Library

If smallpox does not present with fever, it will not erupt, just as grains do not mature without heat. However, the degree of fever varies: mild toxin results in mild fever, while severe toxin results in severe fever. Some cases erupt five to six days after fever onset, others within one or two days. If the fever persists too long, the healthy Qi cannot overcome the pathogenic factor; if eruption is delayed, Qi and Blood stagnation occurs. Only when the body cools down after three to four days of fever and the rash emerges is this considered normal, which is an auspicious sign.

Generally, during fever, if the skin is warm and moist, lips and tongue are moist and clean without coating, voice is clear, there is slight startle during sleep, appetite remains normal (or slightly reduced with drowsiness), these are all auspicious signs. Severe cases present oppositely: upon fever onset, lips crack, tongue becomes scorched, restlessness and chest distress occur, thirst and aversion to cold appear, ears feel burning, eyes are red, and both urination and defecation are obstructed. In such cases, Su Zhi Tang (Perilla and Immature Bitter Orange Decoction) added with alum powder, or Qian Li Ma (Thousand Mile Horse Formula), may be used for purgation. For those averse to heat, purgation alone is used, adjusting dosage based on tongue coating changes. One should not rigidly adhere to the notion that "initial stages require only dispersing." This scenario occurs in only one or two out of a hundred cases and should not be treated as routine. If lips and tongue remain moist, even if other severe symptoms appear, one must absolutely avoid reckless purgation to prevent damaging the body.

Abdominal pain, lower back pain, and limb soreness during fever indicate severe conditions. If pain ceases after the exterior syndrome resolves, it is auspicious; if pain intensifies, it is ominous.

Vomiting and diarrhea during fever should never be stopped abruptly. Only if vomitus or stool has a sour, foul odor can digestive-resolving herbs be added as adjuvants, indicating food stagnation.

Startle preceding smallpox eruption is auspicious. Why? Startle belongs to Yang, while smallpox belongs to Yin. When Yang breaks through Yin obstruction, there is no risk of blockage, hence it is auspicious. Conversely, mistakenly using anticonvulsant herbs may freeze the toxin internally, causing deep harm (some die immediately from fright due to evil invasion).

Delirium, mania, hallucinations, and extreme restlessness during fever result from excessive heat failing to be released via sweating, causing external pathogens and internal toxins to clash. Increasing diaphoretic treatment leads to recovery. A yellow tongue coating necessitates purgation.

Internal organ heat accumulation cannot resolve without mild sweating; thus, any fever requires diaphoretic herbs. Fever persisting for four to five days indicates toxin remains inside; resolving the fever is essential.

Fever lasting four to five days with dark purple, suppressed rash suggests external cold binding and pore closure. Sweating foul sweat allows heat to subside and rash to emerge naturally.

Early fever with several large pustules on the head/face but no other eruptions, accompanied by unresolved heat, is called "Reporting Pustule." Immediately puncture with silver needles and apply rouge; otherwise, healthy Qi fails, leading to lingering disaster.

Initial fever with warm head/cold feet, no thirst, loose stools, pale face, or watery diarrhea with undigested food, vomiting undigested matter indicates deficiency syndrome. Treatment must follow deficiency protocols.

Tang Fangyou stated: All smallpox arises from toxin. Children's constitution varies in deficiency or excess, making treatment straightforward. Yet people claim "deficiency mixed with toxin" is incurable, which is cruel. Consider: how many children are truly robust? How can smallpox exist without toxin? Parents should study Master Fengchu’s book to prevent quacks from harming descendants.

Illuminating skin during fever revealing patchy red-purple discoloration indicates severity. Red face with white lips also indicates severity. Combined with poor appearance, death is certain. Bleeding from nine orifices is fatal.

Closed eyes without spirit, black tongue with hoarse voice, protruding chest, bleeding palm lines are all terminal syndromes. White pus appearing at any stage predicts death within seven days.

Su Jie Tang: Regardless of smallpox presence, administer if child shows fever, yawning, irritability, slight sleep startle, sneezing, dry eyes, coarse breathing, and limb weakness.

Ingredients: Perilla Leaf, Platycodon Root, Peucedanum Root, Licorice Root, Cimicifuga Rhizome, Kudzu Root, Forsythia Fruit, Red Peony Root, Angelica Sinensis Root, Scallion White, Fresh Ginger.

For intense fever with abdominal distension and wheezing, add Ephedra Stem.

For irritability and fullness, add Trichosanthes Root and Ophiopogon Tuber, mixed with Mantianqiu. (Backup formula)

For frequent convulsions/startle, add Akebia Stem and Rehmannia Root.

For sore throat, add Arctium Seed, Scrophularia Root, and Schizonepeta Spikelet.

For cough, add Apricot Kernel and Mulberry Bark.

For severe vomiting, add Tangerine Peel, Coptis Rhizome, Polyporus, and Alisma Rhizome.

For diarrhea, add Polyporus and Alisma Rhizome.

For hematemesis with dry heaving, add Rhinoceros Horn (substitute Water Buffalo Horn), Scutellaria Root, and Coptis Rhizome.

For bloody stool, add Peach Kernel and Coptis Rhizome.

For hematuria, add Rhinoceros Horn (substitute Water Buffalo Horn) and Gardenia Fruit.

