Library

Varicella (smallpox) is called "fetal toxin" (Tai Du), originating from the time of sexual intercourse between man and woman, where the ministerial fire meets first and then essence gathers. This fire brews within the embryo, becoming a thief of blood.
Externally, there are influences of pathogenic factors. It arises suddenly and cannot be stopped. Among them, severity varies; some are caused by parental congenital endowment, others by heavenly luck and qi transformation.
A skilled practitioner guides according to the trend, so what difficulty is there in understanding and resolving it?
The fetus in the womb is like a chick in an egg; its form is not yet complete, and orifices are not open. It relies on maternal blood irrigating through the umbilical cord, which is the primordial qi (Tai Chu Zhi Qi). During birth, maternal blood flows excessively and may seep into the infant's mouth. The folk belief that the infant swallows a "blood cake" which lodges in the Gate of Life (Ming Men) and accumulates into toxin is erroneous. Those with residual umbilical matter are like the juice in fruits and melons; how could this be formed by eating a blood cake? If one claims the abdomen relies on this for nourishment, then this should be the treasure of blood, how could it become toxin?
Shen Xunzhong said: This is the viewpoint of Zhai Shi from Yidu. Fengchu (Cheng Yunpeng) traces his origin to Zhai Shi, pushing forward with each generation to reveal new insights. Zhai Shi obtained what was previously unheard of, and Fengchu further elucidated the reasons, opening the deaf and saving those who would otherwise die young. These two gentlemen are not only meritorious officials in this field.
Fetal toxin for smallpox is inherited from the embryo. It may manifest after several years, ten-plus years, or even decades. Before manifestation, it hides deeply and潜伏ly, with no sound or smell. Just as when a village is peaceful, one cannot grab a person and execute him saying, "You will become a bandit." Why then does the world have theories about preemptively resolving fetal toxin?
Methods for preemptively resolving fetal toxin occasionally work because the child's fetal toxin is originally mild. But if they do not work, what then? I have seen wealthy families, being overly protective, seeking alchemical pills from Daoist practitioners. When smallpox appears, it becomes extremely severe and incurable. This is likely due to the ingested medicines damaging the qi of deficient organs, preventing the smallpox toxin from being disseminated and unblocked.
Smallpox toxin exists nowhere in the human body but does not appear everywhere at once. However, its eruption follows a sequence: from bone marrow to sinews. The Kidney governs bones; when qi and blood are robust, the toxin is sent out to the sinews, resolving the Kidney channel's toxin. From sinews to muscles. The Liver governs sinews; when qi and blood are sufficient, the toxin is sent out to the muscles, resolving the Liver channel's toxin. From muscles to blood vessels. The Spleen governs muscles; when qi and blood are sufficient, the toxin is sent out to the blood vessels, resolving the Spleen channel's toxin. From blood vessels to skin and hair. The Heart governs blood; when qi and blood are sufficient, the toxin is sent out to the skin, resolving the Heart channel's toxin. From skin to pustule bases. The Lung governs skin and hair; when qi and blood are sufficient, the toxin is sent out to the pustule bases, resolving the Lung channel's toxin. Once the toxins of the Five Zang organs are resolved, blood transforms into pus, toxin transforms with the pus, scabs form and fall off, completing the process. If toxin remains slightly in the bone marrow after emerging from sinews, it causes high fever, dry mouth, and restlessness. If it remains slightly in the sinews after emerging from muscles, it causes spasms, convulsions, purple-black tidal fever. If it remains slightly in muscles after emerging from blood vessels, it causes abscesses on the limbs. If it remains slightly in blood vessels after emerging from skin, the pustules are not round and plump. If it remains slightly in skin after emerging from pustule bases, scabbing and falling off are delayed, leaving many pockmarks.
