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(Tian Wan Mi Zhai. This is a concise method for treating smallpox; beginners should read it thoroughly.)

Smallpox originates from fetal toxins, commonly known as "Heavenly Sores." Although it can be transmitted by pestilential qi (severe pathogenic factors), it is essentially the manifestation of lethal potential. Its changes are unpredictable, and its cruelty is unbearable. Muscles and flesh ulcerate and slough off like snakes shedding skin or dragons shedding bones; spirit and energy are exhausted like earthworms struggling in ash or boiling water. Lesions vary in density: sparse ones indicate mild disease, while dense ones indicate severe disease. Toxins vary in severity: mild toxicity brings auspicious outcomes, while severe toxicity brings disaster. It is laughable to those who rigidly adhere to the number of days without understanding the variations of speed; it is pitiable to those confused by ghosts and gods who do not seek good medicine.

The subtle union of Heaven and Earth causes Zhen (Thunder/Yang) and Xun (Wind/Yin) to expand. Qi is received from the father, condensing with Yang essence; form is shaped by the mother, nurtured by Yin blood. The people indulge in desires, and the qi is no longer pure. Lustful fire blazes on the bedchamber, and food filth accumulates in rich meats. The Jing (Essence) and Blood inherit toxic vapors worse than She Wang (a type of poison); the body bears killing energy more dangerous than sharp blades. Some say removing oral blood suffices, which is empty talk; some say resolving fetal toxins suffices, yet no formula rivals the Sages.

The Five Movements are governed in North and South, having major and minor phases; the Six Qi are divided into Host and Guest, Yin and Yang. Changes follow their own rules, and Victory and Repetition (abnormal interactions of the Five Phases) are constant. When order is obtained, Qi is harmonious, and there are no plagues in the state; when order is lost, Qi is chaotic, and people suffer from rashes and sores. Qi that should arrive but does not arrives slowly; one must anticipate and seize its momentum. Qi that should not arrive but does so arrives violently; one must hold steady to avoid its strength. Ignoring this and acting rashly leads to defeat due to violating the season; examining this and acting cautiously leads to prosperity by following Heaven.

Spring is warm and promotes growth; Summer is hot and promotes floating and lengthening; Autumn is cool and promotes descending and gathering; Winter is cold and promotes sinking and storing. This follows the correct Four Seasons and does not harm all things. If Winter is unusually warm, buds sprout early; if Spring is unusually bitter, hibernating insects remain hidden; if Summer is unusually crisp, cool winds strike the flesh; if Autumn is unusually humid, summer sweat wets clothes. Such contrary Qi, once contracted, becomes epidemic; also, Empty Wind (non-seasonal wind) striking causes premature death.

Receiving parents' filth and toxin, it hides in dark places; touching Heaven and Earth's pestilential Qi, it triggers latent storage. Emerging from within, it spreads to four limbs; dispersing from outside, it roots in five Zang organs. The Liver governs tears forming water blisters; the Lung governs nasal discharge forming pus sacs; the Heart presents macules and redness; the Spleen presents papules and yellowish hue; the Kidney is the root of storage, and pathology manifests as black depression. Joyful signs include budding, flowering, and fruiting, like birds shedding spurs; hateful signs include withering and depression, like tigers carrying mountains. East is red, South is white, West is yellow, North is black, each distributed with certainty; Spring generates, Summer grows, Autumn harvests, Winter stores, flowing naturally without boundaries. Initially bleeding spots are bright red, receiving generating Qi; next transforming into clear fluid, a sign of gradual growth; pus formation with yellow color indicates desire to gather; scabbing with black color indicates sealed storage. Saying the Kidney has no symptoms is like saying winter cannot complete the year; saying black is adverse is like abandoning the North to regulate Yang.

During emergence, Spring and Summer are favorable, Autumn and Winter are not auspicious; during consolidation, Autumn and Winter are favorable, Spring and Summer do not store. Emergence reversing to consolidation is called Depression/Fixation; consolidation reversing to emergence is called Overflow. Favorable cases need not be treated, waiting for recovery; adverse cases should not be treated recklessly to avoid blame. For dangerous cases, unique formulas are necessary. Correct treatment turns danger to favor, like spring returning to valleys; incorrect medication turns danger to adversity, like fire raging on Kunlun.

Diseases seeming favorable but actually adverse require habitual recognition; diseases seeming adverse but actually favorable require detailed examination. Piles resembling millet and hard are inferior to distinct and dense lesions; bright red and tender like cinnabar are inferior to pale white and aged lesions. Initial appearance holding water, sudden eruption wearing pus. Pus signifies maturity and drying black; incomplete sacs withered and yellow. Early eruption withering first resembles garden flower buds; rapid growth and disappearance resemble ditch puddles. This is a life-snatching syndrome; do not boast of experienced physicians.

