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Upon observing the ninth day after the appearance of spots, which is the period when pustules should mature into pus, the child exhibits a thin congenital constitution. The pockmarks are depressed and sunken, with irregular bases; the pus is clear and white. There is loose stool, poor appetite, lethargy, and lack of spirit, presenting a picture of deficiency-cold in both Qi and Blood. Urgent warm-tonification and internal support (to push toxins out) are needed to preserve life. However, the physician still believed that the skin heat had not subsided and the fire-toxin was not cleared, continuing to use clearing and resolving (heat/toxin) methods. This is a grave error.

Fever in variola (smallpox/variolous diseases) is its normal manifestation. Generally, without heat, the exterior cannot be vented, the marks cannot grow, the pus cannot be steamed and matured, and the scabs cannot form. Therefore, throughout the course of variolous diseases, this thermal force is indispensable for governing the process. If one attempts to completely attack the heat while disregarding the damage to the Yuan Qi (Original Qi), once the Yuan Qi is injured, how can it send the toxin back to its nest? Just as seedlings fail to flower, few will bear fruit.

Surgical texts discuss carbuncles and sores, stating that presence of pus indicates survival, while absence indicates death; the same applies to variolous diseases. Furthermore, just as Shanghan (Cold Damage) has the method of "nurturing sweat," variolous diseases have the method of "nurturing pus." For Shanghan, before the seventh day, when the pathogenic qi has not yet transmitted, it is still possible to nurture sweat. Similarly, for variolous diseases, before the seventh day, if adverse patterns have not appeared, it is still possible to nurture pus. If one waits until after the seventh day, when the vital energy has already departed, and then thinks of nurturing pus, it is akin to waiting until the pathogenic qi of Shanghan has transmitted and then thinking of nurturing sweat—can this be achieved? The absence of pus, accompanied by itching and collapse, is inevitable. One must worry about complications arising at the twelve critical passes. I tentatively propose Baoyuan Tang (Preserve the Origin Decoction) combined with Ginseng, Angelica Sinensis, and Deer Antler, hoping that the pustules will rise and emit a foul odor (indicating toxin expulsion), perhaps allowing for a lucky recovery.

An Bo's Note: In recent times, physicians specializing in variolous diseases often use acrid-cool detoxifying and bitter-cold antipyretic methods, frequently leading to failure patterns where they are left helpless. This is truly lamentable.

The Liver is the Official of the General, from whom strategies and deliberations emerge. Emotional stagnation leads to Liver Wood depression and disease. As you mentioned, the illness began several years ago, with intermittent pain under the left hypochondrium. After food enters the stomach, the Qi often flows to the left rather than the right. The Classics state that the left and right are the pathways of Yin and Yang. The Liver resides on the left, but its Qi typically moves to the right; the Spleen resides on the right, but its Qi typically moves to the left. Left ascends, right descends, forming an endless cycle. Now, since the Qi deviates to one corner, is it not due to the dysfunction of ascending and descending mechanisms, resulting in disharmony between the Liver and Spleen? Although there are no major issues currently, I fear that long-standing Liver disease may lead to Earth (Spleen) being constrained and Wood (Liver) becoming rampant. This could assault the Stomach causing vomiting, or attack the Spleen causing distension. Should we not take early preventive measures ("bending the chimney and moving the firewood" to prevent disaster)?