Smallpox toxin differs from other sore toxins. Other sore toxins, before taking shape, can be dispersed and internally resolved to heal. After taking shape but before forming pus, they can still be driven away to prevent pus formation and heal. Smallpox toxin originates from the congenital state, opens and falls according to its cycle; it cannot be internally resolved nor driven away. It entirely relies on qi and blood to send the toxin back into the smallpox lesions. (The secret of Zhai Shi lies in these four characters.) Relying on filling with pus and forming scabs, physiological vitality is abundant. Using cold-cooling herbs to freeze the condition leads to numerous complications. Moreover, there are cases that need no resolution and cases that cannot be resolved. If a child has strong congenital endowment, is usually healthy, eats normally, and their qi and blood are sufficient to transport and transform, resulting in a smooth course, why use resolution? If congenital endowment is weak and postnatal Spleen and Stomach are also weak, with reduced appetite during eruption, diarrhea, abdominal distension, cold hands and feet, shortness of breath, hoarseness, slow eruption, non-vibrant bases, white color with depressed tops, failure to suppurate or scab, this indicates qi and blood cannot transport and transform. Rapid warm-tonification is needed. If Ren Shen (Ginseng Root), Huang Qi (Astragalus Root), Dang Gui (Angelica Sinensis), Bai Zhu (Atractylodes Macrocephala Rhizome) are insufficient, add Ding Xiang (Clove), Gui Zhi (Cinnamon Twig), Fu Zi (Aconite Lateral Root Preparata); this is harmless. How can one say it needs resolution?
Smallpox toxin knots in the internal organs and flesh/bone, merging with qi and blood into one block. Before breaking apart, upon pathogenic influence, it gradually separates. Like a fetus about to be born, this "resolution" means separating form and dissolving structure. Thus, for every part of smallpox that emerges, one part of toxin is resolved; when all smallpox emerges, all toxin is resolved, though it remains untransformed in the muscles. If eruption is uneven, swelling does not rise, pus does not form, scabs do not knot, it is due to weak qi and blood; assist them quickly. Assisting them prevents difficult-to-resolve adhesion. To say that un-erupted ones can be made not to erupt, or excessive ones can be made to erupt less, is like saying a fetus in the belly can be prevented from being born, or one about to be born can be prevented from being born.
Smallpox eruption differs from miscellaneous diseases. Miscellaneous diseases involve only one channel; smallpox shows symptoms of all five Zang organs. Ancient texts say it resembles Taiyang disease (Cold Damage), but this is a generalization. Meng Chunyi said: Cold enters from outside (hence aversion to cold); smallpox emerges from inside (hence aversion to heat). Therefore, aversion to cold, no sweat, headache, stiff spine, blue veins on the left forehead, pale and uncomfortable complexion—these are present in Taiyang disease but absent in smallpox. Eyes holding tears like water pearls, coarse nasal breathing, slight startle during sleep, appearance of ear ridges (light red is auspicious, blue-purple is ominous), aversion to heat without aversion to cold—these are present in smallpox but absent in Taiyang disease. Some say only the middle finger is cold, or ears and buttocks are cold; the reasoning is credible.
"Smallpox" (Dou) sounds like "bean" (Dou). If it resembles a bean, life ensues; if not, death ensues. Lack of resemblance means exhaustion of Yuan Shen (Primordial Spirit). Pointed, round, protruding, clean surroundings, and loose texture indicate spirit presence. Like bran (white), like hollow shells, like scabies (rootless granules), like silkworm seeds (black and small), like snake skin (in patches), like mosquito bites (scattered blood spots), like itch macules (scattered roots), like soup blisters (skin/flesh rotting first), like fire thorns (dried blood)—these lack spirit. Can one hope for life if form lacks spirit? Regarding color: desire it like spring flowers with dew (red, vibrant, glossy); do not desire it like autumn grass after frost (dark, dry, yellow). Distinct red and white, bright and moist, indicates colorful vitality. Like face powder, like dead bones, like red rice grains, like pig liver color—these lack color. Form lacking spirit, color lacking vibrancy, vitality is known. Alas, spirit and color are the gates of life and death!