Mild may become severe due to wrong medication or taboos; severe may become mild by meeting a good doctor and proper care. Mosquito bites and flea marks change instantly; snake skins and silkworm shells mean waiting for death. Accompanying rashes, relief when rashes subside; flat tops and depressions, anxiety when they rise. Avoid reckless behavior at bedside; use medication with caution. Disease has root and branch, legislate based on urgency; medicines have tonification and purgation, prescribe based on deficiency and excess.

Alas! Doctors have no fixed methods; confused doctors have no fixed formulas. Generally despising attack and valuing tonification, preferring warmth over coolness. If disease encounters deficiency-cold, warming tonification is effective; if syndrome encounters excess-heat, pungent-aromatics are dared. Pungent-hot entering the throat traps abundant Yang; bitter-cold entering the stomach injures abundant Yin. Avoid sweating and purging at beginning and end; dislike attacking theories; tonify Spleen Earth to control Kidney Water, the norm of liking tonification. Not knowing the shortcomings of tonifiers, how to discuss the strengths of attackers?

Sharp, round, and lustrous forms indicate充盈 Qi; bright, clear, and moist colors indicate nourished Blood. No medication needed, called healthy. Gray-white and flat-depressed indicate Qi-Blood deficiency, tonify with warmth; red-bright and swollen indicate Qi-Blood heat, drain with coolness. Qi arrives but Blood is insufficient, though erupting, the base is not plump; Blood arrives but Qi is insufficient, though bright/moist, the border does not grow. Clinging to chapters and corners, guarding trees to catch rabbits is impossible; galloping debates holding two ends, many paths lead to losing sheep. Spleen is the root of grain and water, must be tonified; Kidney is the source of fluids, must be protected. Earth prevents Water, but Water cannot control Fire's hyperactivity. Kidney governs marrow; inversion into marrow is incurable; Kidney governs closure; turning black to closure can be prevented. These are harms attributed to Kidney, not signs of Kidney strength. Burning toxins dry Kidney Water; ruined Ying Qi injures Spleen Earth. Thus, tonifying Spleen is less effective than saving Kidney, and nourishing Yin aids Yang.

Heat makes Qi-Blood slippery and unconsolidated; cold makes Qi-Blood stagnant and obscure. Qi-Blood loss damages pox/rashes. Heat causes irritability, redness, pain; cold causes shivering, whiteness, itching. Follow seasonal temperature changes, forbid human/livestock contact. Do not disturb toilet odors, do not burn orchid/musk incense, fearing entry through deficiency, aiding toxin disaster. Smallpox is auspicious but violations bring凶 (misfortune), frequent strange changes; syndromes are evil but good treatment brings health.

Regarding pox/rash heat, similar to internal/external injuries. Evil fire blazing burns jade and stone alike; True Water calm raises no waves. Sneezing/coughing scorches Lung Metal; neck stiffness/sudden stuffiness injures Liver Wood. Yawning/startling, Heart Monarch is unsettled; vomiting/diarrhea/sleeping, Spleen Granary fails to store. Each organ/syndrome, only Kidney has no image, not receiving filth/toxin fire, uniquely showing ear-back coolness. Mild heat means little toxin; severe heat means strong fire. High heat quiet, toxin exits with heat, no worry; low heat irritable, toxin hides with heat, preventable. Unpredictable disaster, both hot and thirsty; mild/sparsely allowed, alternating hot/cool. Vomiting/diarrhea not stopping allows toxin to escape without blockage; unsettled startling fears toxin deepening and hiding. Blood leaking from orifices, death faster than snapping fingers; delirious talk of ghosts, changes easier than flipping palms.

Form/syndrome determines density; location decides survival. Scattered smallpox, granular, density determined; clustered measles, blurred, density hurts. Cheek/mouth area, Geng/Wu Yangming position; Cheek/forehead area, Wang/Bing Taiyang region. Head is chief, fears covering head; Neck is pass, dislikes neck lock. Nose tip emerging, lust toxin attacks Tian Gen; Ear leaf appearing, evil fire invades Yu Tang.

Gradual emergence is auspicious; simultaneous surge is ominous. Smallpox about to emerge with reduced heat, do not take medicine rashly; smallpox emerging with intense heat, doctor should prevent early. Resolve fire toxin, fear stagnation/dryness; nourish Qi-Blood, desire flow/smoothness. Avoid cold/heat invasion, damage/nourish seeking peace; assist Spring/Summer commands, reach/release seeking growth. Treat before chaos, repair mulberry roots before rain; know gradual nature, beware ice when treading frost.

