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The affliction arising from this leads to death, and in fact, it is the heart-draining (clearing Heart fire) medications that kill them, yet people remain unaware, and doctors fail to realize it; this is truly lamentable! Therefore, I assert that after the smallpox has erupted but before scabbing occurs, all cooling-heart (clearing Heart fire) medications such as rhinoceros horn (Rhinocerotis Cornu) and rehmannia root (Rehmanniae Radix) should be strictly prohibited for use. They should only be used after scabbing has formed to resolve residual toxins. Someone might ask: If so, does this mean toxins cannot be resolved at all before the scabs form? I say: Why must they all be unresolvable! If the patient's blood qi and pathogenic vapors are both vigorous, the pulse will necessarily be surging and rapid. The pustules may appear purple-black immediately upon eruption, or if erupted, they will be dense and red-purple. Internally, there will be restlessness, stifling sensation, dryness, and thirst, with dark, scanty, and difficult urination, and constipation. This constitutes a excess-heat syndrome, and one should swiftly employ cooling agents to resolve the toxin. If constipation persists for a long time, a small amount of wine-fried rheum (Rhei Radix et Rhizoma) can be added to induce mild purgation, which is acceptable. If the pathogenic vapors are vigorous but the blood qi is not yet robust, the treatment should focus on resolving toxins while simultaneously invigorating blood and nourishing qi; thus, herbs such as codonopsis (Codonopsis Radix), angelica sinensis (Angelicae Sinensis Radix), and white peony root (Paeoniae Radix Alba) should not be absent.

It is also said: In recent times, prescriptions for smallpox have largely followed Huang Xiqiu. His book consistently categorizes cases into favorable (Shun), adverse (Ni), and perilous (Xian) patterns across three diagrams. It is correct that favorable patterns do not require medication. It is reasonable that perilous patterns should be treated with modifications of Baoyuan Tang (Preserve the Origin Decoction). However, stating that adverse patterns are untreatable and that treating them is futile teaches people to stand by and wait for death! Such words are extremely inhumane and cause significant harm to the world. While convenient for quack doctors seeking profit, it severely contradicts the art of saving lives. Medicine is a benevolent art; sages utilized it to assist transformation where education fell short. What is valued is supporting the critical, rescuing the distressed, and bringing the dead back to life. If one treats only easy cases and abandons difficult ones, what is the purpose of being a doctor? Quacks seek profit and fear damage to their reputation; when encountering unfavorable patterns, they often abandon patients. They fear gaining no profit while acquiring a reputation for misdiagnosis. Benevolent gentlemen, however, should strive to save patients from the brink of death. How could one bear to declare certain deaths inevitable and watch without intervening? Thus, Huang Xiqiu’s words benefit quacks but do not serve the world. Moreover, many adverse patterns he describes occur frequently in dense smallpox cases, such as palpitations, vomiting, and diarrhea during initial fever; eruption starting at the Yintang, Sikong, or Tianting points; lack of red halos around the base upon initial eruption; pale, gray, or sunken coloration after eruption; formation of water blisters; itching and collapse; failure to fill with pus when expected; or chills and teeth grinding before scabs fall off. These are all labeled by him as adverse and untreatable, yet I have successfully treated many such cases. Why insist that treatment is useless and warn against it? Only those appearing like silkworm eggs initially, turning purple-black and dry afterward, failing to fill with pus, are mostly incurable. Nevertheless, I would rather attempt treatment and fail than sit idly by without trying. (Synthesizing views from various schools, Part 2.)

