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Nie Jiwu stated: When fever lasts for three to four days before the eruption of smallpox, and the lesions resemble millet grains, if a few pale red and moist spots appear first in the areas of the mouth, nose, cheeks, ears, and Nianshou (tip of the nose), this is the most auspicious sign, and no medication is required. If the rash appears within one or two days of fever onset, starting at Tianting, Sikong, Yintang, or other areas; or if they erupt all at once and are dense; or if they are dry, shriveled, and purple-black; or if they merge into patches without distinct granules, these indicate stagnation of blood and Qi with rampant toxin. These are most concerning. Urgent treatment should focus on invigorating blood and nourishing Qi to guide out the toxins, using Yuanhua Huadu Decoction (Decoction for Restoring Origin and Transforming Toxins). (Ingredients: Sheng Mian Huang [Astragali Radix], Renshen [Ginseng Radix et Rhizoma], Baishao [Paeoniae Radix Alba], Danggui [Angelicae Sinensis Radix], Niubangzi [Arctii Fructus], Lianqiao [Forsythiae Fructus], Huangqin [Scutellariae Radix], Huanglian [Coptidis Rhizoma], Fangfeng [Saposhnikoviae Radix], Jingjie [Schizonepetae Spica], Jiegeng [Platycodonis Radix], Qianhu [Peucedani Radix], Mutong [Akebiae Caulis], Zicao Rong [Lithospermi Radix], Honghua [Carthami Flos], Shengdi [Rehmanniae Radix], Gancao [Glycyrrhizae Radix et Rhizoma], Chan Yi [Bombyx Batryticatus], Zha Rou [Crataegi Fructus]. Decoct and take orally. For abdominal pain, remove Renshen and add Chao Zhike [Fructus Aurantii Preparatus]; for chronic constipation, remove Renshen and add Jiu Chao Dahuang [Rhei Radix et Rhizoma] to induce mild purgation, removing it once bowel movements normalize; if both Qi/Blood and toxins are vigorous with a surging and rapid pulse, reduce Danggui and Baishao by one-third and remove Renshen. This formula uses Renshen to nourish Qi, Danggui, Baishao, Honghua, and Shengdi to invigorate blood, Lianqiao, Niubangzi, Huangqin, Huanglian, Jingjie, Fangfeng, Qianhu, Jiegeng, Zicao, Chan Yi, and Mutong to resolve toxins, and Zhishi and Zharen to regulate Qi.)

