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(Afterword on Ban Du)

The onset of variola (smallpox) and exanthema (measles/rash) begins at the time of an infant's birth. Upon the first cry, the infant swallows the turbid substances in the mouth, which accumulate in the stomach. Due to changes in the Five Movements and Six Qi (Wu Yun Liu Qi), the interaction between the host and guest qi leads to the victory and reversal patterns, causing pathogenic factors to stagnate and erupt. These interact with the congenital turbid substances, creating a struggle that manifests externally on the muscles and skin. The initial presentation resembles Taiyang disease (a syndrome caused by pathogenic invasion of the Taiyang channel). This condition occurs regardless of the season. The classics state: "Spring and summer are favorable; autumn and winter are unfavorable." This is because in spring and summer, Yang Qi spreads, the pores (Xuan Fu) open, and human Qi and Blood flow smoothly, allowing pathogenic toxins to be expelled easily. In autumn and winter, Cold Qi prevails, water freezes, and ice covers the ground; human Qi and Blood become stagnant and sluggish, making expulsion difficult. Children suffering from this condition vary in severity and have different names. Mild cases resemble measles, commonly called "Ma Zi" (hemp seeds); severe cases resemble bean sores, called "Dou Chuang" (bean pox); extremely severe cases are dense like floating duckweed, colloquially known as "Chi Piao" (red float). Once it progresses to this stage, it becomes critical. Physicians and families must examine carefully. Thus, each stage has its specific name: the Heart corresponds to red spots, the Liver to blisters, the Lungs to pustules, and the Spleen to scabs. Only the Kidney, residing in the lower Jiao, does not receive turbid pathogens, so it uniquely lacks its own manifestation. If black sunken sores appear, it indicates toxin entering the Kidney. Immediately administer She Xiang Ren Chi San (Musk and Human Tooth Powder) for rescue, or use Yi Bi Jin (One Spoonful Gold) for superior efficacy. This describes the correspondence of the Five Zang Organs and their manifestations. Initially, there is high fever, lower back pain, coughing, reddening of the face and eyes, alternating chills and fever, slight coldness in both feet, convulsions with delirium, abdominal pain with nausea, headache with irritability and thirst, tight and rapid pulse in all six positions, cold ears and sacrum, yawning, and sudden oppression. By the fifth or sixth day, red spots appear on the body, turning into blisters, then pustules, and finally scabs, after which recovery occurs. When this condition first appears, it seems similar yet different. In cases of doubt, use Sheng Ma Tang (Cimicifuga Decoction) added with Mahuang (Ephedra) to release the exterior, along with Qing Fei Yin (Lung-Clearing Drink). Since the Lung governs Qi, Wang Shi stated: "When the Qi of Dou Chuang is balanced, eruption is rapid." Hence, these are used. However, they should not be overdosed. Moreover, this disease has no purgative method from start to finish; purging will inevitably damage the Spleen and Stomach. All things grow due to the warmth of Earth Qi; purging causes Spleen Earth to become deficient and cold, preventing Qi and Blood from flourishing. Therefore, due to Spleen-Stomach deficiency and cold, Qi and Blood decline, leading to sinking variations. Furthermore, the *Neijing* states: "All pain, itching, ulcers, and sores belong to the Heart." Although each organ has distinct forms and symptoms, the Heart is the master. The Heart governs Blood; when Blood Heat resides internally and encounters invasion by the Six Exogenous Pathogens, internal and external attacks cause the eruption of Dou Chuang externally, always preceded by blood spots forming pustules. Thus, the origin lies in the Heart. Pain indicates excess, while itching indicates deficiency, as stated in the classics: "All pain is excess; all itching is deficiency." One must understand this and avoid reckless medication. Uniform eruption indicates severe disease; irregular eruption indicates mild disease. Use Zhong He Tang (Harmonizing Decoction) to smooth the interior and exterior, and Dang Gui Tang (Angelica Decoction) to promote swelling. If few spots emerge and eruption is scant, it indicates sparse Zheng Qi, and forcing further eruption is inappropriate. For high fever, use Dao Chi Ge San (Zizyphus Root and Scutellaria