Library

The eruption of smallpox/variolae presents with differences between Yang syndromes and Yin syndromes; it is necessary to distinguish them carefully to avoid misdiagnosis. In Taiyang disease (Disease of the Taiyang channel), characterized by aversion to cold, fever, and scanty, dark, or difficult urination, where the eruption is slow, Jingjie Gancao Fangfeng Tang (Schizonepeta, Licorice, and Saposhnikovia Decoction) is indicated. In Shaoyang disease (Disease of the Shaoyang channel), characterized by alternating chills and fever, where the eruption is slow, Lianqiao Fangfeng Tang (Forsythia and Saposhnikovia Decoction) is indicated. In Yangming disease (Disease of the Yangming channel), characterized by fever, red eyes, constipation, and eruptions covering the muscles but emerging slowly, Shengma Gegen Tang (Cimicifugae Rhizoma and Puerariae Radix Decoction) from the initial heat stage, added with Zicao (Arnebiae Radix seu Lithospermi Radix), is indicated. In Taiyin disease (Disease of the Taiyin channel), characterized by spontaneous diarrhea and cold limbs, Fuzi Lizhong Tang (Aconite and Atractylodes Macrocephala Decoction) for diarrhea, and Muxiang San (Costus Powder) for diarrhea are indicated. In Shaoyin disease (Disease of the Shaoyin channel), characterized by black depression of the lesions and dryness of the mouth and tongue, Siwu Tang (Four Substances Decoction) added with Zicao (Arnebiae Radix seu Lithospermi Radix) and Honghua (Carthami Flos) is indicated. In Jueyin disease (Disease of the Jueyin channel), characterized by retraction of the testicles, curling of the tongue, and occasional reversal cold of the limbs, Dayigong San (Great Yi Gong Powder) for slow eruption, added with Fangfeng (Saposhnikoviae Radix) and Qingpi (Citri Reticulatae Pericarpium Viride), is indicated. For the three Yin diseases, the treatment principle dictates rescuing the interior deficiency; therefore, warming agents are appropriate to assist.

(Generally, for variolae/rash diseases, emergence in spring and summer is considered favorable, as this corresponds to the time of pure Yang. The ancient methods of treatment are similar to those for Shanghan [Cold Damage].)
Heat in the lower legs and shins, redness of both cheeks, constipation, difficult urination, unquenchable thirst, rapid breathing, and a surging and rapid pulse.
The above seven signs/symptoms are not suitable for administration of hot-natured medicines.

When the rash first appears, if it is dense like silkworm seeds or sparse like bran, one should employ clearing and releasing the exterior methods; Lianqiao Shengma Tang (Forsythia and Cimicifugae Rhizoma Decoction) at the manifestation stage is indicated. If convulsions occur before the eruption, this indicates concurrent external contraction of wind-cold pathogenic factors; one should administer Jiedu Wan (Detoxification Pill) for variolae fright using tea water as a vehicle, along with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) for hemorrhage stages. If the eruption is slow, but stool and urine are normal and harmonious, indicating the pathogen is in the exterior, mild diaphoresis should be induced; Shengma Gegen Tang (Cimicifugae Rhizoma and Puerariae Radix Decoction) from the initial heat stage is indicated. If the lesions are blue, dry, and black-depressed, without significant body heat, and with obstructed stool and urine, this indicates heat accumulation within the interior; one should decoct Dahuang Tang (Rhubarb Decoction) to administer Xuanfeng San (Dispel Wind Powder) for fever stages. If there is intense heat on the exterior, purgation must not be used. For severe black depression, Baixiang Wan (Hundred Auspicious Pills) for black depression stages is indicated. If the eruption has appeared, is dense, accompanied by slight wheezing, and thirst with desire to drink, mild purgation is appropriate; Danggui Wan (Angelica Sinensis Pill) and Pangshi Dihuang Gao (Pang's Rehmannia Paste) at the manifestation stage are indicated, and Huangbai Gao (Phellodendron Paste) at the manifestation stage should be applied externally to the face. During midsummer when summer-heat is intense, coinciding with severe eruption, restlessness, thirst, and solid stool, Yulu San (Jade Dew Powder) for vomiting/diarrhea stages and Ganlu Yinzi (Sweet Dew Drink) for sore throat stages are indicated. If there is coma with loss of consciousness, frequent convulsions, inverted healing of lesions, and black depression, Zhuxin Longnao Gao (Pig Heart and Borneol Paste) for black depression stages is indicated.