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Xi Taishun stated: Human voice originates from the Lung. When the Lung Qi is clear, the voice is clear; when the Lung Qi is excess/stagnant, the voice becomes hoarse. The Lung belongs to Metal in the Five Elements. It is also said that an empty metal vessel resonates, while a solid one does not sound; when the orifice of the throat is empty, the voice produced is clear. Regarding the pathology of smallpox (痘疮), hoarseness may occur because heat-toxin is congested and obstructed, preventing dispersion, or because Qi and Blood are deficient, allowing external wind-pathogen to invade, leading to phlegm blocking the Lung orifices and impeding the free flow of Qi. Additionally, if pox covers the throat, drinking water causes choking because water invades the airway. Food with residue can enter the throat naturally, hence one chokes on water but not on food. Coughing induces choking, and prolonged choking inevitably leads to hoarseness; this is a necessary principle. Therefore, for syndromes involving choking on water and hoarseness, one must determine the auspiciousness or inauspiciousness based on the color of the pox. If hoarseness results from crying or coughing, and the pox color is bright and lustrous, it is not serious. This syndrome urgently requires clearing the Lung and resolving toxicity, using large doses of formulas containing Niubangzi (Arctii Fructus), Xuanshen (Scrophulariae Radix), Jiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), and Maidong (Ophiopogonis Radix), which constitutes an excellent prescription.

Xi Taishun stated: Why do cold shivering (寒战) and teeth grinding/clenching (切牙) occur throughout the course of smallpox? This syndrome may appear during the fever stage, the eruption stage, the pustule formation stage, or the crusting stage; it is called "cold shivering." Undoubtedly, this disease belongs to Cold. Some experience shivering first followed by coldness, while others feel cold first followed by shivering. Medical texts state that if this syndrome appears before the seventh day, it belongs to Heat and indicates a poor prognosis; if it appears after the seventh day, it belongs to Deficiency and is still treatable. Having deeply experienced and investigated this condition, I found that cold shivering and teeth grinding are mostly due to Fire. In cases where the pox color is red-purple and dry/withered, this syndrome is common. The "cold" here is extreme heat generating cold symptoms; the "shivering" is caused by excessive fire, making Shigao (Gypsum Fibrosum) and Dahuang (Rhei Radix et Rhizoma) appropriate treatments. In cases where the pox color is grayish-white without redness, fails to erupt, is dull with depressed tops, the skin is pale white, accompanied by diarrhea and half-open eyes, the "cold" initially manifests as standing hair follicles and skin resembling chicken skin, with slight coldness and slight shivering. This cold is due to Qi deficiency, and this shivering is due to Blood deficiency. One should heavily use herbs such as Renshen (Ginseng Radix et Rhizoma), [text missing, likely Huangqi], Muxiang (Aucklandiae Radix), Dingxiang (Caryophylli Flos), and Guirou (Cinnamomi Cortex) to support the True Yuan (True Origin). Teeth grinding occurring before the seventh day is governed by the Yangming Stomach Meridian. The Yangming meridian governs muscles and runs through the upper and lower gums; when pathogenic factors merge into the Yangming meridian, teeth grinding occurs. It also indicates Stomach Heat, which should be cleared. Teeth grinding occurring after the seventh day indicates Yangming pathogen sinking into the Yin aspect; Yin deficiency allows Yang to enter the blood vessels causing teeth grinding, primarily due to Blood deficiency, requiring tonification. Thus, teeth grinding has distinctions of Excess and Deficiency, and severity. Generally, one must combine the observation of pox color to determine Excess or Deficiency accurately. For instance, if after the seventh day, the pox base is red but loose, the color is purple-bright, the top is depressed like fire thorns, lips are cracked, there is thirst, irritability, and confusion, can this still be considered a Deficiency syndrome simply because it is after the seventh day? Therefore, when evaluating teeth grinding, one must listen to the sound. A muffled sound like biting a rope or chewing beans indicates Heat; a faint sound like feeding cotton indicates Deficiency. Generally, a loud and hard sound confirms Heat beyond doubt; a low and soft sound confirms Deficiency without hesitation. In summary, by carefully analyzing the manifestations and treating according to the state of the pox, errors will be avoided.