Decoction) to promote urination. For mild fever, use Ju Wu Ling San (Five-Ingredient Powder with Poria) added with Renshen (Ginseng) and Gancao (Licorice), decocted in water. For lesions wanting to emerge but failing, use Kuai Ban Yin (Rapid Eruption Drink). For prolonged failure to scab, indicating exterior heat steaming the skin, use Sheng Ma Tang added with Huangqin (Scutellaria) to resolve it. If Dou Chuang takes shape accompanied by thirst, diarrhea, vomiting, or dysentery, treat with Chen Shi Mu Xiang San (Chen's Atractylodes Macrocephala Powder), Yi Gong San (Extraordinary Power Powder), or Dou Kou Wan (Cardamom Pill). For deficiency-related itching, frequently administer Dang Gui Tang and Zhong He Tang. The general treatment for Dou Chuang is as described above. For other miscellaneous conditions and prevention, refer to the detailed works of Hu Daqing and Chen Wenxiu. Someone asked: "Sheng Ma Tang can be taken before or after eruption of Dou Chuang; what do you think?" I replied: "I often ponder this. I have repeatedly seen families ignore order and suitability, taking it routinely, bringing themselves to danger. It is lamentable. They do not realize that ancient prescriptions have deep intent. Later scholars fail to investigate the subtleties, treating it as a fixed formula, misleading many. Before eruption, it can be taken to open the pores and facilitate rapid eruption. During eruption, it should not be taken because its cool nature stagnates Qi and Blood, trapping toxins and causing harm. After scabbing, it can be taken to resolve residual toxins, harmonize Qi and Blood, and prevent Dou Yong (bean abscess)." Someone asked: "Why does She Xiang Ren Chi San work for some cases of inverted scabs (Dao Ye) but fail in others?" I said: "There are two reasons. If black sunken sores appear, toxin enters the Kidney. The Kidney's color is black. Teeth are the surplus of the Kidney. Using Musk and Teeth guides the toxin to the Kidney and expels it, hence efficacy. Yi Bi Jin also works rapidly. If itching, collapsing, gray-white sores appear, it is due to Spleen deficiency; frequent administration of Chen Shi Yi Gong San yields results. These two syndromes have different treatments; do not adhere rigidly. Examine carefully." Someone asked: "Dou Chuang treated with Zi Cao Yin is good, but some refuse it." Zeng Zi said: "The妙 (wonder) of prescription lies in the roles of Sovereign, Minister, Assistant, and Envoy. Later physicians, unfamiliar with ancient methods, let families select Zi Cao (Arnebia/Lithospermum) themselves, mix flavors, or add it to decoctions. Desiring quick effects, they drink excessive amounts. According to Materia Medica: Zi Cao is cold. For children with solid Spleen Qi, it may occasionally work; for those with deficient Spleen Qi, it causes harm. Dai Shi's formula is named Zi Cao Rong Yin (Arnebia Sprout Drink). Later generations misprinted it, omitting 'Rong' (Sprout). 'Rong' refers to buds born in spring, red and tender, benefiting from Yang Qi. Like attracts like, so it promotes eruption effectively. But fresh sprouts are rare, so later people substituted half-inch tips of Zi Cao, similar to young sprouts. Modern people, lacking understanding, use the whole root indiscriminately. Those with Spleen deficiency suffer diarrhea, and many die from sunken sores. I witnessed this and am deeply saddened. One must understand this principle in treating Dou Chuang. Dai Shi's Zi Cao Rong Yin contains Renshen, Huangqi (Astragalus), Dang Gui, and Baishao (White Peony) as assistants, ensuring efficacy." Someone asked: "Is porridge forbidden for Dou Chuang patients?" I said: "This is a secular taboo. Families fear the sores rot like porridge, hence the prohibition. Actually, this is incorrect. Toxins move from interior to exterior. If the mouth is ulcerated and food cannot enter, feeding porridge prevents Spleen Earth deficiency and sunken sores, avoiding death. It is regrettable. I have treated such cases, consistently providing porridge, saving many lives. Porridge is made of rice; what poison does it contain? Parents must know this." Someone asked: "Why forbid meat and fish?" I said: "This is also a rigid secular view. Heaven generates all things with Five Qi; humans nourish Five Zang with Five Flavors. Dou Chuang originates from internal pathogenic toxins reacting with seasonal Qi, moving outward. Ying and Wei Qi are deficient, and Interior Qi is weak. One must rely on Five Flavors and meat/fish for nourishment to