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Zhang Anshi said: Medicine values specialization. It is advisable to follow the ancient tradition of dividing disciplines for study, each mastering their own strengths, so as to potentially grasp the powers of creation. The field of smallpox and chickenpox (Douzhen) is the first critical barrier in the foundation of an infant's life. I have carefully examined the theories of various schools such as Qian Yi, Chen Wenzhong, Zhu Danxi, and Wei Zhixin. Each adheres to one aspect. This is because their theoretical foundations differ: some discuss based on specific symptoms, some investigate the root cause, and some analyze according to seasonal timing. As mentioned in Fei's *Da Yun Lun* (Treatise on Great Movements): "I have studied smallpox treatments; some exclusively use acrid-hot herbs, some excel in cold-cool methods, and some focus on preserving Yuan Qi (Primordial Qi)." These are all renowned experts in treating smallpox. Why is there no distinction seen year by year? It must be known that this is caused by the movement of heavenly cycles, not because these three approaches are biased. Fei explicitly referred to Zhongyang (Chen Wenzhong), Guiyan, and a third master, but did not mention Jichuan (Li Zhongzi). This is because Jichuan truly grasped the subtlety of "one root yielding myriad branches" and combined the strengths of the three masters. His theories are worthy of emulation and can be followed by later learners.

He stated during the Ding Si to Gui Hai years of Emperor Shenzong's reign that Qi deficiency was predominant then; from the Jia Zi year onwards, Blood heat cases gradually increased. The pathogenic toxicity also deepened accordingly. What previously required heavy tonification now requires light intervention; what previously required light purgation now requires heavy intervention. By the Ding Mao year, even extremely clearing and resolving agents were ineffective for conditions requiring heavy purgation. Only through thorough cleansing could the severe depletion of Yuan Qi and the rampant pathogen be subdued. However, this was merely a temporary measure during the swelling stage. After the Ren Shen year, cleansing methods originally applied before pustule formation were found necessary from beginning to end. Huang's *Questions and Answers on Douzhen* also states: "Since I began practicing in the Xin Si year of Wanli, most cases belonged to deficiency-cold. By the Gui Mao year, the climate changed drastically. Since then, only one or two out of ten cases required warming and tonifying; eight or nine out of ten were deficiency with accompanying fire or phlegm. The rash color also frequently varied. This is undoubtedly due to the influence of climatic cycles. Physicians who hold the keys to life and death should not rigidly adhere to fixed rules without adapting to changes."

Thus, I synthesized the principles of various schools and summarized the main aspects into three major categories: Blood Heat with Toxin Excess, Toxin Excess with Qi Deficiency, and Qi Deficiency with Failure to Rise. And three key points regarding Smooth, Dangerous, and Adverse patterns. For Smooth patterns, no special treatment is needed; for Adverse patterns, what benefit is there in treatment? Only Dangerous patterns require urgent treatment and flexibility. The mechanism allows no delay; one cannot be constrained by the early or late stages of the disease or bound by rigid formulas. Conditions vary in cold and heat, signs in true and false, toxins in shallow and deep, medicines in heavy and light, treatments in slow and rapid, seasons in cold and hot, people in noble and humble, and constitutions in strong and weak. How can they be generalized?

The treatment for wealthy families differs significantly from that for poor families. Wealthy families are accustomed to rich and sweet foods, resulting in delicate and fragile bodies, like plants growing in shade without exposure to wind and sun. They cannot withstand harsh medications. Moreover, once slight spots appear, numerous doctors are summoned. Even skilled physicians find it difficult to offer independent advice. Using any relevant herb may lead to public criticism; merits are unseen, but blame is assigned. This is a matter of social custom, nothing to regret. Poor families consume coarse food, endure wind and frost, and possess stronger constitutions capable of bearing illness. Even when treated, relying on a single method, even if the condition is critical, they can tolerate heavy doses, leading to quick recovery. However, for poor patients, once the condition becomes critical and uncertain, doctors often neglect them and give up, leaving them to die. Yet, those revived by the nourishing nature of earth qi are also common.

Physicians who understand adaptability must seize opportunities at the initial萌芽 (sprouting) stage and adjust before full onset. If toxins arise from exterior pathogens, disperse and resolve them; if from interior pathogens, promote circulation; if heat is severe, cool and moisten; if toxins are trapped, open and vent; if accompanied by fright, clear and calm; if accompanied by phlegm, drive and guide; if deficient, tonify; if excess, reduce; if cold, warm; if hot, clear. These are the general principles of treating Douzhen. One must clearly perceive the mechanism and act decisively. Do not confuse and mix ascending and dispersing herbs due to uncertainty. Once the superficial signs recede, the rash will naturally rise. Treating disease requires seeking the root. If Blood Heat is diagnosed, using cooling resolution acts as ascending; if Qi Deficiency is diagnosed, using tonification and support acts as ascending. Hence, Xinfu advised avoiding Shengma (Cimicifugae Rhizoma) once spots appear, and Danxi warned against using Gegen (Puerariae Lobatae Radix) upon seeing red spots.