If the eruption is slow, the patterns vary greatly and must be distinguished carefully. If the rash is red-purple, dry, and shriveled, or dense like silkworm eggs, or merged into patches without distinct granules, accompanied by fever and constipation with slow eruption, this indicates stagnation of toxins and non-circulation of blood and Qi. Use Yuanhua Huadu Decoction without Renshen, adding Xiao Chuanxiong [Chuanxiong Rhizoma] to clear heat. If the rash is pale white, appetite is reduced, body temperature is low with cold extremities, urination is clear, and stool is loose with slow eruption, this indicates deficiency and weakness of Qi and Blood, unable to carry toxins outward. Use Wenzhong Yiqi Decoction (Decoction for Warming the Middle and Boosting Qi) to support and expel. If there is nasal congestion, heavy voice, cough, aversion to wind/cold, and slow eruption, this is due to obstruction by Wind-Cold. Use Jiashen Su Yin Decoction (Modified Ginseng and Perilla Decoction) to disperse. (Ingredients: Suye [Perillae Folium], Renshen [Ginseng Radix et Rhizoma], Chenpi [Citri Reticulatae Pericarpium], Xiao Chuanxiong [Chuanxiong Rhizoma], Qianghuo [Notopterygii Rhizoma et Radix], Fangfeng [Saposhnikoviae Radix], Jingjie [Schizonepetae Spica], Jiegeng [Platycodonis Radix], Baizhi [Angelicae Dahuricae Radix], Gancao [Glycyrrhizae Radix et Rhizoma]. In winter, add Mahuang [Ephedrae Herba] 5 fen, decoct, and take warm, but do not induce sweating.) If triggered by foul pathogens causing latent sinking and slow eruption, the rash will likely itch. Use Heping Tang (Peaceful Decoction) to resolve. (Ingredients: Renshen [Ginseng Radix et Rhizoma], Danggui [Angelicae Sinensis Radix], Jiegeng [Platycodonis Radix], Baishao [Paeoniae Radix Alba], Zisu [Perillae Folium], Huangqi [Astragali Radix], Fangfeng [Saposhnikoviae Radix], Baizhi [Angelicae Dahuricae Radix], Gancao [Glycyrrhizae Radix et Rhizoma], Guanzi Gui [Cinnamomi Cortex], Chenxiang [Aquilariae Lignum Resinatum], Tanxiang [Santalum Album Lignum], Xuxiang [Olibanum], Huoxiang [Agastaches Herba]. Take warm.) During eruption, if sudden wind-stroke symptoms occur, such as staring eyes and locked jaw, this is due to careless nursing allowing Wind pathogen invasion. Do not lightly use harsh wind-dispelling drugs; use Jiangfu Tang (Ginger and Aconite Decoction) instead. (Ingredients: Baifuzi [Typhonii Rhizoma], Laoshengjiang [Zingiberis Rhizoma Recens] each 2 qian. Decoct strongly, administer 1-2 wine cups. Recovery occurs with slight sweating.) During eruption, mild warmth without extreme heat or cold is ideal; mild, gentle heat is also acceptable. Only high fever is concerning. Fever persisting after complete eruption is particularly worrying. The rash will be dense, red-purple, and dry/shriveled. Continue using Yuanhua Huadu Decoction without Renshen. To determine if eruption is complete, check the soles of the feet; if lesions appear there, eruption is complete. For sparse eruptions, completion is marked by absence of fever. Meat should not be consumed too early; only eat pork after complete eruption and resolution of fever. Eating meat while fever persists aids fire-pathogens and causes severe complications. Chicken is forbidden throughout; only allowed during the swelling phase for weak patients to aid pus formation, but avoided in robust patients. All fish are pungent/fishy, beef and mutton are gamey; these are taboo for smallpox patients and must be strictly avoided. At the initial spotting stage ("Baodou"), if head and face have few spots, tips are sharp/tactile, bases are red/moist, and chest/back lack color, shining like water droplets, this is highly auspicious. "Hua" (flower) precedes "Dou" (pox); Hua resembles Cinnabar Plum color. Pox resembling tender yellow turning old yellow with small red tips at the apex is a favorable pattern. (This is the general rule for identifying "Hua".) If Hua turns red on the sixth day, it is favorable. (Success on the ninth day also indicates this favorable type.) Signs of death include restlessness, unceasing waist/abdominal pain, foul breath, and purple spots. Death also occurs if spots are white, thin-skinned, shiny, with no red base or only a faint red line, growing to mung bean size in 3-5 days without filling with pus, eventually becoming clear fluid; rupturing leads to death. (Do not treat based on appearance alone.) Complete failure to rise, with tops like boiled dumplings or burnt rush, leads to death from itching and collapse after ten days. Red rashes like brocade patterns lead to death on the sixth day. Snake-skin-like full-body eruption is fatal. Black spots like moles with blackened muscle pigment predict imminent death. Over-warming causes toxins to enter the Heart Meridian, leading to death within half a day. Over-cooling prevents internal toxins from reaching the exterior, causing closure and death within five days. (In severe cold, protect with light bedding to prevent external cold invasion; never use bitter-cold herbs that freeze Qi/Blood and block eruption.) Gray-colored, grain-sized spots with itching/pain lead to death on the eighth day. If parents neglected care, transmitting fire-toxin to the infant, appearing first as yellow sores then drying up, followed by sudden disappearance of all signs, toxins entering the Five Zang organs leads to immediate death. Congenital and acquired deficiencies in infants, combined with poor parental nourishment, lead to depletion where no medicine can save them upon eruption. (Death results from Qi/Blood deficiency failing to expel toxins, regardless of spot count.) Complications with measles/rash are difficult to cure. Throat pox blocking airways and preventing eating/drinking leads to death in three days. Eruptions originating internally from the Five Zang without external skin manifestations lead to death instantly. (Identification: Child suddenly develops chills, sweating, water-like bumps on head/neck that are purple/swollen/wanting to burst. Rupture means no rescue. This confirms internal Zang eruption.) Infants should not consume alcohol, sugar, fried foods daily. Excessive consumption leads to pathogenic combination, weak Zheng Qi, inability to control Liver/Spleen Fire despite Kidney Water, resulting in mutual destruction and death within a day. (Parents must prevent this beforehand.) During spotting, pale/dry surroundings indicate Blood Deficiency; white tops with retracted halos and sunken centers indicate Qi Deficiency. Urgently use Xiong, Danggui, Rougui, Muxiang with human milk and good wine. Before eruption, a large golden-yellow spot is called "Zeidou" (Thief Pox), and a black spot of similar size is "Douding" (Pox Carbuncle). Prick immediately with silver needle, suck out foul blood with hot water, apply Zicao Gao or Oil Rouge mixed with Xueyu Hui and Zhenzhu Mo. Other spots will naturally rise. Initial eruption often includes sore throat, hoarseness due to internal toxin blocking airways; treat with Ganjie Tang plus Yuanshen and Niubangzi.