Smallpox differs from other diseases. From initial eruption to scabbing, there are fixed days and hours. To rescue the distressed and support the critical, appropriate medications must be administered promptly, akin to fighting a fire or saving someone from drowning; delay is unacceptable. Smallpox toxins originate from the five zang organs, genuinely disturbing their true qi. When many pustules erupt, much true qi is expended. At this moment, the patient’s blood qi is nearly exhausted, precarious as oil running out of a lamp—if not replenished quickly, the flame extinguishes; or like a candle in the wind—if not shielded quickly, the light goes out. Contemporary doctors are different; they value wealth over human life. Those ignorant of herbal application need not be mentioned. Even those who know some medicine hesitate to apply it timely, hoping to demonstrate merit through severe illness. They wait until various malignant symptoms appear, then exploit the parents' fear to demand heavy fees. Delay continues until blood qi is irrecoverably depleted. Although correct medications exist, they arrive too late, leading to many fatal errors. Alas! Heaven, earth, and spirits are manifest and cannot be deceived. Those who kill for greed, with corrupt intentions, surely face spiritual retribution and heavenly punishment. Misfortune will inevitably befall them and their descendants; escape is impossible. This is a danger to the medical profession, which patients’ families must understand. Furthermore, contemporary doctors have shallow insights and fail to grasp profound principles. Clinging to ancestral formulas without adaptation, they manage mild smallpox cases confidently, claiming credit. But faced with dangerous, severe cases, they are helpless. Treating ten members of one family, seven or eight may die, yet they blame the disease’s severity rather than their own incompetence. Patients’ families also blame the disease, not the doctor. Smallpox is common; with proper management and no extreme symptoms, ten cases can yield ten recoveries. Among extremely severe cases, only one or two in ten are truly incurable. Now, if seven or eight out of ten die, why are there so many severe cases? Is it not due to imprecise skills? Deeply pitying this, I feel compelled to write this treatise and prescribe formulas. (Refuting contemporary medical fallacies.)

Generally, treating any disease requires first distinguishing deficiency (Xu), excess (Shi), cold (Han), and heat (Re). Observation, listening/smelling, inquiry, and palpation aim solely at distinguishing these four. If these four are clear in mind, medication yields immediate results. Failure to distinguish them leads to frequent errors, even if occasional recovery occurs, it is merely luck. Distinguishing deficiency/excess and cold/heat in smallpox is particularly crucial. Unclear distinction leads to treatment failure. Why do历代 (past generations) of smallpox experts differ in theories and prescriptions, often neglecting or vaguely defining deficiency/excess and cold/heat? This leaves practitioners confused about which formula suits which pattern. Thus, hundreds of excellent formulas and theories become useless. No wonder smallpox treatment has been misguided since ancient times, and pediatric care neglected. The deficiency/excess and cold/heat of smallpox differ from other diseases in specific ways. Other diseases with deficiency involve intrinsic yuan qi deficiency, requiring tonification. Smallpox involves exterior deficiency and interior deficiency, also involving intrinsic yuan qi deficiency, requiring tonification—this is similar. Other diseases with excess involve pathogenic excess, requiring purgation. Smallpox involves exterior excess and interior excess, where yuan qi is solid and pathogens cannot harm; purgation is neither necessary nor appropriate—this is different. Severe deficiency in other diseases involves yin excess and yang insufficiency, generating internal cold, requiring warm-tonifying agents. Smallpox severe deficiency similarly involves yin excess and yang insufficiency with internal cold, requiring warm-tonifying agents—this is similar. External cold invading other diseases (exterior contraction) requires dispersal when at the exterior; if lingering internally, it transforms into heat, requiring clearing/resolving. For smallpox, external wind-cold invasion requires warming and dispersing; if external cold enters internally causing vomiting/diarrhea, warming is sufficient. Sweating externally or clearing internally is inappropriate. Deficient heat in other diseases arises from yuan qi deficiency and fluid depletion, with fire rising from deficiency; tonification removes heat without needing heat-clearing. Smallpox deficient heat involves yuan qi deficiency and rampant pathogens; primary treatment is tonifying yuan qi with slight toxin resolution. These three aspects are similar yet distinct. Excess heat in other diseases involves intact blood qi but overwhelming pathogens, treatable with cold/purgative agents alone. Smallpox excess heat involves strong constitution, abundant blood qi, and vigorous pathogens, also treatable with cooling/resolving agents alone—this is similar. From initial fever to post-recovery, one must always differentiate deficiency/excess and cold/heat before prescribing. Careful pattern differentiation ensures medication avoids exacerbating deficiency or excess, avoiding damaging the insufficient or supplementing the excessive, or adding cold to cold and heat to heat. However, smallpox deficiency/excess and cold/heat are more obvious and easier to observe than other diseases. From spotting to scabbing, shape and color are visible. Listening to voice, observing agitation/calmness, checking diet intake, and examining bowel/bladder function provide further clues. For children over three, pulse diagnosis (slow/fast, surging/faint) clarifies patterns distinctly like black and white, making effective treatment easy. (Differentiating differences in deficiency/excess and cold/heat.)

