak constitutions have heavy toxins that cannot be resolved by such means. How can congenital toxins, deeply hidden in the Mingmen Gate without manifesting, be treated with such sinking, yin, and freezing substances to preemptively destroy vitality? This is a dangerous path and must not be followed. If resolution is desired, San Dou Tang is more appropriate.
To know the fortune or misfortune of variola, observe colors and forms in detail. The Nian Shou (Year Longevity area on nose) and Shan Gen (Mountain Root area between eyes) are critical; bright and pleasant colors are auspicious, while dark and blue-green are ominous.
Although sweating and purging methods are generally contraindicated, rigid adherence is not true medical wisdom. One who can distinguish deficiency and excess and adapt accordingly masters the principles of creation.
Consistent regulation of urination and defecation is auspicious; difficulty indicates trouble. Abdominal distension and panting suggest obstruction; urgent dredging is needed to avoid lingering pathogens.
This refers to promoting urination when indicated. Generally, clear urination and moist stool throughout the course denote a smooth progression. If urination is blocked, urgently promote diuresis with Ba Zheng San (Eight Upright Powder); if constipation occurs, quickly use Tong You Tang (Unblocking the Abyss Decoction) to moisten.
Pulse and symptoms in variola favor moderation; neither too rapid nor too slow is ideal. Wiry, rapid, floating, and full pulses indicate excess; thready, slow, short, and choppy pulses indicate deficiency.
The human body relies on Stomach Qi, and so does the pulse. A pulse with Stomach Qi appears moderate, neither distinctly wiry nor stone-like. Excess arises from overabundance, deficiency from insufficiency; careful assessment is crucial.
Variola and Shanghan (Cold Damage) share similar presentations, but skilled physicians must examine details carefully. Do not lightly experiment with sweating or purging; resolving the exterior and harmonizing the interior ensures peace.
Fever in variola resembles Shanghan, but Shanghan presents with symptoms of a single meridian, whereas variola shows signs of all five Zang organs. Yawning and drowsiness indicate Liver involvement; alternating chills and fever, cold extremities, and lethargy indicate Spleen involvement; dry face, red cheeks, cough, and sneezing indicate Lung involvement; palpitations and restlessness indicate Heart involvement; coolness of the sacrum and ears indicates normal Kidney status. Heat in both sacrum and ears indicates pathogen latent in the Kidney meridian.
Although variola belongs to Yang and requires heat to mature, excessive heat is problematic. If heat is severe and toxins are not fully expressed, resolve toxicity and promote urination using Lian Qiao Sheng Ma Ge Gen Tang (Forsythia, Cimicifuga, and Pueraria Decoction).
Abundant appetite indicates sufficient Stomach Qi, leading to robust Ying and Wei Qi. Do not dismiss reduced appetite as harmless; fear Spleen deficiency allowing toxin invasion.
Continuous ability to eat indicates strong Spleen and Stomach, ensuring abundant Qi and Blood for easy maturation and crusting. A sudden decrease in appetite warrants inquiry. Sore throat suggests Gan Jie Tang (Licorice and Platycodon Decoction); food stagnation suggests Ju Pi Tang (Tangerine Peel Decoction); otherwise, if due to weak Spleen Qi and poor digestion, employ Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder).
Tranquility is prized as peace, indicating no exterior-interior pathogens and clear mind. Sudden restlessness requires scrutiny; watch for mental clarity lacking focus. Tranquility implies no pathogens; restlessness implies toxin accumulation and interior disturbance. Scratching indicates itching; mental unrest indicates interior heat; groaning indicates pain. Only experienced practitioners can discern these conditions. See treatments below.
Seasonal treatments must be accurate, addressing summer-heat, dampness, wind, and cold separately. Avoid exposure to abnormal qi to prevent recurring disasters.
In treating diseases, nourish Yang in spring and summer, Yin in autumn and winter. Spring diseases treat the Liver, Summer the Heart, Autumn the Lungs, Winter the Kidneys. Do not violate this. Physicians must understand this. Protect against extreme weather; adjust bedding and environment for warmth or coolness. Heat causes blood and Qi to become loose, leading to rotting sores; cold causes stagnation, hindering eruption. Exposure leads to worsening or strange symptoms, termed "disaster anomalies." Wind injury treated with Gui Zhi Ge Gen Tang (Cinnamon Twig and Pueraria Decoction); Cold damage treated with Zheng Qi San (Righteous Qi Powder); Summer heat treated with Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction); Dampness with diarrhea and heaviness treated with Wei Ling Tang (Stomach and Pinellia Decoction).
Treating variola emphasizes tonifying the Spleen, but harm can result from improper tonification. Do not neglect distinguishing deficiency and excess; prescribe based on accurate diagnosis.
Variola fundamentally relies on the Spleen and Stomach. If diet is normal and Six Fu Organs are full, no medicine is needed; tonifying the Spleen may cause irritability. If unable to eat with frequent diarrhea, it is Qi deficiency; assist with Si Jun Zi Tang (Four Gentlemen Decoction).