harmonize Qi and Blood and facilitate eruption. However, avoid wind-agitating and heat-producing foods that aid toxins; excess leads to harm." Someone asked: "How is post-Dou Chuang condition similar to postpartum?" I said: "Postpartum women suffer blood vessel damage, severe deficiency of Ying and Wei, and incomplete expulsion of lochia. Invasion by Six Exogenous Pathogens causes acute syndromes, sometimes fatal. Guo Shi wrote Twenty-One Discussions on Postpartum for this reason. Similarly, in children with Dou Chuang, essence and blood manifest externally. Heat causes pain and swelling, incessant crying consumes True Qi. After scabbing, interior and exterior are deficient, Ying and Wei are weak, residual toxins remain. Neglect in care leads to sudden pathogen invasion and early death, similar to postpartum complications. Parents who neglect this will regret too late. However, if sores are few and Qi is solid, with normal diet, this rule does not apply. Physicians should judge carefully and not label all as deficiency. Regarding Dou Chuang nearing cure, if it transforms into black, sunken, dry sores, cough, loss of voice, vomiting/diarrhea, irritability/thirst, cold limbs, coma during sleep, reduced appetite, excessive phlegm, shortness of breath, or dry itching, it is untreatable. Physicians must observe. What people call 'Ma Zi' is also Zhen Du (rash toxin). Classics state: 'Rashes belong to the Spleen; the Stomach is the Spleen's mansion.' Disease affects them similarly. Zhen Du results from epidemic Qi changes, influenced by adverse Heaven-Earth Qi, hence called 'Seasonal Qi'. Regardless of age, high fever, continuous cough, back pain, dry mouth, cold feet, chills/fever/abdominal pain, headache/dysentery, or irritability/convulsions occur due to heat. Externally, red raised spots appear on head/body like mosquito bites, with purple-dark bases. Non-seasonal Qi adheres to skin, lingering and combining with external pathogens and internal latent heat, causing toxins to erupt as rashes. If heat is extreme, it becomes carbuncle, gangrene, or erysipelas. Entering Zang-Fu, delayed treatment kills. Congenital turbid fluid with heat-toxin accumulating in Lungs/Stomem, triggered by seasonal Qi, is treated with Qing Fei Yin to release exterior, and Bai Jie San removing Gui Zhi (Cinnamon Twig) adding Huanglian (Coptis), decocted. If residual toxin steams upward causing oral/dental ulceration and bad odor, use Dang Gui San added with Qi Bao San, decocted with salt water and ginger, plus Niu Bang Tang (Burdock Decoction) to disperse wind and resolve toxin. During peak rash, with headache, abdominal heat, and mental agitation, Mai Men Dong Tang (Ophiopogon Decoction) is primary. In summer, with irritability, thirst, scant urine, and restlessness, Que Shu Dan (Heat-Expelling Pill) is effective. Severe toxin causing full-mouth sores, red/swollen/painful eyes, loss of voice, and nausea indicates unresolved residual toxin in Lungs/Stomach, causing deficiency. Lung deficiency leads to incomplete speech; Stomach deficiency leads to inability to eat. Early treatment is urgent. Shortness of breath, irritability, palpitations indicate critical condition. People speak of Wen Du Fa Ban (Warm Toxic Erythema) and Wei Lan Fa Ban (Stomach Rot Erythema). Wen Du Fa Ban presents as net-like rashes under armpits. Armpits are pathways of Qi; accumulated toxin follows Qi pathways and emerges first. Symptoms include cough, oppression, or vomiting clear fluid. Caused by Winter Cold Toxin stopping in muscles, emerging in Spring when Yang Qi moves. Treated with Bai Jie San, Niu Bang Tang, and Dang Gui San added with Chen Pi (Tangerine Peel) and Huanglian. Wei Lan Fa Ban starts from premature purging in Taiyang disease, allowing heat-toxin to enter interior, or failure to purge when needed, causing heat-toxin to steam in Stomach. Stomach heat-toxin erupts on skin. Red spots are treatable; black spots are nearly fatal. Treatment follows previous advice. *Huo Ren Shu* uses Xuan Shen Sheng Ma Tang (Scrophularia and Cimicifuga Decoction), Da Qing Si Wu Tang (Great Indigo Four Substances Decoction), and Hua Ban Tang (Spot-Resolving Decoction). Adults and children share the same pathology; treatment follows ancient methods, differing only in dosage for children. This condition also benefits from Ba Du Yin (Toxin-Pulling Drink) and Sheng Mai Tang (Pulse-Raising Decoction). For residual Dou Chuang toxin causing skin ulceration, treat with Huang Tu San (Yellow Earth Powder).