When examining smallpox, first examine Yuan Qi (Primordial Qi). A smallpox patient's Yuan Qi is neither existent nor nonexistent; it must be perceived intuitively. If appearance/color starts good but ends bad, Yuan Qi is exhausted internally. If appearance/color starts bad but ends good, Yuan Qi is strong internally. Yuan Qi is the root; appearance/color is the branch. Thus, skilled practitioners seek the root.
Cheng Shuyan said: Ancients used Ren Shen (Ginseng Root), Huang Qi (Astragalus Root), Gan Cao (Licorice Root) to form Bao Yuan Tang (Protect Primordial Decoction), unchanged throughout, precisely to strengthen internal Yuan Qi.
Gui Yanzi said: People know smallpox relies on qi and blood, but do not know what smallpox relies on is superior to qi and blood, namely Yuan Qi. When Yuan Qi is vigorous, qi and blood flow smoothly, leading expulsion, carrying and transporting, jointly dispelling toxin, ensuring smallpox opens and falls on schedule. If Yuan Qi is deficient, external cannot connect internally, internal cannot secure externally, toxin acts recklessly, emerging or entering, causing external peeling and internal attacking. Nourishing True Yuan and tonifying qi and blood is indeed the perfect strategy for treating smallpox. If forced to treat other conditions, stop when the disease is addressed. The Classics say: For toxic drugs, remove 80% of the disease; for non-toxic drugs, remove 90%. Encircling blood to form circles is the function of Qi. Qi can constrain blood and control toxin, making the smallpox halo bright and red/vibrant. Depressed tops indicate Qi deficiency; collapsed tops indicate Qi separation; withered halos indicate Blood deficiency; scattered bases indicate Blood separation. Circles and halos are the work of qi and blood. Yet, qi and blood do not act exclusively to form circles and halos.
Wu Dongyuan said: Bases/granules represent Blood transport; pus represents Blood corruption. In the first six days, focus on bases; without bases, pus will not fill (toxin is internal). After six days, focus on pus color; without pus color, scabbing will be difficult (Yuan Qi insufficient). This is principle and trend. Formless relies on formed; formed attaches to formless. They rely on and attach to each other; this is the Way of Heaven and Earth, and also the Way of Qi and Blood. Qi separation does not stem from Blood scattering? Thus, after qi and blood interact, always observe bases and halos as standards. Thick, tight, red, vibrant, full of vitality. If fine, invisible, non-converging, and dull, Qi will flee and fail to control toxin. Therefore, internal attack with scattered bases results in death. Internal attack with attached bases and blood—if not caused by toxin acting violently, it must be due to Three Causes (due to body weakness, due to filth contact, due to mistaken medication).
Qi and Blood have constants, but cannot exceed constants, yet can self-deplete within constants. However, there are times of excess. Why? Toxin obstructs Qi, Fire clashes with Blood. Macules (Ban) indicate Blood excess; Papules (Zhen) indicate Qi excess. The Classics say: Excess of pathogenic qi constitutes Excess syndrome; depletion of true qi constitutes Deficiency syndrome.
Qi resides in the superior position, making smallpox tops round, white, and moist. Blood rests in the inferior position, making surrounding halos red and vibrant. If the entire top is red, it will not suppurate; by day 8-9, itching and collapse lead to death. This is not Blood's fault, but Qi deficiency losing its superiority, allowing Blood to act recklessly and usurp its position. Greatly tonifying Qi might save it; mistaking it for Blood Heat and treating with cooling herbs leads to death (True Blood Heat presents as withered, scorched, purple-black, even areas without smallpox turn purple).
If appearance/color is extremely bad, Qi does not intersect, pus does not form, it seems like death. If spirit is clear, appetite normal, and Tian Ting (Forehead) has one or two pleasing spots, toxin can still erupt, turning into foul-smelling smallpox and healing. Why? Because toxin is external, not internal, hence this statement.
