Library

(There are eighteen verses in total, corresponding to eighteen formulas.)

If fever persists for three days before the smallpox rash appears and is sparse, this indicates that the pathogenic toxin is superficial, which is a auspicious sign. If the rash erupts excessively before the expected time and cannot be controlled, it is mostly due to deficiency of blood and qi after this period.

Generally, if smallpox fever lasts for three days before eruption, it is within the normal cycle. If the eruption is sparse, no medication is needed. If eruption occurs after only one or two days of fever, this indicates excessive pathogenic toxin attacking the Ying (Nutrient) and Wei (Defensive) levels, erupting all at once, difficult to control, representing a dire prognosis. Treatment should focus on clearing heat and detoxifying while protecting the interior to prevent the toxin from sinking inward. The appropriate formula is Xiaodu Kuaiban Tang (Detoxification and Rapid Rash-Expelling Decoction).

If eruption is delayed until four or five days or later, it is because the original blood and qi are deficient and unable to transport the toxin outward. Treatment should tonify the middle jiao, support the interior, and release the exterior. The appropriate formula is Zengsun Bawu Tang (Modified Eight-Ingredient Decoction).

Delayed eruption can arise from several causes: skin closure belongs to wind-cold constraint; internal deficiency with vomiting and diarrhea requires separate treatment; toxin congestion in the Triple Burner makes treatment difficult.

Smallpox eruption follows a regular schedule. If eruption does not occur when expected, or if external wind-cold causes closure of the six fu organs preventing immediate eruption, symptoms include dizziness, body pain, fever without sweat, and a preference for covering up and curling into someone's embrace, indicating aversion to wind and cold. Treatment should involve releasing the exterior. The appropriate formula is Jiawei Rensu Yin (Modified Ginseng and Perilla Leaf Decoction). If there was prior vomiting and diarrhea causing internal deficiency preventing smooth eruption, use Jiajian Tiaozhong Tang (Modified Middle-Regulating Decoction).

If accompanied by fever, irritability, delirium, extreme thirst, dry lips, and cracked tongue, this indicates toxin congestion stagnating without excretion. Toxic fire郁 (stagnates) in the Triple Burner, blocking Ying and Wei circulation, leading to death due to blockage between upper and lower jiao.

What to do if eruption is delayed? One must avoid errors in using exterior-releasing formulas. If accompanied by abdominal distension, hard stool, and severe irritability, Xiaoban Chengqi Tang (Rash-Clearing and Bowel-Purging Decoction) should be used to treat deep-seated conditions.

For smallpox that should erupt but does not, whether due to external wind-cold or internal deficiency with vomiting/diarrhea, treatments differ. As mentioned, Rensu Yin, Tiaozhong Tang, Baidu San (Toxin-Resolving Powder), Gegen Tang (Kudzu Decoction), etc., are effective methods. If heat is intense with abdominal distension, coarse breathing, irritability, restlessness, and constipation, this indicates internal accumulation of toxic fire, requiring urgent resolution with Xiaoban Chengqi Tang.

After eruption, if the body cools down, recovery is auspicious; if high fever persists, it is an ominous sign. If the rash becomes dense throughout the day with no gaps, and strange symptoms arise, suspicion is warranted.

The heat of smallpox is caused by toxic fire. Before eruption, toxic fire is internal, causing external fever; after eruption, the toxin manifests externally, so heat should subside completely, indicating light toxin and sparse rash. If fever persists after eruption, it means toxin accumulates internally and cannot be considered mild. Urgently apply methods to resolve muscle layer, transform rash, and lift/support. If heat subsides after medication, it is auspicious; if not, and the rash becomes dense despite initial sparseness, fear other complications such as delirium, diarrhea, abdominal pain, scratching wounds, loss of voice, throat dryness/vomiting, panting, or black depression, all of which are untreatable.

Observe the face first when assessing eruption patterns; determining auspiciousness is difficult. Eruption around the lips and cheeks is auspicious; eruption on the forehead and between eyebrows is inauspicious.

The face reflects the essence of the five zang organs. The left cheek corresponds to Liver Wood, the right cheek to Lung Metal, the chin to Kidney Water, and the nose to Spleen Earth. The forehead is where the Taiyang (Greater Yang) meridian converges; the lips and cheeks are traversed by the Yangming (Bright Yang) meridians; the sides of the ears are traversed by Shaoyang (Lesser Yang) meridians. Smallpox is a yang toxin, appearing on yang areas of the face. However, the Yangming Stomach and Large Intestine accumulate turbid matter and have abundant qi and blood; eruption here first is auspicious. The Taiyang position is where water and fire clash, and Shaoyang is where wood and fire merge; eruption here is inauspicious. Not only is eruption on the forehead, eyebrows, and ears inauspicious, but any progression (swelling, filling, scabbing) starting from these areas is a reverse/inauspicious sign.

