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[Xue Ji] The condition of fistula and sores (Lou Chuang) arises from congenital deficiency of Qi and Blood, or chronic illness leading to weakness of Qi and Blood, or internal heat due to food stagnation in the Liver and Spleen of children, which fails to generate flesh, or emotional disharmony in the nursing mother causing the Spleen Qi to fail to consolidate. One should examine the etiology, tonify and regulate Yuan Qi, and assist with methods such as Rusheng Biscuit (Rusheng Bing) and scallion moxibustion (Cong Yun). If one uses drugs that circulate Qi, break Blood, or cause erosion, it will instead lead to a deteriorating condition; for other details, refer to the main treatments in respective sections.

Qian Yi said: When the fetus is in the womb, by the sixth or seventh month, its form is already established, consuming the turbid fluids of the mother's abdomen into the five Zang organs. By the tenth month, these turbid fluids fill the stomach. At birth, there is still impurity in the infant's mouth. If the mother wipes it clean with her hand, no disease occurs. However, common practice uses Coptis Rhizome (Huanglian) and Mercury Powder (Gongfen) to purge the turbidity of umbilical stool. This allows residual impure Qi from the mother to enter the infant's Zang organs. Originally caused by slight cold, when combined with wind-cold, pathogenic factors contend, resulting in smallpox and chickenpox (Dou Zhen). Before eruption, heat stirs the five Zang, so Zang symptoms appear first. Initially, there are yawning, drowsiness, sudden palpitations, alternating chills and fever, cold extremities, red and dry cheeks, coughing, and sneezing—indicating all five Zang symptoms are present. Yawning and drowsiness relate to the Liver. Frequent palpitations relate to the Heart. Alternating chills and fever with cold extremities relate to the Spleen. Red face and cheeks with coughing and sneezing relate to the Lung. The Kidney has no specific sign because it is located inferiorly and does not consume turbidity. All sores and rashes are toxins of the five Zang. If they merge into one syndrome, the Liver presents as vesicles, the Lung as pustules, the Heart as macules, and the Spleen as papules. Although the Kidney shows no signs, if the prognosis is poor with inverted crusts and black sinking, it returns to the Kidney. This is due to negligence regarding wind-cold and inability to eat, causing internal deficiency. Dong Yuan stated: The initial signs of rash eruption must include dry face, red cheeks, red eyelids, yawning, drowsiness, alternating fever and chills, coughing, sneezing, slightly cold feet, excessive sleep, waking in fright, along with other rash symptoms. Whether large pustules, small red spots, or urticaria appear, why do these upper symptoms manifest before eruption? These symptoms arise because Taiyang Cold Water originates below the right Kidney, simmering the left Kidney. Foot Taiyang Bladder Cold Water flows counter-current up the spine, over the head and forehead, obstructing Hand Taiyang Fire, preventing its transmission, and reversing onto the face. Thus, these signs appear, as Ren-Gui Cold Water controls Bing-Ding Fire. All eruptions result from counter-flow of Cold Water. Physicians must understand this principle to prescribe safely. The Bao (Womb/Seed Chamber), also called Chigong, Dantian, or Mingmen, stores essence and facilitates transformation in men, and conception in women. It is the source of generation, not part of the Five Elements, nor purely Water or Fire, but an alternative name for Heaven and Earth, resembling Kun Earth generating all things. At conception, if Jing overcomes Xue on days one to two, it becomes male; if Xue overcomes Jing on days three to five, it becomes female. The interaction of these two creates the Spirit (Shen) and Essence (Jing). During the ten months in the womb, the fetus breathes with the mother. Breathing is Yang Qi, promoting movement and nourishing Jing, Qi, and Shen. Hunger and thirst follow maternal blood. As the child grows, bones, sinews, flesh, blood vessels, and Qi become complete. Upon birth, evil blood remains in the mouth. With the first cry, inhalation draws this blood down into the Bao at Mingmen, hiding in a corner. It remains latent until internal injury from milk/food or damp-heat sinks into the Kidneys. The two Fires attack together, Ying Qi fails to follow, reverses in the muscle tissue, and the evil blood erupts. All rashes originate from Kidney Water. After ulceration, flesh gathers and returns to Yangming. The initial signs involve Foot Taiyang Bladder controlling Hand Taiyang Small Intestine. Eruptions start on the face and end in Yangming muscle tissue, where heat transforms into pus. When the two Fires are excessive, they overcome Cold Water, causing full-body eruption via Foot Taiyang transmission. Wan Shi said: The origin of smallpox and chickenpox is debated: some attribute it to turbid toxins, others to excessive fire, others to seasonal epidemics. There is no fixed theory. If it were turbid toxins or excessive fire, why would entire counties and villages suffer similarly with high mortality? If it were seasonal epidemics, why do individuals only contract it once in a lifetime? Parents and children share one body. Toxins of essence and blood accumulate at the beginning of Yang giving and Yin transforming. Thus, fetal toxin exists before birth, not merely from swallowing blood. Men preserve Qi to nourish Essence; women expend Qi to nourish Blood. Neglect leads to future illness. Though inheritance differs, the toxin is one. Is it true that male excessive fire arises from Qi (Yang toxin, easy to treat) and female excessive fire arises from Blood (Yin toxin, hard to treat)? Seasonal diseases have their times, determined by annual influences and irregular four-season Qi. Therefore, timing determines fetal toxin eruption: rapid and critical, slow and lingering, or sudden death depends on Qi strength. Once erupted, the toxin is exhausted, explaining why it occurs only once. Smallpox as fetal toxin is evident. Variations in severity may be due to parental transmission, epidemic infection, or "ghost fixation" (Gui Zhu). These are mysterious and beyond ordinary reasoning. The toxin of smallpox/chickenpox originates in parents. Even after having had it, residual toxins remain in organs, meridians, skin, muscles, and bones. Upon conception, this toxin transfers to the child. Hence, children's scars often resemble parents'. Poor care exacerbates the toxin. Severe cases may stem from parental neglect. Just as physical traits like dwarfism or lameness resemble parents, so does the toxin. Humans receive Qi from Heaven and Earth. Changes in natural Qi affect human Qi. During periods of abnormal climatic shifts, pathogens spread, causing similar symptoms. Mild cases are mild, severe cases severe. This is the work of epidemics. Those who die from plague leave wandering souls that attach to healthy people via Qi, similar to tuberculosis or leprosy transmission. However, those with strong constitutions and good fortune are unaffected. In years of Yin-Yang disorder, weak individuals suffer incurable afflictions. Is this not the harm of ghost fixation? How to treat these three causes? One must preemptively resolve toxins, calm Qi, and change environment to avoid them. Commentary: Smallpox/chickenpox outbreaks clearly show seasonal epidemic Qi spreading between cities and villages. Cases are uniformly light or heavy. Only 10-20% differ. Can we solely attribute this to fetal toxin? Many never contract epidemics, yet everyone contracts smallpox/chickenpox once. Epidemics can recur, but smallpox does not. Thus, the fetal toxin theory cannot be entirely discarded. Ancient texts mention excessive fire and turbid blood, yet did not always link them to smallpox. Dismissing fetal toxin is incorrect. Many things emerge from nothing. Consider the Poppy flower (Yu Meiren), named after Xiang Yu's concubine who died for him. People sang mournfully to the plant, and it swayed. Plants lack consciousness. Before Chu existed, neither the concubine nor the plant existed. Sentient beings create illusions through delusion. Why doubt smallpox then?