Chen Shi said: Smallpox focuses on Hand-Taiyin Lung and Foot-Taiyin Spleen channels. Lung prefers warmth; Spleen prefers dryness. Wan Shi said: Smallpox always focuses on Spleen and Stomach. Stomach should be nourished; Spleen should be tonified. Ma Shi said: Smallpox focuses on Foot-Shaoyin Heart channel.
Fire should not be cleared too much, and Blood should not be cooled too much. Spleen is the solitary organ, governing muscles, transforming food/water into fluids, irrigating all channels, and steaming/developing. Lung governs Qi, Heart governs Blood. When Qi and Blood are abundant, moistening and flowing continuously, can smallpox fail to reach its natural lifespan?
Heart governs Blood and belongs to Fire. Smallpox relies on it to operate the whole body. Warmth allows flow; cold causes stagnation. The world uses Xi Jiao (Rhinoceros Horn - *Note: Now banned/substituted*) to cool it; this ignores Yin-Yang attributes. How can it transform smallpox toxin and succeed? Thus, I only use it for residual toxin after scabbing. If Heavenly Pestilence Qi contends fiercely with Qi and Blood, pulse is surging and rapid, smallpox emerges purple initially, becomes dense red-purple later, with internal symptoms of irritability, restlessness, thirst, red/scanty urine, constipation,酌情 add cooling flavors to resolve, or use Jiu Chao Da Huang (Wine-fried Rhubarb) to mildly purge. If nose/mouth bleeding occurs, temporarily use Xi Jiao. If toxin is盛 (excessive) but Qi/Blood are not, although termed "resolving toxin," one must combine activating Blood and tonifying Qi. Ren Shen (Ginseng Root), Huang Qi (Astragalus Root), Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root)—how can these be omitted?
Huang Lian (Coptis Rhizome) and Xi Jiao (Rhinoceros Horn) are Heart-draining agents. Currently, people rely on them as divine remedies for smallpox, using them indiscriminately regardless of Excess/Deficiency or Cold/Heat, adding Shi Gao (Gypsum), Ming Fen (Calcined Shell/Slippery Stone), Sheng Di Zhi (Rehmannia Root Preparata), Ling Yang Jiao (Antelope Horn), freezing the vitalizing Qi. Alas, how strange!
Smallpox ultimately relies on Heat to succeed. First three days: heat precedes eruption. After full eruption: heat subsides. Before pus formation: heat returns. After full pus: heat subsides. Before pus regression: heat returns. After pus regression: heat subsides. During scabbing/falling: heat returns, named "Burning Scar." All these should not be treated with cooling/resolving methods. Cooling causes Qi/Blood stagnation, leaving toxin internally and causing disaster. (Initial heat not subsided, smallpox erupts immediately: "Fire Flame," use Acrid-Cool to support exterior.)
Smallpox itself does not harm; only the toxin harms. If toxin fully attaches to smallpox, it does not harm. If not fully attached, it harms (Secret Method). Therefore, regardless of cause or formula, add a little Shan Zha Jia (Pangolin Scale) powder to penetrate orifices and drive it out, until toxin returns to the granules. Also add Bai Shao (White Peony Root) to astringe Blood and collect toxin, preventing any leakage. Is this not the method for treating smallpox?
Before smallpox erupts, induce slight sweating to disperse toxin vapors, sending toxin outward so interior becomes safe. After eruption, regulate Qi and assist Blood to fill the pus pathways. Only then does pus form and toxin exhaust.
Toxin stopping in muscles causes swelling; toxin stagnating in skin causes foul odor. Muscles are governed by Yangming, belonging to Earth. Skin is governed by Taiyin, belonging to Metal. Abscesses reflect Earth image; foul odor reflects Metal image. Each follows its kind.