The head is the supreme leader. The throat is the gate for opening and closing (respiration and digestion). If smallpox eruptions are concentrated here, "covering the head" and "locking the neck" will bring disaster.

The Classics state: The head is the residence of clarity and spirit. Since the essence of the five zang organs manifests on the face, it is supreme and sacred, not to be violated. The pharynx (Yan) is the pathway for food and drink in the stomach, governing intake but not output; the larynx (Hou) is the lung tube for respiration, governing breath entry and exit. Without these, food and breath cease, leading to death; thus they are called the gates of opening and closing. It is crucial that smallpox eruptions are sparse on the head and neck. Excessive eruptions on the head/face are called "Meng Tou" (Covering Head); excessive eruptions in the throat are called "Suo Xiang" (Locking Neck). Meng Tou leads to blurred vision/hearing and loss of spirit; Suo Xiang prevents internal expulsion and external entry. This signifies the cessation of spirit and transformation, a sign of death.

Eruptions on the head, face, and chest should be sparse; even if limbs are numerous, the toxin is slight. Whole-body dense fragmentation is distressing; understanding dispersal mechanisms is key to resolution.

The head and face are the convergence of all yang meridians; the chest is the gathering point of yang and the area where zang-fu receive qi. Chen states: Mild smallpox erupts in three or four waves, being sparse on the head/face and absent on the chest, because the clear yang regions must not be turbid. Limbs, though root of yang, serve the body like low-ranking soldiers, so abundance there is tolerated. If the whole body is densely fragmented, urgently detoxify, unblock Ying and Wei, balance qi, activate blood, and promote uniform eruption to avoid drying, blackening, or withering. Use Shudu Kuaiban Tang (Detoxification and Rash-Expelling Decoction), modified according to symptoms.

Standalone, distinct smallpox lesions need no worry; clustered, adherent lesions indicate injury. Lesions resembling silkworm cocoons or snake skins will not last long; those resembling flea bites or mosquito marks portend immeasurable disaster.

When smallpox first appears, observe the distance between lesions. Spacing of 3-5 cun per lesion indicates mild condition; 1-2 cun is quite dense; clustering of 2-3 indicates density and severity, often changing to itching and collapse. Resembling silkworm cocoons/snake skins indicates qi arrival without blood/qi following; treat by moving qi and tonifying blood with Qufeng Yunqi San (Wind-Dispersing and Qi-Balancing Powder). Resembling flea bites/mosquito marks indicates blood arrival without qi following; treat by cooling blood and tonifying qi with Shenhe Qiyin (Ginseng-Harmonizing Qi Decoction).

If the eruption shape appears overly delicate and bright, it indicates thin skin and deficient qi. Melting/breaking easily suggests short survival; forming pus uniformly brings joy.

Normal coloration upon eruption is auspicious. Reddish-bright colors indicate thin skin prone to rupture and uncontrollable itching. Upon seeing brightness, prevent future itching/collapse by early use of wind-dispersing, surface-consolidating, and detoxifying herbs to充实 (fill/strengthen) blood and qi, gradually retreat evil fire, preserve righteous qi, ensure robust drying/scabbing, and avoid irregularities. Use Guyang Sanhuo Tang (Solidify Yang and Disperse Fire Decoction) to detoxify and consolidate the surface.

Fear most the blackened, scorched top (Tao, dark blue-black color); worry about thin skin with melting fluid. Scorched black tops often revert to Kidney; thin skin fears itching/collapse attacks.

Initial smallpox should be bright, moist, fresh, firm, and thick. Scorched black tops indicate toxin in the blood level; urgent treatment is needed to prevent reverting to Kidney (blackening) which is incurable. Use Liangxue Jiedu Tang (Cool Blood and Detoxify Decoction) to disperse blood-level pathogens. Thin, fragile skin indicates toxin in the qi level; urgent treatment is needed to prevent itching/collapse death. Use Jiawei Guyang Sanhuo Tang (Modified Solidify Yang and Disperse Fire Decoction).

Resolving the throat is critical in smallpox; throat obstruction and ulcers indicate floating toxic fire. Fear sudden sealing of the airway, locking the throat, hoarseness, rendering efforts futile.