Today, those famous for treating Douzhen either claim secret family recipes or rely on teacher transmission. Without distinguishing the deficiency or excess of Qi and Blood, the shallow or deep nature of heat and toxins, the strength of constitution, or the presence of concurrent syndromes, they indiscriminately use general ascending and dispersing methods. They wait until the spots are fully erupted to judge auspiciousness or inauspiciousness. Not knowing that after three days, the toxin has entered the meridians, and concurrent attacks cause various complications. This stems from inaccurate insight and erroneous customs. Fei said: Inaccurate insight leads to losing the way; lack of courage leads to abandonment; unremoved conceptual barriers hinder change. Only those with both courage and sincerity, whose minds move with reason, can discuss this.

I have encountered cases where early eruption does not rely on ascending methods; even during the swelling stage, cooling agents may be appropriate. Incorporating tonification within purgation, why fear promoting fluid intake during pustule formation? Using hot herbs for scabbing, why worry about dispersion during scab formation? Regarding clinical judgment, one must carefully observe morphology, examine color, deduce from spirit and expression, and correlate with internal signs. Thus, one can distinguish between apparent deficiency-cold but actual excess-heat, apparent excess but actual deficiency, apparent mild but actually critical, and apparently fatal but actually curable situations, keeping them clear in mind.

For patients with inherent Qi deficiency presenting Blood Heat, at the initial fever stage, while the toxin has not yet entered the meridians and Yuan Qi is still sufficient, treat the branch first with heavy blood-cooling herbs to resolve heat toxin, then secure the root with warming and nourishing herbs to aid pustule formation. If not cleared initially, by day four or five, attempting cooling resolves makes it hard for pustules to rise and fill; attempting tonification is hindered by uncleared heat toxin. At this point, both attacking and tonifying are difficult, leading to frequent deaths.

There is also the syndrome of "Stagnant Pox" (Men Dou). Medical texts only mention White Stagnant, Purple Stagnant, and Tight Stagnant, without rescue methods. I believe stagnant pox is due to toxin obstruction preventing eruption, being the most urgent adverse pattern. Even divine medicine cannot save it. However, some appear stagnant but are not truly stagnant, being slow stagnation, which is a dangerous adverse pattern, i.e., Closed Syndrome. People often abandon these as stagnant pox. Can we attribute this solely to fate? If one understands the cause and opens the closure, danger can turn to safety, like passing a pass at cockcrow. Once passed, other measures can be taken. Causes of closure vary: excessive fire-toxin, phlegm-turbidity blockage, internal attack by parasites, food and blood stasis, or extreme depletion of True Yuan.

For example, fever begins with red spots like cinnabar, body heat like burning, drying to black/purple, restlessness, dry lips, bad breath, or swollen lips/mouth—this is Fire. Even in winter, a large dose of Baihu Huaban Tang (White Tiger Spot-Resolving Decoction) is needed, with Shigao (Gypsum Fibrosum) in large amounts.

If fever presents with inability to lift head/neck, phlegm-wheezing, shortness of breath, closed eyes, coma, dizziness, falling, restlessness, and convulsions—this is Phlegm. Urgently administer Jingui Dahuang Gancao Tang (Major Rhubarb and Licorice Decoction from the Golden Cabinet) to induce vomiting and purging.

If fever brings irritability, vomiting, clear fluid under the tongue, silence/sleepiness alternating with restlessness, abdominal pain, or frequent crying, with blue veins under the tongue or black/white dots on the lower lip—this is Parasites. First give Jiaomei Wan (Pepper and Plum Pill) to lure parasites, then purge with Zicao Chengqi Tang (Arnechia Magnolia Bark Decoction).

If early eruption brings high fever, coma, abdominal pain, delirium, prickly tongue, rough breathing, loose stools (text implies bowel issue, likely constipation or heat diarrhea, context suggests excess), screaming, and restlessness—this is Food Retention. Urgently administer Dachengqi Tang (Major Order the Qi Decoction) or select among the Three Chengqi Decoctions.

If trauma causes blood stasis, delirium, coma, wheezing, distension, or nosebleeds, use Taohé Chengqi Tang (Peach Kernel Magnolia Bark Decoction).

If low-grade fever, fine white spots resembling hoarseness, weak Qi, listless eyes, dull complexion but bright/lustrous face and lips—this is Qi Deficiency with Yang Collapse, scattering essence of Lung and Stomach. Rare, seen only in pampered, fragile individuals. Unless heavy doses of Renshen (Ginseng Radix et Rhizoma, 2-3 liang) and Sheng Huangqi (Astragali Radix, ~1 liang) are used with Shengma (Cimicifugae Rhizoma) and Wuweizi (Schisandrae Fructus), administered continuously, how can Yuan Qi be restored from non-existence and revitalized?

For excess-type closure, striving hard can save half; for deficiency-type closure, it is like Bian Que saving Prince Guo. Thus, the pivot of creation is in our hands; why stick to ordinary standard treatments?