Books state: Red papules indicate life; purple papules indicate death; black/blue papules, one in a hundred survives. Although, there are cases of red papules dying and purple/blue papules surviving. Papules indicate Blood Heat. Failure to resolve/purge leads to papules and malignant smallpox, which is inevitable. Regardless of color, with or without papules, death ensues. Unless Tian Ting (Forehead) is clear, appearance/color is good, and macules appear—this requires separate discussion.
Once, a papule case, physicians could not treat. Summoned me, it had been seven days. Papules divided upper/middle/lower: upper red, middle purple, lower blue. Examining smallpox: protruding, sparse, containing clear fluid, dark/black color, but spirit vigorous. Examining lips/tongue: dry coating. I said: Due to failure to resolve/purge. Administer cooling, and it healed spontaneously. Indeed so. Thus, books should not be rigidly followed. Observing appearance/color and verifying lips/tongue is the standard.
Epistaxis (nosebleed) before or after smallpox indicates toxin vapor leaking outward, rushing to the Lung. This is not an ominous sign. Use Fa Hui San (Ash Powder) or Qing Fei Tang (Clear Lung Decoction) to regulate. Do not use harsh agents like Xi Jiao.
Ding (carbuncle) formation is due to excessive Heat-Toxin, failure to resolve/harmonize, unable to enter internally, knotting in tunnel voids. Malignant smallpox Ding transforms from adverse to favorable. But knotting at front/back heart leads to death; knotting at ear gate/throat leads to death. Differentiating Ding has methods. Beware mistaking black smallpox for Ding. Black smallpox is still smallpox. Ding sinks into flesh, shaped like a snail shell, nodular upon pinching, painless upon cutting, root white or inch-long. Physicians often mistake this. Post-scab Ding ulceration, within seven days before/after, treat with Si Sheng Dan (Four Saints Pill).
During smallpox swelling or scabbing, sudden persistent diarrhea is critical. Yi Gong San (Beneficial Work Powder) may fail. Use Dou Kou Wan (Cardamom Pill) or Bai Zhu San (Atractylodes Powder) to stop. (For Heat-Toxin diarrhea, use Jia Wei Si Ling San). During swelling/suppurating, if no bowel movement for 6-7 days with irritability/pain, it is toxin excess and constipation. Use Qing Du Huo Xue Tang (Clear Toxin Activate Blood Decoction), remove Ren Shen, Huang Qi. Add Niu Xi (Achyranthes Root), double Zi Cao (Arnebia Root), Dang Gui (Angelica Sinensis). Take with half cup raw honey. Severe cases add 3 qian Jiu Chao Da Huang (Wine-fried Rhubarb) to purge. If still blocked, insert Pig Gallbladder juice into anus to通便. Do NOT use Xiao (Mirabilite) and Huang (Rhubarb) for drastic purgation, causing complications. Abstaining from meat/fish is correct. However, children of wealth rely on this diet for Spleen/Stomach development. Depriving them of food deprives vitalizing Qi of steam/nourishment. This cannot be judged by common rules.
Smallpox relies on Blood for nourishment and Qi for filling. Thus, eyes and nose must seal. Eye sealing prevents Spirit from wandering; Nose sealing prevents Qi from escaping. Spirit/Qi nourishes internally, making it rare for toxin not to be controlled. However, nasal congestion with mucus is a good sign. Nasal congestion with dry/black orifice edges indicates death. Eye sealing with tears indicates life. Eye sealing with coal smeared around orbits indicates death. If eyes sealed for 5-6 days without swelling, eye disease will follow sealing. Few smallpox lesions do not require sealing, or seal briefly until scabbing then release.
Differentiation of Qi/Blood is like clarity/turbidity rooted in upper/lower. Intersection of Qi/Blood is like Yin/Yang relying on each other. When differentiation is needed but not done, toxin knots. When intersection is needed but not done, toxin isolates. Knowing Yin-Yang disperses depression, why not differentiate? Knowing Clear Heat Resolves Toxin, why not worry about intersection?