Xi Taishun said: Mild fever reaching the exterior indicates mild disease; internal oppression, confusion, and irritability manifesting externally indicate severe disease. Color should be moist/lustrous, avoiding dullness; granules should be round/clean, avoiding fragmentation; elevation should be high, avoiding flatness; skin should be firm, avoiding thinness; spacing should be sparse, avoiding density. Tight bases distinguish Yin/Yang. Active spotting avoids edema; eruption should be uneven; blood should return/adhere. Fewer spots behind ears, neck, chest, heart are good; luster on brow ridges, Taiyang, forehead without stagnation is excellent. Immediate full eruption is severe; pox with rash is moderately severe; mild redness inside/outside is mild; red outside/black inside is severe. Black needle-hole points indicate extreme heat; cyan/dry/purple/sunken, irritable red/scorched black, drowsiness/sweating, abdominal distension/wheezing/crying, constipation indicate adverse patterns. Skilled practitioners distinguish severity by form/color, ensuring mild cases recover safely and severe cases are stabilized.

Verse 1: Mild heat, clear spirit, large pox; red/vibrant bases, uneven distribution; warm limbs, no chills/fever; normal milk/food intake, thirst/diarrhea resolved; less involvement of waist/neck/chest; regulation suffices, no need for aggressive treatment.

Verse 2: Early eruption on first day of heat; dense, red, reduced appetite; diarrhea, irritability/thirst, abundant on head/face; red macules with rash, blocked bowels/bladder; flat, gray/white, lacking luster; carbuncles/toxins, wet pus flow; prevent such severe cases, do not lament negligence later.

Verse 3: Inspect facial meridians for life/death/auspiciousness. Left cheek=Liver, Right cheek=Lung; Spleen=Nianshou/Renzhong; Heart=Yintang/Forehead; Kidney=Cheekbones/Ears/Nape. These are Yin/Yang zones. Pox dislikes dry/stagnant or bright red. If Nianshou erupts first, same for Renzhong/Cheeks/Feet; pale red, distinct, moist like cinnabar, safe after seven days. If crossing Yintang/Forehead, Heart fire-toxin resolves only at chin; cheekbones/ears/eyes resemble measles, extremely severe, death inevitable.

