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Qian Yi treated the syndromes of sores and pox (chuang zhen) only with agents of warm and cool nature, and also warned against arbitrary purgation or reckless diaphoresis. This is because the toxin erupts at the exterior; if one recklessly induces sweating, Ying and Wei Qi (Nutritive and Defensive Qi) will become deficient, causing the pores to open further and exacerbating the ulceration of sores. Consequently, Wind pathogen may take advantage of this vacancy, leading to altered syndromes. If the root of the toxin lies within, and one recklessly uses purgatives, the internal Qi will become deficient, preventing the toxin from being expelled and causing it to retreat inward. This leads to Earth (Spleen) failing to control Water (Kidney), resulting in blackening of the pox returning to the Kidney, manifesting as body tremors and aversion to cold, ears becoming hot, eyes closed, abdominal distension, and black sunken pox; in such cases, ten out of ten do not survive. The prohibition of both sweating and purging are deeply cautioned against by ancient physicians. From this perspective, although the symptoms of sores and pox resemble those of Cold Damage (Shanghan), their treatment methods are actually different. This is because pathogens in Cold Damage enter from the exterior into the interior, whereas toxins in sores and pox emerge from the interior to the exterior.

If the patient's Qi is substantial, presenting with irritability, intense heat, constipation, and inability to pass stool, it is appropriate to slightly administer laxative or draining agents. If urine is scanty and red, one should employ methods to separate clear from turbid (diuresis), allowing heat to渗 (seep) out. Generally, heat should not be abruptly suppressed but lightly resolved; without heat, the pox cannot erupt.

Zhu Danxi said: When reading the books of predecessors, one must understand their intent. If one reads the book but does not grasp its meaning, one cannot achieve practical application. Regarding the discussion on smallpox, Qian Yi was the most detailed, tracing sources and meridians clearly, distinguishing between exterior/interior and deficiency/excess, and expounding treatment methods supported by dialectical arguments, truly embodying the spirit of writing for instruction. Students who read and apply these methods can derive infinite applications, just as one uses compasses and squares to find circles and rectangles, or a plumb line to measure straightness. Nowadays, people do not understand the causes of disease nor the intent behind prescription formulation. In emergencies, they consult prescriptions based merely on symptoms and try them indiscriminately. If ineffective, they discard the book entirely, which is extremely thoughtless.

Recently, due to the long-standing popularity of the *Ju Fang* (Formulas of the Bureau of People's Welfare), and the neglect of studies on the *Su Wen* (Basic Questions), those discussing medicine while ill tend to prefer warmth over cold, and tonification over dispersal/drainage. Suddenly encountering Chen Shi's (Chen Wenzhong) formulas, which consist of drying, heating, and tonifying agents, people find the language precise and text concise, using them joyfully and believing in them universally, thus concluding that Qian Yi is far inferior to Chen Shi. Someone asked: Do you think Chen Shi's formulas are inadequate? I replied: Chen Shi's formulas indeed have a bias, yet they can be said to belong to those skilled at seeking the condition of illness. His intent largely focuses on the Taiyin Meridian. The Hand Taiyin Lung Meridian belongs to the Lung, governing skin and hair; the Foot Taiyin Spleen Meridian belongs to the Spleen, governing muscles. Metal of the Lung dislikes cold and is easily affected; Earth of the Spleen dislikes dampness and accepts everything. Observing his use of Ding Xiang (Clove) and Guan Gui (Cinnamon Twig) to treat Lung cold, and Fu Zi (Aconite) and Ban Xia (Pinellia) to treat Spleen dampness: if the Lung truly has cold, the Spleen truly has dampness, and there is concomitant deficiency, then administering medication proportionally and stopping when the disease is cured causes no harm. However, nowadays, people merely see delayed eruption, fever, diarrhea, palpitations, shortness of breath, and thirst, regardless of cold/heat or deficiency/excess, and indiscriminately administer Mu Xiang San (Costus Root Powder) or Yi Gong San (Five-Agent Powder). Occasionally, there are coincidental successes. But if misapplied, disaster follows immediately. Why? Ancient physicians used guiding, restraining, counteracting, and conditional herbs in their formulations. Although Qian Yi did not discard herbs like Xi Xin (Asarum), Ding Xiang, Bai Zhu (Atractylodes), and Ren Shen (Ginseng), he included restraining and assisting herbs, not solely focusing on warming and tonifying. However, he used cooling herbs more frequently, leaving the method of assistance only partially developed. It is like talking dreams to an idiot. Qian Yi's considerations were thorough, hoping future experts would expand upon them. Nevertheless, using warming herbs for thirst and tonics for collapsing sores, since Chen Shi's advocacy, has surpassed predecessors, but his frequent use of Gui Zhi (Cinnamon Twig), Fu Zi, and Ding Xiang—drying and heating herbs—is perhaps not universally suitable. For instance, Gui Zhi, Fu Zi, and Ding Xiang are appropriate when there is true cold and deficiency. But what if there is deficiency without cold? The harm could be significant. When Chen Shi formulated, there were likely cases of smallpox complicated by cold, making drying and heating tonification appropriate. But now, using such biased formulas without cold complications risks excessive heat. I have synthesized the essence of various schools and applied their principles, daring not rely blindly on established formulas. Let me cite two examples. My nephew, aged six or seven, suffered from smallpox with fever, slight thirst, and spontaneous diarrhea. Upon pulse diagnosis, I prescribed Mu Xiang San, adding ten grains of Ding Xiang per dose. I harbored doubts. Observing his delayed eruption, partly due to Qi deficiency from diarrhea, I examined his stool, finding it foul and stagnant, indicating accumulation driven by intestinal heat steaming downward, rather than cold-deficiency. I urgently stopped the previous dose. Subsequently, I administered Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity) plus Bai Zhu for ten doses to resolve the heat from Ding Xiang. Diarrhea ceased, and pox erupted. Later, mild fever persisted, and boils appeared on hands and feet; after a month of cooling and tonifying therapy, he recovered.

