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The disease of smallpox (Xiaochuan) is difficult to describe in words. Some patients die after developing fever, while others die before fever appears because the nature of the smallpox was unrecognized; some develop fever for three days, yet the pustules fail to erupt, do not distinguish into distinct grains, become dry and black, and die amidst a mixture of measles rash (Shazhen), smallpox, and chickenpox-like eruptions; some experience sudden sinking of the pus on the fifth day, with muscles suddenly wasting away leading to death; some suffer from obstruction of both large and small intestines on the seventh day, with eyes open but vital energy leaking out leading to death; some die suddenly on the twelfth day; some die after one month. These cases are numerous, referring to those known dangers of smallpox eruption. There is another type where intestinal pain and lower back pain persist for several days without fever or prodromal signs (Bao Dou), followed by sudden shouting and death; how can one know this is the dangerous manifestation of smallpox!

Convulsion preceding eruption is an auspicious sign; a waxy yellow complexion is auspicious; water blisters inside the lips are auspicious. Passing roundworms in stool is harmless; black sunken pustules with pus are harmless; bleeding from scratching is harmless; hoarseness after eruption is harmless. Purple blood at initial eruption is treatable; dense pustules with depressed tops are treatable; slight purple blisters are treatable, (but if purple-black, it is untreatable). Roundworms expelled from the nose are treatable; food accumulation in the throat is treatable; grayish-white color is treatable; unquenchable thirst and diarrhea are treatable; chills and teeth grinding are treatable, (chills at onset are untreatable, but chills on the fourteenth day are treatable; teeth grinding at onset is untreatable, but on the seventh or eighth day is treatable). Bad breath from scabs is treatable; rough texture upon touch is treatable; tender texture upon touch is treatable; persistent heat in hands is treatable; unceasing epistaxis is treatable, (managed by Xijiao Dihuang Tang [Rhino Horn and Rehmannia Decoction]). Unceasing diarrhea is treatable; vomiting and diarrhea are treatable; generalized body pain is treatable, (if pain occurs on the eighth or ninth day, it indicates excessive Qi and Blood, managed by Liangge San [Cooling the Diaphragm Powder]). Incoherent speech is treatable; obstruction of urination and defecation is treatable; hiccups are treatable; white coating on the tongue is treatable; dry lips are treatable; black depressed tops are treatable; initial heat with mental restlessness is treatable; cracked lips are treatable; convulsion accompanying initial eruption is treatable; itching, collapse, and bloody discharge from scratching are treatable; white depressed tops are treatable; loss of all teeth is treatable; bleeding from mouth and nose is treatable; generalized foul-smelling suppuration is treatable; trismus is treatable; irritability and instability are treatable; failure of facial pustules to erupt is treatable; Yin toxin sinking into Yang positions is treatable; Yang toxin sinking into Yin positions is treatable; black stool after resolution is treatable; unceasing teeth grinding after resolution is treatable; copper-gong shaped tops are treatable; menstruation in virgins is treatable; pathology below the fetus in pregnant women is treatable; coldness of ten fingers is treatable, (using the boiled chicken method). Initial shortness of breath is harmless, (shortness of breath on the eighth or ninth day is ominous); initial cough is harmless, (cough on the eighth or ninth day is ominous); expelling one roundworm is harmless, (expelling two roundworms leads to death; if fever persists for three days with markers and roundworm expulsion, it indicates true kidney deficiency and is untreatable); lower back pain on the fourteenth day is harmless, (lower back pain at onset is ominous); closed eyes at onset is harmless, (closed eyes on the fourteenth day lead to death); thirst on the seventh or eighth day is harmless, (indicating Qi and Blood deficiency, treated with Siwu Tang [Four Substances Decoction]); hoarseness at onset is harmless, (initially ominous, later auspicious); toothache is harmless; hematochezia is harmless, (managed by Huanglian Jiedu Tang [Coptis Decoction for Detoxification)]; spitting fresh blood is harmless, (spitting red blood is untreatable); spitting yellow fluid is harmless, (managed by Pingwei San [Calm the Stomach Powder]); abdominal pain is harmless, (managed by Pingwei San). Purulent nasal discharge is unfavorable; hand tremors are untreatable; intraocular hemorrhage is untreatable; auricular hemorrhage is untreatable; hoarseness without voice production is untreatable; immediate shortness of breath is untreatable; immediate cyanotic macules are untreatable; pearl-like eruptions are untreatable; generalized redness involving flesh is untreatable; non-swollen facial pustules are untreatable; seamless papular forms are untreatable; unceasing lower back pain is untreatable; unceasing sneezing is untreatable; eruption followed by convulsion is untreatable; silkworm-seed-like eruptions are untreatable; cough with hoarseness is untreatable; abdominal distension with mental confusion is untreatable; silent crying is untreatable; prolapse of intestines via urine/stool is untreatable; fragile pustules that rupture easily are untreatable; purple-black blood upon puncture is untreatable; tongue retraction and testicular retraction are untreatable; unceasing itching and collapse are untreatable; clustered eruptions are untreatable; erythema and edema are untreatable; lack of spirit in the eyes is untreatable; large white blisters are untreatable; colorless white lesions are untreatable, (white lesions of unequal size are untreatable); generalized pruritus is untreatable; mania and oppression are untreatable; trembling of body and limbs with teeth grinding and lockjaw are untreatable; projectile vomiting is untreatable; black tongue coating is untreatable; white scars after resolution are untreatable; blind eyes are untreatable; clear droplets that do not change color are untreatable; generalized sinking is untreatable; live roundworms from the mouth are untreatable; dual deficiency of Qi and Blood is untreatable.