Verse 4: Fever for three days, normal Qi/Breath; red/vibrant spotting, location irrelevant. Appearance becomes coarse/plump; sparsity ensures survival. Initial fragmentation suggests density. Gradual eruption with heat application, tips round/high, lustrous color; even if dense, salvageable. Simultaneous eruption with red/thin skin, even if sparse, may not survive. Fine white heads like prickly heat, dry/shriveled, certain internal attack; crimson red dots like cinnabar, scorched/withered, certain decline. Coarse/plump but tips not plump, finally white/sunken, tips tender/thin; Cornel patterns indicate empty pus; tender muscle/thin skin, delicate red. Yellow/thin pox turns brown; dark skin/coarse texture, pox color gloomy. Infant muscles vary, cannot generalize. Look for convex vitality, dislike irritable red/dryness, prefer lustrous calm spirit. Spotting like pearls/millet, dry hair/skin, application of poultice, purple/scorched, simultaneous eruption with heat; fear density like needle heads. Even gradual eruption, avoid silkworm egg shapes, bran/prickly heat/rash/scabies forms, unstable bases, no footprints; violation of these implies hopeless cases. Macules like mosquito bites, severe cracking like snake wounds, or snail/cloud/lightning patterns, slightly salvageable. Pre-fever spotting, commonly "Baodou". Persistent fever without spreading treated as carbuncle. Blocks first, sores second: Blocks named "Chidu" (Stupid Toxin), must survive. Sores first, blocks second: Blocks named "Guizhong" (Ghost Swelling), hard to cure. Avoid pox in secluded places, eye lids/lips/mouth prone to凶 (misfortune). Stifled pox in vital areas, tongue/throat/shoulders/back unfavorable. Favorable: does not hate quantity. Adverse: fears single cold carbuncle. Early visible pox, dare not show form. Thief Pox arises, other pox fail to fill; true identification requires immediate pricking. Interior patterns unsettled, pox erupted but toxin internal; muscle-releasing dispersion, detoxification is best. Bowel regulation, calm person, body hot but toxin external; tonification plus dispersion, stabilizing exterior is priority. If interior/exterior patterns balanced, no mixed treatment; observe spirit courage, detail exterior/tonification strategy.

Verse 5: Days 3-4, pox should be complete, reaching soles, momentum stabilizes. Continued non-eruption or hidden/subtle lesions, ancient name "Bu Kuai" (Not Fast). If not due to obstruction, must be Qi/Blood weakness. Before Day 4, toxin emerging, body surface should be cool; After Day 4, toxin fixed, body surface should be warm. Cool harmonizes Qi/Blood, pox lustrous; Warm opens pores, toxin fills easily. If body lacks mild heat here, though not frozen, pox definitely won't grow. Physician must investigate cause: Wind-Cold, vomiting/diarrhea, or foul contact. No heat/non-rising pox becomes ice-hard; red non-rising pox predicts deterioration. Red/lustrous unchanged, but with shortness of breath/abdominal distension, death near. Loss of voice/sorrow, Yang numbers few.

Yu Tianchi said: Predicting auspicious/inauspicious before spotting relies on spirit/expression/pulse. Unless extremely good/bad, future is unclear. Once spotted, form/color visible, favorable/dangerous/adverse paths clear. Form depends on Qi/Color, rooted in Blood/Qi. Regular Qi controls toxin; toxin controlled, pox stable despite density, not blurry/fragmented, distinct granules, clean bases. Led toxin reaches exterior easily, dense but top bursts/aged, Qi regular, form seamless. Regular Blood carries toxin; toxin carried, pox stable despite density, roots supported. Bags thick/nourishing, toxin receives nourishment, pox not dry/astringent, dense but pale-not-white, red-not-delicate, Blood regular, color blameless. Reverse indicates Qi/Blood controlled by toxin. Exterior/Interior deficiency causes slow eruption; Exterior/Interior excess causes toxin stagnation; Qi/Blood deficiency causes thin skin/white color; Toxin-Fire excess causes ugly form/color. Thousands of forms stem from this.

