Library

In the initial stage of variola (smallpox), the use of medicinal substances is extremely difficult. What is the difficulty? It lies in the challenge of preventive care. The expansion and fullness, filling with pus, and scabbing of variola all depend on establishing a foundation at the very beginning when spots first appear; this requires profound deliberation and foresight. Moreover, since the clinical presentation has not yet fully manifested, approximately seventy to eighty percent of cases are treated with acrid-cool methods to release the muscle layer (using acrid-cool medicinal substances to relieve pathogenic factors in the muscle layer), aromatic methods to penetrate collaterals (using aromatic medicinal substances to unblock collaterals), and methods to transform turbidity and resolve toxins. If the patient's own Qi and Blood are deficient and cold, warming and preserving Yuan Qi (warming Yang Qi and protecting primordial Qi) accounts for twenty to thirty percent. One must specifically examine the strength or weakness, fatness or thinness, and skin color (black, white, green, yellow) of the child, identifying where the bias lies and where there is deficiency. After clearly assessing the constitution, one observes whether the spots have appeared and what form the emerging lesions take. These observations are combined with the seasonal characteristics of spring, summer, autumn, and winter, as well as the climatic conditions of cold, heat, dryness, and dampness, and the timing of the onset. Only then can a prescription be determined. It is essential to clear the external pathogenic factors acquired prior to the seventh day; after the seventh day, only fetal toxin remains, preventing contamination by other pathogens.

There are many renowned experts in treating variola, and their theories should not be disregarded individually. If one exclusively adheres to a single theory of cold, heat, warm, or cool to save trouble, disaster will ensue rapidly. In the field of variola, Qian Zhongyang and Chen Wenzhong are highly recommended. Qian advocated cooling methods, while Chen advocated warming methods. Although these two schools have their respective emphases, they are indispensable for later learners. The two schools are like water and fire; although their natures seem extremely different, favoring one harms the other, and favoring the other harms the one. However, all things are formed through water and fire. If heaven had only heat without cold, all things would wither; if it had only cold without heat, all things would freeze. Yin and Yang constitute the Dao. The learning of these two schools seems contradictory but is actually mutually dependent, serving as the guiding principle for treating variola for all generations. How should one apply them? Generally, before the seventh day, external infections dominate, and the eruption of variola is driven by warm Qi; thus, Qian’s cooling methods are used in eighty to ninety percent of cases, while Chen’s warming methods are used in ten to twenty percent. After the seventh day, the patient’s own Qi and Blood become active, relying entirely on the true fire of the Zang organs to refine toxin into pus. If this fire does not vent outward, it will collapse inward; therefore, Chen’s warming methods are used more frequently, and Qian’s cooling methods less so. If the case consistently presents as excess-heat, Qian’s methods are used throughout; if it consistently presents as deficiency-cold, Chen’s methods are used throughout. Since variola presents with no fixed syndrome, there is no fixed prescription. Zhu Danxi proposed the theories of resolving toxins, harmonizing the middle (regulating the Spleen and Stomach), and stabilizing the exterior (protecting the body surface). This is also most pertinent. Variola inherently contains toxins that can be resolved, but resolution must occur before the seventh day. If toxins are stagnant, preventing expansion and pus formation, how can one fail to resolve the toxins? It is akin to extreme yang without rain, resulting in the failure of all things to grow. Harmonizing the middle is essential for variola because the Spleen and Stomach are critical, as previously described as the battlefield of the Middle Jiao. The theory of stabilizing the exterior is even more profound; if the exterior is unstable, failure occurs even near recovery. As previously stated, skin scabbing is the site of success; how can one fail to stabilize it? Stabilization is urgent enough; how could one recklessly induce sweating to cause harm? His preference for Qian over Chen was his bias. Wan Quan focused on the Spleen and Stomach, and Wei Zhi focused on preserving Yuan Qi; both had genuine insight. Although they derived from the two main schools, they leaned slightly toward Chen. Fei Jianzhong’s *Jiu Pian Suo Yan* (Trivial Words on Correcting Bias) aimed to correct the widespread misuse of Chen Wenzhong’s acrid-hot methods due to a lack of understanding of the comprehensive utility of variola. The title implies correcting bias; however, if one strictly applies this method using Rhubarb (*Rhei Radix et Rhizoma*) and Gypsum (*Gypsum Fibrosum*) exclusively, correcting one bias creates another. Hu Shi often employed diaphoresis (sweating therapy) and purgation (draining therapy); purgation has its uses, but diaphoresis is inappropriate. Weng Zhongren’s *Jin Jing Lu* (Golden Mirror Record) is indeed a treasure guide for variola. Its brilliance lies in diagnosis: accurate pattern differentiation ensures effective treatment. Beginners must memorize this book thoroughly before exploring other schools to avoid errors. Later, Zhi Shi and Nie Shi deeply elaborated on the principles of Qi and Blood balance and toxin resolution, clarifying the foundations of Qian and Chen, surpassing other schools. However, their distinctions were too numerous, potentially confusing readers. I believe diagnostic methods should follow Weng Shi, with Ye Tianshi providing supplements to Weng’s omissions. Therapeutic methods should combine Qian and Chen, using Zhi and Nie as commentaries on them, referencing various schools. Recently, the book *Zheng Zong* (Orthodox Standard) has been popular in Beijing. It largely expands upon the methods of Fei and Hu, recklessly employing heavy diaphoresis and purgation, claiming allegiance to decoctions, and consistently using high doses of Gypsum and Rhubarb. This may be suitable for cases with excessive virulent toxins, but it cannot be universally applied to all children. In southern provinces such as Jiangxi and Jiangnan, vaccination is relied upon entirely; spontaneous variola cases receive no treatment. Physicians prohibit cooling medicinal substances regardless of the type of variola, causing patients with toxic heat to deteriorate from mild to severe, or from severe to fatal. These are all harms caused by bias.