For scanty, painful urination, add Akebia Stem, Plantago Seed, and Citron Peel.

For constipation, add Aurantium Fruit and Angelica Sinensis Root.

For wheezing, constipation, high fever, irritability, facial edema, dry lips, thick coating, chills, and cold limbs, add Qianli Ma. (Backup formula) For delirium and mania, add Gypsum and Anemarrhena Rhizome, mixed with Mantianqiu.

For food stagnation with abdominal pain and sour vomiting, add Hawthorn Fruit, Magnolia Bark, Medicated Leaven, and Barley Sprout.

For lower back pain, add Notopterygium Rhizome and Saposhnikovia Root.

For menstruation, add Rehmannia Root and Ligusticum Rhizome.

For unexpected bleeding, add Prepared Rehmannia Root and Rejianchou. (Backup formula)

For sudden aphonia during menstruation, add Ginseng Root, Ophiopogon Tuber, and Rehmannia Root.

For abrupt cessation of menstruation with delirium, add Notopterygium Rhizome and Bupleurum Root, use Rejianchou for purgation.

For constipation, add Qianli Ma.

Yi Yuan Tang: Established for Qi deficiency. Once diagnosed correctly, the core principle remains unchanged despite varying accompanying symptoms, as all stem from Qi deficiency. Adjust based on the base formula.

Ingredients: Ginseng Root, Astragalus Root, Licorice Root, Atractylodes Macrocephala Rhizome, Tangerine Peel, Angelica Sinensis Root, Ligusticum Rhizome, Cimicifuga Rhizome, Platycodon Root, Fresh Ginger.

For severe heat, substitute with Glehnia Root.

For pale complexion, reduce Ligusticum Rhizome.

For stagnation-induced abdominal pain or sour diarrhea, add Hawthorn Fruit and Medicated Leaven. If not due to stagnation, add Dried Ginger and Peony Root.

For severe abdominal pain, add Yigong San. (Backup formula)

For persistent diarrhea, remove Angelica Sinensis Root, add Myristica Seed, or Tiao Zhong Wan.

For constipation, double Angelica Sinensis Root.

For loss of appetite, double Atractylodes Macrocephala Rhizome, add Medicated Leaven.

For painful, red urination, add Citron Peel, Akebia Stem, and Poria.

For vomiting, remove Platycodon Root, add Dried Ginger, Clove Flower, and Tangerine Peel.

For severe vomiting, double Clove Flower.

For deficiency-heat irritability and thirst, add Ophiopogon Tuber and Schisandra Berry.

For cough, add Ophiopogon Tuber, Schisandra Berry, and Apricot Kernel.

For phlegm, add Fritillaria Bulb.

For cold-induced cough, add Perilla Leaf, Saposhnikovia Root, and Apricot Kernel.

For cold limbs, add Dried Ginger and Cinnamon Bark.

For sweating, remove Platycodon Root and Cimicifuga Rhizome, add Cinnamon Twig.

For palpitations/startle, add Gastrodia Rhizome and Uncaria Hook, mixed with An Shen Wan.

For slow eruption after 3-4 days, pale skin, and erect hair follicles, remove Cimicifuga Rhizome, add Cinnamon Twig and Angelica Dahurica Root.

For days 5-6, if eruption is slow, thin-skinned, easily broken, or dull-colored, double Ginseng and Astragalus. Add Angelica Dahurica Root, Cinnamon Twig, Boswellia Resin, and Wine.

For edema, double Atractylodes Macrocephala Rhizome, add Stephania Tetrandra Root and White Peony Root.

Itching follows similar principles.

For severe itching, gently rub with pig bristle brush or use fumigation.

For limb paralysis, add Cinnamon Twig and Saposhnikovia Root.

Days 7-8 mark pus formation. If pus formation stalls, with pale Qi/Blood or clear fluid, add Angelica Dahurica Root, Cinnamon Twig, and Costus Root for regular use. Glutinous rice, milk, and wine should also be regularly consumed.

At this stage, chills, diarrhea, or turning white/itchy/collapsed are inevitable. Upon seeing these, urgently use Mu Xiang Yi Gong San flexibly. Once pus is sufficient and lips/tongue turn red, stop this and switch to adding Poria and White Peony Root for consolidation. Rigid doctors relying solely on warming tonification are biased.

Deficiency presenting with abdominal distension, wheezing, constipation, and thirst is treated with Mai Dong Tang. Throat irritability is treated with Zi Yin Run Zao Tang. These are deficiency transforming into apparent excess, not true excess. Using draining agents without discernment causes rising Qi to collapse. Days 9-10 also use base formula with Poria and White Peony Root, adjusted for complications. Post-scabbing carbuncles refer to later sections.

Smallpox presents as pure deficiency, pure excess, initial excess then deficiency, or initial deficiency then excess. This formula treats pure deficiency. Thus, the method remains constant, focusing on tonifying Qi and Blood. Avoid formulas like Su Jie Tang or Shi Shen Tang.

Critics ask: Isn't sticking to one formula too rigid? Aren't Ginseng and Astragalus too strong? I reply: The key to medication lies in observing lips and tongue. Recognizing their color changes guides dosage adjustment. Frequent use is acceptable; non-use is also acceptable. There is nothing reckless about it.