It is also said: Smallpox success relies entirely on blood and qi. The principles of their fluctuation are subtle and must be thoroughly understood. Qi belongs to heaven and tends upward; blood belongs to earth and tends downward. The elevated vesicles of smallpox represent the position of qi (upper); qi should be充盈 (abundant). The red halos and bases represent the position of blood (lower); blood should adhere. Vesicle tips that are white and moist indicate abundant qi occupying its superior position. Red, vibrant halos around the periphery indicate blood adhering to its subordinate position. When qi occupies its尊贵 (honorable) place and blood remains in its proper division, harmonious blood and qi carry toxins outward. This is the most auspicious smallpox, healable without medication. Sunken tops indicate qi sinking downward, signifying qi deficiency unable to fill; treatment requires tonifying qi. Lack of red halos at the base indicates blood deficiency unable to adhere; treatment requires tonifying blood. This principle is relatively easy to understand. If the entire vesicle turns red and becomes a blood blister, blood is rising upward—an extremely dangerous pattern. Pus formation will fail, leading to death from itching and collapse around day eight or nine. This is not due to blood excess, but qi deficiency losing its governing role, allowing blood to act recklessly and usurp positions. Urgent large-scale qi tonification is needed. Once qi is abundant, it governs blood, preventing reckless overflow, and vesicles turn white. People misunderstanding this see red vesicles, mistakenly diagnose blood heat, and use blood-cooling/moving agents, worsening qi deficiency and accelerating death. Tragic! Thus, the principles of blood/qi fluctuation are subtle and hard to grasp. For smallpox treatment, isolated qi deficiency requires exclusive qi tonification, not blood tonification, because yang cannot follow yin; increasing yin depletes yang. Blood deficiency often stems from stomach qi injury and insufficient yuan qi; yin follows yang, and yang generation promotes yin growth. Huang Ruyan’s *Ming Yi Za Zhuo* claims tonifying qi for blood deficiency causes yang excess and yin depletion. This demonstrates ignorance of yin/yang fluctuation principles and creates great harm. I successfully treat bloody stool with deficiency-slippage, postpartum women with massive blood loss and high fever, and women with uterine bleeding due to blood deficiency, using primarily ginseng (Ren Shen), dried ginger (Gan Jiang), and aconite (Fu Zi), assisted by blood-invigorating and ascending herbs, achieving remarkable results. Who says blood disorders cannot be treated by tonifying qi? For pediatric smallpox, prioritizing stomach qi makes it clear that tonifying blood must begin with tonifying qi. Thus, the principles of blood/qi fluctuation must be deeply understood. (Analyzing principles of blood/qi fluctuation.)

Zhu Chengu states: Smallpox begins with a red spot; red is the color of blood. Blood relies on qi for generation, but fundamentally originates from water. "Heaven generates one water, Earth completes six." Water corresponds to Kan (North), represented by the two kidneys. Sufficient kidney water interacts with wood, fire, earth, and metal qi to mutually nourish and grow, forming qi and blood. Thus, blood originates from water, and water from kidneys is clear. Although heart generates blood, liver stores blood, and spleen envelops blood, if kidney water dries up, how can they generate/store/envelop? Together, the five zang organs constitute one Taiji. Yang movement and yin stillness generate water, fire, wood, metal, and earth. The initial red spot in smallpox is blood. After complete eruption, sequential growth fills the pustules with pus. Pus is transformed from blood and qi, converting toxins into pus. Once pus is sufficient, suppuration occurs and toxins resolve. Gradually turning brown, returning to water, scabs form. Scabs become waxy-gray, completing the process in twelve days. Why did past experts ignore the orthodox principles of yin/yang and five elements, inventing names, claiming only the kidney has no signs, and citing cold ears to prove kidney absence? Also claiming blackening returns to the kidney? These are unfounded tales for over a thousand years, unchallenged. I was forced to write the "Theory of Five Zang Unity" to refute them. (Differentiating the Theory of Five Zang Unity.)