Emerge wanting completion without leaving; erupt wanting penetration growing together. Buds gradually forming nests, warmed by Qi; Blood gradually turning to water, nourished by Blood. Sparse/few toxins, face not swollen, do not fear; Dense/many toxins, Qi-Blood not full, do not panic. Time sufficient, naturally rising mixed; Exterior/Interior free of evil, do not rush to make decoctions. This is like a good general using troops, good attack不如 good defense; also like a good farmer tending fields, do not help growth nor forget.

Sudden throat pain, treat early not delaying time; Pre-swelling of head/face, prolonging days leads to death. Urine wants clear, stool wants firm; Light flavors edible, heavy flavors not to taste. Eating light preserves Stomach Qi; Nourishing heavy increases Fire Evil. Seeing black-dark, quickly dot with rouge; Encountering dry/withered, bath with Populus/Salix. Sudden itching, take Artemisia capillaris for fumigation; Restless scratching, even Lu Bian would hesitate.

Smallpox fills with water, toxin transforms to paste. Love thick pus, hate thin/clear; Take fullness, discard empty/overflow. Want to know penetration, examine hands/feet carefully; Want to know sufficiency, inspect cheeks/cheeks. If extremities not penetrated, take Spleen/Stomach medication; If one side insufficient, view meridians for formula. Like building a mountain, do not fail due to basket soil; Like holding heat, better to wash in boiling water first.

Cheeks dislike broken tops; Shoulders/back fear scorched sacs. Swelling suddenly disappears, Qi escapes; Speech suddenly delirious, Spirit perishes. Eating grains causes vomiting, Stomach rots; Drinking water causes choking, Throat injured. Teeth grinding, Liver fire blazing and Kidney failing; Chills, Yang Qi weak and Yin strong. Pus reverses to dry, inversion; Pus not formed, fixation. Crying endlessly, toxin attacks intestines/stomach; Confusion/restlessness, fire raging in Gaohuang. Granary not storing, souls return to darkness; Springs not stopping, relatives weep on Beimang.

Pus/blood transformed, scabbing appropriate. Signs start from lips, paste gathers like pearls; Ends at Renzhong, parts measured mentally. Commands act in Autumn/Winter, following sequence不乱; Qi responds to Yin/Yang, circulating up/down with regularity. Cheek upper light, fear inverted scabbing; Cheek middle receding first, called inauspicious. Scab not adhering and swelling, due to Ying Blood overflow; Wounds fully cracking and peeling, this Wei Qi residual injury. When scabbing not scabbing, when storing not storing. Constipation not passing, interior heat guided by cool; Loose stool not solid, middle Qi deficient nourished by warm. Heat damaging skin/hair, blame Lung Metal not collecting remaining Qi; Damp damaging muscle, blame Spleen Earth not drying residual paste. Head wounds piling pus uneven, solitary Yang like widower not generating; Foot wounds wrapping water not drying, pure Yin like widow not growing. Diet decreasing, lingering days leading to death; Irritability increasing, sudden life ending.

If asking why scabs do not fall off, between them disease Qi interferes. Smallpox ruined, fill empty holes doubtlessly; Wounds like ulcerated, formed pus not scabbed paste. Whole body oozing, sticking sheets most bitter; Frontal swelling pouring, smelling foul again interfering. Frequent watery discharge, this retaining water disease, water gone stops itself; Stool frequent pus/blood, this inverted scabbing syndrome, pus gone becomes auspicious. Scars concave/convex, depressed deficient and protruding excess; Skin scabs tender/thin, inside troubled and outside sore.

Evil Qi exhausted and Zheng returns, scabs fall and body healthy, if young body often sick, then residual toxin has storage. Erupting not fully, no empty holes must prevent sudden violence; Erupting not penetrated, no ulcerated pus must develop carbuncles. Receiving early, toxin/fire sinks scary; Or overdue not scabbing, evil Qi staying regrettable. Body heat examine deficiency/emaciation, hoarse voice observe vomiting/choking. Do not feel chills and muscle heat, know Wind-Cold external contraction; Sudden vomiting/diarrhea and abdominal pain, must diet internal injury.

Disease painful and dizzy, mostly凶 few吉 omen; Body no evil and drowsy, Pi goes and Tai comes image. Voice not coming, seek Lung/Kidney meridians; Macules/rashes reappearing, blame Heart/Spleen Zang organs. Gan erosion bleeding difficult to treat, hole diarrhea whole grain cannot be cured. Do not say smallpox received and relax, do not say toxin gone and delay. Zheng Qi growing but not recovered, Evil Qi just消散 but not ended. Specifically violating taboos, now immediately generate change; Indulge eating fat/sweet, later surely have disaster.