If initial eruptions resemble millet seeds and do not feel rough, but disappear within three days or turn into water blisters with hoarse, obstructed voice, death occurs during Chen and Wu hours (7:00-13:00) on the seventh day. If eruptions resemble black moles, death occurs on the ninth day. If eruptions fail to rise and eyelids swell first, death occurs on the ninth day. If facial swelling appears first, death occurs on the tenth day. If eruptions on both temples are scratched extensively, death occurs on the tenth day. Scorched, dry, and sunken eruptions lead to death on the fourteenth day.

Expulsion of purulent sputum is harmless, (treated with Xiaotan Yin [Phlegm-Resolving Drink]). Expulsion of foul purulent sputum with lung abscess is untreatable; passage of clear feces is harmless, (treated with Lizhong Tang [Regulate the Middle Decoction]); passage of white feces indicates Cold syndrome and is treatable, (treated with Lizhong Tang). Dense eruptions on the forehead resembling silkworm seeds or needle sprouts with black depressed tops are untreatable. Passage of black feces is untreatable. Eye pain is treatable; palm pain is harmless, (treated with Yiyuan San [Benefit Primordial Powder]); passage of red feces is untreatable; finger pain is untreatable. Pain behind teeth is treatable, (treated with Fuling Tang [Poria Decoction, stops after one dose); back heart pain is treatable, (treated with Qiangtui San [羌退散]). Qu Tian pain is untreatable; chest heart pain is untreatable. Red tongue tip with fire in Five Centers is treatable, (treated with Maidong San [Ophiopogon Powder]). Throat pain is difficult to treat, (throat pain on days 7-8 is treatable, but at onset is untreatable).

Another Formula:
Toxin repelling the Central Palace causes hoarseness; vomiting and teeth grinding make life precarious; irritability, oppression, and panting are unbearable; purulent diarrhea and bleeding are hard to control. Sleepiness and refusal to eat, silence and lethargy like a dream; if green-black appears at initial eruption, only a true miracle cure can save. Half-hidden skin color unseen, wrong medication acts like swords; if a wise physician recognizes these signs, descendants will be rich and illustrious. First check throat for hoarseness, then check if voice strengthens; panting sputum with sweat on head, abdominal fullness with Qi deficiency and slipperiness. If physicians see this, six days later it ends in a dream; further chills bring evil, either heavy or light with internal heat. Black sunken movements like diarrhea, black blood flowing indicates Yin exhaustion; protruding tongue, body shaking, neck turning, face blue-purple-black makes life impossible. How to treat cold breath from mouth? Only those who ride boats to Langyuan can survive.