Spotting after 3 days fever, cool body, clear spirit, distinct granules, pale-red aged, others known favorable, no meds needed. Spotting Day 1, fierce heat/dry blisters, fire-associated eruption, any density, purple-bright or red, others known, this is fierce toxin/fire, plan early to prevent internal ulceration. Urgently attack toxin/clear fire, clear muscle/promote eruption, do not neglect initial sight. Spotting with no fever, tired spirit, accidental eruption due to surrounding Qi influence, pale/thin skin, pores not tight, muscle not solid, unable to constrain. Do not disperse, prevent itching/collapse later, use Tiaozhong Tang. Spotting preceded by vomiting/diarrhea/tiredness, warm head/cold feet, seasonal infection, pale/thin bags, stagnant/non-rising, Qi deficiency unable to promote, use rising methods treating root, prevent inversion/collapse. Spotting fiery heat, purple-bright/red, irritable spirit, days unresolved/non-rising, urgently attack toxin/cool blood, clear fire/disperse muscle. Spotting few grains, not very red/white, warm body, clear spirit, termed favorable. Bags not thick over days, pox not lustrous/plump, floating, termed "Dengban Dou" (Equal Companion Pox). First few spots, "Baodou". Days 4-5, sudden high fever, confused spirit, mass fierce toxin erupts, dense/purple-dark, mostly non-rising, wise ones prick, suck toxin, apply medicinal rouge, internal Zhuwei Gao/Tiantong San to invigorate blood/disperse, rampant momentum requires cleansing to save. Spotting fierce toxin-fire, Qi/Blood unable to constrain, simultaneous eruption, burning heat, urgently detoxify/cool blood/clear fire. Spotting scorching heat, dry/smoke-like, irritable spirit, any density, attack toxin/cool blood, clear muscle/disburse fire, delay allows internal attack. Spotting dry/stagnant alum-red, body should be hot but is cool, toxin-fire suppressed internally, not true cool. Urgently disburse fire/disperse muscle, invigorate blood/promote eruption, wait for fire penetration then cool, do not abruptly clear fire. Spotting sparse, interspersed flea spots or purple-dark, like purple-backed duckweed or string pearls, spirit oppressed/painful, mostly evil toxin residing internal, exterior/internal mismatch, do not neglect due to sparsity. Attack latent toxin, loosen muscle/invigorate blood. Spotting cracked lips/swelling, scorched black like coal, foul mouth odor, tongue prickles, toxin-fire invading Stomach, urgently heavy clear fire/cool blood/detoxify, heavy must attack. Spotting skin/hair stinging, clothes disturbing, toxin congested in Lung, urgently heavy attack toxin, loosen muscle/promote eruption, neglect leads to pus-phase failure, agitation/itching death. Spotting tendon twitching/pulse palpitation, screaming only, latent toxin in Liver, soothe Liver, heavy toxin must attack, grinding teeth same. Spotting delirium/maniacal, seeing ghosts, toxin-fire confusing Heart, cool blood/clear fire, plus burning heat/pain, especially attack toxin. Spotting joint pain, waist like beaten, toxin in Kidney, mostly non-rising, attack toxin urgent. Spotting hair standing erect, blood lines under eyelids, unceasing abdominal pain, burning heat/ice-cold limbs, toxin latent in Spleen, urgently attack toxin/clear muscle/promote eruption. Spotting urine like pickled fish juice, fresh blood, safflower paste, toxin-fire descending Small Intestine, urgently attack toxin/cool blood, epistaxis same. Spotting desire to defecate or grimacing during, stool like lacquer/glue/clots/sheep dung, toxin noted in Large Intestine, urgently attack toxin, guide by momentum. Spotting violent diarrhea like pouring, pure clear water/restless, fire disturbing Large Intestine, separate/drain/cool Large Intestine. Five Zang latent fire/toxin, only diarrhea slightly lighter, intestine as transport ground. Though obstructed, ultimately guided by momentum. Spotting sparse granules, full bags, alum-red/purple-bright/dull colors, toxin-fire in Blood level. Resolve Blood-level toxin, clear Blood-level fire. Spotting strong adherence, but bags not loose/flat/sunken, Blood arrived, Qi not arrived. Widen Qi pathway, loosen muscle/disperse, combine with other violent symptoms, must purge. Spotting perfect shell, but bases dry/stagnant, Qi arrived, Blood not arrived. Clear Ying/invigorate blood, combine with rampant symptoms, must attack. Spotting unresolved exterior, Wind/Cold/Wind-Heat, mild/severe, days non-rising or slow rising, Exterior Excess, examine pathogen/disperse, give toxin exit. Spotting diet un...