Scabies/leprosy ulcerated, one side scar like ghost. Carbuncles/metastatic abscesses, four limbs disabled like withered. Eyes swollen and painful, cold smallpox enters forming nebula; Teeth black/rotten, hot toxin浸s destroying bed. Though said residual toxin causing harm, also all fixed numbers unpreventable. Appearance suddenly changed shocking people, treatment regret late empty self sighing. Say humans cannot conquer Heaven, how establish medicine? Say doctors不如 using witchcraft, how reach窮苍?

But encountering years of smallpox, mostly seeking detoxifying formulas. Severe must become mild, mild not erupting;凶 becoming吉, what harm to吉? Formulas exist, effects not always, rather beforehand lightly rash,不如 lying down carefully detailed. Examine year Qi disaster/auspiciousness, must resolve stagnation; View form Qi bravery/timidity, each level its Zang organs. Want to avoid pestilential transmission, must first choose good land; Want rely on medicine power protection, especially recognize good doctor.

Xingxing Renshen Suxu is wonderful agent for dispersing (Xingxing San, Renshen Suxu San). Renshen Tongsheng truly odd formula for epidemics (Renshen Baidu San, Fangfeng Tongsheng San). Hot and startling palpitations, Daochi Xieqing used (Daochi San, Xieqing Wan). Hot and scorched thirst, Chaihu Gegen made soup (Xiao Chaihu Tang, Shengma Gegen Tang). Self-diarrhea Huangqin (Huangqin Shaoyao Tang); Inconvenient Qingliang (Sishun Qingliang Yin). Abdominal pain toxin attacking, Yunqi San add Zhishi; Lower back pain severe, Baidu San add Muxiang. Tiaoyuan can tonify, exterior/interior excess do not drink (Tiaoyuan Yin). Chengqi can attack, Spleen/Stomach weak do not taste (Xiao Chengqi Tang).

Nourish Zheng Huangqi, Renshen, Gancao; Detox Lianqiao, Shandou, Niubang. Throat bitter pain, Ganju Tang add Dali; Macules/rashes mixed out, Fangfeng San remove Xiaohuang (Fangfeng Tongsheng San). Urine red/astringent, Lianqiao, Daochi (Lianqiao Yin, Daochi Tang); Stool slippery loose, Doukou, Muxiang (Doukou Wan, Muxiang San). Wounds dry/withered, Siwu combine Liangge (Siwu Tang, Dongyuan Liangge San). Smallpox like black depression, Duoming assist Shuiyang (Duoming Dan, Shuiyang Bath Method). Red-bright swelling, Jiedu enter Shenghuang Guishaohuo (Huanglian Jiedu Tang). Gray-white flat, Yigong use Guizhi, Fangfeng (Yigong San).

Qi deficient and toxin盛, Wuja, Sijun, Zhishi (Wujia San, Sijunzi Tang). Blood deficient and toxin盛, Wuja, Siwu, Niubang (Siwu Tang). Qi-Blood both deficient, Shiquan Wuja (Shiquan Dabu Tang). Urination/defecation blocked, Bazheng, Sanhuang (Bazheng San, Sanhuang Wan). Again use Gallbladder draining method, to drain toxin/vapor storage. Black depression examine deficiency/excess, deficient great tonify and excess Liangge (Shiquan Dabu Tang, Hejian Liangge San). Itching/depression divide urgent/slow, urgent Yigong and slow Tiaoyang (Chen's Yigong San, Tiaoyang refers to Yuan Tang). Drowsy/confused delirious, Longnao Gao who knows its wonder; Deficient irritable confused, Baolong Wan none matches its good.

Full face dry/painful, Baihua mix water (Baihua Gao). Whole body ulcerated, Baicao spread bed (Baicao San). Chan Tui remove eye skin nebula (Chan Tui San). Kushen treat body lust sores (Kushen Wan). Deficient heat much sweating, Tiaoyuan Tang reference Fumai; Food accumulation often pain, Pi Ji Wan drink Yuan Tang. Hungry not liking meal, Yigong suitable long (Qian's Yigong San). Thirsty wanting water, Baizhu can often (Baizhu San).

Baidu, Tongsheng, indeed vanguard charging; Tiaoyuan, Yigong, indeed rear guard great officials (Tiaoyuan Tang, Qian's Yigong San).

Generally doctors must recognize syndromes, medicines do not stick to formulas. Specializing in warm tonification, follow Wenzong; Liking cool draining, model after Zhongyang. Not understanding books, like blind walking in streams; Not observing spirit, like dwarf looking at palace walls. Sigh my age old, want deep study but strength insufficient; Fear this way obscure, specially clarify words not clear. Vomit heart/lungs, not wanting to stand out; Labor jaws/tongue, dare not rely on length. Fortunately take correction from knowledgeable eyes, vainly laughed at by great masters.