Xi Taishun states: Smallpox is fetal toxin, called Heavenly Cramps. Transmission depends on external contraction; severity depends on internal injury. Initially, Taiyang Ren Water controls Bing Ding (Fire), later returning to Yangming. Blood and water transform into pus and plasma, urgent as burning eyebrows, changing like flipping a hand. To know exterior/interior and deficiency/excess, one must understand cold/heat/warm/cool. Initial eruption resembles Cold Damage (Shanghan): fever, irritability, red face/lips, body/head pain, alternating chills/fever, sneezing/yawning, sleepy eyes, red lines between cheekbones predict smallpox. On fever day three, support interior and release exterior to facilitate eruption. Days four-five: cool and resolve toxins to facilitate growth. Days six-seven: warm and tonify blood/qi to facilitate pus filling. Days eight-nine: clear, drain, and astringe to facilitate scabbing. This is the standard method. Standards are predictable, variations are not; how can one stick rigidly to one approach? Cooling before eruption stagnates toxins with cold; over-tonifying unresolved heat toxins prevents pus formation. Thus, smallpox treatment requires adaptability. Post-scabbing, merely avoid wind/cold and regulate diet. This is the original theory of smallpox treatment.

It is also said: Ashen-white, non-red, non-elevated, slow eruption, dull/sunken tops indicate exterior cold-deficiency. Clear urine/stool, vomiting/diarrhea, cold limbs/breath, no thirst, poor appetite, white lips/clear mucus, indigestion indicate interior cold-deficiency. This is exterior-interior cold-deficiency syndrome. Urgently warm spleen/stomach, tonify blood/qi; ginseng, cinnamon twig (Guizhi), and aconite are appropriate. Red-purple, firm/high, dusty tops, fire thorns, accompanied by macules/rashes indicate exterior heat-excess. Constipation with dark urine, dry retching/phlegm, abdominal pain, foul breath, irritability/thirst, red cheeks, delirium indicate heat-toxin suppression, interior heat-excess. This is exterior-interior heat-excess syndrome. Urgently cool, purge, resolve toxins, heavily disperse; scutellaria (Huang Qin), coptis (Huang Lian), rhinoceros horn, phellodendron (Huang Bai), gypsum (Shi Gao), gardenia (Zhi Zi), and rheum are appropriate. Exterior-interior deficiency/excess patterns are obvious externally, easy for doctors to identify. Exterior deficiency-interior excess: pale/non-red, slow eruption indicates exterior deficiency; accompanied by frequent internal symptoms, abdominal pain, irritability/thirst, white sclera redness, constipation indicates interior excess. For exterior deficiency-interior excess, doctors should first disperse. Bitter-cold dispersal is inappropriate; otherwise, toxins escape externally but internal heat resolves. Bitter-cold causes toxin freezing, making eruption harder. Around days three-four, consider purgation to clear toxins first, then tonify blood/qi for pus formation. For toxin-stagnation with qi-deficiency unable to fill, Shelian Tang (Ginseng and Coptis Decoction) is suitable. This outlines treating exterior deficiency-interior excess. Interior deficiency-exterior excess is hardest to treat. Irritated red smallpox, tight bases, hot skin, red-dry-purple color indicates exterior excess; accompanied by vomiting/diarrhea, white lips/clear mucus, indigestion. Treatment should invigorate blood and loosen muscle using safflower (Hong Hua), snake molt (She Tui), rehmannia root, and moutan cortex (Mu Dan Pi). Wait for red/vibrant color before supporting/tonifying. Otherwise, pustules fail to elevate/fill, turning purple-dry, inverted scabs, empty sores, urgent as burning eyebrows, changing rapidly. Doctors must examine clinically, not rigidly. (Theory of Exterior/Interior Deficiency/Excess/Cold/Heat.)

It is also said: Excess-heat smallpox begins with high fever, red cheeks/red eyes, thirst, delirium. Internal symptoms are severe; spotting is ominous. Irritated red, fragmented, clustered like mosquito bites. Urgently disperse and purge heavily, named "Double Resolution." Herbs like snake molt, schizonepeta (Jing Jie), saposhnikovia (Fang Feng), pueraria (Ge Gen), gypsum, and rheum are used. Bathing with tamarisk (Xi He Liu) and coriander (Yan Xu) decoctions opens pores, facilitating eruption with heavy cooling. If heat-toxin unresolved, luster dull, bases tight, named blood heat, purgation continues. Add forsythia (Lian Qiao), rhinoceros horn, phellodendron, arnebia/lithospermum (Zi Cao), safflower, peach kernel (Tao Ren), and coptis for blood cooling. Administer pig tail paste (Zhu Wei Gao) and Priceless Powder (Wu Jia San) for effect. For blood-heat stagnation, cooling/resolving is mandatory until scabbing, then clearing/draining/astringing is the key. (Theory of Excess-Heat Stagnation.)