Hoarseness five days after eruption is untreatable. Eruptions not vigorous, whole body scratched, lacking Qi and Blood is untreatable. Old sores not healed is untreatable; phlegm obstruction with shortness of breath is untreatable; unconsciousness before eruption is untreatable; rapid breathing before eruption is untreatable; abdominal distension with purulent bloody diarrhea is untreatable. Immediate failure to erupt, dense as silkworm seeds or flat flower towers is untreatable. Before and after resolution, presence of red-purple blisters is untreatable. Skin dark as bran, ruptured is untreatable. Pus/water unable to enter mouth is untreatable. Immediate dull, dark, scorched black is untreatable; black rice-like spots in eyes is untreatable; floating oil mixing in eyes is untreatable. (Apart from these, even with miscellaneous symptoms, or dense eruptions with slight luster, if the physician is learned, sharp-eyed, sincere, and the family is trusting, careful treatment can save 60-70%.)

Another Formula:
Initial depression with lotus-red flesh, surviving nine days is in vain; no blood points with red-purple, macule disease dies within six days. Black macules die in morning/evening, blue macules vanish quickly; no pus, itching/collapse on twelfth day, avoid pain and chest protrusion. Prodrome like prickly heat/chicken skin, tongue/testicle retraction means death; puncturing cells yielding black blood, choking on food indicates ominous signs. Difficult to treat facial swelling without sore swelling, blue/black sunken and no pus, watery urine/stool with abdominal filth, plus vomiting/diarrhea and roundworms. Warm head, cold feet, good drinking; convulsion before eruption makes medicine hard to attack; shortness of breath, diarrhea, unquenchable thirst, no pus means life cannot be sustained. Loss of voice, hoarseness, calling/crying, even good color is hard to finish; any shortness of breath is hard to treat, especially wind strike during pus-filling stage. See this, take Rensu Yin [Ginseng and Perilla Drink]; analyze other signs diligently.

Forehead eruptions in strings failing to rise indicate dual Qi/Blood deficiency; must tonify Qi/Blood primarily. Otherwise, empty granules, itching/collapse, false white diarrhea, and chills death follow. Women with smallpox: unceasing menstruation is ominous; miscarriage bleeding is ominous; non-miscarriage unceasing bleeding is ominous. Trembling during resolution indicates weak body, (other treatments exist). Spiritless eyes, slow convulsion, blue face after resolution is untreatable. Unceasing throat pain during resolution is ominous. Red dots below waist without appearance above waist is untreatable. Physician observing oblique face like orange peel, indistinguishable flesh ground means death, (this is indistinguishable grains, swollen flesh without swollen sores).

Xi Taishun said: Initial red points with red-purple, macule disease dies in five days. Full neck and flesh red at initial, Qi severs on days 7-8-9; brocade-pattern macules end on sixth day. Blue macules enter Yin instantly; silkworm-seed seamless eruptions, smooth to touch need no treatment. If like soup blisters or burns, ten days itching/collapse death is unavoidable. Waist/abdominal pain unceasing, irritability, purple-black, bad breath death. Head/face like rouge, death after six days, why doubt? Flesh/swollen face without sore swelling, high chest/protruding ears, severe untreatable. White eruptions, smooth face, non-red roots, scratching later leads to death without pus; no pus, itching/collapse on twelfth period, pus/blood means survival. Seamless millet-like eruptions are bad, hoarseness/shortness of breath endanger life. Two signs filling pus with bright color, caused by wind-cold, use Rensu. If crying/coughing/hoarse, bright color is harmless. Bad color with hoarseness, certain death without exception; tongue/testicle retraction, spiritless eyes, food stagnation in throat means hard survival. Punctured purple blisters with black blood, intestinal filth in stool is untreatable. Severe unceasing vomiting/diarrhea, roundworm expulsion means hard-to-hear death. Voice change before/after eruption, convulsion after eruption means restless life. Three days, all pits fail to rise, red/swollen like melons, do not treat.

Depressed top with eye like needle pierce, purple-black means certain death. Filling pus, dry without blood/water, named Empty Granule Smallpox is critical. Unceasing diarrhea, blood in two passages, undigested milk/food, rotten smallpox death. During filling, complete obstruction of two passages, closed eyes/hoarse voice is ominous. Abdominal distension, black muscles, medical treatment will be useless. Resolution itching/collapse without pus/blood, skin like blood shell, Liver exhausted. Chills/teeth grinding/post-eruption convulsion, resolution like bamboo sheath with pus/blood, these are death signs, no need for doctor, even immortals cannot help.