Smallpox forms/symptoms have four: Toxin Obstruction, Blood Heat, Qi Deficiency, Blood Deficiency. Excess/Deficiency have four: Exterior/Interior Excess/Deficiency. Dense eruption points, non-pointed/loose shape, pale/dark color,欲出不出 (wanting to emerge but not) in skin—this is Toxin Obstruction. Deep red points turning purple/black, accompanied by Ding/Papules—this is Blood Heat. Depressed top, thin skin, flat/collapsed—this is Qi Deficiency. Pale color, scattered bases, or smallpox color indistinguishable from flesh—this is Blood Deficiency. Slight fever with sweat is Exterior Deficiency. High fever without sweat, panting, floating pulse, scorched skin/hair, muscle pain—Exterior Excess. Mental fatigue, pale lips/tongue—Interior Deficiency. Mania, excessive Qi, thirst, good appetite, dry lips, yellow/white tongue coating—Interior Excess. Toxin Obstruction and Blood Heat correspond to Exterior/Interior Excess. Qi Deficiency and Blood Deficiency correspond to Exterior/Interior Deficiency. One becomes two, two becomes one. Obstruction: disperse. Heat: cool. Deficiency: tonify. Excess: purge. Neither excess nor deficiency: use neutral formulas to regulate. Understanding these means more than half the thinking is done. Although, differentiating Cold/Heat/Excess/Deficiency especially requires using the tongue as the guideline.
Three Grades: Smooth (Shun), Dangerous (Xian), Adverse (Ni). Smooth: Qi/Blood harmonious, toxin disseminated, no treatment needed. Dangerous: Qi/Blood stagnant, toxin obstructed, or miscellaneous diseases interfering, urgent treatment needed. Adverse: Toxin knotted, Qi/Blood dried up, treatment futile. Five Essentials: 1. Eruption should be complete. 2. Swelling should be thorough. 3. Pus should be thick/full. 4. Scabbing should be uniform. 5. Scabs should be thick. Five Goods: 1. Appetite normal. 2. Bowel/bladder regular. 3. Sores red/vibrant/firm. 4. Pulse calm, body cool, hands/feet warm. 5. Voice clear, movements peaceful. (Cannot get all five; getting one or two is also auspicious.) Seven Evils: 1. Irritability/restlessness, delirium/confusion. 2. Vomiting/diarrhea, inability to eat. 3. Black/depressed/scorched, itchy/collapsed/ruptured. 4. Pre-swelling of head/face, nasal flaring/shrug lifting, staring eyes/cracked lips. 5. Throat/tongue ulceration, vomiting upon eating, choking upon drinking. 6. Chills/tooth-grinding, hoarse voice/dark color. 7. Abdominal distension/panting, cold extremities. (Not all seven need be present; having one or two is already difficult.) Beyond Seven Evils, there are whole-body blood macules, stabbing heart/abdominal pain, sunken/non-emerging, bloody urine/stool, grasping at air/clothes—these are sudden death and incurable.
Ye Tianshi said: Adverse cases can also survive; do not abandon them untreated. Dangerous cases definitely do not have a death sentence; death is the physician's fault, not smallpox's. Now, some select Smooth cases to treat to blend in and gain fame, abandoning Dangerous ones. Therefore, I detest the symptom classification in books like Jin Jing Lu as inhumane.
Best smallpox: Emerges, grows, fills with pus sequentially. Tops round/red/vibrant; slight pus appearance leads immediately to scabbing. Most unique: Emerges, grows, immediately scabs, never seeing pus fluid, named "Dry Smallpox." Both should not be treated; incompetent/arrogant practitioners often kill patients. Rash erupts first, rash scabs then smallpox emerges: "Padding Rash." Rash and smallpox erupt together, rash scabs then smallpox grows: "Clasped Rash." Smallpox emerges with tiny granules piled on top: "Covered Smallpox Rash." When smallpox emerges, hidden in skin/flesh...