Library

There are faintly visible spots on the skin, varying in size, called "Jia Dou" (intermediate smallpox). When the skin and flesh show bright red color like cloud heads protruding in patches, it is called "Dan Du" (erysipelas/toxic heat rash). When scabs fall off after the pockmarks appear and new rashes emerge, it is called "Gai Zhen" (covered rash). Although various conditions differ, they are all manifestations of smallpox toxin floating and diffusing within the skin. Treatment should follow methods for smallpox and should not be categorized together with the toxins of true measles (Zhenzhen).

Generally, symptoms are similar due to the influence of Yunqi (Five Movements and Six Qi/astrological influences). Though there may be a slight difference in name between this and that, the symptoms are indistinguishable; if not due to Yunqi, then what? Dryness indicates excess Fire Stagnation; vomiting, diarrhea, and muscle swelling indicate excess Earth Stagnation; dry throat and rapid breathing indicate excess Metal Stagnation; mutual stagnation and latent presence indicate excess Water Stagnation; stagnation without emergence indicates excess Wood Stagnation. For Fire, use clearing methods; for Earth, use balancing methods; for Wood, use dispersing methods; for Metal, use moistening methods; for Water, use warming methods. Not being rigid in methods but seeking principles in the classics allows one to master the transformation of the disease. This indeed requires superior medical skill to discern the spirit within the physical form. Children's zang-fu organs are prone to both deficiency and excess. Even for those with strong constitutions, excessive dosage causes harm, let alone for the weak. If smallpox lesions are extremely glossy and plump, but suddenly turn adverse during the resolution phase, whose fault is it? If the physical form was originally deficient, tonification is appropriate. Failing to observe this and using attacking or purging methods drives out the Yuan Qi (Original Qi). Although the exterior appears plump, the interior is actually depleted. How can death be avoided? Discerning the physical form means not merely observing its shape but examining the Shen (Spirit) within it.

There are four types of involution (Xian) in smallpox: white, red, gray, and black. Wei Guiyan attributed all to Qi deficiency, but later practitioners who used tonification for all four were mistaken. His discussion on involution explored its root cause. If lips and tongue are moist, body heat is not high, and only the color changes leading to involution, it is attributed to Qi deficiency. However, if lips are dry, tongue has coating, body heat is blazing, color is scorched purple, and lesions are sunken and do not rise, is this deficiency or toxin excess? Blindly administering tonics and following patterns mechanically is not my approach. If there is exterior excess, resolve it; if there is interior excess, clear and purge it; if there are no obvious excess signs inside or outside, use mild formulas to regulate. This applies not only to treating involution but throughout the course of smallpox. Medication follows the tongue's changes; symptoms heal according to the tongue. Alas, the merit of tongue diagnosis is great!

The tongue connects with the five internal organs. People know this but rarely apply it. Without guidance, confusion arises at the bedside, failing to realize this is the pivot of medication. Drugs have cold, cool, warm, and hot properties. Once this pivot is mastered, one can maneuver freely, determining right and wrong. Children are prone to deficiency and excess. Without firm judgment, I cannot believe one avoids harming lives.

This is a secret method of the Wu family, obtained by Xun Zhong from Sun Qiyu and told to me. I reflect that any medicine intended to communicate with organ qi is often held under the tongue to dissolve. Does the tongue not open the orifices of the hundred vessels? Moreover, smallpox relies on Heart Fire to succeed, utilizing the transformative power of nature, entirely centered in the mind-heart (Lingtai Fangcun). This theory is unchangeable.

Medicines for smallpox must not be excessive. Too hot leads to drying up; too cold leads to coagulation; too dry consumes blood; too moist causes loose stools; too attacking damages true Qi; too tonifying aids evil. As the ancients said, medicines must change with the disease; the mechanism lies in whether the doctor understands adaptation.

If pathogenic heat is abundant and meridians blocked, yet death does not occur immediately, it is because the prohibition of cold/cooling herbs was too extreme. If the root granules remain intact and life persists, placing the patient in a cool place to vent heat can lead to recovery. Do not abandon treatment just because vital signs seem absent.

Treating smallpox involves four stages, which must not be confused. Confusion leads to inverted Qi and Blood, rampant fire-toxin, and myriad symptoms. Therefore, convulsions, mania, vomiting, diarrhea, rashes, lower back/abdominal pain, muscle swelling without pustule swelling, and choking on water/throat issues arise because sweating was not performed when indicated, causing toxin to block the Sanjiao (Triple Burner) and stagnate in the airways. Scorched purple, withered black colors, thirst, restlessness, carbuncles, and foul breath result from failing to clear heat when indicated, caused by Yangming internal heat. Failure to tonify when indicated leads to white involution, diarrhea, itching/collapse, and inverted scabs, with external peeling and internal attack, due to Middle Qi deficiency. Failure to promote diuresis/dampness drainage when indicated leads to increased fever, poor appetite, persistent vomiting/diarrhea, or muscle boils/ulcers, due to Spleen dampness invading internally. The branch differs, but the root is unified; when medication matches the stage, complications cease. Deviating from these four methods invites the Three Causes (San Yin). External invasion of Six Qi is an external cause; internal movement of fright/fear is an internal cause; improper regulation is neither-internal-nor-external. The four methods are orthodox (Zheng); the three causes are unorthodox (Qi). Victory comes from the interplay of Zheng and Qi.

