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Danxi stated: When reading the works of predecessors, one must understand their intent in formulating theories. If one does not comprehend their intent, it is impossible to apply them appropriately in clinical practice. Regarding the discussion on smallpox (dou chuang), Qian Yi (Qian Shi) provided the most detailed account. He enumerated the origins and evolution, clarified the meridians, differentiated exterior and interior, deficiency and excess, and opened up treatment methods. By analyzing syndromes through differentiation, he embodied the spirit of writing for instruction, allowing later generations to seek precision as one seeks squares and circles from compasses and set-squares, or measures straightness with a plumb line. By extending these principles and applying them by analogy, their application can be infinite.

However, contemporary practitioners do not understand the causes of disease nor the rationale behind prescription formulation. After a hasty trial, if the treatment fails, they discard both the patient's condition and the books themselves. Recently, due to the prevalence of the *Ju Fang* (Formulary of the Bureau of People's Welfare and Medical Relief) school and the neglect of the principles of the *Su Wen* (Basic Questions of the Yellow Emperor's Inner Canon), people generally prefer warming and tonifying while disliking cooling and purgative/drainage methods. Upon encountering the formulas and discussions of Chen Shi (Chen Wenzhong), they concluded that Qian Shi was inferior.

Although Chen Shi can indeed be considered skilled at discerning pathological conditions, his approach largely emphasizes the Taiyin channels. The Hand Taiyin Lung channel belongs to the Lung, which governs the skin and hair; the Foot Taiyin Spleen channel belongs to the Spleen, which governs the four limbs. Metal of the Lung dislikes cold and is prone to external contraction; Earth of the Spleen dislikes dampness and accepts all influences. Observing his use of Ding Xiang (Caryophylli Flos, Clove) and Guan Gui (Cinnamomi Ramulus, Cinnamon Twig) to treat Lung cold, and Fu Zi (Aconiti Lateralis Radix Praeparata, Prepared Aconite Root), Mu Xiang (Aucklandiae Radix, Aucklandia Root), and Ban Xia (Pinelliae Rhizoma, Pinellia Tuber) to treat Spleen dampness: if the Spleen and Lung truly possess cold and dampness accompanied by deficiency, and the medicine hits the target, what harm would there be?

Nowadays, people merely observe patients with delayed eruption, fever, diarrhea, palpitations, shortness of breath, and thirst craving drinks, and uniformly administer Mu Xiang San (Aucklandia Powder) or Yi Gong San (Yi Gong Powder). Occasionally, there are coincidental successes, but they fail to consider the disaster of bias. As for Qian Shi's prescriptions, they were never abandoned; herbs such as Xi Xin (Asari Radix et Rhizoma, Asarum Root), Ding Xiang, Bai Zhu (Atractylodis Macrocephalae Rhizoma, Atractylodes Rhizome), and Ren Shen (Ginseng Radix, Ginseng Root) often included supervising and assisting agents. However, Qian Shi's formulas contained more cooling herbs, and the method of tonification was only slightly initiated. One cannot speak dreams to the foolish; Qian Shi's foresight was profound, waiting for those who understand to expand upon its use.

The principle of using warming medicines for thirst and tonifying medicines for itching and collapse was pioneered by Chen Shi, surpassing previous generations. However, his frequent use of drying and heating herbs may not always be appropriate. It is likely that when formulating his prescriptions, he accounted for cases complicated by cold pathogens. I have synthesized the essence of various schools and applied it, briefly stating a few examples.

When my nephew was six or seven years old, he developed smallpox with mild fever, slight thirst, and spontaneous diarrhea. Someone suggested using Mu Xiang San with ten grains of Ding Xiang decocted. I observed that his eruption was delayed; while this was partly due to Qi deficiency from diarrhea, examination of his stool revealed foul, stagnant feces caused by heat steaming downward, suggesting it was likely not a cold pattern. I urgently stopped the previous dose, although one packet had already been administered. Instead, I prescribed Huang Lian Jie Du Tang (Coptis Decoction for Resolving Toxins) with added Bai Zhu for nearly ten doses to resolve the heat. The diarrhea ceased, and the rash erupted. Subsequently, his skin remained slightly warm, and abscesses formed on his hands and feet. I then administered cooling formulas for another month until he stabilized.

A seventy-year-old man presented with fever, confusion, and fatigue. His pulse was large and seemingly rapid. I prescribed a strong decoction of Ren Shen, Dang Gui (Angelicae Sinensis Radix, Dong Quai Root), Bai Zhu, and Chen Pi (Citri Reticulatae Pericarpium, Tangerine Peel). After twenty doses, the rash erupted; after another twenty doses, pustules formed, leaving no intact skin on his body. Someone wished to use Chen Shi's original formula, but I said, "There is only deficiency, no cold." I continued with the previous formula, and he recovered after sixty doses.

In the spring of Jiashen year during the Zhizheng era, smallpox ravaged the county, affecting every household. Most used Chen Shi's formulas, resulting in over a hundred deaths among children and infants. Although this may be attributed to heavenly fate, I fear human efforts were also insufficient.

Commentary: Qian Shi's discussion on the appearance, severity, and critical nature of smallpox, along with medication strategies, laid the groundwork. Zhi Jiegu (Zhang Yuansu/Jiegu Old Man) further differentiated accompanying syndromes, listened to voice and respiration, examined physical constitution to diagnose illness, and determined treatments, making the methods quite comprehensive. However, laypeople do not deeply explore the underlying logic, leading to ambiguity and misunderstanding, which is why Danxi spoke so extensively.

Generally, the public prefers warming and dislikes cooling. Failing to expand upon Qian Shi's methods leads to numerous misconceptions. For instance, the statement "do not recklessly purge" contains a warning against imprudence; there should be indications for purging. If early in the eruption, the cause is internal excess leading to slow eruption, accompanied by thirst, rapid pulse, constipation, and irritability, is purging inappropriate? If near resolution, internal excess persists with thirst, constipation, and fever, is purging inappropriate? Some claim purging is forbidden at both onset and end, or specifically for vomiting and diarrhea, which is incorrect. Treatment must be balanced according to the patient's deficiency/excess and seasonal variations.

Thus, Qian Shi's remark to "observe the season" is crucial. In deep winter cold, it is difficult to uniformly apply cooling formulas. Moreover, pediatric smallpox originates from toxins of the five zang organs, not merely falling under the category of "all pain, itching, and sores belong to Heart fire." Therefore, Chen Shi's formulas also achieved many successes. Contemporary errors using Qian Shi's formulas stem from improper application, not flaws in the original methods. One should seek the original intent of the prescriptions. Furthermore, annual qi and seasonal changes vary in depth and severity, and children's constitutions differ in deficiency and excess; medication should not be undertaken lightly. Referencing Jiegu, who combined mild purgation with wind-dispersing agents to incorporate ascending and dispersing intentions, shows caution. How then can heating agents and aromatic penetrating drugs be used indiscriminately? While there may be rare cases where toxic pathogens sink into orifices and muscles/bones, and such methods save lives, this might occur in only one or two out of a thousand cases.