Library

Xi Taishun said: In the favorable presentation of smallpox (Dou Chuang), the lesions are sparse, with red and vibrant roots. By the eighth or ninth day, the pustules are full of fluid, the color gradually turns waxy yellow, the erythema around the base completely dissipates, and the crusts form starting from above and below the philtrum (Renzhong) down to both legs; this is the normal process of crusting (Shou Ye). If encountering a critical presentation, when Qi transforms blood into pus around the fifth or sixth day, the head and face will inevitably swell, and the eyes and nose will be blocked as if steam were escaping from a steamer, causing Qi to stagnate and ferment. By the eighth or ninth day, the lesions will likely merge into a single mass, the skin becomes thin and prone to rupture, with pus and blood flowing simultaneously. At this point, one must urgently apply pine pollen powder by rubbing it on the affected area and internally administer cooling and detoxifying formulas. Around the tenth day, the lesions will inevitably ulcerate and emit a foul odor. Although this is an ominous sign, it remains treatable. As long as the voice is resonant, appetite is normal, and the odor is foul but not repulsive, with the external crusts resembling chicken manure piles, this is the standard prognosis for external crusting. However, if pus and fluids ulcerate and flow continuously without drying, emitting a stench like a corpse, accompanied by loss of appetite, this is termed "rotten smallpox" (Lan Dou). If the voice is short or absent, or hoarse, and although eye swelling subsides, the eyes remain difficult to open, lacking crusts and resembling a skinned rabbit, this is a fatal prognosis for external crusting. Generally, if scratching causes dripping pus and blood, it indicates a treatable stage of external crusting; if only clear fluid flows without pus or blood, preventing scab formation, it is truly difficult to treat.

Method of illumination with paper wicks: Soak a paper wick thoroughly in sesame oil, then dry it. When needed, dip it again in sesame oil and hold it over a lamp, moving it back and forth to slightly heat it until no bubbles appear in the oil before using it for illumination. This prevents hot oil from bursting and injuring the skin and flesh. During illumination, all doors and windows must be closed to create darkness. To view the left side, move the light source to the right; to view the right side, move the light source to the left. Apply this method up and down to illuminate. Then, the number and color of the lesions can be predicted in advance. Measles (Ma Zhen) floats on the surface of the skin without roots in the flesh, whereas smallpox has deep roots within the flesh. Therefore, some diagnose by palpation, verifying based on the presence of root nodules in the lesions; visual inspection alone cannot reveal them. Thus, illumination is superior for prediction. If a child experiences convulsions and loud crying upon illumination, this is also a sign of smallpox. It occurs because Heart Fire is excessive and clashes with the external fire. Treatment should involve mild purgation to guide Heart Fire downward; otherwise, convulsions will follow sequentially.

On medication methods and contraindications for detoxifying and cold-natured herbs: Children often refuse medicine, and even forced administration yields little intake. However, given the rampant disease progression, only medicinal force can expel the pathogen. For smallpox presenting as deficiency-cold, the course may linger for several days; for excess-heat presentations, the nature of fire is rapid, so medication must not be delayed. Therefore, heavy decoctions are appropriate, administered as the first dose (Tou Fu) to ensure the medicinal strength overcomes the disease. The nursing mother should also take large doses so that her milk contains medicinal properties. However, detoxifying and cold-natured herbs must not be used. Early in the onset, when the condition seems mild, this is because smallpox originates from the prenatal essence, lies dormant in the Kidneys, and emerges upon contact with pathogens; its toxicity cannot be easily resisted. Unlike other sores where early eruption can be resolved internally through detoxification, or later stages cured by dispersing toxins, visceral toxins belong to Yin and are deepest. They must rely on Qi and Blood to transport the toxin to the skin, transform it within the follicular sacs, and finally form scabs to restore Yuan Qi. How could there be internal resolution? How could there be no suppuration? Thus, while other sores prioritize detoxification, smallpox relies primarily on Qi and Blood to send out the toxin. Moreover, detoxifying herbs often damage Stomach Qi and deplete Qi and Blood. Furthermore, toxins have those that need not be resolved and those that cannot be resolved. If constitution is strong, Qi and Blood are sufficient, and Stomach function is robust allowing normal eating, the body naturally transports the toxin to success; this is a case where detoxification is unnecessary. If constitution is weak, Qi and Blood are depleted, and Stomach deficiency leads to poor appetite, even tonifying Qi and Blood may fail to transport the toxin successfully; this is a case where detoxification is inadvisable. Regarding detoxifying formulas, if administered during the pre-eruption phase, cold-natured herbs will suppress and stagnate the toxin in the middle Jiao, doing more harm than good. Only after scabbing forms, if residual toxins remain, can they be dispersed via medicinal force to prevent stagnation and abscess formation.