All smallpox cases involve sore throats, like a chimney with fire burning below and flames rising above, naturally causing pain. Use Niubangzi Tang (Arctium Seed Decoction) externally apply Yisheng San (One-Saint Powder) insufflation.

Beware most of rashes entering the eyes; Huangbai paste (Phellodendron Paste) is infinitely effective. Observe redness inside the eyes; urgently drain Heart and Liver fire to protect the pupil.

The toxicity of smallpox primarily threatens the eyes; ancient masters used eye-protection methods with deep foresight. Apply Huangbai Gao (Phellodendron Ointment).

If red veins entangle inside the eyes, or eyes swell/shut with excessive discharge/tears, urgently drain Heart and Liver fire with Chanhua San (Cicada Flower Powder) to clear and resolve.

It is strange if smallpox presents alone; mixing with macules (ban) and papules/rashes (zhen) is highly inadvisable. Clearing rashes requires urgent resolution; failure leads to critical danger.

Qian states: Smallpox presenting uniformly is good. If shapes appear, occasionally dense like mustard seeds, this is mixed Ban (macules), bright red patches under skin; this is mixed Zhen (rashes). Both result from internal toxic fire scorching, causing mixed eruption externally. Urgently detoxify to dissipate ban/zhen so smallpox can form independently. Use Jingfang Jiedu Tang (Aristolochia and Saposhnikovia Detoxifying Decoction) to dissipate.

Seeing only two or three clusters of smallpox marks, with widespread scratching and itching. This is fire-pathogen remaining in the couli (interstices); urgently clear wind-fire, and the condition should improve.

When smallpox first appears, whole-body itching and incessant scratching indicate fire-pathogen trapped in muscle/skin layers, unable to erupt immediately. Similar to cold damage without sweat causing itching, not the itching-collapse type. Drain Heart/Liver fire-pathogens, and itching will remove itself. Use Qingfeng Quhuo Huadu Tang (Clear Wind, Remove Fire, Transform Toxin Decoction) to ascend and disperse.

Foul, fishy odor in the mouth indicates evil toxin steaming and forming lung abscesses. Urgently use fire-draining and metal-clearing methods; delay of seven days brings disaster.

When smallpox first appears, foul breath indicates lung evil fire roasting and desiccating, causing odor. Urgently use Qingjin Xiehuo Tang (Clear Metal and Drain Fire Decoction). If untreated and prolonged, death occurs by the seventh day. The Classics state: Lung exhaustion leads to death in seven days. This is a variation of the condition. Symptoms include loss of voice, panting, dry heaving.

Clusters in skin like cold goosebumps; swollen flesh like hot tumors. How can such cases survive long days? Alas, they will soon return to the Isles of the Blessed!

Initial smallpox should have distinct granules and soft/moist skin/flesh. Clusters in skin like cold gooseberries indicate rapid reversal; without waiting for eruption, they vanish, causing crying/distress and death. Swelling/hardening on face, back, chest, limbs like erysipelas tumors: during eruption phase, lesions turn black/depressed, break open, fail to form pus, become dry/hard, and cause death. All are untreatable.

If eruption shape is unstable and initially contains water, but fills with pus upon rising. If pus/water has not formed but scabbing rushes in, do not boast of medical skill (Qing Nang).

Initial smallpox starts as a drop of blood, transforming to water, then pus; pus formation resolves toxin—this is the natural order. If initially half-water blisters, or filling with white pus prematurely, or scabbing before pus forms, this indicates excessive toxic fire disrupting natural order. "Arriving when not expected" is excess; inversion sinking inward leads to death without cure. This premature eruption is like early wilting. Compared to "not arriving when expected" (due to qi/blood deficiency, allowing remediation via human effort usurping heaven's work), this excess scenario is incomparable.

Nose like stove flue with smoke-scorched face; skin like vermilion paint or orange peel. Dense eruptions in lips, tongue, throat; even with He Huan's skill, heaven cannot be reversed.

Smallpox pathology ultimately focuses on Taiyin and Yangming meridians: Hand-Taiyin Lung, Hand-Yangming Large Intestine, Foot-Taiyin Spleen, Foot-Yangming Stomach. The nose is the orifice of the Lung, valued for moisture; dry/black/nose like stove flue indicates fire punishing metal. The face gathers Yangming meridians, valued for brightness; black/withered face indicates scattered essence. Skin is the exterior of the Lung, desired red-white normal; vermilion color indicates fire; orange-yellow indicates extreme fire turning to earth. Throat/lungs/stomach tubes, lips/orifices of Spleen, tongue collateral of Spleen. Severe eruptions here indicate extreme toxin; how can it be treated?