Another case involved a male, sixteen or seventeen years old, suffering from fever, stupor, blindness, deafness, and large, slightly rapid pulses everywhere, indicating labor injury. At that time, smallpox was prevalent locally. I instructed him to consume strong decoctions of large doses of Ren Shen, Dang Gui (Angelica Sinensis), Bai Zhu, and Chen Pi (Tangerine Peel). After thirty-plus doses, pox began to emerge. After another twenty-plus doses, pustules formed, leaving no intact skin. Someone asked: The condition is terrifying; why not use Chen Shi's complete formula? I replied: This is merely deficiency without cold. Stick to the previous formula. After dozens more doses, he recovered. Inquiry revealed that four or five days prior, fearing smallpox, he had worked hard chopping wood, sweating profusely. Had Chen Shi's full formula been used, regret would surely follow. In the spring of Jiashen year of Zhizheng, Yang Qi moved early. In January, almost every household in the county had smallpox, all treated with Chen Shi's formulas, resulting in hundreds of child deaths. While partly due to Heaven's mandate, I fear human efforts were not exhaustive.

Commentary: Qian Yi discussed the color, shape, severity, and critical nature of smallpox, laying the groundwork for medication. Li Dongyuan (Jiegou) further differentiated concurrent syndromes, voice, respiration, form, and Qi to prescribe treatments, which was quite detailed. However, commoners fail to deeply appreciate the intent, leading to confusion. Hence, Danxi spoke at length. Generally, commoners prefer warmth over cold, distorting Qian Yi's methods. For example, "do not recklessly purge" implies caution; there are situations where purging is warranted. If early-stage pox fails to erupt due to interior excess, accompanied by thirst, rapid pulse, constipation, and irritability, is purging inappropriate? If near resolution, interior excess presents with thirst, constipation, and fever, is purging forbidden? Some say never purge, referring specifically to vomiting and diarrhea. One must adjust according to the patient's deficiency/excess and seasonal regulations, aiming for appropriateness. Thus, Qian Yi's emphasis on "observing the season" is crucial. In deep winter cold, cooling agents cannot be routinely used. Moreover, pediatric smallpox originates from toxins of the five Zang organs, not merely heart fire causing pain and itching. Therefore, Chen Shi's formulas often succeed. However, modern misuse of Qian Yi's formulas causes errors due to poor application, not flawed formulation. One should seek the original intent of balanced prescriptions. Seasonal qi varies in depth, and children differ in constitution; medication must not be taken lightly. Incorporating wind-dispelling herbs, as suggested by Jiegou, aids ascending and dispersing, requiring caution. Can all hot and aromatic penetrating herbs be used routinely? Cases of toxins sinking into orifices, muscles, bones, or sinews recovering with such methods exist but are rare (one in a thousand).

Furthermore, *Ming Yi Za Zhuo* notes that Danxi's smallpox treatment is most comprehensive. Recent popular formulas like Chen Wenzhong's Mu Xiang San and Yi Gong San are biased. They suit deficiency-cold types (weak, pale, itchy, collapsed pox). However, for heat-toxin types (high fever, abundant eruption, red-purple, dry, itchy), blood-cooling is urgent. Since Chen's formulas became popular, deficiency-cold cases survived, but heat-toxin cases died. Smallpox is fetal toxin; ancient methods focused on detoxification. If Qi and Blood are deficient, toxins cannot be expelled or matured. Thus, Chen's method obscured the principle of detoxification, saving one side while harming the other. Now, one must thoroughly study Danxi's methods for universal application without fault.