Treating smallpox without addressing miscellaneous diseases is an eternal secret principle. Miscellaneous diseases have daily variations, while smallpox spans only two seven-day periods. Moreover, miscellaneous symptoms in smallpox arise from mismanagement. Now, if one treats only miscellaneous diseases and ignores smallpox, the miscellaneous symptoms will worsen, and smallpox will become more critical.

Cheng Jixin said: "Miscellaneous diseases are not inherent to smallpox; doctors err by treating them. Let people pay attention: treating miscellaneous diseases by one inch makes smallpox lag by one zhang." Ancients said this; why do moderns repeat this error?

Smallpox cases requiring emesis should be treated with emetics. Emesis contains the intent to disperse. Inability to swallow even water indicates toxin blocking the airway; emesis is indicated. Accumulation of food, drink, and phlegm causing color/form changes indicates suppressed Yang Qi; emesis is indicated. Only those with Qi deficiency and profuse sweating should avoid this (Emetic method: decoct Shengma, Zhizi, and Douchi to induce vomiting).

Smallpox cases requiring sweating should be treated with diaphoretics. Failure to sweat when indicated leads to subsequent complications: high fever, dry skin, rapid breathing, and facial edema indicate sweating is needed. Faintly emerging rashes, swollen muscles but non-swollen sores, toxin stagnation preventing pus formation, or inverted scabs due to cold all indicate sweating is possible. However, combinations of resolving and tonifying vary. Clearing or purging is determined by yellow or white tongue coatings. Warming or tonifying is determined by pale-red tongues. Examine carefully.

Children erupting smallpox have opened desires and consumed Qi/Blood, with deficient fire flaming upward. Symptoms include irritability, thirst, sore throat, or nosebleeds. If swelling is severe and intolerant of warm tonification, administer Shenmai Qingbu Tang (Ginseng and Ophiopogon Clearing-Tonic Decoction) frequently 5-6 days prior. If pus does not form by day 7-8, Shenguilurong Tang (Ginseng, Angelica, and Deer Antler Decoction) is essential.

In women, menstruation occurs on schedule. Sudden onset before the expected time is extremely dangerous. Smallpox success relies on Qi and Blood. Qi deficiency is manageable; Blood deficiency is difficult. If pustules do not collapse and roots remain intact, survival is possible. If collapsed with scattered roots, death is certain. Treatment focuses on nourishing Yang to generate Yin, as the syndrome belongs to Blood Heat. Menstruation during eruption can sometimes be auspicious, but only during the appearance/swelling stage, not during the pus-filling stage.

When treating pregnant women, timing is crucial. Fetal abortion results from either Blood Heat or Qi deficiency. Timely medication ensures fetal safety. By days 4-5, if lips are dry and tongue coated, even Xiaoren (Nitrates/Purgatives) can be used. The Classic states: "If there is pathology, there is no injury, nor to the fetus" (Yougu wuyun, yi wuyun ye). If excess syndromes are not purged, can the fetus be saved? Thus, it is said: Adaptation depends on the practitioner.

For smallpox-induced miscarriage, determine the stage. At initial eruption, tonify and lift. At swelling stage, tonify and clear. At pus-filling stage, strongly tonify. Also, use the integrity of the root halo as a sign of life or death.

Mismanaged smallpox leads to death. What is the state of death? Shen Xuming said: Stagnation without emergence leads to death in 3 days; uneven emergence in 6 days; failure to swell in 9 days; failure to fill with pus in 12 days. All internally attacking smallpox die before day 12; failure to form scabs leads to death by day 15. Toxin sinking into the Spleen causes death via diarrhea; toxin blocking the Stomach causes death via withering/blackening; unresolved stagnating toxin causes death via asthma; unresolved fire toxin causes death via external peeling. These are inevitable outcomes. Jiezhai said: Severe cases of deficiency-cold develop complications after day 9, or extend to 10+ days. Excess-heat cases involve toxin steaming and damaging the five Zang organs, dying within 6 days. I disagree. I do not judge by days, but by death itself. Claiming specific days for death as miraculous, I do not envy.

Some smallpox experts claim their technique determines infant constitution to ensure survival before inoculation, claiming near-perfect success. Failures often involve wealthy children, not due to lack of insight, but greed, attempting inoculation when contraindicated, leading to errors. This is the doctor's fault. Or perhaps the wealthy bring it upon themselves. If they submit to natural fate, even severe smallpox can be treated by skilled physicians. But forcing unnatural interventions destroys the root, making rescue impossible. Is this not tragic?